iosr-JDMS   Volume-12 ~ Issue-6

Abstract:Thyroid nodules are a common clinical problem. Epidemiologic studies have shown the prevalence of palpable thyroid nodules to be approximately 5% in women and 1% in men living in iodine sufficient parts of world[1]. Most of the thyroid nodules are benign and only less than 7% of thyroid nodules are malignant[2]. So it is very important to differentiate between benign and malignant condition preoperatively So the goal of diagnostic workup is to select those patients for surgery who have a high likelihood of harbouring malignancy in nodule. Many procedures are used in diagnostic workup of solitary nodule of thyroid- ie TFT, FNAC, USG
FNAC is considered as the most accurate and cost effective method for evaluating thyroid nodule. The sensitivity and accuracy of FNAC is as high as 95% in experienced hands. Positive predictive value of 90-98% and negative predictive value of 94- 99% established FNAC as a valuable diagnostic modality[3]. Although in our settings we usually found that FNAC results are usually not confirmatory
Ultrasound is considered as the imaging modality of choice for investigation of thyroid nodules.According to new ATA guidelines (AMERICAN THYROID ASSOCIATION) diagnostic ultrasound should be performed in all patients with a suspected thyroid nodule[4].Sensitivity of ultrasound has been demonstrated as high as 86.5% and specificity as high as 92.3%[5] The purpose of this study is to know the efficiency of ultrasound in evaluating solitary nodule of thyroid. It compares final histopathology and ultra sound findings to know the significance of ultrasound in evaluating solitary thyroid nodule. Keywords: fine needle aspiration cytology , malignancy, Solitary nodule thyroid, ultrasound thyroid.

[1]. The spectrum of thyroid disease in a community ;The whick-harm survey.clin Endocrinol(oxf)7:481-490
[2]. Risk of malignancy in non-palpable thyroid nodule;predictive value of ultrasound and color Doppler features.J clin Endocrinol metab 2002;87(5):1941-1946.
[3]. Ultra sound guided fine needle aspirating biopsy ,aspiration biopsy of thyroid nodules,comparison in efficacy according to nodule size.Thyroid 2009 jan ;19(1)27-31 American thyroid association guidelines 2009 Koike et al 2001
[4]. Belfiore A, La Rosa GL, La Porta GA et al: Cancer risk in patients with cold thyroid nodules. Relevance of iodine intake, sex, age and multinodularity. Am J Med 93:363-369, 1992.
[5]. Zygmunk HK: The thyroid gland and the thyroglossal tract in Russell RCG, Williams NS, Bulstrode CJK(eds): Bailey and Love's Short Practice of Surgery, 23rd edn. London: Arnold, 2000, p 713.
[6]. John BH: Thyroid in Courtney MT, Daniel RB, Mark B and et al. (eds): Sabiston Text book of Surgery, 17th edn. Philadelphia: saunders, 2004, p 961.
[7]. Khafagi F, Wright G, Castles H et al. screening for thyroid malignancy: the role of fine needle biopsy. Med J Aust, 1988:149:302-303, 306-307.
[8]. Okamota Yamashita T, Haraswara A et al: Test performances of the diagnostic procedures in evaluating thyroid nodules: Physical examinations, ultrasonography, and fine needle aspiration cytology, Endocr J 1994:41:243-247.
[9]. FratesMC, Benson CB, Charboneau JW, et al. Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement. Radiology2005; 237(3): 794–800. [10]. PapiniE, Guglielmi R, Bianchini A, et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J Clin Endocrinol Metab2002; 87(5): 1941–1946.

Abstract: Herpes Zoster Ophthalmicus(HZO) occurs from the reactivation of latent Varicella Zoster virus within the ophthalmic division of the Trigeminal nerve. Ophthalmic involvement has been considered the most important and potentially serious of all sites of Herpes Zoster. Objectives: 1.To study the modes of presentation and ocular manifestations of HZO. 2.To study the predisposing factors for the development of HZO. 3.To study the ocular complications of HZO after treatment with oral Acyclovir during a follow-up period of one year. Materials and Methods: This prospective clinical study was conducted with all patients who were clinically diagnosed to have HZO who attended the Outpatient Department of Ophthalmology. All the patients underwent a comprehensive ocular examination and were medically treated and followed up for one year. Results: 27 patients with HZO were studied. Advancing age was the most common predisposing factor. Acute neuralgia and skin lesions were the most common modes of presentation. Ocular involvement was seen in 16(59.25%) of the patients with HZO. Cornea was the most common ocular structure involved(62.5%). Conclusion: The potential ocular manifestations of HZO are numerous. Ocular complications were less frequent among patients who received prompt systemic antiviral therapy with oral Acyclovir started within 72 hours of skin rash. Among treated patients development of a serious inflammatory complication was associated with a delay in therapy.

