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Introduction: The prevalence of oral cancer is extremely high in India, contributing significantly to morbidity and mortality. Public awareness of oral cancer may aid in the prevention and early detection of the disease. To achieve successful prevention, it is essential to analyse the level of awareness among the rural Indian population, who often lacks access to healthcare. Aim: To assess the awareness and perception of oral cancer, including its signs, symptoms and treatment options in the rural population. Materials and Methods: This cross-sectional study was conducted in the Department of Oral and Maxillofacial Surgery, Karpaga Vinayaga Institute of Dental Sciences, Madhuranthagam, Tamil Nadu, India over a period of eight months (September 2022 to April 2023) among 350 participants who visited the Dental and Medical College, Outpatient Department (OPD) from the rural population of Chengalpattu district, Tamil Nadu, India. A pretested, self-administered questionnaire consisting of 15 questions was distributed. These questions addressed knowledge and awareness of the signs and symptoms of oral cancer, various aetiological factors, risk factors associated with tobacco use, treatment options, and the quality of life of patients after receiving treatment. Responses were collected and tabulated for data analysis. Statistical analysis was performed using the IBM Corp. Statistical Package for the Social Sciences (SPSS) software for Windows, version 22.0 (Armonk, NY). The Chi-square test with Yates correction was used to compare the associations between males and females regarding awareness and perception of oral cancer. A p-value of

Introduction: Dental local anaesthesia serves several purposes, the most common of which is to minimise pain during dental procedures, thereby improving patient comfort and facilitating treatment. It can also have therapeutic effects, such as temporarily relieving pulpitis pain. Patients often experience anxiety before and after receiving local anaesthesia. Aim: To evaluate the perceptions and attitudes of patients receiving local anaesthesia through a self-administered questionnaire. Materials and Methods: This cross-sectional study was conducted among 398 patients, including 218 males and 180 females, between August 2022 and October 2022, who underwent dental extractions at a dental hospital in Chengalpattu district, Tamil Nadu, India. A 15-item questionnaire was administered to the patients. The questionnaire comprised three domains: the first domain included questions before the administration of local anaesthesia, the second domain included questions during the administration of local anaesthesia, and the third domain included questions after the administration of local anaesthesia. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) software. Results: Of the participants, 126 (40.20%) were between 46 and 60 years of age. Males constituted 218 (54.8%) and females constituted 180 (45.2%) of the sample. Additionally, 76.38% of the patients were unaware of the preinjection topical anaesthesia. Moreover, 70.35% of patients experienced anxiety before the administration of local anaesthesia. During the administration of local anaesthesia, 300 (75.4%) of patients reported experiencing moderate pain. Many patients exhibited physical manifestations of fear, including sweating in 92 (23.12%), light-headedness in 102 (25.63%), and palpitations after the administration of local anaesthesia in 190 (47.74%). Conclusion: Anxiety was more prevalent among patients prior to the administration of local anaesthesia. Patients were more anxious about the fear of the injection rather than the fear of the extraction itself. The outcomes of anaesthesia may be significantly improved by educating patients about dental treatment processes.

Introduction: The increasing usage of smartphones across the globe has resulted in considerable changes in people's daily lives, especially in terms of personality traits among adults. Research shows that the Big Five personality traits influence Problematic Mobile Phone Use (PMPU). Aim: To estimate the prevalence of PMPU using the Mobile Phone Problem Use Scale (MPPUS-10) and to evaluate the personality predictors of PMPU using the Big Five Inventory (BFI) questionnaire. Materials and Methods: A cross-sectional survey was conducted among 289 medical students at a rural tertiary care centre in Tamil Nadu, India from November 2021 to April 2022. The questionnaire consisted of three sections. The first section collected demographic characteristics, the second section included questions on the MPPUS-10, and the third section contained questions from the BFI questionnaire. Reliability analysis was conducted to assess the internal validity of the MPPUS-10 questionnaire. Exploratory factor analysis using principal component analysis with varimax rotation and Kaiser normalisation was performed to measure the structural validity of the MPPUS-10 scale. A multiple linear regression model was applied to determine the relationship between PMPU and the personality domains. Results: The prevalence of PMPU among medical students was found to be 106 (36.7%). Spearman's rank correlation revealed a negative correlation between agreeableness personality (r=- 0.307, p-value

Neonatal cholestasis is a significant cause of chronic liver disease in infants. However, lack of awareness among parents and primary care physicians often leads to delayed diagnosis and management of these children. In this series, the authors discussed four cases of neonatal cholestasis (48 days term female, 3 months term male, 73 days old female, 33 days old term male) that presented in the outpatient department with the chief complaint of yellowish discolouration of the eyes and pale-coloured stools. Clinical and histochemical findings in all cases were suggestive of neonatal cholestasis. The neonates were treated with Ursodeoxycholic Acid (UDCA), vitamin ADEK, and followed up. Fortunately, in all the babies, symptoms resolved after management, except for a three-month-old male baby who unfortunately succumbed to liver failure after two weeks of hospitalisation. Early identification of Progressive Familial Intrahepatic Cholestasis (PFIC) disorders is crucial as it enables effective management and potential definitive therapy. Additionally, prompt implementation of a galactose-free diet is critical for preventing acute toxicity and minimising tissue damage in galactosemia. Late presentation of biliary atresia can lead to increased morbidity and mortality. Therefore, it is crucial to include stool and urine charts in the discharge summary of every newborn and provide parental education on recognizing the signs of cholestasis in the Paediatric Outpatient department.

Introduction: Over the last five years in India, there has been a three-fold increase in the number of candidates taking the Foreign Medical Graduate Examination (FMGE). Foreign Medical Graduates (FMGs) have recently experienced the Coronavirus Disease-2019 (COVID-19) pandemic and wars/internal conflicts in the countries where they study. Aim: To assess the mental health status of FMGs and analyse the associated socio-demographic, economic, and academic factors, as well as the impact of COVID-19 on their mental health. Materials and Methods: This explanatory mixed-method study utilised a quantitative method (Phase 1 - Self-administered questionnaire GHQ-12) followed by a qualitative method {Phase 2 - Focus Group Discussion (FGD)}. The study included 169 FMGs doing their internship (academic year 2022-23) at Government Medical College Krishnagiri, Tamil Nadu, India, and their colleagues/batchmates who were willing to participate in the study. Descriptive statistics and student t-test were used to analyse the variables. Results: In the present study, 99 (58.6%) study participants were male, 130 (76.9%) were in the age group of 23-25 years, and 114 (67.5%) belonged to the upper socio-economic class. About 80 (47.3%) respondents scored higher than the overall mean GHQ-12 score, indicating mental distress. FMGs who had not yet joined the internship reported significant mental health issues compared to those currently in internship. FGD participants felt a lack of confidence in patient care, academic burden, financial burden, family bereavement, and personal health issues were the impacts of the COVID-19 pandemic on their mental health. Conclusion: Almost half of the FMGs in the present study were under stress, which could be attributed to the financial burden in the family, lack of academic confidence, and personal loss during the COVID-19 pandemic.

Introduction: Impulsive behaviour is the urge to act without thinking in any critical situation. Impulsive behaviour and risktaking behaviour in adolescence have the chance of disrupting the balance of their entire lives. Studies and research related to impulsive behaviour are minimal and remain a blind area for any effective interventions to be applied. Aim: To study the prevalence of impulsive behaviour and to determine the factors associated with impulsive behaviour among Medical College Students in Perambalur, Tamil Nadu, India. Materials and Methods: A cross-sectional study was conducted among 133 medical students of Dhanalakshmi Srinivasan Medical College and Hospital in Perambalur, Tamil Nadu, India, from January 2022 to April 2022. All undergraduate students, present in the college at the time of the study, were enrolled in the study. A pre-tested, validated, semi-structured questionnaire was used and the data was collected during the break hours in the morning and afternoon during the college working hours on the weekdays. The obtained data were analysed using statistical tests like paired t-test, unpaired independent t-test and Analysis of Variance (ANOVA). Results: Total of 133 Medical students (mean age: 21.21±1.58 years, 66 (49.6%) males and 67 (50.4%) females) were included in the study and analysed. The factors such as age (M±SD: 21.21±1.58 years with p-value 0.01), Usage of mobile phone (M±SD: 4.94±2.31 hours with p-value 0.01), fear for exam (M±SD: 2.20±0.58 with p-value 0.03), sleeplessness (M±SD: 2.89±0.59 with p-value 0.001) were associated with impulsive behaviour. Conclusion: The impulsive behaviour of a student is influenced by his fear of exams, his lack of sleep, and his usage of mobile phones. Assessment of a person with impulsive behaviour could help in the better prognosis and early intervention of young adult mental disorders.

