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Migration is a universal phenomenon, which existed with the subsistence of the human beings on earth. People migrate from one place to another for several reasons, but the goal or main reason behind changing the residence would be improving their living conditions or to escape from debts and poverty. Migration is also a social phenomenon which influences human life and the environment around. Hence, migration has a great impact on any geographical area and it is known as one of the three basic components of population growth of any particular region (the other two are, mortality and fertility). Migration involves certain phases to go through; hence, it is a process. Many times, lack of preparedness, difficulties in adjusting to the new environment, the complexity of the local system, language difficulties, cultural disparities and adverse experiences would cause distress to the migrants. Moreover subsequently it has a negative impact on mental well-being of such population. Due to globalization, modernization, improved technologies and developments in all the sectors, the migration and its impact on human well-being is a contemporary issue; hence, here is an attempt to understand the migration and its impact on the mental health of the migrants based on the studies conducted around.

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Objective: Drinking plenty of water is commonly recommended in weight loss regimens; however, very limited scientific evidence is available to justify this. Here we studied the effect of drinking 1.5 L of water, over and above the usual intake on body weight, body mass index (BMI), body fat, and appetite score in overweight female participants. Materials and Methods: The study was done on 50 overweight female participants, who were instructed to drink 500 mL of water, three times a day 30 min before breakfast, lunch, and dinner. The 1.5 L water intake was over and above their daily water intake and was continued for 8 consecutive weeks. Body weight, BMI, body fat, and appetite score was measured pre and post-study; and the values were compared by paired t-test using Statistical Packages for Social Sciences (SPSS) version 14.0.1. Results: All the parameters tested were lower after 8 weeks: body weight (pre-study 65.86 ± 3.614 kg vs post-study 64.42 ± 3.704 kg; P < 0.01); BMI (pre-study 26.7002 ± 0.9423 vs post-study 26.1224 ± 1.0632; P < 0.01); sum of skinfold thickness (pre-study 79.626 ± 10.385 mm vs post-study 76.578 ± 10.477 mm; P < 0.01); and the appetite score (pre-study 36.880 ± 4.170 vs post-study 34.673 ± 3.845; P < 0.01). Conclusions : Our study establishes the role of drinking 1.5 L of excessive water in weight reduction, body fat reduction, and appetite suppression in overweight female participants.

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Native species of microalgae were isolated from natural water bodies in the Midwestern United States of America and were screened for the ultimate goal of mass cultivation in Missouri and the surrounding states, and for their potential as biomass and biodiesel sources. A number of different nutrient media recipes were utilized to isolate the maximum number of colonies from each field samples. These nutrient recipes were modified in order to optimize the isolation and growth dynamics of specific colonies. All of the isolates were categorized based on the morphological appearance of the culture and the microscopic cellular appearance of the isolated colonies. Isolates included many common green microalgae and cyanobacteria. Lipid content was determined for selected strains that demonstrated relatively quick growth. Scenedesmus sp. that demonstrated the high growth rate, resistance to invasion, and contained sufficient amounts of lipid was investigated for its potential as a sustainable biomass and biodiesel feedstocks.

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Background and Objectives: Brushing the teeth with fibrous husk of Cocos nucifera (coconut) is a common oral hygiene practice among people of rural areas of South India. However, the probable antimicrobial properties of this plant material against common oral pathogens have not been proved scientifically. Therefore, the present study was designed. Materials and Methods: Alcoholic extract of the husk of Cocos nucifera was prepared and the antimicrobial properties against common oral pathogens like cariogenic bacteria, periodontal pathogens, and candidal organisms were performed by the Agar Well Diffusion Method. The results obtained were then subjected to statistical analysis using One-Way Analysis of Variance (ANOVA) and the Tukey's Honestly Significant Difference (HSD). Results: The alcoholic extract of Cocos nucifera showed a significant concentration-dependent antimicrobial activity, expressed as a zone of inhibition with respect to all tested organisms except Actinomyces species. The inhibitory effect was more significant, with a majority of cariogenic organisms and Candida, with a zone of inhibition ranging from 4.6 mm to 16.3 mm. However, the effect was lesser with Cocos nucifera compared to chlorhexidine. Minimum inhibitory concentration (MIC) ranged from 50 mg/ml to 75 mg/ml. Conclusion: Cocos nucifera has a significant inhibitory action against common oral pathogens, indicating the presence of highly effective antimicrobial compounds. Therefore, it is proved that its use can contribute to oral health to a great extent. Identification of these active compounds provides the scope for incorporating it into a modern oral care system, so as to control oral diseases.

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Intrinsic discoloration of a non-vital permanent incisor tooth due to trauma may have a significant esthetic and social impact on children and adolescents. Treatment options for discolored Non-vital teeth are bleaching, crowns or veneers. However, this restorative crown or veneer approach has a significant drawback of being an invasive technique. Intervention should be minimal destruction of tooth structure and should not compromise future restorative options. The advantage bleaching over crown is that it offers simple conservative approach in removal of stain and whitening discolored teeth without damaging tooth structure.

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Introduction: Hospital wastes pose significant public health hazard if not properly managed. Hence, it is necessary to develop and adopt optimal waste management systems in the hospitals. Material and method: Biomedical waste generated in Coimbatore Medical College Hospital was color coded (blue, yellow, and red) and the data was analyzed retrospectively on a daily basis for 3 years (January 2010-December 2012). Results: Effective segregation protocols significantly reduced biomedical waste generated from 2011 to 2012. While biomedical waste of red category was significantly higher (>50%), the category yellow was the least. Per unit (per bed per day) total biomedical waste generated was 68.5, 68.8, and 61.3 grams in 2010, 2011, and 2012, respectively. Discussion: Segregation of biomedical waste at the source of generation is the first and essential step in biomedical waste management. Continuous training, fixing the responsibility on the nursing persons, and constant supervision are the key criteria's in implementing biomedical waste segregation process, which can significantly reduce per unit biomedical waste generated. Conclusion: We highly recommend all hospitals to adopt our protocol and effectively implement them to reduce generation of biomedical waste.

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Kounis syndrome is a condition that combines allergic, hypersensitivity, anaphylactic or anaphylactoid reactions with acute coronary syndromes including vasospastic angina, acute myocardial infarction and stent thrombosis. This syndrome is a ubiquitous disease affecting patients of any age, involving numerous and continuously increasing causes, with broadening clinical manifestations and covering a wide spectrum of mast cell activation disorders. Drugs, environmental exposures and various conditions are the main offenders. Clinical and therapeutic paradoxes concerning Kounis syndrome therapy, pathophysiology, clinical course and causality have been encountered during its clinical course. Drugs that counteract allergy, such as H2-antihistamines, can induce allergy and Kounis syndrome. The more drugs an atopic patient is exposed to, the easier and quicker anaphylaxis and Kounis syndrome can occur. Every anesthetized patient is under the risk of multiple drugs and substances that can induce anaphylactic reaction and Kounis syndrome. The heart and the coronary arteries seem to be the primary target in severe anaphylaxis manifesting as Kounis syndrome. Commercially available adrenaline saves lives in anaphylaxis but it contains as preservative sodium metabisulfite and should be avoided in the sulfite allergic patients. Thus, careful patient past history and consideration for drug side effects and allergy should be taken into account before use. The decision to prescribe a drug where there is a history of previous adverse reactions requires careful assessment of the risks and potential benefits.

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Background: A vast majority of Indian population are engaged in agriculture. While pesticides help in increasing crop production, inappropriate pesticide storage practice and inadequate protective measures frequently causes accidental poisoning among farmers. Objective: The present study was conducted to explore the pattern of pesticide use among farmers in a district of India with an attempt to identify the lacunae in their knowledge and awareness level on risks and hazards of pesticides use. Materials and Methods: A cross-sectional questionnaire based study was conducted in the district of Burdwan, West Bengal, to address the study objective. Data analysis was performed by using descriptive statistical methods: Frequency, percentage, mean, standard deviation. Results: In the present study alpha-cypermethrin (46%) was the most commonly used pesticide followed by methyl parathion (25.6%), imidacloprid (16.4%), dichlorvos (7.8%) and phorate (4.2%). The farmers used to store pesticides mostly in cowshed (48.4%) followed by storeroom (29.6%). During spraying of pesticides, farmers experienced headache (29.8%) followed by nausea (26%), burning sensation in eyes (9.8%), cough (9.2%), muscle cramps (2%). Regarding the personal protective measures taken by the farmers for spraying, covering nose, mouth with cloth combined with bath after spraying was the most common practice (27%). When asked about suggested actions to be taken if anybody becomes sick following exposure to pesticides, 86% of farmers prefer consulting a doctor. Conclusion: The study suggested that farmers of Burdwan were exposed to highly hazardous, restricted and banned pesticides, with insufficient protection. In this situation, educational and training interventions on pesticide handling and safety precautions are urgently needed.

