Journal of clinical and diagnostic research https://www.jcdr.net/back_issues.asp JCDR Cytological Diagnosis of Pilomatricoma: A Case Report Mary Raju, Kumari Ajitha, Elizabeth Joseph, Sany Philip, Dahlia Joseph Pilomatricoma is an uncommon benign neoplasm arising from the cells of the outer sheath of the hair follicle. Pilomatricoma is often misdiagnosed clinically and cytologically due to rarity of the lesion as well as difficulty in obtaining all cytological features. We report the cytological and histopathological findings of a case of pilomatricoma which presented to us as post auricular swelling. The present case highlight the importance of considering pilomatricoma as differential diagnosis of dermal or subcutaneous nodules and to keep in mind the variability of the cellular composition of this lesion to avoid misdiagnosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=ED01-ED03&id=13673 https://doi.org/10.7860/JCDR/2020/42671.13673 A Rare Co-existence of Pulmonary Nocardiosis with <i>E.coli</i> Infection in Immunocompetent Host Amithash Marulaiah Prabhudev , Thomas Antony , Vyshak Uddur Surendra , Rahul Magazine , Febi Ann Roy Community Acquired Pneumonia (CAP) is the second leading cause of death worldwide. Diagnosis becomes difficult when these are associated with legionella or nocardiosis, as these are not easily grown in routine aerobic culture. In a setting of high burden countries for tuberculosis like India, an acid fast bacilli is always taken as Mycobacterium tuberculosis until and unless proved otherwise. This is a case report of 38-year-old female, with no co-morbid illness, with cough, breathlessness, and fever of two weeks duration. On sputum microbiological evaluation was found to have co-existence of Pulmonary Nocardiosis with Escherichia coli (E.coli) infection. This case is important in many levels; to begin with, considering the diagnosis, a sputum positive for acid fast staining confirms the diagnosis of pulmonary tuberculosis. Hence diagnosis of other rare acid fast bacilli such as Nocardia may be missed. Secondly, aerobic bacteria causing mixed bacterial pneumonia are reported very rarely, and have a high mortality rate. Co-existence of Nocardia with E.coli causing pneumonia is rare. Its occurrence in an immunocompetent host makes it even more difficult for diagnosis. Patient not responding to antibiotic therapy or anti-tubercular therapy, necessitates further evaluation to rule out other co-existing potential pathogen or condition. Patient was started on cefoperazone sulbactum and amikacin along with suplhamethoxazole + trimethoprim for seven days. Suplhamethoxazole + trimethoprim, was continued for six months and she showed clinico-radiological improvement https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=OD01-OD02&id=13674 https://doi.org/10.7860/JCDR/2020/43633.13674 Catastrophic Presentation of a Polycystic Kidney Disease- Case Report and Review Subhash Chandra Dash, Naba Kishore Sundaray, Deba Prasad Kar, Beeravelli Rajesh, Praveen Patil <b>Introduction: </b>Preeclampsia, a transient but potentially dangerous, multisystem disorder is one of the most common complications of pregnancy and is a principal cause of maternal and fetal morbidity and mortality. Calcium deficiency and hypothyroidism have been found to be associated with pregnancy-induced hypertension and preeclampsia. <b>Aim:</b> To estimate the serum calcium level, thyroid profile, their intercorrelation and odds with occurrence of preeclampsia. Calcium and serum Thyroid Stimulating Hormone (TSH) levels were further correlated to Body Mass Index (BMI) of participants and to the birth weight of their newborns to investigate their effects or outcome. <b>Materials and Methods:</b> This cross sectional, case-control study was conducted for a period of one year (July 2018 to June 2019). A total of 170 pregnant women: 80 in preeclampsia group (case group); 90 in normotensive group (control group) were enrolled in the study. All the study subjects were in third trimester and were between 18-45 years of age. Total serum calcium levels and thyroid profile (fT3, fT4 and TSH) of all the study participants were estimated using fully automatic analyser. Proteinuria was measured by urine dipsticks. <b>Results:</b> Mean total serum calcium levels in cases were lower (8.2&#177;0.8) as compared to controls (8.7&#177;0.5), p<0.05 whereas, mean serum TSH levels in cases were found to be higher (5.07&#177;3.34) as compared to controls (3.3&#177;1.75), p<0.05. Odds Ratio (OR) for total serum calcium level <8.2 mg/dL was 10.8 (95% CI=7.437-7.806 p<0.05 and for serum TSH level >5.7 µIU/mL was 4.98, (95% CI=6.726-9.831; p<0.05. A combination of these two parameters together was observed in 18.75% of cases as opposed to none in controls. Birth weight of newborns of preeclamptic mothers was found to be positively correlated with total serum calcium level while a negative correlation was observed with serum TSH level. <b>Conclusion:</b> Findings from the present study suggest that serum calcium level was observed as a better indicator and predisposing risk factor for preeclamptic occurrence than serum TSH levels. Screening of thyroid profile and serum calcium levels and analysis of their combined status during pregnancy can help in minimising the risk of preeclamptic occurrence and associated adverse pregnancy outcomes. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=OD03-OD05&id=13679 https://doi.org/10.7860/JCDR/2020/43807.13679 Bilateral Fibrothecoma: A Rare Case in Young Woman Anupriya Gupta, Shruti Pathak Fibrothecomas are rare sex cord stromal tumours. They usually occur in postmenopausal women and are mostly unilateral. They are usually associated with good prognosis; however, difficulties are encountered in establishing diagnosis. The treatment includes surgical resection. Here, the authors describe a rare case of a bilateral ovarian fibrothecoma in a 20-year-old female who presented with a large pelvic mass. On examination, there was a regular, immobile solid mass extending 30 weeks pregnancy size per abdomen. Pelvic examination revealed a firm nodular mass with minimal mobility and uterus could not be appreciated separately. On ultrasonography, a large solid mass arising from the pelvis superior and to the right of the uterus extending up to right hypochondrium was seen along with few cystic spaces and peripheral vascularity. Computerised tomography demonstrated two large solid cystic abdominopelvic mass lesion with internal solid enhancing areas and calcification of approximately 18 cm on the right side and 14 cm on the left side. The patient underwent exploratory laparotomy. Intra-operatively, the right ovarian mass was found, which was histopathologically confirmed as bilateral ovarian tumour (Bilateral Fibrothecoma). https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=QD01-QD03&id=13680 https://doi.org/10.7860/JCDR/2020/43819.13680 Sensory Useless Hand of Oppenheim: A Rare Case Varsha Muddasani, Raghavendra Bakki Sannegowda Sensory useless hand of Oppenheim was first described in 1911. It is an unusual presentation of Multiple Sclerosis. It is characterised as a functional disorder with loss of sensory modalities and preserved motor functions. Here the present authors report a case of an 18-year-old girl with acute vague symptoms described as &#8216;uselessness&#8217; of left hand. Clinical examination of the neurological system was unremarkable. Imaging investigations revealed hyper-intensities in the Middle Cerebral Peduncle (MCP) and pons, suggestive of demyelination. Treatment with Intravenous and oral steroids showed improvement of symptoms. On follow-up patient presented with cerebellar symptoms after previous complete resolution. Imaging studies showed no new lesion suggesting the old lesion responsible for recurrence of new symptoms. This distribution of symptoms of space and time suggests the diagnosis of useless hand of Oppenheim a rare and uncommon presentation of multiple sclerosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=OD06-OD08&id=13686 https://doi.org/10.7860/JCDR/2020/43615.13686 Asymptomatic Solitary Mastocytoma with Negative Darier's Sign Azra Fathima, Krishnakanth Muralidhar, Mahalakshmi Veeraraghavan, R Madhu, Leena Dennis Joseph, Murugan Sundaram Mastocytosis is a heterogenous group of disorders characterised by clonal proliferation of mast cells accumulating in single or multiple organs in children or adults. Skin is the most common organ involved in children. It usually presents as a nodule or plaque, yellow to tan-brown in colour remaining asymptomatic or may become red and itchy on rubbing indicating Darier&#8217;s sign positivity which helps in clinical diagnosis of mastocytosis. This case is of a three-month-old baby who presented with solitary asymptomatic noduloplaque with negative Darier&#8217;s sign which was clinically suspected to be mastocytosis and was confirmed by histopathology and immunohistochemistry. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=WD01-WD03&id=13689 https://doi.org/10.7860/JCDR/2020/43794.13689 Too Much Stress- A Rare Case of Takotsubo Cardiomyopathy Soorya Narayanan Balasubramani, Mohamed Kasim Abdul Takotsubo syndrome is a reversible, stress-induced transient systolic and diastolic dysfunction. It was first described as a characteristic ballooning of left ventricular apex which closely resembles a Japanese fishing pot. Here the authors present a case report of a 40-yearold female who was posted for elective tonsillectomy, that developed sudden de-saturation immediately post-intubation, examination showed bilateral extensive and ECG showed symmetrical T wave inversion in leads V1 to V6 and troponin I was positive. A diagnosis of Perioperative myocardial infarction was made and hence patient was taken for coronary angiogram which was found to be normal. The left ventricular angiogram showed a typical finding of apical ballooning. The patient was diagnosed to have- Takotsubo Syndrome. Treatment included tablet Torsemide, Ramipril and Metoprolol. She was discharged after 7 days as the vitals got normalised. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=OD09-OD10&id=13690 https://doi.org/10.7860/JCDR/2020/43816.13690 Inadvertent Use of Oral Corticosteroids Leading to Iatrogenic Cushing Syndrome in an Infant with Down Syndrome Neha Babbar , Kapil Bhalla , Sanjiv Nanda , Shuchi Mehra Children with down syndrome often have an increased predisposition to recurrent viral related wheezing episodes and other issues like increased oropharyngeal secretions due to hypotonia. Lower airway anomalies such as tracheobronchomalacia and tracheal stenosis are also common. Children with tracheal abnormalities may have a chronic cough or noisy breathing and these conditions are often misdiagnosed as asthma. Here, we present a case report of a six-month-old baby with down syndrome who was misdiagnosed as having bronchial asthma at two months of age because of recurrent episodes of noisy breathing and was prescribed oral steroids which the parents continued in an unsupervised manner. The child presented with increased buccal fat and buffalo hump and was diagnosed as iatrogenic cushing syndrome after investigations. Steroids were gradually tapered and stopped gradually. On follow-up the child had fully recovered and had no signs of hypercortisolism. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=SD01-SD02&id=13692 https://doi.org/10.7860/JCDR/2020/43588.13692 Iliac Vein Compression- The May-Thurner Syndrome Diagnosed by CT Angiography Shibani Mehra, Mayank Choudhary Chronic venous insufficiency and venous ulcers are a frequent cause of morbidity in diabetic as well as non-diabetic patients. Pelvic veins can often be involved by thrombosis. Imaging with Doppler sonography is essential to diagnose venous thrombosis. However, pelvic vein compression by an adjacent coursing artery is an unusual cause of lower limb venous obstruction, limb swelling and non-healing ulcers. Diagnosis of iliac vein obstruction and identification of compression by the iliac artery requires radiological imaging, with CT angiography being the current favoured modality. Here, a case 23-year-old male presented with painless swelling of the left leg since three years duration with a venous ulcer on the lateral aspect of lower leg since two years. In order to ascertain the cause of pelvic iliac vein compression(as detected on Venous Doppler ultrasonography), Dual-phase thinsection abdominal and bilateral lower limb Computed Tomography (CT) Angiography with venography run were performed, which showed the right common iliac artery compressing the left common iliac vein at its origin Based on these imaging findings, a radiological diagnosis of May-Thurner syndrome was made which highlights that non-thrombotic occlusion of pelvic veins can be a cause of unilateral lower limb swelling and long standing venous ulcer. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=TD01-TD03&id=13695 https://doi.org/10.7860/JCDR/2020/43258.13695 Double Thrombosis- Interesting Case of Polycythemia Vera Subashini Subramanian, Siva Ranganathan Green Polycythemia vera is a myeloproliferative disorder which has a varied manifestation, one of it being venous thrombosis and arterial thrombosis which significantly contributes to the mortality and morbidity. A 30-year-old male with history of deep vein thrombosis presented with history of headache and seizures and was diagnosed to have cortical venous sinus thrombosis with Magnetic Resonance Imaging (MRI) brain and complete blood count showed elevated haemoglobin and Packed Cell Volume (PCV). On evaluation patient was found to be positive for Polycythemia vera. We report this case with recurrent venous thrombosis which is a rare manifestation of polycythemia. Patient was managed with Adequate hydration, phlebotomy, Heparin, aspirin, Tablet Acetrom and Tablet. Hydroxyurea Patient was discharged after improving symptomatically https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=OD11-OD12&id=13704 https://doi.org/10.7860/JCDR/2020/43833.13704 Sudden Vision Loss as First Clinical Manifestation of Anaemic Retinopathy Shrinkhal, Anupam Singh, Ajai Agrawal, Preeti Yadav, Rupal Verma Anaemia can have devastating results, especially when associated with thrombocytopenia. We report here a case of a 16-year-old girl who presented with chief complaint of sudden, painless, nonprogressive diminution of vision in left eye past one day. Ocular examination revealed bilateral pale conjunctiva, bilateral retinal flame shaped haemorrhages, roth spots and large macular sub hyaloid haemorrhage in left eye. Complete haematological examination revealed severe megalobalstic anaemia (with Haemoglobin 4.4 gm%) with thrombocytopenia. Diagnosis of severe anaemic retinopathy due to megaloblastic anaemia with thrombocytopenia was made and the patient was advised propped up position, prescribed iron, folic acid, vitamin C and B12 supplementation. Patient underwent aggressive treatment of megaloblastic anaemia and was kept on follow-up. On follow-up, the retinal haemorrhage spontaneously resolved with clearance of fovea and the patient gained vision. Urgent diagnosis and management is mandatory in these cases. So, a good screening protocol should be established for the identification of nutritional anaemia in developing countries and compulsory fundus examination to be done of the identified subjects for anaemic retinopathy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=ND01-ND03&id=13706 https://doi.org/10.7860/JCDR/2020/44332.13706 Subarachnoid Cyst in the Patient with Psychosis: A Rare Case Poonam Bharti, Sana Usmani, Gunjan Jindal Arachnoid cysts develop between arachnoid membrane and the surface of the brain. These cysts may cause neurological deficits as well as neuropsychiatric symptoms. Intracranial cysts are usually picked accidently on MRI brain studies. Mostly they are congenital and have gender prediction. Here, the authors reported a case of 57-year-old male who came with the complaint of headache, aggressive behaviour and psychotic symptoms. On neuroimaging, he had subarachnoid frontal cyst causing buckling of left frontal region which may be the underlying cause of his psychiatric symptoms. He was admitted and treated with Risperidone, Clonazepam and Naproxen with which he showed gradual improvement in the symptoms. