Journal of clinical and diagnostic research

Serum Calcium: Can It Be A Diagnostic And Prognostic Marker In Essential Hypertension?

Context: To evaluate the usefulness of serum calcium in the diagnosis and prognosis of essential hypertension Objectives: To find out the association of serum calcium with the pathophysiology of essential hypertension Study Design: A cross-sectional analytical study Materials & Methods: Concentrations of serum total and ionized calcium were analyzed and compared between hypertensive cases and normotensive controls by using the unpaired two-tailed Student’s t t test. All statistical analyses were done by using PASW (SPSS) v.18.0. Results: The mean levels of serum total calcium were not statistically different between the hypertensive and the normotensive groups (P > 0.05). The hypertensive subjects had significantly lower mean serum ionized calcium levels (P < 0.001) as compared to the normotensive controls. Correlation studies showed that the serum ionized calcium levels varied negatively with age, both in the hypertensive (r = -0.283, P < 0.01) and the normotensive subjects (r = -0.219, P < 0.01). The Liner regression analysis of serum ionized calcium levels with age indicated that hypertensive subjects had 1.67 times higher variation in serum ionized calcium levels than in the normotensive subjects at a particular age. Conclusion: Essential hypertension is associated with perturbations in calcium metabolism, especially with decreased levels of the ionized fraction of serum calcium, thus contributing to the ageing process. Serum ionized calcium can be used as a diagnostic as well as a prognostic marker in essential hypertension.

Short-Term Furosemide Therapy In Chronic Renal Disease; Implications Of Hypomagnesia And Potential For Improving Hyperkalaemia

Background: Several long term studies on the effect of furosemide in chronic renal diseases exist. Furosemide has been noticed to lead to early electrolyte balance in several long-term studies. Further, some studies have shown that an early, rapid decrease in potassium (K) levels is seen with furosemide therapy. Objectives and Methods: Hence, a short term study was undertaken to study the potential effect of a short, 3-day therapy with furosemide on chronic renal failure (CRF) and nephrotic syndromes. The study evaluated the clinical implications of a short-term furosemide therapy in terms of electrolyte imbalance, and as to whether a rapid decrease in potassium levels can be achieved and may be potentially used to cure hyperkalaemia. The study included 100 subjects, out of which 50 were CRF patients and the rest had nephrotic syndrome. Results: A 3-day course of furosemide showed a rapid decrease in potassium (K) and magnesium (Mg) levels in both the groups. However, the response was protective in patients with CRF, who showed higher pretreatment K and Mg levels, but the nephrotic syndrome patients had normal pretreatment levels (K, Mg). The results were suggestive that furosemide led to hypokalaemia and hypomagnesia. Hence, while caution is needed with furosemide, as it has the potential to cause early hypokalaemia/hypomagnesia, on the other hand, it also depicted a potential of treating hyperkalaemia, as was seen in the CRF patients. Further, a simultaneous decrease in Mg levels suggests a need to supplement Mg in patients who were treated with furosemide, because K supplementation is refractory if Mg is not supplemented. This also undermines a need to monitor the Mg levels in the serum (normally not done), which might be as important as the regular monitoring of the sodium, potassium, and calcium levels, as recommended for loop diuretics. Lipid derangements which are seen with early, short-term furosemide treatments, suggest the need for an early monitoring of the lipid profile, which might be adversely affected; even in case of a short therapy with furosemide. Conclusion: The rapid potential of furosemide for treating hyperkalaemia needs to be reinforced in large-sampled studies.

Study Of Malondialdehyde As An Indicator Of Oxidative Stress And Its Modulation By N-Acetylcysteine In Chronic Obstructive Pulmonary Disease

AMEETA B PATIL*, ANITA B KALE**, SAMEER S SINGHAL***, TANVEER A KHAN****

Background & objectives: Chronic obstructive pulmonary disease (COPD) is an inflammatory lung disease characterized by systemic and local inflammation and oxidative stress. In view of the lack of therapy that might inhibit the progress of the disease, there is an urgent need for a successful therapeutic approach. This study aims to evaluate the effects of administration of oral N-acetylcysteine (NAC) on the oxidative stress and respiratory symptoms and also to check the safety of oral NAC. Methods: This randomized, double blind study was conducted in sixty-eight adult patients diagnosed as having COPD. All patients received standard treatment for COPD and were divided into three groups. Group I received placebo, Group II and Group III received NAC 600 mg once daily (OD) and twice daily (BID) dose respectively for two months. Efficacy parameters included assessment of serum malondialdehyde (MDA) and respiratory symptoms. Adverse drug reactions were monitored as a safety measure. Results: Mean serum MDA levels showed significant fall in group-II (p=0.001) and group-III (P=0.023) as compared to group-I (P=0.147) and improvement in respiratory symptoms was noticeable in group-III followed by group-II from day 0 to day 60. Nausea and stomatitis were the most common adverse drug reactions experienced by the patients in all the three groups. Interpretation & conclusions: Maximum decline in oxidative stress was with OD dose followed by BID dose which indicates that antioxidants above a certain limit may not be much beneficial. Improvement in symptoms was seen maximum with BID dose followed by OD dose. This was due to mucolytic and immunomodulating properties of NAC besides its antioxidant role. Minor adverse drug reactions confirm the safety of NAC with both the doses. This confers a new facet in management of COPD and an attempt to impede the disease progression.

Role Of Oxidative Stress In Obesity With An Insight Into Type II Diabetes Mellitus

SUMAN S DAMBAL*, INDUMATI V#, SUCHETHA KUMARI**

In the present study, the antioxidant status of obese and overweight individuals was analyzed with an insight into the role of diabetes mellitus towards increasing oxidative stress in the subjects. The assay of enzyme superoxide dismutase (SOD) in erythrocytes and that of antioxidant vitamin C in serum was carried out. The assay of vitamin C alone cannot completely focus on the antioxidant status of the system; the Total antioxidant capacity (TAC) of the serum was also assayed to give a summation of the antioxidants in the system. The study was carried out on five groups of subjects in the age group of 40-60 years. Fifty non-diabetic and non-obese subjects formed the Group A, which were designated as the Controls. The study group was categorized into 4 groups, of which, 50 overweight patients were taken as Group B and Group C consisted of 50 overweight subjects who were diagnosed with diabetes mellitus. Fifty obese individuals were considered as Group D and 50 obese subjects with diabetes mellitus were taken to be Group E. The levels of the enzyme, superoxide dismutase were significantly higher (p<0.0001) and the Total Antioxidant Capacity and vitamin C levels were significantly lower [(p<0.0001) and (p<0.0054)] respectively in the study groups, as compared to those in normal individuals, as the disease conditions like obesity and diabetes mellitus in the study groups contributed to increasing the load of the reactive oxygen species in the system, thus utilizing and depleting the dietary antioxidants.

