Primary hepatic lymphoma- A diagnostic dilemma

Primary non-Hodgkin lymphoma of liver is a very rare malignancy. Here we report the case of a 50 year old female who presented with dull ache in the right hypochondrium and decreased appetite since 1 month. CT scan of abdomen and pelvis showed an enlarged liver with an ill- defined soft tissue lesion arising from left lobe measuring 13 × 9 cm suggestive of primary hepatic neoplasm. CT scan of chest, abdomen, and pelvis and whole body positron emission tomography showed no involvement of bone marrow, lymph nodes, spleen, or any other organ. Her liver function tests, alpha fetoprotein and carcinoembryonic antigen levels were normal. Serology was negative for viruses. Pathological examination favored diagnosis of Burkitt's lymphoma. Cytogenetic studies for MYC translocation t (8;14) is suggested for confirming the diagnosis since Ki 67 index is > 70% and not nearly 100% which is characteristic of Burkitt's lymphoma.

A rare case of osteonecrosis of hip in sickle cell disease

Avascular necrosis of bone is a severe complication of sickle cell disease (SCD) and Management of these problems is often difficult because of the diagnostic imprecision of most laboratory and imaging investigations and because of the lack of evidence for most surgical procedures in sickle cell disease. Its treatment is not standardized. The objective in this case is to determine the impact of core decompression and PRP infusion in the management of Avascular necrosis of hip. In this case, a young Indian male with a known history of sickle cell disease presented to the clinic with severe bilateral hip pain. The pain had lasted for several months and had not improved with anti- inflammatory medication and starting on alandronate. There was severe pain with internal and external rotation of the hip. MRI of the femur showed stage 2 or 3 avascular necrosis of the femoral head, while X-rays of the femur were unremarkable. Patient managed conservatively by Non weight- bearing for several weeks and oral medication shortly thereafter, the patient underwent core decompression of the bilateral femoral head as well as continuing on Alendronate, a bisphosphonate. The patient improved temporarily but regressed shortly thereafter. His avascular necrosis worsened radiographically over the next several months. At this point, the only other option would be to do a total hip arthroplasty, but the patient may need several more throughout his lifetime due to the lifespan of the artificial replacement. There have only been scarce reports of avascular necrosis in patients with sickle cell trait. This manuscript presents such a case and includes the trials and tribulations associated with its management.

Concept of Sarat Ritucharya- A Practical Approach

Ayurveda- The science of life, has two aims, firstly it aimed at to preserve and protect the health of a healthy individual and secondly to cure the disease. As Ayurveda gives first priority to the preventive aspects to preserve and protect the health, it described preventive principles under the heading of Swasthavritta. Swasthavritta classically includes Dinacharya, Nishacharya and Ritucharya. These Charyas if followed properly, brings the balance in Thridosha (Vata, Pitta & Kapha) and thus maintains the Samadoshavastha (Homeostasis of humours/health). Thidoshas are always dynamic in nature, especially during seasonal variation. Adaptation to each Ritu is always a challenging to human beings, more in modern era, where people are running with mechanical life and exposing to pollutants. Ayurveda beautifully described Ritucharya prescription to be followed to bring balance in Tridoshavastha and also prevent morbid matter accumulation. There are six Rutus namely Sisira, Vasantha, Greeshma, Varsha, Sharat & Hemantha, among these, Sharat Ritu (mid-September - mid November) comes under the Visargakala constituting of Ashwini and Karthika Masa. In this Ritu physiologically Pitta undergoes Prakopa, if not followed Ritucharya properly, the Pitta will get vitiate and causes Pitta related diseases. In this article an honest attempt has been made to gather information regarding Sarat ritucahrya from all possible literature from Ayurvedic classics with practical aspects.

Advancements in molecular marker technologies and their applications in diversity studies

