Journal of clinical and diagnostic research

The Phenotypic Detection Of Carbapenemase In Meropenem Resistant Acinetobacter Calcoaceticus–Baumannii Complex In A Tertiary Care Hospital In South India

ANIL V KUMAR*, VISHNU S PILLAI**, KAVITHA R. DINESH***, SHAMSUL KARIM****

Background and objectives: The predominant Acinetobacter spp. in clinical settings are the members of the Acinetobacter calcoaceticus– baumannii complex which are multi drug resistant and are responsible for causing outbreaks. Carbapenem resistance due to metallo-β-lactamase production in Acinetobacter spp. is on the rise. We investigated the production of carbapenemase among the meropenem resistant Acinetobacter spp. which were further screened for metallo-β-lacatmase production. The co-resistance to other classes of antibiotics was also investigated. Materials and Methods: Forty five non duplicate consecutive meropenem resistant Acinetobacter calcoaceticus– baumannii complex were investigated for carbapenemase production by the modified Hodge test. The carbapenemase producing isolates were further screened for metallo-β-lacatmase production by the combined disc diffusion test by using imipenem with EDTA as the chelator. The co-resistance to other classes of antibiotics was also investigated to identify the multi drug resistant isolates. Results: Of the 45 non duplicate consecutive meropenem resistant Acinetobacter calcoaceticus– baumannii complex which were screened, 95% (43/45) of them were multi drug resistant and 71% (32/45) were found to be carbapenemase producers by the modified Hodge test, of which 21% (7/32) were found to be metallo-β-lacatmase producers phenotypically by the combined-disk test. Conclusion: Carbapenem resistance in Acinetobacter calcoaceticus– baumannii complex is very high and is predominantly due to carbapenemase production. However, metallo-β-lactamase production among these isolates is not very high but is gradually increasing. Only 21% of our isolates were metallo-β-lactamase phenotypes, thus suggesting that the production of carbapenem hydrolyzing oxacillinase is still the most common mechanism of resistance to carbapenems in this species.

The Incidence Of Candiduria In An ICU – A Study

SEEMA BOSE*, ATINDRA KRISHNA GHOSH**, REKHA BARAPATRE***

Due to the increased use of indwelling drainage devices, the incidence of candiduria has been increasing steadily. Candida isolates from the urine of catheterised patients were identified by the germ tube test, by chlamydospore formation on corn meal agar and by the sugar fermentation test. Simultaneously, the identification of the candida isolates was performed by using CHROM agar candida medium and Hi candida identification kit. Out of 59 urethral catheterized patients, 21 (35.59%) were positive for the growth of yeasts. Candida albicans was the commonest isolate, followed by Candida dubliniensis, Candida glabrata, Candida tropicalis and Candida parapsilosis. The rate of infection was directly proportional to the number of days during which the catheter was present in a patient.

The Prevalence Of Intestinal Parasitic Infections In HIV Infected Patients In A Rural Tertiary Care Hospital Of Western Maharashtra (A 5 Year Study)

SACHIN DEORUKHKAR*, RUCHI KATIYAR**, SANTOSH SAINI***, AU SIDDIQUI****

Purpose: To determine the prevalence of intestinal parasites in patients with HIV infection. Methods: Stool samples from 332 HIV infected patients with diarrhoea and 246 patients HIV infected patients without diarrhoea were examined for intestinal parasites by microscopy. Results: Intestinal parasites were seen in 68.57% HIV patients with diarrhoea as compared to their presence in 30.08% HIV patients without diarrhoea. Giardia intestinalis was the most common parasite which was detected. Conclusion: There is a high prevalence of intestinal parasitic infection in HIV patients. Giardia intestinalis is a predominant intestinal parasite which causes diarrhoea among HIV patients, followed by Cryptosporidium parvum.

Urinary Tract Infections, Pelvic Inflamatory Disease, Hepatitis B, And Diabetes Mellitus Among Women Of The Reproductive Ages In A Developing Nation

PAUL A BOURNE*

Background: With the high prevalence of cervical cancer, sexually transmitted infections, in particular HIV/AIDs, in developing countries, there is a need to examine pelvic inflamatory diseases or urinary tract infections, Hepatitis B, diabetes mellitus and factors which explain pelvic inflamatory diseases or urinary tract infections. No single study has emerged in the developing world, which has explored all these issues. Aims: The present study sought to elucidate information on pelvic inflamatory diseases or urinary tract infections among Jamaican women in reproductive ages, as well as Hepatitis B, diabetes mellitus, and factors which accounted for pelvic inflamatory diseases or urinary tract infections. Setting and design: Stratified random sampling was used to design the sample, and a three-stage sampling design was used. Methods and material: The current study used secondary survey data. An administered questionnaire was completed by a random sample of 7,168 females. Statistical analysis used: The Statistical Packages for the Social Sciences (SPSS) for Windows, Version 16.0 (SPSS Inc; Chicago, IL, USA) was used to analyse the data. Multiple logistic regressions were used to model the factors which explained pelvic inflamatory diseases or urinary tract infections. Results: Twelve percentages of study respondents indicated that they have had pelvic inflamatory diseases or urinary tract infections. Nine variables emerged as statistically associated with urinary tract infections or pelvic inflamatory diseases: forced to have sexual intercourse (Odds ratio, OR, = 22.73, 95% CI = 2.86 – 180.56), education (OR = 1.97, 95%CI = 1.19 – 3.25), Pap smear examination (OR = 9.38, 95% CI = 1.05 – 84.21), partner main source of financial support (OR = 0.10, 95% CI = 0.02 – 0.58), Hepatitis B (OR = 7.31, 95% CI = 0.92 – 54.92), number of miscarriages (OR = 1.25, 95% CI = 1.02 – 1.48), number of abortions (OR = 2.01, 95% CI = 1.49 – 2.73), and social hierarchy. Conclusion: Sexual activity, inconsistent condom usage, and pelvic inflamatory diseases or urinary tract infections are a part of the reality among females of the reproductive age, and within the context of low Pap smear or pelvic examination, public health practitioners need to implement programmes to address these concerns.

The In Vitro Efficacy Testing Of Skin Disinfectants Against Nosocomial Pathogens

Background Nosocomial infections increase the morbidity among hospitalized patients and are a major cause of death. The national surveillance data and public health research have demonstrated that hospital- acquired infections (HAIs) take a major human toll on society. Disinfectants play a major role in reducing the hospital acquired infections (HAIs). There are many skin disinfectants which are commercially available and there has been a considerable recent interest in the bacterial adaptation and resistance to skin disinfectants. Aim To study the bactericidal activity of 0.5% chlorhexidine gluconate, 0.5% chlorhexidine gluconate in 80% ethanol, 5% povidone – iodine, 10% povidone – iodine and 10% 20%, 30%,40%, 60%, 80% and 99.5% ethanol against Methicillin resistant Staphylococcus aureus [MRSA], multi drug resistant [MDR] Pseudomonas aeruginosa, Acinetobacter baumannii, Escherichia coli - extended spectrum beta lactamase producers [ESBL] and Klebsiella pneumoniae [ESBL]. Each strain was evaluated in quadruplicate. Methods The testing was carried out by means of a suspension test. The pathogen was exposed to each of the disinfectants at various concentrations for 15, 30, 60,120 and 240 seconds at room temperature. After the exposure of the inocula to the disinfectants, the antimicrobial activity of the disinfectants in the suspensions was inactivated by neutralizers. Of the resulting suspensions, 100µl of each was transferred to nutrient agar plates in triplicates and these were incubated at 37˚C for 72 hrs. The number of colonies in each plate was counted and tabulated. Results Povidone-iodine (10%) and 60% ethyl alcohol were found to be effective against 20 bacterial strains than 0.5% chlorhexidine gluconate, 0.5% chlorhexidine gluconate in 80% ethyl alcohol and 5% povidone-iodine. Statistical analysis was done by a nonparametric test. The differences in the percentage change in the colony counts between the 4 disinfectants were significant at 15 and 30 seconds of exposure [P < 0.05]. Conclusion The results suggest that 10% povidone-iodine and 60% ethyl alcohol were superior and more potent as well as rapid against the common nosocomial pathogens.

The Comparision of the Motor Nerve Conduction Velocity in the left and right Upper Limbs in normal right handed subjects

HARINDER JOT SINGH, RAJIV ARORA

The nerve conduction velocity depends upon age, temperature, nerve diameter and myelination. The nerve conduction velocity was performed on 50 normal right handed subjects with a matched number of males and females by using a Neuroplus EMG/ NCV Electrophysiology machine at the Punjab Institute of Medical Sciences, Jalandhar. Subjects with compression neuropathy, numbness or any nerve injury were excluded from study. The motor nerve conduction velocity was performed on the left and right hands in the median nerve and in the ulnar nerves and the data was analysed statistically. The motor nerve conduction velocity was greater in the right limb as compared to the left limb both in the median nerve and the ulnar nerve although the difference was not statistically significant. However, the latency of the median nerve of the right upper limb was less than that of the left upper limb with a significant difference.

The prevalence of thyroid dysfunction among South Indian women with Metabolic Syndrome

GAURAV AGARWAL, SUDHAKAR MK, MOHINI SINGH, SENTHIL N, AMARABALAN RAJENDRAN

Metabolic syndrome and thyroid dysfunction are independent risk factors of atherosclerotic cardiovascular disease and the coexistence of the two will substantially increase cardiovascular risk. In the present study, our aim was to investigate the prevalence of thyroid dysfunction in women with metabolic syndrome in a South Indian population. This study was carried out in a tertiary care teaching hospital in Chennai city, South India. The study protocol was approved by the institutional ethics committee and informed consent was obtained from all the participants at the start of study. Seventy six females with metabolic syndrome (NCEP – ATP III criteria) were included in the study. After obtaining the demographic data, fasting blood samples were obtained from the subjects and glucose, total cholesterol, high density lipoprotein (HDL), low density lipo protein (LDL) and triglyceride levels were estimated. The serum thyroid stimulating hormone and free thyroxine levels were also measured. Of the seventy six patients 53% had subclinical hypothyroidism, 25% had overt hypothyroidism and 22% were euthyroid. Overt hyperthyroidism was not present in any of the patients. The mean age of the study group was 52.68, with a standard deviation of 10.20. Women in the 40-60 year age group had a higher incidence of thyroid dysfunction as compared to those in the other age groups. Our study indicates the higher prevalence of thyroid hypofunction in South Indian women with metabolic syndrome and thus it necessitates the need for evaluating the thyroid status in women with metabolic syndrome.

