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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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.