iosr-JDMS   Volume-13 ~ Issue-5 ~ May-2014

Abstract: Refractive errors are a common worldwide problem. Several hypotheses explain a relationship between hypermetropia and intelligence. This study is done to study the Intelligence Quotient in school children with hypermetropia and compare that to children with normal vision. This study was done in Department of Physiology in subjects attending the Ophthalmology Out Patient Department, Department of Ophthalmology, Stanley Medical College, Chennai. 30 subjects of age group 8 to 13 years were chosen and IQ test was performed using Binet- Kamath test, and compared with 30 control group chosen from Master Health Check up Programme. With this data obtained, statistical analysis was done using independent Student t- test and chi square test using SPSS version 15. Of the 30 controls, 8 children were in grade I, 9 in grade II+, 8 in grade II, and 5 in grade III+. From 30 subjects, 6 children were in grade I, 5 in grade II+, 2 in grade II, 8 in III+, and 9 in grade IV with high significant P value. From this study we conclude that hypermetropia has a direct influence on an individual's intelligent quotient and show that blurred hypermetropia may be a risk factor for lower IQ.
Keywords: intelligence quotient, hypermetropia, Binet- Kamath test

[1] Standard Progressive Matrices, Sets A to E. Prepared by J.C.Raven.
[2] Refractory error, IQ and reading ability. Sheila M. Williams; Gerdon.F. Developmental Medicine and Child Neurology 1988 vol 30 page 735- 742.
[3] Hypermetropia is more common in low IQ children. I. Sandfeld; H. Jensen. Invest Ophthalmol Vis Sci 2004.
[4] Degree of hypermetropia in relation to intelligence and educational level. Eames Th. American journal Ophthalmol 1955; 39; 375- 377.
[5] Social class, race, and sex differences on the raven (1956) standard progressive matrices. Tulkin, steven r.; newbrough, j. R. Journal of consulting and clinical psychology, vol 32(4), aug 1968, 400-406

Abstract: Introduction: Both Chronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD) are global epidemics, each affecting in excess of 10 million patients. Both conditions co-exist at different rates and incur significant morbidity and mortality, and present major challenges to healthcare providers. In the developing world the prevalence of CAD is increasing but the prevalence of COPD is unknown. This study was designed to estimate the proportion of patients with CAD who have concomitant COPD and identify factors that may increase the likelihood of COPD in CAD patients. Materials and Methods: A cross sectional study that included 100 consecutive patients of CHD attending the Medicine OPD of the LTMMC Sion and BYL Nair hospital fulfilling the inclusion and exclusion criteria were selected for study. All the patients underwent spirometry using an electronic spirometer. COPD was diagnosed using GOLD classification. Results were analysed using SPSS ver. 19. Results: The mean age (SD) of study subjects was 48.3 (7.7) years. Of the 100 patients; 19 had COPD as per the GOLD classification. COPD was significantly more among patients with severe cardiac dysfunction, smokers and age above 60 years (p < 0.01). Conclusion: In this group of patients with CAD about one in five has concomitant COPD. This will have enormous burden on health expenditure in a region where health budgets are already strained by costs of compacting endemic diseases. The prevalence rate we recorded warrants routine screening of all CAD patients for COPD specially those with severe cardiac dysfunction, h/o smoking and elderly.
Key words: Age, Cardiac abnormality, Chronic obstructive pulmonary disease, Coronary artery disease, Prevalence

[1]. Fuster, Valentin, and Bridget B. Kelly, eds. Promoting cardiovascular health in the developing world: a critical challenge to achieve global health. National Academies Press, 2010.
[2]. GOLD Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: NHLBI/WHO workshop report. 2006; Updated 2006 http://www. goldcopd.com/.
[3]. Elliot M, Andrew P. Harrison`s Principles of Internal medicine. Ischemic Heart Disease. The McGraw-Hill Companies, Maryland, Baltimore, 17th edition 2008; 338:2275-2304.
[4]. Rabe KF, Hurd S, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2007; 176:532–555.
[5]. Anthonisen NR, Connett JE, Kiley JP, et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1: the Lung Health Study. JAMA 1994; 272:1497–1505

