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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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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Aim: To analyze the bcl-2 protein expression in the epithelial lining of the Odontogenic keratocyst (OKC), Radicular (RC), and Dentigerous cysts (DC). Materials and Methods: Forty-five archival samples of paraffin-embedded tissue sections were utilized. Fifteen OKCs, 15 DC, and 15 RC were immunohistochemically analyzed for immunoreactivity of the bcl-2 protein. Results: Expression of bcl-2 was seen in the basal layer of the epithelial lining of the OKC. DC and RC showed almost complete negativity for bcl-2. There was a statistically significant increased expression in all OKCs. Conclusion: The bcl-2 protein overexpression could increase the survival of the epithelial cells and this increased lifespan could in turn, lead to the peculiar aggressive growth pattern of OKC. However, the bcl-2 staining can be useful to differentiate OKC from other odontogenic cysts.

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Ameloblastomas are usually benign, locally aggressive neoplasms derived from the epithelial odontogenic tissues. The tumors are known for their propensity for local recurrence. Different mechanisms have been proposed to explain the mechanism behind the pathogenesis of ameloblastoma. The proper understanding of the pathogenetic mechanism involved in ameloblastoma and its proliferation, aids in constituting proper treatment. Molecules involved in the pathogenesis can serve as markers in long term follow-up. Expression of the ameloblastin and amelogenin genes in these tumors play a role and they potentiate their action through different mechanisms. This review focuses on the molecular changes that occur in ameloblastoma which has a bearing upon its treatment and prognosis.

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Background: Older persons are at a risk of developing cognitive impairment, which is often considered a precursor to more serious conditions, such as dementia, depression or even Alzheimer's disease. Mini Mental State Exam (MMSE), a cognitive screening tests rated on a 30-point scale is most widely used to study cognitive measures. Aims and Objectives: The aim of our study was to determine the prevalence of cognitive impairment among older adults, to describe the pattern of cognitive impairment in rural and urban elderly population and to investigate the influence of socio-demographic and other variables on it. Materials and Methods: A cross-sectional study was carried out between January 2010 and July 2010, in urban and rural areas of Shimla district of Himachal Pradesh. Four hundred elderly people were included in the study. Cognitive levels were assessed with the MMSE scale (cut-off score 23). Data were analysed with SPSS 17.0 software for windows. Results: The prevalence of cognitive impairment was 3.5%. It was higher in rural (2.3%) than in urban population (1.3%), with a rural/urban prevalence ratio (PR) of 1.8 (95%CI 0.6-5.7). In the logistic regression model, old-old, illiterate and widowed showed a higher probability of cognitive impairment. It was not associated with use of alcohol, cigarette smoking or under nutrition. Conclusion: Knowing the prevalence rate of cognitive impairment in elderly, together with the associated factors may inform policy makers and aid in designing better geriatric friendly health services. When planning elderly health services priority should be given to the elderly who are old-old, widowed and those who are illiterate.

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Background: Monitoring HIV disease progression and deciding the time to initiate highly active antiretroviral therapy (HAART) requires evaluation of TCD4 + cell counts and HIV/RNA viral load at regular intervals. Considering the fact that it is the resource restrained developing countries that carry most of the burden of HIV, recently, studies have been carried out to evaluate the utility of low cost, easily performed alternate biomarkers that can be used for HIV disease management and in response to HAART. Unavailability of scientific technology and inadequate infrastructure makes it difficult for resource poor countries to manage HIV-infected individuals. Aim: Our study concentrated on evaluating LDH activities in HIV-infected individuals on HAART. Materials and Methods: The study was conducted between June 2011 to December 2011, and 36 HIV seropositive and antiretroviral therapy naive individuals and 21 HIV seropositive patients presently on HAART since past 3-6 months attending Integrated Counseling and Testing Centre (ICTC) situated at Area hospital Siddipet were enrolled in the study. Results: Our study concentrated on evaluating LDH activities in HIV-infected individuals (220.42 ± 79.04 IU/L) on HAART and showed that higher serum LDH activities were found when compared to controls (160.13 ± 47.11 IU/L). After 3–6 months of HAART, the serum LDH showed statistically significant decrease (188.76 ± 42.91 IU/L) (P < 0.002). Conclusion: LDH assay is useful in monitoring HIV disease progression and treatment response.

