iosr-JDMS   Volume-13 ~ Issue-8 ~ August-2014

Abstract: Intra-myometrial Vasopressin has been studied in 24 patients of atonic PPH intractable to uterotonics (oxytocin and methergin) and PGF2alpha. 20 units of vasopressin diluted in 100ml of normal saline was infiltrated intra myometrially (n= 7) at multiple sites using 23G spinal needle under direct vision at CS, and trans-abdominally (n= 17) in case of normal vaginal delivery. Atonic PPH was controlled in all women with absolute success .Intra myometrial Vasopressin showed immediate response with complete hemostasis and uterine tonicity within 4 to 8 minutes in our study.

Key words: Vasopressin, Atonic PPH (postpartum Hemorrhage), Intramyometrium

[1]. Frederick J, Fletcher H, Simeon D, Mullings A, Hardie M. - Intramyometrial vasopressin: AA haemostatic agent during myomectomy. Br J Obstetric Gynaecol 1944;101:435-7
[2]. Corson SL, Brooks PG, Serden SP, Batzer FR, Gocial B. Effects of vasopressin administration during hysteroscopic surgery. J Reprod Med 1994;39:419-23
[3]. Lurie S, Appleman Z, Katz Z. Sub endometrial vasopressin to control intractable placental bleeding. Lancet 1997;349:698-9
[4]. Schulz KF, Grimes DA, Christensen DD. Vasopressin reduces blood loss from second-trimester dilation and evacuation abortion. Lancet 1985;17:353-6
[5]. Tulandi T, Beique F, Kimia M. Pulmonary edema: A complication of local injection of vasopressin at laparoscopy. Fertil Steril 1996;66:478-80

Abstract: H - type tracheo oesophageal fistula is a rare congenital anomaly that is mainly diagnosed in the neonatal age. H -type isolated tracheo oesophageal fistula presents with a characteristic triad of symptoms : chocking and cyanosis on feeeding, recurrent lower respiratory tract infection and abdominal distension. Symptoms may be intermittent and vary in severity. A high index of suspicion is required because the symptoms are not specific. Preoperative diagnosis and locating it at surgery are both difficult. Surgical division of the fistula is curative . We here reporting a case of h - type tracheo oesophageal fistula which is very rare.

Key words: H type fistula, Tracheo oesophageal fistula, TOF

[1]. Felix JF, Klein A, Tibboel D. Etiology of esophageal atresia and tracheoesophageal fistula: "mind the gap". Curr Gastroenterol Rep. 2010; 12: 215-22.
[2]. Gupta DK (2000) Textbook of Neonatal Surgery, pp. 330-331.
[3]. Crabbe D. Isolated tracheo-oesophageal fistula.PediatrRespir Rev 2003;4:74-8.
[4]. Biechlin A, Delattre A, Fayoux P. Isolatedcongenital tracheoesophageal fistula.Retrospective analysis of 8 cases and review ofthe literature. Rev Laryngol Otol Rhinol2008;129:147-52.
[5]. Brookes JT, Smith MC, Smith RJ, Bauman NM,Manaligod JM, Sandler AD.H-type congenitaltracheoesophagealfistula: University Of Iowaexperience 1985 to 2005. Ann Otol Rhinollaryngol 2007;116:363-8.

Abstract: Cotard's syndrome was first described by Dr. Jules Cotard,a French psychiatrist in 18801. This condition is generally thought to be characterized by various degrees of delusional beliefs in which nihilistic delusion that one is dead or the world no longer exist, is the core feature2. This is a rare syndrome and till today prevalence and incidence is not known3.This syndrome is usually encountered in middle aged or older people with more commonly affecting females4. Cotard's syndrome is seen most commonly with severe major depressive patients5,but also occur with various psycho-organic conditions like Schizophrenia6, Bipolar disorders7, depersonalisation disorder8, dementia9,temporal lobe epilepsy10, parkinson's disease 11,brain injury12 .We report a case of cotard's delusion in bipolar disorder type-II who presented with self destructive behaviour in the form of self starvation leading to sudden collapse.