The Histopathological Profile Of Kidney Diseases In A Single Center In Egypt: An Overview Of 14 Years Of Experience

HAMDY AHMED SLIEM*, GAMAL AHMED TAWFIK**, MAHA ATWA*** Mohammed Mostafa

Background: The histopathological examination of biopsied kidneys is a gold standard for renal diagnosis. Currently, there is a lack of long-term data collection and studies on renal diseases, whether on glomerular or other forms. Therefore, the present study was designed to determine the histopathological profile of nephropathy in a single large center in Egypt in the last 14 years and to discuss the differences from other countries. Methods: The study was a retrospective descriptive study. The demographical and clinical data were analyzed for all patients who underwent renal biopsy in the renal unit of the Suez Canal University Hospital. The records of the renal biopsies which were performed for them at the hospital from January 1996 until the end of December 2009 were retrospectively analyzed. Results: The mean age of the patients was 27.19 ± 14.31 years; 57.14 % were females and 42.86% were males. The most common indication of the kidney biopsy was nephrotic syndrome (43.1%), with the predominance of membranoproliferative glomerulonephritis (MPGN). The second indication was asymptomatic urinary abnormalities (AUA), (25.18%) and the third one was acute renal failure (15.98%). In all biopsies, MPGN was the most prevalent pathological diagnosis (38.74%), followed by membranous glomerulonephritis (22.76%). Lupus was the first co-morbid disease and the most frequent secondary glomerulonephritis. Conclusion: Discussing the Egyptian registry for renal biopsy will help in increasing the understanding of the histopathology of renal diseases in Egypt in general and in the region of the Suez canal and Sinai in particular. Meticulous interest should be paid to AUAs, as about half of them had MPGN.

The Synergistic Hypocholesterolaemic and Immunomodulatory effect of two probiotic strains in vivo

RANDHAWA K M, BHATIA A, CHUGH C, JASROTIA K

Probiotics are known to show beneficial effects to the host. But the effect varies with the species and the strain of the probiotics. The present study was designed to study the functional relationship of two probiotic strains. Lactobacillus delbruckii 405 and Lactobacillus casei subsp. casei 17 were tested in vivo separately and in a 1:1 combination (109cells /ml) for their hypocholesterolaemic and immunomodulatory potential in swiss albino mice. Two sets of experimental groups were made. In the experimental group 1, the effects of Lactobacillus spp. alone or in combination was assessed for hypocholesterolaemic activity and in the experimental group 2, the effects of the probiotic alone or in combination were observed on immune response.The Development of Antibody Titers, the Delayed Type Hypersensitivity test, the Nitroblue Tetrazolium Reduction test, the Inducible Nitric Oxide Synthase test and the Bactericidal Activity test were the tests which were employed to assess the functions of different immunocytes. The data of the tests were statistically analyzed by using oneway ANOVA, followed by Turkey’s Multiple Range Test which was applied for post hoc analysis. Results and Conclusion: It was concluded that the two Lactobacilli strains acted synergistically in vivo, as the effect was more profound in the lowering of cholesterol levels and in the augmentation of the immune system.

The Relationship Between The Intraocular Pressures Of Both The Eyes Before And After Water Ingestion

Background: Oral water ingestion increases the blood volume, and hence the blood pressure, which in turn increases the intraocular pressure (IOP). Aim: To know the effect of water ingestion on the IOP and the relationship between the IOPs of both the eyes, before and after water ingestion. Settings and design: This comparative study was conducted on 36 male medical students in the department of Physiology. Material and Methods: This study was conducted on 36 male medical students. The IOP was recorded every 30 minutes for 2 hours before and after water ingestion, with the subjects in the supine position, by using a Schiotz tonometer. Statistical analysis: It was done by paired t test using SPSS 15.0 version. Results: It was found that water ingestion increases the IOPs of both the eyes. The IOP of the left eye was insigficantly more by 0.2mmHg than that of the right eye in the control trial, but this was not so in the study trial. The transient increase in IOP was quick in the left eye than in the right eye after water ingestion. Conclusion: It can be concluded that there is a difference between the IOPs of both the eyes, before and after water ingestion, whose cause cannot be clearly explained and therefore, this needs a further in depth study of the anatomical and physiological processes that govern the maintenance of the IOPs in both the eyes individually. This would also explain to a variable extent, the aetiology of some cases of unilateral glaucoma.

A Histopathological study of Granulomatous Inflammations with an attemptto find the Aetiology

JAYASHREE PAWALE, REKHA PURANIK, MH KULKARNI

Granulomas are the commonest lesions that the pathologists come across in routine practice. In order to treat these lesions, definitive diagnosis by the demonstration of the aetiological agent is essential, which will bear an impact on the patient management and outcome. Our aim was to find the aetiology in all the granulomatous lesions, on histopathologically evaluated biopsies. A two year prospective study was done in KIMS; Hubli.The biopsies of the cases which were diagnosed as granulomas on H and E stained sections from all the sites were selected. Special stains like Ziehl-Neelsen stain, Gomori’s Methenamine silver, Fite Faraco and Auramine Rhodamine stain were done wherever required. A total of 170 granulomatous lesions were studied. Granulomas with different aetiologies were seen. The commonest were the granulomas due to tuberculosis with 84 (49.41%) cases, followed by those with leprosy, rhinoscleroma, actinomycosis andfungal infections and foreign body granulomas and granulomas with unknown aetiology. An attempt has to be made to put these granulomas into specific aetiological categories for specific treatment. The morphology of the lesions and the use of special stains helped us to diagnose 159 out of the 170 cases.

The effect of oral salbutamol on the metabolism of electrolytes in asthmatic children

NAGDEOTE AN,PAWADE YR

Background: Experimental evidence suggests that sodium and potassium may affect the responsiveness of airways. In asthma, the electrolyte metabolism is also affected during the course of anti-asthmatic therapy by using β2-agonist drugs like salbutamol. Objective: To determine whether the therapy for the treatment of asthma affects the sodium and potassium metabolism. Method: 50 children between 2 to 12 years of age with asthmatic attack were selected for the study. 18 children had a severe attack of asthma. Blood samples were collected from them and the therapy for the treatment of asthma was started, which included β2-agonists like salbutamol. Children with severe asthmatic attack were treated with nebulized salbutamol along with corticosteroids. After 15 days, the asthmatic children were again called for a follow up study and their blood samples were collected. The serum levels of sodium and potassium were measured on an Ion Selective Electrode (ISE) based electrolyte analyzer. Results: The results showed a significant decrease in the serum potassium levels in children receiving the β2-agonists. The decrease in the potassium levels was irrespective of the severity of the asthmatic attack in both the sexes. There was no significant change in the serum sodium levels. Conclusion: The use of β2-agonists may lead to hypokalaemia. The inappropriate and continuous use of such drugs may also cause hypokalaemic paralysis of the respiratory muscles. The monitoring of the electrolytes may be warranted in asthmatic children to decrease the mortality.

Comparison of the Clinical and Socio- Demographical factors in Pulmonary and Extra Pulmonary Tuberculosis patients in Yemen

GAMIL QASEM OTHMAN, MOHAMED IZHAM M IBRAHIM, YAHIA AHMED RAJA A

This study aimed to assess the clinical and socio-demographic factors which were associated with pulmonary and extra pulmonary tuberculosis in Yemen. A cross-sectional study was carried out among 160 Pulmonary Tuberculosis (PTB) and 160 Extra Pulmonary Tuberculosis (EPTB) patients who were diagnosed and treated in TB centres in Sana’a, the capital city of Yemen. Socio demographical, clinical and laboratory data and types of drug regimens which were used for treatment were collected from TB patients and from the medical records from the TB centres. The risk factors for the EPTB patients and the PTB patients were identified through a structured questionnaire. The female to male ratio was 1.2 and 1.6 for PTB and EPTB, respectively. The median age for the PTB patients was 29 and it was 30 for the EPTB patients. It was also found that TB patientswith a low educational level amounted to 52% and 48% in the PTB and EPTB groups, respectively. This study illustrated that the majority of smokers were males (64% for PTB and 58% for EPTB), whose ages ranged between 15-54 years in both the PTB and the EPTB groups. This study found that more numbers of extra pulmonary tuberculosis patients were diagnosed in private hospital and clinics (41%) than the pulmonary tuberculosis patients (26%). More numbers of females and younger patients were seen in both the EPTB and PTB groups. More numbers of extra pulmonary tuberculosis patients were diagnosed in private hospital and clinics than the pulmonary tuberculosis patients. The extra pulmonary patients had less monthly income than the pulmonary TB patients.

Peptiduria in patients with acute renal failure

Introduction: Proteinuria is a common finding in acute renal failure (ARF). Recently, there is an increasing interest in knowing the significance of peptiduria in renal failure patients. The current study has been undertaken to know the levels of peptiduria in ARF patients. Method: 58 ARF patients and 55 healthy controls were selected, based on inclusion and exclusion criteria. Urinary proteins and peptide levels were determined by the spectrophotometer based Lowry and Bradford methods. Results: The urinary %s of peptides in urine were significantly decreased in ARF patients; there was a wide variation in thelevels of peptides in grams per liter of urine and in the levels of peptides in grams per gram of creatinine. Urine creatinine levels correlated positively with the urinary peptide levels. Conclusion: ARF patients showed a significant decrease in the %s of urinary peptides and the %s of the urinary peptides seemed to be a more appropriate measure in determining the levels of urinary peptides. To study the significance of urinary peptides in the diagnosis and management of ARF needs future research in this field.