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"Connectors", the term itself indicates connection or something that connects one thing to the other. In fixed Prosthodontics, connector refers to the portion of a fixed partial denture that unites the retainer and pontic. For two things to be joined together there should be a medium for it. In other words, something that will connect them together to make them look as one. In removable Prosthodontics, connectors are the one which unite the components: Major connector - that connects the components from one side of the arch to the other side of the arch. Minor connectors - the connecting link between the major connector or base of removable partial denture and other units of the prosthesis such as clasps, indirect retainer and occlusal rest. Precision attachments are special type of direct retainers used in partial denture construction. By definition, the term precision denotes 'the quality or state of being precise'. They are sometimes said to be a connecting link between the fixed and removable type of partial dentures as it incorporates features common to both types of construction. This article brings a case report of using the connectors and attachment for oral rehabilitation.

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Background: Stress is an important triggering factor for tension headache. Yoga is one of the effective therapies in reducing stress levels. Studies had shown that shavasana is as effective as electromyography (EMG) biofeedback in reduction of tension headache. Aim: The aim of this study is to evaluate effect of yoga, namely yoga asana and relaxation technique on tension headache. Materials and Methods: Thirty patients diagnosed to have tension headache according to the International Headache Society Criteria II were included in this study. Patients were subjected daily to one yoga session for 1 month. Headache intensity by visual pain analogue scale (VAS) was assessed before and after yoga. Results: There was a significant reduction in VAS after yoga therapy. This study shows that yoga is beneficial in reduction of stress levels thereby reduction in tension headache. Conclusions: The results of this study suggest that yoga has a potential beneficial role in treatment for tension type headache. Further, larger studies are required to substantiate its benefits.

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Hydatid disease, most commonly caused by the larval stage of Echinococcus granulosus, affects mainly human liver and lungs, and rarely other parts of the body. It is prevalent in most sheep-raising Mediterranean countries, Central Asia, the Middle East, Eastern Africa, and parts of South America. Peritoneal hydatid cyst, either primary or secondary, represents an uncommon but significant manifestation of the disease. The present case report describes a case of a giant secondary hydatid disease of the pelvic cavity with primary in the liver.

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Torsion of the non-gravid uterus is rare, but can present as an acute abdominal emergency. As it causes irreversible ischemic damage to uterus and its adnexae, emergency laparotomy is mandatory as a diagnostic and therapeutic procedure. We report a case of torsion of fibroid uterus in a post-menopausal woman who presented with an acute abdomen requiring laparotomy .

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A middle-aged female patient was admitted to our medical ward with the complaints suggestive of congestive heart failure. Her history revealed that she was diagnosed as having thyroid disease about 6 years back, but the patient did not use any medication despite medical advice. Now, she is having small goiter and moderate proptosis. Investigations showed increased thyroid hormone levels with suppressed thyroid stimulating hormone levels. Immunological assay showed increased thyroperoxidase antibodies. Nuclear uptake study confirmed increased diffuse uptake of technetium-99m. Echocardiogram showed dilatation of all chambers of the heart with increased ejection fraction. Pathophysiology, clinical features, and management of Graves' disease, in particular hyperthyroidism induced high out-put failure are discussed and literature is reviewed.

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Background: The objective of the present study was to estimate the levels of interleukin (IL)-17, the proinflammatory cytokine produced by the activated T helper 17 cells in gingival crevicular fluid (GCF) and determine its role in progression of periodontal disease. Materials and Methods: Clinical parameters including gingival index, Russell's periodontal index and probing pocket depth were recorded for 30 subjects divided into two groups. Group 1 (healthy) comprising 10 subjects with clinically healthy periodontium and with no evidence of disease, group 2 (with periodontitis) comprising 20 subjects whose periodontium had clinical signs of inflammation, probing pocket depth ≥5 mm and with radiographic evidence of bone loss. IL-17 levels were estimated in GCF using enzyme-linked immunosorbent assay. Results: The mean concentration of IL-17 was significantly higher in group 2 when compared with group 1. Gingival index and Russell's scores were significantly higher in group 2 when compared with group 1. Conclusion: IL-17 was present in GCF samples from individuals in both healthy and chronic periodontitis groups and its concentration correlates positively with the extent of periodontal destruction, Russell's periodontal index scores and thus levels of IL17 in GCF may act as novel biomarker for estimating periodontal disease progression.

