Abstract: Several new biochemical and hematological parameters are available to diagnose and monitor alcoholic liver disease (ALD), but none are independently sufficient for the purpose. Serum enzymes - Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), Alkaline phosphatase (ALP), Gamma glutamyl transferase (GGT) and AST:ALT ratio (De Ritis Ratio) are conventionally used as markers for diagnosis, treatment, prognosis and monitoring of ALD, based on their correlation with values before and after treatment or abstinence from alcohol intake. We wanted to establish the utility and affordability of estimation of these serum enzymes in ALD. To assess the levels and analyse the costs of estimation of conventional serum liver enzymes in ALD. After IEC clearance, this hospital based study was carried out on 30 male patients of diagnosed ALD and 30 normal control (non-alcoholic, healthy male) subjects between 18-65 years without history of liver disease, HIV, upper gastrointestinal bleeding, shock and/or ischemia to the liver, hepatotoxic medication use or exposure to high levels of environmental hepatotoxins, renal disorders, diabetes mellitus, hypertension. Serum AST, ALT, ALP, GGT levels were estimated using commercially available Roche diagnostic kits and fully automated biochemistry analyser (eCOBAS 6000 c501, Roche). Enzyme levels were expressed as Mean ± SD in IU/ml. Statistical analysis of differences in Means was done with Unpaired Student’s ‘t’ test, using GraphPad Quickcalcs online software, considering significance level as P < 0.05 at 95% confidence interval. Cost calculation of all the tests was done. Serum AST, ALT, ALP, GGT levels were highly significantly raised in ALD patients compared to healthy controls. De Ritis ratio was greater than 2 in 70% ALD patients. Cost calculation revealed that each patient had to pay a total of Rs 80/- for the tests. Conventional serum liver enzyme estimation and calculation of De Ritis ratio are useful and affordable diagnostic and prognostic markers in ALD.

Tuberculosis, inspite of advances in diagnosis and therapeutics still continues to be the leading cause of mortality and morbidity in many developing countries even today. It is one of the major killer infectious disease. In recent years, two important factors which heavily complicate the treatment outcome of tuberculosis patients are MDR-TB and XDR-TB.The mortality in Tuberculosis mainly due to delay in diagnosis. India has the highest TB burden accounting for 1/5 th of Global incidence. The most common form of TB is pulmonary tuberculosis. The sputum microscopy and culture both of them are backbone for the diagnosis of Tuberculosis. The present study aimed to compare and evaluate the of Trisodium Phosphate solution as sputum concentration technique by smear microscopy (Zeihl Neelsen Technique), to compare the smear microscopy. Sputum samples of suspected 150 cases of pulmonary tuberculosis attending Thoracic Medicine and General Medicine OPD at Thanjavur Medical College, (Tamil Nadu) were collected and processed for smear microcopy. Among the 150 sputum samples, AFB positivity in unconcentrated sputum microscopy by Zeihl Neelsen Technique-33(22%),AFB positivity in concentrated sputum microscopy by Zeihl Neelsen Technique-37(25%).The present study confirms that the importance of Trisodium Phosphate solution for sputum concentration technique for the smear microscopy by Zeihl Neelsen Technique.

Thyroid Dysfunction (TD) and Diabetes Mellitus (DM) are often found associated in the same patient and TD may affect the metabolic control of DM. TD is more prevalent in diabetics than in general population. The current study investigates the prevalence of TD in patients with DM, and explores its correlation with age, sex, type and duration of DM, and glycemic control (HbA1c levels). This was an observational, cross-sectional study of 212 patients with DM. All patients had undergone routine clinical and laboratory evaluations as per the standard clinical care. Medical data was collected and analyzed using Epi Info V3.5.4. Among the 212 DM patients evaluated, the overall prevalence of TD was 24.52%. The overall prevalence of TD was less in type-2 DM (T2DM; 24.46%) as compared to type-1 DM (T1DM; 37.5%); and slightly more in females (31.94%) as compared to males (28.65%). The prevalence of TD was high in the middle age (41-60 years) group (52.17%) as compared to other age groups. Subclinical hypothyroidism (SCH) was the most common type of TD (11.79%) with maximum prevalence (50%) in T2DM. Patients with DM reported a high prevalence rate of 24.52% for TD. Patients between 41-60 years of age had higher prevalence of TD. Prevalence was slightly more in more in females as compared to males. Our data suggests for screening of DM patients for risk of TD that might be helpful in secondary and primary prevention and possible better metabolic control

