iosr-JDMS   Volume-13 ~ Issue-4 ~ April-2014

Abstract: In cases with proved breast malignancy axillla can be evaluated pre-operatively with the help of sonographic criteria and one can proceed directly to single-stage breast and axillary surgery without SNLB. Objectives: To assess the efficacy of preoperative ultrasonography of ipsilateral axilla as a non invasive modality for lymph node involvement in breast carcinoma patients. METHODOLOGY: 57 patients with proven breast malignancy underwent ultrasound of axilla & usg guided FNAC preoperatively. Results: Out of 164 lymph nodes, USG labelled 52 lymph nodes as normal(benign) & 112 abnormal(indeterminate+suspicious) Out of 52 normal lymph nodes on USG 43 were true negative on FNAC & out of 112 abnormal L.nodes 106 were found true positive on FNAC, with Sensitivity=92.2%, Specificity=87.8%, NPV =82.7%, PPV=94.6%. Conclusion: axillary ultrasound and ultrasound-guided FNA is a rapid, nonmorbid & cost effective method of axillary staging in breast carcinoma patients and should become a routine part of patient care because it will spare many patients from undergoing SLNB and unnecessary ALND
Keywords: axillary lymph node, breast, malignancy, preoperative, usg.

[1]. Fisher, B et al: Relation of number of positive axillary nodes to the prognosis of patients with primary breast cancer. An MSABP update. Cancer 1983: 52: 1551–7.
[2]. A O'Connor: Preoperative Ultrasound Assessment of Axillary Lymph Nodes in Breast Cancer: Histopathological Correlation in 100 Cases.
[3]. Yang WT, Ahuja A, Tang A, Suen M, King W, Metreweli C. High resolution sonographic detection of axillary lymph node metastases in breast cancer. J Ultrasound Med 1996; 15:241-246
[4]. Bonnema J, Van Geel AN, Van Ooigen B, Mali SPM et al. Ultrasound Guided Aspiration Biopsy For Detection Of Non Palpable Axillary Node Metastases In Breast Cancer Patients: New Diagnostic Method. World J Surg 1997; 21:270-4.
[5]. Yang WT, Chang J, Metreweli C. Patients With Breast Cancer: Differences In Colour Doppler Flow And Gray Scale Us Features Of Benign And Malignant Axillary Lymph Nodes. Radiology 2000;215:568-73.

Abstract: This study aimed at determining the prevalence and factors associated with enuresis in Dogarawa community of Kaduna state, North western Nigeria. Using a structured questionnaire, the prevalence of enuresis was determined amongst apparently healthy 300 children aged 5-17 years from 15th September, 2010 to 20thJanuary, 2011.The prevalence of enuresis was 26.3%. Males accounted for 69.6% (55 subjects) while females made up 30.4% (24 subjects) of those who were enuretic. The relationship between gender and prevalence of enuresis was statistically significant (χc2 = 8.92, df = 1, p< 0.05). All the enuretic children had primary enuresis, no case of secondary enuresis was recorded. There was also no case of strict diurnal enuresis. Sixty-five (21.7%) of the enuretic children had strict nocturnal enuresis and 14 (4.7%) had combined nocturnal and diurnal enuresis. The prevalence of enuresis decreased with increasing age and this was statistically significant (χ2 = 16.3, df =3, p< 0.05).Although not statistically significant, enuresis was commoner in children from low socio-economic background and amongst first order births. There was a positive association between family history of bedwetting and prevalence of enuresis (χc2=124.2, df=4, p < 0.05). The high prevalence of enuresis in this community warrants further studies and appropriate interventional measures.
Keywords: Childhood, Enuresis, Dogarawa, Enuretic, Prevalence.

[1]. Erdogan A, Akkurt H, Boettjer NK, et al. Prevalence and behavioural correlates of enuresis in young children. J Paediatr Child Health. 2008; 44(5):297–301.
[2]. Shreeram S, He JP, Kalaydjian A, Brothers S, Merikangas KR. Prevalence of enuresis and its association with attention – deficit/hyperactivity disorder among U.S. children: results from a nationally representative study. J Am Acad child Adolesc Psychiatry 2009; 48 (1):35 – 41.
[3]. Gulumser D, Sevim S, Serap B, Saadet Y. Prevalence of nocturnal enuresis and related factors in children aged 5-13 in Istanbul. Iran J Pediatr. 2012; 22(2): 205–12.
[4]. Ozkan KU, Garipardic M, Toktamist A, Karabiber H, Sahinkanat T. Enuresis prevalence and accompanying factors in school children: a questionnaire study from southeast Anatolia.UrolInt 2004; 73 (2): 149-55.
[5]. Bourquia A, Chihabeddine K. Enuresis: epidemiological study in Moroccan children. Saudi J Kidney Dis Transpl 2002; 12(2):151-4.

