PHOTOBIOMODULATION IN DENTAL IMPLANT THERAPY: A REVIEW

Photobiomodulation (PBM) or formerly known as low-level laser therapy (LLLT) is nothing but low-dosage biophotonics for therapy which presents an advancing new era of regenerative modalities in dental implantology. It utilizes light emitting diodes (LEDs), broad light sources and lasers for this purpose. Photobiomodulation is intended for relieving pain and inflammation, regulating immune responses as well as stimulating wound healing and tissue regeneration. This helps in combatting the main pathological causes of implant failures that are, peri-implant mucositis and peri-implantitis as well as helps promote osseointegration and improve stability of implants. While the scope of photobiomodulation has been thoroughly investigated in in-vitro and animal studies, human clinical trials are still scarce which makes appropriate protocol formation with respect to dosage and mode of delivery among other parameters difficult. A recently introduced and potential application of photobiomodulation in the field of implantology aims to deliver the positive effects of biophotonics through in-situ ambulatory PBM therapy called the smart dental implant (SDI) system. This comprehensive review presents the current and future trends in the application of photobiomodulation in the field of dental implantology.

Patch testing with expired Indian patch test kits: Results of a pilot study

Background: The reliability of patch testing with expired Indian standard patch test kits has been not evaluated before. Methods: Thirty adults (men:women 25:5) with allergic contact dermatitis were divided into three groups of ten patients each for patch testing by Finn chamber® method using Indian standard patch test kits having expiry in 2016, 2015 and 2014. The results were compared with those from a new kit with 2018 expiry. Results: Ten patients in group-1, eight patients in group-2 and seven patients in group-3 developed positive reactions of identical intensities and mostly from identical allergens from all four kits. The major contact allergens eliciting positive reactions of identical intensities were parthenium in nine, five and three patients, colophony in four, one and zero patients, fragrance mix in three, three and one patients, thiuram mix in three, one and one patients, and paraphenylene diamine in two, one and three patients from group-1,-2, and -3, respectively. Limitations: Small number of patients in each group remains the major limitation of the study. Whether or not these results can be extrapolated with patch test results from other similar patch test kits available across countries also needs confirmation. Conclusion: The patch test allergens can be used beyond labeled expiry dates but needs confirmation by a few large studies and using other available patch test kits. This is important as the relevance of patch test results for individual allergen in this scenario may remain debatable requiring careful interpretation

Outcomes of macular buckling with a T-shaped buckle for myopic tractional maculopathies associated with posterior staphyloma: An Indian experience

Purpose: To report the anatomic and visual outcomes following macular buckling in patients affected by pathological myopia?associated foveoschisis (FS) and macular detachment with or without macular hole (MH). Methods: A retrospective interventional consecutive case series wherein 25 highly myopic eyes (mean axial length 28.46 mm; range, 25–33.8 mm) of 24 patients (16 females and 8 males; mean age 54.1 years; range, 35–74 years) presenting with macular detachment associated with a posterior staphyloma (PS), who underwent macular buckling, were evaluated. Patients with absence or reduction in subretinal fluid by more than 90% during the final follow?up along with inversion of contour of staphyloma were considered to have a successful anatomical outcome and those with improvement or maintenance in visual acuity were considered to have a successful functional outcome. The mean duration of follow?up was 11.2 months. Results: At the time of initial presentation, the mean age of the 24 patients was 54.1 ± 10.28 years. Macular detachment along with FS was present in all cases, whereas full?thickness macular hole?related retinal detachment was present in nine cases. Swept?source optical coherence tomography parameters showed reduction of FS with foveal reattachment in all eyes except one at last visit. Mean axial length decreased from 28.5 mm preoperatively (range 26–33.8 mm) to 26.2 mm (range 24–29.3 mm). The mean best?corrected visual acuity changed from 1.16 log MAR to 1.096 Log MAR (P = 0.165). Visual acuity improved in 10 eyes (40%), remained stable in 11 eyes (44%) and decreased in 4 eyes (16%). Conclusion: Macular buckling is a good surgical technique with encouraging anatomic and visual outcomes in patients with myopic macular detachment associated with PS. Highly selective cases of myopic traction maculopathy can have a viable option of macular buckle surgery in stabilizing the retinal tractional changes, and thereby, vision loss.