Introduction: Severe hyperbilirubinaemia cause long-term morbidity that can be prevented by early prediction of the development of significant jaundice by measuring Umbilical Cord Bilirubin (UCB). Aim: To measure the predictability of UCB as an early marker of development of significant hyperbilirubinaemia needing phototherapy. Materials and Methods: The study was a prospective observational study conducted at Vinayaka Mission Medical College, Karaikal, Pondicherry, India. A total of 50 babies born between February and August 2022 were included in the study. Bilirubin levels were obtained at birth by umbilical cord sampling and rechecked again at third or fourth day. Blood group incompatibility was defined as A or B blood group babies born to O group mothers. Phototherapy was started when the bilirubin levels were above or upto 2 mg/dL below the cut-off for that patient as indicated by the curve for the risk group of the patient as per the American Academy of Paediatrics (AAP) guidelines. Phototherapy also was started if clinically indicated by visual assessment by Kramers rule. Results: Results were analysed by Receiver Operating Characteristics (ROC) curve analysis for measurement of sensitivity and specificity for predicting significant neonatal hyperbilirubinaemia. ROC curve anlaysis revealed that a cut-off of UCB of 1.95 mg/dL resulted in an accepatable sensitivity and specificity for predicting significant jaundice requiring phototherapy at 75% and 68% respectively. ROC curve analysis revealed that Area Under Curve (AUC) for UCB levels of all babies for predicting jaundice requiring treatment was 0.765, 95% CI 0.592 to 0.937. Separate ROC analysis showed that AUC for UCB for predicting phototherapy in babies with blood group incompatibility (AUC 0.80, 95% CI 0.418 to 1.00) was more significant than the AUC for babies without blood group incompatibility (AUC 0.490, 95% CI 0.29 to 0.69). Conclusion: UCB has high predictability for significant jaundice requiring phototherapy. The prediction is more when babies with blood group incompatibility is considered compared to babies without blood group incompatibility.

Introduction: Numerous bioactive grafts have been studied for periodontal defect regeneration of which, b-Tricalcium Phospate (β-TCP) is a very promising bone graft. Hyaluronic Acid (HA), an essential component of periodontal ligament matrix plays a pivotal role in tissue growth, repair and remodeling. Aim: To evaluate the efficacy of 0.8% HA as an adjunct to β-TCP in the treatment of isolated human intrabony defects. Materials and Methods: This prospective clinical study was conducted at the Department of Periodontics, SRM Dental College, Chennai, Tamil Nadu, India, from January 2017 and December 2017 (followed-up to June 2018). The study included 30 intrabony defects from 16 chronic periodontitis patients, 15 of each were randomly assigned into either test/control groups and were reviewed till six months. After phase I therapy regenerative osseous surgery was performed at all the sites. Control sites received β-TCP bone graft alone and test group received β-TCP with 0.8% HA. Postsurgical clinical evaluation of Probing Pocket depth (PPD) and Clinical Attachment level (CAL) was done at three and six months, radiographs were repeated at six months to assess the bone fill. Statistical analysis using Statistical Package for the Social Sciences (SPSS) version 22.0 was done, Mann-Whitney U test and Wilcoxon-Signed Rank test were used to compare the intergroup and intragroup values respectively. Results: The mean age of the control and test groups were 45.7 and 48.5 years respectively. The PPD was reduced, CAL and bone fill were increased in both groups from baseline, indicating clinical effectiveness. From baseline to six months, the PPD reduction and gain in CAL in the test and control groups were 3.27±0.18 mm, 3.20±0.18 mm and 3.07±0.03 mm, 3.07±0.08 mm, respectively, which was statistically significant (p-value 0.05) in both clinical and radiographic parameters. Conclusion: Hyaluronic acid as an adjunct to β-TCP demonstrated only comparable outcomes despite obtaining substantial bone fill and attachment gain.

Introduction: Lithium has been used in the treatment of mood disorders for more than five decades. Despite a few studies focusing on the relationship between the dose of lithium, serum lithium levels, duration of therapy, and cutaneous side-effects, results remain inconclusive. Lithium is known to cause multiple cutaneous side-effects like acneiform eruptions, psoriasiform eruption, seborrheic dermatitis, and follicular keratitis. Aim: To evaluate the relationship between cutaneous side-effects of lithium with the serum lithium levels, dosage and duration of lithium therapy in bipolar affective disorder patients. Materials and Methods: An ambispective observational study conducted among 52 bipolar affective disorder patients on lithium therapy recruited by convenient sampling methods from both Inpatients and Outpatient Psychiatry Units of PSG Institute of medical sciences and research, Coimbatore, Tamil Nadu, India, June 2014 to August 2014. The patients with bipolar affective disorder who are either newly started on lithium or already on lithium therapy were included in the study. They were followedup to assess the effect of lithium dosage, duration of lithium and serum lithium level with skin lesions, once a month for six months and once in two months for one year. Kaplan-Meier survival analysis was done with varying lithium dosages and serum lithium levels. Association between the lithium dose and serum lithium levels with the cutaneous side-effects were calculated using the survival analysis with the p-value of 800 mg/day) was 38%, 46.9%, 52.2%, 59% and for higher lithium levels (>0.8 mEq/L) was 41%, 58.2%, 65.2%, 73.9%. Conclusion: The patients who were treated with lower dosage and who had lower serum lithium level had reduced risk for cutaneous lesions. Lithium continued to exert its mood stabilisation property even when the serum level was maintained less than 0.8 mEq/L. This resulted in better compliance.

Mandibular condyle fractures are the most commonly reported mandible fractures. The incidence of condylar fractures is 25-30% among all mandibular fractures and there are ongoing controversies about their management. The retromandibular transparotid technique is the most frequently employed technique to manage fracture of mandibular condyle. The benefits of this method have been reported to include a shorter working distance between the incision and the fracture site, less morbidity to the facial nerve as it can be identified and retracted under direct vision, cosmetically pleasing outcomes and ease of reduction/fixation of fractures. Nevertheless, surgical treatment of mandibular condyle fractures, can pose danger to facial nerve branches. With respect to condylar fracture surgical treatment, the prevalence of Facial Nerve (FN) injury has been reported to be around 12-48%. This case series reports the surgical and postoperative journey of five patients with subcondylar fracture. The retromandibular transparotid technique was applied in all patients for Open Reduction Internal Fixation (ORIF). Using the House-Brackman facial grading system, FN weakness was assessed. Postoperatively, FN weakness was evident after 24 hours of surgery in two patients. With a mean recovery period of two months, all patients maintained FN function at three months. None presented with persistent paralysis of the facial nerve. Parotid fistulation was not observed in any patient. Inconspicuous scar after six months was observed in four patients. The retromandibular transparotid approach is a safe and effective technique that gives less morbidity to the facial nerve, excellent access, good cosmetic results and patient satisfaction.

