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   2016| July-September  | Volume 5 | Issue 3  
    Online since October 10, 2016

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Phenotypic characterization of macrolide and lincosamide resistance patterns in clinical isolates of staphylococci
Ribekha Zachariah, Sreekanth Basireddy, Vasanti Kabra, Manisha Singh, Salmaan Ali, Ahmed Sardar
July-September 2016, 5(3):187-191
Introduction: The macrolide, lincosamides, and streptogramin (MLS) group of antibiotics are one of the few alternative antibiotics available for the treatment of methicillin-resistant staphylococcal isolates. Clinical failures with these antibiotics have been reported because of the usage of these drugs in improperly characterized and tested isolates. The purpose of this study was to know the prevalence of different phenotypes in our area, with an emphasis on inducible resistance detection. Materials and Methods: A total of 100 methicillin-resistant staphylococcal isolates were included in the study. Phenotypic characterization was done by using erythromycin and clindamycin disks kept at a distance of 15 mm on the Muller Hinton agar plate and incubating at 24 h. Results: Among 100 isolates, 23 were sensitive to both erythromycin and clindamycin (S phenotype). Thirty-one isolates were resistant to erythromycin but sensitive to clindamycin (MS phenotype). Inducible resistance (iMLSB) was seen in 26 of the total isolates. Isolates which were resistant to both the antibiotics numbered 19 (cMLSB). There was only one isolate which was sensitive to erythromycin but resistant to clindamycin (L phenotype). Conclusion: MLS group of antibiotics is still an effective group of antibiotics against methicillin-resistant staphylococcal isolates, and routine testing for the inducible resistance in these isolates will help in the prevention of therapeutic failure and for the better management of the patient.
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An in vitro study to determine fracture resistance of tooth roots after different instrumentation techniques
Marri Shilpa Reddy, P Vanaja Reddy, T Jaisimha Reddy, S Balagopal, Kurinji Amalavathy, G Jaishekar Reddy, T Harini, S Sreedhar Reddy
July-September 2016, 5(3):192-199
Aim: The aim was to study the influence of rotary and hand instruments techniques on the susceptibility of the root to fracture. Materials and Methods: Forty extracted human maxillary permanent first and second molars without any defects were selected as sample. Teeth were randomly divided into four groups of ten teeth in each group. Palatal canals were instrumented depending on the instrumentation techniques used in the groups. Group 1: 0.02 taper K-files and Gates Glidden drills (Mani Inc., Japan); group 2: Hand ProTaper (Dentsply-Maillefer, France); group 3: Rotary ProTaper (Dentsply-Maillefer, France); and group 4: Endowave (J. Morita, Japan). After instrumentation, palatal roots were resected and apical 7 mm sectionally obturated. Obturated roots were embedded in putty impression material and mounted on Universal testing machine (Lloyd instruments, UK). Vertical load was applied by means of a spreader inserted into the canal and load at fracture was recorded for each tooth. Fractured roots were embedded in self-cure resin, sectioned horizontally, and viewed under operating microscope to determine the direction of fracture line: Maximum and minimum remaining dentin thickness was measured at coronal, middle, and apical thirds. Statistical analysis of data was accomplished by one-way ANOVA and post-hoc tests with Tukey honest significant difference. Results: Mean fracture loads was 20.6 ± 3.8 kg (group 1), 9.5 ± 2.4 kg (group 2), 8.4 ± 1.4 kg (group 3), and 13.4 ± 3.1 kg (group 4). There was statistical significance in the values between group 1 and groups 2, 3, and 4 (P < 0.05). Conclusion: Preparation of canals with a conventional hand instrumentation technique using 0.02 taper K-files showed highest fracture resistance with least amount of dentin removed at all levels followed by Endowave, ProTaper Hand, and Rotary files.
