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   2015| January-June  | Volume 6 | Issue 1  
    Online since January 14, 2015

 
 
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RESEARCH ARTICLES
Evaluation of antidiabetic, hypolipedimic and antioxidant activity of hydroalcoholic extract of leaves and fruit peel of Punica granatum in male Wistar albino rats
Kartik J Salwe, Devender O Sachdev, Yogesh Bahurupi, Manimekalai Kumarappan
January-June 2015, 6(1):56-62
DOI:10.4103/0976-9668.149085  PMID:25810635
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.
  13 2,782 589
REVIEW ARTICLES
Current overview on dental stem cells applications in regenerative dentistry
Ramta Bansal, Aditya Jain
January-June 2015, 6(1):29-34
DOI:10.4103/0976-9668.149074  PMID:25810631
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.
  13 4,729 1,134
REVIEW ARTICLES: CHILD HEALTH MINI-SERIES
Diarrheal diseases among children in India: Current scenario and future perspectives
Subitha Lakshminarayanan, Ramakrishnan Jayalakshmy
January-June 2015, 6(1):24-28
DOI:10.4103/0976-9668.149073  PMID:25810630
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.
  12 5,366 786
Malnutrition among under-five children in India and strategies for control
Swaroop Kumar Sahu, S Ganesh Kumar, B Vishnu Bhat, KC Premarajan, Sonali Sarkar, Gautam Roy, Nitin Joseph
January-June 2015, 6(1):18-23
DOI:10.4103/0976-9668.149072  PMID:25810629
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.
  12 6,322 1,032
REVIEW ARTICLES
Laparoscopic ovarian drilling: An alternative but not the ultimate in the management of polycystic ovary syndrome
Subarna Mitra, Prasanta Kumar Nayak, Sarita Agrawal
January-June 2015, 6(1):40-48
DOI:10.4103/0976-9668.149076  PMID:25810633
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.
  8 3,599 596
CASE REPORTS
Autologus Platelet Rich Fibrin aided Revascularization of an immature, non-vital permanent tooth with apical periodontitis: A case report
Ganesh Ranganath Jadhav, Dipali Shah, Srinidhi Surya Raghvendra
January-June 2015, 6(1):224-225
DOI:10.4103/0976-9668.149187  PMID:25810668
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.
  7 1,909 508
RESEARCH ARTICLES
Evaluation of DNA damage in Type 2 diabetes mellitus patients with and without peripheral neuropathy: A study in South Indian population
Mukul Prasad, Stephen Charles Bronson, Tushar Warrier, Agnihotram Badarinath, Shivam Rai, Kaushal Baid, Sneha Sitaraman, Alex George, Anand Moses, Radha Saraswathy, Ranganathan Vasuki, Alagianambi Shanmugam
January-June 2015, 6(1):80-84
DOI:10.4103/0976-9668.149096  PMID:25810640
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.
  7 2,769 312
Relationship between postprandial endotoxemia in nonobese postmenopausal women and diabetic nonobese postmenopausal women
Gaffar Sarwar Zaman, Fawzia Zaman
January-June 2015, 6(1):89-93
DOI:10.4103/0976-9668.149098  PMID:25810642
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.
  6 1,552 220
Does a single loading dose of tranexamic acid reduce perioperative blood loss and transfusion requirements after total knee replacement surgery? A randomized, controlled trial
Ratul Kundu, Anjan Das, Sandip Roy Basunia, Tapas Bhattacharyya, Surajit Chattopadhyay, Anindya Mukherjee
January-June 2015, 6(1):94-99
DOI:10.4103/0976-9668.149099  PMID:25810643
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.
  6 2,110 388
RESEARCH ARTICLES: CHILD HEALTH MINI-SERIES
Prevalence of acute respiratory infection among under-five children in urban and rural areas of puducherry, India
S Ganesh Kumar, Anindo Majumdar, Veera Kumar, Bijay Nanda Naik, Kalaiselvi Selvaraj, Karthik Balajee
January-June 2015, 6(1):3-6
DOI:10.4103/0976-9668.149069  PMID:25810626
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.
  6 4,785 831
RESEARCH ARTICLES
Association of atherosclerosis with dyslipidemia and co-morbid conditions: A descriptive study
Ravinder Garg, Simmi Aggarwal, Raj Kumar, Ghansham Sharma
January-June 2015, 6(1):163-168
DOI:10.4103/0976-9668.149117  PMID:25810656
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.
