Journal of clinical and diagnostic research

Comparison of Plaque Inhibiting Efficacies of Aloe Vera and Propolis Tooth Gels: A Randomized PCR Study

Aravind Kumar, Musalaiah SVV Sunkara, Indeevar Pantareddy, Sankaran Sudhakar

Backgound and Aim: Allopathic medications used for periodontal disease are known to be associated with various side effects. Hence a search for naturotherapies are on the rise. Among the natural pharmacons available aloevera and propolis are considered to be effective and free from adverse effects. Taking this into account, the present study was done to compare the plaque inhibiting efficacies of Aloe vera and Propolis tooth gels in patients with chronic periodontitis. Materials and Methods: Forty patients diagnosed with chronic periodontitis were randomly allocated to groups A and B containing 20 patients each. Patients in group A were advised to use Aloe vera tooth gel while those in group B were advised to use Propolis tooth gel. Clinical and microbiologic parameters using Polymerase chain reaction (PCR) were recorded at baseline and after 3 months. Results: Student t-test was performed for all the obtained results. In the Aloe vera group, comparison of baseline PCR and after 3 month results showed reduction only in P. gingivalis (p=0.001), where as statistically significant reduction in all the three red complex microorganisms was seen in propolis group. All the clinical parameters (Plaque Index, Gingival Index, Bleeding on Probing, Probing pocket Depth, and Clinical Attachment Level) in both the groups showed statistically significant reductions after 3 months. Conclusion: Propolis showed a statistically significant reduction in plaque, microbiologic and clinical parameters. However, clinical trials of longer durations with larger sample sizes are required to evaluate the efficacy.

Indwelling Catheterization in Caesarean Section: Time To Retire It!

Divya Pandey, Sumita Mehta, Anshul Grover, Neerja Goel

Background: Routine placement of indwelling catheter preoperatively in Caesarean Section is being practiced without justified scientific evidence. Aim: To evaluate the effect of routine indwelling catheterization on the postoperative ambulation, morbidity and hospital stay in women undergoing Caesarean section. S ettings and Design: Case-Control study carried in a tertiary teaching hospital. Materials and Methods: This study was carried over 150 women undergoing primary Caesarean section without any medical complication or pre-existing Urinary Tract Infections (UTI). The subjects were randomly allocated to 2 groups i.e. Group 1(Non-Catheterized; NC) and Group 2 (Catheterized for 24 hours postoperatively; C). Parameters noted were; duration of surgery, time of ambulation, postoperative voiding discomfort {graded as - no, mild, moderate-severe, by Visual Analog Scoring (VAS)}, incidence of UTI, postoperative urinary retention, need of postoperative antibiotics and duration of hospital stay. Statistical Analysis: Results were analysed using unpaired t-test. Results: There was no significant difference in duration of surgery and postoperative urinary retention in both groups. However, it was seen that non-catheterized patients had significantly earlier ambulation, shorter hospital stay, took less time for first voiding, lesser voiding discomfort, less incidence of UTI and lesser use of postoperative antibiotics. Conclusion: The routine use of indwelling catheter in Caesarean section is unscientific and unnecessary. There should be selective rather than routine catheterization.

Evaluation of Multidrug Resistant Staphylococcus aureus and their Association with Biofilm Production in a Tertiary Care Hospital, Tripura, Northeast India

Sibabrata Bhattacharya, Raunak Bir, Tapan Majumdar

Background: High morbidity and mortality rates are associated with Methicillin-resistant Staphylococcus aureus (MRSA) because of development of multidrug resistance. Staphylococcus aureus (S. aureus) has the ability to colonize and form biofilms on biomaterials which is causing resistance towards antimicrobials and thus making them difficult to eradicate from the infected hosts. Materials and Methods: Culture isolation, identification was done following standard protocol and antibiogram of the isolates were done. The detection of MRSA, Macrolide-Lincosamide-Streptogramin B resistance (MLSB), vancomycin resistance phenotypes were done by using cefoxitin disc diffusion test, D zone test and vancomycin E test. Biofilm was detected by Congo red agar method. Results: A total of 100 (31.7%) S. aureus strains were isolated from 315 clinical specimens. The prevalence of MRSA was 47% (47/100) with 85.1% were homogeneous MRSA and 14.9% were heterogeneous. Out of 47 MRSA strains, 63.8% were Hospital acquired-MRSA (HA-MRSA) infections whereas rests 36.2% were caused by Community acquired-MRSA (CA-MRSA) strains. Maximum number of MRSA isolates belonged to group A biotype (34%). A 14.9% isolates were of nontypeable group. Out of 100 S. aureus isolates, the prevalence of Vancomycin resistant S. aureus (VRSA) was found to be 3%.The MLSB phenotypes showed that the rates of inducible MLSB (iMLSB), constitutive MLSB (cMLSB) and Macrolide-Streptogramin B (MSB) in case of MRSA to be 19.1%, 31.9% and 12.8%. Prevalence of low-level (MUPL) and high-level mupirocin resistance (MUPH) among MRSA was 19.1% and 6.4%. Biofilm production was found in 55% strains of S. aureus. Out of 47 MRSA strains 76.6%were producing biofilm in comparison to 38.8% in methicillin-sensitive S. aureus (MSSA). Higher degree of antibiotic resistance in biofilm producers was seen especially in case of ciprofloxacin, co-trimoxazole, rifampicin, kanamycin, erythromycin and clindamycin whereas gentamycin, tetracycline and penicillin resistance was more in non-biofilm producers. Conclusion: This study shows high rate of circulating MRSA with a majority of these isolates are multi-drug resistant of which mostly are biofilm producers in our hospital setup. Development of antimicrobial stewardship program based on the local epidemiological data and national guidelines is the need of the hour.

The Prevalence, Risk Factors and Changes in Symptoms of Self Reported Asthma, Rhinitis and Eczema Among Pregnant Women in Ogbomoso, Nigeria

Background: Allergic disorders have become a major public health concern worldwide. No Nigerian study has examined the epidemiology of allergic diseases among women. Aim: To document the prevalence, risk factors and the changes in the symptoms of allergic disorders during pregnancy. Settings and Design: Cross-sectional study conducted at the booking and antenatal clinics of LAUTECH Teaching Hospital and Millennium Development Goals (MDG) Clinic of the Comprehensive Health Center, Oja Igbo, Ogbomoso, Nigeria. Materials and Methods: Study enrolled 432 women from two public hospitals. Sociodemographic and clinical history were obtained and allergic disorders were diagnosed using ISAAC questionnaires. Results: The prevalence of wheezing, eczema and rhinitis in pregnancy are 7.5%, 4.0% and 5.8% respectively. The prevalence of wheezing and eczema was slightly higher among the pregnant in past 12 months. Wheeze worsened in 70% (18/26), improved in 15% (2/26), and stable in 15% (2/26). Eczema worsened in 50% (7/14), improved in 7.1% (1/14) and stable in 42.9% (6/14), while allergic rhinitis worsened in 50% (11/22), improved in 22.7% (5/22) and stabilized in 27.3 % (6/22). In multivariate analysis, the risk of allergic diseases in pregnancy was increase 2 times by low income earning (CI: 1.2 – 2.1, p = 0.002), low level education (OR = 0.6, CI: 0.3 – 0.9, p = 0.011) and by family history of asthma, OR-4.3, CI – 1.3 – 13.9, p = 0.015. Family history of asthma increase the chances of asthma by 18.7 times, CI-2.3 – 152.2, p = 0.006, while the odd of eczema was increased 9.1 times (CI-2.7 – 30.6, p<0.001) and 2.4 times (CI: 1.2 – 4.7, p = 0.008) by second hand home smoking and low-family income respectively. The risk of allergic rhinitis were raised 1.8 times by low family income (CI 1.1 – 2.8, p = 0.013) and 3.9 times by family history of rhinitis (OR = 3.9, CI 1.2 – 12.7, p = 0.024). Conclusion: Prevalence of wheezing and eczema are higher in pregnancy probably due to exacerbation induced by pregnancy. Social and genetic factors are important risk factors for allergic disorders in pregnancy.

Efficacy of Caudal Clonidine and Fentanyl on Analgesia, Neuroendocrine Stress Response and Emergence Agitation in Children Undergoing Lower Abdominal Surgeries Under General Anaesthesia with Sevoflurane

Sharmila Ahuja, Megha Aggarwal, Nandita Joshi, Sujata Chaudhry, SV Madhu

Introduction: Clonidine has proved to be effective drug for postoperative analgesia but it’s efficacy to alter neuroendocrine stress response and emergence agitation is unknown. This study was conducted to assess and compare the efficacy of caudal fentanyl vs. clonidine for analgesia, blunting of neuroendocrine stress responses (NESR) and emergence agitation (EA) following sevoflurane anaesthesia. Materials and Methods: This prospective, randomized, double blind study enrolled 60 children undergoing infraumbilical surgery. Three groups of 20 each were assigned to receive caudal block with either bupivacaine 0.25% 1 ml/kg with normal saline (group I) or bupivacaine 0.25% 1 ml/kg and 1 microgram*kg-1fentanyl (group II), or bupivacaine 0.25% 1 ml/kg and 3 µg/kg clonidine [group III]. Postoperative analgesia, sedation, NESR, emergence agitation and side effects were observed. Results: VAS score at two hours was significantly less in group III (0.60± 0.60) than in group I (1.80± 0.41) and group II (1.25± 0.44),the time to rescue analgesia was also significantly greater in group III (8.03+0.41hours) than groups I and II (4.15± 0.54 hours) and (6.18± 0.5hours) respectively. The EA scores were significantly better in Group III but patients were significantly more sedated postoperatively. Intraoperatively, NESR was blunted in all the groups and the markers of NESR were lowest in group III. Conclusion: Caudal clonidine in a dose of 3 µg/kg prolongs analgesia and decreases emergence agitation as compared to bupivacaine alone or with fentanyl 1µg/kg. Modulation of the neuroendocrine stress response was observed in all the investigated groups though the indicators were lowest in clonidine group.

Effect of Ubiquinol Therapy on Sperm Parameters and Serum Testosterone Levels in Oligoasthenozoospermic Infertile Men

Introduction: The male sperm counts decline due to environmental factors, such as pesticides, heavy metals and exogenous estrogens causing negative impact on spermatogenesis. The low testosterone levels are associated with lower levels of antioxidants that protect against free radical damage to glands that produce testosterone. The earlier studies showed that the supplementation of vitamins and antioxidants including 10mg Ubiquinol per-day increases in sperm count and motility. Materials and Methods: The Ubiquinol is strong antioxidant, hence in view of the above study 150 mg/day Ubiquinol was supplemented to 60 men with age group of 20-40 years. The patients were supplemented for six months, the testosterone level and sperm parameters were analysed before and after supplementation of Ubiquinol every month up to six months. The total sperm count increased by 53% (p<0.05). Results: The total sperm motility was observed 26% (p<0.05) high after supplementations. Out of total motility, the quantity of rapidly motile sperm increased 41% (p<0.05). The number of sluggish motile sperm was decreased approximate 29% (p<0.05). The non motile sperm count was also decreased up to 55% (p<0.05). Conclusion: The testosterone level is maintained during the study and morphology of flagella of sperm has improved. The finding suggests that the supplementation of Ubiquinol may be beneficial for oligospermic patients.

Comparison of Enzyme-Linked Immunosorbent Assay and Immunochromatography for Rotavirus Detection in Children Below Five Years with Acute Gastroenteritis

Shaveta Dhiman, Bimla Devi, Karnail Singh, Pushpa Devi

Background: Group-A rotaviruses are responsible for 30 to 60% of severe watery diarrhea cases in young children. Timely diagnosis of rotavirus infection helps to determine appropriate treatment and prevents unnecessary use of antibiotics. Aim: To compare Immunochromatography (ICG) with standard ELISA test for diagnosis of and to determine incidence, clinical socio-epidemiological profile and possible risk factors associated with rotavirus infection in children below five years with acute gastroenteritis. Settings and Design: A prospective study performed from February 2013 to April 2014 in Microbiology and Paediatrics Departments, Government Medical College, Amritsar, Punjab, India. Materials and Methods: Hundred stool samples from children below five years diagnosed with acute gastroenteritis were taken and tested by ICG and standard ELISA test. Statistical analysis: Performed using the SPSS software for Windows, version 17.0. P-values calculated using ?2 test for categorical variables. A p < 0.05 was considered significant. Results: Maximum cases with ICG showed a sensitivity of 95.24% and specificity of 97.47% when compared to ELISA. Incidence of rotavirus diarrhea was 21% using ELISA and 23% using ICG. With ELISA rotavirus infection was highest in age group 6 months to 24 months (83.3%) and in male (90.47%). The infection was maximum during November to April and presented with triad of diarrhea, vomiting, fever (76.2%). Majority of cases had watery diarrhea in high percentage (90.47%). Severe dehydration (76.19%), respiratory symptoms (38.09%), bottle feeding (52.38%), malnourished children (47.61%), children playing with toys (47.6%) and submersible water pump (61.95%) as a source of drinking water associated with rotavirus infection were found to statistically significant. Conclusion: ICG shows a good agreement with ELISA and has the advantage of being a quicker, cost-effective and useful for testing single specimen, convenient, not requiring additional equipment, readily available, simple to perform and easy-to-read results.

Screening Depression Among Elderly in a City of Southeast Asia

Introduction: Changing family structure (Joint to Nuclear), increased life expectancy above 60 years of age, generation and communication gap, financial dependency on children leads to conflict among family members. This may sometime lead to old age home settlement of elderly people. All these condition leads to isolation and insecurity among elderly people and this condition affect the mental status of elderly people which may sometime lead to depression among Old Age Homes residents and family living elderly people. Objective: To study the prevalence of depression and diagnosed systemic morbidities among elderly people. To study the predictors of depression among study subjects. Materials and Methods: A descriptive cross-sectional study was conducted among elderly people (age =60 years) residing in old age homes (OAHs) and in community/families in Lucknow, India. Multistage sampling technique was used to include required sample of subjects from the community and for OAHs all the elderly people living in OAHs were included. Geriatric depression scale was used to screen depression. Results: Depression was 27.7% among elderly people residing in OAHs while it was 15.6% those residing at their own homes. In community most frequent morbidity was hypertension (17.7%) while 41.1% elderly people had no diagnosed morbidity. In OAHs out of total the musculoskeletal morbidity (33.7%) was most frequent and 18.8% had no diagnosed morbidity. On multivariate analysis financial dependency and education were found to be statistically significant. Conclusion: Depression was more common among elderly living in Old Age Homes as compare to those living in community. Hypertension, musculoskeletal morbidities and eye related morbidities were most frequent diagnosed morbidities. Financial Dependency & Education were found to be primary predictors of depression.

Treatment of Acute Painful Thyroiditis with Low Dose Prednisolone: A Study on Patients from Western Nepal

Krishna Prasad Koirala, Vishal Sharma

Introduction: Thyroiditis is a disorder that involves inflammation of the thyroid gland. Subacute thyroiditis is the most common cause of acute painful thyroiditis. It is thought to be a viral inflammatory disorder. Subacute thyroiditis has been treated with either nonsteroidal anti-inflammatory drugs (NSAIDs) or high dose corticosteroids. The response to steroids is more dramatic and quicker than the NSAIDs. Prednisolone is the most commonly used corticosteroid to treat subacute thyroiditis. The usual dose is one mg/kg/day tapered over six weeks although the basis for this dose has not been established yet by prospective studies. Aim: The current research was carried out to study if prednisolone in lower initial dose (20 mg/day tapered over four weeks) is effective in patients with acute painful thyroiditis. Materials and Methods: This study was a prospective, cross sectional, observational study carried out at Pokhara, Nepal. All the patients presenting with anterior neck pain of less than 1 week with tender thyroid on palpation and ESR more than 30mm/h were included in the study. The patients were administered prednisolone in a starting dose of 20 mg/day tapered over four weeks. Data were collected, analysed and the results were interpreted. Results: One hundred and twenty two patients of acute painful thyroiditis were included in our study. Age of the patients ranged from 19 years to 69 years with the mean age of 36.58 years. Female to Male ratio was 10:1. Mean ESR was 57.03 at the time of presentation. ESR decreased to 29.63 at two weeks and 17.03 mm per hour (normal) at 4 weeks after continuation of the drug. All the patients reported with severe pain in the anterior neck at the time of presentation. Pain was completely relieved in 115 patients (94%) at 2 weeks after starting the treatment and it was better than previous in seven patients. Conclusion: Twenty mg of prednisolone daily tapered over 4 weeks is an adequate treatment of subacute thyroiditis. However, dose can be drastically tapered after 2 weeks.

Efficacy of High Frequency Ultrasound in Localization and Characterization of Orbital Lesions

Rashmi M Nagaraju, G Gurushankar, Bhimarao, Bindushree Kadakola

Background: The complicated anatomy of orbit and the wide spectrum of pathological conditions present a formidable challenge for early diagnosis, which is critical for management. Ultrasonography provides a detailed cross sectional anatomy of the entire globe with excellent topographic visualization and real time display of the moving organ. Objectives of the study: To evaluate the efficacy of high frequency Ultrasound in localization of orbital diseases and to characterize various orbital pathologies sonologically. Materials and Methods: Hundred eyes of 85 patients were examined with ultrasound using linear high frequency probe (5 to 17 MHz) of PHILPS IU22 ultrasound system. Sonological diagnosis was made based on location, acoustic characteristics, kinetic properties and Doppler flow dynamics. Final diagnosis was made based on clinical & laboratory findings/higher cross-sectional imaging/surgery & histopathology (as applicable). Diagnostic accuracy of ultrasonography was evaluated and compared with final diagnosis. Results: The distinction between ocular and extraocular pathologies was made in 100% of cases. The overall sensitivity, specificity, NPV and accuracy of ultrasonography were 94.2%, 98.8%, 92.2% & 94.9% respectively for diagnosis of ocular pathologies and 94.2%, 99.2%, 95.9% & 95.2% respectively for extra ocular pathologies. Conclusion: Ultrasonography is a readily available, simple, cost effective, non ionizing and non invasive modality with overall high diagnostic accuracy in localising and characterising orbital pathologies. It has higher spatial and temporal resolution compared to CT/MRI. However, CT/MRI may be indicated in certain cases for the evaluation of calcifications, bony involvement, extension to adjacent structures and intracranial extension.

Comparative Evaluation of Bolus Administration of Dexmedetomidine and Fentanyl for Stress Attenuation During Laryngoscopy and Endotracheal Intubation

Background: Laryngoscopy and endotracheal intubation can cause hypertension and tachycardia which can result in myocardial ischemia or stroke in vulnerable people. The objective of our study was to compare the efficacy of bolus dose of dexmedetomidine and fentanyl in attenuating haemodynamic stress responses following laryngoscopy and intubation. Materials and Methods: Sixty patients who were fixed to undergo elective surgeries under general anaesthesia were randomly divided into 2 groups. Group 1 received 1 mcg/kg of dexmedetomidine over 10 minutes and group 2 received fentanyl 2mcg/kg before induction. Anaesthesia was standardized in both the groups and vital parameters were recorded for up to 10 minutes after intubation. Results: Dexmedetomidine in a dose of 1mcg/kg prevented an increase in heart rate following laryngoscopy when compared to fentanyl group. This effect lasted for 10 minutes after intubation is performed. Though dexmedetomidine prevented an increase in blood pressure, this effect was statistically significant only for 2 minutes after intubation when compared to fentanyl group. Conclusion: Attenuation of rise in heart rate and blood pressure following laryngoscopy and endotracheal intubation was better with 1mcg/kg of dexmedetomidine when compared to fentanyl.

SBS vs Inhouse Recycling Methods-An Invitro Evaluation

Introduction: In today’s world of economic crisis it is not feasible for an orthodontist to replace each and every debonded bracket with a new bracket- quest for an alternative thrives Orthodontist. The concept of recycling bracket for its reuse has evolved over a period of time. Orthodontist can send the brackets to various commercial recycling companies for recycling, but it’s impractical as these are complex procedures and require time and usage of a new bracket would seem more feasible. Thereby, in-house methods have been developed. The aim of the study was to determine the SBS (Shear Bond Strength) and to compare, evaluate the efficiency of in house recycling methods with that of the SBS of new brackets. Materials and Methods: Five in–house-recycling procedures-Adhesive Grinding Method, Sandblasting Method, Thermal Flaming Method, Buchman method and Acid Bath Method were used in the present study. Initial part of the study included the use of UV/Vis spectrophotometer where in the absorption level of base of new stainless steel bracket is compared with the base of a recycled bracket. The difference seen in the UV absorbance can be attributed to the presence of adhesive remnant. For each recycling procedure the difference in UV absorption is calculated. New stainless steel brackets and recycled brackets were tested for its shear bond strength with Instron testing machine. Comparisons were made between shear bond strength of new brackets with that of recycled brackets. The last part of the study involved correlating the findings of UV/Vis spectrophotometer with the shear bond strength for each recycling procedure. Results: Among the recycled brackets the Sandblasting technique showed the highest shear bond strength (19.789MPa) and the least was shown by the Adhesive Grinding method (13.809MPa). Conclusion: The study concludes that sand blasting can be an effective choice among the 5 in house methods of recycling methods.