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Effect of storage time and temperature change on the dimensional stability of polyvinyl siloxane and polyether impression materials: An in vitro study
William Thomas, Pradeep Kumar, Susan Mathew, Sudeep Sarathchandran, P Jayanthi
July-September 2016, 5(3):204-209
Background: Synthetic elastomers such as polyvinyl siloxane and polyether are the most commonly used impression materials. The accuracy and dimensional stability of these materials are influenced by the temperature, humidity, and storage time. Aim: The aim of this study was to assess the effect of storage time and temperature on the dimensional stability of polyvinyl siloxane and polyether impression materials. Materials and Methods: A stainless steel die was used to prepare the molds from three brands of polyvinyl siloxane (Elite HD, Express STD, Aquasil) and one brand of polyether (Impregnum F) impression materials. The samples were stored at five different temperatures (10°C, 180°C, 280°C, 350°C, and 450°C) for 24, 48, and 72 h, respectively. The linear change in the dimension of the materials were recorded and analyzed. Results: When stored at 280°C and 450°C, polyvinyl siloxane did not show any significant dimensional change in 24, 48, and 72 h when compared to control samples. At 10°C, significant dimensional change was noted in 24 h (P = 0.00) and at 180°C, significant change in the dimension was noted in 24 and 48 h (P = 0.01,P= 0.00, respectively). At 350°C, polyvinyl siloxane showed expansion in 24 and 48 h (P = 0.00,P= 0.04, respectively) whereas no further change occurred in 72 h. Significant changes in the dimensional stability were noted for polyether at all the five storage temperatures (10°C, 180°C, 280°C, 350°C, and 450°C) when compared to control samples. Conclusion: All the three brands of polyvinyl siloxane and the one brand of polyether tested showed statistically significant dimensional changes in 10°C, 180°C, 350°C, and 450°C, whereas at 280°C, all the tested materials showed no significant changes. Most of these changes occurred within 24 h, with very little changes occurring in 48 and 72 h.
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Item analysis of multiple choice questions of undergraduate pharmacology examinations in an International Medical School in India
Yeshwanth Rao Karkal, Ganesh Shenoy Kundapur
July-September 2016, 5(3):183-186
Background: Item analysis is widely used to improve test quality by observing the characteristics of a particular item and this can hence be used to ensure that questions are of an appropriate standard for inclusion in a test. Hence, this study to evaluate the multiple choice questions of an undergraduate pharmacology program. Materials and Methods: A total of 488 items were randomly selected and subjected to item analysis. Facility value (FV) and discrimination index (DI) were calculated by applying the appropriate formulae with the help of MS Excel. Results: The overall mean FV (difficulty index) and DI was 56.64% (±2.36) (mean range: 23.89-71.25%) and 0.22 (±0.84) (mean range: 0.16-0.44), respectively. 71.09% of the items analyzed were found to be “good/optimal” items based on the FV (14.13% — optimal, 56.96% — good) and 36.26% of the items analyzed were found be “very/reasonably” good items based on the DI (20.49% — very good, 15.77% — reasonably good). The number of “poor” items was 22.95% based on the FV and 18.23% based on the DI. When both the parameters were considered together, only 23% of the items were found to be “good” and 17.11% were found to be “poor.” Pearson correlation between the two indices showed a negative correlation (but statistically insignificant) between these two indices (r = −0.001379, P= 0.9774). Conclusion: Item analysis when regularly incorporated can help to develop a very useful, valid and a reliable question bank.
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Reversed Z-shaped anomaly of main pancreatic duct as a cause of recurrent acute pancreatitis: A review
Amarnath Kadimella, Thirunavukkarasu Sampath, Varaprasada Rao Gudi
July-September 2016, 5(3):165-168
Idiopathic pancreatitis comprises of around 20% cases of acute pancreatitis. We report a case with reversed Z-type main pancreatic duct, a very rare and unusual anomaly of the main pancreatic duct as a cause for idiopathic acute pancreatitis. A review of literature showed it is one of the significant causes for idiopathic recurrent acute pancreatitis. Meandering main pancreatic duct (MMPD) comprises loop type and reversed Z-type main pancreatic ducts. These are found more frequently in idiopathic recurrent acute pancreatitis than in the community.