Abstract: Objective:Aim of the study was to evaluate Upper Gastro Intestinal endoscopic findings in patients presenting with dyspepsia and to campare with earlier studies. Material and Method:This retrospective, observational study was conducted in endoscopic unit in the Department of Medicine in chhattisgarh institute of medical sciences, fromJuly 2007 to December 2011. Adult patients with dyspepsia who underwent Upper Gastro Intestinal endoscopies where included in the studies. Patients were referred by the consultants and doctors working in the periphery for endoscopy. Endoscopies were performed as per standard protocol with diagnoses based on accepted criteria. Results: Upper Gastro Intestinal endoscopies were performed on a total of 593 patients. Patients who presented with dyspepsia were scoped. Amongst them 64.9% (n=385) were male and 35.1 %( n=208) were females. The mean age of the studied population was 41.45 years (SD +_ 15.343), most common lesion was gastritis seen in 25.1 %( n=149), esophagitis 3.5 %( n=21), gastric carcinoma 4.6% (n=27), esophageal carcinoma 3.7% (n=22), gastric ulcer 6.7% (n=40) duodenal ulcer was found in 4 %( n=24). Gastric ulcer was more common as compared to duodenal ulcer (6.7% vs. 4%).Endoscopy was normal in 40.0% (n=237) of the patients. Conclusion: Endoscopy is a very important investigative modality to identify the specific pathology in patients of dyspepsia .Gastritis; Esophagitis, Duodenitis, Duodenal ulcer,Gastric ulcer, Gastric carcinomas and esophageal carcinoma were the commonest endoscopic diagnostic findings.

Keywords: Esophagogastroduodenoscopy, dyspepsia

[1] Heatley RV, Rathbone BJ. Dyspepsia: a dilemma for doctors? Lancet. 1987; 2(8562): 779-82.
[2] Talley NJ, Weaver AL, Tesmer DL, Zinmeister AR. Lack of discriminant value of dyspepsia subgroups in patients referred for upper endoscopy. Gastroenterology.1993; 105: 1378-86.
[3] Colin-Jones DG. The management of dyspepsia.Scandinavian Journal of Gastroenterology Supplement.1988; 155: 96-100.
[4] Kasugai T. Endospicdiagnosisin gastroenterology. Tokyo: igaku-sboin 1982.
[5] Olokoba AB, Bojuwoye BJ. Indications for oesophagogastroduodenoscopy in Ilorin, Nigeria--a 30 month review. Nigerian Journal of clinical Practice. 2010; 13(3): 260-3.

Abstract: A 63 year old male presented to our hospital with NonST Elevated Myocardial Infarction and high grade stenotic lesions in distal left main artery and mid right coronary artery.HeunderwentanIntraAorticBalloonPump(IABP) , heparin initiation, Coronary Artery Bypass Grafting(CABG) and got discharged. On 9th postoperative day he presented with STElevated MI, thrombosis of all grafts, thrombocytopenia due to heparin (Heparin Induced Thrombocytopenic Thrombosis).A rescue Per Cutaneous Intervention with Intra AorticBalloonPump of native vessels has been done with use of argotraban as alternative anticoagulant. Later Angiogram showed patent lumen with TIMI-3 flow. He was discharged with improved platelet count and stabilized condition.
Keywords: Intra Aortic Balloon Pump,GraftFailure,Heparin,Heparin induced thrombocytopenic thrombosis,Thrombosis

[1]. Warkentin, TE and Kelton, JG. Heparin-induced thrombocytopenia. ProgrHemostThromb.. 1991; 10: 1–34,PubMed
[2]. Warkentin, TE and Kelton, JG. Interaction of heparin with platelets, including heparin-induced thrombocytopenia.in: Bounameaux H (Ed.) Low-molecular-weight Heparins in Prophylaxis and Therapy of Thromboembolic Diseases. Fundamental and Clinical Cardiology. Vol 19. Marcel Dekker, New York; 1994: 75–127
[3]. Hirsh, J. Heparin. NEJM. 1991; 324: 1565–1574, PubMed
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[5]. (Letter) Amiral, J, Bridey, F, Dreyfus, M et al. Platelet factor 4 complexed to heparin is the target for antibodies generated in heparin-induced thrombocytopenia. ThrombHaemost.. 1992; 68: 95–96,PubMed

