Histological sections, which need to be examined for any length of time or to be stored must be mounted under a cover-slip. There are various types of mounting media available both commercially and also are prepared in one's own laboratory for mounting tissue sections. Some types of mounting media harden to hold the coverslip firmly in place and other types use different solvents such as water, glycerin and xylene because the stains in the sample preparation are sensitive to particular solvent. In order to prevent the of immonoflurescent slides, few mounting media contain antifade reagents. As less emphasis is given in the literature on mounting media, an attempt is made to review, venture and summarize on various types of mounting media and their uses in routine histopathologically and immunochemical staining.

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Elements are present in different forms in the nature, and these elements are very essential for the body to perform different functions. Trace elements are very important for cell functions at biological, chemical and molecular levels. These elements mediate vital biochemical reactions by acting as cofactors for many enzymes, as well as act as centers for stabilizing structures of enzymes and proteins. Some of the trace elements control important biological processes by binding to molecules on the receptor site of cell membrane or by alternating the structure of membrane to prevent entry of specific molecules into the cell. The functions of trace elements have a dual role. In normal levels, they are important for stabilization of the cellular structures, but in deficiency states may stimulate alternate pathways and cause diseases. These trace elements have clinical significance and these can be estimated using different analytical method.

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Hypothyroid myopathy or Hoffman's syndrome is a rare manifestation of a common condition. It's diagnosis is also difficult. We present a case of Hoffman's disease with predominant proximal myopathy and myotonia.

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A lipoma is a common tumor arising from fat cells and can occur anywhere in the body. However, lipoma of the penis is very unusual and rare.

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Cancrum oris or noma is a rapidly spreading gangrenous stomatitis which occurs chiefly in debilitated or malnourished children, destroying the soft and hard tissue structures. Its fulminating course causes progressive and mutilating destruction of the affected tissues. As most patients with noma do not report until the disease is at an advanced stage, its onset and progression still remains a mystery. Survivors of this disease suffer severe facial deformity due to loss of facial tissues and scarring. We report a case report of noma highlighting its onset and progression, the extent of tissue necrosis and its management with an emphasis on the need for early diagnosis and prompt treatment.

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Introduction: Anemia in pregnancy is a ubiquitous problem, more so in the developing countries. Many of the changes that accompany blood loss appear later, rather than sooner, because obstetric patients are usually young fit adults with an expanded blood volume. In such cases, the needs for blood transfusions mainly depend on the clinical condition rather than the preoperative value of the hemoglobin (Hb) and blood loss. This is usually due to the tolerance of these chronic anemia patients to the accompanying blood loss. Aim: This study was aimed to see how frequently the patients actually received blood perioperatively. Material and Methods: This was a retrospective analysis of patients who underwent emergency cesarean sections. A total of 303 patients underwent emergency cesareans with Hb <8.5 g% over a period of 18 months in our hospital. These patients divided into three groups based on Hb status, Group I <7 g%, Group II 7-8 g%, and Group III >8 g%. Patients in each group were studied regarding the perioperative blood transfusion, any multiple units received, and complications encountered Results: In Group I, blood transfusion done in 88% cases fell drastically to 30% in Group II and 20% in Group III. No significant complications were noted and all patients were discharged without any morbidity. Conclusions: The lower cutoff value of Hb level for an emergency surgery remains a big enigma, which needs further evaluation. Clinical judgment in conjunction with the monitoring of tissue oxygen delivery determines the individual patient's transfusion trigger, and not the use of categorical magic number. Parturient women tend to have lower hematocrit values due to physiological changes and dilutional effect, but they still can tolerate this chronic anemia without any ill effects. This may be one of the reasons for the reduced need for blood transfusion in our study and also for the successful outcome in spite of severe anemia.

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The relationship between periodontal health and the restoration of teeth is intimate and inseparable. Maintenance of gingival health constitutes one of the keys for longevity of teeth and dental restoration. An adequate understanding of relationship between periodontal tissues and restorative dentistry is paramount to ensure adequate form, function, esthetics, and comfort of the dentition. Despite of an increased emphasis on the perio-restorative interface in restorative dentistry, many clinicians are unable to incorporate the concept of biologic width in a practical manner. This case report presents restorative management of subgingival caries by endodontal and minimally invasive periodontal treatment.

