Background: Ocular disturbances such as blurring of vision, mydriasis, palpebral ptosis, diplopia, ptosis, enophthalmos, miosis, and blindness (temporary or permanent) are rare complications due to intra-oral local anesthesia. Currently, the guidelines to dentists on preventing and caring for such ocular problems are lacking. Hence, we evaluated the knowledge and attitudes of dentists toward ocular complications of intra-oral anesthesia as a means to assess the need for such guidelines. Materials and Methods: A cross-sectional prospective survey targeting dentists was conducted using a self-administered questionnaire. Totally 500 standardized self-administered questionnaires were sent out by E-mail to practicing dentists or academicians. In total, 390 replies were received, and the data were analyzed. Results: About 39% of graduates and 14% postgraduate dentists knew about ocular complications. Journals were the leading source of information among both graduates and postgraduate dentists. 8.3% graduates and 17.6% postgraduate dentists encountered ocular complications. Interestingly most of the graduates and postgraduates responded that ocular complications are underreported in the literature. 90.5% graduates and 84.3% postgraduates are in the opinion that more research should be carried on ocular complications. 98.3% postgraduates and 97.3% graduates favored the prevention of ocular complications. Conclusion: The dentist's knowledge about ocular complications due to intra-oral anesthesia in our study group is not adequate and needs improvement. Although the awareness and practice of taking preventive measures are satisfactory, there is a need for specific guidelines to dentists in identifying and clinically managing ocular complications of intra-oral anesthesia.

Objective: We analyzed the morphological changes and alkaline phosphatase (ALP) level in fibroblast, which is indicative of their functional ability when cultured in three different commercially available graft materials with osseoconductive property. Materials and Methods: Fibroblasts obtained from fifth passage were seeded within three different bone substitutes (bovine hydroxyapatite [HA] [Osseo-graft ^® ], β-tricalciumphosphate [RTR ^® ], bovine HA [Bio-oss ^® ]) and incubated under standard cell culture conditions. 10 samples in each group were evaluated for cell morphology and alkaline phosphates activity using scanning electron microscopy and spectrophotometric analysis on the 7 ^th day of culture. Results: Fibroblast cultured with RTR ^® showed changes in morphology and increase in ALP activity when compared to fibroblast cultured with Osseo-graft ^® and Bio-oss ^® . Conclusion: Alkaline phosphatase activity was observed in fibroblasts when cultured with three types of commercially available bone grafts. ALP activity was highest when cultured with β-tricalcium phosphate graft material indicating its better bone regenerating capacity of this graft material.

Background: Dermatoglyphic patterns, which are regularly used in judicial and legal investigations, can be valuable in the diagnosis of many diseases associated with genetic disorders. Dental caries although of infectious origin, may have a genetic predisposition. Hence, we evaluated the correlation between dental caries and dermatoglyphic patterns among subjects with and without dental caries and evaluated its association with environmental factors such as salivary pH. Materials and Methods: Totally, 76 female students within the age group of 18-23 years were clinically examined, and their decayed, missing, filled teeth (DMFT) score and oral hygiene index-simplified were recorded. Based on their DMFT score, they were divided into following three groups; group I (n = 16, DMFT score = 0), group II (n = 30, DMFT score <5), and group III (n = 30, DMFT score ≥5). Their fingerprint patterns and salivary pH were recorded and analyzed using descriptive statistics. Results: Dermatoglyphic pattern distribution in caries-free group showed more ulnar loops than high caries group (group III) while high caries group showed more whorl patterns. Presence of whorl with double loop, whorl within a loop was associated with high DMFT score. The total finger ridge count was lower in caries group. The mean salivary pH was higher in caries-free group than high caries group. Thus, we conclude that dermatoglyphic patterns may be potential diagnostic tool for detecting patients prone to develop dental caries.

Aim: We aimed to evaluate the prevalence of Candida and Streptococci species in the oral cavity of Down syndrome patients. Materials and Methods: 50 children/adolescents with Down syndrome with a karyotype of 47 XX, 21+ (female) and 47 XY, 21+ (male), and 50 normal children/adolescents were included in our study. Oral swab/saliva was used to culture and identify Candida and Streptococci species based on gram and periodic acid schiff staining. Results: Of the 50 study group samples, which were cultured, 37 (74%) showed growth of Candida colonies, whereas in the 50 control samples only 18 (36%) were positive for Candida growth. In 4 Sabouraud's dextrose agar culture slopes of the study group, more than one morphological type of colonies were observed. 23 out of 50 samples in our study group had Streptococcus viridans colonies. In the 23 samples positive for Streptococci 16 had many streptococcal colonies, and 7 had few streptococcal colonies in the primary culture. 32 out of 50 samples from the control group had S. viridans colonies. In these 32 samples positive for Streptococci, 29 had predominantly streptococcal colonies while 3 had few streptococcal colonies in the primary culture. Conclusion: The oral cavity is an environment heavily colonized by microorganisms, however, the Down syndrome patients run a greater risk of having opportunistic infections especially from Candida species. Hence to improve the quality of life of an individual with Down syndrome, it is necessary to diagnose and treat these infections by more frequent oral microbial assessment.

Background: Analysis of palatal rugae patterns, which are similar to fingerprints, is one of the techniques used in forensic sciences for human identification. As palatal rugae patterns are genetically determined, they can also be used in population differentiation and gender determination. Hence, we aimed to record the distribution of the predominant rugae pattern in Kerala population. Materials and Methods: A total of 100 maxillary study models (40 males and 60 females) recorded from Kerala population within the age group of 17-25 years were analyzed. The dental casts were examined for the interpretation of the total number, length, shape, location and unification of rugae. Chi-square test and unpaired t-test were employed for statistical analysis. Result: The total number of rugae was significantly (P < 0.001) greater in females than males. Regarding the shape, wavy pattern predominated in both males and females, followed by curve, straight, divergent, convergent and circular pattern. Circular pattern was more in males than females. The rugae patterns were located more in between mesial aspect of first premolar to mesial aspect of second premolar. Conclusion: The palatal rugae and their features of an individual may be considered as a reliable guide for identification purpose, provided antemortem casts are available. Nevertheless, gender differentiation is evident in terms of number and shape of rugae.

