iosr-JDMS   Volume-13 ~ Issue-9 ~ September-2014

Abstract: Granulicatella elegans is a nutritionally variant streptococci generally associated with infective endocarditis. Meningitis due to G.elegans is very rare and it has always occurred in cases following neurosurgical procedures. We report the case of acute pyogenic meningitis with bacteremia with parenteral diarrhea in a ten month old immunocompetent child without any preceding neurosurgical intervention or dental manipulations. This case emphasizes the need of high degree clinical suspicion, use of appropriate culture media for isolation and identification of G.elegans and rapid initiation of adequate antibiotic therapy.

Keywords: Bacteremia, Granulicatella elegans, Meningitis, Nutritionally variant Streptococci

[1] Frenkel A, Hirsch W. Spontaneous development of L forms of streptococci requiring secretions of other bacteria or sulphydryl compounds for normal growth. Nature. 1961; 191:728-730.

[2] Rouff KL. Nurtritionally variant streptococci. Clin Microbiol Rev. 1991;4:184-190.

[3] Collins MD, Lawson PA. The genus Abiotrophia(Kawamura et al.) is not monophyletic: proposal of Granulicatella gen. nov., Granulicatella adiacens comb. Nov., Granulicatella elegans comb. Nov. and Granulicatella balaenopterae comb. Nov. Int J Syst Evol Microbiol 2000;50:365-369.

[4] Senn L, Entenza JM, Greub G et al. Bloodstream and endovascular infections due3 to Abiotrophia defective and Granulicatella species. BMC Infect Dis. 2006;20:6:9.

[5] Liao CH, Teng LJ, Hsueh PR, Chen YC, Huang LM, Chang SC et al., Nutritionally variant Streptococcal infections at a University Hospital in Taiwan: Disease emergence and high prevalence of β Lactam and Macrolide resistance. Clinical Infectious Diseases. 2004;38:452-455.

Abstract: Background: Mid-age people are very susceptible to lose baseline fitness while active life-style is a key to prevent ageing-related hypokinetic and degenerative diseases. Awareness of such scientific facts and application of these in practice are essential in the grass root level. Hardly research works in this area on apparently healthy people are conducted on mid-age people in India. Therefore it deems reasonable to investigate the status of aerobic fitness of morning walker mid-age people in relation to their body composition and resting heart rate. Objective: The purpose of the study was to establish the relationship among body mass index, resting heart rate and aerobic fitness of mid age males. Materials and Methods: 60 middle-aged males who undergo regular physical activities and ranging the age from 36-45 years participated as subjects of the study. Selected parameters for the study were body composition (BMI), resting heart rate (HR), aerobic fitness (AF) and age of subjects. BMI was calculated by using standard method in kg/m2; resting heart rate (HR) was measured by palpation at the radial artery in beats/min.; and aerobic fitness (AF) was measured by '3-min step in place' test in beats/min. Pearson's Product Moment Correlation was used to find out the relationship among the variables. The level of significance was set at 0.05. Findings: BMI and AF 'r' = 0.266 (<0.05); BMI and HR 'r' = -0.256 (<0.05); AF and HR 'r'= 0.035 (>0.05). Result & Conclusion: In this study, statistically significant result is observed between BMI and Aerobic fitness and negative correlation is found between BMI & HR while no significant relationship of resting Heart rate is established with Aerobic fitness of the mid-age subjects. Key Words: Active life style, Aerobic fitness, Body Composition, Heart Rate, Mid Age Men

[1]. Bandyopadhyay A, Chatterjee S. "Body composition, morphological characteristics and their relationship with cardiorespiratory fitness"; Ergonomics SA 2003; 1: 19–27
[2]. Barbosa.F.J, Benchimol-B.P.R, Cordovil I. "Autonomic modulation of the heart in systemic arterial hypertension". Arq Bras Cardiol. 2002;78(2):189-95
[3]. Blair S, Kampert J, Kohl H III, et al. "Influences of cardio-respiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women"; JAMA 1996; 276: 205-210 www.indiana.edu/blair%20cardiovascular%20disease%201996.pdf
[4]. Blair et al. "Cardio-respiratory fitness is known to be as strong predictor of mortality as physical activity both in the normal population and in the population with a cardiovascular disease"; www.indiana.edu/blair%20cardiovascular%20disease%201996.pdf
[5]. European Heart Journal; 18: 1997,1823-1828