Impact of Adjuvant Therapy on Survival in Curatively Resected Gallbladder Carcinoma

Sunil Choudhary, Anupam Kumar Asthana

Background: Gallbladder carcinoma (GBC) has the propensity to fail at loco-regional (LR) and distant sites despite aggressive radical surgery. Adjuvant therapy in the form of radiotherapy (RT), systemic chemotherapy (CT) and chemoradiation (CRT) is the usual practice. Due to rarity of this disease, there is limited evidence to suggest the type of adjuvant treatment which should be offered to the patients. Aim: The study was conducted to evaluate the impact of adjuvant treatment on curatively resected GBC patients. S ettings and Design: Histological proven patients of GBC registered between June, 2008 and July, 2014 were identified from our hospital database and retrospective analysis was done. Materials and Methods: Patients of GBC who had curative resection followed by adjuvant treatment as RT alone, CT alone or CRT were included in the study. S tatistical Analysis: Adverse prognostic factors and the effect of adjuvant treatment on overall survival (OS) and disease free survival (DFS) were evaluated using Cox Regression Method and Kaplan Meier plot. Results: We identified 33 patients of which 23 were Stage I or II disease (Early disease) and the remaining 10 were Stage III or IV disease (Advanced disease). All except one patient had adenocarcinoma. A total of 5 patients were treated with RT alone while 16 patients received CT alone. The remaining 12 patients were treated with CRT. Median follow-up period was 8.5 months. At analysis 4 were alive while the remaining 29 were Dead due to disease. With regard to “Early disease” patients who had RT alone, CT alone and CRT, the median OS was 22.3, 10.3 and 15.2 months respectively (p = .440). Cohort of patients with “Advanced disease” who were treated with CT alone and CRT the median OS was 7.5 and 7.0 months respectively (p = .643). On multivariate analysis none of the prognostic factors had an adverse impact on survival. Conclusion: The impact of adjuvant treatment in the form of RT, CT or CRT after curative resection in GBC patients was seen in terms of improved survival but was not statistically significant.

Prevalence of Zygomatic Air Cell Defect using Orthopantomogram

Aim: To determine the prevalence, radiographic appearance, variations, characteristics and establishing dominant location and type of zygomatic air cell defect (ZACD) among the North Indian population. Materials and Methods: The panoramic radiographs of 2500 dental clinic outpatients were examined for the presence of ZACD for estimating the prevalence and characteristics of the ZACD. Results: ZACD was found in 63 patients with a prevalence of 2.5% with male predominance. Unilateral (70%) and unilocular appearance (78%) of ZACD were the dominant patterns. Patients with ZACD had a mean age of 37.4 years and a range of 19-78 years. Conclusion: The prevalence of ZACD among the Indian population is in accordance with the other studies carried out in other populations of the world. So it is important for surgeons to assess location of ZACD before planning any surgical procedure in order to avoid intraoperative complications.

Development of Screening Questionnaire for Detection of Alcohol Dependence

Shubh Mohan Singh, Ashish Bhalla, Om Prakash Giri, Siddharth Sarkar

Introduction: Alcohol dependence (AD) is a major reason for morbidity and visits to emergency medical settings. However, the detection of AD is often difficult or overlooked. This study aimed to develop a brief screening questionnaire in Hindi language for detection of AD in an emergency medical setting. Materials and Methods: The authors in consultation devised a set of questions related to AD in the Hindi language requiring binary yes/no type of response. These questions were guided by clinical experience, nosological criteria and previously published screening questionnaires. After initial piloting, these questions were administered by the treating doctors to 100 consenting adult patients presenting with possible AD in the emergency medical services of a tertiary care hospital in North India. A diagnosis of AD was arrived at by administering Mini-International Neuropsychiatric Interview separately. Identification of the most discriminant combinations of items for the detection of AD were based on the chi-square test and binary logistic regression analyses. The final version of the questionnaire was then externally validated on another cohort of patients. Results: Based on the analyses, we retained 5 items in the final version of the questionnaire. Sensitivity and specificity values for cut-off scores were calculated. Subsequent external validation revealed satisfactory psychometric properties of the questionnaire. Conclusion: The questionnaire represents a simple and brief clinician-administered instrument for screening of AD in an emergency medical setting.

Influence of Full Veneer Restoration on Fracture Resistance of Three Different Core Materials: An Invitro Study

Aims and Objectives: One of the factor which affects the strength of the tooth restored with core material is the property of the material. In clinical situation all such restored teeth are protected by crowns. This study evaluated the strength of different core materials on a compromised tooth structure after restoration with a crown. Materials and Methods: Seventy extracted intact human premolars were collected and mounted within a mould using auto-polymerizing resin. The teeth were divided in-to four groups - A, B, C and D. Each group contained 20 teeth except group A with 10 teeth. All the teeth were prepared for full veneer cast crown. Except for the teeth in group: A) extensive class-I cavities were prepared in the teeth of all the groups and restored with; B) composite resin, 3M EPSE Filtek P60; C) Silver reinforced glass ionomer, SHOFU Hi Dense XP and; (D) Resin reinforced glass ionomer, GC Gold Label light cure GIC. All the teeth were restored with cast-metal alloy and exposed to 1.2 million cycles of cyclic loading in a chewing simulator. Subsequently, the teeth that survived were loaded till fracture in the universal testing machine. Fracture loads and type of fractures were recorded. Results: All the specimens survived cyclic loading. The mean fracture strength of the silver reinforced glass ionomer was greater with and without crown (p<0.001). Statistical analysis for the mean fracture load of each specimen showed significant difference between the groups. Conclusion: Under the condition of this study, core materials when restored with artificial crown had a significant increase in fracture resistance.

Menstrual Disorders and Its Determinants Among Married Women of Rural Haryana

Introduction: Disorders of menstruation are common problems among women. They have several psychological effects on women’s health. Aim: This study aimed to estimate prevalence of menstrual disorders, usage of sanitary pads and their determinants among married women in selected villages of rural Haryana. Materials and Methods: A cross-sectional study was conducted during September 2011 in 10 villages of PHC (Primary Health Centre) Mandi, Haryana, using a systematic random sampling technique. Currently married women in the age group of 18-45 years living in study area for more than 1 year were included in the study while those who were pregnant and unable to understand questions were excluded. Informed verbal consent was obtained from all participants. Results: A total of 344 women were interviewed. The mean (SD) age of participants was 28.0 (5.4) years. Majority of women were housewives (78.8%) and most had education up to middle school (22.7%). Mean (SD) age at menarche was 14.3 (1.2) years. Nearly one-tenth of women had married before 18 years of age. Prevalence of all menstrual disorders was 20.3% and most common disorder was excessive pain. About one fifth reported irregularity of menstrual cycles. Almost half were not using sanitary pads during menses. Menstrual disorders were more common among non-users of contraception (OR=1.7, p = 0.04) and housewives (OR = 2.4, p= 0.03). Conclusion: Disorders of menstruation were fairly common among women surveyed. Usage of sanitary pads was quiet low. Awareness generation among women regarding menstrual problems and Behaviour Change Communication to promote usage of sanitary pads are important measures to reduce related morbidity.

Influence of Surface Modifications of Acrylic Resin Teeth on Shear Bond Strength with Denture Base Resin-An Invitro Study

Background: Debonding of artificial teeth from the denture base is an important issue for edentulous patients rehabilitated with conventional or implant supported complete dentures. Aim: The purpose of this study was to evaluate shear bond strength between denture base resin and acrylic resin denture teeth subjected to three different surface modifications on the ridge lap area as compared to unmodified denture teeth. Materials and Methods: Forty acrylic resin central incisor denture teeth were selected and randomly divided into four test groups. The teeth in each group were subjected to one of the three different surface modifications, namely, chemical treatment, sandblasting and placement of retentive grooves on the ridge lap area respectively, prior to packing of the denture base resin. The group with unmodified teeth served as control. Forty acrylic resin test blocks thus obtained were tested for shear bond strength between acrylic resin teeth and denture base resin in Universal Testing Machine. Data obtained was statistically analysed using one-way ANOVA and Student- Newman- Keul’s test (p< 0.05). Results: Analysis of shear bond strength revealed that retentive grooves on the ridge lap area showed highest bond strength values followed by sandblasting and both were statistically significant compared to the control and chemically treated groups. Unmodified surface of the resin teeth showed the least bond strength. Conclusion: Within the limitations of this invitro study the placement of retentive grooves or sandblasting of the ridge lap area showed highly significant improvement in shear bond strength compared to the unmodified surface. Chemical treatment did not result in any significant improvement in the shear bond strength compared to the unmodified surface.

A Study on the Level of Oxidative Stress and Inflammatory Markers in Type 2 Diabetes Mellitus Patients with Different Treatment Modalities

Siva Prasad Palem, Philips Abraham

Introduction: The prevalence of type 2 diabetes mellitus is increasing worldwide in all the age group. UKPDS study had shown that good glycaemic control is maintained by the administration of insulin in addition to hypoglycaemic drugs. But, hyperinsulinemia might cause vascular complications in T2DM. Oxidative stress and inflammation are common in diabetes and plays an important role in vascular complications. Aim: The study has been designed to estimate and compare the level of oxidative stress and inflammation in type 2 diabetic patients under different treatment modalities. Materials and Methods: Sixty Type 2 diabetic subjects undergoing treatment were selected from Government Hospital and VMKV Medical College & Hospital at Salem. The subjects were divided into two groups based on treatment modalities, hypoglycaemic drugs subjects as Group-I (30) and hypoglycaemic drugs & Insulin subjects in Group-II (30). BMI was calculated by standard formula and Fasting blood sugar (FBS), postprandial blood sugar (PPBS), glycated haemoglobin (HbA1c), Lipid profile, oxidative stress (MDA) and inflammatory markers were measured by well established methods. SPSS 16.0 version was used for statistical analysis. Result: In our study we have found significantly high levels of BMI, MDA and hsCRP (25.5±2.79, 2.73±1.65, 1.98±0.85) in Group II subjects when compared to Group I subjects (23.4±3.09, 2.23±1.76, 1.168±1.124). Conclusion: Since risk factors like BMI, MDA and hsCRP were high in Diabetes mellitus patients on both oral hypoglycaemic drugs and insulin, they are more susceptible to cardiovascular diseases. Evaluation of these markers at regular interval can reduce the incidence of vascular complications in Type 2 DM patients.

Decreased Bone Mineral Density at the Femoral Neck and Lumbar Spine in South Indian Patients with Type 2 Diabetes

Pratheesh George Mathen, Molly Mary Thabah, Bobby Zachariah, Ashok Kumar Das

Background: With prevalence of diabetes in India reaching epidemic proportions and increase in the population of geriatric age group and risks of falls, it is important to understand the effect that diabetes has on bone health. Aim: The objective was to assess bone mineral density (BMD) of patients with type 2 diabetes mellitus (T2DM) and to study factors contributing to BMD in patients with T2DM. Materials and Methods: This was a prospective cross-sectional study on 150 patients with T2DM (diagnosed at age > 30 years) and an equal number (n=150) of age and sex matched healthy controls from September 2012 to July 2014 at a tertiary care center located in Southern India.BMD was measured at the femoral neck and lumbar spine (L2–L4) by dual energy absorptiometry (DXA) in cases and controls. Serum total calcium, phosphorus and alkaline phosphatase (ALP) and 25-OH- vitamin D3 was measured in patient group. Results: Mean age (SD) was 51.29 (±8.05) and 51 (±8.3) years in cases and controls, respectively. The femoral neck and lumbar spine BMD was significantly lower in T2DM cases compared to controls. Also the femoral neck and lumbar spine T-score was significantly lower in T2DM cases compared to controls. Femoral neck BMD among male patients with T2DM was significantly lower compared to controls (men). Among women, BMD at femoral neck as well as lumbar spine was significantly lower in cases when compared to controls. Ninety six out of 150 (64%) T2DM cases had Vitamin D values <20 ng/mL. There was weak negative correlation between age of patient, duration of diabetes and HbA1C with femoral neck BMD. There was weak negative correlation between HbA1C and lumbar spine BMD. Conclusion: Indian subjects with type 2 diabetes have significantly lower BMD at both femoral neck and lumbar spine compared to age and sex matched healthy controls. We conclude that osteopenia and osteoporosis are overlooked complications of diabetes. Longitudinal studies are needed to see for actual incidence of fractures among this high risk group.

Correlation of Single Nucleotide Polymorphism 35-Kb Upstream of Hla -C and Clinical Profile of Multidrug-Resistant Tuberculosis

Introduction: The SNP HLA-C-35 kb (rs9264942) may contribute to the host immune defense mechanism by affecting the cell surface expression pattern of HLA-C and antigen presentation to CD8+ cytotoxic cells. Thus, this SNP may contribute to intracellular multidrug-resistant (MDR)-tuberculosis (TB) infection. Aim: To examine the association between the SNP HLA-C-35 kb (rs9264942) and the clinical profile of MDR-TB infection. Settings and Design: MDR-TB-positive patients were followed from May 2012 to December 2013 to observe the progression of MDR-TB infection. Non-TB individuals and non-MDR-TB individuals were also recruited as controls. Materials and Methods: The patients’ HLA-C-35 kb (rs9264942) status was determined by PCR. Results: The C allele was slightly more frequent in the MDR-TB patients than in the non-MDR TB patients (OR= 1.28; 95% CI: 0.701 – 2.328). The C allele was found to be more frequent in the MDR-TB patients exhibiting pulmonary fibrosis (OR= 2.13; 95% CI: 0.606 – 7.480) or pulmonary infiltrates (OR= 3.17; 95% CI: 0.690 – 14.598) and among the MDR-TB patients who were classified as underweight (OR= 8.00; 95% CI: 1.261 – 50.770). The CC genotype was associated with the treatment after failure of category II group (OR= 4.17; 95% CI: 1.301 – 13.346). Conclusion: The C allele SNP HLA-C-35 kb (rs9264942) may contribute to the clinical profile in MDR-TB infection.

Burden of Diabetes Related Complications Among Hypertensive and Non Hypertensive Diabetics: A Comparative Study

Background: Diabetes and hypertension are the conditions with overlapping risk factors and complications. Objective of present study was to compare the burden of complications of diabetes among hypertensive and non hypertensive diabetes individuals. Materials and Methods: This cross-sectional study was conducted at Saveetha medical college and hospital, Chennai, India. A total of 100 diabetics having hypertension and 50 non-hypertensive diabetic patients were enrolled on the basis of purposive sampling. Information about sociodemograpic characteristics, general health, health distress, diabetes symptoms, communication with physician, healthcare utilization and lifetime occurrence of diabetes related complications. Mean, standard deviation and median of continuous variables and proportion of categorical variables were recorded. Results: Average age of the hypertensive diabetes patients (M=57; SD=11) was higher than non hypertensive diabetes patients (M=52; SD=11) which was statistically significant (p=.009). Diabetic neuropathy was reported by 45% of the hypertensive and 38% of the non-hypertensive diabetics. Mean self reported general health score was higher among hypertensive diabetic participants (M=3.4; SD=1) in comparison to non hypertensive diabetic participants (M=3; SD=1) and it was found statistically significant (p=.03) indicating towards poor self health perception among hypertensive’s. Results of the study have shown that the proportion of participants who have prepared any list of questions before visiting doctor’s clinic (fairly often to always) was significantly higher among hypertensive diabetics (30%) in comparison to non-hypertensive diabetics (14%). Conclusion: The proportion of participants reporting diabetes neuropathy and retinopathy was higher among hypertensive diabetics in comparison to non hypertensive diabetics.

Have Smartphones Contributed in the Clinical Progress of Oral and Maxillofacial Surgery?

Jigar M. Dhuvad, Mukesh M. Dhuvad, Rajesh A. Kshirsagar

Background: Dental surgeons who encounter complex situations, such as those in unscheduled care, often have limited resources to provide a structured and specialty care. Therefore, there is always a need for cost-effective, easy to handle, easy to carry “Smartphones”. Objective: The purpose of this paper was to undertake a review of literature on “Smartphone in Oral and Maxillofacial Surgery” online data-base and discuss the case series with emphasis on the role of attending dental surgeon and the maxillofacial surgeon. Materials and Methods: The available literature relevant to oral and maxillofacial surgery in online data-base of the United States National Library of Medicine: PubMed (http://www.ncbi.nlm.nih.gov/pubmed/) was searched. The inclusion criterion was to review the published clinical papers, abstracts and evidence based reviews on ‘Uses of Smartphone in Oral and Maxillofacial Surgery’. Results: Six articles were found with the search term “Smartphone in Oral and Maxillofacial Surgery” in the literature searched. Five articles met the inclusion criteria for the study. The relevant data was extracted, tabulated, and reviewed to draw evidence-based conclusions for uses of smartphone in oral and maxillofacial surgery. Conclusion: Utilization of smartphones in oral and maxillofacial surgery facilitate in differential diagnosis, treatment, follow up, prevention of the disease further and thereby improve the quality of patient care without requiring the presence of the maxillofacial surgeon in remote areas.

Comparison of Effects of Different Doses Dexmedetomidine on Inhibiting Tracheal Intubation-Evoked Haemodynamic Response in the Elderly Patients

Guan Zhan -ying, Wang Chang-ming, Tang Shuai,Tong Lin-lin, Han Yu-feng

Background: Dexmedetomidine (DEX) is a selective a2-adrenergic receptor agonist with anxiolytic and analgesic properties. In the present study, we aimed primarily to assess the effects of DEX on sedation, cognitive function and cardiovascular reflex responses before, during and after the tracheal intubation in the elderly patients. Materials and Methods: Eighty patients undergoing elective abdominal surgery were randomly assigned to four Groups: Group A(saline, n=20), Group B (0.25µg/kg DEX, n=20), Group C (0.50µg/kg DEX, n=20) and Group D (1.00µg/kg DEX, n=20). With the constant speed infusion of saline and a loading different doses of DEX (diluted with saline to 50ml) for 10min respectively before induction of anaesthesia, the values of arterial pressure {systolic blood pressure (SBP), diastolic blood pressure (DBP)}, heart rate (HR) and bispectral index (BIS) at the time point of before pump DEX (T0), at the end of infusing DEX (T1), before tracheal intubation (T2), at the moment of tracheal intubation (T3) and 5min after trachea intubation (T4) were observed, oxygen saturation (SPO2) and the Modified Observers Assessment of Alertness/Sedation Scale (OAA/S) score were observed at the time of T1 and T0. Results: Comparison among Groups, compared with Group A, SBP and DBP values in Group C at T2 showed significant differences (p<0.05), SBP and DBP values in Group D at T1, T2 and T4 indicated significant differences (p<0.05), HR values in Group D at T1, T2, T3 and T4 showed significant differences (p<0.05); Compared with Group A, BIS values in Group C at T2 and T3 indicated significant differences (p<0.05), BIS values in Group D at T1, T2, T3 and T4 showed significant differences (p<0.05); Comparison between T3 andT2, means of SBP, DBP and HR in Group A and in Group B showed significant differences (p<0.05); Group D showed significant differences in SPO2 and (OAA/S) betweenT1 and T0 (p<0.05). Conclusion: Comparison within Groups and between Groups in different doses DEX, the present result showed that 0.5µg/kg DEX had an effective inhibition, without respiratory depression, on tracheal intubation evoked cardiovascular response in the elderly patients.

Anti-perinuclear Factor as Diagnostic Marker in Rheumatoid Arthritis

Zeinab Abedian, Masoud Sagafi, Saeid abedian kenari, Farshideh Abedian

Introduction: Rheumatoid Arthritis (RA) is a systemic autoimmune disease. It is associated with several auto antibodies which can serve as diagnostic and prognostic markers. Aim: In this study, Anti perinuclear Factor (APF) was evaluated as a biomarker in comparison with Rheumatoid Factor (RF) in Rheumatoid Arthritis. Materials and Methods: Fifty two sera of patients with RA (mean age 48±15.8), 23 sera of Patient control group (mean age 32.5 ± 16.9) and 30 sera of Healthy control group (mean age 32.1± 16.9) were analysed. The method is based on the binding of APF to perinuclear keratohyalin granules of buccal mucosal cell and its detection using a fluorescently labeled anti human total antiserum. Results: APF were found in 71.2 % (37/52) of patients with RA. The sensitivity and specificity for APF from 1/5 serum dilution was 71.2% and 94.3% respectively. RF test had higher sensitivity (88.5%) compare to the APF test (71.2%), but its specificity was (86.8%) less than APF (94.3%). There was no significant relationship between the onset of APF and severity of disease but there was significant relationship between the APF titer and severity of disease (p<0.05). Conclusion: It is concluded that APF test is a valuable serological tool for the diagnosis of the disease and a useful serological marker to differentiate from the other inflammatory rheumatoid diseases.

