Introduction: The incidence of Acute respiratory infections (ARI) is high among under-five children, especially in developing countries. However, the data on ARI from rural and urban areas in India are scarce. Objective: To estimate the prevalence of ARI and selected associated factors among under-five children. Materials and Methods: A community-based cross-sectional study was conducted in urban and rural areas of Puducherry, India. Data were collected from 509 parents of under-five children regarding ARI incidence along with socio-demographic and selected associated factors. Results: Overall prevalence of ARI was observed to be 59.1%, with prevalence in urban and rural areas being 63.7% and 53.7%, respectively. Bivariate analysis indicated that overcrowding, place of residence, and mother's education were significantly associated with ARI. Multiple logistic regression analysis suggested that presence of overcrowding (adjusted odds ratio [AOR] = 1.492), urban residence (AOR = 2.329), and second birth order (AOR = 0.371) were significant predictors of ARI. Conclusion: The prevalence of ARI is high, particularly in urban areas. Improvement of living conditions may help in reduction of burden of ARI in the community.

Background: Persons with disabilities comprise at least 4 to 8 percent of the Indian population. Children with disabilities in India are subject to multiple deprivations and limited opportunities in several dimensions of their lives. Their families and caregivers also go through lot of stress and challenges in having a person with disability at home which ultimately leads to grave discriminatory practices towards these children. Materials and Methods: The article attempts to analyze and describe the common discriminatory grounds that children with disabilities commonly face from their immediate families and from the larger community through analyzing the filed visit reports of the Basic Needs India Staff providing on job training (handholding support) for the community based rehabilitation workers. Results: The case studies describes the various ugly forms of the discriminatory practices seen in the community towards differently abled children, same been categorized as denial of disability, physical restraints, social boycott, denial of property rights, decreased marital life prospects due to disabled member in family, implications on sexuality of people with disability, women with disability, discrepancies in state welfare programs, and problems in measuring disabilities. Conclusion: During the last two decades, there has been a growing realization that institutional care for the disabled is not entirely suitable for their individual needs, dignity and independence. A movement towards community based rehabilitation has picked up pace and contribute toward greater independence and self sustainability of the disabled.

Childhood obesity is a burden in developed and developing countries. Overweight and obesity are caused by numerous social and environmental factors that influence people's food habit and physical activity. Role of primary or secondary prevention is the mainstay plan for controlling this epidemic. Various adaptable best practice models are available in the developed nations. However, further research needs to be done to examine the most effective strategies of intervention, prevention, and treatment of obesity in our setting. Through this paper, we would like to highlight best practices and potential interventions to reduce the burden of obesity in India.

Malnutrition among under-five children is an important concern for the health authorities in India. The aim of the present review was to assess the burden of under-nutrition and over-nutrition, its determinants and strategies required to tackle malnutrition among under-five children in India. Recent data were collected from Google search, Medline, and others. The information retrieved was reviewed and analyzed for discrepancies. Existing evidence shows that the prevalence of under-nutrition among under-five children was high and varied widely (under-weight: 39-75%, stunting: 15.4-74%, wasting: 10.6-42.3%) depending on the assessment methodology adopted. Studies on assessment of over-nutrition status among under-five children were limited. Distribution of various types of risk factors and its influence on nutrition status of children in a given set up should be analyzed for planning the control measures. Strengthening public health interventions for mild malnutrition cases and vulnerable groups, effective implementation and evaluation of the strategies at regional level, research on overweight, obesity and its etiological factors and steps for improving socioeconomic development are the prerequisites for tackling malnutrition among under-five children in India.

Diarrhea is the third leading cause of childhood mortality in India, and is responsible for 13% of all deaths/year in children under 5 years of age. Information on diarrheal diseases, its determinants and preventive and control strategies need to be reviewed for better planning and organization of health services. This study reviewed literature on diarrheal disease control among under-five children in India from literature published in PubMed, Google search engine and other databases on the internet. Data were described in terms of disease burden in India, determinants, management and intervention strategies, preventive strategies, and role of public health and scope for future action. This review calls for a comprehensive diarrheal disease control strategy, through improved case management, addressing social determinants of health and research in the field of cost-effective interventions to reduce the burden of diarrhea among children in India. With < almost one year left to reach the 2015 Millennium Development Goal on reducing child mortality, progress on control of diarrheal diseases must be accelerated.

Teeth are the most natural, noninvasive source of stem cells. Dental stem cells, which are easy, convenient, and affordable to collect, hold promise for a range of very potential therapeutic applications. We have reviewed the ever-growing literature on dental stem cells archived in Medline using the following key words: Regenerative dentistry, dental stem cells, dental stem cells banking, and stem cells from human exfoliated deciduous teeth. Relevant articles covering topics related to dental stem cells were shortlisted and the facts are compiled. The objective of this review article is to discuss the history of stem cells, different stem cells relevant for dentistry, their isolation approaches, collection, and preservation of dental stem cells along with the current status of dental and medical applications.

Mast cells (MCs) are resident cells of several types of tissues and contain many granules rich in histamine and heparin. They are distributed preferentially about the micro-vascular endothelial cells in the oral mucosa. These cells play a key role in the inflammatory process and thus their number has been found to be altered in various oral pathological conditions such as oral pyogenic granuloma, oral lichen planus, leukoplakia, oral squamous cell carcinoma, periapical cysts etc. The present review article is aimed to describe the alteration in the number of MCs along with their probable roles in these pathological conditions.

Since its introduction in 1984, laparoscopic ovarian drilling has evolved into a safe and effective surgical treatment for anovulatory, infertile women with polycystic ovary syndrome (PCOS), unresponsive to clomiphene citrate. It is as effective as gonadotropins in terms of pregnancy and live birth rates, but without the risks of ovarian hyperstimulation syndrome and multiple pregnancies. It improves ovarian responsiveness to successive ovulation induction agents. Its favorable reproductive and endocrinal effects are sustained long. Despite its advantages, its use in unselected cases of PCOS or for non-fertility indications is not prudent owing to the potential risks of iatrogenic adhesions and ovarian insufficiency.

Background: Platelet rich plasma (PRP) is a blood derivative concentrate of platelets, fibrin and growth factors obtained through withdrawal and centrifugation of autologous blood and use for its inherent hemostatic and adhesive properties to promote wound healing. Hip arthroplasty is often associated with significant perioperative complications including blood loss necessitating blood transfusions, which can lead to multiple adverse reactions, infection transmission, and longer hospital stay. Materials and Methods: We conducted this retrospective comparative study to determine whether the use of PRP can reduce the bleeding complications in hip replacement surgeries and therefore decrease analgesic requirements and shorten the hospital stay. Results: Sixty patients had consecutive hip replacement surgeries. The study group (n=23) received PRP applications while the control group (n=37) were operated without PRP applications. Postoperative drop of hemoglobin, number of red blood cell (RBC) transfusions, analgesic requirements, and duration of hospital stay were recorded. There was no significant difference in the drop of hemoglobin preoperatively and postoperatively comparing study and control groups (P=0.75). There was no difference in transfusion requirements between the two groups (P=0.16) but there was trend toward less transfusion in the PRP-treated group. There were also no statistical differences in analgesic use (P=0.83) and lengths of hospitalization (P=0.68) between the two groups. Conclusion: We concluded that there is no clinical efficacy in using PRP in hip replacement surgeries. We recommend a larger prospective study be conducted to determine its clinical utility as an optimization strategy to improve outcome after hip arthroplasty