Abstract: Background: Pyogenic liver abscess (PLA) has been a condition of high mortality, improving over recent decades with combined antibiotic and percutaneous drainage Percutaneous drainage is currently the treatment of choice in liver abscess. Percutaneous needle aspiration(PNA) as an alternative to continuous percutaneous catheter drainage in combination with systemic antibiotics for the treatment of PLA has never been popular. Aims&Objectives: To evaluate the role of ultrasound (USG) guided percutaneous needle aspiration along with systemic antibiotics in the management of PLA. Material And Methods: From January 2012 to July 2013,50 patients (45 male; 15 female; most common age range 40-50 years; mean age 44.34 years) with PLAs (mean diameter 6.52±1.8 cm; range 4.8- 9cm) underwent PNA with ultrasound (USG) guidance and antibiotic therapy. Complete pus removal from each abscess was attempted with 18 gauge thin-walled trocar needles with USG guidance. If necessary, PNA was repeated every 3 day. Results: The percentage of abscesses requiring one, two, three and more sessions of aspiration was 50%, 30%, 18% and 2% respectively. The success rate was unrelated to the largest size or number of abscess in the patient. Cure (normalization of clinical and laboratory parameters and resolution of hepatic lesions) was achieved in all patients (100%).. Patients were hospitalized for 7-22 days (mean11±4.56days) No patient needed imaging-guided percutaneous catheter drainage or open surgical. Neither complications nor deaths ensued. Recurrence of PLA was not observed in any patient during follow-up (6-12) months Conclusions: USG-guided PNA with antibiotic therapy in treatment for PLA is a safe, effective & low-cost procedure. It should be considered as a first line alternative to catheter drainage. Our data suggest that a trial of percutaneous needle aspiration should always be undertaken before catheter drainage or surgery

Keywords: Pyogenic Liver Abscess, Ultrasonography, Percutaneous Needle Aspiration

[1]. Oschner A, et al,1938: Pyogenic abscess of the liver: an analysis of 47 cases with review of the literature.Am J Surg 181:177-186.
[2]. McFadzean AJ, et al, 1953: Solitary pyogenic liver abscess treated by closed aspiration and antibiotics: a report of 14 consecutive cases with recovery. Br J Surg 41:141-152.
[3]. Bertel C, 1986: Treatment of pyogenic hepatic abscess: surgical versus percutaneous drainage. Arch Surg 121:554-558.
[4]. Gerzof S, et al, 1985: Intrahepatic pyogenic abscess: treatment by percutaneous drainage. Am J Surg 149:487-494.
[5]. Rajak C, et al, 1998: Percutaneous treatment of liver abscesses: needle aspiration versus catheter drainage. AJR Am J Roentgenol 170:1035-1039

Abstract: The emergence of resistance to anti-tubercular drugs in general is a significant public health problem that threatens Tuberculosis care and control worldwide. An observational, cross-sectional, hospital based study was conducted among MDR-TB patients to know the drug resistance pattern and the preventive practices adopted by them. A pre-designed, semi-structured questionnaire was used for collection of data. 53.7% patients were found to be resistant to Rifampicin only, 46.3% to both Rifampicin and Isoniazid. All the patients were nonreactive to ICTC testing. 53.6% of patients disposed off their sputum/ expectorations at a pot kept at bedside and later disposed at bathrooms. 29.2 % spitted at roadsides and rest in their toilets. Health education regarding spread of disease, early detection of MDR-TB by strengthened laboratory support, effective therapy, implicating innovative control measures, and applying them specially among immigrants, would interrupt the ongoing transmission and control this emerging epidemic.

Key Words: MDR-TB, drug resistance, sputum disposal, Anti tubercular treatment

[1]. Sarala Menon, Sujata Dharmshale, Chhaya Chande, Aruna Gohil, Sunil Lilani, Salim Mohammad, et al. Drug resistance profiles of Mycobacterium tuberculosis isolates to first line anti-tuberculous drugs: A five years study. Lung India 2012; 29(3) : 227–31

[2]. Zumla A, Abubakar I, Raviglione M, Hoelscher M, Ditiu L, McHugh TD, et al. Drug –resistant-tuberculosis— current dilemmas,unasnswered questions, challenges and priority needs. J Infect dis. 2012;205(suppl 2):S228-40. Epub 2012 Apr 3.

