Homocysteine (Hcy) is a sulfur-containing amino acid with its only source in the human body being methionine. Three B complex vitamins (B ₆ , folate or B ₉ , and B ₁₂ ) participate in the metabolism of Hcy. Deficiency of these vitamins and the enzymes involved in its metabolism leads to elevated plasma Hcy levels (normal 5 - 15 μmol/l). Hyperhomocysteinemia (HHcy) is associated with several disorders. Hcy levels above 50 μmol/l is thought to be a risk factor for recurrent heart attacks and a value between 150 and 200 μmol/l may cause ischemic stroke. Levels above 300 μmol/l may induce mental deficiency. Several factors contributing to HHcy have been identified. These include lifestyle factors (smoking, alcoholism), drugs (phenytoin, valproate) and genetic causes (cystathionine β synthase deficiency). The various manifestations of HHcy are explained on the basis of oxidative damage and protein homocysteinylation, which cause damage to most tissues/organs leading to health complications and occurrence of various diseases. HHcy may affect major systems in the body like cardiovascular (coronary artery disease, myocardial infarction), central nervous (cerebrovascular accident, Alzheimer's, dementia) skeletal (increased risk of fractures), renal (low GFR), reproductive (risk of infertility), besides increasing the risk of hypothyroidism and cancer. The measures to prevent HHcy include consumption of nutritious foods, lifestyle changes (avoidance of smoking and alcohol) and supplementation of diet with vitamins - B ₆ , folate or B ₉ , and B ₁₂ .

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Background: Alopecias are classified into non-scarring and scarring/cicatricial alopecias. Cicatricial alopecias represent a diverse group of diseases characterized by a lack of follicular ostia and irreversible alopecia. The main purpose of hair revolves around its profound role in social interactions. Loss of hair can lead to significant psychological and emotional distress. Hence, an accurate and early diagnosis and prompt intervention are necessary to prevent further follicular destruction. Objective: To evaluate the epidemiological, clinical, and histopathological characteristics of various acquired primary cicatricial alopecias. Materials and Methods: The study population consists of 50 patients with acquired primary cicatricial alopecias seen in our Dermatology Outpatient Department, during the period from September 2008 to September 2010. Results: The most prevalent diagnoses in order of frequency lichen planopilaris (LPP, 50%), discoid lupus erythematosus (DLE, 20%), and pseudopelade of Brocq (POB, 12%). The ratio of lymphocytic to neutrophilic cicatricial alopecias was 7.3:1. A female predominance of lymphocytic cicatricial alopecias was observed. Both LPP and DLE affected predominantly middle-aged adults. Conclusion: LPP and DLE followed by pseudopelade were the common cicatricial alopecias. In contrast to the previous large-scale studies, which showed DLE and/or pseudopelade as the foremost diagnosis, LPP is the most frequent cause of adult primary scarring alopecia in our study. An accurate diagnosis of cicatricial alopecia can be achieved only through careful clinicopathologic evaluation. Early scalp biopsy is mandatory in all cases. Further large-scale studies are necessary to establish a cause and pathogenesis behind this increased prevalence of LPP in our setting when compared to the western population.

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Background: Breast feeding of every newborn baby is being widely advocated in view of its undoubted and multiple benefits to both newborn baby and mother. But low birth weight (LBW) babies with several handicaps may not maintain blood sugar level. Adequacy of breast milk in maintaining euglycemia in LBW newborn babies is being studied. Aims: To study the pattern of blood sugar levels in LBW babies who feed exclusively on breast milk. Settings and Design: This is a prospective study conducted in postnatal ward and neonatal intensive care unit of a tertiary care centre. One hundred consecutive neonates with a birth weight less than 2500g when born, being fed exclusively with breast milk were studied. Materials and Methods: Estimation of blood sugar levels in LBW neonates with birth weight less than 2500g who were given direct breast feeding or expressed breast milk exclusively. Results: The present study revealed that 95% of LBW neonates maintained adequate blood sugar levels during the first 72 hours of life with breast milk irrespective of gestational age and birth weight studied. Single episode of hypoglycemia occurred in 5% of these LBW babies. Conclusions: There is a very low incidence of hypoglycemia in LBW newborn babies (including intrauterine growth retardation (IUGR) and preterm babies) on exclusive breast feeds. Breast milk is optimal feed in these LBW babies.

