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   2015| April-June  | Volume 4 | Issue 2  
    Online since June 12, 2015

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A review on role of essential trace elements in health and disease
Lingamaneni Prashanth, Kiran Kumar Kattapagari, Ravi Teja Chitturi, Venkat Ramana Reddy Baddam, Lingamaneni Krishna Prasad
April-June 2015, 4(2):75-85
Elements are present in different forms in the nature, and these elements are very essential for the body to perform different functions. Trace elements are very important for cell functions at biological, chemical and molecular levels. These elements mediate vital biochemical reactions by acting as cofactors for many enzymes, as well as act as centers for stabilizing structures of enzymes and proteins. Some of the trace elements control important biological processes by binding to molecules on the receptor site of cell membrane or by alternating the structure of membrane to prevent entry of specific molecules into the cell. The functions of trace elements have a dual role. In normal levels, they are important for stabilization of the cellular structures, but in deficiency states may stimulate alternate pathways and cause diseases. These trace elements have clinical significance and these can be estimated using different analytical method.
  127 99,197 7,658
Klippel-Trenaunay syndrome with review of literature
Onteddu Joji Reddy, Jamkhana Abdul Gafoor, Munirajulu Rajanikanth, Polysetty Obuleswar Prasad
April-June 2015, 4(2):120-123
Klippel-Trenaunay syndrome (KTS) is a rare disorder with an incidence of 3-5/1,00,000. It is characterized by the triad of vascular malformation (capillary hemangioma or port wine stain), venous varicosity and soft tissue and/ or bony hypertrophy. The vascular malformation is usually limited to a single extremity, though multiple extremities can be involved. Alternative names given for Klippel Trenaunay Syndrome are Klippel-Trenaunay-Weber syndrome; Angio-osteohypertrophy; Nevus varicosus osteohypertrophicus syndrome; Hemangiectasia hypertrophicans and Nevus verucosus hypertrophicans.
  3 5,941 396
Role of immunohistochemistry in diagnosis of brain tumors: A single institutional experience
Venugopal Madabhushi, Renuka Inuganti Venkata, Sailabala Garikaparthi, Satya Varaprasad Kakarala, Seshadri Sekhar Duttaluru
April-June 2015, 4(2):103-111
Background: Central nervous system tumors which constitute 1-2% of all tumors pose diagnostic challenges because tumors of varying histogenesis show divergent differentiation and overlap in morphological features. In problematic cases, immunohistochemistry is done in addition to the routine histopathologic examination to overcome the diagnostic difficulties, since an accurate histologic diagnosis helps in predicting the clinical outcome of various brain tumors. Materials and Methods: This study was carried out on a prospective basis in our institution from January 2009 to March 2012. During this period, a total of 246 neurosurgical specimens were received among which 118 brain tumors were diagnosed based on examination of Hematoxylin and Eosin stained sections of formalin-fixed and paraffin-embedded biopsy specimens. Immunohistochemical markers were applied in selective cases for an accurate diagnosis. Results: In adults, astrocytomas occurred most frequently in the study, followed by meningiomas, nerve sheath tumors, metastatic deposits, glioblastomas, and gliosarcomas. Primitive neurectodermal tumors occurred frequently in children. Other rare tumors included lymphomas and mesenchymal tumors. Age and sex incidence and anatomic distribution of various tumors were studied. Grading of the tumors was done as per the revised World Health Organization criteria. The results of immunohistochemical study in selective cases were analyzed. Conclusion: This study highlights the utility of immunohistochemistry as an adjunct in the histologic diagnosis of brain tumors in difficult cases.