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=VD01-VD02&id=13710 https://doi.org/10.7860/JCDR/2020/44067.13710 A Great Masquerader: Acute Respiratory Failure as the Only Initial Presentation for Juvenile Myasthenia Gravis Sai Chandar Dudipala, M Prashanth, CH Amith Kumar Myasthenia Gravis (MG) is most commonly caused by antibodies to acetylcholine receptor (AChRs). MG can present as respiratory failure during the late course of the disease, known as a myasthenia crisis. Mostly, this crisis develops in adult patients and associated with some intercurrent illness like infections. Sometimes, MG can present isolated respiratory failure as an initial presentation of disease, which was a rare presentation. This presentation will create diagnostic dilemmas among treating clinicians. Here, the present authors report a case of about an eight-year-old female with juvenile MG. She presented with isolated respiratory failure as her presenting manifestation. The child was diagnosed as MG based on history and electro-diagnostic tests. Child was recovered with supportive therapy, steroids and pyridostigmine. So, it is important to consider MG in cases of unexplained respiratory failure. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=SD03-SD04&id=13712 https://doi.org/10.7860/JCDR/2020/44145.13712 An Acute Pharyngeal-Cervical-Brachial Variant of Guillain-Barre Syndrome Manifesting as Isolated Bulbar Palsy Ayan Husain, Apoorva Nirmal, Parag Aradhey, Sourya Acharya Guillain Barre Syndrome (GBS) is characterised by acute onset ascending quadriparesis with areflexia. One of its rare variants is the Pharyngeal-Cervical-Brachial (PCB) variant which is characterised by acute weakness of the oropharyngeal, neck, and shoulder muscles with swallowing dysfunction. Here, the authors report a case of 57-year-old female, who presented with sudden onset dysphagia and nasal voice without having any limb weakness. Examination revealed reduced reflexes and weak palatal and pharyngeal muscles. Cerebrospinal Fluid (CSF) examination showed an albumino-cytological dissociation and nerve conduction studies revealed demyelinating motor polyneuropathy. A test for anti-GT1a antibody was positive. These findings were consistent with GBS. However, the patient presented only with bulbar involvement which is likely to be the milder form of the rare PCB variant. The patient recovered with plasmapheresis and was discharged in around three weeks. We conclude that GBS should be considered as differential diagnosis in a patient with isolated bulbar palsy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=OD13-OD15&id=13715 https://doi.org/10.7860/JCDR/2020/43820.13715 Dandy-Walker Malformation with an Occipital Cephalocele in an Infant: A Case Report Muhammad Baba Sule, Ibrahim Haruna Gele, Yakubu Bababa Shirama, Mohammed Abacha Dandy-Walker Malformation (DWM) is an unusual hereditary intracranial anomaly that affects the cerebellum and its components and is also characterised with an enlarged posterior fossa. DWM can appear dramatically or develop unnoticed and occurs with occipital cephalocele in about 5% of cases. This is a case report of a 10-month-old male child with DWM who had a co-existing occipital cephalocele and presented on account of hydrocephalus and poor developmental milestone. He had a Contrast Enhanced Computed Tomographic (CECT) scan of the brain; which showed a posterior fossa cysts, a hypoplastic cerebellar vermis with a dysmorphic fourth ventricle that appear continuous with the posterior fossa cyst giving the so called &#8216;key hole deformity&#8217;. There is also associated hydrocephalus with an occipital cephalocele. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=TD04-TD05&id=13716 https://doi.org/10.7860/JCDR/2020/43253.13716 Successful Revision Surgery: For Above-knee Amputated Leg Infected with Multiple Microorganisms Yeshwant Lamture, D Rajesh Amputation of lower extremity is one of the oldest surgical procedures. Amputated limb with ideal stump has excellent results, whereas bad stumps prolong the prostheses fitting and rehabilitation. Revision amputations are commonly indicated in poor stump formation, infection, recurrent ulceration, stitch abscess, neuroma and flap necrosis. Revision surgery rate of primary amputations stands high despite maximum care at tertiary hospitals. Successful revision surgeries are very rare as infection is inevitable yet preventable cause. This is a case of a 63-year-old male, who presented to the Surgery Outpatient Department (OPD) with wound over the right popliteal region which developed over the course of 15 days after he was attacked by a wild bore and later it was diagnosed as vascular injury. Therapeutic embolisation was done. However, the patient continued to develop gangrenous changes over the wound site. Hence, an emergency above-knee amputation of the right limb was done. However, patient developed infection post-operatively leading to formation of poor stump. Thus, revision surgery was done. This case is rare because, in spite of meticulous search of various medical portals online for similar case scenarios, very rarely revision surgeries done for aboveknee amputations with infected stump are found to be successful. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=PD01-PD03&id=13717 https://doi.org/10.7860/JCDR/2020/42821.13717 Orbital Cellulitis in Paediatric Patient with Sinusitis Gurnoor Singh, Anand Kumar Bhardwaj, Gauri Chauhan, Bharat Bhushan Singh Orbital cellulitis is a serious complication of sinusitis. It is a common life-threatening infection of the post-septal tissues of the orbit and one of the most common causes of orbital inflammation. A five-year-old boy presented to Emergency room with pain and swelling of right eye with history of cough, coryza and fever. He was immediately hospitalised and broad-spectrum antibiotics were started on an empirical basis. MRI showed sign of ethmoidal sinusitis with orbital cellulitis. Functional endoscopic sinus surgery was done and pus was drained from ethmoidal and maxillary sinuses. As child recovered, he was discharged after 14 days course of antibiotics (Ceftriaxone, Metronidazole and Vancomycin). Treatment of such cases usually requires multidisciplinary collaborated management by Paediatric, Radiology, Otorhinolaryngology and Surgical team. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=SD05-SD06&id=13718 https://doi.org/10.7860/JCDR/2020/43417.13718 <i>Candida krusei</i> Infection in an Acute Lymphocytic Leukaemia Patient: A Case Report Aroop Mohanty, Suneeta Meena, Uttam Kumar Nath, Sudeep Vaniyath, Neelam Kaistha Although <i>Candida albicans</i> remains the predominant species causing Blood Stream Infection (BSI), recent studies have demonstrated an emergence of Non-<i>albicans Candida</i> spp (NAC), such as <i>C. glabrata</i>, <i>C. papapsilosis</i> and <i>C. krusei. Candida krusei</i> are yeast-like microorganisms which may colonise the human skin, respiratory or gastrointestinal tract but can cause lethal infections especially in immunocompromised patients. Hereby, author’s report a case of 10-year-old male with T-cell Acute Lymphocytic Leukaemia (ALL) who reported with fever and non-productive cough caused by <i>Candida krusei</i>. Direct gram stain from blood culture and germ tube test was performed. Further, the isolate was initially misidentified by Matrix Assisted Laser Desorption/Ionisation Time of Flight Mass Spectrometry (MALDI-TOF MS) as <i>Trichosporon ovoides</i> which was later identified by molecular sequencing as <i>Candida krusei</i>. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=DD01-DD03&id=13724 https://doi.org/10.7860/JCDR/2020/44269.13724 May Thurner Syndrome: A Case Report and its Endovascular Management P Sudhakar, B Amirthaganesh, T Lokeshkumar, CS Prabhu May Thurner syndrome (MTS) is an anatomical variant in which right common iliac artery compresses the left common iliac vein against the lumbar vertebrae resulting in Deep Venous Thrombosis (DVT) of left lower limb in patients with no obvious cause. It is most common in middle-aged women. This is a case report of 48 year old female who came with complaint of progressively increasing swelling of her left lower limb since one week duration with occasional mild pain. Venous Doppler and CT venogram were done, which suggested MTS, for which she underwent percutaneous transluminal angioplasty and stenting to the left common iliac vein. Immediately after this procedure, the left lower limb venous blood flow returned to normal with some residual thrombus in popliteal vein. Doppler ultrasonography was done after four months which showed patent stent with smooth flow across it and with ~60-70% recanalisation in external iliac vein, common femoral and femoral vein; ~70-80% recanalisation in popliteal vein. The present case report emphasises that MTS should be considered as a cause of acute left lower limb DVT in middle-aged women without any predisposing factors and endovascular treatment (Percutaneous transluminal angioplasty with stenting) is the most practical and effective method of treatment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=TD06-TD08&id=13722 https://doi.org/10.7860/JCDR/2020/44152.13722 Endovascular Management in Post Liver Transplant Recipients with Venous Anastomotic Site Stenosis and an Associated Iatrogenic Arterio-portal Fistula: Case Series and Review of Literature Raghunandan Prasad, Rajanikant R Yadav, Amrin Israrahmed, Somit R Mittal Venous anastomotic site stenosis is a relatively uncommon but an important complication seen in patients post-liver transplant surgery. These stenosis can occur at hepatic vein, portal vein or Inferior Vena Cava (IVC) anastomotic site and may result in hepatic congestion leading to hepatic dysfunction and massive ascites. Routine Doppler ultrasonography is critical for early detection of these complications and in guiding further management. With the advancement in interventional radiology, most of these complications can now be managed by minimally invasive endovascular methods with successful long term outcome. This case series of three patients (one cadaveric and two live related donor recipient) portrays the role of doppler ultrasonography in post-liver transplant graft surveillance and concludes that ultrasound plays a critical role in early diagnosis of venous anastomotic stenosis. The series also highlights the key role of interventional radiology in treating the stenosis safely and successfully by balloon angioplasty with or without stenting. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=TR01-TR04&id=13711 https://doi.org/10.7860/JCDR/2020/44144.13711 COVID-19 Pandemic: Will a Vaccine be Available Soon? Kaushik Bharati https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=AB01-AB03&id=13671 https://doi.org/10.7860/JCDR/2020/13049.13671 Will the COVID-19 Pandemic have a Silver Lining? An Indian Perspective Hemant Jain, Kaushik Bharati, Aarti Garg, Sunanda Das https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=AB04-AB07&id=13732 https://doi.org/10.7860/JCDR/2020/12624.13732 Anecdote from Editors Desk Anecdote 5- Legal Fight to Defend Retraction: An Unhealing Sore Sunanda Das, Aarti Garg, Hemant Jain We received a short communication from a premier government teaching hospital of India. The Head of the Department (HOD) was among the authors, besides two residents. The work was vetted, peer-reviewed and post-peer review published. Few months later, we received a mail from a print journalist who wrote a mail to us stating that the study&#8217;s data was falsified. Such a study couldn&#8217;t have been done in the stated time period because the telephone connection to the department was defunct (which was an integral part of the study methodology). He also attached a published news item from the newspaper he worked in which stated the same. In it was mentioned the name of the journal and the Chief Editor. We were not privy to the internal investigation undertaken by the journalist and hence the reporter didn&#8217;t have the journal&#8217;s version of events. We thought it pertinent to look into the matter. We mailed the corresponding author citing the newspaper article and requested a robust proof of the study including whole data that was collected. One fine day the Chief Editor&#8217;s received a personal call from the senior author (HOD) trying to coax him to stop the inquiry. However, he firmly maintained his stand and re-requested the evidence. Next few weeks were a tussle of email correspondences. Finally the journal office received a courier containing a dairy which was apparently the proof of the study. It had the researcher&#8217;s notes on the data of the study. First impressions from the diary led to a belief that it was done by a less-devoted researcher; the texts were illegible almost like a scribble with very fuzzy data collected for each telephonic conversation (the primary aim of the study). The most outstanding observation was that the notes in the dairy did not match the descriptive outcome that was shown in the manuscript. It appeared that the diary was &#8216;made up&#8217; in haste. Also, every page had signature of either of the co-authors. Now, since we already had the copyright form, we found that none of corresponding signatures match; as if one person had signed for all. We sought an external opinion too &#8211; sent the manuscript and the data to an external expert. The report further confirmed our observations regarding the data mismatch. So, we finally came to the conclusion that we were deliberately misled into publishing a fabricated work and thus we decided to retract the article. Later we came to know that there existed a feud between the senior author (HOD) and the institute head which had spilled over into the media. Following the article retraction, the institute research committee was also convened to and they upheld our decision. The story took a nasty turn when the HOD served us a court notice asking for a sum of INR 10,00,000/- complaining that the retraction has caused him defamation. The notice had named few others too, besides the Chief Editor of JCDR, the newspaper journalist, a department colleague and the institutional head- a total of ten defendants. The lawsuit was filed in the state where the hospital was situated. We decided to contest and hired a lawyer. He found numerous flaws in the lawsuit. The multiple defendants were unrelated to each other and each was charged with a disparate offence. How will the liability be shared? We were forced to make a representation before the court. This in itself was a task at hand. For the first few hearings the Chief Editor had to take few days off for preparation of the case and attend the hearing. Judicial proceedings work at their own slow pace. It has been more than 5 years since the first hearing and the case still remains open; this event remains as an un-healing sore. This case fulfills the first point in favour of retraction as per the COPE guidelines (https://publicationethics.org/files/retraction-guidelines.pdf). The American Journal of Clinical Nutrition and Diabetes were winners against a lawsuit filed against them after they retracted articles based on data falsification. (https://www.nature.com/news/courts-refuse-scientists-bids-to-prevent-retractions-1.18175). In two separate incidences, Guangwen Tang (a nutrition scientist at Tufts University in Boston, Massachusetts) and Mário Saad (a medical researcher at the University of Campinas in São Paulo, Brazil), lost their respective cases against the journals. Even the big-shot publishers like Elsevier too get such threats (https://retractionwatch.com/2016/05/24/author-threatens-to-sue-elsevier-if-paper-remains-retracted/). Another such lawsuit ended where the publisher had to revise the words in the original retraction notice, in order to be sublime towards the author. This was done after the author filed a complaint, lost the case, but the judge ruled in favour of the author&#8217;s argument about his defamation due to the retraction notice. &#8220;Misappropriated data, plagiarised and concealed the authorship of work &#8220;was changed into something milder- &#8220;as some of the findings have previously been published&#8221; (https://retractionwatch.com/2017/12/20/author-wins-judgment-elsevier-lawsuit-retraction/). There are quite a few such stories on journal-author feud leading to civil litigations. The correct modus operandi is to let the authors know about the journal action plan and giving them an opportunity to present their side of argument. If the case is clear and weighs towards fraud or data manipulation, there is no point of wasting time and resources. This would be beneficial for the journal and authors; rather than making it a fight of ego. After this one failed attempt to publish the questionable paper, now it&#8217;s time to let it go. If the research is fundamentally wrong or is nothing but clear fraud then the authors are expected to take the retraction honorably. But, more often than not, the saga does not end at retraction. The Indian Penal Code has sections concerned to plagiarism (section 57 and Section 63 and Section 63 (a) of Copyright Act, 1957) and has specific copyright laws. (http://www.copyright.gov.in/Documents/CopyrightRules1957.pdf). This essentially means that a copyright form is considered significant evidence. Every journal/publisher requires the authors to sign a copyright form acknowledging the declaration that the study is true and honest. In cases such as this anecdote, the author has clearly infringed the copyright law. But paradoxically or perhaps preemptively, they filed a case against us. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=AB08-AB09&id=13737 https://doi.org/10.7860/JCDR/2020/14941.13737 Simple and Efficient Technique for Correction of Unilateral Scissor Bite Using Straight Wire- A Correspondence Pranshu Mathur, Parijat Chakraborty, Richa Dhingra, Roli Dureha, Priyanka Singh https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=ZL01-&id=13725 https://doi.org/10.7860/JCDR/2020/44699.13725 Factors Related to Postpartum Depression in Mothers Referred to Kermanshah Health Centers, Iran Farideh Moradi, Hiva Azami, Behzad Hemmatpour, Mehrdad Maleki Jamasbi, Naser Farahmand, Shadi Khakpour Kermani, Behrouz Bijan <b>Introduction:</b> Postpartum Depression (PPD) is one of the major health problems that have adverse effects on mother and family and can be related to many factors. It is one of the most common psychiatric disorders and a common problem of human life. <b>Aim:</b> To determine the predisposing factors of PPD. <b>Materials and Methods:</b> This was a descriptive-analytical and cross-sectional study in which 242 women referred to Kermanshah health centres (two months after delivery), were selected by cluster random sampling. Data were collected using a standard Edinburgh Depression Inventory. Data were analysed by SPSS software using chi-square, t-test and ANOVA. <b>Results:</b> The average age of study participants was 29 years. A total of 11.3% of mothers had moderate depression and 44.8% had severe depression. There was a statistically significant relationship between the level of depression with spouse support, maternal support, desire and unwanted pregnancy (p-value <0.05). On the other hand, there was no significant relationship between level of depression and type of delivery; mother&#8217;s education and gender of infant (p-value >0.05). The prevalence of depression was also higher in those with unwanted pregnancy (p-value <0.05). <b>Conclusion:</b> More than half of the study population had severe depression. Spouse support in reducing PPD can be effective. So it is necessary to educate their spouses about the important issue of PPD. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=VC01-VC03&id=13726 https://doi.org/10.7860/JCDR/2020/43450.13726 Mutation of CCR5 Delta 32 in Umbilical Cord Blood Samples: Future Potential for HIV-1 Cure Vinayak Virupaksh Kedage, Satyen Yash Sanghavi, Tripti U Gaunkar, Ravi Kumar Bonthala <b>Introduction:</b> Human Immune Deficiency (HIV) virus is a highly mutagenic virus with diverse antigenic types and subtypes. Long latency leading to persistence in infected cell as provirus which poses great problem in developing HIV cure. The C-C Chemokine Receptor Type 5 (CCR5) molecule is a chemokine receptor, is the most important co-receptor for macrophagetropic HIV-1 viral entry into the immune cells. In individuals with homozygous 32-bp deletion in the CCR5 gene (CCR5-del32) leads to near-complete resistance to HIV-1 infection, and also improves the prognosis in heterozygous adults with HIV-AIDS by slowing down the progression rate. <b>Aim:</b> Identification of CCR5 genotype in cord blood units of Indian population to generate an effective database, which may be useful as a future potential for treatment of HIV-1. <b>Materials and Methods:</b> This cross-sectional study for CCR5 genotyping was carried out on randomly selected Umbilical cord blood samples over a period of six months from June 2019 to November 2019 at Regrow Biosciences Private Limited, Lonavala, Pune, Maharashtra, India. Cord blood samples were screened for CCR5-del32 mutation by gene amplification using PCR based method from genomic DNA followed by agarose gel electrophoresis. All positive samples were confirmed by capillary electrophoresis. Statistical analysis was calculated using Fisher’s formula. Confidence level was determined at 95% with Confidence interval of 3.46. <b>Results:</b> Out of 800 samples analysed, 21 were found positive for heterozygous genotype (CCR5 &#916;32/WT) that is 2.62%. None of the samples were of homozygous genotype (CCR5 &#916;32/&#916;32). <b>Conclusion: </b>The CCR5- &#916;32 mutation is a well-studied model of natural selection affecting humans. This mutation is known to occur in the northern Europe and western Asia with higher frequencies. The current study concludes that prevalence of heterozygous CCR5 delta 32 (&#916;32) mutation is extremely rare in India, also the present clinicians didn’t come across any homozygous case, yet there is need to study larger population to allow statistical comparisons. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=KC01-KC03&id=13727 https://doi.org/10.7860/JCDR/2020/43618.13727 Study of Primary Chest Wall Tumours in a Tertiary Care Hospital Ankita Pranab Mandal, Rama Saha <b>Introduction:</b> Primary chest wall tumours are infrequent, but wide variety of tumours arise within the chest wall and comprise 7 to 8% of all intrinsic bone tumours. Tumours that arise from the chest wall include from the bony structures (sternum, scapula, ribs) or from the adjacent soft tissue. <b>Aim:</b> To analyse the clinical details, imaging reports, histological findings of the tumour and its correlation with Immunohistochemistry (IHC). <b>Materials and Methods:</b>A prospective study was conducted from December 2017 to December 2019 at Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal (India). Sixteen cases were evaluated in terms of clinical history, imaging and histological findings, the treatment provided. GraphPad InStat 3 was used to analyse the results. <b>Results:</b> Of the 16 cases of chest wall tumours, 10 (62.5%) were malignant and 6 (37.5%) were benign. Patients with benign and malignant tumours had overlapped age ranges considerably, similar to the ranges of duration of symptoms. The sex distribution did not reveal any marked predilection for males (eight males, eight females). All the patients underwent treatment and are under follow-up. <b>Conclusion:</b> Chest wall neoplasms are group of heterogeneous lesions with varied pathology. Any tumour arising from chest wall should be inspected properly to ascertain the origin of the tumour for a definitive diagnosis. Clinical and imaging correlation along with histopathology and IHC aids in proper diagnosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=EC27-EC32&id=13728 https://doi.org/10.7860/JCDR/2020/44188.13728 Correlation of Metal Ions in Diabetic Patients Meghali Narayan Kaple , Chandrashekhar C Mahakalkar , Anita Kale , Swati Shambharkar <b>Introduction:</b> Diabetes Mellitus (DM) presents with insulin deficiency results in raised blood sugars. Metals are the inorganic elements present in very small amounts in the living tissues and play an important role at cellular level and hence are important for life. Macro metals like Magnesium (Mg) are present in large quantity and hence are called as macro nutrients. <b>Aim:</b> To evaluate the correlation of metal ions in Type I and Type II DM. <b>Materials and Methods:</b> It was a prospective study, carried out at Acharya Vinoba Bhave Rural Hospital, JNMC, Sawangi (Meghe), Wardha, Maharashtra, India from January 2017 to January 2019. Total 260 patients were enrolled in the study. The participants were divided in two groups, diabetic and nondiabetic, based on blood sugar levels. The blood samples were analysed for Calcium, Magnesium, Phosphorous and Iron. The comparison was done using student’s t-test. <b>Results:</b> The mean values of Iron (Fe) were 162.17&#177;13.27 µg/dL, Calcium (Ca) 8.21&#177;0.34 mg/dL, Mg 1.49&#177;0.07 mEq/L, and Phosphorous (P) 2.92.&#177;0.49 mg/dL for the whole study population. The various metal levels when compared with the levels of fasting and post prandial blood sugar in Non-diabetic group and Diabetic group the difference was statistically significant for Fe, Ca and P and was not significant for Mg. <b>Conclusion:</b> Fe levels were raised and Ca, Mg and P were depleted in patient suffering from DM. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=BC14-BC16&id=13730 https://doi.org/10.7860/JCDR/2020/43798.13730 Vitamin D Levels in Gestational Diabetes Mellitus and its Influence on Future Type 2 Diabetes Mellitus- An Observational Study Harini Rangaraju, Shenbaga Lalitha Sankar <b>Introduction:</b> Gestational Diabetes Mellitus (GDM) and persistent hyperglycaemia postpartum is a rising health challenge. Multiple researches have contributed to the understanding of the magnitude of the causal factors involved. One such factor is Vitamin D deficiency though, widely studied exact role in development of Diabetes Mellitus (DM) is not investigated. <b>Aim:</b> To predict the risk of pre-diabetes and DM in GDM patients with Vitamin D deficiency. <b>Materials and Methods:</b> Hundred pregnant women were recruited-50 study group, 50 control group; based on WHO criteria for GDM diagnosis at 24-28 weeks of gestation. Study parameters in antepartum period were maternal age, Body Mass Index (BMI), Vitamin D, Fasting blood glucose, 2 hour Oral Glucose Tolerance Test (OGTT). Study parameters in postpartum follow-up were fasting blood glucose, postprandial blood glucose, vitamin D. Mann-Whitney U-test and Binary Logistic regression analysis were the statistical tools used to predict the risk. <b>Results:</b> Antepartum Vitamin D deficiency (<20 ng/mL) showed 2.2 fold significantly increased risk for developing pre-diabetes and DM. High frequency of pre-diabetes (52% of cases) postdelivery (6 weeks) was proved. Maternal age, BMI and OGTT values had direct relationship in predicting risk of DM which was proved with postpartum follow-up. <b>Conclusion:</b> Vitamin D deficiency has a significant role in development of pre-diabetes and DM in GDM patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=BC17-BC20&id=13731 https://doi.org/10.7860/JCDR/2020/44133.13731 Use of Kinesiologic Therapeutic Tape on Pain, Trismus, Swelling and its Influence on Quality of Life after Mandibular Third Molar Surgery Kho Chai Chiang, N Satya Bhushan, U Siva Kalyan, R Sai Bhavana <b>Introduction:</b> The surgical extraction of impacted mandibular third molar is a routine oral surgical procedure. However, it is often associated with post-operative inflammatory complications like pain, swelling, trismus, and discomfort during the initial post-operative days. This study chooses the use of a non-invasive, elastic Kinesiologic Tape (KT) for effective management of post-operative complications after surgical extraction of the lower third molar. <b>Aim:</b> To study the effect of KT on post-operative complications of surgical removal of impacted third molars like pain, trismus, swelling and its influence on the quality of life after third molar surgery. <b>Materials and Methods:</b> In the present interventional study, 76 patients who visited the Department of Oral and Maxillofacial Surgery with slightly or moderately difficult impacted lower third molar according to modified Pederson&#8217;s index for surgical extraction were selected. Patients were randomly categorised into Group A (received analgesics and antibiotics alone) and Group B (received KT along with analgesics and antibiotics). Pain, trismus, swelling were assessed on the pre-operative day and 3<sup>rd</sup>, 5<sup>th</sup>, and 7<sup>th</sup> post-operative days and quality of life on 3<sup>rd</sup>, 5<sup>th</sup>, and 7<sup>th</sup> days post-operative. Data was analysed using SPSS (version 22). Independent t-test was used for inter group comparisons, and repeated ANOVA was done for intra group comparisons for various parameters to assess statistically significant difference. The p-value <0.05 was taken as statistically significant. <b>Results:</b> Results indicated that the patients in Group B (with KT) had decreased pain (p-value=0.0001), trismus (p-value=0.0001), swelling (p-value=0.0001) and improved quality of life (p-value=0.0001) when compared with Group A (without KT) on 3<sup>rd</sup>, 5<sup>th</sup>, 7<sup>th</sup> post-operative days. <b>Conclusion:</b> The KT is a simple, non-invasive, economical method that can be considered as a potential adjunct for managing post-surgical complications such as pain, swelling, trismus, and thereby improving the Quality of Life after impacted mandibular third molar surgery. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=ZC13-ZC17&id=13719 https://doi.org/10.7860/JCDR/2020/43848.13719 Awareness of Hygiene Practices and Satisfaction Level among Patients Wearing Fixed Dental Prosthesis: A Cross-sectional Survey Sushma Ramaswamy, Shardul Shashikant Taware, Abhijeet Ramachandra Kore, Samruddhi Ashok Sawant, Pronob Kumar Sanyal, Prasad Nayan Tayade <b>Introduction: </b>Fixed Partial Denture (FPD) is a very common treatment modality of prosthodontic rehabilitation. Although it restores the aesthetics and function, the maintenance of the same is of equal importance for it to function on a long term basis. <b>Aim:</b> To assess the awareness of hygiene practices and satisfaction level among the patients rehabilitated with fixed dental prosthesis in suburban region of Karad, Maharashtra. <b>Materials and Methods:</b> A cross-sectional clinical survey to assess the awareness of hygiene practice and satisfaction level of patients wearing FPD/crown was conducted among the patients visiting the at Outpatient Department of Prosthodontics, School of Dental Sciences, Krishna Institute of Medical Sciences “Deemed To Be University”, Karad, Maharashtra. <b>Results:</b> In this study 230 participants with FPD/crown were examined among which female participants contributed about 53% of the total participants and males up to 47%. 