[3]. Open database : WHO's certified [database on the internet]. Multidrug-resistant TB (MDR-TB): 2012 Update.
[4]. Bloch AB et al. Nationwide survey of drug-resistant tuberculosis in the United States. JAMA. 1994 Mar 2;271(9):665-71.

[5]. Bhatt G, Vyas S, Trivedil K. An epidemiological study of multi drug resistant tuberculosis cases registered under Revised National Tuberculosis Control Programme of Ahmedabad City. Indian J Tuberc. 2012 Jan; 59(1):18-27

[6]. Francis JR1, Blyth CC2, Colby S2, Fagan JM2, Waring J2. Multidrug-resistant tuberculosis in Western Australia, 1998-2012. Med J Aust. 2014 Apr 7;200(6):328-32

Abstract: Chronic Suppurative Otitis Media (CSOM) is a very common disease affecting mainly the younger population. Various factors like socioeconomic condition, over-crowding, lack of concern about hygiene, poverty, illiteracy etc. contribute much towards the occurrence of this disease. The audiological impairment is very distressing to the patients even if recurrent otorrhoea ceases. To improve upon the hearing and to check the recurrence, tympanoplasty surgery came into existence. Ossiculoplasty is defined as the reconstruction of the ossicular chain. The ideal prosthesis for ossicular reconstruction should be biocompatible, stable, safe, easily insertable, and capable of yielding optimal sound transmission. Although, autologous and biomaterial implants, both are in practice, yet it is always of interest to find out innovative use of materials other than those being conventionally used. In present study, silicon implants were used. Silicon implants have been successfully used in rhinoplasty[1,2]. The prospects of silicon implants in jaw surgery and innovative areas has been proposed as long back as 1963[3]. Use of silicon implants in ossiculoplasty is rarely reported despite their enormous prospects[4]. The present study is an attempt to evaluate the feasibility, increase in hearing sensitivity, extrusion rate and cost effectiveness of silicon implants in middle ear reconstruction surgeries.

[1] Ahn J, Honrado C and Hom C, Combined Silicone and Cartilage Implants: Augmentation Rhinoplasty in Asian Patients, Arch Facial Plast Surg, 6(2), 2004, 120-123.

[2] Lam SM and Kim Y-K, Augmentation rhinoplasty of the Asian nose with the "bird" silicone implant, Ann Plast Surg, ,51, 2003, 249–256.

[3] Brown JB, Fryer MP, Kollias P, Ohlwiler DA and Templeton JB, Silicone and Teflon Prostheses, Including Full Jaw Substitution, Laboratory and Clinical Studies of Etheron. Annals of Surgery, 157(6), 1963, 932-943.

[4] Gerlinger MD et al. Effect of KTP laser on implants used in middle-ear surgery, The Journal of Laryngology & Otology, 116(7), (2002), 502-506.

[5] Sismairs A. Tympanoplasty (Glasscock Shambaugh.Surgery of ear.5th edition;451).

Abstract: Lupus Vulgaris is a nodular form of cutaneous tuberculosis. Nasal tuberculosis is almost invariably caused by Mycobacterium tuberculosis. Frequent contamination of nasal fossae by Mycobacterium tuberculosis is common in smear positive pulmonary TB. Clinical disease however is extremely rare and in Head and Neck TB, involvement of cervical lymph nodes, larynx, pharynx and ear is more common than nasal involvement. Lupus Vulgaris is rare manifestation of Mycobacterium tuberculosis infection. Furthermore, skin and nasal manifestation of lupus vulgaris makes it difficult to differentiate this clinical entity from other granulomatous condition of nose. But once diagnosed, response to standard six month AKT treatment is satisfactorily with good results. Objective: Hereby we report rare case of Lupus Vulgaris of Nose and demonstrate clinical analysis in differential diagnosis of Lupus Vulgaris. Case Report: A male patient presented with ulceroproliferative lesion over nose and upper lip. On clinical features, histopathological examination and highly positive tuberculin test, diagnosis of Lupus Vulgaris was made. AKT (6 months regimen) was started and ulcerated plaque was completely resolved.