The Participation Of Nurses In Decision Making

MOLOUK JAAFARPOUR* AND ALI KHANI**

Background and Aim: Staff nurse decisional involvement is associated with positive patient outcomes including a higher nurseperceived quality of patient care, lower patient mortality , fewer complications and lower levels of job strain and burnout. The aim of this study was to investigate the actual and preferred levels of the decisional involvement of nurses in the Iranian state. Material and Methods: This was a descriptive study that was performed at the ILAM general hospitals, IR, during the year 2010. The research instrument which was used was the decisional involvement scale (DIS). A sample of 96 registered nurses (RN) were enrolled in the study by using a simple random sampling method. Descriptive and inferential statistical analyses were performed by using the Statistical Package for Social Sciences Program, Version 11.5 Original Article Education Section Molouk Jaafarpour and Ali Khani (SPSS). Results: The nurses reported the actual involvement in their work environment to be only somewhat (M = 2, SD = 0.75) and also reported high levels of preferred involvement (M = 3, SD = 0.75). Collaboration/liaison activities were the most actual involvement aspect in the work environments of the nurses (M = 3.1, SD = 0.69) and unit governance and leadership were the most preferred forms of involvement (M= 4.2, SD= 0.56). Discussion and Conclusion: The results provide support for decisional involvement in the population of Iranian nurses. Therefore, efforts to improve the quality of the nursing work environments into decisional involvement are critically important to sustaining a strong nursing work force in the future. These findings have important implications for nursing leadership.

Detection of inducible Clindamycin resistance in clinical isolates of Staphylococcus aureus by the Disc Diffusion Induction Test

SHANTALA G B*, ADITHI S SHETTY*, RAHUL RAO K*, VASUDEVA*, NAGARATHNAMMA T*

Therapeutic failure to Clindamycin has been reported due to mechanisms which confer resistance constitutively, or by the presence of low level inducers which can lead to therapeutic failure. Therefore, this study was undertaken to identify the strains that have the potential to become resistant during therapy. Inducible Clindamycin resistance was tested by the Clindamycin disc induction test (D test) as per the CLSI recommendations. The study showed 54.78% MRSA isolates and 32.5% inducible Clindamycin resistant isolates among them as compared to 15.53% in MSSA isolates. We concluded that routine screening for inducible resistance to Clindamycin must be performed so that the drug is used effectively and for maximum clinical utility.

Evaluation of Serum Selenium Level in Patients With Uncomplicated Diabetes Mellitus, Raipur, India

USHA JOSHI,PD RAUT*,SK AGRAWAL,PK PATRA,BK MAHESHWARI,MANU APURB,DHIRHE TC.

Objective-Free radicals have important role in the pathogenesis of diabetes mellitus. In diabetes, free radical production is increased whereas capacity of antioxidant system is reduced. This study was, therefore designed to determine and evaluate the serum selenium level in patient with uncomplicated diabetes mellitus and a control group of non-diabetic individuals. Study design- Hospital based non randomized, multistage, stratified, cross-sectional comparative study. Material and Method- 50 uncomplicated diabetic patients (23 male, 27 female) with mean age of 49.10±6.48 years were enrolled in the study. Control group was composed of 50 healthy individual (22 male, 28 female) with mean age of 52.74 ±7.5 years. Serum selenium level was determined by using Hydride generation atomic absorption spectrometry in diabetic patients and controls. Result – Mean serum- selenium concentration measured in uncomplicated diabetic patients (51.9±8.23 µg/lit) were significantly lower than those determined in control group (130.66±37.18 µg/lit) (p< 0.05).There was significant decrease in mean serum selenium level with increasing age. (p<0.05).No significant differences in serum selenium levels were found in relation to the sex of the patient (p> 0.05). Conclusion- The result of this comparative evaluation confirms the relation between low serum selenium and diabetes. Significant reduction in selenium levels are indicators of metabolic response to oxidative stress in patient with diabetes. Hence, selenium can be used in diabetic patient to prevent the late complications. The present study indicates that since it is a hospital based study, the same study should be conducted in general population (community based) to further evaluate the effect of serum-selenium in diabetes.

Readiness For Self Directed Learning Among First Semester Students Of A Medical School In Nepal

Background: Self directed learning (SDL), a central theme in adult education, is considered to be associated with the management of lifelong learning for better outcomes. Certain learning situations help to strengthen SDL. Medical science changes rapidly and there is an information explosion; so, it is important to train doctors for SDL. Aims: The aim of this study was to measure the readiness for SDL of students at the beginning of the undergraduate medical course. Methods: The readiness for SDL was measured among 121 first year undergraduate medical students at Manipal College of Medical Sciences, Pokhara, by using the Self-directed Learning Readiness Scale (SDLRS), an instrument developed by Australian researchers. Results: The observed mean score was 157.8 (range 103 – 190). According to Fisher and coworkers, the developers of the scale total scores greater than 150 indicate readiness for SDL. Most of the students (72.7%) scored more than 150 and so, they could be considered as ready for self directed learning. The mean scores were not significantly different among the male and female students as well as among the self-financing and the scholarship students. Conclusions: Most of the first semester students had a high degree of readiness for self directed learning. Studies correlating the SDL score and the students’ academic performance are lacking and so, the scores of the students could not be used to predict their success in the forthcoming exams. Therefore, more research is required in this field. Similar studies can be done in other medical schools.

A Duration Based Study Of Lipid Profile Status & Associated Changes In The Left Ventricular Function Of Postmenopausal Women

M MUHIL*, U SEMBIAN**, BABITHA***, T MEENA****

Aim : Menopause is the phase of declined ovarian activity & fall in estrogen level. Since there is an increased risk of cardiovascular diseases for women after menopause, the present study was carried out to evaluate the lipid profile status and associated changes in the left ventricular function in Postmenopausal women. Design-: Descriptive Study. Setting: 100 Postmenopausal were selected for study group, they are sub grouped into Postmenopausal <5years (N=50),Postmenopausal>5years (N=50), according to the number of years attained after menopause. Normal reproductive age group women (N50) were selected as control. Materials & Methods: For both the study groups & control, we have measured Body Mass Index ,Waist-Hip Circumference Ratio, Blood lipid profile including Total cholesterol, Triglycerides, Low density lipoprotein (LDL) & High density Lipoprotein (HDL).The Lipid parameters have been estimated by Enzymatic calorimetric method. The contractility indices of Left ventricular function like Fractional Shortening, Ejection Fraction & Left ventricular mass index were assessed by M-Mode Echocardiography. Statistical Analysis: Statistical analysis was done by one way ANOVA test. Results: BMI, W/H Ratio, were found elevated in both the sub groups menopausal women <5 years and >5 years. Among the lipid profile, Total cholesterol is elevated significantly (P < 0.05), in both the sub groups. In Postmenopausal women - > 5 years, LDL cholesterol value was significantly elevated than Postmenopausal < 5 years & control. Echocardiographic findings revealed that there is a significant reduction of Fractional shortening in & Postmenopausal ->5years. Conclusion : Postmenopausal women of longer duration (>5years) ,was the LDL Cholesterol significantly raised, the LV Functions shows significant negative correlation The derangement in lipid profile status is observed markedly in postmenopausal women of longer duration and the LV function significantly and negatively correlates to the lipid profile status in those postmenopausal women > 5 years.