Paper Type	:	Research Paper
Title	:	Intrathoracic tumors in contact with the chest wall – ultrasonographic and computed tomography guided biopsy comparative evaluation
Country	:	Egypt
Authors	:	Yaser G. Abish, Ahmad Okasha Mohammed
	:	10.9790/0853-13421116

Abstract: To retrospectively compare the outcome of computed tomography (CT) and ultrasonography (US) guidance when sampling a consecutive series of peripheral lung or pleural lesions. Institutional review board approval was obtained, and the informed consent requirement was waived. From March 2010 to July 2012, 550 thoracic biopsies were performed at Al Azher unveristy hostiptals (cairo and assuit)Damanhour Oncolgy Center . Among these, 260 lesions in 260 patients (110 men, 150 women; mean age, 66 years ± 23 [standard deviation]; 81 pleural lesions; 179 pulmonary lesions) had pleural origin or were peripherally located in the lung with a small amount of pleural contact. These lesions were sampled with either CT (162 patients; mean age, 65 years ± 22; 52 pleural lesions, 110 peripheral pulmonary lesions) or US (98 patients; mean age, 66 years ± 16; 29 pleural lesions, 69 peripheral pulmonary lesions) guidance by using an 18-gauge modified Menghini needle. Procedure duration, postprocedural pneumothorax or hemorrhage, and sample adequacy were recorded. Fisher exact test, log-rank test, and Mann-Whitney U test were performed.
Keywords: Intrathoracic tumors ,Ultrasound, Computriazd tomography.

[1]. Carrafiello G, Laganà D, Nosari AM, et al.. Utility of computed tomography (CT) and of fine needle aspiration biopsy (FNAB) in early diagnosis of fungal pulmonary infections: study of infections from filamentous fungi in haematologically immunodeficient patients. Radiol Med (Torino) 2006;111(1):33–41.
[2]. Cheung YC, Chang JW, Hsieh JJ, Lin G, Tsai YH. Adequacy and complications of computed tomography–guided core needle biopsy on non–small cell lung cancers for epidermal growth factor receptor mutations demonstration: 18-gauge or 20-gauge biopsy needle. Lung Cancer 2010;67(2):166–169.
[3]. Solomon SB, Zakowski MF, Pao W, et al.. Core needle lung biopsy specimens: adequacy for EGFR and KRAS mutational analysis. AJR Am J Roentgenol 2010;194(1):266–269.
[4]. Gupta S, Madoff DC. Image-guided percutaneous needle biopsy in cancer diagnosis and staging. Tech Vasc Interv Radiol 2007;10(2):88–101.
[5]. Schubert P, Wright CA, Louw M, et al.. Ultrasound-assisted transthoracic biopsy: cells or sections? Diagn Cytopathol 2005;33(4):233–237.

Paper Type	:	Research Paper
Title	:	Is Decompressive Craniectomy is an effective method in treatment of brain swelling in traumatic brain injury
Country	:	Egypt
Authors	:	Mostafa Kamel El Fouly
	:	10.9790/0853-13421720

Abstract: Decompressive craniectomy is considered a line of treatment strategy that indicated after failure of conservative management.
Aim of work: to detect the effectiveness of decompressive Craniotomy as treatment of brain swelling in traumatic brain injury Methods: A cross-sectional study was employed including 20 patients of severe closed head injury in age between 18 and 48 years old operated with decompressive craniectomy and duraplasty. All patients had Glasgow coma score 4 to 8. We follow up the cases at least 6 months following Glasgow outcome scale score. Results: The poor outcome were reported with score 1, 2 and 3 (death, vegetative and severe disability in 35% of cases, while good prognosis are reported in score 4 and 5 (moderate, mild or no disability). The outcome is better with younger patient, high Glasgow coma score, low intracranial pressure and presence of papillary reflex. Conclusion: .Decmpressive craniotomy and duraplasty is a safe procedure that correct the intercranial, so improving the outcome. It is recommended for cases of severe head injury with cerebral swelling in CT scan and medically refractory intracranial hypertension with clinical deterioration neurologically.
Keywords: Brain edema, intracranial pressure, papillary reaction, craniectomy, and head trauma.

[1]. Chang V., Hartzfeld P., Langlois M., Mahmood A. and Seyfried D.: Outcome of cranial repair after craniectomy .Avalable from : http//www.ncbi.nlm. nib. gov/pubmed/19612971, J . Neurosurgery, 2009.
[2]. De Luca G.P., Volpin L., Fornezza U. et al.: The role of decompressive craniectomy in treatment of uncontrollable posttraumatic intracranial hypertension . Acta Neurochir. Suppl , 76:4o1-404, 2000.
[3]. Guerra W.K.,Gaah M.R.,Dietz H., Mueller J., Picck J., and Fritsch M.J. :Surgical decompression for traumatic brain swelling, indication and results . J. Neurosurgery, 90 :187-196, 1999 .
[4]. Huchinson P.,Timofeev I., and Kirkpatrick P. : Surgeryfor brain edema : decompressive craniectomy . Available from ; http:/www. medscape .com /viewarticle/ 559009 _2), 2007 .
[5]. Jacques A., et al.:Brain Trauma Foundation :Americation Association of Neurological Surgeons .Joint Selection on Neurotrauma and Critical Care : Initial management .J. Neurotauma, 17:463-469, 2000.

Paper Type	:	Research Paper
Title	:	Outcome of Emergency Surgery in HIV Infected Patients in Jos
Country	:	Nigeria
Authors	:	Isichei M. W., Misauno M. A., Shitta A.H., Isichei C. O.
	:	10.9790/0853-13422123

Abstract: Surgery in the immune compromised such as the HIV infected patients is a subject shrouded with some doubt and controversy because of the complications that are thought to arise following the surgery. The surgeries performed during the study period were not minimally invasive or highly specialized and was performed by general practitioners, general surgeons and gynecologist. We evaluated the outcomes of emergency surgeries among our patients using the CD4 cell count and the Hemoglobin concentration as predictors of outcome in HIV patients undergoing surgery in our clinic. This was a combined retrospective and prospective evaluation of HIV positive patients who underwent surgery at a Nongovernmental medical facility that renders free care to H IV positive patients in Jos Plateau State from January 2011- December 2013.All consenting patient and those with available medical records were recruited into the study.
Keywords: Outcome, emergency, surgery, HIV infected.