  2 10,276 898
Prevalence of Rotavirus diarrhea among under-5 hospitalized children in a Government tertiary hospital, Tirupati
Manohar Badur, Naramalli Madhavi Latha, Panabaka Ravi Kumar, Shankar Reddy Dudala, Shabbir Ali Shaik, Gagandeep Kang, Cheri Naveen Kumar
April-June 2015, 4(2):112-116
Context: Rotavirus is the most common cause of severe diarrhea requiring hospitalization among infants and young children worldwide. The prevalence of rotavirus diarrhea in India has been found to vary in the range 5-71% in hospitalized children aged under 5 years with acute gastroenteritis. The seasonal variation of rotavirus diarrhea in India varies across different geographical regions, with high incidence in the winter months at low relative humidity in northern India. Aim: This study aimed to estimate the prevalence of rotavirus diarrhea among hospitalized children aged under 5 years and to learn about the genotypic distribution of rotaviruses causing diarrhea. Settings and Design: Study design: hospital-based cross-sectional study. Study setting: the pediatrics department of a tertiary care Government hospital, Tirupati, India. Study period: September 20, 2012-September 19, 2013. Materials and Methods: Study units: children under 5 years of age presenting with diarrhea. Stool specimens from all hospitalized children aged under 5 years who had presented with acute watery diarrhea were collected and tested for rotavirus by the enzyme-linked immunosorbent assay (ELISA). Positive samples were tested for G and P typing by the reverse transcription-polymerase chain reaction (RT-PCR) technique. Statistical Analysis Used: Percentage and chi-square analysis. Results: Among the study sample, 68.7% of children were in the age group between 1-12 months and 25.6% children showed positive result for rotavirus by ELISA. Of the rotavirus positives, 50% were G1P8 viruses. Conclusion: Rotavirus is an important cause of diarrhea in hospitalized children.
  2 4,113 493
Undifferentiated pleomorphic sarcoma presenting as a gingival mass: A rare case
BS Sreenivasan, V Vinod Sankar, Deepu George Mathew, Merin George
April-June 2015, 4(2):130-133
Malignant fibrous histiocytoma which was once considered as a tumor of adults, is now being re-classified and subtyped either as a pleomorphic undifferentiated sarcoma or pleomorphic variant of other spindle cell tumors. Only less than 5% of these cases are reported in the head and neck, and its presentation intra-orally is still rarer. Herein, we report a case of gingival swelling in relation to the 16 region, which on microscopic examination showed a histomorphometric pattern of storiform pleomorphic-malignant fibrous histiocytoma. Immunohistochemical studies were done to exclude similar appearing spindle cell neoplasms. The tumor showed focal positivity for pan histiocytic marker, CD68. Based on the histopathological and immunohistochemical profiles, the tumor was diagnosed as undifferentiated pleomorphic sarcoma.
  1 3,165 221
Primary small cell neuroendocrine carcinoma of the urinary bladder
Geetha Aravind Chilari, Shailaja Prabhala, Srinivas Gutta, Jayashankar Erukkambattu
April-June 2015, 4(2):136-138
Primary small cell neuroendocrine carcinomas of the urinary bladder are rare, highly aggressive tumors and diagnosed mainly at advanced stages. Herein, we report a case of a 75-year-old man who presented with acute urinary retention and was found to have an infiltrative growth in the bladder. Histopathology and immunohistochemistry (IHC) were diagnostic of primary small cell neuroendocrine carcinoma. This case is being presented because of its rarity and highlighting the importance of histopathology and IHC in differentiating clinical mimics and making accurate diagnosis.
  1 2,133 144
Comparison of intravenous lignocaine and intravenous dexmedetomidine for attenuation of hemodynamic stress response to laryngoscopy and endotracheal intubation
Saya Raghavendra Prasad, Uma Maheshwar Matam, Gowthami Priya Ojili
April-June 2015, 4(2):86-90
Context: Direct laryngoscopy and endotracheal intubation following induction of anesthesia is almost always associated with hemodynamic stress response due to reflex sympathoadrenal discharge. Aim: Aim of our study was to compare the efficacy of lignocaine and dexmedetomidine in attenuating the hemodynamic response to laryngoscopy and intubation. Settings and Design: The present prospective randomized study was carried out in a tertiary care teaching hospital. A total of 100 American Society of Anesthesiologist physical status I and II patients posted for elective surgery under general anesthesia were enrolled in the study. Patients were randomly divided into two groups, group L (lignocaine group) and group D (dexmedetomidine group) with 50 patients in each group. Materials and Methods: Group L received 1.5 mg/kg of lignocaine intravenous (IV) and group D received 1 mcg/kg of dexmedetomidine as IV infusion. Thiopentone was given until eyelash reflex disappeared, and intubation was facilitated with succinylcholine. Anesthesia was maintained with 33:66 oxygen: Nitrous oxide, isoflurane, and vecuronium. Hemodynamic parameters were recorded during the basal period, preinduction, after induction, during intubation, 1 min, 3 min, 5 min, and 10 min after intubation. Statistical Analysis Used: Data were analyzed using Graphpad Prism Software version 6.03 (Graphpad Software Inc., USA). P < 0.05 was considered as statistically significant. Results: Maximum increase in heart rate was around 38% in group L and 10% in group D (P = 0.000). Maximum increase in mean arterial pressure was 22% in group L and 6% in group D (P = 0.000). Thiopentone dose requirement was 19% less in group D compared to group L (P < 0.001). Conclusion: Dexmedetomidine attenuates the hemodynamic stress response to laryngoscopy and intubation more effectively compared with lignocaine without any deleterious effects. Furthermore, dexmedetomidine decreases dose of thiopentone for induction of anesthesia.