Introduction: The incidence of mucormycosis in post Coronavirus Disease-2019 (COVID-19) cases increased in the second wave. Patients who had COVID-19 infection with pre-existing co-morbidities underwent treatment and resultant immunosuppression made them vulnerable to secondary infections like mucormycosis. Aim: To analyse the knowledge, level of awareness and practice among the dental professionals towards the mucormycosis infection in patients of post COVID-19 disease. Materials and Methods: This cross-sectional survey was conducted from May 2021 to June 2021 among 428 dental professionals residing in Tamil Nadu, India. The 16-item questionnaire consisted of questions about knowledge, awareness and practice regarding post COVID-19 mucormycosis infection. The questionnaire was sent to the dental practitioners through online portals. The responses were tabulated and the results were analysed using Chi-square test. A p-value

Introduction: Phototherapy is the mainstay of treatment of neonates who develop significant jaundice. Light-emitting Diode (LED) and compact florescent lamp phototherapy units are the newer devices in the management of neonatal hyperbilirubinaemia. The advantage of LED phototherapy includes portability, energy efficiency, less heat production and durability. Blue and white phototherapy devices are more economical but generate more heat leading to hyperthermia and dehydration more often. Aim: To determine the efficacy and side effects of three modes of phototherapy units viz conventional blue and white light phototherapy, Compact Fluorescent Lamp (CFL) phototherapy, and LED phototherapy on neonates having jaundice. Materials and Methods: This cross-sectional study was conducted in Department of Paediatrics at SRM Medical College Hospital and Research Centre (tertiary care teaching hospital), Kattankulathur, Tamil Nadu, India, from February 2021 to January 2022. A total of 150 neonates with hyperbilirubinaemia in the phototherapy range, American Academy of Paediatrics (AAP), were included in this study. Study subjects were divided into three groups of 50 neonates each to receive phototherapy using one of the three phototherapy devices, i.e., blue and white light, CFL, LED phototherapy groups. Data of serum bilirubin levels were recorded at the beginning and end of phototherapy. The number of babies who required exchange transfusion and other clinical side effects among the study groups was recorded. Descriptive statistics were reported as Mean±SD for continuous variables, frequencies (percentage) for categorical variables. The One-way Analysis of Variance (ANOVA) test was used to determine the statistically significant differences between the means of three independent groups. Results: All the three type of phototherapy units generated statistically non significant mean flux (p-value=0.754). Mean difference (from the baseline bilirubin) at end of phototherapy for blue and white light group was 5.77±1.72 mg%, for CFL group was 5.48±1.32 mg%, and for LED group was 6.34±1.48 mg%. The difference was statistically significant in all three groups (p-value=

Introduction: Helicobacter pylori (H. pylori) are microaerophilic gram negative, spiral shaped, flagellated bacterial pathogens transmissible to humans. The prevalence of infection with H. pylori infection varies worldwide. Pharmacologic therapy for eradication must be initiated in symptomatic individuals with emphasis on hygiene and sanitation. The high prevalence of H. pylori infection in the country, and the lack of adequate evidence on the efficacy of the standard triple therapy in Southern India was the drive to conduct this study. Aim: To compare and evaluate the efficacy of 14 days clarithromycin based triple drug therapy over 10 days levofloxacin based triple drug therapy in H. pylori eradication. Materials and Methods: A randomised clinical study was conducted from September 2018 to February 2019, at a tertiary care teaching hospital and research centre in suburban Chennai, Southern India. Eighty patients with dyspepsia, who were diagnosed with H. pylori infection based on both Rapid Urease Test (RUT) and histopathology of antral biopsy, were alternately assigned to treatment with either 14 days clarithromycin based triple drug regimen (PAC) or 10 days levofloxacin based triple drug regimen (PAL). Efficacy of the drugs were compared using both RUT and histopathology of endoscopic antral biopsy specimen four weeks after completion of the treatment. Chi-square test was used for data analysis. Results: Out of the 80 enrolled patients, 70 individuals completed the study, of which 41 were males and 29 were females. Baseline characteristics were similar in the both the groups-mean age 42.31±14.8 years in PAC and 42.20±12.67 years in PAL (p=0.150); 65.7% were males and 34.3% were females in PAC group, 51.4% were males and 48.6% were females in PAL group (p=0.225). Clearance of infection was seen in 23 patients (65.7%) in PAL group as compared to 32 patients (91.4%) in the PAC (p=0.01). Among patients with failure of eradication, 3 (1.05%) from PAC group and 12 (4.20%) from PAL group had persistence of dyspeptic symptoms. In addition, 7.14% (5 out of 70-two from PAC and three from PAL group) of subjects who had H. pylori eradication had persistence of same symptoms of dyspepsia on follow-up at four weeks after completion of the regimen. Conclusion: A 14 days clarithromycin based triple drug regimen is more effective than 10 days levofloxacin based triple drug regime for the eradication of H. pylori infection.

Osteoporosis is a progressive skeletal disorder which is characterised by low bone mass, normal mineralisation and abnormal bone microarchitecture. This disruption of bone microarchitecture causes subsequent increase in bone fragility and raises risk of fractures. Osteoporosis is a growing public health problem and affects approximately over 200 million people worldwide. In the United Kingdom, it is estimated that around 3 million people have osteoporosis. Since the evolution of drug therapy for osteoporosis in the 1940’s with oestrogen therapy several approaches to developing novel therapeutics for osteoporosis in animal studies and clinical observations (e.g., oestrogen, calcitonin, and teriparatide) or opportunistic repurposing of existing compounds (e.g., bisphosphonates) to one driven by advances in fundamental bone biology (e.g., denosumab). The advent of biologic agents has provided a more specific and targeted approach to the treatment of osteoporosis. Sclerostin is a glycoprotein secreted by osteocytes and regulates bone metabolism by inhibiting activation of osteoblast function and bone formation. By inhibiting sclerostin, targeted therapeutic pharmacological agents are being developed to address severe osteoporosis and patients who do not respond well to primary line of medical management of osteoporosis. Romosozumab is humanised as a monoclonal antibody designed to target sclerostin. This review assesses the mechanism and current role of romosozumab in osteoporosis treatment.

Introduction: Despite increase in the knowledge about reduction of dental injuries after tonsillectomy, the incidence is still considerable to attract attention. Presently gauze pieces, rubber or soft plastic materials are used. Hence, it was attempted to use a soft elastomeric putty dental material for this purpose which moulds perfectly to the shape of the upper dentition when applied and also gives full coverage of teeth with no reduction of the space when mouth is opened for surgery. It also gives better protection to the upper dentition as the gag fits perfectly on to it when applied. This, unlike gauze piece threads does not get interwined between the gaps of malaligned, prominent or crooked teeth, thereby offering superior protection. Aim: To describe the feasibility of custom fabricated teeth guard for Boyle Davis mouth gag in oral and oropharyngeal surgeries. Materials and Methods: An cross-sectional study was conducted in the Department of Ear, Nose and Throat, Mahatma Gandhi Medical College, Puducherry, India, in association with Indira Gandhi Institute of Dental Sciences, kerala, India, from February to April 2019. The equipment was simple, comprising of a paste of elastomeric silicone putty which had a base and catalyst which was custom made for the patient, just minutes before application over the patient’s upper dentition and over which the Boyle Davis mouth gag was applied and then the mouth opened for surgery. Total 50 consecutive patients, in the age group of 6-18 posted for tonsillectomy, were inserted with the equipment before application of Boyle Davis (BD) gag. The ease of insertion with a score of 1-4 was recorded from the surgeon. Postoperatively, once the gag was removed along with the custom made putty, the patient’s upper dentition was examined to look for any dental injuries that might have occurred due to gag insertion. The comfort level was assessed by a targeted questionnaire over a scale of difficulty from 1-4, 1 being comfortable and 4 being difficult. Results: The mean age of the patients was 10.56 years with the mean weight of 38.55 kilograms. There were 27 males and 23 females. In all the patients, pre and perioperative period was uneventful. The ease of insertion score was 1 in all the 50 patients; there were no oral injuries and no residual side-effects due to the material used. The mean score for comfort level was 1.8. Conclusion: An indigenously made elastomeric teeth guard is extremely effective in preventing dental injuries after application of Boyle Davis mouth gags in cases of adenotonsillectomy under controlled general anaesthesia.