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Ectrodactyly refers to the congenital limb malformation, characterized by a deep median cleft of the hand and/or foot due to the absence of central rays. Affected individuals may be recognized by a lobster-claw deformity of their limb extremities that causes severe functional disorders. A combination of ectrodactyly, ectodermal dysplasia and cleft (EEC) in the lip or palate is called as EEC syndrome. This paper reports a case of the nonsyn dromic form of ectrodactyly in a 9-year-old girl along with etiological factors and its management.

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Homocysteine (Hcy) is a sulfur-containing amino acid with its only source in the human body being methionine. Three B complex vitamins (B ₆ , folate or B ₉ , and B ₁₂ ) participate in the metabolism of Hcy. Deficiency of these vitamins and the enzymes involved in its metabolism leads to elevated plasma Hcy levels (normal 5 - 15 μmol/l). Hyperhomocysteinemia (HHcy) is associated with several disorders. Hcy levels above 50 μmol/l is thought to be a risk factor for recurrent heart attacks and a value between 150 and 200 μmol/l may cause ischemic stroke. Levels above 300 μmol/l may induce mental deficiency. Several factors contributing to HHcy have been identified. These include lifestyle factors (smoking, alcoholism), drugs (phenytoin, valproate) and genetic causes (cystathionine β synthase deficiency). The various manifestations of HHcy are explained on the basis of oxidative damage and protein homocysteinylation, which cause damage to most tissues/organs leading to health complications and occurrence of various diseases. HHcy may affect major systems in the body like cardiovascular (coronary artery disease, myocardial infarction), central nervous (cerebrovascular accident, Alzheimer's, dementia) skeletal (increased risk of fractures), renal (low GFR), reproductive (risk of infertility), besides increasing the risk of hypothyroidism and cancer. The measures to prevent HHcy include consumption of nutritious foods, lifestyle changes (avoidance of smoking and alcohol) and supplementation of diet with vitamins - B ₆ , folate or B ₉ , and B ₁₂ .

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Objective: This study is aimed at determining maternal and fetal outcome in women with jaundice complicating pregnancy. Materials and Methods: An analysis of maternal and fetal outcome of 18 pregnant women admitted with jaundice during June 2012 to May 2013. Results: All cases in this study were in their third trimester of pregnancy. Serum bilirubin was >10 mg in 8 (44.4%) cases. In patients with jaundice related to pregnancy serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase and alkaline phosphatase were raised in a majority of them. Hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome, acute fatty liver of pregnancy, intrahepatic cholestasis of pregnancy, viral hepatitis, malaria and sickle cell anemia were the causes of jaundice in this study. In this study, HELLP syndrome (33.3%) was the most common cause of jaundice. Of 18 women, 10 (55.6%) of women the onset of labor was spontaneous and 16 (88.9%) delivered vaginally. Perinatal mortality in 6 cases (33.3%) among them 1 (16.6%) stillbirth and 5 (83.3%) intrauterine deaths. 15 (83.3%) women were discharged in improved condition. Maternal mortality in 3 cases (16.66%) 1 case died within 24 h of delivery, 1 on the 4 ^th postnatal day and 1 on the 8 ^th postnatal day. Cause of death was acute fatty liver of pregnancy with multiorgan failure with disseminated intravascular coagulation (DIC) with shock in 2 cases, HELLP syndrome with DIC with renal failure in 1 case. Conclusion(s): Jaundice and pregnancy is a deadly combination resulting in a very high perinatal as well as maternal morbidity and mortality, and requires an early diagnosis and careful management.

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We report a case of 28-year-old male patient who was run over by train, which resulted in above-elbow amputation on the right side and hand amputation on the left side. His financial status precluded the use of upper limb prosthesis. In this report, we evaluated the various aspects of the Krukenberg operation. The parameters were functionality, stereognosis, cosmesis, dominance, patient and societal acceptance. In our country interest in Krukenburg operation should be rekindled. Most of the surgeons neglected it favor of expensive prosthesis on grounds of unfamiliarity with the surgical procedure.

