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   2016| January-March  | Volume 6 | Issue 1  
    Online since January 15, 2016

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Analytical study of intrauterine fetal death cases and associated maternal conditions
Susmita Sharma, Harpreet Sidhu, Sukhbir Kaur
January-March 2016, 6(1):11-13
DOI:10.4103/2229-516X.173986  PMID:26958515
Introduction: Intrauterine fetal death is an important indicator of maternal and perinatal health of a given population. This study was undertaken to study the maternal and fetal factors associated with intrauterine fetal death. Materials and Methods: This was a retrospective single center study. The details were entered in a preformed proforma. The details of complaints at admission, obstetrics history, menstrual history, examination findings, per vaginal examination findings, mode of delivery and fetal outcomes, placental examination, condition of cord and investigation reports were recorded. Results: A total of 250 intrauterine fetal deaths were reported amongst 6942 deliveries conducted during the study period. The incidence rate of intrauterine fetal death was 36/1000 live births. Two hundred and twenty-two deliveries were unbooked and unsupervised. The other observations were rural population (58%), low socioeconomic group (71.2%), previous stillbirth (9.2%), gestational hypertension (32.8%), anemia (74.4%), antepartum hemorrhage (18.8%), and congenital malformations (CMFs) (8.8%). Conclusions: The incidence of intrauterine fetal deaths in our population is higher than that reported from developed countries. This is associated with anemia, pregnancy-induced hypertension, illiteracy, low socioeconomic status, and higher incidence of undiagnosed CMFs.
  6 2,829 493
The diagnostic accuracy of rapid urease biopsy test compared to histopathology in implementing "test and treat" policy for Helicobacter pylori
Asitava Deb Roy, Swapna Deuri, Umesh Chandra Dutta
January-March 2016, 6(1):18-22
DOI:10.4103/2229-516X.174003  PMID:26958517
Background: Helicobacter pylori is one of the most important causes of the varied spectrum of gastroduodenal diseases. It is important to have a rapid diagnostic method to detect the organism so as to initiate the treatment early and check its progression to malignancy. Aims: To evaluate the diagnostic accuracy of rapid urease biopsy test in detecting H. pylori infection and implementation of "test and treat" policy. Materials and Methods: All patients of chronic dyspepsia not responding to conventional treatment were subjected to endoscopy, and mucosal biopsy samples were collected. A rapid urease test (RUT) and histopathology was performed on these samples and taking histopathology as gold standard for H. pylori demonstration, the diagnostic accuracy of RUT was evaluated. Results: The specificity, sensitivity, positive predictive value, negative predictive value, and diagnostic accuracy of RUT were 97.22%, 94.04%, 98.75%, 87.5%, and 95%, respectively. Conclusion: Use of a rapid diagnostic test viz., rapid urease biopsy test to confirm H. pylori infection is recommended for early diagnosis and treatment of H. pylori associated gastroduodenal diseases.
  6 2,842 326
Dyke-Davidoff-Masson syndrome
N Vinay Kumar, TS Gugapriya, Arun T Guru, SD Nalina Kumari
January-March 2016, 6(1):57-59
DOI:10.4103/2229-516X.174016  PMID:26958525
Dyke-Davidoff-Masson syndrome (DDMS) refers to atrophy or hypoplasia of one cerebral hemisphere, due to an insult to the developing brain in fetal or early childhood period. Age of presentation depends on the time of neurologic insult, and characteristic changes may be seen only in adolescence. Male gender and left hemisphere are more frequently involved. A 17-year-old female adolescent with a history of recurrent refractory seizures, hemiplegia and mental retardation reported to Department of Radiology for computed tomography (CT) assessment of brain. On examination, she had facial asymmetry, delayed milestones, and spastic hemiplegia. The CT brain showed right cortical atrophy with ventricular dilatation, prominent sulci, and shifting of falx to the right side. Bone window image showed asymmetry in skull vault thickness, the width of diploic space, the size of paranasal air sinuses and inclination of the petrous ridge between the affected and normal sides. As the above case deviates from the usual presentation of male left sided DDMS, hence the report.