Primary retroperitoneal extraovarian granulosa cell tumor

Extraovarian granulosa cell tumors (GCTs) develop from ectopic gonadal tissue situated along the embryonal route of the genital ridge. Primary retroperitoneal tumors are extremely rare, with an incidence of 02% -06% and 80-85% probability of malignancy. Only eight such case reports have been published previously. We herein, report a rare case of extraovarian retroperitoneal GCT in a 55-year-old woman who presented with intermittent left lumbar region pain of one-year duration. She had a history of hysterectomy and bilateral salpingo-oophorectomy 8 years ago for uterine leiomyoma. Laparotomy revealed a retroperitoneal mass measuring 8cm x 10cm x 20cm in size, solid cystic with areas of necrosis and hemorrhage. The gross features, classical histopathology, and positive immunostaining of the retroperitoneal mass with inhibin, calretinin, PR, WT1 and immunonegativity for EMA were characteristic of adult-type GCT. Excluding any previous history of primary ovarian GCT in this patient, a de-novo retroperitoneal diagnosis was established.

Aceclofenac-Induced Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a rare but severe and potentially life-threatening systemic clinical condition. We report a case of a 44-year-old female, who developed DRESS syndrome after taking two doses of aceclofenac, paracetamol, and thiocolchicoside fixed-dose combination. The patient presented with maculopapular rashes, itching, fever, pedal edema, swelling of the face and lips, difficulty in swallowing, loose stools, and vomiting for 4 days following drug intake. Laboratory and histopathological investigations supported the diagnosis following RegiSCAR criteria. The DRESS syndrome in this patient was definite as per Naranjo’s adverse drug reaction probability scale. The patient was adequately managed using systemic corticosteroids, antibiotics, and intravenous fluids. Aceclofenac is the most likely causative agent of DRESS syndrome in this patient. Early detection and withdrawal of the suspected drug along with adequate supportive treatment are the mainstay of management.

Epstein-Barr Virus-associated Mixed Lymphoepithelioma-like Carcinoma and Adenocarcinoma of the Gall Bladder: An Unusual Entity / 대한소화기학회지

Schmincke described lymphoepithelioma as an undifferentiated carcinoma with abundant lymphoid stroma in the nasopharynx. Tumors with a similar histomorphology in extrapharyngeal areas have been referred to as lymphoepithelioma-like carcinoma (LELC). The association of an Ebstein-Barr virus (EBV) infection with lymphoepithelioma is well established in the nasopharynx but not so well at the extrapharyngeal sites. Only four cases of LELC have been reported in the gall bladder, of which all were negative for the EBV. This paper reports the first case of an EBV-associated mixed gall bladder carcinoma exhibiting a distinct phenotype of LELC and adenocarcinoma with mucinous differentiation. The EBV was confirmed by the strong granular membranous and cytoplasmic expression of LMP-1 (latent membrane protein-1) on immunohistochemistry and nuclear EBER RNA on chromogen in-situ hybridization in the tumor. This is the first case of LELC positive for EBV in the gall bladder. LELC has a more favorable prognosis than conventional adenocarcinoma or squamous cell carcinoma, irrespective of the site. Although a higher T stage and nodal metastasis were exceptional in the present case in contrast to the previous cases, the EBV-associated lymphocytic response might limit the disease spread and confer better overall survival and prognosis in these patients. Nevertheless, more prospective studies with a larger cohort will be needed to understand the pathogenesis, biological behavior, and prognosis of this rare entity.

Epstein-Barr Virus-associated Mixed Lymphoepithelioma-like Carcinoma and Adenocarcinoma of the Gall Bladder: An Unusual Entity / 대한소화기학회지

Schmincke described lymphoepithelioma as an undifferentiated carcinoma with abundant lymphoid stroma in the nasopharynx. Tumors with a similar histomorphology in extrapharyngeal areas have been referred to as lymphoepithelioma-like carcinoma (LELC). The association of an Ebstein-Barr virus (EBV) infection with lymphoepithelioma is well established in the nasopharynx but not so well at the extrapharyngeal sites. Only four cases of LELC have been reported in the gall bladder, of which all were negative for the EBV. This paper reports the first case of an EBV-associated mixed gall bladder carcinoma exhibiting a distinct phenotype of LELC and adenocarcinoma with mucinous differentiation. The EBV was confirmed by the strong granular membranous and cytoplasmic expression of LMP-1 (latent membrane protein-1) on immunohistochemistry and nuclear EBER RNA on chromogen in-situ hybridization in the tumor. This is the first case of LELC positive for EBV in the gall bladder. LELC has a more favorable prognosis than conventional adenocarcinoma or squamous cell carcinoma, irrespective of the site. Although a higher T stage and nodal metastasis were exceptional in the present case in contrast to the previous cases, the EBV-associated lymphocytic response might limit the disease spread and confer better overall survival and prognosis in these patients. Nevertheless, more prospective studies with a larger cohort will be needed to understand the pathogenesis, biological behavior, and prognosis of this rare entity.