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Objective: The objective of this prospective study was assessment of efficacy of bone marrow aspirate (BMA) (containing plasma rich in growth factors and mesenchymal stem cells) injection in treatment of tennis elbow. Materials and Methods: A total of 30 adult patients of previously untreated tennis elbow were administered single injection of BMA. This concentrate was made by centrifugation of iliac BMA at 2000 rpm for 20-30 min and only upper layer containing platelet rich plasma and mononuclear cells was injected. Assessment was performed at baseline, 2 weeks, 6 weeks and 12 weeks using Patient-rated Tennis Elbow Evaluation (PRTEE) score. Results: Baseline pre-injection mean PRTEE score was 72.8 ± 6.97 which decreased to a mean PRTEE score of 40.93 ± 5.94 after 2 weeks of injection which was highly significant (P < 0.0001). The mean PRTEE score at 6 week and 12 week follow-up was 24.46 ± 4.58 and 14.86 ± 3.48 respectively showing a highly significant decrease from baseline scores (P < 0.0001). Conclusion: Treatment of tennis elbow patients with single injection of BMA showed a significant improvement in short to medium term follow-up. In future, such growth factors and/or stem cells based injection therapy can be developed as an alternative conservative treatment for patients of tennis elbow, especially who have failed non-operative treatment before surgical intervention is taken.

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Background: It is well-known that estimation of 24-h urine protein and spot urine protein/creatinine (P/C) ratio are commonly performed investigations to assess proteinuria in preeclamptic women. Serum uric acid has been shown to correlate well with disease severity in preeclampsia. Materials and Methods: A total of 24-h urine protein estimation, spot urine P/C ratio, and serum uric acid measurements were carried out in 75 pregnant preeclamptic women and the correlation between these investigations, as also the association between proteinuria and hyperuricemia with adverse fetomaternal outcomes were studied. Results: Pearson's correlation test showed a positive correlation between 24-h urine protein and spot urine P/C ratio. A statistically significant and direct correlation was also found between serum uric acid and spot urine P/C ratio, while there was no statistically significant difference between proteinuria and hyperuricemia with respect to the various fetal and maternal outcome parameters studied. Conclusion: In the present study, we found a moderate correlation between 24-h urine protein and spot urine P/C ratio. There was a moderate correlation between spot urine P/C ratio and uric acid, while there was no statistical significance of the association between proteinuria and uric acid with fetomaternal outcomes in preeclampsia.

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Purpose: The aim of this study was to compare the microleakage of glass ionomers (conventional and resin modified) with that of recently introduced nanoionomers. Materials and Methods: Standardized class I and class V cavities were prepared on 120 young permanent teeth. Samples were equally divided into group I (class I restorations) and group II (class V restorations), and further divided into subgroups. The subgroups were restored with Fuji IX, Fuji II LC, and newly introduced Ketac^™ N 100 (KN 100). Samples were thermocycled and submerged in Acridine dye for 24 h. Samples were sectioned to view under fluorescent microscope and marginal leakage was evaluated by Chi-square and Kruskal - Wallis test. Results: Fuji IX showed the maximum leakage, followed by LC II and the least was observed in KN 100. In class I restorations, there was significant difference while comparing Fuji IX with Fuji LC II and KN 100 and nonsignificant difference between LC II and KN100. In class V restorations, Fuji IX and KN100, KN 100 and LC II showed significant difference. Fuji IX and LC II showed nonsignificant difference. Conclusion: Within the limitations of this study, Fuji IX showed the maximum microleakage. KN 100 showed minimum leakage, better sealing ability, and was more consistent.

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Dental abnormalities associated with ectodermal dysplasia (ED) cause severe functional, esthetic and psychological problems. This case report describes treatment of a patient with hypohidrotic (Christ-Siemens -Touraine syndrome) ED. Patient was rehabilitated with the use of endosseous implants in mandible following an orthodontic treatment to bring the impacted maxillary canine in the arch. This procedure aided in the preservation of the surrounding bone and retention of the prosthesis. A tooth supported fixed partial denture (FPD) was fabricated for the maxillary arch and three separate (two all-tooth and one all-implant supported) FPDs were fabricated for the mandibular arch. Fixed prostheses boosted the self-esteem of this patient.

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Context: Ghee is a widely consumed dairy product in India and that prepared from cow milk is mentioned in ayurvedic texts as an ingredient of many formulations/additive as well. Detection of cow ghee adulteration with vegetable oils/fats and animal body fats is a key concern. Indicated values for commonly used parameters to differentiate pure and adulterated ghee materials are many a times overlapping. Among reported techniques, ultraviolet fluorescence and paper chromatography technique are not that much sensitive while other methods require sophisticated instrumental facilities (such as gas chromatography, mass spectrometry) and costly analytical processes. Aims: The present paper deals with a promising spectroscopic method to determine the tallow adulteration in cow ghee. Materials and Methods: Ghee and tallow (taken in chloroform) as such and mixed in different proportions were scanned by spectrophotometer and their second order spectra were analyzed. Results: The value of the ratio of the absorbance of peaks at about 238 nm and 297 nm steadily decreases with the increasing proportion of tallow. This decrease shows consistent linearity suggesting its applicability for quantitative estimation of tallow in cow ghee. Conclusion: The developed derivative spectroscopic method is a rapid, sensitive, cost-effective method for detection of tallow adulteration in cow ghee.

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Drug-induced gingival overgrowth (DIGO) can be a serious concern for both patients and clinicians. DIGO is a well-documented side-effect of some pharmacologic agents, including, but not limited to, calcium channel blockers, phenytoin, and cyclosporine. Plasma cell granulomas (pseudotumors) are exceedingly rare, non-neoplastic, reactive tumor-like proliferation, primarily composed of plasma cells that manifest primarily in the lungs, but may occur in various anatomic locations. Intraoral plasma cell granulomas involving the lip, oral mucosa, tongue, and gingiva have been reported in the past. This is the first case report of amlodipine induced plasma cell granuloma of the gingiva in the medical literature presenting a 54 year-old female patient with hypertension, who received amlodipine (10 mg/day, single dose orally) for 2 years, sought medical attention because of developing maxillary anterior massive gingival overgrowth causing functional and esthetic problem, which was treated by excisional biopsy. Histologically, these lesions were composed of mature plasma cells, showing polyclonality for both lambda and kappa light chains and fibrovascular connective tissue stroma confirming a diagnosis of plasma cell granuloma. This case also highlights the need to biopsy for unusual lesions to rule out potential neoplasms.

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There are several conditions that results in excessive gingival display. In case of class I vertical maxillary excess the reason for this excessive display is the hypermobile lip. Though orthodontic treatment is the choice of treatment, surgical repositioning along with the orthodontics gives more predictable and stable results. This case report discusses cosmetic surgical management of case with class I vertical maxillary excess with excessive gingival display. The technique involves removal of strip of mucosal tissue from the labial vestibule thereby limiting the retraction of elevator muscles.