CT PNS – Do We Really Require Before FESS?

There exists a controversy for with regards to the advice of CT for the management of sinusitis and hence, this e study was undertaken to correlate between the CT findings and the endoscopic findings in FESS, the anatomical abnormalities and the mucosal changes in patients with chronic rhinosinusitis and the reliability and validity of CT scan in the management of chronic rhinosinusitis. This was a time bound cross sectional study design. 45 patients with chronic rhinosinusitis underwent pre operative CT PNS , followed by functional endoscopic sinus surgery (FESS). The parameters which were used for the correlation were paradoxical middle turbinate, concha bullosa, bony destruction , ostiomeatal complex disease, polypoidal changes, mucosal thickening and frontoethmoidal disease. The correlation was calculated by using the formula for Kappa’s agreement. The uncinate process attachment, the agger nasi cells and the, anterior and posterior ethmoid sinuses showed excellent correlation .The maxillary sinus did not show good correlation, but this was acceptable. The middle turbinate anomalies, the hiatus, the infundibulum, the frontal recess and haller’s cells showed poor correlation. The pre operative CT scan evaluation of the patients who have to undergo ing FESS is essential. Most of the anatomical abnormalities can be studied on by CT scan, but however, endoscopy also gives other valuable information.

External Dacryocystorhinostomy Versus Endoscopic Dacryocystorhinostomy: A Comparison

KULDEEP MORAS MAHESH BHAT SHREYAS C S NORMAN MENDONCA GEORGE PINTO

Toti’s technique of external dacryocystorhinostomy (DCR) had been the treatment of choice for epiphora due to nasolacrimal duct obstruction since 1904. With the introduction of rigid nasal endoscopes in the 1970s and the advent of endoscopic sinus surgery, intranasal endoscopic dacryocystorhinostomy has come into existence. This study compares the outcome of external dacryocystorhinostomy with endoscopic endonasal dacryocystorhinostomy. 40 patients who were diagnosed with primary acquired nasolacrimal duct obstruction or chronic dacryocystitis were included in the study. They were randomized into two groups. Group I included 20 patients who underwent external dacryocystorhinostomy and group II included the rest of the 20 patients who underwent endoscopic endonasal dacryocystorhinostomy. Although both the procedures had a success rate of 90%, endoscopic DCR was helpful in avoiding a scar on the face and injury to the neighbouring structures like the medial palpebral ligament and the angular facial vessels. The surgical duration for endoscopic DCR was short as compared to that of the external approach. Our study concludes that endoscopic DCR is as good as external DCR for the treatment of primary nasolacrimal duct obstruction and chronic dacryocystitis.

Prevalence and antimicrobial susceptibility pattern of ESBL producing Gram Negative Bacilli

UMADEVI S, KANDHAKUMARI G, JOSEPH N M, KUMAR S, EASOW J M, STEPHEN S, SINGH U K

The production of extended-spectrum- β lactamases (ESBLs) is an important mechanism for resistance to the third-generation cephalosporins. Awareness and the detection of these enzymes are necessary for optimal patient care. To determine the prevalence and the antibiotic sensitivity pattern of ESBL producing gram negative bacilli. A prospective study was conducted at a tertiary care teaching hospital A total of 213 isolates which were recovered between February 2008 and January2009 from various samples were tested for ESBL production by using both the double-disk approximation and the combination disk methods. Among the 132 Escherichia coli, 54 Klebsiella pneumoniae and 27 Pseudomonas isolates which were tested, 81%, 74%, and 14%, respectively were found to be ESBL producers. The ESBL producing E. coli showed maximum susceptibility to imipenem (100%), followed by piperacillin-tazobactum (84%), amikacin (68%), gentamicin (9%), ciprofloxacin (9%) and amoxicillin-clavulanic acid (7%). Similarly, the ESBL producing K. pneumoniae showed very good susceptibility to imipenem (98%), followed by piperacillin-tazobactum (68%), amikacin (40%), gentamicin (15%), ciprofloxacin (15%) and amoxicillin-clavulanic acid (5%).About 87% and 88% of the ESBL producing E. coli and K. pneumoniae respectively showed multi-drug resistance to amoxicillin- clavulanic acid, gentamicin and ciprofloxacin. It is essential to report ESBL production along with the routine sensitivity reporting, which will help the clinician in prescribing the proper antibiotics. Piperacillin-tazobactam and imipenem are the most active and reliable agents for the treatment of infections which are caused by ESBL producing organisms.

Clinico-epidemiological Profile of HIV Patients with Respiratory infections and Tubeculosis in Western India

ASMITA A. MEHTA, V. ANIL KUMAR K.G.VITHALANI, K.R. PATEL

In this study, 50 HIV seropositive patients who attended the Pulmonary Medicine Clinic of a tertiary care teaching institute in western India were enrolled. Of these, 39 were men and 13 were women. The mean age of the study subjects at the time of diagnosis was 34.96 years. Heterosexual contact was the commonest mode of transmission in 34 (68%) patients, followed by blood transfusion in 9(18%). A history which was suggestive of a risk factor for HIV transmission could not be elicited in 7 (14%) patients. Cough (96%), weight loss (96%), fever (88%), chronic diarrhoea (70%) and dyspnoea (52%) were the common presenting symptoms. Tuberculosis was the commonest respiratory infection (72%), followed by bacterial pneumonia (22%), pneumocystic jiroveci infection (6%) and fungal infection (4%). Among the 32 patients who had a diagnosis of active pulmonary TB infection, the tuberculin test was positive in 20 patients and it was negative in 16 patients.

The Role Of Oxidative Stress And The Effect Of Radiotherapy On The Plasma Oxidant-Antioxidant Status In Head And Neck Cancer

MALATHI M, VIJAY M, SHIVASHANKARA A R

Objectives: The present study was aimed to assess the oxidantantioxidant status in head and neck cancer patients before and after radiotherapy. Methods: The subjects comprised of patients who had visited the Oncology Department and were diagnosed of head and neck cancer. The plasma levels of malondialdehyde (MDA), the marker of lipid peroxidation, and the antioxidants, superoxide dismutase (SOD), vitamin A, vitamin C and ceruloplasmin, were assayed before and after radiotherapy, in comparison to the healthy controls. Results: The plasma levels of MDA were higher and the levels of SOD, vitamin A, vitamin C and ceruloplasmin were lower inthe head and neck cancer patients as compared to those in the healthy controls. These parameters showed significant changes after radiotherapy, as indicated by a lower level of MDA and higher levels of SOD, vitamin A, vitamin C and ceruloplasmin in the plasma of the cancer patients after radiotherapy, as compared to the plasma levels before radiotherapy. All the results were statistically significant (P < 0.001). Conclusions: Radiotherapy caused a reduction in the lipid peroxidation and an improvement in the antioxidant status of the head and neck cancer patients.

The prevalence of the elevation serumalanine aminotransaminase at Gorgan in northern Iran

AZAD R MANSOURIAN, AKHTAR SAIFI GHOLAM R VEGHARI

The elevation of serum alanine aminotranferase levels is associated most commonly with some forms of liver diseases. The aim of this study was to determine the prevalence of elevated serum alanine aminotransferase levels and the possible liver damages in this region. This was a clinical laboratory based study. The data was obtained from the Danesh Medical Diagnostic Laboratory at Gorgan in northern Iran. The aminotransferase activity was measured by the pyridoxal -5-phsphate reaction. Values over 31 and 41 U/L were considered as indicative of elevated enzyme activity in females and males respectively. The findings of this study indicated that 16% of our populationin general and of those who were aged 18-40 years in particular, had a form of liver disorder due to elevated enzyme, with a higher incidence among the female subjects, which seemed to be slightly higher than that reported by other studies earlier. The incidence was slightly higher among females. It seemed that high proportions of people (16%) in this region had an elevated serum enzyme activity of alanine aminotranferase and according to well-documented reports, it might probably be associated with non-alcoholic fatty liver disease. A comprehensive study is recommended to elaborate carefully the state of liver diseases in this region of Iran.

A Clinical Evaluation of the Effects of Administration of Midazolam on Ketamine- Induced Emergence Phenomenon

LOHIT K, SRINIVAS V, CHANDA KULKARNI, SHAHEEN

Ketamine administration in anaesthetic practice is known to induce postoperative ‘emergence phenomenon’. In the present study we evaluated effect of peri-operative midazolam on post operative emergence phenomena following ketamine anaesthesia. This was a comparative, prospective, cross sectional, observational study. Total of 60 cases, posted for surgical procedures with 30 each, who received either ketamine or ketamine with midazolam, for elective and emergency surgical procedures were evaluated applying inclusion and exclusion criteria. Data was collected for type of surgery, dose of anaesthesia and occurrence of post operative events for four hours after surgery, including subjective symptoms and adverse effects related to anaesthetic agents. There were more males [78.30%] than females [21.70 %], withmajority between 1-20 years (45%) of age. Surgical procedures included 50% from general surgery, 33% urology and 16.70% orthopaedic departments. Overall post operative recovery was complete in 60%, satisfactory in 28.33% and poor in 11.66%. Occurrence of post operative emergence phenomenon (EP) was seen in 76.66% cases during 2nd and 3rd hour in ketamine group, while a significant reduction in occurrence of adverse events was observed during 4 hrs postoperative period, along with complete recovery in 100% patients who received combination of ketamine with midazolam. In conclusion, perioperative administration of midazolam with ketamine in the present study was found to be effective in controlling EP, leading to a smooth post surgical recovery. Therefore, combined use of ketamine with midazolam may be recommended in future anaesthetic practice.

