Journal of clinical and diagnostic research https://www.jcdr.net/back_issues.asp JCDR A Rare Massive Pulmonary Chondroid Hamartoma Nazneen Abdul Kader, Minnu Khadeeja, PP Sathi Hamartomas are disorganised but benign masses composed of cells indigenous to the involved site. They are the tumourous lesion consisting of anomalously arranged tissues that are components of the normal lung, such as cartilage, fat, smooth muscle, and tubules lined by bronchial or bronchiolar epithelium, which may be entrapped. Hamartoma is the most common benign tumour of the lung, accounting for 8% of pulmonary neoplasms. Here is a case of giant pulmonary chondroid hamartoma. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=ED01-ED02&id=12421 https://doi.org/10.7860/JCDR/2019/35075.12421 Internal Jugular Vein Thrombosis Mimicking Sternoclavicular Joint Septic Arthritis- A Rare Case Report Surendra Umesh Kamath, Arjun Ajith Naik Internal jugular vein thrombosis is a vascular disease occurring spontaneously. Some of the predisposing factors include trauma, intravenous catheterization and deep neck infections. It is important to an orthopaedician, as it mimics sternoclavicular joint septic arthritis very closely. This can lead to wrong decision in opting for surgical drainage of the abscess which may turn out to be disastrous to the patient. Our case report describes a patient who presented to the emergency room with pain, swelling and redness over the sternoclavicular joint. Initial evaluation suggested septic arthritis of left sternoclavicular joint. On further evaluation this was ruled out and finally diagnosed as internal jugular vein thrombosis with adhesive capsulitis of left shoulder. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=RD01-RD02&id=12422 https://doi.org/10.7860/JCDR/2019/38145.12422 Filarial Pleural Effusion with Lymphoma: A Rare Association Kiran Agarwal, Aruna Chhikara Filariasis is endemic in developing countries with highest prevalence in India. Microfilarias are infrequently reported during cytological examination of body cavity fluids. Its association with neoplasm is still rare, with only a few reported cases of co-existent microfilaria with neoplasm. The malignancies reported in association with malignant pleural effusions are mostly carcinomas. Finding microfilaria in a pleural effusion is a very rare event even in the regions endemic for this organism. Its association with a lymphoma is even rarer. On extensive search of literature we could not find any case report of filarial pleural effusion associated with lymphoma. We here report a case of microfilaria in malignant pleural effusion secondary to lymphoma. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=ED03-ED04&id=12423 https://doi.org/10.7860/JCDR/2019/38114.12423 Colonic Metastasis of Renal Cell Carcinoma with Sarcomatoid Differentiation D’SA Bouvier Francis Valere, Nazima Haider, Sohaila Fatima Renal Cell carcinoma (RCC) can metastasize to any site in the body but metastasis to Gastrointestinal Tract (GIT) is extremely rare. Sarcomatoid RCC (sRCC), an aggressive subclone can be seen in variable proportions with other histological subtypes of RCC and is metastatic in majority of the cases. However, sRCC in association with primary papillary carcinoma metastasizing to colon is very rare, to the best of authors’ knowledge has never been reported before. Colonic metastasis of RCC is challenging for both the clinician and pathologist. We hereby present a case of 33-year-old female, a known patient of renal cell carcinoma with left nephrectomy done 3 years back, who presented with a descending colonic mass. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=ED05-ED07&id=12425 https://doi.org/10.7860/JCDR/2019/36735.12425 Case Report of Streptococcus constellatus Bacteremia in an 11-Month-old Child-clinical and Microbiological Aspects Chakrapani Kammineni, Vasu Burli, Sreekanthreddy Basireddy, Sudhakar <i>Streptococcus constellatus (S.constellatus),</i> normal commensal bacteria of the human oral cavity is known to be associated with abscess formation and/or bacteremias. This is an infrequently isolated organism from the blood culture of the patients and is considered pathogenic when isolated. Because of the increased usage and wide availability of newer automated methods and other technological advances, better isolation and identification of these organisms has been possible. We report a case of S.constellatus bacteremia associated with abscess in an 11-month-old child. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=DD01-DD02&id=12433 https://doi.org/10.7860/JCDR/2019/39695.12433 Inferior Accessory Ossicle of Anterior Arch of Atlas: Case Report with 3D Visualisation Rahul Dev, Pankaj Sharma, Yasrab Khan Inferior accessory ossicle of anterior arch of atlas is a rare, albeit normal variant in relation to the cervical spine, invariably detected incidentally while investigating for other unrelated condition. Its existence should always be kept in mind while evaluating any bony fragment in relation to atlas axis vertebrae so as to avoid unnecessary investigation in suspicion of other sinister aetiology. The presence of well-cortical margins, constant size and shape over a course of time, constant position in close relation to anterior atlas arch, normal appearing pre-paravertebral soft tissue are indicators of its presence. We present a case of this anatomical variant detected incidentally in an old man investigated for oral malignancy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=TD01-TD02&id=12435 https://doi.org/10.7860/JCDR/2019/39831.12435 Laparoscopic Pyloroplasty for Jodhpur Disease Nitinkumar Borkar, Debajyoti Mohanty, Sunita Singh Jodhpur disease is the name given to acquire Gastric Outlet Obstruction (GOO) of idiopathic origin. Persistent non bilious vomiting, pain and occasional distension of upper abdomen are the usual clinical presentation. This condition responds well to Henieke-Mikulicz’ pyloroplasty; however, laparoscopic management of Jodhpur disease is yet to become a widely accepted modality of treatment. Herein, we report a case of a three-year-old male child, diagnosed with Jodhpur disease who was managed successfully with three port laparoscopic Henieke-Mikulicz’ pyloroplasty. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=PD01-PD02&id=12439 https://doi.org/10.7860/JCDR/2019/39879.12439 Curious Case of Myocardial Infarction Caused by Lung Abscess Jyoti Bajpai, Pravesh Vishwakarma, Akshyaya Pradhan, Surya Kant, Ayush Jain Lung abscess is a necrotizing infection of lung parenchyma with pus collection usually due to pyogenic organism. Embolic complications involving cardiac structures are extremely rare. Type 2 Myocardial Infarction (MI) denotes myocardial injury and necrosis secondary to coronary spasm, embolus, anaemia, hypotension, respiratory failure, etc. without obvious coronary artery disease. We report a case of type 2 MI complicating lung abscess which posed multiple challenges in diagnosis and management. On one hand, use of anti-ischemic therapy for MI enhances the risk of bleeding (haemoptysis) while on the other hand interrupting them to minimize bleeding predisposes to risk of thrombotic events. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=OD01-OD03&id=12444 https://doi.org/10.7860/JCDR/2019/38433.12444 Sudden Death in a Child: The Mystery Behind the Cardiac Mass Neethu Tony Mampilly, Gayatri Ravikumar, Betty Alben, Julian Crasta A 12-year-old boy suddenly collapsed while playing and was brought to the emergency department, where he was declared dead. The child had no prior medical illness. On autopsy examination, a dumbbell shaped mass was found in the right atrioventricular sulcus on the anterior and posterior aspects. Microscopic examination of the mass revealed a thrombus within the wall of right coronary artery. Careful examination of the epicardial tissue close to the thrombus revealed a granulomatous vasculitis of the right coronary artery, with involvement of the root of aorta. A possible diagnosis of Takayasu’s arteritis was rendered. Vasculitis is the inflammation of the blood vessels. Kawasaki’s and Takayasu’s arteritis are the most common ones affecting the vessels of the heart. Takayasu’s arteritis or “pulseless” disease is a rare, idiopathic, chronic granulomatous vasculitis that affects aorta and its major branches. The rarity of its occurrence and clinical presentation as a thrombus masquerading as cardiac tumour is unusual and hence reported. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=ED08-ED10&id=12446 https://doi.org/10.7860/JCDR/2019/37488.12446 Insulinoma: A Diagnostic Challenge! Janet Prameela D’Souza, Gabriel Sunil Rodrigues, Leena Sequira, Amanda Varghese Insulinoma is a common tumour arising from islets of Langerhans. Patients with insulinomas present with neuroglycopenic symptoms such as repeated episodes of headache, blurred vision, diplopia and lethargy especially with fasting or exercise. Seizures, coma and permanent brain damage results from severe hypoglycaemia. The present report is of a female who got admitted with the chief complaints of swaying on to one side since one month and slurring of speech, seizures and becoming drowsy for four days. Her laboratory values indicated repeated episodes of hypoglycaemia in spite of repeated administration of intravenous dextrose. A CT scan of pancreas revealed insulinoma and was treated by surgical resection. After surgery, patient’s symptoms subsided and she recovered well. The clinical manifestations of insulinoma mimic features of diabetes mellitus and neuropsychiatric disorders, hence a thorough investigation needs to be done to confirm the diagnosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=LD01-LD02&id=12447 https://doi.org/10.7860/JCDR/2019/38279.12447 Rare Case Report of Dual Pathogen Causing Chronic Subcutaneous Infection: <i>Alternaria alternata</i> and <i>Staphylococcus aureus</i> in an Immunocompetent Patient Lavanya Jeyamani, Shanmugasundaram Venkatachalam, Prabhurajan Rajan, Vivekanandan Ramalingam, Preethi Shalini Gandi Chronic pyo-granulomatous infection of subcutaneous tissues with recurrence and exacerbations are predominantly of bacterial origin in Southern India. Most of the infections may not present with the classic triad to be labeled as mycetoma. Frequently, granular discharge is absent or not elicited. More often the infection is monomicrobial. However, rare polymicrobial infections are posing challenges in the treatment of the same. The genus Alternaria belongs to phaeoid fungi infecting immunocompromised hosts. They are associated with cutaneous and subcutaneous infections (70-80%) predominantly. We recount a rare case of chronic subcutaneous mixed infection by Alternaria alternata and methicillin sensitive Staphylococcus aureus in a healthy, immunocompetent, non-diabetic woman. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=DD03-DD05&id=12449 https://doi.org/10.7860/JCDR/2019/39558.12449 Angiolipoma-At a Rare Site A Hari Priya, A Kannan, MS Anandi, CL Krithika, PH Raghuram Angiolipoma (AL), a subtype of lipoma, is a rare benign mesenchymal tumour. It is common in the extremities with rare occurrence in the oral cavity. In this case report, we present a case of non-infiltrating type of angiolipoma present in the buccal mucosa which was surgically excised under local anaesthesia and the specimen was histopathologically examined. The histopathological examination revealed mature adipocytes arranged in sheets separated by thin fibrous connective tissue with interspersed vessels. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=ZD01-ZD04&id=12450 https://doi.org/10.7860/JCDR/2019/37241.12450 Systemic Thrombolytic Therapy for Pulmonary Embolism in Early Postoperative Period Following Laparoscopic Vaginal Hysterectomy BV Sunil, Shaik Gulam Osmani, S Neeta, Sarath Venugopal, Hariharan Kannan A 51-year-old female underwent a laparoscopic-assisted vaginal hysterectomy for fibroid uterus. After an uneventful procedure, the patient developed symptoms of Pulmonary Thromboembolism (PTE). The PTE was managed with, systemic thrombolysis using tissue plasminogen activator (Tenecteplase), appropriate support of inotropes and anticoagulants. While there is less incidence of PTE in laparoscopic procedures, in particular, in gynaecology, there is a definite risk even in a patient with low-risk factors, which has been highlighted. Prompt diagnosis, aggressive therapy and adequate haemodynamic support go a long way to reduce mortality and morbidity from this life-threatening complication. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=QD01-QD02&id=12454 https://doi.org/10.7860/JCDR/2019/39660.12454 Ileal Ischaemic Necrosis due to Metastatic Mesenteric Carcinoid B R Yelikar, K Mamatha, Namrata Balachandra Mestri, Deepthi Chandrika Chintalapudi, Anil Reddy Kondurudi Carcinoid tumours are the rare tumours arising from neuroendocrine cells. These tumours are relatively slow growing and may be clinically apparent only after a metastatic spread or evidence of Carcinoid syndrome. Rarely, these tumours may cause ischaemic necrosis in the non-neoplastic small intestine due to elastic vascular sclerosis of the mesenteric vessels. Here, authors present a case of metastatic mesenteric Carcinoid associated with ischaemic necrosis of the ileum. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=ED11-ED13&id=12452 https://doi.org/10.7860/JCDR/2019/37692.12452 Ameloblastic Fibrodentinoma of Anterior Mandible: A Rare Case Report Nikhat Mukhtar Gazge, Balaji Pachipulusu, Poornima Govindraju, Yogesh Pawar Ameloblastic Fibrodentinoma (AFD) is an extremely rare odontogenic tumour which is a variant of Ameloblastic Fibro-Odontoma (AFO) consisting of both epithelial and connective tissue components of the dental tissue. It was first reported by Field and Ackerman in 1942 and represents less than 1% of all odontogenic tumours in most of the published literature worldwide. It generally occurs during childhood as a slow growing asymptomatic swelling in the posterior mandible. Hereby a unique case of AFD in a 35-year-old male who presented with a gradually growing painless swelling in his anterior mandible region is reported. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=ZD05-ZD07&id=12458 https://doi.org/10.7860/JCDR/2019/36814.12458 Small Incision Osteotomy: An Innovative Approach for Removal of Impacted Kuntscher Nail Vishal Kumar, Chirag Arora, Sameer Aggarwal The use of Kuntscher nail has been one of the most important advancement in trauma surgery. Removal of impacted Kuntscher nail represents one of the difficult problems in orthopaedics today. A 53-year-old male presented with pain and implant back out following Kuntscher nail done 20-years back. The fracture had clinically and radiologically united. Implant extraction was done by an innovative technique described subsequently as small incision osteotomy. Gigli saw wire was passed through the slot of Kuntscher nail by a small bony window near the greater trochanter, another window was made at the tip of the nail and wire end extracted out. Subsequently, osteotomy of femur was done without exposing the whole length of the femur. Osteotomy was opened with a small osteotome and nail was extracted through the entry site. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=RD03-RD05&id=12460 https://doi.org/10.7860/JCDR/2019/34724.12460 Primary Squamous Cell Carcinoma of the Excretory Duct of the Submandibular Gland: A Rare Case Victor Angelo M Montalli, Marcelo Sperandio, Andresa Borges Soares, Antonio D Albuquerque Neto, Vera Cavalcanti DE Araújo Primary Squamous Cell Carcinoma (SCC) of the salivary glands is a very rare disease and establishing the true origin of an SCC manifesting in a salivary gland is always a daunting task, due to the natural proximity of salivary glands to surface epithelia. The aim of this report is to describe and discuss an SCC originating from the excretory duct of the submandibular gland with an unusual histological papillary appearance. A 39-year-old male presented with a slow growing mass in the floor of the mouth, which was clinically nodular, exophytic and ulcerated. Histological examination revealed a predominantly papillary architecture surrounding an intact salivary duct, which showed mucicarmine-positive material and no cell atypia. The duct was in a continuum with the neoplastic tissue, disposed as sheets of basaloid cells with foci of dysplastic squamous epithelium with minimal keratinization. The lesion was positive to CK14 throughout the parenchyma, CK7 in the luminal cells of ductal structures, CK13 in rare epidermoid areas and generally to AE1/AE3, highlighting foci of keratinization. The case reported herein is a very rare neoplasm in an unprecedented intraoral site, which emphasises the importance of histochemistry and immunohistochemistry in the diagnosis of rare lesions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=ED14-ED16&id=12464 https://doi.org/10.7860/JCDR/2019/38305.12464 Er:YAG and Diode Lasers in Treatment of Peri–Implantitis–A Case Report Alexandros Nikitas One of the leading causes of dental implant loss in the present time is peri-implantitis. This paper describes a clinical case of peri-implantitis treatment using Er:YAG and a 980-nm diode laser. In the present case report, it is explained how to use these two different wavelengths on soft tissue and on the implant surface. The use of diode and Er:YAG lasers allows the removal of inflamed tissue and the bacterial biofilm from the implant surface which results in bone regeneration/reparation in the peri-implant area. In the present report, it is recommended using Er:YAG and diode lasers at 2W power to be used in the therapy of peri-implantitis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=ZD08-ZD10&id=12465 https://doi.org/10.7860/JCDR/2019/36611.12465 Ewings Sarcoma of Fourth Metatarsal: A Rare Presentation Chetan Peshin, Kunal Das, Ahmed Abdul Ghaffar, Sirazul Haque Malik Ewings sarcoma is a primary aggressive neoplasm of bone seen in the second decade of life. This is a case report of a 10-year-old male child who presented with Ewings sarcoma of fourth metatarsal of left side with no distant metastases. Patient was managed by neo-adjuvant therapy followed by wide excision of the tumour followed by adjuvant chemotherapy. He had a very good response and was disease free for up to two years on follow-up. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=RD06-RD08&id=12468 https://doi.org/10.7860/JCDR/2019/37214.12468 Misdiagnosing Tubal Pregnancy: A Fortunate Mistake or a Challenging Concern Anjali Mundkur, Shubha Rao, Jyothi Shetty Early pregnancy scan and a good antenatal care are the most important entities which most of the rural areas in India lack. Here, we report a case of late tubal pregnancy who was mistakenly diagnosed as abdominal pregnancy. Intraoperative findings showed an unruptured 16 weeks tubal ectopic pregnancy which states that at such an advanced gestation it would be very difficult to diagnose either. This states the importance of an early ultrasound diagnosis of an intra-uterine pregnancy especially in developing countries which is required in each and every antenatal patient to ensure a safe and a healthy pregnancy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=QD03-QD04&id=12472 https://doi.org/10.7860/JCDR/2019/38140.12472 Periapical Cemento-Osseous Dysplasia in Anterior Maxilla Francisca Lívia Parente Viana, Bruno Carvalho De Vasconcelos, Filipe NobreChaves, Karuza Maria Alves Pereira, Marcelo Bonifácio Da Silva Sampieri Periapical cemento-osseous dysplasia is a reactional fibro-osseous lesion that affects the supporting tissues of vital teeth. A 33-year-old female was referred for endodontic retreatment of the right maxillary central incisor with chief complaint of pain. On radiographic examination, endodontic treatment in tooth 11 and external root resorption in the apex of tooth 12 were observed. Moreover, a radiopaque lesion circled by a radiolucent halo involving the roots of teeth 11 and 12 was also present. The cone beam computed tomography showed resorption and perforation of the cortical bone. The result of the histopathological examination combined with the clinical findings made it possible to confirm the diagnosis of periapical cemento-osseous dysplasia. This case report emphasises on the value of association between imaging findings and histopathological examination in the diagnosis of such lesions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=ZD11-ZD13&id=12473 https://doi.org/10.7860/JCDR/2019/38289.12473 Cocaine-induced Stroke in a First-time User Mary Kate Driscoll, Nitish Kumar Sharma Cocaine is a widely used recreational drug that functions by inhibiting the reuptake of neurotransmitters in the brain, contributing to feelings of euphoria. Its use can result in stroke primarily through the mechanism of vasospasm, especially in the acute phase. Here, we present a case of a 47-year-old previously healthy male with no family or personal risk factors for stroke, who presented with acute neurological deficits after his first intranasal cocaine use with brain imaging showing scattered areas of restricted diffusion in his left Middle Cerebral Artery (MCA) territory and MCA/Posterior Cerebral Artery (PCA) watershed zone consistent with vasospasm. This case highlights the importance of considering a toxicology screen for cocaine even in the absence of history when working up a young patient presenting with stroke-like symptoms. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=OD04-OD05&id=12480 https://doi.org/10.7860/JCDR/2019/39707.12480 Woodhouse-Sakati Syndrome: A Case Report from Indonesia Lucky Aziza Abdullah Bawazir Woodhouse-Sakati Syndrome (WSS) is an extremely rare autosomal recessive neuroendocrine disease with loss of function mutation of DCAF17 gene, located on chromosome 2q31. This report discusses the first documented case of suspected WSS in Indonesia in a 20-year-old female patient with multiple metabolic abnormalities, delayed puberty, secondary osteoporosis, hydronephrosis, colitis, and recurrent urinary tract infection, possibly due to partial urinary retention. The patient was treated with 6 units of insulin aspart (three times a day) and 8 units of insulin Detemir (once a day) for diabetes mellitus. She also received Levothyroxine for hypothyroidism; calcitriol for osteoporosis; as well as bladder training and antibiotics for recurrent urinary tract infection. Within the last one year, the patient has been admitted to hospital three times due to uncontrolled blood glucose level and clinical manifestation of urinary tract infection and colitis. Although the patient has been treated in a top referral hospital in Indonesia, problems in confirming diagnosis of Woodhouse-Sakati syndrome in this patient still persists due to the absence of facilities for genetic sequence analysis and limitations of financial coverage for the patient and her family. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=OD06-OD08&id=12481 https://doi.org/10.7860/JCDR/2019/38431.12481 Vertebral Cryptococcosis Infection in an Immunocompetent Host: A Rare Case Report B Rajeshwari, Salapathi Shanmugam, Sadiya Niamath, Mitra Ghosh Cryptococcosis is a systemic mycosis caused by yeast like fungus Cryptococcus neoformans. The infection results from inhalation of fungal spores in soil, house dust and in pigeon and other bird excreta. Infection usually occurs in immunocompromised individuals with lung and central nervous system being common sites of involvement. Skeletal involvement usually occurs as a component of disseminated cryptococcosis. Isolated skeletal involvement is rare. Here, the author presents a case of isolated skeletal cryptococcosis in an immunocompetent patient who presented with severe back pain and leg pain. Possibility of Tuberculosis of spine was suggested clinically but histopathology showed cryptococcal granulomas. Patient was HIV seronegative and did not have any other co-morbid conditions. There were no lesions in lung or brain. Because of increasing incidence of crytpococcal infections in immunocompetent hosts it should be included in the differential diagnosis of tuberculosis. Spine and fungal cultures should also be done. In the absence of fungal cultures, histopathological examination including the special stains is useful for diagnosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=ED17-ED19&id=12486 https://doi.org/10.7860/JCDR/2019/37639.12486 Bloodstream Infection Caused by <i>Candida auris</i>: A Case Report of an Emerging Fungal Infection–Misidentified by VITEK2 Rup Jyoti Chandak, Bibhabati Mishra, Poonam Sood Loomba This report describes nosocomial blood stream infection caused by Candida auris in a patient with neurological illness in a tertiary care hospital. Blood culture was performed by Bactec and initial identification and sensitivity by VITEK 2. It was misidentified as Candida haemulonii with sensitivity to Caspofungin, Micafungin and Voricanazole. MALDI-TOF analysis on the isolate confirmed it as Candida auris. However, patient was treated with Caspofungin and showed clinical improvement. Thus, multiple automated methods should be employed to accurately diagnose bugs causing life threatening infections. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=DD06-DD08&id=12487 https://doi.org/10.7860/JCDR/2019/39654.12487 Split Hand/Foot Malformation: A Case Report and Review of Literature Divya Chauhan, Alpana Singh Split Hand/Foot Malformation (SHFM) is a rare genetic disorder. It is also known as ectrodactyly. In this disorder, the central rays of the hand and feet are affected leading to various malformations of the hands and feet. Any number of limbs can be affected. It can present in isolation affecting only the limbs or it can be associated with the syndrome. The prevalence of this malformation is 0.06 per 1000 total births. Here, authors report a case in which a pregnant patient had SHFM and the fetus also suffered the same anomaly. The anomaly was detected on ultrasound and medical termination of pregnancy was done. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=QD05-QD06&id=12490 https://doi.org/10.7860/JCDR/2019/38303.12490 Myocarditis with Cardiac Failure: Initial Manifestation of Systemic Lupus Erythematosus Suchi Acharya, Priyankar Pal, Prabhas Prasun Giri, Agnisekhar Saha Cardiac involvement is very rare in Systemic Lupus Erythematosus (SLE). Pericarditis is the leading cardiovascular manifestation in SLE followed by endocarditis, conduction abnormality, coronary artery disease and myocardial dysfunction. Myocardial dysfunction is most often subclinical, but may rarely progress to ventricular dysfunction, cardiogenic shock or severe congestive heart failure. Myocarditis leading to cardiac failure is a very unusual presentation of childhood lupus. We present a four and half-year-old young boy who presented to us with features of congestive heart failure subsequently diagnosed to be secondary to fulminant lupus myocarditis. Despite intensive management, the child ultimately succumbed. His echocardiography revealed dilated left ventricle with an Ejection Fraction (EF) of 18.2%. A positive titre of p-ANCA was also seen in this case. Although, ANCA positivity has been shown as a bad prognostic marker for lupus nephritis, its association with lupus myocarditis is still unknown. Decongestive measures along with immunosuppressant drugs remain the preferred treatment. This case highlights the protean presentation of SLE in the form of lupus myocarditis leading to congestive heart failure that merits an urgent intervention because of the potentially devastating consequences. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=SD01-SD02&id=12492 https://doi.org/10.7860/JCDR/2019/39669.12492 Improvement in Lipid Profile after Long-term Consumption of Policosanol Accompanied by Reduced Oxidation of LDL and Aortic Stiffness via CETP Inhibition in Healthy Middle-aged Women Kyung-Hyun Cho, Dhananjay Yadav, Yong-Bok Park, Jae-Ryong Kim Cuban Policosanol (PCO) was reported to lower serum Total Cholesterol (TC) as well as increase High-Density Lipoprotein Cholesterol (HDL-C) and enhance HDL functionality. In this study, we compared changes in the blood lipid and lipoprotein profiles in hypercholesterolemic women subjects (50-year-old) who consumed policosanol for 20 weeks. At week 0, subject had high TC but low HDL-C levels. After 20 weeks of policosanol consumption, serum TC and Triglyceride (TG) levels were reduced by 10% and 44%, respectively. HDL-C level was elevated 1.7-fold while Low-Density Lipoprotein (LDL) level was reduced by up to 20%. Serum Cholesteryl Ester Transfer Protein (CETP) activity was reduced from 33% CE-transfer at week 0 to 22% CE-transfer at week 20. Glycation extent was significantly reduced in all lipoprotein fractions, especially in LDL and HDL2. In Very Low-Density Lipoprotein (VLDL) and LDL, cholesterol and TG contents were reduced. In HDL2 and HDL3, cholesterol was more enriched and TG content reduced. LDL was more resistant to cupric ion-mediated oxidation and showed less atherogenic properties via phagocytosis into macrophages. Apolipoprotein A-I (apoA-I) was more enriched in HDL2 and HDL3 in a time-dependent manner. The antioxidant ability of HDL was enhanced by 25% in terms of ferric ion reduction ability and paraoxonase activity. In conclusion, 20 weeks of policosanol consumption improved the lipid profile by increasing HDL-C, and lipoprotein functionality to enhance antioxidant, anti-glycation, and anti-atherogenic properties via CETP inhibition. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=OD12-OD14&id=12498 https://doi.org/10.7860/JCDR/2019/35885.12498 Late Onset Atypical Eclampsia: A Case Report Nalini Sharma, Roma Jethani, Shriram Sharma, Vinayak Jante, Manica Agarwal Hypertensive disorders in pregnancy account for substantial maternal and peri-natal morbidity and mortality. Atypical eclampsia presents as a diagnostic dilemma and challenge for the treating obstetrician. The purpose of this case report is to increase awareness of the nonclassic and atypical features of eclampsia so as to avoid complications. Whilst controlling the convulsions by instituting magnesium sulfate therapy, simultaneous search for any organic/metabolic cause for seizure needs to be looked for. Constant vigilance with a high level of suspicion is required for a more positive maternal and foetal outcome. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=QD07-QD08&id=12507 https://doi.org/10.7860/JCDR/2019/39750.12507 Potter’s Sequence with Bilateral Renal Agenesis and Congenital Pouch Colon with Rectovaginal Fistula: A Case Report Preeti Rai, Reema Bhushan, Renu Singh, Mariya Khatoon Ansari Bilateral renal agenesis is an uncommon diagnosis of prenatal life. It is seen to be associated with many other congenital anomalies and is also seen in association with Potters sequence. A still born female baby of 38 weeks and 5 days period of gestation was delivered by Lower Segment Caesarean Section (LSCS) with physical findings of low-set ears, a flat nose, loose skin fold over the neck, wide set eyes and bilateral club foot, suggestive of Potter’s sequence. On autopsy, baby had ascitis with smaller lungs. Both the kidneys were not identified in the renal fossa or at any other (ectopic) site (bilateral renal agenesis). There was also an associated unilateral ureteral agenesis. Additional finding that was detected at autopsy was dilated terminal bowel with congenital pouch colon, rectovaginal fistula and anal atresia (anorectal malformation). This case has been reported due to rarity of the combination of these constellations of findings. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=ED20-ED21&id=12522 https://doi.org/10.7860/JCDR/2019/39612.12522 Fever in a Young Female Patient-A Diagnostic Dilemma Uma Ravishankar, Swathy Moorthy, Suja Lakshmanan, Madhavan Krishnaswami A young female patient on chronic steroid therapy developed Cytomegalovirus gastritis with suspected dissemination. With no other identifiable cause of immune suppression, diagnosis of this unlikely infection under this circumstance proved a challenge. Her non-compliance to treatment further complicated matters. This case highlights the importance of having a high degree of suspicion in diagnosing an unlikely infection in an unforeseen circumstance. It also brings to the limelight the need for clear guidelines on initiating antiviral therapy in non-transplant patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=OD09-OD11&id=12495 https://doi.org/10.7860/JCDR/2019/37623.12495 Dental Implant Rehabilitation in a Young Patient with Generalised Aggressive Periodontitis Mhd Ammar Kouki, Majd Othman, Ali Abou Sulaiman Generalised aggressive periodontitis is a disease that manifests in young patients and causes progressive damage to the periodontium. This report describes the treatment plan of a young patient aged 34 years with generalised aggressive periodontitis. Two implants in each jaw were placed two months after the extraction of all the teeth. After a healing period, an implant-retained prosthesis was fabricated and installed. The patient showed a high level of satisfaction with the provided treatment. Implant-retained denture is an adequate and relatively cheap treatment option for the rehabilitation of edentulous young adults with generalised aggressive periodontitis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=ZD14-ZD16&id=12504 https://doi.org/10.7860/JCDR/2019/39584.12504 Ultrasound-Guided Extraoral Removal of Extraparenchymal Sialoliths Caused by Acute Parotitis Toshinori Iwai, Satomi Sugiyama, Yuichiro Hayashi, Makoto Hirota, Kenji Mitsudo Migration of sialoliths is extremely rare and is presumed to be a consequence of abscess formation. We report a minimally invasive, ultrasound-guided, extraoral approach for the removal of extraparenchymal sialoliths caused by acute parotitis. A 57-year-old man with left buccal swelling and pain had two parotid sialoliths. Buccal undulation was present after administration of antibiotics, and ultrasound showed extraparenchymal sialoliths. The migrated sialoliths from the parotid gland could be identified easily under ultrasound guidance and removed completely with long mosquito forceps via the small skin incision. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=ZD17-ZD18&id=12505 https://doi.org/10.7860/JCDR/2019/40036.12505 Exploring the Coordinates in the Road to Success Mainak Dutta https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=AB01-AB02&id=12550 https://doi.org/10.7860/JCDR/2019/40648.12550 Are We Justified in Withholding Routine Vitamin D Supplementation in Trials? Jogender Kumar, Arushi Yadav https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=SL01-SL02&id=12427 https://doi.org/10.7860/JCDR/2019/39867.12427 Correspondence: Neck Circumference as a Tool for Predicting Hyperuricaemia: A Hospital Based Cross-sectional Study Himel Mondal, Shaikat Mondal https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=CL01-CL02&id=12428 https://doi.org/10.7860/JCDR/2019/37860.12428 Qualitative and Quantitative Comparison of the Remineralisation Potential of Three Suitable Materials-An In vitro SMH and SEM Study Parvathy Sreekumar, Parvathy Kumaran, Arun Mamachan Xavier, R Balagopal Varma, J Suresh Kumar <b>Introduction:</b> Concept of preventive dentistry is the base for this study which focuses on daily treatment of tooth for prevention of caries using some commercially available remineralizing agents. The mechanism of remineralization in the three dentifrices used were different. There is a need for the dental professional to identify the dentifrice with the best remineralizing potential, from the array of products available in the market. <b>Aim:</b> To determine and compare the remineralizing potential of three remineralizing agents using Energy Dispersive X-Ray Analysis (SEM-EDX) and Vickers Microhardness testing (SMH). <b>Materials and Methods:</b> Sixty sound permanent premolar teeth were cut at the cemento-enamel junction. The coronal portions were sectioned mesiodistally and buccolingually to obtain three blocks that were randomly assigned to three groups: CPP-ACP, Sodium fluoride and Novamin. Baseline microhardness testing and SEM EDX were performed. All the samples were demineralized using McInnes solution and subjected to microhardness testing and SEM EDX analysis. Remineralizing agents were applied on the tooth surface twice daily for 30 days. The final microhardness and EDX values of remineralized enamel in each group were evaluated and compared. <b>Results:</b> The mean SMH values for remineralized enamel showed that Sodium fluoride+f-TCP had the highest value (274.83&#177;13.62) followed by CPP-ACP (266.85&#177;37.80) and Novamin (257.64&#177;93.72) (p<0.005). Elemental analysis of the remineralized enamel showed that enamel treated with Sodium fluoride+f-TCP and Novamin had superior quality and surface property compared to that treated with CPP-ACP. <b>Conclusion:</b> Sodium fluoride with f-TCP was found to be the remineralizing agent that gave qualitatively and quantitatively superior enamel. CPP-ACP and bioactive glass also had remineralizing quality and can be considered as an adjunct to sodium fluoride+fTCP and not as an alternative. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=ZC01-ZC04&id=12429 https://doi.org/10.7860/JCDR/2019/37344.12429 Pregnancy Outcome among Elderly Primigravidae: A Five-year Review at Abakaliki, Ebonyi State, Nigeria Okechukwu Bonaventure Anozie, Johnbosco Emmanuel Mamah, Chidi U Esike, Obiora Godfrey Asiegbu, Lucky Osaheni Lawani, Justus Ndulue Eze, Robinson Chukwudi Onoh <b>Introduction:</b> Maternal age is an important determinant of pregnancy outcome and women aged 35 years or more at their first pregnancy are considered high risk pregnancy due to increased risk of feto-maternal morbidity and mortality. <b>Aim:</b> To evaluate the outcome of pregnancy in primigravid women who were aged 35 years and above. <b>Materials and Methods:</b> A five-year retrospective study among elderly primigravidae was conducted. The study assessed 78 booked primigravidae aged 35 years or more who delivered at the Federal Teaching Hospital Abakaliki from 1st January 2012 to 31st December 2016. Each elderly pri migravida was matched with two primigravid women aged 20-25 years who delivered during the same period. Postnatal visit was also assessed. <b>Results:</b> During the study period, there were 11,329 deliveries and 78 of these were elderly primigravidae giving an incidence of 0.69% or 1:145 deliveries. The mean age of the elderly primigravidae was 36.28&#177;1.20 years. The study group had more antepartum complications with anaemia, antepartum haemorrhage, hypertensive disorders of pregnancies, diabetes mellitus and preterm labour (p<0.05). Intrapartum complications such as poor progress of labour and cephalo-pelvic disproportion were also significantly higher. Almost half of the study group were delivered by caesarean section, the commonest indication being maternal request based on prolonged infertility (16.67%). The study group had higher incidence of preterm delivery and perinatal mortality of significant proportion. However, they were more likely to come for the 6th week postnatal visit 71.2% versus 32.1%. <b>Conclusion:</b> The problems of elderly primigravidae are still germane and relevant in present day obstetrics. Efforts should be intensified towards identifying this high-risk group with a view to take proactive measures aimed at minimising pregnancy related complications so as to achieve the best outcome for them and their babies. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=QC01-QC04&id=12431 https://doi.org/10.7860/JCDR/2019/37879.12431 Oral Health Practices, Status and Effect of Malocclusion on Quality of Life of College Going Individuals in Chennai, India A Vinita Mary, Jaideep Mahendra, Joseph John, Joyson Moses, A V Rajesh Ebenezar, R Kesavan <b>Introduction:</b> Diseases affecting oro-facial structures can present themselves in a spectrum varying from pain like in case of acute pulpitis to psychosocial effects like in malocclusion. Poor malocclusion causes poorer oral aesthetic self-perception, and affects emotional and social well-being health domains. <b>Aim:</b> To assess the oral health related practices and status among college going students and to evaluate the effect of malocclusion on their quality of life. <b>Materials and Methods:</b> A cross-sectional study was conducted among 710 subjects of age range 17-23 years. Oral health status was assessed using WHO basic oral health survey (2013), orthodontic treatment needs according to Index of Orthodontic Treatment Needs (IOTN) and oral health quality of life using Oral Health Impact Profile-14 (OHIP-14). Mann-Whitney test and Fisher’s-exact test were used for statistical analysis. <b>Results:</b> A total of 710 students were examined. It was seen that in the study population, only 290 (40.8%) knew that oral health affected general health and 501 (70.6%) had never visited dentist. The mean DMFT was 1.80+2.20 and 493 (69.4%) did not have any periodontal problem and 378 (53.2%) required orthodontic treatment ranging from little/mild to very severe orthodontic treatment need and it was seen that there was a difference in all the domains of OHIP-14 among the individuals in orthodontic treatment needed and not needed group and it was statistically very highly significant (p<0.001). <b>Conclusion:</b> It was seen that the study population had poor dental attendance. The orthodontic treatment need was also high as it should had been initiated at an early age for correction which in turn could improve the oral health related quality of life among the individuals who needed orthodontic treatment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=ZC05-ZC09&id=12432 https://doi.org/10.7860/JCDR/2019/38200.12432 Validity and Reliability of Physiotherapy Student Clinical Assessment Tool to Analyse Students’ Clinical Performance Manisha P Shenoy, Liau Vivian <b>Introduction:</b> Clinical assessment tool provides feedback on the student’s clinical performance by the Clinical Instructors (CIs) and the student themselves. There are few clinical assessment tools that had been used across different countries. However, each different assessment tool has its different strengths and weaknesses. There is no “gold standard” for physiotherapy student when it comes to clinical assessment tool available to assess them. <b>Aim:</b> To determine the validity and reliability of Physiotherapy Student Clinical Assessment Tool (PSCAT) for assessing student’s overall clinical performance during their clinical placement. <b>Materials and Methods:</b> It included development of a questionnaire which was revised and redesigned from various available similar questionnaires. It was distributed to 11 CIs from different universities to validate it. The inter-rater reliability of the tool involved 11 CIs and 40 students. Each student was assessed by two different CIs at the end of clinical posting. The validation was analysed by validity index and the inter-rater reliability was analysed by interpreting the Intraclass Correlation Coefficient (ICC). <b>Results:</b> The results revealed that the PSCAT achieved sufficient construct (0.97), face (0.96), criterion-related (0.99) validity but had weak content validity (0.89). Reliability showed ICC as 0.64-0.33 denoting moderate reliability. There were two components that had weak reliability. <b>Conclusion:</b> Physiotherapy Student Clinical Assessment Tool (PSCAT) is a valid and user-friendly tool where reliability requires further study. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=JC01-JC06&id=12424 https://doi.org/10.7860/JCDR/2019/37703.12424 A 14-year Follow-up of Resin Composite Occlusal Restorations: Split Mouth Randomised Clinical Trial and Wear Evaluation by Optical Coherence Tomography Luís Felipe Espíndola-Castro, Renata Pedrosa Guimarães, Fábio Barbosa de Souza, Gabriela Queiroz de Melo Monteiro, Paulo Fonseca Menezes Filho, Luana Osório Fernandes, Claudio Heliomar Vicente da Silv <b>Introduction:</b> The search for restorative materials with clinical longevity has led to modifications in the composition of the resin composites. <b>Aim:</b> To evaluate the clinical performance and the occlusal wear of posterior restorations with one microhybrid (Suprafill/SS White) and two condensable/packable (Filtek P60/3MESPE and Surefil/Dentsply Caulk) resin composites. <b>Materials and Methods:</b> Sixty restorations (n=20) were performed in 2002 in 20 patients. Class I and II cavities were restored with the studied resin composites in a split-mouth design. Evaluations were done at baseline, 1 and 14-years regarding colour stability, marginal discolouration and integrity, caries incidence, and anatomic form according to the USPHS criteria (United States Public Health Service). OCT (Optical Coherence Tomography) images of the gypsum replica were analysed to observe the wear of the restorations at the buccal and lingual cusps. Data was evaluated through Friedman&#8217;s test and Wilcoxon signed ranks post hoc test (p=0.05). <b>Results:</b> Differences were not observed between the evaluated resin composites regarding each of the analysed parameters (p>0.05). However, for each resin composite, differences were observed between the observation periods through Friedman&#8217;s test (p<0.001), except for caries incidence. Differences were observed when the 14-year data for colour match, anatomic form and marginal adaptation was compared. After 14 years, Surefil presented lower unsatisfactory evaluations when compared to the other groups (only two). No significant differences were found between the buccal and lingual cusps (p>0.05). <b>Conclusion:</b> The condensable/packable resin composites and microhybrid presented similar performance after 14 years. The cast replica analysis by OCT was a viable method for follow-up evaluations consistent with the clinical observations. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=ZC10-ZC15&id=12436 https://doi.org/10.7860/JCDR/2019/37436.12436 The Constitutional Balanced Translocation t(11;22)(q23;q11.2)-An Indian Account Vandana Kamath, Vivi M Srivastava, S Yuvarani, Mary Purna Chacko, Saurabh Kumar Bhattacharya, Samuel Phillip Oommen, Sumita Danda, George Korula <b>Introduction:</b> The balanced translocation t(11;22) is one of the most common constitutional genetic abnormality detected in humans. Carriers of the t(11;22) are usually phenotypically normal and their carrier status is ascertained only if they present with reproductive losses, infertility or a child with an abnormal phenotype. The t(11;22) translocations are a cumulative effect of recombination errors occurring during meiosis. Children with Emanuel syndrome show a gain of additional genetic material in the form of der(22) chromosome on conventional karyotype inherited either from the carrier parents or de novo in origin. Children with der(22) chromosome presented with microcephaly, hypotonia, preauricular sinus and developmental delay. <b>Aim:</b> To study the mode of inheritance and outcome of the balanced translocation t(11;22) in the families. <b>Materials and Methods:</b> A total of 16 individuals from six unrelated families underwent cytogenetic analysis at the Christian Medical College, Vellore, Tamilnadu, India, and their karyotype showed the balanced t(11;22)(q23;q11.2) or a der(22)t(11;22)(q23;q11.2) inherited from a t(11;22) carrier parent. Also, karyogram of the spouses of the carrier individuals were also studied. Conventional cytogenetic analysis of phytohaemagglutinin-stimulated peripheral blood cultures was performed. Fluorescence In Situ Hybridization (FISH) was performed to confirm the der(22) t(11;22)(q23;q11.2). <b>Results:</b> Seven individuals from six unrelated families showed the balanced t(11;22). These included six adults and one child (five females and two males). All six adult carriers were phenotypicaly normal. In three adults, the translocation was ascertained because their children had abnormal phenotypes. The remaining three adults were from families being investigated for recurrent pregnancy losses. One of these subsequently underwent amniocentesis which showed a translocation morphologically identical to that in the father. All the three carrier parents had children with abnormal phenotypes. And their karyogram showed 47 chromosomes due to gain of a supernumerary chromosome+der(22)t(11;22)(q23;q11.2) of maternal origin, while the fourth child presented with a t(11;22) identical to that of her carrier father, but was lost to follow-up. <b>Conclusion:</b> It is important to be aware of this balanced translocation and its varied outcomes, so that members of the family can be studied. This would help to determine the mode of inheritance and to predict the likelihood of other carriers in the family having children with chromosomal imbalance. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=GC01-GC04&id=12438 https://doi.org/10.7860/JCDR/2019/36950.12438 Molecular Characterisation of <i>Stenotrophomonas maltophilia</i> in Nosocomial Infections: Challenges and Way Forward Susmitha Karunasree Perumalla, Naveen Kumar Devanga Ragupathi, Ayyan Raj Neeravi, Shalini Anandan, Joy Sarojini Michael, Balaji Veeraraghavan <b>Introduction:</b> Stenotrophomonas maltophilia (S. maltophilia), is an important rapidly emerging, opportunistic, non-fermenting Gram negative bacillus with high intrinsic resistance to drugs. It is one of the leading causative agents of nosocomial infections especially in the immunocompromised patients. Molecular typing of pathogens provides an important tool in epidemiological investigations involving nosocomial infections. Due to high geno-diversity, typing of S. maltophilia is challenging. <b>Aim:</b> The study was aimed to evaluate the best epidemiological tool to investigate clonal relatedness of S. maltophilia. <b>Materials and Methods:</b> A prospective study was conducted at a 2400 bedded tertiary care centre in southern India over a period of six months. Twenty-six isolates of S.maltophilia were obtained during the study period. Of these, 18 isolates from blood and Endotracheal Aspirates (ETA) cultures were included in the study since they were incriminated in causing nosocomial infection clinically for which appropriate treatment was initiated. These 18 clinical isolates of S. maltophilia were characterised to identify the clonality using Conventional Multi Locus Sequence Typing (MLST). A subset of 9 S. maltophilia isolates were sequenced using IonTorrent PGM platform. Further phylogenetic analysis was inferred from core genome Single Nucleotide Polymorphisms (SNPs). <b>Results:</b> Using conventional MLST, one isolate (S04384), was identified as belonging to sequence type 13 (ST13) whereas sequencing of the remaining 17 isolates could not be successfully done using MLST PCR even after several attempts. A subset of nine isolates from these 17 were subjected to sequencing using Ion Torrent PGM platform. Using MLST Finder tool on this platform, one isolate was found to belong to sequence type 15 (ST15). The remaining eight isolates were observed to have novel sequence types; four of which were assigned sequence types ST283, ST284, ST285 and ST286. The remaining four had <50% similarity for mutM gene. Further phylogenetic analysis was studied using core genome SNPs. They revealed bifurcating and multifurcating groups among all these nine S. maltophilia isolates. None of them belonged to the same clonal group according to SNP based phylogeny. <b>Conclusion:</b> Frequent recombination events in S. maltophilia genome make it difficult to identify the clonality based on MLST. From this study, SNPs based whole genome phylogeny was observed as better methodology to identify clonal relatedness among S. maltophilia. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=DC01-DC04&id=12434 https://doi.org/10.7860/JCDR/2019/39753.12434 Effect of Vitamin D Replacement on Serum TSH in Women with Anti-TPO Positive Sub-clinical Hypothyroidism Kiarash Aminian, Amir Bahrami, Mostafa Najafipour, Farzad Najafipour <b>Introduction:</b> The coexistence of Sub-Clinical Hypothyroidism (SCH) and vitamin D deficiency is a common problem and may lead to various clinical disorders. Several genetic studies have shown an association between gene polymorphism of Vitamin D receptor and of 1a hydroxylase with autoimmune thyroid diseases. <b>Aim:</b> To evaluate the effects of vitamin D3 replacement on Thyroid-Stimulating Hormone (TSH) and anti-TPO levels in women with SCH. <b>Materials and Methods:</b> This clinical trial was performed on 58 Sub-Clinical Hypothyroidism vitamin D deficient women. Patients were treated with 50,000 unit/week vitamin D3 capsule for eight weeks and TSH, Free thyroxine (FT4) and anti-TPO levels were measured before and after drug administration, using an electrochemiluminescence system. <b>Results:</b> The mean age of the population was 38.02&#177;12.68 years. Vitamin D3 replacement caused serum 25(OH) D3 level correction in SCH patients (p<0.001). Additionally, a significant decrease in anti-TPO and TSH levels were also observed in anti-TPO positive patients (n=29) (p=0.002 and p=0.02, respectively). No significant differences in anti-TPO and TSH levels were seen in anti-TPO negative group (p=0.507 and p=0.447, respectively). <b>Conclusion:</b> The study showed that vitamin D3 replacement may be considered as an effective therapy to reduce TSH and anti-TPO levels in vitamin D deficient SCH patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=OC01-OC03&id=12426 https://doi.org/10.7860/JCDR/2019/38168.12426 Evaluation of Sensibility Threshold of Dental Pulp to Electric Pulp Test (EPT) in the Teeth under Fixed Orthodontic Treatment with 0.014 and 0.012 Initial NiTi Archwire Elham Khoshbin, Sepideh Soheilifar, Zakiyeh Donyavi, Nazanin Shahsavand <b>Introduction: </b>The health and integrity of the dental pulp following orthodontic therapy is of major importance for tooth survival. EPT is a conventional method for evaluation of pulp vitality. <b>Aim: </b>The aim of the study was to evaluate sensibility of the dental pulp to EPT in the teeth under fixed orthodontic treatment with 0.014 and 0.012 initial NiTi archwire. <b>Materials and Methods: </b>In this study, 516 teeth (maxillary central and lateral incisors) were studied prospectively in 129 patients assigned to three groups: the 0.012 NiTi archwire, the 0.014 NiTi archwire and the control group. The aligning forces were administered using initial NiTi archwires of 0.012 and 0.014 ligated on fixed appliances by using the MBT straight wire technique. Stimulation of electrical sensibility threshold was done by EPT and was measured pre-bonding (EPT0), immediately upon initiation (EPT1) and one month post orthodontic therapy (EPT2). The data were analysed by paired sample t-test and one-way ANOVA test (p<0.05). <b>Results:</b> The mean values of sensibility threshold for all the experimental and control maxillary incisors at EPT0, EPT1, and EPT2 times were 28.5, 40.8, and 38.0, and 23.2, 23.5, and 22.7 units respectively. The mean values of sensibility threshold for all experimental teeth at EPT0, EPT1 and EPT2 times were statistically different by using Paired sample t-test (p<0.05). Statistical analysis using one-way ANOVA shows that there is a statistically significant difference between sensibility threshold when groups were compared with the control group (p<0.05). <b>Conclusion:</b> Following application of orthodontic forces, physiological changes of the dental pulp could affect the neural response. Response thresholds to electrical stimulation are also increased and consequently the EPT may not initiate a response. This finding is not an indication of loss of pulp vitality because after a few weeks the response threshold decreases. Therefore, the results of electrical pulp testing need to be carefully interpreted and closely scrutinised in orthodontics. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=ZC16-ZC19&id=12459 https://doi.org/10.7860/JCDR/2019/37722.12459 Depressive Symptoms and Bio-psychosocial Problems among Postmenopausal Women of Udupi District, Karnataka, India Shwetha Nayak, V Binil, Soumya Christabel <b>Introduction:</b> Menopause is the transition period in women&#8217;s life. Though it is a normal phenomenon, it has challenging situations. Many women shift to menopause without facing psychiatric problems; however, there is evidence that 20% of them are experiencing depressive symptoms during this crucial period. <b>Aim:</b> To identify the depressive symptoms and bio-psychosocial problems of postmenopausal women. <b>Materials and Methods:</b> A descriptive survey was conducted in three Gram Panchayaths of Udupi district, Karnataka, India. Convenient sampling technique was used to select 290 postmenopausal women between 1-5-years of menopause. Inventory of Depressive Symptomatology-Self Report (IDS-SR) scale was used to assess the depressive symptoms and rating scale on bio-psychosocial problems of postmenopausal women was used to assess the bio-psychosocial problems. Descriptive (frequency and percentage) and inferential statistics (Fisher&#8217;s-exact test and one way ANOVA test) were used to analyse the data. <b>Results:</b> The results showed that 20.7% of women had a mild level of depressive symptoms. Commonly reported bio-psychosocial problem were leg cramps (89.7%), joint and muscle pain (87.6%), backache (87.2%), hot flushes (85.2%), fatigue (79.3%), numbness in extremities (75.9%), night sweating (67.2%), sleep disturbance (66.5%), sexual problems (49.7%), forgetting (31%) and irritation (39.6%). It was also found that there was a significant association between depressive symptoms and age (p=0.001), number of living children (p=0.003), duration after attaining menopause (p=0.012) and age at menopause (p=0.001). <b>Conclusion:</b> Menopause is one of the most significant events in women&#8217;s life. Hence, nurses working in public sector need to identify problems related to postmenopausal women and provide adequate health services. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=VC01-VC04&id=12455 https://doi.org/10.7860/JCDR/2019/38164.12455 Factor Structure of Schizotypal Personality in India Sanjay Kumar, Reshu Chaudhary <b>Introduction:</b> Schizotypal personality represents genetic underpinning of schizophrenia spectrum disorders; hence, it provides conceptual models for understanding psychosis as well as a scheme for high-risk group identification. The study of structure of schizotypal personality is largely confined to western societies, whereas its assessment in varied socio-cultural groups is highly required. <b>Aim:</b> To study the factor structure of schizotypal personality in an Indian population. <b>Materials and Methods:</b> A sample of 492 college students (age, Mean= 21.3, SD= 2.61) filled the Hindi translated version of 74-items Schizotypal Personality Questionnaire (SPQ). Confirmatory Factor Analysis (CFA) technique was used to test the fitness (consonance of the modeled relationships, among latent and observed variables, in the sampled population) of different schizotypal personality models, that is, two-, three-, four-, bi-, and uni-factor models. The best-fit model was also studied for Measurement Invariance (MI) across gender groups. <b>Results:</b> Three, four, and bi-factor models adequately fitted the data. Whereas, four-factor model was the best good-fit model. It also showed partially strong MI across gender groups. The internal consistency of total SPQ was 0.90 and of subscales ranged from 0.62 to 0.78. Men scored higher on several schizotypal facets but lower on social anxiety as compared to women. <b>Conclusion:</b> The factor structure of schizotypal personality in India is similar to that reported elsewhere in the world. Thus, the present study supports the generalisation of schizotypal personality construct to the Indian people. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=VC05-VC09&id=12456 https://doi.org/10.7860/JCDR/2019/37464.12456 Bacterial Colonisation and Antibiotic Sensitivity Profile of Endotracheal Tubes in Mechanically Ventilated Patients Hemanth Natham, Swarnalatha Kondagadapu, Vinay Kadiyala, Alladi Mohan, Abhijit Chaudhury, Aloka Samantaray <b>Introduction:</b> Infections are the most important and leading cause of morbidity and mortality among the patients admitted in Intensive Care Units (ICU). The formation of biofilm around the Endotracheal Tubes (ET) by the micro organisms and their subsequent dislodgement following ET suction and repeated incubations contributes to lung colonisation and may lead ultimately to ventilator-associated pneumonia. The study also analysed common micro organisms associated with these infections and their antibiotic sensitivity profile. <b>Aim:</b> To study the time/trends of bacterial colonisation and sensitivity profile in tracheal tubes, in mechanically ventilated patients, in a tertiary care hospital ICU. <b>Materials and Methods:</b> A total of 109 consecutive patients admitted in the intensive care unit who were on mechanical ventilation for more than seven days were chosen. The study period was for one year. The ET suction catheter tip was cultured at 24 hours and at 48 hours post-incubation and ET tube tip culture was done on 7th day of incubation. Sensitivity of bacterial isolates from ET tip and suction tip cultures to commonly used antibiotics was also tested. All data were recorded in a predesigned study proforma and entered in Microsoft Excel (Microsoft Corporation, Redmond). All entries were double checked for any possible errors. Categorical variables were summarised as percentages. <b>Results:</b> A total of 109 subjects were enrolled in the study. Fifteen patients were excluded from the study. Bacterial colonisation was present in 60 patients at 24 hours, in 76 patients at 48 hours, and in 82 patients on 7th day of incubation. Three most common colonising organisms isolated at 24 hours, 48 hours and on the 7th day of incubation were Non-Fermentative Gram Negative Bacilli (NFGNB) including Acinetobacter, Pseudomonas aeruginosa and Klebsiella pneumonia. At 24 hours of incubation, 47.06% of NFGNB including Acinetobacter and 87.5% of Pseudomonas were sensitive to Cephaperazone-Sulbactam and with Imipenem the sensitivity was 35.29% for NFGNB including Acinetobacter and 93.57% for Pseudomonas. Almost similar trends were found in 48 hours post incubation culture and on 7th day culture. Among ventilator-associated pneumonia patients, Klebsiella pneumonia was the most common isolate. <b>Conclusion:</b> Most commonly isolated organisms were NFGNB including Acinetobacter, Pseudomonas aeruginosa and Klebsiella pneumoniae. Most of isolated organisms were sensitive to Cefaperazone-sulbactam and Imipenem antibiotics. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=UC01-UC06&id=12457 https://doi.org/10.7860/JCDR/2019/37402.12457 Rural Mothers’ Knowledge about Children’s Dental Health in a Developing Country Kazem Hosseinzadeh, Davoud Jamshidi <b>Introduction:</b> Recent epidemiological investigations on dental health among Iranian children revealed that the issue of dental caries is prevalent. According to the dental research in Iran, the general level of dental health, especially among children, is still unsatisfactory. Mothers play a key role in their children’s health behaviour. <b>Aim:</b> To explore the mothers’ knowledge about their children’s dental health. <b>Materials and Methods:</b> A total of 200 mothers of children aged <6 years were enrolled in this cross-sectional study using the convenience sampling technique. A 25-item self-administered questionnaire was used for gathering data. An arbitrary cut-off score of 16 was considered satisfactory. All collected data were entered in SPSS (v. 16.0) software and analysed with descriptive tests and the chi-square test. <b>Results:</b> The mean age of the mothers was 30.8±2.5 years. The mean knowledge score of the participants was 14.2±2.0, and the minimum score was 7.0, while the maximum score was 18.0. Most respondents (58.0%) scored unsatisfactorily at 16 or less. A statistically significant association between the total score of knowledge and demographic characteristics exists (p<0.05). <b>Conclusion:</b> The mothers in the present study did not demonstrate satisfactory knowledge of children’s dental health. Rural parents, especially mothers, need to be educated about their key role as a model for their children and should be encouraged to improve their children’s dental health. Further studies with larger samples are recommended. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=LC01-LC03&id=12451 https://doi.org/10.7860/JCDR/2019/32739.12451 “How Hot Is Too Hot to Handle”: A Retrospective Analysis of “Hot Cholecystectomy” at a Tertiary Care Centre Ankit Jain, Peeyush Kumar, Shah Syed Mahmood, Bachan Singh Barthwal <b>Introduction:</b> Acute Cholecystitis (AC) can either be managed by Laparoscopic Cholecystectomy (LC) during an acute attack, termed as &#8220;Hot Cholecystectomy&#8221;, or can be managed conservatively with antibiotics followed by LC after 6-8 weeks, termed as &#8220;Interval Cholecystectomy&#8221;. Although various studies have now established beneficial role of emergency LC, the timing of early cholecystectomy is still a topic of debate. <b>Aim:</b> To study clinical outcome in patients of emergency LC and compare it with duration of attack of AC. <b>Materials and Methods:</b> This is a retrospective review of patients undergoing LC at Department of General and Laparoscopic Surgery of Max Superspeciality Hospital, Patparganj Industrial area, Delhi. Patients who were treated by emergency LC (Group A, n=121) were compared to those who had undergone elective LC (Group B, n=168). Emergency LC patients were divided into three groups based on duration of AC: <3 days (Group Aa, n=50), 4-7 days (Group Ab, n=42), >7 days (Group Ac, n=29). <b>Results:</b> Mean operative time, duration of hospital stay and use of drain was higher and rate of conversion (1.6%) and complication (1.6%) was low in Group A. Degree of inflammatory changes, duration of stay and operative time was significantly more in Group Ac as compared to Group Aa and Group Ab but conversion rate and complication rates were similar. <b>Conclusion:</b> Hot Cholecystectomy, although technically more challenging is safe and effective with no mortality and similar rate of complication, irrespective of the duration of symptoms. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=PC01-PC05&id=12448 https://doi.org/10.7860/JCDR/2019/38294.12448 Evaluation of Analgesic Activity of Standardised Aqueous Extract of <i>Withania somnifera</i> in Healthy Human Volunteers using Mechanical Pain Model Manjunath Nookala Krishna Murthy, Srinivas Gundagani, Chandrashekhar Nutala Nutala Patiati , Us Harani Pingali <b>Introduction:</b> Drugs commonly used for pain management are associated with adverse effects. Experimental pain models in human healthy volunteers are advantageous for early evaluation of analgesics. Studies with Withania somnifera have demonstrated that it possess anti-inflammatory, analgesic, antioxidant, immunomodulatory properties by virtue of its active constituents. <b>Aim:</b> To evaluate safety and analgesic activity of single oral dose (1000 mg) of Withania somnifera using mechanical pain model in healthy human subjects. <b>Materials and Methods:</b> This randomised, double-blind study was approved by the IEC and was conducted in healthy volunteers after obtaining informed consent from the participants. Volunteers were randomly given either placebo or Withania somnifera capsules (1000 mg). Mechanical pain was assessed using Randall Selitto before and three hours after test drug administration. Pain threshold force and time and pain tolerance force and time were evaluated. A washout period of 10-14 days was given for cross over between two medications. <b>Results:</b> Pain threshold force with Withania somnifera increased from 450.29&#177;75.49 grams to 538.5&#177;72.27 grams (p=0.003) and pain threshold time increased from 5.63 seconds to 6.73 seconds (p=0.003). Further Withania somnifera increased pain tolerance force from 806.9&#177;61.36 grams to 878.2&#177;82.6 grams (p=0.002) and pain tolerance time increased from 10.09 seconds to 10.97 seconds (p=0.002). No statistical significant increase was observed with placebo. <b>Conclusion:</b> In the present study, Withania somnifera significantly increased pain threshold force and time and also pain tolerance force and time compared to placebo. Test drugs were well tolerated. Further studies may be needed in patients suffering from pain conditions (osteoarthritis, rheumatoid arthritis) who require analgesics. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=FC01-FC04&id=12441 https://doi.org/10.7860/JCDR/2019/37590.12441 Impact of Occupational Lead Exposure on Liver and Kidney Function Tests on Silver Jewellery Workers Mandakini S Kshirsagar, Arun J Patil, Jyotsna A Patil <b>Introduction:</b> In unorganised silver jewellery industry, lead fumes and lead oxide dusts are generated while manufacturing the silver ring and the workers involved in this business are highly exposed to lead. This increased blood lead level affects all organ and systems of occupationally lead exposed workers. <b>Aim:</b> To perceive the present scenario of blood lead level and its effects on liver and kidney function test on Silver Jewellery Workers (SJW). <b>Materials and Methods:</b> For this study 42 SJW and 50 normal healthy subjects were included from Western Maharashtra, India. Blood lead level was estimated using lead Care II blood lead analyser and Liver Function Tests (LFT) and Kidney Function Tests (KFT) were measured by standard methods. Statistical analysis was done using Student’s t-test. <b>Results:</b> The blood lead (p<0.001, 325%), serum alanine transaminase (p<0.01, 44.3 %), serum aspartate transaminase (p<0.05, 17.2%), serum bilirubin (p<0.01, 22.64%), serum alkaline phosphatase (p<0.001, 30.59%), blood urea (p<0.001, 11.7%), serum creatinine (p<0.001, 14.28%) and serum uric acid (18.11%) were significantly increased while serum total protein (p<0.01, -5.9 %), albumin (p<0.01, -11.9%) and albumin/globulin ratio (-17.26%) were significantly decreased in SJW as compared to healthy control subjects. <b>Conclusion:</b> In this study increased blood lead level indicates higher absorption of lead in SJW of Western Maharashtra, which slightly impairs the liver and kidney function tests. The regular monitoring of blood lead level, liver and kidney function may prevent severe health hazards caused due to lead. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=BC01-BC04&id=12442 https://doi.org/10.7860/JCDR/2019/38084.12442 “Value of 3D STIR Gated MRI Sequence in Cardiac and Chest Imaging with 3T MRI”: Initial Experiences Geetha Kandasamy, S Babu Peter, R Bharathi Priya <b>Introduction:</b> Cross-sectional imaging has been increasingly used in recent years for cardiac and chest evaluation as multiplanar imaging gives excellent image characterization. Multiplanar imaging with excellent soft tissue contrast without radiation risks in MRI signifies its major role in cardiac and chest imaging. <b>Aim:</b> To evaluate the value of 3-Dimensional T2-Weighted Short Inversion Time Inversion Recovery (3D-T2-STIR) gated sequence in cardiac and chest MR imaging. <b>Materials and Methods:</b> A prospective cross-sectional study was conducted in which 41 adult patients who came for chest and cardiac MRI were included. All our patients were imaged on a 3-T clinical scanner and obtained T2-weighted SPACE STIR gated sequence in addition to routine sequences. The image qualities of 3D-T2-SPACE STIR sequences were compared with routine MRI sequences and were scored by two experienced radiologist in blinded fashion as good, fair and poor. Scan time consumption of 3D-T2-SPACE STIR sequences and routine MRI sequences were also done. <b>Results:</b> A 3D T2 SPACE STIR sequences demonstrated comparable image quality in all patients. The level of agreement between the two radiologists on the image qualities of 3D-T2-SPACE STIR sequences was excellent. In patients with renal failure and pregnant patients where contrast studies and CT is contraindicated 3D SPACE STIR T2 imaging adds value in diagnosing pulmonary thromboembolism, congenital heart disease, bronchiectasis and consolidation with very less sequence acquisition time, ranging from 1 to 3 minutes. <b>Conclusion:</b> A 3D SPACE STIR MRI sequence is a useful adjunct in cardiac and chest imaging especially in renal failure and pregnant patients where contrast is contraindicated and also time conserving in these patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=TC06-TC09&id=12443 https://doi.org/10.7860/JCDR/2019/37604.12443 Altered Serum Electrolyte Status in Acute Stroke Patients in Western Odisha, A Predictor of Syndrome of Inappropriate ADH (SIADH) or Cerebral Salt Wasting Syndrome (CSWS) Manaswini Panda, Pratima Kumari Sahu, Manmath Kumar Mandal, Alok Kumar Mohapatra, Subha Soumya Dany <b>Introduction:</b> Stroke is a major healthcare issue globally with an incidence comparable to coronary events. It has multiple aetiologies and variable clinical manifestations. Dyselectrolytaemia is an important cause of morbidity and mortality in stroke. <b>Aim:</b> To observe the changes in serum electrolyte levels in Cerebrovascular Accident (CVA) patients and to find any relation with other biochemical parameters and type of stroke. <b>Materials and Methods:</b> A total of 60 clinically diagnosed and CT/MRI proven acute stroke patients (ischaemic/haemorrhagic) in age group 40-70 years were studied in the Department of Biochemistry, VIMSAR, Burla, for a duration of two years (September 2013 to August 2015). Control group consisted of 50 age and sex matched individuals. Serum electrolytes, urea, creatinine, fasting blood glucose, age, BMI and other parameters were studied in these patients. <b>Results:</b> Out of 60 patients 41 (68%) were males and 19 (32%) were females. Maximum number of cases had ischaemic stroke (62%) followed by haemorrhagic stroke (38%). Mean serum level of sodium was lower in cases as compared to the controls which was statistically significant (p<0.0001). The serum calcium was lower in cases as compared to the controls which was statistically significant (p<0.0001). A total of 71.66% of stroke patients had hyponatraemia, while ~48.33% of patients had hypocalcaemia. <b>Conclusion:</b> Dyselectrolytaemia is highly prevalent in stroke patients. Dyselectrolytaemia also varies with the type of stroke. Thus, serum electrolytes should be a part of the initial evaluation in all stroke patients to prevent morbidity and mortality. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=BC10-BC13&id=12499 https://doi.org/10.7860/JCDR/2019/37933.12499 Prostate Specific Antigen: A Diagnostic Marker in Polycystic Ovarian Syndrome Kiran Bhat, Meena Bhandari, Vaishali Garg <b>Introduction:</b> Polycystic Ovarian Syndrome (PCOS) is a common condition affecting females in the reproductive age group. Its diagnosis rests on clinical features like obesity, hirsutism, irregular menstrual flow, polycystic ovarian morphology on ultrasonography and laboratory investigations like serum estimation of Luteinizing Hormone (LH), Follicle Stimulating Hormone (FSH), prolactin, dehydroepiandrosterone. The Prostate Specific Antigen (PSA) has been found to be raised in hyperandrogenic states and therefore can be used as a marker for diagnosis of PCOS. <b>Aim:</b> The study was undertaken to evaluate serum PSA levels in patients of PCOS and its possible use in diagnosis of PCOS. <b>Materials and Methods:</b> The case-control study included 40 women with PCOS and 40 age matched healthy women as controls. Serum PSA, LH, FSH and Prolactin levels were measured using immunometric technique. The data so obtained was statistically analysed using Student's t-test. Pearson correlation was used to test the correlation between LH, FSH, Prolactin and total PSA (tPSA). <b>Results:</b> Mean value of serum PSA was significantly higher in women with PCOS (0.03 ng/mL) as compared to control group (0.01 ng/mL). Serum PSA level of >0.01 ng/mL showed 100% sensitivity and specificity. Serum PSA levels had a positive correlation with serum LH levels (p-value 0.001) and serum prolactin levels (p-value 0.03). However, no correlation between PSA and FSH (p-value 0.042) was observed. LH/FSH ratio was raised in 32 out of 40 cases and reversed in remaining eight cases. <b>Conclusion:</b> The serum PSA level with cut-off value >0.01 ng/mL can be used to detect hyperandrogenism in women and therefore can be used as a diagnostic marker for diagnosis of PCOS. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=BC14-BC16&id=12500 https://doi.org/10.7860/JCDR/2019/38177.12500 Thiopurine S-Methyltransferase Polymorphism in Iraqi Paediatric Patients with Acute Lymphoblastic Leukaemia Nawars Mohammed, Manalk Rasheed, Hasanein H Ghali <b>Introduction:</b> Acute Lymphoblastic Leukaemia (ALL) treatment protocols widely used thiopurine drugs as an anti-cancer agent, which over the course of time results in drug toxicity. Thiopurine S-Methyltransferase Enzyme (TPMT) is responsible for the activation of 6-Mercaptopurine (6-MP) to Thioguanine Nucleotides (TGNs) that are incorporated into DNA and trigger cell death. Low TPMT activity is strongly correlated to TPMT genetic polymorphism. <b>Aim:</b> To identify the level of TPMT activity and the most common TPMT polymorphism (TPMT*3A, TPMT*3B and TPMT*3C) and its frequencies in a sample of Iraqi ALL paediatric patients. <b>Materials and Methods:</b> Eighty-one Iraqi ALL paediatric patients receiving 6-MP in the maintenance phase of treatment were enrolled in the study. TPMT activity in the serum was measured by using Enzyme-Linked Immunosorbent Assay Technique (ELISA) in the serum and TPMT genetic polymorphism (TPMT*3A, TPMT*3B and TPMT*3C) was detected by allele-specific multiplex-PCR analysis. Statistical analysis was performed by using a two-sample t-test to evaluate the difference in allele frequencies proportion in TPMT polymorphism. Pearson&#8217;s correlation analysis was done to determine the correlation between TPMT enzyme genotype and phenotype. <b>Results:</b> There were 51 paediatric ALL patients carrying the wild-type allele with allele frequencies of (62.96%), 30 paediatric ALL patients carrying the mutant alleles either TPMT*3A or TPMT*3C with allele frequencies of 29.62% and 7.4% respectively. The mutant allele TPMT*3B was not detected in the patients under study. The difference in mean of the TPMT enzyme activity between the ALL patients carrying the wild-type allele and the mutant allele was highly significant with p-value =0.001. A highly significant positive co-relation (r=0.939) was found between TPMT low activity and presence of genetic mutation across the TPMT gene (p-value=0.001). <b>Conclusion:</b> TMPT genotyping and phenotyping is an essential tool to reduce the cytotoxic effects of the anti-cancer drug 6-MP in Iraqi paediatric patients with ALL for a successful recovery. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=BC17-BC20&id=12501 https://doi.org/10.7860/JCDR/2019/38404.12501 Prevalence of Root Canal Configuration Types Based on Number of Canals at the Apical Third of Mandibular First Molar Roots Rashmi Bansal, Sapna Hegde, Madhusudan Astekar <b>Introduction:</b> Mandibular first molars are the earliest permanent posterior teeth to erupt and are, hence, most frequently in need of endodontic treatment. Success of endodontic treatment depends on three-dimensional obturation at apical third. Single canal with simple tubular configurations are easy to obturate than multiple canals involving merging or splitting of canals at apical third. There are no studies evaluating root canal configuration at apical third. <b>Aim:</b> The aim of the present study was to investigate the prevalence of root canal configuration types based on number of canals at the apical third of mandibular first molar roots. <b>Materials and Methods:</b> This experimental study evaluated a total of 250 mandibular first molars by clearing technique. The number of roots and canals were identified and canal configurations at the apical third were classified according to Vertucci and supplemental classifications. Chi-square test was applied to evaluate prevalence of root canal configuration types based on number of canals at the apical third of mandibular first molar roots. <b>Results:</b> A majority of the mandibular first molars (90.8%) were two-rooted. Three roots were observed in 6% of samples, four roots in 2% and fusion between roots in 1.2%. In the mesial root, two canals (48.4%) in the apical third was most prevalent, followed by one (25.8%), three (14.7%) and four (11.1%) canals. In the distal root, one canal in the apical third (74.2%) was the most prevalent finding followed by two (21.8%), four (2.8%) and three (1.2%) canals. The difference in prevalence of canal numbers in the apical third of the mesial and distal roots was statistically significant. The mesial root exhibited more variability than the distal root in canal configuration types. In the third root of three rooted molars, canal configuration was simple. In all the fused roots, C-shaped configuration was observed. <b>Conclusion:</b> Merging and splitting of root canals resulting in complex configuration although less prevalent were observed at apical third roots of mandibular first molar. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=ZC25-ZC31&id=12502 https://doi.org/10.7860/JCDR/2019/37081.12502 Comparison of the Sealing Ability of MTA-Angelus, Biodentine and CEM Cement in the Repair of Large Furcal Perforations-A Bacterial Leakage Study Tony Francis, Sonal B Joshi, Ar Vivekananda Pai, Nasil Sakkir, Khaleel Ahamed Thaha <b>Introduction:</b> Materials such as MTA-Angelus, Biodentine, and CEM Cement have been recommended for the repair of large furcal perforations. Due to larger surface area of such perforations, evaluating the sealing ability of the aforementioned repair materials is important for their clinical selection. <b>Aim:</b> To compare the sealing ability of MTA-Angelus, Biodentine, and CEM cement when used as repair materials for large furcal perforations. <b>Materials and Methods:</b> Sixty-five extracted human molar teeth were used for the study. Samples were randomly divided into groups 1, 2, and 3 with 20 samples in each (n=20). Five samples were used as controls. Furcal perforations of standardised diameter (2 mm) were prepared in samples of groups 1, 2, and 3 and repaired with MTA-Angelus, Biodentine and CEM Cement, respectively. A bacterial leakage model was used for each sample to study the sealing ability of these repair materials over an experimental period of 50 days. A culture of Enterococcus faecalis and sterile Brain Heart Infusion (BHI) broth were placed into the upper and lower chambers of the model, respectively. Any turbidity of the BHI broth indicated bacterial leakage through the repaired perforations. The day wise number of samples with bacterial leakage and the percentage of these samples during every five-day interval of the experimental period were noted and the results were statistically analysed using Chi-Square and Log Rank (Mantel-Cox) tests. The level of significance was set at p-value less than 0.05. <b>Results:</b> There was no significant difference in the bacterial leakage among the three groups at any 5-day interval of the experimental period (p>0.05). <b>Conclusion:</b> Biodentine and CEM cement with better handling properties could be used as alternatives to MTA-Angelus while repairing furcal perforations. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=ZC32-ZC35&id=12503 https://doi.org/10.7860/JCDR/2019/38476.12503 Socio-demographic and Lifestyle Determinants of Insomnia among Adult Patients Attending Primary Healthcare Centres, Jeddah: A Cross-sectional Study Abeer Lafi Almohammadi, Majed Alghamdi, Emad Lafi Almohammadi <b>Introduction:</b> Insomnia is the most prevalent sleep disorder. Its prevalence differs worldwide, from 5% to 40% depending on the criteria used to define insomnia, techniques, and method of collecting data. In Saudi Arabia, approximately 40% of adults with insomnia also have comorbid medical or psychiatric disorders. There are many factors which are associated with insomnia. <b>Aim:</b> To assess the association between socio-demographic and lifestyle factors with the occurrence of insomnia. <b>Materials and Methods:</b> This was a cross-sectional study conducted in 10 PHC centres of Jeddah. A total of 376 adult participants were interviewed by using a questionnaire which included questions about sociodemographic and lifestyle-related questions. Pittsburgh Sleep Quality Index and the Insomnia Severity Index was used to assess insomnia. Data were analysed and descriptive statistics (i.e., frequency, percentages, mean and standard deviation) were calculated. The chi-square test was applied to test significance of differences between groups. The p-values <0.05 were considered as statistically significant. <b>Results:</b> More than half of participants (51.1%) had poor sleep quality. The highest prevalence of poor sleep quality was observed among those who performed physical exercise four times or more weekly (67.3%). The poor quality of sleep was higher among those who drink coffee (p=0.001). Regarding risk factors for grades of insomnia, higher prevalence of severe insomnia was observed among younger participants (p=0.001), Saudi citizens (p=0.032), obese participants (p=0.045), university educated participants (p<0.001), and those who practised exercise four times or more weekly (p=0.001). <b>Conclusion:</b> Lifestyle factors had a significant effect on sleeping quality especially among young adults, obese people, and highly educated participants. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=LC14-LC20&id=12493 https://doi.org/10.7860/JCDR/2019/38403.12493 Experiential Learning in Epidemiology for Medical Undergraduates: A Mixed-Method Approach Meenakshi Khapre, Mallicka Gupta, Surekha Kishore <b>Introduction:</b> Experiential learning assumes learning to be a continuous process and learner enters in the process according to his preferable learning style. Considering the complex nature of epidemiology and loss of interest in students due to age-old traditional lecturing, it has been only limited to complete the course by just memorising without getting insight into its utilisation in real life. <b>Aim:</b> To assess the effectiveness of teaching epidemiology using experiential learning method in developing interest, improved level of satisfaction and better competency in basic epidemiology among undergraduate students exposed to experiential learning than those exposed to traditional lecture. <b>Materials and Methods:</b> A mixed method design for an educational intervention consisting of a new teaching approach i.e., experiential learning was planned. After selection of topic, the module was prepared followed by an orientation to facilitators and student in new teaching methodology. The module was completed in 12 sessions, two hours per session. The students went through all the four stages of the Kolb cycle depending on the topic. Students were later given the Multiple Choice Questions (recall and higher order level) and satisfaction questionnaire and told to reflect on learning. Another batch was exposed to traditional lectures (20 hours) and given MCQ’s at the end. The learning outcome was assessed by nonparametric test i.e., Mann-Whitney U test. Satisfaction with new methodology was analysed by proportion. <b>Results:</b> Students developed an interest in learning epidemiology as depicted through their written reflections. All the students showed a high level of satisfaction. Student exposed to experiential learning scored much higher than those exposed to lecture more so on higher-order questions. <b>Conclusion:</b> Experiential education activities provide an effective alternative for teaching epidemiology to medical undergraduates. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=JC07-JC12&id=12488 https://doi.org/10.7860/JCDR/2019/38297.12488 Relation of Lymphocyte Subsets and Cytokines in Different Grades of Alcoholic Cirrhosis Archana Chirag Buch, Amardeep Patil, Niladri Haldar, Banyameen Iqbal, Dakshayani Pandit, Arjun Lal Kakrani, Sunita Bamanikar, Harsh Kumar <b>Introduction:</b> The pathogenesis of Alcoholic Liver Disease (ALD) shows immune dysregulation with decreasing lymphocyte subsets and increasing CD4/CD8 ratio. T lymphocyte activation leads to secretion of cytokines like Tumour Necrosis Factor-a (TNF-a) and interleukins causing inflammation and fibrosis. <b>Aim: </b>To correlate lymphocyte subsets and TNF-a and Interleukin 6 (IL-6) in different grades of alcoholic cirrhosis. <b>Materials and Methods:</b> This was a prospective, cross-sectional study carried out over a period of two years at a tertiary care hospital and research centre in Western Maharashtra. The study cohort consisted of 51 patients diagnosed clinically as alcoholic cirrhosis. They were classified into grades A, B and C by Child-Pugh’s score. Lymphocyte subsets were determined by flow cytometry. T lymphocytes were identified (CD3+), and further subdivided into CD4+and CD8+cells. TNF-a and IL-6 were measured by ELISA. All parameters were measured using one-way Analysis of Variance (ANOVA test). <b>Results:</b> There was insignificant change in the total number of lymphocytes with different grades of cirrhosis. T lymphocytes and CD4+cells showed increase in count (885.38±464.19/mm3 to 1002.81±338.52/mm3) and (489.63±248.23/mm3 to 689.05±263.08/mm3) respectively, with corresponding decrease in CD8 count (364±230.37 to 3440.38±165.91). There was also an increase in CD4/CD8 ratio (1.48 to 2.18) along with raised TNF-a (25.16±18.45 to 30.15±36.37) and IL-6 (58.27±50.52 to 175.38±241.85) with increasing grades of cirrhosis. <b>Conclusion:</b> Alcoholic cirrhosis is a complex entity caused due to interaction between various components of immune systems and elaboration of cytokines. We found increase in T lymphocytes and CD4+cells along with increase in cytokines TNF-a and IL-6 with increase in grades of cirrhosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=EC08-EC11&id=12489 https://doi.org/10.7860/JCDR/2019/39593.12489 Interactive Effect of Background Variables and Workload Parameters on the Quality of Life among Nurses Working in Highly Complex Hospital Units: A Cross-sectional Study Milad Abbasi, Somayeh Farhang Dehghan, Rohollah Fallah Madvari, Ahmad Mehri, Mohammad Hossein Ebrahimi, Mohsen Poursadeghiyan, Hossein Marioryad, Maryam Ghaljahi <b>Introduction:</b> Quality of Working Life (QWL) is a vital concept in the employees&#8217; life which can confirm the efficiency of the organisation and job satisfaction of employees. <b>Aim:</b> The present study investigated the interactive effects of background variables (job and demographic characteristics) and workload parameters on the Work-Related Quality of Life (WRQoL) among nurses working in highly complex hospital units (ICU, CCU and Emergency). <b>Materials and Methods:</b> This was a cross-sectional study conducted in 2017, among all male and female volunteer nurses (n=840). For this purpose, NASA-Task Load Index (NASA-TLX) and WRQoL were used. A general questionnaire was also used to collect the job and demographic information of nurses. The statistical analyses were performed through MANOVA, tests between-subject&#8217;s effects, Box&#8217;s M, pair-wise comparisons, Bonferroni method, and multiple regression. <b>Results:</b> The findings indicated that the difference in mean score of WRQoL was statistically significant in all groups of the studied background variables except gender and Body Mass Index (BMI). The relationship between the variables of age, work experience, and the number of patients per shift and scores of work-related quality of life was statistically significant. Also, based on the results of multivariate regression analysis, the variables of overtime hours, the number of patients per shift, age, and the level of workload remained in the regression model and their coefficients of influence were estimated -43%, -23%, -19%, and -15%, respectively. <b>Conclusion:</b> The results indicated the simultaneous effect of the studied variables on the nurses&#8217; WRQoL. Of these, the variables of overtime hours, the number of patients per shift, age, and workload level were finally kept in the regression model to explain the most percentage of changes in the WRQoL. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=LC08-LC13&id=12482 https://doi.org/10.7860/JCDR/2019/37929.12482 Comparative Study of Peripheral Blood Smear, Rapid Antigen Detection, ELISA and PCR Methods for Diagnosis of Malaria in a Tertiary Care Centre Abisha Jayasingh, Vasanthi Rompicherla, Rajesh Kanna Nandagopal Radha, Priyadarshini Shanmugam <b>Introduction:</b> Diagnosis of malaria is largely influenced by the quality and design of the method used and antigenic variation exhibited by the parasite. Appropriate selection of these tests is necessary for routine case investigation, screening and for monitoring the response to various antimalarial agents. <b>Aim:</b> To evaluate the blood samples collected from suspected patients of malaria by various diagnostic methods. <b>Materials and Methods:</b> A total of 100 blood samples were collected from suspected cases of malaria from January 2015 to January 2016. The blood samples were screened by microscopy, rapid malaria antigen detection method (Histidine Rich Protein-2 and Lactate dehydrogenase), solid phase ELISA (Lactate dehydrogenase) and conventional PCR for 18s rRNA. <b>Results:</b> PCR was found to be the most sensitive method from this study. The specificity and positive predictive values were 100% for microscopy, rapid antigen detection method and ELISA. The negative predictive values were 94.4% for microscopy and rapid tests, followed by 93.5% for ELISA. The sensitivity was 75% for microscopy and rapid tests and 70% for ELISA. <b>Conclusion:</b> In this study PCR was found to be the most sensitive method which gave more positive results, followed by microscopy and rapid antigen detection methods, whereas ELISA was the least. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=DC08-DC11&id=12483 https://doi.org/10.7860/JCDR/2019/38213.12483 Diagnostic Evaluation of Multiplex Real Time PCR, GeneXpert MTB/RIF Assay and Conventional Methods in Extrapulmonary Tuberculosis Sanjay Singh Negi, Priyanka Singh, Sachin Chandrakar, Ujjwala Gaikwad, Padma Das, Anudita Bhargava, Ajoy Behra, Nitin M Nagarkar <b>Introduction:</b> Effective management of Extrapulmonary Tuberculosis (EPTB) requires simultaneous identification of Mycobacterium tuberculosis (M.tuberculosis) complex, Non-Tuberculous Mycobacteria (NTM) and Rifampicin (RIF) sensitivity pattern for early and effective evidence based Antitubercular Treatment (ATT). <b>Aim:</b> To evaluate the diagnostic potential of multiplex Real-Time Polymerase Chain Reaction (mRT-PCR) versus GeneXpert and conventional microscopy and culture. <b>Materials and Methods:</b> A total of 110 multivaried extrapulmonary specimens from an equal number of patients with strong clinical/radiological/histopatholgical evidence of EPTB were subjected to conventional microscopy, liquid culture MGIT 960 system, GeneXpert and mRT-PCR. <b>Results:</b> Highest positivity of 88.8% (97/110) was shown by mRT-PCR followed by GeneXpert (52.72%, 58/110), liquid culture MGIT 960 system (44.54%, 49/110) and microscopy (4.54%, 5/110) respectively (p<0.01, ?2=156). Comparing it with culture positive cases (n=49), the sensitivity, specificity, Positive and Negative Predictive Value (PPV and NPV) of GeneXpert was found to be 87.25%, 100%, 100% and 80.64% respectively while the same parameters were 100% each for mRT-PCR. mRT-PCR showed higher positivity over GeneXpert in various individual extrapulmonary sample category with significant difference seen in synovial fluid. The specific added advantage of mRT-PCR was seen in the detection of 17 NTM. GeneXpert advantage seen in detection of five cases of RIF resistance. <b>Conclusion:</b> With individual feature of detection of NTM by mRT-PCR and RIF resistance by GeneXpert, this study may advocate the use of mRT-PCR adjunct to GeneXpert in the diagnostic armamentarium to identify more rapidly and effectively both M.tuberculosis and NTM along with RIF resistance information for early and specific ATT intervention of all EPTB cases including Multi Drug Resistant (MDR). However, further research may be required to enhance the sensitivity of both GeneXpert and mRT-PCR to exclude all possibilities of false negative EPTB cases. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=DC12-DC16&id=12485 https://doi.org/10.7860/JCDR/2019/37569.12485 Estimation of Stature from Upper Extremity Anthropometric Measurements Özlem Uzun, Gülay YegInoglu, Canan Ertemoglu Öksüz, Sahi Nur Kalkisim, NIhat Burak Zihni <b>Introduction:</b> Stature is one of the most important biological profiles for identification procedures. However, major difficulties are experienced in the identification of fragmented bodies in mass deaths. Anthropometric methods have been utilised as a reliable way to quickly establish the identification of victims using only a few parts of the body. <b>Aim:</b> To develop models for stature estimation in forensic situations in which anatomical components and remnants of the upper extremity require identification. <b>Materials and Methods:</b> The study population consisted of aged 18-25 years (200 female, 200 male). Participants were selected from the Karadeniz Technical University, Turkey by stratified randomisation method according to sex. Measurements were taken from the upper extremities of all subjects on the basis of anthropometric points. The relationship between stature and upper extremity parameters was performed using Pearson correlation coefficient. Models were developed from using linear regression analysis. <b>Results:</b> A statistically significant difference was observed between the male and female groups (p<0.05), with male measurements being higher than those of females. All body dimensions positively correlated with stature. The strongest correlations with stature were observed for upper extremity length for all groups and for both right (research: r=0.861; males: r=0.675; females: r=0.768) and left sides (research: r=0.868; r=males: 0.716; r=females: 0.758, p<0.01). Developed models elicited valid and reliable stature estimates with high accuracy rates (p<0.001). The accuracy of stature estimation models ranged from &#177;3.538 to &#177;4.958 cm. <b>Conclusion:</b> The study suggested that estimation of stature can be made possible using various dimensions of the upper extremities. One must consider differences between populations in order to apply functions as such to others. This study provides new forensic standards for stature estimation from the upper extremity measurements of Turkish adults. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=AC09-AC15&id=12475 https://doi.org/10.7860/JCDR/2019/38372.12475 Enclosed by Others: Post Haematopoietic Stem Cell Transplantation Patients Experience-A Phenomenological Study Alireza Nikbakht Nasrabadi, Ali Karimi Rozveh, Shahrzad Ghyasvandian, Leila Sayadi, Mohammad Vaezi <b>Introduction:</b> Haematopoietic Stem Cell Transplantation (HSCT) has been considered as final treatment strategy for many diseases. Many quantitative studies have been conducted regarding the difficulties that these patients experience after the procedure with the focus being on negative side effects. <b>Aim</b> This study was conducted to explore lived experiences of Iranian patients after haematopoietic stem cell transplantation. <b>Materials and Methods:</b>A qualitative design method was used in this study. Based on the philosophical perspective of the naturalistic and the phenomenological approach, Van Manen’s method of doing phenomenological study was used in this study. Six patients who had undergone HSCT at least six months ago, older than 18 years and able to communicate participated in the study. Semi-structured interviews were conducted. Data was analysed by using MaxQDA 10. <b>Results:</b> Participants experienced isolation from social, occupational and emotional activities and stated that they are being excessively controlled by their family members. So main theme was “Enclosed by others” and “Excessive care and excessive support” were the two subthemes. <b>Conclusion:</b> It is vital to pay attention to patients feeling of independence when taking care of themselves and to reduce unnecessary support by others. Educating nurses and families of these patients about different aspects of supportive behaviours are required. Also, different types of supportive and unsupportive behaviours should be included in nurses curriculum. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=LC04-LC07&id=12476 https://doi.org/10.7860/JCDR/2019/37284.12476 Role of CA 19-9 and its Ratio with CRP and Total Bilirubin in Differentiating Malignant from Benign Obstructive Jaundice Sumanta Ghosh, Mriganka Baruah, Ashish Kumar Yadav, Arup Kumar Das <b>Introduction:</b> Obstructive Jaundice resulting from various benign and malignant conditions of gastrointestinal tract may lead to variable increase in serum Carbohydrate Antigen (CA19-9), C Reactive Protein (CRP) and serum bilirubin level. <b>Aim:</b> To investigate the diagnostic utility of CA19-9, CRP, serum bilirubin level and their ratios, CA19-9/total bilirubin ratio and CA19-9/CRP, ratio in differentiating malignant obstructive jaundice from benign obstructive jaundice. <b>Materials and Methods:</b> This case control study considered 75 diagnosed cases of obstructive jaundice which were further divided into two sub-categories; Group I consisted of 36 patients with malignant obstructive jaundice and Group II consisted of 39 patients with benign obstructive jaundice. All patients were subjected to laboratory investigations which included CA 19-9, CRP and Total bilirubin. Median and interquartile range was used in descriptive statistics, as the data was not following normal distribution. The different groups were analysed using non parametric test and ROC used for predictive analysis. The results were statistically analysed using statistical software, R version 3.4.0. <b>Results:</b> A significant increase in serum CA 19-9, serum bilirubin and CRP was observed in malignant obstructive jaundice compared to benign obstructive jaundice. As per ROC analysis CA19-9 alone has the highest sensitivity value of 91.67, at a cut-off point of 410 U/mL whereas CRP reported the lowest in both sensitivity and specificity. However, when a ratio of CRP i.e., (CA19-9/CRP) is taken, the sensitivity value of 83.33 is obtained at a cut-off point of 40.56 and area under ROC is also significant, but there is decrease in both sensitivity and specificity when the ratio of bilirubin i.e., CA19-9/Bilirubin is considered. A logistic regression analysis found total bilirubin to be the most significant independent factor having an impact on malignancy. <b>Conclusion:</b> CA19-9, at a cut-off value of 410, has better sensitivity in differentiating malignant from benign obstructive jaundice compared to the ratio with CRP and total bilirubin. One of the major finding of the study is when CRP is adjusted for CA 19-9 i.e., CA19-9/CRP ratio proves to be a better marker, that can be used along with CA 19-9 in differentiating between malignant and benign obstructive jaundice. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=PC06-PC09&id=12477 https://doi.org/10.7860/JCDR/2019/38019.12477 Randomised Controlled Trial between Ultrasound Guided Femoral Nerve Block and Adductor Canal Block for Postoperative Pain and Functional Outcome in Anterior Cruciate Ligament Reconstruction Aghna Faryal Faiaz, Shaila Surendra Kamath <b>Introduction:</b> Femoral Nerve Block (FNB) is used as an adjunct to postoperative analgesia in Anterior Cruciate Ligament (ACL) reconstruction surgeries. However, it causes a reduction in quadriceps strength following use. To mitigate the loss in muscle function and patient safety, surgeons and anaesthesiologists have recently been exploring the potential benefits of a motor sparing Adductor Canal Nerve Blockade (ACB). To date, few comparative studies exist to determine its clinical utility. <b>Aim:</b> To compare the efficacy of femoral nerve block versus ACB for postoperative pain and functional outcome in patients undergoing ACL reconstruction. <b>Materials and Methods:</b> This prospective, randomised controlled trial was done after approval from Institutional Ethics Committee, Kasturba Medical College, Mangalore, Karnataka, India, 76 ASA Class 1 and 2 patients posted for ACL reconstruction, aged 18-60 years were chosen after consent and were randomised into two groups using computer-generated block randomisation. Group F received femoral nerve block and Group A received adductor canal block postoperatively. Visual analogue scale score at 0, 12 and 24 hours and Medical Research Council grading at 2, 12 and 24 hours post-block were measured and compared between both groups. Data analysis was done using student unpaired t-test, student paired t-test and chi-square test. <b>Results:</b> Visual analogue scale scores at 0, 12 and 24 hours postoperative was 2.29, 3.26 and 3.86 in Group A and 2.59, 3.61 and 4.49 in Group F (statistically non significant). Average time for rescue analgesia was 1 hour and 8 hours in Group A and F respectively. Medical research council grading 2, 12 and 24 hours postoperative was 2.6, 4.09 and 4.77 in Group A and 2.8, 3.15 and 4.05 in Group F (statistically significant). <b>Conclusion:</b> Compared with femoral nerve block, the study suggests that adductor canal block preserves quadriceps strength but is equianalgesic for patients undergoing anterior cruciate ligament reconstruction. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=UC11-UC14&id=12478 https://doi.org/10.7860/JCDR/2019/38453.12478 Comparison of Voiding Cystourethrogram with Cystoscopy in the Prediction of Presence of Posterior Urethral Valve Koyeli Mary Mahata, Gibikote Sidhar, John Mathai <b>Introduction:</b> Posterior Urethral Valves (PUVs) are a major cause of short and long term morbidity in male children. They cause recurrent urinary tract infections and lead to chronic renal failure in a significant proportion of boys. The diagnosis of posterior urethral valves has historically been based off voiding cystourethrograms (VCUGs) and confirmed and treated by cystoscopy, which is the gold standard. To the best of our knowledge the literature is sparse on the role of definitive diagnosis of PUV based on VCUG and no data on the urethral ratios in the normal population. <b>Aim:</b> To determine the ratio of posterior to anterior urethral diameter as an objective means to predict presence of Posterior Urethral Valves (PUV) using cystoscopy as the gold standard and to determine normal urethral ratios in paediatric age groups. <b>Materials and Methods:</b> The study was conducted prospectively in 493 male children over 18 months. Urethral diameters were measured on VCUG and Posterior Urethra/Anterior Urethra (PU/AU) ratios derived. Cystoscopy was the reference standard. Diagnostic accuracy of ratios was calculated using Receiver Operating Characteristic (ROC) curves, best threshold values determined with corresponding estimates of sensitivity and specificity to decide optimal significant ratios. Age stratified normative ratios were calculated. <b>Results:</b> MCU has 97.96% sensitivity, 86.27% specificity, 87.27% positive predictive value (PPV) and 97.78% negative predictive value (NPV) value when compared with cystoscopy which is the current gold standard in the diagnosis of PUV. The Posterior Urethra/Anterior Urethra (PU/AU) ratio was found to be a valid indicator of the presence of PUV. The diagnostic ability of PU/average AU is the best of the three ratios (AUC 0.9055) in predicting the presence of a PUV on cystoscopy. PU/average AU value =2.11 suggests that the patient most likely has a PUV with an 83% sensitivity and 91% specificity, within 95% Confidence Interval of 0.8458-0.96527. With regard to calculation of the normal PU/AU ratio for each age group, we found a general trend of decreasing ratios with increasing patient age. <b>Conclusion:</b> VCUG is useful in predicting presence of PUV.Age group specific standard reference ratios can be used for identifying PUVs. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=TC10-TC14&id=12479 https://doi.org/10.7860/JCDR/2019/38298.12479 Correlation of Forced Expiratory Time with Anthropometric and Spirometric Indices Sujoy Mukherjee, Anil Baran Singha Mahapatra <b>Introduction:</b> Forced Expiratory Time (FET) is the duration of forceful expiration during a Forced Vital Capacity (FVC) manoeuver of spirometry test. Joint recommendation of the American Thoracic Society (ATS) and the European Respiratory Society (ERS) i.e., ATS/ERS has expressed new interest about FET in their latest guidelines (2005). Interpretation of FET in respect to anthropometric and spirometric determinants in the population of eastern India is yet to be established. <b>Aim:</b> To evaluate the correlation of FET with anthropometric {age and Body Mass Index (BMI)} and spirometric indices (FEV1/FVC ratio and PEFR) in subjects having normal range of commonly used spirometry parameters such as FVC, Forced Expiratory Volume in first second (FEV1), FEV1/FVC ratio, forced expiratory flow in the middle half of the FVC (FEF25%-75%), and Peak Expiratory Flow Rate (PEFR). <b>Materials and Methods:</b> A retrospective study was conducted based on spirometry results obtained between February 2016 and July 2016 from the saved database at pulmonary function laboratory of Department of Physiology, RG Kar Medical College, Kolkata, West Bengal, India, after obtaining administrative approval. A total of 220 non-smoker subjects aged between 25 and 50-years including male and female (1:1) having normal spirometry were selected for analysis where the test was conducted by HELIOS 702 as per ATS/ERS protocol (2005) and using 80% ethnic correction during that time period. Age, Sex, BMI, FEV1/FVC ratio (ratio between forced expiratory volume in first second and forced vital capacity), PEFR (percentage value) and FET (seconds) were collected from the record sheet of each patients. Statistical analysis was done by chi-square test, two-sided z-test and Pearson&#8217;s correlation coefficient. Differences were found statistically significant at p-value <0.05. <b>Results:</b> In the present study both age and BMI had shown significant positive correlation {(r:+0.445; p<0.001) and (r:+0.239; p=0.002) respectively} while both FEV1/FVC ratio and PEFRwere presented significant negative correlation {(r:-0.639; p<0.0001) and (r:-0.285; p<0.0001)} with FET. <b>Conclusion:</b> FET increases with age suggesting age related alteration in pulmonary mechanics and positive correlation with BMI denotes FET as an indicator of pulmonary efficiency in obese. Negative correlation of FET with FEV1/FVC and PEFR may suggest airflow limitation and indicates that FET has a diagnostic value in obstructive airway diseases. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=CC01-CC04&id=12469 https://doi.org/10.7860/JCDR/2019/38007.12469 Tracking of Fascicles of Sartorius and Pectineus Nerves-A Key to Neurosurgery Naresh Chandra, Rajani Singh <b>Introduction:</b> Sartorius and pectineus are muscles of thigh innervated by Nerve to Sartorius (NS) and Nerve to Pectineus (NP) respectively. If pectineus and sartorius muscles are paralysed or weakened due to injury to nerves to pectineus and NS or their fascicles, these injured nerves and/or fascicles are to be repaired or stimulated to restore the functions of these muscles. <b>Aim:</b> An experimental histological study of the NP and NS was designed to explore the configuration of fascicles and their identification for repair at fascicular level. This microscopic work has been done at such a close sample interval (1-2 mm) for the first time. <b>Materials and Methods:</b> The slides from 24 blocks of 4/5 mm tissue of femoral nerve were observed under microscope and photographs were taken. The fascicles were identified at emergence of NS and NP and mapped/tracked cranially in presence of transformational processes in their pathways. The group of fascicles contributing to these nerves were also mapped cranially up to the top of cropped femoral nerve. <b>Results:</b> Fascicles 10, 11 and 12 were main contributors to nerve to sartorius. These fascicles underwent 49 transformational processes transforming into fascicles 298, 299, 307, 308 and 309 forming NS in S1 1. Similarly the fascicles 7, 8 and 9 constituted NP having undergone 33 transformational processes forming fascicles 220, 305 and 306 in A24 1 matching with the fascicles of P1 1. The clear picture of pathways of above mentioned fascicles from point of emergence of NS and NP upto top of femoral nerve and vice versa is presented in table Models NP and NS. <b>Conclusion:</b> The pictures of composite fascicles will revolutionise not only diagnosis and treatment of injured fascicles but also interpretation of MRI along with the identification. The study will add new dimension to future diagnosis and treatment of injured nerve or fascicle. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=AC01-AC08&id=12470 https://doi.org/10.7860/JCDR/2019/37790.12470 Significance of Tumour Budding with Cytokeratin 20 Immunostaining as a Histopathological Prognostic Marker in Colorectal Adenocarcinoma Munireddy Swathi, Asha Mahadevappa, Mathew Sherin Susheel <b>Introduction:</b> Tumour Budding (TB) in Colorectal Carcinoma (CRC) has been studied comprehensively and brought TB into the clinical dominion as an additional prognostic parameter. The tumour aggressiveness with poorer survival of CRC patient is linked to presence of Peritumoural Budding (PTB) at the invasion front and Intratumoural Budding (ITB) in the tumour centre. <b>Aim:</b> To study and compare the scoring system of TB by Haematoxylin and Eosin (H&E) staining with immunohistochemistry (IHC) CK20 in resected specimens of CRC and, its relation between TB grades with known prognostic histopathological parameters of CRC. <b>Materials and Methods:</b> The descriptive cross-sectional study was conducted in JSS Medical College and Hospital, Mysuru, Karnataka, India. A total of 50 cases of CRC were studied prospectively over a period of two years. Both H&E and IHC CK20 stained slides were studied. A total of 10 high power field (10 HPF) in invasive front were evaluated for PTB10HPF and within the tumour for ITB10HPF. The high dense area which had the maximum TB was taken as Hot Spot (HS). Continuous and cut off values of PTB, ITB and OTB (overall tumour budding) scores were compared in both H&E and IHC stained sections and also evaluated the association with various clinicopathological prognostic features. <b>Results:</b> An increase in the number of TB (PTB-46%, ITB-72%, OTB-28%), via IHC was noted. On continuous scores PTB, ITB and OTB counts showed significant association with tumour stage, lymph node metastasis and lymphovascular invasion (all p<0.05). When cut-offs were applied these statistical significance were lost. The Pearson’s correlation coefficient confirmed that OTB is better in evaluating TB than PTB and ITB. <b>Conclusion:</b> TB is a potential and potent histopathological prognostic forecaster of lymph nodal metastasis and a higher stage of tumour and allocates as a marker for stratification of patients into high risk categories in CRC. The TB in routine histopathology report should be advocated as H&E staining aided by IHC show significant association with histopathological parameters. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=EC03-EC07&id=12471 https://doi.org/10.7860/JCDR/2019/40023.12471 Molecular Detection of Human Papillomavirus DNA in Oral Lichen Planus Patients Ayesha Sameera, Rosaiah Kotikalpudi, Rajesh Kumar Patel, Kranti Kiran Reddy, Md Prasanna, Sridhar Reddy Erugula <b>Introduction:</b> Oral Lichen Planus (OLP) is a chronic inflammatory disease with cell mediated immunopathologic response. Even though OLP has been studied widely for decades, the aetiology of the disease is yet not hypothesised exactly. Autoimmunity, viruses like Hepatitis C Virus (HCV), Human Papillomavirus (HPV), Human Immunodeficiency Virus (HIV), Herpes Simplex Virus (HSV), Candida albicans and stress have been hypothesised in recent articles. The fact that there is paucity of studies on the aetiopathogenesis of oral lichen planus pivoted the study to analyse the presence of HPV in OLP. <b>Aim:</b> The aim of this study is to detect the presence of HPV DNA in the biopsy samples of OLP and also to determine the role played by the virus in aetiopathogenesis of OLP. <b>Materials and Methods:</b> Biopsy samples comprising 15 Oral Lichen Planus tissues and 15 normal buccal mucosa tissues embedded in paraffin blocks were collected from different dental colleges located in Telangana erstwhile Andhra Pradesh. Parameters like age, sex, site of lesions, type of lesion were also compared. The DNA was extracted from the fixed tissue by using modified protocol and Polymerase Chain Reaction (PCR) was performed by using general primers to amplify HPV L1 gene. On comparison of sequences of 10 patients by using Basic Local Alignment Search Tool (BLAST), the sequences were found similar to HPV-18 L1 gene. <b>Results:</b> Thirteen out of 15 (86.6%) lichen planus cases and none out of 15 controls were HPV 18 positive. Compared between males and females and controls significant relation was observed between sex and OLP too. However, no significant relation was observed based on the site of the lesion and based on type of lesion. <b>Conclusion:</b> The molecular studies confirm presence of HPV-18 in OLP tissues of 13 patients with 8 Single Nucleotide Polymorphism (SNPs) indicating probably new variant of HPV-18 in Indian patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=ZC20-ZC24&id=12466 https://doi.org/10.7860/JCDR/2019/32397.12466 Alternative Rapid Methods for Coverslip Removal: A Comparative Study Mahesh H Karigoudar, Sachin Shivaji Kapse, Disha B Shankar, Shikha Sharma, Divya Prafulla Yerraguntla <b>Introduction:</b> In 21st century, the focus is to develop method which yields outcome in shorter tenure, and are rapid, safe and obtain quicker results. In this study, non-traditional methods were used for removal of coverslip and was compared with traditional methods. <b>Aim: </b>To compare the time taken for coverslip removal of old faded slides with five different methods. <b>Materials and Methods: </b>Faded slides of one year to more than 10-year-old were included in the study. Total of 90 slides were subjected to five different methods of coverslip removal like xylene at room temperature, xylene at 56° Celsius (C), Petrol, Diesel and Freezing method. Time taken for each method was noted. <b>Results:</b> The mean time taken for removal of coverslip was least with freezing method followed by xylene at 56°C, Petrol, xylene at room temperature and diesel. <b>Conclusion:</b> Alternative methods are safe, rapid and has less turn around time compared to routine use of xylene. Hence, can be successfully used for removal of coverslip. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=EC01-EC02&id=12467 https://doi.org/10.7860/JCDR/2019/37367.12467 A Prospective Study to Analyse the Agreement between Empirical Antimicrobials used in Infective Endocarditis and Culture Sensitivity Reports Reshma Reji, Anjana Thomas, Aswathy Rajappan, Siby Joseph, Remya Reghu <b>Introduction:</b> Infective Endocarditis (IE) is defined as a microbial infection of the heart valve or the mural endocardium. Annually the incidence of IE is between 2 and 6 per 100,000 individuals. The diagnostic techniques for IE and selection of empiric antibiotics remain a big challenge in the light of changing microbiological spectrum for IE. <b>Aim:</b> To identify the risk factors of IE, to identify the specific pathogens involved, the empirical therapy provided and to analyse the agreement between the empirical therapy and the culture sensitivity reports. <b>Materials and Methods:</b> The study was a non experimental, descriptive and prospective type of study involving patients diagnosed with IE and fitting into the inclusion and exclusion criteria. This study was conducted on patients admitted under Cardiology department of Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India. Information on risk factors, empirical antibiotic therapy, culture sensitivity report and definitive therapy in IE were collected by accessing the hospital information system. Statistical analysis has been carried out using Chi-square test. <b>Results:</b> The most common non predisposing and predisposing risk factors were diabetes mellitus 30% and rheumatic heart disease 35% respectively. The most commonly identified organisms in blood cultures were Streptococcus and Staphylococcus species. Majority of the patients with native 46% and prosthetic endocarditis 57% had undergone a change in their therapy according to the culture sensitivity report. <b>Conclusion:</b> Optimal empirical antibiotic selection is essential in treating IE because after the culture report, altering antibiotics may lead to increased chances for unintended antibiotic resistance. Isolation of atypical pathogens like Pseudomonas aeruginosa and Mycobacterium abscessus implies changes in the microbiological spectrum for this disease. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=FC05-FC09&id=12461 https://doi.org/10.7860/JCDR/2019/37040.12461 Dengue Fever Outbreak in Remote Tribal Village of Central India Devjyoti Majumdar, Rani Soni, Debashish Samal, Satyaram Satapathy, Jagdish Mahanta <b>Introduction: </b>Dengue fever is known to cause outbreaks in urban and semi urban dwellings and rarely in rural areas. The present study investigates an outbreak in remote tribal village of Chhattisgarh in 2015. Dengue virus is found in circulation of the infected patient in the first four days of fever and headache on day fifth after which dengue virus is not detectable in blood. Therefore, we analysed virus isolation and serotyping in serum of patients who presented with 1-4 days of fever. Since dengue IgM begin to appear after four days of symptoms, these samples were not included for RT-PCR. <b>Aim:</b> Isolation and identification of dengue virus serotype from the patients in a dengue fever outbreak in remote tribal village of central India and also to find out the correlation of dengue symptoms with serotype of dengue virus. <b>Materials and Methods:</b> This outbreak affected a population of 7038. Serum samples of clinically suspected patients were tested by dengue NS1 and dengue IgM capture ELISA. Dengue NS1 positive samples were serotyped by reverse transcriptase real time PCR. <b>Results:</b> Out of 746 samples 167 were dengue NS1 positive and 171 were Dengue IgM positive. Twenty six samples were DENV 2 positive, 77 samples were DENV 3 positive and 36 samples were positive for both DENV 2 and DENV 3. There was no correlation between serotype of dengue and severity of symptoms. <b>Conclusion:</b> Surveillance activities and serotyping by RT-PCR of dengue is necessary in the rainy season for prevention and control of dengue in future outbreaks. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=DC05-DC07&id=12462 https://doi.org/10.7860/JCDR/2019/37607.12462 Ultrasound Guided Oblique Subcostal Transverse Abdominis Plane Block using Local Anaesthetic Versus Saline for Laparoscopic Cholecystectomies: A Randomised Controlled Trial Karl Nicholas SA Ribeiro, Julie CR Misquith, Anthony Eapen, Shilpa A Naik <b>Introduction:</b> Laparoscopic cholecystectomy surgery causes patients to have postoperative discomfort due to pain caused by incisions on the anterior abdominal wall. With the introduction of peripheral nerve blocks, the dosage of systemic analgesics can be significantly reduced and thereby the side-effects that may be caused by them. Oblique Subcostal Transversus Abdominis Plane (OSTAP block) which is a variant of the TAP block provides superior analgesia for supraumbilical procedures. <b>Aim:</b> To compare the efficacy of ultrasound-guided OSTAP block using 0.35% ropivacaine with saline OSTAP block in patients undergoing elective Laparoscopic cholecystectomy surgery. <b>Materials and Methods:</b> Forty-two ASA 1 and 2 patients posted for elective laparoscopic cholecystectomies were randomly assigned into two groups. Group A received bilateral OSTAP block with 0.35% ropivacaine and Group B received bilateral OSTAP block with sterile normal saline after the induction of general anaesthesia. Intraoperatively, the dose of opioid required during surgery and postoperatively pain score, opioid consumption, Postoperative Nausea and Vomiting (PONV) and Post Anaesthesia Care Unit (PACU) length of stay were evaluated. For all statistical evaluations, a two-tailed probability p-value of <0.05 was considered significant. <b>Results:</b> Intraoperative opioid consumption was higher in Group B but was statistically insignificant with a p-value of 0.575. Opioid consumption during the first eight hours after surgery and within 24 hours was also lower in Group A. When considering the quality of postoperative analgesia, Group A showed a significantly lower VAS score than Group B immediately after surgery, 30 minutes, 2 hours, 4 hours, 6 hours and 24 hour postoperatively. PACU stay in Group A was significantly less (p<0.001) with nearly all patients reaching discharge criteria within 30 minutes of reaching the PACU. There was no significant difference in the incidence of postoperative nausea vomiting in the groups. <b>Conclusion:</b> OSTAP block with 0.35% ropivacaine provided adequate analgesia with opioid-sparing effect in the postoperative period after a laparoscopic cholecystectomy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=UC07-UC10&id=12463 https://doi.org/10.7860/JCDR/2019/39675.12463 Comparison of Morphology of Intracranial Aneurysms on Computed Tomography Angiography with Digital Subtraction Angiography and Intraoperative Findings–A Single Centre Experience Santosh PV Rai, Parvathi Chandran, Muralidhar Pai, Mayur Kamath, Keerthiraj Bele, Ashvini Kumar, Shrijeet Chakraborti <b>Introduction:</b> Multi-Detector Computed Tomography (MDCT) angiography is a non-invasive technique in emergency screening of Subarachnoid Haemorrhage (SAH) for accurately detecting aneurysms. Digital Subtraction Angiography (DSA) remains the gold standard for diagnosis of intracranial aneurysm. Computed Tomography Angiography (CTA) is being increasingly used for this purpose and can presently replace DSA as the most reliable means to detect intracranial aneurysms in SAH. <b>Aim:</b> To characterise the morphology of intracranial aneurysms with CTA and to compare it with DSA and intraoperative findings. <b>Materials and Methods:</b> This analytical study includes patients suspected to have intracranial aneurysm and underwent CTA on 16 slice MDCT scanner. Post-processing Multiplanar Reconstructions (MPR), 3D Volume Rendering (VR) and Maximum Intensity Projection (MIP) were performed. The findings of CTA findings were compared with DSA and intraoperative/indocyanine angiography images obtained by Leica neurosurgical operating microscope, wherever possible. Morphological parameters: size (dome, neck, height, dome to neck ratio, aspect ratio in saccular and length, diameter in fusiform), shape, lobulation, tit, location, thrombosis/calcification, blood vessels arising, ruptured or not, grade of SAH (modified CT Fischer score) and vasospasm (grade, number/location of vasospastic segments) were assessed and compared with DSA and intraoperative findings. <b>Results:</b> In 71 patients, 97 intracranial aneurysms were studied. Saccular aneurysm was the most common and anterior communicating artery (ACOM) was the most common location. Significant correlation of dome: neck and aspect ratios between CTA and DSA (p=0.0089) was noted. The sensitivity, Positive Predictive Value (PPV) and accuracy of CTA for aneurysm >3 mm was 100%. Two aneurysms <3 mm were missed on CTA, but detected by DSA. Therefore, for aneurysms <3 mm in size, sensitivity was 92.86%, with a PPV and accuracy of 96.3% and 89.66%, respectively. Overall sensitivity of CTA irrespective of size was 97.9%, with 97.9% PPV and 95.9% accuracy was observed. <b>Conclusion:</b> MDCTA with 3D reconstructions and volume rendering is the ideal first line imaging modality in non-traumatic SAH for detection of aneurysm with a high degree of accuracy. DSA can be used to diagnose tiny aneurysms <3 mm if missed on CTA, if there is a high degree of suspicion. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=TC01-TC05&id=12420 https://doi.org/10.7860/JCDR/2019/37967.12420 Correlation between HDL Level with Clinical and Biochemical Markers of Atherogenesis S Sneha, M Sudhakar Rao, Sudha Vidyasagar, Shubha Seshadri <b>Introduction:</b> HDL cholesterol (HDL-C) level is an independent predictor of risk for cardiovascular events in both genders, low levels of which have been demonstrated to have an inverse association with cardiovascular disease and mortality. Anthropometric measurements serve as surrogate markers for atherogenic burden. Atherosclerosis represents a chronic inflammatory process and low HDL being an inflammatory state, inflammatory markers such as high-sensitivity C Reactive Protein (hs-CRP) may provide an adjunctive method for global assessment of cardiovascular risk. TG/HDL ratio has been proved to have a high association with prevalence of metabolic syndrome and with insulin resistance. <b>Aim:</b> To find out the correlation between High Density Lipoprotein (HDL) level with clinical and biochemical markers of atherogenesis. <b>Materials and Methods:</b> This cross-sectional study was conducted with a study population of 200 individuals, who were either in-patients or outpatients in the Department of Medicine at Kasturba Medical College (KMC), Manipal Karnataka, India. (Study period July 2012-July 2014). Individuals aged 18-70 years being investigated for dyslipidemia for the first time were included. Data was collected by in person interview by specific questionnaire. Height, weight, waist circumference and hip circumference were measured as per standard protocol. Laboratory reports were noted for the estimation of Fasting Blood Sugar (FBS), HDL and Triglycerides (TG), hs-CRP, fasting insulin. Serum LDL was calculated. Statistical data analysis was done using SPSS 16.0 version. Mean and median values were calculated corresponding to the data. Results were analysed using Pearson’s and Spearman’s correlation coefficient. Independent t-test and Mann-Whitney’s tests were used for calculation of significance of correlation. <b>Results:</b> Among the studied individuals 53% (106) were males and 47% (94) were females. A total of 77%(154) of the individuals with low HDL and 70%(140) individuals with normal HDL had abnormal waist circumference. Mean Waist Hip Ratio (WHR) was same across groups with low and normal HDL. Mean Body Mass Index (BMI) was similar in both the groups among males; however, a statistically significant difference was found among females. Abnormal waist circumference was found similar across both the groups. Median hs-CRP showed a statistically significant higher values among individuals with lower HDL. Fasting insulin and HOMA-IR was higher among individuals with low HDL (vs normal HDL), but it was statistically insignificant. Median TG/HDL ratio among 41 individuals were found to be 3.08, which was higher than the cut-off to signify insulin resistance. HOMA-IR and TG/HDL ratio showed a statistically significant positive correlation suggesting that TG/HDL ratio can be used as a marker of insulin resistance. <b>Conclusion:</b> This study revealed that anthropometric indices showed an inverse correlation with HDL levels, with BMI being a better predictor of HDL-C changes. HDL was lower in individuals with insulin resistance, with TG/HDL ratio being a significant marker of insulin resistance. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=OC04-OC07&id=12506 https://doi.org/10.7860/JCDR/2019/36795.12506 Atherogenic Index of Plasma: A Marker for Undetectable Dyslipidaemia among Lichen Planus Patients Noha Mohammed Dawoud, Ola Ahmed Bakry, Mohammed Abd El Moneim Shoeib, Nora Abd El Satar Dawood <b>Introduction:</b> Lichen Planus (LP) is a chronic inflammatory cutaneous disease. Some studies investigated its association with Dyslipidaemia as a main contributing factor for cardiovascular insults. Atherogenic Index of Plasma (AIP) is a strong factor for suspecting that risk. <b>Aim:</b> To investigate lipid profile and calculate AIP in LP patients to early detect atherogenic Dyslipidaemia, if present. <b>Materials and Methods:</b> This case-control study investigated 40 LP patients and 20 age, gender and body mass index (BMI) matched healthy volunteers. Lipid profile of all subjects was evaluated. AIP was estimated as Log {Triglycerides (TGs)/ High Density Lipoprotein-Cholesterol (HDL-C)} and accordingly, patients were categorised into high, medium and low cardiovascular risk patients. <b>Results:</b> Dyslipidaemia was detected in 47.5% of patients, while all control subjects had normal lipid profile (p<0.001). High Total Cholesterol (TC) and Low Density Lipoprotein-Cholesterol (LDL-C) mean values were significantly associated with LP patients as compared to controls (p<0.001 for both), while no significant differences regarding HDL-C and TG levels have been detected. AIP was significantly elevated in LP patients compared to controls (p=0.002). Most of the patients (72.5%) have high cardiovascular risk versus 30% of controls (p=0.004). About one-third of the high cardiovascular risk patients (31.9%) had no dyslipidemia. High risk patients tend to be of older age with no significant differences regarding gender or disease duration. <b>Conclusion:</b> AIP is a good predictor of cardiovascular risk in LP patients even in presence of normal lipid profile and should be evaluated in every case to permit earlier management. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=WC01-WC04&id=12496 https://doi.org/10.7860/JCDR/2019/39639.12496 CD8+ T Lymphocyte Infiltration: A Favourable Prognostic Indicator in Indian Patients with Breast Carcinoma Deep Kumar Raman, Naresh Gupta, Shantanu Khanna, Rajneesh Joshi, Reena Bharadwaj <b>Introduction:</b> Breast cancer is the most commonly diagnosed cancer in women worldwide with over 2.1 million new cases per year. While hereditary and genetic factors as well as many conventional prognostic markers are well established in clinical practice, the role of host immunity in the determining the prognosis is still not clearly understood. <b>Aim:</b> To evaluate the association of Tumour-Infiltrating Lymphocytes (TILs) with known prognostic markers and disease outcome parameters in a cohort of breast carcinoma patients from India. <b>Materials and Methods:</b> Formalin Fixed Paraffin Embedded (FFPE) sections from patients of breast carcinoma who underwent definitive surgery were stained with anti-CD8 antibody by Immunohistochemistry (IHC) and mean number of Intratumoural (iTILs), Stromal (sTILs) and Total (tTILs) TILs ascertained. These were compared with known prognostic markers and survival data using median and inter-quartile range. Wilcoxon-Mann-Whitney test was used. <b>Results:</b> 75 of the 184 cases of breast carcinoma that met the inclusion criteria were included in the study. A statistically significant association was seen with iTIL (p=0.041) and tTIL (p=0.037) for patients with relapse. No association, however, was seen with hormonal receptor status, Her2 neu positivity, the Intrinsic molecular subtypes or other known prognostic markers like the grade, tumour size, nodal metastasis and TNM stage. <b>Conclusion:</b> The present study shows that higher levels of iTIL and tTIL but not sTIL are associated with a lower rate of recurrence and have a better prognosis. TILs appear to be independent markers as none of the known prognostic markers like tumour size, lymph node status are associated with TILs in present cohort. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=EC12-EC17&id=12497 https://doi.org/10.7860/JCDR/2019/39685.12497 Evaluation of Validity and Reliability of Persian Version of the Gender-Equitable Men-Scale (GEM-Scale) in Male Students, Iran Khadijeh Mirzaii Najmabadi, Fatemeh Zahra Karimi, Robab Latifnejad Roudsari, Mahbubeh Abdollahi, Gholamhosein Zarifnejad <b>Introduction:</b> Gender inequality and gender-based discrimination and violence undermine the opportunities and facilities of women and have negative effect on sexual and reproductive health behaviours. Given the importance of men’s role in establishing gender equality, awareness of men’s attitude towards gender equality is very important. However, there are no valid tools for measuring the attitude of men towards gender equality in Persian. <b>Aim:</b> This study was conducted with the aim of investigating the validity and reliability of Persian version of GEM scale in Male Students of Nursing and Midwifery school, Mashhad University of Medical Sciences in 2015. <b>Materials and Methods:</b> This study was a methodological and validation study. A total of 232 male students of Nursing and Midwifery School of Mashhad University of Medical Sciences were selected through census method. The data collection tool was Persian version of GEM-scale. Factor analysis was used to examine the factor structure of the tool and Cronbach’s alpha coefficient was used to investigate the reliability of the tool. The analyses were conducted using LISREL software version 8.8 and SPSS version 20. <b>Results:</b> The fitting indices of the confirmatory factor analysis model showed that the fitting of the two-factor model was appropriate (CFI, GFI, AGFI near 1, RMSEA index less than 0.1, and c2/df ratio less than 3). Cronbach’s alpha coefficient for the whole tool was obtained 0.79, showing that the internal reliability of the tool is also acceptable. <b>Conclusion:</b> The present study confirmed two-factor structure of the Persian version of GEM-scale, which includes inequitable gender norms subscale and equitable gender norms subscale. Therefore, this tool is suitable for assessing the attitude of men towards gender equality in Farsi-speaking men’s society. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=LC21-LC24&id=12523 https://doi.org/10.7860/JCDR/2019/34280.12523 Study of Latency Interval of Moro Reflex in Full-term Newborns with Hypoxic Ischaemic Encephalopathy Kamal Kishore Sagaria, Sunil Kumar Rao <b>Introduction: </b>Neurological morbidities are the earliest presentation of hypoxic insult in newborns. Parents seek medical advice when they notice abnormal posture or abnormal movements or persistent cry or delayed milestones. By that time pathophysiology would have set in and would have led to irreversible changes in brain which subsequently manifests in developing period of brain or later. Early recognition of asphyxiated newborns and their timely referral has better neurological outcome. <b>Aim: </b>To describe Moro’s response in newborns with Hypoxic Ischaemic Encephalopathy (HIE) by using Ordinal scale. <b>Materials and Methods:</b> This was a prospective cross-sectional study conducted in a tertiary care hospital. Inclusion criteria were full term newborns with HIE. Recruited newborns were classified in different grades of HIE after initial stabilisation, two investigators were present in examination room, one investigator examined the Moro’s response while the baby was alert, active and moving the limbs by using head drop method. Whole event was recorded by second investigator and third investigator was calculating the latency interval of Moro’s response by using stopwatch with accuracy of 1/100 of a second from video recording separately. Moro’s response was assessed by ordinal scale. <b>Results:</b> Final analysis was done on 104 newborns, out of which 18 had absent reflex, 17 had long latency interval, 19 had normal latency interval and 50 newborns had short latency interval. Long latency of Moro response had sensitivity of 45.95%, with 50.8% of accuracy to screen deviant Moro’s response in HIE. <b>Conclusion:</b> Long latency interval of Moro response could be a valuable clinical sign to screen for neurological impairment in HIE. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=SC07-SC09&id=12524 https://doi.org/10.7860/JCDR/2019/38072.12524 Assessment of Urinary Liver-Type Fatty Acid Binding Protein (LFABP) Levels in Type 2 Diabetes Mellitus Patients with Nephropathy Pawan Kumar Kare, Mohit Garg <b>Introduction:</b> Diabetic Nephropathy (DN) is a micro-vascular complication of Type 2 Diabetes Mellitus (T2DM). It is known that renal tubular damage plays an important role in DN. Liver-Type Fatty Acid Binding Protein (LFABP) is found in liver and proximal tubular cells of kidney and its levels are associated with the structural and functional changes of tubular cells of kidney. <b>Aim:</b> The present study was carried out to estimate the levels of urinary LFABP and its potential role as a clinical biomarker for early diagnosis of nephropathy in T2DM patients with nephropathy. <b>Materials and Methods:</b> A hospital based cross-sectional study was conducted on 84 subjects divided into 3 groups. Group 1: (n=28) healthy controls, Group 2: (n=28) T2DM patients without nephropathy and Group 3: (n=28) T2DM patients with nephropathy. Serum and urine creatinine were carried out by alkaline picrate Jaffe&#8217;s kinetic method. Urine albumin was estimated by turbidometric method by using nephelometer. Urinary LFABP levels were measured by commercial available ELISA kit. <b>Results:</b> In the present study, a statistically significant difference was found in urinary Albumin Creatinine Ratio (ACR) between the study groups I and III, II and III (p=<0.001). Also, a statistically significant difference was found between the levels of urinary LFABP in groups I and II, I and III (p=0.004 and p=<0.001 respectively). Significantly increased level of urinary LFABP was found in group III as compared to group II. There was a positive correlation observed between urinary LFABP levels with urinary ACR, which indicated that LFABP can predict kidney damage even before micro-albuminuria can be detected. Also a negative correlation was observed between urinary LFABP and estimated Glomerular Filtration Rate (eGFR). <b>Conclusion:</b> The study suggests that the estimation of urinary LFABP could be used as a potential adjunct biomarker along with urinary ACR for early detection of DN and monitoring of progression of DN in clinical practice. This will enable the Institution for preventive strategies that could delay the onset of symptoms of full-blown DM and End Stage Renal Disease (ESRD). https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=BC21-BC24&id=12525 https://doi.org/10.7860/JCDR/2019/38098.12525 Comparison of Single Dose Sertaconazole versus Three Dose Clotrimazole Regime in Treatment of Uncomplicated Vulvovaginal Candidiasis- A Prospective Study Katha Desai, Pradip Sambarey <b>Introduction:</b> Vulvovaginal candidiasis is the second most common vaginitis following bacterial vaginitis amongst the reproductive age group with variable compliance to the treatment. <b>Aim:</b> To compare the efficacy of single dose sertaconazole versus multidose clotrimazole pessaries in patients with vulvovaginal candidiasis in reproductive age group. <b>Materials and Methods:</b> A prospective study was conducted at a tertiary care hospital between October 2014 and September 2016 on 100 patients of reproductive age group with vulvovaginal candidiasis. Group A (n=50) were treated with single dose sertaconazole and group B (n=50) were treated with 3-dose regime clotrimazole. Pregnant females with history of antifungal treatment within past four weeks, past history of hypersensitivity to imidazole agents were excluded from the study. <b>Results:</b> The mean age of patients was 28.7&#177;5.3 years. The average duration between the appearance of symptoms and consultation was 14.8&#177;7.6 days. The prevalence of candidiasis was most amongst the housewife&#8217;s accounting for 64.3%. There was no statistically significant difference between both the groups in terms of socio-economic status and literacy rate. There was no statistically significant difference in the response to treatment between both the drugs. At the end of six weeks, 14% of the patients in group A and 18% of patients in group B had recurrence. <b>Conclusion:</b> It can be a wise option to prefer sertaconazole with respect to its single dosage regime, convenience and better acceptability in uncomplicated cases of vulvovaginal candidiasis. However, no statistical significance has been observed between both the regimes. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=QC12-QC14&id=12526 https://doi.org/10.7860/JCDR/2019/39759.12526 Antimicrobial Efficacy of Garlic-Lemon in Comparison with Sodium Hypochlorite against <i>E. faecalis</i> Riluwan Siddique, K Anjaneyulu, NP Muralidharan <b>Introduction:</b> Sodium hypochlorite is the most commonly used root canal irrigant in endodontics. Although, it is a highly effective antimicrobial agent, it is highly cytotoxic. This study has focused on search of alternative herbal irrigants which is more biocompatible. <b>Aim:</b> To evaluate antimicrobial efficacy of ethanolic garlic-lemon and fresh garlic-lemon mixture in comparison with 2.5% sodium hypochlorite against E. faecalis at different intervals (first, third and sixth day). <b>Materials and Methods:</b> Extracts were divided into three groups: Group 1-ethanolic garlic-lemon extract, Group 2-fresh garlic-lemon and Group 3-2.5% sodium hypochlorite. The antimicrobial activity was determined using agar diffusion test. Zone of inhibition of bacterial growth was recorded for one, three and six days. Statistical analysis was performed using one-way Anova and post-hoc Bonferroni test. <b>Results:</b> On first day, sodium hypochlorite showed maximum inhibitory effect compared to ethanol and fresh garlic-lemon extract. On third day, ethanolic extract of garlic-lemon showed significant maximum inhibitory effect followed by sodium hypochlorite and fresh garlic-lemon extract. On sixth day, ethanolic extract of garlic-lemon showed significant inhibitory effect followed by fresh garlic-lemon extract and sodium hypochlorite. <b>Conclusion:</b> In this study, herbal extract has showed increased antimicrobial efficacy when compared to sodium hypochlorite. Ethanolic extract has showed maximum inhibitory effect compared to fresh garlic-lemon and sodium hypochlorite. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=ZC55-ZC58&id=12527 https://doi.org/10.7860/JCDR/2019/37745.12527 A Comparative Evaluation of the Body Fat Percentage using Bioelectrical Impedance Analyser, Skin-fold Thickness Measurement and BMI B Lalitha Devi, N S Muthiah, K Satya Narayana Murty, CH Ganapathi Swamy <b>Introduction:</b> As there is a global increase in the number of people with obesity world-wide, there is an increasing need for estimation of body composition especially, the calculation of Body Fat (BF) percentage for treatment and prevention of obesity. Hence, the present study deals with the estimation of BF percentage using three methods. <b>Aim:</b> To compare the percentage of BF obtained by bioelectrical impedance method with percentage BF obtained by two other methods, {Skin-fold Thickness Measurements (STM) and Body Mass Index (BMI)}, in healthy subjects. <b>Materials and Methods:</b> A cross-sectional, observational study was conducted on 50 healthy male subjects of the age group 25-55 years in a tertiary care hospital in Rajamahendravaram, Andhra Pradesh, India. BF percent measured using Karada scan HBF-701, compared with percentage BF as calculated by Siri equation (from the sum of skin fold thickness measured at four places-Triceps, Biceps, Suprailiac and Subscapular areas) and percentage BF calculated from BMI. Statistical analysis was done using SPSS software version 20 and MS-Excel-2007 by Pearson Correlation Coefficient test and ANOVA. <b>Results:</b> Mean value of percent BF assessed by bioelectrical impedance was 18.27&#177;3.32, mean BF percentage from Siri equation was 23.33&#177;2.75 and mean BF from BMI was 19.55&#177;3.22 the results showed significant difference in percent BF by different methods. Bioelectrical Impedance Analysis (BIA) underestimated BF when compared to other two methods. There was a statistically significant positive co-relation between Karada scan and BMI (r is 0.336, p is 0.017). <b>Conclusion:</b> According to the results of the study, we can conclude that bioelectrical impedance analyser underestimated BF percentage when compared to other two methods (skinfold thickness measurements and BMI) though there was a positive correlation between BF measurements by BIA and other two methods. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=IC01-IC04&id=12535 https://doi.org/10.7860/JCDR/2019/39781.12535 Emergency Paediatric Airway Imaging: Should MDCT Precede Bronchoscopy in Suspicious Cases of Foreign Body Aspiration? Manali Arora, Vishal Thakker, Nisarg Thakkar, Manasa Pitta, Prashant Modi, Sonali Arora <b>Introduction:</b> Acute onset paediatric respiratory distress with suspicion of Foreign Body (FB) aspiration often demands a quick diagnostic and therapeutic approach. While, Rigid Bronchoscopy (RB) is the Gold Standard diagnostic and therapeutic management, Multi Detector Computed Tomography (MDCT) also has a superb diagnostic capability. However, in this emergent condition, which modality is the quickest, most comprehensive and hassle free in confirming diagnosis, needs to be ascertained. <b>Aim:</b> To evaluate the efficacy of MDCT in diagnosing airway obstruction in paediatric patients with acute onset respiratory distress and suspicion of FB aspiration; thereby directing the need for invasive manoeuvres. <b>>Materials and Methods:</b> A retrospective observational study was done in the Department of Radio-Diagnosis of Pramukhswami Medical College, Anand, Gujarat, India. MDCT Thorax findings of 19 consecutive paediatric patients; who presented with acute onset respiratory distress and suspicion of FB aspiration from June 2016 to May 2018 were analysed. Both source and reconstructed images were analysed and MDCT data was compared with RB findings. <b>Results:</b> In detecting removable airway obstruction and advising for bronchoscopy, MDCT showed a sensitivity of 92.31%, specificity 100% and an overall accuracy of 94.74%.While analysing the type of airway obstruction, with two false negatives, MDCT showed a sensitivity of 81.82% and specificity of 100% and an accuracy of 89.47%. MDCT was successful in preventing unnecessary bronchoscopy six out of seven times with an accuracy of 85.7%. <b>Conclusion:</b> Clinical suspicion of FB aspiration in paediatric acute onset respiratory distress cases may not always be correct and an alternate diagnosis is often to be considered. Therefore, an efficient and comprehensive radiological insight is necessary before going for an invasive bronchoscopy which is aptly provided by MDCT. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=TC21-TC25&id=12542 https://doi.org/10.7860/JCDR/2019/39926.12542 Is Laparoscopic Transabdominal Preperitoneal Hernia Repair more Invasive than Anterior Open Mesh Repair? Takaaki Tsushimi, Kazuhito Oka, Koichi Ueki, Yoshihide Minami <b>Introduction:</b> Tension-free open mesh repair is a popular surgical choice for an inguinal hernia. Laparoscopic Hernia Repair (LAHR) is gradually increasing, however, LAHR is considered more invasive than open mesh repair because the surgical time is longer and has a higher rate of postoperative complications. <b>Aim:</b> To compare the invasiveness of laparoscopic Transabdominal Preperitoneal Hernia Repair (TAPP) with open mesh repair by evaluating surgical time, postoperative stay duration, postoperative complications, and inflammatory marker levels in patients with inguinal hernia.b <b>Materials and Methods:</b> This was a prospective comparative clinical study of 104 patients with inguinal hernia who were divided into two groups based on treatment type: TAPP and open mesh repair. Patient characteristics, surgery-related and postoperative factors, postoperative stay duration, and postoperative complications were analysed and compared between the two groups. Continuous data were presented as mean&#177;standard deviation and were compared using Student&#8217;s t-test (two-tailed). Categorical data were compared using Fisher&#8217;s-exact test. <b>Results:</b> In total, 51 patients underwent TAPP and 53 open mesh repair. Surgical time and postoperative stay duration were not significantly different between the two groups. Similarly, White Blood Cells (WBC) (postoperative days 1 and 3) and C-Reactive Protein (CRP) (day 3) levels were not significantly different between the two groups; however, day 1 CRP levels were significantly lower in the TAPP group than in the open mesh repair group (1.12&#177;0.81 mg/dL and 2.22&#177;1.88 mg/dL, respectively; p<0.01). Postoperative surgical complication rates were not significantly different between the two groups. <b>Conclusion:</b> Both TAPP and open mesh repair are safe and feasible procedures. TAPP is comparable to open mesh repair in terms of surgical stress and is less invasive. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=PC10-PC13&id=12508 https://doi.org/10.7860/JCDR/2019/37846.12508 First Permanent Molar Caries and its Association with Carious Lesions in Other Permanent Teeth Muhammad Ashraf Nazir, Eman Bakhurji, Balgis Osman Gaffar, Asim Al-Ansari, Khalifa Sulaiman Al-Khalifa <b>Introduction:</b> Dental caries is most prevalent in first permanent molars and it is bilaterally distributed in permanent maxillary and mandibular molars. It is assumed that dental caries in first permanent molar is related to caries in other permanent teeth possibly due to its infectious and transmissible nature. However, there is limited data about a relationship between caries in first permanent molar and other permanent teeth. <b>Aim:</b> To assess the association between dental caries in first permanent molar and other permanent teeth in school children. <b>Materials and Methods:</b> This cross-sectional study was conducted on male intermediate school children (12-15 years) in Dammam, Saudi Arabia in 2016. A sample of 1250 children was randomly selected. Data collection involved clinical examination of caries using the World Health Organisation (WHO) criteria and a pilot-tested questionnaire. Training and calibration of examiners were conducted (Kappa=0.6). Statistical analyses involved descriptive statistics, univariate and multivariate logistic and linear regressions using SPSS software. <b>Results:</b> Of 1250 children invited, 1109 participated with a response rate of 88.7%. The first permanent molars had the highest percentage of dental caries among all permanent teeth (50.4%) with a mean of 1.08 carious molars. This was followed by second permanent molars (prevalence=14.7%, mean number of decayed molars=0.25). The canines had the lowest prevalence of dental caries (1.8%) and the mean number of carious canines was 0.02. Logistic regression showed that caries in first permanent molars were significantly associated with higher odds of caries in incisors (OR=4.87), second molars (OR=4.26) and premolars (OR=3.57). It was found that a unit increase in the number of carious first molars was associated with a significant increase in the number of carious incisors, premolars and second molars. <b>Conclusion:</b> The study found associations between caries in first permanent molar with caries in other permanent teeth. School-based oral health promotion programs should start early to target young school children when first permanent molars start to erupt. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=ZC36-ZC39&id=12509 https://doi.org/10.7860/JCDR/2019/38167.12509 Functional Outcome after Successful Revascularisation and Replantation Surgery of the Fingers, Wrist, Forearm and Arm Shalimar Abdullah, Azammuddin Alias, Nor Hazla Mohamed-Haflah, Roohi Ahmad, Parminder Singh Gill, Nur Azuatul Akmal Kamaludin, Jamari Sapuan <b>Introduction:</b> Traumatic amputation (complete or partial) of a limb carries significant morbidity and disability. The primary aim of revascularisation and replant surgery is to restore functional outcome and not just to have a viable segment. Revascularisation and replant surgery has a higher success now with recent advances in microsurgery. <b>Aim:</b> To evaluate the long-term functional outcome of successful revascularisation and replantation surgery at the level of the fingers, wrists, forearms and arms. <b>Materials and Methods:</b> This was a retrospective study on 27 patients with partial or total amputation of the upper limb {digit(s), wrist, forearm and arm} who underwent revascularisation (n=18) or replantation (n=10) surgery. One patient had both revascularisation and replant surgery done. Partial amputation cases underwent revascularisation surgery and total amputation cases underwent replantation surgery. Objective variables noted were power grip, pinch grip, two-point discrimination, total active motion, Disability Assessment of Shoulder and Hand (DASH) scores, delay until operation and cold intolerance. Statistical analysis utilised was the Pearson linear correlation and the student t-test. <b>Results:</b> All 27 patients were males between 17-46-year-old (mean age of 27 years). The mean length of stay following revascularisation and replantation surgery was 11 days (range 4-20 days). The mean period of absence from work was 9.6 months (range 3-24 months). The mean time to surgical operation from the moment of trauma was eight hours and 30 minutes (range 4-12 hours). The mean result for two Point Discrimination (2PD) test was 8.03 mm (range 4-20 mm). Poorest function (highest DASH) was seen at transmetacarpal level of injury. Worst cold intolerance was seen at the wrist level of injury. Grip strength of the affected hand was 37.4% of the unaffected hand. Pinch grip of the affected hand was 74.4% of the unaffected hand. There was a positive correlation between the DASH score and delay to operation time (r=0.193) signifying poorer outcome (higher DASH score) with a delay to operation time. There was a negative correlation between DASH score and power of hand grip (r=-0.644, p<0.001) signifying a lower DASH score (i.e., better function) correlates to a stronger hand grip. On comparing DASH scores with cold intolerance, there was no significant difference. <b>Conclusion:</b> A longer duration from trauma to surgery significantly resulted in poorer functional outcome. Stronger grip strength significantly resulted in better functional outcome. Cold intolerance did not significantly affect functional outcome. Replantation or revascularisation surgery to attach a partial or total amputation remains a worthwhile endeavour as it shows a considerably good outcome. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=RC01-RC04&id=12510 https://doi.org/10.7860/JCDR/2019/38426.12510 Radiation Dose Reduction and Cancer Risk Estimation Associated with Upper Limbs Radiographic Examination by using Optimal Projections: A Phantom Study Mohamed M Abuzaid, Wiam Elshami, Zarmeena Noorajan <b>Introduction:</b> Ionising radiation used during medical imaging examinations should be monitored carefully to reduce the radiation harm and biological effects. In radiography, As Low As Reasonably Achievable (ALARA) principles should be applied during patient positioning by placing the patient sensitive organs away from the radiation beam. <b>Aim:</b> To determine the Entrance Skin Dose (ESD), effective dose and Lifetime Attribute Risk (LAR) of cancer in eye and gonad area when positioning the patient facing towards the primary radiation beam and facing away from it. <b>Materials and Methods:</b> An experimental study conducted using an X-ray phantom to simulate patient position during upper limb radiography. Radiation measurement was done by using TLD placed at the level of the eye and gonads and two different imaging orientations were used (standard and modified). The ESD, effective dose was calculated from TLD’s readings. The BEIRVII report was used to estimate the LAR of cancer. <b>Results:</b> Results showed significant ESD, effective dose, and LAR reduction when the patient was sitting beside the table and not facing the radiation beam. Results indicate that there were significant differences in ESD and ED to the eye and gonads between the different patient orientations. In terms of eye dose, there is a dose difference of 12% between the two projections. For gonad gland doses there is a dose difference of 50% with p-value <0.001. <b>Conclusion:</b> This study confirmed the relation between dose reduction and patient orientation and it aligns with the ALARA principle to ably all efforts to minimise unnecessary radiation exposure. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=TC15-TC17&id=12511 https://doi.org/10.7860/JCDR/2019/39686.12511 Comparing the Efficacy of Berberine against Sodium Hypochlorite and Chlorhexidine Cetrimide as a Chairside Disinfectant of Gutta Percha Cones Namith Rai, Shobana Shetty, Ravi Gupta, Ahana Shetty, Ashish Shetty, Benoy Jacob <b>Introduction:</b> The primary objective in Endodontics has been to disinfect the root canal space, by both mechanical and chemical means. Clinicians rarely give a thought to the fact that contamination can happen from all sorts of instruments, materials and the by clinical setup itself. When disinfection of the root canal is been spoken, studied and researched so extensively, gutta percha cones which are the most commonly used root canal filing material for over 100 years, thanks to its malleability and biocompatibility. They may be contaminated right from the manufacturing process, packaging and use. <b>Aim:</b> This study intended to compare the efficacy of berberine as a more biocompatible alternative to sodium hypochlorite and chlorhexidine cetrimide as a chairside disinfectant for gutta percha cones. <b>Materials and Methods:</b> 180 gutta percha cones collected from freshly opened boxes were contaminated with Microbial suspensions of E. Faecalis (ATCC29212) and S. aureus (ATCC 6538) of approximately 108 CFU/mL artificially. Split into three groups with three different disinfecting agents (6% NaOCl, vista dental products, USA, berberine chloride 2 mg/mL, Chlorhexidine 2% and cetrimide 0.2%) further subdivision was done based on exposure time (one minute, three minutes, five minutes) respectively, After disinfection in chemical agents, the cones were washed in 10 mL of detergent solution (3% Tween 80 and 5% sodium thiosulfate) for five minutes. The cones were rinsed in 10 mL of sterile distilled water, transportation to sterile test tubes containing 10 mL of thioglycollate media and incubated at 37°C for seven days, then were transferred from the 10 mL thioglycollate media to a petridish containing brain heart infusion agar, incubating for 48 hours aerobically at 37°C and the colony forming units were graded under light microscope. <b>Results:</b> Statistical analysis was done with Tukeys HSD test. The mean bacterial count of E. Faecalis or S. aureus was found to be significantly lesser after treating the cones with 6% sodium hypochlorite when compared with other disinfecting solutions for all time intervals tested. Berberine was found to be mildly effective against S. aureus but not effective against E. Faecalis even at the five minute stage. <b>Conclusion:</b> Within the limitations of the study, Sodium Hypochlorite is still the disinfectant to beat, further research is needed with berberine along with concentration modifications and duration. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=ZC40-ZC44&id=12512 https://doi.org/10.7860/JCDR/2019/37606.12512 Short-term Effects of Cardiopulmonary Bypass Temperature on Intracardiac Repair for Tetralogy of Fallot: A Retrospective Single Centre Observational Study Avishek Samaddar, Shyam Kumar Singh Thingnam, Virendra Kumar Arya, Manoj Kumar Rohit, Harkant Singh, Tousif Khan, Vivek Jaswal <b>Introduction: </b>Tetralogy of Fallot (TOF) is a common cyanotic disease and the concept of ideal Cardiopulmonary Bypass (CPB) temperature is still controversial. <b>Aim: </b>To assess the merits and demerits in terms of short term patient outcome of normothermic CPB over hypothermic CPB during intracardiac repair of TOF amongst paediatric patients. <b>Materials and Methods:</b> Among 71 patients of TOF who underwent Intracardiac Repair (ICR) in the Department of Cardiovascular and Thoracic Surgery from 1st January, 2016 to 30th April, 2017, 60 patients were included in our single centre retrospective observational study. Normally distributed variables were expressed by their mean and standard deviation; non normally distributed variables were expressed by their medians and interquartile ranges; categorical variables were expressed as n (%). Statistical software Stata IC version 14, R version 3.2.1 and MedCal were used. All tests were two-tailed with level of significance as <0.05. <b>Results:</b> Normothermic CPB resulted in reduced post-operative Intensive Care Unit (ICU) and hospital stay, lesser incidence of delayed extubation and post-operative Right Ventricular (RV) dysfunction and lesser transfusion requirements of Fresh Frozen Plasma (FFP). (p<0.05). There was no impact of the CPB temperature on renal function, mean blood sugar levels, coagulation parameter and post-operative drain output, post-operative fever, wound infection, arrhythmia or re-exploration. <b>Conclusion:</b> ICR for TOF under normothermic CPB is feasible and results in better post-operative outcomes in terms of duration of ventilation, ICU and hospital stay and RV functions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=SC01-SC06&id=12513 https://doi.org/10.7860/JCDR/2019/38346.12513 Effect of Yoga on Nonlinear Dynamics of Heart Rate in Prediabetic Subjects Sudhanshu Kacker, Neha Saboo, Jitender Sorout <b>Introduction:</b> Pre-diabetes represents the initial stage of type 2 diabetic disease developments. Prediabetes disease progression to overt type 2 diabetes occurs when pancreatic beta cells cannot produce insulin to overcome insulin resistance, resulting in further hyperglycaemia. Prediabetic patients have higher risk for Cardiovascular Diseases (CVDs) which further increases the rate of mortality. Lifestyle interventions such as yoga can prove to be a beneficial non pharmacologic intervention in preventing progression of prediabetes to type 2 diabetes. <b>Aim:</b> Present study highlights the importance of short term intervention i.e., yoga on Heart Rate Variability (HRV) in prediabetic subjects and its use as a tool for homeostasis of Autonomic Nervous System (ANS) and primary prevention of diabetes. <b>Materials and Methods:</b> This was an interventional study conducted on adults aged 30 to 50 years for analysis of frequency domain parameters i.e., Low Frequency (LF), High Frequency (HF), ratio of low frequency to high frequency of HRV. A total 102 prediabetic subjects were recruited from OPD of Jaipuria Hospital. These were divided into two groups A and B. Group A (n=51) were given intervention of set of yogic exercises and Group B (n=51) did not perform any yoga session. Statistical analysis was done by student&#8217;s paired t test for intragroup comparison before applying this test the Smirnov-Kolmogorov test was conducted to confirm the normality of each parameter. <b>Results:</b> Yoga intervention resulted in a significant decline in LF component and increase in HF component and LF/HF (Low Frequency/High Frequency) ratio shift sympathetic to parasympathetic dominance (p-value<0.001) in study group relative to the control group. <b>Conclusion:</b> Short term yoga intervention is helpful in shifting of ANS towards the parasympathetic dominance which is assessed by frequency domain of HRV in prediabetes subjects. This preliminary study indicates that a yogic exercise change mind, body balance that facilitates autonomic balance for adults at high risk for type 2 diabetes. In addition, yoga holds promise as an approach to reducing cardiometabolic risk factors and increases exercise efficacy in prediabetics performing yoga. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=CC05-CC11&id=12514 https://doi.org/10.7860/JCDR/2019/37571.12514 Comparison of Endometrial Thickness with Concomitant Administration of Sildenafil Citrate and Ethinyl Estradiol vs Ethinyl Estradiol Alone for Frozen Embryo Transfer Mahnaz Yavangi, Saeid Heidari-Soureshjani, Artimis Sadeghian, Tayebe Artimani <b>Introduction:</b> Infertility is one of the common medical issues in today&#8217;s world. One of the common causes of infertility is the lack of implantation of the embryo. <b>Aim:</b> To compare the effect of Ethinyl Estradiol (E2) alone on Endometrial Thickness (ET) with that of sildenafil citrate and E2 combination. <b>Materials and Methods:</b> In this clinical trial, 70 infertile women undergoing treatment with Assisted Reproductive Techniques (ARTs) were randomly divided into two groups of 35 each. One group received E2 and vaginal sildenafil and the other E2 alone. On the seventh day of the cycle and, if necessary, until ET reached 8 mm, ET in both groups was measured by transvaginal ultrasound. After the embryo transfer, Beta-Human Chorionic Gonadotropin (BHCG) was performed in both groups. The measured thickness of uterus and BHCG were recorded in the checklist for both groups. Data were analysed by SPSS and p<0.05 was considered significant. <b>Results:</b> The mean duration (in days) to reach an 8 mm ET in infertile women in the E2+sildenafil group (13.59&#177;3.07) was lower than that in the E2 group (14.88&#177;4.78), yet insignificant (p=0.21). Although the mean dose (mg) of E2 and duration (day) to reach an 8 mm ET in the E2+sildenafil group was lower than those in the E2 group, significance (p) levels were 0.02 and 0.21, respectively. <b>Conclusion:</b> In infertile women undergoing ARTs, co-administration of sildenafil citrate and E2 increased ET relatively and reduced the dose of E2 and the duration of its administration. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=QC05-QC08&id=12515 https://doi.org/10.7860/JCDR/2019/39619.12515 The Comparison of Violence and Sexual Function between Fertile and Infertile Women: A Study from Iran Neda Poornowrooz, Safieh Jamali, Marzieh Haghbeen, Shohreh Javadpour, Nader Sharifi, Zahra Mosallanezhad <b>Introduction:</b> Fertility is one of the most important variables. Infertility and others&#8217; attitudes towards this factor make infertile couples vulnerable to mental and emotional disturbances, which ultimately lead to sexual dysfunction and domestic violence. <b>Aim:</b> To investigate violence and sexual function among fertile and infertile women. <b>Materials and Methods:</b> This was a cross-sectional study on 346 individuals (147 infertile women and 199 fertile women) visiting women&#8217;s clinic in Jahrom, Iran from April to October 2017. The research tools were Domestic Violence Inventory and Female Sexual Function Index (FSFI). t-test was used to compare means between the groups and chi-square was used to investigate the relationship of domestic violence with other variables. <b>Results:</b> Comparison of dimensions of domestic violence between fertile and infertile women showed that physical violence (p=0.01), sexual violence (p=0.02) and psychological violence (p<0.001) were higher in infertile women than fertile women and this increase was statistically significant. Comparison of sexual function dimensions between the two groups showed that all dimensions were significantly lower in infertile women than fertile women (p<0.05). No significant relationship was found between domestic violence and sexual function in infertile women. <b>Conclusion:</b> The results showed that dimensions of violence were higher in infertile women than fertile women and sexual function was lower in infertile women than fertile women. Therefore, health managers and politicians should pay specific attention to infertile women and include psychological and sexual counselling alongside infertility treatments. On the other hand, screen for domestic violence should be practised in infertile women as high-risk group. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=QC09-QC11&id=12516 https://doi.org/10.7860/JCDR/2019/37993.12516 Normal Sonographic Optic Nerve Sheath Diameter among Children in South Western Nigeria Ayodeji Anike Olatunji, Olubunmi O Bodunde <b>Introduction:</b> Optic Nerve Sheath Diameter (ONSD) correlates with intracranial pressure and can be utilised for monitoring in emergency situations. <b>Aim:</b> To determine the reference values of optic nerve sheath diameter in healthy school going children in South western Nigeria by using B-mode sonography. <b>Materials and Methods:</b> A cross-sectional study was conducted in children from three selected schools after consent and approval from the parents and Institutional Health Research Ethics committee, respectively. B-mode sonography using a 4-12 MHz probe was carried out on children with normal visual acuity and fundoscopy. Demographics of the children and the optic nerve sheath diameter were recorded in a proforma. Data was analysed with SPSS version 21 and were represented as mean and standard deviation. Paired t-test was used to compare ONSD between the right and left eye. Independent t-test was used to compare ONSD between males and females. Significance was set at p-value <0.05. <b>Results:</b> Optic nerve sheath diameter was measured in both eyes of 468 children. There were 235 (50.2%) boys and 233 (49.8%) girls (M:F Ratio=1.01: 1) and age range was 2 to 16 years. Mean ONSD in the right eyes was 0.56&#177;0.08 cm while in the left eye it was 0.58&#177;0.09 cm for boys, while in girls in the right eyes it was 0.55&#177;0.08 cm and in left eye it was 0.57&#177;0.07 cm. The mean ONSD of the left eyes was longer than the right eyes. (p=<0.001). There was no significant difference in ONSD measurement between males and females (p=0.275). <b>Conclusion:</b> Mean ONSD in children was longer in the left eye than the right, and increases with age. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=TC18-TC20&id=12518 https://doi.org/10.7860/JCDR/2019/38451.12518 Determination of Craniofacial Morphometry of Saudi Adults by Steiner’s Analysis Ibadullah Kundi, Harshal Kumar, Mohammad Khursheed Alam <b>Introduction:</b> Evaluation of craniofacial morphology plays a vital role both in clinical practice and research purpose in dentistry and lateral cephalometric radiograph is the most commonly used and appropriate implement for the evaluation of craniofacial morphology. <b>Aim:</b> The aim of the study was to investigate the craniofacial morphometry of Saudi adults using Steiner’s angular and linear measurements and also to compare their mean values with the established values of Caucasian adults. <b>Materials and Methods:</b> Eighty digital lateral cephalometric radiographs of Saudi adults including 43 males and 37 females with an average age of 22 years were studied. Patients with no craniofacial/skeletal abnormalities and no previous Orthodontic treatment were included in the study. Seventeen cephalometric landmarks were determined, 11 angular and 4 linear measurements of Steiner’s analysis were done using Cassos software. Error study was done on 20% of randomly selected cephalometric radiograph after two weeks of interval. Statistical analysis was done by SPSS software version 22. Independent t-test was used to test the level of significance. p<0.05 considered as significant. <b>Results:</b> Acceptable errors were observed using Dahlberg formula. The results of the present study revealed non-significant difference between the genders on almost all measured values. Saudi females showed larger SNA, SNB, ANB, SND, S to E, U6 to NA and L6 to NB (8 out of 15) than Saudi males. Mean values of cephalometric norms of Saudi adults were different than the Steiner’s established craniofacial morphometric norms. <b>Conclusion:</b> The results revealed non-significant linear and angular differences in craniofacial morphometry among Saudi males and females. Measured craniofacial morphometry showed disparities between Caucasian established values. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=ZC45-ZC48&id=12519 https://doi.org/10.7860/JCDR/2019/36483.12519 Comparative Evaluation of Two Antifungal Agents Incorporated in Auto Polymerising Denture Base Resin, Heat Polymerising Denture Base Resin and Permanent Silicone Soft Liner-An In Vitro Study Swapnil Chincholikar, J Sridevi, N Kalavathy, Sudhanshu Singh, Anmol Kapoor, Sonal Saumya <b>Introduction:</b> Denture-induced candidiasis is a common disease in elderly denture wearers with Candida albicans as the principal causative agent. The problem is aggravated for elderly patients with limited motor skills who fail to follow a strict antifungal drug regime. To overcome this and to avoid the formation of biofilm on denture base resins, several attempts to incorporate antifungal agents/antiseptics into denture base resins, denture reliners and tissue conditioners have been reported. No study has been done to incorporate any herbal extract into polymeric systems and shows its elution and to compare it with commercially available antifungal drug. <b>Aim:</b> To evaluate the leaching of fluconazole and herbal neem extract incorporated into auto polymerising acrylic resin, heat polymerising acrylic resin and permanent silicone soft liner over a period of 21 days. And comparatively evaluate the effect of the leached antifungal agents on the growth of Candida albicans in-vitro. <b>Materials and Methods:</b> A total of 60 samples; 20 each of auto polymerising acrylic resin, heat polymerising acrylic resin and permanent silicone soft liner, (10 samples in each group incorporated with 10% w/w herbal neem extract and the other 10 with 10% w/w fluconazole), were fabricated using a stainless steel die of specific dimensions (50&#177;1 mm in diameter and 1.0&#177;0.05 mm thickness), as per the American Dental Association (ADA) specification no. 12. They were subsequently checked for leaching of the antifungal agents over a time period of three weeks at the intervals of 2,14 and 21 days using the High Performance Liquid Chromatography (HPLC) apparatus. The eluates were also checked for their anti-candidal activity by measuring the zones of inhibition of each agent in all the three test groups. <b>Results:</b> Fluconazole exhibited significantly better elution profile and antifungal activity against Candida albicans as compared to herbal neem extract. Amongst the materials tested, permanent silicone soft liner exhibited significantly higher elution and better antifungal activity in terms of colony inhibition of Candida albicans followed by auto polymerising acrylic resin and heat polymerising acrylic resin. <b>Conclusion:</b> 1) Fluconazole was established to be more potent than herbal neem extract against Candida albicans; 2) Permanent silicone soft liner was established to be the most effective polymeric system for sustained release of antifungal agents up to 21 days. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=ZC49-ZC54&id=12520 https://doi.org/10.7860/JCDR/2019/37889.12520 Clinical and Immunological Outcomes after Initiation of Second Line Antiretroviral Therapy in People Living with HIV Basavaprabhu Achappa, Deepak Madi, Mohammad Yousuff, Satish Rao, John Ramapuram <b>Introduction:</b> Resistance to first-line Antiretroviral Therapy (ART) has been a major concern in People Living with HIV (PLHIV), which necessitates a switch to second-line therapy. Data regarding the outcomes of second-line ART, especially in patients receiving Lopinavir/Ritonavir and Atazanavir/Ritonavir based therapy in a resource-limited setting like India is limited. <b>Aim:</b> To determine the clinical and immunological response to second-line ART as measured by change in mean body weight, change in WHO staging and change in CD4 cell count respectively. <b>Materials and Methods:</b> This facility based cross-sectional was done on PLHIV who were initiated on second-line ART following first-line therapy failure between January 2010 and March 2015. The patients were followed up for a minimum duration of one year after initiating on second-line therapy. The data was collected using a semi-structured proforma. Data regarding the CD4 cell count, body weight and WHO clinical staging at second-line ART initiation, at six months and one year after second-line ART was collected. Statistical analysis was done using ANOVA with Bonferroni test and proportions were compared using chi-square test. <b>Results:</b> A total of 110 patients who received second-line ART following first-line therapy failure were analysed. Majority 75 (68.2%) were males. The mean baseline body weight at the start of the second-line therapy was 50.65&#177;7.9 kg which increased to 53.02&#177;7.93 kg and 54.69&#177;8.16 kg at 6 and 12 months of therapy respectively. The number of patients categorised as WHO Stage 3/Stage 4 reduced to 25 and 6 at the end of 6 and 12 months of therapy respectively. The mean baseline CD4 count at the start of the therapy was 210.95&#177;104.53 cells/mm3 which increased to 352.15&#177;149.78 cells/mm3 and 417.01&#177;147.80 cells/mm3 at 6 and 12 months respectively. There were a total of nine deaths in present study. <b>Conclusion:</b> Second-line ART has a satisfactory outcome in terms of clinical and immunological improvement following first-line failure in PLHIV. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=OC08-OC10&id=12521 https://doi.org/10.7860/JCDR/2019/27990.12521 Should the Urologist Demarcate the Surgical Specimen after Radical Prostatectomy Rodrigo B Abdo, Ana P Drummond-Lage, Daniela Savi, Adilson Savi, Albertorto J A Wainstein <b>Introduction:</b> Although the literature about prostate cancer is vast in tracking discussion about diagnosis and treatment of prostate cancer, there are few publications about the best form of surgical specimen processing of radical prostatectomy. After the surgery, the urologist limits his responsibility to forward surgical specimen for analysis. <b>Aim:</b> To evaluate if the urologist manipulation trying to locate and demarcate suspicious areas of a tumour can improve the microscopic examination. <b>Materials and Methods:</b> Twenty surgical specimens of radical prostatectomy performed in patients with localised prostate cancer were macroscopically analysed by a single urologist and suspicious areas for cancer were marked with surgical thread. Later these areas were correlated with the findings in the microscopic study. <b>Results:</b> It was observed that in 75.8% of cases, there was a positive correlation between the pit and the clinical pathology report on the cancer presence, and in 50% of cases, the demarcated areas corresponded to the area of most considerable extent of cancer throughout the prostate. <b>Conclusion:</b> The demarcation of cancer suspected areas by Urologist, in surgical specimens from radical prostatectomy may provide additional information to the pathologist, directing the histopathological analysis of the prostate to the areas with more significant tumour extension compared to the other sections. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=XG01-XG04&id=12440 https://doi.org/10.7860/JCDR/2019/38197.12440 Pathological Gambling Disorder: An Overview Sambhu Prasad, Om Prakash Jiriwal Gambling has a long back history and also referred to as ‘Natural evil’. The most well-established finding in literature is conceptualisation of pathological gambling as a behaviour addiction with high rate of alcohol and substance use disorders. It finds its place in The Diagnostic and statistical Manual of Mental Disorders, Fifth Edition (DSM 5) and classified in various types as per different authors. The gambling decision is influenced by presence of cues, the activity of dopamine receptors and activation of some brain areas. Treatment of Gambling Disorder (GD) is a challenge. The available options include peer support, brief and motivational interventions, Cognitive-Behavioural Therapy (CBT) and Gamblers Anonymous (GA). The present overview on pathological gambling disorder tries to represents it as heterogeneous disorder based on cognition, its style of gambling, its proneness to relapse and recovery. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=VE01-VE05&id=12445 https://doi.org/10.7860/JCDR/2019/37456.12445 Artificial Intelligence: Patient Care and Health Professional’s Education Divya Bhardwaj Healthcare technologies have captured extensive digitised data in the form of electronic medical record. With the availability of this stored digitised data and advance computational power systems at low cost, there exists an opportunity to develop solutions that just do not follow programmed instruction, but also have some of the human traits such as the ability to reason, discover meaning, and learn from experience without being explicitly programmed. This technique where computers mimic human brain is referred to as Artificial Intelligence (AI). As current AI solutions mature and get more trained, they will assist medical experts in performing simple tasks and will free up their work schedule allowing them to focus on solving more complex cases. AI solutions can also improve the quality of education and prepare next generation of health professionals that can use the latest technology tools, and provide the best possible healthcare services to their patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=ZE01-ZE02&id=12453 https://doi.org/10.7860/JCDR/2019/38035.12453 Dexmedetomidine as an Adjuvant to Local Anaesthetic Agents in Peripheral Nerve Blocks: A Review Prannal Bansal Peripheral Nerve Blocks (PNBs) are widely used for postoperative pain management. PNBs can improve postoperative recovery time and decrease the use of opiates after surgery. PNBs with Local Anaesthetics (LAs) alone last only a few hours. Adjuvants are medications that can be added to LAs to prolong the duration of PNBs. Dexmedetomidine (DEX) is one such adjuvant that has been studied extensively in PNBs. The aim of this review was to present an up-to-date literature on the use of DEX in various PNBs. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=January&volume=13&issue=1&page=UE01-UE07&id=12494 https://doi.org/10.7860/JCDR/2019/38311.12494