Evaluation of Efficacy of Epidural Clonidine with 0.5% Bupivacaine for Postoperative Analgesia for Orthopaedic Lower Limb Surgeries

Karthik Krishnamoorthy, Saravanan Ravi, Ilango Ganesan

Objective: The objective of this study is to evaluate the efficacy of epidural clonidine in intra and postoperative analgesia, the level of sedation caused by clonidine and monitor its side effects. Materials and Methods: Forty patients of ASA1 & ASA2 scheduled for lower limb orthopaediac surgeries were chosen for the study. Study group received 50µg of clonidine diluted to 1ml along with first dose of epidural injection and Control group received 1ml of normal saline along with first dose of epidural. Intra and postoperative vitals, verbal pain rating scale (VRS), sedation score and number of rescue anlgesics required postoperatively were noted. Patients received rescue analgesic when VRS was 1. Results: Addition of clonidine to bupivacaine definitely improves the quality of analgesia by reducing the overall pain score, prolonging the duration of the time of first rescue analgesia and causing reduction of total analgesic consumption in the postoperative period without any hemodynamic instability. Sedation may be beneficial during the intraoperative period. Conclusion: Epidural clonidine produces long lasting, good quality analgesia with good level of sedation and with minimal side effects.

Prevalence of Atherosclerotic Coronary Stenosis in Asymptomatic North Indian Population: A Post-mortem Coronary Angiography Study

Yogender Singh Bansal, Shatrugan Prasad Mandal, Senthil Kumar, Puneet Setia

Aim: A preliminary study of coronaries using post-mortem angiography was undertaken to see the prevalence of atherosclerotic coronary stenosis in non-cardiac unnatural deaths. Materials and Methods: This study was conducted in a tertiary care centre located in Chandigarh. A total of 128 medico-legal cases were studied comprising 88 males and 40 females. Post-mortem examinations of these MLC cases were conducted in the Department of Forensic Medicine, PGIMER, Chandigarh. All hearts were visually screened by post-mortem coronary angiography first and then grossly examined using serial transverse incision technique in positive screening cases to find the degree of narrowing. Results: Of the study group, 34% males and 20% females showed evidence of narrowing on angiography. Of the males showing coronary stenosis, 83% had single vessel disease and 13% had double vessel disease, while only one individual had triple vessel disease. In cases of female, all the cases of coronary stenosis were single vessel disease. Left anterior descending coronary artery (LAD) was the most common vessel involved, followed by right coronary artery (RCA) & Left circumflex artery (LCX) and in cases of double vessel disease, LAD in combination with LCX was responsible for 75% of the cases. Remarkably 23.6% of study population in the age group of less than 40 years showed appreciable narrowing in at least one of the coronaries. Conclusion: In general, the prevalence of CAD is on the rise, particularly in younger population owing to the changes in their lifestyle and food habits. This preliminary study revealed evidence of narrowing of at least one coronary in 34% male and 20% female population and 23.6% subjects were less than 40 years old. Further detailed studies are needed especially in younger age group and to support the need for preventive cardiology in the early years of life.

A Randomized Double Blinded Comparison of Epidural Infusion of Bupivacaine, Ropivacaine, Bupivacaine-Fentanyl, Ropivacaine-Fentanyl for Postoperative Pain Relief in Lower Limb Surgeries

Background: Continuous epidural infusion of Bupivacaine and Ropivacaine with or without the addition of Fentanyl has been evaluated by various researchers for effective postoperative pain relief. Studies however, depict significant variability in their results with regard to analgesic efficacy and adverse effects like hypotension, motor blockade etc. Aim: To comparatively evaluate postoperative analgesic efficacy, motor sparing effect, postoperative haemodynamic variations and total postoperative analgesic consumption in first 24 hours. Materials and Methods: A randomised double blind study was conducted on 100 adult, ASA grade I and II patients, of either sex who had undergone elective lower limb surgery under spinal anaesthesia. According to the group allocated, patients were started on epidural infusion after completion of surgery. Group I (0.2% Ropivacaine), Group II (0.1% Ropivacaine + 2µg/ml Fentanyl), Group III (0.2% Bupivacaine), Group IV (0.1% Bupivacaine + 2µg/ml Fentanyl) at the rate of 6 ml/hour. VAS scores, epidural consumption, supplemental epidural boluses, rescue analgesics, haemodynamics, motor block, sensory block regression,sedation, nausea and pruritis were recorded by a blinded observer for 24 hours. Results: The haemodynamic parameters were stable in all the groups. Side effects including the motor block were negligible and comparable in all groups. Group I patients had significantly lower VAS scores, mean total epidural consumption, supplemental epidural bolus requirement and rescue analgesic requirement among all groups. Conclusion: It can be concluded that epidural analgesia using Ropivacaine 0.2% infusion is more effective than other study groups when used for postoperative pain relief in lower limb surgeries.

Determinants of Capillary Refill Time in Healthy Neonates

Shweta Singh, Ashok Kumar, Sriparna Basu, Baldev Bhatia

Objectives: Traditionally Capillary refilling time (CRT) has been used as a widely accepted method to assess cardiac output and peripheral circulation in neonates. There are only few studies describing normal values and the correct method of recording CRT. The value of CRT is affected by various factors like ambient or skin temperature, age, site of measurement, duration as well as amount of pressure and inter observer variation. However, none of these have been standardized. Hence, we conducted this study to establish the normal value and factors affecting Capillary Refilling Time (CRT) in healthy neonates in Varanasi. Design: Prospective observational study done over a period of 2 years. S etting: Maternity wards and Neonatal intensive care unit of Sir Sunderlal Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India. Participants: Healthy neonates between 35-42 weeks of gestation staying with their mothers and admitted in neonatal intensive care unit. Materials and Methods: CRT was measured by standard technique four times during first week of life on day 1, 3, 5 and 7. S tatistics Analysis: Student t-test was used for analysis. A p-value less than 0.05 was taken as statistically significant. Results: The mean capillary refilling time (CRT) was 2.23 ± 0.37 seconds in healthy neonates during first week of life. We studied each neonate four times in first week of life. Significantly lower values of CRT were noted in low birth weight babies throughout first week in healthy neonates. Babies under phototherapy and radiant warmer had also shorter CRT values. Values were not affected by age, sex and gestation. Conclusion: The normal value of capillary refilling time (CRT) in healthy neonate is less than three seconds. The major determinants of CRT in healthy neonate are birth weight, radiant warmer and phototherapy. CRT alone in neonatal age is less informative haemodynamic parameter; it should be evaluated along with either blood pressure or oxygen saturation with pulse oxymeter. Further studies are needed to assess the reliability and validity of CRT as a clinical tool to measure perfusion in neonates.

A Comparison of Clinical Features, Pathology and Outcomes in Various Subtypes of Breast Cancer in Indian Women

Background: Breast cancer is often classified into subtypes using immunohistochemical markers. These subtypes have distinct biological behaviour. This study was conducted with the aim of estimating the distribution of various subtypes of breast cancer in Indian population based on immunohistochemistry markers and to determine the clinical features, pathology and outcomes of these subtypes of breast cancer. Materials and Methods: A retrospective study was undertaken and all patients of breast cancer over a 5 year period were included. These patients were divided into 4 subgroups depending on the presence or absence of immunohistochemical markers: i) Luminal A (ER/PR+, Her 2 neu–); ii) Luminal B (ER/PR+, Her 2 neu+); iii) Her 2 enriched (ER-/PR-, Her 2 neu+) and; iv) Triple negative (ER-,PR-, Her2 neu-). Clinical and pathological features and survival were compared between patients in the 4 subgroups. Results: Luminal A subgroup had majority of patients (43.8%). Patients in Luminal B, Her 2 enriched, and Triple negative subgroups were 14.8%, 16.1% and 25.3%. Median follow-up of patients was for 34 months. Luminal A subgroup patients were more likely to be postmenopausal and have smaller and lower grade (I/II) tumours with better survival (OS-91.06%). Patients in the Triple negative subgroup were more likely to be premenopausal (p-value 0.036, odds ratio 0.611, CI 0.394-0.949), have larger and higher grade (III) tumours with worse overall survival (OS-88.46%, odds ratio 1.32, 95%CI 0.602-2.39). Her 2 enriched group patients had bad prognostic features like larger size of tumour and higher grade of tumour and worst survival among all the subgroups (OS-85.07%, odds ratio 1.78, 95% CI 0.767-4.163). However, these outcomes were not statistically significant for the subgroups. Conclusion: A retrospective study was undertaken of breast cancer patients in India, according to subtypes based on immunohistochemistry. Luminal A had prognostic features and survival which was better as compared to other subgroups (Luminal B, Her 2 enriched and Triple negative). Incidence of patients with Triple negative breast cancer was higher in the premenopausal period. Patients with Her 2 enriched breast cancer had the worst survival among all the subgroups.

Carotid Artery Intima-Media Thickness in Young Adults with Family History of Coronary Artery Disease

Background: It is well established that accelerated athero-sclerosis occurs in middle-aged and elderly adults with family history of coronary artery disease (CAD). However similar data on younger population with genetic predisposition is lacking. As identifying and treating this target group at an early stage will help in postponing the disease progression and delay the onset of clinical events later in life. Aim: We undertook the present study to investigate whether structural vascular changes related to atherosclerosis are detectable in healthy young adults with family history of CAD by non-invasive high resolution scan of the carotid artery intima media thickness (CIMT). Materials and Methods: Fifty healthy young adults of both sexes, aged 18-25 years with family history of CAD were taken as cases and fifty age, sex, body mass index (BMI) and blood pressure matched subjects without family history of CAD served as control. All participants completed a standardized cardiovascular disease risk assessment questionnaire and resting blood pressure, pulse rate and BMI were recorded. None of the subjects were smoker or alcoholic. Both cases and controls were subjected to high resolution B-mode ultrasonographic evaluation of CIMT. Fasting blood samples were drawn for baseline investigations and lipid profile estimation. Results: Compared to control subjects, cases had increased CIMT (mean of combined sites 0.57 ± 0.08 mm vs 0.46 ± 0.05 mm in controls, p<0.001). Offspring with family history of CAD exhibited an unfavourable lipid profile. We observed a direct association between carotid intima media thickness and triglyceride concentration (Correlation coefficient=0.32). Multiple logistic regression analysis showed family history of CAD to be independent risk factor for CIMT (Odds ratio=5.36, confidence interval 1.84 – 10.53, p=0.003). Conclusion: Arterial wall abnormalities are present at an early age in offspring with family history of CAD. Identifying such high risk individuals is feasible with an easy, non-invasive and reproducible technique like CIMT measurement and hence is recommended.

The Efficacy of Tranexamic Acid in the Reduction of Incidence of Dry Socket: An Institutional Double Blind Study

K.P. Anand, Swadheena Patro, Abhijita Mohapatra, Sumita Mishra

Background: Alveolar osteitis (AO) is an important postoperative problem with an incidence of 20% to 35% especially prevalent after the removal of mandibular molars. Fibrinolysis with subsequent loss of blood clotting is believed to be the general cause of AO. Objectives: This study aims to evaluate the efficacy of tranexamic acid, an antifibrinolytic agent in comparison with a placebo with respect to the reduction of incidence of AO after the extraction of mandibular molars by using following parameters: Pain, disintegration of Clot, halitosis. Materials and Methods: A double blind study consisted of 60 patients, who underwent routine dental extractions of mandibular molar teeth. Group A (30 patients) requiring routine dental extractions of mandibular teeth was randomly selected and was administered a dose of tranexamic acid orally (Pause 500mg) one hour prior to extraction of teeth. Gel foam soaked in tranexamic acid (160mg) was placed into the extraction socket postoperatively. A figure of eight silk suture was placed over the socket to secure the gelfoam. Group B (30 patients); a placebo (crocin) was given orally one hour prior to the extraction and gel foam soaked in saline was placed into the extraction socket postoperatively. A figure of eight silk suture was placed over the socket. Pain was rated individually by each patient at 3rd, 7th, 14th day after extraction and the results was statistically analysed. Results: This study supports that the use of tranexamic acid both locally and systemically following the removal of the teeth reduces the incidence of AO associated with the extraction of mandibular molars. Conclusion: Tranexamic acid has several advantages also when used for simple dental extractions, namely: low cost and ready availability and therefore we recommend this treatment modality.

Clinical Evaluation of Efficacy of CIA and CNA Intrusion Arches

Swati Sharma, Sambhav Vora, Vinisha Pandey

Background and Objectives: Excessive overbite is one of the most common problems that confront the orthodontist. Deep bite can be due to infraocclusion of posterior teeth, supraocclusion of anterior teeth or a combination of the two. Correction of same can be carried out by extrusion of molars, intrusion of incisors or by a combination of both respectively. Various intrusion arches are recommended for correcting deep bite by true intrusion of anterior teeth, Utility arches, Segmental arch, Connecticut Intrusion Arch (CIA) and Connecticut New Arch (CNA). The purpose of this study was to evaluate clinical efficacy of CIA and CNA intrusion arches. Materials and Methods: Tracings recorded from pre and post-treatment lateral cephalograms of 25 patients treated by CIA (Group I) and another 25 patients treated by CNA (Group II) intrusion arches in deep bite cases after four months of treatment were analysed and findings were recorded. S tatistical Analysis: Paired t-test was used to compare pre and post-treatment changes within Groups I and II and unpaired t-test was used to compare treatment changes between Group I and Group II. A P-value of < 0.05 was set for statistical significance. Results: Findings of this study demonstrate that an average of 1mm of intrusion takes place with CIA intrusion arch and 1.3mm with CNA intrusion arch in a period of 4 months. Both intrusion arches do not affect the position of molar in vertical or anteroposterior plane. Interpretation & Conclusion: Both CIA and CNA intrusion arches are effective in bringing about intrusion of lower incisors.

Cross-Cultural Adaptation of Kannada Version of Modified Dental Anxiety Scale Among an Adult Indian Population

Gaurav Gupta, Namita Shanbhag, Manjunath P Puranik

Background: Dental anxiety is one of the most common barriers in seeking dental care. In order to overcome this barrier dentist need to screen patients to successfully help in treatment. A scale is thus needed to measure dental anxiety which is socially & culturally acceptable. Aim: This study aimed to assess the Cross cultural adaptation and validity of the Kannada translation of the Modified Dental Anxiety Scale (MDAS-K). Materials and Methods: A test-retest was conducted on 30 patients visiting a dental institution to assess the reliability of MDAS- K. A cross-sectional survey of 301 patients was conducted in different departments at a dental institution to test the psychometric properties of MDAS-K. The assessment tool consisted of a proforma containing socio-demographic, non socio- demographic variables, MDAS-K and Visual analogue scale (VAS). Statistical analysis: Reliability was assessed using Cronbach’s alpha, inter-item Spearman’s correlation. Independent t-test, ANOVA and post hoc Bonferroni were used to analyse dental anxiety in the psychometric constructs. Results: The internal consistency of MDAS-K was good with Cronbach’s alpha of 0.83. The test-retest reliability for MDAS K had a good correlation of 0.901. The psychometric variables established the construct validity of MDAS-K.MDAS-K also showed good convergent validity with VAS score. The anxiety levels differed in patients visiting different dental departments. Conclusion: The high reliability and validity of the MDAS-K supports its cross cultural adaptation and indicates that it can be a valuable tool for dental practioners in quantifying anxiety among patients and provide quality dental care.

Spectrum of Typical and Atypical Clinico-Histopathological and Radiological Presentation of Soft Tissue and Muscular Cysticercosis in Mid-Western and Far-Western Region of Nepal

Pragya Gautam Ghimire, Prasanna Ghimire, Reena Rana

Introduction: Soft tissue and muscular involvement in cysticercosis is a relatively rarer presentation. Materials and Methods: Twenty seven histopathologically confirmed cases of soft tissue and muscular cysticercosis were collected and the clinical, radiological data was reviewed. Results: There was female predominance for the lesions (19 cases among 27 cases). The most common location for the lesion was in the arm (9 cases), thigh (4 cases), forearm (7 cases), abdominal wall (4 cases) followed by nape of the neck (2 cases). Lesion ranged from 8 mm to 5 cm in size. Ultrasound was diagnostic in 24 cases and inconclusive in three cases. Histopathologically, intact cyst wall was noted in 12 cases, scolex in 5 cases. Seven cases showed degenerating cyst wall surrounded by inflammatory cells, granulation tissue and fibrosis. Conclusion: Fine needle aspiration cytology and histopathological assessment is prudent in the diagnosis of soft tissue and muscular cysticercosis in cases posing clinical diagnostic dilemma.

Psychiatric Morbidity in Infertility Patients in a Tertiary Care Setup

Context: Infertility is regarded as a trigger for psychological morbidity. Infertile couples often suffer from anxiety, depression and lack of self confidence. Aims: To study the demographic factors associated with infertility in a tertiary care setup and to determine the level of anxiety and depression associated with it by using standardized scales. The study protocol also included studying the various coping strategies employed by these patient groups. Settings and Design: Case control study. Materials and Methods: A prestructured questionnaire based study conducted for a span of 6 months. The study population included the patients attending the infertility and the family planning outpatient department. We applied the Hospital Anxiety and Depression scale (HADS) and the Becks Depression Inventory (BDI). Brief COPE Inventory was applied to look for the various coping measures that are employed by the anxious and depressed patients. Statistical Analysis: Data analysis was done using SPSS ver20. Results: A total of 280 study subjects were included in the study; which included 140 women from the infertility clinic and 140 from the family planning OPD. A total of 56.4% (79/140) of the females were found to be suffering from depression and 68.9% (96/140) of the females were found to be suffering from anxiety and depression both. Seven risk factors were found to be significant for depression based on the Beck Depression Inventory (BDI) scale and 6 risk factors were found to be significant based on the Hospital Anxiety and Depression Scale (HADS). The most common coping method employed by depressed women was venting 72.2% (57/79) followed by behavioural disengagement 70.9% (56/79); whereas the most important coping method employed by the anxious and depressed women was behavioural disengagement 71.9% (69/96). Conclusion: Anxiety and depression is common among patients suffering from infertility and measures should be taken to alleviate it.

Serum Adenosine Deaminase as Inflammatory Marker in Rheumatoid Arthritis

Background: Rheumatoid arthritis (RA) is a prototypical inflammatory joint disease. The degree of inflammation is reflected in the extent of joint damage, which further has influence on the quality of life of patients with RA, including risk of atherosclerosis. Hence, besides clinical indices, estimation of degree of inflammation using biochemical markers helps in effecting optimum treatment strategies. C-reactive protein (CRP) is established as an inflammatory marker in patients with RA. Adenosine deaminase (ADA), an enzyme of purine metabolism is considered as a marker of cell mediated immunity and has also been suggested as a marker of inflammatory process in RA. The present study attempts to study the efficacy of serum ADA activity as an inflammatory marker in RA. Materials and Methods: Forty six RA patients and forty six age and sex matched healthy controls were included in the study. ADA activity and high sensitivity C-reactive protein (hsCRP) levels in serum were measured in all the subjects. Statistical analyses were done using Medcalc statistical software version 12.2.2. Results: ADA activity and hsCRP levels were increased in RA patients compared to controls (p<0.0001 and 0.0001 respectively). Significant positive correlation was obtained between hsCRP and ADA in patients (r=0.316, p=0.033). Receiver operating characteristic (ROC) curve analysis revealed statistically significant area under curve (AUC) for ADA that is comparable to that obtained for hsCRP (0.776, p<0.0001 for ADA, 0.726, p<0.0001 for hsCRP). Similar diagnostic utility was obtained with ROC generated cut-off value of 25.3 IU/L (82.6% sensitivity and 65.2% specificity) and with control mean value of 23.48 IU/L (86.96% sensitivity and 54.35% specificity) for ADA. Conclusion: Findings of the present study indicate the importance of ADA as a marker of inflammation. Considering the higher sensitivity obtained, we propose control mean (23.48 IU/L) as a cut-off for serum ADA activity as an inflammatory marker. Owing to the simplicity and also the cost effectiveness of ADA assay, ADA may be recommended as a marker of inflammation in patients with RA. However, further larger and well controlled studies are needed to establish its role as inflammatory marker.