Background: We investigated anti-diabetic, hypolipedimic and antioxidant activity of hydroalcoholic extract from leaves and fruit peel of Punica granatum. Materials and Methods: Streptozotocin induced diabetic Wister rats were used in this study consisting of seven groups of six animals each. Groups (1) normal control, (2) diabetic control, (3) leaves extract 100 mg/kg b.w. of P. granatum, (4) leaves extract 200 mg/kg b.w. of P. granatum, (5) fruit peel extract 100 mg/kg b.w. of P. granatum, (6) peel extract 200 mg/kg b.w. of P. granatum and (7) glibenclamide respectively. Fasting blood sugar was recorded on 1 ^st , 7 ^th , 14 ^th , 21 ^st and 28 ^th day. At the end of the experiment Lipid profile and levels of antioxidants were determined. Safety profile of both extracts was evaluated using acute and chronic toxicity studies. Results: Higher dose of fruit peel extract of P. granatum (PEPG) and glibenclamide significantly lowered blood glucose level from 7 ^th day onwards however glibenclamide was found to be more effective. Leaves extract at higher dose and fruit extract at lower dose also significantly lowered blood glucose level from 14 ^th day onwards. Leaves extract at lower dose also significantly lowered blood glucose level from 21 ^st day onwards. Glibenclamide and higher dose of fruit PEPG extract significantly reduced the total cholesterol, triglyceride levels and significantly increased the high density lipoprotein cholesterol level. Glibenclamide followed by higher dose was found more effective in reducing plasma thiobarbituric acid reactive substances and increasing levels of antioxidant enzymes (superoxide dismutase and catalase). No toxicity was observed even when both extracts were administered at 10 times of higher dose used in this study and no significant changes were seen when it were used chronically. Conclusion: Leaves and fruit PEPG possesses significant anti-diabetic, hypolipedimic and antioxidant properties. This study supports the traditional use of P. granatum in diabetes. Fruit peel which is normally thrown by many while eating pomegranate fruit is having anti-diabetic, hypolipedimic and Antioxidant activity. Furthermore high therapeutic index is safe for chronic use.

Background: 'Retreatment' for tuberculosis (TB) has long been a neglected area in global TB control India. However India disproportionately accounts for nearly half of retreatment TB cases notified globally. Sex differences vary in different age groups and in different parts of the world. The present study focuses on whether gender-based differences are present in notification rates, clinical presentation, and treatment outcomes of different subcategories of patients registered under category II of Revised National TB Control Programme (RNTCP) Chandigarh. Materials and Methods: A longitudinal study was designed and the patients registered under RNTCP category II from June 2010 to December 2011. Out of total 607 patients registered during this period under category II of RNTCP in Chandigarh, 545 consented to participate in the study. These were followed-up to September 2012 till the completion of treatment. All 545 recruited cases were stratified into males and females and the results analyzed. The Z test for proportion (for comparing differences in proportions) and Student's t-test (for comparing mean) were performed for statistical analysis. Results: From the cohort of 545 patients, 348 (63.9%) were males and 197 (36.1%) were female patients with overall male to female ratio 1.8:1. The proportion of male patients notified was significantly higher than females (Z = 5.93, P < 0.001). The proportion of extrapulmonary cases was higher in the females (28.4%) as compared with males (17%) (P < 0.001). Males outnumbered females in all the unfavorable outcomes death, default, and failure. The default in males was significant as compared to the females (Z = 5.21, P < 0.001). Conclusions: The findings of this study suggest a sex difference in the notification rate of retreatment cases of TB. Reasons for a better outcome and low notification rate for TB in females are more due to epidemiological factors than a differential access of the health care. Integrated research is required to outline the relative roles played by epidemiology.

Background: Fixation is the essential step in histopathological processing of tissues. Since formalin is a corroborated biohazard, its routine use as a fixative is a major health and safety concern and hence the quest for safer alternatives is envisaged. Natural sweeteners like jaggery and honey have proved to be effective tissue preservatives over 24 h. This pioneer eco-idea needs further research to expand its application. Aim: (1) To evaluate the fixative property of jaggery and honey over 6 months and ascertaining the results using hematoxylin and eosin stain (H and E). (2) To evaluate the compatibility of jaggery and honey fixed tissues for special stains - Periodic acid Schiff (PAS) and Masson-Trichrome (MT). Materials and Methods: Equal bits of commercially available animal mucosae were preserved in 30% jaggery, 20% honey, and 10% buffered formalin (control) over 6 months at intervals. Following which, tissues were subjected to routine H and E, special stains - PAS and MT using standard operating procedures established in our group. Results: Formalin, jaggery, and honey yielded satisfactory results post 6 months for H and E and special stains, jaggery was comparable to formalin in tissue preservation. Conclusion: We propose the use of eco-friendly jaggery and honey as alternatives to formalin for long term tissue preservation.

Background: Liver abscess is a burning problem in tropical nations, with often lethal consequences and diagnostic/therapeutic challenges. We have determined etiopathology, clinical, radiological, and bacteriological characteristics of this condition and review its management strategies. Materials and Methods: During the period of the month from May 2007 to September 2009, a prospective study was performed involving 125 patients admitted to the in-patient ward of the Department of General Surgery of N.R.S Medical College their diagnosis was made on the basis of clinical features (such as right upper abdomen pain, and fever), laboratory investigations and radiological evidence of liver abscess. Results: Amoebic liver abscess was the most common (88%) type of liver abscess among the study groups. There was a strong correlation with the occurrence of liver abscesses and addiction to alcohol, history of diabetes mellitus and low socioeconomic status. The most common etiology of pyogenic liver abscess was Escherichia coli. Ultrasonography (USG) of the abdomen was accurate and cost-effective in diagnosis of liver abscesses. Percutaneous catheter drainage was the most effective method of treatment (with a 100% success rate). Conclusion: Most patients in our study had liver abscess of amoebic origin and had temporal relationship with diabetes, alcoholism, and staggering socioeconomic status. We suggest early recognition of clinical features and prompt abdominal USG as cost-effective means for treatment initiation and reducing complications.

Background: People spend a considerable part of their childhood time in the schools, a phase that coincides with their physical and mental growth. A healthy educational environment is vital to student's health and wellbeing. Materials and Methods: This study is a descriptive study conducted in 100 primary schools (both state and nonprofit schools) from Sari's Districts 1 and 2 in Iran. Sampling was performed by census and data were collected using the standard questionnaire by direct interview. Data were analyzed by Excel and SPSS software (Version 20.0. IBM Corp, Armonk), NY: IBM Corp using independent numerical T2 testing. Results: Significant relationship was observed between the kind of schools (P = 0.045) and their locations (P = 0.024), however the health, safety and environment (HSE) ratings among boys only versus girls only schools were similar (P = 0.159). Interestingly private and nongovernment schools and primary schools from Sari's districts one had consistently higher HSE ratings. Conclusion: The differential and higher HSE ratings in primary schools run by Private organizations and primary schools from Sari's districts one could be due to manager's awareness and implementation of recommended HSE standards, schools neglecting and overlooking these standards had lower HSE ratings. It is necessary that schools with lower HSE ratings are made aware of the guidelines and necessary infrastructures allocated to improve their HSE ratings.

