Self-assessment and clinical diagnosis of periodontal status among patients visiting dental institution in Bangalore city: a cross-sectional study

Background: Periodontal diseases are a group of lesions affecting tissues surrounding and supporting the teeth. Periodontal diseases are considered as a group of highly prevalent infectious, inflammatory conditions of the supporting structures of the teeth which affects more than 50% of the world’s adult population. The present study was undertaken to evaluate the extent of agreement between clinical and self-assessed periodontal health status among patients visiting the outpatient department of Rajarajeswari Dental College and Hospital, Bangalore, India. Methods: A cross-sectional study was done among 250 patients who attended the outpatient department of Rajarajeswari Dental College and Hospital, Bangalore. The study population was subjected to a self-administered questionnaire which was followed by periodontal examination. The clinical examination included an assessment of the periodontal condition using CPI and mobility. Results: There was a marked discrepancy between the two values of self-assessed and clinically diagnosed periodontal health status which shows that the self-assessed periodontal tool was a poor indicator of the periodontal health status. Conclusions: The present study showed that there is a discrepancy between the subjectively and objectively assessed periodontal health status. Increasing people’s awareness and knowledge of their own dental disorders and changing their attitudes and behavior towards oral health care will help in improving oral as well as general health.

Comparison of various decalcifying agents to evaluate their efficacy

Background: Bone is a biological complex structure primarily comprising collagen and minerals. It is important to demineralize these mineralized tissues to remove their calcium apatite crystals for analysing the sub-cellular, cellular, and fibrillar architecture. Six demineralizing agents’ efficacy was examined by assessing their duration, ease of handling tissue, staining, and histological criteria. The present study aimed to evaluate six commonly used demineralizing agents to identify the best decalcifying agent. Methods: Twenty resected hard tissue specimens (1 cm × 1 cm x 1 cm) from the archives were used in the study. These segments were decalcified by solutions namely 10% nitric acid, 10% formic acid, 14% ethylene di amine tetra acetic acid (EDTA), a mixture of formic acid and hydrochloric acid (formic + HCL) 4% each, and a mixture of formic acid and nitric acid 4% each (formic + HNO3), 10% formal nitric acid further subjected to radiographic endpoint test. Results: The present study confirmed the fact that samples treated with EDTA showed the best overall impression in terms of tissue integrity and histology followed by 10% formal nitric acid which gave fairly good cellular details and was also rapid in the action. Conclusions: Based on the present study findings, we suggest that 10% formal nitric acid is the better decalcifying agent available, considering time and tissue integrity as two main factors.

Ewing’s sarcoma or peripheral primitive neuroectodermal tumor at the base of tongue: a rare location case report

Peripheral primitive neuroectodermal tumor now termed as Ewings sarcoma/PNET, representing a family of tumors with varying degrees of neuronal differentiation and genetic rearrangements. Most common sites are extraosseous involving trunk and lower limb. Base of tongue is a very rare site for Ewing’s/PNET, hence in view of rarity of the location as an uncommon presentation, the case has been reported for the better understanding and supporting the literature with the similar finding. A 68 years old female patient presented with the complaint of difficulty in swallowing since 3 months. On examination growth was identified at the left side base of tongue. Biopsy was processed and stained with H&E and other relevant markers. Differentials on the basis microscopic examination were lymphoma, neuroendocrine tumor and primitive neuroectodermal tumor. Various immunohistochemical markers to rule out the given differential were used. The tumor was positive for CD 99 and vimentin. The case was repored as PNET. Peripheral PNET is a challenging topic. Wide range of extraosseous locations have been observed but head and neck being less reported needs to be studied for understanding the behavior of this highly malignant disease in this rare location so that patient can be benefitted by advanced multimodality treatments including surgery, chemotherapy and radiotherapy.

Ewing’s sarcoma or peripheral primitive neuroectodermal tumor at the base of tongue: a rare location case report

Peripheral primitive neuroectodermal tumor now termed as Ewings sarcoma/PNET, representing a family of tumors with varying degrees of neuronal differentiation and genetic rearrangements. Most common sites are extraosseous involving trunk and lower limb. Base of tongue is a very rare site for Ewing’s/PNET, hence in view of rarity of the location as an uncommon presentation, the case has been reported for the better understanding and supporting the literature with the similar finding. A 68 years old female patient presented with the complaint of difficulty in swallowing since 3 months. On examination growth was identified at the left side base of tongue. Biopsy was processed and stained with H&E and other relevant markers. Differentials on the basis microscopic examination were lymphoma, neuroendocrine tumor and primitive neuroectodermal tumor. Various immunohistochemical markers to rule out the given differential were used. The tumor was positive for CD 99 and vimentin. The case was repored as PNET. Peripheral PNET is a challenging topic. Wide range of extraosseous locations have been observed but head and neck being less reported needs to be studied for understanding the behavior of this highly malignant disease in this rare location so that patient can be benefitted by advanced multimodality treatments including surgery, chemotherapy and radiotherapy.