51.74% of the participants had a habit of brushing their teeth only once in a day and only 13.48% of them flossed their teeth. About 50% of the patients had problems either with food lodgement, aesthetics or pain post cementation. A total of 33.91% patients complained about the food lodgement in the region of the prosthesis. It was also evident through the survey that 60% of the patients were educated well by their dentists regarding maintenance protocols of the prosthesis. <b>Conclusion:</b> Within the limitations of the study, it can be concluded that the prosthesis dislodgement and food lodgement were the most common complaints of the patients regarding fixed partial denture prosthesis. It is the responsibility of the dentist as well the patients to work together to improve the long term prognosis of the prosthesis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=ZC18-ZC21&id=13720 https://doi.org/10.7860/JCDR/2020/43884.13720 The Effect of Hyperthyroidism on the Level of Urinary Neutrophil Gelatinase Associated Lipocalin and Markers of Kidney Function Suyash Saxena, Jyoti Batra, Mahesh Chander Chhabra, Gladys Rai <b>Introduction:</b> Thyroid hormones affect kidneys in various ways ranging from their development to their functions. Serum and urinary Neutrophil Gelatinase-Associated Lipocalin (NGAL) are emerging as the most promising biomarkers for early determination of Acute Kidney Injury (AKI) and Chronic Kidney Disease (CKD). <b>Aim:</b> To evaluate the effects of hyperthyroidism (subclinical and overt) on the markers of kidney function. <b>Materials and Methods:</b> In this cross-sectional study, 300 subjects were recruited from May 2015 to June 2018 and divided in three categories of euthyroid, subclinical and overt hyperthyroid subjects. All the subjects were analysed for Thyroid function (Total T3 , T4 , Thyroid Stimulating Hormone (TSH)) and Kidney Function (Serum Urea, Serum Creatinine, Urinary NGAL, estimated Glomerular Filtration Rate (eGFR)). <b>Results:</b> Statistical analysis revealed a significant decrease in serum urea and serum creatinine in both subclinical (17.32&#177;3.51 mg/dL and 0.58&#177;0.13 mg/dL, respectively) and overt hyperthyroid (13.52&#177;2.78 mg/dL and 0.29&#177;0.10 mg/dL, respectively) patients as compared to euthyroids (19.99&#177;5.38 mg/dL and 0.87&#177;0.25 mg/dL, respectively). Urinary NGAL and eGFR were significantly increased in both subclinical (30.24&#177;8.63 ng/mL and 119.57&#177;11.31 mL/min, respectively) and overt hyperthyroid (44.05&#177;13.02 ng/mL and 155.12&#177;19.75 mL/min, respectively) patients as compared to euthyroids (21.94&#177;18.06 ng/mL and 97.97&#177;25.92 mL/min, respectively). A negative correlation of creatinine and positive correlation of urinary NGAL and eGFR with T3 and T4 was observed in both subclinical and overt hyperthyroidism (p<0.05). <b>Conclusion:</b> The study shows that there are negative effects of hyperthyroidism on kidney functions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=BC10-BC13&id=13721 https://doi.org/10.7860/JCDR/2020/43913.13721 Comparative Evaluation of Antimicrobial Efficacy of Sodium Hypochlorite, Silver Diamine Fluoride, Chitosan and Bioactive Glass Nanoparticles as Root Canal Irrigants against the Bacterial Strain of <i>Enterococcus faecalis</i>- An In vitro Study Dimple Vijay Chaudhari, ND Shashikiran, Ankita Maurya, Sachin Gugwad, Namrata Gaonkar, Swapnil Taur, Savita Hadakar <b>Introduction:</b> Enterococcus faecalis (E. faecalis) is the most commonly encountered microorganism detected in persistent root canal infections. These bacteria possess certain virulence factors, invade dentinal tubules and resist nutritional deprivation. Proper irrigation is an essential step for success in root canal therapies which is achieved by using excellent endodontic irrigants. <b>Aim:</b> To evaluate the antimicrobial efficacy of Sodium Hypochlorite (NaOCl), Silver Diamine Fluoride (SDF), Chitosan Nanoparticles (CNPs) and Bioactive Glass Nanoparticles (BAGNP) as root canal irrigants against the bacterial strain of Enterococcus Faecalis (E. faecalis) using agar well diffusion method. <b>Materials and Methods:</b> In this in-vitro study, the test materials were manipulated in accordance with the manufacturer’s instructions. The antimicrobial properties of root canal irrigants were evaluated by using agar diffusion method using bacterial strain of Enterococcus faecalis (ATCC 29212). 0.25 mL of each irrigant was placed on to 6.5 mm diameter blotting papers which were placed in 7 mm diameter wells on the Mueller Hinton agar plates. Later, E. faecalis strains were inoculated with sterile cotton swab on to the agar plates. All the plates were incubated at 37°C and evaluated at 24, 48 and 72 hours after pre-diffusion of test materials for two hours at room temperature. A 0.5 mm precision ruler was used to measure the microbial inhibition zones and then the results were expressed as mean and standard deviation. The results were tabulated and analysed using One-way ANOVA to find out if there was a significant overall difference between the mean zones of inhibition of various irrigants and Post-hoc Tukey HSD test to find out where the differences occurred. The p-value <0.05 was considered as significant. <b>Results:</b> Sodium Hypochlorite showed the greatest zone of inhibition followed by SDF, Bioactive Glass Nanoparticles and Chitosan Nanoparticles respectively (p<0.0107). Mean zones of inhibition for Sodium Hypochlorite, SDF, Bioactive Glass Nanoparticles and Chitosan Nanoparticles were 11.6 mm, 6.6 mm, 5 mm, and 1.4 mm, respectively. There were no observable differences on 24, 48 and 72 hours. <b>Conclusion:</b> Sodium Hypochlorite was the most effective root canal irrigant followed by SDF and Bioactive Glass Nanoparticle whereas Chitosan Nanoparticles was the least efficacious compared to the rest against Enterococcus Faecalis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=ZC22-ZC26&id=13738 https://doi.org/10.7860/JCDR/2020/44129.13738 A Comparative Study of Dissection and Snare and Electrocautery Techniques of Tonsillectomy- A Randomised Clinical Trial Abhay D Havle, Sanket C Prabhune, Naman Pincha, Tripti <b>Introduction:</b> Tonsillectomy is the preferred surgical modality in chronic tonsillitis or kissing tonsils, globally. Since, many years tonsillectomy is performed using various methods. The ancient Guillotine method of tonsillectomy is obsolete nowa-days whereas, the dissection and snare and electrocautery techniques are in use since late 1960’s. Thus, this study was attempted to evaluate the advantages and disadvantages between these two techniques. <b>Aim:</b> To compare and find the advantages and disadvantages between dissection and snare, and electrocautery techniques of tonsillectomy amongst a rural population of western Maharashtra, India. <b>Materials and Methods:</b> A randomised comparative study of 50 clinically diagnosed cases of chronic tonsillitis that required tonsillectomy was conducted. All cases were randomised into group-I, II and subjected to tonsillectomy using dissection and snare, and electrocautery methods respectively after prior routine investigations. Intra-operative blood loss, duration of surgery, assessment of postoperative pain, total duration of hospitalisation and any other complication and its management as well as condition of tonsillar fossa were noted in all cases after surgery and during follow-up period of 10 days postsurgery. The mean postoperative pain, intra-operative blood loss and total duration of hospitalisation were compared using Mann-Whitney U-test. The mean duration of operating time was compared by Student’s t-test. Dose comparison of analgesic and extended haemostatic measure required were compared by Chi-square test. <b>Results:</b> Mean intra-operative blood loss was significantly less after using electrocautery. The mean postoperative pain was significantly less after dissection and snare method. The mean duration of surgery was significantly less after using electrocautery. The mean duration of hospitalisation, the extended postoperative procedure required was more after electrocautery method however, it was not statistically significant. There was no significant difference in postoperative tonsillar fossa healing in either group during follow-up period of 7-10 days. <b>Conclusion:</b> Even though, the overall advantages of using dissection and snare method was more as compared to electrocautery, the important advantages that would lessen the morbid situations like excessive intra-operative blood loss and duration of surgery and anaesthesia were associated with latter. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=MC01-MC03&id=13723 https://doi.org/10.7860/JCDR/2020/44220.13723 Primary Paediatric CNS Tumours: A 25 Years Analysis at a Tertiary Referral Centre in Southern India Divya Sree Udayagiri, Amit Kumar Chowhan, Rukmanghadha Nandyala, Aruna K Prayaga, AY Lakshmi, Phaneendra Bobbidi Venkata, Bodapati Chandra Mowliswara Prasad <b>Introduction:</b> Paediatric brain tumours are the most common solid tumours in developing countries, leading to cancer related mortality in children globally. Enough data are available regarding the epidemiology of paediatric brain tumours in the western population. But limited data is available in India as only a few cases were reported. <b>Aim:</b> To evaluate the epidemiologic, clinicopathologic and histologic spectrum of paediatric brain and spinal cord tumours in a tertiary care referral centre of Southern India. <b>Materials and Methods:</b> This study was a retrospective, observational study which was undertaken at the Department of Pathology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India. It&#8217;s a 25 years study from January 1993 to December 2017. Data were collected regarding the frequencies of primary brain and spinal cord tumours (diagnosed according to World Health Organisation (WHO) classification) in total of 151 paediatric patients (comprised of all children <18 years of age) from medical records in the tertiary centre. <b>Results:</b> Over a period of 25 years, a total of 151 paediatric brain tumours were identified. Among these 4 were metastatic and the remaining 147 were primary. Primary tumours of brain origin were 112 and the remaining 35 were spinal cord tumours. The mean age for primary paediatric CNS tumours was 11.06 years with a slight male preponderance i.e., male: female ratio of 1.1:1. The most common brain tumour was Astrocytoma with 42 cases (37.5%) and among spinal cord, the most common tumour was Nerve sheath tumour with 13 cases (37.1%). <b>Conclusion:</b> Demographics in the present study are comparable with similar studies from various medical centres on this topic. It is used as a reliable profile to set priorities for rationing the limited resources and thereby aid in developing national data. Various studies like this from different cancer centres across India will help to prepare an epidemiological profile of overall Indian as well as regional Paediatric brain tumours. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=EC01-EC05&id=13672 https://doi.org/10.7860/JCDR/2020/40989.13672 Comparative Analysis of Serum Calcium Level and Thyroid Profile in Pregnant Normotensive and Preeclamptic Women: A Case-control Study Minakshi Misra, Lakbir Singh, Ajit Thakur, Saurabh Singh, Jainendra Kumar, Deepak Juyal <b>Introduction:</b> Preeclampsia, a transient but potentially dangerous, multisystem disorder is one of the most common complications of pregnancy and is a principal cause of maternal and fetal morbidity and mortality. Calcium deficiency and hypothyroidism have been found to be associated with pregnancy-induced hypertension and preeclampsia. <b>Aim:</b> To estimate the serum calcium level, thyroid profile, their intercorrelation and odds with occurrence of preeclampsia. Calcium and serum Thyroid Stimulating Hormone (TSH) levels were further correlated to Body Mass Index (BMI) of participants and to the birth weight of their newborns to investigate their effects or outcome. <b>Materials and Methods:</b> This cross sectional, case-control study was conducted for a period of one year (July 2018 to June 2019). A total of 170 pregnant women: 80 in preeclampsia group (case group); 90 in normotensive group (control group) were enrolled in the study. All the study subjects were in third trimester and were between 18-45 years of age. Total serum calcium levels and thyroid profile (fT3, fT4 and TSH) of all the study participants were estimated using fully automatic analyser. Proteinuria was measured by urine dipsticks. <b>Results:</b> Mean total serum calcium levels in cases were lower (8.2±0.8) as compared to controls (8.7±0.5), p<0.05 whereas, mean serum TSH levels in cases were found to be higher (5.07±3.34) as compared to controls (3.3±1.75), p<0.05. Odds Ratio (OR) for total serum calcium level <8.2 mg/dL was 10.8 (95% CI=7.437-7.806 p<0.05 and for serum TSH level >5.7 µIU/mL was 4.98, (95% CI=6.726-9.831; p<0.05. A combination of these two parameters together was observed in 18.75% of cases as opposed to none in controls. Birth weight of newborns of preeclamptic mothers was found to be positively correlated with total serum calcium level while a negative correlation was observed with serum TSH level. <b>Conclusion: </b>Findings from the present study suggest that serum calcium level was observed as a better indicator and predisposing risk factor for preeclamptic occurrence than serum TSH levels. Screening of thyroid profile and serum calcium levels and analysis of their combined status during pregnancy can help in minimising the risk of preeclamptic occurrence and associated adverse pregnancy outcomes. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=BC05-BC09&id=13687 https://doi.org/10.7860/JCDR/2020/44185.13687 Cytogenetic Analysis for Suspected Chromosomal Anomalies- A Retrospective Study Asoke K Pal, Prafulla S Ambulkar, Jwalant E Waghmare, Moreshwar R Shende, Manish Jain, Poonam Verma Shivkumar <b>Introduction:</b> The chromosomal anomalies are the most significant cause of human genetic disorders. Various types of structural and numerical chromosome aberrations have been identified in clinically suspect of genetic disorders. These aberrations are involved in different kinds of syndromes, infertility, amenorrhea, recurrent pregnancy loss, developmental delay, disorder of sexual development, congenital abnormalities and dysmorphic features etc. <b>Aim:</b> To determine various types of structural and numerical chromosome aberrations and its frequencies from hospital referred patients. <b>Materials and Methods:</b> In the present cross-sectional study, chromosomal analysis was done for various types of suspected 2215 referred patients. The patients were referred from, mainly, Obstetrics and Gynaecology, Paediatrics departments of Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India during the period of January 2000 to June 2019. <b>Results:</b> The overall frequency of chromosomal abnormalities was 12.23% (271/2215). Out of 271 cytogenetic abnormal patients, numerical chromosome abnormalities were found in 204 (75.28%) and structural chromosome abnormalities were detected in 67 (24.72%) patients. Abnormal cytogenetic findings were observed in 164 of 342 Down syndrome (47.95%), 36 of 383 Primary amenorrhea (9.40%), 20 of 768 recurrent pregnancy loss (2.60%), 30 of 473 male infertility (6.34%), 6 of 72 Ambiguous genitalia (8.33%), 13 of 147 congenital abnormalities (8.84%), 2 of 30 psychiatric disorder (6.66%) of patients. <b>Conclusion:</b> Cytogenetic analysis is essential for diagnosis of genetic disorders and to provide precise diagnosis. Chromosomal analysis helps in appropriate genetic counseling to assess the risk of recurrences and to take measures for prevention and management of inherited genetic diseases and disorders. Moreover, there are no registries or databases of genetic disorders in India. Compilation of these kinds of studies will help in making databases or registries of genetic disorders. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=GC01-GC06&id=13688 https://doi.org/10.7860/JCDR/2020/43678.13688 Utility of a Flowcytometry Based Urine Analyser in Screening of Urothelial Malignancies Mona Bargotya, Lalit Kumar, Payel Das, Pinkey Kachhap, Rahul Yadav <b>Introduction:</b> Urothelial malignancies are one of the most prevalent carcinomas. In clinical practice, all patients undergo routine urine examination. If urine examination is used as a screening test to detect malignancies, it will indeed be of great help in early detection and initiation of treatment, leading to better patient care and disease outcome. There is a paucity of literature on detection of urothelial carcinomas based on flowcytometric urine analysers. <b>Aim:</b> To establish flowcytometry based screening criteria which could assist in detecting urothelial carcinomas on routine urine examination. <b>Materials and Methods:</b> The prospective study was conducted in the Department of Pathology, Rajiv Gandhi Super Speciality Hospital, Tahirpur, Delhi, India. All the samples which were sent for urine cytology from July 2017 to June 2018 were included in the study. The samples underwent cytological examination using Giemsa and Papanicolaou stain after being analysed in Sysmex UX 2000. The statistical analysis was performed using Microsoft Excel 2010 and SPSS statistical program (Version 24). <b>Results:</b> Total of 160 patients were included in the study. The male to female ratio in the present study was 5.67:1. Around 22% (35) cases turned out malignant, with 31 (88.6%) men and 4 (11.4%) women. The mean age for malignant cases was 60.2&#177;5.2 years compared to 48.9&#177;33.4 years for non-malignant cases. Multiple parameters were evaluated; only Red Blood Cell (RBC), White Blood Cells (WBC), Small Round Cells (SRC), and Epithelial Cells (EC) were statistically significant. Cut-off value for RBC was established at 52.9 cells/&#956;L with high sensitivity, specificity and Negative Predictive Value (NPV); whereas WBC, SRC and epithelial cells showed increased NPV only. <b>Conclusion:</b> Automated urine analysers, with established cut-off values for detection of urothelial malignancies, could help in screening of the routine samples for early detection of urothelial malignancies. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=EC17-EC20&id=13693 https://doi.org/10.7860/JCDR/2020/43625.13693 Antidepressants Effect on the Self-perception and Satisfaction of Patients Rehabilitated with Bimaxillary Removable Dental Prostheses Valquíria de Jesus Freitas , Larissa Simião da Rocha , Moisès Zacarias Cardoso , Paula Benetti ,Micheline Sandini Trentin , Maria Salete Sandini Linden , João Paulo De Carli <b>Introduction:</b> In addition to restoring function, aesthetics and phonetics, dental prostheses have the potential to improve patients&#8217; personal image, social interactions and quality of life. <b>Aim:</b> Primarily, to evaluate the influence of antidepressant medications, and secondarily evaluate the type of prosthesis, number of remaining teeth, age of the patients, and time of using of the prostheses on the self-perception of oral health conditions and satisfaction in a group of rehabilitated with bimaxillary removable dentures patients using the instrument Oral Health Impact Profile (OHIP-14) and Visual Analog Scale (VAS). <b>Materials and Methods:</b> This is a cross-sectional clinical study which evaluated 175 medical records of patients who underwent oral rehabilitation with removable prosthesis (total and/or partial prosthesis) between 2014 and 2019. A total of 23 patients aged from 40 to 90-year-old participated in the study. The impact of oral health conditions on quality of life was assessed by the OHIP-14 questionnaire. Patients&#8217; satisfaction about the rehabilitation was assessed by VAS according to the following criteria: chewing function, comfort, stability, retention and aesthetics. The use of antidepressants was evaluated as factor potentially related to patient satisfaction with the use of removable dental prostheses. The results were analysed by Mann-Whitney (p&#8804;0.05). <b>Results:</b> Antidepressant users had higher overall OHIP scores (p=0.04), higher physical pain average (p=0.038), more psychological discomfort (p=0.03) and more physical disability (p=0.03). Patients not using antidepressants were more satisfied with the stability/retention of the prostheses (p=0.019). Individuals older than 60 presented greater physical (chewing) disability in the use of removable prostheses (p=0.04). Patients whose removable prostheses were installed more than three years ago had less functional domain (p=0.03) and decreased ability to chew when compared to patients with newer prosthesis (p=0.02). <b>Conclusion:</b> Use of antidepressants for at least one year, advanced age (over 60-year-old), and use of prosthesis for more than three years are factors directly related to self-perceived oral health and patient satisfaction about the prosthetic rehabilitation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=ZC01-ZC06&id=13694 https://doi.org/10.7860/JCDR/2020/43636.13694 Expression of Stem Cell Marker OCT4 and EGF Receptor Predict Recurrence in Transitional Cell Carcinoma of Bladder in Egyptian Patients Mona Mostafa Ahmed, Taiseer Refaat Ibrahim, Safa Ahmed Balata, Mahmoud Malek, Ibrahim Ismail, Ayman Omar <b>Introduction:</b> In the past, the prognosis of bladder cancer was dependent on the presence of muscle invasion. Recently HighGrade T1 (HGT1) Transitional Cell Carcinoma (TCC), found to be associated with similar behaviour and prognosis even following Bacillus Calmette Guerin (BCG) therapy. Recognition of new markers that may help in selection of high-risk cases that need aggressive treatment even in the early stage to avoid unwanted toxicity of chemotherapy has to be high priority. <b>Aim:</b> To evaluate the prognostic value of Octamer-Binding Transcription Factor 4 (OCT4) and Epidermal Growth Factor Receptor (EGFR) immunohistochemical expression in urothelial carcinoma of the bladder and their effect as well as the vascular invasion on the recurrence of these tumours. <b>Materials and Methods:</b> Prospective cohort study conducted in Zagazig University hospital from January 2010 till December 2013. Immunohistochemical staining of OCT4, EGFR and CD34 for 68 cases of bladder cancer samples was done. The correlation between the expressions of each marker and clinicpathologic parameters was then analysed. <b>Results:</b> OCT4 was detected in 53 patients (77.9%) of total cases. EGFR showed high expression in 25 of cases. 18 and 25 cases revealed low and no EGFR expression, respectively. There was a significant association between intensity of OCT4 expression and tumour grade (p<0.001), muscle invasion (p<0.001), vascular invasion (p=0.004) and stage (p=0.001). Significant association was established between EGFR expression and tumour size, grade, lamina propria, muscle and vascular invasion and stage (p 0.005, <0.001, 0.001, <0.001, respectively). Significant association observed between OCT4, EGFR expression and vascular invasion and recurrence (p=0.026, 0.001 and 0.002 respectively). <b>Conclusion:</b> Using selective inhibitors for EGFR and OCT4 especially that approved for EGFR in treating selected cases of urothelial carcinoma of bladder could suppress tumour growth. These markers in addition to presence of vascular invasion have to be used in screening of high risk noninvasive group that benefits from target therapy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=EC11-EC16&id=13691 https://doi.org/10.7860/JCDR/2020/43534.13691 Knowledge, Attitudes and Practices Regarding Rubella Infection among Preparatory Year Students: A Preliminary Exploratory Study in Aden, Yemen Nazeh M Al-abd, Mohammed Alshakka, Sheikh Alshotari, P Ravi Shankar, Mohamed Izham Mohamed Ibrahim <b>Introduction:</b> Rubella is a contagious viral infection characterised by mild fever and rashes. Maternal infection early in pregnancy often leads to birth defects known as Congenital Rubella Syndrome (CRS). Raising awareness among students about the importance of vaccines is a key to helping eliminate the spread of diseases. Moreover, the university students who are young adults will start their own family some day and some might become healthcare providers in the future. Data pertaining to Knowledge, Attitudes and Practices (KAP) regarding rubella are needed to sensitise and create awareness among health care administrators and providers. Aim: To assess the KAP regarding rubella among preparatory year students attending Aden University, Yemen. <b>Materials and Methods:</b> A cross-sectional study was carried out among preparatory year students attending Aden University. The students were chosen randomly. A pre-designed, validated (Cronbach’s alpha was 0.83) and structured questionnaire that gathered personal data and contained questions designed to assess the KAP regarding rubella and its vaccine was administered. Descriptive statistics and the chi-Square test (alpha=0.05) were used to analyse the data. <b>Results:</b> One hundred ninety of the 250 (76%) responses were usable. Overall, 63.2% of participants had heard about rubella but lacked accurate knowledge of the signs, symptoms, causes and modes of transmission of rubella. Regarding their attitude towards rubella, 62.5% of participants considered rubella infection to be harmful to people’s health. <b>Conclusion:</b> This study reveals inadequate KAP regarding rubella among preparatory year students attending Aden University. Hence, there is a great need for adequate health education programs and community mobilisation to enhance public knowledge of rubella. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=LC01-LC05&id=13681 https://doi.org/10.7860/JCDR/2020/44077.13681 Serum Albumin is a Predictor for Postoperative Morbidity and Mortality in Gastrointestinal Surgeries Samuel Lalhruaizela, Benjamin Lalrinpuia, Vanlalhruaii, Dilip Gupta <b>Introduction:</b> The purpose of nutritional support in the surgical patient is to prevent or reverse the catabolic effects of disease or injury. Protein depletion results in delayed wound healing and many other complications. Serum albumin levels at the time of admission were found to be a very useful predictor of such complications. The ultimate validation for nutritional support in surgical patients should be improvement in clinical outcome and restoration of function. <b>Aim:</b> To find the relationship between serum albumin level <3 g/dL and the development of complications and mortality rate among patients following laparotomy for Gastrointestinal (GI) diseases. <b>Materials and Methods:</b> Ninety nine patients, more than 18 years of age with serum albumin level <3 g/dL, posted for emergency and elective laparotomy for GI diseases were included in the study. The following assessments were done: preoperative evaluation of serum albumin, nutritional assessment (Mid Upper Arm Circumference, Skin Fold Thickness) along with Body Mass Index (BMI) and postoperative evaluation of serum albumin after 48 hours and 7 days. Early and late (30 day) postoperative complications were studied. Statistical analysis was done by using descriptive and inferential statistics using Chi-square test and Multiple Regression Analysis. <b>Results:</b> Maximum numbers of patients were in the age group 40-59 years and 59 patients (59.60%) developed postoperative complications. Surgical Site Infection (SSI) was seen in majority (32.32%) of the patients as early postoperative complication and wound dehiscence was the most common late complication (9.09%). Most of the early postoperative complications were present in patients with serum albumin level 2.1-2.7 gm/dL (43.43%). The relation between preoperative serum albumin and early and late postoperative complications was found to be statistically significant. There was a significant co-relation between age, BMI and complications. There were four deaths in the study. <b>Conclusion:</b> Preoperative Hypoalbuminemia <3.0 gm/dL is a strong and independent risk factor for postoperative morbidity and mortality in GI surgeries and BMI is a strong indicator for postoperative complications. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=PC01-PC06&id=13682 https://doi.org/10.7860/JCDR/2020/44315.13682 Relationship between Thyroid Hormones and Body Mass Index in Healthy Indian Adults Haresingh Makwane, Pawan Kumar Kare, Tripti Saxena, Ajay Jandel <b>Introduction:</b> Prior studies have reported that thyroid dysfunction such as overt hypothyroidism and hyperthyroidism are associated with weight gain and loss. In Indian normal healthy adults, relationship between thyroid hormones and Body Mass Index (BMI) has previously been studied but not explained very well. <b>Aim:</b> The present study aims to investigate the relationship between thyroid hormones and obesity measured by BMI in normal healthy adults who further classified in three categories as per the BMI in normal, overweight and obese. <b>Materials and Methods:</b> This observational cross-sectional study was conducted between 1st May 2019 and 30th June 2019. Consecutively, adults who attended Out-Patient Department (OPD) of Department of Medicine at Hamidia Hospital as attendant of patients and healthy hospital’s staff were selected for the study. Thyroid-Stimulating Hormone (TSH), total Thyroxine (T4 ), total Triiodothyronine (T3 ), total cholesterol, Low-Density Lipoprotein Cholesterol (LDL-C), High-Density Lipoprotein Cholesterol (HDL-C), triglyceride and glucose levels were measured in all study subjects. Height, weight, Waist Circumference (WC) and Hip Circumference (HC) were measured and BMI and Waist to Hip Ratio (WHR) were calculated by formula. According to Asian guidelines for BMI, all subjects were divided into three groups as healthy normal (18.5-22.9 Kg/m2 ), Overweight (23-24.9 Kg/m2 ) and Obese (=25 Kg/m2 ). <b>Results:</b> Out of 100 study subjects, 58% were females and 42% were males. According to BMI, 33 (33%) participants were found in normal weight, 36 (36%) were in overweight and 31 (31%) were in obese group. Atherogenic lipid levels such as total cholesterol, LDL-C and triglyceride and blood glucose were found increased and HDL-C levels were found decreased in overweight and obese group. The TSH levels were found significantly increased in overweight and obese subjects as compared to normal subjects, also a statistically significant difference was found for TSH between overweight and obese subjects. Out of 100 subjects, 88% were shown euthyroidism, 10% were shown hypothyroidism and 2% were shown hyperthyroidism. Pearson’s correlation between BMI and TSH was not found significant in normal, overweight and obese groups, while a significant difference was noted between T3 , T4 and BMI in overweight group. <b>Conclusion:</b> In the present study, total 12% thyroid dysfunction was observed. In view of the relationship between BMI and thyroid hormones, any significant relationship was not found in Indian normal as well as obese adults groups https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=BC01-BC04&id=13683 https://doi.org/10.7860/JCDR/2020/43441.13683 Complication of Rubber Band Ligation in Second and Third Degree Haemorrhoids Aditya Ashwani Rajkumar Mehta, Yashwant Lamture <b>Inroduction:</b> Haemorrhoids or piles are symptomatic anal cushions. They can be classified as 1st degree (only bleed), 2nd degree (prolapse but reduce automatically), 3rd degree (prolapse and requires manual reduction) and 4th degree (permanent prolapsed). Haemorrhoids can be managed either conservatively by regular sitz bath, dietary modifications and medications etc., or by minimal invasive procedures like Rubber Band Ligation (RBL), excising and whitehead haemorrhoidectomy. RBL is the most common non surgical and outpatient modality performed, as it is a safe, effective and easier to execute, it is being advised