Background: The increasing incidence of Type 2 diabetes mellitus globally has collaterally increased the incidence of diabetes-associated complications such as neuropathy. Oxidative stress induced DNA damage is one of the mechanisms implicated in the pathogenesis of diabetic complications. Here we aimed to evaluate the extent of DNA damage in diabetes patients with and without clinical neuropathy using the Cytokinesis Block Micronucleus Cytome assay, in a group of South Indian population. Materials and Methods: The Cytokinesis Block Micronucleus Cytome assay was performed in lymphocyte cultures of 42 type 2 diabetes patients (22 with neuropathy and 20 without neuropathy) and 42 age and sex matched controls. Nuclear aberrations like Nuclear Buds, Nucleoplasmic Bridges and Micronuclei were analyzed. Results: The frequency of nuclear aberrations in diabetes patients with neuropathy was higher than compared to diabetes patients without neuropathy. The mean frequencies of nuclear aberrations per cell in diabetes patients with neuropathy and without neuropathy were 0.02 ± 0.02 and 0.01 ± 0.01, respectively. This was significantly higher than in the controls (0.002 ± 0.002) (P < 0.0001). An increasing trend of nuclear aberrations in correlation with the duration of diabetes was observed. Conclusion: This study highlights the use of the Cytokinesis Block Micronucleus Cytome assay as a potent tool for the identification of DNA damage, which may prove to be useful biomarker to assess the severity diabetes-associated complications such as neuropathy. Implementation of this technique at the clinical level would potentially enhance the quality of management of patients with diabetes and its complications like neuropathy.

Objective: Thickened fatty filum terminale (FFT) can cause tethered cord syndrome (TCS) and can be easily diagnosed on magnetic resonance (MR) imaging. We aimed to assess a) the incidence, distribution and clinical significance of the incidentally detected FFT in Kuwaiti population and b) the relationship between degenerative disk disease (DDD) and thickness of the FFT. Materials and Methods: A retrospective study was planned at Jaber Al Ahmad Armed Forces Hospital, Kuwait involving 1111 patients. A 1.5T GE machine was used for MR imaging to acquire multiplanar MR sequences. MR images of lumbar spine in 1111 subjects were reviewed and location, size, tightness of FFT, the DDD and clinical details were evaluated. Results: FFT was observed in 43 out of 1111 (3.9%) subjects based on MRI, out of which 11 were females and 32 were males. The mean distance between the tip of conus medullaris and the FFT was 41 mm. The mean diameter of the FFT was 1.74 mm. 40 of 43 patients had DDD of varying severity on MR images and no significant or appreciable slackness of FFT was observed in these cases. There were no clinical symptoms related to FFT associated with degenerated disks. Conclusion: FFT is frequently observed in Kuwaiti male population. No significant slackness of FFT was observed in cases with varying severity of DDD. There were no clinical symptoms related to FFT with or without degenerated disks.

Background: We hypothesised that nonobese postmenopausal women (NoPoW) and diabetic NoPoW (DNoPoW) may be independently associated with postprandial endotoxemia. Materials and Methods: NoPoW and DNoPoW were evaluated for weight, eating habits, physical activity, body circumferences, fasting plasma glucose level, postprandial plasma glucose level, and insulin level. The lipopolysaccharide (LPS) levels and circulating LPS-binding protein (LBP) were determined in serum at fasting, 1 h, 2 h, 3 h, and 4 h after meal intake and their levels were co-related in 80 NoPoW and 80 DNoPoW. Results: Both DNoPoW group and NoPoW group showed a significant increase (P < 0.05) in LPS levels and circulating LBP in plasma after the meal intake, interestingly the increase was higher in the DNoPoW group. Conclusions: Elevated LPS and circulating LBP were associated significantly with DNoPoW group and NoPoW, especially after a meal intake. These findings suggested a role of LPS and LBP in postprandial systemic inflammation in DNoPoW group. Prospective studies are needed to confirm these results.

Background: Total knee replacement (TKR) is associated with high-perioperative blood loss, which often requires allogenic blood transfusion. Among the many strategies to decrease the need for allogenic transfusion, tranexamic acid (TA) is used systemically in perioperative setting with promising outcome. Here we evaluated the efficacy of single preoperative bolus dose of TA on reduction in blood loss and red blood cell transfusion in patients undergoing unilateral TKR. Materials and Methods: 70, American Society of Anesthesiologists I-II patients scheduled for unilateral TKR were included. Patients were randomly allocated into two groups to receive either TA (Group-TA; 20 mg/kg diluted to 25 cc with normal saline) or an equivalent volume of normal saline (Group P). Hemoglobin concentration, packed cell volume, platelet count, fibrinogen level, D-dimer level was measured preoperatively and at 6 ^th and 24 ^th h postoperative period. Results: In Group P more blood, colloid and crystalloid solutions were used to replace the blood loss. 27 patients in Group TA did not require transfusion of any blood products compared to 6 patients in Group P (P < 0.0001) and only 3 units of blood was transfused in Group TA where as a total of 32 units of blood was transfused in Group P. Despite the more numerous transfusions, Hb% after 6 h and 24 h in Group P were considerably low in comparison with Group TA (P < 0.0001). Conclusion: Tranexamic acid while significantly reducing blood loss caused by TKR surgery collaterally reduced the need for postoperative blood transfusion.

Background: Despite the recent campaigns to eliminate smoking, the rates are still increasing world-wide. Exposure to passive smoking (PS) is associated with morbidity and mortality from awful diseases. Although many college students smoke, little is known about their exposure to PS, common places and sources of exposures in Saudi Arabia. Aim: The aim of the following study is to identify prevalence and magnitude of PS among college students, exposure time, locations, sources of exposure, investigate the effects and make recommendations. Materials and Methods: A cross-sectional study was performed to identify factors associated with PS exposure among students of College of Applied Medical Sciences, Riyadh. Results: Out of 61 students included in the study, 91.8% were found exposed to PS. Exposure in Hospitality venues (Estirah) was the most common followed by other areas. Among the sources of exposure, the highest was among friends and the least were parents and guests. The frequency of highest exposure per month was >15 times and the lowest was 10-15 times. Levels of annoyance varied between 18% and 37.7%, respectively. Since the values obtained for different markers in the pulmonary function test are more than the predicted values, the observed spirometry is normal. The percent oxygen saturation in hemoglobin and blood pressure of PS were in normal range. Conclusion: Since the properties of mainstream smoke and environmental tobacco smoke are quite different, risk extrapolation from active to PS is uncertain, especially during a short period. Nevertheless, it can be deteriorating during a longer duration, hence; the administrators, policy makers and tobacco control advocates may endorse policies to restrict smoking in shared areas, particularly working environment.

