Antibiotic resistance is the ability of a microorganism to with stand the effects of an antibiotic. Antibiotic resistance evolves naturally via natural selection through random mutation, but, it could also be engineered by applying an evolutionary stress on a population. If a bacterium carries several resistance genes, it is called multi-resistant or informally, a superbug. Antibiotic resistance can also be introduced artificially into a microorganism through transformation protocols. This can be a useful way of implanting artificial genes into the microorganism. Antibiotic resistance is a consequence of evolution via natural selection. The antibiotic action is an environmental pressure; those bacteria which have a mutation allowing them to survive will live on to reproduce and then they will pass this trait to their offspring, which will be a fully resistant generation. Several studies have demonstrated that patterns of antibiotic usage greatly affect the number of resistant organisms which develop. Overuse of broad-spectrum antibiotics, such as second- and third-generation cephalosporin, greatly hastens the development of methicillin resistance. Treating a serious infection is a balancing act between timely appropriate empiric antibiotic therapy and avoiding unnecessary antibiotics. The rapidly increasing antibiotic resistance is one of the major clinical, epidemiological, and microbiological problems facing the medical fraternity. This problem needs to be tackled head on using a multi-pronged approach.

Cells are made of many organelles. One of those organelles is lysosome, which are cellular organelles and are the first line of defense. They are found only in animal cells. Their main function is destroying foreign bodies that could harm the cell. They get rid of unwanted matter and also help in repair of damaged plasma membrane and seal the wound. Lysosomal storage diseases (LSD) are metabolic disorders caused by deficiency of a single gene. There are about 50 groups of diseases found which are mostly autosomal inherited and few are X-linked inheritance. No cure for LSDs has been found yet and they are mostly symptomatic. Recently, progress has been made in the treatment of LSDs.

Objective: Clavicle fractures have been treated in the past by conservative means such as figure of eight bandage, sling and swathe etc. Although, acceptable for middle and medial fractures, distal clavicle fractures often require open reduction and internal fixation.Current literature supports both operative fixation and non-operative treatment for distal clavicular fractures and some middle third fractures with displacement. The objective of this present study was to determine the results of operative stabilization of distal clavicle fractures. Materials and Methods: We present the results of 11 cases treated with open reduction and internal fixation with Kirschner wires. This study was carried out in Sebha Medical Centre, Sebha, Libya. Results: Ten patients achieved union and 1 patient developed painless non-union. Conclusions: Operative treatment of lateral clavicular fractures is recommended for early rehabilitation and affords adequate results.

Background: Hospital acquired infection (HAI) due to multidrug resistant pathogens are increasing day by day. Among which MBL producing Pseudomonas aeruginosa and Acinetobacter spp contribute a major portion of HAI. Aims: The objective is to determine the antibiotic susceptibility pattern of P. aeruginosa and Acinetobacter spp. showing imipenem resistance and prevalence of MBL producing strains among them in a tertiary care hospital. Materials and Methods: Over a period of 5 months in a tertiary care hospital, 60 Pseudomonas aeruginosa and 50 Acinetobacter spp. were isolated. These were tested phenotypically for detection of metallo-β-lactamase (MBL) production, by imipenem-ethylenediaminetetraacetic acid (EDTA) combined disc method and by four fold or more reduction of minimum inhibitory concentration (MIC) against imipenem with EDTA. Result and Conclusion: The prevalence of MBL producing Pseudomonas aeruginosa was found to be 41% and Acinetobacter spp. 22%. Antibiotic susceptibility tests revealed multidrug resistance for most antibiotics but 100% sensitivity for colistin. A big proportion of these positive strains were isolated from patients with multiple risk factors like prolonged hospital stay, indwelling urinary catheter, continuous mechanical ventilation, prolonged antimicrobial therapy, intravenous lines. The overall mortality rate among them was as high as 21%.

Background: Prescription order is an important transaction between the physician and the patient. Irrational prescribing is found throughout the world but because of scarcity of funds and resources, assumes increasing importance in the developing countries. Aim: To find out the elements of prescription writing in a tertiary care hospital. Settings and Design: Teaching hospital, Tirupati, Andhra Pradesh. The subjects were selected using systematic random sampling design. Materials and Methods: The study was carried out during January-March 2011 among 180 patients (both out-patient and in-patient) of the medical units. Statistical Analysis Used: The prescriptions were analyzed using MS Excel and Epiinfo 3.3.4 software and appropriate statistical tests of significance tests applied. Results: In all cases, prescription was written in lower writing case with a short signature. Although, superscription and transcription was satisfactory, the inscription dose, route, and duration were mentioned only in 52.8%, 33.9%, and 21.7% cases respectively, while subscription was satisfactory in 21.1% only. The prescription was written for inappropriate duration and dose in 78.3% and 47.2%, respectively. Conclusions: The prescription writing does not conform to the stipulated guidelines in majority of cases.