Crop improvement is a continuous effort, since some 10,000 years ago when primitive man made the transitionfrom hunting and foraging to domestication and crop cultivation. Since then, man-made interventions havechanged the entire scenario of crop evolution, by means of genetic alterations of plants and animals made tosatisfy man’s needs. The process of domestication has led to dramatic changes in their appearance, quality andproductivity that have contributed substantially to global food security. The tremendous decline in cultivableland, freshwater, and increasing risk of biotic and abiotic stress demand immediate attention on cropimprovement to cope with the higher demand of *40% of the food by 2020. Therefore, plant genetic variationplays a key role in plant breeding for its improvement. Most of the genetic variations useful for cropimprovement have been deposited and maintained in seed gene banks across the world; they need to be broughtinto the mainstream of breeding lines. Recent advances and progress made in molecular markers have beensubstantial tools for deeper insights of genetics, and greatly complemented breeding strategies. Integration of thenext-generation sequencing (NGS) technologies with precise phenotyping, association mapping, proteome andmetabolome studies has increased the chances of finding candidate genes and their allelic variants controlling atrait of interest. Further, these functional markers (FMMs), genotype-by-sequencing and association mappingmethodologies have opened new avenues for identification of novel genetic resources (lines) that can facilitateaccelerated crop breeding programs for increased yield, high nutritional quality, and tolerance to a variety ofabiotic and biotic stresses. The details of popular molecular markers, advancement in the technologies andstrategies for crop diversity studies and their application in crop breeding programs are presented here.

Utilization of antenatal services among mothers and its impact on birth weight: a community based cross-sectional study

Background: Safe motherhood initiatives was a worldwide effort launched by WHO in 1987 with an aim to reduce the number of deaths of women associated with pregnancy and childbirth. Appropriate antenatal care (ANC) is one of the pillars of this initiative and an important component of reproductive and child health. The present study was conducted to assess the utilization of antenatal care services, its contributing factors and its impact on birth weight of new-born.Methods: A community based cross-sectional study was conducted for a period of 3 months at Ankuli, field practice area of urban health training centre, Department of Community Medicine. A total of 138 mothers (delivered within 2 years) were included by cluster sampling. Women who were sick and did not give consent were excluded from the study. A pre-designed and pre-tested questionnaire was used for data collection and analysed in SPSS version 16. Chi-square test and bivariate logistic regression was applied at p value <0.05.Results: About 55.07% of mothers were in 25-34 years of age group, 47.82% had studied secondary education and 36.23% mothers belonged to lower middle-class socioeconomic status (SES). About 60.87% of mothers had availed antenatal services completely. Education of the participant and her husband, SES and family type were significant contributors of ANC service utilization. There was a significant association between complete ANC utilization and birth weight of the baby (p<0.05).Conclusions: The utilisation of the antenatal services was low among the mothers in our study which can be increased by proper IEC activities.

Screening for diabetes mellitus among the rural population applying Indian diabetes risk score in field practice areas of Kamineni Academy of Medical Sciences and Research Centre

Background: Globally an estimated 422 million adults are living with Diabetes as per WHO data 2014, and 85 to 90% cases are type 2 diabetes. Maximum number of people with diabetes mellitus are in the age group of 40 to 59 yrs. Among them 50% are undiagnosed. Sedentary lifestyle, diet, dietary fiber, mal-nutrition, some chemical agents, stress, alcohol, viral infections, etc., are some environmental risk factors.Methods: A cross sectional, community based study. Details of the study subjects were recorded using structured predesigned and pretested questionnaire. All the data collected was entered and analyzed with MS Excel software 2007 and Epi info 3.5.3. All tests were considered significant at p <0.05 level.Results: In our study, majority of population participated in the screening camp are between 30 to 35 years of age, Female (53.2%) participants were more. We found that 38 (24.1%) persons were found to be in pre-diabetic stage, 57 (37.3%) are having high risk of getting diabetes.Conclusions: There is significant relationship between smoking, alcohol consumption and sedentary lifestyle (p<0.05) to the risk of diabetes as per Indian diabetes risk score.

Severity of thrombocytopenia and its outcome in preterm and term neonates admitted in neonatal intensive care unit in a rural tertiary care hospital

Background: Detection of thrombocytopenia is a useful initial assessment for sick neonates, and it is considered as one of the complications of the disease process.Methods: The present study was a prospective hospital based observational study done in 60 neonates in the department of Paediatrics, KIMS, Narketpally during the period of October 2016 to September 2018.Results: The proportion of babies with thrombocytopenia admitted to the NICU was 10.9%. out of the sixty newborns with thrombocytopenia, 31(51.7%) were term babies and 29(48.3%) babies were preterm. Out of 29 preterm babies 3 (5%) were extremely preterm, 5 (8.3%) were very preterm and 21(35%) babies were moderate to late preterm. 32 babies (53.3%) had mild thrombocytopenia, 14 babies (23.3%) babies had moderate thrombo cytopenia and 14 babies (23.3%) had severe thrombocytopenia. The most common etiologic association with thrombocytopenia was septicemia (60%) followed by birth asphyxia (23.3%), maternal Pregnancy induced Hypertension (18.3%), both Disseminated intravascular coagulation and Meconium aspiration syndrome were 6.6% and Necrotizing enterocolitis was 3%. Among the 60 babies admitted with thrombocytopenia, the most frequently seen symptom was not feeding well (35%) and lethargy (33.3%) in all three groups that is babies with mild, moderate, and severe thrombocytopenia. Mortality rate among severely thrombocytopenic neonates was significantly higher (57.14%).Conclusions: Low platelet count was an independent risk factor for poor outcome in our study. Hence it could be used as a prognostic indicator in thrombo- cytopenic neonates.