Background: Monitoring blood utilization helps in effective management of blood stock to meet present and future demands in a hospital. Hence, we analyzed the age, gender and frequency distribution of each blood product used in different diseases conditions. Materials and Methods: We included all blood products utilized from January 2008 to December 2012 in our tertiary care hospital in South India. The primary and secondary discharge diagnoses (International Classification of Diseases [ICD-10]) were matched with clinical information provided in the request forms. The most relevant indication requiring blood transfusion was selected for each recipient and grouped into broad diagnostic categories according to the headings of ICD-10. The utilization of stored whole blood, packed red blood cells (RBCs), fresh frozen plasma (FFP) and platelets was stratified according to age, gender and diagnosis. Results: Our results indicated decline in usage of whole blood and an increase in use of FFP and platelets over the years. While packed RBCs were frequently used for treating injury and poisoning conditions, platelets and FFP were preferred for infectious and parasitic diseases. Various blood products were used less frequently in patients aged over 60 years and the overall usage of blood products was higher in males. Conclusion: The patterns of blood products utilization is in contrast to the Western nations, which may be due to difference in age structure among Indian population and higher prevalence of infectious diseases such as Dengue in our region. Nevertheless, this study highlights the importance of understanding the epidemiology of blood transfusion locally to improve usage of blood and blood products.

Background: Periodontal disease is of public health concern and hence data on its prevalence rate are necessary. We have documented the prevalence pattern of periodontal disease in a rural population of Belgaum district, India, and identify the optimal treatment needs (TNs). Materials and Methods: A cross-sectional study was carried on 1680 dentate adult subjects, examined from 12 villages in Belgaum district, Karnataka, India for prevalence of periodontal status and their TNs (using Community Periodontal Index for Treatment Needs [CPITN]). Results: Increase in CPITN score positively correlated with age. Only 4.3% (13) of subjects in the age-group of 20-29 had a CPITN score of 4 indicative of pockets of 6 mm or more when compared to 26% (91) of subjects in the age-group of 45-60 years. 92% (569) of the subjects in the age-group of 30-44 were having a TN score 2 whereas only 5.3% (33) of subjects were having a TN score 0 in the same age-group. Significantly higher need for treatment was observed in males, smokers and subjects using finger and tooth powder. Surprisingly diet of the subjects did not influence TNs. Conclusion: Increased prevalence of periodontal diseases and TNs was observed. There is a need for initiating adequate awareness regarding oral hygiene, specifically primary prevention could help in reducing the prevalence of periodontal disease.

Context: In India, oral cancer accounts for one-third of all cancers. Early detection and immediate intervention can lead to marked reduction in the morbidity and mortality. In India, Ayurveda and homeopathy practitioners are distributed widely in rural and urban areas and are easily accessible. Until date, no assessment on their oral cancer knowledge and practice has been done. Aims: The present study was undertaken to evaluate the knowledge, awareness, and practice concerning oral cancer. Subjects and Methods: Questionnaire comprising 15 questions was distributed to 42 Ayurveda and 38 homeopathy doctors in Davangere District, Karnataka, India, assessing their oral examination habits, knowledge on the risk factors, patient education, clinical signs of the disease and its treatment. Statistical Analysis Used: The results were analyzed using Chi-square test. Results: Lesser number of the practitioners routinely examined oral mucosa (16.7% and 5.3%, respectively). Fewer advised their patients about the risk factors (2.4% and 2.6%). Less positive response was obtained for the correct method for confirmation of diagnosis (28.6% and 15.8%). Many doctors agreed that they had not undergone training in cancer institute (P = 0.29). Twenty-three (54.8%) Ayurveda and 28 (73.7%) homeopathy doctors opined that they did not have sufficient knowledge regarding early detection and prevention of oral cancer and many were desirous of receiving further information (97.6% and 84.2% respectively). Conclusions: This study attempts to highlight the need for improving the oral cancer knowledge and awareness among practicing Ayurveda and homeopathy doctors.

Background: Maternal and neonatal outcome is an index of quality of health and life in human society. To predict serious outcomes in pregnancy various parameters are being researched so that pregnant women who are at risk are identified early and measures taken to ensure a good outcome of pregnancy. Studies have shown an association between microalbuminuria and adverse pregnancy outcome. This study was undertaken to compare obstetric outcome in pregnant women with and without microalbuminuria. Materials and Methods: A prospective cohort study was performed on 69 pregnant women between 20 and 28 weeks of gestation. Urine tests for albuminuria and creatinine measurements were performed in all women and the albumin to creatinine ratio was calculated. The women with microalbuminuria and those without microalbuminuria were monitored until the end of their pregnancy and compared for pregnancy outcome. Results: The age distribution in the two groups was found to be similar and comparable. Preterm labor was strongly associated with microalbuminuria group (P = 0.001**)strongly significant. Incidence of maternal complications were more with microalbuminuria group (P < 0.001**). Fetal complications were significantly more in terms of intrauterine growth restriction, prematurity, low birth weight, low Apgar score and more incidence of neonatal intensive care unit admission with microalbuminuria group (P = 0.010*)moderately significant. Conclusion: It was found that fetal complications were more associated with babies of pregnant women with microalbuminuria. Though maternal complications were more associated with microalbuminuria group, individual events like premature rupture of membrane, preterm premature rupture of membrane had no statistically significant association with microalbuminuria except preterm labor. However, occurrence of pre-eclampsia was more with microalbuminuria, though it didn't carry any statistical significance.

Introduction: Beta angle as a skeletal anteroposterior dysplasia indicator is known to be useful in evaluating normodivergent growth patterns. Hence, we compared and verified the accuracy of Beta angle in predicting sagittal jaw discrepancy among subjects with hyperdivergent, hypodivergent and normodivergent growth patterns. Materials and Methods: Lateral cephalometric radiographs of 179 patients belonging to skeletal Classes I, II, and III were further divided into normodivergent, hyperdivergent, and hypodivergent groups based on their vertical growth patterns. Sagittal dysplasia indicators - angle ANB, Wits appraisal, and Beta angle values were measured and tabulated. The perpendicular point of intersection on line CB (Condylion-Point B) in Beta angle was designated as 'X' and linear dimension XB was evaluated. Results: Statistically significant increase was observed in the mean values of Beta angle and XB distance in the vertical growth pattern groups of both skeletal Class I and Class II patients thus pushing them toward Class III and Class I, respectively. Conclusions: Beta angle is a reliable indicator of sagittal dysplasia in normal and horizontal patterns of growth. However, vertical growth patterns significantly increased Beta angle values, thus affecting their reliability as a sagittal discrepancy assessment tool. Hence, Beta angle may not be a valid tool for assessment of sagittal jaw discrepancy in patients exhibiting vertical growth patterns with skeletal Class I and Class II malocclusions. Nevertheless, Class III malocclusions having the highest Beta angle values were unaffected.