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Aim : This prospective study was carried out over a period of 1 year in a tertiary care teaching hospital. The aim of the study was to determine the organisms causing device-related nosocomial infections and to study their anti-microbial resistance pattern. Materials and Methods : Patients with endotracheal intubation, and central venous catheters (CVC)/venous cut down catheters were included in the study. Colonization of the endotracheal tube and colonization of the CVC/venous cut down catheters was studied. Results: The most common organisms isolated from endotracheal tube tips were Pseudomonas aeruginosa (35%), Klebsiella pneumoniae (18%), Escherichia coli (15%), other enterobacteriaceae (19%), non-fermenting gram-negative bacilli (NFGNB) (13%), and methicillin-resistant Staphylococcus aureus (MRSA) (40%). Pseudomonas aeruginosa was the commonest organism, which showed highest frequency of resistance to gentamicin (81%) and ceftazidime (76%). The common organisms isolated from the vascular catheter tips were pseudomonas (30%), Klebsiella pneumoniae (18%), Escherichia coli (16%), other enterobacteriaceae (25%), NFGNB (11%), and MRSA (65%). Similar to ET tubes, here also pseudomonas aeruginosa was the commonest organism with maximum frequency of resistance to ceftazidime (69%). Conclusion: Knowledge of the resident microbial flora and their anti-microbial susceptibility pattern is necessary for formulating a rational antibiotic policy in a hospital.

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Laryngology and phonosurgery has developed as a subspeciality of otorhinolaryngology and head and neck surgery since last 3 decades.The article traces the journey of the new branch to improve the quality of the voice in the present era of increasing numbers of the voice users for and as a profession. The Indian scenario is also discussed.

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Aim: To evaluate the quantitative and qualitative changes in cytological buccal smears of type II diabetic patients by using the parameters like nuclear area (NA), cytoplasmic area (CA), and cytoplasmic/nuclear ratio (C/N). Materials and Methods: The study was done in 40 known type II diabetic patients and 40 healthy individuals. Buccal smears were taken and subjected to Pap-stain. NA and CA of 20 integral cells in the smear were measured using Image Pro-Express Version 6.0 image analysis system by Media Cybernetics Inc., Bethesda, MD, USA. The C/N ratio was then calculated. For comparing cytomorphometric parameters (NA, CA, C/N ratio), t-test was used. Results: There was a statistically significant increase in average NA and significant decrease in the C/N ratio in diabetics when compared to non-diabetic healthy individuals. The average CA did not show any statistical difference between the two groups. The morphologic alteration seen in diabetic group was the presence of acute inflammation. Conclusion: Exfoliative cytology is an additional tool to aid in diagnosis of diabetes mellitus, apart from the regular standard tests.

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Human saliva plays an important role in the health of the oral cavity and of the body as a whole. It is a complex fluid that is actively secreted by the major and minor salivary glands. Its composition shows variations that reflect the physiology and the systemic health of the individual. It has the potential to be used for early detection of disease and assessment of its progression and treatment outcome. As a diagnostic tool, saliva has the unique advantage of being readily-available, and its collection is non-invasive. The field of salivary diagnostics and research is gaining importance and is becoming a major area of focus for researchers. Discovery of salivary biomarkers and its validation had broadened the use of salivary diagnostics from assessment of dental caries to the diagnosis of cardiac diseases and malignancies remote from the oral cavity. This article intends to give an overview of this exciting area of salivary research.

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Chronic sinusitis is less often caused by fungal infections. In its clinical presentation, the "invasive' form of disease is turbulent in immunocompromised hosts like diabetics. In non-immunocompromised hosts, it rarely becomes invasive and often poses resistance to antifungal agents. We present here a case report of invasive fungal sinusitis, which has been treated surgically and with newer generation antifungal agent, "voriconazole" subsequently. A 1½-year follow-up showed complete resolution of symptoms.

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Prebiotics are necessary additives to diet, which have a positive influence on human health. Top foods containing prebiotics are chicory root, garlic, onion, wheat bran, etc. Prebiotics are of the nature of oligosaccharides and are nondigestible dietary fiber, which reach up to the colon to be utilized as substrates by the useful gut microflora, namely Lactobacilli and bifidobacteria. This results in further multiplication of these bacteria, which prevent colonization by enteric pathogens. Apart from this, several other beneficial effects due to prebiotics are documented: Increase in calcium absorption, potentiation of the immune system, reduction of risk of colorectal cancer and other inflammatory bowel disorders, antihypertensive effect, reduction of constipation, reduction of obesity, antidiabetic effect, etc. All these are attributed to increased production of short-chain fatty acids by the stimulated beneficial bacteria. As prebiotics are heat stable, they can be added to daily food choices like cereals, bread, biscuits, drinks, etc., converting them into functional foods. Addition of both prebiotics and probiotics to foods makes better functional foods. These foods are called synbiotic functional foods. Benefits of prebiotics are still being explored. There is a need to spread knowledge of prebiotics among the elite as well as general public, considering their beneficial effects on health.