[1]. Becker K, Erckenbrecht JF. [Preoperative risk assessment and perioperative management of HIV-infected patients]. Med Klin (Munich). 2001 Jan 15;96(1):26-31.
[2]. Bluvshtein GA, Kulakov AA. [Clinical features of surgical diseases at the patients with HIV/AIDS]. Khirurgiia (Mosk). 2007(5):51-5.
[3]. Songu M, Portmann D. Otologic surgery in HIV-infected patients. Rev Laryngol Otol Rhinol (Bord). 2008;129(1):61-3.
[4]. Huang WC, Kwon EO, Scardino PT, Eastham JA. Radical prostatectomy in patients infected with human immunodeficiency virus. BJU Int. 2006 Aug;98(2):303-7.
[5]. Smirnov GG, Buliskeriia TN, Khachatrian NN, Volodina VN, Arutiunian EN, Lazutkina LI. [Surgical interventions in HIV-infected and patients with AIDS]. Khirurgiia (Mosk). 2000(7):46-50.

Paper Type	:	Research Paper
Title	:	A Clinical Study of Traumatic Perforation of Tympanic Membrane
Country	:	India
Authors	:	Dr. Sarojamma, Dr. Saurabh Raj, Dr. H. S. Satish
	:	10.9790/0853-13422428

Abstract: To evaluate the various etiologies of traumatic tympanic membrane perforations and their prognosis and outcome with its various means of management. In this study most of the patients were females with their presenting complaint was hearing loss, on pure tone audiogram shows conductive in nature with 26-35 dB hearing loss.In all these cases the healing rate was 100% in conservative as well as myringoplasty treatment. Prospective study, Study period: November 2011- may 2013, Place of study: Sri Venkateshwara ENT Institute, Victoria Hospital and Bowring and Lady Curzon Hospital attached to BMCRI, Bangalore, Sample size: 50. In our study, none of the patients got infected in the conservative treatment group. The average time taken for healing by the uninfected cases was 34.78 days. The shortest time taken was 21 days and the longest was 75 days and it can be shown the improvement in hearing as shown by the audiometry report in both the groups, conservative treatment (18.375dB) and Myringoplasty group (19.44 dB).
Keywords: Traumatic perforation of tympanic membrane; Pure Tone Audiometry; Tympanometry.

[1]. Peter JK, Paul HK: Principle of trauma. In Byron J Bailey Head and Neck Surgery - Otolaryngology Volume 61. 3rd edition, Edited by: Byron J, Karen H, Gerald B, Harold C, Jonas T, Eugene M, Robert K, Anthony Pazos, Chri Gralapp, Lippincott Williams & Wilkins Publishers; 2001: 69 of 202.
[2]. Ologe FE: Traumatic perforation of tympanic membrane in Ilorin, Nigeria. Nig J Surg 2002, 8(1):9-12.
[3]. Da Lilly-Tariah OB, Somefun AO: Traumatic perforation of the tympanic membrane in University of Port Harcourt Teaching Hospital, Port Harcourt. Nigeria., Niger Postgrad Med J 2007.
[4]. Chun SH, Lee DW, Shin JK:A Clinical Study of Traumatic Perforation Of Tympanic Membrane,Department of Otolaryngology, Hanil General Hospital, Seoul, Korea.
[5]. Kristensen S et al: Traumatic tympanic membrane perforations:complications and management.Ear Nose Throat J.2009 Jul;68(7):503-16.

Paper Type	:	Research Paper
Title	:	Antegrade flexible intramedullary nailing for fixation of displaced midshaft clavicle fractures
Country	:	India
Authors	:	Dr. Shishir S. M., Dr. Lingaraj, Dr. Ashish Philip Zachariah, Dr. R. Kanagasabai
	:	10.9790/0853-13422937

Abstract: Fractures of the clavicle are common injuries with an incidence of 5-10% of all fractures[1]. These fractures are generally managed conservatively. Titanium elastic nails are a promising minimally invasive treatment for displaced mid-clavicular fractures, which may be an alternative to plate fixation or even non-operative treatment. The aim of the present study was to evaluate the functional and radiological results of intramedullary fixation of mid-clavicular fractures. Between January 2007 and June 2013, 48 patients with type A and type B middle third clavicle fractures (OTA Classification) underwent flexible intramedullary nailing with titanium elastic nail. Implant removal was performed in all the patients after the fracture united completely. The mean constant shoulder score for 47 patients at 6 weeks was 56.98 (range: 44-72), at 3 months was 91.25 (range: 54-98), at 6 months was 96.38 (range:64-100), at 12 months was 98.75 (range:68-100), at 18 months was 99.50 (range:78-100), and at the end of 24 months it was 99.58 (range:80-100).
Keywords: Clavicle plating, Intramedullary clavicle nailing, middle 1/3 rd clavicle fractures, Titanium elastic nailing System (TENS).