Keywords: Acyclovir, Herpes Zoster, Herpes Zoster Ophthalmicus, Varicella Zoster virus.

[1]. Kanski JJ., Cornea, Chapter 5. In: Clinical Ophthalmology. 5th edition., (Edinburgh:Butterworth Heinemann; 2003).p111-114
[2]. Wilson FI. Varicella and Herpes Zoster ophthalmicus. Chap. 25 In : Tabbara K, Hyndiuk R eds. Infections of the eye 2nd edition.( Bosten:Little, Brown, 1996):387-400.
[3]. Deborah Pavan-Langston. Herpes Zoster Ophthalmicus. Neurology 1995;45(suppl 8):S50-S51.
[4]. Schmader KE. Epidemiology of Herpes Zoster. In: Arvin AM, Gershon AA.Eds. Varicella-Zoster virus: Virology and clinical management. (Cambridge.UK: Cambridge University Press;2000).p.220-245
[5]. Liesegang TJ. Corneal complications from Herpes Zoster Ophthalmicus. Ophthalmology. 1985;92:316-324
[6]. Deborah Pavan-Langston.Viral diseases of the ocular anterior segment. Chap 14. In:Foster CS., Azar DT., Dohlman CH.eds. Smolin and Thoft's. The cornea. Scientific foundations and clinical practice. 4th edn.( Philadelphia:Lippincott Williams and Wilkins 2005); p297-397.
[7]. Pavan –Langston D. Viral disease of the cornea and external eye. In: Albert D., Jakobiec F., eds. Principles and practice of Ophthalmology. 2nd edn. (Philadelphia : WB Saunders, 2000):846-893.
[8]. Christopher E. Starr., Deborah Pavan-Langston.Varicella Zoster virus: Mechanisms of pathogenicity and corneal disease. Ophthalmol Clin N Am. 2002; 15:7-15
[9]. Womack L., Liesegang.TJ. Complications of Herpes Zoster Ophthalmicus. Arch Ophthalmol.1983;101:42-45.
[10]. McLeod SD. Infectious keratitis. Chapter 62. In: Yanoff M., Duker JS eds. Ophthalmology, 2nd edn. (St. Louis:Mosby;2004):p 479-481.

Abstract: Depression in old age is associated with genetic susceptibility, chronic disease and disability, pain, frustration with limitations in activities of daily living. The present hospital based cross sectional study was undertaken on 306 patients selected by systemic consecutive sampling from Geriatric O.P.D of Institute of Psychiatry, Kolkata to find out the prevalence of depression and associated factors among geriatric patients. 65.3% of the study population had depression (mild-36.2%, severe-29.1%) and the association of this depression with age (p<.001), gender (p<.001), residence (p=.027), marital status (p=.004), education (p<.001), occupation (p<.001), family type (p<.001) and economic dependency (p=.002), living condition (p<.001) was statistically significant. Social support group, local clubs and respective families should address the issue of depression among elderly. Family counselling for old age care, creation of a viable family and social environment will go a long way to improve the mental health of the elderly. Key Words: geriatric, depression, mental health, family.

[1] Indian J Psychiatry. 2006 Jan-Mar; 48(1): 56–61.
[2] United Nations, World Demographic Estimate and Projections
[3] Ingle GK et al. Geriatric Health in India: Concerns and Solutions. Indian Journal of Community Medicine. 2008;33(4):214-218.
[4] Murray CJ and Lopez AD. Alternative Projections of Mortality and Disability by Cause 1990-2020: Global Burden of Disease Study. Lancet 1997;349:1498-504.
[5] Poongothai S, Pradeepa R, Ganesan A, Mohan V. Prevalence of depression in a large urban South Indian population - The Chennai Urban Rural Epidemiology Study (CURES-70). PloS One2009;4:E7185.
[6] Abhay K et al. Psychiatric disorders in medical inpatients. Indian J Psychiatry 2008;40:73-8
[7] Uwake R. Psychiatric morbidity in elderly patients admitted into non psychiatric wards in a teaching hospital in Nigeria. Int J Geriatr Psychiatry 2000;15:346-54.
[8] Brink TL et al,Development and Validation of a Geriatric Depression Scale: A preliminary report.J Psychiatr Res,1982, 17(1): 37-49
[9] Sood A, Singh P, Gargi DP. Psychiatric morbidity in non-psychiatric geriatric inpatients. Indian J Psychiatry. 2006;48(1):56 – 61
[10] Kalra S, Jhamb R, RuchiR.Profile of Medical and Psychological Disorders in the Elderly Persons attending a Tertiary Care Hospital in DelhiJIACM 2011; 12(1): 21-5.