Estimation of salivary ferritin in children with childhood caries ­ a cross sectional study / Estimativa da ferritina salivar em crianças com cárie na infância - um estudo transversal

Objective: Early childhood caries is the presence of dental caries in a child upto seventy one months of age. Saliva plays a major role in maintaining good oral health. The composition of saliva acts as a marker for oral health and the salivary proteins help in modulating the oral microflora in the oral cavity. Some salivary biomarkers help in detecting caries risk and can also predict their prognosis. Ferritin is one of the major biomarkers present in the saliva which acts as an iron binding protein and also as a monitoring tool in children suffering from iron deficiency. The ferritin levels are in increased in serum as well as in saliva to balance the deficiency of iron in the body. Material and methods: Sixty children were selected for the study aged between three to six years. The saliva sample was collected using standard spit method in a sterile container and Ferritin was tested in the samples by Chemiluminescence microparticle immunoassay(CMIA). Results: Salivary ferritin was found to be higher in the saliva of children with early childhood caries(mean value= 5.867) than in children without early childhood caries(mean value= 3.412). Conclusion: A direct association is present between salivary ferritin levels and dental caries. Increased level of ferritin is observed in children with Early childhood caries. Clinical relevance: The level of salivary ferritin is found to be raised in the present study in children with Early childhood caries. The exact mechanism is although not known it can be assumed that the children with early childhood caries might have deficiency of iron which has led to the increased amount of salivary ferritin in the saliva. (AU)

Objetivo: A cárie precoce é definida como a presença de cárie dentária em uma criança de até setenta e um meses de idade. A saliva desempenha um papel importante na manutenção de uma boa saúde bucal. A composição da saliva atua como um marcador para a saúde bucal e as proteínas salivares auxiliam na modulação da microflora oral na cavidade oral. Alguns biomarcadores salivares ajudam a detectar o risco de cárie e também podem prever seu prognóstico. A ferritina é um dos principais biomarcadores presentes na saliva, que atua como uma proteína ligadora de ferro e também como uma ferramenta de monitoramento em crianças com deficiência de ferro. Os níveis de ferritina aumentam tanto no soro quanto na saliva para equilibrar a deficiência de ferro no corpo. Material e Métodos: foram selecionadas para o estudo 60 crianças com idades entre três e seis anos. A amostra de saliva foi coletada pelo método padrão de cuspir em um recipiente estéril e a ferritina foi testada nas amostras através de um imunoensaio de micropartículas por quimioluminescência (CMIA). Resultados: A ferritina salivar foi maior na saliva de crianças com cárie na primeira infância (valor médio = 5,867) do que em crianças sem cárie na primeira infância (valor médio = 3,412). Conclusão: Existe uma associação direta entre os níveis de ferritina salivar e a cárie dentária. Nível elevado de ferritina é observado em crianças com cárie na primeira infância. Relevância clínica: O nível de ferritina salivar está elevado no presente estudo em crianças com cárie na primeira infância. Embora o mecanismo exato seja desconhecido, pode-se presumir que crianças com cárie na primeira infância podem ter deficiência de ferro, o que levou a um aumento na quantidade de ferritina salivar na saliva. (AU)

Perception of Indian Dental Students to Pursue Higher Education Abroad during COVID-19