[1]. GereonSchiffer, ChristophFaymonville, Emmanouil Skouras, Jonas Andermahr, Axel Jubel .MidclavicularFracture:Not Just a Trivial Injury. Current Treatment Options.DeutschesÄrzteblatt International | DtschArzteblInt 2010; 107(41): 711–7.
[2]. Neer C. S. (1984) Fractures of the clavicle. In : Rockwood C. A., Green D. P. (eds.). Fractures in Adults. 2nd ed. Philadelphia : JB Lippincott 707-713.
[3]. Nordqvist.A.,Petersson.C. The incidence of fractures of the clavicle.ClinOrthop, 1994, 300: 127-132.
[4]. Rowe C. R. An atlas of anatomy and treatment of mid-clavicular fractures.ClinOrthop, 1968, 58: 29-42.
[5]. Allman F. L. Fractures and ligamentous injuries of the clavicle and its articulation. J Bone Joint Surg, 1967, 49-A: 774-784.

Paper Type	:	Research Paper
Title	:	Immediate Natural Tooth Pontic- A Case Report
Country	:	India
Authors	:	Dr. Ravikumar Akulwar, Dr. Ajit Jankar, Dr. Ashwini Khandare
	:	10.9790/0853-13423840

Abstract: Sudden tooth loss in the anterior region can be due to trauma, periodontal disease or endodontic failure. The loss of anterior teeth can be psychologically and socially damaging to the patient. Despite a wide range of treatment options available, traumatized teeth may be inevitably lost on certain occasions. This paper describes the immediate replacement of incisors using a composite resin with the natural tooth crown as pontic. This immediate provisional restoration provides exact repositioning of the coronal part of the extracted tooth in its original intraoral 3-dimensional position. This chair side technique does not required laboratory involvement.
Key words: composite, esthetic, interim restoration, natural tooth pontic.

[1] Daly CG. Use of patient's natural crown as the pontic in a composite resin-retained temporary bridge. Aust dent journal, 28:1983;
301-3.
[2] Ashley M, Holden v. An immediate adhesive bridge using the natural tooth.. British Dent journal,184 ; 1998: 18-20 .
[3] Safirstein JJ, Owens BM, Swords RL. The resin retained natural tooth pontic: a transitional esthetic solution journal,ten dent
assoc, 8: 2001; 31 -33.
[4] Abishek parolia, kundabala M Shenoy, Manuel Thomas, Mandakini Mohan. Aust endod journal, 36; 2010; 35-38.
[5] Beli S, Ozer f. A simple method for single anterior tooth replacement. Journal Adhes Dent: 2:2000: 67-70.

Paper Type	:	Research Paper
Title	:	Knowledge Regarding Diabetes among Women Residing In Kolkata, West Bengal, India
Country	:	India
Authors	:	Sonali Majumdar (Das), Sarmistha Mukherjee, Anil Baran Singhamahapatra, Munna Das
	:	10.9790/0853-13424146

Abstract: Prevalence of Diabetes Mellitus has increased dramatically in India especially Eastern region which has insufficient resources to combat the scourge. Women are the worst sufferers of the condition, but limited study exists regarding knowledge of Diabetes among the resident women. Kolkata being the most important city of Eastern India, so the present study was undertaken to assess knowledge regarding Diabetes among women residing in Kolkata.
Key words: Diabetes, Knowledge, Kolkata, West Bengal, Women.

[1]. Diabetes Atlas 3rd edition, International Diabetes Federation, 2006, 5.
[2]. M.Legato et al, "Gender- specific care of patients with diabetes: Review and Recommendations", Gender Medicine, 3, 2006,131.
[3]. A. Ghaffar et al, "Burden of non-communicable diseases in South Asia", BMJ, 328, 2004, 807-10.
[4]. P. Balagopal ,N. Kamalamma , T.G.Patel ,R. Misra, A Community-Based Diabetes Prevention and Management Education Program in a Rural Village in India, Diabetes Care, 2008, 31, 1097–1104.
[5]. A.Ghosh, M.Bhagat, Indian diabetic risk score according to menopausal status in Asian Indian women: the Shantiniketan Women Study, Journal of Diabetes, 2009, 1, 140-141.

Paper Type	:	Research Paper
Title	:	Effect of whole body vibration on bone mineral density in children with myelomeningocele
Country	:	Egypt
Authors	:	Hatem A. Emara
	:	10.9790/0853-13424751

Abstract: In patients with myelomeningocele (MMC), a high number of fractures occur in the paralyzed extremities, affecting mobility and independence.The purpose of this study was to investigate the effect of whole body vibration on bone mineral density in children with MMC. Methodology:20 children with MMC ,fromboth sexes, participated in this study.Their age ranged from 2 to 5 years.They were divided randomly into 2 groups of equal number:Control group(groupA) this group received a specially designed physical therapy program and group B( study group) this group received the same exercise program given to group A ,in addition to, whole body vibration(WBV).Bone mineral density (BMD) of the legs, femur and spine was measured using lunar prodigy advance apparatus pre and after 3 months.Results:There was significant increase in bone mineral density in both groups with more improvement in the study group.Conclusion:Whole body vibration can be used as an effective method for increasing BMD for children with MMC.
Keywords: Bone mineral density, Myelomeningocele ,whole body vibration.

[1] S.L. Boulet, Q .Yang, C .Mai et al., Trends in the postfortification prevalence of spina bifida and anencephaly in the United States, Birth Defects Res A Clin Mol Te ratol,82,2008,527-532.
[2] L.E. Mitchell, N.S. Adzick, J. Melchionne, et al., Spina bifida, Lancet ,364,2004,1885-1895.
[3] WHO Scientific Group on the Prevention and Management of Osteoporosis. Prevention and management of osteoporosis: report of a WHO scientific grou, Internet Communication, 2007.
[4] K.M.Valtonen, L.A.Goksor, O.Jonsson, D.Mellstrom, H.T. Alaranta and E.R. Viikari-Juntura , Osteoprosis in adults with meningomyelocele, an unrecognized problem at rehabilitation clinics,Arch. Phys. Med. Rehabil,87(3),2006, 376-82-305.
[5] K.Parsch , Origin and treatment of fractures in spina bifida,Eur.J. Pediatr. Surg, 1(5)1991, 298-306.