A Study On The Detection Of Micrometastases In The Cervical Lymph Nodes Of Oral Squamous Cell Carcinomas By Serial Sectioning

A RAVI PRAKASH¹, G S KUMAR², PUSHPARAJA SHETTY³

Background: Metastatic deposits in the regional lymph nodes have always been a subject of great interest in oncology. There is a need for the detection of micrometastases in the lymph nodes in oral carcinomas by serial sectioning, so that any missed tumour cells in the routine single sectioning technique could be detected by this. The present study was aimed at the detection of micrometastases in the cervical lymph nodes in oral squamous cell carcinomas- by serial sectioning.Materials and Methods: This study was done on 16 cases with 119 lymph nodes which measured 1cm or less in greatest diameter, by a single section routine method and this was compared with serial sectioning at 100µm intervals. All the 2269 sections were stained with the routine Hematoxylin and Eosin staining for the detection of micrometastases.Results: The detection of micrometastases by the serial sectioning method was 2.03%. The percentage was the same for both the one section and the serial sectioning methods.Conclusion: The serial sectioning of the lymph nodes did not reveal any other detection than that was revealed by the one section method. But definitely, the serial sectioning method appears to be the best feasible method to evaluate micrometastases. Key words: Carcinoma, Lymph nodes, Micrometastases

Bilateral Chondroepitrochlearis Muscle: Incidence, Phylogenetic And Clinical Significance

S ARUNA*, R HANNAH SUGIRTHABAI RAJILA**, VAITHIANATHAN G***

To study the incidence and the phylogenetic and the clinical implications of a rare variant muscle slip arising from the pectoralis major muscle in the Indian population.. In this article, we have described a muscle slip which is present bilaterally, which originates from the lower ribs along with the lower fibres of the pectoralis major muscle. This muscle slip arches across the axilla and then inserts to the medial epicondlye of the humerus. The phylogenetic relationship of the muscle to the abdomino humeralis or to the xiphihumeralis in quadrapeds and to the patagii muscle in birds is discussed. The clinical significance of this muscle is also discussed, as the chondro epitrochlearis muscle forms an important differential diagnosis for ulnar nerve entrapment. It is also an important but a rare cause of the restriction of movements at the shoulder joint.

Hypertensive And Modeling Their Social Determinants Of Self-Rated Health Status In A Middle-Income Developing Nation

PAUL A BOURNE1 AND CHRISTOPHER A D CHARLES2,3

Introduction: A piecemeal approach has been taken in studies on hypertension, but there is a void in the literature on (1) the socio-demographic profile of those with the disease in a Latin American and Caribbean nation, (2) healthcare seeking behaviour, (3) healthcare utilization, and (4) modelling the social determinants of self-rated health status. Objective: The aim of this study was to elucidate information on hypertension and the socio-demographic profile of those with the disease in a Latin American and Caribbean nation, as well as to model the self-rated health status of the hypertensives. Materials and methods: The current study used the 2007 Jamaica Survey of Living Conditions dataset to carry out the analyses. This study extracted a sub-sample of 206 respondents, who indicated being diagnosed with hypertension, from a larger, nationally cross-sectional survey. Statistical Analyses: The Statistical Package for the Social Sciences for Windows, Version 16.0 (SPSS Inc; Chicago, IL, USA), and STATA were used to analyze the data. Multiple logistic regressions were used to analyze the possible explanatory variables of self-rated health status. Results: Twenty-seven in every 100 hypertensive persons had at least a good self-rated health status. The current study found that 2.5 times more females than males were affected by hypertension; and that the hypertensives were more likely to: be married, be elderly, utilise private health care facilities, record moderate health status, be in the lower socioeconomic strata, and be rural dwellers. Most had sought medical care during the last 4-week period. Rural hypertensives recorded the greatest very poor health status, and two variables emerged as statistically significant factors of the self-rated health status of the hypertensives in Jamaica. Conclusion: Our findings have provided policy makers with evidence that can be used to enhance policy formulation and intervention programmes.

A Morphometric Anatomical Study Of The Ethmoidal Foramina On Dry Human Skulls

Study of ethmoidal foramina are important in orbital surgeries, surgeries of anterior cranial fossa and in endonasal micro surgeries of ethmoidal region. The present study was undertaken to provide anaotomical morphometric data which will guide surgeons in locating these foramina during different surgeries. We measured the distances between all the ethmoidal foramina and the optic canal from the frontomaxillary suture. We also noted the number, location and presence or absence of these foraminas.

Hearing In Alcoholics – A Case Control Study

KAVITHA ASHOK KUMAR* AND REEBA PATRICK**

Alcohol is the most prevalent addiction in the world. It affects every organ in the body and its toxic effects are well documented. This article studies its effect on the auditory system. The authors have compared the hearing in 30 subjects where the single risk factor was alcohol consumption for more than 2 years, with 30 age and sex matched controls. The association of the severity of hearing loss with the duration and quantity of alcohol intake were studied. An attempt has been made to know whether abstinence from alcohol following de-addiction would bring about any change in hearing.

The Comparison Of Hearing Loss Among Diabetic And Non-Diabetic Patients

TAZIKI MOHAMMAD H* AND MANSOURIAN AZAD R**

Introduction: The prevalence of Diabetes Mellitus is steadily increasing. This is a multi- systemic abnormality, causing side- effects which are mainly irreversible. Hearing loss is one of the common symptoms, and there are many studies, with contradictory results. Aim of this study was to compare the hearing loss among diabetic with non- diabetic patients. Material and Methods: In this study 50 diabetic patients were chosen randomly from those overt diabetic patients referred to the Diabetes clinic in Gorgan hospital northern Iran, 50 other patients who referred to the 5th Azar hospital, with any other ENT complaint were also randomly chosen as control group. The case and control groups were matched. Demographic questionnaires were filled for each subjects in case and control groups, and those with intervening factors were omitted from this study. Data were analyzed using SPSS. Results: In this study 66% and 34% of participants were men and women respectively. The age distribution of the patient were 15-75 years. The hearing loss among diabetic patients and non- diabetic subjects were 16% and 5% respectively, which showed that the diabetic patient has 3.2 times more possibility to acquire hearing problem. It was also shown, that there was a direct correlation between increasing age and hearing loss. More women are at risk, of getting hearing loss than men. The hearing loss also has a correlation with the duration of disease onset and the consumption of Glibanclamid. Conclusion The careful periodical assessment of hearing loss, and the application of hearing facilities to improve the quality of diabetic patients life is recommended due to chronic and irreversible Symptom of the disease.