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Background: Dental fear, anxiety and phobia have consistently been reported as widespread problems that persist despite the technological advances that have made dentistry less painful and less uncomfortable. The aim of this study was to assess the prevalence of dental anxiety (DA) and its relation to age and sex among Coastal Andhra (Visakhapatnam) population. Materials and Methods : A randomized controlled study was designed among 340 individuals at GITAM Dental College and Hospital, Visakhapatnam. The sample for the study consisted of 180 female and 160 male subjects between 15 and 65 years of age; all were supplied with two questionnaires (Corah DA scale [CDAS] and Clarke and Rustvold dental concerns assessment scale describing anxiety provoking stimuli. The Mann-Whitney U-test and the Kruskal-Wallis test were applied (significance level P < 0.05). The correlations between the two questionnaires were calculated using the Spearman's rank correlation coefficient. Results: Two questionnaires were collected from all 340 individuals and the Indian translation of both instruments was found to be internally reliable with a Cronbach's alpha of 0.093. Overall prevalence of DA was high (77.4%) but severe (22.6%) anxiety (phobia) was low. Kruskal-Wallis test showed a significant relation between age and DA. The mean CDAS scores were high in 25-35 (11.08) and low in 55-65 (9.45) year age groups. Mann-Whitney U test showed significant relation between sex and DA. Mean CDAS score levels were significantly higher in females (10.88) than in males (9.96) (P < 0.0001). Conclusion: Patients anxious about dental procedures are often more difficult to treat. If Dentists become aware about the level of DA among their patients, they can anticipate patient's behavior and can be prepared to take behavioral/pharmacological measures to reduce anxiety levels.

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Introduction: Abruptio placentae (AP) which is a major cause of maternal morbidity and perinatal mortality globally is of serious concern in the developing world. We retrospectively analyzed the AP cases and evaluated its impact on fetal and maternal outcomes. Materials and Methods: The present study was undertaken from September 2007-August 2009 at a tertiary care center attached to medical college; patients of AP were selected from all cases with minimum of 28 weeks of gestation, presenting with antepartum hemorrhage. Patients underwent complete obstetrical investigations and were managed according to maternal and fetal condition. Results: 4.4% incidence rate of AP was documented accounting for 318 cases during the study period. Most of cases were unbooked, with an average age of 34.5 years (range, 18-44) and nearly two-third of the patients were from lower socioeconomic class. Anemia was observed in 96% of patients, with 3.5 and 68% incidence of maternal and fetal mortality, respectively. Conclusion: We observed a higher than expected frequency of AP and neonatal mortality in our study population, which is of major concern. We envisage need for mass information regarding the importance of antenatal maternal care and improvement in nutritional status, which may reduce the frequency of maternal and fetal morbidity and mortality associated with AP.

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Background: Xylene is used as a clearing agent in hematoxylin and eosin (H and E) staining of tissue sections in routine histopathology based diagnosis. However, the hazards associated with exposure to xylene are of concern. Numerous solutions mainly essential oils have been evaluated in the past as clearing agents, which can possibly be substituted for xylene during the routine tissue processing. Aim: The aim of this study is to compare the efficacy of essential oil (cedarwood oil), as a possible replacement for xylene in H and E staining procedures. Materials and Methods: The study was carried out in the Department of Oral Pathology and Microbiology. Thirty paraffin blocks of the routine biopsy specimen were retrieved from the department archives. The cedarwood oil was procured from organic and essential oil dealer in the local market. Two to three paraffin sections of four micron thickness were cut from each of the 30 paraffin blocks of processed tissue specimens, were subjected to different clearing agents: Essential oil (8% cedarwood oil) or xylene and stained with H and E stain. The stained sections were scored based on nuclear and cytoplasmic details, clarity and uniformity of staining. Results: Significant correlation was observed between cedarwood oil and xylene in terms of the three staining quality parameters assessed. Conclusions: We conclude that cedarwood oil can be an effective, eco-friendly and safe alternative to xylene as a clearing agent in the histopathological laboratory.

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Background: Endophytic bacteria do have several potential applications in medicine and in other various sectors of biotechnology including agriculture. Bacterial endophytes need to be explored for their potential applications in agricultural biotechnology. One of the potential applications of bacterial endophytes in agricultural is to enhance the growth of the agricultural crops. Hence, this study was undertaken to explore the plant growth promoting potential application of bacterial endophytes. Objective: The objective of this study was to examine the effect of endophytic bacteria from mangrove tree (Rhizophora apiculata Blume) for their efficacy in promoting seedling growth in rice. Materials and Methods: Eight endophytic bacterial isolates (EBIs) isolated from twig and petiole tissues of the mangrove were identified based on their 16S ribosomal ribonucleic acid (rRNA) gene sequence homology. Separately, surface sterilized paddy seeds were treated with cell-free broth and cell suspension of the EBIs. Rice seedlings were analyzed by various bioassays and data was recorded. Results: The gene sequences of the isolates were closely related to two genera namely, Bacillus and Pantoea. Inoculation of EBIs from R. apiculata with rice seeds resulted in accelerated root and shoot growth with significant increase in chlorophyll content. Among the isolates, Pantoea ananatis (1MSE1) and Bacillus amyloliquefaciens (3MPE1) had shown predominance of activity. Endophytic invasion was recognized by the non-host by rapid accumulation of reactive oxygen species (ROS) and was counteracted by the production of hydrogen peroxide (H ₂ O ₂ ) and lipid peroxide. The results demonstrated that EBIs from mangrove tree can increase the fitness of the rice seedlings under controlled conditions. Conclusion: These research findings could be useful to enhance the seedling growth and could serve as foundation in further research on enhancing the growth of the rice crop using endophytic bacteria.

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Thalassemia is a rare, complex disease, representing a group of disorders of hemoglobin synthesis that are characterized by reduced synthesis of either the alpha-globin or β-globin chains of the hemoglobin molecule. Defective synthesis of β-globin resulting from a variety of molecular defects causes β-thalassemia. Thalassemia is an autosomal recessive disorder, which requires prompt diagnosis and an appropriate treatment. Thorough clinical, radiographic and laboratory assessment helps in diagnosing thalassemia and any other hematological disorder. Here, two cases of β-thalassemia showing distinct features are presented and the importance of detailed work-up of the cases has been highlighted.

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Background: Hypertension is one of the most common complication during pregnancy. It contributes significantly to maternal and perinatal morbidity and mortality. This study was designed to investigate the morphological and histopathological changes in placenta from pregnancies complicated with hypertension. Objectives: To study the morbid changes in placenta in cases of pregnancy-induced hypertension (PIH) and to correlate the findings with birth weight of new born babies in comparison with normotensive mothers. Materials and Methods: The study was done on 100 placentas, out of which 50 were collected from normotensive mothers and the remaining 50 from PIH cases. All the placentas were studied morphologically and histologically. The birth weight of neonates was recorded. Results: In the present study it was observed that weight and dimensions of placenta was less in study group when compared with control group. The mean neonatal birth weight was more in normal pregnancy and feto-placental weight ratio was significantly high in hypertensive group. Histopathological study showed significant number of syncitial knots, areas of fibrinoid necrosis, hyalinization, calcification, and medial coat proliferation of medium sized blood vessels in hypertensive group. Conclusion: PIH significantly affects the placenta by reducing its weight and dimensions. These changes may cause placental insufficiency as a result of compromised utero-placental blood flow. Therefore has an adverse affect on the neonatal birth weight. PIH has definite influence on morphology, histology of placenta, and thus affects the growth of the fetus.

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Background: Letrazole is an aromatase inhibitor, which is useful in ovulation induction. However, evidence on its efficacy over clomiphene citrate, which is the first of drug used for therapy of anovulation, is insufficient in Indian patients. Aims: To compare the efficacy of letrozole and clomiphene citrate in attaining optimal follicular growth. Materials and Methods: The study was conducted in the infertility clinic of Mahatma Gandhi Medical College and Research Institute, Pondicherry, India from June 2008 to December 2009. Fifty women with ovulatory dysfunction as a cause of infertility were enrolled and randomized into two groups of 25 each. Group 1 received clomiphene citrate in incremental dose from 50 mg up to150 mg and Group 2 patient received letrozole in incremental dose from 2.5 mg to 7.5 mg, depending upon the ovulation response. In both the groups, number of follicles, diameter of large follicle, endometrial thickness, and serum estradiol and pregnancy rate were compared. The data from both groups are represented as mean and standard deviation and statistically compared using Student's t test. Results: The number of follicles (1.89 ± 0.9 vs 1.18 ± 0.393) and serum estradiol levels (437.5 ± 293.7 pg/mL vs 291.82 ± 59.86 pg/mL) were higher in Group 1, while follicular diameter (20.67 ± 0.970 mm vs. 20.76 ± 0.903 mm) and endometrial thickness (8.5 mm vs.7.4 mm) were similar in both the Groups. Conclusions: Although letrozole is used for ovulation induction in anovulatory infertility, no significant beneficial effects of letrozole compared to use of clomiphene citratewere observedin ourstudy. Hence, we concur with the use of clomiphene citrate as the first line of drug for ovulation induction in Indian population and warrant larger size studiesto further validate our results.