Cystic fibrosis presenting as small bowel obstruction in pediatric patient: a case report

Intestinal obstruction complete or incomplete has been found commonly in patients with cystic fibrosis in all age groups with variable presentation. Prevalence of intestinal obstruction in children with cystic fibrosis is 7-8%. Neonates present with meconium ileus due to inspissated meconium and complete obstruction. This case demonstrates similar presentation in a pediatric patient. A six day old male patient presented in the pediatric surgery department with abdominal distention, vomiting and fever. Patient was operated and intraoperative meconium plug was seen along with dilated proximal bowel, filled with sticky meconium. Resected gut segment was received in the Department of Pathology. Grossly dilated gut segment on cut section was seen filled with thick putty like greenish fecal matter. Histopathological examination showed features consistent with cystic fibrosis. There are multiple causes for intestinal obstruction in neonates, cystic fibrosis can be one of them which needs to be considered by the clinicians. Such cases need to be reported for better understanding of their clinico-pathological presentation and prevalence.

Patterns of Medication Use and Their Determinants in Pregnancy among Women Admitted to the Obstetrics Wards of a Tertiary Care Hospital: A Cross-Sectional Study: Patterns of Medication Use and Their Determinants in Pregnancy

Objective To assess the patterns and factors affecting medication use during antenatal and perinatal periods and to examine maternal and fetal outcomes among pregnant women admitted to a tertiary care hospital in a developing country. Methods A cross-sectional study was conducted in the obstetrics wards from 2017 to 2019. Data on patient demographics, co-existent medical conditions, medications, and patient outcomes were collected. Descriptive statistics were used to analyze baseline data, chi-square test was used for categorical variables, and multivariate logistic regression was used for factors influencing drug prescription. Results Out of 442 pregnant women, 56% were primigravida with a mean age of 24.7 ± 3.9 years. Approximately 32% experienced at least one disease condition during pregnancy; hypothyroidism (9.7%) was the commonest. The mean number of medications was 2.7 and 38.9% received drugs for a disease condition. Antimicrobials (24.5%) were the commonest drug class. Maternal age of over 25 [(OR (CI): 1.508 (1.191–2.716) (p = .005)] and maternal illness [OR (CI) 2.934 (1.8–4.7) (p = .00)] were identified as factors affecting drug prescription. Approximately 39.8% of deliveries were cesarean. Of the newborns, 12.6% had low birth weight, 9.2% were admitted to the newborn intensive care unit, and 14.9% were premature. Conclusions Most patients were primigravida and under 25 years. Antimicrobials were the most prescribed drug class. Maternal age over 25 years and maternal illness were identified as the factors affecting medication use. The prevalence of cesareans and prematurity was similar to previous studies.

Histopathological Evaluation of Solitary Nodules of Thyroid

Introduction: Solitary Thyroid nodules (STNs) can be ofboth non-neoplastic or neoplastic in nature and it is difficultto assess whether an STN is neoplastic or non-neoplasticby clinical examination alone. Imaging technique mayhelp in differentiating them preoperatively but histologicalexamination offers the final diagnosis. This study was aimedat studying the incidence rates of various types of STNs as itvaries from one geographical area to another.Material and methods: A total of 58 cases of STNsreceived over the period of 18 months were studied andhistopathological features were analysed.Results: In this study, non-neoplastic STNs were 32 (55.17%)and neoplastic were 26 (44.82%), the former being morecommon. There was a female preponderance in both nonneoplastic and neoplastic STNs with an incidence of 90.62%and 84.61% respectively. Mean age of presentation of STNswas 42.09 years. Non-neoplastic lesions of thyroid were; 18cases of colloid nodules, 10 cases of hyperplastic nodulargoitre, 04 cases of Hashimoto Thyroiditis and the neoplasticlesions were; 05 cases of follicular adenoma, 11 cases oftypical/conventional papillary carcinoma of thyroid (PTC),6 cases of papillary carcinoma thyroid variants, 01 case offollicular carcinoma 01 case of Undifferentiated carcinoma,01 case of Squamous cell carcinoma and 01 case of medullarycarcinoma.Conclusion: STNs are not so uncommon and comprise of agamut of both non-neoplastic and neoplastic lesions. Colloidnodule and PTC are the most common of non-neoplastic andneoplastic STNs respectively.

