Journal of clinical and diagnostic research https://www.jcdr.net/back_issues.asp JCDR An Overview of Malaria Burden in India and Road-Blocks in Its Control Sarika Jain, T.D.Chugh Malaria continues to be a major public health problem with India alone contributing about 70% of the 2.5 million reported cases in South East Asia. P. vivax is a predominant parasite species in the country; however, malaria control programs have been neglecting the species and have garnered all efforts against P. falciparum. The parasite resistance to insecticide and antimalarial drugs is growing and the alarming reports of emergence of multi-drug resistance poses a real threat to the impact of most of the malaria control programmes. Intensive monitoring of drug resistance along with the strategies to reduce its future emergence and spread is imperative, especially as there appears to be no near-future promise of antimalarial vaccines being available for clinical use. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=915-916&id=1578 https://doi.org/10.7860/JCDR/2011/.1578 Analysis of Multiple Myeloma by FTIR Spectroscopy Coupled with Statistical Analysis SANKARI G., AISHWARYA T.S., GUNASEKARAN S., SURAPANENI K.M. <b>Background:</b> Myeloma is a disorder in which malignant plasma cells accumulate in the bone marrow and produce excess immunoglobulin that leads to many complications. <b>Aim:</b> The aim of the present work was to analyze the difference in the nature of the immunoglobulin protein in healthy human blood plasma and myeloma which was infiltrated by human blood plasma, by employing Fourier Transform Infra Red (FTIR) Spectroscopy which was coupled with statistical analysis. <b>Materials and Methods:</b> An infrared spectrum was recorded in the mid frequency region, in the 4000 – 450 cm-1 range for normaland various types of myeloma which were infiltrated with blood plasma samples, namely IgA and IgG. The proposed method was then quantitatively analyzed by intensity ratio calculation among the spectral absorption peaks and by the Independent t-test. <b>Results:</b> In Ig A myeloma, the proliferation is more when compared to the normal healthy controls. On contrary, in Ig G myeloma, there observed a reduction in the Ig G immunoglobulins. <b>Conclusion:</b> From the results, it has been established that IR spectroscopy has the potential to be an efficient and effective diagnostic tool in the analysis of blood. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=1001-1007&id=1573 https://doi.org/10.7860/JCDR/2011/.1573 Daytime Sleepiness and Quality of Sleep in Punjabi Diabetic Population Upneet Bedi, Gaurav Mittal, Rajiv Arora The study was carried out at the medicine outpatient department of Punjab Institute of Medical Sciences Hospital and Medical College Jalandhar to examine the daytime sleepiness and quality of sleep in diabetic population sample. A total number of 201 T2DM patients aged above 20 years of age were taken. The study included information about socio-demographic characteristics including age, sex, income, education level, occupation, and other parameters like height, weight, BP, fasting blood sugar, lipid profile and physical activity and sleeping habits during the past month. Epworth sleepiness score (ESS) and the Pittsburgh sleep quality index (PSQI) have been used to study sleep quality and daytime sleepiness. Chi-square tests were performed to test for differences in proportions of categorical variables between two or more groups. The level p<0.05 was considered as the cut- off value for significance. Of the studied diabetic patients 101 were males and 100 were females. Comparison of sleeping quality using Epworth sleepiness scale(ESS) showed that female diabetic patients had significantly high chances of falling asleep during the day time than men; in terms of watching TV (p = 0.00008), passenger in car (p = 0.0001), lying down to rest in afternoon (p = 0.019), sitting & talking (p = 0.027) and car stopped in traffic (p = 0.00001). However, there existed an insignificant difference between males & females in terms of falling asleep during day while sitting and reading (p = 0.206), sitting inactive in public place (p = 0.109), sitting quietly after lunch (p = 0.28) and ESS score results (p = 0.245) Overall 35% of the diabetic patients were very sleepy during the daytime with 49% men and 50% women. Obesity was significantly higher in diabetic women who had higher chances of daytime sleepiness than men (p = 0.00005). Physical activity was significantly lower in diabetic women with poor sleep compared to men (p = 0.001). This study finding showed that sleep quality was bad in diabetic population and also day time sleepiness was observed in diabetic population. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=1051-1055&id=1575 https://doi.org/10.7860/JCDR/2011/.1575 Study of Surgical Site Infections in Abdominal Surgeries Satyanarayana V., Prashanth H.V., Basavaraj Bhandare, Kavyashree A.N. <b>Background:</b> Surgical site infections (SSI) have been responsible for the increasing cost, morbidity and mortality related to surgical operations and continue to be a major problem even in hospitals with most modern facilities and standard protocols of pre-operative preparation and antibiotic prophylaxis. <b>Aims:</b> This study aimed to determine the incidence of SSI in the abdominal surgeries and to identify risk factors associated with the development of SSI. <b>Settings and Design:</b> This retrospective observational study included patients who had undergone surgeries (abdominal) in the Department of General Surgery and Department of Obstetrics and Gynacology. It was conducted over a period of 18 months. <b>Materials and Methods:</b> All surgeries (1000 cases) where abdominal wall was opened were considered for the study. Wound class was considered as clean, clean contaminated, contaminated and dirty based on the extent of intraoperative contamination. The data collected includes details of timing of antimicrobial prophylaxis, surgical wound infection, types of surgeries (emergency and elective surgeries), the wound classes, apart from demographic profile of the patient. <b>Results:</b> The overall surgical wound infection rate was 13.7%. The infection rate was more with emergency surgery (25.2%) when compared to elective surgery (7.6%). The surgical site infection rate increased as the risk index score increased from 0 to 3. SSI was more with early operative and post operative prophylaxis. There was definite correlation between the wound infection rate and the timing of prophylaxis. Statistical Analysis: Chi-square test was applied and the level of significance was set at 5%. <b>Conclusion:</b> A pre-existing medical illness, prolonged operating time, the wound class, emergency surgeries and wound contamination strongly predispose to wound infection. Antimicrobial prophylaxis is effective in reducing the incidence of post-operative wound infections for a number of different operative procedures but, timing of administration is critical. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=935-939&id=1814 https://doi.org/10.7860/JCDR/2011/.1814 Cystic Hygroma: Cytological and Radiological Co-Relation ALKA, PREETI, RAJIV KUMAR <b>Aim:</b> The aim of this study is to illustrate and discuss the pathological spectrum of radiologically diagnosed “possibility of cystic hygroma” as there is severe paucity of literature regarding this. Our purpose is to differentiate cystic hygromas from other cystic lesions like branchial cysts especially when cystic hygromas present at an unusual site and unusual age. <b>Materials & Methods:</b> Total of 20 cases of radiologically diagnosed as “possibility of cystic hygroma” were aspirated using 23 guage needle. Appearance and amount of fluid aspirated was recorded and then centrifuged. Wet fixed & air dried smears were made from the sediment and were stained with Papanicolaou (Pap) stain, Haematoxylin & Eosin (H&E) stain and Giemsa stain. <b>Results:</b> Cytological analysis was rendered on all the 20 cases, out of which 15 cases were diagnosed as cystic hygroma. Restof the 5 cases were diagnosed as branchial cleft cyst (2 cases), laryngocele (2 cases) and non-conclusive (1case). Out of 20 aspirates, 10 aspirates (50.0%) were from the posterior triangle of the neck, 4 aspirates (20.0%) were from the middle triangle of the neck and 4 aspirates (20.0%) were from the anterior triangle of the neck. One (5.0%) of the aspirate was from the mediastinum and one (5.0%) aspirate was from the axilla. Histopathological correlation was available for 2 of these patients and both of these were diagnosed as cystic hygroma. <b>Conclusion:</b> Fine Needle Aspiration Cytology (FNAC) along with radiological correlation serves as a highly effective and efficient modality for the confident diagnosis of cystic hygroma especially in patients with atypical presentation, age and location. It provides a safe alternative to more cumbersome and time consuming surgical modalities of diagnosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=1008-1010&id=1556 https://doi.org/10.7860/JCDR/2011/.1556 Management of Corrosive Injuries of the Upper Gastrointestinal Tract PRAMOD MIRJI, CHHAYA JOSHI, ASHOK MALLAPUR, VISHWANATH G., SHAILESH EMMI <b>Introduction:</b> A corrosive injury to the upper gastrointestinal tract is a common problem and has a wide spectrum of presentations. We have prospectively evaluated 16 patients who ingested corrosive substances for the location, extent and the severity of injury and its outcome. The best time to assess the injury is by 12-48 hours of ingestion of the corrosive substances. Upper gastrointestinal (GI) endoscopy is the single most important investigation which helps to grade the injury and to plan the further management. <b>Materials and Methods:</b> All the patients who presented to the Casualty and to the Out patients Department of the H S K hospital, Bagalkot, during August 2009 to July 2010, with a history of corrosive agent ingestion were admitted and resuscitated. In the indicated cases, upper GI endoscopy was done to assess the severity of the injury. The following grading system was used. Grade 0- Normal mucosa, Grade1(superficial)- Superficial hyperaemia and oedema, Grade2A (Transmucosal)- Haemorrhage, exudates, linear erosions, blisters, shallow ulcers involving the mucosa and the submucosa, Grade2B- Circumferential burn present, Grade3-Deep ulceration, eschar formation with necrosis, full thickness injury with and without perforation. <b>Results:</b> Out of the 16 patients, 10 were females and most were of the age group of 10-30 years.10 had consumed acid and 3 alkalis and in another 3 cases, the substance which was ingested was not elicitable. 15 patients had consumed the substances with suicidal intentions and in only one patient it was accidental. The predominant symptom was pain and most had oesophageal injuries. The grade 2 injury was the most common type of injury. 