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Background: Its being long recognized about the highly debilitating and destructive nature of cerebrovascular accidents (CVAs). Around the world CVAs has posed as a major factor in medical morbidity and mortality. It has thrown up challenges with regards to their medical management and also towards posttreatment rehabilitation. It is well-known that neurologic disorder contributes variously towards varied electrocardiogram (ECG) changes and stroke is no exception. Objective: To study the ECG changes and its relation to mortality in cases of CVA. Materials and Methods: A total of 100 patients with acute stroke were enrolled in the study. All the 100 patients underwent ECG recording within first 24 h of admission. The patients were divided into ischemic and hemorrhagic group depending on the nature of lesion. Results: Out of 100 cases, 58 were ischemic and 42 were hemorrhagic. The ECG changes were noted in 78 patients. Among the ischemic group, the changes noted in the ECG were: T wave inversion (34.48%), ST segment depression (32.75%), QTc prolongation (29.31%), and presence of U waves (27.58%). In cases of hemorrhagic stroke, it was: T wave inversion (33.33%), arrhythmias (33.33%), U waves (30.95%), and ST segment depression (23.80%). Mortality was higher in patients with ST-T changes in ischemic group (66.66%) and in patients with positive U waves (60%) in hemorrhagic group. Conclusion: In acute stroke patients, changes in ECG were commonly seen. The changes varied from T-wave inversion to ST segment depression in ischemic stroke. In hemorrhagic stroke it consisted of T wave inversion and arrhythmias. Overall mortality was high in cases of hemorrhagic compared to ischemic group.

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Background: In the first half of 20 ^th century; mortality from colorectal surgery often exceeded 20%, mainly due to sepsis. Modern surgical techniques and improved perioperative care have significantly lowered the mortality rate. Mechanical bowel preparation (MBP) is aimed at cleansing the large bowel of fecal content thus reducing morbidity and mortality related to colorectal surgery. We carried out a study aimed to investigate the outcomes of colorectal surgery with and without MBPs, to avoid unpleasant side-effects of MBP and also to design a protocol for preparation of a patient for colorectal surgery. Materials and Methods: This was a prospective study over a period of March 2008-May 2010 carried out at Department of General Surgery of our institution. A total of 63 patients were included in this study; among those 32 patients were operated with MBPs and 31 without it; admitted in in-patient department undergoing resection of left colon and rectum for benign and malignant conditions in both emergency and elective conditions. Results: Anastomotic leakage, intra-abdominal collections was detected clinically and radiologically in 2 and 4 patients in each group respectively. P > 0.5 in both situations, indicating statistically no difference between results of two groups. Wound infections were detected in 12 (37.5%) patients with MBP group and 11 (35.48%) patients without MBP. Conclusion: The present results suggest that the omission of MBP does not impair healing of colonic anastomosis; neither increases the risk of leakage.

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Aims: The evaluation of clinical and specific microbiological changes associated with chlorhexidine chip in the chronic periodontitis patients. Materials and Methods: A total of 30 chronic periodontitis patients (aged 20-65 years) having pocket depth of ≥5 mm in molar teeth were selected and randomly divided into following treatment groups: Group 1 - Scaling and root planning (SRP), Group 2 - SRP along with chlorhexidine chip and Group 3 - Only chlorhexidine chip. The clinical and microbial parameters were recorded at baseline and 1 and 3 months post-treatment as above. Benzoyl-DL-arginine-naphthylamide (BANA) chair side test was used for estimation of specific microbiota. Results: Gingival index, probing pocket depth and clinical attachment level scores in selected teeth within the groups at different time intervals was significantly (P < 0.001) different. Although, the comparison between groups for specific microbiota in selected sites at different intervals was not statistically significant at baseline and 1 month, it reached statistical significance at 3 ^rd month post-treatment. Although significant reductions in percentage of BANA positive sites were observed in all three groups, the Group 2 had significantly greater percentage of BANA negative sites. Conclusion: Local drug delivery using chlorhexidine chip enhances the benefit of SRP in the treatment of chronic periodontitis.

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Introduction: The IR absorption patterns (in cm⁻¹ ) provide the basis to distinguish among the constituents and to separately quantify as well as qualify them and they possess many advantages such as very small sample volume requirement, good precision over entire physiological range, avoid of costly disposables, wealth of information from a single spectral measurement. The efficacy of anti-diabetic drug metformin hydrochloride as used to treat diabetic-induced Wistar rats and their sera were analyzed by FT-IR (ATR) in absorption mode. Materials and Methods: The present work was attempted in the study of normal and antidiabetic regimen-treated rat blood samples using FTIR spectroscopy by the attenuated total refl ectance (ATR) sampling technique. The biomolecule characteristics were measured as intensity ratio parameter (IRP) values and interpreted. Results: To quantify the results three IRPs such as R1, R2 and R3 were calculated, respectively, for lipid, protein, and glucose. The glucose IRP value R3 showed, 0.3802, 0.3304, and 0.2847, respectively, for diseased, metformin-treated, and normal rats. Conclusion: The IRP values for glucose are compared to the glucose level obtained by using a glucometer. This study can be conveniently used in diagnostic procedures, patient compliance assessment, and efficacy evaluation of metformin hydrochlorides.

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Background: Estimation of β-galactosidase (βgal) activity in human cells and tissues indicate its possible use as a marker of senescence. Objectives: This study was done to detect senescence-associated βgal (SA-βgal) activity in canine skin tissue by using its substrate 5-bromo-4-chloro-3-indolyl β-D-galactosidase (X-gal). Materials and Methods: Skin samples were collected through rapid necropsy process. The X-gal staining was done by altering different factors of the staining procedure like pH of the reagents and incubation time. Further, effect of tissue preservation procedure was also evaluated. Results: Typical X-gal staining was detected in old dogs' skin samples and it was detectable both at pH 6 and pH 7.3. The cells present in the inner lining of the hair follicles and sebaceous glands are the major cells that have high SA-βgal activity. The X-gal staining intensity was more prominent in tissues preserved in liquid nitrogen at -196°C than in -80°C freezer. Prolonged incubation period increased the intensity of staining. Conclusions: This study indicates possibility of X-gal staining in canine tissues and opens an avenue for further in-depth studies that might be useful for different research and clinical studies like determination of dog's approximate age.

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Introduction: Diabetes mellitus is growing at epidemic proportions world wide and associated with this is an increase in incidence of diabetic foot ulcers. For better understanding and ease of management, diabetic foot ulcer severity is often classified using the Wagner system. In recent times, various treatment modalities have been put to test for getting early wound healing, including growth factors like human epidermal growth factor. Materials and Methods: The present study was conducted in the Department of Surgery, Dayanand Medical College and Hospital, Ludhiana. The patients were divided into two groups of 25 patients each. Group 1 was the study group and patients in this group received topical application of beta urogastrone (rhEGF) gel. Group 2 was the control group and patients in this group received betadine dressing. The patients were followed up after every two weeks for eight weeks. Results: The age and sex were comparable in both groups. Mode of onset was either spontaneous or posttraumatic or following debridement. Initially in group A, 12 patients each had serous and seropurulent discharge respectively. I patient did not have any discharge. In group B, 15 patients had sero purulent discharge, 9 patients had serous discharge and 1 patient had purulent discharge. Initially, 13 patients in group A and 15 patients in group B had granulation tissue. Mean size at the beginning of the study in-group A was 19.56 sq cm and 21.20 sq cm in group B. Two patients from group A had incomplete healing at the end of the study as compared to 14 patients from group B. Conclusions: The application of rhEGF shortens the wound healing time significantly and the mean closure was significantly higher in the EGF group compared with placebo.