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Background: Malnutrition continues to affect children aged 0-6 years in large numbers in India. Many of these children lack proper nutrition at birth and in early childhood, which results in growth faltering. Growth monitoring is a good tool for visualization of growth in children, but episodes of growth faltering among healthy as well as malnourished children has failed to catch the attention of the Anganwadi workers so far. Objectives: (1) To assess the magnitude of growth faltering among 0-6 years children in an adopted village of MediCiti Institute of Medical Sciences (MIMS) and (2) To study their nutritional status. Materials and Methods: A large village in the field practice area of MediCiti Institute of Medical Sciences was conveniently selected. All children enrolled in three Anganwadis of the village were studied for growth faltering episodes and breast-feeding and dietary practices by interviewing their mothers through a predesigned and pre-tested proforma. Anthropometric measurements were taken. Data was analyzed using Epi Info Version 3.5.3. Results: Sixty growth-faltered children were analyzed. The mean number of episodes of growth faltering was 1.13 episodes per child and 10% children's growth had faltered on more than one occasion. Most of them belonged to poor socio-economic status. Late initiation of breast-feeding was present in about 55% of these children, and they showed an overall dietary calorie and protein deficit. About 47% of the children were underweight, 57% were stunted, and 25% were wasted. Conclusion: Growth of children aged 0-6 years may be improved by focusing on breast-feeding and nutrition. Further research is required to establish the correlates of growth faltering.

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Mycosis fungoides (MF) mimics a variety of dermatoses. A case of hypopigmented MF, a rare variant mimicking leprosy and vitiligo, is reported.

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Hair dye poisoning is becoming common in India. Three patients who were admitted into the Emergency Medical Department with a history of ingestion of hair dye available in the market as Supervasmol 33 are presented. Their clinical features, complications, and treatment modalities are discussed and the literature is reviewed.

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Background: Oral submucous fibrosis (OSMF) is considered as a potentially malignant disease, which is associated with betel quid and pan masala chewing. It is thought to be due to the defective collagen synthesis and degradation. The amount of collagen in the diseased varies with the functional stages and histopathological grades of the disease. Aims: The aim of the study was to assess the severity of the disease in oral submucous fibrosis, by correlating the functional staging with the histopathological grading and analyze the collagen distribution in different grades of OSMF using picrosirius red stain under polarizing microscope and also to assess the quantitative changes in collagen with respect to various histopathological grades of OSMF using spectrophotometry. Materials and Methods: The study conducted on 40 subjects, which included 30 subjects with different functional and histopathological grades of oral submucous fibrosis (OSMF), and 10 were in control group. Functional staging and histopathological grading was done based on the definite criteria. A Histopathological and quantitative analysis of collagen was conducted using picrosirius red stain, polarizing microscope and spectrophotometer, respectively. The results were analyzed using chi-square test, and the significance was tabulated. Results: The functional staging and the histopathological grading did not show statistical correlation, but as the histopathological grade of the disease increased; there was a shift in the polarizing color from yellow-green to orange-red. In the colorimetric estimation, the optical densities of the sample decreased as with increased grades of OSMF. Conclusion: In the present study, we observed that the histopathological grading of OSMF is not correlating with the functional staging of OSMF. Therefore, it mandates the proper correlation between the functional staging and the histopathological grading before the commencement of the treatment to render better outcome of the treatment.

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Background: Cinnamomum Zeylanicum is traditionally used in various diseases because of its medicinal properties. Cinnamon is a spice obtained from the inner bark of several trees from the genus Cinnamomum that is widely used as a spice. Cinnamomum Zeylanicum is principally employed in cookery as a condiment and flavoring material. One of its uses is in musculoskeletal disorder. Aims: The study aims to evaluate the skeletal muscle relaxant activity of the Aqueous Extract of Cinnamomum Zeylanicum Bark (AECZB) in albino mice in Comparison with Diazepam. Materials and Methods: Thirty Swiss albino mice (SWR) aged six to seven weeks, of either sex, weighing about 25 - 30 g, were taken, and after acute toxicity studies three different doses were selected. The animals were divided into five different groups. The first group was kept as the control (Normal Saline), second as the standard (Diazepam) and the remaining three groups as Test I, Test II, and Test III, and given different doses of the AECZB. Skeletal muscle relaxant activity (motor coordination) on Rotarod and Locomotor activity on Photoactometer were performed. The results were expressed as mean ± SD. Statistical analysis was carried out by using ANOVA, followed by Dunnet's multiple comparison tests, using primer of biostatistics McGraw-Hill software version 5.0.0.0 (2011). P-values < 0.05 were considered significant. Results: The result from the Actophotometer test and Rotarod test showed that the extract significantly reduced the motor coordination of the tested animals. Conclusions: Our data indicates that AECZB possesses sedative and skeletal muscle relaxant activities.