The Prevalence Of Elevated Carcinoembroynic Antigen At Gorgan South- East Caspian Sea Of Northern Iran

AZAD REZAMANSOURIAN* AND EZZATLAH GHAEMI*

The aim of this study was to find out the prevalence of CEA elevation among subjects, regardless of the contradictory arguments about the senstivity and specificity of this tumor marker. Carcinoemroyonic antigen (CEA) is a tumor marker widely practiced to screen, diagnose, monitor and follow-up patients with gastrointestinal, and particularly colorectal tumor. This tumor marker is not a specific antigen for colorectal carcinoma and its concentration may be elevated in other forms of carcinomas, such as breast, ovary liver and pancreas, but still its elevated serum concentration is a valuable index widely used in clinical practice for gastrointestinal carcinogen. The data for this retrospective study obtained from data base of Danesh medical diagnostic laboratory in Gorgan located in northern Iran.The conclusion of the findings of this investigation indicated that 17.39% suspected patients had tumor marker for a particular carcinoma, the CEA elevated level should be considered either for tumor or its recurrence. The findings of this study indicated that even among all controversial arguments about CEA as a specific and alarming tool to both the patients and clinician, which is the least contribution CEA level can offer in cancer patient management.

The Role Of Serum Electrolytes In Pregnancy Induced hypertension

INDUMATI V+, KODLIWADMATH M V*, SHEELA M K**

Background and Objectives:Pregnancy Induced Hypertension (PIH) is one of the most common complications of pregnancy and it contributes significantly to the maternal mortality, premature birth, intra uterine growth retardation (IUGR) and perinatal mortality. The study of electrolytes is gaining ground in the pathophysiology of hypertension. Multiple strategies have been proposed and evaluated for the prevention and management of PIH, which include the moderate dietary restriction of sodium and the administration of magnesium and calcium. Methods: Our study consisted of 50 normal non-pregnant women, 50 normal primigravida in the second or third trimester of pregnancy and 50 pregnant women with PIH. The present study was undertaken to evaluate the serum ionized calcium, magnesium, sodium and potassium levels in PIH and to find out if the deficiency of these electrolytes was a predisposing factor in the genesis of PIH. Results: There was a linear fall in serum ionized calcium, magnesium and sodium levels in the normal pregnancy cases as compared to those in the non-pregnant controls (P< 0.001), with a further significant fall in the PIH cases as compared to the normal pregnancy cases (P< 0.0001). There was no significant change in the potassium levels in the PIH cases as compared to those in the normal pregnancy cases (P<0.457). A decreased calcium intake leads to an increase in the parathyroid hormone, which increases intracellular calcium, thus leading to an increase in the vascular smooth muscle contraction and thus, an elevation in the blood pressure. Low levels of magnesium and sodium cause hypocalcaemia, which in turn increases the blood pressure. Thus, along with a moderate dietary restriction of sodium, a dietary supplementation of calcium and magnesium in the form of milk, cheese, soybean products, leafy vegetables, etc. during pregnancy, could result in a reduction in the incidence of PIH

Sensory Changes In The Upper Limb In Type 2 Diabetic Patients - A Case Control Study

SMITA SARKAR*, CHARU EAPEN**, PRABHA ADHIKARI***

THE USE OF A TWO POINT DISCRIMINATION TEST IN THE DIAGNOSIS OF UPPER LIMB NEUROPATHY IN TYPE 2 DIABETES Sensory changes are associated with diabetic neuropathy and the assessment of sensation is commonly done in the foot to prevent ulcers. Though sensory changes may be present in the upper limb also, its documentation is not done routinely. Aims: To find out the two point discrimination values and other sensory changes in the upper limb in type 2 diabetic patients. Settings and design: This was a cross sectional design using a case control study, which was done in a hospital with both inpatients and outpatients. Methods and material: 75 subjects with type 2 diabetes were included in the case group; patients with a diagnosed case of neuropathy were excluded. These were compared with age and sex matched subjects in the control group with no diabetes. Vibration sensation, pressure threshold and two point discrimination were assessed on the hands in both the groups. The Duruoz’s Hand Index was used to assess the general functional status with regards to the abilities of daily living in both the groups. Statistical analysis: The data was analysed by using the SPSS package, version 13, with p values <.05 being taken as significant. Results: In the diabetic group, approximately 11 % of the patients had the loss of protective sensation; the median value of the vibration sensation was 11 -14 volts as compared to 3-4 volts in the control group and the mean value of the two point discrimination was 4-5mm.The results were significantly different between the diabetic and the control groups. The median value of DHI was eight in the diabetic group. Conclusions: All the sensations which were checked were altered in the diabetic patients, thus indicating the possible underlying neuropathy changes. The two point discrimination test can be used to detect upper limb neuropathy in patients with type 2 diabetes, which can further be validated with nerve conduction velocity tests. A sensory evaluation should be done in the upper limb, especially with patients who had diabetes for more than five years, for the possible presence of neuropathy.

A Drug Utilization Study In The Ophthalmology Department Of a Medical College, Karnataka, India

YASMEEN MANIYAR*, PRABHU BHIXAVATIMATH*, VIDYASHREE AKKONE**

Aim: There is concern regarding the irrational production, prescription and the use of drugs in India. The present study was conducted to evaluate the pattern of prescription and the use of drugs in the outpatients Ophthalmology Department at S. Nijalingappa Medical College and HSK Hospital and Research Center, Bagalkot. Methods: The prescriptions of 660 out patients were audited through a specially designed form, in which 1322 prescriptions were analyzed for the following: average number of drugs per prescription, the duration of treatment, the dosage form, the frequency of administration, the number of encounters with antibiotics and the percentage of drugs prescribed by their generic names. Results: Prescription analysis showed that the average number of drugs per prescription was 2.00%. The maximum number of drugs which were prescribed, were in the form of eye drops (65.81%), followed by ointments (17.63%), capsules (8.02%), tablets (6.59%), syrups (0.76%), injections (0.76%) and lotions (0.31%). The dosage form was indicated for 99.88% of the drugs, the frequency of drug administration for 94% of the drugs and the duration of treatment for only 75% of the drugs prescribed. The number of antibiotics which were prescribed were 399(30.18%), out of which 257(64.3%) were antibiotics which were prescribed in the form of drops, 129(32.26%) were prescribed as ointments and 13 (3.25%) were prescribed orally. The number of encounters with anti inflammatory and anti allergic drugs were138 (10.43%), those with mydriatics and cycloplegics were 96(7.26%), those with miotics were 30 (2.26%) and those with multivitamins were 87 (6.58%). The common prescription writing errors wereminimum and there was no evidence of polypharmacy. However, the duration of treatment and prescribing by the generic names was low.

