Journal of clinical and diagnostic research https://www.jcdr.net/back_issues.asp JCDR Evaluation of the Secretor Status of ABO Blood Group Antigens in Saliva among Southern Rajasthan Population Using Absorption Inhibition Method Rashmi Metgud, Nidhi Khajuria, Mamta, Gayathri Ramesh <b>Introduction:</b> The ABO blood group system was the significant element for forensic serological examination of blood and body fluids in the past before the wide adaptation of DNA typing. A significant proportion of individuals (80%) are secretors, meaning that antigens present in the blood are also found in other body fluids such as saliva. Absorption inhibition is one such method that works by reducing strength of an antiserum based on type and amount of antigen present in the stains. <b>Aim:</b> To check the efficacy of identifying the blood group antigens in saliva and to know the secretor status using absorption inhibition method among southern Rajasthan population. <b>Materials and Methods:</b> Blood and saliva samples were collected from 80 individuals comprising 20 individuals in each blood group. The absorption inhibition method was used to determine the blood group antigens in the saliva and then the results were correlated with the blood group of the collected blood sample. The compiled data was statistically analysed using chi-square test. <b>Results:</b> Blood groups A & O revealed 100% secretor status for both males and females. While blood groups B and AB revealed 95% secretor status. <b>Conclusion:</b> Secretor status evaluation of the ABO blood group antigen in saliva using absorption inhibition method can be a useful tool in forensic examination. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ZC01-ZC03&id=7161 https://doi.org/10.7860/JCDR/2016/.7161 Analysis of the Distribution of Mucins in Adult Human Gastric Mucosa and Its Functional Significance Lokadolalu Chandracharya Prasanna <b>Introduction:</b> Mucins are complex composition of carbohydrates seen in the epithelial cells lining the gastrointestinal tract (GIT). Normal distribution of such mucins in different part of the GIT and its alteration in various inflammatory, benign and malignant lesions of GIT has aroused interest in the field of histochemistry. <b>Aim:</b> By applying variety of histochemical techniques an attempt has been made to draw a map of mucin secretion by the different epithelial cell types in different parts of the stomach. <b>Materials and Methods:</b> Fifty samples were taken each from different parts of the stomach like fundus, body and pylorus, from dissected fresh specimens (total of 150 specimens). Tissue samples were subjected for routine process and studied for histological and different histochemical staining. <b>Results:</b> Mucin pattern in adult predominantly secretes neutral mucosubstances. Surface epithelium shows predominant neutral mucin while cardiac and gastric glands with foveolar cells show moderate amount. Sialomucin is present in a few cells of the surface epithelium, foveolar cells and in most of the mucous neck cells. Small amount of sialomucin and sulphomucin are found in surface epithelial foveolar cells while traces of sulphomucin are found in deep foveolar cells. Mucous neck cells secrete both sulphomucin and sialomucin. <b>Conclusion:</b> Normal gastric mucosa adjacent to gastric ulcers and malignant tumours of stomach secretes mucins which differ histochemically and biochemically from that of normal. Early recognition of such changes could be useful in recognizing the different type of carcinomas and their prognosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=AC01-AC04&id=7162 https://doi.org/10.7860/JCDR/2016/.7162 Comparative Study of 5’-Nucleotidase Test in Various Liver Diseases Mohd Azam Hyder, Marghoob Hasan, Abdelmarouf Mohieldein <b>Introduction:</b> The liver regulates many important metabolic functions. The 5’-nucleotidase activity is increased in obstructive jaundice, parenchymal liver disease, and hepatic metastases. <b>Aim:</b> This study was conducted to assess the serum levels of 5’-nucleotidase on patients with viral hepatitis, alcoholic liver diseases and liver cirrhosis, moreover to make comparison to assess the degree of biliary involvement. <b>Materials and Methods:</b> A total of 60 male subjects (15 healthy controls and 45 case subjects) were enrolled, aged between 30 -50 years, each case group consisted of 15 male age-matched patients suffering with viral hepatitis, alcoholic liver disease (more than 10 years.) and liver cirrhosis. Serum 5’-nucleotidase was analyzed as per the standard laboratory procedure. <b>Results:</b> The 5’-nucleotidase levels were significantly raised in viral hepatitis, alcoholic liver disease and cirrhosis patients. The levels being 35.2±8.43, 29.87±3.94, and 24.07± 4.33 respectively as compared to healthy control (11±3.42) U/L. <b>Conclusion:</b> Serum 5’-nucleotidase levels showed elevations in mean value of three fold in viral hepatitis, 2.5 folds elevation in alcoholic liver disease and two fold in cirrhosis as compared of healthy control subjects. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=BC01-BC03&id=7163 https://doi.org/10.7860/JCDR/2016/.7163 Qualitative Analysis of Collagen Fibers in Oral Submucous Fibrosis using Picrosirius Red Stain and Polarising Microscope T. Radhika, Preethi Sekaran, Malathi Narasimhan <b>Introduction:</b> Oral Submucous Fibrosis (OSMF) is an oral potentially malignant condition caused predominantly by areca nut chewing. Early recognition with accurate staging of the disease and appropriate treatment planning is of utmost importance to prevent the malignant transformation and to improve the quality of life of the patient. Picrosirius red stain is specific for collagen and enhances its birefringence under polarising light producing different colours in different stages of the disease. <b>Aim:</b> To compare the clinical and functional staging with histopathologic staging methods used to assess the severity of OSMF and to perform a qualitative analysis of the collagen fibres in various histopathologic stages of OSMF using picrosirius red stain and polarising microscope. <b>Materials and Methods:</b> It is a retrospective study done on archival samples. The study sample included a total of 30 cases which was divided into two groups. Group I comprised of 20 OSMF samples and Group II comprised of 10 normal tissue samples. Clinical, functional and histopathological staging was performed for all OSMF samples. Comparative analysis between clinical and functional stages with the histopathological staging was done using chi square test. Picrosirius red- stained sections of OSMF were analysed using polarising microscopy to evaluate the qualitative changes in the collagen fibers. <b>Statistical Analysis Used:</b> Descriptive data which includes frequency and percentages were calculated for each group. Categorical data were analysed by chi-square test. A p-value of 0.05 or less was considered statistically significant. <b>Results:</b> Comparative analysis between clinical and functional stages with the histopathological staging revealed a significant correlation (p < 0.05) between the functional and histopathological stage. Enhanced birefringence of the collagen fibers due to picrosirius red stain yielded characteristic prominent polarising colours in different stages of OSMF. <b>Conclusion:</b> Comparison of functional staging with histopathologic grading is more reliable in determining the severity of the disease than the clinical staging. Production of characteristic polarising colours by various stages of picrosirius red stained sections of OSMF substantiates the use of picrosirius red stain and polarising microscope as a tool in assessing the severity of this condition thereby aiding in better treatment planning. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ZC04-ZC07&id=7164 https://doi.org/10.7860/JCDR/2016/.7164 Efficacy of Photodynamic Therapy and Lasers as an Adjunct to Scaling and Root Planing in the Treatment of Aggressive Periodontitis – A Clinical and Microbiologic Short Term Study Sreedhar Annaji, Indranil Sarkar, Padma Rajan, Jagdish Pai, Sachin Malagi, Radhika Bharmappa, Vinesh Kamath <b>Introduction:</b> Aggressive periodontitis comprises a group of rare, severe, rapidly progressive form of periodontitis. Conventional treatment includes mechanical debridement augmented with adjunctive antimicrobial therapy. Development of antibiotic resistance has led to use of lasers. Photodynamic therapy (PDT) is a novel non-invasive therapeutic approach with increased site and pathogen specificity. This study compares PDT and Lasers as an adjunct to conventional Scaling in the treatment of patients with aggressive periodontitis. <b>Materials and Methods:</b> Fifteen untreated aggressive periodo-ntitis patients were randomly assigned in a split mouth design for one of the following treatment modalities: 1) SRP alone; (2) SRP + Diode Laser irradiation with 810 nm at 1W, continuous mode for 30 sec per tooth; (3) SRP + PDT on “0” day; (4) SRP + PDT on “0”, 7th and 21st day. The clinical parameters included PI, BOP, PPD, CAL recorded at the baseline & 3rd month. The site with greatest probing pocket depth (PPD) was selected from each quadrant for bacterial sampling and cultured for Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis & Prevotella intermedia. <b>Results:</b> Statistically significant reduction in clinical & microbial parameters was seen. Sites 4 showed a greater reduction compared to other groups. <b>Conclusion:</b> Photodynamic therapy is a valuable treatment modality adjunctive to conventional scaling and root planing. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ZC08-ZC12&id=7165 https://doi.org/10.7860/JCDR/2016/.7165 Periostin - A Novel Systemic Biomarker for Eosinophilic Airway Inflammation: A Case Control Study Viswanathan Emprm, MG Rajanandh,AD Nageswari <b>Introduction:</b> Chronic airway inflammation and remodelling are fundamental features of asthma. The molecular phenotypes in asthma are Th2 high and Th2 low. Serum periostin is a biomarker which aid in understanding Th2 high eosinophilic asthma. <b>Aim:</b> The present study aimed to identify whether or not serum periostin is a systemic biomarker for eosinophilic airway inflammation in asthmatics. <b>Materials and Methods:</b> The study was designed as a prospective, case control study. Patients who presented with consistent symptoms of asthma and confirmed by spirometry with reversibility were the cases. The controls were healthy subjects who had no history of lung disease with normal lung function. The sputum and blood samples were collected from both the groups. Sputum eosinophils, Absolute Eosinophil Counts (AEC) and serum periostin levels were compared between the groups. <b>Results:</b> The study comprised of 101 participants in which 30 were controls and 71 were cases. In the study group, mean post FEV1 was 64.45. There was a positive correlation of sputum eosinophils with severity of obstruction. The ROC curve analysis showed the cut-off value of 24.556 for serum periostin with the p-value of <0.001. As the severity of obstruction increased, the serum periostin levels were also found to be increased. Serum periostin had a sensitivity and specificity of 97.18% and 86.67% with a diagnostic accuracy of 94.06%. <b>Conclusion:</b> Serum periostin appears to be a more sensitive tool for detection of airflow limitation in asthmatic patients with a Th2 high eosinophilic phenotype when compared to AEC and sputum eosinophils. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=OC01-OC04&id=7166 https://doi.org/10.7860/JCDR/2016/.7166 Chloramphenicol – A Potent Armament Against Multi-Drug Resistant (MDR) Gram Negative Bacilli? Smita Sood <b>Introduction:</b> Multidrug-resistant gram-negative bacteria cause infections which are hard to treat and cause high morbidity and mortality. Due to limited therapeutic options there is a renewed interest upon older antimicrobials which had fallen into disuse as a result of toxic side effects. One such antibiotic is chloramphenicol which was sidelined due to reports linking its use with the development of aplastic anaemia. <b>Aim:</b> A study was conducted to evaluate the susceptibility of chloramphenicol in light of the emerging problem of multi-drug resistant gram negative bacteria (MDR GNB). <b>Materials and Methods:</b> A total of 483 MDR GNB of the 650 consecutive Gram Negative Bacteria isolated from various clinical samples of patients admitted at a tertiary care hospital in Jaipur between January-June 2014 were screened for chloramphenicol susceptibility by the disc diffusion method as per CLSI guidelines. <b>Results:</b> The MDR GNB isolates were obtained from 217 (45%) urine, 163 (34%) from respiratory samples, 52(11%) from pus, 42 (9%) from blood and 9 (2%) from body fluids. A 68% of the MDR GNB isolates were found to be sensitive to chloramphenicol. <b>Conclusion:</b> Clinicians should always check for the local susceptibility of Gram-negative bacteria to chloramphenicol. This antibiotic has a potential to play a role in the therapeutic management of infections due to MDR GNB pathogens. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=DC01-DC03&id=7167 https://doi.org/10.7860/JCDR/2016/.7167 Comparison of Long-term Complications in Patients on Haemodialysis and Peritoneal Dialysis Longer than 10 Years Arzu Ozdemir Kayalar, Taner Basturk, Yener Koc, Figen Yilmaz, Feyza Bayraktar Caglayan, Tamer Sakaci, Elbis Ahbap, Abdulkadir Ünsal <b>Introduction:</b> Depending on developments in dialysis techniques and new treatment strategies for comorbid diseases, life expectancy has increased. As a result, dialysis related long term complications could be seen more frequently. We investigated and compared long term complications of the Haemodialysis (HD) and Peritoneal Dialysis (PD) in patients with history if either mode at least 10years. <b>Materials and Methods:</b> A 13HD & 16PD patients were included to the study. Basic demographic parameters and prevalence of cardiovascular diseases (CVD), uraemic peripheral neuropathy (PNP), parathyroid adenoma, parathyroidectomy and acquired cystic disease (ACD) were assessed. <b>Results:</b> HD patients were older than PD patients (p=0.035) and duration of dialysis was longer in HD patients (p=0.001). CVD was present in 18 patients (9 HD, 9 PD). There was no difference in presence of CVD between HD and PD patients (p=0.455). Valvular diseases (n=15), diastolic dysfunction (n=8), left ventricular hypertrophy (n=5), ischemic heart disease (n=3) and congestive heart failure (n=1) were investigated. Uraemic peripheral neuropathy was observed in 14 of the patients (8 HD, 6 PD patients). Eight patients had mixed type sensory motor neuropathy and 3 patients had mixed type sensorial neuropathy, 2 patients had demyelinating PNP, 1 patient had axonal PNP and 3 of them had CTS related to peripheral neuropathy. Parathyroid adenoma was detected in 4 patients (2 HD, 2 PD) and 3 patients (1 HD, 2 PD) had history of parathyroidectomy. Serum phosphate and iPTH levels were higher in HD patients (p=0.003, p=0.04, respectively). ACD was detected in 14 patients (7 HD, 7 PD). There was no difference between PD and HD patients (p=0.75). <b>Conclusion:</b> HD patients were older than PD patients and had longer duration of dialysis. The prevalence of long term complications was similar in HD and PD modalities. CVD especially valvular diseases were common complication in both modalities. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=OC05-OC08&id=7172 https://doi.org/10.7860/JCDR/2016/.7172 Effect of Probiotic Curd on Salivary pH and Streptococcus mutans: A Double Blind Parallel Randomized Controlled Trial Shivangi Srivastava, Sabyasachi Saha, Minti Kumari, Shafaat Mohd <b>Background:</b> Dairy products like curd seem to be the most natural way to ingest probiotics which can reduce Streptococcus mutans level and also increase salivary pH thereby reducing the dental caries risk. <b>Objectives:</b> To estimate the role of probiotic curd on salivary pH and Streptococcus mutans count, over a period of 7 days. <b>Materials and Methods:</b> This double blind parallel randomized clinical trial was conducted at the institution with 60 caries free volunteers belonging to the age group of 20-25 years who were randomly allocated into two groups. Test Group consisted of 30 subjects who consumed 100ml of probiotic curd daily for seven days while an equal numbered Control Group were given 100ml of regular curd for seven days. Saliva samples were assessed at baseline, after ½ hour 1 hour and 7 days of intervention period using pH meter and Mitis Salivarius Bacitracin agar to estimate salivary pH and S. mutans count. Data was statistically analysed using Paired and Unpaired t-test. <b>Results:</b> The study revealed a reduction in salivary pH after ½ hour and 1 hour in both the groups. However after 7 days, normal curd showed a statistically significant (p< 0.05) reduction in salivary pH while probiotic curd showed a statistically significant (p< 0.05) increase in salivary pH. Similarly with regard to S. mutans colony counts probiotic curd showed statistically significant reduction (p< 0.05) as compared to normal curd. <b>Conclusion:</b> Short-term consumption of probiotic curds showed marked salivary pH elevation and reduction of salivary S. mutans counts and thus can be exploited for the prevention of enamel demineralization as a long-term remedy keeping in mind its cost effectiveness. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ZC13-ZC16&id=7178 https://doi.org/10.7860/JCDR/2016/.7178 A Prospective Study on Radiological and Functional Outcome of Displaced Tongue Type Intra-Articular Calcaneal Fractures Treated by Percutaneous Screw Fixation Anoop Hegde, Lawrence John Mathias, Arjun Ballal, Vikram Shetty, Ashwin Shetty <b>Introduction:</b> Calcaneal fractures have posed a challenge to orthopaedic surgeon for many years. The major problem is to reconstruct the fracture and improve healing of the fracture and also the surrounding tissues. Anatomic restoration of the three-dimensional anatomy of the calcaneum is the goal of surgical management of calcaneal fractures. Over the years, various techniques have been developed to accomplish this goal. <b>Aim:</b> To determine the functional outcome in displaced tongue-type calcaneal fracture treated by percutaneous screw fixation. <b>Materials and Methods:</b> A prospective study was conducted from October 2012 and September 2014. A total of 23 patients with intra-articular ‘tongue type’ calcaneal fractures were included in the study. Complete clinical and radiological evaluation was done. The surgical procedure encompassed closed reduction and fixation with two criss-cross 6.5 mm cannulated cancellous across the fracture site under fluoroscopic guidance. Postoperatively, on day three ankle and toe mobilization was begun. Non-weight bearing crutch mobilization was begun on postoperative day three. Reviews were done at 6 weeks, 12 weeks and 24 weeks postoperatively. At 6 weeks partial weight bearing mobilization was started. Full weight bearing was begun at 12 weeks. The patient was finally reviewed at 24 weeks and assessment of ankle function was done as per the Maryland foot scoring system. Radiographs were compared and preoperative and postoperative Gissane’s and Bohler’s angles were also compared. The results were analysed as per descriptive statistics (frequency, percentage). The complications noted were documented. <b>Results:</b> Of the 23 patients under the study, three had excellent results with mean score of 90, 17 had good results with mean score of 82.94 and three had fair results with mean score of 74. Only one patient had subtalar arthritis as a complication. No other complications were seen. <b>Conclusion:</b> Percutaneous screw fixation of tongue type calcaneal fractures is a very effective surgical technique. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=RC01-RC04&id=7179 https://doi.org/10.7860/JCDR/2016/.7179 The Oral Carriage of Candida in Oral Cancer Patients of Indian Origin Undergoing Radiotherapy and/or Chemotherapy Manish Jain, Raksha Shah, Betina Chandolia, Ayush Mathur, Yashwant Chauhan, Jyoti Chawda, Siddarth Mosby, Sanjay Bhagalia https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ZC17-ZC20&id=7180 https://doi.org/10.7860/JCDR/2016/.7180 Hepatic Venous Waveform, Splenoportal and Damping Index in Liver Cirrhosis: Correlation with Child Pugh’s Score and Oesophageal Varices Neha Antil, Binit Sureka, Mahesh Kumar Mittal, Amita Malik, Bhupender Gupta, Brij Bhushan Thukral <b>Introduction:</b> Clinical assessment of chronic liver disease is done by Modified Child Pugh’s and Model for end-stage liver disease scoring system. Measurement of hepatic venous pressure gradient (HVPG) and Upper GI Endoscopy are considered the gold standards for measurement of portal hypertension in cirrhotics. There is a need for non-invasive evaluation of portal hypertension. Ultrasonography with colour and spectral Doppler evaluation may be an effective, rapid and inexpensive alternative. <b>Aim:</b> To evaluate hepatic venous waveform, damping index, splenoportal index in patients of cirrhosis on Colour Doppler ultrasound, also predict severity of portal hypertension and presence of oesophageal varices. <b>Materials and Methods:</b> Thirty patients of chronic liver disease were included in the study. Ultrasound and colour Doppler was done to look hepatic venous waveform pattern, Damping Index (DI), and Splenoportal Index (SPI). Contrast-enhanced Computed Tomography scan (CT) was done if renal function tests were normal, else endoscopy when the renal function tests were deranged to look for oesophageal varices. <b>Results:</b> Twenty two (73.3%) patients had monophasic waveform. Biphasic and triphasic waveforms were seen in 4 (13.3%) cases. Twenty two patients (73.3%) had monophasic waveforms and majority of them were in class C. This distribution of hepatic vein waveform was statistically significantly with the Child Pugh’s class (p<0.05). Twenty patients (66.7%) had value of Damping index more than >0.6 where majority of patients (18) belonged to class C and 2 in class B. There was a positive correlation between Child Pugh’s total score and Damping index (r=0.614; p<0.05). There was weak positive correlation between splenoportal index and Child Pugh’s score (r=0.269; p=0.15). <b>Conclusion:</b> Change in triphasic to monophasic waveform and DI >0.6 suggests severe liver dysfunction and is associated with severe portal hypertension. Hepatic venous waveform pressure changes, DI and SPI have no value in predicting presence of oesophageal varices. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=TC01-TC05&id=7181 https://doi.org/10.7860/JCDR/2016/.7181 Anterior Ridge Extension Using Modified Kazanjian Technique in Mandible- A Clinical Study Jagannadham Vijay Kumar, Pandi Srinivas Chakravarthi, Meka Sridhar, Kolli Naga Neelima Devi, Vivekananad Sabanna Kattimani, Krishna Prasad Lingamaneni <b>Introduction:</b> Good alveolar ridge is a prerequisite for successful conventional/ implant supported partial/complete denture. Extensively resorbed ridges with shallow vestibule and high insertion of muscles in to the ridge crest, leads to failure of prosthesis. Success of prosthesis depends on surgical repositioning of mucosa and muscle insertions, which increases the depth of vestibule and denture flange area for retention. So, the study was planned to provide good attached gingiva with adequate vestibular depth using Modified Kazanjian Vestibuloplasty (MKV). <b>Aim:</b> To evaluate efficacy of MKV technique for increasing vestibular depth in anterior mandible so that successful prosthesis can be delivered. Efficacy of the technique was evaluated through operating time required, vestibular depth achieved, scarring or relapse and any postoperative complications associated with the healing. <b>Materials and Methods:</b> Total of 10 patients were included in the study, who had minimum 20mm of bone height and less than 5mm of vestibular depth for MKV procedure. The results were tabulated and statistical analysis was carried out to assess vestibular depth achieved i.e. from crest of the ridge to junction of attached mucosa both pre and postoperatively. The study results were compared with existing literature. <b>Results:</b> Healing of raw surface was uneventful with satisfactory achievement of vestibular depth. The average gain in vestibular depth was 11 mm. The patients had good satisfaction index for prosthesis. <b>Conclusion:</b> Even in the era of implant prosthesis Modified Kazanjian technique is worth to practice to achieve good results and overcorrection is not required as that of standard Kazanjian technique. It provides adequate attached gingiva for successful prosthesis. Extension of vestibular depth enables fabrication of better denture flange with improved oral hygiene. This technique does not require hospitalization and additional surgery for grafts. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ZC21-ZC24&id=7192 https://doi.org/10.7860/JCDR/2016/.7192 An Epidemiological Study of Malnutrition Among Under Five Children of Rural and Urban Haryana Sachin Singh Yadav, Shweta Tomar Yadav, Prabhaker Mishra, Anshu Mittal, Randhir Kumar, Jagjeet Singh <b>Introduction:</b> A child is future of nation. Malnutrition is a big public health problem in India as it can be attributed for more than half (54 percent) of all under five mortality in India. <b>Aim:</b> To assess prevalence of malnutrition among urban and rural population of Haryana using newly developed WHO growth standards. <b>Settings and Design:</b> A community based cross-sectional survey was conducted in children of 3-60 months age living in the urban and rural field practice areas of Department of Community Medicine MMIMSR, Mullana, Ambala during January 2012 to December 2012. <b>Materials and Methods:</b> Seven hundred and fifty children, aged 3-60 months, were studied for nutritional status, socio-demographic measures were obtained from structured questionnaire and followed by anthropometric assessment using standards methods. Z score for Anthropometric data was calculated by WHO Anthro 2010 software (beta version). <b>Statistical Analysis:</b> Descriptive statistics as well as simple proportion were calculated with SPSS 20. <b>Results:</b> We found that 41.3% children were underweight and 14% were severe underweight. Female children were more nutritionally deprived than males. Among sociodemographic factors maternal educational and working status as well as SES class and rural background of family had greater impact on nutritional status of child. <b>Conclusion:</b> We found that almost half of our under five children are underweight, girl child being affected more. For attainment of best possible nutrition and growth in children, targeted short-term strategies addressing underlying risk factors and more long-term poverty alleviation strategies may be needed. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=LC07-LC10&id=7193 https://doi.org/10.7860/JCDR/2016/.7193 Comparative Study of Two Different Myringoplasty Techniques in Mucosal Type of Chronic Otitis Media Mallikarjunappa Ajjampura Murugendrappa, Prakash Naganahalli Siddappa, Abhilash Shambulingegowda, Girish Pattanada Basavaraj <b>Introduction:</b> Myringoplasty is a surgical procedure used to close the perforation of pars tensa of the tympanic membrane and to improve the hearing loss. <b>Aim:</b> To compare the two different techniques of myringoplasty- circumferential subannular grafting technique and conventional underlay technique in cases of chronic otitis media with inactive mucosal disease. <b>Materials and Methods:</b> This is a prospective study of 12 months (July 2014 to June 2015) duration conducted in Department of Otorhinolaryngology and Head and Neck Surgery, JJM Medical College, Davanagere and data was collected from the 50 patients admitted for myringoplasty, 25 in each group. Results were calculated in terms of graft success rate and improvement in hearing after 3 months postoperatively. <b>Results:</b> A total of 50 cases are included in this study, out of which 21 were males and 29 were females with male to female ratio of 0.72:1. The success rate of graft take up by circumferential subannular grafting technique is 96% and by conventional underlay technique is 76% respectively. In circumferential subannular grafting technique, the pre-op mean PTA was 36.92db, and the post-op mean PTA after 3 months was 25.87 db with a mean difference in PTA (dB) was 11.05 with t value of 7.74. In case of conventional underlay technique, the pre-op mean PTA was 38.24 db, and the post-op mean PTA after 3 months was 30.28 db with a mean difference in PTA (dB) was 7.96 with t-value of 14.39. <b>Conclusion:</b> The study showed that circumferential grafting technique is superior in graft success rate and postoperative hearing improvement when compared to conventional underlay technique. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=MC01-MC03&id=7194 https://doi.org/10.7860/JCDR/2016/.7194 Effect of Oral Premedication on the Efficacy of Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis: A Prospective, Double-Blind, Randomized Controlled Clinical Trial Suparna Ganguly Saha, Sohini Jain, Sandeep Dubey, Shubham Kala, Abhinav Misuriya, Devendra kataria <b>Introduction:</b> It is generally accepted that achieving complete anaesthesia with an Inferior Alveolar Nerve Block (IANB) in mandibular molars with symptomatic irreversible pulpitis is more challenging than for other teeth. Therefore, administration of Non-Steroidal Anti-Inflammatory Agents (NSAIDs) 1 hour prior to anaesthetic administration has been proposed as a means to increase the efficacy of the IANB in such patients. <b>Aim:</b> The purpose of this prospective, double-blind, randomized clinical trial was to determine the effect of administration of oral premedication with ketorolac (KETO) and diclofenac potassium (DP) on the efficacy of IANB in patients with irreversible pulpitis. <b>Materials and Methods:</b> One hundred and fifty patients with irreversible pulpitis were evaluated preoperatively for pain using Heft Parker visual analogue scale, after which they were randomly divided into three groups. The subjects received identical tablets of ketorolac, diclofenac pottasium or cellulose powder (placebo), 1 hour prior to administration of IANB with 2% lidocaine containing 1:200 000 epinephrine. Lip numbness as well as positive and negative responses to cold test were ascertained. Additionally pain score of each patient was recorded during cavity preparation and root canal instrumentation. Success was defined as the absence of pain or mild pain based on the visual analog scale readings. The data was analysed using One-Way Anova, Post-Hoc Tukey pair wise, Paired T – Test and chi-square test. Trial Registery Number is 4722/2015 for this clinical trial study. <b>Results:</b> There were no significant differences with respect to age (p =0.098), gender (p = 0.801) and pre-VAS score (DP-KETO p=0.645, PLAC-KETO p =0.964, PLAC-DP p = 0.801) between the three groups. All patients had subjective lip anaesthesia with the IAN blocks. Patients of all the three groups reported a significant decrease in active pain after local anaesthesia (p< 0.05). The post injection VAS Score was least in group 1 (KETO) followed by group II (DP) & maximum in group III (PLACEBO). <b>Conclusion:</b> Oral pre-medication with 10 mg KETO resulted in significantly higher percentage of successful inferior alveolar block in patients with irreversible pulpitis than pre-medication with 50 mg DP & PLAC. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ZC25-ZC29&id=7195 https://doi.org/10.7860/JCDR/2016/.7195 Effect of Dissection of the Recurrent Laryngeal Nerves on Parathyroid Insufficiency during Total Thyroidectomy for Multinodular Goitre Vengayil Sukumaran, Bhavuray Teli, Sreekant Avula, Jagadeesh Pavuluru <b>Introduction:</b> Total thyroidectomy is the accepted standard treatment for benign goitrous enlargements. The surgical skill and technique is one of the most important factor which affect the outcome in thyroid surgery. Hypocalcaemia due to parathyroid insufficiency remains a significant postoperative morbidity after total thyroidectomy. The primary cause is unintentional damage to, or devascularization of, one or more parathyroid glands during surgery. <b>Aim:</b> To study the risk of hypocalcaemia due to recurrent laryngeal nerves (RLNs) dissection during total thyroidectomy for benign multinodular goitre (MNG). <b>Materials and Methods:</b> The study is a non-randomized control trial, where 100 patients with benign MNG were divided into two groups (group A and group B) each consisting of 50 patients. All 100 patients underwent total thyroidectomy by a subcapsular dissection. In patients of group A, both RLNs were clearly dissected for a minimum length of 2cm down from its entry into the larynx before total thyroidectomy was performed. In group B, each patient had total thyroidectomy without making any deliberate attempt to dissect and demonstrate the RLNs. The patients in the two groups were followed up for the incidence of clinically significant hypocalcaemia in the postoperative period. <b>Results:</b> A total of 30% of patients in group A developed clinical and biochemical manifestations of hypocalcaemia but the incidence of hypocalcaemia was only 6% in the group B. Three (6%) patients out of those who developed hypocalcaemia in group A had a prolonged hypocalcaemia for upto six months. p-value is 0.003 and odds ratio is 6.59. <b>Conclusion:</b> Routine dissection to identify the RLNs could predispose to a higher incidence of postop hypocalcaemia. Subcapsular dissection of the thyroid safely preserves the parathyroid glands. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=PC01-PC03&id=7196 https://doi.org/10.7860/JCDR/2016/.7196 Effect of Left, Right and Alternate Nostril Breathing on Verbal and Spatial Memory Rinku Garg, Varun Malhotra, Yogesh Tripathi, Ritu Agarawal <b>Introduction:</b> Yoga has beneficial effects on memory. In females, left hemisphere of the brain is responsible for verbal memory and right hemisphere is responsible for the spatial memory, while the opposite is true for males. <b>Aim:</b> Aim of the present was to study the effect of unilateral right nostril breathing, left nostril breathing and alternate nostril breathing on verbal and spatial memory scores. <b>Materials and Methods:</b> A total of 51 female subjects (age 18-25 years, mean±SD =21.71±3.11) were taken and divided into three groups (n=17). Each group was imparted one of the three different types of nostril breathing practices such as Right Nostril Breathing (RNB), Left Nostril Breathing (LNB) and Alternate Nostril Breathing (ANB) for 1 week for 45 minutes daily. Subjects were given the memory test, before and after 45 minutes of intervention for three consecutive days. Memory tests were performed by using Wechsler Adult Intelligent Scale. Statistical Analysis: Results were analysed by ANOVA with SPSS version 17.0. <b>Results:</b> Results showed that there was increase in recall of digit span-forward, digit-span backward, associate learning and spatial memory scores with RNB, LNB and ANB, which were statistically highly significant(p<0.005). <b>Conclusion:</b> Inclusion of nostril breathing in exercise regimen may be helpful in improving recall of memory https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=CC01-CC03&id=7197 https://doi.org/10.7860/JCDR/2016/.7197 Using Korotkoff Sounds to Detect the Degree of Vascular Compliance in Different Age Groups Dushyant Ramakrishnan <b>Introduction:</b> The principle behind the generation of the Korotkoff sounds is the turbulence of blood flowing through a partially occluded area in the artery. With increasing age, the vascular wall compliance is expected to decrease, which is due to the thickening of the vessel wall, due to which the amplitude of the transmitted Korotkoff sounds is decreased. There is also an accompanying rise in the systolic B.P. and pulse pressure. <b>Aim:</b> To record and compare the amplitudes of the intermediate Korotkoff sounds and the blood pressures in individuals of the two age groups, and calculate the pulse pressure and determine whether they vary in relation to the amplitude of the intermediate Korotkoff sounds recorded. <b>Materials and Methods:</b> The cross-sectional study was conducted on 50 young subjects (15-25 years) and 50 older subjects (50-70 years). The mid arm circumference was measured using a tape. A phonoarteriogram was placed over the left brachial artery and the sphygmomanometer cuff was tied 2cm above the cubital fossa of the left arm. The blood pressure was recorded using the Lab Tutor software. The Korotkoff sounds picked up and transmitted by the phonoarteriogram are represented as distinct lines on the graphical recording. Statistical Analysis: Independent samples t-test to look for significant mean amplitude differences and for correlating mean amplitude and pulse pressure. Null hypothesis rejected at p<0.05. Data analysed using the SPSS software version 20.0 (SPSS Inc.). <b>Results:</b> There was a significant difference in the mean amplitudes of Korotkoff sounds among the different age groups (p=0.001) and subject categories (p=0.043 among males, p=0.037 among females). A significant difference in pulse pressures was also seen among different age groups and subject categories. The decrease in the amplitudes of Korotkoff sounds in the older age group accompanies the increase in pulse pressures seen in this group and the same was seen among the different age groups within each sex (r=-0.574, p=0.001 among males) and (r=-0.449, p=0.002 among females). <b>Conclusion:</b> Measuring the amplitude of Korotkoff sounds can give us an idea of the nature of the arterial wall as shown by a decrease in amplitude in older individuals when compared to the younger individuals and of the volume of blood flowing through the artery as shown by the higher amplitudes observed in males when compared to females. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=CC04-CC07&id=7198 https://doi.org/10.7860/JCDR/2016/.7198 Hearing Impairment and High Blood Pressure among Bus Drivers in Puducherry Rajeshwar Balaji, Rajalakshmi Rajasegaran, Nitin Ashok John, Umadevi Sajja Venkatappa <b>Introduction:</b> Noise Induced Hearing Loss (NIHL), a major heath concern due to constant exposure to loud noise is on the rising trend in today’s world. The bus drivers are more vulnerable to the auditory and non-auditory ill effects of noise pollution. <b>Aim:</b> The aim of this study was to assess and compare the hearing level, blood pressure and peak expiratory flow rate of bus drivers and individuals employed in office jobs. <b>Materials and Methods:</b> Fifty male bus drivers aged 30-50 years and fifty males of the same group employed in office jobs were recruited as the test and control groups respectively. The hearing level of the individuals in both the groups was assessed using the Hearing Deterioration Index (HDI). The lung function and cardiovascular status of the study participants were assessed by measuring their Peak Expiratory Flow Rate (PEFR) and Blood Pressure (BP) respectively. The mean HDI, PEFR and BP values of both the groups were compared using the unpaired t-test and the extent of correlation between HDI, service years, exposure level, systolic blood pressure (SBP) and diastolic blood pressure (DBP) was determined using Pearson correlation coefficient test. <b>Results:</b> HDI, SBP and DBP were significantly higher among the bus drivers when compared to the controls. However, there was no significant difference in the PEFR values between the test and the control groups. There was a highly significant positive correlation between HDI and service years and exposure level. Similarly, there was a significant positive correlation between exposure level and systolic and diastolic blood pressure. <b>Conclusion:</b> Prolonged exposure to high intensity of sound results in deterioration of hearing capacity and increase in blood pressure among the bus drivers. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=CC08-CC10&id=7199 https://doi.org/10.7860/JCDR/2016/.7199 Assessment of Anthropometric Indices, Salt Intake and Physical Activity in the Aetiology of Prehypertension Arsalan Moinuddin, Rani Gupta, Yogesh Saxena <b>Introduction:</b> Globally, prehypertension is responsible for approximately 62% of cardiovascular and 49% of ischemic heart disease (IHD) episodes. Current data from the Indian subcontinent suggests that prevalence of prehypertension was 47% amongst young urban residents. Considering its serious prognosis, the current study was undertaken to assess risk factors such as for cardiovascular diseases in prehypertensives adult males in Uttarakhand region. <b>Materials and Methods:</b> This cross-sectional analytical study was conducted in the Department of Physiology, HIMS, Dehradun, over a period of 12 months. Volunteers (20-40 years) were divided into two groups; Group I (Controls): normotensives and Group II (Cases): prehypertensives based on JNC VII classification. <b>Results:</b> Exercise capacity, determined by peak VO2 consumption was significantly lower in prehypertensive group than the normotensive group (p<0.001). Daily salt intake of pre-hypertensives was significantly greater than the normotensive subjects (p<0.001). Multiple Linear Regression analysis revealed that average baseline SBP increases by 0.34 mmHg for every 1 kg increase in weight and average baseline DBP increases by 0.25 mmHg for every 1 year increase in age. <b>Conclusion:</b> Exercise capacity was found decreased in pre-hypertensives and they have high daily salt intake. Also, weight and age emerged as independent risk factors for SBP and DBP respectively. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=CC11-CC14&id=7200 https://doi.org/10.7860/JCDR/2016/.7200 Detection of Vancomycin Resistance among Enterococcus faecalis and Staphylococcus aureus Ramya Rengaraj, Shanthi Mariappan, Uma Sekar, Arunagiri Kamalanadhan <b>Introduction:</b> Vancomycin remains the drug of choice for resistant gram positive infections caused by Enterococcus spp and Methicillin resistant Staphylococcus aureus (MRSA). Increased use of vancomycin has led to frank resistance and increase in MIC (MIC creep). Vancomycin intermediate Staphylococcus aureus (VISA), Vancomycin resistant Staphylococcus aureus (VRSA) & Vancomycin resistant Enterococci (VRE) are important emerging nosocomial pathogens resulting in treatment failures. <b>Aim:</b> This study was undertaken to detect vancomycin resistance among clinical isolates of Staphylococcus aureus and Enterococcus faecalis by phenotypic and genotypic methods. <b>Materials and Methods:</b> The study was conducted in a 1850 bedded university teaching hospital from November 2013 to April 2014. Non-repetitive, consecutive clinically significant Staphylococcus aureus (109) and Enterococcus faecalis (124) were included in this study. They were identified up to species level by conventional and automated methods. Susceptibility to various antibiotics was tested by disc diffusion method. MIC of vancomycin was determined by agar dilution method. Inducible resistance to clindamycin was detected by the D test. Methicillin resistance in Staphylococcus aureus (MRSA) was screened using cefoxitin disc. All isolates were subjected to polymerase chain reaction (PCR) to detect van A and van B genes. <b>Results:</b> Out of 109 Staphylococcus aureus isolates, 54 were MRSA. By MIC there was no resistance observed to vancomycin.MIC50 was 1µg/ml. None of the isolates harboured van A and van B. Among Enterococcus faecalis, sixteen isolates (12.9%) and four isolates (3.2%) exhibited resistance to vancomycin and teicoplanin by disc diffusion respectively. All isolates were susceptible to linezolid. Van A was detected in 2, van B in 7 and one had both van A and van B. <b>Conclusion:</b> PCR remains the gold standard for diagnosis of vancomycin resistance. There was no resistance observed to vancomycin among Staphylococci though the MIC creep detected is a cause for concern. Eight percent of Enterococci were vancomycin resistant. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=DC04-DC06&id=7201 https://doi.org/10.7860/JCDR/2016/.7201 Lipid Peroxidation and Antioxidant Status in Patients with Medullary Thyroid Carcinoma: A Case-Control Study Seyed-Mostafa Hosseini-Zijoud, Seyed Alireza Ebadi, Mohammad Taghi Goodarzi, Mehdi Hedayati, Roghayeh Abbasalipourkabir, Mohammad Parsa Mahjoob, Jalal Poorolajal, Fabio Zicker, Nasrin Sheikh <b>Introduction:</b> Oxidative stress or oxidant/antioxidant imbalance has a crucial role in the pathogenesis of some diseases like cancer. Medullary thyroid carcinoma (MTC) originates in the thyroid parafollicular cells and includes 3-4% of the malignant neoplasms that have an effect on this gland. The aetiology of MTC has not been clarified. However, oxidative stress may be one of the factors involved. <b>Aim:</b> The aim of the current study was to evaluate the antioxidant enzyme activity of catalase (CAT), Glutathione (GSH), total antioxidant capacity (TAC) and the levels of the lipid peroxidation product malondialdehyde (MDA) in blood samples of MTC patients as compared to healthy controls. <b>Materials and Methods:</b> A case-control study was designed enrolling patients with confirmed MTC diagnosis and age-and sex group matched healthy volunteers referred to the clinic of the Research Institute for Endocrine Sciences, Tehran, Iran from April 2013 to July 2015. Fasting blood samples were taken for study. Catalase, GSH, MDA and TAC levels were measured by colorimetry using commercial kits (ZellBio GmbH, Germany). Data were analysed using SPSS 17 software, comparing mean±SD through t-test and difference between proportions through chi-square. <b>Results:</b> No statistical difference was observed in the demographic characteristic between cases and controls. The final MTC group included 40 males and 45 females with a mean age of 30±12.9 year, and the control group 40 males and 47 females, with a mean age of 31.2±12.3 year. Anthropometric parameters, dietary and thyroid hormones levels (T3, T4 and TSH) were similar. Serum TAC (p=0.015), GSH (p=0.029) and CAT (p<0.001) levels were found to be significantly lower in the MTC patients, while serum MDA levels were significantly higher in MTC patients than controls (p<0.001). <b>Conclusion:</b> These preliminary findings suggest that oxidant/antioxidant imbalance may be associated with or possibly indicate an increased risk to medullary thyroid carcinoma. Further studies are needed to explore these findings. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=BC04-BC07&id=7202 https://doi.org/10.7860/JCDR/2016/.7202 Hajdu Cheney Syndrome Shini Susan Samuel, Shrinath Shetty, Gautham Arunachal, Santosh Koshy, Thomas Vizhalil Paul Hajdu-Cheney Syndrome is a rare genetic disorder characterised by progressive focal bone destruction. It is known to be an autosomal dominant disorder but there have been reports of sporadic cases as well. Although the disease manifestation is found to begin from birth, it is most often not diagnosed until adolescence or adulthood. It could be due to the rarity of the condition and the variation of the disease manifestation at different age groups. We report a case of Hajdu-Cheney Syndrome in a 26-year-old male who presented with severe periodontitis and premature loss of teeth. The other characteristic features included craniofacial dysmorphism, abnormalities of the digits and dental anomalies. Patients with craniofacial dysmorphism along with dental abnormalities should be thoroughly examined for any underlying systemic disorder. A team of specialists may be able to diagnose this condition before the disease is advanced. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=OD07-OD09&id=7203 https://doi.org/10.7860/JCDR/2016/.7203 Spectrum of Lesions Affecting the Renal Pelvis and Pelviureteric Junction: A 13-Year Retrospective Analysis Hema Kini, Hanaganahalli Basavaiah Sridevi, Pooja Kundapur Suresh, Laxman Prabhu Gurupur Guni, Shaila Bhat, Jyoti Ramanath Kini <b>Introduction:</b> Both, the renal pelvis and the ureter, are affected by developmental, reactive and neoplastic disorders, though rare in incidence. <b>Aim:</b> This series of cases were analysed to study the clinicopathological characteristics of the common and comparatively rare lesions involving the renal pelvis and pelviureteric junction. <b>Materials and Methods:</b> A retrospective collection of 476 nephrectomies and pelviureteric junction resections, received over a period of 13 years from 2001 to 2013 was done. The patients’ clinical details were obtained and the histopathological findings reviewed. The lesions were classified into non-neoplastic and neoplastic categories. <b>Results:</b> Primary involvement of the renal pelvis and pelviureteric junction was seen in 105 of 476 specimens. The mean age was 54.5 years with a male to female ratio of 2.2:1. The non-neoplastic lesions accounted for 76.2% of cases with a majority being pelviureteric junction obstruction due to inflammation induced fibromuscular hypertrophy (68.6%) causing hydronephrosis. Urothelial carcinomas were encountered in 20% of the cases. A majority of the urothelial carcinomas were infiltrative (81%) and high grade (71%) tumours. <b>Conclusion:</b> Renal pelvis, a conduit to propel urine, can be the site for numerous disorders. Non-neoplastic lesions were more common than neoplasms. Pelviureteric junction obstruction due to inflammation induced fibromuscular hypertrophy was the commonest lesion in our study. In the neoplastic category, urothelial carcinoma was most common. However, rare lesions such as hamartomatous fibroepithelial polyp, Von Brunn’s nests, flat urothelial hyperplasia and intramuscular haemangioma of upper ureter at the pelviureteric junction were encountered along with occasional cases of tuberculosis and squamous cell carcinomas. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=EC01-EC04&id=7175 https://doi.org/10.7860/JCDR/2016/.7175 FNAC Versus Core Needle Biopsy: A Comparative Study in Evaluation of Palpable Breast Lump Abhijit Saha, Madhumita Mukhopapadhyay, Chhandadas, Koushik Sarkar, Ashis Kumar Saha, Diptendra KR Sarkar <b>Introduction:</b> Breast carcinoma is the most common malignant tumour and the leading cause of carcinoma death in women in world. The main purpose of FNAC or CNB of breast lumps is to confirm cancer preoperatively and to avoid unnecessary surgery in specific benign conditions. <b>Aims and Objective:</b> The objective of the study was to compare between Fine Needle Aspiration Cytology (FNAC) and Core Needle Biopsy (CNB) in the diagnosis of breast carcinoma with final histological diagnosis from excision specimen as it is gold standard. <b>Materials and Methods:</b> A prospective study was done on 50 cases. Patients undergoing all three procedures (Fine Needle Aspiration Cytology and Core Needle Biopsy done at Department of Pathology; subsequent excision surgeries done at Department of General Surgery) were selected. May Grunwald Giemsa (MGG) and Papaniculou (PAP) staining were performed on cytology smears. Haematoxylin and Eosin (H&E) staining was done on both the CNB and tissue specimens obtained from subsequent excision surgeries to see the histological features. <b>Results:</b> FNAC showed sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 69%, 100%, 100%, 38.1%, and 74% respectively in diagnosing carcinoma. CNB had sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 88.3%, 100%, 100%, 53.3% and 86%. Both FNAC and CNB showed statistically significant correlation with confirmatory HPE of excision specimen (p-value <0.05) in the diagnosis of breast carcinoma. <b>Conclusion:</b> Fine needle aspiration cytology (FNAC) is a rapid, less complicated, economical, reliable and relevant method for the preoperative pathological diagnosis of breast carcinoma in a developing nation like ours. If the initial FNAC is inadequate, core needle biopsy (CNB) can be a useful second line method of pathological diagnosis in order to minimize the chance of missed diagnosis of breast cancer. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=EC05-EC08&id=7185 https://doi.org/10.7860/JCDR/2016/.7185 Implementation of Indigenous Electronic Medical Record System to Facilitate Care of Sickle Cell Disease Patients in Chhattisgarh Mona Choubey, Hrishikesh Mishra, Khushboo Soni, Pradeep Kumar Patra <b>Introduction:</b> Sickle cell disease (SCD) is prevalent in central India including Chhattisgarh. Screening for SCD is being carried out by Government of Chhattisgarh. Electronic Medical Record (EMR) system was developed and implemented in two phases. <b>Aim:</b> Aim was to use informatics techniques and indigenously develop EMR system to improve the care of SCD patients in Chhattisgarh. EMR systems had to be developed to store and manage: i) huge data generated through state wide screening for SCD; ii) clinical data for SCD patients attending the outpatient department (OPD) of institute. <b>Materials and Methods:</b> ‘State Wide Screening Data Interface’ (SWSDI) was designed and implemented for storing and managing data generated through screening program. Further, ‘Sickle Cell Patients Temporal Data Management System’ (SCPTDMS) was developed and implemented for storing, managing and analysing sickle cell disease patients’ data at OPD. Both systems were developed using VB.Net and MS SQL Server 2012. <b>Results:</b> Till April 2015, SWSDI has data of 1294558 persons, out of which 121819 and 4087 persons are carriers and patients of sickle cell disease respectively. Similarly till June 2015, SCPTDMS has data of 3760 persons, of which 923 are sickle cell disease patients (SS) and 1355 are sickle cell carriers (AS). <b>Conclusion:</b> Both systems are proving to be useful in efficient storage, management and analysis of data for clinical and research purposes. The systems are an example of beneficial usage of medical informatics solutions for managing large data at community level. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=LC01-LC06&id=7186 https://doi.org/10.7860/JCDR/2016/.7186 Prevalence of Thyroid Disorders in Children at a Tertiary Care Hospital in Western India Amitabh Singh, Charul Purani, Anirban Mandal, Kishor M Mehariya, Rashmi Ranjan Das <b>Introduction:</b> Thyroid hormone abnormalities are the commonest endocrine disorder in India and also the commonest preventable cause of mental retardation. In the absence of neonatal screening, thyroid disorders remain largely unrecognized in Indian children. <b>Aim:</b> To determine the prevalence, clinical profile, aetiology and associated co-morbidities of thyroid dysfunction in children. <b>Materials and Methods:</b> A prospective, hospital based, observational study was conducted at a tertiary care hospital in Western India. Children below 12 years of age visiting the Pediatric out-patient department (OPD) and in-patient department (IPD) were included if they had clinical suspicion of thyroid dysfunction. Demographic data and clinical features of the recruited children were noted along with family history of thyroid disorders and use of iodized salt. Thyroid profile consisting of Tri-iodothyronin (T3), Thyroxin (T4) and Thyroid stimulating hormone (TSH) levels were tested in all. Investigations were also carried out to look for the cause and complications of hypothyroidism. These children were also followed up with appropriate therapy to look for response of therapy and complications to the same. <b>Results:</b> Sixty five children were found to have thyroid function abnormalities, 61 having hypothyroidism and 4 having hyperthyroidism. There was a low prevalence of goiter. The clinical feature of patients with hypo and hyperthyroidism was similar to other reported studies. The commonest aetiology of hypothyroidism was found to be dyshormonogenesis. A host of co-morbidities was observed along with thyroid dysfunction. On follow up with appropriate therapy, most of the children became euthyroid and complications were observed in only a minority. <b>Conclusion:</b> There is a high prevalence of thyroid dysfunction in children in western India and need for similar studies from different regions of the country covering larger population are well appreciated. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=SC01-SC04&id=7189 https://doi.org/10.7860/JCDR/2016/.7189 Versitality of the Use of Collagen Membrane in Oral Cavity N. Poornima Sowjanya, NagaMalleswara Rao, N.V.V. Satya Bhushan, Gokkula Krishnan <b>Introduction:</b> Bovine derived collagen membrane is usually and regularly used as a temporary cover or dressing for the extra oral wounds and for the burns on the body. It has wide applications because of its usefulness and biocompatibility. This has provoked us to do a study with the use of collagen membrane even for the intraoral minor surgical defects. <b>Aim:</b> The study was conducted to evaluate the clinical efficacy of collagen membrane as a biological dressing material for intraoral wounds, to check for haemostasis, pain control, granulation tissue formation, rapid re-epithelialization and minimal contracture. <b>Materials and Methods:</b> A total of 30 patients 19 male, 11 female were taken for excision of various intraoral lesions like leukoplakia patches, mucocele, epulis growths, irritational fibroma, frenectomy and the surgical defects were closed with collagen membrane. Postoperatively healing was assessed by taking five clinical parameters of Haemostasis, Pain, Granulation tissue, Epithelialization, Contracture. <b>Results:</b> Among 30 patients, haemostasis score was found to be good in 28 cases, fair in two cases. Pain relief score was good in seven cases, fair in 19 cases, poor in four cases. Granulation tissue formation score was good in eight cases, fair in 13 cases, poor in nine cases. Epithelialization score was good in 19 cases, fair in seven cases, poor in four cases. Contracture score was good in six cases, fair in 16 cases, poor in eight cases. Total score of all the five parameters, which was rated as effectiveness score, was calculated by using a standard scale. Final scoring was very effective in six cases, effective in 20 cases, ineffective in four cases. <b>Conclusion:</b> Reconstituted bovine derived collagen membrane used in our study was found to be an effective intraoral wound dressing material for faster uneventful healing of intraorally also. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ZC30-ZC33&id=7205 https://doi.org/10.7860/JCDR/2016/.7205 Evaluation of Lacrimal Gland Dimensions and Volume in Turkish Population with Computed Tomography Erdogan Bulbul, Alper Yazici, Bahar Yanik, Hasmet Yazici, Gulen Demirpolat <b>Introduction:</b> Computed tomography (CT) is a widespread method for evaluating head and neck pathologies. The lacrimal glands (LGs) are usually visible in routine head and neck CT scans. LG pathologies usually manifests with changes in gland sizes, so it is important to know the normal values of the LG dimensions and volume. The LG sizes may change with age, gender and race. The normal values of LG dimensions and volume in Turkish population was not reported before. <b>Aim:</b> The aim of this study was to evaluate the dimensions and volumes of the LGs by CT in a Turkish population. <b>Materials and Methods:</b> Two hundred seventeen consecutive paranasal CT scans of subjects evaluated retrospectively. Measurements of LG dimensions were performed in axial and coronal paranasal CT images. The LG volume was calculated with Aquarius software by outlining the gland in all consecutive axial images. <b>Results:</b> Four hundred orbits of 200 subjects were included to the study. The mean axial LG length in right and left orbits were 16.2±2.0 mm and 16.0±2.0 mm and the mean axial width of the right and left orbits were 4.1±0.7 mm and 4.0±0.7 mm. The right and left LG mean values for coronal length and width were equal 18.3 ±2.2 mm and 4.1±0.7mm respectively. The mean LG volume was 0.617±0.210 cm3 in right and 0.597±0.197 cm3 in the left orbits. There were statistically significant differences in the axial width and volume of the LG according to sides, however there was no significant difference according to gender. Age and LG measurements were negatively correlated. <b>Conclusion:</b> Our study may serve as a guide to determine the average values of the LG measurements in Turkish population and find out the orbital pathologies that involves the LG. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=TC06-TC08&id=7207 https://doi.org/10.7860/JCDR/2016/.7207 Sleep Dysfunction in Parkinson's Disease Vinoth Kanna Selvaraj, Bhanu Keshavamurthy <b>Introduction:</b> Sleep disorders are common in Parkinson’s Disease (PD). It can antedate the motor manifestations of PD. It is related primarily to the involvement of sleep regulating structures, secondary involvement through motor, depressive and dysautonomic symptoms and the tertiary involvement through anti-parkinsonian medications. <b>Aim:</b> The aim of our study is to evaluate the frequency and nature of the sleep abnormalities in Idiopathic Parkinson’s Disease, analysing the sleep architecture using polysomnography and to correlate the results with the disease parameters. <b>Materials and Methods:</b> A cross-sectional study was done in 50 patients who fulfill the “UK Parkinson’s Disease Society Brain Bank Clinical Diagnostic Criteria”. They were assessed using detailed history and clinical neurological examination. The severity of the disease was assessed based on Unified Parkinson’s Disease Rating Scale (UPDRS part III) and the sleep is assessed using Parkinson’s Disease Sleepiness Scale (PDSS) and Epworth Sleepiness Scale (ESS). Objective sleep study was done using polysomnography. <b>Results:</b> Disturbed sleep was reported by 70% of patients. Sixty percent of them had difficulty in falling asleep and 48% had difficulty in maintaining the sleep due to frequent awakenings. Day time somnolence was reported by 30% of patients. Polysomnographic analysis showed reduced total sleep time in 40 patients (80%). Correlation analysis of the total sleep time, sleep efficiency, deep sleep time, REM sleep time with the disease duration, staging, severity, PDSS Score, showed significant positive correlation (p<0.05). Sleep related movement disorders like Periodic Limb Movements (PLMS), Restless Leg Syndrome (RLS) also showed inverse correlation with disease duration and severity (p<0.05). <b>Conclusion:</b> Sleep architecture is markedly disturbed in patients with Idiopathic Parkinson’s disease. There is a reduction in the total sleep time, deep sleep time and REM Sleep duration. Periodic limb movements in sleep, restless leg syndrome, and obstructive sleep apnea contributes to the sleep fragmentation resulting in defective day time functioning. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=OC09-OC12&id=7208 https://doi.org/10.7860/JCDR/2016/.7208 Assessment of Cardiac Autonomic Functions in Medical Students With Type D Personality Shuba Narasimhan, R. Abhilasha Singh Panwar <b>Introduction:</b> Type D personality experiences joint occurrence of Negative Affectivity and Social Inhibition. It is an emerging risk factor for cardiovascular disease, with prevalence being 18-53% among cardiac patients. Type D personality people have exaggerated cardiovascular activity mediated by increased sympathetic drive and decreased vagal control of the heart which leads to enhanced risk of hypertension and is an independent risk factor for coronary heart disease. <b>Aim:</b> To compare the cardiac autonomic function of Type D and non-Type D students. To compare cardiac autonomic functions among male and female students and students with and without family history of hypertension and coronary artery disease among Type D. To find the most affected test among Type D students. <b>Materials and Methods:</b> Thirty Type D and 30 non- Type D medical students were identified by DS14. The Parasympathetic cardiac autonomic tests done assessed Heart Rate response to valsalva manoeuvre, immediate heart rate response to standing and heart rate variation during deep breathing. Sympathetic tests assessed BP response to standing and Sustained Hand Grip. The heart rate and R-R interval measurement were got from lead II of ECG recordings on Polyrite D. Statistical analysis was done using SPSS software. Unpaired student’s t-test was used and p-value <0.05 was considered to be statistically significant. <b>Results:</b> Type D students showed slightly decreased parasympathetic activity and increased sympathetic activity when compared to non-Type D students even though there was no statistically significant difference between them. There is a statistically significant decrease in valsalva ratio among females (p<0.01) when compared to males. There is a statistically significant decrease in 30:15 ratio and BP response to handgrip (p<0.05) among students with family history of hypertension and coronary artery disease when compared with students with no family history of coronary artery disease. Valsalva ratio is the most affected test in Type D students. <b>Conclusion:</b> Cardiac autonomic functions of Type D personality persons without cardiovascular disease is not different from that of non-Type D. Regular follow up studies over years are required to find if Type D personality is associated with cardiovascular risk in healthy individuals. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=CC15-CC19&id=7214 https://doi.org/10.7860/JCDR/2016/.7214 Predicting Healthcare Utilization by Patients Admitted for COPD Exacerbation Karthikeyan Ramaraju, Anupama Murthy Kaza, Nithilavalli Balasubramanian, Siddhuraj Chandrasekaran <b>Background:</b> Healthcare utilization, especially length of hospital stay and ICU admission, for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) determine overall outcomes in terms of morbidity, mortality and cost burden. Predicting prolonged hospital stay (PHS) and prolonged intensive care (PIC) for AECOPD is useful for rational allocation of resources in healthcare centres. <b>Aim:</b> To characterize the pattern of healthcare utilization by COPD patients hospitalized for acute exacerbation, and to identify clinical and laboratory predictors of ‘prolonged hospital stay’ (PHS) and ‘prolonged intensive care’(PIC) <b>Materials and Methods:</b> This study attempted through retrospective data analysis, to identify risk factors and evolve prediction models for increased healthcare utilization namely PHS and PIC for AECOPD. The data were extracted from 255 eligible admissions for AECOPD by 166 patients from Aug 2012 to July 2013. Logistic regression analysis was used for identifying predictors and models were tested with area under receiver operating characteristic curve. <b>Results:</b> Independent predictors of prolonged hospital stay (= 6 days) were chronic respiratory failure at baseline, low saturation at admission, high HbA1c level and positive isolates in sputum culture. Independent predictors of prolonged intensive care (for = 48 hours) were past history of pulmonary tuberculosis, chronic respiratory failure at baseline, low saturation at admission, high leukocyte count and positive culture isolates in sputum. Prediction models evolved from variables available at admission showed AUC 0.805 (95% CI 0.729 – 0.881) and 0.825 (95% CI 0.75 – 0.90) for PHS and ICU admissions respectively. <b>Conclusion:</b> Our prediction models derived from simple and easily available variables show good discriminative properties in predicting PHS and PIC for AECOPD. When prospectively validated, these models are useful for rational allocation of services especially in resource limited settings. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=OC13-OC17&id=7216 https://doi.org/10.7860/JCDR/2016/.7216 Prevalence of Metabolic Syndrome in Psoriasis Patients and its Relation to Disease Duration: A Hospital Based Case-Control Study Udayakumar Praveenkumar, Satyaki Ganguly, Lopamudra Ray, Sunil Kumar Nanda, Sheela Kuruvila <b>Introduction:</b> Previous studies indicate a higher prevalence of metabolic syndrome in psoriatic patients. This study aimed to investigate the association of metabolic syndrome and its components with psoriasis. It also studied the relation between presence of metabolic syndrome and disease duration in psoriasis patients. <b>Materials and Methods:</b> This was a hospital-based, case-control study conducted with 30 clinically diagnosed patients of chronic plaque psoriasis and 30 age- and sex-matched control subjects. Height, weight, BMI, blood pressure and waist circumference were assessed in all the subjects. Fasting levels of serum glucose, serum triglycerides and serum HDL were estimated by automated clinical chemistry analyser. Metabolic syndrome was diagnosed by the presence of at least 3 criteria of NCEP ATP III with Asian modification for waist circumference. <b>Results:</b> Metabolic syndrome was more common in psoriatic patients than in controls but the difference was statistically insignificant (60% vs. 40%, p-value=0.12). The psoriasis group had a higher prevalence of elevated blood glucose levels and higher waist circumference compared to controls. Psoriasis patients had a higher prevalence of high triglyceride levels than controls, the difference being statistically insignificant (40% vs. 30%, p-value = 0.41). The prevalence of low HDL levels was significantly higher in cases compared to controls (86.7% vs. 60%, p-value = 0.02). There was no relation between presence of metabolic syndrome and duration of psoriasis. <b>Conclusion:</b> Our findings suggest that metabolic syndrome as well as dyslipidaemia is commoner in psoriasis patients. This underlines the need for screening of all psoriasis patients for early diagnosis and treatment of associated metabolic syndrome to reduce the high burden of morbidity and mortality. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=WC01-WC05&id=7218 https://doi.org/10.7860/JCDR/2016/.7218 A Comparative Study between Closed Reduction and Cast Application Versus Percutaneous K- Wire Fixation for Extra-Articular Fracture Distal end of Radius Raghu Begur Venkatesh, Gopinath Karpenahalli Maranna, Roshan Kumar Bangalore Narayanappa <b>Introduction:</b> In extra-articular distal radius fractures closed reduction and casting has been the mainstay of treatment, difficulty lies in predicting and maintaining the proper reduction at final union. Percutaneous K-wire stabilization is also a widely accepted treatment option, but there is no consensus on its outcome in comparison to closed reduction and casting. <b>Aim:</b> To evaluate the results of closed reduction and casting versus closed reduction with percutaneous K wire fixation and casting in the treatment of the distal radius extra-articular fracture with reference to the restoration of radial height, radial inclination, volar tilt of the distal articular surface and to assess the functional outcome of the same measured by the Gartland and Werley demerit scoring system. <b>Materials and Methods:</b> Prospective study was conducted on 60 patients attending the Department of Orthopaedics, from December 2013 to May 2015 with extra-articular fractures (AO type 23-A2 and 23-A3) of distal radius and fulfilling all the inclusion and exclusion criteria. The cases were randomly divided into two equal groups of 30 patients, the first group treated by closed reduction and below elbow cast application, while the second group were treated by closed reduction percutaneous K-wire application and below elbow cast application. The radiological outcome of both groups were evaluated by measuring the Volar inclination, Radial inclination and Radial height, while the functional outcome was evaluated by the demerit scoring system of Gartland and Werley. <b>Results:</b> The Cast application group had 13 excellent, 9 good, 7 fair and 1 poor result the mean outcome score of the group was 5.2. The K wiring group had 11 excellent, 13 good, 5 fair and 1 poor result, the mean score of the group was 5.17. The unpaired student’s t-test on the values obtained from both groups yielded a p-value of 0.9816. The mean radial height in the Cast application group was 8.033mm while the mean in the k wiring group was 11.783mm. The mean volar tilt was 4.867 degrees and 7.5 degrees respectively. The mean radial inclination was 14.23 degrees and 19.1respectively. Unpaired student’s t-test on the values revealed a p-value of 0.0001 for all three. <b>Conclusion:</b> We concluded that closed reduction with percutaneous K-wire fixation under C-arm for treatment of extra articular fractures of distal radius gives statistically significantly better radiological outcome than treatment with closed reduction and casting alone, but there is no statistically significant difference in functional outcome. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=RC05-RC09&id=7220 https://doi.org/10.7860/JCDR/2016/.7220 Spectrum of Sickle Cell Diseases in Patients Diagnosed at a Tertiary Care Centre in Karnataka with Special Emphasis on their Clinicohaematological Profile Hemalata Lokanatha, Pradeep Rudramurthy, Rajashekar Murthy G Ramachandrappa <b>Introduction:</b> Sickle cell disease is a monogenic disorder with considerable clinical diversity and Sickle haemoglobin is responsible for wide spectrum of disorders which vary with respect to severity of anaemia, frequency of crises and duration of survival. As they are confused with many other clinically aggressive disorders, precision in diagnosis is essential both to proper clinical management and subsequent genetic counselling. Hence, this study was taken up in order to diagnose these conditions and administer suitable counselling measures to minimise the incidence of sickle cell disease in the future. <b>Aim:</b> The aim of this study was to identify the spectrum of all Sickle cell diseases diagnosed at a tertiary care centre in Bangalore, Karnataka, India who presented over a period of five years from 2009 to 2013 and also to screen the parents and siblings of the patients for their carrier status. <b>Materials and Methods:</b> We reviewed 26 cases of Sickle Cell Disease (SCD) and also 38 parents & 10 siblings of these children for their carrier status. Haemoglobin electrophoreses was performed by using alkaline gel method, followed by High Performance Liquid Chromatography when needed. <b>Results:</b> A total of 26 children diagnosed with SCD were enrolled in the study. Most common entity was Sickle Cell Anaemia (SCA), followed by sickle thalassaemia and Sickle Cell Trait (SCT). Commonest clinical presentation was fever and pallor. Amongst the parents and siblings, sickle cell trait was the most common entity followed by thalassaemia trait. One interesting case of HbSE disease was encountered, which is a rare entity in India. <b>Conclusion:</b> This study brings out the total spectrum of SCDs in a tertiary care centre in Karnataka, with more emphasis on screening of the parents and siblings for their carrier status. A ge N o of children 0-5yrs https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=EC09-EC11&id=7221 https://doi.org/10.7860/JCDR/2016/.7221 Salivary Lactate Dehydrogenase (LDH)- A Novel Technique in Oral Cancer Detection and Diagnosis Kavyashree Lokesh, Jayanthi Kannabiran, Mahesh Dathu Rao <b>Introduction:</b> Oral squamous cell carcinoma (OSCC) is the sixth most common malignancy which is a major cause for cancer morbidity and mortality worldwide. Early diagnosis and intervention improves the overall survival rate. <b>Aim:</b> The current study was done to evaluate the accuracy of salivary LDH as a potential biomarker for diagnosis of OSCC and to correlate the levels of salivary LDH with the histological differentiation of the tumour. <b>Materials and Methods:</b> Thirty patients visiting the outpatient department diagnosed clinically and histologically with OSCC were selected for the study with a control group of 20 patients. Unstimulated salivary samples collected from the selected patients were centrifuged and processed. Readings of enzyme activity in the salivary samples was established through auto analysis using International Federation of Clinical Chemistry (IFCC) method. Levels of the enzyme activity in both the control and the study group were compared and statistically analysed using student t-test. The three subgroups were also compared and statistically analysed. <b>Results:</b> The results showed a mean value of 497.00 with a SD of 51.75 among the control group and a mean value of 1225.40 with a SD of 221.79 among the cases with a p-value of 0.0001 which was statistically significant. Furthermore, when the LDH values for the various grades of OSCC were compared, the mean values were 1049.07, 1309.50 and 1586.20 respectively, for well differentiated, moderately differentiated and poorly differentiated carcinoma. <b>Conclusion:</b> The p-value thus obtained revealed LDH values which were significantly higher in patients with OSCC and furthermore the levels significantly correlated with the histopathological grade of the tumour. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ZC34-ZC37&id=7223 https://doi.org/10.7860/JCDR/2016/.7223 A Comparative Study of Sonographic Grading of Renal Parenchymal Changes and Estimated Glomerular Filtration Rate (eGFR) using Modified Diet in Renal Disease Formula Vinayaka Undemane Shivashankara, Siddharudha Shivalli, B.H. Santhosh Pai, Koteshwara Devadasa Acharya, Ravichandra Gopalakrishnan, Vivek Srikanth, Vishwanath Reddy, Arafat Haris <b>Introduction:</b> The sonographic findings are of help in evaluating the nephrological diseases. Glomerular filtration rate is another parameter for assessing the reserved renal function and an indicator of prognosis. In clinical practice GFR estimation (eGFR) is done by using a mathematical formula. In our study, we compared the sonographic grading of renal parenchymal changes with eGFR calculated using Modified Diet in Renal Diseases formula based on serum creatinine, age, gender and ethnicity. <b>Aim:</b> To evaluate the relevance of sonographic grading of renal parenchymal changes in assessing the severity of the renal disease and comparing it to the eGFR calculated using MDRD formula based on the age, gender and serum creatinine value of the patient. <b>Materials and Methods:</b> The adult patients with suspected kidney disease referred for sonography of abdomen were our study participants. As per our study design following strict inclusion and exclusion criteria, patients were selected as study participants and for each of the patient’s renal parenchymal status, serum creatinine, age, gender and ethnicity were documented. <b>Results:</b> A total of 70 patients were our study participants, out of which 67.1% were males and 32.9% were females. Our study showed a linear correlation between sonographic grading of renal parenchymal changes with eGFR. <b>Conclusion:</b> We conclude that by evaluating the kidneys with sonography and calculating eGFR using MDRD formula the renal status will be more accurately interpreted. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=TC09-TC11&id=7233 https://doi.org/10.7860/JCDR/2016/.7233 Insulin-Like Growth Factor I Receptor (IGF-IR) Ligands and BMI in Squamous Intra-Epithelial Lesion (SIL) of Cervix Praveen Sablania, Swaraj Batra, Alpana Saxena <b>Introduction:</b> Cancer cervix is the most common cancer in women in developing countries like India. Several studies have linked insulin-like growth factors-I & II (IGF-I and IGF-II) and IGF binding proteins-3 (IGFBP-3) with pathogenesis of Squamous Intraepithelial Lesion of cervix (SIL). To the best of our knowledge, no study has shown any correlation between circulating C-Peptide levels and SIL. <b>Aim:</b> The present study has attempted to evaluate the correlation between SIL and IGF-IR ligands (IGF-I, IGF-II, C-Peptide), IGF binding protein (IGFBP-3) and Body Mass Index (BMI). <b>Materials and Methods:</b> The present case-control study consisted of 31 histologically proven SIL cases and 31 age matched controls without evidence of SIL. A 10 ml blood sample was collected in heparinized vial. Plasma was separated immediately using centrifugation and was stored at -800 C till further analysis. Plasma levels of IGF-I, IGF-II, C-peptide and IGFBP3 were measured using commercially available Enzyme Linked Immunosorbent Assay (ELISA) kit. Height and weight was noted for calculation of BMI. Bio-effective molar ratio (BEMR) was calculated as 3.72 x {(0.25 x IGF-I) + (0.032 x IGF-II) + (0.0025 x C-peptide)} / {(1435 + IGFBP-3) – (2.79 x IGF-I) – (2.87 x IGF-II)}. Statistical analysis was performed using SPSS and Microsoft Excel software employing student t-test, Mann-Whitney and Chi-square test for trend while binary logistic regression was used to estimate the odds ratios (OR) and corresponding 95% Confidence Intervals (CI). <b>Result:</b> IGF-I, IGF-II levels and BEMR were significantly increased in SIL compared to controls (p= 0.001, p <0.001, and p <0.001, respectively). C-Peptide levels were higher in controls than SIL (p = 0.04). IGFBP-3 & BMI in SIL were not significantly related when compared with controls. Risk of SIL in 4th quartile for BEMR, IGF-I, and IGF-II was 12.18(95% CI= 3.13-47.39), 3.94(95% CI = 1.24-12.56), and 4.57(95% CI = 1.42-14.7), respectively. <b>Conclusion:</b> Elevated levels of IGF-I and IGF-II are associated with risk of SIL while BEMR emerges out to be a derived factor strongly associated with risk of SIL. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=BC11-BC15&id=7234 https://doi.org/10.7860/JCDR/2016/.7234 Evaluation of the Stress Induced in Tooth, Periodontal Ligament & Alveolar Bone with Varying Degrees of Bone Loss During Various Types of Orthodontic Tooth Movements Anupam Agarwal, Shalu Mahajan, Santosh Verma, Preeti Bhardwaj, Geeta Sharma <b>Introduction:</b> The force applied on to a tooth with periodontal bone loss may generate different magnitude and pattern of stresses in the periodontium when compared to a tooth with no bone loss & under the same force system. The intensity of the forces and moment to force ratios needed to be applied during an Orthodontic treatment must be adapted to obtain the same movement as in a tooth with a healthy periodontal support. <b>Aim:</b> Evaluation and assessment of the stress distribution during various types of Orthodontic tooth movement on application of Orthodontic force, at various levels of alveolar bone loss; & determination of the most ideal force system producing the Optimum Stress (i.e., stress within optimum range), uniformly (conducive to bodily movement of maxillary canine with varying degrees of bone loss). <b>Materials and Methods:</b> A human maxillary canine tooth of right side was simulated by means of Finite Element Method (FEM). Five different models were constructed with bone loss ranging from 0mm in model 1, to 8mm in model 5 (progressing at 2mm per model). Ten different loading conditions were applied on these models and the stress generated was charted at various occluso-gingival levels and surfaces around the tooth. The evaluation and assessment of the stress distribution during various types of Orthodontic tooth movement on application of Orthodontic force, at various levels of alveolar bone loss was done. <b>Results:</b> The results showed that there was a high positive correlation between the increase in bone loss & the stress generated, suggesting an elevation in the stress with advancing bone loss. Additionally, the type of tooth movement was found to be changed with bone loss. During the determination of ideal force system it was found that the centre of resistance of the canine migrated apically with bone loss and an increase in the moment to force ratio (Mc:F) was required to control the root position in these cases. <b>Conclusion:</b> A high positive correlation exists between the increase in bone loss and the stress generated. Suitable modification should be done in the force system under bone loss conditions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ZC46-ZC52&id=7235 https://doi.org/10.7860/JCDR/2016/.7235 Comparative Evaluation of Fluoride Recharge Ability of Conventional and Hydroxyapatite Modified Glass Ionomer Cement with Daily Low Fluoride Exposure- An Invitro Study Antarmayee Panigrahi, S.Sudeep, Shalini Sharma, Susant Mohanty <b>Introduction:</b> Glass ionomer cement (GIC) has best suited paediatric dentists and is well recognised in the preventive era of dentistry. However its use is affected by its inferior mechanical properties. Hydroxyapatite whiskers have been lately introduced as strengthening additive without affecting its fluoride releasing property, but literature lacks data related to its effect on recharging ability of glass ionomer cement. <b>Aim:</b> To evaluate and compare fluoride release from hydroxyapatite incorporated glass ionomer cement following recharging with low fluoride dentifrices. <b>Materials and Methods:</b> An 8% Hydroxyapatite whiskers were added to Conventional Glass ionomer powder and 40 specimens each of conventional and Hydroxyapatite Glass ionomer cement were prepared using customised Teflon mould (5mm x 2mm) and were suspended in deionised water. Recharging of aged specimens was done using low fluoridated dentifrices containing 500ppm fluoride, twice daily and water was replenished every 24 hours. Fluoride release was analysed daily for 7 days and then weekly till 21 days using Sension 4 pH/ion selective electrode. Data thus obtained was statistically analysed by descriptive analysis followed by repeated measures ANOVA. <b>Results:</b> Significant (p<0.01) increase in fluoride release was observed in both the materials following recharging regimen. Recharge pattern of hydroxyapatite glass ionomer was found to be similar to conventional glass ionomer cement. <b>Conclusion:</b> Within the limitations of this study it can be evinced that fluoride rechargability and re-release remains unaffected by the addition of hydroxyapatite whiskers and hence proves to be more acceptable additive to glass ionomer cement to improve its mechanical properties widening its arena of usage by clinicians. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ZC53-ZC55&id=7236 https://doi.org/10.7860/JCDR/2016/.7236 A Study of the Supratrochlear Foramen of the Humerus: Anatomical and Clinical Perspective Asha Joselet Mathew, Geetha Sulochana Gopidas, Tintu Thottiyil Sukumaran <b>Introduction:</b> The Supratrochlear Foramen (STF) is a variably shaped perforation present in the bony septum that separates the olecranon and coronoid fossae at the distal end of the humerus, between the two epicondyles. Its incidence varies widely from 0.3% to 58% in different races. <b>Aim:</b> This study aims to describe its prevalence and morphometry in relation to its shape and size and distance from the epicondyles. <b>Materials and Methods:</b> A prospective study of 244 unpaired humerii, 130 of the left side and 114 of the right side of unknown age and sex were examined for the presence of STF and prevalence stated. The STF was classified according to shape and their metric assessment was carried out, along with measures of its distance from the epicodyles and trochlear margin. <b>Results:</b> Of the 244 humeri studied 60 showed presence of the foramen, 45 were opaque and 139 showed translucent septum. The sidewise prevalence of opacity, translucent septum and foraminae were tabulated. The commonest shape noted was oval. Other shapes such as round, triangular, rectangular, sieve and reniform were visualised. In the oval STF, transverse and vertical diameters were measured. The transverse and vertical diameters on the left were 4.9 and 3.27 mm and on the right it was 5.12 and 3.48mm respectively. The distance from the medial epicondyle, lateral epicondyle and trochlea to the STF margins was measured and the mean values were calculated separately for right and left sides. The mean diameter of the round foramen was 3.23 and 4.89mm for left and right sides respectively. In the triangular type the maximum vertical and transverse diameters were recorded. There was only one sample of the rectangular type. Its length was 4.1mm and the breadth was 2.27mm and it belonged to the right side. The reniform type totalled 7 of which 6 were of the left side. The average vertical length at the hilum was 4.52 mm and the transverse measurement was 7.44 mm. The foraminae of the right side were found to be larger, regardless of shape. <b>Conclusion:</b> Its existence is important to the orthopaedician in the preoperative planning of nailing fractures of the distal humerus and to the radiologist for differentiating it from an osteolytic or cystic lesion. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=AC05-AC08&id=7237 https://doi.org/10.7860/JCDR/2016/.7237 Clinicopathologic Correlation of White, Non scrapable Oral Mucosal Surface Lesions: A Study of 100 Cases Mohammed Abidullah, Vandana Raghunath, Tanveer Karpe, Syed Akifuddin, Shahid Imran, Venkata Naga Nalini Dhurjati, Mohammed Ahtesham Aleem, Farheen Khatoon Hatoon <b>Introduction:</b> White, non scrapable lesions are commonly seen in the oral cavity. Based on their history and clinical appearance, most of these lesions can be easily diagnosed, but sometimes diagnosis may go wrong. In order to arrive to a confirmative diagnosis, histopathological assessment is needed in many cases, if not all. <b>Aims:</b> 1) To find out the prevalence of clinically diagnosed oral white, non scrapable lesions. 2) To find out the prevalence of histopathologically diagnosed oral white, non scrapable lesions. 3) To correlate the clinical and histopathological diagnosis in the above lesions. <b>Materials and Methods:</b> A total of 100 cases of oral white, non scrapable lesions were included in the study. Based on their history and clinical presentation, clinical provisional diagnosis was made. Then biopsy was done and confirmatory histopathological diagnosis was given and both were correlated. In order to correlate clinical and histopathological diagnosis Discrepancy Index (DI) was calculated for all the cases. <b>Results:</b> Based on clinical diagnosis, there were 59 cases (59%) of leukoplakia, 29 cases (29%) of lichen planus and six cases (6%) of lichenoid reaction; whereas, based on histopathological diagnosis, there were 66 cases (66%) of leukoplakia epithelial hyperplasia and hyperkeratosis (leukoplakia) and 30 cases (30%) of lichen planus. Seventy eight clinically diagnosed cases (78%) correlated with the histopathological diagnosis and 22 cases (22%) did not correlate. The total discrepancy index was 22%. <b>Conclusion:</b> A clinician needs to be aware of oral white, non scrapable lesions. Due to the overlapping of many clinical features in some of these lesions and also due to their malignant potential, a histopathological confirmative diagnosis is recommended. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ZC38-ZC41&id=7226 https://doi.org/10.7860/JCDR/2016/.7226 Commercial and Plant Extract Denture Cleansers in Prevention of Candida albicans Growth on Soft Denture Reliner: In Vitro Study Mohammed Asif Khan, Sunil Dhaded, Shalini Joshi <b>Objective:</b> To evaluate and compare the efficacy of two plant extracts and two commercially available denture cleansers against candida albicans adherent to soft denture reline material. <b>Materials and Methods:</b> In this study 60 specimens of soft denture reliner material specimens were fabricated with dimensions 10x10x2 mm. The sterile specimens were inoculated by immersion in Sabourand broth containing Candida albicans for 16 hours at 37°C in an incubator. Then the specimens were washed and immersed in denture cleansers which were divided into group five groups from Group I-V for CD Clean®, Nigella sativa, thyme essential oil, Fittydent® and distilled water respectively, for 8 hours at room temperature. Then they were washed, fixed with methanol and stained with crystal violet. Candida cells adherent to the specimens were counted under microscope. The number of cells adherent to test samples were compared with that adherent to control. <b>Results:</b> The effectiveness of Fittydent® was more than CD Clean® in reducing the adherent candida albicans and the difference was statically significant (p = <0.001). Both thyme essential oil and nigella sativa were almost same in effectiveness against candida albicans but the difference was not statically significant (p= 0.79). Post-hoc Tukey?s test was performed which indicated that Fittydent® was the most effective amongst the denture cleansers tested in this study, followed by thyme essential oil, nigella sativa and CD Clean®. <b>Conclusion:</b> The results of the study showed that all denture cleansers used in the study were significantly effective. The study indicated that Fittydent is more effective amongst the denture cleansers because of its mechanism of action; however the plant extracts used in this study were also significantly effective against candida albicans. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ZC42-ZC45&id=7228 https://doi.org/10.7860/JCDR/2016/.7228 Correlation of Oxidative Damage with Pro-Inflammatory Markers (IL-6, TNF-a) in Meningocele Bedabrata Mukhopadhyay, Roshni Gavel, Ajay N. Gongopadhyay, Pooja Vashistha, Anjali Rani, Surendra Pratap Mishra <b>Introduction:</b> Oxidative damage induces alteration in the status of pro-inflammatory markers like IL-6 and TNF-a in meningocele. The study was performed with estimation of the levels of MDA (Malonyldialdehyde), SOD (Superoxide dismutase) taken as oxidative damage markers and IL-6 (interleukin 6) and TNF-a (Tumour necrosis factor alpha) taken as inflammatory markers, in the serum of meningocele patients and age, sex matched normal neonates. Correlation among the different serum levels of MDA, SOD, IL-6 and TNF-a was determined. <b>Materials and Methods:</b> It is a case-control study, comprising of 153 participants: 101 newborns with meningocele and 52 healthy newborns. The study was conducted in the Department of Biochemistry, Institute of Medical Sciences, Banaras Hindu University, Varanasi, in collaboration with the Department of Paediatric Surgery and Department of Obstetrics and Gynecology, Sir Sunderlal Hospital, Banaras Hindu University, Varanasi. The study was conducted during the period of 2012 to 2014. Serum was extracted from blood collected from both groups i.e. meningocele patient group and healthy neonatal control group. The levels of MDA and SOD were determined by spectrophotometric method. IL-6 was determined by the Human IL-6 High Sensitivity ELISA Kit and TNF-a was determined by the Human TNF-a ELISA KIT. <b>Results:</b> The levels of MDA, TNF-a and IL-6 were found to be much higher and level of SOD was found lower in the patients with meningocele as compared to the normal healthy neonates. <b>Conclusion:</b> Increased MDA (oxidative damage product), IL-6, and TNF-a (inflammatory marker) and low level of SOD shows an increased inflammatory response in Meningocele. Our study shows Negative Correlation between MDA and SOD in case & control groups, while a Positive Correlation between TNF alpha and IL-6 in control & case groups. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=BC08-BC10&id=7229 https://doi.org/10.7860/JCDR/2016/.7229 Segmental Comparison of Peripheral Arteries by Doppler Ultrasound and CT Angiography Prem kumar Chidambaram, Ram Kumar Swaminathan, Prakash Ganesan, Manibharathi Mayavan <b>Introduction:</b> Diseases of peripheral arterial system are one of the common causes of limb pain, especially in elderly patients. Here we analyse non invasive imaging of peripheral arterial segments. <b>Aim:</b> Aim of the study was to compare arterial diseases of extremities using Doppler ultrasound and CT angiography, and to find the better non-invasive modality of choice. <b>Materials and Methods:</b> Fifty patients {14 patients with upper limb complaints (15 upper limbs) and 36 patients with lower limb complaints (72 lower limbs)} of peripheral arterial disease underwent Doppler ultrasound (USG) and CT Angiogram (CTA). Arterial systems divided into anatomic segments and luminal narrowing were compared using gray scale Doppler ultrasound and axial images of arterial phase of CT angiogram. Using statistical methods, sensitivity, specificity and accuracy of Doppler ultrasound and CT angiography were determined. <b>Results:</b> Six hundred and nineteen arterial segments were studied with CT angiography and Doppler ultrasound. Of which 226 diseased segments were identified in CT angiography. Doppler overestimated narrowing by one grade in 47 segments, by two grade in 11 segments, by three grades in 30 segments and by four grades in 22 segments; underestimated by one grade in 28 segments, by two grades in 9 segments, by three grades in 5 segments and by four grades in 3 segments. Significant statistical difference exists between Doppler USG and CT angiography. Doppler showed good correlation with CT angiography in 74%, but, Doppler overestimated stenosis grade in a significant percentage. The sensitivity, specificity and accuracy of Doppler USG compared with CT angiography was 93.36%, 82.44%, and 86.42%. <b>Conclusion:</b> Duplex Doppler can be the first investigation in excluding peripheral arterial disease, especially for evaluation of infra inguinal region of lower limbs and from second part of the subclavian artery in upper limbs. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=TC12-TC16&id=7242 https://doi.org/10.7860/JCDR/2016/.7242 A Study of Tubal Recanalization in Era of ART (Assisted Reproduction Technology) Sowmya Koteshwar, Anjali Siddesh <b>Introduction:</b> Tubectomy remains one of the most popular methods of permanent contraception in developing countries. But about 10% of them regret their decision and 1% want to restore their fertility. Out of many options open method of tubal recanalisation is one of the method of restoring fertility. <b>Aim:</b> Primary objective was to analyse whether open tubal recanalization is a feasible option for those planning to conceive after tubectomy. Secondary objective was to evaluate the pregnancy rate and analyse the various factors affecting pregnancy rate after tubal recanalization. <b>Materials and Methods:</b> A prospective study, follow-up of 2 year in patients treated with tubal recanalization during 2012-2013 at tertiary teaching hospital. 10 women underwent tubal recanalization procedure. Open surgery was done and the principles of microsurgery were followed meticulously throughout the procedure. S tatistical Analysis: All statistical analyses were performed using SPSS for Windows version 17.0 (SPSS Inc., Chicago, IL, USA). Data were expressed as means, medians, standard deviations, and percentages. We used Student's t-test to compare group means and Fisher-exact test to compare proportions. A p-value of <0.05 was considered significant. <b>Results:</b> Out of 10 women who went recanalization an overall 50% pregnancy rate was achieved. All pregnancies occurred within 1 year of procedure. When previous sterilisation was done by laparoscopic route, after reversal all of them (100%) conceived while in those sterilised by Pomeroys method the pregnancy rate after reversal was only 16.6%. Following reversal pregnancy was stastically more significant in those with final tubal length of >5cm (p=0.04) and in those with Isthmo-Isthmic type of anastomosis . <b>Conclusion:</b> Open tubal recanalisation remains a feasible option for those planning pregnancy after tubectomy. The important factors for determining the success of operation were age of the patient, time interval between sterilization and reversal, site of ligation, method used for previous ligation and the remaining length of the tube after recanalisation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=QC01-QC03&id=7243 https://doi.org/10.7860/JCDR/2016/.7243 Alcohol Used as Disinfectant before Venipuncture does not Lead to Sample Haemolysis or Sample Dilution Devajit Sarmah, Booloo Sharma, Dilutpal Sharma, Sheeja Mathew <b>Introduction:</b> Sample haemolysis is often the leading cause of sample rejections in clinical laboratory. Isopropyl alcohol or ethyl alcohol, used as disinfectant during sample collection is often considered an important cause of sample haemolysis or sample dilution; although there is a paucity of scientific documentation verifying the same. <b>Aim:</b> To verify whether avoidance to wipe out alcohol from the venipuncture site, before sample collection leads to sample haemolysis; or leads to sample dilution. <b>Materials and Methods:</b> This was a prospective randomized study, where every second patient coming to the phlebotomist during the study period, in the age group of 20 to 50 years, was considered for the study. A total of 60 patients were considered for the study. For unbiased comparison sample were collected from both left upper limb (alcohol dry) and right upper limb (alcohol wet) of all the patients. Visual inspection for haemolysis was done, and serum potassium (K), Calcium (Ca), Lactate Dehydrogenase (LDH), Aspartate transaminase (AST), Alanine transaminase (ALT), Alkaline phosphatase (ALKP) and Glucose were estimated in both the set. Also experiences of patients in both limb collections were considered. <b>Results:</b> On visual inspection none of the sample was haemolysed. 51.67% of the patients experienced same level of discomfort in both limbs (alcohol dry and alcohol wet) during venipuncture. While 28.3% experienced burning sensation in alcohol wet limb, another 20% experienced a more soothing sensation in the alcohol wet limb during venipuncture. There is no statistically significant difference in the measured value of serum K, LDH, Ca, AST, ALT and ALKP and Glucose between the two sets of sample - alcohol dry and alcohol wet. <b>Conclusion:</b> The study concludes that avoidance to wipe alcohol before venipuncture does not lead to sample haemolysis or sample dilution. Also most patient experienced same or more soothing sensation in alcohol wet limb. Therefore sample can be collected without a waiting period for alcohol to dry off, thereby preventing haemoconcentration and decreasing sample collection time. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=BC16-BC18&id=7245 https://doi.org/10.7860/JCDR/2016/.7245 Martin–Gruber Anastomosis– A Cadaveric Study in North Indian Population Neelamjit Kaur, Rajan Kumar Singla, Jagdev Singh Kullar <b>Introduction:</b> Communications between peripheral nerves are important in the light of the fact that these are responsible for a myriad of clinical symptoms. Communication between the median nerve and ulnar nerve (Martin-Gruber anastomosis) is a frequent finding observed anatomically in 10%-30.6% subjects and physiologically in 5-40%. It may lead to exacerbated or attenuated clinical symptoms. <b>Aims & Objectives:</b> To find out the incidence of Martin-Gruber anastomosis in North Indian population by cadaveric dissection. <b>Materials and Methods:</b> The material comprised of 60 upper limbs belonging to 30 cadavers (M:F::28:2) which were dissected to find out incidence of Martin-Gruber anastomosis. <b>Results:</b> Martin-Gruber anastomosis was encountered in 7(11.6%) limbs of the present study. It was seen more frequently unilaterally (16.6%) than bilaterally (3.3%) and only in males. Classification of limbs into various patterns and types was done. Further its ontogeny, phylogeny, genetic inheritance and clinical implications are discussed in detail. <b>Conclusion:</b> To conclude, in North Indian population, the Martin-Gruber anastomosis is encountered in 11.6% limbs. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=AC09-AC11&id=7247 https://doi.org/10.7860/JCDR/2016/.7247 A Prediction Formula for Double Product in Pregnancy Anita Teli, Shrilaxmi Bagali, Ravi Ghatanatti <b>Introduction:</b> Maternal cardiovascular changes in pregnancy are numerous and increase in double product throughout pregnancy is the part of the same process. Double product is a cardinal surrogate of the myocardial oxygen demand and cardiac workload. It is the product of heart rate and systolic blood pressure and an important determinant of cardiovascular risk in hypertensive patients. <b>Aim:</b> This study was intended to determine the double product by comparing normal individuals with different trimesters of pregnancy. <b>Materials and Methods:</b> A cross sectional study was conducted in 220 healthy women in the age range of 18-35 years with 60 subjects each in 1st, 2nd and 3rd trimesters and 40 non pregnant subjects as control group. Cardiovascular parameters were recorded in both the groups. Statistical analysis was done by comparison of parameters using one-way ANOVA and post-hoc by Tukey-Krammer test. Correlation of double product and weeks of pregnancy was done using Pearson’s correlation. Regression analysis was done to know the predictor of double product. <b>Results:</b> It was observed that there was statistically very highly significant increase (p=0.000) in the double product throughout the pregnancy and duration of pregnancy was found to be the predictor of the product. <b>Conclusion:</b> The increase in the double product is due to increase in heart rate and stroke volume. Double product is the useful predictor for early identification of preeclampsia and acute myocardial infarction in pregnant women when compared to normal non- pregnant women and hence helps in the early management of complications. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=CC20-CC22&id=7248 https://doi.org/10.7860/JCDR/2016/.7248 Evaluation of CT and MRI Findings among Patients Presented with Chief Complaint of Headache in Central India Garjesh Singh Rai,Tina Rai, Leena Jain, Mahendra Mohan Vyas, Rakesh Roshan <b>Introduction:</b> Headache is one of the most common presenting complaints in day to day medical practice however the secondary causes of headache are uncommon. Thus, appropriate selection of headache patient (Pt) is important to determine those that require neuroimaging due to likely secondary cause. Red flags and Clinical warning criterion (CWC) act as a screening tool to help in identifying those who may get benefit from neuroimaging. <b>Aim:</b> To evaluate the findings of computed tomography (CT) and Magnetic Resonance Imaging (MRI) among patients presented with the chief complaint of headache and to compare the findings between two groups of patients. <b>Materials and Methods:</b> This retrospective observational study was carried out in 500 selected patients, who underwent CT or MRI scan of head in Peoples College of Medical Sciences and Research centre, Bhopal, MP during the period of 2 year in between Jan 2013 to Dec 2014. Siemens Somatom sensation 40 slice MDCT and Siemens magnetom 1.5T MRI scanner were used for imaging. Five hundred patients of 10 to 70 year age were selected for the study based on our criterions of selection. <b>Results:</b> All 500 patients were divided in to two groups A and B based on presence or absence of red flag signs and CWC signs. Group A consists of 48 patients having one or more red flag or CWC signs and group B consists of 452 patients those don’t have any above signs. 29 cases (60.4%) out of total 48 cases of group A is suffering from chronic headache as compared to 97 cases (21.5%) out of total 452 patients of group B is having positive findings (p-value<0.05). Out of 500 patients, only 29 cases (5.8%) revealed some form of brain parenchymal pathology whereas other associated findings were seen in 97 cases e.g. sinusitis in 58 (11.6%), bone related pathology in 26 (5.2%) and chronic suppurative otitis media (CSOM) in 13 (2.6%) patients. <b>Conclusion:</b> CT/MRI in patients without red flag or CWC sign yields very low percentage of clinically significant positive findings in neuroimaging. In the absence of these, the only reason for CT or MRI scan seems to reassure the patients and their loved ones. CT or MRI as a screening tool in these patients has limited value in term of cost effectiveness. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=TC21-TC25&id=7249 https://doi.org/10.7860/JCDR/2016/.7249 Public–Private Partnership in Health Care: A Comparative Cross–sectional Study of Perceived Quality of Care Among Parents of Children Admitted in Two Government District–hospitals, Southern India B. Shantaram Baliga, S.R. Ravikiran, Suchetha S. Rao, Anitha Coutinho, Animesh Jain <b>Introduction:</b> Perceived better quality of care draws lower socio-economic classes of Indians to more expensive private setups, leading to poverty illness poverty cycle. Urgent measures need to be taken to improve perceived quality of public hospitals. The present study compares the difference in perceived quality of care among parents of children admitted at two government district hospitals. <b>Materials and Methods:</b> A cross-sectional, comparative, questionnaire based study was conducted between February 2011 and February 2012 at Government medical college hospitals of two district headquarters in South-India: one with private-public-partnership (PPP-model); another directly operated by government - Public Hospital-model (PH-model). A total of 461 inpatients from the PH model hospital and 580 from the PPP model hospital were eligible. Patients who left against advice (LAMA) (n=44 in PH and 19 in PPP) and expired (n=25 in PH and 59 in PPP) were excluded. Fourteen incomplete forms from PH and 10 from PPP model hospital were also excluded. Responders rated perception on a 1-5 scale in each domain: accessibility of health-facility, time spent waiting, manner and quality of physician, manner and quality of nurse, manner and quality of supporting staff, perception of equipment, explanation of treatment details and general comfort. The responders also rated overall satisfaction on a 1-10 scale. In the 1-5 scale, rating>4 in each domain was considered good. Rating>8 in 1-10 scale was considered satisfaction. <b>Results:</b> Responders from PPP-model hospital were significantly more satisfied than those from PH-model {n=529 (91.2%) vs. n=148 (32.1%) p<0.001}. This was true even when controlled for age-group, sex, maternal education, family-type, days of hospital-stay and socioeconomic class {O.R.(CI) =23.58 (16.13-34.48); p<0.001} by binary logistic regression model. In the PPP-model hospital the time spent waiting for treatment {4.28(2.07-8.82), p<.001} and manner of support staff {3.64(1.02-12.99), p=0.04} significantly predicted satisfaction. In PH-model hospital explanation given regarding treatment details significantly predicted overall satisfaction {2.99(1.61-5.54), p<.001}. <b>Conclusion:</b> Perceived quality of hospital care, as evidenced by the satisfaction and perception ratings of responders, was better in PPP-model hospital. This model could be emulated in developing countries to draw patients of lower socio-economic classes to tertiary-care public hospitals which are less expensive. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=SC05-SC09&id=7250 https://doi.org/10.7860/JCDR/2016/.7250 Metabolic Evaluation in Paediatric Urolithiasis: A 4-Year Open Prospective Study Ajay Kumar R Gajengi, Vinayak Gorakhnath Wagaskar, Harshwawardhan V Tanwawar, Sunil Mhaske, Sujata K Patwawardhan <b>Introduction:</b> Children with urolithiasis are associated with considerable morbidity and commonly associated with metabolic abnormalities. By treating these abnormalities stone formation is prevented. <b>Objectives:</b> To study the metabolic risk factors of urolithiasis in children and compare them with literature. <b>Materials and Methods:</b> In open, prospective and observational study, 75 children were evaluated from August 2010 to June 2014. In all patients’ dietary history, water intake and results of laboratory findings were recorded. All urine samples obtained from patients were without dietary restrictions. Reference paediatric 24 hour urinary parameter was used according to western literature. <b>Results:</b> We investigated 75 patients with urolithiasis. Low urine volume was found in 49 patients which is comparable with previous studies indicating simple intervention as to increase water intake. Low calcium intake was found in 44 patients suggesting that low calcium intake is associated with higher incidence of urolithiasis due to increased intestinal oxalate absorption. Hypocalcaemia was found in 32 patients and 24 hour urinary abnormality was found in only 16 patients’. Both these finding does not support previous literature. Stone analysis finding does not correlate with urinary finding. <b>Conclusions:</b> Low urine volume secondary to low water intake is predominant finding. Hypocalcaemia is major metabolic abnormality in contradiction to western literature. There are no nomograms for urinary excretion of Calcium, uric acid, oxalate and citrate in Indian children. Keeping the optimum blood calcium level & increased fluid intake can prevent stone formation in children. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=PC04-PC06&id=7251 https://doi.org/10.7860/JCDR/2016/.7251 Open Versus Closed Laparoscopy: Yet an Unresolved Controversy Milan Kumar Taye, Syed Abul Fazal, David Pegu, Dayanada Saikia <b>Introduction:</b> Safe placement of the Verres needle or the primary trocar for establishment of pneumoperitoneum is the most critical step in laparoscopic procedure as it is associated with bowel, bladder and life threatening vascular injuries and embolism. In the last few decades many techniques and guidelines have been introduced to eliminate complications in creation of pneumoperitoneum. Classical closed technique (Verres needle) and the open classic technique (Hasson) are the most commonly used techniques for creation of pneumoperitoneum. <b>Aim:</b> To compare the rate of occurrence and nature of complications in open and closed laparoscopy during establishment of pneumoperitoneum in different surgical and gynaecological procedures. <b>Materials and Methods:</b> This was a comparative study conducted at three hospitals in Dibrugarh district, Assam, India from January 2012 to December 2014. Total 3000 cases were included in the study with 1500 cases of open laparoscopy and 1500 cases of closed laparoscopy. Complications occurring in both the groups were compared by using Fisher’s-exact test. <b>Results:</b> In closed laparoscopy group minor complications occurred in 80 (5.33%) and major complications in 20 (1.33%) cases. In open laparoscopy group minor complications were observed in 60 (4%) and major complications in 2 (0.13%). The p-value of the difference between the two groups for minor complications was 0.0834 and for major complications was 0.0001(significant). <b>Conclusion:</b> Open laparoscopy was seen to be better than closed laparoscopy in terms of not only the rate of occurrence of complications but also the nature and severity of the complications. This study is clinically relevant as there is no consensus for a particular method of safe entry in to the peritoneal cavity warranting the need for more research. Open technique can be performed in all cases irrespective of previous operative scar, suspected intra peritoneal adhesions or obesity. Favourable outcome may be achieved in closed technique in cases of normal BMI, absence of postoperative scar in the abdomen, absence of abdominal and genital tuberculosis and pelvic inflammatory disease. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=QC04-QC07&id=7252 https://doi.org/10.7860/JCDR/2016/.7252 Characterization of Extended-Spectrum Beta-lactamase from Escherichia coli and Klebsiella Species from North Eastern Nigeria Yahaya Mohammed, Galadima Bala Gadzama, Sambo Bello Zailani, Aaron Oladipo Aboderin <b>Introduction:</b> Resistance to antimicrobials has become a serious global health concern complicating treatment strategies and increasing health-care costs. The extended-spectrum beta-lactamase producing bacteria stand out as bacteria of great epidemic concern among Gram negative bacilli. Control and appropriate interventions for antimicrobial resistance depend on effective surveillance and knowledge of the patterns and determinants of resistance. <b>Aim:</b> The present study was undertaken to detect and characterize ESBLs in Escherichia coli and Klebsiella Species from University of Maiduguri Teaching Hospital, Maiduguri, North-Eastern Nigeria. <b>Materials and Methods:</b> Confirmed variants of Escherichia coli and Klebsiella Species isolated from 439 patients that were admitted in various units of University of Maiduguri Teaching Hospital (UMTH) were screened for ESBL using CLSI breakpoints. Suspected ESBLs producers were subjected to confirmation using double disk synergy method. Detection of ESBL genes was further done by multiplex PCR. <b>Results:</b> Out of the 439 isolates screened; the result shows 147 (33.5%) were ESBL producers but only 121(23.6%) were confirmed by the double disk synergy method. The prevalence of ESBL amongst the organisms were; 41/172 (23.8%) for Escherichia coli and 80/267/(30.0%) for Klebsiella Species. Based on PCR analysis, the various percentage genotypes of the ESBL producers were 44 (36.4%) for SHV gene followed by 38(31.4%) for TEM gene and the lowest of 33(27.3%) for CTX-M gene. <b>Conclusion:</b> ESBLs are prevalent among Species of Escherichia coli and Klebsiella Species in Maiduguri, Borno State, not only are there TEM and SHV but also CTX-M types. Antibiotic stewardship program to maximise use of available antibiotics is underscored as well as coordinated national efforts in combating resistance. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=DC07-DC10&id=7254 https://doi.org/10.7860/JCDR/2016/.7254 Effect of Heparin on Coagulation Tests: A Comparison of Continuous and Bolus Infusion in Haemodialysis Patients Ali Akbar Nasiri, Sudabeh Ahmadidarrehsima, Abbas Balouchi, Hosein Shahdadi, Mahdiye Poodine Moghadam <b>Introduction:</b> Haemodialysis is one of the most conventional treatments of chronic renal failure. The risk of clot formation is high during haemodialysis due to regular contact of blood with the surfaces of foreign objects such as catheters, dialyzers’ membrane, and other materials used for dialysis. Therefore, to prevent clot formation during haemodialysis, the dialysis system requires anticoagulation; this is usually done by heparin. <b>Aim:</b> The present study aimed to compare two heparinization methods and determine the proper impacts of these methods. <b>Materials and Methods:</b> In this quasi-experimental study, 80 haemodialysis patients covered by the dialysis center of Amir-al-momenin Hospital of Zabol were studied in two 40-member groups of heparin therapy methods of bolus injection and continuous infusion. PT and PTT were measured in blood samples collected from all patients before starting haemodialysis. The first group received 3000 units of heparin once the haemodialysis machine started to work and 2000 units of heparin two hours later as bolus injection. In the second group, 1500 units of heparin was injected at the start of dialysis after then, 5000 units of heparin (one mL) were mixed with 11 mL of distilled water and infused using a heparin injection pump up to half an hour before the end of dialysis. At 30 minutes after starting dialysis and at the end of 4 hours of haemodialysis, PT and PTT were measured and compared between the two groups. <b>Results:</b> According to the results, the mean partial thromboplastin time in the bolus and continuous heparin-receiving group was 41.75±6.29 and 37.90±4.77, respectively, which was statistically significant (p=0.036). But PT was 14.45±1.82 in the bolus heparin group and 13.95±1.39 in the continuous heparin group, which was not significant according to the results of independent t-test (p=0.336). <b>Conclusion:</b> The results indicated a statistically significant difference between the bolus heparin injection and the continuous heparin infusion groups in terms of coagulation tests in haemodialysis patients (p=0.036). Therefore, given the effects of heparin on coagulation, it was more effective in the bolus heparin group than the continuous infusion group. It is recommended to use the bolus method for heparin therapy during haemodialysis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=OC18-OC21&id=7231 https://doi.org/10.7860/JCDR/2016/.7231 Dimensional Accuracy of Hydrophilic and Hydrophobic VPS Impression Materials Using Different Impression Techniques - An Invitro Study Sreeramulu Basapogu, Ajai Pilla, Suman Pathipaka <b>Introduction:</b> The dimensional stability of the impression material could have an influence on the accuracy of the final restoration. Vinyl Polysiloxane Impression materials (VPS) are most frequently used as the impression material in fixed prosthodontics. As VPS is hydrophobic when it is poured with gypsum products, manufacturers added intrinsic surfactants and marketed as hydrophilic VPS. These hydrophilic VPS have shown increased wettability with gypsum slurries. VPS are available in different viscosities ranging from very low to very high for usage under different impression techniques. <b>Aim:</b> To compare the dimensional accuracy of hydrophilic VPS and hydrophobic VPS using monophase, one step and two step putty wash impression techniques. <b>Materials and Methods:</b> To test the dimensional accuracy of the impression materials a stainless steel die was fabricated as prescribed by ADA specification no. 19 for elastomeric impression materials. A total. of 60 impressions were made. The materials were divided into two groups, Group1 hydrophilic VPS (Aquasil) and Group 2 hydrophobic VPS (Variotime). These were further divided into three subgroups A, B, C for monophase, one-step and two-step putty wash technique with 10 samples in each subgroup. The dimensional accuracy of the impressions was evaluated after 24 hours using vertical profile projector with lens magnification range of 20X-125X illumination. The study was analyzed through one-way ANOVA, post-hoc Tukey HSD test and unpaired t-test for mean comparison between groups. <b>Results:</b> Results showed that the three different impression techniques (monophase, 1-step, 2-step putty wash techniques) did cause significant change in dimensional accuracy between hydrophilic VPS and hydrophobic VPS impression materials. One-way ANOVA disclosed, mean dimensional change and SD for hydrophilic VPS varied between 0.56% and 0.16%, which were low, suggesting hydrophilic VPS was satisfactory with all three impression techniques. However, mean dimensional change and SD for hydrophobic VPS were much higher with monophase, mere increase for 1-step and 2-step, than the standard steel die (p<0.05). Unpaired t-test displayed that hydrophilic VPS judged satisfactory compared to hydrophobic VPS among 1-step and 2-step impression technique. <b>Conclusion:</b> Within the limitations of this study, it can be concluded that hydrophilic Vinyl polysiloxane was more dimensionally accurate than hydrophobic Vinyl polysiloxane using monophase, one step and two step putty wash impression techniques under moist conditions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ZC56-ZC59&id=7259 https://doi.org/10.7860/JCDR/2016/.7259 Prevalence of MRSA Nasal Carriage in Patients Admitted to a Tertiary Care Hospital in Southern India Kalpana George, Jasmine Kulapurathu Abdulkader, Madhan Sugumar, Girija Kalarikkal Rajagopal <b>Introduction:</b> Infections with MRSA, both community and hospital acquired, are well established and the source of infection is often a carrier. There are very few studies showing the magnitude of MRSA nasal colonization among healthy persons from the community. This study was conducted to detect the prevalence of MRSA nasal carriage in patients who did not have any known risk factors associated with HA- MRSA colonization, admitted to a tertiary care centre in Kerala. <b>Materials and Methods:</b> Nasal swabs were collected from patients within 24 hours of admission. Specimen were inoculated on chromogenic agar (HiCrome MeReSa agar-HiMedia) for MRSA screening. Isolates were then subjected to antibiotic sensitivity tests, SCCmec typing and PVL gene detection. <b>Results:</b> Out of 683 patients, 16 carried MRSA in their nares (2.3%). Of the 16 strains 13 (81.25 %) strain were SCCmec type III and one belonged to SCCmec type IV (6.25 %). Two strains failed to amplify SCCmec genes. Three strains carried genes for PVL toxin (18.75%). <b>Conclusion:</b> With a better understanding of the complex epidemiology of MRSA it is increasingly apparent that demarcations between the HA and CA phenotypes are not as clear cut as previously thought. In this study of nasal carriage of MRSA in the community we have demonstrated prevalence consistent with published data. Most isolates however were shown to belong to the type conventionally assigned to HA-MRSA. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=DC11-DC13&id=7262 https://doi.org/10.7860/JCDR/2016/.7262 Neonatal Intestinal Obstruction: A 15 Year Experience in a Tertiary Care Hospital Anjali Verma, Kamal Nain Rattan, Ravi Yadav <b>Introduction:</b> Neonatal intestinal obstruction is the most common surgical emergency in a newborn requiring prompt intervention. There are only very few studies done in world regarding pattern of neonatal intestinal obstruction. <b>Aim:</b> This study was conducted to see the aetiological spectrum of neonatal intestinal obstruction and to find out the problems and outcome of surgical management. <b>Materials and Methods:</b> This study was done retrospectively to include all operated cases of neonatal intestinal obstruction from June 2000 to May 2015 and various factors affecting outcome were analysed. <b>Results:</b> A total of 298 newborns were included in the study. Male-female ratio was 1.8:1. Gestational age was variable from 32 to 42 weeks (mean = 37.5 weeks) and birth weight from 1.4 to 3.5kg (mean= 2.25 kg). Mean age of presentation was 6 days with intestinal atresia (49.6%) as the commonest cause. Other causes were Hirschsprung (13%), Malrotation gut (11.7%), Meconium ileus (7.3%), patent VID (5%), duodenal obstruction (4%), duplication cyst (3.7%), obstructed hernia (2.7%) and others (2.7%). Mortality rate was 16.4% with sepsis both pre as well as post operative as the main cause of mortality. <b>Conclusion:</b> The morbidity and mortality of neonatal intestinal obstruction has improved over last few years mainly due to antenatal detection, early intervention, meticulous resuscitation before surgery along with good NICU care. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=SC10-SC13&id=7268 https://doi.org/10.7860/JCDR/2016/.7268 Use of ECT in Nepal: A One Year Study From the Country’s Largest Psychiatric Facility Sandip Subedi, Tapas Kumar Aich, Niru Sharma <b>Introduction:</b> Electro-Convulsive Therapy (ECT) refers to the electrical stimulation of the brain to produce seizures for therapeutic purpose. Since the development of ECT, it’s use has been consistent. Inspite of the common use, data pertaining to the use of ECT in Nepal is lacking. <b>Aim:</b> This study was undertaken with the aim of exploring the clinico-demographic profile of patients treated with ECT in the largest psychiatry facility in the country. <b>Materials and Methods:</b> It is a retrospective descriptive study of patients who were treated with ECT after admission in the inpatient psychiatry unit of Universal College of Medical Sciences Teaching Hospital, Bhairahawa, Nepal during a period of one year (August 2012 to July 2013). <b>Results:</b> Out of 1095 patients admitted during the specified period, 81 (7.39%) patients received ECT. About 44.44% of the patients belonged to 20-29 years age group. Female patients constituted more than half of the subjects (55.56%). Review of diagnostic profile showed that majority of patients receiving ECT were suffering from Schizophrenia (44.4%), followed by Bipolar Affective Disorder/Mania (29.6%), Depressive disorder (11.1%), Acute and Transient Psychotic Disorder (6.2%), Post-partum Psychosis (3.7%) and substance induced mood/psychotic disorders (3.7%). A significant majority of subjects (75.3%) received about 5-7 ECT treatments. The mean seizure duration after ECT treatment was 31.13±5.79 seconds. No any major complications were noted during ECT treatment. <b>Conclusion:</b> This study suggests that ECT, use, as a treatment modality is common in young adults and females with Schizophrenia being the most common indication. Direct ECT is safe when used judiciously. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=VC01-VC04&id=7269 https://doi.org/10.7860/JCDR/2016/.7269 Study of Drug Utilization Pattern for Skin Diseases in Dermatology OPD of an Indian Tertiary Care Hospital - A Prescription Survey Anuj Kumar Pathak, Subodh Kumar, Manish Kumar, Lalit Mohan, Harihar Dikshit <b>Introduction:</b> Skin diseases are the major contributors of disease burden in society. It affects individuals of all ages, neonates to elderly. Owing to its chronic nature, it causes serious impact on quality of life and financial status of the sufferer and his family. The problem gets compounded with the inappropriate and irrational use of medicines. Periodic prescription audit in form of drug utilization study is a way to improve the quality of prescription and curb the menace of irrational prescribing which has become a global phenomenon. <b>Aim:</b> This study aims to determine the drug utilization pattern and assess the economic burden of the patient with skin disease. <b>Materials and Methods:</b> It was a prospective, cross-sectional study conducted over a period of three months from January to March 2015 in newly diagnosed cases attending outpatient department of Skin and VD, IGIMS, Patna. The prescriptions were analysed with the help of descriptive statistics and results were expressed in percentage. <b>Results:</b> Total 752 prescriptions were analysed during the study. Male patients were lesser as compared to female as male to female ratio was 0.88. Over 50% of patients were in adolescent age group i.e. 21-40 years. Acne (17.95%) was most common disease in the study population followed by eczema and Dermatophytosis. Among the drugs, antihistaminics (24.13%) were prescribed most frequently followed by antifungals and antibiotics. Topical agents constituted almost 60% of the total prescription and average number of drugs per prescription was 5.13, irrespective of the dosage forms prescribed. <b>Conclusion:</b> This drug utilization study provides an insight to the prescriber regarding various issues related to polypharmacy, cost analysis and prevalent disease pattern in the region. This study also suggests periodic evaluation of prescription pattern to monitor and improve quality of prescription in other departments of the hospital. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=FC01-FC05&id=7270 https://doi.org/10.7860/JCDR/2016/.7270 Study the Impact of Diabetes Camps on Adherence to Medication and Glycaemic Control in Uttarakhand Monika Pathania, Hemant Kumar Dutt, Javin Bisnu Gogoi, Vyas Rathaur, Ganesh Singh, Parul Singh <b>Introduction:</b> Diabetes is a major public health problem which needs to be addressed with outmost planning in resource poor settings. Good glycaemic control and medication adherence patterns can play an important role in reducing disease related complications thereby reducing morbidity and mortality among diabetics. Disease specific camps can act as a stepping stone in providing limited care to the patients. <b>Aim:</b> The study was planned to study the impact of diabetes camp on glycaemic control and adherence to antidiabetic medication among diabetic patients at a Government Teaching Hospital, Srinagar, Garhwal, Uttarakhand, India. <b>Materials and Methods:</b> A cross-sectional study using a medication adherence questionnaire collected from the patients participating in diabetic camps and measuring their HbA1C levels before and after the camps along with spreading awareness about the disease. Two diabetes awareness camps were organized, three month apart and the participants were imparted knowledge about the disease. A total of 50 patients with type 2 DM who had self reported history of diabetes and were on some form of oral anti diabetics confirmed by their prescriptions. The patients were called for monthly follow up in outpatient department. A six question preformed questionnaire – the Girerd’s instrument was used to assess the level of adherence to the prescribed anti-diabetic drugs in 50 patients with type 2 diabetes mellitus, their HbA1C levels were estimated and the results were analysed using standard statistical methods. <b>Results:</b> A total of 50 type 2 diabetic, 48 were studied comprising 23 (47.9%) women and 25 (52.1%) men with a mean age of 57.43 years. The average duration of diabetes among participants was 7.02 years. Poor medication adherence score was recorded in 27 participants and only 7 participants had good adherence to medication before the camp. After the camp, 19 participants had good adherence and 7 had poor medication adherence scores. As a result of improved adherence, improvement in glycaemic control was noticed by a decrease of 0.5 units in the mean HbA1C value by the end of the study. <b>Conclusion:</b> The results clearly showed that group intervention in the form of camp combined with monthly follow-ups could improve adherence as well as glycaemic control at a government teaching hospital in a resource poor setting. This could also involve and encourage society as well as young trainees to participate collectively in the care of diabetics. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=OC22-OC26&id=7271 https://doi.org/10.7860/JCDR/2016/.7271 Alteration of T Cell Subtypes in Beta-Thalassaemia Major: Impact of Ferritin Level Batoul Pourgheysari, Leila Karimi, Pezhman Beshkar <b>Introduction:</b> Oxidative damage and regular antigenic stimulation are main factors in accelerating immunosenescence. The present study was conducted to investigate new concepts of early immunosenescence in thalassaemia patients. <b>Materials and Methods:</b> Twenty seven beta-thalassaemia major patients and a group of matched healthy volunteers aged 10-30 years in Shahrekord, Iran were recruited into the study. Ferritin level was determined and CD4 or CD8 T cells were analysed versus phenotyping markers, CD27, CD28, CD57 and CCR7, by flowcytometry. Data were analysed by Mann-Whitney and Spearman’s correlation coefficient test in SPSS 11.5. <b>Results:</b> Absolute lymphocytosis and partial decrease in T cells were observed in the patients. CD4+CD57+ and CD4+CCR7- T cells were significantly higher, whereas CD8+CD27+ and CD8+CCR7+ T cells were partially higher in patients. A negative correlation was observed between ferritin level and number of CD8+CD27+ and CD8+CCR7+ T cells, whereas the correlation was positive between ferritin level and number of CD57+ T cells. <b>Conclusion:</b> Moderate alteration of T cell repertoire and increase in CCR27-, CCR7-, and CD57+ T cells could reflect antigenic stimulation, decline in naïve T cells, and being closer to terminally differentiated cells. Effect of iron overload is potentially explained by positive correlation of blood transfusion and ferritin level with frequency of CD3+CD27- and that of ferritin with frequency of CD57+ T cells. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=DC14-DC18&id=7272 https://doi.org/10.7860/JCDR/2016/.7272 A Study on Polypharmacy and Potential Drug-Drug Interactions among Elderly Patients Admitted in Department of Medicine of a Tertiary Care Hospital in Puducherry Kartik Janardan Salwe, Dharani Kalyansundaram, Yogesh Bahurupi <b>Introduction:</b> The proportion of elderly population has been constantly increasing over last few years. Polypharmacy is unavoidable in the elderly as they often suffer from multiple co-morbidities. Potential drug-drug interaction due to polypharmacy and potential inappropriate medication among the elderly must be carefully assessed. <b>Aim:</b> To find out polypharmacy and potential drug-drug interactions among elderly patients admitted and discharged in Department of Medicine. <b>Materials and Methods:</b> This study was carried out on 100 patients above 65 years of age both males and females. Data was collected through review of case sheets. Polypharmacy was observed based on admission and discharge prescriptions. Frequently occurring drug-drug interactions were assessed using online checks. <b>Results:</b> Mean number of drugs prescribed to patients on admission (7.61 ± 3.37) was more than that on discharge (5.48±2.46). More than half of these patients received 5 to 9 number of drugs. On admission 52.69% potential drug-drug interactions were observed and on discharge 52.91%. Most common drug interactions observed in both the groups were of moderate grade. <b>Conclusion:</b> From the present study we can conclude that polypharmacy leads to more potential drug-drug interactions. To improve drug safety in this high-risk population, appropriate prescribing is very important. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=FC06-FC10&id=7273 https://doi.org/10.7860/JCDR/2016/.7273 Early Conversion of External Fixation to Interlocked Nailing in Open Fractures of Both Bone Leg Assisted with Vacuum Closure (VAC) - Final Outcome Simrat Pal Singh Gill, Manish Raj, Sunil Kumar, Pulkesh Singh, Dinesh Kumar, Jasveer Singh, Akash Deep <b>Introduction:</b> Management of compound grade III fractures of both bone leg includes external stabilization for long period, followed by various soft tissue coverage procedures. Primary interlocking of tibia had been also done with variable results. External fixation for long time without any bone loss often leads to infected nonunion, loss of reduction, pin tract infection and failure of fixation, primary interlocking in compound grade III fractures had shown high medullary infection rate. We managed all cases of compound grade III A/B fractures with primary external fixation, simultaneous wound management using vacuum assisted closure (VAC) followed by early conversion to interlocking within 2 weeks of fixator application. <b>Aim:</b> To determine the effectiveness of vacuum assisted closure (VAC) for the early conversion of external fixator to definitive interlocking in open fractures of the both bone leg. <b>Materials and Methods:</b> In current study we selected 84 cases of compound grade IIIA/B diaphyseal fractures of both bone leg during period of May 2010 to September 2013. We managed these cases by immediate debridement and application of external fixation followed by repeated debridement, application of vacuum assisted closure (VAC) and conversion to interlocking within two weeks. <b>Results:</b> Out of 84 cases union was achieved in 80(95%) of cases with definitive tibial interlocking. Excellent to good result were obtained in 77(91.8%) of cases and fair to poor result seen in rest of 7(8.2%) of cases according to modified Ketenjian's criteria. 