Journal of clinical and diagnostic research https://www.jcdr.net/back_issues.asp JCDR Unilateral Connation of Primary Mandibular Lateral Incisor and Canine Associated with Missing Succedaneous Teeth: Report of a Rare Case in Siblings Umapathy Thimmegowda, Pavana Mysore Parameshwara, Navin Hadadi Krishnamurthy, Naveena Preethi Connation is one of the developmental anomalies of the dental hard tissue. The terms such as double formation, double teeth, twinned teeth, synodontia, joined teeth, or fused teeth are often used to describe connation. Connation can be defined as union of two normally separated tooth germs typically leading to one tooth less than normal in the affected arch. It may be complete or incomplete. Connation in siblings are rare and probably show a hereditary aetiology. Here, we report two cases of unilateral connation of primary mandibular incisor and canine associated with missing succedaneous permanent lateral incisor in siblings along with their diagnosis and management. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=ZD01-ZD03&id=10922 https://doi.org/10.7860/JCDR/2017/29325.10922 Extra-adrenal Myelolipoma: Tumour at an Unusual Site BR Yelikar, K Mamatha, Abhey Chawla, Neha Kathpal A myelolipoma is a rare, well circumscribed, benign tumour composed of mature adipose and haematopoietic tissue. Classical location is adrenal gland but extra-adrenal cases are also reported in the presacral region, liver, mediastinum, perirenal, stomach with most common site being the presacral area. Only few cases of extra-adrenal myelolipoma have been reported in literature till now with an incidence of 14% of all myelolipomas. Differential diagnosis includes liposarcoma, teratoma, and extramedullary haematopoiesis. Histopathological diagnosis plays a major role in confirmation but also requires concordance of CT, MRI, and Guided biopsy. Extra-adrenal myelolipomas are very rare and their presence and location can be easily confused with malignant tumour. We present this case in a 54-year-old male with mass per abdomen and weight loss since one year. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=ED01-ED02&id=10935 https://doi.org/10.7860/JCDR/2017/30916.10935 Co-existence of <i>Wuchereria bancrofti</i> Microfilaraemia in a Case of Multiple Myeloma: An Incidental Finding or an Association? Sonam Sharma, Rahul Mannan, Rachit Sharma, Sansar Chand Sharma Filariasis is a global health problem which is endemic in tropical and subtropical regions of Asia, Central and South America and Pacific island nations. The most common parasite causing lymphatic filariasis in India is Wuchereria bancrofti, the microfilariae of which has been detected incidentally in fine needle aspirates and aspirated body fluids. However, its presence in bone marrow aspirates is quite uncommon and that too in co-existence with a haematological malignancy. We report one such extremely rare case of Wuchereria bancrofti microfilaraemia in a multiple myeloma patient, which is second case to be documented in the world literature to the best of our knowledge. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=ED06-ED08&id=10940 https://doi.org/10.7860/JCDR/2017/32300.10940 Knot of Henry: Role in Tendon Transfer Parul Kaushal, Aritra Banerjee, Pushpa Dhar The term “Master knot of Henry” refers to the site of cross connections between long (extrinsic) tendons of foot namely Flexor Digitorum Longus Tendon (FDLT) and Flexor Hallucis Longus Tendon (FHLT). This chiasmatic structure in the second layer of sole, was first described by Henry in 1940. Over the years it has gained importance because of its close association with surgical procedures such as ‘Tendon Transfers’, whereby insertion of a muscle-tendon unit is relocated at another site for restoration of lost function. The demand for these surgical procedures is constantly increasing in parallel with increasing number of irreparable nerve injuries, spinal cord injuries and road traffic accidents etc. Both FDLT and FHLT are identified as potential tendon transfer candidates and variations of cross connections between FDLT and FHLT at Henry’s knot have been reported. In the majority of cases, slips proceeding from FHLT to FDLT have been observed. However, we observed the presence of two variant tendinous slips extending from the FDLT to FHLT, one lying proximal and the other distal to the chiasmatic crossover, in left foot of a male cadaver. Awareness regarding possible variations with context to the cross pattern at the knot could be the determining factor in deciding about the preferential tendon transfer candidate with maximal preservation of functioning of hallux as well as other little digits. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=AD01-AD02&id=10974 https://doi.org/10.7860/JCDR/2017/30192.10974 Solitary Intramammary Plexiform Schwannoma Mimicking Phyllodes Tumour on Cytology Shveta, Kiran Agarwal, Ankita Sharma Plexiform schwannoma is a rare subtype of schwannoma with no case reported in the breast to the best of our knowledge. We report a case of intramammary plexiform schwannoma in a 20-year-old female which was diagnosed as Phyllodes tumour on cytology. Marginal resection is curative. This diagnosis show be kept in mind when reporting on Fine Needle Aspirates of stromal lesions of breast. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=ED17-ED18&id=10975 https://doi.org/10.7860/JCDR/2017/31553.10975 Colloid Cyst – A Small Third Ventricle Cyst with Unusual Psammomatous Calcifications Sadaf Khan, Manna Valiathan We report a case of a colloid cyst in the foramen of Monro, with an unusual finding of psammomatous calcifications. Colloid cysts of the third ventricle with calcifications in the wall are very rare. Colloid cysts are benign, slowly progressing lesions that most often arise from the roof of the anterior third of the ventricle along the foramen of Monro, account for almost 0.5-2% of all intracranial neoplasms, ranging from 1 to 3 cm in diameter and contain intraluminal homogenous mucoid or semi-solid colloid like material. Few cases have also been reported in septum pellucidum and fourth ventricle. They are usually incidentally discovered or can cause repeated attacks of worsening headache, syncope, memory loss and visual disturbances. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=ED19-ED21&id=10977 https://doi.org/10.7860/JCDR/2017/34015.10977 Idiosyncratic Liver Injury due to Rivaroxaban Aneesh Cherakulam Ratheendran, Mukund A Prabhu, KU Natarajan, Saritha Sekhar Rivaroxaban is an oral direct factor Xa inhibitor that has been used for the primary and secondary prophylaxis of thromboembolic disorders. Once daily dosing makes it an attractive alternative when compared to other Novel Oral Anticoagulants (NOACS). Although, major and minor bleeding manifestations are commonly associated with rivaroxaban, hepatotoxicity has also been mentioned in the literature as a possible adverse effect. We report a case of drug induced liver injury in a 29-year-old male patient who was started on rivaroxaban for prophylaxis following an episode of Pulmonary Thromboembolism (PTE). There was a strong temporal relationship between the onset of symptoms and drug exposure in our case and the association was further validated by standard criteria. Roussel Uclaf Causality Assessment Method (RUCAM) score of 7 suggests rivaroxaban as the ‘probable’ culprit for drug induced liver injury in the present case. The temporal association of starting rivaroxaban and onset of symptoms along with elevated liver enzymes and bilirubin is a strong point in favour of drug induced liver injury due to rivaroxaban. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=OD08-OD09&id=11001 https://doi.org/10.7860/JCDR/2017/30329.11001 Solitary Giant Osteoma of Mandible Poonam Sagar, Kirti Jain, Shyama Jain, Ramanuj Bansal Osteomas are benign osteogenic tumours characterised by the proliferation of compact, cancellous or mixed bone. Mandible is an uncommon site for solitary osteoma. Osteomas usually occur as asymptomatic swelling but may cause significant concern due to their size, problem during mastication or even sleep disturbance. Osteomas can be a part of Gardener’s syndrome, which is characterised by the multiple colonic polyposis which have high incidence of malignant degeneration. We report a case of solitary giant osteoma of mandible in 30-year-old male who presented with large swelling of lower jaw since two years. In the present case, osteoma had both extraosseous and intraosseous component that involved lower border and body of the mandible. Excision was done using oscillating saw preserving the alveolar margin of the mandible. Mandibular reinforcement was done with titanium plates. In the present case, syndromic association was ruled out with colonoscopic examination. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=MD04-MD06&id=11011 https://doi.org/10.7860/JCDR/2017/29220.11011 Intestinal Sinonasal Adenocarcinoma with Distinct Immunophenotype Monika Sharma, Sabina Khan, Shaan Khetrapal, Sujata Jetley, Abhinav Jain Sinonasal adenocarcinomas are uncommon tumours accounting for 3% of all malignant tumours of the head and neck. They often present with symptoms of chronic nasal obstruction and recurrent epistaxis in patients with middle age to older age group. We report a case of intestinal sinonasal adenocarcinoma in a 60-year-old male which posed a diagnostic challenge due to its rarity, uncommon radiological presentation and distinct immunophenotype. Our results demonstrate that there exists a subset of intestinal sinonasal adenocarcinoma that is CK7-/CK20+. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=ED24-ED25&id=11014 https://doi.org/10.7860/JCDR/2017/31819.11014 A Rare Case of Ulceronodular Cutaneous Metastases from Nasopharyngeal Carcinoma Richa Chauhan, Naveen Kuna, Vinita Trivedi, Rita Rani, Usha Singh, Vasudha Singh Nasopharyngeal cancer is a rare cancer in most part of the world, but commonly seen in natives of southern China, Southeast Asia, the Arctic, and the Middle East/North Africa. It is sensitive to radiotherapy and chemotherapy and is usually treated by chemoradiation. It is highly predisposed to nodal and distant metastasis. Still, cutaneous metastasis is rarely seen. Here in this report, we present the case of nasopharyngeal carcinoma with an ulceronodular type of cutaneous metastasis, presenting six years after the initial diagnosis without any visceral metastases. Another feature noted in our patient was the sensitivity to low dose radiotherapy both for bulky primary disease which was progressive on 5Fluorouracil (5FU) and cisplatin based chemotherapy, and subsequent metastases. Theoretically, skin metastases can occur through spread via dermal lymphatics or when the pulmonary filtration is bypassed via the vertebral venous system and Batson’s plexus allowing skin implantation. Further, resistance to chemotherapy and high sensitivity to radiation suggests heterogeneity among nasopharyngeal cancers with intrinsic molecular subtype. The good response of metastatic disease to short course radiation suggests that patients with cutaneous and nodal metastases without visceral metastases could be aggressively treated and the patient can have a good quality of life. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=XD06-XD08&id=11016 https://doi.org/10.7860/JCDR/2017/32832.11016 Focal Reactive Overgrowths: Case Series with Review of Literature Sagar J Shah, Uma Vasant Datar, Pooja Pharne, Sampada Shriram Kanitkar, Mamata Kamat Focal Reactive Overgrowths (FROGs) are commonly occurring mucosal lesions in oral cavity. FROGs include Focal Fibrous Hyperplasia (FFH), Pyogenic Granuloma (PG), Peripheral Ossifying Fibroma (POF) and Peripheral Giant Cell Granuloma (PGCG). These overgrowths comprise of lesions that are essentially a response to a low-grade stimulus. These lesions have similar clinical and biological behaviour but differ in their histogenesis and histopathological features. Despite the differences, the treatment of all the lesions is essentially the same i.e., efficient plaque control, removal of aetiological factors and conservative excision of the tissue. Though, recurrence rate of these lesions is low, follow up is imperative. Few peripheral odontogenic tumours, benign and malignant epithelial and connective tissue tumours may imitate FROGs clinically. Hence, it is necessary that clinicians have adequate knowledge about FROGs so as to differentiate them from other lesions. Herein, we present a series of eight cases of FROGs, highlighting their clinicopathological features along with a brief review of literature. The aim of this paper is to further the knowledge of FROGs amongst the clinicians. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=ZR01-ZR04&id=11018 https://doi.org/10.7860/JCDR/2017/30261.11018 Inflammatory Myofibroblastic Tumour –An Unusual Tumour with Intermediate Malignant Potential– Report of Three Cases Indusarath, Sangeetha K Nayanar, Nizamudheen M Pareekutty, B Satheesan, Satheesh Babu Inflammatory Myofibroblastic Tumour (IMT) is a rare mesenchymal neoplasm of borderline malignancy. It is characterised by proliferation of myofibroblasts and fibroblasts with variable amount of inflammatory infiltrate. About 50-60% of the cases show Anaplastic Lymphoma Kinase (ALK) rearrangements. The recurrence rate and metastasis depends on the anatomic site, resectability, size and presence of ALK rearrangements. In this case series, we are presenting three cases diagnosed as IMT. All the patients were elderly. Sites included abdomen, subcutaneous tissue over scapula and orbit. Scapular lesion presented as recurrence in six months after first excision. All three cases were ALK negative. IMTs that occur in elderly persons can mimic malignancy. Surgical excision is the treatment of choice. Diagnosis depends on histopathological features and immunohistochemical examination. Correct histological diagnosis is crucial for further management. Chance of recurrence and metastasis is more in abdominopelvic location, large size and ALK negativity. This case series aims to create awareness of the non-specific presentation of this tumour and need of follow up as this tumour may recur in a very short interval. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=ER01-ER03&id=11008 https://doi.org/10.7860/JCDR/2017/32212.11008 Colonic Arteriovenous Malformation in a Child with Klippel Trenaunay Weber Syndrome Suneel Mundkur, Sandeep Kumar, Shrikiran Aroor, Adel Moideen https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=SL01-&id=10923 https://doi.org/10.7860/JCDR/2017/30925.10923 Influence of Storage Time and Cementation Strategies on Push-Out Bond Strength of Fiber Posts to Root Dentin Ravi Chandra Ravi, Jyothi Mandava, Uma Chalasani, Roopesh Borugadda, Mohan Rao Boddeda, Md Ghazanfaruddin <b>Introduction:</b> The restoration of structurally compromised endodontically treated teeth pose most challenging adhesive restorative procedure and controversies still exist about which material or technique are best for their restoration. <b>Aim: </b>To evaluate the push-out bond strength of two fiber post systems luted with self-etch adhesive after phosphoric acid conditioning of the root dentin at two different storage periods. <b>Materials and Methods:</b> Eighty mandibular premolars with single straight canals, decoronated at cementoenamel junction were endodontically treated and post spaces of 8 mm were prepared. Root samples were randomly divided into two groups; Groups 1 and 2 (n=40 each) according to the storage period and four subgroups (n=10 each) depending on the type of fiber post (subgroups A and C: glass fiber posts, B and D: carbon fiber posts) cemented. In subgroups A and B, fiber posts were luted with self-adhesive (Rely X U200) cement. In C and D subgroups, 37% phosphoric acid etching of the root dentin was done prior to cementation of the posts. After one month and 12 months storage period, uniform root slices were obtained for all the specimens with the help of a diamond saw and the slices were subjected to push-out test. The results were analysed with two-way ANOVA and Tukey’s multiple post-hoc test. <b>Results:</b> The 37% phosphoric acid etching significantly improved the bond strength of fiber posts luted with self-adhesive resin (p<0.05) cement. Storage time significantly influenced the bond strength (p<0.05). The statistically significant difference was found between the type of posts tested, glass fiber posts exhibited better push-out bond strength compared to carbon fiber posts. Among the prepared post space regions lowest bond strength was observed in apical thirds. <b>Conclusion: </b>Post space conditioning with 37% phosphoric acid prior to cementation could improve the bond strength of fiber posts luted with self-adhesive cements. Both storage time and location within the post space significantly influenced the push-out bond strength. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=ZC05-ZC08&id=10924 https://doi.org/10.7860/JCDR/2017/29866.10924 Budesonide Nasal Douching: An Effective Method in Postoperative AFRS Management Neena Chaudhary, Shashank Gupta, Rajeev Kumar Verma, Santosha Ram Choudhary <b>Introduction:</b> The aim of management of Allergic Fungal Rhinosinusitis (AFRS) is to control the disease process and the local immune response of the nasal mucosa. This is achieved by a two pronged approach – surgical clearance of all sinuses by Functional Endoscopic Sinus Surgery (FESS) followed by suppression of local immune response using steroids. Recently delivery of topical steroid by way of douching has been introduced. The effect of budesonide in management of postoperative AFRS patients is yet to be studied. <b>Aim: </b>To evaluate the role of budesonide nasal douching in postoperative management of AFRS. <b>Materials and Methods:</b> A total of 60 postoperative AFRS patients were randomly divided into two groups. Both groups received routine post Functional Endoscopic Sinus Surgery (FESS) medication as per the institute protocol. One group of patients received budesonide douching in addition to the routine care. Both groups were evaluated endoscopically at one, two and six weeks post op. Pre and postoperative quality of life change, patient complains, need for revision surgery and endoscopic Kupferberg scoring were used to compare the two postoperative groups. <b>Results: </b>The average preoperative Sino-Nasal Outcome Test 22 (SNOT-22) score was 50.2. It was reduced to an average of 29.6 in patients who used the standard postoperative regimen and to 19.8 postoperatively in patients who had budesonide added to their douching solutions. The average Kupferberg score was 1.2 for patients who did receive budesonide as compared to 1.9 for patients who did not receive budesonide douching. <b>Conclusion:</b> Budesonide douching can offer a safe and effective tool in managing local inflammatory response in AFRS. It leads to a significantly better quality of life and has an effective response on nasal mucosa – leading to lesser mucosal oedema and lesser incidence of polypoidal changes postoperatively. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=MC01-MC03&id=10925 https://doi.org/10.7860/JCDR/2017/28412.10925 Barriers to Stroke Thrombolysis Ajay Panwar, Madhavarao Veeramalla, Chandrasekhar Valupadas, Kurimilla Ramesh Mohammed Owais, Rohini Muriki <b>Introduction: </b>Thrombolytic therapy with intravenous recombinant tissue plasminogen activator (rt-PA) is the cornerstone of acute ischaemic stroke treatment. The number of stroke patients receiving thrombolytic therapy in India has improved over the recent years. However, Warangal despite being the second largest city in Telangana, witnesses stroke thrombolysis infrequently. <b>Aim: </b>To study the factors which prevent stroke thrombolysis at a tertiary care center in Warangal. <b>Materials and Methods:</b> The study was undertaken at Kakatiya Medical College (KMC) and its associate Mahatma Gandhi Memorial Hospital (MGMH), from October 2016 to March 2017. The study subjects were recruited from the patients presenting to medical emergency or neurology outpatient department (OPD).We enrolled the consecutive ischaemic stroke patients who presented within three days of the symptoms onset and fulfilled the inclusion and exclusion criteria for thrombolysis as defined by the National Institute of Neurological Disorders and Stroke (NINDS) rt-PA study group. We included the patients arriving after time window for thrombolysis, so as to study the causes associated with pre-hospital delay. Thrombolysis therapy was given within four and a half hours of the stroke onset. <b>Results: </b>Among a total of 223 study subjects, only 13 (5.8%) arrived within the time window for rt-PA infusion and nine (4%) received thrombolytic therapy. The pre-hospital delay was the single most important constraint for providing timely stroke treatment. ‘Lack of awareness of patients and their relatives to recognize stroke as a medical emergency’ and ‘lack of awareness about thrombolysis’ were the most important factors associated with the pre-hospital delay. Non-affordability and in-hospital delays were the barriers for successful stroke treatment among the patients who presented to the medical emergency on time and could not get thrombolytic therapy. <b>Conclusion: </b>The results of our study suggest the need for a comprehensive stroke care program at our health center to escalate the rate of thrombolytic therapy. Stroke education and awareness modules should be incorporated in the stroke program. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=OC01-OC05&id=10919 https://doi.org/10.7860/JCDR/2017/31815.10919 Spinal Anaesthesia for Quicker Recovery in Fast-Track Abdominal Hysterectomy Jyothi Shetty, KS Shilpa Gupta, Adithya Shetty, Ujjawala Singh, HD Arun Kumar, Deeksha Pandey <b>Introduction:</b> Fast-track approach during hysterectomy has revolutionized the postoperative recovery. In this study we tried to analyse the effect of one more component (spinal anaesthesia versus general anaesthesia) during hysterectomy for benign gynaecological conditions to further hasten the postoperative recovery and thus evolve the concept. <b>Aim:</b> To compare recovery among those who receive spinal anaesthesia versus those who receive general anaesthesia during fast tract abdominal hysterectomy. <b>Materials and Methods:</b> A total of 97 women were recruited who were planned for hysterectomy for benign conditions and agreed to follow the fast-track protocol. Forty six consented for spinal anaesthesia (three cases were excluded later) and 51 for general anaesthesia. Fast-track protocol was followed that included preoperative counselling, and no preoperative sedation. Postoperatively all patients were monitored for pain, vomiting, drowsiness and fatigue. Early oral intake and ambulation was encouraged. Postoperative events and complications as well as duration of hospital stay were compared among the two groups. Differences in continuous variables were analysed with student’s t-test for normally distributed data and the Mann-Whitney U Test for skewed data. Pain score was analysed by repeated measures of ANOVA. <b>Results:</b> Mean operating time in spinal anaesthesia group, was much less (92.72+23.61 minutes) than in general anaesthesia group (124.20+33.61 minutes), the difference being statistically significant (p<0.001). Mean blood loss was also less in spinal anaesthesia group (298.14+61.34 ml versus 404.90+110.57 ml; p<0.001). Women in this group could be started on oral fluids earlier, had less vomiting and fatigue postoperatively, and passed motion earlier. Duration of hospital stay was not found to be much different between the groups. However, patients who were in the spinal anaesthesia resumed their routine activities earlier (15.47+2.77 versus 18.55+4.25 days; p<0.001). We also noted an interesting finding yet undiscussed in the literature that general anaesthesia group had more than 2.5 times higher incidence of postoperative cough which has the potential to influence postoperative recovery following any abdominal surgery. <b>Conclusion:</b> Spinal anaesthesia should be considered in cases that are planned for hysterectomy under fast-track setting to optimise the results. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=QC01-QC04&id=10920 https://doi.org/10.7860/JCDR/2017/28884.10920 Assessment of Marginal Integrity of Proximal Composite Resin Restorations Performed with or without Magnification Pallavi Reddy, Vallari Jain, Mamta Kaushik, Roshni, Neha Mehra, Ritu Rana, Mona Yadav <b>Introduction:</b> Composite resins are the most frequently used direct tooth coloured restorative materials. Their use in the posterior teeth has increased because of their improved mechanical performance and wear resistance. However, marginal leakage is one of the major concerns for composite failures especially in the gingival margins of posterior teeth which leads to subsequent failure of the restoration. So, under magnification good integrity can be ensured by maintaining the ergonomics. <b>Aim:</b> To compare the effect of magnification on the marginal integrity of proximal composite resin restorations. <b>Materials and Methods:</b> Non-bevelled proximal slots (4.1x4x2.5) mm were prepared on the mesial surfaces of extracted mandibular first molars (N=40) for this in vitro study conducted over a period of one week in the Department of Conservative Dentistry and Endodontics at Army College of Dental Sciences, Secunderabad, Telangana, India. The teeth were randomly divided into two groups (n=20) based on the use of magnification: Group1, direct vision and Group 2, magnification with dental operating microscope. After establishing proximal contacts, the slots were restored with composite resin (Tetric N-Ceram, Ivoclar Vivadent, Mumbai, India) using a sectional matrix system (Palodent Plus Sectional Matrix System Kit, Dentsply, Caulk, US). The margins were analysed using an environmental Scanning Electron Microscope (SEM). The data was statistically analysed using Kruskal–Wallis and Mann–Whitney U tests (p<0.05). <b>Results:</b> Indicate that the difference in marginal quality of gingival margin was significantly influenced by magnified vision when compared with unaided direct vision (p<0.05). However, the difference was not statistically significant between the groups in relation to buccal and lingual margins. Within the groups, Group 1 showed a higher percentage of gaps in gingival margins as compared to buccal and lingual margins. Whereas, in Group 2, the marginal gaps in both lingual and gingival margins were higher than buccal margins. <b>Conclusion:</b> The marginal integrity of proximal composite restorations can be improved when performed under magnification. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=ZC01-ZC04&id=10921 https://doi.org/10.7860/JCDR/2017/29860.10921 Associations of Maternal Serum Zonulin and Elements Concentrations with Neonatal Birth Weight: A Case-Control Study Seyed Ahmad Hosseini, Omid Kiani Ghalesardi, Zahra Kamaei, Shekoofeh Aghili, Damoon Ashtary-Larky, Seyed Saheb Hoseininejad, Matin Ghanavati, Meysam Alipour <b>Introduction:</b> Intake of micronutrients and zonulin levels (as a marker for intestinal permeability) during pregnancy can be effective on birth weight of infants. However, no studies have investigated the relationship between the infants birth weight and maternal zonulin level. <b>Aim:</b> This study aimed to compare the zonulin levels and maternal trace elements in infants with low birth weight (LBW) and Normal Birth Weight (NBW) and its relationship between the Level of zonulin and maternal elements with weight, length and head circumference of infants. <b>Materials and Methods:</b> In this study, 368 infants were divided into two groups: case (n=82) with birth weight of <2500 gm and control (n=286) with birth weight of =2500 gm. Maternal zonulin, zinc, calcium, copper and iron levels were evaluated. Weight, length and head circumference of infants were measured. The maternal serum level zonulin and micronutrients between the two groups were assessed using Student t-test or Chi-squared test and the relationship between variables using Spearman’s rank correlation. <b>Results:</b> A significant difference was seen in the maternal zonulin and zinc serum levels between the LBW and the NBW infants (P <0.05). No significant difference was observed in the calcium, copper, and iron levels between the two groups. A significant positive relationship was seen between maternal serum zonulin and zinc concentration with the birth weight of the LBW infants (respectively r=0.45 and r=0.41) (P <0.05). No relationship was seen between maternal serum zonulin and zinc concentration with the length and head circumference of the infants. <b>Conclusion:</b> The results showed that the maternal serum Zn level is associated with the infants birth weight. In addition, intestinal permeability, as a new factor could affect the birth weight and birth rate of the LBW infants. Further studies in this area are recommended. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=SC01-SC04&id=10936 https://doi.org/10.7860/JCDR/2017/27820.10936 Varied Clinico-haematological Presentation of Patients of Megaloblastic Anaemia with Deficiency of Vitamin B12 and Folic Acid in a Tertiary Care Center of Northern India Amreen Brown, Nishi Tandon, Syed Riaz Mehdi, Zeba Siddiqui <b>Introduction:</b> Megaloblastic anaemia is caused by vitamin B12 and/or folic acid deficiency. Clinically megaloblastic anaemia may present as a continuum of asymptomatic metabolic abnormalities ranging to life-threatening clinical syndrome. Patients with megaloblastic anaemia have a risk of developing many complications. <b>Aim:</b> The aim of present study was to evaluate the varied clinico-haematological presentation of patients of megaloblastic anaemia associated with deficiency of vitamin B12 and folic acid. <b>Materials and Methods:</b> This cross-sectional study was carried out in the Department of Pathology, Era’s Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India, over a period of 18 months. We studied 90 cases which were grouped as follows: Group A: no deficiency; Group B: vitamin B12 deficiency; Group C: folic acid deficiency; Group D: combined deficiency. Complete blood count was done using Sysmex XS-800i. Vitamin B12 and folic acid assay was done using Enzyme Linked Immunosorbent Assay (ELISA). Bone marrow aspiration was also done. <b>Results:</b> Out of 90 patients, maximum (n=42; 46.7%) had vitamin B12 deficiency. In all the four groups, weakness and fatigue were most common complaints. All the cases had pallor. Icterus, tingling, numbness and murmurs were relatively rare. All the fourteen cases in which bone marrow examination was carried out had erythroid hyperplasia and megaloblastic reaction. <b>Conclusion:</b> On the basis of above findings, it was concluded that there is a significant difference in the clinical presentation of patients of megaloblastic anaemia with vitamin B12 and folic acid deficiency. However, not very significant difference has been noticed in the haematological parameters. Thus, clinical and haematological profile both should be thoroughly assessed to differentiate between vitamin B12 and folic acid deficiency. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=EC06-EC09&id=10937 https://doi.org/10.7860/JCDR/2017/30253.10937 Factors Associated with Adverse Outcome in Papillary Microcarcinoma of Thyroid K Rajasree Varma, Sheima R Das, KP Aravindan <b>Introduction:</b> Papillary microcarcinoma thyroid are increasingly diagnosed recently, and are found to have an indolent course and excellent prognosis. Distant metastasis and tumour related mortality are very less. However, there is a subset of microcarcinomas which are aggressive and require therapeutic management similar to larger tumours. The prognostic factor in this aggressive subtype is not well-defined. This study attempts to identify the factors associated with lymph node metastasis and recurrence and hence, the risk stratification of patients. <b>Aim:</b> To determine the clinical and histomorphological factors that are associated with adverse outcome in patients with papillary microcarcinoma of thyroid. <b>Materials and Methods:</b> This was a cohort study done from 2008 to 2015 in the Department of Pathology. Study subjects included retrospective cases from 2008 to 2013 and prospective subjects from 2013 to 2015. The clinical details and histopathological features were assessed and were compared in patients with and without adverse outcome. <b>Results:</b> A total of 55 patients were included in the study. Majority of the patients belonged to the age group of 41-50 years and were females. Only five patients had lymph node metastasis at the time of presentation. None had recurrence during the follow-up period. Male gender, multifocality, capsular invasion and moderate tumour fibrosis were found to be significantly more associated with adverse outcome. <b>Conclusion: </b>This study focuses on the importance of assessing histopathological features in determining the high risk groups in papillary microcarcinoma. The high risk groups require radioablation and more rigorous follow-ups. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=EC10-EC13&id=10938 https://doi.org/10.7860/JCDR/2017/32045.10938 Diffuse Nodular Lymphoid Hyperplasia of Colon in a Child- A Case Report with Review of Literature Chikkanaganna Pillavenkataswamy Manjula, Belur Venugopal Suguna, SR Niveditha, Sreedhar Murthy Diffuse Nodular Lymphoid Hyperplasia (DNLH) of the Gastrointestinal Tract (GIT) is an uncommon, benign reactive lesion occurring in all age groups. It is seen distributed throughout the GIT. DNLH is characterized by diffuse mucosal polypoid masses of 2-5 mm diameter. Commonly mistaken for various polyposis syndromes on endoscopy, It may present with abdominal pain, recurrent hematochezia, intussusception, intestinal obstruction and anaemia. Childhood DNLH is associated with various etiologies from food hypersensitivity to immunodeficiency syndromes. As DNLH is mostly a benign, reactive process, histopathology plays an important role in its recognition to prevent misdiagnosis and radical procedures. Here, we present a rare case of DNLH of colon in a two year old female child, presenting with abdominal distension. Colonoscopy revealed multiple colonic polyps. Total colectomy specimen revealed multiple, sessile polyps of 0.2 to 0.3cm carpeting the entire colonic mucosa. Microscopy revealed polyps comprised of lymphoid follicles with germinal centre in the mucosal and submucosal location. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=ED03-ED05&id=10939 https://doi.org/10.7860/JCDR/2017/32163.10939 Caries Detection with ICDAS and the WHO Criteria: A Comparitive Study Raveen Haricharan Bhoopathi, Pavan Uday Patil, B Vinayak Kamath, Deepika Gopal, Sai Kumar, Ganesh Kulkarni <b>Introduction:</b> Dental caries is the most prevalent chronic disease affecting mankind and is the primary reason for tooth pain and edentulism. The presence or absence of caries depends on the diagnostic cut-off points selected. <b>Aim:</b> This study evaluated the comparability of two systems i.e., the International Caries Detection and Assessment system (ICDAS II) and the World Health Organization (WHO) criteria for detection of carious lesions among a set of outpatient subjects and was assessed for a equivalency point between the systems. <b>Materials and Methods: </b>A total of 242 subjects were independently inspected by two examiners who were trained and calibrated accordingly for detecting a carious lesion using the WHO and the ICDAS II criteria. Caries prevalence and the mean decayed teeth were calculated using both the systems. Wilcoxon test was employed to compare the mean caries score obtained with the WHO criteria and the ICDAS. Caries prevalence, according to the WHO criteria and ICDAS II criteria was compared using McNemars test. <b>Results:</b> The equivalency point between these two systems was at score four of the ICDAS II in this particular study. <b>Conclusion:</b> In addition to unearthing a significant number of non-cavitated carious lesions, the ICDAS II can be equated to the WHO criteria at score four of the ICDAS II. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=ZC09-ZC12&id=10929 https://doi.org/10.7860/JCDR/2017/29017.10929 Hair Loss in Paediatric and Adolescent Age Group: A Clinico-Pathological Analysis in a Tertiary Health Care Centre Umamaheswari Gurusamy, Chaitra Venkataswamy <b>Introduction:</b> Hair loss in children causes deep distress to both the child and the parent. The most common causes of paediatric alopecia are tinea capitis, alopecia areata, traction alopecia and trichotillomania. Timely diagnosis and treatment are indeed required to reverse these conditions. <b>Aim:</b> To categorize paediatric alopecia into non-scarring, scarring and miscellaneous causes and to describe the histopathological features of each entity. <b>Materials and Methods:</b> This retrospective study was carried out for duration of 10 years (July 2006 to July 2016) in the Department of Pathology. Scalp biopsies from patients aged 0-18 years with the history of hair loss were included in the study. <b>Results:</b> There were 35 cases, which included non-scarring 22 (63%) cases, scarring 6 (17%) cases and miscellaneous causes 7 (20%) cases. Rare genetic causes such as Vitamin D resistant rickets associated with alopecia and epidermolysis bullosa were seen among the miscellaneous causes. Alopecia areata was the leading cause of hair loss in children followed by trichotillomania. The histopathological features of non-scarring and scarring alopecia were similar to that described in adults. KFSD, rarely seen in females, showed dilated infundibulum with follicular plugging, polytrichia, perifollicular lymphocytic infiltration and fibrosis on histology. Alopecia in patients with vitamin D resistant rickets showed reduction in number of hair follicles, irregular epithelial structures and epithelial cysts. <b>Conclusion:</b> The commonest cause of paediatric alopecia seen in this study was alopecia areata. A holistic approach including history, clinical examination and histopathology will be essential for correct diagnosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=EC01-EC05&id=10930 https://doi.org/10.7860/JCDR/2017/30889.10930 Role-playing versus Conventional Strategy in Midwifery Clinical Education on Breast Self-examination: A Quasi-Experimental Study Mahnaz Khatiban, Gita Sangestani, Nicole Bennett, Khodayar Oshvandi <b>Introduction: </b>Iranian women develop breast cancer 10 years earlier than those in developed countries. Breast Self-Examination (BSE) is a useful screening tool. The emphasis on counseling and training is given to promote breast health in the society by midwives. There is a need to educate students with the necessary skills in this area. <b>Aim:</b> To compare the impact of role-playing versus conventional strategy on midwifery student’s skills, and subsequently on their clients knowledge, skills, and health beliefs about BSE. <b>Materials and Methods:</b> This quasi-experimental study was conducted in two parts. At first, 32 students were equally divided as the role-playing and conventional groups. After educational intervention, the skills of the students in BSE counseling and training were evaluated by a checklist. Then, through convenience sampling, 60 women were equally divided in the experimental and control groups. The experimental group was taught by role-playing group of students and the control group was taught by conventional group of students. The women’s BSE health beliefs, skills, and knowledge were compared before and after education to demonstrate the impact of the students skills. The women filled out the BSE health beliefs questionnaires. The BSE knowledge questionnaires and the BSE skills checklists were completed by the student through interview and observation respectively. The data were analysed on 5% error using software SPSS-version 16.0. <b>Results:</b> According to the results, the mean score of students skills in the role-playing group was significantly higher than that of the conventional group (p<0.001) in BSE education and counseling. The results also showed that the women trained by the role-playing group of students had dramatically higher scores (p<0.001) in health beliefs, skills and knowledge about BSE. <b>Conclusion: </b>Role-playing strategy can improve the midwifery student’s counseling and training skills. So, they could be effective in development of women’s knowledge, skills and health beliefs about BSE. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=JC01-JC06&id=10931 https://doi.org/10.7860/JCDR/2017/29334.10931 VCAM-1(rs3783605A>G) Single-Nucleotide Polymorphism Genotyping in a Sample of Type 2 Diabetes Mellitus Iraqi Patients Nadia Fadhil Salman, Asmaa MSalih Almohaidi, Ahmed Kadhim Mohammed, Dhurgham Hameed Hasan <b>Introduction:</b> The Vascular Adhesion Molecule-1 (VCAM-1) is a cell surface glycoprotein expressed by cytokine-activated endothelium, mediates the adhesion of monocytes and lymphocytes. Diabetes mellitus is a common global health problem represented by metabolic disorder in which common genetic variants interact with environmental factors like older age, obesity, family history of diabetes to unmask the disease which might be a result of inflammation reflecting response. <b>Aim:</b> Detection of the VCAM-1(rs3783605 A>G) gene polymorphism in a group of Type 2 Diabetes Mellitus (T2DM) Iraqi patients. <b>Materials and Methods:</b> The study enrolled 129 subjects (68 patients, 61 controls). Clinical features and laboratory investigations included: Body Mass Index, Abdominal Circumference, fasting blood sugar, Glycohemoglobin (HbA1c) and lipid profile were measured for each subject. Genotyping of the VCAM-1(rs3783605 A>G) gene polymorphism was performed using Sequence Specific Primer (SSP) Polymerase Chain Reaction (PCR) technique and the PCR product was visualized by agarose gel electrophoresis. <b>Results:</b> The clinical characteristics showed a significant increase (p<0.05) in the patients group compared to the control group. VCAM-1polymorphism analysis showed a higher frequency of A/G genotype in control group than patients group (100% versus 88.2%), while the analysis of the allele impact, including the genotypes that contain the G allele showed no significant association in patient group compared with control. <b>Conclusion: The results of the present study showed that control group had a higher frequency of the A/G genotype regarding the patients group, and that the G allele of the VCAM-1 (rs3783605 A>G) single nucleotide polymorphism has more role in the pathogenesis of T2DM than the A allele, and could be considered as a risk factor for T2DM in Iraqi population, as well as the association of the A/G genotype with the incidence of T2DM in Iraqi patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=GC01-GC05&id=10932 https://doi.org/10.7860/JCDR/2017/29397.10932 MRI Evaluation of Size and Shape of Normal Pituitary Gland: Age and Sex Related Changes Pratiksha Yadav, Shubham Singhal, Surbhi Chauhan, Saumya Harit <b>Introduction:</b> For complete assessment of pituitary gland, we should be aware of its normal anatomy with the physiological variations in its size and shape in different age groups in both males and females. Measurements of the normal pituitary gland for various age ranges are helpful to diagnose pathologies in pituitary gland. <b>Aim:</b> To study the size, shape and mean normal volume of normal pituitary gland in different age groups of both genders with Magnetic Resonance Imaging (MRI). <b>Materials and Methods:</b> It was a retrospective study in which 500 patients were included (261 males and 239 females, ranging from one year up to 80 years of age) who underwent brain MRI in the Radio-diagnosis department. Patients with pituitary or endocrine abnormalities were excluded from the study. All MRI images were acquired on a Siemens Avanto 1.5T MRI machine. Precise mid-sagittal T1WI and coronal T2WI were selected for measurement. Statistical calculations were done by Software Open Epi Version 3 for epidemiological age groups. Relation between mean height and age and relation between volume and age were done by ANOVA test, Chi-square test. A p-value <0.05 was considered as significant. <b>Results: </b>The observation was divided into six groups according to age. Mean height of pituitary gland in female patients of each age group was greater than that of male patients in the same age group. Height of pituitary gland reached a maximum in the 21 to 30 years of age group in both males and females, after which, there was a decline in the pituitary height in the subsequent age groups. The overall mean pituitary height in the age group 1-10 years came out to be 5.3±1.4 mm. In the age group 11-20 years, mean pituitary height was 6.2±1.1 mm. In the age group 21-30 years 6.8±1.9 mm, 31-40 years age group 6.3±1.8 mm, in 41-50 years age group 6.5±1.5 mm and individuals above 50 years of age, mean pituitary height was observed as 7±2.1 mm. In all the age groups and both the sexes, the most common shape was flat which was seen in 46% of people followed by convex in 31.2% and concave shape in 22.8% people. The mean pituitary volume in the age group 1-10 years came out to be males 210±0.73 mm3 and in females 200±0.75 mm3. In the age group 11-20 years mean pituitary volume in males was 340±127 mm3 and in female’s 280±123 mm3. In the age group 21-30 years, mean pituitary volume in males was 430±116 mm3 and in females 440±180 mm3. In the age group 31-40 years, mean pituitary volume in males was 380±140 mm3 and in females was 440±111 mm3. In 41-50 age groups mean pituitary volume in males was 400±159 mm3 and in females it was 420±116 mm3. In individuals above 50 years of age the mean pituitary volume was observed in males as 410±168 mm3 and 420±174 mm3 in females. <b>Conclusion:</b> Knowledge of physiological variation in the size and shape of pituitary gland is necessary to compare the abnormal increase in the size. In the cases where there is a borderline abnormality in the size and shape of pituitary gland, it should be further evaluated by dynamic contrast study on MRI. Pituitary size and shape evaluation needs to compare with the normal range of height and volume of the normal pituitary gland in various age groups in both genders in Indian population. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=TC01-TC04&id=10933 https://doi.org/10.7860/JCDR/2017/31034.10933 Ultrasound Elastography for Differentiating Benign from Malignant Cervical Lymphadenopathy: Comparison with B-Mode and Color Doppler Findings Ranjana Gupta, Puneet Mittal, Tavpreet Kaur, Harkirat Kaur, Mohd. Aamir, Rishu Malik <b>Introduction:</b> Elastography is a new technique that aim to assess tissue hardness non-invasively. Recently, it has been used for differentiating benign from malignant lymphadenopathy. <b>Aim:</b> To evaluate the sensitivity and specificity of elastography for differentiating benign from malignant cervical lymphadenopathy and to compare its findings with B-mode and color doppler findings. <b>Materials and Methods:</b> The present study was conducted on 50 patients with cervical lymphadenopathy. In each patient, even if multiple enlarged lymph nodes were found, only one lymph node was sampled which was most suspicious for malignancy. This selection was based on size of the lymph node and other B-mode sonography characteristics. B-mode and color doppler findings were recorded. In addition to this, strain elastography was done and five elastography patterns were defined: high elasticity (soft): pattern I represented no or very small hard area while spectrum pattern V presented where almost whole of lymph node showed hard pattern on strain elastography. Patterns II and III represented hard areas <45% and >45% respectively while pattern IV represented peripheral hard area with central soft area (due to central necrosis). Patterns I and II were considered benign. Patterns III, IV and V were considered to represent malignant lymph nodes. Additionally, a cine loop of elastography was acquired for calculation of strain ratio using adjacent muscle as reference. A cut-off value of less then two (<2) of strain ratio was used to define benign lymph nodes and more then or equal to two (=2) was used to define malignant lymph nodes. Final diagnosis of benign versus malignant lymph node was based upon other relevant investigations like Fine Needle Aspiration Cytology (FNAC)/biopsy findings and/or clinical follow-up after three months. Statistical analysis was done using StatPac version 4.0 (StatPac, Inc., Bloomington, MN). Chi-square test was used to compare various B-mode and color doppler parameters, elastography patterns and strain ratio between benign and malignant groups. <b>Results:</b> Of all the B-mode parameters, only lymph node border and hilum showed more than 70% accuracy for correctly differentiating benign from malignant lymph nodes while color doppler showed 82% accuracy for the same. Elastography pattern and strain ratio achieved 90% and 94% accuracy for correctly differentiating benign from malignant lymph nodes. <b>Conclusion:</b> Elastography pattern and strain ratio are useful in addition to B-mode and color doppler ultrasound for evaluation of cervical lymph nodes. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=TC05-TC08&id=10934 https://doi.org/10.7860/JCDR/2017/32127.10934 Evaluation of Tumour Associated Tissue Eosinophilia and Other Histomorphological Variants as Markers of Metastasis in Squamous Cell Carcinomas Nadia Shirazi, Neena Chauhan, Sunil Saini, Meena Harsh, Sohaib Ahmad <b>Introduction:</b> Tumour Associated Tissue Eosinophilia (TATE), is characterised by the presence of eosinophils as a component of peri and intratumoral inflammatory response. Though lymphocytes are widely recognised in inducing favourable tumour microenvironment, the association with tissue eosinophilia has been infrequently studied. <b>Aim: </b>This study was undertaken to assess the grades of Tumour Associated Tissue Eosinophilia (TATE) and its association with various neoplastic histopathological variables, host tissue inflammatory reaction and the presence or absence of metastases. <b>Materials and Methods: </b>Surgically resected or biopsy specimens (n=148) from patients with squamous cell carcinomas, who had not received any chemotherapy and/ or radiotherapy were included. Those with coexisting tumours, or demonstrating large areas of ulceration and/or necrosis were excluded. TATE was graded from 0 to 4+ depending upon the number of eosinophils/High Power Field (HPF). Tumour morphology, metastases and a variety of other histopathological variables were also observed. <b>Results:</b> High grades of TATE (3+ and 4+) were found in 60.8% of well differentiated squamous cell carcinomas, and were associated with pushing borders (82.3%), intense inflammatory infiltrate (62.7%) and high grade desmoplasia (92.1%). In contrast, low grades of TATE were associated with infiltrating borders (76.2%), low grades of desmoplasia (51.5%) cases and moderate inflammatory infiltrate (59.7%). Tumour metastasized in 45.9% cases of which 89.7% were seen to be associated with low grades of TATE. The association between low grades of TATE and metastases as determined by Chi-square test was highly significant (p<0.001). <b>Conclusion: </b>High grades of TATE are associated with lesser tendency of tumour metastasis and hence may be considered a favourable prognostic marker in squamous cell carcinomas. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=EC14-EC17&id=10942 https://doi.org/10.7860/JCDR/2017/30634.10942 Environmental and Biological Risk Factors Associated with the Prevalence of Language Delay in Children Upto 6 Years of Age from Rural South India Premkumar Belgin, Binu Abraham, Stephenson Baburaj, MK Mohandas <b>Introduction:</b> There is large amount of data on the prevalence and risk factors of speech and language delay in children up to three years of age, but the data from three to six years of age group is very limited. <b>Aim:</b>To assess the speech and language delay in children from birth to six years of age and its association with environmental and biological risk factors. <b>Materials and Methods:</b> A total of 400 children aged zero to six years attending well baby clinics and daily paediatrics outpatient department for routine check-up and immunization were evaluated using Language Evaluation Scale Trivandrum (LEST) zero to three and three to six. The prevalence and the association with risk factors in each age group was calculated and analysed using SPSS version 18.0. Chi-square test and Fisher's exact test were used in the statistical analysis. <b>Results:</b> Language delay was seen in 38 (9.5%) children among the 400 children studied. The children of age group 49 to 60 months (p-value 0.839) and male gender (p-value 0.923) showed more delay but statistically not significant. Among the various environmental factors studied, second born child Odds Ratio (OR-3.5), children who were not single in family (OR-1.9) and children not living together with their both parents (OR-4.3) showed significant association. The biological risk factors like preterm children (OR-3.11), babies who were born of caesarean section(OR-3.9), who had significant birth history (OR-11.1) and those who were not exclusively breast fed (OR-4.4) showed significant association. <b>Conclusion:</b> A nurturing home environment with exclusive breast feeding and harmony in family in early years of life help a lot in achieving language skill. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=SC11-SC14&id=10943 https://doi.org/10.7860/JCDR/2017/31738.10943 Yogic Intervention for Coping with Distress Rudra Bahadur Bhandari <b>Introduction: </b>The wide prevalence of stress among the corporate workforce and its adverse impacts on employee health and work performance is skyrocketing. This warrants assessing efficacy of complementary and alternative approaches like yoga for stress management and health promotion. <b>Aim:</b> This study was primarily aimed at assessing the efficacy of Integrated Yogic Intervention (IYI) on Physical Distress (PD), Emotional Distress (ED) and Total Distress (TD) and predicting nature of relationship between PD and ED after the IYI. <b>Materials and Methods:</b> A 45-day IYI was administered among 75 corporate personnel (60 males and 15 females with mean age 31.52±8.22 and 27.83±4.37 years respectively) by creating a randomised control groups- Experimental Group (EG) and Control Group (CG) with same size and gender ratio (75 members in each group with 60 males and 15 females). A mixed factorial ANVOA was used to check intra and inter group differences by treating baseline and after distress of participants measured by male and female versions of Cornell Medical Index Health Questionnaires (CMIHQs). <b>Results:</b> Comparisons of means between EG and CG by computing unpaired t-test showed significant reduction (p<0.001) in PD, ED and TD of the male practitioners and ED of the female practitioners whereas, reduction in the female practitioners after mean PD and TD was significant at p <0.01 as compared to their controls. Comparison of intra group means by computing paired t-test in EG showed significant reduction (p<0.001) in after mean distress (PD, ED and TD) in case of both male and female practitioners. Significant association (p< 0.01) found between after PD and ED of the participants revealed ED as the predictor of PD. <b>Conclusion:</b> Integrated Yogic Intervention may be used as an inexpensive alternative to moderate distress and improve psychosomatic health of workforce in contemporary corporate organisations. The emotional health is to be bettered to empower somatic health. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=OC44-OC49&id=10944 https://doi.org/10.7860/JCDR/2017/29332.10944 Comparative Study on Efficacy of Intralesional Bleomycin Injection in Head and Neck Lymphangioma and Vascular Malformation Deepak Regmi, Meera Bista, Sangita Shrestha, Diva Shrestha, Nain Bahadur Mahato <b>Introduction:</b> Head and neck region is the most common site of occurrence for lymphangioma and vascular malformation. The surgical modality of treatment for these conditions carries higher risk of neurovascular damages, recurrence and bad scar. Intralesional Bleomycin Injection (IBI) has been used extensively as a non surgical treatment because of its low cost, easy availability and high sclerosing effect on vascular endothelium. Most of the researches have been focused on reporting its efficacy on lymphangioma or vascular malformation or haemangioma only. <b>Aim:</b> To compare the efficacy and safety of intralesional bleomycin injection in lymphangioma and vascular malformation of head and neck region. <b>Materials and Methods:</b> A prospective comparative study was carried out in the Department of ENT-HNS in Kathmandu Medical College Teaching Hospital, Nepal from January 2015 to June 2016. First 15 patients of lymphangioma (Group 1) and same number of slow flow vascular malformation (Group 2) were offered IBI in the dose of 0.5 mg/kg/dose (not exceeding 15 mg/dose). The injection was repeated every three weeks, if needed. The size of the lesion was measured and serial photographs were taken. Complications were also recorded. The mean and standard deviation was calculated and results were compared using Chi-square and Student’s t-test. <b>Results:</b> Response rate (size reduction) between the groups was comparable (p=0.361). Mean number of injections required in Group 1 and Group 2 were 3 and 5 respectively. The number of injections required to meet the above mentioned response was statistically higher in Group 2 as compared to Group 1 (p=0.002). Apart from minor complications like fever and transient increase in swelling in both the groups (20%) and skin hyperpigmentation in Group 2 (13%), there were no haematological or pulmonary complication in due course of treatment and follow up. <b>Conclusion:</b> Intralesional bleomycin injection is equally effective for lymphangioma and slow flow vascular malformation but vascular malformations require significantly higher number of injections than lymphangioma. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=MC04-MC06&id=10945 https://doi.org/10.7860/JCDR/2017/34167.10945 A Clinical Study on Islanded Reverse Sural Artery Flap for the Reconstruction of Defects over the Lower Third of Leg and Foot Surya Rao Rao Venkata Mahipathy, Selvan Ranganathan, Sridharan Murugesan, Alagar Raja Durairaj, Narayanamurthy Sundaramurthy, Sasikumar Muthu <b>Introduction:</b> The islanded reverse sural artery flap is a versatile, relatively simple procedure, useful in reconstruction of lower third leg, heel, tendo achilles region, malleoli and hind foot defects because of the long vascular pedicle. The surgical technique is safe, of short duration and provides alternative to microsurgical reconstruction. <b>Aim:</b> To study the versatility and applications of islanded reverse sural artery flaps in the reconstruction of distal third leg, heel and foot defects. <b>Materials and Methods:</b> A prospective study was conducted between October 2007 to March 2010, 26 patients with moderate sized skin and soft tissue defects in the distal third of leg and foot were treated with Islanded Reverse Sural Artery Flap at Government Chengalpattu Medical College, Tamil Nadu, India. The flap was planned in reverse, after marking with Doppler and procedure was performed. Factors like size of defect, length and width of pedicle, comorbid factors and complications were taken into account for the study. <b>Results:</b> Most of the flaps were done on post traumatic defects. Around 80% of the flaps had settled well with no or minimal donor site morbidity. Increasing age, co-morbid factors, narrow pedicle and arc of rotation of about 180 degrees all caused an increased complication rate which varied from 10 to 38%. <b>Conclusion:</b> Islanded reverse sural artery flap with its wide arc of rotation can provide cover to lower third of leg, heel and foot defects, thereby, reducing the need for staged cross leg flap and other flaps. It is a reliable and versatile flap in the hands of reconstructive surgeon to provide good quality skin cover for defects of the leg and foot with acceptable donor site morbidity in a single stage. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=PC01-PC06&id=10946 https://doi.org/10.7860/JCDR/2017/31115.10946 Spectrum of Haemoglobinopathies: A Hospital Based Study in Uttarakhand Shivani Nayar, Seema Acharya, Rajiv Acharya, Sanjeev Kishore, Brijesh Thakur <b>Introduction:</b> Haemoglobinopathy is a worldwide inherited problem as recognized by WHO and care of affected patients incurs heavy expense on the limited resources of developing countries. There is a need for prevention of births of children with clinically significant haemoglobinopathies by population screening. Cation Exchange-High Performance Liquid Chromatography (CE-HPLC) has emerged to be a simple and precise method to quantify HbA2, HbF and other variant haemoglobins with certain limitations. Most of the variant haemoglobins can be identified by their retention times, percentages and peak characteristics. <b>Aim:</b> The present study was undertaken to assess the prevalence and spectrum of various haemoglobinopathies in patients reporting to a tertiary health care centre in Uttarakhand, India. <b>Materials and Methods:</b> This was a prospective study conducted on 8144 samples. RBC indices were obtained by sysmex XP 100. CE-HPLC was performed on Biorad D10. The variant haemoglobins were identified on the basis of their percentages, retention times and peak characteristics. Peripheral blood film, reticulocyte count, HbH inclusion and sickling test were done in selected cases. Continuous variables were expressed as mean±SD. Categorical variables were expressed as percentages. <b>Results:</b> Antenatal population formed the bulk of the 8144 cases enrolled in this study. Haemoglobinopathy was seen in 5.9% of the cases with ß thalassaemia trait being the commonest abnormality (2.82% of cases). HbD (Punjab) trait was the commonest variant haemoglobin encountered in the study population. There was a significant difference in percentages of variant fractions between compound heterozygotes and variant traits. A presumptive diagnosis of alpha thalassaemia trait was rendered based on RBC indices, iron profile and chromatogram study. Molecular studies were recommended in 81 cases with borderline increase in HbA2 levels to rule out silent mutations. <b>Conclusion:</b> A reasonably high frequency (5.9%) of haemoglobinopathies warrants a routine antenatal screening of total population. An accurate diagnosis can be made in majority of cases by haematological parameters, CE-HPLC chromatograms, cascade screening for haemoglobinopathies and spouses of antenatal cases positive for haemoglobinopathy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=EC18-EC21&id=10947 https://doi.org/10.7860/JCDR/2017/31731.10947 Effectiveness of Structured Teaching Programme on Knowledge Regarding Preventive Measures of Uterine Prolapse among Mothers Greeshma G Nathan, Linda Varghese, J Kanmani <b>Introduction:</b> Uterine Prolapse (UP) is the contributor to reproductive health problems that influence the women’s quality of life. It is the most frequent cause of gynaecological morbidities among women in India and major indication for hysterectomy. <b>Aim:</b> To evaluate the effectiveness of Structured Teaching Programme (STP) on knowledge regarding preventive measures of UP among mothers and to find out the association between knowledge of mothers regarding preventive measures of UP and selected demographic variables. <b>Materials and Methods:</b> A quantitative research approach with pre-experimental one group pre-test and post-test design was used for the study. The setting of the study was Gynaecology OPD at AIMS, Kochi. By using non-probability convenience sampling technique, 40 antenatal mothers were selected. A semi-structured questionnaire was used to assess the demographic data and knowledge regarding preventive measures of the UP in mothers. The STP was provided to the participants after pre-test. The post-test was done on the 14th day after pre-test. The sample characteristics were described using frequency, percentage. Chi–square test was used to find out the association between knowledge of mothers regarding preventive measures of UP and selected demographic variables. <b>Results:</b> The mean pre-test knowledge score was 11.85±4.36 and the mean post-test knowledge score was 19.75±2.98. There was a statistically significant improvement in the level of knowledge regarding preventive measures of UP among the mothers (t-value=16.01, p<0.05) and significant association was found between Pre-test level of knowledge and age of mothers (?2=6.30,p=0.043). However, no significant association was found between pre-test level of knowledge and selected demographic and clinical variable which includes education, occupation, place of residence, previous information about UP etc. <b>Conclusion:</b> The findings of the study showed a significant improvement in knowledge regarding preventive measures of UP among mothers. The STP was effective and it is also suggested that the programme should be continued in order to uplift the overall health and practices of mothers. Hence, it will help to reduce the incidence of UP and enhance the quality of life in future. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=QC05-QC08&id=10949 https://doi.org/10.7860/JCDR/2017/31180.10949 Immunohistochemical Analysis of Natural Killer Cells and CD8+ T Lymphocytes in Lower Lip Squamous Cell Carcinoma Thais Aline Oliveira Maciel, Marianna Sampaio Serpa, Rodrigo Porpino Mafra, Amanda Katarinny Goes Gonzaga, Lélia Batista de Souza, Leão Pereira Pinto <b>Introduction:</b> Inflammatory cells may influence the growth of malignant neoplasms through pro and anti-tumour effects. Natural Killer (NK) cells and cytotoxic T lymphocytes (CD8+) are the main effector cells against cancer. <b>Aim:</b> This study aimed to evaluate the presence of NK cells and CD8+ T lymphocytes in lower lip Squamous Cell Carcinomas (SCCs) and its correlation with clinico-pathologic parameters. <b>Materials and Methods:</b> Thirty two cases of lower lip SCCs were selected for clinical, morphologic and Immunohistochemical (IHC) assessment. NK cells (CD57+) and CD8+ T lymphocytes were identified and analysed quantitatively in five microscopic fields at the tumour invasion front using IHC markers. <b>Results:</b> All cases showed immunopositivity for both biomarkers. CD57+ and CD8+ T cells were more abundant in clinical stages I/II, nonmetastatic cases and low-grade malignancy tumours. However, there were no statistically significant differences. Similarly, no significant differences were found regarding local recurrence and clinical outcome. A strong positive correlation, statistically significant between CD57+ and CD8+ T cells was also observed (r=0.761, p<0.001). <b>Conclusion:</b> The high expression of CD57+ and CD8+ cells at the invasion front suggests they are involved in anti-tumour defense. However, these cells do not seem to effectively influence the progression of lower lip SCC. This may partially reflect the activities of other components of the immune system in the tumour microenvironment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=EC22-EC25&id=10956 https://doi.org/10.7860/JCDR/2017/29455.10956 Role of Nuclear Morphometry as Objective Parameter to Evaluate Cytology Smears of Epithelial Breast Lesions Anadi Roy Chowdhury, Manas Talukdar, Anjan Adhikari <b>Introduction:</b> Most of the breast lesions (both benign and malignant) present as palpable swelling in the organ and Fine Needle Aspiration Cytology (FNAC) is regarded as first-line of investigation along with other ancillary tests. However, FNAC itself has its own disadvantages due to subjective nature and therefore, chance of interobserver variability especially in grey zone areas. <b>Aim:</b> To assess role of nuclear morphometric parameters like radius, perimeter and area to differentiate benign and malignant epithelial breast lesions so that they can be utilised as objective parameters for evaluation of cytological smears. <b>Materials and Methods:</b> Archived FNAC slides {Leishman-Giemsa and Papanicolaou (PAP) stained} having corresponding histopathology reports were examined under trinocular microscope with attached digital camera and computer system installed with imaging software (Scope Image 9.0) and nuclear morphometric parameters were evaluated. Statistical evaluation was done using unpaired t-test. <b>Results:</b> Out of total 108 cases selected, 68 were malignant lesions and 40 were benign. The mean (±SD) age of patients was 56.8 (±8.3) years and 24.5 (±5.4) years respectively. The mean nuclear radius, perimeter and area were 3.87 µm, 24.36 µm and 47.32 µm² for benign cases respectively whereas 6.67 µm, 41.92 µm and 140.75 µm² for malignant cases respectively. <b>Conclusion:</b> This study established that all the three nuclear morphometric parameters were significantly higher in malignant epithelial breast lesions compared to benign epithelial breast lesions (p-value <0.001). Thus, these parameters can be utilised as an objective tool to assess breast cytology smears in adjunct to other subjective features. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=EC26-EC28&id=10957 https://doi.org/10.7860/JCDR/2017/30799.10957 Effects of Tamoxifen-Loaded Solid Lipid Nanoparticles on Kidney and Liver of Female Ovariectomized Rats Nasrin Ziamajidi, Arash Dehghan, Naser Zangeneh, Parham Norouzian, Roghayeh Abbasalipourkabir <b>Introduction:</b> Tamoxifen (TMX) has harmful dose-dependent long-term side effects such as liquid retention in postmenopausal breast cancer patients. Although, encapsulation of low-dose TMX in colloidal delivery systems have been effective, an in vivo study is needed to survey the effect of TMX-loaded Solid Lipid Nanoparticles (TMX-loaded SLN) on the liver and kidneys of rats as mammalian model. <b>Aim:</b> The aim of this study was to compare the effect of TMX and TMX-loaded SLN on the liver and kidney of ovariectomized female Wistar rats. <b>Materials and Methods:</b> An in vivo study was conducted at Hamadan University of Medical Sciences from May 2015 to April 2016. Twenty four adult female rats were divided randomly into four groups. One group served as healthy control animals (H) and treated with deionized water. The other three groups ovariectomized and treated with TMX, TMX-loaded SLN and olive oil (C) respectively. The treatments were given orally for 21 days consecutive to the animals using gastric intubations. At the end of the study, the rats were sacrificed and determined for liver biomarkers {Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), Alkaline Phosphatase (ALP), lactate Dehydrogenase (LDH) activities} and renal biomarkers Uric Acid (UA), Blood Urea Nitrogen (BUN) and Creatinine (Cre) and study of the liver and renal tissue structure. <b>Results:</b> The serum analysis showed that the levels of Cre, urea and activity of liver enzymes; ALP, AST and ALT increased insignificantly in ovariectomized rats compared to healthy control. The ovariectomized rats treated with TMX and TMX-loaded SLN showed reduction in activity of liver enzymes; ALP, LDH, AST, ALT in comparison to ovariectomized control group. Decreased UA level in serum of TMX and TMX-loaded SLN groups was seen. No structural abnormalities were observed in the animals’ tissue during the study. <b>Conclusion:</b> The study suggests that TMX-loaded SLN as well as free TMX reduced impact of the drug on the liver and kidney of ovariectomized rats. Therefore, the encapsulation of drug with nanoparticles may preserve its biological effects. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=KC01-KC05&id=10958 https://doi.org/10.7860/JCDR/2017/24285.10958 Volumetric Analysis of the Jaws in Skeletal Class I and Class II Patients using CBCT and Derived Lateral Cephalograms Batol Darjazini Nahas, Mohammad Y Hajeer, Mowaffak A Ajaj, Aghiad Yassin Alsabbagh <b>Introduction:</b> Cone Beam Computed Tomography (CBCT) imaging recently has become a very common diagnostic tool in the orthodontic literature. Recent research work has shown that CBCT imaging would give additional information regarding the volumetric assessment of the craniofacial structures. However, the previous published work has not considered the impact of the anterior-posterior skeletal classification and the vertical skeletal pattern on the volumetric assessment of the maxillary and mandibular bones. <b>Aim: </b>To evaluate maxillary and mandibular volumes (MxV and MdV, respectively) in hyper-divergent skeletal Class II (CII) and normo-divergent skeletal Class I (CI) patients and to investigate any possible correlation between CBCT derived lateral cephalometric variables and the calculated volumes. <b>Materials and Methods: </b>CBCT images of 60 patients (30 patients: CI, 30 patients: CII) were obtained and processed with Mimics® 17 software (Materialise, NV, Belgium). The three-dimensional models of both jaws were reconstructed and the related volumes were calculated using a novel approach. CBCT based cephalograms were also derived and linear and angular measurements of the craniofacial complex were obtained. Significance tests were based on t-tests (alpha set at 5%) and Pearson’s correlation coefficients were calculated. <b>Results:</b> No significant differences were detected between the two groups in the MxV (p=0.435) and the MdV (p=0.507). In the CI group, no or weak correlations were found between the volumetric measurements and the 2D variables. In the CII group, there was a strong correlation between both MxV and MdV and both the posterior facial height (r=0.60, 0.78 respectively) and the facial height index (r=0.62, 0.72 respectively). A negative moderate correlation was found between both MxV and MdV and the mandibular plane angle (r=-0.48, -0.44 respectively) and Bjorks sum (r=-0.48, -0.44 respectively). <b>Conclusion:</b> There were no significant differences in the MxV and MdV between CI and CII skeletal patterns. Some cephalometric variables had moderate to strong correlation with the MxV and MdV in the CII group. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=ZC13-ZC18&id=10959 https://doi.org/10.7860/JCDR/2017/31120.10959 In vitro Antibacterial Activity of Vitamin C and in Combination with Ciprofloxacin against Uropathogenic <i>Escherichia coli</i> Rohan Jacob Verghese, SR Ramya, Reba Kanungo <b>Introduction:</b> Multidrug Resistant (MDR) bacteria have become a major cause for concern; there has been limited success in the search for newer antibiotics. The search for options has led researchers to vitamin C, an unlikely ally. Its antibacterial effects on Staphylococcus aureus, Mycobacterium tuberculosis, and Escherichia coli (E. coli) have been documented. It can also enhance the action of antibiotics such as levofloxacin. <b>Aim: </b>This study aims to analyse the inhibitory effects of vitamin C alone and in combination with ciprofloxacin against E. coli. <b>Materials and Methods:</b> Present laboratory based prospective study was conducted at Department of Microbiology, Pondicherry Institute of Medical Sciences, Puducherry, India. A total 50 isolates of E. coli from urine samples sent between August to September 2016 were inoculated in media containing vitamin C (ascorbic acid and sodium ascorbate) in concentrations of 5 mg/mL, 10 mg/mL both alone and in combination with ciprofloxacin (1 µg/mL). After overnight incubation, absorbance was measured by spectrophotometry at 450 nm. Mean absorbance at each concentration was calculated. Unpaired t-test and multivariate analysis by ANOVA were used to compare mean absorbance of isolates. A p-value <0.05 was considered as statistically significant. <b>Results:</b> Absorbance values of bacterial solutions revealed a decreasing trend as vitamin C concentration was increased. The combination of vitamin C and ciprofloxacin produced no statistically significant drop in the absorbance (p-value=1). <b>Conclusion:</b> Ascorbic acid did not show any synergistic action in combination with ciprofloxacin when tested on uropathogenic E. coli. However when tested alone, ascorbic acid significantly inhibited the growth of E. coli. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=DC01-DC05&id=10960 https://doi.org/10.7860/JCDR/2017/31251.10960 Effects of Group Counselling on Health-Promoting Behaviours in Mothers During Postpartum Period: A Randomised Controlled Trial Parisa Parsa, Nazli Alafchi, Farzaneh Soltani, Ghodratalah Roshanaei <b>Introduction:</b> The postpartum period is important to maintain and promote maternal and child health. During this period investigation of mother’s health and lifestyle is necessary. <b>Aim:</b> To determine the effect of group consulting on health promotion behaviours during postpartum period on primiparous mothers. <b>Materials and Methods:</b> This clinical trial study was conducted on 112 primiparous mothers after vaginal delivery, who attended the healthcare centers in Hamadan, Iran. The participants of the study were selected via two-stage cluster sampling strategy and were assigned into two groups-experimental and control. Using a questionnaire of demographic information and health promoting lifestyle profile II, the data were collected. The experimental group received health promoting counselling in three weekly sessions. The health behaviours and lifestyle of the two groups were compared before and after counselling. Data analysis using SPSS version 20.0 were carried out by Fisher's exact test, Chi-square analysis, Independent t-test, paired t-test, and analysis of covariance. <b>Results:</b> There was no significant difference between the two groups on mean scores of health behaviours before counselling (p=0.6). However, a significant difference existed between the two groups after counselling (p<0.001). Moreover, significant increase was found in lifestyle scores within the experimental group (p<0.001). Whereas, no significant difference was found within the control group (p=0.1). <b>Conclusion:</b> Health promoting behaviours counselling leads to change of perceptions, beliefs, attitudes, behaviours, and finally results in changing lifestyle and promote mothers health during postpartum period. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=QC09-QC13&id=10978 https://doi.org/10.7860/JCDR/2017/29582.10978 Applicability of Toronto Clinical Neuropathy Scoring and its Correlation with Diabetic Peripheral Neuropathy: A Prospective Cross-sectional Study D Udayashankar, Sarah S Premraj, K Mayilananthi, Vishwanath Naragond <b>Introduction:</b> Diabetes is a non-communicable metabolic disorder which is associated with numerous vascular and non-vascular complications. Neuropathy is one of the most important complications which, if not recognized and treated early may result in significant disability and poor quality of life. In a resource poor setting like India, where diagnostic modalities like Nerve Conduction Study (NCS) are expensive for early diagnosis, the present study aimed to evaluate the effectiveness of a simple bed side assessment test, the Toronto Clinical Neuropathy Scoring (TCNS) system in diagnosing Diabetic Peripheral Neuropathy (DPN). <b>Aim:</b> The primary objective was to determine the applicability of Toronto clinical scoring system in DPN diagnosed by NCS in the South Indian population. The secondary objective was to evaluate the correlation between duration of Diabetes Mellitus (DM), HbA1C, diabetic retinopathy and neuropathy with severity of diabetic neuropathy as determined by the TCNS. <b>Materials and Methods:</b> In a prospective cross-sectional study, conducted over a period of 12 months from June 2015 to May 2016 at a tertiary care institute in semi-urban South India, 50 diabetic patients with symptomatic neuropathy were included. All patients were subjected to TCNS and the results were compared with neuropathy confirmed by NCS. Categorical variables were expressed as percentage or proportions. Comparison of normally and abnormally distributed continuous variables were done by independent sample t-test and Mann – Whitney U test respectively. Categorical variables were compared using Chi-square test or Fisher’s exact test. A p-value less than 0.05 was considered statistically significant. <b>Results:</b> The presence of neuropathy by TCNS was confirmed in all cases by NCS. Further the severity of neuropathy as assessed by TCNS was found to correlate well with duration of diabetes, and the presence of diabetic retinopathy and nephropathy. Presence of foot weakness, ataxia and upper limb symptoms also had direct correlation with severity of diabetic neuropathy. <b>Conclusion:</b> TCNS is a sensitive scoring system used to diagnose diabetic neuropathy and can be used as an inexpensive bedside screening tool. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=OC10-OC13&id=10986 https://doi.org/10.7860/JCDR/2017/30598.10986 Role of Clinical Profile, Comorbidities and Neutrophil Lymphocyte Ratio on Prognosis of Acute Pancreatitis Sreenivasa Rao Sudulagunta, Monica Kumbhat, Mahesh Babu Sudulagunta, Aravinda Settikere Nataraju, Shiva Kumar Bangalore Raja <b>Introduction:</b> Acute pancreatitis is the sudden onset of reversible inflammation of pancreas in which pancreatic enzymes cause autodigestion of the gland. Acute pancreatitis varies from mild (mortality rate <1%; usually resolves in several days) to severe (mortality rate can be up to 30%). <b>Aim:</b> The aim of the study was to study the clinical profile, detection of amylase, lipase for diagnosis, progression to pancreatic necrosis and chronic pancreatitis, and Neutrophil Lymphocyte Ratio (NLR) in prognostication of outcome. <b>Materials and Methods:</b> The retrospective study analysed data of patients admitted with acute pancreatitis or presenting to outpatient department (previous medical records) with pancreatitis between January 2011 and September 2016. A total of 339 patients fulfilled the clinical and diagnostic criteria of pancreatitis out of which 252 patients had acute pancreatitis and 78 patients had chronic pancreatitis. Nine patients of acute pancreatitis group were excluded due to lack of complete data and consents. <b>Results:</b> Acute pancreatitis is about six times more common in males than females. The sensitivity and specificity of lipase in our study was 98.41% and 99.19% respectively. The sensitivity and specificity of amylase in our study for the diagnosis of acute pancreatitis was 86.90% and 98.79% respectively. In severe acute pancreatitis, the NLR remains well above normal level for 3-4 days with peak in first or second day indicating ongoing inflammatory process. <b>Conclusion:</b> Serum lipase levels are more sensitive and specific than serum amylase levels and some cases of pancreatitis can be missed if serum amylase alone was measured. Dynamic NLR monitoring i.e., neutrophilia and lymphopenia is cost effective, easy to perform, repeatable and accurate marker for prognosis in severe acute pancreatitis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=OC19-OC23&id=10993 https://doi.org/10.7860/JCDR/2017/25229.10993 Autologous Iliac Crest Bone Marrow Mononuclear Cells in Bone Fusion G Lakshmi Prasad, Shashank Sharad Kale, Sujata P Mohanty, Sumit Sinha, P Sarat Chandra <b>Introduction:</b> Autologous iliac bone harvesting is associated with significant drawbacks and low fusion rates are noted in conditions such as osteoporosis. Bone Marrow Aspirate (BMA) is relatively inexpensive and contains mononuclear cells which can be utilised. <b>Aim:</b> To document the efficacy of concentrated Bone Marrow Mononuclear Cells (BM-MNC) in bone fusion and compare fusion rates with autologous Iliac Crest Bone Graft (ICBG) alone versus combined ICBG and BM-MNC. <b>Materials and Methods:</b> This prospective, non randomised study included study group and age matched control group (of previously operated craniovertebral junction anomalies) with 15 patients in each group. Combined autologous ICBG+BM-MNC (study group) was compared with autologous ICBG alone (control group). The BMA was processed in stem-cell laboratory to procure mononuclear cells. Morcelised graft pieces mixed with BM-MNC were applied over fusion site after instrumentation. Patients were assessed for fusion and neurological outcome. Qualitative data analysis was done using Fisher’s exact test. <b>Results:</b> Mean age, surgical procedures and complications were similar in both groups. Average duration for procurement of cells was 98 minutes. Average of 40.6 million cells were utilised. Higher fusion rates were noted in the study group both at three and six months which, however, was not statistically significant (p-value 0.06 and 0.26 respectively). <b>Conclusion:</b> To the best of our knowledge, this is the first study of its kind to utilise concentrated mononuclear cells combined with iliac graft which lead to higher proportion of fusion and was effective in all surgical procedures. It seems economical and might be suitable for patients who cannot afford expensive graft substitutes and with conditions like osteoporosis. Further prospective studies in larger numbers are needed to confirm these findings. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=PC11-PC15&id=10994 https://doi.org/10.7860/JCDR/2017/28075.10994 Analysis of Role of Angiogenesis in Epithelial Dysplasia: An Immunohistochemical Study Sonia Gupta, Vineeta Gupta, Nutan Tyagi, Ruchieka Vij, Hitesh Vij, Ettishree Sharma <b>Introduction:</b> Vascular Endothelial Growth Factor (VEGF) is an angiogenic cytokine which induces endothelial cell proliferation, migration and is important in developing new vascular beds. CD34 is a heavily glycosylated type I transmembrane glycoprotein and considered as an important marker for tissue vascularisation which represents microvascular density in the tissue. <b>Aim:</b> The aim of the present study was to assess, compare and correlate the expression of VEGF and CD34 in normal oral mucosa and in different grades of epithelial dysplasia to infer if angiogenesis has a role in progression of epithelial dysplasia. <b>Materials and Methods:</b> A retrospective study was conducted on 40 formalin-fixed, paraffin-embedded tissue blocks, including normal oral mucosa (10 cases), mild epithelial dysplasia (10 cases), moderate epithelial dysplasia (10 cases) and severe epithelial dysplasia (10 cases) which are histopathologically diagnosed using Hematoxylin and Eosin (H&E). VEGF expression was observed on the basis of localization, intensity and area of stained cells whereas, CD34 expression was assessed in relation to the localisation and microvessel density. <b>Results:</b> The expression of VEGF and CD34 was found to increase significantly during the transition from normal oral mucosa to severe oral epithelial dysplasia. A statistically significant correlation (p<0.001) was observed between VEGF and CD34 expression. <b>Conclusion:</b> The evaluation of expression of VEGF in the epithelium and CD34 in the connective tissue can be an adjuvant aid for the assessment of the severity of the lesions in biopsy specimens apart from the routinely used methods for histopathological diagnosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=EC29-EC34&id=10995 https://doi.org/10.7860/JCDR/2017/30853.10995 Investigation into the Factors affecting Death Anxiety in Iranian Students Abolfazl Khoshi, Hamid Sharif Nia, Hojjat Torkmandi <b>Introduction:</b> Death anxiety can have many effects on behaviour. Student’s dropout can be the result of student death anxiety. Death anxiety can be related to several factors in students of different countries . <b>Aim:</b> The present study was carried out in order to examine the factors affecting death anxiety in Iranian students. <b>Materials and Methods:</b> The present study was a cross-sectional investigation that was carried out using simple random sampling on 500 students attending universities of Tehran in 2016. The students’ demographic data were collected through a data registration form, and the extended version of Templer Death Anxiety Scale (51-item) was employed to collect data on the students’ death anxiety. Kolmogorov-Smirnov test, Leven’s test, ANOVA, and Independent t-test were employed in this study. <b>Results:</b> The mean score of death anxiety among the students was 21.7±7. The mean score of death anxiety was higher among the female students (22.86) than the male (20.98) students (p=0.006). The undergraduate and graduate students had the highest 21.90 (7.93) and the lowest 10.23 (4.64) levels of death and anxiety respectively. In comparison with the single students, the married ones experienced higher death anxiety (p=0.038). The results of the multiple linear regression analysis indicated that ‘women’ and the ‘married’ were the only remaining variables in the regression model that could be predictor variables. <b>Conclusion: </b>According to the findings of the present study, many students, in different levels and majors, experienced death anxiety. There was a relationship between gender, education level, marital status, and death anxiety. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=OC24-OC27&id=10996 https://doi.org/10.7860/JCDR/2017/27856.10996 Perceptions of Accredited Social Health Activists Regarding Teenage Pregnancy: A Qualitative Study in a Rural Area of West Bengal, India Aritra Bhattacharyya, Bijit Biswas, Shobhit Garg, Atanu Dey, Aparajita Dasgupta <b>Introduction:</b> Teenage pregnancy is one of the most important social and public health problems all over the world. Accredited Social Health Activists (ASHAs) may play a substantial role to reduce the magnitude of the problem. <b>Aim:</b> To understand the perceptions of ASHAs regarding teenage pregnancy and its preventive measures. <b>Materials and Methods:</b> This was a qualitative study which included 10 ASHAs in Singur block. A focussed group discussion guide was prepared with following themes-Theme 1: Knowledge of teenage pregnancy, legal age of marriage and pregnancy, Theme 2: Burden of teenage pregnancy, Theme 3: Reasons behind teenage pregnancy, Theme 4: Harmful effects of teenage pregnancy, Theme 5: Role of health workers in reducing burden of teenage pregnancy, Theme 6: Role of government in reducing burden of teenage pregnancy and Theme 7: Suggestions for reducing burden of teenage pregnancy. The analysis of the reports was done thematically. <b>Results:</b> It was found that teenage pregnancy though reported less in past few years still exist in the rural society. The main reasons reported for such finding was lack of education, lack of awareness about ill effects of teenage pregnancy, lack of women empowerment, early marriage, poor knowledge of family planning services etc. ASHAs said that it may be reduced by means of personal counselling, women empowerment, monthly awareness meetings, provision of sex education at school level, intersectorial coordination at all levels of health care delivery system and provision of more stringent law against early marriages. Sociogram shows fair amount of participation that strengthen the study results. <b>Conclusion:</b> The study revealed that burden of teenage pregnancy is though low but still exists. ASHAs highlighted facts regarding teenage pregnancy and their laid suggestions which may help policy makers to design suitable interventions and conduct further study with broader conceptual framework in future. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=LC09-LC14&id=10991 https://doi.org/10.7860/JCDR/2017/31103.10991 Peri-operative Inotrope Use in Off Pump Coronary Artery Bypass Graft Surgeries Nidheesh Chooriyil, Dhanya Sasidharan Palappallil <b>Introduction:</b> Off-Pump Coronary Artery Bypass Graft (OPCABG) surgery is now widely accepted and practiced. The literature on inotrope use in OPCABG is sparse. <b>Aim:</b> To look into the intra-operative and immediate post-operative (up to 12 hours after skin closure) use of inotropes in OPCABG. <b>Materials and Methods:</b> This was a prospective observational study done in the cardiac surgery department of Apollo Hospitals, Greams Road, Chennai, India. All the patients undergoing OPCABG from 1st August 2011 to 31st October 2011 were recruited after getting their informed consent. Data was analysed using SPSS 16.0. Descriptive data were expressed as frequencies (percentages) and chi-square test was done to find association of inotrope use with independent variables. <b>Results:</b> A total of 180 patients with mean age 59±10.18 years and male: female ratio 8.47:1 were included. Intra-operatively 56 (31.1%) received inotropes while 81 (45%) received them in the immediate post-operative period. More than one inotrope was given to 16 (8.89%) patients intraoperatively and 29 (16.11%) post-operatively. The most commonly used inotrope was noradrenaline. Age 46-60 years [Odds Ratio (OR) 2.04], 76-90 years (OR 0.17), Smoking (OR 2.09), moderately reduced ejection fraction (OR 2.68), left main coronary artery disease (OR 1.3) and use of two or more grafts (OR =1.93) were significant predictors of intraoperative inotrope use. Post-operative inotrope indicators were moderately reduced ejection fraction (OR 2.64), left main coronary artery disease (OR 2.5) and use of two or more grafts (OR =7.03). <b>Conclusion:</b> The predictors of inotrope use in OPCABG are not different from that published literature for conventional CABG. Larger cohorts of both off pump and on pump CABG have to be studied to get a wider comparative angle. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=PC16-PC19&id=10998 https://doi.org/10.7860/JCDR/2017/30857.10998 Association between Physical and Sexual Violence and Mental Health in Suburban Women of Zahedan: A Cross-sectional Study Samira Khayat, Mahrokh Dolatian, Ali Navidian, Zohreh Mahmoodi, Amir Kasaeian <b>Introduction: </b>Suburban population is a group at risk of violence and mental disorder due to inappropriate socioeconomic and environmental factors in informal settlements. Sexual and physical violence are associated with short and long-term mental health disorders. <b>Aim:</b> To investigate the association between physical and sexual violence and mental health status in suburban women of reproductive age. <b>Materials and Methods:</b> This correlational cross-sectional study assessed the sexual and physical violence and mental health among 400 suburban women living in Zahedan, Iran in 2016. Randomised one stage cluster sampling was used. General Health Questionnaire-28 (GHQ-28) and sexual and physical violence questionnaire was used for data collection. For data analysis, descriptive statistical methods, independent t-tests and linear regression analysis were performed. <b>Results:</b> In 400 samples, 72 (18%), 156 (39%) and 248 of women (62%) experienced physical violence, sexual violence and mental disorders respectively. There were significant differences between the mean of GHQ-28 scores in groups with and without a history of physical violence (p<0.001) also in groups with and without a history of sexual violence (p=0.03). Linear regression analysis showed physical and sexual violence had significant relationship with GHQ-28 (p<0.001, p=0.03 respectively). <b>Conclusion:</b> Status of mental health of suburban women is inappropriate and is under effects of physical and sexual violence. Policy and planning to reduce violence, mental health promotion and providing acceptable service for these people are essential. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=IC01-IC05&id=10999 https://doi.org/10.7860/JCDR/2017/28411.10999 Assessment of Cytotoxicity of Titanium Tetrafluoride on Human Fibroblast Cell Line and Optimisation of Operational Conditions using Response Surface Methodology Tahereh Eskandarian, Mohammad Hossein Morowvat, Mahsa Zare <b>Introduction:</b> Fluoride products have an important effect on preventing Early Childhood Caries (ECC). Titanium tetrafluoride (TiF4)’s efficacy as a preventive agent suggests its use for inhibition of caries in man; however, its cytotoxicity is still questionable. <b>Aim:</b> To assess the optimisation of operational conditions via detecting the cell viability against TiF4. <b>Materials and Methods:</b> In order to find the optimal operational conditions after TiF4’s application on human Gingival Fibroblast-like cells (HGF1-PI 1), the Design of Experiments (DoE) based on Central Composite Design (CCD) was utilised. Concentration, pH and time of application of TiF4 solution were the three factors that were evaluated for optimisation of operational conditions. <b>Results:</b> The proposed optimal operational condition included 2.28% concentration of TiF4 solution with pH value of 1.89 and 1.09 minutes of application period. The model prediction of 86% cell viability at this optimal condition was verified experimentally at 82% of cell viability, presenting 95.34% of agreement. This consistency of the values proved the precision of the Response Surface Methodology (RSM) method to predict optimal operational conditions. <b>Conclusion:</b> The study introduced RSM as a precision and valid method to evaluate cytotoxicity of newly-developed dental materials. DOE-based studies could be successfully employed for optimising the operational conditions during TiF4 solution application to minimise the possible toxicity on fibroblast-like cells. Since the present proposed optimum conditions are in 95.34% of agreement with the experimental ones, thus these conditions can be considered as optimum operational conditions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=ZC23-ZC26&id=11000 https://doi.org/10.7860/JCDR/2017/29838.11000 Knowledge and Attitude Towards the Translation of Medical Research to Clinical Benefit Amongst Researchers in A Tertiary Care Hospital S Shanmugapriya, Deena Sangeetha, Ramalingam Sankaran <b>Introduction:</b> One of the primary goals of any biomedical researcher should be practical applicability or the translation of scientific discoveries to clinical care. Research that lacks potential for translation contributes to ineffective use of resources, time and manpower. Hence, it is important for researchers to be aware that the clinical significance should not be forgotten in the quest for a significant p-value. <b>Aim:</b> To assess the knowledge of researchers in ascertaining the practical applicability of his/her own research, to ascertain their motives in planning research and to evaluate the attitude of researchers towards the ethics of doing research that is less likely to translate into clinical benefit. <b>Materials and Methods:</b> This cross-sectional study was conducted at a tertiary care medical college hospital in South India. Teaching faculty from clinical, pre and para-clinical departments were administered a questionnaire which included 14 questions. The questionnaire consisted of five knowledge and nine attitude questions. The responses were analysed qualitatively and expressed as frequency distributions. <b>Results:</b> A total of 60 researchers were included and given the questionnaire. The respondent rate was 32 (53.3%). Only 3 (9.4%) were completely aware of “translational research” while about 11 (34.4%) knew that research done by pre and para-clinical sciences could be both basic and translational. Also, 17 (53.1%) of participants were willing to do research that did not result in either immediate or direct clinical benefit. A small minority of 4 (12.5%) admitted that the focus of their research was to achieve statistical significance. About 10 (31.3%) of researchers surveyed and felt that research offered an opportunity for free treatment to patients and 5 (15.6%) felt that therapeutic misconception was acceptable. <b>Conclusion: </b>This study identified the gap between knowledge and understanding of the practical applicability of research and its ethical perspectives amongst researchers and hence, indicates the need for increasing awareness on the importance of assessing the translatability of one’s research. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=FC01-FC05&id=10976 https://doi.org/10.7860/JCDR/2017/30896.10976 Aptitude of Medical Research in Undergraduate Students of a Medical University - Miles to go Before we Sow Simran Kaur Bains, Preetha John, Dhanushree Nair, Sourya Acharya, Samarth Shukla, Neema Acharya <b>Introduction:</b> In the era of modern medicine, research is a fundamental tool to study the natural behaviour of diseases and evidence based management of patients. Excluding a few developed countries, research is still a neglected field. India, being one of the most populated countries, is still behind when it comes to producing and publishing standard medical research publications. <b>Aim:</b> To evaluate the aptitude of research in undergraduate students of a medical university. <b>Materials and Methods:</b> A cross-sectional study was done with a validated questionnaire containing 12 objective questions to evaluate the current scenario of research amongst undergraduate students. The questionnaire was validated by the School for Health Professionals Education and Research (SHPER) of the university. It was distributed among 510 students from the dental and medical colleges of the Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India. The feedback data was collected and analysed using descriptive statistical analysis. <b>Results:</b> From the medical and dental colleges of the university, 510 students were surveyed. Four hundred and twenty students (82.35%) were aware of clinical research, out of which only 99 students (19.41%), actually participated in research. Thirteen students (13.13%) participated in research to better their chances of career abroad. Hectic schedule was seen as the foremost hindrance amongst 227 students (55.23%). Around 398 students (78.03%) sense research to be an important part of the curriculum. Around 430 students (84.31%) think that research should be taught as a part of the curriculum and 253 students (49.60%) wanted to pursue research as a career. <b>Conclusion:</b> Change can be brought about in the present scenario of contribution to research by undergraduate students from India on a global scale by making research a part of the curriculum and providing incentives to students. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=JC07-JC11&id=10972 https://doi.org/10.7860/JCDR/2017/29318.10972 Thyroid Profile in Patients of Cirrhosis of Liver: A Cross-sectional Study Sudhir Kumar Verma, Vivek Kumar, Pradyot Tiwari, Nikhil Kumar P Joge, Ravi Misra <b>Introduction:</b> Death anxiety can have many effects on behaviour. Student’s dropout can be the result of student death anxiety. Death anxiety can be related to several factors in students of different countries . <b>Aim:</b> The present study was carried out in order to examine the factors affecting death anxiety in Iranian students. <b>Materials and Methods:</b> The present study was a cross-sectional investigation that was carried out using simple random sampling on 500 students attending universities of Tehran in 2016. The students’ demographic data were collected through a data registration form, and the extended version of Templer Death Anxiety Scale (51-item) was employed to collect data on the students’ death anxiety. Kolmogorov-Smirnov test, Leven’s test, ANOVA, and Independent t-test were employed in this study. <b>Results:</b> The mean score of death anxiety among the students was 21.7±7. The mean score of death anxiety was higher among the female students (22.86) than the male (20.98) students (p=0.006). The undergraduate and graduate students had the highest 21.90 (7.93) and the lowest 10.23 (4.64) levels of death and anxiety respectively. In comparison with the single students, the married ones experienced higher death anxiety (p=0.038). The results of the multiple linear regression analysis indicated that ‘women’ and the ‘married’ were the only remaining variables in the regression model that could be predictor variables. <b>Conclusion: </b>According to the findings of the present study, many students, in different levels and majors, experienced death anxiety. There was a relationship between gender, education level, marital status, and death anxiety. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=OC06-OC09&id=10973 https://doi.org/10.7860/JCDR/2017/28033.10973 A Study on Relationship between Domestic Violence and Childhood Mortality in India: Using Weibull frailty Modelling Approach Ashish Kumar Yadav, Jeetendra Yadav, Sarvesh Awasthi, Subhash Gautam <b>Introduction:</b> Domestic violence is not an untold story in India but it often goes unreported. According to United Nation Population Fund Report, around two-third of married Indian women are victims of some form of domestic violence. A few studies, mostly from high-income countries, have suggested that domestic violence and under five mortality are linked. Little is known about the possible effect of violence against women on the survival of their offspring. Mosley and Chen had already established the proximate determinants of under-five mortality in developing countries, and accordingly, a lot of emphases have been made on these factors to reduce under-five mortality, but unfortunately, we still are lagging far behind compared to other developed countries. <b>Aim:</b> To explore the relationship between domestic violence and under-five mortality rate in India. The specific objectives of the study were to compare under-five mortality by mother’s exposure to domestic violence and to evaluate whether domestic violence acts as an unobserved heterogeneity variable (frailty) that may influence under-five mortality. <b>Materials and Methods:</b> The present study uses National Family Health Survey (NFHS-3) data of India. The third round NFHS-3 in India was completed during 2005-06 covering a nationally representative sample of ever married women aged 15-49 years. The study type was descriptive and the study design was cross-sectional. For the present study aggregated national data of 124,385 women having 51,555 live births and experiencing 3,551 under-five mortality was considered. Modified Conflict Tactics Scale (CTS 2) was used to assess domestic violence experience. Kaplan-Meir method was used to compare survival estimates of under-five mortality by mother’s exposure. Logistic regression was used to assess the odds of under-five death in children of mothers exposed to domestic violence. Extended Weibull Proportional Hazard model (PH model) with domestic violence as frailty variable was used. <b>Results:</b> Out of total 124,385 women surveyed 67% (N=83704) women had experienced physical violence in the past 12 months. The study included 51,555 live births out of which 3,551 experienced under-five mortality. More than 35% (N=1245) of children who died before completing their fifth birthday belonged to mothers who were victims of domestic violence. It was found that the survival probability for a child whose mother was exposed to any form of violence was significantly lower than the child whose mother does not have any such experience. The risk of domestic violence was significantly high (30-38%) among mothers who reported unwanted pregnancies and abortions (36-73%). <b>Conclusion:</b> The major finding of the study was that domestic violence was acting as significant frailty variable suggesting that it should be considered along with already established proximate determinants of under-five mortality in India. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=SC05-SC10&id=10980 https://doi.org/10.7860/JCDR/2017/27670.10980 Effect of Health-related Lifestyle Self-management Program on Quality of Life of Patients with Ischaemic Heart Disease: A Quasi-experimental Study Roya Amini, Maryam Rajabi, Alireza Soltanian <b>Introduction:</b> Ischaemic Heart Disease (IHD) is the most common type of heart diseases and also the major cause of death or disability. This disease affects the Quality Of Life (QOL) of the patients. <b>Aim:</b> To investigate the effect of a Health-related Lifestyle self-Management (HELM) program on QOL of the patients with IHD. <b>Materials and Methods:</b> The present quasi-experimental study was conducted on 92 patients using convenience sampling method. Data collection was performed using the demographic and the MacNew QOL questionnaires. All the participants completed the questionnaires in two sessions (at the onset of the study and after eight weeks). In the case group, a lifestyle self-management program was executed along with the daily records; while the regular trainings were performed in the control group. Analysis of the obtained data was performed using Statistical Package for Social Sciences (SPSS) version 16.0, Kolmogorov-Smirnov test, Chi-square test, Fisher’s test, Independent t-test, paired t-test, and descriptive tests. <b>Results:</b> There was no significant difference between the two groups in terms of the demographic variables including age, gender, education, occupation, and marital status. Based on the results, before the intervention, the two groups had no significant difference in terms of the mean scores of the QOL (p>0.05); while, comparing the groups after the intervention indicated significant differences in the scores of QOL as well as in three fields emotional, physical, and social fields (p<0.05). In addition, the mean score of the QOL of the control group showed no significant difference before and after the intervention (p>0.05), but difference of the same score in the test group before and after the intervention was statistically significant (p<0.05). <b>Conclusion:</b> Findings of the present study showed that the HELM program affected the QOL of the patients with heart diseases, and thus such an interventional approach would help improving the QOL of the patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=LC05-LC08&id=10981 https://doi.org/10.7860/JCDR/2017/27874.10981 Profile of Multidrug Resistant Isolates from Paediatric Patients in a Tertiary Care Hospital, Puducherry A Malini, Nandita Banaji, AK Shanthi <b>Introduction:</b> Nowadays, antimicrobial resistance is a challenge faced by physicians globally. Infections due to Multidrug Resistant Organisms (MDROs) is a significant problem in Paediatric Intensive Care Unit (PICU). <b>Aim:</b>To identify the burden of antimicrobial resistance in hospital isolates from paediatric patients and elucidate the resistance pattern of MDROs. <b>Materials and Methods:</b> A hospital based, prospective study was conducted for a period of two years. Samples from paediatric outpatients and inpatients were included and data were collected from those yielding growth on culture. Standard methods were followed for culture and antimicrobial susceptibility. <b>Results:</b> A total of 5443 samples were received, from 3881 patients, including urine, blood, exudate, respiratory specimens, stool and body fluids. Total 561 bacteria were isolated from these samples with the majority being from urine 419 (74.7%) and blood 86 (15.3%). Of the 419 bacteria from urine, 238 (56.8%) and of the 86 isolates from blood, 24 (27.9%) were multidrug resistant, respectively. Escherichia coli (E. coli) was the most common pathogen as well as the most common MDRO followed by Klebsiella species. Multidrug resistant Gram negative bacteria were sensitive to amikacin (73-88%), piperacillin-tazobactam (82-100%) and imipenem (82-100%). Enterococcus spp. was the most resistant organism among Gram positive bacteria. <b>Conclusion:</b> This study revealed a high prevalence of multidrug resistant pathogens among paediatric population. E. coli, Klebsiella spp. and Enterococcus spp. were the most common multidrug resistant pathogens, majority of them isolated from urine culture. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=DC06-DC10&id=10982 https://doi.org/10.7860/JCDR/2017/31895.10982 Is it Necessary to use Drain after Thyroid Surgeries? A Prospective Randomised Clinical Trial Asgari Abaszadeh, Mohammad Zamani, Askari Noorbaran, sekineh Kamali Ahangar, Mohammad Reza Sheikh Ansari, Novin Nikbakhsh <b>Introduction:</b> In the past, drains were used in thyroid surgeries due to the fear from hematoma and airway obstruction. However, the utilization of this technique is not generally accepted nowadays and some surgeons prefer not to use it. <b>Aim:</b> To investigate the advantages and disadvantages of drain application in thyroidectomy. <b>Materials and Methods:</b> In this clinical trial, 180 patients undergoing thyroidectomy surgery between January 2013 to March 2015, were randomly assigned into two groups of with and without drain by random allocation. The patients were visited in the first, third and 30th day after the surgery and were examined for post-operative complications, such as hematoma, seroma, infection, transient hypocalcaemia and recurrent laryngeal nerve paralysis. The demographic information and informed consent were collected from all subjects. Data were analysed using chi-square and t-test tests. A p-value <0.05 was considered significant. <b>Results:</b> None of the patients in both groups showed hematoma, seroma, infection or recurrent laryngeal nerve injury. Sixteen patients 17.7 (45.7%) in the no-drain group and 19 patients 21.1 (54.3%) in the drain group had transient hypocalcaemia on the first day, but the difference was not significant. Duration of the surgery in the group without drain (131.94 ± 38.85 min) was significantly less than in the group with drain (147.22 ± 39.31 min) (p=0.009). The duration of hospitalisation in the no-drain group (2.18 ± 0.08 days) was less than the group with drain (2.36 ± 0.67 days), but the difference was not significant. <b>Conclusion:</b> The results of the study indicated that lack of use of drains was not associated with any complications, but also could reduce the patients’ discomfort. Therefore, drain use after thyroidectomy seems not to be necessary, at least in patients https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=PC07-PC10&id=10965 https://doi.org/10.7860/JCDR/2017/29864.10965 Impact of Feedback on Continuous Cumulative Evaluation System for Learning in Physiology Puja Dulloo, Neeraj Vedi, Geetanjali Purohit <b>Introduction:</b> Effective feedback helps students to realize their error and confirm most appropriate response posed by them which moreover, magnifies their conceptual understanding. Implementation of the innovative feedback on formative assessment of Continuous Cumulative Evaluation System (CCES) at our institute primes the untrained minds towards better understanding of the assessed content. <b>Aim:</b> To determine the impact of feedback on CCES process in medical students on learning physiology. <b>Materials and Methods:</b> Non-randomized, purposive, survey questionnaire based study for 150 students enrolled in 2015 to 2016 for medical program of SBKSMIRC, Sumandeep Vidyapeeth University were considered. Three focus group discussions were conducted with eight students in each group after completion of session. Pre and post-test was conducted to assess learning outcome of students by feedback methodology. Data was collected, and analyzed statistically using paired t-test and correlation analysis for gender variability for perception. <b>Results:</b> Pre and post-test showed statistical significance (p<0.001) for learning outcome. Significant correlation for gender variation was observed for some of the survey questions. Focus Group Discussion (FGD) and survey results implied that students improved in the process of learning after receiving feedback. <b>Conclusion: </b>In depth understanding of the core context of the topic was achieved after receiving feedback with new approach for the formative assessment. This feedback method also showed good peer interaction and better compatibility with the instructor. However, majority disapproved applying the feedback to their future exams. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=CC01-CC05&id=10966 https://doi.org/10.7860/JCDR/2017/29128.10966 Effect of Transcutaneous Electrical Nerve Stimulation versus Home Exercise Programme in Management of Temporomandibular Joint Disorder Santosh R Patil, Kaladhar R Aileni <b>Introduction:</b> The aetiology of temporomandibular joint disorder is multifactorial and different therapeutic approaches have been adopted for effective management of this condition. <b>Aim:</b> To compare the effectiveness of Transcutaneous Electrical Nerve Stimulation (TENS) and Home Exercise (HE) in management of Temporomandibular Joint Disorders (TMD). <b>Materials and Methods:</b> Thirty six subjects who satisfied the Research Diagnostic Criteria for Temporomandibular Disorder (RDC/TMD) were randomly assigned to TENS group and HE group. TENS group patients were administered TENS therapy as per standard protocol and HE group patients were advised an exercise program consisting of active and passive mouth opening and closing exercises, isometric mouth exercises, mouth stretching exercises and resistive mouth exercises. Muscle pain, joint tenderness on Visual Analogue Scale (VAS) scale and maximum mouth opening scores were evaluated at pre-treatment visit, one, two, three and four week of treatment and compared using independent and paired t-tests. <b>Results:</b> A significant reduction in muscular and Temporomandibular Joint (TMJ) tenderness was observed in both TENS and HE groups. Comparing the both, the value obtained with the TENS was higher than HE at the end of fourth week (p<0.05). Although, significant reduction was observed with respect to maximum mouth opening in TENS group and in HE group at the end of the treatment period but a non-significant difference was observed when TENS and HE groups were compared (p>0.05). <b>Conclusion:</b> Transcutaneous electrical nerve stimulation and HE treatment modalities demonstrated similar effectiveness in the improvement of mouth opening. Hence, this study justify the use of TENS therapy as well as HE therapy in the management of TMD. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=ZC19-ZC22&id=10967 https://doi.org/10.7860/JCDR/2017/32761.10967 A Country Level Situational Analysis of Biomedical Waste Management: Evidence from DLHS-4 Nitika, Pallavi Lohani, Sidharth Sekhar Mishra, Swagata Mandal <b>Introduction:</b> As per WHO report, hospital waste generated is either general waste (80%) or infectious/toxic waste (20%) The infectious waste requires proper handling so as to avoid any spread of infections. <b>Aim:</b> This study was carried out to document existing infrastructure and practices related to Biomedical Waste (BMW) management at country level using District Level Health Survey–4 (DLHS-4) data. <b>Materials and Methods:</b> The facility level data from fourth wave of DLHS was used for the analysis. The outcome measures assessed were mode of disposal of infectious, non-infectious waste, and availability of various infrastructure related to waste disposal. Simple and two-way cross tabulations was done for important BMW management indicators. <b>Results:</b> The facilities are not following the practice of segregation. The similar worrisome situation was observed for availability of colour-coded bags at primary healthcare facilities. The recommended methods for disposal of BMW were better in health facilities of non- Annual Health Survey (AHS) states than their counterparts in AHS states. Sharps waste were seen in the vicinity of the facilities in about one-fourth of District Hospitals (DHs) in both AHS and non-AHS states <b>Conclusion:</b> BMW disposal infrastructure is not in place and proper guidelines are not being followed across the health facilities. To tackle the worrisome situation, training for the health staff should be conducted at regular intervals. Furthermore, the infrastructure required for BMW has to be provided at the health facilities so as to ensure the proper disposal. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=LC01-LC04&id=10968 https://doi.org/10.7860/JCDR/2017/28391.10968 Effect of Vitamin D Replacement Therapy on Glycaemic Control in Type 2 Diabetic Mellitus Patients Charu Agarwal, Sadhna Marwah, Bindu Kulshrestha, Anubhuti <b>Introduction:</b> Vitamin deficiency has been recently shown to play an important role in the onset and progression of Type 2 Diabetes Mellitus (T2DM). The present study was planned to look for the changes in Serum 25-hydroxyvitamin D [25(OH)D] concentration and subsequent risk of type 2 diabetes levels in diabetic patients after vitamin D supplementation. <b>Aim:</b> To study the effect of vitamin D therapy on glycaemic control in type 2 diabetes mellitus patients. <b>Materials and Methods:</b> The present study was conducted in the Department of Pathology, Biochemistry and Endocrinology over a period of one year from November 2010 to December 2011. The study design was open labelled randomised controlled trial. It was a prospective study. The study was approved by the Institutional Ethics Committee and written informed consent was obtained from all the patients. Oral cholecalciferol in a dose of 60,000 units was administered every 15 days for three months to group of 30 patients selected by simple randomisation technique. Changes in fasting and postprandial sugar levels, HbA1c, routine biochemistry and total vitamin D and Parathyroid Hormone (PTH) were assessed for all patients after three months. <b>Results:</b> The group supplemented with vitamin D showed a significant improvement in postprandial glucose levels (p= 0.016). Fasting glucose and HbA1c values also showed a decline but it was not statistically significant. <b>Conclusion:</b> It is concluded that supplementation of vitamin D for three months improved levels of post prandial sugar levels in vitamin D deficient T2DM patients in the present study. Thereby raising the vitamin D levels in patients at risk of T2DM may reduce their risk or slow the development of the disease. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=OC40-OC43&id=11009 https://doi.org/10.7860/JCDR/2017/29371.11009 Analysis of Lymphocyte Subsets Including Th17 Cells in Alcoholic Liver Disease Bidyut Bikash Gogoi, Vandana Raphael, Kyrshanlang Giri Lynrah, Akash Handique, Noor Topno, Ankit Jitani <b>Introduction:</b> Alcoholic Liver Disease (ALD), which consists of three major diseases: (1) fatty liver, (2) alcoholic hepatitis and (3) cirrhosis, is described to be associated with lymphopenia and an altered ratio of lymphocyte subsets but the reported results are not uniform. <b>Aim:</b> To compare the Absolute Lymphocyte Counts (ALC) and its subsets including T-helper 17 (Th17) or Interleukin 17 (IL-17) secreting lymphocyte subsets between ALD patients and controls and to correlate these findings with biochemical and radiology findings. <b>Materials and Methods:</b> Forty cases of ALD at various stages of presentation were included in the study along with equal number of age and sex matched healthy controls. Ultrasound abdomen and liver function tests were done in all cases. Peripheral blood was collected and subjected to flow cytometric analysis for estimation of CD3, CD4, CD8 and Th17 cells. <b>Results:</b> On ultrasound, 13, 19 and 8 cases were found to be fatty liver, chronic hepatitis and cirrhosis respectively. With advanced stage of ALD, there was a significant decrease in ALC, CD3, CD4 and CD8 and while Th17 increased markedly. ROC curves were made and Th17% of 2.44 was found to be the optimum level for predicting progression to chronic hepatitis and 6.07 for cirrhosis. <b>Conclusion:</b> Th17 levels increase while ALC, CD3, CD4 and CD8 cells decrease with advancing stage of liver disease. These may be potential markers for staging and prognostication of ALD. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=EC35-EC39&id=11010 https://doi.org/10.7860/JCDR/2017/30990.11010 Merits of Oil Pulling Therapy in the Management of Xerostomia and Stomatopyrosis in Burning Mouth Syndrome Achint Garg, Aakriti Bhatnagar, Srishti Tayal, Uday Pratap Singh <b>Introduction: </b>Burning Mouth Syndrome (BMS) is a condition which is characterised by xerostomia, stomatopyrosis, dysgeusia and primarily affects the women of perimenopausal age. Despite the plethora of trials that have been going on since decades for management of this condition, there seems to be no definitive cure till date, which is mainly attributed to the ambiguity of this condition. Oil pulling is a simple, ancient technique which can be used as an adjunctive or supplemental therapy in a number of conditions, including BMS. <b>Aim:</b> To assess the efficacy of oil pulling therapy using sesame oil on xerostomia and stomatopyrosis in patients suffering from primary BMS. <b>Materials and Methods:</b> This is a prospective study conducted at I.T.S. Dental College, Greater Noida, Uttar Pradesh, India, between April 2016 to April 2017 and included a total of 25 patients. On the basis of the detailed case history and complete haemogram, patients clinically diagnosed with primary BMS were advised oil pulling therapy once daily for a period of three months and symptoms of xerostomia and stomatopyrosis were assessed at the end of every month using Visual Analog Scale (VAS). Paired t-test was applied. The level of significance was set at p<0.05. The software used for analysis was SPSS software version 16.0. <b>Results:</b> All patients showed a statistically significant improvement in symptoms of both xerostomia and stomatopyrosis at the end of three months when compared with the baseline values (p=<0.05). <b>Conclusion:</b> Oil pulling therapy using sesame oil is found to be a simple yet effective modality with no harmful side effects, which can be advised to patients of BMS. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=ZC27-ZC29&id=11002 https://doi.org/10.7860/JCDR/2017/30414.11002 Efficacy of Combination Therapy of Rosuvastatin and Ezetimibe vs Rosuvastatin Monotherapy on Lipid Profile of Patients with Coronary Artery Disease Sandeep Joshi, Ruby Sharma, Harbir Kaur Rao, Udit Narang, Nitin Gupta <b>Introduction:</b> Dyslipidaemia is one of the most important modifiable risk factor for the development of Coronary Artery Disease (CAD). Although, statins are established as first line lipid-lowering therapy, they may not be able to achieve treatment goals in significant number of patients. Combination therapy of statin with a non-statin drug like Ezetimibe is a therapeutic option. <b>Aim:</b> To compare the efficacy and safety of Rosuvastatin/Ezetimibe combination therapy vs Rosuvastatin alone on the lipid profile of patients with CAD in Northern India. <b>Materials and Methods:</b> This randomized prospective study was conducted on 80 patients of CAD presenting to Department of Medicine, Government Medical College, Patiala, Punjab, India. The patients were randomly divided into age and sex matched two groups of 40 each. After baseline investigations and lifestyle modifications, Group I was started on rosuvastatin 10 mg once daily, while Group II was started on rosuvastatin 10 mg+ezetimibe 10 mg daily. The fasting serum lipid profile was repeated initially after 12 weeks and then after 24 weeks. The two groups were observed for side effects which were noted. <b>Results:</b> The combination therapy of rosuvastatin and ezetimibe resulted in significantly higher change in all lipid parameters (LDL-C, TC, TG, HDL-C) as compared to treatment with rosuvastatin alone. There was no difference in the adverse effects seen after treatment in the two groups. <b>Conclusion:</b> Our study showed that combination therapy of ezetimibe with rosuvastatin can be used as an effective and safe therapy in high risk patients of CAD, especially in patients in whom statin monotherapy is not able to achieve the target lipid levels. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=OC28-OC31&id=11004 https://doi.org/10.7860/JCDR/2017/30458.11004 Association between Overweight, Obesity in Relation to Serum Hs-CRP Levels in Adults 20-70 Years Kasukurti Lavanya, Kusugodlu Ramamoorthi, Raviraja V Acharya, Sharath P Madhyastha <b>Introduction:</b> The prevalence of overweight and obesity is progressively increasing in general population of India. There is a growing concern for obesity related morbidity and mortality. high sensitivity C-reactive Protein (hs-CRP), is an emerging inflammatory marker and a predictor of diabetes mellitus and ischaemic heart disease. <b>Aim:</b> To study the relationship of hs-CRP with Fasting Blood Sugar (FBS), Body Mass Index (BMI), Waist Circumference (WC), Waist-Hip Ratio (WHR), and fasting lipid profiles of obese and overweight normotensive and normoglycaemic subjects. <b>Materials and Methods:</b> The cross-sectional study was conducted on 228 subjects of age between 20-70 years from October 2014 to June 2016. The study included three groups of subjects based on BMI. Descriptive statistics were used for normally distributed variables. Pearson's correlation coefficient was used to find out the relationship among hs-CRP levels and different parameters in all groups. Linear regression analysis and multiple linear regression analysis were done to find out the independent factors affecting hs-CRP and to assess the final predictor of its variability. <b>Results:</b> Out of 228 subjects, 87 (38.15%) had normal BMI, followed by 64 (28%) and 77 (33.78%) subjects were overweight and obese respectively. About 75% of overweight and 93.5% of obese subjects had high levels of hs-CRP respectively. About 68.2% of subjects with impaired blood sugar level had high levels of hs-CRP. Pearson’s correlation coefficient ratio revealed moderate correlation of Total Cholesterol (TC), Low-Density Lipoprotein (LDL), TC/HDL (Total Cholesterol and High Density Lipoprotein) WHR with hs-CRP, with p-value <0.01. Linear regression analysis of various parameters with hs-CRP showed positive association (p<0.001) except Triglyceride (TGL) and negative association with HDL. FBS, BMI, WC, LDL, TC/HDL were found to be very significantly associated with hs-CRP on multiple regression analysis. <b>Conclusion:</b> Overweight and obesity have significant correlation with hs-CRP, suggesting obesity is a state of chronic inflammation, and hence, hs-CRP levels can be used in assessing future morbidity risk. With an increasing prevalence of obesity in India in recent years, which has a major adverse impact on the socioeconomic and healthcare sectors of the country, hs-CRP can be used to assess the risk of obesity related disorders for an early intervention. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=OC32-OC35&id=11005 https://doi.org/10.7860/JCDR/2017/32422.11005 Correlation Curve Correction and Spinal Length Gain in Patients with Adolescent Idiopathic Scoliosis-ARTICLE RETRACTED Hasan Ghandhari, Mir Bahram Safari, Ebrahim Ameri, Habib Kheirabadi, Ali Tabrizi Owing to some conflict the article has been retracted Date to Retraction: 6 June 2018 https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=RC01-RC04&id=11006 https://doi.org/10.7860/JCDR/2017/29396.11006 Effects of 60° Semi-recumbent Position on Preventing Ventilator-associated Pneumonia: A Single-blind Prospective Randomised Clinical Trial Hadi Hassankhani, Sharzad Akbarzadeh, Sima Lakdizaji, Atabak Najafi, Ebrahim Aliafsari Mamaghani <b>Introduction:</b> Head-of-Bed Elevation (HOBE) is now considered as a main modifiable factor for decreasing Ventilator-Associated Pneumonia (VAP) especially in the area of intensive care nursing. Despite numerous studies on the beneficial effects of different HOBE, there is little scientific evidence examining the effect of a 60° HOBE position. <b>Aim:</b> The present study aimed to examine the effect of 60° HOBE on preventing VAP and respiratory parameters in mechanically ventilated patients. <b>Materials and Methods:</b> In a single-blind prospective randomised clinical trial, 25 patients were recruited in the multidisciplinary surgical intensive care unit over a period of a year (June 2011 to April 2012), and randomly assigned to the intervention group maintaining position of 60° (n=14) and the control group in the routine position of 45° (n=11). VAP and respiratory parameters (tidal volume, pulmonary compliance, pulmonary resistance, and respiratory rate) were investigated from first to the seventh day of intubation. <b>Results:</b> HOBE at 60° resulted in significantly lower pulmonary infiltration on chest X-ray (p=0.009), lower axillary temperature (p=0.001), as well as higher tidal volume (p<0.001) and higher pulmonary compliance (p=0.038) compared with the control group. The overall prevalence of VAP was 20% in the intervention group and 73% in the control group (p=0.016). In this regard, HOBE from 45° to 60° reduced the risk of VAP more than three times. <b>Conclusion:</b> HOBE at 60° results in a significant decrease in the occurrence of VAP and also improvement in some mechanical respiratory parameters including tidal volume and pulmonary compliance. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=OC36-OC39&id=11007 https://doi.org/10.7860/JCDR/2017/27443.11007 A Prospective, Randomised, Double-blind Comparative Study for Efficacy of Paravertebral Block By Ropivacaine in Postoperative Analgesia after Percutaneous Nephrolithotomy Pankaj N Maheshwari, Vinayak Gorakhnath Wagaskar, Ashish A Pathak, PS Garcha, Tanaji Mhatre <b>Introduction:</b> Percutaneous Nephrolithotomy (PCNL) is a painful procedure that involves placement of large bore access sheath in the flank through which stones are fragmented and then removed. Inability to control this pain may hamper discharge from hospital and might lengthen their return to work. <b>Aim:</b> To evaluate the efficacy of Paravertebral Block (PVB) with ropivacaine on postoperative pain management in patients after PCNL. <b>Materials and Methods:</b> A prospective randomized double-blind comparative study was conducted from January 2012 to December 2013 in 60 adult patients posted for PCNL. Sixty patients were randomized into two groups of 30 each: Group A received PVB with ropivacaine while Group B was the control group who did not receive PVB. In the postoperative period, the pain status of patients was evaluated at postoperative 6 and 24 hours by using the Visual Analogue Scale (VAS). Continuous data were described as mean±standard deviation and categorical variables are given as number (%). Continuous variables were compared using t-test for two independent samples. Percentages were compared using Chi-square analysis. <b>Results:</b> There was no statistically significant difference between the two groups regarding the demographic characteristics, surgical complications, and postoperative hospital stay. Our findings revealed that in Group A, VAS score was lower significantly at 6 hours (p<0.001) but not at 24 hours (p=0.082). Requirement of rescue analgesia was lower (p<0.05), when compared with the Group B. <b>Conclusion:</b> PVB by Ropivacaine was shown to be safe and efficacious as an analgesia method after PCNL. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=PC20-PC22&id=11017 https://doi.org/10.7860/JCDR/2017/24378.11017 Etidronate as A Weak Chelating Agent on Root Canal Dentin: An Update Review Samah Samir Bedir, Hossam Mossa, Ahmed Mohammed Hassan Successful root canal treatment depends on proper biomechanical cleaning and shaping of root canal system followed by three-dimensional obturation. Irrigation solutions and chelating agents are used during root canal treatment to assist in smear layer removal and enhanced bonding with sealer. Different chelating agents are used in combination with irrigation solutions such as Ethylenediaminetetraacetic Acid (EDTA), Citric Acid (CA), mixture of doxycycline, citric acid and a detergent {Tween 80 (MTAD)}, chitosan, maleic acid and etidronate. Etidronate is a weak biocompatible chelating agent effective in smear layer removal with less harmful erosive effects on root canal dentin, compared with other strong chelating agents like EDTA and citric acid. Etidronate can be mixed with Sodium Hypochlorite (NaOCl) without interfering with its antimicrobial or dissolving activity while EDTA retains its calcium-complex when it is mixed with NaOCl reducing its tissue dissolving capacity. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=ZE05-ZE09&id=11015 https://doi.org/10.7860/JCDR/2017/29740.11015 The Effect of Climate Change on Cardiopulmonary Disease - A Systematic Review Ghader Ghanizadeh, Mohammad Heidari, Bahar Seifi, Hamid Jafari, Shahrzad Pakjouei <b>Introduction: </b>Researchers expect climate change to alter human health in important ways, with significant regional variations. This change has the potential to affect human health in many ways. Aim: To systematically review relevant literature in relation to the effect of climatic variables on cardiopulmonary function as an emerging health challenge. <b>Materials and Methods: </b>The present systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The key words “environment”, “weather”, “chronic obstructive pulmonary disease”, climate change” were used in combination with the Boolean operators “OR” and “AND”. We did electronic searches on PubMed, Science Direct, Springer Link and Google Scholar. The search was conducted with publication year limitation between January 2006 to June 2016. <b>Results:</b> A total of 1021 articles were extracted and 13 articles were selected for final review, based on the objective of the study. Results suggested that climate changes are not only an environmental and economic problem but also play a role in population health. Climate change parameters like temperature, humidity and air pollution can affect cardiopulmonary health. <b>Conclusion:</b> The study shows the effect of climate change on cardiopulmonary health, and identifies it as an emerging phenomenon that needs effective planning for emerging and re-emerging concerns. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=IE01-IE04&id=11012 https://doi.org/10.7860/JCDR/2017/26478.11012 Role of X-linked Inhibitor of Apoptosis Protein as Cancer Biomarker Manoj Pandey, Manisha Shrivastava, Shweta Mishra, Rashmi Bathri X-linked Inhibitor of Apoptosis Protein (XIAP), is one of the most important apoptotic inhibitors that plays a vital role in regulating various aspects of cell functions including cell cycle progression, arrest, and apoptosis. It is one of the most potent and widely studied members of the Inhibitors of Apoptosis Protein (IAP) family which promotes cell survival by inhibiting both extrinsic and intrinsic pathway of apoptosis depending on its intracellular concentration. It blocks major molecules (caspases-3, 7 and 9) which leads to the apoptosome formation responsible for cell death by neutralising caspases-3, 7 and caspase-9, through BIR3 and BIR2 domain respectively. As XIAP has a dominant contribution in the suppression of apoptosis in cancer cells and promotes cell growth, it plays an important role in development of various types of cancers. Overexpression of this protein is directly correlated with the prognosis of different malignancies. The property of XIAP as an apoptosis inhibitor with overexpression in different cancers makes it a useful therapeutic target for cancer therapy especially in resistant tumours and is a focus of molecular and clinical research both in vitro and in vivo. This review summarizes current knowledge on differential roles of XIAP as a cancer biomarker in common malignancies, its role as a predictive and prognostic tool and therapeutic target for cancer therapy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=XE01-XE05&id=11013 https://doi.org/10.7860/JCDR/2017/29896.11013 A Case of Idiopathic CD4 Lymphocytopenia (ICL): Immunological Mystery Leading to Storm of Diseases Ram Manohar Talupula, Tom Jose Kakkanattu, Arvind Kumar, Ajay Gogia, Naveet Wig In medicine for any disease, common differentials should be thought first but in cases of recurrent and resistant infections where desired result is not achieved with protocol and evidence based management, other rare causes should come into our minds. In this case, after extensive academic review, we ultimately reached to a very rare diagnosis of idiopathic CD4+ deficiency. So, in cases of chronic and recurrent resistant to treat infections, besides known causes of secondary immunodeficiency, idiopathic CD4+ deficiency should also be kept in mind. While labelling it idiopathic today, it should be realised that before 1992, CD4+ deficiency associated with HIV was also thought to be idiopathic. Here we describe a case, which started as a routine case of tubercular lymphadenitis but had a rare underlying aetiology. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=OD01-OD03&id=10941 https://doi.org/10.7860/JCDR/2017/29358.10941 Castleman Disease Presenting with Cervical Adenopathy in a Four-Year-Old Girl: A Case Report and Review of Literature Ankur Singh, Vijay Kumar Jha, Rajniti Prasad, Mohan Kumar, Om Prakash Mishra Castleman Disease (CD) is an uncommon cause of cervical lymphadenopathy in paediatric age group. Only few cases have been reported from outside Indian Subcontinent so far in paediatric age group (=18 years), presenting with cervical adenopathy. A four-year-old girl child presented to the our OPD with bilateral enlargement of cervical lympho nodes. FNAC of cervical node revealed CD. Child responded well to conservative treatment and is in follow up without any of recurrence and need of surgery. This case highlights the overall benign course of disease in unicentric hyaline vascular type CD. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=SD01-SD03&id=10971 https://doi.org/10.7860/JCDR/2017/26622.10971 Tracheal Amyloidosis Presenting as Life Threatening Airway Obstruction Alkesh Kumar Khurana, Vikas Gupta, Abhishek Goyal, Ganakalyan Behera, Garima Goel We hereby present a case of a 62-year-old man who presented with tracheostomy in situ for the last two years and unexplained etiology for the life-threatening airway compromise. Thorough work up revealed tracheal amyloidosis as the cause for airway obstruction. This case describes not only the uncommon presentation of the disease but also the isolated nature of deposition of amyloid. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=OD06-OD07&id=10992 https://doi.org/10.7860/JCDR/2017/31992.10992 ER PR Positive Vulval Leiomyoma with Myxoid Change Mimicking Bartholin’s Cyst- A Rare Presentation Mithila Bisht, Ranjan Agrawal, Menka Verma, Parbodh Kumar Vulval leiomyomas are rare entities which are seen in the reproductive age group. They are most commonly misdiagnosed as Bartholin’s cyst or Bartholin’s abscess when presenting with features of inflammation. Excisional biopsy is the treatment of choice. Besides this, Estrogen Receptor (ER) and Progesterone Receptor (PR) positivity implicates the usefulness of adjuvant hormonal therapy. We present a case of 38-year-old female who presented with a vulval swelling. She was misdiagnosed clinically as Bartholin’s cyst. Marsupialization of the cyst was done and tissue was sent for histopathology. Microscopy confirmed the diagnosis of vulval leiomyoma with myxoid changes. Additionally, immunohistochemical stains were was also applied, which showed positivity for Vimentin, Desmin, ER and PR and negativity for Pan Cytokeratin (CK), S100. ER and PR positivity is a rare finding in case of leiomyoma with myxoid changes. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=ED22-ED23&id=10997 https://doi.org/10.7860/JCDR/2017/30626.10997 Improved Outcome with Gefitinib in Recurrent Middle Ear Squamous Cell Carcinoma Satyajeet Rath, Madhup Rastogi, Ajeet Kumar Gandhi, Paritosh Pandey, Sambit Swarup Nanda Middle ear and external ear malignancies are rare. There is lack of consensus in managing such cases. Surgery followed by radiotherapy is the best option for advanced cancers, while radiotherapy alone in radical doses is sufficient for early disease. There is also dearth of literature in management of recurrence or metastasis. We present the case of a 25-year-old boy who had recurrence following surgery and radiotherapy for middle ear Squamous Cell Carcinoma (SCC). He was started on gefitinib and showed remarkable improvement in symptoms within two months of the treatment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=XD04-XD05&id=10989 https://doi.org/10.7860/JCDR/2017/34511.10989 Aneurysmal Bone Cyst of C2 Cervical Spine Presenting as an Asymptomatic Posterior Neck Swelling Pradosh Kumar Sarangi, Jayashree Mohanty, Sasmita Parida, Basanta Manjari Swain, Sunil Kumar Aneurysmal Bone Cysts (ABC) are benign tumour-like expansile lytic lesions commonly affecting metaphysis of long bones. They are relatively rare in vertebral column accounting for about 12 to 30% of all ABC cases, predominantly involving posterior elements. ABC of cervical spine account for only 2% cases. They commonly present as back pain, palpable mass, spinal deformity, rarely pathological fracture and neurological deficit (paraplegia, cord compression, and cauda equina syndrome). Surgical treatment of ABC of cervical spine in paediatric patients is challenging because of proximity of lesions to neurovascular structures and the potential remaining growth of the spine. Here, we report a case of ABC of C2 vertebra with isolated posterior arch involvement who presented with a palpable posterior nuchal swelling and skin discoloration without any neurological deficit or difficulty in neck movement. Biopsy led to the definite diagnosis of ABC. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=TD01-TD03&id=10990 https://doi.org/10.7860/JCDR/2017/32660.10990 Concomitant Pulmonary Embolism and Acute Renal Failure in a Patient Undergoing Head Neck Surgery: A Case Report and Review of Literature Xin Yang, Shalva R Gvetadze, Lv Mingming, Jinbing Wang, Jun Li Surgical interventions for malignant neoplasms of the head and neck region bear a risk of general medical complications. Venous thromboembolism and pulmonary embolism is closely tied to patients suffering from carcinoma who are exposed to thrombotic events. These comprise the most common medical complications in patients undergoing head neck surgery. In patients with pulmonary embolism, the incidence of acute renal failure ranges is not rare. Rhabdomyolysis is an unusual and probably often overlooked clinical syndrome which may lead to acute renal failure and permanent myoglobinuric renal damage. Clinical case which is outlined here represents an example of pulmonary embolism combined with acute renal failure in a patient with no obvious risk factors after bilateral neck dissection. Rhabdomyolysis in such conditions may be an overlooked and underdiagnosed reason of acute renal failure development. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=MD01-MD03&id=10979 https://doi.org/10.7860/JCDR/2017/30254.10979 Management of Chronic Blink Related Microtrauma in Stevens-Johnson Syndrome with Oral Mucous Membrane Graft Transplantation: A Novel Approach Rahul Nandkishor Laturiya, Syed Mohiuddin Ahmed, Priyanka Mallikarjun Tapsale,Vishnukant Vankatrao Ghonsikar, Ahtesham Qurishi Ahmed A 26-year-old male was referred with sequel of Stevens-Johnson Syndrome (SJS) in form of bilateral severe keratinisation of lid margin and Symbhlepharon involving in particular forniceal region. At the time of presentation his visual acuity was 20/120. Indirect ophthalmoscopic examination revealed normal optic nerve head with attached retina. Superficial dissection was done between palpebral and bulbar conjunctiva so as to release symblepharon and further ocular surface reconstruction was carried out with labial Mucous Membrane Graft [MMG]. His best corrected final visual acuity was 20/40 with well accepted graft indicating that this technique definitely improves visual acuity and alleviates patient discomfort by improving ocular surface milieu and hence, possibly further avoids deterioration of ocular surface in SJS. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=ZD04-ZD06&id=10984 https://doi.org/10.7860/JCDR/2017/30720.10984 Mammary Analogue Secretory Carcinoma of Salivary Gland – A Diagnostic Dilemma Chetan S Chaudhari, Shruti Chandrakar, Ganesh R Kshirsagar, Prashant V Kumavat, Nitin M Gadgil Mammary Analogue Secretory Carcinoma (MASC) of salivary gland is a recently described entity with unique morphologic, clinical and genetic characteristics, including the characteristic t(12;15)(p13;q25) with ETV6-NTRK3 translocation found in secretory carcinomas of the breast. Before their initial description, these salivary gland tumours were generally diagnosed as acinic cell carcinoma or adenocarcinoma. We present a case of 32-year-old, male presenting with painless swelling over left cheek which was gradually increasing in size. The histopathological examination of the lesion was done and two possible differential diagnosis were acinic cell carcinoma (papillary cystic variant) and MASC of the parotid gland. Immunohistochemistry was performed which demonstrated combined positivity for S-100, mammglobin, CK-7 and DOG-1 negativity which confirmed the diagnosis of MASC of parotid. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=ED13-ED14&id=10961 https://doi.org/10.7860/JCDR/2017/32246.10961 Primary Paraganglioma of the Thyroid Gland- A Rare Case Report Manjot Gill, Arnav KR Roychoudhury, Shaffy Thukral, Anshul Gupta, Nidhi Bansal Paragangliomas are uncommon neoplasms that can arise in adrenal as well as in extra-adrenal paraganglia of the Autonomic Nervous System (ANS). Thyroid paraganglioma is a rare tumour that can be frequently mistaken for other thyroid neoplasms. Increased awareness is essential for avoiding diagnostic pitfalls regarding their characteristic features. We describe here a case of primary paraganglioma of thyroid gland. The neoplastic cells were strongly and diffusely immunoreactive with chromogranin. It showed a delicate S-100 protein positive supporting sustentacular framework. Level of calcitonin was also checked and found to be negative. We also reviewed the literature to summarize the characteristics of this distinctive lesion of thyroid gland. Though, a very rare paraganglioma, it should be included in the differential diagnosis of hypervascular thyroidal neoplasms. The gold standard of diagnosis relies on the histopathogical findings along with adjunctive immunohistochemical studies. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=ED15-ED16&id=10962 https://doi.org/10.7860/JCDR/2017/32355.10962 Actinomycosis Calcaneum- A Rare Case Report Vipin Sharma, Abhimanyu Virmani, Manik Sehgal, Ravi K Soni, Seema Sharma Actinomyces is anaerobic, gram-positive bacilli that superficially resemble fungi and give rise to suppurative and granulomatous infection. The organisms are commensals to human body but under suitable conditions can involve any organ system. Cervicofacial actinomycosis is the most common presentation while actinomycosis of extremity especially calcaneum is very rare. We report a rare case of 40-year-old woman who presented with chief complaints of pain and swelling of the right foot for one year. She was diagnosed with isolated calcaneal actinomycosis and was managed by antibiotics, curettage of calcaneum and triple arthrodesis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=RD01-RD03&id=10950 https://doi.org/10.7860/JCDR/2017/28475.10950 <i>Rothia dentocariosa</i> Infection in a Critically Ill Patient with Multiple Myeloma- First Case Report from India Kausalya Raghuraman, Nishat Hussain Ahmed, Frincy Khandelwal Baruah, Rajesh Grover Rothia dentocariosa is a Gram positive organism, known to cause infection very rarely in immunocompromised patients. We report isolation of Rothia dentocariosa in blood and Cerebrospinal Fluid (CSF) of an elderly patient with multiple myeloma. The present case highlights pathogenic role of an uncommon Gram positive organism. To the best of our knowledge Rothia dentocariosa is being reported for the first time from India, in an immunocompromised patient with haematological malignancy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=DD01-DD03&id=10951 https://doi.org/10.7860/JCDR/2017/30698.10951 Osteochondrolipoma – A Rare Entity at a Rare Site Manjula Jain, Shivali Sehgal Osteochondrolipoma is an extremely rare histological variant of lipoma with most reported cases in the head and neck area and the upper half of the body. We report a case of osteochondrolipoma occurring in the right distal fibula of an 11-year-old female. The physical examination revealed a painless, firm swelling over the right ankle joint with no history of trauma preceding it. Histologically, the tumour showed the presence of sheets of mature adipose tissue admixed with mature bony trabeculae. Also, seen in between were the foci of cartilage, proliferating fibroblasts, numerous blood vessels with the evidence of endochondral ossification favouring the diagnosis of osteochondrolipoma. Considering its rare site, the clinicians and pathologists should regard osteochondrolipoma as a possible diagnosis for a well-defined, calcified/ossified mass in the lower half of the body. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=ED09-ED10&id=10952 https://doi.org/10.7860/JCDR/2017/30525.10952 Homozygous Protein C Deficiency in a Premature Infant- A Case Report Ravi Teja Juloori, Febe Renjitha Suman, Rithika Rajendran, B Uma Maheswari Homozygous protein C deficiency is a rare autosomal recessive inherited disorder manifesting as neonatal purpura fulminans. A two-day-old male baby delivered at 31 weeks developed purpuric lesions over the left medial malleolus progressing to other areas. Investigations done showed no detectable protein C activity. Genetic testing identified a homozygous mutation at PROC gene Exon 7; p.Arg211Gln. The diagnosis of inherited homozygous protein C deficiency was made. Heterozygous mutation was identified in the parents. Genetic analysis to detect the heterozygous state in the parents will help in prenatal diagnosis in future pregnancies and in genetic counseling. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=ED11-ED12&id=10953 https://doi.org/10.7860/JCDR/2017/32141.10953 A Case of Undiagnosed Diabetes Mellitus with Alcohol Dependence Presenting as Epilepsia Partialis Continua Debjit Roy, Arvind Nongpiur, Amrita Sarkar, Manoj Prithviraj Non-Ketotic Hyperglycaemia (NKH) or hyperosmolar hyperglycaemic state is a rare cause of Epilepsia Partialis Continua (EPC) or any other types of seizures. However, it poses a diagnostic challenge when a previously undiagnosed diabetic patient presents with partial seizures owing to NKH. We report a 53-year-old male, alcohol dependent patient who was not a known diabetic, presenting with jerky movements of the right arm. He was initially started on phenytoin without any signs of improvement. His blood glucose was 900 mg/dL. He was treated in lines of NKH induced partial seizure with regular insulin infusion and the anti-epileptics were stopped. He showed dramatic improvement with control of blood glucose. We recommend that elderly patients presenting with first episode of partial seizure should be investigated for metabolic disorders along with imaging studies. Also, partial seizures in elderly patients with alcohol dependence should arouse suspicion for metabolic disorders. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=OD04-OD05&id=10954 https://doi.org/10.7860/JCDR/2017/30453.10954 An Unusual Case of Primary Plasma Cell Leukaemia Mimicking Acute Leukaemia: A Case Report and Review of Literature Abha Singla, Monica Gupta Plasma Cell Leukaemia (PCL) is rare and an aggressive disease accounting for only 2-3% of all plasma cell dyscrasias. Diagnosis is made when there are more than 2x109/L plasma cells in the peripheral blood or monoclonal plasmacytosis more than 20% of the Total Leucocyte Count (TLC). We report a case of 58-year-old male with history of high grade fever, generalized weakness and giddiness for two to three months. Peripheral blood film revealed marked leucocytosis with 88% of atypical cells resembling blasts. Flow cytometric immunophenotyping confirmed plasmacytic lineage. Bone marrow was planned but the patient deteriorated very rapidly and died within 3 days. PCL has no definitive treatment and has a dismal prognosis, requiring more extensive data to improve the disease course. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=XD01-XD03&id=10948 https://doi.org/10.7860/JCDR/2017/31003.10948 Dapsone Hypersensitivity Syndrome: A Potentially Fatal Condition – Case Report Harshad Vijay Kesari, Ujwala Pramod Gawali, Makbool Ali M Agharia Dapsone, an antimicrobial and anti-inflammatory drug, has wide applications. Dapsone Hypersensitivity Syndrome (DHS) is an Adverse Drug Reaction (ADR) ranging from mild cutaneous manifestations to severe life-threatening complications. A classic triad consists of fever, skin eruption and multi-organ involvement. If left untreated, it can be fatal. Organs involved must be identified and other possible causes need to be ruled out. Along with a brief review of DHS, this report emphasizes the need for awareness about ADRs among healthcare professionals as well as patients. We report a case of 30-year-old woman with lepromatous leprosy, started on the World Health Organisation (WHO) Multi-Drug Therapy (MDT) regimen, who presented with fever, malaise, diffuse rash with itching and epigastric discomfort that began on the 21st day of treatment. She had icterus, cervical lymphadenopathy, anaemia and deranged liver function test. Dapsone was withdrawn and intravenous dexamethasone and cefotaxime were given along with oral (antihistamines, vitamin supplements) and topical drugs. She was discharged after one week. With continuation of oral treatment and regular follow up, her recovery was complete after four weeks of treatment. As she reported early and received prompt treatment, her recovery was early with lesser morbidity. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=FD01-FD03&id=10927 https://doi.org/10.7860/JCDR/2017/30842.10927 Sterile Aortic Root Abscess Mimicking Calcified Aortic Nodule: A Rare Case Rupesh Kumar, Javid Raja, Alok Kumar Aortic root abscess or aortic annular abscess is a serious complication of aortic valve endocarditis. It usually occurs in patients with prosthetic aortic valve and coagulase-negative staphylococcal endocarditis. However, we came across a young individual of bicuspid aortic valve with no features of Infective Endocarditis (IE) with severe aortic valve regurgitation with sterile aortic root abscess and severe mitral valve regurgitation. He underwent repair of aortic root followed by replacement of both the valves with mechanical valve prosthesis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=PD01-PD02&id=10928 https://doi.org/10.7860/JCDR/2017/32112.10928 Factors Determining Adherence to Inhaled Corticosteroids in Bronchial Asthma Patients at a Tertiary Care Hospital in India Deepak Aggarwal, Manisha Bhardwaj, Bhavneet Singh, AK Janmeja <b>Introduction:</b> Non-adherence to inhalation therapy is a vital but a controllable factor in asthma management that affects disease control. Despite its known importance, there is scarcity of data on adherence to Inhaled Corticosteroids (ICS) among Indian asthma patients. <b>Aim:</b> To evaluate the prevalence of factors predicting medication (ICS) adherence in bronchial asthma using an objective adherence measure. <b>Materials and Methods:</b> Stable bronchial asthma patients on ICS with or without inhaled bronchodilators were enrolled and their relevant demographic and clinical information was recorded. Adherence to ICS was calculated by using an objective method (dose counters/pill counting) as well as through self-reporting adherence. Certain pre-defined; patients, disease and therapy related factors were evaluated for their association with medication adherence using each adherence method separately. <b>Results: </b>One hundred and three patients were enrolled in the study. Mean age of patients was 41.9±16 years. Females out numbered males in the ratio of 3:2. Medication adherence was seen in a total of 78 (75.7%) and 56 (72.7%) patients by self-reported adherence and objective measurement respectively. On applying multivariate logistic regression analysis, being literate, having poor forced expiratory volume in one second (FEV1), and knowledge about asthma were found to be independent determinants of adherence to ICS using both adherence methods. Use of Dry Powder Inhalers (DPI) was measured using subjective assessment and was found to be a significant factor. <b>Conclusion: </b>Knowledge about medication adherence and literacy are two important patient related modifiable factors predicting adherence to ICS in Indian patients with asthma. Objective monitoring of medication adherence seems to be a better tool than self reported adherence for the evaluation of adherence to ICS in asthma. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=OC14-OC18&id=10988 https://doi.org/10.7860/JCDR/2017/32568.10988 Dentinal Defects in Endodontically Treated Teeth using NiTi Rotary vs Reciprocating Endodontic Instruments- A Systematic Review Gaurav Lal Aidasani, Sanjyot Mulay, Vini Paresh Mehta, Rahul Anand <b>Introduction:</b> Nickel titanium (NiTi) instruments offer many advantages over conventional files. It is mandatory for the clinician to know the pros and cons of each endodontic file systems available today. With more root structure removed while increasing the diameter of the root canal, fracture resistance of the tooth is reduced thus, propagating dentinal craze lines. <b>Aim:</b> To critically review published in vitro reports comparing effects of rotary and reciprocating file systems on dentin defects of the root canal and to identify, synthesize and present an analysis of the available data. <b>Materials and Methods:</b> MEDLINE, The Cochrane Library, Science Direct, Wiley Online Library and Google Scholar were searched for studies from 1st January 2005 to 31st December 2016. Two reviewers independently screened the articles for eligibility criteria. In vitro studies comparing the formation of dentinal microcracks and defects caused by different rotary and reciprocating file systems were included. The main outcomes of interest was dentinal defects in endodontically treated tooth using greater tapered instruments. Only relevant studies that met the reviewer’s objectives were considered. <b>Results:</b> A total of eight articles out of 300 titles met the eligibility criteria which included 100 mandibular incisors, 60 mandibular first molars, 150 mandibular premolars, 100 mesiobuccal canals of mandibular molars, 180 mandibular premolars, 120 mandibular premolars, Seven distobuccal roots of maxillary molars, Seven mesial roots of the mandibular molars, 100 mandibular incisors, 100 extracted mandibular premolars. Almost all studies reported dentinal cracks with engine driven endodontic systems. One study showed a reciprocating system to produce more complete cracks than a rotary system. One study reported no cracks with self-adjusting file system. <b>Conclusion:</b> Mechanical instrumentation invariably produces micro cracks in the radicular dentin. While full sequence rotary instruments induce more complete dentinal craze lines, single reciprocating file systems produce more incomplete dentinal cracks. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=ZE01-ZE04&id=10970 https://doi.org/10.7860/JCDR/2017/28764.10970 Medical Education System in South Asia and its Consequences on our Health: A Review Syed Raza Shah, Rimsha Ahmed, Muneebah Munir, Safwan Masood, Yousuf Aijaz, Adil Al-Karim Manji, Saad AnasKhan Yousufzai South Asia is home to nearly one-quarter of the world's population, making it the most densely populated geographical region in the world plagued with high rates of communicable and non-communicable diseases, maternal and child mortality and morbidity and road traffic injuries, to name a few. The role and objective of medical education is to produce compassionate healers who then go on to serve society in their own capacity and as a collective unit. Every country wants a better system with good medical academics and specialists. The importance of medical education is slowly being acknowledged in medical schools across South Asia. Educational system suffering from weak financial models along with logistical hinderance due to political/social pressures have weak output. Countries of South Asia need to improve their medical education and system to achieve success and meet the standards of education being provided in other regions of the world. Medical schools in South Asia have been lacking quality and quantity of medical education since a long time due to weak and poorly defined curriculum. This curriculum needs to be improved according to the community needs and the country as a whole. It is mandatory to make new policies and plans to make this system better for quality health care. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=JE01-JE04&id=10983 https://doi.org/10.7860/JCDR/2017/29484.10983 Potency of Injectable Hydroxyapatite Chitosan Scaffold for Bone Regeneration Endang Winiati Bachtiar, Dewi Fatma Suniarti, Nadia Desti Fadhilah, Rahmi Ulfiana, Basril Abbas <b>Introduction:</b> Several methods are used to enhance bone regeneration and new bone formation. There is a significant clinical need to develop alternatives to autografts and allografts for bone grafting procedures. Biopolymer chitosan combined with hydroxyapatite have been investigated as bone grafts substitute in the form of injectable, porous and biodegradable structure. <b>Aim:</b> To evaluate the effect of Injectable Hydroxyapatite Chitosan (IHAC) Scaffold for rabbit femoral condyle bone regeneration by assessing its histological view. <b>Matertials and Methods:</b> The experiment was conducted on New Zealand White Rabbits. IHAC scaffold was transplanted into the femoral defect of a treated rabbit, while the control rabbit’s defect was left empty. Bone regeneration was analysed histologically using Modified Salkeld Histological Scoring, four weeks postoperatively. <b>Results:</b> Cortical bone fusion occurred better in the treated rabbit compared to control rabbit. Active osteoblasts were found in the periphery of the mature bone. Cortical bone had undergone complete maturation. Control rabbit still showed the presence of haemorrhagic area and fibrocartilage that indicated early phase of bone regeneration. <b>Conclusion:</b> IHAC scaffold is effective for treatment of bone defect by guiding the host response to regenerate the bone tissue. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=ZF01-ZF03&id=11003 https://doi.org/10.7860/JCDR/2017/29544.11003 Manifestation of Primary Syphilis in Two Extragenital Regions João Paulo De Carli, Silas Antonio Juvencio De Freitas Filho, Luiz Renato Paranhos, Gisele Rovani, Mateus Ericson Flores https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=ZJ01-ZJ02&id=10985 https://doi.org/10.7860/JCDR/2017/32730.10985 Linezolid Resistant <i>Enterococcus</i>: An Important Emerging Pathogen Isolated from a Non Healing Ulcer of a Diabetic Foot Patient Priya Datta, Varsha Gupta, Gursimran Kaur Mohi, Mandeep Kaur, Jagdish Chander https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=DL01-DL02&id=10969 https://doi.org/10.7860/JCDR/2017/26793.10969 Introduction of Another Approach of Ultrasound-Guided Maxillary Nerve Block via Pterygopalatine Fossa Ying Ying Lyu, Dong Ping Du https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=UL01-&id=10955 https://doi.org/10.7860/JCDR/2017/31668.10955 Implications of Coexistence of Diabetes and Liver Cirrhosis: Are Two Worse Than One? Ankur Gupta https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=OL01-&id=10963 https://doi.org/10.7860/JCDR/2017/34521.10963 Physical Activity in Building Stronger Community Vinoth Gnana Chellaiyan, Fasna Liaquath Ali, Murali Ramachandran Inadequate Physical Activity (PA) is one of the major risk factors contributing to global mortality. Community Wide Intervention (CWI) to increase PA at the community level is effective in not only the prevention but also in the control of Non Communicable Diseases (NCDs). In our analysis, we could observe that CWI are not satisfactory on the basis of their methodology and varying results. This article is a commentary on the study conducted by Kamada M et al. We could also infer that the standardised tool in measuring PA is not adequate and therefore, suggest to include comprehensive measurements such as anthropometric indices, diet and calorie calculations in future studies. The period of intervention usually recommended is six months to seven years to bring effective change in the PA among the total population. Studies should focus on adverse outcomes like unintended risk factors, injuries, and cost. We recommend multicomponent interventions like social marketing through mass media, individual counselling, screening of risk factors, focusing on target groups like adults, children, older people, and disabled people. Conducting interventional studies in workplace and creating access for PA would yield better results. We also suggest new strategies such as improving physical education in students, integrating physical education in their regular curriculum, encouraging change in physical behaviour and providing suitable environment for the physical activities. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=LM01-LM02&id=10964 https://doi.org/10.7860/JCDR/2017/29935.10964 Managing Exertional Heat Stroke Among the Combatants Santosh Kumar Singh, Sarvinder Singh, Bhaskar Shahbabu, Ajai T Kumar, Vani Singh Exertional Heat Stroke (EHS) is a medical emergency which when not addressed timely can lead to high mortality and morbidity. Armed forces are vulnerable to heat stroke because of their involvement in strenuous physical exercises in extremes of climatic conditions. The present case series aimed to analyse the clinical features, complications and effect of prompt treatment on the final outcome of the patients. Soldiers reporting with heat related cases were screened to identify those suffering from EHS and various relevant information was collected. It was found that 33.3% of patients were not acclimatised to the environment before taking part in strenuous physical activities and had deranged liver and renal function. Most (77.8%) of the patients had run 5 km just before having EHS. All patients had delirium on presentation and 16.7% had seizures. Majority (77.8%) of the patients had normal blood pressure on presentations. All patients developed diarrhea whereas liver enzymes were raised in 11.1%, 33.3% had renal failure and 11.1% developed multiorgan failure. On aggressive management with rapid cooling, intravenous fluids and other supportive medications, all patients of EHS recovered completely without any mortality and were discharged from the hospital within one week of admission, without any residual neurological deficit except two patients who developed multiorgan failure requiring haemodialysis for six weeks. Despite taking innumerable precautionary measures, EHS cannot be entirely prevented but continuous monitoring and aggressive management can lead to a great reduction in morbidity and mortality of the patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=OR01-OR04&id=10926 https://doi.org/10.7860/JCDR/2017/28015.10926 Leukemoid Reaction in Complicated Haemorrhagic Fever with Renal Syndrome Xiaopeng Yang, Sanming Chai, Xining Xu, Ling Hui, Meiliang Wang Hantaan Virus (HTNV) infections are mostly associated with fever, haemorrhagic and renal manifestations, known as Haemorrhagic Fever with Renal Syndrome (HFRS). We herein describe three cases with acute HTNV infection, confirming that HTNV infection may cause leukemoid reaction and prominent liver involvement, along with profound thrombocytopenia and mild to severe Acute Kidney Injury (AKI). These cases highlight the need for considering hantavirus testing in cases of thrombocytopenia, extreme leukocytosis, and fever of unknown origin, especially in areas endemic for the infection. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=December&volume=11&issue=12&page=IR01-IR03&id=10987 https://doi.org/10.7860/JCDR/2017/29306.10987