iosr-JDMS   Volume-13 ~ Issue-7 ~ July-2014

Abstract: The observational study is done to find out the frequency of gall bladder cancer in patients of gall bladder disease, found preoperatively or incidentally on biopsy of cholecystectomy specimen. Methodology: The study was carried in surgery ward-6 of Guru Nanak Dev hospital attached to Govt. Medical College Amritsar in which 200 patients of gall bladder disease were studied and relative frequency of gall bladder cancer was noted. Results: In our study, 200 patients of gall bladder disease during a period of 2 years were included. Out of these,20 patients were male while 180 were female. Maximum no of patients reported with Gall Bladder Disease were in age group 31-40 years. 7 patients out of 200 were diagnosed with carcinoma gall bladder,in which 6 were female and 1 was male with majority of patients presenting in the age group 61-70 years. Gall Bladder cancer constituted 8.2% of all Cancers in the body and 50% of all Gastrointestinal Tract cancers.3 patients out of 7 diagnosed with Gall Bladder Cancer were diagnosed preoperatively and rest 4 were diagnosed incidentally on histopathological examination of biopsy specimen of gall bladder. Conclusions: The frequency of Gall Bladder Cancer in our study is 3.5%, with females out numbering males with F/M ratio 6:1 and most of them presenting in the 5th and 6th decade of life. Gall Bladder Cancer was strongly associated with gall stones (100%). Gall Bladder Cancer is the most common Gastrointestinal tract cancer.Most of the patients (57%) presented with incidental diagnosis on HPE post cholecystectomy. 43% patients diagnosed preoperatively, were given neoadjuvent chemotherapy.

Keywords: Gall bladder,Cacer,Cholecystectomy,Gastrointestinal cancer,undifferentiated cancer

[1]. Greenlee RT, Hill-Harmon MB, Murray T, Thun M. Cancer Statistics 2001. Cancer J Clin 2001;51(1):15-36.
[2]. Panday M, Shukla M, Shukla V.Diet and Gall Bladder Cancer.Indian Journal of Medical and Pediatric Oncology 2008;29(1) 6-7.
[3]. Randi G.M Malvezzi, F. Levi, J.Ferlay, E. Negri, S. Franceschi, La Vecchia C. Epidemiology of biliary tract cancers: an update . Annals of Oncology 2009; 20:146-159.(s)
[4]. Nervi F., Duarte I., Gomez G, Rodriguez G, Pino G D , Ferrerio O et. Al. Frequency of gall bladder cancer in Chile, a high risk area. International Journal of cancer , 1988; (41) 657-660.(s)
[5]. Ahmad M, Khan AH, Mansoor A. The pattern of malignant tumors in Northen Pakistan J Pak Med Assoc 1991;41:270-73
[6]. Rizvi TJH, Zuberi SJ. Risk factors for gallbladder cancer in Karachi. J Ayub Med Coll Abottabad 2003;15(3):16-8.
[7]. Chaudhary MA, Ahad A, Durrani KM, Akbar J. Carcinoma of gallbladder. Proceeding SZPGMI 1989;

Abstract: Normally aorta gives rise to a single renal artery on each side which supplies respective kidneys. Common variations of renal artery are it's variable number and unusual branching pattern. Supernumerary arteries have been classified into hilar or polar arteries. In a study of 50 kidneys from twenty five formalin fixed cadavers lower polar supernumerary renal arteries were seen in left kidney of two cadavers (4%). The lower polar supernumerary left renal artery was superficially crossed by the left ureter. Such an artery lying superficial to the ureter can cause ureteropelvic obstruction. Variations of renal arteries are of immense importance during planned renal transplants, urological procedures and angiographic interventions as they lead to renal complications. Hence major renal surgeries should be preempted by CT scan and renal angiograms to detect renal artery variations and plan the surgical procedure accordingly.

Key words: Accessory renal artery, Hilar renal artery, polar renal artery, renal transplant, supernumerary renal artery.