Background: Predentin, the unmineralized organic matrix is important in maintaining the integrity of dentin. It is usually thick where active dentinogenesis occurs. A wide variation in its thickness is reported. Hence, we determined the variation in predentin thickness at various sites of different age groups. Materials and Methods: 60 freshly extracted teeth (maxillary and mandibular first premolars) were divided into three groups with 20 teeth in each as, Group 1 - teeth with incomplete root formation (age <16 years), Group 2 - teeth with complete root formation (aged between 16 and 30 years), Group 3 - teeth of patients aged above 30 years. The teeth were fixed, decalcified and sections of 6 μ thickness were obtained, and stained with hematoxylin and eosin. The distance between the odontoblastic cell layers of the pulp to the border line of the dentin was considered for the measurement of the predentin thickness. A total of nine sites were considered for each specimen. Results: The present study revealed varied mean predentin thickness at all nine sites in all three age groups. Maximum and minimum thickness was observed at the apex and pulp floor respectively in all three groups. There was a statistical significant difference in predentin thickness between groups 1 and 3 and 2 and 3. Conclusion: The predentin thickness in the first group gradually increased toward the growing end near the apex, while it was relatively constant in the second group and increased overall thickness at all the sites in the third group. A notable finding was a linear increase with age in width of the predentin and the thickness vary as a function of odontoblastic activity during different stages of tooth development.

Despite over 2.3 million (26% of global burden) cases of tuberculosis (TB) in India the accurate diagnosis of childhood TB remains a major challenge. Children with TB usually have paucibacillary disease and contribute little to disease transmission within the community. Consequently the treatment of children with TB is often not considered a priority by TB control programmes. Adequate and timely assessment of TB infection in childhood could diminish epidemiological burden as underdiagnosed pediatric patients can eventually evolve in to an active state and have the potential to disseminate the etiological agent Mycobacterium tuberculosis, notably increasing this worldwide public health problem. In this review we discuss the most important recent advances in the diagnosis of childhood TB: (1) Symptom-based approaches, (2) novel immune-based approaches, including in vitro interferon-γ IGRA release assays IGRA tests; and (3) bacteriological and molecular methods that are more rapid and/or less expensive than conventional culture techniques for TB diagnosis and/or drug-resistance testing. Recent advances have improved our ability to diagnose latent infection and active TB in children, nevertheless establishing a diagnosis of either latent infection or active disease in HIV-infected children remains a major challenge.

Despite the complexities of the relationship between vestibular stimulation and endocrine disorders being well known, research efforts to understand these complexities are lacking. Interestingly vestibular stimulation may potentially prevent/delay development/progression of diabetes. Here we review the science behind this concept and highlight the need for necessary translational research in this area. Current evidence supports the use of vestibular stimulation not only as a potential intervention to prevent or delay the development of diabetes mellitus in at-risk population, but also to use it as supplementary therapy for diabetic patients management. We urge clinicians to recommend vestibular stimulation by simple means like swing as a goal in maintaining a healthy lifestyle.

Background: Cervical cancer is the most common cancer among Indian women of reproductive age. Unfortunately, despite the evidence of methods for prevention, most of the women remain unscreened. The reported barriers to screening include unawareness of risk factors, symptoms and prevention; stigma and misconceptions about gynecological diseases and lack of national cervical cancer screening guidelines and policies. This study attempts to assess the knowledge, attitude, and practices related to cervical cancer and its screening among women of reproductive age (15-45 years). Materials and Methods: A facility-based cross-sectional study was done on 400 females of reproductive age who presented to out-patient-department of All India Institute of Medical Sciences Bhopal. Structured questionnaire consisting 20 knowledge items and 7-items for attitude and history of pap smear for practices were administered by one of the investigators after informed consent. Data were entered and analyzed using Epi-Info version 7. Qualitative variables were summarized as counts and percentages while quantitative variables as mean and standard deviation. Predictors of better knowledge, attitude, and practices were identified by binary logistic regression analysis. Results: A total of 442 women were approached for interview of which 400 responded of which two-third (65.5%) had heard of cervical cancer. At least one symptom and one risk factor were known to 35.25% and 39.75% participants. Only 34.5% participants had heard, and 9.5% actually underwent screening test, however, 76.25% of the participants expressed a favorable attitude for screening. Binary logistic regression analysis revealed that education age and income were independent predictors of better knowledge. Education level influences attitude toward screening and actual practice depends on age, income, and marital status. This study shows that despite the fact that women had suboptimal level of knowledge regarding cervical cancer, their attitude is favorable for screening. However, uptake is low in actual practice. Strategic communication targeting eligible women may increase the uptake of screening.

Background: We evaluated the influence of lifestyle patterns such as watching TV, working with computer and idle sitting time on perceptions of obesity and beliefs about overweight are associated with obesity and overweight amongst Expatriates in Abha. Materials and Methods: The method used in this study was a cross-sectional survey with a self-administered paper-based questionnaire. The survey collected information on lifestyle choices and the risk factors that contribute to obesity. In addition, height and weight were measured. Results: Greater number of our study subjects spent over 2 h/day without any physical activity, specifically accounting for over 2 h/day each in viewing TV, computer, and spending idle time. This increased lack of physical activities was significantly associated with overweight. While the overweight subjects were aware of very wide options for treating their condition, a significant number believed in self-effort in managing their diet and exercise regimen as the best efforts to reduce their overweight. Interestingly very few overweight subjects considered medication or surgery as a potential therapeutic option and 75% of the overweight subjects considered overweight to be of no or only slight concern on wellbeing. Conclusions: Overweight and obesity among expatriates within Saudi Arabia poses an important public health problem. The lack of awareness about the potential impact of obesity on health and optimal treatment options is a serious concern, which needs to be addressed by appropriate public health programs at national level.