Impaction of first, second and third molars at once comprise a rare clinical scenario with diverse therapeutic approaches and possess a great challenge for the dentist. Early detection of the eruption disturbances helps to manage and produce optimal outcomes. Here, the authors reported a case of 17-year-old male patient who reported with the chief complaint of pain in his lower left back tooth region with difficulty in mouth opening and chewing that revealed impacted mandibular left first, second and third molar on radiographic investigation. A proper decision making is required to satisfy the patient and also get an effective result. As the patient had severe pain in the left side of the jaw near the angle of the mandible, surgical removal of the impacted molars was planned and performed using extra oral submandibular approach. Following the removal of the teeth, implants were placed in the extracted site supported by bone graft material and fixed orthodontic appliance therapy was carried out to correct the supraerupted upper molars on the left side and arch expansion screw with upper Hawley’s appliance was given to expand the maxillary arch to aid in appropriate occlusion. Restoration of the implant was done after one year of orthodontic treatment using ceramic crowns. The combined surgical, orthodontic and periodontal interdisciplinary approach helped the patient to gain proper occlusion and satisfactory masticatory function.

Introduction: Cardiovascular Disease (CVD) is one of the established causes of mortality and morbidity in hypothyroid patients. A predictor of cardiovascular risk in hypothyroid patients becomes essential to prevent the occurrence of cardiac event. One such prognosticator of CVD is the Lipid Accumulation Product (LAP). Aim: To compare the trend of LAP scores in hypothyroid patients with that of healthy controls. Materials and Methods: After obtaining approval from the Ethics Committee, this cross-sectional study was conducted. After obtaining written informed consent, details such as age, gender, waist circumference, serum Thyroid Stimulating Hormone (TSH), and serum triglyceride levels were collected. LAP was calculated among study participants as follows: LAP for men={Waist circumference (cm)-65}×{Triglyceride concentration (mmol/L)}. LAP for women={Waist circumference (cm)-58}×{Triglyceride concentration (mmol/L)}. Statistical analysis was performed with Microsoft excel and Statistical Package for the Social Sciences (SPSS) software version 24.0 for Windows. Results: The total number of participants were 118 among which 59 (50%) were hypothyroid cases and 59 (50%) were healthy controls. The two groups had statistically significant difference in their LAP scores. The mean LAP score among cases and controls was 38.6±15.6 cm.mmol/L and 30.9±13.2 cm.mmol/L, respectively with a p-value of 0.004. The LAP scores showed positive correlation with TSH levels with r-value of 0.784 and p-value

Corona Virus Disease (COVID-19) has resulted in restriction of face-to-face consultations and mechanisms to access health care. Oesteoarthritis (OA) is one of the most common forms of musculoskeletal disease encountered and a leading cause of painful disability in adults and elderly. The assessment of the challenges and strategies encountered in the nonoperative management of OA of knee care during the COVID-19 pandemic was done. A comprehensive review of the literature using suitable keywords such as ‘COVID-19’, ‘OA’, ‘OA knee’, ‘knee joint’ on the search engines of PubMed, SCOPUS, Google Scholar and Research Gate in May 2020 on developments and guidance during the current COVID-19 pandemic. The management of OA has been hampered by COVID-19 pandemic lock down with subsequent suspension of elective surgeries. Nonoperative complementary therapy has been evaluated with National Institute for Health and Care Excellence (NICE) recommendations to guide management. Conservative strategies including judicial use of analgesia as recommended by NICE, supportive orthosis, patient education and advice using remote telecommunication consultations play an important role in the nonoperative management of OA till elective surgery can safely resume.

Paraurethral Leiomyomas (PL) are rare benign mesenchymal tumours. Here, authors, report two premenopausal women presenting with obstructive urinary symptoms and a paraurethral vaginal swelling. They had firm mobile paraurethral masses. On magnetic resonance imaging, they were well-defined and no urethral invasion was noted. Surgical excision was performed in both women and histopathological examination confirmed benign spindle cell neoplasm suggestive of leiomyoma. After catheter removal, the patients voided well with maximum flow-rate of 27 mL/second and 25 mL/second respectively. Long-term follow-up is required as late recurrences and transformation to leiomyosarcoma have been reported.

Schwannomas are infrequent tumours of oral cavity that are not routinely included in the differential diagnosis of oropharyngeal masses. The tumour presents with non-specific clinical symptoms and is clinically indistinguishable from varied soft tissue neoplasms of the oral cavity. Of the 84 cases of lingual schwannoma reported in English literature in the past 61 years, only 18 cases have been reported in paediatric age group ranging from 1 to 15 years. We, herein, report a rare case of schwannoma of the tongue in a 14-year-old boy, presented as a painless swelling with characteristic Antoni A and Antoni B pattern with Verocay bodies on histopathology. Strongly positive immunohistochemical staining with S 100 protein confirmed the Schwann cell origin.

Introduction: Radius is the bone of the forearm that is present on the lateral side. The proximal and distal end of radius are commonly susceptible to trauma, about 2-6% of fractures occur in the proximal end and neck of radius and the distal end of fracture is about 8-20% which is more commonly seen in geriatric population. If the fracture is severe then the person should undergo radial head prosthesis. Aim: To determine the morphometric parameters of proximal and distal end of radius and its clinical significance. Materials and Methods: The present observational study was conducted at Saveetha Medical College, Chennai, Tamil Nadu, India between February 2017 to August 2017. The morphometric parameters of proximal and distal end of radius were measured and observed using digital vernier caliper, divider, normal ruler, inch tape and inelastic thread. The mean and the standard deviation of the morphometric parameters were assessed. Results: The mean length of radius bone in medial side (22.7 cm) and lateral side (23.7 cm), circumference of the head (6.3 cm), length of the head from medial side (0.6 cm) and lateral side (0.32 cm), distance between the radial head and the radial tuberosity (0.75 cm), length of the radial tuberosity (3.36 cm), circumference of the radial neck (4.64 cm). The mean width of the ulnar notch (1.41 cm), length of the ulnar notch from anterior aspect (0.30 cm) and posterior aspect (0.62 cm), length of the styloid process (1.01 cm), circumference of the distal end of the bone (8.40 cm), circumference of the distal end of the shaft (5.63 cm), scaphoid and lunate fossa from anterior (2.79 cm), posterior (2.50 cm), and base (1.32 cm). Conclusion: The length of the radius on the medial and lateral aspect, circumference of radius head, diameter of the radius, Length of the radial head on the medial and lateral aspect, distance between the radial head and the radial tuberosity, circumference of the radial neck, length of the radial tuberosity, length of styloid process, length of ulnar notch on the anterior and posterior aspect, width of the ulnar notch, inferior articular facet of radius in anterior, and posterior aspect the following parameters will be useful for orthopaedic surgeons in case of severe fracture and oncologist in case of tumour in distal end for the purpose of making prosthesis for the radial head and distal end of radius and for reconstruction of bicipital tendon.