[1] V. Budhiraja, R. Rastogi, V. Anjankar, C. S. Ramesh Babu and P. Goel, Supernumerary Renal Arteries and Their Embryological and Clinical Correlation: A Cadaveric Study from North India, ISRN Anatomy, vol. 2013, Article ID 405712, 2013, 1 - 4 .

[2] R. J. Merklin and N. A. Michels, The variant renal and suprarenal blood supply with data on the inferior phrenic, ureteral and gonadal arteries: a statistical analysis based on 185 dissections and review of the literature, The Journal of the International College of Surgeons, 29( 1),1958, 41–76.
[3] KP Hlaing, S Das , IM Sulaiman, A Abd-Latiff , N Abd Gafar, FH Suhaimi ,F Othman , Accessory renal vessels at the upper and lower pole of the kidney: a cadaveric study with clinical implications. Bratisl Lek Listy,111(5), 2010,308-10.

[4] F. J. B. Sampaio and M. A. R. F. Passos, Renal arteries: anatomic study for surgical and radiological practice, Surgical and Radiologic Anatomy, 14( 2) 1992, 113–117.

[5] P.B. Johnson, S.O.Cawich , S.D. Shah, A. William, R.G. McGregor, H. Brown and M.T. Gardner. Accessory renal arteries in a Caribbean population: a computed tomography based study, SpringerPlus 2(1),2013, 443.

Abstract: Introduction: This study compares two bacterial expression (Prevotella intermedia , Prevotella nigresens) and their expression in pregnant and gestational diabetic patients with periodontal disease and proposes to explore the microbiologic nature of the association between early colonizers, such as P.intermedia and P.nigresens are bound by later colonizers such as P. gingivalis and T.forsythia . Materials and methods: Forty pregnant women in each group with Chronic Periodontitis with and without gestational diabetes, were grouped into two groups – as a case control study. Plaque samples from these patients were collected using paper points. The samples were evaluated using Real Time –Polymerase Chain Reaction technique. Results: This study resulted in an increased presence of early colonizers in both groups , showing a "3 fold increase" of Prevotella intermedia among pregnant patients with diabetes and periodontal disease and showed a "1 fold increase" among pregnant patient patients without diabetes compared to Prevotella nigrescens. Conclusion: The current study indicates that Prevotella intermedia is significantly increased among the gestational diabetic and therefore involved in the demonstrated microbial shift during pregnancy and Gestational Diabetes Melitus and more prone for periodontal breakdown. Keywords: Chronic Periodontitis, Gestational diabetes, Prevotella intermedia, Prevotella nigrescens Tanerella forsythia

[1] Socransky SS. Microbial etiological agents of destructive periodontal diseases. Periodontol 2000 1994; 5:78-111.
[2] Karagiannis T , Bekiari E, Manolopoulos K,Paletas K, Tsapas A. Gestational diabetes mellitus:why screen and how to diagnose. Hippokratia 2010; 3: 151-154.
[3] Xiong X, Buekens P, Vastardis S, Pridjian G . Periodontal disease and gestational diabetes mellitus. Am J Obstet Gynecol 2006 ;195:1086-1089.
[4] Novak B, Genco RJ, Trevisan M, Grossi S, Zambon JJ, De Nardin E. Periodontal infections contribute to elevated systemic C-reactive protein level. J Periodontol 2001 ; 72(9):1221-1227.
[5] Carpenter, M.W & Coustan, D.R. Criteria for screening tests for gestational diabetes. American journal of obstetrics and gynecology 1982; 144: 768-773.

