Journal of clinical and diagnostic research https://www.jcdr.net/back_issues.asp JCDR Anatomical Variations in the Emergence of the Cutaneous Nerves from the Nerve Point in the Neck and Identification of the Landmarks to Locate the Nerve Point with Its Clinical Implications: A Cadaveric Study on South Indian Human Foetuses Chandni Gupta, Antony Sylvan D’Souza, Biswabina Ray <b>Objective:</b> The cutaneous nerves from the cervical plexuses are anaesthetized by using local anaesthetics for pain relief or when minor surgical operations are performed. Knowing the variations in these nerves is important for anaestheticists to administer an effective anaesthesia to a particular nerve. So, the aim of this study was to look for the variations in the emerging patterns of the cervical cutaneous nerves in the neck and to locate the nerve point in the neck by using the superficial landmarks. <b>Materials and Methods:</b> The neck was dissected in 16 foetal cadavers (total 32). The foetuses were divided into 2 groups, depending upon their ages- group 1 (13-24wks) and group 2 (24-38wks). The cervical cutaneous nerves were dissected. Measurements for locating the nerve point, were taken in both the groups. <b>Results:</b> The statistical analysis of the measurements was done. In group 1, the mean distances of the nerve point from the External Acoustic Meatus (EAM), on the right and left sides, were 2.06cm and1.85cm and in group 2, the distances on the right and left sides were 2.32cm and 2.08cm. The mean distance of the nerve point from the clavicle in group 1, on both the right and the left sides was 1.85cm, and in group 2, the mean distances on the right and left sides were 2.67cm and 2.62cm. The variations in the cutaneous nerves which emerged from the nerve point were recorded and photographed. <b>Conclusion:</b> These landmarks will help the anaestheticists in locating the nerve point. These variations in the branches of the cervical plexus should be known to the anaestheticists while they give anaesthesia to a particular nerve during a nerve block. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=413-417&id=2787 https://doi.org/10.7860/JCDR/2013/.2787 A Study on the Accessory Head of the Flexor Pollicis Longus Muscle(Gantzer’s Muscle) Gunnal S.A., Siddiqui A.U., Daimi S.R., Farooqui M.S., Wabale R.N. <b>Introduction:</b> The present study was planned to analyze the Accessory Head of the Flexor Pollicis Longus muscle’ (AHFPL) or Gantzer’s muscle and its incidence. It is an additional muscle in the forearm which might cause pressure symptoms to the underlying structures, especially to the anterior interosseus nerve. <b>Materials and Methods:</b> This study was performed on 180 upper limbs (90 right and 90 left). The morphology and the morphometry of AHFPL was done. In this investigation, we observed the various shapes, origins, insertions, nerve supplies and relations of the muscle. <b>Observations and Results:</b> The incidence of the accessory head of the flexor pollicis longus muscle was seen in 92 cases (51.11%). It was found bilaterally in 66 (71.73%) cases and unilaterally in 26 cases (28.26%), among which, in 16, it was seen on the right side and in 10 on the left side. With the increasing incidence of the Gantzer’s muscle, one can call it as an evolutionary muscle. <b>Conclusion:</b> The present study supplements the knowledge on the morphology of AHFPL muscle and its relationship with the anterior interosseus nerve. An increased incidence of this muscle may be the causative factor for the complete anterior interosseous nerve syndrome. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=418-421&id=2788 https://doi.org/10.7860/JCDR/2013/.2788 Morphometry of the Iliolumbar Artery and the Iliolumbar Veins and Their Correlations with the Lumbosacral Trunk and the Obturator Nerve Chandrika Gurulingappa Teli, Nilesh Netaji Kate, Usha Kothandaraman <b>Objectives:</b> To reveal the variations of the iliolumbar artery and the iliolumabar veins and their correlation with the surrounding important structures. <b>Methods:</b> We dissected the iliolumbar region bilaterally in 20 formalin-fixed adult cadavers. The diameter of the iliolumbar artery at its origin, its length up to the branching point, the distance between the iliolumbar artery and the inferior margin of the fifth lumbar vertebra and the distance between the iliolumbar artery and the bifurcation point of the common iliac artery, were measured. The pattern of drainage, the dimensions, the points of confluence with the common iliac vein and the obliquity of the iliolumbar vein were noted. The correlation between the iliolumbar artery and the veins to the obturator nerve and the lumbosacral trunk was recorded. <b>Results:</b> The iliolumbar artery originated from the posterior trunk of the internal iliac artery or from the internal iliac artery. The mean diameter of the iliolumbar artery, at its origin, was 3.5±0.5 mm. The mean distance between the origin of the iliolumbar artery and the bifurcation point to the iliac and the lumbar branches was 12.2±5.5 mm. The distance between the origin of the iliolumbar artery and the lower edge of the fifth lumbar vertebra was 43.2±11.6 mm. The distance between the origin of the iliolumbar artery and the bifurcation point of the common iliac artery was 38.7±10.6 mm. The mean distance of the iliolumbar veins from the inferior vena cava, overall, was 35± 9.9 mm. The mean width of the mouth of the iliolumbar vein was10.7 ± 5.1 mm and the mean angle of obliquity of the vein with respect to the long axis of the common iliac vein was 75.50. The tributaries which drained into the main iliolumbar vein were variable. The iliolumbar artery passed anterior in 70% and it passed posterior to the obturator nerve in 30%. The veins were lying anterior to the obturator nerve in 45% and they were lying posterior in 55%. The multiple tributaries which drained into the iliolumbar vein relation of the tributaries were variable, few passed anterior and few passed posterior. The iliolumbar artery was seen anterior to the lumbosacral trunk in 30%, it was posterior in 54%, it was cleaved in 8% and the branches of the artery were passing on either side of the lumbosacral trunk to enclose it like a clasp in 8%. The veins were anterior to the lumbosacral trunk in 40% and they were posterior in 60%. <b>Conclusion:</b> The anatomical features of the iliolumbar artery, the iliolumbar veins and their correlation with the anatomical landmarks, which were presented here, would be helpful in decreasing the iatrogenic trauma to the neurovascular structures in the iliolumbar region. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=422-426&id=2789 https://doi.org/10.7860/JCDR/2013/.2789 An Anatomical Study on the Foramen Ovale and the Foramen Spinosum Karan Bhagwan Khairnar, Prashant Amanrao Bhusari <b>Introduction:</b> An anatomical study was undertaken to note the shape of the foramen ovale(FO), foramen spinosum (FS) & presence or absence of canalis innominatus. FO is present in the posterior part of the greater wing of sphenoid. FS is located posterolareral to foramen ovale. <b>Aims & Objective:</b> We attempted this study to find out the variations in shape, bony growth & divisions of FO & FS in available dry human skulls. <b>Material & Methods:</b> We studied 100 human skulls available in the Department of Anatomy MVPS Medical College, Nashik. This study of FO & FS was done in both male & female skulls. <b>Observation & Results:</b> We found oval, round, almond, triangular shaped FO. Variations in the shape of FO showed the maximum as oval shaped followed by almond, round & slit like. <b>Conclusion:</b> FO is of great surgical & diagnostic importance in procedures like percutaneous trigeminal rizotomy in trigeminal neuralgia, transfacial fine needle aspiration technique etc. Considering such clinical importance of FO & FS, this study was worthwhile as far as neurosurgeons are concerned. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=427-429&id=2790 https://doi.org/10.7860/JCDR/2013/.2790 Semmelweis’s Forgotten Gift: Has Handwashing Lost Its Importance? Yashasvi Chugh, Shrikala Baliga <b>Background and Objectives:</b> The hands harbour a kaleidoscope of bacteria, thus making hand washing an essential attribute in preventing the transmission of nosocomial pathogens. Medical students, as a part of their curriculum, are taught about handwashing. However, their adherence to it is doubtful. This study was carried out to ascertain the impact of educating medical students about the correct technique of handwashing and its role in reducing the bacterial contamination of their hands. <b>Methods:</b> The hands of 50 medical students who attended the clinical postings were screened for bacterial colonisation. Following their screening, 30 students who had the highest colonization of bacteria were followed up for a second round of sampling. They were further allotted into two arbitrary groups: the control group and the test group. The procedure for an adequate handwash was taught to the test group, whereas the control group had been taught it as a part of their clinical curriculum during their postings. Each student’s hands were sampled, both preceding and following a handwash. <b>Results:</b> Following the handwashing, the students of the test group had a significantly (p=0.011) lower mean bacterial colonization on their hands, in contrast to the control group. Moreover, 86.7% of the students from the control group harboured Staphylococcus aureus even after handwashing, whereas only 40% of the test group students had it. The preliminary screening concluded that: (i) Females harboured a significantly greater (p=0.038) bacterial colonization on their hands than males.