Background and Objective: The safety of Mn ₂ O ₃ nanoparticles (which are extensively used in industries) on male reproductive system is not known. Hence, we investigated the effects of Mn ₂ O ₃ nanoparticles on male reproductive system. Materials and Methods: A total of 40 Wistar adult male rats were randomly assigned to four groups of 10 rats each. Three groups received Mn ₂ O ₃ solution in concentrations of 100, 200, and 400 ppm orally for 14 days; the control group received equal volume of saline solution. Blood samples and testicles were collected for analysis. Results: Significant reduction in luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone, spermatogonial cells, primary spermatocyte, spermatid and Leydig cell was observed in the Mn ₂ O ₃ nanoparticles treated groups compared with controls. Conclusion: Mn ₂ O ₃ nanoparticles significantly reduce FSH, LH, and testosterone levels resulting in a significant reduction in testicular cytology.

Aim: We evaluated the effect of incorporating Fluconazole, Chlorhexidine Gluconate, and Silver-Zinc Zeolite as bioactive materials (10% of mass) on the flexural strength of commercially available heat-cured polymethyl methacrylate (PMMA; Travelon). Materials and Methods: The following four groups were compared; Group 1: Control group with pure PMMA, Group 2: Antibacterial drug group with chlorhexidine gluconate in powder form + PMMA, Group 3: Antifungal drug group with fluconazole in powder form + PMMA, Group 4: Antimicrobial agent group with silver zinc zeolite in powder form + PMMA. After processing, the specimens were subjected for flexural strength testing using three-point bending test in a universal testing machine. Results: A significant (P < 0.0001) decrease in flexural strength following incorporation of Fluconazole, Chlorhexidine Gluconate, and Silver-Zinc Zeolite to heat polymerized acrylic resin was observed when compared with the control group. The decrease in mean flexural strength was minimal in the fluconazole group. Conclusion: Although the addition of a bioactive material to PMMA acrylic is desirable, it is not practical as it reduces flexural strength of the acrylic base.

Objectives: The objective was to estimate the level of alkaline phosphatase (ALP) in gingival crevicular fluid (GCF) during en-masse retraction stage of orthodontic tooth movement. Materials and Methods: 10 patients in the age group of 15-20 years participated in this study. GCF was sampled from the distal surface of the canine and mesial surface of the second premolar on day 0, 1, 7, 14, 21, and 28 postorthodontic treatment. Results: A marked fall in the level of ALP was evident following force application. A progressive decreasing trend in ALP activity on both distal aspect of canine and mesial aspect of the second premolar was observed. The fall in ALP was more on distal aspect canine when compared to the mesial aspect of the second premolar. Conclusions: Measure of ALP activity in GCF could be an indicator of the biochemical and cellular alterations in bone turnover and hence rate the amount of tooth movement following orthodontic force application.

Background: Early identification of the prehypertensive state can greatly improve the disease risk management. Although increased levels of highly sensitive C-reactive protein (hsCRP) and dyslipidemia is reported among patients with hypertension, the correlation of these parameters among prehypertensives in not known. Hence, the present study was designed to compare the levels of serum hsCRP and lipid profile among prehypertensives and normal subjects and correlate it with blood pressure (BP) levels. Materials and Methods: Anthropometric measurements and BP were recorded in 40 prehypertensive and 40 normal subjects. Subjects were assigned to a group based on their BP as per Joint National Committee 7 criteria. Serum hsCRP and lipid profile were measured and correlated with BP levels. Results: Serum hsCRP showed no significant difference between the two groups. There was no significant correlation of BP with hsCRP in both the groups. Total cholesterol (TC) and low-density lipoprotein (LDL) were significantly increased in prehypertensives as compared to normal subjects. There was no significant association between BP and lipid parameters in prehypertensives. Conclusions: Significant increase of TC and LDL but not hsCRP was evident among prehypertensives as compared to normal subjects.

Background: The major aim of this work was to study the protective effects of fish oil (FO), allopurinol, and verapamil on hepatic ischemia-reperfusion (IR)-induced injury in experimental rats. Materials and Methods: Sixty male Wistar albino rats were randomly assigned to six groups of 10 rats each. Group 1 served as a negative control. Group 2 served as hepatic IR control injury. Groups 3, 4, 5, and 6 received N-acetylcysteine (standard), FO, allopurinol, and verapamil, respectively, for 3 consecutive days prior to ischemia. All animals were fasted for 12 h, anesthetized and underwent midline laparotomy. The portal triads were clamped by mini-artery clamp for 30 min followed by reperfusion for 30 min. Blood samples were withdrawn for estimation of serum alanine transaminase (ALT) and aspartate transaminase (AST) activities as well as hepatic thiobarbituric acid reactive substances, reduced glutathione, myeloperoxidase, and total nitrate/nitrite levels, in addition to histopathological examination. Results: Fish oil, allopurinol, and verapamil reduced hepatic IR injury as evidenced by significant reduction in serum ALT and AST enzyme activities. FO and verapamil markedly reduced oxidative stress as compared to control IR injury. Levels of inflammatory biomarkers in liver were also reduced after treatment with FO, allopurinol, or verapamil. In accordance, a marked improvement of histopathological findings was observed with all of the three treatments. Conclusion: The findings of this study prove the benefits of FO, allopurinol, and verapamil on hepatic IR-induced liver injury and are promising for further clinical trials.

Background: Obesity and hypertension among school children have a huge impact on public health. Hence, we estimated the prevalence and sociodemographic correlates of childhood obesity and elevated blood pressure (BP) among adolescent schoolchildren (11-19 years) in urban areas of Gangtok, Sikkim, India. Materials and Methods: A population based cross-sectional study was conducted on 979 school children, during November 1, 2009 - April 30, 2010 in Gangtok, East Sikkim India. Anthropometric measurements and BP were recorded among the study population. Obesity and hypertension prevalent among adolescent school children and their correlates were analyzed. Results and Conclusion: Prevalence of obesity, overweight, and hypertension was 2.04%, 14.5% and 5.62%, respectively. The average fast food intake, screen time and limited outdoor activities were significantly associated with obesity. Increase in abdominal height positively correlated with increase in body mass index and body fat; however waist - hip ratio was not a reliable index. The burden of overweight/obesity as well as hypertension with all its associated risk was found to high among our study population, which necessitates framing of policies and actions at national level to address the risk associated with these noncommunicable diseases.