Paper Type	:	Research Paper
Title	:	Lymphoepithelial Carcinoma with Special Reference to Nasopharynx-A Study of 35 Cases
Country	:	India
Authors	:	Dr. T. Subachitra, Dr. A. Sundaram, Dr. Chithra Srinivasan, Dr. R. Sathyalakshmi
	:	10.9790/0853-13425257

Abstract: Lymphoepithelial carcinoma is an undifferentiated neoplasm arising in the nasopharyngeal mucosa.The incidence of Lymphoepithelial carcinoma in the Indian subcontinent is not well documented.The aim of the present study compares the incidence, age,sex distribution ,clinical presentation ,and relationship of EBV virus and LEC in sporadic cases of LEC from India world statistics. And also the role of LatentMembraneProtein-1in diagnosing the EBV association.Malignant lesions with prominent lymphoepithelial component were taken for the study .Pancytokeratin,lymphoma markers were used to confirm the histopathological diagnosis.LMP-1 was used to demonstrate EBV in tissue sections.It was observed that nasopharynx being the commonest site for LEC.It showed male preponderance with bimodal age distribution.Intense staining of LMP-1was demonstated in LEC of nasopharynx than other sites. Hence confirming the strong EBV association in LEC of nasopharynx. It was also observed that LEC with early lymphnode metastasis showed intense LMP-1 staining.Thus confirming the progressiveness and metastatic potential of LMP-1 expression in EBV associated LEC when compare to EBV negative LEC. Hence LMP-1 proves to be a useful IHC marker in establishing the metastatic potential of LEC and the need for early diagnosis and treatment of LEC.
Key Words: Lymphoepithelial carcinoma,Nasopharynx,Latent membrane protein-1 ,EBV virus.

[1]. Muhitranga A,Tanunyitthawongese C,Pornthanakarem W,KerekhanjanarongV,Yenrundi S,et al.genomic alteration in nasopharyngeal carcinoma;Epstein Barr virus infection.BritJ cancer1997;76:770-6
[2]. James E,Marks M.D,Jessi Linn Philips,Herman R Menck et al nasopharyngeal carcinoma in India.Cancer 1998;83:582-588
[3]. Abdel Majid Khabir,Hela Karry,Sandrine Rodriguez,Mathieu Rose et al EBV Latent Membrane Protein -1 Abundance correlates with patent age but not with the metastatic behaviour in North African nasopharyngeal carcinoma.Virology J 2005;2:39
[4]. Zong YS,Sham JS,Ng MH,Ou XT,Guo YQ,Zheng SA et al,Immunoglobulin A against capsid antigen of Epatein Barr virus and Indirect mirror examination of the nasopharynx in the detection of Nasopharyngeal cancer in a high risk population.J Natl Cancer Inst 1999;91:796-800
[5]. Koppikar SB,Advain SH,GopalR,Dinshaw KA,Pandle SC,Nair CN,et al, Nasopharyngeal carcinoma in India :End result analysis(1980-1984).U Surg Oncol 1988:39:179-82.

Paper Type	:	Research Paper
Title	:	Hormonal Assay in Infertility Cases 0f Women
Country	:	India
Authors	:	M. Indira, Ch. Sudhakar babu
	:	10.9790/0853-13425862

Abstract: The present study was undertaken to evaluate the endocrinal causes of infertility in women .Infertility affects 10-15% 0f couples 0f reproductive age groups and female factor is responsible for 40 – 50 %of cases , most common causes of female infertility are ovulatory disfunction and thyroid hormone ,and estrogen ,progestiron ,and serum Prolactin dysfunction . Estimation of FSH,LH,and thyroid hormones useful in diagnosis the type of ovulatory disfunction and useful in deciding the mode of treatment. The present study has been undertaken to evaluate hormone levels (FHS ,LH, ) in ovulatory disfunction cases of female infertility after elimination of PCOD the fertility of female reproductive system is maintained by prevaling hormonal mainly which is delicately balanced by Hypothalamic ,Pituitary ,Thyroid, adrenal and gonadal axis .The problem of infertility are faced from the time of evaluation of man will probably remain with as forever .little is added every year to the present understanding and more remains unknown Infertility affects 10-15% of couples of reproductive age groups .Male factor in 25-40 % female factor in 40- 55% .male and female in 10%, unexplained in 10% cases are responsible for infertility .ovulatory dysfunction is responsible for upto 40% of female cases and for 20-25% of total infertility cases
Key words: Female infertility, FHS, LH, TSH, T3,T4, Hypo& Hyper Gonadotrophic anovulation.

[1]. Allan G. Gornal, Allan W.Luxton, Bhagu R. Bhavnani: Endocrine disorders. Applied Biochemistry of clinical Disorders, 2nd edition, 285-296.
[2]. Ann M. Gronowski; Mary Landau - Levine: Reproductive Endocrine Function, Tietz Textbook of clinical Chemistry, 3rd edition. 1606- 1626.
[3]. Ervin E. Jones, Stephen P. Boyers: Ovarian evaluation - Amenorrhea. Decision making in Infertility, 1st editil on 12- 21
[4]. Babek Imani et al: Ovulation induction in normogonadotropic infertility. Journal of clinical Endocrinology and Metabolism, Vol.83, No.7, 2361-2365.
[5]. Curcl:1od A. et al : Value and Limitations of FSH and LH assay in female sterility and amenorrhea. Schweiz Med Wochenschr, 31; 101 (30) : 1114 - 21.

