Introduction: Diabetic nephropathy is a microvascular complication and is the leading cause of diabetes related morbidity, mortality and important cause of end-stage kidney disease. Both microalbuminuria and macroalbuminuria are associated with increased risk of cardiovascular disease. Evidence has been accumulating from clinical trials that assessing the levels of apolipoprotein B (ApoB), a constituent of atherogenic lipoproteins: ApoA1, a component of anti-atherogenic high density lipoprotein (HDL) cholesterol; and the ApoB/ApoA1 ratio will provide better prediction of future cardiovascular events than measuring serum low-density lipoprotein (LDL)-cholesterol levels. There is paucity of published data linking ApoB/ApoA1 ratio to diabetic nephropathy especially from developing countries, hence this study was carried out. Materials and Methods: The present study was conducted in the Department of Medicine, CSM Medical University, Lucknow between August 2009 and July 2010. Patients with type 2 Diabetes Mellitus (DM) attending the Diabetic and Medical Out-Patient clinics or who were admitted to the medical wards of Gandhi Memorial and Association Hospital CSM University, Lucknow were included. One hundred patients were enrolled; 64 of those were cases (Micro- and Macroalbuminuria groups) and 36 without nephropathy (Normoalbuminuria) were controls. The cut-off value for higher ApoB/ApoA1 ratio for male was 0.97 and for female was 0.86. Results: Older age, durations and control of DM were significantly correlated with degree of albuminuria. Fifty-six patients (56%) had raised ApoB/ApoA1 ratio, 19.4% in the Normoalbuminuria group (n=7/36), 71.4% in the Microalbuminuria group (n=30/42), and 86.4% in the Macroalbuminuria group (n=19/22). There were no statistical differences in the mean total cholesterol, HDL, LDL, triglycerides among the groups. Conclusion: In our study higher ApoB/ApoA1 ratio was significantly correlated with diabetic nephropathy.
Apolipoprotein A-I ; Apolipoproteins B ; Complications ; Diabetes Mellitus ; Kidney Diseases

Zygomatic fractures are the second most common fractures of the facial skeleton, after nasal bone fractures. Due to its uniqueness, the malar bone plays a very important role in maintaining appropriate facial contours. Zygomatic fractures can cause ocular and mandibular functional impairment, along with cosmetic defects. With the help of advanced imaging techniques and various treatment options, the management of zygomatic fractures has become more sophisticated and less invasive. This article discusses zygomatic fractures in detail: their clinical and radiographic features, and the various treatment options available.
Nasal Bone ; Skeleton ; Zygoma ; Zygomatic Fractures

Maxillofacial prosthodontics is an art and science which provides life like appearance to the person with facial deformity. Maxillofacial prosthetic rehabilitation for acquired defects has become more complex and sophisticated with advancement in techniques and materials. This case report describes the clinical and laboratory procedure for fabricating an auricular prosthesis for a patient with trauma related bilateral auricular deformity. Ear prosthesis was fabricated in two parts taking retention from external auditory canal.
Congenital Abnormalities ; Ear ; Ear Canal ; Humans ; Prostheses and Implants ; Prosthodontics ; Retention (Psychology)

PURPOSE: Breast cancers can be asymptomatic at an early stage and hence screening programmes play an important role in detecting breast cancers early. Even in those patients who present with breast symptoms, breast cancers may be present at a site remote to the site of symptoms. In this study, we aimed to assess the frequency, site and imaging modality used to identify these incidental cancers in the symptomatic one-stop breast clinic. METHODS: All patients who were seen in our breast clinic with breast symptoms over a two-year period were included in the study. We correlated the presenting symptoms of patients diagnosed with breast cancer with imaging (mammogram and ultrasound) findings. Incidental cancers were defined as "histologically confirmed breast cancers which were impalpable, remote to the site of symptoms and only identified on imaging." RESULTS: In the study period, 281 women were diagnosed with breast cancer out of 4,400 patients seen at the one-stop breast clinic. Thirty six patients (12.8%) diagnosed with breast cancer had an incidental cancer which was only identified by imaging. The majority of contralateral, incidental cancers were identified by both mammography and ultrasound (US) and patients were all above 35 years. CONCLUSION: We suggest mammography of both breasts and US of the symptomatic breast in order to identify incidental cancers.
Breast ; Breast Neoplasms ; Female ; Humans ; Mammography ; Mass Screening

Early evaluation of the pyramidal tract using Diffusion Tensor Imaging (DTI) is a prerequisite to decide the optimal treatment or to assess appropriate rehabilitation. The early predictive value of DTI for assessing motor and functional recovery in ischemic stroke (IS) has yielded contradictory results. The purpose is to systematically review and summarize the current available literature on the value of Fractional Anisotropy (FA) parameter of the DTI in predicting upper limb motor recovery after sub-acute IS. MEDLINE, PubMed, EMBASE, Google Scholar and Cochrane CENTRAL searches were conducted from January 1, 1950, to July 31, 2015, which was supplemented with relevant articles identified in the references. Correlation between FA and upper limb motor recovery measure was done. Heterogeneity was examined using Higgins I-squared, Tau-squared. Summary of correlation coefficient was determined using Random Effects model. Out of 166 citations, only eleven studies met the criteria for inclusion in the systematic review and six studies were included in the meta-analysis. A random effects model revealed that DTI parameter FA is a significant predictor for upper limb motor recovery after sub-acute IS [Correlation Coefficient=0.82; 95% Confidence Interval-0.66 to 0.90, P value<0.001]. Moderate heterogeneity was observed (Tau-squared=0.12, I-squared=62.14). The studies reported so far on correlation between DTI and upper limb motor recovery are few with small sample sizes. This meta-analysis suggests strong correlation between DTI parameter FA and upper limb motor recovery. Well-designed prospective trials embedded with larger sample size are required to establish these findings.
Anisotropy ; Diffusion Tensor Imaging* ; Diffusion* ; Paresis ; Population Characteristics ; Prospective Studies ; Pyramidal Tracts ; Rehabilitation ; Sample Size ; Stroke* ; Upper Extremity*

