Journal of clinical and diagnostic research https://www.jcdr.net/back_issues.asp JCDR Bilateral Lateral Rotation of Kidneys with Unilateral Cryptorchidism Abhijit Jagdale, Vinitkumar Deshmukh, Bikash Parida, Sumit Patil, Sanjiv Thakur Different types of renal anomalies like renal agenesis, ectopic kidney, horseshoe kidney, aberrant renal arteries are common. However, renal rotational anomalies are relatively rare. The present case is unique and may be the first reported case of bilateral renal lateral rotation with unilateral cryptorchidism. During embryological development, kidneys ascend from the sacral region to the lumbar region while the testis descend downwards laterally from lumbar region to iliac part of pelvis and then medially downwards to scrotal sac through inguinal canal. The path of descent of testis and ascent of kidneys are fixed. We assume that in this patient due to lateral rotation of the kidneys, the lateralised ureter might had obstructed the descent of the testis. Developmental anomaly of the kidneys like lateral rotation can arrest descent of testis and cause cryptorchidism. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=PD01-PD02&id=11142 https://doi.org/10.7860/JCDR/2018/32810.11142 Emphasising the Distinctive Epithelioid Morphology and Clinical Connotation of Hepatic LECT2-Associated Amyloidosis (ALECT2): A Case Report and Review of the Literature DongHyang Kwon, Bhaskar V Kallakury Amyloidosis is a protein deposition disorder caused by pathologic accumulation of fibrils, leading to organ dysfunction. The newest protein is Leukocyte Cell-derived Chemotaxin 2 Amyloidosis (ALECT2), which shows ethnic predilection for Hispanics, Middle Eastern, and other minority groups. We report a case of 71-year-old Persian male with history of hepatitis B and resected hepatocellular carcinoma who presented with acute onset jaundice and abnormal liver function tests. Liver biopsy performed for diagnostic workup revealed hepatic ALECT2 with distinct signet-ring like globular proteinaceous deposits infiltrating hepatic parenchyma, mimicking epithelioid/histiocytic neoplasm. The infiltrative spherular material was positive for Congo red and negative for pan-keratin stains. Amyloid protein analysis by Liquid Chromatography tandem Mass Spectrometry (LC MS/MS) identified a peptide profile indicative of ALECT2. Although, ALECT2 accounts for the second most common cause of hepatic amyloidosis, only limited cases of hepatic ALECT2 are reported in the literature and little is known about patient management, especially the role of transplant as curative option. In summary, hepatic ALECT2 is an emerging disorder with relative high prevalence that deserves morphologic recognition. The report intends to emphasise distinctive morphology for accurate diagnosis and understanding its pathogenesis, clinical significance, and therapeutic strategies. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=ED01-ED03&id=11143 https://doi.org/10.7860/JCDR/2018/31043.11143 Importance of Mycologic Evaluation in Chronic Non Healing Ulcers Vivek Hada, Anuradha Sharma, Vijaya Lakshmi Nag, Kushwant Singh Rathore Chronic non healing ulcers are caused by various aetiologies ranging from infections, autoimmune disorders to neoplasms. Fungal infections are important yet neglected cause of non healing ulcers. In most of these instances there is a history of direct inoculation due to minor trauma. Presence of immuno-compromised state is an important risk factor. In this case report, we are discussing a case of 48-year-old immunocompetent female patient, who had undergone local debridement at a rural hospital about eight months back on her left foot, later she developed a chronic non healing ulcer at the site. Chronic non healing ulcers should always be investigated for bacterial as well as fungal aetiologies despite patient’s normal immune status to prevent misuse of antibiotics along with prolonged disability of the patient. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=DD01-DD03&id=11145 https://doi.org/10.7860/JCDR/2018/29917.11145 Compound (External) Dislocation of Testis: An Unusual Case Vijayakumar Chellappa, Anitha Muthusami, Ganesh Vijaykumar, Sudharsanan Sundaramurthi, TP Elamurugan Blunt testicular injury is a common entity. They usually lead to scrotal hematoma or contusion. Here we report an unusual case of compound dislocation of testis following blunt trauma to scrotum. A 40-year-old male presented to surgical casualty with history of blunt injury to scrotum following a road traffic accident. On examination, the left testes along with epididymis and distal spermatic cord was found prolapsing outside through a 1 cm wound in the lateral aspect of the root of left scrotum. The scrotal skin and the testes were found normal and viable. The patient underwent scrotal exploration and repositioning with orchidopexy. The mechanism of this injury in this case is unique because a blunt injury has caused separation of the testis from the scrotal thereby causing external dislocation of testis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=PD03-PD04&id=11146 https://doi.org/10.7860/JCDR/2018/30169.11146 A Rare Cause of Headache during Pregnancy Fabiane Amaral das Neves, Filipa Raquel Pereira Nunes, Maria Inês Marques Polónio Aneurysmal Subarachnoid Hemorrhage (SAH) during pregnancy is an important cause of maternal and fetal morbidity and mortality. Controversies still exist related to its diagnostic and treatment approach. This article aims to call attention to the importance of early diagnosis and treatment of intracranial aneurysm during pregnancy, through, a case report of a 38-year-old female, 38 weeks 5 days pregnant, with essential Arterial Hypertension (AHT), treated with Nifedipine, was admitted to the emergency room after suffering a mild headache. She presented high blood pressure and moderate proteinuria. She was also submitted to cranial-cephalic MRI, showing SAH and angio-MRI, confirming cerebral aneurysm of the right middle artery. Immediately afterwards, the patient underwent emergency cesarean section and aneurysm clipping. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=QD01-QD02&id=11147 https://doi.org/10.7860/JCDR/2018/30087.11147 Ureteric Obstruction due to Aberrant Vessel Masquerading as Retrocaval Ureter Sunirmal Choudhury, Pritesh Jain, Dilip Kumar Pal Aberrant vessels, although rare, may extrinsically compress ureter which on imaging may masquerade as retrocaval ureter. The exact cause of obstruction in such atypical cases can be confirmed intraoperatively. We are presenting a case which on basis of radiological features was diagnosed as a case of retrocaval ureter, however, intraoperatively it was found to be a case of ureteric obstruction due to an aberrant vessel. Thus, whenever on imaging an atypical feature of retrocaval ureter is found, differential diagnosis of aberrant vessels should also be kept in mind. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=PD05-PD06&id=11154 https://doi.org/10.7860/JCDR/2018/29216.11154 Bilateral Isolated Nasal Cleft Management: A Facile Solution or a Treatment Conundrum? Natarajan Chellappa, Parit Ladani, Hermann Sailer Alar defects are usually secondary to trauma or nasal tumour excision. Congenital alar defects are rare of which isolated bilateral nasal clefts are extremely sparse. Reconstruction of these bilateral nasal clefts poses additional challenge due to lack of equivalent structural analogue on the opposite side to weigh against. Myriad of strategies are available for management of these clefts ranging from intelligible rotation flaps to more complex grafting procedures. Here we present a case report of bilateral isolated nasal cleft management in a 17-year-old male patient and the hurdles involved in achieving the desired results. It is important for an astute surgeon to provide an aesthetically appealing result on the most dominant structure defining the mid face. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=ZD01-ZD03&id=11159 https://doi.org/10.7860/JCDR/2018/31620.11159 Application of Le Fort I Osteotomy for Post-traumatic Malocclusion Secondary to Condylar Fractures in an Elderly Patient: A Case Report Shinsuke Yamamoto, Toshihiko Takenobu, Izumi Kouchi, Yuzo Hirai, Naoki Taniike The condylar region is a common site of mandibular fractures, and inadequate treatment of condylar fractures causes an anterior open bite. This malocclusion reduces the quality of life and requires surgical intervention in some cases. However, in elderly patients with a relevant history, the treatment method should be minimally invasive and safe. Here we report a rare case on the application of Le Fort I osteotomy for post-traumatic malocclusion secondary to condylar fractures in an elderly patient. A 76-year-old man with a medical history of a cerebral infarction and diabetes mellitus was referred to our department with the chief complaint of malocclusion. The diagnosis was post-traumatic malocclusion mainly secondary to condylar fractures. Le Fort I osteotomy was performed to re-establish the occlusion. The postoperative course was uneventful and normal occlusion and good mandibular mobility was achieved. The course of this patient provides two important suggestions. First, Le Fort I osteotomy is effective in improving post-traumatic malocclusion secondary to condylar fractures. Second, this method is minimally invasive and safe for treatment of elderly patients. This case report highlights the usefulness of Le Fort I osteotomy for post-traumatic malocclusion secondary to condylar fractures in elderly patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=ZD04-ZD06&id=11166 https://doi.org/10.7860/JCDR/2018/30600.11166 Bronchogenic Cyst over Sternum–An Unusual Location Amol Jagdale, Shopnil Prasla, Saurav Mittal Bronchogenic cyst is congenital anomaly arising from the abnormal budding of the tracheobronchial tree during foregut maturation. The cyst is most commonly located in mediastinum and intraparenchymal region. Suprasternal region is considered as rare location for bronchogenic cyst to occur. Most of the cases of the cyst have been reported in male patient within paediatric age group. We report a 13-year-old female child with a swelling present over suprasternal region in midline since birth. Surgical excision was done and diagnosis was confirmed by histopathological examination. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=TD03-TD05&id=11181 https://doi.org/10.7860/JCDR/2018/22689.11181 Buparvaquone Intoxication: Report of a Life-Threatening Thrombocytopenia in a Child and Review of Literature Omid Reza Zekavat, Gholamreza Fathpour, Mohammadreza Bordbar, Sezaneh Haghpanah, Nader Shakibazad Drug induced thrombocytopenia is uncommon cause of life-threatening bleeding. The mechanisms may include bone marrow suppression or antibody-mediated platelet destruction. We report the case of a two-year-old boy with incedental ingestion of Buparvaquone (BPQ), which is a veterinary drug against theileriosis in cattle that efficiently inhibits tachyzoite replication of parasite. He presented with severe Gastrointestinal (GI) bleeding, petechiae and purpura. Laboratory findings showed severe thrombocytopenia. Intravenous immunoglobulin (IVIg) and Methylprednisolone were started for him. GI bleeding and thrombocytopenia was recovered. Therefore, in cases of life-threatening bleeding due to thrombocytopenia, we should also consider poisioning from drugs. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=SD01-SD03&id=11192 https://doi.org/10.7860/JCDR/2018/31088.11192 Multisystem Fibro Inflammatory Disease: A Rare Combination Sivakami Pradheepkumar, Ramesh Kumar Rudrappa Idiopathic Retroperitoneal Fibrosis (RPF) is a disease of unknown aetiology, characterised by extensive peri aortic sclerosis. A subset of idiopathic RPF is found to be associated with Immunoglobulin G4-Related Disease (IgG4-RD) which is also designated as Multisystem Fibro Inflammatory Disease (MFID). IgG4-RD is an emerging immune mediated disorder of unknown aetiology being increasingly appreciated in recent times. This disorder encompasses a spectrum of disorders involving more than one organ system and shares a common pool of clinical, serological and pathological features. There are few clinical, radiological, pathological and treatment response differences found between the subset of idiopathic RPF that is associated with IgG4-RD and the rest without IgG4-RD association. Here we present a case of MFID with a rare combination of idiopathic RPF causing bilateral ureteral encasement, large bowel obstruction and gross pericardial effusion. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=TD06-TD08&id=11193 https://doi.org/10.7860/JCDR/2018/31871.11193 Acute Disseminated Encephalomyelitis: A Rare Complication of Varicella Zoster Infection in an Adult Jahnvi Dhar, Lokesh Kumar, Pranav Ish, S Anuradha Acute Disseminated Encephalomyelitis (ADEM) is a mutifocal, demyelinating disease of the brain and spinal cord of acute onset. It usually occurs after viral infections or post vaccination. Its occurrence in immunocompetent middle-aged adults, that too without cerebral dysfunction following Varicella Zoster Virus (VZV) infection is extremely rare. Here, we report a case of a 42-year-old female who developed ADEM after an episode of VZV infection. The patient responded dramatically to corticosteroids and made complete neurological recovery. Though she had extensive lesions on her brain MRI, she had no symptoms/signs related to brain involvement clinically. To the best of our knowledge, such a presentation has not been reported in literature so far. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=OD01-OD03&id=11194 https://doi.org/10.7860/JCDR/2018/32208.11194 Clear Cell Primary Seminal Vesicle Carcinoma in a Young Male-A Rare Case Report Saurabh Gaur, Bhavna Nayal, Sunil B PillAi, Padmaraj Hegde, Arun Kumar Chawla, Aseem Kapadia Primary malignancies of Seminal Vesicle (SV) are rare. When involved, it is most commonly due to secondaries or by contiguous spread from adjacent organs. Primary tumours that can arise in SV can be epithelial and mesenchymal. Adenocarcinoma is most common epithelial tumour, and the Clear Cell variant of Adenocarcinoma (CCA) so far has not been reported in literature. Primary SV malignancies like adenocarcinoma pose a diagnostic dilemma as it becomes difficult to differentiate it from secondaries or as involvement from other adjacent organs even with imaging, histopathology and Immunohistochemistry (IHC). Here we present a case of 34-year-old male who presented with occasional total painless haematuria for four years and was evaluated by Contrast Enhanced Computed Tomography (CECT) which revealed pelvic mass. After evaluation by biopsy, histopathology and IHC he was diagnosed as primary clear cell adenocarcinoma. Despite all investigations this malignancy is difficult to differentiate from mullerian duct cyst carcinoma. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=XD01-XD02&id=11204 https://doi.org/10.7860/JCDR/2018/29342.11204 Genital Tuberculosis: Coexisting Vulval and Endometrial Tuberculosis in a Multiparous Female Shalini Bahadur, Ruchi Rathore, Ruchi Bansal, Upasana Verma, Namrata Nargotra Vulval Tuberculosis (TB) is rare and is diagnosed in only about 0.2% cases of genital tract TB which itself constitutes 0.2 to 2% of all gynaecological cases. Clinically signs and symptoms are variable ranging from asymptomatic to infertility and chronic Pelvic Inflammatory Diseases (PID). Female genital tract is involved via haematogenous or lymphatic dissemination or from direct contiguity from a primary focus of infection elsewhere in the body. Diagnosis of vulval or endometrial TB is made on histopathological examination of lesions which show classical caseating granulomas. Demonstration of Mycobacterium is considered as gold standard. Authors in the past have found typical epitheloid granulomas but failed to obtain positive results on ZN staining. We hereby present a rare case of TB of vulva in an unsuspecting multiparous middle aged female who presented with two years amenorrhoea, burning micturition and difficulty in walking, backache and lower abdominal pain off and on and a popular ulceration on inner aspect of labia minora. The patient was clinically misdiagnosed as pelvic inflammatory disease. Investigations following diagnosis of vulval TB helped discover underlying co existent endometrial tubercular involvement as well. In present case Acid Fast Bacilli (AFB) were identified on ZN staining of the histopathology sections. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=ED09-ED10&id=11213 https://doi.org/10.7860/JCDR/2018/31851.11213 A Rare Association of Amoebic Liver Abscess and Hepatitis E: Case Report Avinash Pathuri, Janak TaTarun Bahirwani, Shipra Rai, Biji Bob Thomas Amoebiasis is a global disease, which is caused by the protozoan Entamoeba histolytica. This infection affects nearly 10% of the population of the developing world. Hepatitis E predominantly affects young adults in the age group of 15-40 years. Both these infections are usually related to contamination of water. We are reporting a rare case of co-infection of amoebic liver abscess with Hepatitis E, in a patient who presented with complaints of high grade fever, yellowish discolouration of eyes and pain in the right upper abdomen. In this patient laboratory investigations showed significantly elevated liver enzymes and conjugated hyperbilirubinaemia. Ultrasound scan of the abdomen revealed a liver abscess. Amoebic serology was positive. He was treated with 'Ceftriaxone' and 'Metronidazole'. Due to persistent elevation of liver enzymes, a viral hepatitis panel was sent which showed Hepatitis E IgM (ELISA) positive. With treatment, his symptoms resolved and the elevated liver enzymes normalised. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=OD04-OD05&id=11214 https://doi.org/10.7860/JCDR/2018/31382.11214 Intraosseous Collagenous Fibroma (Desmoplastic Fibroblastoma) Involving Maxillary Bone Natália Galvão Garcia, Silas Antonio Juvencio De Freitaitas Filho, Cléverson Teixeira Soares, Caio Márcio Figueiredo, Denise Tostes Oliveira The collagenous fibroma (desmoplastic fibroblastoma) is a rare benign soft tissue tumour that can occur in the oral mucosa; intraosseous lesion is uncommon. A 43-year-old woman showed a well-circumscribed intraosseous radiolucency involving the maxillary edentulous area corresponding to 22 and 23 teeth. On intraoral examination, the edentulous ridge was covered by normal oral mucosa. The patient underwent an excisional biopsy and histopathological analysis revealed a tumour composed of spindle to stellate shaped cells scattered within a myxocollagenous stroma with invasion of skeletal muscle. The collagen bands showed strong positivity for Masson’s trichrome and the tumour cells showed focal positivity for HHF-35 and a-smooth muscle actin. The diagnosis was intraosseous collagenous fibroma according to both clinical and histopathological patterns. The patient was followed up for six months and there were no signs of recurrences. We report the second case of oral intraosseous collagenous fibroma and a critical review of English literature of the tumour in oral cavity. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=ED06-ED08&id=11207 https://doi.org/10.7860/JCDR/2018/32613.11207 <i>Penicillium roqueforti:</i> A Rare Fungus Causing Infection in an Immunocompromised Host Jisha Asokan, Ajithkumar Vellanithamunni, Rema Devi Surendran Penicillium roqueforti is a fungus that widely exists in the environment and is often non-pathogenic to humans. However, in immunocompromised hosts, it may be recognized as a cause of systemic mycosis. We report a rare case of mycosis due to Penicillium roqueforti in six-year-old haemato-oncology patient. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=DD04-DD05&id=11210 https://doi.org/10.7860/JCDR/2018/30933.11210 Myoclonic Seizures and Lactic Acidemia in a Term Newborn Born with No History of Asphyxia Sushil Choudhary, Viraraghavan Vadakkencherry Ramaswamy, Sushma Nangia, Arvind Saili We here report an unusual case of a term neonate who presented with myoclonic seizures and lactic acidemia at 30 hours of life, who was later on diagnosed as a case of pyridoxine dependant epilepsy. Pyridoxine dependant epilepsy is one of the rare but easily treatable causes of refractory neonatal seizures. Failure to diagnose and treat this condition early would result in devastating neurodevelopmental outcomes for the surviving newborn. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=SD04-SD05&id=11223 https://doi.org/10.7860/JCDR/2018/31090.11223 Sodium Valproate Induced Hyperammonaemia without Hepatic Failure in Adults: A Series of Three Cases Vybhav Krishna, Sereen Rose Thomson, Bharti Chogtu, Ganga Parameshwari Soundarrajan, PSVN Sharma Valproate is an antiepileptic drug that is most commonly prescribed because of its wide spectrum of antiepileptic activity. It is used for the treatment of many psychiatric conditions such as bipolar disorder, schizoaffective disorder, social phobias etc. Valproate is associated with modest elevation of plasma ammonia levels. Some of the risk factors associated with this are poor nutritional intake, antiepileptic polypharmacy, febrile conditions which are thought to deplete L-carnitine levels. Hence, it is important to monitor the plasma ammonia levels at intervals before the patient could develop hyperammonaemic encephalopathy. We hereby report a series of three cases of patients who developed hyperammonaemia following the intake of Sodium Valproate. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=FR01-FR02&id=11221 https://doi.org/10.7860/JCDR/2018/30892.11221 A Clinical and Biochemical Camouflage-Carnitine Palmitoyltransferase-1 Deficiency: A Case Series Shrikiran Hebbar, Sowmya Shashidhara, Suneel Mundkur, Shravan Kanaparthi Carnitine Palmitoyltransferase-1 (CPT-1) deficiency is a rare metabolic disorder of fatty acid oxidation. The presentation of this deficiency is a mixed bag of several clinical and biochemical manifestations which is determined by the tissue-specific isoforms of the enzyme. Presenting in one way, which can be lethal due to cardiac complications, another way that this disorder can come to a clinician’s attention is when children manifests with increasing lethargy during intercurrent illnesses. Rarely, but not exclusively, a seizure may be the only presenting complaint along with severe metabolic acidosis. In this case series, we present a discussion of three cases with CPT1 deficiency presenting with a camouflage of various contrasting clinical and biochemical manifestations. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=SR01-SR03&id=11164 https://doi.org/10.7860/JCDR/2018/29861.11164 Effect of <i>Myristica fragrans</i> Extract on Food Intake and Body Weight in Experimental Models Yakaiah Vangoori, Anusha Dakshinamoorthi, R Prabhakar Rao, Darling Chelathai David, K Anantha Babu <b>Introduction:</b> Myristica fragrans (Mace) is one of the commonly used Indian spices. It was used in traditional medicine to treat digestive problems, rheumatism, hyperlipidaemia, diarrhoea and insomnia. More food intake than required on a daily basis, can lead to overweight Body Mass Index (BMI 25-30) or Obesity (BMI >30). Herbal supplements and diet based therapies for weight loss are among the most common in Complementary and Alternative Medicine (CAM) modalities. Myristica fragrans (M. fragrans) contains Tetrahydrofuran (THF), Lignans. Saponins, flavonoids, glycosides, tannins and terpenoids. These chemical compounds are believed to have anti-obesity properties. Hence, Mace extract was selected to observe its effect on food intake and body weight. <b>Aim:</b> To evaluate the effect of M. fragrans extract on food intake and body weight in normal and obese wistar albino rats. <b>Materials and Methods:</b> Healthy albino rats (male/female) weighing between 150-180 gm were selected and randomly divided into five groups with six rats each. Body weight of all rats was recorded on day one. From day one to day 35 (five weeks), Body weight (BW) and Food intake (FI) capacity of an individual rat per day and for 35 days was measured in all the groups before treatment with M. fragrans extract. Group-I (Control) was treated with standard pellet diet and normal saline, Group-II (Test 1) with M. fragrans extract 200 mg/kg and Group-III (Test 2) with Myristica fragrans Extract (MFE) 400 mg/kg for 35 days (day 36 to day 70). Group IV (Test 3) and V (Test 4) were given Cafeteria Diet (CD) to induce obesity for first five weeks and last five weeks treated with M. fragrans Extract in the doses of 200 mg/kg and 400 mg/kg respectively. On day 70, FI capacity and BW of each rat was measured statistically using SPSS Statistics 20.0 (IBM software) for the analysis. Animals were observed for FI capacity and BW for 70 days (first 35 days and last 35 days). <b>Results:</b> Repeated measures one-way analysis of variance (ANOVA) indicated that, after 35 days of treatment (between 36-70 days), there was a significant reduction of FI capacity and BW in Group III and V, and slightly reduced in Group-II and IV in a dose dependent manner (p<0.01) but there was no difference in Group-I animals. <b>Conclusion:</b> These results suggest that M. fragrans extract may have clinical value in the treatment of obesity due to its inhibitory effect on FI capacity (by inhibiting hunger sensory mechanism) and BW by inhibiting pancreatic lipase enzyme. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=FF01-FF05&id=11169 https://doi.org/10.7860/JCDR/2018/28944.11169 A Persistent Upper Lip Swelling: A Diagnostic Dilemma Abhishek Soni, Ashish M Warhekar, Panjab V Wanjari https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=ZJ01-ZJ02&id=11167 https://doi.org/10.7860/JCDR/2018/31551.11167 Paranasal Sinus Carcinoma Dissimulating as Alveolar Osteitis Arulmozhi Nandakumar, K Vijayalakshmi, Ramya Ramadoss, A Kannan https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=ZJ03-ZJ04&id=11168 https://doi.org/10.7860/JCDR/2018/34361.11168 Fused Eyelids at Birth Rakhi Kusumesh, Anita Ambastha, Santosh Kumar Thakur, Megha Gulati https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=NJ01-NJ02&id=11160 https://doi.org/10.7860/JCDR/2018/30470.11160 Treating Odontomes : Surgical Management with Plasma Rich Fibrin as New Front Foot Keerti Chandail, Satyam Dutt, Punit Singh https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=ZJ05-ZJ07&id=11180 https://doi.org/10.7860/JCDR/2018/22583.11180 A Swimmer in a Sea of Tumour Aminder Singh, Pavneet Kaur Selhi, Neena Sood, Manjot Kaur https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=EL01-&id=11153 https://doi.org/10.7860/JCDR/2018/31451.11153 Correspondence: Role of Anaemia and Magnesium Levels on the Sputum Smear Conversion among Pulmonary Tuberculosis Patients Anirban Mandal, Puneet Kaur Sahi https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=OL01-&id=11189 https://doi.org/10.7860/JCDR/2018/30595.11189 Correspondence: Health Issues among Radiologists: Toll they Pay to their Profession Venkatraman Indiran, J Kokilavani https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=TL01-TL01&id=11205 https://doi.org/10.7860/JCDR/2018/29630.11205 CDX-2 Protein Expression in Premalignant and Malignant Lesions of Gallbladder Mayank Anand, Malti Kumari Maurya, Madhu Mati Goel, Madhu Kumar, Ajay Kumar Singh, Preeti Agarwal, Vishal Gupta, Annu Makker <b>Introduction:</b> CDX2 is a caudal type homeobox gene encoding a transcription factor that play important role in regulating proliferation and differentiation of the intestinal epithelium. Recent studies demonstrated CDX2 expression in metaplasia and carcinoma of oesophagus, stomach, ampulla of Vater, gallbladder and cholangiocarcinoma. Clinical and pathological significance of CDX2 in gallbladder carcinoma is not well established. <b>Aim:</b> To evaluate CDX2 expression in premalignant and malignant lesions of gallbladder and its correlation with histological grades and clinicopathological features. <b>Materials and Methods:</b> A total 93 cases of gallbladder lesions including 57 cases of adenocarcinoma, 27 cases of premalignant condition and 9 cases of chronic cholecystitis were selected both prospectively and retrospectively. Histological grading and typing was done. Immunohistochemical staining was performed using mouse monoclonal anti-human CDX2 as per manufacturer’s protocol. Statistical analysis was done using SPSS software (version 21.0). <b>Results:</b> CDX2 expression was strongly associated with well and moderately differentiated adenocarcinoma as compared to poorly differentiated (100% 77.3% and 35.3% respectively, p<0.001). Papillary and intestinal type showed strong expression of CDX2 (100%). There was low CDX2 expression with cases of lymph node metastasis and cases with surrounding tissue invasion. Positive or increased CDX2 expression was associated with increased overall survival rate. <b>Conclusion:</b> CDX2 expression has inverse relation with tumour grade and is an independent marker of clinical outcome in gallbladder adenocarcinoma. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=EC10-EC14&id=11206 https://doi.org/10.7860/JCDR/2018/30934.11206 The Effect of Hydro-Alcoholic Extraction of Valerian on Number and Morphology of Raphe Magnus Nucleus in Astrocytes in Rat Model Hatamijoni Sajad, Rozbehi Amrollah, Seyed Forootan Farzad, Jafari Barmak Mehrzad <b>Introduction:</b> The valerian root extract has been used to treat sleep disorders, stress, depression, anxiety, muscle stiffness and tension. Astrocyte cells are involved in neural support, nutrition and protection. They regulate the transmission of electrical impulses within the brain. <b>Aim:</b> The aim of the present study was to evaluate the effect(s) of valerian extract on the number and size of the astrocyte cells in raphe magnus nucleus of rats. <b>Materials and Methods:</b> In the present experimental study, 40 male Wistar rats weighing 170-250 gm were randomly divided into four groups as follows: one control and three experimental groups. The control group received distilled water while animals in Group 2, 3 and 4 were gavaged by 300, 400 and 600 mg valerian root extract daily, respectively for two weeks. Astrocyte cells were stained with phosphotungstic acid. The size and number of astrocyte cells were calculated using the LS starter software. The collected data were analysed using SPSS statistical analysis with ANOVA and LSD tests. <b>Results:</b> The mean number of astrocytes in experimental Groups 3 and 4 showed a significant increase in comparison with the control and experimental Group 2 (p-value <0.05). The mean diameter of astrocytes in all groups compared with the control group showed a significant decrease. Moreover, in Group 2, compared with Groups 3 and 4, the difference was statistically significant (p-value <0.05). <b>Conclusion:</b> Aqueous extracts of valerian taken orally will increase the number of astrocytes in the raphe magnus. In addition, administration of this extract reduced the diameter of astrocytes in nucleus raphe magnus, which is indicative of cell proliferation in the nucleus raphe magnus. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=AC10-AC13&id=11198 https://doi.org/10.7860/JCDR/2018/26326.11198 Effect of Low-flow Sevoflurane Anaesthesia on Renal Functions in Patients Undergoing Surgery: A Retrospective Study Umesh Deshmukh, Gurpreet Singh Popli, Darshan Pal Singh, Anuvijayant Goel <b>Introduction:</b> Sevoflurane is a commonly used inhalational anaesthetic agent in India. However, there is limited information on the effect of low-flow sevoflurane anaesthesia on renal function in Indian patients undergoing major surgeries. <b>Aim:</b> To assess the effect of low-flow sevoflurane anaesthesia on renal parameters in adult patients undergoing elective surgery for more than two hours. <b>Materials and Methods:</b> This was a cross-sectional, single centre, retrospective study was conducted in the Department of Anaesthesia, Fortis Hospital, Delhi, India (November 2016 to May 2017). Change in serum creatinine and Blood Urea Nitrogen (BUN) values from baseline to postsurgery and number of patients experiencing postoperative glucosuria and proteinuria were recorded. Categorical data are presented using numbers and percentages whereas continuous data are summarised using mean and standard deviation. Statistical difference in the preoperative values of serum creatinine and BUN was evaluated using paired t-test and p-value less than 0.5 was considered statistically significant. <b>Results:</b> The study included 100 patients (44% males and 56% females) with mean age of 41.3±12.59 years. Mean duration of surgery was 163.3±51.78 minutes. There was no clinically significant difference in the vital parameters after surgery. Serum creatinine (0.77 vs 0.76 mg/dL; p=0.2415) and BUN (11.79 vs 12.26 mg/dL; p=0.2624) did not change significantly after surgery. None of the patients developed proteinuria or glucosuria. There was no report of change in the dose or anaesthetic drug due to intolerance or adverse event caused by sevoflurane. <b>Conclusion:</b> Low-flow sevoflurane can be safely administered as an anaesthetic agent in elective surgeries among Indian adult patients with normal renal functions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=UC13-UC16&id=11200 https://doi.org/10.7860/JCDR/2018/34568.11200 Evaluation of Clonidine and Lignocaine for Attenuation of Haemodynamic Response to Laryngoscopy and Intubation: A Randomised Controlled Trial Abhinav Gupta, Hari Kishan Mahajan, Arijit Sarkar, Parashu Ram Chauhan, Ravinder Dhanerwa, Shalu Singh, Anish Joseph, Deepika Chaubey <b>Introduction:</b> Laryngoscopy and intubation leads to stimulation of the laryngopharyngeal and tracheal structures which leads to reflex sympathetic response and sudden rise of Blood Pressure (BP) and Heart Rate (HR). This sudden rise, particularly in patients with cardiovascular and cerebrovascular diseases, can lead to precipitation of Myocardial ischaemia or heart failure. Drugs like fentanyl, esmolol, lignocaine, clonidine when given before the procedure can blunt this reflex, but their response varies widely. <b>Aim: </b>To compare the efficacy of lignocaine and clonidine in attenuating BP and HR response to intubation. <b>Materials and Methods:</b> The study was a double-blind randomised controlled trial was conducted in Operation Theatre (OT) of Indian Spinal Injuries Centre, New Delhi, India (between March 2009 to April 2011). After taking an informed consent, 105 patients of American Society of Anaesthesiologists (ASA) Grade I and II were randomised into three groups: a) Lignocaine; b) Clonidine and c) control group with Normal Saline (NS) and outcome of 90 patients was noted. The drugs were given by IV route before induction of anaesthesia and vital parameters before and after intubation were noted. An anaesthesiologist who was blinded to the study drugs for each group gave the drugs. Statistical analysis was done using Paired t-test, ANOVA, Duncan’s multiple range test. Significant p-value was considered less than 0.05. <b>Results:</b> The rise in BP and HR from baseline to one minute after intubation, was significantly less in both lignocaine and clonidine groups, as compared to the control. <b>Conclusion:</b> Both lignocaine and clonidine can be used to attenuate the haemodynamic response however, lignocaine seems to be better in maintaining vitals around baseline level and rise and fall of BP and HR is less. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=UC17-UC20&id=11201 https://doi.org/10.7860/JCDR/2018/31728.11201 An Audit of Urethroplasty Techniques used for Managing Anterior Urethral Strictures at a Tertiary Care Teaching Institute-What We Learned Ajit S Sawant, Abhishek J Savalia, Prakash W Pawar, Sunil R Patil, Gaurav V Kasat, Sayalee Narwade, Ashwin S Tamhankar, Shankar T Mundhe <b>Introduction:</b> Anastomotic and augmented urethroplasty for managing bulbar urethral strictures and Johanson’s staged urethroplasty for managing penile, penobulbar and panurethral strictures are established techniques. In the field of urethroplasty, a reconstructive surgeon refines and evolves his technique at regular intervals, through an audit of his results. <b>Aim:</b> To review our results and techniques on urethroplasty conducted at a tertiary care teaching institute, and to refine them where found lacking. <b>Materials and Methods:</b> A retrospective review of records was done (2012 to 2016). A total of 90 patients underwent urethroplasty for anterior urethral strictures, of which 76 were available for follow up. Twenty nine men underwent End-To-End Urethroplasty (EEU); 14 underwent augmented urethroplasty for bulbar strictures; 33 underwent staged urethroplasty for penile/penobulbar/panurethral strictures. They were followed for mean 21 months (range 1-48 months) with the help of Retrograde Urethrogram (RGU), Micturating Cystogram (MCU) and Uroflowmetry (UFR) at three and six months and one year. Cystoscopy was reserved for those who had recurrent symptoms or RGU/UFR was suspicious of recurrent stricture. Success was defined as absence of obstructive symptoms and no recurrence in RGU, UFR or cystoscopy. <b>Results:</b> Most common causes were trauma and idiopathic. Average stricture length was 1.8, 3 and 4.5 cm for EEU, augmented and staged urethroplasty respectively. Primary success rate was 86%, 85% and 57% for EEU, staged urethroplasty and augmented urethroplasty respectively. Secondary success rate for augmented urethroplasty after single Visual Internal Urethrotomy (VIU) was 86%. <b>Conclusion:</b> Our results with EEU and staged urethroplasty are comparable with international studies; however, augmented urethroplasty had lower primary success rate. Introducing augmented anastomotic urethroplasty instead of just augmentation for dense spongiofibrosis and extending dorsal spatulation into healthy urethra may improve our success rates. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=PC17-PC21&id=11202 https://doi.org/10.7860/JCDR/2018/31367.11202 The Contribution of Health and Psychological Factors in Patients with Chronic Neck Pain and Disability: A Cross-sectional Study Pavlos Bobos, Goris Nazari, Stephania Palimeris, Evdokia Billis, Joy C MacDermid <b>Introduction:</b> One approach to reduce the burden of neck pain is the management of the prognostic factors that are associated with greater disability. Studies which quantify these predictors can support interventions that attempt to modify these trajectories. <b>Aim:</b> The aim of the present study to determine the contribution of psychological and health factors that are commonly associated with neck pain and disability levels. <b>Materials and Methods:</b> Patients between 18-65 years old were recruited to participate in the present study if they had neck pain for more than three months, with a minimum score 5/50 on the Neck Disability Index (NDI). Sixty patients were included in the study and they completed four patient reported outcomes including the Numeric Pain Rating Scale (NPRS), NDI, Short Form-12 (SF-12) and the Hospital Anxiety and Depression Scale (HADS). Multivariable regression analysis were performed to determine the contribution levels of anxiety, depression and health status on pain and disability levels. <b>Results:</b> There were 13 males and 47 females in the study with a mean age of 39.45±12.67 years. Pain levels were explained by physical and mental components of SF-12 and HADS subscales which accounted for 40% of the variance. SF-12 and the HADS subscales explained 50% of the variance in patients disability levels. <b>Conclusion:</b> The self-reported anxiety of HADS and the physical health status of SF-12 were the two significant contributors of pain and disability levels for patients with chronic neck pain. Future interventions should aim to modify these factors. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=YC04-YC07&id=11203 https://doi.org/10.7860/JCDR/2018/31284.11203 Recovery Profile of Atracurium versus Cisatracurium Harpreet Kaur, Joginder Pal Attri, Veena Chatrath, Harkomal Kaur, Jaspreet Kaur <b>Introduction:</b> Atracurium and cisatracurium are promising drugs offering a predictable recovery due to non-organ dependent elimination. However, due to the variability in metabolism and narrow therapeutic window, monitoring of neuromuscular functions has significant importance. <b>Aim:</b> To compare the onset time, duration of block and recovery indices of atracurium and cisatracurium in equipotent doses. The secondary aim included comparing haemodynamic profile and signs of histamine release. <b>Materials and Methods:</b> The present study was a prospective randomised observational study conducted in the Department of Anaesthesia, Government Medical College, Amritsar, Punjab, India (December 2016 to March 2017). It comprised of 60 ASA Grade I patients in the age group of 18-65 years posted for elective laparoscopic cholecystectomies. Patients were divided into two groups of 30 each. Group C (Cisatracurium) patients received cisatracurium 0.1 mg/kg as loading dose while Group A (Atracurium), patients were administered atracurium 0.5 mg/kg. The onset time, duration of block and recovery index were recorded using Train of Four (TOF) response along with the haemodynamic profile and signs of histamine release, using SPSS 22.0 software considering a p-value<0.05 as significant. <b>Results:</b> The onset time, duration and recovery index in Group A were found to be 168.60±13.44 seconds, 37.12±7.62 minutes and 14.63±1.84 minutes and in Group C, they were recorded to be 181.03±21.76 seconds, 40.37±7.04 minutes and 15.30±1.96 minutes respectively. The haemodynamic profiles in both the groups were comparable and no signs of histamine release were observed. <b>Conclusion:</b> Atracurium has a shorter time of onset as compared to cisatracurium in equipotent dose (2xED95) (p-value<0.01). However, the duration of neuromuscular blockade and the recovery profile of both the drugs were comparable. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=UC09-UC12&id=11190 https://doi.org/10.7860/JCDR/2018/30686.11190 Clinicopathologic Profile of Dentigerous Cyst in North Karnataka Region of India: A 20 Years Review Rekha Krishnapillai, Kurian Punnoose <b>Introduction:</b> The Dentigerous Cyst (DC) is the second most common odontogenic cyst, accounting to approximately 20.3% of all epithelium-lined cysts of the jaws with distinct clinico-pathologic features. However, comprehensive data regarding DC alone is sparse in the literature and none exist in Indian population. <b>Aim: </b>To determine the distribution of histologically confirmed DCs diagnosed over a period of 20 years in an Indian population according to age, gender and affected site as well as to compare these data with previously reported studies in literature from various countries. <b>Materials and Methods: </b>Biopsy Services were searched from 1989 to 2009 which retrieved 68 histologically confirmed DCs from 6400 patients. These cases were retrospectively analysed for incidence, age, gender, site distribution, clinical presentation and histopathological features. <b>Results:</b> Dentigerous cyst accounted for 9.93% amongst odontogenic cysts with a mean age of 22.76 years and a peak incidence in the second decade of life. It demonstrated a male predilection with predominance for the maxilla (58.82%) especially in the anterior region. They were mostly associated with impacted teeth especially third molar and maxillary canine and even with impacted supernumerary teeth. Most of the cases presented with an asymptomatic swelling (43/68) and were found accidentally during radiographic examination as unilocular radiolucency surrounding the crown of an unerupted tooth. DCs were also seen associated with other odontogenic cysts or tumours. Additionally, there were nine cases which clinically presented as DCs, but on histological examination revealed an associated odontogenic tumour either an Adenomatoid Odontogenic Tumour (AOT) or ameloblastoma originating from DC. <b>Conclusion:</b> Among the odontogenic cysts, DC was the third most common cyst following radicular cyst and Odontogenic Keratocyst (OKC). Rare findings noticed were association of DC with supernumerary teeth and AOT arising from DC lining (9 cases), apart from classic findings reported in literature. Additional epidemiological research is warranted to understand the frequency and variations in the clinicopathologic presentation in different populations. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=ZC14-ZC17&id=11191 https://doi.org/10.7860/JCDR/2018/30693.11191 Qualitative and Quantitative Assessment of Enhancement and Washout Characteristics of HCC and non HCC Hypervascular Liver Tumours Prerna Garg, Salil Pandey, Muthusubramanian, Cindrel, B Devanand, V Maheshwaran, R Rajakumar <b>Introduction: </b>The image based diagnosis of Hepatocellular Carcinoma (HCC) relies on assessment of arterial enhancement and venous or delayed phase washout. This assessment is based on visual analysis; however, studies quantifying such enhancement and washout are lacking. <b>Aim:</b> To qualitative assessment of the imaging characteristics of HCC and non HCC hypervascular liver tumours followed by quantitative assessment of the enhancement and washout kinetics, and also to derive objective values that may help in differentiating HCC from non HCC on Computed Tomography (CT). <b>Materials and Methods:</b> The present study was carried out in PSG hospitals, Coimbatore, Tamil Nadu, India. Retrospective analysis of hypervascular liver lesions was performed over a study period of four years (January 2012 to February 2016). These lesions were divided into two groups namely; HCC and non HCC. All non HCCs were pathologically proven, while HCC cases included those diagnosed on histopathology or typical imaging findings based on American Association for the Study of Liver Diseases (AASLD) (2010) and Liver Imaging Reporting and Data Systems (LIRADS) (2014) diagnostic criteria along with an elevated Alpha Fetoprotein (AFP) of more than 400 IU/mL. A qualitative analysis of the enhancement and washout patterns was done followed by quantitative analysis using Regions of Interest (ROI) measurement of attenuation in Hounsfield units (HU). The quantitative parameters assessed were; Mean Attenuation (MA) of lesions in different phases, Attenuation Gain Percentage (AGP) on arterial phase, Arterial Phase Attenuation Change (AAC), Attenuation Loss Percentage in venous and delayed phases (ALP-V, ALP-D), Percentage Attenuation Ratio in venous and delayed phases (PAR-V, PAR-D) and Relative Washout Ratios from arterial to venous/delayed (RWR A-V, RWR A-D) and from venous to delayed phases (RWR V-D). Sensitivity and specificity were calculated for qualitative washout. For quantitative variables comparative analysis between HCCs and non HCCs was done using Student’s t-test. ANOVA was used to compare different categories. ROC curves were drawn for values that were significantly different to establish a cutoff value. <b>Results:</b> A total of 120 lesions were evaluated consisting of HCCs (n=88) and non HCCs (n=32). Qualitatively majority (81) of HCCs demonstrated arterial enhancement and washout with eight cases of these demonstrating subtle washout requiring settlement by consensus. Washout were absent in seven cases. True mimics of HCC on qualitative analysis were hepatic adenomas, few cases of metastasis and hepatoblastoma were also there. The overall sensitivity of the washout appearance for predicting HCC was 92% while specificity was 78%. On quantitative analysis a PAR-V=106 has sensitivity of 70% and specificity of 75%, RWR-V-D=41.79 has sensitivity of 75% and specificity of 70% for HCC detection. Additionally significant difference was seen between RWR V-D of HCC when compared to cholangiocarcinomas (p-value 0.035) and metastasis (p-value 0.026) and also between PAR-V of HCC and metastasis (p-value 0.033). <b>Conclusion:</b> The qualitative analysis combined with quantitative assessment of washout using percentage attenuation ratio in venous phase and relative washout ratio from venous to delayed phase offers good sensitivity and specificity in image based diagnosis of HCC. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=TC07-TC12&id=11195 https://doi.org/10.7860/JCDR/2018/32528.11195 Accuracy of Computerised Tomography Scan for the Diagnosis of Lymph Node Metastasis in Cholangiocarcinoma Metha Songthamwat, Nitaya Chamadol, Narong Khuntikeo, Jadsada Thinkhamrop, Supinda Koonmee, Nathaphop Chaichaya, Bandit Thinkhamrop <b>Introduction:</b> Lymph Node Metastasis (LNM) is the most unfavourable outcome and a criterion of inoperability in Cholangiocarcinoma (CCA). Computerised Tomography (CT) scans are commonly used for preoperative evaluation of LNM. However, the accuracy of CT scan in LNM detection has not been clearly evaluated. <b>Aim:</b> The aim of this study was to evaluate the accuracy of CT scan for preoperative LNM detection in CCA. <b>Materials and Methods: </b>This diagnostic test study was based on an ongoing prospective cohort study (Cholangiocarcinoma Screening and Care Program, CASCAP) in nine tertiary care hospitals in the Northeastern region of Thailand. The subjects were patients with suspected CCA based on ultrasound examination. CT scan was done to evaluate the lesion and LNM. For operable subjects, the lymph nodes were dissected and sent for pathological diagnosis. The results were then compared with the radiographic results. <b>Results:</b> The CT scan accurately detected the presence or absence of LNM in 78 of 127 CCA subjects (61.4%, 95% CI 52.4-69.9), resulting in a sensitivity of 50.8% (95% CI 37.9-63.6) and a specificity of 71.9% (95% CI 59.2-82.4). The positive and negative predictive values were 64.0% (95% CI: 49.2-77.1) and 59.7% (95% CI: 47.9-70.8), respectively. The positive likelihood ratio was 1.81 (95% CI: 1.14-2.86) and the negative likelihood ratio was 0.69 (95% CI: 0.51-0.92). <b>Conclusion:</b> The CT scan has limited accuracy in the preoperative diagnosis of LNM. Therefore, surgeons should be aware of the number of false positives in determining inoperable patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=PC12-PC16&id=11196 https://doi.org/10.7860/JCDR/2018/34033.11196 Effect of Phytonutrient Rich Juice Blends on Antioxidant Status and Lipid Profile in Young Adults: A Randomised Trial Vaishali Vilas Agte, Prachi Pathare, Smita Nilegaonkar, Rashmi Tupe, Krishna Adesara, Amol Mali, Meghana Padwal, Rajani Melinkeri <b>Introduction:</b> Phytonutrients like polyphenols, carotenoids, glucosinolates and phytoestrogens may not be as essential as micronutrients. But, these have been useful to prevent disease and keep the fitness of the body. Amla (Indian Gooseberry), guava, kokum and purple grapes are highly nutritious seasonal fruits, rich in these phytonutrients and micronutrients. Regular consumption of these fruit-based beverages can improve the antioxidant status and health of the young adults. <b>Aim:</b> The aim was to study efficacy of two formulations (F1 and F2) as health beverages made using juices of amla and dark grapes as main ingredients to be assessed as antioxidant rich natural fortificants. <b>Materials and Methods:</b> Fourty-eight healthy volunteers were recruited (age 18-35 years) and randomised in a double blind trial of four weeks comprising of three groups (placebo, F1 and F2). Placebo was pineapple flavoured sugar syrup, F1 was amla based syrup containing water extracts of tulsi, brahmi, bael and jambhul juice while F2 had purple grape juice as major ingredient along with guava, pomegranate and kokum juices in sugar syrup. Results were assessed using two-way ANOVA followed by paired t-test and p-value <0.05 was considered significant. <b>Results:</b> F1 resulted in significant decrease in total cholesterol, High Density Lipoprotein (HDL) and Low Density Lipoprotein (LDL) levels (p-value <0.001, 0.001 and 0.01, respectively); while F2 resulted in significant lowering in plasma glucose, total cholesterol and HDL levels (p-value <0.05, 0.001 and 0.001, respectively). Both F1 and F2, showed a significant decrease in alkaline phosphatase. Further, F2 resulted in a significant increase of haemoglobin percentage and F1 exhibited decrease in SGOT. There was a significant effect of F1 and F2 on plasma MDA (biomarker of lipid peroxidation), Trolox Equivalent Antioxidant Capacity (TEAC), Catalase (CAT) and Super Oxide Dismutase (SOD). Two way ANOVA indicated time by treatment interaction terms between F1 and placebo to be significant for MDA, TEAC and SOD. In case of F2, differences between placebo and F2 were significant for Reduced Glutathion (GSH), and time by treatment interaction terms between F2 and placebo were significant for MDA and TEAC. <b>Conclusion:</b> The present formulations as functional food products have shown a favourable effect on lipid profile and antioxidant status of healthy human subjects. These will have value as health beverages both at national and international level. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=BC06-BC10&id=11222 https://doi.org/10.7860/JCDR/2018/28324.11222 Impact of Educational Intervention on Quality of Discharge Summaries Ajay Gajanan PhaTak, Mahesh Matheathew, Nikhil M Dave, Mihir Parekh, Himanshu V Pandya <b>Introduction:</b> Immaculate and timely communication among healthcare providers is crucial for continuity of care. Discharge summaries are commonly used for communication among different healthcare facilities. Deficiencies in discharge summaries may lead to various adversities and hamper optimal resource utilisation. In academic institutions, discharge summaries are prepared by junior doctors without formal training. <b>Aim:</b> To assess the effect of educational intervention in improving quality of discharge summaries. <b>Materials and Methods:</b> The present educational intervention study was conducted in Department of General Medicine of a tertiary care rural teaching hospital in Gujarat, India. A two-hour structured workshop for medicine residents was conducted in September 2013 by a senior consultant. Discharge summaries of patients admitted for more than 48 hours in Department of General Medicine in August 2013 and October 2013 were audited by trained consultants. Individual Feedback Form (IFF) for discharge summaries from Reviewing Effective and Accurate Documentation (READ) workshop was used for assessing the quality of discharge summaries. Descriptive statistics {mean±SD, frequency (%)} were used to depict pertinent characteristics of the data. Independent sample t-test was used to gauge the effect of the educational intervention in different domains assessed on five point Likert scale as well as for total score. Chi-square test was applied to assess the effect of the educational intervention on categorical variables. The analysis was performed using STATA (14.2). <b>Results:</b> A total of 18 residents participated in the study. Total 426 discharge summaries (223 and 203 from pre and post intervention periods respectively) were audited. The quality of discharge summaries improved significantly in the domains of history, physical examination, diagnostic data, hospital course and discharge plan as well as composite score (total score). The documentation quality of ‘basic elements’ as well as ‘overall impression’ also improved significantly. Despite these improvements, serious lapses in social and family history were observed. An informal discussion by the statistician revealed that most residents were positive about the experience but expressed concern about ‘lack of time’ and suggested automation as a feasible solution. <b>Conclusion:</b> The quality of discharge summaries was suboptimal before the educational intervention. Albeit retention of skills was not evaluated, the educational intervention improved the quality of discharge summaries. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=JC04-JC08&id=11188 https://doi.org/10.7860/JCDR/2018/30042.11188 Total Basal Ovarian Volume as a Marker of Ovarian Reserve: Myth or Reality Arjit Agarwal, Shubhra Agarwal, Ashish Verma, Ram Chandra Shukla <b>Introduction:</b> Total Basal Ovarian Volume (BOV) is a marker of ovarian follicular pool assessment known as ovarian reserve. Assisted Reproductive Techniques (ART) centres rely on Antral Follicular Count (AFC) for the planning of stimulation protocols. BOV is presently considered a subordinate marker and trailing behind the AFC and Anti-Mullerian Hormone (AMH) in their relative importance. <b>Aim:</b> The aim of the present study was to evaluate the role of BOV as a marker of ovarian reserve and its correlation with the age and AFC. <b>Materials and Methods:</b> In this prospective, case-control study, A total of 30 patients were included and compared to the equal number of controls (with proven fertility). The BOV was measured and then compared with clinical and other sonographic parameters, recorded for the same patient in both the groups. SPSS platform was used to perform the Student’s t-test and Mann-Whitney U test for intergroup comparisons. Correlations were determined by Pearson’s ranked correlation coefficient. <b>Results:</b> Regression analysis revealed the best correlation of BOV with AFC in both the groups in the present study. The correlation of BOV with age was nonlinear and insignificant in the group of subfertile patients; however, BOV strongly correlated with AFC in both the groups. <b>Conclusion:</b> Ovarian volume is a routine parameter to be measured in pelvic sonography; however, its role in prediction of ovarian reserve is confounded by many factors and hence, should be treated as a surrogate marker with no remarkable impression over treatment planning. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=TC13-TC16&id=11211 https://doi.org/10.7860/JCDR/2018/31482.11211 Evaluation of Liver Biopsies using Histopathological Scoring System in Neonatal Hepatitis and Biliary Atresia: Correlation with Clinico-Radiological and Biochemical Parameters Prasath Sathiah, Debdatta Basu, Rakhee Kar, Barath Jagadisan, S Kumaravel <b>Introduction:</b> Biliary Atresia (BA) and Neonatal Hepatitis (NH) are common causes of Neonatal Cholestasis (NC). There is a high degree of overlap between clinical and other investigational characteristics of BA and NH. <b>Aim:</b> To study the histopathological features of liver biopsies in cases of NC syndromes and to apply a histopathological scoring system in differentiating BA from other causes of NC. <b>Materials and Methods:</b> This study included 51 cases of NC (BA=25, NH=26) from Jan 2010 to June 2014. A scoring system, devised by Lee WS and Looi LM was applied to all the cases. Clinical, biochemical, Hepatobiliary scan (HIDA scan) and Peroperative Cholangiogram (POC) details of all the patients were collected. <b>Results:</b> Liver biopsy showed moderate to marked bile ductular proliferation in 24 (96%), bile plugging in 13 (52%), portal expansion in >50% of portal tracts in 19 (76%) and moderate/severe lymphocytic infiltration in 15 (60%) cases of BA. Diffuse giant cell transformation and hepatocytic swelling were present in 19 (73%) and 22 (85%), respectively of NH. Score of =7 was helpful in differentiating BA from NH with 92% sensitivity and 96% specificity. Non-excretion of dye in the HIDA scan had 91% sensitivity and 65% specificity for the score of =7 which favoured the diagnosis of BA. POC was taken as the gold standard. <b>Conclusion:</b> A detailed histomorphology of liver biopsy along with a Lee and Looi score of =7 was helpful in differentiating BA from NH. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=EC15-EC19&id=11212 https://doi.org/10.7860/JCDR/2018/30685.11212 Immunohistochemical Stain-Phosphohistone H3: Most Specific Mitotic Marker N Sudarshini, Spoorthi Ravi Banavar, Shwetha K Nambiar, Dominic Augustine, SV Sowmya, Vanishree C Haragannavar, Roopa S Rao <b>Introduction:</b> Quantification of Mitotic Figures (MFs) is a prognostic indicator in assessment of Oral Epithelial Dysplasia (OED), Oral Squamous Cell Carcinoma (OSCC) and is part of many histopathological grading systems. Evaluation of MFs is done as part of post treatment (chemoradiotherapy) to monitor any changes in the treated area. But identification and quantification of MFs in routine stains is a tedious process and subjective to errors. <b>Aim:</b> To stain, compare and analyse mitosis specific marker anti–phosphohistone H3 (anti-PHH3) with H&E stain and 1% crystal violet in OED and OSCC. <b>Materials and Methods:</b> Study sample included archival tissues embedded in paraffin blocks histopathologically diagnosed as OED (n=30) and OSCC (n=30). Three serial sections of each tissue specimen were stained separately with H&E stain, 1% crystal violet stain and anti-PHH3 (IHC stain). The stained sections were examined for identification and counting of MFs. The data were analysed using Chi-square test and Kruskal Wallis Test. <b>Results:</b> MFs were significantly increased in OSCC in comparison with OED. There was a significant increase in number of MFs in anti-PHH3 in comparison with crystal violet and H&E stained tissue sections. <b>Conclusion:</b> It was seen that anti-PHH3 is the most specific stain for identification of MFs amongst H&E, crystal violet and anti-PHH3. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=ZC18-ZC21&id=11208 https://doi.org/10.7860/JCDR/2018/24936.11208 Utilisation of Adolescent Health Services Under RMNCH+A in an Urban Slum of Berhampur, Odisha, India Radha Madhab Tripathy, Sambedana Mohanty, Manasee Panda, Monali Kar <b>Introduction:</b> Adolescents constitute 22.3% percent of the global population. Many challenges are faced by the adolescent girls for which adolescent health services under National Rural Health Mission (NRHM) are being provided to them. Reproductive, Maternal, Neonatal, Child and Adolescent Health (RMNCH+A) approach launched in 2013 was an attempt to address the major causes of mortality among women and children. The RMNCH+A approach has been developed strategically to provide an understanding of ‘continuum of care’ across various life stages. <b>Aim:</b> To study the knowledge and extent of utilisation of services under RMNCH+A programme among adolescent girls of Berhampur, Odisha. <b>Materials and Methods:</b> This field based cross-sectional study was carried out in the Anganwadi centres (AWCs) of urban slums of Berhampur under Urban Health Training Centre (UHTC) of the institution from April 2015 to October 2016. All the unmarried adolescent girls and Anganwadi Workers (AWWs) were the study subjects. Data was collected from the girls using pre-tested, Self designed, semi-structured questionnaire and by in-depth interview from seven AWWs. <b>Results:</b> A total of 142 Hindu adolescent girls were interviewed. Majority belonged to nuclear families and upper lower socio economic class. Most of them had completed their education upto high school level but 2 (1.4%) had never gone to school. All of them had knowledge about distribution of Iron and Folic Acid tablets (IFA) and 110 (77.4%) were aware about deworming tablets. The media played important role in making girls aware about Sexual and Reproductive Health (SRH). They were not given any preventive health checkups. There were, 30 (21.1%) girls suffering from Reproductive Tract Infections (RTI). But none of them went to the AWWs for consultation. Sanitary napkins were exclusively used by 31 (43.7%) girls. Menstrual hygiene was adequate among 49 (69%) girls. The AWWs had knowledge about services to be provided under RMNCH+A but no health education to the beneficiaries was imparted by them. <b>Conclusion: </b>All the beneficiaries and AWWs were aware about some services available under RMNCH+A. Inspite of the adequate supply, one third of girls were not consuming IFA. None of the AWWs provided any health education to the ir beneficiaries. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=LC01-LC05&id=11209 https://doi.org/10.7860/JCDR/2018/31753.11209 Healthcare Associated Infection in Paediatric Intensive Care Unit-A Tertiary Care Hospital Experience Ponnusamy Venmugil, MK Senthil Kumar <b>Introduction:</b> Healthcare Associated Infections (HAI) are those that are acquired in a health care setting or one that is acquired in the hospital environment by a patient who had been admitted to the hospital for a different reason. The HAI are one of a cause of increased morbidity and mortality of hospitalised patients, especially the ones admitted to an Intensive Care Unit (ICU). The study of incidence of HAI in the ICU of tertiary hospitals has been conducted previously with significant results but there is a lack of data exist regarding HAI in the Paediatric Intensive Care Unit (PICU). Hence a study was conducted in the PICU of a tertiary care hospital to estimate the incidence of HAI and study the clinical and microbiological profile, so as to acquire knowledge regarding the prevailing conditions in the PICU. The knowledge thus, obtained may then be applied in lowering the further incidence of HAI and serve to establish better patient care services. <b>Aim:</b> To estimate the incidence of HAI in the PICU of a tertiary care hospital and to study the clinical, microbiological profile and analyse the same to understand the probable risk factors involved, thereby developing effective infection control measures and strategies. <b>Materials and Methods:</b> A prospective, descriptive, observational study was conducted in the PICU of a tertiary care hospital over a period of one year (August 2013 to July 2014). The present study included children of the age group between 1 month and 12 years admitted in the PICU, who were suspected to have acquired HAI during the hospital stay. Relative frequencies of known risk factors like age, anaemia, malnutrition, and duration of PICU stay were studied in these patients. Microbiological culture and antimicrobial sensitivity were done by using standard techniques in the microbiological laboratory. <b>Results:</b> During the study period, out of the 588 patients admitted to PICU, a total of 68 (11.56%) developed one or more HAIs. It was found that the clinical outcome of the patients with HAI did not have any statistically significant relationship to the parameters such as age or sex distribution, nutritional status, degree of anaemia, duration of hospital stay or the site of HAI. But highly significant correlation was established between the duration of mechanical ventilation of a patient and reintubation with the clinical outcome of the patient. The most common HAI identified in the PICU was vascular site infection, identified in 41 patients, contributing to more than half (53%) of all the HAI. This was followed by ventilator related infections in 13 patients (17%), primary blood stream infections in 12 patients (16%) and the others that occurred in minor frequencies included those of the skin, pneumonias, infections of the urinary tract and surgical site. The most common microorganism isolated from the patients with HAI in the PICU was Klebsiella species. The antibiotic to which majority of microbial isolates including Klebsiella were sensitive was Amikacin. <b>Conclusion:</b> It is recommended to follow strict hand hygiene and aseptic precautions during intravascular catheterisation procedures. The antibiotic Amikacin may be considered in the empirical treatment of suspected HAI while culture reports are being awaited. The challenges for the future are to minimize HAI in the PICU and ensure better clinical outcome for all. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=SC10-SC13&id=11215 https://doi.org/10.7860/JCDR/2018/30245.11215 Anatomical and Clinical Perspective of Medial Arm Region Perforators-A Potential Flap for Reconstructive Surgeries Richa Gupta, Tulika Gupta, Sunil Gaba, Anjali Aggarwal, Kaur Harjeet, Daisy Sahni <b>Introduction:</b> The medial arm region can be a potential donor site for the flap surgeries because of its excellent colour and ideal thickness. It is an excellent choice for coverage of elbow, axilla, distant microvascular transfer, as the free posterior brachial fascial flap or the superficial circumflex iliac artery perforator flap, to head and neck, upper and lower extremities. <b>Aim:</b> To locate a consistent site and dimensions of perforators in medial arm region so as to make it easier for surgeons to design medial arm perforator flaps for various surgeries. <b>Materials and Methods:</b> 30 upper limbs of 15 fresh adult cadavers with mean age of 79±3 years were studied. Dimensions, total number, location and source vessel of individual perforators were determined. Also, brachial artery, its branches and course along with variations, if any were studied. <b>Results:</b> Consistent location was found to be 9.32±0.46 cm proximal and 4.4±1.72 cm medial to the medial epicondyle. Total number of perforators was 192. Brachial artery was the main source vessel in 67% (128) of cases, followed by superior ulnar collateral artery in 28% (54) of the cases. 56% (107) of the perforators had diameter more than 0.5 mm, while 33% (64) had diameter more than 1 mm. Mean length of perforators was found to be 33.76±0.52 mm. <b>Conclusion:</b> Larger the diameter of the perforator lesser is the chances of necrosis of the flap due to better vascularisation. As 89% (171) of perforators in the medial arm region had diameter more than 0.5 mm, there are higher chances of successful flap surgeries. Knowledge of consistent position of perforators can help in designing of flaps accordingly. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=AC14-AC18&id=11216 https://doi.org/10.7860/JCDR/2018/26498.11216 Intra- and Inter-operator Reproducibility Analysis of Automated Cloud-based Carotid Intima Media Thickness Ultrasound Measurement Luca Saba, Sumit K Banchhor, Tadashi Araki, Harman S Suri, Narendra D Londhe, John R Laird, Klaudija Viskovic, Jasjit S Suri <b>Introduction:</b> Manual carotid intima media thickness (cIMT) measurements are tedious and prone to errors. Further, these measurements are subject to intra and inter-observer variability. Several studies affirm the requirement for an automated system for cIMT computation, but they still suffer from low reproducibility and lack standardisation towards clinical trials. The novelty of this study is to demonstrate the intra and inter-operator reproducibility for a cloud-based automated cIMT measurement system. <b>Aim:</b> To demonstrate the reproducibility analysis and validation of cloud-based automated cIMT measurement systems. <b>Materials and Methods:</b> The reproducibility analysis was performed by two operators at three separate times (six auto readings: 1a, 1b, 1c, 2a, 2b, 2c). For validation of cloud-based cIMT measurement system, we compared the automated readings against the manual readings by the expert. The expert readings were provided by two observers who manually traced the LI/MA borders at two separate times (four manual readings: 1a, 1b, 2a, 2b). Further, we also performed the variability analysis of the manual readings. <b>Results:</b> The mean Correlation Coefficients (CC) for six intra and nine inter-operator reproducibilities between the auto readings pairs were: 0.99 (p<0.001) and 0.96 (p<0.001), respectively. The mean CCs for two intra and four inter-observer variabilities between the manual readings pairs were 0.94 (p<0.001) and 0.95 (p<0.001), respectively. The accuracy computed between the mean of the six auto readings against each of the four manual readings were: 96.88%, 97.26%, 99.04%, and 98.95%, respectively. While keeping the threshold at 0.9 mm, the ROC using eight combinations give a mean AUC of 0.97±0.01. <b>Conclusion:</b> The proposed cloud-based automated cIMT measurement software system showed high reproducibility. The system can be adapted for routine or clinical (pharmaceutical) trial modes. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=KC01-KC11&id=11217 https://doi.org/10.7860/JCDR/2018/34311.11217 Para-Substituted Functionalised Ferrocene Esters with Novel Antibacterial Properties Kevin Muñoz Forti, Faviola Bernard, Gustavo Santiago-Collazo, Waldemar Garcia, Jose L Vera, Enrique Meléndez, Edu B Suarez-Martinez <b>Introduction:</b> Bacterial antibiotic resistance is on rise despite advances in the development of new antibiotics. In an attempt to circumvent resistance, scientists are shifting focus from modifying existent antibiotics to identifying new antibiotic compounds. <b>Aim:</b> To assess the potential antibiotic effects of functionalised ferrocenecarboxylates para-substituted on the phenoxy pendant group to form: 4-fluorophenyl, 4-chlorophenyl, 4-bromophenyl, 4-iodophenyl and 4-(H-pyrrol-1-yl)phenyl. <b>Materials and Methods:<b> For this, we employed the Kirby-Bauer disc diffusion method using a collection of nine bacterial species: Staphylococcus aureus, Escherichia coli, Micrococcus luteus, Pseudomonas aeruginosa, Serratia marcescens, Klebsiella pneumoniae, Bacillus subtilis, Proteus vulgaris and Enterobacter aerogenes. <b>Results:</b> The results show that all four-halogen substituted ferrocenecarboxylates 4-fluorophenyl (23.33 µM, 11.66 µM, 5.83 µM), 4-chlorophenyl (10.16 µM, 5.08 µM, 2.54 µM), 4-bromophenyl (9.0 µM, 4.5 µM, 2.25 µM), and 4-iodophenyl (17.12 µM, 8.56 µM, 4.28 µM) exhibited an antibacterial effect by reducing proliferation of Bacillus subtilis. Meanwhile, only 4-bromophenyl (9.0 µM) and 4-chlorophenyl (10.16 µM) ferrocenecarboxylates were able to decrease the growth of Micrococcus luteus. <b>Conclusion:</b> Hence, functionalised ferrocenecarboxylates para-substituted with small and simple groups represent a novel class of bio-organometallic compounds with the potential to be used as antibacterial agents. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=DC01-DC04&id=11218 https://doi.org/10.7860/JCDR/2018/30149.11218 Effectiveness of a Teacher Training Workshop: An Interventional Study Anuradha Mokkapati, Prashanth Mada <b>Introduction:</b> There is an increasing demand upon medical school faculty to be effective teachers. Faculty development is an important component in medical education, for the institutes to excel. Pre test/post-test evaluation is one of the assessment tools commonly used in many educational workshops. <b>Aim:</b> To conduct a faculty development workshop for two days, and to test the improvement in knowledge of the participants by using pre test and post-test evaluation. <b>Materials and Methods:</b> A two day teacher training workshop was conducted in January 2017. A total of 29 faculty participated in the workshop. The sessions were interactive with several group activities. A pre test with 15 questions was given before the sessions, and the same questions were repeated after the sessions, to test the participants improvement in knowledge. The mean test scores for both pre test and post-test were compared using a Paired t-test. <b>Results:</b> The mean post-test scores (12.552±2.080) showed significant improvement (p<0.001) compared to the mean pre test score (3.655±1.798), using a Paired t-test. The number of incorrect responses per question showed considerable drop: 6.138±2.199 in the pre test and 1.448±1.270 in the post-test. The number of not attempted questions also showed a decrease in the post-test (1±1.414) compared to pre test (5.207±2.896). <b>Conclusion:</b> There was an improvement in the faculty knowledge, as seen on comparison of the pre-test (3.655±1.798) scores with that of the post-test (12.552±2.080) scores. Regular faculty development programs should be conducted. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=JC09-JC12&id=11219 https://doi.org/10.7860/JCDR/2018/30165.11219 Dermatoglyphics and Alcohol-Tobacco Consumption Goutham Gandham, K Thajuddeen <b>Introduction:</b> Epidermal ridge patterns form early in foetal development which remains unchanged throughout life and hence they can be used to indicate genetic abnormalities. Several studies indicate that alcohol-tobacco consumption has a genetic component. <b>Aim:</b> To compare the dermatoglyphic patterns in alcohol and/or tobacco consumers with non consumers and to identify dermatoglyphic patterns which are peculiar to alcohol and/or tobacco consumers if any. <b>Materials and Methods:</b> In present study 250 cases of alcohol and/or tobacco use disorder individuals were studied for dermatoglyphic parameters such as ‘ATD’ angle and the patterns of fingerprints. These cases were compared with 250 non consumers and analysed for statistical significance. Quantitative variables (‘ATD’ angle) were analysed using Student's t-test and qualitative variables (fingerprint patterns) by Chi-square test. A p-value less than 0.05 was considered as significant. <b>Results:</b> In present study, there was a decrease in ‘ATD’ angle in both hands of male (p<0.001) and female (p<0.001) cases as compared to controls which was statistically highly significant. In our study we noticed that percentage of ulnar loops (p=0.020), arches (p=0.010) and composite patterns (p=0.005) are less among male cases compared to male controls, which was statistically significant. Percentage of whorls was more among male cases compared to male controls which was statistically highly significant (p<0.001). Percentage of radial loops was more among female cases compared to female controls, which wasstatistically significant (p=0.017). <b>Conclusion:</b> In the present study an association was observed between palmar dermatoglyphics and alcohol-tobacco consumption. Dermatoglyphics by itself is not enough to diagnose alcohol-tobacco abuse individuals, but the results of this work may serve to strengthen the diagnostic criteria. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=GC06-GC08&id=11220 https://doi.org/10.7860/JCDR/2018/26829.11220 Allergy Profile of Patients Visiting a Tertiary Care Hospital in Hilly Areas of Solan, Himachal Pradesh, India Manpreet Singh Nanda, Kamaljit Singh, Rama Devi <b>Introduction:</b> Allergic diseases are common and affect a large population worldwide. Not many studies are available regarding the same and almost none in our Solan district. <b>Aim:</b> The aim of present study was to assess the prevalence of allergies in this region, the major symptoms involved, the major allergens causing them and their association with vitamin D insufficiency. <b>Materials and Methods:</b> Total 159 patients in allergic group were evaluated for age and sex distribution, common symptoms involved, spirometry, nasal endoscopy findings and the common allergens responsible. They were compared with 148 patients in the control group for utility of Skin Prick Tests (SPT), Total IgE levels and to study the impact of vitamin D insufficiency on the disease. <b>Results:</b> Allergies were common in younger age group of 21 to 40 years of age (n=61%) and in females the most common complaints were nasal (n=63%) and the most common allergens involved were dust mite mix, cockroach and pine mix in this region. Majority of the patients had obstructive disease with reversibility suggestive of asthma and most common nasal finding is Bilateral Inferior Turbinate Hypertrophy (65%). SPT are more sensitive and specific as compared to total IgE levels. There is good association between allergic diseases and Vitamin D insufficiency (odds ratio 3.4). <b>Conclusion:</b> Present study focussed on the nature of allergens among allergic patients in the Solan district and found SPT to be the most reliable and vitamin D insufficiency to be one of the factors for allergies. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=MC01-MC03&id=11161 https://doi.org/10.7860/JCDR/2018/34780.11161 Impact of Upper Limb Musculoskeletal Disorders on Quality of Life in Type 2 Diabetes Mellitus Maryam Mobini, Parastoo Karimi, Reza Ali Mohammadpour, Fatemeh Niksolat, Zahra Kashi <b>Introduction:</b> Diabetes Mellitus (DM) is a chronic multisystem disease characterised by persistent hyperglycaemia that lead to a wide range of complications, including Musculoskeletal Disorders (MSD). Quality Of Life (QOL) in chronic diseases such as DM has an important role in mental, physical and social performance of patients and plays an important role in health care. <b>Aim:</b> To study the impact of upper limbs MSD on QOL in diabetic patients. <b>Materials and Methods:</b> A cross-sectional study was conducted at Department of Internal Medicine in Imam Khomeini Hospital, Sari, North of Iran from March 2013 to April 2016, on 50 patients with type 2 DM suffering from upper limb MSD and 50 age and sex matched diabetic patients with no upper limb problems. QOL was evaluated using the Mental and Physical Components Scores (MCS and PCS) of the Short Form-36 and Diabetes Quality of Life (DQOL). In patients with MSD, Arthritis Impact Measurement Scales 2-Short Form (AIMS2-SF) was completed. Comparisons between groups were undertaken using Chi-square test for categorical data and t-tests for continuous data. Statistical significance was taken at p=0.05. <b>Results:</b> Patients with MSD showed significantly lower mean of PCS (36.05±6.8 vs. 41.52±10.4, p=0.003), and higher DQOL (2.76±0.41 vs. 2.45±0.6, p=0.006), but MCS scores were not significantly different. <b>Conclusion:</b> Upper limb MSDs could reduce quality of life in diabetic patients. Physicians are required to be aware of these complications and manage them effectively. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=OC01-OC04&id=11162 https://doi.org/10.7860/JCDR/2018/26910.11162 Comparing the Ease of Insertion and Haemodynamic changes of Laryngeal Mask Airway and Combitube in Patients undergoing General Anaesthesia Parmod Kumar, Balwinder Kaur, Ajay Kumar Basra, Pankaj Sarangal, Gurpreet Kaur Atwal <b>Introduction:</b> Laryngeal Mask Airway (LMA) and combitube are used as an alternative to endotracheal tube for airway maintenance and in elective surgeries whenever required. <b>Aim:</b> To compare the ease of insertion and haemodynamic changes of LMA and combitube in patients undergoing general anaesthesia. <b>Materials and Methods:</b> The present prospective, comparative, randomised and observational study was conducted in Government Medical College and Rajindera Hospital, Patiala, Punjab, India (from December 2015 to November 2016) on 100 patients aged between 20 to 55 years of both sexes, belonging to the American Society of Anaesthesiologists (ASA) Grades I and II, scheduled for elective surgeries under general anaesthesia. The patients were randomly divided into two groups: Group L, LMA (n=50) and Group C, Combitube (n=50). The ease of insertion as per four grades, haemodynamic changes, changes in oxygen saturation (SpO2), End-tidal Carbon dioxide (EtCO2), and postoperative complications were recorded. <b>Results:</b> The ease of insertion, SpO2 and EtCO2 in the Group L were statistically insignificant when compared to those in Group C (p>0.05). The increased haemodynamic changes (i.e., heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure) observed in Group C when compared to those in Group L showed statistical significance immediately after insertion, one minute after insertion and three minutes after insertion (p<0.05), but not at five 10, and 15 minutes after insertion. Incidence of trauma was statistically significant in Group C (p<0.05), but postoperative sore throat was not statistically significant in both the groups (p>0.05). <b>Conclusion:</b> This study suggests that both combitube and LMA are equally effective in airway maintenance in elective surgeries. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=UC01-UC04&id=11163 https://doi.org/10.7860/JCDR/2018/26032.11163 Survival Impact of Postoperative Adjuvant Radiotherapy for Treatment of Advanced Stage Maxillary Sinus Cancer Patients Upendra Nandwana, Manoj Verma, Tej Prakash Soni, Naresh Jakhotia, Nidhi Patni, Anil Kumar Gupta, Lalit Mohan Sharma, Rajesh Pasricha <b>Introduction:</b> Maxillary sinus cancer is a rare disease and usually present in advanced stage. Limited clinical data exists from India about the use of adjuvant radiotherapy in advanced cases and survival thereafter. <b>Aim:</b> To study survival and identify prognostic factors of importance in patients irradiated postoperatively for advanced stage maxillary sinus carcinoma. <b>Materials and Methods:</b> Medical records of 25 patients of advanced stage maxillary sinus carcinoma treated with curative intent from January 2011 to November 2016 were analysed retrospectively. All the patients underwent primary surgery followed by postoperative adjuvant radiotherapy. Survival analysis was done using Kaplan-Meier method. <b>Results:</b> All patients presented with advanced disease Stage III or IV; nodal involvement was observed in 5 (20%) patients. The three-year overall survival after surgery and postoperative radiotherapy with or without concurrent chemotherapy was 74%. Median survival was 17 months. Most common pattern of recurrence was at the primary site, observed in 5 (20%) patients. Lymph node involvement, pT4 lesion, surgical margins positive, depth of invasion >10 mm, high grade, lymphovascular/perineural invasion were prognostic factors of importance. <b>Conclusion:</b> Primary surgical treatment of maxillary sinus carcinoma in advanced stage followed by postoperative adjuvant radiotherapy is a good treatment option. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=XC01-XC03&id=11155 https://doi.org/10.7860/JCDR/2018/31045.11155 Assessment of Multidetector Computed Tomography Signs of Unilateral Vocal Cord Palsy: Do We Really Need to Evaluate Coronal Reformatted Images? Ankur Malhotra, Rajiv Azad, Rajendra Kumar Srivastava, Abhinav Juneja, Devkant Lakhera, Tarun Kumar Chauhan <b>Introduction:</b> Vocal Cord Palsy (VCP) is a common clinical presentation and must be considered as a sign of underlying disease, rather than simply a diagnosis unto itself. Despite of idiopathic causes in nearly half of the cases, imaging studies are still indispensible for evaluating the varied aetiologies. Most of the signs of VCP are clearly demonstrable on axial Computed Tomography (CT) sections except one i.e., flattening of ipsilateral subglottic arch which needs specific evaluation only on coronal reformatted images. The diagnostic value of this sign is still debatable. <b>Aim:</b> To evaluate any additional advantage offered by coronal reformatted images in cases of unilateral VCP especially those with confusing/equivocal findings and to find out most reliable signs of unilateral VCP on axial CT sections. <b>Materials and Methods:</b> This retrospective study comprised of patients with clinical suspicion of VCP who were referred for CT neck and thorax in Department of Radiology at tertiary care hospital in the previous 36 months (July 2014 to June 2017). Only the cases with laryngoscopically confirmed unilateral VCP were included. The cases with laryngeal malignancy were excluded. Various imaging signs of unilateral VCP were evaluated on both axial and coronal reformatted images. Spearman’s rho (?) correlation coefficient was calculated to assess correlation between most frequent signs of unilateral VCP individually and also with flattening of ipsilateral subglottic arch (evaluated on coronal reformatted images). <b>Results:</b> Thickening and medialisation of ipsilateral aryepiglottic fold was uniformly present in all the cases of unilateral VCP. Two other most frequent signs which correlated strongly with unilateral VCP were dilatation of ipsilateral laryngeal ventricle (n=29, 93.5%) and dilatation of ipsilateral pyriform sinus (n=27, 87%). Flattening of ipsilateral subglottic arch on coronal reformatted images was seen in only 26% patients. This sign was absent in all four cases with equivocal and contralateral findings in present study. <b>Conclusion:</b> The coronal reformatted images failed to demonstrate any additional advantage over axial sections in diagnosing unilateral VCP even in equivocal or difficult cases. The thickening and medialisation of ipsilateral aryepiglottic fold on routine axial CT images is probably the most reliable and consistent sign for diagnosing unilateral VCP with dilatation of ipsilateral laryngeal ventricle and ipsilateral pyriform sinus as two other major supportive signs. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=TC01-TC06&id=11156 https://doi.org/10.7860/JCDR/2018/34893.11156 Histological Evaluation of Root Repair after Damage due to Intentional Contact with Orthodontic Micro-Screw Implants: An in vivo Study Sujata A Yerawadekar, Jayesh S Rahalkar, Milind Darda, Sachin C Sarode, Gargi S Sarode <b>Introduction:</b> Orthodontic Micro-Screw Implants (MSIs) are modern orthodontic aids, generally used for conditions where orthodontic procedures like mass movement of teeth, rectification of severe overbite, retraction of anterior teeth without compromising the anchorage, molar intrusion for treatment of open bites etc., are required. However, the use of MSIs can lead to complications such as peri-implant mucositis, mucosal ulcerations, root injury of the teeth adjacent to the implants and fracture of the implant. Among these complications, root injury and its squeal may be the most deleterious effect for the patient's oral health. This is the most likely reason why orthodontists are apprehensive about the placement procedures of these MSIs. <b>Aim:</b> To evaluate the root repair after damage due to intentional damage with orthodontic MSIs in humans using a histological method. <b>Materials and Methods:</b> Cases indicated for premolar extraction for orthodontic treatment were selected. Intentional damage using MSIs was made to the roots of four premolars, selected from 10 patients, followed by extraction at time intervals of one day, three weeks, six weeks and 12 weeks. Forty extracted teeth were then demineralised and processed for paraffin embedded sectioning. Haematoxylin and Eosin (H&E) stained sections were analysed using compound light microscope and thickness of newly formed cementum was measured using image-analysing software. Comparison of mean healing cementum thickness in each group was done using ANOVA and unpaired t-test. <b>Results:</b> The stained decalcified sections of all the damaged teeth showed break in the continuity of cementum after one day. Cementum formation began at early third week, and the thickness gradually increased by the end of 12 weeks. Progressive increase in the thickness of newly formed cementum filled the notch completely at the end of 12 weeks. The average mean thickness of cementum was 8.49 µm at the end of three weeks, 69.05 µm at the end of six weeks and 192.40 µm at the end of 12 weeks. The root repair was nearly complete at the end of 12 weeks suggesting that, a minimum period of 12 weeks is required for root healing during which further tooth movement should be avoided. <b>Conclusion:</b> The average mean thickness of cementum was 8.49 µm at the end of three weeks, 69.05 µm at the end of six weeks and 192.40 µm at the end of 12 weeks. The root repair was nearly complete at the end of 12 weeks suggesting that, a minimum period of 12 weeks is required for root healing during which further tooth movement should be avoided. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=ZC01-ZC04&id=11157 https://doi.org/10.7860/JCDR/2018/31166.11157 Radiomorphometeric Evaluation of Clivus in Indian Paediatric Population Visiting a Tertiary Dental Hospital- A Cone Beam Computed Tomography Study Akhilanand Chaurasia, Ranjitkumar Patil, Gaurav Katheriya <b>Introduction:</b> The clivus is the part of the skull base situated between the foramen magnum and the dorsum sellae. It results from the fusion of the synchondrosis between the basioccipital and exoccipital bones which grows and ossify from three to 25 years of age to form the basisphenoid and the basiocciput. The clivus is a dense part of skull, so mostly it is recovered intact from a damaged or incinerated skull. So, clivus can be used for morphometeric evaluation of humans. <b>Aim:</b> To determine the age and sex related changes in clivus length and clivus width. The clivus width and clivus length was also evaluated for age prediction of individuals. <b>Material and Methods:</b> The CBCT images of 150 study subjects obtained from Carestream 9000cc (USA) CBCT machine at 90 Kvp, 4 mA for 11.3 seconds at FOV (17”×13.5”), voxel size of 300 in the age group of six to 17 years (76 male, 74 female) were chosen prospectively. The clivus length and clivus width were measured using Trophy Dicom Ink software programme on axial and saggital images (DICOM images). Categorical variables was presented in number and percentage (%) and continuous variables was presented as mean and SD. Unpaired t-test and ANOVA test was used for comparison between groups. Pearson correlation coefficients were used to evaluate the correlations. The data analysis was done using SPSS version 21.0. <b>Results:</b> Irrespective of age and sex, the mean clivus width was 28.8±3.98 and mean clivus length was 42.7±3.98. Statistically no significant difference was observed between male and female (p-value>0.05) with clivus width. However, the clivus length was statistically significant (p<0.001) in both male and female population. The clivus width and clivus length was directly associated with age. The mathematical equations derived from linear regression analysis can be used in prediction of age of an individual if the clivus width/clivus length is known. <b>Conclusion:</b> The clivus measurements on CBCT can be used to predict the age of an individuals in medicolegal disputes. As pearson correlation coefficient showed strong association between the clivus measurements, age and gender, clivus measurements can be used to differentiate between sex of humans and helps in age determination. Clivus dimensions can be used as an additional parameter in age and sex determination in inconclusive medicolegal cases. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=ZC05-ZC08&id=11158 https://doi.org/10.7860/JCDR/2018/32373.11158 Association of Serum Homocysteine and hs-CRP with Idiopathic Generalised Epilepsy and Duration of Antiepileptic Drug Therapy DKV Prasad, TS Prabhakararao, U Satyanarayana, T Surya Prabha, Anjana Munshi <b>Introduction:</b> Several human and experimental studies have revealed that chronic inflammation may play a vital role in neurodegenerative processes including epilepsy. There is accumulating evidence that inflammatory processes affect the pathophysiology of different epilepsy types. <b>Aim:</b> To assess the concentrations of Homocysteine (Hcy) and High Sensitivity C-Reactive Protein (hs-CRP) in Idiopathic Generalised Epilepsy (IGE) patients and their association with IGE and duration of the Anti Epileptic Drugs (AEDs). <b>Materials and Methods:</b> This case-control study consisted of 100 IGE patients (50 tonic–clonic, 15 absence and 35 myoclonic seizures) and equal number of healthy controls. Hcy levels were assayed by Centaur XP using ADVIA centaur Hcy; whereas hs-CRP levels by ELISA method using commercially available kits. <b>Results:</b> The Hcy and hs-CRP levels were significantly increased in both the patient groups (<18 years and >18 years). Significant difference in the levels of Hcy was observed between different epilepsy types of <18 years patients (p=0.01), whereas hs-CRP in >18 years patients (<0.05). Significantly elevated levels of hs-CRP were noticed in non-responders group compared to responders (<0.05). There was a positive correlation between hs-CRP and Hcy (R2=0.44 and p<0.001) and significant difference in the levels of Hcy and hs-CRP was observed in the patient subgroups who were on AEDs for different time periods (=1 year, 1- =5 years and >5 years) (p=0.002 and p<0.05 respectively) since, AEDs can induce oxidative stress. <b>Conclusion:</b> Hyperhomocysteinaemia (Hyper-Hcy) can induce as well as promote oxidative stress and hence, it can be implicated in neurodegeneration in epilepsy. Elevated levels of hs-CRP in non-responders may be resulted by the contribution of inflammatory pathways in ictogenesis in epileptic tissue, causing intractable epilepsy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=BC01-BC05&id=11148 https://doi.org/10.7860/JCDR/2018/30001.11148 Can Mean Platelet Volume and Platelet Distribution Width be used as Predictive Markers for Impending Diabetic Vascular Complications? R Lavanya Rajagopal, Sundaram Arunachalam, Saleh Mohammed Abdullah, Vinothkumar Ganesan, Kumerasan Kathamuthu, Balaji Ramraj <b>Introduction:</b> Diabetes Mellitus (DM) has been considered as a prothrombotic state which has impact on a wide series of pathways regulating platelet function, the cornerstone is represented by increased platelet reactivity. Many hypothesis have attempted to explain the pathophysiological mechanism by which these hyperreactive platelets contribute to diabetic vascular complications. However, a comprehensive analysis of the relationship between platelet indices and diabetic status is still lacking. <b>Aim:</b> To analyse platelet indices with glycaemic status in Type-2 DM patients and to establish the correlation between Mean Platelet Volume (MPV), Platelet Distribution Width (PDW), Fasting Blood Sugar (FBS) and Glycated haemoglobin (HbA1c) values. <b>Materials and Methods:</b> A cross-sectional study was carried out in SRM Medical College Hospital and Research Centre, Chennai. Totally 450 subjects (150 controlled and 150 uncontrolled diabetics, 150 non-diabetics) were included and investigated for HbA1c, FBS and platelet indices. <b>Results:</b> Diabetics had higher mean platelet count when compared to non-diabetics. MPV and PDW among uncontrolled diabetics were significantly higher than controlled diabetics and non-diabetics. MPV, PDW and platelet count showed a significant positive correlation with both HbA1c and FBS. We observed a significant difference in PDW and MPV when compared with various grades of HbA1c. <b>Conclusion:</b> MPV and PDW are increased in diabetics. They are simple and cost-effective tools that can be used as a good indicator of platelet activation and an independent predictor of impending vascular complications in DM. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=EC01-EC05&id=11150 https://doi.org/10.7860/JCDR/2018/32574.11150 Inter-rater Reliability of Posture Pro 8 Software Analysis in Upper Body Dysfunction: A Prospective Study Purushothaman Senthil, Sudhakar Subramanian, Pannirselvam Senthilselvam, Perisamy Sivakumar, Radhakrishanan, Rangasamy Sarala <b>Introduction:</b> Postural compensatory movement impairment is the most common musculoskeletal problem in all age-related population. Upper body dysfunction is a new terminology of movement impairment where the subjects have discomfort in either the neck, shoulder, or upper back region mainly due to poor postural adaptation. Varying postural analysis methods are in practice; however, photography of subjects on posture software analysis is very rarely used. The literature on using this postural analysis software is also not adequately available. <b>Aim:</b> To evaluate inter-rater reliability of the Posture pro 8 software for measuring the postural changes from digital photos of subjects with upper body dysfunction. <b>Materials and Methods:</b> This study has a prospective cross-sectional study design and obtained ethical consent from the Institutional Ethical Committee before participants enrolment. Sixty participants of both sexes (28 males and 32 females) with neck, shoulder, or upper back problems for more than three months participated in this reliability study. The lateral-view photos of the participants in a relaxed standing posture were taken. Postural evaluations of the photos of the participants were performed by three observers with a repetition after a week. In this study, postural abnormalities of the participants were evaluated by the three observers using the Posture pro 8 software. <b>Results:</b> Inter-rater reliabilities were calculated using Intraclass Correlation Coefficients (ICC). ICC value of 0.774 and 0.972 were found to be in the range of acceptable to excellent between the observers. <b>Conclusion:</b> Postural evaluations of the participants with upper body dysfunction using the Posture pro 8 software were found to be reliable and repeatable. The present method was an easy and non-invasive method and may be utilised by researchers who are in search of an alternative method for postural assessments. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=YC01-YC03&id=11095 https://doi.org/10.7860/JCDR/2018/31038.11095 Vertebro-Subclavian Trunk: A Rare Aortic Arch Anomaly CS Rameshbabu, Vinay Sharma, Arjun Kumar, Muhammad Qasim, Om Prakash Gupta <b>Introduction:</b> Variations in the branching pattern of the arch of aorta are not uncommon. The common trunk of origin of left vertebral and left subclavian arteries from the arch of aorta, named as the Vertebro-Subclavian Trunk (VST), is a very rare aortic arch branching anomaly sporadically reported in the literature. <b>Aim:</b> To assess the aortic arch branching anomalies especially the presence of the VST. <b>Materials and Methods:</b> Contrast Enhanced Computed Tomographic (CECT) scans of chest of 410 patients were analysed and interpreted by two radiologists. <b>Results:</b> The VST was noted in three male patients with an estimated incidence of 0.73%. In one male patient the VST was associated with the presence of a common stem of origin of brachiocephalic trunk and left common carotid artery (so called bovine arch). Thus, there were two common trunks originating from the arch. <b>Conclusion:</b> Careful observation of aortic arch branching pattern has revealed the presence of origin of left vertebral artery from the root of left subclavian artery just above the arch, the common trunk designated as VST. Catheterisation of left vertebral artery in such cases may be difficult and adequate pre-procedural knowledge can help in successful accomplishment of interventional procedures. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=AC01-AC04&id=11152 https://doi.org/10.7860/JCDR/2018/31209.11152 Post Procedure Effects of Diagnostic Rigid Cystoscopy Vivek Agrawal, Ashesh Kumar Jha, Dekid Palmo, Debjyoti Mohanty <b>Introduction: </b>Cystoscopy is an important diagnostic tool in the field of urology. It may be performed with either rigid or flexible endoscopes. However, post procedure complications are more commonly observed after rigid cystoscopy. <b>Aim:</b> To assess the post procedure effects and complications of diagnostic rigid cystoscopy. <b>Materials and Methods: </b>This prospective observational study consisted of 150 patients, who underwent diagnostic cystoscopy. Evaluation of these subjects included evaluation of anxiety and apprehension by Global Anxiety-Visual Analogue Scale (GA-VAS), pain assessment by Visual Analogue Scale (VAS), evaluation of lower urinary tract symptoms by International Prostate Symptom Score (IPSS), erectile dysfunction by Erectile Dysfunction Intensity Score (EDIS), health performance by ECOG or WHO or Zubrod score and quality of life by Short Form health survey with 36 questionnaire (SF-36). Evaluation of these parameters was done before the commencement of the procedure and was repeated on day 1, day 2 and after two weeks. <b>Results: </b>As per GA-VAS score assessed in our study, females were found to be more anxious. The mean baseline VAS was 0.52±2.18. Females had more post procedure pain than males. Following cystoscopy, the change in the mean of average urine flow showed a slight improvement on day 1 and day 2, and it was found to be statistically significant (p<0.001, p=0.016). Urine infection rate, change in IPSS and EDIS were not significant before and after the procedure. The change in the value of SF-36 score before and after cystoscopy was not found to be significant. <b>Conclusion: </b>Cystoscopy has a minor impact on quality of life of the patient; mental component being affected more than the physical component. Considering the usefulness of rigid cystoscopy, it should be liberally performed, whenever indicated, as it has only minor impact on the quality of life. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=PC08-PC11&id=11182 https://doi.org/10.7860/JCDR/2018/27283.11182 Spectrum of Breast Carcinoma in Relation to ER, PR and HER2/neu Status with Special Emphasis on Changing Patterns in Recurrence Koushik Sarkar, Chhanda Das, Madhumita Mukhopadhyay, Madhu Kumari, Ashis Kumar Saha, Bedabrata Mukhopadhyay <b>Introduction:</b> Breast carcinoma is the most common malignant tumour and the leading cause of carcinoma death in women, worldwide. The immunohistochemical classification provides both therapeutic and prognostic information. <b>Aim:</b> To classify breast carcinoma according to molecular subtype and to know the association between molecular classification and clinicopathological parameters of prognostic significance. Also, to look for changes in Immunohistochemistry (IHC) pattern and lymph node status in case of recurrence. <b>Materials and Methods:</b> A prospective study conducted in the Department of Pathology in association with Department of General Surgery in Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India (January 2014 to June 2015) was done on 50 cases. Patients undergoing mastectomy for breast carcinoma and reoperated for recurrent mass were selected. Haematoxylin and Eosin (H&E) staining and IHC staining were done. The specimens were classified according to IHC staining into molecular subtypes and these were correlated with clinicopathological features. IHC study was also done on recurrent masses following surgical removal. All statistical tests were performed using software IBM SPSS statistics version 20.0. Significance p-value was considered at <0.05. <b>Results:</b> Maximum cases 25 (50%) were luminal A, followed by 11 (22%) Human Epidermal Growth Factor 2 (HER2)/neu, 9 (18%) were luminal B and 5 (10%) were triple negative or basal type. Among 50 patients only five patients developed recurrent mass. Among the five patients who developed recurrence, the initial lymph node status was as follows- N0-0 patient, N1-1 patient, N2-3 patients and N3-1 patient. All the five patients who had recurrence initially had grade III tumour (p-value=0.0007). Surgical margin was involved in five patients of which two patients developed recurrent mass (p-value=0.02). As the gradation of carcinoma increased, their IHC pattern also changed from luminal A to luminal B to HER2/neu to basal type. <b>Conclusion: </b>It was found that luminal A and luminal B subtype have relatively favourable prognostic significance than HER2/neu and basal subtype. IHC subtypes are also proportionate with Nottingham combined histological grading system. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=EC06-EC09&id=11183 https://doi.org/10.7860/JCDR/2018/27701.11183 Effect of Position during Induction of Spinal Anaesthesia for Caesarean Section on Maternal Haemodynamic: Randomised Clinical Trial Atashkhoei Simin, Bahman Naghipour, Haleh farzin, Maddahi Saeede, Hatami Marandi Pouya, Pourfathi Hojjat <b>Introduction:</b> Hypotension is common after spinal anaesthesia during caesarean section (c/s). Methods for prevention of hypotension are mechanical approaches such as leg rise, compression stocks and positioning. On the other hand, mother position may have an effect on haemodynamic variables due to speed of onset of sensory block. Position during induction has maternal and foetal importance. <b>Aim:</b> To compare the maternal haemodynamic variables after spinal anaesthesia in sitting or lateral decubitus position in patients undergoing c/s. <b>Materials and Methods:</b> In this prospective, randomised and double-blinded clinical trial, 76 healthy parturient, undergoing c/s, were allocated in two groups. The study was conducted from September 2014 to August 2015 at Al-Zahra Hospital. Spinal anaesthesia was induced in lateral decubitus position (study group; n=38) or sitting position (control group; n=38). Maternal haemodynamic, block characteristic, side effects, and neonate Apgar scores were recorded. Data were analysed using SPSS version 16.0 software and students t-test, Chi-square test, and Mann Whitney U test were used for statistical analysis. <b>Results:</b> Incidence of hypotension (50% vs 76.3%; p=0.016), bradycardia (0% vs 21.1%; p=0.014) and vasopressors consumption (36.2% vs 76.3%; p=0.012) were statistically lower in lateral position. There was no significant differences in sensory height (p=0.89) and duration of sensory and motor block between two groups (p=0.42, p=0.29; respectively). <b>Conclusion:</b> The changes in maternal haemodynamic were significantly lower in lateral position than sitting position in patients undergoing spinal anaesthesia for c/s. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=UC05-UC08&id=11184 https://doi.org/10.7860/JCDR/2018/27753.11184 Measurement of Sacral Parameters of Surgical Importance in North Indian Population Shabnam Arora, Minakshi Verma, Sohinder Kaur, Sudha Chhabra, Priyanka Jain <b>Introduction:</b> Posterior screw placement on sacrum is done in various conditions. Screws are inserted into the body of first/second sacral vertebra. So, Linear parameters form the basis for adequate fixation of bone and to avoid injury to neurovascular structures. Detailed information about sacral parameters will be helpful for surgeons performing dorsal screw placement, Anterior Lumbar Interbody Fusion (ALIF), Posterior Lumbar Interbody Fusion (PLIF) with better prognosis and lesser complications. <b>Aim:</b> To measure and compare various linear parameters of sacrum in males and females. <b>Materials and Methods:</b> In the present study, 48 dry sacra (24 males and 24 females) were taken. Linear parameters of upper sacrum like sacral length, sacral breadth, first sacral anteroposterior and transverse diameter, sacral canal anteroposterior and tranverse diameter, posterior pedicle height, pedicle depth, pedicle width, vertical and transverse diameter of auricular surface were manually measured with digital, vernier caliper. The data were analysed, using SPSS version 16.0 and compared using Student’s t-test with p value <0.05 taken as significant. <b>Results:</b> Statistically significant gender difference was observed in sacral length, values were more in males (10.57±0.95 cm), than in females (8.56±0.49 cm) with p<0.05 and second sacral body height was found to be more in males (2.55±0.23 cm) than in females (2.16±0.20 cm) with p<0.05. Sacral canal anteroposterior diameter values were more in males (2.31±0.33 cm) than in females (2.07±0.36 cm) with p<0.05. Vertical diameter of auricular surface values on right side were more in males (5.43±0.40 cm) than in females (5.07±0.37 cm) with p<0.05. <b>Conclusion:</b> Precise measurements of dry sacra and gender comparison will be helpful for the surgical intervention in sacral region. The values obtained can be used as a baseline data for making population specific prosthesis and during implant insertion. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=AC05-AC09&id=11185 https://doi.org/10.7860/JCDR/2018/28616.11185 Atraumatic Restorative Treatment vs. Hall Technique for Occlusoproximal Lesions in Primary Dentition-An In vivo Study Siragam Pavani Lakshmi, Suzan Sahana, Aron Arun Kumar Vasa, Ghanashyam Prasad Madu, Sushma Bezawada, Mamidi Deepika <b>Introduction:</b> The economically deprived community often face significant barriers in accessing dental care, and children too have unmet dental needs. The occlusoproximal surfaces of primary molars are more prone to acquisition of biofilm and are at greater risk of developing caries. Atraumatic Restorative Treatment (ART) and the Hall Technique (HT) can be considered the most clinically acceptable and cost effective strategies for managing occlusoproximal lesions in primary molars that can be provided in a community setting. <b>Aim:</b> To evaluate and compare the general acceptability of ART and HT for restoring occlusoproximal caries in primary molars. <b>Materials and Methods:</b> The study population comprised of 30 children in the age group of five to eight years presenting with at least one occlusoproximal carious primary molar. The restorative treatments were carried out following random allocation of participants to either HT or ART. Baseline measures and the outcome data were assessed through participant report using questionnaire that recorded the child’s level of comfort and general opinion of the technique followed by clinical examination to determine the occlusovertical dimension and finally the time taken for each procedure. The obtained data were subjected to analysis by SPSS 11.5. Chi-square with Yate’s correction and Mann-Whitney U tests were used to investigate the primary outcome. Paired and independent t-tests were used to evaluate the dependent variables. <b>Results:</b> The HT was rated by children, as causing no apparent discomfort compared to ART. Statistically significant increase in Occlusal Vertical Dimension (OVD) following HT was recorded. The ART outperformed HT in terms of patient reported aesthetic acceptability and operator’s time concern. Patient satisfaction was similar in both groups as no statistical significant difference was observed. <b>Conclusion:</b> Occlusoproximal lesions in children can be treated with minimal discomfort using HT. ART can also be recommended owing to its acceptable aesthetics, no OVD changes and minimal time requirement. Patient satisfaction was evident in both ART as well as HT. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=ZC09-ZC13&id=11186 https://doi.org/10.7860/JCDR/2018/29576.11186 <i>TP53</i> Gene Alterations including Codon 72 Polymorphism in Patients with Multiple Myeloma Perumal Govindasamy, Charles Sharchil, Nithya Mohan, Prabu Pandurangan, Anil Tarigopula, Rama Mani, Chandra R Samuel <b>Introduction:</b> Multiple Myeloma (MM) is a cytogenetically heterogeneous haematologic malignancy characterised by uncontrolled proliferation of clonal plasma cells within the bone marrow. TP53 gene inactivation is considered as an independent prognostic marker and patients harbouring these mutations are usually resistant to standard therapy. <b>Aim:</b> To determine the frequency of TP53 gene mutations in exons 4 to 9 and the distribution of Arg72Pro polymorphism in exon 4 in newly diagnosed multiple myeloma patients. <b>Materials and Methods:</b> Mutation analysis of genomic DNA from unsorted bone marrow aspirates of 30 patients (10 showed TP53 deletion by interphase FISH) and from peripheral blood lymphocytes of 30 healthy control individuals was performed by direct sequencing of amplified products using self-designed primers. The codon 72 polymorphism was studied using Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) technique in an additional 108 MM patients and 70 healthy controls. <b>Results:</b> TP53 gene alterations were recorded in six patients (20%) and three of them showed two or more changes. No alterations were observed in exons 5, 7 and 9 in myeloma patients. Four mutations in codons c.284C>T (exon 4), c.641A>G (exon 6), c.787A>G and c.808T>G (exon 8) and three intronic variants c.672+48G>A (intron 6), c.782+72C>T and c.782+92T>G (intron 7) were seen only in the patient group. The variants c.108G>A (exon 4), c.672+62A>G (intron 6) and c.993+12T>C (intron 9) were observed in both groups. Three patients died within six months of diagnosis. The genotype and allele frequencies for Arg72Pro polymorphism were similar in the patient and in the control groups. <b>Conclusion:</b> The presence of TP53 mutations denoted a poor prognosis while the TP53 Pro72Arg polymorphism is not associated with increased risk for MM. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=GC01-GC05&id=11170 https://doi.org/10.7860/JCDR/2018/34222.11170 Single-Dose Oral Dexamethasone Compared with Three Day Course of Oral Prednisolone in Children with Moderate Exacerbation of Asthma-A Pilot Double-Blinded Randomised Controlled Trial Kandasamy Prasannavenkatesh, Dhandapany Gunasekaran, Karuppiah Pandi, Rangan Srinivasaraghavan, Chandramohan Anandhi, Palanisamy Soundararajan <b>Introduction:</b> Corticosteroids are the mainstay of treatment for a child with acute exacerbation of asthma. Though, several guidelines suggest use of prednisolone for few days, recently single dose dexamethasone has been found to be equally efficacious. Studies comparing single dose dexamethasone with multiple doses of prednisolone in childhood asthma are lacking in India. <b>Aim:</b> To find out whether a single dose of dexamethasone is as efficacious as multiple doses of prednisolone in the management of moderate exacerbation of acute bronchial asthma in children. <b>Materials and Methods:</b> This is a double blinded, placebo controlled, pilot randomised controlled trial, conducted at a medical college and hospital in Southern India between November 2015 to August 2016. Sixty children aged two to twelve years diagnosed with moderate exacerbation of bronchial asthma, based on Paediatric Respiratory Assessment Measure (PRAM) score, were randomly divided into two groups of equal number; 30 children received a single dose of dexamethasone orally stat followed by second dose and third dose as placebo on days two and three while remaining 30 children received prednisolone for three days in single daily doses. The time taken for PRAM score to reach a value <2, number of bronchodilator nebulisations required and relapse within 24 hours of reaching PRAM<2 were assessed and analysed. <b>Results:</b> No statistically significant difference was found in the mean time (hours) required to attain PRAM score of <2 (prednisolone group 56.9±12.9 vs. dexamethasone group 58.6±11.5, p-value=0.3) and in the number of bronchodilator nebulisations required (prednisolone group 42.7±13.5 vs dexamethasone group 40.97±17.98, p-value=0.2). <b>Conclusion:</b> A single dose of oral dexamethasone is atleast as effective as three daily doses of prednisolone in children with moderate exacerbation of bronchial asthma. However, the results need to be confirmed with large randomised controlled trials in diverse settings. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=SC01-SC03&id=11171 https://doi.org/10.7860/JCDR/2018/30505.11171 Clinicoradiological Evaluation of Newly Diagnosed Epilepsy: A Monocentric Prospective Study from a Tertiary Care Hospital of Eastern India Maheswar Samanta, Ashok Kumar Mallick, Geeta Mohanty, Kali Prasanna Swain <b>Introduction:</b> Newly Diagnosed Epilepsy (NDE) is defined as a subset of epileptic disorders, which is presented or diagnosed first time during study period and had two or more than two episodes of seizure. Early evaluation and diagnosis of epilepsy is very important for better treatment. <b>Aim:</b> To evaluate epidemiological, clinical profile as well as radiologic characteristics in cases of NDE and to find out correlation between them. Materials and Methods: It was a prospective and descriptive study of three year duration conducted in the Department of Neurology in SCB Medical College and Hospital, Cuttack, Odisha, India. A total of 300 NDE patients more than five years of age were included and subjected to detailed clinical and radiological evaluation. <b>Results:</b> Majority patients in our study were from second and third decade (mean age 25 years, SD=11.04) with characteristic male preponderance. Most patients were from rural background and majority of them (60%) had attended Neurology clinic after three to 10 episodes of seizures. Seizures in awake state and seizures without precipitating factors were more common. Headache was the most common prodromal symptom. Generalised seizure dominated over focal seizure (62:34) with tonic-clonic type (66.67%) being most common in the generalised seizure cohort. Focal seizure with secondary generalisation was seen in 70.5% cases. Drowsiness (38%) and Todd’s Palsy (6%) were most and least common postictal symptoms in our study. Our study also revealed abnormal Computed Tomography (CT) findings in 70.6% of focal seizures and 24.2% of generalised seizures. MRI, though done in 250 patients only, 53.6% were abnormal. Granulomatous lesion was dominant neuroimaging finding in our study. <b>Conclusion:</b> This study concluded that males of second and third decade from rural background are highly prone to epilepsy. Infectious causes like Neurocysticercosis (NCC) and tuberculoma are predominant aetiologies in our area. Neuroimaging plays an important role in establishing and localising aetiology of seizure. Any patient coming with history of epilepsy must be investigated with neuroimaging for further management. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=OC05-OC09&id=11172 https://doi.org/10.7860/JCDR/2018/29988.11172 Assessing the Correlation between Severity of Obstructive Sleep Apnoea and Systemic Hypertension Yadvir Garg, Neha Kakria, Vasu Vardhan, CDS Katoch, Priyanka Singh <b>Introduction:</b> Patients suffering from Obstructive Sleep Apnoea (OSA) have a strong association with acute cardiovascular events and chronic conditions such as systemic hypertension, coronary artery disease and heart failure. <b>Aim:</b> To study the prevalence of hypertension in OSA patients and correlating the severity of hypertension with severity of OSA in terms of Apnoea-Hypopnoea Index (AHI). <b>Materials and Methods:</b> A descriptive cross-sectional study was conducted at OPD of a tertiary care centre. The patients suffering from OSA as detected by a whole night polysomnography were included in the study. History of hypertension and number of antihypertensive medications taken for Blood Pressure (BP) control was obtained. BP measurement was done on two consecutive days and average of the readings was taken to calculate systolic and diastolic pressure. All continuous variables were summarised in terms of mean±SD, and categorical variables were expressed as percentages. Pearson’s linear correlation was applied for continuous variables for comparison with AHI values and Fisher’s exact test was used for nominal variables. <b>Results:</b> Out of the total number of 42 patients suffering from OSA, 29 (69%) were found to be hypertensive and 4 (13.79%) of these 29 subjects were suffering from drug-resistant hypertension. Severe OSA (AHI >30) was found in 26 patients and frequency of hypertension in patients suffering from severe OSA was 23/26 (88.46%). Mild to moderate OSA (AHI <30) was seen in 16 patients and 6 (37.5%) out of these 16 patients were detected to be having hypertension. Fisher’s exact test found statistically significant association between severe OSA and hypertension (p-value-0.0008). In non-obese patients, association between severe OSA and hypertension was assessed separately with p-value-0.0065. Pearson’s correlation coefficient was greater for association between BP (SBP 0.643, DBP 0.653) with AHI than that of BMI. <b>Conclusion:</b> Our study found the statistically significant correlation between systemic hypertension and OSA patients, independent of the confounding factor of obesity. Severity of hypertension showed linear correlation with the severity of OSA as indicated by AHI score. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=OC10-OC13&id=11173 https://doi.org/10.7860/JCDR/2018/30608.11173 Caffeine Effect on Bone Mineral Density: A Cross-sectional Study Manal Faiez Alshanbari, Eman Mohasny Alsofyani, Dhaifallah Mohammed Almalki, Khaled Abdullah Alswat <b>Introduction:</b> Osteoporosis is a serious disease of bone, all elderly people and post menopausal women will eventually experience it in their lives. Recent studies have shown that caffeine has a negative effect on Bone Mineral Density (BMD) by accelerating osteoporosis through different mechanisms. <b>Aim: </b>To determine the relationship between caffeine intake from different sources (arabic coffee, black tea and green tea) collectively and the effect of each one of these sources separately on the BMD. <b>Materials and Methods:</b> The present cross-sectional study was conducted from October 2014 to 2015 that included men and post menopausal women above the age of 50 years. Osteoporosis risk factors were evaluated through a questionnaire that was constructed by our team and the daily amount of caffeine consumed was estimated. Information about calcium and vitamin D intake was also collected as they play an important role in maintaining bone health. All the patients underwent Dual-energy X-ray Absorptiometry (DXA) scan. SPSS statistics software was used for data analysis. <b>Results:</b> A total of 250 subjects participated in the study, with only 22 (8.8%) male subjects. The mean age was 65 years and 125 (50%) of the patients were diagnosed with osteopenia, 80 (32%) had osteoporosis, and 45 (18%) had normal BMD. The total estimated daily caffeine intake was 186 mg/day. Osteoporotic group showed to have non significantly higher calcium/vitamin D intake and was more likely to report sedentary lifestyle and had fragility fractures. Osteoporotic group reported to have non significantly higher caffeine intake mainly from arabic coffee and black tea, but lower caffeine from green tea when compared to the osteopenic group. Adjusting for possible confounding factors, a non significant negative partial correlation was found between total caffeine intake and L-spine BMD, and between caffeine from black tea and femoral neck BMD. Also, a non significant positive partial correlation was observed between total caffeine and femoral neck BMD, and between caffeine from black tea and L-spine BMD, and between caffeine from green tea and arabic coffee and both L-spine and femoral neck BMD. <b>Conclusion:</b> According to the results of the present study it was observed that there is no significant correlation between BMD and daily caffeine consumption and therefore we may conclude that there is no relationship between osteoporosis and caffeine consumption. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=OC14-OC17&id=11174 https://doi.org/10.7860/JCDR/2018/31216.11174 Survival after In-hospital Cardiac Arrest among Paediatric Patients-A Descriptive Study Raja Guru Ganesan, Sarthak Das, Narayanan Parameswara, Niranjan Biswawal, Ajith Pabhu <b>Introduction:</b> Cardiac arrest in children is a fatal incident usually ending in death or very poor neurological results. Western countries that have reliable data have put in place, mechanisms to anticipate cardiac arrest due to common condition and also effective response for a cardiac arrest in vulnerable children. The prevalence and survival of paediatric cardiopulmonary arrest are not well-studied in a developing country like India. Moreover, data regarding the effectiveness of CardioPulmonary Resuscitation (CPR) and the survival of children after suffering cardiac arrest in the hospital is also scarce from developing countries. Data on the precipitating events, survival and predictors of adverse outcome of cardiac arrest in our patient population can potentially help us in planning for the delivery of better care to our patients. The differences in data from India and rest of the world are highlighted. <b>Aim: </b>To identify underlying aetiology, precipitating factors, the outcome in terms of survival, and the predictors of survival among hospitalised paediatric patients developing cardiac arrest. <b>Materials and Methods:</b> This prospective descriptive study was conducted from October 2012 to June 2014 in JIPMER, a tertiary care teaching institute in Puducherry, India. A total of 137 cases were included in the study. There clinical baseline, pre-arrest, arrest, post-arrest parameters were recorded. Final outcome of the patient as survival or death was also recorded. For the survivors Paediatric Cerebral Performance Category (PCPC) measure of cognitive function was recorded. The result obtained from the study was analysed using SPSS 20.0. <b>Results:</b> Total 137 patients included in the study after qualified the inclusion criteria and majority 77 (56.2%) patients were infants. Infections was major 103 (75.18%) underlying aetiology. 