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Background and Objectives : Gingivitis and periodontitis are primarily bacterial infections caused by diverse groups of microorganisms. The prevalence and severity of these diseases can be reduced by mechanical plaque removal or a variety of systemic and topically applied antimicrobial agents, aimed at selectively removing or inhibiting pathogenic bacteria. Hence, the present study is designed to evaluate the role of professional subgingival irrigation in chronic generalized periodontitis patients. Materials and Methods: Eight subjects were randomly selected between age groups 25 and 55 years, with a total of 160 active sites with chronic periodontitis. Each quadrant was required to have at least one site with a probing depth of ≥5 mm to ≤9 mm, with radiographic evidence of bone loss. For every patient, the first quadrant received no treatment, the second quadrant received scaling and root planning (SRP) only, the third quadrant received SRP plus professional subgingival 0.12% chlorhexidine gluconate irrigation with WaterPik^; device, and the fourth quadrant received treatment with WaterPik^; device only. Treatment sites were irrigated on 0, 7 ^th , and 15 ^th days. Plaque index, bleeding index, gingival index, and clinical attachment levels were measured and recorded at 0, 15 ^th , 30 ^th , and 45 ^th days. Results: With subgingival irrigation with 0.12% chlorhexidine gluconate, there was significant reduction in all clinical parameters: plaque index, bleeding index, and gingival index in all the groups. Interpretation and Conclusion: Subgingival irrigation with 0.12% chlorhexidine gluconate along with scaling and root planing appeared to be effective in gaining clinical attachment levels and other parameters than scaling and root planing alone or subgingival irrigation with 0.12% chlorhexidine gluconate alone in the treatment of chronic adult periodontitis.

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The relationship between periodontal health and the restoration of teeth is intimate and inseparable. Maintenance of gingival health constitutes one of the keys for longevity of teeth and dental restoration. An adequate understanding of relationship between periodontal tissues and restorative dentistry is paramount to ensure adequate form, function, esthetics, and comfort of the dentition. Despite of an increased emphasis on the perio-restorative interface in restorative dentistry, many clinicians are unable to incorporate the concept of biologic width in a practical manner. This case report presents restorative management of subgingival caries by endodontal and minimally invasive periodontal treatment.

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Wilkie's syndrome, well known as superior mesenteric artery syndrome, is a rare but well-recognized clinical entity causing upper abdominal symptoms. A 26-year-old woman presented with recurrent upper abdominal pain, vomiting, loss of weight, early satiety, and fullness of upper abdomen for 2 years. She was subjected to open appendicectomy and laparoscopic adhesionolysis within 20 months without relief. Clinical suspicion and thorough investigation revealed compression at transverse portion (third part) of duodenum. Though ideally a duodenojejunostomy is preferred, due to technical reasons an anterior gastrojejunostomy was performed, which resulted in relief of obstructive symptoms.

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Background and Aims: Apoptosis (programmed cell death) is considered to play a critical role in tumor genesis, where a down regulation of the process contributes to development and progress of neoplasia. Medullary carcinoma (MC) of breast has generally been considered to have a better prognosis than invasive ductal carcinoma not otherwise specified (IDCC-NOS), which would seem to be discrepant when one considers its anaplastic histology and high mitotic rate. We, hence, attempted to elucidate the importance and implications of apoptosis in the prognosis of medullary carcinoma of breast. Materials and Methods: Formalin-fixed, paraffin-embedded sections of 30 cases of medullary carcinoma of breast and 30 cases of IDCC-NOS (controls) were investigated by light microscopy. Results: Mean values of apoptotic count was significantly higher in MC than in IDCC-NOS (P< 0.01) while there was no significant difference in the age of patients, size of tumors, histological grade , nuclear grade, mitotic count and Apoptosis/Mitosis ratio (A:M ratio). Conclusion: It appears that a high frequency of apoptosis may be related to a favorable prognosis in medullary carcinoma even though it demonstrates a high mitotic count with a rapid cell turnover. Since apoptotic cells can be counted with a good reproducibility in H and E stained tumor sections, the apoptotic index could possibly be used as an additional prognostic indicator in invasive breast cancer.