Abstract: The rise in the incidence of faciomaxillary injuries is a cause of concern for trauma units, plastic & faciomaxillary surgeons and E.N.T surgeons. In 2005, road traffic injuries resulted in the death of an estimated 110 000 persons, 2.5 million hospitalizations, 8–9 million minor injuries and economic losses to the tune of 3% of the gross domestic product (GDP) in India. This is most likely to increase further to 200 000 deaths and more than 3.5 million hospitalizations annually by 2015.1 The study conducted by Bhuyan et al has shown that head and neck (66%) is commonly involved in an accident, followed by upper and lower limb (44% and 41% respectively). Most common injury patterns are head and neck with extremities (45%).2 Istomin in his study also described that in road accidents predominant injury sites were head and neck with extremities (35.9%).3 In another study conducted on the faciomaxillary fractures by Mohammad H et al, he reported that mandibular fracture constituted 72.9% of the 237 patients examined.4 In our study we specifically look into the pattern of mandibular fractures only of faciomaxillary injuries; in Assam, one of the seven north eastern states of India, which had been limping back into normalcy after a decade of militancy. The study was conducted at the Department of E.N.T at the Assam Medical College and Hospital, Dibrugarh and the Guwahati Medical College and Hospital, Guwahati. The study was conducted on the mandibular fracture patients admitted in this department during the period of March 2011 to March 2012.

[1]. THE NATIONAL MEDICAL JOURNAL OF INDIA VOL. 21, NO. 1, 2008
[2]. Road traffic deaths, injuries and disabilities in India:
[3]. Current scenario:G. GURURAJ
[4]. Bhuyan PJ, Ahmed F. Road traffic accident: An emerging public health problem in Assam. Indian J Community Med 2013;38:100-4
[5]. Istomin GP. Injuries in RTAs: Improvement of the system of prevention rendering of medical aid and treatment of the victims. Ortop Travamatol Protez 1989;6:1-7
[6]. Mohammad Hosein Kalantar Motamedi. An assessment of maxillofacial fractures: A 5-year study of 237 patients. Journal of Oral and Maxillofacial Surgery 2003;61:61-4

Abstract: Background: This initiative is a consequence of the absence of recent information since studies being conducted much before in the past on the prevalence of gingivitis and periodontitis among schools children in Lucknow region of Uttar Pradesh, India. Aims and Objectives: To assess the prevalence of gingivitis and periodontitis among schools children and evaluating the pattern of these diseases in different age groups among them. Setting and Design: It was a cross-sectional study done in Lucknow region of Uttar Pradesh, India. Subjects & Methods: A total of 650 school going children were examined, 225 children were in 8-10 years age group and 215 & 210 children were in the age group of 11 -14 years & 15-17 years, respectively. The gingival index, given by Loe & Silness was used for recording the severity of gingivitis and periodontal disease index, given by Ramfjord was used for evaluating periodontitis. Result: The prevalence of gingivitis and periodontitis were 77.52% and 16.03%, respectively. Conclusion: The overall prevalence of gingivitis and periodontitis were 77.52% and 16.03%, respectively among schools children of 8 to 17 years of age in Lucknow region of Uttar Pradesh, India. The younger age group children had comparatively lesser percentage of gingivitis and periodontitis than older age group children. Keywords: Gingivitis, periodontitis, prevalence.

[1]. H. Loe, J. Silness, Periodontal disease in pregnancy. 1. Prevalence and severity, Acta Odontol Scand, 21, 1963, 53
[2]. SP Ramfjord, Indices for prevalence and incidence of periodontal disease, J Periodontol 30, 1959, 51.
[3]. AK Holm, Caries in preschool children-international trends, J Dent 18, 1990, 291-295.
[4]. A. Jose, MR Joseph, Prevalence of dental health problems among school going children in rural Kerala. J Indian Soc Pedod Prev Dent 21, 2003, 147-151.
[5]. MP Kumar, T Joseph, RB Varma, M Jayanth, Oral health status of 5 years and 12 years schools going children in Chennai city: An epidemiological study, J Indian Soc Pedod Prev Dent 23, 2005, 17-22.
[6]. V Dhar, A Jain , TE Van Dyke, A Kohli, Prevalence of gingival disease in school going children of rural areas in Udaipur District, J Indian Soc Pedod Prev Dent 25, 2007,103-105.