[1]. Yamada K, Katsuragi S, Fujii I. A case study of Cotard's syndrome: stages and diagnosis. Acta Psychiatr Scand. 1999; 100:396–398.
[2]. Berrios G.E., Luque RCotard's delusion or syndrome?Aconceptual history.Compr Psychiatry 1995;36(3):218-223
[3]. Hans D, Michael P, Kathelijne P, and Kurt A. Cotard's Syndrome review .Mind & Brain,J of psychi 2011; 2(1):67-72
[4]. Halfon O, Mouren-Simeoni MC, Dugas M: The Cotard syndrome in adolescents Ann Med Psychol.1985.143:876-879.
[5]. Berrios G.E., Luque R. Cotard's syndrome: analysis of 100 cases. Acta Psychiatr Scand.1995. 91(3):185-188.
[6]. Nejad AG, Kerdegari M, Reihani-Kermani H. Self-mutilation of the nose in a schizophrenic patient with Cotard syndrome. Arch Iranian Med.2007;10:540-542

Abstract: Total knee arthroplasty is done to reduce pain and disability in elderly individuals with conditions like osteoarthritis and rheumatoid arthritis. One of the dreaded complications of TKR is infection which causes surgery a total failure and furthermore the subsequent treatment becomes more complicated and causes more morbidity and financial expenditure to the patient. TKR to treat active joint tuberculosis remains controversial and most authors advice not to do joint replacements in cases with active discharging sinuses1, 4, 9 - 11. As a precaution it is always necessary to rule out infection pre operatively by thoroughly investigating the patient. But sometimes we can encounter unexpected things. A 55 year old female who was apparently normal two years back developed right knee pain. Pain is insidious, continuous, not associated with fever or any trauma. She is not a known case of TB of any other organ. But she is a known case of rheumatoid arthritis and epilepsy, on treatment. On investigating she had increased ESR of 56 for one hour, CRP is elevated to 2.4 and serum alkaline phosphatase elevated to 155. As there were no signs to suspect active TB in any of the systems or organs both clinically and radiologically, we proceeded with the total knee replacement. But on opening the joint synovium looked inflamed and hence it was sent for biopsy and TKR was completed with Genesis II (Smith and Nephew). The biopsy report came as granulomatous lesion consistent with tuberculosis. Synovium specimen showed epithelioid granuloma with Langhans Giant cells. But AFB and fungal staining came as negative

[1]. Yi-chao Zhang, MD; Hong Zhang MD; One stage Total joint arthroplasty for patients with active tuberculosis.,healio.com, Vol 36 Issue 5, May 2013
[2]. Su JY, Huang TL, Lin SY, Total knee arthroplasty in tuberculous arthritis, CORR,1996 (323) 181-187
[3]. Sidhu S, Singh AP, Singh AP, Total hip replacement in active advanced tuberculous arthritis, JBJS Br 2009,(10) 1301-1304
[4]. Yoon TR, Rowe SM et al, Immediate Cementless THR for active TB Hip, J Arthroplasty 2005, 20(7); 923-6
[5]. Ha KY, Chang YG et al, Adherence and biofilm formation of S.Epidermidis, M tuberculosis on various spine implants, Spine ( Phila Pa 1976), 2005; 30(1): 38-43

Abstract: For treatment of pediatric femur shaft fractures in Children of age less than five years; there has been no controversy prevails and can be best treated by traction followed by cast method as proved by number of studies because of early union and rapid remodeling. Children with age higher than five years have more chances of malunion and plaster complication. Our study on pediatric diaphyseal femoral fractures at these age group shows good outcome with closed reduction and fixation by Titanium Elastic Intramedullary Nails; as compare to traditional methods like conservative traction followed by cast method, open reduction and plate fixation, external fixator as they have their possible drawbacks in results described by conventional studies.

