Journal of clinical and diagnostic research https://www.jcdr.net/back_issues.asp JCDR An Invitro Evaluation of Antibacterial Properties of Self Etching Dental Adhesive Systems Rama Krishnam Raju Penmetsa, Sri Rekha A, Krishna Chaitanya Poppuri, Sai Prashanth P, Surendranath Garapati <b>Background and Objectives:</b> The microbial flora of the oral cavity is extremely diverse. Residual bacteria in the oral cavity may remain at the tooth restoration interface and increase the risk of developing recurrent caries. The aim of this study is to evaluate the immediate and long term antibacterial effect of polymerised self etching adhesive systems. <b>Materials and Methods:</b> Streptococcus mutans were used as a test organism. The self etching dental adhesives that were used are Adper Easy One, G-Bond, Clearfil S3 bond and Xeno V. Agar diffusion test (ADT) was performed on agar plates, in which four holes that were 4mm in diameter were punched. Then 200 µL of freshly grown S.mutans spread evenly. The four holes were immediately filled with the four tested materials and light polymerised them using a light curing unit. The agar plates were incubated for 72h at 37°C. For the direct contact test (DCT), the bonding agents were placed on the side walls of microtiter plate wells and light polymerized according to the manufacturer’s instructions. A 10µL bacterial suspension was placed on the tested material samples. Bacteria were allowed to directly contact the polymerized dental adhesives for 1h at 37oC. Fresh Brain heart infusion broth was then added. The bacterial growth was then spectrophotometrically measured in the wells every 30 min for 16h for 1,2, 7 and 14 days. <b>Results:</b> In the ADT, inhibitory halos were found around all the bonding agents, with greater inhibition halo seen around Xeno V after incubating for 72 h at 37ºC. The readings obtained through DCT were subjected to ANOVA and Tukey’s multiple comparisons tests, which showed no bacterial growth on fresh samples and after aging for one day in PBS with self etching adhesives. Results of DCT after aging for 2 days, 7 days and 14 days showed bacterial growth in all the bonding agents used with no significant difference from the control group.(p<0.001). <b>Conclusion:</b> All the dental adhesives showed antibacterial properties immediately and one day after polymerization but none of the self-etching adhesives had long-lasting antibacterial properties. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZC01-ZC05&id=4467 https://doi.org/10.7860/JCDR/2014/.4467 Recognizing Changes in Cognition in Sub Types of Acute Confusional State Raheel Mushtaq, Sheikh Shoib, Tabindah Shah, M Maqbool Dar, Sahil Mushtaq <b>Background:</b> Delirium or acute confusional state is an acute neuropsychiatric syndrome, with varied cognitive dysfunctions. However, no comprehensive studies about this common condition have been carried out in India. <b>Objectives:</b> To assess cognitive dysfunctions in hypoactive and hyperactive delirium. <b>Materials and Methods:</b> Forty cases of delirium including hypoactive and hyperactive delirium and 40 other patients (neuropsychiatric patients) were studied as controls. Cognitive status estimation test, mini mental state examination and memorial delirium assessment scale were administered to each patient. All assessments were carried out three times in 24 hour cycle of day and night. The data was analysed using two sample independent t-test. <b>Results:</b> The mean age (standard deviation) of study and control group was 27.85(13.73) and 33.10 (11.26) years respectively. 70% patients had hyperactive delirium while 30% were having hypoactive delirium. Hypoactive delirium had more cognitive impairment compared to hyperactive delirium (p=0.001). The difference between highest and lowest score of MMSE in both types of delirium (day to night) was found to be statically significant (p=0.001). <b>Conclusion:</b> The fluctuation in intensity of cognitive symptoms varies from day to night in both types of delirium, but more in hypoactive delirium and wider fluctuation in cognitive dysfunctions was noted in delirium cases with psychosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=MC01-MC03&id=4526 https://doi.org/10.7860/JCDR/2014/.4526 An Exploratory Survey for Understanding Perceptions, Knowledge and Educational Needs of General Practitioners Regarding Autistic Disorders in New South Wales (NSW), Australia Pankaj Garg, David Lillystone, David Dossetor, Carolyn Kefford, Shanley Chong <b>Aim:</b> A survey was conducted to ascertain General Practitioners (GPs’) perceptions, knowledge and educational needs regarding autistic disorders in childhood. <b>Methods:</b> A concurrent mixed method approach was used for data collection and analysis. Exploratory factor analysis(EFA) of the data was done and groups were compared using appropriate statistical tests. <b>Results:</b> There was more response from female GPs, Australian medical graduates and those with an interest in mental and / or child health. Variability was noted in how GPs perceived their competence and knowledge of autistic disorders. About 60% correctly believed that an early-individualised treatment programme was evidence based. Knowledge was inversely related to the number of years in practice and enhanced by personal involvement with children of these disorders and awareness of community resources. Parallel analysis of knowledge scale revealed a “general knowledge” dimension loading items helpful for early identification and referral and a “surveillance” dimension helpful for ongoing involvement of GPs for management of children with ASDs. <b>Conclusions:</b> Although further development and refinement of knowledge questionnaire using these dimensions for primary care physicians are needed these are relevant target areas for education. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=PC01-PC09&id=4527 https://doi.org/10.7860/JCDR/2014/.4527 Evaluation of Antiurolithic Activity of Alcoholic Extract of Roots of Cissampelos Pareira in Albino Rats Suresh Babu Sayana, Chitra C Khanwelkar, Venkat Rao Nimmagadda, Vasant R Chavan, Ramesh BH, Naveen Kumar S <b>Background:</b> In ayurvedic system of medicine a vast number of medicinal plants are reported to possess with antiurolithic activity. <b>Aim:</b> To study the antiurolithic activity of alcoholic extract of roots of Cissampelos pareira (AERCP) in chemicals induced urolithiasis in albino rats. Materials and Methods: Nine Groups of albino rats (n=6) were used to evaluate the antiurolithic activity of alcoholic extract of roots of C.Pareira. Group I received with rat chow diet, Group II with 2% Ammonium chloride (AC) and 0.75% Ethylene glycol (EG) Group III with EG plus AC and cystone (5 ml/kg), Groups IV, V, VI with low (100 mg/kg), medium (200 mg/kg), and high (400 mg/kg) doses of root extract, Groups VII, VIII, IX with EG plus AC and low (100 mg/kg), medium (200 mg/kg), and high (400 mg/kg) doses of root extract respectively for 10 days. Urolithiasis was induced by supplying drinking water mixed with 2% Ammonium chloride and 0.75% Ethylene glycol for 10 days. On 11th day three rats from each Group were kept in one metabolic cage and urine (pooled) collected for 24h was subjected for estimation of biochemical parameters like urinary calcium, uric acid and magnesium. Blood was collected on the same day and analysed for various parameters. Kidneys were observed for the histopathological changes. <b>Results:</b> The rats treated with alcoholic extract of roots of C. pareira at 03 different doses significantly (p= 0.05) reduced urinary calcium, uric acid and increased urinary magnesium levels, reduced serum calcium, creatinine and increased serum magnesium. Rats treated with 200 mg/kg and 400 mg/kg doses revealed less tissue damage and the cytology of the nephrotic tissue was almost similar to normal control Group I rats. <b>Conclusion:</b> Results showed that alcoholic extract of roots of C. pareira has exhibited a significant antiurolithic effect against urolithiasis in experimental rats. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=HC01-HC04&id=4528 https://doi.org/10.7860/JCDR/2014/.4528 Oxidative Stress in Non-Obese Women with Polycystic Ovarian Syndrome Varalakshmi Desai, Namburi Rajendra Prasad, Suchitra Musturu Manohar, Alok Sachan, Srinivasa Rao Pemmaraju Venkata Lakshmi Narasimha, Aparna Rajeshwar Rao Bitla <b>Background:</b> Polycystic ovarian syndrome (PCOS) is one of the most common endocrine diseases of women. Oxidative stress is an important component of the cardio-metabolic risk seen in these women. Oxidative stress has been reported in obese PCOS women. This study is taken up to study oxidative stress in non-obese PCOS women. <b>Materials and Methods:</b> Twenty five non-obese women with PCOS attending the Endocrinology outpatient Department of Sri Venkateswara Institute of Medical Sciences, Tirupati, India along with 25 healthy BMI matched controls were included in the study. The changes in the lipid peroxidation products (MDA), and total anti oxidant capacity (FRAP) as an index of anti oxidant status along with fasting glucose, insulin and uric acid levels were measured in both groups. Insulin resistance was evaluated by using homeostasis model assessment for insulin resistance [HOMA-IR)= [FPG (mg/dl) × insulin (mIU/L)]/ 405] in both groups. <b>Results:</b> Serum MDA and uric acid levels were increased in the study group compared with controls and FRAP levels were decreased in the study group compared to controls though statistically insignificant. <b>Conclusion:</b> Oxidative stress is also present in non-obese women with PCOS. Oxidative stress further increases the CVD risk in these women.Correcting oxidative stress with antioxidants along with monitoring the antioxidant status using a simple assay like FRAP could have a beneficial effect on oxidative stress induced insulin resistance and hyperandrogenism seen in these women. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=CC01-CC03&id=4530 https://doi.org/10.7860/JCDR/2014/.4530 HIV Associated Sensory Neuropathy Amruth G, Praveen-kumar S, Nataraju B, Nagaraja BS <b>Background:</b> In the era of highly active antiretroviral therapy (HAART), sensory neuropathies have increased in prevalence. We have documented the frequency and profile of the two most common forms of sensory neuropathies associated with Human Immunodeficiency Virus (HIV) infection and looked into clinicoelectrophysiological correlates to differentiate the two entities. <b>Methods:</b> The study population comprised of all consecutive patients detected to be HIV positive and attending the Neurology outpatient department (from March 2011 to March 2012) who were aged = 18 years and were able to give informed consent. The data were collected from the patient records (including CD4 counts and treatment details) and questionnaire based interview with each patient. All patients underwent detailed clinical examination and nerve conduction studies (NCSs). <b>Results:</b> Among the total study population of 50 patients, there were 31 men and 19 women. Thirty two patients were in age range of 21 - 40 years and rest were above 40 years. 25 were on antiretroviral therapy (18 on regimen containing zidovudine; seven on regimen containing stavudine). The mean duration of antiretroviral therapy was 16.6±8.4 months. Low CD4 counts (<200) were noted in 24 patients (13 of these were on antiretroviral therapy). Clinically, the patients were classified as asymptomatic (n=34) and symptomatic (n=16). Among the symptomatic patients, nine were on antiretroviral therapy since less than one year (seven of these were on regimen containing stavudine). Ten patients aged more than 40-years had symptomatic neuropathy. No significant correlation was found between low CD4 counts and symptomatic neuropathy (p=0.21). Impaired vibration (100%) and absent ankle jerks (75%) were commoner than reduced pin sensitivity (46.6%). Twenty two patients had abnormal NCS results (18 of these were on antiretroviral therapy). Axonal distal symmetrical sensory neuropathy was the commonest pattern noted in 14 patients who were receiving antiretroviral therapy. Subclinical involvement as evidenced by NCSs was noted in 5 asymptomatic patients who were all on antiretroviral therapy. <b>Conclusion:</b> Symptomatic neuropathy was seen predominantly in HIV patients who were on antiretroviral therapy. All patients receiving stavudine containing regimen had severe symptomatic neuropathy within 1 year. There was an increase in the likelihood of symptomatic neuropathy among patients aged > 40 years. Subclinical neuropathy was common in those on antiretroviral therapy. Axonal neuropathy was the commonest pattern noted in patients who were receiving antiretroviral therapy and demyelinating neuropathy in patients not on antiretroviral therapy. Surprisingly no significant correlation was found between low CD4 counts and symptomatic neuropathy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=MC04-MC07&id=4531 https://doi.org/10.7860/JCDR/2014/.4531 Association of Lipid Profile and Uric Acid with Pre-Eclampsia of Third Trimester in Nullipara Women Vibhuti Agarwal, Bharat Kumar Gupta, Abhishek Vishnu, MamtaT yagi, ShipraSolanki, Jas Kiran <b>Background:</b> Pre-eclampsia affects approximately 3% of all pregnancies worldwide, with onset of symptoms in the late second or third trimester, commonly after 32nd week. It is common in nulliparous women. To avoid complications it is necessary to diagnose it in advance, but the available tools are unable to clinch the diagnosis of preeclampsia effectively in majority. <b>Aim:</b> To find out an association of lipid profile and uric acid with pre-eclampsia in nullipara pregnant women in third trimester. <b>Materials and Methods:</b> One hundred nulliparous pregnant women in their third trimester of 18-35 years were divided into; 50 pre-eclamptics of study group and 50 non pre-eclamptic in control group; further subdivided according to age, 18-26 and 27-35 yrs. Diagnosis was confirmed as per the standard criteria. Lipid profile and uric acid levels were estimated by Vitros 250 dry chemistry analyser. Data was analysed statistically by student t-test at p<0.01 level of significance. <b>Results:</b> TC, LDL-c and VLDL-c levels in the study group as a whole and in the patients between 18-26 years were significant; HDL-c levels in the patients between 27-35 years were significant while TG and uric acid levels in all the three study groups were significant. <b>Conclusion:</b> Total cholesterol, LDL-c, VLDL-c, triglycerides and uric acid levels were raised in preeclampsia and statistically significant; while HDL-c levels were raised in these patients but statistically non-significant, it can be concluded that there exists an association in lipid profile and uric acid with pre-eclampsia therefore dyslipidemia and raised uric acid levels are the features of pre-eclampsia in nullipara pregnant women in their third trimester. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=CC04-CC07&id=4533 https://doi.org/10.7860/JCDR/2014/.4533 Cost-Efficiency of Indigenously Fabricated Mobile-Portable Dental Unit in Delivery of Primary Healthcare in Rural India Pankaj Goel, Ashok Goel, Nilesh Arjun Torwane <b>Aim:</b> Innovation in primary oral healthcare delivery is a potential yet relatively unexplored area in Dental literature. Aim of the present study was to assess the economic gains that can be made by designing and operating an indigenously fabricated portable dental unit in rural areas. <b>Materials and Methods:</b> Cost-efficiency was determined by comparing total revenue (number of patients treated) with total costs (direct – capital cost of fabrication; and indirect – dental materials, disposables, transport, miscellaneous) over a period of seven years (2005 to 2012). Operational efficiency of portable dental units was also compared with dental vans on various categories of performance indicators. Data analysis was based on institutional records of Rajasthan Dental College (RDC), Jaipur, India. <b>Results:</b> Results show that a total of 52,900 patients who attended 223 camps during this period were provided various primary oral healthcare services using four such portable dental units that were developed @ Rs. 24,000 ($ 417) per unit. Based on a cost-efficiency of Rs 35.53 ($ 0.65) per person, which is among the lowest reported from any part of the world, the authors conclude that indigenously fabricated portable dental units provide a cost-efficient service. The other aspects most relevant to portable equipment were ease of transportation and feasibility in domiciliary care provision. <b>Conclusion:</b> The Limitations of productivity due to time spent in setting up the unit and need for additional space/equipment was their main drawbacks vis-à-vis dental vans. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZC06-ZC09&id=4534 https://doi.org/10.7860/JCDR/2014/.4534 Knowledge and Pattern of Antibiotic and Non Narcotic Analgesic Prescription for Pulpal and Periapical Pathologies- A Survey Among Dentists M Jayadev, P Karunakar, B Vishwanath, S Soumya Chinmayi, P Siddhartha, B Chaitanya <b>Aim:</b> The objective was to assess the knowledge and pattern of antibiotic and non narcotic analgesic prescription for pulpal and periapical pathologies among dentists, registered with IDA, in and around Hyderabad. <b>Materials and Methods:</b> Cross-sectional survey was conducted from January 2014 to February 2014 in and around Hyderabad, Andhra Pradesh, India. A questionnaire for this cross-sectional survey was designed for evaluating the knowledge and patterns of antibiotic and non narcotic analgesic prescription for pulpal and periapical pathologies. It included some demographic information, questions regarding clinical and non clinical factors, type of antibiotics and non narcotics analgesics prescribed were recorded. Data was computed and analysed using SPSS software. Descriptive statistics was performed. <b>Results:</b> The response rate for the study was 85%, 51.4% being males and 53.9% were pursuing post graduation. Of the respondents, 44.3% would prescribe medication with elevated body temperatures and evidence of systemic involvement, while 42.8% would prescribe medication for non clinical factors such as unsure of diagnosis. Necrotic pulp with acute apical periodontitis with swelling present and mod/severe preoperative symptoms was the most common condition identified for antibiotic therapy (56.4%). The first antibiotic of choice in patients with no medical allergies is amoxicillin, followed by amoxicillin and metronidazole. The first antibiotic of choice in case of allergic to penicillin was erythromycin. 55.1% and 37.3% would not prescribe antibiotic and analgesic after Root canal treatment respectively. The most commonly prescribed NSAID is Diclofenac (51.1%). Factors influencing the choice of analgesics among respondents is severity of pain (61.4%). 31.7% remained informed of current prophylactic practices through pharmaceutical companies followed by university training sessions and scientific societies (30.7%). <b>Conclusion:</b> The results of the present survey have demonstrated a lack of uniformity among the dental practitioners. All the clinicians should make themselves aware of the current guidelines available, to ensure highest degree of patient care. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZC10-ZC14&id=4536 https://doi.org/10.7860/JCDR/2014/.4536 Levels of Serum Calcium and Magnesium in Pre-eclamptic and Normal Pregnancy: A Study from Coastal India Deepa V Kanagal, Aparna Rajesh, Kavyarashmi Rao, Ullal Harshini Devi, Harish Shetty, Sucheta Kumari, Prasanna Kumar Shetty <b>Background:</b> Pre-eclampsia is one of the major causes of maternal and fetal morbidity and mortality. Though the aetiology is obscure, recent studies indicate that serum levels of calcium and magnesium may have a role in pre-eclampsia. <b>Aim:</b> The aim of this study was to find out the relationship of serum levels of calcium and magnesium in pre-eclamptic pregnancies compared to normal pregnancies in women from southern coastal India. <b>Settings and Design:</b> This study was done in a medical college hospital in southern coastal India. <b>Materials and Methods:</b> The blood samples from 60 pre-eclamptic women and an equal number of controls were analysed for calcium and magnesium levels. Data on Body Mass Index, maternal and gestational ages, serum calcium and magnesium were compared between the two groups. Outcome of pregnancy was analysed in both the groups and compared. <b>Statistical Analysis:</b> Data was expressed as Mean ± Standard Deviation. Data analysis was done by SPSS version 20. Comparison of serum levels of the elements between the two groups was performed by Independent t-test and Chi-square test and P-value of < 0.05 was considered as statistically significant. <b>Results:</b> The serum calcium concentration was significantly lower in the pre-eclamptic group compared to normotensives (7.84 ± 0.87 mg/dl Vs 8.97± 0.69 mg/dl, p<0.001) whereas the levels of serum magnesium showed a marginal difference in both the groups. (1.43± 0.55 mg/dl Vs, 1.57 ± 0.72 mg/dl P 0.257) The study also showed that pre-eclamptic women were older, their BMI was higher and birth weight of babies lower compared to normotensives. <b>Conclusion:</b> According to the results of our research, intake of supplements, mainly calcium may help in the reduction of incidence of pre-eclampsia especially in a population of a developing country like ours where the nutrition is poor. Not many studies have been done in developing countries to assess the role of these elements in pre-eclampsia. The actual role of magnesium and calcium supplements needs further investigation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=OC01-OC04&id=4537 https://doi.org/10.7860/JCDR/2014/.4537 Comparison of Point of Care (POC) Testing of Glucose by B Braun Glucometer and Hemocue Glucose 201+ Analyser Versus Centralised Testing in Neonatal Intensive Care Unit (NICU) Sudha Reddy V R, Sumathi M E, Beere Gowda Y C, Mohamed Suhail S <b>Background:</b>Neonatal hypoglycemia is the most common carbohydrate metabolic disturbance seen in case of neonates and especially in preterm neonates. Accurate and rapid determination of hypoglycemia and its prompt treatment is of utmost importance to decrease morbidity and mortality of neonates. <b>Aims:</b>To estimate blood glucose in neonates and test the efficacy of HemoCue Glucose 201+ analyser and B Braun Glucometer by comparing with centralised laboratory testing. To compare the blood glucose in capillary and venous blood samples of neonates. <b>Settings and Design:</b>Hospital setting; Comparative Study. <b>Materials and Methods:</b>After obtaining informed consent, all neonates admitted to Neonatal Intensive Care Unit were screened for blood sugar. Capillary and venous blood glucose was estimated employing HemoCue Glucose 201+ analyser and B Braun Glucometer. Simultaneously, the same venous sample was collected in fluoride tube and sent to central clinical biochemistry laboratory for glucose estimation. When anaemia or polycythemia was clinically suspected the same venous sample was sent for estimation of Hematocrit (Hct). <b>Statistical Analysis:</b>Comparison of blood glucose concentration of B Braun glucometer, HemoCue Glucose 201+ analyser and centralis/ed plasma glucose levels was done by using stude nts test. All the statistical analysis were done using software SPSS 6 version. <b>Results:</b>Mean values of blood glucose (100.2 +48.4) with B Braun glucometer was significantly higher (p=0.003) when compared to plasma glucose values (76.95 + 45.99) estimated in central laboratory and HemoCue glucose 201+ analyser (82.9 + 51.4). HemoCue glucose 201+ analyser did not show significant difference (p=0.463) with central laboratory testing. There was no significant difference between the capillary and venous sample estimated in both the instruments. Estimation with HemoCue glucose 201+ analyser correlated well with central laboratory testing in neonates with blood glucose <55mg/dl <b>Conclusion:</b> We conclude that HemoCue glucose 201+ analyser appears to be a suitable point of care blood glucose measurement device in neonates on both capillary and venous blood samples, as it showed a good correlation with central laboratory values without significant interference from Hct. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=PC10-PC13&id=4538 https://doi.org/10.7860/JCDR/2014/.4538 Sarcomatoid Renal Cell Carcinoma: Case Report and Review of Literature Maryann Margaret Bukelo, Srikanth.U, Sharada Rai Sarcomatoid renal cell carcinoma is a tumour with aggressive behaviour. It is a form of dedifferentiated carcinoma with high incidence of metastases to the lungs. We report a case of 55-year-old male who presented with complaints of loin pain and hematuria. The biopsy confirmed sarcomatoid variant of renal cell carcinoma. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=FD01-FD03&id=4539 https://doi.org/10.7860/JCDR/2014/.4539 Intra Articular Synovial Lipoma of the Right Tarsometatarsal Joint- A Rare Case Report Pavithra. P, Arundhathi.S, C. R. Kodandaswamy Intra articular synovial lipomas are very rare and only few cases have been reported till now. We are reporting a rare case of intra articular synovial lipoma of the tarsometatarsal joint in the right foot in a 38-year-old male who presented with dull aching pain in the plantar aspect of the foot while walking. The lesion was resected and subjected to histopathological examination, which showed well defined lobules of mature adipocytes separated by thin fibrous septa and covered by synovial lining. Immunohistochemistry with S100 antigen showed membrane positivity. A diagnosis of intra articular synovial lipoma of the tarsometatarsal joint of the right foot was made. Our English literature search failed to yield any information regarding the occurrence of synovial lipoma in small joints and our case may be the first of its kind. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=FD03-FD04&id=4540 https://doi.org/10.7860/JCDR/2014/.4540 Achalasia Cardia: An Interesting Variation as a Large Neck Swelling Haris Manzoor Qadri, Arun Y. Dehadaray,Maitri Kaushik, Danish Zamir Andrabi In this report we present a case of large neck swelling that turned out to be achalasia cardia, not a very common presentation of this disease. An elderly female presented with complain of progressive dysphagia, aspiration and regurgitation of food along with right sided neck swelling measuring 10x5 cm. It was associated with weight loss. X-ray chest depicted an unusually large mass in paramediastinal region parallel to right mediastinal border showing central lucencies. A CT scan of neck revealed a gross dilatation of cervical and thoracic oesophagus. Oesophagus enlargement was enormous to the extent that it could be palpated in the neck compressing airway. This presentation of large neck swelling turning out to be a huge dilatation of esophagus on CT, depicts one of the many interesting variations that this condition can present as. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=KD01-KD02&id=4541 https://doi.org/10.7860/JCDR/2014/.4541 Gaint Follicular Cyst of Ovary in an Adolescent Girl Disha Rajput, Jaya Gedam, Minal Bhalerao, Ponambalaganpathi A Nadar Cystic abdominal lesions are extremely common in adolescent girls and are now diagnosed more frequently due to the availability of better imaging modalities. Presentations as huge cysts have become rare as most of them are diagnosed and treated early. Adolescent girls presenting with huge benign abdominal cysts is not uncommon, most of them due to serious cystadenomas of the ovary, but large follicular cysts are rare. We present a 13-year-old girl who presented with a large abdominal mass which was subsequently diagnosed as juvenile follicular cyst of the ovary. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=OD03-OD04&id=4542 https://doi.org/10.7860/JCDR/2014/.4542 3D Laparoscopy - Help or Hype: Initial Experience of A Tertiary Health Centre Diwakar Sahu, Mittu John Mathew, Prasanna Kumar Reddy <b>Introduction:</b> To evaluate the advantages of 3D laparoscopy and compare its significance with conventional 2D laparoscopy during various operative procedures. <b>Materials and Methods:</b> During present study, two groups were formed. Group A included patients who were operated using 3D laparoscopic imaging and Group B consisted of operated patients by 2D laparoscopy. Operative performance of both the groups was compared in terms of operative time and quality of imaging. <b>Results:</b> Operative time interval for various procedures was significantly less in Group A as compared to Group B. Also, imaging quality was far superior with use of 3D imaging system especially in terms of depth perception. <b>Conclusion:</b> Advantages of 3D laparoscopy are well appreciated during operative procedures as previously documented by other studies in training models. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=NC01-NC03&id=4543 https://doi.org/10.7860/JCDR/2014/.4543 A Retrospective Audit of Hundred Patients of Orbitozygomatic Fractures with Brain Injury Garg Ramneesh, Gupta Gulzar, Uppal Sanjeev, Mittal Rajinder, Pal Ranabir, Garg Nikhil <b>Background:</b>Orbitozygomatic fracture that most commonly accompanies craniofacial injury is a challenge for medical science to reduce complications and to attain aesthetically satisfying results. <b>Objective:</b>To summarize our experiences with the optimum management of orbito-zygomatic fractures. <b>Materials and Methods:</b>This retrospective study was aimed at investigating indications and surgical approaches for orbito- zygomatic fractures with clinical follow-up, particularly with regard to postoperative complications. Since 2010, 100 cases with facio- maxillary injury were assessed for Orbitozygomatic fractures with the help of physical examination, non-invasive investigations including computed tomography of the orbit. Patients were retrospectively analysed for data, such as mechanism of injury, classification of fracture, and complications. <b>Results:</b>Amongst 100 consecutive patients with orbito-zygomatic fractures an overwhelming majority were males (n=83). In the age distribution a great majority (45%) were in 30-45 years age group, followed by 15-30 years (22%) and 45-60 years (18%). So in the productive age group i.e. 15-60 years age group were affected mostly (85%) in our series. Among different injury mechanism, Road traffic accident affected most (69%) that landed up in orbito-zygomatic fractures followed by altercations (22%). We preferred Open reduction and internal fixation (ORIF) for 68% of the patients with orbito- zygomatic fractures, followed by closed reduction (12%). <b>Conclusion:</b> Ophthalmology consultation is recommended for all patients presenting with orbitozygomatic fractures, and is essential for patients with orbital blowout fractures, based on the high incidence of clinical ocular findings and injuries in this subgroup of patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=NC04-NC06&id=4547 https://doi.org/10.7860/JCDR/2014/.4547 Malnutrition Among Under-Five Children of Kadukuruba Tribe: Need to Reach the Unreached Renuka Manjunath, Jagadish Kumar K, Praveen Kulkarni, Khyrunissa Begum, Gangadhar M R <b>Introduction:</b> Poor nutritional status of tribal children observed in different parts of India, calls for introspection into various factors influencing it, in order to seek remedial measures. <b>Objectives:</b> To assess the prevalence of malnutrition among under-five children of Kadukuruba tribe and socio-demographic factors associated with it. <b>Materials and Methods:</b> Community based cross-sectional study was done in Kadukuruba tribes of Mysore district over a period of one year among 101 under-five children. Socio- demographic information and anthropometric measurements were obtained by using standard techniques. Height and weight of each child was compared with WHO child growth standards- 2006 for that particular age and sex to get W/A, H/A and W/H Indices and below 2SD of the reference median on these indices were considered as underweight, stunted and wasted respectively. <b>Results:</b> Prevalence of underweight, stunting and wasting was 60.4 %, 55.4% and 43% respectively which was significantly associated with respect to age, presence of ration card in the family and egg in the child’s diet. <b>Conclusion:</b> Significantly higher prevalence of under-nutrition was noted among under-five children in this community. This calls for educating mothers and other caretakers in the family regarding increased nutritional requirements with increasing age, strengthening Public Distribution System and ensuring egg made available in the regular weekly Menu at all Anganwadi’s. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=JC01-JC04&id=4548 https://doi.org/10.7860/JCDR/2014/.4548 Effect of Traditionally Used Neem and Babool Chewing Stick (Datun) on Streptococcus Mutans: An In–Vitro Study Abhishek Sharma, Bharat Sankhla, Sujal M Parkar, Sudheer Hongal, Thanveer K, Ajithkrishnan Cg <b>Purpose:</b>There are various plants, which are used as chewing sticks in different parts of the world. Several studies have been reported on the antimicrobial effects of chewing sticks on oral bacteria. This study was conducted to evaluate the effectiveness of traditionally used neem and babool chewing sticks (datun) extracts on Streptococcus mutans . <b>Materials and Methods:</b> The present invitro study was conducted to assess effectiveness of 5%, 10%, and 50% neem and babool extract on Streptococcus mutans . The ditch plate method was used to test the antimicrobial activity. Ditches were prepared on blood agar plates with the help of punch having 6mm diameter. The plates were left for 1h at room temperature and then incubated at 37°C for 48h and examined for zone of inhibition. <b>Results:</b>There was no zone of inhibition observed with 5% babool and neem aqueous extract. There was significant difference in mean diameter of zone of inhibition of 10% neem and babool extract (p-value 0.001 < 0.05). Similarly the mean difference in 50% neem and babool extract was found to be significant (p-value < 0.001). <b>Conclusion:</b>Both neem and babool extracts had antimicrobial activity against Streptococcus mutans , while antimicrobial activity was significantly higher in neem aqueous extract than babool aqueous extract. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZC15-ZC17&id=4549 https://doi.org/10.7860/JCDR/2014/.4549 Influence of Deep Breathing on Heart Rate Variability in Parkinson’s Disease: Co-relation with Severity of Disease and Non-Motor Symptom Scale Score Mukta Pritam Bidikar, Gayatri J Jagtap, Rahul T Chakor <b>Context:</b> Dysautonomia and non-motor symptoms (NMS) in Parkinson’s disease (PD) are frequent, disabling and reduce quality of life of patient. <b>Aims and Objective:</b> There is a paucity of studies on autonomic dysfunction in PD in Indian population. The study aimed to evaluate autonomic dysfunction in PD patients and co-relate the findings with severity of PD and Non-Motor Symptoms Scale (NMSS) score. <b>Materials and Methods:</b> We evaluated autonomic function in 30 diagnosed patients of PD (age 55-70 years) and 30 healthy agematched controls by 3 min deep breathing test (DBT). NMSS was used to identify non-motor symptoms and Hoehn and Yahr(HY) Scale to grade severity of PD. The DBT findings were co-related with severity of PD (HY staging) and NMSS score. <b>Results:</b> DBT was found to be abnormal in 40% while it was on borderline in 33.3% of PD patients. There was a statistically significant difference (p<0.01) between patients and control group for the DBT. NMS were reported across all the stages of PD but with variable frequency and severity for individual symptom. A negative co-relation was found between results of deep breathing test and clinical severity of disease and NMSS score. <b>Conclusion:</b> Abnormalities of autonomic function and NMS were integral and present across all the stages of PD patients. Early recognition and treatment of these may decrease morbidity and improve quality of life of PD patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=BC01-BC03&id=4550 https://doi.org/10.7860/JCDR/2014/.4550 Analysis of Blood and Salivary Urea Levels in Patients Undergoing Haemodialysis and Kidney Transplant Suresh.G, Ravi Kiran.A, Samata.Y, Purnachandrarao Naik.N, Vijay Kumar.A <b>Aims and Objectives:</b> To determine correlation between the Salivary Urea (SaU) levels with that of Blood Urea (BU) levels. <b>Materials and Methods:</b> Subjects were selected from patients undergoing haemodialysis HD and patients who had underwent kidney transplantation at Ashwini Hospitals Guntur. The study comprised of 45 patients, of which HD group with 20 patients, Transplant (T) group with 15 patients and 10 patients in control group. Samples of blood and saliva were taken from all the patients to assess the Blood Urea Nitrogen (BUN) and SaU levels respectively under strict aseptic precautions. Blood was collected just prior to the dialysis in HD group and in renal transplant (T) patients during their review visit. Informed consent was taken from patients and ethical committee approval taken. <b>Results:</b> There was a statistically significant difference between BU and SaU levels in the HD and T group (p<0.05). There was a statistically significant difference between T and Control group with respect to BU and SaU levels. The salivary urea levels are slightly higher than blood urea levels in all the study groups. <b>Conclusion:</b> The SaU tests can be used in place of blood tests as a non invasive diagnostic tool. Thus, preventing the unnecessary and periodic withdraw of blood which is not only cumbersome but also leads to recurrent infections. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZC18-ZC20&id=4553 https://doi.org/10.7860/JCDR/2014/.4553 Comparison of Intrusion Effects on Maxillary Incisors Among Mini Implant Anchorage, J-Hook Headgear and Utility Arch Ravindra Kumar Jain, Sridhar Prem Kumar, W.S. Manjula <b>Background:</b> Intrusion of maxillary incisors is one of the most important and difficult tooth movements to achieve as a part of orthodontic therapy. A variety of techniques were used in the past to intrude the maxillary incisors before the emergence of mini implants in Orthodontics. Mini implants are temporary anchorage devices used to produce various tooth movements. The research was carried out to evaluate and compare the efficiency of producing intrusion of maxillary incisors using mini implants, utility arch and j- hook headgear. <b>Materials and Methods:</b> The study was conducted on 30 subjects divided into 3 Groups equally. Group 1- mini implant anchorage, Group 2 - j- hooks headgear and Group 3- utility arch were used for intrusion of the maxillary incisors. Conventional lateral cephalograms were taken before treatment and at the end of intrusion. Five cephalometric parameters were used to measure the amount of intrusion attained in each Group. Intra Group comparisons were done using student t-test and inter Group comparisons were done using ANOVA The duration of intrusion was four months in all the three Groups. <b>Results:</b> In Group 1 the mean average intrusion attained was 2.1mm, the mean average intrusion attained in Group 2 was 0.7 mm, and the mean average intrusion achieved in Group 3 was 1.4 mm with a side effect of 0.75 mm of molar extrusion. <b>Conclusion:</b> Although, both mini implants and utility arch can be used to attain significant amounts of incisor intrusion but using mini implants will produce true intrusion without any other side effects. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZC21-ZC24&id=4554 https://doi.org/10.7860/JCDR/2014/.4554 Study of Aortic-Common Iliac Bifurcation and Its Clinical Significance Arvind Deswal, Binod Kumar Tamang, Anju Bala <b>Objective:</b> To determine the position of the aortic bifurcation, angle of aortic-common iliac bifurcation in relation to the lumbar vertebra, diameter of distal aorta, length of common iliac, diameter of iliac at bifurcation in cadavers. <b>Materials and Methods:</b> The present study was done on 25 cadavers (16 males, 9 females) used for the dissection by 1st year MBBS students. The dissections were performed by anterior approach to the lumbar vertebra. The position of the aortic bifurcation, aortic bifurcation angle were measured in relation to lumbar vertebra. The remaining parameters were measured with the help of digital vernier caliper. <b>Results:</b> The aortic bifurcation was seen in between L3 and L5 vertebra in all the cases. In majority of cases, 16 (64%), the bifurcation was observed at the level of L4 vertebra. During statistical analysis, significant differences were observed in the mean values of aortic-iliac take off angles and in mean diameter of distal aorta. <b>Conclusion:</b> The exact location of aortic bifurcation is useful when invasive procedures are performed in the pelvis, laproscopic lumbar discectomy and lumbosacral total disc arthroplasty. The aortic bifurcation mostly found at the level of L4 vertebra in the present study similar to previous studies. The aortic bifurcation can be a reliable landmark for determining the lumbar vertebral segments on MRI or CT. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=AC06-AC08&id=4559 https://doi.org/10.7860/JCDR/2014/.4559 Risk Factors Assessment of the Difficult Intubation using Intubation Difficulty Scale (IDS) Vaibhav K.Nasa, Shaila S.Kamath <b>Background:</b> The major responsibility of anaesthesiologist is to maintain adequate gas exchange in his patients in all circumstances and this require that patency of upper airway is constantly maintained. Problems with upper airway management are among the most frequent causes of anaesthetic mishaps. Using intubation difficulty scale (IDS) we made an attempt to objectively assess the predictors of difficult intubation. We assessed classical bedside tests such as modified Mallampati test, Thyromental distance test and also neck extension test. <b>Methods:</b> We prospectively observed 400 patients undergoing general anaesthesia with endotracheal intubation, for each patient intubation difficulty score was recorded during intubation. Risk factors assessment of difficult intubation done using IDS. Risk factor assessed includes modified mallampati class III and IV, thyromental distance = 6cm and neck extension < 5cm. Patients were categorised as Easy intubation (IDS, 0 to 2), slightly difficult intubation (IDS, 3 to 4) and difficult intubation (IDS ? 5). Preoperative airway assessment was done by thyromental distance measurement, neck extension measurement and modified mallampati test. Data was analysed using Receiver operating characteristic (ROC) curve and area under curve (AUC) for each test computed. p<0.05 was considered significant. <b>Results:</b> The incidence of difficult intubation was 8% and there were no failure to intubate the trachea. The AUC were as follows: modified Mallampati test 0.473 (p<0.005), Thyromental distance test 0.753 (p<0.005) and neck extension test 0.768 (p<0.005). <b>Conclusion:</b> The results indicate that neck extension test is strongest predictor of difficult intubation (IDS=5) in comparison to Thyromental test and modified mallampati test. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=GC01-GC03&id=4560 https://doi.org/10.7860/JCDR/2014/.4560 Ethics Workshops-Are They Effective in Improving the Competencies of Faculty and Postgraduates? Sudha Ramalingam, S Bhuvaneswari, Ramalingam Sankaran <b>Introduction:</b> Responsible conduct of research requires a good knowledge about research ethics. With the recent changes in the clinical trial regulations and the proposed introduction of ethics in medical curriculum by the Medical Council of India, there is an urgent need to train the medical faculty and postgraduates in research ethics. <b>Methodology:</b> We wanted to measure the effectiveness of a one day program which was organized using didactic lectures and case scenarios on the knowledge, attitude and skills on ethics among faculty and postgraduates. This was done using a retropre questionnaire. We performed a Kolmogorov Smirnov test to measure the normality, Mann Whitney U-test to test the difference in scores between faculty and postgraduates and a Wilcoxin signed rank test to measure the prepost scores. <b>Results:</b> The faculty showed better scores in knowledge and attitude (p<0.05) when compared to postgraduates both before and after the workshop. The overall scores for both faculty and postgraduates had increased after the workshop (p<0.05). <b>Conclusion:</b> This re-emphasizes the need for introduction of ethics training during undergraduate course and also the fact that even a short training program in research ethics could be effective. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=XC01-XC03&id=4561 https://doi.org/10.7860/JCDR/2014/.4561 Expression of Bcl-2 and MIB-1 Markers in Oral Squamous Cell Carcinoma (OSCC)- A Comparative Study Jessica Garewal, Ripin Garewal, Keya Sircar <b>Background:</b> Neoplasia results from various genetic and epigenetic factors. Our study focused on the pathogenesis which involved an imbalance in various molecular mechanisms which regulated cell proliferation and apoptosis. The anti-apoptotic mechanism is regulated by Bcl-2 gene, while Ki-67 is expressed exclusively in nuclei of proliferating cells. This study was done to evaluate the basic pathologic process which underlay well and poorly differentiated oral squamous cell carcinoma (OSCC). <b>Materials and Methods:</b> Thirty cases of oscc were selected, out of which 11 were well differentiated, 9 were moderately differentiated and 10 were poorly differentiated. Three slides of 4µm thickness were prepared out of each sample, which were then subjected to Hematoxylin and eosin stain (H&E) staining and two types of immunohistochemical (IHC) staining. Immunohistochmical markers used were Ki-67 (proliferative marker using MIB-1 (Molecular Immunology Borstel 1) antibody) and Bcl-2 (anti-apoptotic marker). The number of MIB-1 and Bcl-2 positive cells was calculated from ten different high power fields, by counting the number of positive cells per 50 cells in each field, by making a grid pattern. The overall percentage value for each case was evaluated for MIB-1 and Bcl-2 positive cells. Karl-Pearson’s co-relation coefficient was calculated between MIB-1 and Bcl-2 in each group. The aim of this study was to co-relate the expression of Ki-67, a proliferative marker, by using MIB-1 antibody and Bcl-2, an anti-apoptotic marker in various grades of oscc and also to determine whether there was any co-relation between these two markers in the 30 cases of oscc . <b>Results:</b> A statistically significant increase for MIB-1 and a statistically significant decrease for Bcl-2 was found in well to moderately to poorly differentiated Squamous cell carcinoma (SCC). A statistically significant co-relation was also found between MIB-1 and Bcl-2 in poorly differentiated oscc . <b>Conclusion:</b> MIB-1 expression is predominant in well, moderate and poorly differentiated SCCs. Bcl-2 expression is predominant in well differentiated than in moderately and poorly differentiated oscc , which suggested that apoptosis probably played a major role in the early stages of carcinogenesis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=QC01-QC04&id=4562 https://doi.org/10.7860/JCDR/2014/.4562 Donor Deferral Characteristics for Plateletpheresis at a Tertiary Care Center in India- A Retrospective Analysis Mukta Pujani, P Lalita Jyotsna, Shalini Bahadur, Sangeeta Pahuja, Chintamani Pathak, Manjula Jain <b>Background:</b> The demand for plateletpheresis is increasing day by day due to its many merits over random donor platelets. However, in our country, there is a dearth of apheresis donors due to greater devotion and time required for the procedure and lack of awareness. <b>Aim:</b> The aim of the present study is to analyse the reasons for deferral of apheresis donors at a tertiary care center. <b>Materials and Methods:</b> This retrospective analysis was conducted to study the causes, frequency and the type of plateletpheresis donor deferral at regional blood transfusion center, Lady Hardinge Medical College and associated Shrimati Sucheta Kriplani Hospital and Kalawati Saran Childrens’ Hospital. The study was undertaken over a period of two years (from January 2010 to December 2011. <b>Results:</b> Out of a total of 343 donors screened, 87 donors were deferred, the overall deferral rate being 25.36%. The most frequent cause of deferral was a low platelet count accounting for 43.5% of all the causes followed by a low hemoglobin level (27.05%). Among the donors deferred for anaemia, 15 out of 23 (65.2%) had hemoglobin in the range of 11.5-12.4gm%, representing 17.2% of all deferrals. <b>Conclusion:</b> Based on these findings and the scarcity of apheresis donors in our country, we are of the opinion that the selection criteria for plateletpheresis donors should be revised to accommodate more donors and reduce deferral rate without compromising on the health of the donors. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=FC01-FC03&id=4563 https://doi.org/10.7860/JCDR/2014/.4563 Anatomical Study of Pectoral Nerves and its Implications in Surgery Prakash KG, Saniya K <b>Introduction:</b>This anatomical study of the pectoral nerves and their innervation is to provide detail informations on the pectoral nerves and their variations in their course, to guide the cosmetic and plastic surgeons for their easy intra operative localization and to improve the understanding of the pectoral muscle innervation, which is very much required during breast reconstruction after modified radical mastectomy (MRM) in breast cancer; axillary dissection; removal of the pectoralis minor muscle, and in harvesting the pectoralis major for myocutaneous head and neck island flap surgeries. <b>Materials and Methods:</b>A total of 50 pectoral region specimens (both right and left sided) from 25 embalmed adult human cadavers (20 female & 05 male) were studied by dissection method. <b>Statistical Analysis:</b>The data were tabulated in Microsoft excel and analysed by using Statistical Package for Social Science (SPSS 17 th version). Mean, Proportion, Standard deviation and Unpaired t-test were applied for analysing the data obtained. <b>Result and Conclusion:</b>In all the specimens, the medial pectoral nerve pierces the pectoralis minor muscle; but as a single trunk in 76%, and as dividing branches in 34% specimens. The extent of costal attachment of the pectoralis minor muscle found to be less than 6.0 cm in cases of the medial pectoral nerve piercing the pectoralis minor muscle as a single trunk. The medial pectoral nerve after piercing the pectoralis minor, ramify within the muscle supplying it, finally runs along the lateral aspect (lower border) of the pectoralis minor muscle to supply the lower portion or distal segment of the pectoralis major muscle. Similarly, the lateral pectoral nerve runs along the upper border (medial aspect) of the pectoralis minor muscle (98%) and then runs under surface of the pectoralis major muscle along with the pectoral branch of thoracoacromial artery, supplying the upper portion or most of the proximal 2/3 rd of the pectoralis major muscle. Therefore, when the pectoralis minor muscle is removed in a modified radical mastectomy or during dissection between the two muscles, there is partial denervation of the pectoralis major muscle with partial atrophy and decrease in muscle mass. If the lateral pectoral nerve also injured along with the medial pectoral nerve, it can result in total denervation of the pectoralis major muscle with severe atrophy and fibrosis. In breast augmentation implants placing behind the pectoralis major muscle, it is found to be more advantageous if the pectoralis major muscle is partially denervated for the better projection and contour. The distance of the branches of the medial pectoral nerve and the lateral pectoral nerve in the pectoral muscles from the lateral margin of the sternum being 8.8-10.8cm and 5.8-10.2cm respectively. The proximal segment or upper portion of the pectoralis major muscle has got separate independent vascular and nerve supply; therefore, it can be safely used as a myocutaneous flap in surgeries of head and neck or anterior chest wall. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=AC01-AC05&id=4545 https://doi.org/10.7860/JCDR/2014/.4545 Dental Caries and Periodontal Status of Mentally Handicapped Institutilized Children Jitender Solanki, Sarika Gupta, Astha Arya <b>Background:</b> Dental caries and periodontal disease are the most prevalent dental disease among mentally retarded children worldwide. <b>Aims and Objectives:</b> A study was carried out in Jodhpur city of Rajasthan state of India to assess the Dental caries and periodontal Status of Mentally handicapped attending special schools children in Jodhpur city. <b>Material and Methods:</b> A cross-sectional descriptive survey was conducted in 80 mentally handicapped subjects, attending a Special Needs school in Jodhpur City. Dental caries and Periodontal Status were recorded following the WHO basic oral health survey. <b>Results:</b> None of the subject had healthy periodontal status, dental caries was found in 79.2% of the subjects, Lymphadenopathy was observed in highest number of subjects 55 (76.3%). <b>Conclusion:</b> Health professionals should therefore be aware of the impact of mental illness and its treatment on oral health, Health personnel should receive training to support and provide all possible services to this population. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZC25-ZC27&id=4557 https://doi.org/10.7860/JCDR/2014/.4557 Clinical Awareness of Do’s and Don’ts of Cardiopulmonary Resuscitation Among University Medical Students-A Questionnaire Study Meena Kumari K, Mohan babu Amberkar, Suhas Alur S, Pavan Madhukar Bhat, Siddharth Bansal <b>Background:</b>Medical students today are tomorrow’s future doctors. One of the key skills that students should develop during their graduation training is to be prepared for emergency life saving measures like cardiopulmonary resuscitation (CPR) anytime, anywhere. The students play integral role in learning, mastering and inculcating the most pragmatic clinical skill of CPR. <b>Objectives:</b> a) To evaluate the CPR awareness among undergraduate medical students. b) To screen the knowledge regarding accurate, effective CPR procedural techniques and various barriers of CPR failure in clinical practice from student perspective. c) To ascertain interest in CPR training programs and also inculcating CPR as an active part of clinical practice in future. <b>Materials and Methods:</b>The questionnaire comprised of three parts, first one dealing with general questions to know the importance of CPR in clinical practice, second one comprised of the main goal and accuracy of CPR intervention and the last segment consisted of questions targeting the indications, methods and effectiveness of CPR. <b>Statistical Analysis:</b>Descriptive statistics and multiple response analyses were done by using SPSS 17. <b>Results:</b>The students had good knowledge about the importance of CPR in clinical practice and stand average in knowing its indications and effectiveness. Whereas, only 1.2% of them were completely aware about the universal compression ventilation ratio, and 20.4% were aware of the current order of CPR being compression, airway and breathing. <b>Conclusion:</b>Though, CPR awareness is good among the students but skills of CPR have to be mastered by proper certified training programs at regular intervals and knowledge has to be updated with the changing trends in CPR. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=MC08-MC11&id=4567 https://doi.org/10.7860/JCDR/2014/.4567 Abdominal Tuberculosis with an Acute Abdomen: Our Clinical Experience Arunima Mukhopadhyay, Ramprasad Dey, Ujjwal Bhattacharya <b>Introduction:</b>Tuberculosis is an important cause of morbidity in India. Abdominal Tuberculosis is a great mimicker and is difficult to diagnose. This prospective observational study is based on those patients who were diagnosed to be suffering from Abdominal Tuberculosis only after they presented with an acute abdomen. This study aims to document the nature of different types of acute presentation in Abdominal Tuberculosis according to involved sites and surgical pathology. The study also discusses the indications and extent of surgical intervention. <b>Methods:</b>Seventy new cases of Abdominal Tuberculosis (out of 718 cases of acute abdomen) were diagnosed and treated over a period of three years in the surgical ward of Calcutta National Medical College. Macroscopic appearance of abdominal tissues during surgery suggested the diagnosis of tuberculosis. The diagnosis was confirmed by histopathology and tissue culture. All patients were subsequently treated with a full course of antitubercular drugs (ATD). <b>Results:</b>The clinical presentations of acute abdomen included acute intestinal obstruction, perforative peritonitis and acute appendicitis etc. Terminal ileum and ileocaecal region were predominantly involved. The most common pathology was intestinal stricture with or without perforation. Most of the patients (approx 78.5%) required emergency surgery as a therapeutic intervention. A two-stage procedure was preferred in peritonitis and sepsis. Most of the remaining patients (12.8%) required surgery after initial conservative treatment for the first few days. Undiagnosed Abdominal Tuberculosis represents a notable percentage (10%) of patients who present with an acute abdomen as a surgical emergency. <b>Conclusion:</b> Abdominal Tuberculosis is very difficult to diagnose and diagnosis is often delayed till an acute abdomen is presented with. Almost all patients needed surgical intervention. Irrespective of surgery, all patients of Abdominal Tuberculosis require a full course of antitubercular drugs (ATD) https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=NC07-NC09&id=4574 https://doi.org/10.7860/JCDR/2014/.4574 Lip Prints and Inheritance of Cleft Lip and Cleft Palate Manasa Ravath CJ, Girish HC, Sanjay Murgod, Ramesh B Hegde, Savita JK <b>Background:</b> Labial mucosa has elevations and depressions forming a pattern called ‘Lip Prints’. Parents of patients with cleft lip &/or palate are known to have a particular lip print pattern. <b>Objectives:</b> Analysis of lip prints and relationship between Cheiloscopy and inheritance of cleft lip &/or cleft palate. <b>Methodology:</b> The study included 100 subjects [study groupparents with children having cleft lip &/or cleft palate, 50 fathers and 50 mothers) and 50 subjects (control group-parents having children without cleft lip &/or cleft palate, 25 fathers and 25 mothers]. The lip prints of the subjects were obtained using the cellophane method and analysed using Suzuki & Tsuchihashi classification of lip prints. The data was subjected to Chi- Square test, Fisher Exact test and Student t-test [two tailed, independent]. <b>Results:</b> A new whorl pattern was present in the study group. The groove count was higher in the fathers’ than in the mothers’ prints in the upper lip and vice versa in the lower lip. <b>Conclusion:</b> The new pattern was present in the study group in a significant number of cases. The groove count was significantly high in the study group. These two parameters can be of significant value to similar future studies. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZC28-ZC32&id=4575 https://doi.org/10.7860/JCDR/2014/.4575 Evaluation of Effects and Effectiveness of Various a and ß Angulations for Three Different Loop Made of Stainless Steel Arch Wires – A FEM Study Supradeep Kumar Kamisetty, Raghuveer N, Rajavikram N, Chakrapani N, Dwaragesh, Praven <b>Introduction:</b> Evaluations on retraction loop designs have been limited to describe the force systems applied to the buccal surfaces of the tooth that can be in different planes resulting undesirable effects, needing corrective action in future. By initially understanding these effects, modifications to the loop design can essentially counteract the undesired affects. <b>Aim:</b> To deter-mine Moments & M/F ratios produced by different gabling in the three retraction loops (Tear drop loop, T-loop, Open vertical loop) and movement of the anterior teeth and posterior teeth) of the maxillary arch in an extraction model, on activation of three retraction loops by1 mm. </b>Materials and Methods:</b> A PC with Quad core processor, 8GB RAM, 1TB storage space and Graphic Accelerator was used. <b>Computer Software:</b> ANSYS Version11, PRO/ENGINEER was used in the study. The first step is modeling, done by using Pro/ Engineer software and for creating a model the CT scan data is required. The maxilla with teeth of a patient is scanned at various sections at regular intervals of 0.5 mm. These scanned images are then imported into Pro/E software to various offset planes. Once imported, the software can do an automatic meshing and establishes contact automatically. <b>Results:</b> When angulations increases intrusive or extrusive movements and movements in horizontal direction of crown tip and root tip increases. All values of T-loop are more than Teardrop loop and less than Open vertical loop. <b>Conclusion:</b> FEM study concludes that Teardrop loop with 10- 20( a - ß ) combination is preferred for Group A anchorage. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZC33-ZC37&id=4576 https://doi.org/10.7860/JCDR/2014/.4576 Clinical Profile of SE in Children in a Tertiary Care Hospital in Bihar Mritunjay Kumar, Rashmi Kumari, Nigam Prakash Narain <b>Background:</b>Status epilepticus (SE) is a common, life threatening neurologic disorder that is essentially an acute, prolonged epileptic crisis. SE can represent an exacerbation of a pre-existing seizure disorder, the initial manifestation of a seizure disorder, or an insult other than a seizure disorder. <b>Objectives:</b> To study the aetiology, clinical profile, and outcome of SE in pediatric age group. Setting and study design: Prospective study at a tertiary care medical college hospital in Bihar, India. <b>Materials and methods:</b> Study was carried out for a period of one year (from April 2008 to March 2009). Seventy patients of SE in the age group of 6 month to 12 years were included in the study. Clinical history, general and systemic examination and relevant investigations along with pretested questionnaire were used to categorise different variables. Independent t-test was used for continuous variables and chi-square test for categorical variables. <b>Results:</b> Mean age for the study population was found to be 5.94 years (SD=3.152). Preponderance of male (60%) over female (40%) was observed. Aetiology included Idiopathic (27.14%), remote symptomatic (20%), acute symptomatic (47.14%), febrile (2.86%) and progressive encephalopathy (2.86%) groups. Generalised tonic clonic convulsion (GTC) convulsion was observed in 91.4% of SE patients while 8.6% had partial SE. Eighteen patients (25.7%) had prior history of convulsion whereas 52 patients (74.3%) presented with SE as first episode of convulsion. In our study, mortality rate was found to be 31.4% and acute symptomatic causes were responsible for most of the deaths. <b>Conclusion:</b> SE is a severe life threatening emergency with substantial morbidity and mortality. Patients with younger age and male sex are slightly more vulnerable to develop SE. Longer duration of SE and acute symptomatic aetiologies are independent predictors for poor outcome. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=PC14-PC17&id=4579 https://doi.org/10.7860/JCDR/2014/.4579 Lymphangioma Involving the Foetal Lower Limb, A Rare Condition Diagnosed on Prenatal Ultrasound Sunil Kumar K S,Suchith Hoblidar, Ramesh Kumar R, Rathnamala M Desai, Nayana A Yelamali Foetal lymphangiomas are found to frequently occur at the nuchal region. We are reporting a case of a foetal lypmhangioma which involved the abdominal wall and right lower extremity, which was diagnosed by prenatal ultrasonography at 27 weeks of gestation. Prenatal ultrasound, along with Doppler, provided reliable information regarding the extent of the lesion. Magnetic resonance imaging (MRI) is required only in doubtful cases. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=OD10-OD11&id=4581 https://doi.org/10.7860/JCDR/2014/.4581 A Comparison of Dimensional Accuracy of Addition Silicone of Different Consistencies with Two Different Spacer Designs - In-vitro Study Suprabha Rathee, B Es waran, MA Es waran, R Prabhu, KR Geetha, GP Krishna, Jagadeshwari <b>Introduction: </b>Dimensional accuracy of impression materials is crucial for the production of working casts in Fixed Prosthodontics. The accurate replication of tooth preparations and their arch position requires impression materials that exhibit limited distortion. <b>Method:</b> This study was conducted to comparatively evaluate the dimensional accuracy of additional silicones by comparing two different techniques and spacer designs, by measuring the linear changes in interpreparation distance. The impressions were made from a stainless steel master die simulating a three unit bridge. A total 80 die stone (type IV, Ultrarock) models were obtained from the impressions made using two different parameters. The two different parameters are Multimix and Monophasic technique and different spacer designs. <b>Result: </b>The interpreparation distance of the abutments in the casts was measured using a travelling microscope. Each sample was measured thrice and the mean value was calculated. The results obtained were statistically analysed and the values fall within the clinically acceptable range. <b>Conclusion:</b> The most accurate combination is multimix technique with spacer design which uses less bulk of impression material. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZC38-ZC41&id=4585 https://doi.org/10.7860/JCDR/2014/.4585 Effect of Yoga on Oxidative Stress in Elderly with Grade-I Hypertension: A Randomized Controlled Study Satish G Patil, Gopal B Dhanakshirur, Manjunatha R Aithala, Govindanagouda Naregal, Kusal K Das <b>Background and Objectives:</b> Hypertension, especially in elderly is a strong risk factor for cardiovascular mortality and morbidity. Oxidative stress has been implicated as one of the underlying cause of hypertension. Yoga has been found to control hypertension in the elderly, but the underlying benefits of mechanism in relation to oxidative stress regulation remains unclear. The purpose of the study was to investigate the effect of yoga on oxidative stress in elderly with Grade-I hypertension. <b>Methods:</b> An open parallel-arm randomised controlled study was conducted at BLDE University’s Shri B.M.Patil Medical College, Hospital and Research Centre, India on elderly male individuals with Grade-I hypertension (n=57, age 60-80 years). Study (Yoga) group was assigned for yoga intervention and control group for walking for one hour in the morning for six days in a week for three months under the supervision of yoga instructor and physical training instructor respectively. Serum malondialdehyde (MDA) as an indicator of oxidative stress and antioxidants such as serum superoxide dismutase (SOD), reduced glutathione (GSH) and vitamin C levels were estimated. <b>Results:</b> Yoga practice for three months has significantly reduced serum MDA level (p<0.001), and enhanced antioxidants level such as SOD activity (p=0.007), serum GSH (p=0.002) and vitamin C (p=0.002). In the control group, we observed a significant increase in serum MDA level (p=0.04) and reduction in serum vitamin C level (p=0.015) with no significant difference in the SOD activity and GSH level. <b>Conclusion:</b> These findings suggest that yoga is an effective means to reduce oxidative stress and to improve antioxidant defense in elderly hypertensive individuals. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=BC04-BC07&id=4586 https://doi.org/10.7860/JCDR/2014/.4586 Demonstration of Mycobacterium Tuberculosis in Sputum and Saliva Smears of Tuberculosis Patients Using Ziehl Neelsen and Flurochrome Staining- A Comparative Study Anuja G Holani, Sindhu M Ganvir, Nishat N Shah3, Shriram C Bansode, Va ishali Shende, Rashmi Jawade, Shobha C Bijjargi <B>Background:</b>Early detection of tuberculosis is important for reducing its morbidity and mortality especially in the patients with non-productive cough. To overcome the cumbersome process involved in collection and processing of the sputum specimen, the time consumed for reporting of sputum by Ziehl Neelsen (ZN) method and to introduce a routine screening test in suspected, symptomless tuberculosis patients, the present study was designed using saliva as diagnostic medium and Auramine Rhodamine (AR) as staining method. On review of literature, there was no study which has tried diagnosing tuberculosis using saliva with flurochrome stain; hence the present study was designed. <b>Aim:</b>To introduce a routine screening test for tuberculosis patient using saliva and to determine the diagnostic efficacy of routine ZN staining method and AR fluorescent staining method in sputum and saliva smears of pulmonary tuberculosis patients. <b>Settings and Design:</b> Laboratory settings and Experimental design. <b>Materials and Method:</b> Fifty smears samples of sputum and saliva of known cases of pulmonary tuberculosis were stained with routine ZN stain and other with AR fluorescent stain. All the specimens were inoculated into Lowenstein-Jensen culture media. The smears were subjected for scanning of Mycobacterium tuberculous bacilli under X 1000 magnification for ZN stain and X 400 magnification for AR stain by grid pattern proposed by National tuberculosis institute and graded by RNTCP grading system. <b>Results:</b> All 50 sputum samples showed 100% positivity by ZN and AR stain while only 76% positivity was seen by culture. Of the 50 saliva samples 10% cases were positive by ZN, 76% were positive by AR & 70% by culture method. Statistical analysis using chi square test was done, and the value was found to be statistically highly significant for AR staining technique. (p<0.001). <b>Conclusion:</b> Saliva can prove to be an important tool for the diagnosis as w ell as screening of the patients with pulmonary tuberculosis when aided with flurochrome staining method. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZC42-ZC45&id=4587 https://doi.org/10.7860/JCDR/2014/.4587 Portal Vein Doppler: A Tool for Non-Invasive Prediction of Esophageal Varices in Cirrhosis Minal Shastri, Sujay Kulkarni, Rushad Patell, Sarfaraz Jasdanwala <b>Background and Objectives:</b> Esophageal varices (EV), a major complication of liver cirrhosis, can lead to life threatening gastrointestinal (GI) bleeding. Esophagogastroduodenoscopy (EGD) is the gold standard for diagnosis and management of esophageal varices. However, it is not always available in resourceconstrained settings.This study was aimed at evaluating portal vein indices (PVI) using Doppler on ultrasound abdomen, which is more widely available, as tools to predict the presence of EV. <b>Methods: </b>A total of 50 adult patients with cirrhosis were included in the study. All subjects underwent a percutaneous liver biopsy, abdominal ultrasound and EGD along with other tests as part of the work up for cirrhosis. The portal vein indices that were studied included hepatic congestion index (HCI), portal vein diameter (PVD) and portal vein velocity (PVV). Their sensitivity, specificity and predictive values were calculated using EGD as a gold standard. <b>Results:</b> Association of PVD, PVV and HCI with presence of EV was statistically significant (p-value <0.01). PVV had the highest sensitivity 84% (95% CI 66.45%- 94.10%) for detecting the presence of EV. PVD and HCI had the highest specificity of 55% (95% CI 0.31-0.77) and the highest negative predictive value of 38%(95% CI 0.24-0.52). Positive predictive value was highest PVV at 76%. (95% CI 0.61-0.86) <b>Conclusion:</b> In resources- constricted settings where EGD is not available, PVI (PVV, PVD and HCI) on ultrasound abdomen can be used as non-invasive parameters to predict the presence of EV. Although EGD remains the gold standard for the diagnosis and management of EV, when this is not possible due to scarcity of resources, PVV may be used a tool to triage patients for referral for an EGD as it has the highest sensitivity of 84% (95% CI 66.45%- 94.10%) and positive predictive value of 76% (95% CI 61.51%-86.47%) amongst the PVI studied for detecting the presence of EV. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=MC12-MC15&id=4589 https://doi.org/10.7860/JCDR/2014/.4589 Effect of Smoking on Periodontal Health Rahul Visvanathan, Jaideep Mahendra, Am balavanan .N, PandiSuba, Chalini <b>Aims and Objectives:</b> The aim of the study was to assess and compare the effect of smoking on mRNA expression of MMP -8 and TIMP-1 in patients with untreated chronic periodontitis and in periodontally healthy subjects and to examine the correlation of MMP-8 and TIMP-1 levels with clinical parameters. <b>Materials and Methods:</b> Out of 60 subjects, 40 were selected subjects for the study, and were divided into Group I (periodontitis subject) and Group II (healthy subjects). Each group was further subdivided into subgroups I-A (chronic periodontitis smokers CPS), and I-B (chronic periodontitis non-smokers CPN), subgroup II-A (healthy smokers HS) and II B (healthy non-smokers HS). Both the groups underwent periodontal examination and clinical parameters were recorded. Tissue samples from both groups were subjected to the isolation of RNA which was then followed by qRT-PCR and the expression of the mRNA levels of MMP-8 and TIMP-1 were analyzed. <b>Results:</b> The mRNA expression of MMP-8 and TIMP-1 was further compared with the periodontal status of all the four groups. The mRNA expression of MMP-8 was compared between the groups and showed that Group I-A (CPS) had higher expression of MMP-8 compared to group I-B (CPN). Group I-B (CPN) vs Group I-A (CPS) showed statistically significant difference in MMP-8/TIMP-1 with higher values for Group I-A (CPS) than Group I-B (CPN). A positive correlation was found between MMP-8 expression and probing depth and clinical attachment level among Group I-B (CPN) and Group I-A (CPS) subjects. A significant correlation was also found between MMP-8 and TIMP-1 expression with probing depth and clinical attachment level among Group II B(HN) group subjects. TIMP-1 also showed a positive correlation with gingival index among group II A (HS) subjects. <b>Conclusion:</b> It is concluded that smoking has an impact on the periodontal status and mRNA expression of MMP-8 and TIMP-1 in chronic periodontitis patients. The earlier evaluation of MMP-8 and TIMP-1, can be used as a biomarker in predicting periodontal disease susceptibility. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZC46-ZC49&id=4597 https://doi.org/10.7860/JCDR/2014/.4597 Establishment of Reference Interval of Serum Prolactin in an Indian Population Kapil Deb Lahiri, Mriganka Baruah, Joya Ghosh, Soumendyu Sengupta <b>Background:</b> Reference data on serum prolactin levels based on a representative Indian sample are still lacking. The western normative laboratory values used for clinical diagnosis may not be applicable to Indian population. The objective of the study was to measure the serum prolactin levels in healthy Indian male and female in order to establish reference interval and to compare with the available reference intervals. It is a cross- sectional study done in West Bengal, India. <b>Materials and Methods:</b> Based on the history, clinical examination and laboratory investigations, serum prolactin levels of 1316 apparently healthy subjects were estimated by microplate immunoenzymometric assay using pooled serum. Statistical analysis was performed using SPSS software. <b>Results:</b> The serum prolactin levels for all ages were 10.7 ± 3 ng/ml in healthy male and 11.6 ± 2.8 ng/ml in healthy female. Decade-wise analysis of serum prolactin level in female showed a steady increase from 20-29 years to advancing decades until 4th decade and thereafter declines steadily although it was not same for male. <b>Conclusion:</b> Our study will help each laboratory to formulate their own reference interval for prolactin. As of now they were dependent either on the values written on the kit-literature supplied by the reagent manufacturing company or the reference intervals of foreign population. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=CC08-CC10&id=4599 https://doi.org/10.7860/JCDR/2014/.4599 Relationship between Serum Level of Interleukin-2 in Patients with Systemic Lupus Erythematosus and Disease Activity in Comparison with Control Group Sima Sedighi, Mehrdad Aghaei, Sara Musavi, Mahin Nomali <b>Background:</b>Despite the large number of surveys, there are not any validated biomarkers for SLE disease activity till now. This study aimed to evaluate the relationship between serum level of IL-2 in patients with SLE and disease activity in comparison with control group. <b>Materials and Methods:</b> In this case-control study, 73 patients with lupus and 73 healthy subjects referred to the rheumatology clinic of 5 Azar Hospital in Gorgan (North of Iran).They were studied via convenience sampling during 2011-2012. Blood samples were taken from both groups and serum levels of interleukin -2 measured by Avi Bion Human IL-2 ELISA kit. Serum Level of IL-2 greater than 15 pg/ml defined positive and lesser than this amount defined negative. Disease activity evaluated with SLE disease activity index. Score greater than or equal to three or four defined as active disease. Data analysis conducted by SPSS software (version 16) and by using descriptive statistics and statistical tests. <b>Results:</b> Serum level of IL-2 was positive in 45.2% of sample studied and negative in 54.8% in case group, while in control group, serum level of IL-2 only in 11% of sample studied was positive and in 89% was negative. Statistical analysis indicated a significant relationship between serum level of IL-2 and the SLE disease activity index (p=0.025). <b>Conclusion:</b> This study showed the relationship between serum levels of IL-2 and disease activity, so this biomarker can be used as a clinical indicator for assessing disease activity in patients with SLE. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=MC16-MC18&id=4602 https://doi.org/10.7860/JCDR/2014/.4602 Cord Blood TSH Level Variations in Newborn – Experience from A Rural Centre in Southern India Sunil Raj, Stephenson Baburaj, Jumaly Georeg, Binu Abraham, Sundar Singh <b>Background:</b> Universal screening of all neonates has for long been recognized as the most effective method to detect congenital hypothyroidism. However, various maternal as well as perinatal factors can influence the cord blood TSH levels. <b>Objectives:</b> To evaluate the effect of perinatal factors on cord blood TSH level variations in neonates born in a rural tertiary care institution in South India. <b>Methods:</b> A cross-sectional study was done in 430 term neonates at birth to analyse the cord blood TSH levels and a repeat TSH estimation was done on 3rd postnatal day for those having abnormal values. The values were statistically analysed with respect to maternal, paternal and perinatal parameters. <b>Results:</b> The mean value of CBTSH was 12.88 mIU/mL. One hundred twenty five of the 430 neonates (29.06%) were found to have elevated CBTSH levels. Two babies (0.46%) had CBTSH levels below 2.3 mIU/mL. Repeat TSH estimation done on third postnatal day in the 127 babies who had abnormal CBTSH levels revealed only 5 (3.94%) babies had abnormal levels. Serum T4 levels done on the same sample showed abnormal values in 3 (2.67%) babies. CBTSH levels showed no gender varations but increased significantly with the gestational age of the baby (p=0.001). CBTSH levels increased with increasing maternal age (p<0.001) and were significantly higher in babies of mothers with history of hypothyroidism. <b>Conclusion:</b> The incidence of congenital hypothyroidism was 3 in 430 babies, which was high compared to national and international references, highlighting the urgent need of universal screening giving importance to maternal factors also. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=PC18-PC20&id=4603 https://doi.org/10.7860/JCDR/2014/.4603 Modified Approach of Double Papillae Laterally Positioned Flap Technique using Alloderm® for Root Coverage Chitra Agarwal, Pragya Purohit, Suresh Kumar Sharma, Aashish Sharma Cosmetic concern is on increase in dental patients these days resulting in more demand for periodontal plastic surgical procedures. Gingival recession is one of the common problems which impairs aesthetic and may result in hypersensitivity and increase chances of root caries. Several plastic procedures are available to correct the defect. Double papilla laterally positioned flap combined with Alloderm has been used to cover single tooth class I recession site as adequate width of keratinized gingiva is present on adjacent teeth. The technique has resulted in 80% of root coverage. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZD25-ZD27&id=4606 https://doi.org/10.7860/JCDR/2014/.4606 Lemongrass - Incorporated Tissue Conditioner Against Candida albicans Culture Pokpong Amornvit, Suwan Choonharuangdej, Theerathavaj Srithavaj <b>Background:</b> Tissue conditioner is applied popularly with dental prosthesis during wound healing process but it becomes a reservoir of oral microbiota, especially Candida species after long-term usage. Several antifungal drugs have been mixed with this material to control fungal level. In this study, lemongrass essential oil was added into COE-COMFORT tissue conditioner before being determined for anti-Candida efficacy. <b>Materials and Methods:</b> Lemongrass (Cymbopogon citratus) essential oil was primarily determined for antifungal activity against C. albicans American type culture collection (ATCC) 10231 and MIC (minimum inhibitory concentration) value by agar disk diffusion and broth microdilution methods, respectively. COECOMFORT tissue conditioner was prepared as recommended by the manufacturer after a fixed volume of the oil at its MIC or higher concentrations were mixed thoroughly in its liquid part. Antifungal efficacy of the tissue conditioner with/without herb was finally analyzed. <b>Results:</b> Lemongrass essential oil displayed potent antifungal activity against C. albicans ATCC 10231and its MIC value was 0.06% (v/v). Dissimilarly, the tissue conditioner containing the oil at MIC level did not cease the growth of the tested fungus. Both reference and clinical isolates of C. albicans were completely inhibited after exposed to the tissue conditioner containing at least 0.25% (v/v) of the oil (approximately 4-time MIC). The tissue conditioner without herb or with nystatin was employed as negative or positive control, respectively. <b>Conclusion:</b> COE-COMFORT tissue conditioner supplemented with lemongrass essential oil obviously demonstrated another desirable property as in vitro anti-Candida efficacy to minimize the risk of getting Candidal infection. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZC50-ZC52&id=4607 https://doi.org/10.7860/JCDR/2014/.4607 Effect of Exercise Intensity on Lipid Profile in Sedentary Obese Adults Umamaheswari Kannan, Kavita Vasudevan, Kavita Balasubramaniam, Dhanalakshmi Yerrabelli, Karthik Shanmugavel, Nitin Ashok John <b>Background:</b> Exercise is a lifestyle change that has been recommended for lowering atherogenic index in adults. The intensity and duration of exercise to bring about a change in the lipid parameters are yet to be determined. Previous studies examining the effects of exercise intensity on lipid and lipoprotein levels have reported conflicting findings. Thus we aimed at determining the changes in lipid profile in sedentary obese adults influenced by different intensity of exercise. <b>Methodology:</b> Study included 51 obese adults with sedentary lifestyle. Participants performed exercise of moderate intensity (n=22) and high intermittent intensity (n=29) for a duration of 40min/day for 5 days/week and 20 min/day for 3 days/week respectively on bicycle ergometer for a period of 15 weeks. <b>Outcome Measures: </b> Pretesting and post testing included measurement of height, weight, blood pressure and lipid profile. <b>Statistical Analysis:</b> Results were analysed using the Paired and Unpaired samples t-test. <b>Results: </b> Postexercise revealed significant reduction in the LDL-C and diastolic blood pressure (p<0.05) with the high intensity exercise group.There was a significant difference in BMI, lipid profile and blood pressure in both the moderate and high intensity exercise group. <b>Conclusion:</b> This study suggests that exercise is “elixir” for a healthy life. High intermittent intensity can be considered for individuals who have time constraints and lead a sedentary life style and moderate intensity exercise advised for individuals who are willing to create time for their health benefits. A programmed protocol of exercise will help in reduction of lipid parameters. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=BC08-BC10&id=4611 https://doi.org/10.7860/JCDR/2014/.4611 Effect of Intensity of Cigarette Smoking on Haematological and Lipid Parameters Anandha Lakshmi.S, Anandhi Lakshmanan, Ganesh Kumar.P, Saravanan.A <b>Background:</b> Smoking is the single largest preventable cause of disease and premature death and major tobacco related diseases like cancer costs India more than Rs.308.33 billion per year. Cigarette smoking increases the total peripheral blood leukocyte count but its effect on other haematological parameters is largely unexplored. <b>Objective:</b> To study the effect of smoking and its intensity on hematological and lipid parameters. <b>Materials and Methods:</b> This cross sectional study included 40 cigarette smokers and 40 non-smokers in the age range of 25 and 40 years at SRM Medical College, Kattangulathur, Tamilnadu, India. In this study the volunteers were otherwise healthy and the smokers were enquired about their intensity of smoking using smoking index. Common hematological and lipid parameters were measured in all subjects. Comparison of smoking status and its intensity among the study subjects were analysed using t-test and ANOVA. <b>Results:</b> There is a significant increase in levels of haemoglobin, hematocrit, total leukocyte count, total cholesterol, triglycerides, low density lipoprotein(LDL), very low density lipoprotein(VLDL) and reduced levels of high density lipoprotein (HDL) among the smokers. Heavy smokers showed significant dyslipidemia, increase in red blood cell count, total leukocyte count and neutrophil count. <b>Conclusion:</b> Increase in hemoglobin, hematocrit, total leucocyte count and dyslipidemia were found significant among smokers and in heavy smokers there is dyslipidemia with increased RBC count, total leukocyte count with specific increase in neutrophils. As per the existing literature, these changes may lead to future fatal cardiac diseases among the smokers. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=BC11-BC13&id=4612 https://doi.org/10.7860/JCDR/2014/.4612 Prevalence of Microalbuminuria among Rural North Indian Population with Diabetes Mellitus and its Correlation with Glycosylated Haemoglobin and Smoking Juhi Aggarwal, Mayur Kumar <b>Introduction:</b> Macrovascular and microvascular complications of diabetes mellitus are a consequence of metabolic derangement mainly hyperglycemia. Diabetic nephropathy being one of them causes end stage renal disease. Hence, to detect renal involvement, microalbuminuria can be considered as an early marker. <b>Aim:</b> To study mean albumin creatinine ratio (ACR) in type 1 and type 2 diabetes mellitus with respect to HBA1c, duration of diabetes and smoking. <b>Materials and Methods:</b> Two hundred cases of type 1 and type 2 diabetes mellitus and one hundred controls, age and sex matched were included in this study and measured for spot urinary albumin, spot urinary creatinine, fasting plasma glucose and HBA1c. <b>Results:</b> It was observed that mean ACR was significantly elevated in type 1 and type 2 diabetes mellitus as compared to the controls. Mean ACR increases in diabetics with poor glycemic control, duration of diabetes and smoking. Conclusion: The early detection of microalbumin in diabetics can significantly reduce the progression of renal complications and before the development of proteinuria. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=CC11-CC13&id=4613 https://doi.org/10.7860/JCDR/2014/.4613 Identification and Differentiation of Carbapenemases in Klebsiella Pneumoniae: A Phenotypic Test Evaluation Study from Jaipur, India Smita Sood <b>Background:</b> Carbapenem resistance is one of the major threats faced in antimicrobial treatment of infections caused by gram negative organisms. In recent years, carbapenem resistance has emerged in Klebsiella pneumoniae isolates due to acquisition of carbapenemases which belong to Ambler class A KPC type enzymes or to Ambler class B metallo- ? -lactamases (MBL). Routine lab detection of carbapenemase producing K. pneumoniae isolates is crucial, both for a therapeutic management and an efficient infection control. <b>Materials and Methods:</b> A study was conducted on 60 carbapenem resistant Klebsiella pneumoniae strains which were isolated from various clinical samples over a period of one year (September 2010-August 2011), at a tertiary care hospital in Jaipur. Phenotypic confirmatory test was done by using discs of Meropenem alone and those with phenyl boronic acid (PBA) or Ethylenediaminetetraacetic acid (EDTA) or both, for detection of carbapenemase production and differentiation of KPC and MBL enzymes. <b>Results:</b> Of the 60 carbapenem resistant Klebsiella pneumoniae isolates, 53 (88.33%) were found to be MBL producers, 4(6.66%) were found to be MBL and KPC co-producers and the rest of the 3(5%) isolates were negative for both MBL and KPC production, as was seen by combined disc testing. <b>Conclusion:</b> The combined disc test is a simple test which can be used for differentiation of carbapenemases and it can be easily incorporated in routine microbiology lab testing. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=DC01-DC03&id=4614 https://doi.org/10.7860/JCDR/2014/.4614 Role of CSF CK, LDH, GGTP Enzyme Levels in Diagnostic and Prognostic Evaluation of Meningitis Purna Chandra Dash, Debasish Patro <b>Background:</b> Aetiological diagnosis for meningitis remains a challenge and often a thorough Cerebrospinal fluid (CSF) examination may not give a precise diagnosis as at times CSF findings may simulate meningitis like picture as in carcinomatous meningitis, chemical meningitis, early stages of Guillan bare syndrome, subarachnoid hemorrhage, ICSOL, brain abscess, intracranial extension of epidural or subdural infection. Lesions of tissue rich in enzymes may cause enzymatic release on tissue destruction, so also in meningitis and many enzymes are known to be present in abundance in nervous system. <b>Aim:</b> To evaluate the diagnostic and prognostic significance of Creatine Kinase (CK), Lactate Dehydrogenase (LDH) and Gamma Glutamyl Transpeptidase (GGTP) enzymes in CSF of meningitis. Materials and Methods: A prospective cases control study of pyogenic and tubercular meningitis patients of 44 cases admitted in department of medicine from September 2011-September 2012 was done. Enzymes like CK, LDH and GGTP were estimated on day 0 (day of admission) and 7th day in the CSF and in serum. CSF and serum CK, LDH, GGTP was estimated on 0th day 0 only in cases of controls. <b>Result:</b> Out of 44 patients, total 32 were tubercular meningitis and 12 were pyogenic meningitis. Mean CSF CK, LDH levels were significantly raised in both conditions with respect to controls in day 0 with p < 0.0001 and p < 0.05 respectively. Mean CSF CK, LDH level were also significantly reduced from 0 to 7th day in both tubercular, pyogenic meningitis, while CSF GGTP was not significantly raised with respect to control in day 0. <b>Conclusion:</b> Enzymes level in CSF like CK, LDH are significantly raised in the meningitis and accessing its value can be an important diagnostic and prognostic marker. But more studies are required to establish the usefulness of estimating these enzymes. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=MC19-MC22&id=4615 https://doi.org/10.7860/JCDR/2014/.4615 Comparison of the Debonding Characteristics of Conventional and New Debonding Instrument used for Ceramic, Composite and Metallic Brackets – An Invitro Study Garima Choudhary, Vikas Gill, Y. N. N. Reddy, Sudhanshu Sanadhya, Pankaj Aapaliya, Nidhi Sharma <b>Background:</b> Debonding procedure is time consuming and damaging to the enamel if performed with improper technique. Various debonding methods include: the conventional methods that use pliers or wrenches, an ultrasonic method, electrothermal devices, air pressure impulse devices, diamond burs to grind the brackets off the tooth surface and lasers. Among all these methods, using debonding pliers is most convenient and effective method but has been reported to cause damage to the teeth. Recently, a New Debonding Instrument designed specifically for ceramic and composite brackets has been introduced. As this is a new instrument, little information is available on efficacy of this instrument. The purpose of this study was to evaluate the debonding characteristics of both ?the conventional debonding Pliers? and ?the New debonding instrument? when removing ceramic, composite and metallic brackets. <b>Materials and Methods:</b> One Hundred Thirty eight extracted maxillary premolar teeth were collected and divided into two Groups: Group A and Group B (n = 69) respectively. They were further divided into 3 subGroups (n = 23) each according to the types of brackets to be bonded. In subGroups A1 and B1{stainless steel};A2 and B2{ceramic};A3 and B3{composite}adhesive pre- coated maxillary premolar brackets were used. Among them {ceramic and composite} adhesive pre-coated maxillary premolar brackets were bonded. All the teeth were etched using 37% phosphoric acid for 15 seconds and the brackets were bonded using Transbond XT primer. Brackets were debonded using Conventional Debonding Plier and New Debonding Instrument (Group B). After debonding, the enamel surface of each tooth was examined under stereo microscope (10X magnifications). Amodifiedadhesive remnant index (ARI) was used to quantify the amount of remaining adhesive on each tooth. <b>Results:</b> The observations demonstrate that the results of New Debonding Instrument for debonding of metal, ceramic and composite brackets were statistically significantly different (p = 0.04) and superior from the results of conventional debonding Pliers. <b>Conclusion:</b> The debonding efficiency of New Debonding Instrument is better than the debonding efficiency of Conventional Debonding Pliers for use of metal, ceramic and composite brackets respectively. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZC53-ZC55&id=4617 https://doi.org/10.7860/JCDR/2014/.4617 Comparative Study of Dentascan and Radiography for Radiological Evaluation of Impacted Teeth Shruti Chandak, Chandrakant M Shetty <b>Introduction:</b> Impacted teeth present a very common problem in dentistry due to the variable numbers of problems they cause. They have previously been imaged by radiography which is very inaccurate. Dental CT is an upcoming modality which very accurately images the teeth. <b>Aim:</b> The aim of our study was to compare the efficacy of Dental CT with radiography in assessing the morphology of the impacted tooth and its relation to adjacent structures. <b>Materials and Methods:</b> We conducted a hospital based prospective study in which all patients with impacted teeth who underwent Dental CT and Radiographic evaluation were evaluated. <b>Results:</b> The morphology of all the teeth was well visualized on CT. Resorption of adjacent tooth was missed in 7 teeth by radiography. In a significant number of cases (10/30) the relation of the impacted tooth with the mandibular canal could not be visualized on the radiographs. <b>Conclusion:</b> We concluded that Dental CT yields markedly better information than radiographs regarding impacted teeth with respect to divergence of the roots, relation of the impacted tooth with the adjacent tooth, nasal floor, maxillary sinus and mandibular canal. However, Dental CT was found to be only marginally better than Radiographs for assessment of number of roots, inclination of the impacted tooth and relation of the tooth with alveolar crest. Dental CT was also proved to be an indispensable diagnostic tool for the determination of the buccolingual inclination and relations of the impacted tooth. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=RC01-RC05&id=4618 https://doi.org/10.7860/JCDR/2014/.4618 Histopathology and Prognostic Indices of Carcinoma Breast with Special Reference to p53 Marker Rajesh Kanna Nandagopal Radha, Viswanathan P, Krishnaswamy B <b>Introduction:</b> Cancer of the breast is one of the commonest carcinomas in women, both in western world and in India. The high frequency of breast cancer in women has prompted an intensive study of possible modifiable risk factors (clinical parameters, morphological typing, and biological markers) for assessment of prognosis, prevention strategies, and treatment modalities. p53 is one of the most significant prognostic markers for breast carcinomas. <b>Aims and Objectives:</b> This study was undertaken to ascertain the prevalence of p53 mutated protein in breast carcinomas by immunohistochemistry and correlating the results with clinical and histological parameters and also determine its influence on axillary node metastasis. <b>Materials and Methods:</b> Clinico-pathological evaluation of 50 cases of infiltrating ductal carcinoma of the breast, with reference to p53 mutated protein expression by means of immunohistochemistry was undertaken. <b>Results:</b> The percentage positivity of p53 immunohistochemistry of this study was 22% which is similar to the reported statistics of various other studies. The immunohistochemistry results also showed an equivocal p53 status in both the positive and negative cases of lymph node metastases. The carcinomas with p53 positivity demonstrated aggressive characteristics, including larger size, higher grade, in comparison with p53 negative cases. The probability of getting positive p53 status was higher for those with severe lymphocytic reaction of tumours, for patients less than 35 years of age and for those with tumour on the left side. This study clearly indicates that p53 over expression in breast cancers are mostly aggressive tumours and they confer poor prognosis and likelihood of a poor response to endocrine therapy and chemotherapy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=FC04-FC08&id=4609 https://doi.org/10.7860/JCDR/2014/.4609 Polio Eradication–Lessons from the Past and Future Perspective Swati Jain, Basavaraj.P, Shilpi Singh, Ashish Singla, Hansa Kundu, Khushboo Singh <b>Background:</b> India has recently achieved the “Polio free status” by WHO with stringent efforts of the Health Ministry to control its spread. However, we should not forget the lessons learnt from the failure of National malaria eradication Programme and National Tuberculosis control Programme which creates a need to assess the probable barriers for the various National Health Programmes. The present article presents an overview of the Polio Eradication programme in India highlighting the lessons learnt from the past. Also, it evaluates the reality behind full participation of Pulse Polio Programme. <b>Materials and Methods:</b> The study results of a cross-sectional survey conducted with an aim to assess the probable reasons and barriers behind non compliance of Pulse Polio Programme among parents of children (1-5 yr of age) of Modinagar area have also been discussed. The survey instrument was a structured, 10 item, closed ended questionnaire. <b>Statistical analysis used:</b> Chi-square test was used to analyze the difference between proportions of individual responses for each question and multiple logistic regression was used to assess relation between socio demographic parameter and absence from Polio Ravivaar. <b>Results:</b> The study reveals a surprising 68% attendance of Pulse Polio programme which is far behind the desired goal. Most of the parents who did not attend polio ravivaar considered that there was no need for the repetition of Polio vaccine (76.9%) followed by their fear that the vaccine might get contaminated during transportation (74.5%). A significant positive association was found between older age group of the eligible children (4-5 yr, O.R.1.52), female gender, illiterate parents, distance of more than one km from residence to vaccination and lack of source of information (O.R. 1.47). <b>Conclusion:</b> Efforts should be done to investigate the probable reasons behind non compliance for various immunization programmes to analyse the current situation in detail and formulate appropriate programs for coming years so that the efforts so far don’t go in vain and we secure a healthy Polio free nation for our future generations. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZC56-ZC60&id=4621 https://doi.org/10.7860/JCDR/2014/.4621 Effect of Vitamin C on Male Fertility in Rats Subjected to Forced Swimming Stress Sanghishetti Vijayprasad, Ghongane BB, Nayak BB <b>Introduction:</b> Stress is defined as a general body response to initially threatening external or internal demands, involving the mobilization of physiological and psychological resources to deal with them. Recently, oxidative stress has become the focus of interest as a potential cause of male infertility. Normally, equilibrium exists between reactive oxygen species (ROS) production and antioxidant scavenging activities in the male reproductive organs. The ascorbic acid is a known antioxidant present in the testis with the precise role of protecting the latter from the oxidative damage. It also contributes to the support of spermatogensis at least in part through its capacity to maintain antioxidant in an active state. <b>Materials and Methods:</b> Group1: Normal Control animal received Distilled water, Group 2: Positive control (Only Stress), Group 3: Normal rats received an intermediate dose of Vitamin C (20mg/kg/day), Group 4: Stress + Low dose Vitamin C (10mg/kg/day), Group 5: Stress+ Intermediate dose Vitamin C (20mg/kg/day), Group 6: High dose Vitamin C (30mg/kg/day). On 16th day effect of stress on body weight, Reproductive organ weight, sperm parameters, and hormonal assay was studied. <b>Results:</b> In the present context, in stress group the sperm count, motility, testicular weight declined significantly. The intermediate dose and high dose of vitamin C showed significantly increased effect on the sperm count and motility. <b>Conclusion:</b> Various physiological changes produced force swimming indicates that swimming is an effective model for producing stress in albino rats. The results suggest that Vitamin C supplementation improves the stress induced reproductive infertility due to both their testosterone increase effect and their antioxidant effect. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=HC05-HC08&id=4622 https://doi.org/10.7860/JCDR/2014/.4622 Periodontal Health Status of Different Socio-economic Groups in Out-Patient Department of TMDC&RC, Moradabad, India Safalya S. Kadtane, D.J. Bhaskar, Chandan Agali, Himanshu Punia, Vipul Gupta, Manu Batra, Vikas Singh, Swapnil S. Bumb <b>Aims & Objective:</b> To assess the oral health awareness and periodontal health status of different socio-economic groups in out-patient department of the Teerthanker Mahaveer Dental College and Research Centre (TMDC&RC), Moradabad, India. <b>Materials and Methodology:</b> This cross-sectional study was conducted on 416 subjects of 30-60yrs age group with different socio-economic status classified according to modified Kuppuswamy scale (2012). Subjects were interviewed by the questionnaire and Community Periodontal Index was recorded. <b>Statistical Analysis:</b> Chi-square test (SPSS version 17). <b>Result:</b> This study showed that the code 2 and code 3 is more in lower socio-economic status (p =0.115 and p=0.079 respectively). Significant association was seen in Code 0, code 1 & code 4 (p<0.01) which is indicative that upper class have more healthy periodontal status than lower. <b>Conclusion:</b> Significant association exists between oral health awareness and periodontal health with the socio-economic status of the individual. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZC61-ZC64&id=4624 https://doi.org/10.7860/JCDR/2014/.4624 Assessing Oral Candidal Carriage with Mixed Salivary Glucose Levels as Non-Invasive Diagnostic Tool in Type-2 Diabetics of Davangere, Karnataka, India Rashmi Naik, Ahmed Mujib B.R, U.R. Raaju, Neethu Telagi <b>Background:</b> The health of oral tissues is known to be related to salivary flow and its composition which may be altered in diabetic patients. The purpose of this study is to correlate mixed salivary glucose levels and oral candidal carriage and to assess the prevalence of candidal carriage in diabetics and controls. <b>Method:</b> Thirty adults with type-2 diabetes and 30 without diabetes (control subjects), aged 30-60 yr, participated in the study. Unstimulated saliva was collected and investigated for glucose levels (using glucose oxidase method) and colony- forming units (CFU) of Candida , this was stained with two stains, periodic acid-schiff stain and Grocott Gomori stain. <b>Results:</b> In the present study mixed salivary glucose concentration in diabetics was significantly higher (p<0.01) compared to the controls. Diabetics with intraoral candidal carriage had higher salivary glucose levels (mean = 12.76±5.85 mg/dl) compared to cases where Candida was not isolated. The diabetics without intraoral candidal carriage had lower salivary glucose levels (mean = 5.36±2.24 mg/dl). This relationship could be seen in controls (non-diabetics) also. Diabetics showed an oral candidal carriage rate of 80% which was significantly higher compared to nondiabetics who showed an oral candidal carriage rate of 40% . <b>Conclusion:</b> Mixed salivary glucose levels were significantly higher in diabetics. The possible high salivary glucose level could predispose to oral candidal infection. So saliva can be used as a quick, non-invasive tool to assess the oral candidal status and possible infection. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZC69-ZC72&id=4628 https://doi.org/10.7860/JCDR/2014/.4628 Antimicrobial efficacy of Punicagranatum mesocarp, Nelumbonucifera leaf, Psidiumguajava leaf and Coffeacanephora Extract on Common Oral Pathogens: An in-vitro Study Viral V. Mehta, Gururaghavendran Rajesh, As hwini Rao, Ramya Shenoy, Mithun Pai B.H. <B>Background and Objectives:</b> Alternative therapies are increasingly being explored as extensive use of synthetic chemicals has led to the emergence of substantial side effects. Phytomedicine has been well practiced as traditional medicine in various cultures for treatment of oral diseases. It has gained importance of late as an alternative to the conventional therapy. Various plant and fruit extracts have been monitored recently to assess their potential against the common oral pathogens. Aim of this study was to assess in-vitro efficacy of pomegranate peel, lotus leaf, guava leaf and coffee extracts on oral microorganisms. <b>Materials and Method:</b> Concentrations of 1%, 5%, 10%, 15% and 20% were prepared for each, followed by efficacy testing using disc diffusion method against Streptococcus mutans, Streptococcus mitis, Porphyromonas gingivalis, Prevotella intermedia and Candida albicans . <b>Results:</b> All the four extracts were found to be effective against S.mutans and S.mitis , with maximum efficacy against S.mutans and S.mitis displayed by pomegranate and lotus. Antifungal efficacy was demonstrated by coffee and pomegranate. Guava, lotus and coffee were effective against P.intermedia , while only coffee was found to be effective against P. gingivalis . All the results were found to be statistically significant (p < 0.05). <b>Interpretations & Conclusions:</b> Pomegranate, guava, lotus and coffee displayed significant anticariogenic effect while coffee was found to be most effective against periodontal pathogens as well as Candida albicans . Results revealed that natural products may be used as economical and suitable adjuvant to synthetic medicines and compounds and their judicious use might not only help to inhibit the side effects of synthetic chemicals but also prove to be cost effective in developing economies. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZC65-ZC68&id=4629 https://doi.org/10.7860/JCDR/2014/.4629 Methicillin Resistant Staphylococcus aureus Carriage, Antibiotic Resistance and Molecular Pathogenicity among Healthy Individuals Exposed and Not Exposed to Hospital Environment Veena Krishnamurthy, Avinandan Saha, Bhadravati Virupaksha Renushri, Elkal Rajappa Nagaraj <b>Background:</b> Healthcare workers as well as healthy community-dwelling individuals may be colonised by methicillin-resistant Staphylococcus aureus (MRSA). Healthcare workers who carry MRSA may transmit it to patients, causing various nosocomial infections. Literature shows that the differences between MRSA isolated from healthcare settings and from community settings, with regard to multi-drug resistance (traditionally exhibited by the former) and possession of pvl genes (traditionally exhibited by the latter), is diminishing due to a large community reservoir and increasing influx of community harboured strains into the hospital. However, there is no literature on the current scenario in India. <b>Aims and Objectives:</b> This study examines the influence of exposure to hospital environment on MRSA carriage, antimicrobial resistance patterns of MRSA, and the presence of genes encoding five extracellular pathogenicity determinants (pvl, sea, seb, tsst-1 and hly a). <b>Materials and Methods:</b> Nasal, throat and palmar swabs were collected from 119 nursing students of the age group 18-23 years (exposed group) and 100 age matched pharmacy students (non-exposed group). S. aureus was identified and antibiogram obtained as per Clinical and Laboratory Standards Institute (CLSI) guidelines. MRSA was detected by cefoxitin disc diffusion test and by growth on oxacillin screen agar as per CLSI guidelines. Conventional PCR was performed for mecA, pvl, sea, seb, tsst-1 and hly a. <b>Results:</b> The differences in carrier rates, antibiotic resistance patterns and expression of extracellular pathogenicity determinants between MRSA isolates from the two study groups were not significant, and pvl was found in all the MRSA isolates. <b>Conclusion:</b> The nursing students carried MRSA strains similar to those carried by the non-exposed group. Our results suggest that healthcare workers could act as a link and transmit MRSA acquired from the community to patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=DC04-DC08&id=4638 https://doi.org/10.7860/JCDR/2014/.4638 Prevalence and Distribution of Developmental Defects of Enamel in the Primary Dentition of IVF Children of West Bengal Sudipta Kar, Subrata Sarkar, Ananya Mukherjee <b>Introduction:</b> Developmental defects of the enamel (D.D.E.) are changes in the deciduous dentition may lead to aesthetic problems, dental sensitivity and may be predictors of dental caries. The aim of this study was to estimate the prevalence and distribution of D.D.E. in the deciduous dentition of IVF children of West Bengal. <b>Materials and Methods:</b> A cross-sectional study was carried out with a sample of 153 IVF children aged three to five enrolled in institute of reproductive medicine Kolkata West Bengal. One hundred fifty three spontaneously conceived matched controlled children also examined as control group. All of the teeth were examined and the enamel defects were assessed according to the Modified D.D.E Index. The differences were tested for statistical significance by using the Chi-Square test & z-test. <b>Results:</b> The prevalence of D.D.E. was 7.18% in IVF Children and 8.49% in spontaneously conceived children. Diffuse opacities was the common defect found (2.61%) in both group. The most affected teeth were the deciduous maxillary central incisors (12.82% and 13.63% found in IVF and spontaneously conceived group respectively). Defects were observed more frequently in the maxillary arch than in mandibular arch in both groups. <b>Conclusion:</b> There is no significant difference found in IVF & Spontaneously Conceived Children group. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZC73-ZC76&id=4639 https://doi.org/10.7860/JCDR/2014/.4639 Neck Circumference and Cardio-Metabolic Syndrome Nagendran Vijaya Kumar, Mohammed H.Ismail, Mahesha P, Girish M, Monica Tripathy <b>Background:</b> Only few studies about neck circumference (NC) as a measure of cardio metabolic syndrome available from India. Study was conducted to establish an association between neck circumference and cardio metabolic syndrome. <b>Material and Methods:</b> Cross-sectional study was conducted in a tertiary care hospital in South India. NCEP: ATPIII 2001 guideline was used for diagnosis of Cardio-metabolic syndrome among subjects. Neck circumference was measured and it was correlated with Cardio-metabolic syndrome. <b>Results:</b> Mean neck circumference was found to be 36.5 cms. Cardio-metabolic syndrome was present in 272 participants, of which 100 were females and 172 males. Among females and among males 117(68%)had NC >37cms and 55(32%) had NC<37cms. All individual parameter of cardio metabolic risk factor i.e. BMI, waist circumference, hip circumference, systolic blood pressure, diastolic blood pressure, FBS, HDL & TG except waist/hip ratio were correlating with abnormal neck circumference when compared with those with normal neck circumference. <b>Conclusion:</b> Neck circumference with metabolic syndrome correlated better among females than males. Men with NC >37 cm and women with NC >34 cm are more prone for cardio metabolic syndrome and require additional evaluation. Measurement of NC is a simple, time saving, and least invasive measurement tool. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=MC23-MC25&id=4641 https://doi.org/10.7860/JCDR/2014/.4641 Pancreatic Schwannoma - A Rare Case Report Devi J , Sathyalakshmi R, Chandramouleeswari k, Nalli R. Sumitra Devi Pancreatic schwannomas are rare neoplasms. Only 47 cases have been reported in literature as of date. Age group that is commonly involved varies between the range of 20-87 years, with an almost equal sex ratio. Tumour size ranges from 1-20 cm. Locations where schwannomas can be encountered in the pancreas are in the vast majority , the head and body, the incidence being: head-40 %, junction of head and body-6 %, body-21 %, body and tail-15 %, tail-4 % and uncinate process-13 %. 60 % of the tumours are cystic, the rest being solid tumours. We hereby report a case where in total gastrectomy with distal pancreatectomy and splenectomy was done for carcinoma stomach involving the stomach bed and pancreatic schwannoma was an incidental finding in this case. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=FD15-FD16&id=4642 https://doi.org/10.7860/JCDR/2014/.4642 Rupture of Aortic Sinus Valsalva Aneurysm and its Management Kalyan Chakravarthy Peddinti, Vijayalakshmi Gattu, Kartika Balaji Samala,M anikumari Karuturi, Pratap Ramathoti Here, we present successful management of a patient with rupture of right sinus valsalva and ventricular septal defect. Aneurysm of the aortic sinus also known as sinus of valsalva (ASOV) is a rare cardiac defect which can be congenital or acquired. Right coronary sinus (most common) usually ruptures into the right ventricle causing left to right shunt as seen in our patient. Unruptured aneurysms cause obstruction to right ventricular outflow tract. A 29-year-old male patient presented with dyspnea, palpitations, easy fatigability and severe limitation of physical activity. Transthoracic echocardiography showed membranous out pouching of the right coronary cusp (RCC) into the right ventricle. Patient was medically managed with drugs. Under general anaesthesia, after instituting cardiopulmonary bypass (CPB) surgical repair with pericardial patch, closure of subpulmonic ventricular septal defect was performed. Patient vitals were stable after surgery and he was asymptomatic on the first follow-up after discharge. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=GD05-GD06&id=4643 https://doi.org/10.7860/JCDR/2014/.4643 Congential Lumbar Hernia with Malrotation of Left Kidney and Hydronephrosis in an Infant: A Rare Presentation Rohit Kapoor, Premila Paul, Sarthak Sachdeva Congenital Lumbar hernia was previously known as Lumbocostovertebral syndrome. This syndrome consists of the presence of hemivertebrae, rib defects, abdominal wall anomalies and hypoplasia of the abdominal musculature. This case report describes a 40-hour-old infant with malrotation of left kidney and hydronephrosis in association with congenital lumbar hernia. Various congenital renal anomalies like renal pyelectasis, bilateral renal agenesis and pelviureteric junction obstruction, malascended kidneys, hypospadiasis have been reported in association with this disease. Malrotation has only been reported in adults so far. However ours is the first ever case in literature to report malrotation of kidney in association with this syndrome in neonatal age group. Treatment of this condition is done usually by mesh hernioplasty. Presence of this condition must prompt the surgeon to carry out all possible investigations to rule out various other congenital orthopedic, neurological, and urological anomalies. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=PD03-PD04&id=4644 https://doi.org/10.7860/JCDR/2014/.4644 Chemoresistant Gestational Trophoblastic Neoplasia: A Case Report Sudha Cp, Sahana M Gestational trophoblastic neoplasia (GTN) is a disease of women in reproductive age. It is one of the most chemotherapy responsive and highly curable cancer. It is diagnosed when there is clinical, radiologic, pathologic, and/or hormonal evidence of persistent or relapsed gestational trophoblastic disease. In most instances, it is cured by surgical evacuation of the uterus. If persistent, it is treated with chemotherapy which provides response in >90% of the cases. In the unresponsive persistent cases and if the women has completed her child bearing, hysterectomy is generally recommended. Here, we report a rare case of chemoresistant GTN which was confirmed to be placental-site trophoblastic tumour (PSTT) on biopsy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=OD12-OD13&id=4645 https://doi.org/10.7860/JCDR/2014/.4645 Granulocytic Sarcoma with Compressive Myelopathy: A Rare Presentation of Chronic Myelogenous Leukemia Abhijeet P. Ganap ule, Auro Viswabandya, Anita Ja sper, Palak Patel, Gautami Kokil Granulocytic sarcoma occurs most commonly in acute myelogenous leukemia. The appearance of granulocytic sarcoma in chronic myelogenous leukemia signals accelerated phase/ blast transformation. This is a rare case of undiagnosed chronic myelogenous leukemia with granulocytic sarcoma causing cord compression, which went into tumour lysis syndrome requiring dialysis after starting of steroids and radiotherapy. A 43-year-old male presented in emergency department with acute onset of flaccid paralysis. On clinical examination, there was hepatosplenomegaly and lower motor neuron paralysis in the lower limbs. The peripheral smear was consistent with chronic myelogenous leukemia in chronic phase. The MRI spine revealed para-spinal and epidural masses causing cord compression and the biopsy from the paraspinal mass was consistent with granulocytic sarcoma. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=QD03-QD04&id=4640 https://doi.org/10.7860/JCDR/2014/.4640 Intraosseous Epidermoid Cyst Associated with Impacted Mandibular Wisdom Teeth: An Uncommon Entity Orcun Toptas, Ismail Akkas, Must afa Tek, Fati h Ozan, Ceti n Boran Epidermoid and dermoid cysts of the jaws are seen rarely. The formation theories of the intraosseous epidermoid cyst (IEC) are not clear. The radiographic appearance is similar with unilocular cysts. Surgical enucleation is the suggested treatment method for epidermoid cysts. This case report presents bilateral mandibular intraosseous epidermoid cysts with impacted wisdom teeth which is the first documented case in the literature. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZD31-ZD32&id=4630 https://doi.org/10.7860/JCDR/2014/.4630 Neuromyelitis Optica with NMO-IgG/Anti-AQP4 Antibody Positive: First Case Reported from Uttarakhand India Manish Mittal, Garima Mittal Neuromyelitis optica (also known as Devic’s disease) is an idiopathic, severe, demyelinating disease of the central nervous system that preferentially affects the optic nerve and spinal cord. The presence of a highly specific serum autoantibody marker (NMO-IgG) further dif - ferentiates neuromyelitis optica from multiple sclerosis and has helped to define a neuromyelitis optica spectrum of disorders. We present a case of 37-year-old man who has initially presented with transverse myelitis from which he recovered partially after treatment but later presented with bilateral optic neuritis. MRI brain revealed hyperintensity in bilateral optic nerves, periventricular area and also in the thalamic region. Diagnosis was confirmed by positive NMO – IgG/anti-AQP4 antibody. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=MD03-MD04&id=4625 https://doi.org/10.7860/JCDR/2014/.4625 A Rare Variant of Wallenberg’s Syndrome: Opalski syndrome Parathan KK, Kannan R, Chitrambalam P, Senthil Kumar Aiyappan, Deepthi N Lateral Medullary Syndrome (LMS) is a well-documented vascular syndrome of the posterior circulation territory. This syndrome is easily localised because of characteristic presentation, unique territory of blood supply and very small area of involvement. We present a case of Wallenberg’s syndrome which did not have all the classical components of the syndrome, like Horner’s syndrome. Opalski syndrome is a rare variant of Wallenberg syndrome, where lateral medullary syndrome is associated with ipsilateral hemiparesis. This case report highlights how differential involvement of the lateral part of medulla can result in varied presentation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=MD05-MD06&id=4626 https://doi.org/10.7860/JCDR/2014/.4626 Chondroid Syringoma–An Unusual Presentation Sonti Sulochana, Madavan Manoharan, Anitha Chondroid syringoma is a rare mixed tumour of the skin. It was first described by Hirsch and Helwig. The tumour is composed of a proliferation of epithelial cells present in a myxoid and chondroid matrix. Although chondroid syringoma was predominantly benign, sweat-gland tumour, the usual presentation is of an asymptomatic, slowly growing mass, typically located on the head and neck region. The present case was located in right leg, lateral aspect and rare. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=FD13-FD14&id=4627 https://doi.org/10.7860/JCDR/2014/.4627 Diclofenac–Serratiopeptidase Combination Induced Stevens – Johnson Syndrome – A Rare Case Report with Review of Literature Saibal Moitra, Sukanta Sen, Indranil Banerjee, Prasanta Das, Santanu K Tripathi Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions (SCAR) which are frequently caused by exposure to drugs and cause significant morbidity and mortality. A careful literature search revealed that only a few reports of diclofenac induced and one case of serratiopeptidase associated case report of SJS or TEN have been published till date. However, to our knowledge, no case report of diclofenac-serratiopeptidase combination induced SJS have been published till date. In this backdrop, we describe the first case of a 62-year-old woman who developed diffuse, erythematous rash on face, trunk and both extremities which later turned into blisters following five day treatment with diclofenac and serratiopeptidase combination. There was extensive ulceration of buccal, genital and ocular mucosa. The body surface area involvement of the patient at the time of presentation was 9%. A provisional diagnosis of SJS was made by the treating physician. After administration of intravenous antibiotic, topical antiseptic, anti-histamine, topical lubricants, fluid therapy and parenteral nutrition patient recovered and were discharged. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=YD08-YD11&id=4610 https://doi.org/10.7860/JCDR/2014/.4610 Primary Retroperitoneal Inter-aorto-Caval paraganglioma of the Organ of Zuckerkandl Vaibhav Vikas,Zeeshanuddin Ahmed, Onkar Singh, Sudhir Singh Pal, Mool Chand Songra Tumour that arise from chromaffin cells at extra-adrenal locations are termed paragangliomas which are rare tumour. The organ of Zuckerkandl located along aortic bifurcation is the most common site of their occurrence. Herein, we report a case of 20-year-old male with large abdomino-pelvic paraganglioma of the organ of Zuckerkandl with multiple pedicles to abdominal aorta. On exploratory laparotomy it revealed a large retroperitoneal mass with variable consistency with surfaces covered with tortuous vessels. This mass was adhered to the retroperitoneum with multiple arterial pedicles to abdominal aorta. Histopathologic evaluation revealed features of extra-adrenal paraganglioma with characteristic Zellballen appearance. Postoperative course was uneventful. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ND06-ND07&id=4619 https://doi.org/10.7860/JCDR/2014/.4619 Aggressive Giant Cell Tumour of Talus with Pulmonary Metastasis-A Rare Presentation B Udaya Kumar, P Ravi Sharma, G Santhosh Ram, P Varun Kumar Giant cell tumour (GCT) is a primary benign neoplasm of bone. It is classically described as a locally invasive tumour that occurs close to the joint of a mature bone. It accounts for 5% of all skeletal tumours. It usually originates from long bones. Giant Cell Tumour of the small bones of the hand and foot are relatively uncommon. Giant Cell Tumour of talus is a rare occurrence. We report a rare presentation of giant cell tumour of the talus in a 62-year-old farmer treated by talectomy and tibiocalcaneal fusion, who later presented with features suggestive of recurrence and secondaries in chest within six months following surgical resection of the primary. Below knee amputation was performed to manage the recurrence. At two years follow-up the patient showed no further progression of pulmonary metastasis or local recurrence. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=LD01-LD03&id=4616 https://doi.org/10.7860/JCDR/2014/.4616 Non-Syndromic Occurrence of Multiple Dental and Skeletal Anomalies: A Rare Case Report and Brief Literature Review Santosh Patil, Nidhi Yadav, Prashant Patil Abstract: Oral physician has always been challenged when it comes to diagnosing rare nonsyndromic cases because of the varied presentation of multiple dental abnormalities caused due to mutations in developmental regulatory genes. This coupled with skeletal abnormalities makes the task more difficult. But as we come across such rare constellation of findings, it makes the field more intriguing. Here, we report an extremely rare case of non syndromic occurrence of dental manifestations like multiple dens invaginatus, generalised microdontia, generalised hypoplasia, hypodontia, pulp stones and widening of pulp chamber along with skeletal findings of bilateral syndactyly of legs and brachydactyly of hands and legs. Although many non syndromic cases have been reported in the literature, the unusual occurrence of findings in the present case is being reported for the first time. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZD28-ZD30&id=4608 https://doi.org/10.7860/JCDR/2014/.4608 Basal Cell Carcinoma Arising within Seborrheic Keratosis Recep Bedir, Cuneytyurdakul,Hasan Gucer, Ibrahim Sehitoglu Malignant tumour development within a seborrheic keratosis (SK) is extremely rare. Though the most commonly developed malignant tumour is the basal cell carcinoma (BCC), other tumour types have also been reported in literature. Herein, we will report a superficial type BCC case developed within SK localized in hairy skin of a 78-year-old female patient. In immunohistochemical evaluation, diffuse positive staining with CK19 and over-expression in p53 compared with non-neoplastic areas were determined in neoplastic basaloid islands. It is always not easy to differentiate especially superficial type BCC cases from non-neoplastic epithelium of SK with histopathological evaluation. As far as this reason we believe that in difficult differentiation of these 2 lesions, in order to show the differentiation in basal epithelium, immunohistochemical evaluation may be helpful. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=YD06-YD07&id=4604 https://doi.org/10.7860/JCDR/2014/.4604 Extended Open Transgastric Necrosectomy (EOTN) as a Safer Procedure for Necrotizing Pancreatitis Prasad Sasnur, Ravindra Nidoni, Ramakanth Baloorkar, Vikram Sindgikar, Bharat Shankar The treatment of infected necrotizing pancreatitis has evolved from time to time and the success of surgical intervention depends on the timing of necrosectomy. Bacterial infection occurs in 40–70% of patients with necrotizing pancreatitis. Infection is the main risk factor for mortality among patients with pancreatic necrosis. Timely intervention is generally required for pancreatic necrosis but is now deferred until four weeks after disease onset in order to permit encapsulation and demarcation of the necrotic material. Demarcation facilitates necrosectomy and reduces complications related to the drainage and debridement procedures. The approach to pancreatic necrosectomy has evolved from primary open necrosectomy to minimally-invasive radiologic, surgical and endoscopic procedures. Direct endoscopic necrosectomy is a minimally-invasive technique that was introduced in recent years for the treatment of walled-off necrosis. The pancreas is approached through the posterior wall of stomach and debridement is done. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=NR01-NR02&id=4600 https://doi.org/10.7860/JCDR/2014/.4600 A Rare Case of Vitamin B12 Deficiency with Ascites Putta Rajsekhar, Mugannagari Maheshwar Reddy, Sameeraja Vaddera, G Rajini, Vinil Tik eli Vitamin B12 deficiency is widespread than assumed in population. At risk are older people, pregnant women, vegans, patients with renal and intestinal diseases. Vitamin B12 deficiency can present with various hematological, gastrointestinal and neurological manifestations. In the population, the prevalence of vitamin B12 deficiency in younger people is 5% to 7% which is less compared to elderly people. In developing countries, deficiency is much more common, starting in early life and persisting across the life span. Here, we present a 16-year-old female patient presenting with ascites since 2 months who was subsequently investigated and diagnosed to have nutritional megaloblastic anaemia secondary to vitamin B12 deficiency after exclusion of other infective, neoplastic, autoimmune and inflammatory diseases. Inspite, patient was treated with antitubercular drugs but she did not respond. After supplementation of Vitamin B12, ascites responded well. Inadequate intake due to low consumption of animal source foods is the main cause of low serum vitamin B12 in younger adults and likely the main cause in poor population worldwide. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=MD01-MD02&id=4601 https://doi.org/10.7860/JCDR/2014/.4601 Laparoscopic Cholecystectomy in Situs Inversus Totalis Raghuveer M N, Mahesh Shetty S, Sunil Kumar B B Situs inversus totalis is a rare condition where the organs in the body is placed in the opposite side. When such patient presents with the diseases of the intra abdominal organs the diagnosis is challenging and the operative procedure to be performed will be difficult. This may require the anticipation of variations in anatomy, ergonomic changes required during surgery and mastery over the operative skills in re - versed anatomy. Cholelithiasis in situs inversus totalis is one such situation. Herein we report a case of situs inversus totalis who underwent successful laparoscopic cholecystectomy for symptomatic gallbladder calculi. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ND03-ND05&id=4598 https://doi.org/10.7860/JCDR/2014/.4598 Penicillium keratitis in an Immunocompetent Patient from Pune, Maharashtra, India Chanda Ratnakar Vyawahare, Rabindra Nath Misra, Nageswari Rajesh Gandham, Kalpna Mohan Angadi, Retina Paul The incidence of fungal keratitis is less common than bacterial and viral keratitis. However, it remains a diagnostic and therapeutic challenge. Delayed clinical diagnosis is common mainly because of lack of suspicion. Further slow growth of fungus increases the time for confirmed laboratory diagnosis. After accurate diagnosis, patient’s management remains inadequate due to lack of availability of antifungal agents and its poor corneal penetration. Multitude of genera of molds and yeast have been identified in fungal keratitis. Due to their ubiquitous nature and easy isolation from the environment, their role in true pathogenesis is difficult to ascertain. Worldwide, incidence of fungal keratitis is rising at present. The predisposing factors comprises trauma, use of contact lenses and topical steroids. Filamentous fungi and dematiaceous fungi are the frequently encountered etiological agents of fungal keratitis. Dimorphic fungi are reported less frequently. Fungal keratitis tends to occur more frequently in young males and usually in winter and monsoon. Penicillium genera includes several species. By far Penicillium marneffei (P. marneffei) infection is most common, mainly associated with AIDS. A number of infections caused by species other than P. marneffei have been reported as well. Here we report a case of Penicillium keratitis in a young, HIV negative male farmer. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=DD01-DD02&id=4647 https://doi.org/10.7860/JCDR/2014/.4647 Acute Myeloid Leukemia Presenting as “Bowel Upset”: A Case Report Smeeta Gajendra, Ajay Gogia, Prasenjit Das, Ritu Gupta, Pranay Tanwar Myeloid sarcomas (MS) are the extramedullary presentation of acute myeloid leukemias. At times, they are difficult to diagnose due to lack of any supportive findings in peripheral blood/bone marrow aspirate examination. The involvement of gastrointestinal tract (GIT) by myeloid sarcoma is rare phenomenon. This diagnostic challenge becomes more complex when it is added by vague clinical symptoms. Many times, they have been misdiagnosed as Non-Hodgkin’s lymphoma, small round cell tumour or carcinoma. Here, we are reporting a case of myeloid sarcoma with no haematological abnormality which presented with the symptoms of bowel obstruction and a rare combination of inv. (16) and trisomy 22. The journey to reach the conclusive diagnosis in this case is interesting and sensitizes us to have high index of suspicion in a case, where there is paucity of clinical evidences. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=FD09-FD10&id=4578 https://doi.org/10.7860/JCDR/2014/.4578 Verruciform Xanthoma of Oral Cavity- A Case Report Shivani Aggarwal, As him Aggarwal, Sharanjeet Gill,Yujika bakshi , Harkanwal Preet Singh Verruciform xanthoma is an uncommon benign lesion of undetermined aetiology. It is a superficial normo-lipemic xanthoma, probably re - flecting a multifactorial reactive and dystrophic process. Its clinical and pathological recognition and correct diagnosis is critical because it can occur in conjunction with other systemic and cutaneous inflammatory diseases; therefore, it necessitates further clinical assessment. We, hereby report a rare case of verruciform xanthoma in 46-year-old male patient with history of leukemia with emphasis on need of vigilant comprehensive analysis of clinicopathological and immunohistohemical finding to arrive at definitive diagnosis and for better understanding of pathogenesis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=FD11-FD12&id=4590 https://doi.org/10.7860/JCDR/2014/.4590 Primary Cutaneous Actinomycosis: A Case Report Mohua Bose, Ranadeep Ghosh, Kheya Mukherjee , Loknath Ghoshal Actinomycosis is a subacute or chronic suppurative bacterial infection caused by filamentous gram positive, anaerobic to microaerophilic non acid fast bacilli primarily of the genus Actinomyces that normally colonize the mouth, colon and vagina. Primary cutaneous actinomycosis is a rare entity and is generally associated with trauma. We report a case of primary cutaneous actinomycosis of the back and left axilla in a 32-year-old female patient with no suggestive history of trauma.The diagnosis was suggested by the characteristic lesions with multiple discharging sinuses draining sero-sanguinous fluid scattered all over the lesions. Gram positive bacilli with plenty of pus cells were demonstrated in the direct examination of the discharging pus. Diagnosis was confirmed by isolation of the organisms by anaerobic culture giving typical molar tooth colonies. Final confirmation was done by histopathological examination. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=YD03-YD05&id=4591 https://doi.org/10.7860/JCDR/2014/.4591 Endodontic Management of a Haemophilic Patient- A Clinical Perspective Pooja Gupta Dudeja, Krishan Kumar Dudeja, Manisha Lakhanpal, Sartaj Ali Haemophilia and other bleeding disorders remain an enigma to the dentists world over. They not only challenge the skills of dental specialists but also raise the question of how these individuals should be managed emotionally as well as psychologically. The high incidence of dental problems in haemophiliacs is most likely caused by the fear and apprehension not only on the part of the patients but also dentists of inducing bleeding during treatment which can even be life threatening in certain cases. With proper care, diligence and meticulous treatment plan - ning, there is no dental treatment that cannot be performed in such patients. Mild haemophiliacs can be easily managed and can effectively undergo even surgical endodontics without factor replacement therapies. However, severe haemophilia can pose significant health hazard and needs thorough preparation to meet any exigencies arising during the treatment. This case report describes how one such severely hae - mophilic patient with pain and swelling in the left submandibular region was managed with nonsurgical endodontic treatment in mandibular molar teeth and also discusses the importance of correct methods of diagnosis and various treatment considerations in such patients https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZD17-ZD18&id=4592 https://doi.org/10.7860/JCDR/2014/.4592 Prosthodontic Management of Flat Mandibular Ridge by Mini Implant Supported Over Denture Mirna Garhnayak, Lokanath Garhnayak, Shruti Dev, Aswini Kumar Kar, Abhijita Mohapatra Loosening of lower denture has always been a common complaint of denture wearer, particularly in case of severe bone resorption. Various treatment modalities including preprosthetic surgery or ridge augmentation therapy to improve the ridge height and conventional implant treatments are available. But many patients are not willing to undergo through such extensive surgical procedure or conventional twin stage implant therapy owing to the chronic old age ailment and cost factor. So mini implant (SENDAX MDI) supported over denture is a boon for them who want a quick and minimally invasive solution, with a much lower cost. In this article we shall discuss the case report of a 60-year-old female patient with atropic mandibular ridge rehabilitated with MDI, (mini dental implant), Sendax mini implant. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZD19-ZD21&id=4593 https://doi.org/10.7860/JCDR/2014/.4593 Full Mouth Rehabilitation in a Medically Compromised Patient with Fluorosis Ramta Bansal, Aditya Jain, Sunandan Mittal, Tarun Kumar Severely worn out dentition needs to be given definite attention as it not only affects aesthetics but can also cause psychological distress to the affected individual. It can cause chewing difficulty, temporomandibular joint problems, headaches, pain and facial collapse. Before any attempt to restore severely worn dentition, aetiology of excessive tooth wear should be established. Severe wear can result from chemical cause, mechanical cause or a combination of various causes. Dental fluorosis can also result in severe wear of teeth. Teeth sometimes become extremely porous and friable with a mottled appearance ranging from yellow to brown-black. There occurs loss of tooth substance and anatomic dental deformities resulting in un-aesthetic dentition requiring full mouth rehabilitation. Here a similar case of full mouth rehabilitation of severely worn dentition due to dental fluorosis in a 27-year-old patient is presented. This case report conjointly presents the uncommon association of diabetes insipidus with dental fluorosis. Diabetes insipidus through its characteristic symptom of polydipsia can result in intake of more than permitted dose of fluoride thus causing dental fluorosis. In literature only few cases have been reported of dental fluorosis in association of diabetes insipidus. Full mouth rehabilitation of the patient was successfully accomplished through well-planned systematic approach to simultaneously fulfill aesthetic, occlusal and functional parameters. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZD22-ZD24&id=4594 https://doi.org/10.7860/JCDR/2014/.4594 left Atrial Thrombus in a Neonate with Normal Heart after Sustained Supraventricular Tachycardia Amirtha Ganesh B, Ravi Cherian Mathew Left Atrial Thrombus is uncommon in neonates. We present a neonate who had Paroxysmal Supraventricular Tachycardia (PSVT), whose echocardiography revealed a large left atrial thrombus which resolved later with treatment. Supra Ventricular Tachycardia (SVT) is not an uncommon event in infants with an incidence of 1:2500. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=PD01-PD02&id=4595 https://doi.org/10.7860/JCDR/2014/.4595 Mandibular Metastasis of Thyroid Carcinoma: A Case Report Lavanya.C, Ranganathan.K, Veerabahu.M Metastatic carcinomas to the jaw bones are uncommon and comprise to about 1% of all malignant oral neoplasms. It may be the first indication of an unknown malignancy from a distant primary site which is usually associated with poor prognosis. We report a rare case of thyroid carcinoma metastatic to the mandible in a 76-year-old elderly male patient in which the lesion was asymptomatic. Microscopic examination revealed a tumour structure consisting of cords and islands of infiltrating epithelium. The immunohistochemical marker, thyroid transcription factor -1 was done which showed a positive staining by the follicular cells. The tumour was diagnosed as metastatic follicular thyroid carcinoma. It should be emphasized that histopathological diagnosis along with panel of markers play an important role in diagnosing the site of origin of bone metastasis and these lesions should be included in the differential diagnosis of asymptomatic jaw lesions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZD15-ZD16&id=4588 https://doi.org/10.7860/JCDR/2014/.4588 Laryngeal Squamous Cell Carcinoma (SCC) in a 12-Year-old Boy with Cutaneous Metastasis: An Unusual Presentation Sinha Reena , Singh Reecha, Kumar Kaushal, Verma Pranav Kumar, Singh J.K Laryngeal squamous cell carcinoma (SCC) in adolescents is a rare clinical entity and behaves aggressively. The mechanism of laryngeal oncogenesis is complex. Further studies need to be done to know the role that human papilloma virus plays in laryngeal SCC in adolescents.We report a rare case of laryngeal SCC in a 12-year-old boy presenting with cutaneous forehead metastasis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=QD01-QD02&id=4582 https://doi.org/10.7860/JCDR/2014/.4582 Submucous Uterine Fibroid Mimicking Ruptured Ectopic Gestation: A Case Report Rosemary N Ogu, Cosmos E Enyindah, Ngozi C Orazulike, Anthony OU OKPANI Ectopic pregnancy is the greatest mimic in gynaecology. Ruptured ectopic gestation usually presents with syncope and severe anaemia. We report the clinical dilemma exposed by the management of a 22-year-old student who presented with syncope and severe anaemia due to a small solitary submucous uterine fibroid. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=OD08-OD09&id=4580 https://doi.org/10.7860/JCDR/2014/.4580 Non-Rigid Connector for Managing Pier Abutment in FPD: A Case Report Ravikumar Suryakanth Akulwar, ASHWIN KODGI A frequent clinical situation, either in the maxillary or mandibular arch, is of a missing first premolar and first molar, resulting in fixed partial denture design in which the canine and the second molar act as terminal abutments and second premolar act as a pier abutment. It has been postulated that the tendency of terminal abutments to intrude during function results in a teetering movements, where the pier abutment act as a fulcrum. These movements will eventually result in debonding of the less retentive terminal retainer. In order to overcome this potential risk, utilization of non rigid connectors has been advised. This clinical case report describes incorporation of non rigid connector to rehabilitate pier abutment case. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZD12-ZD14&id=4572 https://doi.org/10.7860/JCDR/2014/.4572 Unilateral Molariform Macrodont Mandibular Second Premolar: An Unusual Case Report in A Nonsyndromic Patient Prashant Babaji, Vishwajit Rampratap Chaurasia, Vinay Kumar Masamatti, Samarth Tiwari, SIDHARATH HARATH MALIK Macrodontia is a rare dental anomaly that refers to teeth appears larger than normal. It can be generalized or isolated macrodontia. Isolated macrodontia involving premolar is very rare. This case report presents an unusual unilateral molarifrom macrodontia of mandibular second premolar. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZD08-ZD09&id=4568 https://doi.org/10.7860/JCDR/2014/.4568 Erupted Odontoma: A Case Report Nilesh Raval, Dhaval Mehta, Kanan Vachhrajani, Abhishek Nimavat Odontomas are nonaggressive, hamartomatous developmental malformations or lesions of odontogenic origin, which consist of enamel, dentin, cementum and pulpal tissue ‘Erupted odontoma’ is a term used to specifically denote odontomas, which are exposed into the oral cavity. These are rare entities with only 25-30 cases being reported so far in the dental literature. Here, we present a rare case of an erupted odontoma in an adolescent patient who came with a complaint of bad aesthetics due to the presence of multiple small teeth like structures in the upper front teeth region. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZD10-ZD11&id=4569 https://doi.org/10.7860/JCDR/2014/.4569 Role of Trans Vaginal Ultrasound and Doppler in Diagnosis of Pelvic Congestion Syndrome Kaveri Sharma, Manash Kumar Bora, Jess y Varghese, Gaurav Malik, Robin Kuruvilla Pelvic congestion syndrome (PCS) is a cause of chronic pelvic pain in women and is defined as pelvic pain lasting for more than six months.The diagnosis of PCS is a challenging task for the gynaecologist. It can be due to many varied causes like endometriosis, adhesions, chronic pelvic inflammatory disease (PID), ovarian cyst, fibroids, pelvic varicosities. Radiology plays an important role in the diagnosis and management of PCS. Pelvic UltraSonography (PUS),transvaginal sonography (TVS) with doppler, Magnetic resonance imaging (MRI), computed tomography (CT) and ovarian venography are usually used in the diagnosis of this condition. We report a case of a 35-year-old multiparous patient with history of pain in lower abdomen, vaginal discharge and general lethargy for past three years who was diagnosed as a case of PCS based on typical TVS and Doppler findings. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=OD05-OD07&id=4570 https://doi.org/10.7860/JCDR/2014/.4570 Primary Necrotising Fasciitis of the Breast: Case Report and Brief Review of Literature Prabhat Yaji, Balachandra Bhat, Harish E Necrotizing fasciitis is a rapidly spreading progressive infection of the fascia with necrosis of the subcutaneous tissues. Primary necrotising fasciitis of the breast is extremely rare and hence we report the case of a 55-year-old woman presenting to our hospital with primary necrotising fasciitis of the breast in a state of systemic septic shock. She was admitted in surgical intensive care unit and treated with resuscitation, intravenous antibiotics and aggressive debridement. We discuss the details of the case, our treatment approach, the outcome and also briefly review the literature. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ND01-ND02&id=4558 https://doi.org/10.7860/JCDR/2014/.4558 Susuk – Black Magic Exposed “White” by Dental Radiographs Arishiya Thapasum F, Faraz Mohammed Susuk or charm needles are a facial cum body art widely practiced among women of Malaysia, Brunei, Singapore, Thailand and Indonesia. These are small, needle-shaped metallic talismans inserted subcutaneously in different parts of the body. The concealed art of susuk was “exposed” by routine radiographic examination in the oral and maxillofacial region. This paper reports two such cases of unusual incidental radiographic finding in dental radiographs which were taken on a routine basis as part of the diagnostic work up. This article will also primar - ily enlighten the importance of radiographs in detecting such charm needles as the wearer keeps the body art a “hidden secret” thereby avoiding misdiagnosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZD03-ZD04&id=4546 https://doi.org/10.7860/JCDR/2014/.4546 Emergency Diagnosis of Giant Cell Tumour (GCT) of Spine by Image Guided Fine Needle Aspiration Cytology (FNAC) Prem Singh, Manish Chaudhry, Amitoj Singh Giant cell tumour (GCT) of spine is an extremely rare neoplasm accounting 0.5% to 1.5% of all cases. The patient usually presents with weakness of lower limbs. We describe a case of 25-year-old male who presented with sudden onset of paraplegia. On plain radiograph there was an osteolytic lesion in T9 vertebra. Computed tomography (CT) scan revealed expansile lytic lesion in T9 vertebral body with involvement of posterior elements on right side with associated soft tissue mass in the extradural location extending into the spinal cord. Further Magnetic Resonance Imaging (MRI) scan (T1 contrast) showed the enhancing extradural mass involving spinal cord from D 8-10 levels. A provisional radiological diagnosis of GCT was made. A CT guided FNAC of the mass was performed which revealed typical cytological features of Giant cell tumour. Role of image guided Fine Needle Aspiration Cytology (FNAC) of vertebral mass and its role in emergency situations with clear emphasis on differential diagnosis is highlighted. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=FD07-FD08&id=4564 https://doi.org/10.7860/JCDR/2014/.4564 Tinea Barbae: In Released from Treatment (RFT) Hansen’s Disease Patient Pugazhenthan Thangaraju, VC Giri, Hosanna Singh, Vinod Kumar, Showkath Ali Hansen Disease (leprosy) is a chronic inflammatory infectious disease that primarily targets skin, nerves and other internal organs (testis, liver etc.) caused by the acid fast intracellular bacilli, Mycobacterium leprae. Clinical presentation occurs with a wide spectrum including hypo pigmented anaesthetic patches, raised erythematous plaques and nodules and thickened peripheral nerves showing tenderness. The most important complication is the disability and deformity. The diagnosis of leprosy is frequently delayed because of its similarity with other more common skin conditions prevailing in some non endemic areas. We present a rare case report of tinea barbae in an old treated case of leprosy. This case is one of the rarest fungal infection in leprosy patient searched in PUBMED as there were other more tinea infection involving various sites in body which sometimes misdiagnosed as leprosy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=YD01-YD02&id=4565 https://doi.org/10.7860/JCDR/2014/.4565 Perioperative Management of Hysterectomy in a Patient with Polycystic Kidney Disease Savitri. K., Ashwini. H.R., Sreedevi. S. Polycystic disease of the kidney, inherited as an autosomal dominant trait is characterised by progressive expansion of numerous fluid- filled cysts resulting in massive enlargement of the kidneys ultimately resulting in kidney failure. An understanding of alterations in the renal physiology due to hemodynamic changes is important for successful perioperative management. We report a successful perioperative management of a vaginal hysterectomy in a female patient with adult polycystic kidney disease. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=GD03-GD04&id=4566 https://doi.org/10.7860/JCDR/2014/.4566 Management of Gingival Recession Associated with Orthodontic Treatment: A Case Report Tarun Kumar Rana, Megha Phogat, Tarun Sharma, Narayana Prasad, Shailendra Singh Many patients undergo orthodontic treatment for aesthetic improvement. It is well established that the patients who undergo orthodontic treatment have a high susceptibility to present plaque accumulation on their teeth because of the presence of brackets, wires and/or other orthodontic elements on the teeth surfaces with which the oral hygiene procedures might be more difficult. The orthodontic treatment is a double-action procedure regarding the periodontal tissues which may be very meaningful in increasing the periodontal health status and may be a harmful procedure which can be followed by several types of periodontal complications. There is a strong correlation between the severity and extent of gingival recessions and the orthodontic treatment suggesting that orthodontic tooth movement may lead to gingival recession. The principal objective in the treatment of gingival recession is to cover the exposed root surfaces to improve aesthetics and to reduce hypersensitivity. Different soft tissue grafting procedures have been proposed in the treatment of gingival recessions. Subepithelial connective tissue graft is a reliable method for treatment of gingival recession. The purpose of this case report was to illustrate the relationship between orthodontic therapy and gingival recession and to describe the management of this case. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZD05-ZD07&id=4555 https://doi.org/10.7860/JCDR/2014/.4555 Cytological Diagnosis of Follicular Carcinoma Thyroid Metastasis in Pelvic Muscles- A Rare and Unusual Site Sanjay Piplani, Rahul Mannan, Tejinder Singh Bhasin, Mridu Manjari, Karamjit Singh Gill Distant metastasis of thyroid neoplasm as an initial presentation is rarely encountered. The present case report describes a chance diagnosis of follicular carcinoma thyroid (FCT) metastasis in a 75-year-old female who was presented with symptoms related to pelvic mass. This is a rare site of reporting as only three cases have been reported previously at the first diagnosis. It is important to identify the presence of distant metastasis as it is the most important prognostic indicator (associated with 50% mortality). This is significant as this has a direct bearing upon its treatment and managing the patient. Hence more awareness is required by both diagnosticians and clinicians regarding this. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=FD05-FD06&id=4551 https://doi.org/10.7860/JCDR/2014/.4551 Epidural Anesthesia for Caesarean Section in a Pregnant Patient with Pituitary Macroadenoma Remadevi R., D. Dinesh Bab u, K. Sureshkumar , Shubhada A. Patil Anaesthesia for patient with pituitary adenoma posted for non-neurosurgical surgeries is a challenge to the anaesthesiologist with the risk of sudden change in intracranial dynamics during administration of spinal anaesthesia or during stress response of general anaesthesia. There is a chance of increase in tumour size during antenatal period. A careful assessment of pituitary function and a screening of visual field and fundus examination are essential to rule out any mass effect. We are presenting the anaesthetic management of patient with pituitary macroadenoma posted for elective caesarean section done under epidural anaesthesia due to its rarity. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=GD01-GD02&id=4552 https://doi.org/10.7860/JCDR/2014/.4552 Dental Treatment Abuse Paul Chalakkal, Ida De Noronha De Ataide, Ramesh Krishnan, Rajdeep Pavaskar These case reports highlight dental treatment abuse performed by a quack on children. The anterior teeth of these children were metal capped using cement, which were otherwise healthy. The treatment was done on children without parental consent by a quack from Denmark who gave the reason as for resolving proclination of upper permanent incisors. The unanatomic, unaesthetic metal caps were removed after the child reported to the Department of Pedodontics and Preventive Dentistry. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZD01-ZD02&id=4544 https://doi.org/10.7860/JCDR/2014/.4544 Fibroid after Hysterectomy: A Diagnostic Dilemma Pallavee P, Seetesh Ghose, Sunita Samal, Jasmina Begum, Mariyam Zabeen Broad ligament fibroids are rare and often pose clinical diagnostic difficulties. We report a case of broad ligament fibroid in a woman after hysterectomy. The lady presented to us with continuous lower abdominal pain of seven months duration. Bimanual examination revealed a firm mass on the right side of the vaginal vault. Transvaginal sonogram and computed tomography scan was suggestive of possible parasitic leiomyoma or a broad ligament fibroid. Exploratory laparotomy and removal of the mass, followed by histological examination confirmed leiomyoma. Extra-uterine fibroid should be considered in the differential diagnosis of pelvic masses even in the post-hysterectomy state. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=OD01-OD02&id=4532 https://doi.org/10.7860/JCDR/2014/.4532 Strategies to Combat Antimicrobial Resistance Rajesh R Uchil, Gurdeep Singh Kohli, Vijay M Katekhaye, Onkar C Swami The global burden of antimicrobial resistance is rising and is associated with increased morbidity and mortality in clinical and community setting. Spread of antibiotic resistance to different environmental niches and development of superbugs have further complicated the effective control strategies. International, national and local approaches have been advised for control and prevention of antimicrobial resistance. Rational use of antimicrobials, regulation on over-the-counter availability of antibiotics, improving hand hygiene and improving infection prevention and control are the major recommended approaches. Thorough understanding of resistance mechanism and innovation in new drugs and vaccines is the need. A multidisciplinary, collaborative, regulatory approach is demanded for combating antimicrobial resistance. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ME01-ME04&id=4529 https://doi.org/10.7860/JCDR/2014/.4529 Temporal Dimension in Reference Standard Misclassification – A Concept Note S A Rizwan, Baridalyne Nongkynrih, S Lena Charlette, Anand Krishnan In situations of diagnostic tests studies where the gold standard(GS) test is not absolutely perfect, validity measures of index tests vary in subgroups with varying disease prevalence. This is called reference standard misclassification. Although this is widely known, little is explained about the variations in the performance of index tests when the validity of the GS test itself varies with the time duration of illness. This article attempts to expand the concept of reference standard misclassification specifically on the effect of time dependence of diagnostic tests. A brief literature review is also presented which documents the existent knowledge among researchers about the concept and the methods they usually employ to adjust. A list of solutions which can address the issue has also been discussed to enable researchers to design and analyse diagnostic test studies in better ways. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=JE01-JE05&id=4571 https://doi.org/10.7860/JCDR/2014/.4571 Dentistry and Mass Disaster – A Review Mark David Edward Nathan, D Sri Sakthi Mass disaster situations may arise from natural or manmade circumstances like bioterrorism and dentists or dental responders have significant roles in human identification, following such occurrences. The various roles of dentists in mass disaster management, that include bio surveillance and notification, diagnosis and monitoring, triage, referrals of patients, immunizations, decontamination and infection control would be considered. The varying extents of use of forensic dental techniques and the resulting positive impacts made on human identification will also be included. The importance of preparation by way of special training for the dental personnel, mass disaster rehearsal, and use of modern day technology will be stressed on. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZE01-ZE03&id=4573 https://doi.org/10.7860/JCDR/2014/.4573 Minimal Intervention Dentistry – A New Frontier in Clinical Dentistry Jingarwar MM., Bajwa NK., Pathak A Minimally invasive procedures are the new paradigm in health care. Everything from heart bypasses to gall bladder, surgeries are being performed with these dynamic new techniques. Dentistry is joining this exciting revolution as well. Minimally invasive dentistry adopts a philosophy that integrates prevention, remineralisation and minimal intervention for the placement and replacement of restorations. Minimally invasive dentistry reaches the treatment objective using the least invasive surgical approach, with the removal of the minimal amount of healthy tissues. This paper reviews in brief the concept of minimal intervention in dentistry https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZE04-ZE08&id=4583 https://doi.org/10.7860/JCDR/2014/.4583 The Baffling Human Body and the Boundless Nanomaterial Boon- A Trap for Cancer Crab S. Jeelani, G. S. As okan, G. Anuradha, J. Parthiban, T. Sivasankari Life is a balance of infinite physiochemical balanced harmonies and the basic unit cell is responsible in maintaining it. Cardiovascular diseases and Cancer are the prime causes of death worldwide. Cancerous cells break the harmonious balance and result in uncontrolled growth and spread. Emerging among the existing modalities for management of cancer, as a ray of hope is Nanotechnology based treatment. Dendrimers, Quantum dots and nanobubbles contribute significantly as part of nano based diagnosis and treatment in the management of cancer. Dendrimers are nanoparticles which employ the principle of Trojan horse strategy in that encapsulation and conjugation of anti cancer agents helps in targeting the cancerous cells specifically without affecting the adjacent healthy cells. Quantum dots are cadmium based nanoparticles which when exposed to UV light glow and help in destroying the cancerous cells in the incipient stage. Nanobubbles are generated with short pulses of laser, which helps in identifying the individual cancerous cells and explodes them. Apart from them other technologies such as liposomes, fullerenes, carbon nanotubes, nanoshells, paramagnetic nanoparticles, nanoburrs, respirocytes, microbiovores, nanopores, smart coating and nano bandaid contribute a great lot as boundless nanomaterial boon for the management of cancer, cardiovascular problems and overall systemic health. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZE09-ZE12&id=4584 https://doi.org/10.7860/JCDR/2014/.4584 The Role of Virtual Articulator in Prosthetic and Restorative Dentistry Pavankumar Ravi Koralakunte, Mohammad Aljanakh Virtual reality is a computer based technology linked with the future of dentistry and dental practice. The virtual articulator is one such application in prosthetic and restorative dentistry based on virtual reality that will significantly reduce the limitations of the mechanical articulator, and by simulation of real patient data, allow analyses with regard to static and dynamic occlusion as well as to jaw relation. It is the purpose of this article to present the concepts and strategies for a future replacement of the mechanical articulator by a virtual one. Also, a brief note on virtual reality haptic system has been highlighted along with newly developed touch enabled virtual articulator. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZE25-ZE28&id=4648 https://doi.org/10.7860/JCDR/2014/.4648 Exercise Prescriptions to Prevent Musculoskeletal Disorders in Dentists Dodda Kiran Kumar, Neelima Rathan, Sreevalli Mohan, Mohammadi Begum, Bhanu Prasad, Eswar Ravi Vara Prasad Since the number of dental patients is increasing day by day dentists are forced to spend longer times in dental chairs. This is increasing the prevalence of musculoskeletal disorders in dentists. This article reviews the mechanisms causing musculoskeletal disorders among dentists and also covers the exercises that can be done to prevent them. Exercises that increase the fitness of a dentist are divided into aerobic exercises – concentrating on total body fitness, stretching exercises – that concentrate on the muscles that tend to tighten in prolonged dental postures and strengthening exercises – that concentrate on the muscles that are opposite to the tight muscles. These exercises are made simple and of minimal intensity so that a dentist can practice them independently. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZE13-ZE16&id=4620 https://doi.org/10.7860/JCDR/2014/.4620 The Trimeric Model: A New Model of Periodontal Treatment Planning Khalid G Azouni, Bassel Tarakji Treatment of periodontal disease is a complex and multidisciplinary procedure, requiring periodontal, surgical, restorative, and orthodontic treatment modalities. Several authors attempted to formulate models for periodontal treatment that orders the treatment steps in a logical and easy to remember manner. In this article, we discuss two models of periodontal treatment planning from two of the most well-known textbook in the specialty of periodontics internationally. Then modify them to arrive at a new model of periodontal treatment planning, The Trimeric Model. Adding restorative and orthodontic interrelationships with periodontal treatment allows us to expand this model into the Extended Trimeric Model of periodontal treatment planning. These models will provide a logical framework and a clear order of the treatment of periodontal disease for general practitioners and periodontists alike. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZE17-ZE20&id=4623 https://doi.org/10.7860/JCDR/2014/.4623 C-Reactive Protein (CRP) and its Association with Periodontal Disease: A Brief Review Tushika Bansal, Anita Pandey, Deepa D, Ashish K Asthana Periodontal disease is a chronic infection of the gums characterised by a loss of attachment between the tooth and bone, and bone loss. C-reactive protein (CRP) elevation is a part of the acute phase response to acute and chronic inflammation. Many epidemiological studies have shown that serum CRP levels were elevated in patients with chronic periodontitis. CRP levels increase to hundreds of µg/ml within hours following infection. It out-performs erythrocyte sedimentation rate (ESR) in terms of responsiveness and specificity for inflammation. While CRP elevation is suggestive of inflammation or infection in the appropriate clinical context, it can also occur with obesity and renal dysfunction. Conversely, a lack of CRP elevation in inflammation may be seen with hepatic failure, as well as during flares of conditions such as systemic lupus erythematosus. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZE21-ZE24&id=4646 https://doi.org/10.7860/JCDR/2014/.4646 Classification & Prevalence of Dental Surface Defects in Areas of Gingival Recession- A Clinical Study Bhusari Prashant, Nitin Agrawal, Shivam Up adhyay, Shiras Verma, Amiyavardhan Jain, Shraddha Jaroli <b>Background:</b>Apical migration of the gingival margin beyond the cement-enamel junction (CEJ) is called as gingival recession. Various classifications of gingival recession have been proposed to evaluate different degrees of damage to periodontal tissues, but do not consider the condition of the exposed root surface: presence of an identifiable CEJ and presence of root abrasion. Sometimes these lesions may be associated with enamel abrasion. Therefore, the aim of this paper is to propose the new classification of dental surface defects in gingival recession area. <b>Methods:</b>Two factors were evaluated to set up a classification system: presence (A) or absence (B) of cemento-enamel junction (CEJ) and presence (+) or absence (-) of dental surface discrepancy caused by abrasion (step). Four classes (A+, A-, B+, and B-) were identified on the basis of these variables. The classification was used on 1000 gingival recessions to examine the distribution of the four classes. <b>Results:</b> Out of 1000 exposed root surfaces, 380 showed an identifiable CEJ associated with step (Class A+, 38%); 280 an identifiable CEJ without any associated step (Class A-, 28%); 200 an unidentifiable CEJ with a step (Class B+, 20%); and 140 an unidentifiable CEJ without any associated step (Class B-, 14%). <b>Conclusion:</b> The proposed classification describes the dental surface defects that are of paramount importance in diagnosing gingival recession areas which might help in selecting the definite treatment approach. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZF01-ZF04&id=4577 https://doi.org/10.7860/JCDR/2014/.4577 Comparison of Microscopic Morphology of Fungi Using Lactophenol Cotton Blue (LPCB), Iodine Glycerol and Congo Red Formaldehyde Staining Vacharavel Shamly, Arunava Kali, Sreenivasan Srirangaraj, Sivaraman Umadevi https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=DL01-DL02&id=4535 https://doi.org/10.7860/JCDR/2014/.4535 Green Dentistry, A Metamorphosis Towards an Eco-Friendly Dentistry: A Short Communication Varun Rastogi, Rachna Sharma, Lalita Yadav, Pranali Satpute, Vandana Sharma Dentistry is most importantly and foremost a healing profession. In today’s world, it is very necessary to understand the importance of being eco-friendly in every facet of our lives, including dental practice which has a huge impact on the environment due to the large amount of metallic waste generated by various dental procedures along with excessive use of water and electricity, which specifically emphasis the thrust to move towards ‘Green dentistry’. Green dentistry is an innovative way of dental practice which is environment friendly and at the same time conserves money and time by reducing waste, conserving energy and decreasing pollution with the use of latest techniques and procedures. Green dentistry therefore, protects the environment and mankind from the hazards of rapid urbanisation in developing countries. The authors wish to emphasize the practice of eco-friendly, green dentistry in a developing country like India which needs to conserve resources and curb environmental pollution. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZM01-ZM02&id=4556 https://doi.org/10.7860/JCDR/2014/.4556 A Simple 2D Accurate Mini Implant Positioning Guide ARUN KUMAR DASARI, SUSHMA PARIMI, KISHORE M.S.V, NAGAM REDDY SHASHIDHAR, SATHU REDDY DHARMENDER One of the major issues in orthodontic treatment is anchorage planning when using a pre adjusted edgewise appliance system. The conventional methods described in the literature include banding of second molars, transpalatal arches and headgears that involve additional teeth or wire components. With the introduction of temporary anchorage devices, anchorage can be ideally planned to treat a case successfully. However, the stability and placement of these mini implants demands accurate positioning, good bone thickness without damaging the adjacent structures. Here, we illustrate a very economical and two dimensional mini implant guide for accurate and easy placement. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=July&volume=8&issue=7&page=ZM03-ZM04&id=4596 https://doi.org/10.7860/JCDR/2014/.4596