Effect of Cigarette Smoke on Surface Roughness of Different Denture Base Materials

Background: Surface roughness is an important property of denture bases since denture bases are in contact with oral tissues and a rough surface may affect tissues health due to microorganism accumulation. Therefore, the effect of cigarette smoke on the surface roughness of two commercially available denture base materials was evaluated to emphasize which type has superior properties for clinical use. Materials and Methods: A total numbers of 40 specimens were constructed from two commercially available denture base materials; heat-cured PMMA and visible light cured UDMA resins (20 for each). The specimens for each type were randomly divided into: Group I: Heat cured resin control group; Group II: Heat cured acrylic resin specimens exposed to cigarette smoking; Group III: Light cured resin control group; Group IV: Light cured resin specimens exposed to cigarette smoking. The control groups used for immersion in distilled water and the smoke test groups used for exposure to cigarette smoking. The smoke test groups specimens were exposed to smoking in a custom made smoking chamber by using 20 cigarettes for each specimen. The surface roughness was measured by using Pocket SurfPS1 profilometer and the measurements considered as the difference between the initial and final roughness measured before and after smoking. Results: The t-test for paired observation of test specimens after exposure to smoking was indicated significant change in surface roughness for Group II (p< 0.05) but has no significance with Group IV. Otherwise, there were no significant differences with control groups (Group I and III). Conclusion: The surface roughness of the dentures constructed from heat cured acrylic resin had been increased after exposure to cigarette smoke but had no impact on the dentures constructed from visible light cured resin.

Impact of Bariatric Surgery and Diet Modification on Periodontal Status: A Six Month Cohort Study

Background: Nutrition is an essential component of oral health and improper nutrition is an important aetiological factor in the development of obesity as well. Aims and Objectives: This study aimed to evaluate effect of diet modification and oral hygiene maintenance after bariatric surgery on the periodontal status of Class III and IV obese patients. Materials and Methods: Two hundred and twenty four patients between the age ranges of 18 -64 years, from both sexes, were subjected to complete periodontal examination prior to bariatric surgery and 6 months post surgery. Patients were advised diet modification which included more fibrous food intake & decreased intake of soft and sugary food along with supragingival scaling & oral health care regime after bariatric surgery with a 6 month follow up. No periodontal surgical intervention was performed. Results: The patients showed a mean differences in the bleeding score, plaque and gingival index which was found to be statistically significant (p<0.001). The improvement in clinical attachment level and probing pocket depth before and after surgery were found to be statistically insignificant (p>0.05). Conclusion: Thus we conclude that fibrous diet along with good periodontal care can help to improve the oral hygiene status of patients undergoing bariatric surgery, even if periodontal surgical intervention is not performed resulting in freedom from periodontitis, thus improving quality of life of the patient.

Effect of Refractive Status and Axial Length on Peripapillary Retinal Nerve Fibre Layer Thickness: An Analysis Using 3D OCT

Sowmya V., Venkataramanan V.R., Vishnu Prasad

Background: Accurate measurement of retinal nerve fiber layer (RNFL) is now possible with the high resolution optical coherence tomography (OCT). Effect of refractive status of the eye on RNFL thickness may be relevant in the diagnosis of glaucoma and other optic nerve diseases. Aim: To assess the RNFL thickness and compare its correlation with refractive status and axial length of the eye. Material and Methods: Three hundred eyes of 150 patients were included in this study, who underwent RNFL analysis using TOPCON 3D OCT 2000. Analysis of variance has been used to find the significance of study parameters between the study groups. Results: The study showed that refractive status/axial length affected the peripapillary RNFL thickness significantly. Conclusion: The study suggests that the diagnostic accuracy of OCT may be improved by considering refractive status and axial length of the eye when RNFL is measured.

Evaluation of Cord Blood - Haematological Scoring System as an Early Predictive Screening Method for the Detection of Early Onset Neonatal Sepsis

Vamseedhar Annam, Vijayashree Medarametla, Nalinimohan Chakkirala

Background: Sepsis is one of the major causes of neonatal morbidity and mortality. Early recognition and diagnosis of neonatal sepsis are difficult because of the variable and nonspecific clinical presentation of this condition. Hence, there is a need for early predictive screening method for neonatal sepsis. Objectives: To evaluate the role of Cord blood Haematological Scoring System as an early predictive screening method for detection of early onset neonatal sepsis and also to identify the neonates who are at risk of developing neonatal sepsis using cord blood. Settings and Design: The present prospective cross-sectional study was conducted by taking 153 cord blood samples of full term newborns immediately after delivery in the hospital. Preterm, still birth and emergency deliveries were excluded from the study. Materials and Methods: The cord blood was collected and analysed for various Haematological parameters like Total leucocyte count, Absolute Neutrophil count, Immature to mature Neutrophil ratio, immature to mature ratio, Neutrophil morphology, nucleated erythrocytes, platelet count, micro erythrocyte sedimentation rate. Blood cultures were performed as gold standard for diagnosing neonatal sepsis. Statistical Analysis: Chi-square test, Risk ratio, risks in exposed and risk in unexposed were performed. Results: Of 153 newborns for analysis, 59 (38.56%) developed sepsis. The haematological scoring system found that an abnormal immature to total neutrophil ratio, Neutropenia, micro erythrocyte sedimentation rate followed by an abnormal immature to mature neutrophil ratio were the most sensitive indicators in identifying infants with sepsis. The study also found that higher the score, the greater the certainty of sepsis being present. Conclusion: The haematological scoring system using cord blood can be considered as an early predictive screening method for detection of early onset neonatal sepsis. Identifying the risk of developing sepsis early can prevent morbidity and mortality of the neonates.

Desensitizing Agent Reduces Dentin Hypersensitivity During Ultrasonic Scaling: A Pilot Study

Background: Dentin hypersensitivity can interfere with optimal periodontal care by dentists and patients. The pain associated with dentin hypersensitivity during ultrasonic scaling is intolerable for patient and interferes with the procedure, particularly during supportive periodontal therapy (SPT) for patients with gingival recession. Aim: This study proposed to evaluate the desensitizing effect of the oxalic acid agent on pain caused by dentin hypersensitivity during ultrasonic scaling. Materials and Methods: This study involved 12 patients who were incorporated in SPT program and complained of dentin hypersensitivity during ultrasonic scaling. We examined the availability of the oxalic acid agent to compare the degree of pain during ultrasonic scaling with or without the application of the dentin hypersensitivity agent. Evaluation of effects on dentin hypersensitivity was determined by a questionnaire and visual analog scale (VAS) pain scores after ultrasonic scaling. The statistical analysis was performed using the paired Student t-test and Spearman rank correlation coefficient. Results: The desensitizing agent reduced the mean VAS pain score from 69.33 ± 16.02 at baseline to 26.08 ± 27.99 after application. The questionnaire revealed that >80% patients were satisfied and requested the application of the desensitizing agent for future ultrasonic scaling sessions. Conclusion: This study shows that the application of the oxalic acid agent considerably reduces pain associated with dentin hypersensitivity experienced during ultrasonic scaling. This pain control treatment may improve patient participation and treatment efficiency.

A Case Control Study to Evaluate the Association between Primary Cesarean Section for Dystocia and Vitamin D Deficiency

Background: Milder forms of vitamin D deficiency could be responsible for poor muscular performance causing dysfunctional labor. The aim of our research was to study the association between vitamin D deficiency and primary cesarean section. Materials and Methods: This was a case control study. Forty six women who delivered by primary cesarean section with dystocia as primary or secondary indication after 37 weeks of gestation were taken as cases and a similar number of women who delivered vaginally were taken as controls. Vitamin D deficiency was diagnosed when the serum 25(OH)D level was =20 ng/ml and this was compared between cases and controls. Results: Median serum (OH) vitamin D levels was 23.3ng/ml among women who delivered by cesarean section and 26.2ng/ ml among controls (p=0.196). Baseline characteristics were similar in both groups except for a strong association between Body Mass Index (BMI) and cesarean section, (29.7kg/m2 in cases and 25.9kg/m2 in controls p=0.001) seen in multivariate analysis. Vitamin D deficiency was seen in 34.8% of cases and 21.7% of controls (p=0.165). Conclusion: This small case control study did not show a significant association between vitamin D deficiency and primary cesarean section.

Spectrophotometric Study of the Effect of Luting Agents on the Resultant Shade of Ceramic Veneers: An Invitro Study

Evaluation of Microleakage of Dental Composites Using Bonding Agents with Different Placement Techniques: An Invitro Study

Background: The rapid progress of adhesive dentistry over the past decade has been attributed to the significant advances in dentin bonding technology. Requirements of an ideal bonding agent are quite similar to those indicated by Buonocore despite of many improvements. As we enter the new millennium, it is important for us to examine the past. Objective: To evaluate the microleakage of three bonding agents namely Single Bond, Prime & Bond NT and Excite using different composite materials namely Z100, Spectrum TPH, Tetric with three different placement techniques. Materials and Methods: Fifty four extracted human premolars were taken & divided into 9 groups depending upon application of bonding agents followed by composite restorations. Specimens were subjected to thermal cycling at 60 C, 370 C, 540 C and again at 370 C & then placed in 10 ml each of freshly prepared 50% silver nitrate solution for 2 hour in darkness, washed & placed under sun light for 24 hours. The sectioned specimens were then observed under stereomicroscope to detect microleakage. Results: On comparing the mean microleakage scores among the three groups, maximum microleakage scores have been obtained when no bonding agent was used, while least microleakage scores were obtained with double coat of bonding agent. Conclusion: The present study suggests that the placement of bonding agent technique before composite restoration can be effective to limit the microleakage at the tooth restoration interface.

Role of High Resolution Computed Tomography in Evaluation of Pathologies of Temporal Bone

Background: High Resolution Computed Tomography (HRCT), a modification of routine CT, provides a direct visual window in the temporal bone providing minute structural details. Purpose of the present study was to evaluate the normal variations, pathological processes (infections and congenital anomalies) and their extent involving the temporal bone along with their complications on HRCT and to correlate these imaging findings surgically, wherever available. Materials and Methods: The prospective study included 50 patients who were referred to the radiology department with clinically suspected temporal bone or ear pathologies. After detailed clinical examination, the patients were subjected to high resolution computed tomography (HRCT) examination. The imaging findings were correlated with the surgical findings wherever available. The surgical findings were considered as final. Results: From a total of 50 cases, 83.33% had cholesteatoma. The surgical and radiological findings showed a high level of sensitivity (89.29%) in the identification of cholesteatoma. HRCT provides a good sensitivity of 80.65% in the identification of changes to the ossicular chain despite the presence of surrounding soft tissue. HRCT was highly informative in identification of erosion of lateral semicircular canal. In diagnosis of facial canal dehiscence HRCT had a low sensitivity of 33.33%. In the evaluation of any congenital abnormality of the ear HRCT proved to be beneficial in depicting the anatomical details. Conclusion: The clinical and radiological findings showed a high level sensitivity with intraoperative findings as regards to the presence of cholesteatoma, changes of the ossicular chain and erosion of the lateral semicircular canal. HRCT findings, in the treatment of any congenital abnormality of the ear were a good guide to the surgeon for planning and management.

Prevalence and Difficulty Index Associated with the 3rd Mandibular Molar Impaction among Malaysian Ethnicities: A Clinico-Radiographic Study

Haydar Majeed Mahdey, Shelly Arora, Myint Wei

Background: The mandibular third molars (3Mms) are the most common impacted teeth in the human dentition and their prevalence ranges from 27-68.8% in various parts of the world. The assessment of surgical difficulty of 3Mms extraction helps in better formulation of treatment plan by minimizing postoperative complications. Objectives: The aim of this retrospective study was to investigate the prevalence and pattern of 3Mm impaction in patients between 20-44-year-old among Malaysian’s ethnicities attending Oral Health Center/ SEGi University, Faculty of dentistry. Materials and Methods: This study reviewed 1249 orthopantomograms (OPGs) of subjects aged 20 to 44 years of three Malaysian ethnic groups. Of the study population 918 OPGs were considered for the study. Patient’s details include age, gender and ethnicity were extracted from the patient’s clinical record and all details related to impaction were obtained from patient’s panoramic radiograph that was individually examined by two investigators. The data collected was statistically analysed using SPSS 16. Results: This study found that Chinese female recorded the highest number of patients with “very difficult” category of impacted mandibular third molars. The most common age group involved was 20-24 years, mesioangular impaction, deep occlusal level and no ramus space for impacted mandibular third molars (3ms) were the most common findings observed. Conclusion: The present study suggests that predicting the level of difficulty preoperatively for impacted 3m surgery will help in formulating the better treatment plan, thereby minimizing the postoperative complication for the ultimate benefit of the patient.

Inhibition of Tongue Coat and Dental Plaque Formation by Stabilized Chlorine Dioxide Vs Chlorhexidine Mouthrinse: A Randomized, Triple Blinded Study

Seema Roodmal Yadav, Vineet Vaman Kini, Ashvini Padhye

Background: Chlorine dioxide (ClO2) is an oxidizing agent with known bactericidal, viricidal and fungicidal properties. Its efficacy in reducing the halitosis has been established by previous literature. However, data evaluating its antiplaque property is scarce. Chlorhexidine (CHX) is considered as the gold standard and an effective adjunctive to mechanical plaque removal. However, it is associated with few reversible side effects. Therefore a study was conducted to assess the antiplaque property of ClO2 containing mouthrinse against CHX mouthrinse. Aims and Objectives: To evaluate the efficacy of stabilized chlorine dioxide containing mouthrinse and CHX containing mouthrinse in inhibition of tongue coat accumulation and dental plaque formation using a four day plaque regrowth model clinically and microbiologically in a healthy dental cohort. Materials and Methods: A Single Center, Randomized, Triple blinded, Microbiological clinical trial was conducted involving 25 healthy dental students volunteers (11 males, 14 females). Two commercially available mouthrinse: Mouthrinse A – Aqueous based ClO2 mouthrinse Freshchlor® and Mouthrinse B - Aqueous based 0.2% CHX mouthrinse Hexidine® were selected as the test products. Subjects were asked to rinse and gargle for 1 minute with the allocated mouthrinse under supervision after supragingival scaling, polishing and tongue coat removal. After four hours, smears were taken from the buccal mucosa and tooth surface. On the fifth day from baseline of four day non brushing plaque regrowth model the samples were again taken from buccal mucosa and tooth surface followed by recording of plaque scores by Rastogi Modification of Navy Plaque index, extent of tongue coat by Winkel’s tongue coating index and measuring tongue coat wet weight in grams. The samples collected were subjected to microbial analysis and the results were expressed as colony forming units (CFUs) per sample. Statistical Analysis: The Data was analysed using SPSS 16.00 and presented using descriptive statistics. Independent t-test was used for the comparison between mouthrinse A groups & mouthrinse B group. Results: The plaque scores and Winkels tongue coat scores, wet tongue coat weight recorded on the fifth day after the use of the two mouthrinse didn’t show a statistically significant difference. The CFU per sample from tooth and mucosa after four hours revealed low bacteria count with respect to mouthrinse B however the CFU obtained on the fifth day did not show a statistically significant difference between the two mouthrinse. Conclusion: The clinical antiplaque efficacy of CHX and ClO2 mouthwash is comparable and so is the efficacy in reducing the oral bacterial load.

Synchronous Bilateral Breast Cancers

Naveen Padmanabhan, Annapurneswari Subramanyan, Selvi Radhakrishna

Background: Bilateral breast cancer (BBC) is not an uncommon entity in contemporary breast clinics. Improved life expectancy after breast cancer treatment and routine use of contra-lateral breast mammography has led to increased incidence of BBC. Our study objective was to define the epidemiological and tumour characteristics of BBC in India. Materials and Methods: A total of 1251 breast cancer patients were treated during the period January 2007 to March 2015 and 30 patients were found to have BBC who constituted the study population (60 tumour samples). Synchronous bilateral breast cancers (SBC) was defined as two tumours diagnosed within an interval of 6 months and a second cancer diagnosed after 6 months was labelled as metachronous breast cancer (MBC). Analyses of patient and tumour characteristics were done in this prospective data base of BBC patients. Results: Median patient age was 66 years (range 39-85). Majority of the patients had SBC (n=28) and in 12 patients the second tumour was clinically occult and detected only by mammography of the contra-lateral breast. The second tumour was found at lower tumour size compared to the first in 73% of cases and was negative for axillary metastasis in 80% of cases (24/30). Infiltrating ductal carcinoma was the commonest histological type (n=51) and majority of the tumours were ER/PR positive (50/60). Her2 was overexpressed in 13 tumours (21%). Over 70% (22/30) of patients had similar histology in both breasts and amongst them grade concordance was present in about 69% (15/22) of patients. Concordance rates of ER, PR and Her2 statuses were 83%, 80% and 90% respectively. Bilateral mastectomy was the commonest surgery performed in 80% of the patients followed by bilateral breast conservation in 13%. At the end of study period, 26 patients were alive and disease free. Median survival was 29 months (range 3-86 months). Conclusion: In most patients with BBC, the second tumour is identified at an early stage than index tumours supporting the importance of contralateral breast cancer screening at the time of primary diagnosis and during follow-up. BBC occurs more frequently in old age group and majority of these tumours are estrogen dependent. There is good pathological concordance between the index tumour and the contralateral breast cancer.

Identifying the Factors Causing Delayed Presentation of Cancer Patients to a Government Medical College of Central India

Background: The incidence of cancer is increasing throughout the world. One of the prime aims of its management is early diagnosis and therapeutic intervention. Factors causing delay to either of these goals should be identified and rectified. Aim: To identify the factors causing delayed initial diagnosis and subsequent management in patients presenting to the Oncology department. Materials and Methods: Three hundred proven cancer patients were prospectively evaluated for the pattern of presentation to the outpatient Department of Radiation Oncology of a Government Medical College (MC) in Central India. Results: The mean age of presentation was 51.05 years (range 7 months-77 years). The number of male patients was 168 while females were 132. The duration of symptoms ranged from 20 days to 3 years. The number of patients with little/no education presented mainly in advanced stages as compared to their educated counterpart and this difference was statistically significant (p<0.001). The number of patients presenting directly to the department was 108, those diagnosed outside and referred to us was 84 while those diagnosed and received some form of oncologic treatment outside and referred thereafter was 108. The difference in the primary delay between patients presenting directly to the MC versus those diagnosed outside was significant (p=0.0126). The mean duration of starting definitive treatment after presentation to the outpatient was 4.68 days (range 0-22 days) and was very significantly (p< 0.001) less than the secondary delays caused to the other two subsets of patients. Conclusion: Factors causing delayed presentation are both patient and system related. It is imperative to educate the common people regarding the early signs and symptoms of cancer. At the same time, the system needs to overhaul its efficiency to avoid secondary delays that adversely affect the treatment outcome. An upgradation of the existing oncology facilities in the public sector can achieve this target efficiently

Management of Proximal Tibia Fractures Using Wire Based Circular External Fixator

Harpreet Singh, Rakesh Kumar Misra, Manjinder Kaur

Introduction: Management of high grade proximal tibia or tibial plateau fractures is often associated with complications. The use of wire fixators for the definitive treatment of such fractures entails a minimally invasive technique of insertion that gives good fracture reduction and stability combined with minimal postoperative complications. Aim: To assess the outcome of treatment of such fractures by the use of Joshi’s external stabilization system (JESS), which is a wire based, circular external fixator system. Materials and Methods: A prospective, uncontrolled study was done using JESS on 20 consecutive patients of high energy fractures of the tibial plateau, classified according to the Schatzker’s classification as type VI. Results: In this series, road traffic accidents accounted for most of the injuries (n=12), while pedestrian accidents (n=4), injury due to fall from height (n=3) and injury due to fall while playing (n=1) were the other modes of injury. The mean patient age was 39.4 years. The mean follow up period was 24 weeks. In this study, using Knee society score evaluation, excellent results were seen in 12 patients (60%), good results were seen in 5 patients (25%), fair in 2 patients (10%) and bad in 1 patient (5%). Complications seen were, pin tract infections in two cases (10%) which resolved with dressings and oral antibiotics and one case of non-union (5%), in which the tibial plateau fracture extended into proximal 1/3 of the tibial shaft with severe comminution. No other complication was encountered. Conclusion: JESS is a simple, inexpensive and useful technique in the management of high grade tibial plateau fractures.