13 patients were managed conservatively and 3 required surgery. The most common complication was a stricture in the oesophagus. <b>Conclusion:</b> The corrosive injury is more common in females. Most of the patients were of younger ages. Acid ingestion was more common than alkali ingestion, and most had suicidal intentions. Early upper G.I. endoscopy has a definite role in diagnosing the severity of the injury and in planning the management. Most of the patients with corrosive injuries can be managed conservatively with follow up for the stricture, which is the most common complication that is often treated by dilatation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=944-947&id=1557 https://doi.org/10.7860/JCDR/2011/.1557 A Study on Industrial Eye Injuries Somashekar P. Biradar, Arvind H.S. <b>Background:</b> Eye injuries have been known since ancient times. Although nature has provided a protective bony wall and lids to cover the eye to protect it from injury, it is still exposed to all types of trauma. Trauma is the leading cause of patient presentation to the eye clinic, accounting for 52% of the patient load. Occupational eye injuries are more common in younger men and comprise 70% of all the ocular injuries. <b>Aim of the Study:</b> To determine the various aetiological factors which are responsible for ocular injuries in various industrial environments and to assess the types of injuries and their outcomes in various types of occupations. <b>Material and Methods:</b> This study included 65 cases with a history of trauma, which was sustained while working, who presented directly or were referred to the Aravind Eye Hospital, Coimbatore, during the study period from May 2003 to December2004. In all the cases, a thorough history was obtained, with particular emphasis on the type of industry, the nature of work, the hours of work daily, the exact nature of the event which led to the injury and the object which caused the injury. The patient’s symptoms following the injury were enquired about in detail. A relevant past ocular and general medical history was obtained for risk assessment in the present ocular injury. The history of prior treatment for the injury was recorded. All the patients were subjected to a complete ophthalmic examination. Their visual outcomes were considered. <b>Results:</b> The males were commonly injured. The commonest age group which was affected was the 21-30 years age group. Mechanical injuries were the most common type of injury. <b>Conclusion:</b> An attempt was made to find out the various aetiological factors for ocular injuries and their visual outcomes. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=1076-1081&id=1558 https://doi.org/10.7860/JCDR/2011/.1558 A Study on the Radial Nerve Supply to the Human Brachialis Muscle and Its Clinical Correlation Srimathi and Umapathy Sembian Fractures of the humeral shaft are commonly encountered by orthopaedic surgeons, accounting for approximately three percent of all the fractures. The appropriate treatment for such fractures requires an understanding of the anatomy of the neurovascular structures and the muscles in the arm. <b>Aim:</b> To study the radial nerve innervation pattern of the human brachialis muscle and its clinical correlation. <b>Materials and Methods:</b> In fifty upper limbs of both the sides, the brachialis muscle, the musculocutaneous nerve and the radial nerve were exposed in the arm by routine dissection. The branches to the brachialis from the radial nerve were exposed and studied in detail. The presence or absence of the muscular branches of the radial nerve to the brachialis and their number, length, site of entry into the brachialis and the distance from the lateral epicondyle to the site of emergence of these branches were studied. <b>Results:</b> In the present study, the radial nerve was found to supply the brachialis in 88% of the limbs and in 12% limbs,the radial nerve branches to the brachialis were absent. In 52% limbs, these branches were two in number, in 26% limbs, these were three in number and in 10% limbs, there was only one branch from the radial nerve to the brachialis. In 84% limbs, the branches entered the lower one third of the muscle, in 24% limbs, they entered the middle third of the muscle and in 4% limbs, they entered the upper third of the muscle. The average length of the muscular branches was about 4.4 cm and the average distance from the site of emergence to the lateral epicondyle was 5.63 cm. <b>Conclusion:</b> The clinical importance of the study of the radial nerve innervation of the brachialis muscle lies in the surgical treatment of the fractures of the shaft of the humerus by an anterolateral approach (Thomson-Henry`s method). Surgical dissection should be done through the mid muscle belly of the brachialis muscle to preserve the musculocutaneous nerve on its medial and radial nerve on its lateral border. Therefore, this study will be useful to the orthopaedic surgeons in avoiding iatrogenic injury to the radial and the musculocutaneous nerves. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=986-989&id=1559 https://doi.org/10.7860/JCDR/2011/.1559 Acute Ocular Side Effects of Topiramate Ritesh Singla, Vippan Goyal, Gaurav Singla, Pooja Gupta, Rajiv kumar <b>Purpose:</b> To evaluate the acute ocular side effects of Topiramate in patients of migraine. <b>Design:</b> Retrospective study. <b>Materials and Methods:</b> 296 patients of migraine of all ages and of either sex, who were being treated with Topiramate from January 2010 to January 2011 by the neurologist, were retrospectively studied for severe ocular side effects. <b>Results:</b> Four patients of different ages and of either sex reportedwith signs of shallow anterior chamber , bilateral acute myopia and angle closure glaucoma of varying severity. All four patients responded well to conservative treatment and immediate cessation of Topiramate therapy. <b>Conclusions:</b> Topiramate which is recently being used quite frequently and effectively in the treatment of migraine has rare but potential side effects in the form of bilateral acute angle closure glaucoma which can be effectively managed with prompt stoppage of Topiramate therapy and conservative management. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=1082-1085&id=1560 https://doi.org/10.7860/JCDR/2011/.1560 Cytomorphological study of Lateral Neck Swellings Manjula K., C.S.B.R. Prasad, Gayathri B.N., Harendra Kumar <b>Background:</b> Swellings in the neck may be due to various causes. These swellings can be divided into midline swellings and lateral neck swellings (LNS). The common swellings are lymph node swellings, salivary gland enlargement, thyroid enlargement and branchial cyst. A neck mass in a 50- year-old smoker is different from neck mass in 15-year-old with respiratory tract infection. Fine needle aspiration cytology (FNAC) has become an important first line of investigation in palpable masses. It is one of the most useful accurate, sensitive, inexpensive, and rapid investigation available in the assessment of patients with lateral neck swellings. <b>Aims:</b> To find out the relative frequencies of various pathological conditions presenting as lateral neck swelling with respect to age and sex. And also to evaluate the role of FNAC in their diagnosis. <b>Methodology:</b> This study was undertaken in the Department of Pathology, Sri Devaraj Urs Medical College, over a period oftwo years from January 2009 to December 2010. FNAC was done on patients who presented with lateral neck swelling. The cytological features were evaluated. The accuracy of FNAC was verified by histopathological examination in 70 cases. <b>Results:</b> The study included 386 patients, with mean age of 24.5 years and male predominance. FNAC revealed that non neoplastic conditions of the LNS were in 251 (66.05%) cases, malignant neoplasms were in 104 (27.36%) cases and benign neoplasms were in 25(6.57%). Among the malignant neoplasms, metastatic squamous carcinoma was the commonest. <b>Conclusions:</b> Reactive lymphadenitis is the commonest cause of LNS in children and in adolescence and squamous cell carcinoma is the commonest cause of LNS in patients older than 40 years. FNAC of lateral neck swellings is useful in diagnosis, can differentiate neoplastic and non neoplastic lesions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=1016-1019&id=1561 https://doi.org/10.7860/JCDR/2011/.1561 Pedigree Analysis and Cytogenetic Study in Vitiligo Archana Shekokar, Ramakrishna Ghubde A total 300 cases of vitiligo with family history & cytogenetic study in patients having positive family history male to female ratio 1:1. Vitiligo begins in the younger age groups, symmetrical lesions in 50% cases, 72 cases gave definite positive family history & transmitted by autosomal dominant characteristic. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=929-931&id=1542 https://doi.org/10.7860/JCDR/2011/.1542 Physical Activity, Indices of Obesity and Mean Arterial Blood Pressure: Does Place of Living Matters? Rural vs Urban Mridula Mittal, Meena Arora, Rachna Bachhel, Kaur N, Rajinder Singh Sidhu <b>Introduction:</b> Physical inactivity is a risk factor for many diseases and conditions. Adequate physical activity is considered as a key factor in the fight against the obesity epidemic. Looking at the technology based lifestyle which is increasingly becoming more popular in this era; percentage of obese is increasing every year. Even an increase in blood pressure is observed because of: stressors associated with cultural change and health behaviour changes (diet, physical activity, etc.). If no effective strategies or programs are established to fight and control the risk factors including obesity, diabetes, hypertension, dyslipidemia; the obesity related non-communicable diseases will be prevalent in the near future and will elevate the socio-economic burden dramatically. In this era of epidemic diabetes and obesity, studying the joint influences of body mass index and physical activity becomes increasingly important because these reflect actual combined exposures. <b>Aims and Objectives:</b> • To assess different levels of physical activity in the general population. • To measure BMI, Waist Circumference (indices of obesity) and mean arterial pressure.• To study the inter-relationship between physical activities, indices of obesity (BMI, WC) and mean arterial pressure in urban and rural population. <b>Materials and Methods:</b> The present study was conducted on a total of 520 subjects randomly selected from general population of district Amritsar in Punjab in the age group of 20-50 years, divided into urban (130 men and 130 women) and rural (130 men and 130 women) population. After measuring the weight and height, body mass index (BMI) was calculated. Waist circumference was taken separately. Mean arterial blood pressure was derived from diastolic blood pressure and pulse pressure. Physical activity levels were assessed by general physical activity questionnaire. <b>Results:</b> A significant decline in waist circumference (WC), body mass index (BMI) and mean arterial pressure was observed in physically active population as compared to the sedentary life style population. <b>Conclusion:</b> Physical activity is the best road to good health. Urgent measures should be taken to inculcate the habit of exercising in all age groups. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=1038-1042&id=1571 https://doi.org/10.7860/JCDR/2011/.1571 Prevalence of Tobacco Consumption among the Adolescents of the Tribal Areas in Maharashtra DHEKALE DILIP NARAYAN, GADEKAR RAMBHAU DHONDIBARAO, KOLHE CHARULATA GHANSHYAM <b>Background:</b> Tobacco consumption is one of the major preventable causes of tobacco related cancer. In India, tobacco related cancer accounts for half the total cancer cases among males and 20% of the cancer cases among women. The prevalence of tobacco consumption among the tribal youths is high. <b>Aim:</b> To know the prevalence and the pattern of tobacco consumption among the adolescents of tribal areas. Settings: Five tribal villages under the Primary Health Centre, Waradh, in the District Yavatmal, Maharashtra State, India. <b>Design:</b> A community based cross sectional study. <b>Methods and Material:</b> The study consisted of 502 adolescents of both the sexes. The data was collected on a predesigned proforma during the period from October 2009 to September 2010. After obtaining the consent of the subjects, the information which was related to their socio-demographic characteristics and tobacco consumption was collected. The statistical analysis was done by using the Chi square test and percentage. <b>Results:</b> Overall, the prevalence of tobacco consumption among the adolescents of the tribal areas was 45.42%. 