Introduction: Magnetic Resonance Urethrography (MRU) is a new and less widely used technique in the evaluation of male urethral strictures. Aim: This study intends to establish the role of MRU in the evaluation of male urethral strictures and to compare the efficacy with that of conventional Retrograde Urethrography (RUG). Materials and Methods: A total of 32 patients with symptoms of poor urinary stream and straining during micturition underwent conventional RUG followed by MRU. The parameters studied by RUG and MRU such as stricture site, number, length, diameter and associated false tracts or diverticulum were compared with intraoperative findings, which is taken as gold standard. The sensitivity, specificity, positive and negative predictive values of all the parameters was calculated. Karl pearson correlation coefficient and Wilcoxon’s signed rank test were used where appropriate. A p-value of

Deliberate self-harm by overdosing on iron tablets although rare is an emergency and requires early recognition and intervention. We present the case of a 19-year-old girl who presented with abdominal distension, colicky abdominal pain, obstipation and intractable vomiting two days after an attempt at deliberate self-harm with ingestion of 30 iron tablets. She was admitted at another hospital, underwent gastric lavage and was monitored in their intensive care unit (ICU) for two days following which she was asymptomatic at discharge. At our hospital, abdominal radiographs showed multiple air fluid levels and dilated bowel loops. CECT showed focal thickening of the distal ileum with luminal occlusion, mesenteric hyperemia and fat stranding. She made complete recovery after conservative management with bowel rest, Deferoxamine (DFO) therapy and supportive care. Segmental enteritis caused by iron ingestion has not been well described and its sequelae causing luminal occlusion leading to intestinal obstruction within a week is very rare. Due to the infrequent occurrence of this condition and lack of evidence, management of intestinal obstruction following iron toxicity is case based. However, rigorous monitoring and follow up until complete resolution of symptoms is essential.

Introduction: Palliative care knowledge is being given meager importance in the curriculum of medical and other allied medical sciences. It is vital that all health care practitioners including medical, pharmacy, physiotherapy and nursing are aware and apply the best principles of palliative care. Aim: To assess the awareness of palliative care among undergraduate students of medical, nursing, pharmacy and physiotherapy. Materials and Methods: The study population included total of 200 students. Among 200 students, 50 were from each of the colleges of medicine, nursing, pharmacy and physiotherapy. After obtaining informed consent, questionnaire was given. The questionnaire contained the sociodemographic profile and 35 statements under nine groups, for which the respondents were expected to answer one out of the three options (Yes, No, Don’t know). The groups of statements deal with palliative care definition, its philosophy, communication issues, nonpain symptoms, medications use and context of application of palliative care. Results: It was found that less than 20% of nursing students were unaware of palliative care. Among the undergraduates of college of pharmacy, more than 50% had no knowledge of palliative care. More than 80% of physiotherapy, nursing and medical students agree that death should occur without any pain or symptoms. The need of palliative care was well understood by more than 70% of students of physiotherapy, pharmacy, nursing and medical colleges. Conclusion: Basic knowledge about palliative care was inadequate among the undergraduate students related to healthcare.

Introduction: Scrub typhus, an acute febrile illness, caused by Orientia tsutsugamushi, is an important cause of pyrexia of unknown origin in regions of endemicity. This disease is mostly underdiagnosed or misdiagnosed, the reasons for this being a combination of factors which include clinical manifestations that can mimic other infections, lack of easy and reliable diagnostic methods and variation among strains in endemic areas. Hence, easy and reliable methods of diagnosis will contribute to rapid identification and treatment of the infection. Aim: The aim of the study was to compare four different methods of detection of scrub typhus and to identify one single test or a combination of tests detecting maximum number of cases. Materials and Methods: One hundred and forty-five suspected scrub typhus cases were included in this study. Duration of fever and presence of eschar in each patient was noted down. EnzymeLinked Immunosorbent Assay (ELISA) to detect Immunoglobulin M (IgM) antibodies and Polymerase Chain Reaction (PCR) to detect three genes of Orientia, namely, 56 kDa, 16S rRNA, and groEL were done on these samples. The results of each test were analyzed to identify the test picking up maximum number of positive samples. Statistical analysis was performed using Chi-square test. The level of significance was set at p

Introduction: Solanum nigrum Linn. is a common medicinal plant possessing a wide variety of pharmacological activity. Current treatment of diabetes mellitus has plenty of adverse effects necessitating the search of alternate drugs. Aim: Evaluation of antidiabetic effect of Aqueous Extract of Solanum Nigrum Linn Berries (AESNB) in alloxan induced diabetic Wistar rats. Materials and Methods: There were five groups (normal control, diabetic control, AESNB 200 mg/kg/day, ASENB 400 mg/kg/day and standard i.e., glimepride 0.1 mg/kg/day) with six animals in each group. Alloxan was used to induce diabetes in rats. The standard drug glimepride in the dose of 0.1 mg/kg/ day and the test drug AESNB were given orally in the doses of 200 mg/kg/day and 400 mg/kg/day. The fasting blood glucose level was measured by glucometer on day 0, 1,7,14 and 21 after 12 hour. On 21st day after the blood glucose measurement all the animals were sacrificed and their pancreas were analysed histopathologically. The results were analysed statistically by using one-way ANOVA. Results: Aqueous extract of Solanum nigrum Linn berries in the dose of 200 mg/kg/day produced significant blood glucose reduction (p

Introduction: Treatment of a tooth with necrotic pulp and open apex is a special challenge to the clinicians. Apexification with calcium hydroxide and MTA barrier technique fails to induce continued root maturation which makes the tooth susceptible to root fracture. Hence, an ideal outcome for such a tooth should be regeneration of pulp like tissue into the root canal capable of continuing normal root maturation. Aim: This study aims to compare the effect of Platelet Rich Fibrin (PRF), induced bleeding technique and Platelet Rich Plasma (PRP) in the revascularization of tooth with necrotic pulp and open apex. The main objectives of the study were to: (a) Radiographically evaluate the continuation of root development, increase in the dentin wall thickness and narrowing of canal space, apical closure and resolution of the periapical lesion; and to (b) To clinically evaluate the response to pulp sensibility testing and response to percussion and palpation tests. Materials and Methods: Sixty patients (6 to 28 years) with necrotic immature permanent tooth were randomly categorised into three groups after the root canal disinfection procedure. PRF as scaffolding material (Group A: n=20), revascularization with conventional induced bleeding technique (Group B: n=20), and PRP as the biomaterial (Group C: n=20). The primary outcome variable was measured using Periapical Index (PAI) (for periapical healing), Chen and Chen index (for apical responses), Schei’s ruler (for root lengthening and root thickening) and other clinical parameters. The Chi-square test was used to interpret the data among the three groups at the end of 12 months for the variables root lengthening and lateral wall thickness. ANOVA test was performed to compare the mean of the PAI scores of the three groups at preoperative stage and 12 months. If statistically significant, Bonferroni test was done to compare the outcome among the three groups. The significant level was set at p

Wunderlich Syndrome (WS) is an uncommon condition where acute onset of spontaneous bleeding occurs into the subcapsular and perirenal spaces. It can prove fatal if not recognized and treated aggressively at the appropriate time. A 32-year-old male diagnosed elsewhere as acute renal failure presented with tender left loin mass, fever and hypovolemic shock with serum creatinine 8.4 mg/dl. He was started on higher antibiotics and initiated on haemodialysis. Ultrasonogram (USG), Non-Contrast Computed Tomography (NCCT) and Magnetic Resonance Imaging (MRI) showed bilateral perirenal subcapsular haematomas – right 3.6 x 3.1 cm and left 10.3 x 10.3 cm compressing and displacing left kidney, fed by capsular branch of left renal artery on CT angiogram. Initial aspirate was bloody but he persisted to have febrile spikes, renal failure and urosepsis and he was managed conservatively. Repeat NCCT 10 days later revealed left perinephric abscess and Percutaneous Drainage (PCD) was done. Patient improved, serum creatinine stabilized at 2 mg/dl without haemodialysis and PCD was removed after two weeks. To conclude, bilateral idiopathic spontaneous retroperitoneal haemorrhage with renal failure is a rare presentation. This case highlights the need for high index of suspicion, the role of repeated imaging and successful minimally invasive management with timely PCD and supportive care.

