Background and Objectives: The determination of sex in forensic investigation is an important and crucial step. Unidentifiable crania are very common due to warfare, mass disasters, intentional attempt to obscure facial identity in criminal attacks, or physical injury caused by weapons, explosives, or fire. In such a situation, the determination of sex becomes extremely complicated and challenging. Aim: The present study was undertaken to provide data on foramen magnum and occipital condyle (OC) for the purpose of sex determination for establishing the identity in cases of unknown fragmentary skulls. Settings and Design: Retrospective. Subjects and Methods: The study group included computed tomography scan images of 200 patients (100 males and 100 females) in the age range of 21-80 years fulfilling the inclusion and exclusion criteria. Seven variables were used to measure the dimensions of foramen magnum and OC. Statistical Analysis Used: Descriptive statistics, discriminate analysis, and unpaired t-test. Results: Significant differences were observed in all the metric variables in male and female population. The dimensions of foramen magnum and OC were significantly larger in male population. Discriminant function analysis revealed an accuracy of 94% (91% in male and 97% in female population). Conclusion: The dimensions of foramen magnum and OC can be accurately used for sex determination thus opening avenues for new research in the field of anthropology and forensic sciences.

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The hard palate is one of the common sites of local complications following administration of local anesthetics. The hard, unyielding palatal tissues coupled with either forceful or excessive administration of solution, induction of trauma, use of contaminated solutions, or reactivation of latent viruses may present or aggravate local complications in the palatal area. Ulceration and necrosis is unusual and a rare complication of local anesthesia. Presented is such an uncommon case in a 16-year-old girl.

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Introduction: The recent years have witnessed a substance abuse epidemic with serious health, social, economic, and political repercussions. Initially, a problem of the developed countries, but now has assumed alarming dimensions even in developing countries. India too has been caught in this vicious circle of substance abuse. Materials and Methods: Six hundred adolescents of age group between 10 and 19 years in the area of UHC Ram Nagar and Rukmini Nagar were interviewed with the help of predesigned and pretested questionnaire. Data were analyzed using SPSS version 20. Results: Out of 600 participants, 505 were males and 95 were females. The prevalence of substance use was found to be 71 (11.8%), with females having the highest prevalence (17.9%) than males (10.7%). Smokeless form of tobacco (78.87%) being the most common substance use followed by smoke form of tobacco (15.49%) and least (2.82%) with alcohol and ganja. Conclusion: Smokeless form of tobacco and smoke form being the most common form of substance abuse among adolescents in urban slum. Females had a higher prevalence of substance use than males.

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Chromobacterium violaceum is an opportunistic pathogen in humans. Nearly 150 cases have been reported worldwide. The usual presentation is with an initial localized skin lesion and progression to multiple liver and lung abscesses and finally fatal septicemia. Progression is usually seen in immunocompromised individuals or when appropriate antimicrobial therapy was delayed. Mortality ranges up to 60% if not promptly treated. A 73-year-old male presented with febrile urinary tract infection (UTI). His urine culture grew C. violaceum. Neither was he immunocompromised nor was he having any risk factor for this infection. He was not admitted in any hospital in the recent past. He did not have any urological intervention in the past. He was treated successfully with culture sensitive antibiotics. He responded well and he continues to be asymptomatic at 6 months of follow-up. The incidence of UTI by C. violaceum is on the rise. Only three cases of UTI caused by C. violaceum have been reported so far worldwide. This is the second case of symptomatic UTI caused by C. violaceum from the Indian subcontinent. The early recognition of this infection and prompt treatment with appropriate antibiotic go a long way in the prevention of sepsis and its associated morbidity.

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Introduction: Population explosion is one of the most hazards to the development of India. The most effective way to control this is by reducing birth rate using contraception. Objective: To know the prevalence of contraceptive use among married women. Methodology: Community-based cross-sectional study was conducted among married women aged 15-44 years residing in three urban areas of Belagavi using predesigned and pretested questionnaire after obtaining informed consent. Results: The prevalence of contraceptive use in the present study was 353 (58.8%), among them 96 (16.0%) were condom user, 113 (18.9%) were using intrauterine device, 26 (4.3%) were practicing rhythm method, 20 (3.3%) of them were using oral contraceptive pill, and 98 (16.3%) were practicing sterilization method. Conclusion: Prevalence rate of contraceptive use was relatively less. Improving female literacy and proper counseling of couples for family planning would help improve the prevalence rate.