Paper Type	:	Research Paper
Title	:	Comparative study of the efficacy of nanocrystalline silver dressing and silver sulfadiazine applied on burns in hospitalized patients
Country	:	Brazil
Authors	:	M. N. Silva, M. Taminato, A. L. R. Z. Beretta
	:	10.9790/0853-13426367

Abstract: Objective: To evaluate the efficacy of dressing based on silver as nanocrystalline silver and silver sulfadiazine in patients with burns and clinical signs of infection, in the healing process, seeking a favorable outcome of local therapy. Methods: A prospective and exploratory study, carried out with patients with burns with a quantitative approach by the method of clinical investigation. The study population comprised 30 patients, burn victims, aged between 03 and 40 years old. The patients had between 04% to 27% of Body Surface Burned (SCQ), with the majority of second degree burns. Topical therapy was performed in 30 patients with exudating wounds, while 15 patients received injections of silver sulfadiazine and 15 nanocrystalline silver. Results: Patients who used nanocrystalline silver showed significant improvement of the lesions in addition to decreased exudation and early epitheliazation after the second day of healing, while those who had used silver sulfadiazine began to show improvement from the fourth day of healing. Conclusions: The results with nanocrystalline silver showed a reduced incidence of exudate in comparison with the dressing made with silver sulfadiazine.
Keywords: Burns, Silver, Therapeutic use, Dressings.

[1]. V.D.S. Carlucci, L.A. Rossi, A.M.F.T. Ficher, E. Ferreira, E.C. Carvalho, Burn experiences from the patient´s perpective. Rev.esc.Enf.USP. 2007; 41(1):21-8.
[2]. D.A. Peters, C. Verchere , Healing at home: comparing chorts of children with médium-sized Burns treated as outpatients with in-hospital applied ActicoatTM to those children treated as inpatients with silver sulfadiazine. J.Burn Care Res.2006;27:198-201.
[3]. M.A. Cyrillo, Microrganismos, Microbiologia e suas aplicações. Prática Hospitalar, São Paulo. 2000; 8 : 41-43.
[4]. S. Erol et al. Changes of microbial flora and wound colonization in burned patients. Burns. 2004; 30: 357-61.
[5]. R. Strohal, M. Shelling, M.. Takacs, W. Jurecka , U. Gruber, F.Offner, Nanocrystalline silver dressing as na efficient anti-MRSA barrier: a new solution to na increasing problem.J.Hosp.Infec.2005;60(3): 226-30.

Paper Type	:	Research Paper
Title	:	Plesiomonas shigelloides diarrhea in Enugu area of south eastern Nigeria: Incidence, clinical and epidemiological features
Country	:	Nigeria
Authors	:	Nwokocha, A R C, Onyemelukwe, N F
	:	10.9790/0853-13426873

Abstract: The role of Plesiomonas shigelloides was determined in patients attending health centres and cottage hospitals in parts of Enugu State of Nigeria had diarrhoea. During the 12-month study (March 2012 – Feb 2013), P. shigelloides was isolated from 51 (7.2%) patients who had diarrhoea and none from 500 patients without diarrhoea (p<0.01) recruited from a match control group. The age and sex distribution of the P. shigelloides patients showed that the age group 19 – 31 months (16.7%) yielded the highest isolation for Plasiomonas shigelloides, while females 31 (60.8%) were higher than males 20 (39.2%), though the difference was not statistically significant (p>0,05). A seasonality distribution in favour of rainy season was also observed with the highest cases recruited in the periods June – August (54.9%) and September – October (23.5%). Only 2 (3.9%) were recruited between December and February. Thirty-seven (5.2%) patients had single infection with Plesimonas while 14 (2.0%) were co-infected with other bacterial pathogens.

[1]. Janda JM (2005). Family Enterobacteriaceaegenus xxvii. Plesiomonas Habs and Schubert 1962, Bergey's manual of systematic bacteriology, 2nd ed, vol. 2 In: D.J. Brenner, N.R, Krieg , J.T Staley , New York: Springe – Verlag. 740-744
[2]. Escobar, J.C. Bhavanani, D, Trueta, G, Ponce, K, Cevallos, W et al. (2012). Plesiomonas shigelloides infection, Ecuador,2004-2008. Emerging Infectious Diseases 18: 322-324.
[3]. Bodhidatta, L, Mc Daniel, P, Sornsakrin, S, Srijan, A, Serichantalergs, O, et al (2010) case control study of diarrhoeal disease aetiology in a remote area in western Thailand. American T. of Trop medicine and hygiene 83: 1106-1109
[4]. Ozdemir, O, Sari ,S, Terzioglus, Zenciroglu ,A (2010). Plesiomonas shigelloides sepsis and meningoencephalitis in a surviving neonate. J. Microbiol Immunal Infect. 43: 344-346
[5]. Schneider, F, Lang N, Reibke R, Michaely HJ, Hiddemann W. et al (2009). Plesiomonas shigelloides Pneumonia, Med mal Infect 39: 397-400.