Evaluation of Salivary Levels of Pyridinoline Cross Linked Carboxyterminal Telopeptide of Type I Collagen (ICTP) in Periodontal Health and Disease

Background: Traditional parameters (Pocket depth, bleeding on probing, clinical attachment loss, radiographic findings) have been used for a long time for the assessment of periodontal disease conditions. However, these parameters only indicate towards the periodontal damage that has already taken place but do not give any idea regarding the current status of the periodontal health or disease. Hence, the present study is aimed at evaluating the concentration of the bone biomarker ICTP in saliva, which can give a better real time assessment of periodontal health and disease. Materials and Methods: Forty three patients were selected and divided into three groups based on the recorded clinical parameters of probing pocket depth, attachment loss and bleeding on probing. Group I (Healthy, n = 11), Group II (Gingivitis, n = 17), Group III (Periodontitis. n = 15). Salivary samples were collected before scaling and root planning to avoid contamination by blood. ICTP levels were evaluated in the salivary samples by using enzyme linked immunosorbent assay (ELISA). Statistical analysis used: Kruskal Wallis test was used to compare the mean ICTP level of the three groups. Results: ICTP was detected in all the samples. Highest mean ICTP concentrations in saliva were obtained for group III (periodontitis group) and the lowest mean ICTP concentrations were seen in group I (healthy group). This suggests that the level of ICTP in saliva increases proportionally from periodontal health to diseased conditions (gingivitis & periodontitis). Conclusion: There is a substantial increase in the salivary concentration of ICTP in chronic periodontitis patients than in gingivitis and healthy patients. Salivary ICTP levels were the maximum in chronic periodontitis patients followed by gingivitis patients and the least in healthy individuals. ICTP may be considered as a biomarker in periodontal disease progression.

Intubating Conditions of two Different Doses of Rocuronium At 60 Seconds; by Clinical Assessment; and with T.O.F Response of Adductor Pollicis Muscle

Vijayakumar.M.Heggeri, Aparna S. Harbishettar, Ajitkumar Deka , Tejwant Rajkhowa

Background: At 60 seconds, 2xED95 dose (0.6mg/kg) of rocuronium is frequently used for intubation. Some studies suggest 3XED95 (0.9mg/kg body weight) dose in achieving excellent intubating conditions. In this context, present study aimed at comparing intubating conditions with these two doses of rocuronium, using clinical criteria by cooper’s score; assisted with adductor pollicis T.O.F response. Materials and Methods: Present prospective randomized comparative clinical study was conducted on 60 patients subjected for general anaesthesia. Induction was done with fentanyl (1mcg/kg body weight) and propofol (2mg/kg body weight) and relaxation achieved with Rocuronium 0.6 mg/kg (Group A-30 cases); 0.9mg/kg (Group B- 30 cases). (n=30) intubation was done at 60 seconds. Intubating conditions were assessed clinically by cooper’s score.T.O.F responses of AP by visual and tactile means. Results: Intubating conditions clinically were excellent in 16 cases (53%), good in 12 cases (40%), and fair in 2 cases (7%) respectively in Group-A. In group-B excellent in 29 cases (97%) and good in 1case (3%). In group A in no case TOF-0 achieved. TOF 1, 2, 3, and 4 were observed in 1 case (3%), 7 cases (23%) 16 cases (54%) and 6 cases (20%) respectively. Whereas in group B, TOF 0, 1, 2, 3 were observed in 18 cases (61%), 4 cases (13%), 7 cases (23%) and 1 case (3%). In no case TOF-4 observed. Chi square test (p<0.0001) confirmed a highly significant statistical difference with respect to elicited TOFcounts, and intubating conditions achieved. Conclusion: 3xED95 dose of Rocuronium achieves more intense NMB and better conditions for intubation at 60 seconds than 2ED 95 dose.

Prevalence of Y Chromosome Microdeletions in Idiopathic Azoospermia Cases in Central Indian Men

Prafulla Ambulkar, Ajay Chuadhary, Jwalant Waghmare, Aaditya Tarnekar, Asoke Pal

Background: Genetic factor is important determinant of human male fertility, it is involved in 10-15% infertile males. Chromosome abnormalities and Y chromosome microdeletions are the main genetic causative factors for infertility. The frequency of male infertility & microdeletions in Y chromosome are also related to ethnic, geographical variations. In this study, we evaluated the prevalence of chromosomal abnormalities and microdeletions of Y chromosome in infertile azoospermia cases in central India to assess the geographical or population based variations. Materials and Methods: We have studied 160 non-obstructive azoospermia cases to find out frequency of chromosomal abnormalities and Y chromosome microdeletions of AZF locus. G-banding method was used for exclusion of chromosomal abnormalities. One hundred and forty eight azoospermic infertile men were screened using 12 sequence-tagged-sites (STS) primers of AZFa, AZFb, AZFc region and SRY gene (Yp) region by polymerase chain reactions. Results: Out of 160 azoospermic infertile males, 12 (7.5%) confirmed chromosomal abnormalities and Klinefelter’s syndrome was predominantly cause of azoospermia. Of the 148 infertile males, 19 (12.8%) were shown microdeletions in different AZF regions. Deletions in AZFa region were 2.02% and 3.37% was in AZFb whereas high frequencies of deletions (6.08%) in AZFc were recorded in azoospermic males. In two azoospermic males were shown microdeletions in AZFb+c loci. Conclusion: The prevalence of Y chromosome microdeletions in azoospermic men was 12.8% in this geographical region. Klinefelter’s syndrome is important cause in male infertility. So, the screening of Y microdeletions is essential.

Effect of Age on Response to Experimental Pain in Normal Indian Males

Background and Objectives: Response to experimental pain depends on the nature of the pain stimulus, as well as on gender, racial, cultural and socioeconomic factors. This study investigates the effect of age on pain sensitivity and cardiovascular reactivity produced by experimental pain. We have also compared the values of body mass index (BMI) and resting blood pressure of volunteers with the normal values. Materials and Methods: The study was conducted on 83 Indian males of different age groups. The volunteers were divided into 4 groups: Children, Young Adults, Middle-Aged Adults and Old Adults; and their basal parameters (BMI, resting pulse and blood pressure) were recorded. Selected volunteers were subjected to cold pressor task (CPT). Pain sensitivity (PS) (pain threshold, tolerance and pain rating on a visual analog scale) and cardiovascular reactivity (CVR) (increase in pulse and blood pressure) were recorded. Results: Many volunteers had abnormal values of BMI and resting blood pressure and had to be excluded from the study. PS and CVR between different groups were compared by oneway ANOVA. Significant differences in PS were observed, with highest pain sensitivity in Children and lowest in Old Adults. No significant differences were observed in the CVR. Conclusion: The high numbers of volunteers with abnormal basal parameters (BMI and resting blood pressure) show an urgent need to educate the general public about the dangers and risk factors of obesity and hypertension. Less exposure of children to painful encounters may be responsible for their high pain sensitivity while higher values of resting blood pressure and decreased sensitivity of the sensory systems with advancing age may be responsible for the hypoalgesia observed in old adults.

Estimation of Release of Nickel and Chromium by Indian Made Orthodontic Appliance in Saliva

Sandeep Parashar, Rajkumar Maurya, Ankur Gupta, Chatura Hegde, Neelima Anand

Introduction: With increasing use of Indian made orthodontic materials, need was felt to know nickel and chromium release from these material. Materials and Methods: This study was conducted on simulated appliances consisting of brackets (022’’Roth, Modern orthodontics, Ludhiana, India), from second premolar to central incisor, buccal tube and 0.019×0.025- inch SS arch wires secured with SS ligatures. Immersion was done in artificial saliva. Samples were analysed to using Atomic Absorption Photospectrometer (GVC ScientificEquipment Pvt. Ltd Australia) at AES Laboratories (P) Ltd., Noida India on 1st, 7th, 14th and 28th day. Results: SPSS (ver 17, Inc., Chicago, Illinois, USA) was used toperform the statistical analysis. Descriptive statistics i.e. median and 25 and75 percentiles were used. Peak nickel release was on 7th day and subsequently declined over 14th and 28th day. The peak level of chromium concentration was on 14th day, which declined thereafter. Conclusion: Average daily release of nickel and chromium over a period of one month was 97.368 µg/day and 47.664 µg/day respectively. The estimated release rates were approximately 32% and 16% of the reported average daily dietary.

Evaluation of Relationship Between Demographics and Dental Status in a Defined Group of Iranian Paediatric Patients Undergoing Cancer Therapy

Context: Cancer is a major cause of death in children under 15 years of age. Aims: This study aimed to evaluate relationship between demographics and dental status in a defined group of Iranian paediatric patients undergoing cancer therapy. Settings and Design: This cross-sectional study was accomplished on 161 subjects age ranging 8-12 years. There were 76 cancerous patients hospitalized at Mahak Hospital (one of the major children’s cancer centers in Tehran) as the study group and 85 healthy children attending at Dental School, International Branch of Shahid Beheshti University of Medical Sciences, Tehran, Iran from 2012 to 2013. Materials and Methods: Demographics were gathered by using data-form. Oral examination and DMFT Index were used to describe teeth status in all teeth and in the first permanent molars. According to Becker’s definition, “D” stands for untreated decayed teeth, “M” indicates missing teeth, and “F” shows Filled teeth. It is noteworthy that full coverage crowns are considered as “F” in this Index. Statistical Analysis: Chi-square, Mann-Whitney U, Student’s t-tests and Logistic Regression were used for data analysis. Results: The most frequent type of cancer was acute lymphoblastic/lymphocytic leukemia (33.3%). Patients were significantly shorter than controls (p=0.03), and their fathers and mothers were of lower educational achievement (p=0.01, p= 0.001). Although DMFT of all dentition showed significantly higher score in cancerous children (p=0.001), DMFT of four first permanent molars (left, right, upper, and lower) was borderline significantly higher in patients (p= 0.06). Moreover, frequency of cancer was borderline significantly higher in children with lower birth order (p= 0.05). According to Logistic Regression, in as much as patients grew elder 1 year, DMFT index increased 1.5 units. Conclusion: Patients under cancer therapy were shorter than healthy ones, and their parents were of lower educational levels. In addition, their teeth status was poorer than controls.

Study of Normal Branching Pattern of the Coeliac Trunk and its Variations Using CT Angiography

Lakshana Selvaraj, Indumathi Sundaramurthi

Introduction: Blood vessel anomalies are always interesting from embryological view and of considerable significance from a clinical or a surgical standpoint. Vascular anomalies are usually asymptomatic; they may cause problems in patients undergoing diagnostic angiography or any operative procedure. The length and course of the coeliac artery are variable and its branches frequently arise separately from the main trunk. Several other branches may additionally arise from the coeliac trunk, for example, inferior phrenic arteries, the dorsal pancreatic artery, and the middle colic artery. Aim: The present study was undertaken to analyse the vertebral level of origin of coeliac artery, its branching pattern and the associated variations using computed tomographic angiography in 75 subjects. Results: The results obtained were analysed and classified based on Adachi’s and Lipshutz’s classification method. The results were also compared with various other studies cited in the literature. The level of origin was found to be at the inter-vertebral disc between T12 and L1 in a majority of the cases (70.6%). It was also found that the coeliac trunk trifurcates in majority of the cases i.e. 90.6%. Trifurcation was of two types, classical and non-classical, the classical trunk being the commonest type. Variations included bifurcation of the trunk (8%) with Left gastric artery arising directly from the aorta, in a few cases (1.3%) Common hepatic artery arose as a separate trunk from the aorta. Conclusion: A comprehensive knowledge of this arterial anatomy and variations will be very useful when planning abdominal surgeries and image-guided interventions. The success of procedures such as liver transplantation, intestinal anastomosis, intra-arterial chemotherapy, chemo-embolization, and radio-embolization requires a detailed knowledge of the coeliac artery and its anatomical variants, which are extremely common, to avoid iatrogenic injuries and to prevent complications.

Spontaneous Bone Regeneration After Enucleation of Large Jaw Cysts: A Digital Radiographic Analysis of 44 Consecutive Cases

Rabin Chacko, Saurabh Kumar, Arun Paul, Arvind

Purpose: This study evaluated the healing in cystic defect of the jaw to substantiate our understanding of spontaneous bone healing after enucleation of jaw cysts subjectively and with analysis of digital postoperative panoramic radiographs. Materials and Methods: Fourty four consecutive patients reporting to the Department of Dental and Oral Surgery, during the period between 2008-2012 having maxillary and mandibular cysts treated by either surgical enucleation or by marsupialization followed by enucleation were evaluated for subsequent bone formation at the site of cystectomy defect by subjective clinical examination along with digital radiographic examination. Postoperative clinical and radiographic examinations were performed at 6,9,12, and 24 months. Bone regeneration was evaluated by reduction of the size of residual cavities at the cystectomy defect using digital orthopantomogram. Results: Out of 44 patients 15 patients completed two years of follow-up with all the patients having 6 months follow-up. The maximum size of the cystic pathology was 150.40mm and minimum of 14.73mm at the time of presentation (average size of 58.16mm). Twenty patients were diagnosed with odontogenic keratocyst, with one patient having multiple OKC associated with Gorlin Goltz Syndrome, 17 patients had dentigerous cyst, 5 had Radicular cyst; solitary bone cyst and globulomaxillary cyst formed one each. Uneventful healing and spontaneous filling of the residual cavities were obtained in all cases. The digital analysis of the postoperative radiographs showed mean values of reduction in size of the residual cavity of 25.85% after 6 months, 57.13% after 9 months, 81.03% after one year and 100% after two year. Conclusion: Spontaneous bone regeneration can occur after surgical removal of jaw cysts without the aid of any graft materials even in large cystic cavity sufficiently surrounded by enough bony walls. This simplifies the surgical procedure, decreases the overall cost of surgery, and reduces the risk of postoperative complications associated with grafting.

Hypokalaemic Periodic Paralysis– A Prospective Study of the Underlying Etiologies

Background: Hypokalaemic periodic paralysis (HPP) is a rare muscular disorder characterised by episodic weakness associated with hypokalaemia. The disease can either be inherited or acquired and misdiagnosis of the disease is quite common. Most of the data available on the disease is from the western world. Studies reporting aetiological, clinical and metabolic profiles of Indian population are sparse. Hence we tried to provide insights of the disease among the Indian population. Aim: To study the aetiological, clinical and metabolic profile of patients diagnosed with Hypokalaemic Periodic Paralysis (HPP). Materials and Methods: This is an observational and analytical study on HPP diagnosed patients, during September 2011 to September 2014 in Kasturba Hospital, Manipal. A total of 23 patients were studied. Detailed history, clinical evaluation and metabolic workup for secondary causes of HPP were analysed. Results: Of the 23 patients, 57% had primary HPP while 43% had secondary HPP. The group of patients with primary HPP comprised of 92% males and 8% females with mean age of 28 years and the mean duration of symptoms of 18 hours. The group with secondary HPP comprised of 70% males and 30% females with mean age of 38.7 years and the mean duration of symptoms of 60 hours. The secondary causes of HPP were thyrotoxicosis (50%), infective diarrhea (20%), Crohn’s disease (10%), renal tubular acidosis (RTA) Type I (10%) and Conn’s syndrome (10%). Conclusion: In our study primary HPP was found to be more common than secondary HPP. Males were predominantly affected in both groups. HPP should be ruled out before starting therapy for Guillain-Barré Syndrome (GBS).

Measurement of Ulnar Variance in a Regional Subset of Indian Population—A Pilot Study of 30 Subjects

Divesh Jalan, Abhay Elhence, Prakrati Yadav

Background: The variation of level of distal articulating surface of ulna with respect to distal articulating surface of radius is known as ulnar variance (UV). Positive and negative UV has been implicated in various wrist and hand pathologies. Aim: To measure ulnar variance in a regional subset of Indian population and to compare two techniques of measurement of ulnar variance viz. method of perpendiculars and modification of the concentric circles method. Materials and Methods: UV was measured in a regional subset of Indian population comprising of 30 subjects. The mean age of patients was 35.9 years. There were 16 males and 14 females in the study group. Antero-posterior (AP) X-rays of wrist in neutral position were taken and UV was measured using method of perpendiculars and the modified circle method. Results: The mean UV using method of perpendiculars (UVA) was 0.387 mm and using modified circle method (UVB) was 0.507mm. A higher predominance of positive UV in this regional subset of Indian population was observed. There was no correlation between UV with respect to age and sex. No statistically significant difference was observed between the two methods of measurement utilized in the study. Conclusion: The documentation of a negative and positive ulnar variance will help in prophylactic and timely intervention for various wrist pathologies, if required. However, a larger sample size with a longer follow up is required to suggest a correlation of ulnar variance with clinically symptomatic disease.

Information Education and Communication can Improve Adherence to Artemether-Lumefantrine Combination in Patients of Uncomplicated Falciparum Malaria

Trupti Rekha Swain, Anshupa Raulo, Namita Mohapatra, Malaya Ranjan Singha

Background: Early diagnosis and prompt treatment with Artemisinin combination therapy (ACT) is vital to improve mortality in Falciparum Malaria. Information education and communication (IEC) is a strong tool that can improve drug adherence. Aim: To explore if IEC in the form of designed drug bags with verbal communication can improve ACT adherence in Falciparum Malaria patients. Materials and Methods: A prospective, interventional, controlled study was conducted in OPD patients of both SCB Medical college, Cuttack and district headquarter hospital Cuttack district of Odisha. IEC material in the form of well designed drug bag and verbal communication was used for intervention. Control group received ACT combinations but were not given IEC. Results: Adherence to IEC was significantly higher (81%) in patients receiving IEC compared to controlled patients not receiving IEC. Educational status and the geographical area of the patient were found out to affect adherence to IEC to a significant extent. Conclusion: IEC in the form of designed drug bags, supplemented by verbal communication can improve ACT adherence in Falciparum Malaria.

Role of Behavioural Risk Factors in Symptoms Related to UTI Among Nursing Students

Introduction: UTI is a well known entity amongst young girls, and the majority of girls have recurrent infections within one year. Anything that disturbs the usual vaginal environment would result in conditions favouring the production of unwanted microorganisms leading to infections of this very sensitive area. Studies have shown that, there is an evident relation of UTI's among students and practices of personal hygiene. Aim: To determine association between the behavioural risk factors and UTI among nursing girls. Materials and Methods: The present study was undertaken amongst unmarried nursing students of a Medical College Hospital. A predesigned pretested questionnaire was used to know the personal hygiene of students and to find out its association with UTI in the last three months. Chi-square test was used to analyse the data. Results: A significant association was observed between perineal hygiene and UTI. The major risk factors of UTI identified were incorrect perineal washing technique, use of synthetic/silk innerwears, not sundrying the innerwears, improper menstrual hygiene. Conclusion: There are still major gaps in the knowledge regarding causation of UTI among the nursing students. This calls for an urgent need for educational talks periodically addressing these gaps.

Association of Serum Ferritin Levels with Metabolic Syndrome and Insulin Resistance

Meghana. K. Padwal, Mohsin Murshid, Prachee Nirmale, R. R. Melinkeri

Introduction: The impact of CVDs and Type II DM is increasing over the last decade. It has been estimated that by 2025 their incidence will double. Ferritin is one of the key proteins regulating iron homeostasis and is a widely available clinical biomarker of iron status. Some studies suggest that prevalence of atherosclerosis and insulin resistance increases significantly with increasing serum ferritin. Metabolic syndrome is known to be associated with increased risk of atherosclerosis as well as insulin resistance. Aim: The present study was designed to explore the association of serum ferritin levels with metabolic syndrome and insulin resistance. Materials and Methods: The present study was prospective, cross sectional. The study protocol was approved by IEC. The study group consisted of 90 participants (50 cases of metabolic syndrome and 40 age and sex matched controls). Diagnosis of metabolic syndrome was done as per NCEP ATP III criteria. Estimation of serum Ferritin and Insulin was done by Chemiluminescence Immunoassay (CLIA) while Glucose by Glucose Oxidase and Peroxidase (GOD-POD) method. Insulin Resistance was calculated by HOMA IR score. Statistical Analysis: Data obtained was statistically analysed by using student t-test. Results: We found statistically significant rise in the levels of serum ferritin (p=<0.001), glucose (p=<0.001), insulin (p=<0.001) and HOMA IR score (p=<0.0001) in cases of metabolic syndrome as compared with controls. Conclusion: High serum ferritin levels though within normal range are significantly associated with both metabolic syndrome and insulin resistance.

Prevalence of Elongated Styloid Process in a Central Brazilian Population

Background: Eagle’s syndrome comprises a rare disorder caused by compression of an elongated or deformed styloid process or ossified/calcified stylohyoid ligament on neural and vascular structures. It is characterized by facial and neck pain and can be confused with a wide variety of facial neuralgias, oral and dental diseases and temporomandibular disorders. An imaging evaluation associated with a careful clinical examination, are mandatory in structuring a correct differential diagnosis and in the establishment of a proper therapeutic protocol. Aim: To investigate the prevalence of the elongated styloid process in a Central Brazilian population and its relation to gender, age and side. Materials and Methods: Digital panoramic radiographs of 736 patients (412 female and 324 male, with a mean age of 35.03 years) were consecutively selected from a private radiology clinic s secondary database. The apparent length of the styloid process was measured from the point where the styloid left the tympanic plate to the tip of the process by two specialists in dental radiology, with the help of the measuring tools on the accompanying software. Styloid process measuring more than 30 mm was considered elongated. The statistical analysis included frequency distribution and cross tabulation. The data were analysed by using Chi-squared tests. The level of significance was set at 5% for all analyses. Results: A total of 323 (43.89%) radiographic images were suggestive of elongated styloid process. No statistically significant difference was found between the genders, although a higher prevalence was noticed in female participants. Approximately, 31% of the elongated styloid process was observed in 18-53-year-old participants (p < 0.05). Two hundred and sixty seven styloid processes (36.28%) were elongated on both right and left sides. Conclusion: The prevalence of elongated styloid process was high and no statistically significant correlation was found between the presence of elongated styloid process and the studied variables with the exception of the age.