  1 3,996 331
Solid pseudopapillary carcinoma of pancreas: A rare case report
Vudutha Srihari, Janga Jayaram, Golla Baleswari, M Naveen Kumar
July-September 2016, 5(3):215-217
A 20-year-old female presented with abdominal pain and loss of weight of 3 months duration, initially diagnosed as acid peptic disorder ultra sound examination revealed pancreatic mass and contrast-enhanced computed tomography abdomen confirmed distal pancreatic mass, which was excised and sent for histopathological examination, which revealed solid pseudopapillay tumor of pancreas. Solid pseudopapillary tumors most commonly occur in young women. Till recently the tumors are misclassified as nonfunctioning islet cell tumors or solid cystic tumor of pancreas or papillary cystadeno carcionoma. The tumors are well-encapsulated and cut surfaces show solid and hemorrhagic necrotic patterns. The neoplasms usually behave like a very low grade malignancy; hence complete surgical removal is treatment of choice.
  - 1,492 98
Bilateral xanthomas of tendoachilles in a patient of cerebro-tendinous xanthomatosis: A case report
Vutukuru Sri Ravindranath, V. R. K Sastry, Varun Sharma, VL Sravanthi
July-September 2016, 5(3):218-221
Cerebro-tendinous xanthomatosis is a very rare autosomal recessive disorder. An 18-year-old male presented to us with swellings of both tendoachilles, proved to be xanthomas. The diagnosis was confirmed by biochemical, clinical, and radiological studies. Such a rare and perplexing case of tendon xanthomas in this disorder should be kept as a differential diagnosis for the more common tendon swellings of this region as the conditions are treated differently. The mere postoperative recurrence in this case clearly proves that surgical excision is not the right treatment option for cerebro-tendinous xanthomatosis, which can be the primary tempting option.
  - 1,877 129
A rare case of neurofibromatosis type 1
Vijaya Prasad Balda, Siva Rama Krishna, Satyavaraprasd Kadali
July-September 2016, 5(3):222-225
Neurofibromatosis type 1 disease is characterized by pigmented cutaneous lesions and generalized tumors of neural crest origin. Sphenoid dysplasia is one of the characteristics of this syndrome which occurs in 5-10% of the cases. However, complete sphenoid wing agenesis is rare. Traditional surgical treatment of sphenoid dysplasia involves split bone grafting and repair of anterior skull defect. However, the results of this procedure may not be entirely sustainable owing to bone graft resorption and recurrence of proptosis and pulsating exophthalmos. We report here a rare case of neurofibromatosis type 1 disease with associated absence of sphenoid wing, for which the newer method of reconstruction with titanium mesh was employed by intracranial approach.
  - 2,648 153
Surgical repositioning of a pathologically displaced central incisor with a large cystic lesion
Udayakumar Palaniswamy, Mamta Kaushik, Karminder Singh, Shikha Arya
July-September 2016, 5(3):226-229
Apical cyst development is one of the late sequels of trauma to teeth, which can make the treatment challenging. Till the time the condition becomes symptomatic or gets noticed by the surgeon, displacement of the involved tooth with increase in the size of the lesion may occur. This report presents the case of a 30-year-old female patient with a large cystic lesion around the maxillary right central incisor, along with malpositioning. Root canal treatment was performed followed by enucleation of the cystic lining. Intentional luxation and repositioning of the tooth in a more favorable position were performed and it was splinted for 4 weeks. On regular follow-up, the patient showed no symptoms with bony healing of the cystic cavity and reduction in tooth mobility.
