Journal of clinical and diagnostic research https://www.jcdr.net/back_issues.asp JCDR “Why We Say No! A Look Through the Editor´s Eye” Aarti Garg, Sunanda Das, Hemant Jain <b>Background:</b> The rapidly flourishing health science has provided a ground to perform research work and contribute to the field of science. On the other hand, reporting the research is equally important as carrying out research. Many such researches and their ground breaking work remain unreported or do not reach the guild, because of poor drafting skills. In nine years since Journal of Clinical and Diagnostic Research (JCDR) inception, editorial have come across many manuscripts which are clinically and socially relevant in their message, but lack legible drafting. It was felt that an objective analysis of the reasons for rejection, of manuscripts, is required. <b>Aim:</b> The present study was conducted with the aim to determine the reasons for rejection of medical and dental manuscript submitted in JCDR. <b>Materials and Methods:</b> Retrospective analysis of 1000 consecutive medical and dental articles submitted to JCDR since 1st August 2014 was done. Only those articles (902) that reached the end point on decision were considered. The reasons of rejection for medical and dental articles were enlisted and analyzed. When there were multiple reasons of rejection and all of them were critical, then they were counted in all the categories. <b>Results:</b> Out of the 902 consecutive articles 522 articles underwent rejection. Among the rejected ones, dental specialty comprised of 43.5% and medical articles contributed 56.5%. The most frequent reasons for rejection were commonality (44.6%), non compliance by authors (17.8%), methodological issues (17.3%), plagiarism (11.1%), received same topic and published (7.66%), poor draft (6.70%), data inconsistency (5.77%), mismanagement (1.72%), blacklisted author (1.14%), ethical and out of scope were 0.57% each. <b>Conclusion:</b> Based on our findings, it can be concluded that manuscript rejection can be avoided by the authors, if the topic is well choosen and communication is maintained with the journal editorial. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=JB01-JB05&id=6699 https://doi.org/10.7860/JCDR/2015/.6699 The Current Mental Health Status of Ebola Survivors in Western Africa Sankalp Yadav, Gautam Rawal The epidemic of Ebola virus disease has claimed many lives. The impact of this disease is evident in the mental health of the survivors. The mere drafting of policies will not help; rather execution at the ground level is essential. There is an urgent need, to focus on the ways by which the sufferings should be reduced. The present article throws light on this grave problem in Africa. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=LA01-LA02&id=6559 https://doi.org/10.7860/JCDR/2015/.6559 Perception of Aesthetics by Different Professionals of Different Communities Amit Pratap Majethia, Vaishali Devidas Vadgaonkar, Kiran Jayant Deshpapande, Parag Vishnu Gangurde <b>Aim:</b> To evaluate the perception of aesthetics by different professionals of different communities in India by a photographic study. <b>Materials and Methods:</b> This was a photographic study conducted among different professionals of different communities to establish an aesthetic norm for Indian population. The communities to which the professionals belonged were North Indian, South Indian, Maharashtrian, Gujarati and Parsi. The subjects photographed were aesthetic profiles with good occlusion. Five different facial photographic views each for male and female were obtained. These photographs were then subjected to changes in increments of 2 mm and 4 mm in retrusive and protrusive profile in Adobe Photoshop CS5 after which they were evaluated by different professionals of different communities according to their preference from most liked to least liked. <b>Results:</b> The aesthetic preferences differed widely among different professionals of different community. <b>Conclusion:</b> The established aesthetic norms can be utilized by the dental fraternity in general and Orthodontist’s in particular in diagnosis and treatment planning of Samples belonging to different communities to have the treatment outcome in unison with the established soft tissue norm for that particular community. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ZC18-ZC22&id=6584 https://doi.org/10.7860/JCDR/2015/.6584 Psychiatric Morbidity in Patients with Chikungunya Fever: First Report from India M.S. Bhatia, Priyanka Gautam, Anurag Jhanjee <b>Background:</b> Chikungunya fever is an acute illness caused by an arbovirus and has various complications like neurological, psychological, dermatological and even multi organ failure. Psychiatric co-morbidity is not very well studied till now. This is the first report from India. <b>Aim:</b> Aim of the study was to assess the psychiatric morbidity during or after the onset of Chikungunya fever. <b>Materials and Methods:</b> Patients referred from Medicine department with confirmed diagnosis of Chikungunya fever were recruited, after taking informed consent. Patient’s socio-demographic characteristics were noted and Psychiatric co-morbidity was assessed by complete history taking and mental status examination, using WHO International Classification of Diseases, 10th edition (ICD -10) of Mental and Behavioural Disorders, Diagnostic criteria for research. <b>Results:</b> The age range of the study group was found to be 23-48 years. Fourteen (70%) were males and 6 (30%) were females. Five (25%) patients were diagnosed with depressive disorder, 3 (15%) patients had Generalized Anxiety Disorder (GAD), 2 (10%) patients GAD with Panic attacks, 1(5%) patients phobic disorder (claustrophobia), 3 (15%) patients Somatoform Disorder, 3 (15%), Neurasthenia (Fatigue Syndrome), etc. Two (10%) patients presented with vague somatic complaints which did not fit into any of the diagnostic category. <b>Conclusion:</b> Chikungunya fever can result in significant psychiatric morbidity, mainly in the form of depressive episode, anxiety disorder and even long persisting illnesses like somato-form disorders. Further research is required to know about the phenomenology or the neurobiology of the psychiatric disorders occurring in the course of this illness. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=VC01-VC03&id=6586 https://doi.org/10.7860/JCDR/2015/.6586 Evaluation of Patients’ Satisfaction after Class III Orthognathic Surgery Osvaldo Magro-Filho, Marcelo Coelho Goiato, Derly Tescaro Narcizo Oliveira, Lidia Pimenta Martins, Marcio Salazar, Rodrigo Antonio de Medeiros, Daniela Micheline dos Santos <b>Background:</b> Well-planned orthognathic surgery improves psychological health, aesthetics and function of patients. <b>Aim:</b> The present study aimed to investigate patients’ satisfaction after orthognathic surgery by means of a satisfaction questionnaire before and after surgery. <b>Materials and Methods:</b> A total of 29 patients was selected (17 women and 12 men), with a mean age of 28 years, randomly selected from a private clinic at Araçatuba – São Paulo by two investigators. Anamnesis and clinical examination were performed. Subjects with facial deformities submitted to orthodontic treatment before and after orthognathic surgery with a minimum post-surgery period of 6 months, answered a satisfaction questionnaire composed of 10 questions regarding dental and facial aesthetics. In this study, the maximum satisfaction score was 10. <b>Results:</b> Regarding aesthetics, two satisfaction parameters were investigated: dental and facial. For all indices, the average satisfaction was up to score 7. <b>Conclusion:</b> According to the results, it can be concluded that orthognathic surgery has been an effective treatment for dentofacial deformities, aesthetics and functional problems, what was verified by pre and postoperative questionnaire application. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ZC23-ZC27&id=6587 https://doi.org/10.7860/JCDR/2015/.6587 Competing Risk Approach (CRA) for Estimation of Disability Adjusted Life Years (DALY’s) for Female Breast Cancer in India Radhika Kunnavil, Chethana Thirthahalli, Shalini Chandrashekar Nooyi, NS Shivaraj, Nandagudi Srinivasa Murthy <b>Background:</b> Competing Risk Approach (CRA) has been used to compute burden of disease in terms of Disability Adjusted Life Years (DALYs) based on a life table for an initially disease-free cohort over time. <b>Objective:</b> To compute Years of Life Lost (YLL) due to premature mortality, Years of life lost due to Disability (YLD), DALYs and loss in expectation of life (LEL) using competing risk approach for female breast cancer patients for the year 2008 in India. <b>Materials and Methods:</b> The published data on breast cancer by age & sex, incidence & mortality for the year 2006-2008 relating to six population based cancer registries (PBCR) under Indian Council of Medical Research (ICMR), general mortality rates of 2007 in India, published in national health profile 2010; based on Sample Registration System (SRS) were utilized for computations. Three life tables were constructed by applying attrition of factors: (i) risk of death from all causes (‘a’; where a is the general death rate); (ii) risk of incidence and that of death from causes other than breast cancer (‘b-a+c’; where ‘b’ is the incidence of breast cancer and ‘c’ is the mortality of breast cancer); and (iii) risk of death from all other causes after excluding cancer mortality (‘a-c’). Taking the differences in Total Person Years Lived (TPYL), YLD and YLL were derived along with LEL. <b>Results:</b> CRA revealed that the DALYs were 40209 per 100,000 females in the life time of 0-70+ years with a LEL of 0.11 years per person. Percentage of YLL to DALYs was 28.20% in the cohort. <b>Conclusion:</b> The method of calculation of DALYs based on the CRA is simple and this will help to identify the burden of diseases using minimal information in terms of YLL, YLD, DALYs and LEL. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=LC01-LC04&id=6590 https://doi.org/10.7860/JCDR/2015/.6590 Quantitative Analysis of Acute Phase Proteins in Post Chemo-Radiation Mucositis Chethana, Pratima S Rao, Lal P Madathil, Suresh Rao, Pushparaja Shetty, Madhvika Patidar <b>Aim:</b> Oral mucositis induced by radiation is an inevitable but transient side-effect of radiotherapy. Acute phase proteins are a class of proteins whose phase concentrations fluctuate in response to inflammation. The best known of the acute phase proteins is C-reactive protein, a protein that rises in the blood with inflammation. <b>Materials and Methods:</b> 30 patients undergoing chemo – radiotherapy for head and neck cancer were clinically evaluated for mucositis on day 0, 7, 14, 28 and 42. Blood investigations like C-reactive protein, erythrocyte sedimentation rate and total leukocyte count were also conducted. <b>Results:</b> There was a significant increase in the severity of mucositis during the course of treatment followed by a gradual decrease in severity towards the end of radiotherapy. Comparison of C-reactive protein levels from day 0 to day 42 in the study group showed a significant increase towards the end of radiotherapy. There was a significant increase in erythrocyte sedimentation rate levels till day 14 followed by a decrease towards the end of radiotherapy whereas total leukocyte count showed a significant decrease from day 0 to day 7 followed by an increase towards the end of radiotherapy. <b>Conclusion:</b> The oral mucosa bears only a small clinical spectrum of the side-effect conveyed by chemo-radiation. Both widespread and late effects do occur, and tissues may never return to normal completely. Inflammatory serum markers like C-reactive protein, erythrocyte sedimentation rate and total leukocyte count can thus be used as an objective measure to study the complexities of radiation mucositis which is documented as one of the worst side effects of head and neck cancer therapy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ZC28-ZC31&id=6591 https://doi.org/10.7860/JCDR/2015/.6591 Effect of Different Phases of Menstrual Cycle on Heart Rate Variability (HRV) Tejinder Kaur Brar, K. D. Singh, Avnish Kumar <b>Background:</b> Heart Rate Variability (HRV), which is a measure of the cardiac autonomic tone, displays physiological changes throughout the menstrual cycle. The functions of the ANS in various phases of the menstrual cycle were examined in some studies. <b>Aims and Objectives:</b> The aim of our study was to observe the effect of menstrual cycle on cardiac autonomic function parameters in healthy females. <b>Materials and Methods:</b> A cross-sectional (observational) study was conducted on 50 healthy females, in the age group of 18-25 years. Heart Rate Variability (HRV) was recorded by Physio Pac (PC-2004). The data consisted of Time Domain Analysis and Frequency Domain Analysis in menstrual, proliferative and secretory phase of menstrual cycle. Data collected was analysed statistically using student’s pair t-test. <b>Results:</b> The difference in mean heart rate, LF power%, LFnu and HFnu in menstrual and proliferative phase was found to be statistically significant. The difference in mean RR, Mean HR, RMSSD (the square root of the mean of the squares of the successive differences between adjacent NNs.), NN50 (the number of pairs of successive NNs that differ by more than 50 ms), pNN50 (the proportion of NN50 divided by total number of NNs.), VLF (very low frequency) power, LF (low frequency) power, LF power%, HF power %, LF/HF ratio, LFnu and HFnu was found to be statistically significant in proliferative and secretory phase. The difference in Mean RR, Mean HR, LFnu and HFnu was found to be statistically significant in secretory and menstrual phases. <b>Conclusion:</b> From the study it can be concluded that sympathetic nervous activity in secretory phase is greater than in the proliferative phase, whereas parasympathetic nervous activity is predominant in proliferative phase. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=CC01-CC04&id=6592 https://doi.org/10.7860/JCDR/2015/.6592 Fluoride Content of Bottled Drinking Water in Chennai, Tamilnadu Sujatha Somasundaram, Karunya Ravi, K. Rajapandian, Deepa Gurunathan <b>Context:</b> The optimum level of fluoride in drinking water is 0.7 to 1.2 ppm. Decreased fluoride concentration leads to increased risk of caries and increased concentration can lead to dental or skeletal fluorosis. One crore liters of water is supplied to Chennai and surrounding areas through pouches and bottles which carters about one third of city population. <b>Aim:</b> The aim of this study is to determine the fluoride concentration in top 10 bottled waters in Chennai and to check the accuracy of their labelling. <b>Materials and Methods:</b> Top selling bottled waters, 6 multinational and 4 Non- multinational brands were selected for the study. Three different batches of each brand were purchased. The labels of the bottled were removed after collecting the details regarding fluoride content. All the bottles were numbered and sent for fluoride content analysis using SPADNS calorimetric method. <b>Results:</b> All the brands and batches which were analysed for the study had less than optimal fluoride content and there is a significant variation in fluoride concentration of each brand and among different batches of same brand bottled waters. The range of fluoride level in tested samples was between 0.27 to 0.59. Only one brand’s label had information regarding the fluoride content. <b>Conclusion:</b> Standardization of fluoride levels in bottled waters and labelling of fluoride content should become mandatory. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ZC32-ZC34&id=6594 https://doi.org/10.7860/JCDR/2015/.6594 Efficacy of Transcerebellar Diameter/Abdominal Circumference Versus Head Circumference/Abdominal Circumference in Predicting Asymmetric Intrauterine Growth Retardation Bhimarao, Rashmi M. Nagaraju, Venk ataramana Bhat, Puttanna VN Gowda <b>Background:</b> The high incidence of IUGR and its low recognition lead to increasing perinatal morbidity and mortality for which prediction of IUGR with timely management decisions is of paramount importance. Many studies have compared the efficacy of several gestational age independent parameters and found that TCD/AC is a better predictor of asymmetric IUGR. <b>Aim:</b> To compare the accuracy of transcerebellar diameter/abdominal circumference with head circumference/abdominal circumference in predicting asymmetric intrauterine growth retardation after 20 weeks of gestation. <b>Materials and Methods:</b> The prospective study was conducted over a period of one year on 50 clinically suspected IUGR pregnancies who were evaluated with 3.5 MHz frequency ultrasound scanner by a single sonologist. BPD, HC, AC and FL along with TCD were measured for assessing the sonological gestational age. Two morphometric ratios- TCD/AC and HC/AC were calculated. Estimated fetal weight was calculated for all these pregnancies and its percentile was determined. Statistical Methods: The TCD/AC and HC/AC ratios were correlated with advancing gestational age to know if these were related to GA. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy (DA) for TCD/AC and HC/AC ratios in evaluating IUGR fetuses were calculated. <b>Results:</b> In the present study, linear relation of TCD and HC in IUGR fetuses with gestation was noted. The sensitivity, specificity, PPV, NPV & DA were 88%, 93.5%, 77.1%, 96.3% & 92.4% respectively for TCD/AC ratio versus 84%, 92%, 72.4%, 95.8% & 90.4% respectively for HC/AC ratio in predicting IUGR. <b>Conclusion:</b> Both ratios were gestational age independent and can be used in detecting IUGR with good diagnostic accuracy. However, TCD/AC ratio had a better diagnostic validity and accuracy compared to HC/AC ratio in predicting asymmetric IUGR. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=TC01-TC05&id=6554 https://doi.org/10.7860/JCDR/2015/.6554 Effect of Surgical Periodontal Therapy on Serum C-reactive Protein Levels Using ELISA in Both Chronic and Aggressive Periodontitis Patient Bharat Gupta, Anshul Sawhney, Neha Patil, Manoj Yadav, Shashank Tripathi, Saurabh Sinha, Saurabh Sharma, Saurabh Gupta <b>Background:</b> Periodontitis can be defined as a local inflammatory process which mediates destruction of periodontal tissues & is triggered by bacterial insult. In periodontal infections, the levels of C reactive proteins are elevated as compared to the levels in a periodontally healthy individual. The study was done to determine the relative levels of serum CRP in aggressive, chronic and periodontally healthy subjects and to evaluate the effect of surgical periodontal therapy on serum C-reactive protein levels. <b>Materials and Methods:</b> Serum samples were collected from 150 participants (50 healthy control patients (non-periodontitis), 50 patients with chronic periodontitis and aggressive periodontitis. Serum C- reactive protein levels were assessed by means of immunoturbidimetric assay at baseline for subjects in all the 3 groups and 3 months after completion of surgical therapy. <b>Results:</b> The mean baseline C-reactive protein (CRP) concentrations in the Groups I, II and III were 1.65±0.57 mg/L, 3.03±2.14 mg/L and 3.09±2.27 mg/L respectively. After treatment, the mean C-reactive protein (CRP) levels in Groups II and III reduced from 3.03±1.67 mg/L to 1.46±1.67 mg/L and from 3.09±1.21 to 1.43±1.21 mg/L respectively. Similar results were found for probing depth and all indexes in Group II and III after treatment. Also, the mean attachment loss in Groups II and III reduced, so the results were highly significant. <b>Conclusion:</b> Successful periodontal treatment results in significant decrease in serum C-reactive protein (CRP) levels in otherwise healthy subjects. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ZC01-ZC05&id=6558 https://doi.org/10.7860/JCDR/2015/.6558 Influence of Media in the Choice of Oral Hygiene Products Used Among the Population of Maduravoyal, Chennai, India Anitha Logaranjani, Jaideep Mahendra, Rajapriya Perumalsamy, Rajeshree Rangari Narayan, Sathish Rajendran, Ambalavanan Namasivayam <b>Background and Aims:</b> To assess the factors influencing the awareness and practice of oral hygiene among the local population Maduravoyal, Chennai, India. <b>Materials and Methods:</b> A cross-sectional questionnaire based study was conducted to understand the factors influencing the choice and practice of oral hygiene products among the population of Maduravoyal, Chennai, India. Data was collected by means of a self administered structured questionnaire written in English and validated through a pilot survey. One thousand two hundred and nine subjects, with an age range of 15 to 70 years, who visited the Department of Periodontology, Meenakshi Ammal Dental College, Chennai were selected for investigation. The data obtained was analyzed using the SPSS version 13.0. The frequency of distribution and percentages were calculated. <b>Results:</b> The results of the study showed that tooth brush (98.5%) and toothpaste (98%) were the main products used for the maintenance of oral hygiene and around 84.6% of the population brushed once daily. Information from the media (59.4%) and decay prevention (49.7%) were the major factors that influenced the choice of toothpaste among the study population. <b>Conclusion:</b> The major factor which influenced the choice of oral hygiene products was based on information obtained from advertisements and other sources. There is a need for the dental professionals to be aware of the ever-increasing development and marketing of oral hygiene products from various databases. Hence, the education of people regarding the importance of oral hygiene maintenance, proper selection of oral hygiene products is essential. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ZC06-ZC08&id=6562 https://doi.org/10.7860/JCDR/2015/.6562 Is Prophylactic Drainage of Peritoneal Cavity after Gut Surgery Necessary?: A Non-Randomized Comparative Study from a Teaching Hospital Salamat Khan, Pranil Rai, Gorakh Misra <b>Introduction:</b> Prophylactic use of intra-peritoneal drain is commonly practiced by surgeons in the hope of early detection of complication and reducing mortality and morbidity. The aim of the study was to determine evidence based value of prophylactic drainage of peritoneal cavity in cases of secondary peritonitis and resection and anastomosis of small and large bowel. <b>Materials and Methods:</b> One hundred and seventy one (171) cases were included in the study from March 2012-May 2013 that underwent laparotomy for peptic ulcer perforation (PUP), simple and complicated acute appendicitis (appendicular perforation with localized/generalized peritonitis), small bowel obstruction (SBO) and sigmoid volvulus, traumatic and non-traumatic perforation of small and large bowel. Appropriate management was done after resuscitation and investigation. After completion of operation peritoneal cavity was either drained or not drained according operator’s preference. They were divided into drain and non-drain groups. Surgical outcome and postoperative complications =30 days of operation was noted and compared between two groups. <b>Results:</b> No significant difference was observed between drained group and non-drained group in terms of age (32.08±15.99 vs. 35.57 ± 16.42 years), Sex (76M: 42F vs. 40M: 13F), weight 50.9 ± 11.75 vs. 48.4 ± 16.1 kg), height (1.6 ± 0.13 vs. 1.5 ± 0.18 Meter), BMI (20 ± 4.7 vs. 20 ± 7.2), ASA score (p= >0.05). However there was significant difference was observed between drained group and non-drained groups in terms of length of hospital stay (9 ± 4 vs 5 ± 3.4 days), operative duration (115.6 ± 41.0 vs. 80 ± 38.1 minutes), infection rates in dirty wound (40.0% vs 12.5%) and overall postoperative complications (35.85% vs16.11%). <b>Conclusion:</b> Based on these results, present study suggests that prophylactic drainage of peritoneal cavity after gastrointestinal surgery is not necessary as it does not offer additional benefits for the patients undergoing gut surgery. Moreover, it increases operative duration, length of hospital stay and surgical site infection (SSI). https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=PC01-PC03&id=6577 https://doi.org/10.7860/JCDR/2015/.6577 Total and Free Fluoride Concentration in Various Brands of Toothpaste Marketed in India Shibu Thomas Sebastian, Sunitha Siddanna <b>Background:</b> For fluoridated toothpaste to be effective in controlling dental caries, an adequate concentration of soluble fluoride must be available in the oral cavity. <b>Aim:</b> To determine the total and free fluoride concentration in various brands of toothpaste marketed in India. <b>Materials and Methods:</b> Three samples of 12 different toothpastes were purchased from supermarkets in Mysore city, Karnataka, India. Toothpastes were analysed in duplicate using a fluoride ion-specific electrode. The concentration of total fluoride (TF) and total soluble fluoride (TSF) were determined. <b>Results:</b> Measured TF was consistent with that declared by the manufacturer in five products. Four toothpastes showed lower TF and two higher TF than declared. Most toothpastes exhibited TSF concentrations similar to the TF content except four samples that displayed considerably lower TSF than TF. <b>Conclusion:</b> The measurement of total and free fluoride concentrations of toothpastes available in India showed inhomogenities. Therefore there is a need for stringent regulatory control measures for the determination of fluoride content in toothpastes in developing country like India. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ZC09-ZC12&id=6578 https://doi.org/10.7860/JCDR/2015/.6578 Risk Factors for Stress During Antenatal Period Among Pregnant Women in Tertiary Care Hospital of Southern India Reeta Vijayaselvi, Manisha Madhai Beck, Anuja Abraham, Suja Kurian, Annie Regi, Grace Rebekah <b>Background:</b> The well-being of an infant may be affected when the mother is subjected to psychosocial stress during her pregnancy. Mothers exposed to stressful conditions were more prone for preterm birth than those without any stress. In this study perceived stress has been used as an indicator of levels of stress. There are very few studies published from developing countries on the levels of perceived stress and its causes in pregnant women. <b>Materials and Methods:</b> This study employed a cross-sectional assessment of pregnant women attending the outpatient services of a tertiary care hospital for regular antenatal check-up. Women not known to have any risk factors at 28 weeks to 34 weeks of pregnancy who agreed to participate in the study were interviewed to assess the perceived stress score. <b>Results:</b> Among the total patients 57.7% were primigravida and the mean score on perceived stress scale was 13.5±5.02. The majority of the group (102; 65.4%) scored higher than the mean value of total score on the perceived stress scale. Unplanned pregnancy and husband’s employment status were associated with high levels of perceived stress in multivariate analysis in this set of women. <b>Conclusion:</b> Individual as well as pregnancy related factors can contribute to perceived stress in pregnant women. With the established relationship between maternal mental health, pregnancy outcome and infant growth, the assessment and management of stress early in the pregnancy is crucial. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=QC01-QC05&id=6580 https://doi.org/10.7860/JCDR/2015/.6580 Efficacy of 0.25% Lemongrass Oil Mouthwash: A Three Arm Prospective Parallel Clinical Study Subha Soumya Dany, Pritam Mohanty, Pradeep Tangade, Prashant Rajput, Manu Batra <b>Background:</b> Chlorhexidine mouthwash has earned eponym of gold standard to treat and/or prevent periodontal diseases. However, the present study was carried out to explore an alternative herbal mouthwash. Aim: To compare the anti-plaque and anti-gingivitis efficacy of a 0.25% lemongrass oil mouthwash to that of 0.2% chlorhexidine mouthwash. <b>Materials and Methods:</b> A double-blinded parallel designed clinical trial with 60 subjects was taken for the study. Baseline plaque index (PI) & gingival index (GI) score was recorded. Oral prophylaxis was done and the plaque score was set at zero. Then, subjects were randomly allocated into 3 groups (N=20 in each): 0.25% lemongrass oil mouthwash, 0.2% chlorhexidine mouthwash and oral prophylaxis only. Subjects were asked to swish with respective mouthwash twice daily for 21 days. Subjects were again re-evaluated on 14th and 21st day for GI and PI. Comparison of the mean difference among the variables was performed by parametric tests. <b>Results:</b> Lemongrass oil mouthwash group showed highest reduction in GI & PI at both 14th and 21st day, which was statistically significant (p=0.05). <b>Conclusion:</b> Lemongrass oil mouthwash can also be used as a good herbal alternative to chlorhexidine mouthwash, so further studies are needed. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ZC13-ZC17&id=6581 https://doi.org/10.7860/JCDR/2015/.6581 Estimation of Stature From Hand and Foot Measurements in a Rare Tribe of Kerala State in India GN Geetha, Swathi, Sunita Arvind Athavale <b>Introduction:</b> The present study has been undertaken on the Vettuvar group of tribes in Kasargod district of Kerala state, and explores the usability of dimensions of hands and feet as predictors of stature in the tribal population of Kasargod District of Kerala, India. The present study is the first ever documented anthropological work on the tribes of Kasargod district, Kerala, India. <b>Materials and Methods:</b> Two hundred subjects comprising of 100 males and 100 females in 20-30 years age group were included in the study group. Dimensions of hands and feet viz: hand length, hand breadth, foot length and foot breadth were measured independently on left and right side of each individual using a Sliding calliper. Stature of individuals was measured with the help of a Stadiometer. <b>Results:</b> Statistical analysis indicated that the bilateral variations were insignificant for all the measurements except foot breadth among females (p<0.001). The paired sample t-test showed that the statistical difference between males and females was highly significant for all the measurements (p<0.001). The correlation between the stature and various parameters studied in males and females were found to be positive and statistically highly significant. Linear and multiple regression equation for stature estimation were calculated separately for males and females. <b>Conclusion:</b> The significant positive correlation between the study variables and the stature indicates that these variables can be successfully used to predict stature. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=HC01-HC04&id=6582 https://doi.org/10.7860/JCDR/2015/.6582 Validation of Gujarati Version of ABILOCO-Kids Questionnaire Shraddha Diwan, Jasmin Diwan, Pankaj Patel, Ankita B. Bansal <b>Background:</b> ABILOCO-Kids is a measure of locomotion ability for children with cerebral palsy (CP) aged 6 to 15 years & is available in English & French. Aim: To validate the Gujarati version of ABILOCO-Kids questionnaire to be used in clinical research on Gujarati population. <b>Materials and Methods:</b> ABILOCO-Kids questionnaire was translated into Gujarati from English using forward-backward-forward method. To ensure face & content validity of Gujarati version using group consensus method, each item was examined by group of experts having mean experience of 24.62 years in field of paediatric and paediatric physiotherapy. Each item was analysed for content, meaning, wording, format, ease of administration & scoring. Each item was scored by expert group as either accepted, rejected or accepted with modification. Procedure was continued until 80% of consensus for all items. Concurrent validity was examined on 55 children with Cerebral Palsy (6-15 years) of all Gross Motor Functional Classification System (GMFCS) level & all clinical types by correlating score of ABILOCO-Kids with Gross Motor Functional Measure & GMFCS. <b>Result:</b> In phase 1 of validation, 16 items were accepted as it is; 22 items accepted with modification & 3 items went for phase 2 validation. For concurrent validity, highly significant positive correlation was found between score of ABILOCO-Kids & total GMFM (r=0.713, p<0.005) & highly significant negative correlation with GMFCS (r= -0.778, p<0.005). <b>Conclusion:</b> Gujarati translated version of ABILOCO-Kids questionnaire has good face & content validity as well as concurrent validity which can be used to measure caregiver reported locomotion ability in children with CP. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=YC01-YC04&id=6604 https://doi.org/10.7860/JCDR/2015/.6604 Effects of Scaling and Root Planing on Gingival Status during Menstrual Cycle- A Cross-Sectional Analytical Study Shivani Rathore, Nitin Khuller, Yash Paul Dev, Preetinder Singh, Patthi Basavaraj, Karan Gera <b>Introduction:</b> Variations in sex steroid hormones, noticeable through the menstrual cycle of women, may impact periodontal health. A relationship between female sex hormone levels and periodontal changes during puberty, pregnancy, and menopause has been reported. Little research on gingival status at different periods of menstrual cycle, but very less work has been done to observe the effect of scaling on gingival status during different periods of menstrual cycle. <b>Materials and Methods:</b> Thirty female subjects, aged 18-25 years were selected for a three month study. In Stage 1, clinical parameters {Plaque Index (PI), Gingival Index (GI), Modified Sulcular Bleeding Index (mSBI) and Probing depth (PD)} were recorded at three different time intervals {OV (Ovulation), PM (Premenstruation), M (Menstruation)} of their menstrual cycle, without scaling and polishing. In Stage 2, all clinical parameters were recorded at their subsequent menstrual cycle after scaling and polishing. <b>Results:</b> In interstage analysis, OV 1 > OV 2, PM 1 > PM 2 and M 1> M 2. In intrastage analysis, for PI, mean difference between all values was not statistically significant. For mSBI, PM 1 > OV 1 > M 1, also PM 2 > OV 2 > M 2. For GI, PM 1 > OV 1 > M 1, also PM 2 > OV 2 > M 2. For PD, mean difference was not statistically significant. <b>Conclusion:</b> Ovarian hormones influence gingival status of females, with an increase observed primarily during PM and OV phases of menstrual cycle. Scaling leads to a subsequent decrease in gingival inflammation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ZC35-ZC39&id=6605 https://doi.org/10.7860/JCDR/2015/.6605 Diagnosis and Treatment of Symptomatic Carpal Bossing Hendryk Vieweg, Sebastian Radmer, Robert Fresow, Arash Mehdi Tabibzada, Peter Kamusella, Fabian Scheer, Reimer Andresen <b>Context:</b> Carpal bossing is an osseous formation at the dorsal portion of the quadrangular joint, which rarely becomes symptomatic. However, in some patients it causes pain, restricted mobility and can lead to complications like tendon rupture, inflammatory and degenerative joint disease. <b>Aim:</b> In this article, we present our experiences with this rare disorder in order to improve diagnostic and therapeutic proceedings. <b>Settings Design:</b> This is a multicenter and interdisciplinary observation made by orthopaedic surgeons and radiologists in the years 2010 to 2015. Retrospective observational study. The follow up period was 2 years. <b>Materials and Methods:</b> In the observed time period, eight patients were diagnosed with symptomatic carpal bossing. Symptoms were pain at palmar flexion and limited mobility of the wrist in combination with a palpable protuberance over the quadrangular joint. All patients underwent X-ray, CT and MRI examinations. A conservative treatment strategy was initiated for 6 weeks in all patients, followed by a wedge resection when symptoms were persisting and disabling. <b>Results:</b> After the conservative treatment schedule, five patients were asymptomatic. Three patients had persisting pain and were thus recommended for surgery. In the postoperative course, two patients were asymptomatic. One patient developed a type 1 complex regional pain syndrome (CRPS) in the first postoperative year, which was successfully treated with pain-adapted physiotherapy, pharmacotherapy with analgesics and calcitonin, and a triple CT-guided thoracic sympathetic nerve blockade. <b>Conclusion:</b> Carpal bossing is a mostly asymptomatic entity, which in our experience gets symptomatic due to direct trauma or repetitive stress, especially in competitive racket sports players. It can be diagnosed by thorough clinical examination and multimodal diagnostic imaging. Conservative treatment comprises an excellent prognosis, however surgery, either wedge resection or arthrodesis, must be considered if the response is not positive after 6 weeks. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=RC01-RC03&id=6606 https://doi.org/10.7860/JCDR/2015/.6606 Is Xanthine Oxidase, a Marker in Pre-eclampsia? A Case-Control Study Vanishree Bambrana, C.D.Dayanand, Pushpa P Kotur <b>Introduction:</b> Pre-eclampsia is an obstetrics problem that affects multiple systemic functions and leads to the increased maternal and fetal morbidity and mortality. The objective of the study was to evaluate the plasma levels of Xanthine oxidase (XO) activity, uric acid and Nitric oxide (NO) levels in women with pre-eclampsia and normal pregnancy during antenatal and postpartum period. <b>Materials and Methods:</b> A case control study was conducted in women with normal pregnancy (n=50) and pre-eclampsia (n=50) before and after delivery. XO activity, uric acid and NO levels were determined from samples at 30-39 weeks of gestation. The current study was conducted in association with Obstetrics and Gynecology Department of R.L. Jalappa Hospital and Research Center. The blood samples were analysed for assay of XO, uric acid and NO. The results were analysed by using SPSS software version 2013. P-value < 0.05 was considered as statistically significant. <b>Results:</b> The plasma XO activity was elevated (p<0.001) in the pre-eclampsia compared to normotensive pregnant women before delivery and decreased after delivery (p<0.001) significantly. Uric acid level showed a significant increase in pre-eclampsia when compared to the control before delivery (p<0.001) however values were non-significant after delivery. <b>Conclusion:</b> Placenta plays a key role in the pathophysiology of pre-eclampsia. Placenta removal leads to decrease trend of xanthine oxidase activity, uric acid and elevation of Nitric oxide as reversible changes in pre-eclampsia patients within 48 hours after delivery. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=BC01-BC03&id=6607 https://doi.org/10.7860/JCDR/2015/.6607 Optic Strut and Para–clinoid Region – Assessment by Multi–detector Computed Tomography with Multiplanar and 3 Dimensional Reconstructions K. Suprasanna, S.R. Ravikiran, Ashvini Kumar, Channabasappa chavadi, Sanyal Pulastya <b>Purpose:</b> To evaluate thickness, location and orientation of optic strut and anterior clinoid process and variations in paraclinoid region, solely based on multidetector computed tomography (MDCT) images with multiplanar (MPR) and 3 dimensional (3D) reconstructions, among Indian population. <b>Materials and Methods:</b> Ninety five CT scans of head and paranasal sinuses patients were retrospectively evaluated with MPR and 3D reconstructions to assess optic strut thickness, angle and location, variations like pneumatisation, carotico-clinoid foramen and inter-clinoid osseous ridge. <b>Results:</b> Mean optic strut thickness was 3.64mm (±0.64), optic strut angle was 42.67 (±6.16) degrees. Mean width and length of anterior clinoid process were 10.65mm (±0.79) and 11.20mm (±0.95) respectively. Optic strut attachment to sphenoid body was predominantly sulcal as in 52 cases (54.74%) and was most frequently attached to anterior 2/5th of anterior clinoid process, seen in 93 sides (48.95%). Pneumatisation of optic strut occurred in 23 sides. Carotico-clinoid foramen was observed in 42 cases (22.11%), complete foramen in 10 cases (5.26%), incomplete foramen in 24 cases (12.63%) and contact type in 8 cases (4.21%). Inter-clinoid osseous bridge was seen unilaterally in 4 cases. <b>Conclusion:</b> The study assesses morphometric features and anatomical variations of paraclinoid region using MDCT 3D and multiplanar reconstructions in Indian population. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=TC06-TC09&id=6615 https://doi.org/10.7860/JCDR/2015/.6615 Clinical Profile and Predictors of Outcomes in Older Inpatients with Pyelonephritis in a Tertiary Care Hospital in Southern India Gopinath Kango Gopal, Benny Paul Wilson, Surekha Viggeswarpu, Sowmya Sathyendra, Ramya Iyyadurai, Renuka Visvanathan, Kuruvilla Prasad Mathews <b>Background:</b> Pyelonephritis is a serious infection associated with significant morbidity and mortality in the elderly with an estimated annual incidence rate of around 10% from previous studies. Older people are at a higher risk for pyelonephritis due to multiple factors including structural, functional and co-existent conditions. There is very little data on the incidence, clinical features and outcomes among elderly patients with pyelonephritis in India. <b>Materials and Methods:</b> We performed a retrospective review of case records of 100 consecutive patients over the age of 60 years with pyelonephritis admitted to a tertiary care hospital. <b>Results:</b> One fourth of our patients (26%) did not have fever, 49% had delirium and 52% had systemic inflammatory response syndrome (SIRS). Sixty five percent of the patients were diabetic and 60% had infections caused by extended spectrum beta lactamase (ESBL) producing organisms. As in other studies, the commonest organism isolated was E.coli (49%). A low serum albumin level was a predictor of mortality (p<0.001) and increased length of hospital stay (p<0.005). Delirium was also associated with a poor outcome (p=0.009) in these patients. Patients with pyelonephritis secondary to ESBL producing organisms had a higher length of stay (p<0.005). <b>Conclusion:</b> Hypoalbuminemia and delirium predicted poor outcomes in our patients. We found a high prevalence of ESBL infections in this study. Further research is required to assess the efficacy of aggressive management of delirium and low albumin in improving health and cost outcomes. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=OC05-OC07&id=6616 https://doi.org/10.7860/JCDR/2015/.6616 Thyroidectomy Under Regional Anaesthesia: An ORL Perspective Santosh U. P, Prashanth K. B, Shamna J. Mohammed, Nivedeeta J. Pereira, Srijoy Gupta, Sumanth K. R, Triveni K. M <b>Background:</b> The use of regional anaesthesia as an effective alternative to general anaesthesia in thyroid surgeries is now being accepted in many parts of the world. In this day of computers and technology, there is an increased awareness among the people of the available options of anaesthesia and the adverse effects of general anaesthesia. They thus have an inclination to avoid general anaesthesia wherever feasible. This study dwells on the use of regional anaesthesia as an alternative tool that can be offered to the patients undergoing thyroidectomy. <b>Aims:</b> This study aims at analysing the effectiveness, safety, ease and patient acceptability of performing thyroidectomies under regional anaesthesia. <b>Settings and Design:</b> This prospective study was performed at a university – affiliated hospital. <b>Materials and Methods:</b> Twenty nine patients who underwent thyroidectomy for benign thyroid diseases under regional anaesthesia were included in this study: 20 patients under deep cervical plexus block and 9 patients under cervical epidural anaesthesia. <b>Statistical analysis used:</b> Z-test and validity test. <b>Results:</b> In our study, all the 29 patients who underwent thyroidectomy under regional anaesthesia found the anaesthesia effective and were comfortable throughout the procedure. The surgeon too was at ease while performing the surgery. No complications were recorded. <b>Conclusion:</b> In our present study, regional anaesthesia (Cervical epidural anaesthesia and Cervical plexus block) has been used safely and effectively in 29 thyroid surgeries. We conclude that although regional anaesthesia has been reserved for high risk thyroidectomies it may be offered as effective alternative to general anaesthesia even in routine thyroid surgeries. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=MC01-MC04&id=6617 https://doi.org/10.7860/JCDR/2015/.6617 Prevalence of Co-existing Endometrial Carcinoma in Patients with Preoperative Diagnosis of Endometrial Hyperplasia Pinar Kadirogullari, Cemal Resat Atalay, Ozhan Ozdemir, Mustafa Erkan Sari <b>Introduction:</b> Endometrial hyperplasia has been associated with the presence of concomitant endometrial carcinoma. In this study, patients who were diagnosed with endometrial hyperplasia and had hysterectomy, determination of the incidence of endometrial cancer accompanying postoperatively and clinical parameters associated with cancer are aimed. <b>Materials and Methods:</b> Endometrial biopsies were taken from patients for various reasons and among them 158 patients diagnosed with endometrial hyperplasia from pathologic examination results were retrospectively evaluated. All of the patient’s age, parity, weight, transvaginal ultrasound measured by endometrial thickness, concomitant systemic disease (diabetes, hypertension, hypothyroidism), tamoxifen use, hormone use and whether in reproductive age or menopause were all questioned. Patients who applied with endometrial cancer, their cervical stromal involvement, lymph node involvement, cytology positivity and omental metastases were examined. Patients were classified according to their stage and grade. Patients who had intraoperative frozen were re-evaluated. <b>Results:</b> Fifteen cases with preoperative endometrial hyperplasia diagnosed with endometrial cancer postoperatively, 2 cases had complex hyperplasia without atypia and 13 cases had complex atypical hyperplasia. The rate of preoperative hyperplasia with postoperative endometrial cancer was found to be 10.8% where by 15 cases of patients diagnosed with endometrial cancer postoperatively 11 cases were in postmenopausal period. In patients diagnosed with endometrial cancer according to their histologic types 14 cases had endometrioid adenocarcinoma while one patient with preoperative complex hyperplasia without atypia was diagnosed with serous papillary carcinoma postoperatively. Evaluation of stages in patients diagnosed with cancer, 7 cases of patients had stage IA, 7 cases of patients had stage IB, and 7 cases cases of patients with serous papillary carcinoma were evaluated as stage 3C. <b>Conclusion:</b> The risk of endometrial cancer in patients diagnosed with endometrial hyperplasia especially endometrial hyperplasia ranges between 15% to 45% and among them 7.9%–51% are found to have myometrial inversion. Therefore, preoperative ultrasound and magnetic resonance imaging should be perfomed in patients diagnosed with complex atypical hyperplasia. Even intraoperative frozen section examination can provide useful information in selected cases. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=QC10-QC14&id=6618 https://doi.org/10.7860/JCDR/2015/.6618 Assessment of the Potential of CFC (Calcium hydroxide Flagyl Ciprofloxacin) for the Rapid Disinfection of Resilon and Gutta-Percha Mariam Omer Bin Hamza, Khalid Gufran, Kusai Baroudi <b>Introduction:</b> Obturating materials exposed to the dental operating environment has been shown to be contaminated, making rapid chair side disinfection mandatory to ensure the sterility of the root canals. Objective: The purpose of this study was to investigate the effectiveness of CFC (combination of Calcium hydroxide, Flagyl and Ciprofloxacin) for the rapid disinfection of Gutta-percha and Resilon cones. <b>Materials and Methods:</b> Seventy new Gutta-percha and Resilon cones were randomly selected, contaminated with Enterococcus faecalis and divided into 4 group according to the irrigant used for disinfection {Group I: 5.25% Sodium Hypochlorite (NaOCl), Group II: MTAD, Group III: 2% Chlorhexidine (CHX), Group IV: CFC (a combination of Calcium hydroxide, Flagyl and Ciprofloxacin)}. All the samples were placed in a centrifuge tube with BHI broth after being washed with sterile water. The samples were then incubated for 7 days at 37oC. Samples were randomly plated on Mac Conkey agar plate and the colony count was recorded and the observations were drawn. <b>Results:</b> A 5.25% NaOCl required 1 minute exposure for effective disinfection of all the samples. MTAD could eliminate E.faecalis from gutta-percha samples in 30 seconds whereas it required 1 minute of exposure for Resilon cones. Both 2% CHX and CFC could not disinfect the samples with 1 minute exposure and a minimum of 5 minute exposure was required. <b>Conclusion:</b> A 5.25% NaOCl and Biopure MTAD required less chair side time to disinfect all the samples effectively when compared with 2% CHX and CFC. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ZC40-ZC43&id=6619 https://doi.org/10.7860/JCDR/2015/.6619 Analysis of Vascular Access in Haemodialysis Patients - Single Center Experience R. Hemachandar <b>Background:</b> Vascular access is the key in successful management of chronic haemodialysis (HD) patients. Though native arteriovenous fistula (AVF) is considered the access of choice, many patients in our country initiate haemodialysis through central venous catheter (CVC). There is paucity of data on vascular access in haemodialysis patients from southern India. <b>Aim:</b> Aim of the present study was to review our experience of vascular access in Haemodialysis patients (both central venous catheters and arteriovenous fistula) and to assess its success rate and common complications. <b>Materials and Methods:</b> This prospective study was conducted between January 2014 and December 2014 in our institute. A total of 50 patients with Chronic Kidney Disease (CKD) underwent vascular access intervention during the above period. <b>Results:</b> A temporary venous catheter (96%) in the right internal jugular vein was the most common mode of initiation of haemodialysis with 34.48% incidence of catheter related sepsis. Fifty percent of catheters were removed electively with mean duration of catheter survival of 77.23 ± 14.8 days. Wrist AVF (60%) was the most common site of AVF creation followed by arm (30%), mid-forearm (7.5%) and leg (2.5%). Complications include distal oedema (17.5%) and venous hypertension (2.5%). Primary failure occurred in 25% of patients and was more common in diabetic, elderly (>60 years) and in distal fistulas. Elderly patients (>60 years) starting dialysis with a CVC were more likely to be CVC dependent at 90 days. <b>Conclusion:</b> Late presentation and delayed diagnosis of chronic kidney disease (CKD) necessitates dialysis initiation through temporary catheter. Dialysis catheter with its attendant complications further adds to the morbidity, mortality, health care burden and costs. Early nephrology referral and permanent access creation in the pre dialysis stage could avert the unnecessary complications and costs of catheter. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=OC01-OC04&id=6611 https://doi.org/10.7860/JCDR/2015/.6611 Expectant Versus Surgical Management of Early Pregnancy Miscarriages- A Prospective Study Reshma Sajan, Mumtaz Pulikkathodi, Abdul Vahab, Valsan Mankara Kunjitty, Hassan Sheikh Imrana <b>Background:</b> Surgical, medical and expectant management are the various options available to manage early pregnancy miscarriages; each with its own merits and demerits. In the last two decades, the efficacy and safety of expectant management which allows for the spontaneous passage of retained products of conception has been studied and confirmed. <b>Aim:</b> To compare the safety and efficacy of expectant management of early pregnancy miscarriages with surgical uterine evacuation. <b>Materials and Methods :</b> The prospective study conducted in tertiary care centre for 5 years, included 212 patients with USG confirmed pregnancy miscarriages of less than 13 weeks, who were allocated to expectant management (Cases, n=112) and surgical evacuation (Control, n=100). Patients were allocated for expectant management as outpatients for 2 weeks, without any intervention till they had spontaneous complete miscarriage which was confirmed by sonography. Those who failed to do so, underwent a planned surgical uterine evacuation. Emergency admission and evacuation was done, if the patients became symptomatic in the waiting period. Patients allocated to surgical group underwent planned surgical evacuation once diagnosed. Success rate and complications like emergency evacuation, vaginal bleeding, abdominal pain, limitation of physical activity and patient satisfaction were assessed. Both groups were followed up for 6 more weeks. Statistical analysis was done with Z-test. <b>Results:</b> Success rate of the expectant management was 71% as against 97% in surgical group. Severe vaginal bleeding was comparable (5% in both groups), 8% of expectant had severe abdominal pain versus 4% in surgical group. Unplanned admissions and emergency evacuation rate was high in expectant 9% against 1% in surgical group. Twenty one percent patients in expectant and 17% patients in surgical group experienced limitation of physical activity. Overall patient satisfaction rate was comparable (74% in expectant 80% in surgical group). <b>Conclusion:</b> Expectant management of miscarriages has a success rate of 71%. Compared to surgical management, abdominal pain, unplanned admissions, emergency evacuation and limitation of physical activity were more in expectant group. Success rate can be improved and complications can be minimised with proper patient selection and counseling. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=QC06-QC09&id=6613 https://doi.org/10.7860/JCDR/2015/.6613 Modified External Dacryocystorhinostomy in Primary Acquired Nasolacrimal Duct Obstruction Hans Raj Sharma, Ashok K. Sharma, Rajni Sharma <b>Background:</b> Epiphora secondary to acquired nasolacrimal duct obstruction is a common ophthalmic problem in adults requiring surgical management. External dacryocystorhinostomy (DCR) is a reliable but difficult surgical technique for the treatment of nasolacrimal duct obstruction. <b>Purpose:</b> To evaluate the success rate and complications of modified external DCR in patients with primary acquired nasolacrimal duct obstruction. <b>Materials and Methods:</b> This hospital based prospective interventional study included 56 patients with primary acquired nasolacrimal duct obstruction. Diagnosis of nasolacrimal duct obstruction was made through irrigation of the nasolacrimal drainage system. All patients were operated by modified technique of external DCR with anastomosis of the anterior lacrimal and nasal mucosal flaps only, whereas posterior mucosal flaps were excised. Patients were followed up for a period of 6 months. During the follow up, success rate and complications if any were recorded. Success was defined objectively by a patent lacrimal passage on irrigation and subjectively by the absence of watering or discharge. Results: The mean age of the study population was 39.23 ± 10.66 years, and 78.6% of patients were females (male to female ratio 1:3.7). The average operation time was 36.48 ± 4.72 minutes. Objective and subjective success rates were 92.9% and 89.3%, respectively after a follow up period of 6 months. Intraoperatively, haemorrhage occurred in 3 patients (5.3%) and laceration of the nasal mucosa in 4 patients (7.1%). Postoperative complications included significant lid swelling and periorbital ecchymosis in 3 patients (5.3%), epistaxis in 2 patients (3.6%) and hypertrophic scar in 2 patients (3.6%). <b>Conclusion:</b> These results suggest that modified external DCR with anterior flaps anastomosis only is a simple, safe, less time consuming surgical technique that is easy to perform, and the outcome is comparable to conventional DCR. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=NC01-NC05&id=6624 https://doi.org/10.7860/JCDR/2015/.6624 Methicillin Resistant Staphylococcus aureus: Inconsistencies in Vancomycin Susceptibility Testing Methods, Limitations and Advantages of each Method Himani, Charu Agrawal, Molly Madan, Anita Pandey, Bhaskar Thakuria <b>Background:</b> Vancomycin may be ineffective against an increasing proportion of methicillin resistant Staphylococcus aureus (MRSA) with minimum inhibitory concentrations (MICs) well within the susceptible range. On the other hand it is common knowledge that determination of vancomycin MICs is method dependent. Therefore, given the apparent variability in vancomycin MIC results obtained with the different methods, the use of the vancomycin MIC to predict the outcome of serious S. aureus infections needs to take into account the method used and the results of studies using that particular method. <b>Aim:</b> Comparative study was carried out to evaluate the MICs obtained by BMD method, E-test, and Vitek 2 method and to detect inconsistencies in these vancomycin for 66 MRSA isolates obtained from various samples of patients attending the OPDs & IPDs within a period of one year. <b>Materials and Methods:</b> A comparative study was carried out to evaluate the MICs obtained by BMD method, E-test, and Vitek 2 method to detect vancomycin susceptibility in 66 clinical isolates of MRSA obtained from various samples of patients attending the OPDs & IPDs within a period of one year. The study was conducted in Department of Microbiology, Subharti Medical College, Meerut from January to December 2012. <b>Results:</b> On determination of MICs for vancomycin for the MRSA isolates, all were identified as VSSA by BMD, E-Test & Vitek 2 methods. However, the vancomycin MIC values obtained by E-test correlated better with BMD method (correlation factor= 0.6727) than Vitek 2 (correlation factor=0.5316), indicating E-Test to be a better method for determination of vancomycin MICs as compared to Vitek 2. <b>Conclusion:</b> MRSA isolates with higher vancomycin MICs, even within the susceptibility range, are being observed more frequently which result in treatment failures with vancomycin. Because of the discrepancy that exists in vancomycin MIC results from different methods, the prediction of outcome of serious S.aureus infections should take into account the m https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=DC01-DC04&id=6625 https://doi.org/10.7860/JCDR/2015/.6625 Comparison of Antimicrobial Efficacy of Triclosan- Containing, Herbal and Homeopathy Toothpastes- An Invitro Study Basu Anushree, Mohammed Alimullah Fawaz, Rao Narahari, Tanveer Shahela, Afroz Syed <b>Background:</b> Use of antimicrobial agents is one of the important strategies to prevent oral diseases. These agents vary in their abilities to deliver preventive and therapeutic benefits. Objectives: This invitro study was conducted to assess antimicrobial efficacy of different toothpastes against various oral pathogens. <b>Materials and Methods:</b> A total of nine toothpastes in three groups were tested for their antimicrobial activity against Escherichia coli (ATCC 25922), Staphylococcus aureus (ATCC 25923), Streptococcus mutans (ATCC 0266P) and Candida albicans (Laboratory Strain) by modified agar well diffusion method. Statistical Analysis was performed using Minitab Software. A p-value of less than 0.05 was considered significant. <b>Results:</b> Triclosan-based dental formulation with combination of fluoride (1000ppm) exhibited higher antimicrobial activity against test organisms than the combination of lower fluoride-concentration or sodium monofluorophosphate. Among herbal dentifrices, formulation containing Neem, Pudina, Long, Babool, Turmeric and Vajradanti showed significant antimicrobial activity against all the four tested microorganisms (p<0.05). However, against Streptococcus mutans, all three herbal products showed significant antimicrobial activity. Homeo products showed least antimicrobial activity on the tested strains. Formulation with kreosotum, Plantago major and calendula was significantly effective only against Streptococcus mutans. <b>Conclusion:</b> In the present study, antimicrobial activity of the toothpaste containing both triclosan and fluoride (1000ppm) as active ingredients showed a significant difference (p< 0.05) against all four tested microflora compared to that of with lower fluoride-concentration or sodium monofluorophosphate. Of herbal groups, the only dentifrice containing several phytochemicals was found to be significantly effective and comparable to triclosan-fluoride (1000ppm) formulation. Thus, this herbal toothpaste can be used as alternative to triclosan-based formulations. However, these results might not be clinically useful unless tested invivo. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=DC05-DC08&id=6626 https://doi.org/10.7860/JCDR/2015/.6626 Early Menopause in Type 2 Diabetes – A Study from a South Indian Tertiary Care Centre T.V.D. Sasi Sekhar, Soumya Medarametla, Arifa Rahman, Satya Sahi Adapa <b>Introduction:</b> Menopause marks the end of ovarian function and it is called ‘early’ or ‘premature’ if it occurs before 45 years. Very little is known about the menopause transition in Diabetic women. Metabolic disorders like diabetes will accelerate the reproductive ageing and determine premature ovarian failure by various mechanisms. Early menopause along with diabetes has a synergistic effect over the incidence of cardiovascular diseases and other illnesses. There is no data regarding menopausal age in Indian population. Hence, present study was aimed at understanding the age of menopause in diabetic Indian women. <b>Materials and Methods:</b> This study was carried out at a tertiary care, teaching hospital in Southern India. Post-menopausal women who attended the Department of Medicine during August 2013 to August 2014, were included in the study. Six hundred patients were recruited by a systematic random sampling, 300 diabetic and 300 non-diabetic after obtaining their consents. They were all non-smokers, took mixed diet and other somatometric variables were similar in both the groups. <b>Results:</b> Average age of menopause among diabetic women was 44.65 years which is much earlier than the menopause in non-diabetic women (48.2 years). Out of the 600 women, 212 women had an early menopause (<45 yrs.). Among them, 54 were non-diabetic and 158 were diabetic. Present study also revealed a higher BMI among the diabetics than the non-diabetic women. This may be due to the changes in body composition and increase in abdominal fat after menopause. This change is more in diabetics due to the disturbances in insulin sensitivity and glucose metabolism. <b>Conclusion:</b> The present study confirms that Type 2 Diabetes increases the risk of early menopause. The study reinforces the importance of early diagnosis and treatment of diabetes for a long term well being of a woman. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=OC08-OC10&id=6628 https://doi.org/10.7860/JCDR/2015/.6628 Acute Poisonings Admitted to a Tertiary Level Intensive Care Unit in Northern India: Patient Profile and Outcomes Hemani Ahuja, Ashu Sara Mathai, Aman Pannu, Rohit Arora <b>Background:</b> Poisoning is becoming a real health care burden for developing countries like India. An improved knowledge of the patterns of poisonings, as well as the clinical course and outcomes of these cases can help to formulate better preventive and management strategies. Aim: To study the demographic and clinical profiles of patients admitted to the ICU with acute poisoning and to study the factors that predict their mortality. <b>Materials and Methods:</b> Retrospective two years (September 1, 2010 to August 31, 2012) study of all consecutive patients admitted to the Intensive Care Unit (ICU) with acute poisoning at a tertiary care hospital in Northern India. <b>Results:</b> Out of the 67 patients admitted to the ICU during the study period, the majority were young (median age 29 years) males (69%) who had consumed poison intentionally. Pesticides were the most commonly employed poison, notably organophosphorus compounds (22 patients, 32.8%) and aluminium phosphide (14 patients, 20.9%). While the overall mortality from all poisonings was low (18%), aluminium phosphide was highly toxic, with a mortality rate of 35%. The factors at ICU admission that were found to be associated with a significant risk of death were, high APACHE II and SOFA scores (p =0.0001 and p=0.006, respectively), as well as the need for mechanical ventilation and drugs for vasoactive support (p=0.012 and p= 0.0001, respectively). <b>Conclusion:</b> Use of pesticides for intentional poisoning continues to be rampant in Northern India, with many patients presenting in a critical condition to tertiary level hospitals. Pesticide regulations laws, educational awareness, counseling and poison information centers will help to curtail this public health problem. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=UC01-UC04&id=6632 https://doi.org/10.7860/JCDR/2015/.6632 Major Delays in the Diagnosis and Management of Tuberculosis Patients in Nepal Roshan Kumar Mahato, Wongsa Laohasiriwong, Kriangsak Vaeteewootacharn, Rajendra Koju, Ratna Bhattarai <b>Background:</b> Early diagnosis is a determining factor for spread of tuberculosis. Delay in diagnosis and treatment of tuberculosis geometrically increases spread and infectivity of the disease and is associated with higher risk of mortality. <b>Aim:</b> The present study aimed to investigate the length of delays in diagnosis and treatment among new pulmonary tuberculosis patients in central development region of Nepal. Materials and Methods: A cross-sectional study was conducted by administration of structured questionnaire interview and reviewing the medical records of the new sputum smear positive pulmonary tuberculosis cases during January–May 2015. Simple random sampling was applied to select samples from 5 districts of 19 districts comprising at least one each from 3 ecological regions of Nepal. <b>Results:</b> A total of 374 new sputum smear positive pulmonary tuberculosis cases were included in the study. The median patient delay, health system delay, and total delay were 32 days, 3 days and 39.5 days respectively. The unacceptable patients delay was 53.21% (95% CI: 48.12-58.29) of all new patients, whereas it was 26.74% (95% CI: 22.23-31.24) for the unacceptable health system delay and the unacceptable total delay was 62.83% (95% CI: 57.91-67.75). <b>Conclusion:</b> TB diagnosis and treatment is still a significant problem of Nepal. Majority of unacceptable delays were from patients. Identifying factors influencing delays and developing evidence-based approaches to address those delays will help in advancing tuberculosis prevention and management in low-income settings. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=LC05-LC09&id=6633 https://doi.org/10.7860/JCDR/2015/.6633 Current Clinical Practice Scenario of Osteoporosis Management in India Shailesh Jhaveri, Tejas Upashani, Jitendra Bhadauria, Swati Biswas, Kamlesh Patel <b>Background:</b> Various osteoporosis guidelines are available for practice. Aim: To understand the current clinical practice scenario from the perspective of Indian orthopaedicians, especially about the epidemiology, clinical manifestations, approach to diagnosis and management and patient compliance patterns to long term treatment. <b>Materials and Methods:</b> A pre-validated structured questionnaire containing questions (mostly objective, some open-ended) catering to various objectives of the study was circulated amongst orthopaedic surgeons across India by means of post/courier, after giving a brief overview of the study telephonically. Data was extracted from the completed questionnaires, and analysed using Microsoft Excel software. <b>Results:</b> The questionnaire was filled by a total of 84 orthopaedicians throughout India. The prevalence of osteoporosis in India according to the orthopaedic surgeons was 38.4% and there was a female preponderance. Most of the respondents felt out of every 100 osteoporosis patients in India, less than 20 patients are actually diagnosed and treated for osteoporosis. The most common initial presenting feature of established osteoporosis cases was general symptoms. Most respondents preferred Dual-energy X-ray absorptiometry (DEXA) as the initial investigation for the diagnosis of osteoporosis in a patient presenting with typical features. While most respondents preferred once-a-month oral over intravenous (IV) bisphosphonates, they agreed that IV administration had advantages such as lower gastrointestinal side effects and improved compliance. The average duration of therapy of oral bisphosphonates was the longest (27.04 months) among the other anti- osteoporosis therapies that they used. On an average, the patient compliance rate in osteoporosis management was around 64%. IV Zoledronic acid (ZA) and intranasal calcitonin were infrequently used than other anti- osteoporosis therapies. While concerns about cost and availability deterred more frequent usage, there was an agreement that if used regularly these two agents may improve compliance rates among patients. <b>Conclusion:</b> Current clinical practice scenario of osteoporosis management in India largely adheres to various clinical practice guidelines for osteoporosis. Side effects and lengthy duration of therapy with bisphosphonates seem to be the main factors leading to a low patient compliance. Widespread popularization of once-yearly Zoledronic acid and intranasal calcitonin spray may improve patient compliance and reduce side effect incidence. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=RC04-RC08&id=6635 https://doi.org/10.7860/JCDR/2015/.6635 Study of the Continuous Improvement Trend for Health, Safety and Environmental Indicators, after Establishment of Integrated Management System (IMS) in a Pharmaceutical Industry in Iran Pegah Mariouryad, Farideh Golbabaei, Parvin Nasiri, Iraj Mohammadfam, Hossein Marioryad <b>Background:</b> Nowadays, organizations try to improve their services and consequently adopt management systems and standards which have become key parts in various industries. One of these management systems which have been noticed in the recent years is Integrated Management System that is the combination of quality, health, safety and environment management systems. <b>Aim:</b> This study was conducted with the aim of evaluating the improvement trend after establishment of integrated management system for health, safety and environment indicators, in a pharmaceutical industry in Iran. <b>Materials and Methods:</b> First, during several inspections in different parts of the industry, indicators that should have been noted were listed and then these indicators were organized in 3 domains of health, safety and environment in the form of a questionnaire that followed Likert method of scaling. Also, the weight of each index was resulted from averaging out of 30 managers and the viewpoints of the related experts in the field. Moreover, by checking the documents and evidence of different years (5 contemplation years of this study), the score of each indicator was determined by multiplying the weight and score of the indices and were finally analysed. <b>Results:</b> Over 5 years, scores of health scope indicators, increased from 161.99 to 202.23. Score in the first year after applying the integrated management system establishment was 172.37 in safety part and in the final year increased to 197.57. The changes of environmental scope rates, from the beginning of the program up to the last year increased from 49.24 to 64.27. <b>Conclusion:</b> Integrated management systems help organizations to improve programs to achieve their objectives. Although in this study all trends of health, safety and environmental indicator changes were positive, but at the same time showed to be slow. So, one can suggest that the result of an annual evaluation should be applied in planning future activities for the years ahead. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=LC18-LC20&id=6700 https://doi.org/10.7860/JCDR/2015/.6700 The Comparative Evaluation of Patient’s Satisfaction and Comfort Level by Diode Laser and Scalpel in the Management of Mucogingival Anomalies Rajesh Kumar, Garima Jain, Shrikant Vishnu Dhodapkar, Kanteshwari I.K., Gagan Jaiswawal <b>Background:</b> Surgical correction of mucogingival anomalies is required to enhance patient’s compatibility to maintain oral hygiene or to improve facial aesthetics or both. Laser has become a desirable and dependable alternative for traditional surgical techniques because it is simple and painless with more predictable outcomes. <b>Aim:</b> The aim of this study was to compare the effects of the conventional scalpel technique and the laser technique on the degree of discomfort, satisfaction, healing and postoperative pain experienced by patients after correction of mucogingival anomalies. <b>Materials and Methods:</b> In the present study 70 patients were enrolled and randomly distributed in two groups i.e. surgical correction of mucogingival anomalies by scalpel and by laser. Patient’s comfort level, pain and satisfaction level was assessed by using Visual analogue scale (VAS) and healing was evaluated by healing index. <b>Results:</b> The results indicated patients treated with the diode laser had less postoperative pain and discomfort with remarkable satisfactory results and healing compared to patients treated with the conventional technique. <b>Conclusion:</b> Laser is a desirable therapeutic alternative to correct soft tissue anomalies. It allows good control of haemorrhage with comfortable healing phase and appreciable satisfactory outcomes. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ZC56-ZC58&id=6659 https://doi.org/10.7860/JCDR/2015/.6659 Prevalence and Association of Developmental Defects of Enamel with, Dental- Caries and Nutritional Status in Pre-School Children, Lucknow Pramod Kumar Yadav, Sabyasachi Saha, G.V.Jagannath, Sanjay Singh <b>Background:</b> Developmental Defects of Enamel in the primary dentition may be associated and predictors of dental caries and nutritional status. The aim of the present study was to assess the Prevalence of Developmental Defects of Enamel and its Association with, Dental-Caries and Nutritional Status in Pre-School Children of Lucknow, India. <b>Materials and Methods:</b> Multistage Sampling was done. A total of 302 pre-school (Rural and Urban) children were examined. Type III examination was conducted with WHO Probe. Developmental Enamel Defects (DED) and Dental Caries were assessed using WHO (1997) Proforma. <b>Results:</b> The prevalence of DED of any type was 39.9% with that of demarcated opacities being the highest, followed by hypoplasia. The most frequently affected teeth were maxillary anterior teeth, while the least affected teeth were mandibular incisors. The mean dmft was 3.5. A positive association between DED and caries was observed. Association between Dental Caries & BMI was non-significant whereas Pearson correlation showed a negative correlation between the two. <b>Conclusion:</b> The prevalence of enamel defects and caries was high, as the enamel defects were strongly associated with caries. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ZC71-ZC74&id=6681 https://doi.org/10.7860/JCDR/2015/.6681 Quality of Life Perspective Towards Acne among Adolescents at Tertiary Care Center of Gujarat, India Pragya Ashok Nair, Ashok Raman Nair <b>Introduction:</b> Acne is the most common disease of skin affecting adolescents, which can have a significant psychological impact leading to anxiety and depression. <b>Aims:</b> Study was undertaken to see the impact of acne on the Quality of life <b>Materials and Methods:</b> The study was conducted from March 2012 to February 2013, in the age group 14–25, using a validated self-administered questionnaire The questions were evaluated using 4 point Likert scale (0–3). <b>Statistical Analysis:</b> Statistical calculations were done using Excel 2010 and Statgraphics Centurion XVI.I. <b>Results:</b> Among 869 participants, 608(69.97%) had acne while 261 (30.03%) had no acne. Of acne sufferers 43.75% were males and 56.25% were females with maximum 67.93% in the age group 18–21. Of Non-acne participants 57.09% considered acne as a problem and 54.02% were disturbed by the idea of having acne. Study showed p-values<0.05 indicating statistically significant non-zero correlations at 95.0% confidence level. <b>Conclusion:</b> The quality of life scale of acne varies according to individual perception and differs from population to population. Questionnaire evaluation is a useful tool, but cannot replace proper psychological assessment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=WC01-WC04&id=6683 https://doi.org/10.7860/JCDR/2015/.6683 Heart-Type Fatty Acid Binding Protein: A Better Cardiac Biomarker than CK-MB and Myoglobin in the Early Diagnosis of Acute Myocardial Infarction Anand K Pyati, Basa varaj B Devaranavadagi, Sanjeev L Sajjannar, Shas hikant V Nikam, Mohd Shannawaz, Sudharani <b>Background:</b> Early diagnosis and therapeutic intervention can improve the outcome of acute myocardial infarction (AMI). However, there are no satisfactory cardiac biomarkers for the diagnosis of AMI within 6 hours of onset of symptoms. Among novel biochemical markers of AMI, heart-type fatty acid binding protein (H-FABP) is of particular interest. <b>Aim:</b> To compare the diagnostic value of H-FABP with that of CK-MB and myoglobin in suspected AMI patients within first 6 hours after the onset of symptoms. <b>Settings and Design:</b> The study includes 40 AMI cases and 40 non-cardiac chest pain otherwise healthy controls. The cases and controls were further divided into 2 groups depending on the time since chest pain as those subjects within 3 hours and those between 3-6 hours of onset of chest pain. <b>Materials and Methods:</b> In all the cases and controls, serum H-FABP, CK-MB and myoglobin concentrations were measured by Immunoturbidimetric method, immuno-inhibition method and Chemiluminescence immunoassay respectively. <b>Statistical Analysis:</b> Data is presented as mean ± SD values. Differences between means of two groups were assessed by Student t-test. Sensitivity, Specificity, Positive predictive value, Negative predictive values were calculated and ROC curve analysis was done to assess the diagnostic validity of each study parameter. <b>Results:</b> The sensitivity, specificity, PPV, NPV of H-FABP were greater than CK-MB and myoglobin and ROC curve analysis demonstrated highest area under curve for H-FABP followed by myoglobin and CK-MB in patients with suspected AMI both within 3 hours and 3-6 hours after the onset of chest pain. <b>Conclusion:</b> The diagnostic efficiency of H-FABP is greater than CK-MB and myoglobin for the early diagnosis of AMI within first 6 hours of chest pain. H-FABP can be used as an additional diagnostic tool for the early diagnosis of AMI. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=BC08-BC11&id=6684 https://doi.org/10.7860/JCDR/2015/.6684 Imaging Patterns in MRI in Recent Bone Injuries Following Negative or Inconclusive Plain Radiographs Raghu Teja Sadineni, Ashirwad Pasumarthy, Narayan Chander Bellapa, Sandeep Velicheti <b>Background:</b> Few bony injuries and most soft tissue injuries cannot be detected on plain radiography. Magnetic resonance imaging (MRI) can detect such occult bony injuries due to signal changes in bone marrow. In addition to excluding serious bony injuries, it can also identify tendon, ligament, cartilage and other soft tissue injuries and thus help in localizing the cause of morbidity. <b>Aims and Objectives:</b> To determine the MRI imaging patterns in recent bone injuries (less than 4 weeks) following negative or inconclusive plain radiographs. To determine the role of MRI in recent fractures. <b>Results:</b> Out of the 75 individuals with history of recent injury of less than 4 weeks duration, fracture line was demonstrated in 16 patients (21%) who had no obvious evidence of bone injury on plain radiographs. Bone contusion or bruising of the bone was demonstrated in 39 (52%) patients. This was the commonest abnormality detected in MRI. The remaining 20 patients did not show any obvious injury to the bone on MR imaging however, soft tissue injury could be demonstrated in 12 (16%) patients which show that the extent of soft tissue injury was relatively well demonstrated by MR imaging. The present study showed that occult injuries commonly occur at the Knee followed by Ankle, Wrist, Foot, Elbow, Leg, Hands, Hips & Spine. <b>Conclusion:</b> The study showed that MR is efficient in the detection of occult bone injuries which are missed on radiography. Compared to radiographs, MRI clearly depicted the extent of injuries and associated soft tissue involvement. MRI demonstrates both acute and chronic injuries and also differentiates both, whereas radiography has poor sensitivity for acute injuries. Also, the soft tissue injuries like tendionous and ligamentous injuries cannot be identified on radiographs. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=TC10-TC13&id=6685 https://doi.org/10.7860/JCDR/2015/.6685 Effectiveness of Various Sensory Input Methods in Dental Health Education Among Blind Children- A Comparative Study Aruna Kumari Ganapathi, Srinivas Namineni, Phani Himaja Vaaka, Vamsilatha K, Rupali Das, Maruti Devi, Anitha Akkaloori, Aravind Kumbakonam <b>Aim:</b> The aim of the study is to evaluate effectiveness of various sensory input methods in dental health education among blind children. Oral hygiene status was assessed through visible plaque index and oral hygiene knowledge was assessed through questionnaire before and after oral health education. <b>Materials and Methods:</b> The study involved of 200 blind children with the age range of 8 to 14 years of both genders from two blind schools similar in standard of teaching. The total study population (n=200) was randomized and divided into five Groups, comprising of 40 children in each Group. The first four were the experimental Groups who received dental health education through different modes, while the fifth Group served as control. Oral health related knowledge and plaque scores were assessed in all the study Groups before and after dental health education. <b>Results:</b> After intervention, the mean knowledge scores and plaque scores were statistically significant in all the study Groups when compared to the baseline scores. <b>Conclusion:</b> The present study proved that blind children can maintain an acceptable level of oral hygiene when taught with special customized methods like multisensory approach with creative use of other senses which was found to be effective than unisensory method. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ZC75-ZC78&id=6686 https://doi.org/10.7860/JCDR/2015/.6686 Clinical Evaluation of Correlation Between Diabetic Retinopathy with Modifiable, Non-Modifiable and Other Independent Risk Factors in Tertiary Set-up in Central Rural India Anjali P. Shrote, Sachin Diagavane <b>Introduction:</b> Diabetes mellitus and its related ocular complication like diabetic retinopathy (DR) are showing increased prevalence in India, but the magnitude of presence and progression of DR in central rural population and its relation to certain variables requires further exploration. Aim: To study the demographic profile on diabetic retinopathy and the association between different risk factors of diabetic retinopathy with its onset and severity. <b>Materials and Methods:</b> A cross-sectional study was carried out on patients suffering from diabetes mellitus (n=100) admitted to AVBRH, Sawangi (Meghe) in a duration of 2 months from April to June 2014. Snellen’s chart, slit lamp, and indirect ophthalmoscope were used for ocular examination of all patients. Comprehensive examination was used for risk factor assessment. <b>Statistical Analysis:</b> All data was entered into the proforma. Chi-square test, Student’s unpaired t-test and one way ANOVA using SPSS 17.0 and Graph Pad Prism 5.0. (p<0.05 was considered significant). R esults: The study showed that among all the diabetics (mean age 56.4+11.2 years), 68% were males and 97% type 2 diabetics. This study showed statistically significant association between serum triglyceride (p=0.0003), duration since diagnosis of diabetes mellitus (p=0.0006), serum total cholesterol (p=0.0021), FBG (p=0.003), serum HDL (p=0.012) and hypertension (p=0.045) with presence of diabetic retinopathy. The study also revealed that serum triglycerides (p=0.001), serum total cholesterol (p=0.006), BMI (p=0.04) and duration of diabetes (p=0.04) are the only factors which showed significant association with the severity of diabetic retinopathy. <b>Conclusion:</b> Effective screening strategies for early detection of both diabetes and diabetic retinopathy should be formulated especially for the rural population which is not aware about the various complications of diabetes and their final outcomes. Diabetics should follow proper guidelines to prevent or delay progression of DR. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=NC10-NC14&id=6689 https://doi.org/10.7860/JCDR/2015/.6689 Candiduria in Catheter Associated Urinary Tract Infection with Special Reference to Biofilm Production Mythreyi Shekar Rishpana, Jyoti S Kabbin <b>Introduction:</b> Urinary tract infections as a result of Candida species are becoming increasingly common in hospital settings. The association is higher in patients with prolonged urinary catheterization and also various pre-disposing factors. <b>Aim:</b> This study was done to look into the significance of candiduria in the catheterized patients and to perform microbial catheterization of yeast and biofilm detection by tube method to guide treatment protocol. <b>Materials and Methods:</b> This is a prospective study. One hundred urine samples were collected over a period of 3 months. Specimens included were those of patients presenting with nosocomial Urinary tract infection (UTI) after 72 hours of hospitalization. The urine samples obtained were immediately processed in microbiology laboratory by semi-quantitative method as per standard protocol. All yeast isolates were stored for further microbial characterization. Biofilm production was detected by tube method. <b>Results:</b> In the present study we observed that out of 100 samples obtained from catheterized patients presenting with nosocomial UTI 26% were caused by Candida species. Among the 26 Candida isolates 16 (61.53%) were non albicans Candida and 10(38.47%) were Candida albicans. Out 26 Candida isolates, 14(53.84%) of the candida isolates were found to produce biofilm. Biofilm production was found to occur more frequently among non albicans Candida 10(62.5%) than Candida albicans 4(40.0%). <b>Conclusion:</b> The present study reiterates the presence of candiduria in catheterized patients. Non-albicans candida speices are replacing candida albicans as the predominant pathogen for nosocomial UTI. It was also observed that Biofilm formation is seen more frequently with non albicans candida species than with Candida albicans. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=DC11-DC13&id=6690 https://doi.org/10.7860/JCDR/2015/.6690 Bacteriological Quality of Treated Water and Dialysate in Haemodialysis Unit of A Tertiary Care Hospital Shiva Verma, V A Indumathi, K C Gurudev, Shalini Ashok Naik <b>Introduction:</b> Haemodialysis is one of the treatment modalities for patients suffering from end stage renal disease (ESRD). Dialysis patients are exposed to large volumes of water for production of dialysis fluids. Treated water and dialysate come in direct contact with the patient’s bloodstream. Such patients suffer from abnormalities of the immune system, making them more susceptible to infections. Microbial contamination of the treated water and dialysate can lead to biofilm formation and release of endotoxins in Haemodialysis system. These can give rise to pyrogenic reactions in the short term and ß2 amyloidosis, atherosclerosis, and increased mortality in the long term. <b>Aim:</b> To assess the bacteriological quality of treated water and dialysate used in the Haemodialysis unit of a tertiary care hospital. <b>Materials and Methods:</b> A retrospective review of records of treated water and dialysate samples sent to the Microbiology laboratory for analysis of bacteriological contamination of the water used in haemodialysis treatment from January 2013 to June 2014 was conducted. The acceptable limits for treated water and dialysate were taken as <200 CFU/ml and < 2000 CFU/ml respectively as per Government of India Guidelines for Maintenance Haemodialysis. <b>Results:</b> Thirty six samples of treated water and 394 samples of dialysate were analysed for bacteriological contamination. 4 out of 36 (11.1%) samples of treated water and 44 out of 394 dialysate samples (11.2%) showed unacceptable bacteriological growth. <b>Conclusion:</b> Regular and continual monitoring of the disinfection protocol of the water distribution system in haemodialysis unit is necessary to get good microbiological quality of treated water and dialysate fluid. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=DC14-DC16&id=6692 https://doi.org/10.7860/JCDR/2015/.6692 Hepatitis C Seroprevalence and Risk Factors in Adult Population of Chaharmahal and Bakhtiari Province of Iran in 2013 Masoumeh Moezzi, Reza Imani, Ali Karimi, Behrouz Pourheidar <b>Introduction:</b> Hepatitis C is the second leading viral infectious disease worldwide. In Iran, hepatitis C is the most important and prevalent reason for chronic hepatitis and liver cirrhosis in the multi transfused population. <b>Aim:</b> This study was conducted to determine seroprevalence and burden of hepatitis C in Chaharmahal and Bakhtiari province and to plan for controlling it. <b>Materials and Methods:</b> For this analytical, population-based study, 3000 samples older than 15 years old were enrolled from urban and rural areas of Chaharmahal and Bakhtiari province, southwest Iran per cluster sampling. Written informed consent was obtained from the participants and the demographic data, transmission route and risk factors were collected after blood sample taking. Hepatitis C virus antibody (HCV Ab) and western blotting were consecutively run. S tatistical Analysis: Data analysis was done by SPSS 19 using descriptive statistics, and chi-square test, Fisher’s exact test, and logistic regression Ap value of 0.05 was considered as the level of significance. <b>Results:</b> The prevalence of HCV Ab was obtained 1.4% (95% CI, 0.95-1.7) and that of positive hepatitis C by western blotting 0.9% (95% CI, 0.65-1.3). The prevalence in men (1.2%) was obtained two times higher than women. The highest prevalence was obtained in 35 to 44-year-old population (2%). The prevalence was higher in married individuals and less in higher educated. History of hospital stay, first degree relatives infected with HCV, jaundice, history of blood transfusion, tattoo, outpatient surgery, imprisonment, contact with the infected, intravenous (IV) drug abuse, and smoking had significant association with disease prevalence (p<0.05). The highest odds ratio was obtained for history of IV drug abuse (OR=38.2, 95% CI, 14.06-103.9) followed by imprisonment (OR=8.9, 95% CI, 2.97-26.6). However, by logistic regression only history of IV drug abuse was obtained as significant (p<0.05). <b>Conclusion:</b> Hepatitis C is growing and emerging as the most prevalent chronic, viral hepatic disease, so further consideration of risk factors and routes of transmission is crucial for appropriate planning for, and preventing, treating, and controlling hepatitis C. IV drug abusers as the most important group need special consideration and surveillance in order to cut infection chain and decrease the disease incidence. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=LC13-LC17&id=6694 https://doi.org/10.7860/JCDR/2015/.6694 Malaria Diagnosis Using Automated Analysers: A Boon for Hematopathologists in Endemic Areas Aminder Singh, Vikram Narang, Neena Sood, Bhavna Garg, Vikram Kumar Gupta <b>Background:</b> Haematological abnormalities are common in acute febrile tropical illnesses. Malaria is a major health problem in tropics. In endemic areas especially in the post monsoon season, it is not practical to manually screen all peripheral blood films (PBF) for malarial parasite. Automated analysers offer rapid, sensitive and cost effective screening of all samples. <b>Aim:</b> The study was done to evaluate the usefulness of automated cell counters analysing their histograms, scatter-grams and the flaggings generated in malaria positive and negative cases. The comparison of other haematological parameters were also studied which could help to identify malaria parasite in peripheral blood smear. Materials and Methods: The blood samples were analysed using Beckman coulter LH-750. The abnormal scatter grams and additional peaks in WBC histograms were observed diligently & compared with normal controls. Haematological abnormalities were also evaluated. <b>Statistical Analysis:</b> Statistical analysis was done by using software Epi-Info version 7.1.4 freely available from CDC website. Fisher exact test was applied to calculate the p-value and value < 0.05 was considered as significant. Final identification of malarial parasite species was done independently by peripheral blood smear examination by two pathologists. <b>Results:</b> Of all the 200 cases evaluated abnormal scatter grams were observed in all the cases of malaria while abnormal WBC histogram peaks were noted in 96% cases demonstrating a peak at the threshold of the histogram. The difference between number of slides positive for abnormal WBC scatter gram and abnormal WBC histogram peaks were statistically highly significant (p=0.007). So abnormal WBC scatter gram can better give idea of malarial parasite presence. Of the haematological parameters thrombocytopenia (92% cases) emerged as the strongest predictor of malaria. <b>Conclusion:</b> It is recommended for haematopathologists to review the haematological data and the scatter plots on the analyser along with peripheral blood smear examination. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=EC05-EC08&id=6696 https://doi.org/10.7860/JCDR/2015/.6696 Laboratory Profiles of Patients on Hemodialysis - A Retrospective One Year Study in a Rural Tertiary Care Hospital Udipi Badikillaya Vijayalakshmi, Manasa Rayidi <b>Introduction:</b> The global prevalence of chronic kidney disease (CKD) is estimated to be 8-16%. Studies have shown that the increased mortality in patients with CKD is due to anemia that leads to cardiovascular disease (CVD), also known as “Cardio renal anemia syndrome”. The present study was undertaken to look into the laboratory profiles of end stage renal disease (ESRD) patients. <b>Aim:</b> To study the laboratory profiles of End stage renal disease (ESRD) patients coming for hemodialysis. <b>Materials and Methods:</b> The study was a retrospective, crosssectional study done by collecting data from the medical case records of all patients during a period of one year from January 1st 2014 to December 31st 2014. Records of a total of 140 patients who underwent hemodialysis during this period were taken. The laboratory profiles that was recorded included haemoglobin, serum sodium, potassium, chloride, fasting glucose, calcium and phosphorus. <b>Results:</b> The mean age of the subjects was 53.5±14.5 yrs. All the patients had moderate anaemia. There was a significant difference in the mean systolic and diastolic blood pressure, serum creatinine and serum urea values between males and females. The mean serum calcium levels were low. <b>Conclusion:</b> The present study is the first such study in this rural area and shows evidence of a relatively young population with ESRD having moderate anaemia and hypertension. There is evidence of hypocalcaemia and serum phosphorus is on the higher end of the normal range. These findings are usually associated with a higher risk of mortality. With the explosion of diabetes and hypertension in India, chronic kidney disease should be diagnosed and managed as early as possible if not prevented. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=BC12-BC15&id=6697 https://doi.org/10.7860/JCDR/2015/.6697 Bacteriological Profile of Surgical Site Infections and Their Antibiogram: A Study From Resource Constrained Rural Setting of Uttarakhand State, India Vikrant Negi, Shekhar Pal, Deepak Juyal, Munesh Kumar Sharma, Neelam Sharma <b>Introduction:</b> Surgical site infections (SSI) constitute a major public health problem worldwide and are the second most frequently reported nosocomial infections. They are responsible for increasing the treatment cost, length of hospital stay and significant morbidity and mortality. <b>Aim:</b> To determine the incidence of SSIs and the prevalence of aerobic bacterial pathogens involved with their antibiogram. <b>Materials and Methods:</b> Samples were collected using sterile cotton swabs from 137 patients clinically diagnosed of having SSIs and were processed as per standard microbiological techniques. Antimicrobial susceptibility testing was done using modified Kirby-Bauer disc diffusion method. This cross sectional study was conducted for a period of six months (January 2013 to June 2013) in the Department of Microbiology at a rural tertiary care hospital of Uttarakhand state, India. <b>Results:</b> Out of 768 patients, 137 (17.8%) were found to have SSIs and samples were collected from them. Out of total 137 samples, 132 (96.4%) yielded bacterial growth and 139 bacterial isolates were obtained. Staphylococcus aureus (50.4%) was the commonest organism followed by Escherichia coli (23.02%), Pseudomonas aeruginosa (7.9%) and Citrobacter species (7.9%). Antimicrobial profile of gram positive isolates revealed maximum sensitivity to vancomycin, teicoplanin and linezolid, whereas among gram negative isolates meropenem, piperacillin-tazobactam, and amikacin were found to be most sensitive. <b>Conclusion:</b> The rate of SSI observed in this study was comparable to other similar studies, however we observed a higher degree of antimicrobial resistance. Adherence to strict infection control measures, maintenance of proper hand hygiene and optimal preoperative, intraoperative and postoperative patient care will surely reduce the incidence of SSIs. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=DC17-DC20&id=6698 https://doi.org/10.7860/JCDR/2015/.6698 The Mystery of Handprints: Assesment and Correlation of Dermatoglyphics with Early Childhood Caries A Case-Control Study Saumya Navit, Dheera Chadha, Suleman Abbas Khan, Rahul Kumar Singh, Nikita Johri, Pragati Navit, Anshul Sharma, Rachana Bahuguna <b>Background:</b> It has been acknowledged that genetics play a significant role in determination of dermatoglyphic patterns. Since caries is a multifactorial disease with the influence of genetic pattern, this study was undertaken to assess dermatoglyphic patterns and correlate them with early childhood caries. <b>Aim:</b> The aim of the study was to determine the association and correlation of dermatoglyphic patterns with early childhood caries. <b>Materials and Methods:</b> The study sample consisted of 100 children aged between 3 and 6 years, divided into two groups of 50 children each. The deft score was evaluated to select the experimental group and control group. Finger and palm prints were recorded using the ink method described by Cummins and Midlo. The handprints obtained were checked for their clarity with a magnifying glass (×2) and coded. The presence of core and the triradii of the dermatoglyphic pattern were checked thoroughly to include the handprint in the study. A total of 1000 digital prints and 200 palmar prints were obtained. <b>Results:</b> The presence of whorls in the index finger of the right hand predicts significantly lower risk of caries in children (male and female; combined). Presence of whorls in the ring finger of the right hand predicts significantly lower risk of caries in female children. Statistically no correlation between atd angle and early childhood caries was obtained from the present data. <b>Conclusion:</b> The results obtained from the present study creates a notion on the validity of the results of the previous studies and point them to be chance findings. Due to increasing acceptability of dermatoglyphics as a diagnostic tool for congenital diseases, further large scale extensive research should be undertaken to evaluate the role of the same in children with Early Childhood Caries (ECC). https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ZC44-ZC48&id=6639 https://doi.org/10.7860/JCDR/2015/.6639 Impact of Induction Chemotherapy Followed by Radiotherapy in Patients of Invasive Cervical Carcinoma with Inadvertent Hysterectomy: A Retrospective Study Sunil Choudhary <b>Background:</b> The standard of care for patients who undergo an inadvertent hysterectomy for invasive cervical carcinoma is not well established. Aim: The aim of this study was to evaluate the role of induction chemotherapy followed by external beam radiotherapy and brachytherapy in patients who had an inadequate hysterectomy for carcinoma of the cervix. <b>Materials and Methods:</b> Patients with history of inadequate hysterectomy with no residual disease at presentation to our outpatients department of Radiotherapy and registered between October 2011 to June 2014 were retrospectively analyzed. Most of these patients had received three cycles of induction chemotherapy using Paclitaxel and Carboplatin regime. Thereafter, these patients had received external beam radiotherapy and vaginal brachytherapy. The primary end points were overall survival and disease-free survival. Survival analysis was done using Kaplan-Meier method and the differences in survival rates were compared using log-rank test. <b>Results:</b> A total of 34 patients were eligible for the study. Overall survival and Disease-free survival at 3-years were 70% and 68%. Patients who had Taxane-based chemotherapy had significantly better survival outcomes than their counterparts. Vaginal vault boost with brachytherapy had a significant impact on prognosis of these patients. <b>Conclusion:</b> Induction chemotherapy using Paclitaxel and Carboplatin followed by external beam radiotherapy and brachytherapy is a good treatment option for patients of carcinoma of the cervix who have undergone inadvertent hysterectomy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=XC01-XC04&id=6640 https://doi.org/10.7860/JCDR/2015/.6640 Management of Osteoarthritis Knee by Graduated Open Wedge High Tibial Osteotomy in 40-60 Years Age Group Using Limb Reconstruction System: A Clinical Study Rajesh Kapila, Pawan Kumar Sharma, Ankush Chugh, Randhir Singh <b>Background:</b> With i ncrease in elderly population, osteoarthritis has become major concern nowadays. Knee joint is most commonly affected joint. A number of methods have been developed in the last few years which help in treating the osteoarthritis knee, which includes non pharmacological, pharmacological and surgical methods. Among the most promising techniques with renewed interest for osteoarthritis knee with deformity is the use of high tibial osteotomy. Uni-compartmental osteoarthritis knee with deformity especially in relatively younger age group (less than 60 years) constitutes the main indication. <b>Aim:</b> The aim of present study was to evaluate management of osteoarthritis knee by graduated open wedge high tibial osteotomy in 40-60 years age group using limb reconstruction system. <b>Materials and Methods:</b> Medial Opening Wedge High Tibial Osteotomy leaving the lateral cortex intact which acts as a hinge, was done in 30 patients and stabilized by Limb Reconstruction System. Distraction was started at 7th day at the rate of 1 mm/day and continued till proper alignment was achieved. <b>Results:</b> Medial Opening Wedge High Tibial Osteotomy stabilized by unilateral external fixator is a good method for unicompartmental osteoarthritis knee with deformity as it gives precise control over final limb alignment and its ability to perform a residual correction. Deformity correction can be quantified at the time of correction as it is not acute correction. Gradual deformity correction can be done over time by distraction histogenesis with the help of unilateral external fixator. It is also a good method in young patients requiring large correction. <b>Conclusion:</b> Medial Opening Wedge High Tibial Osteotomy is having many benefits over closed wedge osteotomy and stabilization by unilateral external fixator also has its added benefits. It is less invasive, no internal hardware present and safer in terms of neurovascular complications. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=RC09-RC11&id=6644 https://doi.org/10.7860/JCDR/2015/.6644 Prevalence and Spectrum of Gastro Esophageal Reflux Disease in Bronchial Asthma Sahoo Rameschandra, Vishak Acharya, Kunal, Tantry Vishwanath, Anand Ramkrishna, Preetam Acharya <b>Background:</b> There exists a complex interplay between asthma and gastroesophageal reflux disease. Both these diseases are known to aggravate each other and amelioration of one is necessary for the control of the other. There is a paucity of studies in Indian population on this subject. <b>Aim:</b> To evaluate the clinical features and the endoscopic findings of the upper gastrointestinal tract in patients with bronchial asthma. <b>Materials and Methods:</b> Study was conducted at KMC group of hospitals, Mangalore in the Department of chest medicine in association with Department of gastroenterology. Subjects included 50 cases of bronchial asthma and controls were 58 non asthmatic patients with allergic rhinitis and chronic urticaria. All patients were queried about presence or absence of symptoms of upper gastro intestinal tract disorders by gastro oesophageal reflux disease (GERD) questionnaire and all the included patients underwent upper gastro intestinal endoscopy. <b>Results:</b> The study showed that symptoms of gastroesophageal reflux were significantly more in asthmatics (52%) as compared to the controls (28%). The common presenting features of gastroesophageal reflux in asthmatics were heartburn (40%) retrosternal pain (24%), nocturnal cough (18%), dyspepsia (16%) and regurgitation (14%) and the above symptoms were significantly more common in asthmatics as compared to controls. Gastroesophageal reflux disease was found to be significantly more common in the asthmatics (58%) as compared to the control group where it was present in 32.75% of the subjects. Clinical or endoscopic evidence of any upper gastrointestinal disorder was found in 68% of the asthmatics as compared to 37.93% of the controls. This difference was found to be statistically significant. <b>Conclusion:</b> The study showed that gastroesophageal reflux disease was significantly more in asthmatics as compared to the controls. Upper gastrointestinal symptoms were more common in asthmatics as against controls. Clinical or endoscopic evidence of upper gastrointestinal disorder and gastroesophageal reflux disease was found in significantly higher proportion of the asthmatics as compared to the controls. Clinically silent gastroesophageal reflux disease was however seen in both control and asthmatic groups equally with a lower prevalence. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=OC11-OC14&id=6645 https://doi.org/10.7860/JCDR/2015/.6645 Effect of Habits and Nutritional Status on Clinical Grading and Histopathological Staging in Patients with Oral Sub Mucous Fibrosis Abhayjeet Singh, Rama Brahmam Lanke, Rakhith Shetty, Syed Akifuddin, Manish Sahu, Navneet Singh, Gagandeep Kaur, Garish Goyal <b>Background:</b> Oral submucous fibrosis (OSMF) is a chronic progressive debilitating disease affecting the oral, oropharyngeal and sometimes the oesophageal mucosa resulting in inability to eat due to burning, ulcers and stiffness. <b>Aim:</b> The study was undertaken, to evaluate the correlation of clinical staging, histological grading and nutritional status using body mass index (BMI) with gutkha (habit) index in OSMF patients. <b>Materials and Methods:</b> The study group comprised of 50 patients clinically diagnosed and histopathologically confirmed cases of OSMF. Habit (gutkha) index was calculated by multiplying duration and frequency. Body mass index was calculated by dividing weight in kilograms and height in centimetres of the patient. <b>Results:</b> Male to female ratio was 2.8:1. Clinical grading increased with increase in gutkha index, patients with gutkha index 1-50, maximum were in mild stage; with gutkha index 51-100, maximum in moderate and patients with gutkha index 101-150, all were in severe stage. Histological staging showed direct correlation with gutkha index, it increased with increase in gutkha index with p <0.05. Site analysis showed that buccal mucosa and retromolar area were involved in all the patient and floor of mouth in 46% of patients Body mass index analysis revealed that out of 27 patients with moderate clinical staging 3 was underweight; out of 3 with severe clinical staging, 2 was underweight. <b>Conclusion:</b> The duration and frequency of areca nut product use effects on the incidence and severity of OSMF and the patient becomes unable to eat due to burning, ulcers and inability to open mouth which affect the health of the individual. Thus it is important to access the nutritional status to improve the survival rate of patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ZC49-ZC52&id=6648 https://doi.org/10.7860/JCDR/2015/.6648 Invitro Study of the Effect of Different Samples of Water Used for Washing the Etchant on Bracket Bond Strength Sandesh Phaphe, Chanamallappa Ganiger, Yusuf Ahammed, Pratap Mane <b>Background:</b> Bonding is a very important step in the orthodontic treatment planning. Effective bonding enhances the treatment by reducing the bond failure and thereby reducing the treatment duration and also increases efficiency in orthodontic mechanics. The success of the bonded brackets is negatively affected by contamination with oral fluids such as blood and saliva. <b>Aim:</b> The aim of the present study was to evaluate the effect of hardness of water used in removing the etchant on the bracket bond strength. <b>Materials and Methods:</b> Seventy five extracted premolars were divided in three groups of 25 each. The teeth in all the three groups were etched with 35% phosphoric acid. The etchant in each of the group I, II and III was removed using distilled water (soft), corporation water (moderately hard) and hard water respectively. Stainless steel brackets were attached using light cure bonding agent (transbond XT, 3M UNITEK) and cured for 10sec with a light cure unit. The shear bond strength was evaluated by mechanical testing machine. Statistically significant differences were defined for p < 0.05. <b>Result:</b> The results showed significant increase in bond strength in samples where in soft water was used for cleaning the etchant on the bonding surface. <b>Conclusion:</b> Hardness of water used for washing the etchant affects the bracket bond strength. Shear bond strength of soft water is significantly increased compared to moderately hard and very hard water. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ZC53-ZC55&id=6649 https://doi.org/10.7860/JCDR/2015/.6649 A Framework for Developing a Curriculum Regarding Autism Spectrum Disorders for Primary Care Providers Pankaj Garg, David Lillystone, David Dossetor, Helen Wilkinson, Carolyn Kefford, John Eastwood, Siaw Teng Liaw <b>Introduction:</b> The prevalence of Autism Spectrum Disorders (ASDs) has increased and varies across age groups. Thus there is an increasing need for educational opportunities for General Practitioners (GPs) and other Primary Care providers to help in early identification and referral to specialist services. An earlier survey of GPs in New South Wales (Australia) demonstrated two broad domains for educational activities: (1) a general knowledge (important for early identification and referral) and (2) surveillance (important for ongoing management). <b>Aim:</b> To seek further evidence to these domains and synthesize the important contents for educational programs for GPs. <b>Materials and Methods:</b> We conducted a (1) Confirmatory Factor Analysis (CFA) on our original survey data and (2) systematic review of the literature to identify important educational topics, using a life cycle approach. <b>Results:</b> CFA and literature review support theoretical framework of two domains. Alerts and red flags for ASDs, knowledge of simple surveillance tools, communication of diagnosis with parents, referral pathways particularly to speech pathologists before a formal diagnosis is confirmed, and appreciation of vulnerabilities for identifying supports were important in the general knowledge domain, while supporting the families through transition points such as from pre-school to school entry, secondary school and adolescence, role of psychopharmacology such as medications for sleep issues, and for common co-morbidities of anxiety were important in the surveillance dimension. <b>Conclusion:</b> GP supervisors and medical and nursing educators can use findings from this paper for developing structured learning activities for training primary health care workforce regarding ASD’s. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=SC01-SC06&id=6651 https://doi.org/10.7860/JCDR/2015/.6651 Adverse Drug Reaction Profile in Patients on Anti-tubercular Treatment Alone and in Combination with Highly Active Antiretroviral Therapy Shamiya Sadiq, Vijay Khajuria, Vishal R. Tandon, Annil Mahajan, Jang B. Singh <b>Background and Objectives:</b> Adverse drug reactions are very common among patients on anti-tubercular treatment alone or in combination with highly active antiretroviral therapy but comparatively studied very less. Hence, the current study was done to evalaute the adverse drug reaction (ADR) profile in patients receiving anti-tubercular treatment (ATT) and ATT with highly active antiretroviral therapy (HAART). <b>Materials and Methods:</b> A one year prospective, cross-sectional observational study was undertaken using suspected adverse drug data collection form available under Pharmacovigilance Programme of India. <b>Results:</b> Seventy four patients receiving ATT & 32 patients on both ATT & HAART presented with 74 and 45 adverse drug events (ADE) respectively. Males were more affected than females in both the groups. DOTS category- 1 regimen was mostly responsible for ADE in both the groups. Epigastric pain was the most common ADE in TB patients, while anaemia was the most common presentation in TB with HIV group. On comparison, ADE rate of TB with HIV co-morbid patients was more (55.8%) than TB patients (0.36%) (p < 0.001). Urban population presented more with ADR in TB/HIV group unlike rural population in TB group (p<0.0001). Whereas, illiterate were more involved in TB group unlike literate in TB/HIV group (p<0.05). Type A reactions were more common in TB group (p < 0.001). Addition of drugs for the management of ADR events was more in TB/HIV group (p < 0.001) as compared to TB group. Rest all the parameters were comparable. <b>Conclusion:</b> The study underscores that concomitant HAART and ATT, result in more ADRs in comparison to ATT alone demanding collaboration & integration of National AIDS Control programme and PvPI to enhance drug safety in this field. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=FC01-FC04&id=6652 https://doi.org/10.7860/JCDR/2015/.6652 Quest for An Ideal, Simple and Cost-Effective Stain for Morphological Assessment of Sperms Hemalatha Anthanahalli Lingappa, Abhishek Mandya Govindashetty, Anoosha Krishnamurthy, Ashok Kagathur Puttaveerachary, Sanjay Manchaiah, Indira Channagangappa Shimoga, Sushma Hulikere Mallaradhya, Sar <b>Background:</b> Recent alarming trends of a substantial rise in the number of cases of infertility with as many as 30-40% being attributed to male-factor associated causes have created a need for further studies and advancements in semen analysis. Despite the focus on semen analysis over the years, assessment of sperm morphology has not been given due importance although it is a simple, standard and baseline diagnostic modality. It can be used to predict the need and outcome of Artificial Reproductive Techniques such as Invitro Fertilization, Gamete Intra Fallopian Tube Transfer and Intra Cytoplasmic Sperm Injection. <b>Aim:</b> To find the ideal, simple and cost-effective basic stain for assessment of sperm morphology in a rural tertiary care set- up where advanced equipment for assessment of sperm morphometry are inaccessible. <b>Materials and Methods:</b> An updated way of determining sperm shape is called the Kruger’s strict morphology method. Keeping this as the standard criterion, we studied semen samples of 62 healthy male subjects using four basic staining techniques and the consensus of four independent observers was tabulated. R esults: We found that Haematoxylin and Eosin stain was the best stain for assessment of sperm head morphology. Rapid Papanicolau stain was the most ideal, simple and cost-effective stain for overall assessment of sperm morphology. <b>Conclusion:</b> Sperm morphology assessment remains the baseline necessity for the diagnosis and management of male factor associated infertility when advanced techniques are unavailable, inaccessible or unaffordable. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=EC01-EC04&id=6655 https://doi.org/10.7860/JCDR/2015/.6655 Diurnal Variation in Peak Expiratory Flow and Forced Expiratory Volume Arun Goel, Manish Goyal, Ruchi Singh, Narsingh Verma, Sunita Tiwari <b>Introduction:</b> Diurnal variability in airways has most commonly been reported using peak expiratory flow (PEF) and forced expiratory volume in one second (FEV1). Characteristics of variability in small, mid and large airways caliber are expected to be different but have not been studied. <b>Aim:</b> The aim of the study was to assess diurnal variation in small mid and large airways caliber using FEF25, FEF50, FEF75 and FEF25-75 along with PEF and FEV1 in healthy subjects. <b>Materials and Methods:</b> Spirometry was performed in 161 healthy subjects twice in a day. Diurnal variability in FEF25, FEF50, FEF75, FEF25-75, PEF and FEV1 were determined and compared. <b>Results:</b> It revealed that all parameters exhibit significant diurnal variability. Diurnal variability is highest in large airways and lowest in smaller airways. <b>Conclusion:</b> Proximal airways show greater diurnal variation in their caliber than distal airways as reflected by greater variability in PEF as compared to FEV1. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=CC05-CC07&id=6661 https://doi.org/10.7860/JCDR/2015/.6661 Heart Rate Variability in Adolescents – Normative Data Stratified by Sex and Physical Activity Vivek Kumar Sharma, Senthil Kumar Subramanian, Vinayathan Arunachalam, Rajathi Rajendran <b>Background:</b> Heart rate variability (HRV) refers to the beat-to-beat fluctuations in the cardiac rhythm occurring due to modulation of the pacemaker (sinoatrial node) activity of the heart by the sympathetic and parasympathetic branches of the autonomic nervous system. Nowadays, cardiovascular diseases and their risk factors are increasingly occurring at a younger age (children and adolescents) and recording of HRV in them will help us to identify cardiovascular autonomic derangement earlier. However, to be used clinically, normative data has to be established in this age group considering other major factors that can influence HRV such as sex, physical activity, and BMI. <b>Materials and Methods:</b> Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology has provided the standards for measurement of heart rate variability and we have followed the same. In the present study, we have described the normative data for HRV in the adolescent in the age group of 12-17 years, stratified based on sex and physical activity. <b>Results:</b> Data given below are expressed as median with interquartile range (Median (IQR)) in the following order: non-athlete girls, non athlete boys, athlete girls and athlete boys. Time domain indices - SDNN - 66.35 (40.78), 63.20 (36.20), 113.00 (31.40) and 94.20 (35.55); RMSSD – 69.00 (50.55), 58.70 (43.40), 94.90 (42.10) and 100.30 (47.50); NN50 - 137.50 (100.25), 116.00 (90.50), 137.00 (81.00) and 156.00 (81.50). The frequency domain indices – LF power 1015.00 (1098.75), 945.00 (831.00), 1465 (642.25), and 1211.00 (811.37); HF power – 1324.00 (1707.00), 988.00 (1426.50), 2409.00 (1387.50), and 2219.00 (1752.00); Total power – 3374.50 (3094.25), 2757.00 (2641.00), 5202.00 (2501.50) and 5273.00 (3507.50); LFnu – 45.44 (16.61), 47.63 (29.98), 38.59 (11.81) and 37.10 (11.21); HFnu – 54.56 (16.61), 52.37 (29.98), 61.41 (11.81) and 62.90 (11.21). <b>Conclusion:</b> We have given sex and physical activity stratified HRV normative data for adolescents in the age between 12-17 years. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=CC08-CC13&id=6662 https://doi.org/10.7860/JCDR/2015/.6662 Evaluation of CareSens POCT Devices for Glucose Testing in the Routine Hospital Setting Kagan Huysal, Yasemin U Budak, Hakan Demirci, Mehmet Ali Önelge <b>Introduction:</b> Glucose meters are used routinely in hospital wards to manage blood glucose levels in patients requiring frequent monitoring of blood glucose. Objective: Our institution has 50 POC instruments utilized by diverse population of all ages and medical conditions. The primary objective of our study was to investigate whether all these CareSens glucose meters (I-sense Inc, Seoul, South Korea) results in hospitalized patients during routine clinical care jointly satisfy the specified quality specifications, as defined by Clinical and Laboratory Standards Institute (CLSI) guideline POCT12-A3. <b>Materials and Methods:</b> The records of hospitalized patients who underwent simultaneous measures of glucose levels with both glucose meters and a central laboratory analyser between January and June 2013 were retrospectively analysed. We also performed a prospective evaluation of the accuracy of the CareSens glucose Strip. <b>Results:</b> Glucose concentrations measured in 840 patients ranged from 1.66 to 31.72 mmol/L The Bland–Altman difference plot between the auto analyser and all the 50 CareSens glucosemeters revealed a mean bias of -2.2%, with analytical biases for the two methods varying from -31.1% to 26.8%. Eighty four percent of the glucose meter's glucose values were within ± 12.5% for values 5.54 mmol/L of the comparative laboratory glucose values and 93% of the results were within 20% of the reference for glucose >4.2 mmol/L and 65% of the results were within 0.8 mmol/L for glucose <4.2 mmol/L. <b>Conclusion:</b> CareSens glucose meter readings in hospital settings, especially in hypoglycaemic patients, should be confirmed by central laboratory analysers whenever possible. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=BC04-BC07&id=6664 https://doi.org/10.7860/JCDR/2015/.6664 Arthrocentesis A Minimally Invasive Method for TMJ Disc Disorders - A Prospective Study Vidya Kodage Chandrashekhar, Umesh Kenchappa, Sangamesh Ningappa Chinnannavar,Sarabjeet Singh <b>Background:</b> Temporomandibular joint (TMJ) disc disorders are one of the major concerns to the mankind and doctors in day to day life due to its complex nature and failure to treat these kinds of conditions successfully. Objectives: The aim of the present study was to evaluate the efficacy of arthrocentesis in patients suffering from TMJ disc disorders. <b>Materials and Methods:</b> A total of 50 subjects suffering from TMJ disc disorders were selected and treated by arthrocentesis. The subjects were followed up for a period of one year. <b>Results:</b>The mean maximal mouth opening prior to arthro-centesis was 32.13mm and after the procedure the mean maximal mouth opening was 46.6mm. The mean right and left lateral movements before arthrocentesis were 7.15mm and 7.59mm respectively, and the mean right and left lateral movements of 9.49 and 9.31 respectively were present after the procedure. The mean degree of pain before arthrocentesis was 8.7, and after the procedure the mean degree of pain was 1.13 as per the visual analogue scale. <b>Conclusion:</b> The findings of this study suggested potential utility of arthrocentesis in the management of TMJ disc disorders. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ZC59-ZC62&id=6665 https://doi.org/10.7860/JCDR/2015/.6665 Assessment of Fluoride Concentration of Soil and Vegetables in Vicinity of Zinc Smelter, Debari, Udaipur, Rajasthan Nagesh Bhat, Sandeep Jain, Kailash Asawa, Mridula Tak, Kushal Shinde, Anukriti Singh, Neha Gandhi, Vivek Vardhan Gupta <b>Background:</b> As of late, natural contamination has stimulated as a reaction of mechanical and other human exercises. In India, with the expanding industrialization, numerous unsafe substances are utilized or are discharged amid generation as cleans, exhaust, vapours and gasses. These substances at last are blended in the earth and causes health hazards. <b>Objective:</b> To determine concentration of fluoride in soils and vegetables grown in the vicinity of Zinc Smelter, Debari, Udaipur, Rajasthan. <b>Materials and Methods:</b> Samples of vegetables and soil were collected from areas situated at 0, 1, 2, 5, and 10 km distance from the zinc smelter, Debari. Three samples of vegetables (i.e. Cabbage, Onion and Tomato) and 3 samples of soil {one sample from the upper layer of soil (i.e. 0 to 20 cm) and one from the deep layer (i.e. 20 – 40 cm)} at each distance were collected. The soil and vegetable samples were sealed in clean polythene bags and transported to the laboratory for analysis. One sample each of water and fertilizer from each distance were also collected. <b>Results:</b> The mean fluoride concentration in the vegetables grown varied between 0.36 ± 0.69 to 0.71 ± 0.90 ppm. The fluoride concentration in fertilizer and water sample from various distances was found to be in the range of 1.4 – 1.5 ppm and 1.8 – 1.9 ppm respectively. <b>Conclusion:</b> The fluoride content of soil and vegetables was found to be higher in places near to the zinc smelter. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ZC63-ZC66&id=6667 https://doi.org/10.7860/JCDR/2015/.6667 Personality Factor as a Predictor of Depression Score Among Depressed and CHD Patients Sattar Kikhavani, Hamid Taghinejad <b>Introduction:</b> Many risk factors can affect depression and coronary disease, these including physiological and psychological risk factors (such as personality traits) Objectives: Our objectives were to examine whether personality factors (The Five-Factor Model) can predict depression score in the depressed and coronary heart disease (CHD) individuals compared to that of healthy subjects. <b>Materials and Methods:</b> To achieve the above objectives, 100 depressed (Mean=35.90 years, SD=10.59 years), and 100 CHD (Mean=46.42 years, SD=12.52 years), patients and 100 healthy subjects (Mean = 37.97 years, SD =12.49 years) were selected by convenience sampling method. To compare the three groups of participants, ANOVA test was used. Stepwise Multiple Regression Analysis was used to identify the variables that most closely predict the perceived stress and depression scores. Pearson’s Correlation Co-efficient was used to examine the correlation between variables. <b>Results:</b> In Neuroticism, the CHD patients had significant highest scores, followed by depressed patients. The healthy group had the least scores. In case of Extraversion, Openness and Agreeableness, healthy participants had significant higher scores followed by the depressed and CHD patients. Only in conscientiousness factor, Depressive and CHD groups had statistically less scores compared to the healthy group. Also, high Neuroticism and Age, and low Extraversion were significant protective factors for depression Scores of CHD patients, while high Neuroticism and low Extraversion function as predictors in the depressed and healthy groups. <b>Conclusion:</b> The effects of Neuroticism and Extraversion on depression have been reported as inconsistent across previous studies. This study indicates that, older CHD individuals with high Neuroticism and low Extraversion scores are more vulnerable for depression. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=VC04-VC07&id=6668 https://doi.org/10.7860/JCDR/2015/.6668 Adjuvant Radiotherapy with Three-Dimensional Conformal Radiotherapy of Lacrimal Gland Adenoid Cystic Carcinoma Vikas Roshan, Sushmita Pathy, Supriya Mallick, Subhash Chander, Seema Sen, Bhavna Chawla <b>Background & Aim:</b> Adenoid cystic carcinoma (ACC) of lacrimal gland is a rare tumour with aggressive behaviour. There is sparse data to address optimum therapy for such tumours. So, the present study was aimed at evaluating the role of adjuvant three dimensional conformal radiotherapy (3D-CRT) in cases of incomplete (R1) resection along with review of literature pertaining to management of lacrimal adenoid cystic carcinoma <b>Materials and Methods:</b> We retrospectively reviewed the demographic and treatment data of 10 biopsy proven ACC of lacrimal gland patients, treated from December 2006 to June 2013. They were treated with radiotherapy following surgical resection. Eight patients underwent gross total excision of the tumour mass (enbloc excision) followed by conformal radiotherapy to a dose of 60 Gray/30fractions/ 6 weeks. Two patients with advanced disease were treated with palliative radiotherapy after biopsy. <b>Results:</b> The median age was 32 years. There were equal numbers of male and female patients. The median duration of symptoms was 7 months. At a median follow up of 21 months, eight patients had no evidence of disease and had complete tumour response, two patients worsened, and one of the two had systemic failure with bone metastasis. <b>Conclusion:</b> Despite a small sample size and short follow, enbloc surgical excision with adjuvant radiotherapy is well tolerated and shows good control in ACC of lacrimal gland. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=XC05-XC07&id=6669 https://doi.org/10.7860/JCDR/2015/.6669 Effect of Oral Lactoferrin on Cataract Surgery Induced Dry Eye: A Randomised Controlled Trial Jaya Devendra, Sneha Singh <b>Context:</b> Cataract surgery is one of the most frequently performed intra-ocular surgeries, of these manual Small Incision Cataract Surgery (SICS) is a time tested technique of cataract removal. Any corneal incisional surgery, including cataract surgery, can induce dry eye postoperatively. Various factors have been implicated, of which oneis the inflammation induced by the surgery. Lactoferrin, a glycoprotein present in tears is said to have anti-inflammatory effects, and promotes cell growth. It has been used orally in patients of immune mediated dry eye to alleviate symptoms. <b>Aim:</b> This study was aimed to evaluate the dry eyes induced by manual Small Incision Cataract Surgery, and the effect if any, of oral lactoferrin on the dry eyes. <b>Settings and Trial Design:</b> A single centre, prospective randomised controlled trial with a concurrent parallel design. The study was carried out on patients presenting in the OPD of Rohilkhand Medical College hospital for cataract surgery. <b>Materials and Methods:</b> Sixty four patients of cataract surgery were included in the study. Patients with pre-existing dry eyes, ocular disease or systemic disease predisposing to dry eyes were excluded from the study. The selected patients were assigned into two groups by simple randomisation-Control Group A-32 patients that did not receive oral lactoferrin postoperatively. Group B-32 patients that received oral lactoferrin 350 gm postoperatively from day 1 after SICS. All patients were operated for cataract and their pre and postoperative (on days 7, 14, 30 and 60) dry eye status was assessed using the mean tear film break-up time (tBUT) and Schirmer test 1 (ST 1) as the evaluating parameters. Subjective evaluation of dry eye was done using Ocular Surface Disease Index (OSDI) scoring. Data was analysed for 58 patients, as 6 did not complete the follow up. <b>Statistical Analysis:</b> Unpaired t-test was used to calculate the p-values. <b>Result:</b> There was a statistically significant difference between the tBUT values of the Control and Lactoferrin group from day 14 onwards. The tBUT of control group on day 60 was 7.86 (±0.86) seconds as compared to 13.9(± 0.99) seconds in the lactoferrin group. The Schirmer test 1 values also showed a statistically significant difference between the two groups- 15.86 (± 5.83) seconds in the control group versus 30.9 (±1.66) in the lactoferrin group on day 60. OSDI score showed 42.8% patients complaining of at least mild dry eye symptoms in the control group, as compared to 26.6% patients in the lactoferrin group on day 60. <b>Conclusion:</b> Small Incision Cataract Surgery induces dry eye postoperatively. Oral lactoferrin given postoperatively improves tear film status and dry eye after cataract surgery. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=NC06-NC09&id=6670 https://doi.org/10.7860/JCDR/2015/.6670 Induction Chemotherapy with Cisplatin and 5-Fluorouracil in Advanced Head and Neck Cancers: A Short Term Response Evaluation Raghavendra Rao, Suhas SS, Vijendra Shenoy, Mahesh Chandra Hegde, Vishnu Prasad, Krishna Prasad <b>Background:</b> Considering the uprising number of Head and neck cancer in the state with limited options of medical and surgical treatment, the focus of this study involved on chemotherapy in advanced Head and neck cancers. The aim of this study was to evaluate the efficacy and toxicity of combination of Cisplatin and 5-Fluorouracil (PF) as induction chemotherapy in patients in locally advanced squamous cell cancer of head and neck. <b>Materials and Methods:</b> Forty four patients with previously untreated stage III -IV advanced and inoperable cases were included in this prospective study. Induction chemotherapy consisted of 3 cycles of Cisplatin 100mg/mt2 as infusion on day 1, 5-Fluorouracil of 750mg/mt2 on day 2, 5-Fluorouracil of 1000mg/mt2 as infusion on day 3 in an inpatient basis. Cycles were repeated with an interval of 21 days. Patients were evaluated within a period of 3 weeks at the end of completion of third cycle of chemotherapy. Post chemotherapy local therapy was individualized based on the response, site and stage of the tumour. <b>Results:</b> Out of 44 eligible and evaluable patients, major dominance was noted in male group constituting 68%. After induction chemotherapy 58.8% of stage III experienced stable response, & 44% had partial response. In stage IV, 44% showed a stable response and 33.3% had partial response. But in comparison to primary tumour response and nodal response, which had a significant clinical response, the overall response of malignancy with respect to stage and site specificity was clinically insignificant. Moderate adverse reaction was noted in 47.6% and 42.1% had mild reactions. Majority of patients experienced grade 3 adverse events, of which anaemia in females and leucopenia in males pre-dominated. <b>Conclusion:</b> With the use of cisplatin and 5-FU as induction chemotherapy agents in advanced and inoperable squamous cell carcinoma of head and neck, a distinct benefit was seen in stabilizing the tumour from progression. But achieving a significant complete response to the same is of faint possibility. An alternate multidrug regimen or multimodality treatment would be ideal to gain the optimum results from induction agents. Toxicity related to chemotherapy usually is transient at therapeutic doses, and can be controlled by adequate prophylactic measures. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=XC08-XC12&id=6671 https://doi.org/10.7860/JCDR/2015/.6671 The Use of the MyoDK for Mechanical Pressure in the Treatment of Chronic Lateral Epicondylalgia: A Pilot Study Jason Outrequin, Farshid Moshiri, Rahim Khorassani Zadeh <b>Introduction:</b> Chronic Lateral Epicondylalgia (CLE) is potentially associated with a significant reduction of the patient’s quality of life; its treatment by manual Deep Transverse Friction (DTF), although widely accepted, lacks standardization. The purpose of our study was to evaluate the efficacy of the MyoDK device, which allows deep transverse pressure (DTP) monitoring, for treatment of CLE. <b>Materials and Methods:</b> This is a single centre observational study for treatment of CLE by the MyoDK device. In a given year, all patients who appeared at our institution with a diagnostic of CLE were screened for possible inclusion. <b>Exclusion criteria were:</b> confounding factors on pain and function of the upper limb, cognitive impairment, inability or unwilling to give informed consent or to comply with treatment protocol. Our primary outcome measure was the pain reduction measured by the VAS pain scale (VAS) at 6 weeks. Our intervention consisted in applying a pressure from 0.5 to 10kg/100mm2 for 20 minutes, once a week for 6 weeks, using the MyoDK device. <b>Results:</b> Thirty patients were screened. Two were excluded for incomplete protocol, remaining 28 for analysis. Mean age was 47.3, 23 were male (82.1%), 24 were affected on their dominant side (85.7%). We had a significant reduction in VAS pain score at 12 weeks (80.8 vs 13.0; p<0.01). There were no side effects reported. <b>Conclusion:</b> Our study showed the safety of the use of a standard protocol using the MyoDK device for treatment of CLE. We believe that further controlled studies will establish the MyoDK as a reliable option for treatment of CLE. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=YC05-YC08&id=6673 https://doi.org/10.7860/JCDR/2015/.6673 Impact of Dental Neglect Scale on Oral Health Status Among Different Professionals in Indore City-A Cross- Sectional Study Pubali Sarkar, Pralhad Dasar, Sandesh Nagarajappa, Prashant Mishra, Sandeep Kumar, Swati Balsaraf, Afsheen lalani, Astha Chauhan <b>Background:</b> Young educated Indian generation are very much health conscious. They take adequate nutritious balanced diet and practice physical exercise regularly to keep themselves active and healthy. Oral health is a part of general health care system. If oral health is neglected it may affect our general health and as a result it affects our quality of life too. <b>Aim:</b> To assess dental negligence and oral health status by using Dental Neglect scale questionnaire among different professionals of Indore city. <b>Materials and Methods:</b> The study consisted of a convenient sample of 400 students of aged 18-25 years from 4 different professional colleges of Sri Aurobindo Group of Institutes of the same campus. A pretested validated questionnaire was used for assessing dental neglect and home dental care practices. Oral health examination was conducted to assess dental caries and oral hygiene status by using DMFT and OHIS respectively. Data was analysed using SPSS Software (version 20). <b>Results:</b> For OHI(S), majority of the respondents (57.7%) showed fair oral hygiene for DNS score <15, whereas majority of the professionals (63.7%), showed poor oral hygiene for DNS score >15. The Dental Neglect Scale (DNS) score was found statistically significant with OHIS and caries experience at 95% Confidence Interval. There was no statistically significant difference between DNS score and frequency of Decayed, Missing and Filled teeth DMFT. <b>Conclusion:</b> The Dental Neglect Scale appears to be a sound method for objectifying dental neglect. It has many of the features of a satisfying health index. However, further validation with other age groups, cultures, place and a larger population is required in order to justify the utility of Dental Neglect Scale in different situations. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ZC67-ZC70&id=6674 https://doi.org/10.7860/JCDR/2015/.6674 Biological Reference Interval for Hematological Profile of Umbilical Cord Blood: A Study Conducted at A Tertiary Care Centre in South India Febe Renjitha Suman, Reddy S. Sudheer Raj, N. Priyathersini, Rithika Rajendran, Rashmika Rajendran, Umalakshmi Ramadoss <b>Introduction:</b> Umbilical cord blood (UCB) a source of hematopoietic stem cells, is also an acceptable sample to assess neonatal sepsis. Though reports are available for stem cell counts very minimal literature is available regarding hematologic parameters, which may vary on ethnicity. <b>Aim:</b> To establish biological reference interval for hematological parameters of umbilical cord blood to guide neonatologists, hematopoietic stem cell transplant specialists and future analysis. <b>Materials and Methods:</b> Prospective longitudinal study was done from January 2014 to April 2014 after ethics committee approval. UCB from 120 full term new borns of normal birth weight born out of uneventful pregnancy to mothers aged between 21 to 45 years with hemoglobin above 10g/dL were processed in Beckman Coulter LH780 analyzer for complete blood count and counter checked by peripheral smear. Results tabulated in Microsoft excel are analyzed using IBM SPSS statistics 16 software. <b>Results:</b> Male to female ratio is 1:1.05. There is no difference in the values between males and females. When compared with few studies available, though many values are comparable a few values are not comparable. <b>Conclusion:</b> This study can be a useful guide to neonatologists, hematopoietic stem cells transplant hematologists and future analysis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=SC07-SC09&id=6675 https://doi.org/10.7860/JCDR/2015/.6675 Study of Third Coronary Artery in Adult Human Cadaveric Hearts Manisha Randhir Dhobale, Medha Girish Puranik, Nitin Radhakishan Mudiraj, Uttama Umesh Joshi <b>Introduction:</b> Third coronary artery (TCA) is a direct branch arising from the anterior aortic sinus (right aortic sinus) which supplies right ventricular outflow tract. It is found frequently and may be an important source for collateral coronary blood flow through a vascular anastomotic bridge (circle of Vieussens) between the right and left coronary systems. <b>Aim:</b> To evaluate the gross anatomy of third coronary artery in terms of their number, origin, extent and distribution. <b>Materials and Methods:</b> After an ethical approval, 150 formalin fixed adult human cadaveric hearts were collected from Department of Anatomy, BVDU Medical College and Hospital, Sangli and Pune over the period of six years. The careful dissection was carried out to note details about third coronary artery and data was analysed using SPSS computer software. <b>Results:</b> The TCA was present in 32% of the heart specimens. In 42 hearts (28%) single TCA and in 6 hearts (4%) double TCA were noted. It was found to be variably distributed to conus arteriosus, anterior wall of the right ventricle, interventricular septum and the apex of the heart. TCA was larger than right coronary artery in 8 hearts and later ended at inferior border of heart. Myocardial bridge was noted over large third coronary artery in one specimen. <b>Conclusion:</b> TCA is present frequently. It anastomoses with branches of left anterior descending artery (LADA) and contributes to apical and septal perfusion. Hence role of TCA should always be considered during diagnostic and therapeutic interventions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=AC01-AC04&id=6676 https://doi.org/10.7860/JCDR/2015/.6676 SNAPPE-II (Score for Neonatal Acute Physiology with Perinatal Extension-II) in Predicting Mortality and Morbidity in NICU Shivanna Sree Harsha, Banur Raju Archana <b>Introduction:</b> A number of illness severity scores have evolved which would predict mortality and morbidity in intensive care units. One such scoring system developed by Richardson was SNAPPE-II (Score for Neonatal Acute Physiology with Perinatal extension-II). <b>Aim:</b> The present study was conducted to assess the validity of SNAPPE-II score as a predictor of mortality and morbidity. <b>Materials and Methods:</b> A total of 248 neonates who met the inclusion criteria were included in the study and SNAPPE-II score was calculated. Receiver Operating Characteristic (ROC) curve was constructed to derive the best cut-off score and SPSS package (Statistical Package for the Social Sciences) was used for statistical analysis. <b>Results:</b> SNAPPE-II score was higher among expired neonates compared to survived ones. A mean score of 37 was associated with higher mortality. However, it didn’t accurately predict the length of stay. <b>Conclusion:</b> SNAPPE II score is a better predictor of mortality irrespective of gestational ages and it is not a good predictor of morbidity. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=SC10-SC12&id=6677 https://doi.org/10.7860/JCDR/2015/.6677 Screening for Mupirocin Resistance in Staphylococcus Avr Jeya Sanju, Sridharan Sathyamoorthy Kopula, Kennedy Kumar Palraj <b>Introduction:</b> Mupirocin is widely used topical antibiotic for the treatment of skin and soft tissue infections caused by Staphylococcus and Streptococcus. In addition nasal formulations are approved for the use in nasal eradication of methicillin-resistant Staphylococcus aureus in patients and health care workers. Wide usage of mupirocin has resulted in resistance leading to treatment failure. <b>Aim:</b> To screen for the mupirocin resistance among the Staphylococcus isolates using disc diffusion and minimum inhibitory concentration method. <b>Materials and Methods:</b> A cross-sectional study was done at Microbiology Department of Sri Ramachandra University with 100 strains of Staphylococcus spp isolated from skin and soft tissue infections. Methicillin susceptibility was done by disc diffusion method using oxacillin (1 µgm) and cefoxitin (30 µgm) discs. Isolates were screened for mupirocin resistance by disc diffusion method using 5 µgm discs. High level and low level resistance determined by MIC using agar dilution method. <b>Results:</b> In 100 Staphylococcus spp 56 were Staphylococcus aureus and 44 were CoNS. Among the 56 Staphylococcus aureus 49 (87.5%) were mupirocin susceptible and 7 (12.5%) resistant by 5µg disc diffusion method. However by MIC method 11 (19.6%) were high and low level mupirocin resistant. Out of 44 CoNS 22 (50%) and 18 (41%) were susceptible by disc diffusion and MIC method respectively. Of the 26 resistant CoNS low level and high level mupirocin resistant was observed in 7 (15.9%) and 19 (43.1%) respectively. <b>Conclusion:</b> Screening for mupirocin resistance by disc diffusion method is important before attempting decolonisation. Mupirocin resistance is more with CoNS. Disc diffusion method may miss low level Mupirocin resistance. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=DC09-DC10&id=6678 https://doi.org/10.7860/JCDR/2015/.6678 Choriocarcinoma with Uterine Rupture and Shock: A Rare Case Report Manika Agarwal, Ritesh Kumar, Jupirika Pyrbot, A.S. Singh Choriocarcinoma is a rare neoplasm and a malignant form of gestational trophoblastic disease. Choriocarcinoma is frequently preceded by a complete mole, ectopic pregnancy, nonmolar intrauterine abortion, and uncommonly by a partial mole. It is treated medically with chemotherapeutic drugs usually. However, we managed to save a life with appropriate and timely surgical intervention in a case of choriocarcinoma who presented with uterine rupture, haemoperitoneum, anaemia and hypovolemic shock. The patient underwent exploratory laparotomy and hysterectomy followed by systemic chemotherapy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ED20-ED21&id=6679 https://doi.org/10.7860/JCDR/2015/.6679 Acute Hypercalcaemia and Hypervitaminosis D in an Infant with Extra Pulmonary Tuberculosis Devi Dayal, Siya Ram Didel, Sikha Agarwal, Naresh Sachdeva, Meenu Singh In patients with tuberculosis, abnormal extrarenal production of 1,25-dihydroxyvitamin D3 by activated macrophages in granulomatous tissues may result in hypercalcaemia. More commonly reported in adults with active pulmonary tuberculosis, this complication may rarely occur in extrapulmonary tuberculosis, and children. The hypercalcaemia may be precipitated by usually recommended vitamin D and calcium supplementation in patients with tuberculosis. We report here an infant with tubercular meningitis who developed hypercalcaemia 12 days after starting routine vitamin D and calcium supplementation. This communication highlights the importance of close monitoring of calcium levels in patients with tuberculosis, especially if started on vitamin D and calcium replacement before anti-tubercular therapy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=SD03-SD04&id=6680 https://doi.org/10.7860/JCDR/2015/.6680 Severely Resorbed Edentulous Ridges: A Preventive Prosthodontic Approach – A Case Report Shalini Karnam, Swapna Basimi, Haragopal Surapaneni, Sreeramulu Basapogu, Ramlal Gantala As a dentist our main aim should be prevention which not only includes prevention of caries and or periodontal disease but also prevention of residual alveolar bone loss after teeth are extracted. Today with greater stress on preventive measures, the dental profession has expanded this preventive concept into Prosthodontics. Preventive Prosthodontics emphasizes the importance of any procedure that can delay or eliminate the future Prosthodontic problem and stop further progression of oral disease and prevent the loss of remaining tissues. The Residual Ridge Resorption (RRR) is an inevitable consequence of tooth loss and denture wearing. Severe RRR gradually results in increased interarch distance, significant horizontal discrepancy between edentulous ridges, occurrence of flabby displaceable tissues in the denture bearing area and other sequelae. Prosthetic rehabilitation in these patients can be challenging. The conventional complete denture fabrication in such cases may further compound the poor denture bearing ability of the tissues and lead to decreased retention, stability and support which may result in psychological problems and social isolation. This case report emphasizes the importance of preventive concepts in every step of complete denture fabrication to offer a long serviceable prosthesis without any significant complications and compromise. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ZD17-ZD19&id=6666 https://doi.org/10.7860/JCDR/2015/.6666 Reticulum vs Inclusions: A Learning Experience in Haemoglobin H Disease Hanaganahalli B Sridevi , Anupama Hegde , Prashantha Balanthimogru , Urmila N. Khadilkar , Shrijeet Chakraborti Haemoglobin H disease, also known as the alpha-thalassaemia is characterized by the presence of HbH inclusions in red blood cells, detectable on supra-vital stain. We present a case of a previously asymptomatic 31-year-old male, who insidiously developed anaemia and had prominent splenomegaly. Peripheral smear examination revealed microcytic hypochromic anaemia with numerous spherocytes and moderate polychromasia. In reticulocyte preparation with Brilliant cresyl blue, HbH inclusions were mistakenly identified as granulofilamentous reticulum of reticulocytes, giving a spuriously high reticulocyte percentage. After the literature review, repeat assessment was performed and with the aid of high performance liquid chromatography result, it was possible to delineate the HbH inclusions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ED17-ED19&id=6657 https://doi.org/10.7860/JCDR/2015/.6657 Facilitated Eruption of an Impacted Premolar 8 Years Post-eruption Timing- Think before You Treat!!! Neha, Tulika Tripathi, Priyank Rai, Navneet Singh The treatment planning of impacted teeth usually involves surgical intervention for bringing about its eruption with traction. But a thoughtful analysis in such cases looking at the possible aetiology may save the complexity of therapy. The present case demonstrates the importance of correct diagnosis in resolving impaction wherein an impacted mandibular second premolar was made to erupt using a simple removable appliance 8 years after its normal range of eruption timing. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ZD14-ZD16&id=6658 https://doi.org/10.7860/JCDR/2015/.6658 Spermatic Cord and Peritoneal Metastases from Unruptured Hepatocellular Carcinoma Udit Chauhan, S Rajesh, Vivek Kasana, Shailesh Gupta, Chhagan Bihari Extrahepatic metastases are not uncommon in patients with late-stage hepatocellular carcinoma (HCC). These extrahepatic lesions are most commonly found in the lungs, lymph nodes and bones. The authors report the case of a patient with chronic liver disease who presented with left inguinal swelling which was thought to be incarcerated hernia on clinical examination. Further evaluation revealed that the patient had HCC with spermatic cord metastasis which was masquerading as inguinal hernia. He also had extensive peritoneal dissemination. Awareness and accurate detection of these unusual sites of extrahepatic dissemination of HCC is of paramount importance for radiologists to avoid unnecessary surgery as well as after loco regional therapy to assess for recurrence. Details of the case are discussed with a review of the relevant literature. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=TD04-TD05&id=6650 https://doi.org/10.7860/JCDR/2015/.6650 Ectopic Paratubal Adrenal Cell Rest Associated with Mucinous Cystadenoma of Ovary Binny Khandakar, Soumit Dey, Prasenjit Sen Ray, Ranu Sarkar, Palas Bhattacharyya Ectopic adrenal cortex is a rare entity. Usually found in male children; commonly located around kidney, retroperitoneum, spermatic cord and para-testicular region. Rarely, adults with heterotopic adrenal glands are described. Incidence in females is very less; though sometimes detected accidentally in hysterectomy specimens. We describe a case of ectopic adrenal cortical cell in paratubal region in a patient with mucinous cyst adenoma of ovary. A 26-year-old female presented with complains of menstrual irregularities and abdominal discomfort for 6 months. Investigations suggested a right ovarian cyst. Right ovarian cystectomy with partial salpingectomy was performed; histopathology revealed mucinous cyst adenoma. Sections from tube showed presence of ectopic adrenal cortical rest in the paratubal region, incidentally discovered on microscopy. We present this case because of its rarity in females, interesting presentation with another unrelated gynaecological pathology, its potentiality for malignant transformation and possible complications. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ED13-ED14&id=6638 https://doi.org/10.7860/JCDR/2015/.6638 Microfilaria Coexistent with Fibroadenoma – An Unusual Association Kavita Chandrahas Sane, Sandhya Unmesh Bholay, Vaibhav Bhika Bari, Manoj Narayan Kulkarni Filariasis is an endemic problem in India. Involvement of breast by filariasis is uncommon, but known to occur in endemic areas. However, microfilaria co-existing with neoplastic lesions is very rare. Here we report an unusual finding of microfilaria co-existing with fibroadenoma in a 20-year-old female patient. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ED15-ED16&id=6647 https://doi.org/10.7860/JCDR/2015/.6647 Primary Antiphospholipid Antibody Syndrome: A Case Report Deepak K Kadeli, Siddaraya Y Hanjagi Primary Antiphospholipid antibody syndrome is a rare disease associated with thromboembolic events which may affect either the arterial or the venous vasculature. It presents with an increased risk of thrombosis in pregnant woman leading to repeated fetal losses. We present here a case of primary antiphospholipid antibody syndrome in young women who had previous event of gangrene of toes leading to their amputation and repeated fetal losses. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=OD04-OD05&id=6641 https://doi.org/10.7860/JCDR/2015/.6641 Appendicitis in Postpartum Period: A Diagnostic Challenge Divya Wadhawan, Seema Singhal, Nivedtia Sarda, Renu Arora Infections that occur in the postpartum period are assumed to be related to pregnancy or delivery; however other causes should also be considered. Appendicitis is one of the most common conditions requiring laparotomy during pregnancy, but very few cases of postpartum appendicitis have been reported. We report two such cases and the challenges faced by clinicians in diagnosis of immediate postpartum appendicitis. The first case was managed on lines of puerperal sepsis and the second one as enteric fever. Appendicular pathology was detected incidentally on laparotomy. In postpartum patients with no obvious focus of sepsis, appendicitis should be kept in mind. A team approach involving sensitized obstetricians and surgeons is likely to reduce serious morbidities. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=QD10-QD11&id=6642 https://doi.org/10.7860/JCDR/2015/.6642 Morning Glory Disc Anomaly, A Report of a Successfully Treated Case of Functional Amblyopia Humberto Cavazos -Adame, Abraham Olvera-Barrios, Alejandro Martinez-Lo pez-Portillo, Jesus Mohamed-Hamsho Morning Glory Disc Anomaly (MGDA) is a congenital malformation of the optic nerve characterized by the presence of a funnel-shaped macropapilla with neuroglial remnants in its center surrounded by an elevated and pigmented chorioretinal ring. Its incidence is rare and no gender predisposition has been found. Associated conditions like strabismus lead to an early diagnosis. We report the case of a 3.8-year-old boy with amblyopia of the right eye (count fingers 0.3 meters) due to MGDA. Correction of the refractive error with glasses, along with occlusive therapy resulted in a visual acuity of 20/100 after a five-year follow up. The presence of amblyopia in these cases demands an early management oriented to improve the visual acuity. Every patient with an anatomical malformation diagnosed during the period of sensory maturation should be treated with occlusive therapy and followed on a regular basis to diagnose associated conditions such as retinal detachment. We recommend occlusive therapy in every patient diagnosed with MGDA or in any patient with unilateral or asymmetric structural abnormalities that could lead to amblyopia. This 5-year case follow-up provides additional evidence of the importance of treatment during the period of amblyopia reversibility. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ND01-ND03&id=6695 https://doi.org/10.7860/JCDR/2015/.6695 Schwanomma From Cervical Sympathetic Chain Ganglion – A Rare Presentation A. Affee Asma, E. Kannah Schwanommas arising from cervical sympathetic chain are tumours that are rare in occurrence. These lesions are usually difficult to differentiate from a vagal schwanomma and a carotid body tumour during the initial workup. In this report, a rarely seen huge cervical sympathetic chain schwanomma case with partial Horner’s syndrome is being presented in detail, which to our known knowledge, is one of the few cases reported in literature. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=PD08-PD09&id=6693 https://doi.org/10.7860/JCDR/2015/.6693 Atypical Presentation of Capillary Hemangioma in Oral Cavity- A Case Report Veena Raj Vasantha Kumari, Chitra Girija Vallabhan, Seema Geetha, Manoj S Nair, Tharun Varghese Jacob Capillary Haemangioma is a benign vascular tumour characterized by proliferation of blood vessels that are primarily reported to be a developmental hamartomatous lesion of infancy and childhood. Pyogenic granuloma is a non-neoplastic benign lesion found in the oral cavity having a striking predilection for occurrence in the gingiva. The present case report is an atypical presentation of capillary haemangioma on gingiva which is considered to be extremely rare. The lesion in this case was clinically diagnosed as pyogenic granuloma but histopathologically as capillary haemangioma. These lesions present as a diagnostic dilemma to the clinician and can lead to serious complications if not carefully managed. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ZD26-ZD28&id=6691 https://doi.org/10.7860/JCDR/2015/.6691 Modified SARME (Surgically Assisted Rapid Maxillary Expansion) in Conjunction with Orthodontic Treatment- A Case Report Sagar Dahiya, Prasad Chitra, Sadam Srinivas Rao, Sukhvinder Bindra Transverse maxillary hypoplasia or maxillary constriction in conjunction with unilateral or bilateral posterior cross bites is a common finding in cleft palate patients. These situations are also commonly encountered in adults who have not had recourse to orthodontic treatment in childhood. In adults, after ossification of the mid palatal suture is complete, the accepted means of correcting transverse skeletal discrepancies is by Surgically Assisted Rapid Maxillary Expansion (SARME). The disadvantage of this technique in the Indian scenario is reduced patient acceptance and increased treatment costs. Le Fort-I down fracture and mid palatal suture sectioning requires hospitalization and increases morbidity. A case of a 21-year-old non-cleft male who presented with Class I malocclusion with transverse skeletal discrepancy and bilateral posterior cross bites is presented. A modified SAARME technique was performed without pterygomaxillary disjunction, as an outpatient procedure. The results obtained were satisfactory and the desired amount of transverse skeletal correction was achieved. The patient was discharged the same day. The technique can be used to successfully treat a large number of patients in India with maxillary skeletal transverse problems with increased predictability, reduced costs and morbidity and higher rates of acceptance. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ZD20-ZD22&id=6687 https://doi.org/10.7860/JCDR/2015/.6687 A Novel Approach to Regain Anterior Space Using Modified 2 by 3 Fixed Appliance: A Report of Two Cases Ziauddin Mohammad, Sampath Redd Y Cheruku, Sarada Penmetcha, Apeksha Bagalkotkar, Surabhi Kumari Early loss of permanent anterior teeth in growing children has a psychological impact on the child. Anterior teeth are important both aesthetically and functionally. When a permanent tooth is lost, the teeth adjacent to the created space tend to migrate into the space resulting in the space loss. Management of regaining space with the removable appliance always depends on child cooperation for using the appliance as well as for the recall visits. The advantages of fixed appliances over the removable appliances are minimal discomfort, reduced need for patient cooperation and increased control of tooth movements in all three directions of space. Thus, a short course of fixed appliance like the modified 2 by 3 fixed appliance followed by fixed functional space maintainer could be an ideal treatment option for such cases. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ZD23-ZD25&id=6688 https://doi.org/10.7860/JCDR/2015/.6688 Urethral Diverticulum Masquerading as Anterior Vaginal Wall Cyst: A Diagnostic Dilemma Gurpreet Kaur, Sandhya Jain, Abha Sharma, Amita Suneja, Kiran Guleria Urethral diverticulum (UD) is a condition in which a variably sized outpouching forms, next to the urethra. Because it connects to the urethra, this outpouching repeatedly gets filled with urine during micturition, thus causing symptoms. In females, it presents as a bulge in anterior vagina, mimicking a vaginal wall cyst. Various aetiologies proposed attributing to urethral diverticulum formation is repeated infection of the periurethral gland, childbirth trauma, iatrogenic and urethral instrumentation. Patients of UD present with non specific irritative lower urinary tract symptoms such as increased frequency, urgency and dysuria; symptoms may not correlate with the size of the diverticulum. Recurrent cystitis or urinary tract infection is seen in one-third of patients. Pain, hematuria, post-void dribbling, dyspareunia, urinary retention or incontinence is other symptoms. In some cases, there may be associated urethral calculi or carcinoma. Magnetic resonance imaging (MRI) is highly sensitive and specific for the diagnosis of UD, although non invasive sonography may be the first line investigation. Treatment is by transvaginal diverticulectomy or marsupialization. A 60-year-old P9L6 postmenopausal lady, presented with a tender, hard suburethral anterior vaginal wall mass. Cystourethroscopy revealed a small opening in posterior urethra, with stone visible through it. With the final diagnosis of suburethral diverticulum with retained multiple calculi, excision of the diverticulum and repair of urethra was done vaginally. Correct evaluation and treatment of this condition can lead to avoidance of urinary tract injury. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=QD08-QD09&id=6636 https://doi.org/10.7860/JCDR/2015/.6636 Gas in Hepatic Portal Veins with Gastric Massive Dilatation and Pneumatosis in Acute Pancreatitis Maulana M. Ansari, Nadeem Mushtaq, Vibhor Pateria, Imtiyaz Ahmad, Nitin Kulshreshtha Gas in portal veins is a rare phenomenon observed secondary to bowel ischaemia and necrosis. A young girl with history of pica ingestion presented with acute abdomen with huge distension. Investigation revealed air in hepatic portal veins, air within stomach wall, and massive distension of stomach secondary to acute pancreatitis. Successful conservative treatment confirmed the current concept that all cases of hepatic portal venous gas do not warrant immediate surgical intervention. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=PD05-PD07&id=6634 https://doi.org/10.7860/JCDR/2015/.6634 A Case of Intraoral Lymphangioma Circumscripta – A Diagnostic Dilemma Dara Balaji Gandhi Babu, B.Raj Kumar, Niharika Harsha Boinepally, Ashalata Gannepalli Lymphangiomas are developmental malformations which present as benign hamartomas of lymphatic channels. They are commonly located in the head and neck region and are less frequently reported in the oral cavity. However affected sites in the oral cavity include the tongue, palate, gingiva, buccal mucosa, lips and alveolar ridge of the mandible. The most common site in the oral cavity is tongue. Lymphangioma of the buccal mucosa is rare as per the available literature and they usually occur as lobular masses or cystic lesions. Histopathologically, lymphangioma appear as proliferated lymphatic vessels lined by plump endothelial cells. Surgical excision, laser therapy and sclerotherapy are the eventual modes of treatment. This paper reports a rare case of lymphangioma of the buccal mucosa in a 60-year old male patient managed by surgical excision. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ZD11-ZD13&id=6629 https://doi.org/10.7860/JCDR/2015/.6629 Large Nabothian Cyst Obstructing Labour Passage Fisun Vural, ilhan Sanverdi, Ayse Deniz Ertürk Coskun, Alim Kusgöz, Orhan Temel Nabothian cysts are common and silent retention cysts of the uterine cervix with no particular intervention required. It is quite rare to reach a size of more than 4 cm and it is a diagnostic dilemma to differ it from adenoma malignum. We report a case of a woman with 38 weeks of gestation presented to the maternity unit with labour pain and protruding cystic mass (60x70 mm) out of the vagina. Simple drainage was performed to allow the vaginal delivery. She delivered 4130 grams, 9-10 Apgar, male baby by spontaneous vaginal delivery. The patient’s and the newborn postpartum course was uneventful. Gynaecologic examination revealed a persisting cystic mass in the cervix (40x50 mm) two months after the delivery. We performed a total excision of the cyst to confirm the pathologic diagnosis. This paper is the first report of nabothian cysts obstructing labour passage. In the view of this case, we aimed to discuss cervical cystic masses and a review of the literature. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=QD06-QD07&id=6630 https://doi.org/10.7860/JCDR/2015/.6630 Renal Myxoma- A Rare Variety of Benign Genitourinary Tumour Kamlesh S. Suthar, Aruna V. Vanikar, Rashmi D. Patel, Kamal V. Kanodia Renal myxomas are rare neoplasms and very few cases have been reported in literature. Here we report a renal myxoma in a 48-year-old lady with hypothyroidism who presented with abdominal pain. She was found to have a mass lesion of 67 x 61 x 74 mm with exophytic component in the right kidney on ultrasonography and computed tomography. Right radical nephrectomy was performed due to suspicion of malignancy. Grossly the resected kidney showed a gelatinous, semi-translucent mass involving the mid and lower poles. Microscopy revealed marked hypocellular appearance of loose myxoid tissue with foamy histiocytes. Tumour cells were reactive for vimentin. At eight months of follow-up, patient is doing well. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ED11-ED12&id=6631 https://doi.org/10.7860/JCDR/2015/.6631 Serous Microcystadenoma of Pancreas Puvitha Rajeswari Duraisami, Vinuta Malaichamy, Lalitha Chithambaram Cystic tumours of the pancreas are less common, representing 5% to 10% of all pancreatic neoplasms. They constitute an important subset because many cystic tumour are either benign or low-grade (indolent) malignant neoplasm. Cystic lesions are also detected more commonly owing to the increased use of sensitive imaging techniques. A female patient 48-year-old, presented with upper abdominal symptoms. CT abdomen reveals a large multicystic mass with central scar shows no communication with pancreatic duct. Resected specimen, show a large lobulated mass with central scar and many small cysts. Microscopic examination confirms the diagnosis of serous adenoma. PAS positivity is used to demonstrate the glycogen content of the lining epithelium. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ED09-ED10&id=6627 https://doi.org/10.7860/JCDR/2015/.6627 Pelvic Floor Support Defect in Apical Anterior Vaginal Prolapse with Cervical Hypertrophy. Review with Case Report in a 20-year-old Cadaver Kalpana Chhetri Apical anterior vaginal wall prolapse (AVWP) with central defect is uncommon in young non hysterectomized patients causing considerable mortality after the fourth decade of life. Its high propensity to recurrence poses the greatest challenge to pelvic reconstructive surgeons. Approximately 40% of women with prolapse have hypertrophic cervical elongation and the extent of elongation increases with greater degrees of prolapse. Women with prolapse either have inherent hypertrophic elongation of the cervix which predisposes them to prolapse or the downward traction in prolapse leads to cervical elongation. The Pelvic Organ Prolapse Quantification (POP-Q) examination includes measurement of the location of the posterior fornix (point D) with the assumption that this measurement is associated with cervical elongation. Multifocal site involvement with apical and perineal descent primarily afflicts elderly, postmenopausal women after the fourth decade while cervical hypertrophic elongation with prolapse is observed in younger women less than 40 years of age. A review of the anatomical implication of the association of cervical hypertrophy in prolapse is carried out in this article. We observed a combination of distension type anterior vaginal prolapse with apical descent and cervical hypertrophy in a 20-year-old cadaver during routine dissection for undergraduate medical students at Sikkim Manipal Institute of Medical Sciences in 2013. Distension type anterior vaginal prolapse with central defect is rarer as most reported cases are of the displacement type, paravaginal defect. Hypertrophic cervical elongation is either the cause or consequence of prolapse and its identification before reconstructive surgery is paramount as uterine suspension in the face of cervical elongation is contraindicated. Inappropriate identification of all support defects and breaking of tissues is the primary cause of failure of laparoscopic pelvic reconstructive surgery. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=AD01-AD04&id=6614 https://doi.org/10.7860/JCDR/2015/.6614 Keratoacanthoma of Upper Lip: Review and Report of Case Managed Surgically Saakshi Gulati, Deepak Pandiar, Selvan Kakky, Achal Y Jiwane, Anita Balan Keratoacanthoma is a benign lesion usually presenting as a solitary, dome shaped nodule with a central crater filled with keratin. It frequently occurs on the sun exposed areas of the skin. Keratoacanthoma can be difficult to differentiate from oral squamous cell carcinoma both clinically and microscopically. A case of keratoacanthoma involving the upper lip in a 51-year-old male is reported presenting as an exophytic growth that resolved after excisional biopsy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ZD08-ZD10&id=6620 https://doi.org/10.7860/JCDR/2015/.6620 Case series: Pregnancy Outcome in Patients with Uterine Fibroids B.H. Radhika, Kusuma Naik, S. Shreelatha, Harshini Vana Fibroids in pregnancy is a commonly encountered clinical entity. Objective of this study was to evaluate the maternal and fetal outcome in women having pregnancy with uterine fibroids. We present the clinical, obstetric data, perinatal outcomes of 15 patients from a prospective study. Fifteen pregnant women with fibroid >3cm were prospectively included in study. Major proportion of patient with fibroids were in younger age group of 25-30 years when compared to older age group of 31-35 years (66% vs 33%). Fibroids were more frequent in multi-gravidae, compared to primigravidae. In almost half of patients, (53.3%) fibroids were diagnosed before pregnancy. Common complications encountered during pregnancy in decreasing order of frequency were pain abdomen (46.6%), followed by threatened preterm labour (26.6%) and anaemia (26.6%). Out of 15, three (20%) women had abortion. In remaining, 11/12 patients attained term pregnancy between 37 to 40 weeks. Two patients required antenatal myomectomy. Caesarean section was done in 75% of women who attained term pregnancy and one patient had technical difficulty during caesarean section. Post partum heamorrhage was seen in 5/15 (33.3%) of patients. Out of 12, five babies were low birth weight. Four babies required NICU admission. There was no perinatal mortality. In our small patient series high incidence of caesarean section rates and increased incidence of threatened preterm labour, anaemia, and postpartum haemorrhage, was observed in pregnant patients with fibroids and hence, the pregnancy with fibroids should be considered as high risk pregnancy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=QR01-QR04&id=6621 https://doi.org/10.7860/JCDR/2015/.6621 Unusual Course of Splenic Artery: A Case Report Hemamalini Splenic artery is the largest branch from the celiac trunk. It is remarkably tortuous in its course before it enters the hilum of the spleen. During routine dissection of abdomen for undergraduate students in a 60-year-old male cadaver, we observed an unusual course and tortuosity in the splenic artery. Knowledge of such unusual tortuous splenic artery is important in partial or total splenectomy, splenic aneurysum, splenic embolisation and surgeries related to pancreas, stomach. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=AD05-AD06&id=6622 https://doi.org/10.7860/JCDR/2015/.6622 TASER® Electronic Control Device-Induced Rhabdomyolysis and Renal Failure: A Case Report James Benjamin Gleason, Ibrahim Ahmad Many law enforcement agencies around the United States are employing the use of TASER® electronic control devices (TASER® International Inc.) to subdue combative suspects. Since its inception the TASER® has had a temporal association with reports of rhabdomyolysis. Case reports have reported TASER® induced rhabdomyolysis as mild but serious cases have also been reported. Herein we present the case of a single patient who was admitted to our health network with severe rhabdomyolysis after receiving TASER® shocks and review the pertinent literature. No direct link has been established between clinically significant rhabdomyolysis and TASER® device application but this case serves as an example of a sparsely documented but serious complication that may occur in patients who are at risk for restraint by an electronic control device. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=HD01-HD02&id=6608 https://doi.org/10.7860/JCDR/2015/.6608 Primary Bacteremia Caused by Rhizobium radiobacter in Neonate: A Rare Case Report Shreekant Tiwari, Siba Shanker Beriha Rhizobium radiobacter is a gram-negative tumourigenic plant pathogen that rarely causes infections in humans. Rhizobium radiobacter has a strong predilection to cause infection particularly in those patients who have long standing indwelling foreign devices. Herewith we report a rare case of Rhizobium radiobacter bacteremia in a new born baby without other risk factors. The patient was successfully treated with gentamicin and imipenem. To the best of our knowledge this is the first documented case of R. radiobacter from India causing neonatal infection. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=DD01-DD02&id=6598 https://doi.org/10.7860/JCDR/2015/.6598 Successful Retrieval of Uncoiled Coronary Guidewire Using Simple Balloon Method Shivanand Patil, Rangraj Ramalingam, Jayashree Kharge, Mohan Nayak, Cholenahally Nanjappa Manjunath Breakage of angioplasty device in coronary artery can cause panic in the catheterization laboratory. These broken fragments may serve as a nidus for thrombus formation; hence, removal of these fragments becomes mandatory. Since the incidence of guidewire fracture during angioplasty are rarely reported, evidence-based approaches are not available for the management of such incidental conditions. Here, we report an interesting case of entrapment and unravelling of guidewire. We successfully retrieved unravelled guidewire using a noncompliant balloon inflated in the guiding catheter. Subsequently, the procedure was completed successfully with an implantation of a stent in the culprit lesion. We are of opinion that this novel technique is quite easy and less cumbersome than other described techniques reported earlier. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=OD01-OD03&id=6599 https://doi.org/10.7860/JCDR/2015/.6599 Intraneural Hybrid Neurofibroma/Schwannoma In Scalp: A Case Report Kishori Moni Panda, Naik Reena Benign Peripheral Nerve Sheath Tumours (BPNSTs) are traditionally classified into schwannoma, neurofibroma and perinurioma. Due to advances in molecular techniques, hybrid BPNSTs containing more than one histologic types have been documented. Recent studies have demonstrated their frequent association with inherited syndromes like schwannomatosis and neurofibromatosis. Intraneural variant of hybrid neurofibroma/schwannoma is yet to be described. Here we report such a case in a 30-year-old male, who presented with a scalp swelling and histology showed intraneural neurofibromatous tumour admixed with schwannoma-like nodules. IHC (immunohistochemistry) showed variable S100 staining in neurofibromatous areas, diffuse S100 staining in schwannoma-like areas and negative EMA staining in the tumour. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ED05-ED06&id=6600 https://doi.org/10.7860/JCDR/2015/.6600 Pseudoepitheliomatous, Keratotic and Micaceous Balanitis: A Case Report Shashikant Malkud, Veeresh Dyavannanavar Pseudoepitheliomatous, keratotic and micaceous balanitis (KPMB) is a rare condition affecting glans penis of elderly men. It is characterized by thick hyperkeratotic plaque with micaceous scaling often leading to phimosis. Here we are reporting a rare case of pseudoepitheliomatous, keratotic, and micaceous balanitis in 50-year-old man who has undergone circumcision 16 years back. Till date only a handful cases have been reported in world literature. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=WD01-WD02&id=6601 https://doi.org/10.7860/JCDR/2015/.6601 Intraparenchymal Angiomatous Meningioma: A Diagnostic Dilemma Divya Bansal, Preeti Diwaker, Priyanka Gogoi, Wazid Nazir, Anupama Tandon Meningioma arises from the arachnoid cap cells of the cerebrum. Intraparenchymal meningiomas or meningiomas without dural attachment are rare. We report a case of 40-year-old male who presented with a history of headache, dizziness and gradual loss of vision since one year. Clinicoradiological diagnosis of a high grade glioma was considered. Tumour was excised and haematoxylin and eosin stained sections revealed a tumour comprised predominantly of variable sized blood vessels showing hyalinization in a background of plump spindle cells with oval vesicular nuclei. In view of these features angiomatous meningioma was suspected. However, to confirm the diagnosis, a panel of immunohistochemical markers including vimentin, EMA and GFAP was done and a final diagnosis of angiomatous meningioma was offered. Angiomatous meningioma is a rare variant of meningioma and even much rarer in the intraparenchymal location. Angiomatous meningioma should be considered in the differential diagnosis of highly vascular intraparenchymal brain tumours. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ED07-ED08&id=6602 https://doi.org/10.7860/JCDR/2015/.6602 A Rare Case Report on Bilateral Intertrochanteric Fractures in a Child Following Child Abuse Raghavendra S Kembhavi, Boblee James Diagnosis of non accidental injury needs careful history elicitation, proper examination and thorough workup including blood investigation and radiological assessment to avoid misdiagnosis or under diagnosis. Correct diagnosis and reporting would avoid possible similar incidents in the future. Four-year-old female child brought to our hospital by her mother with apparent history of fall from height. Following detailed examination and radiological assessment we suspected of child abuse. Child had multiple fractures in different stages of healing which included bilateral intertrochanteric fractures. Child was operated for bilateral intertrochanteric fractures which appeared relatively fresh compared to other old malunited fractures with open reduction and fixation with titanium elastic nailing and was immobilized by hip spica. Two months postoperatively, there was complete radiological union of fractures and child was being counseled by child psychologist. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=RD03-RD05&id=6603 https://doi.org/10.7860/JCDR/2015/.6603 Plasmacytoid Myoepithelioma of the Hard Palate in a Child – A Rare Case Report Padmaja Ramesh Kulkarni, Anita Pandit Javalgi, Bhaswanth Pottipati, Fazil Shajahan Myoepithelioma is a rare tumour accounting for 1-1.5% of salivary gland tumours, 21% of which occur in soft & hard palate. Cytologic features of these tumours are not well established leading to diagnostic pitfall in many cases on FNAC. However, as radiologic findings are overlapping and inconclusive in salivary gland tumours, preoperative cytologic diagnosis may help surgeons to plan surgery especially in patients requiring facial surgery. Here, we present a rare case of plasmacytoid myoepithelioma of the hard palate in an 11-year-old boy which was conclusively diagnosed on FNAC and further confirmed by histopathological and immunohistochemical studies. We have made an attempt to describe cytologic features of myoepithelioma with differential diagnosis of these tumours through review of literature. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ED01-ED02&id=6583 https://doi.org/10.7860/JCDR/2015/.6583 Improving Gingival Aesthetics Using Platelet Rich Fibrin and Synthetic Collagen Membrane: A Report of Two Cases Debasish Mishra, Vijay Babu Kalapurakkal, Satya Ranjan Misra Covering the clinically exposed root surface of a tooth has now become a routine demand of patients to improve aesthetics and also to reduce the instances of hypersensitivity. The idea behind the treatment of gingival recession is to place the gingiva as close as possible to the cement-enamel junction so that the exposed root area is covered and a normal sulcus is created. Here we present a series of two cases of gingival recession treatment in young patients affecting the maxillary anterior region. The affected sites were treated by a periodontal flap with synthetic collagen membrane and patient derived platelet rich fibrin. It may be emphasized that platelet-rich fibrin can be used as a membrane for periodontal tissue regeneration and it has the ability to promote platelet aggregation, be chemotactic for fibroblast and enhance wound stability and proper healing. Hence, both the methods can be successfully used in place of a connective tissue graft for treating gingival recession. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ZD01-ZD04&id=6579 https://doi.org/10.7860/JCDR/2015/.6579 Low Grade Fibromyxoid Sarcoma of the Palate: A Case Report Srikanth Soma, Shriram Bhat, Sunil Kumar Shetty Low-grade fibromyxoid sarcoma (LGFMS) are rare soft-tissue sarcomas that usually come to attention as slow growing masses. Males and females are affected approximately equally and typically arising in the soft tissue of the proximal extremities. Primary occurrence within the head and neck is exceedingly rare. We report a case arising from the hard palate of a 40-year-old male and according to our knowledge this is the first ever case of LGFMS involving the palate to be reported. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=XD01-XD02&id=6557 https://doi.org/10.7860/JCDR/2015/.6557 Missed Iatrogenic Bladder Rupture Following Normal Vaginal Delivery Vidyasagar H Baheti, Vinayak G Wagaskar, Sujata K Patwardhan Bladder rupture following caesarian section is well documented complications. Intraperitoneal bladder rupture following normal vaginal delivery is very rare. Hereby, we present a case report of intraperitoneal bladder rupture presented late following normal vaginal delivery. We report a case of spontaneous intraperitoneal urinary bladder rupture following uneventful outlet forceps delivery in a 22-year-old primi gravid woman with gestational diabetes mellitus and fetal macrosomia who presented with large urinary ascites, anuria and renal failure. Emergent exploratory laparotomy with repair of the intraperitoneal bladder rupture helped to prevent its potential complications. Postpartum patients who undergo episiotomy or perineal repair may land up in unnoticed urinary retention which may rarely terminate in spontaneous urinary bladder rupture. Awareness of its manifestations amongst emergency physician would help to initiate appropriate timely management. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=PD01-PD02&id=6555 https://doi.org/10.7860/JCDR/2015/.6555 Comprehensive Evaluation of Cardiac Hydatid Using 256 Slice Dual Source CT: One Stop Shop Neeraj Jain, Sonali Sethi, Nishant Gupta, Vandana Goel, Sunil Kumar Puri https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=TD01-TD03&id=6550 https://doi.org/10.7860/JCDR/2015/.6550 Uncommon Presentation of Triploidy: A Case Report Isil Uzun, Özlem Pata, Cihat Unlu, Fatma Tokat, Mucize Ozdemir A 28-year-old woman presented in her first pregnancy was admitted with severe hyperemesis gravidarium. Increased nuchal translucency with cardiac anomaly and omphalocele at the first trimester was observed at the ultrasound examination. Chorionic villus biopsy confirmed triploidy. The combination of type I and type II triploidy patterns were seen together in the second trimester of the pregnancy. Although the symptoms due to increased human chorionic levels occured, at the pathologic investigation there were no molar changes in the placenta. Here we report a case of uncommon presentation of triploidy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=QD01-QD02&id=6553 https://doi.org/10.7860/JCDR/2015/.6553 Giant Gastric Lipoma Presenting as Gastric Outlet Obstruction – A Case Report Rajeev Nayan Priyadarshi, Utpal Anand, Manish Kumar Pandey, Binita Chaudhary, Ramesh Kumar Gartric lipomas are rare. They are mostly small in size, and usually remain asymptomatic. We report a case of giant (14×11cm) gastric lipoma in a 46-year-old male who presented with features of gastric outlet obstruction clinically mimicking gastric malignancy. Upper endoscopy showed a large smooth polypoid mass with broad base arising from posterior wall of gastric antrum with areas of superficial ulcerations. Multiple endoscopic biopsy specimens were nondiagnostic. A computed tomography (CT) scan of the abdomen revealed a huge cauliflower- like intraluminal mass with lobulated surface projecting into gastric lumen and pyloric canal. The mass demonstrated uniform fat density consistent with lipoma. The case is presented to stress the diagnostic problems related to this condition, and emphasize the role of CT in arriving at a correct diagnosis of lipomatous gastrointestinal tract tumours. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=PD03-PD04&id=6595 https://doi.org/10.7860/JCDR/2015/.6595 Claudication Due to Sciatic Nerve Palsy Following Nicolau Syndrome: A Case Report Masoud Hatefi, Nabi Ramezani Pirabadi, Javaher Khajavikhan, Molouk Jaafarpour Nicolau syndrome is a rare drug reaction due to intramuscular injection administration that can lead to limb loss or even death. A 3.8-year-old Iranian boy received an intramuscular injection of Benzathine Penicillin. Immediately after injection the child developed lower limb pain and livedoid discolouration and was referred to our department. The patient was diagnosed to develop Nicolau syndrome and fasciotomy carried out due to compartment syndrome. Pharmacologic therapy with Heparin, Cefazolin and Methylprednisolone was initiated. On 18th day, he was discharged, although he was not able to move. Finally, after 6 months of care at home, physiotherapy and Electromyography (EMG) at regular intervals, the child was gradually able to move and his claudication improved. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=RD01-RD02&id=6596 https://doi.org/10.7860/JCDR/2015/.6596 A Rare Entity of Giant Epidermal Exophytic Naevus of Hemifacial Region Tanveer Karpe, Naveen Kokkula, Mohammed Abidullah, Kiran Gundamaraju, Fazil Arshad The term nevi constitute a hamartomatous growth of either skin or mucosa that is generally found at birth or shortly after birth. An epidermal nevus consisting chiefly of sebaceous glands is called as nevus sebaceous. Typically this entity is seen as a solitary bald patch over the scalp at birth. We report a case of exophytic lesion following blaschko's lines at birth. We find this case as peculiar because of the multiplicity of lesions, their pattern of distribution, as well as their atypical morphology. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ZD05-ZD07&id=6593 https://doi.org/10.7860/JCDR/2015/.6593 A Rare Case of Bilateral Broad Ligament Haematoma in Twin Pregnancy Vijayalakshmi bankada, pallavi purra, Amulya marikatte ningappa, Shankar jirankal We report a rare case of bilateral broad ligament haematoma in twin pregnancy presented as gravida 3 para 2 living 2 (G3P2A0L2), with undelivered second twin with transverse lie with cord and hand prolapse with obstructed labour referred to our hospital from primary health centre after spontaneous vaginal delivery of first live healthy twin baby four hours later. On examination patient was stable, her investigations were within normal limits and patient was taken up for emergency lower segment caesarian section. Intraoperatively features of obstructed labour were present; a dead term baby was extracted with dichorionic diamniotic placenta. Bilateral broad ligament haematomas approximately of 8x8 cm were noted which were increasing in size after extraction of baby. On both sides haematomas were evacuated and drained along with bilateral uterine artery ligation. Three pints of blood were transfused intra and postoperatively. Her postoperative period was uneventful and the patient was discharged on postoperative day 14. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=QD03-QD05&id=6588 https://doi.org/10.7860/JCDR/2015/.6588 Trichinella spiralis: Mere Co-Existence or Carcinogenic Parasite For Oral Squamous Cell Carcinoma? Nadia Shirazi, Sampan Singh Bist, Sohaib Ahmad, Meena Harsh Trichinella spiralis is a parasite which is usually seen in pork-eaters. Most of the trichinosis infections cause little or no symptoms. We report a rare case of a middle aged North Indian male who presented with a painless ulcer in right buccal mucosa which was biopsied and reported as squamous cell carcinoma. Wide local excision was done subsequently which showed encysted larvae of Trichinella spiralis in the deeper skeletal muscle bundles. This article supports the carcinogenic potential of trichinosis and suggests timely work-up and treatment of the parasite. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ED03-ED04&id=6585 https://doi.org/10.7860/JCDR/2015/.6585 Neonatal Carnitine Palmitoyltransferase II Deficiency: A Lethal Entity Sushma Malik, Ashutosh Abhimanyu Paldiwal, Charusheela Sujit Korday, Shruti Sudhir Jadhav Carnitine palmitoyltransferase II (CPTII) deficiency is a rare disorder of mitochondrial fatty acid oxidation with autosomal recessive mode of inheritance. Three classic forms of CPT II deficiency have been described namely the lethal neonatal form, severe infantile hepatocardiomuscular form and the myopathic form. We present a three-day-old female child, admitted to us for lethargy, icterus, low sugars and convulsions. Persistent non ketotic hypoglycaemia, hyperammonemia, raised liver enzymes with hepatomegaly and cardiomyopathy led to the suspicion of fatty acid oxidation defect. Tandem mass spectrometry helped to clinch the diagnosis of CPT II Deficiency in the present case. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=SD01-SD02&id=6560 https://doi.org/10.7860/JCDR/2015/.6560 Allergic Reactions to Dental Materials- A Systematic Review Meena Syed, Radhika Chopra, Vinod Sachdev <b>Introduction:</b> Utility of various dental materials ranging from diagnosis to rehabilitation for the management of oral diseases are not devoid of posing a potential risk of inducing allergic reactions to the patient, technician and dentist. This review aims to develop a systematic approach for the selection and monitoring of dental materials available in the market thereby giving an insight to predict their risk of inducing allergic reactions. <b>Materials and Methods:</b> Our data included 71 relevant articles which included 60 case reports, 8 prospective studies and 3 retrospective studies. The source of these articles was Pub Med search done with the following terms: allergies to impression materials, sodium hypochlorite, Ledermix paste, zinc oxide eugenol, formaldehyde, Latex gloves, Methyl methacrylate, fissure sealant, composites, mercury, Nickel-chromium, Titanium, polishing paste and local anaesthesia. All the relevant articles and their references were analysed. The clinical manifestations of allergy to different dental materials based on different case reports were reviewed. <b>Results:</b> After reviewing the literature, we found that the dental material reported to cause most adverse reactions in patients is amalgam and the incidence of oral lichenoid reactions adjacent to amalgam restorations occur more often than other dental materials. <b>Conclusion:</b> The most common allergic reactions in dental staff are allergies to latex, acrylates and formaldehyde. While polymethylmethacrylates and latex trigger delayed hypersensitivity reactions, sodium metabisulphite and nickel cause immediate reactions. Over the last few years, due to the rise in number of patients with allergies from different materials, the practicing dentists should have knowledge about documented allergies to known materials and thus avoid such allergic manifestations in the dental clinic. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ZE04-ZE09&id=6589 https://doi.org/10.7860/JCDR/2015/.6589 Curcumin – Pharmacological Actions And its Role in Oral Submucous Fibrosis: A Review Abhijeet Alok, Indra Deo Singh, Shivani Singh, Mallika Kishore, Prakash Chandra Jha Turmeric has been in use for thousands of years as a dye, flavouring and a medicinal herb. Ancient Indian medicine has touted turmeric as an herb with the ability to provide glow and lustre to the skin as well as vigour and vitality to the entire body. Since curcumin has antimicrobial, antioxidant, astringents and other useful properties, it is quite useful in dentistry also. Curcumin, the most active polyphenolic constituent, is the active ingredient in the traditional herbal remedy and dietary spice turmeric. In gel form it is a component in local drugs delivery system. The objective of this article is to review the pharmacological action of turmeric and its use in treating oral submucous fibrosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ZE01-ZE03&id=6552 https://doi.org/10.7860/JCDR/2015/.6552 Oral Squamous Cell Carcinoma: Picro Sirius Red Stain Ketki Kalele, Noopur Kulkarni, Rahul Kathariya https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ZJ01-&id=6551 https://doi.org/10.7860/JCDR/2015/.6551 Miles to Discover in Histological Grading of Odontogenic Tumours Anjali Narwal, Anju Devi, Achla Bharti Yadav, Virender Singh https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ZJ02-ZJ03&id=6556 https://doi.org/10.7860/JCDR/2015/.6556 Gastric Glomus Tumour: A Rare Cause of Gastrointestinal Bleeding Tushar Sahni, Lipka Lipi, Pankaj Mishra, Smeeta Gajendra, Ritesh Sachdev https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=EJ01-&id=6561 https://doi.org/10.7860/JCDR/2015/.6561 Desmoplastic Ameloblastoma – An Unusual Presentation Shanmukha Reddy Kallam, Rashmitha Arutla, Sai Sravanthi Gadwalwari, Jithender Reddy Kubbi, Sanjeeva Reddy Gari Shylaja Ameloblastomas are the most common and represents a family of diseases with diverse biological behaviour and contribute to 11-18% of odontogenic epithelial neoplasms. Downstream it has been regarded as benign neoplasm with local aggressiveness. Desmoplastic ameloblastoma is the least frequent of all the variants of ameloblastoma and contribute to 4-5%. The uniqueness of this lesion can be further enhanced with respect to its site of occurrence and the radiographic features in contrast to the classical type of ameloblastoma. Here in, we report a case of Desmoplastic Ameloblastoma in anterior mandible in a 65-year-old male crossing the midline, which deserves preponderency because of its distinct site, radiological features, local aggressiveness and high chances of false clinical impression. This case report is an effort to develop a high index of suspicion in diagnosing such rare cases. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ZJ04-ZJ05&id=6609 https://doi.org/10.7860/JCDR/2015/.6609 Heterotopic Tooth: An Exceptional Entity Ruchieka Vij, Meenu Goel, Puneet Batra, Hitesh Vij, Saurabh Sonar https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=ZJ06-&id=6612 https://doi.org/10.7860/JCDR/2015/.6612 Medico Legal Consideration in Postmortem Diagnostic of Intracranial Haemorrhage Francesco Massoni, Lidia Ricci, Maria Assunta Crusco, Serafino Ricci https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=HJ01-&id=6682 https://doi.org/10.7860/JCDR/2015/.6682 Isolated Hypoglossal Nerve Schwannoma: An Uncommon Presentation of Schwannoma Pokhraj Prakashchandra Suthar, Kewal Arunkumar Mistry, Patel Rajan, Patel Ankit, Chetan Mehta https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=TJ01-TJ02&id=6643 https://doi.org/10.7860/JCDR/2015/.6643 Innominate Artery Aneurysm: Simulating a Thyroid Nodule K. Felix Jebasingh, Dukhabandhu Naik, Anuradha Chandramohan, Rahul Thampi, Nihal Thomas https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=OJ01-OJ02&id=6646 https://doi.org/10.7860/JCDR/2015/.6646 Fibroepithelial Polyps of the Vagina in Pregnancy Sunil Kumar Samal, Setu Rathod, Seetesh Ghose https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=QJ01-QJ02&id=6656 https://doi.org/10.7860/JCDR/2015/.6656 Primary Retroperitoneal Inflammatory Myofibroblastic Tumour Tarun Jindal, Rajan Kumar Sinha, Barun Saha, Nilanjan Mitra, Subhabrata Mukherjee https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=PJ01-PJ02&id=6672 https://doi.org/10.7860/JCDR/2015/.6672 Pancreatic Lipomatosis: Complete Replacement of Pancreas by Fat Paurush Ambesh, Hira Lal https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=OL01-&id=6653 https://doi.org/10.7860/JCDR/2015/.6653 Simplified Protocol for the Phenotypic Identification of Carbapenem Resistance Mechanism in Enterobacteriaceae Ramalingam Sekar, Ramesh Srivani https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=DL01-&id=6597 https://doi.org/10.7860/JCDR/2015/.6597 Subcutaneous Fungal Cyst Masquerading as Benign Lesions – A Series of Eight Cases Gayathri Priyadharshini, Renu G’boy Varghese, Manjiri Phansalkar, Anita Ramdas, Authy.K, Thangiah.G <b>Background:</b> Subcutaneous fungal infections are caused by penetration of the causative fungi into the subcutaneous layer and are usually localised. We present a series of eight cases with subcutaneous fungal cystic lesions masquerading as benign lesions. <b>Materials and Methods:</b> A retrospective study was conducted on subcutaneous fungal infections seen between January 2007 to July 2014 in the Department of Pathology. Eight patients with biopsy proven subcutaneous fungal infection were included. We collected and analysed their demographic, clinical and histopathological details. <b>Results:</b> Among eight patients, six were male and two were female. The mean age was 47 years (Range: 21-70). All the eight patients presented with non-tender cystic swelling. The size of the swellings varied from a minimum of 3x3 cm to maximum of 10x4 cm. Out of eight, hand was involved in three, forearm in one, elbow in two, leg in one and foot in one. On H&E staining, all the cases showed fibro collagenous cyst wall, lined by histiocytes, granulomatous reaction, foreign body type of giant cells with acute and chronic inflammatory infiltrate containing fungal elements. Six were identified as hyalohyphomycosis and two were identified as phaeohyphomycotic cysts based on pigmentation of hyphae. <b>Conclusion:</b> Fungal infection should be suspected in all subcutaneous cystic lesions. Excised tissue should always be sent for culture and histopathology. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=EM01-EM04&id=6637 https://doi.org/10.7860/JCDR/2015/.6637 Scrub Typhus Seroprevalence in Healthy Indian Population Mallika Sengupta, Shalini Anandan, Dolly Daniel, John Antony Jude Prakash Scrub typhus, a zoonosis caused by Orientia tsutsugamushi, is an important cause of acute febrile illness in India. This preliminary study determines the seroprevalence of scrub typhus in healthy Indian adults by measuring IgM and IgG antibodies to scrub typhus by ELISA in 100 healthy blood donors. Our study demonstrates a 15% seroprevalence of scrub typhus in adults. Further studies are needed to confirm these findings especially in children. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=DM01-DM02&id=6623 https://doi.org/10.7860/JCDR/2015/.6623 Clinical and Haematological Effects of Hydroxyurea in ß-Thalassemia Intermedia Patients Bijan Keikhaei, Homayon Yousefi, Mohammad Bahadoram <b>Introduction:</b> It is well known that hydroxyurea (HU) impacts on clinical and haematologic indices in thalassemia. We aimed to evaluate the effect of hydroxyurea on clinical and haematological improvement in children with thalassemia intermedia. <b>Materials and Methods:</b> After the patients’ enrollment in the study their data such as transfusion, hospitalization, spleen size, visit, total Hb, HbF levels, MCV and MCH were compared before and after treatment with HU 10 mg/kg/day/for one year. <b>Results:</b> In patients with thalassemia intermedia, HU significantly diminished the rate of transfusion, hospitalization, spleen size and significantly increased Hb MCH, HbF and MCV. Moreover HU was well tolerated in our patients and we got no remarkable adverse effect. <b>Conclusion:</b> We divulged hydroxyurea 10 mg/kg/day during one year. This significantly increased HbF, total haemoglobin, MCV, MCH, without any remarkable adverse events. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=October&volume=9&issue=10&page=OM01-OM03&id=6660 https://doi.org/10.7860/JCDR/2015/.6660