Paper Type	:	Research Paper
Title	:	Primary Extraskeletal Ewings Sarcoma of Ala of Nose
Country	:	India
Authors	:	Dr. Irappa Madabhavi, Dr. Apurva Patel, Dr. Mukesh Choudhary, Dr. Asha Anand
	:	10.9790/0853-13427476

Abstract: Extra skeletal Ewing's sarcoma is often described as a tumour involving the soft tissues of the lower extremities and the para vertebral region. Ewing's sarcoma presents a rare tumour of the head and neck, and even rarer in the nasal cavity and/or paranasal sinuses. Primary Ewing's sarcoma of the ala of the nose has not been commonly described previously in the English literature. We present a case of primary Ewing's sarcoma of the nose in a 23-year-old male, presented as a fleshy mass in the ala of the left side of the nose with symptoms of nasal obstruction. The obstructing lesion was excised and microscopy showed a neoplasm composed of comparatively uniform undifferentiated cells forming solid nests. The cytoplasm of the cells was clear but poorly demarcated, partly vacuolated and contained much glycogen. The cells expressed the MIC2 gene (using the CD99 marker). Managed with wide local excision and all resection margins are microscopically free of tumour margins. Post-operative adjuvant chemotherapy was started with High-Risk protocol (vincristine, doxorubicin, cyclophosphamide and mesna alternating every 3 weeks combined ifosfamide and etoposide) and is under follow up. An extensive review of literature, to the best of our knowledge, did not reveal many cases of EES of ala of nose.
Keywords: Ewing's sarcoma, extra skeletal, nasal cavity, small round cell tumour.

[1]. Iriz A, Albayrak L, Eryilmaz A. Extra skeletal primary Ewing's sarcoma of the nasal cavity. Int J Pediatr Otorhinolaryngol 2007; 2:194-7.
[2]. Dahlin, D.C. (1978): Bone tumours, General aspects and data on 6,221 cases. Third Edition, Springfield, Illinois Charles C Thomas, 274-287.
[3]. Tefft M, Vawter GF, Mitus A. Para vertebral 'round cell' tumours in children. Radiology 1969; 92(7):1501-09.
[4]. O' Keeffe F, Lorigan JG, Wallace S. Radiological features of extra skeletal Ewing's Sarcoma. Br J Radiol 1990; 63(750): 456-60.
[5]. de Alava E, Kawai A, Healey JH, Fligman I, Meyers PA, Huvos Ag, et al. EWS-FLI1 fusion transcript structure is an independent determinant of prognosis in Ewing's Sarcoma. J Clin Oncol 1998 Aug; 16(8):2895.

Paper Type	:	Research Paper
Title	:	Reno alimentary fistulae
Country	:	Malaysia
Authors	:	Dr. J. V. Hardikar
	:	10.9790/0853-13427779

Abstract: Reno alimentary fistulae are rare. The article describes various types of reno alimentary fistulae including rarer calico colic fistula and vesico colic fistula due to diverticulosis. The clinical features and management is discussed; and the relevant literature reviewed.
Key words: reno alimentary fistulae,calico colic fistula, vesico colic fistula.

[1]. Colo-renal fistula: An unusual cause of hematochezia John D Wy etal World J Gastrointest Pathophysiol. 2010 August 15; 1(3): 106–108. Published online 2010 August 15 10.4291/wjgp.v1.i3.106 PMCID: PMC3097949 [2]. Martha K Terris, MD, FACS; Chief Editor: Edward David Kim, MD, FACS emedicine.medscape.com/article/441604-overview [3]. Silverman SG, Tuncali K, vanSonnenberg E, Morrison PR, Shankar S, Ramaiya N, Richie JP. Renal tumors: MR imaging-guided percutaneous cryotherapy--initial experience in 23 patients. Radiology. 2005;236:716–724. [PubMed] [4]. Arthur GW, Morris DG. Reno-alimentary fistulae. Br J Surg. May 1966;53(5):396-402. [Medline].
[5]. Vanderbrink BA, Rastinehad A, Caplin D, Ost MC, Lobko I, Lee BR. Successful conservative management of colorenal fistula after percutaneous cryoablation of renal-cell carcinoma. J Endourol. 2007;21:726–729. [PubMed]
*The author was Professor and head, department of Surgery at Seth G.S.medical College & K.E.M.Hospital ,Mumbai India.

Paper Type	:	Research Paper
Title	:	Dental Treatment in Asperger Syndrome
Country	:	Turkey
Authors	:	Halenur Onat, Gül Tosun,Yağmur Şener
	:	10.9790/0853-13428082

Abstract: Abnormal behaviours observed in children can be an expression of pathological childhood diseases involving neuromuscular systems, the first symptoms of mental retardation, or indications of behavioural disorders. Asperger Syndrome (AS) is a disorder that causes social difficulties, a stereotypical behavioural pattern and a limited range of interests. Dentists face various problems during treatment of such patients, such as a deficiency in communication and little cooperation. The purpose of this case report is to describe the dental treatment of a child with Asperger Syndrome. Dental treatment was performed under general anaesthesia. The Paediatric dentist should be aware of the symptoms of Asperger Syndrome, and how these can interfere with dental care.
Key Words: Asperger Syndrome, Behavioural Management, Dental Treatment.