Key Words: Lupus Vulgaris, Nose, Anti-Koch's Treatment (AKT)

[1]. Freitag DS, Clin R. Facial granulomas with nasal destruction. Chest 1988;93:422-423.
[2]. Kumar B, Muralidhar S. Cutaneous tuberculosis: a twenty year prospective study. IntJ Tuberc Lung Dis 1999;3:494-500.
[3]. Sehgal VN, Wagh SA. Cutaneous tuberculosis. Current concepts. Int J Dermatol 1990;29:237-252.
[4]. Kanwar AJ. Lupus vulgaris following BCG vaccination. Int J Dermatol 1988;27:525-526.
[5]. Khandpur S, Nanda S, Reddy BSN. An unusual episode of lupus vulgaris masquerading as sporotrichosis. Int J Dermatol 2001;40 336-339.

Abstract: Stem cells are undifferentiated cells capable of self - renewal and multilineage differentiation. The use of cells as mesenchymal dental stem cells, which has immunosuppressant properties, high proliferation, and capacity to differentiate into osteoblasts, odontoblasts, cementoblasts and other cells, suppose a good perspective in clinical dentistry. Also, these cells need a scaffold that facilitate their integration, differentiation, matrix synthesis and promote multiple specific interactions between cells. To date, different human dental stem cell progenitors have been identified and isolated - bone marrow stromal cells (BMMSC), human pulp tissue (DPSC), exfoliated deciduous teeth (SHED), periodontal ligament (PDLSC), apical papilla (SCAP), dental follicle (DFSC). Also included in this article are the potential applications of stem cell therapy in periodontics. The tissue engineering triad of cells, signaling molecules, scaffolds plays a significant role in achieving regeneration.

Key Words: Multilineage differentiation , self- renewal , tissue engineering triad, undifferentiated cells

[1]. Crubezy E, Murali P, Girard L, Bernadou JP. False teeth of the roman world. Nature 1998, 391-429.
[2]. Shalini H. Stem cells in periodontal regeneration. JournalofDentalandMedicalSciences , 12(2), 2013, 59-63.
[3]. Orban , Development and growth of teeth, Kumar.G.S. (Ed), Orban's Oral Histology And Embryology, 12e , 2007, 22-43.
[4]. Ramalho-Santos M, Willenbring H. On the origin of the term 'stem cell', StemCell , 1, 2007, 35-38.
[5]. Stevens LC, Little CC. Spontaneous testicular teratomas in an inbred strain of mice. PNAS, 40(11), 1954, 1080-1087.
[6]. Aquino R, Papaccio J. Human mandibular bone defect repair by grafting of dental pulp stem cells and collagen sponge biocomplexes. Europeancellsandmaterials, 18, 2009, 75-83.

Abstract: Intracranial lipomas are rare benign neoplasms accounting for <0.1% of all primary brain tumors. Most lipomas were incidentally detected by autopsy or computed tomography or MRI imaging. These slow growing benign lesions are usually asymptomatic and rarely require surgery. We have been reported an incidental finding of Quadrigeminal plate cistern lipoma in three patients on MRI imaging from India.

Keywords: Lipoma, Intracranial lipoma, Quadrigeminal cistern lipoma, Brain lipoma.

[1]. Selcuk Y, Hasan K, Kaya A. Quadrigeminal cistern lipoma. J Clin Neurosci 2005; : 596–9. [CrossRef] [Medline] [Web of Science]
[2]. Senoglu M, Altun I. Lipoma of the quadrigeminal plate cistern. The Internet Journal of 2. Radiology 2009; : 1-3.
[3]. Ono J, Ikeda T, Imai K, et al. Intracranial lipoma of the quadrigeminal region associated with complex partial seizures.
[4]. Pediatr Radiol 1998; : 729–31. [CrossRef] [Medline] [Web of Science] Nikaido Y, Imanishi M, Monobe T. Lipoma in the quadrigeminal cistern – case report. Neurol Med Chir (Tokyo) 1995; 175–8. [CrossRef] [Medline]
[5]. Hayashi T, Shojima K, Yamamoto M, et al. Intracranial lipomas – report of six cases [in Japanese]. No to Shinkei 1983; : 257–68. [Medline]
[6]. Ambrosetto P, Martinelli P, Bacci A, et al. Lipoma of the quadrigeminal plate cistern. Ital J Neurol Sci 1985; : 347–9. [CrossRef] [Medline] [Web of Science]