ABSTRACT Objective: To evaluate Indian dental students' perception of seeking international dental higher education during COVID-19. Material and Methods: We conducted an online survey among the dental students. A self-administered questionnaire was prepared, which had information on country choice, reasons for the decision to study abroad, measures to be taken by the foreign universities because of COVID-19, the application's status, current plan, and opinions on exploring other possibilities. Results: Four hundred students constituted the final sample, out of which the majority were females (69.3%). Most of the students were not sure about their status in the application process (63%). The current plan to study abroad remained uncertain for almost half of the students (50.2%). Concerning the status of the application process, a significantly higher number of female students were "not sure" and are still "searching colleges" (p<0.001). Similarly, a higher number of females were "uncertain" or "postponed" or "canceled" when compared to the males concerning the current plan to study abroad (p=0.001). Also, a significantly higher proportion of female students cited the study budget as the main deterrent for pursuing a career abroad and opined that "flexible study options" will help them get admissions post-COVID-19 (p=0.001 and 0.035). Conclusion: A substantial impact was perceived by Indian dental students concerning higher education abroad, more among females.

Multiple myeloma presenting as acute tubulointerstitial nephritis

Background Acute tubulointerstitial nephritis (ATIN) is a very rare paraneoplastic manifestation in patients with multiple myeloma (MM). It is an uncommon pattern of renal disease in such patients. Case presentation We report a case of an 82-year-old male who was admitted with acute kidney injury. Renal biopsy showed typical findings of light chain-associated ATIN with scattered inflammatory cells in the interstitium and associated active tubulitis. No other common manifestations of MM were present at the time of presentation, including hypercalcemia, hyperuricemia, proteinuria, bone pain or lytic bone lesions. Subsequent immunoassays revealed significant serum lambda light chain burden and Bence Jones protein in urine. Immunofluorescence demonstrated linear tubular basement membranes with positive staining for lambda light chain (3+). Electron microscopy (EM) further showed interstitial edema and inflammation. All the aforementioned findings are consistent with ATIN and supported the diagnosis of MM. Conclusions In conclusion, light chain-associated ATIN should be considered in the differential diagnosis of acute interstitial nephritis. Henceforth, serum free light chains as well as serum and urine protein electrophoresis should be included in the workup of such patients.

Video modelling technique used to manage the behaviour of uncooperative children in a dental set up / Técnica de modelagem em vídeo usada no manejo de comportamento de crianças não cooperativas no consultório odontológico

Objective: To investigate if video modelling is an effective technique in behaviour modelling of a child in a dental set up. Material and Methods: Fifty children aged 4-6 years indicated for pulpectomy were enrolled in this study. They were selected based on their behaviour using Frankl behaviour rating scale. Children with Frankl behaviour rating 1 and 2 were selected for this study. The video of a child who was cooperative while undergoing pulpectomy was shown to these children. The behaviour was assessed using Frankl behaviour rating scale after the video was shown to the children included in the study. Results: There was a statistically significant difference in the behaviour rating score of the children before after the video of the cooperative child was shown to them. Conclusion: It was observed that video modelling is an effective technique in managing the behaviour of an uncooperative child in a dental set up. (AU)

Objetivo: Investigar se a modelagem em vídeo é uma técnica eficaz no manejo do comportamento de crianças no consultório odontológico. Material e Métodos: Cinquenta crianças, de 4 a 6 anos, indicadas para pulpectomia foram incluídas neste estudo. Elas foram selecionadas com base em seu comportamento utilizando a Escala de Classificação de Comportamento de Frankl. Crianças com classificação de comportamento Frankl 1 e 2 foram selecionadas para este estudo. O vídeo de uma criança que cooperou durante o procedimento de pulpectomia foi mostrado a essas crianças. Posteriormente, o comportamento das mesmas foi avaliado usando a Escala de Classificação de Comportamento de Frankl. Resultados: Houve uma diferença estatisticamente significativa na pontuação da classificação do comportamento das crianças antes e depois do vídeo da criança cooperativa ter sido mostrado a elas. Conclusão: Observou-se que a modelagem em vídeo é uma técnica eficaz no manejo do comportamento de uma criança não cooperativa em um ambiente odontológico (AU)

Laboratory biosafety measures in receiving, preparation and processing of pathology specimens in suspected and positive coronavirus infection

COVID-19, caused by SARS-CoV-2 virus which is declared as a pandemic by the WHO on March 2020 has made a huge difference in the practice and daily activities of the laboratory services. There are high chances of receiving potentially infectious samples to the laboratory for various tests. Authors propose a few biosafety measures in the preparation and processing of various pathology specimens received to the lab during this pandemic time in correlation with guidelines given by WHO. These safety measures aim at protecting and safe guarding the laboratory staff, trainees, and pathologists by minimizing the exposure to COVID-19.