5 out of these 7 poor result group cases were from Compound Grade III B group to start with. Deep infection rate in our series were 7% i.e. total 6 cases and 4 out of these were from compound Grade III B group to start with. <b>Conclusion:</b> Vacuum assisted closure (VAC) give a good help for rapid closure of the wound and help in early conversion to definitive intramedullary nailing. Reamed nail could well be used in compound grade IIIA/B fractures without increasing the risk of infection. It gives better stability to fracture site and lessen the risk of implant failure. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=RC10-RC14&id=7265 https://doi.org/10.7860/JCDR/2016/.7265 Accuracy of Needle Placement into the Intra-Articular Space of the Knee in Osteoarthritis Patients for Viscosupplementation Manaswini Telikicherla, Surendra Umesh Kamath <b>Introduction:</b> Knee osteoarthritis is characterized by inflammation in the intra-articular space or synovial membrane, breakdown of articular cartilage, and sclerosis of the subchondral bone. Intra-articular injections of Sodium hyaluronate which have viscoelastic and protective effect on articular cartilage and restores normal articular homeostasis. The efficacy of these injections is diminished when they are placed inadvertently outside the joint. For the maximum benefit, injection of hyaluronic acid derivatives needs to be placed accurately into the knee joint. <b>Aim:</b> The study was performed to know the correct placement of needle inside the knee joint prior to Viscosupplementation by fluoroscopy using a contrast material. <b>Materials and Methods:</b> The accurate placement of needle was evaluated in a prospective series of 94 consecutive injections in patients without clinical knee effusion. All the injections were performed by single orthopaedic surgeon using a 5 cm 21-gauge needle through anterolateral, and lateral midpatellar portals. The needle placement in the knee joint was confirmed with fluoroscopy using the contrast material. <b>Results:</b> The accuracy rates through Lateral midpatellar and Anterolateral portals were lower than expected rate (100%). A total of 43 out of 47 injections were intra-articular, indicating accuracy of 91.5% through lateral midpatellar portal, 41 out of 47 injections were intra-articular through anterolateral portal with accuracy of 87.4%. <b>Conclusion:</b> Study showed that the accuracy of needle placement was higher through Lateral midpatellar than the Anterolateral portal. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=RC15-RC17&id=7275 https://doi.org/10.7860/JCDR/2016/.7275 Profile of Breast Diseases in Post Pubertal Women Assessed By Clinical Breast Examination – A Community Based Study in Rural Pondicherry Kavasseri L Janaki, Narayanasamy Subbaraju Kannan, M.Palaniappan, Partha Nandi <b>Introduction:</b> Breast diseases in women, whether benign or malignant, are very commonly encountered. Benign diseases are under reported and cancer is one of the leading causes of mortality in women. This study was undertaken with an aim to study the profile of various breast disease in the community. <b>Materials and Methods:</b> In this observational study all the post pubertal women residing in the selected village (n=1000) were included. The study was done from September 2013 to August 2015. A thorough history taking was done with the help of a predesigned proforma followed by a clinical breast examination and further investigation at our hospital if necessary. <b>Results:</b> It was found in this study that mastalgia, both cyclical and non-cyclical as well as lumps were a common finding in the general population. Significant proportions of women were found to be in the peri-menopausal age group. Median age of menarche was 13 years; menopause was 45 years. The average age at first childbirth was 21 years with 1 year being the median duration of breast-feeding. A total of 128 women (1 in 8) had positive symptomatology with 94 (1 in 11) of them having a breast disease on examination. One was diagnosed with breast cancer. The prevalence of cyclical mastalgia was 1 in 11, non-cyclical mastalgia 1 in 34, fibroadenosis 1 in 23 and fibroadenoma 1 in 100. The awareness regarding risk factors and the availability of screening program was very poor. The average age of presentation of mastalgia was 34 years; fibroadenosis was 35 years and fibroadenoma 29 years. None of the women interacted with or had consulted a practitioner regarding mastalgia as it was not perceived to be a sign of malignancy and did not cause any significant discomfort. <b>Conclusion:</b> It was thus concluded from this study that benign breast diseases are a common occurrence in the general population. Breast cancer continues to be diagnosed only at later stages owing to lack of awareness and inadequately structured screening program. The concept of self-breast examination seems to be poorly understood. CBE is more fruitful with subsequent radiological and histopathological investigation, if warranted. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=PC07-PC11&id=7276 https://doi.org/10.7860/JCDR/2016/.7276 Can EDTA Change MRSA into MSSA? A Future Prospective! Sonia Jain, Manideepa Sengupta, Soma Sarkar, Sougata Ghosh, Anita Nandi (Mitra), Anuradha Sinha, Sriparna Chakravorty <b>Introduction:</b> In the present era we are left behind with limited options for the treatment of serious infections caused by multidrug resistant S.aureus, most remarkably nosocomially acquired Methicillin resistant S.aureus (MRSA). The problem increases more when these strains easily become multidrug resistant (MDR) due to biofilm formation. Those staphylococcal species that are vancomycin and linezolid resistant are also resistant to other antistaphylococcal agents which call for an urgent intervention to develop newer antimicrobial agents. <b>Aim:</b> The present study was undertaken with the aim to evaluate the antibiofilm effect of EDTA against the biofilm forming MRSA isolates, isolated from different clinical infections. <b>Materials and Methods:</b> The biofilms formed on polystyrene microtitre plates by the MRSA strains were treated by different concentrations of EDTA to find out its anti-biofilm activity. Further simultaneously the antibiotic susceptibility pattern was noted down to check whether the MRSA strains become MSSA (Methicillin sensitive S.aureus). <b>Results:</b> Our data demonstrates that EDTA at 4mM concentration inhibits biofilm of MRSA and at 20 mM have an ability to reduce and dissociate the biofilm membrane, allowing the antibiotics to enter and convert MRSA strains into MSSA. <b>Conclusion:</b> These findings suggest that commercially available EDTA could be used in future to control MRSA and its biofilm- related infections. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=DC22-DC25&id=7280 https://doi.org/10.7860/JCDR/2016/.7280 Uric Acid and Coronary Artery Disease, Two Sides of a Single Coin: A Determinant of Antioxidant System or a Factor in Metabolic Syndrome Babak Bagheri, Mehryar Zargari, Fatemeh Meshkini, Kolsoum Dinarvand, Vahid Mokhberi, Soheil Azizi, Mehdi Rasouli <b>Introduction:</b> Uric acid has antioxidant activity and it is expected to protect against coronary artery disease (CAD). Contradictory, it is a component of metabolic syndrome and so a risk factor for CAD. The associations of plasma total antioxidant capacity (TAOC) and uric acid (UA) as well as other risk factors were investigated relative to the occurrence and severity of CAD. <b>Materials and Methods:</b> The study population consisted of 148 males and 152 females aged 35-76 years who were classified as CAD cases and controls according to the results of coronary angiography. The severity of CAD was scored on the basis of the number and the extent of lesions at coronary arteries. The concentrations of UA and TAOC were measured by using of FRAP and enzymatic uricase methods. <b>Results:</b> The prevalence of hypertension, cigarette smoking and diabetes mellitus was more frequent in CAD cases than controls. Patients with CAD when compared with the controls had increased levels of glucose, triglycerides, creatinine, UA, TAOC and decreased levels of HDL- cholesterol. Serum UA was high positive correlate of serum total and LDL-cholesterol, triglyceride, creatinine, BUN, bilirubin, TAOC and negative correlate of glucose and HDL-C. TAOC and its major determinant UA but not bilirubin and albumin are significantly associated with the prevalence and severity of CAD. In multivariate analysis and in the absence of hypertension, UA but not TAOC would remain and be associated with CAD by the OR of 1.57 (1.07-2.29), p=0.02. If the results adjusted for all major risk factors including hypertension, neither TAOC nor UA would remain in the regression equation. <b>Conclusion:</b> The results suggest that TAOC and UA but not bilirubin and albumin are associated with CAD significantly. But, the correlation is not independent and is attributed to the metabolic syndrome. The measurement of UA and TAOC will not improve the prognostic power beyond the classical risk factors. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=OC27-OC31&id=7281 https://doi.org/10.7860/JCDR/2016/.7281 Visual Evoked Potential Response Among Drug Abusers- A Cross Sectional Study Sonia Garg, Rajeev Sharma, Satish Thapar, Shilekh Mittal <b>Introduction:</b> There is important preclinical evidence that substance abuse may produce neurophysiological disturbances particularly in relation to altered neural synchronization in Visual Evoked Potentials (VEP). <b>Aim :</b> The purpose of current study was to compare the latencies and amplitudes of different waveforms of VEP among different drug abusers and controls and also to identify early neurological damage so that proper counseling and timely intervention can be undertaken. <b>Materials and Methods:</b> VEP was assessed by Data Acquisition and Analysis system in a sample of 58 drug abusers, all males, within age group of 15-45 years as well as in age matched 30 healthy controls. The peak latencies and peak to peak amplitudes of different waveforms were measured by applying one-way Anova test and unpaired t-test using SPSS version 16. <b>Results:</b> In between drug abusers and controls, the difference in the duration of N75 and P100 waveform of VEP was found to be statistically highly significant (p<0.001) in both the eyes. Also the amplitude of wave P100 was found to be decreased among drug abusers in both eyes. <b>Conclusion:</b> Chronic intoxication by different drugs has been extensively associated with amplitude reduction of P100 and prolonged latency of N75 and P100 reflecting an adverse effects of drug dependence on neural transmission within primary visual areas of brain. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=CC23-CC26&id=7282 https://doi.org/10.7860/JCDR/2016/.7282 Changes in Habitual and Active Sagittal Posture in Children and Adolescents with and without Visual Input – Implications for Diagnostic Analysis of Posture Oliver Ludwig, Carola Mazet, Dirk Mazet, Annette Hammes, Eduard Schmitt <b>Introduction:</b> Poor posture in children and adolescents has a prevalence of 22-65% and is suggested to be responsible for back pain. To assess posture, photometric imaging of sagittal posture is widely used, but usually only habitual posture positions (resting position with minimal muscle activity) are analysed. <b>Aim:</b> The objective of this study was 1) to investigate possible changes in posture-describing parameters in the sagittal plane, when the subjects changed from a habitual passive posture to an actively corrected posture, and 2) to investigate the changes in posture parameters when an actively corrected posture was to be maintained with closed eyes. <b>Materials and Methods:</b> In a group of 216 male children and adolescents (average 12.4 ± 2.5 years, range 7.0 – 17.6 years), six sagittal posture parameters (body tilt BT, trunk incline TI, posture index PI, horizontal distances between ear, shoulder and hip and the perpendicular to the ankle joint) were determined by means of photometric imaging in an habitual passive posture position, in an actively erect posture with eyes open, and in active stance with eyes closed. The change in these parameters during the transition between the posture positions was analysed statistically (dependent t-Test or Wilcoxon-Test) after Bonferroni correction (p<0.004). <b>Results:</b> When moving from a habitual passive to an active posture BT, TI, PI, dEar, dShoulder, and dHip decreased significantly(p< 0.004). When the eyes were closed, only the perpendicular distances (dEar, dShoulder, and dHip) increased significantly. The parameters that describe the alignment of the trunk sections in relation to each other (BT, TI, PI), remained unchanged in both actively regulated posture positions. <b>Conclusion:</b> Changes in sagittal posture parameters that occur when a habitual passive posture switches into an active posture or when an active posture is to be maintained while the eyes are closed can be used for diagnostic purposes regarding poor posture and posture regulation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=SC14-SC17&id=7283 https://doi.org/10.7860/JCDR/2016/.7283 Major Protein of Carcinoembryonic Antigen Gene Family - CD66c, A Novel Marker in Colon Carcinoma Suma M Nataraj, Chaitra Linganna Prema, Manjunath Gubbanna Vimalambike, Sheeladevi Chandakavadi Shivalingaiah, Shivakumar Sundaram, Anjali Pradeep Kumar, Ananda Kuruvatti Math, Akila Prashant <b>Introduction:</b> In view of rising trend of the incidence of colorectal carcinoma in the Indian population due to adoption of western lifestyles and behaviours, we investigated the expression of the new emerging stem cell biomarker, CD66c in colorectal carcinoma of Indian origin. Aim: To study the expression of CD66c in human colorectal carcinoma and to correlate level of marker expression with tumour staging. <b>Materials and Methods:</b> This hospital based prospective study was conducted on 26 colorectal carcinoma patients in the age group of 20 years to 70 years. Surgically resected tumour specimens along with adjacent normal tissue were collected taking necessary precautions, paraffin embedded sections were prepared and used for histological and immunohistochemical analysis of CD66c. <b>Statistical analysis:</b> Descriptive statistical measures like mean, standard deviation, percentage was applied. Other inferential statistical tests like Chi-square, Fisher’s-exact test and one-way ANOVA was applied to find out the association of CD66c with different stages. The difference were interpreted as statistically significant when p <0.05. <b>Results:</b> CD66c showed differential expression with membrane positivity in normal colorectal epithelial cells and cytoplasmic expression in tumour cells. There was significant correlation between CD66c expression and tumour site (p=0.02) with colon carcinoma showing positive expression compared to the rectal carcinoma. There was no significant correlation between CD66c staining and tumour stage (p=0.947). No significant relationship was observed between CD66c expression and other clinicopathologic variables studied such as sex (p=0.552), age (p=0.713) and tumour grade (p=0.263). <b>Conclusion:</b> CD66c can be specifically used for colon carcinoma and may be a novel marker in colon carcinoma stem cell isolation. The quantification of CD66c can be further verified by flow cytometry and RT-PCR. Further studies can be carried out using CD66c alone or in combination with other markers to develop cancer stem cell directed therapy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=XC01-XC04&id=7286 https://doi.org/10.7860/JCDR/2016/.7286 A Hospital Based Study to Establish the Correlation between Recurrent Wheeze and Vitamin D Deficiency Among Children of Age Group Less than 3 Years in Indian Scenario Santosh Prasad, Rishabh Kumar Rana, Ronak Sheth, Anupama V Mauskar <b>Introduction:</b> Early childhood wheezing is a heterogeneous condition, which has several phenotypic expressions and a complex relationship with the development of asthma later in life. New studies indicate the prevalence of recurrent wheeze to be associated with Vitamin D deficiency. This has not been explored in Indian settings widely, mandating this exploration. <b>Aim:</b> To determine the severity of Vitamin D deficiency and its association with recurrent wheeze in children less than 3 years of age. <b>Materials and Methods:</b> Consecutive type of non-probability sampling was followed for selection of study subjects with a total sample size to be 122 children in the Hospital setting. A pre- formed, pre- tested, structured interview schedule was used to obtain information. Estimation of 25 (OH) Vitamin D was done using ELISA method. Kit used for estimation was DLD Diagnostika GMBH 25(OH) Vitamin D ELISA from Germany. Standard statistical tools were used including Logistic regression analysis, and ROC curve, p value <0.05 was considered to be statistically significant. SPSS software version 17.0 was used. <b>Results:</b> Each 10ng/ml decrease in Vitamin D level is associated with 7.25% greater odds of wheezing. Our study also suggests, exclusive breast feeding and delaying of complementary feeding beyond 6 months of age are significant predictors of Vitamin D deficiency and have indirect association with increased incidence of wheezing in children. <b>Conclusion:</b> The study concluded that Vitamin D deficiency is associated with increased risk of recurrent wheezing. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=SC18-SC21&id=7287 https://doi.org/10.7860/JCDR/2016/.7287 Evaluation of Genotypic and Phenotypic Methods for Detection of Methicillin Resistant Staphylococcus aureus in a Tertiary Care Hospital of Eastern Odisha Rakesh Kumar Panda, Ashoka Mahapatra, Bandana Mallick, Nirupama Chayani <b>Introduction:</b> Methicillin resistant Staphylococcus aureus has emerged as an important pathogen in nosocomial and community acquired infections. Accurate and rapid identification of MRSA in clinical specimens is essential for timely decision of effective antimicrobial chemotherapy. <b>Aim:</b> The present study was conducted to compare efficacy of four conventional phenotypic methods, with mec- A based polymerase chain reaction (PCR) for MRSA identification. <b>Materials and Methods:</b> Methicillin resistance was determined in 200 S.aureus isolates by oxacillin disc diffusion, cefoxitin disc diffusion, Oxacillin Resistance Screening Agar and E-test. The results were compared with mec-A based PCR. <b>Results:</b> Among 200 S.aureus isolates 62 (31%) were positive for mec-A gene by PCR. Cefoxitin disc diffusion, Oxacillin Resistance Screening Agar and E-test showed 100% specificity. Oxacillin disc diffusion had lowest sensitivity (82.5%) and specificity (98.5%) among all. The conventional methods take more time than PCR for diagnosing MRSA. Linezolid, Vancomycin & Dalfopristin were the highly sensitive drugs against MRSA isolates. <b>Conclusion:</b> Cefoxitin disc diffusion, is rapid, simple and cheaper, hence can be used routinely as an alternative to PCR for detection of MRSA in resource constraint laboratories. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=DC19-DC21&id=7278 https://doi.org/10.7860/JCDR/2016/.7278 Correlation of Endothelial Nitric Oxide Synthase Gene Polymorphism (GG, TT and GT Genotype) with Proteinuria and Retinopathy in Type 2 Diabetic Patients Ali Momeni, Morteza Hashemzadeh Chaleshtori, Saeed Saadatmand, Soleiman Kheiri <b>Background:</b> Nephropathy is the most important leading cause of end stage renal failure in type 2 diabetic patients, so numerous studies were done to diagnose and evaluate risk factors of diabetic nephropathy (DN). Some gene polymorphisms may be associated with progression or regression of DN, so the aim of this study was to compare prevalence of eNOS gene polymorphism in diabetic patients with controls and its association with diabetic nephropathy. <b>Materials and Methods:</b> In a cross-sectional study, 94 type 2 diabetic patients and 94 normal participants were enrolled. Patients without retinopathy were excluded from this study. For all of the patients, fasting blood sugar (FBS), 2 hours post-prandial (BS), Blood Urea Nitrogen (BUN), Creatinine (Cr), 24 hours urine protein were measured in the case group. Endothelial nitric oxide synthetase gene polymorphism was evaluated in the case and control groups. <b>Results:</b> There was no significant difference based on age and sex between patients in case and control groups. GG genotype of eNOS was less common in the patient group compared to control group. There was no difference between prevalence of TT, GT or GG genotype based on age and sex. There was no correlation between diabetic retinopathy or proteinuria and genotypes of eNOs. <b>Conclusion:</b> The study showed that in type 2 diabetic patients, NOS gene polymorphism was more common compared to normal population; however, there is no correlation between this gene polymorphism and proteinuria or retinopathy in these patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=OC32-OC35&id=7291 https://doi.org/10.7860/JCDR/2016/.7291 Lichtenstein Mesh Repair (LMR) v/s Modified Bassini´s Repair (MBR) + Lichtenstein Mesh Repair of Direct Inguinal Hernias in Rural Population – A Comparative Study Santosh M Patil, Avinash Gurujala, Ashok Kumar, Kuthadi Sravan Kumar, Gorre Mithun <b>Introduction:</b> Lichtenstein’s tension free mesh hernioplasty is the commonly done open technique for inguinal hernias. As our hospital is in rural area, majority of patients are labourers, open hernias are commonly done. The present study was done by comparing Lichtenstein Mesh Repair (LMR) v/s Modified Bassini’s repair (MBR) + Lichtenstein mesh repair (LMR) of direct Inguinal Hernias to compare the technique of both surgeries and its outcome like postoperative complications and recurrence rate. <b>Materials and Methods:</b> A comparative randomized study was conducted on patients reporting to MNR hospital, sangareddy with direct inguinal hernias. A total of fifty consecutive patients were included in this study of which, 25 patients were operated by LMR and 25 patients were operated by MBR+LMR and followed up for a period of two years. The outcomes of the both techniques were compared. <b>Results:</b> Study involved 25 each of Lichtenstein’s mesh repair (LMR) and modified bassini’s repair (MBR) + LMR, over a period of 2 years. The duration of surgery for lichtenstein mesh repair is around 34.56 min compared to LMR+MBR, which is 47.56 min which was statistically significant (p-value is <0.0001). In this study the most common complication for both the groups was seroma. The pain was relatively higher in LMR+MBR group in POD 1, but not statistically significant (p-value is 0.0949) and from POD 7 the pain was almost similar in both groups. The recurrence rate is 2% for LMR and 0% for MBR+LMR. <b>Conclusion:</b> LMR+MBR was comparatively better than only LMR in all direct inguinal hernias because of low recurrence rate (0%) and low postoperative complications, which showed in our present study. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=PC12-PC15&id=7292 https://doi.org/10.7860/JCDR/2016/.7292 Outcome and Predicting Factor Following Severe Traumatic Brain Injury: A Retrospective Cross-Sectional Study Javaher Khajavikhan, Aminolah Vasigh, Ali Khani, Molouk Jaafarpour, Taleb Kokhazade <b>Introduction:</b> Severe traumatic brain injury (TBI) is a major and challenging problem in critical care medicine. <b>Aim:</b> To assess the outcome and predicting factor following severe TBI. <b>Materials and Methods:</b> This is a retrospective and crosssectional study. Data were collected from two sections; one section consisting of a questionnaire answered by the patients and other section from the patient records. The instruments used included the Glasgow Outcome Scale (GOS), SF-36 and the Hospital Anxiety and Depression Scale (HAD). <b>Results:</b> The mortality rate of the patients was 46.2%. The quality of life (QOL) of the patients in most dimension were impaired and (58%) of patients had unfavourable QOL. About (37.5%) of patients with anxiety and (27.5%) had a depression. A significant correlation was found between age, GCS arrival, length of ICU stay, mechanical ventilation, VAP & ARDS and pupil reactivity with QOL, GOS, HAD-A and HAD-D (p<0.05, p< 0.001). GCS arrival a predicate factor for QOL and GOS (p <0.001, OR: 1.75, 1.94 respectively); length of ICU stay a predicate factor for QOL and GOS (p <0.05, OR : 1.11 ,1.28 respectively); mechanical ventilation a predicate factor for GOS (p <0.001, OR : 1.78); ventilation associated pneumonia (VAP) & acute respiratory distress syndrome (ARDS) and pupil reactivity a predicate factor for GOS (p <0.05, OR : 1.36; p<0.001, OR: 1.94 respectively). The GCS arrival and ICU stay a predicate factor for HAD-A (p<0.05, OR: 1.73, 1.38 respectively). <b>Conclusion:</b> With respect to results advanced in pre hospital, medical and surgical care for the decrease in mortality rates of Head trauma (HT), the use of trauma triage tools and strict enforcement of traffic rules are necessary. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=PC16-PC19&id=7294 https://doi.org/10.7860/JCDR/2016/.7294 Anatomical Consideration and Potential Complications of Coronary Sinus Catheterisation Lalit Mehra, Shashi Raheja, Sneh Agarwal, Yashoda Rani, Kulwinder Kaur, Anita Tuli <b>Introduction:</b> Coronary venous catheterisation has been used for performing various cardiologic interventions. The procedure might become complicated due to obstruction offered by the valve of coronary sinus (Thebesian valve) the acute bend of the Great Cardiac Vein (GCV). The present study sought to expound the anatomical considerations of coronary venous catheterization and to elucidate the potential causes of obstruction and the complications of this procedure. <b>Materials and Methods:</b> In this cross-sectional observational study, coronary sinus and GCV were dissected in 40, formalin fixed, adult cadaveric human hearts. Course, length, diameter and angle of bend of GCV, length of coronary sinus and its diameter at its ostium in right atrium were recorded. Thebesian valve morphology and percentage coverage of coronary sinus ostium was recorded. Relation of the coronary sinus and GCV with their neighbouring arteries was described. <b>Results:</b> Coronary sinus: near its termination was directly related to the left atrium. Length: 35.35±4.43 mm (1 SD). Diameter: 11.75 ± 2.66mm. Diameter of CS ostium was more in hearts where Thebesian valve was absent. GCV travelled superficial or deep to the left diagonal artery and crossed circumflex artery superficially. Length: 96.23 ±22.52mm. Diameter: 5.99 ±1.02mm. Angle of bend: 107 ±6.74 degrees. Thebesian valve: Absent in 3 hearts. Various morphologies were observed: thin band, thin band with fenestrations, broad band with fenestrations, well developed semilunar valve (Thin/thick). In five hearts, valve covered more than 50% of coronary sinus ostium. <b>Conclusion:</b> Coronary sinus and GCV diameter will help cardiologists and cardiothoracic surgeons to choose an appropriate sized catheter and their length will decide the length of catheter advancement. Thebesian valve may cause obstruction to the catheter due to an extensive coverage of coronary sinus ostium, which is seen in 12.5% cases. The obtuse angle of GCV has to be negotiated in order to enter this vessel. Arteries lying deep to coronary sinus and GCV might be compressed leading to myocardial ischemia. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=AC12-AC15&id=7295 https://doi.org/10.7860/JCDR/2016/.7295 The Effects of Fetal Movement Counting on Pregnancy Outcomes Masoumeh Delaram, Lobat Jafarzadeh <b>Introduction:</b> Counting fetal movements may lead to timely assess fetal health and prevent the adverse effects of pregnancy. <b>Aim:</b> The aim of this study was to determine the effect of fetal movement counting on pregnancy outcomes. <b>Materials and Methods:</b> In a randomized controlled trial, 208 women with singleton pregnancy were randomly divided into two groups of fetal movement counting and control. Pregnancy outcomes were compared between the two groups. Data were analysed with SPSS and p<0.05 was considered significant. <b>Results:</b> There was no significant difference in the mean maternal concern (p=0.36), admission to hospital due to the decreased fetal movements (p=0.99), birth weight (p=0.21), Apgar score (p=0.51), the mean of gestational age at the time of decreased fetal movements (p=0.49) and mode of delivery (p=0.69) between the two groups. There were no cases of premature labour, intrauterine growth retardation and fetal death in the two groups. <b>Conclusion:</b> Pregnancy outcome was similar in the two groups of fetal movement counting and control. Further studies are needed to evaluate the effect of fetal movement counting on the major outcomes of pregnancy such as intrauterine fetal death. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=SC22-SC24&id=7296 https://doi.org/10.7860/JCDR/2016/.7296 Vestibular Stimulation for Stress Management in Students Sai Sailesh Kumar, Archana Rajagopalan, Joseph Kurien Mukkadan <b>Introduction:</b> Although several methods are developed to alleviate stress among college students, logistic limitations in adopting them have limited their utility. <b>Aim:</b> Hence, we aimed to test a very practical approach to alleviate stress among college students by achieving vestibular stimulation using swings. <b>Materials and Methods:</b> In this study 60 male and female participants were randomly assigned into vestibular stimulation or control groups. Depression, anxiety, stress scores, sleep quality, heart rate, blood pressure, Autonomic functions, respiratory, haematological, cognitive function, Quality of life were recorded before and after 1st, 7th, 14th, 21st, 28th days of vestibular stimulation. <b>Results:</b> STAI S and STAI T scores were significantly improved on day 28th following vestibular stimulation. Diastolic and mean arterial blood pressure were significantly decreased and remained within normal limits in vestibular group on day 28th following vestibular stimulation. Postural fall in blood pressure was significantly improved on day 14 onwards, following vestibular stimulation. Respiratory rate was significantly improved on day 7 onwards, following vestibular stimulation. PSQI sleep disturbance, PSQI sleep latency, PSQI total score and bleeding time was significantly improved following vestibular stimulation. <b>Conclusion:</b> Our study supports the adoption of vestibular stimulation for stress management. Hence, placement of swings in college campuses must be considered, which may be a simple approach to alleviate stress among college students. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=CC27-CC31&id=7299 https://doi.org/10.7860/JCDR/2016/.7299 Orientation of Dental Professionals in India towards Integrative Medicine: A Cross-Sectional Survey Balasubramanian Madhan, Haritheertham Gayathri, Mirna Garhnayak, Eslavath Seena Naik <b>Introduction:</b> There is a growing demand on our health care system, including Dentistry, to shift from a bio-medical approach to Integrative model of care. The attitudes of health professionals towards Integrative Medicine (IM) are an important factor that influences this transition. <b>Aim:</b> The aim of this study was to evaluate and compare the orientation of the dental professionals in India towards the principles and practice of Integrative Medicine. <b>Materials and Methods:</b> A cross-sectional survey was conducted on 286 dental faculty and postgraduate students from three dental schools in India. The participants voluntarily and anonymously completed the ‘Integrative Medicine-30’ questionnaire, a 30 item self-report instrument that measures the health care provider’s orientation towards Integrative Medicine in five subscales. Data analysis included summary statistics and intergroup comparisons by gender and professional status with independent samples Mann-Whitney U test. <b>Results:</b> The overall orientation of the dental professionals towards IM was almost neutral. While the use of learning resources on Complementary and Alternative Medicine was lower, they showed a more positive orientation towards patient-centred care. Compared to postgraduate students of Dentistry, the dental faculty were more oriented towards IM (median score of 82 vs. 79.5, p<0.01), especially in terms of learning from alternate paradigms (14 vs. 12, p<0.01) and safety of Complementary and Alternative Medicine (13 vs. 12, p<0.01). Females scored better than males both in terms of overall orientation (82 vs. 78, p<0.01) and towards patient-centred care (12 vs. 11, p<0.001). <b>Conclusion:</b> The results highlight the impending need to improve the orientation of dental professionals in India towards the principles and practice of IM. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ZC60-ZC62&id=7300 https://doi.org/10.7860/JCDR/2016/.7300 Role of Amylase and Lipase Levels in Diagnosis of Blunt Trauma Abdomen Ravinder Pal Singh, Nikhil Garg, Amandeep S Nar, Anuj Mahajan, Atul Mishra, Jaspal Singh, Ashish Ahuja, Ashvind Bawa <b>Introduction:</b> Blunt Trauma Abdomen (BTA) is the leading cause of morbidity and mortality amongst all age groups. Spectrum of injury may vary from simple to life threatening multi organ involvement and therefore proper assessment and diagnosis becomes very important. <b>Aim:</b> To evaluate the role of serum amylase and lipase in diagnosis of blunt trauma abdomen. <b>Materials and Methods:</b> This study was done on 50 patients with diagnosis of BTA admitted in Dayanand Medical College and Hospital, Ludhiana. Serum amylase and lipase levels were estimated on days 1, 3 and 5 of admission. <b>Results:</b> Road side accident was the most common aetiology accounting for 40 patients. Thirty one patients were less than 35 years of age and 42 patients were males. Abdominal tenderness was the most common per abdomen finding, found in 31 patients, followed by distension, found in 21 patients. The most common organ injured was liver, seen in 27 patients. Fifteen patients underwent laparotomy while 35 patients were managed conservatively. There was statistically significant rise in serum amylase levels on days 1, 3 and 5 in patients with small and large intestinal injury. There was statistically significant rise in serum lipase levels on days 1, 3 and 5 in patients with stomach injury. Raised levels of serum amylase and lipase had a statistically significant prediction for the need of surgery in these patients. <b>Conclusion:</b> Serum amylase and lipase levels, when coupled with other laboratory tests and imaging modalities, may have significant role in predicting the site of injury as well as the surgical outcome in patients of BTA. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=PC20-PC23&id=7308 https://doi.org/10.7860/JCDR/2016/.7308 Correlation between MRI and Arthroscopy in Diagnosis of Shoulder Pathology Abhinav Bhatnagar, Sachin Bhonsle, Sonu Mehta <b>Introduction:</b> Shoulder pain can cause significant pain, discomfort and reduce the ability to perform activities of daily living, thus making it the third most common cause of musculoskeletal consultation. The current gold standard diagnostic investigation is arthroscopy. MRI is a proved sensitive and accurate non-invasive tool in investigating shoulder pathology, but false and misleading results are equally reported. <b>Aim:</b> The aim of the study is to compare the efficacy of MRI in diagnosing shoulder pathologies in comparison to arthroscopy, considering arthroscopy as the gold standard. <b>Materials and Methods:</b> Thirty nine consecutive patients, between 18-80 years of age, presenting with chronic shoulder pain or instability of more than 6 weeks, or with clinical signs of impingement or tear were included in the study. MRI of the shoulder joint was done followed by shoulder arthroscopy. The data collected was analysed for the significant correlation between MRI of shoulder and arthroscopic findings by kappa statistics. <b>Results:</b> Out of 39 patients, Rotator cuff (RC) tear was the most common pathology. MRI showed excellent sensitivity in the diagnosis of rotator cuff tears (0.91) and osteochondral defects (OCD), very good sensitivity for Bankart's lesion (0.8) and had poor sensitivity to detect SLAP tear (0.15). MRI was specific for all shoulder pathologies. MRI detected RC tears with kappa score of 0.73, Bankart's tear and OCD's with kappa score of 0.83 and 1.0 respectively and SLAP lesion with kappa score of 0.14. The accuracy of MRI was highest in diagnosing OCD's (1.0), followed by RC tear (0.9), Bankart's tear (0.9) and accuracy was least in diagnosing SLAP lesion (0.7). False negative results were more than false positives. <b>Conclusion:</b> The present study supports that MRI is effective in diagnosing rotator cuff tears, Bankart's tear and ostechondral defects but was not found to be helpful in diagnosing SLAP lesions. MRI and arthroscopy have complimentary roles in the diagnosis of shoulder pathology. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=RC18-RC21&id=7309 https://doi.org/10.7860/JCDR/2016/.7309 Thyroid Gland Involvement in Carcinoma Larynx and Hypopharynx-Predictive Factors and Prognostic Significance Elizabeth Mathew Iype, Vijay Jagad, Santhosh Kumar Nochikattil, Bipin T. Varghese, Paul Sebastian <b>Introduction:</b> Intraoperative management of thyroid gland in laryngeal and hypopharyngeal cancer is controversial. <b>Aim:</b> The objectives of this study were to determine the incidence of thyroid gland invasion in patients undergoing surgery for laryngeal or hypopharyngeal carcinoma, to assess predictive factors and to assess the prognosis in patients with and without thyroid gland invasion. <b>Materials and Methods:</b> One hundred and thirty-three patients who underwent surgery for carcinoma larynx and hypopharynx from 2006 to 2010 were reviewed retrospectively. Surgical specimens were examined to determine the incidence of thyroid gland invasion and predictive factors were analysed. The recurrence rate and the survival in patients with and without thyroid gland invasion were also analysed. <b>Results:</b> Out of the 133 patients with carcinoma larynx and hypopharynx who underwent surgery, histological thyroid gland invasion was observed in 28/133 (21%) patients. Significant relationship was found between histological thyroid gland invasion and preoperative evidence of thyroid cartilage erosion by CT scan and also when gross thyroid gland involvement observed during surgery. There is significant association between thyroid gland invasion when there is upper oesophageal or subglottic involvement. <b>Conclusion:</b> After analysing the retrospective data from our study, we would like to suggest that thyroid gland need not be removed routinely in all laryngectomies, unless there is advanced disease with thyroid cartilage erosion and gross thyroid gland involvement or disease with significant subglottic or oesophageal involvement. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=XC05-XC07&id=7310 https://doi.org/10.7860/JCDR/2016/.7310 Utility of Serological Tests in the Era of Molecular Testing for Diagnosis of Human Brucellosis in Endemic Area with Limited Resources Shashank Purwar, Sharada C. Metgud, Manohar B Mutnal, Mahantesh B Nagamoti, Chidanand S. Patil <b>Background:</b> The culture has always been the gold standard test for diagnosis of human brucellosis but the conventional Brucella diagnostic tests viz. serology and culture are often beset with poor specificity & sensitivity respectively. The culture positivity rates for Brucella vary from 92% for bone marrow to 10% for non-blood samples and also dependent on the type of sample. The primary immune-determinant for Brucella species is the cell wall surface lipopolysaccharide, which is antigenically similar to other gram-negative rods. Hence, Brucella serological tests cross react with Escherichia coli 0116 and 0157, Salmonella urbana, Yersinia enterocolitica 0:9, Vibrio cholerae, Xanthomonas maltophilia and Afipia clevellandensis infections, which are common in developing countries also having higher incidence of brucellosis. <b>Aim:</b> The aim of the study was evaluation of conventional serological techniques and PCR for diagnosis of human brucellosis in and around north Karnataka which is endemic for brucellosis and patients often present with elevated base line antibody titers and confounding clinical manifestations. <b>Materials and Methods:</b> Blood/serum samples of 400 patients suffering from acute undifferentiated fever (AUF) were subjected to culture, Brucella slide agglutination test (SAT), standard tube agglutination test (STAT coupled with 2 ME) and PCR. <b>Results:</b> Of the 400 AUF patients, anti-Brucella antibodies were detected by SAT and STAT in serum of 35 and 34 patients respectively. IS711 gene for Brucella was identified in 32 patients by PCR. Twenty samples yielded Brucella in culture on biphasic medium with average incubation period of 9 days. All patients having titer of = 160IU / ml in STAT were found positive by PCR also. <b>Conclusion:</b> Brucella STAT corroborated well with PCR results in all those cases where antibodies were present at least one dilution above cut-off value of 80 IU/ml. We probably need to raise cut-off titers to =160 IU/ml because of endemic region. The SAT was upheld as very good quick, easy to perform and economical screening test for human brucellosis. SAT as rapid screening test and STAT as more definitive test can be very well adopted by laboratories working in resource scarce settings for diagnosis of human brucellosis in absence of PCR even for population with normally elevated antibodies levels due to residing in Brucella endemic areas. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=DC26-DC29&id=7311 https://doi.org/10.7860/JCDR/2016/.7311 Burnout and Work Engagement Among Dental Practitioners in Bangalore City: A Cross-Sectional Study Pallavi V. Jugale, Pramila Mallaiah, Archana Krishna Murthy, Ranganath Sangha <b>Introduction:</b> Burnout is a job-related stress reaction; a potential hazard for personal, professional lives of dentists. Work Engagement (WE) is the antithesis of Burnout and they can co-exist. <b>Aim:</b> This study was taken up to know the prevalence of Burnout and WE among dentists in Bangalore, India. <b>Matreials and Methods:</b> In a cross-sectional study, all (n=116) dentists practicing in Bangalore East Zone were randomly selected. A structured, self-administered questionnaire revealing dentists’ demographics, practice characteristics, Burnout level [6-item from Maslach Burnout Inventory] and WE [4-item from Utrecht Work Engagement Scale] was used. Ethical clearance and informed consent was obtained. The data was analyzed using SPSS version 15.0. <b>Results:</b> With a response rate of 58.6%, high burnout was seen in 5.15% dentists. Personal Accomplishment was significantly associated with dentists in older age-group (p=0.002), married (p=0.014), MDS qualified (p=0.038), having long working hours (p=0.009) with assistants (p=0.024), more years into practice (0.007), travelling more distance from residence (p=0.021). Significance was also seen for dedication among dentists with assistants (p=0.006), emotional exhaustion among dentist with long working hours (p=0.009), and driving own vehicle (p=0.028). Finally absorption was found significant in dentists practicing solo. <b>Conclusion:</b> Higher WE were found but still burnout persisted. Thus, burnout and WE were found to co-exist. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ZC63-ZC67&id=7312 https://doi.org/10.7860/JCDR/2016/.7312 A Focus on Variation in Morphology of Soft Palate Using Cone-Beam Computed Tomography with Assessment of Need’s Ratio in Central Madhya Pradesh Population Priyal Agrawal, Anjali Gupta, Tushar Phulambrikar, Siddharth Kumar Singh, B.K. Sharma, Deepshikha Rodricks <b>Introduction:</b> Soft palate is an anatomical structure that helps in modifying the quality of voice and to breathe while swallowing. Through the variants and shapes of the soft palate, we can assess the age and gender of an individual. <b>Aim:</b> The aim of the present study was to investigate the variation in morphology of soft palate and to find its association with the Need’s ratio, Velar Length (VL), Velar Width (VW) and Pharyngeal Depth (PD), in age groups and gender using CBCT in Central Madhya Pradesh population. <b>Materials and Methods:</b> The study sample consisted of 121 CBCT scans of individuals aged between 15 to 45 years. These scans were retrieved from the Department of Oral Radiology. The velar morphology on CBCT was examined and grouped into six types. The results obtained were subjected to a statistical analysis to find the association between variants of the soft palate with gender and different age groups. ANOVA and Z-test were used for statistical analysis. The p=0.05 was considered as significant while p=0.001 was considered as highly significant. <b>Results:</b> The most frequent type of soft palate was rat tail shaped. The mean VL and VW values were significantly higher in males while PD and Need’s ratio were higher among females, insignificantly associated with the types of soft palate. A significant association was observed between the mean VL and VW with various age groups, showing an increase in values with an increase in age. <b>Conclusion:</b> A variation in morphology of soft palate plays an important role in the assessment of velopharyngeal closure and in diagnosing obstructive sleep apnoea individuals. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ZC68-ZC71&id=7315 https://doi.org/10.7860/JCDR/2016/.7315 Carpal Tunnel Syndrome in Hypothyroidism Sampada Swapneel Karne, Nilima Sudhakar Bhalerao <b>Introduction:</b> Carpal Tunnel Syndrome (CTS) is an entrapment neuropathy that occurs due to compression of median nerve in the carpal tunnel and hypothyroidism is one of the important causes of CTS. Aim: To study clinical profile of carpal tunnel syndrome in patients with primary hypothyroidism. <b>Materials and Methods:</b> This was cross-sectional study done in Smt. Kashibai Navale Medical College, Pune, Maharashtra. Adult patients with diagnosis of primary hypothyroidism were included in this study. Patients with other possible causes of CTS were excluded. Detailed medical history was obtained and all patients underwent clinical examination and nerve conduction study by electrophysiological method. <b>Results:</b> Total 36 adult patients were included in this study, 86.1% females and 13.9% males. CTS were found in 6 (16.7%) patients. Increased Body Mass Index (BMI) and presence of clinical symptoms and/or signs of CTS correlated independently with presence of CTS in hypothyroidism. (p-value- 0.03 and < 0.0001 respectively). No correlation was found between gender, age of the patient, duration of disease, serum TSH level, aetiology of the disease, thyroid hormone replacement therapy and occurrence of CTS in hypothyroidism. <b>Conclusion:</b> Increase in BMI is an important risk factor for CTS in hypothyroidism and clinical evidence of CTS is a very sensitive parameter for the same. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=OC36-OC38&id=7316 https://doi.org/10.7860/JCDR/2016/.7316 Detection of Tuberculosis in HIV Co–infected Individuals: Use of Multiple ELISA Responses to 38kDa, Lipoarabinomannan and ESAT– 6 of M. tuberculosis Ravi Gutlapalli, Aparna Sykam, Sandeep P Tenali, Priscilla Chandran, Sujai Suneetha, Lavanya M Suneetha <b>Introduction:</b> There is a constant search for more sensitive and specific laboratory markers for tuberculosis (TB) infection. The early detection of TB in HIV co infected individuals is a diagnostic challenge. This is further compounded in those harbouring extrapulmonary disease. <b>Aim:</b> To evaluate the use of multiple Enzyme Linked Immunosorbent Assays (ELISA) quantifying antibody responses to 38kDa, LAM and ESAT-6 M.tb antigens in detection of TB in patients with TB and HIV-TB co-infection. <b>Materials and Methods:</b> This is a cross-sectional study carried out in Hyderabad, India. Patient groups included 124 HIV-TB {62 with pulmonary TB (PTB) and 62 with extrapulmonary TB (ETB)}, 39 TB, 56 HIV and 57 healthy subjects (HS). A combination of anti 38kDa and LAM ELISAs measuring IgG, IgM and IgA levels and another ELISA measuring anti ESAT-6 combined antibody levels of IgG, IgM and IgA were evaluated. One-way ANOVA was performed to compare antibody responses among groups. To assess the efficacy of multiple ELISAs in detecting TB, concomitant seropositivity of an individual for all four ELISAs were evaluated for sensitivity and specificity. <b>Results:</b> A single ELISA carried out to detect TB in HIV patients showed a sensitivity ranging from 39% to 72%. The sensitivities of concomitant evaluation of multiple ELISAs were 92% for any single, 72% for any two, 44% for any three and 14% for any four. Based on the specificities, a simple algorithm for TB detection can be deduced. When four ELISAs are positive (specificity 100%) in a patient-confirmed TB; when three ELISAs are positive (specificity 98%) – probably TB; when two ELISAs are positive (specificity 95%) – possibly TB; and when one ELISA is positive (specificity 70%) – suspicion of TB. <b>Conclusion:</b> The present study establishes the value of combining two or more M.tb antigen based ELISAs to enhance the sensitivity and specificity of TB detection in patients with tuberculosis as well as in those co-infected with HIV. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=KC01-KC04&id=7322 https://doi.org/10.7860/JCDR/2016/.7322 Bullying and Victimization Trends in Undergraduate Medical Students – A Self–Reported Cross–Sectional Observational Survey Shrea Kapoor, Shaunak Ajinkya, Pradeep R Jadhav <b>Introduction:</b> Bullying is a form of behaviour that can negatively impact a person. It can lead to several deleterious consequences like low self-confidence, drop in academic performance and depression. Studies have shown that bullying behaviour exists amongst medical students also. In the medical field, it is known to negatively impact dispensing of health care and attitudes of medical students towards becoming doctors. It is very difficult for medical students to cope with such a menace as they are already burdened with a vast curriculum and rigorous schedules. There exists paucity of studies regarding bullying amongst undergraduate medical students in Indian context. <b>Aim:</b> To study prevalence of peer-based bullying and victimization along with their associated factors in undergraduate medical students. <b>Materials and Methods:</b> Four hundred randomly chosen undergraduate medical students were included in the study. Socio-demographic and personal details including history of substance use were recorded in a self-designed case record form. Illinois Bullying Scale was used to assess bullying behaviours. Out of total 400 students, 383 completed the survey and this data was analysed. <b>Results:</b> In this study, 98.69% participants self-reported to having indulged in bullying while 88.77% reported feeling victimized. Physical (p<0.001) as well as verbal (p=0.001) bullying was found to be of significantly greater severity in males as compared to females. Students of the third year of medical school indulged in significantly (p=0.034) greater severity of physical bullying than those of other years. Alcohol consumption (p=0.001) and cigarette smoking (p<0.001) were significantly associated with physical bullying. <b>Conclusion:</b> Peer-based bullying and victimization was found to be highly prevalent amongst undergraduate medical students. There is an urgent need for more detailed studies on bullying in medical students so that remedial measures can be initiated and steps to limit such behaviours can be looked at seriously. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=VC05-VC08&id=7323 https://doi.org/10.7860/JCDR/2016/.7323 Prevalence of Tooth Shade and its Correlation with Skin Colour - A Cross-sectional Study Suneel. V. Vadavadagi, K.V Halini Kumari, Gopal Krishna Choudhury, Abhishek Madhukar Vilekar, Sitansu Sekhar Das, Debkant Jena, Bharat Kataraki, Bhavana B.L <b>Introduction:</b> Aesthetics has become an important issue in modern society. Tooth shade is one of the factors in determining aesthetics. Studies have revealed that tooth shade is influenced by age, gender, eye colour, skin colour and other factors. <b>Aim:</b> The present study was aimed to assess the prevalence of tooth shade and its correlation with skin colour. <b>Materials and Methods:</B> A total of 300 subjects aged 18-20 years were evaluated for tooth shade using Vitapan – 3D shade guide. Anterior teeth were checked under natural light and facial skin colour by Lakme liquid foundation make up as a shade guide. Data was analysed using chi square test and spearman’s correlation. <b>Results:</b> Out of 300 students, 114 (38.00%) had A2 tooth shade; the least prevalent tooth shade among Chitradurga population was C1 (4.00%). There was a positive correlation between tooth shade and skin colour which was found to be statistically significant (p <0.05). <b>Conclusion:</b> The most prevalent tooth shade among Chitradurga population was A2 and least was C1. There was a significant correlation between tooth shade and skin colour with lighter skin tone subjects having lighter tooth shade hence skin colour can be used as a guide for shade selection. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ZC72-ZC74&id=7324 https://doi.org/10.7860/JCDR/2016/.7324 University-Based Smoking Cessation Program Through Pharmacist-Physician Initiative: An Economic Evaluation Mohamed Izham Mohamed Ibrahim, Nagmeldien Ahmed Mohammed Magzoub, Norlela Maarup <b>Introduction:</b> Annually, especially in poor resourced countries, significant amount of money is spent to treat chronic diseases. The money instead could be saved by spending on health promotion programs for preventing chronic diseases. <b>Aim:</b> To conduct cost-effectiveness analysis of various intervention modules in the “Smoking Cessation” program conducted in Universiti Sains Malaysia (USM). <b>Materials and Methods:</b> This was an observational study design. Cost-effectiveness analysis was used to assess the costs and outcomes of the intervention. Data were collected retrospectively from medical records of all clients (n= 129) and then all the participants were followed-up for at least 6 months from the date of participation. Data were analysed descriptively using frequency (%) and mean (sd). Kolmogorov-Smirnov test was carried out to test for normality. Chi-square and Kruskal-Wallis tests were used at alpha level of 0.05. All analyses were done using SPSS version 19. <b>Results:</b> The findings of the study showed that the majority of participants were Malays (n= 108; 83.7%), males (n= 128; 99.2%), USM’s staff (n= 71; 55.0%) and within an age group of 23 years or less (n= 38; 29.5%). Among those who successfully quit were male (n= 30; 100%), Malays (n= 29; 96.7%), staff (n= 19; 63.3%), moreover, their age ranged from 35 to 56-year-old (n= 15; 50.0%). Further analysis of data showed that there were significant associations between success rate and modules of intervention, occupation, motivation factors, and frequency of counselling. Total cost of the Smoking Cessation Program was MYR 38,634.66 (during a period of 34.5 months), with a success rate equal to 29.1%. The most cost-effective module of intervention was counselling alone (CE ratio equal to MYR360.00 per 1% of success rate). The study found counselling with patch was ineffective during the study period. <b>Conclusion:</b> Counselling alone module was the most cost-effective in Smoking Cessation program conducted in USM, Malaysia. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=LC11-LC15&id=7325 https://doi.org/10.7860/JCDR/2016/.7325 Accuracy of Common Femoral Artery Doppler Waveform Analysis in Predicting Haemodynamically Significant Aortoiliac Lesions Varsha P. Rangankar, Kishor B. Taori, Rajesh G. Mundhada, Atul D. Rewatkar <b>Introduction:</b> Doppler ultrasound is cost-effective and accurate noninvasive method for evaluation of peripheral arterial disease. However, there is difficulty in detection of aortoiliac lesions due to inadequate visualization of aortoiliac arteries in many patients. The Doppler waveform changes occurring distal to significant stenosis or occlusion are well documented. Accordingly, common femoral artery (CFA) Doppler waveform analysis may be used to predict haemodynamically significant proximal aortoiliac lesions. Aim To evaluate the accuracy of Doppler waveform analysis at the CFA for diagnosing haemodynamically significant aortoiliac stenosis or occlusion in patients of peripheral arterial disease. <b>Materials and Methods:</b> A total of 67 patients (114 aortoiliac segments) with suspected peripheral arterial disease were retrospectively evaluated and labeled as normal or abnormal by analysing the Doppler waveform of CFA. The triphasic waveform with normal reversal pattern was categorized as normal, while low velocity biphasic or monophasic waveform were labeled as abnormal and indirect diagnosis of normal or diseased (>50% stenosis or occlusion) aortoiliac segment was made. The results were compared to intra-arterial angiography, considered as the gold standard. <b>Results:</b> The Doppler waveform analysis of CFA was abnormal in 41 out of 114 common femoral arteries, while intra-arterial angiography showed significant stenosis (21 arteries) or occlusion (26 arteries) in 47 (41%) of 114 aortoiliac segments in 67 patients. Out of 67 normal aortoiliac segments seen on angiography, the CFA waveform analysis was interpreted as normal in 62 segments. An abnormal CFA waveform could diagnose significant aortoiliac lesion with 87% sensitivity, 92% specificity, 89% Positive Predictive Value (PPV), 91% Negative Predictive Value (NPV) and 90% accuracy using angiography as the gold standard. The low velocity monophasic waveform which was seen in 38 (33%) of 114 segments was reliable predictor of significant aortoiliac disease with 93% positive predictive value. <b>Conclusion:</b> CFA Doppler waveform pattern analysis is a sensitive and accurate technique for the prediction of haemodynamically significant aortoiliac stenosis or occlusion. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=TC26-TC28&id=7326 https://doi.org/10.7860/JCDR/2016/.7326 Serial Peak Expiratory Flow Rates in Patients Undergoing Upper Abdominal Surgeries Under General Anaesthesia and Thoracic Epidural Analgesia Julie C.R. Misquith, Rammoorthi Rao, Karl Sa Ribeiro <b>Introduction:</b> Anaesthesia and upper abdominal surgeries alter lung compliance and functional residual capacity resulting from atelectasis. Upper abdominal surgeries also cause a decrease in peak expiratory flow rates, cough reflex due to pain limited inspiration. <b>Aim:</b> This study aimed to study the effect of thoracic epidural analgesia (TEA) on the peak expiratory flow rates in patients undergoing upper abdominal surgeries. <b>Materials and Methods:</b> A total of 44 patients posted for elective surgery were enrolled. Group 1 patients received GA + 0.125% bupivacaine infusion TEA and Group 2 received GA + Inj. Diclofenac sodium 50 mg slow i.v. TID for Postoperative analgesia. Haemodynamics, VAS pain score, PEFR measurements were done at 60 minutes, 24 hours, 48 hours and 4 days after surgery in both groups. ABG analysis was taken pre operatively and 24 hours after surgery. <b>Results:</b> The SBP and DBP values obtained at 60 minutes (p<0.016) 24 and 48 hours (p<0.001) and day 4 (p<0.02) postoperative showed highly significant difference between the two groups which indicate better haemodynamic parameters in patients receiving epidural analgesia. Postoperatively the difference in PEFR values at 60 minutes, 24 hour, 48 hour and day 4 were very highly significant. (p<0.001). Group1 had a 10.739% deficit on day 4 from its pre operative baseline value while group 2 showed a 34.825 % deficit which was very highly significant (p<0.001). The difference in VAS scores recorded at 60 minutes, 24 hours, 48 hours and day 4 post op were very highly statistically significant (p < 0.001). The ABG taken at 24 hours shows statistically significant difference with patients in group 2 showing decreased values in pCO2 and pO2 reflecting poorer ventilation and oxygenation. <b>Conclusion:</b> Thoracic epidural analgesia provides superior analgesia, better cough reflex as seen by better PEFR values, were haemodynamically more stable and their ABG values were better than the NSAID group. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=UC01-UC04&id=7327 https://doi.org/10.7860/JCDR/2016/.7327 Chemotherapy: Impact on Anti-Müllerian Hormone Levels in Breast Carcinoma Jyoti Bala, Shashi Seth, Rakesh Dhankhar, Veena Singh Ghalaut <b>Introduction:</b> Anti-Mullerian Hormone (AMH) is a glycoprotein of the transforming growth factor-ß (TGF-ß) family that seems to reflect the continuous non-cyclical growth of small follicles and can be considered an indirect index of the size of the resting primordial follicle pool. Accordingly, AMH represents a marker of Ovarian Reserve (OR) and is particularly useful in demonstrating ovarian tissue damage induced by chemotherapy. <b>Aim:</b> To evaluate and compare the levels of AMH in Breast Carcinoma patients before and after chemotherapy with age matched healthy controls and to assess whether AMH as a biochemical marker of the OR might improve prediction of chemotherapy related outcomes in these patients. <b>Materials and Methods:</b> The present study was conducted in the Department of Biochemistry in collaboration with Department of Radiotherapy, Pt. B.D. Sharma, University of Health Sciences, Rohtak between June 2013 and June 2014. The subjects were divided into two groups. A total of 30 female patients of confirmed diagnosis of breast carcinoma were enrolled in the study group (Group I). The enrolled breast cancer cases were further divided into subgroups (Group-IA=Prechemotherapy & Group-IB= Postchemotherapy). Thirty healthy age matched female volunteers were enrolled as controls (Group II). Serum levels of AMH were determined by the ultrasensitive anti-müllerian hormone/ müllerian inhibiting substance (US AMH/MIS) Enzyme Linked Immuno Sorbent Assay (ELISA). <b>Results:</b> There was a significant decrease in serum AMH levels in the both study group-IA and study group-IB as compared to control group-II (p<0.05 and p<0.001 respectively). The prechemotherapy (group-IA) serum AMH levels dropped significantly after chemotherapy (group-IB) (p<0.001). <b>Conclusion:</b> AMH levels declined after chemotherapy indicates direct chemotherapy induced damage to the granulosa cells and growing follicles, reflecting decrease ovarian reserve and fertility. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=BC19-BC21&id=7328 https://doi.org/10.7860/JCDR/2016/.7328 Seroprevalence of Hepatitis B Surface Antigen and Occupational Risk Factors Among Health Care Workers in Ekiti State, Nigeria Oluwole Ojo Alese, Margaret Olutayo Alese, Afolabi Ohunakin, Peter Olumuyiwa Oluyide <b>Introduction:</b> Hepatitis B virus (HBV) infection is contracted from blood and other body fluid making healthcare workers (HCW) prone to the infection especially in the developing world. Though it is a vaccine preventable disease, the level of awareness and universal precaution among HCW is low in sub-Saharan African and Asia. <b>Aim:</b> The study was aimed at determining the seroprevalence of hepatitis B surface antigen and occupational risk factors among health care workers at Ekiti State University Teaching Hospital, Ado Ekiti. <b>Materials and Methods:</b> One hundred and eighty-seven (187) blood samples were collected from volunteer subjects who comprised of medical doctors, nurses, health attendants, and porters who are in regular contact with blood, body fluids and patients after informed consent. Well detailed and structured questionnaires were used to obtain demographic and other relevant data from the subjects. Blood samples were tested by Enzyme Linked Immunosorbent assay (ELISA) for hepatitis B surface antigen. <b>Results:</b> Out of the 187 HCWs there were 91 males (48.7%) and 96 (51.3%) females. Only 2 participants tested positive to hepatitis B surface antigen with a prevalence of 1.1%. Also, only 30 (16.0%) of the participants had been fully vaccinated against the infection while the remaining 157(84.0%) had no adult vaccination. <b>Conclusion:</b> It is obvious that the awareness of the infection is low among the HCWs studied thus the need to incorporate screening for HbsAg and vaccination against HBV into the periodic/pre-employment health intervention programmes by employers to help in the protection of HCWs and control the spread of the virus. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=LC16-LC18&id=7329 https://doi.org/10.7860/JCDR/2016/.7329 Genotype Phenotype Correlation of Genetic Polymorphism of PPAR Gamma Gene and Therapeutic Response to Pioglitazone in Type 2 Diabetes Mellitus- A Pilot Study S. Shanmuga Priya, Ramalingam Sankaran, Sudha Ramalingam, Thiagarajan Sairam, LS Somasundaram <b>Introduction:</b> Pro12Ala polymorphism is a missense mutation at codon 12 in peroxisome proliferator-activated receptor ? gene (PPARG). This polymorphism is known to be associated with increased insulin sensitivity. Pioglitazone, a thiazolidinedione, is an anti-diabetic drug which acts as an agonist at PPAR ? receptor. <b>Aim:</b> To determine the association between Pro12Ala polymorphism of the PPARG and variation in therapeutic response to the PPAR? agonist, pioglitazone. <b>Materials and Methods:</b> The study was done as a hospital based pilot project in 30 patients with type 2 diabetes mellitus, on treatment with sulfonylurea or metformin but without adequate glycaemic control. They were started on pioglitazone as add on therapy for a period of 12 weeks. The participants were categorized as responders and non-responders based on the change in HbA1C level after 12 weeks. Pro12Ala polymorphism was analysed by polymerase chain reaction-restriction fragment length polymorphism. <b>Statistical Analysis:</b> Logistic regression analysis was done to evaluate the associations between age, baseline body weight, BMI, waist circumference, waist-hip ratio and Pro12Ala variants with the response to pioglitazone. The p-value< 0.05 was considered significant. <b>Results:</b> The frequency distributions of PPAR gamma genotypes were 80% for Pro/Pro and 20% for Pro/Ala in the study population. Among the study participants, 30% were non-responders and 70% responders to pioglitazone. A significantly higher frequency of the polymorphism was detected in the responders (p=0.005) compared to non-responders group. <b>Conclusion:</b> Our study suggests that there is a potential association between Pro12Ala polymorphism and glycaemic response to pioglitazone. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=FC11-FC14&id=7331 https://doi.org/10.7860/JCDR/2016/.7331 A Rare and Extensive Case of Oral Malignant Melanoma involving Mandibular Gingiva Rajendrasinh S Rathore, Rashmi GS Phulari, Dharmeshg Vasavada, Dipen K Patel Oral malignant melanoma is an infrequent but an aggressive neoplasm of unknown etiology, seen most commonly in middle age male patients and is more frequently seen at the hard palate and gingiva. The tumor tends to metastasize or locally invade tissue more readily than other malignant tumors in the oral region. In this article, we report a rare case of extensive oral melanoma in a 55-year-old male patient, with a chief complaint of painless growth in mandibular anterior gingiva measuring about 2.6 X 1.7 X 0.8 cm and extending bilaterally till posterior mandibular gingiva and unilaterally to right buccal mucosa. The most common site being hard palate and maxillary gingiva, it is extremely rare in mandibular gingiva (less than 7%) and hence, this rare occurrence in mandibular gingiva is reported, the diagnosis of which was confirmed by histopathology and immunohistochemistry. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ZD11-ZD12&id=7320 https://doi.org/10.7860/JCDR/2016/.7320 Biliary Cystadenoma: A Case Report Johnsy Merla Joel, Suresh Durai Jeyasingh, Shantaraman Kalyanaraman Biliary cystadenoma is a rare cystic neoplasms of liver that usually occurs in middle-aged women characterized by multiloculated cysts with internal septae and mural nodules. Unilocular biliary cystadenomas are rare and are difficult to differentiate from other cysts by radiology. Biliary cystadenomas are slow growing benign lesions that are easily resectable with a reported recurrence rate of 90% when the resection is incomplete. We present a case of 65-year-old male with unilocular biliary cystadenoma with mesenchymal stroma who presented with abdominal pain and distension. Laparotomy followed by cystectomy was done and postoperative period was uneventful with no abnormal biochemical, heamatological or imaging findings. Preoperative radio-imaging techniques may not always be helpful in arriving at a specific diagnosis in such cases. Hence thorough sampling and a careful histopathological examination is considered gold standard for specific diagnosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ED19-ED20&id=7330 https://doi.org/10.7860/JCDR/2016/.7330 Gerbode Defect of Congenital Variety in an Infant: A Case Report Ankur Singh, Ravindra Kumar, Abhishek Abhinay, Rajniti Prasad, Om Prakash Mishra Gerbode defect is a rare communication from left ventricle to right atrium. It is of two types: congenital versus acquired OR Direct (type I) versus Indirect (type II). Acquired forms are more common and increasingly reported than congenital. We report a second Indian case of such a rare defect and highlight the salient points of all such previously reported cases to make aware the clinicians and paediatricians of need of early diagnosis and timely surgery/ referral for successful outcome. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=SD06-SD07&id=7318 https://doi.org/10.7860/JCDR/2016/.7318 Recurrent Primary Angiosarcoma of the Breast Presenting as Kasabach-Merritt Syndrome: A Case Report and Review of Literature Adithya Malolan, Prashanth Basappa Chowdary, Shivaswamy Badanaval Sadashivaiah Angiosarcoma of the breast is an unusual tumour. The diagnosis of this condition is difficult clinically, pathologically and radiologically. Treatment includes surgery followed by chemoradiation. The tumour is notorious for its recurrence and is generally associated with poor prognosis. Kasabach-Merritt syndrome also is a very rare entity seen primarily in infants with vascular malformations and carries a poor prognosis. In this report, the authors describe a patient with recurrent primary angiosarcoma of the breast, which presented as Kasabach-Merritt syndrome. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=XD04-XD07&id=7313 https://doi.org/10.7860/JCDR/2016/.7313 An Interesting Case of Non–Resolving Hepatogastric Fistula – An Unseen Cause Vinay G Zanwar, Sunil V Pawar, Pravir A Gambhire, Samit S Jain, Pravin M Rathi Hepatic tuberculosis presents one of the rare forms of extra-pulmonary tuberculosis. It is usually secondary to infection in the lung or the gut. Tuberculous liver abscess is the rarer manifestation even in endemic areas of Mycobacterium tuberculosis. Hepatogastric fistula secondary to tuberculous liver abscess has never been reported in literature. We herein report a case of a disseminated tuberculous liver abscess complicated by hepatogastric fistula, which posed a considerable diagnostic challenge. It was treated successfully with anti tubercular drugs. Liver abscess with atypical features and non responsive to antibiotics should raise the suspicious of tuberculosis or fungal infections. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=PD27-PD28&id=7301 https://doi.org/10.7860/JCDR/2016/.7301 Eccentric Training as an Adjunct to Rehabilitation Program for Hereditary Multiple Exostoses: A Case Report Zeynep Hazar Kanik, Gurkan Gunaydin, Ugur Sozlu, Seyit Citaker , Erdinc Esen Hereditary multiple exostoses an autosomal dominant skeletal disorder characterized by multiple cartilage-capped benign exostoses that typically occur in the metaphysis of long bones. The prevalence of hereditary multiple exostoses is estimated to be 1 in 50,000. Although, there have been many studies concerning this rare disorder, no research has yet examined the rehabilitation of hereditary multiple exostoses. The case diagnosed with hereditary multiple exostoses referred to our department with several complaints, namely pain, joint limitations, muscle weakness, and functional insufficiency after arthroscopic distal left femur exostoses excision. The aim of this case report was to present effectiveness of eccentric training as an adjunct to rehabilitation program for hereditary multiple exostoses. According to the results, eccentric training after arthroscopic exostoses excision may help reduce pain, increase range of motion, muscle strength, and functional levels in patients with hereditary multiple exostoses. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=YD03-YD04&id=7302 https://doi.org/10.7860/JCDR/2016/.7302 “Petrified Ears” in Secondary Adrenal Insufficiency Soumi k Goswami, Partha Pratim Chakraborty, Sayantan Ray, Sujoy Ghosh, Subhankar Chowdhury Petrification of the auricle, a rarely encountered clinical entity usually results from ectopic calcification of the auricular cartilages and manifests as rigid ear. The underlying pathogenesis remains ambiguous with several proposed hypotheses till date. Auricular calcification may be the sole cutaneous marker of underlying endocrinopathy at times. Adrenal insufficiency is the most common endocrinological disorder to be associated with such stiff ears and it has been described in both primary as well as secondary forms of the disease. We present here a 30-year-old man whose clinical condition deteriorated following levothyroxine supplementation and the presence of “petrified ears” ultimately provided a clue to the diagnosis of associated secondary adrenal insufficiency. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=OD23-OD24&id=7303 https://doi.org/10.7860/JCDR/2016/.7303 Vasculitis as a Presenting Manifestation of Chronic Hepatitis B Virus Infection: A Case Report Harpreet Singh, Vikram Singh Tanwar, Gagandeep Sukhija, Parminder Kaur, Nikhil Govil Hepatitis B virus is responsible for causing hepatic complications like acute and chronic hepatitis, cirrhosis and hepatocellular carcinoma along with some uncommon immune mediated extrahepatic manifestations. Vasculitis remains an uncommon extrahepatic complication of hepatitis B virus infection. Herein we report a case of hepatitis B infection that presented with leucocytoclastic vasculitis as an initial manifestation and managed successfully with entacavir therapy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=OD25-OD26&id=7304 https://doi.org/10.7860/JCDR/2016/.7304 Dioctophymiasis: A Rare Case Report Sapna Chauhan, Sunil Kaval, Swati Tewari Dioctophyma renale commonly known as “giant kidney worm’’ is found in the kidney of carnivorous mammals. Human infestation is rare, but results in destruction of the kidneys. Very few cases have been reported worldwide. We are here reporting a case of Dioctophymiasis in a 35-year-old male patient who presented with retention of urine and subsequent passage of worm and blood in urine. The worm was confirmed as Dioctophyma renale based on its morphology and clinical presentation. This is a very rare case report and to best of our knowledge only two cases have been reported from India. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=DD01-DD02&id=7305 https://doi.org/10.7860/JCDR/2016/.7305 Ovarian Vein Thrombosis Presenting as Acute Abdomen in Puerperium Flavia Sorbi, Luca Mannini, Martina Aldinucci, Viola Ghizzoni, Massimiliano Fambrini Postpartum Ovarian Vein Thrombosis (POVT) is a rare, but serious condition that causes slow quadrant pain in the postpartum period. POVT must be considered in the differential diagnosis of postpartum acute abdomen. We hereby report a case on a 36-year-old Italian woman who developed an acute abdomen a week after spontaneous vaginal delivery. She had persistent fever and constipation. Diagnosis of POVT was made with an abdominal Computed Tomography (CT) and treatment with heparin and broad-spectrum antibiotics were started. After 72 hours, the patient was switched from low molecular weight heparin to oral anticoagulant treatment. After 5 months a complete recanalization was demonstrated by abdomen CT and the treatment was stopped 6 months after diagnosis. POVT is a diagnosis of exclusion in the puerperium. This case illustrated that POVT may also occur in low risk patient. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=QD03-QD04&id=7306 https://doi.org/10.7860/JCDR/2016/.7306 Ingested Sharp Bone Fragment: An Unusual Cause of Acute Bowel Obstruction- Case Report Raju Rangaswamy, Samit Kumar Badai, Sadyojata M urugesan, Chabungbam Gyan Singh, Haobam Manihar Singh Acute bowel obstruction due to ingested foreign body (FB) like sharp bone fragment is a rare entity. As preoperative diagnosis was uncertain due to lack of proper history, diagnosis is usually done intraoperatively. Even though it is rare, we should consider it as differential diagnosis in patients with recent dietary history. Herein, we are reporting a 38-year-old man, without any psychiatric illness or previous surgery presenting to emergency department with the features of acute bowel obstruction. CT scan shows high density object in ileum suspicious of foreign body. Patient underwent exploratory laparatomy which reveals dilated small bowel with sharp bony object in ileum, which was retrieved with enterotomy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=PD25-PD26&id=7297 https://doi.org/10.7860/JCDR/2016/.7297 Forgotten Vaginal Foreign Body Presenting as Cervical Dystocia Sonia Chawla, Anshuja Singla, Charu Chandra, Swati Falodia Generally encountered in paediatrics age group, vaginal foreign body is a rare presentation in gynaecological clinics. Inserted as a part of sexual abuse, gratification or psychiatric disorder, these foreign bodies can present with a varied symptomatology. We report a case of 22-year-old female, a victim of domestic violence, who had a foreign body inserted in the vagina which was forgotten. Later it was discovered when she presented at term with cervical dystocia. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=QD01-QD02&id=7298 https://doi.org/10.7860/JCDR/2016/.7298 Schwannoma of the Submandibular Gland: A Rare Case Report Satish Kumar Ranjan, Mini Sinha, Amrisha Sharan, Vishnu Singh Munda, Preeti Usha, Sanjay Kumar Yadav Schwannoma is a slow growing, benign, encapsulated tumour of Schwann cells, which form myelin in peripheral nerves. It is the most common tumour of peripheral nerve, also known as neurilemoma or neurimoma. Schawannomas of head and neck area is common and may arise from peripheral, central or autonomic nerve but Salivary gland schwannomas are rare extracranial forms. We report a rare case of schawannoma of submandibular gland which presented with painless swelling in submandibular region, treated by total excision of submandibular gland. There was no postoperative nerve deficit or recurrence within 9 months of follow up. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=PD23-PD24&id=7293 https://doi.org/10.7860/JCDR/2016/.7293 Congenital Atresia of Wharton’s Duct Anne Hseu, Premchand Anne, Samantha Anne This is a case report of a three-month-old male who presented to clinic with a cystic lesion under the tongue. On clinical examination, a cystic lesion was observed in the, floor-of-mouth. The patient was referred to Paediatric Otorhinolaryngology service for further management. The differential diagnoses for floor-of-mouth lesions should be reviewed with primary focus on the Wharton’s duct atresia and its management. It is crucial to recognize submandibular duct atresia in the primary Paediatric clinic in order to expedite management of lesion before complications arise including infection, enlargement of cyst, and feeding and breathing difficulties. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=MD01-MD02&id=7279 https://doi.org/10.7860/JCDR/2016/.7279 Stewart Treves Syndrome in a Woman with Mastectomy Sevil Alan, Habibullah Aktas, Ömer, Faik Ersoy, Alpay Aktümen, Harun Erol Stewart Treves Syndrome is an angiosarcoma generally seen long time after radical mastectomy in breast carcinoma patients in chronic lymphoedema area. It's an angiosarcoma developed on a long standing lymphoedema, following a radical mastectomy. An 86-year-old woman was referred to our Dermatology outpatient clinic which developed a giant erythematous, oedematous, purplish lobulated plaque on her right forearm anteromedially with a few satellite erythematous papulonodules on her arm. The pathology revealed spindle-shaped tumour cells invading dermis with vascular differentiation into the subcutaneus tissue which are compatible with a diagnosis of angiosarcoma. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=WD01-WD02&id=7288 https://doi.org/10.7860/JCDR/2016/.7288 Synchronous Appearance of Adenocarcinoma and Gastrointestinal Stromal Tumour (GIST) of the Stomach: A Case Report Ramesh Babu Telugu, Magesh Pushparaj, Dipti Masih, Anna Pulimood Adenocarcinoma is the most common histological type of gastric tumour, accounting for approximately 95% of all gastric carcinomas. Gastrointestinal stromal tumours (GISTs) are rare mesenchymal neoplasms of the digestive tract. Synchronous adenocarcinoma and gastrointestinal stromal tumour (GIST) occurring in the stomach is rare and very few cases have been reported in literature. Synchronous tumours in the stomach are rarely diagnosed preoperatively. A 63-year-old gentleman was diagnosed with a gastric adenocarcinoma on endoscopic biopsy and underwent surgery. Postoperative histopathologic examination revealed 2 synchronous tumours with both adenocarcinoma and GIST. The adenocarcinoma was determined to be the aggressive tumour based on histologic features. GIST was categorized as a very low risk of malignancy, based on its size and mitosis. The patient underwent chemotherapy for adenocarcinoma. He is under follow up and is currently disease free. Careful histopathologic evaluation is required to detect co-existing rare synchronous tumours. Presence of the second tumour may require additional procedures or protocols. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ED16-ED18&id=7289 https://doi.org/10.7860/JCDR/2016/.7289 Hypertonic Dextrose Injection for The Treatment of a Baker's Cyst Ferdi Yavuz, Sibel Kibar, Birol Balaban We present extremely rare and interesting case of a Bakers cyst treated with hypertonic dextrose injection. A 54-year-old female patient had a Bakers cyst which was diagnosed by an ultrasonography. After the failure of the two-weekly conservative treatment, we injected hypertonic dextrose (25%) into her right knee joint for the treatment of a Bakers cyst. Two weeks after the injection, the patient reported improvement in posterior knee pain, and an US showed a resolution of the posterior knee cyst. Certainly hypertonic dextrose injection for the treatment of a Baker’s cyst appears to be a reasonable treatment option. Further studies are needed in order to elucidate the efficacy of hypertonic dextrose injection in the treatment of Baker s cysts. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=YD01-YD02&id=7290 https://doi.org/10.7860/JCDR/2016/.7290 Hydrocele of the Canal of Nuck (Female Hydrocele): A Rare Differential for Inguino-Labial Swelling Santanu Sarkar, Soumyajyoti Panja, Sandeep Kumar The inguinal canal is traversed by the spermatic cord in men and the round ligament of uterus in women. The round ligament is attached to the uterine cornu near the origin of fallopian tube at one end and to the ipsilateral labia majora at the other. The round ligament accompanies a pouch of parietal peritoneum in the inguinal canal, which is known as ‘canal of nuck’. It is analogous to the processus vaginalis in males. Incomplete obliteration of the peritoneal pouch causes indirect inguinal hernia or hydrocele of the canal of nuck; a very rare condition in women. As these types of cases are rarely seen in surgical practice we present a case of such little-known developmental disorder in a three-year-old girl. She presented with irreducible, tender right inguino-labial swelling with tachycardia simulating incarcerated inguinal hernia, which necessitates emergency surgical exploration. On exploration it was found to be an encysted hydrocele of canal of nuck; so although rare, this entity should be considered in differential diagnosis in a female child presented with inguino-labial swelling. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=PD21-PD22&id=7284 https://doi.org/10.7860/JCDR/2016/.7284 Gullo’s Syndrome: A Case Report Prabhat Kumar, Anindya Ghosh, Vaibhav Tandon, Ratnakar Sahoo Benign Pancreatic Hyperenzymemia (BPH) or Gullo’s Syndrome is a new entity with only few reported cases till date. It is characterized by persistently elevated pancreatic enzymes without any clinical or pathological evidence of pancreatic disease. Gullo’s syndrome is a diagnosis of exclusion and clinician should be aware of various other conditions which can cause elevation of pancreatic enzymes. There are no reported cases of Gullo’s syndrome from Indian subcontinent till date. A 42-year-old lady presented to us with complaints of fever and cough for which she was evaluated and diagnosed to be having left upper zone pneumonia. However, her routine investigations showed persistently elevated serum amylase and lipase levels. She was extensively worked up for pancreatic hyperenzymemia but no pancreatic disease was detected. She was followed up for a period of one year and raised levels of serum lipase and amylase persisted even after a year. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=OD21-OD22&id=7285 https://doi.org/10.7860/JCDR/2016/.7285 Persistent Mullerian Duct Syndrome with Ovarian Endometriosis- A Rare Case Report Savitri Mallikarjun Nerune, Surekha B. Hippargi, Namrata B.Mestri, Nikhil M.Mehrotra Persistent Mullerian Duct Syndrome (PMDS) is a rare form of internal male pseudohermaphroditism, characterised by presence of Mullerian duct derivatives in a genotypic and phenotypic male. It is caused by absence of anti- Mullerian hormone or defective functioning of its receptors. We report a case of 19-year-old cryptorchid male with history of orchideopexy who was clinically and radiologically diagnosed as left sided chylocele. A definitive diagnosis of PMDS with ovarian endometriosis was made on histopathological examination which is important for genetic counselling and to reduce complications like infertility and neoplastic transformation. We report this case of PMDS with ovary showing evidence of endometriosis for its rarity https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ED14-ED15&id=7266 https://doi.org/10.7860/JCDR/2016/.7266 A Case Report of Cornelia De Lange Syndrome in Northern Iran; A Clinical and Diagnostic Study Seyyed- Mohsen Hosseininejad, Behna Z Bazrafshan, Ehsan Alaee As a rare multisystem congenital anomaly disorder, Cornelia de Lange syndrome (CdLS) is featured by delayed growth and development, distinct facial dimorphism, limb malformations and multiple organ defects. CdLS is a genetic syndrome affecting 1/10000-1/60000 neonates with unknown genetic basis. Delayed growth and development, hirsute, structural anomalies of the limbs and distinct facial dimorphism are considered as its main clinical characteristics. Introducing CdLS cases of different ethnic backgrounds could add distinctions to the phenotypic picture of the syndrome and be useful in diagnosis. Early diagnosis and decreased death rates are achievable through enhanced awareness on this syndrome. We present here a 45-day-old girl, as the first case of Cornelia in Golestan (Northern Iran), referred to our hospital with the symptoms as mentioned above. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=SD03-SD05&id=7267 https://doi.org/10.7860/JCDR/2016/.7267 Japanese Encephalitis Complicated with Obstructive Hydrocephalus Vivek suman, Ujjawal Roy, Ajay Panwar, Alpana Raizada Japanese Encephalitis (JE), caused by Japanese encephalitis virus (JEV), a flavi-virus, is the most significant aetiology of arboviral encephalitis worldwide. It has resulted in epidemics of encephalitis in the Indian subcontinent. Here, we report a case of 36-year-old female who presented with a short history of fever and headache followed by altered sensorium. Funduscopic examination revealed Papilloedema. Pyogenic or viral meningoencephalitis along with complicated malaria were kept as initial differential diagnosis. Magnetic Resonance Imaging (MRI) of brain revealed involvement of posterior limb of internal capsule and bilateral thalami in the form of haemorrhagic encephalitis along with obstructive hydrocephalus. Cerebro Spinal Fluid (CSF) serology (IgM ELISA) showed JE as the causative agent. Despite extensive literature search, we could not find a case of JE reported with hydrocephalus as a complication. This case highlights the typical and atypical features of JE including imaging findings and exemplifies the way, how diversely JE can present and would thus help in preparing management paradigms accordingly. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=OD18-OD20&id=7274 https://doi.org/10.7860/JCDR/2016/.7274 Metastatic Collision Tumour (Papillary Thyroid Carcinoma and Squamous Cell Carcinoma) in Cervical Lymph Nodes: An Immunohistochemical Analysis Alshimaa Mahmoud Alhanafy, Dalia Al-Sharaky, Asmaa Gaber Abdou, Rania Abdallah Abdallah Collision tumours are a rare entity, in this report, we describe a case of 73-year-old woman presented with a rapid enlargement of left upper cervical lymph node (LN) associated with right thyroid nodular goiter. The histopathological examination of the excised LN showed definite areas of papillary thyroid carcinoma admixed with moderately differentiated squamous cell carcinoma (SCC). Thyroglobulin immunostaining was positive in papillary carcinomatous areas confirming thyroid gland as a source of metastasis. Then the patient underwent total thyroidectomy and neck dissection, which revealed multicentric classic papillary thyroid carcinoma with an absence of squamous differentiation on extensive sampling. The patient received adjuvant radioactive iodine, but the neck swelling was rapidly progressing, ulcerated and infected. Computed tomography (CT) revealed left large cervical amalgamated LN and two metastatic lung nodules, the patient received 2 cycles of chemotherapy and was planned for external beam radiotherapy but she died within 7 months of first presentation. Collision tumours pose a diagnostic as well as therapeutic challenge and carry a rapidly progressive course and a fatal outcome. SCC is considered as a dedifferentiation of papillary thyroid carcinoma, which may appear in metastatic site rather than the primary site. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ED11-ED13&id=7263 https://doi.org/10.7860/JCDR/2016/.7263 Malignant Proliferative Trichilemmal Tumour of The Nape of The Neck – A Case Report Alagar Raja Durairaj, Surya Rao Rao Venkata Mahipathy, Thanga Thirupathi Rajan Vivavakaran, Volga Harikrishnan, Muthuvel Esakki Proliferating trichilemmal tumours are benign but locally aggressive tumours arising from the hair follicle. They are biologically benign lesions, but may be locally aggressive. They are generally solitary lesion and commonly occurring in the scalp of elderly women. Malignant transformation has been known to occur but very rarely. Here we report a rare case of a recurrent malignant trichilemmal tumour of the scalp in a middle aged male which was surgically excised. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=PD19-PD20&id=7258 https://doi.org/10.7860/JCDR/2016/.7258 Spindle Cell Carcinoma of the Mandibular Gingiva – A Case Report Sangeeta R. Patankar, Pratyusha P. Gaonkar, Prachi R. Bhandare, Nidhi Tripathi, Gokul Sridharan Spindle cell carcinoma is a malignancy of epithelial origin often mimicking its mesenchymal counterpart thus posing a diagnostic challenge. It is a rare biphasic malignant tumour mostly encountered in the upper aerodigestive tract. The chief differential diagnoses of spindle cell carcinoma are true superficial sarcomas and they especially need to be differentiated from fibrosarcoma. This presentation reports a spindle cell carcinoma of the gingiva and highlights the difficulties encountered in the diagnosis. It also emphasizes the importance of accurate and thorough diagnosis of malignant spindle cell lesions to determine the appropriate therapeutic modality. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ZD08-ZD10&id=7261 https://doi.org/10.7860/JCDR/2016/.7261 Necessity is the Mother of Invention Ramanand Prasad Sinha, Shivani Rakesh Kothari, Ashok Suryakant Thakkar A well executed transseptal puncture is crucial for successful percutaneous transvenous mitral balloon valvotomy. We report a case of accidentally damaged Mullins sheath dilator. Due to immediate unavailability of another dilator at cardiac catheterization laboratory, angioplasty guidewire and balloon was used as an additional assisting armamentarium for successful percutaneous transvenous mitral balloon valvotomy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=OD14-OD15&id=7232 https://doi.org/10.7860/JCDR/2016/.7232 The Extensor Indicis Brevis – A Rare Variation and Its Significance Rohini Arathala, P.K. Sankaran, Gunapriya Ragunath, Soma Sri Harsha, Tharani Sree Sugumar Variations in muscle attachments are valuable in interpreting rare clinical conditions. This case report discusses about the abnormal extensor indicis muscle attachment in left hand of male cadaver and its clinical relevance. The extensor indicis muscle was arising from lunate carpal bone and posterior radiocarpal ligament which further continued as short belly and had its distal attachment on the proximal phalanx of the index finger. This muscular variation has been described in earlier studies with 1.0% incidence. Abnormal origin of extensor indicis may be associated with pain and swelling at the back of the hand. This pain may be confused with other clinical conditions like synovial cyst and ganglion. Knowledge of such rare variations are useful to clinicians, surgeons, occupational and physical therapists for planning better surgical decisions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=AD03-AD04&id=7255 https://doi.org/10.7860/JCDR/2016/.7255 Autotransplantation of a Buccally Erupted Matured Mandibular Third Molar to Replace a Grossly Decayed Second Molar Sukhwant Singh Yadav, Ranjeet Bodh, Aishvarya Kaushik, Sangeeta Talwar Autotransplantation can be a treatment option for tooth loss as an alternative to fixed or implant-supported prostheses. It has predictable results comparable to implants, with reported success rates often greater than 90%. In present case, buccally erupted matured third molar was autotransplanted in extraction socket of grossly carious mandibular second molar. The tooth was splinted for 1 week followed by root canal treatment. After 12 months follow up, tooth was in perfect state of function and aesthetic with healthy periapical and periodontal architecture. High success rate was found in immature tooth transplantation in previous case reports. This case report describes that even matured tooth can also be used as donor if atraumatic extraction is possible and endodontic treatment is well performed. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ZD06-ZD07&id=7256 https://doi.org/10.7860/JCDR/2016/.7256 A Neonatal Septic Arthritis Case Caused by Klebsiella pneumoniae: A Case Report Tamer Ozsari, Gülhan Bora, Özmert M.A Ozdemir, Ilknur Kiliç Septic arthritis is encountered very rarely during the neonatal period and its diagnosis can delay because of atypical symptoms, thus it may lead to serious sequelae. The sequale can be prevented by early diagnosis and concomitant treatment. In neonates, pain can be experienced as a result of pseudoparalysis and of movement of the effected joints. A 17-day-old neonatal patient was brought to our hospital with complaint of unrest and then diagnosed with septic arthritis due to propagation of Klebsiella pneumoniae in joint fluid culture was represented because of the rarity of such a case. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=SD01-SD02&id=7230 https://doi.org/10.7860/JCDR/2016/.7230 Mixed Germ Cell Tumour in an Infertile Male Having Unilateral Cryptorchidism: A Rare Case Report Anand Singla, Navneet Kaur, Gunjeet Sandhu, Rupesh Nagori Mixed germ cell tumours with multiple components occur more frequently than the pure varieties of germ cell tumours. Embryonal carcinoma and teratoma together form the most common components of the mixed germ cell tumour but the yolk sac tumour is usually seen as a minor component in patients presenting with mixed germ cell tumour. We report a rare case of 27-year-old Hepatitis C positive male presenting with pain in left lower abdomen with associated history of same sided undescended testis and infertility. Right sided testis lying in scrotal sac appeared normal on ultrasonography but patient was azoospermic. He had raised levels of serum markers, alpha feto protein and beta HCG. Examination showed a large mass in left lower abdomen involving the sigmoid colon with the absence of left testis in left scrotum which was confirmed on CT scan. Excision of the mass was done and histopathology examination revealed it as a malignant mixed germ cell tumour composed predominantly of a yolk sac tumour, with minor component as seminoma and embryonal carcinoma in an undescended testis. Following this, the level of serum markers came down. The patient is now undergoing adjuvant chemotherapy and is doing well. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=PD17-PD18&id=7238 https://doi.org/10.7860/JCDR/2016/.7238 Embryonal Hepatoblastoma with Co-existent Glycogen Storage Disease in a Seven-month-old Child Nadia Shirazi, Brahma Prakash Kalra, Nowneet Kumar Bhat, Sanobar Wasim Hepatoblastoma is an uncommon malignant liver tumour diagnosed usually during the first three years of life. It presents as abdominal mass with elevated alpha fetoprotein levels. The definite diagnosis requires histopathological confirmation. Although conditions like Familial Adenomatous Polyposis (FAP) or Beckwith-Wiedman Syndrome may be associated with hepatoblastomas, storage disorders are uncommonly documented. We describe a rare case of hepatoblastoma with co-existent glycogen storage disease in an infant male who presented with a progressively increasing mass in abdomen along with failure to thrive. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ED09-ED10&id=7239 https://doi.org/10.7860/JCDR/2016/.7239 Acute Myoclonic Jerk Terminated by A Simple Procedure – A Case Report Manigandan Gopi, Aashish Arumugam Myoclonic jerks are brief involuntary twitching of a muscle or a group of muscles. It is a medical sign and not a diagnosis of a disease. It occurs in number of secondary conditions like hepatic failure, renal failure, dyselectrolytaemia, etc in addition to the physiologic, epileptic, essential and psychogenic causes. Myoclonic jerks secondary to uraemia usually occur in the end stage renal failure and is resolved by renal replacement therapy. Here we report a case of uremic myoclonic jerk presented to our emergency department which occurred secondary to obstructive uropathy secondary to neurogenic bladder caused by old traumatic paraparesis and it was resolved by simple and timely intervention by bladder catheterization and it prevented the patient from going into uremic encephalopathy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=OD16-OD17&id=7240 https://doi.org/10.7860/JCDR/2016/.7240 Sialocele of Parotid Duct: Report of Case with Review of Literature Ravleen Nagi, Yashoda Bhoomi Reddy Kantharaj, Rakesh Nagaraju, Sujatha Janardhan Reddy Parotid duct sialocele is a salivary cavity arising at the expense of parotid duct. Facial trauma is the most common cause of this rare condition. If left untreated, a sialocele may develop into a significantly large facial swelling. Fistula formation may occur, often draining extraorally. We report a case of Parotid duct sialocele that was assessed by sialography and ultrasonogarphy and was managed by placement of intraductal cannula for fifteen days till duct was found patent. We also discuss various treatment options of this condition in this case report. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ZD04-ZD05&id=7224 https://doi.org/10.7860/JCDR/2016/.7224 Endodontic Management of a Mandibular Incisor Exhibiting Concurrence of Fusion, Talon Cusp and Dens Invaginatus using CBCT as a Diagnostic Aid Ruchi Juneja, Varun Kumar Teeth with aberrant anatomy present a challenge to the endodontist. Advanced tools like cone beam computed tomography aid in exploring the details of endodontic architecture in such cases. The aim of this case report is to highlight the advantage of CBCT in endodontic management of teeth with multiple dental anomalies. A mandibular lateral incisor associated with an extraoral sinus tract revealed unusual clinical anatomy. A provisional diagnosis of type III dens in dente was made based on radiographic findings. Considering the complex anatomy, CBCT was advised to get a confirmatory diagnosis. The anatomic details revealed by CBCT differed significantly from the provisional diagnosis. A final diagnosis of concurrence of fusion with a supernumerary tooth, talon cusp and type II dens invaginatus was established and endodontic treatment of the concerned tooth was carried out. Non-surgical endodontic treatment resulted in successful resolution of the sinus tract and healing of the periapical lesion. CBCT, thus proves to be an excellent diagnostic tool for management of teeth with unusual anatomy, paving way for a conservative treatment free of endodontic mishaps. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ZD01-ZD03&id=7222 https://doi.org/10.7860/JCDR/2016/.7222 Non-Functional Paraganglioma of the Urinary Bladder Treated by Transurethral Resection: Report of Two Cases Richa Katiyar, Saloni Dwivedi, Sameer Trivedi, Shashikant C.U. Patne, Uday Shankar Dwivedi Paraganglioma of the urinary bladder is a rare tumour derived from chromaffin tissue of the sympathetic nervous system. Paraganglioma of the urinary bladder especially the non-functional type is often misdiagnosed as urothelial cancer. Two female patients aged 32 years and 45 years presented with painless haematuria without any symptoms of catecholamine excess. Radiological investigations revealed urinary bladder tumour. The tumour was removed by transurethral resection in both the patients. Histopathological diagnosis was paraganglioma, which was confirmed by immunohistochemistry. Complete resection of tumour by transurethral approach is curative in paraganglioma of the urinary bladder. We hereby, also discuss the salient features of nonfunctional paraganglioma of the urinary bladder. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=XD01-XD03&id=7219 https://doi.org/10.7860/JCDR/2016/.7219 Paget’s Disease of Nipple in Male Breast with Cancer Murali Uthamalingam, Karthikkumaran Periyasamy Carcinoma of the male breast accounts for less than 0.5% of all cases of breast cancer. However, Paget’s disease of nipple in male is extremely rare. We report on a case of Paget’s disease of nipple with breast cancer in a 51-year-old gentleman. He presented with a ulcerative lesion and lump in the left breast beneath the nipple-areolar region with single mobile ipsilateral central group of axillary nodes. Modified radical mastectomy was performed. On follow up, patient was doing well with no recurrence. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=PD14-PD16&id=7217 https://doi.org/10.7860/JCDR/2016/.7217 Bifurcated Bicipital Aponeurosis Giving Origin to Flexor and Extensor Muscles of the Forearm – A Case Report Satheesha B Nayak, Ravindra S Swamy, Prakashchandra Shetty, Prasad A Maloor, Melanie R Dsouza Bicipital aponeurosis is usually attached to the antebrachial fascia on the medial side of forearm and to posterior border of ulna assisting in the supination of the forearm along with biceps brachii muscle. Variations in the bicipital aponeurosis may lead to neurovascular compression as reported earlier. In the present case, the bicipital aponeurosis had two slips i.e. medial and lateral. Medial slip gave origin to some fibers of pronator teres and flexor carpi radialis and the lateral slip gave origin to some fibers of brachioradialis. Such unusual slips of bicipital aponeurosis may distribute the stress concentration and may work in different directions affecting the supination of forearm by biceps brachii muscle and bicipital aponeurosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=AD01-AD02&id=7215 https://doi.org/10.7860/JCDR/2016/.7215 Primary Spindle Cell Malignant Melanoma of Esophagus: An Unusual Finding Nirmalkumar A. Rawandale, Kishor H. Suryawanshi Malignant melanoma of esophagus is usually a metastatic tumour rather than a primary tumour. Primary malignant melanoma accounts for less than 0.2% of all esophageal neoplasm. We report a case of primary spindle cell malignant melanoma of esophagus in a 69-year-old male who presented with history of dysphagia since 1 month. Radiological examinations revealed polypoidal growth at lateral aspect of esophagus. Biopsy was reported as grade III squamous cell carcinoma. Video assisted thoracoscopic esophagectomy was performed. Histopathological examination along with immunohistochemistry gave confirmed diagnosis of primary spindle cell malignant melanoma of esophagus. Though a rare entity, due to its aggressive nature and poor prognosis primary malignant melanoma should be one of the differential diagnoses in a patient with polypoidal esophageal mass lesion. Despite radical surgical treatment prognosis is extremely poor. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=OD03-OD04&id=7188 https://doi.org/10.7860/JCDR/2016/.7188 Bladder Endometriosis Mimicking TCC – A Case Report Asish Gupta, Atul Bhatnagar, B N Seth, Arbinder Dang, Vineeta Gupta Endometriosis is the ectopic presence of endometrial tissue outside the uterus. Though on its own endometriosis is not a rare lesion, the involvement of the urinary tract is rare but with the bladder being the most commonly affected organ. Endometriosis is usually seen in females between the ages of 30-40 years and may occur due to fluctuating levels of oestrogen and progesterone. Clinically the patient maybe asymptomatic or show symptoms of dysmenorrhea, irregular or heavy periods, pain in the pelvic area, lower abdomen or in the back. It has been suggested that ultrasonography should be done either before or during menstruation as the lesion becomes more evident and a biopsy taken during this period is a strong aid in reaching a final diagnosis. We report here an unusual case of bladder endometriosis where the patient came with severe pelvic pain and an endoluminal mass seen on the ultrasonographic report. Based on these findings a differential of transitional cell carcinoma was given which was ruled out based on the cystoscopic findings. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=PD12-PD13&id=7213 https://doi.org/10.7860/JCDR/2016/.7213 Purple Urine Bag Syndrome- An Alarming Situation M S Faridi, Md Jawaid Rahman, Naloh Mibang, N Shantajit, Khumukchum Somarendra Purple urine bag syndrome (PUBS) is an uncommon condition that occurs mainly in chronically catheterized patient and associated with urinary tract infection. It is characterised by purple discolouration of urine bag which leads to significant stress and anxiety to patient, care takers and health workers, so awareness regarding this condition is of utmost importance. In our report, an old gentleman with Benign Prostate Hyperplasia (BPH) on per urethral catheter (PUC) with past history of recurrent urinary tract infection developed burning micturition of urine with purple discoloration of urine bag. After proper antibiotic and catheter changed, discoloration subsided. In India, as life expectancy and geriatric care is improving, more patients are on PUC for various diseases. So, the incidence of PUBS will increase and awareness is required about the condition and its management. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=PD05-PD06&id=7209 https://doi.org/10.7860/JCDR/2016/.7209 Left Sided Appendicitis: Once Burned Twice Shy Christos Kaselas, Ioannis Spyridakis, Dimitrios Patoulias, Paschalis Tsioulas, Ioannis Patoulias Acute appendicitis is one of the most common surgical conditions that are diagnosed in children presenting with acute abdominal pain in the emergency department. An atypical presentation of symptoms is encountered in 30% of cases. Atypical localization of the appendix as in left sided appendicitis, although rare, has an increased risk of missed or delayed diagnosis. We present two consecutive cases of left sided appendicitis in order to describe how increased awareness in the second case helped us to avoid pitfalls in the management and diagnosis of this atypical and variant condition. Increased cautiousness and awareness of left sided appendicitis can assist emergency physicians to avoid pitfalls in the management and diagnosis of this atypical and variant condition. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=PD07-PD09&id=7210 https://doi.org/10.7860/JCDR/2016/.7210 Gastric Trichobezoar with Rapunzel Syndrome: A Case Report Anoop Dixit, Mohd Arshad Raza, Rohit Tiwari Bezoars are collections of non-digestible matter that usually accumulates in stomach and can extend to small bowel. Trichobezoars (concretions of hair) are unusual and are usually found in young psychiatric females, who often deny eating their own hair (trichophagy). We are presenting a case of gastric trichobezoar with a long thin tail in a 20 years young female with a history of trichophagia. Patient was managed by exploratory laparotomy and anterior gastrotomy. Postoperatively she recovered well and was discharged in satisfactory condition with advice for psychiatric follow-up. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=PD10-PD11&id=7211 https://doi.org/10.7860/JCDR/2016/.7211 Fever with Rash, an Alarm to the Physicians - A Case Report of Atypical Measles Prabhakaran Raman, Syed Bahavudeen Hussaini, Paramasivam Saravanan, Kuttuva Jeyaram Measles is a highly contagious disease caused by Paramyxovirus group. It has been estimated that globally deaths occurs out of measles. The disease still remains as one of the leading cause of death among young children and adults despite the effective vaccination. The outbreak of measles is on rise in recent years with serologically confirmed cases in India. The incidence and complications of atypical measles is usually severe among older age groups even prior immunization. We report a case of 15-year-old male with symptoms of fever and rash with possible differential diagnosis and emphasize on the clinical presentation of atypical measles among adolescent age group with an additional evidence of investigations. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=OD12-OD13&id=7206 https://doi.org/10.7860/JCDR/2016/.7206 Exchange Transfusion in Severe Falciparum Malaria Harshad Chandrakant Dongare, Khalid Ismail Khatib Malaria is endemic in India with the incidence of P. falciparum Malaria increasing gradually over the last decade. Severe malaria is an acute disease, caused by P. falciparum, but increasingly also by P. vivax with major signs of organ dysfunction and/or high levels of parasitaemia (>10%) in blood smear. Use of exchange transfusion with antimalarial drug therapy as an additional modality of treatment in severe Falciparum malaria is controversial and is unclear. We report a case of severe malaria complicated by multiorgan failure and ARDS. Patient responded well to manual exchange transfusion with standard artesunate-based chemotherapy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=OD05-OD06&id=7190 https://doi.org/10.7860/JCDR/2016/.7190 An Unusual ST Elevation in a Case of Left Atrial Myxoma Nikunj Vyas, Ravi Ghatanatti, Amrutraj Nerlikar, Mohan Gan, Mahadev Dixit Myxomas are the most common and potentially dangerous benign tumours of the heart. They may have either smooth or papillary surfaces and may have thrombus adherent. As both the papillary excrescences and the surface thrombi are friable in nature hence may undergo embolization. We report a case of left atrial myxoma, which underwent excision of the tumour for mitral valve obstructive features. In the immediate postoperative period patient developed ST elevation in lead II, III and aVF. Coronary angiogram revealed normal coronary pattern. Patient was treated with aspirin, heparin and IABP for 48 hours and recovered well. We conclude that there is a tendency for spontaneous recanalization of the obstructed coronary vessels by tumour emboli, hence patient can be managed conservatively. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=PD01-PD02&id=7176 https://doi.org/10.7860/JCDR/2016/.7176 Natural Killer Cell Lymphoma: A Case with Classification Dilemma Ankit Kumar Jitani, Yookarin Khonglah, Ritesh Kumar, Bidyut Bikash Gogoi, Ekta Jajodia Non-Hodgkins lymphoma of the Natural Killer (NK) cell type is rare. World Health Organisation recognises 3 NK-cell phenotypic entities; extranodal NK/T cell lymphoma, nasal type (ENK/TL); aggressive NK cell leukaemia (ANKL); and chronic lymphoproliferative disorders of NK cells (CLPD-NK) which is classified as a provisional entity. Though specific clinical, morphological and immunophenotypic criteria have been laid down to diagnose these conditions there may however, be considerable variations in the clinical presentation making diagnosis difficult. We present a case with contrasting clinical and haematopathological findings posing difficulty in its diagnosis and classification, and despite the aggressive presentation showing favourable response to treatment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ED07-ED08&id=7177 https://doi.org/10.7860/JCDR/2016/.7177 Paraquat Poisoning: A Case Report Harish Kumar, Veer Bahadur Singh, Babu Lal Meena, Subhash Gaur, Rahul Singla Paraquat is commonly used herbicide by farmers in North West Rajasthan. Despite its easy availability, poisoning of its not common. Fatal dose of paraquat is so small that >10 ml poison can damage lungs permanently. Diagnosis is often difficult without proper history, absence of specific clinical feature and lack of diagnostic test. Inhalation exposures represent one of the most important routes of poisoning. We are reporting a case of inhaled paraquat poisoning with complication of irreversible acute kidney, liver and lung injury. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=OD10-OD11&id=7204 https://doi.org/10.7860/JCDR/2016/.7204 Spinal Anaesthesia is Safe in a Patient with Wolff-Parkinson-White Syndrome Undergoing Evacuation of Molar Pregnancy Pravalika Deviseti, Vinayak S Pujari Wolff-Parkinson-White (WPW) syndrome is an uncommon cardiac condition where there is an abnormal band of atrial tissue connecting atria and ventricles which can electrically bypass atrioventricular node. The anaesthetic management in these patients is challenging as life threatening complications can occur perioperatively like paroxysmal supraventricular tachycardia and atrial fibrillation. Also, regional anaesthetic technique like subarachnoid block is a safe and cost effective alternative to general anaesthesia as it avoids polypharmacy. We report the successful anaesthetic management of Wolff Parkinson White syndrome in a primi with hydatiform mole posted for suction and evacuation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=UD01-UD02&id=7182 https://doi.org/10.7860/JCDR/2016/.7182 Acute Exercise-Induced Compartment Syndrome of the Leg- Don’t Miss It Manish Dewangan, Manish Kumar Khare, Sumanta Mishra, Jogesh Chandra Marhual Acute exercise induced compartment syndrome of leg is a very rare and very oftenly missed entity which leads to delay in its management. We are presenting such case in which diagnosis was established two days after the onset of symptoms. Urgent decompressive fasciotomy was done. After 3 months of follow up, patient has got full functional recovery of his affected limb. This case highlights the importance of keeping high index of clinical suspicion to diagnose the problem and manage promptly. We have reviewed the English literature and found only about 40 cases since 1945. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=PD03-PD04&id=7183 https://doi.org/10.7860/JCDR/2016/.7183 Primary Axillary Porocarcinoma: A Rare Cutaneous Tumour Nalli. R. Sumitra Devi, K. Valarmathi, Mary Lilly, Selvi Satish, Nidhi Mishra Eccrine porocarcinoma, a rare cutaneous malignant tumour accounts for a fraction of sweat gland tumours. This tumour is found to originate from the intraepithelial parts of the sweat glands. It commonly involves the lower extremities in elderly patients and carries an aggressive behaviour. Cutaneous and visceral metastasis can occur and hence prompt treatment is mandatory. Surgical excision is the mainstay of treatment modality. We hereby present a case of eccrine porocarcinoma in a 50-year-old male in the right axillary region presenting as a verrucous lesion. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ED04-ED06&id=7171 https://doi.org/10.7860/JCDR/2016/.7171 Unraveling the Mystery Behind A Patient with ‘Refractory Seizures’ Mithun Jacob Varghese, Anadaroop Lahiri, Vipin Kumar, Devi A Manuel, Oommen K George Neurological manifestations such as seizures although rare are well recognized presentations of cardiac arrhythmias. Almost always, such events are primarily generalized in nature leading on to loss of consciousness. Rarely however, cardiac seizures can manifest with focal neurological events. We report a case of a sexagenarian who presented with recurrent focal seizures with secondary generalization, who was misdiagnosed and treated as seizure disorder; only a careful history and focussed investigations helped in realising a precise diagnosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=OD01-OD02&id=7174 https://doi.org/10.7860/JCDR/2016/.7174 Juvenile Granulosa Cell Tumour: Anaplastic Variant with Omental Deposits Anuradha C.K. Rao, Manjari Kishore, Vidya Monappa Juvenile Granulosa Cell Tumour (JGCT) of ovary represents a small fraction of all primary ovarian malignancies. It is a subtype of granulosa cell tumour that is almost always found during the first three decades of life. Histologically, it differs from the typical adult type of granulosa cell tumour. It accounts for 5-15% of all granulosa cell tumours, majority being unilateral. Herein, we describe an unusual histopathological variant of JGCT with numerous large cystic spaces, anaplasia and focal syncytiotrophoblast like giant cells. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ED01-ED03&id=7168 https://doi.org/10.7860/JCDR/2016/.7168 Use of Complementary and Alternative Medicine among Osteoarthritic Patients: A Review Muhammad Umair Khan, Shazia Qasim Jamshed, Akram Ahmad, Mohd Ashraf Bin Ahmad Bidin, Mohammad Jamshed Siddiqui, Abdul Kareem Al-Shami <b>Introduction:</b> One of the most important indications of complementary and alternative medicines (CAM) is in arthritis. The popularity of CAM in arthritis is consistently on the rise because of the potential side effects of the conventional therapy (Methotrexate) of arthritis. In view of this, it was important to summarize the information, for healthcare professionals and the patients, about the safety and effectiveness of various CAM use in arthritis. <b>Materials and Methods:</b> This comprehensive review is based on the content derived through a thorough literature search using 5 electronic databases such as Science direct, Springer link, PubMed, Jet P and Google scholar. Equivalent terms in thesauruses or Medical Subject Heading (MeSH) browsers were used whenever possible. We included all the articles those are used CAM medications for the treatment of arthritis around the globe and searched for the required articles published in English in peer reviewed journals from January 1999 to February 2014. Reports were then arranged and analysed on the basis of country specific studies. <b>Results:</b> Initially, a total of 156 articles were retrieved, after further screening, 27 articles were selected according to meet objectives of the study and those articles which did not qualify, were excluded. Seventeen appropriate studies were finally included in the review. Indeed most of the studies that fulfilled the objective of this review were carried out in US (n=8, 47%), then in India (n=2, 11.76%), UK (n=1, 5.88%), Canada (n=1, 5.88%), Australia (n=1, 5.88%), Korea (n=1, 5.88%), Thailand (n=1, 5.88%), Turkey (n=1, 5.88%) and Malaysia (n=1, 5.88%). <b>Conclusion:</b> The review revealed that family, friend, past experiences and lack of effectiveness of conventional therapy are the major factors that influenced patients’ decision of initiating and persisting with CAM therapy. The review highlighted the need to conduct future studies by using some more specific health related outcome measures. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=JE01-JE06&id=7169 https://doi.org/10.7860/JCDR/2016/.7169 Association of Genital Infections Other Than Human Papillomavirus with Pre-Invasive and Invasive Cervical Neoplasia Ishita Ghosh, Ranajit Mandal, Pratip Kundu, Jaydip Biswas Human papillomavirus (HPV) is a well-established causative agent of malignancy of the female genital tract and a common Sexually Transmitted Infection. The probable co-factors that prevent spontaneous clearance of HPV and progression to neoplasia are genital tract infections from organisms like Chlamydia, Trichomonas vaginalis etc, smoking, nutritional deficiencies and multiparity. Inflammatory conditions can lead to pre-neoplastic manifestations in the cervical epithelium; however their specific role in cervical carcinogenesis is not yet established. Therefore it is imperative to study the likely association between HPV and co-infection with various common pathogens in the genital tract of women having cervical precancer or cancer. A “Pubmed” search was made for articles in Literature on this topic using the words: Cervical neoplasia, HPV, co-infections, Cervical Intraepithelial Neoplasia (CIN), Trichomonas vaginalis, Candida, Chlamydia and the relevant information obtained was used to draft the review. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=XE01-XE06&id=7173 https://doi.org/10.7860/JCDR/2016/.7173 Rehabilitation of Glossectomy Cases with Tongue Prosthesis: A Literature Review Muthu kumar Balasubramaniam, Ahila Singaravel Chidambaranathan, Gokul Shanmugam, Rajdeep Tah Tongue is the only movable muscular organ without any bone in the human body. It has very important role in perception of taste and sensations like touch, pressure, heat and cold. The purpose of the article is to review various types of tongue prosthesis and their clinical applications. This review helps the clinician to choose the appropriate type of tongue prosthesis for different clinical situations, retention of tongue prosthesis and material selection for each type of prosthesis. A broad search of published literature was performed using the keyword glossectomy, glossal prosthesis and tongue prosthesis from 1980 to 2014 in Medline, Google scholar, internet and text book. This review gives basic knowledge of glossal prosthesis and selection of the same for various clinical conditions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ZE01-ZE04&id=7184 https://doi.org/10.7860/JCDR/2016/.7184 Paediatric Geographic Tongue: A Case Report, Review and Recent Updates Doddabasavaiah Basavapur Nandini, Shivanand Bagalad Bhavana, Byathnal Suryakanth Deepak, Ramakrishna Ashwini Geographic tongue is a benign recurrent condition of uncertain aetiology affecting the tongue characterized by loss of epithelium especially filiform papillae giving a characteristic appearance. The clinical presentation may vary from asymptomatic to painful and burning ulceration. The condition is commonly seen in adults but few cases are reported in children. A case of asymptomatic geographic tongue in three-year-old male child and literature review with new insight in aetiology is presented here. Management depends on the clinical condition and underlying aetiology. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ZE05-ZE09&id=7191 https://doi.org/10.7860/JCDR/2016/.7191 Natural Micronized Progesterone Sustained Release (SR) and Luteal Phase: Role Redefined!! Sonia Malik, Korukonda Krishnaprasad Role of progesterone in reproductive medicine is evolving with its suggested clinical role for the hormonal and nonhormonal actions in reproductive medicine. The main function of progesterone is to induce ’secretory’ changes in endometrium that is further complimented by its immunomodulatory and anti-inflammatory actions. It positively modulates PIBF, NK cells and HOXA 10 genes for better implantation. MHRA recommends Serum Progesterone levels =14ng/ml in the mid-luteal phase for supporting pregnancy adequately. Oral Natural Micronized Progesterone SR formulation represents a therapeutic advance in this direction offering ‘therapeutic compliance’ with oral formulation while avoiding the local side effects related to long-term patient compliance in reproductive disorders. The formulation offers round the clock efficiency and efficacy with single dose administration thereby improving patient convenience and compliance. This formulation has been marketed globally since 1986 utilizing the well validated drug delivery system involving Methylcellulose base. The clinical utility of this formulation is further suggested especially in various conditions related with luteal phase insufficiency and Bad obstetric history (BOH) or luteal phase support in ART. The level of evidence has been quite robust with several clinical studies including Prescription Event Monitoring and Investigator initiated studies supporting the clinical role of oral NMP SR formulation especially in ‘Real world’ clinic settings for Luteal phase insufficiency that may be physiological or iatrogenic. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=QE01-QE04&id=7212 https://doi.org/10.7860/JCDR/2016/.7212 Medical Management of Oral Lichen Planus: A Systematic Review Swetha Singh Suresh, Krunal Chokshi, Sachin Desai, Rahul Malu, Achala Chokshi <b>Introduction:</b> Oral Lichen Planus (OLP) is a chronic inflammatory, T-cell-mediated autoimmune oral mucosal disease with unclear aetiology. The clinical management of OLP poses considerable difficulties to the oral physician. <b>Aim:</b> The aim was to assess the efficacy of any form of intervention used to medically manage OLP. <b>Materials and Methods:</b> We searched and analysed the following databases (from January 1990 to December 2014):- Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. All Randomised Controlled Trials (RCTs) for the medical management of OLP which compared active treatment with placebo or between active treatments were considered in this systematic review. Participants of any age, gender or race having symptomatic OLP (including mixed forms), unconnected to any identifiable cause (e.g. lichenoid drug reactions) and confirmed by histopathology have been included. Interventions of all types, including topical treatments or systemic drugs of variable dosage, duration & frequency of delivery have been considered. All the trials identified were appraised by five review authors and the data for all the trials were synthesised using specifically designed data extraction form. Binary data has been presented as risk ratios (RR) with 95% confidence intervals (CI) and continuous data as mean differences (MD) with 95% CIs. <b>Results:</b> A total of 35 RCTs were included in this systematic review on medical management of OLP. No strong evidence suggesting superiority of any specific intervention in reducing pain and clinical signs of OLP were shown by the RCTs included here. <b>Conclusion:</b> Future RCTs on a larger scale, adopting standardized outcome assessing parameters should be considered. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ZE10-ZE15&id=7225 https://doi.org/10.7860/JCDR/2016/.7225 State of Science, “Intuition in Nursing Practice”: A Systematic Review Study Parkhide Hassani, Alireza Abdi, Rostam Jalali <b>Introduction:</b> There were many attempts for introducing “intuition” to nursing practice, But despite the efficacy, it has been ignored as a valid way of knowing. Therefore the current study was conducted for evaluating the state of sciences to intuition in nursing practice. <b>Materials and Methods:</b> In a systematic review study, all researches, published from 1995 to 2014, were searched in the databases of “PubMed”, using “intuition” and “nursing” keywords. The abstract of articles were read in scrutiny, then the related researches selected, thereafter the full text of them was assessed carefully. <b>Results:</b> From searching the databases, 144 articles with “intuition and nursing” were found, 53 as original research, and 15 with inclusion criteria were selected. Most of the studies had qualitative approaches design as phenomenology (N=4), content analyses (N=2) and grounded theory (N=1), six was done for developing the instrument, and two studies have been conducted as descriptive method. <b>Conclusion:</b> The results revealed the researches about intuition in nursing mostly were conducted with qualitative and instrument developing methodology and there is a lack of quantitative and trial studies. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=JE07-JE11&id=7260 https://doi.org/10.7860/JCDR/2016/.7260 The Need for Patient Follow-up Strategies to Confirm Diabetes Mellitus in Large Scale Opportunistic Screening A.K. Savitha, S. Gopalakrishnan, R. Umadevi, R. Rama Diabetes mellitus is a metabolic disorder characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both. Type 2 (non–insulin dependent) Diabetes mellitus is one of the preventable non communicable disease resulting in increased morbidity and mortality in developing countries like India. It is characterized by disorders of insulin action and/or insulin secretion. Number of people with Type 2 Diabetes is growing rapidly worldwide with economic development, ageing populations, increasing urbanisation, dietary changes, reduced physical activity and lifestyle changes. The global prevalence of diabetes is 9%, while in India it is 8.63% and in Tamil Nadu it is 10.4%. National and State programmes on Diabetes control are implemented to combat the disease burden. A detailed review of the programme modules, operational guidelines and visit to health facilities were done to understand the implementation process related to control of Diabetes mellitus. As part of these programmes, opportunistic screening is implemented for target population. Though these programmes are unique, there are few lacunae identified which are missing opportunities and time consuming. There are no strategies so far in such programmes to make the screened positive cases to undergo confirmatory tests. Since screening is only opportunistic, the screened positive cases can be subjected to undergo confirmatory tests by different methods. The specified roles and responsibilities of health staffs at various levels to ensure follow up should also be framed and followed. The objective of this article is to review the existing strategies and to suggest the need for follow up pathways to be adopted from the first contact level to the level of final confirmation for better compliance. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=LE01-LE04&id=7314 https://doi.org/10.7860/JCDR/2016/.7314 Automated Triplex (HBV, HCV and HIV) NAT Assay Systems for Blood Screening in India Manoj Kumar Rajput This review is confined to triplex nucleic acid testing (NAT) assays to be used on fully automated platform. Around the world, these assays are being used at various transfusion medicine centres or blood banks to screen blood units for HBV, HCV and HIV. These assay systems can screen up to 1000 blood units for HBV, HCV and HIV simultaneously in a day. This area has been dominated by mainly two manufacturers: M/s Gen-Probe-Novartis and M/s Roche Molecular Systems. The triplex NAT assay systems of both manufacturers are licensed by United States Food and Drug Administration. There is not much awareness about the technology and procedures used in these assays. The main objective of this review is to create awareness about the technology and procedure of these assays. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=KE01-KE04&id=7319 https://doi.org/10.7860/JCDR/2016/.7319 Haematopoietic, Antioxidant and Membrane Stabilizing Property of Diallyl Disulphide in Irradiated Mice Yogish Somayaji Tenkanidiyoor, Vidya Vasudeva, Shama Rao, Damodara Gowda, Chandrika Rao, Ganesh Sanjeev, Suchetha Kumari Nalilu <b>Introduction:</b> Diallyl disulphide is an organo-sulphur compound which is present in garlic and responsible for the characteristic odor of garlic. It is known for its anticancer and invitro membrane stabilizing properties. <b>Aim:</b> The main aim was to evaluate the haematopoietic, antioxidant and membrane stabilizing property of diallyl disulfide in irradiated mice. <b>Materials and Methods:</b> Mice were grouped into 6 groups as control, drug control, radiation control and drug pre-treatment groups (i.e. drug administration + radiation group) The mice were fed orally for 15 consecutive days and on the 15th day, one hour after drug administration, the mice were irradiated with 6Gy electron beam radiation. The changes in blood cell count, total antioxidant levels, malondialdehyde and reduced glutathione levels were determined. The immunomodulatory response of DADS to the radiological effects was determined by the estimation of IL-6 levels. <b>Results:</b> A significant improvement in pre-drug treatment group when compared to control groups in the haemoglobin, red blood cell count, white blood cell count, haematocrit and platelet counts was observed. There is an increased level of interleukin-6 in the drug treated groups compared to the radiation control. An increase in the malondialdehyde levels and decrease in the glutathione levels in the irradiated group indicate increased lipid peroxidation and oxidative stress, whereas, there is a significant reduction in the malondialdehyde levels and increased glutathione levels in the drug pre-treatment groups showing membrane stabilization. <b>Conclusion:</b> Thus DADS proves to be an effective haematopoietic and antioxidative agent to counter radiation induced haematopoietic suppression and oxidative stress. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=BF01-BF05&id=7246 https://doi.org/10.7860/JCDR/2016/.7246 Odontogenic Myxoma of Mandible: Report of A Rare Case Amita Aditya, Pragun Khandelwal, Shruti Joshi, Sahil Trimbake, Rahul Dighe https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ZJ01-ZJ02&id=7227 https://doi.org/10.7860/JCDR/2016/.7227 Hammer in the Heart on Coronary Angiography Naresh Monigari, Rohith Poondru, Hashir Kareem, Tom Devasia https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=OJ01-&id=7241 https://doi.org/10.7860/JCDR/2016/.7241 A Rare Association of Bilateral and Unilateral Masseter Hypertrophy with Hypertrophy of Pterygoids Vijaya Kamble, Kajal Mitra https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=TJ03-TJ04&id=7187 https://doi.org/10.7860/JCDR/2016/.7187 A Co-Presentation of Biliary Ascariasis and Hepatic Hydatidosis Rajaram Sharma, Amit Kumar Dey, Nikunj Khatri, Hemangini Thakkar https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=TJ01-TJ02&id=7170 https://doi.org/10.7860/JCDR/2016/.7170 Implant – Supported Full Mouth Rehabilitation: A Guided Surgical and Prosthetic Protocol Segin Chandran, Nasil Sakkir https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ZJ05-ZJ06&id=7264 https://doi.org/10.7860/JCDR/2016/.7264 Images in Medicine: Triplicated Primary Anterior Teeth - A Report of Two Cases Deepti Thakkar, Jatinder Kaur Dhillon, Mridula Goswami https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ZJ03-ZJ04&id=7253 https://doi.org/10.7860/JCDR/2016/.7253 Malaria and Typhoid Coinfection: Need to Interpret Serological Results Cautiously Monika Matlani, Bhavna Sharma, Rajni Gaind https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=DL01-&id=7257 https://doi.org/10.7860/JCDR/2016/.7257 A Case Report of Chorea Associated with Hyperthyroidism Blerim Arifi, Sorab Gupta, Shorabh Sharma, Aswani Daraboina, Shradha Ahuja https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=PL01-&id=7277 https://doi.org/10.7860/JCDR/2016/.7277 A Girl with No Pain: Congenital Insensitivity To Pain and Anhidrosis (HSAN) Type IV - A Case Report Neena Indavara Eregowda, Sneha Yadav, Poornima Parameshwarappa, Roopa korishettar Basavraj https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ZL01-ZL02&id=7317 https://doi.org/10.7860/JCDR/2016/.7317 Awareness about Research Ethics among General Practitioners not Attached with Research Institutions Subramanian Kavitha, Govindarajan Sumitra, Durairaj Vijaya, Marudachalam Kavitha, Subramanian Bhuvaneshwari https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=BL01-&id=7307 https://doi.org/10.7860/JCDR/2016/.7307 Correction: 2015 October: 9(10)): JB01-JB05 <b>Aarti Garg, Sunanda Das, Hemant Jain</b>, Why We Say No! A Look Through the Editor’s Eye” . (Published in Journal of Clinical and Diagnostic Research. 2015 October: 9(10)): JB01-JB05. In this article a change has been done in the reference enlisted number 25. <b>Correction:</b> Bazdaric K, Bilic-Zulle L, Brumini G, Petrovecki M. Prevalance of plagiarism in recent submission to Croatian medical journal. Sci Eng Ethics.2012; 18(2):223-39. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ZZ01-&id=7514 https://doi.org/10.7860/JCDR/2016/.7514 Correction: 2015 May: 9(5)): DC06-DC10. <b>Priyadarshi Soumyaranjan Sahu, Shubhransu Patro, Payod Kumar Jena, Santosh Kumar Swain, Bidyut Kumar Das</b>,Imaging and Serological-Evidence of Neurocysticercosis Among Patients with Seizures in Odisha, an Unexplored Eastern Coastal Province in India (Published in Journal of Clinical and Diagnostic Research. 2015 May: 9(5)): DC06-DC10. In this article a change has been done in abstract. There was typo error in value under results section of abstract.The percentage now is corrected to 28.12%. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&month=February&volume=10&issue=2&page=ZZ02-&id=7515 https://doi.org/10.7860/JCDR/2016/.7515