Abstract: Background: Obesity is rapidly increasing in India in all age groups. College-based data indicates prevalence rate 24% in adolescents. Adolescent obesity is associated with a greater long-term risk of hypertension and type 2 diabetes mellitus in adulthood. However studies investigating lung functions in obese adolescents are few. The present study assesses lung functions in obese adolescent, first year medical students of KIMS medical students, Amalapuram, EG dist, Andhra Pradesh. Aims: Assessment of lung functions in obese adolescent medical students. Materials and Methods: Lung functions were measured in 67 overweight or obese adolescent medical students and an equal number of age-matched controls by using MEDI: SPIROWIN software (Maestros Medline Systems Ltd., Navi Mumbai, India). RESULTS: Forced expiratory volume in 1st second (FEV1) and forced vital capacity (FVC) were significantly decreased in the overweight and obese group (P < 0.001). Pulmonary functions in the study population negatively correlated with obesity, weight, body mass index (BMI), The strongest negative correlation was between BMI and FVC, FEV1 and FEV1/FVC % (P < 0.001) . Conclusion: Lung function impairment particularly decreased FVC and FEV1 is associated with obesity in adolescents. In addition lung functions deteriorate with increasing obesity in adolescents. This study reveals another health hazard associated with obesity and highlights the need to reduce weight at a younger age.
Keywords: Adolescent obesity, body mass index, lung function tests (FVC, FEV1).

[1]. World Health Organization. Obesity: Preventing and managing the global epidemic. Geneva, Switzerland: World Health Organization; 1997.
[2]. Dietz WH. Health consequences of obesity in youth: Childhood predictors of adult disease. Pediatrics 1998; 101:518-25.
[3]. Yadav S. Obesity: An increasing problem in the developing countries. Indian Journal of Practical Pediatrics 2001; 4:293-7.
[4]. Kapil U, Singh P, Pathak P, Dwivedi N, Bhasin S. Prevalence of obesity amongst affluent schoolchildren in Delhi. Indian Pediatr 2002; 39:449-52.
[5]. Bhave S, Bavdekar A, Otiv M. IAP national task force for childhood prevention of adult diseases: Childhood obesity. Indian Pediatr 2004; 41:559-75.

Abstract: This paper is designed as a tool that a researcher could use in planning and conducting quality research. This is a review paper which gives a discussion of various aspects of designing consideration in medical research. This paper covers the essentials in calculating power and sample size for a variety of applied study designs. Sample size computation for survey type of studies, observation studies and experimental studies based on means and proportions or rates, sensitivity – specificity tests for assessing the categorical outcome are presented in detail. Over the last decades, considerable interest has been focused on medical research designs and sample size estimation. The resulting literature is scattered over many textbooks and journals. This paper presents these methods in a single review and comments on their application in practice.

Keywords: Types of studies, sample size determination, inferential statistics, sensitivity, specificity, odd ratios

[1] Hintze JL. Kaysville, Utah, USA: 2008. Power analysis and sample size system (PASS) for windows User's Guide I. NCSS.
[2] Jones S R, Carley S & Harrison M. "An introduction to power and sample size estimation" Emergency Medical journal 2003; 20;
453-458,2003.
[3] Gebski V, Marschner I, Keech AC. Specifying objectives and outcomes for clinical trials. Med J Aust 2002; 176(10): 491-2.
[4] Wittes J. Sample size calculations for randomized controlled trials. Epidemiol Rev. 2002;24:39–53.[PubMed].
[5] Lui KJ, Cumberland WG. Sample size determination for equivalence test using rate ratio of sensitivity and specificity in paired
sample data. Control Clin Trials 2001;22(4):373-89. 23

Abstract: Ameloblastoma is a true neoplasm of odontogenic epithelial origin. It is the second most common odontogenic neoplasm, and only odontoma outnumbers it in reported frequency of occurrence. Its incidence, combined with its clinical behaviour, makes ameloblastoma the most significant odontogenic neoplasm. Unicystic ameloblastoma (UA) refers to those cystic lesions that show clinical, radiographic, or gross features of a mandibular cyst, but on histological examination, it showed a typical ameloblastomatous epithelium lining part of the cyst cavity, with or without luminal and/or mural tumor growth. It accounts for 5-15% of all intraosseous ameloblastomas. We report a case of unicystic ameloblastoma in a 16-year-old female, and review the literature.