  5 2,014 256
Evaluation of carotid arteries in stroke patients using color Doppler sonography: A prospective study conducted in a tertiary care hospital in South India
Merwyn Fernandes, B Keerthiraj, Ajith R Mahale, Ashwini Kumar, Anees Dudekula
January-March 2016, 6(1):38-44
DOI:10.4103/2229-516X.174007  PMID:26958521
Aims and Objectives: Cerebral ischemic stroke is life-threatening and debilitating neurological disease, it is the third leading cause of death in the world. Studies have shown that there is a close relationship between carotid artery stenosis and ischemic cerebral vascular disease. This study is done to assess the carotid arteries with the help of color Doppler sonography and to correlate cerebrovascular accidents. Materials and Methods: The prospective study was carried out on 50 patients using purposive sampling technique. Risk factors such as hypertension, diabetes mellitus, smoking, and family history were documented. The data gathered from color Doppler examination consisted of peak systolic velocity of common carotid artery (CCA) and internal carotid artery (ICA), velocity ratios between CCA and ICA and plaque characteristics as seen on real-time image. Statistical Analysis Used: The collected data were analyzed and presented in the form of tables, figures, graphs, and diagrams wherever necessary. As this study deals with the only frequency distribution of various factors, so no tests of significance were applied. Results: The highest incidence of stroke was found in the male population in the age group of 60-69 years. Various risk factors included hypertension, diabetes mellitus, smoking, and family history. Of 50 patients, 12 patients showed significant stenosis (>60%). Atherosclerotic plaques were seen in 39 patients (78%). Conclusion: Color Doppler examination is an economic, safe, reproducible, and less time-consuming method of demonstrating the cause of cerebrovascular insufficiency in extracranial carotid artery system and will guide in instituting treatment modalities.
  4 3,716 370
Primary pulmonary synovial sarcoma: A case report and review of literature
Debasis Bhattacharya, Samadarshi Datta, Anirban Das, Khokan Chand Halder, Sarbani Chattopadhyay
January-March 2016, 6(1):63-65
DOI:10.4103/2229-516X.174019  PMID:26958527
Primary pulmonary synovial sarcoma is a very rare, but highly aggressive tumor. Metastatic pulmonary sarcoma due to hematogenous dissemination is much more common. Hence why in any case of pulmonary sarcoma, whole body survey is necessary to exclude a primary tumor elsewhere. No clinical or radiological presentations are specific for pulmonary sarcoma hence; it is often confused with bronchogenic carcinoma. On the other hand, image-guided fine needle aspiration cytology (FNAC) is very much helpful in diagnosis of bronchogenic carcinoma, whereas, it may be inclusive in cases pulmonary sarcomas including primary synovial sarcoma, especially in cases of huge pulmonary masses. So why image-guided tru-cut core biopsy or open lung biopsy and their histopathological examination, supplemented by immunohistochemistry are preferable for the tissue diagnosis of pulmonary synovial sarcoma, although FNAC and immunocytochemistry may be used for the diagnosis. Surgical resection is treatment of choice, if it is not possible, palliative chemotherapy may be an option. Here, we report a rare case of primary synovial sarcoma which occupied almost whole of the right hemithorax in a 60-year-old male farmer.
  3 1,691 313
A study to compare the plasma glucose levels obtained in sodium fluoride and citrate buffer tubes at a tertiary care hospital in Punjab
Shalini Gupta, Ashwani K Gupta, Minni Verma, Kamaljit Singh, Amandeep Kaur, Brinder Chopra, Vaneet Kaur
January-March 2016, 6(1):50-53
DOI:10.4103/2229-516X.174010  PMID:26958523
Objectives: Recent guidelines for estimation of glucose recommend the use of citrate buffer tubes to inhibit glycolysis if the sample cannot be cooled immediately and separated within 30 min. These tubes are currently not available in India. We prepared the citrate tubes and compared the glucose results obtained with sodium fluoride tubes. Methods: Random blood samples of 44 apparently healthy volunteers were collected in three pairs of citrate buffer and sodium fluoride tubes during September to October 2013. They were labeled as 0 h, 1 h and 2 h samples indicating a delay in centrifugation to separate plasma. Glucose was analyzed on the fully auto analyzer in duplicates using glucose oxidase-peroxidase method. Results: The mean glucose concentrations at 0 h in citrate tubes were 105.8 ± 19.5 mg/dl compared to 99.6 ± 18.3 mg/dl in sodium fluoride tube. There was statistically significant difference in the glucose levels measured in plasma separated from citrate buffer tube and sodium fluoride tube at 0 h, 1 h, and 2 h. The difference between citrate and sodium fluoride tube results ranged from 6.1 mg/dl at 0 h to 7.4 mg/dl at 2 h. Glucose levels decreased significantly at 2 h in both citrate and sodium fluoride tubes. Conclusion: There is a significant decrease in glucose levels in sodium fluoride tubes even with immediate separation of plasma. There is urgent need to standardize the preanalytical conditions for glucose estimation so that effective inhibition of glycolysis can be done.