  5 1,725 216
Comparison of relationship between salivary electrolyte levels and dental caries in children with Down syndrome
Vikram Singh, Ruchi Arora, Deepak Bhayya, Deepesh Singh, Bhumi Sarvaiya, Dhaval Mehta
January-June 2015, 6(1):144-148
DOI:10.4103/0976-9668.149113  PMID:25810652
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.
  5 2,488 512
RESEARCH ARTICLES: CHILD HEALTH MINI-SERIES
Discrimination against differently abled children among rural communities in India: Need for action
N Janardhana, D Muralidhar, DM Naidu, Guru Raghevendra
January-June 2015, 6(1):7-11
DOI:10.4103/0976-9668.149070  PMID:25810627
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.
  5 2,395 324
CASE REPORTS
Prune Belly syndrome: A rare case report
Sunil Kumar Samal, Setu Rathod
January-June 2015, 6(1):255-257
DOI:10.4103/0976-9668.149218  PMID:25810678
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.
  4 1,802 214
RESEARCH ARTICLES
Antibiotic susceptibility pattern of Enterobacteriaceae and non-fermenter Gram-negative clinical isolates of microbial resource orchid
Periasamy Hariharan, Thirunavukkarasu Bharani, Jonathan Sampath Franklyne, Prithwijit Biswas, Shakti S Solanki, Maneesh Paul-Satyaseela
January-June 2015, 6(1):198-201
DOI:10.4103/0976-9668.149121  PMID:25810660
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.
  4 1,700 243
CASE REPORTS
Primary adenocarcinoma of rete testis with distinct biphasic pattern: An extremely rare entity and diagnostic challenge
Prithwijit Ghosh, Kaushik Saha
January-June 2015, 6(1):211-213
DOI:10.4103/0976-9668.149125  PMID:25810664
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.
  3 1,594 189
Urinothorax: A path, less travelled: Case report and review of literature
Vikrant Ranjan, Santosh Agrawal, Saurabh Sudhir Chipde, Ravi Dosi
January-June 2015, 6(1):213-216
DOI:10.4103/0976-9668.149182  PMID:25810665
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.
  3 1,748 238
Cervical ectopic pregnancy
Sunil Kumar Samal, Setu Rathod
January-June 2015, 6(1):257-260
DOI:10.4103/0976-9668.149221  PMID:25810679
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.
  3 3,246 397
An unusual oral manifestation of type 1 neurofibromatosis: A case report and review of literature
Vandana Shekar, Vishwanath Rangdhol, W John Baliah, Sivasankari Thirunavukarasu
January-June 2015, 6(1):261-263
DOI:10.4103/0976-9668.149225  PMID:25810680
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.
  3 1,850 261
Sirenomelia: The mermaid syndrome: Report of two cases
Sunil Kumar Samal, Setu Rathod
January-June 2015, 6(1):264-266
DOI:10.4103/0976-9668.149227  PMID:25810681
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.
  3 2,460 232
Infra-orbital nerve schwannoma: Report and review
Kumar Nilesh
January-June 2015, 6(1):267-271
DOI:10.4103/0976-9668.149229  PMID:25810682
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.
  3 1,635 212
RESEARCH ARTICLES
Isolation and identification of Acinetobacter species with special reference to antibiotic resistance
Neetu Gupta, Nageswari Gandham, Savita Jadhav, Ravindra Nath Mishra
January-June 2015, 6(1):159-162
DOI:10.4103/0976-9668.149116  PMID:25810655
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.
  3 2,909 479
REVIEW ARTICLES
Mast cells and oral pathologies: A Review
Reet Kamal, Parveen Dahiya, Niti Goyal, Mukesh Kumar, Neeta Sharma, Hans Raj Saini
January-June 2015, 6(1):35-39
DOI:10.4103/0976-9668.149075  PMID:25810632
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.
  3 2,133 531
CASE REPORTS
A rare case of cleidocranial dysplasia presenting with failure to thrive
Parag Suresh Mahajan, Anuradha Parag Mahajan, Prashant Suresh Mahajan
January-June 2015, 6(1):232-235
DOI:10.4103/0976-9668.149198  PMID:25810671
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.
  2 2,819 257
Rhinosporidiosis presenting as an oropharyngeal mass: A clinical predicament?