[1]. Kahairi A, Ahmad RL, Wan Islah L, Norra H: Management of large mandibular ameloblastoma - a case report and literature reviews; Archives of Orofacial Sciences 2008, 3(2):52-55.
[2]. Gerzenshtein J, Zhang F, Caplan J, Anand V, Lineaweaver W: Immediatemandibular reconstruction with microsurgical fibula flap transfer following wide resection for ameloblastoma. J Craniofac Surg 2006, 17(1):178-182.
[3]. Philipsen HP, Reichart PA: Classification of odontogenic tumors and allied lesions. Odontogenic tumors and allied lesions Quintessence Pub. Co. Ltd 2004, 21-3.
[4]. Chana , Jagdeep S, Yang-Ming Chang, Wei , Fu-Chan , Shen , Yu-Fen , Chan Chiu-Po, Lin Hsiu-Na, Tsai Chi-Ying, Jeng Seng-Feng: Segmental mandibulectomy and immediate free fibula osteoseptocutaneous flap reconstruction with endosteal implants: An ideal treatment method for mandibular ameloblastoma. Plast Reconstr Surg 2004, 113(1):80-87.
[5]. Robinson L, Martinez M. Unicystic ameloblastoma. Cancer 1977; 40 : 2278-85.

Abstract: Background: Fine-needle aspiration cytology (FNAC) is a simple, accurate, and safe procedure for the diagnosis of palpable breast lumps (PBLs), yet in certain situation there is a need for more definitive and more invasive techniques such as core needle biopsy (CNB) to touch a definitive diagnosis. This procedure is performed instead of excisional or frozen section in some breast cancer units. The aim of this study was to analyze if FNAC is still an accurate procedure for diagnosis of PBLs as well as to correlate between FNAC and histopathological findings of CNB in PBLs. Material and methods: An observational study was conducted on 66 patients presenting with PBLs. All these patients underwent outpatient FNAC. Core needle biopsy (CNB) was performed for the inadequate, suspicious, and malignant cases. Evaluation of all the prepared cytologic and histopathological slides was done. Results: benign tumors are forming the major component of FNAC cases that seen, majority of them is fibroadenoma. Conversely 7 cases are cytologically malignant that proved histologically to be malignant. Three out of 6 cases that are cytologically highly suspicious are diagnosed malignant histologically Conclusion: in spite of the simplicity, rapidity, and cost effectiveness of FNAC in the preoperative diagnosis of cancer, tissue diagnosis by CNB is highly recommended in selected cases for more confirmation.
Key Words: FNAC, Breast, PBLs, Carcinoma, Histopathology

[1]. Mottahedeh M, Rashid MH, Gateley CA. Final diagnoses followingC3 (atypical, probably benign) breast cytology. Breast
2003;12:276–279.
[2]. Srilakshmi HP and Chavda J. A study of cyto-histological correlation of breast lesions. NJIRM 2013; 4(2) : 54-56.
[3]. David L. Value of cytopathologist-performed ultrasound-guided fine needle aspiration as a screening test for ultrasound-guided
core-needle biopsy in non-palpable breast masses. Diagn Cytopathol 2009;37:262–269.
[4]. Abdel-Hadi M, Abdel-Hamid GF, Abdel-Razek N, Fawzy RK. Should Fine-Needle Aspiration Cytology be the First Choice
Diagnostic Modality for Assessment of All Non palpable Breast Lesions? The Experience of a Breast Cancer Screening Center in
Alexandria, Egypt. Diagnostic Cytopathology 2010, Vol 38, No 12: 880-889.
[5]. David L. Cytopathologist-performed ultrasound-guided fine-needle aspiration and core-needle biopsy: A prospective study of 500
consecutive cases. Diagnostic Cytopathology 2008, vol. 36, issue5, May 2008