Introduction: With advances in endourology, open stone surgery for staghorn calculi has markedly diminished. Anatrophic Nephrolithotomy (AN) is performed for complex staghorn stones which cannot be cleared by a reasonable number of Percutaneous Nephrolithotomy (PNL) attempts. Aim: To assess the indications and outcomes of AN in the modern era. Materials and Methods: Between April 2008 and July 2015, AN was done in 14 renal units in 13 patients. In this retrospective study, demography, stone characteristics, operative details, clearance and long term outcomes were assessed. Results: AN was performed for complex staghorn calculi involving pelvis and all calyces in 10 patients, infundibular stenosis in two patients and failed PNL in one patient. Mean (SD) in situ cold ischemia time was 47.64 (5.27) minutes. Retroperitoneal drain and double J stent were placed in all 13 patients. Median (IQR) estimated blood loss was 130 (75) ml. There was no perioperative mortality. Surgical site infection was seen in 2 patients and urosepsis in 2 patients. Drain was removed at a mean (SD) of 9.11 (6.15) days. Mean (SD) postoperative length of hospitalization was 15.44 (7.14) days. Stent removal was done in all patients between 2-8 weeks. Median (IQR) clearance was 95 (7.5%). There was no renal failure or new calculi during the follow up period {median (IQR): 1(3) years}. Conclusion: AN is effective in management of large staghorn calculi failed minimally invasive approaches and achieves 80%- 100% clearance without much need for secondary interventions. Renal function is preserved and with emergence of laparoscopy and robotics, postoperative stay is minimized with expedited recovery and comparable results with open surgery.

One of the known aberrations in root canal morphology of maxillary second permanent molars is the presence of collateral mesiobuccal canals. This case report describes the endodontic management of a maxillary second molar that had a single fused root with six canals that was successfully managed with the aid of dental operating microscope. Six canal orifices were located namely MB1 (Mesiobuccal), MB2, MB3, DB1 (Distobuccal), DB2 and palatal. During the cleaning and shaping, instrument separation occurred at the apical third of the palatal canal which was removed with ultrasonics. After cleaning and shaping, the canals were obturated with resin sealer and laterally condensed gutta-percha. The patient was recalled for periodic review. After two years of follow up the patient remained asymptomatic. Cone Beam Computed Tomography (CBCT) evaluation revealed satisfactory periapical status.

Introduction: Adequate apical sealing ability of the root canal filling material is an essential requisite for a successful endodontic therapy. Various endodontic irrigants are used for the removal of smear layer before obturating with a solid core material, thereby, reducing microleakage and improving apical seal. Resilon, a synthetic material was developed as an alternative to replace the conventional gutta-percha (standard root canal filling material) and traditional sealers for the obturation of endodontically treated teeth. Aim: To evaluate and compare in-vitro, the post obturation apical seal obtained with Resilon /Epiphany SE (Self Etch) sealer following irrigation with 17% Ethylenediamine TetraAcetic Acid (EDTA), 10% citric acid, and MTAD (a mixture of doxycycline, citric acid, and a detergent, Tween 80), as final irrigants in combination with Sodium hypochlorite (NaOCl) using dye leakage under vacuum method. Materials and Methods: Fifty five single rooted human maxillary central incisors were subjected to root canal instrumentation. Based on the final irrigation solution, samples were divided into three experimental groups (n=15); (I) 17% EDTA + 1.3% NaOCl, (II) 10% citric acid + 1.3% NaOCl, (III) MTAD + 1.3% NaOCl and two control groups (positive and negative) with 0.9% normal saline as a final irrigant. The samples were obturated with resilon/ epiphany SE sealer according to manufacturer instructions and placed in 2% rhodamine B dye solution under vacuum pressure for 30 minutes and allowed to remain in the dye for seven days. All samples were then longitudinally split and examined for dye leakage under stereomicroscope and the data were statistically analysed using one-way ANOVA and post hoc tukey test. Results: Statistically significant difference (p=0.001) was observed in the mean apical leakage between the experimental and the control groups. However, there was no significant difference (p>0.05) observed in the mean apical leakage amongst the three experimental groups. Conclusion: 17% EDTA, 10% citric acid, and MTAD were equally effective in achieving the post-obturation apical seal with resilon/epiphany SE sealer when used as a final irrigant in combination with NaOCl.

Introduction: Aesthetic restoration of severely mutilated primary anterior teeth still remains as a special challenge to paediatric dentist. Due to increased parent’s concern for aesthetic rehabilitation for their children, paediatric dentist are in a state to improve technique sensitive restorative procedure to improve aesthetic rehabilitation in children. Aim: The purpose of the study was to evaluate the effect of different root surface treatment on the shear bond strength of glass fibre reinforced post in primary anterior teeth using Universal Testing Machine (UTM). Materials and Methods: Twenty single rooted primary anterior teeth were selected. Coronal portions of the teeth were sectioned transversally 2 mm above the Cemento-Enamel Junction (CEJ) and specimens were treated endodontically and obturated using metapex. Then the specimens were randomly divided into four groups. Group 1: Control group; Group 2: Chemical surface treatment of the root with 2% chlorhexidine; Group 3: Mechanical surface treatment with mushroom-shaped undercut; Group 4: Combination of mechanical and chemical surface treatments. Samples were tested for shear bond strength. ANOVA and Posthoc Tukey test were used for statistical analysis using SPSS version 20.0. Results: Combination of mechanical and chemical surface treatments exhibited higher mean shear bond strength (8.41 MPa), followed by mechanical surface treatment (4.68 MPa), chemical surface treatment (3.92 MPa) and control group (2.76 MPa). Conclusion: Mechanical and chemical surface treatments together led to a improved shear bond strength and increased the retention of the post to the root surface.

Introduction: Three-dimensional control throughout the orthodontic treatment is essential for uncompromised results. Mini screws introduced for orthodontic anchorage has given the clinician an option of absolute three dimensional control. The purpose of this study was to compare and measure the vertical control and torque control of incisors and molar during enmass retraction with titanium microimplants and conventional molar anchorage. Material and Methods: Twenty patients were selected with extraction of all first premolars and bonded with 0.022” slot MBT system. After aligning and leveling, all subjects were placed with 0.019” X 0.025” posted SS wire with standardized torquing curve. The 20 subjects were randomly divided into 2 groups consisting of 10 each (Group A & Group B). Group A subjects, implants were placed and Group B formed the control group. Retraction was carried out using NiTi closed coil springs. The assessment of the vertical and torque control of incisors and tipping and vertical control of molars was done by radiographic method using lateral cephalogram taken before and after retraction. Results: The torque control of incisors, P11 value in group A and B indicated no significant difference. The molar tip, P12 value in group A indicated that there was distal tipping of molars while the P12 in group B indicated mesial tipping. On vertical plane P21, P22 and P23 values in Group A indicated that there was intrusion of incisors and molars while value in Group B indicated extrusion of incisors and molars. Conclusion: Three dimensional control is better in the implant group compared to the non implant group. Therefore the implant group definitely has citied advantages over conventional method.

Introduction: Marginal discrepancy severely affects the long term success of All ceramic complete veneer crowns. The precise role of resin luting agents influencing this phenomenon needs to be explored further. Aim: To estimate and compare the marginal discrepancy in CAD/CAM processed All ceramic complete veneer crowns prior and following luting with resin bonded luting agents. Materials and Methods: Extracted human maxillary first premolars were randomly allocated into four groups of 27 samples each Viz., Group I-Resin Modified Glass Ionomer Cement (GIC) (RelyX), Group II-Bis-GMA based dual cure resin cement (Variolink II), Group III-PMMA based resin cement (Superbond), Group IV- Urethane Dimethacrylate resin cement (Calibra). Following tooth preparation, CAD/CAM All ceramic complete veneer crowns were fabricated and sectioned and marginal discrepancy was evaluated using a scanning electron microscope (TESCAN, Magnification power-1,00,000x) prior and after luting with the experimental resin cements. Results: The vertical and horizontal discrepancy before and after cementation with Group I [270.08±103.10µm, 165.3±53.00µm and 270.86±102.70µm, 166.62±54.96µm respectively]; Group II [254.21±79.20µm, 117.75±24.29µm and 234.81±79µm, 116.89±18.22µm respectively]; Group III [272.47±86.25µm, 142.08±50.83µm and 251.82±62.69µm, 136.07±44.95µm respectively]; Group IV were [260.28±64.81µm, 116.98±17.71µm and 233.08±69.44µm, 116.58±21.13µm respectively]. ANOVA inferred a statistically significant difference between the four test specimen with regards to vertical and horizontal marginal discrepancy after cementation (F=9.092, p

Iron related disorders are encountered in daily clinical settings. Maintenance of stable extracellular iron concentrations requires the coordinate regulation of iron transport into plasma from dietary sources in the duodenum, from recycled senescent red cells in macrophages and from storage in hepatocytes. Hepcidin acts as a systemic iron-regulatory hormone. Many human diseases are associated with alterations in hepcidin concentrations. This review has focused on hepcidin structure, kinetics and function, its correlation with iron metabolism disorders, the therapeutic potential for modulating hepcidin expression and the diagnostic potential of hepcidin measurements in clinical practice.