Mesenchymal hamartoma of liver is the second most common benign liver tumor in children after hepatoblastoma. First described in 2006 as multicystic biliary hamartoma, it generally presents as large multicystic mass in less than three years of age.We report one such case in a 3 year old male child who came with history of fever and rash and was incidentally diagnosed with a cystic mass in the liver. Partial hepatectomy was done which on microscopy revealed epithelial structures in loose connective tissue stroma along with cystically dilated spaces lined by columnar and flattened epithelial cells, typical of Mesenchymal Hamartoma of liver. We are presenting this case because of its rarity.

In this correlational study, 54 MA students were selected out of 68 initial participants majoring in TEFL at Khatam ol-Anbia University, Tehran, Iran. The homogeneity of participants was calculated through administration The Cambridge Proficiency Test. Then, participants took a motivation test. After that, a topic was given to them to write an essay. All important parts of essay including thesis statement, body paragraphs, conclusion, outlining, and coherence was already taught to the participants. In addition, they were asked to read their own writing and score based on Writing Scoring Rubric modified. In order to avoid subjective rating and ensure the intra- rater reliability of the assessment, these writing samples were scored twice based on the same scale that the students utilized in self-assessment. The results revealed that there was not statistically significant relationship between motivation and students` self-assessment. Moreover, the relationship between self-assessment and teacher’s rating of students` writing ability was statistically significant. The findings have some implications for language teaching and assessment.

β-Lactam antibiotics are commonly used to treat bacterial infections. Increased use of antibiotics, particularly the third generation of cephalosporins, has been associated with the emergence of ESBL producing bacteria, most commonly in E. coli. And Klebsiella pneumonia. Infection due to ESBL producers range from uncomplicated urinary tract infection to life threatening sepsis. This study was undertaken to assess the prevalence of ESBL producing E.coli and Klebsiella isolates. Patients taking treatment in P.D.U. Hospital and Medical College, Rajkot- a tertiary care hospital in Gujarat, India, were included in study. During the half year period from July 2014 to December 2014, a total of 600 E. coli and Klebsiella isolates from various clinical specimens were included in the study. The isolated organisms of E. coli and Klebsiella were characterized for their production of ESBL. Out of 600 E. coli and Klebsiella isolate, E. coli were 224 (37.3% and Klebsiella spp. 376 (62.7%). The overall rate of production of ESBL (by phenotypic confirmatory test with double disc diffusion method) in total isolates of E. coli and Klebsiella spp. is 22.5% (135/600). The rate of production of ESBL in E. coli is 29.9% (67/224) and in Klebsiella spp. is 18.1% (68/376). ESBL producing E. coli and Klebsiella showed high prevalence in present study. Routine laboratory testing for ESBL is needed in order to optimize antibiotic management to reduce ESBL associated morbidity & mortality.