Analytical study of mortality in Intensive Care Unit

Background: Intensive care Unit is the one place where we come across various medical critical cases and high number of deaths is also recorded here. In spite of so many deaths occurring at this unit, cause of death is poorly reported. We studied the different causes for deaths in ICU which includes single and multiple factors for cause of death.Methods: A retrospective study performed between January 2017 to January 2018 at Rajiv Gandhi Institute of Medical sciences, Kadapa, Ongole, A.P. This study includes 260 deaths among patients admitted in ICU of our institute during this duration. We gathered data at various levels like clinical evaluation and investigations.Results: A total of 260 deaths were recorded during this study. Among these 215 (82.69%) are female and 45 (17.30%) are male. At the time of death 174 (66.92%) patients has single systemic cause 86 (33.06%) had more than one systemic cause. Cardiovascular death 50 (19.23%) is the most common cause of death among all in which CAD 28 (10.76%) are major portion and congestive cardiac failure 20 (7.6%) are the remaining portion of the cardiac deaths. Chronic kidney disease 37 (14.2%) is the next highest deaths recorded and cerebro vascular 35 (13.46%) deaths follows the next in line.Conclusions: Majority of ICU patients were present with at least one organ failure at the time of death. What we have concluded in this study is that there are more number of deaths with single systemic cause than multiple systemic causes

Study to assess knowledge, attitude on organ donation among medical students in a medical college, Telangana, India

Background: Organ donation rate in India is only 0.26 per million. This is mainly due to lack of knowledge about the need of organ donation. Health care professionals play a vital role in imparting positive knowledge regarding organ donation.Methods: Institutional based cross sectional study was conducted among 1st year MBBS students (n=135). Data was collected and pre and post analysis was done using a pre-validated self-administered questionnaire. Data was entered in Ms Excel and analysed using SPSS 17 software.Results: Media was found to be most common source of information regarding organ donation. 91.1% support organ donation. 78.5% have not heard about donor card. Only 34.6% have heard about jeevandan scheme. 77.8% participants has knowledge that brain death is irreversible and 65.9% students believe that there is age limit for organ donation. 87.4% has adequate knowledge that single donor can donate to multiple recipients and 95.6% students believe that organs should not be donated from persons who has cancers or HIV.Conclusions: From the data analysed it is evident that there was a significant increase in knowledge following Awareness session on organ donation. Many have a positive attitude towards organ donation

Thoracoscopy and its Role in Evaluating Undiagnosed Pleural Effusions

Introduction: Definition of undiagnosed pleural effusion was considered as the failure to achieve an etiologic diagnosis byinitial pleural fluid microbiological, biochemical analysis, and at least three pleural fluid cytologies negative for malignant cells orother definite causes. Medical thoracoscopy also referred to as pleuroscopy is an endoscopic evaluation of the pleural space.Thoracoscopy was mainly used in the etiological diagnosis of pleural effusions and therapeutic procedures such as pleurodesisand adhesiolysis. In around 20%–30% of cases, etiology remains unclear and in this context, thoracoscopy becomes animportant investigation modality.Materials and Methods: It is a prospective, interventional study taken up as a pilot project by the Department of PulmonaryMedicine of SVS Medical College and Hospital, Mahabubnagar, Telangana, India. A total of 30 patients were satisfyingthe inclusion criteria and were further studied for their thoracoscopic and histopathological findings from January 2018 toNovember 2018.Results: A total of 30 patients out of whom 19 patients were male (63.3%) and 11 patients (36.6%) were female. The mostcommon respiratory symptom was shortness of breath in 18 patients (60%) and cough in 12 patients (40%). Out of the total30 cases, 23 (76.66%) were malignant and 7 (23.33%) were diagnosed to be having tuberculosis (benign). According to thehistopathological diagnosis, 20 (66.6%) had metastatic adenocarcinoma, 7 (23.3%) had tuberculosis and malignant lymphoma,and metastatic squamous cell carcinoma and sarcoma were detected in 1 (3.3%) patient. According to thoracoscopic findings,13 (43.3%) patients had mass lesion, 12 (40%) patients had nodule, 3 (6.6%) patients had adhesions, and 2 (10%) patientshad plaques. Majority of the mass lesions 11 (36.66%) were metastatic adenocarcinomas and majority of nodules 5 (16.66%)were diagnosed as tuberculous lesions.