Prevalence of Upper Extremity Musculo skeletal Disorders among workers in an industrial town in Tamilnadu

WMS JOHNSON,BERTHA A PRISCILLA JOHNSON

Background: Musculo Skeletal Disorders (MSD) contribute 37% of the disease burden which is attributable to occupational risk factors globally, resulting in substantial disability. Despite mechanization and automation, there is an ever increasing incidence of MSD, which has an adverse impact on the individual and the society. Little information on the prevalence of MSD is available in South India. Aim: The present study was aimed primarily to evaluate the prevalence of MSD in industrial workers and also secondarily to identify the location specific MSD, to generate guidelines to optimize the work, to minimize the risk of injury development and to maximize the output quality. Material and Methods: This cross sectional pilot study included 219 subjects of age groups ranging from 18 to 55 years, from three different industries. Questionnaires were administered to assess the work exposure and health. The range of movementof the joints was calculated by using a Goniometer. The postural workload was assessed by using a RULA work sheet. A clinical examination was done to diagnose MSD. Results: 32.6% of the subjects suffered from MSD. The highest prevalence of MSD was seen among pyrotechnics (44.4 %), followed by match makers (32.7%) and litho offset printers (19.2%). An increased prevalence of symptom severity was observed in women (36.1%) and in individuals who performed moderately strenuous tasks (52.8%). Conclusion: The present study has estimated the baseline prevalence of MSD in industrial workers, which can be effectively applied for the optimisation of the work system to minimise the risk of injury and to maximise productivity. Key message: The knowledge of musculoskeletal disorders and its prevalence among industrial workers can be effectively applied for the optimisation of the work system to minimise the risk of injury and to maximise productivity.

Psoriasis: An oxidative stress condition

JYOTHI R.S. GOVINDSWAMY K.S., GURUPADAPPA K.

Psoriasis is a chronic inflammatory skin disease that has been associated with abnormal lipid metabolism and a high frequency of cardiovascular events. Several studies have attributed the hypertriglyceridaemia and hyperlipoproteinaemia to retinoids, corticosteroids and thiazide diuretics which are used in the treatment of psoriasis. The present study was undertaken to evaluate whether psoriasis per se is associated with an abnormal lipid profile or whether an abnormal lipid profile occurs due to the medications of psoriasis. Efforts were made to find other diseases which were associated with psoriasis. This study included 20 male and 20 female, moderate to severe psoriatic patients between the age group of 20-50 years. These patients were clinically diagnosed as psoriasis and had not yet received any treatment. These patients were compared with age and sex matched healthy control subjects. We estimated serumlipid profile, Vitamin E, malondialdehyde (MDA), fasting blood sugar and aspartate amino transferase (AST) and alanine amino transferase (ALT) levels in psoriatic patients and in the control subjects by using the “auto analyzer” and spectrophotometric methods. The psoriatic patients presented a significant increase in the serum lipid profile and malondialdehyde levels and a significant decrease in vitamin E levels. They also showed a significant increase in the fasting blood sugar and the AST and ALT levels. The data which were obtained from the study i.e. increase in serum lipids and malondialdehyde and decrease in Vitamin E levels show an established state of oxidative stress. The increase in fasting blood sugar and AST and ALT levels indicate that psoriasis may be associated with other oxidative conditions like diabetes mellitus and “non specific” liver disease.

Career Choice among Physiotherapy Students at Mangalore, India

Context: Understanding the factors which influence the career preferences is of importance to policy makers, health care educationist and other stake holders. So, it would be interesting to know what makes the students join Physiotherapy course and their future plans. Objectives: The aim of the present study was to explore the career choices and the intentions of a cohort of undergraduate students of physiotherapy in Mangalore, India. Methods: An anonymous, self-administered, questionnaire based survey was carried out among the consenting undergraduate students of physiotherapy. Results and Conclusion: The final response rate was 98% (79/81). The mean age of the students was 22 years (SD 3, range 18-25years). Forty-five students (57%) were females and 34 students (43%) were males. The participants were more influenced in the career choices by their own passion for the allied health sciences, followed by being inspired by a family member. A majority of the students wanted to pursue further specialization in physiotherapy in the form of post-graduation studies. A majority of the students expressed great satisfaction with career choice and had less intention of changing their profession. A majority of the students opted to work in India rather than to migrate abroad after the completion of their studies (p= 0.0027). Future work in multi-specialty hospitals and private-practice was highly preferred by a majority of students as compared to academic career (p=0.011).

The Incidence of Tinea capitis in a Tertiary Care Rural Hospital - A Study

SEEMA BOSE, SANJEEV G KULKARNI, IRFAAN AKHTER

Tinea capitis continues to contribute to the pathological burden, especially in school children. This study was undertaken to document the clinicomycological pattern of the patients who were infected with Tinea capitis, who attended the dermatology OPD in a rural hospital of Maharashtra and to find out the type of infection from the close contacts of the patients. Hair and skin scrapings were obtained from 79 clinically suspected cases of Tinea capitis over a period of one year. In the suspected contacts, brushes and moistened sterile carpet discs were used to collect the samples. Dermatophytes wereisolated from the samples and were identified by conventional methods. Out of the 79 suspected cases of Tinea capitis, 19(24.05%) were culturepositive. The commonest isolate was Trichophyton mentagrophytes 9(47.36%), followed by Microsporum gypseum, Microsporum canis and Trichophyton rubrum. It was seen more commonly in the 5 – 10 years age group, i.e. 12(63.15%). The male: female ratio was 2.8:1. The seborrhoid type was the commonest clinical type, 9(47.36%). Out of 26(32.91%) close contacts of the patients, 6(7.59%) were culture positive and the isolates were the same as that which were obtained from the patients.

A study on the Morphology and the Morphometry of the Human Placenta and its Clinical Relevance in a population in Tamilnadu

GUNAPRIYA RAGHUNATH, VIJAYALAKSHMI, VARSHA SHENOY

Context (Background): The placenta is a dynamic organ which is unique in its development and functions. It is the only organ in the body which is derived from two separate individuals, the mother and the foetus. The placenta is responsible for the respiratory, nutritional, excretory, endocrinal and the immunological functions of the foetus. The anomalies of the placenta are usually associated with placental insufficiency, which could lead to complications in the foetus. Hence, a thorough examination of the placenta in-utero, as well as post-partum, gives valuable information about the state of the foetal well being. Aims: To study the morphology and the morphometric analysis of the placenta and to clinically correlate it with the foetal parameters, in order to help in the assessment of the state of the well being of the foetus. Methods and material: A total of 101 placentae were freshly collected (76 from uncomplicated deliveries and 25 from various factors which complicated the pregnancy). The placental parameters and their respective maternal and foetal details were collected, analysed and clinically correlated. Results: Out of 101 placentae which were collected (91 full term babies and 10 preterm babies), 94 were circular in shape and 7 were oval in shape. In this study, the average diameter of the placenta was 17.4cm, the average thickness 2.1cm and the average weight of the placenta was 528.55gm.This study showed a placental coefficient of 0.19. The parameters of the placentae which were collected from babies whose mothers had factorswhich complicated their pregnancy, correlated well with their foetal parameters. A subchorionic placental cyst with clear serous fluid was observed in one case. The amniotic membrane was translucent in 93% of the cases. The placental cotyledons on an average were 18 in number. This study revealed the presence of placental calcification in 20% of the cases, retro-placental clots in three cases and the presence of placenta succenturiata in three cases. Conclusion: An adequate knowledge of the morphometry of the placenta and its clinical relevance can prove to be valuable in the early assessment of the foetal well being, especially in a community like ours, where antenatal mothers still come unbooked to the labour room, with no prior investigations done.

Anatomical study of Dorsalis pedis Artery and Its Clinical Correlations

VIJAYALAKSHMI S, GUNAPRIYA RAGHUNATH, VARSHA SHENOY.

To evaluate patients with arterial disease, palpation of peripheral arterial pulse is commonly used. In lower limb, palpation of dorsalis pedis artery is used to evaluate the arteriosclerotic diseases. Dorsalis pedis artery is the main source of blood supply to the foot. A knowledge about the origin, course and branching pattern of this artery is essential, as it forms the stem for one of the major myocutaneous flaps, used for ankle surgeries in plastic and reconstructive surgeries. Fifty free lower limbs were dissected and the origin, course and branching pattern of dorsalis pedis artery were studied. 50 free lower limbs were collected from the anatomy dissection hall. The dorsalis pedis artery was dissected and its origin, course and branching pattern were studied. In the present study dorsalis pedis artery was found to have a normal course and branching pattern in 56%, variation in origin in 8%, variation in branching pattern in 16%, absence of the artery in 2% and duplication in 2% of the specimens studied. As variation in dorsalis pedis artery is not uncommon, it is essential to have a sound knowledge about the artery. It is advisable to have preoperative angiography for any abnormality, to prevent risks during surgical intervention.

A study on the Iron status In Iron Deficiency Anaemia one month before and after Iron Therapy in school going children

MAHESHWARI B.K, RAUT P,AGARWAL S.K.,JOSHI U, DHIRHE T.C, GAHINE R

Objective 1) To determine the iron status (Hb, MCV, MCH, MCHC, RDW, Serum Iron, TIBC and Serum Ferritin) before iron therapy in school going children. 2) To determine the haemoglobin concentration after one month of iron therapy in children whose haemoglobin concentrations were lower for the given age and sex. 3) To evaluate the therapeutic outcomes of the oral iron therapy. A total of hundred anaemic children from three government schools of Raipur city were subjected to anthropometric, iron status and clinical examinations before they underwent iron therapy and the response to therapeutic iron was assessed by the estimation of the haemoglobin percentage after one month following the administration of ferrous sulphate, 6mg/kg body weight along with folic acid. Not a single patient withdrew from the study because of adverse effects. A significant increase in the haemoglobin (p<0.009) level was observed in both boys and girls after 30 days of iron supplementation. A total of hundred anaemic children were subjected for the study. In all the 100 children, clinical pallor was the first finding(in 100%), followed by fatigue (in 54%), weakness (in 38%), anorexia (in 18%) and icterus (in 5%). The commonest blood picture was that of microcytic hypochromic. Age dependent MCV, MCH, MCHC and RDW showed that the maximum number of cases had below normal MCV, MCH and MCHC values. RDW values were increased in 74% cases, 82% cases had serum iron values below normal (<50μg/dl) and 91% cases had TIBC values above the normal range. The serum ferritin levels in 35% children was <15ng/ml (in 18% boys and in 17% girls). The nutritional status according to the IAP classification showed that by weight, 19% children were well nourished and that 81% were undernourished. The mean and SD of Hb before therapy was 8.60 ± 2.05 and after therapy, it was 9.55±1.88 respectively. An early diagnosis of anaemia can be made by assessing the serum ferritin levels and this has been found to be more reliable. If iron is given in the early stages of anaemia to children, the response is quite significant.