Rachna Rath, Shadab Ali Baig, Tribikram Debata
January-June 2015, 6(1):241-245
DOI:10.4103/0976-9668.149207  PMID:25810674
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.
  2 3,688 194
Facial nerve paralysis: A case report of rare complication in uncontrolled diabetic patient with mucormycosis
Vandana Shekar, Jeelani Sikander, Vishwanath Rangdhol, Madhulika Naidu
January-June 2015, 6(1):226-228
DOI:10.4103/0976-9668.149195  PMID:25810669
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.
  2 1,571 257
Tooth fragment reattachment: An esthetic, biological restoration
Ajay Choudhary, Rakesh Garg, Anindya Bhalla, Rohit Kumar Khatri
January-June 2015, 6(1):205-207
DOI:10.4103/0976-9668.149123  PMID:25810662
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.
  2 1,533 322
Enterogenous cyst of the small bowel causing intussusception in an adult: Case report and review of literature
Nihar Shah, Therese Lizardo-Escaño, Hamid Shaaban, Gautamy Dhadham, Arya Karki, Robert Spira
January-June 2015, 6(1):208-210
DOI:10.4103/0976-9668.149124  PMID:25810663
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.
  2 6,323 348
RESEARCH ARTICLES
Conventional versus digital approach for measuring dentin translucency in forensic age estimation
Varun Chopra, Gopal Thodasam, Zeeshan Heera Ahmad, Simranjit Singh, Indresh Rajawat, Sonal Gupta
January-June 2015, 6(1):139-143
DOI:10.4103/0976-9668.149112  PMID:25810651
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.
  2 1,807 298
Survey on utility of yoga as an alternative therapy for occupational hazards among dental practioners
Ananthalakshmi Ramamoorthy, Sathiya Jeeva Jeevakarunyam, Sunitha Janardhanan, Nadeem Jeddy, Srikaanth Aranmanai Vasan, Arundayanadhi Raja, Parvez Ikram
January-June 2015, 6(1):149-152
DOI:10.4103/0976-9668.149114  PMID:25810653
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.
  2 1,620 288
Antioxidant and protective effects of Phytocee against carbon tetrachloride-induced oxidative stress
Joshua Allan Joseph, Uma Radhakrishnan, Sridhar Mutyala, Krishnagouda Shankargouda Goudar, Usha Parackal Thachappully Ayyappan, Amit Agarwal
January-June 2015, 6(1):183-187
DOI:10.4103/0976-9668.149119  PMID:25810658
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.
  2 1,569 196
A study of blood utilization in a tertiary care hospital in South India
M Moses Ambroise, Kandasamy Ravichandran, Anita Ramdas, Ganthimathy Sekhar
January-June 2015, 6(1):106-110
DOI:10.4103/0976-9668.149101  PMID:25810645
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.
  2 1,787 304
Awareness and practice concerning oral cancer among Ayurveda and Homeopathy practitioners in Davangere District: A speciality-wise analysis
Ravikumar S Kulkarni, P Dupare Arun, Raj Rai, V Shashi Kanth, Vinod Sargaiyan, S Kandasamy
January-June 2015, 6(1):116-119
DOI:10.4103/0976-9668.149104  PMID:25810647
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.
  2 2,175 297
Clinicopathological study and management of liver abscess in a tertiary care center
Amitesh Kumar Jha, Anjan Das, Firoz Chowdhury, Madhuri Ranjana Biswas, Sanjay Kumar Prasad, Surajit Chattopadhyay
January-June 2015, 6(1):71-75
DOI:10.4103/0976-9668.149091  PMID:25810638
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.
  2 2,660 461
The clinical efficacy of using autologous platelet rich plasma in hip arthroplasty: A retrospective comparative study
Atif Safdar, Hamid Shaaban, Restituto Tibayan, Richard Miller, Richard Boairdo, Gunwant Guron
January-June 2015, 6(1):49-55
DOI:10.4103/0976-9668.149077  PMID:25810634
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
  2 1,835 360
Gender disparities in retreatment patients of tuberculosis: A north Indian study
Sandeep Singh Sarpal, Naveen Krishan Goel, Dinesh Kumar, Ashok Kumar Janmeja
January-June 2015, 6(1):63-66
DOI:10.4103/0976-9668.149087  PMID:25810636
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.