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Introduction: Creatinine and urea are nonprotein nitrogenous compounds which are eliminated from the body. Creatinine is a word obtained from a Greek term "Kreas" meaning flesh. An anhydrous form of creatine is creatinine. Around 0.5% of total muscle weight constitutes creatine. Muscle, brain, blood, etc., are the tissues, in which creatinine is present as high-energy compound, phosphocreatine, and creatine as free compound. Optimal storage of serum specimens in biobanks for long time for multicenter reference interval studies remains to be determined. Hence, in this context, the present study was undertaken to determine the effect of storage time and temperature on the laboratory results of urea and creatinine in pooled serum samples. Objective: To determine the effect of storage and temperature on two biochemical analytes (creatinine and urea) in pooled serum samples stored at ­20°C. Materials and Methods: The study comprised ten pooled serum samples. Each pooled serum sample was prepared by mixing ten individual serum samples. The serum samples were used for the estimation of effect of storage and temperature on two biochemical analytes (creatinine and urea) in pooled serum samples stored at ­20°C in semi-automated analyzer by kit method. Results: The results of the present study on creatinine concentration were found to increase above the normal levels in ten pooled serum samples after storage for 10 days at ­20°C. Concentration of urea was found to increase above the normal levels (>20-40 mg/dL) in two samples out of ten, whereas other eight samples were found to be within the normal range. Conclusion: The levels of creatinine were affected due to storage at ­20°C for 10 days. However, urea retained its stability when stored at ­20°C for 10 days. Thus, to ensure valid results, the samples should be analyzed within 24 h of collection.

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Introduction: Dengue is an underestimated and under-reported disease. We have analyzed the last 15 years data of dengue reported in Rajasthan with special reference to the year 2015 to assess the trends. Materials and Methods: This observational, descriptive study was conducted during January 2016-August 2016. Secondary data were collected from Integrated Disease Surveillance Programme (IDSP) Cell, Directorate, Medical and Health, Jaipur, the website of National Vector Borne Disease Control Programme, Census 2011. Reports of P form and L form and line listing of dengue cases of 2015 were collected. Results: Rajasthan had 1452 laboratory-confirmed cases in 2001 and 1850 in 2006 after a gap of 6 years. The next surge came only after 3 years gap. Recently, there was a fourfold increase (>4000 cases/year) during 2013 and 2015. There were substantial dengue deaths till 2009, but thereafter, it never crossed the figure of 10. Surprisingly five districts, i.e., Bhilwara, Chittorgarh, Jhalawar, Pali, and Sirohi, did not report a single case of dengue during 2015. There was fourfold increase in dengue cases but paradoxically fourfold decrease in malaria cases in the last 5 years. Conclusion: Dengue was the new emerging disease with 1452 confirmed cases in Rajasthan in 2001. Thereafter, there was a constant high load of dengue; however, case-fatality rate is below one after 2010. Recently, there was a fourfold increase (>4000 cases/year) during 2013 and 2015. Zero reporting of dengue in a few districts indicates the need for improvement in IDSP reporting in these districts.

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Context: Extracorporeal shock wave lithotripsy (ESWL) commonly used procedure for treating upper urinary tract stones may result in acute kidney injury (AKI) with release of biomarkers. Association of plasma total homocysteine (tHCy), serum high-sensitivity C-reactive protein (hs-CRP), and serum creatinine with renal dysfunction and their role as acute renal injury markers is to be assessed. Aim: The study aims to assess plasma tHCy as a marker of AKI in patients undergoing ESWL for renal stone disease and compare the same with other markers, i.e., serum creatinine and serum hs-CRP. Setting and Design: One-year cross-sectional study at a tertiary care teaching hospital. Subjects and Methods: Sixty-four patients undergoing ESWL for renal stone disease were investigated for plasma tHCy, serum creatinine, and serum hs-CRP 24 h before and after ESWL procedure. Patients were divided into AKI and non-AKI group. Statistical Analysis: SPSS statistical software, rates, ratios, percentages, and mean ± standard deviation. A P ͳ 0.05 at 95% confidence interval was considered as statistically significant. Results: Following ESWL, AKI developed in 56.25% of the patients. Post-ESWL mean plasma tHCy levels were significantly high in patients with AKI (21.01 ± 7.67 vs. 16.93 ± 7.44 μmol/L; P = 0.036) compared to those who did not develop AKI. The post-ESWL mean serum creatinine levels and mean change were significantly high in patients with AKI. The post-ESWL mean serum hs-CRP levels were comparable in patients with AKI and those who did not develop AKI. However, 72.22% of the patients with AKI had significant rise of serum hs-CRP (≥2-fold of baseline) level following ESWL which was the only insult on kidney in 24 h. Conclusion: Plasma tHcy, Serum hs-CRP, and Serum creatinine can be used as acute renal injury markers following ESWL in patients with renal stone disease.