  1 5,375 599
Psammomatous ossifying fibroma: A case report
Sreedhar Bora, Chaganti Padmavathi Devi, Kakumanu Nageswara Rao, Aparna Chinnam
April-June 2015, 4(2):139-140
Psammomatous ossifying fibroma is a rare lesion representing a unique subtype of fibro-osseous lesions of bone. We report a case of psammomatous ossifying fibroma involving the sinonasal tract in a 26-year-old female who presented with nasal obstruction.
  - 2,260 182
Neoadjuvant chemotherapy in neonatal Wilms' tumor
Ramesh K Reddy, Lavanya Kannaiyan, Srinivas Srirampur, Gulam Mohammed Irfan, Subba Rao
April-June 2015, 4(2):134-135
Neonatal presentation of Wilms' tumor is rare with an incidence of 0.16%. The treatment protocol has to be tailored according to the need. Most studies recommend nephroureterectomy followed by chemotherapy. We present our experience with a baby who came with stage 2 Wilms' tumor in the neonatal period and was treated using neoadjuvant chemotherapy.
  - 2,672 205
Nasopalatine duct cyst: A case report
Saikrishna Pasupuleti, Nadeem Jeddy, Makeshraj Loganathan Sambandamoorthy, Kavitha Seeralan, Ananthalakshmi Ramamurthy, Shankar Kolappan Arumugam
April-June 2015, 4(2):117-119
Nasopalatine duct cyst (NPDC) is the most common non-odontogenic cyst of oral cavity. Clinically, Nasopalatine duct cyst manifests as an asymptomatic swelling of the palate or the upper lip. Radiographically, it is seen as a heart-shaped radiolucency and can be confused with periapical pathology. The aim of this article is to report a case of a nasopalatine duct cyst in a 36-year-old patient which was misinterpreted for a periapical cyst. Diagnosis of a Nasopalatine duct cyst can be given through clinical, radiographical, and histopathological examination.
  - 2,762 287
Prosthetic rehabilitation of a patient with Type-I ectodermal dysplasia: A case report
Laxman Rao, Revathy Gounder
April-June 2015, 4(2):124-127
Type-I ectodermal dysplasia (Christ-Siemens-Touraine syndrome) is characterized by clinical triad of hypohidrosis, hypotrichosis, and hypodontia or anodontia. Depending on the severity of the condition, various prosthodontic treatments are recommended to re-establish the masticatory function, appearance, speech, and also to improve the emotional and social aspects of the child. The various treatments may include removable partial/complete prosthesis, fixed and/or implant-supported prosthesis, or a combination of these. In this clinical report, an 11 year old girl is presented with hypohidrotic ectodermal dysplasia. Implant-supported restorations can improve the physiologic and psychosocial function, when compared with removable dentures; but their placement in growing jaws can cause complications. So, a maxillary flexible removable partial denture and a mandibular conventional complete denture with neutral zone technique were fabricated after considering her growth and the number and condition of her present teeth. Composite resin material was used to restore the conical maxillary canine for a favorable aesthetic appearance.
  - 2,827 245
Lipoma of the penis, a very rare presentation
Jagadamba Sharan, Ram Chandra Kesarwani, Deepika Verma
April-June 2015, 4(2):128-129
A lipoma is a common tumor arising from fat cells and can occur anywhere in the body. However, lipoma of the penis is very unusual and rare.