Utility of lung ultrasound in childhood pneumonia in a tertiary care center

Background: Pneumonia is a major cause of childhood mortality and morbidity worldwide. Chest radiography has been used as a modality for diagnosing but has the disadvantage of radiation exposure and inter-observer variability. Hence studies have explored the possibility of using lung ultrasound in the diagnosis of pneumonia. To assess lung ultrasound (LUS) findings in childhood pneumonia and to correlate lung ultrasound findings with clinical findings.Methods: 210 children between 2 months to 5 years admitted in the hospital with diagnosis of pneumonia were enrolled in the study. They underwent LUS within 24 hours of admission and the results were analysed.Results: Out of the 210 patients enrolled in the study, 41 (19.5%) had positive LUS findings. However, LUS findings correlated well with clinical findings in cases with very severe pneumonia.Conclusions: This study showed that lung ultrasound cannot be used a sole diagnostic tool in childhood pneumonia, but it has a valuable role in detection of complications. Lung ultrasound will require more training for detection of early indicators of pneumonia.

Clinicopathological profile of rickettsial fever in tertiary healthcare centre: a prospective case study

Background: Rickettsia are obligate intracellular proteobacteria spread by eukaryotic vectors like ticks, mites, fleas and lice. Rickettsial infections are generally incapacitating and difficult to diagnose; Case fatality rates up to 45 percent is seen in cases with multiple organ dysfunction. The disease continues to be under diagnosed and treated. Objective of this study was to study the clinicopathological profile and outcome of children admitted with rickettsial fever. To study the correlation between Rathi-Goodman-Aghai score and Weil-Felix test. To study the response of rickettsial fever to Doxycycline.''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''Methods: This study is a prospective observational study conducted from December 2017 to April 2019 at a tertiary health care center in South India, involving patients admitted between 2 months to 18 years of age with a diagnosis of Rickettsial fever. Clinical data and investigations were collected and analysed. The response to doxycycline was recorded.'''''''''''''''''''''''''''''''''''''''''''''''' '''''''''Results: Total of 49 patients were enrolled in the study. Most common age group affected was between 1 to 5 years accounting for 32.7% of the cases. 78% of the patients hailed from rural background. Most common presentation being fever, present in 100% of the cases. 81.6% of patients had significant Rathi-Goodman-Aghai score of >14. Weil felix showed significant titres (1:80) in 97.9% out of which serology suggestive of scrub typhus was found in 79.6% patients. There was no statistical significance between rickettsial score and Weil-Felix test (p value= 0.736). 26.5% of the cases required respiratory support and 2% cases required dialysis. 10.2% cases succumbed and 89.8% cases improved.Conclusions: Rickettsial infection is re-emerging with propensity for life threatening complications. There is no statistical significant correlation between Rickettsial score and Weil Felix test. Early treatment has better outcome.

Analysis of serum leptin levels as a biomarker in metabolic syndrome in type 2 diabetic patients in Okhla industrial area

Background: Metabolic syndrome is a progressive disorder which includes a wide array of disorders i.e. central obesity, hypertension, dyslipidemia, hyperglycemia, and insulin resistance. In patients with metabolic syndrome there is an increased risk of mortality due to coronary heart disease, stroke, vascular dysfunction etc. Obesity is one of the most crucial epidemics of modern times and hormone leptin plays an important role in regulation of body weight and energy balance.Methods: A total of 355 individuals were selected from the OPD, Department of general medicine at ESIC hospital, Okhla and it comprised of 196 males and 159 females suffering from type 2 diabetes mellitus with metabolic syndrome. The data was collected over a year i.e. June 2018 to July 2019. After baseline clinical and anthropometric evaluation, Fasting Blood Sugar (FBS), Post Prandial Blood Sugar (PPBS), lipid profile, Insulin (fasting), and leptin levels of the patients were analyzed.Results: Blood sugar fasting, blood sugar post prandial, lipid profile, leptin and insulin levels were increased significantly in female patients as compared to male patients with type 2 diabetic patients and metabolic syndrome.Conclusions: Based on the study results, it was found that leptin correlate significantly with metabolic syndrome and could be used as a biomarker for the early detection of the disease.