Key Words: Titanium Elastic Nail (TEN), Diaphyseal, Femur.

[1] R J Brumback, Intramedullary nailing of femoral shaft fractures part 2. Fracture healing with static interlocking fixation JBJS 70A, 1988, 1453-1462.
[2] GOODSHIP A.E. The influence of induced micromovement upon the healing of experimental tibia fractures. JBJS 67B (4): 1985, 650-655.
[3] Ender H.G., Subtrochantere Bruchedes Oberschenkeis:behandlung mit Federnagelen.Chir.9:359,1974.
[4] Flynn J.M., Luedtke L.M., Ganley T.J.,Dawson J.,Davidason R.S.,Dormans J.P.,Ecker M.L.,Greg J.R.,Horn B.D.,Drummond D.S., Comparison of titanium elastic nails with traction and spica cast to treat femoral fracturesin children, J Bone & Joint Surg. Am., 2004(86 A):770-777.
[5] K.C.Saikia,S K Bhuyan, T.D. Bhattacharya, Titanium elastic nailing in femoral diaphyseal fractures of children in 6-16 years of age. IJO 2007, vol.41, issue 4,381-385.

Abstract: Children are the wealth of tomorrow. Nationally unintentional injuries take away the lives of more than 2000 children every day. The lifelong disabilities in children will increase the financial burden on family, community and nation. India as a developing country is experiencing a similar burden. The major areas identified in childhood injury in India are burns, falls, poisoning and drowning. This article calls the public attention on major childhood injuries of the country. The country need to pay attention on education, rehabilitation, care, legislation and article modification, for the reduction of childhood injury. This paper emphasizes the need for more researches in the community to increase the community participation in the care of children and thereby to reduce the incidence of injuries in the vulnerable pediatric population.

Key words: Burns, Childhood, Drowning, Evidence, Fall, Injury, Poisoning

[1]. Jurkovich GJ, Rivara FP, Johansen JM, Maier RV. Centers for Disease Control and Prevention injury research agenda: identification of acute care research topics of interest to the Centers for disease Control and Prevention--National Center for Injury Prevention and Control. J Trauma. 2004 May;56(5):1166-70.
[2]. WHO, UNICEF. World report on child injury prevention2014.
[3]. Harvey A, Towner E, Peden M, Soori H, Bartolomeos K. Injury prevention and the attainment of child and adolescent health. Bull World Health Organ. 2009 May;87(5):390-4.
[4]. WHO, UNCF. World report on child injury prevention. Geneva:: World Health Organization & United Nations Children's Fund2008.
[5]. Gururaj G. Injury Prevention and Care : An Important Public Health Agenda for Health, Survival and Safety of Children. Indian Journal Of Pediatrics. 2012:1-9.

Abstract: Breast cancer is a most common site specific cancer in women. It is the leading cause of death from cancer, exceeded only by, lung cancer. Traditionally they are classified by TNM classification consisting of Tumour, node and metastasis. They are then staged and also histopathology is taken into consideration. It has been seen that the same stage cancer behave differently to same treatment. The answer lies in its molecular biology. There are various biomarkers which have prognostic and predictive values. Their assessment helps in individualising the treatment of carcinoma breast. In this article an attempt is made to describe the various biomarkers and their influence. The basic workup for carcinoma breast consists of staging, histological classification and at least ER/PR and HER 2/new status. The proliferation marker Ki-67 provides important prognostic information particularly for the patients with small tumour and no axillary lymph node involvement.

Keywords: Carcinoma breast, immunohistochemistry, hormone receptors, ER/PR, Her-2/neu.

[1] Gunie VF: epidemiology of breast cancer, in Bland KI, Cope land EM III (ed): The breast comprehensive management of benign and malignant disease (Philadelphia: WB saunders 1998) p 339.

[2] Jemal A, et al cancer statics 2008. Ca breast j clin 58:71, 2008.

[3] Cleator S, Ashworth A. Molecular profiling of breast cancer, Clinical implications. Br J cancer 200; 90: 1020-4.