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Antioxidants (vitamins E and C, β-carotene, superoxide dismutase [SOD], catalase etc.) are the substances that protect cells from the damage caused by free radicals, formed as a result of oxidative stress. Free radicals (O _{2⁻ , H 2 O2,} OH⁻ , ROO⁻ etc.) are generated during the cellular metabolism and also due to environmental effects (cigarette smoke, ionizing radiations). Excessive production of free radicals has been implicated in the causation and progression of several diseases, e.g., atherosclerosis, cancer, rheumatoid arthritis, diabetes, and cataract. The general belief is that since free radicals are bad for health, antioxidants are good. This led to an indiscriminate use and supplementation of antioxidants, which is currently a controversial issue. This review gives an updated information on the effects of supplementation of antioxidants (vitamins E and C, β-carotene, SOD, catalase etc.). While some studies suggest that antioxidants are beneficial and protective, other interventional trials showed no health benefits. There are some interventional studies which demonstrated the deleterious effects of antioxidants (high risk of cancer, increased mortality). Further, antioxidant supplements were found to diminish the beneficial effects of certain drugs. It is suggested that indiscriminate use of antioxidant supplements should be avoided. Perhaps, antioxidants may be prescribed (not exceeding the recommended daily allowance) to the elderly, strict vegetarians or people who are on calorie-restricted diets. It is advisable that the antioxidants are consumed from rich natural dietary sources rather than supplements. Further, healthy individuals should exercise utmost caution while overdosing themselves with antioxidant supplements.

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Introduction: There are about 5 million truck drivers in India. As the eye sight plays a prominent role in safe driving, the truck driver's visual tasks/vision sense needs to be checked periodically. Aims: The aim of the study was to detect refractive errors and color blindness among truck drivers. Materials and Methods: We carried out a cross-sectional study on truck drivers. Truck drivers were screened at their resting places after obtaining their prior consent. In our study, we screened 140 truck drivers in various age groups. Statistical analysis used: We have analyzed the data obtained from the study by using Microsoft Office Excel 2007. Results: Out of 140 truck drivers screened, the number of truck drivers with visual acuity 6/6 (normal vision) was 100 (71.43%) while the drivers with refractive errors were 40 (28.57%). Of the 40 truck drivers with refractive errors; 11 were having myopia, 20 hypermetropia, and nine were found to have astigmatism. In the entire study, 44 truck drivers were found to have presbyopia. None of the divers had color blindness and/or night blindness. Conclusions: Most of the truck drivers having defective vision were in the age group of 41-60 years. This indicates that the drivers of this age group should be screened frequently to detect visual defects and they should be encouraged to wear corrective glasses (spectacles) to have normal visual acuity.

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Background: A uniform and reliable clinical and practical evaluation of medical students is always desirable. The method of objective structured practical examination (OSPE)/objective structured clinical examination (OSCE) tests the students on what they can do rather than what they know. This method is now believed to meet the deficiencies of the conventional system of practical/clinical examination. Aims: The aim of the present study is to take the perceptions and opinions of the medical education training (MET)-trained faculty regarding OSCE/OSPE, and their interest in introducing it as an assessment tool. Materials and Methods: This is a detailed, structured questionnaire study carried out in Government Medical College, Ananthapuramu, Andhra Pradesh, India in the period from May 2014 to July 2014 and was conducted on 50 members of MET-trained faculty. Results: Among the faculty, 96% agreed that it was a good and useful learning methodology; 98% agreed that it was a good assessment tool; 100% agreed that it assessed all the three domains; 80% agreed that it was a transparent, comprehensive, and fair assessment tool, 90% were of the opinion that it was mentally and physically taxing and required additional faculty hours to construct, review, and implement the arrangement of stations initially; 100% agreed that the combination with classical practical examination (CPE) produced good results; and 84% responded that it could partially replace CPE. Conclusion: We conclude that any change must first be thoroughly evaluated before it can uproot a well-defined and time-tested assessment methodology. OSCE/OSPE has several distinct advantages. In the current situation, it may be realistic to expect its inclusion in the evaluation schedule of universities and in day-to-day assessment of students to improve their clinical competence.