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Introduction: Determining the age of a person in the absence of documentary evidence of birth is essential for legal and medico-legal purpose. Fishman method of skeletal maturation is widely used for this purpose; however, the reliability of this method for people with all geographic locations is not well-established. Aims and Objectives: In this study, we assessed various stages of carpal and metacarpal bone maturation and tested the reliability of Fishman method of skeletal maturation to estimate the age in South Indian population. We also evaluated the correlation between the chronological age (CA) and predicted age based on the Fishman method of skeletal maturation. Materials and Methods: Digital right hand-wrist radiographs of 330 individuals aged 9-20 years were obtained and the skeletal maturity stage for each subject was determined using Fishman method. The skeletal maturation indicator scores were obtained and analyzed with reference to CA and sex. Data was analyzed using the SPSS software package (version 12, SPSS Inc., Chicago, IL, USA). Results: The study subjects had a tendency toward late maturation with the mean skeletal age (SA) estimated being significantly lowers (P < 0.05) than the mean CA at various skeletal maturity stages. Nevertheless, significant correlation was observed in this study between SA and CA for males (r = 0.82) and females (r = 0.85). Interestingly, female subjects were observed to be advanced in SA compared with males. Conclusion: Fishman method of skeletal maturation can be used as an alternative tool for the assessment of mean age of an individual of unknown CA in South Indian children.

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Aim: To Study the Factors affecting compliance to diabetes management and study risk factors and complications of type II diabetes. Settings and Design: Primary health center, Descriptive study. Materials and Methods: A descriptive study of previously diagnosed diabetics (n = 135) attending the chronic disease clinic of Urban Health Center, Jawaharlal Institute of Postgraduate Medical Education and Research (JIUHC) was carried out during October 2011 to December 2011. Data were collected by personal interview on demographic parameters, duration of diabetes, number of doses missed in the last 15 days, co-morbidities, knowledge and practice of dietary modification, physical activity, self-care, family support, awareness about risk factors and complications of diabetes. Statistical Analysis Used: The findings were expressed in terms of proportions. Chi-square test was used to study the association between socio-demographic factors and compliance. Results: Majority of patients were in the age group of 50-59, of which 80% were females. Compliance (defined as not missing more than two doses in the last 15 days) to oral hypoglycemic agents was found in 103 (76%; 68.5-82.9). Dietary modifications was practiced by 110 (81.4%; 74.2-87.3) and 37% (29.2-45.4) practice physical activity. Annual eye check-up was carried out by 43.7%, renal function test by 46.6% and foot care by 54%. Knowledge regarding risk factors (66%; 42.7-59.4) and complications (79%; 71.8-85.4) was comparatively better than knowledge about self-care. Conclusions: Three-fourth of patients were compliant to medications and diet, but less than half follows modifications in physical activity and other self-care practices. Hence, it is essential to educate and motivate people in primary health-care level about self-care and life-style modifications.

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Background: Colorectal carcinoma (CRC) is the fourth most commonly diagnosed malignant disease worldwide, with over 1 million new cases and approximately 5,00,000 deaths each year. Aims and Objectives: This prospective observational study was done to study the clinicopathological characteristics of CRC including mucin stains and correlate the preoperative serum carcinoembryonic antigen (CEA) and cancer antigen (CA)-125 levels with the prognosis. Materials and Methods: A total of 90 CRCs were included from December 2010 to June 2013. Detailed history and relevant clinical/radiological findings were noted in all clinically and/or radiologically suspected cases of CRC. Preoperative blood samples were collected for serum CEA and CA-125 level estimation. The mucin expression was evaluated with special stains. Results: The combined Alcian blue-periodic acid Schiff (PAS) staining was positive for both stains in 68.88% cases indicating that both neutral and acidic mucins are increased in CRC. High preoperative serum CEA levels were seen in 82.22% cases, whereas preoperative serum CA-125 levels showed an increase in 20% cases. Higher levels of these tumor markers corresponded with higher TNM stage. Conclusions: Mucin evaluation in CRCs remains one of the valuable methods as mucinous variants correlate with worse prognosis. Preoperative serum CEA level assessment is an indispensible adjunct to the diagnosis and prognosis of CRC. However, preoperative serum CA-125 level measurement is not an efficient tool for prognostication in CRC and should not be recommended for routine use.

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Objective: Root surfaces of periodontitis-affected teeth are hypermineralized and contaminated with cytotoxic and other biologically active substances. To achieve complete decontamination of the tooth surfaces, various methods including root conditioning following scaling and root planning are present. The main objective of this article is to throw light on the different root conditioning agents used and the goals accomplished by root conditioning in the field of periodontology. Materials and Methods: 20 human maxillary anterior teeth indicated for extraction due to chronic periodontitis were collected and root planned. The teeth were sectioned and specimens were divided into two groups - Group I and II. Group I dentin specimens were treated with EDTA and group II specimens were treated with tetracycline HCl solution at concentration of 10% by active burnishing technique for 3 minutes. The root surface samples were then examined by scanning electron microscope (SEM). Results: The results of the study showed that EDTA and tetracycline HCl were equally effective in removing the smear layer. It was observed that the total and patent dentinal tubules were more in number in teeth treated with tetracycline as compared to EDTA group. However, EDTA was found to be much more effective as root conditioning agent because it enlarged the diameter of dentinal tubules more than that of tetracycline HCl. Conclusion: Results of in-vitro study showed that both the agents are good root conditioning agents if applied in addition to periodontal therapy. However, further studies are required to establish the in-vivo importance of EDTA and tetracycline HCL as root conditioners.

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Cherubism is a rare congenital disease resulting in malformation of the jaw. It occurs before the age of 5 years and regress spontaneously after puberty. It can result into enlargement of the jaw bone, tooth displacement, facial disfigurement and psychological trauma to patient. Hence, the understanding about the condition, its progression and management is necessary.

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Background: The present study was undertaken with an objective to develop a simple, accurate, cost-effective and reproducible ultraviolet spectrophotometric method for the estimation of metronidazole benzoate (MB) from pharmaceutical formulations. Materials and Methods: The analysis was performed on λ_max 268 nm by using 0.1 NHCl as diluents. The proposed method was validated on International Conference Harmonization guideline including the parameters viz., accuracy, linearity, precision, specificity and reproducibility. The proposed method was also used to access the content of MB in two commercial brands of Indian market. Results: Beer's law was obeyed in the concentration range of 1-10 μg/ml having regression equation y = 0.078 x-0.012.The accuracy value for 4 μg/ml and 5 μg/ml concentration of MB was found to be 99.37% and 98.9% respectively. The relative standard deviation of interday and intraday was lesser than 1%. The developed method was applied on two different marketed brands and contents of MB were found to be 98.62% and 98.59% incompliance with labeled claim. The results were under the limit of acceptance statistically. Conclusion: It was concluded that the proposed method canbe used for routine analysis of MB in bulk and commercial formulations.

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This is a rare anomaly of midline nasal dermoid cyst (NDC) along with Tessier's 0 cleft. Midline NDCs present most commonly result from aberrant embryological development, and most commonly give rise to bifid nasal deformity resulting in midline cleft of the nose. Craniofacial clefts are among the most disfiguring of all facial anomalies. They exist in a multitude of patterns and with varying degrees of severity. The bifid nose deformity is generally an indicator of Tessier number 0 cleft. We present a rare combination of midline NDC with a mild Tessier's 0 cleft in a 4-year-old female child who was surgically treated with wide emphasis given on its diagnosis and other treatment modalities.

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Phyllodes tumor (PT) is an uncommon tumor of female breast. The tumor clinically, radiologically, cytologically as well as histologically can mimic fibroadenoma which is a common tumor of fibroepithelial group. Ductal carcinoma in situ (DCIS) in the epithelial component of PT is very rare. We report a rare case of intermediate grade DCIS arising in a benign PT in a 42-year-old lady. The patient presented with a small nodule in right breast along with serosanguineous discharge from nipple. Ultrasonography and cytology failed to distinguish between fibroadenoma and PT. Histopathological examination following wide local excision displayed the biphasic tumor comprising of benign looking cellular stroma and epithelial lining. It also demonstrated the foci of intermediate grade DCIS without any invasive component. Considering the clinicoradiological profile along with histopathological features, the diagnosis of DCIS in a benign PT of breast was made.