The correlation of the duration of Diabetes with Anthropometric Indices in Type-2 Diabetes Mellitus

Background: With the increasing incidence of type-2 diabetes mellitus, there is an ever increasing need to correlate this disease with many parameters in order to ease the diagnosis and, to predict the risk factors and the hazards which are associated with it. Aim: To correlate the duration of diabetes with the waist-hip ratio (WHR) and thigh circumference . Settings and design: This is was a comparative study which was conducted on 30 subjects Material and Methods: Twenty two males and eight females who were, already diagnosed as to be having type-2 diabetes mellitus, were considered for the study. The history regarding the duration of diabetes mellitus with its duration was noted down. The anthropometric measurements (height, weight, waist circumference, hip circumference and, thigh circumference) were made by using standard procedures. The Body Mass Index (BMI) and the Waist Hip Ratio were also calculated. Statistical analysis: The statistical analysis was made done by Pearson’s correlation, by using the SPSS software (version15.0). Results: There was a positive correlation between the duration of diabetes and the waist hip ratio and a negative correlation between the duration of diabetes and the thigh circumference. Conclusion: As the duration of diabetes mellitus increases, the anthropometric parameters also increase, and so does the incidence of cardiovascular risk, thus signaling suggesting that a check to must be kept on the much easily measurable anthropometric parameters, which could warn about the future risks.

Waist Circumference, Body Mass Index, Hip Circumference and Waist-To-Hip Ratio in type 2 diabetes patients in Gorgan, Iran

ABDOLJALAL MARJANI

The present study was aimed to assess the anthropometric parameters of type 2 diabetic patients. The anthropometric parameters were determined. The data were collected from the subjects with type 2 diabetes mellitus in Gorgan, Iran. Insulin sensitivity, waist circumference, waist to hip ratio, fasting insulin and beta cell function were higher in males than in females, but the females had a higher body fat percent and hip circumference than the males. The waist circumference was found to correlate positively and significantly with BMI, the waist to hipratio and body fat percentage in diabetic females and males. There was a correlation between the waist circumference and hip circumference in diabetic females. The waist circumference very highly correlated with the body fat percent and the waist to hip ratio was likely to behave similarly in diabetes prediction. The body mass index, despite having a lower correlation with waist circumference, appears to have the same ability to predict diabetes as do both the body fat percentage and the waist to hip ratio. Waist circumference appears to be a better predictor for diabetes risk than other parameters.

Evaluation of the Thyriod Status, Oxidant Stress and Antioxidant Status in patients with Type - 2 Diabetes Mellitus

KEDARI G S R

Diabetes mellitus is the world’s most common endocrine disorder and the aim of the present study was to evaluate the role of the thyroid hormone status in type-2 diabetes cases by measuring serum free 3, 5, 3’-tri-iodothyronine (FT3), free tetra-iodothyronine (FT4) and thyroid stimulating hormone (TSH) levels, the role of oxidative stress by assessing plasma malondialdehyde (MDA) levels, as well as the status of antioxidants like ascorbic acid and reduced glutathione (GSH) in blood. For this, 30 casesof diabetes mellitus were included .The findings were compared with 30 age matched healthy controls, irrespective of sex. A significant increase in the levels of MDA was observed in the cases as compared to the controls. A significant decrease in the levels of serum FT3, vitamin-C, and GSH was also noticed in the cases as compared to the controls. There was no significant difference in the levels of serum FT4 and Serum TSH.

Clinical Profile Of Posterior Circulation Stroke In A Tertiary Care Centre In Southern India Key Words

KORA.S.A, DODDAMANI.G.B, PRAMILA DEVI, GOORANNAVAR S.M, BIRADAR SATISH

The present study has been undertaken in a tertiary care centre in southern India to known the clinical profile of posterior circulation stroke as there are few studies for the same in that mainly the New England Medical Center – Posterior Circulation Stroke Registry. To the best of our knowledge there are no studies available in literature regarding posterior circulation hemorrhagic strokes in India. A total number of 25 cases were studied during the period from Jan 2010 to Dec 2010 who were admitted to department of Medicine and Neurology in S.Nijalingappa Medical College and HSK Hospital & Research Center. Detailed clinical history was taken in all patients with general physical examination. CBC, urine analysis, random blood sugar, blood urea, serum electrolytes, lipid profile, ECG, CXR, and CT scan were done. In some selected cases CSF analysis, EEG and ECHO were done. Incidence of posterior circulation strokes was 12.31 % and male to female ratio was 3.1:1. Amongst posterior circulation strokes, ischaemic were far commoner than haemorrhagic (76% vs. 24%). The common manifestations were motor disturbances, altered sensorium, headache, speech and visual disturbances in ischaemic strokes. Altered sensorium was present in all cases of haemorrhagic strokes. The commonest predisposing factors were tobacco abuse and hypertension. The commonest neurological findings were altered sensorium, motor disturbances, cranial nerve involvement and cerebellar signs. Infratentorial infarcts were seen more frequently than supratentorial infarcts, in this study. Incidence of mortality was higher in haemorrhagic strokes than ischaemic strokes (50% vs. 26.3%)

Influence of height on the nerve conduction study parameters of the peripheral nerves

THAKUR D, JHA S, PANDEY NK, JHA CB, BAJAJ BK, PAUDEL BH

BACKGROUND: Nerve conduction studies (NCS) which assess peripheral nerve functions and their parameters, are known to vary with anthropometric measurements. OBJECTIVE: To study the effect of height on the NCS variables in the peripheral nerves of the limbs. SETTINGS AND DESIGNS: Department of Physiology, normative. METHODS AND MATERIAL: This study was done on 34 (age: 31.24±11.57 years) consenting, healthy adults of either sex. The anthropometric factors (height, weight and BMI); the compound muscle action potential (CMAP) and the sensory nerve action potential (SNAP) were recorded by using standard techniques. STATISTICAL ANALYSIS: The correlation of height with the NCS variables was analyzed by using the Pearson’s correlation test. RESULTS: After the adjustment of other anthropometric factors, height (158.5±10.21cm) showed a positive correlation with the CMAP duration of all the motor nerves: right median (r=0.734, p<0.001), left median (r=0.422, p<0.05), right ulnar (r=0.561, p<0.01), left ulnar (r=0.661, p<0.001), right tibial (r=0.372, p<0.05) Thakur D, Jha S, Pandey NK, Jha CB, Bajaj BK, Paudel BH and the left tibial (r=0.353, p<0.05). The CMAP amplitudes and the latencies were also positively correlated, with the exception of the ulnar and the right radial nerves. A positive correlation with the F- wave latencies were seen in all the nerves, except in the left common peroneal nerve. However, a negative correlation was seen with the SNAP amplitude of the right sural nerve (r= -0.442, p<0.01) and the conduction velocity of the ulnar motor nerves: right ulnar (r= -0.536, p<0.01) and left ulnar (r= -0.430, p<0.05). The SNAP duration and the conduction velocity did not show any correlation with height. CONCLUSION: Height showed a significant correlation with the NCS parameters of the motor and few sensory nerves. Diagnostic conclusions which are made from the nerve conduction data without making corrections for the height may be invalid in patients who are taller and shorter than the average individuals. This must be also be considered while developing standard/reference normative data for different nerves.

Existing and expected practical medical pharmacology curriculum - A survey

VASUNDARA K, PUNDARIKAKSHA H P, VIJENDRA R, GIRISH K, JYOTHI R, SRINIVASA P

To collect the opinions of the junior doctors (interns, postgraduate students, and junior residents) regarding the existing and suggested changes in the undergraduate pharmacology curriculum to make it more relevant, useful, and applicable for clinical practice. A survey was conducted among junior doctors from various medical colleges by using a standardized questionnaire. A majority of the participants felt that the present practical pharmacology curriculum (experimental pharmacology and dispensing pharmacy exercises) was not relevant for clinical practice. A majority of the participants felt the necessity for prior exposure to the medicinal preparations and newer drug delivery devices. Prescribing in special risk groups, pharmacoeconomics, adverse drug reaction monitoring, and the critical evaluation of drug promotional literature were other areas where the participants needed more guidance. Hospital-based and real patientbased learning of pharmacology and integrating pharmacology with other clinical subjects was felt to be more relevant in the present scenario. The present survey indicates the opinion of the junior doctors regarding the nature and the extent of the changes which are necessary in the undergraduate pharmacology curriculum for a better clinical application of the knowledge of pharmacology.