  3 3,417 316
Antibiotic sensitivity pattern in blaNDM-1-positive and carbapenemase-producing Enterobacteriaceae
Summaiya Mulla, Jaykaran Charan, Sangita Rajdev
January-March 2016, 6(1):14-17
DOI:10.4103/2229-516X.173989  PMID:26958516
Background: Some studies published in recent time revealed that many bacteria from Enterobacteriaceae group are multi-antibiotic-resistant because of the production enzymes carbapenemase particularly New Delhi metallo-beta-lactamase encoded by gene called blaNDM-1. Looking at public health importance of this issue there is a need for studies at other centers to confirm or refute published findings. Objectives: This study was designed with the aim of exploring antibiotic resistance in Enterobacteriaceae group of bacteria and also to explore gene and enzyme responsible for it. Materials and Methods: Samples of Enterobacteriaceae were collected from wards and outpatient departments. Antibiotic sensitivity was checked by an automated system (VITEK 2 COMPACT). Carbapenemase production was assessed by Modified Hodge Test. Presence of blaNDM-1 was assessed by polymerase chain reaction. Statistics: Frequency and percentage were used to describe the data. Frequency of sensitivity was compared between carbapenemase producers and noncarbapenemase producers by Fisher's exact test. Results: Forty-seven percent bacteria were found to be producing carbapenemase enzyme. These bacteria were significantly less sensitive to cefoperazone, cefepime, and amikacin. Among carbapenemase-producing organisms, 3% and 6% were resistant to tigecycline and colistin, respectively. Forty percent bacteria were found to be having blaNDM-1 gene. There was a significant difference between blaNDM-1-positive and blaNDM-1-negative for sensitivity toward cefoperazone + sulbactam, imipenem, meropenem, amikacin, tobramycine, ciprofloxacin, and levofloxacin. Conclusion: Presence of carbapenemase enzyme and blaNDM-1 gene is associated with high level of resistance in Enterobacteriaceae group of bacteria and only few antibiotics have good sensitivity for these organisms.
  3 1,881 350
Tuberous sclerosis with oral manifestations: A rare case report
SPS Sodhi, Ramandeep Singh Dang, Gursimrat Brar
January-March 2016, 6(1):60-62
DOI:10.4103/2229-516X.174018  PMID:26958526
Tuberous sclerosis complex (TSC) is a neurocutaneous syndrome, inherited as an autosomal dominant trait with a high incidence of sporadic cases and protean clinical expression, with a incidence of prevalence between 1 in 10,000 and 1 in 170,000. The cardinal features of TSC are skin lesions, convulsive seizures, and mental retardation. We report a sporadically occurring case of definite TSC in a young female who presented with oral and cutaneous manifestations without mental retardation or history of convulsive seizures, which to the best of our knowledge has not been reported so far.
  2 1,803 241
Isolated pulmonary mucormycosis presenting as cavitary lesion in an immunocompetent adult: A rare case report
Sourya Acharya, Samarth Shukla, Obaid Noman, Pratibha Dawande
January-March 2016, 6(1):73-74
DOI:10.4103/2229-516X.174023  PMID:26958531
Cavitary lung lesions have a specific array of differential diagnosis. Among rare causes is mucormycosis that should not be overlooked. A high index of suspicion is necessary for a correct diagnosis and aggressive management. It usually occurs in immunosupressed patients. It is a life-threatening, rapidly progressive, and angioinvasive fungal infection. We present a case of pulmonary mucormycosis presenting as a cavity in an immunocompetent middle aged male.