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Introduction: In India, accidental contact with direct flame is the most common cause of burns. More than 90% of burn wounds are II and III degree, though surface area involved is less than 40%. Burn patients are at high risk of infection as a result of the nature of injury, immunocompromising effect of burn, prolonged hospital stay, and invasive procedures. Multidrug-resistant bacterial infection is major cause of mortality in these patients. Aim: This study was undertaken to determine the prevalence of metallo b lactamase (MBL) producing gram-negative isolates in burn wound infections, so as to guide the clinicians to select appropriate antimicrobial therapy and prevent the spread of MBL in gram-negative bacteria. Materials and Methods: Pus sample collected from 147 patients admitted to the burn unit, of government general hospital Karimnagar were processed by standard bacteriological methods. Imipenem-resistant isolates were screened for MBL production by combined disk test. Results: Study revealed that 40% Proteus and 19.05% Pseudomonas produce MBL and MBL producers are 100% resistant to imipenem and ceftazidime. Conclusion: Patients of burn with MBL-positive P. aeruginosa infections will have higher morbidity and mortality. Piperacillin/tazobactam seems to be effective options for the treatment of MBL-positive P. aeruginosa infections.

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Epidermoid cysts are benign, uncommon lesions accounting for less than 1% of all intracranial tumors. Their location is intradiploic in 25% of cases, and rarely subtentorial. We report here a rare case of giant subtentorial intradiploic epidermoid cyst in a thirty year old patient who presented with subcutaneous retromastoid swelling. Computerized Tomography (CT) scan and Magnetic Resonance (MR) imaging revealed a giant osteolytic extradural lesion of the posterior fossa. Retrosigmoid suboccpital craniectomy and total removal of the tumor was done. Histopathological examination confirmed an epidermoid cyst. The outcome was good.

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Background: Default remains an important challenge and a threat for tuberculosis (TB) control. Aims and Objectives: Objectives of the study were to analyze timing of treatment interruption and pattern of default among TB patients on directly observed treatment, short-course under Revised National Tuberculosis Control Programme. Materials and Methods: The present cross sectional study was conducted among the cohort of patients registered during January 2011 to September 2011 at the Tuberculosis Unit, Ambala city. Number of interruptions/doses missed, number, and timing of default were taken from TB register and treatment cards. Results: Out of 80 defaulters, majority (50,62.5%) defaulted in the continuation phase of treatment. Out of these 50 patients, 31 were new and remaining 19 were from previously treated categories. In category I, maximum default was seen in the third month of treatment ( 2.84%). The cumulative default rate at the end of second month was 2.57%. The default rate at the end of the eighth month, when all patients were censored, was 8.18%. In category II, maximum default (3.61%) occurred in the fourth month. The cumulative default rate by the end of third month was 13.92%; and by the end of eighth month, 21.76%. The default rate by the end of the tenth month, by which time all patients were censored, was 21.76%. Conclusions: Patient defaulting from treatment remains a matter of concern. Factors behind higher default rate in continuation phase need to be explored. Default in intensive phase of treatment and without smear conversion at the end of intensive phase should be retrieved on a priority basis.

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Retrograde jejunogastric intussusception (JGI) is an unusual complication following gastrojejunostomy and Billroth II gastrectomy. It was first described in 1914 by Bozzi in a patient with gastrojejunostomy, and about 300 cases have been reported so far in the medical literature. High index clinical suspicion is required to make the diagnosis. Pyloroplasty is one of the well-accepted and proven surgical options in such cases. We report a case of retrograde JGI involving both loops of jejunum in a male patient who underwent truncal vagotomy and posterior gastrojejunostomy for chronic duodenal ulcer 6 years ago.

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