Migrating foreign body in an adult bronchus: An aspirated denture

As a safety measure, dentures are routinely removed before surgery. Aspiration of a denture could be catastrophic, with medicolegal implications. Foreign body aspiration is uncommon in adults; however, aspirations may remain asymptomatic and undiagnosed for long periods of time. We report an adult male who presented with a cough for more than 6 months. On radiography, a foreign body was found migrating within the tracheobronchial tree from one mainstem bronchus to the other, at different time points. The foreign body was later found to be a portion of his denture. The aspiration may have occurred at the time of a surgical procedure.

Synthesis, spectroscopic characterization and biological applications of Cu(II) and Ni(II) complexes with 2-butyl-4-chloro-5-formylimidazole thiosemicarbazone.

Cu(II) and Ni(II) complexes of 2-butyl-4-chloro-5-formylimidazole thiosemicarbazone (L) are synthesized and characterized by using spectroscopic techniques like elemental analysis, FT-IR, mass spectrometry, electronic and EPR spectra. The complexes are found to have characteristic electronic spectra and the geometry of the complexes are identified as octahedron. Both the complexes are found to exhibit similar anti-microbial activity against the gram –ve and gram +ve bacteria. Anti-cancer activity against the cancer cell lines (MDA-MB 231 cell lines) among the compounds studied for % of viability, the inhibition concentration 50 values were shown by Cu(II)-L complex at 80 mg/ml and by Ni(II)-L complex at 100 mg/ml.

Oral contraceptives and oral health: an insight.

Oral contraceptive pills are a safe and effective means of avoiding pregnancy followed by women worldwide. These drugs were first introduced in 1960s and 70s and contained higher dose of estrogen and progesterone and were reported to cause unwanted side effects like gingival inflammation, localized osteitis, alterations in salivary flow rate, changes in salivary components and gingival melanosis in oral tissues. With the advent of new generation formulations of low dose oral contraceptive pills, the effects on oral health is minimized and presently users are not considered as risk group for developing gingival and periodontal disease. This review briefs the effects of oral contraceptive pills on general health and oral health in particular and controversies surrounding their use.

Role of mast cells and neuronal hypertrophy in acute appendicitis

Acute appendicitis is a common surgical emergency. Appendix continues to be the major chunk of surgical specimens received in Pathology laboratory. However, pathogenesis of appendicitis remains poorly understood. Obstruction and inflammation is implied in pathogenesis of acute appendicitis. Presently there is increasing evidence of involvement of enteric nervous system in immune regulation and in inflammatory responses. The present study combines routine histopathology and immunohistochemistry to study the role of mast cells and enteric nervous system in pathophysiology of acute appendicitis. We have done a prospective study for a period of one and half years from January 2014 to July 2015. Appendicectomy specimens from patients who are clinically diagnosed as acute appendicitis were included in study group as cases. Appendix specimens removed at Forensic autopsies were used as controls. Study was conducted on total 138 appendix specimens of which 118 were surgically removed from patients with acute appendicitis, taken as study group. 20 specimens from Forensic autopsy, were used as comparison group (normal control group). We found a consistent increase in mast cell and neuronal counts along with prominence of ganglion cells in specimens with acute appendicitis compared to the control group.

Significance of fibrotic bands in utero ‑ Amniotic band sequence with limb body wall complex: A rare case of fetal autopsy.

Amniotic band sequence (ABS) includes a wide spectrum of abnormalities resulting from entrapment of various fetal parts from a disrupted amnion, ranging from a mere constriction ring affecting a finger to a fatal form called limb body wall complex (LBWC). Reported cases of ABS with LBWC are very few. The spectrum of anomalies depends on which part gets entrapped and at what point of gestation. Hence, the clinical presentation can be extremely variable. Early detection of such cases using sonology is really challenging due to the small size of the fibrotic bands. Here, we present a case of amniotic band syndrome with LBWC in a fetus at 24 weeks of gestation, which was referred for an autopsy. The fetus also showed scoliosis, gastroschisis, lumbosacral meningocele, congenital talipes equinovarus, and cleft palate, thus having features of placenta cranial and placenta abdominal phenotype which is very rare.

Uterine low grade endometrial stromal sarcoma: a case report with review of literature.