  2 1,646 191
Association of polymorphisms in angiotensin-converting enzyme gene with gestational diabetes mellitus in Indian women
Parul Aggarwal, Nutan Agarwal, Nibhriti Das, Krishna Dalal
January-March 2016, 6(1):31-37
DOI:10.4103/2229-516X.174006  PMID:26958520
Background: Numerous genes have been reported in relation with gestational diabetes mellitus (GDM), but the findings were not consistently replicated across populations, or there have been no detailed studies on them. Previous literatures suggested that, out of all angiotensin converting enzyme (ACE) gene polymorphisms, only ACE insertion/deletion (I/D) gene polymorphism has a strong association with GDM in Asian Indian women. Aim: This study was devoted to evaluate the association of four single nucleotide polymorphisms (SNPs) ACE A240T, C1237T, G2350A and I/D with GDM and Type 2 diabetes mellitus. Materials and Methods: This study recruited 105 GDM cases, 119 Type 2 diabetes mellitus subjects and 120 controls. PCR-RFLP was used for identifying genotypes of ACE A240T, C1237T and G2350A and PCR was performed in the case of ACE I/D. Results: Significant associations of ACE SNP's, C1237T, and G2350A with GDM were observed. Haplotype analysis revealed the remarkably significant evidence of association with SNP combination ACE A240T, C1237T, G2350A, and I/D with GDM patients (P = 0.024). Individuals possessing haplotype "TTAI" (frequency 30% in GDM and 0 in controls) derived from these SNPs had 185 fold increased risk of developing GDM (95% of confidence interval: 11.13-3102.15), which was highest when compared with other 15 haplotypes. Conclusion: Shorter-range haplotypes were also significant, but the only consistently associated alleles were found to be in ACE C1237T, G2350A, and I/D. These results suggested that the variant in close proximity to ACE C1237T, G2350A and/or I/D modulates susceptibility to GDM and noninsulin dependent diabetes mellitus in Indian women.
  2 2,090 318
The effect of bone growth factor in the tendon to bone healing in anterior cruciate ligament reconstruction: An experimental study in rabbits
Mohammed T Al-Bluwi, Md Q Azam, Mir Sadat-Ali
January-March 2016, 6(1):23-27
DOI:10.4103/2229-516X.174004  PMID:26958518
Background: Reconstruction of the anterior cruciate ligament (ACL) involves use of semintendinosis and gracilis tendons graft that is transplanted into bone tunnels at the femoral and tibial insertion sites and the sites and the bone tendon interface is a weak link in the early healing period due to slow rate of healing. We hypothesized that an addition of bone growth factor like Sadat-Habdan mesenchymal stimulating peptide (SHMSP) could enhance bone tendon healing rate so that re-rupture of the tendon does not take place. Methodology: Twenty skeletally mature rabbits underwent ACL reconstruction of the right knee. In 10 of the rabbits at the site of the tendon-graft 5 mg/kg body weight of SHMSP was put in the bone tunnel. In 10 other animals, nothing was added. At eight and 12 weeks 5 animals from each group were sacrificed. The tendon-graft site was harvested and sent for histopathological examination to assess the healing at the tendon-bone graft to the tibial tunnel. Results: There were no deaths in both the groups. One rabbit of the control group developed an infection. In all the animals of the study group from 4 weeks onward showed bone formation, wherein the control group only granulation tissue was observed. By 8 weeks in the study group, the canal was totally obliterated with the new bone formation which extended onto the periosteal area. In the control, there was minimal change in the formation of the new bone formation. Conclusion: Addition of a growth factor like SHMSP would enhance the osteo-integration of the tendon-graft in the bony tunnel after ACL reconstruction in vivo.
  2 1,818 386
Short-term acute effects of gutkha chewing on heart rate variability among young adults: A cross-sectional study
Afreen Begum H Itagi, Dimple Arora, Navin A Patil, Sandeep Anant Bailwad, GY Yunus, Ankit Goel
January-March 2016, 6(1):45-49
DOI:10.4103/2229-516X.174008  PMID:26958522
Background and Objectives: An increase in the consumption of smokeless tobacco has been noticed among high school, college students, and adults. Despite the antiquity and popularity of chewing tobacco in India, its effects have not been investigated systematically in humans. The aim of this study was to investigate acute effects of gutkha chewing on heart rate variability (HRV) among healthy young adults. Materials and Methods: A total of 60 young adult males were included in the study. Each individual was asked to chew tobacco and subjected to HRV analysis. HRV analysis using short-term electrocardiogram recording was used to measure HRV parameters before gutkha chewing and at 5, 15, and 30 min after chewing tobacco. One-way analysis of variance and paired t-test was used to assess changes over time. Results: There was a significant increase in heart rate (HR) during tobacco chewing. Mean HR at baseline measured 73.0 ± 6.2 bpm. There was a rise in mean HR to 83.7 ± 9.1 bpm at 5 min during tobacco chewing and gradual reduction to baseline observed after 15 min followed by no significant change till 30 min. The normalized low-frequency power and LF/high-frequency (HF) power ratio were elevated after 5 min; however, normalized HF power was reduced after 5 min tobacco chewing. Conclusion: Gutkha is closely associated with traditional cardiovascular risk factors as detected by a transient enhancing sympathetic activity during tobacco chewing in the form of increased HRV parameters or an imbalance between sympathetic and parasympathetic neural activity among healthy young adults.