Clinical Study of Pediatric Abdominal Trauma

Introduction: Blunt trauma accounts for approximately 90%of all pediatric injuries, with falls and motor vehicle collisionsrepresenting the most common mechanism of injury. Headand extremity injuries occur most frequently; however, injuryto the abdomen occurs in up to 8% of children and abdominalinjury is responsible for 9% of all trauma deaths. Study aimedto know the Nature of trauma, Mode of injury, Associatedinjuries, Investigative modalities and their relative accuracyin diagnosing blunt abdominal trauma.Material and methods: Analysis of 98 children admittedwith blunt abdominal trauma, from sep-2013 to jan-2016 wereincluded in this study and results were analyzed.Results: More than 40% of children are in 6 to 10 years.2/3rdof children are males. Blunt trauma is the commonest cause oftrauma. Accidental fall and RTA constituted 75.42% of cases.Polytrauma was seen in 41.8% of cases, head injury is thecommonest association. Out of 98 abdominal trauma cases,68 were managed conservatively and 23 underwent operativeintervention. Total 35 cases had injury to solid organ. Onlaparotomy bowel injury was found in 17 cases, solid organinjury was found in 27 cases. Bowel perforations were foundin 13 cases, most of them required simple closure in twolayers, 4 cases of ileum perforations with gangrene due tomesenteric tear required resection and end to end anastomosis.There were 3 deaths all of them had polytrauma with all the 3cases died during initial emergency resuscitation.Conclusion: Effective strategies, coupled with aggressivemanagement can reduce the mortality and morbidity. Nowis the time has to establish separate pediatric trauma units inall pediatric hospitals for effective management of injuredchildren.

Profile of respiratory pathogens causing acute respiratory infections in hospitalised children at Rajasthan a 4 year's study

Introduction: Various pathogens cause respiratory tract infections in children of <5 years of age causing severe morbidity and mortality. The profile of causative agents varies from place to place. Aims: The objectives of our study were to detect the profile and trends of respiratory pathogens causing acute respiratory tract infection in children using a custom multiplex real-time polymerase chain reaction (RT-PCR) and to develop a diagnostic algorithm. Materials and Methods: A total of 997 children with clinical manifestations of respiratory infections were included in the study. Their nasopharyngeal aspirate and throat swab samples were subjected to nucleic acid extraction followed by multiplex RT-PCR for eighteen viruses and six bacteria. Statistical Analysis Used: Chi-square test was employed to study the P value of different viruses and bacteria. Results: A total of 765 (76.73%) samples were found to be positive for one of the respiratory pathogens. Viruses were detected in 598 (59.98%) and bacteria in 167 (41.85%) samples, respectively. The prevalence of single and co-infections among viruses and bacteria were 77.76% and 22.24%, 81.44% and 18.56% each, respectively. Respiratory syncytial virus (RSV) A/B and Streptococcus pneumoniae were the most predominant pathogens detected in the study and were associated with lower respiratory tract infections. Conclusion: RSV and S. pneumoniae were the most common pathogens detected, higher prevalence was observed in children <1 year of age. Viruses were predominant during winter months. The study helped to prepare diagnostic algorithm which will help in reducing diagnostic costs. However, further studies are required to assess whether viruses are bystander or real pathogens and include larger panel of bacteria and viruses for diagnosis.