Magnesium And Calcium Levels In Early Surgical Menopause

Background and objectives: Many endocrinal and metabolic changes were observed in our patients after hysterectomy (surgical menopause), leading to osteoporosis and many other systemic complications and hence, the levels of magnesium, calcium and phosphorus were measured. Materials and Methods: 34 early hysterectomy patients with 32 late hysterectomy patients and 28 normal healthy controls were included in the study. All parameters in blood were measured by using a Hitachi 917 chemistry auto analyzer (disc model). The statistical analyses were done by ANOVA. Results: The levels of magnesium and calcium were significantly decreased (p<0.001) and the level of phosphorus was significantly increased (p<0.001) in both early and late hysterectomy patients as compared to the controls. Conclusion: After hysterectomy, the levels of magnesium, calcium and phosphorus were found to be dysregulated, which might be due to a hormonal imbalance.

Paraoxonase Activity In Type 2 Diabetes Mellitus Patients With And Without Complications

Introduction: Type 2 diabetes mellitus (DM) is a disease of metabolic dysregulation. The current study was undertaken to understand the relationship between the fasting lipid profile and the paraoxonase 1 (PON1) activity in type 2 diabetic patients, with and without complications. Materials and methods: The study group consisted of a total of 155 subjects, which included non-diabetic healthy control subjects (n = 50) and diabetic patients with complications (group I, n = 66) and without complications (group II, n=39). PON1 activity was measured in all the subjects, based on spectrophotometric methods and the fasting lipid profile and the fasting plasma glucose (FPG) levels were determined by using a clinical chemistry analyzer, Hitachi 912. Results: FPG (p<0.001) and triacylglycerides (TAG) (p<0.001) were significantly increased and high-density lipoprotein-cholesterol (HDL-C) (p<0.001) and PON1 (p<0.001) were significantly decreased in group I patients as compared to the normal controls. In group II patients, FPG (p<0.001), TAG (p<0.001) and total cholesterol (TC) (p<0.05) were significantly increased and HDL-C (p<0.05) was significantly decreased as compared to the normal controls. By using Pearson’s correlation, HDL-C was found to be positively correlated with PON1 in group I patients (r=0.317, p<0.01). Conclusion: Type 2 DM patients with complications have significantly decreased HDL-C levels and PON1 activity, possibly indicating their decreased biochemical roles in these patients.

The Prevalence Of Inducible Clindamycin Resistance Among Gram Positive Cocci From Various Clinical Specimens

MOHANASOUNDARAM K M*

Clindamycin is an excellent drug which can be used for the treatment of skin and soft tissue infections which are caused by Gram positive cocci and it also serves as an alternative for penicillin in penicillin allergic patients. Clindamycin resistance may be inducible or constitutive. Inducible resistance cannot be detected by the routine antimicrobial susceptibility tests or by the disc diffusion method. This study was undertaken to study the prevalence of inducible resistance in Gram positive cocci by the D test as per the CLSI guidelines. 73(42%) out of the 168 consecutive isolates of MRSA, MSSA, CONS, S.pneumoniae and S.pyogenes were erythromycin resistant. 27(16%) isolates showed inducible clindamycin resistance and a higher percentage was noted in MRSA (28%) as compared to MSSA (12%) and CONS (14%). This study indicates the importance of the D test in detecting inducible clindamycin resistance in Gram positive cocci and to use it as an aid in the optimal treatment of the patients.

Anatomical Variations In Termination Of Common Facial Vein

BERTHA A, SUGANTHY RABI.

Introduction: Variations in the venous drainage pattern of the face and neck are quite common. The objective of this study was to observe the variations in the formation and the drainage of the common facial vein. Methods: The variations of the superficial veins of the neck were noted in thirty five specimens (17 belonging to the left side and 18 to the right) of the South Indian population which were used for routine dissection, for teaching the medical graduates in Christian Medical College, Vellore. Results: This is a a report on the unusual drainage of the common facial veins into the subclavian and the absent external jugular veins bilaterally. Another interesting variant is the undivided retromandibular vein continuing as the external jugular vein and the anterior facial vein opening into the internal jugular vein. In three cases, the common facial veins were found to open into the external jugular vein at varying distances from the base of the mandible. The embryological basis for the variations is discussed here. Conclusion: The knowledge of the varying venous patterns in the neck is important for clinical practitioners who perform procedures like cannulation and venegraft harvesting in endarterectomy.

A Study Evaluating The Efficacy Of A Home Based Intact Polymeric Formula In The Nutritional Management Of Critically Ill Patients

DEEPA AGARWAL*, HEMAMALINI A J*, GOPALAN T R*

Background and Objective: Malnutrition is prevalent to a high degree among hospitalized patients throughout the world. As many as 40% of the adult patients are seriously malnourished at their hospital admission, and two thirds of all patients experience deterioration of their nutritional status during their hospital stay. India, with its nearly 1 billion inhabitants, has an estimated 350-400 million people below the poverty line, 75 per cent of them in the rural areas. Meeting the nutritional requirements of all those under such conditions is a daunting task. Sri Ramachandra University Hospital caters to the needs of people from different socio economic backgrounds and there has been a constant approach in meeting the nutritional requirements of all, irrespective of their socio economic status. A home based intact polymeric formula is being used for more than a decade to meet the nutritional requirement of the patients at the free Inpatient block of the hospital, where patients from poor economical backgrounds are admitted and treated. There has been no documented complaint of any gastrointestinal complication due to the intact polymeric formula, contrary to the published reports by various authors in their research carried out in different hospital settings. Hence, this present study was undertaken to prove the efficacy of this home based intact polymeric formula in the nutritional management and recovery of critically ill patients, while maintaining the safety standards. Design: A prospective study design was adopted to carry out the study. A total of 30 subjects were studied between the study period from January’09 to March’09. There were 15 subjects each in the two study groups (Patients who were administered the home based Intact polymeric formula and the standard Commercial formula). These patients were followed up for various outcome variables such as nutrient intake, length of stay in the ICU, gastrointestinal complications, duration of mechanical ventilation and feed costs. Results: Despite receiving different types of formulas, the nutrient intake, length of stay in the ICU and the duration of mechanical ventilation were not significantly different in the two study groups. There was a significant (p<0.05) difference in the feed costs which were incurred to the patients who were fed with both the formulas. Conclusion: It is inferred from this study, that the home based intact polymeric formula is comparable to the standard commercial formulas, if the formula is planned with nutritionally adequate components, reconstituted adequately and implemented as per the protocols, in improving the expected clinical outcome in the critically ill patients.

