Journal of clinical and diagnostic research https://www.jcdr.net/back_issues.asp JCDR Perioperative Carbon Dioxide Narcosis during ERCP: Report of Two Cases Aditya N Shukla, Surendra Kumar Endoscopic Retrograde Cholangiopancreatography (ERCP) is a common diagnostic and therapeutic gastrointestinal intervention. It is gaining prominence and use because of low morbidity associated with it compared to surgical procedure. ERCP is usually conducted outside operating suite, with compromised position under deep sedation or General Anaesthesia (GA) without control of airway. We report development of CO2 narcosis in two patients who underwent ERCP under general anaesthesia, for removal of biliary stone and biliary stenting. We also reviewed the available literature on administration of anaesthesia and monitoring for ERCP. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=UD01-UD02&id=13184 https://doi.org/10.7860/JCDR/2019/42358.13184 Reconstruction of Scalp Avulsion in a Resource Restraint Rural Hospital Rudra Rajesh Nair, Shweta Shaji Mathew, Anna Mary Jose, Suhas Jajoo, Samarth Shukla Occupational hazard is a major contributing factor to various deformities that workers who work with machines are subjected to, especially when the machines are rotating and are unprotected. Women workers with long hair not capped or tied appropriately may become a victim of moving or rotating machines, when the hair gets caught in the rotating part of the machine causing avulsion of the scalp. Scalp avulsion may lead to loss of life, disfigurement, require hospitalisation as well as psychological harm to the person. We present a case managed practically in a rural based hospital of a young girl, who had a complete scalp avulsion, and the challenges that were faced in a setting where microvascular surgery was not an option. It was treated with debridement and a simple split skin graft to cover the wound. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=PD01-PD02&id=13185 https://doi.org/10.7860/JCDR/2019/41767.13185 A Rare Case of Extensive Brain Calcinosis and Features of Parkinsonism Secondary to Iatrogenic Hypoparathyroidism Kalaimani Sivamani, R Prasanna Venkatesh, A Tumbanatham, Siva Ranganathan Green Extensive intracranial calcification is rare in iatrogenic hypoparathyroidism and Parkinsonism at the time of diagnosis is uncommon. We report a case of a 55-year-old woman who presented to us 20 years after thyroid surgery with symptoms of hypocalcaemia and clinical features of Parkinsonism. On detailed evaluation, patient was found to have extensive calcification involving the basal ganglia, periventricular white matter and cerebellum and serum parathormone was low. With calcium and calcitriol supplementation there was symptomatic improvement however features of parkinsonism persisted. We present this case to highlight the unusual presentation of Parkinsonism in a patient with post-thyroidectomy hypoparathyroidism with brain calcinosis. This case also underscores the importance of regular follow-up of patients after thyroid surgery to detect hypoparathyroidism, the treatment of which could prevent future morbidity to the patient. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=OD01-OD03&id=13187 https://doi.org/10.7860/JCDR/2019/42491.13187 Early Onset Radiation Induced Sarcoma Following Treatment for Glioblastoma: A Case Report and Review of the Literature Zachariah Chowdhury, Yookarin Khonglah, Jaya Mishra, Binoy Singh Radiation induced sarcoma after irradiation of brain tumour is a rare complication of radiotherapy, with an incidence of 0.03 to 0.3%. It is associated with poor prognosis and frequently occurs five years after completion of treatment. Herein we report a case of a 35-year-old female who had been diagnosed with glioblastoma of the left frontal region. After surgical resection of the tumor, she was treated with external beam radiotherapy. Subsequently she developed a scalp swelling of the left temporal region within two years of completing treatment. Histopathologic examination of the swelling aided by immunohistochemistry in collaboration with the history and the latency period suggested the diagnosis of radiation induced sarcoma. We report this case for its rarity and to highlight the short latency period (within two years) of development of a secondary neoplasm after postoperative radiotherapy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=ED01-ED03&id=13188 https://doi.org/10.7860/JCDR/2019/41869.13188 Cystadenofibroma of Ovary- A Rare Cause of Postmenopausal Bleeding Tanuja Muthyala, Sujata Siwatch, Shalini Gainder, Minakshi Rohilla, Vanita Jain, Parikshaa Gupta Postmenopausal bleeding may be a presenting complaint for genital tract malignancy. Benign uterine causes predominate while endometrial cancer contributes 10% of symptomatic cases. Extra-uterine causes are rare and include carcinoma cervix or hormone secreting tumours of the ovary. We report a case of 50-year-old postmenopausal lady that presented with postmenopausal bleeding. On evaluation, she was found to have a complex adnexal mass, normal ovarian tumour markers and endometrial histology was normal on biopsy. She underwent exploratory laparotomy and total abdominal hysterectomy with bilateral salpingo-oophorectomy. The postoperative diagnosis was cystadenofibroma of ovary. We reported this case because of its rare incidence and varied symptomatology and presentation on imaging. One should consider diagnosis of a cystadenofibroma of ovary when a postmenopausal lady presents with a triad of an adnexal mass, postmenopausal bleeding with normal endometrial evaluation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=QD01-QD02&id=13191 https://doi.org/10.7860/JCDR/2019/42399.13191 Challenges in Management of Misplaced Intrauterine Devices: A Case Series and Review of Literature Alpana Singh, Divya Chauhan, Ayalur Gopalakrishnan Radhika Intrauterine Devices (IUD) have many advantages over other methods of contraception. At the same time, some complications may also occur. Missing string of IUD is a common problem and an IUD in uterus is easily removed by hysteroscopy. However, embedment of IUD in myometrium may pose challenges. Perforation of uterus by IUD is another serious complication. Hereby three such enlightening cases are presented. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=QD03-QD05&id=13197 https://doi.org/10.7860/JCDR/2019/42163.13197 Cystic Lymphangioma of the Pancreas- Report of a Rare Case Aniket Halder, Ranajoy Ghosh, Sukanta Ray Lymphangiomas are benign tumours of the lymphatic vessels usually occurring in the head-neck region and axillary region, frequently affecting children and young adults. Most of the lymphangiomas are congenital. Lymphangiomas affecting abdominal organs are uncommon, of which pancreatic involvement is one of the rarest and seen in <1% cases. The cystic lesions commonly affecting the pancreas are pseudocysts, simple cysts, serous cystadenomas, Mucinous Cystic Neoplasms (MCNs), Intraductal Papillary Mucinous Neoplasms (IPMNs) and cystic pancreatic carcinomas. There are less than a hundred cases described in literature till date, with less than 10 cases reported from India. Here, the present authors report a rare case of cystic lymphangioma of the pancreas in an adult and describe its morphological characteristics and diagnostic modalities which help in differentiating it from other cystic lesions of the pancreas. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=ED04-ED06&id=13204 https://doi.org/10.7860/JCDR/2019/42290.13204 Carcinosarcoma of Uterus with Left Adnexal Metastasis: A Rare Case Report Ruchi Agarwal, Kulwant Singh, Monika Gathwal, Yudhvir Singh, Swarn Kaur Carcinosarcomas are rare and aggressive tumour consisting of both carcinomatous and sarcomatous elements within same tumour. These tumours are supposed to arise from monoclonal proliferation of epithelial component. Carcinosarcoma of the uterus account for 2-5% of all uterine malignancies. They typically present with abnormal vaginal bleeding and may present with bloody discharge, abdominal pain or abdominal mass. Hereby a case report of a 60-year-old post-menopausal female presenting with painless lump abdomen progressively increasing in size has been described. Ultrasonography revealed a large solid-cystic mass in left adnexa. Total hysterectomy with bilateral salpingo-oophorectomy was performed. Histological examination of specimen revealed carcinosarcoma of uterus with left adnexal metastasis and left ovarian endometriotic cyst. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=ED07-ED09&id=13213 https://doi.org/10.7860/JCDR/2019/42428.13213 Detection of Cup-like Blasts in Acute Myeloid Leukaemia Supriya Mehrotra, Priyanka Singh, Rajesh Kumar Srivastava, AK Kapoor A 59-year-old female, presented with generalised weakness for several months. Her complete blood cell count revealed mild anaemia moderate thrombocytopenia with hyperleukocytosis. Differential leucocyte count revealed large number of blast cells (88%), with most of the blast cells having cup-like invaginations of nuclear membrane (giving it a fish-mouth-like nuclear appearance). Using a strict criteria of &#x2265;10% blasts with nuclear invaginations and occupying&#x2265;25% of nuclear area, most of immature cells were cuplike blasts. The blast cells had fine chromatin, high nuclear cytoplasmic ratio and 1 to 2 nucleoli. Cytoplasm of blast cells did not contain granules or Auer rods. Morphologically, the blast cells were suggestive of Acute Myeloid Leukaemia (AML) and the M1 subtype (FAB classification). Flow cytometric examination revealed moderate positivity for CD33 and mild positivity for CD11<sub>c</sub>, CD117 and CD45 antigens. Moderate expression of CD33 suggested aberrant expression on myeloid cells and Nucleophosmin (NPM 1) mutation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=ED10-ED11&id=13221 https://doi.org/10.7860/JCDR/2019/41889.13221 Omeprazole Induced Increase in Liver Markers-A Case Report Marwa F Elmahdy, Jadees M Almater Proton pump inhibitors are one of the most widely used antisecretory agents used in the treatment of hyperacidity. These proton inhibitors have direct propulsive effect on gastrointestinal bacteria towards liver in absence of gastric acid. The report is about a patient suffering from Gastro-oesophageal Reflux Disease (GERD) receiving ranitidine and omeprazole. On measuring the biomarkers of liver function, the serum levels of Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), Gamma Glutamyl Transferase (GGT), Albumin to Globulin Ratio (A/G ratio), cholesterol and creatinine were found to be increased. After cessation of the treatment with PPIs, diet regulation and usage of herbal products, the biomarker levels decreased and after another one month ALT and AST returned to normal. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=FD01-FD02&id=13218 https://doi.org/10.7860/JCDR/2019/41848.13218 LipStaT- Know Where, When and How? Priyanka Chopra, Shalini Kapoor, Preeti Karhana Excessive Gingival Display (EGD) is an aesthetic concern affecting a considerable section of the population. Labial hyperactivity, gingival overgrowth, delayed passive eruption, vertical maxillary excess or a combination of them may result in excessive gingival appearance. LipStaT was similar technique to first introduced by Rubinstein and Kostianovsky’s in 1973 for treatment of high smile lines. Here, a case of 22-year-old female patient who reported with the chief complaint of gummy smile has been discussed. On extra-oral examination, the face was found to be bilaterally symmetrical with competent lips. Intraorally, gingival display was 6 mm during dynamic smile which extended from premolar to premolar. The treatment planned was to surgically minimise the gingival display in her smile using LipStaT Technique. The present paper also discuss in detail about the indications of LipStaT, clinical case selection, treatment and possible complications. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=ZD05-ZD07&id=13239 https://doi.org/10.7860/JCDR/2019/42195.13239 Plaster Ingestion and Concurrent Fuel Oil Poisoning: An Unusual Method of Suicide Asad Imani, Hamid Heidarzadeh, Hadis Nazari, Sara Mohammadnejad, Saleheh Tajalli Suicide is one of the leading causes of death in the world and all type of suicides are remarkable for health workers. However, concurrent use of plaster diluted in water and fuel oil (gasoline) is new and odd. A 68-year-old man with previous history of suicide attempts was brought to the emergency department. He attempted suicide by consuming 50 gm of plaster powder diluted in water and gasoline (30 gm) concurrently. In the present case, due to low plaster ingestion (50 gm), the surgical intervention was not done; and the treatment approach was mainly conservative in nature. This composition is not reported as a method of suicide in the literature review. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=LD01-LD02&id=13244 https://doi.org/10.7860/JCDR/2019/42385.13244 Adrenal Ganglioneuroma- A Rare Site Entity Byna Syam Sundara Rao, Vissa Shanthi, Nandam Mohan Rao, Bhavana Grandhi, R Sujitha Ganglioneuroma is a rare lesion reported in many organs including adrenal gland. Adrenal ganglioneuroma is a rare benign sympathetic tumour which originates from Adrenal medulla. The adrenal gland tends to be unusual site but few cases have been reported in the literature. Here, the present authors report a case of Adrenal ganglioneuroma in 35-year-old male. He presented with complaints of diarrhoea and mild pain in abdomen. After abdominal CT scan, the patient underwent laparoscopic right adrenalectomy. Diagnosis was confirmed by histopathological examination as adrenal ganglioneuroma. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=ED12-ED14&id=13245 https://doi.org/10.7860/JCDR/2019/42476.13245 A Very Rare Diabetic Foot Co-infection Due to <i>Escherichia hermannii</i> and <i>Enterobacter aerogenes</i> in an Elderly Patient Nedim Cakir, Kaya Süer, Hamza Duygu <i>Escherichia hermannii</i> is a microorganism very rarely isolated from clinical specimens, since its first identification in 1982. So far, there are around 17 human cases reported in medical sources. This small number of isolated case, eventually leads to a lack of information about the pathology and pathogenesis of infections caused by this microorganism. In the present article, we report a diabetic foot co-infection due to <i>Escherichia hermannii</i> and <i>Enterobacter aerogenes</i>. The treatment of the patient was started with a combination of empiric piperacillin/tazobactam and teicoplanin therapy. Later, based on the microbiology test results, this medication was converted to meropenem. When the patient’s septic condition improved, coronary artery bypass and transtibial amputation operations were performed. The patient recovered completely and was discharged without further issues. To the best of our knowledge, this is the first <i>E. hermannii</i> infection report from Cyprus and the Middle East. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=DD01-DD02&id=13246 https://doi.org/10.7860/JCDR/2019/42078.13246 Giant Periosteal Chondroma: Report of a Rare Case Amritha Kesavan, Divya Surendran, Joy Augustine, Dominic K Puthoor, Dijoe Davis Periosteal chondromas are uncommon benign cartilaginous neoplasms which account for <2% of all bone tumours. They are rarely >5 cm in greatest diameter with an average size of 3 cm, with proximal humerus being a characteristic location. Large periosteal chondromas are very rare. Clinically, they present as palpable often painful masses. Radiographically, they appear as radiolucent bone surface tumours that form sharply marginated erosions (“saucerisation”) of the cortex and are well demarcated from the underlying medullary cavity by a thin rim of sclerosis. Histologically, these tumours are well circumscribed, and are characterised by lobules of cartilage with benign clusters of chondrocytes that do not have a permeative growth pattern. Occasionally, these tumours can be more cellular showing nuclear pleomorphism and binucleation, which can be misdiagnosed as chondrosarcoma. Periosteal chondromas are treated with en-bloc excisions. This case report describes a case of giant periosteal chondroma of proximal humerus. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=ED15-ED17&id=13248 https://doi.org/10.7860/JCDR/2019/42339.13248 Surgical Management of Extensive Plunging Ranula in a Newborn with A Review of Literature Ana Luiza Lima Medeiros Paz, Carlos Rodrigo Barros de Siqueira, Adalberto Novaes, Ana Thereza Saboia de Campos Neves, Luiz Evaristo Ricci Volpato Ranula is an oral floor cyst, originating from the extravasation of salivary mucus from the sublingual gland due to obstruction of the gland ducts. This report presents the case of an extensive congenital plunging ranula in a 19-day-old male newborn. The infant presented easy fatigue, with delay in the time of the feedings during breastfeeding due to volumetric enlargement in mouth floor and ventral tongue regions since birth. The therapeutic proposal was marsupialization of the lesion. However, during surgery, due to the ranula’s location and the possibility of relapse, the enucleation of the lesion was performed. Infant was kept intubated in the neonatal ICU for three days and was under nasogastric fed for seven days. Excision of the ranula and maintenance of intubation was done until the reduction of post-operative oedema prevented intercurrences in the post-operative period and allowed a good clinical evolution of the child who recovered his respiratory and digestive function. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=ZD01-ZD04&id=13237 https://doi.org/10.7860/JCDR/2019/40030.13237 Varied Presentation, Location and Outcomes in Management of Left Atrial Myxomas in a Tertiary Care Institution: A Case Series Rupesh Kumar, Alok Kumar, Sanjib Rawat Primary tumours of heart are a rare entity, and are mostly benign. Among them myxomas is the most common, typically Left Atrial (LA) arising from inter-atrial septum. Here we present a case series in which five patients were operated, of which four were female and one was male. The mean age was 57.4±16.1 years. Shortness of breath was the most common chief complaint followed by palpitation, altered sensorium. Majority of the patients belonged to NYHA II and III and ASA (American Society of Anaesthesiologists) 2 category. All were pedunculated masses. Of the masses three originated from interatrial septum, one from LA appendage, and another from the base of anterior mitral leaflet (aorto-mitral mitral junction). Transseptal approach, via right atrium was used in most cases. The mean cross clamp time was 50.6 minutes and cardiopulmonary bypass time was 80.2 minutes. The mean Vasoactive-Inotropic Score (VIS) was 8.6, and mean intensive care unit stay was 3.6 days. Besides a patient requiring tracheostomy, there were no other complications. They are easily diagnosed with echocardiography and once operated they have an excellent recovery, and remain symptom free. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=PR01-PR03&id=13193 https://doi.org/10.7860/JCDR/2019/42578.13193 mSPECTRA: Email Management System of <i>The Journal of Clinical and Diagnostic Research</i> Ruchi Shukla, Nikhita Gulati, Hemant Jain In an organisation with multiple departments and division of labour, email management becomes a daunting task, and choosing the right email allocation system significantly impacts the success of business communication. Although various webmail services and email client are available, mSPECTRA was developed at Journal of Clinical and Diagnostic Research (JCDR) to meet the key requirements of the company. mSPECTRA is an easy-to-use web-based email management system integrated in manuscript database portal and database resources that helps to effectively manage, track and respond to the large influx of emails. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=AB01-AB05&id=13233 https://doi.org/10.7860/JCDR/2019/42760.13233 Has Violence against Doctors Become the Norm in India? Kaushik Bharati, Sunanda Das https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=AB06-AB09&id=13236 https://doi.org/10.7860/JCDR/2019/13567.13236 Comment on the Editorial-Naive or Caper: Author Behaviour Sarika Mondal https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=JL01-&id=13227 https://doi.org/10.7860/JCDR/2019/42444.13227 Letter to the Editor on ‘PCR as a Diagnostic Tool for Extra-Pulmonary Tuberculosis’ Takahiko Nagamine https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=OL01-&id=13247 https://doi.org/10.7860/JCDR/2019/42763.13247 A Case of Parotid Gland Lymphoma: A Rare Entity Manika Khare, Zai Wade, Sunil Garg https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=XL01-XL03&id=13192 https://doi.org/10.7860/JCDR/2019/42146.13192 Prevalence of Functional Disability Due to Neck Pain and Back Pain among Microscope Users of Punjabi University Patiala, Punjab, India Shveta Sharma, G Jayraman, Saurabh Kumar <b>Introduction:</b> Prolonged use of microscope can result in discomfort and injuries which may lead to functional disability. <b>Aim:</b> To determine the prevalence of functional disability due to neck pain and back pain among microscope users. <b>Materials and Methods:</b> This study was survey; conducted at Punjabi university, Patiala, Punjab, India. Total 100 microscope users of both genders, age; 19 to 40 years from different departments were included in the study. The prevalence of neck pain and back pain was evaluated with the use of an interview questionnaire. Furthermore, the functional disability related to neck pain and back pain was assessed by the Neck Disability Index (NDI) and Oswestry low back pain and Disability Index (ODI). <b>Results:</b> The prevalence of neck pain and back pain was 46% and 24% respectively. The subjects who were at the age of 21-30 years were highly affected with neck and back pain. Around 50.0% subjects of back pain and 50% of neck pain had mild disability, 18.2% of back pain and 81.8% of neck pain had moderate disability, 36.4% subjects of back pain and 63.6% of neck pain had indicates severe disability and 13 subjects of back pain and 25 of neck pain indicates complete disability on NDI and ODI. <b>Conclusion:</b> A higher risk of neck pain and low back pain among microscope users predisposes this occupation at high risk of developing spine injuries which needs further consideration like knowledge of ergonomics, appropriate body position while working, selection of good chair and break time, etc. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=YC01-YC04&id=13195 https://doi.org/10.7860/JCDR/2019/42040.13195 Antibacterial Effect of <i>Annona muricata</i> L. Leaves on <i>Streptococcus mutans</i> ATCC 25175 Strains Joana L Rodriguez-Perez, Pablo A Millones-Gomez <b>Introduction:</b> Soursop is a pleasantly flavoured tropical fruit commonly consumed in Peru and is of great importance due to its health benefits. Although there are some research studies reported which showed the antimicrobial properties, there are still few studies on Peruvian varieties. <b>Aim:</b> This study compared the antibacterial effect of different concentrations of <i>Annona muricata</i> L. leaf extracts on <i>Streptococcus mutans</i> ATCC 25175 strains in-vitro. <b>Materials and Methods:</b> Ethanolic extracts were prepared by leaching at concentrations of 10%, 20%, 30%, 40%, 50%, 60%, 70%, and 80%. Plates were prepared with Brain Heart Infusion (BHI) agar medium and seeded with S. mutans inoculum using the swab method. The antibacterial effect was evaluated via the well diffusion method, using 0.12% chlorhexidine gluconate as the positive control and 70% ethanol as the negative control. The plates were incubated in anaerobic jars at 37°C for 48 hours. Inhibition halos were measured using a millimeter ruler. This experimental study was performed at the Department of Oral Microbiology, National University of Trujillo, Perú. <b>Results:</b> The results showed antibacterial activity at all concentrations, with the greatest inhibition halo at the 80% concentration (27.20 mm) and the smallest at 10% (9 mm). <b>Conclusion:</b> The present study revealed that increased antibacterial activity was directly proportional to the increase in concentration. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=ZC13-ZC16&id=13196 https://doi.org/10.7860/JCDR/2019/42089.13196 Physical Activity and Sedentary Lifestyle among Diabetes Healthcare Providers in Nigeria: Time to Examine the Examiners Ejiofor Ugwu, Bede Nnolim, David Soyoye, Marcellinus Nkpozi, Joseph Ojobi, Michael Abonyi <b>Introduction:</b> Diabetes Healthcare Providers (DHPs) are notable advocates of increased Physical Activity (PA) as a veritable means of preventing type 2 diabetes mellitus and related non-communicable diseases. However, the extent to which the DHPs themselves comply with this important lifestyle habit is not known. <b>Aim:</b> To evaluate PA and sedentary living among DHPs in Nigeria and identify some determinants of PA in this population. <b>Materials and Methods:</b> In this cross-sectional study, PA was assessed using the short form of the International Physical Activity Questionnaire (IPAQ-SF). Besides socio-demographic and anthropometric indices, participants were asked about frequency and duration of engagements in vigorous PA, moderate PA, walking and average sitting time, in the past 7 days. Data were analysed using Chi-square, t-test, Spearman’s test of correlation and logistic regression statistics on SPSS version 23. <b>Results:</b> One hundred and eight subjects (63% males), with a mean age of 42.1±7.7 years, participated in the study. Although 86% of the participants were adjudged physically active, the intensity of PA was low in 52.8% and 74.1% did not meet the World Health Organisation recommended target for adequate PA. A significant negative correlation was observed between intensity of PA and Body Mass Index (BMI) while sitting time positively correlated with BMI. BMI &#x2265;25 kg/m<sup>2</sup> and higher professional cadre were significant independent predictors of low PA. <b>Conclusion:</b> Nearly three-quarter of DHPs in Nigeria do not engage in sufficient PA. This observation calls to question their ascribed status as role models of healthy lifestyles and may portend increased health risks among this important group of healthcare workforce. There is a significant inverse relationship between PA and BMI as well as professional cadre. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=OC05-OC09&id=13198 https://doi.org/10.7860/JCDR/2019/42468.13198 Minimally Invasive Coronary Artery Bypass Grafting for Multivessel Coronary Artery Disease: A Prospective Longitudinal Study Vivek Shrihari, Ramkumar Jayavelan, Karthick Kavin, Ramkumar Shanmuga Sundaram, Girish Gopinathan, Periyasamy Thangavel <b>Introduction:</b> Minimally invasive coronary artery bypass grafting has been predominantly used in single vessel coronary artery disease and is gaining wider acceptance over the conventional approach. Minimally invasive surgery for multivessel coronary disease is still restricted to fewer centres due to its technical difficulty and longer learning curve. <b>Aim:</b> To evaluate patients who underwent minimally invasive coronary artery bypass grafting surgery for multi-vessel coronary artery disease. <b>Materials and Methods:</b> Forty three patients underwent minimally invasive beating heart coronary artery bypass grafting surgery for multi-vessel coronary artery disease. Data was analysed with inferential and descriptive statistics. Continuous or interval based variables were expressed as mean&#177;standard deviation. Postoperative Visual Analogue Scoring (VAS) of pain (1-10) was recorded on day 1 and day 2 after surgery. They were compared using paired one-tail student t-test. <b>Results:</b> The mean age of 43 patients was 57.88&#177;7.91 years. Thirty three patients received two grafts. Ten patients received 3 grafts. The mean duration of ventilation was 8&#177;3.3 hours. The length of intensive care unit stay ranged from 1 day to 3 days with a mean of 2.23&#177;0.57 days. The mean VAS score of pain on postoperative day 1 was 3.93&#177;2.23. It significantly reduced to 1.67&#177;1.43 on day 2 (p<0.05). The duration of hospital stay ranged from 5 days to 18 days with a mean of 9.5&#177;2.7 days. The duration required for the patient to resume routine physical activities was 10.35&#177;9.13 days. <b>Conclusion:</b> Minimally invasive coronary artery bypass grafting surgery through left anterior thoracotomy approach can be done safely for multi-vessel coronary artery disease with good and acceptable postoperative outcomes. There is a significant reduction of pain by second postoperative day. Three-fourth of the patients resumed routine physical activity within 12 days of surgery. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=PC01-PC04&id=13199 https://doi.org/10.7860/JCDR/2019/42641.13199 A Case Study of Bedbug Infestation in the Student Dormitories of Iran-2018 Hamed Ramezani Awal Riabi <b>Introduction:</b> The bedbug bites is one of the most important health problems in human places, especially college dormitories. Risks related to bedbugs include insomnia, itchy bites, skin oedema, anaemia, stress and economic losses. The potential for severe contact to pesticides was used for bedbug control. <b>Aim:</b> To identify college dormitories that were infested by bedbug, prevent them from spreading to other dormitories and minimise the bite of the pest, which was possible by designing a comprehensive guideline. <b>Materials and Methods:</> This research was a descriptive and analytic study, done in 2018 year (Apr to Jun) in student dormitories infested with bedbugs in Iran. Bedbugs alive were caught from 25 rooms of 100 rooms in dormitories by applying the sticky traps, vacuum cleaner, and forceps. The rooms were leveled according to the severity infested to bedbug, including high (>5 bedbugs), medium (3-4 bedbugs) and low levels (1-2 bedbugs). A questionnaire was designed on student demographic questions and information about behavioural bedbug to manage the control bedbug in the dormitory (MCBBD-Q). For validation of the questionnaire, Cronbach’s alpha was used with a coefficient of 0.7. To determine the consistency of the questionnaire, a test-retest method was used. The questionnaire was completed for 100 students and returned to them after 14 days. Three methods were used (I,II,III): applying only Insecticides, applying Insecticides and changing mattress and Integrated Pest Management (IPM) including: Replace mattress, Heat up, washing dress, checking suitcase, apply Naphthalene, Vaccum cleaner and Use glass wool) methods. Data was analysed by using SPSS 20 software and statistical Chi-Square test and one-way ANOVA. <b>Results:</b> Eighty bedbugs were caught from 25 rooms of 100 rooms. A total of 52% students were male and 48% were female. In total more than 80% of students didn’t have information about the biology of bedbug. A significant difference was found by comparing three methods (I-III) in bedbug eradication after 7 days (F=2.60; df=4, 20; p=0.06), 14 days (F=6.27; df=2, 22; p-value=0.07) and 24 days (F=7.65, df=1, 23; p-value=0.01). There was also a significant difference in the effectiveness of the used control methods (p<0.05). The eradication rate of the bedbugs through the three methods (I-III) was 25, 75 and 100%, 24 days after using control methods, respectively. <b>Conclusion:</b> According to the results of this study, it is recommended 1) To prevent the entry of the bedbug into the dormitory, it is necessary to check students suitcase out of rooms, cover the mattress, use of standard bed for students, cleaning the room twice a week with a vacuum cleaner. 