Abstract: The mandibular first molars ( primary and permanent) usually have 2 roots located mesially and distally, but occasionally they have an additional root located distolingually requiring special attention when root canal treatment is being considered . The additional root is regarded as a normal racial and morphological variation rather than as an abnormality. It appears to be more common in races of Mongoloid origin, including Malay, Chinese, Japanese, Eskimo, and American and Canadian Indian populations.1To study about the rarest root and root canal anatomy using spiral ct and r.v.g. Computed tomography and radio visiography has long been used as a diagnostic aid in dentistry .With the advent of new diagnostic aids like spiral computed tomography it has become very easy for the dentist to diagnose different root and root canal anatomy and accordingly plan the treatment.
Keywords: Radix Entomolaris, Radix Paramolaris, Radix Paraentomolaris, spiral computed tomography, radio visio graphy.

[1]. Oh Kim, DDS, PhD,b Byung-Jai Choi, DDS, PhD,c Hyung-Jun Choi, DDS, PhD,d Heung-Kyu Son, DDS, PhD,c and Jae-Ho Lee, Je Seon Song, DDS, MSD,a Seong- DDS, PhD,e Seoul, Korea 2009Incidence and relationship of an additional root in the mandibular first permanent molar and primary molars . Oral Surg Oral Med Oral Pathol Oral Radiol Endod 107,e56-e60.
[2]. ELISABETTA COTTI & GIROLAMO CAMPISI 2004 Advanced radiographic techniques for the detection of lesions in bone. Endodontic Topics 7,52-72.
[3]. Carlsen O. Munksgaard.1987. Dental morphology 1st edition.
[4]. Scott GR, Turner II CG. 2000 The anthropology of modern human teeth.
[5]. Walker RT. 1988 Root form and canal anatomy of mandibular second molars in a southern Chinese population. J Endod,14 ,325–9.

Abstract: Sedentary lifestyle and physical inactivity is a world-wide health problem increasing the morbidity and mortality of the population in developing countries. The aim of the study was to assess and evaluate the level of physical activity and cardiovascular responses following aerobic exercise.Method: The study was focussed to a group of post-graduate students and House officers working in the tertiary referral hospital. 165 (female=30; male=135) with mean age (male=31.40±5.73; female=30.2±5.63) were subjected to Bruce Modified Treadmill Test (BMTT) along with Questionnaires (Short term last 7 day Recall Self-administered format. Statistical analysis:All values are given as means±SD. Analysis of statistical significance for variablesmainly heart rate (HR), blood pressure (BP) (pre, during and post TMT test), and METs values were done by one-way analysis of variance (ANOVA). Paired't' test and independent't' test for different variables for both sexes were done. Result: Mean and Standard Deviation of the HR (84.95±9.75), SBP (126.95±12.19), and DBP (82.27±8.68) were all raised significantly during Treadmill Test (TMT); HR (163.58±16.48), SBP (152.71±11.76) and DBP (85.69±9.66)and unable to return to normal even after 5 minutes recovery period, whereas the DBP returned to lower than normal after 3 minutes recovery period (81.98±8.26). Significant correlation of BMI with all other variables i.e.HR, SBP, and DBP (pre, during and post TMT) were noted except a negative correlation with TMT-HR (Significance=0.447) was noted. There was significant correlation between Q-METs (8.20±3.46) and TMT-METs (9.64±1.79) and between different genders, it was the opposite.

Key words: Physical activity, METs, TMT, HR, SBP, DBP

[1]. Caspersen CJ, Powell KE, Christenson GM et al. Physical Activity, Exercise and Physical Fitness: Definitions and distinctions for health related research. Public Health Resp Mar-Apr 1985; 100(2): 126-31.
[2]. Barbosa N, Sanchez CE, Vera JA, Perez W, Thalabard JC and Rieu M. A physical activity questionnaire: Reproducibility and Validity. Journal of Sports Science and Medicine 2007; 6: 505-18.
[3]. Global Status Report on Non-communicable Diseases WHO Jan-March 2012; 1-123.
[4]. Morshedi-Meibodi A, Larson M G, Levy D, O'Donnell C J, and Vasan R S. Heart Rate Recovery After Treadmill Exercise Testing and Risk of Cardiovascular Disease Events ( The Framingham Heart Study). Am J Cardiol October 2002; 90:848-852.
[5]. Dipla K, Nassis G P, and Vrabas I S. Blood Pressure Control at Rest and during Exercise in Obese Children and Adults. Journal of Obesity 2012; ID 147385: 10.
[6]. Kriska A Caspersen C. Introduction to a Collection of Physical Activity Questionnaires. Med Sci Sports Exerc 1997; 29(6): S5-S9.