Role Of Vitreous Potassium Level In Estimating Postmortem Interval And The Factors Affecting It

Rajinderjit Singh Ahi*, Vishal Garg**

Aim: The present study was conducted to assess the level of potassium in the vitreous fluid, to calculate the post mortem interval from it and to study the effects of environmental factors like temperature and humidity on it. Material and Methods: 176 cases were included in the study. The vitreous fluid was taken from the left eye just before the commencement of autopsy and was assessed for potassium level. The potassium level was determined by flame photometry method. The post mortem interval (PMI) was then calculated by applying the Sturner equation. Result: Level of potassium in vitreous was found to be increased significantly with increase in PMI. It was found that the vitreous humour potassium concentration was increasing in a linear fashion with increasing time since death (TSD) and this increase in the level was independent of the factors like environmental temperature and humidity. Conclusion: Potassium level in the vitreous fluid increases significantly with increase in PMI and the environmental factors like temperature and humidity has no significant effect on the potassium levels in vitreous fluid.

Seroprevalence Of Brucellosis In Davangere, Karnataka.

Context: Brucellosis is chronic, contagious and zoonotic disease. It is usually difficult to diagnose clinically in the absence of specific clinical features. Hence serological testing forms the mainstay of diagnosing the disease. Aim: The present study was done to know the seroprevalence of brucellosis in Davangere (Karnataka) and to compare Rose Bengal plate test with Standard tube agglutination test. Materials and Methods: Three hundred eighty Blood samples received at Microbiology Department for various serological tests and 45 Blood samples collected from veterinary staff were used for study. Serum was separated from samples and Rose Bengal plate test (RBPT) and Standard tube agglutination test (STAT) were done. Results:The overall seroprevalence of brucellosis in the study was 3.3%, it was 2.4% in general population and 11.1% in veterinary staff. Prevalence was more among males than in females . 20-40 years age group was more affected (3.6%). Shepherds had the highest prevalence rate (5.9%), followed by farmers (5.2%). Sera received for Widal test and Brucella agglutination test, showed a prevalence of 1.6% and 6.0% respectively. When compared with STAT, RBPT showed sensitivity of 100% and specificity of 99%. Conclusion: Prevalence of brucellosis in Davangere was found to be significant. It was fairly common among the veterinary personnel in this area. Shepherds and farmers were found to be largely affected. RBPT is highly reliable and has a close relation with STAT in the diagnosis of human brucellosis.

Calcaneal Ewing’s Sarcoma with Skip Metastases to the adjacent Tarsal Bones

Ewing’s sarcoma (ES) is a malignant non-osteogenic primary tumour of the bone, which is mainly seen in the diaphysis of the long bones and in the flat bones of the pelvic girdles in young patients. In 30% of the cases, Ewing’s sarcoma is multicentric in origin and in 14-50% of the cases, multiple metastases are present at the time of diagnosis. Ewing’s Sarcoma of the calcaneum has been infrequently reported in literature.Skip metastases to the adjacent tarsal bones have been reported even more rarely. We wish to report a case of primary Ewing’s sarcoma of the calcaneum with skip metastases to the adjacent tarsal bones, which was diagnosed by clinicoradiological examination and confirmed by histopathology.

The Atypical Presentation Of Multicystic Dysplastic Kidney InNigerian Adults: Two Case Reports

INTRODUCTION: Multicystic dysplastic kidney, an uncommon congenital cystic renal disease, is often diagnosed by prenatal ultrasound in the third trimester of pregnancy or in infancy when it commonly presents as an abdominal mass. The typical presentation in childhood is hypertension and/or abdominal mass. However, to the best of our knowledge, the presentation as an abdominal mass in adulthood has not been previously reported, since the renal mass characteristically regresses and is not detectable by age five. Also, the only two cases of this rare condition which were seen in our centre in the past five years, were not found in foetuses or infants, but were rather found in adults and they presented with abdominal masses rather than the common adulthood presentation of abdominal pain and/or hypertension. The imaging features were also not characteristic of multicystic dysplastic kidney. CASE PRESENTATION: Both patients were Nigerian females of the Yoruba tribe, from the Southwestern part of Nigeria, with ages fifty-five and twenty-four and they presented with abdominal masses. Also, the imaging features were not characteristic of multicystic dysplastic kidney; though they had cystic renal masses, the cysts were communicating.The diagnosis was eventually made on the basis of histology after nephrectomy. CONCLUSION: Multicystic dysplastic kidney should be considered as one of the differential diagnoses of renal /abdominal masses in adults. Also, all communicating centrally located renal cysts are not dilated calyces.These facts should be noted by urologists and radiologists.

Oral Mucosal Melanoma With Extensive Nodal And Visceral Metastasis: A Case Report

AMIR ALI*, RAJESH PATIL*, RESHMA SALELKAR***, SUHAIL AHAMED SHARIFF****

Mucosal Malignant melanoma of the oral cavity is an extremely rare condition, constituting approximately 1-2% of all the melanomas. It has a poor prognosis. Clinicians should have high index of suspicion for any pigmented lesion in the oral cavity, which should be routinely biopsied, in order to detect this disease early, so that it can be managed appropriately. Here is an unusual case of a lady presenting with a nodule in the breast with cervical lymphadenopathy, who on detailed examination, was found to have an asymptomatic pigmented lesion on the hard palate, the biopsy of which confirmed melanoma, but on further investigation, it was found to have extensive metastasis.

The Knowledge And Perception About Lymphatic Filariasis In One Of The Endemic Talukas Of Rural North Karnataka

Research Question: 1) To study the knowledge and perception about lymphatic filariasis (LF) in one of the endemic talukas of rural north Karnataka Objectives: 1. To evaluate the knowledge and perception about lymphatic filariasis in one of the endemic talukas of rural north Karnataka. 2. To find out the source of information of the MDA activity of the respondents. Study Design: A cross sectional study. Study Area: The Bilagi taluka of Bagalkot district which comprises 65 villages. Study Period: The study was conducted for 6 months i.e. from March 2009 to September 2009. Study Participants: People from the villages of the Bilagi taluka. Methods: The data was collected by using pre- tested and pre- designed proforma. Results: Most of the study population (68.99%) was not aware about the mode of spread of lymphatic filariasis (LF). Only 31.01% knew that LF spread by mosquito bites. A majority of the study population (63.67%) said that mosquitos breed in dirty water and only 6.64 % said that mosquitos breed in clean water. 64.86% of the study population had knowledge about the manifestations of lymphatic filariasis, while 35.14% did not have any knowledge about the manifestations of the disease. 70.83% were aware about the treatment for filariasis, while the rest of them (29.17%) were not aware about it. The most common sources of information about the MDA activity were government workers like ANMs (40.24%) and Anganwadi workers (30.19%). Teachers were the source of information for only 23.16% of the population. The role of media as a source of information on MDA activity was minimal (0.27%).