  2 1,730 232
Delayed migration of a bullet from loin to scrotum
Gouranga Dutta, Nandini Das, Jayanta Bain
January-March 2016, 6(1):66-67
DOI:10.4103/2229-516X.174020  PMID:26958528
Here, we report a rare case of migration of a foreign body has occurred from loin to scrotum. A 35-year-old male patient presented with right sided scrotal mass, on exploration it was found to be a metallic bullet. The patient had a history of gunshot injury in his loin 8 years back and was treated conservatively that time. The probable explanation to this mysterious incident may be that, the bullet might have entered the peritoneal cavity through the loin, but did not cause any extensive damage, so the patient well responded to the initial conservative management. With time, due to changes in abdominal pressure or may be due to gravitational force, it had migrated to the dependent scrotum through the patent processus vaginalis. So, this case signifies that a foreign body can migrate through the body planes and get settled far from the primary place.
  1 1,439 135
Serum prolactin in patients with liver disease in comparison with healthy adults: A preliminary cross-sectional study
Sumit Kant Jha, Sridharan Kannan
January-March 2016, 6(1):8-10
DOI:10.4103/2229-516X.173984  PMID:26958514
Introduction: Studies from the west have shown raised prolactin levels in patients with liver disease. Considering the lacunae on Indian context, we conducted the present study with an objective to assess the prolactin levels in patients with cirrhosis and viral hepatitis with or without features of encephalopathy. The data presented here are the results of the preliminary analysis. Materials and Methods: The present study was a prospective, cohort study among patients diagnosed as either viral hepatitis or cirrhosis liver. A cohort of normal healthy adults was selected based on history and laboratory investigations (complete blood count, liver and renal function tests). Serum prolactin was measured for all the study participants, and Kruskal-Wallis H-test with post-hoc Dunn's test was used to analyze the significance of the differences in the levels between various groups. Tests of diagnostic accuracy were used to assess the prediction capability of serum prolactin with a cut-off level of 50 ng/ml. Results: A total of 70 patients (10 - normal healthy; 25 - acute viral hepatitis; 35 - cirrhosis liver) were recruited in the present study with the median (range) age in years of 56 (34-68) and male: female ratio of 2:1. A statistically significant (P < 0.05) increase in the serum prolactin was observed in patients with cirrhosis with or without encephalopathy. But, among the patients with viral hepatitis, a significant elevation was observed only in patients with encephalopathy. Additionally, a statistically significant association was observed between serum prolactin levels with serum bilirubin (r =0.67, P = 0.04) and aspartate aminotransferase (r =0.72, P = 0.05). A cut-off value of 50 ng/ml of serum prolactin was found to predict the mortality. A total of 4/12 (33.3%) with prolactin value of <50 ng/ml died while 11/23 (47.8%) died with values >50 ng/ml (P < 0.05). Similarly, in patients with viral hepatitis with encephalopathy features, 1/4 (25%) with prolactin value of <50 ng/ml died while among those without any such features (n = 21), 9 (42.9%) died (P < 0.05). Conclusion: Serum prolactin has a significant association with patients with liver disease and predicts mortality.