[1]. Rabe-Jablonska J. [Affective disorders in the fourth edition of the classification of mental disorders prepared by the American
Psychiatric Association -- diagnostic and statistical manual of mental disorders]. Psychiatr Pol 1993,27:269-279.
[2]. Filipek PA, Accardo PJ, Baranek GT, Cook EH, Jr., Dawson G, Gordon B, et al. The screening and diagnosis of autistic spectrum disorders. J Autism Dev Disord 1999,29:439-484.
[3]. Gillberg IC, Gillberg C. Asperger syndrome--some epidemiological considerations: a research note. J Child Psychol Psychiatry 1989,30:631-638.
[4]. Vincent JB, Herbrick JA, Gurling HM, Bolton PF, Roberts W, Scherer SW. Identification of a novel gene on chromosome 7q31 that is interrupted by a translocation breakpoint in an autistic individual. Am J Hum Genet 2000,67:510-514.
[5]. Klin A. Asperger syndrome: an update. Rev Bras Psiquiatr 2003,25:103-109.

Paper Type	:	Research Paper
Title	:	An Anatomical Study of Mandibular and Accessory Mandibular Foramen in Dry Adult Human Mandibles of South Indian Origin
Country	:	India
Authors	:	Padmavathi G, Suman Tiwari, Varalakshmi KL, Roopashree R
	:	10.9790/0853-13428388

Abstract: Mandibular foramen is an important anatomical landmark for the inferior alveolar nerve blocks, mandibular osteotomies and implant treatment. A thorough knowledge of the anatomy of the mandibular foramen is very essential hence this study aims to determine the position of the mandibular foramen and incidence of accessory mandibular foramen in south Indian population.

[1]. Williams,P.L.,Bannister, L.H.Berry, M.M.,Collins.P.,Dyson.M.,Dussek.J.E.et.al. Gray's anatomy38th.ed.churchill Livingstone, 2000,576-7
[2]. Daw,J.L Jr., de la Paz, M.G., Han.H., Aitken, M.E., Patel,P.K, The mandibular foramen: an anatomic study and its relevance to the sagittal ramus osteotomy, J Craniofac Surg,10(6),1999, 475-9.
[3]. Erika Cvetko, Bilateral anomalous high position of the mandibular foramen: a case report, Surg Radiol Anat,10,2013.
[4]. Kanan Shah, Pratik Shah, Ajay Parmar, Study of the Location of the Mandibular Foramina in Indian Dry Mandibles, Global Research Analysis, 2(7), 2013,128-30
[5]. Das.S and Suri,R.K, An anatomico-radiological study of an accessory mandibular foramen on the medial mandibular surface, Folia Morphol,63,2004,511-13.

Paper Type	:	Research Paper
Title	:	Appropriate And Inappropriate Fresh Frozen Plasma (Ffp) Use In Coagulation Disorders
Country	:	India
Authors	:	M. A. Sameer, S. A. Deshpande, Vikas Dagar, Santosh Pawar, D. P. Meshram
	:	10.9790/0853-13428992

Abstract: The aim of this study was to evaluate the usage of fresh frozen plasma (FFP) according to indications and to reduce inappropriate usage. Method: A two year retrospective study was conducted in Dr.S.C.G.M.C.and hospital blood bank . Based on the guidelines published by college of American pathologist,national health and medical research council and Australian society for blood transfusion FFP usage were categorized into appropriate and inappropriate

[1]. Nagareka kulkarni , Evaluation of fresh frozen plasma usage at a medical college hospital-A two year study, International journal of blood transfusion and immunohematology,vol 2,2012,16-20.
[2]. Meltem AKKAS, Denya KOMUR ATAMAN, Canan AKMAN , Nalan METIN AKSU, Mehmet Ali KARACA , Salih AKSU , Mehmet Mahir OZMEN , Inappropriate fresh frozem plasma use in coagulation disorder , European journal of surgical science , 2011;2(2):38-41.
[3]. medicine, international 2012,2(1);19-24.
[4]. Practice parameter for the use of FFP, cryprecipitate and platelets,.Administration practice guidelibnes, development task force of the cologe of american pathologist, JAMA 1994; 271(10); 777-81
[5]. National health and medical research council, clinical practice guidelines on the use of blood components 2001.

Paper Type	:	Research Paper
Title	:	Gangrenous Adult Midgut Volvulus from Midgut Malrotation: A Case Report
Country	:	Nigeria
Authors	:	Uwaezuoke S. C., Udoye E. P.
	:	10.9790/0853-13429395

Abstract: Malrotation of the midgut is mainly a childhood congenital anomaly. Adult Midgut malrotation is rare with the clinical symptomatology varied and non-specific making pre-operative diagnosis difficult. Midgut volvulus from malrotation is a true surgical emergency requiring early intervention to prevent bowel necrosis and death.We report a 27yr old male who was referred to our centre with paralytic ileus post appendectomy. He underwent emergency laparotomy with findings of gangrenous volvulus involving almost the entire midgut from malrotation. He had bowel resection with jejunocolic anastomosis.

[1]. Tores AM, Ziegler MM; Malrotation of the intestine. World J Surg 1993, 17:326-331.
[2]. Strouse PJ. Disorders of intestinal rotation and fixation("malrotation"). PediatrRadiol 2004; 34: 837 – 851.
[3]. Papaziogas B, Patsas A, Paraskevas G, Tsiaousis P, Koutelidakis I, Christoforakis C, Atmatzidis K . Adult Intestinal Malrotation: A Case Report. The Internet Journal of Surgery. 2008 volume19 number 2
[4]. Sing S, Das A, Chawla AS, Arya SV, Chaggar J. A rare presentation of midgut malrotation as an acute intestinal obstruction in an adult: Two case reports and literature reviews.Int J Surg Case Rep 2013; 4:72-75(PMID:23123419 DOI:10.1016/j.ijscr.2012.10.005)