Driving the Mineral out Faster: Simple Modifications of the Decalcification Technique

Introduction: Quicker decalcification is essential for faster diagnosis of hard tissue pathology. Heat and mechanical agitation are known to hasten decalcification. Aim: To compare the rate of decalcification, cellular and staining characteristics of decalcified specimens of bone and teeth by using the conventional method (10% formal formic acid), heating to 45oC and by physical agitation with magnetic stirrer. Materials and Methods: Weight-matched samples of caprine-origin bone (n=15) and teeth (n=15) were decalcified using three methods namely: a) Gooding and Stewart’s fluid; b) Gooding and Stewart’s fluid heated to 45oC for 6 hours daily; and c) Gooding and Stewart’s fluid agitated using a magnetic stirrer for 6 hours daily. Non-lesional skin tissue samples were placed along with each specimen. End point of decalcification (chemical test) was noted; 4 micron sections were taken and stained with H&E. Statistical analysis: Differences in rate of decalcification and staining characteristics were assessed by Kruskal Wallis test and chi-square test respectively. Results: Hard tissues decalcified faster with stirring and heating methods. The amount of osteocyte retraction noted in bone was significantly reduced in the stirring method. In tooth specimens, modified techniques resulted in poorer nuclear-cytoplasmic contrast of pulp cells. Heating affected the odontoblast layer. Soft tissues exhibited higher eosinophilia in stirring and conventional methods, whereas nuclear-cytoplasmic contrast and chromatin staining was poorest in heating and conventional methods. Conclusion: Physical agitation of decalcifying fluid may be recommended while maintaining satisfactory quality of tissue morphology and staining.

Attitude Towards Alzheimer’s Disease Among Undergraduate Students of University of the West Indies, Trinidad and Tobago

Background: Alzheimer’s disease is most common among the dementias and is characterized by gradual declines in functional and cognitive abilities. Caregivers including family members play a key role in providing critically needed care for these patients. Objective: This study compared the knowledge and attitudes of pre-healthcare and non-medical undergraduate students towards patients with Alzheimer’s disease. Materials and Methods: A cross-sectional study was conducted involving quota sampling of 691 undergraduate students (369 pre-healthcare and 322 non-medical). A 28-item questionnaire was utilised comprising of closed-ended questions and some based on a scale rating. The students’ knowledge of Alzheimer’s disease was arranged into categories such as: 0 for no knowledge about Alzheimer’s disease, 1 for very little knowledge about Alzheimer’s disease, 2 for fair knowledge about Alzheimer’s disease and 3 for great knowledge about Alzheimer’s disease. Statistical Analysis: The data was analysed using the computer software SPSS and the Chi squared test of independence was also used to determine which knowledge variables were independent of student’s status. Results: Overall, 40.01% of the students have great or fair knowledge of Alzheimer’s disease, with that of pre-healthcare students being satisfactory (54.47%). Pre-healthcare students have a more positive attitude towards Alzheimer’s disease and 82.2% of students wished to take advantage of predictive test for Alzheimer’s disease. Age and genetics were identified as risk factors of the disease. Conclusion: Pre-healthcare students had greater understanding of Alzheimer’s disease and depicted a more empathetic and caring attitude towards patients. This can be attributed mainly to their knowledge and exposure toward the disease.

Amnion and Chorion Allografts in Combination with Coronally Advanced Flap in the Treatment of Gingival Recession: A Clinical Study

Background: Guided tissue regeneration (GTR) based root coverage using different allograft membranes has been utilized to correct gingival recession defects with promising results. Amnion and chorion allograft membranes of alternative origin derived from human placental tissue has been advocated in the treatment of gingival recession. However, chorion membrane has been used in combination with amnion membrane no study has compared these allograft membranes in the treatment of gingival recession. Therefore, the purpose of this study was to clinically evaluate and compare the efficacy of amnion membrane and chorion membrane in combination with coronally advanced flap in the treatment of gingival recessions. Materials and Methods: Twelve systemically healthy patients having at least 2 bilateral Miller’s Class I or Class II gingival recession were recruited and coronally advanced flap was performed with amnion membrane or chorion membrane. Clinical parameters such as gingival Index, plaque index, length of the recession, width of the recession, width of keratinized gingiva, relative attachment level were evaluated at baseline, 3 and 6 months post-surgery. Results: The mean decrease in length of recession (LR) for Chorion site was 2.00±1.54mm and amnion site was 1.58±1.14mm. The gain in attachment level for amnion site was 2.17±1.53mm and for chorion site was 1.58±1.22mm. The total mean percentage of root coverage was 34% for chorion site and 22% for amnion site. Conclusion: Both amnion membrane and chorion membrane has shown to be versatile allograft material to be used in the treatment of root coverage.

Multi Drug Resistant Klebsiella Isolates in Burn Patients: A Comparative Study

Naz Perween, S. Kirshna Prakash, Oves Siddiqui

Introduction: Infections are the most common complications in the burn patients admitted to the hospitals leading to high morbidity and mortality. Klebsiella is one of the most frequently isolated bacteria from burn wounds. Materials and Methods: We studied antimicrobial susceptibility patterns of Klebsiella isolates from burn patients. In this cross- sectional study wound swabs from 1294 patients hospitalized in burnward were collected for bacteriological examination. Antibiotic sensitivity testing of Klebsiella isolates was done by modified Stokes disc diffusion method. Results: Out of 883 isolates from 1294 patients 195 were found to be Klebsiella spp. Based on the biochemical properties 153 isolates were Klebsiella pneumoniae, 37 were Klebsiella oxytoca and 5 were others species. In our study we found that 54% of the Klebsiella isolates were multidrug resistant as they were resistant to at least one antibiotic of three or more different groups of antibiotics. Conclusion: Rate of isolation of Klebsiella as well as its resistance for commonly used antibiotics is increasing over the time.

Study of Asymptomatic Hypoglycemia in Full Term Exclusively Breastfed Neonates in First 48 Hours of Life

Introduction: Hypoglycemia is a common metabolic problem in the neonatal period especially in the presence of settings like prematurity, small for gestational age babies and sepsis. Episodes of asymptomatic hypoglycemia may occur in term neonates without apparent risk factors. Aim: This study was conducted to estimate the incidence of hypoglycemia in healthy, intramural, singleton full term neonates and to correlate the above incidence with maternal factors like parity, mode of delivery and time of initiation of breast feeding after birth. Materials and Methods: A hospital based, prospective longitudinal study involving healthy, term, asymptomatic neonates. Blood glucose values were measured at 1, 6, 24 and 48 hours of life. Results: The overall incidence of hypoglycemia was 10 % in asymptomatic, healthy term newborns. All the hypoglycemic episodes occurred in the first 24 hours of life. 23.07% of neonates born to primiparous mothers had hypoglycemia, against 5.4% neonates born to multiparous mothers (p<0.05). There was a higher recording of hypoglycemia when breast feeding was initiated > 1 hour after delivery (16.67%) than when breast feeding was initiated within one hour of delivery (7.89%). Conclusion: Asymptomatic hypoglycemia occurred in about 10% of healthy, full term neonates; primiparity and delayed initiation of breast feeding > 1 hour are noted as additional risk factors.

A Rare Case of Jejunal Atresia Due to Intrauterine Intussusception

Intestinal atresia is generally caused by intrauterine vascular obstructions involving mesenteric vessels. Intrauterine intussusceptions (IUI) are one of these disruptive events. Intestinal intussusceptions affects children commonly between 3 months and 3 years of age,but it rarely affects in intrauterine life.The relationship between intrauterine intussusception and intestinal atresia has been demonstrated by few cases in literature, suggesting intrauterine intussusception as a rare cause of intestinal atresia. We report a 7-day-old full term neonate presenting with intrauterine intussusceptions (jejuno-jejunal) resulting in jejunal atresia.

Post Surgical Giant Epidermal Inclusion Cyst of the Lid and Orbit- A Rare Case

Salil Kumar Mandal, Aparna Mandal, Arghya Bandyopadhya

Epidermoid cyst within the lid and orbit is extremely rare. Epidermoid tumours are inclusion of ectodermal elements in the site not normally containing these structures. It is of two types; primary type related to implantation of ectoderm at the time of closure of the neural groove and secondary type caused by post traumatic inclusion of the surface epithelium. A 45-year-old male had complaint of swelling on the right upper lid and orbital region. It first appeared two years back. It was painless progressively increased in size and shape. There was difficulty in opening of eye lid due to large swelling, feeling of heaviness in the right upper lid and occasional headache. There was history of right eye ocular infection following vegetative matter injury three years back. Evisceration of right eye was done for aforementioned reason. USG report shows cystic encapsulated mass with calcification foci in right upper lid-orbital region with fat component. MRI right orbit shows fairly large hyperintense cystic lesion seen involving right orbit with posterior extension up to optic canal. No intracranial extension. FNAC confirmed epidermal inclusion cyst. We did upper lid reconstruction with removal of mass. We have successfully removed the mass without any complication and with one year follow-up there is no recurrence.

Co–Existence of Acinic Cell Carcinoma – Papillary Cystic Variant and Extrapulmonary Tuberculosis – Report of A Case with Brief Review

Krishnappa Amita, Shivshankar VijayShankar, Manchaiah Sanjay

Tuberculosis (TB) and cancer are two lethal diseases causing significant morbidity and mortality in developing countries like India. Co-existence of these two disease lead to diagnostic dielemma among the clinicians. Overlapping clinical manifestations lead to delay in diagnosis. We report a case of acinic cell carcinoma –papillary cystic variant of the salivary gland and extra pulmonary tuberculosis in a young female. We emphasize the importance of the awareness of the co-existence of these two diseases and the role of fine needle aspiration cytology in the initial diagnosis.

Deceptive Lesions of Periodontium: A Case Series

Basic pathology of the common appearing diseases of the periodontium are not always common inflammatory reactions. The root cause may be malignant and metastatic lesions. Here, we present unusual causes of these common periodontal lesions. This article also stress upon the importance of histopathological examination of the surgically excised localized gingival swellings which fail to regress after conservative therapy.

Gerbode Defect—A Rare Defect of Atrioventricular Septum and Tricuspid Valve

Abhay Tidake, Pranil Gangurde, Ajay Mahajan

Left ventricular to right atrial communications (the Gerbode defect) are rare types of ventricular septal defect and present as direct or an indirect type. We hereby, report two cases, one direct and another indirect type. Cardiopulmonary bypass surgery was done and a successful suture closure of ventricularseptal defect using pericardial patch was performed.

Inheritance of Hereditary Persistence of Fetal Haemoglobin (HPFH) in a Family of Western Odisha, India

Hereditary persistence of foetal haemoglobin (HPFH) is a rare inherited haemoglobin disorders in India. We encountered five cases of HPFH-3 in heterozygous condition in a single family of western Odisha, India. All the cases had raised % HbF (26.1±3.23%) with pancellular distribution of HbF in erythrocytes. There were no abnormalities found in the red cell indices. All the cases were asymptomatic till date with normal growth and development. Molecular confirmation of this haemoglobin disorders is important for control and prevention of haemoglobinopathies in this region.

CT Guided Removal of Iatrogenic Foreign Body: A Broken Intravenous Cannula

Amanpreet Singh, Anupama Kaur, Majhail Singh, Surinder Kaur

Foreign bodies are encountered on day to day basis by a surgeon. Usually foreign bodies are lodged in narrow cavities of the body and the common age group is in children. They may range from foreign bodies in ear, nose, cricopharynx and even in rectum. Iatrogenic foreign bodies are not uncommon. Unknowingly, surgeons have been known to leave sponges, artery forceps in the abdomen which lead to hazardous sequelae. Intravascular foreign bodies occurrence has increased from a decade or so.

An Extemly Rare Case of Left Atrium and Right Pulmonary Vein Leiomyosarcoma

V.V.L. Srividya, V. Sailendra

We report a case of a 43-year-old female, presented with complaints of breathlessness for 1 month and had three episodes of syncopal attacks in the past two months. On clinical evaluation, bilateral pedal oedema was noticed. Echo cardiogram revealed large left atrial blood clot measuring 5.7x4.3x4.3 cm. Ultrasound whole abdomen was normal. We received an excised mass with right pulmonary vein end arterectomy speciemen. Histopathology of the mass revealed characteristic features of leiomyosarcoma with grade III, according to FNCCS grading system. The tumour was consistent with substantial amount of poorly differentiated fasicles of pleomorphic spindle cells and brisk atypical mitosis, with marked necrosis. Immunohistochemistry revealed the tumour cells in strong diffuse cytoplasmic positive for smooth muscle actin and Ki-67 showed 15-20% of tumour cells postivity. The prognosis depends on the individual tumour origin for individual site, size of tumour and depth of tumour than histological features. Pulmonary venous leiomyosarcomas were assumed to be misinterpretation of left atrial leiomyosarcomas with growth of the tumour into pulmonary vein lumen. We report this case in view of its extreme rarity.

An Abdominal Wall Desmoid Tumour Mimicking Cesarean Scar Endometriomas: A Case Report and Review of the Literature

Birol Vural, Fisun Vural, Bahar Müezzinoglu

Abdominal wall desmoid tumours (DT) are rare, slow-growing benign muscular-aponeurotic fibrous tumours with the tendency to locally invade and recur. They constitute 0.03% of all neoplasms and high infiltration and recurrence rate, but there is no metastatic potential. Although surgery is the primary treatment modality, the optimal treatment remains unclear. Abdominal wall endometriosis is also an unusual disease, and preoperative clinical diagnosis is not always easy. The preoperative radiologic imaging modalities may not aid all the time. Herein, we report an abdominal mass presenting as cyclic pain. Forty-two years old woman who gave birth by cesarean section admitted the complaints of painful abdominal mass (78x45 mm in size) under her cesarean incision scar. She had severe pain, particularly during menstruation. The clinical and radiological imaging findings mimicking endometrioma. We performed wide surgical excision of mass with a 1 cm tumor-free margin with the diagnosis of a benign mesenchymal tumor in the frozen section. The postoperative course was uneventful and recovered without any complication and recurrence three years after surgery. This report presents a case of abdominal wall desmoid tumor mimicking endometrioma. In this paper, shortcomings in diagnosis, abdominal wall endometriomas, and DTs were discussed in the view of literature.

Primary Tubal Choriocarcinoma Presented as Ruptured Ectopic Pregnancy

Erbil Karaman, Orkun Çetin, Ali Kolusari, Irfan Bayram

The primary tubal choriocarcinoma associated with ectopic pregnancy is very rare. A 31-year-old woman was admitted to the emergency room due to amenorrhea, left lower abdominal pain and fatigue. Her ß-Hcg level was 29251.4 mIU/ml and transvaginal ultrasund revealed a 24x21 mm of left tubal ectopic pregancy mass with large amount of free fluid in pelvic cavity. The patient was diagnosed with ruptured tubal ectopic pregnancy and thus, she underwent laparotomy with left total salpingectomy. The pathological assessment was reported as primary tubal choriocarcinoma with the involvement of whole tubal layer. The patient was defined to have stage I choriocarcinoma with good prognostic factors and methotrexate monotherapy was administered. Serum ß- Hcg levels of the patient gradually declined and eventually became negative at the first month of the treatment. With this case report we aimed to implicate that when diagnosing the ectopic pregnancy, even very rare, the tubal choriocarcinoma should be kept in mind.

Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond

Ankur Sachdeva, Mona Choudhary, Mina Chandra

Alcohol dependence is an increasing and pervasive problem. Alcohol withdrawal symptoms are a part of alcohol dependence syndrome and are commonly encountered in general hospital settings, in most of the departments. Alcohol withdrawal syndrome ranges from mild to severe. The severe complicated alcohol withdrawal may present with hallucinations, seizures or delirium tremens. Benzodiazepines have the largest and the best evidence base in the treatment of alcohol withdrawal, and are considered the gold standard. Others, such as anticonvulsants, barbiturates, adrenergic drugs, and GABA agonists have been tried and have evidence. Supportive care and use of vitamins is essential in the management. Symptom triggered regime is favoured over fixed tapering dose regime, although monitoring through scales is cumbersome. This article aims to review the evidence base for appropriate clinical management of the alcohol withdrawal syndrome. We searched Pubmed for articles published in English on ‘Alcohol withdrawal syndrome’ in humans during the last 10 years. A total of 1182 articles came up. Articles not relevant to clinical utility and management were excluded based on the titles and abstract available. Full text articles, meta-analyses, systematic reviews and randomized controlled trials were obtained from this list and were considered for review.

Breast Abscess by Salmonella Paratyphi A: Case Report and Literature Review

Smita Sood

A case of suspicious breast mass due to Salmonella enterica serotype Paratyphi A in a non-lactating, diabetic female is being described. The infection was successfully treated with a combination of surgical drainage and antibiotic treatment. This case highlights the fact that a focal Salmonella infection involving the breast should be considered as a rare differential diagnosis for breast malignancy and submission of specimens for microbiological analysis may be helpful in establishment of an accurate diagnosis and management.

Pleomorphic Adenoma in Subcutaneous Plane of the Neck: A Rare Entity

Bharat Kamath, Pooja Kamath, Prasad Bhukebag

Heterotopic Salivary Gland Tissue (HSGT) is salivary tissue found in locations not normally host to it. Neoplasms occurring in these heterotopic tissues are very rare. Review of literature has revealed the neck to be host to HSGT and rarely, tumourigenic changes in these inclusions have been observed. We present a clinically unsuspected case of an ectopic pleomorphic adenoma of lower neck in which the ectopic salivary tissue was found in subcutaneous plane, which to the best of our knowledge has not been reported and was proved only on cytology and histopathology. There is a probability of this tumour undergoing malignant transformation. Therefore, these tumours need to be promptly diagnosed, adequately treated and should be included in the differential diagnosis of neck masses.

Ectopic Spleen Presenting as Lump Abdomen: A Rare Case Report and Review of Literature

Ectopic spleen is due to failure of fusion of the mesogastrium and the lining body wall epithelium, resulting in lax or absent supporting ligaments of spleen, making it abnormally mobile. This case presented as lump abdomen with history of recurrent attacks of abdominal pain. Clinical diagnosis was unidentified abdominal mass. The radiological imaging was suggestive of the diagnosis, and the exploration of abdomen has clinched the diagnosis.

Magnet and Semi Precision Attachment in an Implant Retained Partial Denture for the Rehabilitation of an Irradiated Marginal Mandibulectomy Patient: A Case Report

Surgical treatment of malignancies in the oral cavity (mandible, tongue, floor of the mouth, alveolus, buccal sulcus) often results in an unfavourable anatomic condition for prosthodontic rehabilitation. Hence, maxillofacial prosthetic rehabilitation becomes a mightier task when resection is accompanied by radiation therapy. In selected cases, implant therapy comes to rescue. The following report throws light on the case of prosthetic rehabilitation of a patient who underwent right marginal mandibulectomy and right partial glossectomy, with the aid of a single implant, semi precision attachment and magnet supported partial denture.

Pacinian Neuroma Presenting as Congenital Macrodactyly: A Rare Case Report

Surya Rao Rao Venkata Mahipathy, Alagar Raja Durairaj, Jayaganesh Parthasarathy

Pacinian neuromas are rare benign tumours of pacinian corpuscles of the digits. They generally occur on the volar aspect of the fingertips. Pacinian corpuscles are specialised nerve endings with a lamellated structure and are regarded as pressure and vibration receptors. Here, we report a case of pacinian neuroma presenting as congenital macrodactyly of the right little finger with pain for which the lesion was surgically excised.

Middle Interhemispheric Variant of Holoprosencephaly – Presenting as Non–Visualized Cavum Septum Pellucidum and An Interhemispheric Cyst in A 19–Weeks Fetus

Middle Interhemispheric variant (MIH) is a rare subtype of holoprosencephaly (HPE), also known as syntelencephaly. We present a case of MIH, which was diagnosed as an interhemispheric cyst on antenatal sonography at 19 weeks, but later diagnosed as MIH variant of holoprosencephaly after a postabortal MRI and perinatal autopsy.