2) It is better to use the IPM method to control the bedbug in college dormitories. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=LC01-LC07&id=13200 https://doi.org/10.7860/JCDR/2019/41375.13200 A Study on Association of Urine Cytology as Reported by the Paris System with Histopathology and p53 Expression in Urinary Bladder Epithelial Neoplasms Soumitra Das, Anadi Roy Chowdhury, Supriya Basu, Abhisek Lath <b>Introduction:</b> Urinary bladder cancer is the ninth most common cancer worldwide. Urine cytology is a simple yet effective tool for detecting high grade urothelial carcinomas. The grade of the tumour can be detected on histopathology and confirmed by immunohistochemistry as p53 mutations have well established association with invasive urothelial cancers and high grade lesions. <b>Aim:</b> To evaluate urine cytology as an investigational tool for urothelial carcinomas using The Paris System. The main goal was to evaluate the diagnostic accuracy of this system. The histopathological features and immunohistochemical expression of p53 were evaluated to confirm the diagnosis. <b>Materials and Methods:</b> This study was a descriptive cross- sectional study, conducted in the Department of Pathology in collaboration with the Department of Urosurgery, R.G. Kar Medical College and Hospital, Kolkata, over a time period of 18 months (January 2017-June 2018). The study population comprised patients presenting with haematuria and urinary bladder neoplasm. Preoperative cytological examination of urine was reported as per the Paris System. Results were correlated with Histopathology. Immunochemical estimation of p53 expression was done. Test thresholds were selected for cytology, histopathology and immunohistochemistry. Chi-square tests were performed for correlation between the three tests. <b>Results:</b> Using Suspicious for High Grade Urothelial Carcinoma (SHGUC) as diagnostic threshold, the sensitivity and specificity of urine cytology in detecting high grade lesions was evaluated to be 89.80% and 69.23% respectively. Immunostaining with p53, keeping 10% positivity in the nuclei as threshold, gave a sensitivity of 89.8% and specificity of 53.85%. Both immunohistochemistry and cytology as reported by The Paris System, were found to be significant in detecting high grade cancers (p<0.05). The tests were also done using other cut-offs and validation of the best threshold was estimated. <b>Conclusion:</b> Significant association was found between p53 positive cases and cases diagnosed as SHGUC and High Grade Urothelial Carcinoma (HGUC) in cytology as reported by TPS with cases that showed presence of high grade cells on biopsy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=EC04-EC09&id=13201 https://doi.org/10.7860/JCDR/2019/42014.13201 Role of Barium Swallow in Globus Pharyngeus: An Observational Study Taruni Lalchandani, Ashish Chandra Agarwal, Sugandha Jauhari, Shamrendra Narayan, Tanu Misra <b>Introduction:</b> Globus pharyngeus is a common condition affecting around 46% of healthy individuals. Most common symptom is feeling of lump in throat. It is a diagnostic challenge and is difficult to treat. Barium swallow is one of the investigations which can rule out organic pathology. It is a safe procedure with rare complications. <b>Aim:</b> To assess the utility of barium swallow in patients with globus like symptoms and normal Ear, Nose, Throat (ENT) examination. <b>Materials and Methods:</b> A prospective study was done at a tertiary care hospital in the state of U.P. in India on 100 patients who came to the ENT Out-Patient Department (OPD) with complaints of throat pain, sticking sensation in the throat or a feeling of lump in the throat. Patients were examined clinically which included an indirect laryngoscopy examination. They were advised routine blood investigations and a barium swallow. The association between chief complaints of the study participants i.e., symptoms reported and findings of barium swallow (normal/abnormal) were analysed using cross-tabulations and chi-square test where p-value <0.5 was considered significant. <b>Results:</b> Out of 100 patients, 9 were found to have an abnormal barium swallow. Association between barium swallow and symptoms of lump in throat, pain and sticking sensation was found to be significant. Symptom of burning sensation was not found to be significant. <b>Conclusion:</b> Barium swallow examination proved to be useful in investigating patients with symptoms of globus pharyngeus. It also helped in excluding any life-threatening illness and in reassuring the patient. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=MC01-MC04&id=13202 https://doi.org/10.7860/JCDR/2019/42100.13202 The Prevalence and Determinants of PRECEDE Framework and Health Literacy Associated with Overweight and Obesity among Adolescents: A Population-Based Survey of 12-19 Years-Old in the Northeast of Thailand Pornthip Kaewchin, Pannee Banchonhattakit <b>Introduction:</b> Obesity is a serious chronic disease that damages both physical and mental health. The global prevalence and trends of overweight and obesity among adolescents and children had increased. <b>Aim:</b> This study was aimed to investigate the prevalence and determinants of PRECEDE Framework and health literacy associated with overweight and obesity among adolescents (12-19 years of age) in the Northeast of Thailand. <b>Materials and Methods:</b> This cross-sectional analytical study was conducted among 1,129 samples selected through multistage random sampling among 4 provinces from 20 provinces of the Northeast of Thailand, between September 2017 to March 2018 after they which completed constructive questionnaires using the PRECEDE Framework Model including three factors; predisposing factors, enabling factors and reinforcing factors and health literacy including cognitive, access, communication, self-management, media literacy and decision. Multiple logistic regression was administered to determine the association using the PRECEDE Framework Model and health literacy to find associated with overweight and obesity. <b>Results:</b> It was found that the prevalence of overweight and obesity was 10.63% (95% CI: 8.89-12.57) and 10.45% (95% CI: 8.72-12.38), respectively. Multivariate analysis suggests that the factors that were statistically significant in association with overweight and obesity included watching television =3 hours per day (Adjusted OR=1.94; p<0.001), time to surf internet >5 hours per day (Adjusted OR=1.82; p=0.007), the PRECEDE Framework Model including low levels of attitude (Adjusted OR=2.61; p=0.001) and low levels of reinforcing factors (Adjusted OR=1.79; p=0.030), health literacy including: low levels of media literacy skills (Adjusted OR=3.64; p<0.001) and the low levels of decision skills (Adjusted OR=5.12; p<0.001). <b>Conclusion:</b> The present study’s results reveal the prevalence of overweight and obesity among adolescents were found to be high. It was essentially associated with determinants of PRECEDE Framework Model include low levels of attitude and reinforcing factors, low levels of health literacy including media literacy skills, decision skills and other covariates including watching television, time to surf internet. This study indicates that future prevention programs must take these risk factors into account. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=LC08-LC13&id=13203 https://doi.org/10.7860/JCDR/2019/42125.13203 Rate and Indications of Caesarean Section in College of Medical Sciences and Teaching Hospital- A Retrospective Study Tara Manandhar <b>Introduction:</b> Caesarean Section (CS) is the most common abdominal surgery in obstetrical practice and it is in increasing trend. <b>Aim:</b> To analyse the rate and indication for CS in our institute. <b>Materials and Methods:</b> A retrospective study was conducted in which the medical records of patients who underwent Lower Segment Caesarean Section (LSCS) at our institution from February 2010 to February 2012 were analysed. Various obstetrical parameters including rate and indications of Caesarean section were analysed. <b>Results:</b> Out of 1412 deliveries, 412 patients had CS over the two year study period. The mean (SD; range) age of patients was 24.4 (4.2; 16-42) years, mean (SD; range) period of gestation was 38.6 (2.2; 29.6-43.5) weeks. Primigravida accounted for 54.4% of the patients. Emergency LSCS was done in 79.1%. Previous CS, severe oligohydramnios and foetal malpresentations were the common indications for LSCS accounting to 16.9, 15.8 and 13.6% respectively. The CS rate was 29.17%. There was no maternal mortality. <b>Conclusion:</b> CS is a common and a safe mode of delivery whenever indicated. Unjudicial CS poses threat rather than improving feto-maternal outcome; hence the rate of caesarean should be kept to the minimal recommended threshold level. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=QC01-QC03&id=13189 https://doi.org/10.7860/JCDR/2019/42038.13189 Comparison of Tacrolimus and Sirolimus Based Regimens on Regulatory T Cell Levels in Renal Transplant Recipients: A Study from a Tertiary Care Centre in Kerala, India Roshan Nasimudeen, Saji Francis, Melemadathil Sreelatha, Sathi Puthenparambath <b>Introduction:</b> A subset of CD4 lymphocytes known as regulatory T (Treg) cells is known to downregulate the immune system. If their levels are raised, immune tolerance can be increased. It was seen that certain drugs like tacrolimus (calcineurin inhibitor) and sirolimus (mTOR inhibitor) used for immunosuppression in renal transplant recipients influenced the Treg counts. <b>Aim:</b> To evaluate the varied effect of calcineurin inhibitors and mTOR inhibitors on the peripheral blood Treg count in renal transplant recipients. We also sought to find the Treg cell levels in the general population. <b>Materials and Methods:</b> It was a cross-sectional comparative study conducted on renal transplant recipients. The study included 58 subjects, of which 36 were renal transplant recipients on immunosuppressive regimens. Among these 21 were on tacrolimus and 15 on sirolimus. The remaining 22 individuals were healthy controls. Immunophenotyping with flow cytometry was done on peripheral blood of the study subjects and their Treg levels ascertained. Data was analysed using SPSS software, version 18. <b>Results:</b> The mean percentage of regulatory T cells in patients on tacrolimus, sirolimus and the control population were 13.1&#177;7.8%, 13.4&#177;5.6% and 11.9&#177;5.4%, respectively of the CD4 lymphocytes. There were no statistically significant differences between the three groups with a p-value of 0.75. <b>Conclusion:</b> Immunosuppression with tacrolimus or sirolimus based regimens did not influence the Treg cell levels. The regulatory T cell levels in patients on these regimens were similar to the healthy control population. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=EC01-EC03&id=13190 https://doi.org/10.7860/JCDR/2019/42355.13190 In-Vitro Study to Check the Viability of Fixed Partial Dentures with Built-in Passive RFIDs- A Forensic Dentistry Tool R Venkat, AS Adchaya, B Muthukumar, Sunayana Manipal <b>Introduction:</b>Lack of quick and easy techniques to handle human identification devices during mass disasters like Indian Ocean earthquake and Tsunami (2004), Kedarnath landslide (2013), Kolkata market fire (2013), Chennai flood (2015), and Kerala flood (2018), emphasised on the necessity to develop this tool. <b>Aim:</b> To develop a simple, yet reliable tool that can serve the purpose as a potential forensic record as well as patient data retrieval system. <b>Materials and Methods:</b> In-vitro experiment was carried out by incorporation of passive radio frequency identification microchips into a cavity on lingual surface of 3 unit metal ceramic fixed partial denture models and sealing the cavity using ceramic repair kit. These thirty six fixed partial denture samples were divided into 12 samples of each three groups as group 1 -100°C, group 2 -200°C and group 3 -300°C. Viability of microchips before and after heat treatment using RenfertMagma Pre heating furnace of each group with a temperature holding time of 15 minutes was assessed using radio frequency identification device reader and values were computed. Statistics was computed using Pearson chi-square analysis. Scanning Electron Microscopic (SEM) analysis at a resolution of 500 µm was carried to study surface characteristics before and after heat treatment. <b>Results:</b> In group 1 (100°C) and group 2 (200°C) microchips were found to be 100% viable before and after heat treatment. In case of group 3 (300°C), 100% of samples failed to read out after heat treatment. Since the values obtained in all the three groups before firing was constant; no statistical difference was computed. Likewise cross tabulation of values between before and after firing were constant; so no statistical differences were computed. Pearson chi-square analysis of after firing group values computed p-value <0.001 which is statistically significant. SEM analysis revealed disrupted composite-ceramic interface, disintegrated microchips with carbonization in group 3 samples. <b>Conclusion:</b> Within constraints, successful development of limited heat resistant (up to 200°C) Radio Frequency Identification Device (RFID) incorporated fixed partial dentures was established. Further prospective studies are needed to improvise the heat resistance of this device. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=ZC08-ZC12&id=13186 https://doi.org/10.7860/JCDR/2019/42412.13186 Application of Stereomicroscope in the Pre-Analytic Macroscopic Examination of Biopsy Specimens Mathew Jacob, N Mohan, Saramma Mathew Fenn, P Rajathi, P Suryagopan, L Vishalini <b>Introduction:</b> The “gap” between the clinical and the microscopic features in pathology is “bridged” by the macroscopic examination of biopsy specimens in the pre-analytic phase of tissue processing. However, such a step has been undermined in the current practice to the fulfilment of academic criteria. There is a need of a “gold standard” instrument in viewing, studying and recording macroscopic features of biopsy specimens in the pre-analytic phase of gross examination and tissue processing. <b>Aim:</b> To assess the utility of stereomicroscope in the macroscopic examination of biopsy specimens in the pre-analytic phase of tissue processing. <b>Materials and Methods:</b> A total of thirty soft specimens from the Department of Oral Pathology and Microbiology were utilised in the study. Three observers were to gross examine and record the macroscopic features of each specimen with and without stereomicroscope. Following which, the observers were to answer a questionnaire using a 5 point Likert scale with options ranging from 1 (very good) to 5 (very poor) to indicate the level of satisfaction in utilisation, operation and preference of stereomicroscope in gross examination over the conventional method (unaided eye) in pre-analytic phase of tissue processing. <b>Results:</b> The responses to each item in the questionnaire by all three observers had shown the preference of studying biopsy specimens with the stereomicroscope when compared with the conventional method of macroscopic examination. <b>Conclusion:</b> The present study evaluated the application, operation and the preference of the stereozoom microscope in gross examination and found that the stereozoom microscope was a useful tool in examining, recording macroscopic features of biopsy specimens and improves the existing practice of gross examination. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=ZC01-ZC07&id=13182 https://doi.org/10.7860/JCDR/2019/42116.13182 Trans-catheter Device Closure of Ruptured Sinus of Valsalva Aneurysms using PDA Occluder Devices Nathaniel Samson, Lijo Varghese, Oommen George, George Joseph, Paul George, John Roshan <b>Introduction:</b> Ruptured Sinus of Valsalva (RSOV) is a rare congenital heart disease. Indian data regarding trans-catheter device closure of RSOV is limited. In the current study we aim to look at the feasibility of using a Patent Ductus Arteriosus (PDA) occluder device for this purpose as it is a much economical alternative to the conventional devices. <b>Aim:</b> To study the immediate and intermediate term follow-up after RSOV device closure using PDA device. <b>Materials and Methods:</b> This retrospective analysis, from a large tertiary care hospital in South India, included 24 patients who underwent trans-catheter device closure of RSOV between December 2004 and December 2017, mostly using PDA occluders devices. Patient demographics, clinical characteristics, procedural and device related variables; immediate outcomes during hospital stay were collected from medical records. Follow-up data for residual shunt and complications were also collected. For the descriptive analysis, all continuous variables are expressed as mean values and standard deviation or median with range as appropriate, and discrete variables are presented as percentages. <b>Results:</b> Of the 24 patients 75% were males; the mean age was 35 years (range: 12-61 years). Twenty three PDA occluders (Lifetech, Cardi-O-Fix) and 1-vascular plug were used in total. Successful device closure was achieved in 21 patients (87.5%) and the result was sustained at 6 months follow-up (median follow-up was 8 months). There was one procedure related mortality (immediate) due to aneurysm rupture, one patient was referred for surgical closure (one week after percutaneous procedure) due to persistent shunt across the defect and another referred for surgery due to device embolization (after 24 hours of the procedure). No other procedure related complications such as significant aortic regurgitation or coronary artery occlusion occurred. <b>Conclusion:</b> Trans-catheter device closure of RSOV using PDA device occluder is a safe, feasible, effective and economical modality of treatment with good short-term and intermediate outcomes. In carefully selected patients this provides an attractive alternative to surgical closure, thereby avoiding the inherent morbidity of sternotomy and cardiopulmonary bypass. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=OC01-OC04&id=13183 https://doi.org/10.7860/JCDR/2019/42492.13183 A One-Year Treatment Outcome Comparison of Pulpotomies in Primary Molars using Biodentine and Formocresol in Thai Children: A Randomised Control Trial Tongjai Chotitanmapong, Yuwadee Asvanund, Kemthong Mitrakul <b>Introduction:</b> Pulpotomy is the treatment to preserve radicular pulp in order to maintain the integrity of the teeth after caries or traumatic exposure. Pulpotomy medication has been studied for many years. Biodentine is a new material which has been studied recently and showed promising results. <b>Aim:</b> To evaluate the clinical and radiographic outcomes and compare the treatment success rate in primary molars using biodentine and formocresol during a 12 months period. <b>Materials and Methods:</b> A parallel-design, randomised control trial was performed in children aged 3 to 8 years old who had at least one primary molar that required pulpotomy treatment. Fifty teeth were selected from 38 children and randomly assigned into two groups which were formocresol (n=25) and biodentine (n=25) as pulpotomy agents. The final restoration for all teeth were stainless steel crown. Clinical and radiographic outcomes were evaluated at 6 and 12 months after the treatment. Chi-square test was used for statistical analysis between two groups (significance level at p<0.05). <b>Results:</b> A total of 50 primary molars were included in this study. Both groups were the same in terms of age, sex and tooth treated. At 6 months, 47 teeth were available to follow-up (23 from formocresol, 24 from biodentine). At 12 months, 45 teeth were available to follow-up (23 from formocresol, 22 from biodentine). An additional two teeth from biodentine group were lost due to patient relocation. Clinical success rates for both groups were 100% at 6 and 12 months follow-up. The radiographic success rate at 6 month follow-up in formocresol and biodentine groups were 65% and 79%, respectively. The radiographic success rate at 12 month follow-up in formocresol and biodentine groups were 74% and 96%, respectively. There was statistically difference in radiographic success rates between 2 groups at 12 months follow-up (p=0.022). <b>Conclusion:</b> Biodentine showed similar clinical effective and higher radiographic success rate at 12 months follow-up when compared to formocresol. Biodentine can be used as pulpotomy medicaments alternative to formocresol in primary teeth. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=ZC17-ZC21&id=13223 https://doi.org/10.7860/JCDR/2019/41960.13223 Elderly Patients with Trauma: Radiologist’s Perspective of Burden of Disease in a Nigerian Sub-Urban Tertiary Hospital Ayodeji Anike Olatunji, Mojisola Adejoke Olusola-Bello <b>Introduction:</b> Fractures are known to be common among older and elderly persons of age 60 years and above, partly because of bone weakness or increase in frequency of falls and trauma. Data on fractures in elderly are scarce and there is need to document frequencies and predisposing factor in our community. <b>Aim:</b> To review the radiographs of patients aged 60 years and above and to determine the frequency of fracture, sex distribution, associated event, and bones involved. <b>Materials and Methods:</b> The present study was retrospective study in which the radiographs of elderly patients were collected from the radiology department between January, 2016 to November, 2018 and were reviewed to determine the prevalence and causes of fractures, as well as factors associated with them. <b>Results:</b> Of the 561 radiographs reviewed, fractures were found in 73, consisting of 28 in men and 45 in women. Thirty-eight, (53%) of the fractures occurred in the 60-70 years age group. Fracture on left side was more common and females had fracture more on the left side in 27 patients as against 17 on the right side, with one having fracture in the pubic bone. Fractures were associated with trauma, falls and Road Traffic Accidents (RTA) equally. The bones of the lower limbs were involved in 50 cases, while those of the upper limb were involved in 22 cases, with only one in the axial skeleton. The femur was involved in 23 (31.5%) of the cases. <b>Conclusion:</b> The study established the vulnerability of elderly people aged 60-70 years, particularly women, to fractures. There is a constant need for adequate social protection policy to be implied for such vulnerable group of people. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=TC01-TC03&id=13224 https://doi.org/10.7860/JCDR/2019/42023.13224 Educational Interventions and its Impact on Prevention of Diarrhoea in Urban Slums of Khordha, Odisha, India Jagatabandhu Mohapatra, Parthsarathi Dehury, Ranjit Kumar Dehury, Sangita Behera <b>Introduction:</b> Diarrhoea is a frequently found disease among children which causes childhood morbidity and mortality. Effective management of diarrhoea with Oral Rehydration Solution (ORS) immensely helps reducing the morbidity and mortality from diarrhoea among children. The preparation and administration of ORS depend on the awareness level of parents. The use of ORS can be enhanced by suitable health education and promotion among the targeted population. <b>Aim:</b> To find out the knowledge among urban slum dwellers of Bhubaneswar city of Khordha district about management of diarrhoea and preparation of ORS in pre-training and post-training interventions. <b>Materials and Methods:</b> A community based interventional study was conducted among 400 community members of the five urban slums of Bhubaneswar city of Khordha district from June to December 2018. There was an intervention in terms of health education and promotion among the respondents. The baseline awareness level of the participant regarding diarrhoea and preparation of ORS was assessed by pre-tested, pre-designed questionnaire. The educational interventional training was imparted to the participants. Pre and Post training measurements were done regarding the knowledge level of respondents by using the scoring method. <b>Results:</b> The result shows that the knowledge regarding preventive measures and management of diarrhoea had been improved after the educational interventions. The current study found that, 194 (48.5%) of respondents were highly satisfied on the Odia skit and 82 (20.5%) shows their positive response towards demonstrations as effective methods for health education. Whereas, 52 (13%) of the respondents were satisfied with group discussion, 46 (11.5%) of respondents shows their positive response towards posters and pamphlets, and 26 (6.5%) of them positively responded towards extra-mural lectures as suitable communication methods for enhancement of knowledge. <b>Conclusion:</b> Knowledge of the people regarding causes, signs, symptoms, and prevention of diarrhoea and correct method of preparation of ORS has been increased significantly after these interventions. The study shows that role play (Odiya skit) is one of the best methods which would deliver the desired messages to the community. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=IC01-IC06&id=13225 https://doi.org/10.7860/JCDR/2019/42303.13225 Is Oxford Position Better to Prevent Undesirable Higher Blockade and to Maintain Haemodynamic Stability in Subarachnoid Block for LSCS Ananda Bangera, G Priyanka <b>Introduction:</b> The conventional positioning technique has higher incidence of the unpredictability of block height and haemodynamic instability during and after subarachnoid block in caesarean section. In &#8216;Oxford&#8217; position, the woman is placed left lateral with two pillows under the shoulder and three pillows supporting the head. Following spinal injection, the woman is turned to supine position with pillows in-situ in order to minimise aorto-caval compression, which also expected to prevent higher blockade and minimise the hypotension. <b>Aim:</b> To determine whether Oxford position during spinal anaesthesia produces adequate sensory and motor block height while maintaining haemodynamic stability for caesarean section. <b>Materials and Methods:</b> Hundred parturients aged 18-45 years (ASA I and II) undergoing caesarean section were enrolled in this study, after obtaining written informed consent and institutional ethical clearance. Subarachnoid block was performed in the conventional left lateral position (Group L, n=50) and the Oxford position (Group O, n=50). Intrathecal injection of 2.5 mL of bupivacaine hyperbaric 0.5% was given with 25G QB spinal needle, and the parturient was positioned supine in group L (left lateral position) and with pillows in situ in group O (Oxford Position) after the subarachnoid block. Injection ephedrine 6 mg were given intravenously to maintain the Systolic Blood Pressure (SBP) >100 mmHg. Intraoperative haemodynamic parameters, the sensory and motor blockade level and time to reach T6 dermatome were monitored. The univariate analysis was done for anthropometric measurements and vitals which are shown using frequency, percentages, mean and standard deviation. Independent t-test was used to find the difference in between mean. The p-value <0.05 was taken as significant. <b>Results:</b> The incidence of hypotension was more in the conventional left lateral position. Time to reach T6 dermatome was minimum in the left lateral position (5.57&#177;0.821 min versus 9.52&#177;1.56 min in the Oxford position p<0.0001). <b>Conclusion:</b> Oxford position maintains better haemodynamic stability after subarachnoid block for ceasarean section compared to conventional position. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=UC05-UC08&id=13226 https://doi.org/10.7860/JCDR/2019/42688.13226 A Study of Electrocardiographic Abnormalities in Patients with Acute Cerebrovascular Events Gadde Sudhish, Swathy Moorthy, Krishnaswamy Madhavan <b>Introduction:</b> Cerebrovascular accidents have long been recognised for their debilitating impact on one’s life, posing a major contributor for morbidity and mortality. An array of cardiovascular events occur with an increased frequency among patients with cerebrovascular events in spite of no previous cardiac diseases. Electrocardiographic changes are well known to occur in patients with neurological disorders. <b>Aim:</b> To identify the abnormal ECG patterns associated with the type of acute stroke and determine if the specific changes in ECG associated with elevated cardiac enzymes, echocardiographic abnormalities and the patient outcomes. <b>Materials and Methods:</b> A total of 100 patients with no previous cardiac disease or ECG abnormality, admitted with acute stroke was enrolled in the study. All the patients underwent an electrocardiographic recording within the first two hours of admission and the abnormal findings were recorded and correlated in relation to the nature of stroke whether the ischaemic or the haemorrhagic type, the echocardiographic findings, cardiac biomarkers and the patient outcomes. The data were analysed with SPSS software and categorical variables with chi-square test. A p-value of <0.05 was considered statistically significant. <b>Results:</b> Among the study population, 78 patients had ischaemic stroke while 22 patients had haemorrhagic stroke. ECG changes were noted among 97 patients. The common ECG changes among both the ischaemic and haemorrhagic groups were T wave inversion and ST depression. Thirty-three patients with ECG abnormalities also had echocardiographic abnormalities in ischaemic group while seven patients had ECG and echocardiographic abnormalities in the haemorrhagic group. Thirty-two patients with changes in the ECG had elevated cardiac biomarkers. ST depression was strongly associated with elevated troponin T, CPK- MB, BNP and abnormal echocardiographic findings with a p-value of &#x2264;0.001. Both ST segment depression on ECG and elevated CPK MB were strong predictors of mortality among patients with acute cerebrovascular events individually, with a p-value <0.001. <b>Conclusion:</b> ECG abnormalities were commonly seen among patients with acute cerebrovascular accidents which vary from T wave inversion to ST segment depression. CPK MB, troponin T and BNP were elevated among 32 patients with ECG changes and 40% patients with ECG changes had abnormalities noted in their echocardiogram. Mortality was slightly higher among the haemorrhagic group compared to the ischaemic stroke group, though not significant. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=OC13-OC16&id=13214 https://doi.org/10.7860/JCDR/2019/42477.13214 Effect of Magnesium Sulphate as an Adjuvant to Bupivacaine in Interscalene Brachial Plexus Block for Postoperative Analgesia Aparna Sharma, Sofia Jaswal, Vikas Jaswal, Jyoti Pathania <b>Introduction:</b> Ultrasound guided interscalene block is used for the upper limb surgeries. Various adjuvants have been used for prolonging the local anaesthetic action, without increasing the drug dosage. <b>Aim:</b> To evaluate the effect of magnesium sulphate (MgSO<sub>4</sub>) as an adjuvant to bupivacaine on onset and duration of interscalene block, haemodynamic parameters, and requirement of postoperative analgesics. <b>Materials and Methods:</b> A total of 60 ASA I and II patients of age group 20-60 years were scheduled for shoulder and arm surgeries. The patients received 20 mL of 0.5% bupivacaine with 0.5 mL of MgSO<sub>4</sub> (50%) in Group I and 20 mL of bupivacaine with 0.5 mL saline in Group II for ultrasound guided interscalene block. Onset and duration of sensory and motor block was noted. VAS score, time to first rescue analgesic and total analgesic used in 24 hour were recorded. <b>Results:</b> The demographic profile was comparable (p>0.05). The mean onset of sensory blockade and motor blockade was comparable in both the groups (p>0.05). The duration of sensory blockade was significantly prolonged in Group I (759.93 min) as compared to Group II (568.37 min) (p<0.001). The duration of motor blockade was 350.17 minutes in group I and 300.27 minutes in Group II and the difference was significant (p<0.001). The VAS scores were significantly lower in Group I as compared to Group II (p<0.05). The time to first rescue analgesic and total analgesic used in 24 hours were significantly less in group I (p<0.001). <b>Conclusion:</b> MgSO<sub>4</sub> as an adjuvant to ultrasound guided interscalene block significantly improves the quality and duration of the block. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=UC01-UC04&id=13215 https://doi.org/10.7860/JCDR/2019/42006.13215 Immunohistochemical Expression of Tumour Associated Macrophage Related Marker (CD68) and Proliferative Marker Ki-67 in Malignant Salivary Glands Tumour: Correlation with the Clinicopathological Factors, Oestrogen Receptor-a and HER-2 Omneya Youssef Bassyoni, Samah Said Elbasateeny, Mahmoud Abdou Yassin, Taha Abdelwahab Baiomy <b>Introduction:</b> In the majority of malignant tumours including salivary glands tumours, the clinical stage and histological features are considered the most valuable prognostic and predictive factors for targeted therapy. Nevertheless, new prognostic factors for the Mucoepidermoid Carcinoma (MEC) are required due to the high rate of recurrence that occurs even with the early stage of the disease. The Adenoid Cystic Carcinoma (ACC) also needs more effective treatment as it show high rate of local recurrence and distant metastasis, even after surgical excision and radiotherapy. <b>Aim: </b>To assess the immunohistochemical expression of Tumour Associated Macrophage (TAMs) related marker (CD68) and proliferative marker (Ki-67) in salivary carcinomas (MEC and ACC). Furthermore, to study their correlation with clinicopathological factors, ERa, and HER-2 to detect the usefulness of these markers in the prognosis of such tumours. <b>Materials and Methods:</b> The present study was a cross-sectional study conducted at Departments of Pathology, Surgery, Zagazig and Banha Universities, Egypt. The study included 37 salivary carcinomas (25 cases of MEC and 12 cases of ACC). The control group consisted of 10 normal salivary tissues. All paraffin blocks were dissected and stained with H&E to confirm the diagnosis and grade the tumours. IHC expression of CD68 and Ki-67 was assessed in all the cases and further correlated with clinicopathological factors, ERa and HER-2. <b>Results:</b> High TAMs was detected in 64.0% of MEC and 41.7% of ACC. High TAMs was significantly detected in high grades (p=0.006 and 0.045 for MEC and ACC respectively), in advanced stage (p=0.033 and 0.015 for MEC and ACC respectively), and in larger MEC (p=0.017). Ki-67 was significantly expressed in MEC compared to ACC (p=0.046), it was significantly expressed in high-grades MEC (p=0.011) and ACC (p=0.01). ERa was detected in 16.0% of MEC and 25.0% of ACC. HER-2 was detected in 12.0% of MEC and 16.7% of ACC. Correlation between CD68 and Ki-67 among the studied carcinomas revealed a significant moderate positive correlation (r=0.449, p=0.005). <b>Conclusion:</b> High level of TAMs expressed by CD68 and high proliferative activity measured by Ki-67 could be regarded as a poor prognostic parameter in MEC and ACC. A strong correlation between both markers was found, thus controlling the level of TAMs may have promoting role in targeted therapy. However, these results pointed towards a limited application of ERa and HER-2 in targeted therapy due to limited expressions in the present studied carcinomas. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=EC10-EC15&id=13216 https://doi.org/10.7860/JCDR/2019/42392.13216 Assessment of Nutritional Anaemia and its Predisposing Factors among Women of Reproductive Age Group in a Slum of Kolkata, West Bengal, India Nivedita Roychoudhury, Tania Pan, Keya Roy, Lina Bandyopadhyay, Aparajita Dasgupta, Bobby Paul <b>Introduction:</b> Anaemia is a major public health problem affecting women of reproductive age groups all over the world. As per NFHS-IV data, prevalence of anaemia in India is 53% and in urban areas of West Bengal is 58.2%. Studies conducted among women of reproductive age in slums of Mumbai and Bhubaneswar, the prevalence of anaemia was 49.5% and 60.8% respectively. <b>Aim:</b> To assess the nutritional anaemia and its predisposing factors among women of reproductive age group in a slum of Kolkata, West Bengal, India. <b>Materials and Methods:</b> A community based cross-sectional study was carried out in a slum of Kolkata, West Bengal, India. Total study participants enrolled were 122 women of the reproductive age group (15-49 years). The surveyed women were gathered in three days through three different camps organised in the field service area of Urban Health Unit and Training Center, Chetla. All the respondents were interviewed and anthropometric measurement and blood examination were carried out. Data was analysed using SPSS version 16 and chi-square test was used to find out the association between variables. <b>Results:</b> Among all women, 112 (91.8%) had anaemia with proportion of mild and moderate anaemia being 67.2% and 24.6%, respectively. No woman was suffering from severe anaemia. The factors associated with anaemia were age, education, socio-economic status, parity, abortion, interval between two successive pregnancies less than three years, menorrhagia, BMI and dietary habits. <b>Conclusion:</b> The current study noted that education level, socio-economic status, consumption of iron rich food, increased order of pregnancies and abortion, interval between successive pregnancies affect the blood haemoglobin level successively. To increase the health awareness and decrease the prevalence of anaemia, community awareness about iron folic acid supplementation and schooling of girls, decreasing school dropout are to be addressed. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=LC14-LC17&id=13217 https://doi.org/10.7860/JCDR/2019/41716.13217 Influence of Living and Working Environments on Depressive Symptoms among Myanmar Migrant Workers in the South of Thailand Kanit Hnuploy, Wongsa Laohasiriwong, Kittipong Sornlorm, Thitima Nutrawong <b>Introduction:</b> Previous studies indicated that living and working environments have influence on depression. However, there are limited studies on the association between living and working environments and depressive symptoms among Myanmar migrant workers in Thailand. <b>Aim:</b> This study aimed to determine the prevalence of depressive symptoms and influence of living and working environments on depressive symptoms among Myanmar migrant workers in the South of Thailand. <b>Materials and Methods:</b> A cross-sectional analytical study was conducted among 1,022 Myanmar migrants who were selected by using a multi-stage random sampling technique. A structured questionnaire was developed and used for interviewing the participants. The multilevel logistic regression was performed to determine the association between living and working environments and depressive symptoms when controlling other covariates. <b>Results:</b> The prevalence of depressive symptoms was 53.03% (95% CI: 49.96-56.09). Living and working environments significantly associated with depressive symptoms were; moderate to severe problems on living conditions (adj. OR=2.45; 95% CI: 1.55-3.86, p-value <0.001), the limitation in traveling (adj. OR=2.28; 95%CI: 1.47-3.53, p-value <0.001), high level of involvement with peers (adj. OR=1.61; 95% CI: 1.20-2.16, p-value=0.001) and indoor workplace (adj. OR=1.60; 95% CI: 1.17-2.18, p-value=0.003). Significant other covariates were; chronic diseases and received health information. <b>Conclusion:</b> Depressive symptoms were common among Myanmar migrants in the South of Thailand. Living and working conditions, social interaction and health awareness had influenced their mental health status. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=VC01-VC05&id=13205 https://doi.org/10.7860/JCDR/2019/42293.13205 The Magnesium Story in Pregnancy-Levels in Maternal and Cord Blood-Correlation with Pregnancy Outcome S Mangalesh, Kanchan Kulhari, Bhasker Mukherjee, KS Rajmohan, BD Toora <b>Introduction:</b> Magnesium (Mg) is the second most abundant intracellular cation, and is vital for a multitude of cellular functions and enzymes. Derangement of Mg homeostasis often leads to various diseases such as, Diabetes Mellitus (DM) and Insulin Resistance (IR), hypertension, atherosclerosis and depression. In pregnancy particularly, hypomagnesaemia has been associated with preterm delivery and low birth weight. <b>Aim:</b> To measure maternal and cord blood Mg levels at delivery to calculate the prevalence of hypomagnesaemia in pregnancy, and to correlate Mg levels with other maternal and foetal variables at birth. <b>Materials and Methods:</b> This cross-sectional correlational study was conducted in a 1000- bedded tertiary care centre in Northern India, and consisted of 110 pregnant women admitted for delivery. Maternal and cord blood was obtained at birth and analysed for serum Mg levels. The normality of continuous data was assessed by the Shapiro-Wilk test. Pearson’s correlation analysis was used to determine the relationship between continuous variables. Comparison of means of different groups was done by using unpaired t-test. A p-value <0.05 was considered statistically significant. <b>Results:</b> Participants were aged between 18 to 36 years (Mean=26.8; SD=3.25). Out of 110 participants, 44 (40%) were hypomagnesaemic with serum Mg &#x2264;1.8 mg/dL. Mean maternal Mg level was 1.93±0.31 mg/dL. Mean cord blood Mg level was 2.19±0.28 mg/dL. Maternal Mg levels were positively correlated with the period of gestation (r-value=0.246, p-value <0.01) and birth weight (r-value=0.205, p-value <0.05). Negative correlation was observed between cord blood Mg and period of gestation (r-value= -0.240, p-value <0.05) and birth weight (r-value=-0.303, p-value <0.01). Among the studied population, 58 (52.73%) women were vegetarians, and they had higher Mg levels than non-vegetarians (t= 2.14, p-value<0.05). <b>Conclusion:</b> Hypomagnesaemia was highly prevalent among pregnant women in our setting. Micronutrient deficiencies are a potential public health problem. Larger, trimester-specific studies for antenatal screening to elucidate Mg deficiency, and alongside an all-round patient educational approach emphasising Mg-rich diet or Mg supplementation, could be highly beneficial to pregnant women in India. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=BC01-BC05&id=13206 https://doi.org/10.7860/JCDR/2019/42359.13206 Retinal Health Investigation by Segmentation of Major and Minor Blood Vessels in Fundus Images for Diabetes Patients S Poonguzhali, Rekha Chakravarthi <b>Introduction: </b>The Major and Minor blood vessel and the optic disc are the important factors for finding the presence of retinal disease like diabetic retinopathy. <b>Aim: </b>To segment the blood vessel using Major vessel extraction and Minor vessel classification methods. <b>Materials and Methods:</b> The retinal blood vessels are analysed from the images, for determining the changes in the blood vessels depending on the vessel branching pattern, width and density. High pass filter is used for easily segmenting the major vessels and also to make the retinal nerves lighter and the eye background dark to avoid fovea. A morphological operation like the top hat is performed for zooming and shrinking the nerves to adjust the outer structure of the eye. The Minor vessels are obtained by using the derivative of Gaussian filter without any crack or without any breaks in the structure of the retinal nerves which is used to determine the presence of blood clot in the eye. Gabor Filter is used to strengthening the pixels of the image. <b>Conclusion:</b> The segmented outputs of the Major vessel and Minor vessels are together added to get the resultant image of the eyes. Thus extracted and classified vessels can be sent to an intelligent artificial neural network for comparison with threshold values for diagnosing the problems due to high glucose level, cardiac disorders, etc. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=NC01-NC04&id=13207 https://doi.org/10.7860/JCDR/2019/41221.13207 Assessment of Endometrial Specimens for Tubercular Infection among Infertile Women using DNA-PCR Swati B Gajbhiye, Jayshree B Bhakre, Ajit S Damle <b>Introduction:</b> Genital Tuberculosis (GTB) is an important cause of infertility in developing countries like India. Diagnostic dilemma arises because of atypical clinical presentation, different results on imaging and mixed bag of bacteriological and serological tests such as routine microbiological tests such as Acid Fast Bacilli (AFB) staining and culture are of little significance because of its Paucibacillary nature. Specific and rapid diagnosis using Polymerase Chain Reaction (PCR), early anti-tuberculous treatment and appropriate surgical interventions can improve the results for restoration of female reproductive functions and reduction of procedural and postoperative complications. <b>Aim:</b> To assess the diagnostic performance of PCR, AFB culture and staining in infertility due to Female Genital Tuberculosis (FGTB). <b>Materials and Methods:</b> This observational cross-sectional study was conducted in Microbiology Department of Tertiary Care Hospital, Aurangabad, Maharashtra, India. Relevant clinical specimens were collected using standard procedures from 50 infertile women satisfying inclusion and exclusion criteria; and were evaluated by AFB staining, culture and TB-PCR.Categorical variables were compared using Chi-square test. A p-value <0.05 was considered as statistically significant. <b>Results:</b> Presence of FGTB was found in 6 (12%) cases by using all the investigative parameters alone or in combination. AFB smear alone was positive in 2 (4%), culture in 1 (2%) and TB-PCR in 5 (10%) of cases. <b>Conclusion:</b> PCR has highest sensitivity 100% with negative predictive value of 100% compared to microscopy and culture. Therefore, when the clinical suspicion is high and smear and culture results are negative, PCR is the method of choice for identifying the infection in FGTB cases. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=DC01-DC05&id=13208 https://doi.org/10.7860/JCDR/2019/42587.13208 Prevalence of Various Types of Cancers and an Observational Study of Various Haemoglobin Levels in Different Grade of Cancer: A South Indian Hospital Based Study Silvya Mathangi, Siva Reddy Challa, Naga Akhila Bhuvaneswari Kondru, Divya Arangi, Sri Lekhya Chowdary Kambham, Gopichand Mamillapalli, MV Subba Rao <b>Introduction:</b> The status report on the global burden of cancer worldwide by the International Agency for Research on Cancer using GLOBOCAN 2018 estimated 18.1 million newer cancer cases and 9.6 million cancer deaths in 2018. Particularly, breast cancer ranks second according to incidence of cancers in women in the world. There is growing evidence that anaemia has an impact on treatment outcome, prognosis and survival of cancer patients. <b>Aim:</b> To assess the prevalence of different types of cancers and frequency of pre-diagnosed haemoglobin levels in cancer patients. <b>Materials and Methods:</b> A cross-sectional study was carried out for two months period between September 2017 and October 2017 in a Tertiary cancer care hospital, A South Indian hospital based study. A total of 90 patients were recruited into the study based on inclusion criteria. The collected data was analysed by calculating the percentage frequency. <b>Results:</b> Breast cancer (n=45, 50%), gastrointestinal cancers (n=14, 16%), urogenital cancers (n=14, 16%), Hodgkin’s lymphoma (n=5, 6%), non-Hodgkin’s lymphoma (n=1, 1%), other advanced metastatic carcinomas (n=9, 10%), sarcomas (n=2, 2%) were reported. In our study population breast cancer patients were highly prevalent. In breast cancer patients, the maximum number of patients was diagnosed with Infiltrating Ductal Carcinoma (IDC). In IDC patients, majority of patients were diagnosed in Grade II IDC. <b>Conclusion:</b> Prevalence of breast cancer patients was high in our study population of cancer patients. Most of the patients diagnosed in Grade II were found to have less haemoglobin levels while it was not observed in Grade I. Our result implies that anaemia could be one of the poor prognostic factors for cancer progression. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=XC01-XC04&id=13209 https://doi.org/10.7860/JCDR/2019/41728.13209 Visual Evoked Potential: A Tool for Detection of Preretinopathy and Prognostication in Diabetes G Krishnachandra Prasad, Anjamparuthikal Aboobekar Haris <b>Introduction:</b> Diabetic Retinopathy (DR) is a common complication of Diabetes Mellitus (DM) that affects retinal blood vessels. It is the leading cause of blindness in the age group of 20 to 74 years despite the fact that visual loss due to DM may be preventable by glycaemic control. Unfortunately, in many cases, the patient is asymptomatic until it is too late for effective treatment. Diagnosis of retinal changes and determination of prognosis can be done by studying the pattern Visual Evoked Potential (VEP). <b>Aim:</b> To investigate the ability of VEP in detecting preclinical neuro-degenerative changes in patients with diabetic preretinopathy by studying changes in VEP, in terms of P100 wave latency in diabetic patients without retinopathy. <b>Materials and Methods:</b> This study included 35 diabetic patients without retinopathy and 35 non-diabetic controls. They were selected from patients attending the outpatient Department of Ophthalmology for the screening of DR. Controls were selected from the bystanders of the patients who came to the Ophthalmology outpatient department. VEP study was done in subjects and controls and the latency of P100 wave was analysed. P100 wave of VEP was chosen as it was the most reliable with less inter-subject variability. Mean P100 wave latency of both groups were compared and analysis was done checking for any variation in P100 wave latency with respect to the duration of diabetes and the control of diabetes. Data was analysed using SPSS-16. Student’s t-test was applied when two groups were compared while ANOVA (Analysis of Variance) test was applied for multiple group comparisons. The p-value <0.001 is considered significant in this study. <b>Results:</b> There was a significant prolongation of P100 wave latency in diabetics without retinopathy. It was also found that there was positive correlation between prolongation of P100 wave latency and the duration of diabetes. In patients with good diabetic control the prolongation was less, as compared to those with poor diabetic control. <b>Conclusion:</b> Analysis of P100 wave of VEP is helpful in the detection of diabetic preretinopathy changes. This could be a better tool for the detection of very early retinal changes before any clinical evidence of retinopathy has set in. Better glycaemic control by means of exercise, diet or change or increase in dose of medicines could prevent the early development of retinopathy if done at this stage. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=OC10-OC12&id=13210 https://doi.org/10.7860/JCDR/2019/41774.13210 To Compare Cosmetic Outcome using Cutting Diathermy against Scalpel for Incising Skin during Elective Abdominal Surgery: A Randomised Controlled Trial Yash Thakkar, Ramesh Dumbre, Arun Fernandes, Deepak Phalgune <b>Introduction:</b> Use of diathermy has become ubiquitous in majority of surgical specialities for its convenience and advantages with respect to haemostasis and sharps safety. However, its use for incising epidermis and dermis of the skin remains controversial because of the fear of thermal burns, resulting in a scar that is cosmetically inferior to that from the use of a scalpel. <b>Aim:</b> To compare the cosmetic outcome of cutting diathermy against scalpel for incising skin during Elective Abdominal Surgery. <b>Materials and Methods:</b> Two hundred eighteen patients admitted for elective open abdominal procedures were randomised for skin incision, into scalpel and cutting diathermy group. Postoperative wound pain was measured using Visual Analogue Scale (VAS) score after 6, 12, 24 and 48 hours. At 1, 3 and 6 months after surgery, patient’s surgical scars were evaluated by using Patient and Observer Scar Assessment Scale (POSAS). Inter-group comparison of categorical and continuous variables was done using chi-square test/Fisher’s-exact test and Unpaired t-test respectively. <b>Results:</b> Mean VAS score in scalpel group was significantly higher as compared to diathermy group. Mean total score of POSAS patient scale, mean total and overall score of POSAS observer scale at 1 and 3 months was significantly higher in diathermy group compared to scalpel group. Mean total and overall score of POSAS patient scale and mean total and overall score of POSAS observer scale at 6 months did not differ significantly between two study groups. <b>Conclusion:</b> Cutting diathermy incisions in elective open abdominal procedures had less postoperative pain and better cosmetic outcome in healing as measured by POSAS at one month and 3 months whereas cosmetic outcome was comparable to scalpel incisions at six months follow-up. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=PC05-PC08&id=13211 https://doi.org/10.7860/JCDR/2019/42349.13211 Correlation between Smartphone Addiction, Sleep Quality and Physical Activity among Young Adults S Haripriya, Sanjay Eapen Samuel, M Megha <b>Introduction:</b> In this era of smartphone revolution, the users are prone to get addicted to the convenience provided by it. The youth are the most vulnerable group for smartphone addiction. The smartphone revolution since 2000 is bringing noticeable changes in daily lives of people as it is providing more convenience in day to day life but along with that, there are many adverse-effects in interpersonal relationships, psychological well-being and physical health. <b>Aim:</b> To measure smartphone addiction, assess sleep quality and assess physical activity among young adults and to establish the relationship among the three. <b>Materials and Methods:</b> A cross-sectional study was conducted on 113 students recruited from a health science college in Mangaluru. Smartphone addiction was measured using Smartphone Addiction Proneness Scale-short version (SAPS) which classifies the users as high risk, potential or dangerous risk and no risk users, sleep quality was assessed using Pittsburgh Sleep Quality Index (PSQI) and physical activity assessed using International Physical Activity Questionnaire-Short Form (IPAQ-SF). Karl Pearson’s correlation coefficient test was used to find the correlation between the three. <b>Results:</b> The correlation coefficient of smartphone addiction and sleep quality was 0.473 indicating a moderately significant positive correlation and that of smartphone addiction and physical activity was -0.335 indicating a negative significant moderate correlation. <b>Conclusion:</b> From the present study it can be concluded that in high risk and dangerous or potential risk users of smartphones the quality of sleep and physical activity tends to decrease. Young adults showing insomnia symptoms should be attentively monitored for smartphone addiction. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=YC05-YC09&id=13212 https://doi.org/10.7860/JCDR/2019/42168.13212 Factors Influencing Sputum Smear Conversion among Smear Positive Pulmonary Tuberculosis Patients in Kandahar City, Afghanistan Muhammad Haroon Stanikzai, Mohan Bairwa, Abdul Wahed Wasiq, Shiv Dutt Gupta, Khalid Akbari <b>Introduction:</b> Sputum conversion is an important indicator of successful Tuberculosis (TB) treatment and control program. There is no published research on sputum conversion rate and its determinants, from Afghanistan. <b>Aim:</b> To determine sputum smear conversion rate and identify the factors associated with delayed sputum conversion following TB treatment among smear positive pulmonary TB patients. <b>Materials and Methods:</b> The study was based on a secondary data analysis of a retrospective cohort of 345 newly diagnosed sputum smear positive pulmonary TB patients, from 13 public health facilities in Kandahar city, Afghanistan during the year 2017. Data was extracted in a predesigned format, which included socio-demographic, clinical, microbiological, radiological, and treatment initiation and follow-up data from TB registers. Sputum conversion rate was presented as percentage. Bivariate analysis and multiple logistic regressions were used to identify the predictors of delayed sputum conversion. <b>Results:</b> The mean age of the study participants was 38.3 years (SD&#177;17.6). Of the total, 165 (48%) were male and 180 (52%) were female. About 83% study participants were successfully converted to sputum smear negative at the end of the intensive phase of treatment. On bivariate analysis, age group 50 years and above, female sex, haemoptysis at the first visit, and heavy bacterial load (sputum acid fast bacilli grading 3+) were found to be associated with delayed sputum conversion. Multiple logistic regression showed that heavy sputum bacterial load (adjusted odds ratio=15.7, 95% CI=7.82-31.6) was the single independent predictor of delayed conversion. <b>Conclusion:</b> Higher sputum AFB grading has a greater risk of poor outcome than the patients with lower smear grading. Hence, the policy makers in Afghanistan should take a note of the results of this study to accelerate the TB control in the country. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=LC18-LC21&id=13249 https://doi.org/10.7860/JCDR/2019/42689.13249 Analysis of Patients Presenting with Adnexal Mass in a Tertiary Care Centre Mukta Agarwal, Divendu Bhushan, Ruchi Sinha, Nishant Sahay <b>Introduction:</b> Adnexal masses are a common diagnosis in Gynaecology out-patient department. It can be benign or malignant. To arrive on a diagnosis, patient should be subjected to clinical examination and a variety of investigations. Management is tailored according to the diagnosis, age of the patient and the reproductive goal of the patient in future. <b>Aim:</b> To evaluate the proportion of benign and malignant aetiology in patients presented with adnexal mass and secondarily to correlate preoperative diagnosis with the histopathological diagnosis. <b>Materials and Methods:</b> A prospective observational study was conducted, where patients with adnexal masse presented during one year were included. After work-up for all the patients, appropriate case based management was done. Clinical diagnosis of benign or malignant as pre-operative was co-related with histo-pathology and proportion of benign and malignant cases were noted. <b>Results:</b> Total 81 cases with the diagnosis of adnexal mass were included in the study. Mean age of presentation was 36.26 years. Most common presentation was pain in abdomen; 70 (86.4%) patients had benign masses, while 11 (13.6%) masses were malignant including two cases of borderline variety. Both patients underwent exploratory laparotomy with peritoneal lavage with total abdominal hysterectomy with bilateral salpingo-oophorectomy with infracolicomentectomy. <b>Conclusion:</b> All Adnexal masses need to be evaluated clinically and radiologically. All investigations should aim at to differentiate benign and malignant masses. Preoperative diagnosis of benign or malignant mass is very important to plan optimum management of the case. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=QC04-QC06&id=13250 https://doi.org/10.7860/JCDR/2019/42018.13250 Avascular Necrosis of Femoral Head: A Retrospective Study of MRI Scans Prateek Singh Gehlot, Kajal Agrawal, Ritema Mangal, Varsha Sodani <b>Introduction:</b> Avascular necrosis of the femoral head is commonly encountered now-a-days with increasing use of steroids and alcohol. MRI is considered the most effective diagnostic investigation for avascular necrosis and is helpful for screening and detecting at early stage. <b>Aim:</b> The aim of the study was to determine the prevalence pattern and stages of presentation of Avascular Necrosis (AVN) of the femoral head. <b>Materials and Methods:</b> This was a retrospective study carried out at the Department of Radio-diagnosis in which MRI of the hip joint was performed during our study period, only those patients which showed positive signs for avascular necrosis of femoral head were included and were analysed over a period of seven years. The age, sex, laterally distribution, causative factors, staging according to Ficat and Arlet classification was done. <b>Results:</b> It was found that most commonly males of productive age group (21 to 40 years) were affected. Most of them had bilateral involvement however the involvement of left and right hip joint was nearly the same. Mostly, patient presented with stage-III disease accounting for 81 patients. <b>Conclusion:</b> Considering that the young males were commonly affected and presented with advanced stage disease it was recommended that screening MRI should be done in all patients presenting with hip complaints especially males of productive age group. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=TC04-TC06&id=13251 https://doi.org/10.7860/JCDR/2019/40929.13251 A Genomic Study of <i>Salmonella</i> Typhi ‘Vi’ Specific Bacteriophages: Futuristic Approach in Therapeutics Pratibha Gavel, Sujit Bharti, Gopal Nath, Ragini Srivastava <b>Introduction:</b> Considering the high endemicity of typhoid in developing country and the feasibility of phage therapy for this disease, the study was planned to determine the genomic structure of bacteriophages specific to ‘Vi’ positive <i>Salmonella</i> Typhi. <b>Aim:</b> To use different molecular tools to characterise <i>Salmonella</i> Typhi ‘Vi’ specific bacteriophages genotypically. <b>Materials and Methods:</b> <i>Salmonella</i> Typhi ‘Vi’ specific bacteriophages were isolated and propagated. Phage DNA was extracted and analysed by spectrophotometry, agarose gel electrophoresis and restriction enzyme digestion was done. <b>Results:</b> In the present study, two bacteriophages targeted against ‘Vi’ positive <i>Salmonella</i> Typhi were isolated. DNA of the phages was extracted for molecular characterisation. On restriction analysis, both the phages were found to be of similar pattern, suggesting that they were genetically similar, although they had different plaque morphologies. <b>Conclusion:</b> The present study may be helpful in genomic characterisation of <i>Salmonella</i> Typhi ‘Vi’ specific bacteriophages for their future use in therapeutics. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=BC14-BC17&id=13252 https://doi.org/10.7860/JCDR/2019/42189.13252 Hyponatremia in Children Hospitalised with Community-acquired Pneumonia: A Prospective Observational Study Mohd Haseeb, Madhuri Engade, Aashna Valecha, Namita Shanbag, Sachin Wagh <b>Introduction:</b> Community-acquired Pneumonia (CAP) is a common cause of mortality and morbidity among the under-5 years age population. Hyponatremia (HN) is common in patients with CAP, it is usually asymptomatic but it is associated with severe disease and poor outcome. Its monitoring and early identification can guide proper fluid therapy in patients with CAP. <b>Aim:</b> To evaluate the occurrence of Hyponatremia (HN) in paediatric patients with CAP and to analyse its association with severity of pneumonia. <b>Materials and Methods:</b> This prospective observational study was conducted in MGM Medical College and Hospital Aurangabad, India, over a period of 2 years. Serum sodium concentration was measured in 76 hospitalised children with clinically and radiologically confirmed CAP. Those with hyponatremia were identified. Statistical analysis was done by chi-square test for categorical variables and t-test for continuous variables to study the relationship of hyponatremia with various clinical parameters and inflammatory markers. <b>Results:</b> Out of 76 patients, 41(54%) had hyponatremia on the day of admission. In the majority of patients (38.2%), HN was mild (mild HN 131-134 mEq/L moderate HN 126-130 mEq/L, severe HN less than 125 mEq/L). None of the patients had neurological symptoms due to HN. On admission, hyponatremic patients had higher white blood cell count (40 vs. 28 p 0.013), neutrophil count (38 vs. 25 p 0.014) and serum C-reactive protein (39 vs. 28 p 0.032) than normonatremic ones. No association was found with the type of intravenous fluid (0.45% DNS or Isolyte P) used and hyponatremia (P 0.6471). <b>Conclusion:</b> It can be concluded that hyponatremia is common in CAP and it is associated with the disease severity. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=SC01-SC04&id=13238 https://doi.org/10.7860/JCDR/2019/42103.13238 Comparison of Anti-Epileptic Drugs in Terms of Treatment Outcomes, Adverse Effects and Quality of Life MD Shafiqur Rahman, Amir Ali Syed, Javeria Khaled Syeda, Mahnoor Ahmed, Afia Masroor Sara, Mehruq Fatima <b>Introduction:</b> Epilepsy is a disorder of the nervous system requiring prompt medical care and life-long treatment. Unfortunately, data regarding efficacy, Adverse Drug Reactions (ADRs) and Quality Of Life (QOL) in patients using different Anti-Epileptic Drugs (AEDs) is sparse. <b>Aim:</b> To evaluate five AEDs in comparison for efficacy in reducing seizures, improvement in QOL and ADRs due to the prescribed drug. <b>Materials and Methods:</b> In this cohort study, 81 epilepsy patients (age >10 years) receiving the following drugs: Levetiracetam, Lacosamide, Oxcarbazepine, Valproate and Phenytoin for atleast six months were enrolled. Quality of Life in Epilepsy Inventory–31 (QOLIE-31) questionnaire was used for measuring the QOL. Efficacy of AEDs was measured on the basis of seizure control, QOL and adverse effects. All the patients were followed-up weekly for six months for treatment response and adverse effects. Overall, QOLIE scores were calculated. T-tests, analysis of variance and regression analysis were used wherever appropriate. The p-value <0.05 was considered statistically significant. <b>Results:</b> Seizure control was reported in 79% of the patients. A total of 43.2% patients were reported to have experienced an ADR during the course of the study. Adverse events predominantly affected gastroenterologic, psychiatric and general body systems. Patients on Levetiracetam had the best QOL and phenytoin the least. <b>Conclusion:</b> Better seizure control, high medication adherence and improved QoL was seen in patients with Levetiracetam; followed by Lacosamide, Oxcarbazepine, Valproate and least in Phenytoin. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=FC01-FC07&id=13228 https://doi.org/10.7860/JCDR/2019/41895.13228 Histogenesis of Human Fetal Spleen at Different Gestational Ages Sandhya Vikas Yatagiri, Ashwini B Nuchhi, Vijayalaxmi S Patil, Vikas R Yatagiri, Balappa M Bannur <b>Introduction:</b> Among the lymphoid organs, spleen is the largest one with rich blood supply. It serves to filter the blood, shows immune response to antigens and in fetal life acts as a haematopoietic organ to produce erythrocytes and granulocytes. As of known, the human lymphoid organs shows variations, spleen lacks the definite histogenetic changes. <b>Aim: </b>To find out the histogenesis of spleen in different gestational ages between normal pregnancy and hypertension in pregnancy. <b>Materials and Methods:</b> The present observational study was carried out on 100 human aborted and stillborn foetuses, aged between 12 to 40 gestational weeks. Out of 100 fetuses, 50 belonged to normal pregnancy and 50 belonged to hypertension in pregnancy. The foetuses were obtained from the Department of Obstetrics and Gynaecology and Department of Pathology. The tissue was processed, slides prepared and stained with Haematoxylin and eosin. The slides were observed under compound microscope using 4x,10x,40x and 100x objectives and interpreted. <b>Results:</b> The following microscopic features were observed in the present study at different gestational ages in normal pregnancy. At 12-18 weeks, spleen was lined by thin capsule, parenchyma with blood vessels, reticular cells and haematopoietic cells seen, at 17 weeks central arteriole started appearing. At 19 weeks trabeculae were seen, venous sinuses, central arteriole surrounded by few lymphocytes, 20-weeks; red and white pulp were seen, Peri-arteriolar lymphatic sheath was seen. At 24 weeks capsule was more thick with increased trabeculae. At 24-30 weeks germinal centre was seen along with the ring fibres. At 30-36 weeks, capsule was thick, white pulp was well defined. At 37 weeks, germinal centre was well-defined. At 38-40 weeks, the fetal spleen resembled that of an adult spleen. The present study attempted studying the histogenesis of fetal spleen in hypertension in pregnancy. The microscopic features of spleen did not show differences between normal pregnancy and that in hypertension in pregnancy. The study could not establish any comparable differences in the two situations. <b>Conclusion:</b> The present study served to study the splenic histogenesis to some extent. The findings in individual Author variations are still existing. The study could not conclude difference in the histogenesis of spleen in normal pregnancy and hypertension in pregnancy. This study may serve the Anatomists and the Pathologists for studying the individual variations in histogenesis of spleen. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=AC01-AC04&id=13229 https://doi.org/10.7860/JCDR/2019/42530.13229 Risk Factors for Recurrent Intussusception in Children: A Record Based Descriptive Study Liya Joseph <b>Introduction:</b> Early diagnosis and management of cases of recurrent intussusception is challenging. It is well accepted that Pathological Lead Points (PLP) can precipitate recurrence. A few recent studies have identified association of a few clinical variables with recurrence. <b>Aim:</b> To assess the frequency of clinical features and PLP in recurrent intussusception and to find the risk factors that lead to recurrence. <b>Materials and Methods:</b> This was a retrospective cohort study that included medical records and ultrasound scan registry of children with intussusceptions treated with ultrasound guided hydrostatic saline reduction or surgery, between January 2010 to December 2017 in a Government Tertiary care and teaching institution. Totally, 362 cases of intussusceptions were reviewed. Follow-up data were collected. There were 86 recurrent cases: 64 had single and 22 had multiple recurrences. The clinical parameters-age of child, gender, duration of symptoms, presence of vomiting, bloody stools, abdominal mass, ultrasound features, PLP identified, were evaluated. Fisher’s-exact test and logistic regression analysis were used to measure significant factors affecting recurrent intussusception. <b>Results:</b> After comparing recurrent and non-recurrent cases, it was determined that factors-age >1 year, shorter duration of symptoms (&#x2264;24 hrs), absence of vomiting and absence of bloody stools were significantly and independently associated with recurrent intussusception. <b>Conclusion:</b> Intussusception in older children with shorter duration of symptoms and subtle clinical features need to be followed-up closely for recurrence. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=PC12-PC14&id=13230 https://doi.org/10.7860/JCDR/2019/42630.13230 Diathermy Versus Conventional Scalpel in Making an Abdominal Incision: A Prospective Study Shruti Pandey, Rajendra Prasad Choubey, Indra Tiwari Narain <b>Introduction: </b>Scalpel incisions produce nominal harm to neighboring and adjacent tissues. Diathermy is considered to be an efficient mode of incision and its use is widespread, but due to scarring potential, advanced wound contamination rate and poor wound healing, the extensive use of surgical diathermy for incisions. <b>Aim: </b>To compare the use of electrosurgery and conventional scalpel in making an abdominal incision with respect to blood loss, operating time, wound infection rate and post-operative pain. <b>Materials and Methods:</b> This was a prospective study in which patients above 16 years of age were included and all patients undergoing abdominal surgery were randomly allocated to two arms of the study. In Group A, incision by conventional scalpel and in group B, incision by diathermy were made. Incisions were of three types i.e., Kocher’s incision were 4, Midline were 22 and Pfannestiel were 44. Data was collected and entered in the Microsoft excel sheet and analysed for blood loss, operating time, wound infection rate and post-operative pain. <b>Results:</b> Total number of patients included in this study was 70. Age of the participants were in range of second to seventh decade, youngest being 19 years and the oldest being 73 Years of age. Male and female ratio was 1:6. Time taken for incision and blood loss in group B is less than group A respectively. (p=0.009, p=0.001) in all types of incision. Rate of complications following electrocautery incision were also low and no haematoma or seroma were noted in those wounds. <b>Conclusion:</b> Diathermy technique is compatible with conventional scalpel being safe, effective and simple. Less blood loss was noted with clearer field of dissection, as compared to one created by conventional steel scalpel. Because of the faster haemostasis, the mean time of making an incision was also less in case of diathermy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=PC09-PC11&id=13219 https://doi.org/10.7860/JCDR/2019/42093.13219 Serum Paraoxonase-Early Diagnostic Biomarker in NASH/NAFLD Jyotchna Devi Bade, Kiranmai Chittajallu, Naazia Arifuddin, Thejaswini Muppala, Balachandrarao Naidu Menda, Uma Lakshmi Valluri <b>Introduction:</b> Non-Alcoholic Steatohepatitis (Nash)/Non-Alcoholic Fatty Liver Disease (NAFLD) is one of the important causes of morbidity and mortality worldwide. Serum paraoxonase (PON 1) is a glycosylated protein, an esterase associated with High density lipoprotein (HDL), and can be speculated to be a potential biomarker of liver injury or lipid peroxidation. <b>Aim:</b> To assess the PON 1activity in NASH/NAFLD in combination with standard liver function tests in evaluating liver damage. <b>Materials and Methods:</b> The case-control study was conducted at Department of Biochemistry, Osmania General Hospital, Hyderabad, India. Serum Paraoxonase levels were estimated in 30 clinically diagnosed NASH/NAFLD patients, and 30 apparently healthy blood donors. Serum Paraoxonase levels was measured by kinetic assay in spectrophotometer along with standard liver function tests (total and direct bilirubin, total protein, albumin, Alanine Transaminase (AST), Aspartate Transaminase (AST), Alkaline Phosphatase (ALP). Results were expressed as Mean&#177;Standard deviation (Mean&#177;SD) of various parameters. Paired t-test was used to compare the parameters between control and case group. ROC curve analysis was done to assess maximum sensitivity and maximum specificity and diagnostic efficiency. A p-value of <0.05 was considered to be statistically significant. <b>Results:</b> Serum PON 1 levels were significantly (p-value < 0.001) decreased in patients (712.7&#177;232.9 ng/mL) when compared with controls (988&#177;238 ng/mL). ROC curve analysis showed increased senstivity (86.67%) and decreased specificity (60%) of PON 1 as compared to total and direct bilirubin, AST and ALT. The Area Under Curve (AUC) for serum PON 1 was 0.79, and PON 1 had highest diagnostic efficiency of 73% as compared to other liver parameters (56.6%-69.9%) in NASH /NAFLD. <b>Conclusion:</b> Serum Paraoxonase is an early diagnostic marker for patients with oxidative stress like NASH/NAFLD and serum PON 1 levels should be measured along with standard liver function tests. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=BC06-BC09&id=13220 https://doi.org/10.7860/JCDR/2019/42414.13220 Effect of Fluoxetine on Kidney of Albino Rats- A Histological Study Alka Aggarwal, SL Jethani, RK Rohatgi, Juhi Kalra <b>Introduction:</b> Fluoxetine and other Selective Serotonin Reuptake Inhibitors (SSRIs) are reported to produce hyponatremia especially in elderly patients. <b>Aim:</b> To evaluate histological changes in kidney tissue of albino rats by different doses of fluoxetine for different duration and changes in the mean diameter of Proximal Convoluted Tubules (PCT) and Distal Convoluted Tubules (DCT) in control and experimental group was observed. <b>Materials and Methods:</b> An Experimental study was conducted in which total of 72 albino rats (36 male and 36 female) received single different doses- Mild (10 mg/Kg/day), moderate (20 mg/kg/day) and high (40 mg/kg/day) of intraperitoneal injection of fluoxetine hydrochloride daily for 14 days (2 weeks), 28 days (4 weeks) and 84 days (12 weeks). Changes in kidney tissue histology were investigated and changes in the mean diameter of PCT and Distal convoluted tubules were also observed. <b>Results:</b> Mild and moderate doses of fluoxetine hydrochloride produce changes in the kidney histology in the form of appearance of podocytes bridge, degenerated/shrunken and swollen glomerulus, dilated tubules when given for long duration. High doses of fluoxetine change kidney histology within few days in the form of hypercellular shrunken glomerulus with apparently increased urinary/capsular space, appearance of podocytes bridge, dilated and degenerated tubules with presence of cast. Mean diameter of PCT was found to be increased in experimental rats in comparison to control rats (p<0.01) but there was no statistical significant change in diameter of DCT. <b>Conclusion:</b> The findings showed that fluoxetine produce changes in kidney histology both at the level of glomerulus and tubules. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=AC05-AC08&id=13232 https://doi.org/10.7860/JCDR/2019/42396.13232 Association between Serum Leptin Levels in Obesity and Type 2 Diabetes Mellitus Raviraj Gawali, Arun Bahulikar, Deepak Sadashiv Phalgune, Ajit Tambolkar <b>Introduction:</b> It is hypothesised that leptin, the gene product of the obese gene plays an important role in regulating body weight and has a potential role as a treatment tool for obesity and Type 2 Diabetes Mellitus (T2DM). There is little documentation describing the relationship between serum leptin and the indices of obesity such as Body Mass Index (BMI) and T2DM. <b>Aim:</b> To determine the relationship of serum leptin levels with BMI and type 2 DM patients. <b>Materials and Methods:</b> This observational study was conducted in 140 patients with known diagnosis of type 2 DM with and without obesity and non-diabetic patient with BMI &#x2265;25 kg/m<sup>2</sup>. Patient’s BMI and waist hip ratio were noted. Estimation of fasting serum leptin, fasting serum glucose, serum Total Cholesterol (TC), serum Triglycerides (TG), serum High Density Lipoprotein (HDL) cholesterol, serum Low-Density Lipoprotein (LDL) cholesterol and Very Low Density Lipoprotein (VLDL) cholesterol were done. Kruskal Wallis test and Mann-Whitney U test was used to compare median of continuous variables. Correlation analysis was done using Spearman’s correlation technique. <b>Results:</b> Median serum leptin level was significantly higher in patients who had DM and whose BMI was &#x2265;25 kg/m<sup>2</sup>. Fasting glucose, TC, LDL cholesterol, and VLDL cholesterol showed statistically significant and positive correlation, whereas HDL-cholesterol showed statistically significant and negative correlation with serum leptin levels. <b>Conclusion:</b> Serum leptin levels were higher in type 2 DM and obese patients. Fasting glucose, TC, LDL cholesterol, and VLDL cholesterol showed positive correlation, whereas HDL-cholesterol showed negative correlation with serum leptin levels. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=OC17-OC19&id=13235 https://doi.org/10.7860/JCDR/2019/42410.13235 A Proposed Composite Disease Activity Score for Extra-articular Manifestations in Rheumatoid Arthritis Bhaskar Thakur, Prasanta Padhan <b>Introduction:</b> In Rheumatoid Arthritis (RA), extra-articular disease is single most important cause of morbidity and mortality. Although DAS-28 score is used for disease assessment in RA, extra-articular manifestations are not included in the same. Therefore an initial attempt was done for development of a composite Disease Assessment Score for Extra-Articular Manifestations (DAS-EAM) based on rheumatologists consensus. <b>Aim:</b> The study was an initial attempt to make a composite disease assessment score for EAMs in RA. <b>Materials and Methods:</b> A hospital based cross-sectional study done on 226 RA patients with various clinical parameters with waiting scores were included to develop the DAS-EAM score. This was compared with DAS-28 and Physician’s Global Assessment score and other demographic parameters and serology {RF, Anti-Cyclic Citrullinated Peptide (Anti-CCP)}. A Pearson’s correlation coefficient and Kappa agreement were calculated to find out the correlation as well as agreement between DAS-EAM score, Physician’s Global Assessment score and DAS-28 scores. <b>Results:</b> Patient’s age was significantly different among the DAS-EAM score (p=0.001). Other parameters such as gender, duration of disease and serology were not significantly associated with DAS-EAM score. There was no agreement between DAS-28 and DAS EAM score. <b>Conclusion:</b> Despite the major limitations such as single centered cross-sectional study design with small sample size, this is an initial attempt for development of a composite tool for extra-articular disease in RA. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=OC20-OC23&id=13240 https://doi.org/10.7860/JCDR/2019/42346.13240 Evaluation of the Effect of <i>Enicostemma axillare</i> Extract on Migration of MCF-7 Cell Line Kamalam Ravi, Krishnamoorthy Gunasekaran, Vijayaraghavan Rajagopalan, Santhi Silambanan <b>Introduction:</b> Breast cancer is the second leading cause of death among women and majority of them are due to metastasis of cancerous cells. The use of plant based compounds as complementary or alternative treatment has gained much significance in the recent times due to their low toxicity levels. <i>Enicostemma axillare</i> is the perennial herb known to have anti-inflammatory, anti-allergic, anti-oxidant, anti-microbial, anti-cancer and hypoglycaemic properties. <b>Aim:</b> To evaluate the effect of <i>E. axillare</i> extract on the migration of cancerous cells. <b>Materials and Methods:</b> The secondary metabolites from the plant were extracted using ethanol. Wound healing assay and western blotting were used to study anti-migratory effect and expression of migration associated proteins in human breast cancer MCF-7 cell lines. Statistical analyses were conducted by one-way ANOVA and Tukey HSD post-hoc tests, the p-value <0.05 was considered as significant. <b>Results:</b> The rate of migration of cells in control group was 100% accounting to a mean of 325 cells. In case of cell lines treated with <i>E. axillare</i> extract, the rate of migration was 32% accounting to a mean of 104 cells. There was a significant reduction (p-value <0.05) in the expression of Vascular Endothelial Growth Factor Receptors (VEGFR), phosphorylated Vascular Endothelial Growth Factor Receptor (pVEGFR), Insulin Like Growth Factor 1 Receptor (IGF1R), Matrix Metallopeptidase 9 (MMP-9), Phosphoinositide 3-kinases (PI3K) and Protein Kinase B (Akt) proteins in cell lines treated with <i>E. axillare</i> extract (12.5 µg) in comparison to the control. In addition, the extract also significantly upregulate the expression of Phosphatase and Tensin Homolog (PTEN) and protein (p-value <0.01). <b>Conclusion:</b> The study indicates that <i>E. axillare</i> extract inhibit the migration of cancer cells by inhibiting the expression of Matrix Metalloproteinase (MMPs) and Epidermal Growth Factor Receptors (EGFRs). Therefore, <i>E. axillare</i> extract can be used in formulations for breast cancer treatments. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=BC10-BC13&id=13241 https://doi.org/10.7860/JCDR/2019/42371.13241 Seroprevalence of Anti-Brucella Antibodies IgG and IgM in Acute Polyarthritis in a Tertiary Care Center in Southern India Therese Mary Dhason, Meenakshi Subramanian, Aravindhan Mani, Nesa Aurlene <b>Introduction:</b> Acute polyarthritis is a clinical manifestation of diverse aetiologies. Infectious diseases like Brucellosis, Lyme disease, Viral infections like Chikungunya are some of the causes for Acute polyarthritis. Brucellosis can present with fever, malaise and arthralgia. Osteoarticular complications leading to polyarthritis is not uncommon with Brucellosis. <b>Aim:</b> To find out the seroprevalence of Brucellosis in acute polyarthritis in a Tertiary Care Center. <b>Materials and Methods:</b> A prospective study was done in a Tertiary Care Center, Tamil Nadu for a period of six months from January 2017 to June 2017. Blood samples were collected from 60 patients with acute polyarthritis and also from 20 age and sex matched healthy controls. Sera were tested for the presence of anti IgM and anti IgG <i>Brucella</i> antibodies by Enzyme Linked Immuno Sorbent Assay (ELISA). Also, the acute phase reactant C-Reactive Protein (CRP) levels were measured by latex agglutination test. Statistical analysis was done by Chi-square test. <b>Results:</b> In patients with acute polyarthritis serum IgM was found significant (p=0.000347) compared to IgG. The mean CRP in the diseased group was 24.12&#177;12.10 mg/dL. <b>Conclusion:</b> Even though there was no statistical significance between <i>Brucella</i> antibodies and acute polyarthritis 16.66% were <i>Brucella</i> antibody positive. Hence screening for brucella antibodies on acute polyarthritis has a definite role while evaluating a case of acute polyarthritis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=DC06-DC09&id=13242 https://doi.org/10.7860/JCDR/2019/42205.13242 Self Reported Physical Activity Level and Barriers to Physical Activity in Youth of Bangalore, India Garima Gupta, Princy Varghese, Angaihi <b>Introduction:</b> Physical activity plays an important role in our day-to-day life. It is approximated that 36.9% of total Indian population is reported to be physically inactive, the fourth leading cause of non-communicable disease. <b>Aim:</b> To find out self reported physical activity levels and the existing barriers to physical activity among the youth of Bangalore, India. <b>Materials and Methods:</b> A total of 147 participants aged between 18-25 years were included in this observational study. The key tools in aiding the data collection were International Physical Activity Questionnaire (IPAQ), Barrier to Being Physically Active Quiz (BBAQ) and Pittsburgh Sleep Quality Index (PSQI). Descriptive statistical analysis for perceived barriers and co-relational analysis among physical activity and barriers using SPSS software was done. <b>Results:</b> The data uncovered that 38% of youth population had low physical activity level. Lack of will power (76.2%) and lack of energy (63.9%) were the maximum reported barriers to physical activity. Co-relational analysis among the barriers to physical activity showed that almost all the barriers of physical activity are significantly correlated with each other. <b>Conclusion:</b> It was found out that 38% of youth population in Bangalore was reported to have low physical activity level. Presently will power is the most challenging internal barrier faced by the youth. Study finding also suggest that if the individual is physically active they do not tend to encounter barrier to physical activity as compared to individual who are insufficiently active. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=YC10-YC13&id=13243 https://doi.org/10.7860/JCDR/2019/42281.13243 Precision Medicine: Emerging Trends in Cancer Therapy Rahul Badwaik Every individual has a different genetic make-up; even the genetic alterations are different in the same type of cancer. This demands specific and personalised treatment for the individual. Thus, studying the patient’s genetic and clinical profile is the foundation for precision medicine. With the developing technologies and newer molecular tools, it has become easy to select a target-specific treatment based on the genetic makeup of an individual. More individualised approach through precision medicines will not only help in treating cancer but shall negate the scope of early detection with the advanced screening techniques and might also aid in preventing them. In this review, author discuss different aspects of precision medicine in cancer therapy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=FE01-FE04&id=13231 https://doi.org/10.7860/JCDR/2019/42394.13231 Short Duration, Intensive Bed Mobility Training in Idiopathic Parkinson’s Patients- One Group Pre-post Test Study Design Venkatesh Venkatraman Sankarapandian, Deepti Chaitanya Lele, Immanuel Jeyasingraj Krishnasamy Pandian <b>Introduction:</b> Patients with Parkinson’s disease have difficulty in moving inside and getting out of the bed. Lack of bed mobility has several impacts on these patients including sleep disturbances. Generally, the length of stay in hospital for these patients is limited to few days which become a challenging task for significant improvement in bed mobility. <b>Aim:</b> To determine the effectiveness of short duration, intensive bed mobility training in idiopathic Parkinson’s disease patients. <b>Materials and Methods:</b> One group pre post-test study design was used. The study included 15 patients diagnosed with Idiopathic Parkinson’s disease in the age group of 50-75 years. All the participants in the study were between stage 1.5 to stage 3 on Modified Hoen and Yahr scale. Modified Hoehn and Yahr scale has 1-5 stages which describe the motor symptoms of the Parkinson’s disease. This helps in categorising the advancement of the disease based on its stages and track progression of the disease. This study uses modified version of the same scale. The participants were conveniently assigned in a single group, who satisfied the selection criteria. Pre and Post test scores were taken using bed mobility component of Lindop Parkinson’s disease mobility assessment (LPAS), body bradykinesia components and turning in bed of Unified Parkinson’s Disease Rating Scale (UPDRS). Patients received intensive bed mobility training of short duration (30 mins/session) three times a day for seven days. Total 21 sessions were given to each patient. Paired t-test was used to compare the results of pre and post training for LPAS and UPDRS which were the outcome measures. <b>Results:</b> There was significant improvement in performing tasks of bed mobility. Patients were able to perform turning in bed without difficulty. Speed and the quality of movements showed drastic improvement. This was supported by statistically significant difference in LPAS bed mobility component, and a statistically significant improvement in pre and post-test performance for UPDRS-turning in bed and body bradykinesia components. <b>Conclusion:</b> Smaller duration of exercise sessions was effective in improving bed mobility of the idiopathic Parkinson’s patients. Practising tasks multiple times a day helped in improving the performance of these patients. Short duration intensive training is effective in improving bed mobility. Studying the long-term effect of short duration intensive training with larger sample size should be considered for further research. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=YM01-YM04&id=13234 https://doi.org/10.7860/JCDR/2019/42280.13234 Radiological Imaging in Diagnosis of Proteus Syndrome Shibani Mehra, Umesh Garga, Parika Rampal Proteus syndrome is a rare hamartomatous condition with multisystem involvement and diverse clinical manifestations, common ones being hemihypertrophy of one or more body parts, presence of lipomas, cutaneous epidermal nevi and vascular malformations. Imaging plays a role in bringing out internal organ involvement and helps in differentiating this syndrome from other hemihypertrophy syndromes with vascular malformations like Klipppel-Trenauny syndrome, NF-1 and Bannayan-Riley-Ruvalcaba syndrome. X-rays reveal the musculoskeletal features associated with this syndrome. Cross sectional imaging modalities reveal the visceral involvement and the presence of tumours. Vascular malformations are a part of this syndrome and those in muscle or subcutaneous tissues are diagnosed with Doppler ultrasound while those in viscera are diagnosed by MRI. In the absence of genetic testing, the diagnosis of Proteus syndrome can be made with clinical and radiological criteria. We report the clinical and radiological findings in a patient of Proteus syndrome. Our case is unique as it showed certain features that have not been commonly mentioned in literature, such as benign retroperitoneal vascular tumour, discordant advanced bone age and associated hemihypertrophy of ipsilateral anterior and posterior abdominal wall. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=TD01-TD04&id=13181 https://doi.org/10.7860/JCDR/2019/41601.13181 Announcement Pedicon 2012 is pleased to announce a <a href="https://pedicon2020.com/research-office.php">Pre-conference workshop</a> on 8th January 2020 on the topic “HOW TO ORGANIZE RESEARCH IN OFFICE PRACTICE” at Hotel Effotel, Ring Road, Indore. If you wish to register- log on to <a href="https://www.pedicon2020.com/">www.pedicon2020.com</a> https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=October&volume=13&issue=10&page=ZZ01-&id=13253 https://doi.org/10.7860/JCDR/2019/.13253