Clinical analysis of cardiac failure in post-myocardial infarction patients

Background: Cardiac failure is one of the common complications of Acute Myocardial Infarction. As CAD is the leading cause of death and post MI Cardiac failure also causing increase in rate of Mortality. It directs us to assess the complications of MI and to evaluate the precautionary & preventive steps of cardiac failure.Methods: The present study comprises of 50 cardiac failure patients with history of MI in the past and who presented with myocardial infarction with cardiac failure were included in this study. We excluded the patients who presented with Cardiac failure without Prior history of MI. This hospital based cross sectional study was conducted at Rajiv Gandhi Institute of Medical Sciences (RIMS), Ongole, Prakasam District, Andhra Pradesh. The study was carried out for a period of 1 year with informed consent.Results: In present study majority number of patients (33) show hypokinesia and 10 are found to have dyskinesia and only 4 are akinesia. In this study More than 50% patients are with history of anterior wall involvement. 36(72%) patients have elevated JVP, 34(68%) have cardiomegaly, 38 patients presented with PND. 29(58%) patients are DM and 35(70%) are HTN and only 6(12%) patients are neither DM, nor HTN.Conclusions: Cardiac failure is a common complication after MI. Most common presentations are breathlessness, chest pain, PND, JVP etc. Anterior wall MI on ECG either isolated or associated with other walls is the leading cause of post MI cardiac failure.

Prevalence of vitamin B12 deficiency among individuals with type 2 diabetes mellitus in a South Indian rural community

Background: To estimate the prevalence of vitamin B12 deficiency in a rural south Indian community and to evaluate the association between metformin use and prevalent vitamin B12 deficiency in people with T2DM stratified by oral vitamin B12 supplementation.Methods: Using a cross sectional study design, a random sample of people with T2DM (N=438) was recruited from a rural community. Vitamin B12 deficiency was defined as serum B12 ?200pg/ml. Data on metformin dose, duration of use, oral vitamin B12 supplementation, and diet were collected. Laboratory measurements included complete blood count, tests for hepatic, renal, and thyroid function, as well as serum vitamin B12 levels and HbA1c.Results: The prevalence of vitamin B12 deficiency in people with T2DM was 11.2% (95% Confidence Interval (CI) 8.2%-14.1%). The odds of vitamin B12 deficiency in patients receiving a metformin dose of 2 grams/day were 4 times higher compared to those receiving ?1 gram/day, after adjusting for oral B12 supplementation (odds ratio 4.2;95% CI 1.5-11.8). The odds of vitamin B12 deficiency in those taking metformin and receiving oral vitamin B12 supplementation were lower compared to those on metformin and not receiving vitamin B12 supplementation (adjusted odds ratio 0.20; 95% CI 0.06-0.70).Conclusions: Vitamin B12 deficiency affects 1 in 10 people with T2DM, is associated with higher dose metformin use, and oral vitamin B12 supplementation mitigates B12 deficiency in this group.

Obstetric outcomes and antenatal access among adolescent pregnancies in Kwazulu-Natal, South Africa

Background: Pregnancy among adolescents in South Africa is a growing concern as it may be associated with adverse socioeconomic and health impacts. Timeous initiation and optimal utilisation of antenatal care (ANC) services is imperative to ensure positive pregnancy outcomes. However, this is not always possible owing to various challenges. Methods: A multi-method study design using both retrospective record review and qualitative interviews was undertaken at a district hospital on the North Coast of KwaZulu-Natal, South Africa. Data on ANC attendance trends and obstetric/perinatal outcomes for all recorded adolescent pregnancies (13­16 years) at the district hospital under study was collected over 3 years (2011­2013) (n = 314). Qualitative interviews with randomly selected pregnant adolescents were conducted to assess experiences of ANC access and utilisation.Results: Late ANC booking and reduced ANC visits were common for adolescent pregnancies. Under-utilisation of ANC (i.e. less than 4 visits) was significantly associated with lower gestational age (< 37 weeks) (OR = 2.64; 95% CI = 1.04; 6.74; p < 0.05). Low birthweight, low Apgar scores as well as the incidence of maternal anaemia and pregnancy-induced hypertension (PIH) were found to be related to late ANC booking. In-depth interviews suggested that teenagers suffered emotional vulnerability linked to family, partner and financial support. They discussed various barriers linked with accessing ANC while acknowledging perceived benefits.Conclusion: Adolescent pregnancy was associated with late booking and reduced ANC visits, which was a risk for adverse maternal health outcomes. In-depth interviews suggested numerous challenges associated with ANC access including; financial barriers, attitude of healthcare workers (HCWs), long queues, distance travelled to access ANC services, human immunodeficiency virus (HIV) status and a lack of knowledge

A Non-Randomized Prospective Study of Management of Intracapsular Fracture Neck of Femur with Bipolar Hemiarthroplasty.