A Clinical Study on NPSLE in a Tertiary Care Hospital in Northeast India

Introduction: Neuropsychiatric Systemic LupusErythematosus (NPSLE) is a disease with central andperipheral nervous system manifestations. The diagnosis ofNPSLE is often a diagnostic challenge though the criteria forNPSLE is well-established.Objective: To study the prevalence and pattern ofneuropsychiatric manifestations in SLE.Materials and Methods: This hospital based observationalstudy was carried out from Nov 2017 to June 2018. A total of58 cases of SLE were assessed clinically and investigatedaccordingly. Special emphasis was given to look forNeurological involvement. MMSE, HAM A and HAM D scaleswere used for assessment of cognitive dysfunction, anxiety anddepression respectively. The disease activity was measured bythe SLEDAI.Results: In a total of 58 patients with SLE evaluated, 92%were female. The most common age group was 21 to 30 years.Mean age was 25.6 years. Nervous system involvement wasfound in 37 (63.79%) patients. Headache was the mostfrequent manifestation, present in 32 (55.17%) patientsfollowed by Cognitive dysfunction in 8 patients (13.79%).Seizure disorder was present in 6 (10.34%), acute confusionalstate in 2 (3.44%), depression in 4 (6.89%), anxiety in 2(3.44%) and psychosis in 2 (26.31%) patients. Asepticmeningitis and peripheral neuropathy was found in 2 (3.44%)and 1 (1.72%) patients respectively. Many of the patients hadmore than one neurological involvement. SLEDAI score washigh in SLE patients with neurological manifestations.Conclusion: The frequency of Neuropsychiatric involvementwas found in the majority of the patients with SLE andheadache was the most common manifestation. Patients withNPSLE showed high disease activity.

Gynecological problems and reproductive health awareness amongst late adolescent girls pursuing professional courses: a questionnaire based survey

Background: Dysmenorrhoeais a debilitating menstrual problem and may be related to body mass index (BMI). This study was done to explore the various gynecological problems in girls in their late adolescence that is pursuing professional courses in medicine, dental and nursing.Methods: This was a prospective, questionnaire based study conducted between January and February 2019 in a medical college in Visakhapatnam, India. The survey included female undergraduate students of the Medical, Dental and Nursing colleges to find out their menstrual history and reproductive awareness with the help of a self-structured questionnaire. Participants were categorized based on BMI. Data was reported as number and percentage.Results: Of the 190 participants, 154 participants (age range; 16-19 years) were included in the study. Fifty percent of the total participants reported to have dysmenorrhoea, of which 21% reported severe dysmenorrhoea. A very high % of participants in the obese category (77.8%) reported severe dysmenorrhoea, followed by 27.3% in the underweight category. A U-shaped relationship between percentage of participants with severe dysmenorrhoea and increasing BMI was observed. A fair percentage of obese participants reported for infrequent periods beyond 35-45 days and androgenic features like excess hair, acne and dark pigmentation around neck, suggestive of polycystic ovarian syndrome (PCOS). The participants possessed a high level of awareness and reported in the range of 87.1 to 96.8% related to reproductive health.Conclusions: Despite high level of awareness among the participants we observed a considerably high prevalence of dysmenorrhoea which was even more prevalent, in the obese category.

A Hospital Based Observational Study on Clinical Profile of Hyponatremia in Elderly