Endometrial stromal sarcomas are rare uterine tumours usually seen in perimenopausal females. We report here a case of low grade endometrial stromal sarcoma in a 45 year female with a clinical diagnosis of fibroid uterus and final histological diagnosis of low grade endometrial stromal sarcoma.

Detection of vancomycin susceptibility among clinical isolates of MRSA by using minimum inhibitory concentration method.

Background: Staphylococcus aureus is considered as a major pathogen causing a diversity of infections including bacteremia, pneumonia, skin and soft tissue including osteoarticular infections. Since 1961, Methicillin Resistant Staphylococci aureus (MRSA) emerged has one of the major and common cause of hospital acquired infection. However, due to wide spread usage of vancomycin for MRSA infections resulted in reduced susceptibility of S. aureus to vancomycin has been identified as a serious public health concern. The aim of the study is to identify the Methicillin Resistant Staphylococcus aureus (MRSA) from various clinical samples and to detect vancomycin susceptibility by Minimum Inhibitory Concentration (MIC) method. Methods: This study was conducted over period of one year December 2013 to November 2014. Clinical samples like pus, blood, sputum, urine and cerebrospinal fluid were collected from various clinical departments in Narayana General Hospital for selective isolation of Staphylococcus aureus. A total of 100 Staphylococcal aureus isolates were isolatedby using standard laboratory procedures. MRSA were detected using Oxacillin Disc on Muller Hinton Agar with 4% NaCl. Sensitivity pattern for vancomycin (30 μg) disc and for other recommended antibiotics was determined by Kirby-Bauer’s disk diffusion method. Minimum Inhibitory Concentration (MIC) was done for vancomycin sensitive isolates by standard agar dilution method. Results: Out of 100 S. aureus isolates, all were susceptible to vancomycin (30 μg) by disk diffusion method. But, 82 isolates of MRSA were susceptible to vancomycin at the concentration of 0.5-2 μg/ml of agar. 17 isolates showed intermediate sensitivity to vancomycin, in which 13 isolates with MIC 4μg/ml and 4 isolates with MIC 8 μg/ml and one isolate was resistant to vancomycin even with MIC of 16 μg/ml. Conclusions: The present study reveals the emergence of Vancomycin Intermediate Sensitive Staphylococcus aureus (VISA) and Vancomycin Resistant Staphylococcus aureus (VRSA). Disc diffusion method should not be employed for detection of vancomycin sensitivity for MRSA stains. The major cause may be attributed to unawareness and irrational usage of broad spectrum antibiotics.

Incidence of carbapenem resistant nonfermenting gram negative bacilli from patients with respiratory tract infections among intensive care units.

Background: Non fermenting gram negative bacilli that were considered to be contaminants in the past have now emerged as important healthcare- associated pathogens. Pseudomonas aeruginosa and Acinetobacter species are now known to be the common nosocomial pathogens. Carbapenems are one of the essential antibiotics in the armamentarium against, serious nosocomial infections. Development of resistance against these is a cause of concern. Misuse and inappropriate duration of antibiotic therapy helps in development of resistance. Methods: A total of 200 endo tracheal aspirates and sputum samples were collected from patients of all age groups with clinical evidence of lower respiratory tract infection from Medical, surgical, pediatric ICUS. Non fermenting gram negative bacilli isolated and identified according to CLSI guidelines and antibiotic sensitivity test was performed by Kirby Bauer disc diffusion method. Results: Out of 200 samples 50 Acinetobacter spp. and 38 Pseudomonas aeruginosa were isolated. Among 38 Pseudomonas isolates (42%) 16 were resistant to imipenem and 11 (29%) were resistant to meropenem. Among 50 Acinetobacter isolates 14 (28%) were resistant to imipenem and 12 (24%) were resistant to meropenem. Conclusions: Our study documents an increase in the carbapenem resistance. Reduction in antimicrobial resistance in the ICUS has been a goal for all ICUS as it improves outcome and cost of patient care. Carbapenem must be used judiciously to prevent further resistance or else this would erode the strength of life saving antibiotics.

Tamsulosin vs Naftopidil in Medical Expulsive Therapy for Ureteral Stones — A Randomized Controlled Study.

