Drugs used locally or systemically induce several micro- and macroscopic tissue alterations. However, nearly 20 drugs have been reported so far in the literature, having association with the gingival enlargement. Many systemic diseases have their limited therapeutic options and such drugs or their metabolites have adverse influence on different systems/organs, and one of such is, they initiate or accelerate the overgrowth of gingival tissue. The over increase in the size of gingiva may be to the extent that, teeth may be partially or completely covered. And the resultant "gummy smile" may result in esthetic insult of the sufferer. In the presence of bacterial inflammation in gingiva, many of these drugs enhance collagen production by fibroblast cells, and simultaneously retard collagen destruction and hence increase the bulk of gingival tissue. It is apparent that there is subpopulation of fibroblasts those are sensitive to these drugs. The exuberant growth of gingival tissue has great esthetic concern, which may require mechanical removal of bacterial plaque, calculus, and surgical intervention and/or substitution of drug therapy by analogs. Relatively healthy oral environment provided by the dentist will reduce local micro-flora that will help eliminating the major focus of infection. Patient's physicians, general practitioners and dentist need to make coordinated and concise treatment plane to prevent or minimize the overgrowth and will be beneficial for the patients. This article will facilitate full information to physicians and general practitioners to involve dentists in the multidisciplinary treatment plane for these patients.

Background and Objective : Many neonates with sepsis die worldwide due to lack of early diagnosis and prompt treatment. This study was carried out to analyze various immunological and hematological parameters singly and in combination to formulate a guideline for the rapid diagnosis of neonatal sepsis. Materials and Methods : In a prospective study, 62 patients having clinical suspicion of neonatal sepsis were evaluated with a battery of investigations. Neonates admitted for other causes and without clinical suspicion of sepsis were selected as controls (n = 40). The tests included blood culture, hemoglobin (Hb) level, total and differential blood count, absolute neutrophil count (ANC), immature to total neutrophil count (I/T ratio), micro-erythrocyte sedimentation rate (m-ESR), C-reactive protein (CRP), platelet count, serum immunoglobulin M (IgM), and plasma fibrinogen level. Patients were divided into proven cases (positive blood culture) and probable cases (blood culture negative). Results : Positive blood culture was seen in 38 cases (61.3%). Raised m-ESR (>8 mm in 1 ^st h) was seen in 63.2% of proven and 66.7% of probable cases. An I/T ratio of ≥0.2 was seen in 63.2% and 58.3% of proven and probable cases. Morphological changes were detected in 68.4% of proved and 91.7% of probable cases. Positive CRP test (≥6 mg/L) was found in 84.2% of proven and 100% of probable cases. Raised serum IgM, leukopenia, and neutropenia were seen in minority of patients (11-37%). Raised fibrinogen (>400 mg/L) was seen in the patients as well as in controls. Conclusions : Four useful tests were m-ESR, I/T ratio, morphological changes in neutrophils, and CRP; and were statistically significant (P < 0.05). Most sensitive test was CRP (84%) and m-ESR was most specific test (94%). Combination of three or more of these four tests were highly specific (95-100%).

Background: In recent years, non-albicans Candida (NAC) are being increasingly reported in many laboratories. There is a need to diagnose them early as some of the species are resistant to antifungals. We evaluated the utility of HiCrome agar for speciation of Candida in comparison to conventional methods. Materials and Methods: Ninety-six isolates of Candida were speciated by morphology on corn meal agar (CMA), sugar assimilation tests (SAT), and HiCrome agar. Sensitivity, specificity, and positive predictive and negative predictive values were obtained. Results: Sensitivity of HiCrome agar in identification of Candida albicans was 97.05%, C. tropicalis was 83.33%, C. glabrata 100%, and C. krusei 87.5%; and specificity was 98.07, 91.93, 92, and 92.30%, respectively. Conclusion: The present Candida differential agar is useful in identifying a few of the species. With further modifications this media may replace the need for conventional methods. The rapid availability of results and identification of species in mixed cultures is significant.