Abstract: Introduction: About 1/5th of the world population is affected by allergic rhinitis, affecting to quality of life, require a systemic approach of history, examination, investigation and sometime special allergic testing. Objective of this study is to evaluate the nasal endoscopic findings in the patients of allergic rhinitis. Material and Method: This study consists of 58 patients of Allergic Rhinitis in whom nasal endoscopic examination was done. All the patients had nasal symptoms; rhinorrhoea(100%) ,nasal obstruction (87.96%), sneezing(81.03), itching of the palate(41.38%), fullness of the ears(37.93%), headache(29.31%). In all patients nasal endoscopic examinations were done under local anesthesia except in children. Result: Nasal endoscopic findings were as follows : DNS(72.41%), inferior turbinate hypertrophy (55.17%), watery discharge on nasal floor (41.38%) , septal spur (27.59%), polypoidal anteriore end of middle turbinate and blocked maxillary ostia were found in 24.14% each, abnormal ethmoidal bullae (13.79 ), enlarged aggar nasi cells (27.59%), mucopurulent discharge in maxillary ostia (22.41%). Concha bullosa and medially bent uncinate process were found in (09.09%) each ,paradoxical bent middle turbinate (03.44%) and polyp in sphenoethmoidal recess (09.09%) of cases. . Conclusion: Nasal endoscopic work up is an effective diagnostic tool. It is particularly useful for the delineation of the structures in the region of middle meatus distinguishing the middle turbinate from other soft tissue. It can also be used for taking nasal tissue for biopsy.
Key words: Nose, Endoscopy, Allergic Rhinitis

[1]. Gutman, Michael., Augusto Torres, Kevin J. Keen et al. Prevalence of allergy in patients with chronic rhino sinusitis. Otolaryngology- Head and Neck Surgery. 2004;130(5): 545-552.
[2]. Hansel FK. Clinical allergy. St. Louis, The C.V. Mosby co.1953; 654-659, 779-790.
[3]. James A. Stankiewicz and James M. Chow . Nasal endoscopy and the definition and diagnosis of chronic rhinosinusitis. Otolaryngology – Head and Neck Surgery. 2002; 126 (6): 623-627.
[4]. Gupta SC. Sachin Jain, et al Antroscopic and cytological Study of the maxillary sinus mucosa in allergic rhinitis.2004; 2(4):
[5]. Jareoncharsi P. Thitadilok V. et al . Nasal endoscopic findings in patients with perennial allergic rhinitis. Asian Pacific Journal of Allergy & Immunology. 1999; 17(4): 261-7.
[6]. Benninger, Michael S. Nasal endoscopy; Its role in office diagnosis. American Journal of Rhinology. 1997; 11(2):177-180(4).
[7]. Ameli F, Brocchetti F. et al. Nasal endoscopy in children with suspected allergic rhinitis. Laryngoscope.2011; 121(10): 2055-9

Abstract: The purpose of this study was to determine student perceptions of the methods used to teach pharmacology via problem-based learning (PBL). To improve problem solving skills and link basic sciences to clinical practice, medical educators have turned to problem based learning as a partial replacement for traditional didactic lectures approach. PBL is an instructional method that uses cases or problems as vehicles for students to acquire critical thinking and problem-solving skills. In problem-based learning, new knowledge is acquired in the context of some meaningful problems or situation. Using likert scale we assessed the students' perceptions of pharmacology education and learning of pharmacology concepts through PBL. Survey responses were anonymous, and results were reported as aggregate data. The survey statements were answered on a five-point Likert scale with 1 indicating strong disagreement and 5 indicating strong agreement. Via a ten-question MCQ instrument, students performance was assessed. In our study there was significant increase in performance of students after PBL sessions. Student's feedback shown that PBL enhanced their understanding in Pharmacology, motivated them to read more as well as developed self directed and problem solving attitude in them. Most of students suggested to continue PBL sessions but don't want to replace all didactic lectures by PBL sessions.
Keywords: didactic lectures, pharmacology, problem based learning, teaching learning methods

[1]. Hudec R,Tisonova J,Bozekova L, Wawruch M, Kriska M, Kristova V Modified Problem-based learning in Pharmacology Bratisl Lek Listy. 2009; 110(11): 732-735.
[2]. Regan-Smith MG,Obenshain SS,Woodward C, Richards B, Zeitz HJ, Small PA. Rote learning in medical school. JAMA 1994;272:1380-1
[3]. Vernon DT,Blake RL. Does problem based learning work?A meta-analysis of evaluative research.Acad Med 1993;68:550-63.
[4]. The Use of Student-Centered, Problem-Based, Clinical Case Discussions to Enhance Learning in Pharmacology and Medicinal Chemistry1: Richard N. Herrier, Terrence R. Jackson and Paul F. Consroe; American Journal of Pharmaceutical Education Vol. 61, Winter 1997.
[5]. Lau YT. Problem –based learning (PBL) in Physiology:a survey of department heads in medicalschool in Taiwan. J Med Edu 2002; 6:488-91.  