  - 1,857 127
Multifocal primary cutaneous anaplastic lymphoma
Panthalla Vijaya Lakshmi, Indukuri Chandrasekhar Reddy, Mounika Ala
July-September 2016, 5(3):230-233
Primary cutaneous anaplastic large cell lymphoma (CALCL) is a rare lymphoproliferative disorder characterized by proliferation of CD4 T helper cells that express CD30+ marker with anaplastic cytology. These lymphomas are seen in adults and present as solitary or multiple and often ulcerated nodules most often on the trunk. Multifocal lesions are seen in only 20% of patients. Careful staging with computed tomography scan is required to exclude systemic CD30+ anaplastic large cell lymphoma. Multifocal primary CALCL, not extensively reported is more likely to progress to extracutaneous involvement than localized disease. Herein, we report a case of an 83-year-old male with a 6 months history of minimally pruritic generalized ulcerated nodules.
  - 1,726 110
Umbilical cord thrice around the abdomen of the fetus leading to intrauterine death (IUD) of the fetus: A cause or effect
Geetha Lakshmi Sreerama, Talisetty Bharathi, Paraiveedu Arumugam Chandrasekharan
July-September 2016, 5(3):234-237
The umbilical cord transmits oxygen and nutrients through the blood from the mother to the fetus. The umbilical cord abnormalities and cord compression leads to a decreased blood supply through the umbilical cord causes intrauterine growth restriction (IUGR) and even intra uterine death (IUD). We are reporting a case a 25-year-old gravida 3, para 2, live 2 in the 9th month of gestational age (GA) who was a known asthmatic with previous two caesarean sections (C/S) with IUGR, severe oligohydramnios, and IUD with elevated liver enzymes and abnormal coagulation profile was referred from Rajiv Gandhi Institute of Medical Sciences (RIIMS) Kadapa, Andhra Pradesh, India. Clinically, 28-30 weeks of gestation in the transverse lie are with absent fetal heart sound (FHS). Fetal findings were confirmed by ultrasound (USG) examination. Emergency lower segment caesarean section (EMLSCS) was performed, which delivered a dead 2-kg male child with the cord thrice around the abdomen of the fetus. A lengthy cord of 76 cm entangling thrice around the fetal abdomen and associated oligohydramnios leads to cord compression causing fetal death. On USG examination of oligohydramnios, IUGR can be treated and any decreased fetal movements during the antenatal period, abnormal Doppler velocimetry, and abnormal cord position may need early intervention results to salvage the baby. Hence, routine Doppler studies for the cord position may be useful.
  - 4,350 152
Psoriasis vulgaris occurring in a known case of neurofibromatosis type I: A rare association
Konakanchi Venkata Chalam, Gummalla Ajay Kumar, Padmasri S Yandapalli, Anila P Sunandini
July-September 2016, 5(3):238-240
Neurofibromatosis type 1 (NF-1) is an autosomal dominantly inherited neurocutaneous disorder due to mutations in the neurofibromin (NF) gene that encodes protein NF. NF regulates signal transduction by inactivating RAS proteins. Mutations in the NF-1 gene increases RAS activity causing increased transduction of many growth factors and kinase pathways leading to increased mitosis and occurrence of neoplasms and proliferative conditions such as psoriasis. Psoriasis is a chronic, inflammatory proliferative condition of the skin in which both genetic and environmental factors have a vital role. The underlying pathogenesis is epidermal proliferation, vascular changes, and inflammatory changes mediated by multiple growth factors of which in particular are epidermal growth factor (EGF), transforming growth factor (TGF)-alpha, tumor necrosis factor (TNF)-alpha etc. We report a rare association of NF-1 with psoriasis occurring by chance or due to decreased NF protein.