  1 2,183 407
Unusual communications of the brachial plexus
Sarika Rachel Tigga, Surbhi Wadhwa, Preeti Goswami
January-March 2016, 6(1):68-70
DOI:10.4103/2229-516X.174021  PMID:26958529
The knowledge of innervation of pectoral muscles is important to surgeons performing breast surgeries, axillary lymph node dissection, harvesting pectoralis major/minor for flaps, and during neurotization procedures where the pectoral nerves are particularly at risk. The present case describes the innervation of the pectoral muscles solely by a nerve trunk arising from the ansa pectoralis (AP) - the loop of medial and lateral pectoral nerves. Interestingly, there was also a communication between the AP and roots forming the median nerve. It is imperative for the operating surgeons to be aware of these rare variations in order to prevent denervation and subsequent atrophy of the pectoral musculature.
  - 1,937 203
Twist to matricing: Restoration of adjacent proximal defects in a novel manner
Naveen Chhabra, Hitesh Gyanani, Vishnu Pratap Singh Rathore, Purnil Shah
January-March 2016, 6(1):71-72
DOI:10.4103/2229-516X.174022  PMID:26958530
The quality treatment in an efficient way is the road map to successful clinical practice. Various methods are employed to achieve goals. Refurbishment of the adequate marginal ridge, proximal contact, and contour are the prime challenges in restoring two adjacent proximal defects. This paper presents an overview of achieving satisfactory proximal restorations in a time saving innovative manner.
  - 1,645 210
Oral teratoma
Shreesh S Kolekar, Tejas Chincholi, Nitin Nangare, Ritvij Patankar
January-March 2016, 6(1):54-56
DOI:10.4103/2229-516X.174015  PMID:26958524
For congenital teratomas, oropharyngeal cavity is one of the rarest sites (2% of all teratomas). They are rarely picked up by prenatal ultrasonography. Postnatally, newborns present with respiratory distress and at this point role of pediatricians is very crucial in establishing secure airway after which they need to be carefully evaluated and surgically managed. We present a female neonate with palatal teratoma which was treated successfully with surgery.
  - 3,707 222
Cancer generated lactic acid: Novel therapeutic approach
Kapil Gupta
January-March 2016, 6(1):1-2
DOI:10.4103/2229-516X.173976  PMID:26958512
  - 1,773 333
The post-analytical phase of histopathology practice: Storage, retention and use of human tissue specimens
Supriya Nikita Kapila, Karen Boaz, Srikant Natarajan
January-March 2016, 6(1):3-7
DOI:10.4103/2229-516X.173982  PMID:26958513
There are several aspects to a histopathology practice besides the acquisition of biopsy specimens and histopathological diagnosis. Pathology Departments are home to an abundant source of knowledge in the form of stored specimens and slides. We attempt to highlight the importance of regulation of storage, retention, and appropriate use of human tissue material in research and ownership rights to the same. We also discuss requirement and waiver of informed consent for scientific work involving the use of such tissues, which in the absence of defined laws come under the purview of Institution Review Boards. Pathology Departments, under the binding of the parent institution, are conceded the responsibility of maintenance and retention of pathology specimens. This communication highlights some of the important aspects in human tissue material handling and research, underscoring the necessity for established regulations regarding the same.
  - 2,185 358
Oral exfoliative cytology as a screening tool for iron overload in ß-thalassemia patients
Ajit Singh Rathore, Neha Keshri, Devi Charan Shetty, Saurabh Juneja
January-March 2016, 6(1):28-30
DOI:10.4103/2229-516X.174005  PMID:26958519
Background: Increased iron overload is frequent problem in thalassemia patients, and this is monitored by serum ferritin levels or chemical assessment of the iron levels in liver tissue. However, repeated monitoring of serum ferritin levels to assess the iron overload is an invasive procedure associated with practical problems. Aims: To use Perl's Prussian blue reaction to evaluate the iron overload in beta-thalassemia patients by staining the oral cytosmears. Materials and Methods: The study comprised 35 patients diagnosed with beta-thalassemia. Cytosmears were prepared from exfoliated oral epithelial cells, fixed in 70% ethanol and stained with Perl's Prussian blue stain for detection of blue colored granules in the cytoplasm. Results: 29/35 (82.9%) cases showed a positive reaction for Perl's Prussian blue reaction while 6/35 (17%) cases did not show the presence of blue colored granules in the oral cytosmears. The presence of iron detected by Perl's Prussian blue reaction correlated with serum ferritin level (P < 0.05). Conclusion: Perl's Prussian blue reaction can be used to evaluate the iron overload in beta-thalassemia patients by staining the oral cytosmears. It is a simple and noninvasive method for assessment of iron overload in such patients.
  - 1,917 228