Abstract: Background- 'Macrocytes' refers to larger erythrocytes with increased mean corpuscular volume (MCV) in routine blood smears. It can be either an incidental finding or may be associated with underlying disease. Aim of the study- to identify the underlying cause for macrocytosis and also to analyse the haematological features of macrocytosis in routine haemogram and peripheral blood smear Results- out of 89 adult patients, alcoholism was the major etiological factor of macrocytosis, followed by Vitamin B12 deficiency and drug intake. Isolated macrocytosis without anaemia was seen in 20 cases. Peripheral smear examination revealed hypersegmented neutrophils and macro- ovalocytes predominantly in megaloblastic conditions. Conclusions- Macrocytes on peripheral blood smears has to be evaluated even in absence of anaemia. Careful analysis of routine haemograms and peripheral blood smears assist in identifying the underlying cause for macrocytosis.
Keywords: Alcoholism, Macrocytes, Mean Corpuscular Volume (MCV), Megaloblastic Anaemia, Peripheral Blood Smear.

[1] Aslinia F, Mazza JJ, Yale SH, Megaloblastic anemia and other causes of macrocytosis, Clin Med Res, 4(3), 2006, 236–241.
[2] Hoffbrand V, Provan D, ABC of clinical haematology- Macrocytic anaemias, BMJ, 314(8), 1997, 430–433.
[3] Kaferle J, Strzoda CE, Evaluation of macrocytosis, Am Fam Physician, 79(3), 2009, 203–208.
[4] Lee GR, Foerster J, Lukens J, Paraskevas F, Greer JP, Rodgers GM, Wintrobe's clinical hematology, Williams and Wilkins, Baltimore, 1998.
[5] Seppa¨ K, Heinila¨ K, Sillanaukee P, Saarni M, Evaluation of macrocytosis by general practitioners, J Stud Alcohol, 57, 1996, 97–100.
[6] Davidson RJ, Hamilton PJ (1978) High mean red cell volume: its incidence and significance in routine haematology, J Clin Pathol, 31, 1978, 493–498

Abstract: The objective of this study was to know the bacteriological profile and its antibiotic susceptibility pattern of ear infection in patients attending tertiary care hospital & to study the antimicrobial resistance pattern of the above isolates. Ear swabs were collected & immediately processed. A total of 80 patients prescription were collected over a period of 7 months comprising 42 males and 38 females. Out of these, Chronic Suppurative Otitis Media (CSOM) was the most common disease & maximum number of cases was from the age group 21 to 30 years 22 cases (27.5%). Out of total 80 specimens 11 shows no growth of organism while 69 specimens shows growth of one or two organisms. Out of 69 growths, 58 shows single isolate and 11 shows two isolates. , Pseudomonas, Proteus, Acinetobacter, Klebsiella & Enterobacter species were the most common Gram–negative bacteria isolated followed by Staphylococcus aureus & CONS Gram–positive bacteria. The occurrence of gram negative organisms (GNB) was higher than for gram positive (GPC) with GNB 58/91 (63.73%), GPC 25/91 (27.47%) and fungi 8/91 (8.80%). Gram negative bacteria shows >90% sensitivity to Ceftazidime, Ciprofloxacin, Lomefloxacin, Gentamicin & Netilline, >75% sensitivity to Pefloxacin, Ofloxacin, Cefaperazone & Amikacin. They are resistance to Amoxyclave, Cefotaxime & Cefuroxime. Gram positive bacteria shows >90% sensitivity to Cephalexin, Linezolid, Gentamicin & Tetracycline. >80% sensitivity Cloxacillin, Cefotaxime, Lincomycin, Co-trimoxazole, Tetracycline & Amoxyclave.
Keywords: Bacteriology, Ear infection, Culture & sensitivity.