Abstract: Osteomas are benign, osteogenic lesions that may arise from proliferation of cancellous (trabeculae), compact bone (dense lamellae) or can be composed by a combination of both1. There are three different types of osteomas: central, peripheral and extra-skeletal. The central osteoma arises from the endosteum, the peripheral osteoma from the periosteum and the extra-skeletal soft tissue osteoma usually develops within the muscle1. In the facial bones, both central and peripheral osteomas have been described. Peripheral type of osteoma is most common in the lower jaws, which occurs at the surface of the cortical bone and is sessile or pedicled1. Most of the osteomas occurring in the mandible are dense osteomas, and the cancellous osteoma is comparatively rare. The most interesting clinical feature of osteoid osteoma is an exquisite dull pain produce of a very small lesion never greater than 1cm in diameter severe enough to interfere with patients sleep. It accounts 3% of primary bone tumor, and about 10% of benign tumor. About 80% of osteoid osteoma occurs in long bones, while less than 1% occur in jaw. That makes our case very rare2,4 We report the case of 72 year old women patient with osteoma of right side mandible in relation with mental foramen and nerve

Keywords: Benign lesion, Osteoma, Pain, Radiopacity)

[1]. Osteoma of The Mandible Journal of Dental Sciences and Research, Vol 2, Issue 1, Feb 2011 Dr.Gayathri Goudar, Dr.RaviKumar.R, Dr.Manjunath.G.A, Dr.Jyothi Mahadesh
[2]. Osteoid osteoma of mandible: a rare entity Journal of Indian Academy of Oral Medicine and Radiology .Cherry walia, parvati devi, thimmarasa VB, jayadev S.July-Sept 2010;22(3):162-164.
[3]. ID Roy :Peripheral Osteoma ofMandible :MJAFI;2008;64:385-386. Masuki Y. Peripheral osteoma atthe mentum of mandible. RinshoDerma 2002; 44: 735-7.
[4]. Ida M, Kurabayashi T, Takahashi Y, Takagi M, Sasaki T. Osteoide osteoma in the mandible. Dentomaxillofac Radiol. 2002;31:385-7.
[5]. Osteoma of the zygomatic arch and mandible: report of two cases. Durão, Ana Reis; Chilvarquer, Israel; Hayek, Jorge Elie; Provenzano, Márcia; Kendall, Márcia Reis; Rev Port Estomatol Med Dent Cir Maxilofac.. 2012;53:103-7

Abstract: 30 still born fetuses of age group (13-40weeks) were studied macroscopically and microscopically to observe the sequential changes in the obliteration process of Ductus arteriosus. The Ductus arteriosus (DA) was found to originate either from left pulmonary artery or from the bifurcation of pulmonary trunk. Significant changes in the length, outer and inner diameter of DA were observed in different gestational period. The tunics of DA showed structural changes in arrangement of muscle layers, appearance of intimal cushion, organization of elastic and collagen fibers. The proliferation and migration of muscle fibers from tunic media and formation of intimal cushion marked the process of gradual closure of DA.

Key words: Ductus Arteriosus, intimal cushion, intimal mounds, internal elastic lamina

[1]. Park M. K. Peadiatric cardiology for practioners. Part III: pathophysiology: 4th edition.2004; 96- 97.
[2]. Agren Pia, Cogolludo A.L, Kessels C G A, Pe´rez-Vizcaı´no F, Mey J G R, Blanco C E,Villamor E. Ontogeny of chicken Ductus Arteriosus response to oxygen and vasoconstrictors. Am J Physiol Regul Integr Comp Physiol. 2007; 292: 485–495.
[3]. Reese J. Death, dying, and exhaustion in the Ductus Arteriosus: prerequisites for permanent closure. Am J Physiol Regul Integr Comp Physiol.2006; 290: R357- 8
[4]. Douglas J. Schneider and John W. Moore. Patent Ductus Arteriosus. Circulation. 2006; 114:1873- 82.
[5]. Charissa Richard, JuGao, Bonnie LaFleur. Patency of the preterm fetal Ductus Arteriosus is regulated by endothelial nitric oxide synthase and is independent of vasa vasorum in the mouse. Am J Physiol regul Integr Comp Physiol. 2004; 287: 652-60.