Recurrent Fibromatosis

SRIKANTAIAH H C*

Fibromatoses are a group of rare fibrous tissue proliferations of benign nature. They are characterized by an infiltrative growth with a tendency towards recurrence; however, they never metastasize.However, they do display local aggressiveness, with complete resection being the treatment of choice.

Akathisia And Dyskinesia On Starting Methylphenidate In A Patient On Risperidone

DEVARAMANE V1, BHANDARY PV2, VEENA N3, BHARTI C4, VASUDEV S5

Methylphenidate is a stimulant drug which is used for the treatment of attention deficit hyperactivity disorder. Here, we report a case of akathisia and dyskinesia on starting methylphenidate in patient who was on risperidone. The symptoms disappeared on stopping methylphenidate, despite continuing risperidone and reappeared on starting methylphenidate again. Hence, physicians should be aware of the possible effect of dyskinesia when using a neuroleptic and a methylphenidate together in a patient.

A Single Stage Procedure For Congenital Pouch Colon And Its Complications: A Case Report

RAJENDRA K GHRITLAHAREY* AND JYOTI SRIVASTAVA**

This is a report of a case of congenital pouch colon (CPC) type II, who was managed by a single stage procedure (exploratory laparotomy, ligation of the colo-vesical fistula, excision of the pouch and abdomino-perineal pull-through of the colon) which was done on the 2nd day of life. He developed severe stricture of the pulled colon and needed three further major operations (exploration and ileostomy, pull-through of the ileum and ileostomy closure). At present, he is 4 years old, is continent, is passing 3-4 stools per day and is doing well.

Plasmapheresis As An Adjuvant Treatment Modality In Toxic Epidermal Necrolysis: A Case Report

RAMANATH MAHALE*, CHETAN G*, HIREMATH SAGAR*, RAJIV AGGARWAL*

Toxic Epidermal Necrolysis (TEN) is an idiosyncratic reaction to some drugs, which is rarely seen in the paediatric population. Although plasmapheresis has been used in the management of such cases, as seen in various case reports, no standard guidelines have been established till date. We report here, an 8yr old boy who presented to us with severe TEN, who was successfully treated with plasmapheresis as a primary modality of treatment.

Pulmonary And Extrapulmonary Tuberculosis Along With Pulmonary Nocardiosis In A Patient With Human Immunodeficiency Virus Infection

ANIL KUMAR*, ASMITA MEHTA**, GHANSHYAM KAVATHIA***, MOLLY MADAN****

A 53 year old male presented with respiratory symptoms, low grade intermittent fever, anorexia, diarrhoea and weight loss of 5 months duration. Chest X-ray showed bilateral upper and mid-zone non-homogenous opacity and right lower zone homogenous opacity with hilar enlargement, while USG abdomen revealed a peripancreatic mass. The serology of HIV-1 was positive by enzyme linked immunosorbent assay (ELISA) and western blot. The patient was diagnosed with pulmonary and extrapulmonary tuberculosis along with concomitant pulmonary nocardiosis.

Biofilms: A Challenge To Medical Science

SEEMA BOSE* AND ATINDRA KRISHNA GHOSH**

Biofilms are a group of microbes which are encased in an exopolysaccharide matrix on both biotic and abiotic surfaces. Various changes occur during their transition from a planktonic to a surface attached community. This causes a number of persistent infections which respond poorly to conventional antibiotic therapy. This review summarizes the nature, prevalence, detection and the treatment of biofilm associated infections.

Immune Mediated Containment And The Consequences Of The Human Immunodeficiency Virus Infection

GAYATHREE NAIK* , SRINIVAS R DESHPANDE**

The Human immunodeficiency virus infection is essentially an infection of the immune system, with progressive and profound defects in the cell mediated immune response. The pathogenesis of the Human immunodeficiency virus infection is a multi-factorial process, consisting of aberrant cellular activation and the disregulation of nearly every aspect of the immune system. The lentivirus subverts the immune system by infecting the CD4+Tcells that normally orchestrate immune responses and by activating the immune system and inducing a cytokine milieu that the virus uses to its own replication advantage. The disease outcome depends on the innate immune response, the adaptive immune response, the host genetic factors and the differences in viral pathogenicity.

Subacute Hepatic Failure

KORA S A*, DODDAMANI G B**, DODDAMANI USHA***, BIRADAR SATISH****

Subacute hepatic failure (SAHF) had been recognized and reported from India in 1982, but until now, there has been no precise definition of the disease or the description of its nomenclature, clinical and pathological factors, aetiology, diagnosis and its management. So, we have analyzed all the material which was available for over 30 years and have summarized a few points. a) Poor regeneration of hepatocytes is the main pathogenesis of this disease. b) Viral hepatitis, including hepatitis ‘E’, is the main aetiology of SAHF. c) Ascites is the cardinal feature of this disease and it occurs in the 4th or 5th decade. d) Liver biopsy shows submassive or bridging necrosis and plasma fibronectin levels are low. e) The mortality is upto 70% when treated medically and the best available treatment is liver transplantation. f) Renal failure indicates a bad prognosis. It can be concluded that it requires further case studies and research to define the disease and to describe its nomenclature, aetiology, pathogenesis, clinical features, prognostic factors, investigation and management in the coming years.

Juvenile Periodontitis- A Case Report

SUJATA M BYAHATTI*

An abnormal, extremely invasive condition characterized by severe localized pocketing and bone loss in the dental alveoli of children and adolescents, generally associated with poor oral hygiene and inadequate nutrition.Aggressive periodontitis is a group of infrequent types of periodontal diseases with rapid attachment loss and bone destruction, which are initiated at a young age. Aggressive periodontitis has received considerable attention due to its peculiar clinical presentation, occurring around puberty, with an apparent lack of local factors such as heavy amounts of plaque and calculus, in patients with reasonably good oral hygiene. Here, we present a case of a 21 years old female patient who complained of malaligned teeth and wanted the correction of these malaligned teeth.