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High-dose effect is a common phenomenon documented in various immunological and serological assays, which results in false-negative results. Due to limited amounts of reagent antibodies in the coated wells and extremely high concentrations of analyte in the sample leads to decrease in the formation of antigen-antibody complex and ultimately resulting in false low values of the analyte. High-dose hook effect has important medical implications, and simple methods of sample dilution helps in preventing false low concentrations.

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Background: Temporomandibular joint dysfunction (TMJD) is a clinically significant condition which can be a source of acute or chronic orofacial pain and dysfunction including limitation of mandibular movement, pain with mandibular function and joint sounds. Arthrocentesis is joint lavage which washes out these inflammatory mediators, thereby, relieving pain. Aim: The aim of this study is to evaluate the efficacy of arthrocentesis of temporomandibular joint (TMJ) followed by intra-articular injection of piroxicam in patients with TMJD. Materials and Methods: Forty TMJ's from thirty patients, aged 18-48 years (mean age 27.33 years) with clinical and radiological diagnosis of TMJD, based on clinical diagnostic criteria (CDC/TMD) were included in the study and underwent arthrocentesis followed by injection of piroxicam. Patient evaluation was done preoperatively and post operatively immediately following the procedure and on 7 ^th day, 2 ^nd , 3 ^rd and 4 ^th week, 2, 3, 4, 5 and 6 months. Pain on mouth opening on a Visual Analogue Scale (VAS) scale (score 0-10), clicking or popping sounds and maximum mouth opening were recorded at each interval. Magnetic resonance imaging (MRI) was performed before treatment and 6 months after treatment in both groups. Results: Evaluation of assisted and unassisted mouth opening showed increase at all time intervals. There was significant improvement in pain, range of motion, joint effusion and joint sounds. Conclusion: Arthrocentesis followed by intra-articular injection of piroxicam is a safe, simple, minimally invasive and effective treatment of temporomandibular joint dysfunction.

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Background: Central nervous system tumors which constitute 1-2% of all tumors pose diagnostic challenges because tumors of varying histogenesis show divergent differentiation and overlap in morphological features. In problematic cases, immunohistochemistry is done in addition to the routine histopathologic examination to overcome the diagnostic difficulties, since an accurate histologic diagnosis helps in predicting the clinical outcome of various brain tumors. Materials and Methods: This study was carried out on a prospective basis in our institution from January 2009 to March 2012. During this period, a total of 246 neurosurgical specimens were received among which 118 brain tumors were diagnosed based on examination of Hematoxylin and Eosin stained sections of formalin-fixed and paraffin-embedded biopsy specimens. Immunohistochemical markers were applied in selective cases for an accurate diagnosis. Results: In adults, astrocytomas occurred most frequently in the study, followed by meningiomas, nerve sheath tumors, metastatic deposits, glioblastomas, and gliosarcomas. Primitive neurectodermal tumors occurred frequently in children. Other rare tumors included lymphomas and mesenchymal tumors. Age and sex incidence and anatomic distribution of various tumors were studied. Grading of the tumors was done as per the revised World Health Organization criteria. The results of immunohistochemical study in selective cases were analyzed. Conclusion: This study highlights the utility of immunohistochemistry as an adjunct in the histologic diagnosis of brain tumors in difficult cases.

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Congenital brain anomalies are rare among the congenital anomalies of various organ systems. It is important to diagnose these conditions at the earliest due to its far reaching neurological deficit and detrimental outcome. Most of the congenital brain anomalies can be reliably diagnose by neuroimaging (computed tomography or magnetic resonance imaging) of brain. Radiologist and treating physician should be aware of various specific imaging appearances and unique signs of these anomalies to avoid delay in diagnosis and thereby further treatment. A widely accepted classification of brain anomalies with each representative radiological image are illustrated with its distinctive findings.