Abstract: Treacher Collins Syndrome, also known as mandibulofacial dysostosis is a rare autosomal dominant disorder characterized by craniofacial abnormalities and dysmorphic facies. The estimated incidence varies about 1 in 40,000 to 1 in 70,000 live births. It is associated with difficult mask ventilation and intubation because of facial abnormalities. Hence, recognition of this syndrome is of prime importance for us as anaesthesiologists to prevent potential airway problems under anaesthesia. Here, we report a case of Treacher Collins Syndrome posted for pseudopterygium excision, who was successfully managed with general anaesthesia.

Keywords: Treacher Collins Syndrome; Micrognathia; General anaesthesia; difficult airway

[1] Dean L. Mittman, MD, and Orlando G. Rodman, MD Detroit ,Michigan. Mandibulofacial dysostosis (treacher collins syndrome):a case report. Journal of the national medical association;vol. 84(12), 1992,1051-1054.
[2] Sowmya B Shetty, Ann Thomas, Raghavendra Pidamale. Treacher Collins syndrome : A case report and a brief review on diagnostic aids. International Journal Of Clinical Pediatric Dentistry, 4(3), 2011,235-239
[3] Necita L. Roa, MD and Kenneth S. Moss, MD. Treacher Collins syndrome and sleep apnoea: Anesthetic considerations. Anesthesiology, 60(1) ,1984, 71-73

[4] Abengochea Cotaina A, Sanmiguel Gilg,Vila Sanchez M,Martinez Trens M,Baena Montilla P.Anaesthesia in a patient with Treacher Collins syndrome. Rev Esp Anesthesiol Reanim.;37(2),1990, 95-97
[5] Fahim Ahmed Shah,Ramakrishna.S,Ingle Vijendra,Dada J E,Khabori Mazin A1, Murty PSN. Treacher Collins Syndrome with acute airway obstruction. International journal of pediatric otorhinolaryngology. 54, 2000, 41-43.
[6] Garry S. Sklar, M.D and Benton D. King, M.D. Endotracheal intubation and Treacher Collins syndrome. Anesthesiology; 44( 3), March 1976

Abstract: This is a comparative study between Open and Closed Hemorrhoidectomy. The comparison has been done with postoperative pain, bleeding, operating time, duration of stay and wound healing in patients undergoing open and Closed Hemorrhoidectomy. Ten patients (7 males & 3 females), admitted between Jan 2013 to Dec 2013 diagnosed as external haemorrhoids who underwent open/closed haemorrhoidectomy under spinal anesthesia at Shivamogga Institute of Medical Sciences(SIMS), were selected. Median age of patients admitted for open haemorrhoidectomy was 42.6 years and 43.1 years is median age in patients posted for closed hemmoroidectomy. Out of 10 cases 6 were assigned for open haemorrhoidectomy and 4 were assigned to closed haemorrhoidectomy. Mean operating time in open hemmoroidectomy was 45 mins and in closed hemmoroidectomy 60 min. Early postoperative mild bleeding was noted in two patients in open haemorrhoidectomy as compared to one patients in the closed group . The pain scores were significantly low in the open group compared to closed haemorrhoidectomy procedure. Hence better outcome in terms of less post-operative bleeding and complete wound healing is provided by closed haemorrhoidectomy , but it is associated with more pain and requires longer operative time as compared to open haemorrhoidectomy.

Keywords: Closed Hemorrhoidectomy, hospital stay, Open Hemorrhoidectomy, Post-operative pain, Post- operative bleeding

[1]. Sardinha T C, Corman ML. Hemorrhoids. SurgClin North Am 2002;82:1153–67
[2]. Sandhu PS, Singh K. A randomized comparativestudy of micrinized flavonoids and rubber bandligation in the treatment of acute internal haemorrhoids. Indian J Surg 2004;66:281-5.
[3]. Orlay G. Haemorrhoids - a review. AustFamPhysician 2003;32:523-6.
[4]. Hartlay G C. Rectal bleeding. AustFamPhysician 2000;29:829-33.
[5]. Shoaib M, Ali AA, Naqvi N, GondalKM,Chaudhry AM. Open versus closed haemorrhoidectomy, an experience at MayoHospital. Ann KE Med Coll 2003;9:65-8.
[6]. Ramadan E, Vishne T, Dreznik Z. Harmonicscalpel haemorrhoidectomy: preliminary resultsof a new alternative method. Tech Coloproctol2002; 6:89-92