  2 1,662 235
REVIEW ARTICLES: CHILD HEALTH MINI-SERIES
Prevention of childhood obesity in India: Way forward
Sitanshu Sekhar Kar, Subhranshu Sekhar Kar
January-June 2015, 6(1):12-17
DOI:10.4103/0976-9668.149071  PMID:25810628
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.
  2 3,326 446
BRIEF REPORT
Better theoretical models and protein design experiments can help to understand protein folding
Konda Mani Saravanan, Samuel Selvaraj
January-June 2015, 6(1):202-204
DOI:10.4103/0976-9668.149122  PMID:25810661
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.
  1 1,322 176
CASE REPORTS
A rare case of clear cell variant of oral squamous cell carcinoma
Sriram Kaliamoorthy, Vijayparthiban Sethuraman, Sathish Muthukumar Ramalingam, Sandhya Arunkumar
January-June 2015, 6(1):245-247
DOI:10.4103/0976-9668.149209  PMID:25810675
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.
  1 1,711 312
Wilson's disease: A Clinical autopsy case report with review of literature
Kalyani Raju, Gayathri Nagaraj Bangalore, Suresh Nagaraj Thuruvekere, Venkatarathnamma Narayanappa Pathavanalli
January-June 2015, 6(1):248-252
DOI:10.4103/0976-9668.149210  PMID:25810676
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.
  1 1,885 294
Corporate social responsibility in public health: A case-study on HIV/AIDS epidemic by Johnson & Johnson company in Africa
Vijay Kumar Chattu
January-June 2015, 6(1):219-223
DOI:10.4103/0976-9668.149193  PMID:25810667
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.
  1 2,200 345
RESEARCH ARTICLES
Natural sweeteners as fixatives in histopathology: A longitudinal study
Shankargouda Patil, Roopa S Rao, BS Ganavi, Barnali Majumdar
January-June 2015, 6(1):67-70
DOI:10.4103/0976-9668.149089  PMID:25810637
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.
  1 2,360 415
Comparison of obstetric outcome in pregnant women with and without microalbuminuria
Harneet Singh, Sunita Samal, Akshaya Mahapatro, Seetesh Ghose
January-June 2015, 6(1):120-124
DOI:10.4103/0976-9668.149106  PMID:25810648
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.
  1 1,494 253
Reliability of Beta angle in assessing true anteroposterior apical base discrepancy in different growth patterns
Shobha Sundareswaran, Vinay Kumar
January-June 2015, 6(1):125-130
DOI:10.4103/0976-9668.149109  PMID:25810649
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.
  1 2,182 341
Diagnostic role of magnetic resonance cholangiopancreatography in evaluation of obstructive biliopathies and correlating it with final diagnosis and clinical profile of patients
Umesh Chandra Parashari, Sachin Khanduri, Samarjit Bhadury, Deepika Upadhyay, Kaushal Kishore
January-June 2015, 6(1):131-138
DOI:10.4103/0976-9668.149110  PMID:25810650
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.
  1 1,798 225
A Prospective, double-blinded randomized controlled study comparing two different Trendelenburg tilts in laparoscopically assisted vaginal hysterectomy positioning
Shibananda Mallick, Anjan Das, Sanjib Dutta, Surajit Chattopadhyay, Tanuka Das, Rezina Banu
January-June 2015, 6(1):153-158
DOI:10.4103/0976-9668.149115  PMID:25810654
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.
  1 1,523 165
CASE REPORTS
Floral double mesiodentes: A rare case report
Gowri Sankar Singaraju, B Reddy, G Supraja, K Narayana Reddy
January-June 2015, 6(1):229-231
DOI:10.4103/0976-9668.149197  PMID:25810670
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.
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Transanal impalement of double J steel bar with colonic and jejunal injury: A unique pediatric case report
Divya Gupta, Devendra Kumar Yadav, Shasanka Shekhar Panda, Meely Panda, Deepak Bagga, Samir Kant Acharya, Nischal Anand, Bikash Kumar Naredi
January-June 2015, 6(1):217-219
DOI:10.4103/0976-9668.149186  PMID:25810666
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.
  - 1,889 157
A rare case of thyrotoxic periodic paralysis precipitated by hydrocortisone
Subrata Chakrabarti
January-June 2015, 6(1):271-274
DOI:10.4103/0976-9668.149236  PMID:25810683
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.
  - 1,266 154
Rehabilitation of amputed thumb with a silicone prosthesis
Pooja Asnani, Chandu Giriyapura Shivalingappa, Sunil Kumar Mishra, Kirti Somkuwar, Faisal Khan
January-June 2015, 6(1):275-277
DOI:10.4103/0976-9668.149239  PMID:25810684
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.
