Journal of clinical and diagnostic research https://www.jcdr.net/back_issues.asp JCDR Tracheal Schwannoma: An Uncommon Entity Zeeshanuddin Ahmad, Sanjay M Desai, Amar Jain, Deepak Agrawal Primary tracheal tumours are extremely rare with most of them being malignant. Histologically, both primary tracheal tumours and main stem tumours are similar but the former is about 100 times less common than the latter. Primary neurogenic tumours of trachea account for only about 9% of all neoplasms of trachea. Tracheal schwannoma is the rarest of all neurogenic tumours and there is no unanimous opinion regarding line of treatment. They are usually seen in females and their clinical features are not specific. Chronic cough, progressive respiratory distress and sometimes asthma-like symptoms prevail as the presenting complaints. The reported patient had completely obstructing right endobronchial tumour extending in lower third of trachea. Pneumonectomy along with sleeve excision of trachea with hilar dissection was done. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=XD01-XD03&id=11588 https://doi.org/10.7860/JCDR/2018/35518.11588 Sciatic Nerve Schwannoma at Sciatic Foramen: Importance of Transvaginal Sonography Guided Biopsy and Magnetic Resonance Imaging in its Diagnosis Puneet Garg, Anirudh Chawla, Rajeev Malhotra, Bhawna S Narula, Anuj Thakral Schwannomas are truly encapsulated benign tumours associated with the nerves arising from the schwann cells. Schwannomas arising from the sciatic nerve is of rare occurrence and is estimated to be less than one in hundred cases of schwannomas detected. Generally sciatic nerve schwannomas symptomatically mimic sciatica due to herniated disc or sometimes it may be asymptomatic and incidentally detected. In this case report, we are describing a case of asymptomatic middle aged female patient, who is a follow up case of hysterectomy and bilateral salpingo-oophorectomy for a gyanecological malignancy around 5 years back. During routine follow up sonography (TVS), a mass was detected deep within the pelvis, which was further investigated with MRI and found to be a possible nerve sheath tumour of sciatic nerve at the left sciatic foramen. Further TVS guided biopsy and histopathological correlation, confirmed it to be an ancient schwannoma (neurilemmoma). https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=TD01-TD03&id=11589 https://doi.org/10.7860/JCDR/2018/36133.11589 Peripheral Ameloblastoma in an Adolescent Girl: Differential Diagnosis with Other Gingival Lesions Saede Atarbashi-Moghadam, Ali Lotfi, Fazele Atarbashi-Moghadam, Yasamin Ghaedsharafi Differential diagnosis of intra-oral lesions is challenging and rare lesions are usually neglected. Peripheral (extra-osseous) ameloblastoma is the rarest form of ameloblastoma with high predominance in male. It occurs most commonly in the gingiva. The peak of incidence is above 50 years. The purpose of this report is to describe a case of peripheral ameloblastoma in an 18-year-old female, for more acquaintance with this rare lesion. Differential diagnosis of this lesion is also discussed in detail. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=ZD01-ZD03&id=11582 https://doi.org/10.7860/JCDR/2018/35005.11582 Minor Salivary Gland Sialolithiasis: A Clinical Diagnostic Challenge Roberto Pippi, Marcello Santoro, Angelina Pernazza, Daniela Bosco Sialolithiasis is a non-neoplastic salivary gland disease that rarely affects the minor salivary glands. There are no guidelines in the literature which can suggest which is the best surgical approach to treat Minor Salivary Glands Sialolithiasis (MSGL). The present case was of a 48-year-old male patient complaining of painful swelling localized in the left back-commissural zone which was 0.5 mm in diameter, for which surgical enucleation approach was done and in that some small calcific masses ranging from 0.2 to 4 mm in diameter were found. They were surrounded by granulation tissue and associated with small pus oozing. Histopathological examination was carried out leading to a final diagnosis of MSGL. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=ZD04-ZD06&id=11583 https://doi.org/10.7860/JCDR/2018/35213.11583 Treatment of Tongue Thrusting Habit Using Modified Blue Grass Appliance: A Case Report K Mithun, Mala Ram Manohar, Naveen Shamnur, G Shivaprakash, Poorya Naik Tongue thrusting habit is a major aetiological factor in the development of anterior open bite. Persistence of an infantile swallow during childhood and adolescence leads to a tongue thrusting habit with clinical features of open bite and protrusion of anterior tooth segment. Sequelae of treatment for the habit are removal of the aetiology, retraining exercises and use of mechanical restraining appliances. Palatal crib or palatal spurs are commonly used as habit-breaking appliances. These appliances cause problems like difficulty in speech, mastication, and iatrogenically or self-inflicted injuries. This case report discusses a case with anterior open bite, dental proclination and spacing which was treated by a fixed tongue trainer in the form of modified blue grass appliance and extraction of the first premolar followed by fixed orthodontic therapy for treatment of dentoalveolar protrusion. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=ZD07-ZD09&id=11585 https://doi.org/10.7860/JCDR/2018/31723.11585 Synchronous Odontogenic Cysts in Mandible Neha Agrawal, Sunitha Carnelio, Raghu Radhakrishnan, Adarsh Kudva, Gabriel Rodrigues Odontogenic cysts are derived from odontogenic apparatus which may develop before or after the formation of tooth. Most of these are developmental in origin. However, non-odontogenic cysts also exist in the jaw. Among the odontogenic cysts the most prevalent are periapical cyst followed by dentigerous and Odontogenic Keratocyst (OKC). OKC was also termed as Keratocystic Odontogenic Tumour (KCOT), well-known for its aggressive behaviour, varied origin, debated development and tendency to recur has been the focus of much research and discussion since four decades. It arises either from epithelial rests of the dental lamina or the tooth primordium and is generally aggressive and invasive, while dentigerous cysts are common odontogenic cysts that are related to the crown of the impacted tooth and known to arise from reduced enamel epithelium. It is rare to find both these entities occurring simultaneously in the same patient. Multiple OKC are generally associated with nevoid basal cell carcinoma syndrome, and accounts to the mutation in the PTCH, a tumour suppressor gene. However, this case reports a non-syndromic variant. A 13-year-old female patient with multiple cysts in the jaw that were evaluated, diagnosed and treated adequately based on clinical, radiographic and histopathological examination has been discussed. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=ZD10-ZD12&id=11586 https://doi.org/10.7860/JCDR/2018/32148.11586 Serous Papillary Endometrial Carcinoma, Lower Uterine Segment: An Unusual Occurence Garima M Anandani, Shanmuga Samy Kathirvelu, Anandraj Vaithy, Sowmya Srinivasan, R Narsimhan The majority of Endometrial Carcinomas (EC) is type 1 endometrioid type followed by rare type 2 serous papillary type. Serous papillary EC is a rare but highly aggressive form of uterine endometrial cancer. This is a case of a postmenopausal 57-year-old patient who presented with abnormal uterine bleeding without a specific medical history. Endometrial curettings were taken followed by total abdominal hysterectomy. Histopathology showed serous papillary EC associated with rare features such as unusual site and not invading endocervical mucosa, with accompanying myometritis and senile cystic atrophy of endometrium. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=ED01-ED03&id=11598 https://doi.org/10.7860/JCDR/2018/35660.11598 Idiopathic Abdominal Cocoon and Ileal Fecaloma: A Rare Combination Causing Acute Intestinal Obstruction in an Elderly Male Narendra Pandit, Laligen Awale, Sridhar Keerthi, Lokesh Shekher Jaiswal, Shailesh Adhikary Abdominal cocoon is a rare cause of intestinal obstruction commonly seen in adolescent girl or adults of young age group in tropics; however its occurrence in elderly male is rare. Moreover, fecaloma although described in setting of megacolon, it has not been reported for small bowel in presence of cocoon abdomen. Here, we report a rare combination of fecaloma and cocoon abdomen causing intestinal obstruction in an elderly male diagnosed preoperatively by Contrast Enhanced CT (CECT) abdomen and operated successfully by surgery. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=PD01-PD02&id=11602 https://doi.org/10.7860/JCDR/2018/35724.11602 Cerebral Venous Sinus Thrombosis Complicating Adult Onset Nephrotic Syndrome Arun Karat Anandan, Pradeep Balachandran, Arpitha Chowksey, Gomathy Sankaranarayanan, Usha Samuel Nephrotic syndrome is well known for its hypercoagulable state and thrombotic complications. This warrants cautious management of the disease with meticulous monitoring for thrombotic complications as it carries high morbidity and mortality than the original disease itself most often. Here, we present a case of adult onset nephrotic syndrome referred to our centre for further evaluation and management. On detailed work up, she turned out to be a case of minimal change disease. During her recovery period in the hospital she developed headache and diplopia. Sudden onset of neurological symptoms in the background of a thrombotic milieu prompted us to do further neurological evaluation which revealed extensive cerebral venous sinus thrombosis. She received anticoagulation without delay. Although the condition is associated with high mortality our patient showed very good response to anticoagulation and she was discharged in a stable condition. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=OD01-OD03&id=11603 https://doi.org/10.7860/JCDR/2018/35771.11603 <i>Mycobacterium fortuitum</i> Bacteraemia in a Immunocompromised Patient of Invasive Ductal Carcinoma of Breast and Long Term Venous Access Device Swati Kumari, Kopula Sathyamurthy Sridharan, R Packia Nancy, Gifty Sara Mathew Mycobacterium fortuitum is rapidly growing mycobacteria ubiquitous in nature. We report a case of Mycobacterium fortuitum bacteraemia in a immunocompromised 62-year-old female patient of carcinoma breast who underwent mastectomy one year back. Patient was on intensive chemotherapy for past six months and having in situ intra vascular device. Patient was admitted with complaint of fever on and off for which multiple blood samples were collected from patient for three consecutive days from both peripheral and central venous catheter which was subjected to BACTEC® automation system followed by direct microscopic examination and culture. The identification to species level was performed by phenotypic, biochemical and DNA sequencing targeting heat shock protein 65 (hsp 65) gene. Patient improved remarkably on removal of catheter and receiving appropriate antimicrobial therapy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=DD01-DD02&id=11606 https://doi.org/10.7860/JCDR/2018/35402.11606 Atypical Intra-Bronchial Carcinoid -A Rare Case Report Malgere R Ramitha, Gajanan S Gaude Bronchial carcinoids are uncommon, slow growing; low-grade malignant neoplasms of the lungs, which rarely metastasize outside the thoracic cavity. We hereby report a case of atypical intra-bronchial carcinoid tumour of the lung in a young female which was treated successfully with surgery and chemotherapy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=OD04-OD05&id=11610 https://doi.org/10.7860/JCDR/2018/34484.11610 Acute Hypersensitivity Reaction Related to use of Pantoprazole Lacking Cross-Reactivity with Omeprazole Hemangini Rajanikant Acharya, Manish Jasmatbhai Barvaliya, Tejas Kamleshbhai Patel, CB Tripathi Proton Pump Inhibitors (PPIs) are widely used drugs for peptic ulcer and other acid related disorders those are rarely causing allergic reactions. Cross-reactivity between the various PPIs has been documented. In present case, a 57-year-old male patient developed urticaria and itching all over the body after 30 minutes of taking second dose of pantoprazole. He also had eye congestion, oedema below the eyes and over nose with some skin exfoliation over forehead. Urticaria and itching relieved within one hour with the use of levocetrizine. Other symptoms recovered within 48 hours. Further doses of pantoprazole were avoided and patient took two doses of omeprazole that did not cause any allergic reaction. Even though, patient did not show cross-reactivity between pantoprazole and omeprazole, use of other PPIs should be avoided when patient is hypersensitive to one PPI as it is difficult to judge cross-reactivity clinically. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=FD01-FD02&id=11612 https://doi.org/10.7860/JCDR/2018/35559.11612 Benzodiazepine Induced Acute Pancreatitis Poornima Sangmeshwar Tadkal, Nithin Bhat, Manjunatha Hande Acute pancreatitis is acute inflammation of pancreas, caused mainly due to alcohol and gall stones. Drug induced pancreatitis is rare and benzodiazepine induced pancreatitis is still rare. Drug induced pancreatitis is a diagnosis of exclusion. We present a case of 64-year-old female, taking benzodiazepines for her disturbed sleep, admitted to the hospital with pain abdomen. Evaluation showed that she was suffering from acute pancreatitis, which was most likely secondary to her benzodiazepine intake. A high index of clinical suspicion and good drug history helped in diagnosing the cause of pancreatitis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=OD06-OD07&id=11613 https://doi.org/10.7860/JCDR/2018/35644.11613 Nitisinone-Induced Keratopathy in Alkaptonuria Disease: A Case Report and Literature Review Khalid Mousa Al Zubi, Mohammed Salem Alsbou, Mahmoud Hussein Alkhasawneh, Hani Mosleh Al-Shagahin We report a case of nitisinone-induced keratopathy in a 52-year-old male patient with Alkaptonuria (AKU) disease in Jordan. The patient presented with slight drop of left eye vision for the last four weeks, associated with a foreign body sensation in his left eye. On examination, it was found that his left eye vision was reduced to 6/12 and there were left dendrite-like corneal opacities in the left eye. He was given 10 mg of nitisinone per day, two years before his visual complaint. Three months following discontinuation of nitisinone, his visual acuity and corneal opacities disappeared completely. This is the fifth reported case of nitisinone-induced keratopathy, due to secondary tyrosinaemia in alkaptonuria. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=ND01-ND03&id=11629 https://doi.org/10.7860/JCDR/2018/35741.11629 Hypoplastic and Accessory Radial Arteries: A Case Report Heidar Toolee, Yousef Mohamadi Arterial variations in the upper extremity occur in a high prevalence. The radial artery is a terminal branch of the brachial artery in the cubital fossa. This artery is used in some treatment interventions and it’s variation is important for clinicians. Here, we report a cadaver with a rare pattern of two radial arteries. In this cadaver, a hypoplastic radial artery in the cubital fossa was seen as a terminal branch of the brachial artery and high origin accessory radial artery in the arm separated from the brachial artery was also found. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=AD01-AD02&id=11619 https://doi.org/10.7860/JCDR/2018/29618.11619 “Electrocardiogram Changes with Elevated Troponins Mimicking MI: All that Glitters is not Gold” Monika Bhandari, Pravesh Vishwakarma, Akshyaya Pradhan, Rishi Sethi Temporary transvenous pacing is often required as life saving measure in conditions such as Stokes Adams attack and symptomatic bradyarrhythmias. Bradyarrhythmias are also known complications of acute Myocardial Infarction (MI), which can be transient or persistent and often demand temporary pacing too. It is difficult to diagnose underlying MI in the setting of paced rhythm due to secondary ST-T changes. Elevated cardiac enzymes are essential in the scenario of paced rhythm to diagnose underlying acute MI. Remarkable T wave inversion and ST depression {similar to Left Bundle Branch Block (LBBB)} do occur in right ventricular paced ECG and some changes may persist following withdrawal of pacing (cardiac memory T waves) simulating ischaemia. Very rarely arrhythmias can also lead to troponin rise causing diagnostic dilemma in such a setting. Here, we report a case of an elderly female who presented with symptomatic Complete Heart Block (CHB) and developed T wave inversion with Q wave formation in anterior leads in sinus rhythm following temporary pacing. She also demonstrated a dynamic rise in serial cardiac troponin values mimicking an acute coronary syndrome. Ultimately, an invasive coronary angiogram was performed to rule of significant coronary artery disease. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=OD08-OD09&id=11622 https://doi.org/10.7860/JCDR/2018/33903.11622 Intraoperative Hyperkalemia Leading to Ventricular Tachycardia during Laparoscopic Renal Transplant Prachi Kadam, Unnati Bhatia, Mitali Patel Chronic kidney disease, consequent upon a variety of causes is a leading cause of morbidity and mortality. Renal transplantation is the preferred therapeutic approach for these patients. Hyperkalemia is a common complication observed intraoperatively during transplant surgery. Some of the causes of the same could be administration of succinylcholine, blood transfusion, metabolic acidosis and reperfusion injury. We wish to highlight a case where during laparoscopic kidney transplant we encountered respiratory acidosis as one of the causes of hyperkalemia leading to ventricular tachycardia. In future, laparoscopic kidney transplant will become the standard of care similar to how laparoscopic donor nephrectomy is. It is thus, imperative for anaesthetists’ to be well aware of challenges faced during this surgery, in order to ensure effective perioperative management. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=UD01-UD02&id=11627 https://doi.org/10.7860/JCDR/2018/35527.11627 Eslicarbazepine Induced Stevens-Johnson Syndrome: A Rare Case Report Kamal Nath, Robin Victor, Shruti Sharma Stevens-Johnson Syndrome (SJS) is a rare severe cutaneous disease which may be fatal at times. One of the important aetiology of SJS is drug induced commonly due to drugs like carbamazepine, allopurinol, penicillin, sulfa drugs, ibuprofen, sodium valproate, phenytoin and lamotrigine etc. The objective of this article was to report a rare case of SJS/Toxic Epidermal Necrolysis (TEN) secondary to Eslicarbazepine administration in 28-year-old male who presented with chief complaints of fever, macular rashes over various body parts, difficulty in speaking and swallowing and painful ulceration of lips and tongue. The peculiarity about this case is that although cutaneous reactions have been reported in the past with carbamazepine group of drugs, the eruptions always occur within 4-5 days of drug administration when the drug has reached its steady state plasma concentration. Here the rashes started after two and a half weeks of starting the drug. Moreover, even on stopping Eslicarbazepine after admission to the hospital and initiation of treatment, new rashes continued to occur. Patient was managed with a combination of antihistamines, antibiotics, steroid and antipsychotics drugs to which he responded and was discharged after three weeks of admission and asked for regular follow-up. Hence healthcare professionals should be vigilant regarding the prescription of various drugs and prompt recognition and diagnosis of SJS for early initiation of treatment leading to a favourable outcome. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=VD01-VD03&id=11656 https://doi.org/10.7860/JCDR/2018/34051.11656 Comparative Study of Robinson’s and Mouriquand’s Cytological Grading Systems and Correlation with Histological Grading in Breast Carcinoma Imran A Khan, Supriya Basu, Dawood Khan, Arpan Choudhary, Shaheen Khan Wilms’ tumour, also known as nephroblastoma, is the most common malignant renal tumour in children but rare in adults with significant difference in symptomatology. Here, we report a case of 23-year-old second-gravida female with 22 weeks of gestation with Wilms’ tumour. Gadolinium-based contrast enhanced magnetic resonance imaging was used, which revealed a heterogeneous space-occupying lesion involving right kidney. The patient was planned for nephron sparing surgery, however after open retroperitoneal exploration, partial nephrectomy was performed. We concluded that Wilms’ tumour in pregnancy can be dealt safely with partial nephrectomy with a retroperitoneal approach. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=PD05-PD06&id=11658 https://doi.org/10.7860/JCDR/2018/32860.11658 Point Matching Technique for Root Coverage Exposed by Visible Gingival Recession Awadhesh Kumar Singh, Anurag Saxena A new point matching technique as a viable and effective treatment option for coverage of root surface exposed by visible gingival recession was designed while avoiding the complications and complaints often associated with traditional grafting procedures. A patient with 3.5 mm of visible gingival recession of Miller class I, 4.0 mm of gingival height and 2.0 mm of probing depth was treated by the point matching technique. At the end of one year, 100% root coverage, 5.0 mm of gingival height and 1.0 mm of probing depth were obtained. Thus, point matching technique is a viable and effective treatment option for root coverage exposed by visible gingival recession. The long term and more close follow-up appointments with clinical and histological studies will be required to obtained more information about point matching technique for root coverage exposed by visible gingival recession. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=ZD13-ZD15&id=11667 https://doi.org/10.7860/JCDR/2018/32372.11667 Successful Orthodontic and Periodontic Management of Impacted Central Incisor with Compromised Labial Bone Mohammed Abdullah AlSarhan, Naif Abdullah Bindayel Normal eruption of teeth is considered a critical phase for the development of hard and soft tissue apparatus of the craniofacial system. Disturbance in tooth eruption, in general, may lead to delay of eruption time or abnormal eruption position or both. Early orthodontic assessment and intervention can have a decisive role in the future of ectopically erupting or impacted teeth. While, the objective of orthodontics in these cases is to return teeth to their normal position within the alveolar housing, it may be complicated by deficiencies in hard and soft tissue surrounding these teeth. This paper presents a successful management of ectopically impacted maxillary central incisor by a combined periodontal surgery and orthodontic treatment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=ZD18-ZD21&id=11692 https://doi.org/10.7860/JCDR/2018/35987.11692 A Giant Hepatic Cyst Mimicking Echinococcosis Leszek Sulkowski, Maciej Matyja, Artur Pasternak Echinococcosis is a life-threatening disease for humans. It occurs all over the world. We report a case of large and complicated hepatic cyst mimicking the Echinococcosis. A 68-year-old female was referred with epigastric pain. Physical examination did not reveal any abnormality. A giant hepatic cyst with a non-homogeneous content was revealed in ultrasound and Computed Tomography (CT). Due to suspicion of Echinococcosis, she underwent surgery with cystectomy. A non-parasitic cyst localised in the liver may mimic the parasitic ones, especially when they are complicated with septa and non-homogenous content. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=PD07-PD08&id=11675 https://doi.org/10.7860/JCDR/2018/36194.11675 Nasolabial Extraosseous Benign CD68+ Giant Cell Neoplasm with Low Malignant Potential Ashok Kumar Kapoor, Surbhi Rajauria, Akanksha Singh, Anil Kumar Verma The present case report highlights the histopathological features of a small nasolabial tumour in a 22-year-old female. The tumour was adequately excised. It consisted of proliferated Mononuclear Spindle (MNS) cells admixed with numerous giant cells. Tumour was located in superficial subcutaneous tissue. Immunohistochemical (IHC) examination showed strong positivity of giant cells for anti-CD68+ antibody, suggesting their origin from Monocyte-macrophage (MØ) cells. Both MNS cells and giant cells showed strong positive staining with anti-vimentin antibody. In addition, MNS cells did not show nuclear atypia and mitoses. It was finally diagnosed as a Giant Cell Tumour of Soft Tissue (GCT-ST). It is a highly cellular neoplasm. Receptor Activator of Nuclear Factor Kappa-B Ligand (RANKL) expression by MNS cells stimulates osteoclast formation, resorption and osteolysis associated with this tumour. A benign course is expected after complete excision of this tumour. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=ED04-ED05&id=11678 https://doi.org/10.7860/JCDR/2018/35022.11678 Conus Medullaris Dermoid Rupture into Central Canal: A Case Report Kanumukul Lakshminarayana Surendra, Sriram Patwari, Harsha Chadaga, Anita Nagadi, Rekha Priya Intramedullary spinal dermoids are benign, uncommon, mostly congenital and slow growing tumours. Here, we present a rare case of ruptured intramedullary dermoid in a 45-year-old male who presented with lower back ache and both lower limb weakness. Magnetic Resonance Imaging (MRI) demonstrated an elongated mass expanding the conus medullaris and displacing the cauda equina with extension into lower thoracic spinal cord and ruptured fat droplets within the central canal of lower thoracic spinal cord. Correlative CT imaging confirmed the presence of fat within the lesion. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=TD04-TD06&id=11679 https://doi.org/10.7860/JCDR/2018/35361.11679 Kienböck’s Disease Hidden behind the Ganglion Cyst: A Clinical Clue Deniz Aydin, Baris Polat Ganglion cyst is the most common soft tissue mass of the wrist. Diagnosis is made by physical examination. Ultrasonography is used for diagnosis of occult ganglions. Cosmetic appearence and annoying pain are the most common complains of the patient with a wrist ganglion. It is a benign lesion and most of the time it regresses spontaneously or is treated with simple strategies. On the other hand, dorsal wrist ganglions could be misleading in diagnosis of underlying more serious pathologies. Traumatic bone or ligament injuries, benign bone tumours, inflammatory arthropathies, ulnar impaction syndrome, Kienböck’s disease and many other pathologies may have the similar symptoms with the wrist ganglion. Physicians should be suspicious in case of debilitating progressive symptoms. Ultrasonography is not diagnostic for most of the possible underlying diseases so further evaluation should be done with radiography and Magnetic Resonance Imaging (MRI). We report a case of 21-year-old man with severe right wrist pain and dorsal wrist ganglion, diagnosed with Kienböck’s disease seven months after the beginning of symptoms. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=RD01-RD02&id=11682 https://doi.org/10.7860/JCDR/2018/35937.11682 Adenocarcinoma of the Sigmoid Colon Following Ureterosigmoidostomy: A Rare Long Term Sequela Manjunatha Sathyanarayanaprasad, Suresh Bhat, Fredrick Paul Carcinoma developing at the Ureterosigmoidostomy (US) anastomosis is a complication known to us. Patients generally present late because of non specific symptoms like loin pain, loss of appetite and weight loss. Colonoscopy and abdominal imaging studies are recommended for early detection and prompt management of these malignancies. We report a case of mucin secreting adenocarcinoma of the colon, 26 years after US. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=PD09-PD10&id=11683 https://doi.org/10.7860/JCDR/2018/30123.11683 Esthetic Simultaneous Intrusion and Retention (E-SIR) Appliance Ram Gopal, Tulika Tripathi, Priyank Rai, Prateek Gupta Esthetics is the chief concern with which the patient approaches to an orthodontist. Orthodontists are gearing up to make the treatment esthetic in both the active and the retentive phase. Here, we present a relapsed case of 15-year-old female patient who got her fixed treatment done and was wearing Hawley’s appliance with anterior bite plane as retainer irregularly. Getting an orthodontic treatment again with fixed braces or clear aligners would be both exhausting and expensive for the patient. Clear appliances can be made with a pressure molding machine for minor tooth corrections in clinical set-up. Thus, this article is intended to introduce a novel esthetic retainer which provides both retention following orthodontic treatment and correction of extruded upper left lateral incisor as intrusion cannot be performed with conventional retainers. Compared with conventional removable orthodontic retainers, present appliance is more esthetic, comfortable and inexpensive. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=ZD16-ZD17&id=11685 https://doi.org/10.7860/JCDR/2018/32382.11685 Camel Bite Injuries in North-Western Nigeria Joseph Olorunsogo Mejabi, Oni Nasiru Salawu, Taofeek Adeyemi, Chikwendu Nwosu, Elkanah Ayodele Orimolade Camel bites are unusual type of injuries that are scarcely reported in the literature. It results in injuries that can be life threatening or limb threatening. Male camels are commonly implicated, during the rutting season. This article is a case series of six cases: all were males and camel rearers. Their injuries included open fractures of the upper limbs (Gustillo and Anderson IIIB and IIIC). Three patients underwent debridement with external fixation; one required amputation and the remaining two signed against medical advice. Out of the three that had external fixation, one died from generalised tetanus that had developed before presentation, the remaining two had non-union, requiring second procedure. Camel bite injuries are severe injuries and late presentation worsens the outcome of treatment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=RR01-RR02&id=11574 https://doi.org/10.7860/JCDR/2018/31480.11574 Management of Flabby Tissue with Reinforcement of Metal Mesh in Custom Tray Veena Raghottam Saraf, Sayali Sunil Kalantri, Divya Govindprasad Toshniwal, Deepak Macchindra Vikhe Patients with flabby tissue require impression procedures which will record the entire denture bearing area in a functional form and the flabby tissue in undisplaced form. This article presents simple and practical approach, to incorporate reinforcing metal mesh in to the custom tray to minimize the displacement of flabby tissue while making the impression with predictable outcome. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=ZH01-ZH02&id=11623 https://doi.org/10.7860/JCDR/2018/34169.11623 Prevalence of Potential Pathogenic <i>Candida</i> Species in Hospital and Municipal Sewages in Southwestern Province of Saudi Arabia: A Microarray Analysis of Sewage Samples Vinod Kumar Basode, Ahmed Abdulhaq, Mohammed Uthman A Alamoudi, Hassan Mohammad Tohari, Waleed Ali Quhal https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=DL01-DL02&id=11601 https://doi.org/10.7860/JCDR/2018/33973.11601 Orthosis-A “Necessity or Choice” for Gait Training in Children with Spastic Paraplegic Cerebral Palsy Rakesh Krishna Kovela, Mukesh Kumar Sinha https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=YL01-&id=11684 https://doi.org/10.7860/JCDR/2018/35998.11684 Effect of Life Skills Counseling on Marital Satisfaction of Pregnant Women Referring to Health Clinics in Asadabad, Hamadan, Iran Batoul Khodakarami, Roya Asadi, Seyedeh Zahra Masoumi, Alireza Soltanian <b>Introduction:</b> Marital satisfaction is one of the factors related to the health of pregnant women and their fetuses. Life skills counseling is a consultation on abilities for adaptive and positive behavior enabling humans to effectively deal with the demands and challenges of life. <b>Aim:</b> To examine the effects of life skills counseling on marital satisfaction of pregnant women in Asadabad town, Iran. <b>Materials and Methods:</b> The present study was conducted with a pre-test and post-test design. The participants included 64 pregnant women selected via simple random sampling method. The participants were randomly assigned to two group, experimental and control groups (each with 32 members). The required data were collected through a questionnaire covering demographic characteristics of the participants and the ENRICH Inventory. The pregnant women completed both questionnaires at the pre-test stage. Then, members of the experimental group received eight sessions of life skills training, while members of the control group received no intervention. Members of both groups completed the ENRICH Inventory again immediately after the intervention and again four weeks later. Using the SPSS-16 software, the collected data were analysed through independent t-test and least significant difference test. <b>Results:</b> Comparison of pre-test scores to post-test scores indicated that life skills training could positively affect marital satisfaction. Results showed that pregnant women in the experimental group obtained higher scores as a result of the intervention, and the difference between their pre-test scores and their post-test scores was statistically significant. Moreover, the difference between the pre and post-test scores for both experimental and control groups was statistically significant (p<0.001). <b>Conclusion:</b> Life skills counseling positively affects marital satisfaction of people, especially pregnant women. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=VC06-VC10&id=11676 https://doi.org/10.7860/JCDR/2018/31699.11676 Influence of Tobacco Chewing and Smoking on the Salivary Total Antioxidant Power-A Clinical Comparative Study Sankepalli Shwetha , V Chandra Sekhara Reddy , KM Sudhir , RVS Krishna Kumar , G Srinivasulu <b>Introduction:</b> Both smoking and tobacco chewing are associated with increased risk of oral cancer due to the imbalance in the free radicals and antioxidants. Saliva is the first biological medium encountered during tobacco chewing and smoking. Evaluation of total antioxidant power in saliva helps in understanding the risk of oral cancer. <b>Aim:</b> To assess the effect of tobacco chewing and smoking on salivary flow rate, pH and salivary total antioxidant power. <b>Materials and Methods:</b> A comparative study was done on male subjects (35-50 years old) accompanying the patients attending Narayana Medical and Dental Hospitals, Andhra Pradesh, India. Unstimulated saliva samples were collected from 45 subjects, categorised as chewers (15), smokers (15), and healthy controls (15) using spitting method. Salivary flow rate, pH and total antioxidant power were determined. The salivary total antioxidant power was measured by using Ferric Reducing Antioxidant Power (FRAP) assay. Analysis of Variance (ANOVA) was used for comparison of three groups with respect to salivary total antioxidant power, flow rate, pH. Tukeys post-hoc analysis was used for pairwise comparison of study groups with respect to salivary total antioxidant power, flow rate and pH. <b>Results:</b> Salivary total antioxidant power was lowest in tobacco chewers (407±48), compared to smokers (573±60) and controls (800±67). Salivary flow rate was lowest in tobacco chewers (1.43±0.70), compared to smokers (2.31±0.65) and controls (3.09±0.48). Salivary pH was lowest in tobacco chewers (6.34±0.25), compared to smokers (6.73±0.17) and controls (7.05±0.20). The mean difference between the three groups was statistically significant (<0.001). <b>Conclusion:</b> The evidence of the decreased salivary antioxidants in the tobacco chewers and smokers emphasises the role of smoking and tobacco chewing in the pathogenesis of oral cancers. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=ZC09-ZC12&id=11677 https://doi.org/10.7860/JCDR/2018/30278.11677 Observational Study Comparing the Measurement of Abdominal Aortic Aneurysm (AAA) Diameter in Different Morphology with Ultrasound and CT Scan Ahmed Shalan, James Forsyth, Andrew Thompson <b>Introduction:</b> Ultrasound (US) is the gold standard imaging modality used to measure the diameter of Abdominal Aortic Aneurysms (AAA), and it is used in the surveillance of AAAs. The use of Computed Tomography (CT) has now become widespread. There has always been disagreement between CT and US, which significantly affects management decisions. <b>Aim:</b> To examine the agreement between US and CT in measuring aortic diameter. Furthermore, it was used to investigate if size discrepancy between US and CT increases as the AAA size increases. <b>Materials and Methods: </b>This was a single centre retrospective observational study. It included 212 patients, with infra-renal aorta of diameters =3 cm, who had undergone an US of the aorta and a CT aortogram within 90 days of each other. US-measured maximum Antero-Posterior (AP) aortic diameter and CT-measured maximum aortic diameter were considered. Statistical analysis was performed using Bland-Altman plot, paired t-test and Pearson’s correlation. <b>Results:</b> There was a significant disagreement between measurements on CT and US. The mean US measured AP diameter was 5.4 cm (SD1.05), whereas the mean maximum measured aortic diameter on CT was 5.7 cm (SD1.13) (p<0.001). We did not find any disagreement between US and CT as the size of the AAA increased, with significant but weak correlation (cc 0.27) (p<0.001). <b>Conclusion:</b> Our results demonstrate that US, on average, underestimates the size of AAAs by 0.3 cm when compared to CT. We failed to demonstrate correlation between increasing aneurysm size and increasing disagreement between CT and US. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=PC05-PC07&id=11665 https://doi.org/10.7860/JCDR/2018/35413.11665 CBNAAT Co-Testing of Sputum and BAL Fluid with Sputum Microscopy: May it Halt the March of Tuberculosis ! Amiya Kumar Dwari, Sumanta Jha, Dibakar Haldar, Bisanka Biswas, Sanjay Kumar Saha, Partha Pratim Roy, Abhijit Mandal, Baisakhi Maji <b>Introduction:</b> Growing concern for Tuberculosis (TB) epidemic forces World Health Organization (WHO) and government of India (GOI) to incorporate newer rapid and highly specific diagnostic test like Cartridge Based Nucleic Acid Amplification Test (CBNAAT). <b>Aim:</b> To find the usefulness of CBNAAT in increasing Acid Fast Bacilli (AFB) positive patient pool over and above the yield of traditional sputum microscopy. <b>Materials and Methods:</b> The cross-sectional survey was conducted in the Department of Respiratory Medicine, Nilratan Sircar Medical College and Hospital (NRSMCH), Kolkata, India. The study involved 94 smear negative TB suspects referred from other health facilities as well as diagnosed by the department itself. After collecting baseline information like age, sex, previous history of TB and its treatment by interview and scrutinizing records using predesigned questionnaire, the patients were put on sputum CBNAAT and Broncho-Alveolar Lavage (BAL)-CBNAAT testing. Data were analysed by estimating mean, Standard Deviation (SD), proportion and using independent t-test, chi-square test. <b>Results: </b>Overall, average age of participants was 44.7±15.3 (mean±SD) years. Male-female ratio was 1:2.8. Altogether 44.7% patients were detected sputum positive out of which 34.0% were detected only by sputum CBNAAT and another 10.7% detected when BAL-CBNAAT testing was used among the negatives yielded from sputum CBNAAT only. These differences were statistically significant. <b>Conclusion:</b> Utility of CBNAAT over and above traditional diagnostic methods was reaffirmed. With added advantage of detecting MDR cases simple, sensitive, speedy and automated CBNAAT seems new mile stone in ‘Stop TB’ strategy and needs utilised to its highest potentiality through monitoring and supervision. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=LC22-LC24&id=11666 https://doi.org/10.7860/JCDR/2018/35651.11666 Effect of High Fibre, Low Calorie Balanced Diet in Obese Women with Hirsutism: A Randomised Clinical Trail Atefeh Krouni, Sedighe Forouhari, Marzieh Akbarzadeh, Mohammad Hossein Dabbaghmanesh, Farideh Jowkar, Mousa Salehi, Elnazkhayer, Ferdows Mohammad Alian <b>Introduction:</b> Hirsutism is both an endocrine and cosmetic problem therefore, it becomes necessary for investigations to be carried out to determine the probability of an underlying disease, its effect on sexual performance and reproduction. The appropriate diet composition for individuals with hirsutism has not been specified yet. <b>Aim: </b>To investigate the effect of high fibre, low caloric balanced diet on some related hormone levels in obese or overweight women with hirsutism in Iran. <b>Materials and Methods:</b> In the present randomised clinical trial, 50 obese or overweight women suffering from hirsutism were randomly assigned into two groups. The intervention group received a high fibre, low caloric balanced diet while the control group followed a normal diet for three months. The level of Body Mass Index (BMI) was measured and blood sampling (on the 3rd-5th day of menstruation) was carried out before and 12 weeks after the intervention, and the collected data were analysed using SPSS software version 22.0. <b>Results:</b> Variations in BMI in intervention group was seen. There was an average reduction of 1.89 units in intervention group while it was increased by 0.3 units in the control group. This observed difference was statistically significant (p<0.001). The observed variation in the level of free testosterone hormone in the two groups was significant (p=0.034) i.e., mean±SD free testosterone in intervention group (before intervention was 0.49±0.49 and after intervention was 0.43± 0.57) and in control group (before 0.38±0.30 and after it was 0.49±0.57). Moreover, there was a remarkable decrease in LH hormone and increase in Sex Hormone Binding Globulin (SHBG) was also observed. <b>Conclusion:</b> A high fibre diet led to a decrease in BMI in the intervention group, and this decrease had a remarkable effect on improvement of androgenic parameters; as a result, it is recommended that the diet of individuals with hirsutism should be considered and attended. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=IC06-IC09&id=11686 https://doi.org/10.7860/JCDR/2018/30133.11686 Cytokines TNF-Alpha and IL-8 Gene Polymorphisms in Sickle Cell Anaemia Patients under Hydroxyurea Treatment Fathelrahman M Hassan, Faisal M Alzahrani <b>Introduction:</b> Sickle Cell Anaemia (SCA) is an inherited disorder characterised by homozygosis for the mutation that causes Haemoglobin S (Hb S) production. SCA patients have increased serum levels of circulating Tumour Necrosis Factor Alpha (TNF-a) and Interleukin 8 (IL-8) during crisis events occasions because of increased production from inflammatory cells, glia and neurons, these inflammatory molecules additionally presumably contribute to the advanced mechanisms concerned in vascular occlusion events. <b>Aim:</b> This study aimed to investigate polymorphisms in the TNF-alpha and IL-8 genes, their association with the haematological changes, to investigate the association between the TNF-alpha and IL-8 gene polymorphisms and the TNF-alpha and IL-8 serum levels in Saudi SCA patients presented with or without treatment in comparison to healthy individuals. <b>Materials and Methods:</b> The study included 87 SCA patients diagnosed as homozygous for Haemoglobin S (Hb S; using haemoglobin electrophoresis methods and High-Performance Liquid Chromatography (HPLC) and attended at hereditary blood disease centre (Al-Ahsa; Saudi Arabia) for follow-up. The patients of both genders in all age groups were subdivided into two groups; 27 of the patients were undergoing hydroxyurea treatment (AHU) and 60 patients without hydroxyurea treatment against 30 healthy individual setting as control group. The collected data were analysed using the STATA SE 10 and GraphPad Prism 5.0. <b>Results:</b> TNF-a and IL-8 levels were significantly higher within the plasma of SCA individuals compared to control individuals. The GG and AA genotypes of TNF-alpha-308G>A were associated with the increase in the serum levels of TNF-alpha in SCA patients. While, AA and TT genotypes -251A>T IL-8 gene polymorphism was associated with increase in the serum levels of IL-8 in SCA patients. <b>Conclusion:</b> The haematological investigations of SCA further highlight the contribution of genetic modifications to the risk of clinical genotypes to understand the association of serum levels of TNF-a and IL-8 in patients under HU compared to their gene polymorphism. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=EC14-EC17&id=11681 https://doi.org/10.7860/JCDR/2018/35740.11681 Prevalence, Characterisation and Diagnosis of Common Connective Tissue Diseases from Coimbatore Region in Tamil Nadu Jacinth Angel, Marina Thomas, Jayalakshmi Jayarajan <b>Introduction:</b> Systemic autoimmune diseases include condi­ tions where the immune system fails to recognise self antigens leading to production of “auto antibodies” and subsequent damage to several organs and tissue systems. It is commonly observed worldwide, that Connective Tissue Diseases (CTDs) occur predominantly among women in childbearing age groups. The most common laboratory diagnosis done is to detect Antinuclear Antibodies (ANAs) by ELISA. Indirect Fluorescence Antibody (IFA) and ANA profile analysis are newer and slowly progressing concepts. The fewer existing studies available show that, IFA test in conjunction with ANA ELISA can provide more conclusive diagnosis. Not much data is available on the detailed diagnostic aspects of CTDs involving ELISA, IFA and ANA profile together as diagnostic tools. <b>Aim:</b> To analyse the common CTDs in Coimbatore region in Tamil Nadu and to determine the classical clinical and diagnostic features of the common CTDs. <b>Materials and Methods:</b> The study was conducted among 442 patients who attended PSG Hospitals, Coimbatore. ANAs were tested in patients clinically suspected to have connective tissue disease using ANA ELISA and ANA­IFA (Indirect Fluorescent Antibody). ANA profile was done on selected cases as final confirmatory test. Clinical details of patients were obtained from medical records. <b>Results:</b> A total of 193 (44%) patients had CTDs. Females constituted to about 88% and 53% of the patients were between the age group of 21­40 years. The three most commonly occurring CTDs were Systemic Lupus Erythematosus (SLE), Mixed Connective Tissue Disease (MCTD) and Scleroderma or Systemic Sclerosis (SS). <b>Conclusion:</b> CTDs are common in our community. Females are commonly affected. IFA was a useful diagnostic tool and ANA profile was a valuable confirmatory test. SLE was the most common CTD. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=OC21-OC24&id=11688 https://doi.org/10.7860/JCDR/2018/35686.11688 Markers of Oxidative Stress, Inflammation and Endothelial Dysfunction in ESRD Patients with Hepatitis-C Virus Positive on Maintenance Haemodialysis Krishna Kishore Chennu, Niimmanapalli Harini Devi, PVLN Srinivasa Rao, AY Lakshmi, Vishnubotla Siva Kumar <b>Introduction:</b> Hepatitis C Virus (HCV) infection is the significant cause of morbidity and mortality in Haemodialysis (HD) patients and kidney transplant recipients. HD technique may contribute to maintaining the inflammatory state in many HD patients. Oxidative stress, inflammation and endothelial dysfunction are common in patients with End-Stage Renal Disease (ESRD). <b>Aim:</b> To assess the possible relationships between oxidative stress, inflammatory and endothelial dysfunction markers with HCV positive status on maintenance HD. <b>Materials and Methods:</b> The study enrolled 22 patients with ESRD, seropositive for HCV; 22 patients with ESRD, seronegative for HCV on maintenance HD and 19 healthy subjects as controls. In the present study, high sensitivity C-reactive protein (hs-CRP) was estimated by immunoturbidimetry method, Homocysteine (Hcy) was estimated by enzymatic recycling method, Malondialdehyde (MDA), Ferric Reducing Ability of Plasma (FRAP) and Nitric oxide (NO) were estimated by spectrophotometric method and Carotid Intima Media Thickness (CIMT) was estimated by Carotid Ultrasonography. <b>Results:</b> There is statistically significant increase in serum MDA, Hcy, hs-CRP, CIMT levels and statistically significant decrease in serum NO and FRAP levels in HCV positive and HCV negative groups when compared to controls. Correlation analysis of CIMT with other markers in the study showed statistically significant negative correlations among CIMT with FRAP and NO and statistically significant positive correlations among CIMT with hs-CRP and Hcy but no association with MDA. <b>Conclusion:</b> Oxidative stress, inflammation, and endothelial dysfunction might be associated with HCV infection in ESRD patients on maintenance HD. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=BC17-BC20&id=11689 https://doi.org/10.7860/JCDR/2018/31614.11689 Atherogenic Index of Plasma an Indicator for Predicting Cardiovascular Risk in Addition to Endothelial Dysfunction in Type 2 Diabetic Subjects Siva Prasad Palem, Philips Abraham <b>Introduction:</b> Prevalence of Cardiovascular Disease (CVD) in diabetic subjects is higher than that in the general population. Dyslipidaemia is a known atherogenic factor which causes vascular complications in both general and diabetic population. Antherogenic Index of Plasma (AIP) is the ratio of triglyceride to HDL, which is a major factor for detecting cardiovascular risk. Endothelial Dysfunction (ED) is the primary stage for the development of atherosclerosis and vascular complications. <b>Aim:</b> To estimate whether AIP will be a strong indicator for predicting cardiovascular risk in addition to endothelial dysfunction in type 2 diabetes mellitus. <b>Materials and Methods: </b>The study was conducted on 80 subjects with age group 38-60 years. Among these subjects 40 were type 2 diabetic subjects and remaining 40 were age and sex matched healthy controls. Blood sugar, lipid profile were measured by using well established methods in fully autoanalyser. Lipoprotein ratios were calculated by using lipid profile values in Microsoft Excel. AIP was calculated by using formula log (TG/HDL-c). Nitric Oxide (NO) was estimated by kinetic cadmium reduction method in spectrophotometer. Statistical analysis was done by using SPSS software version 21.0, “Kruskal-Wallis” test was performed for variables between the study groups. <b>Results:</b> Significantly high levels of Triglyceride (TG) and LDL (151.75±62.38 and 181.70±45.72) were observed in type 2 diabetic subjects than healthy controls (121.15±72.72 and 119.13±34.13). The study also observed significantly high levels of TG/HDL and LDL/HDL ratio’s and AIP in type 2 diabetic subjects. Significantly lower level of NO was observed in diabetic subjects; NO is negatively correlated with AIP, TG, LDL, TG/HDL and LDL/HDL. <b>Conclusion:</b> We found negative correlation of AIP with NO. Hence, estimation of NO in addition to AIP can be a strong indicator for predicting CVD in type 2 diabetic subjects. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=BC21-BC24&id=11690 https://doi.org/10.7860/JCDR/2018/31834.11690 Comparative Study of Lidocaine and Palonosetron Pretreatment in Reduction of Propofol Induced Injection Pain Suruchi Ambasta, Swagat Mahapatra <b>Introduction:</b> Propofol is very popular as an induction agent in modern day anaesthesia because of its favourable pharmacodynamics and fewer side effects. Any pain pre or post-anaesthesia leads to patient dissatisfaction. The incidence of pain during propofol induction is almost 70%. <b>Aim:</b> To compare palanosetron and lidocaine to each other as well as with the control group receiving normal saline as placebo in decreasing propofol induced injection pain and to compare patient satisfaction in both the test groups. <b>Materials and Methods:</b> A total of 150 patients were randomised to constitute three groups. Group L who received 0.5 mg/kg of 2% lidocaine, Group P received palonosetron 0.075 mg, and Group N who received normal saline 0.9% constituted the control group. Patients were given a 5 mL pretreatment solution, containing either lignocaine 0.5 mg/kg, palonosetron 0.075 mg or 0.9% normal saline intravenously. Following pretreatment, venous drainage was occluded at midarm level with a tourniquet. Tourniquet was released after one minute. Propofol injection was given over five seconds at 25% of the total calculated induction dose. Patients were then interviewed about the magnitude of pain and rated as per a pain scale. Descriptive statistics such as range, mean, Standard Deviation (SD) were used to summarise the baseline clinical and demographic profile of the patients. Chi-square test was performed for comparison of categorical data. <b>Results:</b> Both the study drugs i.e., lidocaine and palonosetron caused significant reduction in pain as compared to the placebo (normal saline) group. Only 20% of patients had pain free induction (at five seconds) in saline group as compared to 64% and 70% in Groups P and L respectively. Comparison among three groups was highly significant with p<0.001. <b>Conclusion:</b> Palonosetron was almost as effective as lidocaine in reducing propofol induced injection pain. Palonosetron has an added advantage because of its antiemetic property so can be chosen as an alternative to lidocaine. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=UC13-UC16&id=11691 https://doi.org/10.7860/JCDR/2018/34596.11691 Women’s Views on Routine Antenatal Ultrasound Scan in a Low Resource Nigerian Setting Anthony Tagbo Agbata, Chukwuemeka Ikechi Ukaegbe, Lucky O Lawani, Kenneth C Ekwedigwe, Leonard O Ajah <b>Introduction:</b> Obstetric ultrasound is a popular and attractive management tool in Obstetrics. In recent times, it has gained wide acceptance amongst expectant mothers in many parts of the developing world. Many Obstetricians now regard it as an integral part of antenatal care. Despite this popularity, little is known about women’s views regarding the antenatal ultrasound scan in Nigeria. <b>Aim:</b> The aim of the study was to explore the views of women on the routine antenatal ultrasound scan in Abakaliki, Southeast Nigeria. <b>Materials and Methods:</b> This was a cross-sectional descriptive study involving 335 antenatal women who booked for antenatal care at the Federal Teaching Hospital, Abakaliki (FETHA), between July 2017 to November 2017. Sampling was by non probability sampling technique. The survey instrument was a semi structured questionnaire. Statistical analysis was performed using IBM SPSS Statistics for Windows, version 24.0. Armonk, NY: IBM Corp. Data were analysed using descriptive statistics. <b>Results:</b> A total of 335 antenatal women were interviewed. Mean age was 27.9±4.3 years (range 17 to 44 years). Women’s knowledge of ultrasound use for antenatal care and the indications for the scan was high; 326 (97.6%) out of 334 and 244 (75.5%) out of 323 respectively. 254 (75%) out of 331 were not properly counselled before the ultrasound procedure. About 35 (10%) out of 333 thought the ultrasound scan could harm their unborn baby. 167 (52%) out of 321 of the women interacted with the sonologist during the ultrasound scan. After the procedure, 247 (76.0%) out of 325 participants had the ultrasound findings explained to them. About 275 (82%) out of 334 wanted to know the sex of their foetus. The ultrasound experience was positive for 198 (60%) out of 330 of the women. <b>Conclusion:</b> Knowledge of antenatal ultrasound scan and the indication for the scan was high amongst present study women. There was equally a high level of interaction between the sonologist and the pregnant women during the scan. This may have contributed to the high rate of satisfaction and positive ultrasound experience recorded in this study. There was however, lack of proper counselling of the women by the obstetricians before the ultrasound procedure. Improvement in this aspect of patient care is needed to further enhance the ultrasound experience of present study women, and to reduce anxiety and dispel any misconceptions and irrational expectations regarding the antenatal ultrasound scan. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=QC21-QC25&id=11693 https://doi.org/10.7860/JCDR/2018/35992.11693 Quality of Life in Patients with Allergic Rhinitis in the North of Iran Jalali Mir Mohammad, Gerami Hooshang, Soleimani Robabeh, Alizadeh Pegah <b>Introduction:</b> Allergic Rhinitis (AR) is a chronic disease which affects the quality of life in adult patients. Fatigue, impairment of sleep quality and sexual dysfunction might be manifestations of the quality of life impairment in adults. <b>Aim:</b> To evaluate different aspects of the quality of life in AR patients compared to control groups. <b>Materials and Methods:</b> In a cross-sectional study, we enrolled three groups of adult individuals (18-45 years old) who visited hospitals at the Guilan University of Medical Sciences in 2014-2015. The groups included adult patients with AR, Chronic Rhinosinusitis (CRS) and healthy controls. Total 288 subjects (144 males and 144 females) participated in this study. After signing informed consent, participants completed Pittsburgh Sleep Quality Index (PSQI), Multidimensional Fatigue Inventory (MFI) and Female Sexual Function Index (FSFI) or International Index of Erectile Function (IIEF) questionnaires. A statistical analysis of the material was performed with the use of Analysis of Variance (ANOVA) and chi-square test. Data were analysed using SPSS version 22.0. <b>Results:</b> The mean age (±SD) of patients with AR, CRS and healthy controls were 34.6 (±6.2), 34.7 (±8.1) and 34.2 (±7.4) years respectively (p=0.8). There was no significant difference in demographic characteristics of participants among three groups in men or women. In comprehensive evaluation of the quality of life of male subjects, patients with AR had significantly lower score in sleep quality and sexual function than CRS patients (6.9 vs. 7.9 for sleep quality, p=0.01; 49.8 vs. 56.0 for sexual function, p<0.001). However, there was no significant difference among various aspects of quality life in the female participants. <b>Conclusion:</b> The present results showed impaired sleep quality and sexual function in AR patients when compared to patients with rhinosinusitis or healthy controls. The effect of AR on the various aspects of quality life in the male participants was more than females. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=MC01-MC04&id=11694 https://doi.org/10.7860/JCDR/2018/32872.11694 Cut-off Levels of CRP to Predict Outcomes in Patients with Influenza Infection Omer Karasahin, Hasan Selçuk Özger, Rezan Harman, Sibel Iba Yilmaz <b>Introduction:</b> Seasonal flu is an acute viral infection caused by an influenza virus. People with weakened or suppressed immune system and people with existing chronic disorders are at a greater risk of serious complications after exposure to influenza virus infection. Therefore, determining prognostic markers that are practical, accessible and assessable within the first 24 hours of admission, is of great importance. <b>Aim:</b> To determine the cut-off levels for several bio-chemical markers to predict mortality and determine which patient would require ICU admission in adults with Influenza A infection. <b>Materials and Methods:</b> All patients (155) included in the study were above the age of 18 years and diagnosed with Influenza A from December 2015 to March 2016. ROC analysis, Cox regression model and Kaplan-Meier analysis were used to determine the prognostic predictions of the biomarkers, C-Reactive Protein (CRP), Creatine Kinase (CK) and risk factors. <b>Results:</b> Serum CRP and CK levels were significantly high in patients who required ICU support or died. The highest sensitivity and specificity cut-off value for mortality and intensive care unit needs was 76.5 mg/L for CRP. The highest sensitivity and specificity cut-off value for mortality prediction of CK was 234 U/L, and that for intensive care unit needs was 302 U/L. With each 1 mg/L increase in serum CRP values, the risk of mortality increased by 1.007 times (95% CI 1.001-1.013; p=0.017). The mean life span of patients with serum CRP levels above 76.5 mg/L was shortened. <b>Conclusion:</b> The cut-off value of CRP for ICU admission and mortality was indicated as 76.5 mg/L. The frequency of development of mortality in cases below this limit value was determined as <1% and survival times were found significantly longer. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=DC56-DC60&id=11695 https://doi.org/10.7860/JCDR/2018/35263.11695 Translation, Cultural Adaptation and Validation of ACE III for Assessment of Cognition for Gujarati Population Dhara Abhinav Sharma, Pradhyuman Chaudhary, Megha Sheth, Disha Dalal <b>Introduction:</b> Cognition is defined as “the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses.” It is a method used by Central Nervous System (CNS) to process information. Ageing leads to cognitive decline and timely diagnosis and intervention might help for successful ageing. Addenbrooke’s Cognitive examination III (ACE III) is a screening tool to detect dementia and mild cognitive impairment. It assesses different domains of cognition like attention, memory, verbal fluency, language and visuo-spatial abilities. The tool was originally developed in English and later was translated to many other languages like Spanish, Thai, Japanese, Malayalam and Hindi. Gujarati is the official language of the state of Gujarat, India. Out of the total population of Gujarat 8.3% are 60 years and above. <b>Aim:</b> To translate ACE III to Gujarati language, and also to culturally adapt and validate ACE III for Gujarati population. <b>Materials and Methods:</b> This methodological study carried out in Ahmedabad Institute of Medical Sciences, Gujarat, India, from November 2016 to May 2017. The ACE III was translated to Gujarati using forward–backward–forward method. The face validity was established by an expert panel consisting of seven neurological medicine and neuro rehabilitation professionals. After obtaining the final Gujarati translated copy of ACE III, both original English version and Gujarati version were administered to group of bilingual older adults to establish the content validity. The data was analysed using Microsoft Excel 2010 and SPSS version 16.0. <b>Results:</b> The results indicated that there is strong positive correlation between original English version and Gujarati version of ACE III with Pearson’s correlation coefficient r=0.87 and p=0.01. The Gujarati version correlated with Education level with Spearman’s correlation coefficient r=0.75, p=0.05 and the original English version of ACE III also correlated with Education level of older adults with Spearman’s correlation coefficient r=0.75, p=0.05. <b>Conclusion:</b> The produced Gujarati version of ACE III is equivalent to original English ACE III and can be used to assess cognition in older adults. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=VC11-VC14&id=11696 https://doi.org/10.7860/JCDR/2018/30694.11696 Adnexal Torsion: Clinical Presentations and Challenges Debjyoti Santra, Anirban Dasgupta, Nita Ray, Anirban Talukder, Subhendu Dasgupta <b>Introduction:</b> Adnexal torsion contributes to 2.7-7.4% of all gynaecological emergencies and delayed or misdiagnosis results in loss of ovarian function. Diagnosis is not straight forward, both clinically and radiologically, and it can be confused with a number of other surgical and gynaecological emergencies. <b>Aim:</b> The aim of the present study was to correctly identify ovarian torsion among different cyst accidents, its overall incidence, the types of surgery involved and the histopathological diagnoses of the twisted adnexal masses in a prospective observation over two years. <b>Materials and Methods:</b> The clinical scoring was used in one group (n=14) and its reliability was assessed in correct identification of adnexal torsion by comparing with another group without the scoring (n=12). This scoring was developed in an Institute in Paris in (2000-04) using logistic regression model to select a combination of five best parameters namely: unilateral lumbar or abdominal pain, pain duration of less than 8 hours at first presentation, vomiting, absence of leucorrhoea and metrorrhagia, and cyst size more than 5 cm on ultrasound; to develop a combined score to diagnose torsion. A combined score of more than 60 was used to diagnose torsion in present study, and a score less than 40 to rule it out. For the intermediate range 41-60, clinical judgement was used in addition to scoring, to screen for torsion. Common differential diagnoses masquerading as torsion were also noted. Simple measures like specificity, sensitivity, PPV were calculated in both groups and compared between the two groups using Fischer’s-exact test for significance. <b>Results:</b> Cyst accidents and torsion accounted for 5% (n=19) and 3.7% (n=14) of all gynaecological emergencies (n=374). Lower abdominal pain and fever were the most common symptoms. Clinical diagnosis aided by the scoring correctly identified torsion in (n=8) 89% patients as compared to (n=6) 60% in group without scoring. The most common histopathological diagnosis was dermoid while the common procedures were de-torsion and cystectomy and unilateral salpingo-oophorectomy. Several interesting scenarios like torsion and bilateral dermoid cysts, torsion of one ovary over the pedicle of contralateral ovarian cyst, a bulky ovary with an enlarged appendicular lump, endometriomas, tubo-ovarian masses mimicking torsion were also noted and diagnostic challenges were discussed. <b>Conclusion:</b> Clinical detection of adnexal torsion with perfect accuracy remains a challenge in emergency and a clinical scoring with careful imaging can help in refining diagnostic accuracy and plan appropriate surgery. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=QC26-QC31&id=11697 https://doi.org/10.7860/JCDR/2018/34508.11697 Histomorphological Study of the Endometrium in Response to Insulin Resistance Induced by High Energy Diets in Swiss Albino Mice Gnanagurudasan Ekambaram, Senthil Kumar Sampath Kumar <b>Introduction:</b> The morphology of endometrium is continuously influenced by hormones in each menstrual cycle. In addition to this, metabolic syndrome such as obesity and insulin resistance affects the morphology of endometrium through elevated estrogen and insulin levels. <b>Aim:</b> To study the histomorphological effects in the endometrium due to insulin resistance through high energy diets in swiss albino mice. <b>Materials and Methods:</b> Thirty six swiss albino mice were randomly divided into control, high fat diet and high fructose diet groups with 12 animals in each group. The animals were fed respective diets and the study was carried out for 12 weeks. After the study period the blood was collected from the animals in the retro orbital sinus under general anaesthesia and animals were sacrificed by the administration of ether. Serum was separated in centrifuge and stored at -20ºC for the analysis of glucose and insulin levels. Uterus was removed and kept in neutral buffered formalin for tissue processing. Homeostasis Model Assessment of Insulin Resistance (HOMA–IR) was calculated to assess the insulin resistance. <b>Results:</b> The glucose, insulin and HOMA–IR levels were higher in high fat and high fructose diet groups. There was complex atypical hyperplasia with glandular crowding in the endometrium of high fat diet and high fructose diet animals. <b>Conclusion:</b> The present study concludes the positive role of metabolic syndromes such as insulin resistance in the development of preneoplastic lesions in the endometrium. If the condition persists for a long time it can progress into endometrial carcinoma. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=AC07-AC10&id=11698 https://doi.org/10.7860/JCDR/2018/34496.11698 Fairness of Health Financing before and after Introduction of Iranian Health Sector Evolution Plan: A Case Study Soraya Nouraei Motlagh, Banafsheh Darvishi, Payam Haghighatfard, Mohammad-Hasan Imani-Nasab <b>Introduction:</b> Since out-of-pocket payments of household are a serious obstacle to the equitable utilization of health services, paying attention to the direct payment of households and, consequently, incidence of catastrophic health expenditures should always be considered in the planning and policy-making of health services. Iranian Health Sector Evolution Plan (HSEP) has been implemented since 2014, aiming at achieving universal coverage of health services and reducing the amount of out-of-pocket payments as a percentage of total health expenditures. <b>Aim:</b> To measure the fairness of health care financing and to identify incidence rate of catastrophic health expenditures and its most important determinants before and after implementing the HSEP among households in one province of Iran (Lorestan). <b>Materials and Methods:</b> The study population of present cross-sectional research was Lorestan households whose information was collected by a three-stage randomized cluster sampling method by the Statistics Center of Iran during 4/2012-3/2015. For data analysis, Logit’s regression model using Stata14 software was performed. <b>Results:</b> Based on the findings between 4/2012 and 3/2015, the incidence rate of Catastrophic Health Expenditure (CHE) reduced from 6.7 to 4.34; Fairness Financial Contribution Index (FFCI) varied from 0.66 to 0.74 and percentage of poverty due to health expenditure varied from 1.96% to 0.28%. The most important determinants of facing catastrophic health expenditure are economic status of households, location of households (urban or rural), and number of people over the age of 65 and under the age of 5 in the household, age and sex of household head and insurance status of households. The use of health care also showed a significant relationship with the incidence of catastrophic health expenditure. <b>Conclusion: </b>After implementing Iranian HSEP, the incidence of CHE and the percentage of poverty caused by health expenditure at the level of households were reduced to some degree, and fairness financial contribution index improved. The finding of this study will help health policymakers to identify factors increasing the likelihood of household exposure to catastrophic health expenditure, and based on these factors, to review and revise the programs implemented within the framework of Iranian HSEP and adopt appropriate policies to promote the protection of households against catastrophic health expenditure. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=IC10-IC15&id=11699 https://doi.org/10.7860/JCDR/2018/35366.11699 Correlation of Serum Nitric Oxide with Haematological and Biochemical Parameters in Acute Ischaemic Stroke Patients Priti Chaturvedi, Vinit Mehrotra, Yogesh Saxena, Soumen Manna <b>Introduction:</b> Nitric oxide (NO), different haematological and biochemical parameters, play an important role in the pathogenesis of Acute Ischaemic Stroke (AIS) (<24 hour). <b>Aim:</b> To establish a correlation between NO with haematological and biochemical parameters in AIS patients. <b>Materials and Methods: </b>A hospital based, cross-sectional study was done in 50 patients of AIS and 25 healthy controls. Serum NO level was measured by ELISA. Complete lipid profile, Random Blood Sugar (RBS), serum Blood Urea Nitrogen (BUN), creatinine and haemogram were assessed by automated devices. Pearson’s correlation coefficients were analysed to look for the relationship between NO with biochemical and haematological parameters. The p-value was considered significant if p<0.05. <b>Results:</b> Statistically highly significant (p<0.001) elevation in mean serum NO levels were observed in cases (32.06 µmol/L) as compared to controls (24.41 µmol/L). NO was positively correlated with elevated levels of Triacylglycerol (TAG), T-Chol, Low Density Lipoprotein (LDL-C), VLDL-C, RBS, and negatively correlated with High Density Lipoprotein (HDL-C), BUN, serum creatinine, Total Leukocyte Count (TLC), ESR, but none of the correlation coefficient was found to be statistically significant. <b>Conclusion:</b> Elevated NO and derangement of biochemical and haematological parameters may be linked to pathogenesis of AIS. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=BC25-BC28&id=11700 https://doi.org/10.7860/JCDR/2018/32132.11700 Hypermethylation Markers in Saliva of Smokers with High Risk for Oral Potentially Malignant Disorders Pravin Raj Solomon, Enotoobong Aniekan Ekanem <b>Introduction:</b> Oral Potentially Malignant Disorder (OPMD) is considered as a disease symptom which if neglected without treatment may lead to cancer. OPMDs comprise leukoplakia, erythroplakia, erytholeukoplakia (the combination of both leukoplakia and erythroplakia), Oral Submucous Fibrosis (OSMF) and lichen planus (which has a low risk of turning malignancy). It is observed that a variety of factors influence the spread of OPMDs and these includes age distribution, gender distribution and geographic distribution, amongst others. <b>Aim:</b> The aim of the study is to identify the differential presence of p16 gene promoter hypermethylation in the saliva of smokers and non smokers. <b>Materials and Methods:</b> A total of 52 saliva samples were collected and prepared with full acknowledgement of the subjects. DNA isolation, restriction digestion of genomic DNA, extraction of restriction enzyme digested genomic DNA, Polymerase Chain Reaction (PCR) and finally Agarose Gel Electrophoresis (AGE) were performed. <b>Results:</b> 14 (70%) out of 20 samples collected from smokers were found to be methylated in p16 gene while 6 (30%) out of 20 showed no methylation. In non smokers, 29 (91%) out of 32 samples were found to be methylated. The present study shows a marginally lower rate of p16 gene hypermethylation in smokers compared to non smokers. <b>Conclusion:</b> p16 gene hyper methylation is not recommended to be used as a marker for early detection of OPMDs among Malaysians. Promoter hypermethylation of p16 gene is not an early event in the prognosis of Malaysian Oral Squamous Cell Carcinoma (OSCC) patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=XC08-XC11&id=11701 https://doi.org/10.7860/JCDR/2018/34521.11701 Modelling the Health Economic Impact of Influenza Vaccination Strategies for High-Risk Children in Vietnam Trung Quang Vo, Usa Chaikledkaew, Minh Van Hoang, Arthorn Riewpaiboon <b>Introduction:</b> In Vietnam, since 2011 a National Influenza Surveillance System in Vietnam has implemented Severe Acute Respiratory Infection (SARI) surveillance to assemble information and inform administrational and methods of prevention. Children and elderly people belonging high risk-group are recommended for vaccination whereas, need for cost effectiveness study to aid strategic decisions on Vietnamese Expanded Program on Immunization. <b>Aim:</b> To explore the cost-effectiveness analysis of influenza vaccination strategies for high-risk children in Vietnam. <b> Materials and Methods:</b> The outcomes of influenza vaccination were calculated by cost-effectiveness analysis in children which were monitored until the age of 15-year-old. Cost-effectiveness analysis were performed based on Quality-Adjusted Life-Years (QALYs) gained due to vaccination comparing to no vaccination. Country-specific data of Vietnam was approached as much as possible for input parameters. Cost-effectiveness analysis was performed in terms of Incremental Cost-Effectiveness Ratio (ICER), and cost benefit analysis is presented as net present value. <b> Results:</b> Cost of get vaccination program was recorded at 30.68 USD (the United State Dollar), whereas cost of no get vaccination program was 17.99 USD. The ICER of get influenza vaccine versus no influenza vaccine in children under 15-year-old were USD 25.31 USD/QALY (quality-adjusted life-years) and 31.03 USD/QALY for social and healthcare provider perspective. <b> Conclusion: </b>To better inform the policy decisions of influenza prevention and control to give influenza vaccination into Vietnamese Expanded Program on Immunisation (VEPI), economic and math models are necessary. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=LC26-LC32&id=11702 https://doi.org/10.7860/JCDR/2018/35722.11702 Medical Services for a Provincial Hospital in Vietnam: Cost Analysis for Data Management Phung Thu Hoa Tran, Trung Quang Vo, Duyen Thi Phuong Huynh, Luyen Dinh Pham, Thuy Van Ha <b> Introduction:</b> Health care expenditure has been increasing in both developing and developed nations, but control or improved efficiency can be obtained by applying health economics in management. The unit cost of health care services play a critical role in health economic analyses that involve health economic evaluations. <b>Aim:</b> To identify the unit costs of medical services at the General Hospital in Lam Dong, Vietnam. <b> Materials and Methods:</b> A standard costing approach was applied to calculate unit cost of medical services. This study was a retrospective cost analysis, using the descriptive statistic function in Microsoft Excel for Window®. All cost centres in the institute were identified and classified into two categories: Temporary Cost Centres (TCCs) and Absorbing Cost Centres (ACCs). The unit cost of each medical service was estimated by a cost-to-charge ratio method. <b>Results: </b>The total costs of the Lam Dong General Hospital in the fiscal year 2015 were 4,560,891 USD. The contributions of capital costs, material costs and labour costs for all cost centres to the total direct cost were 16.36%, 49.07% and 34.57%, respectively. After allocation, the direct and indirect costs of all ACCs were 3,590,168 USD and 970,723 USD, accounting for 78.72% and 21.28%, respectively. The cost-to-charge ratios of the remaining medical services ranged from 0.36 to 164.68. <b>Conclusion:</b> The results of this study can help hospital administrators understand their cost structures and run their facilities more efficiently. The study also provides unit costs for government data and aids in completing the Vietnam standard cost list. This will be helpful for health economic evaluations. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=LC33-LC37&id=11703 https://doi.org/10.7860/JCDR/2018/35723.11703 Medical Expenditures of Community- Acquired Pneumonia Hospitalization: A Two-Year Retrospective Study from a Hospital Electronic Database in Vietnam Trung Quang Vo, Hien Thu Bui, Thuy Phan Chung Tran, Tram Thi Huyen Nguyen, Thuy Van Ha, Ha Thi Song Nguyen <b>Introduction:</b> Community-Acquired Pneumonia (CAP) causes respiratory diseases that lead to numerous deaths and an increased burden on the healthcare system. In 2014, the Ministry of Health of Vietnam reported that 4000 children under the age of 5 die because of CAP every year. <b> Aim: </b>The aim of this study was to estimate the direct medical costs per case for CAP treatment from the hospital perspective and to evaluate the use of antibiotics at a public hospital in Ho Chi Minh City. <b> Materials and Methods:</b> A retrospective study was conducted between January 2015 and December 2016 at Trung-Vuong Hospital. Pneumonia episodes, identified by ICD-10 (J10–J18) and assigned to medical encounters, were validated through the hospital electronic database (n=1,854). Treatment costs consisted of costs of hospital beds, diagnostics, operations, laboratory tests, pharmaceuticals, medical supplies and other services, which was calculated and .presented by using descriptive statistics methods. <b>Results: </b>The average cost per case (mean/SD) of all age groups was $795.1/$86.2; the highest cost was incurred by the group aged over 85 years, at $1253.7/$90.3. The average cost to treat CAP in male patients was $810.2/$85.5, which was higher than the treatment cost for females, at $778.6/$86.7, but the difference was not significant (P=0.450). The total burden of CAP in the period 2015–2016 was $1,474,052.9. The total costs of pharmaceuticals represented the largest proportion of the total costs (65.9%), at $971,646, and the cost of antibiotics was $380.5/$111.8 per episode. According to the sensitivity analysis, if the costs of the hospital beds were reduced by 20%, the total treatment cost for CAP would fall by 1.6%. <b> Conclusion:</b> The study contributed evidence of the high treatment costs of CAP in the Vietnamese context. Given the significance of the disease burden, the potential benefit of vaccination in adults is substantial. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=LC38-LC43&id=11704 https://doi.org/10.7860/JCDR/2018/35731.11704 Assessment of Health-Related Quality of Life in Patients with Type II Diabetes Mellitus: A Population-Based Study at a Tertiary Hospital Thai Quang Nguyen, Trung Quang Vo, Giang Huong Nguyen, Thoai Dang Nguyen <b> Introduction:</b> The rising incidence of diabetes, worldwide, has necessitated an evaluation of diabetes impacts on Health- Related Quality of Life (HRQoL). The recognition of risk factors that lower HRQoL can improve HRQoL in patients with Type 2 Diabetes Mellitus (T2DM). <b>Aim:</b> To explore the impact of T2DM on HRQoL among adolescents/adults treated at a tertiary hospital in southern Vietnam. <b>Materials and Methods: </b>This cross-sectional study was conducted from July–September 2017 at District 9 Hospital, Ho Chi Minh City, Vietnam. In total, 286 patients with T2DM underwent face-to-face interviews and completed the Diabetes- 39 (D-39) questionnaire (previously evaluated for reliability). Each subscale score was summed and transformed into a scale of 0–100. HRQoL differences were evaluated by Mann-Whitney and Kruskal-Wallis nonparametric tests. <b>Results: </b>The Cronbach’s alpha coefficients were all over 0.80 and showed acceptable high internal consistency. The lowest Cronbach’s alpha was obtained for ‘Anxiety and worry’ (0.81) and the highest for ‘Diabetes control’ and ‘Sexual behaviour’ (0.93). The Intraclass Correlation Coefficient (ICC) ranged from 0.80 for ‘Anxiety and worry’ to 0.93 for ‘Sexual behaviour’ and agreed well for all subscales and the D-39 total score. The median D-39 total score was 35.0 (scale 0–100). Patients prescribed insulin or who had a family history of diabetes scored higher on ‘Diabetes control’ and ‘Social behaviour’ and the D-39 total score. Multiple linear regression analyses revealed that having an urban area residence, no income and high BMI predicted a lower impact of diabetes on HRQoL scores. Conversely, unemployment correlated with higher scores for ‘Energy and mobility’ and the total HRQoL, while family history had a higher impact on ‘Anxiety and worry’ and ‘Social burden’. The presence of complications was associated with a higher ‘Energy and mobility’ score. <b> Conclusion:</b> The Diabetes-39 Vietnamese version used in our study had acceptable reliability for evaluating HRQoL in patients with T2DM. The ‘Energy and mobility’ and ‘Anxiety and worry’ subscales were highly impacted by T2DM, indicating a need to address physical function and patient psychology. The independent predictors are useful additions to diabetes care programs suitable for individuals. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=LC44-LC51&id=11705 https://doi.org/10.7860/JCDR/2018/35733.11705 Direct Medical Costs of Kidney Stone: A Retrospective Study Trung Quang Vo, Tram Thuy Ngoc Nguyen, Thao Quy Thi Le, Luyen Dinh Pham, Quang Vinh Tran <b> Introduction: </b>Nephrolithiasis imposes a weighty economic burden on individuals and their families, the healthcare system, and society. In Vietnam, expenses related to nephrolithiasis are poorly investigated. <b>Aim:</b> To assess the direct medical cost of treating nephrolithiasis and provide data on the economic burden of kidney stone disease in actual clinical practice in Vietnam. <b>Materials and Methods:</b> A retrospective costs approach from a hospital perspective was employed. Data was collected from Binh-Dan Hospital – a public hospital in Ho Chi Minh City, Vietnam, to estimate direct medical costs. The Bootstraping method of 2,000 times of resampling was used due to a skewed data. <b>Results:</b> A total of 57,332 nephrolithiasis patients from Binh- Dan Hospital were enrolled in the study. Throughout the study period, the per-episode direct medical cost of nephrolithiasis in the Inpatient Department (IPD) and outpatient department (OPD) was US$ 532.1 (95% CI, 524.8-539.9) and US$ 50.1 (95% CI, 49.7-50.4), respectively. The two most significant components of direct medical cost were medical procedures (24.7%) and pharmaceuticals (20.2%). <b> Conclusion: </b>The findings indicate that nephrolithiasis places a considerable economic burden on public healthcare services in Vietnam. Analysis demonstrating the magnitude of the economic impact of nephrolithiasis management in Vietnam’s healthcare system may help facilitate health and social policy interventions to improve the prevention and treatment of nephrolithiasis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=LC52-LC58&id=11706 https://doi.org/10.7860/JCDR/2018/36673.11706 Economic Consequences of Treating Type-2 Diabetes Mellitus in a Private Hospital: A Fiscal, Analytical Approach (2013-2017) Trung Quang Vo, Pol Van Nguyen, Nghiem Quan Le, Loan Thi Kim Nguyen <b>Introduction:</b> Spread and the costs of Type-2 Diabetes Mellitus (T2DM) treatment are a burden on both Vietnam’s nascent economy and its society. <b>Aim:</b> Cost study with T2DM patients to evaluate the economicconsequence changes in T2DM treatment and strengthen the economic evidence base further. <b> Materials and Methods:</b> This retrospective study was based on perspectives of patients and third-party payers using ICD 10 code to filter data from the electronic medical records database. It estimated the overall economic impact, accounting for spillovers through the economy at a private hospital from January 2013 to December 2017. <b> Results:</b>The cases of 120,257 T2DM patients receiving treatment at a private hospital resulted in per patient expenditure of 29.0±11.5 USD (95% CI: 29.0-29.1) and 348.6±137.5 USD every year. The T2DM patients showed a higher prevalence of hypertension (64.1%), disorders of lipoprotein metabolism (42.5%) and gastritis (22.8%). The mean total cost for patients without any comorbidities was almost 27.1±10.8 USD (95% CI: 26.9-27.2) per month, while those having at least one comorbidity spent more (=28.8 USD per month). The cost of drug and related products were 3,082,452.0 USD (87.4%), in which sulfonylurea (18.2%) and metformin (10.9%) were primarily responsible. <b> Conclusion: </b> From the results of the present study, it can be concluded that the direct medical costs for T2DM treatment in a private Vietnamese hospital are higher than the corresponding costs for a public hospital and T2DM will continue to be a heavy burden on health budgets. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=LC59-LC65&id=11707 https://doi.org/10.7860/JCDR/2018/36676.11707 Impact of Chronic Kidney Disease on Health-Related Quality of Life: A Prospective Observational Study using the Kdqol-36 Instrument Trung Quang Vo, Thai Quang Tran, Khanh Ngoc Cong Duong, Khang Chi Pham <b>Introduction:</b> Chronic Kidney Disease (CKD) is an umbrella term that describes a wide range of disorders affecting the structure and function of the kidney, seriously devastating the patients’ health-related quality of life (HRQoL). A great deal of research has been conducted in an attempt to understand the factors that influence HRQoL in CKD patients. <b>Aim:</b> To identify the HRQoL of patients with CKD in Vietnam and to reveal the association between several socio-demographic factors and the patients’ HRQoL. <b>Materials and Methods:</b> The research consisted of a prospective observational study among patients referred to a general hospital for CKD from January to February 2018. The Kidney Disease Quality of Life 36 questionnaire (KDQoL-36) was administered via direct interviews with the patients. <b>Results:</b> Total 316 participants were recruited, including 194 patients with Stage 5 CKD (61.4%) with an average age of 54.2±15.8 years. The mean HRQoL scores of the CKD patients were below average (42.9±9.7) with the lowest score in burden of disease domain (21.2±17.3). Patients with Stage 1–4 CKD scored better than those with Stage 5 CKD in all subscales including Symptom/Problem list (SoD), Burden of Disease (BoD), Physical Component Summary (PCS) (p<0.05), except for Effect of Disease (EoD) and Mental Component Summary (MCS). The multivariable regression analysis results in each HRQoL subscales, exercise and CKD stage were found to be significantly associated with most of the HRQoL indicators in each subscale. CKD stage is predictor of SoD (p<0.001), BoD (p=0.033), PCS (p<0.001), MCS (p=0.015). <b>Conclusion: </b>The findings illustrate that HRQoL in Vietnamese patients with CKD is below average and there are several socio-demographic characteristics influencing on HRQoL in this population. To improve HRQoL in CKD patients, these socio-demographic factors should be considered by medical researchers and practitioners. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=LC66-LC71&id=11708 https://doi.org/10.7860/JCDR/2018/36694.11708 An Assessment of an Adapted Version of the Arthritis Impact Measurement Scales Short-Form Questionnaire to Determine Health-Related Quality of Life in Vietnamese Patients with Arthritis Trung Quang Vo, Khanh Ngoc Cong Duong, Oanh Thi Ngoc Vu, An Thanh Pham, Nam Xuan Vo <b>Introduction:</b> Arthritis significantly decreases the physical and psychological health of patients and is a leading cause of disability. In recent years, the importance of measuring Health-Related Quality of Life (HRQOL) is increasingly recognised by clinicians and policy-makers in informing patient management and policy decisions, especially in the management of patients with chronic diseases. <b>Aim:</b> The primary objective was to evaluate the psychometric properties of a culturally adapted (Vietnamese) version of the internationally recognised Arthritis Impact Measurement Scales short-form (AIMS2-SF) questionnaire for use in Vietnamese-speaking patients with Osteoarthritis (OA) and Rheumatoid Arthritis (RA) (Vie-AIMS2-SF). The secondary objectives were to demonstrate the HRQOL of patients with arthritis and identify socio-demographic factors that impacted on HRQOL. <b>Materials and Methods:</b> This observational, cross-sectional study was conducted on a convenience sample of Vietnamese patients (n=333, 207 women), presenting at a public, specialist orthopaedic hospital in Ho Chi Minh City, southern Vietnam, from January to March 2018. The patients were directly interviewed with the Vie-AIMS2-SF. The reliability and validity of the questionnaire were evaluated by using Cronbachs alpha coefficient (a) and Exploratory Factor Analysis (EFA) respectively. <b>Results: </b>The Vie-AIMS2-SF met the criteria of reliability and validity. Twenty-six items were identified and categorised as five key components: physical (upper and lower limb function), affect, symptom, role and social interaction. Cronbachs alpha coefficient for the Vie-AIMS2-SF Questionnaire ranged from 0.52 to 0.88 indicates a good internal consistency. Regarding HRQOL score, the mean score ranged from 2.3±1.7 for the physical component to 5.0±2.3 for the symptom one. After applying the multivariable linear regression, monthly income and income satisfaction were found to be statistically significant with majority of components (p<0.050). <b>Conclusion:</b> The Vie-AIMS2-SF questionnaire was found to be a valid and reliable instrument to use as assessing HRQOL of Vietnamese patients with arthritis. HRQOL was observed to be “moderate” and several socio-demographic factors should be taken into account in order to improve the HRQOL in this population. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=LC79-LC84&id=11709 https://doi.org/10.7860/JCDR/2018/36954.11709 Outcomes Assessment of Transoral Laser Microsurgery for T1 and T2 Glottic Cancer at the Ho Chi Minh City Ear-Nose-Throat Hospital Thuy Phan Chung Tran, Tuan Thanh Nguyen <b>Introduction:</b> Transoral Laser Microsurgery (TLM) has been accepted as a major treatment modality for early glottic carcinoma (T1, T2), with well-known advantages over Radiation Therapy (RT) and open partial laryngectomy. <b>Aim:</b> To evaluate the oncological outcomes in a consecutive series of early glottic carcinomas treated with TLM as a singlemodality therapy. <b>Materials and Methods:</b> The study was conducted using the medical records of 32 consecutive patients who underwent TLMs and postoperative follow-ups. We only evaluated the oncological outcomes for 1-year disease-free survival and the organ preservation rate. The prognostic values of the related clinicopathological factors were evaluated using univariate analysis. <b>Results:</b> Of the 32 patients, 31 were males and one was a female, with an average age of 61 years. The tumours were treated by cordectomy types IV (78.1%), Va (18.8%) and Vb (3.3%). The voice outcomes were assessed using the Voice Handicap Index scale, which showed that 8 patients had normal voices and 22 had mild changes. Only 2 had moderateto- severe voice changes. The mean hospitalization period was 4.4 days (range 3-7 days). For resection margins, as reported by the pathologist, 31 cases (96.9%) had negative margins and 1 case (3.1%) had a positive margin. <b>Conclusion:</b> Laser surgery has very good oncological outcomes for T1 and T2 glottic cancer with the highly proportion of negative margins and the voice outcomes is normal or mild changed. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=XC01-XC04&id=11710 https://doi.org/10.7860/JCDR/2018/36675.11710 Chronic Kidney Disease– Related Health Economic Impacts: A Vietnamese Hospital Perspective, 2014– 2017 Phuong Thi Lan Nguyen, Trung Quang Vo, Hue Ngoc Hong <b>Introduction:</b> Chronic Kidney Disease (CKD) has a high morbidity and mortality in developing countries. A cost analysis is needed to inform the economic evaluations for prevention strategies and treatment options. The unaffordable price of medication and haemodialysis remains one of the major barriers to the successful treatment of CKD. <b>Aim:</b> To estimate the direct costs associated with treating CKD at the outpatient and inpatient departments of a general hospital in Vietnam. <b>Materials and Methods:</b> A retrospective cost-of-illness study measured the economic burden of CKD outpatient and inpatient care in Vietnam based on a patient, provider, and payer perspective. Data on 4,429 individuals with CKD treated at the Kien Giang General Hospital for the years 2014–2017 was analysed. Description statistics for different types of direct medical costs and medications were evaluated and the differences between direct costs identified by characteristic were compared using the independent sample t-test or the oneway analysis of variances test. <b>Results:</b> The direct medical costs per year, per patient receiving either haemodialysis or not at the outpatient department were US $2,401 and US $957, respectively; the corresponding figures for a patient receiving treatment at the inpatient department were US $611 and US $202, respectively. Treatment costs were found to be statistically significantly higher for patients on haemodialysis, for patients whose treatment was supported by insurance and for patients living in rural areas. Erythropoietin stimulating agents and cardiovascular disease-related medicines were the most costly medications. <b>Conclusions:</b> CKD is a significant contributor to the financial burden of patients and society. Our study provides a baseline estimate of CKD cost that can be used by future studies for comparison. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=LC72-LC78&id=11711 https://doi.org/10.7860/JCDR/2018/36915.11711 Health-Related Quality of Life of Vietnamese Patients with Chronic Obstructive Pulmonary Disease Nhung Thi Tuyet Vo, Trung Quang Vo, Thao Phuong Huynh, Thoai Dang Nguyen <b>Introduction:</b> Chronic Obstructive Pulmonary Disease (COPD) is a severe condition that leads to respiratory disability, considerably reduces the comfort of living and affects all aspects of a patient’s life. <b>Aim: </b>This study assessed the Health-Related Quality of Life (HRQL) of patients with COPD by using St. George’s Respiratory Questionnaire (SGRQ), as a research tool. <b>Materials and Methods: </b>A 2-week cross-sectional survey was conducted at Dong Nai General Hospital, Bien Hoa City, Southern Vietnam. Data were collected by performing face-to-face interviews of 317 patients with COPD {Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages III and IV} by using the SGRQ. Statistical analysis was performed using SPSS for Windows version 22.0. <b>Results:</b> This study included patients with severe and very severe COPD (28.1% patients with GOLD stage III COPD and 71.9% patients with GOLD stage IV COPD). Median (IQR) SGRQ total score was 53.3 (37.7–71.1), which increased with an increase in the GOLD stage {42.9 (27.0–57.2) for patients with GOLD stage III COPD and 56.3 (41.1–75.8) for patients with GOLD stage IV COPD}. Significant differences were observed between the SGRQ total score and patient characteristic sdistribution, including age, gender, place of residence, marital status, BMI, education level, employment status, monthly income, exercise status, health insurance status and Modified Medical Research Council (MMRC) score (p<0.05). <b>Conclusion:</b> The SGRQ seems to be a useful tool for assessing the health status of patients with COPD. Our results indicate that the impact of COPD on the quality of life patients can be assessed using a specific instrument and that an increase in COPD severity is significantly associated with the SGRQ symptom, activity, impact and total scores. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=LC85-LC91&id=11712 https://doi.org/10.7860/JCDR/2018/36716.11712 Cost Trend Analysis of Chronic Obstructive Pulmonary Disease among Vietnamese Patients: Findings from Two Provincial Facilities 2015–2017 Trung Quang Vo, Tien Cam Ngoc Phung, Thang Quoc Vu, Thanh Ngoc Tran, Thao Thanh Thi Vo, Vu Huy Anh PHAN, Luyen Dinh Pham <b>Introduction:</b> Chronic Obstructive Pulmonary Disease (COPD) is a serious public health concern and a leading cause of disability. <b>Aim:</b> To explore the direct medical costs associated with COPD and identify the key cost drivers of disease of management. <b>Materials and Methods:</b> In this retrospective prevalence-based study, a hospital electronic database was used to examine the healthcare utilization and costs associated with COPD from the patient, payer and provider perspectives. The analysis horizon was the three-year period between 2015 and 2017. <b>Results:</b> A total of 33,617 patients with a diagnosis of COPD were identified, of which 28,869 outpatients met the criteria for direct medical cost analysis. The sample was predominantly male (86.0–92.2%). The age of majority was between 60 and 69 years, and almost all patients had health insurance. The mean age was 69.7±10.9 and 69.2±10.8, at Dong Nai General Hospital (DNGH) and Pham Ngoc Thach Hospital (PNTH), respectively. The median number of days for Length Of Stay (LOS) varied from 6 to 10 days (range 1–77). The direct medical costs varied from $22.4 to $32.7 per outpatient visit and from $180.9 to $386.9 per inpatient visit. The key driver of cost was pharmaceuticals, which accounted for more than 50% of total costs. <b>Conclusion:</b> This analysis, for the first time, states the specific costs for COPD, which will provide state public health practitioners with estimates of the economic burden of COPD and illustrate the potential medical cost savings for the nation by implementing programs designed to prevent the onset of COPD (e.g., tobacco prevention and cessation). https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=LC92-LC98&id=11715 https://doi.org/10.7860/JCDR/2018/36668.11715 Socioeconomic Costs of Chronic Kidney Disease: Evidence from Southwest Vietnam Thai Quang Nguyen, Trung Quang Vo, Gia Hon Luu, Nghiem Quan Le <b>Introduction:</b> Chronic Kidney Disease (CKD) has a high mortality in developing countries. This burden is increasing rapidly in Vietnam. The high cost of medication and haemodialysis are major barriers in the successful treatment of CKD. <b>Aim:</b> To determine from a societal perspective the complete cost associated with CKD. <b>Materials and Methods:</b> A cross-sectional study was conducted to estimate the total costs associated with the cost-of-illness, based on the prevalence of the disease at Kien Giang General Hospital. An electronic database provided information related to direct medical costs and biochemical parameters, whereas face-to-face interviews with CKD patients were conducted by questionnaire to collect demographic characteristics, direct nonmedical costs and indirect costs. The population was divided into three groups based on the stages of CKD including the CKD 1–3 group, CKD 4–5 pre-dialysis group and haemodialysis group. <b>Results:</b> A total of 327 patients were enrolled in the study. Costs varied among three groups of CKD patients. The annual cost per patient in the CKD 1–3 group, CKD 4-5 pre-dialysis group and haemodialysis group were USD 2,826.3 (95%CI: 2,592.3– 3,077.1), USD 3,320.3 (95%CI: 2,765.2–3,913.8) and USD 9,498.3 (95%CI: 9,152.5–9,881.4), respectively. Direct medical costs represented the greatest proportion of total costs. The annual cost per patient in the CKD 1–3 group was affected by many characteristics such as age, residence, BMI, education level, exercise and number of comorbidities. In contrast to the CKD 1–3 group, in the haemodialysis group most results were not significantly different in the yearly cost per patient according to demographic and clinical characteristics. Whereas, patients in the CKD 4–5 pre-dialysis group were impacted by factors such as age, residence, occupation and the number of comorbidities. <b>Conclusion:</b> The annual cost per patient in CKD 1–3, CKD 4–5 pre-dialysis and haemodialysis groups were substantial. Patients on haemodialysis incurred the highest cost, about three times compared with the other two groups. The differences in demographic and clinical characteristics affected the annual cost per patient, especially in the CKD 1–3 group. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=LC99-LC105&id=11716 https://doi.org/10.7860/JCDR/2018/36719.11716 Cepstral Peak Prominence of Blom-Singer ‘Non-Indwelling Low Pressure’ and ‘Classic Indwelling’ Voice Prosthesis in Male Tracheo-oesophageal Speakers Sheela Shekaraiah, Venkataraja U Aithal, Bellur Rajashekhar, Vasudeva Guddattu <b>Introduction:</b> Tracheo-oesophageal (TE) speech is one of the most commonly used alaryngeal voice restoration options for individuals who have undergone a total laryngectomy. Cepstral Peak Prominence (CPP) implies the overall voice quality objectively. <b>Aim:</b> To compare the CPP between Blom-Singer non-indwelling low pressure and classic indwelling voice prosthesis across vowel phonation /a/ and text-reading tasks in male TE speakers. <b>Materials and Methods:</b> The study included 10 male TE speakers in the age range of 45-75 years. Dr. Hillenbrand’s ‘Speech Tool’ software was used to measure CPP. Two types of speech prosthesis used were Blom-Singer non-indwelling low pressure and classic indwelling voice prosthesis (both of 16 French diameter) and the tasks vowel phonation and text-reading were considered. The SPSS software, version 15.0 (SPSS Inc., Chicago, IL) was used for data analysis. The parametric paired t-test was applied to compare CPP between two types of voice prostheses across speech tasks. <b>Results:</b> There was no significant difference between Blom-Singer non-indwelling low pressure voice prosthesis and classic indwelling voice prosthesis for CPP during vowel phonation/a/task {t(9)=0.74, p=0.516} and text-reading task {t(9)=0.72, p=0.947)}. Similarly, there was no significant difference for CPP between speech tasks for Blom-Singer non-indwelling low pressure voice prosthesis {t(9)=1.11, p=0.347)} and Blom-Singer classic indwelling voice prosthesis {t(9)=0.51, p=0.644)}. <b>Conclusion:</b> In TE speakers, CPP is not influenced by prosthesis type in terms of mode of fitting, prosthesis design and valve opening pressure across speech tasks, implying no difference in the objective measure of overall voice quality. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=MC05-MC08&id=11741 https://doi.org/10.7860/JCDR/2018/36961.11741 Correlation of Gender and Leptin with Analgesic Effect of Tramadol in High Fat Diet Induced Obese Rats Shakta Mani Satyam, Laxminarayana Kurady Bairy, Vasudha Devi <b>Introduction:</b> Gender and obesity related influences on the experience of pain have received considerable empirical attention in recent years. Differences in pain sensitivity among individuals may have implications for pain management which might account in part for the variability in analgesic requirements between individuals. <b>Aim:</b> To investigate the correlation of gender and serum leptin level with analgesic modulation of tramadol in high fat diet induced obese Wistar rats. <b>Materials and Methods:</b> A total of 48 Wistar rats (24 each male and female; body weight 100-150 gm) were housed as two rats/cage. In addition to the normal pellet diet, these animals were orally fed with a mixture of Vanaspati daalda+Coconut oil (3:1)- 10 mL/kg/day for 90 days. After 90 days, these rats attained body weight approximately =300 gm (obese). Thereafter, each 24 male and 24 female obese rats were randomly divided into two groups (n=6/group) (Group I- Control: 0.9% NaCl; 1 mL/kg/day i.p. and Group II- Test: Tramadol 10 mg/kg/day i.p.) for each nociception model-plantar test (12 male rats and 12 female rats) and acetic acid induced writhing test (12 male rats and 12 female rats). The treatment duration was of five days. <b>Results:</b> Paw Withdrawal Latency (PWL) was significantly decreased (p<0.001) and both number of writhing movements and serum leptin concentrations were significantly increased (p<0.001) in obese female control group compared to obese male control group. Tramadol treated both obese male and female rats had significantly increased PWL (p<0.001) and decreased both number of writhing movements and serum leptin concentration (p<0.001) in comparison with both obese male and female control groups respectively. In tramadol treated obese female rats, PWL was significantly decreased (p=0.048) and both number of writhing movements and serum leptin concentration were significantly increased (p<0.001) in comparison with the tramadol treated obese male rats. PWL was negatively correlated with serum leptin concentration (Pearson correlation coefficient= -0.754, 2-tailed significance; p<0.001) and number of writhing movements were positively correlated with serum leptin concentration (Pearson correlation coefficient=0.507, 2-tailed significance; p=0.011). <b>Conclusion: </b>The present study revealed that obese female rats have more serum leptin concentration than obese male rats which could be one of the possible reasons for having more pain sensation to noxious stimuli in obese female rats compared to obese male rats. Tramadol treatment at the dose of 10 mg/kg for five days has decreased serum leptin level in rats which might be one of the additional analgesic mechanisms of action of tramadol. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=FC06-FC10&id=11668 https://doi.org/10.7860/JCDR/2018/36789.11668 Comparative Analysis of External Quality Assessment Results from Dimension EXL 200 and VITROS® 4600 Bhasker Mukherjee, Kanchan Kulhari, Sanjeev Kumar Mishra, Rakhi Negi <b>Introduction:</b> In order to maintain a strict control over the results generated in clinical chemistry laboratories, a number of procedures are followed to maintain the quality of results. The procedures followed in order to compare the performances between different laboratories are known as External Quality Assessment (EQA). Separate EQA programmes for different analysers are recommended as the methods and principles may be different for them. <b>Aim:</b> To compare the performance of EQA results from Dimension EXL 200 and VITROS® 4600 analysers from two consecutive years and to analyse differences, if any. <b>Materials and Methods:</b> The clinical chemistry laboratory of this tertiary care hospital is enrolled in EQA with CMC Vellore. The lab has Dimension EXL 200 and VITROS® 4600 analysers. The results from two different EQA cycles of 2016 (Dimension EXL 200) and 2017 (VITROS® 4600) have been for analysed and compared. The Variable Index Score (VIS) and Standard Deviation Index (SDI) from these reports were analysed. <b>Results:</b> The data for 2016 for Dimension EXL 200 had 15 parameters in the EQA while VITROS® 4600 had 20 parameters in the EQA list. There were some parameters that were not common and hence have not been compared. The overall VIS for the Dimension had 07 parameters (46.7%) VIS (<100) ‘very good’, 05 (33%) VIS (100-150) ‘good category’, 02 (13%) VIS (151-200) in ‘satisfactory’ and 01 (07%) parameter had VIS (>200) ‘not acceptable’ category. The overall VIS for the VITROS® 4600 had 15 parameters (75%) with VIS (<100) ‘very good’, 04 (20%) with VIS (100-150) ‘good category’, 01 (13%) with VIS (151-200) in ‘satisfactory’ category. The SDI of the same parameters on both the equipments were similar with DIMENSION having 12 (86%) and VITROS 4600 having 11 (79%) results in the ‘excellent’ category while each had a single parameter in the ‘accept with caution’ category with no parameter requiring any corrective action. <b>Conclusion:</b> The VIS results from the VITROS® 4600 as compared to Dimension EXL 200 showed marked improvement with 71.4% parameters undergoing a reduction in the VIS values while the SDI results were mostly similar. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=BC09-BC12&id=11669 https://doi.org/10.7860/JCDR/2018/31368.11669 Accuracy and Usability Evaluation of Six Commercially Available Blood Glucose Monitoring Systems Anastasios Tentolouris, Ioanna Eleftheriadou, Pinelopi Grigoropoulou, Maria Nikoloudi, Evangelia Siami, Diamantis I Tsilimigras, Nikolaos Tentolouri <b>Introduction:</b> Self-Monitoring of Blood Glucose (SMBG) is essential for achieving glycaemic control in individuals with diabetes mellitus. <b>Aim:</b> The aim of the study was to evaluate the accuracy and the usability of six different commercially available SMBG systems. <b>Materials and Methods:</b> A total of 120 individuals with both types of diabetes, aged between 18-80 years, were recruited. Capillary Blood Glucose (BG) was measured on six SMBG systems, while the YSI 2300 STAT PLUS was used as a reference method. Accuracy performance was based on requirements resembling the ISO 15197:2013 (95% of the BG results within ±15 mg/dL of the reference method at BG concentrations <100 mg/dL and within ±15% of the reference method at BG concentration =100 mg/dL). Usability testing of the SMBG was performed using the Likert Scale Questionnaire. <b>Results:</b> Four out of six and five out of six glucometers demonstrated excellent performance in BG values <100 mg/dL (n=40) and in BG values =100 mg/dL (n=80), respectively. Across the overall BG range tested, five out of six SMBG systems had good accuracy performance. Among the three SMBG systems with the highest performance (>99%) in the overall BG range (29-475 mg/dL) the one with an innovative strip insertion technique was less favoured by the participants. <b>Conclusion:</b> Most of the examined commercially available SMBG devices demonstrated adequate performance when they were tested in requirements resembling the ISO 15197:2013. Regarding usability, the Accu-Chek Aviva Plus and the Contour Next were the most convenient devices. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=OC10-OC14&id=11671 https://doi.org/10.7860/JCDR/2018/34055.11671 The Effect of Haemodialysis on Lipid Peroxidation and Lipid Atherogenic Risk Ratios as a Predictor of Cardiovascular Disease Hanan Mahmoud Fayed, Abdelkader Ahmed Hashim <b>Introduction:</b> Cardiovascular risk factors are prevalent in Haemodialysis (HD) patients. <b>Aim:</b> To assess the effect of HD on lipid peroxidation marker (Malondialdehyde (MDA)), lipid atherogenic ratios, and peripheral inflammatory markers in HD patients. <b>Materials and Methods:</b> A cross-sectional case-control study was conducted on 60 patients on regular HD attending nephrology unit of Luxor general hospital between June 2016 and May 2017, (33 males/27 females) and 30 healthy controls (17 males/13 females) were enrolled. Blood samples were obtained for estimation of lipid profile, MDA, and complete blood counts. One-way analysis of variance (ANOVA) was used for comparisons between groups, receiver operator characteristic curve was performed to obtain the cut-off value of MDA, sensitivity, specificity, and area under the curve was used to discriminate between HD patients and controls. The correlation study was used to measure the relationship between variables. Logistic Regression (Odd’s Ratio) was performed for calculation of cardiac risk factors for heart attack in HD cases. <b>Results:</b> HD patients had significantly low WBCs (p=0.010) and lymphocyte counts (p<0.00001); with insignificant difference between pre- and post-HD. HD-patients had significantly higher cholesterol (p=0.019), triglycerides, VLDL-c, MDA (p<0.00001) and non-HDL-c (p=0.002) all increased significantly post-HD. Inversely, HDL-c was significantly lower in HD-patients and decreased significantly in post-HD (p<0.00001). HD-patients had significantly higher indexes for (TC/HDL, LDL/HDL, VLDL/ HDL, TG/HDL, Non-HDL/HDL) (p<0.00001), monocyte: HDL ratio (p=0.003) and Platelet: Lymphocyte Ratio (PLR) (p=0.042) all significantly increased post-HD. Inversely; HD-patients had significant lower LDL/VLDL (p<0.00001) and Lymphocyte: Monocyte Ratio (LMR) (p=0.0003) with insignificant difference between pre- and post-HD. However, Neutrophil: Lymphocyte Ratio (NLR) (p=0.095), monocyte count (p=0.626) showed insignificant difference. MDA was correlated with TG, VLDL, non-HDL/HDL, and TG/HDL; but multivariate regression analysis indicates inter-related variables and none was considered independent risk factor. <b>Conclusion:</b> HD worsens oxidative stress caused by uraemia and accentuates lipid peroxidation and dyslipidemia present in HD patient. Lipid peroxidation and dyslipidemia are probable independent modifiable risk factor that contributes to high morbidity and mortality by promoting cardiovascular complications. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=OC15-OC20&id=11672 https://doi.org/10.7860/JCDR/2018/35033.11672 Influence of Type 2 Diabetes on Serum Electrolytes and Renal Function Indices in Patients Godwill Azeh Engwa, Friday Nweke Nwalo, Thom-Justus Chidera Atta ma, Micheal Chinweuba Abonyi, Emmanuela N. Akaniro-Ejim, Marian N. Unachukwu, Ambrose N. Njokunwogbu, Benjamin Ewa Ubi <b>Introduction:</b> Type 2 diabetes, a disease condition characterised by hyperglycaemia can damage the kidney, an organ which regulates water and electrolytes. Also, high blood sugar can increase plasma osmolarity thereby, drifting water movement from the intracellular to the extracellular spaces and alter the distribution of electrolytes in the body. However, little is known on the relationship between serum electrolytes, renal function and Type 2 Diabetes (T2D). <b>Aim:</b> This study was aimed to assess the serum electrolyte level of diabetic patients in order to evaluate the relationship of these electrolytes with renal dysfunction indices as well as other diabetes risk factors in T2D patients. <b>Materials and Methods: </b>A case-control study involving 72 T2D and 75 Non-Diabetic (ND) outpatients was conducted at Enugu State University Teaching Hospital (ESUTH) Enugu, Nigeria. The patients’ demographic and anthropometric data was obtained and the serum electrolytes; potassium (K+), sodium (Na+) and chloride (Cl-) ions along with creatinine and urea as renal function indices were measured. <b>Results:</b> Serum K+ was significantly higher (p = 0.002) in T2D patients while Na+, Cl-, creatinine and urea were insignificantly higher in T2D patients compared to the ND patients. Serum K+ disorder were significantly greater (p<0.05) in T2D patients as 8.8% of T2D patients were hyperkalaemic compared to ND patients (2.7%). Creatinine level positively correlated with K+ (p = 0.004) while age, Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) correlated with serum electrolytes. <b>Conclusion:</b> T2D was found to promote electrolyte imbalance particularly potassium ion derangement and may affect renal function. Risk factors of T2D such as old age and high blood pressure may also promote electrolyte disorders. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=BC13-BC16&id=11673 https://doi.org/10.7860/JCDR/2018/35940.11673 Expression of Extracellular Matrix Metalloproteinase Inducer (CD147) in Astrocytomas: A Histopathological and Immunohistochemical Study Samia Mohammed Gabal, Samar AbdelMonem Elsheikh, Mona Salah El-Din Abdelmaged, Rania Mohamed Sabry <b>Introduction:</b> Extracellular Matrix Metalloproteinase Inducer (EMMPRIN), also known as CD147, is a member of the adhesion molecules which play important roles in cellular function both in physiological and pathological processes. The main function of EMMPRIN is its role in tumour metastasis, angiogenesis, and chemoresistance. <b>Aim:</b> To investigate the immunohistochemical expression of EMMPRIN in cases of astrocytic CNS tumours. <b>Materials and Methods:</b> This retrospective study included a total of 60 archived, formalin fixed, paraffin embedded tissue blocks of 60 cases of astrocytic CNS tumours. The samples were immunohistochemically analysed for EMMPRIN expression. <b>Results:</b> A statistically significant correlation was detected between EMMPRIN expression and astrocytic CNS WHO tumour grade (p-value=0.035). <b>Conclusion:</b> EMMPRIN is a prognostic marker in astrocytic CNS tumours. In addition, it is implicated in tumour progression including invasion and migration. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=EC09-EC13&id=11674 https://doi.org/10.7860/JCDR/2018/35218.11674 Crown Dimensions of Deciduous Teeth: The Tool for Predicting the Physical Height of the Child: A Pilot Study Siddhi Nilesh Savla, Swati Shrikant Gotmare, Treville Pereira, Mandavi Waghmare, Sushma Sonawane, Tanmik Shah, Anish Gupta, Nithi Rajadhyaksha <b>Introduction:</b> Dental profiling is one of the well known methods in forensic sciences that help in identification of disaster victim. In forensic sciences there are many techniques used for personal identification which give definite results. As adult height estimation can be done by measuring the dimensions of the long bones of hand, foot and vertebral column, similarly stature of the child can be estimated using tooth dimension. <b>Aim:</b> To evaluate the relationship between height of the child and the clinical crown length of deciduous teeth. <b>Materials and Methods:</b> The sample size used in the present study was 30, comprising of 15 boys and 15 girls which ranged in the age group of 3-6 years. The clinical crown length of tooth numbers-51, 52, 53, 54, 55 were measured with the help of Vernier calliper and standard measuring tape was used to measure the height of the child. Ratios of the crown length and height were calculated. Student’s unpaired t-test and Pearson’s correlation coefficient was used to evaluate the relationship between the tooth crown length and height of the child. <b>Results:</b> Significant values were obtained in tooth numbers-52 in combined samples, 51 and 52 in male samples and 53 in female samples. Mean height of the crown in male patients with respect to tooth number 51, 52, 53, 54 and 55 were found to be 5.89, 4.77, 5.94, 4.55, and 4.18 respectively. However, the mean height of the individuals was found to be 942.84 mm. The mean height of crown in females was 5.02, 4.53, 5.31, 4.76 and 4.68 respectively while their mean height was found to be 1001.77 mm. <b>Conclusion:</b> As per the present study, clinical crown length of anterior teeth (51, 52) in males can be used for predicting the physical height of the child and clinical crown length of canines (53) in female can be used for predicting the physical height of the child with caution. For more significant results, further studies should be done with a larger sample size. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=ZC01-ZC03&id=11659 https://doi.org/10.7860/JCDR/2018/31369.11659 Influence of Gender, Class Year, Academic Performance and Paternal Socioeconomic Status on Learning Style Preferences among Dental Students Muhammad Ashraf Nazir, Asim Al-Ansari, Faraz Ahmed Farooqi <b>Introduction:</b> Satisfaction with student learning is a big challenge for instructors in dental education. However, better understanding of learning style preferences and their associated factors can help provide rewarding learning experience to the students. <b>Aim:</b> The study evaluated the influence of gender, class year, academic performance and paternal socioeconomic status on learning style preferences among dental students. <b>Materials and Methods:</b> This cross-sectional study included male and female students (second-year to six-year class) from a dental college. The Visual, Aural, Read/write and Kinesthetic (VARK) questionnaire version 7.8 was used to collect data about students’ preferences for VARK learning modes. Gender, socioeconomic status, year of study, and Grade Point Average (GPA) were independent variables in the study. Chi-square test and Kruskal Wallis H test were performed to evaluate the influence of these independent variables on learning style preferences. <b>Results:</b> Of 452 students, 389 returned the questionnaires with a response rate of 86.06%. The sample comprised 46.5% of male and 53.5% of female students. Mean age of students was 20.42±0.99 years. In the study, 76% dental students preferred unimodal learning style, of which kinesthetic was the most common (23.7%) style. Male students predominantly (29%) preferred multimodal while most female students (23%) demonstrated kinesthetic style. Preclinical students had the highest proportion of multimodal learners (25.7%) whereas clinical year students had the highest percent of visual learners (24.2%) with (p-value=0.038). The students with high GPA preferred multimodal learning style (25.4%) whereas most of the students with low GPA (32.9%) learned through doing things (kinesthetic). No significant influence of gender, GPA, and of paternal income and education on learning styles was observed. <b>Conclusion: </b>Most students had preferences for unimodal learning style. Paternal income and education, gender and GPA had no significant association with learning style preferences. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=ZC04-ZC08&id=11660 https://doi.org/10.7860/JCDR/2018/35692.11660 Morphometric Analysis of the Sacrum and its Surgical Implications Sandeep Saluja, Sneh Agarwal, Anita Tuli, Shashi Raheja, Sarika Rachel Tigga, Shipra Paul <b>Introduction:</b> The predisposition of the human sacrum to a wide range of traumatic, degenerative and metastatic ailments demands frequent surgical interventions. For effective surgical management of these conditions, a comprehensive anatomical knowledge of the sacrum is mandatory but variability in morphometric dimensions exists amongst different population and precludes the standardisation of measurements. <b>Aim:</b> To present a morphometric reference database for sacral instrumentation in Indian population and enable comparisons with other populations. <b>Materials and Methods:</b> The study was performed on 108 adult human sacra. Linear measurements of the sacra were taken with the help of digital Vernier’s calliper and angular parameters were determined with a goniometer. <b>Results:</b> The morphometric analysis of the sacra of Indian population demonstrated that height and width of the first Anterior Sacral Foramina (ASF) were 12.97 mm and 12.23 mm respectively while height and width of the first Posterior Sacral Foramina (PSF) were 10.36 mm and 7.66 mm respectively. The height and width of the second ASF were 12.85 mm and 13.13 mm respectively but the height and width of the second PSF were 7.05 mm and 7.30 mm respectively. Further, the anterior and posterior pedicle height was observed to be 20.74 mm and 20.18 mm respectively. Anteromedial and anterolateral screw trajectory distance were noted to be 45.67 mm and 44.60 mm respectively. The S1 pedicle depth was 23.48 mm but the S1 wing depth was 44.09 mm. Furthermore, there existed a highly significant difference (p<0.001) between the angular parameters of the right and left sides. <b>Conclusion:</b> The height and width of the sacral foramina along with transverse distances between them were less in Indian sacra. Anterior pedicle height was observed to be greater in Indian sacra. However, posterior pedicle height was found to be lower than the values reported by other population. Additionally, the screw trajectory distances also displayed lower values in Indian population. Hence, present study signifies the application of screws of shorter length during sacral instrumentation as the morphometric dimensions are of lesser value in Indian population. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=AC01-AC06&id=11661 https://doi.org/10.7860/JCDR/2018/33991.11661 Assessment of Female Satisfaction with the Role of Male Community Pharmacists in the Kingdom of Saudi Arabia Mahmoud S Alhaddad, Ethar Abdullah Mudhish, Rawan Abdulrahman Bukhari, Al-Anood Aoun Aladwani, Shahad Mohammed Asiri <b>Introduction:</b> Traditionally, females in Saudi Arabia are usually embarrassed to discuss feminine related issues with males, who are the only pharmacy services providers at community pharmacies in the Kingdom. With a lack of data present on the assessment of this facet, the current study was performed to know about the comfort among females while approaching male community pharmacist’s. <b>Aim: </b>To assess the level of satisfaction of female residents in Kingdom of Saudi Arabia (KSA) regarding services provided by male community pharmacists. <b>Materials and Methods:</b> A cross-sectional study using non probability convenience sampling technique was conducted from 3rd January 2016 to 31st March 2016. A total of 1200 participants were approached in the public areas of Taif City for electronic and face to face interviews using a pre-validated questionnaire. Chi-square and Fisher’s-exact tests were used to analyse the data and all p-values of less than 0.05 was considered significant. <b>Results:</b> A total of 290 respondents (35.3%) were completely satisfied with male community pharmacists’ services; while (n= 415, 50.5%) participants were only satisfied to a certain extent. About (n=512, 63%) participants were embarrassed to discuss with male pharmacist about the sensitive women requirements. About (n=501, 61%) of the participants preferred the presence of female pharmacists at community pharmacies. <b>Conclusion:</b> Almost, two-thirds of the participants were satisfied at least to a certain extent from services provided by male community pharmacists. Decision makers in Saudi Arabia should consider the involvement of female pharmacy graduates in KSA to provide services at community pharmacies. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=FC01-FC05&id=11662 https://doi.org/10.7860/JCDR/2018/33921.11662 Comparison of Refractive Error Measurements between KR-1W Wavefront Analyser and KR-8800 Automatic Refractometer in School Children Jing Dong, Qiang Wu, Xiaogang Wang <b>Introduction:</b> A number of methods and instruments, such as retinoscopy, Hartmann-Shack sensor, ray tracing method and rotary prism technology, are available for assessing refractive status in clinic. The literature on comparison of refractive error values between KR-1W wavefront analyser and KR-8800 automatic refractometer is not adequately available. <b>Aim:</b> To compare refractive error measurements taken by KR- 1W wavefront analyser and KR-8800 automatic refractometer and study factors influencing the refractive error values, such as age and gender. <b>Materials and Methods:</b> As a prospective observational study, one eye of 57 school children underwent refractive error measurements with the sequence of KR-8800 and KR-1W with the time interval less than five minutes under no cycloplegic condition. The interdevice agreement was evaluated using the Bland-Altman analysis, Pearson correlation coefficient, and paired two-tailed t-test. Vector analysis was used to compare astigmatism measurements. <b>Results:</b> The spherical power values measured by the KR8800 were significantly more negative about 0.16±0.51 diopter than those of the KR-1W (p=0.024). The cylinder power values measured by the KR-8800 were significantly more positive about 0.11±0.32 diopter than those of the KR-1W (p=0.014). Moreover, KR-8800 and KR-1W were significantly different in astigmatism measurements using vector analysis. There was a significant linear correlation between the KR-8800 and KR-1W instruments for the spherical error (r=0.974, p<0.0001), cylinder power (r=0.807, p<0.0001). The interdevice 95% Limits of Agreement (LoA) range for the spherical error and cylinder power were 2.02 D and 1.25 D, respectively. Age negatively correlated with spherical error and cylinder power and the spherical error showed much more negative correlation values than cylinder power. However, gender showed no significant correlations with neither spherical error nor cylinder power of both instruments. <b>Conclusion:</b> The spherical power and astigmatism showed significant difference between the KR-1W and KR-8800 devices. However, the measurements of the two instruments showed significant linear correlation to each other. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=NC09-NC12&id=11663 https://doi.org/10.7860/JCDR/2018/34555.11663 Ketamine versus Dexmedetomidine Sedation in the Attenuation of Surgical Stress Response and Postoperative Pain: A Retrospective Study Basak Altiparmak, Melke Korkmaz Toker, Ali Ihsan Uysal <b>Introduction:</b> Surgical procedures cause stress response in the body. This response involves endocrine, metabolic, haematologic and immunologic reactions. Ketamine has an anti-proinflammatory effect as limiting exacerbation of systemic inflammation. Likewise, dexmedetomidine has anti-stress, sedative, analgesic actions and decreases surgical stress response and leads to better stable haemodynamic properties. <b>Aim:</b> To compare effects of ketamine, dexmedetomidine and determine correlation between postoperative pain scores and serum C-reactive protein on surgical stress response. <b>Materials and Methods:</b> Electronic records of 121 patients who had inguinal hernia repair were analysed retrospectively. Patients’ age, sex, operation time, sedation drug, preoperative and postoperative C-Reactive Protein (CRP) and leukocyte levels, postoperative visual analogue scale scores were recorded. Normality of the variables were analysed by Kolmogorov-Smirnov test and homogeneity was analysed by Levene’s test. Mean tests were compared using independent t-test if data distribution was normal or using nonparametric Mann-Whitney U-test if data were not distributed normally. Pearson's correlation was used to analyse correlation between VAS score and postoperative CRP level. The p-value <0.05 was considered statistically significant. <b>Results:</b> Postoperative mean CRP level was 42.3±9 mg/dL in ketamine group and 65.4±6.6 mg/dL in dexmedetomidine group. Mean visual analogue scale at postoperative 24th hour was 2.6±0.8 in ketamine group and 3±0.7 in dexmedetomidine level. These differences were statistically significant (p<0.05). Leukocyte counts were similar between groups. There was a moderate positive correlation between postoperative 24th hour CRP levels and pain scores. <b>Conclusion:</b> Ketamine was found to be more effective then dexmedetomidine at attenuation of surgical stress response. Postoperative serum CRP level was correlated with postoperative pain scores. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=UC10-UC12&id=11657 https://doi.org/10.7860/JCDR/2018/34139.11657 Childhood Cancer in Brazil: Characterising from a 15-year Temporal Analysis Laís Guedes Alcoforado de Carvalho,Isabella Lima Arrais Ribeiro,Candice Regadas Gondim,Renato Carvalho Morais Junior,Gabriel Garcia de Carvalho,Hellen Bandeira de Pontes Santos,Ana Maria Gondim <b>Introduction:</b> Childhood cancer has a high incidence worldwide. Knowing how this disease presents itself in childhood is important for a correct diagnosis. <b>Aim:</b> This study aimed at characterizing childhood cancer in Brazil, indicating the histological type of cancer and the most prevalent tumour site for this age group, in a 15-years temporal analysis. <b>Materials and Methods:</b> This was an epidemiological, ecological, sectional, and descriptive study with a quantitative data approach. The data from the Hospital Records of Cancer (HRC), between the years of 2000 and 2014, were evaluated. A total of 57,006 cases of childhood cancer, from 0 to 19-year-old, were evaluated. The variables selected were: age, gender, previous history of cancer, most relevant base for diagnosis, primary tumour site and histological type of cancer. The descriptive and inferential statistical analysis was performed using the IBM SPSS software (20.0), using Chi-Square test, Kolmogorov-Smirnov to test the data’s normal distribution, Kruskal-Wallis Test, and Mann-Whitney Test (Significance level of 5%). <b>Results:</b> The childhood cancer cases had a higher prevalence among males (54.1%). The most frequent histological types of cancer were Acute Lymphoblastic Leukaemia (12.6%) and Acute Myeloid Leukaemia (4.6%). The predominant site was the bone marrow (28.0%), followed by lymph nodes (10.8%). The distribution of mean age varied between the histological types and location of childhood tumours (p<0.001). The Retinoblastoma and the Willm’s tumour were more frequently observed in early childhood patients, mean age of 1.90 (±1.94) and 3.69 (±3.18), respectively. The Hodgkin Lymphoma and Osteosarcoma were more frequently detected in patients with mean age of 13.43 (± 4.48) and 13.65 (±3.60), respectively. <b>Conclusion:</b> During the years of 2000 to 2014 in Brazil, childhood cancer has mainly affected males, with a mean age of 9.48; for females, the most prevalent age was 9.39. The most prevalent types of neoplasms were Acute Lymphoblastic Leukaemia and Acute Myeloid Leukaemia. There are differences in the mean age of the different types of tumour and tumour sites approached. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=XC04-XC07&id=11628 https://doi.org/10.7860/JCDR/2018/35720.11628 Comparative Evaluation of Dexmedetomidine and Tramadol for Attenuation of Post-Spinal Anaesthesia Shivering Arjun Verma, Dhiraj Bhandari, Pradeep Dhande, Sudha Jain, Sucheta Tidke <b>Introduction:</b> It is important that as anaesthesiologists we understand the adverse effects of hypothermia and shivering on human body which can occur when the patients are anaesthetized, and provide timely intervention. Various non-pharmacological and pharmacological methods have been studied to control intraoperative shivering with varying success. Tramadol and dexmedetomidine have been studied in literature with varying success but few studies have been reported from the Indian subcontinent. <b>Aim:</b> To compare the effects of dexmedetomidine 0.5 µg/kg with tramadol 0.5 mg/kg for treating shivering developed intraoperatively after spinal anaesthesia for patients undergoing lower limb, lower abdominal surgeries, gynaecological procedures and caesarean sections. <b>Materials and Methods:</b> This was a prospective, randomised, double blind comparative study carried out in the Department of Anaesthesiology of a tertiary care Rural Medical College and Hospital. All patients who fulfilled the inclusion criteria and developed post-spinal anaesthesia shivering during the intraoperative course were enrolled and randomised equally into either of the two groups. Group D (n=60) received inj. dexmedetomidine 0.5 µg/kg IV whereas Group T received inj. tramadol 0.5 mg/kg IV after development of post-spinal anaesthesia shivering. Response rate, haemodynamics, recurrence of shivering and complications were monitored. The data was statistically evaluated using STATA version 10 software. <b>Results:</b> A 98.30% of patients shivering ceased after administration of dexmedetomidine, where as success rate was 86.67% in tramadol group. There was early response as well as less recurrence of shivering in dexmedetomidine group. Nausea and vomiting occurred significantly more in tramadol group. There was no significant haemodynamic instability in any group. <b>Conclusion:</b> Dexmedetomidine when used at a dose of 0.5 µg/kg IV is more effective and rapid than tramadol used at a dose of 0.5 mg/kg IV to treat shivering as developed after spinal anaesthesia without any increased side effects as well as inducing a comfortable sedation for the patient. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=UC01-UC04&id=11599 https://doi.org/10.7860/JCDR/2018/28136.11599 Cutaneous Correlates of Metabolic Syndrome and its Components in Ogbomoso, Nigeria Adeolu Oladayo Akinboro, Abdulkareem Afolabi Salawu, Olugbenga Edward Ayodele, Olaniyi Emmanuel Onayemi <b>Introduction:</b> Metabolic syndrome (MetS) has been associated with some skin disorders including psoriasis, acne vulgaris, hidradenitis suppurativa, androgenetic alopecia, atopic dermatitis and many others. Although metabolic syndrome is not a dermatological entity, but the increasing isolated reports of its association with cutaneous disorders is a reason for a cross sectional study of this nature. <b>Aim:</b> To examine cutaneous correlates of MetS and its components as defined by National Cholesterol Education Program-Adult Treatment Panel (NCEP ATP) III criteria. <b>Materials and Methods:</b> A cross-sectional study was conducted in which 197 apparently healthy male and non-pregnant female adults attending the General Outpatient Department (GOPD) of Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital, Ogbomoso, Nigeria were included. MetS was diagnosed using NCEP-ATP III criteria and the participants’ skin examined for cutaneous disorders. Univariate and multivariate logistic regression were utilised to demonstrate association between metabolic syndrome, its components and cutaneous disorders. <b>Results:</b> The prevalence of MetS was 32.9%, of which 86.2% of participants were females. Skin disorders associated with MetS reflected the dominance of central obesity on other components. Flat feet (38.5%, p=0.005), and striae (32.3%, p=0.003) were significantly associated with metabolic syndrome in univariate analysis. Abdominal obesity was significantly associated with flat feet (42.7%, p<0.001), achrocordon and varicose veins (18.0% each, p=0.006), striae distensae (31.5%, p<0.001), candida intertrigo and erythrasma (12.4% each, p=0.001). Participants with Striae and flat feet had significant higher mean waist circumference (p<0.001), mean systolic blood pressure (p=0.022 and 0.034 respectively), diastolic blood pressure (p=0.013 and 0.019 respectively) and higher mean BMI (P<0.001). Flat feet was associated with significant higher mean total cholesterol (4.89±1.34 vs. 4.50±1.14, p=0.046) and LDL-c (3.34±1.25vs. 2.86±1.05, p=0.008). In multivariate analysis, the presence of flat feet predicts the odds of metabolic syndrome by 2.2 (95%CI-1.0-4.7, p=0.039) after adjustment of confounders. <b>Conclusion:</b> We demonstrated that flat feet could be an indicator of underlying Metabolic syndrome in obese individuals. Striae distensae, flat feet, and candida intertrigo are significant correlates of abdominal obesity. Obese patients with flat feet are recommended for Metabolic syndrome screenings. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=WC01-WC06&id=11600 https://doi.org/10.7860/JCDR/2018/34103.11600 Does Two Hour Post 75-Gram Sugar Test Levels for Diagnosis of Gestational Diabetes Correlate with Type of Intervention Required? An Audit from Tertiary Care Center of India Namrata Kumar, Vinita Das, Anjoo Agarwal, Amita Pandey, Smriti Agrawal <b>Introduction:</b> Gestational diabetes mellitus is carbohydrate intolerance of variable severity with onset or first recognition during pregnancy. <b>Aim:</b> This study was planned to correlate the relation of 2 hours post 75-gram glucose test done irrespective of meals with type of intervention required and fetomaternal outcome. <b>Materials and Methods: </b>This was a retrospective observational study conducted over a period of one year. All women registering in antenatal outpatient department in the university and who were diagnosed with gestational diabetes were enrolled in the study. Total number of women registered was 1922. Out of them, 211 had sugar level more than or equal to 140 mg/dL while 14 were having type 2 diabetes known prior to pregnancy. Data was analysed using Statistical Package for Social Sciences (SPSS) version 15.0. Frequency distribution, percentages and students t-test was used for statistical analysis. <b>Results:</b> Occurrence of GDM came out be 10.9% in our antenatal population. With increasing sugar levels, insulin requirement increases. Three fourth of the women with Diabetes In Pregnancy Study group of India (DIPSI) sugar test levels between 140-160 mg/dL were well controlled with medical nutrition therapy itself. Our study showed that more than half of the women on MNT alone could be easily carried beyond 37 weeks. However, the number perhaps reduced significantly in patients who required insulin in addition to MNT. Intrauterine demise, preterm births and FGR are more common compared to foetal malformation and macrosomia in our population. <b>Conclusion: </b>Timely diagnosis and intervention is of great help in improving both short and long term health benefits in mother and baby. Medical nutrition therapy is an easy intervention with definite benefits. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=QC06-QC09&id=11587 https://doi.org/10.7860/JCDR/2018/35514.11587 Reamed Intramedullary Nailing Versus Anatomic Plating by MIPO in Distal Tibia Extra-Articular Metaphyseal Fracture Mayank Mahendra, Rahul Singh <b>Introduction:</b> Distal tibia metaphyseal extra-articular fractures are common injuries and despite of advancement in management, optimal surgical technique is still controversial because of their close proximity with ankle joint and soft tissue scarcity. <b>Aim: </b>To evaluate and compare the functional outcome of anatomic plating with minimally invasive plate osteosynthesis technique (MIPO) and reamed Intramedullary (IM) nailing for distal tibia extra articular metaphyseal fracture. <b>Materials and Methods:</b> Forty five patients with type Orthopaedic Trauma Association (OTA) 43A fracture were included and treated with anatomic plate fixation (Group A, n=20) and IM nailing (Group B, n=25) and followed up for minimum of two years. Results compared using independent student’s t-test and Oleurd Molandar score for functional evaluation. <b>Results:</b> No significant difference was found for mean union time (Group A 26.6±7.14 weeks, Group B 25.6±4.07 weeks, t-value 0.11, p-value 0.594), angulation (Group A 1.45±2.66°, Group B 3.54±3.66°, t-value 0.76, p-value 0.107) and shortening (Group A 0.21±0.32 cm, Group B 0.28±0.34 cm, t-value 0.009, p-value 0.446). Surgical time however was significantly shorter in Group B (Group A 94.5±10.11 minute, Group B 79±5.59 minute, t-value 2.0, p-value< 0.05). Malunion occured in one patient (5%) in Group A and in 4 patients (16%) in Group B. Mean Oleurd Molandar score in group A was 81.5±12.9 (range, 95-40) and in Group B was 82.4±11.5 (range 95-60). <b>Conclusion:</b> There was no difference pertaining to union rate, angulation, shortening and functional Oleurd Molandar score in IM nailing and anatomical plating groups however, IM nailing had the advantage of shorter surgical time. We conclude that both anatomical plating and IM nailing are possible treatment for distal tibia extra articular metaphyseal fracture. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=RC01-RC04&id=11584 https://doi.org/10.7860/JCDR/2018/30181.11584 A Study to Analyse the Influence of Bacterial Bio-Burden on the Success Rate of Split Thickness Skin Grafting S Geethabanu, R Vanaja <b>Introduction:</b> Split Thickness Skin Grafting (STSG) is one of the main surgical procedures to repair soft tissue loss in patients with non-healing chronic wounds. Even when the prerequisites for successful grafting are met, graft may fail if the wound bed contains more than 105 bacteria/g of tissue. Hence in this present study quantitative bacteriological profile of granulating wound beds that were prepared for grafting was done preoperatively, to analyse the influence of bacterial bio-burden on the success rate of STSG. <b>Aim:</b> 1) To determine quantitative aerobic bacterial culture of granulating wounds that are prepared for grafting; 2) To assess the success rate of graft uptake postoperatively. <b>Materials and Methods:</b> This cross-sectional study was carried out in the Institute of Microbiology, Madras Medical College, Chennai, Tamilnadu, India. A total of 100 patients prepared for STSG surgery were included in this study from March 2016 to August 2016. Tissue sample from the recipient wound bed was collected before grafting and quantitative aerobic bacterial culture of the specimen was done. <b>Results:</b> Out of 100 patients, 32 patients had significant bacterial growth with bacterial counts =105CFU/g of tissue in preoperative quantitative culture. On clinical evaluation the graft uptake was reduced when preoperative quantitative bacterial count is = 105CFU/g of tissue, which was statistically significant. The most commonly isolated pathogens in preoperative quantitative culture were Staphylococcus aureus (26.4%) and Pseudomonas aeruginosa (26.4%). The mean graft uptake was reduced by 24.5% and 31.2% if immediate preoperative culture showed Staphylococcus aureus and Pseudomonas aeruginosa respectively when compared to the no growth group, which was statistically significant. <b>Conclusion: </b>This study emphasises the importance of quantitative and qualitative bacteriological culture of pre-grafted wound beds prior to skin grafting, thereby preventing graft failure. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=DC23-DC26&id=11607 https://doi.org/10.7860/JCDR/2018/35793.11607 Serum Zinc Levels in Thai Children with Acute Diarrhoea Sanguansak Rerksuppaphol, Nicharee Na-Songkhla, Lakkana Rerksuppaphol <b>Introduction:</b> Diarrhoea remains a leading cause of morbidity and mortality in children in developing countries. Zinc has been recommended by the WHO for the prophylaxis and treatment of acute diarrhoea. However, data on zinc levels in children remains scarce. <b>Aim:</b> To assess serum zinc levels in children admitted with acute diarrhoea to the paediatric unit of Srinakharinwirot University Hospital, Thailand. <b>Materials and Methods:</b> A cross-sectional study was conducted in children admitted to hospital with the diagnosis of acute diarrhoea, between July 2016 and February 2017. Children < 60 months, with watery and/or mucous stool >3 times within previous 24 hours were included. Anthropometric parameters were recorded. Serum electrolytes, Complete Blood Count (CBC) and serum zinc levels were measured. Children with serum zinc level lower than thresholds as recommended by the International Zinc Nutrition Consultation Group criteria and time of collection were defined as zinc deficient. The results were descriptively presented as mean and standard deviation, median and Interquartile Range (IQR), or frequency and percentage. Pearson’s chi-square or Fisher-exact test was used to compare proportions between groups, whereas, Student’s t-test or Mann-Whitney U-test was used to verify the differences of continuous variables. <b>Results:</b> Fifty children with acute diarrhoea were included in the study (50% female). The median duration of diarrhoea prior to admission was 24.0 hours (IQR, 12.0-72.0 hours) and the frequency of diarrhoeal episodes in preceding 24 hours was 4 times (IQR, 3-6 times). Mean serum zinc concentration at admission was 69.2±18.5µg/dL. A total of 22 (44%) children had zinc deficiency. There were no significant differences in demographic and clinical characteristics between patients with normal zinc levels and those with zinc deficiency. <b>Conclusion:</b> There is a high prevalence of low zinc levels in Thai children with acute diarrhoea. More efforts are needed towards improved coverage of zinc supplementation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=SC01-SC04&id=11576 https://doi.org/10.7860/JCDR/2018/34703.11576 Economic Analysis of Type-2 Diabetes Mellitus in Vietnam: A Retrospective Study at a District Hospital, Ba Ria-Vung Tau Province Trung Quang Vo, Nhung Thi Tuyet Vo, Thuy Van Ha, Cuc Thi Nguyen, Nguyen Dang Tu Le, Dat Van Truong, Huy Manh Nguyen <b>Introduction:</b> In Vietnam, despite the major health concerns of type-2 Diabetes Mellitus (T2DM), comprehensive information on its economic costs is lacking. <b>Aim:</b> To evaluate the economic burden caused by diabetic patients in a district hospital in Vietnam from 2014 to 2016. <b>Materials and Methods:</b> This retrospective study was conducted from January to June 2017, where the data of 1,841 patients, from 2014 to 2016, were extracted from the records of Dat Do Medical Centre. The study included patients diagnosed with a minimum of explicit diabetic symptoms or prescribed blood glucose lowering medications at a minimal time of one registered outpatient visit and for whom information about hospitalisation without complications was available. Cost components included the costs of operations, pharmaceuticals, diagnostics, hospital beds and health care services. <b>Results:</b> The studied cohort included 582, 670 and 589 patients, in 2014, 2015 and 2016, respectively. The average age range was 59.6±11.2 years. Of the 1,814 patients, 71.8% were females. The economic burden of diabetes was estimated as 26,890; 22,960 and 16,744 USD in 2014, 2015 and 2016, respectively. A comparison based on the ratio of the yearly costs indicated that pharmaceutical costs accounted for the highest percentage (78.9%, 2014–2016). A comparison of the costs of illness per case indicated that the greatest average cost was incurred by the group of patients aged over 69 years, at 40.9±43 USD. <b>Conclusion: </b> Diabetes places a considerable and rising economic burden in Vietnam. Consequently, the findings of this study may form a foundation for the future formulation of investment plans and fund allocations for the appropriate resolution of type-2 diabetes mellitus. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=LC01-LC04&id=11577 https://doi.org/10.7860/JCDR/2018/35725.11577 Economic Aspects of Post-Stroke Rehabilitation: A Retrospective Data at a Traditional Medicine Hospital in Vietnam Trung Quang Vo, Ha Thi Thanh Tran, Nam Phuong Nguyen, Ha Thi Song Nguyen, Thuy Van Ha, Nghiem Quan Le <b>Introduction:</b> Stroke is the leading cause of disability in the world and places an economic burden on the healthcare systems worldwide. About 200,000 stroke patients are diagnosed annually in Vietnam, with 50% mortality, and only 10% of stroke patients recover completely and return to normal life. <b>Aim: </b>To evaluate the economic burden of stroke from a hospital perspective and to extrapolate these costs to southern Vietnam and the whole country. <b>Materials and Methods:</b> A retrospective study was conducted from January 2014 to December 2016 at a public hospital. Patient information was taken from the hospital electronic medical records. The input was ICD-10 code and treatment year, the output was direct medical cost, which included consumer material, diagnosis, hospital bed, laboratory test, operation, medication and other services. <b>Results:</b> Of 1134 patients examined during the period from 2014-2016, 57.9% were male. The average age of rehabilitation after stroke patient was 61.7±12.0 years old. The average hospital stay was 41.9±46.4 days. The most common disease after stroke was hypertension (50.4%). Total direct medical costs on 1,134 patients were 985,701.5 USD and average of 869.2±1,181.4 USD per patient per year. The costs between two patients group, living in rural and living in urban, was statistically different. <b>Conclusion:</b> Rehabilitation after stroke places a severe economic burden in Vietnam. The probable economic value of rehabilitation after stroke management is significant. As such, there is a need for an updated evaluation of the economic impact of post-stroke rehabilitation in Vietnam that also includes more regions within the country and adheres to the new guidelines and recommendations. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=LC05-LC10&id=11578 https://doi.org/10.7860/JCDR/2018/35730.11578 Economic Analysis of Hospitalised Paediatric Community-Acquired-Pneumonia at a Private Hospital in Southern Vietnam, Fiscal Year 2015-2016 Trung Quang Vo, Thoai Dang Nguyen, Quang Vinh Tran, Son Ngoc Xuan Pham <b>Introduction:</b> Community-Acquired Pneumonia (CAP) is a commonly occurring serious disease causing substantial morbidity and mortality worldwide. Various studies of treatment costs for CAP cases indicate that it presents a heavy economic burden to society. <b>Aim:</b> The present study was conducted to estimate the direct medical costs for CAP treatment at a private hospital in Southern of Vietnam. <b>Materials and Methods:</b> A retrospective, prevalence-based study was conducted using the electronic medical records database from the hospital to calculate direct medical costs of hospitalised paediatric (under 18-year-old) cases (ICD-10 code J10-J18) based on hospital, healthcare payer and patient perspectives from January, 2015 to December, 2016. <b>Results:</b> There were 855 patients (males accounted for 54.7%) suffering from CAP in the period 2015–2016, with an average age of 10.8±1.8 years. Patients stayed at hospital an average of 6.5±5.5 days. The average treatment cost per case was ?VND 40 million and hospital beds accounted for the highest proportion of the total costs (41.5%). The total economic burden caused by CAP in the private hospital from 2015 to 2016 was over ?VND 34.1 billion. <b>Conclusion:</b> CAP is a high-burden disease that should receive more attention in treatment and prevention. The findings of this study give policy makers more evidence confirming the high treatment cost of CAP in the Vietnamese context. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=LC11-LC15&id=11579 https://doi.org/10.7860/JCDR/2018/35732.11579 Quality of Working Life among Pharmacists in Vietnam: A Preliminary Study using an Internet-Based Survey Nam Hoang Nguyen, Trung Quang Vo <b>Introduction:</b> The Quality of Working Life (QWL) is an important factor for achieving high-performance effectiveness from workers. Despite the importance of studying QWL to enhance worker satisfaction and performance, little information has been presented in Vietnam on healthcare human resources. <b>Aim:</b> This study aimed to measure the QWL among pharmacists in Vietnam through an Internet-based survey. <b>Materials and Methods:</b> Research was carried out via a cross-sectional study among 185 Vietnamese pharmacists between December 2016 and February 2017. The questionnaire contained 34 items, including questions regarding demographical characteristics and six categories of QWL. These six categories were job and career satisfaction, general well-being, stress at work, control at work, home-work interface, and working conditions. Descriptive statistical analysis, a Mann-Whitney U test and a Kruskal-Wallis H test were utilized to explore the relationship between demographics and QWL. <b>Results:</b> Of the 185 pharmacists surveyed, the average age was 26.65±3.99 and almost two thirds of the sample had a Bachelor degree. Most of the respondents were working in the business and distribution of pharmaceuticals (n=98, 53.0%) and spent about 25 to 50 hours per week working (n=149, 80.5%). The mean overall QWL score was 3.21 out of 5.00 with a Standard Deviation (SD) of 0.58. The QWL score for job and career satisfaction was the highest (mean=3.37, SD=0.7), while the stress at work subscale had the lowest score (mean=2.92, SD=0.94). The factors that affected overall QWL were line of work (?2=14.341, p=0.006), total income (?2=12.132, p=0.007), adequate income (U=2356.500, p<0.001), and working hours per week (?2=7.868, p=0.049). <b>Conclusion:</b> This study on the QWL of pharmacists has demonstrated that aiming to create and maintain a healthy work life for pharmacists is vital to enhance their performance and productivity. The most significant associations were found between QWL and line of work, total income, adequate income, and working hours per week, which could offer managers opportunities to launch appropriate strategies to improve the work lives of their employees. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=LC16-LC20&id=11580 https://doi.org/10.7860/JCDR/2018/35734.11580 Financial Report of Medical Costs Associated with Type-2 Diabetes Mellitus in Vietnam using Hospital Administration Database, 2012-2015 Trung Quang Vo, Quynh Thi Hong Ha, Thuy Van Ha, Ha Thi Thu Nguyen <b>Introduction:</b> Diabetes mellitus is among the top ten causes of death and disability, leading to a large economic burden worldwide. <b>Aim:</b> To estimate the cost of treating Type-2 Diabetes Mellitus (T2DM) from both the third-payer and patient perspective in a public hospital in Vietnam for the period 2012 to 2015. <b>Materials and Methods:</b> A study was conducted using retrospective data from District 9 Hospital in Ho Chi Minh City, Vietnam from January 2012 to December 2015. Demographic information and treatment costs were collected from medical records stored in the hospital’s electronic databases. Treatment costs including the cost of medical examination, diagnosis, pharmaceuticals, procedures and medical supplements was performed by using descriptive statistics. Kruskal-Wallis test and Mann-Whitney test were used to compare costs between patients groups. <b>Results:</b> The average cost per patient for the period 2012 to 2015 was 49.02 (63.65) USD, of which third-payers disbursed 25.28 (33.27) USD, and patients paid 23.74 (36.48) USD. The patients who aged from 60 to 69 paid the highest cost (72.00 USD per patient). Female patients had a significantly higher average treatment cost than did male patients, 55.40 (68.27) USD and 36.57 (51.75) USD, respectively. Patients in the group with a blood glucose level =180 mg/dL had an average treatment cost of 69.93 (80.27) USD and were the highest in all groups of blood glucose levels. <b>Conclusion:</b> This study estimated the cost of treatment for patients with T2DM in order to be a reference for the government to adopt more appropriate diabetes mellitus management policies. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=LC21-LC25&id=11581 https://doi.org/10.7860/JCDR/2018/35745.11581 Incidence of SHV-1 and CTX-M-15 Extended Spectrum of ß-Lactamases Producing Gram-Negative Bacterial Isolates from Antenatal Women with Asymptomatic Bacteriuria Ramakrishnan Kalaivani, Pravin Charles, Saranathan, Seetha Kunigal, Kenchappa Prashanth <b>Introduction:</b> Asymptomatic Bacteriuria (ASB) occurs in 2% to 10% of cases during pregnancy, the risk of onset increases between 9th to 17th weeks of gestation. ASB leads to adverse anomalies like acute pyelonephritis, low birth weight infants and premature delivery. The incidence of Extended Spectrum ß-lactamases (ESBLs) e.g., blaCTX-M, blaSHV and blaTEM type producing uropathogenic bacteria have been increasing over the years which has lead to additional therapeutic burden to the patients. <b>Aim: </b>To investigate the ESBL producing Multidrug Resistant (MDR) Gram negative bacteria and to ascertain the most prevalent ESBL gene among the antenatal women with asymptomatic bacteriuria. <b>Materials and Methods:</b> A prospective cohort study involving 637 antenatal mother with asymptomatic bacteriuria was conducted. Their mid-stream clean catch urine sample were collected and processed. Gram-negative pathogens were isolated and phenotypically confirmed for ESBL production. All the ESBL positive isolates were further screened by conventional Polymerse Chain Reaction (PCR) for the presence of blaCTX-M, blaSHV and blaTEM using gene specific primers and sequenced. <b>Results:</b> From a total of 637 samples, 271 gram-negative pathogens were isolated. Phenotypically 37% (101) were ESBL producers. Out of these 101 isolates, 73%(74) were MDR isolates and none of them carried blaTEM. The presence of blaCTX-M and blaSHV were noted in 58% (59) and 4%(4) of isolates respectively. Sequence analysis confirmed them to be belonging to the same variant i.e., blaCTXM-15 and blaSHV-1. <b>Conclusion:</b> Occurrence of blaCTX M-15 and blaSHV-1 genes among the isolates reflects their prevalence within the community. Inappropriate, indiscriminate, inadequate antibiotics could be the source for wide dissemination of ß-lactamases. Proper, adequate antenatal checkup with periodic urine examination will reduce the morbidity and mortality among antenatal mothers due to asymptomatic bacteriuria. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=DC01-DC04&id=11568 https://doi.org/10.7860/JCDR/2018/35728.11568 Correlation of the Components of Student’s Lifestyles and their Health Promotion Parvin Abbasi, Arash Ziapour, Neda Kianipour <b>Introduction:</b> Health promoting lifestyle is one of the determinants of health. University years are an important phase of life when one can develop health promoting lifestyle. Given the high cost of healthcare there is need to shift from a treatment based approach to a preventive approach in which appropriate methods should be developed to promote health and productivity among youth. <b>Aim:</b> To investigate the correlation of the components of student’s lifestyles and their health promotion at Kermanshah University of Medical Sciences. <b>Materials and Methods:</b> In this descriptive-correlational study, 434 students at Kermanshah University of Medical Sciences were selected in the academic year 2015-2016 through cluster sampling. Furthermore, to collect data, a demographic questionnaire and the lifestyle questionnaire were utilised. The data were analysed through the Kolmogorov-Smirnov test, independent t-test, and ANOVA. Additionally, the SPSS Statistics Software Version 21.0 was employed. <b>Results:</b> The mean and SD of the lifestyle of university students was measured to be 2.50±0.13. Further, the highest and lowest scores in the spiritual health and weight control and nutrition were 2.72±0.16 and 2.21±0.36, respectively. Additionally, the demographic variables and total score of the components of healthy lifestyle were significantly correlated (p<0.05). <b>Conclusion:</b> The results of the present study demonstrated that the lifestyle of students was in average condition at Kermanshah University of Medical Sciences. The results were also indicative of low scores in the dimension of weight control and nutrition. Therefore, to hone and promote healthy lifestyles, university students requires more detailed planning, provision of suitable nutritional programs, rectification of lifestyles, and continuing education from medical teams engaged in topics centering nutrition. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=LC01-LC04&id=11569 https://doi.org/10.7860/JCDR/2018/32836.11569 Co-infection of Dengue and Leptospirosis in Patients Presenting to a Tertiary Care Hospital with Acute Febrile Illness: A Cross-sectional Study Anitha Ravindar, Priyadarshini Shanmugam <b>Introduction:</b> Dengue and Leptospirosis are emerging important public health problems in India. While Dengue is a vector borne viral infection transmitted by Aedes mosquitoes, Leptospirosis is a zoonosis caused by pathogenic Leptospira. The incidence of both these infections increases during the rainy season. Due to simultaneous transmission of both these infections during rainy season, co-infections can occur. These mixed infections can change the clinical spectrum of disease to more fulminant course and presents a diagnostic and therapeutic challenge to the treating physicians. <b>Aim:</b> To determine the prevalence of Dengue and Leptospira co-infection by Dengue NS1 antigen, IgM and IgG ELISA, Leptospira PCR and Leptospira IgM ELISA. <b>Materials and Methods:</b> This was a cross-sectional study done over a period of one year at Chettinad Hospital and Research Institute. Symptomatic patients belonging to all age groups with fever of 7 days duration were included in the study. Blood (10mL) was collected from 100 febrile patients by using aseptic techniques, serum separated by centrifugation and then screened for both infections. <b>Results:</b> Dengue infection was found to be positive in 29 patients (29%) and Leptospirosis was found to be positive in 18 patients (18%). Four (4%) patients had a co-infection of dengue and leptospirosis. Among the 29 dengue positive patients, NS1 antigen was positive in 22 (75.86%), anti-dengue IgM was positive in 15 (51.72%) and anti-dengue IgG was positive in 8 (27.58%) patients. Dengue RT-PCR was found to be positive in 20 patients (68.96%). Among the 18 Leptospira positive patients, Leptospira IgM and Leptospira PCR were positive in 8 (44.44%) & 10 (55.55%) patients respectively. Of the co-infected patients, 75% were found to be positive for Dengue NS1, RT-PCR and Leptospira PCR and 25% was found to be positive for anti-dengue IgM and Leptospira IgM antibodies. <b>Conclusion: </b>Co-infections may result in illness with overlapping signs and symptoms and enhanced ability to diagnose it early in illness with robust diagnostic methods which will help guide the physicians. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=DC05-DC09&id=11570 https://doi.org/10.7860/JCDR/2018/36112.11570 Effect of Group Assertiveness-Based Sexual Counseling on Marital Satisfaction among Female University Students Neda Dastyar, Ameneh Safarzadeh Sarasiyabi, Gholamreza Sanagoye Moharer, Ali Navidian <b>Introduction:</b> Sexual assertiveness is one of the factor affecting sexual performance as well as the satisfaction and quality of marital relationship. <b>Aim:</b> To determine the effect of assertiveness-based sexual group counseling on the marital satisfaction of female university students. <b>Materials and Methods:</b> This quasi-experimental study was conducted on 80 married female students in the academic year of 2016-2017. The eligible students were selected and randomly allocated to two groups of intervention (n=40) and control (n=40). The intervention group received total 4 session of group sexual assertiveness counseling in 2 week time and each session was of 2 hours. After 12 weeks, the data were collected using the ENRICH Marital Satisfaction Scale. The total scores obtained from the scale were converted into a value ranging between 0 and 100. To analyze the data, independent t-test, paired t-test, Chi-square test, and Analysis of Covariance (ANCOVA) were run in SPSS, version 21. <b>Results:</b> No significant difference was observed between the control and intervention groups in terms of demographic characteristics. However, after the intervention, the mean marital satisfaction score of the intervention group was significantly higher than that of the control group (p<0.05). <b>Conclusion:</b> Group sexual assertiveness counseling had a positive effect on the marital satisfaction of female students. Therefore, it is recommended to integrate this intervention with premarital counseling programs, especially in cultures where females have a low sexual assertiveness. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=QC01-QC05&id=11571 https://doi.org/10.7860/JCDR/2018/36045.11571 Molecular Diversity of Hepatitis B Virus X Gene in Central Kerala, Southern India Ozhiparambil A Jagan, Gopi Manoj, Natamai S Jayaprakash, Ramesh M Nair, Sara Chandy <b>Introduction:</b> Hepatitis B Virus (HBV) causes diverse clinical manifestations ranging from acute fulminant Hepatitis, Chronic Hepatitis (CHB) to liver cirrhosis and Haepatocellular Carcinoma (HCC). The HBV X gene (HBV-X) is a 154 amino acid multifunctional protein, mutates frequently and has a role in HBV related HCC. <b>Aim:</b> The current study was to explore the genetic variability and identify mutations of HBV-X in CHB patients from Central Kerala, India. <b>Materials and Methods:</b> The HBV-X sequences (n=39) from CHB (n=90) patients were analysed for nucleotide and amino acid diversity. Phylogenetic analyses were done using MEGA version 7.0.21 software to determine different genotypes. <b>Results:</b> Basal Core Promoter (BCP) mutations: A1762T/G1764A (n=5) were found in HBeAg negative subjects (n=3, 60%). Bioinformatic analysis showed that the substitutions and mutations were HBV genotype/subgenotype specific. The predominant genotype detected was A1 (n=52, 57.77%) followed by genotype D (n=27, 30.00%). Nucleotide and amino acid diversities were more in genotype A1 than in D, which is responsible for transactivation (p<0.0001), those infected with this genotype may be at high risk for HCC. <b>Conclusion:</b> Genotype A1 isolates displayed most mutations/substitutions in HBV-X, Further studies are necessary to understand its role in contributing to the development of HCC. The study represents the first formal investigation of HBV-X genetic variability in Kerala. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=DC10-DC14&id=11572 https://doi.org/10.7860/JCDR/2018/33935.11572 A Study on the Occupational Stress, Job Satisfaction and Job Performance among Hospital Nurses in Ilam, Iran Hamid Safarpour, Sakineh Sabzevari, Ali Delpisheh <b>Introduction:</b> Occupational stress and job satisfaction in nursing are issues that affect job performance and the quality of care provided by nurses. <b>Aim: </b>The aim of this study was to assess occupational stress, job satisfaction and job performance and how they are influenced by personal and work characteristics among hospital nurses in Ilam, Iran in 2013. <b>Materials and Methods:</b> In this descriptive cross-sectional study the sample included all nurses working in teaching hospitals in Ilam. All of the participants were chosen by census sampling method. The total number of nurses according to the inclusion criteria were 208, out of which 198 nurses completed the questionnaire. Study tools included Harris’s Nurse Stress Index (NSI), Spector’s Job Satisfaction Survey (JSS), Schwirian Six Dimension Scale of Nursing Performance (6-DSNP) and also a demographic questionnaire. Data were analysed using descriptive and inferential statistics such as ANOVA and Pearson correlation coefficient at the level of significance <0.05. <b>Results:</b> The mean of occupational stress and job satisfaction of nurses was moderate and the mean job performance was at a high level. In this study, there was a significant relationship between occupational stress and job satisfaction (p=0.001) and also occupational stress and job performance (p=0.04). There was no significant relationship between job satisfaction and job performance. <b>Conclusion:</b> The results of this study show the importance of nurses’ occupational stress on their job satisfaction and performance. In addition, the demographic variables were influential on the main variables in this study. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=JC01-JC05&id=11573 https://doi.org/10.7860/JCDR/2018/27410.11573 Comparative Study of Nanocrystalline Silver Ion Dressings with Normal Saline Dressings in Diabetic Foot Ulcers Varun Gupta, Gurkaran Kakkar, Angad Singh Gill, Chiranjiv Singh Gill, Manvi Gupta <b>Introduction:</b> Diabetic foot is a broad spectrum term which includes infection, ulceration and foot gangrene. Proper assessment of wound along with an aggressive multidisciplinary approach can reduce the risk of limb amputation. Wound dressings play an important role in diabetic foot care management. Nanocrystalline silver ion dressing is a newer modality that has been in consideration for the treatment of diabetic wounds. <b>Aim: </b>To analyse the effect of nanocrystalline silver ion dressings and its comparison with standard normal saline dressings in diabetic foot ulcers. <b>Materials and Methods: </b>This was a prospective study conducted in the Department of Surgery, Dayanand Medical College and Hospital, Ludhiana from January 2016 to June 2017. A total of 30 diabetic patients were included in the study and were equally divided into – Study group and Control group randomly. The study group received nanocrystalline silver ion dressings while the controls received daily dressings with normal saline soaked gauges. Data regarding presence of wound discharge, type of discharge, granulation tissue, changes in the size of wound and presence of slough was recorded and analysed (Chi-square tests). <b>Results:</b> Study group showed better outcomes with 10 Patients (66.7%) being complete responders as compared to control group where 5 patients (33.3%) were complete responders. The wound discharge shifted from purulent to serous, faster in the study group. Granulation tissue formation and slough assessment was significantly better in study group. <b>Conclusion:</b> Nanocrystalline silver ion dressings is a cost effective option in diabetic foot ulcer management. It decreases the period of hospitalization and reduces the burden on the health care system. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=PC01-PC04&id=11590 https://doi.org/10.7860/JCDR/2018/36691.11590 Prevalence of Microalbuminuria and Dyslipidemia in Polycystic Ovarian Disease Patients Sasmita Mishra, M Manju, Surya R Priya, Sowmiya Murali, Sri N Sudhardhan <b>Introduction:</b> Polycystic Ovarian Disease (PCOD) is the most common hormonal disorder in women. PCOD is associated with an increase in subclinical atherosclerotic disease and endothelial dysfunction. The altered endothelial function and early endothelial damage can be assessed by Urinary Albumin Excretion (UAE), a marker of an atherogenic background. Dyslipidaemia is a very common metabolic abnormality in women with PCOD due to elevated androgen level and insulin resistance. As evidenced from previous studies PCOD patients are at an increased cardiovascular risk compared with the age matched controls. <b>Aim:</b> To evaluate the prevalence of microalbuminuria and dyslipidaemia in premenopausal PCOD patients compared to normal premenopausal women. <b>Materials and Methods:</b> The present study was carried out at Department of Biochemistry, Aarupadai Veedu Medical College and Hospital Puducherry, India. A total of 40 diagnosed PCOD patients (according to Rotterdam criteria) of premenopausal age (21 to 42 years) and 40 age and sex matched controls (22 to 43 years) without PCOD were included in the study. All subjects had undergone measurement of height, weight and Blood Pressure (BP), and detailed systemic examination. Fasting plasma glucose, serum cholesterol, Triglycerides (TG), and High Density Lipoprotein-Cholesterol (HDLc) were estimated by using commercially available kits in automated Chemistry Analyser (ChemWell). Low Density Lipoprotein-Cholesterol (LDLc) and Very Low Density Lipoprotein-Cholesterol (VLDLc) were calculated by Friedwald’s equation. Urine microalbumin was estimated by Latex turbidimetry method using semi Autoanalyser BIOTRON BTR830. Urine creatinine was estimated by commercial kit in Autoanalyser. Albumin-Creatinine Ratio (ACR) value more than 30 mg/g was taken as microalbuminuria positive. Student’s t-test and SPSS version 16.0 were used for statistical analysis. <b>Results:</b> Out of 40 PCOD patients 21 patients were having microalbuminuria and out of 40 controls only two were having microalbuminuria. Routine biochemical investigations registered a significant rise of fasting plasma glucose, TG, TC, LDLc and VLDLc in PCOD patients, incomparison with controls (p=0.02 for LDLc and p<0.001 for all otherparameters). Significant alterations in lipid parameters showed association of dyslipidaemia in PCOD patients. <b>Conclusion:</b> In the present study prevalence of microalbuminuria and dyslipidaemia are more in patients with polycystic ovary disease than age matched controls so these parameters can be frequently estimated to prevent complications in PCOD patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=BC01-BC04&id=11591 https://doi.org/10.7860/JCDR/2018/29598.11591 Agreement of Axial Length Measurements by Three Different Biometric Devices Anika Amritanand, Arathi Roddam Simha, Ringsar Baglari, Jenifer Roselin, John Michael, Gowri Mahasampath <b>Introduction:</b> Accurate Intraocular Lens (IOL) power calculation is crucial for spectacle independence and patient satisfaction post cataract surgery. Of the various parameters measured to calculate IOL power, Axial Length (AL) is the most crucial. There have been several advances in AL measurement devices with the current gold standard being Optical Biometry (OB). However, OB cannot be used in all cases and hence the earlier Ultrasound (US) biometry continues to be relevant. It is however important to conduct agreement analysis with the gold standard to ensure accuracy of results in all cases. <b>Aim:</b> To compare the AL measurements obtained by Tomey AL 4000 US biometer and pachymeter (Tomey US), built in US biometer of the Nidek AL Scan biometer (Nidek AL US), and the Nidek AL partial coherence interferometry optical biometer (Nidek AL OB). <b>Materials and Methods:</b> This was a non-interventional cross-sectional observational study. Patients with immature cataract satisfying the inclusion criteria scheduled for surgery and undergoing biometry underwent AL measurements by the three methods. AL measurements obtained with the two US devices were compared with OB measurements and agreement analysis was done. <b>Results:</b> A total of 98 eyes of 60 patients were studied. The average AL measured by the three devices were, 22.97±0.79 mm by Tomey US, 23.24±0.89 mm by the built in applanation US of Nidek AL US scan and 23.08±0.81 mm by the Nidek AL OB. The mean inter-device difference in AL between Tomey US and Nidek AL OB was -0.11±0.15 mm and 0.16±0.44 mm between Nidek US and Nidek OB. There was excellent correlation between the Nidek AL OB and the Tomey US, Interclass Correlation was (ICC)=0.98, 95% CI (0.95, 0.99). Bland Altman Plot analysis also showed high agreement between these two devices. About 94% of the values were within 0.3 mm difference between these two devices and there were no eyes with =1 mm difference. <b>Conclusion:</b> There was excellent correlation of AL as measured by Nidek AL OB and Tomey US. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=NC01-NC04&id=11592 https://doi.org/10.7860/JCDR/2018/31225.11592 Primary Intraventricular Haemorrhage: Clinical and Aetiological Profile with Predictors of Outcome-A Hospital Based Study Koushik Pan, Alak Pandit, Bhaskar Bhattacharyya, Tejendranath Kundu <b>Introduction:</b> Primary Intraventricular Haemorrhage (PIVH) is defined as bleeding in the ventricular system without a discernable parenchymal component or arising within 15 mm from the ventricular wall. PIVH is rare in clinical practice. Due to its rarity clinical and radiological factors affecting the outcome have not been widely studied. <b>Aim:</b> To evaluate clinical features, aetiology and predictors of outcome in PIVH. <b>Materials and Methods:</b> Forty patients with PIVH evaluated and treated at Bangur Institute of Neurosciences, Kolkata, West Bengal, India, from March 2015 to October 2016. PIVH was diagnosed as haemorrhage in the ventricles only, detected by Computed Tomography (CT) scan without evidence of intraparenchymal, Subarachnoid Haemorrhage (SAH), and Intraventricular Haemorrhage (IVH) associated with trauma. MR angiography was done in all patients as well as Digital Subtraction Angiography (DSA) was done in 34 patients. Categorical and continuous data were analysed using SPSS version 20.0.1. <b>Results:</b> A total of (n=16, 40%) patients were females and (n=24, 60%) were males. Headache was the most common mode of presentation (n=12, 30%). Hypertension was the most common predisposing factor (n=24, 60%) followed by Arterio Venous Malformations (AVMs) (n=10, 25%), Moyamoya Disease (MMD), (n=8, 20%), aneurysm (n=5, 12.5%), vaso occlusive disease (n=4, 10%). Seven patients developed hydrocephalus and died, while the rest 33 survived. Aetiology remained unidentified in 10 patients. <b>Conclusion:</b> Hypertension is an important predisposing factor in PIVH. Hydrocephalus is a common complication. There is a need for an appropriate work-up on patients with PIVH, as most cases are potentially treatable. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=OC01-OC04&id=11593 https://doi.org/10.7860/JCDR/2018/32328.11593 Comparative Study of 3% Hypertonic Saline Nebulisation Versus 0.9% Normal Saline Nebulisation for Treating Acute Bronchiolitis Tanveer Bashir, Kallem Venkat Reddy, Kaiser Ahmed, Saima Shafi <b>Introduction:</b> Bronchiolitis is commonly noticed condition in children, especially in infants and characterised by inflammation of bronchioles. Inspite of this common occurrence the evidence for the treatment options is limited. <b>Aim:</b> To compare the effect of 3% Hypertonic Saline (HS) nebulisation with 0.9% Normal Saline (NS) nebulisation for treating acute bronchiolitis in moderately ill hospitalised infants and children (<18 months) on Length Of Hospital Stay (LOS) and improvement in clinical severity score. <b>Materials and Methods:</b> This is a randomised controlled trial, done in a tertiary care paediatric hospital over a period of one year from April 2014 to March 2015. Out of 189 children randomised, 96 patients and 93 patients received HS nebulisation and NS nebulisation respectively. Treating doctors and patients were blinded to intervention and outcome. <b>Results:</b> Reduction in clinical severity score in 3% HS nebulisation group was 2.26 (0.684) and in 0.9% NS nebulisation group was 1.23 (0.492), with statistically significant p<0.001. LOS in 3% HS nebulisation group was 1.45 (0.540) days and in 0.9% NS nebulisation group was 2.35 (0.619) days with mean difference of 0.91 (0.084) day with statistically significant p<0.001. <b>Conclusion:</b> This study demonstrates that 3% HS nebulisation is safe and effective treatment for infants up to the age of 18 months hospitalised with acute bronchiolitis and decreases hospital stay by about one day. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=SC05-SC08&id=11594 https://doi.org/10.7860/JCDR/2018/34766.11594 Invasive Breast Carcinoma with Axillary Tuberculous Lymphadenitis Sunil V Jagtap, Ravindra G Naniwadekar, Cyrus Dara Jokhi, Swati Sunil Jagtap The simultaneous occurrence of breast cancer and tuberculosis is rare. As there are no pathognomic clinical signs and symptoms, it can create problem in diagnosis and treatment of both diseases. A 50-year-old female patient presented with right breast lump diagnosed on histopathology as invasive breast carcinoma Grade III, with extensive granulomatous right axillary lymphadenitis due to tuberculosis. Thus, diagnosis helps in down staging of carcinoma of breast and further management of the case. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=EC01-EC03&id=11595 https://doi.org/10.7860/JCDR/2018/35563.11595 Molecular Study of Aetiology of Acute Gastroenteritis in Children of South Mumbai Seema Naresh Rohra, Vinay K Saxena, Neeru Praful Vithalani, Aruna Ananda Poojary, Tarique HIH Qureshi <b>Introduction:</b> Globally, Acute Gastroenteritis (AGE) is the leading cause of morbidity and mortality among children under five years of age. Majority of diarrhoeal illness in childhood are of viral aetiology. In the era of Rotavirus vaccine, Norovirus is emerging as an important cause of AGE in children. <b>Aim:</b> To evaluate the aetiology of diarrhoea in children of South Mumbai. <b>Materials and Methods:</b> A prospective study was carried out during July 2013 at a tertiary care hospital and research centre for evaluating diarrhoea in children =12 years of age. Clinical details of the patients were recorded on a case record form. Severity of disease was assessed by the modified Vesikari scoring pattern. Stool samples were collected from outpatients and inpatients. Stool routine microscopy and culture were done at tertiary care hospital. Aliquots of stool samples were tested at the Research Centre for Rota Virus, Adenovirus, Norovirus and Enterovirus by Polymerase Chain Reaction (PCR). <b>Results:</b> A total of 51 patients were included in the study. Of these, 45.10% (23/51) were positive for viruses by real time PCR. Routine stool culture was positive for only one patient for E. coli O157. One patient had Entamoeba histolytica infection. Of 23 patients positive for viral aetiology, Norovirus was detected in 41.18% (21/51). Of the Norovirus positive children, 42.85% were =1 year of age. Diarrhoea followed by fever was the most common presentation. Among the Norovirus positive children, 33.33% (7/21) had moderately severe disease while 66.66 % (14/21) had mild disease. <b>Conclusion:</b> Norovirus was the leading cause of acute gastroenteritis in the children included in the study. This study emphasizes the need to include Norovirus in the routine diagnostic algorithm of children with AGE and paves the way for syndromic approach based testing. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=DC15-DC19&id=11596 https://doi.org/10.7860/JCDR/2018/35011.11596 Microbiological Profile of Deep Tissue and Bone Tissue in Diabetic Foot Osteomyelitis Sanyuktha Shettigar, Shalini Shenoy, Sevitha Bhat, Pooja Rao <b>Introduction:</b> Osteomyelitis occurs by contiguous spread or direct inoculation of bacteria into bone from contiguous soft tissue infection or chronic overlying open wound. The common etiological agents in diabetic foot infections include Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli. Specimen of choice in diabetic foot osteomyelitis is bone biopsy and deep tissue. <b>Aim:</b> Isolation and identification of the bacteria from deep tissue and bone tissue obtained from diabetic foot osteomyelitis. To study the antibiotic susceptibility pattern of the isolated bacteria, to study the concordance of bone biopsy and deep tissue culture in the diagnosis of diabetic foot osteomyelitis and to study the biofilm formation in these pathogens. <b>Materials and Methods:</b> Descriptive study was conducted in the Department of Microbiology, Kasturba Medical College, Mangaluru for a period of six months from December 2016- May 2017. All the deep tissue and bone tissue samples of diabetic foot ulcer patients received in the microbiology department were processed. <b>Results:</b> The study included 54 bone tissue and 33 deep tissue specimens. In 31 cases, both bone and deep tissue were studied. Concordance in culture was observed in 22/31(70.96%) cases. The isolation rates of Gram negative and Gram positive organisms were 71.3% and 28.7%. The common isolates were S.aureus, Proteus spp., E.coli, Enterobacter spp., Pseudomonas spp. The rate of Methicillin Resistant Staphylococcus Aureus (MRSA) and Clindamycin resistance in S. aureus were 41% and 38%. Extended Spectrum beta lactamases (ESBL) production was seen in 27.27% of E.coli and Klebsiella spp. The rates of resistance to amikacin, ciprofloxacin and carbapenem among Gram negative bacilli were 28.5%, 23.5% and 15.58% respectively. <b>Conclusion:</b> The bone biopsy along with deep tissue specimen taken simultaneously would increase the accuracy of detecting the bacterial isolate and to provide effective management. The study of antibiotic susceptibility is necessary to reduce the net effect of the increasing severity of infections. Bone biopsy culture can be substituted by deep tissue samples taken during amputation or debridement. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=DC20-DC22&id=11597 https://doi.org/10.7860/JCDR/2018/35462.11597 Quality of Antenatal Care Service at Debre Berhan Referral Hospital Wassie Negash Mekonnen, Kokebe Kefelegn Asefa <b>Introduction:</b> Antenatal Care (ANC) has been proven to be effective in order to decrease maternal mortality. It helps to improve pregnancy outcome through quality of ANC services. <b>Aim:</b> The general objective of this study was to assess the quality of ANC in Debre Berhan Referral Hospital, Debre Berhan, Ethiopia. <b>Materials and Methods:</b> Descriptive cross-sectional study design was conducted from January 2015 to June 2015 to assess the quality of ANC by using Donabedian’s framework for measurement of healthcare quality. A systematic sampling technique was used to select the study participants. EPI-Infoversion 3.1 and SPSS version 20.0 were used for data entry and analysis respectively. In addition, binary linear regression analysis was done to see the association between variables. Multivariable linear regression analysis was done to see the confounding effect at 95% confidence interval and p-value of <0.05 considered as statistically significant. <b>Results:</b> A total of 356 ANC attendant women were interviewed which is 97.0% response rate. About 19.8% was below 24 years and the mean ages of respondents were 29.07 years. Mean satisfaction score was 2.5±0.84 in 4 likert scales which is equivalent to 63.9%. About 98.3% of mothers were satisfied with the overall care given. Only 78.7% of the study participants were satisfied with the waiting time. High percentages (96.3%) of women were satisfied with the attitude of Healthcare Provider (HCP). About (94.9%) were satisfied with the advice given by the HCP. Regarding the availability of resources 68% of patients agreed on increasing number of HCP, 51.4% and 67.4% agreed on improving laboratory service and shortening waiting time respectively. Waiting time, cleanliness of waiting area, HCPs’ respect, advice given, availability of medications and overall care given, were independent predictors. <b>Conclusion:</b> Quality of ANC with respect to process and structural component is high but with respect to outcome is sub-optimal. Waiting time, cleanliness of waiting area, advice given, privacy of examination room, time given by HCPs, HCPs’ respect towards the patients and availability of medications were the independent predictor of patient satisfaction. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=IC01-IC05&id=11624 https://doi.org/10.7860/JCDR/2018/32812.11624 A Study on Pulmonary Manifestations of Rheumatoid Arthritis Sandipan Banik, Sumit Roy Tapadar, Aniruddha Ray, Arunabha Datta Chaudhuri <b>Introduction:</b> In approximately 50%, are Rheumatoid Arthritis (RA), there are extra articular manifestations. Pulmonary involvement ranges between 10%-67%. Interestingly, mortality in patients of RA is further increased with extra-articular affection, among which pulmonary involvement accounts for 10-20% mortality. <b>Aim:</b> To evaluate the spectrum, relevant factors and frequency of pulmonary affection in diagnosed patients of RA. <b>Materials and Methods: </b>A cross-sectional, study was done in RG Kar Medical College, a tertiary care teaching hospital of Kolkata, India. A total of 63 consecutive patients of RA were enlisted and evaluated – clinically, High Resolution Coaxial Tomography (HRCT) scan of thorax, spirometry and echocardiography. <b>Results:</b> About one third (n=19) of the RA patients had respiratory symptoms; half (n=31) showed abnormal spirometry results and less than half (n=28) had some abnormality in HRCT. The most common abnormality was decreased attenuation, found in 36.5% patients. Others were bronchiectasis (n=19, 30.2%), bronchial wall thickening (n=16, 25.4%), pulmonary nodules (n=3, 4.8%), pleural effusion (n=10, 15.9%), pleural thickening (n=5, 7.9%), ground glass opacity (n=6, 9.5%), reticulo-nodular shadow (n=8, 12.7%) and air trapping (n=11, 17.5%). Pulmonary Hypertension (PH) was found in about one quarter (n=17) of the study population and in about half (n=8) of them it was clinically silent. <b>Conclusion:</b> Pulmonary manifestations are quite common in RA and they often remain clinically silent particularly in early part of the disease. They increase with duration of RA and age of the patient with exception of pleural effusion which is more prevalent early in the disease. Pulmonary evaluation should be considered early in RA patients irrespective of having any respiratory symptoms. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=OC05-OC09&id=11625 https://doi.org/10.7860/JCDR/2018/30208.11625 Can the Six-Minute Step Test Predict the VO<sub>2</sub> Peak in Healthy Young Men? Cristiane Travensolo, Walace Monteiro, Tainah Lima, Roberta Pinto, Paulo Farinatti, Marcos Polito <b>Introduction:</b> The six-minute step test can estimate the oxygen consumption in patients with chronic obstructive pulmonary disease. However, the literature is scarce regarding to six-minute step test application to health and young subjects. <b>Aim:</b> To correlate peak oxygen consumption (VO2 peak) obtained in a Cardiopulmonary Exercise Test (CPX) with performance in the 6-Minute Step Test (6MST) in a group of healthy young men. <b>Materials and Methods:</b> In a prospective observational cross-sectional study, thirty-one young healthy men (22.3±2.2years) were volunteers. The study was conducted during two non-consecutive days. On the first day, the VO2 peak was obtained using CPX on a treadmill. After 72 hour, the 6MST (20 cm of height) was performed at a self-selected cadence. The reproducibility of the 6MST was tested in 14 subjects, 30 minute after the first 6MST. <b>Results:</b> The 6MST demonstrated reproducibility (ICC=0.977; 95%CI 0.932 to 0.992). There was a significant correlation between the total number of steps and heart rate in the 6th minute of the 6MST (r=0.794; p<0.001). The multiple regression did not identify variables that could be associated with the VO2 peak. <b>Conclusion:</b> The 6MST has no power to estimate the VO2 peak in healthy young men. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=YC01-YC04&id=11626 https://doi.org/10.7860/JCDR/2018/28692.11626 Reliability of Visual Field Index in Staging Glaucomatous Visual Field Damage Neetha Kuzhuppilly, Shilpa Patil, Shibi Dev, Aditya Deo <b>Introduction:</b> Standard automated perimetry is integral to the testing of visual function in glaucoma. Classification of glaucomatous visual field defects into different severity levels is important to guide effective management; but the available classification systems may be cumbersome and impractical on a daily basis. <b>Aim:</b> To quantify, correlate and analyse the relation between Visual Field Index (VFI) and the stages of glaucomatous field damage as defined by Hodapp Parrish Anderson (HPA). To check the validity of Glaucoma Staging Indices (GSI), which is a new glaucomatous field classification system dependent on VFI. <b>Materials and Methods:</b> The study was a prospective, observational analysis of consecutive visual field tests done between August 2015 and March 2016. The Institutional Ethical Committee approved the protocol, and participants who gave written informed consent were included in the study. Patients underwent a comprehensive eye examination including standard automated perimetry with Humphrey Visual Field Analyser. Data was collected from each visual field and the fields were evaluated and classified into four stages- Normal, Early defect, Moderate defect or Severe defect based on HPA classification. HPA and Geological Strength Index (GSI) classification systems were compared and analysed with Kappa analysis. <b>Results:</b> Analysis of 170 visual fields of 95 patients showed that VFI was significantly different between Normal, Early defect, Moderate defect and Severe defects as classified with HPA staging, p<0.001. VFI had strong positive correlation with Mean Deviation (MD), r=0.984, p<0.001 and non-linear correlation with Pattern Standard Deviation (PSD), r = -0.472, p<0.001. On comparing HPA staging with GSI, ?=0.633, p<0.001. VFI, MD and PSD in each of the severity stages across the two classification systems showed no significant differences (p>0.05). <b>Conclusion:</b> In established glaucoma, GSI is a good dependable staging system. It is readily available on the single field print out and can be a quick reference for decision making in the management of glaucoma patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=NC05-NC08&id=11620 https://doi.org/10.7860/JCDR/2018/34541.11620 Prevalence and Pathological Analysis of Adenocarcinoma Prostate Discovered Incidentally in Radical Cystoprostatectomy Specimen: An Indian Center Experience Rajat Mahadik, Priyank Bijalwan, Appu Thomas <b>Introduction:</b> Potency-preserving techniques of radical cystectomy raise concern because of a possible association with incidental prostate adenocarcinoma. Cystoprostatectomy specimen provides a unique opportunity to estimate the prevalence and to define the morphological features of silent (incidental) adenocarcinoma of the prostate. <b>Aim:</b> To determine the prevalence and histopathological features of incidental prostate carcinoma detected in radical cystoprostatectomy specimens taken for muscle invasive bladder cancer. <b>Materials and Methods: </b>A retrospective chart review of patients who underwent radical cystoprostatectomy for infiltrating bladder tumors during the period between 2003 and April 2014 was done. The histopathology slides of these patients were reviewed. <b>Results:</b> Fourteen incidental prostate cancers were identified in 113 radical cystoprostatectomies. The mean patient’s age was 65 years (range 48-75 years). The median Gleason Score was 3+3 (3+3, 4+3). Nine patients (64%) had Gleason 6 and five (36%) had Gleason 7 disease. Pelvic lymph node metastasis from prostate adenocarcinoma was detected in four patients. On mean follow up of 2.5 years for three patients with node positive disease there was no evidence of biochemical recurrence. For patients with node negative disease, six patients had no evidence of recurrence on a follow up of 3.5 years. <b>Conclusion:</b> Percentage of incidentally detected prostate cancer in cystoprostatectomy specimen at our clinical center is much lower (12.4%) than reported rates in the world until now (23-68%), which can be attributed to varying methods of pathological examination and regional difference in prostate cancer . It would be prudent to do digital rectal examination (for clinical prostate evaluation) and Prostate-Specific Antigen (PSA) testing along with bladder cancer work up. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=XC01-XC03&id=11621 https://doi.org/10.7860/JCDR/2018/31154.11621 Effect of the Sexual Education Program on the Knowledge and Attitude of Preschoolers’ Mothers Katayun Mobredi, Seyedeh Batool Hasanpoor–Azghady, Seyed Ali Azin, Hamid Haghani, Leila Amiri Farahani <b>Introduction:</b> Sexual instinct needs education and training similar to other aspects of the human life. Education can promote changes in knowledge and attitudes of parents, especially mothers. Education has a main role in teaching healthy sexual behaviours among pre-school age children. <b>Aim:</b> To investigate the effect of the sexual education program on the knowledge and attitude of preschoolers’ mothers. <b>Materials and Methods:</b> This quasi-experimental study was consucted in two healthcare centers in an urban area of Iran. Study subjects were preschoolers’ mothers, which were selected using a multistage method. For each control and experiment groups, 39 individuals each were selected. The experiment group participated in four educational sessions in four weeks, one session per week. A self-administered questionnaire was developed for data collection. Descriptive and inferential statistics were used for data analysis. <b>Results:</b> Statistically significant differences in the mean score of knowledge and attitude between the groups immediately and eight weeks after the education program were reported (p < 0.001). The mean score of knowledge was increased from 27.23 to 34.2 immediately and to 37.44 eight weeks after the education program. The mean score of attitude in the experiment group significantly was increased from 48.54 to 59.15 immediately and to 64.49 eight weeks after the intervention (p < 0.001). <b>Conclusion:</b> The sexual education program influenced the knowledge and attitude of preschoolers’ mothers. Therefore, mothers should be empowered regarding children’s sexual education. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=JC06-JC09&id=11616 https://doi.org/10.7860/JCDR/2018/32702.11616 Efficacy of Amnitear Vs Conventional Method for Artificial Rupture of Membranes: A Prospective Study Nidhi Gupta, Aruna Nigam, Neha Varun, Snehlata Meena, Rashmi Aggarwalla <b>Introduction:</b> Amnitear is a newer device which is to be worn over gloved index finger for doing artificial rupture of membranes. <b>Aim:</b> To evaluate the efficacy of Amnitear in doing Artificial Rupture of Membrane (ARM) and to compare the efficacy and safety of amnitear Vs the conventional method (kocher’s clamp) in ARM. <b>Material & Methods:</b> A prospective, single-blinded, randomized study was done to evaluate the efficacy of Amnitear Vs conventional method (kocher’s clamp) for doing ARM. Patients with even Inpatient Department (IPD) number were grouped as ‘A’ (study group) in which ARM was done with amnitear & Group ‘K’ (control group) constituted the patients with odd IPD number in which ARM was done with conventional method (kocher’s clamp). There were 60 patients in each group. Obstetrician comfort level was assessed by the experience felt by the concerned doctor; in terms of excellent, good and poor. Pain and discomfort felt by the patient during the procedure was assessed with the help of visual analogue scale scoring system. <b>Results:</b> One hundered and twenty women in labour requiring ARM were randomized into 2 groups. The efficacy of Amnitear was assessed in terms of number of attempts required to successfully perform the procedure which showed a statistical significant difference (p=0.02) in the two groups. Obstetrician comfort level was significantly better in amnitear group. No statistically significant difference was seen in the pain and discomfort felt by the patient during both the procedure. <b>Conclusion:</b> Amnitear appears to be an efficacious device to do the ARM. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=QC18-QC20&id=11617 https://doi.org/10.7860/JCDR/2018/32304.11617 Optimism, Communication Skills and Its Related Factors in Midwifery Students Safoura Taheri, Saba Farzi, Azita Tiznobaik, Hamid Taghinejad, Nazanin Rezaei, Zainab Suhrabi, Tayebeh Azadi, Mahnaz Shafieian <b>Introduction:</b> Optimism is a tendency towards life and its events. It can affect health via the promotion of social relationships. <b>Aim:</b> This study aimed at investigating optimism, communication skills, and its related factors in midwifery students. <b>Materials and Methods:</b> This descriptive-analytic study was conducted during September to December, 2016. Participants were 115 midwifery students from Ilam University of Medical Sciences who were enrolled into this study through census sampling. Data were collected using demographic characteristics, communication skills, and life-orientation questionnaires. Data were analysed using descriptive and analytical statistics in SPSS version 16. <b>Results:</b> The mean score of communication skills and optimism was 108.9±10.9 and 13.9±3.5, respectively. Pearson’s correlation coefficient showed that there was a direct correlation between communication skill and optimism scores (r=0.477, p<0.001). Analytical statistical analysis showed a direct relation between age and communication scores (p=0.01) and there was a significant relation in the mean score of communication skills in married people than in single ones (p=0.02). Also, there was a significant correlation between optimism score and the level of awareness of the field of study (p<0.001). <b>Conclusion:</b> In this study, the level of communication skills in midwifery students in Ilam University of Medical Sciences, Iran was moderate and comprehensive training is needed to improve these skills. The level of optimism of life in most midwifery students was relatively good, but more studies are suggested in this regard. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=QC10-QC13&id=11618 https://doi.org/10.7860/JCDR/2018/33907.11618 Role of Magnetic Resonance Urethrography in Evaluation of Male Urethral Stricture Against Conventional Retrograde Urethrography Vijaya Karthikeyan Murugesan, Padhmini Balasubramanian <b>Introduction:</b> Magnetic Resonance Urethrography (MRU) is a new and less widely used technique in the evaluation of male urethral strictures. <b>Aim:</b> This study intends to establish the role of MRU in the evaluation of male urethral strictures and to compare the efficacy with that of conventional Retrograde Urethrography (RUG). <b>Materials and Methods:</b> A total of 32 patients with symptoms of poor urinary stream and straining during micturition underwent conventional RUG followed by MRU. The parameters studied by RUG and MRU such as stricture site, number, length, diameter and associated false tracts or diverticulum were compared with intraoperative findings, which is taken as gold standard. The sensitivity, specificity, positive and negative predictive values of all the parameters was calculated. Karl pearson correlation coefficient and Wilcoxon’s signed rank test were used where appropriate. A p-value of <0.05 was considered statistically significant. <b>Results:</b> Both modalities had 100% sensitivity and specificity in the detection of stricture site. MRU showed better correlation with surgical findings than RUG in strictures less than 3 cm and the RUG showed better correlation with surgical findings than MRU in strictures longer than 3 cm, even though there was no significant statistical difference between the two. Stricture lengths in four cases of long penile urethral strictures with submeatal extension were underestimated by MRU. RUG overestimated the length of four cases of penile urethral stricture. Both RUG and MRU slightly overestimated the severity of strictures in the 2 to 4 mm diameter range. RUG detected all the false tracts, whereas MRU failed to detect one of the false tracts. Accuracy in the detection of spongiofibrosis in MRU was directly proportional to the severity, with no false negatives in moderate to severe degrees of spongiofibrosis. <b>Conclusion:</b> RUG and MRU are equally efficacious in detecting urethral strictures. MRU showed better stricture length assessment in bulbar urethra and accurately delineated posterior urethral distraction defect. MRU effectively detects and characterises spongiofibrosis, which is not possible in RUG. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=TC07-TC11&id=11648 https://doi.org/10.7860/JCDR/2018/26988.11648 Professional Attitude in Iranian Nursing Students Masoumeh Shohani, Leili Abedi, Mahboobeh Rasouli <b>Introduction:</b> The first and most critical stage in nursing profession is when an individual enters the educational or apprenticeship environment as a nursing student. Therefore, the students’ professional attitudes and behaviours are very important during the courses. <b>Aim:</b> To determine the professional attitude in Iranian Nursing Students. <b>Materials and Methods:</b> This descriptive cross-sectional study was conducted from October 2015 to October 2016 at Ilam University of Medical Sciences. One hundred fourteen nursing students who studied in fourth to eighth semesters were randomly selected through proportionate stratified random sampling. Data collection tools consisted of a demographic information form and the Inventory to Measure Professional Attitudes in Student Nurses. Data analysis was performed using descriptive and inferential statistics through SPSS 18, while p<0.05 was considered significant. <b>Results:</b> A total of 75 (65.8%) of the student were interested in the nursing profession. A 60.52% and 15.8% of students considered educators and nurses to be effective in their professionalism, respectively. A 13.2% of the subjects were members of the Iranian Nursing Organization. The mean and standard deviation for the total score of the professional attitude was 91.01±15.7, which was above average. Scores in different factors of professionalism were contribution to the increase in scientific information load (15.97±3.35), collaboration (15.97±3.35), community service (10.93±2.74), ethical codes and theory (10.73±2.55), competence and continuous education (9.76±2.51), participation in professional organisations and professional development (9.61±2.17), autonomy (9.51±2.00) and working in committees (6.85±1.82). <b>Conclusion:</b> Iranian nursing students are at moderate level of professionalism. Therefore, it seems necessary to identify the existing weaknesses in different aspects and try to fix them, while improving their strengths during student life. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=JC10-JC13&id=11649 https://doi.org/10.7860/JCDR/2018/27804.11649 Epidemiological Profile and Subjective Reasons of Relapse in Inpatient Service Personnel of Alcohol Dependence Syndrome-A Cross-sectional Study Sudip Azad, Siddharth Dixit <b>Introduction:</b> An elaborate understanding of reasons of relapse is essential for successful de-addiction treatment in an endeavour to guide patient towards recovery. In service environment implications of relapse are deleterious to service prospect of armed force personnel. <b>Aim:</b> To explore epidemiological profile and subjective reasons for relapse in service personnels with Alcohol Dependence Syndrome (ADS) after de-addiction treatment. <b>Materials and Methods:</b> The sample consisted of 100 consecutive male patients of diagnosed Alcohol Dependence Syndrome (as per ICD-10: WHO 1992) undergoing inpatient treatment for 1st relapse. Semi structured interview to enumerate individual’s demographic profile, support system and other alcoholic milestones were taken into consideration. Reasons For Drinking Again Questionnaire (RFDAQ) was used in to identify reasons of relapse among relapse precipitants. The data was statistically analysed Independence of the attributes was compared by use of Chi-square contingency table analysis. Comparisons of the means in the groups were done using the student’s t-test. A significance level of p < 0.05 was accepted for all analysis. Non parametric t-test was also used. <b>Results:</b> In our study the mean age of the participants was 38.03 years (7.92). Mean age of onset of alcohol use was 24.31 years (3.642). 64% of study group manifested with relapse within 03 months of de-addiction treatment and only 20 % could maintain sobriety for more than a year. In our study 65% relapse participants manifested with uncomplicated alcohol withdrawal followed by 25% with alcohol withdrawal delirium tremens and 5% with seizures. The most common reasons for resuming alcohol intake were feeling sad, drinking as a result of good mood and someone offering them a drink. <b>Conclusion:</b> The reasons for resuming alcohol intake after achieving a period of abstinence were mostly intrapersonal factors like feeling of sadness and good mood followed by intrapersonal issues like someone offering a drink. Therapeutic implications are discussed. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=VC01-VC05&id=11650 https://doi.org/10.7860/JCDR/2018/28965.11650 Effect of Maternal Lipid Levels during Late Pregnancy on the Birth of Large for Gestational Age Newborns in a Tertiary Care Setting in Southern Sri Lanka Amarasingha Arachchige Dinusha Subhashini Amarasingha, Mohamed Fassy Fathima Nasrina, Ruwani Punyakanthi Hewawasam, Mawananehewa Aruna Devapriya De Silva, Mampitiya Arachchige Gayani Iresha <b>Introduction:</b> Incidence of childhood obesity is increasing worldwide and obesity related comorbidities are also increasing simultaneously in the paediatric population. During pregnancy, growth of the foetus is highly influenced by the in utero environment. It is established that Asians have lower skeletal muscle mass and excess body fat for a given Body Mass Index (BMI). <b>Aim:</b> To determine the associations between aetiologies and the birth of Large for Gestational Age (LGA) babies for the first time in a tertiary care setting in Southern Sri Lanka and to determine whether changes in maternal lipid profile are associated with the birth of LGA babies. <b>Materials and Methods:</b> In the first arm of the study, 149 mothers were interviewed to obtain information on aetiologies and complications associated with birth of LGA babies. In the second arm of the study, 3 mL of blood was collected from 104 mothers and serum total cholesterol, triglycerides and HDL-cholesterol concentration were measured and LDL cholesterol concentration was calculated by the Friedewald equation. Anthropometric parameters of the newborns were measured. <b>Results:</b> There were significantly higher levels (p<0.001) of serum triglycerides and significantly lower levels (p<0.001) of serum HDL in mothers who delivered LGA babies compared to mothers who delivered appropriate for gestational age babies. There were significant correlations between maternal serum triglyceride and HDL level and the birth weight (r=0.529, 0.397), length (r=0.485, 0.358) and head circumference (r=0.228, 0.252) of the newborn respectively. <b>Conclusion:</b> Our findings suggest that high maternal TG and Low HDL levels in late pregnancy are independently and significantly associated with the birth of LGA infants. The results of present study were not significantly different from previously published results on other populations hence this preliminary study suggest that having high body fat in the Sri Lankan population had no significant impact on the birth of LGA infants. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=SC09-SC14&id=11651 https://doi.org/10.7860/JCDR/2018/34050.11651 Comparing the Anaesthetic and Analgesic Efficacy of Caudal Levobupivacaine and Ropivacaine in Paediatric Patients Sai Tejashree Veeravalli, BV Sunil, TV Shenoy <b>Introduction:</b> Introduction of S enantiomer of bupivacaine is a major breakthrough in the history of local anaesthesia as the pharmacodynamics of these drugs were favourable in reducing the occurrence of cardiotoxicity, neurotoxicity and unintended motor blockade. <b>Aim:</b> To compare efficacy, postoperative analgesia and postoperative motor blockade of 0.25% levobupivacaine with 0.25% ropivacaine in caudal block for children, scheduled for lower abdominal and lowerlimb surgeries. <b>Materials and Methods:</b> 80 children, ASA I–II, 1-10 years, weighing between 5-30 kg, scheduled for elective lower abdominal and lower limb surgeries were given single caudal injection of 1 mL/kg of either levobupivacaine or ropivacaine. Caudal block was given after general anaesthesia using sevoflurane as induction agent airway secured with laryngeal mask. Postoperative pain score was assessed using Children and Infants Postoperative Pain Scale (CHIPPS) scale in children less than 6 years and numerical scale for children more than 6 years. Motor recovery was assessed by modified Bromage scale. <b>Results:</b> Onset of analgesia, duration of analgesia, postoperative pain and motor blockade were comparable between the two groups, of 40 each. Analgesia time was within 5 minutes in both the groups. Duration of analgesia was 404.8±67.6 minutes for levobupivacaine and 413.5±44.4 minutes for ropivacaine, which was not significant statistically. Postoperative analgesia was same between the two groups. It took 120 minutes for complete postoperative motor recovery. The motor recovery between the two groups was statistically not significant at immediate postoperative period (p=0.111), at 60 minutes (p=0.692). <b>Conclusion:</b> We conclude that both 1 mL of 0.25% levobupivacaine and 0.25% ropivacaine provide similar effect caudal anaesthesia and analgesia with motor blockade for 120 minutes. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=UC05-UC09&id=11652 https://doi.org/10.7860/JCDR/2018/34700.11652 Psychological Empowerment and its Associated Factors among Operational Staff of Tehran Emergency Center Aram Ghaniyoun, Mohammad Heidari, Khosro Shakeri <b>Introduction: </b>Emergency medical personnel often face chronic stress which, in many situations causes psychological problems. In this regard, psychological empowerment can reduce psychological tensions in health care environment through increasing efficiency and motivation. <b>Aim:</b> To investigate psychological empowerment and its related factors in operational staff of Tehran Emergency Center (TEC). <b>Materials and Methods:</b> In this analytical study, a total of 285 people were selected by simple sampling method from 1100 operational staff of TEC. Data was collected using demographic information and Spritzer’s psychological empowerment questionnaire. SPSS/19 software and descriptive analytical tests were used for data analysis. <b>Results:</b> The findings suggested that most of the participants (46%) were in intermediate level in terms of psychological empowerment, and the mean score of psychological empowerment in participants was 46.43. A significant correlation was found between the dimension of self-determination of psychological empowerment and work experience (p<0.05). <b>Conclusion:</b> Owing to the critical duties of medical emergency centers in maintaining and improving public health, and based on the findings of this study, it is recommended that the authorities should pay more attention to the capabilities of the staff while giving responsibilities to them and to conduct effective planning in this regard. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=LC15-LC17&id=11653 https://doi.org/10.7860/JCDR/2018/35221.11653 The Effect of Entrepreneurship Education on Self-Efficacy Beliefs and Entrepreneurial Intention of Nurses Simin Jahani, Mahbubeh Babazadeh, Shayesteh Haghighi, Bahman Cheraghian <b>Introduction:</b> One of the most important factors in the development of entrepreneurship is education, and this has been ignored in nursing. <b>Aim:</b> To investigate the effect of entrepreneurship education on the self-efficacy and entrepreneurial intention of nurses. <b>Materials and Methods:</b> This quasi-experimental study was conducted on 76 nurses working in two hospitals in Ahvaz in 2016. Nurses working in Imam Khomeini Hospital were considered as the control group and those working in Golestan Hospital constituted the intervention group. Nurses of the intervention group were trained for three sessions in three consecutive days. Nurses in the control group did not receive any training. In both groups, Sherer self-efficacy, and Linan and Chen’s entrepreneurial intention questionnaires were completed. The data collected were analysed using Chi-squared test, independent t-test and paired t-test. <b>Results:</b> In terms of self-efficacy belief (p=0.044) and entrepreneurial intention (p=0.047), there was a significant difference between the two groups after training, while the two groups were not significantly different before the training (p=0.619 and p=0.892). In the intervention group, there was a significant difference between the mean of self-efficacy belief (p=0.037) and entrepreneurial intention (p=0.041) before and after training, while there was no significant difference in the control group (p=0.837 and p=0.72). <b>Conclusion:</b> Given the findings of this study, it seems that entrepreneurship education can affect nurses’ self-efficacy belief and entrepreneurship intention. More studies are recommended to be conducted though. The findings of this study can be presented as a practical guide to nursing board, hospital managers, and entrepreneurship centers. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=LC18-LC21&id=11654 https://doi.org/10.7860/JCDR/2018/31525.11654 Communication Skills Training for Medical Students: A Prospective, Observational, Single Centre Study Kalpana Ketan Kulkarni, Pradnya Milind Bhalearo, Varsha Shrikant Sarode <b>Introduction:</b> Communication is an important clinical skill, critical to effective diagnosis and management. It helps to connect with patients on a cognitive and emotional level. Good communication leads to a better patient outcome in terms of satisfaction and adherence. It decreases the incidence of malpractice. <b>Aim:</b> To assess the effectiveness of the newly developed communication skill training module for the second year medical students in order to improve their knowledge, skills and attitude and identify the pitfalls and vital areas of implementation. <b>Materials and Methods:</b> The present study was a prospective observational study. Here, the communication skill modules were taught through interactive lectures intercept with role play by the faculty. Pre-validated questionnaire in the form of pre-test and post-test was used as an assessment tool. This was followed by performances by students in the form of role play on given scenarios and they were assessed by direct observation with a checklist. The present module was conducted on three batches of second year MBBS students. And data were analysed in the percentage. <b>Results:</b> Students were evaluated through a multiple choice pre-test and post-test and results were given in form of percentage. An increase in scores from pre-test to post-test was observed in 93 (76.86%), 113 (76.51%) and 131 (78.45%) students respectively. The percentage of students who agreed to apply what they had learnt, into practice was >90%. Evaluation of the faculty was done through a feedback. The overall improvement in faculty performance was seen over the three years. <b>Conclusion:</b> Thus, an attempt to teach communication skills to second year medicos was made through evaluation, feedback and identification of pitfalls for further improvement. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=JC14-JC17&id=11655 https://doi.org/10.7860/JCDR/2018/31592.11655 The Relationship between Food Insecurity and Lifestyle in Women with Gestational Diabetes Mehrafza Gharachorlo, Zohreh Mahmoodi, Kourosh Kabir, Nasibeh Sharifi <b>Introduction:</b> Gestational Diabetes (GDM) is among the most prevalent disorders during pregnancy, affecting the health of mothers and infants. <b>Aim:</b> To explore the relationship between food insecurity and lifestyle among women with GDM. <b>Materials and Methods:</b> This cross-sectional study recruited 120 pregnant women with GDM who were in 24-28 weeks of pregnancy. They referred to gynaecology clinics of Alborz and Kamali Hospitals, Karaj, Iran, in 2017. The samples that had the inclusion criteria were enrolled in the study. Data collection tools included three questionnaires for evaluating Demographic Obstetrics Questionnaires (DOQ), Household Food Security Scale (HFSS) and Lifestyle Questionnaire (LSQ). The data were analysed using descriptive and inferential statistics in SPSS, version 16.0. p-value <0.05 was considered significant. <b>Results:</b> Most pregnant mothers were food secure or food insecure without hunger. Results indicated that 63.9% of pregnant mothers with GDM who did not have children under 18 years were food secure, while 5.6% were food insecure with moderate hunger. There was a significant relationship between lifestyle and the level of food security in households without children under 18 years (p=0.009). <b>Conclusion:</b> Food insecurity is a risk factor affecting lifestyle. Therefore, planners must focus on reducing food insecurity, especially among pregnant women. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=QC14-QC17&id=11630 https://doi.org/10.7860/JCDR/2018/36071.11630 Serum Erythropoietin Level in Type II Diabetic Nephropathy Zainab Abbas Jwad, Haider Kamel Zaidan, Mahmoud Hussein Hadwan <b>Introduction:</b> Diabetes is a disease characterised by poor glycaemic control and development of various complications with age. Diabetic complications include development of nephropathy as well as other complications. <b>Aim:</b> The study was aimed to elucidate the consequences of diabetic nephropathy on erythropoietin levels and microalbuminuria. <b>Materials and Methods:</b> A total of 66 subjects with Type II Diabetes Mellitus (T2DM) with and without microalbuminuria and 22 healthy subjects were enrolled in the present study. The following case-control study was completed in Al-Najaf Centre for Diabetes and Endocrinology, Al-Najaf City, Iraq from March 2016 to May 2016. Serum erythropoietin levels and microalbuminuria concentrations were documented in addition to demographic and biochemical data. <b>Results:</b> Serum erythropoietin concentrations were decreased significantly in patients with T2DM compared to that of healthy control subjects. Microalbuminuria concentrations were increased significantly in patients with T2DM compared to that of healthy control subjects. <b>Conclusion:</b> Microalbuminuria and erythropoietin levels can be used to assess the occurance of complications in patients with diabetic nephropathy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=BC05-BC08&id=11631 https://doi.org/10.7860/JCDR/2018/32813.11631 Biofilm Formation in Clinical Isolates of <i>S. aureus</i> is Associated with Presence of Device and Dissemination of Infection Ana Paula Becker, Cicero AG Dias, Alexandre José Macedo <b>Introduction:</b> Biofilms are complex microbial communities attached to abiotic or biotic surfaces. These communities produce their own extracellular matrix, where they interact with one another and with the environment. <b>Aim:</b> To observe the biofilm formation isolates of Staphylococcus aureus from South Brazil. <b>Materials and Methods:</b> A total of 126 consecutive S. aureus isolates were collected, causing a variety of infections at a tertiary hospital from 2011 to 2014. We investigated biofilm-forming ability by using a microtiter plate assay (crystal violet method) and compared the clinical characteristics and outcomes of infected patients with biofilm-forming ability. The following clinical characteristics were evaluated: presence of polymicrobial infection; presence of another micro-organism (in another clinical material at the same time); recurrence of infection; presence of device and site of infection. <b>Results:</b> Biofilm forming bacteria were categorized as high producers (n=46, 36.5%), moderate producers (n=59, 46.8%) and weak producers or non-producers (n=21, 16.7%). The presence of another microorganism isolated in the same day in another clinical specimen was significantly associated with biofilm-formation (p<0.006) as well the presence of invasive devices (p<0.02). <b>Conclusion:</b> This study allows planning medical conducts, e.g., the choice of appropriate antimicrobials, in patients with devices such as catheters and patients with infections at different sites to adequately adjust treatment of infections by biofilm-forming bacteria. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=DC27-DC30&id=11632 https://doi.org/10.7860/JCDR/2018/35117.11632 Role of Ultrasonography in Imaging of Tumours Around Knee Joint Prabakaran Palanisamy, Sujata Patnaik, Abhishek Arora, C Vijaykrishna, Shantveer G Uppin <b>Introduction:</b> Imaging of the neoplasms of knee is important for multidisciplinary management in the modern day practice. Radiography followed by Magnetic Resonance Imaging (MRI) is a commonly used modality, whereas Ultrasonography (USG) is less commonly used method for this purpose, especially for bone tumours. <b>Aim:</b> To evaluate the role of USG in tumours around knee joint. <b>Materials and Methods:</b> This was a prospective descriptive study carried out in Nizam’s institute of Medical Sciences, Hyderabad, India from January 2015 to June 2017. During the study period, 158 patients presented to the orthopaedic department with complaints of swelling of knee were included. Based on clinical history of trauma, joint pain, fever, swelling of knee, restricted movements of knee and clinical examination of affected knee with radiography, 58 patients with 59 lesions were included. USG and cross-sectional imaging (CT/MRI) were done in all patients. Final diagnosis was made by histopathological findings or classical imaging features. Non parametric Mann-Whitney-Wilcoxon test was used to differentiate the resistive indices of benign and malignant lesions. <b>Results:</b> Study group consisted of 59 lesions where 77.97% (46/59) were bone lesions and 22.03 % (13/59) were soft tissue lesions. USG is 100% sensitive to demonstrate cortical thinning/break/fracture, soft tissue component, Neurovascular Bundle (NVB) involvement, cystic component with fluid-fluid level and joint effusion. USG is better than CT for assessing the cartilage cap of osteochondroma; USG is better than MRI and comparable to CT to identify the calcifications; Doppler USG had 89.5% sensitivity and 80% specificity to differentiate benign and malignant lesions, although only 61% lesions (36/59) showed vascularity; Doppler along with gray scale parameters (like peritumoural oedema, necrosis, absent fat rim, size and heterogeneity of soft tissue component in bone lesions, invasion of adjacent joint, muscles, NVB and lymph node involvement) was helpful in 88.1% (52/59) for diagnosing as well as differentiating benign from malignant lesions. <b>Conclusion:</b> USG is useful in all soft tissue tumours and bone tumours with cortical discontinuity, whereas less informative in intra-osseous and sclerotic lesions. It is useful to differentiate benign and malignant lesions. It is very informative than any other modality in recurrent tumours with implants producing artefacts. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=TC01-TC06&id=11633 https://doi.org/10.7860/JCDR/2018/35566.11633 Assessment of Perceived Stress in Postgraduate Medical Students during Training Programme Anuradha Rajiv Joshi, Mitsha Nagpal <b>Introduction:</b> Postgraduate (PG) training programme in medical field is a transitional period for PG students. They are expected to be able to present state of the art information for the decisions taken for treating the patients. It requires extraordinary time demand leading to physical exhaustion. Academic, professional and personal factors cause stress in day to day life. Sustained stress leads to increased rate of anxiety, depression and suicidal tendencies. Many studies have been done to evaluate stress in undergraduate medical students but very few studies have been done in PG medical students in India. <b>Aim:</b> To evaluate and compare stress amongst I and III year post graduate students by Perceived Stress Scale (PSS) and by estimating the levels of salivary cortisol. <b>Materials and Methods:</b> This was a cross-sectional observational study using self administered questionnaire. The study group consisted of 60 PG students (I year-30 students and III year-30 students). They were asked to complete a questionnaire which included personal data, academic problems, social support, and other stress inducing factors. Stress was measured by PSS score and estimation of salivary cortisol was done by ELISA. Salivary cortisol was analysed by unpaired t-test. Simple percentage analysis of PSS questionnaire was done. <b>Results:</b> Analysis of salivary cortisol levels and PSS score amongst I and III year PG students was statistically significant (p<0.05) and salivary cortisol levels were positively correlated with PSS score. PSS score of I year PG students was moderate (17.46±2.09) which might be due to burden of the clinical ward work, getting exposed for first time to treat critically ill patients in emergency room, dealing with patients relatives in death situations and lack of time for friends and family. PSS score of III year PG students was more as compared to first year students (22.2±4.32), which might be due to additional burden of thesis work, lack of time to review what has been learnt, vast academic curriculum and worries about future. These effects affected their daily sleep duration, diet, interpersonal relations with colleagues and family members leading to increased stress. The mean salivary cortisol level was more (9.27±2.38ng/mL) in III year PG students than I year PG students (7.12±1.60 ng/mL). <b>Conclusion:</b> This study explored that both I year and III year PG medical students are under moderate stress and PSS score is directly correlated with salivary cortisol levels. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=CC01-CC04&id=11634 https://doi.org/10.7860/JCDR/2018/28300.11634 Prevalence of Chlamydia Pneumoniae Infection in Atherosclerotic Plaques of Corpses Mohammad Reza Eskandarion, Reza Nasr, Mohammad Reza Akbari Eidgahi, Elnaz Mozaffari, Mehdi Norouzi, Mohsen Tabasi, Mohammad Reza Ghasemi, Jaber Ghareh Daghi <b>Introduction:</b>Microbes such as Chlamydia pneumoniae play an important role in development of atherosclerosis. The bacterium invades vessels walls, directly or indirectly, and by releasing endotoxins or lipopolysaccharides into the bloodstream leads to injuries to endothelial cells. <b>Aim:</b> To determine the prevalence of C. pneumoniae in atherosclerotic plaques of corpses, by PCR (Polymerase Chain Reaction) and to examine the correlation between clinical status and presence of this bacterium in Iran. <b>Materials and Methods:</b> In this descriptive comparative study, a total of 118 samples, including 59 from corpses with atherosclerotic plaques in arteries (44 coronary and 15 abdominal aorta samples) and 59 from corpses without atherosclerotic plaques or obstruct in arteries (44 coronary and 15 abdominal aorta samples) were refrigerated at -70°C. Then, DNA was extracted and to detect C. pneumoniae, the pstI gene was selected and after amplification, samples were electrophoresed to confirm the presence of expected PCR products. The data were analysed using Chi-square statistical test and p-value less than 0.05 was considered to be statistically significant. Also, the relation between C. pneumoniae and some variables of atherosclerotic diseases such as hypertension, hyperlipidemia, smoking and diabetes were studied. <b>Results:</b> In this study, 15% (9/59) of samples from corpses with atherosclerotic plaque were positive for C. pneumoniae DNA, 11% (7/59) in coronary arteries and 4% (2/59) in aortic wall layer while, there was no evidence of C. pneumoniae in corpses with no plaque or obstruction in arteries. Variables such as hypertension, hyperlipidemia and myocardial infarction had higher values in C. pneumoniae positive samples; however, there was no statistically significant difference (p> 0.52). <b>Conclusion:</b> Presence of C. pneumoniae in atherosclerotic plaques and absence in healthy vessels, confirm the possible role of C. pneumoniae in development of atherosclerosis, especially in regions with frequent infections. Nevertheless, the exact mechanism explaining the high prevalence of atherosclerotic vascular disease is completely unknown. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=HC01-HC04&id=11635 https://doi.org/10.7860/JCDR/2018/31010.11635 Assessment of Knack of Clinical <i>Staphylococcus aureus</i> Isolates for the Biofilm Formation and Presence of <i>icaABCD</i> Family Genes Alka Hasani, Leila Dehghani, Mohammad Ahangarzadeh Rezaee, Akbar Hasani, Mohammad Asghari Jafarabadi, Naser Alizadeh, Nasim Asadi, Hossein Samadi Kafil <b>Introduction: </b>Superbug known as Staphylococcus aureus possess a tendency to form biofilm, which has a significant role in causing infection and abating host defense response. Amongst many mechanisms, biofilm formation depends on the icaABCD operon involved in the synthesis of a polysaccharide intercellular adhesion. <b>Aim:</b> To investigate biofilm forming ability of S. aureus isolates by phenotypic and genotypic methods. <b>Materials and Methods: </b>Of the 97 S. aureus clinical isolates collected, the quantitative biofilm formation was determined by microtiter plates. All S. aureus isolates were examined for detection of the icaABCD genes and mecA gene by using PCR method. Statistical analysis was performed with SPSS program version 17.0. <b>Results: </b>Among 97 S. aureus isolates from blood, wound, skin, surgery, internal, burn and infectious wards, urine and body fluids specimens, five isolates appeared as strong biofilm producer, while 28 displayed moderate biofilm formation, and 55 showed weak biofilm formation. Nine isolates did not reveal biofilm production on microtiter plates. The frequency of icaA, icaB, icaC and icaD genes in S. aureus isolates was 81 (83.5%), 71 (73.2%), 51 (52.5%) and 97 (100%), respectively. There was no relation between presence of icaABCD genes and biofilm formation (p=0.74). <b>Conclusion:</b> The presence of biofilm genes may not coincide with the ability to produce biofilm or vice versa. At the results, S. aureus clinical isolates possess different capacity to produce biofilm and adhesion. Methicillin resistance and susceptible isolates may not differ in their capacity to form biofilm. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=DC31-DC36&id=11636 https://doi.org/10.7860/JCDR/2018/34140.11636 Determinants of Intrauterine Device Acceptance among Married Women in Coastal Karnataka, India Avinash Kumar, Anam A Alwani, B Unnikrishnan, Rekha Thapar, Prasanna Mithra, Nithin Kumar, Vaman Kulkarni, Ramesh Holla <b>Introduction:</b> Intrauterine Devices (IUDs) are the most effective long term, temporary method of contraception which have many benefits such as low cost and minimal side effects. Despite this, IUD use is not prevalent in India; though, the expanding population stresses the dire need for effective contraceptive use. <b>Aim:</b> To determine the reasons for acceptance and use of IUDs among the women and the side effects experienced by them, to utilise this information to further increase the rate of acceptance of IUDs. <b>Materials and Methods:</b> The present cross-sectional study was done in three health care facilities: a Government Maternity Hospital, a private tertiary care hospital and a Community Health Centre (CHC), associated with Kasturba Medical College (KMC), Mangalore, Karnataka, India. Before conducting the study, ethical clearance was obtained from the Institutional Ethics Committee (IEC) of KMC, Mangalore. Participant information sheets and informed consent forms were distributed. We studied 110 married women who had IUDs inserted. Demographic details, source of information, factors motivating IUD use, reasons for the use of IUDs and side effects were assessed using a questionnaire. <b>Results:</b> The mean age of the study participants was 26.65±4.0. 77% were Hindus, 99.1% of the participants were literate and 86.4% were housewives. Only 2.7% of the husbands were illiterate and 53.6% were employed in semiskilled professions. Almost 91% of the husbands and 82% of the families were favourable towards the use of contraceptives. For 89% of the participants, the health care provider served as a chief source of information about IUDs. Out of all the participants, 68.2% were using IUDs for child spacing and 29.1% were using it for prevention of pregnancy. Around 36% of the women experienced side effects due to IUD use, out of which 61.5% complained of vaginal bleed. <b>Conclusion:</b> IUDs are being accepted in our society. Benefits of use outweigh the risk involved. Health care providers play an effective role in promoting IUD use in society. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=LC05-LC09&id=11637 https://doi.org/10.7860/JCDR/2018/34146.11637 Evaluation of Goitre and its Sociodemographic Risk Factors among Rural School Children of Kancheepuram, Tamil Nadu, India AS Anusha, S Gopalakrishnan, AK Savitha, R Rama <b>Introduction: </b>Iodine Deficiency Disorders (IDDs) are one of the most important disorders of childhood affecting the brain development. It is marked by a diffuse enlargement of the thyroid gland, known as goiter. A district is said to be endemic for goiter when its prevalence is >10% in the general population. Despite several national policies to rectify the problem, goiter seems to continue to persist as a major public health problem. <b>Aim:</b> This study was done to evaluate the prevalence of clinical goiter among school going children and their salt consumption pattern. <b>Materials and Methods:</b> This cross-sectional study was carried out among 670 school students between 6-14 years of age studying in rural schools of Kancheepuram, Tamil Nadu, India. The students were selected from five schools. The sampling method used was Probability Proportional to Size (PPS). A pretested structured interview schedule was used to collect information regarding the sociodemographic factors. Clinical examination was carried out and salt samples were procured for testing the iodine levels. Data collected was analysed using SPSS version 17.0. <b>Results:</b> In present study, 388 (57.9%) were males and 282 (42.1%) were females and belonged to the age group of 6-14 years. The overall prevalence of goiter was 6.6%. About 43.5% of the participants consumed salt procured from petty shops. In 46.6% of the samples, the level of iodisation was between 7 to 14.99 ppm. It was observed that age, socioeconomic status, family history of goiter and iodisation levels <15 ppm were significant risk factors for goiter (p<0.0001). <b>Conclusion:</b> This study shows that goiter still continues to be a major public health problem in Kancheepuram, Tamil Nadu, India. The public health authorities should ensure public awareness about the effects of IDDs and the need to consume adequately iodised salt. The availability of adequate and regular supply of iodised salt should be ensured. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=LC10-LC14&id=11638 https://doi.org/10.7860/JCDR/2018/34477.11638 Mutual Influence between Dispatchers and Callers: Experience and Perception of Iranian Service Providers Babak Farzinnia, Hamidreza Khankeh, Davoud Khorasani-Zavareh, Moussa Amiri, Ali Ardalan <b>Introduction:</b> In emergencies, where dispatchers are not directly involved at the incident scene, little attention is paid to the adverse events on them. Caller’s reactions may influence their decisions. Few studies about human aspects of emergency calls have been conducted but none of them was conducted from Iran. <b>Aim:</b> To explore mutual influence between dispatchers and callers based on experiences and perceptions of the dispatchers. <b>Materials and Methods:</b> The present qualitative study utilised constant comparative analysis method, recommended by Corbin and Strauss 2008 and was conducted among 15 Iranian dispatchers using semi structured in-depth interviews, from May 2016 to June 2016. The study participants were selected purposefully from four main emergency call centers in Tehran (Police, Emergency Medical Services, Iranian Red Crescent and Fire Department). <b>Results:</b> Dispatchers, who have experiences in the dispatch centers and key informants, were selected for interviews. These personnel were employed as dispatchers with at least two years of experience or they were key informants. According to the participant’s experiences, mutual influence between dispatchers and callers as the main concept of the study was categorised into three subcategories including human and innovative essence of the emergency dispatcher’s job, psychological aspects, and surge of false emergency calls. In Iran, the multiplicity of emergency services along with their emergency numbers negatively affects the mutual influence between dispatchers and callers. <b>Conclusion:</b> According to the findings, psychosocial support programs should be instituted in call centers not only for dispatchers but also for their family members and callers. Proper use of emergency numbers should become a common sense in the community. Relief agencies should move to create a national emergency number for more coordination between call centers to reduce caller’s confusion. There are several factors that cause anxiety in callers and consequently lead to aggression and false calls. These factors require exploration to reduce false calls. Exploring the processes of emergency call centers in Iranian context is suggested for future studies. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=KC01-KC05&id=11639 https://doi.org/10.7860/JCDR/2018/35697.11639 Antimycobacterial Activities of an Edible Mushroom Extract and its Synergy with the Standard Antituberculous Drugs Debasmita Chatterjee, Dipankar Halder, Urmita Chakraborty, Devarati Dutta, Satadal Das <b>Introduction:</b> Tuberculosis is a leading cause of death in most developing countries mainly due to drug resistance. Mushrooms are reservoirs of many unexplored active ingredients in relation to antimicrobial applications, giving us a scope to exploit it to see whether antituberculosis activity is pertaining with it. <b>Aim:</b> We explored one member of edible mushroom Pleurotus ostreatus for its antimycobacterial activities. <b>Materials and Methods:</b> Minimum Inhibitory Concentration (MIC) of the mushroom extract was assayed against Mycobacterial strains-H37Ra, 2 clinical Mycobacterium tuberculosis isolates and one MOTT (Mycobacterium Other Than Tuberculosis). Haemotoxicity analysis and characterisation of bioactive ingredients of extract were also studied. Synergistic study with Ethambutol (EMB), Isoniazid (INH) and Rifampicin (RIF) was also done. <b>Results:</b> Ethanolic extract of mushroom showed MIC values in the range of 2.5 mg/mL-15 mg/mL against the strains collected. No haemotoxicity was found by the bioactive components of the extract upto a concentration of 20 mg/mL. Specific phenol and flavonoid compounds are attributed to the antimycobacterial activity shown by the extract. Excellent synergy of the extract was revealed with RIF followed by EMB against the strains of Mycobacteria, while INH only show synergy against the MOTT. <b>Conclusion:</b> Mushrooms can be considered as a potent source of bioactive compounds showing antituberculosis activity. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=DC37-DC41&id=11640 https://doi.org/10.7860/JCDR/2018/35569.11640 An Epidemiological Study to Estimate the Baseline Titres of Widal Test in Apparently Healthy Individuals of Bhubaneswar, Odisha Subhajit Giri, Surya Narayan Mishra, Basanta Kumar Behera, Dipti Pattnaik <b>Introduction:</b> Enteric fever is one of the most prevalent community acquired infection especially in the developing countries; caused by Salmonella enterica serovar Typhi, Paratyphi A and Paratyphi B. The Widal test is a well-known test to detect the serological evidences of presence of Salmonella groups. As the baseline Widal titre varies substantially region wise; updating the baseline Widal titre among the healthy individuals is a must for the proper interpretation of the Widal test. <b>Aim:</b> To determine the baseline Widal titre (titre of the antibodies to the O and H antigens of Salmonella enterica serovar Typhi and the H-antigens of S. Paratyphi A and Paratyphi B) amongst apparently healthy individuals of Bhubaneswar, Odisha. <b>Materials and Methods:</b> To determine the baseline Widal titre among apparently healthy individuals of Bhubaneswar; a prospective study covering 500 blood samples was conducted using tube Widal test. Healthy young individuals who were neither vaccinated nor have a recent hospitalization history were included in the study. <b>Results:</b> Out of the total 500 serum samples, 340 were positive for agglutinins (1 = in 20) and 160 serum samples were negative for agglutinin (1 = in 20). The distribution of the samples with an antibody titre = 1:20 against different serotypes of Salmonella enterica subspecies enterica showed an antibody to anti O antigen in 340 samples (68%), an antibody to anti H antigen in 292 samples (58.4%), an antibody to anti AH antigen in 268 (53.6%), an antibody to anti BH antigen in 224 samples (44.8%) out of the total 500 samples. The baseline titre for Widal test in apparently healthy individuals of Bhubaneswar was calculated to be: 1:40 for the anti TO antibodies and of 1:20 each for the anti- TH, anti AH and anti BH antibodies. <b>Conclusion:</b> It is clear that Salmonella agglutinins are common among apparently healthy people and as endemicity of typhoid in an area may change over time, information of baseline titre will help a better clinical diagnosis and treatment to the deserving patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=DC42-DC45&id=11641 https://doi.org/10.7860/JCDR/2018/34179.11641 Molecular Detection of <i>Human papillomavirus</i> (HPV) in Females and Assessment of Risk Factors for HPV Infection: A Study from Coastal Karnataka Varsha Saxena, Vidya Pai, K Rajagopal, Abdulla Mehnaz <b>Introduction: </b>Cervical cancer is the fourth common malignancies in world and Human Papillomavirus (HPV) infection may lead to the development of the precancerous and cancerous lesions of the cervix. <b>Aim:</b> This study was conducted to evaluate the presence of HPV in women who were admitted with cervical abnormality or attending Gynaecology OPD for any reason. <b>Materials and Methods:</b> In this study a complete clinical history and demographic details of 90 subjects were recorded of which total 50 tissue biopsies and 40 cytobrush samples were collected. Results of histopathology and Papanicolaou (PAP) smear for biopsies and cytobrushes respectively were recorded from the medical records. Further PCR was performed for the presence or absence of HPV in all samples. <b>Results:</b> Various risk factors for the acquision of HPV infection were analysed in the present study. Out of 50 tissue biopsies, 15 had cervical carcinoma, 2 had Cervical Intraepithelial Neoplasia-II and 33 had chronic cervicitis. Whereas out of 40 cytobrushes, 32 were Negative for Intraepithelial Lesions/Malignancy, 2 had Atypical Squamous Cells of Undetermined Significance, 3 had Inflammatory Smear with Reactive Atypia and 3 had Inflammatory Smear. PCR results confirmed only 11 HPV positives among 50 tissue biopsies and 6 HPV positives among 40 cytobrush samples. The overall prevalence of HPV in our study was 18.8% only. <b>Conclusion:</b> Present study shows that the occurrence of HPV is low as compared to the other studies done in other parts of India and in our region there is no awareness regarding HPV infection as well. Overall, these findings could have important implications for the preventions of cervical cancer. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=DC46-DC50&id=11642 https://doi.org/10.7860/JCDR/2018/35457.11642 Immune Response in Pregnant Women Infected with Acute Vaginal Abscess Caused by <i>Staphylococcus aureus</i> and <i>Trichomonas vaginalis</i> Ahmed Abduljabbar Jaloob Aljanaby, Saleem Alhadraawy, Sukayna Mushattat <b>Introduction:</b> Vaginal abscess in pregnant women caused by Staphylococcus aureus and Trichomonas vaginalis is one of the most important disease, this infection is still medically uncontrolled because of poor health awareness due to the absence of personal hygiene in some women. <b>Aim:</b> This study is aimed add evaluation of immune response in pregnant women infected with acute vaginal abscess caused by S.aureus and T.vaginalis due to the determination of four biomarkers level; Interleukin13 (IL-13), Prostaglandin E2 (PGE2), Transforming growth factor ß1(TGF-ß1) and Lactoferrin. <b>Materials and Methods:</b> This is a case control study was done in AL-Zahra hospital in AL-Najaf City, Iraq from January 2017 to November 2017. 120 pregnant women were included in this study, 30 women infected with S. aureus, 30 women infected with T. vaginalis, 30 women infected with both pathogens (inclusion criteria in this study) and 30 healthy pregnant women as control. All other cases were excluded from this study. Enzyme Linked Immunosorbent Assay (ELISA) technique was used in this study to estimate biomarkers level in serum of pregnant women infected with acute vaginal abscess. <b>Results:</b> The results of the current study proved that there was significant increase (P <0.05) in IL-3, PGE2 and TGF-ß1 levels in serum of women infected with acute vaginal abscess caused by S.aureus, T.vaginalis and both pathogens as compared with control; while, there was significant decrease (P <0.05) in lactoferrin level in serum of pregnant women infected with T.vaginalis as compared with women infected with S.aureus and control. <b>Conclusion:</b> The synergistically pathogenic effect of S.aureus and T.vaginalis in pregnant women infected with acute vaginal abscess lead to activation of T-cell and overproduction of IL-3, PGE2 and TGF-ß1 as a good signaling markers against infection. In contrast, this synergistic effect leads to reduction of lactoferrin level in the same women. That mean these women may be susceptible to acute anemia that may be lead to abortion. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=DC51-DC55&id=11643 https://doi.org/10.7860/JCDR/2018/35653.11643 Comparative Study of Robinson’s and Mouriquand’s Cytological Grading Systems and Correlation with Histological Grading in Breast Carcinoma Vishnu Priya Bukya, Rukmangadha Nandyala, Manilal Banoth, Mutheeswaraiah Yootla, Amit Kumar Chowhan, Aruna K Prayaga <b>Introduction:</b> Fine Needle Aspiration Cytology (FNAC) plays a critical role in the initial evaluation and early diagnosis of breast masses, by providing relevant information on aggressiveness of tumour thus helping in the management. There is no gold standard for cytological grading due to lack of agreement among the pathologists and clinicians to accept them on par with Scarff-Bloom-Richardson (SBR) grading system. <b>Aim:</b> To study cytological grading by fine needle aspirate smears of breast carcinoma using Robinson’s grading and Mouriquand’s grading and to correlate with SBR histopathological grading on excised breast cancer specimens. <b>Materials and Methods:</b> This was a prospective study from March 2016 to August 2017, which included 75 cases of cytologically proven duct cell carcinoma of breast with their corresponding histopathology. They were graded cytologically by Robinson’s and Mouriquand’s methods and correlated histologically with SBR grading method. SPSS version 16.0 was used to calculate sensitivity, specificity and diagnostic accuracy. Concordance and discordance rates were measured by Kappa measurement of agreement. <b>Results:</b> Cases were divided into 3 grades both by Robinson’s and Mouriquand’s cytological grading methods. By Robinson’s method out of 75 cases, 10 cases (13.33%) were Grade I, 57cases (76%) were Grade II and 8 cases (10.66%) were Grade III. According to Mouriquand’s method cases were graded as Grade I-14 cases (18.66%), Grade II-54 cases (72%) and Grade III-7 cases (9.33%). As per histological grading done on surgical specimens according to SBR grading system, we found 23 (30.66%) were Grade I, 41(54.66%) were Grade II and 11 (14.66%) were Grade III. The concordance between the 2 cytological gradings was 85%. The concordance and discordance rates between Robinson’s cytological and Mouriquand’s grading with SBR histological grading was 78.6%, 66.6% ,21.4% and 33.4% respectively. The kappa values of agreement for Robinson’s and Mouriquand’s cytological gradings were k=0.100 (very good agreement) and k=0.118(fair agreement) respectively. <b>Conclusion:</b> Cytological grading of breast carcinoma can be done by both Robinson’s and Mouriquand’s cytological grading with variable concordance with histological grading. However we observed Robinson’s cytological grading to be superior to Mouriquand’s cytological grading and hence can be preferred for routine cytological grading of breast carcinomas. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=EC04-EC08&id=11644 https://doi.org/10.7860/JCDR/2018/36387.11644 Effects of Aerobic Exercise on Frontal EEG Asymmetry, Coherence and Mood: A Pilot Study Vernon Bond JR, Alexis Osby, Thomas Obisesan, Krishna Kumar, Sudhakar Pemminati, Vasavi Rakesh Gorantla, Yulia Andreevna Volkova, Richard Mark Millis <b>Introduction:</b> Electroencephalographically-measured frontal alpha asymmetry is shown to reflect changes in mood. Negative mood changes are purported to limit exercise capacity in some groups, thereby contributing to the current epidemic of overweight, obesity and related diseases. <b>Aim:</b> This study tests the hypothesis that the mood changes associated with aerobic exercise are correlated with changes in frontal EEG asymmetry. <b>Materials and Methods:</b> Healthy young adult African-American (AA) men (n=8) and women (n=8) were subjected to quantitative EEG brain mapping of delta, theta, alpha and beta bandwidths after a period of rest or a period of aerobic exercise at a fixed energy expenditure. Brain mapping was performed within 30 min after rest or exercise, immediately before completing a questionnaire which included a total mood disturbance score (tMDS) and specific mood subcategory scores consisting of vigor, fatigue, anger, confusion tension, depression. Prefrontal and inferior frontal asymmetry were evaluated. Significance of differences between rest and exercise prefrontal and inferior frontal AS was evaluated by one-way ANOVA. <b>Results:</b> Exercise-related decrements in asymmetry were significant for prefrontal delta (p=0.05) and marginally significant for prefrontal alpha and theta (p=0.07) in the male subjects. There were significant decrements in tension and tMDS for the males and females and a decrement in depression score for the females between the post-control rest and the post-exercise conditions. Significant negative correlation between the tMDS and prefrontal beta asymmetry was found, across post-rest and post-exercise (r= -0.38, p=0.05, 30 df). There were also significant correlations between confusion and prefrontal beta asymmetry during rest (r= 0.48, p=0.05, 14 df), between vigor and inferior frontal beta asymmetry, between vigor and both inferior frontal theta asymmetry and inferior frontal delta asymmetry during exercise (r= 0.46, -0.54, p=0.05, 14 df), and between vigor, confusion, tension and inferior frontal delta asymmetry post-exercise (r= -0.49, -0.45, -0.49, p=0.05, 14 df). <b>Conclusion:</b> The high prefrontal beta asymmetry associated with depressed mood in AA males and females, the lessening of prefrontal delta, theta and alpha asymmetry in the males and the lower depression scores after aerobic exercise in the females seem to support the hypothesis that decreased asymmetry with increased activation of the right prefrontal and frontal cortices may accompany the mood changes associated with aerobic exercise. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=CC05-CC10&id=11645 https://doi.org/10.7860/JCDR/2018/32657.11645 Auditory and Visual Reaction Time in Polycystic Ovarian Syndrome Rupali Mehta, Manjinder Kaur, Pooja Gandhi, Priyanka Parihar <b>Introduction:</b> Polycystic Ovarian Syndrome (PCOS) is a hormonal disorder of female reproductive system causing infertility, irregular menstrual cycle and hormonal imbalance characterised by hyperestrogenemia, hyperprolactinemia, increased Anti Mullerian Hormone (AMH) and Thyroid Stimulating Hormone (TSH). Apart from the role in female reproductive system, these hormones are shown to have neuromodulatory role, affecting the neuronal activity. Thus, the auditory and visual reaction time may be affected in the women with polycystic ovaries. <b>Aim:</b> To evaluate the auditory and visual reaction time, in patients with polycystic ovarian syndrome. <b>Materials and Methods:</b> The study was designed as a case-control study where the 80 otherwise healthy women, attending infertility OPD, were recruited for the study and divided into groups viz., PCOS (n=40) and NPCOS (n=40). The subjects from both the groups were evaluated for their anthropometric data, hormone levels {Serum estrogen, Serum prolactin, Serum TSH, Serum AMH} using COBAS-6000 analyser along with the auditory and visual reaction time using RTM-608 (Medicaid). The observations were recorded and analysed using paired t-test. <b>Results:</b> Auditory reaction time had significantly decreased (p=0.012) while visual reaction time was non-significantly reduced in Group PCOS as compared to Group NPCOS. <b>Conclusion:</b> The altered hormonal profile in PCOS i.e., hyperestrogenemia and hyperprolactinemia exerts enhanced neuromodulatory action through neural ERa receptors and tuberoinfundibular dopaminergic neurons in hypothalamus, thus resulting in increased neuronal excitability and decreased reaction time in patients with PCOS. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=CC11-CC13&id=11646 https://doi.org/10.7860/JCDR/2018/31863.11646 A Review of Influenza Vaccination among Different Population Groups in Iran Mohsen Keshavarz, Ahmad Tavakoli, Amir Sasan Mozaffari Nejad, Talat Mokhtari-Azad, Farhad Rezaei Annual influenza vaccination is the best means of prevention and control of influenza virus infection and its complications. Efforts to increase influenza vaccines coverage, especially in high-risk groups including young children, the elderly, pregnant women and immunocompromised individuals have led to substantial reduction in health burden, severity and duration of infection. This review will focus on vaccination coverage against influenza infection among different population groups in Iran. Also, available evidences of effectiveness and adverse effects of currently licensed influenza vaccines will be discussed. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=LE09-LE13&id=11647 https://doi.org/10.7860/JCDR/2018/35486.11647 Receiver Operator Characteristic Analysis of Biomarkers Evaluation in Diagnostic Research Karimollah Hajian-Tilaki Receiver Operator Characteristic (ROC) analysis is the choice of method in evaluation of biomarkers in bioinformatics research. However, there is no single method and also no single accuracy index in evaluating diagnostic tools. This review provides an extensive illustration of different methods of ROC curve analysis that can be used in clinical practice of diagnostic studies. It includes their early use for rating data and the recent developments for quantitative data with a discussion of choice of model selection in parametric ROC analysis compared with non-parametric approach. The relevant methodological issues of these two alternative approaches have been discussed in terms of bias and sampling variability of Area under the curve (AUC) index that may influence on the performance of diagnostic tests. The methods were illustrated with two relevant clinical examples. The semi-parametric and parametric model of mixture of Gaussian is comparable with purely nonparametric approach. The choice between methods depends on practical conveniences unless the presence of severe departure from binormality. The recent new development and the gaps in knowledge concerning their behaviours in actual applications for medical researches and a guideline for future research have been discussed. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=LE01-LE08&id=11609 https://doi.org/10.7860/JCDR/2018/32856.11609 A Review of Clinical Evaluation and Management of Delirium Bhupendra Shah, Bijay Bartuala Delirium is a syndrome characterised by the acute onset, fluctuating course of disturbed consciousness and cognitive impairment. It is an important medical condition with poor outcomes. Delirium is still under-recognised problem in intensive care unit. This is our endeavor to review the diagnosis and management of delirium based on the published literature. Two reviewer independently searched Electronic databases MEDLINE/PubMed, Google Scholar, Cochrane library and Scopemed with Mesh (Medical Subject Headings) terms “delirium”, “diagnosis”, and “management” from earliest possible date to January 31st, 2018. Articles in any language especially those published in recent years were given preference. Delirium is categorised into hypoactive, hyperactive and mixed type. The Confusional assessment method is an effective, easy and user-friendly tool to diagnose delirium. The non-pharmacological management like reorientation, mobilisation, and termination of the reversible cause is the initial step of delirium management. Haloperidol is a drug choice for delirium; however, newer antipsychotics are showing promising results. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=OE01-OE04&id=11664 https://doi.org/10.7860/JCDR/2018/35356.11664 Review of Ayuvedic Strategies to Overcome Nidranasha and Improve Quality of Life Thanusree N Nair, Akhilesh Shukla, Haritha Chandran, Leena P Nair <b>Introduction:</b> Insomnia is the most commonly reported sleep problem, which profoundly affects the person’s quality of life. In Ayurveda various non-pharmacological methods related with dietary modifications, physical and psychological factors are well described for the effective management of Nidranasha (primary insomnia) and to improve the quality of life. <b>Aim: </b>To explore the non-pharmacological strategies for the effective management of Nidranasha (primary insomnia) from the perspective of Ayurveda. Comparison with Pharmacologic Treatments: Various pharmacological compounds are effectively used for the symptomatic treatment of insomnia such as hypnotics, antidepressants, neuroleptics etc., however, their safety, dependency and adverse effect remains a matter of concern among physicians, when used for the long-term. Ayurvedic approaches can be a better choice in this situation. <b>Materials and Methods: </b>For this, Ayurevda classics have been thoroughly studied, PubMed was searched using key words, Anidra, Nidranasha and non-pharmacological treatment for insomnia from Ayurveda, the free full text article published during 2000 to 2017 were reviewed. The information was also taken from the modern medical science article from the same year and from the official web page of Centers for Disease Control and Prevention. <b>Results:</b> A total of 5 free full text articles from Ayurveda and 40 from modern medicine were found in the PubMed search. Information from the classical Ayurveda texts and published articles both were utilized in this review. <b>Conclusion:</b> Ayurveda gives importance to the natural sleep for the maintenance of health. It is always better that Nidranasha (primary insomnia) should be initially managed without the use of any pharmacological compound. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=KE01-KE05&id=11670 https://doi.org/10.7860/JCDR/2018/35301.11670 Implementation of a Pilot Test mHealth Application to Improve Home Based Newborn Care (IMNCI) in Remote Tribal Gujarat Kandarp Talati, Amee A Amin, Somashekhar M Nimbalkar India has adopted a neonatal component to Integrated Management of Childhood Illness (IMCI), creating IMNCI. In the era of Digital India initiatives, we reviewed the appropriateness of an electronic IMNCI/IMCI, the barriers to adherence and potential of Information and Communication Technologies (ICT) for evaluation and management of young infants (0-2 months). An Audit of local and national challenges related to IMCI/IMNCI practices was performed accompanied with a review of local and global mHealth initiatives that have demonstrated success in exploring and collaborating ICT with IMCI/IMNCI practices. IMNCI algorithm for evaluation and management of neonate and young infant has a good sensitivity and specificity for referring cases with severe illness. However, gross deficiencies have been identified in the areas of long-term knowledge and skill retention among trained workers, lagging refresher training, referrals of young infants, non-availability of a trained paediatrician at rural or block level health facilities coupled with poor healthcare seeking in the postnatal period. Diagnostic discordance between IMNCI algorithm and IMNCI trained medical officers’ or health workers’ decision is also of concern. IMCI Computerised Adaptation and Training Tool and similar approaches leveraging ICT have demonstrated reduced training time, improved adherence, potential cost-effectiveness and quality data collection to strengthen program implementation and policy decisions. Smartphones have developed advanced computing capabilities, which is why development of a mobile app to digitise the algorithm, to reduce the cognitive load on the peripheral worker, and to enhance utilisation of IMNCI is in process. India should pilot test m-IMNCI prototype targeting present implementation challenges as decision support technologies have considerable potential to improve coverage and quality of health care for the poor. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=SE01-SE03&id=11687 https://doi.org/10.7860/JCDR/2018/35229.11687 The Role of Epidermal Growth Factor Receptor in Cancer and their Application for New Targeted Cancer Therapy Farajolah Maleki, Sadeghifard Noorkhoda, Raheleh Halabian, Elham Behzadi, Abbas Ali Imani Fooladi Epidermal Growth Factor Receptor (EGFR) has central role in cancer therapy because it causes tumour progression in many cases. The EGFR has seven ligands. Each factor that can block this binding, inhibits the intracellular signal transduction and prevents progression of the tumours. Immune system response is the most important factor for suppressing the initial stage of tumour growth and destroying some initial malignant cells, daily. On the other hand, tumours have different mechanisms to hide their antigens and escape from immune system responses. In contrary, tumours use some mechanisms to escape from immune system such as: 1) use of TGF-ß to initiate angiogenesis and immune suppression; 2) Induces Treg cell activation to modulate other immune cells; 3) secretion of the prostaglandin E2 to convert T cell into Treg. So, if a superantigen fused to one of the EGFR-ligands, causes the induction of immune system responses against the tumour cells. One of the new methods is based on the use of the fused super antigen with a ligand of the EGFR to inhibit ligand attaching to the EGFR and inducing immune system responses. To achieve this goal, we can block binding of EGFR to their ligands in the extracellular domain by fusing ligands with bacterial superantigens, toxins or cytokines of the viruses and plants that can induce immune system responses and kill malignant cells. So, the fused ligand can both block signal transduction and induce immune system response against malignant cells. In addition, with combining traditional drugs, high efficacy of the tumour treatment can be achieved. The aim of this review is to assess the mentioned strategy for targeting tumours. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=XE01-XE06&id=11680 https://doi.org/10.7860/JCDR/2018/35499.11680 VanA Mediated Glycopeptide Resistant <i>Enterococcus faecium</i> (GRE) Infection in an Elderly Patient with Chronic Kidney Disease – A Case Report Martin Jane Esther, PK Rath, R Gopalakrishnan A 66-year-old male patient who is a known case of chronic kidney disease was admitted to the hospital with complaint of seizures. He was uremic and showed signs of encephalopathy. He was previously hospitalized frequently and was on antitubercular treatment. A left sided radio cephalic fistula was made and the patient was on dialysis. Urinary catheter and central venous catheter were placed. Urine and blood cultures showed growth of Enterococcus faecium which was resistant to vancomycin – Vancomycin Resistant Enterococci (VRE) or Glycopeptide Resistant Enterococci (GRE) by antibiotic susceptibility testing. The isolate was genotyped for detection of Van A, Van B and Van C genes and was found to harbour Van A gene. The treatment details of the patient and his outcome have been described. As Enterococci are inherently resistant to many drugs, their treatment is quite challenging. Combination therapy and de-escalation from broad spectrum antimicrobials to specific narrow spectrum antibiotics immediately after antibiotic sensitivity report is available which prevents emergence of drug resistance. Spread of VRE infection must be controlled by strict infection control methods as plasmid mediated rapid transfer of VRE can occur to other organisms like Staphylococci which is a serious threat. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=DD03-DD05&id=11614 https://doi.org/10.7860/JCDR/2018/35671.11614 Primary Ewings Sarcoma of Kidney: A Case Report Krishnendu Maiti, Akash Agrawal, Chhanda Datta, Dilip Kumar Pal Primary Ewings Sarcoma (EWS) of the kidney is a very rare tumour and very few cases have been reported till date. We present a case of a 36-year-old lady presenting to us with flank pain and haematuria, with a huge renal mass. Following left radical nephrectomy, histopathology was reported as ewings sarcoma. Hence, while dealing with renal masses in young patients, this entity should always be kept in mind. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=PD03-PD04&id=11611 https://doi.org/10.7860/JCDR/2018/35180.11611 Correction :2013 Mar: 7(3): 422–426 <b>Chandrika Gurulingappa Teli, Nilesh Netaji Kate, Usha Kothandaraman</b>, Morphometry of the Iliolumbar Artery and the Iliolumbar Veins and Their Correlations with the Lumbosacral Trunk and the Obturator Nerve (Published in Journal of Clinical and Diagnostic Research. 2013 Mar: 7(3). Introduction and a part of Discussion were found to be plagiarized, hence these sections were re-written. The authors acknowledged it to be a genuine mistake. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=June&volume=12&issue=6&page=ZZ01-&id=11409 https://doi.org/10.7860/JCDR/2018/.11409