Background: The fracture neck of femur is one of the commonest fractures in elderly. With life expectancy increasing with each decade, our society is becoming increasingly an active geriatric society, with significant number of hospitalized and nursing home patients with femoral neck fractures and their sequelae. Selection of the type of prosthesis is very important in hemiarthroplasty as different types are available. Since the last two decades, bipolar replacements of the femoral head have gained popularity for treating femoral neck fractures. Aim & Objective – To assess and analyse the results of management of fracture neck of femur with bipolar hemiarthroplasty. Methods: After obtaining ethical committee approval and informed consent from patient, detailed history of patient was taken with particular emphasize on mode of injury and associated medical illness. On the day of surgery , under anesthesia and patient in lateral position, following strict aseptic precautions, either lateral (Hardinge) or Posterior (Southern-Moore) approach incision made, tissues dissected, joint capsule incised and femoral head extracted with the help of cork screw. Then the appropriate size of prosthesis with cement was seated. The wound was closed meticulously in layers. Knee flexion, isotonic quadriceps exercises were started from 1st or 2nd post op day and patients were mobilized with walker as tolerated. Patients are educated on different position of legs that should be avoided in the postoperative period. Follow up was done after 6 weeks and for further at 3 months, 6 months & 1 year .Result: In our series, at the end of final follow-up, there was no evidence of loosening, radiolucent zones, distal migration or subsidence of prosthesis. The patient with Periprosthetic fracture healed and is weight bearing fully with no pain. One patient who had moderate heterotopic ossification had still has some mild pain occasionally. Conclusion: we conclude that bipolar hemiarthroplasty produces good functional outcomes with minimal complications for displaced intracapsular femoral neck fractures and has several advantages; these results are comparable to the other studies.

Hypocholesterolemic Effect of Moringa oleifera Polyphenols in Rats Fed High Fat-Cholesterol Diet?

Introduction: One of the greatest risk factors for cardiovascular diseases is hypercholesterolemia. Moringa oleifera is a good source of phytochemicals and is well explored for its antioxidant properties. Methods: The main aim of the present study was to assess the potential cholesterol lowering effect of Moringa oleifera leaf polyphenols (MOP) in an animal model. Five groups of male Wister rats were fed for 45 days as follows: a standard diet (GI); high fat-cholesterol diet (GII); high fat-cholesterol with MOP (100 and 200mg/kg body wt GIII & GIV respectively); and high fat-cholesterol with statins (Atorvastatin) (G-V). Results: Administration of MOP rich extract (GII and GIV) significantly (p=0.05) lowered the serum cholesterol, triglycerides and low-density lipoprotein cholesterol. A significant (p=0.05) decrease in the activity of the HMG CoA reductase enzyme was observed in GIII, GIV and GV but not in GI & GII. Conclusion: The results demonstrate that the polyphenol extract of Moringa oleifera leaves has a significant cholesterol lowering effect through inhibiting HMG CoA reductase activity and faecal bile acid binding.

Evaluation of efficacy of photodynamic therapy as an adjunct to nonsurgical periodontal therapy in treatment of chronic periodontitis patients: A clinico-microbiological study.

Background and Objectives: Photodynamic therapy (PDT) is a local noninvasive treatment modality without side effects caused by antibiotics. The aim of this study was to evaluate the efficacy of adjunctive use of PDT with scaling and root planing as compared with SRP alone in the treatment of chronic periodontitis. Subjects and Methods: Twenty participants with chronic periodontitis having probing pocket depths (PDs) of ≥5 mm were selected for the study. Patients were randomly divided into control group and test group with ten patients in each group. Full-mouth SRP was performed in both the groups, followed by PDT in test group. Assessment of plaque index (PI), gingival index (GI), PD, and clinical attachment level (CAL) was done at baseline and after 3 months. Microbiological assessment of Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola was done by polymerase chain reaction (PCR) at baseline and 3 months after the therapy. Results: There was a significant reduction in PI, GI, PD, CAL, and microbiologic parameters in test group, following SRP and PDT, when compared with SRP alone in control group. Conclusion: PDT in conjunction with SRP has shown additional improvement in periodontal parameters when compared to SRP alone and has a beneficial effect in chronic periodontitis patients.

Uterocutaneous Fistula –A Rare Clinical Entity

Uterocutaneous fistula is a rare complication that may follow caesarean section. Herein is described a rare case of uterocutaneous fistula. The 35-year-old P3 L3 female patient presented to general surgery OPD with complaints of bleeding from sinus near the caesarean section scar site for last 2 years. She underwent three caesarean sections in the past. Laparotomy was performed. Conservative surgical treatment was successful. At 6-month follow-up, hysteroscopy revealed a normal uterine cavity. We conclude that conservative surgical treatment can be an efficient procedure.