Hyperuricemia is commonly seen in subjects with cardiovascular disease and it one of the risk factor for morbidity and mortality with cardiovascular diseases. Uric acid is a product of synthesis from nucleic acids, amino acids, and Kreb's Cycle. Uric acid is biologically active and can stimulate oxidative stress and endothelial dysfunctions, inflammation, and vasoconstriction. The present study tries to evaluate the levels of uric acid in patients suffering from an acute ischemic stroke in comparison with normal subjects. Methods: This prospective cross-sectional study was conducted in the Departments of General Medicine and Biochemistry Prathima Institute of Medical Sciences, Naganoor, Karimnagar. A total of 80 subjects were included in the study. They were divided into two groups. Group I [cases] (n=40) consisted of patients reporting to the Emergency Department within 24 hours of onset of symptoms of stroke. The Group II [controls] (n=40) were the age and sex-matched patients attending the General Medicine OPD with minor complaints. Results: The mean age of Group I (n=40) was 61.42 ± 2.99 years and Group II was (n=40) 48.9 ± 4.53 years. The numbers of the male in Group I were 29 and female were 11 and in control, Group was 20 male and female each. The blood urea Group I was 38.7 ± 5.59 mg/dl and in Group II 30.12 ± 8.86 the p values were not found to be significant. The serum creatinine was 1.13 ± 6.61 in group I and in Group II was 0.91± 0.17 mg/dl and the p values were found to be significant. The uric acid levels were 7.32 ± 2.25 mg/dl in group II and 4.95 ± 1.5 mg/dl in Group I the values were found to be significant. Conclusion: Within the limitations of the present study it can be concluded that serum uric acid levels are significantly associated with ischemic stroke in this group of the population. The other important factors for the risk of ischemic strokes include Hypertension and Diabetes mellitus. There is growing evidence that uric acid may play a key role in the development and progression of cardiovascular diseases

Pigmented lesions of the oral cavity are an heterogeneous group with several etiophatogenesis and they can have melanocytic or non-melanocytic origin . Solitary pigmented melanocytic lesions of the oral cavity are rare. Oral nevus is a benign proliferations of cells of melanocytic origin and they are rare, for this reason, the literature is poor. Diagnosis of pigmented lesions of the oral cavity and perioral tissues is difficult, therefore is essential the histopathological examination to make a correct diagnosis . The objective of this article is to present a rare case report of oral nevus in the palate. A 63 years old female patient reported a small black spot not bulging and asymptomatic. This lesion has been surgically removed and analyzed. The histological examination of the sample has confirmed the diagnosis and after a week the palate was completely healed.

Naso-Orbito-Ethmoidal fractures can occur in single entity or in conjunction with other craniofacial fractures. Most often they are associated with frontal Le Fort II or Le Fort III fractures. It involves nasal bones including bony septum, the frontal process of the maxilla and nasal–orbital–ethmoid complex bilaterally. Open and Closed reduction are the two ways of management which are adapted by surgeons according to the situation and severity. This article describes a case report of 21-year male patient with history of road traffic accident who is diagnosed with naso-orbito-ethmoid fracture and was treated with open reduction and internal fixation

The mouth is regarded as a mirror and the gateway to health. Various dental treatment modalities frequently require appointments, which are more than one in number for completion of the entire treatment program. Missed dental appointments are an issue which has been noticed for years but very little research has been conducted around it. To assess various factors responsible for missed dental appointments among the patients attending a dental college. A cross-sectional study was conducted among the patients attending various departments of the college. A sample size of 960 was calculated based on the results of the pilot study and the patients who missed their appointment at least once during their treatment procedures were included in the study. A self-structured 19 item questionnaire was used to measure various factors responsible for missing the appointment. The collected data was subjected to statistical analysis by using SPSS version 21.0. Among 960 patients, 53% were females and 46% were males. Various reasons for not attending recall were assessed in patient’s perspective and college perspective. Lack of time (63%). fear (62%) were cited to be the most common factors for not attending recall in patients perspective and inconvenient appointment timings (47%) and dissatisfaction with the reception area(44%) were cited to be the most common factor for missing the appointment in college perspective. This study concluded that patients who miss appointments cite the most common reason as lack of time, fear, lack of transportation inconvenient appointment timings. The key in dealing with the issue of missed dental appointment lies in altering patient’s psychology during the first appointment. Counselling and motivation is required to be done at first dental visit to reduce the chances of missed appointment.