Ultrasonographical evaluation of Asymptomatic Gall Bladder Diseases – An epidemiological study in North India

ASHISH VERMA, SUYASH MOHAN SANJAY SARAN BAIJAL

To detect the prevalence of asymptomatic gall bladder (GB) diseases by using ultrasonography (USG) as the primary screening modality. Ultrasonography is the most appropriate tool which can be used for the diagnosis of gall bladder disease. Despite the availability of sophisticated imaging modalities, especially computerized tomography (CT) and magnetic resonance imaging (MRI), USG still remains the initial and powerful screening modality of choice for evaluating the GB pathology. Over a period of two and a half years (July 2004 to Jan 2007), 640 subjects (105 healthy volunteers and 535 randomly selected patients with unrelated medical problems) were examined by using real time, grey scale, B mode USG with a 3.5 MHz convex transducer (Sonoline G60S system, Siemens Medical Solutions, WA, USA). To ensure adequate GB distension, the examination was performed after an overnight fast of 8 – 12 hours. Among the 105 healthy volunteers, the prevalence of the silentGB disease was 15.24%, while among the 535 patients presenting with unrelated symptoms, the prevalence was 10.84 %. However, the overall prevalence was 11.56%. Asymptomatic GB disease is more common in females, in the fourth and fifth decades of life, the mean age being 42.0 ± 12.64%. Cholelithiasis (4.22%), followed by chronic cholecystitis with cholelithiasis (3.12%), were the commonest abnormalities which were detected. The accuracy of USG in delineating asymptomatic GB disease at our center was found to be 94.12%, as revealed by consistent USG and histopathological findings. Cholecystosonography is a potentially valuable tool which is used for the diagnosis of GB disease. A strong case is made to recommend the USG screening of females between the ages of 41 – 50 years who were otherwise normal.

Ectopic thyroid – a case series

BERTHA A, JULIE HEPHZIBAH, NYLLA SHANTHLY

Introduction and aim: Thyroid dysgenesis refers to conditions which are related to defects in the thyroid organogenesis, which present as absent, ectopically located or reduced glandular tissue. We report our experience on ectopic thyroid and its diagnosis and management in our institution over the past five years. Materials and methods: A retrospective analysis of all the patients who were evaluated for pathologies in the thyroid, who underwent thyroid scintigraphy by using 99mTechnetium from January 2005 to December 2010, was done. 2 mCi of pertechnetate was given intravenously and the images were acquired after 20 minutes. The patients were imaged by using a gamma camera. Observations: A total of 134 patients underwent the study, of which 12 patients (8.95%) were found to have ectopic thyroid. Ectopic thyroid tissue was observed not only in the midline cervical region – in the lingual, suprahyoid and the subhyoid locations, but also in the submandibular region in one individual. Conclusion: In our series of observations, 8.95% of all the cases which were screened for thyroid diseases, showed ectopic thyroid tissue. Lingual thyroid was seen in 41.6% of the cases. Most of our patients responded well to hormonal therapy and did not need any surgical intervention. Long term follow up is absolutely necessary, as the prevalence of malignancies is higher in these individuals.

The Morphological Analysis of the Superior Articular Facet of the adult Human Atlas vertebra

LALIT M , PIPLANI S, KULLAR J S, ARORA A K, MANNAN R

The ‘Atlas’ is first cervical vertebra, supporting the “globe” of the head. The sound knowledge of of the Atlas vertebra is a well established entity in Anatomy. In a number of 30 atlas vertebrae, 60 superior articular facets were studied for the presence of a constriction or a groove and a tendency to separate i.e complete or incomplete separation. On the basis of this, different shapes of the superior articular facets were also studied This study was performed in the Department of Anatomy, Government MedicalCollege, Amritsar. The results were compared with those of other studies and were statistically analysed. The clinical significance of this study has been thus discussed with a reference to its possible effect on the restriction of the neck at the atlanto-occipital joint.

A Study On The Association Of Coronary Artery Disease And Smoking By A Questionnaire Method

YATHISH .T.R, MANJULA .C.G , SRINIVAS.R.DESHPANDE, GAYATHREE.L

Background: Coronary artery disease is an important cause of morbidity and mortality in developed and developing countries. Cigarette smoking is thought to be major risk factor. Aim: To study coronary artery disease among smokers by the Rose questionnaire method. Methods: A cross-sectional study was done from March 2005 to March 2006. The presence of coronary artery disease was detected by the Rose Angina Questionnaire. The questionnaire method which was adopted was noninvasive and inexpensive. Results: This study showed that the occurrence of coronary artery disease was higher in the smokers (61%), with a relative risk of 1.71(95% confidence interval 1.4, 2.0) as compared to the nonsmokers (36%), which was significant. Increased levels of nicotine may be a contributory factor to atherosclerosis which is observed in smokers. Conclusion: Cigarette smoking not only accelerates the early onset of coronary artery disease but also increases the risk of the development of coronary artery disease by more than 80%.

Morphological Variations in the origin and insertion of Lumbricals of the Upper Limb in Cadavers

ASHWINI M MUTALIK

The human hand represents a revolution in evolution. The muscles of the lumbricals though small in size, have a significantly greater role to play in the intricate movements of the fingers. These muscles show anomalous origins and insertions. Hence, this study was an effort to know more about these muscles, as it is of significant value in the design of surgical procedures. This study was conducted on 30 (both in the male and female populations) cadavers which were available from the Department of Anatomy. Dissection was carried out according to the Cunningham’s manual of practical anatomy. In the present study, many split insertions and misplaced insertions and even the absence of these muscles were noted. Apart from the anomalies in the attachments, the length, breadth, width and tendon length of all these intrinsic muscles were studied and noted. In this study, the values of length, breadth, width and tendon length of all the lumbricals, was measured. On applying the test of significance, these values were found to be statistically significant.

The effects of a Nutritional Supplement (eXfuze Seven+) on blood glucose; a double-blind, randomized study

SANDRA H. LEE, GARY M. BOOTH

This report is an analysis of a randomized, double-blind study which was conducted to determine whether eXfuzeTM Seven+, a nutritional supplement, could lower the blood glucose levels. All volunteers (n = 883) from the Huntsman Senior World Games who were participants at St. George, UT, were to consume randomly, either the eXfuzeTM Seven+ drink, (treatment A) or a commercially obtained grape juice (treatment B; placebo). We used Bayer’s CONTOUR® blood glucose monitoring units to measure before and after blood glucose levels. All the participants voluntarily consented to be a part of the study and their ages and genders were also noted down for further analysis. A SigmaPlot11.0 ®statistical program was used to compare the treatment A (n = 496) and the placebo (n =387) by using t-tests which showed that treatment A had a blood glucose lowering trend as compared to the placebo (p-value = 0.024). Further analysis showed that gender did not affect the treatments (p-valuefemales = 0.120, p-valuemales= 0.063). Also, age did not affect the data (p-value = 0.2). When analyzing the treatment data of the individuals with a change which was greater than or equal to 0, the p-value was found to be less than 0.001, thus indicating that treatment A appeared to cause less spiking of the blood glucose than the placebo. By graphing these data, we saw a pattern where the treatment A data-points tended to aggregate closer to zero than the treatment B data-points. Therefore, this study strongly suggests that the eXfuzeTM Seven+ treatment causes a downward trend in the blood glucose levels as compared to the placebo. Background: eXfuzeTM Seven+ (eXf+) is a health supplement containing various botanical fruit extracts which have purported health benefits. Aim: To determine the effects of eXfuzeTM Seven+ on the blood glucose levels. Materials and Methods:Treatment cups (one-ounce) which were labeled as ‘treatment A’ (eXf+) and ‘treatment B’ (placebo) were given to 883 participants from the 2009 Huntsman Senior World Games which were held at St. George, Utah; each participant received a cup containing one ounce of a particular drink. The pretreatment and post-treatment blood glucose levels of the volunteers were measured by using Bayer’s blood glucose monitoring units. Furthermore, the ages, genders, sports, and before and after dosing-times of the participants were noted. All the participants voluntarily agreed to participate in the study as a part of the health screen which was provided by the Huntsman Senior World Games. The participants were asked to return within a 30-60 minute time interval to take a final glucose measurement. There was no attempt to control the participants’ consumption of food or drink before the treatment, but they were encouraged to avoid simple carbohydrates after drinking the treatment or placebo. A total of 296 valid data points were collected from the individuals who consumed eXfuzeTM Seven+ (treatment A), and a total of 287 valid data points were collected from those who consumed commercially the available grape juice (treatment B; placebo). SigmaPlot 11.0®was used to determine the t-tests and the homogeneity of the variance. Further analysis was done by using the statistics programme called SAS®. Results: The p-values from both the statistical programmes showed the same levels of significance, differing only slightly due to a difference in the number of data points which were used for the analysis. An initial comparison between all the treatment A and placebo data resulted in a statistically significant difference (p=0.024). The overall mean change for treatment A was -1.77 mg% of blood glucose, whereas the mean change for treatment B was +1.88 mg% of blood glucose. Hence, treatment A, with its decreasing trend, was significantly different than the placebo’s increasing trend. The analyses of gender versus treatment and age versus treatment resulted in no significant differences (p=0.9119 and p = 0.680 respectively). Conclusions: The data clearly show that eXfuzeTM Seven+ causes a significant decreasing trend in the blood glucose levels.

The Prevalence Of Moraxella Catarrhalis In Lower Respiratory Tract Infections

ANITA K .B,FASEELA T.S, NEVILLE FERNANDEZ,CHAITHRA S MALLI, SRIKARA MALLYA

The recognition of Moraxella catarrhalis as an important human respiratory tract pathogen, together with the increasing prevalence of beta lactamase producing strains, has generated much interest in this bacterium. The aim of the present study was to know the prevalence of respiratory tract infections which were caused due to Moraxella catarrhalis, to compare its isolation rates with the common respiratory pathogens and to study its antibiotic susceptibility pattern. Sputum samples were collected from 1402 adult patients with lower respiratory tract infections. The specimens were subjected to gram staining, culturing and antibiotic sensitivity testing. The isolates were identified by their appearance on gram staining and their colony characteristics and their biochemical tests. The β - lactamse assay ANITA K .B,. FASEELA T S, NEVILLE FERNANDEZ, CHAITHRA S MALLI, SRIKARA MALLYA and antibiotic susceptibility testing were done. A total of 137 Moraxella catarrhalis strains were isolated from 1402 sputum samples (9.8%). The isolation rate of Moraxella catarrhalis alone was 10.2%. The isolation with H. influenzae was 10.9% and with S. pneumoniae, it was 4.16%. The isolation along with both H. influenzae and S. pneumoniae was 30.6%. The antibiotic sensitivity pattern showed only 14% sensitivity to Penicillin, but the sensitivity to Amoxyclav was 100%. There was more than 90% sensitivity to both cefotaxime and ceftriaxone. The sensitivity to erythromycin was 84%, while it was 95% to both tetracycline and chloramphenicol. β -lactamase production was detected in 86% of the isolates.