65.31% male and 26.46% female adolescents were habituated to it. All female, and majority of the male adolescents predominantly consumed a smokeless form of tobacco. Most of them (89%) started chewing tobacco / gutkha between 5-15 years of age. The females had started consuming tobacco at younger ages than the males. Social customs were the major influencing factor for the tobacco consumption, followed by peer pressure. The consumption of tobacco among the family members significantly (p<0.001) increased the tobacco use among the adolescents. <b>Conclusion:</b> The prevalence of tobacco consumption was high in the tribal adolescents. Social customs, peer pressure and the consumption of tobacco by the family members were the major contributing factors which emphasized the need of strengthening the information, education and communication (IEC) activities. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=1060-1063&id=1518 https://doi.org/10.7860/JCDR/2011/.1518 A Study on the Lung Function Tests in Petrol-Pump Workers APRAJITA, NEERAJ KANT PANWAR, SHARMA R.S. <b>Introduction:</b> Air pollution from vehicles is an inescapable part of the urban life. A long-term exposure to petrol and diesel fumes lead to a deleterious effect on the respiratory function. Inaddition to the exposure to the hazardous exhaust of vehicles, petrol-pump workers are also exposed to the vapours of petrol. <b>Aim and Objectives:</b> The aim of this study was to assess the extent of altered pulmonary functions in petrol-pump workers who were exposed to petrol and diesel fumes. In-addition, the effect of the duration of the service at the petrol-pumps was also studied and these changes were compared with those of agematched healthy controls. <b>Material and Methods:</b> The study comprised of 150 petrol-pump workers who were categorized into three groups, depending on the duration of the exposure. Fifty, healthy, age-matched males served as the controls. Each subject’s age, smoking habits, the duration of the exposure and health conditions were recorded.Their pulmonary-function tests were studied at their workplace by using a Med-spiror. The statistical analysis was done by using one-way ANOVA (analysis of variance). <b>Results:</b> The results showed a statistically significant decline in the values of FVC, FEV0.5, FEV1, FEV3, FEF 50%, FEF 25-75% and PEFR in the petrol-pump workers. However, a decline in the mean values of MVV, FEF 25%, FEF 75%, FEV 0.5 / FVC, FEV1/ FVC and FEV3 / FVC was statistically insignificant. <b>Conclusion:</b> Our findings are suggestive of the adverse effects of petrol/diesel fumes on pulmonary functions. In order to prevent these changes in the petrol filling workers, we suggest a medical observation including pre-employment and periodic medical check-ups, including pulmonary function tests. The early recognition and the removal of the susceptible workers from the work place before chronic impairment develops will prove to be beneficial. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=1046-1050&id=1520 https://doi.org/10.7860/JCDR/2011/.1520 A Retrospective Drug Utilization Study of Antidepressants in the Psychiatric Unit of a Tertiary Care Hospital Kingshuk Lahon, Harsha M. Shetty, Amith Paramel, Gyaneswar Sharma <b>Introduction:</b> Drug utilization is the marketing, distribution, prescription and the use of drugs in a society. Antidepressant prescribing patterns have changed globally over the last few years. Hence, we wanted to observe the prescribing pattern of antidepressants at our hospital and assess the rationality of the prescriptions and the prevalence of antidepressant usage in the community. <b>Methods:</b> A retrospective, observational analysis of the case records of patients who received antidepressant prescriptions at the Psychiatry outpatients clinic of a tertiary care hospital during the period from 1st January 2006 to 31st December 2006, to study the pattern and the rationality in prescription of antidepressant drugs, the WHO prescribing indicators, the Defined daily dose (DDD)/1000/day (DID), the Prescribed daily dose (PDD) and the PDD to DDD ratio. <b>Results:</b> Antidepressants were prescribed in 76.18% prescriptions (duloxetine – 50%, escitalopram – 22.40%, mirtazapine – 17.19%, sertraline – 6.77% and others – 3.64%). The average number of drugs/prescription was 2.32, the number of drugswhich were prescribed by their generic names was 88.54% and the number of drugs which were prescribed from WHO EML was 1.56%. There were no prescriptions for FDCs or injectibles. The DID of the antidepressants was 0.02 mg. The PDD to DDD ratios were < 1 for duloxetine and mirtazapine; for others, they were &#8805;1. <b>Conclusion:</b> Antidepressants were the most commonly prescribed psychotropic medicines. Duloxetine, escitalopram, mirtazapine and sertraline were the most commonly used ones. The prescriptions were complete and without polypharmacy. Favourable and unfavourable outcomes were seen for 3 and 2 WHO prescribing indicators respectively. The antidepressant consumption in the community was low. Adequate dosing was seen for all the antidepressants, except for duloxetine and mirtazapine (under-dosing). Adherence to standard treatment guidelines, choosing drugs from the EML and restricting the prescription of concomitant sedative hypnotics will decrease the number of drugs and the cost of the therapy and they will promote the rational use of medicines. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=1069-1075&id=1521 https://doi.org/10.7860/JCDR/2011/.1521 Menstrual Hygiene: Knowledge and Practice among Adolescent School Girls of Saoner, Nagpur District SUBHASH B. THAKRE, SUSHAMA S. THAKRE, MONICA REDDY, NIDHI RATHI, KETAKI PATHAK, SURESH UGHADE <b>Background:</b> Menstruation is generally considered as unclean in the Indian society. Isolation of the menstruating girls and restrictions being imposed on them in the family, have reinforced a negative attitude towards this phenomenon. There is a substantial lacuna in the knowledge about menstruation among adolescent girls. Good hygienic practices such as the use of sanitary pads and adequate washing of the genital area are essential during menstruation. Menstrual hygiene and management will directly contribute to the Millennium Development Goal (MDG)-2 on universal education and MDG -3 on gender equality and women empowerment. <b>Aim and Objectives:</b> To assess the knowledge and the practices of menstrual hygiene among rural and urban school going adolescent girls. <b>Materials and Methods:</b> A community based, cross sectional study was conducted in January- March, 2011 on 387 school going girls. The present study was undertaken among adolescent school going girls in the field practice area of the Rural Health Unit and Training Centre, Saoner, in the Nagpur district. Three hundred and eighty seven girls of the 8th and 9th standards were purposively selected for the study. A pre-designed, pretestedand structured questionnaire was used in the study. The data collection technique was a personal interview of the study subjects. <b>Results:</b> Only 36.95% of the girls were aware of menstruation before menarche. The major source of information about menstruation for them was found to be their mothers. More than three fourth of the girls in the study were not aware of the cause and the source of the bleeding. A majority of them had knowledge about the use of sanitary pads. The mean age of menarche in the study subjects was 12.85 ± 0.867 years; sanitary pads were used by 49.35% of the selected girls. The practice of the use of old clothes was reported in 45.74% of the subjects. Satisfactory cleaning of the external genitalia was practised by 33.85% of the girls. Three fourth of the study girls practised various restrictions during menstruation. Some menstrual hygiene indices have shown a significant difference in the rural and urban girls. <b>Conclusion:</b> A variety of factors are known to affect menstrual behaviours, the most influential being economic status and residential status (urban and rural). Awareness regarding the need for information about healthy menstrual practices is very important. It is essential to design a mechanism to address and for the access of healthy menstrual knowledge. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=1027-1033&id=1522 https://doi.org/10.7860/JCDR/2011/.1522 A Study on an Ossified Pterygospinous Ligament VIJAYKUMAR SHANKAR SHINDE, MALLIKARJUN M., RAVEENDRA PATIL <b>Introduction:</b> Posterior border of lateral pterygoid plate near its upper border shows a ligament which may get ossified some times. <b>Methods:</b> Study of ossification of pterygospinous ligament was conducted on 65 human adult skull bone specimens. The lateral pterygoid plate of the sphenoid bone and the presence of ossified pterygospinous ligament were studied. <b>Results:</b> Out of 65 specimens, only in 2 cases we observed the presence of flattened and broad lateral pterygoid plate andincompletely ossified pterygospinous ligament on left side in one and on right side of another skull bone. <b>Conclusion:</b> The ossification of pterygospinous ligament can result in formation of a foramen through which mandibular nerve branches may pass in most of these cases. Mandibular nerve and chorda tympani nerves may get compressed depicting various clinical symptoms, which intern depend upon dimensions of the foramen and grades of compression. This is important for radiologists, maxillofacial surgeons, dental surgeons and anaesthetists. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=978-979&id=1523 https://doi.org/10.7860/JCDR/2011/.1523 Evaluation of the Cost-Effectiveness of Different Insulin Regimes during the Peri- Operative Period in Type-2 Diabetics in India MUSHTAQ AHMAD, ZAHOOR AHMAD WAFAI, ZAFER YAB KHAN, VIKAS SETH <b>Background and Objectives:</b> Diabetes accounts for at least 10% of the total expenditure in many countries. Diabetics who undergo surgery are prone to adverse outcomes that can prolong their hospital stay and increase their health care expenditure. This prompted the present study to compare the cost-effectiveness of different insulin regimes during the perioperative period in type 2 diabetics. <b>Study Design:</b> This study was a multi-centric, prospective, single blind, randomised study. Two hundred eighty nine type 2 diabetes mellitus patients who underwent major elective surgeries were enrolled and randomly allocated to four groups A, B, C and D, receiving pre-mixed Regular/NPH(30:70), splitmixed Regular/NPH, split-mixed Glargine/Lispro and split-mixed Detemir/Aspart, respectively. <b>Materials and Methods:</b> Each group received multiple injections from the preoperative to the postoperative period until the patients were switched back to the same treatment regime which they received preoperatively. The starting dose of the insulin was 0.5 units per/kg body weight, which was then adjusted to maintain the average blood glucose level between 120-180mg/dl during the peri-operative period. The cost-effectiveness was calculatedand the interventions were compared on the basis of the amount which was needed to treat the patient. The average one day cost for all the regimes was calculated and the total cost was divided by the percentage of the success of the regime by applying an incremental cost-effectiveness formula. The Chi-square test was employed for analysis of the complications and one way ANOVA was used for the rest of the data. A probability value of less than 0.05 (p<0.05) was considered to be statistically significant. <b>Results:</b> There was a highly significant difference (p<0.001) in the mean costs of the regime A, B, C and D, respectively. The cost-effectiveness was done in a fashion of regime A vs. B and regime C vs. D. The incremental cost of the treatment for regime B was Rs. 7.21 and for regime D, it was Rs. 20.17 per added patient, with no peri-operative complications. However, the percentage of the incidence of the complications and the total cost was comparatively low with regime A. <b>Conclusions:</b> This study found the pre-mixed NPH/regular (30:70) regime to be a cost-effective therapy among the regimes which were compared, while the split-mixed (NPH) regime posed a greater financial burden on the patient in terms of the complications which occurred and the total cost of the treatment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=1064-1068&id=1524 