Introduction: The attire of the dentist has an influence on child’s behaviour in dental setup. Recent research has shown that the children have preferences towards the outfit worn by the dentist. Aim: The aim of the study was to determine the preference of children towards dentists’ attire based on various age groups and environment. Materials and Methods: A total of 534 children aged between 6-11 years participated in the study. Children were divided into three groups based on their age as younger, middle and older age groups. Photographs of the dentist in different attires such as white coat, surgical scrubs and regular outfit were shown to children and the questionnaire was evaluated by a single, qualified Paediatric dentist in two different environmental set ups, namely school and dental environment. The anxiety level was evaluated by using Modified Child Dental Anxiety Scale [MCDAS (f)]. Data was collected and tabulated. Statistical analysis was done using SPSS version 20.0. Results: A statistically significant difference was evident in the preference level of children towards dentist attire (p-value= 0.002). There was a positive correlation in the preference level of children towards dentist attire in different age groups. A statistically significant difference was evident in the preference level of children towards the dentist attire in school and dental environment (p-value

Introduction: Natural killer cells are believed to promote placental and trophoblastic growth and provide immunemodulation at maternal-fetal interface in pregnancy and their role in reproductive failure has been a matter of discussion. Aim: To study CD56+ Natural killer cells in spontaneous pregnancy loss. Materials and Methods: In this prospective observational study, formalin-fixed paraffin embedded sections from products of conception from twenty women each with spontaneous early pregnancy loss (test group) and elective pregnancy termination (control group). Immunohistochemical staining with CD 56 monoclonal antibody was done by avidin-biotin peroxidase technique. CD56+ cells in decidua were counted under light microscopy by two independent observers in ten high power fields (40X) and mean cell count taken. Student’s paired ‘t’-test was used to statistically compare CD56+ NK cell population between the test and control groups. Results: The mean number of CD56+ NK cells was higher in the decidual tissue of women who had spontaneous early pregnancy loss (mean±SD, 57.55±1.79) as compared to the mean number of CD56+ NK cells in the decidual tissue from women who underwent elective termination (mean±SD, 50.9±3.46). The difference was statistically significant (difference of 6.65 with 95% confidence interval of 4.76 to 8.54, p-value

Introduction: Magnetic Resonance (MR) Mammography is being increasingly used now-a-days for the evaluation of breast lesions. Aim: To find out the effectiveness and the exact role of MR mammography in differentiating benign lesions from malignant lesions in patients with palpable, suspicious breast masses found on routine conventional imaging techniques. Materials and Methods: It was a prospective study wherein patients with suspicious breast lesions were subjected to MR mammography. The morphological feature (smooth vs irregular margin) and the enhancement patterns (Type Ia/Ib vs Type II vs Type III) of the lesions were assessed and finally the effectiveness of MR mammography in differentiating benign and malignant lesions was judged by taking the histopathological diagnosis as the gold standard. Results: A total of 33 patients with 35 breast lesions were finally analysed. The sensitivity, specificity, Positive Predictive Value (PPV) and the Negative Predictive Value (NPV) in differentiating benign from malignant breast lesion for the type of margin on MR mammography was 95.45%, 84.6%, 91.3% and 91.7%, while for the type of enhancement curve it was 76.2%, 90.9%, 94.1% and 66.7% respectively. The sensitivity and negative predictive value for the type of margins was statistically better when compared to the type of enhancement curve in differentiating benign from malignant lesions but the specificity and PPV though better for the type of enhancement curve was not found to be statistically significant. Conclusion: MR mammography was found to be an effective tool in differentiating benign from malignant suspicious breast lesions. The type of margin and the enhancement patterns both individually and in combination provide the clinicians with ample information so as to decide on further management.

Adrenal schwannomas are very rare tumours that are difficult to diagnose preoperatively. A 42-year-old male presented with epigastric pain and indigestion. He had history of repeated operations for recurrent facial swelling on both sides of face diagnosed as Angiolymphoid Hyperplasia with Eosinophilia (ALHE). Physical examination revealed right facial swelling. Laboratory tests showed no evidence of hormonal hypersecretion. CECT abdomen showed a well-defined heterogenously enhancing right adrenal mass (5x4cm). Patient underwent right adrenalectomy. Histopathology revealed adrenal schwannoma, confirmed by immunohistochemistry (IHC) showing diffuse expression of S-100. Fine-needle aspiration biopsy of facial lesion confirmed ALHE recurrence. Less than 35 cases have been reported. Diagnosis of adrenal schwannoma on imaging studies is very difficult and surgical resection when performed for non-functioning adrenal masses >4cm clinches the diagnosis. Adrenal schwannoma is highly uncommon and was incidentally associated with recurrent ALHE.

The penile circular fasciocutaneous flap (FCF) is employed in the successful single stage reconstruction of long segment complex anterior urethral strictures especially when buccal mucosa is unavailable due to various reasons. A 65-year-old gentleman, chronic smoker and tobacco chewer, hypertensive on treatment, presented with obstructive lower urinary tract symptoms for 8 months. He had no prior urethral catheterization. On examination, he had circumcised penis, with stenosis of the external urethral meatus. Glans had no changes suggesting balanitis xerotica obliterans. Suprapubic cystostomy was done as he developed acute urinary retention during evaluation. Retrograde urethrogram (RGU) showed pan-anterior urethral stricture. He was planned for substitution urethroplasty. On oral cavity examination, he had moderate trismus with oral submucous fibrosis. As buccal mucosal graft was unavailable, he was planned for FCF. A ventral onlay tubularization FCF urethroplasty from meatus to bulbar urethra based on dartos dorsal pedicle was done. His postoperative recovery was uneventful. Pericatheter RGU did not show extravastion and he voided well with Qmax 14 ml/second. He is doing well at follow-up.

Introduction: Rhinosporidiosis is an age old endemic scourge which has affected various parts of the world, most notably India and Sri Lanka. Although a large body of literature exists regarding this problem, postoperative recurrence rates continue to vary, and the effect of public health education in the eradication of this disease has not been taken into account. Aim: The aim of this study was to find out the site, presentation and postoperative recurrence rate in patients with rhinosporidiosis. Materials and Methods: This was a retrospective study involving operated cases of rhinosporidiosis in the Department of Ear,Nose and Throat of a rural tertiary care referral centre over a period of 3 years. The behavioural pattern of the disease, its epidemiology, rate of recurrence and outcomes of surgical management were analysed. Results: A statistically significant correlation could be found between male gender and rural residential status and incidence of rhinosporidiosis. Bathing in rivers and ponds were found to be strongly associated with rhinosporidiosis (p=0.005). Almost all patients were found to be of low socioeconomic status. Nasal obstruction and epistaxis were the most common presenting complaints. Conclusion: Rhinosporidiosis is strongly associated with male gender, young and middle aged adults, agricultural occupations, rural residential status, a history of bathing in ponds and rivers and a low socioeconomic status. Post-surgical recurrence of rhinosporidial masses can be avoided with careful and complete clearance of the mass and cauterization of the base. Appropriate and consistent public health education helps to reduce the incidence of rhinosporidiosis in endemic communities.