Retroperitoneal Malignant Melonoma – A Curiosity

This is a case report of an extremely rare primary malignant melanoma, presenting in the retroperitoneum of a 76 year old male. USG and CT scan revealed a large retroperitoneal, well defined, 8.6x5.1cm mass in the retrocaval compartment, displacing the IVC anteriorly. Multiple tiny, hypodense/cystic, hepatic metastases were seen predominantly in the superior segments of the right lobe. Minimal peritoneal free fluid was seen. Fine needle aspiration cytology revealed features whichwere suggestive of malignant melanoma, which was followed by a biopsy of the retroperitoneal mass. The histopathology of the biopsy was suggestive of malignant melanoma. The detailed clinical history revealed that there was no previous melanoma which was excised or regressed, and that the patient did not have any lesions on the skin or in the eyes or in the gastrointestinal tract. So, the case was diagnosed as primary retroperitoneal malignant melanoma – A RARE FINDING with only 5 cases in the literature.

Malignant Extragastrointestinal Stromal Tumours: what are the Prognostic features to depend upon?

USHA DUBEY, RUMPA DAS ASHA AGRAWAL, CHAYANIKA PANTOLA NEELIMA VERMA

Extragastrointestinal stromal tumours (EGISTs) are rare intra abdominal tumours which occur in the omentum, the mesentry and other intra abdominal sites. Their histogenesis is said to be from the interstitial cells of the Cajal, as these cells express CD-117. The differential diagnosis includes fibromatosis, smooth muscle and neural tumours, etc. We present a case of a 50 year old man, who presented with acute pain in the abdomen. Ultrasonography (USG) showed multiple, round, homogenous, hypoechoic masses in the mesentry, measuring 1.5 to 2.5 cm in diameter. USG guided fine needle aspiration was performed. On the basis of the cytological findings, a diagnosis of malignant spindle cell lesion was made. On the basis of the histopathological findings, the tumour was diagnosed as an extragastrointestinal stromal tumour. The tumour showed CD-117 positivity, which confirmed the diagnosis. We are presenting this case to highlight the diagnostic features and the prognostic values of the different features which are mentioned in different literatures.

Death related to Herbal Therapy for Joint Pains – A rare case of Gloriossa Superba Poisoning

PETER GEORGE MD

Native practitioners in rural areas use plant parts or extracts as medications for common ailments. Herbal medications are gaining popularity, even in developed countries. However, there are no qualitative or quantitative standards for most of the herbal medications. Due to this, the patients at times, suffer fatalities. We report the case of an elderly woman who consumed the tubers of Gloriosa superba as treatment for her joint pains and died of its toxicity. Colchicine is the alkaloid extract of Gloriosa superba and it is used in many rheumatological and immunological diseases.

Salivary duct carcinoma of the minor salivary glands: A rare case report

RAJINI KANTH M, A RAVI PRAKASH, P SREENIVAS REDDY

Salivary duct carcinoma (SDC) is a rare invasive malignancy arising in the ductal epithelium of the salivary glands. These are an uncommon but distinct group of highly malignant salivary gland tumours. These are usually seen in the major salivary glands, especially in the parotid gland. This malignancy was established as a distinct clinicopathological entity and was delineated from ‘’adenocarcinoma (NOS)” in 1991 by the World Health Organization. Salivary duct carcinomas affecting the minor salivary glands have been reported in only 4% of the SDC cases and constitute 2% of all the salivary gland malignant neoplasms. Its biological behaviour is highly aggressive; the metastatic and the tumour-related death rates were 75% and 73%, respectively. In this article, wereport a case of a salivary gland carcinoma which was present in the palate of a 55-yearold male patient.

Secondary Cardiac Pleomorphic Rhabdomyosarcoma – A Case Report and Review of Literature

SANDHYA ILANTHODI,ARAVIND PALLIPADY, JAYAPRAKASH K, FRANCIS N P MONTEIRO

Pleomorphic rhabdomyosarcoma (PRMS) is a rare and controversial tumour of the skeletal muscle phenotype. Although it has been recognized that aggressive soft tissue sarcomas may give rise to cardiac metastases, these manifestations are usually late and clinically silent, they being the prevailing findings in exceptional cases. This report describes the occurrence of a massive cardiac metastasis which was secondary to the PRMS of the lower limbs, for which the patient had undergone amputation. This manifestation was the cause of rapidly progressive congestive heart failure and together with the unusual occurrence of autoimmune thrombocytopaenia, this led to a difficult patient care with a significantly negative influence on the outcome.

Retinal Dysplasia-A Mimic Of Malignant Ocular Pathology

NEHA AGARWAL*, CHAYANIKA PANTOLA**, PRASHANT GUPTA***, ASHA AGARWAL****

Retinal dyplasia is considered as a lesion with specific morphological characteristics, rather than a disease or a syndrome in itself .It may occur in otherwise normal individuals as a unilateral lesion, or it may be observed as a component of several syndromes with intraocular involvement and may present a diagnostic dilemma in the differentiation between benign and malignant ocular pathologies. Here, we report a case of retinal dyplasia in a one and a half month old child, who initially presented to us with red eye which was clinically suspected and radiolgically supported as a case of retinoblastoma.

Massive subhyaloid haemorrhage as a presenting feature of Cryptococcal meningitis (CM) in Acquired Immuno Deficiency Syndrome (AIDS)

SHEETAL A SAVUR, UMA D KULKARNI

Cryptococcal meningitis is a life and vision threatening complication in patients with AIDS. Ocular morbidity usually occurs secondarily to intracranial involvement and may manifest as papillo-oedema, optic neuritis and optic atrophy. Our patient however, had an unusual presentation of unilateral subhyaloid haemorrhage, which has not been reported earlier. The visual loss in cases of CM is usually due to secondary optic atrophy or optic neuritis. Cases of AIDS, presenting with subhyaloid haemorrhage, should be investigated for CM. An early recognition and prompt management can prevent vision loss.

Idiopathic Gangrene of the Penis

H.C. SRIKANTAIAH

A Disguised Tuberculosis of the Oral Buccal Mucosa

Tuberculosis (TB) is a major cause of ill health and death worldwide. It is a chronic granulomatous disease that can affect any part of the body, including the oral cavity. Oral lesions of TB, though they are uncommon, are seen in both the primary and secondary stages of the disease. The authors present here, a case of TB of the buccal mucosa, manifesting as a non healing, non painful ulcer. The diagnosis was confirmed, based on the histopathology, sputum examination and immunological investixxgation. The patient underwent anti-tuberculosis therapy and her oral and systemic conditions improved rapidly. Although the oral manifestations of TB are rare, the clinicians should include TB in the differential diagnosis of various types of oral ulcers. An early diagnosis with prompt treatment can prevent complications and potential contaminations.

Recurrent Tracheo– Oesophageal Fistula Mesh in the Trachea – A Rare Clinical Scenario

SRIKANTAIAH H C, RUDRESH H K, ASHOK A C

Oral Capecitabine - Can It Cause The Hand-Foot Syndrome?

AKASH S S, BHOUNSULE A S

The Hand Foot Syndrome (HFS) or palmo-plantar erythrodysesthaesia (PPE) manifests as acral erythema with swelling and dysesthaesia of the palms and the plantar aspects of the feet, which in the absence of dosage reduction or drug cessation, progresses to moist desquamation and ulceration, resulting in serious infections and loss of function (1). The Hand –foot syndrome is a cutaneous adverse event which is associated with various anti- cancerous chemotherapeutic drugs viz; capecitabine, 5-fluorouracil, cytarabine, doxorubicin, epirubicin, fluorodeoxyuridine(FUDR), mercaptopurine, cyclophosphamide, docetaxel, (2) gemcitabine, sunitinib, erlotinib and sorafenib (3), idarubicin (4), vinorelbine (1), high doseinterleukin(IL2) (5) , hydroxyurea (6), mitotane, and thiotepa. Although the pathogenesis of HFS is not fully understood, it is suspected that it may be caused due to damaged deep capillaries in the soles of the feet and on the palms of the hands, leading to a COX inflammatory-type reaction, or that it is related to the enzymes which are involved in the metabolism of capecitabine, namely, thymidine phosphorylase and dihydropyrimidine dehydrogenase. Ethnic variations in the clinical manifestation of HFS warrant further attention, and an alternative system for grading HFS in non-white patients has been proposed (7). We report here, a case of HFS, induced by oral capecitabine, with moist desquamation and ulceration over the feet and hands.

In utero intestinal perforation presenting as Ileal atresia with calcification: A Case Report

RAJENDRA K GHRITLAHAREY, JYOTI SRIVASTAVA

We report a case of intrauterine bowel perforation presenting as ileal atresia with calcification. A seven-day-old girl presented with abdominal distension, bilious vomiting and not passing meconium. A provisional diagnosis of distal ileal atresia was made on clinical examination and investigations. Exploratory laparotomy revealed distal ileal atresia type IV, a calcified mass attached to atretic ileum and adhesions. Adhesiolysis, resection of atretic segments with calcified mass and ileostomy was done. She was on regular follow up for one month, thereafter lost to follow up.