Abstract: Dental caries, also known as tooth decay or a cavity, is an infection, bacterial in origin, that causes demineralization and destruction of the hard tissues of the teeth (enamel, dentin and cementum). It is a result of the production of acid by bacterial fermentation of food debris accumulated on the tooth surface [1]. Dental caries and its consequences pose important and uncomfortable problems not only in developing countries but also in all industrialized countries since 1970s. Even increase in prevalence has been occurred in some countries [2]. In general, dental caries levels vary considerably between and within different countries, but population groups in the lower socio-economic status (SES) have higher caries levels than those in the upper SES and these differences are consistent in industrialized and urbanized developing countries. For treatment of dental caries there should be a balance between de-mineralization and re-mineralization that normally happen in the mouth. Sometimes, weak organization of tooth structures and alterations in diet, oral hygiene or bacterial activity can lead to the predominance of de-mineralizing agents, resulting in initial lesion formation and tooth decay. Dental caries will progressively develop in enamel and dentin as a result of frequently episodes of PH drop in the biofilm exposed to sugar [3]. Early diagnosis and the right approach can stop the progressive destruction and sometimes it is possible to repair and completely heal lesions.

[1]. Medline Plus Encyclopedia Dental Cavities
[2]. Dye BA, Tan S, Smith V, Lewis BG, Barker LK, Thornton Evans G, trends in oral health status: United states 1988-1994 and 1999-2004. Vital and health statistics series 11, Data from the national health survey 2007; (248): 1-92.
[3]. Gonzalez-Cabezas C: the chemistry of caries: remineralization events with direct clinical relevance. Dent Clin North Am 2010;54:469-478.
[4]. Gianmaria F.Ferrrazzano, Ivana Amato, Tiziana Cantile, Giancarla Sangianantoni and Aniello Ingenito. In vivo re-mineralising effect of GC Tooth Mousse on early dental enamel lesions:SEM analysis.International dental journal 2011; 61:210-215.
[5]. Altenburger MJ, Gmeiner B, Hellwig E, Wrbas KT, Schirrmeister JF. The evaluation of fluorescence changes after application of casein phosphopeptides (CPP) and amorphous calcium phosphate (ACP) on early carious lesions. Am J Dent. 2010 Aug;23(4):188-92.
[6]. Najibfard K, Ramalingam K, Chedjieu I, Amaechi BT. Remineralization of early caries by a nano-hydroxyapatite dentifrice. J Clin Dent. 2011;22(5):139-43.
[7]. Bailey DL, Adams GG, Tsao CE, Hyslop A, Escobar K, Manton DJ, Reynolds EC, Morgan MV. Regression of post-orthodontic lesions by a remineralizing cream. J Dent Res. 2009 Dec;88(12):1148-53. Epub 2009 Nov 3.
[8]. Nakamura A, Sakuma S, Yoshihara A, Deguchi T, Yagi M, Miyazaki H. Long-term follow-up of the effects of a school-based caries preventive programme involving fluoride mouth rinse and targeted fissure sealant: evaluation at 20 years old. Int Dent J. 2009 Aug;59(4):215-21.
[9]. Reynolds EC, Cai F, Cochrane NJ, Shen P, Walker GD, Morgan MV, Reynolds C. Fluoride and casein phosphopeptide-amorphous calcium phosphate. J Dent Res. 2008 Apr;87(4): 344-8.
[10]. Andersson A, Sköld-Larsson K, Hallgren A, Petersson LG, Twetman S. Effect of a dental cream containing amorphous cream phosphate complexes on white spot lesion regression assessed by laser fluorescence. Oral Health Prev Dent. 2007;5(3):229-33.