(ii) The students who wore rings showed a higher contamination (p=0.05. <b>Interpretation and Conclusion:</b> This study revealed that the students of the test group were at an advantage, as they had been given immediate prior instructions, whereas the control group had been taught the same technique at their clinical postings and were not instructed preceding the handwash and the sample collection. It can be concluded that a prior instruction in the form of teaching or visual aids such as posters etc., regarding the method of handwashing, is essential for an effective handwash, regardless of the past teaching. The instruction that is imparted to the students as a part of their curriculum needs reinforcement. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=434-436&id=2792 https://doi.org/10.7860/JCDR/2013/.2792 The Baseline Widal Titre Among the Healthy Individuals of the Hilly Areas in the Garhwal Region of Uttarakhand, India Shekhar Pal, Rajat Prakash, Deepak Juyal, Neelam Sharma, Amit Rana, Sandeep Negi <b>Introduction:</b> Typhoid fever is endemic in all parts of India and the Widal test is widely used for its diagnosis. In the endemic areas, the healthy people may contain antibodies which are capable of reacting upto a variable titre in the Widal test, due to a past exposure, TAB vaccination and cross reacting antigens. Therefore it varies widely from place to place and is referred to as the baseline titre of that area. The aim of this study was to determine the average baseline titre of the apparently healthy population in the Garhwal region of Uttarakhand, India. <b>Material and Methods:</b> Blood samples were collected from healthy volunteers over the period from February 2011 to January 2012 and they were analyzed for the presence of the Salmonella antibodies by carrying out the Widal tube agglutination test. <b>Results:</b> Among the 2164 serum specimens which were tested, 922 (42.6%) sera were found to be positive for the Widal test and 1242 were negative. The most frequently recorded titre of the reactive sera was 1:40 for the anti-O antibodies and it was 1:80 for the anti-H antibodies and this was the baseline titre for this region. <b>Conclusion:</b> Based on the above results of our study, it has been recommended that the cut-off titre of 1:80 for the anti-O antibodies and of 1:160 for the anti-H antibodies may be considered as diagnostic for enteric fever in the Garhwal region of Uttarakhand, India. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=437-440&id=2793 https://doi.org/10.7860/JCDR/2013/.2793 The Bacteriology of Diabetic Foot Ulcers, with a Special Reference to Multidrug Resistant Strains Priyadarshini Shanmugam, Jeya M, Linda Susan S <b>Introduction:</b> A diabetic foot infection is one of the most feared complications of Diabetes mellitus. Many studies have reported on the bacteriology of Diabetic Foot Infections (DFIs) over the past 25 years, but the results have been varied and often contradictory. <b>Aims and Objectives:</b> This study was carried out to determine the bacterial profiles of infected ulcers and the antibiotic resistance pattern of the isolates. <b>Materials and Methods:</b> Samples were collected from 50 patients with diabetic foot ulcers by using sterile swabs and they were processed. <b>Results:</b> A total of 75 bacterial isolates were obtained from 50 patients with diabetic foot ulcers. The age group of these patients ranged from 35 to 80 years and the maximum number of patients was in the age group of 60 to 65 years. Gram negative bacilli were more prevalent (65.1%) than gram positive cocci (34.9%). The commonest isolate was Pseudomonas spp (16%), followed by Escherichia coli (14.6%) and Staphylococcus aureus (13.3%).The antibiotic sensivity profiles of the bacteria were also studied. 37.5% of the gram negative bacilli were ESBL producers and 31% were carbapenemase producers. <b>Conclusion:</b> This study showed a preponderance of gram negative bacilli among the isolates from the diabetic foot ulcers. Knowledge on the antibiotic sensitivity pattern of the isolates will be helpful in determining the drugs for the empirical treatment of diabetic ulcers. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=441-445&id=2794 https://doi.org/10.7860/JCDR/2013/.2794 The Prevalence of Group A Streptococci Carriers Among Asymptomatic School Children Vijaya D, Sathish JV, Jankiram K <b>Aim:</b> The Group A Streptococci (GAS) cause several suppurative and nonsuppurative infections. GAS frequently gets colonized in the throat of asymptomatic school children. A preliminary study was conducted to identify the GAS carrier state in apparently healthy children who belonged to various schools which were located in and around the rural village, B.G.Nagara, Mandya Dist, Karnataka state, India. <b>Material and Methods:</b> Throat swabs were collected from 2000 asymptomatic school children who were aged 5-15 years. The beta haemolytic streptococci isolates were sero-grouped by agglutination tests by using specific antisera (HiStrep Latex Test, Hi-Media, Mumbai, India. <b>Results:</b> Out of the 44 (2.2%) beta haemolytic Streptococci which were isolated, 38 (86.36%) were GAS, 5 (11.36%) were Group C Streptococci and one (2.27%) was Group G Streptococcus. Among the 38 GAS positive children, 24 (63.16%) were transient carriers, 10(26.32%) were recurrent carriers and 4 (10.52%) were chronic carriers. The GAS chronic carriers were of the age group of 9-12 years. <b>Conclusion:</b> The present study showed the prevalence of GAS among the asymptomatic school children in this location. The chronic carriers were treated with azithromycin for 3 days. A bacteriological cure was confirmed by doing throat swab cultures at intervals of one month and four months after the treatment. Identification of the GAS carriers and treating them, not only prevents them from developing non -suppurative complications, but they also prevent the spread of GAS to their family members and other children. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=446-448&id=2795 https://doi.org/10.7860/JCDR/2013/.2795 Multidrug-Resistance and Extended Spectrum Beta-Lactamase Production in Uropathogenic E. Coli which were Isolated from Hospitalized Patients in Kolkata, India Mandira Mukherjee, Shreya Basu, Sandip Kumar Mukherjee, Monalisa Majumder <b>Background and Objective:</b> Urinary Tract Infections (UTIs) are mostly caused by Escherichia coli. The appropriate therapy demands a current knowledge on the antimicrobial susceptibility pattern amongst these pathogens, as an inappropriate use of antibiotics may lead to complications and treatment failure. The UTIs which are caused by multidrug resistant Extended-Spectrum Beta-Lactamase (ESBL) producing bacteria further pose a severe problem, as the treatment options are limited. The aim of this study was to identify the pattern of multi drug resistance amongst the uropathogenic E. coli (UPEC) isolates which were obtained from hospitalized patients. <b>Materials and Methods:</b> Forty UPEC were isolated from 200 urine samples of hospitalized patients who were clinically suspected for UTIs. Antimicrobial susceptibility screening was performed by using 16 antibiotics, by the Kirby Bauer disk diffusion technique. The isolates which were resistant to the third generation cephalosporins were subjected to the ESBL confirmatory test by using drug and drug-inhibitor combination disks by following the CLSI guidelines. <b>Results:</b> All the 40 isolates except three were multidrug resistant. They showed the highest sensitivities for nitrofurantoin (72.5%) and amikacin (70%). A high level of resistance was observed against ampicillin (97.5%), nalidixic acid and cefelexin (95%), amoxicillin (92.5%), cotrimoxazole (82.5%) and ciprofloxacin (80%) respectively. Thirty different antibiotic resistance patterns were observed against the different antibiotics. Twenty-eight out of the 40 isolates were resistant to the third generation cephalosporins. However, the phenotypic test for the ESBL confirmation indicated that eighteen out of the twenty-eight isolates were ESBL producers and that eleven different drug resistance patterns were observed amongst them. <b>Conclusions:</b> Therefore, this study accounts for the varied multidrug resistance pattern amongst the uropathogenic E. coli which were isolated from hospitalized patients in Kolkata, an eastern region of India. Nitrofurantoin and amikacin should be assigned as potent drugs to treat this infection in this region of the country. These varied resistance patterns present major therapeutic and infection control challenges and they suggest a heterogeneous population of the uropathogenic E. coli isolates which circulate in this sector of India. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=449-453&id=2796 https://doi.org/10.7860/JCDR/2013/.2796 The Prevalence of Intestinal Parasitic Infestation and the Related Profile of the CD4+ Counts in HIV/AIDS People with Diarrhoea in Jaipur City Nitya Vyas, Smita Sood, Babita Sharma, Munesh kumar <b>Introduction:</b> Gastrointestinal Tract (GIT) infections are among the most frequent infections in HIV/AIDS patients. The intestinal opportunistic parasitic infections in HIV-infected subjects present most commonly as diarrhoea. A study was conducted to determine the prevalence of enteric parasitic infections in HIV infected patients with diarrhoea, with different levels of immunity. <b>Methods:</b> This study was carried out at the HIV Lab of the Microbiology Department of a tertiary care teaching hospital in Jaipur, Rajasthan, between June–October 2009 among consecutively enrolled 75 HIV infected patients who presented with diarrhoea. Stool samples were collected and examined for enteric parasites by using microscopy and special staining methods. The CD4 + cell counts were estimated by using the FACS count system. <b>Results:</b> Intestinal parasitic pathogens were detected in 38.66% patients, Cryptosporidium species was the most common enteric opportunistic parasite which accounted for 37.93 % of the total parasites, followed by Isospora belli 31.03 %. In the HIV infected patients with CD4+ counts of < 200 cells/µl, parasites were identified in 56.25 % patients and in HIV patients with CD4+ counts between 200-499 cells /µl, parasites could be identified in 27.5 % of the patients . No parasite was detected in the patients with CD4 + counts of >500 cells/ µl. <b>Conclusion:</b> Parasitic infections were detected in 38.66% HIV infected patients with diarrhoea and a low CD4+ count was significantly associated with opportunistic infections. Identification of the aetiological agent of diarrhoea in an HIV patient is very important, as it can help in the institution of the appropriate therapy and the reduction of the morbidity and the mortality in these patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=454-456&id=2797 https://doi.org/10.7860/JCDR/2013/.2797 The Clinical, Serological and Molecular Diagnosis of Emerging Dengue Infection at a Tertiary Care Institute in Southern, India Mamidi Neeraja, Vemu Lakshmi, P.K. Dash, M.M. Parida, P.V.L. Rao <b>Introduction:</b> Dengue is an acute viral infection which presents as uneventful pyrexia to a fatal complication. This infection is increasingly being recognized as the world’s major emerging tropical disease and an important public health problem. This article highlights the clinical manifestations of Dengue virus infection and the various molecular tests that were used for its laboratory diagnosis. <b>Methods:</b> Serum samples from 713 suspected cases of Dengue were collected between August and December 2007. The clinical profiles of 123 hospitalized patients were analyzed. Serology, RT- PCR, virus isolation and sequencing were done. <b>Results:</b> The most common clinical symptoms were fever, thrombocytopenia, rash and elevated liver enzymes. The demonstration of the Dengue RNA in 5.16% samples, the detection of Dengue specific IgM antibodies in 18% samples and the isolation of the DENV-4 and the DENV-3 viruses from the clinical samples confirmed this Dengue outbreak. A co -infection with Chikungunya was observed in 2.06% of the cases. The phylogenetic analysis revealed that the Indian Dengue-4 isolates from this outbreak belonged to the genotype I. This study clearly indicated the sudden dominance of DENV-4 in an Indian Dengue outbreak. <b>Conclusion:</b> The surveillance of the Dengue viruses needs to be closely monitored for the emergence of newer serotype(s) in hitherto unknown areas. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=457-461&id=2798 https://doi.org/10.7860/JCDR/2013/.2798 The Patients’ Adherence and Adverse Drug Reactions (ADRs) which are Caused by Helicobacter Pylori Eradication Regimens Mohammad Abbasinazari, Zahra Sahraee, Maryam Mirahmadi <b>Background:</b> Helicobacter pylori is a major cause of upper gastrointestinal disorders. The eradication of H. pylori has been recommended for the treatment of different gastrointestinal diseases. Notwithstanding, a combination therapy is needed for Helicobacter pylori eradication, but using these medications can be the cause, the incidence risk of patients’ adherence to treatment regimens reduction and probably increase risk of Adverse Drug Reactions (ADRS), so, it is seem that evaluation the out come of combination therapy is need more than the past. <b>Aim:</b> The aim of present study was to determine the patients’ adherence to the treatment and the ADRs with five eradiation regimens. <b>Setting and Design:</b> A cross sectional study was done in a well known referral clinic of gastrointestinal disorders in Tehran, Iran. <b>Methods and Materials:</b> 90 patients were evaluated the study (18 in each of the five regimens). The adherence to the treatment and the ADRs of the patients were asked during the treatment, twice, by doing telephone assays. <b>Statistical Analysis Used:</b> The data were analyzed by using the SPSS, 17 software and the statistical significance was accepted for the P values of 0.05. <b>Results:</b> 81% of the patients had a good adherence and there was no significant difference between the types of regimens (triple or quadruple therapy) and the adherence to the treatment regimens by the patients (p=0.6). Also, we found that there was no significant relationship between the types of regimens and the sex (p=0.99), education level (p=0.99), accommodation (p=0.93), an existence of underlying disease (p=0.86) and the concurrent use other medications (p=0.93). But there was a significant relationship between the patients’ age and adherence to the treatment regimens (p=0.008). The most reported ADRs belonged to gastrointestinal (GI) disorders (an abnormal taste had the most prevalence (36.6%) among the GI disorders). There was no significant relationship between the regimen type and the GI ADRs, (p=0.48). <b>Conclusion:</b> The findings of this study showed that the patients’ adherence to the treatment regimens and the ADRs did not have a significant relationship with the various eradication regimens for H.pylori. It seems that the type of H. pylori eradication regimen may not be an important factor in the patients’ adherence to the treatment regimens and the ADRs. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=462-466&id=2799 https://doi.org/10.7860/JCDR/2013/.2799 The Pattern of Drug Use in Acute Fever by General Practitioners (GPs) in Pune City, India Shirish Gajanan Beri, Vijaya Anil Pandit, Kapil Shatrughn Khade, Kushal Dilip Sarda <b>Objectives:</b> 1) To determine the WHO Prescribing Core Drug Use (PCDU) indicators in the management of acute fever (of less than 2 weeks duration) of the MBBS (allopathic) and BAMS (ayurvedic) General Practitioners (GPs) in Pune city. 2) To verify the appropriateness of the treatment. and 3) To compare the above parameters of the MBBS and the BAMS practitioners. <b>Methods:</b> Pune city was divided in five zones, north, south, east, west and central. A list of doctors was obtained from the Indian Medical Association and it was divided zone wise. 2 MBBS and 2 BAMS GPs. were selected per zone. An informed consent was obtained from the GPs. The sample size was 20 encounters per GP. The patients of all ages and both sexes, who suffered from fever of less than 2 weeks duration, were included in the study. The indicators which were studied were 1) the WHO Prescribing Core Drug Use indicators and 2) the complimentary drug use indicators for the appropriateness of the treatment. <b>Results:</b> 1) The age, sex and diagnosis wise distribution of the patients was comparable in both the groups. 2) Among the WHO PCDU indicators, a highly significant difference was observed in the average number of drugs which was prescribed, the antibiotic usage and in the injections which were prescribed among the MBBS and the BAMS GPs 3) The use of the drugs from EDL and that of the generic drugs were comparable in both the groups.4) A marked irrationality was found in the injectable antimicrobials by the BAMS GPs.5) The selection of the antimicrobials was inappropriate in 64.14% and 17.5% of the encounters which were made by the BAMS and the MBBS GPs respectively. <b>Conclusion:</b> Among the BAMS GPs: the WHO prescribing core drug use indicators were all significantly abnormal and the percentage of the inappropriate prescriptions was alarmingly high (92%). <b>Among the MBBS GPs:</b> There was more use of the antimicrobials but the proportion of the inappropriate prescriptions was less (42%). https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=467-472&id=2800 https://doi.org/10.7860/JCDR/2013/.2800 Changes in Megakaryocytes in Cases of Thrombocytopenia: Bone Marrow Aspiration and Biopsy Analysis Tejinder Singh Bhasin, Sonam Sharma, Mridu Manjari, Rahul Mannan, Vandana Kansal, Manish Chandey, Sanjay Piplani <b>Background:</b> Thrombocytopenia (platelet counts less than 150,000/µl) is commonly encountered in various hematological disorders including myelodysplastic syndromes as well as various non-myelodysplastic hematological conditions. <b>Aim:</b> The present study was undertaken to calculate the prevalence of various conditions associated with thrombocytopenia and to record the megakaryocytic alterations in various cases of thrombocytopenia. Apart from this by means of statistical analysis it was tried to analyze whether a significant difference existed in megakaryocytic alteration noted in myelodysplastic versus non- myelodysplastic conditions. <b>Materials and Methods:</b> A prospective series of 60 bone marrow aspirations along with concomitant bone marrow biopsies was conducted in a tertiary care centre catering to both urban as well as rural population in north India. <b>Statistical Analysis:</b> The distribution of morphological changes in cases of non myelodysplastic conditions and myelodysplastic were compared using Chi-Square test. A p-value less than 0.05 was considered significant. <b>Results:</b> The commonest cause of thrombocytopenia for which bone marrow examination was sought was dimorphic anaemia (18 cases, 30%), followed by myelodysplastic syndrome (06 cases, 10%) which was followed equally by acute lymphocytic leukemia and blast crisis of chronic myeloid leukemia (CML). Of all the non-MDS conditions apart from dimorphic anaemia, idiopathic thrombocytopenic purpura and chronic myeloid leukemia (blast crisis); megakaryocytic dysplastic forms were not noted in any other condition. In cases of myelodysplasia; dysplastic forms, bare megakaryocytic nuclei, hypogranular forms and micromegakaryocytes were seen. Comparison between frequencies of normal, high and low number of nuclear lobes among MDS (n=9) and non MDS (n=68) conditions were found to be statistically significant. <b>Conclusion:</b> Further studies on the evaluation of megakaryocytic alteration and their contribution to thrombocytopenia can provide growing knowledge to the pathogenesis of numerous hematopoietic disorders that may identify broader clinical applications of the newer strategies to regulate platelet count and functioning. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=473-479&id=2801 https://doi.org/10.7860/JCDR/2013/.2801 The Diagnostic Significance of the Holter Monitoring in the Evaluation of Palpitation Badri Paudel, Klara Paudel <b>Purpose:</b> To determine the diagnostic yield of the 24-hour Holter monitoring in the patients who were evaluated for palpitations. <b>Methods:</b> A prospective, single-centre study was performed to evaluate the diagnostic yield of the Holter monitoring. The inclusion criteria was age greater then 18 years with the symptom of unexplained recurrent palpitations. The exclusion criteria was patients with known medical causes of palpitation, a history of documented arrhythmias, or a history of or the current use of anti-arrhythmic drugs. The outcomes included a diagnostic Holter monitor recording. <b>Results:</b> The data analysis of the 335 patients who were studied, showed that there were 160 (47.8%) females and 175 (52.2%) males with a mean age of 55± 18.85 years (18 to 90 years). Ventricular ectopics as bigeminy in 36.7% patients and as couplets in, were detected. Non-sustained VT was detected in 5.7% patients, VT was detected in 0.9% cases and SVT was detected in 12.5% cases. 3.58% cases had paraxosymal atrial flutter/fibrillation. The ST segment shift which is suggestive of silent ischaemia, was present in 17.6% of the study population. Second or higher degrees of AV blocks were noted in 2 cases, while one patient had the WPW syndrome. Ventricular bigeminy, couplets, VT,SVT and AF were statistically significant in the patients who were over the age of 50 years as compared to those who were less than 50 years. <b>Conclusion:</b> In patients with non-specific symptoms, Holter monitoring has a significant role in the primary diagnosis of myocardial ischaemia or arrhythmia as a cause of such symptoms in the older age groups. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=480-483&id=2802 https://doi.org/10.7860/JCDR/2013/.2802 The Use of the Mini-Mental State Examination and the Clock-Drawing Test for Dementia in a Tertiary Hospital Khaled Sallam, Mostafa AMR <b>Introduction:</b> An early and a quick identification of dementia is desirable to improve the overall care to the affected persons in the developing countries. The aim of this study was to evaluate the discriminative abilities of the Mini Mental State Examination (MMSE) and the Clock Drawing Test (CDT) in differentiating the demented patients from the controls and also the differentiation between the different types of dementia. <b>Patients and Methods:</b> This study was designed to evaluate the patients with varied types and severities of dementia, who were diagnosed by using the Clinical Dementia Rating (CDR) scale. All the patients completed the MMSE and the simplified CDT. <b>Results:</b> This study included 197 patients with an age range of 43-79 years. Fifty-one patients (25.9%) were diagnosed with Alzheimer Dementia (AD), 37 patients (18.8%) with Vascular Dementia (VD), 23 patients (11.7%) with Parkinson’s Disease Dementia (PDD) and 86 patients (43.6%) with other variants of dementia. The total MMSE score of the enrolled patients was significantly lower as compared to that of the control subjects, with a non-significant difference between the varied diagnoses. The total CDT scores were significantly lower in the patients as compared to those in the controls, with significantly lower scores in the PDD group as compared to those in the AD group. The patients who had AD showed non-significantly higher CDT scores as compared to the patients who had vascular and other types of dementia. <b>Conclusion:</b> A combined application of both MMSE and CDT can identify the persons with a cognitive affection and this may be a useful tool for the diagnosis of the non Alzheimer’s type of dementia. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=484-488&id=2803 https://doi.org/10.7860/JCDR/2013/.2803 Alcohol Expectancy Responses from Teenagers: The Early Forewarning Signals Sandhya B., Carol B.M.S., Kotian M.S., Ganaraja B. <b>Background:</b> The Indian population is overwhelmed by the rapid developmental activities in the new millennium. This has brought in urbanization and several banes of the faster life. Alcoholism is one among the menaces which have to be tackled at an early stage. <b>Objective:</b> To assess the subjective expectancies from alcohol intake in young college students. <b>Methods:</b> We carried out a survey on the expectancy from youth of the alcohol effects, which in fact is known as the principal motivator of alcohol intake. We chose the pre-university students (n= 200; 100 males and 100 females) of one of the oldest and prestigious colleges of Mangalore (south India). The survey used the Comprehensive Effect of Alcohol (CEOA) where the students had to respond to two sets of 38 questions, in which they would mention whether they agreed or disagreed to the statement regarding the effects of alcohol intake. <b>Results:</b> From the results, we found that these young students were in agreement of the view that alcohol could cause a positive reinforcement. They also strongly agreed that alcohol consumption could cause negative effects. This was significantly more pronounced among the girls. Strikingly, only 25% of the boys and 14.5% of girls had consumed alcohol before, who indicated a stronger positive reinforce response as compared to those who had not tasted alcohol. <b>Conclusions:</b> The results reveal that the first exposure to alcohol consumption is the key factor which leads to alcoholism. If the experience of alcohol intake and the effects of alcohol are liked with the subjects, that becomes a motivating factor for future attempts. This needs a closer look by the clinicians, counselors and the parents, who need to actively interfere in educating the youth and in guiding them in the right direction during their formative ages. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=489-492&id=2804 https://doi.org/10.7860/JCDR/2013/.2804 Survey of the Attitude to, the Knowledge and the Practice of Contraception and Medical Abortion in Women Who Attended a Family Planning Clinic Umashankar K.M., Dharmavijaya M.N., Jayanta Kumar D.E., Kala K., Abed Gulab Nagure, Ramadevi <b>Objective:</b> To assess the attitude to, the knowledge and practice of contraception and medical abortion in women attending the family planning clinic at the mvj medical college , hosakote , Bangalore, India. <b>Materials and Methods:</b> Between 1st of August, 2011 and 31st of July, 2012 200 women attending family planning clinic of the mvj medical college, hosakote, Bangalore India of which 105 requested for medical termination of pregnancy (mtp), 95 for family planning advice, were interrogated on a structured questionnaire. The age of women ranged in between 20-45 years, 71 (35.5%) were illiterate, 30 (15%) had primary school education and 99 (49.5%) had diplomas from high school and above. Patients were grouped into low and high socio-economic status according to modified kuppuswamy socio-economic status scale: (i). upper class, (ii). Upper middle class, (iii). Middle class, (iv). Lower middle class, (v). lower class.consent of both husband and wife was taken. They were counseled about the various contraceptives available and allowed to choose whichever suited them best. <b>Results:</b> Among the 200 women 85 (42%) did not use contraception; 51 (25.5 %) were on the barrier method; 49 (18.31%) used intrauterine devices (iud); 12 (6%) used oral pills and and 3 (1.5%) used other methods. the request for mtp was on grounds of unplanned pregnancy in 55.25% cases or failure of contraception in 44.7%. there was no eugenic indication of the women, 3 (1.5%) had heard about emergency contraceptives, however none had used them; 20 (10%) had heard of medical abortion and 12 (6%) had previously undergone mtp with satisfaction. the various methods of contraception accepted by the women post abortion were ocps by 11 (10.47%), iuds by 54 (51.5%) and female sterilization by 26 (24.71%). in the other group, 23 (24.2%) had iuds removed and reinserted; 37.8% had iuds inserted; 26 (27.36%) women underwent sterilization operation; and 6 (6.31%) had iuds removed opting for pregnancy. statistical analysis was done using spss software (Chicago) with ?2 test taking p value of 0.05 as significant. <b>Conclusion:</b> There is lack of awareness of emergency contraception and medical abortion in the women community under study. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=493-495&id=2805 https://doi.org/10.7860/JCDR/2013/.2805 A Clinico-Pathological Study on Benign Breast Diseases Mima Maychet B. Sangma, Kishori Panda, Simon Dasiah <b>Background:</b> To study the patterns of clinically benign breast disease in females and to co-relate them with the pathological findings. <b>Methods:</b> One hundred females who attended the Surgery Outpatients Department in Indira Gandhi Medical College and Research Institute, Pondicherry, with various forms of benign breast diseases during the period from October 2011 to September 2012, were studied. Early diagnoses by doing a triple assessment like a clinical examination, FNAC or a core needle biopsy and imaging methods like ultrasonography or mammography, were made within 72 hrs from the first consultation. The clinical diagnoses were compared with the cytological or histological findings wherever possible and their accuracies were evaluated. <b>Results:</b> Out of the 100 female patients who were studied, 87 patients who presented with breast lumps and fibroadenoma, accounted for 48% of the cases, which was the highest number of patients. Fibrocystic changes and breast abscesses came next with 18% and 12% cases respectively. We detected 3 cases of proliferative disease with atypia and one case with florid hyperplasia, which had high and low risk factors respectively, for developing invasive carcinoma. The oldest lady of the group who was clinically diagnosed to have benign disease, was detected to have invasive ductal carcinoma. They were treated in our hospital and were advised follow up. <b>Conclusion:</b> Benign breast diseases are common in female patients and fibroadenoma is the commonest of them all. Triple assessment provided a quick diagnosis and it alleviated unnecessary anxiety from the patients about breast cancer. The clinical diagnosis of a breast lump, as confirmed by cytology and histology, was accurate in 91.95 % of the cases. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=503-506&id=2807 https://doi.org/10.7860/JCDR/2013/.2807 The Impact of the Broadcasting Mistake Management Culture in a Healthy Organization on the Quality of the Personnel Work Life Alireza Amini, Saeed Mortazavi <b>Background:</b> Today, healthy organizations such as hospital have found out the importance of quality of work life (QWL) of their personnel. QWL direct to increase job satisfaction, improve the quality of services to patient of hospital, and create high performance. One of factors that impact QWL is mistake management culture (MMC) when contribute different organization aspects such as QWL and cover its needs and finally promote job performance. <b>Material and Method:</b> A questionarie was designed with items involve five-item Likert-type scale items and it distributesamong a sample of 207 nurses of four hospitalsthat voluntarily participated in research plan in Mashhad city. Two hospitals were private and two hospitals were public. <b>Result:</b> There are significant relationships between MMC, QWL and performance. <b>Conclusion:</b> According to importance of enhancement of QWL and job performance in organizations such as hospital, broadcasting culture of mistake management plays positive role and promotes quality level of work life of employees. Therefore, we can improve job satisfaction by changing and manipulating QWL factors, and thus move toward the development of the organization. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=507-512&id=2808 https://doi.org/10.7860/JCDR/2013/.2808 Utilization of CHC (Complete Health Checkup) Type Charts to Improve the Students’ Understanding of Clinical Pathology A.R. Subhashree, B. Shanthi <b>Background:</b> Second year undergraduate medical students lack an integrated approach towards the basic laboratory data. So, they find it difficult when analytical exercises are asked for in pathology practical examinations. A Complete Health Checkup (CHC) is one exercise where an individual undergoes a clinical examination, followed by various basic laboratory tests, along with other tests like ECG, X-ray and USG of the abdomen. A critical analysis of such charts would help in developing higher cognitive skills in the form of integration of all the data which is available, in order to arrive at a final diagnosis. We hypothesized that facilitating the students to analyze a set of clinical pathology tests by using CHC charts as modules would enhance their integrated approach towards the laboratory data. <b>Aim:</b> To evaluate the use of pre designed complete health charts which were designed to enhance the students’ ability to apply and integrate their knowledge on the clinical pathology data. <b>Materials and Methods:</b> Two batches of 44 students each (Group 1 and Group 2), who attended the clinical pathology postings, were included in the study (totally 88 students). Informed consents were obtained from all of them. In addition to their routine posting schedules, the students in Group 2 were exposed to fifteen CHC charts, one at a time, with the subsequent analysis of each chart by using an objective test and a discussion. At the end of their clinical pathology postings, an OSPE was conducted for all the students and the test scores were analyzed. The statistical analysis was done using SPSS, version 15. <b>Results:</b> Group 1 obtained a score which ranged from 48% to 78%, with a mean±SE (mean) of 62.0% ± 1.21 and Group 2 obtained a score which ranged from 65% to 94%, with a mean±SE (mean) of 86.2% ± 0.96. The Student’s-t-test for the equality of means with a value of 15.59 (p=0.000), implied a statistical significance in the mean score, as was observed between the two groups. <b>Conclusion:</b> Facilitating the students’ learning by using CHC charts helps in improving the students’ capacity to analyze and interpret the clinical pathology data and so, it can be utilized on a routine basis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=496-498&id=2850 https://doi.org/10.7860/JCDR/2013/.2850 Distribution of Glaucoma in the Major Religious Communities of a North Indian Town: A Hospital Survey Smita Agarwal, M. A Shamshad, Dishanter Goel, Maryem Ansari <b>Introduction:</b> Glaucoma is the leading cause of blindness in India and the numbers of the patients are increasing every day. The prevalence of glaucoma depends upon various factors like racial and ethnic factors, the socioeconomic status, etc. <b>Aim:</b> To study the pattern of glaucoma distribution among the patients in a tertiary care hospital. <b>Materials and Methods:</b> A retrospective analysis of 1500 glaucoma patients was done, who presented between 2007 and 2012 in TMMC and RC, Moradabad, U.P, India. The age and the gender distribution of glaucoma was studied along with its subtypes in different religious groups (mainly among Hindus and Muslims). <b>Results:</b> The mean age of the glaucoma patients was 52.7 years. Glaucoma was diagnosed in 882(58.8%) Muslim and in 561(37.4%) Hindu patients. The prevalence of POAG (33.0%) was almost equal to that of PACG (32.7%). POAG was the most common type of glaucoma in males (16.8%), while PACG was very common among females (18.8%). In Hindu patients, POAG (40.8%) was the commonest form of glaucoma, while in Muslims, PACG (40.1%) was the highest form of glaucoma. <b>Conclusion:</b> Glaucoma is a major ocular disease which is prevalent in the Muslim population of the western Uttar Pradesh region. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=499-502&id=2851 https://doi.org/10.7860/JCDR/2013/.2851 A Rare Case of an Epidermoid Cyst in the Parotid Gland – which was Diagnosed by Fine Needle Aspiration Cytology Panna N. Hegde, Kishan Prasad H.L., Sunil Kumar Y., Sajitha K., Pooja Sarda Roy, Mary Raju, Vikram Shetty Cystic lesions are common in the head and neck. The most common are the cutaneous cysts, which are referred to as epidermal cysts. These cysts present as nodular and fluctuant subcutaneous lesions and they are seen most commonly in the acne - prone areas like the head, neck and the back. They arise following a localized inflammation of the hair follicle and occasionally after the implantation of the epithelium, following a trauma or surgery. The presence of benign cystic lesions in the salivary glands is rare.We are presenting a rare case of a 55-year-old male who presented with a soft swelling on the left side of the face. A diagnosis of an epidermoid cyst was given on cytology. A superficial parotidectomy was performed and the histopathology confirmed the above diagnosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=550-552&id=2822 https://doi.org/10.7860/JCDR/2013/.2822 Huge Dedifferentiated Liposarcoma of the Left Thigh with a High Grade Fibrosarcomatous Differentiation and a Local Recurrence Sunil V. Jagtap, Dhiraj B. Nikumbh, Swati S. Jagtap, Ashok Y. Kshirsagar, Anuya S. Badve Dedifferentiated liposarcoma is one of the variants of liposarcoma which has a more aggressive course. It constitutes less than 10% of all the liposarcomas and is often found in the retroperitoneum and the mediastinum. We are reporting a rare case of a 60 years old female who presented with a huge, soft tissue mass in the left thigh with a past history of an operation which was done15 years back. The histopathological examination showed a well differentiated liposarcoma with a high grade fibrosarcomatous differentiation. Immunohistochemical studies confirmed the dedifferentiated liposarcoma with the high grade fibrosarcomatous differentiation. To the best of our knowledge, this is the 11th case in the literature with rare findings. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=553-556&id=2823 https://doi.org/10.7860/JCDR/2013/.2823 Myofibroma which was Associated with A Rudimentary Eyeball, which Masqueraded as an Ocular Palpebral Cyst Hemlatha A. L., Sumana Sindhuram V., Asha U. Myofibroma, a benign neoplasm of the myofibroblasts, is most commonly encountered in the head and neck region, which includes the scalp, the forehead, the parotid region and the oral cavity. It is most rarely reported in the eyelids. Ocular myofibroma typically presents during childhood and it is rare in older patients. One such rare case which occurred in a 26 year old female with a clinical diagnosis of a palperbral orbital cyst, which was associated with a rudimentary eyeball, has been presented here. Rudimentary eyeballs which are associated with other congenital anomalies of the central nervous system, the female genital system and the skeletal system, have been frequently reported, but the occurrence of myofibroma in a rudimentary eyeball, as was seen in the present case, is an exceptional feature and an extensive review of literature did not reveal any report of such an occurrence. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=557-559&id=2824 https://doi.org/10.7860/JCDR/2013/.2824 Carcinosarcoma of the Gallbladder: A Case Report and Review of the Literature Menka Khanna, Ashish Khanna, Mridu Manjari A carcinosarcoma is a rare type of gallbladder malignancy, the diagnosis of which requires the presence of both malignant epithelial and mesenchymal components. The prognosis of this disease is extremely poor because it normally presents at advanced stages.We are reporting a case of carcinosarcoma of the gallbladder in a 45 year-old woman who was treated by cholecystectomy, as the tumour was confined to the gall bladder only. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=560-562&id=2825 https://doi.org/10.7860/JCDR/2013/.2825 A Secondary Carcinomatous Lesion Masquerading as A Primary Osteosarcoma - A Case Report Thamilselvi Ramachandran, P.M. Subramanium, K. Prakasam Penile carcinomas account for 10% of all the malignancies in men with a predominant regional lymph node involvement, but a distant metastasis of such a carcinoma via the haematogenous route is rare (2.3%), with the common sites being the kidneys, adrenal glands, retroperitoneal lymph nodes, lungs, brain and the dorsal spine. The pattern of the metastatic spread from carcinomas of the penis has been well described in the literature, with the inguinal and the iliac nodes being the commonest sites. The distant metastases are uncommon and delayed, even in advanced disease. Although metastases to the liver and lungs have been reported, the osseous metastases are exceptionally rare. We are presenting a case of carcinoma of the penis which metastasized to the tibia. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=563-565&id=2826 https://doi.org/10.7860/JCDR/2013/.2826 Organic Mania in Dengue Shruti Srivastava, M.S. Bhatia, Anurag Jhanjee Dengue fever is considered to be one of the major health problems in south east Asia. In the recent past, epidemic outbreaks of Dengue have also been noticed in India. Initially, the neurological manifestations which were associated with Dengue received little attention, but now, there have been several reports of encephalitis and encephalopathy . However, nowhere in the literature has Dengue fever been mentioned as a cause of acute psychosis or mania. Here, we are reporting a 21-year-old male, a resident of Delhi, India who after the Dengue infection, developed an episode of classical mania. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=566-567&id=2827 https://doi.org/10.7860/JCDR/2013/.2827 Intracystic Papillary Carcinoma of the Breast in Males: A Case Report and Review of the Literature Hariprasad S, Prajna Hariprasad, Teerthanath Srinivas Carcinoma of the male breast is a relatively rare disease that accounts for less than 1% of all the cases of cancer in men. Intracystic Papillary Carcinoma (IPC) is an extremely rare disease of the male breast, with a few case reports. The prognosis is excellent for the patients who are diagnosed with IPC, regardless of whether the tumour is in-situ or of an invasive type. We are reporting the case of a 50 year old man who presented with a painless cystic lump in the left breast. Ultrasonography revealed an intracystic tumour. Fine needle aspiration suggested a papillary tumour. The patient underwent simple mastectomy without a sentinel lymph node biopsy. The final pathologic examination revealed an intracystic papillary carcinoma of a low nuclear grade without an invasion. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=568-570&id=2828 https://doi.org/10.7860/JCDR/2013/.2828 Vascular Leiomyoma of Foot Suhith Gajanthodi, Rakesh Rai, Rajeev Kumar Chaudhry Vascular leiomyomas of the foot are relatively rare benign soft tissue tumours which arise from the tunica media and present as painful or painless solitary subcutaneous nodules. We are reporting a rare case of vascular leiomyoma with a dystrophic calcification and a myxoid change. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=571-572&id=2829 https://doi.org/10.7860/JCDR/2013/.2829 Unicentric Mesenteric Castleman`S Disease- A Diagnostic Quandary- A Case Report Rajeshwara K.V., Clement R.S. D’Souza, Elroy Saldanha, Klien Dantis, Preethi Rai Castleman`s Disease (CD) is a rare lymphoproliferative disorder and a mesenteric location is unusual. The unicentric variety is more difficult to diagnose clinically and it requires a histopathological confirmation. The excision biopsy itself will help both in the diagnosis and in planning the treatment. Here, we are presenting a case of unicentric mesenteric Castleman`s disease which we suspected to be lymphoma. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=573-575&id=2830 https://doi.org/10.7860/JCDR/2013/.2830 Pathological Fractures in Primary Non-Hodgkin’s Lymphoma of the Bone: A Case Series with Review of the Literature Yasir Salam Siddiqui, Abdul Qayyum Khan, MKA Sherwani Primary non-Hodgkin’s lymphoma of bone (PLB) is a rare entity. Patients generally present with localized bone pain and, less frequently, soft-tissue swelling or a palpable mass. Pathological fracture of the proximal femur and proximal humerus secondary to soft-tissue tumours is well documented in the literature; however, lymphomas presenting primarily at these sites with pathological fracture is unusual. A review of the world literature shows that the incidence of skeletal manifestation from NHL is less than 5%, and in all these cases, bony involvement was reported many years after presentation of the primary cancer. Histopathologically, PLB usually represents diffuse large B-cell lymphoma. We report our experience with two cases of Primary non-Hodgkin’s lymphoma of proximal femur and proximal humerus with pathological fracture and their management. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=513-517&id=2809 https://doi.org/10.7860/JCDR/2013/.2809 A Rare Presentation of the Double Inferior Vena Cava with an Anomalous Retrocaval Right Ureter: Embryogenesis and Clinical Implications Pratibha Gupta, Meenakshi Khullar, Ravikant Sharma, Richhpal Singh On dissection of the abdomen of an adult male cadaver, in addition to the normal inferior vena cava on the right side, an unusual venous channel which connected the left renal vein with the left common iliac vein was found; (probably the left inferior vena cava). The left testicular and the left suprarenal veins were opening into the left renal vein as usual. Other than this, a retrocaval ureter was found on the right side. The works of previous authors have highlighted the incidence of a venacaval duplication and its surgical implications, but here, we are presenting a unique case of a double inferior vena cava with an anomalous retrocaval ureter. A conglomeration of such vascular malformations is of immense surgical importance, and it is indicative of a grossly defective angiogenesis. Keeping in mind the clinical relevance of the variations which were observed, an attempt was made to explain them in the light of the embryogenic development. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=518-521&id=2810 https://doi.org/10.7860/JCDR/2013/.2810 A Case Report of a Spontaneous Oesophageal Pleural Fistula Sanjeev Kumar, Arshdeep Singh, Prithpal S Matreja, Sanjiv Kumar Kler We are reporting a case of an asthmatic patient who presented to us with retrosternal chest pain, constipation, and shortness of breath, with features which were suggestive of a hydropneumothorax and shock. On recovery from the shock, the patient was found to have increased chest tube drainage, which was suggestive of an oesophageal rupture. The Computerized Tomography (CT) scan showed a fistulous track. The patient was diagnosed as a case of a spontaneous oesophageal pleural fistula (Spontaneous EPF) on the basis of her clinical and radiological findings. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=522-524&id=2811 https://doi.org/10.7860/JCDR/2013/.2811 A Case of Bone Marrow Necrosis of an Idiopathic Aetiology: The Report of a Rare Entity with Review of the Literature Tejinder Singh Bhasin, Sonam Sharma, Manish Chandey, Puneet Kaur Bhatia, Rahul Mannan Bone Marrow Necrosis (BMN) is regarded as a rare entity in the aspirates and the trephine biopsies which are obtained from living patients and it is a rare antemortem diagnosis. Usually, BMN is associated with a poor prognosis and it has a 90% association with malignancies (mainly haematological). Its other causes include infections, drugs and other non malignant haematological causes. BMN which occurs due to unknown causes (idiopathic), is very rare. The present case report describes a case of BMN in a 14 year old male child from rural background, who came to the medicine outpatient department of a tertiary care centre in north India, with the complaints of generalized weakness, severe bone pains, especially in the ribcage area and fatigue. His peripheral blood film revealed pancytopaenia. His bone marrow aspiration yielded a watery, sero-sanguinous fluid from 2 different sites. Microscopy revealed “ghost like” haematopoietic cells lying in eosinophilic, proteinaceous material. Bone marrow biopsies from both the sites revealed extensive foci of gelatinous transformation and necrosis. A diagnosis of BMN was rendered. No underlying neoplastic / non neoplastic cause was identified, even after a thorough systematic investigation (haematological/biochemical/ radiological and immunological). Thus, a final diagnosis of BMN due to an idiopathic cause, was finally given. The patient was given supportive treatment, after which he was referred to a higher centre. BMN which arises idiopathically is usually very rare and often precedes the aetiological diagnosis and obscures the diagnosis. Traditionally, the prognoses of the patients with BMN were considered as poor, but with better treatment aids (chemotherapy and supportive treatment), the prognoses of these patients have been found to improve. Vigorous supportive care, along with a disease specific treatment, is the key to its management. This case was worth reporting, as no cause of BMN was elicited in it and we have summarized the signs and symptoms, the associations, haematological and other lab investigations and the role of radiology, which helped in its diagnosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=525-528&id=2812 https://doi.org/10.7860/JCDR/2013/.2812 The Appropriate DOTS Regimen Greatly Reduces the Disabilities in Polyarticular EPTB Arvnd S. Pandey, Ashish Surana The placement of cases of Extrapulmonary Tuberculosis (EPTB) on the appropriate Directly Observed Treatment Short Course (DOTS) regimen remains a problematic issue in India and often, consultants delay this, leading to significant avoidable pain, discomfort and reduction in the quality of life of the patients. In contrast, a prompt institution of the DOTS regimen can regress such problems, even at a delayed stage. The following case report on polyarticular tuberculosis which involved the bilateral knee and ankle joints without a pulmonary or disseminated form of tuberculosis, amply highlights these facts. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=529-531&id=2813 https://doi.org/10.7860/JCDR/2013/.2813 Fahr’s Syndrome- An Interesting Case Presentation Athulya Geetha Asokan, Sydney D’souza, Jayakumar Jeganathan, Shivananda Pai Fahr’s syndrome refers to a rare syndrome which is characterized by symmetrical and bilateral intracranial calcification. We are presenting a 63 year old male, who complained of progressive dysarthria of 6 months, which was associated with slowness of movements. His neurological examination revealed Parkinsonian features. His CT scan revealed a symmetrical large area of calcification over the basal ganglia, the thalamus and the cerebellum. The secondary causes of the bilateral calcification were ruled out to make the clinical diagnosis of Idiopathic Bilateral Striopallidodentate Calcinosis, which is otherwise called as the Fahr’s syndrome. Deposits of calcium and minerals cannot be linked to a single chromosomal locus and further genetic studies are in progress for identifying the chromosomal locus of the disease. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=532-533&id=2814 https://doi.org/10.7860/JCDR/2013/.2814 An Interesting Case of Dysphagia in a HIV Patient Deepak Madi, Basavaprabhu Achappa, John T. Ramapuram, Nithyananda Chowta, Soundarya Mahalingam Oesophageal tuberculosis is a rare disease. Tuberculosis (TB) can cause dysphagia due to oesophageal ulcers, Tracheo-Oesophageal Fistulas (TOFs) and an extrinsic compression which is caused by the mediastinal lymph nodes. A 33-year-old gentleman was admitted to our hospital for the evaluation of fever, dysphagia and cough. His chest X-ray was suggestive of miliary tuberculosis. A CT scan of his chest revealed miliary tuberculosis, mediastinal lymphadenopathy and pneumomediastinum. His sputum AFB (acid-fast bacilli) test was positive. An upper gastrointestinal endoscopy revealed a large ulcer in the oesophagus with a fistulous opening which was suggestive of a tracheo-oesophageal fistula. A biopsy from the ulcer was positive for AFB. The test for HIV-1 was positive. A nasogastric feeding tube was placed and the Anti Tubercular Therapy ( ATT) was started. The main aim of this case report is to sensitize the clinicians about the fact that Tuberculosis can present with dysphagia, especially in HIV patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=534-536&id=2815 https://doi.org/10.7860/JCDR/2013/.2815 A Splenic Abscess which was Caused by Salmonella Typhi in a Non Sickler Patient: A Rare Case Finding Nutan Narayan Bhongle, Neena Vinay Nagdeo, Vilas R. Thombare A splenic abscess which is caused by Salmonella typhi is a very rare complication of typhoid fever. We are reporting a case of a 14 year old female who presented with fever and pain in the abdomen. She was treated for fever of unknown origin in a rural hospital and was then admitted to our hospital after 15 days . She complained of fever and pain in the abdomen. On ultrasound, multiple splenic abscesses were seen. A USG guided aspiration was done and the aspirated material was received for culture, which was found to be positive for Salmonella typhi. A blood and stool culture which were done were negative and the Widal test showed a positive result with titres of TO 1:320 and TH 1:320. No predisposing factor was found in our case. Sickling was negative and HIV and HBsAg screening showed negative results. She responded favourably to the antibiotics which were given as per our antibiotic sensitivity report. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=537-538&id=2816 https://doi.org/10.7860/JCDR/2013/.2816 External Ophthalmomyiasis which was Caused by Sheep Botfly (Oestrus ovis) Larva: A Report of 10 Cases Sucilathangam G., Meenakshisundaram A., Hariramasubramanian S., Anandhi D., Palaniappan N., Anna T. Myiasis is the infestation of the tissues and organs of animals or man by fly larvae. Ophthalmic myiasis has been reported from various world regions. In this study, we are presenting the clinical manifestations of external ophthalmomyiasis which was caused by the larvae of the sheep nasal botfly, Oestrus ovis, in 10 patients in the Tirunelveli and the Tuticorin districts of Tamil Nadu state (India). All the patients were farmers, who worked in close contact with sheep and goats. All the patients presented with severe conjunctivitis. The larvae were observed in the bulbar conjunctiva and following their removal, the symptom of eye inflammation improved in a few hours. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=539-542&id=2817 https://doi.org/10.7860/JCDR/2013/.2817 The Limb-Abdominal Wall Complex Defects, a form of Amniotic Band Sydrome: A Rare Case Report Sudhanshu ku. Das, Sidharth Sankar Maharana, Monalisa Subudhi, P. V. Subha Rao The limb-body wall complex defects a form of amniotic band syndrome which consists of a polymal formation with a thoracic and /or an abdominal-schisis, eventration of the internal organ and anomalies of the extremities. We are presenting a case of a limb-body wall complex defect with the phenotype of a placenta-abdominal attachment, anomalies of the abdominal wall defect, absence of the right lower limb and genitourinary defects. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=543-544&id=2818 https://doi.org/10.7860/JCDR/2013/.2818 CRAO in Moyamoya Disease Ashok Kumar M., Amirtha Ganesh B. Moyo Moya Disease (MMD) is a rare, progressively stenotic condition of the intracranial arteries with various cerebrovascular manifestations. Ocular manifestations are seen very rarely and there are only few case reports of ocular perfusion anomalies. Central Retinal Artery Occlusion (CRAO) can be caused by atherosclerosis related thrombosis, carotid embolism, cardiac embolism, thrombophilic disorders, giant cell arteritis, etc. We are reporting a 26 years old patient with CRAO in the right eye, who was found to have the typical features of MMD on cerebral angiography. CRAO with MMD is a rare occurrence. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=545-547&id=2819 https://doi.org/10.7860/JCDR/2013/.2819 The Spontaneous Prelabour Rupture of Anunscarred Uterus at 34 Weeks of Pregnancy Malabika Misra, Ronita Roychowdhury,Nayan Chandra Sarkar,Murary Mohan Koley Uterine rupture is an obstetric emergency needs immediate surgery and is associated with poor fetal & maternal outcome. Usually uterine rupture occurs at the lower segment (weakest part) if there is no history of uterine surgery. We hereby are reporting a case of spontaneous uterine rupture at fundus, at 34 weeks of gestation in a patient who has never had uterine surgery. Only uterine curettage was done once for missed abortion. In this case, diagnosis was delayed until the patient went into massive hemorrhagic shock; because, there was no history of previous uterine surgery. However, clinical picture of the ruptured uterus at the fundus suggests there was some weakness at the fundus. Thereafter, D & C operation was taken into account. Subtotal hysterectomy was done as the rupture was irreparable damage to the fundus. Her one month follow up was uneventful. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=548-549&id=2820 https://doi.org/10.7860/JCDR/2013/.2820 Increasing Antimicrobial Resistance and Narrowing Therapeutics in Typhoidal Salmonellae Jaspal Kaur Multidrug-resistant typhoid fever (MDRTF) is a major public health problem in developing countries and is an emerging problem in the developed world. Because of the difficulties in preventing typhoid by public health measures or immunization in developing countries, great reliance is placed on antimicrobial chemotherapy. The treatment should commence as soon as the clinical diagnosis is made rather than after the results of antimicrobial susceptibility tests but the existence of MDRTF poses a serious clinical dilemma in the selection of empiric antimicrobial therapy. With the widespread emergence and spread of strains resistant to chloramphenicol, ampicillin and trimethoprim, ciprofloxacin became the drug of choice for the treatment of typhoid fever. However, of late the efficacy of fluoroquinolones too has been questioned, mainly due to increasing reports of increasing defervescence time and poor patient response. This indicates that the organism has begun to develop resistance to fluoroquinolones, and is corroborated by a steady increase in Minimum Inhibitory Concentration (MIC) of ciprofloxacin. The therapeutics of ciprofloxacin-resistant enteric fever narrows down to third- and fourth-generation cephalosporins and azithromycin. However, the emergence of extended-spectrum b-lactamases (ESBLs) in typhoidal Salmonellae poses a new challenge and would greatly limit the therapeutic options leaving only tigecycline and carbepenems as secondary antimicrobial drugs. This increasing resistance is alarming and emphasizes the need of effective preventive measures to control typhoid and to limit the unnecessary use of antibiotics. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=576-579&id=2831 https://doi.org/10.7860/JCDR/2013/.2831 Oxidative/Nitrosative Stress and the Pathobiology of Chronic Obstructive Pulmonary Disease Rajesh Pandey, Mamta Singh, UditaSinghal, Krishna Bihari Gupta, Surendra Kumar Aggarwal The understanding of the pathobiology of Chronic Obstructive Pulmonary Disease (COPD) has undergone a major change in the past three decades. The classical ‘protease-antiprotease’ hypothesis still holds true, nevertheless, the sequence of the biochemical events which lead to the protease/antiprotease imbalance have been unraveled. For instance, tobacco smoke, a primary risk factor for COPD, contains a plethora of reactive Oxygen/Nitrogen Species (ROS/RNS) that serve to initiate the oxidant/antioxidant imbalance in the respiratory tract of chronic smokers, a phenomenon that is amplified if certain other risk factors co-exist (e.g. a genetic deficiency of the major antiproteases, a suboptimal antioxidant defense system, airway hyper responsiveness etc.). The inflammatory response that ensues as a result of the initial occult exogenous oxidative/ nitrosative stress becomes a secondary endogenous source of ROS/RNS. This perpetuates the ongoing lung damage, even though the primary insult may no longer be present (abstinence). Depletion of the pulmonary antioxidants, damage to the local antiprotease protective screen, a decreased immune response, hypersecretion of mucus, superadded infections, oxygen therapy-induced oxidant production, etc. are some of the critical factors which account for the oxidative/ nitrosative stress-mediated pulmonary as well as extrapulmonary features of COPD. In the light of the recent developments, remarkable efforts are being made, either to develop novel therapeutic strategies or to improve the existing ones, which are aimed at treating different aspects of the disease. Thus, it is reasonable to recommend antioxidants as a useful adjunct to the more conventional treatment options, keeping in view the ‘oxidant/antioxidant’ hypothesis as a unifying theme for the ‘protease/antiprotease’ theory of COPD. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=580-588&id=2832 https://doi.org/10.7860/JCDR/2013/.2832 Planning an Objective and Need Based Curriculum: The Logistics with Reference to the Undergraduate Medical Education in Biochemistry Ramesh Ramasamy, Niranjan Gopal, Srinivasan A R, Sathish Babu Murugaiyan <b>Purpose:</b> The medical education is recently being transformed into several domains in order to adapt to the need and the value based academics which is required for the quality doctors who serve the community. Presently, the biochemistry curricula for the graduate students of medicine have been questioned by as many experts, because of their multiple lacunae. In this review, we would like to highlight the scenario which is related to the existing biochemistry curricula for graduate medical students, which have been followed in several medical schools and universities and we also hope to share our ideas for implementing objective and pragmatic curricula. Evidence based research, wherein the articles which are related to innovative teaching-learning tools are collected and the pros and cons which are related to the different methods analyzed in biochemistry point of view. <b>Conclusion:</b> Rapid changes in the content of the curriculum may not be required, but a gradual introduction of the novel approach and the methods of teaching biochemistry can be adopted into the curriculum. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=589-594&id=2833 https://doi.org/10.7860/JCDR/2013/.2833 Evaluation of the Effect of Probiotic (Inersan®) Alone, Combination of Probiotic with Doxycycline and Doxycycline Alone on Aggressive Periodontitis – A Clinical and Microbiological Study Mishal Piyush Shah, Sheela Kumar Gujjari,Veerendrakumar Siddhpur Chandrasekhar <b>Introduction:</b> The purpose of the present study was to evaluate the effect of a probiotic (Inersan®) alone, a combination of the probiotic with doxycycline and doxycycline alone on aggressive periodontitis patients. <b>Methods:</b> Thirty patients who satisfied the inclusion and exclusion criteria, were assigned to one of the above mentioned three groups by using block randomization. The clinical and the microbiological parameters were recorded on day 0, at 2 weeks and at 2 months. On day 0, before recording the clinical parameters, 0.5 ml of unstimulated saliva was collected for the evaluation of the microbiological parameters. The clinical parameters which were recorded were the plaque index, the gingival index, the probing pocket depth and the clinical attachment level. The microbiological parameters which were recorded were Lactobacilli and Aggregatibacter actinomycetemcomitans. After this, Scaling and Root Planing (SRP) was performed on day 0. Two weeks after the SRP, the patients were recalled for the saliva sample collection and for the evaluation of the clinical parameters. On the same day, medications were given to the patients to be taken for fourteen days according to the group which they belonged to (Group A – probiotic alone, Group B – a combination of the probiotic with doxycycline, Group C – doxycycline alone). The patients were then recalled at two months for the saliva sample collection and for the evaluation of the clinical parameters. <b>Results:</b> The administration of the probiotic alone, a combination of the probiotic with doxycycline and doxycycline alone, resulted in a decrease in the plaque index, the gingival index, the probing pocket depth and the clinical attachment level at 2 months, which was statistically significant (p < 0.05). The A. actinomycetemcomitans count tended to decrease in all the three groups at 2 months, which was statistically non-significant (p > 0.05). The Lactobacilli count tended to increase significantly in the probiotic alone group (p < 0.05). <b>Conclusion:</b> Probiotics have a future in the treatment of aggressive periodontitis, as antibiotics are prescribed most of the time. These antibiotics can lead to the emergence of drug resistant micro-organisms and they can also disturb the beneficial microflora of the body. Thus, as an alternative to antibiotics, probiotics can be used, as they repopulate the beneficial microflora and reduce the pathogenic bacteria. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=595-600&id=2834 https://doi.org/10.7860/JCDR/2013/.2834 The Mandibular First Molar with Three Canals in the Mesial Root- A Case Report Mohanavelu Deepalakshmi, Ramachandran Anupama, Hidayathulla Sulthan Ibrahim raja khan, Kumarappan Senthil kumar The dynamic concept of the root canal system, which describes a variable morphology of the multiple root canals which are inter-connected by anastomoses, has been established as the prevailing state in the mandibular molars. The aim of this case report was to describe the unusual root canal anatomy that was detected in the mandibular first molar during the routine endodontic treatment. The clinical and the radiographic examinations allowed the detection of the middle mesial root canal between the mesiobuccal and the mesiolingual root canals. This report highlights the importance of such examinations and the need to find and treat the additional canals, to achieve a successful endodontic treatment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=601-603&id=2835 https://doi.org/10.7860/JCDR/2013/.2835 Aberrant Adrenal Tissue in Omentum: An Incidental Finding on Ovarian Cystectomy Meenu Pujani, Neha Kawatra Madan, Monisha Choudhury, Meenakshi Rao https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=606-607&id=2836 https://doi.org/10.7860/JCDR/2013/.2836 Crystallizing Galactocele – An Unusual Diagnosis on Fine Needle Aspiration Cytology Dhiraj B Nikumbh, Sushama R Desai, Pallavi A Shrigondekar, Ajay Brahmnalkar, Avinash M Mane https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2013&month=March&volume=7&issue=3&page=604-605&id=2821 https://doi.org/10.7860/JCDR/2013/.2821