[4] Bast RC jr, Ravdin P, Hayes DF, Bates S, Friksche H jr, Jessup JM et al. Update of recommendation for the use of tumour markers in breast and colorectal cancers. Clinical practice guidelines, of the American society, of clinical oncology. J clin oncol 2001; 19: 1865-78. [5] Puzztai L, Mazounic, Anderson K, Wu Y, Symmans WF. Molecular classification of breast cancer, limitation and potential. Oncologist 2006; 11: 868-77.

Abstract: Controlled clinical evaluation of Bruhaniya Gana (Shatavari, Kakoli, Kshirkakoli, Bala, Ashwgandha, Vidari, Tiltaila, Gokshir, Goghrita, Sita and Madhu) siddha Kshirpan and Kshirbasti with Alamine SN and Cap.Alamine forte in the management of Garbhashosh (IUGR) in 60 subjects for a period of 15 days was done. The study was conducted over a period of 2 years at M.A.Podar (Ayu) Hospital, Mumbai, by Dept. of Streerog Prasutitantra. After treatment it was observed by statistical analysis that, in IUGR, Bruhaniya ganasiddha ksheerbasti along with ksheerapan has better effect over drug Alamine Forte. Trial group showed improvement in weakness, fatigues, general debility etc., the newborn baby shows improvement in the birth weight and complexion. This shows that basti improves quality of life of mother along with fetus.

[1]. Ashtanga Hridayam with Sarvanga Sundar Vyakhya of Arundutta and Ayurveda Rasayana Vyakhya of Hemadri (Sanskrit) chowkhamba Surbharati Prakashan, Varnasi, 1997.
[2]. Ashtanga Sangrahah with Sarvanga Sundar Vykhya of Pt.Lalchandra Shastry Vaidya (Hindi), Baidyanath Ayurveda Bhavan Private Ltd., 1st Edition 1989.
[3]. Charaka Samhita with Nibandha Sangrah Vyakhya of Dalhana (Sanskrit), Chaukhamba Orientails, Varanasi.
[4]. Text book of obstetrics – D.C.Dutta, 1990.
[5]. Williom‟s obstetrics
[6]. Kashyap Samhita Khilsthana.

Abstract: In recent years there is an increase in the studies related to the use of probiotics for oral diseases. It has been effectively used for the control of dental caries but its use in the treatment of periodontal disease is still under study. This article aims at understanding how probiotics work and its application in the field of periodontology.

Key Words: probiotics, periodontitis, gingivitis

[1]. Joint FAO/WHO working group report on drafting guidelines for the evaluation of probiotics in food. London, Ontario, Canada 2002 April 30 and May 1.
[2]. Iva Stamatova, Jukka H. Meurman. Probiotics and periodontal disease. Periodontology 2000, vol 51,2009,141-151
[3]. Wim Teughels, Mark Van Essche, Isabelle Sliepen and Marc Quirynen, Probiotics and oral health. Periodontology 2000,2008,111-141
[4]. Anirban Chatterjee, Hirak Bhattacharya, Abhishek Kandwal. Probiotics in periodontal health and disease. J Indian Soc Periodontology 2011 Jan-Mar;15(1):23-28
[5]. JH meurman, I stamatova, probiotics: contributions to oral health, oral disease volume 13, issue 5, 443-451
[6]. D deepa and DS Mehta, is the role of probiotics friendly in the treatment of periodontal diseases. J Indian Soc Periodontol. 2009 Jan-Apr;13(1):30-31

Abstract: Objectives: the purpose of this study was to compare the effectiveness of acupuncture and study to acupuncture-like transcutaneous electrical nerve stimulation in treating primary dysmenorrhea Methods: Subjects: Eligible women were aged 11–30 years with a diagnosis of primary dysmenorrhea. Twelve subjects each were randomized to control, acupuncture and ACUTENS groups. All subjects completed two pain questionnaires (Pain Rating Index (PRI) of McGill Pain Questionnaire and Visual Analogue Scale) before treatment; immediately post treatment; 30, 60, 120 post-treatment and the next morning upon awakening. The data were treated as means and standard deviation analyzed with one way analysis of variance and Bonferroni post hoc analysis test.