A Rare Combination of Avulsion Fractures Around the Knee –A Case Report

Patella fractures, tibial spine avulsion and Segond fractures are mainly due to trauma to the knee which may be direct or indirect injuries. While each entity is well documented when occurring in isolation, but bilateral inferior pole patella fracture, tibial spine avulsion in the right knee and bilateral segond fracture in a same patient is a rare occurrence. We report a case of 24-year-old male with such an injury. The diagnosis was confirmed by X-ray, CT scan and MRI imaging of right knee. Then the patient was treated with arthroscopic anterior cruciate ligament (ACL) avulsion fixation with pull through technique and suture disc; bilateral inferior pole patella was treated conservatively with knee brace, segond fracture was treated conservatively similarly. To the best of our knowledge, this is the rare case in the medical literature with all these injuries occurring simultaneously.

Diode Laser in Management of Tracheobronchial Typical Carcinoid: A Case Report with Review of Literature

Navin Bhambhani, Jayesh Gori, Vishwanath Masurkar, Sonal Thombre

Tracheobronchial carcinoids are relatively uncommon neoplasms with malignant (though indolent) potential and variable behavior. Clinical presentation is usually similar to any obstructive tracheobronchial lesions or rarely with presentation of carcinoid syndrome. Management varies from Pneumonectomy to use of lung sparing bronchoscoplastic techniques. We report the case of a 32-year-old male patient diagnosed with carcinoid of left main bronchus. Patient was successfully treated with trans-bronchoscopic diode laser. At 24 months of follow up patient remains asymptomatic and recurrence-free.

Metastatic Renal Cell Carcinoma: An Unusual Cause of Bleeding Pancreatic Mass

Smeeta Gajendra, Ritesh Sachdev, Ishani Mohapatra, Ruchika Goel, Shalini Goel

Sports Induced Cardiac Arrest: A Case of Missed Rhabdomyolysis

Parshotam L Gautam, Neeru Luthra, Prabhdeep Singh Nain

Exercise induced rhabdomyolysis although uncommon, is well known in strenuous and exhaustive sports like marathons, cycling and wrestlers. But it is not known in Kabaddi players. We report a case of nearly fatal rhabdomyolysis which was missed during early resuscitation in emergency room and lead to cardiac arrest due to catastrophic metabolic acidosis and severe -hyperkalemia. After high quality cardiopulmonary resuscitation and return of spontaneous rhythm, emergency resuscitative exploratory laparotomy was performed for suspected bladder injury which was negative. He had remarkable recovery over 24 h following diagnosis and aggressive supportive management including peritoneal dialysis. Heat stroke and rhabdomyolysis should be suspected early in players playing strenuous sports in tropical countries even during winter. High degree of suspicion and early aggressive general support is the key to success for unusual clinical presentation of any such clinical entity.

A Case Series & Review of Literature of Angiomyolipoma with Medical & Surgical Perspective

Santosh Kumar, Kumar Jayant, Shrawan Kumar Singh, Swati Agrawal

The angiomyolipoma of renal origin is a rare benign tumour composed of fat cells, smooth muscle cells, and thick-wall blood vessels. Mostly these are sporadic origin, asymptomatic and benign in nature. Here we present two cases of Renal angiomyolipoma (AML) presenting as fever, pain, perirenal haematoma & frank haematuria. After initial stabilization, evaluated by contrast enhanced computer tomography (CECT) & diagnosed as renal angiomyolipoma because of low Hounsfield areas (10-20HU) suggestive for fat. Patient later underwent angiography with selective angioembolisation. Post intervention period was uneventful and was treated by an oral Everolimus 10 mg daily for a period of one year in first case & partial resection was done in second case. On two year follow-up both patients were doing well & had normal renal function without any recurrence. Embolisation is the emergency treatment of choice for bleeding angiomyolipoma. When preventive treatment is considered a nephron sparing approach by either transarterial embolisation or partial nephrectomy is clearly important. While angiomyolipoma in both kidneys or in solitary functioning kidneys, renal preservation is mandatory in order to avoid need for renal replacement therapy. Also, recently approved drug Everolimus may be considered for patients not suitable for surgery particularly in tumour seen with tuberous sclerosis.

Immunologic Cerebral Vasculitis and Extrapulmonary Tuberculosis: An Uncommon Association

Yiyi Wang, Qian Li, Xiaohan Zhen, Yuan Liu, Qi Wu

Infection can cause cerebral vasculitis not only by direct invasion of the vessel wall, but by immune complex deposition, or through secondary cryoglobulineamia. There are also two types of cerebral vasculitis associated with tuberculosis (TB). In TB treatment, cerebral vasculitis caused by immunologic injury received little attention than vasculitis due to direct invasion of TB infection. We report a case in a young woman who presented with fever, generalized lymphadenopathy, stroke-like events, movement disorder and coma, which was found to be active, lymph node TB with immunologic cerebral vacuities without tuberculosis meningitis.

Cytologic Interpretation of Melanotic Neuroectodermal Tumour of Infancy Involving Cranial Bones: Clue to Diagnosis

Asaranti Kar, Priyadarshini Biswal, Susmita Behera, Ipsita Dhal, Surabhi

Melanotic neuroectodermal tumour of infancy (MNTI) is a rare, benign but locally aggressive neoplasm of infants commonly affecting the maxilla. It can also involve other areas like skull, mandible, brain and epididymis. The tumour comprise of dual populations of cells like small, basophilic neuroblast like cells and large pigment laden epithelial cells arranged in tubular and pseudoglandular pattern. The proportion of two components varies and therefore the diagnosis can be difficult in absence of the large cells. We describe the cytologic, histologic and immunohistochemical findings in a case of MNTI involving left side orbit with frontal, temporal and parietal bones. The cytologic interpretation could be made due to the suggestive clinical and radiologic findings and detection of large epithelial pigmented cells on thorough searching. The neuroblast like cells was positive for Neuron specific enolase, large cells for HMB-45 and Pan CK. Both the cellular components were negative for desmin. This case report is presented due to its rarity and also to aid the surgical pathologists in diagnosis where the findings are not too straight forward.

Retroperitoneal Malignant Peripheral Nerve Sheath Tumour: A Rare Case Report

Ayse Nur Deger, Mehmet Akif Bayar, Muzaffer Caydere, Hakki Deger, Mahir TaTayfur

Heterogeneity of Nasolabial Flap- Role in Prevention of Morbidity Associated with Reconstruction of Orofacial Defects

Roshni Abida, Muhamed Sajid Ayyallil

Reconstructive technique after surgical excision of malignancy in orofacial region should be planned in preoperative period itself. Surgery is the preferred modality of treatment if the tumour is small and located in an accessible area. Nasolabial flap is a versatile flap which is well suited to cover small defects in maxillofacial region. Nasolabial flap can be used as an alternative to other distant pedicled flaps in selected cases. A retrospective analysis of 12 cases of oral cancer treated with primary excision and reconstruction using nasolabial flap was done. Patients who underwent resection of tumour and reconstruction with nasolabial flap in selected cases reduced the morbidity associated with Distant pedicled flaps. Two selected cases are described in detail.

Therapeutic Hypothermia after Prolonged Cardiac Arrest: Case Report with Review of Literature

Gautam Rawal, Sankalp Yadav, Nitin Garg

Patients who survive cardiac arrest often develop severe neurological dysfunction due to the hypoxic brain injury and reperfusion induced cell death. Therapeutic hypothermia (TH) has become a standard therapy of cerebral protection following the successful return of spontaneous circulation in patients of out-of-hospital cardiac arrest, according to American heart association guidelines. This is a case report of a 30-year-old patient who developed in-hospital cardiac arrest and was revived after prolonged cardiopulmonary resuscitation (CPR) and also required primary angioplasty. TH was then established with local measures for 24 hours for cerebral protection. The patient was gradually and successfully weaned off from ventilator with no neurological impairment. There is an increasing evidence of TH and its protective mechanisms in patients with non-shockable arrest rhythms with particular emphasis on neurological outcomes. This article emphasizes the role of TH in every successful CPR irrespective of the cardiac rhythm.

Intramuscular Ossified Haemangioma: A Rare Case Report

Haemangiomas are benign vascular neoplasm and intra muscular haemangioma constitutes 0.8% of all. Of these intramuscular ossified haemangioma is very rare. Here we are reporting a 30-year-old female admitted in our institute with complaints of pain and swelling in the medial aspect of right thigh for duration of one year. On evaluation CT showed well defined soft tissue lesion with calcification in vastus medialis which on guided aspiration showed numerous RBCs along with clusters of histiocytes with occasional calcified specs seen without presence of granulomas. The swelling was excised and histopathology confirmed intra muscular haemangioma with ossification. We hereby reporting a rare case of calcified intra muscular cavernous haemangioma which should be considered as differential diagnosis in any case of deep seated swelling with unexplained pain.

Takayasu Arteritis with Bilateral Renal Artery Stenosis and Left Subclavian Artery Stenosis in Pregnancy

Sharma Nalini, Singh Ahanthem Santa

Takayasu arteritis (TA) is a rare, systemic, chronic inflammatory, progressive, idiopathic disease of aorta and its main branches. It causes narrowing, occlusion and aneurysm of arteries. It affects mainly young females in about 80-90% of cases (young female arteritis). TA has adverse effect on pregnancy in the form of abortion, superimposed preeclampsia, IUGR (Intrauterine growth restriction), IUFD (intrauterine fetal death), abruption and CCF (congestive cardiac failure). Careful assessment, treatment of TA complication, regular antenatal followup and multidisciplinary approach involving obstetrician, cardiologist, rheumatologist and anaesthetist improve maternal and fetal outcome. We described here a case of pregnancy with TA with bilateral renal artery stenosis and left subclavian artery stenosis.

Mesenchymal Hamartoma of Chest Wall in an Infant: Mimicking Persistent Pneumonia

Amitabh Singh, Rachna Seth, Gautham Pai, Lesa Dawman, Amit Satapaapathy

Mesenchymal Hamartoma of the chest wall (MHCW) is a very rare benign tumour. They are usually discovered in infancy. Spontaneous regression is known to occur in this benign condition. Management is surgical removal of mass if respiratory compromise is present. Conservative management is preferred modality in asymptomatic children as malignant transformation is not reported. Herein, we present a case of MHCW in a 5 month old infant presenting with acute respiratory distress with history of respiratory problem at 3 months of age. Child was suspected to have persistent pneumonia in view of radiological findings. Child’s respiratory distress improved with antibiotics and bronchodilators. Respiratory symptoms in MHCW are due to extrinsic compression of lung parenchyma. Present case had respiratory symptoms with persistent radiological findings leading to suspicion of persistent pneumonia. His respiratory symptoms and exacerbation on follow up was attributed to hyper reactive airway disease and MHCW was managed conservatively. The non-neoplastic nature, characteristic presentation, histopathology, imaging modality and management options of MHCW are discussed.

Post-Partum Diastasis of the Pubic Symphysis: Report of a Rare Case

Jeevitha Kamakoti Jayaraman, Prabha Ganapathy, Nalliannan Indira

Post-partum pubic symphysis diastasis refers to an abnormally wide gap between the two pubic bones following delivery. It is an uncommon and under diagnosed condition resulting in acute pelvic pain. A case of pelvic diastasis in a 24-year-old G2A1 following normal vaginal delivery is reported. Management consisted of simple conservative treatment with binders and analgesics, which were sufficient in achieving a complete reversal of the condition. The low incidence of 1 in 3700 normal vaginal deliveries over a 5 year period at Public Health Centre, Chennai, coupled with the rarity of the condition renders it as a salient presentation in the practice of our profession.

Paraganglioma of Urinary Bladder Presenting as An Early Preeclampsia with Successful Perinatal Outcome After Surgery: A Case Report and Review of Literature

Paraganglioma in urinary bladder associated with pregnancy is extremely rare with a prevalence of less than 1%. We report a case of 25-year-old pregnant female who presented with gross haematuria and clot retention during first trimester. MRI pelvis showed a mass antero- inferior to bladder. Transurethral resection biopsy revealed paraganglioma of the urinary bladder. Her workup showed neither raised plasma free normetanephrine levels. Patient underwent partial cystectomy during second trimester. Postoperatively, she is normotensive with normal serum free normetanephrine levels. At term, she delivered a healthy female child. This case highlights a successful perinatal outcome with timely intervention, adequate preoperative control of hypertension and counselling. We report a case of paraganglioma of urinary bladder presenting as an early preeclampsia with successful perinatal outcome after surgery.

Penile Metastases From Prostate Adenocarcinoma: A Rare Presentation

Srikanth Soma, Poorna Chander Reddy, Rahul Bhat, Shivananda Prabhu

Penile metastases are rare in occurrence and are usually secondary to other genitourinary primary tumours. It is a debilitating near terminal condition at presentation with a dismal prognosis and poor survival rates. Supportive and palliative care is generally recommended to improve the quality of life of patients. We present a case of penile metastases in a 74-year-old male patient with prostatic adenocarcinoma in association with multiple skeletal metastases.

De novo Choledocholithiasis in Retained Common Bile Duct Stent

Manish H. Upwanshi, Salman T. Shaikh, Smruti R. Ghetla, Tilakdas S. Shetty

De novo choledocholithiasis means formation of stone in the common bile duct (CBD). It can present as biliary colic, jaundice, cholangitis, pancreatitis or it may be asymptomatic. There are various indications for biliary stenting like CBD stone, CBD stricture, biliary leak, peri ampullary carcinoma, CBD malignancy, etc. Foreign bodies like silk sutures, endo-clips, fish bone, retained T- tubes, plastic or metallic stents, etc. lead to biliary stasis leading to eventual stone formation. Here, we discuss a case of choledocholithiasis post-cholecystectomy with CBD stenting done 15 years back which had migrated and acted as a nidus for stone formation in the CBD and hepatic duct.

An Unusual Presacral Cyst in An Infant

The neurenteric cyst is a rare developmental lesion arising as a result of persistence of the neurenteric canal. It usually presents in the second and third decade. Lesions occurring in children are rare. Majority of the cases presented with signs of spinal cord involvement. This is a rare case of neurenteric cyst in an infant who presented with a presacral mass. A nine-month-old female had an antenatally diagnosed sacrococcygeal lesion. Radiology suggested a diagnosis of sacrococcygeal teratoma. Histology was typical of a neurenteric cyst. We report this case to create awareness about this rare cystic lesion and inclusion of this entity in the differential diagnosis of cystic masses in children at this location.

Obsessive Compulsive Disorder with Intellectual Disability: A Diagnostic and Therapeutic Challenge

Priyanka Gautam, M.S. Bhatia

Obsessive compulsive disorder (OCD) are known to occur in patients with intellectual disability and at rates least proportional to the general population but often the developmental disabilities and lack of communication in these patients make it difficult to diagnose and assess the disorder and hence go undetected and untreated. Once diagnosed, treating OCD is another challenge faced by therapist in patients with intellectual disabilities. We report a case of intellectual disability with OCD highlighting the diagnostic and therapeutic challenges.

Reconstruction and Intentional Replantation of a Maxillary Central Incisor with a Complete Vertical Root Fracture: A Rare Case Report with Three Years Follow up

Deepti Dua, Ankur Dua

Vertical root fractures in teeth present with challenges not only with diagnosis but also with management. The prognosis in such teeth is generally questionable with extraction of the tooth being the most common treatment option. However, conservative treatment options such as reconstruction of the fractured fragments with adhesive resin followed by intentional replantation have been recently suggested. There are only a few case reports that describe management of complete vertical root fracture by reconstruction of fragments. The present case report describes successful management of an unusual complete vertical root fracture of a maxillary right central incisor in a 23-year-old male by reconstructing the fragments with a dual cure resin followed by intentional replantation. At the three year follow up, the tooth was asymptomatic, radiographically sound with probing depth and mobility within normal physiological limits.

Perigraft Seroma Presenting as Discharging Sinus and Spontaneous Exteriorization of Vascular Graft – A Rare Entity Following Vascular Repair with PTFE Graft

Annu Babu, Manish Kumar Pandey, Amit Gupta, Piyush Ranjan, Maneesh Singhal

Perigraft seroma presenting as discharging sinus and spontaneous exteriorization of vascular graft are rare complication of vascular injury repair with polytetrafluoroethylene (PTFE) grafts. We hereby report a case of young boy who presented with discharging sinuses and vascular graft coming out from one of the sinuses following vascular repair of femoral artery with PTFE graft after a follow-up of six months but the limb was salvaged. On evaluation PTFE graft was found to be thrombosed and collaterals were formed for distal perfusion. Because of persistent discharging sinuses, PTFE graft was removed and femoral artery was ligated proximal and distal to the graft. This case highlights an unusual complication of PTFE grafts that is commonly used in vascular surgery and also highlights the fact that these graft buy time for gradual collaterals formation for distal perfusion and hence when thrombosed and complicated can be safely removed.

A Case of Dentinogenesis Imperfecta Treated with Submerged Root Technique

Ginjupally Uday, Bhanu Chandar, J. Srilakshmi, Tanya Khaitan, B. Balaji Babu

Dentinogenesis imperfecta (DGI), an autosomal dominant trait, is one of the most common hereditary disorders affecting both the formation and mineralization of dentin. Either or both primary and permanent dentition is affected by it. Here, we present a case report of a 13-year-old female patient affected with DGI who had undergone prosthetic rehabilitation with submerged root technique.

Bisalbuminemia in a Hypothyroid Patient with Diabetes: A Case Report

Jeevan K. Shetty, Ravindra Maradi, Krishnananda Prabhu, Gopalkrishna Bhat

Bisalbuminemia is a rarely encountered anomaly characterized by presence of bifid albumin bands or a single widened albumin band in electrophoretogram. Inherited bisalbuminemia is quite rare and inherited as an autosomal dominant form. The acquired form of bisalbuminemia is usually transient and may be observed during long term beta lactam antibiotic therapy, acute pancreatitis, myeloma and nephrotic syndrome. This is a case of bisalbuminemia in 61-year-old diabetic female with hypothyroidism came with acute exacerbation of bronchial asthma.

Isolated Langerhans Histiocytosis in Thyroid: Thyroidectomy or Chemotherapy?

Anoop Attakkil, Vandana Thorawade, Mohan Jagade,Rajesh Kar, Kartik Parelkar

Langerhans cell histiocytosis (LCH) is a rare disorder of mononuclear phagocytic system whose clinical presentation varies from the localised involvement of a single bone to a widely disseminated disease. Langerhans cell histiocytosis rarely involves the thyroid gland and isolated involvement of thyroid is even rarer. We report a case of an eight-year-old male child diagnosed with Langerhans cell histiocytosis limited to thyroid gland with review of literature. Should thyroidectomy be done or proceed with chemotherapy? Our case report raises this question with a note on the role of 18 fluoro deoxy glucose positron emission tomography-computed tomography in the management of the same.

Oncologic Concerns in An Exstrophied Urinary Bladder - An Indian Scenario

S Shwetha, Hemanth S Ghalige, Love Goyal, Preety Jain, Fakhruddin

Exstrophy of the urinary bladder is a rare congenital anomaly which if untreated causes bladder carcinoma and intestinal tumours noted if urinary diversion is performed. It is seen that 50% of all persons afflicted with exstrophy are dead by their tenth year and 66-67% are dead by their twentieth year. It is thus a great rarity to see a case of ectopia vesicae in adulthood. Still more uncommon is to see a case of exstrophy complicated by carcinoma. Here, we report a case of papillary adenocarcinoma of ectopic urinary bladder in a 42-year-old male patient. In view of locally advanced disease, patient was given neoadjuvant chemotherapy. The case is being reported on account of its rarity to sensitise clinicians about rising incidence of carcinoma if mismanaged due to lack of protocol in oncological screening.

A Rare Case of Emphysematous Cholecystitis

Supreet Khare, Aswini K Pujahari

Emphysematous cholecystitis is an acute infection of the gallbladder wall caused by gas-forming organisms. It is infrequent with insidious onset and diagnosed by the use of radiographs detecting presence of air within the gallbladder wall or lumen. The report describes the case of a 42-year-old alcoholic male who presented with sudden onset of pain in the right upper quadrant of abdomen, fever and bilious vomiting of two days duration. The patient did not have symptoms of jaundice. Emergency partial cholecystectomy was done and the culture directed antibiotics were given. The patient was followed up for 4 years and he remained asymptomatic.

Ectopic Ureter Accompanied by Duplicated Ureter: Three Cases

Ufuk Senel, Halil Ibrahim Tanriverdi, Zafer Ozmen, Selami Sozubir

We report cases of ectopic ureter accompanied by three types of ureteral duplication that had been diagnosed previously and treated for enuresis. Data from three female patients ranging in age from 1 to 10 years were evaluated. The ectopic ureter was observed on the left in one case, on the right in another and bilateral in the third case. Complete duplication was found in two cases, while the third had incomplete duplication. Ureteroneocystostomy was performed in one case and subtotal nephrectomy was carried out in the other two cases. Ureteroneocystostomy was performed for the ectopic ureter found in the opposite urinary system in one of the cases. Ectopic duplicated ureter should be considered in treatment-resistant enuresis and urinary tract infections and after a careful physical examination, imaging as well as function tests should be performed.