The aim of the present study was to compare the efficacy of naftopidil and tamsulosin in the management of ureteral stones. A total of 92 patients with symptomatic, single < 10 mm ureteral stone, were enrolled in a prospective study and randomized into two groups. Group 1, received 0.4 mg tamsulosin daily, whereas Group 2, received 50 mg naftopidil daily. Patients were followed –up for up to 6 weeks. The primary end point was stone expulsion rate and secondary end points were stone expulsion time , the rate of interventions such as uretero-renoscopy, ureteric stenting and extracorporeal shock wave lithotripsy and side effects. There were no significant differences between the groups with respect to age, sex, stone size and location. Stone expulsion rate were 76% and 56% in the tamsulosin and naftopidil group respectively. No significant difference in the stone expulsion time and the rate of interventions between the two groups. The finding suggest that tamsulosin is superior to naftopidil for stone expulsion therapy.

A study of correlation of expression of ER, PR and HER2/neu receptor status with clinico-pathological parameters in breast carcinoma at a tertiary care centre.

Background: In English literature it is documented that the expression of ER and PR is low in Asian countries when compared to that of Western countries. HER2/neu over expression is uniform throughout the world. Studies have shown that triple-negative breast carcinomas are aggressive, likely to spread beyond the breast and recur after treatment. Aims and objectives: To correlate the expression of ER, PR and HER 2/neu with clinico-pathological parameters in infiltrating ductal carcinoma and other variants of breast carcinoma. To determine the clinicopathological parameters in triple negative cases. Methods: This is a prospective study for a period of two years in the Department of Pathology, Andhra Medical College, a tertiary care centre. We received 111 mastectomy specimens during this period out of which 52 patients were funded under Arogyasri and were subjected for ER, PR, HER2/neu receptor study. Results: In the present study total cases analyzed were 52. Infiltrating ductal carcinoma was 41/52 (78.84%) and other variants were 11/52 (21.15%). In our institute infiltrating duct cell carcinoma (NOS) type was the commonest type of carcinoma breast with significant group occurring in less than 45 years of age, 95 % of women were multipara with two or more children and triple negative tumors being 54.83%.In infiltrating ductal carcinoma ER, PR positive expression has no association with age and size of tumor. Their expression was higher in grade 1 tumors 83.3%.The ER,PR negative expression was more in size of tumor being greater than 2 cm; (92.5%),positive lymph nodes (51.8%) and stage II and stage III tumors (96.2%). HER2/neu negative expression was seen in 51.61% of cases. Triple negative receptor expression was seen in 54.83% of infiltrating ductal carcinoma. In the English literature medullary carcinoma is negative for HER2/neu expression but in the present study in 2 cases the expression for HER2/neu was positive. Conclusion: In the present study significant group occurred in less than 45 years of age presenting in advanced stage of the disease. Triple negative cases were seen in 54.8% cases of infiltrating duct cell carcinoma indicating bad prognosis.

Effect of Nutrients on Biological Nitrification.

Biological nitrification is the most commonly used process for nitrogen removal from wastewater. Nitrification is carried out in two steps. First ammonia is converted to nitrite by ammonia oxidizing bacteria. In the second step nitrite oxidizing bacteria convert nitrite to nitrate. The study involves the effect of nutrients (both organic and inorganic components) on biological nitrification and the optimum concentrations of di-sodium hydrogen phosphate, potassium di-hydrogen phosphate, sodium hydrogen phosphate, sucrose and ferric chloride were observed over ammonium ion removal. The effect of dissolved oxygen also was studied and maximum percentage removal of ammonium ion was found to be 89.2%.

Biological Nitrification of Waste Water.

Nitrification has been studied extensively as a result of its significance within the biological process and at intervals the necessity for treatment of waste water. In the last decade, the treatment of high ammonical concentration effluents has become a matter of nice interest. Many effluents will contain some hundred milligrams of nitrogen per liter (supernatants from anaerobic digestion, lechates from municipal water, etc.) may have specific treatment before utilization them to the plant recycling process. Sometimes this reaction is applied by maintaining robust ammonical concentrations which have the role of inhibiting the nitrite – oxidizing population responsible for the reaction of nitrites into nitrates (final stage of nitrification). However the nitrification methods served as a very important basis for the development of today understands and mathematical models for several waste treatment processes (activated sludge process using biofilm reactors) and self – purification in rivers. Often nitrogen removal from sea wastewater is problematic due to the low rate of bacteria concerned. Immobilization is an economical technique to retain slow growing organisms in continuous flow reactors. Immobilized cells can be classified into “naturally” attached cells (biofilms) and “artificially” immobilized cells. The simultaneous nitrification and denitrification within the step feeding biological nitrogen removal method were investigated below different inflowing substrate and aeration flow rates. The experimental results showed that there was additionally linear relationship between simultaneous nitrification and denitrification and DO concentration below the conditions of low and high aeration rate.