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Aim: To study the association between taurodontism and numeric anomalies in adult population. Materials and Methods: Out of 1,012; 946 panoramic radiographs and dental records were retrospectively assessed to determine the presence of dental agenesis and supernumerary and taurodont teeth. Results: Taurodontism of one or more teeth was observed in 164 cases (97 females and 67 males). Hypodontia was observed in 148 patients (84 females and 64 males) with 62 patients having associated taurodontism (38 females, 24 males), oligodontia in 12 patients (five females and seven males) of whom nine patients also had taurodontism of one or more teeth (five females and four males). Forty-five patients (32 females and 13 males) presented with 57 supernumerary teeth (ST) with 12 patients having simultaneous presence of taurodontic tooth (seven females and five males). Conclusion: Our study suggests a preferential association between tooth agenesis and taurodontism; however, such association was not observed in individuals with hyperdontia. Understanding the nature of this preferential association may be of importance in determining the etiology of both conditions. This association may also define a subphenotype for future genetic studies on dental development. Further molecular studies are necessary to verify the etiology and mechanism of taurodontism associated with tooth agenesis.

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The aim of the present study was to search the effective ratio of whole plant of Fumaria vaillantii Loisel (Fumaria vaillantii L.) and fruit of Benincasa hispida Thunb. (Benincasa hispidaT.) in composite form, namely "FVBH" for the management of hypochlorhydria along with iron deficiency in male albino rats. Hypochlorhydria refers to suppression of hydrochloric acid secretion by the stomach. Hypochlorhydria was induced by ranitidine in this study. We used four composite extracts of the mentioned plant and fruit with different ratios (1:1, 1:2, 2:1, and 3:2) for searching the most effective composite extract for the correction of hypochlorhydria. Gastric acidity is an important factor for iron absorption. Thus, hypochlorhydria causes iron deficiency in rat and it was prevented significantly by the extract treatment at the ratio of 1:1 of the said plant and fruit. The correction of iron deficiency by the composite extract was compared with iron supplementation to hypochlorhydric rat. It was found that preadministration followed by coadministration of FVBH-1 (1:1) able to prevent the ranitidine-induced hypochlorhydria and iron deficiency. The composite extract, FVBH-1 (1:1) significantly (P<0.05) increased the pepsin concentration, chloride level in gastric juice, iron levels in serum and liver along with blood hemoglobin level than other ratios used here. Hence, it can be concluded that FVBH-1 (1:1) is an effective herbal formulation for the management of hypochlorhydria and related iron deficiency.

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Background and Objectives: Road traffic injuries are one of the leading causes of death in the world. The present study aims at evaluation of pattern and distribution of injuries among pedestrians thereby planning successful measures to minimize fatalities. Materials and Methods: The present study was conducted in the Department of Forensic Medicine and Toxicology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal. This study included 50 cases of pedestrian victims of fatal road traffic accident, brought for medico-legal postmortem examination. Results: Highest number (17 or 21.3%) of fatalities occurred in the 41-50 years age group followed by the age group 31-40 years (15 or 18.7%). Male victims outnumbered female resulting in male to female ratio of 1.8:1. Most of the pedestrians were illiterate (26 or 32.5%) followed by those who were educated up to primary school (14 or 17.5%). Nearly half of the cases (38 or 47.5%), four or more wheelers - heavy vehicles - were involved. Fracture was the most common type of injuries (55 or 28.9%) followed by laceration (50 or 26.3%). In 44 (55%) cases, primary impact injuries were noted, secondary impact injuries in 55 (68.7%) cases, and secondary injuries in 62 (77.5%) cases. More than one-fourth (22 or 27.5%) of the deaths were due to pelvic and extremities injuries. Conclusion: Pedestrians, people who travel by foot, wheelchair, stroller, or similar means, are most vulnerable users of the road. Before head out on foot for a stroll, power walk, or errand, there are important safety tips to remember. A greater awareness about traffic rules will go a long way in curbing the incidence of fatal pedestrian accidents.

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Objectives: The present study was aimed to investigate the association of mental well-being and depression with periodontal clinical attachment loss among young adults in postwar urban population of Sebha city, Libya. Materials and Methods: Mental well-being and depression were assessed using Arabic versions of World Health Organization (WHO) five well-being index and major depression inventory (ICD-10), respectively. Random sample of 149 subjects were studied. Degree of periodontal attachment was measured at six sites per tooth using a rigid manual periodontal probe. Result and Conclusion: A total of 59.11% of the studied samples had healthy mental well-being state, whereas 40.81% had poor mental well-being. The severity of depression was stronger in males than in females. In the present study mental well-being, depression, and all its categories did not have any significant effect on periodontal attachment loss. Further studies and health interventions can be planned based on this data.

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Context: Preterm delivery is associated with high perinatal mortality and morbidity. Although detection of fetal fibronectin in cervical can predict preterm labor, but it is not available in lower source setting area. So, cervical length measurement by ultrasound can be used as an alternative to fetal fibronectin for predicting preterm labor. Aims: To find out the effectiveness of assessment of cervical length by endovaginal ultrasonography in predicting preterm delivery. Settings and Design: The study was conducted in the infertility clinic of Mahatma Gandhi Medical College and Research Institute, Pondicherry from January 2010 to July 2011. Materials and Methods: A total of 130 women with singleton gestation were studied with transvaginal ultrasonography (TVS) to assess the cervical changes (cervical length, dilation of internal os, presence of funneling) between 22 weeks and 24 weeks of gestation. The gestational age at delivery in women with cervical length with ≥25 mm were compared with those of <25 mm. Statistical Analysis Used: Statistical analysis was done using Chi-square test. The P value is <0.001 which is statistically significant. Results: The mean cervical length in the study population was 33.16 mm. 16 women had cervical length <25 mm at mid trimesters can out of which 13 (40.62%) went for spontaneous preterm delivery. The relative risk of preterm delivery increased as the length of the cervix decreased. The P value is <0.001 which is statistically significant. A significant difference was found between multigravida at risk of preterm being 62.5% compared to primigravida which was 37.5%. Conclusions: The risk of spontaneous preterm delivery is increased in women who are found to have a short cervix by TVS during pregnancy and it is a sensitive, simple and cost effective method of assessing risk of preterm delivery.

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Context: Tuberculosis (TB) affects the economically productive age group and has emerged as a disease of significant socio-economic global burden. Aims: The aim of this study is to identify epidemiological factors responsible for TB and the clinico-social correlates influencing their compliance. Subjects and Methods: All new smear positive TB (NSP-TB) patients registered in Dhubri District Tuberculosis Center-Tuberculosis Unit during 2007 in Assam were included in this study. The study was performed by interview technique using a pre-tested questionnaire. Results: Nearly 90.76% of the participants were in the age group of 15-55 years and were predominantly unskilled workers and sole earning member of their family. 83.33% of the patients had symptoms of cough for more than 3 weeks and most of them (98.15%) lived in overcrowded houses. More than half of the patients had X-ray examination as their initial approach to diagnosis. More males (59.18%) than females (40.82%) reported to the health institution within first 6 weeks after the onset of symptom and among them 91.84% were declared cured after completion of therapy and while, only 40% of the patients initiating treatment after 6 weeks of the onset of symptoms were declared cured after completion of therapy. Conclusions: The prevalence of NSP-TB cases was more among the illiterate and underprivileged population who needs counseling and motivation for early intervention.

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Epidermal inclusion cyst (EIC) is a benign lesion, which occurs due to proliferation and implantation of epidermal elements within a circumscribed space in dermis. They usually occur in the head and neck region, trunk and extremities. EIC occurring in the breast is very rare. In this study, we are presenting a rare case of EIC occurring in the breast; which was diagnosed by fine-needle aspiration cytology (FNAC). Later on, histopathology confirmed the diagnosis. We are presenting this case not only because of its rare site of presentation, but also to highlight the role of FNAC in diagnosing this benign lesion.