Aims and Objective : We assessed the utility of magnetic resonance cholangiopancreatography (MRCP) as a noninvasive diagnostic tool in patients with obstructive biliopathies. Materials and Methods: A prospective study was conducted on 54 patients with clinically suspected biliary obstruction. MRCP in these patients was compared and correlated with final diagnosis and their clinical profile. Statistical Analysis: Sample profile was described in terms of sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy. Pearson's Chi-square statistics was used to assess the strength of association between diagnostic accuracy of MRCP and final diagnosis. Results: Out of the 54 patients, 50 had biliary obstruction. The cause of biliary obstruction was finally identified on the basis of direct cholangiography/surgery/histopathology. In 52 of the 54 patients, MRCP agreed with final diagnosis in identifying the level of block. MRCP agreed with final diagnosis in identifying the cause of obstruction in 48 of the 54 patients (89%). Sensitivity of MRCP in identifying the level of obstruction in comparison with final diagnosis was 100%, while diagnostic accuracy of MRCP in identifying the level of obstruction in comparison with final diagnosis was 96.29%. The correlation between MRCP and final diagnosis in diagnosing cause of obstruction was 0.95 (Pearson's correlation coefficient, P = 0.017). Conclusion: MRCP is a safe ionizing radiation and iodinated contrast free modality which has the ability to display the biliary tree by combining the advantages of projectional and cross-sectional imaging.

Background: Root dentine translucency remains the method of choice providing the most accurate results for age estimation. Conventionally, translucency is measured using calipers. In recent times, computer-based methods are proposed, which require the use of custom-built software programs. Aims and Objectives: The aim was to use a digital method to measure dentinal translucency on sectioned teeth and to compare digital measurements to conventionally obtained translucency measurements. Materials and Methods: A total of 200 extracted permanent teeth were collected and were sectioned to a thickness of 250 μm. Translucency measurements were obtained using the digital method and compared with those obtained using a caliper. Results: Correlation coefficients of translucency measurements to age were statistically significant for both methods (P < 0.001), although marginally higher correlation was observed for the conventional method (r = 0.612). Application of derived linear regression equations on an independent sample (n = 25) suggested that conventional approach is marginally better in estimating age to within 5 years of the actual age, both the methods are similar in assessing age within 5-10 years of the actual age, and digital approach is marginally better in estimating age beyond 10 years of actual age. Conclusion: The translucency measurements obtained by the two methods were identical, with no clear superiority of one method over the other.

Aim: The aim of this study was to relate the salivary electrolyte levels with dental caries in children with Down syndrome and to compare salivary electrolyte levels and dental caries of these children with their siblings. Materials and Methods: Study population consisted of 30 Down syndrome children (study group) and their 30 healthy siblings (control group). Caries status was determined by dental caries indices in deciduous and permanent dentitions. Un-stimulated saliva from both groups was collected for salivary electrolyte examination. Results: In the study group, mean caries experience in primary dentition was 1.00 ± 0.79 and in the control group it was 2.33 ± 1.42, the difference being statistically significant. Mean caries experience in the permanent dentition of the study group (0. 97 ± 0.76) was significantly lower than the control group (2.47 ± 1.25). Salivary electrolyte levels in the study group were significantly higher than the control group. Conclusion: There was a significant decrease in dental caries in primary as well as permanent dentition of Down syndrome patients with increase in their salivary electrolyte levels.

Background: The therapeutic potential of yoga are often considered complementary to various forms of medical practice. Very few studies have evaluated the effects of yoga in the treatment of occupational hazards among dentists. Hence, this cross-sectional study was designed to evaluate the adoption of yoga techinques as an alternative therapy in treatment of physical and psychological occupational hazards among dental general practitioners in Chennai, India. Materials and Methods: A validated closed-ended questionnaire was circulated to 500 dental general practitioners in Chennai, India and we received 394 completed questionnaires. The questionnaire documented demographic data, occupational hazards and the type of treatment taken for the hazards. Results: Musculoskeletal pain with stress (47%) was the most common occupational hazard reported, followed by only stress (27.4%), and only musculoskeletal pain (25.6%). Only 9.6% of practitioners adopted yoga as an alternative treatment for these occupational hazards. Interestingly, majority (46.4%) of them did exercise, gym, massage, walking and heard music. Surprisingly, 43.9% did not take any measures to treat these occupational hazards. However 53.3% of the dentists who did not consider yoga as an alternative therapy, stated lack of time as a reason for not practicing yoga while 17.6% of them don't believe yoga as a therapy. Conclusion: Despite musculoskeletal pain and stress being the most common occupational hazard prevalent among dentists, over 50% of the subjects surveyed didn't seek any measure to treat these occupational hazards and only 10% of them practiced yoga as the alternative therapy.

Background: Bispectral index (BIS) used for intra-operative depth assessment under general anesthesia (GA) can be altered by different factors. This study was designed to detect the alteration in BIS reading with two different Trendelenburg (TBG) tilt in laparoscopically assisted vaginal hysterectomy (LAVH) procedure. Materials and Methods: A prospective, double-blinded, randomized controlled study was designed involving 40 American Society of Anesthesiologists Grade I and II female patients, aged 35-60 years, scheduled to undergo LAVH under GA. Patients were divided into two groups with TBG >30° and TBG <30°. BIS readings; systolic and diastolic blood pressure, heart rate were recorded in supine position. Patients were then shifted to desired TBG position either (>30°) or (<30°) as per group allotment. Data were recorded at 30 min intervals and all the patients were followed upto 24 h postoperatively for any recall. Results: A rise in BIS value was noticed, when position was changed from supine to head down in both groups. During comparison between two groups with different angulations, TBG >30° showed a higher BIS value than TBG <30°. This statistically significant (P < 0.05) trend was observed at all the 30, 60, 90, and 120 ^th min interval. Interestingly, BIS values returned to preoperative levels following adopting final supine position. No incidence of awareness was reported in both the series throughout the study. Conclusion: Though awareness remains unaltered BIS value gets increased with higher angle of inclination in TBG position during LAVH operation.

Background: Acinetobacter is clinically important pathogen with widespread resistance to various antibiotics. We assessed the incidence of Acinetobacter infection at a tertiary care hospital, analyze their resistance pattern and identify the production of extended spectrum β-lactamases (ESBLs) and metallo β-lactamases (MBLs). Materials and Methods: The study was conducted in tertiary care hospital, India over a period of 2 years. Acinetobacter species were isolated from various clinical samples received in Department of Microbiology. After identification, Acinetobacter isolates were speciated and antibiotic susceptibility was determined by the standard disc diffusion method. ESBL and MBL production was detected by the double disc synergy test and combined disc diffusion test respectively. Results: Of 3298 infected samples, 111 (3.36%) were found to be Acinetobacter. The most predominant species was Acinetobacter calcoaceticus-A. baumannii (Acb) complex (72%). High incidence of resistance was recorded for piperacillin (55%), followed by ceftriaxone (46%) and ceftazidime (46%). Isolation rate and antibiotic resistance was higher in the Intensive Care Units (ICUs) of the hospital. ESBL and MBL production was detected in 31.5% and 14.4% of the isolates respectively. Discussion and Conclusion: A high level of antibiotic resistance was observed in our study and maximum isolation rate of Acinetobacter was in the ICUs. Acb complex was the most predominant and most resistant species. The analysis of susceptibility pattern will be useful in understanding the epidemiology of this organism in our hospital setup, which will help in treating individual cases and controlling the spread of resistant isolates to other individuals.