126 cases (92%) of the observed cardiac arrest occurred in Paediatric Intensive Care Unit (PICU). Return of Spontaneous Circulation (ROSC) was achieved in 82 children (59.8%) and 27 children (19.7%) survived to hospital discharge. A 77.8% of the survivors had normal to mild disability and one patient (<1%) had severe disability at discharge. Most common observed rhythm at the time of cardiac arrest was bradycardia 100 (72.9%) cases. At the time of arrest, prolonged CPR, multiple doses of adrenaline, venous blood gas disturbances were predictors of poor outcome. In the post-arrest period, presence of hypotension, prolonged capillary refilling time, low SpO2, hypothermia and lab parameters like thrombocytopenia and liver dysfunction were associated with poor outcome. <b>Conclusion:</b> In paediatric CPR prevalence of survival is absolutely excellent. Independent association between many parameters and hospital mortality is established. Subsequent research should focus on whether each of these association establish as cause and effect in future. In paediatric cardiac arrest clinical epidemiologist determining the efficiency of present day interventions like therapeutic hypothermia is crucial to recognise these associations in their research methodology. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=SC04-SC09&id=11175 https://doi.org/10.7860/JCDR/2018/32395.11175 Primary Early Surgical Management of Pancreatic Ascites Complicating Chronic Pancreatitis-A Single Centre Experience Ramalingam Durai Rajan Somasekar, Raju Prabhakaran, Anbalagan Amudhan, Murugaiyan Gnanasekar, Kalyanashanmugam Sivakumar, Govindaraj Raman Senthilkumaran, Shanmugasundaram Rajendran, Obla Naganathbabu <b>Introduction:</b> The traditional method of managing Pancreatic Ascites (PA) complicating Chronic Pancreatitis (CP) was with initial conservative treatment which was associated with increased morbidity and mortality. <b>Aim:</b> To describe about the new treatment protocol which lays emphasis on primary early surgical intervention for PA complicating advanced CP cases based on the pathological morphology of the disease instead of an initial trial of conservative treatment. <b>Materials and Methods:</b> This was a prospective observational study of 15 cases of CP with PA managed over a three year period. The approach was guided by the pathological morphology defined by a CECT abdomen and/or Magnetic Resonance Cholangiopancreatography (MRCP). Of the observed 15 cases, imaging showed a dilated Main Pancreatic Duct (MPD) 5-10 mm in 11 cases, ductal disruption in 4/11 cases and pseudocyst in 8/11 cases. These 11 cases underwent primary early direct surgery. Surgery was tailored to the individual case with a combination of internal ductal/pseudocyst drainage and/or distal resection. Resolution of PA and relief of symptoms were the primary outcome measures. Recurrence of PA at one year follow up after surgery was the secondary outcome measure. <b>Results:</b> Resolution of PA and relief of symptoms occurred in all patients in the primary surgery group. The mean duration of hospital stay was 16 days in the primary surgery group with a range of nine to 23 days with no mortality and no disease recurrence after one year of follow up. <b>Conclusion:</b> Primary early direct surgery guided by the MPD morphology (duct diameter >5 mm) in selected patients with CP and PA leads to faster recovery of the patient and it takes care of the primary pathology too. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=PC01-PC07&id=11176 https://doi.org/10.7860/JCDR/2018/29907.11176 Predictive Value of Fasting Plasma Glucose on First Antenatal Visit before 20 Weeks of Gestation to Diagnose Gestational Diabetes Mellitus Manisha Sharma, K Nayanisri, Rekha Jain, Rajiv Ranjan <b>Introduction:</b> Gestational Diabetes Mellitus (GDM) is an important public health concern due to its association with adverse foetomaternal outcome. Steadily increasing prevalence necessitates screening and early treatment of women at risk of developing the disease in order to reduce threats to maternal and foetal health. <b>Aim:</b> To find out Fasting Plasma Glucose (FPG) in the pregnant women at first antenatal visit and to correlate it with Oral Glucose Tolerance Test (OGTT) with 75 gm glucose at 24-28 weeks of gestation. <b>Materials and Methods:</b> It was a hospital based prospective study conducted on 246 antenatal patients (<20 weeks gestation) in the Department of Obstetrics and Gynaecology at Hindu Rao Hospital, Delhi, India. The patients were subjected to FPG test on first antenatal visit and patients with FPG < 126 mg/dL were again subjected to OGTT with 75 gm glucose at 24 to 28 weeks. All the analysis were carried out on SPSS software version 16.0 (Chicago, Inc., USA). Cutoff levels of fasting glucose were analysed as screening test in correlation with OGTT. <b>Results:</b> The incidence of GDM was 6.5% in our study. Mean gestational age on first visit was 16.48±1.77 weeks. The mean age in GDM and Normal Glucose Tolerance (NGT) group was 24.56±2.87 and 25.11±4.11 year respectively (p=0.01). Mean Body Mass Index (BMI) was 22.97±2.68 and 23.25±2.59 kg/m2 in the GDM and NGT group respectively (p-value 0.68). As the pregnancy advanced, 18.75% and 5.2% cases developed preeclampsia in the GDM and NGT group respectively (p-value<0.01). Glycosuria was observed in 31.2% in GDM group and none in the NGT group. FPG was found to be significantly (p=0.0001) higher in GDM (99.44±10.26) than NGT (76.26±10.35). OGTT at 0, one and two hours was significantly (p=0.0001) higher in GDM group. There was a strong positive correlation between FPG and GTT at 0, one and two hour respectively. Receiver Operating Characteristic (ROC) curve showed that a cut off level of fasting blood glucose =84.5 mg/dL had a sensitivity of 93.8% and specificity of 74.3%. The positive and negative predictive values were 20.3% and 99.4% respectively. <b>Conclusion:</b> FPG on first antenatal visit is a useful screening test to identify GDM on first antenatal visit. Early diagnosis of the disease and early intervention will always improve the pregnancy outcome. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=QC01-QC04&id=11177 https://doi.org/10.7860/JCDR/2018/31741.11177 Attiude of Medical Science Students towards Medical Ethics Arash Ziapour, Alireza Khatony, Faranak Jafaafari, Neda Kianipour <b>Introduction:</b> Medical ethics is an analytical activity whereby various aspects of decisions on moral issues in the practice of medicine are investigated. <b>Aim:</b> The present study aimed to delve into students’ attitudes towards medical ethics at Kermanshah University of Medical Sciences. <b>Materials and Methods:</b> In this descriptive-correlational study, the statistical population consisted of 380 medical, nursing and midwifery students at Kermanshah University of Medical Sciences in the second semester of the academic year 2014-2015. A sample of 380 subjects (200 females and 180 males) was selected through quota sampling. For data collection, a demographic information questionnaire and an attitude measuring scale developed by Motamed-Jahromi M and Dehghani SL in the year 2014, were used. Data were analysed through the descriptive (frequency distribution, mean, and standard deviation) and inferential statistics (independent t-test and One-way ANOVA). Further, the SPSS Statistics 21.0 was used for data analysis. <b>Results:</b> The results of the present study demonstrated that the students’ overall attitude towards medical ethics was positive (4.47±0.35). The highest and lowest means of attitude towards medical ethics was related to the principles of beneficence (4.62±0.67) and justice (4.29±0.80), respectively. Also, the results of t-test revealed that there was a significant relationship between the attitudes towards medical ethics in terms of gender, age, and marital status (p<0.05). Besides, the results of analysis of variance showed that the students’ field of study and their attitudes towards medical ethics were significantly related (p<0.05). <b>Conclusion:</b> To address paramount issues, including the ethical considerations within the scope of medicine, is one of the basic necessities among university students that should be taken into consideration in the comprehensive system of health. So, it is suggested that the medical, nursing and midwifery students be educated in medical ethics by means of short-term training programs or workshops. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=JC01-JC03&id=11178 https://doi.org/10.7860/JCDR/2018/25827.11178 Incidence of Pin Site Infection in Buried versus Unburied K-wire Fixation Techniques in Fracture Fixation Jojin Jose Chitten, P Muthaiyan, Boblee James, Vincent Bosco Savery <b>Introduction:</b> Kirschner Wires (K-wires) are widely used in orthopaedic procedures. The most common complication of K-wire fixation is pin site infection. There are only few studies which compare the infection rate between buried and unburied K-wires and there is no consensus regarding whether the K-wires should be buried under the skin or left unburied after fracture fixation, to reduce the chance of post operative infection. While some advocate there is definite advantage of burying K-wires in terms of post operative pin site infection, some studies have shown that the infection rate is similar in both the groups. <b>Aim:</b> To determine whether there is a difference in the incidence of pin site infection between buried and unburied K-wire fixation techniques of fracture fixation. <b>Materials and Methods:</b> A multi centric retrospective, cohort study in two tertiary care centres in Puducherry, in patients who underwent K-wire fixations for various fractures in upper limbs and lower limbs during the time period between January 2010 to August 2017. Data were retrieved from medical records and radiology archives. <b>Results:</b> A total of 474 patients were included in the present study. Their median age was 32 years (range: 2-87 years), 409 (86%) were males and 65 (14%) were females. Surgeons buried K-wires in 141 patients and left K-wires unburied in 333 patients. Overall, post operative infection rates were lower in buried K-wire fixation compared to unburied K-wire fixation. However, the difference was not statistically significant. In the sub analysis of closed fractures, infection rates were significantly lower in the buried K-wire technique compared to unburied K-wire technique. Among open fractures, post operative infection rates were not significantly different between these two groups. <b>Conclusion:</b> Significant lower infection in buried K-wire fixations compared to unburied K-wire fixations in closed fractures. Hence, we recommend that K-wires should be kept buried after fracture fixation in closed fractures. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=RC01-RC03&id=11179 https://doi.org/10.7860/JCDR/2018/34198.11179 Therapeutic Applications: Natural Killer Cells Preeti Sharma, Pradeep Kumar, Rachna Sharma Natural Killer (NK) cells are potent cytotoxic effector cells for cancer therapy and also for keeping severe viral infections in check. Since, they represent only 10% of the lymphocytes and are often dysfunctional, there are technical challenges in obtaining sufficient numbers of functionally active NK cells from a patient’s blood. Recent advances in therapeutic regimen of NK cells are intended to enhance NK cell activity and targeting strategies. With recent advances in the field of NK cell biology and translational research, it seems that over the next few years, NK cell immunotherapy will move to the forefront of cancer immunotherapy. The current review focuses on recent developments in NK cell immunotherapy including various approaches i.e. augmentation of Antibody-Dependent Cell-Mediated Cytotoxicity (ADCC), manipulation of receptor-mediated activation, and adoptive immunotherapy with ex vivo-expanded NK cells, Chimeric Antigen Receptor (CAR)-engineered, or engager-modified NK cells. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=BE01-BE03&id=11187 https://doi.org/10.7860/JCDR/2018/29970.11187 Lesinurad, a Novel Uricosuric Drug for Allopurinol-Refractory Gout Patients Yashika Garg, Vishant Gawri, Rajeshwari Gore, Radhe Shyam Garg, Arun Kumar Gout is the most common type of arthritis in developed countries that is often inadequately managed. Evidence regarding role of hyperuricaemia in poor outcomes in gout patients (e.g., disability, recurrent hospital admissions) with/without other chronic cardiometabolic comorbidities prompts the search of newer and more effective drugs. Current management of gout is limited to NSAIDS and intra-articular corticosteroids in acute gout and Allopurinol or Febuxostat with or without probenecid in chronic gout. Other drugs used as add-on therapy in refractory cases of gout who fail on monotherapy include benzbromarone and pegloticase but with limited role. Though these drugs have been available for several years, significant proportion of compliant patients fail to achieve consistent control of uric acid levels resulting in acute gout flares. Recent advances in the role of urate transporters in proximal tubules of kidney have resulted in the development of new generation uricosuric drugs including lesinurad. It is recently approved by US Food and Drug Administration (US FDA) and European Medicines Agency (EMA) in patients with uncontrolled gout along with Allopurinol or Febuxostat. Hopefully, it will contribute to fulfill the unmet goals in management of gout. This review aims at exploring the current therapeutic strategies for the management of chronic gout patients as well as their limitations and the role of Lesinurad in patients who have failed on monotherapy. The published studies and poster presentations were identified by conducting a literature search from electronic database from 1980 till January 2017, using various medical subject headings and terminologies. These studies were screened and publications considered relevant to the topic were included in the study. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=FE01-FE05&id=11149 https://doi.org/10.7860/JCDR/2018/27997.11149 Olmesartan in Management of Proteinuria Satyanarayan Routray, VN Shah, Abhay Sahoo, Priti Sanghavi, Amit Omprakash Gupta, Onkar C Swami Proteinuria is a marker and predictor of cardiovascular morbidity and mortality. Blockade of angiotensin receptor might result in reduction in proteinuria. Olmesartan, an Angiotensin Receptor Blocker (ARB) which is approved for the treatment of hypertension is believed to produce antiproteinuric effects through different mechanisms. The objective of this review is to assess the cause, duration and degree of proteinuria and understand the current place of olmesartan in management of proteinuria associated with Cardiovascular Disease (CVD) and hypertension. We performed a comprehensive search of MEDLINE, PubMed and Google Scholar databases for articles related to Olmesartan and proteinuria (till June 2017). Angiotensin-II induces transforming growth factor-ß upregulation and increase transcapillary pressure. AT-I receptor blocked by olmesartan result in reduction in proteinuria. Olmesartan significantly reduces Blood Pressure (BP) and delays the onset of Chronic Kidney Disease (CKD), it also delayed the risk of onset of microalbuminuria. Olmesartan have nephroprotective, antioxidant, antifibrotic activities and proteinuria reducing effects which can be beneficial in patients with hypertension. Olmesartanis believed to produce antiproteinuric effects through different mechanisms. It is indicated for treatment of hypertension to reduce the risk of fatal and non fatal CV events which may or may not be associated with proteinuria. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=OE01-OE05&id=11199 https://doi.org/10.7860/JCDR/2018/32522.11199 Angiomyoma: An Unusual Diagnosis of Preauricular Swelling Anamika Kashyap, Smita Singh, Kiran Agarwal Angiomyoma is a benign tumour arising from smooth muscle of blood vessel walls. These tumours are usually found in the lower extremities presenting as a painful mass. Angiomyoma of the preauricular area is rare, and only a few cases have been reported. Here, we report the case of a 56-year-old male patient with preauricular swelling for 30 years mimicking benign parotid neoplasm. A diagnosis of angiomyoma of the preauricular area was made on the basis of histopathology. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=ED04-ED05&id=11151 https://doi.org/10.7860/JCDR/2018/31709.11151 Erdheim-Chester Disease: Utility of <sup>18</sup>F-FDG Positron Emission Tomography Angelina Cistaro, Maria Licari, Simone Margotti, Daniele Penna, Vincenzo Arena Erdheim-Chester Disease (ECD) is a rare non Langerhans cell histiocytosis of unknown origin with multiorgan involvement. We report a case of a man who presented to us with haematuria, asthenia, fever, nausea and malleolar oedema. After computed tomography and magnetic resonance imaging, the patient underwent a Positron Emission Tomography/Computed Tomography (PET/CT) with 18F-fluorodeoxyglucose (18F-FDG) that revealed multiple focal uptake in the skeleton and also visceral and vascular involvement. After a retroperitoneal biopsy, diagnosis of ECD was made. The treatment begun with steroids and after one month, a second 18F-FDG PET/CT was performed, highlighting a partial response. After five months of specific treatment with inhibitors of tyrosine kinases, a third 18F-FDG PET/CT was done showing a complete response. The 18F-FDG PET/CT allows assessing the extent of involvement in ECD, to detect the most easily accessible sites for diagnostic biopsy and to monitor disease activity and response to consolidated and new therapies. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=TD01-TD02&id=11165 https://doi.org/10.7860/JCDR/2018/31708.11165 RETRACTED ARTICLE <b>Sabapathy VA, Prabhu Thilaak, Srinivasa Sarma Marella Gopal, Srinivasan Pongiyanadar</b>, Endotracheal intubation without muscle relaxants in children undergoing cleft lip, palate and alveolar surgery A comparative study of sevoflurane and propofol (Published in Journal of Clinical and Diagnostic Research. 2011 Nov : 5(7):). 1421 - 1425 This article has been retracted by the editorial due to problems found in data post publication in addition to content plagiarism. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=February&volume=12&issue=2&page=ZZ01-ZZ02&id=11197 https://doi.org/10.7860/JCDR/2018/.11197