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Context: Diabetes has emerged as pandemic health problem and its prevalence is increasing at an alarming rate. Aims: The aim of the following study was carried out to understand the prevalence of diabetes mellitus, its associated risk factors and related co-morbidities amongst persons residing in rural hilly terrain of Upper Siang district of Arunachal Pradesh, India. Settings and Design: Population based cross-sectional study on 1370 participants in the field practice area of a private Nursing School in Yingkion in Upper Siang district of Arunachal Pradesh, India was conducted during April 2009-March, 2010. Materials and Methods: The clinico-social data related to diabetes was gathered by personal interview. Body weight, height, waist circumference and blood pressure were measured and blood glucose was estimated in fasting venous blood samples. Results: Diabetes mellitus was observed among 19.78% of the participants with additional 12.04% patients with impaired glucose tolerance (IGT). Diabetes mellitus was most prevalent among 50-59 years age group (32.10%). Hypertension was observed among participants with diabetes and IGT was 65.13% (hypertensive diabetics) and 53.94% (diabetics only). Mean body mass index and associated family history was added risk factors in prevalence of diabetes. Conclusions: Effective primary prevention strategies are to be intensified among the high-risk population groups to promote awareness through behavior change communication.

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Background: Opportunistic infections (OI) are the major cause of morbidity and mortality among human immunodeficiency virus (HIV) infected individuals. The pattern of OIs differs widely, hence it is necessary to correlate spectrum of OIs and CD4 counts among HIV infected individuals in specific localities. Materials and Methods: The present study describes the clinical and laboratory profiles of different OIs among 55 HIV seropositive patients. CD4 count was estimated and antiretroviral therapy (ART) was started in 27 patients as per National Acquired Immunodeficiency Syndrome Control Organization guidelines. These 27 patients were classified into stage 1, stage 2 and stage 3 based on CD4 counts of >500 cells/μl, 200-499 cells/μl and <200 cells/μl respectively. The OIs presented by respective groups were documented. Results: Pulmonary tuberculosis was found to be the most common OI constituting 43.6% of all cases followed by candidiasis (30.9%), cryptosporidial diarrhea (21.8%), herpes zoster (16.3%), cryptococcal meningitis (3.63%), Pneumocystis jirovecii pneumonia (1.81%), and other miscellaneous infections (23.6%). Only 1 patient was found in stage I while 13 patients each were grouped in stage II or stage III. The mean CD4 count in our study population who were on ART was 230 ± 150 cells/µl. Conclusion: The pattern of OIs among our study group did not differ significantly from patients not receiving ART. The effect of ART on CD4 count differs from patient to patient based on the degree of depletion of CD4 count before the initiation of ART, drug adherence, concomitant OIs and their treatment.

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Background: Dental plaque being one of the most-studied biofilm communities, is particularly complex because it consists of thousands of bacterial species, and new species are still being isolated and characterized. The aim of the present study is to characterize surface topography of the biofilm formed by a new bacterial isolate, obtained from the dental caries lesion using atomic force microscopy. Materials and Methods: Ten clinical isolates were obtained from five teeth with carious lesions involving dentine. Quantification of the biofilm forming ability of the clinical isolates was performed using microtiter plate assay. Bacterial isolate exhibiting maximum biofilm formation was subjected to phylogenetic analysis based on 16S rRNA gene sequencing and atomic force microscopic analysis. Results: The bacterial strain JKAS-CD2 displayed the highest similarity to 16S rRNA gene sequences of members of the family Streptococcaceae. It shared 95.3-99.3% similarity to the type strains of genus Streptococcus and 99.9% sequence similarity to the type strain Streptococcus infantarius. Atomic Force Microscopic analysis confirmed that the sucrose dependent bacterial adhesion for stable biofilm development has increased over a time-span on the thin film of enamel. Major structural components of plaque such as clumping of colonies and slime layer were clearly visualized by surface image of JKAS-CD2 cells grown on the enamel powder coated glass surface. Conclusion: JKAS-CD2 emerged as an obligate biofilm forming microbe under sucrose-dependent condition; a mechanism for adherence that determines the survival and persistence of the bacteria in the oral cavity and thus implicated with the dental caries.

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Aims and Objectives: The aim of the present study was to evaluate the knowledge of dentists regarding human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). Materials and Methods: A structured questionnaire to evaluate the knowledge, fears, and attitudes was self administered to 102 dentists. The data was then evaluated using Chi-square test and a P < 0.05 was considered statistically significant. Results and Conclusion: The findings of the present study suggest that dentists in private practice and affiliated with teaching institutions, had better knowledge than their counterparts who were into private practice alone. It was concluded that despite good knowledge many of the dentists expressed some hesitation in treating patients with HIV/AIDS.

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The aim of this article is to emphasize that the accidental displacement of a lower third molar during extraction is a rare, but potentially serious complication. We present two case reports on a lower third molar tooth dislodged into the submandibular space following its removal from the sockets and the subsequent management of this rare complication. Differences in the direction of displacement, the size of fragment, delay in retrieval, and tissue reactions can all influence this potential serious complication and hence no one technique is uniformly applicable. Though a rare complication, clinicians must be aware of possible lower third molars dislodgement into tissue spaces and the necessity to initiate prompt and appropriate management.

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Oral lichen planus (OLP) is a mucocutaneous disease with well-established clinical and histopathological features. It has a prevalence of approximately 1%. The etiopathogenesis is poorly understood. The annual malignant transformation is less than 0.5%. There are no effective means to either predict or to prevent such event. Clinically, OLP present as bilateral symmetrical lesion and hence lichen planus isolated to a single oral site other than the gingiva is very uncommon. On the other hand lichenoid reaction (LR) are the lesions which are similar clinically and histopathologically with OLP, but they are induced with some drug reaction and usually they do not show bilateral pattern like lichen planus. We reported a very uncommon case of unilateral lichen planus which was clinically diagnosed as LR, but in the absence of any cause-effective relationship biopsy was taken for histopathological examination Histopathologically, LR cannot be differentiated with OLP, so the final diagnosis was made on the immunohistochemical ground.

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Osteoarthritis of knee is one of the common problems in elderly population. Intraarticular corticosteroid injection is a conservative management modality in osteoarthritis of knee. Septic arthritis is an infective complication of intraarticular corticosteroid injection. Septic arthritis in rheumatoid arthritis patients have worse prognosis because of delay in diagnosis. A higher rate of infectious complications following intraarticular injection is expected in immunocompromised and rheumatoid patients. We would like to report an extremely rare case of simultaneous bilateral knee septic arthritis after bilateral knee intraarticular steroid injection in a rheumatoid arthritis patient. Patient was treated successfully with multiple bilateral knee arthroscopic washouts and long-term intravenous antibiotics. This case report emphasizes the increased risk of infection in rheumatoid arthritis patients and a risk benefit assessment on individual basis before carrying out intraarticular steroid injection. Patient should be aware of this increased risk of infection.

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Background: The CYP19 gene is located on chromosome 15 and it plays an important role in aromatization, which results in production of estrogen from androgens. The mutation in this gene can result in either increased or decreased aromatase activity. Materials and Methods: A case-control study was designed to compare 250 breast cancer cases with 250 age-matched healthy controls. The frequency distribution of CYP19 polymorphism was assessed by polymerase chain reaction confronting two pair primers (PCR-CTPP). Results: CYP19 polymorphism at codon 39 Trp/Arg (W39R) results in three genotypes TT, TC, and CC, but in the present study CC genotype was not found in breast cancer cases as well as in controls. The TT genotype was significantly elevated in disease (90.8%) as compared to controls (68.5%). The frequency of TC was found to be increased in premenopausal women with breast cancer (12.2%) and the frequency of TT genotype was increased in patients who were postmenopausal (94.1%). The increased frequency of heterozygotes was found in cases with familial incidences of cancer (10.8%), estrogen and progesterone receptor positive status, node positive status (9.8%), and occupied in agriculture (14.8%). Higher frequencies of both TT and TC genotype were increased in patients with high body mass index (BMI). The frequency of TT genotype was found to be increased in advanced stage of the disease. Conclusion: Hence, we conclude that W39 with increased aromatase activity confers greater risk to develop breast cancer especially in postmenopausal women and might also contribute to advanced stage.