Background: Dyslipidemia (Dys), the commonest cause of cardiovascular diseases, leads to lipid deposits on the arterial wall, thereby aggravating the process of atherosclerosis. To assess the impact of Dys and other co-morbid conditions on atherosclerosis (i.e., increased intimo medial thickness (IMT) or plaques) in the common carotid arteries (CCAs) we studied the incidence and association of plaques and increased IMT in dyslipidemic patients from North Indian population (south-west of Punjab, India). Materials and Methods: A cross-sectional study consisting of 88 (male-39 and female-49) dyslipidemic patients (age group 30-80 years); was designed. Blood pressure, waist circumference (WC), hip circumference (HC) were measured and fasting lipid profile, renal function, and liver function tests were performed. B-mode sonography, for CCA, was performed to assess IMT. Results: Average value (mg/dl) of total cholesterol, triglyceride, low density lipoprotein and high density lipoprotein in males and females was 220.30 versus 231.93, 240.3 versus 242.14, 125.29 versus 133.62 and 44.33 versus 46.09 respectively (P > 0.05, all), while WC, HC, systolic blood pressure and diastolic blood pressure were 101.8 versus 96.53 cm, 98.23 versus 99.53 cm, 143.23 versus 138.98 mmHg and 91.53 versus 88.97 mmHg respectively. Increased IMT and atherosclerotic plaques were observed in 36.36% cases (n = 32, male - 14 and female - 18) and 29.54% cases (n = 26, male 14, female 12) respectively. Odd ratio (OR) for plaques was more for Dys with coronary artery disease (CAD; 11.43) and Dys with CAD (Dys-CAD) + hypertension (HT) (24) respectively vs isolated Dys. Conclusion: Dyslipidemia patients have higher waist and HCs than normal subjects. Incidence and OR of plaques is higher in Dys-CAD or Dys-CAD + HT when compared to isolated Dys or Dys with HT. Hence, treatment of dyslipidemic patients' needs to be intensified if more than one risk factor(s) is present simultaneously.

Introduction: The paper analysis the performance of CSIR at the overall level as well as laboratory level in terms of various indicators during 2007-11. It identifies the strength and weakness of CSIR at the overall level as well as under laboratory level under 13 broad subjects. Materials and Methods: The paper uses Scopes database for analyzing publications on CSIR and its 37 laboratories during 2007-11. Results: The largest contribution of CSIR has been in the area of chemistry, followed by biochemistry, genetics and molecular biology, materials science, chemical engineering, physics, engineering, pharmacology, toxicology and pharmaceutics, agricultural and biological sciences, environmental science, medicine, earth and planetary sciences and energy.

Background: This study evaluated the antioxidant potential of a polyherbal formulation (Phytocee^™ ) in the rodent model. Materials and Methods: Four groups of rats (n = 6) were pretreated with Vitamin C (20 mg/kg) or Phytocee^™ (20, 100, and 200 mg/kg), respectively for 10 days. Oxidative stress in rat liver was induced by administration of carbon tetrachloride (CCl ₄ ) at 2 ml/kg as a single dose orally to all groups except the vehicle control group. After 24 h of administration of CCl ₄ , hepatic levels of malondialdehyde (MDA), serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), hepatic superoxide dismutase (SOD), catalase, and reduced glutathione (GSH) levels were evaluated. Results: Phytocee^™ administered groups at all the dose levels significantly reduced the hepatic MDA, serum ALT and AST levels with a marked increase in hepatic SOD and catalase as compared with CCl ₄ treated group. Conclusion: The findings suggest that Phytocee^™ markedly reversed the effects of CCl ₄ induced oxidative stress and can be used as an antioxidant feed supplement.

Background: There is experimental evidence of many cases of stable macromolecular conformations with charged amino-acids facing lipid, an arrangement thought to be energetically unfavourable. Methods and Objectives: Employing classical electrostatics, we show that, this is not necessarily the case and studied the physical basis of the specific role of proximity of charges to the dielectric interface between two different environments. We illustrate how self and induced energies due to the dielectric medium polarization, on either side of the interface, contribute differentially to the stability of a pair of charges and hence the mutual conformation of the S3b-S4 α-helix pair of the voltage-gated K ⁺ channel. Results and Conclusion: We show that (1) a pair of opposite charges on either side of lipid-protein interface confers significant stability; (2) hydrophobic media has an important role in holding together two similar repelling charges; (3) dielectric interface has stabilizing effect on a pair of charges, when an ion is closer to its interface than its neighboring charge; (4) in spite of the presence of dielectric interface, there is a nonexistence of any dielectric effect, when an ion is equidistant from its image and neighboring charge. We also demonstrate that, variation in dielectric media of the surrounding environment confers new mutual conformations to S3b-S4 α-helices of voltage sensor domain at zero potential, especially lipid environment on the helix side, which improved stability to the configuration by lowering the potential energy. Our results provide an answer to the long standing question of why charges face hydrophobic lipid membranes in the stable conformation of a protein.

Background: Microbial resource orchid is a collection of Gram-positive and Gram-negative clinical isolates sourced from different hospitals and diagnostic laboratories in India. We determined the antibiotic susceptibility of a set of Gram-negative Enterobacteriaceae and non-fermenter clinical isolates from microbial resource orchid, collected during the period of 2002-2012 against commonly used antibiotics. Materials and Methods: A total of 247 Gram negative strains consisting of 142 Enterobacteriaceae and 105 non-fermenters from microbial resource orchid were selected for determining minimum inhibitory concentration against β-lactams, aminoglycosides, quinolone, and tetracycline by agar dilution method as per clinical and laboratory standards institute guidelines. Results: All the isolates had high resistance to ampicillin, piperacillin, ceftazidime, gentamicin, tetracycline, and ciprofloxacin. Pseudomonas aeruginosa showed moderate resistance to carbapenems. Conclusion: This study demonstrated the high level of antibiotic resistance among the strains collected under microbial resource orchid and further, such data and the strains can be used in new chemical entities profiling.

In our study, we have concluded that two proteins with 88% homology choose different energetically favorable pathways in the very early stage of the folding process to attain their native folds. Subsequent reports from other investigators by performing folding and unfolding kinetics experiments concur with our findings. We herewith discuss the key papers revealing computational and experimental analysis of two designed proteins with similar sequence distant folds. Further we suggest that the theoretical/computational analysis of protein sequences and structures along with the relevant experiments provide a better understanding of the relationship between protein sequence, folding, and structure.

Coronal fractures of the anterior teeth are a common form of dental trauma. If the original tooth fragment is retained following fracture, reattachment of the fractured fragment to the remaining tooth can provide better and long lasting esthetics, improved function, a positive psychological response, and is a faster and less complicated procedure. This paper reports on coronal tooth fracture case that was successfully treated using adhesive reattachment of fractured fragment and post placement.

Small bowel intussusception is a rare congenital disease entity, mostly manifesting before the age of two with abdominal pain and acute intestinal obstruction. In adults, colon intussusception is a rare event causing approximately 1% of all acute intestinal obstructions and they can occur idiopathically in adults or due to an intraluminal tumor mass. We report a case of an enterogenous cyst causing intussusception and iron deficiency anemia in an adult treated by surgical excision and resection of the small bowel.

Primary adenocarcinoma of rete testis is one of the rarest intrascrotal tumors. Very few cases have been reported in the literature. In addition, presence of biphasic component creates difficulty in the diagnosis. We present here a unique third case of rete testis adenocarcinoma having distinct cytologically malignant spindle cell component in a young male who presented with recurrent hydrocele.