Objectives: The present study was conducted for isolation, screening, and identification of Azotobacter and Trichoderma from different soil samples. Methods: A total of 10 isolates of Azotobacter and Trichoderma were isolated from rhizospheric soils. The test isolates were biochemically characterized and screened in in-vitro conditions for their plant growth promoting properties. DNA polymorphism of isolates was studied using randomly amplified polymorphic DNA analysis. Results: A total of 41 bands were scored, out of which 35 bands were found to be 85.59% polymorphic in Azotobacter and in Trichoderma among total 37 bands scored of which 29 were found to be 78.37% polymorphic. The influence of isolated plant growth promoting rhizobacteria (PGPR) strains on plant growth was studied using different parameters such as height of the plant, number of leaves, and number of branches, and bio-control activity was studied. Conclusion: The present results concluded that the multiple beneficial activities of PGPR traits increase the plant growth and bio-control activity.

Background: In recent years, herbal products have been suggested as an economic, safe and probably effective alternative for prevention and control of various oral diseases. But still there are some products which need to be evaluated. Of lately, Propolis is one such product. To assess and compare the efficacy of herbal dentifrice containing Propolis with Miswak and Colgate total toothpastes in controlling plaque formation. Materials and Methods: A double blind, randomized, crossover study design was conducted among thirty healthy dental students. After oral prophylaxis all subjects were given a washout product for one week period. Subjects were then made to brush with (washout product) for 1 minute followed by 1 minute brushing with assigned test product. The baseline MGMPI plaque scores were recorded. Subjects were then refrained from oral hygiene for 24 hours, and were recalled to be re-disclosed and re-measured for plaque formation. This procedure was repeated according to crossover design after a washout period of (2 week). Statistical tests used were Krukalwallis and Wilcoxon sign rank test. Results: There was a significant difference in 24 hour score between the test products evaluated. When the change from baseline to 24 hours was analyzed, the test product Propolis resulted in a consistently and significantly (p < 0.05) lower MGMPI mean scores than the Colgate Total and Miswak toothpastes. Conclusion: Propolis was found to be safe and effective in reducing plaque accumulation when compared to Miswak and Colgate total toothpaste.

Aim: We aimed to determine the epidemiology and symptoms of red eyes in patients from Northern Iran. Materials and Methods: A descriptive study was planned involving 840 patients referred to the eye clinic of Bu-Ali Sina hospital in Sari, Iran, with the chief complaint of eye redness. Results: Of 840 patients, 525 were men (62.5%) and 315 were women (37.5%). Most of the patients were over 39 years of age. 55.7 percentage of them lived in cities and 44% were from villages. The most common eye symptoms with eye redness were: Eye abrasion (57%), tears in eyes (49%) and swollen eye lid (30%). Red eyes without any symptoms in eyes were diagnosed as runny nose (4.2%) and headaches (3.4%). 11.9% and 19.6% of the patients had a previous history of red eye and had visited doctors for red eyes respectively. Conclusions: Red eyes are more common in men than women. Introducing dangerous causes of red eyes in the future can help to health care professional to on time diagnosis of red eyes related problems.

Background: Identifying the commonly prevailing health and nutritional disorders in school going children is essential to initiate appropriate public health measures. Materials and Methods: A cross-sectional prospective study was designed to conduct a detail physical health assessment of children studying in class 1-8 (age- 5-13 years) of 31 schools of Ahmedabad city, India between December 2011 and February 2012. Under the school health program of state government, medical history, height, weight and general physical examination findings, including dental and ophthalmic examination were recorded by qualified medical practitioners. Children with abnormal results were further investigated and treated by the subject experts. Result: Total 28,256 children were screened (boys-15,087 and girls-13,169). Mean weight and height of the children were 27.04 kg and 128.81 cm, respectively. Analysis of nutritional status of the cohort population as compared to body mass index standards revealed that 8319 (29.44%) children were underweight while only 221 (0.78%) children were either overweight or obese. The subgroup analysis of basic nutrition indices in children revealed prevalence of significant malnutrition (based on Indian Council of Medical Research standards) in children below 10 years of age. Commonly prevailing health disorders included worm infestation (42%), upper respiratory tract infection (36.39%), anemia (30.99%) dental caries (25.19%) and refractory errors (10.2%). Conclusions: Malnutrition and related health disorders are commonly prevailing childhood diseases in the urban community and can effectively be addressed by appropriate public health program.

Background: Use of opioids for perioperative analgesia is associated with sedation, respiratory depression and postoperative nausea and vomiting. N-methyl-D-aspartate receptor antagonist such as ketamine has both analgesic and antihyperalgesic properties. We studied the effect of intraoperative infusion of low-dose ketamine on postoperative analgesia and its management with opioids. Materials and Methods: A total of 80 patients scheduled for open cholecystectomy under general anesthesia were randomly allocated into two equal groups in a randomized double-blinded way. The general anesthetic technique was standardized in both groups. Group K patients (n = 40) received bolus of ketamine 0.2 mg/kg intravenously followed by an infusion of 0.1 mg/kg/h before skin incision, which was continued up to the end of surgery. Similar volume of saline was infused in Group C (n = 40). The pain score at different intervals and cumulative morphine consumption over 24 h was observed. Secondary outcomes such as hemodynamic parameters, patient satisfaction score and incidences of side effects were also recorded. Results: Intraoperative infusion of low-dose ketamine resulted in effective analgesia in first 6 h of the postoperative period, which was evident from reduced pain scores and reduced opioid requirements (P = 0.001). The incidence of side effects and patient satisfaction were similar in both groups. Conclusion: Intraoperative low-dose ketamine infusion provides good postoperative analgesia while reducing need of opioid analgesics, which must be considered for better management of postoperative analgesia.