Chronic Obstructive Pulmonary Disease is associated with increased inflammatory cells. Combination of long acting beta agonist and inhaled corticosteroids are standard treatment. Roflumilast targets inflammatory cells and decreases the frequency of exacerbation. This study looks at the effect of Roflumilast on inflammatory cells in sputum and inflammatory markers in the blood when used as add-on therapy in COPD patients. This observational comparative study conducted in Department of Pulmonary Medicine for 1.5 years duration. 70 COPD patients were divided into two Group A (Roflumilast + Standard treatment) and Group B (Standard treatment). Pulmonary Function Test, Sputum Eosinophil & Sputum Neutrophil, CRP were measured at baseline and after 4 months of treatment in both groups. Intergroup analysis between Group A and Group B was done at baseline and after 4 months. Mean age of patients in Group A was 64.3 years and in Group B was 61.2 years. Maximum patients were in age groups 51-60 and 61-70 years. Of total 70 patients, 60% were males and 40% females. Majority of patients in both groups had low BMI. Sputum inflammatory cells were significantly lower in Roflumilast group. Pulmonary function parameters showed significant improvement in Roflumilast treated group. There was no significant decrease in CRP when compared between two groups. Roflumilast, add-on therapy to standard treatment in COPD patients have improved lung function and decreased level of inflammatory cells in airway significantly.

To evaluate clinical performance of three different resin composites (microfilled, nanohybrid, nanofilled) polished with one-step polishing system in cervical restorations after 24 month. Thirty adult patients were selected from outpatient clinics with a total of 90 restorations (30 of each type of dental composite resin). All of the restorations were finished using fine grit finishing diamond under water-cooling to remove gross excess and polished with one-step polishing system. All restorations showed only minor changes and no differences were detected between their performance at any time period. Nanofill and nanohybrid composite resin showed a satisfactory clinical performance after 24 month as microfill composite resin.

The present study aimed to investigate role of Attitudes towards medication, subjective norms and Perceived Behavioral Control in predicting Intentions of patients to take Anti-TB medication. The sample comprised of 147 patients with pulmonary TB, recruited from Gulab Devi Chest Hospital, Lahore. Correlation Research design was used. Urdu translated version of Theory of planned behavior questionnaire was used for assessment. Results showed that, Distance to hospital and Attitude of doctors and staff negatively predicted Intentions. However, Monthly family Income, Attitudes towards medication and Subjective Norms positively predicted Intentions. Results also revealed that high and low intenders were significantly different in terms of Behavioral, Normative and Control Beliefs. Findings of the present study highlighted the importance of environmental and patient related factors influencing the decisions to take medication. These factors should be considered while developing interventions to promote future medication adherence behavior as intentions drives behavior and patients has to be motivated in order to perform the behavior.

The parasitic weed Striga hermonthica poses a serious threat to sorghum production in Northern Cameroon. To evaluate the response to S. hermonthica of 24 genotypes of rainfed sorghum and the effect of sodium carbonate on this parasite, field and pot experiments were conducted at Touboro (North Cameroon) in 2016 and 2017. In pot and in field, under striga infestation, results showed varietal responses of sorghum for the number of emerged Striga, the height of sorghum, the stem diameter, the number of leaves per plant, the panicle weight and the grain yield. Globally, Striga infestation significantly reduced the height, the stem diameter, and the number of leaves, the panicle weight and the grain yield of sorghum accessions by 28.94%, 19.54%, 17.78%, 28.24% and 44.17% respectively. Application of natural sodium carbonate salt reduced significantly the emerged Striga and the host plant damage by 74.29% and 41.94%. Under Striga infestation, sodium carbonate also increased the growth and yield sorghum accessions. Among the 24 studied genotypes, complete resistance was no recorded, but landraces LMO-LT18, LMO-LT22, KW-CP09 and LMT-21 appeared as the most resistant and tolerant to S. hermonthica. Combination of sodium carbonate with resistant and tolerant genotypes should be investigated as a major component of integrated packages to the effective control of Striga on sorghum in northern Cameroon.

Clear cell sarcoma of tendon and aponeuroses is extremely rare tumour, arises in deeper soft tissues, bound to tendons or aponeuroses. Despite histological similarity with cutaneous melanoma, it is distinct from it clinically, genetically. It is mainly seen between the ages 20 to 40 yrs and rarely occurs in children. Here we report a case of clear cell sarcoma of soft tissue arising in the left foot of a 12 year old child