Urinothorax is a very rare occurrence of urine in the pleural space. Urinothorax can occur as a consequence to percutaneous nephrolithotomy (PCNL), ureterorenoscopic lithotripsy (URSL) or shock wave lithotripsy (SWL). We herewith report a rare case of Urinothorax in a 35 years old male patient and discuss its current knowhow and clinical management.

Pediatric transanal impalement injuries are relatively uncommon and most are attributed to accidental fall on offending objects, sexual assault or blunt trauma. There may be difficulty in recognizing or properly treating such injuries because their severity may not be reflected externally. Evaluation of suspected rectal impalement injury involves careful history and physical examination and proper investigation. There are very few reports on pediatric perianal impalement with associated visceral injuries. We report a case of assault transanal impalement injury associated with mesenteric tear and jejunal perforation leading to devitalization of proximal jejunum in a 2 year male child and relevant literatures were reviewed. To the best of our knowledge, such dual proximal and distal gastrointestinal injury in such a small child has not been reported in any of the English literature so far.

HIV/AIDS has claimed millions of lives in the global workforce and continues to remain a threat to many businesses. An estimated 36.5 million of working people are living with HIV; the global workforce has lost 28 million people from AIDS since the beginning of the epidemic. In the absence of access to treatment, this number could grow to 74 million by 2015. The epidemic continues to affect the working population through absenteeism, sickness and death. Corporate Social Responsibility (CSR) is an obligation that corporates have toward their employees, community and society. A review and documentation of one such CSR by Johnson & Johnson (a multinational company) for HIV/AIDS in Africa is presented here. Johnson & Johnson Company is involved in numerous projects around the world to combat the HIV/AIDS epidemic. The company is working to fight the spread of the disease and improve the quality of life for those living with the illness through various donations of its products and sponsorship of local programs. This case study also highlights different categories of CSR activities such as Cause Promotion, Cause related Marketing, Corporate Philanthropy, Corporate Social Marketing, Corporate Volunteering and Socially responsible business practices, which are discussed with specific examples from different countries in Africa. Conclusions: CSR of any business encompasses the economic, legal, ethical & discretionary expectation placed on the organization by society at a given point of time. CSR is therefore the obligation that corporations have toward their stakeholders and society in general which horizons beyond what is prescribed by law or union contracts. Johnson & Johnson has a proved history of being committed to caring for people and a good example of a company with a long history of citizenship and sustainability.

Caries or trauma induced non-vital immature permanent tooth with blunderbuss, thin root which are very common among childrens are corrected using regenerative endodontic (revascularization) procedures. In the presented case, a 16-year-old boy reported with chief complaint of pain in maxillary left central incisor (Tooth #21). Tooth #21 showed grade III mobility, draining labial sinus, and short blunderbuss root with diffuse periapical radiolucency. Patient was explained the treatment plan and written informed consent was taken. Platelet rich fibrin (PRF) was prepared according to standard protocol. Autologous PRF was carried to the apical portion of the root canal after inducing revascularization. Access opening was double sealed with MTA and resin modified glass ionomer cement (RMGI). Baseline, 12 month and 18 month follow-up intraoral radiographs were taken. Clinically case was asymptomatic with complete resolution of intraoral sinus. Periapical healing, apical closure, root lengthening and dentinal wall thickening were uneventful. Thus PRF supplementation hastens the predictability and rate of revascularization in non-vital immature permanent teeth.

Mucormycosis is a rare opportunistic aggressive and fatal infection caused by mucor fungus. Seven types of mucormycosis are identified based on the extension and involvement of the lesion, of which the rhino orbital mucormycosis is most common in the head and neck region. Although it is widely spread in nature, clinical cases are rare and observed only in immunocompromised patients and patients with uncontrolled diabetes mellitus. Early symptoms include fever, nasal ulceration or necrosis, periorbital edema or facial swelling, paresthesia and reduced vision. Involvement of cranial nerves although not common, facial nerve palsy is a rare finding. The infection may spread through cribriform plate to the brain resulting in extensive cerebellar infarctions. Timely diagnosis and early recognition of the signs and symptoms, correction of underlying medical disorders, and aggressive medical and surgical intervention are necessary for successful therapeutic outcome.

Mesiodens is the most commonly erupting supernumerary in the midline between two maxillary central incisors. Mesiodentes is a rare condition when mesiodens erupt in multiples, which may present as either labial or palatal to permanent central incisors. We report a rare case of double mesiodentes (non-syndromic mesiodentes) with floret like appearance. The presence of mesiodens has functional and esthetic implications. Careful radiographic evaluation should be done to prevent complications during their extraction.

Cleidocranial dysplasia (CCD) is a rare (1:1,000,000) congenital condition secondary to spontaneous mutation (40%) or autosomal dominant inheritance (60%) affecting skeletal and dental systems. Hypomineralization of the hypoplastic clavicles and/or cranium is the major feature observed by prenatal ultrasound. Radiologically clavicles are hypoplastic or absent in chest X-ray. Delayed closure of the fontanelle and the skull sutures in pediatric and adolescent population and increased mobility of shoulders in all age groups (exhibited by the ability to bring shoulders close to each other) are prominent clinical diagnostic features of CCD. The diagnosis of CCD is often missed or significantly delayed. The management of CCD involves a multidisciplinary approach and its early diagnosis is essential to select an optimum plan and therapeutic benefit. We present here a case of CCD in a 17-month-old girl referred to us for investigation of below average weight and height gain; we stress on the usefulness of early diagnosis in the management of CCD and discuss current management concepts.

We present computed tomography (CT) and magnetic resonance imaging (MRI) features of a very rare case of a primary epidermoid tumor of the jugular foramen (JF). A 45-year-old male patient presented with gradually progressive vertigo and tinnitus. CT and MRI scans revealed a 3.5 cm right-sided JF tumor with characteristic bright signal (restricted diffusion) on diffusion-weighted MRI (DWI). DWI may be useful in accurately differentiating the lesion from other cystic neoplasms of the JF. We describe the imaging features of intracranial epidermoid and JF tumors and discuss its differential diagnosis.

We report the case of a 29-year-old male who presented with vague right upper quadrant pain, 8 years following a pancreaticoduodenectomy for a symptomatic pancreatic islet cell tumor. Subsequent imaging revealed multiple lesions in the right lobe of the liver. A diagnosis of metastatic disease could not be out ruled and hence a formal resection was performed. A formal retrospective review of case notes, preoperative imaging, operative notes, subsequent histology as well as a review of the current literature using the Medline, CINAHL, and EMBASE databases was performed. Histologic analysis showed these lesions to be hepatocellular adenomas. We highlight in this case the importance of preoperative imaging and workup, discuss hepatocellular adenomas in males and hypothesize as to the underlying pathophysiology in this particular case based on the available evidence.

Rhinosporidiosis, is a chronic granulomatous disease presenting as a polypoidal mass in the nasal cavity and nasopharynx caused by Rhinosporidium seeberi and is endemic in India and Sri Lanka. Diagnosis is mainly by clinical observations and is confirmed by histopathology. We report a case of atypical rhinosporidiosis that presented as an oropharyngeal mass and mimicked chronic tonsillitis. Hence possibility of this atypical rhinosporidiosis should be included in the clinical differential diagnosis of any posterior oral or oropharyngeal mass, particularly when managing patients from rural endemic areas.