  - 1,747 107
Rare case of cervical cancer arising in bicornuate uterus
Amitabh Jena, Rashmi Patnayak
July-September 2016, 5(3):241-243
Very few case reports are available in the literature regarding cervical cancer arising in bicornuate uterus. A 43-year-old Indian woman presented with complaint of bleeding per vaginum and white discharge for last 1 year. On examination, there was an ulceroproliferative lesion in the cervical region with free fornices. Per rectal examination did not reveal any parametrial involvement. Magnetic resonance imaging of the pelvis showed bicornuate uterus with growth in the cervix. Clinically, the patient was diagnosed as carcinoma cervix stage IB/IIA. Histopathology of the cervical biopsy was reported as moderately differentiated squamous cell carcinoma. The patient underwent radical hysterectomy, and the postoperative period was uneventful. Then she was referred to radiotherapy. After 1 month follow-up, she was healthy.
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Flexible fiberoptic bronchoscopy (FOB) as a diagnostic tool in endobronchial lesions
Srikanti Raghu, Chaitanya Sravanthi Rachaputi, Laxmi Kumari Somisetty
July-September 2016, 5(3):173-175
Introduction: Flexible fiberoptic bronchoscopy (FOB) has revolutionized the way pulmonary lesions are diagnosed, especially when endobronchial involvement is suspected. We aimed to evaluate the role of FOB by comparing the efficacy of forceps biopsy, bronchial brushings, and bronchial washings individually and in combination. Materials and Methods: This study was performed on 40 patients whose diagnosis was uncertain despite various diagnostic techniques. After initial screening, FOB was performed on patients suspected of endobronchial tumor. During the procedure of biopsy, brushings and washings were collected and sent for microbiology, cytology, and histopathology. The criteria for FOB included chronic cough, recurrent hemoptysis, and abnormal radiological opacity. Results: Twenty-five patients had visible endobronchial tumor, mean age of presentation was 41-70 years, and males were predominant. The chief complaint was cough followed by persistant fever. Lung cancer (84%) was the most common etiology followed by tuberculosis (TB) (16%). Bronchial brushings gave the highest yield, slightly higher than forceps biopsy. Conclusion: FOB is a very useful and safe diagnostic technique for the evaluation of endobronchial tumor. Because of the high prevalence of TB, the possibility of TB should be considered next to lung cancer. Bronchial brushings has an advantage over forceps biopsy in situations where biopsy forceps cannot reach or open at the site of growth.
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Influence of ethanol on aluminum-induced alterations in oxidative stress of rat thalamic area
Prasunpriya Nayak, Shiv Bhushan Sharma, Nadella Vijaya Subbaraya Chowdary
July-September 2016, 5(3):176-182
Background: Neurotoxic impacts of aluminum are associated with oxidant imbalance and implicated in many senile neurodegenerative disorders. Thalamus is relatively protected from aging-related issues, however, seldom studied. Aims: The study is aimed to find out the aluminum-induced oxidative stress in thalamic area and the influence of ethanol on that. Settings and Design: Influence of aluminum on oxidative stress parameters in the thalamic area has been studied in the presence of varied levels of ethanol exposures. Materials and Methods: Male Wistar rats were exposed to aluminum (10 mg/kg bw) and ethanol (0.8-1.6 g/kg bw). Thalamic levels of reduced glutathione (GSH) and lipid peroxidation thiobarbituric acid reactive substances (TBARS) were studied, along with the activities of superoxide dismutase (SOD), catalase, glutathione peroxidise (GPx), and glutathione reductase (GR). Statistical Analysis Used: The data were statistically analyzed using Kruskal-Wallis test for variance and the significance of the difference between groups was studied using Mann-Whitney U test. Results: Lone aluminum exposure failed to produce any alterations in all the tested parameters, except the GPx activity of thalamic area. Nevertheless, concomitant ethanol exposure caused significant alterations in those thalamic parameters barring GSH level and SOD activity. Maximum response was observed with the highest dose of ethanol exposure. Conclusions: Though thalamic area is reported to be selectively susceptible to aluminum-induced oxidative stress, concomitant presence of pro-oxidant dominance might have augmented the aluminum-induced oxidative stress there. The observation may help to understand the mechanistic riddle of oxidative stress created by aluminum, a redox-inactive metal.