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Objective: Cryptococcal meningitis (CM) caused by encapsulated opportunistic yeast Cryptococcus neoformans is an important contributor to morbidity and mortality in people living with human immunodeficiency virus/acquired immunodeficiency syndrome (PLHAs). Early diagnosis of such patients is the key to their therapeutic success. A retrospective study was conducted to evaluate the clinical features, laboratory findings, and prevalence of CM among hospitalized PLHAs in a tertiary care setting. Materials and Methods: A total of 112 clinically diagnosed CM patients were subjected to cerebrospinal fluid analysis and tests for human immunodeficiency virus antibodies by the standard laboratory operating procedures. Results: Out of 112, 16 showed a definite diagnosis of C. neoformans with the prevalence of 14.3%. Males in the age group of 21-40 years were most commonly affected than females. The clinical manifestations observed were fever and headache (100%), followed by altered sensorium (93.7%), neck stiffness (75%), and vomiting (62.5%). Overall, Cluster of differentiation 4 (CD4) T-lymphocytes count was <100 cells/μl except 1 case in which the CD4 T-lymphocytes count was 137 cells/μl. No concomitant cryptococcal and tubercular meningitis case was detected. All 16 patients responded initially to induction therapy of IV amphotericin B 1 mg/kg and fluconazole 800 mg daily for 2 weeks. Subsequently, 4 (25%) patients were lost for follow-up and 2 (12.5%) patients expired during their hospital stay. Conclusion: As the clinical and radiological pictures of CM are often non-pointing, routine mycological evaluation is necessary for early definite diagnosis and subsequent initiation of appropriate therapy as the majority of patients respond well to treatment if started early.

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Objectives: The objective of this study is to evaluate the relationship of anatomical landmarks of the face and geometric progression as predictors for the width of the maxillary incisor teeth. Materials and Methods: The central incisor width (CIW), lateral incisor width (LIW), inner-canthal distance (ICD) and inter-alar distance (IAD) from a total of 150 subjects were measured clinically. The width of the root of the nose (WRN) was measured on standard photographs of the subjects. Student t-test has been used to find the significance of parameters between male and female. Pearson correlation has been used to find any relation of the parameters. Results: The IAD and the WRN measurements suggest that the shape of the nose is wider and more triangular in males. The mean maxillary CIW and ICD was significantly higher in males than females. Conclusion: The proportion of IAD to WRN seems to be a reliable guide for deciding the proportion of the maxillary central and LIW. The ICD, when multiplied by a decreasing function value of the geometric progression term 0.618 and divided by 2, was a reliable predictor of the maxillary CIW.

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Aim: To study the accessibility of chair side blood glucose non-invasive screening method for diabetes mellitus during routine periodontal examination. Materials and Methods: Fifteen non-diabetics and 15 newly onset type 2 diabetics patients with moderate to severe periodontitis were selected after meeting inclusion and exclusion criteria. Periodontal pocket probing was performed using a Williams Graduated periodontal probe. Blood oozing from gingival sulcus of anterior teeth following periodontal pocket probing was collected with stick of a glucose self-monitoring device. As control, finger stick capillary blood was taken. Results: A statistically significant correlation was observed between the blood glucose level of gingival crevicular blood (GCB) and peripheral fasting blood (PFB) of diabetic subjects. The mean GCB glucose level of the subjects in diabetic group was 172.27 ± 5.02 mg/dl while mean PFB glucose was 167.80 ± 8.87 mg/dl. The correlation coefficient of diabetic and non-diabetic subjects were r = +0.715 and r = +0.619, respectively. Conclusion: The results suggested that blood oozing during routine periodontal examination may be used for diabetic mellitus screening in a dental office setting without the need for any extra procedure.

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Background: Metallo-beta-lactamase (MBL) mediated resistance to carbapenems is an emerging threat in Pseudomonas aeruginosa (PA) nosocomial infections. Limited data on role of Imipenem resistant MBL positive PA (IR-MBLP-PA) and IR-MBL negative-PA (IR-MBLN-PA) infections on mortality and morbidity initiated the present study. Objectives: The aim of this study is to determine the role of IR-MBLP-PA and IR-MBLN-PA infections on mortality and morbidity. Materials and Methods: Prospective observational study of 1 year with 110 PA nosocomial infections was conducted with Imipenem + ethylene-diamine-tetra-acetic acid combined disc test for MBL detection. Role of IR-MBLP-PA and IR-MBLN-PA infections on the outcome and morbidity were assessed in terms of crude mortality rate, Charlson's comorbidity score and mean duration of stay in intensive care unit (ICU) until cure and until death, number of episodes of complications and underlying disease. Results were analyzed by z test for proportions and Student t-test. Results: Relatively high crude mortality was observed among IR-MBLP-PA infections than IR-MBLN-PA (42.86% [6/14] vs. 20% [2/10], Z = 0.69, P = 0.49 NS). Ventilator-associated pneumonia was the underlying disease and a confounding factor in all deaths due to IR-MBLP-PA infections. IR-MBLP-PA infections resulted in rapid downhill course to death with short mean duration of stay in ICU until death than IR-MBLN-PA infections (3.167 ± 0.98 days vs. 16 ± 2.82, P < 0.001 highly significant [HS]) with more number of complications (5.85 ± 1.65 vs. 3.7 ± 1.31, P < 0.001 HS). With the exception of previous Imipenem therapy, association of higher Charlson's comorbidity score, severe underlying diseases, multidrug and pandrug resistance and pre-disposing risk factors with IR-MBLP-PA infections was not statistically significant. Conclusions: Higher mortality in IR-MBLP-PA than in IR-MBLN-PA was not significant indicating IR as an important predictor of mortality than MBL production. Higher morbidity and increased virulence was observed with certainty in IR-MBLP-PA infections.

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Extranodal disease in Hodgkin's lymphoma (HL) is very rare and it occurs in 15-30% of all cases. The intrathoracic area is the most common extranodal presentation. There are very few cases in the medical literature of breast involvement with HL. We report a 25-year-old woman who had been managed and treated for nodular sclerosing HL for 6 months, but she was noncompliant with chemotherapy. She presented 1 year later with a palpable left breast mass and B symptoms. The fluorine-18 fluorodeoxyglucose-positron emission tomography images revealed disseminated disease with a left breast mass demonstrating fluorodeoxyglucose uptake. Histopathology of the ultrasound-guided biopsy specimen of the breast mass was consistent with recurrence. This case highlights the need for an awareness of HL presenting in this way because the diagnosis has therapeutic and prognostic implications.

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Background: Null genetic polymorphism of Glutathione S-transferase T1 (GSTT1) and -463 G>A promoter polymorphism of myeloperoxidase (MPO) were studied for association with lung cancer. Materials and Methods: In a case- control study 26 lung cancer patients and 33 healthy individuals from hilly Kumaun region of northern India were investigated. DNA was extracted from peripheral blood. GSTT1 null polymorphism was detected by duplex PCR, and MPO polymorphism was detected by performing PCR-RFLP. Results: An increased but statistically non- significant risk for lung cancer was found for GSTT1 null genotype. No association for MPO -463G>A genotype was evident. Conclusion: Further study with large sample size may reveal such association in this population.

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Laparoscopic heminephrectomy in patients with horseshoe kidney is technically challenging procedure and only few cases have been reported in the literature. Various approaches have been described for handling the isthmus. We report the management of a case of symptomatic nonfunctioning right moiety of a horseshoe kidney secondary to ureteropelvic junction (UPJ) obstruction using Ligasure ^TM for vessel sealing and division of isthmus. We discuss here the various challenges during laparoscopic heminephrectomy and ways and tricks to deal with.

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Background/Aim: Significant change has been happening in the introduction of technology in medical teaching all over the world. We aim to determine if the undergraduate medical students and teachers are open to incorporating changes in the current medical curriculum or if there is a need for the same in the Republic of Ireland. Materials and Methods: A cross-sectional study involving 202 participants of whom 152 were medical students and 50 medical professionals (teachers and hospital doctors) were carried out involving three different medical universities namely; University College Cork (UCC), University College Dublin (UCD), and National University of Ireland in Galway (NUIG). Participants were requested to answer a series of 15 questions designed incorporating various fields of technology necessary for the study. The data was collected and analyzed using Statistical Package for Social Sciences (SPSS) software to determine statistical significance. Results: The participants overall had a positive attitude toward the utility of modern technology and web-based applications in current medical curriculum. Ninety-one percent of the participants preferred the introduction of modern technology into medical education and 7% were against the idea and a further 2% of them remained undecided. Conclusion: There seems to be a "technology gap" in the current undergraduate medical curriculum in Ireland. A large-scale study involving more participants from all the medical schools in Ireland is recommended. We believe, changes can be brought into the current medical teaching and learning to make the process more fruitful and successful.

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