Abstract: Between the age of 45 to 60 years, 85% of the women display the typical symptoms of climacterium. Out of these 35% of the women experience little weakness, 35% display moderate symptoms, 25% complain of severe pain and 5 % of these are so much affected that they are incapable of working. There have been number of alternative treatments available for treating climacteric symptoms apart from hormonal therapy. The present comparative study is aimed to find out the advantages of one therapy over other so that it could be easily followed by women suffering from climacteric syndrome. Materials & Methods: It was two group simple randomized design 250 women were screened, out of which 132 perimenopausal were used for selecting 60 samples by purposive sampling with random allocation by using lottery method and equally divided into two groups. Results: There was significant improvement in all the parameters of climacterium (Psychological, vasomotor and somatic) except the sexual component within both the groups because of their mechanism of working on sympathetic nervous system by decreasing the cortisol levels and modulating central adrenergic activity.

Keywords: Climacterium, Green Climacteric Scale, Kupperman's Index, Perceived Stress Scale, Perimenopause

[1]. Chattha R, Kulkarni R, Nagarathna R. Factor analysis of Greene's Climacteric Scale for Indian Women. Maturitas 2008;59:22-27
[2]. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1993;24:386-396
[3]. Lucero MA, McCloskey WW. Alternatives to estrogen for the treatment of hot flashes. Ann Pharmacother; US National Library Of Medicine; National Institutes Of Health; 1997;31:915-917
[4]. Wijma K, Melin A, Nedstrand E, Hammar M. Treatment of menopausal symptoms with applied relaxation: a pilot study. J Behav Ther Exp Psychiatry; US National Library Of Medicine; National Institutes Of Health; 1997;28:251-261
[5]. Allen B, Freidman BH. Positive emotion reduces dyspnea during slow paced respiration. Psychophysiology; US National Library Of Medicine; National Institutes Of Health; 2012;49:690-696

Abstract: A 55 year old male patient presented to us with compliant of injury over left hip as a result of slip over ground. After trauma he was unable to stand and walk. On physical examination his left lower limb was externally rotated, flexed, adducted & shortened. There was a huge swelling present over groin region of left side. Skiagram and CT scan revealed anterior dislocation of hip with ipsilateral fracture neck of femur left side. Traumatic anterior dislocation of hip with ipsilateral fracture neck of femur is rare. This rare presentation was subsequently managed by arthroplasty and is reported

[1]. Delee JC ,Evans JA ,Thomas J (1980) Anterior dislocation of hip and associated femoral head fractures . J Bone Joint Surg (Am) 62 :960-964.
[2]. DummerRe ,Sanzana ES (1999) hip dislocations associated with ipsilateral femoral neck fracture. IntOrthop 23:353-354.
[3]. Epstein HC, Harvey JP Jr(1972) traumatic anterior dislocation of hip: management & results # An analysis of 55 cases # J Bone Joint Surg (Am) 54 1561-1562.
[4]. Hart VL(1942) Fracture-dislocation of hip J Bone Surg 24:458-460.
[5]. McClelland SJ ,Bauman PA ,Medley CF Jr, Shelton ML (1987). Obturator hip dislocations with ipsilateral fractures of femoral head & neck (A case report) ClinOrthop 224:164-168

Abstract: Objective: Complex tibial plateau fractures are caused by variety of mechanisms and have different fracture patterns, may be associated with soft tissue injuries, compartment syndrome, blistrations. Restoration of joint congruity, limb alignment, early range of motion, with a stable knee is difficult at times. We studied efficacy of JESS (Joshi's External Stabilizing System) with or without limited fixations in these complex tibial plateau fractures. Material and Methods: 32 patients of complex tibial plateau fractures (Schatzker type V and VI) associated with severe soft tissue injury, crushing , compartment syndrome were studied. All cases were treated by Joshi's External Stabilizing System with or without limited fixation by cannulated cancellous screws. Progress and complaints of the patients were recorded in accordance with Rick/Delamertier and Meason Hohl scoring system. Follow up of patients was at regular interval of 4 weeks for 6 months and thereafter 6 monthly. Results: Out of 32 patients of complex tibial plateau fractures ( 23 Schatzker Type VI and 9 Type V) with mean age 37.47 (range 20-68) years had right knee injury (n=20) more than left knee (n=12). Mean interval period between injury and the surgery was 6.44 (range 3-16) days. Mean duration of hospital stay was 9.03 (range 5-25) days. Mean range of flexion was 112.190 (range 750-1300), Extensor lag of 50-100 seen in 4 cases. 26 patients have no limitation in activity. Post operative complications like superficial / Pin tract infection in 7, deep infection in 1 and non-union in 1 case were observed. Excellent in 26, good in 4 and satisfactory results in 2 patients were observed in this study.