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Cancrum oris or noma is a rapidly spreading gangrenous stomatitis which occurs chiefly in debilitated or malnourished children, destroying the soft and hard tissue structures. Its fulminating course causes progressive and mutilating destruction of the affected tissues. As most patients with noma do not report until the disease is at an advanced stage, its onset and progression still remains a mystery. Survivors of this disease suffer severe facial deformity due to loss of facial tissues and scarring. We report a case report of noma highlighting its onset and progression, the extent of tissue necrosis and its management with an emphasis on the need for early diagnosis and prompt treatment.

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Background: The prevalence of psychiatric disorders is an important area of concern in the elderly population. But, most of the psychiatric morbidity remains undetected in this age group. Aim: To study the prevalence and pattern of psychiatric disorders in geriatric inpatients. Materials and Methods: All the geriatric inpatients admitted in the non-psychiatric wards of Mamata General Hospital for a period of 1 month were assessed using a semi-structured interview consisting of socio-demographic details. Brief Psychiatric Rating Scale (BPRS) was used to screen for psychotic and non-psychotic symptoms. Mini Mental Status Examination (MMSE) was used to screen for cognitive decline. The diagnosis was made according to ICD-10 diagnostic criteria. Results: Out of 120 patients, 48 (40%) had psychiatric illness. Psychiatric disorders were more common among females and in patients living in nuclear families. Depression was found to be the most common (25%) illness. Conclusion: This study emphasizes the importance of co-ordination between the physicians and psychiatrists for providing better psychiatric care of the geriatric inpatients.

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Retroperitoneal schwannomas are rare tumors originating from Schwann cells of peripheral nerve ending and are uncommon (0.5-1.2%). Absence of typical clinical picture and lack of specific signs make preoperative diagnosis hard to ascertain. We report a case of a 45-year-old male who presented with constipation and difficulty in micturition for 5 days. Ultrasound abdomen showed a large mass of 13 cm × 10 cm with internal echoes posterior to urinary bladder and was confirmed by contrast enhanced computed tomography abdomen. A complete resection of mass without injuring the adjacent structures was carried out through a midline laparotomy. Histopathological evaluation and immunohistochemistry documented a benign retroperitoneal schwannoma.Retroperitoneal schwannomas are rare tumors originating from Schwann cells of peripheral nerve ending and are uncommon (0.5-1.2%). Absence of typical clinical picture and lack of specific signs make preoperative diagnosis hard to ascertain. We report a case of a 45-year-old male who presented with constipation and difficulty in micturition for 5 days. Ultrasound abdomen showed a large mass of 13 cm × 10 cm with internal echoes posterior to urinary bladder and was confirmed by contrast enhanced computed tomography abdomen. A complete resection of mass without injuring the adjacent structures was carried out through a midline laparotomy. Histopathological evaluation and immunohistochemistry documented a benign retroperitoneal schwannoma.

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Background: Postoperative discomfort that arises from pain is annoying for the child and parents. Genital and perineal surgical procedures are followed by moderate to severe pain resulting in postoperative complications like infection and also long term psychological effects on children. Under treatment of children for pain in post operative period has been reported in several centers. Intramuscular or intravenous analgesics have unpredictable effects and not accepted by children. Caudal bupivacaine with midazolam prolongs post operative pain relief. Aim: To evaluate the relative efficacy and duration of caudal extradural bupivacaine 0.25% and a combination of bupivacaine and midazolam for intra and post operative analgesia. Materials and Methods: This study was conducted in 50 ASA I children from pediatric surgery department requiring general anaesthesia for infra umbilical surgeries. After induction of general anaesthesia the children were given caudal extradural 1 ml/kg bupivacaine (0.25%) or bupivacaine with midazolam (0.50 micromg/kg) intra operative vitals, response to surgical stimulus measured. Post operatively assessment of pain was done by using objective pain score up to 24 hrs in the ward. Results: The mean basal values of systolic blood pressure in both the group were comparable intraoperatively and didn't show any statistical significance indicating adequate analgesia intra operatively. Postoperatively 68% children in the bupivacaine group were pain free until 3 hours as compared to 80% children in bupivacaine with midazolam. Only 4% children in bupivacaine group were pain free until 6 hours post operatively, compared to 72% children in bupivacaine with midazolam indicating prolonged analgesia in this group. There was no significant changes hemo- dynamically in both groups post operatively. Conclusion: Caudal extradural analgesia with bupivacaine and midazolam gives prolonged analgesia postoperatively and can be used safely in children. It will also reduce the use of parenteral analgesics significantly with minimum side effects.

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