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Incidence of coronary artery disease is on rise amongst the population, which is the major underlying pathology for acute coronary syndrome (ACS). So every anesthetist may encounter the patients with ACS and should know how to recognize and manage them. Its earliest detection and proper management can prevent further myocardial damage, thus preventing further morbidity and mortality. The patient described here had an increased risk for perioperative ischemia because of old age associated with history of hypertension, diabetes mellitus, chronic renal failure, and underwent a major surgical procedure (laprotomy). Beta-blockers were not administered and aspirin was discontinued during his preoperative preparation. All these factors might have contributed for the genesis of the myocardial ischemia in this patient.

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Introduction: Flexible fiberoptic bronchoscopy (FOB) has revolutionized the way pulmonary lesions are diagnosed, especially when endobronchial involvement is suspected. We aimed to evaluate the role of FOB by comparing the efficacy of forceps biopsy, bronchial brushings, and bronchial washings individually and in combination. Materials and Methods: This study was performed on 40 patients whose diagnosis was uncertain despite various diagnostic techniques. After initial screening, FOB was performed on patients suspected of endobronchial tumor. During the procedure of biopsy, brushings and washings were collected and sent for microbiology, cytology, and histopathology. The criteria for FOB included chronic cough, recurrent hemoptysis, and abnormal radiological opacity. Results: Twenty-five patients had visible endobronchial tumor, mean age of presentation was 41-70 years, and males were predominant. The chief complaint was cough followed by persistant fever. Lung cancer (84%) was the most common etiology followed by tuberculosis (TB) (16%). Bronchial brushings gave the highest yield, slightly higher than forceps biopsy. Conclusion: FOB is a very useful and safe diagnostic technique for the evaluation of endobronchial tumor. Because of the high prevalence of TB, the possibility of TB should be considered next to lung cancer. Bronchial brushings has an advantage over forceps biopsy in situations where biopsy forceps cannot reach or open at the site of growth.

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Pathological basal ganglia calcification can be due to various causes such as metabolic disorders, infections and genetic diseases. Hypoparathyroidism is one of the most common causes of pathological basal ganglia calcification. However, the presence of extensive intracranial calcifications involving other areas of the brain is uncommon. Patients with hypoparathyroidism can present with neurological symptoms related to hypocalcemia, extrapyramidal signs and seizures. We report the case of a young adult who presented with seizures, signs of cerebellar involvement and extensive intracranial calcifications. Investigations revealed that the patient had hypocalcemia, hyperphosphatemia and low parathyroid hormone levels. Since adequate treatment of hypoparathyroidism may lead to marked clinical improvement, this entity should be considered as a differential diagnosis in patients presenting with seizures and extensive intracranial calcifications.

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Background: Alopecias are classified into non-scarring and scarring/cicatricial alopecias. Cicatricial alopecias represent a diverse group of diseases characterized by a lack of follicular ostia and irreversible alopecia. The main purpose of hair revolves around its profound role in social interactions. Loss of hair can lead to significant psychological and emotional distress. Hence, an accurate and early diagnosis and prompt intervention are necessary to prevent further follicular destruction. Objective: To evaluate the epidemiological, clinical, and histopathological characteristics of various acquired primary cicatricial alopecias. Materials and Methods: The study population consists of 50 patients with acquired primary cicatricial alopecias seen in our Dermatology Outpatient Department, during the period from September 2008 to September 2010. Results: The most prevalent diagnoses in order of frequency lichen planopilaris (LPP, 50%), discoid lupus erythematosus (DLE, 20%), and pseudopelade of Brocq (POB, 12%). The ratio of lymphocytic to neutrophilic cicatricial alopecias was 7.3:1. A female predominance of lymphocytic cicatricial alopecias was observed. Both LPP and DLE affected predominantly middle-aged adults. Conclusion: LPP and DLE followed by pseudopelade were the common cicatricial alopecias. In contrast to the previous large-scale studies, which showed DLE and/or pseudopelade as the foremost diagnosis, LPP is the most frequent cause of adult primary scarring alopecia in our study. An accurate diagnosis of cicatricial alopecia can be achieved only through careful clinicopathologic evaluation. Early scalp biopsy is mandatory in all cases. Further large-scale studies are necessary to establish a cause and pathogenesis behind this increased prevalence of LPP in our setting when compared to the western population.

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