  - 18,929 400
A comparative study of the physical and elastic properties of new generation elastomeric ligatures with conventional elastomeric ligatures
Chandra Sekhar Gandikota, Cherukuru Neeharika, Shubhaker Rao Juvvadi, Ksheerasagara Yadagiri Poornima, Ranjit Manne, Laxmi Prasanna Apuri
April-June 2015, 4(2):91-96
Context: One of the most common methods of securing arch wires to orthodontic brackets is the application of elastomeric ligatures. New generation elastomeric ligatures were introduced to overcome the disadvantages of force decay and staining in conventional ligatures. Aims: The aim was to compare the physical and elastic properties of new generation elastomeric ligatures with the conventional elastomeric ligatures. Materials and Methods: Four groups of clear elastomeric modules (conventional polyurethane based modules, latex free elastomeric modules, alastik easy to tie modules, silver and silicone impregnated super ligatures) were tested for tensile properties, frictional resistance, and color stability in as received condition and following 1-week, 2 weeks, and 1-month of intra-oral exposure. A universal testing machine was used for testing tensile properties. The color stability was tested by measuring the color change using scanned images of the modules at different time periods. Statistical Analysis: Two-way ANOVA, post-hoc multiple comparisons Bonferroni-Dunn test and the paired t-test were used. Results: The alastik group showed the highest mean tensile strength and super ligatures showed the lowest tensile strength values. There was a statistically significant decrease in the mean tensile strength in all groups following intra-oral exposure (P < 0.05). The super ligatures showed the lowest mean frictional resistance and latex free group showed the highest mean frictional resistance values. The color change following intra-oral exposure was significant in all the groups (P < 0.05) with the change being the highest in super ligatures group and the least in alastik group. Conclusions: There are significant differences in physical and elastic properties of different brands of ligatures, which should be considered during the selection of these products.
  - 3,671 379
Evaluation of treatment changes produced by different orthodontic treatment modalities using Peer Assessment Rating (PAR) index
Seena Naik Eslavath, Thirumal Naik Mood, Kalyan Srinivasa Aravind Narahari, Manjunath Chekka, Sreelaxmi Natta
April-June 2015, 4(2):97-102
Background: The assessment of treatment outcome has been an important facet of the orthodontic specialty for several decades. Generally, the orthodontic outcome is graded subjectively or by some objective method of evaluation in the clinical setting or of the study groups. The individual grading of one's own treatment results can be a self-educating exercise to improve the quality of care. Unfortunately, the variation in the criteria used by different orthodontists makes it difficult to compare the results Materials and Methods: A sample of 150 treated cases was divided into three groups as follows: Group A (n = 50) treated with edgewise mechanotherapy, Group B (n = 50) treated with light wire mechanotherapy, and Group C (n = 50) treated with functional appliance therapy. All the three groups were analyzed using Peer Assessment Rating (PAR) index. The degree of improvement in each case was categorized into three as worse-no improvement, improved, and greatly improved. Statistical analysis used: Chi-square test was used for comparison within groups and one-way analysis of variance (ANOVA) for comparing treatment improvement between groups. Results: All the three groups showed significant overall improvement after treatment. However, the patients in edgewise group demonstrated greater degree of overall improvement in comparison to the rest. Conclusions: The PAR index appeared to be sensitive enough to determine the difference in outcome between the techniques used in this study.
  - 2,710 252
Disorders of lung development
Srikanti Raghu
April-June 2015, 4(2):65-74
Congenital lung malformations rarely occur but could represent an important cause of respiratory distress in the newborn. As the development of the respiratory tract occurs according to a strict timetable, abnormalities present at birth may be accurately dated to disturbances of intercellular relationships that have occurred at fixed points in intrauterine life. Major structural abnormalities of the respiratory tract are usually fatal or frequently diagnosed before birth or early in postnatal life. Other developmental anomalies may not manifest themselves until much later in life. Antenatal diagnosis by ultrasound scan permits early recognition and thus adequate management. After birth, thoracic-computed tomography is the most useful diagnostic tool. Management of the lesions is based on the characteristics of the lesion and the clinical status of the patient. The pathogenesis, clinical presentation, diagnostic tools, and management options of the important congenital lung malformations are briefly reviewed.
  - 5,556 499