Background: Production of β-lactamase enzymes by Gram-negative bacteria is the most common mechanism to acquire drug resistance to β-lactam antibiotics. Limitations in detecting extended spectrum β-lactamases (ESBL) and Amp-C β-lactamases have contributed to the uncontrolled spread of bacterial resistance and are of significant clinical concern. Materials and Methods: A total of 148 samples was selected on the basis of resistance against third-generation cephalosporin for screening ESBLs and Amp-C β-lactamases production. These multidrug-resistant strains were phenotypically screened for ESBL production by phenotypic confirmatory disc diffusion test and double disc synergy test. Modified three-dimensional method was used for Amp-C β-lactamases detection. Result: Among the 148 isolates, 82 (55.40%) were ESBL producers, and 115 (77.70%) were Amp-C β-lactamases producers. Co-existence of ESBL and Amp-C was observed in 70 (47.29%) isolates. Escherichia coli was the most common ESBL and Amp-C β-lactamase producer. All ESBL producers were highly resistant to ciprofloxacin (83.10%), cotrimoxazole (95.27%), and gentamicin (89.18%). However, these bacterial strains were sensitive to imipenem 146 (98.64%) and piperacillin/tazobactam 143 (96.62%). Conclusion: Our study showed that ESBL producing organisms were not only resistant to cephalosporins but also to other group of drugs and also that multiple mechanisms play a role in drug resistance among Gram-negative bacteria.

Aim: We evaluated the potential of magnetic resonance imaging (MRI) in the diagnosis of spinal infections and specifically its accuracy in differentiating tubercular and pyogenic spondylodiscitis. Materials and Methods: Totally, 50 patients referred for MRI scans with the clinical diagnosis of spinal infections were included in our study. The patients were classified as tubercular (TS), pyogenic (PS), and indeterminate spondylodiscitis on the basis of imaging findings and were correlated with the final diagnosis made by histopathology/cytology/culture/biochemistry or with successful therapeutic outcome. Imaging findings were subsequently analyzed for differentiating tubercular and pyogenic spondylodiscitis using the Chi-square test. Results: The most common pattern of spinal infection was spondylodiscitis (78% incidence rate) with epidural extension (86%) and cord compression (64%) being most common complications observed. Imaging (postcontrast study) and final diagnosis correlated in 93.7% tubercular (sensitivity of 75% and specificity of 90%) and 75% pyogenic (sensitivity of 90% and specificity of 83.3%) spondylodiscitis. The patients with tubercular spondylitis had a significantly (P < 0.05) higher incidence of following MRI findings: A well-defined paraspinal abnormal signal (80% in TS vs. 40% in PS), a thin and smooth abscess wall (84.2% in TS vs. 10% in PS), presence of intraosseous abscess (35% in TS vs. 0% in PS), focal and heterogenous enhancement of the vertebral body (75% in TS vs. 20% in PS), vertebral destruction more than or equal to grade 3 (71.8% in TS vs. 0% in PS), loss of cortical definition (75% in TS vs. 20% in PS), and spinal deformity (50% in TS vs. 5% in PS). Conclusion: Contrast-enhanced images improve the sensitivity and specificity of detection and differentiation of tubercular and PS.

Background: Resistance to commonly used antibiotics by Enterococci causing nosocomial infections is of concern, which necessitates judicious, responsible and evidence-based use of antibiotics. The present study was conducted to review the prevalence and identify therapeutic options for nosocomial Enterococcal infections in our tertiary care hospital. Materials and Methods: Isolates identified by morphological and biochemical characteristics were tested for antibiotic susceptibility using Kirby-Bauer method. Result: 153 of 2096 culture positive clinical samples comprised of 101 urine, 30 wound swab/pus, 13 blood and 09 high vaginal swab isolates were identified as Enterococcus faecalis (90.85%), Enterococcus faecium (8.50%) and Enterococcus gallinarum (0.65%). Enterococci accounted for 8.45%, 4.53%, 4.23%, 4.43% of urinary, wound swab or pus, blood, high vaginal swab isolates respectively, causing 7.3% of all nosocomial infections. Significant number of Enterococci isolated from nosocomial urinary tract infection (66.01%) and wound infections (19.6%) were multidrug resistant (MDR). Although all isolates were sensitive to vancomycin and linezolid, resistance to erythromycin (71.24%) and ciprofloxacin (49.67%) was frequently observed. High-level gentamicin resistance was observed in 43.88%, and 61.53% of E. faecalis and E. faecium isolates respectively. Minimal inhibitory concentration of vancomycin of all the isolates were ≤1 μg/ml. 7% of the Enterococcal isolates were MDR strains and vancomycin or linezolid were the only effective antibiotics. Conclusion: A combination of vancomycin and/or linezolid were effective against Enterococci causing nosocomial infections in our tertiary care facility, nevertheless continuous and frequent surveillance for resistance patterns are necessary for judicious and evidence based use of antibiotics.

Background: Exposure to radiation during radiological investigations is of health concern, which referring physicians should rationalize. Hence, we assessed the clinician's awareness and concern of radiation exposure to patients, in relation to their referral practice. Materials and Methods: A prospective study was conducted involving specialists from Punjab (India), who were handed a standard set of questionnaire concerning knowledge of radiation hazards and doses from imaging procedures, consideration of radiation dose and age when referring, referrals not likely to affect treatment, and use of referral guidelines were included. Of the 150 medical doctors given the questionnaire, 106 returned it. Results: Majority of the clinicians underestimated radiation doses, while a few overestimated it. Almost half of the clinicians (55.5%) favored to select the rationale of asking about previous radiological examinations as clinical need only, which was surprising. Rates of referrals unlikely to affect treatment were more (66%) than reported rates in previous studies. Worryingly, only 30.1% of the clinicians had knowledge of referral guidelines and alarmingly only 10.5% had made use of it. Conclusions: Our study although in a small population size identifies inadequate knowledge on radiation and its guidelines among referral physicians, which warrants the immediate need for training programs to bridge this knowledge gap.

Aims: We assessed the impact of detecting anti-thyroid peroxidase antibodies (anti-TPO-Ab) in the first trimester of pregnancy on pregnancy outcomes and maternal thyroid function during the postpartum period. Materials and Methods: In a prospective study consisting 400 pregnant women (8-12 weeks pregnant) were screened for their thyroid profile and followed-up to 12 weeks postpartum. Patients with abnormal thyroid function at 12 weeks postpartum were further followed-up with repeated assessment of thyroid stimulating hormone (TSH) and serum-free thyroxine-4 levels at 8 weeks interval up to 12 months postpartum. Results: 11.5% of the subjects were positive for anti-TPO-Ab who had mean TSH level of 2.31 μIU/ml, which was significantly (P- 0.0001) higher than pregnant women negative for anti-TPO-Ab (1.73 μIU/ml). Increased incidence of miscarriage was observed in anti-TPO positive mothers when compared to antibody negative mothers. Postpartum thyroid dysfunction developed in 4.7% cases at 12 weeks, among them antibody positivity was observed in 81.25% of subjects. In 18.75% mothers positive for anti-TPO-Ab, the thyroid dysfunction persisted up to 12 months postpartum. Conclusions: Thyroid antibodies detected in early pregnancy seems to be predicting pregnancy complications and later maternal thyroid disease related morbidity.