[1]. Richard. E. B and Roberts. M. K. (1996). Otitis Media and its complications in Nelson's Texbook of peadiatrics. pp 1814-1824.
[2]. B Iqbal J, Khan W, Raza SN, Naqvi NU, Rahat ZM, Azeem QE. Frequency of chronic suppurative otitis media in the junior ranks of Pak army. Pak Armed Forces Med J 2009; 59:367-70.
[3]. Krišto B, Buljan M. Microbiology of the chronic suppurative otitis media. Medicinski Glasnik. 2011;8:2.
[4]. Srivastava A, Singh R, Varshney S, Gupta P, Bist S, Bhagat S, et al. Microbiological Evaluation of an Active Tubotympanic Type of Chronic Suppurative Otitis Media. Nepalese Journal of ENT Head and Neck Surgery. 2011;12:14-6.
[5]. Haraldsson G, Holbrook WP, Könönen E. Clonal similarity of salivary and nasopharyngeal Fusobacterium nucleatum in infants with acute otitis media experience. Journal of medical microbiology. 2004;532:161-5.
[6]. Oguntibeju O. Bacterial isolates from patients with ear infection. Indian Journal of Medical Microbiology. 2003; 214:294

Abstract: This study investigated the antimicrobial susceptibility pattern of Gram negative bacilli causing UTI in two Hospitals in a cosmopolitan community in South West, Nigeria. BU is a Tertiary-Care Hospital, and SH is a Private General Practitioner Hospital. One hundred (100) urine samples were collected at each station during the six-month study period and analyzed using standard bacteriology procedures. Bacteria were isolated from the urine samples on MacConkey agar, Blood agar and chocolate agar and isolates tested for susceptibility to 28 different antibiotics using the disc diffusion method. Further, isolates showing resistance to ceftazidime were screened for ESBL production by double disc synergy test (DDST). 20 urine samples (16 from SH and 4 from BU) yielded growth of bacteria which all showed resistance to more than one of the tested antibiotics. The urine samples from a patient yielded growth of two different bacteria species. All isolates showing resistance to ceflazidime (n=15) tested positive for ESBL. Blochemical characterization tests confirmed the ESBL producers as Klebsiella. pneumonia (n=14) and Enterobacter cloacae (n=1). There was an incidence of multiple drug-resistant ESBL producing Gram negative bacilli in this community.
Keywords: UTI Klebsiella pneumonia, Enterobacter cloacae, multiple drug-resistance, ESBL Gram negative bacteria

[1]. Kenneth Todar. Bacterial resistance to antibiotics. Todar' Online Textbook of Bacteriology. Textbook of bacteriology.net/resantimicrobia_2.html
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[3]. Davies J. and Davies (2010) Origins and evolution of antibiotic resistance. Microbiol. Mol. Biol Re. 74; 417-435
[4]. Marshall B.M., and Levy, S.B. (2011) Food animals and antimicrobials; impacts on human health. Clin Microbiol Rev: 24:718-733
[5]. Monica C. Medical Laboratory Manual for Tropical Countries (VII) Microbiology. Butterworth Co, 1st ed. 1984
[6]. Christie Bailey. ESBL-type bacteria have joined the growing number of antibiotic pathogens that cause hospital-acquired infections. Suite 101, Mar 25, 2013.

Abstract: Hepatotoxicity in HIV is associated with anti-retroviral regimens and hepatitis B and C virus coinfection. Altered liver enzymes activities in HIV mono infected patients yet to commence and those on HAART for at least six months were studied. 45 HIV seropositive patients on HAART for at least six months attending LAUTECH Teaching Hospital, Osogbo, Nigeria, 40 newly diagnosed HIV seropositive patients yet to commence HAART (naive) and 40 HIV-negative subjects (control) were recruited. 5 ml venous blood was drawn from each subject. Serum liver function tests were estimated by spectrophotometry. Hepatitis B surface antigen and antibody to hepatitis C virus were determined using ELISA. Data were analyzed statistically and p<0.05 was regarded as significant. Hepatotoxicity was defined using a standardized toxicity grade scale. Total bilirubin, alanine and aspartate aminotransferases (ALT, AST) in HIV-HAART and HIV-naive exceeded the upper limit of normal with lower values recorded in HIV-naïve. There were > 2-fold increase in alkaline phosphatase and AST in HIV-HAART than in controls . Conjugated bilirubin was slightly lower in control subjects than in HIV-HAART and naïve groups. All subjects were negative for HBsAg and anti-HCV. Even in the absence of HAART, mild hepatotoxicity is seen in HIV patients.
Keywords: Antiretroviral Therapy, Hepatotoxicity, HIV, Mono Infection