Background: Necrotizing fasciitis (NF) is a common presenting problem in septic wards of Government hospitals. Ignorance plays a role in application of counter irritants as a remedy for minor ailments, which may result in necrotizing fasciitis. Aim: A pilot study was conducted to identify an association between application of counter irritants and subsequent development of NF. Materials and Methods: Patients presented with features of NF were queried with a structured pro forma regarding application of counter irritants. Results: Seventy six out of One Hundred and Ten patients confessed to application of various aromatic resinous substances. Conclusion: There is a strong index of suspicion that irritant balms may be one of the etiological agent or an aggravating factor in causation of NF.

Objective: To estimate the nation-wide prevalence of chewable smokeless tobacco consumption among Indian females. Design: Secondary data taken from cross-sectional nationally representative population-based household survey. Subjects: 1,24,385 women aged 15-49 years who were sampled in the National Family Health Survey-3(2005-2006). Prevalence of chewable smokeless tobacco consumption was compared with socio-demographic characters. Materials and Methods: The prevalence of various smokeless tobacco current uses was used as outcome measures. Simple and two-way cross tabulations were the main analytical methods. Results: Of all the female participants, 13,309 (10.7%) used one or another chewing products; 3.3% used Panmasala, 1.8% used gutka and 6.6%used other chewable tobacco products. 12.8% of women used tobacco in some or the other form and 1.7% smokes tobacco. Smokeless tobacco consumption was more common in poor and less educated. The prevalence of tobacco consumption showed variation with types and varied widely between states and geographical location. This reflects a strong association with an individual's sociocultural characteristics. Conclusion : The findings of the study highlight that an agenda to improve the health outcomes among the poor in India must include effective interventions to control tobacco use. The higher use of chewable smokeless tobacco among Indian women is a cause of concern. There is a need for periodical surveys using more consistent definitions of tobacco use and eliciting information on different types of tobacco consumed. Such outcomes will help to frame policies that could curb the increasing use of tobacco in Indian Women.

Aim: This study evaluated the shear bond strength and microleakage of two repair systems for porcelain fused metal restoration. Materials and Methods: Forty cylindrical samples were fabricated in nickel-chromium alloy and 40 samples in feldspathic porcelain. Twenty samples of Ni-Cr alloy and 20 samples of porcelain disks were embedded in the acrylic resin, except its examination surface. The remaining 20 samples of Ni-Cr alloy and 20 samples of porcelain prepared for testing microleakage were covered with double-faced transparent tape on one surface and resin composite was bonded with the CoJet-3M and Ceramic Repair-Ivoclar. The samples were stored in distilled water for 24 h at 37°C before thermocycling at 5° to 55°C for 300 cycles and again stored at 37°C for 8 days. Shear bond strength test were performed in a universal testing machine with cross head speed of 1 mm/min. The data was analyzed using one way ANOVA and the Tukey honestly significant difference (HSD) test (P < 0.05). A total of 40 samples were tested. The remaining samples were prepared for testing microleakage samples. After thermocycling, the samples were placed in 0.5% basic fuchsin solution for 24 h and washed under tap water. These samples were transversely sectioned and the split samples were examined under 10 x microscopes for better evaluation of the samples. The leakage along the interface was measured under the microscope. Later, the inter-reliability of the scores was assessed using Kappa test. The data were analyzed statistically using a non-parametric Kruskal-Wallis test. Results: Mean bond strength values for G ₁ M ₁ B 35.77 ± 2.52 was the highest followed by G ₁ P ₁ B 33.23 ± 3.24, G ₂ P ₂ B 32.47 ± 3.53 and the lowest showed in G ₂ M ₂ B 24.70 ± 2.87. Test of significant showed that the mean value was significant among the groups (P < 0.001). The bond strength of the repair systems could not be related to the degree of leakage. Conclusion: For the metal surfaces, the greatest strengths were achieved with use of the CoJet-System. The bond strength of the repair systems could not be related to the degree of leakage.

Objective: Endodontic irrigants solutions with anti-bacterial activity have been used in treatment of teeth with infected root canals; however, these solutions can irritate periapical tissues. The objective of this study was to evaluate the cytotoxicity of two chlorine-releasing irrigating solutions on cultured human periodontal ligament fibroblasts. Materials and Methods: Periodontal ligament fibroblasts cells were cultured from orthodontically extracted premolars. The passage number between 3-6 was taken for further experiments. 2.5% sodium hypochlorite and 0.6% sodium dichloroisocyanuarate are the irrigating solution used for testing their cytotoxicity. The viability of cells after treating with irrigating solutions was evaluated by trypan blue dye exclusion. Results: Results showed that 0.6% NaDCC solution was less cytotoxic on cultured human periodontal ligament fibroblasts compared with 2.5% NaOCl at 2 min, 30 min, and 1 hr. Conclusion: This study suggested that sodium dichloroisocyanuarate is less cytotoxic than 2.5% NaOCl, suggesting its potential for use as root canal irrigant.