Peri-Implantitis: A Risk Factor In Implant Failure

HEMANT KUMAR GUPTA*, AMIT GARG**, NAVJOT KAUR BEDI***

Peri-implantitis is a site specific infectious disease that causes an inflammatory process in soft tissues, and bone loss around an osseointegrated implant in function. Implant failure has classically been attributed to bacterial infections, occlusal overload, surgical trauma, faulty or incorrect prosthetic design and/or improper surgical placement. The management of implant infection should be focused both on the infection control of the lesion, the detoxification of the implant surface and regeneration procedures. The treatment option can be surgical or non-surgical. It was observed that the non surgical treatment of peri-implantitis was unpredictable, while the use of chemical agents such as chlorhexidine had only limited clinical effects. Adjunctive local or systemic antibiotics were shown to reduce bleeding on probing and probing depths and some beneficial effects of laser therapy on peri-implantitis have been shown. Regenerative therapies can also be applied in conjunction with the anti-infective procedures. The purpose of this paper is to review the literature with regards to peri-implantitis as a risk factor in implant failure and also to identify the protocols which may assist in its diagnosis and management.

The Role Of CT Scan In The Posterior Maxilla: A Boon For Dental Implant Planning

ANUJ CHHABRA*, NIDHI**, ANIL SHARMA***

Recent developments in computed tomography (CT scan) have changed diagnostic and radiological assessments, not only in general medicine, but also in implant dentistry. The aim is not only to improve the precision and the predictability of implant placement, but also to change an invasive surgical protocol for sinus grafting and subsequent implant placement in the posterior maxillary region. In compromised situations of rear maxilla with some bone available, the best position of the implant placement is evaluated, and the need for additional surgical interventions such as sinus lift and grafting procedures can be exactly determined. This improves the predictability of the treatment goals, allows for better risk management, and provides more individual information for the patient.

Prevalence Of Dental Caries, Socio-Economic Status And Treatment Needs Among 5 To 15 Year Old School Going Children Of Chidambaram

JOYSON MOSES*, B N RANGEETH**, DEEPA GURUNATHAN***

Introduction: Dental caries is a disease with multifactorial causes. The prevalence and incidence of dental caries in a population is influenced by a number of risk factor such as sex, age, socioeconomic status, dietary patterns and oral hygiene habits. Thus the present study was designed to assess the prevalence of dental caries in school children in Chidambaram between 5-15 age groups. Materials and methods: The study population consisted of 2362 children, 1258 were boys and 1104 were girls. A total of 7 schools were selected. Trained Dental Surgeon was involved in the examining and the children were examined according to the Dentition status and Treatment Needs, WHO oral health assessment 1987. Results: Off all the three groups, group II (9-11yrs old) had high percentage of caries. In total, dental caries were observed in 1484(63.83%) of study population. The mean (±SD) value of dmft/DMFT of all groups, the decayed teeth accounted for the greatest percentage. In all 80.4%of the student belong to low socio-economic group and showed dental caries .Restoration was the most required treatment in all three groups which was follow by pulp therapy. Conclusion: The result of this study is a pointer to the fact that there still exist a large segment of the population who continue to remain ignorant about the detriment effects of poor oral health and the multiple benefits enjoyed from good oral health.

A Hollow Bulb Obturator For Maxillary Resection In A Completely Edentulous Patient- A Case Report

RAJANI DABLE*

Palatal defect of any extent causes multiple problems in speech, mastication and esthetics. Palatal obturator is the only substitute which covers the defect and contributes to normal speech production. It eliminates hypernasality and improves the communication. An obturator prosthesis for an edentulous patient becomes more critical in terms of its movements as there is no mechanical retention available. Denture is supported only by the underlying residual ridge and the defect.In the present case, surgical removal of part of the palate made the labial and buccal mucosa more stretched and fibrous, thus limited the potential to use features which otherwise help in retention and stability of denture such as the depth of sulci, muscle function or neuromuscular control. Hollow bulb obturator was the treatment of choice here, which helped in reducing the extra loads on underlying tissues and remaining amount of bone.

Odontoma Associated With Non- Syndrome Multiple Supplemental Supernumerary Teeth

MEETKAMAL* AND PARWINDER KAUR**

Odontomes are considered as developmental anomalies resulting from the growth of completely differentiated epithelial and mesenchymal cells that give rise to ameloblasts and odontoblasts. These tumours are formed of enamel and dentin, but they can also have a variable amount of cementum and pulp tissue. Odontomes are defined as tumours of odontogenic origin. They are considered to be hamartomatous malformations rather than true neoplasms and are generally asymptomatic. Here, we report a case of a 20 year old female patient who visited a private dental clinic with a chief complaint of pain in the lower left back tooth region since 15 days. Familial, medical, and dental history or extra oral findings did not reveal any abnormality. Intra oral examination revealed pericoronitis in relation to 38. The patient was sent for OPG, which revealed a classic picture of impacted 38, along with numerous small radio-opaque masses surrounded by radiolucent border. A provisional diagnosis of odontome was made. The odontome were surgically removed and sent for histopathological examination, which revealed features which were suggestive of odontoma of the compound composite type.

Acellular Dermal Graft Material For The Treatment Of Gingival Recession

SUNITHA J* AND SHOBHA PRAKASH**

The treatment of gingival recession has been a common practice in periodontics for years. As the aesthetic demands of periodontal patients increase, more root coverage procedures will be performed to satisfy their aesthetic demands. Often, the patients present with multiple areas which require treatment. Palatal anatomy may limit the amount of autogenous tissue that can be harvested, thus limiting the number of procedures that can be performed. A patient may not desire to have additional tissue transplanted from the palate, due to increased pain and morbidity which are associated with multiple transplant procedures.

Developing CL-II Div 1 Malocclusion- Should We Wait Or Intercept?

ANIL SHARMA*

In our day to day practice, we come across many cases in which a class-II div-I malocclusion is developing due to the mesial drifting of the maxillary permanent 1st molars. This mesial drift could be the result of the loss of tooth material due to caries (1), the premature exfoliation/ extraction of the deciduous molars (2) or the ectopic eruption of the maxillary permanent 1st molars (3). A common advise at this juncture by a general practitioner, is to wait till the eruption of the full compliment of the teeth before initiating orthodontic treatment, thereby increasing the chances of premolar extractions for the correction of a full blown class-II div-I malocclusion. Presented in this article are cases in which a developing Class-II div1 malocclusion was successfully intercepted and corrected in the mixed dentition period.

Hepascore – A New Liver Function Test

SANGEETA KAPOOR*

Restricting The Use Of The FDC Of Ampicillin/Amoxicillin And Cloxacillin In A Nepalese Teaching Hospital

SHANKAR P R*, PIRYANI R M*, THAPA H S*, JHA N*