https://doi.org/10.7860/JCDR/2011/.1524 Lipoprotein Profile in Patients with Chronic Obstructive Pulmonary Disease in a Tertiary Care Hospital in South India Niranjan M R ,Dadapeer k, Rashmi B K <b>Context:</b> Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death world over. COPD has been defined as a disease state characterized by airflow limitation. Spirometric tests like Forced Expiratory Volume in first second (FEV1 ) < 80% and FEV1/FVC (ratio of Forced Expiratory Volume in first second to the Fixed Vital Capacity) 0.7 is the diagnostic criteria for COPD. In COPD smoking is the major risk factor and smoking affects the lipid profile of COPD patients. <b>Aims:</b> To investigate the levels of total cholesterol (TCH), triglycerides (TG), low density lipoproteins (LDL), very low density lipoproteins (VLDL), high density lipoproteins (HDL) and correlating FEV1 and FEV1/FVC ratio with lipid profile. <b>Settings and Design:</b> A prospective cross-sectional case control study. <b>Methods and Materials:</b> Fifty cases were selected on the basis of simple random sampling method. The FEV1, FEV1/FVC ratio and various lipoprotein levels like total cholesterol (TCH), triglycerides (TG), low density lipoproteins (LDL), very low density lipoproteins (VLDL), high density lipoproteins (HDL) were studied and a group of 20 non-smoker healthy subjects were selected as controls. FEV1, FEV1/FVC ratio were correlated with lipid profile. <b>Statistical Analysis:</b> Comparison of various parameters were performed by “t” test, correlation between two variables were performed by Pearson’s correlation co-efficient “r” <b>Results:</b> Majority of the patients had moderate (50%) and severe (42%) airflow limitation. Mean LDL concentration among cases was 114.89 ± 19.61(mg/dl) as against control group who had mean LDL concentration of 96.22 ± 19.96(mg/dl), which was statistically significant (p-value < 0.05). However no significant difference in LDL, HDL and in triglycerides levels were observed. <b>Conclusion:</b> Smoking significantly affects the lipid profile in COPD patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=990-993&id=1525 https://doi.org/10.7860/JCDR/2011/.1525 Sociodemographic Profile of the Organophosphorus Poisoning Cases in Southern India KORA S.A., DODDAMANI G.B., HALAGALI G.R., VIJAYAMAHANTESH S.N., BOKE UMAKANTH <b>Aim:</b> The aim of this study was to analyze the patterns, the social factors and the clinical outcomes of Organophosphorus poisoning in north Karnataka region. <b>Materials and Methods:</b> All the OP poisoning cases who were admitted to the emergency department of S.N.Medical College and Hanagal Shree Kumareshwar Hospital and Research Center, Bagalkot, during the period of one year from Jan 1st to Dec 31st 2010 were studied. <b>Results:</b> 148 cases of OP poisoning were studied out of a total of 232 poison cases. In the present study, 52.8% cases were females and a majority of the cases were from the urban areas (56.75%). Females were more in both the married and unmarriedcategories, with the highest number of cases in the age group of 21 to 30 years (46.62%). The commonest motive was suicide (95.94%). The mean time interval for the hospital admission was 4.27 hours, with a mean hospital stay of 5.17 days. Winter was commonest season for the poisoning, with 41 cases being observed in winter. The poison was consumed mainly in the afternoon (43.95%). Housewives were found in high numbers in this study (55 cases). The mortality rate was 4.72%. <b>Conclusion:</b> There was a high incidence of OP poisoning with mortality in this region. The OP compounds were readily available at low costs in the market. A time of stress and frustration can lead to their use as a common poison to commit suicide with. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=953-956&id=1526 https://doi.org/10.7860/JCDR/2011/.1526 Eclampsia and Perinatal Outcome: A Retrospective Study in a Teaching Hospital Rajasri G. Yaliwal, P.B. Jaju, M. Vanishree <b>Background:</b> Eclampsia is associated with devastating maternal and foetal complications. <b>Aims:</b> To determine the perinatal mortality rate in eclamptic women. To assess the perinatal outcome with respect to time between first convulsion and delivery, time of treatment and delivery .To assess the perinatal outcome and mode of delivery. <b>Setting and Design:</b> Eclamptic women admitted to the labour ward of Shri BM Patil Medical College Hospital and Research Center, Bijapur, Karnataka, India from 1.1.2001 to 31.12.2010. Clinic data along with the results of the investigations were collected and analysed. <b>Results:</b> The study comprised of 98 pregnant women with eclampsia and gestational age of more than 28 weeks who satisfied the inclusion and exclusion criteria. The total number of babies delivered was 100. The perinatal death rate was 350/1000. Perinatal mortality was high in patients who had a systolic Blood Pressure of &#8805;160mm of Hg, a diastolic Blood Pressure of &#8805;110mm of Hg, babies who weighed less than 2 kgs and urine albumin>2+. Perinatal mortality was low in those patients who had delivered within 6 hours of convulsion, within 6 hours of commencement of treatment, babies delivered by caesarean section. <b>Conclusion:</b> Timeliness in the management of these cases can reduce the perinatal mortality. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=1056-1059&id=1527 https://doi.org/10.7860/JCDR/2011/.1527 Physiological Changes of Intraocular Pressure (IOP) in the Second and Third Trimesters of Normal Pregnancy PITTA PARAMJYOTHI, A.N.R. LAKSHMI, D. SUREKHA <b>Background:</b> Numerous physiological changes occur in the body during pregnancy and the eye is no exception. Pregnancy brings in an increase in hormones that may cause changes in the vision by altering the strength of refraction. The temporary changes in the vision will return to normal after the delivery. <b>Aim:</b> To study the physiological IOP changes in the second and third trimesters of pregnancy, as pregnancy affects the preexisting ocular conditions such as diabetic retinopathy, toxaemia of pregnancy, tumours and immunological disorders, but it can have beneficial effects on one such pre-existing condition such as glaucoma. <b>Settings and Design:</b> In the present study, the IOP in the right and left eyes was recorded by Schioltz tonometry in the secondand third trimester pregnant women of the age group 20-30 years, who were without any refractive error presently and previously. <b>Methods and Material:</b> The IOP changes of 30 pregnant women in the second trimester were compared to that of 30 pregnant women in the third trimester. <b>Statistical Analysis:</b> The data which was obtained was analyzed by using the Student’s t-test. <b>Results:</b> During the second and third trimesters, the p values of the IOP in both the eyes are highly significant (<0.0001). <b>Conclusion:</b> The physiological decrease in the IOP during pregnancy is due to an increase in the aqueous outflow because of the influence of increased progesterone and the beta subunit of the human chorionic gonadotrophin levels. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=1043-1045&id=1528 https://doi.org/10.7860/JCDR/2011/.1528 The Psychopathology and the Sociodemographic Determinants of Attempted Suicide Patients Pirdutt Bansal, Amit Gupta, Rajiv Kumar <b>Background:</B> Suicide and suicidal behaviour are known since the birth of humanity. Unfortunately, it is not possible to predict suicidal behaviour with certainty. Suicide is common, but there scanty data on this topic from India. <b>Materials and Methods:</b> A cross sectional study was performed for a period of 1 year in a medical college and research center in North India. <b>Results:</b> A majority of the samples were males (61%), 70% were less than 30 years of age, 57% were married, 25% werehousewives and had high school education. The most common method of suicide was self poisoning (69%), followed by burning, hanging, getting electrocuted and getting run over by trains. The most common psychiatric illness which was found was affective disorder (57%). Depressive disorder (46%) constituted a major category of the affective disorders. <b>Conclusion:</b> Awareness programmes and preventive measures should be undertaken and a proper psychiatric referral system should be built up to reduce the incidence of suicides. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=917-920&id=1510 https://doi.org/10.7860/JCDR/2011/.1510 To Study the Prevalence of Anaemia in Young Males and Females with Respect to the Age, Body Mass Index (BMI), Activity Profile and the Socioeconomic Status in Rural Punjab Vitull K. Gupta, Arun Kumar Maria, Rajiv Kumar, Jagjeet Singh Bahia, Sonia Arora, Rakendra Singh, Shelza, Varun Gupta <b>Background:</b> Anaemia is one of India’s major public health problems. The prevalence of anaemia was found to range from 30% to 98% in different studies from different regions. The National Family Health Survey–3 data showed that Punjab, along with Manipur, Mizoram, Goa, and Kerala, had the lowest levels of anaemia throughout the country. <b>Objectives:</b> The present study was designed to assess the prevalence of anaemia among the apparently healthy young males and females from rural Punjab. <b>Methods:</b> The young population, both males (5-20 years) and females (5-30 years) from rural Punjab, was studied for the prevalence of anaemia with respect to the body mass index, the activity profile and the socio-economic status. <b>Results:</b> The prevalence of anaemia in females (5-30 years) was 89.5%, which included 49.8% of mild, 38.2% of moderate and1.5% of severe anaemia cases. The prevalence of anaemia in males (5-20 years) was 89.9%, with 51.2% suffering from mild, 38% from moderate and 0.7% from severe anaemia. Both males and females who were in the younger age group, who were underweight, who belonged to a lower socio-economic status and who had a low activity life style, had a higher prevalence of anaemia. <b>Conclusions:</b> The present study found a high prevalence of anaemia in both males and females in the rural population, thus indicating that the problem of anaemia was related to a wider population than the traditional groups of the pregnant and lactating females and children. More detailed studies are needed to find out the cause and the type of anaemia along with other risk factors in all the age groups, irrespective of sex. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=1020-1026&id=1513 https://doi.org/10.7860/JCDR/2011/.1513 LMA Classic and LMA Proseal: A Comparative Study in Paralyzed Anaesthetized Patients UDAY AMBI, RAMESH KOPPAL, CHHAYA JOSHI, PRAKASHAPPA D.S., HEMLATA IYER <b>Introduction:</b> Airway management is a fundamental aspect of the anaesthesia practice and of emergency and critical care medicine.The proseal laryngeal mask airway (PLMA), a modified version of the classic laryngeal mask airway (LMA), is being considered as an alternative airway device for a wide range of surgical procedures. The aim of the study was to assess the use of the PLMA as a ventilatory device in anaesthetized, paralyzed patients for various elective procedures. <b>Materials and Methods:</b> This prospective study comprised of 50 patients between the ages of 18-60 years, of either sex andbelonging to the physical status ASA I and ASA II. We assessed the haemodynamic responses to the insertion of the PLMA, ventilatory parameters, the ease of the gastric tube placement, gastric insufflation and any postoperative complications. <b>Results:</b> The statistically analyzed results showed that the PLMA caused minimum haemodynamic responses to the insertion and that it was a reliable airway management device which ensured adequate ventilation and provided an effective glottic seal. <b>Conclusion:</b> We conclude that the Proseal LMA is capable of achieving a better seal than the LMA and facilitating gastric placement, but later is more difficult to insert. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=940-943&id=1516 https://doi.org/10.7860/JCDR/2011/.1516 The Accessory Renal Arteries: A Comparative Study in Vertebrates with Its Clinical Implications Anupma Gupta, Raman Gupta, Rajan Kumar Singhla Anomalous blood vessels are always interesting from a purely scientific point of view, especially since they so often shed light on obscure problems of phylogeny and ontogeny. The evolutionary history of kidney & renal artery is recapitulated during embryonic development .Most of the variations of human renal vessels can be explained on the basis of phylogeny as many conditions which are anomalous in human are normally present in some animals. The most common variation of renal artery is the presence of an accessory renal artery, occurring in approximately 30% of cases. <b>Aims:</b> The present study was undertaken with the aim to study the accessory renal artery in human as well as in some other vertebrates and to make an attempt to explain them on ontogenetic & phylogenetic basis. <b>Materials and Methods:</b> Material of this study comprised of 30 adult human cadavers (60 sides) and 30 animals of specifiedvertebrate series. These were dissected to expose the kidneys and their arterial supply. The renal and accessory renal arteries were traced up to their origin from abdominal aorta. <b>Result and Discussion:</b> In this study, in all experimental animals except mammals multiple renal arteries were found. In human beings the accessory renal arteries were found in 17(28.3%) kidneys. All of these were compared for understanding of the phylogeny and ontogeny of accessory renal arteries. Further an attempt has been made to discuss their clinical and surgical significance. <b>Conclusion:</b> We as anatomist believe that knowledge and awareness of causes of these accessory renal arteries are necessary for better surgical management during urological procedures & angiographic interventions as well as to design newer technique for them. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=970-973&id=1530 https://doi.org/10.7860/JCDR/2011/.1530 Branching Pattern of the Anterior Nerve of Latarjet and Its Clinical Significance K.C. Shanthi, Sudhaseshayyan Highly selective or proximal gastric vagotomy is one of the definitive treatments for gastric ulcers. The results of this operation, in comparison to truncal vagotomy, is well appreciated by the surgeons. On the contrary, the incomplete and inadequate performance of this procedure results in the recurrence of the ulcers, post vagotomy diarrhoea and the dumping syndrome. The knowledge about the normal and abnormal patterns of the anterior and posterior gastric nerves is an imperative to the surgeons who perform highly selective vagotomy. Most of the studies in this region have been done on the western population and the perspective of truncal and highly selective vagotomy is based on the western literature only. However, Indian studies regarding this topic, are only few and far inbetween. This nature of study on the Indian population in this part of the country was an initiative. 55 stomach specimens were utilized for the study. The anterior gastric nerve was dissected out from the level of commencement to the level of termination by the dissection method. The branching pattern, plexus formation and crow’s foot appearance at the level of the termination of the anterior gastric nerve were studied. The results which were obtained are analyzed and discussed in detail. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=980-983&id=1531 https://doi.org/10.7860/JCDR/2011/.1531 Comparative Study of Peripheral Blood Smear, QBC and Antigen Detection in Malaria Diagnosis Manjunath P. Salmani, Preeti B. Mindolli Basavaraj V. Peerapur Rapid diagnosis of malaria is pre-requisite for effective treatment and reducing mortality and morbidity of malaria. In this study, Quantitative Buffy Coat (QBC) was compared with thick and thin peripheral blood smears and malaria antigen test. A total of 387 samples were collected from patients presenting with fever and chills. Malaria was diagnosed in 60, 72 and 56 patients by Leishman staining technique, QBC method and malaria antigen test respectively. The QBC method allowed an additional 12 cases. Thus the prevalence rate of malaria during the study was 18.6%. In 315 patients who were negative by the QBC, malariaantigen test and the Leishman stained smears were also negative for malarial parasite. Although QBC method was superior to the smear for malarial parasite detection, species identification was not possible in 32 cases by this technique. The QBC method has its advantages in terms of speed, sensitivity and ease, especially in an endemic area as ours. The QBC method helps in the diagnosis of jaundice, aplastic anaemia and kala-azar. The QBC system can also be used in the diagnosis of other parasitic diseases such as filariasis. However, Leishman stained thin blood smear still appear superior for species identification. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=967-969&id=1536 https://doi.org/10.7860/JCDR/2011/.1536 Comparison of Bolus Phenylephrine, Ephedrine and Mephentermine for Maintenance of Arterial Pressure during Spinal Anaesthesia in Caesarean Section Ganeshanavar Anilkumar, Ambi Uday S., Shettar Adarsh E., Koppal Ramesh, R. Ravi <b>Introduction:</b> Hypotension following spinal anaesthesia for Caesarean section one of the common problem encountered by an anaesthesiologist. This study was aimed at comparing the efficacy of IV bolus Phenylephrine, Ephedrine, Mephentermine for maintenance of arterial blood pressure during spinal anesthesia in caesarean section. <b>Materials and Methods:</b> Ninty American Society of An esthesiologists (ASA) type 1 and 2 patients scheduled for elective as well as emergency caesarean section under spinal anaesthesia who developed hypotension were selected. These were allocated into 3 groups of 30 each to receive Group P-Phenylephrine 100 8g, Group E- Ephedrine 6 mg, and Group M-Mephentermine 6 mg in 1 ml as bolus IV. <b>Results:</b> On intergroup comparison rise of diastolic blood pressure at 2, 4, and 6 minutes post study drugs weresignificantly less in Ephedrine group and Mephentermine group as compared to the Phenylephrine group (p<0.05). Similarly elevation of systolic arterial pressure in Phenylephrine group was significantly higher compared to other two groups for first 6 minutes. Thereafter the differences narrowed off. No significant differences were observed between changes in systolic and diastolic blood pressure of Ephedrine and Mephentermine group at any time. In Phenylephrine group, post study drug values of heart rate were decreased significantly from the values at onset of the hypotension till the end of the surgery when compared to other two groups (p<0.001). <b>Conclusion :</b> Phenylephrine group had quicker control of blood pressure compared to the other two groups. However, as the time elapsed all drugs achieved comparable control of blood pressure. Phenylephrine did show some advantage over others with regard to reduction in heart rate. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=948-952&id=1537 https://doi.org/10.7860/JCDR/2011/.1537 Nitrofurantoin: An Alternative Therapy for Uncomplicated Cystitis in the Era of Antimicrobial Resistance Asha Pai K.B., Rekha Rai, Sanjeev H., Vimal Kumar Karnaker, Krishna Prasad M.S. <b>Introduction :</b> Escherichia coli have been implicated as the commonest organism causing uncomplicated cystitis. The frequent irrational use of antibiotics has led to an increased prevalence of resistance to commonly used antibiotics like cotrimoxazole, Fluoroquinolones and &#946;-lactams. Alternative antibiotic compounds are needed to treat such infections. This study was conducted to assess the prevalence of antimicrobial resistance among Escherichia coli causing cystitis and evaluate the sensitivitity of these strains to nitrofurantoin. <b>Material and methods:</b> Three hundred and thirty two strains of Escherichia coli obtained from 2293 fresh midstream urine samples were included in the study. Antibiotic sensitivity testing was done byKirby Bauer disc diffusion method according to CLSI guidelines. <b>Results :</b> Seven hundred and thirty six (32.09%) cases showed significant bacteriuria. A significant number of Escherichia coli isolates were found to be resistant to ciprofloxacin (72.59%), Norfloxacin (73.49%) and cotrimoxazole (71.38%). Over 90% of the strains were sensitive to nitrofurantoin. Two hundred and seventeen isolates (65.36%) were found to be ESBL producers by phenotypic confirmatory test. The ESBL producing isolates showed a high rate of sensitivity to ertapenem (96.77%), nitrofurantoin (88.94%) and amikacin (83.41%). <b>Conclusion:</b> We consider that nitrofurantoin is a good alternative antibiotic to treat uncomplicated cystitis caused by antibiotic resistant Escherichia coli. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=964-966&id=1538 https://doi.org/10.7860/JCDR/2011/.1538 Oxidative Stress in Diabetic Retinopathy Desai Vidya, Ravi Shekhar, Siva Prabodh, N.V.S. Chowdary, M.C. Das. M. Joji Reddy Diabetic retinopathy (DR) is one of the micro-vascular complications of diabetes which leads to blindness among the working age individuals. Chronic hyperglycaemia and dyslipidaemia cause oxidative stress and increase the free radicals. Oxidative stress is one of the important causes in the genesis of microangiopathy. Twenty five patients of Type II Diabetes mellitus (DM) without retinopathy, 50 patients of Type II Diabetes mellitus with non-proliferative diabetic retinopathy and proliferative diabetic retinopathy and 25 normal subjects were included in the study. Fasting plasma glucose (FPG), post prandial plasma glucose (PPPG), glycosylated haemoglobin, lipid profile, plasma malondialdehyde (MDA) and Vitamin C were estimated. The plasma MDA levels were significantly elevated (p< 0.001) and the Vitamin C levels were significantly decreased (p<0.01) as compared to the controls. The study revealed a significant positive association between plasma MDA and both FPG and PPPG (r=0.438, p<0.01, r=0.455, p<0.01 ) , a positive correlation between plasma MDA and HbA1c and also, a positive correlation between plasma MDA and serum triglycerides (r=0.028, p<0.01, r=0.454, p<0.01) and a negative correlation between MDA and Vitamin C (r=0.241, p<0.01). The results suggest that increased lipid peroxidation and a decline in the antioxidant defense mechanisms plays a very important role in the initiation and progression of micro-vascular complications like diabetic retinopathy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=994-997&id=1533 https://doi.org/10.7860/JCDR/2011/.1533 The Prevalence of Overweight And Obesity Among Women In An Urban Slum of Chennai Anuradha R., Ravivarman G., Timsi Jain <b>Context:</b> Obesity and overweight are creating a global epidemic. They are the risk factors for many non-communicable diseases. Once considered as a problem which was related to affluence, obesity is now growing fast in many developing countries. The prevalence of obesity is on the rise among the slum population. <b>Aims:</b>To find out the prevalence of overweight and obesity among women aged 20 years and above in an urban slum of Chennai. To identify the risk factors which were associated with overweight and obesity in the above study population. <b>Settings and Design:</b> An urban slum in Chennai, a cross sectional study. <b>Methods and Material:</b> The present study was undertaken in an urban slum in Chennai city, among women aged 20 years and above. One slum was selected randomly and the households in the slum were sampled by a systematic random sampling method. A pre-designed and pre-tested questionnaire was used to collect information regarding the socio-demographic profile, the diet pattern , the intake of vegetables and fruits, the duration of television viewing in a day and the duration of sleep at night of the study subjects. Anthropometric data regarding height andweight was also taken. WHO Asian Classification of the body mass index (BMI) was used to classify the study population. <b>Statistical Analysis:</b> The analysis was done using the Statistical Package For Social Sciences (SPSS), version 11.5. The prevalence was expressed in percentage and the Chi square test was used to find association with the factors. <b>Results:</b> In the study population, the prevalence of overweight (BMI &#8805; 23) was 27.7% (95% confidence interval [CI] 24.3–32.2) and the prevalence of obesity (BMI &#8805; 25) was 19.8% (95% CI 16.5–23.6). A significant association was noted between overweight/obesity and higher educational level, higher socio-economic status, inadequate fruit intake, an increased duration of television viewing and a sleep duration of < 7 hours and >9 hours per night. <b>Conclusion:</b> There is a rising prevalence of overweight and obesity among the urban slum women. The prevalence of overweight and obesity was found to be significantly higher among the slum women with inadequate fruit intake , increased duration of television viewing and a sleep duration of <7 hours and >9 hours per night. The prevention is economical and easy at an early stage, with the change occurring in the form of lifestyle modifications at an individual level with increasing awareness. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=957-960&id=1534 https://doi.org/10.7860/JCDR/2011/.1534 TheRole of Silver Staining Nucleolar Organiser Regions (AgNORs) in Lesions of the Oral Cavity SANDHYA PANJETA GULIA, EMANI SITARAMAM, KARRI PRASADA REDDY <b>Aims and Objectives:</b> • To establish the role of AgNORs in differentiating the benign from the pre-malignant and the malignant lesions of the oral cavity. • To establish the degree / grade of malignancy according to the AgNOR count. • To predict the probable prognosis of the cases on the basis of the AgNOR count, if possible. <b>Materials and Methods:</b> A retrospective study was conducted on 100 cases from July 2006 – July 2007 on the biopsies which were obtained from the oral mucosa. Two slides were prepared for each case – one was stained with the haematoxylin and eosin stain and the other was subjected to silver staining. The data was analyzed by using the independent T-test and ANOVA for the intergroup comparisons. <b>Results:</b> The results showed that the mean AgNOR count of the carcinomas was significantly higher than that of the normal oral epithelium, the hyperplastic lesions, papillomas and the leukoplakias (p < 0.05). The AgNOR dots tend to be small, homogenously stained and regular in the benign lesions and as the grade of the tumour increased, the AgNOR dots became irregular, large dots or bizarre clusters. <b>Conclusions:</b> AgNOR staining can be considered as a useful adjunct to diagnostic pathology. This study was helpful in evaluating the importance of AgNORs in differentiating the benign, pre-malignant and malignant lesions of the oral cavity and it could be considered as a valuable tool along with the histopathological criteria for the evaluation of the proliferative activity of the cell. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=1011-1015&id=1540 https://doi.org/10.7860/JCDR/2011/.1540 Psychiatric Morbidity in Industrial Workers of South India Kiran Kumar P.K., Jayaprakash K., Francis N.P. Monteiro, Prashantha Bhagavath <b>Background:</b> The literature on psychiatric morbidity in industrial workers is scarce in India. This information will go a long way in planning preventive and promotive measures in industrial population thereby safeguarding their health. <b>Aim:</b> This cross sectional was undertaken in the year 2001 in workers of a largest iron ore processing unit of India to study the prevalence of psychiatric morbidity and the associated risk factors. <b>Materials and Methods:</b> This study was conducted in an Iron Ore processing company located in Chickamagalore District of Karnataka in the year 2001 using Mini International Neuropsychiatric Interview Plus and Occupational Stress Index. The total industrial work force was 1537 employees. A total of 252 (16.4%) formed the sample for the study of whom 235 (93.3%) were responders and 17 (6.7%) were non-responders. Following a detailed interview with the selected industrial workers, diagnosis was made based on International Classification of Diseases-10, Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. <b>Results:</b> Majority of the study sample consists of males (95.7%), Hindus (85.5%), married persons (96.2%), and originally fromthe state in which industry is located, i.e., Karnataka (96.2%). Education wise majority are ITI graduates (29%), 20% studied up to high school, and 12.3% hold diploma in engineering. 11% of the sample had hypertension, 8.1% had diabetes mellitus and 3.0% had both hypertension and diabetes. 69.4% did not had any physical problem. Prevalence rate for lifetime psychiatric disorder in the study sample was 56.2% (95% confidence interval = 49.8-62.6) using MINI plus. Prevalence rate for current psychiatric disorder in the study sample is 36.2% (95% confidence interval = 30.1-42). Nicotine dependence is the major diagnosis (27.7%) followed by alcohol abuse (12.3%). 7.25% of the population fulfilled criteria for alcohol dependence syndrome. There were 137 subjects reporting mild occupational stress and 48 reporting moderate to severe occupational stress. Persons with non-technical educational status had significantly higher proportions of mild stress and less of moderate to severe stress as compared to other groups. Stress levels seemed to be uniformly distributed amongst those with or without physical and psychiatric disorder. <b>Conclusion:</b> A considerable proportion of industrial workers had psychiatric morbidity having many associated risk factors. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=921-925&id=1545 https://doi.org/10.7860/JCDR/2011/.1545 An Unusual Variation of Extra Hepatic Biliary Ductal System: Hepaticocystic Duct Sharmila Aristotle, Christilda Felicia, Sumathilatha Sakthivelavan <b>Aim:</b> The aim of this study was to focus on the variations occurring in the formation of extra hepatic biliary tract. These variations can occur from the gallbladder, cystic duct, hepatic ducts, common bile duct. Most of these variations are due to aberrations in the normal embryological development. <b>Materials and Methods:</b> The study was carried out in 25 foetal specimens of 7 to 9 months gestational age collected from the obstetrics and gynaecology department, Madras medical college, Chennai. Gallbladder was identified and dissection was carried out from the neck of gallbladder. Cystic duct, right hepatic duct, left hepatic duct, common hepatic duct and common bile duct were traced out. The relation of hepatic artery to the duct system was also noted. <b>Result:</b> This study reports an unusual variation in a foetal specimen out of 25 foetal specimens studied by dissection. In one of the specimen the common bile duct was absent. A small common hepatic duct from the liver entered directly into the neck of gallbladder. Further drainage of bile from the gallbladder was carried out by a long cystic duct which opened into the duodenum. The right and left hepatic ducts united intra hepatically to form the common hepatic duct. <b>Conclusion:</b> The variation noted here has been reported less in the literatures. knowledge of this congenital variation along with variations in cystic duct, common hepatic duct, common bile duct and the surrounding vessels is necessary to avoid iatrogenic ductal injuries and inadvertent complications during biliary surgery. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=984-985&id=1546 https://doi.org/10.7860/JCDR/2011/.1546 Effect of Mukh Bhastrika (A Type of Pranayama) on the Sensory: Motor Performance SHASHIKALA G.V., SHASHIDHAR P.K., BALJOSHI V.S., ANITA HERUR, ROOPA B. ANKAD, SUREKHARANI CHINAGUDI <b>Background:</b> Pranayama has a very important role in the yogic system of exercises and it has been said to be much more important than yogasanas for keeping sound health. The practice of Mukh Bhastrika, a type of pranayama, is known to improve human performance. The studies which have been conducted till date were on the effect of the short term practice of Mukh Bhastrika, other types of pranayamas and yoga in general. The Reaction Time (RT) is a means of determining the sensory motor association and the performance. <b>Aim:</b> The aim of the present study was to know whether practising Mukh Bhastrika alone had any beneficial effect on the CNS arousal, the sensory-motor association and its performance. <b>Materials and Methods:</b> This interventional study was done in 50 young, male volunteers in whom the auditory and the visual reaction times were recorded before and after 12 weeks of Mukh Bhastrika training. <b>Results:</b> There was a decrease in both the auditory and the visual reaction times. This indicated an improvement in the sensorymotor performance and the enhanced processing ability of the central nervous system. <b>Conclusion:</b> Hence, the regular practice of Mukh Bhastrika should be encouraged for better performance in situations which require faster reactivity such as sports, race driving, specialized surgery, machine operation, trainable mentally retarded children, etc. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=1034-1037&id=1547 https://doi.org/10.7860/JCDR/2011/.1547 Morphometric Study of Spleen in North Indian Adult Population: CT Scan Image Based Study Adil Asghar, Shagufta Naaz, Dushyant Agrawa l, P.K. Sharma <b>Introduction :</b> A prospective study was done on 126 patients (72 male and 54 female) whose abdominal CT scan was found normal and no disorder was diagnosed which alters the size of spleen to estimate normal linear dimensions of spleen in North Indian adult population. <b>Material & Methods : </b>Collected CT scan were evaluated with the help of Able 3-D doctor software. Body habitus of patients were determined. All linear dimension of spleen – length, width and thickness were calculated and they were analysed with body habitus – Age, height, weight,BSA (body surface area) and BMI (body mass index) was calculated by linear and non-linear regression model to know exact pattern of correlation. <b>Result :</b> The mean length, width and thickness of spleen were 10.67±1.62 cm, 6.26±1.66 cm and 4.86±1.22 cm respectively. <b>Conclusion :</b> All linear splenic dimensions have significant positive correlation with height of patients and normative data can be produced with the help of regression formula developed with the help of statistics which can be used as research tool where objective determination of splenomegaly is required. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=974-977&id=1548 https://doi.org/10.7860/JCDR/2011/.1548 Comparison of the Midazolam Transnasal Atomizer and Oral Midazolam For Sedative Premedication in Paediatric Cases Ramesh Koppal, Adarsh E.S., Uday Ambi, Anilkumar G. <b>Background:</b> The role of effective premedication in children is of utmost importance in the conduct of paediatric anaesthesia. Midazolam is a proven and safe sedative anxiolytic in the paediatric group. <b>Objective:</b> To evaluate the safety and effectiveness of Midazolam by the transnasal and oral routes for paediatric sedation. <b>Materials and Methods:</b> We evaluated 60 ASA grade I and II children who were randomized to receive either oral (0.5mg/kg)or transnasal (0.5mg/kg) midazolam. The demographic details, the sedation score and the separation score were noted by a blinded observer and were statistically analysed. <b>Results:</b> Both the routes were equally effective in achieving the adequate sedation and the separation scores. The transnasal route showed a faster onset of the adequate sedation scores. The oral route was better accepted by children. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=932-934&id=1550 https://doi.org/10.7860/JCDR/2011/.1550 Lipid Profile in ‘Newly Diagnosed’ and ‘On Treatment’ Hypothyroid RAVI SHEKHAR, SRINIVAS C.H., M.C. DAS <b>Introduction:</b> Primary hypothyroidism is a common disorder affecting a large group of population and is a cause of the secondary hyperlipidemia. The aim of the present study was to assess the relation between the lipid profile and thyroid profile in newly diagnosed hypothyroid, subjects on treatment for hypothyroidism and controls. <b>Materials and Methods:</b> The present study was performed on 150 subjects of both sexes between 11–78 years of age. The subjects were divided into three groups. First group was Controls (n = 50), second group was ‘Newly Diagnosed’ hypothyroid (n = 50) and the third group was hypothyroid patients‘On Treatment’ (n = 50). T3, T4, TSH, Total Cholesterol, High Density Lipoproteins (HDL), Low Density Lipoproteins (LDL) and Triglycerides were estimated. <b>Results:</b> ANOVA was calculated among the three groups. TSH, Total Cholesterol and LDL levels were decreased in “On treatment” group when compared to “Newly diagnosed” group. T4 was found to be elevated, but T3 remained low in “On treatment” group. <b>Conclusion:</b> Cholesterol and LDL levels are elevated in hypothyroidism and their levels decreases with treatment but not to the level of euthyroid state. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=998-1000&id=1551 https://doi.org/10.7860/JCDR/2011/.1551 Correlation of Quantitative Buffy Coat, Blood smear and Antigen Detection in Diagnosing Malarial Infection Binesh Lal Y., Jayakumar S., Kalyani M., Renu Mathew, Shameem Banu A.S., Dhinesh R. <b>Objective:</b> To correlate the diagnostic methods such as Quantitative Buffy coat (QBC), Blood smear and Antigen detection in diagnosing malarial infection. <b>Design:</b> A hospital based prospective study. <b>Place and Duration of Study:</b> Department of Microbiology, Saveetha medical college, Thandalam, Kanchepuram district. From April 2010 to September 2010. <b>Material and Methods:</b> A total of 572 blood samples from clinically suspected malaria patients were included in this study. All the samples were subjected to three different techniques suchas staining technique (thick and thin smear), antigen detection test and Quantitative Buffy Coat technique (QBC). <b>Results:</b> Among the 572 samples, 92 (16.08 %) samples were found to be positive for malarial parasite. Of the positive samples, 90 (97.82%) samples were positive by smear, 78 (84.78%) samples were positive by QBC, 69 (75%) samples were positive by antigen detection test. <b>Conclusion:</b> In conclusion we suggest using two diagnostic tools, antigen detection and smear in conjunction for the early diagnosis of malarial infection or use antigen detection as a primary test as well as a screening tool for obtaining a fast positive or negative result and confirming it with gold standard test. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=961-963&id=1552 https://doi.org/10.7860/JCDR/2011/.1552 Radiological evaluation of chest in Abdominal Tuberculosis Sujit Kumar Bhattacharyya, Abhijit Mandal, Sumitra Basu Thakur, Sumita Mukherjee, Samirendra Kumar Saha, Aloke Gopal Ghoshal. <b>Aim:</b> To evaluate the chest x-ray in all non-HIV patients with abdominal tuberculosis. <b>Methods:</b> Total 161 patients were studied who were retrospectively diagnosed as abdominal tuberculosis based on clinical examination and various biochemical, histopathological and radiological investigations . They were analyzed in the Department of Pulmonary Medicine of a tertiary medical centre during the period May 2005 to April 2010. All patients with abdominal tuberculosis were reviewed with x-ray chest both PA and Lateral view. <b>Results:</b> Total 161 patients were studied with x-ray chest PA and lateral view. In 63 cases (39.13%) there were no radiological abnormalities and 98 cases (60.87%) showed radiological abnormalities of which 49 cases (30.43%) had features consistent with old lesion and 49 cases (30.43%) had features of active lesions. Commonest old lesion was pulmonary fibrosis found in 21cases (13.04%) of which majority (80.95%) were solitary. Pleural thickening was found in 9 cases (5.59%), calcification of pleura in 8 cases (4.97%) and mostly in the left side. Calcified hilar lymphnode found in 2 cases (1.24%) and combination group under old lesion seen in 9 cases (5.59%).Commonest active lesion was pulmonary infiltrate seen in 25 cases (15.52 %) and majority ( 80%) were solitary. Pleural effusion found in 8 patients (4.97%) and was more common in the right side. Miliary opacities were found in 2 cases (1.24%). Isolated hilar and paratracheal lymphadenopathy were found in 1case (0.62%) and 2 cases respectively. Mediastinal widening was found in 2 cases (1.24%), cavitary lesion seen in 3 cases (1.86%) and all were found in upper zone and combination group with active lesions observed in 6 cases(3.72%). <b>Conclusion:</b> In our study ,more than 60% cases showed radiological abnormalities of chest. It was equal in number both for old lesion and active lesion. Pulmonary fibrosis was the commonest old lesion whereas pulmonary infiltrate was the commonest radiological abnormalities among active lesion .Diagnosis of abdominal tuberculosis often poses a challenge to the physicians. High degree of clinical suspicion is required and x-ray chest often helps to diagnose these cases. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=926-928&id=1554 https://doi.org/10.7860/JCDR/2011/.1554 An Interesting Case Report on Cerebellar and Psychiatric Manifestations in Malaria Mohammed Ashraf, Madhu Kumar, Smitha C. Saldanha, Veerendra K.H Malaria remains a major cause of morbidity and mortality worldwide. The classic presentation of malaria with paroxysms of fever is seen only in 50%–70% of the patients. The development of immunity, the increasing resistance to anti-malarial drugs, and the indiscriminate use of anti-malarial drugs have led to malaria with the presentation of unusual features. Cerebellar ataxia, extrapyramidal rigidity and various psychiatric symptoms have been described either as early manifestations of cerebral malaria or as a part of post malaria neurological syndrome. In this case report, we present a patient with mixed malaria, who developed bilateral cerebellar signs and a delayed onset of psychiatric manifestations, who responded to anti-malarial treatment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=1104-1105&id=1555 https://doi.org/10.7860/JCDR/2011/.1555 Leprosy in Chronic Lymphocytic Leukaemia: Rare Case Report Sudhakar Rao K.M., Jayashree Pawale, Ankad B.S., Varna Naidu, H.B. Kotbagi This is a case report of a rare chronic lymphocytic leukaemia with lepromatous leprosy. A fifty nine year old male presented with epistaxis and abdominal pain. Investigations revealed high leucocyte count of 72,600cells/cmm, a differential count of 89% lymphocytes and 11% polymorphs and a platelet count 13,000cells/cmm. The case was diagnosed as chronic lymphocytic leukaemia and pulse chemotherapy was started. Three months after the chemotherapy, the patient developed a painful, non-pruritic, tender nodule, which on biopsy, showed histiocytic granulomas in the dermis. AFB staining showed globi and fragmented baciili. The patient received treatment for both leukaemia and leprosy. After six months, the lesions are becoming faint. On follow up, the patient has been found to be recovering. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=1106-1108&id=1541 https://doi.org/10.7860/JCDR/2011/.1541 Intestinal Perforation due to Tapeworm: Taenia Solium Narayan Shrihari, Mariraj J., Kumudini T.S., Krishna S. The infestation with tapeworm is a major problem in many parts of the world. A majority of the patients are asymptomatic and do not have serious sequelae. However, sometimes they can cause serious problems like intestinal obstruction due to the entanglement of the worms and the migration of the segments, which may cause appendicitis and intestinal perforation. The infection with Taenia solium is caused due to the ingestion of under cooked pork meat which contains cysticercus cellulosae. The scolex is released after the digestion of the cysticercus which attaches to the intestinal mucosa and starts budding off segments. We received the tapeworm segments from the Department of Surgery. The segments were obtained during emergency exploratory laparotomy of a patient with intestinal perforation and the tapeworm segments were identified as that of Taenia solium in our laboratory. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=1101-1103&id=1535 https://doi.org/10.7860/JCDR/2011/.1535 Necrotizing Fasciitis of the Breast with Shock and Postpartum Psychosis Vishwanath G., Basarkod S.I., Geetanjali M. Katageri, Promod Mirji, Ashok S. Mallapur Necrotizing fasciitis (NF) is a rapidly progressive infection of skin and subcutaneous tissue with high morbidity. NF is frequently found with trauma, bites, surgery, IV drug abuse, diabetes and immune compromised patients. . NF involving the breast is not common. Delay in differentiating NF from puerperal mastitis leads to increased morbidity or loss of breast tissue to variable extent. We report a case of NF of the breast in shock with postpartum psychosis necessitating mastectomy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=1117-1119&id=1539 https://doi.org/10.7860/JCDR/2011/.1539 A Rare Presentation of Fatal Sacral Meningocele: A Case Report N. Bhimai Devi, B. Narasinga Rao A case of sacral meningocele presented as a diverticulum within the confines of a cystic enlargement found in a full term male foetus. The sacral meningocele does not cause any mortality, but in the present case the foetus is still born. This is the reason for taking up the case. An autopsy of the foetus revealed an extensive syringomyelia in the histological sections of the spinal cord at cervical, thoracic and lumbar segments. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=1089-1091&id=1532 https://doi.org/10.7860/JCDR/2011/.1532 Carcinoid of the Caecum with Osseous and Soft Tissue Metastases: A Rare Case Report Sanjukta Padhi, Lucy Pattanayak, Biswaranjan Routray, Debadipti Pradhan <b>Background:</b> The carcinoid tumour arises from the enterochromaffin cells of Kulchitsky at the base of the crypts of Leiberkuhn. Gastrointestinal (GI) carcinoids account for 95 % of all the carcinoids and caecal carcinoids account for 5 % of all the carcinoids. They remain silent and asymptomatic for years and many a times, are diagnosed intraoperatively, endoscopically or during autopsy, based on their histopathological findings. Malignant carcinoids metastasise to the liver and the lymph nodes, while bone and soft tissue metastasis have rarely been reported. We present here, a rare case of caecal carcinoid with bone and soft tissue metastasis. <b>Case Report:</b> A 47 year old female was admitted with pain in the abdomen in our hospital, 3 years back. Colonoscopy showed caecal pathology, for which resection and anastomosis was done. Her post operative histopathology revealed carcinoidof the caecum which invaded the subserosa with lymph node metastasis. She received adjuvant chemotherapy and presented to the OPD 3 years later, with swellings over the medial end of the right clavicle, the anterior chest wall and the node on the right side of the neck. FNAC from all these sites revealed metastatic carcinoid. She was treated with chemotherapy and palliative radiotherapy and has been asymptomatic for the past two years. <b>Conclusion:</b> Carcinoids are slow growing, indolent tumours and they may remain asymptomatic for years. Malignant carcinoids rarely metastasise to the bone and soft tissues. The present report adds to the literature, an interesting case of caecal carcinoid with osseous and soft tissue metastasis, besides highlighting the importance of histopathology in its diagnosis, as well as the role of chemotherapy and palliative radiotherapy in controlling the symptoms. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=1098-1100&id=1517 https://doi.org/10.7860/JCDR/2011/.1517 Isolated “Blow Out” Jejunal Perforation Following Blunt Abdominal Trauma- Experience of Two Cases B.V. Goudar, Uday Ambi, Y. Lamani, Sunil Telkar Small bowel injury following blunt abdominal trauma has been widely reported. Isolated jejunal perforation which is caused by blunt abdominal trauma is rare and is most often seen in road traffic accidents. Here, we present two cases of isolated jejunal perforation due to raised intra abdominal pressure in the form of abdominal tightening by the dhoti after it was caught in the belt of an engine and a fall from the stairs while stepping down. Explorative laparotomy revealed the slit-like perforation on the anti mesenteric border. Early surgical intervention led to good recovery in both the cases. A high index of suspicion, repeated clinical examination and the proper utilization of investigational tools definitely helped us in managing these kinds of rare cases. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=1120-1122&id=1514 https://doi.org/10.7860/JCDR/2011/.1514 Unilateral Cranio-Facial Cleft with an Open Encephalocele MANTRARATAM PRAMILA PADMINI, BHATTAM NARASINGA RAO Foetal craniofacial development is a complex series of events that occurs between the third and eighth weeks of gestation. Facial clefts are deformations of the face and/or cranium caused by relative excesses or deficits of tissue along linear anatomic planes. The present case was a stillborn female child of a 31yearold mother by caersarian route at 36 weeks’ gestation. It is a very rare case with an open encephalocele in the squamous part of the frontal bone with a unilateral craniofacial cleft extending up to the encephalocele and probably would be the first case to be reported. Although the precise aetiology is unknown, multiple genetic and environmental factors may be involved. The environmental risk factors implicated include antenatal exposure to radiation, viral infections, metabolic abnormalities, and teratogenic compounds. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=1086-1088&id=1515 https://doi.org/10.7860/JCDR/2011/.1515 An Unusual Case of Multifactorial Posterior Reversible Encephalopathy Syndrome (PRES) Rashmi Teresa Mathai, Smitha Bhat, K.S. Bhat Posterior Reversible Encephalopathy Syndrome (PRES) is a clinico-neuroradiological entity which is characterized by headache, vomiting, altered mental status, blurred vision and seizures which can be detected by neuroimaging, demonstrating white-gray matter oedema and involving predominantly the posterior region of the brain.1 We report a case of a hypertensive woman who presented with sepsis and Multi-organ Dysfunction Syndrome (MODS), underwent haemodialysis for acute kidney injury and subsequently developed PRES. She responded well to the treatment, as was evidenced by a complete resolution of her clinical and radiological findings. Vasogenic oedema due to the dysfunction of cerebral blood vessel autoregulation points towards the endothelium as the key factor in the pathogenesis of PRES in MODS, thus making it a potential therapeutic target. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=1114-1116&id=1511 https://doi.org/10.7860/JCDR/2011/.1511 Mucinous Cystadenocarcinoma of the Pelvicalyceal System: A Case Report with Review of the Literature Sulata M. Kamath, Vijaya V. Mysorekar, Prasad Mylarappa Primary, mucinous cystic neoplasms are extraordinarily rare tumours of the kidney, with very few case reports in the literature. We describe here, a case of a 42-year-old female who presented with abdominal pain and a mass. Nephrectomy showed an enlarged kidney which was replaced by a large, cystic mass, which was filled with mucin and with partial destruction of the renal parenchyma. Histopathological evaluation revealed a mucinous cystadenocarcinoma .The patient was doing well during the six month follow up period. We have reported the above described unusual form of cancer and have reviewed the literature. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=1095-1097&id=1512 https://doi.org/10.7860/JCDR/2011/.1512 Neurilemmoma Masquerading as Tonsillitis: A Case Report PIPLANI S., MANJARI M., SARIN V., LALIT M. Neurilemmoma, also known as schwannoma, is a benign neoplasm which originates from the Schwann cells which cover the myelinated nerve fibres. The most common site is the tongue while palatal schwannomas are even rarer. A case of schwannoma which was clinically diagnosed as a tonsillar mass (tonsillar hyperplasia) which caused obstructive symptoms in a young male child has been reported here. The patient presented with repeated episodes of sore throat, fever and difficulty in and pain on swallowing, of 6 months duration, along with a recent episode of high grade fever, which subsided with antibiotics. On local examination, it was observed that there was bilateral hypertrophy of the tonsils with congested pillars and that the right tonsil appeared to be more enlarged in size than theleft one. The right side anterior pillar could not be separately differentiated from the tonsil. The tonsilolingual sulcus on the right side was obliterated and it was assumed that the palatine tonsil was enlarged and intermingled with the lingual tonsil. Bilateral tonsillectomy was perfomed and the tissue was sent for histopathological examination. The right sided mass turned out to be Neurilemmoma. This case was worth reporting as it highlighted the importance of including schwanomma as an important differential diagnosis whenever a treating physician encountered a tonsillar mass or a mass of unexplained aetiology in the oral cavity, which caused a diagnostic dilemma. A detailed clinical history, physical examination, cytology and radiological assessment helps in differentiating schwanomma in such settings. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=1092-1094&id=1529 https://doi.org/10.7860/JCDR/2011/.1529 Ruptured Endometrioma Presenting as Acute Abdomen with Highly Raised Serum CA-125 Levels: A Case Report ANAGHA KAMATH A 35 yr old lady, para 2, living 2, with 2 previous caesarean sections, presented with the features of acute abdomen. The clinical and laboratory evaluations revealed a bilateral ovarian mass with solid and cystic components, with raised serum CA-125 levels and raised ESR. The differential diagnosis included abdominal or genital tuberculosis, secondary carcinoma of the ovaries and endometriomas. This case is being reported and discussed in detail, for which an emergency exploratory laporotomy was performed. The intraoperative features suggested the diagnosis of spontaneous peritonitis which was secondary to ruptured b/l ovarian endometriomas. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=1109-1110&id=1572 https://doi.org/10.7860/JCDR/2011/.1572 Intramedullary Tuberculomas of Cervical Spinal Cord in a Young Immunocompetent Patient: A Case Report Seshu Lakshmi Borra, Venkata Umakant Kodali, Mallikarjuna Rao Sanda, Rajeev Donepudi, Surendra Babu M. Spinal intramedullary tuberculosis is a rare form of tuberculosis. We report a rare case of intramedullary tuberculomas in cervical spinal cord in young immunocompetent patient with no evidence of tuberculosis elsewhere in the body. Magnetic Resonance Imaging (MRI) showed cervical cord edema and circumscribed lesions at C4-C5 level. The lesions showed conglomerate ring enhancement with central hypointensity on contrast enhanced MRI, suggestive of granulomatous etiology. Patient received anti-tuberculous treatment following which patient was symptom free and MRI showed complete resolution of the lesions. Intramedullary tuberculosis if diagnosed early, usually has good response to medical treatment preventing the need for surgical intervention. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=1111-1113&id=1562 https://doi.org/10.7860/JCDR/2011/.1562 Unusual Clinical Presentation of a Case of Localized Plasma Cell Gingivitis Shruthi S., Sheela Kumar Gujjari, Usha Hegde, Veerendra Kumar S.C. Plasma cell gingivitis, which is also called atypical gingivitis or plasma cell gingivostomatitis, is a rare benign inflammatory condition of unknown aetiology. It presents clinically as a diffuse, erythematous and papillary lesion of the gingiva, which frequently bleeds, with minimal trauma. This is a case report of a 57 year old female patient, where dental plaque was the aetiological factor for plasma cell gingivitis with an unusual presentation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=1125-1127&id=1543 https://doi.org/10.7860/JCDR/2011/.1543 Caution! We Are Erupting As Twins R. VEERAKUMAR, M. ARUL PARI, M.N. Prabhu The phenomenon of tooth fusion arises through union of two normally separated tooth germs, and depending upon the stage of development of the teeth at the time of union, it may be either complete or incomplete. On some occasions, two independent pulp chambers and root canals can be seen. Fusion occurs infrequently but could cause esthetic, spacing and a periodontal problem. The purpose of this article was to present a clinical case where fusion is present. The present article highlights the presence of a primary double tooth and also the fusion of permanent successors in the maxillary anterior region. These cases necessitate careful examination and treatment planning as they may be associated with anomalies in the succeeding permanent dentition. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=1123-1124&id=1544 https://doi.org/10.7860/JCDR/2011/.1544 Retention in Conventional Fixed Partial Dentures: A Review Siddharth Narula, Vikas Punia, Meenakshi Khandelwal, Vivek Sharma, Sonal Pamecha The long-term clinical outcome of fixed prosthodontic treatment depends on guidelines that promote the creation of mechanically, biologically, and aesthetically sound tooth preparations. Successful tooth preparation and success of subsequent restoration depend on important factors like retention and resistance form. The quality of a preparation that prevents the restoration from becoming dislodged by such forces parallel to the path of withdrawal is known as retention. For good retention in fixed prosthesis, there are various factors starting from the size of the teeth, magnitude of dislodging forces, geometry of tooth preparation, roughness of fitting surface, cement to be used and the film thickness of luting agent. The purpose of this article is to review and enumerate all the retention factors, which are necessary to increase the clinical longevity of the restoration that could be considered permanent in the traditional sense. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=1128-1133&id=1582 https://doi.org/10.7860/JCDR/2011/.1582 OSCE in Pathology Monika Gupta , Ankit Seth, Jamila Rose, B.O.Parijatham https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=1134-&id=1574 https://doi.org/10.7860/JCDR/2011/.1574 Errata : Naveen K. Kansal, Omna Chawla, Amandeep Singh, Prithpal S. Matreja. The cutaneous adverse effects of lithium. Journal of Clinical and Diagnostic Research. 2011 June, Vol-5(3): 570-572 The Editor, Journal of Clinical and Diagnostic Research This is with reference to the article (published in JCDR, June 2011): Naveen K. Kansal, Omna Chawla, Amandeep Singh, Prithpal S. Matreja. The cutaneous adverse effects of lithium. Journal of Clinical and Diagnostic Research. 2011 June, Vol-5(3): 570-572 In this connection, Readers are informed that the authors’ particulars are misprinted: [AUTHOR(S): 1. Dr. Naveen K Kansal 2. Dr. Omna Chawla 3. Dr. Amandeep Singh 4. Dr. Prithpal S Matreja PARTICULARS OF CONTRIBUTORS: Department of Pharmacology, Gian Sagar Medical College and Hospital, Ramnagar, Patiala, India] Correct Author particulars should be read as following.: AUTHOR(S): 1. Dr. Naveen K Kansal* 2. Dr. Omna Chawla** 3. Dr. Amandeep Singh§ 4. Dr. Prithpal S Matreja§ PARTI CULARS OF CONTRIBUTORS: *Consultant Dermatologist, Panchkula, India **Department of Physiology §Department of Pharmacology, Gian Sagar Medical College and Hospital, Ramnagar, Patiala, India Editors JCDR https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2011&month=October&volume=5&issue=5&page=1135-&id=1579 https://doi.org/10.7860/JCDR/2011/.1579