Key words: Acupuncture, Acupuncture-like Transcutaneous Electrical Nerve stimulation, Dysmenorrhea, Pain, Physiotherapy

[1]. Dawood MY, "Primary dysmenorrhea: advances in pathogenesis and management," Obstetrics and Gynecology 2006, 108 (2):428–441
[2]. Burnett MA, Antao V, and Black A, "Prevalence of primary dysmenorrhea in Canada," Journal of Obstetrics and Gynaecology Canada 2005, 27, (8):765–770
[3]. Hillen TIJ, Grbavac SL, Johnston PJ, Straton JAY, and Keogh JMF, "Primary dysmenorrhea in young Western Australian women: prevalence, impact, and knowledge of treatment," Journal of Adolescent Health 1999, 25: 40–45
[4]. Harel Z, "Dysmenorrhea in adolescents and young adults: etiology and management," Journal of Pediatric and Adolescent Gynecology 2006, 19: 363–371
[5]. Wong CL, Farquhar C, Roberts H, and Proctor M, "Oral contraceptive pill as treatment for primary dysmenorrhoea," Cochrane Database of Systematic Reviews, no. 2, Article ID CD002120, 2009.

Abstract: Cowden syndrome is a rare autosomal dominant disorder that is characterized by multiple hamartomas in a variety of tissues and this is associated with germline mutations in the phosphatase and tensin homologue (PTEN) gene, which is the tumor suppressor gene located on chromosome 10q23.3. It is characterized by multiple hamartomatous neoplasms of the skin, oral mucosa, gastrointestinal (GI) tract, bones, central nervous system, eyes, and genitourinary tract. Clinical features of Cowden's disease are explained by the mutation of the PTEN tumour suppressor gene, whose modification leads to an uncoordinated growth of tissues. The importance of this disease lies in the increased susceptibility to malignization of some lesions, specially breast, thyroid and genito-urinary tract lesions. As a result, the disease has been considered a preneoplasic condition. Despite its varied phenotypic expression, this disease is generally unknown. Consequently, many cases are undiagnosed or diagnosis comes at a late stage, what points out the importance of an early diagnosis of the disease so the patient can have periodic check-ups to prevent malignant diseases. We present a case of a 28 year old female with Cowden.s disease. The patient had facial papules,intra oral lesions multiple GI hyperplastic polyps, oesophageal glycogenic acanthosis and, goiter.

Key words: Cowden.s disease, Hamartoma, Hyperplastic polyp, PTEN gene,

[1]. Eng C: Will the real Cowden syndrome please stand up: revised diagnostic criteria.J MedGenet 2000, 37:82830.

[2]. Eng C: PTEN: one gene, many syndromes. Hum Mutat 2003, 22:183 98.

[3]. Liaw D, Marsh DJ, Li J, Dahia PL, Wang SI, Zheng Z, Bose S, Call KM, Tsou HC, Peacocke M, Eng C, Parsons R: Germline mutations of the PTEN gene in Cowden disease, an inherited breast and thyroid cancer syndrome.Nat Genet 1997, 16:64-7

[4]. Starink TM. Cowden disease. Analysis of fourteen new cases. J Am Acad Dematol 1984; 11:1127-1141.

[5]. Williard W, Borgen P, Bol R, Tiwari R, Osborne M.Cowden disease: a case report with analyses at the molecular level. Cancer 1992; 69:2969-2974.