Background: Most commonly practiced surgical "lay open" technique to treat fistula-in-ano (a common anorectal pathology) has high rate of recurrence and anal incontinence. Alternatively, a nonsurgical cost efficient treatment with Ksharasutra (cotton Seton coated with Ayurvedic medicines) has minimal complications. In our study, we have tried to compare these two techniques. Materials and Methods: A prospective randomized control study was designed involving patients referred to the Department of General Surgery in RG Kar Medical College, Kolkata, India, from January 2010 to September 2011. Results: Among 50 patients, 26 were in Ksharasutra and 24 were in fistulotomy group. 86% patients were male and 54% of the patients were in the fourth decade. About 74% fistulas are inter-sphincteric and 26% were of trans-sphincteric variety. Severe postoperative pain was more (7.7% vs. 25%) in fistulotomy group, while wound discharge was more associated with Ksharasutra group (15.3% vs. 8.3%). Wound scarring, bleeding, and infection rate were similar in both groups. Ksharasutra group took more time to heal (mean: 53 vs. 35.7 days, P = 0.002) despite reduced disruption to their routine work (2.7 vs. 15.5 days work off, P <0.001). Interestingly, pain experienced was less in Ksharasutra group, there was no open wound in contrast to fistulotomy and it was significantly cost effective (Rupees 166 vs. 464). Conclusion: Treatment of fistula-in-ano with Ksharasutra is a simple with low complications and minimal cost.

Background: We evaluated the cost of different components of the national program for control of blindness (NPCB) and assess the cost effectiveness of this program. Materials and Methods: An observational study was conducted in Jorhat District of Assam, India from July 2009 to June 2010 for assessing the cost effectiveness of the NPCB. Four broad categories of cost inputs, that is, capital costs, recurrent costs, prime/variable costs, and fixed costs were considered. The cost incurred by the provider was taken as the actual cost of delivery of different component of services to the patients, which was calculated from the costs of labor, material, and capital costs using the time utilization pattern recommended by WHO. Result: The District Blindness Control Society, Jorhat had spent 58.93% of total expense on fixed heads of which 65.86% had been spent for cataract surgery. The medical care cost was found to be Indian rupee (INR) 425 for intracapsular cataract extraction (ICCE), INR 675 for extracapsular cataract extraction + intraocular lens (ECCE + IOL) and INR 225 for refractive error correction. The patient-wise provider cost was estimated to be INR 519 for ICCE, INR 769 for ECCE + IOL implantation and INR 319 for spectacle correction of refractive error. Conclusion: National program for control of blindness is a cost effective means of controlling and treating blindness.

Medicinal properties of Asparagus racemosus (vernacular name: Shatavari) are attributed to its steroidal saponins called shatavarins. This plant is facing the threat of being endangered due to several developmental, seasonal constrains and malpractices involved in its collection and storage. To support its conservation, a tissue culture protocol is standardized which produces 20 fold higher levels of shatavarin. Here we evaluate the bioactivity and immunomodulatory potential of in vitro produced shatavarins from cell cultures of AR using human peripheral blood lymphocytes. In vitro produced shatavarin stimulated immune cell proliferation and IgG secretion in a dose dependent manner. It stimulated interleukin (IL)-12 production and inhibited production of IL-6. It also had strong modulatory effects on Th1/Th2 cytokine profile, indicating its potential application for immunotherapies where Th1/Th2 balance is envisaged. Our study demonstrating the bioactivity of tissue cultured AR extracts supports further in vivo evaluation of its immunomodulatory efficacy.

Background: Gastric ulcer is one of the most serious diseases. Most classic treatment lines produce adverse drug reactions. Therefore, this study aimed to investigate the protective effects of two natural extracts, namely ginger and marshmallow extracts, on indomethacin-induced gastric ulcer in rats. Materials and Methods: Animals were divided into five groups; a normal control group, an ulcer control group, and three treatment groups receiving famotidine (20 mg/kg), ginger (100 mg/kg), and marshmallow (100 mg/kg). Treatments were given orally on a daily basis for 14 days prior to a single intra-peritoneal administration of indomethacin (20 mg/kg). Results: Indomethacin administration resulted in significant ulcerogenic effect evidenced by significant elevations in ulcer number, ulcer index, and blood superoxide dismutase activity accompanied by significant decreases in gastric mucosal nitric oxide and glutathione levels. In addition, elevations in gastric mucosal lipid peroxides and histamine content were observed. Alternatively, pretreatment with famotidine, ginger or marshmallow significantly corrected macroscopic and biochemical findings, supported microscopically by results of histopathological study. Conclusion: These results demonstrate that administration of either ginger or marshmallow extract could protect against indomethacin-induced peptic ulcer in rats presumably via their antioxidant properties and inhibition of histamine release.

Background: Amphibians have provided a remarkable array of biological active compounds, which are secreted from socalled granular skin glands which serve to protect the amphibians from predators due to its noxious effects on buccal tissue and at least in the case of some peptides, to protect from bacterial (or) protozoan infections. Given the respiratory and antimicrobial functions of amphibian skin, it is likely that some of the novel molecules found in amphibian granular gland secretions might be of use in the treatment of skin and respiratory infections. Secretions from common Indian toad (Bufo melanostictus) a member of Bufonidae family has the history of medicinal use however the anti-diabetic activity is not reported. The present study is aimed to determine whether paratoid gland extract have any influence on the diabetes and the pharmacokinetics and pharmacodynamics of glimepiride (GLM) in normal and diabetic rats. Materials and Methods: An aqueous and methanolic extracts of paratoid glandular secretions were prepared, air dried and used to determine the antidiabetic activity in rats. The blood sampling was done at preset time intervals between 0, 0.5, 1, 2, 4, 6, 8 and 12 h, using heparinized capillaries. The blood glucose levels are estimated by glucose oxidase-peroxidase method, and reversed-phase high-performance liquid chromatography is used to determine the pharmacokinetic parameters of GLM using glibenclamide as an internal standard. Results: Both the aqueous and methanolic extracts produced better glycemic control in diabetic rats, and methanolic extract is better than the aqueous extract. Serum concentrations of GLM increased at 2 ^nd h, and the percentage glucose reduction is maximal at the 4 ^th h with both aqueous and methanolic extracts of paratoid secretions of common Indian toad. Conclusions: Paratoid gland secretions of the common Indian toad is antidiabetic, in addition it has beneficial effects in combination with GLM. Further, it requires the systematic structure elucidation of the compounds and pharmacokinetic studies to explore the beneficial effects.