Primary Bladder Neurofibroma: A Rare Case with Clinical Implications and Diagnostic Challenges

Neurofibroma of the genito-urinary tract is rare. Urinary bladder is the commonest organ involved in cases of urinary tract involvement. Patients present early in life and there is male preponderance. We discuss here a case of primary neurofibroma of the urinary bladder in a 52-year-male presenting with haematuria, irritative bladder symptoms and pelvic mass. Cystoscopy showed a swelling in the left lateral wall. A transurethral biopsy revealed neurofibroma of the urinary bladder. Immunohistochemical studies confirmed the diagnosis.

Incontinence in Intellectual Disability: An Under Recognized Cause

Lal DevayaniVasudevan Nair, Benjamin Sagayaraj, Rajan V.T.T., Radha Kumar

Many children with Down syndrome may develop urinary incontinence during adolescence or nearing adulthood. Most often low mental ability, behavioural issues, urinary tract infection, hypothyroidism, atlanto-axial subluxation or sexual abuse may be suspected to be the reason. We report a case of Down syndrome with tethered cord syndrome (TCS) and Lipoma of Filum terminale with Cauda equina in normal position, as a cause of bowel and bladder incontinence. The need for operating with Cauda Equina in normal position is debated. But a conscious decision was taken to operate and the incontinence improved markedly which was documented by using a standardized questionnaire (King’s questionnaire) and thereby making a difference in the child’s life. A literature search did not result in any case of Down syndrome with tethered cord syndrome and secondary incontinence as presentation. Considering the possibility of TCS as a cause of incontinence, often neglected even in normal children, careful evaluation and correction of such problems will make a difference in the life of many intellectually disabled children. Incontinence should not be casually attributed to intellectual disability without ruling out other causes.

Junctura Tendinae in the First Intermetacarpal Space: A Case Report

Biju Urumese Palatty, Raveendranath Veeramani, Manjunath K.Y

The anatomy of extensor tendons and juncturae tendinum (JT) is of interest to both anatomists and surgeons. Understanding the structure of the JTs and the interactions between the tendons of the fingers is of utmost importance in hand assessment, especially during the reconstructive procedures such as tendon transfers. During routine dissection of extensor tendons of dorsum of hand there was a filamentous band between the tendon of extensor pollicis longus and extensor indices in the first intermetacarpal space. This band was identified as Juncturae tendinae of Type 1. It was attached to the extensor tendons on either side of the first intermetacarpal space in a transverse direction. The presence of Juncturae tendinae in the first intermetacarpal space is a rare variation. This variation is important as it interferes with independent motion of thumb and index finger and also in tendon repairs.

Pulmonary Infection by Blastoschizomyces capitatus in An old Tuberculosis Patient

Sapna Chauhan, Swati Tiwari, Paramjit Singh, Roma Goyal

Blastoschizomyces capitatus is an arthrospore filamentous fungus. Lung infection by Blastoschizomyces can develop as an opportunistic infection in patients with underlying conditions especially when there is immunosuppression including neutropenia. However, it can occur in non-neutropenic patients with solid organ transplant and patients whose local pulmonary defenses are altered by chronic underlying lung pathology. We report here a case of pulmonary infection by B. capitatus in an old tuberculosis patient.

Otocephaly: Agnathia– Microstomia–Synotia Syndrome– A Rare Congenital Anomaly

Sunil Vitthalrao Jagtap, Neerav Saini, Swati Jagtap, Sneha Saini

Otocephaly is a rare malformation characterized by the association of agnathia (agenesis of mandible) or mandibular hypoplasia, melotia (anteromedial malposition of ears), microstomia (small mouth), aglossia or microglossia (absent or rudimentary tongue). This rare anomaly of the ventral portion of first brachial arch is a consequence of failure of migration of neural crest cells from hind brain. It leads to the development of maxillary and mandibular prominences and starts to develop at the fourth and fifth week of gestation. We hereby present the autopsy findings of a fetus of 28 weeks gestation abortus having otocephaly without holoprosencephaly.

Serous Microcystic Adenocarcinoma of Pancreas Infiltrating Into Spleen: A Case Report

Cystic tumours of pancreas account for 5-10% of all pancreatic neoplasms and serous tumours represent 1% among those tumours. Most of the serous tumours are benign and very rarely they infiltrate adjacent organs like liver and spleen. Herewith we present a rare case report of serous cystadenocarcinoma of pancreas in a 65-year-old woman. The tumour involved the body and tail of pancreas and contiguously invaded the spleen. The histopathology of tumour was similar to serous cystadenoma with mild nuclear hyperchromasia and atypia. The spleen showed tumour infiltration as microcysts diffusely infitrating the red pulp.

An Unusual Transorbital Penetrating Injury by House-key (lock): A Case Report with a Small Review of Literature

Santanu Sarkar, Sandeep Modi, Arup kumar seth, Soumyajyoti Panja

Penetrating injuries of the brain are quite uncommon, comprising approximately 0.4% of all head injuries. In our case, a four-year-old boy who fell forward on a house-key (lock) accidentally while playing with some other children sustained a left sided penetrating transorbital brain injury. After hospital admission, the patient had a Glasgow Coma Scale (GCS) score of 15/15, no visual loss but restriction of upward gaze (left eye) and profuse bleeding from the wound site. Firstly, the metallic key was removed in emergency operation theatre and haemostasis secured. Next day we did a combined surgical approach with neurosurgeons, Eye-surgeons and general surgeons after having CT scan report. We report this case because penetrating head injury is rare and transorbital penetrating head injury is even rarer and a predicament in emergency surgical practice with controversial management.

Virilizing Ovarian Steroid Cell Tumor: A Rare Case

Ovarian steroid cell tumours are fewer than 5 percent of sex-cord stromal tumours and 0.1% of all ovarian tumours. The average age at diagnosis is the mid-20s, but patients can present at virtually any age. We present a case of 38-year-old multipara with history of secondary amenorrhea, clinical signs & symptoms of virilization developed over the past 5 years. With elevated (115ng/dL) serum testosterone level and radiological findings of a left adnexal solid mass; the patient was suspected to have a virilizing tumour of left ovary. Laparoscopic left salpingo-oophorectomy was performed. Histopathology revealed tumour cells in small nests with vacuolated to eosinophilic cytoplasm with nuclear atypia completely replacing the ovarian tissue suggestive of steroid cell tumour (NOS) of ovary. The patient was discharged and advised for follow up with serum testosterone levels after 3 weeks.

A Huge Mature Cystic Teratoma in a Nulliparous Patient

Isil Uzun, Melih Gunduz, Ozlem Pata, Cihat Unlu

Here we report a case of a giant mature cystic teratoma of the ovary in a 38-year-old nullipaous woman. The patient presented with abdominal distension and abdominal pain. Laparotomy and cystectomy yielded satisfactory results. Histologic evaluation confirmed a benign cystic teratoma of the ovary. The patient underwent surgery for rupture of corpus luteum six years ago and no gross lesion was seen at the operation. This case demonstrates that dermoid cysts can grow to enormous sizes within a short duration.

Modified Occlusal Table - An Aid to Enhance Function of Hemimandibulectomy Patient: A Case Report

Completely edentulous patients who have undergone hemimandibulectomy suffer severe anatomic and functional loss. Functions like mastication, speech and deglutition are severely compromised. The mandibular deviation towards the resected side leads to inefficient mastication. In order to alleviate the difficulties encountered by the patient, construction of a modified occlusal table into conventional complete denture has been described in this article. This simple modification enables the patient to articulate teeth on a broader surface area. The inclines of the cusps also help in mandibular guidance. Thus, prosthetic rehabilitation of hemimandibulectomy patients with two rows of teeth on the unresected side serves to restore function and aaesthetics providing them with an added psychological comfort.

Pregnancy with Irreducible Utero-Vaginal Prolapse

Pradip kumar Saha, Vanita Suri, Puja Sikka

Pregnancy with uterine prolapse is a relatively rare condition. Irreducible prolapse occurring during pregnancy is even rarer. There is still a need for obstetricians to be aware about the management of uterine prolapse which allows for an uneventful pregnancy, labour and delivery. Here we present a case of a woman who developed irreducible uterine prolapse during pregnancy and the issues surrounding its management. We had to abort her pregnancy to reduce her prolapse which could otherwise have been life threatening.

Prevalence and Current Approaches of Ebola Virus Disease in ASEAN Countries

As indicated by the World Health Organization as of year 2014, around 10,000 people have been influenced with Ebola infection. The episode of Ebola in African locale is courged with a high death rate. Notwithstanding, in the United States, people influenced by Ebola have been given brilliant wellbeing offices, as the U.S. is one of the highest nations that have taken sterner wellbeing measures and principles against Ebola. Aside from the U.S., individuals in Asia, where billions live in indigence and general wellbeing frameworks are frequently extremely powerless, are under more serious danger of the Ebola infection. Despite the fact that nations like Singapore, Malaysia, South Korea and Japan can take stretched out measures to battle against the infection, nations like Philippines and Indonesia have unfathomable quantities of poor who may be incredibly influenced by a conceivable episode. At this moment, the chances that Asia will take a critical hit from the Ebola infection appear to be genuinely little. Yet, while it is far-fetched that Asia will encounter a real flare-up, genuine concerns stay about the infection coming to urban communities like Hong Kong, Beijing, Shanghai and Singapore through their worldwide airplane terminals. Wellbeing priests from the Association of Southeast Asian Nations (ASEAN) reported key measures not long ago to keep the Ebola plague from coming to the locale and to backing influenced nations. This article accordingly will concentrate on the prevalence and current approaches of Ebola Virus Disease in ASEAN nations which is the need of the hour.

Proposed Clinico-Pathological Classification for Oral Exophytic Lesions

Arvind Babu Rajendra Santosh, Doryck Boyd, Kumaraswamy Kikeri Laxminarayana

Oral exophytic lesions often have proven to be diagnostically challenging due to the varied clinical presentation. The exophytic growth of the oral lesions is due to the type of pathology and histological changes. Careful clinical interpretation with a better histological understanding of exophytic lesions may ease the diagnosis from the differential diagnosis panel. The purpose of proposing classification system is to categorize the exophytic lesions of interest under specific clinical and/or histological explanation; and this will eventually lead to better understanding of the pathological condition that is described. To the best of our knowledge, there is no such classification system available for oral exophytic lesions and hence proposal of classification system is attempted in this study. Further, proposing a new classification system is not just to influence the academic contribution, but also to assist at greatest extent for diagnosis during clinical practice.

Telogen Effluvium: A Review

Shashikant Malkud

Telogen effluvium was first described by Kligman in 1961. It is a most common cause of diffuse hair loss. Women with telogen effluvium more frequently present to dermatologist. A wide variety of potential triggers have been implicated in the pathogenesis of telogen effluvium. Diffuse shedding of telogen hair are seen after 3-4 months of triggering event. The observation of increased telogen hair shedding does not infer a cause. Establishing aetiology of telogen effluvium requires elicitation of relevant history and appropriate laboratory investigations to exclude endocrine, nutritional and autoimmune disorders.

Follicular Bronchiolitis: A Literature Review

Basheer Tashtoush, Ndubuisi C. Okafor, Jose F. Ramirez, Laurence Smolley

Follicular bronchiolitis (FB) also known as hyperplasia of the bronchial associated lymphoid tissue (BALT), or bronchiolar nodular lymphoid hyperplasia, is an entity characterized by the development of lymphoid follicles with germinal centers in the walls of small airways. FB is thought to be caused by antigenic stimulation of BALT, followed by a polyclonal lymphoid hyperplasia. It is currently classified as one of the reactive pulmonary lymphoid disorders in a group known as the lymphoproliferative pulmonary diseases (LPDs). FB is a pathological diagnosis that can be seen in several clinical settings, including connective tissue diseases, immunodeficiency states, autoimmune diseases, infections, obstructive airway diseases, as well as several types of interstitial lung diseases (ILDs). Its characteristics need to be carefully identified and differentiated from other closely related diseases in the group of LPDs due to significant differences in treatment and prognosis.

Toll–Like Receptors: A Key Marker for Periodontal Disease and Preterm Birth – A Contemporary Review

Prathahini Parthiban, Jaideep mahendra

The receptors of the innate immune system have evolved to recognize pathogenic bacteria in a complex manner. Out of these immune receptors, the pattern recognition receptors (PRRs) such as Toll like receptors have gained importance off late to play a key role in the activation of cascade of inflammatory cytokines in pathogenesis of preterm birth. Preterm birth has become leading cause of neonatal deaths globally. The concept of oral infection influencing the occurrence of preterm delivery has gained importance. Translocation of periodontal pathogens and inflammatory mediators play role in the pathogenesis of preterm labour. The transmembrane toll like receptors of innate immunity have been recently implicated in the association of periodontal infection and preterm labour. The TLRs are considered as a key marker and TLR blockade can be a critical method for treating women who are exposed to periodontal pathogens. This review is aimed at discussing the role of TLR in periodontal disease and its relationship with preterm birth.

A Review on Perforation Repair Materials

Perforation is an artificial communication between the root canal system and supporting tissues of the teeth. Root perforation complicates the treatment and deprives the prognosis if not properly managed. A wide variety of materials to seal the perforations have been suggested in literature. There are many comparative studies showing the efficacy of one material over the other. Literature shows many reviews on diagnosis, treatment plan and factors affecting prognosis of perforation repair; but none of these articles elaborated upon various materials available to seal the perforation. The present article aims at describing all the materials used for perforation repair from the past till date; it also offers a literature review of all the articles published over last four decades referred to the treatment of perforation with various root repair materials.

Osseoperception: An Implant Mediated Sensory Motor Control- A Review

Osseointegration of dental implants has been researched extensively, covering various aspects such as bone apposition, biomechanics and microbiology etc however, physiologic integration of implants and the associated prosthesis in the body has received very little attention. This integration is due to the development of a special sensory ability, which is able to restore peripheral sensory feedback mechanism. The underlying mechanism of this so-called ‘osseoperception’ phenomenon remains a matter of debate. The following article reveals the histological, neurophysiologic and psychophysical aspects of osseoperception. A comprehensive research to provide scientific evidence of osseoperception was carried out using various online resources such as Pubmed, Google scholar etc to retrieve studies published between 1985 to 2014 using the following keywords: “osseoperception’’, “mechanoreceptors”, “tactile sensibility”. Published data suggests that a peripheral feedback pathway can be restored with osseointegrated implants. This implant-mediated sensory-motor control may have important clinical implications in the normal functioning of the implant supported prosthesis.

Biomedical Biopolymers, their Origin and Evolution in Biomedical Sciences: A Systematic Review

Preeti Yadav, Harsh Yadav, Veena Gowri Shah, Gaurav Shah, Gaurav Dhaka

Biopolymers provide a plethora of applications in the pharmaceutical and medical applications. A material that can be used for biomedical applications like wound healing, drug delivery and tissue engineering should possess certain properties like biocompatibility, biodegradation to non-toxic products, low antigenicity, high bio-activity, processability to complicated shapes with appropriate porosity, ability to support cell growth and proliferation and appropriate mechanical properties, as well as maintaining mechanical strength. This paper reviews biodegradable biopolymers focusing on their potential in biomedical applications. Biopolymers most commonly used and most abundantly available have been described with focus on the properties relevant to biomedical importance.

Human Microbiome Engineering: The Future and Beyond

Arunava Kali

Microbial flora of skin and mucosal surface are vital component of human biology. Current research indicates that this microbial constellation, rather than being inert commensals, has greater implications in health and disease. They play essential role in metabolism, immunity, inflammation, neuro-endocrine regulation and even moderate host response to cancer. Genetic engineering was a major breakthrough in medical research in 1970's and it opened up newer dimensions in vaccinology, large-scale synthesis of bio-molecule and drug development. Engineering human microbiome is a novel concept. Recombinant DNA technology can be employed to modify the genome of critical components of resident microflora to achieve unprecedented goals.

Forensic Facial Reconstruction: The Final Frontier

Sonia Gupta, Vineeta Gupta, Hitesh Vij, Ruchieka Vij, Nutan Tyagi

Forensic facial reconstruction can be used to identify unknown human remains when other techniques fail. Through this article, we attempt to review the different methods of facial reconstruction reported in literature. There are several techniques of doing facial reconstruction, which vary from two dimensional drawings to three dimensional clay models. With the advancement in 3D technology, a rapid, efficient and cost effective computerized 3D forensic facial reconstruction method has been developed which has brought down the degree of error previously encountered. There are several methods of manual facial reconstruction but the combination Manchester method has been reported to be the best and most accurate method for the positive recognition of an individual. Recognition allows the involved government agencies to make a list of suspected victims’. This list can then be narrowed down and a positive identification may be given by the more conventional method of forensic medicine. Facial reconstruction allows visual identification by the individual’s family and associates to become easy and more definite.

Leprosy Mimicking Psoriasis

Rita V Vora, Abhishek P Pilani, Nidhi Jivani, Rahul Krishna Kota

Lhermitte-Duclos Disease: Diagnosis on MRI, MR Spectroscopy, CT and Positron Emission Tomography

Neeraj Jain, Udit Chauhan, Vandana Goel, Sunil Kumar Puri

Pseudo-ballooning of Radial Artery- An Artifact

Surender Deora, Sanjay Shah, Tejas Patel

Oral Squamous Cell Carcinoma: Hematoxylin and Eosin Staining

Ketki Kalele, Noopur Kulkarni, Rahul Kathariya

The Use of Hyperbaric Oxygen Therapy in Dentistry

Tolga Cakmak, Suleyman Metin, Sevket Balta, Ahmet Sen, Ahmet Akin

Is the Time Right to Start Using Flipped Classrooms in Indian Medical Colleges?

Navin Rajaratnam, Suzanne Maria D’cruz

Letter to the Editor Regarding Prevalence of Periodontal Disease and Characterization of its Extent and Severity in An Adult Population: An Observational Study

Pooja Khare, Amit Khare

Atrial Fibrillation Due to Acute Myocarditis During Dengue Haemorrhagic Fever

Hans Raj Pahadiya, Veeram Parmar, Harish Kumar, Amit Sagar

Post Esophagectomy Hiatal Hernia; Expect the Unexpected

Karthik Krishna Prasad, Rahul Kumar Chaudhary

A Simple Technique to Prevent Reverse Flow of Blood From Intravenous Line in Ipsilateral Arm with Noninvasive Blood Pressure Cuff

Paurush Ambesh, Sushil P Ambesh

Rapid Screening for Carbapenem Resistant Organisms: Current Results and Future Approaches

Carbapenem producing Enterobacteriaceae (CPE) is a major public health threat. A total of 120 carbapenem resistant E.coli (n=32) and K.pneumoniae (n=88) from blood stream infections were screened for the presence of carbapenem resistant genes KPC, NDM, IMP, VIM, and OXA-48 like using both conventional multiplex PCR and Xpert® Carba-R test. Additionally 26 faeces samples were directly screened with Xpert® Carba-R test. Of the tested isolates, 40% (n=48) of NDM and 39.2% (n=47/) of OXA-48-like were identified. Co-production of OXA-48 and NDM was seen in 15 (12.5%) isolates. In Xpert® Carba-R test, only NDM was identified in 55% (n=66) of tested isolates. Of the tested faeces samples, 12 were identified as carbapenemase producers: nine with NDM, two with the co-production of NDM and VIM and in Klebsiella spp (n=1), NDM and KPC co-production was seen. However, Xpert® Carba-R test fails to detect OXA-48 like as compared with multiplex PCR. The sensitivity, specificity, PPV, NPV of Xpert® Carba-R test was 100%, 77%, 96% and 100% respectively. Incorporation of OXA-48 like specific sequence in the panel of Xpert® Carba-R test may improve its sensitivity and maximize the coverage of assay.

A Contemporary Approach to Classify Ghost Cells Comprising Oral Lesions

Achla Bharti Yadav, Sumit Kumar Yadav, Anjali Narwal, Anju Devi

Ghost cells are swollen eosinophilic epithelial cells that have lost their nuclei but retain the cellular and nuclear outline. Pathologic ghost cell formation could be the process of aberrant keratinization or the result of coagulative necrosis. Ghost cells have been described in several odontogenic lesions, which include calcifying epithelial odontogenic cysts or tumours like odontomas, ameloblastic fibro-odontomas, and ameloblastomas. This article present a view on the formation of ghost cells with proposal/introduction of a classification for ghost cell lesions of the oral cavity in an attempt to organize these lesions for the better understanding and academic purpose.