Abstract: Background: The outcome of live kidney donation has been of concern since the recognition of hyperfiltration injury post live kidney donation. Studies on the topic have arrived at different conclusions regarding kidney function following live kidney donation; some suggest the possibility of renal progression while others report renal function similar to that of the general population. However, there are no studies done in a homogeneously African population to compare with. Beginning the year 2010 at Kenyatta National Hospital, Kenya, live kidney donation happened regularly with an average of two live related kidney donation and transplantation per month. The purpose of this study was to assess the impact of renal donation on renal function of live kidney donors at Kenyatta national hospital. Objective: To determine serum creatinine levels, eGFR, prevalence of proteinuria, and hypertension among living kidney donors at Kenyatta National Hospital. Study design: Cross-sectional descriptive study Conclusion: At the mean duration of follow up of 15.9 months, the kidney donors studied regained their renal function with a tendency towards hyperfiltration. The prevalence of proteinuria and hypertension was low. The results of the study compared well with those obtained from other studies

[1]. Sean J. Barbour, Michael Schachter, Lee Er, Ognjenka and Adeera Levin. A systemic review of ethnic differences in the rate of renal progression in CKD patients. Nephrol Dial Transplant 2010; 25:2422-2430.
[2]. Naicker S. Burden of End-stage renal disease in Sub-Saharan Africa. Ethn Dis. 2009;19:S13-S15
[3]. Evans K, Coresh J, Bash LD, Gary-Webb T, Köttgen A, Carson K, et al. Race differences in access to health care and disparities in incident of chronic kidney disease in the US. Nephrol Dial Transplant 2011;26:899-908
[4]. Ricardo Correa-Rotter. The cost barrier to renal replacement therapy and peritoneal dialysis in developing world. Perit Dial Int.2001;21:S314-317S
[5]. Harris RC, Neilson EG. Toward a unified theory of renal progression. Annu Rev Med. 2006; 57: 365-80
[6]. Otieno L.S., Awori N.W., Bagshawe A.J., Abdulla M.S. and Kyambi J.M. et al. The first kidney transplant in Kenya. East Afr. med. J. 1980; 57:369-373

Abstract: The effect of viral hepatitis on some coagulation parameters APTT, PT,TT,Fibrinogen and platelets were determined among blood donors at FMC Umuahia. One hundred and sixty three blood donors were sampled comprising One hundred and thirteen as follows; (HAV 16, HBV 65 and HCV 32) and fifty non hepatitis subjects who served as control. The parameters were analysed using standard haematology technique. Results obtained showed no statistical significant changes in the coagulation parameters in HAV subjects (32.8±2.6) secs, 12.4±1.5 (secs), 16.7±1.3 secs, 2.9±0.2g/L and 249±73 109/L when compared with control group 34.1±3.1 secs 13.4±1.7 secs 16.7±1.5 secs 2.5±0.6g/L and (263±74) 109/L respectively for the parameters as stated above (P > 0.05), significant change in HBV infection 42.4±5.8 (secs); 22.3±10.7 (secs); 23.9±4.7 (secs); 1.8±1.1(g/L); and 162±144(109/L) when compared with the control 34.1±3.1 (secs); 13.4±171 (secs); 16.7±1.5 (secs); 2.5±0.6 g/L); 26. ±74 (109/L) respectively at P<0.05. The HCV infection showed the same significant changes in all the coagulation factors estimated; 45.0±6.3 (secs); 20.9±4.9 (secs); 24.6±5.6 (secs); 1.6±0.6 (g/L) and 170±61 (109g/L) when compared with the same control group. The APTT showed a positive relationship with PT and TT and a negative relationship with fibrinogen and platelets. PT had a strong positive correlation with TT and a negative relationship with fibrinogen and platelet. TT showed a strong negative relationship with fibrinogen and platelet. The result showed an alteration in the levels of coagulation factors following viral infection of the liver.