as an Outpatient Department (OPD) procedure. <b>Aim:</b> To study the complications of RBL in 2nd and 3rd degree haemorrhoids. <b>Materials and Methods:</b> The study was conducted as a prospective interventional study at Department of Surgery. The study population consisted of 50 cases of second and third degree haemorrhoids, who underwent RBL as a outpatient procedure. Post-operative complication were studied. Statistical analysis was done using descriptive and inferential statistics through chi-square test. SPSS software 24.0 version and Graph Pad Prism 7.0 version were used in the analysis. Level of significance was considered as less than 0.05. <b>Results:</b> Total 84% had 2nd degree haemorrhoids and 16% had 3rd degree haemorrhoids. The study showed an overall higher success rate (94%) of RBL procedure for 2nd and 3rd degree haemorrhoids; recurrence rate after RBL was 6% (3 patients), when followed-up for a period of 6 weeks The most common complication was pain (62%) followed by urinary retention (8%). The post RBL pain was significantly higher in the 2nd degree haemorrhoids. <b>Conclusion:</b> RBL is an effective, safe outpatient procedure but the complications are more in 3rd degree when compared to 2nd degree haemorrhoids https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=PC07-PC09&id=13684 https://doi.org/10.7860/JCDR/2020/43046.13684 A Study of Arrhythmias in First 48 Hours of Acute Myocardial Infarction in a Tertiary Care Hospital Mohini Singh, Monika Ghai, SR Ramakrishnan <b>Introduction:</b> Myocardial infarction is defined as a clinical or pathologic event caused by myocardial ischemia in which there is evidence of myocardial injury or necrosis. The diagnosis of myocardial infarction is established by typical symptoms, cardiac biomarkers, electrocardiographic changes, or imaging evidence of new regional wall motion abnormality or new loss of viable myocardium. Arrhythmias are well-recognised complications of Acute Myocardial Infarction (AMI) and are important risk factors for mortality in both men and women, across a wide age range. <b>Aim: </b>To analyse the incidence of arrhythmias in acute myocardial infarction with respect to the type, age, gender distribution, location and extension of AMI and to interpret effect of arrhythmias on mortality and morbidity in patents in the first 48 hours of AMI. <b>Materials and Methods:</b> This observational study included 120 patients admitted within one hour of chest pain in Cardiac care unit at Sri Ramachandra Institute of Higher Education and Research Chennai, Tamil Nadu, India from February 2017 to April 2018 after fulfilling the inclusion criteria. Diagnosis of AMI with arrhythmia was made on clinical features, electrocardiography, cardiac biomarkers and echocardiogram. For statistical analysis of data, Statistical Package for Social Sciences (SPSS 16.0 version) was used. <b>Results:</b> In this study of 120 patients, 74 (61.7%) were males and 46 (38.3%) were females (post-menopause) and highest incidence of arrhythmia was noted in the age group of 61- 70 years (32.5%). A total of 71 patients (59.2%) presented with chest pain (p<0.001) and 59.2% had type 2 diabetes. Anterior Wall Myocardial Infarction (AWMI) was observed in 29.16%, followed by Inferoposterior Wall Myocardial Infarction (IPWMI) which was observed in 21.6%. A total of 40.8% had arrhythmias within first hour of hospitalisation. In this study, ventricular premature complex was the most common arrhythmia, observed in 29.2%, followed by sinus tachycardia (20%). Tachyarrhythmias were more frequently observed in anterior infarction whereas bradyarrhythmias were more frequently observed in inferior infarction. 30.8% of patients had ejection fraction of <40%. Overall, mortality was 10% {5.8% in AWMI and 1.7% in IPWMI}. Cardiac biomarkers and left ventricular function were good predictors of extent of infarction (p<0.001). Ten deaths were due to arrhythmias and two secondarily to cardiogenic shock. <b>Conclusion:</b> In this study, it was observed that incidence of myocardial infarction increases with age and was noted more in males than females and in females it was noted more in postmenopausal group. Most common type of arrhythmias observed were ventricular premature complexes and sinus tachycardia and significant number of patients had arrhythmias during the first hour of hospitalisation. Overall, mortality rate was 10% and cardiac biomarkers and left ventricular function are good predictors of infarct size. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=OC05-OC11&id=13685 https://doi.org/10.7860/JCDR/2020/43332.13685 Publication of Postgraduate Thesis in Pathology: An Introspection Pooja Sharma Kala , AR Piyush , Hari Shankar Pandey , Naveen Thapliyal <b>Introduction:</b> Thesis is an important aspect of postgraduate curriculum, mandatory to be submitted for obtaining Doctor of Medicine (MD)/Masters of Surgery (MS) degree in India. The quality of research in thesis and their publication rates in field of Pathology in India has never been commented upon. <b>Aim:</b> To evaluate and analyse the research quality and publication rates of postgraduate thesis in speciality of General Pathology in India. <b>Materials and Methods:</b> This cross-sectional study was done on 41 postgraduate theses (Pathology) submitted for review over a period of 7 years 6 months (January 2012-July 2019) from six different medical institutes from Northern India. Data were recorded and Google online search was done for each topic, author and guide. Publication status, details of publication and journals were recorded and analysed. A journal was considered national or international as declared by the journal itself on the homepage (online journals) and/or cover page (print journals) as well as by the affiliations of editorial board members. The research quality was assessed by the publication status and article citation rates. Statistical analysis was done using SPSS version 18.0 software. <b>Results:</b> Of all theses assessed, 26 (63.4%) were published in peer-reviewed indexed journals. Of these, 20 (76.9%) were published in a journal indexed with &#8805;2 indexing bodies. 25 (96.2%) of these were published in international and only 1 (3.8%) was published in a national journal. Most of these 15 (58%) were published within a year of completion of postgraduation. The principal investigator was the first author in 81% of published theses. The mean impact factors of national and international journals were 0.696 and 3.532&#177;1.828, respectively. Of all the published articles, only one was cited with a citation rate of 0.5 per year. Mean citation rate was 0.02 per paper per year which was low. <b>Conclusion:</b> The publication rate of postgraduate thesis in Pathology was 63.4% but a low citation rate questions the quality of research. Publication of thesis should be encouraged in order to disseminate the knowledge inferred and provide directions for the future researches. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=EC06-EC10&id=13675 https://doi.org/10.7860/JCDR/2020/43488.13675 Utility of B Cell Activating Factor (BAFF) and a Proliferation induced Ligand (APRIL) Cytokines as Markers of Response to Anti-Tubercular Therapy Anuj Singhal, VK Sashindran, Ashwini Aggarwal, Arun Kumar Yadav, Suresh Kayastha <b>Introduction:</b> Serum estimation of cytokines, that play an important role in the pathogenesis of tuberculosis, may be useful to predict early response to Anti-Tubercular Therapy (ATT). This study will help in identifying the role of cytokines in predicting the early response to Tuberculosis (TB). <b>Aim:</b> To find out the utility of B Cell Activating Factor (BAFF) and a proliferation induced ligand (APRIL) cytokines as markers of response to ATT in patients with active TB. <b>Materials and Methods:</b> This was a prospective pilot study carried out at two Tuberculosis Nodal Centers in Pune city, Maharashtra, India. All new Pulmonary Tuberculosis (PTB) cases either sputum positive or sputum negative were considered for enrollment. Exclusion criteria included those subjects whose clinical history was suspected of MDR-TB. Based on their sputum positivity, the PTB patients were divided into two groups: subjects with active PTB patients whose sputum smear was negative for AFB or whose Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) did not detect MTB and group 2 consisted of active PTB patients with sputum smear positive for AFB or MTB detected on CBNAAT. Then, serum was drawn for estimation of BAFF, APRIL, CRP and serum ferritin. The same estimation was repeated after first and second months of standard Intensive Phase (IP) of ATT. All statistical tests were performed using Stata Statistical Software: Release 13. College Station, TX: Stata Corp LP. <b>Results:</b> In this study, 124 patients were analysed; on clinical examination, the most common clinical finding was of consolidation followed by pleural effusion and the most common radiographic finding was consolidation. There was no significant difference in change in acute phase reactants before and after IP in two groups. Receiver Operating Characteristic (ROC) plot for baseline values of BAFF and APRIL for group 2 subjects showed no significant area under the curve. Hierarchical modeling did not show any statistically significant correlation between sputum conversion, and change in levels of BAFF, APRIL, ferritin and CRP and weight gain. <b>Conclusion:</b> This study looked at utility of two specific cytokines BAFF and APRIL as biomarkers of treatment response in TB. There was no significant difference in the levels of these cytokines (BAFF and APRIL) before and after IP of ATT. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=OC01-OC04&id=13676 https://doi.org/10.7860/JCDR/2020/43605.13676 A Study on the Normative Values of Finger Flexion Cascade in Power Grip Users and Non-power Grip Users Jibu George Varghese, Vidhya Venugopal, V Srinivasan, GA Geetha Hari Priya <b>Introduction:</b> The adult hand forms a normal Finger Flexion Cascade (FFC) when at rest. It is the normal alignment of the fingers with some flexion of the digits. The index finger assumes less flexion when compared to the little finger which acquires more progressive flexion when at rest. FFC can vary with occupation as prolonged period of work can have an influence on flexion of joints of hand. Certain occupations cause injury to the long flexor tendons of the hand and can disrupt this natural FFC. Hence an understanding of the normative values of the FFC is required to rehabilitate the subjects to their pre-injury level and manufacture of equipments that match the resting Range of Motion (ROM) values which can reduce the cumulative stress on joints of hand. <b>Aim:</b> To identify the range of values of FFC among individuals working with non-power grips and to compare the FFC between the individuals with occupations involving power grip and individuals with non-power grip occupations and hence identify the minimal resting ROM values required for both the groups. <b>Materials and Methods:</b> A cross-sectional study was conducted in a mixed population of 510 active individuals, aged between 25 and 40 years, belonging to various occupations like heavy equipment handling, industrial work and individuals working with software company. After completing a questionnaire based on occupation, the subjects were grouped into Power Grip Users (PGU) (Group I) and Non-Power Grip Users (NPGU) (Group II). Among 260 subjects included in PGU group, 10 were excluded from the study due to severe callosities and deformity in the hand; 250 subjects working in Software Company were included in NPGU group. The ROM of the joints of all the fingers namely, Metacarpophalangeal (MCP), Proximal Interphalangeal (PIP) and Distal Interphalangeal (DIP) joints of both dominant hand and non-dominant hand were measured for all the 500 subjects in both the groups, using universal finger goniometer and the composite finger flexion was measured using a geometric ruler. The results were recorded and Un-paired t-test was used to compare the FFC between PGU and NPGU groups. <b>Results:</b> The FFC variations in both the dominant and non-dominant hands of subjects in PGU and NPGU were recorded. It was found that the DIP joint of 5<sup>th</sup> digit, PIP joint of the 4<sup>th</sup> digit and MCP joint of the 3<sup>rd</sup> digit was more than the other digits in both the hands. The comparison between range of values of both groups revealed that the values in PGU group were more than the NPGU group with a statistical significance of p<0.001. <b>Conclusion:</b> The FFC was found to be more closed in the PGU than in the NPGU. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=YC01-YC07&id=13677 https://doi.org/10.7860/JCDR/2020/43340.13677 Patient's Attitude towards Resident Involvement in the Surgical Management of Cataract in a Teaching Hospital in Dakshina Kannada- A Prospective Study Sheetal Savur, Chaithanya Blevender Singh <b>Introduction:</b> Cataract surgery is one of the most frequent surgeries performed by the ophthalmologist. Surgical teaching can be in conflict between the doctor-patient contract. However good surgeons evolve only after being imparted with adequate surgical skill through hands on surgical training. Scarce data is available in India regarding the patient perception of resident involvement in cataract surgery. <b>Aim:</b> To evaluate the patient attitude regarding the involvement of residents in their cataract surgery in a teaching hospital. <b>Materials and Methods: </b>A prospective study was conducted on patients undergoing elective cataract surgery in a teaching hospital. The questionnaire was administered to 140 consenting patients from September 2013 to January 2016. Ten questionnaires were incomplete. Hence, 130 questionnaires were used for analysis. The questionnaire consisted of demographic data and nine questions including multiple choice questions and likert-type 5 point responses which primarily intended to find out their awareness regarding the involvement, qualification and attitude of patients towards involvement of residents in the surgical management with and without prior permission. Responses of patients were graded using a 5-point Likert-type scale. The data was analysed using SPSS-version 19 and descriptive statistics mainly in the form of percentages was used. <b>Results:</b> The results revealed that 60 (46%) agreed that being a patient in a teaching hospital implied that trainee eye specialists will be involved in all aspects of management. The number of participants who were unlikely to seek treatment elsewhere even if they found out that a postgraduate was likely to assist or perform the surgery was 50 (38.4%). A large number of them 50 (38.4%) felt that it was very important to be asked permission in advance before a postgraduate performed or assisted in cataract surgery. If they found that resident had performed the whole surgery on them without prior permission 40 (30.7%) would not be upset at all. <b>Conclusion:</b> Most of the patients seeking treatment in a teaching hospital were aware of the fact that postgraduate residents play a role in the surgical management. Few would be upset if they hadn’t been informed regarding the same. However, many patients preferred to be informed regarding the involvement of residents during their surgery https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=NC01-NC04&id=13678 https://doi.org/10.7860/JCDR/2020/43491.13678 Visual Outcome in Metallic Orbital Foreign Body Following C-Arm Guided Extraction: Comparison with OTS Predictive Value Hendrian Dwikoloso Soebagjo, Susy Fatmarianti, Budi Utomo <b>Introduction:</b> Orbital Foreign Body (OFB) is a complication that can occur in orbital trauma. Penetration of an air gun pellet (as a foreign body) into orbit that has penetrated the orbital cavity and is lodged in it, can cause severe complications and damage to the orbital cavity; even result in blindness. <b>Aim:</b> To compare the visual outcome of patients with air gun pellet injury who underwent C-arm guided extraction with OTS predictive value. <b>Materials and Methods:</b> Thirty patients with orbital pellet injury were surgically treated with C-Arm fluoroscopy. The data were studied retrospectively and it included demographic data, the number of pellets, complete eye examination findings, post-traumatic (pre-operative) visual acuity and post-operative visual acuity and post-traumatic ocular complications. The statistical analysis was performed using SPSS version 16.0 for Windows. <b>Results:</b> Most of the patients were men (27 patients/90%), with an average age of 29.03&#177;15.54 years. Sixteen cases (53.33%) involved left orbit. Six patients (20%) experienced pre-operative visual acuity of No Light Perception (NLP), as well as visual acuity of &#8805;20/200. Follow-up was performed two months after the retrieval of pellets in the orbital cavity. There were no significant differences in the pre-operative vision (2.04&#177;1.07), compared to the post-operative vision 2.07&#177;1.13 with a p-value of 0.937. In addition, there were no patients that had surgical complications, needed secondary, additional surgeries, and significant differences between the pre-operative and post-operative visual acuity. <b>Conclusion:</b> C-Arm guided extraction of the OFB does not affect the patients&#8217; visual acuity, so the method is safe to extract the foreign metal objects (pellets) in the orbital cavity. OTS predictive value might not be applicable for the OTS injury due to gun pellets. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=NC05-NC09&id=13713 https://doi.org/10.7860/JCDR/2020/44170.13713 Comprehensive Evaluation of Effect of Low Dose Local Steroid Injection in Carpal Tunnel Syndrome Junis Ali, Diganta Borah, Nonica Laisram, SY Kothari, C Chethan <b>Introduction:</b> Carpal Tunnel Syndrome (CTS) is one of the most common entrapment neuropathy with significant affection of hand function. Diagnosis is based on clinical, electrophysiological findings and ultrasonographic findings. Treatment may be nonsurgical or surgical. Of the nonsurgical methods, local glucocorticoid injection has yielded promising results in mild to moderate CTS. Use of different doses of steroid for CTS ranging from 12 mg to 40 mg with comparable results has been reported in the literature. To the best of our knowledge, efficacy of low dose steroid injection has not been evaluated in a comprehensive manner. <b>Aim:</b> To assess the efficacy of a low dose local steroid injection in CTS patients utilising clinical, electrophysiological and ultrasonographic parameters. <b>Materials and Methods:</b> Fifty five diagnosed patients of mild and moderate CTS, on the basis of electrophysiologic findings, were recruited for the study. Clinical evaluation was done in terms of grip strength and pain status. For baseline electrophysiological evaluation, nerve conduction studies were performed. This included Sensory Nerve Action Potentials (SNAPs), Sensory Distal Latency (SDL), Motor Distal Latency (MDL) and sensory and motor Conduction Velocity (CV) of median nerve as assessment parameters. Cross Sectional Area (CSA) of median nerve and bowing of flexor retinaculum was assessed using ultrasonography. Single dose of 20 mg methylprednisolone acetate was injected into the carpal tunnel under all aseptic precautions. Pain status was assessed at one week after the procedure. Overall, efficacy of the intervention was assessed using all the assessment parameters at one and three months after intervention. Statistical analysis was done using SPSS version 17 and p-value of <0.05 was considered as statistically significant. <b>Results:</b> 44 patients completed three months follow-up period. Most of the parameters assessed showed improvement at one month and three months after the intervention. At one month, grip strength, pain, SNAP, MDL, sensory CV and CSA of median nerve were found to be significantly improved. At three months follow-up, in addition to the further improvement in these parameters, SDL also showed significant improvement in comparison to baseline. However, motor nerve CV showed no significant improvement during the study period. <b>Conclusion:</b> Low dose local steroid injection is an effective intervention for treating CTS subjects. It provides rapid pain relief and improvement in objective parameters which persists till the end of three months https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=OC20-OC23&id=13714 https://doi.org/10.7860/JCDR/2020/43471.13714 Assessment of Reaction and Perception about Training to Train the Resident as a Clinical Counselor through Feedback Rano Mal Piryani, Suneel Piryani, Ravish Mishra, Nagendra Chaudhary <b>Introduction:</b> Counseling the patient and family is among the responsibilities of residents, so, training residents for enhancing their counselling skills is of utmost importance. Hence, Universal College of Medical Sciences Bhairahawa, Nepal organised one-day &#8220;Training to train resident as a clinical counselor&#8221;. <b>Aim:</b> To take feedback of the participant residents and assess their reaction and perception about training. <b>Materials and Methods:</b> Feedback of the training participants was taken on the valid semi-structured questionnaire comprised of four parts: Part A-Demographic information, Part B-Overall feedback on training, Part C. Feedback on specific sessions and Part D- Feedback for the improvement. Data was analysed using IBM SPSS version 21. <b>Results:</b> The participants rated training on scale 1-10 for usefulness 8.86&#177;1.03, content 9.07&#177;1.41, relevance 8.86&#177;1.35, facilitation 9.21&#177;1.12, and overall 8.64&#177;1.86. The residents perceived training transformed their counselling skills (3.57&#177;0.51) rated on Likert Scale 1-4. Their rating on specific sessions were remarkable. Training clarified concepts and was comprehensive, interactive and effective were among the strengths of training while include more scenario, include real patients in role play were among the suggestions of the participants. <b>Conclusion:</b> The rating of participants on the training was notable and their perception of was positive. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=JC01-JC03&id=13707 https://doi.org/10.7860/JCDR/2020/43261.13707 Speciation and Susceptibility Pattern of Enterococcal Species with Special Reference to High Level Gentamicin and Vancomycin Vibi Varghese, Ardra R Menon, K Prithi Nair <b>Introduction:</b> Enterococci have emerged as the second most common cause of nosocomial infections in the gastrointestinal tract, oral cavity and genitourinary tract. The common species of Enterococci which cause human infections are <i>E. faecalis</i> and <i>E. faecium</i>, their resistance to common antibiotics is a major obstacle for treatment. Identification to the species level is crucial for the proper treatment, epidemiology and infection control. <b>Aim:</b> To isolate and speciate Enterococcal species obtained from clinical samples, to study their antimicrobial susceptibility pattern with special reference to High Level Gentamicin Resistance (HLGR) and Vancomycin. <b>Materials and Methods:</b> A hospital based cross-sectional study was done using 75 clinical isolates of Enterococci over a period of one year in the Department of Microbiology, Government Medical College, Thrissur, Kerala, India. The isolates were identified, speciated using standard methods and antibiotic susceptibility was determined by Kirby Bauer disc diffusion method; and Vancomycin MIC was determined by E-test method. Statistical analysis was done by counts and percentages using MS Excel version 2010. <b>Results:</b> Out of the 75 Enterococci strains, 50 (66.7%) were <i>E. faecalis</i>, 16 (21.4%) were <i>E. faecium</i>, 6 (8%) were <i>E.raffinosus</i>, 2 (2.6%) were <i>E.durans</i> and 1 (1.3%) was <i>E.avium</i>. The maximum no. of isolates were from male patients, and pus samples yielded more Enterococci. HLGR was found in 25/75 (33.3%) strains and 3/75 (4%) strains showed Vancomycin resistance. Isolates had 100% sensitivity to Linezolid. <b>Conclusion:</b> The study showed more drug resistance to <i>E.faecium isolates</i>, with high rate of resistance to Penicillin, Vancomycin, Ciprofloxacin and Aminoglycosides; which emphasises the urgent need for more rational use of antimicrobials and infection control. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=DC08-DC12&id=13708 https://doi.org/10.7860/JCDR/2020/44014.13708 Evaluation of Brain Tumours using Magnetic Resonance Perfusion Imaging: A Prospective Study Darshan Singh Grewal, Uddandam Rajesh, CM Sreedhar, Shikha Awasthi, C Vijayakumar <b>Introduction:</b> Brain tumours are an important cause of neurological problems. Grade of these tumours is one of the parameters which decide the treatment offered to patients. Magnetic Resonance Imaging (MRI) though superior to other conventional modalities still has few limitations in assessing grade of tumours. Perfusion MRI by virtue of its ability to measure haemodynamic parameters can be used to access grade of tumour. <b>Aim:</b> To evaluate the role of perfusion MRI in evaluation of brain tumours by using relative Cerebral Blood Volume (rCBV). <b>Materials and Methods:</b> A prospective study was carried out in a tertiary care hospital from July 2015 to June 2018. MRI was performed on 23 patients using conventional imaging, perfusion imaging with T2*-weighted Echo-Planar sequence after administration of Gadopentetate dimeglumine. Perfusion data was processed to obtain colour maps and rCBV value was generated. rCBV values were correlated with histopathological grade of tumours. Statistical analysis was done by using SPSS (Statistical Package for Social Sciences) Version 20.0. Tukey’s test was used to compare the mean rCBV value for pairwise comparison of grades of tumour and unpaired t-test was used to compare the mean rCBV between high grade and low grade astrocytomas. Receiver’s Operating Characteristics (ROC) curve was used to find the sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) and cut-off value of rCBV for detection of high grade tumour. <b>Results:</b> Grade I astrocytoma and Grade II astrocytoma had mean rCBV of 1.435&#177;1.063 and 2.046&#177;1.282, respectively. Grade III astrocytoma and Grade IV astrocytoma had mean rCBV of 7.620&#177;3.463 and 12.455&#177;0.361 respectively. Mean rCBV of medulloblastoma was 4.185&#177;2.482. Low grade astrocytoma (grade I and grade II) had mean rCBV of 1.817&#177;1.207 and high grade astrocytoma (grade III and grade IV) had mean rCBV of 9.554&#177;3.611. There was significant difference between mean rCBV in Grade I/II vs III/IV (p<0.001), there was no significant difference between mean rCBV in Grade I and Grade II. <b>Conclusion:</b> Perfusion MRI is useful in differentiating low grade (grade I and II) astrocytoma from high grade (grade III and IV) astrocytoma. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=TC01-TC04&id=13709 https://doi.org/10.7860/JCDR/2020/44051.13709 A Comparative Study of Clinical and Angiographic Profile of Acute Coronary Syndrome in Young Diabetics and Non-diabetics B Lakshmi Narayanan, Mohamed Hanifah, B Amirtha Ganesh <b>Introduction:</b> The clinical presentations and angiographic findings of Coronary Artery Disease (CAD) vary from diabetic and non-diabetic patients and also vary with the age of patients. CAD in patients below the age of 45 is a special subset. Clinical presentations of CAD in young patients with various risk factors differ, which may play an important role in management strategies. <b>Aim:</b> To compare the clinical and angiographic profile in patients presenting as Acute Coronary Syndrome (ACS) with Diabetes Mellitus (DM) and without DM below the age of 45 years. Materials and Methods: It was a comparative observational study done between the time period of January 2018 to June 2019. in patients presenting with symptoms suggestive of ACS. Patients below 45 years of age were subdivided into two major groups, Group A (ACS with DM) and Group B (ACS without DM) and analysed for the clinical and angiographic pattern. The data was analysed using SPSS software. Significance was assessed with Chi-square test. <b>Results:</b> Eighty ACS patients were analysed. Mean age was found to be 41.2&#177;4.01 years, with a mean Glycated Haemoglobin (HbA1c) value of 8.65&#177;3.3%. Clinical profile and pattern of involvement of coronary arteries, as assessed by coronary angiography were found to be different in younger CAD patients; ST-Elevation Myocardial Infarction (STEMI) was the most common type of ACS. Single Vessel Disease (SVD) was the most common angiographic finding and Echocardiography (ECHO) showed normal Left Ventricular (LV) function. Atypical chest pain and multiple vessel disease were common in diabetics with higher HbA1c (p=0.001). <b>Conclusion:</b> Younger and non-diabetic ACS patients get lesser burden of disease as compared with diabetics and elderly people. This finding might help in prognostication of disease. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=OC16-OC19&id=13705 https://doi.org/10.7860/JCDR/2020/43858.13705 The Association between <i>lasB</i> and <i>nanI</i> Genes with Biofilm Formation in <i>Pseudomonas aeruginosa</i> Clinical Isolates Zahra Mahdavi, Saeed Hemati, Nourkhoda Sadeghifard, Farid Azizi Jalilian, Morovat Taherikalani, Lida Bimanand, Iraj Pakzad, Sobhan Ghafourian <b>Introduction:</b> Several acute and chronic infections in humans can be caused by <i>Pseudomonas aeruginosa (P.aeruginosa)</i>. Biofilm formation by these bacteria threatens health setting via increasing resistance against antimicrobial agents. <b>Aim:</b> To investigate the association between <i>lasB</i> and <i>nanI</i> genes with biofilm formation in <i>P. aeruginosa</i> clinical isolates. <b>Materials and Methods:</b> A total of 161 <i>P. aeruginosa</i> clinical isolates were collected. The Microtiter Plate (MTP) method was applied for biofilm formation assay. Gene amplification was conducted by PCR method with specific primers. <b>Results:</b> Present study findings showed that the prevalence of <i>lasB</i> and the <i>nanI</i> were 80.7% (130/161) and 24.8% (40/161), respectively. The biofilm formation results demonstrated that 15.5% (25/161) of isolates were not able to produce biofilm formation. It was considerable that the prevalence of <i>lasB</i> in <i>P. aeruginosa</i> producing biofilm was higher. <b>Conclusion:</b> <i>lasB</i> can be considered as an effective factor for biofilm formation in <i>P. aeruginosa</i> isolates. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=DC01-DC03&id=13697 https://doi.org/10.7860/JCDR/2020/16076.13697 Allergic Bronchopulmonary Aspergillosis in Acute Severe Asthma- A Cross-sectional Study Aneesa Shahul, Vishnukanth Govindaraj, Saka Vinod Kumar, Veer Singh Negi, Vinay Pandit, Abhisekh Singh Chauhan <b>Introduction:</b> The prevalence of Allergic Bronchopulmonary Aspergillosis (ABPA) is sparingly studied among asthmatics in Southern India. <b>Aim:</b> To assess the occurrence of ABPA in patients with Acute Severe Asthma and to describe the clinical spectrum of ABPA among them. <b>Materials and Methods:</b> This was a cross-sectional analytical study performed on 150 patients of acute severe asthma, who attended Pulmonary Medicine Department and Emergency Medical Services department in a government tertiary care institute in Southern India; from January 2016 to December 2017 over a period of two years. Patients were evaluated for ABPA using Rosenberg-Patterson criteria. The distribution of data for the categorical variables such as gender of patients, signs and symptoms, radiological parameters etc., was expressed as frequencies and percentages. The comparison of these variables between the groups was carried out by using Chi-square or Fishers-Exact test. The comparison of these variables between the groups was carried out by using independent Students t-test or Mann-Whitney U test whichever was appropriate. All statistical analysis was carried out at 5% level of significance and p-value <0.05 was considered significant. <b>Results:</b> There were 49 males and 101 females (mean age 40.25±12.8 years). As per Rosenberg Paterson criteria, 31.3% had ABPA-Central Bronchiectasis and 10% ABPA-Seropositive. The occurrence of Aspergillus Hypersensitivity (AH) was 54% (81/150) and occurrence of ABPA was 41.3% (62/150) in acute severe asthma. <b>Conclusion:</b> The study reflects high occurrence of AH and ABPA in severe asthmatics. Such alarming values calls for the use of Skin prick test as a screening tool for evaluation of patients with severe asthma. There is a pressing need for early diagnosis and timely treatment to protect the patients from irreversible lung damage. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=OC12-OC15&id=13698 https://doi.org/10.7860/JCDR/2020/43385.13698 Factors Associated with Health Literacy for Public Health Students Saowaluk Seedaket, Niruwan Turnbull, Teerasak Phajan <b>Introduction:</b> Health literacy is a necessary skill for a future workforce who will be a healthcare model for patients and even people around them. This will enhance knowledge of people to engage in the prevention of diseases and health risk factors, especially supporting people to modify their health behaviour. <b>Aim:</b> To investigate the factors associated with Health Literacy for Public Health Students. <b>Materials and Methods:</b> This cross-sectional descriptive research involved 143 students from Sirindhorn College of Public Health, Praboromarajchanok Institute, Ministry of Public Health, Thailand. The data was collected from August to November, 2019 using a questionnaire, which was tested for content validity by 3 experts and its reliability was assessed using Cronbach&#8217;s alpha. The critical thinking and health literacy yielded a score of 0.75 and 0.96, respectively. The data was analysed using descriptive statistics and multiple logistics regression at 0.05 level of significance, the adjusted odds ratio, 95% confidence Interval and p-value. <b>Results:</b> It was found that 109 (76.22%) of the respondents were female, the average age was 23.39&#177;4.15 years, and 57 (39.86%) had a Grade Point Average (GPA) 3.00 from 4.00. The critical thinking and health literacy was classified as high level at 18 (12.59%) and 78 (54.55%), respectively. The factors significantly associated with reported high health literacy (p-value <0.05) were: (1) Gender (Adjusted OR=3.11, 95% CI: 1.28-7.58; p-value=0.012); (2) GPA (Adjusted OR=2.41, 95% CI: 1.15-5.04; p-value=0.019); and (3) Critical thinking (Adjusted OR=2.99, 95 % CI: 1.36-6.54; p-value=0.006). <b>Conclusion:</b> The factors associated with high health literacy were: gender, GPA and student&#8217;s critical thinking. Therefore, the stakeholders or policy makers should be concerned with ensuring students improve their learning and encourage them to gain a higher level of health literacy for a sustainable healthcare professional career. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=LC06-LC09&id=13699 https://doi.org/10.7860/JCDR/2020/43557.13699 Evaluation of Effect of Surface Treatment of Intaglio Surface on Retention of Complete Cast Crowns Cemented with Different Cements: An <i>In vitro</i> Study Veena B Benakatti, Ulhas N Amasi, Raghunath Patil <b>Introduction:</b> Recently, several adhesive primers for base metals have become commercially available. The effect of metal primers on noble alloys has been studied several times and proved to be efficacious but there is insubstantial information about their effect on base metal alloys. Hence, the purpose of this study is to evaluate the effect of surface treatment (sandblasting with alumina oxide particles and metal primer) on retention of complete cast crowns luted with different cements. <b>Aim:</b> To compare and evaluate the effect of surface treatments of intaglio surface on retention of complete cast crowns cemented with different luting cements. <b>Materials and Methods:</b> In this in-vitro experimental study a total of 50 extracted human sound premolar teeth were prepared to receive cast metal crowns made of cobalt-chromium alloy. Teeth were mounted in an index using autopolymerising acrylic resin; crown preparations were made with a high-speed hand piece stabilised by using a k-9 crown installation machine and 6° taper was achieved for all preparations. Occluso-cervical dimension of the teeth was standardised at 4 mm for all the samples. Based on type of luting cement, the teeth were divided into five groups: glass ionomer cement (10); resin modified glass ionomer cement (10); resin-modified glass ionomer cement with surface treatment (10); resin cement (10); and resin cement with surface treatment (10). After surface treatment and cementation procedures, samples were stored in storing media and then subjected to tensile loading with universal testing machine (TU400 Batch no-99/01, Fine Spavy, INDIA) to separate crowns from the tooth. ANOVA test followed by Tukey’s Honest Significant Difference (HSD) post-hoc test were employed in the analysis of data. SPSS 17.0 statistical software was used to analyse the data. <b>Results:</b> Among cements tested in the study, resin cement with surface treatment (7.61±0.78) Mpa had the highest tensile bond strength, while glass ionomer had the lowest tensile bond strength (3.78±0.65) Mpa. Significant improvement was observed in tensile bond strength after surface treatment with both the cements (resin modified glass ionomer and resin cement) with p<0.001. <b>Conclusion:</b> The study reasonably concluded that the type of surface treatment may have a significant effect on retentive strength of crowns. Combination of sandblasting and metal primer https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=ZC07-ZC12&id=13700 https://doi.org/10.7860/JCDR/2020/43749.13700 Histopathological Types of Benign Proliferative Lesions in Peritumoural Vicinity of Carcinoma Breast Ankita Gajanan Laddha, Samarth Shukla, Ravindra P Kadu, Arvind S Bhake, Sunita Vagha, Miheer Jagtap <b>Introduction:</b> The majority (90%) of lesions that occur in the breast are benign. In India, although benign breast diseases had a high incidence they have always been overshadowed clinically by breast cancer. Retrospective and prospective studies have shown relative risk of breast cancer of 1.5 to 1.6 for women with benign breast disease as compared with women in the general population. The presence of different lesions within the same breast adjacent to malignancy is also a phenomenon that can prove the multistep progression to malignancy. <b>Aim:</b> To determine the presence of any change in peritumoural area of carcinoma breast and to compare the pathological findings of tumour and adjacent area for co-existing benign proliferative lesions. <b>Materials and Methods:</b> The prospective, cross-sectional and observational study included 75 cases of mastectomy specimens of carcinoma breast conducted in the histopathology section of Department of Pathology, Jawaharlal Nehru Medical College (JNMC) in Sawangi (M) Wardha, from 1<sup>st</sup> August 2017 to 31<sup>st</sup> July 2019. The cases in which the histopathological diagnosis of infiltrating ductal carcinoma-not otherwise specified were made on Haematoxylin and Eosin (H&E) staining. Sections of the tumour and peritumoural area were studied in detail for co-existing lesions. Based on the predominant epithelial benign lesion present in peritumoural area, the lesions were classified morphologically as: Non-proliferative, Proliferative disease without atypia and Proliferative disease with atypia. Statistical analysis was done using descriptive and inferential statistics with the chi-square test and software used in the analysis were SPSS 24.0 version and GraphPad Prism 7.0 version. <b>Results:</b> Out of 75 cases diagnosed as carcinoma breast on H&E further peritumoural area was subcategorised as 29 cases of fibrocystic changes (38.67%), 8 cases of proliferative disease without atypia (10.66%) and 33 cases of proliferative disease with atypia (44%) associated with tumour. <b>Conclusion:</b> The study concludes that the most predominant histological lesions in peritumoural area of carcinoma breast are proliferative changes with atypia followed by fibrocystic changes which has an absolute lifetime risk of 13-17% transforming into carcinoma breast making these patients mandatory for follow-up and further management. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=EC21-EC26&id=13701 https://doi.org/10.7860/JCDR/2020/43291.13701 Common Salt, An Effective Remedy for Management of Umbilical GranulomaAn Observational Study Eti Sthapak, Vijai Datta Upadhyaya, Basant Kumar, Anita Singh, Akash Pandiata, Kirti Narngane <b>Introduction:</b> Usually, the residual umbilical stump separates by 7-15 days postpartum and the umbilical ring closes with epithelisation. In few infants, the umbilicus ring does not get epithealialised completely it forms an umbilical polyp and disappears in 2-3 weeks. Umbilical polyp requires medical attention if it persists beyond 3 weeks. Application of common salt for management of umbilical granuloma is one of the known modality of treatment owing to its hygroscopic action, though literature is sparse on the topic. <b>Aim:</b> To observe the effect of common salt on umbilical granuloma. <b>Materials and Methods:</b> Common salt application for management of umbilical granuloma is a standard modality at the study Institute. This was a retrospective observational study from January 2015 to December 2018. All data on infants of diagnosed umbilical granuloma, managed with application of salt, were evaluated. A total of 76 cases were managed during this period. Detailed demographic and clinical data was retrieved and collected in structured proforma from the electronic and manual record system. Descriptive statistical analysis was done. <b>Results:</b> In all cases, the granuloma healed within a span of two weeks. Number of salt application ranged from 8 to 24 applications. Total time for which salt remained in contact of umbilicus ranged from 8 to 24 hours. The number of sessions of salt application from presentation of patient to cure ranged from 8 to 24; median for sessions of salt application for complete cure was 12. Median for 25 quartile and 75 quartile was 12. Parents did not report any behavioural changes, sleep disturbances, or irritability in the infants after the application. No other complication or recurrence was noted in follow-up of 1 year. <b>Conclusion:</b> Common salt can be an effective modality to treat umbilical granuloma. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=PC10-PC13&id=13702 https://doi.org/10.7860/JCDR/2020/43424.13702 Comparison of Manual and Automated Method for Speciation and Antifungal Susceptibility of <i>Candida</i> Species Causing Blood Stream Infection in Critically ill Patients Swati Jain, Bichitrananda Swain, Sunita Kabi <b>Introduction:</b> Globally, the incidence Blood Stream Infection (BSI) by Candida species is increasing. It is associated with high mortality rates especially in immunocompromised critically ill patients. The epidemiology has been shifted from <i>Candida</i> species to <i>Non-albicans Candida</i> (NAC) in recent decades. Speciation of <i>Candida spp.</i> can help to improve the outcome of patients as few <i>Candida </i>species are intrinsically resistant to antifungal agents. <b>Aim:</b> To identify the spectrum of <i>Candida </i>species causing BSI, study their sensitivity pattern to antifungal agents and comparison of conventional (germ tube test, Dalmau plate culture and Chromagar) and automated (Vitek-2) methods for the same. <b>Materials and Methods:</b> Blood specimens of the clinically suspected cases of septicaemic patients were cultured by BacT/ ALERT before administration of antibiotics or antifungals during the study period of one and half year. The isolated <i>Candida </i>were identified to the species level along with antifungal susceptibility testing done by both conventional and automated (Vitek-2) methods. Statistical analysis was done using Chi-square test. <b>Results:</b> Of the total 100 <i>Candida </i>isolated, the most common <i>Candida</i> species was C.parapsilosis (26%), followed by C.tropicalis (23%), C.albicans (21%) and C.auris (15%). Total concordance between manual and Vitek-2 identification was 74%. Significant risk factors involved in patients with candidemia were malignancy, diabetes mellitus and chronic kidney disease. Antifungal susceptibility rate for amphotericin B, caspofungin, Fluconazole, Flucytosine, Micafungin and Voriconazole was 94%, 90.5%, 73.8%, 96.4%, 98.8% and 95.2%, respectively. Mortality rate was 45% due to sepsis and associated complications. <b>Conclusion: </b>Early isolation, speciation and antifungal susceptibility is the key for management of candidemia cases to get the better outcome as C.auris, the important multidrug resistant variant has caused a major epidemiologic shift in candidemia. Molecular studies are required for accurate speciation of <i>Candida </i>species like C. auris, C. haemulonii, C. famata, etc. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=DC04-DC07&id=13703 https://doi.org/10.7860/JCDR/2020/43642.13703 Diabetes Specific Quality of Life in the Association of Southeast Asian Nations- A Systematic Review Nghiep Ke Le, Niruwan Turnbuill, Cuong Van Dam <b>Introduction:</b> Diabetes Mellitus (DM) is flagrant for its metabolic influence, acute and long-term complications and encroachment on the Health-Related Quality of Life (HRQoL). <bAim:</b> The existing systematic review was conducted in The Association of Southeast Asian Nations (ASEAN) to ascertain: 1) the latest available knowledge about HRQoL; 2) the principal methodological flaws on the HRQoL studies; and 3) the main factors associated with HRQoL in diabetic people. <b>Materials and Methods:</b> National and International databases (Y hoc Thanh Pho Ho Chi Minh, Vietnam Journal of Preventive Medicine, Journal of Practical Medicine, Pubmed, Medline, Web of Science, CINAHL, Scopus, PsycINFO, ERIC, Google and Google Scholar) were searched following search terms: “diabetes”, “quality of life”, “d¯ái tháo d¯u’o`’ng” and “cha´` ´ t lu’o’ng cuo´`c so´` ´ ng”. The data was analysed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. <b>Results:</b> A total of 36 studies passed the inclusion criteria and comprised the review. The studies were as follows: 18 studies in Malaysia, 9 studies in Singapore, 6 studies in Indonesia, 2 studies in Thailand, one study in Vietnam. Most studies investigated HRQoL among people with type 2 DM with the use of 17 different instruments. The findings of this review showed that diabetic persons had a lower HRQoL than healthy people. This discovery also indicated that better socioeconomic status, better control of risk factors and complications were associated with a better HRQoL among diabetic patients. Moreover, treatment adherence improved the HRQoL. The reviewed studies suffered from major methodological and reporting flaws which limited the validity and generalisation of their discoveries. <b>Conclusion:</b> There were many tools that have been used to assess the HRQoL of diabetic patients in the Association of Southeast Asian Nations (ASEAN). HRQoL diabetes is lower than that of healthy people, and it varies according to different characteristics of the patient. There were several gaps in the studies that need to be further assessed in subsequent studies. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=May&volume=14&issue=5&page=LE01-LE06&id=13696 https://doi.org/10.7860/JCDR/2020/43580.13696