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We present two case reports of twin reversed arterial perfusion sequence - a rare type of twin-twin transfusion syndrome, wherein there maldevelopment of one twin and is supplied by the normal twin. Then, we discuss the importance of this entity and various measures required if such a situation is encountered.

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Context: Dental ceramics are the most natural appearing replacement material for missing tooth substance available in a range of shades and translucencies to achieve a life-like result. Ceramic restorations are fabricated with porcelain layers of different opacity, shade, and thickness to provide a natural appearance. Since the ceramic layer thickness is important for shade development, utmost precision and control are required for a predictable and reproducible result. Shade guides provided by various companies are of 2.5 mm thickness, but clinically all-ceramic crown restoration requires a maximum thickness of 1.5 mm. Aim: The purpose of this study was to evaluate the shade of clinical ceramic restorations with dental shade guide by two distinct observer population. Materials and Methods: A total of 400 individuals aged 23-45 years participated in this observational study. Two hundred were dental professionals (DPs) and other 200 were nonprofessionals (NPs), a random passerby in the vicinity of the dental school. Evaluation was done between a shade guide and ceramic restorations of thickness 1.5 mm. For visual evaluation, observers were asked to take one shade tab from a box containing eight shades and to select the matching clinical ceramic restoration, and a number of correctly matched shades were recorded. Same experiment was repeated after 1 month for half of the observers. For instrumental evaluation, spectrophotometer was used, and three readings were taken per sample. Results: The results from the present study showed that there was a significant difference for number of correct shades matched by two observer groups. Percentage of correctly matched shades by instrumental evaluation was 37%. Good visual-instrumental shade agreement was observed. Conclusions: The present study concluded that there was significant difference for number of correct shades matched by two observer groups - DP and NP. Good visual-instrumental agreement was found.

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Background: Cardiovascular disease is a major cause of mortality in chronic obstructive pulmonary disease (COPD), particularly in patients with mild to moderate severity. Microalbuminuria (MAB) has a strong association with cardiovascular events and death, and it reflects generalized endothelial dysfunction. There is evidence of vascular dysfunction in patients with COPD. Objectives: (a) To study the prevalence of MAB in stable COPD patients. (b) To determine the relationship of MAB with clinical and physiological descriptors of COPD severity and cardiovascular risk factors. Materials and Methods: A cross-sectional study in 150 COPD patients over a period of 1 year. Lung function, 6-min walk distance, smoking history, arterial blood pressure (BP), BODE index, and arterial blood gases were measured. Screening for MAB was done by measuring urinary albumin-to-creatinine ratio in a random spot urine collection. Stepwise logistic regression was performed using MAB as the dependent variable. P < 0.05 was taken as statistically significant. Results: Forty-six patients (30.0%) had MAB. There was negative association between hypoxemia and MAB. Stepwise logistic regression analysis with MAB as the dependent variable showed smoking (odds ratio [OR]: 2.29; 95% confidence interval [CI]: 1.54-3.41), lower forced expiratory volume in 1 s % (OR: 1.04; 95% CI: 0.98-1.10), and PaO₂ (OR: 0.68; 95% CI: 0.57-0.83) as independent predictors of MAB. Conclusions: MAB in severe COPD patients should be examined in regular periods for risk of cardiovascular morbidity or mortality.

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Introduction: Stroke is the leading cause of mortality and morbidity worldwide. Diabetes mellitus (DM) is most commonly associated with the acute stroke. Abnormalities in serum albumin are known to occur in acute stroke patients. Ischemia-modified albumin (IMA) is a novel marker of acute stroke and hence, it is important to know the factors affecting IMA estimation. The objective of this study was to find out the correlation between serum albumin and IMA in acute stroke with or without DM. Subjects and Methods: This cross-sectional study comprised sixty acute stroke patients (thirty with DM, thirty without DM) and thirty healthy controls. The blood sample was collected from the patients soon after the clinical diagnosis of stroke. IMA and albumin were measured. IMA concentration was expressed in absorbance units. Pearson's correlation coefficient was estimated. Results: In stroke with DM (r = ­0.103, P = 0.58) and control (r = ­0.007, P = 0.96) groups, there was a negative correlation between IMA and serum albumin which was statistically not significant. In stroke without DM group, there was a positive correlation between IMA and serum albumin which was again statistically insignificant (r = 0.111, P = 0.56). Discussion and Conclusion: There was no statistically significant correlation between IMA and serum albumin levels in all the three groups. Hence, it can be concluded that IMA concentration is independent of serum albumin concentration and probably, it depends on the severity and duration of ischemia or oxidative stress in acute stroke patients.