Early evaluation of the pyramidal tract using Diffusion Tensor Imaging (DTI) is a prerequisite to decide the optimal treatment or to assess appropriate rehabilitation. The early predictive value of DTI for assessing motor and functional recovery in ischemic stroke (IS) has yielded contradictory results. The purpose is to systematically review and summarize the current available literature on the value of Fractional Anisotropy (FA) parameter of the DTI in predicting upper limb motor recovery after sub-acute IS. MEDLINE, PubMed, EMBASE, Google Scholar and Cochrane CENTRAL searches were conducted from January 1, 1950, to July 31, 2015, which was supplemented with relevant articles identified in the references. Correlation between FA and upper limb motor recovery measure was done. Heterogeneity was examined using Higgins I-squared, Tau-squared. Summary of correlation coefficient was determined using Random Effects model. Out of 166 citations, only eleven studies met the criteria for inclusion in the systematic review and six studies were included in the meta-analysis. A random effects model revealed that DTI parameter FA is a significant predictor for upper limb motor recovery after sub-acute IS [Correlation Coefficient=0.82; 95% Confidence Interval-0.66 to 0.90, P value<0.001]. Moderate heterogeneity was observed (Tau-squared=0.12, I-squared=62.14). The studies reported so far on correlation between DTI and upper limb motor recovery are few with small sample sizes. This meta-analysis suggests strong correlation between DTI parameter FA and upper limb motor recovery. Well-designed prospective trials embedded with larger sample size are required to establish these findings.
Anisotropy ; Diffusion Tensor Imaging* ; Diffusion* ; Paresis ; Population Characteristics ; Prospective Studies ; Pyramidal Tracts ; Rehabilitation ; Sample Size ; Stroke* ; Upper Extremity*

We report the case of a 55-year-old woman with bilateral, large, calcified adrenal tumors who was treated by laparoscopic adrenalectomy. The patient presented with upper abdominal discomfort for the past 5 years. Her imaging showed bilateral enlarged adrenal glands up to 10-cm size with punctate calcifications. Positron emission tomography scan demonstrated moderate fluorodeoxyglucose avidity in the left adrenal mass. Bilateral laparoscopic adrenalectomy was performed through a transperitoneal approach. The postoperative period was uneventful, and the patient was discharged on the third postoperative day. Histology findings were consistent with adrenal leiomyomatosis.
Adrenal Gland Neoplasms ; Adrenal Glands ; Adrenalectomy ; Female ; Humans ; Laparoscopy ; Leiomyoma* ; Leiomyomatosis ; Middle Aged ; Positron-Emission Tomography ; Postoperative Period

The aim of this article was to showcase the endodontic management of a maxillary first molar with an unusual crown and root anatomy. Clinical diagnosis of the roots and root canal configuration was confirmed by a cone-beam computed tomography (CBCT) and the detection of the canals was made using a dental operating microscope. CBCT images revealed the presence of 5 roots with Vertucci type I canal configuration in all, except, in the middle root which had 2 canals with type IV configuration. The 6 canal orifices were clinically visualized under the dental operating microscope. Clinicians should familiarize themselves with the latest technologies to get additional information in endodontic practice in order to enhance the outcomes of endodontic therapy.
Cone-Beam Computed Tomography ; Crowns* ; Dental Pulp Cavity ; Diagnosis ; Molar*

INTRODUCTIONNourishment for the brain, a highly vascular organ, is derived from a unique structure called the 'circle of Willis', which is formed by the terminal branches of the internal carotid arteries (ICAs) and basilar arteries (BAs). The circle of Willis forms an anastomotic link between the carotid and vertebrobasilar systems in the arterial supply of the brain, while the BA forms an important component of the brain's posterior circulation and supplies its many vital parts.

METHODSA study was performed on 20 brain specimens used for routine dissections at the Anatomy Department, Kasturba Medical College, in order to examine the morphology of BAs in the brain.

RESULTSIn most specimens, the position of the termination of BA was normal, although variations were present in the mode of termination. In one specimen, the BA terminated by dividing into two superior cerebellar arteries. The posterior cerebral arteries (PCAs) arose from ICAs on both sides in this specimen, and a communicating branch was present between the terminal point of the BA and PCA on the left. In another specimen, unilateral variation was seen, with the PCA arising from the ICA on the right and a posterior communicating artery arising from the PCA, connecting it with the BA. The anatomy on the left side was normal.

CONCLUSIONWe highlight the morphological aspects of the BA, the knowledge of which would help neurosurgeons safely diagnose, as well as plan and execute vascular bypass and shunting procedures for the treatment of stenosis, aneurysms and arteriovenous malformations in the posterior cranial fossa.

Basilar Artery ; abnormalities ; anatomy & histology ; Brain ; anatomy & histology ; blood supply ; Cadaver ; Carotid Arteries ; pathology ; Carotid Artery, Internal ; anatomy & histology ; Circle of Willis ; anatomy & histology ; Humans ; Posterior Cerebral Artery ; anatomy & histology