  - 1,691 228
Hemisection: A conservative management of periodontally involved molar tooth in a young patient
Prashant Babaji, Tarun Sihag, Vishwajit Rampratap Chaurasia, Sivaramalingam Senthilnathan
January-June 2015, 6(1):253-255
DOI:10.4103/0976-9668.149212  PMID:25810677
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.
  - 2,068 360
Computed tomography and magnetic resonance imaging features of a rare case of a primary epidermoid tumor of the jugular foramen
Parag Suresh Mahajan, Anuradha Parag Mahajan, Nawal M Al Moosawi
January-June 2015, 6(1):236-239
DOI:10.4103/0976-9668.149201  PMID:25810672
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.
  - 1,346 165
Multiple hepatocellular adenomas presenting in a male 8 years post-pancreaticoduodenectomy for islet cell tumor of the pancreas
Tom Kevin Gallagher, Udupa K Venkatesh, Donal M Maguire
January-June 2015, 6(1):239-241
DOI:10.4103/0976-9668.149204  PMID:25810673
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.
  - 1,212 247
EDITORIAL
Need for evidence-based practice at grass root level to improve child health and development
Ganesh Kumar, Arun H. S. Kumar
January-June 2015, 6(1):1-2
DOI:10.4103/0976-9668.149068  PMID:25810625
  - 1,790 358
LETTERS TO EDITOR
Reaching the limits of reform: medical education and the Hellenic academic institutions facing the euro-crisis
John Botis, Gregorios Chatzilymperis, Konstantinos Kalafatakis, Nikolina Skandali, Alexandros Skandalis, Naoum Mylonas, Apostolos Zarros
January-June 2015, 6(1):278-279
DOI:10.4103/0976-9668.149246  PMID:25810685
  - 990 138
Tissue antinuclear antibodies in renal biopsies of patients with systemic connective tissue disorders
Seema Chhabra, Shreekant Bharti, Ranjana Walker Minz, Ranjeet Bhardwaj, Neelam Pasricha
January-June 2015, 6(1):279-280
DOI:10.4103/0976-9668.149250  PMID:25810686
  - 1,045 134
RESEARCH ARTICLES
Effects of passive smoking on students at College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh
Abdullah Alanazi, Farhan Al Enezi, Mohammd Mesfer Alqahtani, Turki Faleh Alshammari, Mumtaz Ahmed Ansari, Saleh Al-Oraibi, Shoeb Qureshi
January-June 2015, 6(1):100-105
DOI:10.4103/0976-9668.149100  PMID:25810644
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.
  - 1,791 264
Periodontal health status and treatment needs of the rural population of India: A cross-sectional study
Tegbir Singh Sekhon, Simran Grewal, Ramandeep Singh Gambhir
January-June 2015, 6(1):111-115
DOI:10.4103/0976-9668.149102  PMID:25810646
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.
  - 1,948 301
Effect of dielectric interface on charge aggregation in the voltage-gated K + ion channel
Lipika Adhya, Tarunendu Mapder, Samit Adhya
January-June 2015, 6(1):188-197
DOI:10.4103/0976-9668.149120  PMID:25810659
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.
  - 1,432 182
Contribution and citation Impact of CSIR, India publications during 2007-11
Brij M Gupta, Avinash Kshitig, Ritu Gupta
January-June 2015, 6(1):169-182
DOI:10.4103/0976-9668.149118  PMID:25810657
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.
  - 1,415 188
Health, safety and environment conditions in primary schools of Northern Iran
Seyed Mohammad Asadi Behzadkolaee, Seyed Taghi Mirmohammadi, Jamshid Yazdani, Ali Morad Heidari Gorji, Ameneh Toosi, Mohammad Rokni, Mohammad Ali Heidari Gorji
January-June 2015, 6(1):76-79
DOI:10.4103/0976-9668.149094  PMID:25810639
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.
  - 1,638 213
Retrospective magnetic resonance imaging evaluation of fatty filum terminale in Kuwaiti population
Parag Suresh Mahajan, Nazeer Ahamad, Anuradha Parag Mahajan, Nawal M Al Moosawi
January-June 2015, 6(1):85-88
DOI:10.4103/0976-9668.149097  PMID:25810641
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.
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