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Background: Mothers and children are one of the most vulnerable or special risk groups, and the risk for this group is associated with pregnancy, childbirth, and also in postnatal period. A number of demand generation schemes have been launched by the Government of India for the welfare of the pregnant women, but still a significant reduction in maternal mortality and morbidity has not been achieved yet. Objective: To assess the awareness of various demand generation schemes among pregnant women. Methodology: A community-based cross-sectional study was done among 540 pregnant women in Primary Health Centre area of Handiganur, Belagavi. Results: Among 540 study participants, 373 (69.1%) participants knew about Prasuthi Araike, 206 (38.1%) participants knew about Janani Suraksha Yojana, 396 (73.3%) knew about Madilu kit, and only 104 (19.3%) knew about Thayi Bhagya Plus. Conclusion: The awareness about demand generation schemes is very high, which has successfully promoted women's preference to institutional deliveries.

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Background and Objectives: Severe asthma seen in substantial proportion of patients has been a poorly controlled disease, with recurring symptoms and exacerbations despite the use of inhaled glucocorticoids (ICS), long-acting beta-agonists (LABAs-2), leukotriene receptor antagonist (LTRA), and theophyllines. A potential alternative approach is addition of a second bronchodilator with an alternative mode of action, the anticholinergic tiotropium bromide. Hence, the present study was undertaken to evaluate clinical effectiveness of tiotropium bromide 18 mcg as add-on therapy in severe asthma patients. Methodology: A single-blinded randomized study was carried in patients with severe asthma. The patients were randomized into two groups. The study group received an addition of 18 mcg of tiotropium while both groups were continued on LABA and high dose ICS combination, theophyllines, and LTRA. Improvement in lung function (forced expiratory volume in 1 s [FEV1], forced vital capacity [FVC], and peak expiratory flow rate [PEFR]), clinical symptoms, and quality of life were assessed by mini asthma quality of life questionnaire (mini-AQLQ) at 4, 8, and 12 weeks. Results: Seventy patients were included in the study, of which 63 completed the study period. Baseline characteristics were well matched between the groups. At the end of 12 weeks, the tiotropium group showed a mean improvement in FEV1 and FVC of 450 ml and 560 ml, respectively, as compared to the control group (P < 0.0001). PEFR showed mean difference of 16.8 L/min in the study group at the end of 12 weeks as compared to the control group and it was statistically significant (P < 0.0001). Quality of life as assessed by mini-AQLQ was statistically significant in study group as compared to control group (3.42 vs. 3.07; P < 0.0001). In study group, about 21 patients (65.62%) had no exacerbations compared to eight patients (25.8%) in the control group (P = 0.045). Conclusions: The addition of once-daily tiotropium to severe asthma treatment regimen including high-dose ICS plus LABA, theophyllines, and LTRA significantly improves lung functions and quality of life over 12 weeks of therapy.

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Aim and Objective: The main objective of this research was to formulate and evaluate gastroretentive-floating multiparticulate system of lisinopril to prolong the gastric residence time. Materials and Methods: Gastroretentive system of lisinopril was developed by ionotropic-gelation technique using isabgol (Plantago ovata F.) husk mucilage (IHM) as a floating agent, sodium alginate as a mucoadhesive polymer, and sodium bicarbonate as a gas-generating agent. Results: The beads were evaluated for entrapment efficiency (EE), in vitro drug release, and ex vivo mucoadhesion. The beads of batch F-2 exhibited high-EE (96.04 ± 0.74%), complete drug release (95.27 ± 0.12%), and good mucoadhesion (50% in 8 h). The in vitro drug release from these beads exhibited first-order kinetics that followed Higuchi diffusion model. Conclusion: The beads by virtue of the high EE, complete drug release, and good mucoadhesivity that exhibit prolonged gastric residence time are likely to improve the bioavailability of the drugs having the absorption window in proximal stomach.

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Background: In Okelele, Ilorin, Kwara State, Nigeria, malaria remains an important public health concern with a little information about its prevalence. Objective: To determine the prevalence of malaria infection at Okelele Health Centre, Okelele, Ilorin. Methodology: A cross-sectional descriptive study in which patients were diagnosed clinically with severe or uncomplicated malaria at the study site was conducted. Rapid diagnostic testing (RDT) for malaria and microscopy using Giemsa staining by thick and thin blood smears were done for study patients. Results: In this study, 200 malaria patients attending Okelele Health Centre, Okelele, Ilorin, were tested for malaria infection, with females having the highest prevalence rates and parasitemia density. The highest positivity rates were found in children <6 years while adolescents had the lowest prevalence rates. Socioeconomic factors of patients such as occupation and education played a major role in malaria prevalence. Conclusion: Although RDT is quick and easy to use, negative malaria cases gotten by RDT should be confirmed by expert microscopy to prevent misdiagnosis of malaria.