Background and Aims: Peripheral arterial disease (PAD) is a marker for macrovascular disease and a risk factor for lower limb amputations, in patients with diabetes. The extent and impact of PAD in the rural population in India has not been well studied. The aim of this study was to screen for asymptomatic PAD using ankle brachial index (ABI) in order to characterize and compare risk factors associated with it and to look for the presence of ischemic heart disease (IHD) in rural and urban populations. Materials and Methods: This was an observational, cross-sectional study involving type 2 diabetic patients attending the diabetes clinic in an urban and rural hospital, in South India. Two hundred rural (R) and 400 urban (U) patients were screened for PAD over a period of1 year. An ABI ≤0.9 or >1.3 was considered abnormal. Patients with known PAD and or claudication were excluded as the aim was to look for PAD in asymptomatic patients. Anthropometric measurements and investigations were carried out. Risk factors were analyzed and P values and odds ratio (OR) were calculated. Results: 17.8% of patients had an ABI suggestive of PAD (R 20% vs U 16.8%). 63.6% were male. Known risk factors of PAD were identified and included dyslipidemia (85%; R 92.5% vs U 80.6%; OR 1.61), obesity (84.1%; R 85% vs U 83.6%; OR 0.75), hypertension (59.8%; R 47.5% vs U 67.2%; OR 1.26), and age >50 years (64.5%; R 55% vs U 70%; OR1.24). Except for smoking (22.4%; R 32.5% vs U 16.4%; OR 1.03), none of the other risk factors were different between groups. Mean duration of type 2 diabetes mellitus (T2DM) was 7.95±7.50 (R 4.66±5.22 vs U 9.61±7.93; P<0.001). Electrocardiogram (ECG) changes consistent with IHD were found in 25.3% of patients with PAD (R 20% vs U 28.3%; OR 3.06; confidence interval (CI) 1.81-5.18; P=0.001). Conclusion: Our study demonstrates that one in six asymptomatic South Indians with T2DM have PAD. One in four patients with PAD had ECG changes of IHD which was statistically significant. Based on the odds ratio, the rural patients with PAD had two and a half times higher risk of IHD, even though there was no statistically significant difference in cardiovascular risk factors, age, sex, and mean hemoglobin A1c (HbA1c) in both groups. Prevalence of PAD with a lower duration of DM and higher strength of association with IHD noted in the asymptomatic rural population in our study is a cause for concern.

Viral hepatitis is an infection that has been reported to be present throughout the year, but some particular months are associated with higher incidences. The primary objective was to review and report on the current knowledge and evidence that exists on seasonality of different type of acute viral hepatitis world-wide in order to develop recommendations for future research, prevention and control. Materials and Methods: A systematic literature review was performed to identify all the primary reports and studies published during 1970-2012 on acute hepatitis A, B, C and E (AHA, AHB, AHC and AHE) in human subjects by searching PubMed, reference lists of major articles and correspondence with scientific experts. For each report or study included, the following information was extracted (as applicable to study): Location (country and setting), study population (number of cases, patients), seasonal or monthly rate and study duration. Results: There is no definite and consistent seasonal pattern has been observed on AHA; AHB; AHE and AHC, although evidence points towards spring and summer peak for hepatitis A, B, C and E. Multiple source of transmission such as; summer travel to an endemic area, swimming habits of the population in hot months, increase sexual contact, tattoo, poor hygiene and environmental sanitation and food habits (feco-oral transmission of viral hepatitis) probably exists and should be further investigated through analytical and epidemiological.

The typical presentation of complete androgen insensitivity syndrome (CAIS) is with an inguinal hernia in an infant or a child and with primary amenorrhea in adult phenotypic female. We hereby report a case reared as a female and considered to have primary amenorrhea, who presented with acute abdomen, provisionally diagnosed to have torsion of ovary and underwent laparoscopic gonadectomy. Histopathology revealed gangrenous testicular tissue; karyotyping was 46XY. So, finally, a diagnosis of complete androgen insensitivity with torsion of intra-abdominal testis was made. We also discuss the rarity of such a presentation, risk of neoplasia, and timing of gonadectomy in such patients.

Laparoscopic procedures are commonly performed and preferred over open laparotomies due to their unique advantages. Many laparotomies are now amenable to laparoscopic repair. One such surgery is laparoscopic fundoplication for hiatus hernia repair. The advent of this surgery has given rise to unique consequences which may turn out to be complications if not attended appropriately.

Toxoplasmosis is a parasitic disease caused by the protozoan Toxoplasma gondii and infects most genera of warm-blooded animals, including humans, but the primary host is the felid (cat) family. This infection may clinically resemble influenza, hence causing diagnostic dilemma. Here we report a rare case of toxoplasmosis in a male patient aged 21 years with healthy immune system presented with flu like symptoms and eosinophilic leukocytosis. There was no clinical suspicion of toxoplasmosis. Serological detection of antibody titers is useful and rapid technique in the diagnosis of toxoplasmosis. Toxoplasmosis should be included in the differential diagnosis of parasitic infestation with persistant eosinophilia and detection of antibody titers is the best guide to a clinician in the absence of clinical suspicion.