[1]. M Egger, M May, G Chene, B Hirscel, W Huber, and T S Li, Prognosis of HIV-1 infected patients starting highly active antiretroviral therapy: A collaborative analysis of prospective studies, Lancet; 60, 2002,119-129.
[2]. P CaCoub , P Stanislas , C Perronne, and ANRS HCO2 – Ribavic study Team, Management of the Co-infected Patient with Human Immunodeficiency Syndrome on Course of Hepatitis C Virus Infection: A Meta-Analysis, Infectious Disease in Clinical Practice, 15(1),: 2004, 38-48.
[3]. J A Mata-Marín, J Gaytán-Martínez, H B Grados-Chavarría , J Fuentes-Allen , C I Arroyo-Anduiza and A Alfaro-Mejía, Correlation between HIV viral load and aminotransferases as liver damage markers in HIV infected naive patients: a concordance cross-sectional study. Virology Journal, 6, 2009,181.
[4]. I Sanne, H Mommeja-Marin, J Hinkle, J A Bartlett, M M Lederman , and G Maartens, Severe hepatotoxicity associated with nevirapine use in HIV-infected subject. Journal of Infectious Disease, 191, 2005,825-9.
[5]. V J Navarro, and J R Senior, Drug related hepatotoxicity, National England Journal of Medicine, 354, 2006,731-9.
[6]. J D Lewis, and B L Strom, Balancing safety of dietary supplements with the free market. Annals of Internal Medicine, 136, 2002,616-8.

Abstract: Emergency department (in a health care facility) is a section of an institution that is staffed and equipped to provide rapid and varied emergency care, especially for those who are stricken with sudden and acute illness or who are the victims of severe trauma. This study analyzed the disease pattern of patients presenting to the emergency department of a tertiary care insurance based hospital in Delhi. The results showed maximum patients attended were under the Medicine and Surgery discipline. A large proportion of these patients were non emergency cases that could have been managed in the Outpatient Department (OPD). As the cause of overcrowding of the hospital emergency department was attributed to the number of people presenting to the emergency department with non emergent problems it discusses the steps that can be taken to better channelize the use of emergency medical services.

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Abstract: Clutch plates are usually made of cast iron and high carbon steels. The properties of cast iron have high compressive strength, low tensile strength and no ductility. It can be easily machined. Due to this reason, it is suitable for the clutch plate but its cost is high. In order to reduce the cost of clutch plate material without affecting the life and effectiveness of the clutch plate, we modify other material low carbon steel for clutch plate.
Keywords: low carbon steel, effectiveness.

[1]. A Text book of Machine Design Eurasia Publishing House (Pvt) Ltd, 2010 - R.S. Khurmi & J.K. Gupta
[2]. PSG Design Data‖, Kalaikathir Achchagam, 2003
[3]. Norton L.R Machine Design – An integrated Approach Pearson Education,2005
[4]. Shigley , J.E Mechanical Engineering Design Mcgraw Hill 1985
[5]. BOltzharol A Material Handling Hand book, The Ronald Press Company 1958

Abstract: Pilomatricoma or Benign calcifying epithelioma of Malherbe is an uncommon lesion in the external auditory meatus, arising from the matrix cells at the base of the hair. Histologically it was characterized by the presence of ghost cells, basophilic cells and foreign body giant cells. It is a rare benign tumor, starting in the hair matrix and clinically resembling a hard subcutaneous swelling. Here we report a case of 47 year-old female with a pilomatricoma in the external auditory canal. We discuss the clinical, histopathological characteristics of pilomatricoma or calcifying epithelioma of Malherbe.

Key Words: Pilomatricoma, External Auditory Meatus, Hair matrix

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