Key words: Complex tibial plateau fractures; ligamentotaxis; jess fixator.

[1] Bennett WF, Browner B: Tibial plateau fractures: A study of associated soft tissue injuries. J Orthop Trauma 8:183-188,1994

[2] Honkonen SE : Degenerative arthritis after tibial plateau fractures. J Orthop Trauma 9:273-277,1995

[3] Watson JT. High-energy fractures of the tibial plateau. Orthop Clin North Am 1994;25:723–52.

[4] Cole PA, Zlowodzki M, Kregor PJ. Treatment of proximal tibia fractures using the less invasive stabilization system: surgical experience and early clinical results in 77 fractures. J Orthop Trauma 2004;18:528–35.

[5] Mallik AR, Covall DJ, Whitelaw GP: Internal versus external fixation of bicondylar tibial plateau fractures. Orthop Rev 21:1433-14336, 1992

Abstract: Nigella sativa is a herbal plant commonly used for the treatment of several diseases including gastric ones. This study investigates the histological effects of cool extraction of Nigella sativa oil against CCl4-induced stomach and the duodenum damage in adult Wistar rats of both sexes. 35 adult Wistar rats of both sexes were equally divided into 5 groups (5 rats). Group 1 rats were administered normal Saline (volume per body weight) orally. Group 2 rats were administered olive oil 4ml/kg body weight orally. Group 3 rats were administered 4ml/kg body weight of N. sativa oil orally for 2 weeks. Group 4 rats were administered 4ml/kg body weight CCl4 (30% CCl4 in 70% olive oil) orally. Group 5 rats were administered 4ml/kg body weight of N. sativa oil plus 4ml/kg body weight CCl4 (30% CCl4 in 70% olive oil) orally. Histopathological changes were observed. The stomach and the duodenum in group 1, 2 and 3 showed normal stomach and the duodenum architecture. There was a widespread degeneration and ulceration in the stomach and the duodenum in the epithelium of group 4 rats. N .sativa oil showed protective effect on the histological section of the stomach and the duodenum in groups 5. From the results it is suggested that cool extraction of Nigella sativa oil extract has the ability to protect the stomach and the duodenum histological damages, possibly through antioxidant effects of its bioactive compounds.

Keywords: CCl4, stomach, duodenum, histological, Nigella sativa

[1]. Alam, M. M., M. Yasmin, et al. (2010). "Antibacterial activity of chloroform and ethanol extracts of black cumin seeds (Nigella sativa) against multi-drug resistant human pathogens under laboratory conditions " J Med Plant Res 4(18): 1901-1905.
[2]. Bacon, B. R and Britton, R. S. (1990). The pathology of hepatic iron overload: a free radical mediated process? Hepatology 11: 127-137.
[3]. Calapai, G. (2008). European Legislation on Herbal Medicines: A Look into the Future. Drug Safety;31:428-31.
[4]. El Daly, E. S. (1998). Protective effect of cysteine and vitamin E, Crocus sativus and Nigella sativa extracts on cisplatin-induced toxicity in rats. J Pharm Belg 53: 87-93; discussion 93-5
[5]. El-Kadi, A and Kandil, O. (1987) The black seed (Nigella sativa) and immunity: its effect on human T cell subset. Fed Proc 46:222

Abstract: Dental implants can be placed in fresh sockets just after tooth extraction. These are called "immediate implants‟. The advantages of immediate implants are that treatment time can be shortened and that bone height might be maintained thus possibly improving the aesthetic results. The potential disadvantages as per the studies are an increased risk of infection and failures of the immediately placed implants. We report a case of 65 year old patient with root stump in relation to right mandibular molar, who came for replacement of the same.