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Better outcome of head injuries in a strategically designed trauma care center
Injeti Babji Syam Kumar, Tanneeru Venu Gopal Rao, Amalakanti Sridhar, Kanaparthy Snehalatha
July-September 2016, 5(3):210-214
Context: The Govt. of India has established Level II trauma care centers across the country to improve the outcome of patients suffering injuries due to trauma. Aims: To compare the outcome of head injury patients before and after the establishment of one such center. Objectives: To study the significance of a well planned neurosurgical centre in improving patient outcomes. To compare the clinical profile and surgical outcomes of head injury patients between an age old Govt hospital setup and a new trauma care centre in the Govt sector. Settings and Design: In the Govt. General Hospital (GGH), Guntur, we prospectively compared the outcomes of head injury patients. Materials and Methods: One hundred patients admitted prior to the inauguration of the new trauma care center were classified under Group 1 and 100 consecutive patients admitted after the establishment were classified under Group 2. Statistical Analysis Used: Comparison of means and percentages. Results: Clinicodemographic features at admission of patients in both the groups were similar. Ninety percent of patients in Group 2 were discharged in contrast to 68% of patients from Group 1. Conclusions: A better designed trauma care center showed dramatic improvement in the outcome in head injury patients.
  - 2,016 118
Assessment of periodontal health among jail inmates of Guntur city Andhra Pradesh: A cross-sectional study
Narayana Rao Vinnakota, Vikram Simha Bommireddy, Srinivas Pachava, Srinivas Ravoori, Devaki Talluri, Suresh Sanikommu
July-September 2016, 5(3):200-203
Introduction: Oral health is an integral part of general health. Various factors are responsible for maintenance of good oral health. Socioeconomic status, occupation, education are playing major role in the maintenance of good oral health. Prisoners are psychologically, socially, morally and economically affected group, which makes them to neglect their general, as well as oral health. Materials and Methods: A descriptive cross-sectional epidemiological study was designed and undertaken at district prison in Guntur city to assess the periodontal health status and loss of attachment (LOA) in accordance with their years of imprisonment. Results: The total prison population of the district prison was 180 (145 males, 35 females) with the age group of 18-65 years. Calculus was observed among 38.8% of total inmates, and it was observed more 25 (35.7%) who were imprisoned for 4-6 years. Pockets measuring 4-5 mm was observed among 15.5% of total inmates and it was observed 10 (35.7%) who were imprisoned for 2-4 years. Pockets measuring >6 mm were observed among 5%of total inmates and it was observed more 4 (40%) who were imprisoned for >6 years. There was highly statistically significant differences in LOA scores between the inmates imprisoned for a different period of imprisonment (P = 0.005). Conclusion: This study conducted in central jail has clearly indicated that their periodontal health status is poor because of lack of knowledge on oral health care measures and accessibility to aids used in oral hygiene practices. Preventive measures to improve dental care and provision of dental health education are very much necessary to ensure optimum oral health among the inmates.
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Gamma knife radiosurgery: Making lives merrier for refractory trigeminal neuralgia
Raj Kumar Badam, Supraja Chowdary, Sudheer Kanth Kondamari, Sujan Kumar Kotha
July-September 2016, 5(3):169-172
Trigeminal neuralgia (TN), also known as tic Dolorex, is a unilateral paroxysmal lancinating pain affecting one or more of the branches of the trigeminal nerve. The treatment of TN can be very challenging despite the numerous options patients and physicians can choose from. Stereotactic radiosurgery (SR) with gamma knife surgery (GKS) is a rapidly emerging surgical modality in the management of medically refractory TN. GKS is the most recent and least invasive neurosurgical treatment alternative to microvascular decompression and rhizotomies. The gamma knife is a complex machine that uses cobalt-60 as energy and is able to focus a precise intersection of 201 beams of these gamma rays to perform radiosurgery. It is associated with a low risk of facial paresthesia, an approximately 80% rate of significant pain relief, and a low recurrence rate.
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