Introduction: Hyponatremia, which is defined as a plasmasodium concentration less than (<) 135mmol/L, is a verycommon disorder and can occur in up to 22% of hospitalisedpatients. Its prevalence among non-hospitalised elderlypatients has been estimated to be between 7% to 11.4%,increasing to 11% to 22.5% among the hospitalised patients. Itis also the most common dyselectrolytemia seen in thegeriatric population which occurs due to impaired water andelectrolytes balance in response to diet, drugs andenvironmental changes.Aims and Objectives: The aims of the study were to describethe clinical features and different causes of hyponatremia inhospitalised elderly patients and to find out the types ofhyponatremia and to assess the short term outcomes duringhospital stay.Methods and Materials: The study was a hospital basedobservational study conducted in Medicine Department andGeriatric Regional Centre, Gauhati Medical College andHospital, Guwahati for a period of one year from August 2017to September 2018. Ethical clearance was obtained from theethical committee. A total of 106 patients with hyponatremiawere included in the study with aged greater than or equal to(≥) 60 years.Results and Observations: The mean age was 70.04 yearswith a standard deviation of 6.73 years. Male and Female ratiowas 1: 1.12. The mean serum sodium level was 124.8 mmol/Lwith a standard deviation of 5.8 mmol/L. Altered sensorium (48cases, 45.3%) was the most common presenting symptomfollowed by lethargy (21 cases ,19.8%). The most commonetiology was found to be SIADH (32 cases, 30.2%) followed byrenal failure (19 cases, 18%) and intake of drugs like diuretics(18 cases, 17%). Among SIADH majority of the cases werefound to have pneumonia (12 cases, 37.5%) followed by stroke(9 cases, 28.1%) and brain infections like meningitis andencephalitis (5 cases, 15.6%). In hyponatremia, majority of thecases was found to be in euvolemic status (55 cases, 51.9%).The overall mortality of hyponatremic patients was 8.5%. Shortterm outcomes in patients with comorbid condition like chronickidney disease was found to be significantly higher (pvalue=0.0396).Conclusion: Hyponatremia is a very common dyseletrolytemiaand clinical problem encountered in the elderly population andis associated with high morbidity and mortality particularlywhen associated with comorbidities.

Nutritional status and common morbidities among school-going adolescents of rural areas of Vadodara, Gujarat: a cross sectional study

Background: Abnormal nutritional status i.e. underweight, overweight and obesity is increasing rapidly amongst adolescents irrespective of socioeconomic status and geography. This study was carried out to assess prevalence of abnormal nutritional status and common associated morbidities among school going adolescent of rural areas of Vadodara, Gujarat, India.Methods: A cross sectional observational study was done among school going adolescents of rural areas of Vadodara, Gujarat. A predesigned and pretested semi-structured proforma was used to get relevant clinical details of study participants. Total 474 students aged 12-17 years participated in our study.Results: Out of 474 enrolled adolescents, 16.67% were underweight, where as 3.8% and 2.95% were obese and overweight respectively. The prevalence of overweight and obesity were almost similar in both genders. Out of total 16.24% were stunted with predominance in boys compared to girls (p value: 0.039). Hypertension was found in 5.0% of participants with 3 times more prevalent in girls than boys (p value 0.011). Similarly, anemia was affecting both genders equally.Conclusions: Although underweight is a known nutritional problem of adolescents from rural areas, overweight and obesity are also rapidly growing health issues among them now a days. With keeping in mind this increasing burden of abnormal nutritional status and associated morbidities, regular health check-up, education of parents and adolescents on healthy lifestyle and inclusion of adolescents in existing government programmes are essential measures to reduce these problems.

Effect of Antiepileptic Drugs on Liver Function Tests and Lipid Profile in Paediatric Age Group in Okhla Industrial Area

Epilepsy is the fourth most common neurological disease and affects people of all ages. There are 150,000 new cases of epilepsy every year.The highest incidence of epilepsy in children coupled with the need of long-term antiepileptic treatment could lead to alterations in haemato-biochemical parameters at an early age. Phenytoin and valproic acid are commonly used antiepileptic drugs in children. This study was aimed to assess the serum lipid profile and liver function tests in children with epilepsy on phenytoin or valproic acid monotherapy for 6 months and their control counterparts. Methods: This case control study recruited children from the pediatric outpatient department of Esic Hospital, Okhla. All consecutive children diagnosed with epilepsy as per International League against Epilepsy definition on phenytoin or valproic acid monotherapy for 6 months were enrolled along with the percentage distribution of type of seizures they were suffering. After baseline clinical and anthropometric evaluation (including body mass index [BMI]), the fasting blood samples were analyzed for serum lipid profile and liver function changes. Results: Total of 133 children were enrolled. There were 42 and 36 patients in phenytoin and valproic acid groups respectively and 55 in normal healthy control group. We observed statistically significant high mean total cholesterol and alkaline phosphatase levels in group receiving phenytoin when compared with valproic acid or control group. Conclusion: The lipid and liver enzyme abnormalities may be observed in children on phenytoin or valproic acid therapy, which warrants careful screening and monitoring as young children have immature detoxification mechanisms and a greater variability in dosing owing to a wider range of body size and weight. New epilepsy research should be integrated in areas i.e. Genomics, neuroimaging, neuropsychology and neuropathology for better understanding of the disease and to improve the global health outcomes.