Key Words: Immediate Implant, Osseointegration, Fresh extraction socket

[1]. Wilson G, Schenk R, Buser D, et al (1998) Implants placed in immediate extraction sites: a report of histologic and histometric analysis of human biopsies. Int J Oral Maxillofac Implants13: 333-341.
[2]. Schwartz-Arad D, Caushu G (1997) The ways and where fores of immediate placement of implants into fresh extraction sites: a literature review. J Periodontol68: 915-923.
[3]. Schwartz-Arad D, Caushu G (1997) Placement of implants into fresh extraction sites: 4-7 years retrospective evaluation of 95 immediate implants. J Periodontol68:1110-1116.
[4]. Novaes AB Jr, Vidigal GM Jr, Novaes AB, et al (1998) Immediate implants placed into infected sites. a histomorphometric study in dogs. Int J Oral Maxillofac Implants13:422-427.
[5]. Ganeles J, Wismeijer D (2004) Early and immediately restored and loaded dental implants for single tooth and partial arch applications. Int J Oral Maxillofac Implants19 (Suppl):92-102.

Abstract: Necrotizing fasciitis (NF) is a rare infection of the facial planes and it is less common in head and neck, because of the rarity and higher vascularity in the region. We report a case of necrotizing fasciitis in a 67-year-old man, arising from a dental infection treated successfully by early diagnosis, prompt surgical management, antibiotic therapy and adjunctive hyperbaric oxygen (HBO) therapy. It is associated with a high mortality and results in severe disfigurement of the face, posing challenging reconstructive problems. The authors present their experience on the comprehensive management of NF of face

Key Words: with severe disfigurement affecting a 67 year old male patient.

[1]. Shimizu T, Tokuda Y. Necrotizing fasciitis. Inter Med 2010; 49: 1051–7.
[2]. Lanisnik B, Cizmarevic B. Necrotizing fasciitis of the head and neck: 34 cases of a single institution experience. Eur Arch Otorhinolaryngol 2010; 267:415–21.
[3]. Benavides etal, Necrotizing fasciitis of the face: a report of one successfully treated case. Otolaryngol Head Neck Surg 2003; 128:894 – 6.
[4]. Shindo etal, Necrotizing fasciitis of the face. Laryngoscope 1997; 107:1071 – 9.
[5]. Ali MH, Zayed ME. Necrotizing fasciitis of the head and neck: report of three cases. Ann Saudi Med 1997; 17: 641–5.
[6]. Muto T, Sato K, Kanazawa M. Necrotizing fasciitis of the neck and chest: report of a case. Int J Oral Maxillofac Surg 1992; 21:236–8.

Abstract: Myasthenia Gravis (pronounced My-as-theen-ee-a Grav-us) comes from the Greek and Latin words meaning "grave muscular weakness." The most common form of MG is a chronic autoimmune neuromuscular disorder that is characterized by fluctuating weakness of the voluntary muscle groups. Myasthenia gravis (MG) was first described by Thomas Willis in 1672. Myasthenia Gravis occurs in all races, both genders, and at any age. MG is not thought to be directly inherited nor is it contagious. It does occasionally occur in more than one member of the same family. It is an acquired autoimmune disease with antibodies against the nicotinic acetylcholine receptor (AChR) at the neuromuscular junction or muscle-specific tyrosine kinase (MuSK). This leads to muscular weakness with easy 'fatiguability', which is worse on exercise and improves with rest. MG shows clinical presentations like weakness of Muscle fatigues more readily after exercise,Droop of the upper eyelids, Small muscles of the hands, Seizures, Deltoid and triceps muscles,Bulbar muscles common,causing a nasal sound to speech that is slurred. Facial muscles. MG can be managed by administering Corticosteroids, ACEinhibitors Azathioprine, Cyclosporine, Mycophenolate mofetil, Plasma exchange, Intravenous immunoglobulin, Thymectomy. Telithromycin is a macrolide antibiotic which inhibits the nicotinic acetylcholine receptors (nAChR) at the neuromuscular junction (α3β2 and NMJ) which shows exacerbation of MG in all the patients leading to myasthenia gravis crisis.