Introduction: Each kidney is supplied by a single renal artery originating from abdominal aorta. Since there are lots of renal surgeries happening now-a-days, it becomes mandatory for the surgeons to understand the abnormality and variations in the renal vasculature. Aim: To study the variations in the branching pattern of renal artery for the presence of early division and accessory renal artery in Indian kidney donors using CT angiography. Materials and Methods: The CT angiogram images of 100 normal individuals willing for kidney donation were analysed for early divisions and occurrence of accessory renal artery. Results: A 51% of kidney donors showed variation in the renal artery. Out of 51% variations 38 individuals had accessory renal artery and 13 individuals had early division of renal artery. The distribution of accessory renal artery was equal on both sides (13% on right and left) and 12% of individuals had accessory renal artery on both sides. Out of 13% earlier divisions, 5% was on right side, 7% was on left side and 1% was on both sides. Conclusion: This study concludes that 51% of kidney donors had renal artery variations. Hence, awareness of variations by evaluating the donors is a must before renal transplantation, urological procedures and angiographic interventions.

Background: Healthcare utilization, especially length of hospital stay and ICU admission, for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) determine overall outcomes in terms of morbidity, mortality and cost burden. Predicting prolonged hospital stay (PHS) and prolonged intensive care (PIC) for AECOPD is useful for rational allocation of resources in healthcare centres. Aim: To characterize the pattern of healthcare utilization by COPD patients hospitalized for acute exacerbation, and to identify clinical and laboratory predictors of ‘prolonged hospital stay’ (PHS) and ‘prolonged intensive care’(PIC) Materials and Methods: This study attempted through retrospective data analysis, to identify risk factors and evolve prediction models for increased healthcare utilization namely PHS and PIC for AECOPD. The data were extracted from 255 eligible admissions for AECOPD by 166 patients from Aug 2012 to July 2013. Logistic regression analysis was used for identifying predictors and models were tested with area under receiver operating characteristic curve. Results: Independent predictors of prolonged hospital stay (≥ 6 days) were chronic respiratory failure at baseline, low saturation at admission, high HbA1c level and positive isolates in sputum culture. Independent predictors of prolonged intensive care (for ≥ 48 hours) were past history of pulmonary tuberculosis, chronic respiratory failure at baseline, low saturation at admission, high leukocyte count and positive culture isolates in sputum. Prediction models evolved from variables available at admission showed AUC 0.805 (95% CI 0.729 – 0.881) and 0.825 (95% CI 0.75 – 0.90) for PHS and ICU admissions respectively. Conclusion: Our prediction models derived from simple and easily available variables show good discriminative properties in predicting PHS and PIC for AECOPD. When prospectively validated, these models are useful for rational allocation of services especially in resource limited settings.

Introduction: The topographical modifications may vary from millimeter wide grooves to nano size structures. Recently growing nano technology is rapidly advancing surface engineering in implant dentistry. This advancement has resulted in difference in surface properties including the morphology, chemistry, crystal structure and mechanical properties of the implant. Aim: To evaluate the anticandidal effect of titanium, zirconium and aluminium nanoparticles against C. albicans at 24 hours, 72 hours and one week time interval. Materials and Methods: According to ISO/TR 11175:1993, the samples were prepared with the dimension of 20mm diameter and 1mm thickness in grade IV titanium. A total of 40 samples were made and the samples were divided into four groups. The samples without coating were Group-A (control), samples coated with titanium nano particles were Group-B, samples coated with zirconium nano particles were Group-C and samples coated with aluminium nano particles were Group-D. The samples were cleaned by sonicating in acetone and subsequently in water three times for 15 min. Then they were treated with TiO2 , ZrO2 and Al2 O3 nanoparticles. The discs were sterilized under uv radiation and placed in SDA for C.albicans. The colonies were counted in 24, 72 hours and one week intervals. Results: The values were statistically analyzed using one-way ANOVA and Tukey HSD Test. Significance p-value was < .001, which showed that significant difference in C.F.U among the groups in titanium coated samples at 24 hours, 72 hours and one week time intervals. Conclusion: TiO2 nanoparticles coated titanium plates showed significant anticandidal effect compared to ZrO2 and Al2 O3 nanoparticles at 24, 72 hours and one week time interval.

Introduction: Education, being a process of knowledge transfer always has advances which are generally on par with the discovery of newer technologies. Currently, most of the education process has shifted away from the conventional black board towards the usage of more student friendly technologies. This leads us to the aim of this study, which is to analyse the impact of video based learning on the performance of dental post graduate students in their biostatistics course. Materials and Methods: A new video based discussion method was followed to teach biostatistics to MDS postgraduate students in 2013 (test group, n=44). The performance of these students were compared to a historical cohort of scores obtained by students of the 2012 batch (control group, n=44) who underwent a traditional lecture based teaching for the same course. The scores obtained by the students in their undergraduate board exams were compared to test for difference in academic aptitude of the students in the two groups. Results: The mean exam score of the test group was significantly higher (66.60±8.92) when compared to the control group (53.48±8.38); (p < 0.001 Independent Sample t-test). There was no significant difference in the overall academic performance of the students from both groups (test group mean academic performance was 61.47±4.86 and control group was 63.19±4.69. Conclusion: The results of this study suggest that video based discussion based teaching is more effective in training postgraduate dental students in biostatistics.

Background: Fine needle aspiration cytology (FNAC) is an important investigation in preoperative diagnosis of thyroid lesions. Follicular variant of papillary carcinoma thyroid (FVPTC) is a well defined entity in histopathology, but its diagnosis in FNAC is usually missed and is challenging compared to classic papillary thyroid carcinoma. Aims: The purpose of this study is to retrospectively analyze cytological features in histologically confirmed cases of FVPTC, compare them with literature and document the features that could increase the sensitivity of FNAC diagnosis. Materials and Methods: Cytological smears from 22 histologically confirmed cases of FVPTC were evaluated for microscopic pattern and nuclear features by two independent pathologists and results compared with previous studies. Statistical analysis was done based on bivariate Pearson’s correlation coefficient. Results: Among 22 cases 21 were female and one male with age range 21 – 50 years . All patients had a solitary nodule except one with multicentric presentation. Preoperative cytological diagnosis were, classic papillary thyroid carcinoma (PTC); 7, FVPTC; 3, suspicious for PTC; 4, follicular neoplasm; 5 and adenomatous goiter;3. Diagnosis upon cytological review were, FVPTC; 11, classic PTC; 7 , suspicious for PTC; 2, follicular adenoma;1 and adenomatous goiter; 1. Conclusion: We conclude that cellular smears with features as observed in our case like microfollicular pattern, syncytial clusters, fine powdery chromatin, anisonucleosis and nucleomegaly should alert the pathologist to look carefully for other more specific features like nuclear grooves and nuclear pseudoinclusions. This approach will help in avoiding misdiagnosis of FVPTC and would aid in choosing the right treatment modality.

An adult patient with proclination and spacing was performed orthodontic treatment combined with corticotomy and the burstone three piece intrusive arch who desired a shortened treatment period. The patient had Angle’s Class I malocclusion with flaring of the maxillary and mandibular incisors. Pre adjusted edgewise appliance (MBT prescription) was fixed to the maxillary and mandibular teeth. Then corticotomy was performed on the cortical bone of the buccal sides in the maxillary anterior regions. Intrusion and retraction initiated immediately after the corticotomy. The intrusive arch was adjusted once in every 2 weeks. The total treatment time for intrusion was 5 months. Cephalometric superimpositions showed no anchorage loss, and panoramic radiographs showed neither significant reduction in the crestal bone height nor marked apical root resorption. A corticotomy-facilitated orthodontic treatment shortened treatment period without any anchorage loss or adverse effects.