Journal of clinical and diagnostic research https://www.jcdr.net/back_issues.asp JCDR Metastatic Renal Cell Carcinoma in Nasopharynx-A Paradox: Case Report and Review of Literature Kachnar Varma, Faheema Hasan, Vatsala Misra, PA Singh Metastatic renal cell carcinoma of the head and neck is extremely rare. Metastasis to the nasopharynx is extremely unusual and can be misdiagnosed as primary of the specific site hindering further management. The present case report of an 82-year-old male presenting with epistaxis was found to have a nasopharyngeal mass on radiology. Microscopic evaluation of the nasopharyngeal mass revealed a highly vascular clear cell tumour with cells arranged in alveolar and trabecular pattern. Immunohistochemical assessment revealed positive PAX 8, CD10 and vimentin which are highly specific for metastatic renal cell carcinoma. Retrospective computed tomography scan revealed a renal mass; however, the patient succumbed before any biopsy could be performed. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=ED01-ED03&id=11713 https://doi.org/10.7860/JCDR/2018/29478.11713 Gunning Splint Modified to Complete Dentures Prosthesis: A Conservative Management of Edentulous Mandibular Fracture Satya Prakash Shah, Vishal B Verma, Arun Kumar Talkal, Shraddha Saini, Rupal J Shah The objective of the study was to fabricate definitive prosthesis by modifying the splints used for fracture reduction, so as to simplify the treatment of edentulous patient. Traumatic fractures are known to present with clinically debilitating repercussions, and when occurring in edentulous jaws, achieving effective management becomes an even more herculean task for the clinician. Thus, deciding for the most appropriate line of management, whether surgical or conservative, becomes crucial, which is guided by a plethora of factors, namely patient factors, nature of mandibular fracture (displaced or undisplaced, favourable or unfavourable), type of armamentarium available and the surgeon’s skills. Closed reduction of undisplaced fractures of edentulous mandible using Gunning splint, though an old concept, still reckons a trust worthy treatment aid in treating such types of fractures. This study illustrates a case report of edentulous mandibular fracture in which a gunning splint with posterior teeth as occlusal stops were used for achieving adequate immobilisation and fixation of parasymphyseal fracture segments, and it was subsequently modified to complete denture prosthesis as a simplified rehabilitation measure. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=ZD01-ZD03&id=11714 https://doi.org/10.7860/JCDR/2018/32745.11714 Accidental Inferior Epigastric Artery Injury in Laparoscopic Inguinal Hernia Repair: A Case Report Mahendra Lodha, Banwarilal Bairwa, Ashok Puranik, Satya Prakash Meena, Hitesh Bulchandani Inferior Epigastric Artery (IEA) is an important landmark in laparoscopic inguinal hernia surgery. Injury to this artery is although very rare, but it is vulnerable to injury if due care is not taken while doing Laparoscopic Inguinal Hernia (LIH) surgery. We report a case of accidental inferior epigastric artery injury in a LIH. It was a partial injury to the wall of artery, we were able to manage it by monopolar electrocautery on maryland forceps. This case report will discuss the anatomy of inferior epigastric artery, its mechanism of injury and management. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=PD01-PD02&id=11717 https://doi.org/10.7860/JCDR/2018/33997.11717 Subarachnoid Haemorrhage Following Spinal Anaesthesia in Pregnant Women: A Rare Occurrence Vineet V Mishra, Sunita Lamba, Kavita Mistry, Ruchika Verneker With the increasing trend of caesarean delivery, spinal anaesthesia is the most common anaesthetic procedure performed today. The most common complication following this procedure is post spinal headache. However, more dreadful and devastating complication like Subarachnoid Haemorrhage can occur and should be considered in case of persistent headache. We present a case of Subarachnoid Haemorrhage (SAH) following spinal anaesthesia in a woman who underwent full-term caesarean section. Post spinal anaesthesia, she had continuous headache and vomiting. On fourth postoperative day, headache was aggravated and imaging studies revealed subarachnoid haemorrhage with intraventricular bleeding. This article discusses the consideration of SAH following dural puncture, its differential diagnosis and management. Post spinal headache should always be evaluated properly taking into consideration the various differential diagnosis of postoperative headache. Dreadful complication like SAH should be timely diagnosed and treated for better outcome. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=QD01-QD02&id=11718 https://doi.org/10.7860/JCDR/2018/36186.11718 Tuberculosis of Intestine with Concurrent Complex Enterovesical and Enterocutaneous Fistula Deepak Balachandra, Hirdaya Hulas Nag, Puja Sakhuja, Sandip Barman Intestinal tuberculosis is one of the common presentations of tuberculosis. It can manifest with various complications. However, spontaneous development of enterovesical fistula especially in association with colovesical and enterocutaneous fistulae is extremely rare in the era of highly effective Antituberculosis Treatment (ATT). This particular situation poses a management difficulty. Although initial treatment includes medical management, these patients may require some sort of surgical resection and reconstruction. Here, we report the case of a 21-year-old male patient who presented with recurrence of intestinal TB with spontaneous complex ileovesical, sigmoid colovesical and enterocutaneous fistulae. The diagnosis was established with an array of investigations including colonoscopy and biopsy, Contrast Enhanced Computed Tomography (CECT) of the abdomen with fistulogram and cystoscopy. This unusual complex fistula was successfully managed by staged surgical procedure along with ATT. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=PD03-PD05&id=11723 https://doi.org/10.7860/JCDR/2018/35275.11723 The Window Approach for Extraction of Tooth Root Fragments: A Different Soft Tissue Management Roberto Pippi, Rita Colaci, Alessandra Pietrantoni Different techniques have been proposed for the removal of the apical portion of fractured teeth. The window approach was proposed in the past to remove a tooth root fragment through a buccal bone opening at the level of fragment. In the classical approach, a marginal triangular flap is elevated, only the bone overlying the fractured apex is removed and then the apex is pushed out by an elevator toward the alveolar crest. In this technique, the bone removal is minimal, and it does not involve the marginal bone so that patient’s post-surgical discomfort is reduced, and bone resorption is less. A different kind of soft tissue management for bone exposure is proposed here with a simple linear incision at the level of the root apex without any vertical incision. This kind of incision is simple and versatile, leads to a lesser discomfort to the patient and avoids un-aesthetic scar. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=ZD04-ZD05&id=11725 https://doi.org/10.7860/JCDR/2018/35501.11725 Left-Sided Vanishing Lung Tumour: A Rare Case Karanam Gowrinath, Chinnangari Vijay Amaranatha Reddy In some cases of congestive heart failure, interlobar transudative pleural effusions may occur and appear like a tumour in the chest radiograph and disappear with diuretic therapy. They are called as Vanishing or Phantom or Pseudotumours and detected most often in the right lung. Left-sided vanishing lung tumour is very rare and we are not aware of similar previous case report in English literature. We report a left-sided vanishing lung tumour as a manifestation of cardiac failure in an elderly man who presented with intermittent swelling of feet during follow-up after coronary bypass surgery. Addition of oral diuretic (furosemide) led to rapid symptomatic relief and complete resolution of interlobar effusion in the left oblique fissure within two months. The follow-up computed tomography of chest showed left-sided small residual pleural thickening near left oblique fissure as possible cause of unusual site of vanishing tumour in our case. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=OD01-OD02&id=11727 https://doi.org/10.7860/JCDR/2018/35858.11727 Odontogenic Fibroma Associated with an Impacted Tooth Reema Talat Ayesha, Balaji Pachipulusu, Poornima Govindraju, Sanjana Ravindra Central Odontogenic Fibroma (COF) is an extremely rare benign tumour caused by proliferation of mature odontogenic mesenchyme that accounts for 0.1%-0.5% of all odontogenic tumours. It has a female predilection and often affects patients in between 2nd and 4th decade. Mandible is more commonly affected than maxilla. Clinically, it presents as a slow growing, asymptomatic, swelling which may cause expansion of cortical plates. Radiographically, it presents as a unilocular or multilocular radiolucency, with large lesions showing scalloped margins. Few cases show occurrence of calcification in the form of flecks and may be associated with an unerupted tooth. Histological appearance is characterized by presence of small inactive odontogenic islands in matrix of collagenous connective tissue with variable amounts of calcification. Typical conservative surgical intervention includes enucleation and curettage with good prognosis. Here we present a case of Odontogenic Fibroma in a 25-year-old female involving the maxilla. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=ZD06-ZD08&id=11736 https://doi.org/10.7860/JCDR/2018/34642.11736 Variant Insertion of Deltoid Muscle Lydia S Quadros, Antony Sylvan D’souza During the routine dissection for the undergraduate medical students a unilateral variation was seen in the insertion of deltoid muscle in the left arm. The muscle took origin as usual. The most anterior clavicular fibers inserted in the form of a long tendon into the medial epicondyle of the humerus. The tendon crossed the neurovascular structures of the arm. This type of variation may compress upon the neurovascular structures leading to lack of blood supply and neurological compromise of the distal parts of the upper limb. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=AD01-AD02&id=11742 https://doi.org/10.7860/JCDR/2018/13045.11742 Chronic Unresolved Haematoma of Thigh with Acute Expansion- Emulating Neoplasm Pankaj Kumar Mishra, Pratyush Goyal, Manish Kumar Verma, Deepak Singh Maravi, Aashish Gohiya Chronic haematoma formation and its acute expansion are rare in clinical scenario. Its clinical presentation may simulate to malignant soft tissue lesion. Usually they remain inactive for long time but sometimes shows sudden spurt of growth. The accepted treatment is excision of the haematoma. Here we are presenting the chronic haematoma of thigh in young boy, which remained dormant for years. But until recently it became huge and rendered the surgeon in dilemma for diagnosis making, which was managed after clinico-radiological evaluation. Here we are sharing our experience of a young patient with acutely expanded huge haematoma swelling which emulated to neoplasm. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=RD01-RD03&id=11753 https://doi.org/10.7860/JCDR/2018/34181.11753 A Perplexing Case of Cellular Leiomyoma with Excessive Myxoid Degeneration Monika Anant, Kajal Sinha, Khusboo, Puna M Bhadani Uterine leiomyomas are the most common benign lesions of the uterus. This tumour can vary in size, location, presentation and degenerations. In most cases, they are easy to diagnose clinically with help of imaging. We present a case of a fibroid with excessive myxoid degeneration where the preoperative diagnosis was haemangio/angiosarcoma. Whereas, cellular leiomyomas are a variant of leiomyoma with increased cellular component, myxoid degeneration in leiomyoma is uncommon and has to be differentiated from leiomyosarcoma. Histopathology and immunohistochemical analysis is confirmatory in arriving at this diagnosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=QD03-QD05&id=11757 https://doi.org/10.7860/JCDR/2018/32549.11757 Uterine Rupture in an Unscarred Uterus in Second Trimester: A Case Report Dhwany M Munshi, Manisha M Laddad, Gauri R Shinde Uterine rupture in an unscarred uterus is rare and diagnosis is not always obvious; leading to increased morbidity and mortality of the mother and the foetus. Here we report a case of complete spontaneous uterine rupture in a multigravida with 23 week’s pregnancy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=QD06-QD07&id=11760 https://doi.org/10.7860/JCDR/2018/32594.11760 A Treatment Dilemma: Inadvertently Placed Temporary Dialysis Catheter in the Subclavian Artery of a Critically Ill Patient Mustafa Salam Mawih, Isai Gopalakrish Bowline Each year, more than 5 million Central Venous Catheters (CVCs) are placed in the United States and mechanical complications occur in 19% of them. Despite the advances in the procedure technique and the use of bedside ultrasound, mechanical complications can still occur. Arterial puncture and catheterisation is one of the well-recognised mechanical complications. We report a case of arterial catheterisation of a temporary non-tunneled dialysis catheter in a critically ill patient. The treatment of this complication can be challenging, and, in present case, all treatment options were infeasible. Removal of the CVC from the artery carries a risk of haemorrhage, stroke and pseudoaneurysm, which necessitates a careful consideration of the risks and benefits of each treatment option. Treatment options include manual compression after catheter removal, endovascular and open surgical repair. The present case highlights some of the risk factors associated with arterial catheterisation of CVCs and the limitations of the treatment options. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=OD03-OD05&id=11767 https://doi.org/10.7860/JCDR/2018/36856.11767 Effective Treatment of Epithelial Downgrowth in Persistent Wound Leak Following Removal of Silicone Oil Mae-Lynn Catherine Bastion, Kong Yong Then, Aida Mohd Zahidin This case report aims to share the successful management of Epithelial Downgrowth (ED) which occurred following persistent wound leak, after Removal of Silicone Oil (ROSO) via the anterior chamber. A teenage male with history of high myopia underwent bilateral phacoemulsification and implantation of Multifocal Intraocular Lens (MFIOLs). Four months later, he complained of left eye floaters and blurring of vision. Fundus showed left vitreous haemorrhage with lens subluxation. Left 23 gauge pars plana vitrectomy revealed multiple retinal tears. Endolaser and gas injection with MFIOL repositioning was done. Retinal redetachment and MFIOL subluxation occurred six weeks postoperatively. Revision vitrectomy with silicone oil and explantation of MFIOL was performed rendering left eye aphakic. Four months later, he underwent ROSO via a superior corneal incision. Positive Seidels was seen two weeks post-ROSO and resuturing was performed. Unfortunately, advancing ED was noted at the superior cornea. One month after ROSO, scleral fixated IOL implantation with manual removal of ED and intracameral injection of 5-fluorouracil (5-FU) were performed. Twelve months postoperatively, cornea remained clear with a pinhole vision of 6/7.5 and retina was flat. In conclusion, wound leak after ROSO via the anterior chamber in aphakic individuals may predispose to ED. Key to treatment of this sight threatening condition is thoughtful anterior segment examination. Manual removal of the membrane combined with 5-FU injection during secondary lens implantation surgery is an effective treatment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=ND01-ND03&id=11780 https://doi.org/10.7860/JCDR/2018/36315.11780 Ectopic Isolation of an Adult Female Round Worm along with Colourless Eggs Vaibhav V Rajhans, Sanjaykumar R More, Sharmila S Raut, Vivek M Gujar, Vimal S Rathod Nematodes are probably the most widespread and abundant group of animal often occurring in huge numbers in very diverse environments. The largest number of helminthic parasites of humans belongs to the phylum nematoda and Ascaris lumbricoides is the most common of human helminthic parasites. Commonly known as roundworm, Ascaris lumbricoides is cosmopolitan, especially prevalent in the tropical countries like India. The adult roundworm commonly lives in small intestine, retaining its position by the virtue of its own muscle tone. Eggs of roundworm are bile stained, appearing yellowish brown in colour. Roundworm is a restless wanderer, showing great inquisitiveness as it tends to move itself from the original site, and get into any aperture it may find on its way. So it’s quite possible to encounter this commonest and largest intestinal nematode of humans at some odd sites in the body. Here, we are presenting a very rare case of finding colourless (i.e., non bile stained) eggs with a female roundworm isolated from an ectopic site. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=DD01-DD03&id=11784 https://doi.org/10.7860/JCDR/2018/30843.11784 Isolated Traumatic Chronic Anterior Dislocation of Radial Head Akshay Rakeshmohan Bhardwaj, Gaurav Mahesh Sharma Isolated traumatic anterior radial head dislocation is extremely rare and very commonly missed injury. A 12-year-old male had a fall on outstretched hand with pronated forearm. He presented after 6 weeks with complaints of swelling around the antero-lateral aspect of right elbow joint with restriction of movements. The dislocation was treated with open reduction and trans-capitellar K wire fixation. There were no signs of recurrence at one year follow-up. Probability of radial head dislocations should always be kept in mind while dealing with such injuries. Early detection can alleviate the need for open reduction at a later stage. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=RD04-RD05&id=11803 https://doi.org/10.7860/JCDR/2018/36277.11803 Laparoscopic Bariatric Surgery of Super-obese Patient with Intractable Anterior Abdominal Wall Cellulitis: A Rare Challenge to Anaesthesiologist Himani Prashar, Kamakshi Garg, Sanyam Nandwani, Neeru Luthra, Palavi Garg Obesity has become an epidemic problem worldwide. Obesity and its related comorbidities present a variety of challenges to anaesthesiologist. Bariatric surgery is the best treatment modality for patients who do not respond to dietary restriction and medical management. An anaesthesiologist should be experienced enough to handle the airway, pain, fluid management and acidosis in the obese patients undergoing bariatric surgery. Laparoscopic vertical sleeve gastrectomy for weight loss was planned for a 48-year-old, super-obese male patient (weight 187 kg, height 155 cm, BMI 77 kg/m2) with anterior abdominal wall cellulitis which was not responding to antibiotics. On pre-operative examination, patient had a short thick neck, Grade 3 mallampati class, mild obstructive sleep apnoea and hypertension. Patient was given trial of Continuous Positive Airway Pressure (CPAP) in pre-operative period. Induction of anaesthesia was done in the semi-sitting position. Maintenance was provided with desflurane, oxygen/air mixture and dexmedetomidine infusion. However, patient had delayed recovery. Extubation was done on return of spontaneous ventilation and when patient was awake. He was initially put on CPAP and later on, reintubation was done as he was unable to maintain saturation in immediate post-operative period. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=UD01-UD03&id=11804 https://doi.org/10.7860/JCDR/2018/27966.11804 Melioidosis: An Emerging Infectious Disease as a Cause of Parotid Abscess: A Case Report Reshmi M Nair, Sonya Joy, Dhanya Elappulli Krishnamurthy Parotid abscess as a complication following parotitis is rare and it usually occurs due to salivary stasis, the most common organisms being isolated are Staphylococcus aureus and anaerobic bacteria. Burkholderia pseudomallei causing an isolated parotid abscess is rare in adults with very few reported cases. We present here a case of left sided parotid abscess in a diabetic female which on microbiologic evaluation turned out to be due to Burkholderia pseudomallei. She was successfully treated with a combination of injection ceftazidime six grams in three divided doses and cotrimoxazole (320mg +1600 mg) in two divided doses for initial two weeks followed by a maintenance phase with cotrimoxazole alone during the next 12 weeks. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=MD01-MD02&id=11796 https://doi.org/10.7860/JCDR/2018/32614.11796 Cryptococcal Meningitis: Imaging Findings in an Immunocompetent Patient Ishak Syazana, Erica Yee Hing Cryptococcal meningitis is a fatal central nervous system disease commonly affecting immunocompromised patients, and rarely affects immunocompetent patients. We report a 51-year-old previously well male who presented with giddiness, altered sensorium and intermittent fever. India Ink stain and cryptococcal antigen test of cerebral spinal fluid were both positive. Immunodeficiency screening was negative. Although MRI brain demonstrated several features that are characteristic, they are unfortunately non-specific. It is important to realise immunocompetence does not exclude one from contracting cryptococcal meningitis, and a high index of suspicion with consideration of various imaging differentials and biochemical markers is helpful in narrowing down the diagnosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=TD01-TD02&id=11812 https://doi.org/10.7860/JCDR/2018/36215.11812 Methylenedioxymethamphetamine Induced Neuro-Psychiatric Disorders: A Case Report from Southern India NA Uvais The recreational drug MDMA (3,4-methylenedioxymethamphetamine), which is a stimulant and hallucinogen, has become increasingly popular among the young population of both developed and developing world. We describe a case report of persistent neuropsychiatric disorders in a previously healthy, 21-year-old college student after a single ingestion of MDMA. We detail the psychiatric symptoms with syndromic diagnosis and treatment outcome. Furthermore, the paper describe changes in the demographics of the use of MDMA and discuss the public health challenges posed by the increasing popularity of recreational drugs in the Indian context. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=VD01-VD02&id=11821 https://doi.org/10.7860/JCDR/2018/35217.11821 Low Grade Central Osteosarcoma-A Diagnostic Challenge Parampalli Srinivas Srilatha, Ranjini Kudva, Simanchal P Mohanty Low Grade Central Osteosarcoma (LGCO) is a rare intramedullary and well differentiated variant of osteosarcoma with a better prognosis than the more common conventional variant. It was first described by Unni et al., in 1977. Due to its subtle histological features of malignancy, it is difficult to diagnose on biopsy. Even in the resection specimen it can be mistaken for lesions like fibrous dysplasia, desmoplastic fibroma, parosteal osteosarcoma and fibrosarcoma. Adequate sampling of the tumour is essential to arrive at a correct diagnosis. Histological features such as cytological atypia, mitotic activity, permeation into the bone marrow, entrapment of the native bone, cortical disruption and soft tissue extension will help in the diagnosis of this tumour. We report a case of a 30-year-old man who presented with pain in the right hip of three months duration. On radiological evaluation, a lytic lesion was noted in the upper part of right femur and a possible diagnosis of locally aggressive giant cell tumour of bone was proposed. On histopathological study of the resected upper part of the right femur, a diagnosis of LGCO was rendered. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=ED06-ED08&id=11822 https://doi.org/10.7860/JCDR/2018/35819.11822 Permanent Maxillary First Molar with Two Rooted Anatomy: A Rare Occurrence Renita Soares, Ida de Noronha de Ataide, Karla Maria Carvalho, Neil de Souza, Sergio Martires The basis of successful endodontic therapy resides on sound and thorough knowledge of the root canal anatomy, its variations and the clinical skills. The importance of the knowledge of the anatomy of root canals cannot be overemphasized. Unusual root and root canal morphologies associated with maxillary molars have been reported in several studies, in the literature. The morphology of the maxillary first molar has been studied and reviewed extensively. However the presence of two roots in a maxillary first molar is a rare occurrence and such cases have seldom been reported in literature. This clinical report presents a permanent maxillary first molar with an unusual morphology of two roots with two canals. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=ZD09-ZD10&id=11823 https://doi.org/10.7860/JCDR/2018/35290.11823 Successful Management of Traumatic Rupture of the Inferior Rectus Muscle Teena Mariet Mendonca, Gurudutt M Kamath A 25-year-old male patient presented with diplopia after a penetrating injury to the right eye. Examination revealed right hypertopia and limitation of infraduction of right eye with rupture of Inferior Rectus (IR) muscle and conjunctival tear. Computed Tomography (CT) of the orbits did not reveal any remarkable findings. Immediate surgical exploration was done and IR was retrieved and anastomosis was carried out. On follow-up after two months postoperatively, he was free of diplopia and had normal infraduction and no vertical strabismus. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=ND04-ND05&id=11824 https://doi.org/10.7860/JCDR/2018/35823.11824 Childhood Onset Nephrotic Syndrome-A Journey Through Two Pregnancies Shashikala K Bhat, Shashikiran Umakanth, Krupa Shah, AP Ashwini, Ravindra Prabhu Nephrotic Syndrome (NS), a unique renal disease complex associated with heavy proteinuria (protein excretion >3.5 gm/day), hypoalbuminemia (<30 gm/L) and peripheral oedema. It is a rare entity in pregnancy, with an incidence of about 0.012-0.025%. There have been very few reports of pregnancy with co-existing NS. We hereby report a case of steroid sensitive childhood onset NS, due to minimal change disease and her course through two pregnancies. While she had a relapse of NS during her first pregnancy, she sailed through her second pregnancy without relapse. Women with NS can have a good maternal and perinatal outcome with multidisciplinary approach. Pregnancy does not always worsen the existing NS by causing a relapse or disease progression. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=QD08-QD09&id=11836 https://doi.org/10.7860/JCDR/2018/36044.11836 Unexpected Uterine Rupture: A Case Series and Review of Literature Sunita Dubey, Jyotsna Rani, Mohit Satodiya Unscarred uterine rupture is rare and disastrous for the mother and the fetus. It has been reported in each trimester of pregnancy and its presentation varies from silent uterine rupture to haemorrhagic shock. It may occur in prelabour stage, second stage or even in fourth stage of labour causing uncontrolled postpartum haemorrhage. Here, we report 4 cases of unscarred uterine rupture during labour. First case was of gravida 3, para 2 who came in shock following failed attempt of forceps application during second stage of labour. Laparotomy revealed uterine rupture with dead fetus. Second case was of gravida 2 para 1 who was referred in view of deep transverse arrest but she went into shock and uterine rupture was confirmed on laparotomy with delivery of an alive baby with poor APGAR score. Third case was of a primigravida who had cessation of uterine contraction after applying fundal pressure. Clinically, she was diagnosed with rupture uterus that was confirmed on laparotomy with delivery of still born baby. Fourth case was of a primigravida who was induced with misoprostol. She had fetal bradycardia followed by cessation of uterine contractions during second stage of labour. On laparotomy she had uterine rupture and a still born baby was delivered. All these cases were survived as a result of timely diagnosis and immediate laparotomy. All of them received multiple blood transfusions and discharged in satisfactory condition. High index of suspicion of an unscarred uterine rupture should be kept in mind irrespective of trimester or phase of labour. Immediate action must be taken to prevent major maternal and fetal morbidity. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=QR01-QR03&id=11783 https://doi.org/10.7860/JCDR/2018/32189.11783 Microscopic Artefacts in Clinical Practice- A Diagnostic Dilemma Mohit Bhatia, Bibhabati Mishra, Archana Thakur, Poonam Sood Loomba, Vinita Dogra Clinical Microbiologists often come across strange structures during microscopic examination of clinical specimens which are often confused with and misreported as micro-organisms. We studied series of cases in a super speciality hospital from January 2015 to December 2016 with the aim of enumerating artefacts and mimickers that may simulate infectious agents. Microscopic examination of various clinical specimens like pus, tissue, sputum and blood (for peripheral smear examination) received by the department of Microbiology during this period was carried out as per requisition received from clinicians. Photographs of several microscopic artefacts were obtained using a high definition camera. For comparative purpose, photographs of common pathogenic micro-organisms closely resembling these structures were also obtained. Various microscopic artefacts closely resembling pathogenic micro-organisms like fungal hyphae, microfilariae, malaria parasites, acid fast bacilli, budding yeast cells and hooklets of Echinococcus granulosus were observed during the course of this study and enumerated. Owing to paucity of available literature, it is absolutely essential to highlight the issue of misreporting of infectious diseases during microscopic examination of clinical specimens. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=DR01-DR04&id=11805 https://doi.org/10.7860/JCDR/2018/36537.11805 Childhood Bezoars: A Case Series Kamal Nain Rattan, Rashmi Hooda, Shalu Ogha, Ahmad Khursheed, Aashima Bezoars are the rarest causes of upper abdominal masses and upper gastric outlet obstruction in children and are most commonly seen in females of adolescent age. They can present with the common symptoms of abdominal mass or abdominal pain but may lead to serious complications as well. They must be diagnosed and managed early despite their rarity so as to prevent complications like obstruction, perforation and bleeding. This article is reporting our 25 years experience with abdominal bezoars with variable presentation in our tertiary care centre. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=PR01-PR03&id=11776 https://doi.org/10.7860/JCDR/2018/33876.11776 Eyelid Discoid Lupus Erythematosus Misdiagnosed as Leishmaniasis Amir Feily, Farhang Houshmand, Marigdalia K Ramirez-Fort https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=WH01-WH02&id=11766 https://doi.org/10.7860/JCDR/2018/35575.11766 Diode Laser-Assisted Fibrotomy in the Management of Oral Sub-Mucous Fibrosis: A New Technique in Surgical Management Sana Farista, Butchibabu Kalakonda, Shanin Farista, Vidyaa Hari Iyer Oral Sub-Mucous Fibrosis (OSMF) has a high prevalence in the Indian subcontinent and is a matter of grave concern because of its alarming malignant potential. Numerous treatment modalities; from antioxidants, vitamin supplements, placental extract injections to surgical methods (fibrotomy either by the use of a scalpel or an electrocautery) have been attempted with varying degrees of success along with some disadvantages associated with each. With the advent of technology, laser offers certain advantages which was utilized in this case to overcome the shortcomings of conventional technique. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=ZH01-ZH02&id=11831 https://doi.org/10.7860/JCDR/2018/36571.11831 Effect of Dry-Needling Induced Muscle Soreness (DIMS) on the Severity of Pain Post Deep Trigger Point Needling Sukumar Shanmugam, Lawrence Mathias, Ajay Thakur <b>Introduction:</b> Dry-Needling (DN) induced muscle soreness is a common adverse event that takes place in almost majority of patients who received deep dry needling treatment. The effect of soreness on clinical outcomes has not been evidenced in the existing literature. <b>Aim:</b> To evaluate the correlation between the deep dry-needling induced muscle soreness and severity of shoulder pain in patients with myofascial pain. <b>Materials and Methods:</b> Seventy six participants in the age group of 30 to 60 years with Myofascial Trigger Points (MTrP) in the shoulder girdle muscles were treated with 10-12 minutes of deep dry needling. Shoulder pain severity was assessed at baseline prior to dry needling and 48 hours after dry needling using 0-10 cm Visual Analog Scale (VAS). The severity of muscle soreness was assessed immediately after dry needling, at 24 hours and 48 hours after the deep dry needling. Correlation between the shoulder pain and muscle soreness was analysed using the Spearman correlation coefficient. <b>Result: </b>A significant reduction of shoulder pain was observed at 48 hours (Median VAS: 7 at Baseline, 3 at 48 hours, and Median difference = 4, IQR = 2 - 3) after the dry needling. No significant correlation was observed between the original pain severity and needle induced muscle soreness at 24 hours (rho = -.218, p = 0.059) and 48 hours (rho = -.170, p=0.143). <b>Conclusion:</b> Based on the result, we conclude that there is no significant correlation between the dry-needling induced muscle soreness and shoulder pain severity among the patients who received deep dry-needling for myofascial pain. We also suggest that dry-needling induced muscle soreness has no adverse effect on the shoulder pain severity post deep trigger point dry needling. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=YF01-YF04&id=11841 https://doi.org/10.7860/JCDR/2018/35141.11841 Head Rotation Manoeuvre during Flexible Bronchoscopy Rahul Magazine https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=OL01-&id=11733 https://doi.org/10.7860/JCDR/2018/35203.11733 Jategaonkar’s Triple-Jerk Technique: A Safety Augmenting Method for Laparoscopic Suprapubic Trocar Insertion Priyadarshan Anand Jategaonkar, Smita Priyadarshan Jategaonkar, Sudeep Pradeep Yadav https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=PL01-PL02&id=11726 https://doi.org/10.7860/JCDR/2018/36038.11726 Effects of Postnatal Home-Based Education on Primiparous Women’s Perceived Self-Efficacy in Neonatal Care Maryam Koochakzai, Ali Mansouri, Ameneh Safarzadeh, Ali Navidian <b>Introduction:</b> During the postnatal period, mothers face different challenges such as learning how to care for their infants and how to fulfill their own parental roles. <b>Aim:</b> To evaluate the effects of postnatal home-based education on primiparous women’s perceived self-efficacy in neonatal care. <b>Materials and Methods:</b> This quasi-experimental study was done on 100 primiparous women who referred to healthcare centers in Zahedan, Iran, to receive routine postnatal care services. Women were conveniently recruited and randomly allocated to an experimental (n=50) and a control (n=50) group. A demographic questionnaire and Reece’s Parent Expectations Survey were used for data collection both before and six weeks after the intervention. Women in the experimental group received routine postnatal care services as well as postnatal home-based neonatal care education in three sessions. However, women in the control group solely received routine postnatal care services. The SPSS software (v. 20.0) was used and for analysis of covariance, paired and independent-sample t, Chi-square tests were used. <b>Results:</b> Mean age in the experimental and the control groups were 22.82±4.56 and 21.02±5.20 years respectively. After the intervention, the average increase in the score of perceived self-efficacy in the experimental group (44.84±13.50) was significantly greater than the control group (10.90±8.45; p < 0.0001). <b>Conclusion:</b> Postnatal home-based education improves primiparous women’s perceived self-efficacy in neonatal care. Home-based educational programs are recommended for the improvement of maternal and infantile outcomes in postnatal period. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=QC01-QC04&id=11724 https://doi.org/10.7860/JCDR/2018/35593.11724 Enhancement of Student Centered Learning using Video Based Practical Demonstration in First Year Medical Undergraduates Santosh Laxman Wakode, Naina Santosh Wakode <b>Introduction:</b> Recently, video demonstration or procedure video has been integrated into preclinical laboratory teaching and practical demonstrations. Although the computer assisted learning is introduced in to the medical institutions, there is no evidence that such move can improve student learning. <b>Aim:</b> The present study was designed to compare the effectiveness of traditional physiology practical demonstration with computer assisted pre-recorded video demonstration of the same practical procedure. <b>Materials and Methods:</b> Total 100 first year medical undergraduates participated in the study and was randomly assigned to two groups. The students in group 1 (n = 50) watched procedure video on the projector while students in group 2 (n = 50) attended a live demonstration of procedure performed by the same faculty for blood group determination. After completing the practical assignment, assessment was done for both groups according to pre-specified criteria. Subsequently student’s perception of their ability to perform practical activities was assessed on Likert scale with the help of questionnaire. Student's t-test was used for statistical analysis. <b>Results:</b> Statistically significant difference was seen for two groups. On Likert type scale the procedure video learners (group 1) reported higher average score (3.34) than traditional live demonstration learners (group 2) (3.06), also the percentage of score achieved by video learners for assignment was higher. A 80% or above percentage score was achieved by 32 (64%) of group 1 learners where as only 21 (42%) of group 2 learners were able to achieve it. <b>Conclusion:</b> Thus, a video based practical demonstration for laboratory teaching enables teachers to reflect on their teaching and promotes student-centered learning. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=JC01-JC03&id=11729 https://doi.org/10.7860/JCDR/2018/35181.11729 Comparative Evaluation of Propofol Fentanyl, Propofol-Midazolam and Propofol-Dexmedetomidine on Haemodynamic and Postoperative Recovery for Endoscopic Retrograde Cholangiopancreatography Vinit Kumar Srivastava , Devendra Singh, Sanjay Agrawal, Saima Khan, Ankita Gupta, Roop Das Miree <b>Introduction: </b>Adequate patient sedation is mandatory for Endoscopic Retrograde Cholangiopancreatography (ERCP). Recent studies indicate that propofol and combination of midazolam or fentanyl or dexmedetomidine is superior to propofol alone in terms of haemodynamic stability, sedation efficacy and recovery parameter. <b>Aim:</b> The present study compared the efficacy of propofol-fentanyl, propofol-midazolam and propofol-dexmedetomidine on haemodynamic and postoperative recovery in ERCP patients. <b>Materials and Methods:</b> A total of 105 patients were randomly assigned to three groups. Group I received fentanyl 1 mcg/kg over 10 min, followed by propofol loading dose 1-2 mg/kg before procedure and maintenance 1-5 mg/kg/h throughout the procedure. Group II received midazolam 0.04 mg/kg over 10 minute, followed by the same dose of propofol and group III received dexmedetomidine 1 mcg/kg over 10 minute, followed by the same dose of propofol throughout the procedure. Heart rate, blood pressure and oxygen saturation were recorded at preoperative, after study drug, after induction, during procedure and after 5 minute of end of the procedure. Time to achieve Modified Aldrete Score of 9-10, endoscopist’s satisfaction and patients’s satisfaction (according to Visual Analog Scale 0-100 mm) were also recorded. Patient characteristic data were analysed with one-way analysis of variance (ANOVA) and Chi-square test. Haemodynamic parameters were compared with ANOVA. Satisfaction score was analysed by the Kruskal-Wallis test. <b>Results:</b> Demographic data of all the groups were comparable. In group III, there was no significant increase in heart rate and blood pressure values during the procedure (p>0.05), while in group I and II there was a significant change in heart rate and blood pressure at various intervals. Endoscopist’s satisfaction was significantly more in group I and group III compared to group II (p<0.05), but patients’s satisfaction was similar among the groups (p>0.05). <b>Conclusion:</b> Dexmedetomidine-propofol and fentanyl-propofol combination are more effective than midazolam-propofol for maintaining the haemodynamic stability during ERCP. Dexmedetomidine is most appropriate adjuvant because it reduces the pain level and the amount of propofol to be administered to the greatest extent and is not different from other agents in terms of satisfaction score and side effects. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=UC01-UC05&id=11730 https://doi.org/10.7860/JCDR/2018/32201.11730 Effect of Chlorhexidine and Cystatin Incorporated Adhesives on MMPs and Cysteine Cathepsin-An In-vitro Zymographic Analysis Poorna Gomathi Bhoopathi, Karthi Keyan Kittappa, Kavitha Sanjeev, Mahalaxmi Sekar <b>Introduction: </b>Host-derived proteases such as Matrix Metallo Proteinases (MMPs) and Cysteine Cathepsin have been reported to degrade the collagen matrix of incompletely-resin infiltrated dentin. In an effort to improve the bond durability, specific and non-specific proteolytic inhibitors have been identified. <b>Aim:</b> The aim of this study was to comparatively evaluate the presence of MMPs and Cysteine Cathepsin in dentin after the incorporation of non-specific inhibitor 0.2% chlorhexidine and specific inhibitor cystatin to total etch and self-etch adhesives using zymographic analysis. <b>Materials and Methods:</b> Quantitative analysis of 135 coronal dentin specimens of human mandibular molars, which were randomly divided into three groups, based on the adhesive systems with and without the inhibitors was done. These were further subjected to zymographic analysis at various time periods at CLRI Institute, Chennai, following this the results were subjected to descriptive analysis. <b>Results:</b> The results obtained were calculated and expressed in terms of frequency. Results revealed that with combined use of both 0.2% chlorhexidine and cystatin, the gelatinolytic activity was completely absent at all time intervals. <b>Conclusion:</b> The incorporation of both 0.2% chlorhexidine and cystatin in adhesives inhibited MMPs and Cysteine Cathepsin activity completely, thereby prolonging the durability of resin dentin bond over a period of time. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=ZC01-ZC05&id=11731 https://doi.org/10.7860/JCDR/2018/31972.11731 Evaluation of the Role of HBA1c in Chronic Kidney Disease Kommineni Sai Subramanyam, Siddharth Gosavi, Divya Tenneti, Roopa Murgod <b>Introduction:</b> Chronic Kidney Disease (CKD) refers to a group of heterogeneous disorders that results in gradual loss of structure and function of the kidneys. <b>Aim:</b> To evaluate the role of glycated haemoglobin (HBA1c) due to type II diabetes mellitus by correlating glycated haemoglobin with estimated Glomerular Filtration Rate (GFR) and serum creatinine parameters. <b>Materials and Methods:</b> This study was conducted over a period of one year during which 60 patients with CKD were enrolled for the study. Sixty age and sex matched controls were also enrolled. The diagnosis of CKD was done based on estimated Glomerular Filtration Rate (eGFR) calculation after obtaining history/clinico-pathological information. Blood samples were analysed for the following parameters: fasting blood sugar, HBA1c, blood urea, serum creatinine, serum albumin and electrolytes. The eGFR was calculated by using Modification of Diet in Renal Disease equation. Statistical analysis was done by using SPSS software. <b>Results:</b> On comparison, the values of fasting blood sugar, HBA1c, blood urea, serum creatinine and serum potassium levels were significantly higher in CKD cases than in controls (p< 0.001). The values of haemoglobin and serum albumin were found to be significantly lower in the cases than the control group (p< 0.001). Among the CKD cases, correlation studies were done. HBA1c values negatively correlated with eGFR and positively correlated with serum creatinine values. The CKD cases were subdivided based on their stage (stage 3, 4 and 5) and compared with each other. A statistically significant difference (p < 0.001) between median values of HBA1c, eGFR and serum creatinine was observed among the three groups of stage 3, 4 and 5. <b>Conclusion:</b> As the results show, greater glycaemic control is emulated by lower HBA1c levels which in turn are directly related to severity of the renal disease as indicated by the falling eGFR and rising serum creatinine values. These findings suggest that proper and timely control of HbA1c level in patients with chronic renal disease with diabetic aetiology is of utmost importance for staging and prognosis of the disease. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=BC01-BC04&id=11732 https://doi.org/10.7860/JCDR/2018/34732.11732 Effect of Pre-Analytic Variables on Prothrombin Time and Activated Partial Thromboplastin Time- ARTICLE RETRACTED Garima M Anandani, Swati B Parikh <b>Garima M Anandani, Swati B Parikh</b>, Effect of Pre-Analytic Variables on Prothrombin Time and Activated Partial Thromboplastin Time (Published in Journal of Cilinical and Diagnostic Research. 2018 July: 12(7):). EC01–EC05 Investigating on the complaint received, the journal could not ascertain the authenticity of the study even after consultation with the head of the institution and other authors of the study, hence article has been retracted. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=EC01-EC05&id=11719 https://doi.org/10.7860/JCDR/2018/32666.11719 <i>Saksenaea vasiformis</i> Causing Cutaneous Zygomycosis: An Experience from Tertiary Care Hospital in Mumbai Shashir Wasudeorao Wanjare, Sulmaz Fayaz Reshi, Preeti Rajiv Mehta <b>Introduction:</b> Zygomycosis, a fungal infection caused by a group of filamentous fungi, Zygomycetes. Zygomycetes belong to orders Mucorales and Entomorphthorales. Infection occurs in rhinocerebral, pulmonary, cutaneous, abdominal, pelvic and disseminated forms. Cutaneous zygomycosis is the third most common presentation, usually occurring as gradual and slowly progressive disease but may sometimes become fulminant leading to necrotizing lesion and haematogenous dissemination. Infection caused by Saksenaea vasiformis is rare but are emerging pathogens having a tendency to cause infection even in immunocompetent hosts. <b>Aim:</b> To analyse cases of cutaneous zygomycosis caused by Saksenaea vasiformis with respect to risk factors, clinical presentation, causative agents, management and patient outcome. <b>Materials and Methods:</b> A retrospective study was conducted at the Department of Microbiology, Seth GS Medical College and KEM Hospital, Mumbai. All the diagnosed cases of cutaneous zygomycosis caused by Saksenaea vasiformis during the period 2010-2017 were included in the study. Case information was retrieved from medical records department. Diagnosis of zygomycosis was based on 10% Potassium Hydroxoide (KOH) examination, culture on Sabouraud’s Dextrose Agar (SDA), identification of fungus by slide culture, Lactophenol Cotton Blue (LPCB) mount and Water Agar method. <b>Results:</b> In the present study, seven cases of cutaneous Zygomycosis caused by emerging pathogen Saksenaea vasiformis were studied. On analysing these cases, it was found that break in the skin integrity predisposes to infection. Two patients were known cases of Diabetes mellitus, while five of them had no underlying associated medical conditions. This study shows that although infection with Saksenaea vasiformis is more common in immunocompromised patients but a healthy individuals can be infected and may have a bad prognosis if diagnosis and treatment is delayed. <b>Conclusion:</b> In cases of rapidly progressive necrosis of wound not responding to antibiotics, Saksenaea vasiformis should be considered as one of the aetiological agents and laboratory plays the major role for diagnosing these cases and thereby helps in prompt management of patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=DC01-DC05&id=11720 https://doi.org/10.7860/JCDR/2018/33895.11720 The Effect of Inhalation Aromatherapy with Lavender Essential oil on Pain Severity of Patients After Coronary Artery Bypass Surgery: A Single-blind Randomised Clinical Trial Zahra Seifi, Ali Bikmoradi, Mohammad-Rafi Bazrafshan, Jalal Poorolajal, Malihe Araghchian, Seyyed Hannan Kashfi, Esmaeil Kavi, Mozhgan Jokar <b>Introduction:</b> Pain control and management are the most important issues of human basic needs and healthcare. The use of aromatherapy to relieve pain has grown substantially compared with other supplementary therapies. Aroma molecules convert to nervous signals in the olfactory bulb, amygdala and the limbic system and produce therapeutic effects by causing the release of a variety of neurotransmitters such as encephalin, endorphins and serotonin. <b>Aim:</b> This study aimed to investigate the effects of inhalation aromatherapy with lavender essential oil on pain severity of patients after coronary artery bypass surgery. <b>Materials and Methods:</b> A single-blinded randomised clinical trial was conducted with 60 patients after coronary artery bypass surgeries that were recruited during 2013 from Ekbatan Therapeutic Center of Hamadan, Iran. The intervention continued for two days for pain management. The intervention group inhaled two drops of 2% lavender essential oil, while the control group used the same amount of distilled water for 20 minutes on the second and third postoperative days. Pain was measured at baseline and 5, 30, and 60 minutes following the intervention via vital sign tests and Visual Analogue Scale (VAS). Independent t-test and ANOVA were performed to measure continuous variables, while chi-square was conducted for the analysis of categorical variables, using stata version 11.0. <b>Results:</b> The mean chest pain score decreased significantly in both groups after surgery however, there were significant differences between the aromatherapy and control groups before and after intervention only at the 30th minute (p=0.001) and 60th minute (p=0.012) on the second day after surgery. <b>Conclusion:</b> Inhalational aromatherapy with lavender essential oil could relief pain of patients in the first days following coronary artery bypass surgery. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=LC01-LC05&id=11721 https://doi.org/10.7860/JCDR/2018/34865.11721 Effect of Different Lighting Conditions on Proximal Caries Detection in Dental School Settings Mohammed Alsaati, Thomas Deahl, Marcel Noujeim <b>Introduction:</b> Environmental factors, including ambient light, play an important role in caries detection. Dental private practices and dental school clinics are exposed to extraneous light from fluorescent fixtures operative unit lights and/or windows. In previous studies, visual fatigue and impaired diagnostic accuracy are found to be associated with the viewing conditions. <b>Aim:</b> The study aims to evaluate and compare dental students’ performance at detecting proximal caries on intraoral digital radiographs, under different ambient light conditions. <b>Materials and Methods:</b> Eight randomly chosen senior dental students and a dentist evaluated intraoral digital images of 32 extracted teeth mounted in 12 quadrants. Almost half of the teeth are courteous as confirmed by histology. The illuminance measuring unit (Lux) is used to measure the light conditions at luminous flux per unit area. Raters viewed the images in ambient light conditions i.e., dim light settings (Less than 50 Lux) and in bright light settings (more than 800 Lux). Images were viewed with the same calibrated monitor. All other viewing conditions were controlled. Raters stated their certainty of caries presence on a 5-point scale. Sensitivity, specificity and Receiver Operating Characteristic (ROC) curve was calculated for all observations and for both light settings. <b>Results:</b> Raters performed at a higher specificity under dim light conditions, statistically significant (at the 0.05). ROC analysis showed that the overall performance under dim light environment was better than the bright light environment (0.745 vs. 0.710), which was physically significant (at the 0.05). <b>Conclusion:</b> The results support reducing ambient light levels to rule out caries, as there is a significantly higher specificity and performance in a dim light environment compared to bright one. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=ZC06-ZC10&id=11734 https://doi.org/10.7860/JCDR/2018/34353.11734 Comparison of Predebridement and Debridement Cultures in Predicting Postoperative Infections in Compound Fractures Adisesh Mangala, Krishnarao Arthi, R Deepa <b>Introduction:</b> Compound fractures are fractures which communicate to the external environment through a wound, exposing the bone. Bacterial contamination is reported to occur in 60-70% of the cases which may be responsible for the infectious complications in these patients. This study has aimed to predict the appropriate time of culture, its frequency and the type of specimen to be processed for determining the microbial flora of the fracture wound which will help in instituting rational antibiotic treatment for the patient. <b>Aim:</b> To compare predebridement and debridement cultures in causing postoperative infections in patients with compound fractures of long bones. <b>Materials and Methods:</b> This was a prospective study conducted at Madras Medical College for a period of 6 months involving 100 samples consisting of sequential swabs and tissue specimens sent to the Microbiology laboratory for investigation. <b>Results:</b> In the predebridement period, within 6 hours of injury, 15% of the cultures showed significant growth out of which Staphylococcus aureus was isolated in 53%. Among the debridement cultures 41% showed significant growth. Postoperative follow up was done for 6 weeks. Forty six percent of patients showed clinical signs of infection. Thirty nine percent of patients turned out to be culture positive confirming the presence of postoperative infection. It was noted that 53 percent of predebridement culture positive patients continued to have persistent infection in the postoperative period and 66% of the debridement culture positive patients developed postoperative infection. It was concluded that the sensitivity of predebridement cultures and debridement cultures were 21% and 69% respectively. <b>Conclusion:</b> It is therefore recommended that debridement culture with a higher sensitivity will provide guidance regarding the choice of antimicrobial therapy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=DC06-DC09&id=11735 https://doi.org/10.7860/JCDR/2018/36011.11735 Role Conflict and Psychological Well-Being in School Teachers: A Cross-Sectional Study from Southern India Megha Thakur, Varalakshmi Chandrasekaran, Vasudeva Guddattu <b>Introduction:</b> With mental strength being the requisite skill in this knowledge era, rather than physical strength, women seem to flood into every industry on par with men. This shift in the lives of women indeed gives them more confidence and opportunities to identify their assets, but also brings a challenge as they have to perform equally at home and at work. The attempt of working women to integrate, organize and balance the various problems and activities in their different roles simultaneously puts them under tremendous pressure. <b>Aim:</b> The present study endeavours to gain insight into role conflict and how it influences psychological well-being of school teachers. <b>Materials and Methods:</b> A cross-sectional study was conducted in the government, aided and unaided schools in Udupi, Karnataka. A total of 645 school teachers were interviewed using a self-administered questionnaire. Tools used were Netemeyer scale for role conflict, Brief COPE inventory for coping mechanism and GHQ-12 for assessing psychological well-being. Univariate and multiple logistic regression analyses were carried out to assess the association between role conflict and major variables in the study. Post-hoc test was used to identify the differences in coping among various groups. <b>Results:</b> Religion, age of the children and performing school related work on the weekend were found to be significantly associated with role conflict. Gender was not found to influence role conflict in the present study. No significant association was found between role conflict and psychological well-being. Active coping, religion and use of emotional and instrumental support were the most commonly adopted coping mechanisms. <b>Conclusion:</b> Thus, teachers must be provided a friendly working environment and they must be motivated for their psychological well-being. Stress relieving sessions also would help in balancing the work life. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=VC01-VC06&id=11738 https://doi.org/10.7860/JCDR/2018/31776.11738 Urological Manifestations in HIV and AIDS: At Tertiary Referral Centre Narayan Rao Gachchi Thakappa, Jayaram Sreenivas, R Keshavamurthy, M Shivalingaiah, RP Sanjay <b>Introduction:</b> The prevalence of HIV and AIDS continues to grow worldwide. Urological manifestations of HIV and AIDS such as urolithiasis, obstructive uropathy, complicated UTI and malignancy are often first clinical signs. With the availability of antiretroviral drugs and surgical intervention, the prognosis of HIV-infected patients is same as that of general population. <b>Aim:</b> To evaluate incidence of urological manifestations, their treatment and outcome in HIV and AIDS patients. <b>Material and Methods:</b> This was retrospective study conducted at Institute of Nephro-Urology, Bengaluru from June 2011 to May 2016. Inclusion criteria were all HIV and AIDS patients suffering from urological diseases. The data were collected in a Microsoft® Excel database and analysed through SPSS 20 version. <b>Results:</b> A total of 161 patients (male -93, female-68) with HIV and AIDS were analysed retrospectively. The most common presentations were Urosepsis (31.05%), Urolithiasis (27.32%), Malignancy (16.77%), Renal dysfunction (11.18%), Stricture urethra (7.45%), GUTB (Genito-Urinary Tuberculosis) (3.10%) and others (2.4%). The most common surgical intervention done was DJ stenting. Renal abscess, psoas abscess and stricture urethra patients underwent surgical intervention. Uncomplicated UTI was treated conservatively. Sepsis and pyogenic infections were more common in patients with CD4 count <200 cells/mm3.Out come was compared with non HIV-AIDS patients. <b>Conclusion:</b> Complicated UTI followed by calculus disease were most common in our study. It is important to create awareness of the urologic manifestations of HIV and AIDS among the retroviral positive patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=PC01-PC04&id=11739 https://doi.org/10.7860/JCDR/2018/35903.11739 Dental Erosive Potency of Commercially Available Ice Candies in India Using an Invitro Model KM Sudhir, Mandava Soundarya Chowdary, Vuyurru Chandrasekhara Reddy, Gomasani Srinivasulu, RVS Krishna Kumar, NT Chaitra, Narayan Rangari Rajeshree <b>Introduction: </b>Recent studies have shown that frozen fruit juices cause a greater drop in dental plaque and salivary pH. Since ice candies contain ingredients such as citric acid, sugar and flavouring substances similar to juices and it in frozen form, they may also have the potency to erode. <b>Aim:</b> To evaluate the erosive potency of commercially available and commonly consumed ice candies in India using an invitro model. <b>Materials and Methods:</b> An invitro experimental study was conducted among two commercially available ice cream brands. Two flavoured ice candies with lowest pH and highest Titrable Acidity (TA) were selected and were compared with a placebo ice candy made up of sterile water. Enamel slabs were prepared from extracted teeth and were placed in the selected ice candies for 21 days. At the end of the pH cycle protocol, enamel slabs were sent for micro hardness and Scanning Electron Microscopy (SEM) analysis. <b>Results:</b>Grape flavour (pH-2.18, TA-20 mL) and orange flavour (pH-2.14, TA-23 mL) ice candies showed the lowest pH and highest TA. Significant reduction in micro hardness of enamel was observed between baseline and after exposure in group A (Grape) {baseline-450.5 VHN (Vickers micro hardness number), after-349.6 VHN} with mean difference of 100.9 and group B (Orange) (baseline-400.1 VHN, after-298.1 VHN) with mean difference of 102. The SEM analysis showed a significant destruction of the enamel ultrastructure with exposure to grape and orange ice candies when compared to placebo. <b>Conclusion:</b> The commercially available and commonly consumed ice candies in India which were tested were found to be highly acidogenic and potentially erosive. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=ZC11-ZC15&id=11740 https://doi.org/10.7860/JCDR/2018/31311.11740 Hyponatremia Induced by Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers-A Pilot Study S Bhuvaneshwari, Prakash Vel Sankhya Saroj, D Vijaya, M Sabari Sowmya, R Senthil Kumar <b>Introduction:</b> Hyponatremia, serum sodium <135 mmol/L, can result in neurological manifestation in acute cases, may lead to seizures and coma. Angiotensin Converting Enzyme Inhibitor (ACEI) and Angiotensin II Receptor Blockers (ARB) are drugs that have been commonly prescribed for the treatment of hypertension and cardiac diseases. It has become important to evaluate and investigate the incidence of hyponatremia on consumption of these drugs. <b>Aim:</b> To determine the susceptibility of patients on ACEI and ARB to hyponatremia and to ascertain the drug producing notable hyponatremia among ACEI and ARB. <b>Materials and Methods:</b> The study was conducted in a tertiary care hospital. Serum sodium levels were assayed in patients taking ACEI and ARB; 50 patients were recruited. The patient’s age, sex, drug dosage, frequency of the drug administration were collected using a proforma. Statistical analysis of data were performed using SPSS version 19.0. <b>Results:</b> Among all, 48% (24 out of 50) of the study population administered with ACEI and ARB developed hyponatremia. Predisposition to develop hyponatremia was high in males compared to females. Incidence of hyponatremia was 62.5% (10 out of 16) in the age group of 56-75 years. Though, incidence of hyponatremia was 54.5% (18 out of 33) in ACEI group compared to 35.2% (6 out of 17) in ARB group, but it was not statistically significant. The study also revealed that metosartan had a higher association with hyponatremia compared to other drugs. <b>Conclusion:</b> Hyponatremia was induced in nearly 50% of patients taking ACEI and ARB. The incidence of hyponatremia among patients on these two drugs did not show statistical variation. Metosartan showed a higher incidence of hyponatremia compared to enalapril, ramipril, captopril, telmisartan, losartan included in the study. This study revealed that monitoring of serum sodium level in the patients with ACEI and ARB administration will help to elude unexpected adverse reactions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=FC01-FC03&id=11754 https://doi.org/10.7860/JCDR/2018/31983.11754 Pathological and Biochemical Evaluation of Toxic Effects of Repeated Administration of Jasada Bhasma (Zinc Ash Formulation) in Wistar Albino Rats Ravi Bhaskar, Megha A Doshi, Anjana Shidaraddi, Shakunthala Ramdas Pai, Naveen Kumar, Ravi Shankar, Ravi Mundugaru <b>Introduction: </b>Jasada Bhasma is the well known potent zinc formulation commonly used in ‘Ayurveda’ medicine system. Its extensive usage in the health care sector is proved to be successful in the treatment of certain illness and is considered to be popular in its stability, lower dose, and its availability. <b>Aim: </b>To evaluate the toxicity profile of Jasada Bhasma with primary emphasis on haematological, biochemical and histopathological changes in Wistar albino rats. <b>Materials and Methods:</b> For toxicity study, Wistar albino rats of either sex, weighing from 150-225 gm of body weight were used, and they were divided into three groups, ten rats in each group. Group-I administered with carboxymethyl cellulose and considered as vehicle control. Group-II and III were administered with two levels of Jasada Bhasma, i.e., 10.8 mg/kg (Therapeutic dose) and 54 mg/kg (Five times of therapeutic dose) respectively for 28 consecutive days. On the 28th day, the animals were sacrificed. Blood sample and vital organs were collected for haematological, biochemical and histopathological examinations. <b>Results:</b> The repeated administration of Jasada Bhasma on Wistar albino rats did not produce remarkable toxicity changes at both the dose levels in most of the haematological parameters tested except there was a significant (p<0.01) increase in the mean cell haemoglobin concentration. Biochemically, the significant increase (p<0.01) in the serum creatinine but decrease in urea level has been shown in both levels of administration. The significant rise in potassium and total protein levels were also evident. Histopathologically, sections of liver and kidney showed pathological cytoarchitecture at both level dose exposures. However, sections of spleen showed mild to moderate increase in white pulp proportionate the five times of therapeutic dose level. <b>Conclusion:</b> The repeated administration of test drug Jasada Bhasma at therapeutic dose was relatively safer; however, at higher dose level it produces some functional changes in histopathological sections of kidney and liver. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=AC01-AC04&id=11755 https://doi.org/10.7860/JCDR/2018/36665.11755 A Retrospective Study of Paediatric Dengue Cases in a Tertiary Care Hospital in Southern India Padmanabhan P Athira, Ozhiparambil A Jagan, Padma Umadevi, Komaravolu Pragnatha, P Menon Veena <b>Introduction:</b> Dengue is an important arthropod-borne viral infection in humans and is the second most important reemerging tropical disease. Children are particularly at risk of developing severe dengue and clinically identifying such cases are often a challenge. <b>Aim:</b> To characterise the clinical and laboratory risk factors of dengue fever and its severity in children. <b>Materials and Methods:</b> Retrospective evaluation of demographics, clinical, laboratory findings and outcome of suspected dengue fever in children admitted to the hospital between Jan 2015 - Feb 2017 was performed to identify risk factors of dengue fever and its severity. <b>Results:</b> During the study period, a total of 211 children were clinically suspected on the admission as dengue fever, 34 of these were serologically confirmed dengue positive. A 74% (27/34) of these were primary dengue infections. The mean age of the dengue cohort was 7.6 years (±s.d. 4.8) with 59% (20/34) being boys. Based on 2009 WHO clinical criteria, 16 were identified as Dengue with warning Signs (DS), 7 as Dengue Without warning Signs (DWS) while 11 were identified as Severe Dengue (SD). Some of the frequently observed clinical features were fever (31/34), headache (5/34), thrombocytopenia (9/34), leukopenia (4/34) and rash (5/34). The mean WBC in children with severe dengue was 7.9 % (s.d.±5.0) with elevated monocytes 12.2 % (s.d.±3.5) compared to 11.3% (s.d.±5.8) and 6.6% (s.d.±2.0) in children with DS and DWS respectively. Transaminitis was more frequently observed in severe dengue. <b>Conclusion:</b> Clinical and laboratory parameters of acute febrile illness in children can act as early prognosticators of dengue fever and its severity. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=SC01-SC06&id=11756 https://doi.org/10.7860/JCDR/2018/34710.11756 Prevalence of Urinary Incontinence among Females with Vaginal Delivery, Lower Segmental Cesarean Section, Diabetic and Hypothyroidism and Its Impact on Quality of Life V Rajalaxmi, P Sutharsika, CV Senthilnathan, G Yuvarani, SS Subramanian <b>Introduction:</b> Urinary incontinence is defined as involuntary loss of urine that represents both hygienic and social problem to the individual. Prevalence of urinary incontinence in women is nearly 30 to 40% in middle aged and 50% in older women. There are some risk factors associated with urinary incontinence such as age, childbirth, pregnancy, surgery, lifestyle habits, neurological problem, menopause, obesity, pelvic organ prolapsed etc. Some studies suggested that urinary incontinence has been related with BMI, races, age, smoking, alcohol intake, physical activity. <b>Aim:</b> The study aimed to find out the prevalence of urinary incontinence among different aged women with vaginal delivery, lower segmental caesarean section, diabetic and hypothyroidism and its impact on quality of life. <b>Materials and Methods:</b> A total of 240 women were selected from 300 volunteers based on the inclusion criteria of six months after delivery either a vaginal delivery or lower segmental caesarean section and females taking medication for hypothyroidism and diabetes for maximum of five years. Exclusion criteria were patients who underwent recent abdominal surgeries, any recent fracture, long standing disease, uncooperative patient and neurological or psychological problems. They were divided into four groups, 60 in each group. After getting the consent from the patients, assessment form and questionnaires were given and to be filled by the sample and asked to answer the entire question ensuring confidentiality. The materials used were Questionnaires for Urinary Incontinence Diagnosis (QUID), Incontinence Impact Questionnaire short form (IIQ-7) and Incontinence Severity Index (ISI). <b>Results:</b>The study showed that the prevalence of urinary incontinence was higher among women with Group C (Diabetic) followed by Group A (Vaginal delivery), Group B (Lower segmental caesarean section) and Group D (Hypothyroidism. It showed invariable effect on the quality of life of the women. <b>Conclusion:</b> The study concluded that the prevalence of urinary incontinence among the four groups of women is higher in Group C (diabetic) followed by Group A (vaginal delivery), Group B (lower segmental caesarean section), and Group D (hypothyroidism). The urge incontinence was more prevalent than the stress incontinence. However, it also showed that there is an impact on the quality of life of the affected women. Thus, the null hypothesis is rejected and alternate hypothesis is accepted. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=QC05-QC08&id=11743 https://doi.org/10.7860/JCDR/2018/34081.11743 Management of Mesenteric Cysts in Children: Review of Ten Cases Rajendra Kumar Ghritlaharey <b>Introduction:</b> Mesenteric cysts are rare, benign, intra-abdominal entities with diverse clinical presentation, and most frequently located in the mesentery of the small bowel. Complete excision of the mesenteric cysts is a therapy of choice, although more than 50% require bowel resection and anastomosis during complete excision. <b>Aim:</b> To review the clinical presentation, and management of mesenteric cysts in children. <b>Materials and Methods:</b> During Jan 2000 to Dec 2016, 10 children with mesenteric cysts under the age of 12-years were treated by author at Department of Paediatric Surgery. Desired data was obtained from case sheets. The intention was to review their clinical presentation, diagnostic modalities used, and results of surgical excision done for mesenteric cysts. <b>Results:</b> This retrospective review of the management of mesenteric cysts included six boys and four girls. The mean age at the time of presentation was 43.6±26.84 months, and ranged from 2 to 96 months. Seven of them presented with acute intestinal obstruction, and remaining three presented with abdominal lump and abdominal pain. Mesenteric cysts involved the jejunum in six, and ileum was involved in remaining four cases. Surgical procedures executed in order of frequency were: (a) en bloc excision of mesenteric cysts, part of involved jejunum and jejuno-jejunal anastomosis n=5; (b) en bloc excision of mesenteric cysts, part of involved ileum and ileoileal anastomosis n=2; (c) complete excision of mesenteric cyst and repair of mesenteric defects n=2; and (d) en bloc excision of mesenteric cyst, part of involved ileum, and an ileostomy which was closed 2 and half months later n=1. Histologically, all of them were reported as mesenteric cysts. Recurrence was not noted in follow up period, which ranged from 6-months to 2-years. <b>Conclusion:</b> Mesenteric cysts are rare, benign, intra-abdominal pathology in children, and most of them present as an acute intestinal obstruction. In the study, volvulus of the small intestine due to mesenteric cysts was observed in 70% of the cases. Bowel resection was also required in 80% of the cases during surgical excision of the mesenteric cysts. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=PC05-PC09&id=11744 https://doi.org/10.7860/JCDR/2018/29018.11744 Association of Plasma Uric Acid with Inflammatory and Oxidative Stress Markers in Diabetic Nephropathy in North Indian Population: A Case Control Study Stuti Gupta, Mohini Sharma, Mohit Mehndiratta, Om P Kalra, Rimi Shukla, Jasvinder K Gambhir <b>Introduction:</b> Uric acid (UA), despite being a major antioxidant in human plasma, is also associated with development of diseases associated with oxidative stress. There have been few studies exploring the relationship of Plasma Uric Acid (PUA) with oxidative stress and inflammation. <b>Aim:</b> To analyse the association between UA and markers of oxidative stress and inflammation in diabetic nephropathy. <b>Materials and Methods:</b> The present case control study enrolled 100 participants and were categorized into two Groups (50 each) i.e., Type 2 Diabetes Mellitus without complication (T2DM) and Type 2 Diabetes Mellitus with Nephropathy (DN). Markers of oxidative stress like reduced Glutathione (GSH), Ferric Reducing Ability of Plasma (FRAP), Glutathione-S-Transferase (GST) and Malondialdehyde (MDA) were measured spectrophotometrically. Plasma TNF-a, hsCRP, urinary MCP-1 as markers of inflammation was estimated by ELISA. PUA was measured by uricase-PAP method. Student's t-test, pearson correlation and, linear regression were used for statistical analysis. <b>Results:</b> Plasma TNF-a, hsCRP, urinary MCP-1 were significantly (p<0.001) higher in DN as compared to patients with T2DM. GSH, FRAP and GST were lower (p<0.001) in DN as compared to T2DM group. However, plasma MDA was significantly higher in DN group as compared to T2DM. PUA significantly correlated negatively with GSH(r=-0.937, p<0.001), FRAP (r=-0.649, p<0.01), GST (r=-0.905, p<0.01) and positively with MDA (r=0.931, p<0.01), TNF-a (r=0.552, p<0.01), hsCRP (r=0.815, p<0.01), uMCP-1 (r=0.811, p< 0.001). In multivariate analysis, PUA was associated negatively with FRAP (Model 3:p=0.045) and GST (Model 3:p=0.44) but lost significance with GSH (Model 3:p=0.741), MDA (Model 3:p=0.884). However, PUA was associated with positively with TNF-a (Model 3:p=0.038), hsCRP (Model 3:p=0.036) and uMCP-1 (Model 3:p=0.040). <b>Conclusion:</b> PUA was associated negatively with FRAP, GST and positively with TNF-a, hsCRP, uMCP-1 in diabetic patients. These results suggest that UA contributes to oxidative stress and systemic inflammation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=BC05-BC09&id=11745 https://doi.org/10.7860/JCDR/2018/31649.11745 Building Centres of Excellence in Dental Institute to Foster Organisational Development-A Preliminary Report Amol Deshmukh, Usha Radke, Saee Deshpande, Tapasya Karemore, Kavita Hotwani <b>Introduction:</b> A Centre of Excellence (CoE) can be described as an executive setting to develop benchmark of conduct in the fields of research, invention and scholarship. The CoE at Vidya Shikshan Prasarak Mandal dental college and research centre (VSPMDCRC), Nagpur, India was started in 2016 to cater to oral healthcare in rural Indian population and foster organisational development through an integrated approach. The long-term objective for establishing the CoE was to stand out as a pioneer in Central Indian region in the respective fields. <b>Aim: </b>The present report was aimed to preliminarily evaluate the impact of CoE through an assessment framework that was developed using a consensus building exercise with stakeholder groups and experts and present an evaluation report for the same. <b>Materials and Methods:</b> The CoE was planned and executed under two working units as centre for Maxillofacial rehabilitation and centre for Oral Implantology at the institute. The second phase involved assessment of CoE functioning and analysis at the end of one year using an assessment framework for quantitative data. Qualitative data was collected from stakeholders (staff, students and patients) using personal interviews and a structured validated questionnaire for assessing implementation, effectiveness, efficiency, cost-effectiveness and attribution of the CoE. The overall impact was categorised and discussed as per the excellence criteria’s modified, based on Boyer’s model of scholarship. <b>Results:</b> Qualitative and quantitative data analysis depicted that the current excellence intervention laid down a foundation for our institute by virtue of pillars of excellence encompassing academic development, research activities, clinical patient work, faculty development and technological and social upliftment. <b>Conclusion: </b>The preliminary evaluation of the current CoE program showed potential for the institutional growth in all aspects, reflected in the form of advancements in the six pillars of excellence. It also helped in fostering teamwork and collaboration, improving patient outlook towards our institution and generating better training opportunities for students. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=ZC16-ZC19&id=11747 https://doi.org/10.7860/JCDR/2018/31757.11747 Psychiatric Morbidity in Chronic Low Back Pain-A Cross-Sectional Study Anithakumari Ayirolimeethal, Firoz Kazhungil, AM Kunhikoyamu, V Ravikumar <b>Introduction:</b> Psychiatric disorders are found to be predisposing or perpetuating factors in patients with Chronic Low Back Pain (CLBP) and these may also arise as a consequence of CLBP. More than one third of patients with CLBP are reported to have psychiatric morbidity along with physical or radiological signs and another third has no physical or radiological signs, but only psychiatric disorders. On the basis of clinical and radiological findings and presence of psychiatric diagnosis, patients with CLBP can be grouped in to three: 1) those with psychiatric disorder alone- the psychiatric group; 2) those with only physical illness with no psychiatric disorder- the organic group; and 3) group with both physical illness with psychiatric disorder-the combined group. Prevalence of psychiatric disorders in CLBP is understudied. Identification and treatment of psychiatric disorders in CLBP will help to reduce disability. <b>Aim:</b> To assess the type of psychiatric disorders and to compare psychiatric disorders between psychiatric, non-psychiatric and combined group of CLBP. <b>Materials and Methods:</b> This was a cross-sectional observational study conducted in 92 consecutive patients presented with CLBP (back pain lasting for more than 12 weeks duration) to outpatient orthopaedics department during April to September 2001. These patients were evaluated for physical disorders using clinical and radiological examinations and psychiatric disorders using ICD 10 Classification of Mental and Behavioural Disorder-Diagnostic Criteria for Research (DCR). On the basis of clinical and radiological findings and presence of psychiatric diagnosis, subjects were grouped in to three; psychiatric group, organic group and the combined group. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 16.0. Sociodemographic and clinical characteristics between the groups were compared using Chi-square test for categorical variables and ANOVA for continuous variables. <b>Results:</b> Of 92 subjects 45(48.9%) belonged to the combined group, 38(41.3%) to psychiatric group and 9(9.8%) to organic disorder group. Depressive disorder was significantly higher (p=0.01) but somatoform disorder was significantly lower in combined group (p<0.01) compared to psychiatric group. There were more patients with severe pain in psychiatric group compared to other two groups (p<0.05). <b>Conclusion:</b> Psychiatric disorders are highly prevalent in CLBP. Proper and timely identification of psychiatric disorders may help clinicians to judiciously select the treatment in CLBP. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=VC07-VC11&id=11748 https://doi.org/10.7860/JCDR/2018/35160.11748 Pharmacoepidemiology of Snake Bite Cases at a Tertiary Care Teaching Hospital in Odisha Kunal Priyadarshi, Jayanti Prava Behera, Abinash Panda <b>Introduction:</b> Snake bite is a neglected but widely distributed public health problem. It results in significant morbidity and mortality in many active young people which can be reduced with proper awareness, first aid and prompt hospital management. The present study institution is the only referral hospital in southern Odisha, serving most of the rural area cases, where the patients are mainly farmers or labourers. Odisha has a high number of fatalities accounting to 1000 snakebite deaths per annum. Not only has the rural and agricultural preponderance contributed to high mortality, but the lack of transportation service and loss of golden hour of treatment are the reasons. <b>Aim:</b> To assess the demographic characteristics, pharmacological interventions, with special reference to drug utilisation and risk factors associated with fatal outcomes in snake bite cases. <b>Materials and Methods: </b>This was a prospective, observational and hospital based study, carried out at emergency OPD and medicine IPD of MKCG MCH, Brahmapur, Odisha, from April to October 2016. Two hundered sixty cases of snake bite were included in this study, who satisfied the selection criteria and patient/ relative agreed to give written informed consent. Data regarding sociodemographic characters like age, sex, occupation, rural or urban area, of residence time elapsed after snake bite till hospitalisation, drug use and treatment outcome in terms of cure and death were collected in a case record form from hospital record and by interviewing to the relatives. The categorical data were expressed in percentage and risk factor associations were analysed by Chi-square test and Odds’ Ratio. <b>Results: </b>Out of the 260 cases, 56% cases belonged to 30-60 years of age group and maximum number were males, accounting for 60% (156) cases. Majority of cases i.e., 85% (221) were from rural areas, of low socio-economic back ground i.e., 77% (200) and mostly illiterate. Prior to hospitalisation 58% (150) patients were treated using local remedies like traditional ayurvedic medicine or traditional healer. The case fatality was significantly associated with time elapsed from snake bite to administration of ASV, complications and initial dose of ASV for treatment and was observed to be 6.1% in this study population. Cobra bite constituted 16% of cases which had a significant association with mortality (p<0.001). Majority of cases (92%) received ASV within 1-6 hours and were significantly cured. But the patients who were treated with ASV after 6 hours i.e., 7.6%, showed significant association with fatal outcome (p<0.001). <b>Conclusion:</b> This study observed a direct association between different risk factors like delay in ASV administration, development of complications and initial dose of ASV and mortality. The study emphasises the need for improvement in transportation and ambulance service and proper sensitisation of general public with reference to appropriate first aid measures and undue reliance on traditional healers.. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=FC04-FC07&id=11777 https://doi.org/10.7860/JCDR/2018/28667.11777 Comparison of Apically Extruded Debris after Retreatment Procedure with ProTaper and Endostar Retreatment File Systems Amit Jena, Govind Shashirekha, Sudipto Barai, A Mahaprasad <b>Introduction:</b> During endodontic retreatment apical extrusion of debris in the form of filling materials, necrotic pulp tissues, microorganisms as well as irrigants may lead to post instrumentation pain, inflammation and impaired healing. <b>Aim:</b> The aim of the study was to compare the amount of debris extruded from the apex during retreatment procedures using ProTaper R (PTR; Dentsply Maillefer, Ballaigues, Switzerland) and Endostar RE Re endo rotary system (ERE; Poldent Co. Ltd., Warsaw, Poland) file systems. <b>Materials and Methods: </b>A total of 30 extracted mandibular premolars were prepared and obturated with gutta-percha and AH Plus sealer (Dentsply DeTrey, Konstanz, Germany) using warm vertical compaction technique. The teeth were randomly divided into two groups of 15 each for removal of root canal filling material with PTR and ERE files. The Apically Extruded Debris (AED) was collected in preweighed eppendorf tubes. Data were analysed statistically using independent sample t-test. Significance level was established at a=0.05 <b>Results:</b> No significant difference (p=0.701) was found among the groups regarding the amount of AED. AED was more for PTR files as compared to ERE files while PTR files cleaned the canal walls better as compared to ERE. <b>Conclusion:</b>Both retreatment file systems were associated with some degree of debris extrusion from the apex. Though statistically insignificant PTR files extruded more debris than ERE files. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=ZC31-ZC34&id=11778 https://doi.org/10.7860/JCDR/2018/34090.11778 Stress Management Training among Mothers with Autistic Children Referred to Autism Centres in Tehran Shima Bastanfar, Faezeh Sahbaei, Mohammad Fesharaki <b>Introduction:</b> Parental mental health can be strongly influenced by a child with a disability such as autism. This disorder involves a wide range of behaviours and in particular social behaviours. <b>Aim:</b> To investigate the impact of stress management training on the stress level of mothers with autistic children referring to the selected autism centres of Tehran. <b>Materials and Methods:</b> The present quasi-experimental study was a clinical trial that included 70 mothers with autistic children who were referred to autism centres in Tehran from October 2016 to September 2017. A random stratified sampling method was used to select the centres. The data collection tool was demographic information questionnaire and Cohen’s Perceived Stress Scale (CPSS). The research was conducted in three stages (before intervention, during intervention, and after intervention) and the collected data were analysed using SPSS software, version 16.0. <b>Results:</b> According to the findings, 51 (72.9%) of the participants before the stress management training had moderate stress and most of them 46 (65.7%) had mild stress management training. Also, paired t-test at p<0.001 showed significant difference between stress before and after stress management training. <b>Conclusion:</b> Based on the results of the research, stress management education can be considered as an important part of interventions to promote mental health of mothers with autistic children. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=LC10-LC13&id=11779 https://doi.org/10.7860/JCDR/2018/35237.11779 Significance of Serum Vitamin D Level in Tuberculosis Patients Salauddin Khan, Nafees Ahmad Khan, Mohammad Shameem, Rakesh Bhargva, Irfan Khan, Nithin Anand <b>Introduction:</b> The role of vitamin D in bone homeostasis is well known but nowadays, its role in various essential body processes including prevention of various infective and chronic illnesses like Tuberculosis (TB), by facilitating adaptive and innate immunity in lungs and peripheral blood, is being a matter of debate. Low levels have been associated with respiratory tract infections like TB. Present study aimed to evaluate the level of vitamin D in tubercular patients. <b>Aim: </b>To determine serum vitamin D level in patients with TB and compare it with controls. To compare serum vitamin D level among different types of TB, including Pulmonary TB (PTB), tubercular lymphadenitis and tubercular pleural effusion. <b>Materials and Methods:</b> The present study was a single centre cross-sectional study done during the study period from September 2013 to September 2016 at a tertiary care centre of Uttar Pradesh, India. Total 216 subjects aged between 21 and 60 years were included randomly out of which 113 patients were cases and 103 were controls. Cases of TB were confirmed by sputum Acid Fast Bacilli (AFB) staining, sputum and pleural fluid cytology, Adenosine Deaminase (ADA) of pleural fluid and Fine Needle Aspiration Cytology (FNAC) of lymph nodes. Controls were healthy subjects. Total serum vitamin D levels were measured by Diasorin competitive Radioimmunoassay (RIA) (Autoimmune Diagnostika, GmbH, Strasburg, Germany). <b>Results:</b> The mean serum vitamin D level for patients with TB was 22.4±8.5 ng/mL. Among controls, it was 30.5±8.6 ng/mL (p<0.001). This analysis showed that mean serum vitamin D levels were significantly lower in TB patients as compared with controls and there is no significant difference of serum vitamin D levels in various groups of TB. Also, there was no effect of confounding factors like age, sex and indoor/outdoor activity. <b>Conclusion:</b> The findings of the present study showed that hypovitaminosis-D was highly prevalent among patients with TB as compared to general population in same geographical area and severity of it is not significantly related to different type of TB. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=OC01-OC05&id=11781 https://doi.org/10.7860/JCDR/2018/28226.11781 Effect of a Multi-Component Exercise Program on Functional Mobility, Exercise Capacity and Quality of Life in Older Adults Santhakumar Haripriya, Dhanesh Kumar, Sanjay Eapen Samuel, Ajith Soman <b>Introduction:</b> Older people have limitations in their functional and regenerative abilities, and are more prone to diseases and infirmities, when compared to younger adults. Ageing is seen to decrease physical fitness, which includes the components of endurance, strength, flexibility and agility. This decrease can lead to difficulties in functioning normally and carrying out activities of daily living. Exercise training has been seen to have positive effects on fitness levels, cardio-respiratory functions, fall risk and cognitive function in elderly individuals. <b>Aim:</b> To study the effect of a multi-component exercise program on functional mobility, functional exercise capacity and quality of life in elderly individuals. <b>Materials and Methods:</b> A total of 30 older adults above the age of 65 years, who were able to ambulate independently and able to understand instructions, and who did not suffer from severe musculoskeletal, neurological or cardiopulmonary disease were given an exercise program of 10 weeks duration which comprised of aerobic, resistance, functional and balance training components. The subjects were assessed using the 8-foot up and go test (8 UG) for functional mobility, Six Minute Walk Test (6 MWT) for functional exercise capacity and short form 36 scale (SF-36) for quality of life at baseline and every two weeks up to the end of the intervention. <b>Results:</b> Paired t-test results for the three outcome measures namely 8 UG, 6MWT and SF-36 showed a significant difference in all three measures when post-intervention scores were compared with pre-intervention scores (p<0.01). Multivariate analysis was done to test the significance of the values obtained at intervals of two weeks during the intervention, which showed that, all the three outcome measures showed a significant difference between the weeks (p<0.01). <b>Conclusion:</b> A 10-week multi-component exercise program comprising of aerobic, resistance, functional and balance exercises significantly improved the mobility, functional exercise capacity and health- related quality of life in elderly individuals. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=YC01-YC04&id=11782 https://doi.org/10.7860/JCDR/2018/30986.11782 Sexually Transmitted Infections and Adverse Birth and Infant Outcomes among Pregnant Women in Rural Southern India Noah Kojima, Nandita Sharma, Kavitha Ravi, Anjali Arun, Claire C Bristow, Sunil Sethi, Jeffrey D Klausner, Purnima Madhivanan <b>Introduction:</b> Sexually Transmitted Infections (STIs) in pregnancy have been reported to be associated with adverse birth and infant outcomes. <b>Aim:</b> To examine the relationship between adverse birth outcomes and select STIs in a cohort of pregnant women in rural Southern India, using stored vaginal samples. <b>Materials and Methods:</b> Pregnant women with (n=208) and without (n=213) adverse birth outcomes were matched on women’s age and parity. Adverse birth or infant outcomes were defined as newborns that weighed less than 2.5 kilograms, were delivered before 37 weeks of gestation, or were stillborn, died, or admitted to an intensive care unit at birth. Those women were compared to pregnant women who delivered a full-term baby that had normal birthweight. A one-tailed prevalence ratio was calculated. Mean cycle threshold values were compared between symptomatic and asymptomatic women with Trichomonas Vaginalis (TV) infection. <b>Results:</b> Among the 208 women with adverse birth outcomes, 22 (10.6%) tested positive for any STI: 15 (7.2%) tested positive for TV, 1 (0.5%) for Chlamydia Trachomatis (CT), 1 (0.5%) for Neisseria Gonorrhoeae (NG), 2 (1.0%) for Human Immunodeficiency Virus (HIV), and 3 (1.4%) for Hepatitis B. Among 213 women with normal birth outcomes, 14 (6.6%) tested positive for any STI, 12 (5.6%) tested positive for only TV monoinfection, 1 (0.5%) for NG monoinfection, 1 (0.5%) for every tested STI, i.e., TV, CT, and NG. In the present study, we found that women with adverse birth outcomes had a higher ratio of STIs than those without adverse birth outcomes (prevalence ratio of 1.7 {95% CI: 0.9-3.3]}. Among women who tested positive for any STI with or without adverse birth outcomes, 67.7% were asymptomatic. Among pregnant women that tested positive for TV infection, there was no difference between mean cycle threshold values between symptomatic and asymptomatic women. <b>Conclusion:</b> Adverse birth outcomes were more common among women with STIs. Nucleic acid amplification testing identified modest numbers of STIs among pregnant women. Many women with positive nucleic acid amplification tests were not treated for infections because they were asymptomatic. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=QC09-QC12&id=11752 https://doi.org/10.7860/JCDR/2018/32378.11752 An Anatomical Landmark to Identify the Neurovascular Bundle in the Dorsum of Foot - A Cadaveric Study in South Indian Population Mohana Priya, Suganthy Rabi <b>Introduction:</b> The Neurovascular Bundle (NVB) in the dorsum of the foot is likely to get injured during midfoot surgeries. Finding an anatomical landmark to identify this NVB is essential to prevent iatrogenic injury. <b>Aim:</b> To identify an anatomical landmark to locate the Dorsalis Pedis Artery (DPA) and Deep Peroneal Nerve (DPN) in the dorsum of foot. <b>Materials and Methods:</b> The relationship of this NVB to Extensor Hallucis Brevis Musculotendinous (EHBMT) junction was noted in dorsum of seventy feet. Correlation between the foot length and EHBMT junction length was determined. <b>Result:</b> In 30 feet (42.85%), the DPN was medial to DPA and in 40 (57.14%), it was lateral to DPA. In two feet, the medial branch of DPN pierced the EHB proximal to the musculotendinous junction and in the remaining feet it passed behind EHBMT junction. There was a positive correlation between the foot length and the EHBMT junction length. <b>Conclusion:</b> The EHBMT junction can be used as a reliable landmark to identify the DPN during the mid-foot surgical approaches. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=AC10-AC12&id=11765 https://doi.org/10.7860/JCDR/2018/32731.11765 Evaluation of the Physical and Mechanical Properties of Flexible Resins under the Influence of Thermocycling Marcelo Coelho Goiato, Mariana Vivela Sônego,Lucas Seraphim Souza, Betina Chiarelo Commar,Humberto Gennari-Filho,Emily Vivianne Freitas da Silva,Fernanda Pereira de Caxias,Daniela Micheline dos Santos <b>Introduction:</b> New materials are developed all the time to better suit the patients' needs, such as flexible injectable thermoplastic resins that provide more esthetics to patients using removable partial dentures. <b>Aim:</b> The objective of this study was to evaluate the color change, microhardness and flexural strength of an experimental flexible acrylic resin under the influence of thermocycling. <b>Materials and Methods:</b> This in vitro study was conducted in Aracatuba Dental School, UNESP University. Two types of samples were made, 30 in circular format (3×10 mm) for color and microhardness tests, and 60 in rectangular format (64×10×3.3 mm) for the flexural strength test. The samples were divided into three groups (n=10), one of the experimental flexible resin tested, one with a flexible resin already marketed (Sorriflex), and a control group of a conventional thermopolymerisable acrylic resin (Lucitone). After the preparation, color, microhardness and flexural strength readings were taken, initially and after 2000 thermocycling cycles. The obtained data was submitted to analysis of variance ANOVA and post-hoc Tukey’s test when necessary. <b>Results:</b> All resins presented a clinically acceptable color variation (?E), with no significant difference between resin type (p>0.05). There was a difference in the hardness of resins in ascending order (Sorriflex, experimental and Lucitone) and the hardness increased after thermocycling (p<0.05). For the flexural strength, the only difference was related to the type of resin, the acrylic resin presented higher value with respect to the thermoplastic resins. <b>Conclusion:</b> We conclude that the tested experimental resin has properties similar to those found in the market, presenting the advantage of greater surface hardness. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=ZC35-ZC38&id=11785 https://doi.org/10.7860/JCDR/2018/31055.11785 Significant Bacterial Islolates in Patients Presenting with Acute Exacerbation of Idiopathic Pulmonary Fibrosis Harish Mahender, Suryanarayana Vegi, Aleemullah Mohammed Fazluddin, Sivaraja Subramaniam <b>Introduction:</b> Idiopathic Pulmonary Fibrosis (IPF) is a chronic and progressive, condition that is due to aberrant wound healing response following repetitive alveolar injury. Though traditionally viruses have played a key role in altering the wound healing cascade, the role played by bacteria in the pathogenesis of IPF is unclear. If there is a recurrent bacterial isolate in sputum or bronchial wash, an appropriate antibiotic both prophylactically and therapeutically can help prevent the decline in lung function and morbidity. This is particularly relevant in the treatment since it involves immunosuppressives during exacerbations. <b>Aim:</b>This study analyses the sputum for bacterial isolates in patients with acute exacerbation of IPF and aims to find the significance of such association. <b>Materials and Methods:</b> Sputum samples of 60 patients who came with acute exacerbation of IPF to a Tertiary Medical College and Hospital between February 2015 to March 2016 were analysed. Patients who were unable to produce sputum and who had received antibiotics for the present exacerbation prior to admission were excluded. Expectorated sputum samples were collected in wide mouth sterile containers and were subjected to gram staining and culture using blood agar after assessing the sputum quality. Chi-Square tests were used to find the significant association between the bacterial isolates in the sputum samples. <b>Results:</b> Among the 60 patients, there were isolates in 78.3% (n=47) and rest had no isolates. Streptococcus pneumoniae was isolated in 12 patients and Escherichia Coli in 13 patients and these were found to have significant association statistically in patients presenting with acute exacerbation of IPF. Whereas the rest of the isolates like Klebsiella (n=9), Haemophillus influenza (n=8), Enterococcus (n=2) and Moraxella catarrhalis (n=3) were found to have insignificant association. <b>Conclusion:</b> Preserving the lung functions in patients with IPF is the basis of treatment. Whether infectious causes play a role in attenuating lung function and treating these with prophylactic antibiotics needs to be seen with larger studies in different geographic areas. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=OC06-OC08&id=11786 https://doi.org/10.7860/JCDR/2018/34516.11786 Prevalence of Alcoholism and Related Problems in Medical and Paramedical Students Measured Using Shorter Version of Alcohol Use Disorder Identification Test (AUDIT) Kuldeep Singh Shekhawat, Tajmulla Ahmed, S Sakthidevi, Arunima Chauhan, M Senthil, Sarguna Baladevan <b>Introduction:</b> Alcohol consumption is a growing public health problem. Medical and para-medical professionals are seen as role models in society. However, alcohol consumption is also becoming a matter of concern among healthcare students as well. <b>Aim:</b> To determine the prevalence of students who consumed alcohol and identifying those with alcohol disorders using short version of Alcohol Use Disorder Identification Test (AUDIT). <b>Materials and Methods:</b> A Cross-sectional questionnaire study was conducted in a deemed Private University in Southern part of India. Data on alcohol consumption was collected from 405 medical, dental and nursing students using shorter five item version of AUDIT. Data on other variables like gender, age, place of current residence, religion, specialty and year of study was collected using closed ended questionnaire. Frequency distribution for proportions and Logistic regression analysis was done to determine the influence of predictor variable on outcome variable. <b>Results:</b> Overall Prevalence of alcohol use was found to be 79.5 percent. Among these 56.5 percent were found having alcohol related problems. Males reported higher problems than females. Logistic regression revealed gender {odd’s ratio: 1.015; (p=0.03)} and year of study {odd’s ration: 0.743 (p=0.02)} to be influencing alcohol related problems. <b>Conclusion:</b> Prevalence of alcohol consumption and those with related problems was found to be more than 50 percent (both males and females). There is a need to draft and implement policies by university which utilizes existing resources to prevent the increasing proportion of students consuming alcohol with associated problems. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=LC14-LC17&id=11787 https://doi.org/10.7860/JCDR/2018/29268.11787 Adiponectin: Role in Glucose Homeostasis in Relation to BMI in Type 2 Diabetics Meenu Salaria, Satinder Kaur, Navjot Kaur, Parminder Singh <b>Introduction:</b> Amongst the many adipocytokines discovered in recent times, Adiponectin has drawn much attention for its insulin sensitising, anti-atherogenic and anti-inflammatory actions. Though, Adiponectin is secreted by adipose tissue, its decreased levels are associated with obesity and Type 2 Diabetes Mellitus (T2DM). <b>Aim:</b> The present investigation was conducted to study the role of Adiponectin in glucose homeostasis in T2DM subjects in relation to Body Mass Index (BMI). <b>Materials and Methods: </b>Seventy five T2DM patients visiting the Endocrinology OPD of a tertiary care hospital were selected for the study. Patients on thiazolidinediones were not included. They were divided into three groups of 25 each based on BMI. Group A: <25 kg/m2 Group B: 25-29.99 kg/m2 Group C: =30 kg/m2. Waist Hip Ratio (WHR) was recorded. Serum Adiponectin levels were estimated by ELISA, FBS, CRP, HbA1c, insulin and lipid profile was analysed on Cobas 6000 (Roche). Insulin resistance was measured by Homeostasis Model Assessment (HOMA-IR). <b>Results: </b>A 56% patients had low Adiponectin levels (<10 µg/mL), only 10.8% patients had >25 µg/mL. Group B patients had lowest levels of Adiponectin (11.86±8.79 µg/mL). FBS, HbA1c, insulin levels and HOMA-IR showed a negative correlation with Adiponectin in all the groups but was significant in group B only (r=-0.555, -0.611, -0.477 and -0.528 respectively). CRP and all the fractions of lipid profile (except HDL) showed negative correlation with Adiponectin in all the groups but it was not significant. HDL levels increased with increase in Adiponectin levels in all the groups. <b>Conclusion: </b>This study reaffirms the significant role that adipose tissue hormones play in pathophysiology of T2DM. Significant negative correlation of glucose, HbA1c, insulin resistance with Adiponectin noted in overweight diabetics supports the hypothesis that these patients can be potential therapeutic target for drugs increasing Adiponectin levels. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=BC14-BC17&id=11789 https://doi.org/10.7860/JCDR/2018/31378.11789 Role of Synovial Fluid Examination in Diagnosis of Joint Diseases Praveen Garg, Vibhuti Goyal <b>Introduction:</b> Joint effusion is a common clinical problem resulting from various inflammatory and non-inflammatory conditions. Synovial fluid analysis is one of the most important diagnostic tests to classify the type of effusion. <b>Aim: </b>To assess the role of synovial fluid analysis in the diagnosis of joint diseases and also to assess the pattern of arthritis in tertiary care centre. <b>Materials and Methods: </b>A total of 100 samples of synovial fluid were examined. Synovial fluids were subjected to gross examination for colour, viscosity, appearance, wet mount preparation, total and differential leukocyte count, microbiologic assays and crystal analysis by polarised microscopy. <b>Results:</b> Out of 100 samples analysed, Effusion was non-inflammatory in 32 (32%) cases, inflammatory in 46 (46%) cases, infective in 10 (10%) cases, traumatic in 3 (3%) cases, crystal induced in 3 (3%) cases, normal in 4 (4%) cases and non-diagnostic in 2 (2%) cases. The majority of cases were of osteoarthritis 22 (22%), then rheumatoid arthritis 16 (16%), tuberculous arthritis in 6 (6%) cases, septic arthritis in 4 (4%) cases, gout in 3 (3%) cases and traumatic arthritis in 3 (3%) cases. 10 (10%) cases were of non-inflammatory arthritis-not otherwise specified and 30 (30%) cases were of inflammatory arthritis-not otherwise specified. A total of 4 (4%) cases were normal and 2 (2%) cases were non-diagnostic. Total leukocyte count was found to be highest in septic arthtritis (60,000-78,000 cells/mm3) and lowest in osteoarthritis (120-23,00 cells/mm3). Polymorphs were highest in septic arthtritis (95%) and lowest in non-inflammatory conditions like osteoarthritis (23%). Sensitivity and specificity for gross examination to differentiate between inflammatory and non-inflammatory conditions was 0.91 and 0.70 respectively while it was 0.94 and 0.86 respectively for white blood cell count. <b>Conclusion:</b>Synovial fluid analysis is a simple procedure. The study of synovial fluid is a tool that allows the establishment of diagnosis and treatment of patient with joint diseases. Gross examination, total leukocyte count and differential leukocyte count accomplish well to differentiate between various inflammatory and non-inflammatory arthritis and also to diagnose septic arthritis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=EC06-EC09&id=11790 https://doi.org/10.7860/JCDR/2018/31333.11790 Evaluation of Salivary Cardiac Troponin-I as Potential Marker for Detection of Acute Myocardial Infarction Vaibhav Mishra, Ranjitkumar Patil, Vikram Khanna, Anurag Tripathi, Vandana Singh, Shivani Pandey, Akhilanand Chaurasia <b>Introduction:</b> Serum cardiac troponin-I is a specific biomarker and raised significantly after Myocardial Infarction. Saliva is a non-interventional bio-fluid which contains portion of serum constituents and can be key in diagnosis of MI. <b>Aim:</b> To estimate and correlate the level of cardiac Troponin-I (cTnI) in un-stimulated whole saliva and serum in acute MI patients and control group. <b>Materials and Methods:</b> Total of 60 individuals were enrolled and equally divided in to study (group I) and control group (Group II). Informed consent form was taken from all the subjects. Saliva and blood samples were obtained from patients with ECG features suggestive of acute MI within 24 hours. Serum and saliva samples were processed further for cTnI. The results obtained were then statistically analysed. <b>Results:</b> The mean cTnI level in serum of group I and group II were found to be 4.27±1.79 mg/L and 0.158±0.05 mg/L respectively. The mean cTnI level in saliva of group I and group II was found to be 0.67±0.10ng/L and 0.160±0.05 ng/L respectively. On analysing serum values and saliva values, p-value was found to be significant’. <b>Conclusion:</b> The saliva levels of cTnI were directly associated with serum levels demonstrating a highly significant strong positive relation and confirms the diagnostic ability of saliva for detection of cTnI. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=ZC44-ZC47&id=11791 https://doi.org/10.7860/JCDR/2018/32109.11791 Mechanical Behaviour of Ceramic Layered Zirconia Restorations: A Three Dimensional Finite Element Analysis using Microcomputed Tomography Data Shruti Singh, Ponnanna Appanna, Kashinatha Holenarasipur Manjunath, Nitesh Rai, Ranganatha Rao K Jingade, Harish Kumar Muniswamy <b>Introduction:</b> Combining the strength of zirconia cores and superior aesthetics of a weaker veneer ceramic can result in a reliable and more biocompatible restoration. <b>Aim:</b> To investigate the mechanical behaviour with respect to different designs of zirconia-ceramic veneer interface using three-dimensional finite element analysis. <b>Materials and Methods:</b> Tooth preparation of the indicated mandibular molar was done for three patients. Each patient was restored with a different design of zirconia-ceramic interface (Design I- full ceramic veneer, Design II- ceramic veneer on buccal surface extending upto occlusal surface, Design III- ceramic veneer on buccal surface only). Cone Beam Computed Tomography (CBCT) image was taken for each patient after the cementation of the restoration which was used to develop 3D finite element models by applying appropriate softwares (Mimics, Rapidform, Hypermesh, ANSYS). Four types of loads were applied to each of the 3D finite element model-600 N load was applied vertically, 225 N load was applied in three directions (vertically, oblique at 45° and horizontally) at different points on occlusal surface and their buccal inclines. Maximum principal stress and minimum principal stress were obtained by finite element analysis. <b>Results:</b> When vertical loads of 600 N and 225 N were applied, ceramic layer of design II experienced larger tensile stresses 21.83 MPa and 28.33 MPa. When horizontal load of 225 N was applied, tensile stress in ceramic layer was largest in design I i.e., 29.87 MPa. When an oblique load of 225 N was applied, largest tensile stress in ceramic layer of 12.82 MPa was observed in design I. <b>Conclusion:</b> The different design characteristics of the junction between ceramic and zirconia will affect the bond between zirconia core and ceramic veneer. Design III has the least chances of chipping of ceramic layer under masticatory loads. Design II is more prone to chipping of ceramic layer under masticatory loads. Design I may show chipping under high occlusal loads. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=ZC39-ZC43&id=11792 https://doi.org/10.7860/JCDR/2018/31339.11792 An Observational Study to Evaluate the Changes in Bone Mineral Density of Women with Aging in a Tertiary Care Centre Mriganka Mouli Saha, Subikas Biswas, Banasree Bhadra <b>Introduction:</b> Osteoporosis has become a serious health threat for women. The osteoporosis related fracture rate as well as treatment cost is increasing in recent times due to aging population. <b>Aim:</b> The aim of the present study was to investigate the risk factors of osteoporosis, identifying the risk group and the changes of Bone Mineral Density (BMD) in aging women. <b>Materials and Methods:</b> This was a descriptive type cross-sectional study conducted at the Institute of Postgraduate Medical Education and Research, Kolkata and College of Medicine, Kalyani, West Bengal from July 2013 to June 2016. Total 196 women who attended Gynaecology OPD were included in the study and interviewed regarding risk factors for developing osteoporosis. They were divided in two groups i.e., presence or absence of risk factors. Calculation of Body Mass Index (BMI) and T-score was done for all the subjects along with the Dual Energy X-Ray Absorpsiometry (DEXA) scan. It was a cross-sectional parallel group open level study. The tests were both sided with 95% confidence interval where p-value <0.05 was considered significant. Statistica and GraphPad InStat, version 3.0 were used for analysis. <b>Results:</b> BMD T-score was less than -1.5 for all women and less than -2.5 after 40 years in the study group. However, in control population BMD T-score was less than -2.5 only after 50 years. <b>Conclusion:</b> Osteopenia is a major concern for women in the presence of risk factors for osteoporosis even before menopause is achieved. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=QC13-QC15&id=11793 https://doi.org/10.7860/JCDR/2018/34292.11793 Microbiological Profile of Bronchoalveolar Lavage in Patients with Nosocomial Pneumonia in Intensive Care Unit Kalyani Sri Koneru, Priya Joy, V Gangadharan, Ashok Kumar, Sathish Kumar <b>Introduction:</b> Intensive Care Units (ICU) are a major threat to nosocomial pneumonias. It is defined as manifestation of infection after 48 hours of hospital admission which can be also attributed to any procedures done to the patient. As resistance to these microorganisms are on the rise in ICU, it is indeed necessary to find out microorganisms and their resistance patterns in ICUs of each institute. <b>Aim:</b> To find out the most common microorganism with pulmonary involvement in the ICU setup and to determine the sensitivity patterns of microorganisms to the antibiotics by doing Bronchoalveolar Lavage (BAL). <b>Materials and Methods:</b> A retrospective study was done at a tertiary care centre in Chennai, India, over a period of one year (from January 2017 to December 2017). The study included microbiological reports collected from 92 BAL samples with a diagnosis of pneumonia after 48 hours of ICU admission. <b>Results:</b> The most common organism isolated was Acinetobacter {36/92 (39%)} followed by Klebsiella Pneumonia {28/92 (31%)} and Pseudomonas {12/92 (13%)}. Acinetobacter was mainly isolated from intubated patients with a sensitivity of 28% to the common broad spectrum antibiotics and 100% to Colistin. While 40% Klebsiella pneumoniae was sensitive to only Colistin and Polymixin, all the Pseudomonas isolates were sensitive to the common broad spectrum antibiotics like Piperacillin-Tazobactum, Amikacin, Cefperazone-Sulbactum. <b>Conclusion:</b> As per the present study Acinetobacter was the most common organism isolated from ventilator associated pneumonia patients with a high percentage of resistant strains followed by Klebsiella and Pseudomonas. Although, all the microorganisms were sensitive to high level antibiotics only a few were sensitive to the common broad spectrum antibiotics. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=OC09-OC12&id=11794 https://doi.org/10.7860/JCDR/2018/36708.11794 Neck Circumference as a Tool for Predicting Hyperuricaemia: A Hospital Based Cross-Sectional Study Ankita Chaturvedi, Sunita Tiwari, Narsingh Verma, Jagadish Narayan, Arvind Kumar Pal, Neena Srivastava <b>Introduction:</b> Upper-body fat distribution has long been recognised as a risk factor to increased cardiovascular disease. Neck circumference has been used as an index for upper body fat distribution. Serum uric acid levels are also included as a risk factor for cardiovascular disease. <b>Aim:</b> This study was aimed to evaluate the relationship of neck circumference as a parameter in predicting hyperuricaemia. <b>Materials and Methods:</b> The present cross-sectional study was conducted in the Department of Physiology and Pathology of King George’s Medical University, Lucknow, Uttar Pradesh, India, from December 2016 to April 2017. A total of 160 subjects aged 18-60 years were enrolled in the study excluding those having any anatomical deformity, diabetes and/or hypertension for more than five years. Their anthropometric parameters, blood pressure, lipid profile, fasting plasma glucose and uric acid levels were measured. <b>Results:</b> In this study, 62.5% subjects were males and 37.5% were females. Mean age of the study population was 38.8±13.17 years. The study population was divided into three groups based on their serum uric acid levels. Mean neck circumference of subjects with hyperuricaemia and normal serum uric acid levels were 38.42±2.34 cm and 37.35±3.99 cm respectively and was found significantly higher than subjects with below normal uric acid levels (34.80±4.33 cm). The association of uric acid level with neck circumference was highly significant (p - 0.011). <b>Conclusion:</b> The significant association of uric acid level with neck circumference suggests neck circumference as an emerging novel marker for metabolic syndrome. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=CC01-CC03&id=11795 https://doi.org/10.7860/JCDR/2018/34649.11795 Attitude and Knowledge of Undergraduate Medical Students towards the Use of Animals in Medical Research: An Exploratory Study Sharmada Nerlekar, Sagar Karia, Devavrat Harshe, Romil Warkari, Avinash Desousa <b>Introduction:</b> Medical undergraduate courses and medical students have less emphasis on animal research and the various ethical issues surrounding animal research. Animal research plays a vital role in basic medical research and yet undergraduate students know very little about the same. <b>Aim:</b> To assess the attitude and knowledge of medical undergraduate students towards animal research in general. <b>Materials and Methods:</b> A total of 152 undergraduate medical students in the final year of their medical studies from two medical colleges (one from Mumbai and one from Kolhapur) were administered a semi-structured questionnaire on attitude and knowledge towards animal research. The questionnaire was validated by three senior researchers and was specially designed for the study. The data were collected and analysed using frequency and percentages. <b>Results:</b> Only 66(43.42%) students had visited an animal house/animal laboratory in their medical training and 114 (75%) of them had actual experience of handling animals mainly in the form of dissection studies on rats, frogs and guinea pigs. Only 21(13.8%) were aware of ethical guidelines regarding animal research and 23 (15.1%) strongly agreed that ethical aspects of animal research needed stringent regulation in India. <b>Conclusion:</b> Animal research awareness is scarce in undergraduate medical students and there is a need to incorporate animal research awareness from a medical science point of view in their curriculum to help them develop an understanding of animal research and its ethical dimensions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=JC04-JC06&id=11768 https://doi.org/10.7860/JCDR/2018/32260.11768 Labour Epidural Analgesia: A Randomised Double Blind Comparative Study of 0.1% Levobupivacaine with Fentanyl vs. 0.1% Ropivacaine with Fentanyl Debasmita Das, Deepali Pankaj Thakur, Bharati Anil Tendolkar <b>Introduction:</b> Levobupivacaine and ropivacaine are suitable alternatives to bupivacaine for labour analgesia as they produce less motor blockade, decreased incidence of instrumental deliveries and less toxicity. <b>Aim:</b> To study the efficacy of epidural levobupivacaine and ropivacaine in intermittent doses for labour analgesia. <b>Materials and Methods:</b> In the present prospective, randomised, double blind study, 60 parturients consenting for labour epidural analgesia using intermittent top-up technique were randomly allocated to receive either levobupivacaine 0.1% with Fentanyl 2 mcg/mL (LF) or ropivacaine 0.1% with Fentanyl 2 mcg/mL (RF). Haemodynamic parameters, sedation score, onset and quality of analgesia, sensory and motor blockade, local anaesthetic requirement, side effects, duration of labour, mode of delivery, neonatal outcome and maternal satisfaction were compared between groups. Statistical analysis included students unpaired t-test, chi-square test, Fischer’s-exact test, Mann-Whitney U-test as appropriate with p<0.05 was considered statistically significant. <b>Results:</b> Demographic and obstetric parameters were comparable in two groups. Both drugs were comparable with respect to haemodynamics, sedation score, onset and quality of analgesia, sensory and motor blockade, local anaesthetic requirement, duration of labour, mode of delivery, neonatal outcome, maternal satisfaction and side effects. One parturient (3.33%) in RF group developed motor block of Bromage grade 1 as compared to none in LF group without any statistical significance. No parturient required Rescue analgesia. <b>Conclusion:</b> The combinations of low concentration (0.1%) of epidural levobupivacaine and ropivacaine with fentanyl provide equivalent labour analgesia, without significant maternal or fetal side effects. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=UC06-UC10&id=11769 https://doi.org/10.7860/JCDR/2018/31764.11769 Relationship between Academic Self-efficacy and Motivation among Medical Science Students Zahra Taheri-Kharameh, Fatemeh Sharififard, Hamid Asayesh, Mohammadreza Sepahvandi, Mahsa Hajimohamad Hoseini <b>Introduction:</b> Academic motivation and its underlying factors have long been the major concern of educational institutions. Self-efficacy has been a key factor contributing to academic motivation, the students’ interest, and their academic performance. <b>Aim:</b> To investigate the relationship between academic self-efficacy and academic motivation among medical science students in Iran. <b>Materials and Methods:</b> In the present study 264 undergraduate nursing students at Qom University of Medical Sciences, Qom, Iran, were selected through a random sampling method. Data were gathered through academic motivation and academic self-efficacy questionnaires and analysed using multiple regression and descriptive statistical analysis. <b>Results:</b> The mean score of the academic motivation and self-efficacy of students was 145.30±21.40 and 179.46±47.44, respectively. The results of a stepwise-regression analysis showed out of classroom performance as well as semester level explained 19% of the variance in the motivation. <b>Conclusion:</b> Based on the findings of the study, confidence in academic performance out of the classroom resulted in students’ success. Such performance seems to encourage the student to believe in their abilities and their self-efficacy and be more academically motivated. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=JC07-JC10&id=11770 https://doi.org/10.7860/JCDR/2018/29482.11770 Trigger Finger: A Prospective Randomised Control Trial Comparing Percutaneous Release versus Open Release Niraj Ranjeet, Krishna Sapkota, Pabin Thapa, Pratyenta Raj Onta, Krishna Wahegoankar, Upendra Jung Thapa, Himanshu Shah <b>Introduction:</b> Trigger Finger (TF) is frequently encountered problem by an orthopaedic surgeon which if not managed causes pain, discomfort and disability in hand function. Patient’s presents with pain at Metacarpo-phalangeal (MCP) or Proximal Inter-phalangeal (PIP) joint or clicking of the thumb, ring or long fingers. It is commonly caused by mismatch between the flexor sheath and the flexor tendon, which may be because of enlargement of the tendon or thickening of the fibrous flexor sheath of the 1st annular pulley. <b>Aim:</b> To compare percutaneous release with that of open surgery in terms of its effectiveness in releasing the A1 pulley and their complications and also to determine if the results are comparable with those observed in other studies. <b>Materials and Methods:</b> From January to December 2016, 56 patients presented to Manipal Teaching Hospital, Kaski, Nepal, with diagnosis of TF, were blindly randomised to two groups with 28 patients and 30 fingers each. One group was treated with percutaneous release while the other group was treated with open release. All the patients were followed up in OPD on two days, two weeks and eight weeks and were evaluated for postoperative pain, presence of infection, persistence or recurrence of triggering, presence of digital nerve injury and finger range of motion. <b>Results:</b> There was no statistical difference between the two groups with regard to the above parameters. Although, there was a trend to earlier return to full activities of daily living and full range of motion in the percutaneous group and also the complication rates were low and without any surgical scar, the difference was insignificant compared to the open release group. <b>Conclusion:</b> The present study recommend that both the open and percutaneous release is equally effective in treating TFs. Depending on the surgeon’s preference and experience the surgeon may opt to choose any of the surgical procedure for his patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=RC05-RC08&id=11771 https://doi.org/10.7860/JCDR/2018/34100.11771 Evaluation of the Nature of Thyroid Nodules by Duplex Ultrasound and Assessment of the Diagnostic Accuracy of TIRADS Classification Nani Lampung, Saifullah Khalid, Mohd Khalid, Basmah Abdur Rashid, Sayeedul Hasan Arif <b>Introduction:</b> Ultrasound (US) is the primary modality used to assess the thyroid glands. However, the terminology used by the radiologist is not easy for clinicians to understand. Thyroid Imaging Reporting and Data System (TIRADS) classification is the best attempt to facilitate better communication between the radiologist and clinicians. <b>Aim:</b> To assess the Thyroid Ultrasonography (USG) characteristics which are highly suggestive of malignancy and to assess the reliability of TIRADS in the differentiation of malignant from benign thyroid nodules. <b>Materials and Methods:</b> The present study was an observational study conducted on 200 consecutive patients presenting for thyroid swelling and underwent ultrasound of the thyroid. USG features recorded were the internal component, echogenicity, margins, calcifications, shape and vascularity. Using the modified Russ classification, each nodule was classified into a TIRADS category (I, II, III, IVA, IVB and V) based on the US features. Sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) was calculated for each of the suspicious US features. The risk of malignancy for each category of TIRADS classification was determined. All the nodules underwent cytological confirmation. The threshold for statistical significance was set at 0.05. <b>Results:</b> Among the USG characteristics, spiculated margin, microcalcification and taller than wide shape had highest specificity for malignant nodules. Anechoic nodule, iso or hyperechogenicity, predominantly cystic nature, macrocalcification and peripheral vascularity had a high NPV for the malignancy. The maximum number of the patients belonged to TIRADS Grade 3. The PPV was 100% for Grade V malignant nodules followed by 75% for Grade IVB malignant nodules. There was significant difference between IVA and IVB malignant nodules with IV A having very low risk for malignancy and IVB and V having significantly high risk for malignancy. <b>Conclusion:</b> There is no single ultrasound feature which can diagnose malignancy in thyroid nodules however, there are combinations of USG features that can strongly suggest the possibility of malignancy. TIRADS serves as a convenient classification system which can be easily understood by the clinicians and guide them to biopsy the TIRADS IV and V nodules which have highest malignant risk, thus helping in better patient management. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=TC01-TC04&id=11772 https://doi.org/10.7860/JCDR/2018/36145.11772 Morbidity Profile and Associated Risk Factors among Construction Workers in an Urban Area of Kancheepuram District, Tamil Nadu, India P Mohankumar, S Gopalakrishnan, M Muthulakshmi <b>Introduction:</b> The construction industry is one of the world’s major industries. Construction industries are an unorganised sector involving huge number of skilled and semi-skilled work force. Construction workers are at a greater risk of developing certain health disorders and sickness due to their poor working conditions and living environment. <b>Aim:</b> To determine the morbidity profile and to identify the association between risk factors and morbidities among the construction workers in an urban area of Kancheepuram District, Tamil Nadu, India. <b>Materials and Methods:</b> This was a cross-sectional descriptive study carried out in the urban area in Kancheepuram district. Using probability proportional to size and simple random sampling method, 312 construction workers were identified. The data were collected using a pretested structured questionnaire followed by clinical examination. Data was analysed using SPSS version 21 software and presented as descriptive and analytical statistics. <b>Results:</b> It was observed that, 80.1% of the workers had at least one health related morbidity problem at the time of the study. It was identified that musculoskeletal problem (71.5%) was the major cause of morbidities. This was followed by skin problems (59.3%), eye problems (53.3%), abdominal problems (52%), respiratory problems (51.7%) and external injuries (44.3%). There was a strong statistical association between the presence of morbidity and the presence of smoking, alcohol consumption, and use of other forms of tobacco, type/nature of work, marital status and type of diet they consumed. <b>Conclusion:</b> There is a need to create awareness among the workers about their health and environmental safety issues at work place. Provision of health insurance coverage and health screening services should also be made available to help them lead a socially and economically productive life. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=LC06-LC09&id=11773 https://doi.org/10.7860/JCDR/2018/34678.11773 Serum Lipoprotein (a) as a Diagnostic Marker of Coronary Artery Disease: A Case-Control Study MM Kavitha, Jeevan G Ambekar, Sangappa V Kashinakunti, Nilima Dongre <b>Introduction:</b> Coronary Artery Disease (CAD) is a major cause of mortality in India. Conventional risk factors fail to explain the increasing burden of CAD, thus necessitating to search for newer risk factors like Lipoprotein (a) {Lp(a)}. Lp(a) is considered as one of the risk marker of CAD. Lp(a) levels have shown wide ethnic variation among human population. <b>Aim:</b> The study was aimed to estimate Lp(a) levels in CAD patients and to compare it with healthy controls. To see the correlation between Lp (a) with other lipid parameters and also to find the best cut-off value for Lp(a) in CAD patients in North Karnataka population. <b>Materials and Methods:</b> This was hospital based, observational, case-control study done on 120 participants, with 60 CAD patients and 60 healthy controls. Lipid profile, Lp(a) and FBS (Fasting Blood Sugar) was analysed along with anthropometric measurements. Quantitative data expressed as mean±SD. Students t-test for comparison, Pearson correlation for correlation and Receiver Operating Curve (ROC) to get the best cut-off value for Lp(a) was used. <b>Results:</b> Lp(a) levels were significantly increased (p<0.001) in CAD patients compared to controls with mean values 52.34±24.87 and 16.81±3.91 respectively. Triglyceride (TG) was significantly increased (p<0.001) and High Density Lipoprotein (HDL) was significantly decreased in CAD patients. Area under the curve is >0.8 with 78% sensitivity and 86% specificity. The best cut-off value is 23.7 mg/dL. Lp(a) positively correlated with Total Cholesterol (TC), Low Density Lipoprotein cholesterol (LDL) and negatively correlated with HDL. <b>Conclusion:</b> Raised Lp(a) levels is associated with an increased risk and may serve as marker of CAD. When Lp(a) is above 23.7 mg/dL. it acts as a predictor for CAD even when lipid levels are in normal range. It is better to assess the Lp(a) along with routine lipid profile in all patients with CAD in north Karnataka. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=BC10-BC13&id=11774 https://doi.org/10.7860/JCDR/2018/36832.11774 Stress and Displacement Pattern in the Maxilla and the Mandible with Reverse Twin Block: A Finite Element Analysis Adeeba Khanum, Sunil Kumar, Silju Mathew, Prashantha Govinakovi Shivamurty, Vinod Pattabiraman, Madhavi Naidu <b>Introduction:</b> Class III malocclusion exists when the mandibular molar occludes mesial to the maxillary molar as a result of a skeletal discrepancy i.e., normal maxilla and protruded mandible, retruded maxilla and a normal mandible or a retruded maxilla and a protruded mandible, concomitant with or without a dental discrepancy, or due to the functional shift of the mandible. Orthopaedic and functional appliances like chin cup, Functional Regulator 3 (FR3), Class III activator, reverse twin block etc., can be used to treat Class III malocclusion. Reverse twin block is a patient friendly appliance, presenting acceptable clinical results. Stresses are the key to remodelling of the alveolar and craniofacial bones incident to functional and orthopaedic forces, which can be elucidated via Finite Element Analysis (FEA). Literature lacks studies pertaining to biomechanical evidence on the functional appliance effect in Class III malocclusion. <b>Aim:</b> To evaluate the patterns of stress distribution and displacement in the maxilla and the mandible with the reverse twin block appliance, in four groups with combinations of bite force of 107 N and without bite force, along with passive tension of 1.27 N and 1.47 N for 2 mm and 4 mm interincisal clearance respectively, through FEA. <b>Materials and Methods:</b> A three dimensional finite element model was developed from the Cone Beam Computed Tomography (CBCT) images of a patient with Class III malocclusion using Hypermesh 13.0 software. The model simulated forces of reverse twin block appliance with 2 mm and 4 mm interincisal clearance with and without maximum bite force of 107 N. Stress distribution and displacement in the region of glenoid fossa, maxillary tuberosity, Anterior Nasal Spine (ANS), neck of the condyle and gonial region was studied. <b>Results:</b> Maximum stresses were observed in the glenoid fossa and the neck of the condyle. Stress generation was subsequently more with 4 mm interincisal clearance group. The displacement resulting from reverse twin block was mainly dentoalveolar. Maxillary incisors displaced more than the mandibular incisors. The mandible displaced more in the forward and downward direction. <b>Conclusion:</b> The treatment outcomes with reverse twin block appliance previously assessed by means of cephalometric studies were validated with insight of stresses induced at different regions of the maxilla and the mandible via the finite element methodology. The forces exerted by this appliance directed the stresses more towards the dentoalveolar region. Stresses were more profound when the passive tension was concurrent with the bite force. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=ZC24-ZC30&id=11775 https://doi.org/10.7860/JCDR/2018/35426.11775 Assessment of Tooth Shade in Primary Dentition among Indian Paediatric Population and its Association with Skin, Lip and Gingival Colour: An Observational Study MB Ranju, Naseemoon Shaik, Raghavendra Shanbog <b>Introduction:</b> Assessment of dental aesthetics is a complex procedure because a large number of factors can contribute to aesthetic perceptions. These factors include hard tissue characteristics such as tooth colour, shape and alignment, and soft tissue considerations like gingival colour, skin complexion and lip shade. Studies have not been reported evaluating harmony between primary tooth shades related to soft tissue characteristics in children. <b>Aim:</b> To determine the shade of primary teeth and associate it with skin, lip and gingival colour among Indian paediatric population. <b>Materials and Methods:</b> Among 318 consented children, after collecting the demographic information, clinical examination was conducted independently by three calibrated examiners for tooth shade, skin, lip and gingival colour using standard protocol. The collected data were statistically analysed using Pearson correlation and chi-square test. <b>Results:</b> Tooth shade of primary central incisors among half of the study subjects did not match with any of the shades of Vitapan classical shade guide (n=152, 47.79%). A1 (Vitapan classical) was the most commonly observed shade among primary incisors (n=135, 42.45%). Intra and inter arch primary tooth shade variation was not observed (p<0.001). A statistically insignificant negative correlation was observed when primary tooth shade was correlated with skin and lip colour (p=0.11), and a positive correlation with gingival colour (p=0.71). <b>Conclusion:</b> It was found that the shade of primary dentition among half of the children did not match with any of the shades in the Vitapan classical shade guide and there is a need for a new shade guide for primary dentition which can be used effectively and efficiently for clinical purposes. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=ZC20-ZC23&id=11762 https://doi.org/10.7860/JCDR/2018/36632.11762 Histological Changes in Testis of Wistar Albino Rats Following Formaldehyde Exposure by Inhalation Jeyanthi C Gnanadeepam, Anjana Thamanan Sowdamman Rajavel, Srivdhyae Eswaran, Preethi Ramya Thiagarajan <b>Introduction:</b> Formaldehyde use remains a crucial occupational hazard, especially for anatomists and pathologists and has long been suspected of causing adverse effects on reproductive organs. <b>Aim: </b>To evaluate the histological changes in the testis of wistar albino rats following formaldehyde exposure through inhalation. <b>Materials and Methods:</b> The toxic effects of formaldehyde were studied by an animal experimental study at the Department of Anatomy, Government Kilpauk Medical College, Chennai, India. The study was conducted on 20 wistar albino rats. The rats were divided into five groups of four rats each. The control Group I was not exposed to formaldehyde. The exposure Group II (E1a) and Group III (E1b) were exposed to 1.5 ppm of formaldehyde for seven (6 hours) and twelve (4 hours) weeks respectively. The Group IV (E2a) and Group V (E2b) were exposed to 3 ppm of formaldehyde for seven (6 hours) and twelve (4 hours) weeks respectively. At the end of exposure period, the testis were dissected and observed for gross and microscopic (using haematoxylin and eosin stain) changes. <b>Results:</b> The control group showed normal architecture with no microscopic changes. On gross examination, there was a significant and progressive reduction in the total body weight and in testis length in the experiment groups compared to the control group with increasing concentration gradient. The groups E1a and E1b showed focal atrophy of seminiferous tubules resulting in architectural distortion with hypospermatogenesis and focal tubular necrosis. Peritubular fibrosis was also observed. The interstitial and sertoli cells appeared normal. The groups E2a and E2b showed features of absent spermatogenesis in addition to architectural distortion of seminiferous tubules. There was no tubular necrosis but increased peritubal fibrosis was present. Focal hyperplasia of interstitial cells and sertoli cell crowding were also observed. <b>Conclusion:</b> Formaldehyde is a suspected toxicant affecting the reproductive organs. The present study confirmed the altered microscopic structure following formaldehyde exposure through inhalation. The increase in concentration gradient resulted in more damage. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=AC05-AC09&id=11763 https://doi.org/10.7860/JCDR/2018/36555.11763 Green Hospital Initiative by a North Delhi Tertiary Care Hospital: Current Scenario and Future Prospects Tanisha Bharara, Renu Gur, Shalini Dewan Duggal, Pragnya Jena, Shilpa Khatri, Pradeep Sharma <b>Introduction:</b> Climate change is likely to affect all forms of life. Healthcare professionals and planners are gearing up to shoulder responsibility to mitigate climate change. The present study was undertaken to explore the journey of our hospital towards becoming a climate friendly green hospital. <b>Aim:</b> To study the progress made by our institute towards becoming a climate friendly green hospital based on seven directives of World Health Organization’s (WHO) discussion draft on climate change. <b>Materials and Methods:</b> A retrospective observational study was conducted from January 2013 to December 2017 by the Departments of Biomedical Waste management (BMW) and Public Works Deprtment (PWD) to analyse hospital’s journey towards becoming a green hospital. The observation was made in line with the 7 WHO directives related to climate change and compared over the years. <b>Results:</b> It was observed that in the past five years there have been several initiatives taken by the hospital with intent to improve energy efficiency like replacement of halogens and Compact Fluorescent Lamps (CFL) with Light Emitting Diodes (LED), diesel with Compressed Natural Gas (CNG) as fuel for boiler in laundry. For conservation and effective utilisation of resources, solar water heating system and seven rain water harvesting systems have been installed. Efforts have been made towards waste minimisation and efficient management with a sewage treatment plant for management of liquid waste and BMW management and recycling as per the guidelines. <b>Conclusion:</b> Over the years we have taken several steps towards becoming a climate friendly green hospital. This study emphasises our commitment towards a healthy environment for the wellbeing of our patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=DC10-DC14&id=11758 https://doi.org/10.7860/JCDR/2018/34360.11758 Intraperitoneal Analgesia Instillation for Postoperative Pain Relief after Laparoscopic Cholecystectomy Noor Topno, Arup Jyoti Baruah, Sandeep Ghosh, Jyoutishman Saikia, Dathiadam Tongper, Ojing Komut <b>Introduction:</b> Laparoscopic Cholecystectomy (LC) has numerous benefits over the open method; still postoperative pain remains an issue. Postoperative pain, requiring injectable analgesics prolong the patient’s hospital stay, and is one of the hurdles in performing LC as a day-case surgery. <b>Aim:</b> To assess the analgesic effect of Intraperitoneal (IP) administration of Inj. Bupivacaine± Inj. Tramadol in patients undergoing LC. <b>Materials and Methods:</b> A total of 100 patients scheduled for LC were enrolled in the study after meeting the inclusion criteria. Patients were randomly divided into 3 groups. Patient allocated to Group A received 30 mL of inj. normal saline IP, Group B received 30 mL of 0.25% inj. bupivacaine and Group C received 30 mL of 0.25% inj. bupivacaine along with 100 mg inj. tramadol. The local anaesthetic/analgesic or placebo solution was sprayed on the upper surface of the liver and on right subdiaphragmatic space and over gall bladder bed. The pain intensity of pain for patients in all the three groups were recorded using VAS at 0, 1, 2, 6, 12 and 24 hours after surgery. The student t-test was used to compare mean pain score between groups. The p-value =0.05 was taken as significant. <b>Results:</b> There was statistically significant difference in postoperative pain intensity in group A vs groups B (p <0.0001) and also between group A vs group C (p <0.0001) during the first 6 hours postoperatively. But the difference in VAS scores between groups B and C were not statistically significant at all times of postoperative recordings. The addition of inj. tramadol to inj. bupivacaine (group C) IP did not cause a significant reduction in pain compared to bupivacaine only group(group B) but there was increased incidence of Post Operative Nausea and Vomiting (PONV) noted in group C as compared to group B. <b>Conclusion:</b> IP inj. bupivacaine may be used routinely in LC as a part of day-case surgery leading to adequate postoperative pain relief, decreasing need for analgesia and opioids which may lead to early ambulation and initiation of oral feeds, leading to faster postoperative recovery and hence shorter hospital stay, thereby decreasing the burden both to the patient as well as to the hospital. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=PC10-PC13&id=11759 https://doi.org/10.7860/JCDR/2018/30979.11759 Outcome of Total Hip Arthroplasty in Northern Iran: A Prospective Study Ghaffar Habibi Shekardasht, Nasser Janmohammadi, Masoud Shayesteh Azar, Mohammad Hossein Karimi Nasab, Seyed Mokhtar Esmaeilnezhad Ganji, Mohammad Zamani <b>Introduction:</b> Total Hip Arthroplasty (THA) is one of the most frequent major surgical procedures in orthopedics. <b>Aim:</b> To audit the results of THA in Babol, Northern Iran. <b>Materials and Methods:</b> From 2014 to 2015, all patients with indication for THA referred to Shahid Beheshti and Rohani teaching hospitals in Babol were recruited in this prospective study. Patients with severe osteoarthritis of the knee, a psychiatric disorder, history of previous arthroplasty, bilateral osteoarthritis, contraindications to a major surgery, or failure to attend follow-up were excluded. The Harris Hip Score (HHS) was used to measure physical hip performance, ranging from 0 (poor) to 100 (excellent) points. All patients were followed for six months. Data were collected and analysed using SPSS with t-test analysis. <b>Results:</b> A total of 58 patients were finally assessed, of whom 24 (41.4%) were male and others were female. The mean age was 56.8±16.56 years. The postoperative complications included infection (one case), posterior hip dislocation (two cases) and peroneal nerve paresis (one case). The mean HHS was 49.69±5 before the surgery, but it improved significantly to 88.02±4.04 at sixth months after THA (p<0.001). <b>Conclusion:</b> According to this audit, THA is associated with a significant improvement and satisfactory outcome in the patients and the rate of complications was low. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=RC01-RC04&id=11750 https://doi.org/10.7860/JCDR/2018/35706.11750 Evaluation and Comparison of Blood Parameters in Diabetic Patients with and without Peripheral Neuropathy KP Ranjith, Bhanuchandar Potu, M Anju, Saleena Ummer Velladath, Manjunatha Hande <b>Introduction:</b> Diabetic Peripheral Neuropathy (DPN) is the most prevalent and troublesome microvascular complication (50%) of Diabetes Mellitus (DM). The factors involved in the pathogenesis of diabetic neuropathy have not been understood completely. Studies have shown that neuronal dysfunction and inflammation play important roles in the development of DPN. <b>Aim:</b> To evaluate and compare the inflammatory marker Neutrophil to Lymphocyte Ratio (NLR) and serum markers calcium, urea, and uric acid in diabetic patients with and without peripheral neuropathy. <b>Materials and Methods:</b> We prospectively studied 118 diabetic patients who visited Kasturba Hospital, Manipal, Karnataka, India during December 2016- June 2017. After obtaining the ethical approval (IEC 791/2016), the patients were grouped into those with DPN (n=55) and without DPN (n=63). NLR and serum markers calcium, urea, and uric acid were estimated. <b>Results:</b> The data were analysed using Student's t-test and Mann-Whitney U test and revealed a significantly high uric acid (p<0.001) and low calcium levels (p<0.001) in DPN patients compared to controls. The NLR was significantly high in DPN group {2.62 (2.3-3.1)} compared to that {1.9 (1.6-2.4)} in non-DPN group (p<0.001). <b>Conclusion:</b> Monitoring the simple biomarkers routinely in diabetic patients may give an early signal to prevent DPN and thus better management of the patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=BC30-BC33&id=11842 https://doi.org/10.7860/JCDR/2018/37075.11842 The Spectrum of Heart Disease in Pregnancy and its Outcome in Patients Visiting a Tertiary Care Centre of Northeastern: A Prospective Study Dina Aisha Khan, Nalini Sharma, Manish Kapoor, Sourabh Gohain Duwarah, Santa Singh Ahanthem <b>Introduction:</b> An increased prevalence of cardiovascular disease has been found in women of child bearing age which varies between 0.3-3.5%. Heart diseases are the most significant non obstetrical causes of maternal deaths accounting for as much as 20.5% of all cases. Heart disease in pregnancy is a high risk condition with increased risk of maternal and foetal morbidity and mortality; hence it mandates a multidisciplinary approach. <b>Aim:</b> To find out prevalence, spectrum of disorder and outcome in pregnancy with heart disease in a tertiary care centre in North Eastern India. <b>Materials and Methods:</b> In this prospective hospital based, time bound study all pregnant women or puerperia with heart disease during the study period were followed up throughout pregnancy and their feto-maternal outcomes were compared with equal number of women without heart disease. Based on the symptoms all the patients were classified according to New York Heart Association (NYHA) functional classification. Patients were evaluated for development of any cardiac complication, obstetrical complication, and perinatal outcomes. Statistical analysis was performed using the SPSS software package (version 16.0). <b>Results: </b>Total number of pregnant women with heart disease was 55 and prevalence of heart disease in pregnant women admitted during the study period was found to be 2.32%. Congenital heart disease was the most common encountered type 49.09% followed by Rheumatic Heart Disease (RHD) 41.82%. Cardiac complications were present in 18% women and most common complication was congestive cardiac failure (80%). Preterm delivery was significantly higher among the cases (25%). Instrumental deliveries were higher among the cases (23.06% vs. 7.6%). The foetal outcome (live birth) was significantly better in controls. Low birth weight was higher among the cases (34.61% babies among cases and 12.73% babies among controls). Out of all maternal deaths, 10.34% were attributed to cardiac cause. All three mothers who died belonged to NYHA Class 4 and were anaemic. <b>Conclusion:</b> There is a significant shift in trends of spectrum of heart disease with congenital emerging as predominant lesion. This signifies an important change in the trends and spectrum of cardiac disease in our institute with lower incidence of RHD. With better health facilities, pregnant women with congenital heart disease will continue to rise and hence expertise in management of such conditions is imperative in times to come. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=QC16-QC20&id=11837 https://doi.org/10.7860/JCDR/2018/35407.11837 Vitamin D Status in Pregnant Women and their Newborns with Respect to Socioeconomic Status: A Hospital Based Cross-sectional Study Vuppala Subbarao, Rajesh Shimoga Mahabala <b>Introduction:</b> The prevalence of vitamin D deficiency in India is about 70% to 100%. India has a large population of socioeconomically backward people. Pregnant women are considered as a high risk group with global reports citing 20-80% of pregnant women may suffer from vitamin D inadequacy and deficiency. There are evidences suggesting that vitamin D deficient women and vitamin deficient babies are at higher risk of various illnesses. <b>Aim:</b> To study the vitamin D level in maternal and their newborn and to correlate the maternal and newborn vitamin D level with their socioeconomic status. <b>Materials and Methods:</b> A cross-sectional study was conducted in Government referral Hospital and Kasturba Medical College Hospital, Mangalore, India for a period of two years. A total of 80 term pregnant women were selected; all pregnant women who were antenatal booked cases either in private or government have received calcium supplements. About 2 mL of maternal blood and cord blood samples were collected during labour. The estimation of vitamin D was done by ELISA kit. The socioeconomic status of the mother were assessed. The data collected were stastically analysed using Student’s paired t-test, chi-square/Fishers test and Pearson’s correlation. <b>Results:</b> Vitamin D deficiency was observed in 41.2% of the mother and 70% of the newborn, insufficiency in 33.8% of the mothers and 22.5% of the newborn and normal level of vitamin D in 25% of the mother and 7.5% of the baby. There was a positive correlation observed with maternal vitamin D levels and cord blood. Vitamin D deficiency in mother and their newborn of different socioeconomic status found to be statistically significant. Calcium and vitamin D supplementation in the mother had statistical significance on maternal vitamin D status. <b>Conclusion:</b>Maternal vitamin D levels have positive correlation with vitamin D levels of newborn, adequate vitamin D supplements in the mother has a positive correlation with vitamin D levels in both mother and newborn. Lower socioeconomic status of the mother has negative impact on Vitamin D levels of both mother and newborn. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=SC07-SC10&id=11838 https://doi.org/10.7860/JCDR/2018/35570.11838 Effect of Increased Prepregnancy Body Mass Index on Placental Morphologic Features in Gestational Diabetes Ilavenil Karunakaran, SD Nalinakumari, Kalavathy Ponniraivan <b>Introduction:</b> Gestational Diabetes Mellitus (GDM) and obesity are both independent and associated risk factors that complicate pregnancy. There has been a worldwide increase in the incidence of GDM. This has been explained by the global epidemic of obesity which has, in turn, resulted in an increase in number of pre-obese and obese women of reproductive age group. Both conditions are associated with metabolic and functional disturbances that affect the placenta. The gross morphologic alterations in gestational diabetic placentae have been extensively studied. The morphopathologic impact of obesity on the gestational diabetic placenta is yet to be explored. <b>Aim:</b> The aim of the present study was to evaluate the changes in placental morphology of GDM pregnancies as compared to placentae from normoglycaemic, normal prepregnancy Body Mass Index (BMI) pregnancies and to further assess the effect of high prepregnancy BMI on the placentae of GDM in comparison with the placentae of GDM with normal prepregnancy BMI. <b>Materials and Methods: </b>The observational cross-sectional comparative study was carried out among women who attended three specialty obstetric clinics in an urban city in central Tamil Nadu, India. The study was carried out between May to August 2016. A total of 95 women, of whom 65 were gestational diabetic participated in the study. The control group comprised of 30 women who had normal prepregnancy BMI and who were normoglycaemic throughout pregnancy. BMI was calculated from the prepregnancy weight and height. Using Indian standards of BMI classification, the GDM women were grouped into Lean GDM (LG; n=30) and Obese GDM (OG; n=35). At term, the placentae were collected after the delivery from both study and control groups and analysed for gross morphological parameters including placental weight, volume, thickness, diameter, shape and size, number of cotyledons and site of cord insertion. Statistical test ANOVA with post-hoc analysis was used to compare the groups and Pearson’s coefficient was used to correlate BMI with placental parameters, using the Statistical Package for Social Sciences (SPSS) version 21.0.0, IBM. <b>Results:</b> Placental weight, volume, thickness and diameter showed a significant increase in the GDM group as compared to control group. There were a higher proportion of irregular placental shapes and marginal and velamentous cord insertion among gestational diabetic placentae. Placental weight, volume and thickness were significantly increased in OG placentae as compared to LG. Pearson’s r showed a weak however, significant positive correlation between maternal prepregnancy BMI and placental weight, volume and thickness. <b>Conclusion:</b> Maternal prepregnancy BMI influences gross morphological features of the placenta. The finding is relevant in the context of understanding the response of the placenta to obesity and GDM and in evolving ultrasonographic placental examination criteria that can be used to monitor and safeguard against adverse pregnancy outcomes. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=AC13-AC17&id=11839 https://doi.org/10.7860/JCDR/2018/36885.11839 Clinical Tools and Biochemical Markers to Assess Short-Term Mortality in Acute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD) Govind Narayan Srivastava, Manoj Meena, Ankit Patel, Ashok Singh Charan, Mukesh Goyal, Piyush Arora, Ramniwas Meena <b>Introduction:</b> Acute exacerbation of COPD is one of the leading causes of death worldwide. <b>Aim:</b> This study was aimed to study the role of clinical tools and biochemical markers which have significant impact on short-term mortality in COPD patients presenting with acute exacerbation. <b>Material and Methods:</b> A total of 50 patients were studied. Patients of age >40 years having COPD exacerbation and presenting with two of the three cardinal features of exacerbation: increase in amount of cough, increase in purulence of cough, increase in baseline dyspnoea which were severe enough to necessitate a hospital admission, were evaluated after admission. A thorough history taking and clinical examination was performed. Along with this, all necessary laboratory parameters were studied. Study population was followed for 30 days. Data were analysed using Chi-square test and multivariate regression analysis using SPSS version 16.0. <b>Results:</b> Out of 50 patients, 30% (15/50) did not survive despite treatment. Parameters such as, history of mechanical ventilation in past one year, low GCS (Glasgow Coma Scale), raised JVP (Juglar Venous Pressure), low pH and raised IL-6 levels were significantly associated with mortality in multivariate analysis (p-value <0.05). <b>Conclusion:</b> Severity of disease as well as severity of present exacerbation was related with short-term mortality. Interleukin-6 is an independent predictor of mortality. Parameters like past history of mechanical ventilation and raised JVP point towards the need of overall better management of COPD patients not only during exacerbations. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=OC16-OC19&id=11832 https://doi.org/10.7860/JCDR/2018/35775.11832 Comparison of Chest X-ray and Clinical Findings in Trauma Patients after Chest Tube Removal Ramyar Farzan, Reza Shojaee, Afrooz Haghdoost, Mohammadreza Mobayen <b>Introduction:</b> Selective omission of Chest X-ray (CXR) after chest tube removal in asymptomatic patients has an important role in reduction of the consequences of unnecessary radiographies. <b>Aim:</b> The aim of this study was to compare CXR and clinical findings in traumatic patients after chest tube removal. <b>Materials and Methods: </b>This was a cross-sectional descriptive study on 130 trauma patients, who required a chest tube. CXR were obtained from all patients after four hours following chest tube removal and were studied by a radiologist. Clinical signs and symptoms were monitored and recorded and compared together. The correlation between CXR findings and clinical findings were analysed and compared with statistical tests. <b>Results:</b> Among 116 patients with normal CXR, no patient needed an intervention and among 14 patients with abnormal CXR, 5 (35.7%) patients required an intervention, with the difference being statistically significant. Correlation percentage among CXR results and need for an intervention was 50% (Kappa=0.5, p<0.001), and among clinical manifestation and need for an intervention was 79% (Kappa=0.79, p<0.001). <b>Conclusion:</b> It seems that taking a routine CXR in an asymptomatic patient after chest tube removal may not be necessary and can cause additional radiological exposure. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=PC19-PC21&id=11833 https://doi.org/10.7860/JCDR/2018/31989.11833 Association between Serum 25-Hydroxyvitamin D and Carotid Intima-Media Thickness in Acute Ischaemic Stroke: A Cross-Sectional Study Mehboob Subhani Siddiqui, Ajay Kumar Mishra, Pragya Mishra, Davendra Kumar, Vasudha Jain <b>Introduction:</b> Vitamin D has been shown to have a strong association with both ischaemic stroke and cardiovascular disease. There is a scarcity of published data from Indian subcontinent on vitamin D status and its association with acute ischaemic stroke. <b>Aim: </b>To study the association between serum 25-hydroxyvitamin D and Carotid Intima-Media Thickness (CIMT) in acute ischaemic stroke. <b>Materials and Methods:</b> One hundred ten consecutive subjects with acute ischaemic stroke were selected as cases and 55 healthy age and gender match subjects were included as controls. Quantitative measurement of 25-OH vitamin D in serum and plasma samples was done. Common Carotid Artery (CCA) doppler images were obtained to measure Intima-Media Thickness (IMT) by using three different angle views for each vessel. Student’s t-test was used for comparison of continuous variables. The results of comparing the correlation between two continuous variables were indicated by the correlation coefficient (r) using correlation analysis. <b>Results:</b> In the study population i.e., both in cases and controls, 59.39% subjects had vitamin D insufficiency, 34.44%had vitamin D deficiency and only 6.06% had Vitamin D levels within normal limits. The difference between the mean Vitamin D levels of cases (13.35±5.58 ng/mL) and controls (18.78±9.28 ng/mL) was found to be statistically significant (p<0.001). The difference mean CIMT among the cases (0.09±0.01 mm) and controls (0.07±0.01 mm) was also found to be statistically significant (p<0.001). Correlation between age and vitamin D levels was not statistically significant. A weak statistically significant negative correlation between CIMT and Vitamin D levels was found (r= -0.184 p=0.018). <b>Conclusion:</b> The findings suggest that there is a probable association between low Vitamin D levels and acute ischaemic stroke. However, in view of presence of numerous confounding factors like diabetes, hypertension and obesity in our study a definite causal relationship cannot be established. Although both Vitamin D levels and CIMT show a strong association with acute ischaemic stroke; the linear relationship between Vitamin D levels and CIMT is rather weak. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=OC20-OC23&id=11834 https://doi.org/10.7860/JCDR/2018/35067.11834 Aesthetic Perception about Gingival Display on Maxillary Incisor Inclination among Saudi Dentists, Orthodontist and Lay Persons Al Hassan Alyami, Jamal Al Sanea, Rafi Ahmad Togoo, Tasneem S Ain <b>Introduction:</b> Aesthetic perception varies from one individual to another and is determined by social and environmental factors as well as by personal experience. Dental aesthetics affects one’s quality of life and self esteem. <b>Aim:</b> A study was conducted to assess the aesthetic perceptions of dentists, orthodontist and lay persons in Saudi Arabia, regarding the effect of gingival display on the incisor inclination. <b>Materials and Methods:</b> An observational, cross-sectional questionnaire based study was conducted among dentists, orthodontists and lay persons in Saudi Arabia. A total of 90 subjects were taken in the study. A close-ended questionnaire was used that contained pictures altered at different gingival levels in three planes. They had to choose one option regarding their perception about incisor inclination at different gingival levels in all three planes. Descriptive statistics and Pearson chi-square test was used for analysing the data. The level of significance for all tests was set at p=0.05. <b>Results:</b> Statistically significant differences were found among the groups, with orthodontists being more critical when assessing the smile at different inclinations and gingival levels. Two-way cross tabulation showed, regardless of actual upper incisor inclination (normal/proclined/retroclined), as the gingival display increased the upper incisor were perceived more proclined by dentists and lay person but not by orthodontists. Pearson chi-square test showed this association to be statistically significant (p<0.05), for the total groups. <b>Conclusion:</b> Regardless of actual upper incisor inclination (normal/proclined/retroclined) as the gingival display increased the upper incisors were perceived more proclined by dentists and lay person but not by orthodontists. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=ZC56-ZC60&id=11835 https://doi.org/10.7860/JCDR/2018/33965.11835 Platelet Count Estimation using Unstained and Stained Peripheral Blood Smears: A Comparative Study Suman Dhakar, Preeti Diwaker, Priyanka Gogoi, Bharat Singh, Surender Kumar <b>Introduction:</b> The manual count of platelets using stained smears is the most commonly employed method, although this method has its own limitations. Hence, we planned to use unstained peripheral blood smear for platelet count estimation which is comparatively less time consuming to assess whether it can be used to detect the platelet count in emergency situations like dengue period when workload is more. <b>Aim:</b> To compare the platelet count on unstained and stained peripheral blood smear and to compare the advantages and disadvantages of these two methods. <b>Materials and Methods:</b> The present comparative study was conducted in University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, in August and September 2016. Platelet counts were estimated in 500 cases on unstained smears using light microscope under 100X objectives without immersion oil. Condenser of microscope was lowered and iris diaphragm was closed to reduce illumination. Platelets were counted in 10 fields and area was marked. The same smear was stained using ‘Wright stain’ and examined using oil immersion. Average number of platelets in 10 fields was multiplied by 20,000 in both the methods to get platelet count estimate per micro litre and results of both the methods were compared using Intra-class Correlation Coefficient (ICC). <b>Results:</b> A total of 500 cases were categorised into four classes based on average number of platelets per 10 fields under oil immersion on peripheral smears stained with Wright stain. The p-value and agreement between unstained and stained smear was assessed using ICC. Excellent agreement was noted in Class 1 (0.995) while in Class 4 it was average (0.511) with p-value less than 0.05. <b>Conclusion:</b> Platelet count estimation on unstained peripheral smears can bring down the need of stained peripheral smears and automated platelet counters to a good extent where workload is more and laboratory facilities are not easily available. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=EC14-EC16&id=11816 https://doi.org/10.7860/JCDR/2018/35640.11816 Factors Influencing Examination Anxiety among Undergraduate Nursing Students: An Exploratory Factor Analysis Charlet Jasmine Vaz, Twinkle Dan Pothiyil, Linu Sara George, Soumya Alex, Dan Isaac Pothiyil, Asha Kamath <b>Introduction:</b> The time of examination is a stressful period where stress is on its highest levels. To some extent, low level of stress can help in motivating the students, however on the contrary more stress can be discouraging. It will make students exhausted, overwhelmed and confused. <b>Aim:</b> To assess examination anxiety and explore the factors influencing the examination anxiety. <b>Materials and Methods:</b> The present exploratory study was conducted among 341 undergraduate nursing students enrolled in selected colleges of nursing. The data were collected by using a demographic proforma used to collect the background information and test anxiety scale to assess examination anxiety and a Likert’s scale to explore the factors influencing examination anxiety. Factors were identified by exploratory factor analysis using extraction method of principal component analysis with varimax rotation. Data were analysed using SPSS version 16.0. Demographic proforma and test anxiety score was analysed using frequency and percentage. <b>Results:</b> Majority (90.3%) of the samples were females. Maximum number of participants (95%) had English as their medium of instruction in Preuniversity College. Most (61%) of subjects were normal or had no test anxiety, 25% had mild test anxiety, 12% had moderate test anxiety, and 2% subjects had severe test anxiety. Factor analysis identified four factors (Learning Process, Perceptions related to examination, Learning pattern, Over expectations related to learning outcome) that influence examination anxiety. <b>Conclusion:</b> The study findings will help the teaching faculty to take into consideration these factors during examination and help students to overcome anxiety. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=JC16-JC19&id=11817 https://doi.org/10.7860/JCDR/2018/35878.11817 Association of Coronary Artery Diseases with ABO and Lewis Blood Group Phenotypes at a Tertiary Care Teaching Hospital in Southern India Anitha Madithadu, Arun Rajendran, Rajashekar Durgaprasad, Sarella Jothibai <b>Introduction:</b> Since the discovery of blood group systems, involvement of ABO system to coronary artery disease was suggested. Epidemiological data on the association of ABO and Lewis blood group with coronary artery disease from Southern India was not available. <b>Aim:</b> To assess the pattern and association of ABO and Lewis blood group phenotypes in confirmed Coronary Artery Disease (CAD) patients attending the tertiary care hospital in Southern India. <b>Materials and Methods:</b> The present study was a single centric case control analytic study where 187 clinically confirmed CAD cases were compared with age and gender matched 187 healthy controls. ABO grouping and Lewis antigen typing were determined to know the association with CAD and its risk factors. Statistical analysis was done using SPSS version 20.0 and by computing categorical variables in percentage. <b>Results:</b> Blood group O was the most common (41.2%) blood group in the controls followed by blood group B (33.2%), A (21.9%), AB (3.7%). The prevalence of O group in the CAD patients was almost similar to controls, but comparatively, the frequency of Non O groups showed a mild increase in the CAD patients; the frequency of AB groups in these patients was comparatively less than the controls. The prevalence of Le (a-b-) phenotype has been observed to be 32.6%. We observed that 94.1% of cases were associated with risk factors like ‘Smoking’, ‘Hypertension’, ‘Diabetes mellitus’, ‘Dyslipidemia’. <b>Conclusion:</b> The present study failed to show a significant association of ABO blood group with CAD but showed a significant association of ABO group with risk factors like hypertension, dyslipidemia and smoking. It also showed a significant association of Le (a-b-) phenotype with CAD and with risk factors like diabetes mellitus, dyslipidemia and smoking. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=EC17-EC21&id=11818 https://doi.org/10.7860/JCDR/2018/36646.11818 Clinicomicrobiological Study of Bacteraemia Caused by Coliforms in Adults Ankita Porwal, Sevitha Bhat, Ashwini Hegde, Pooja Rao, Shalini Shenoy <b>Introduction: </b>Bacteraemia due to gram-negative bacilli is a huge challenge to the clinicians because of the rapidly emerging multidrug resistance among these microorganisms. <b>Aim:</b>To study the associated infections and risk factors, antibiotic resistance in coliforms by phenotypic and genotypic methods, to evaluate antibiotic treatment and outcome in coliform bacteraemia. <b>Materials and Methods:</b> The study was carried out in the Microbiology laboratory of a tertiary care centre. Blood samples were cultured using BacT/ALERT. Antibiotic susceptibility pattern was noted by Vitek 2 Compact system. Phenotypic tests were performed for Amp C beta lactamase, Carbapenemase and MBL.blaNDM-1 & blaKPC gene in carbapenem resistant strains of Coliforms were detected by conventional PCR. The statistical methods used were Chi-square test and Odds ratio. <b>Results:</b> Urinary Tract Infection (UTI), skin and soft tissue infections and pneumonia were associated with bacteraemia. Risk factors were invasive procedures, previous hospital and ICU admission. Penicillins, Fluoroquinolones, 3rd generation cephalosporins showed high resistance. Of the 25 Carbapenem resistant isolates, Modified Hodge Test (MHT) positive were 11. MBL production by E-test detected 14 of the 25. Of 68 isolates resistant to 3rd generation Cephalosporins, 35 were Amp C producers. Sixteen isolates harbored blaNDM-1, none had blaKPC. Mortality rate was 11.4%. <b>Conclusion: </b>ESBLs and Carbapenem resistant strains are spreading fast in community and pose therapeutic challenges. There is a dire need to initiate regional surveillance, carry out more effectual antibiotic stewardship and infection control measures to prevent further spread. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=DC15-DC19&id=11819 https://doi.org/10.7860/JCDR/2018/36015.11819 Perception of Community Pharmacy Personnel towards Patient Counseling and Continuing Pharmacy Education Programs in Aden, Yemen Mohamed Alshakka, Awsan Bahattab, P Ravi Shankar, Mukhtar Ansari, Heyam Saad Ali, Mohamed Izham Mohamed Ibrahim <b>Introduction: </b>Patient counseling is a major component of pharmaceutical care, especially in community pharmacy settings. However, most community pharmacists still do not offer patient-oriented services. Despite the beneficial role of community pharmacists, research examining their roles and responsibilities in developing countries like Yemen is lacking. <b>Aim:</b> To assess the community pharmacy personnel’s perceptions towards patient counseling and to recognise the major barriers to successful counseling; and to assess their perception towards continuing pharmacy education programs in Aden. <b>Materials and Methods:</b> A descriptive, cross-sectional study was conducted among 200 community pharmacy personnel in Aden using a self-administered, structured questionnaire. Data were collected regarding community pharmacy personnel’s knowledge, attitude, and their perception about patients’ attitude concerning patient counseling and respondents’ attitude towards the continuing pharmacy education. <b>Results:</b> The majority of the respondents had a positive attitude towards patient counseling (85%) and continuing pharmacy education (94.0%); dose and frequency (43.0%), duration (34.0%) and indication (11.5%) were the major information mentioned while counseling their patients. Lack of patient interest (47.0%), lack of knowledge (20.0%) and lack of time (15.5%) were the major barriers towards counseling. <b>Conclusion: </b>The present study showed that most community pharmacy personnel in Aden, Yemen had a positive perception towards patient counseling and continuing pharmacy education program. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=LC18-LC22&id=11820 https://doi.org/10.7860/JCDR/2018/34106.11820 An Improved Osmotic Fragility Protocol for Screening of Beta Thalassaemia Carriers in Remote and Resource Limited Settings Dinesh B Jagtap, Malay B Mukherjee, Roshan B Colah <b>Introduction:</b> In a vast country like India where beta thalassaemia is a health burden and majority of the population reside in rural regions, a simple and economic primary screening test is vital. <b>Aim:</b> To modify the existing Naked Eye Single Tube Red Cell Osmotic Fragility Test (NESTROFT) to increase it’s sensitivity. <b>Materials and Methods:</b> A 3.6% stock buffer containing HEPES (4-(2-hydroxyethyl)-1-piperazineethanesulfonic acid) was compared with one without HEPES over a period of 6 months. The working buffers (0.36%) were freshly prepared by a 1:10 dilution using HPLC grade water. One hundred fifty seven individuals were tested which included normal individuals, beta thalassaemia carriers and HbS carriers. <b>Results:</b> The solution containing HEPES picked up all the beta thalassaemia carriers and had a sensitivity of 100%, specificity of 79.22%, positive predictive value of 80.95% and negative predictive value of 100% for detection of beta thalassaemia carriers. The standard buffer without HEPES missed 3 beta thalassaemia carriers and had a sensitivity of 95.59%, specificity of 74.03%, positive predictive value of 76.47% and negative predictive value of 95.0%. The pH of the stock solution containing HEPES remained stable for 150 days as compared to one without HEPES. All the HbS carriers were also picked up with the former buffer while 4 of them were missed with the standard buffer. <b>Conclusion:</b> In remote and resource limited settings NESTROFT is a valid first line screening test for beta thalassaemia carriers. We have been able to improve its sensitivity and negative predictive value by using a modified solution which is stable for a longer period. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=EC22-EC25&id=11825 https://doi.org/10.7860/JCDR/2018/32773.11825 Clinical Profile of Haemorrhoid Cases Admitted in Various Tertiary Care Hospitals in an Urban Area of Southern India Nitin Joseph, Damodar Sandeep Pai, Sharique Ahmed, Vaishakh Bengrodi Vishnu, Mohammed Shameer, Syed Waquas Ahmed <b>Introduction:</b> Clinical presentation of haemorrhoids is varied resembling number of anorectal diseases. <b>Aim:</b> To assess risk factors, clinical profile and management practices of haemorrhoid cases. <b>Materials and Methods:</b> This retrospective record based study was done at a government and private tertiary care hospital in Mangalore. Data from medical records of 220 haemorrhoid cases, over the past 10 years were collected and analysed. Chi-square test was used to test association. <b>Results:</b> Out of the 220 cases, 196 (89.1%) were males, 87.3% were unskilled workers and 123 (55.9%) were from urban areas. Among the cases, 96.5% were non-vegetarians, 150 (68.2%) gave history of frequent lifting of heavy weights, 69 (31.4%) had positive history of prolonged standing and 68 (30.9%) had history of constipation. Majority of cases had internal haemorrhoids 177 (80.5%) and were of third degree 92 (41.8%) variety. As many as 99 (45%) presented with haemorrhoids in 3 o’ clock position. The most common presentation was rectal bleeding 175 (79.5%) followed by anal pain 55 (25%). Rectal bleeding was present among most cases (80.8%) with internal haemorrhoids while majority of cases (28.2%) with external haemorrhoids complained of anal pain. Proctoscopy was the most common investigative procedure performed in 75% cases. Among conservative procedures, majority of cases 79 (35.9%) received warm sitz bath. Ferguson haemorrhoidectomy (closed haemorrhoidectomy) was the most common surgical procedure done in 83.8% cases. The outcome of management was recovery in 214 (97.3%) cases and recurrence reported in 6 (2.7%) cases. <b>Conclusion:</b> The high risk groups identified in this study such as non-vegetarians and those with history of frequent lifting of heavy weights need to be made aware of the risk of developing haemorrhoids. Suitable changes in their lifestyles will be useful in prevention of haemorrhoids. Information on its common clinical presentation would be useful in screening activities. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=PC14-PC18&id=11826 https://doi.org/10.7860/JCDR/2018/34887.11826 Comparison of Tissue Culture Plate and Modified Tissue Culture Plate Method for Biofilm Detection in Members of Family Enterobacteriaceae Shruti Asati, Uma Chaudhary <b>Introduction:</b> Microorganisms associated with biofilm formation have tendency to delay healing and show increased resistance to antimicrobial drugs resulting in chronic infection. This increases morbidity of patient as well as cost of treatment. Among the several methods of biofilm detection, Tissue Culture Plate (TCP) method and Modified Tissue Culture Plate (MTCP) method were studied. <b>Aim: </b>1) To detect biofilm production in pus isolates by TCP method and MTCP method; 2) To compare Antimicrobial Susceptibility Testing (AST) of biofilm producing and biofilm non-producing isolates. <b>Materials and Methods:</b> In the present study, 240 pus samples obtained from patients attending Pt. B.D. Sharma PGIMS, Rohtak were studied. The organism was identified using standard microbiological procedures and AST was done by Kirby-Bauer disc diffusion method in accordance with CLSI guidelines 2016. Biofilm production was detected by TCP and MTCP methods. <b>Results:</b> A total of 160 isolates were studied which included Klebsiella spp. (n=51), Escherichia coli (n=41), Citrobacter spp. (n=32), Proteus spp. (n=26), Enterobacter spp. (n=10). Out of these, 52.5% isolates showed biofilm production by TCP and 65.6% by MTCP method. The sensitivity of MTCP was found to be higher than TCP method. Also, it was observed that 79.7% biofilm producing isolates were multidrug resistant as compared to 29% non- biofilm producing strains. Overall 55.6% isolates were found to be multidrug resistant. <b>Conclusion: </b>MTCP was found to be more accurate method for biofilm detection and quantification. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=DC20-DC23&id=11827 https://doi.org/10.7860/JCDR/2018/34795.11827 Vitamin D in Treatment-Resistant Carpal Tunnel Syndrome Patients with Hypovitaminosis D Marzieh Mohtashamkia, Sharareh Roshanzamir, Seyed Mohammad Saghanezhad <b>Introduction:</b> Vitamin D is significantly effective on health promotion during adulthood. Extraskeletal effects of vitamin D play an important role in tendency to use it in recent years. Vitamin D can be helpful in improving treatment process. <b>Aim:</b> To study effect of treatment with vitamin D in intractable Carpal Tunnel Syndrome (CTS) patients with hypovitaminosis D referred to the Physical Medicine and Rehabilitation Clinics of Shiraz University of Medical Sciences in 2015. <b>Materials and Methods:</b> This interventional quasi-experimental study has investigated 50 intractable CTS patients by electrodiagnostic study and physical examinations who have not responded to standard management of CTS for 6 weeks with concomitant hypovitaminosis D (25(OH) vitamin D serum level less than 30 ng/dL) by High Performance Liquid Chromatography (HPLC) method. A dose of 50000 IU vitamin D3 was taken orally per week for 12 weeks. Re-evaluation of patients by electrodiagnostic study was done within one week of taking the last dose. A questionnaire was designed to collect data including age, gender, Body Mass Index (BMI), past medical history, drug history, boston score before and after treatment with vitamin D, serum level of vitamin D before treatment and put data on the Excel 2013 software. Pairwise t-test (a=0.05) and SPSS version 20.0 were used to analyze data. <b>Results:</b> The mean Boston symptom score before treatment (3.45±0.90) was reduced to (2.04±0.71) after treatment. The mean Boston function score before treatment (3.41±0.85) was reduced to (2.08±0.82) after treatment. Mean Slat values before treatment (4.5±0.57) were reduced to (3.89±0.53) after treatment. Mean Mlat values before treatment (5.03±0.49) were reduced to (4.66±0.44) after treatment. Mean NCV values before treatment (27.02±4.64) were reduced to (32.58±4.54) after treatment. There was a significant difference between Boston scores, Slat, Mlat and NCV values before and after treatment with vitamin D (p-value=0.0001). <b>Conclusion:</b> It is concluded that treatment with vitamin D improves clinical and electrodiagnostic conditions of treatment-resistant CTS patients with hypovitaminosis D. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=LC23-LC26&id=11828 https://doi.org/10.7860/JCDR/2018/26417.11828 Perceptions and Effectiveness of Use of E-Learning in Pharmacology Education Parvati B Patel, Tejas Patel, Manoj Kumar Saurabh, Sejal Thakkar <b>Introduction:</b> E-learning improves learning by easy access to learning content, teaching material for revision and clarification at each learning sequence and controlled pace. <b>Aim:</b> The present study aimed to design an e-learning module in pharmacology and assess its effectiveness, acceptability and feasibility in undergraduate teaching. <b>Materials and Methods:</b> E-learning module was prepared with the help of Microsoft office, 2007 and iSpring Suite 8.3 software. Six learning objectives from a must know area of a subject (pharmacovigilance) were selected for the present module. Pre-post intervention study was conducted on undetrgraduates (2nd year MBBS students) to assess its effectiveness through the class average normalised gain. Students and faculty perceptions were collected through SurveyMonkey tool. <b>Results:</b> A total of 124 (97.7%) out of 127 participating students completed pre and post-test assessment. A medium (45.9%) and high (76.6%) class-average normalised gain were observed in Short Answer Questions (SAQ) and ADR form filling exercise, respectively. Students perceived the module positively about the amount of time to complete it (73.6%), the pace of learning (84.0%), self-learning opportunity (98.4%), their future performance (91.7%) and achieving learning outcomes (98.3%). The analysis of general comments suggests students felt module was informative, easy to understand, interesting and systematically explained. The faculty perceived it positively about the appropriateness of the content (81.3%), self-directed learning resource (81.3%) and achieving the learning objectives (93.8%). <b>Conclusion:</b> E-learning module was effective in acquiring cognitive gain. Students and faculty perceived it as easy to understand, interesting and facilitating a method for self-directed learning. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=FC12-FC16&id=11829 https://doi.org/10.7860/JCDR/2018/35791.11829 Risk Factors for Descemet’s Membrane Detachment Following Small Incision Cataract Surgery Ajita Sasidharan, Poornima Kandasamy <b>Introduction:</b> Separation of Descemet's membrane and the endothelium from the stroma is called Descemet's detachment. The most common cause of Descemet’s Membrane Detachment (DMD) is mechanical separation near the incision site by an instrument, fluid or viscoelastic substance. DMD is an important vision threatening complication after cataract surgery. <b>Aim:</b> To evaluate the risk factors for DMD following manual Small Incision Cataract Surgery (SICS). <b>Materials and Methods:</b> A retrospective, non-comparative clinical analysis of the risk factors causing DMD was performed using computerised database. All cases operated for cataract extraction and intraocular lens implantation by manual SICS, in which only blade was used for construction of the sclera-corneal tunnel (incision, tunnel and entry)-no crescent and no keratome technique, under community outreach department between January 1st, 2013 and December 31st, 2013, were analysed. We analysed the preoperative, intraoperative and postoperative records of all the patients who suffered with a DMD. We compared the surgeon’s experience, ocular risk factors and the DMD. <b>Results:</b> The mean age of patients having DMD was 64.89 years. Male to female ratio was found to be 0.54:1. The incidence of DMD was found to be 0.15% (57 patients out of 36,898). Dense cataract, shallow anterior chamber, Pseudoexfoliation (PXF), corneal opacities, steep cornea were found associated with DMD. Incidence of DMD was higher among final year trainees than the first year trainees. All DMDs were re-attached on first postoperative day. <b>Conclusion:</b> DMD is a surgeon induced preventable cause for postoperative corneal oedema and low vision. Gentle instrumentation, early detection, judicious management may reduce the incidence and outcome of DMD especially in dense cataract, PXF, steep cornea and corneal opacities. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=NC01-NC03&id=11813 https://doi.org/10.7860/JCDR/2018/34057.11813 Quantifying Serum IL-1ß Cut-Off Point for Detecting Cardiovascular Diseases in a Population from Western Maharashtra Smita Amol Deokar, Sucheta P Dandekar, Vinay G Patke, Yasmeen Khatib, Roshni D’souza, Savita Karnad, Amol Deokar, Ramesh Chaturvedi <b>Introduction:</b> In India alone in 2000 there were 30 million people suffered with Coronary Heart Diseases (CHD) with 3% prevalence and incidence of HF with CHD is 0.4% to 2.3% per year. There are many traditional and non-traditional risk factors that are associated with cardiovascular diseases (CVD) which are an aetiologically multifactorial. Currently atherosclerosis is not only a lipid disorder but it is the process of active communication between endothelial dysfunction, sub-endothelial inflammation and wound healing process of vascular smooth muscle cells. Inflammation leads to atherosclerosis which results in a CAD where innate and adaptive immune systems play a major role where Interleukin-1 (IL-1) may show a major portion in the development of atherosclerotic CAD by promoting atherogenesis. <b>Aim:</b> To determine serum IL-1ß levels for detecting CVD patients from Western Maharashtra population. <b>Materials and Methods:</b> We recruited 229 cases of CVDs (16 cases of complete heart block, one case of congenital heart disease, 22 cases of heart failure, 169 cases of myocardial infarction, one case of myocarditis and 20 cases of rheumatic heart disease) who were enrolled at Cardiology and Medicine Department of Lokamanya Tilak Municipal General Hospital, Sion, Mumbai along with 229 age and sex matched healthy controls were included in this case control study. Serum IL-1ß was measured with commercially available ELISA kit. Cut-off level for estimation of IL-1ß was done with Receiver Operative Curve (ROC) analysis. Statistical analysis was carried out using SPSS version 16.0 and Microsoft Excel 2007. <b>Results:</b> The median and Inter Quartile Range (IQR) level of IL-1ß in CVD group was significantly higher than control group (p-value<0.0005). According to the Receiver Operating Characteristic (ROC) curve analysis, IL-1ß levels significantly discriminated between CVD and non-CVD condition with the optimal cut off point at 2 pg/mL, sensitivity 37.4% and specificity of 95.6% with a large significant sample size. <b>Conclusion:</b> Measuring serum IL-1ß level is a highly sensitive and highly specific test for detecting CVDs at the estimated 2 pg/mL cut-off point in this specific CVD patients sample. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=BC18-BC21&id=11797 https://doi.org/10.7860/JCDR/2018/28457.11797 Assessment of Primary Solid Renal Mass using Texture Analysis of CT Images of Kidney by Active Contour Method: A Novel Method Gomalavalli Ramesh, Sriram Krishnamoorthy, Muttan Sourirajan, Venkata Sai <b>Introduction:</b> The overall incidence of the renal masses is on the rise. With better imaging modalities more of these masses are picked up earlier. Most of the times, the diagnosis is confirmed after radical nephrectomy. More often there is an inherent tendency to offer overtreatment in cases of benign renal masses. Renal biopsy to discriminate benign from malignant masses can be very useful in such instances but are more invasive. Grey Level Co-Occurence Matrix (GLCM) is recognized as the most representative radiological parameter to define the heterogeneity of solid renal masses. <b>Aim:</b> To identify certain radiological parameters that might help us to differentiate the benign from malignant renal masses, obviating the need for a biopsy. <b>Materials and Methods:</b> This was a prospective study done over three years from June 2014 to May 2017. A total of 188 patients were included. These patients were equally divided into two broad groups of 94 patients each: Group 1 was patients with renal mass, of which 67 were malignant and 27 were benign. The group 2 was the control group. We used the active contour method to delineate the renal mass and study the features in them. Data analysis for each feature was individually calculated with the help of Sigma Stats 4.0 software and one-way ANOVA analysis. <b>Results:</b> Six CT parameters showed significant data that helped the clinician to differentiate the benign from the malignant renal masses. From the study it was evident that the parameters namely, entropy, energy, sum average, sum variance, inertia and low gray level emphasis were found to be statistically significant which helps the clinician to differentiate the benign from the malignant renal masses. <b>Conclusion:</b> Our data shows that GLCM parameters are crucial tool for the determination of the solid mass composition of tumour. This obviates the need for an invasive procedure like Ultrasound or a CT guided biopsy of the mass. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=TC05-TC09&id=11798 https://doi.org/10.7860/JCDR/2018/34702.11798 Morphological Patterns and Immunohistochemical Characteristics of Metaplastic Carcinoma Breast: A Six Year Analysis in a Tertiary Care Hospital Lekshmidevi Padmanabhan, Cicy Petta Joseph, Jeji Gopinathan, Lillykutty Pothen, Sansho Elavumkal Ulahannan <b>Introduction:</b> Carcinoma breast is a leading cause of morbidity and mortality in females. Metaplastic Carcinoma Breast (MCB) accounts for less than 1% of invasive breast carcinomas. This variant has an aggressive behaviour and hence poor prognosis. Since metaplastic carcinomas are rare and most patients succumb within a short span of time, detailed studies are required in this area. Moreover, being a heterogeneous group, sub classification and prediction of biologic behaviour of metaplastic carcinomas is challenging. World Health Organization (WHO) classification and recent studies show the importance of identifying the subtypes of MCB based on histopathology. <b>Aim:</b> To analyse the histopathological patterns and expression of Immunohistochemical (IHC) markers in MCB. <b>Materials and Methods:</b> All cases of MCB diagnosed in Pathology Department of our Institute during the period of 6 years from January 2011 to December 2016 were analysed. Age distribution, histopathological and IHC patterns were studied using the registers, histopathology slides and IHC slides in the department. The data collected were analysed using SPSS software 16.0. <b>Results:</b> A total of 36 cases of MCB accounting for 2.6% of breast carcinomas (n=36, total number of invasive breast carcinomas=1405) were received in our Institution, which is a tertiary care centre. Age distribution ranged between 34 to 72 years. All except one were female patients. Predominant histopathological pattern was malignant spindle cells accounting for 53% cases. Seventeen percent showed predominant squamous areas. Other types were heterologous differentiation (chondroid/osseous) in 11%, mixed pattern (squamous areas+invasive ca NST(No Special Type) in 11%, choriocarcinomatous component in 3%, fibromatosis like in 3% and low grade adenosquamous type in 3%. Lymph node metastasis was present in 41.4% (n=12) and 69.2% of cases showed triple negative pattern in immunohistochemistry. <b>Conclusion:</b> Majority of metaplastic carcinomas was solid grey white growths with infiltrative margins but cystic degeneration (in 24.1% cases) was associated with squamous areas. Presence of epithelial elements confers an increased chance of nodal spread and sarcomatous elements confers increased risk of extra nodal dissemination, hence this should be highlighted in the report stressing the need for a more aggressive follow up of those with sarcomatous component. The results of this study were comparable with other similar studies. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=EC10-EC13&id=11799 https://doi.org/10.7860/JCDR/2018/32618.11799 Expression of SOX2 and EGFR in Ameloblastoma, Odontoameloblastoma and Ameloblastic Carcinoma Karpagaselvi Sanjai, Sumana Bukanakere Sangappa, Divya Shivalingaiah, Harish Muniswamy Kumar, Anjum Baker <b>Introduction:</b> While de novo Ameloblastic Carcinomas (ACs) are easily diagnosed, it is the benign Ameloblastoma (AM) showing areas of malignant transformation which is a diagnostic challenge. SOX2, a transcription factor and Epidermal Growth Factor Receptor (EGFR) are oncogene on virtue of being embryogenic including odontogenic and adult stem cell regulator. Both are aberrantly expressed and amplified in several epithelial human cancers and have been used as immunohistochemical markers. <b>Aim: </b>To determine the expression of SOX2 and EGFR in AM, Odontoameloblastoma (OA) and AC in order to assess efficacy of the markers in differentiating between these tumours. <b>Materials and Methods:</b> This retrospective study was conducted to determine the immunohistochemical expression of SOX2 and EGFR on microscopic sections of AM (n=11), OA (n=2) and AC (n=6) retrieved from archives of the Department of Oral Pathology, Vydehi Institute of Dental Sciences, Bengaluru, India, from the period of January 2010 to December 2015. The data obtained were analysed using statistical software IBM SPSS version 21.0. <b>Results:</b> EGFR expression was noted in all cases of AM, OA and AC. Eight cases (72.72%) of AM showed SOX2 negative expression. Five cases (83%) of AC showed SOX2 positive expression (p=0.05). Both the cases of OA demonstrated SOX2 positivity. Two cases (50%) of recurrent AMs (n=4) showed SOX2 overexpression. <b>Conclusion:</b> While SOX2 has negative expression in AM, its positivity in OA and AC reiterates, its role in presence of cell lineage of tooth development and as an adjunct marker to highlight suspicious tumour aggregates respectively. SOX2 overexpression in recurrent cases of AM can be used to follow-up the patient. Strong EGFR overexpression indicates possibility of anti-EGFR treatment modality for both AM and AC. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=ZC48-ZC52&id=11800 https://doi.org/10.7860/JCDR/2018/34269.11800 Factors Influencing Academic Success of High Achievers and Low Achievers in Physiology Reem Rachel Abraham, M Ganesh Kamath, Asha Vashe, Wong Hong Jun, Muhammad Faiq Afif Bin Mohd Tahrim, Muhammad Faiz Bin Kasmuri <b>Introduction:</b> Academic success of medical students is influenced by several factors. <b>Aim:</b> To determine whether academic success of, high as well as low achievers, in physiology, in the present academic context is influenced by pre-reported factors. <b>Materials and Methods:</b> Focus Group Discussion (FGD) sessions were conducted to explore perceptions of high as well as low achievers in physiology, regarding seven pre-reported factors influencing academic success. These factors were: attitude towards medical school, attitude towards teachers, interest in subject, time-management, strategic studying, academic self-perceptions and test competence. First year students (n=13) who had scored distinction (>75%) in physiology, in three block-end examinations and second year students (n=7) who had distinction in all four block-end examinations when they were in first year, were categorized as high achievers. Students (n=14) who were unsuccessful in first year final summative examination, were grouped as low achievers. <b>Results:</b> The FGD data which was analysed using a deductive analysis framework revealed a positive link between responses for all pre-reported factors with the academic success of high achievers, except time management and strategic studying. Even though the responses from low achievers regarding medical profession, teachers, and interest in subject were positive, these could not be linked to their academic performance in first year. The low achievers in the present study believed that with continuous teacher support, their understanding of physiology could be improved, which in turn could lead to an increased interest in the subject which could motivate them to work hard and improve their academic performance. <b>Conclusion:</b> Academic success of both high and low achievers in the present academic context were influenced by pre-reported factors. Through this study, students were provided with an opportunity to reflect upon the learning process which is reported to be a learning supportive process. This study also gathered evidence for the fact that medical students need to be made aware of and has to be trained in effective time management skills. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=JC11-JC15&id=11801 https://doi.org/10.7860/JCDR/2018/35584.11801 Comparison of CHA2DS2-VASc-HS Score and Gensini Score to Predict Severity of Coronary Artery Disease Gautam Naik, Saritha Sekhar, Mukund Prabhu, Gurpreet Singh, Aniketh Vijay, Muthiah Subrahmanian, KU Natarajan <b>Introduction:</b> A plethora of risk assessment scores which identify the severity of Coronary Artery Disease (CAD) are available. However, most of them require results of coronary angiography or coronary computed tomography angiography. <b>Aim:</b> In this study, we assessed the accuracy of newly developed CHA2DS2-VASc-HS scoring system which does not require such sophisticated evaluations and compared it with Gensini score. <b>Materials and Methods:</b> The study was a single center, prospective, observational cohort study. The cohort of patients admitted to the Amrita School of Medicine, Kochi, Kerala, India for diagnostic angiography from November 2014 to October 2015 were observed for Gensini score and CHA2DS2-VASc-HS scores. Patients undergoing repeat angiography were excluded. The outcomes were classified into three groups as Normal, Mild CAD and Severe (Obstructive) CAD and the scores were compared. Statistical methods such an ANOVA, Spearman’s rank correlation and Mann-Whitney test were applied. <b>Results:</b> A total of 100 patients were studied whose mean age was 59.4±8.9 years. Among these patients, 19 patients (19%) had normal angiograms, 22 patients (22%) had mild CAD, and 59 (59%) patients had obstructive (severe) CAD. A significant increase in both the scores was observed with increase in severity of CAD. Mean Gensini score in the group with CHA2DS2-VASc-HS score <3 (n=44) was 2.34±4.13 (median-1, range 0-21), while the mean Gensini score in the group with CHA2DS2-VASc-HS score =3 (n=58) was 43.66±31.95 (median-33.8, range 0-153). There was a positive correlation between CHA2DS2-VASc-HS score and Gensini Score (correlation coefficient 0.813, p<0.001). <b>Conclusion:</b> This newly developed scoring system is an effective, convenient as well as rapid screening method, which can be used in hospital settings to predict severity of CAD. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=IC01-IC04&id=11802 https://doi.org/10.7860/JCDR/2018/28509.11802 Evaluating the Feasibility of Nested PCR as a Screening Tool to Detect HPV Infection in Saliva of Oral Squamous Cell Carcinoma Subjects Pushkal Sinduvadi Ramesh, Devananda Devegowda, Pundalik Rama Naik, Prathibha, Parveen Doddamani, Suma M Nataraj Clinical Microbiologists often come across strange structures during microscopic examination of clinical specimens which are often confused with and misreported as micro-organisms. We studied series of cases in a super speciality hospital from January 2015 to December 2016 with the aim of enumerating artefacts and mimickers that may simulate infectious agents. Microscopic examination of various clinical specimens like pus, tissue, sputum and blood (for peripheral smear examination) received by the department of Microbiology during this period was carried out as per requisition received from clinicians. Photographs of several microscopic artefacts were obtained using a high definition camera. For comparative purpose, photographs of common pathogenic micro-organisms closely resembling these structures were also obtained. Various microscopic artefacts closely resembling pathogenic micro-organisms like fungal hyphae, microfilariae, malaria parasites, acid fast bacilli, budding yeast cells and hooklets of Echinococcus granulosus were observed during the course of this study and enumerated. Owing to paucity of available literature, it is absolutely essential to highlight the issue of misreporting of infectious diseases during microscopic examination of clinical specimens. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=BC22-BC25&id=11806 https://doi.org/10.7860/JCDR/2018/34880.11806 Effectiveness of Two Techniques in Removal of Calcium Hydroxide Medicament from Root Canals: An in-vitro Assessment Ravi Gupta, Hunny Sharma, R Anitha Kumari, Arun C Prakash, Namith Rai, Lipika Jain <b>Introduction:</b> Calcium Hydroxide {Ca(OH)2} is widely used as intracanal medicament. However, complete removal of Ca(OH)2 is very difficult from canal walls resulting in its residues on canal wall which interfere with bonding of sealers and reduce success of root canal treatment. <b>Aim:</b> To compare the effectiveness of two techniques, i.e., wave one and wave one with EndoActivator in removing Ca(OH)2 from the root canals. <b>Materials and Methods: </b>This was an in-vitro study involving 30 extracted single-rooted mandibular premolar bicuspid teeth. Access opening was done followed by biomechanical preparation with ProTaper universal rotary file system (Dentsply, Tulsa Dental Specialities) till F2. Canals were filled with injectable Ca(OH)2 (UltraCal XS, Ultradent Products, INC). The tooth was stored in saline for one week. Then samples were divided into two main groups T1 and T2 (n=15) according to the method of Ca(OH)2 removal. Group 1 (T1): Ca(OH)2 was removed using wave one file alone. Group 2 (T2): Ca(OH)2 was removed using wave one file followed by EndoActivator. Teeth were sectioned buccolingually. The amount of residual Ca(OH)2 was observed and under a stereo microscope (30X magnification) for coronal, middle and apical third. The data were analysed using Mann-Whitney U test to compare between the two techniques, i.e., T1 and T2, taking into consideration p<0.05 as statistically significant. <b>Results:</b> In the coronal third, there was no difference between the two groups (p>0.05). The most efficient Ca(OH)2 removal in apical and middle third was recorded in Group 2 (T2), i.e., Wave one with EndoActivator (p<0.05) as compared to Group 1 (T1) wave one file alone. <b>Conclusion:</b> EndoActivator results in better debridement of root canals when used in combination with different rotary file systems. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=ZC53-ZC55&id=11807 https://doi.org/10.7860/JCDR/2018/36025.11807 Role of D-Mannose as an Antiglycolytic Agent to Eliminate Preanalytical Error in Glucose Testing Mithu Banerjee, Ankit Batra, Pratibha Misra <b>Introduction:</b> Correct assessment of glucose is required for diagnosis of diabetes and monitoring of antihyperglycaemic therapy in adults as well monitoring neonatal hypoglycaemia. As per American Diabetes Association, sodium fluoride alone is an unreliable antiglycolytic agent in vitro due its ineffective action during first 4 hours of sample collection. <b>Aim:</b> To evaluate the efficacy of mannose as compared to conventional antiglycolytic agent for blood glucose estimation and to assess its use as a preservative for other routine biochemical analytes. <b>Materials and Methods:</b> The study was carried out in three steps. Fifteen samples of plasma were aliquoted into 5 parts. One was without any additive and in other four D-mannose was added in concentration of 1,2,3 and 5 mg/mL. Blood glucose was analysed immediately, at 1.5 hours, 3 hours and 5 hours to optimize the concentration of D-mannose. Fifteen serum samples were aliquoted into 2 parts, one without any additive and the other with D-mannose at a concentration of 3 mg/dL. Both were subjected for routine biochemistry to check for any interference by D-mannose in analysis. Fifteen samples were collected in heparin (with mannose added in concentration of 3mg/dL), plain tube, EDTA and sodium fluoride vacutainers. Blood glucose and other routine analytes were measured immediately, at 1.5 hrs and 3 hrs to compare D-mannose with other preservatives. Results were analysed using Student’s t-test. <b>Results:</b> Optimal concentration of D-mannose was found to be of 3 mg/mL. D-Mannose showed a less decrease of blood glucose at the end of 3 hrs compared to sodium fluoride. D-Mannose does not interfere with estimation of any analytes except potassium. Creatine kinase was found to be lower with EDTA compared to other preservatives. <b>Conclusion:</b> D-Mannose is an ideal preservative for blood glucose. All routine analytes (except potassium) can be estimated from a single vacutainer containing D-mannose at a concentration of 3 mg/dL. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=BC26-BC29&id=11808 https://doi.org/10.7860/JCDR/2018/35950.11808 Effect of <i>Carica papaya</i> Linn. Unripe and Ripe Fruit Pulp Juice in Augmenting Platelet Count in Rats: An Experimental Study Maria Jose, MB Sasmi, MI Elsy <b>Introduction:</b> Thrombocytopenia is often associated with diseases like dengue, Idiopathic Thrombocytopenic Purpura (ITP), malignancy, aplastic anaemia, drug induced thrombocytopenic purpura and haemolytic uremic syndrome. There are no effective methods to treat thrombocytopenia. Carica papaya (C. papaya) fruit pulp juice contains many constituents that can act on the bone marrow and enhance its ability to produce platelets. <b>Aim:</b> To evaluate the effects of fresh Carica papaya unripe and ripe fruit pulp juice on platelet count in cyclophosphamide induced thrombocytopenic rat model. <b>Materials and Methods:</b> A total of 24 male Albino Wistar rats were grouped into 'Control' (A), 'Drug control' (B), 'Papaya unripe fruit pulp' (C) and 'Papaya ripe fruit pulp' (D) groups. Thrombocytopenia was induced by three doses of cyclophosphamide (50 mg/kg body weight) given subcutaneously to Groups B, C and D from day 1 to 3. Groups C and D received Carica papaya unripe and ripe fruit pulp juice orally from day 11 to 14 respectively. Platelet count, Packed Cell Volume (PCV), Red Blood Cell (RBC) count, Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST) and serum creatinine levels was measured on day 1, 10, 14 and 21. For comparison between groups, ‘unpaired t-test’ and within the group, paired t-test were used. A p-value =0.05 was considered significant. <b>Results:</b> There was significant increase in platelet count in Group C (6.27×105/µL) and D (20.5×105/µL) compared to drug control B (3.94×105/µL) on day 14. Within the group, there was significant increase in platelet count in Group C and D on day 14 compared to day 10. Between the groups, Group D showed higher platelet increasing effect on thrombocytopenic rats. <b>Conclusion:</b> Carica papaya ripe and unripe fruit pulp juice has platelet enhancing effect. Further preclinical studies are required to identify those chemicals of C. papaya fruit responsible for boosting thrombopoiesis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=FC08-FC11&id=11809 https://doi.org/10.7860/JCDR/2018/35470.11809 Ophthalmic Manifestation of Sickle Cell Patients in Eastern India Swati Samant, Srikant Kumar Dhar, Mahesh Chandra Sahu <b>Introduction:</b> Sickle Cell Disease (SCD) is the most common and a serious form of an inherited blood disorder that leads to increased risk of early mortality and morbidity. Some of the ophthalmological complications of SCD include retinal changes, vitreous haemorrhage, and abnormalities of the conjunctiva. Irrecoverable Vision loss may be a manifestation if not diagnosed early and treated appropriately. <b>Aim:</b> To determine different ophthalmic manifestations in SCD patients and correlate in relation to HbS window. <b>Materials and Methods: </b>A total of 49 cases of sickle cell disease (HbSS) that presented to IMS & SUM Hospital were evaluated for ophthalmic manifestations in Ophthalmology OPD with comprehensive eye examination, slit lamp examination, Fundoscopy (Direct and Indirect) and OCT (Optical Coherence Tomography). Demographics and pattern of presentation were recorded in the proforma prepared for the study. <b>Results:</b> Male:Female ratio was 3:1. About 2/3rd of the patients were below 40 years of age. Examination of posterior segment revealed 5 (10%) of the patients presented with proliferative retinopathy, 15 (30%) with non proliferative retinopathy, 13(26%) with optic disc changes, 7 (14%) with retinal macular changes and 2 (4%) had retinal detachment findings are significantly different at p=0.001 in ANOVA Test. Anterior segment of eye evaluation demonstrated significant (p=0.0001) changes 18 (36%) patients suffered conjunctival vascular changes, Cataract in 8(16%) patients, and hyphema in only 2 (4%) patients. Both anterior and posterior segment manifestations significantly (p=0.0027) increased with progressive increase in HbS window. <b>Conclusion:</b> Sickle cell patients need periodic ophthalmic examinations to identify treatable lesions amenable to intervention and to prevent blindness. Both anterior and posterior segment manifestations increases with progressive increase in HbS window in HbSS patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=OC13-OC15&id=11810 https://doi.org/10.7860/JCDR/2018/36868.11810 Evaluation of Dyslipidaemia and Echocardiographic Markers of Myocardial Contractility in Smokers with Ischaemic Heart Disease Sandhya Metta, Nitin Fal Dessai, Satyanarayana Uppala, Shruti Mohanty, Archana Anand Dharwadkar <b>Introduction:</b> Cigarette smoking is responsible for dyslipidaemia and haemodynamic disturbances. <b>Aim:</b> The present study was conducted to evaluate the parameters of dyslipidaemia and left ventricular ejection fraction in smokers with Ischemic Heart Disease (IHD). <b>Materials and Methods:</b> Total number of study subjects included 327 males, which included 127 healthy subjects and 200 subjects admitted as IHD patients under the inclusion criteria meant for categorizing chronic smokers. They were subsequently divided into smoker and non-smoker groups and evaluated for lipid profile and 2D echocardiography. <b>Results:</b> The parameters of lipid profile revealed significant difference (p<0.001) in all lipid parameters except HDL among non-smokers vs smokers in both patient and control groups. The echocardiography analysis suggested significantly (<0.001) reduced ejection fraction in patients with smoking habit compared to without smoking habit. <b>Conclusion:</b> Chronic smokers with history of =15 pack years should undergo screening for IHD by timely evaluation of ejection fraction along with estimation of lipid profile. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=CC04-CC06&id=11811 https://doi.org/10.7860/JCDR/2018/35417.11811 Imaging Features of Extraspinal Osteoarticular Tuberculosis and its Mimickers: A Review Bargavee Venkat, Vineet Aggarwal, Neeti Aggarwal, Sanjiv Sharma Tuberculosis (TB) is a major public health problem worldwide. It can virtually affect any tissue in the body. Musculo-skeletal forms constitute only 1-3% of all tuberculous infections. Spine is the most common site, followed by peripheral joints. Tuberculosis is a double-edged sword in clinical practice. Making an incorrect diagnosis of tuberculosis is potentially as harmful as missing the diagnosis in true cases. A false positive diagnosis of tuberculosis not only results in ineffective treatment but also administration of antitubercular drugs in these patients can result in toxic side effects. A variety of clinical conditions mimic tuberculosis in bones and joints. Absence of pathognomonic imaging findings in extra-axial osetoarticular TB makes it even more difficult to make an accurate diagnosis radiologically in these patients. Pyogenic and fungal infections, inflammatory arthritis like rheumatoid arthritis are the common mimickers. Differential diagnosis varies according to the site affected, like bone tumours like enchondroma and giant cell tumour may mimic tubercular dactylitis. Clinical and radiological features of the extraspinal osteoarticular TB have been summarized in this review with illustrations. Radiological features and practical points of difference of the clinically relevant mimickers of the musculo-skeletal TB have been summed up. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=TE01-TE07&id=11815 https://doi.org/10.7860/JCDR/2018/32131.11815 Autism Spectrum Disorders-Aetiopathogenesis Babu George, ML Leena, MKC Nair Autism Spectrum Disorders (ASD) are characterised by a range of clinical features that can vary from individual to individual in both degree of severity and variability of the clinical presentation. The aetiology or causation of ASD has been a widely debated issue for several decades; however, the exact cause of autism is still unknown. Research has suggested that ASD may be caused by genetic and/or environmental factors. Among those, children with low genetic susceptibility, some maternal and obstetric factors have an independent role in autism aetiology, whereas among genetically susceptible children, these factors appear to play a lesser role. It was observed that there is an increased risk of ASD due to: (i) advanced maternal age; (ii) advanced paternal age; (iii) duration of gestation; (iv) intrapartum hypoxia; and (v) birth weight. Recent evidence also suggests potential links of immune dysfunction, dietary, metabolic and gastrointestinal factors. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=SE01-SE05&id=11751 https://doi.org/10.7860/JCDR/2018/36431.11751 Nitric Oxide: It’s Role in Immunity Shailaza Shreshtha, Preeti Sharma, Pradeep Kumar, Rachna Sharma, SP Singh Nitric Oxide (NO), a lipophilic gas synthesised by the enzyme Nitric Oxide Synthase (NOS) from the substrate arginine, is an important biomolecule that mediates cellular signaling. It has a wide spectrum of biological functions including immunomodulation, inflammation, microbial and tumour eradication. Cells of the immune system such as macrophages on activation by cytokines and microbial antigens eradicate a number of microbes or parasites as well as tumour cells by releasing a number of effector molecules which also includes NO. However, this versatile molecule is shown to have dual roles. In lower concentration, this is beneficial and regulates the physiological processes in the body whereas at higher concentrations it is harmful to not only the microbes or tumor cells but can produce undesirable effects on the host cells too. This suggests that NO has both protective and toxic roles that occur parallel in the body depending upon cellular microenvironment. Therefore, it is very essential to have the knowledge of the physiological processes involved in signaling cascades of NO since it might have novel clinical applications when therapeutic potential of NOS inhibitors and NO donors are to be considered. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=BE01-BE05&id=11764 https://doi.org/10.7860/JCDR/2018/31817.11764 Role of Interleukin-33 in Immunity and Periodontal Inflammation-A Literature Review Sasi Kumar Karuppanan, Santhosh Sekar, Sakthi Saranya Devi The Interleukin-33 (IL-33) is a member of IL-1 family discovered in the year of 2005. The Interleukin-1 (IL-1) family of cytokines is commonly encountered in chronic inflammatory diseases such as rheumatoid arthritis and periodontitis. IL-33 regulates the innate and adaptive immunity and it also participates in initiation and progression of periodontal diseases. The aim of this review was to analyse the biological and immunological role of IL-33 in progression of periodontal diseases. This review also deals with the IL-33 signaling pathway in the periodontal inflammation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=ZE08-ZE10&id=11788 https://doi.org/10.7860/JCDR/2018/32737.11788 An Insight into the Concept of Osseodensification-Enhancing the Implant Stability and Success Hema Kanathila, Ashwin Pangi Osseointegration is an important factor which contributes to the long term success of dental implants. Many factors, including surgical techniques, bone quantity and quality are a strong base for achieving primary stability. And this primary stability is considered to be a prerequisite for establishing good osseointegration. Osseodensification (OD), a recently developed interesting technique enhances the bone density around dental implants and increases primary stability. Many studies have been carried out on the efficacy of this new surgical technique. The purpose of this review article is to discuss in detail on OD procedure. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=ZE01-ZE03&id=11749 https://doi.org/10.7860/JCDR/2018/35626.11749 Overview of the Therapeutic Effects of <i>Origanum vulgare</i> and <i>Hypericum perforatum</i> Based on Iran’s Ethnopharmacological Documents Mahmoud Bahmani, Mojtaba Khaksarian, Mahmoud Rafieian-Kopaei, Naser Abbasi Herbs have played an important role in the health and wellness of human beings. Nowadays, medicinal herbs are at the forefront of studies of medical science because of their importance in public health. Understanding the traditional and therapeutic effects of medicinal plants is important because they can be effective as a source of medication. Based on the results obtained from the review of Irans ethnopharmacological literature, it was found that the Origanum vulgare can be used as energy producer, diuretic, stomach booster, nervous system reliever, laxative, anticancer, relief of migraine, fracture healing, numbness of organs, relief of toothache, disinfectant, anticonvulsant, expectorant, analgesic, antitussive, anti-inflammatory, menstrual regulator, decreases urinary tract infection, treatment of sexual dysfunction, colic, sinusitis, cardiac tonic and blockage remover. Also, Hypericum perforatum is used as a digestive and nervous system relaxant, respiratory and uterine stimulant, a booster of the immune system, antidepressant, anticancer, anti-AIDS, analgesic, bile cathartic, relaxing, anti-tussive, analgesic, treating nervous system diseases, astringent, antiparasitic, expectorant, diuretic, and blood pressure regulator. Preliminary results presented in this review study enlighten us that the herbal plants could be the basis for experimental and clinical studies to promote the use of natural agents in the treatment of human diseases. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=FE01-FE04&id=11728 https://doi.org/10.7860/JCDR/2018/34177.11728 Trauma from Armed Conflict and the Effect on Mental Health in Thailand's Deep South: A Systematic Review Wit Wichaidit <b>Introduction:</b> The Deep South region of Thailand has faced a situation of jihadist insurgency since 2004 with indiscriminate attacks on civilians and more than 19,000 casualties as of September 2016. Despite the large number of casualties, the conflict has received little attention from the international community, and the characteristics and burden of the trauma from the conflict has never been reviewed. <b>Aim:</b> This review describes the trauma associated with the South Thailand insurgency and the burden of trauma on the mental health of the affected population. <b>Materials and Methods: </b>Systematic searches were made in English and Thai using PubMed, Google Scholar, and Google. Sources included research articles in peer-reviewed journals and grey literatures in Thai and English languages published between 2004 and 2016, with “Thailand”, “Insurgency” and “Post-Traumatic Stress Disorder (PTSD)” as keywords. Irrelevant articles were screened out prior to the review. <b>Results:</b> The present review includes 16 articles, of which 2 articles were listed on PubMed, while 14 articles were found by Google Scholar and Google search in Thai. Most articles were cross-sectional studies. Trauma associated with the conflict can be divided into direct trauma, traumatic grief /loss of loved one, and historical trauma. There was a large degree of heterogeneity in the literature with regard to prevalence and determinants of PTSD and other mental health disorders. <b>Conclusion:</b> Prevalence of PTSD and mental health disorders in the insurgency area varied widely and could be subjected to biases. Future studies should consider a more accurate measurement of the association between trauma and PTSD and assess for effect modification by adverse childhood experiences. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=VE01-VE06&id=11722 https://doi.org/10.7860/JCDR/2018/35017.11722 Cross Cultural Adaptation, into Gujarati, of the English version, Strengths and Difficulties Questionnaire Jagdish Varma, Sandhya Nair, Jaishree Ganjiwale, Somashekhar Nimbalkar, Nikhil Kharod <b>Introduction:</b> Adolescent mental health is a neglected entity today which needs to be addressed at the earliest. Several mental health screening questionnaires and tools are available for the same. <b>Aim:</b> To translate and validate self-report version of Strengths and Difficulties Questionnaire (SDQ), (11-17 years) into Gujarati (language). <b>Materials and Methods:</b> Cross-sectional study was conducted in two bilingual higher secondary schools from Anand district, Gujarat. A total of 30 students with 15 students (11-17 years) from Gujarati and English medium schools each belonged to 8th and 9th grades who were fluent in both Gujarati and English were selected. Scale performance was measured as normal/borderline/abnormal based on the scores of the 25 items of SDQ. Linguistic equivalence, conceptual equivalence, scale equivalence and reliability of both versions of the SDQ were compared. Ethical clearance from the Ethics Committee was obtained and permission was sought from the heads of the schools. <b>Results:</b> Linguistic equivalence between the two versions was assessed using mean-difference scores for each item. 7 out of 25 items had mean difference score more than set standard 0.166. Items 9 and 10 had significantly different mean difference. Spearmans rank correlation coefficients showed good conceptual agreement between item and its corresponding subscale score in both, except item 7, 12 and 23 for Gujarati and item 12 for English version. Difference between pair of correlation coefficient was comparable for all except items 7,8 and 10. Concordance rate between classifications by 2 scales was good for Emotional (92.8%), Conduct (92.8%) and Pro-social behaviour subscale (96%) and fair for Hyperactivity and Peer problems subscale (67.8%). Total score concordance rate was 92.8%. <b>Conclusion:</b> Gujarati version of SDQ (11-17 years) has acceptable linguistic and conceptual equivalence and found to be a valid and reliable measure. Items 9 and 10 were rephrased after analysis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=VM01-VM03&id=11840 https://doi.org/10.7860/JCDR/2018/34087.11840 Pattern of Usage of TB Diagnostic Procedures in Private Sector across Three Cities of a Central Indian State Subbanna Jonnalagada, Janmejaya Samal <b>Introduction:</b> Despite the preference of Revised National Tuberculosis Control Program (RNTCP) for sputum microscopy, a variety of Tuberclosis (TB) diagnostic procedures are being used in private sector for the diagnosis of TB. <b>Aim:</b> To understand the pattern of usage of TB diagnostic procedures in private sector in one of the central Indian states. <b>Materials and Methods:</b> Seven months (June 2016 to December 2016) data were collected from selected leading laboratories across three cities of Chhattisgarh that included 6, 6 and 3 labs in Bilaspur, Durg & Bhilai and Rajnandgoan respectively. <b>Results:</b> Different diagnostic tests such as; Adenosine Deaminase (ADA), Fine Needle Aspiration Cytology (FNAC), Abdominal Ultra Sonography (USG), Chest X-ray (CXR), Immunoglobulin M (IGM) and serological tests such as TB Gold were found to be practiced in these cities without a definite pattern. Similarly of all the tests 9.4%, 13.4%, 46.7% and 30.3% (n=3295) were serological tests, sputum microscopy, CXR and other tests respectively across all the cities. <b>Conclusion:</b> Despite Government of India’s gazette to stop malpractice in TB diagnosis serological tests are rampantly happening across the three cities. Systematic reviews carried out on the commercial serological tests reveal that the results are inconsistent and of low quality. Furthermore, none of the international guidelines support the use of serological tests for the diagnosis of active TB. In addition, in one city over reliance on CXR was found which many a time is believed to be the major fuelling factor for irrational therapy and DR-TB. During the seven months period not even a single test of sputum microscopy has been carried out in the same city. Cooperation of private sector for TB care and control in needed in India and is also the vision of National Strategic Plan (NSP) however the same is only possible if the sector stops malpractice and adheres to standard guidelines. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=LM01-LM03&id=11830 https://doi.org/10.7860/JCDR/2018/35553.11830 Ectopic Primary Intrathyroidal Thymoma: A Case Report and Review of Literature Jiby Soosen Ninan, Sandhya Ilanthodi, Muktha R Pai Thymomas are rare neoplasms comprising less than 1% of adult cancers. Ectopic thymomas are thought to arise from aberrant thymic tissue displaced during embryologic development and are extremely rare accounting for only upto 4% of all thymomas. Ectopic intrathyroidal thymoma is a rare entity with only eight previous cases reported to the best of our knowledge. Here we present a rare case of ectopic primary intra thyroidal thymoma with the clinical, morphological and immunohistochemical features. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=ED04-ED05&id=11814 https://doi.org/10.7860/JCDR/2018/36489.11814 Mixed Mucinous Male Breast Carcinoma: A Rare Histological Variant of a Rare Disease Badareesh Lakshminarayana, Ankita Harijee, Prashanth Shetty, Rama Rani Krishna Bhat Male breast carcinoma is rare neoplasm, accounting for <1% of all diagnosed breast malignancy. Histologically, most often it is infiltrating ductal carcinoma and rarely mucinous carcinoma. A 73-year-old male presented with lump in right breast since six months. On examination a 5x5 cm hard, non tender lump fixed to overlying skin, with no right axillary lymphadenopathy. Incisional biopsy showed mixed mucinous carcinoma of breast. After investigations he underwent right modified radical mastectomy. Histopathology confirmed mixed mucinous carcinoma and infiltrating ductal carcinoma. Patient received adjuvant radiotherapy, chemotherapy and hormonal therapy. Mixed mucinous and infiltrating ductal carcinoma is extremely rare. Clinical stage and axillary lymph node status are of prognostic value. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=PD06-PD07&id=11737 https://doi.org/10.7860/JCDR/2018/25045.11737 Patients with Autism Spectrum Disorders: Strategy for Orthodontic Care Swati Saraswata Acharya, Satyabrata Patnaik, Smruti Bhusan Nanda Autism Spectrum Disorders (ASD) are developmental behavioural defined neuropsychiatric disorders that start in early childhood involving social abnormalities, language-communication deficit play, and restricted behaviour. There has been an increasing appreciation that other fields or domains of neurologic and cognitive functioning beyond this diagnostic triad are associated in this syndrome. With the increased prevalence of children having these disorders, orthodontists have one or two autistic patients in their practice. Orthodontic requirements constitute only a small fraction of the overall need of these patients. This review focuses about ASD as an amnestic abnormality of memory, unique features of memory dysfunction with neurobiologic context, mechanisms and comprehensive knowledge pertaining to orthodontic treatment considerations in these patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=July&volume=12&issue=7&page=ZE04-ZE07&id=11761 https://doi.org/10.7860/JCDR/2018/32845.11761