Duloxetine Induced Discontinuation Syndrome: A Case Report On Drug Safety

KINGSHUK LAHON, HARSHA M SHETTY, AMITH PARAMEL, GYANESWAR SHARMA

Introduction: Discontinuation symptoms are those which are experienced on stopping prescribed drugs that are not drugs of dependence, with predictable onset, duration and cessation of action. The symptoms can be suppressed by the reinstitution of the discontinued medication. Antidepressant discontinuation symptoms can cause morbidity, they can affect compliance, they can prevent the cessation of antidepressant therapy and can be misdiagnosed, thus leading to inappropriate treatment. The alertness of clinicians regarding the possibility of the antidepressant-induced discontinuation syndrome is necessary for its prevention and management. Hence, we wanted to assess the causality of a suspected case of discontinuation reaction with duloxetine. Case report: Suspected adverse drug reaction (ADR) data which were collected retrospectively from the case records of patients attending the Psychiatry Outpatients Clinic of a teaching hospital in Pondicherry was analysed for causality by using Naranjo’s scale. A 50 year old female who was diagnosed with mixed anxiety and depressive disorder with somatoform disorder, was prescribed duloxetine for six months along with zolpidem. Later on, zolpidem was changed to lorazepam. On stopping the drug after a gradual taper over eight weeks, she developed a feeling of tension and irritability, insomnia, indigestion, dizziness and a crawling sensation in the scalp on the next day. On readministration of duloxetine, the symptoms disappeared within a day. Naranjo’s score was 6 (probable) for the ADR. Discussion: The ADR fulfils the diagnostic criteria for discontinuation reaction for the onset, duration, type of symptoms, risk factors and the response to the reinstitution of the withdrawn drug. Conclusion: This is a probable case of duloxetine induced discontinuation reaction which appeared even though a gradual taper was done over eight weeks before stopping treatment. The current guidelines require a taper over four weeks only. A high index of suspicion is helpful in identifying antidepressant induced discontinuation symptoms for their proper management and prevention in future.

Pleomorphic Lipoma : A Cytological Diagnostic Dilemma

ARAVIND PALLIPADY* AND SANDHYA ILANTHODI**

This is a case report of a seventy year old male with a swelling in the lower back.A Fine needle aspiration cytology conducted on the sample diagnosed the case as spindle cell sarcoma. Wide excision sample was sent to histopathology that showed predominant adipocytes with few pleomorphic bizarre cells, floret like giant cells and ropy collagen bundles. Re-evaluation of cytological smears dawned on us authors the pitfalls in the diagnosis of Pleomorhic lipoma.We present this rare case in view of minimizing radical surgeries in such deceptive benign lesions.

The Role of the Anti-Müllerian Hormone in Female Fertility: A Review

PRIYA DAHIYA, KIRAN DAHIYA, RAKESH DHANKHAR, NAVDEEP HOODA, K.D. NAYAR

The Anti- Müllerian hormone (AMH) is a recent biomarker for the ovarian reserve. Initially, it was considered mainly in the context of the müllerian regression and the sexual differentiation in males, but its role in ovarian functions is gaining interest very fast. It is mainly expressed in the small antral follicles and its levels decline with the growth in the follicular size. Its capability as a predictor for ovarian response can be utilised to devise a more individualised approach in the patients who opt for assisted reproductive technology (ART). It has an inhibitory effect on the primordial follicular recruitment in the ovary and on the responsiveness of the growing follicles to the follicle stimulating hormone (FSH); thus it is important in patients with polycystic ovary syndrome. This review summarizes the recent findings which concern AMH and its role in the female fertility.

Emphasizing a new developmental Variation of the Mandibular Molars - A Mermaid In Dentistry?

MADHUSHANKARI G S, BASAVANNA R S, DEEPSHIKHA DAHIYA , SONIKA

Dental size and morphology are easily recorded aspects of phenotypic variations. The majority of pathological variations in shape affect the crown of the tooth. The variations in the crown of the mandibular permanent molars include the occurrence of the sixth cusp on the first molars and the fifth cusp on the second molars. As the variations are always varied, we present here, a unique case of bilateral, mandibular, first permanent molars with an oblique ridge resembling the crown of the maxillary molars.

Restorative - Orthodontics: Is This An Option?

ANIL SHARMA

Edentulous spaces in the dental arches have conventionally been managed with either implants or other fixed or removable prostheses. This article describes another possibility of orthodontically closing these extraction spaces, especially in young individuals, thereby restoring an ideal occlusion and arch integrity without the need of aprosthesis. This article presentscase reports where the edentulous spaces were closed orthodontically, leaving no room for a prosthesis, thereby providing a physiologically balanced occlusion and avoiding the lifelong maintenance of a prosthesis.

The Effect Of The Supervised Use Of Fluoridated Toothpaste On The Gingival Health Of Children

ROHIT IT ANAND

Purpose: The present study was envisaged to study the effect of fluoridated toothpaste on the gingival health of children. Materials and Methods: Subjects in the age group of 8 to 10 years were selected for the study, irrespective of their sex and socio economic status. Toothpastes containing 0.38% sodium mono fluorophosphates, 500 PPm fluorides, 0.35% sodiummono fluorophosphates and 458 PPm fluorides were used. The criterion for gingival health scoring was a marginal gingival index. Result: The results of this study showed that the oral health of the child patients improved over a 10 week period by the use fluoridated toothpastes. Conclusion: This study shows that the use of fluoride toothpastes leads to a reduction in the gingival inflammation in children.

Adenomatoid Odontogenic Tumour of the Maxilla and the Mandible: A report of 2 cases

A RAVI PRAKASH, P. SREENIVAS REDDY, V. SAIRAM

The purpose of this study was to report two cases of Adenomatoid Odontogenic Tumour (AOT) with a classical histological picture, one of which was located in the maxilla and the other in the mandible. Two female patients aged 17 and 22 years old presented with a painless swelling in the anterior maxilla and in the anterior mandible . The panoramic view showed circumscribed radiolucent areas with fine calcifications in both the cases. The lesions were totally enucleated and the teeth 21 and 22 in the 1st case and 31 and 32 in the 2nd case were removed. The AOT frequently resembles other odontogenic lesions such as dentigerous cysts or ameloblastomas. Therefore, it should be distinguished from the more common lesions of odontogenic origin in routine dental examinations

Gorlin–Goltz Syndrome – Case Report

PAYAL GARG*, FRENY KARJODKAR**, SHOBHIT K GARG***

The simultaneous occurrence of multiple cysts in both the jaws of a patient is rare and it usually occurs as the manifestation of a syndrome. Whenever multiple cysts are found, it is necessary to rule out an association with any syndrome, as the chances of recurrence are very high and a periodic follow-up is required for such patients. In our patient, cyst enucleation was done previously, but the association with the Gorlin-Goltz syndrome was missed and no follow-ups were advised.

Bilateral Bifid Mandibular Condyle

Avinash Tejasvi,Laxmikanth Chatra Prashanth Shenai.K

The bifid condyle is a rather uncommon condition that is diagnosed radiographically. It is characterized by the duplicity of the head of the mandibular condyle and thus, it is also known as double - headed condyle. The bifid condyle’s aetiology and pathogenesis are not known. It is said that it may be a developmental abnormality or that it may occur due to trauma. In the literature, only 30 cases of bilateral bifid mandibular condyle have been reported. The present case is a 23-yearold young male patient with bilateral bifid mandibular condyle, which was diagnosed during a panoramic radiographical examination.

Digital Imaging

SUJATA M BYAHATTI

With the rapid developments in the field of computers and technology, newer methods of image acquisition and processing are available, which have been made very easy to perform. These systems utilize electronic media to record the image and advanced computer software to process the acquired image and also to modify it according to our needs. In digital imaging, the tonal value of each pixel is represented in a binary code. The binary digits for each pixel are called “bits,” which are read by the computer to determine the analog display of the image. The number of pixels-per-inch (ppi) is a good indicator of the resolution, which is the ability to distinguish the spatial detail of the digital image. The bit-depth and the pixel measurement of the pictures relate to the colours which are viewable in the image, and determine the size of the image file on a computer. Images with only two pixel shades – black and white – are binary. Grayxxscale images are typically displayed in an 8-bit mode, which is 256 shades of gray. The aim of this article is to enlighten this latest imaging technology with its advantages and disadvantages and its multiple applications in dentistry

Periodontal Abscess: A Review

PUNIT VAIBHAV PATEL, SHEELA KUMAR G, AMRITA PATEL

Periodontal abscess is the third most frequent dental emergency, representing 7–14% of all the dental emergencies. Numerous aetiologies have been implicated: exacerbations of the existing disease, post-therapy abscesses, the impaction of foreign objects, the factors altering root morphology, etc. The diagnosis is done by the analysis of the signs and symptoms and by the usage of supplemental diagnostic aids. Evidences suggest that the micro-flora which are related to periodontal abscesses are not specific and that they are usually dominated by gram-negative strict anaerobe, rods, etc. The treatment of the periodontal abscess has been a challenge for many years. In the past, the periodontal abscess in periodontal diseased teeth was the main reason for tooth extraction. Today, three therapeutic approaches are being discussed in dentistry, that include, drainage and debridement, systemic antibiotics and periodontal surgical procedures which are applied in the chronic phase of the disease. The localization of the acute periodontal abscess and the possibility of obtaining drainage are essential considerations for successful treatment. Several antibiotics have been advocated to be prescribed in case of general symptoms or if the complications are suspected. Antibiotics like Penicillin, Metronidazole, Tetracyclines and Clindamycin are the drugs of choice.

β –Blockers in reactive airway disease

BHARTI CHOGTU, RAHUL MAGAZINE, K.L.BAIRY

Beta-2- adrenergic agonists agonists are used in the treatment of reversible airway disease. β- blockers, due to their bronchoconstrictor effects, are supposed to be deleterious in such patients. In this review, we are putting forth some recent studies and meta analysis, which indicate that the chronic use of β- blockers in patients with reversible airway disease does not produce pulmonary impairment. Also, these drugs need not be withheld from patients with other diseases like hypertension, after weighing the risk: benefit ratio.

Intraparenchymal Choroid Plexus Papilloma : Can Trauma be an etiological factor?

RUMPA DAS, USHA DUBEY ASHA AGARWAL, CHAYANIKA PANTOLA

Differential diagnosis: Cases with equal Posteriori Likelihoods

ASHUTOSH KUMAR DIXIT