Variable atypical symptoms are commonly observed in malaria caused by Plasmodium falciparum especially in endemic tropical nations such as India. Nystagmus is observed following involvement of the cerebellum especially during the postrecovery phase. While psychotic features such as severe agitation, hallucination, paranoia may be the early symptoms of falciparum malaria among pediatric patients, urticaria with or without fever can be the initial manifestation of the disease. As the morbidity and mortality of severe malaria are very high in India, these atypical presentations should be considered during diagnosis. We believe our report on atypical cases of falciparum malaria will sensitize doctors and health personnel about rare presentations in children and help in early diagnosis and management to reduce the severity and death toll due to the disease.

Type 1 neurofibromatosis (NF1), which mainly involves ectodermal tissue arising from the neural crest, can increase the risk of developing malignant peripheral nerve sheath tumors (MPNSTs), soft tissue sarcomas and subarachnoid hemorrhage. We describe a patient with neurofibromatosis type 1 who developed soft tissue sarcoma, MPNST, and subarachnoid hemorrhage. A 22-year-old male reported right focal seizures consequence to severe headache. He had a weakness in both legs, could walk only with the support of a stick for the last 3 months and suffered from constipation and intermittent urinary retention for the past 1 week. The patient had a history of swelling in the back of left thigh for which surgical resection was done 6 months back. Cutaneous examination revealed multiple nodules of varying sizes all over the body, along with many café-au-lait spots and Lisch nodule in iris. Patient had weakness in bilateral hip abduction, extension, knee flexion, extension and ankle dorsiflexion and plantiflexion. Bilateral ankle reflexes were absent while other deep tendon reflexes were sub-optimal. A noncontrast computed tomography brain indicated subarachnoid hemorrhage in left perisylvian region. Ultrasound of left thigh showed a hypoechoic solid lesion in the posterior aspect of left thigh in muscle plane. Histopathology of the lesion following resection showed features suggestive of a low-grade pleomorphic rhabdomyosarcoma. Histology of cutaneous nodules was consistent with neurofibroma. Magnetic resonance imaging of the lumbosacral spine demonstrated a tumor arising from cauda equina. Histopathological examination of the tumor suggested high-grade MPNST. Unfortunately, the patient's MPNST was inoperable, and he received palliative radiotherapy for local control of the disease. The care of a patient with neurofibromatosis requires a comprehensive multisystem evaluation. MPNST occurs in 8-13% patients with neurofibromatosis. Early diagnosis and surgical resection are key to prolong survival. Though rare, rhabdomyosarcoma can occur with a higher frequency in NF1, necessitating through clinical investigation. Subarachnoid hemorrhage can occur due to aneurismal rupture or vascular friability in NF1 patients.

A case of a 42-year-old man with back pain associated with left radiculopathy and infiltrative mass involving the T12 and L5 vertebrae is described. Magnetic resonance imaging (MRI) and computed tomography indicated aggressive hemangiomas involving the T12 and L5 vertebrae. Three-year follow-up by imaging indicated minimally increased aggressiveness of the L5 lesion without any significant change in appearance of the T12 lesion thus, confirming the initial diagnosis of multiple aggressive vertebral hemangiomas.

Successful root canal therapy requires an accurate diagnosis and management of complex root canal morphology. Although the occurrence of three root canals in maxillary and mandibular premolars is very rare, the clinician must be able to identify it clinically and radiographically to make the necessary changes in his shaping and obturation techniques. We present the endodontic management of a maxillary first premolar with three separate roots and canals, which was diagnosed with the aberrant anatomy only after the access preparation. Then, a mandibular premolar with three root canals and fused roots, which were diagnosed radiographically, is presented. The necessary modifications of the routine clinical steps and the application of dental operating microscope for successful management of the complex anatomy, with emphasis on access modifications and radiographic interpretations are also explained. Teeth with extra roots and/or canals pose a challenge in clinical management. Identifying them early is necessary to facilitate appropriate modifications in treatment protocol, armamentarium to be used and plan optimal number of treatment sittings.

Trauma to the anterior teeth affects the esthetic and psychological well-being of the patient. Advancement in the adhesive dentistry has facilitated the restoration of the coronal tooth fractures by minimally invasive procedures when the original tooth fragment is available. Reattachment of fractured fragment offers immediate treatment with improved preponderant aesthetics and restoration of function. Here, we describe a case of complicated fracture of the maxillary left immature permanent central incisor, which was treated endodontically followed by esthetic reattachment of the fractured fragment using the glass fiber post. Functional demands and esthetic considerations of the patient were fully met with this biologic mode of fragment reattachment.

Mandibular deviation is multifactorial defect and its severity is based on the extent of osseous and soft tissue involvement, degree of tongue impaired, the loss of sensory and motor innervations, the type of wound closure, the presence of remaining natural teeth and finally the first initiation of prosthetic treatment. We describe a case of prosthetic management of a maxillary partially edentulous patient with hemimandibulectomy who reported after 4 years of postsurgical cancer therapy. A simple maxillary guided hollow inclined plane with twin occlusion acrylic prosthesis was fabricated as a functional training device to correct mandibular deviation, restore maxillomandibular relation and occlusal approximation. The patient was able to functionally achieve good maxillomandibular occlusal approximation with guidance therapy combined with physiotherapy in 2 weeks. A 6 months follow-up revealed patient satisfactory appreciation by understanding the limitations of overall prosthetic rehabilitation.