Adrenocortical carcinoma is a rare neoplasm with an incidence of about one case per million population. We present a rare case of an adrenal cortical tumor with paraneoplastic myelopathy and features of virilization and Cushing's disease.

Papular mucinosis is a relatively uncommon condition. We report a 50-year-old female patient who presented with asymptomatic skin colored lesions in a segmental pattern involving the T3 and T4 segments of the left side. Lesional biopsy (H and E) showed a sparse superficial perivascular lymphocytic infiltrate with abundant mucin throughout the reticular dermis. Special staining with Alcian blue confirmed mucinosis.

Proliferative myositis is a benign, reactive, pseudosarcomatous fibroblastic proliferation associated with bizarre giant cells resembling ganglion cells. It is most commonly seen in 5 ^th decade of life. It is a skeletal muscle counterpart of proliferative fasciitis, which clinically and histologically resembles it. It most commonly affects skeletal muscles of shoulder, thorax, and thigh. Trauma is considered to be most common etiological factor. Grossly, it presents as a discrete solitary nodular mass with irregular margins measuring 1-6 cm in size. Histopathological examination of tissue shows sheets of myofibroblasts amixed with large cells, which resemble ganglion cells. Immunohistochemical evaluation of the tissue shows positivity for vimentin and SMA and negativity for desmin in myofibroblasts, whereas ganglion cell-like cells are focally positive for SMA. We report a case of proliferative myositis in a 42-years-old female patient who presented with a slow-growing, painless, irregular swelling in left forearm 3 cm below the elbow.

Necrotizing fasciitis is a potentially fatal, progressive soft tissue infection that typically occurs in adults, but rare in infants and young children. It's an uncommon but serious complication of varicella infection in children. We hereby report a case of 10 month-old-female infant who presented with necrotizing fasciitis following varicella.

Glanzmann's thrombasthenia is a rare medical condition with only 300 cases reported in medical literature. It is an autosomal recessive platelet disorder. Patients usually present with mucocutaneous bleeding and excessive bleeding associated with trauma and/or surgery. We are reporting one such rare case of Glanzmann thrombasthenia.

A 45-year-old female visited our medical out-patient department with a history of gradual increase in the thickness of her skin and prominence of lower jaw and forehead in the past 10 years. Hormonal assay revealed unsuppressed growth hormone levels (7.86 ng/ml) with oral glucose load at 1 hour. Magnetic resonance imaging (MRI) of brain showed pituitary macroadenoma. Perimetric examination revealed visual field defects. Clinical, hormonal, imaging, and perimetric studies together confirmed the diagnosis of pituitary macroadenoma with acromegaly and pressure effects.

The term 'Hypodontia' refers to the developmental absence of one or more teeth, either in primary or permanent dentition, excluding the third molars. It is the most common craniofacial malformation. If six or more permanent teeth are missing, the term 'Oligodontia' is used. Oligodontia creates significant challenges to the clinicians in both diagnosis and management. Comprehensive management often requires a multidisciplinary approach. The ability to address this condition during the early stages of the dentition maximizes the potential for a treatment with functional, esthetic, and stable results. This case report presents prosthodontic management of a case of nonsyndromic Oligodontia of a 15-year-old female patient. Apart from the condition of Oligodontia, the age and compliance of the patient posed a greater difficulty during the treatment procedures. The management was possible only through multidisciplinary approach, which included oral surgery, restorative and prosthodontic specialties.

Facial asymmetry does exist in general population as an innate equity and contributes to the uniqueness of an individual. Absolute facial symmetry of two halves of the face is a rare occurrence, some degree of right and left variation is not an exception. Management of facial asymmetry varies with the age and clinical features of the patient. A case of unilateral condylar hyperplasia on right side, with prognathic mandible was reported to the department. Detailed history, clinical examination, and radiographic (cephalometric) evaluation was carried out and a comprehensive management was designed, which included presurgical orthodontics, surgical procedures (condylectomy, bilateral sagittal split osteotomy, and lefort I osteotomy) followed by postsurgical orthodontics. This case report highlights the interdisciplinary mode of management in treating facial asymmetries for better results.

Crown root fractures with subgingival extent are difficult to manage as the biologic width is difficult to maintain. Various treatment options range from conservative reattachment procedure to radical procedures like extraction. One among them is forced eruption or orthodontic extrusion. A novel technique is reported in the management of fractured anterior tooth using the method of forced eruption. This case report gives an option of multidisciplinary approach that does not compromise the aesthetics even during the treatment.