KeyWords: Drug Interactions, Management, Myasthenia Gravis Crisis, Pathophysiology, Telithromycin

[1]. Evolia, TonaliPA, PaduaL. "Clinical correlates with antiMuSK antibodies in generalized seronegative myasthenia gravis. Brain". Oct 2003; 126(Pt 10):2304-11.

[2]. Sanders DB, Howard JF, Massey JM. "Seronegative myasthenia gravis". Ann Neurol. 1987; 22:126.

[3]. Gajdos P, Chevret S, Toyka K. "Intravenous immunoglobulin for myasthenia gravis". Cochrane Database Syst Rev. Jan 23 2008; CD002277.

[4]. Martignago S, Fanin M, Albertini E, Pegoraro E, Angelini C. "Muscle histopathology in myasthenia gravis with antibodies against MuSK and AChR". Neuropathol Appl Neurobiol. Feb 2009; 35(1):103-10.

[5]. Keller DM. "Late-Onset Myasthenia Gravis Linked to Higher Cancer Risk". Medscape Medical News [serial nline]. Jul 2 2013; Accessed Jul 17 2013.

Abstract: Most individuals who develop cardiovascular disease (CVD) have cluster of multiple risk factors like dyslipidaemia, hypertension and hyperglycaemia. This cluster have termed as metabolic syndrome. It is well known that the prevalence of obesity, diabetes and metabolic syndrome all increase with age and linking to oxidative stress markers. Very few studies have been done to show the role of oxidative stress markers in metabolic syndrome. Methodology: A prospective randomized double blinded case control study was undertaken on 30 metabolic syndrome patients and 30 healthy controls in the age group of 40-70 years of either sex admitted to the respective specialty unit. The study protocol was approved by the institutional ethical committee. Aseptically 3ml of venous blood was collected with due consent from the patients and the controls for estimating : GGT and Uric acid Result: The statistical significant difference were observered in the mean values of GGT and uric acid parameters between study groups. Both the parameters shows a direct correlation with the syndrome. Conclusion: Hence, by periodically estimating the above said parameters with regular treatment protocols in diagnosed or in suspected metabolic syndrome patients will predict early and better outcome.

Keywords: oxidative markers, obesity, metabolic syndrome, dyslipidaemia, hyperglycaemia.

[1]. Scott M. Grundy, H. Bryan Brewer, Jr, James I. Cleeman, Sidney C. Smith, Jr; Reviewed John Beilby; Definition of Metabolic Syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association Conference on Scientific Issues Related to Definition; Circulation 2004;109:433-8.
[2]. Türk Kardiyol Dern Arş - Arch Turk Soc ;Increased serum gamma-glutamyltransferase activity in patients with metabolic syndrome. Cardiol 2011;39(2):122-8.
[3]. Nobukazu Ishizaka, Yuko Ishizaka, Ei-Ichi Toda, Ryozo Nagai; Association Between Serum Uric Acid, Metabolic Syndrome, and Carotid atheroscelorosis in Japanese individual; J of American Heart Association;Arterioscler Thromb Vasc Biol 2005;25:1038-44.
[4]. Lehto S, Niskanen L, Ronnemaa T, Laakso M. Serum uric acid is a strong predictor of stroke in patients with non-insulin-dependent diabetes mellitus. Stroke. 1998;29:635– 9.
[5]. Hongqiao Zhang and Henry Jay Forman; Redox Regulation of g-Glutamyl Transpeptidase; American Journal of Respiratory cell and molecular biology, VOL 41 2009;509-15.