Keywords: APTT, PT, TT, Fibrinogen and Platelet

[1]. Blanchard, R. A., Furie, B. C., and Jorgensen, M., (1981). Acquired Vitamin K-dependent Carboxylation deficiency in Liver disease. New England Journal of Medicine: 305: 242-248.
[2]. Dacie and Lewis (2001)"Haemostasis" In test book of practical Haemetology. 9th Edition. Ed: Lewis, S.M., Bain, B.J., and Bates, I.) Churchill Livingstone London pp 339-342.
[3]. Emechebe, G.O., Emodi, I.J., Ikefuna, A.N., Ilechukwu, G.C., Igwe, W.C., and Ejiofor, O.S., (2009). Hepatitis infection in Nigeria-a review. Nigeria journal of medicine 50 (1):18-22.
[4]. Francesca, R. P., valerio, De.S., and Antorio, G., (2009) Viral Grrhosis: an overview of haemostatic and Clinical Consequences. Meditterean Journal of Haematology and infections Diseases 1(3):
[5]. Hyers, T.M., Agneli, G., and Hill, R.D., (2001). Antithrombotic theraphy for venous thromboembolic disease. Chest: 119: 176-193.

Abstract: Hydatid disease is a parasitic infestation, the pulmonary variant, caused by Echinococcus multilocularis is less common and the extra pulmonary thoracic variant even rare .We report a case of 52 year old female who underwent complete surgical excision of isolated right sided thoracic extrapulmonary hydatid cyst with subcutaneous extension. The postoperative period was uneventful. She was discharged on the 6th post op day and is in regular follow up and doing well.

[1]. McManus DP, Smyth JD. Hydatidosis: changing concepts in epidemiology and speciation. Parasitol Today. 1986;2:163–68.
[2]. Saidi F. Treatment of echinococcal cysts. In: Nyhus LM, Baker RJ, Sabiston DC, editors. Mastery of surgery. 2nd ed. London: Little, Brown and Company; 1992. p. 818–37.
[3]. Barrett NR. Surgical treatment of the hydatid cyst of the lung. Thorax. 1947;2:21.
[4]. Harlaftis NN, Altreas HA, Panagiotis SN. Hydatid disease of the lung. In: Shields TW, LoCicerco J, Ponn RB, Rusch VW, editors. General Thoracic Surgery. 6th Ed. Philadelphia: Lippincott Williams& Wilkins, P.1298.
[5]. Ozvaran MK, Ersoy Y, Uskul B, et al. Pleural complications of pulmonary hydatid disease. Respirology. 2004;9:115–19.
[6]. Kabiri el-H, Caidi M, al Aziz S, el Maslout A, Benosman A. Surgical treatment of hydatidothorax. Series of 79 cases. Acta Chir Belg. 2003;103:401–04.

Abstract: Substance abuse has become one of the major contributor to psychiatric morbidity worldwide. The pattern of substance abuse, in patients attending psychiatry OPD of IGMC, Shimla, from the years 2006 to 2008, was studied. Alcohol abuse was found to be the most prevalent, followed by that of cannabis. Opioid, sedative and inhalant abuse trends were found increase over these years. Key Words: Alcohol abuse, cannabis abuse, opioid abuse, tobacco, sedative and multiple substance abuse

[1]. Basu D. and Mattoo S.K.: Epidemiology of substance abuse in India: Methodological issues and future perspectives. Indian Journal of Psychiatry, 1999, 41(2), 145-153.
[2]. Epidemiologic Trends in Drug Abuse: Advance Report, June 1999. Community Epidemiology Work Group. National Institutes of Health, National Institute on Drug Abuse.
[3]. Gururaj G., Rao G.N., Bengal V., Murthy P.: Alcohol use and public health: the Indian perspective. National Institute of Mental Health and Neurosciences Bangalore, India, for World Health Organization, 2006.
[4]. Anand K.: Assessment of burden and surveillance of major noncommunicable diseases in India. World Health Organization(WHO) South East Asia Regional Office, workshop document: New Delhi 2000.
[5]. Meena, Khanna P., Vohra A.K., Rajput R.: Prevalence and pattern of alcohol and substance abuse in urban areas of Rohtak city. Indian Journal of Psychiatry, 2002, 44(4) 348-352.