We report a rare case with herniation of the uterus, fallopian tube, and ovary in a femoral hernia. A female patient was admitted with complain of the painful lump in the left groin. Clinical examination indicated strangulated femoral hernia, which necessitated an emergency surgery. During surgical procedure, the uterine tube, left fallopian tube and left ovary, were observed as the contents of the hernia. The contents were reduced back into the pelvic cavity, and the hernia was repaired. The patient made good recovery postsurgery.

Mucormycosis is an opportunistic fungal infection, more commonly observed in immunocompromised patients. The mode of infection is via the inhalation route and infection begins initially in the nose and paranasal sinuses with subsequent invasion into the vascular tissue, eventually leading to thrombosis and necrosis of nearby hard and soft tissues. Here, we report a case of chronic osteomyelitis of the maxillary bone with fungal infection (mucormycosis) and extensive tissue necrosis in an uncontrolled diabetes mellitus patient.

Acquired immunodeficiency syndrome (AIDS)-associated Kaposi's sarcoma (KS) occurs with increased frequency in all HIV transmission groups and at a particularly high rate among homosexual men. It usually presents initially as violaceous cutaneous lesions, but oral mucosa, lymph nodes and visceral organs may be affected, sometimes without skin involvement. KS in a 20-year-old HIV-seropositive patient with oral involvement as the sole presentation of the disease is presented herewith; thus contributing a new AIDS-related KS case reported in Indian Literature.

Fibrous dysplasia (FD) is a benign bone disorder characterized by alteration in bone morphology. Monostotic FD is the commonest variant and affects the craniofacial bones. Raynaud's phenomenon is recurrent vasospasm of the fingers and toes due to cold exposure. The disease is usually idiopathic or secondary to connective tissue disorders. Raynaud's phenomenon is not described previously with FD. We recently encountered two interesting patients of craniofacial monostotic FD with Raynaud's phenomenon and report the same in this report.

Pycnodysostosis is a rare sclerosing bone disorder characterized by short stature, brachycephaly, short/stubby fingers, open cranial sutures/fontanelle, and diffuse osteosclerosis, where multiple fractures of long bones and osteomyelitis of the jaw are common complications. We present a rare case of pycnodysostosis with chronic suppurative osteomyelitis of the mandible in a 36-year-old woman; which was nonsurgically managed by a conservative approach involving a novel protocol referred to as intra-lesional antibiotic therapy.

This case report presented a karyotype and pedigree analysis of a case with unusual combination of dental anomalies: Generalized short roots, talon cusps, dens invagination, low alveolar bone heights, very prominent cusp of carabelli and protostylid on first permanent molars, taurodontism of second permanent molars, rotated, missing and impacted teeth. None of the anomalies alone are rare. However, until date, nonsyndromic pandental anomalies that are affecting entire dentition with detailed karyotype, pedigree and cone-beam computerized tomography analysis have not been reported. The occurrence of these anomalies is probably incidental as the conditions are etiologically unrelated.

Sellar masses are frequently adenomatous pituitary tumors. Metastatic disease is unusual, often mimicking the presentations of adenomas. Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy but unusual to have a pituitary metastasis (PM). A 65-year-old man presented with headache, diplopia, ptosis, decreased vision in the right eye and unintentional weight loss of 32lbs. Preliminary out-patient work-up revealed a mass in the pituitary region. Cranial imaging showed 3.1 cm × 3.2 cm × 4.4 cm lesion. Abdominal imaging (computed tomography and magnetic resonance imaging) demonstrated a lobulated, nodular and heterogeneous right lobe of the liver. Trans-sphenoidal resection of the sellar mass favored metastatic HCC on histology. Liver biopsy confirmed HCC. We recommend maintaining an increased clinical suspicion upon evaluation of nonclassical clinical and radiological presentations of suspected PM/malignancy; as well as pursuing additional investigations in all early cases.

Small colony variants (SCV) are persistent, intracellular morphotypes of Staphylococcus aureus causing indolent, subclinical infections. They are usually auxotrophic for Thymidine, menadione or carbon dioxide. Diagnosis is often misleading due to small colony type, delayed coagulase activity and lack of hemolysis. We hereby describe a case of CO ₂ -auxotrophic SCV of S. aureus causing left breast abscess in a young female with duct atresia of breast, detected by increased colony size in CO ₂ rich environment. SCVs can often be missed and have to be identified and treated properly.

Although prevalence of Enterobius vermicularis (EV) infestation in Intestines ranges from 35% to 70%, its prevalence in female genital tract is not known despite several incidental findings. Acute inflammatory cells in the background of cervical Pap smear indicate infestation and should not be neglected as contamination. A 40-year-woman presented with white vaginal discharge persistent for past 1 year. Local examination showed hypertrophied cervix with eversion of both lips and hard consistency of the anterior lip of cervix. A clinical diagnosis of cervical carcinoma was made. However, cervical Pap smear indicated EV eggs in an inflammatory background, treatment to which resulted in completely recovery.

The etiology of gastric antral vascular ectasia (GAVE) syndrome or gastric hyperplastic polyps (HPs) is not fully understood. We report a case of gastric HP arising in a patient treated with argon plasma coagulation (APC) for GAVE syndrome. Despite unclear etiologic progression, this and previously reported cases suggest a temporal relationship between the treatment of GAVE and HP. A 68-year-old male with a history of coronary artery disease, congestive heart failure and diabetes type II who initially presented with symptomatic anemia 2 weeks after starting aspirin and clopidogrel therapy. Diagnostic esophagogastroduodenoscopy (EGD) demonstrated diffuse GAVE. He was treated with 5 APC treatments, at 6-week intervals, over a 30 weeks period. 16 months after the initial APC treatment, an EGD performed secondary to persistent anemia demonstrated innumerable, large, bleeding polyps in the gastric antrum. Biopsy performed at that time confirmed hyperplastic gastric polyps. It has been proposed that HPs are regenerative lesions that arise at sites of severe mucosal injury. Our patient's treatment of GAVE with APC created significant mucosal injury, resulting in HP. Technique and genetic factors may have promoted hyperplastic changes during the regeneration of mucosa, at sites previously treated with APC. This case highlights the potential progression of GAVE to HP in a patient with persistent anemia after APC therapy.