Oral squamous cell carcinoma with prominent clear cell differentiation is a rare occurrence. A 35-year-old female patient presented with a nonhealing ulcer persistent for 1-month involving the left lateral border of the tongue and lingual vestibule. Lobules of malignant squamous epithelial cells with abundant cytoplasm and vesicular nuclei in the connective tissue were observed following histopathology. Neoplastic cells constituting majority of lobules exhibited clear cell changes. Periodic acid-Schiff and mucicarmine stains showed negative reaction. Immunohistochemical study using antibody for cytokeratin, revealed diffuse and intense positivity. The neoplastic cells showed complete negative reaction with antibodies for vimentin, smooth muscle actin and homatropine bromide-45 antigens.

Wilson's disease is an autosomal recessive disease resulting in defective copper metabolism, which is usually seen in young adults, predominantly affecting liver and brain. Although it is not uncommon in India, variation in epidemiology, clinical presentation and course are reported. However, community-based incidence and prevalence rates are not available in India and incidences are limited to hospital based reports. Most often, the diagnosis is delayed. We present a clinical autopsy case in a 39 year-old female who had presented with clinical symptoms at 18 years of age. The duration of illness was 21 years. Patient's parent had consanguineous marriage and the younger sibling had died at 5 years of age with similar complaints.

Hemisection is sectioning of multi-rooted teeth with its crown portion, with the loss of periodontal attachment and is performed to retain the original tooth structure and attain the fixed prosthodontic prosthesis. We describe hemisection of a mandibular molar tooth followed by adequate restoration in a young patient.

Prune Belly syndrome (PBS) is a rare congenital anomaly of uncertain etiology almost exclusive to males. We report a case of term male baby born to a 39-year-old grand multipara with previous four normal vaginal births. There was no history of genetic or congenital anomaly in her family. Examination of the baby revealed hypotonia, deficient abdominal muscle, cryptorchidism, palpable kidney, and bladder. Ultrasound examination of the abdomen revealed bilateral gross hydronephrosis and megaureter. Provisional diagnosis of PBS was made and the baby was admitted in neonatal intensive care units for further management. Routine antenatal care with ultrasonography will help in detecting renal anomalies, which can be followed postnatally. Early diagnosis of this syndrome and determining its optimal treatment are very important in helping to avoid its fatal course.

Cervical pregnancy is a rare type of ectopic pregnancy and it represents <1% of all ectopic pregnancies. Early diagnosis and medical management with systemic or local administration of methotrexate is the treatment of choice. If the pregnancy is disturbed, it may lead to massive hemorrhage, which may require hysterectomy to save the patient. We report three cases of cervical pregnancy managed successfully with different approaches of management. Our first case, 28 years old G ₃ P ₂ L ₂ with previous two lower segment cesarean sections, presented with bleeding per vaginum following 6 weeks of amenorrhea. Clinical examination followed by transvaginal ultrasound confirmed the diagnosis of cervical pregnancy. Total abdominal hysterectomy was done in view of intractable bleeding to save the patient. The second case, a 26-year-old second gravida with previous normal vaginal delivery presented with pain abdomen and single episode of spotting per vaginum following 7 weeks of amenorrhea. Transvaginal ultrasound revealed empty endometrial cavity, closed internal os with gestational sac containing live fetus of 7 weeks gestational age in cervical canal and she was treated with intra-amniotic potassium chloride followed by systemic methotrexate. Follow up with serum beta human chorionic gonadotropin level revealed successful outcome. Our third case, a 27-year-old primigravida with history of infertility treatment admitted with complaints of bleeding per vaginum for 1 day following 8 weeks amenorrhea. She was diagnosed as cervical pregnancy by clinical examination, confirmed by transvaginal ultrasonography and subsequently managed by dilation and curettage with intracervical Foleys' ballon tamponade.

Neurofibroma is a benign peripheral nerve sheath tumor and is the most frequent tumor of neural origin. Its presence is one of the clinical criteria for the diagnosis of neurofibromatosis type 1 (NF1; a common hereditary disease occurring in one out of every 3000 births). The diagnosis can sometimes be made at birth, while in others the diagnosis is made later in life after the appearance of additional clinical criteria. Majority of the solitary neurofibromas are sporadic, while a few are associated with NF1 syndrome. Oral hard and soft tissue are affected by the tumor; however, the tongue is the most affected site. Gingival neurofibroma is an uncommon oral manifestation of NF. Here, we report a rare case of gingival neurofibroma in NF1 patient. One of the most feared complications of NF1 is its transformation into neurofibrosarcoma, which bears a very poor prognosis. Treatment of neurofibroma is surgical resection.

Sirenomelia (mermaid syndrome) is a rare congenital fetal anomaly with characteristic feature of complete or partial fusion of lower limbs. Although, this syndrome is incompatible with life due to the association of several congenital visceral abnormalities; however, there are few reports of surviving infants. Our first case was a live born, normally delivered at term by a 27-year-old third gravida of lower socioeconomic status with history of tobacco use. Examination of the baby revealed caudal dysgenesis having fusion of lower limbs, single leg with 1 foot and 5 toes. There was no identifiable external genitalia and anus. The second case was a 34 week, 1.6 kg preterm infant of unidentified sex born to a 28-year-old primigravida mother with overt diabetes mellitus. Incidentally, both the infants died few hours after birth and we report these cases due to their rarity and term live birth.

Extra-cranial schwannomas although common in head and neck region are very rarely seen originating from the infra-orbital nerve. We report a case of schwannoma arising from infra-orbital nerve in a 40-year-old male patient. The case presented as an isolated, asymptomatic, slow growing sub-cutaneous nodular swelling over left side of mid-face. On ultrasonography, a localized lesion within the sub-cutaneous tissue of cheek was observed, without involvement of orbital, maxillary sinus or underlying bone. Aspiration biopsy of the lesion showed spindle shaped cells predominantly arranged in Antoni A pattern around verocay bodies, with less organized Antoni B tissue in few places. Diagnosis of schwannoma, probably arising from terminal branch of infra-orbital nerve was established. The tumor was approached through skin incision. At the time of exploration, the lesion was found to emanate from the nerve trunk of peripheral branch of infra-orbital nerve, which was dissected and preserved. We correlate our experience with previously reported cases of infra-orbital nerve schwannoma.

Thyrotoxic periodic paralysis (TPP) is a rare, but serious condition characterized by acute paralytic attacks and hypokalemia in association with thyrotoxicosis. Although carbohydrate rich meals, strenuous exercise, alcohol, emotional stress are known precipitants of TPP, steroid treatment has rarely been reported to induce TPP. We report a case in which a patient with previously untreated Grave's disease developed TPP following administration of Intravenous hydrocortisone for control of severe anaphylaxis, which to best of our knowledge is very rare.

Creating prosthesis, having realistic skin surface and seamless visual integration with the surrounding tissues, requires both artistic and technical skill. Anatomical design, thin margins, lifelike fingernails and realistic color/contours are essential for patient satisfaction. Prosthesis is especially useful in case of lost body parts, as reconstructive surgery cannot fully restore aesthetics. This case report describes a simple technique for fabricating silicon finger prosthesis for a patient.