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Title: A prospective randomised clinical trial for comparison of two techniques of insertion of proseal laryngeal mask airway in adults - index finger insertion technique versus 90 degree rotational technique. Introduction: ProSeal laryngeal mask airway is not easy to be inserted due to its larger cuff especially in Indian population.The 90 degrees rotation technique for inserting the PLMA is reported to be better than the standard index finger insertion technique to improve the insertion success rate. The objective of this study was to evaluate and compare the ease of insertion through the rotational and standard insertion technique in terms of number of attempts, duration of insertion and occurrence of complications. Methods: 120 adult patients were allocated to either a standard technique or a rotation technique group with 60 patients in each group. In the rotation technique group the entire cuff of the PLMA was placed in the patient's mouth in a midline approach without finger insertion, rotated 90 degrees counter clockwise around the patient's tongue, advanced and then rotated back until resistance was felt. The outcomes measured were success rate at first insertion, insertion time, haemodynamic changes and complications. Results: For the rotation technique group the success rate at first insertion was greater (98% vs 78%, respectively; P = 0.001), and less time for insertion was required (11.88 +/- 3.62 sec vs 25.98 +/- 10.92 sec, respectively; P <0.0001). Changes in haemodynamic parameters were not clinically significant. Conclusion: The 90 degrees rotation technique for inserting the PLMA has a higher success rate at first insertion than the standard index finger insertion technique with lesser insertion time and fewer side effects.

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Context: Health of the child depends directly on the environment and state of the fetus in intrauterine life. Supplementing Rasayana (rejuvenating and immunomodulatory) drugs in a Garbhini (pregnant women) provides positive maternal environment which helps the fetus to avoid or overcome diseases. Integrating Rasayana therapy in Garbhini Paricharya (antenatal care) not only benefits the pregnant lady but also the growing fetus in her womb. Aim: The aim of this study was to evaluate the efficacy of Rasayana Avaleha (RA) (Rasayana electuary) on fetal growth and development and its influence on fetal immune system. Setting and Design: Pregnant women fulfilling the inclusion criteria were selected from outpatient department of SDM Ayurveda Hospital, Udupi, Karnataka, for the study. The study was a randomized comparative clinical trial. Subjects and Methods: Trial group (n = 15) was administered RA 12 g twice a day with Ksheera (milk) as Anupana (adjuvant) in the 6 ^th and 7 ^th month of pregnancy. Control group (n = 15) was given calcium carbonate 500 mg and ferrous sulfate 200 mg once in a day during 6 ^th and 7 ^th month. Statistical Analysis: Paired t-test was used to compare within the group and unpaired t-test to compare between two groups. Results: With the overall effect of the study, fetus of the Rasayana group showed statistically significant increase in the ultrasonography parameters biparietal diameter and estimated fetal birth weight. Significant results were also seen in fetal birth weight and fetal immunoglobulin G when compared to control group. Conclusion: Administering RA in Garbhini (pregnancy) acts as a complete micronutrient providing positive effect on the fetal growth and nourishment and also in enhancing the fetal immunity level.

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Background and Objectives: The present study was undertaken to compare the glottic view during intubation using Airtraq and Macintosh laryngoscopes in adult patients undergoing surgeries under general anesthesia with a simulated cervical spine immobilization. Methods: This 1-year randomized clinical study was conducted between January 2015 and December 2015 on 60 American Society of Anesthesiologists Grade I and II patients of either gender, aged between 18 and 60 years. The study population was randomly divided into two groups. Group A (n = 30): intubation performed using Airtraq laryngoscope. Group L (n = 30): intubation performed using Macintosh laryngoscope. Results: In the present study, 76.67% of patients in Group A had a Cormack-Lehane Grade 1 view of glottis compared to 13.33% in Group L. While most of the patients (56.67%) in Group L had Cormack-Lehane Grade 2 view of glottis compared to 23.33% in patients of Group A. Thus, Airtraq laryngoscope had better Cormack-Lehane grade of glottic view with P = 0.001. It was observed in our study that the mean heart rate, mean systolic blood pressure, mean diastolic blood pressure, and mean arterial pressure were higher in Group L compared to Group A at 1 min, 3 min, and 5 min intervals. Conclusion: These findings suggest that tracheal intubation with Airtraq offers better view of glottis with minimal changes in hemodynamic parameters in patients with a simulated cervical spine immobilization compared to Macintosh laryngoscope.

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