Abstract: Background: Diabetes mellitus(DM) is one of highly prevalent medical illnesses and it is a major cause of morbidity, mortality and economic expense worldwide.Many studies have shown a relationship between diabetes and psychiatric disorders especially depression. Objectives: This study was designed to investigate the rate of depression among diabetic patients followed at the Babylon Diabetic Center in Marjan Teaching Hospital. Method: This hospital-based cross-sectional study was carried out in a tertiary centre (in Marjan Teaching Hospital). 200 patients with DM seen at the Babylon Diabetic Center in Marjan Teaching Hospital from August 2013 to April 2014 were included in this study. Beck Depression Inventory Scale was used to diagnose and assess the severity of depression. Socio-Demographic characteristics, medical history and diabetic features were obtained from diabetic patients.Statistical analysis was carried out using SPSS version 18. Categorical variables were presented as frequencies and percentages. Continuous variables were presented as means with their 95% confidence interval (CI). The Pearson's chi-square test (x2) test was used to determine the associations between categorical variables.

Keywords: DM, Depression, Merjan Teaching Hospital

[1]. Boyle JP, Honeycutt AA, Narayan KM, et al(2001). Projection of diabetes burden through 2050: Impact of changing demography and disease prevalence in the US. DiabetesCare.24:1936–1940.
[2]. Shoback, edited by David G. Gardner, Dolores (2011). Greenspan's basic & clinical endocrinology (9th ed.). New York: McGraw-Hill Medical. pp. Chapter 17.
[3]. Giuffrida FM, Reis AF (2005) Genetic and clinical characteristics of maturity onset diabetes of the young.Diabetes ObesMetab7(4):318–326.
[4]. Anderson RJ, Freedland KE, Clouse RE, LustmanPJ(2001). The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care. 24:1069-1078.
[5]. Vinkers DJ, Gussekloo J, Stek ML, Westendorp RG, van der Mast RC(2004). Temporal relation between depression and cognitive impairment in old age: prospective population based study. BMJ.329:881.

Abstract: Background: Metabolic Syndrome (MS) has become prevalent medical problem globally and the main consequence of Diabetes Mellitus (DM) and Coronary Heart Diseases (CHD). Aim of Study: To determine the proportion of MS among patients with type 2 DM and its association with MS risk factors at Merjan Teaching Hospital in Al-Hilla City. Materials and Methods: Ahospital-based cross sectional study design was carried out on (300) diabetic type 2 DM patients at diabetic outpatient clinic in Merjan Teaching Hospital. The study duration was from December 2011to December 2012. Categorical variables were presented as frequencies and percentages. Continuous variables were presented as means with their 95% confidence interval (CI) and standard deviation. The Pearson's chi-square test (x2) was used to determine the associations between categorical variables. Binary Logistic regression was done for multivariate analysis. A p-value of < 0.05 was considered as statistically significant. Results: The results showedthat, out of 300 diabetic patients, the proportion of MS was 226 (75.3%). The overall mean age of patients was 57.26± 7.07 years. (60.0%) patients were male and (45.7%) ofthe patients were from urban area. (60.0%) of patients had abdominal obesity and (61.0%) of patients adapt sedentary life style. (76.7%) of patients had high triglyceride, meanwhile,only (39.7%) had normal HDL. Hypertension was presented in (73.7%) of patients. Metabolic syndrome was statistically significant with male, urban area, abdominal obesity, sedentary lifestyle, high triglyceride and hypertension.Patients with high triglyceride were 71 times more likely to develop MS than patients with normal triglyceride. Conclusion: High proportion of MS among diabetic type 2patients in this study. High triglyceride, urban area and sedentary lifestyle were the strongest predictors of MS.
Key words: Metabolic Syndrome (MS), Type 2 DM, High Triglyceride, Abdominal Obesity

[1]. Felber JP, Golay A. Pathway from obesity to diabetes 2002.Int. J Obes, 2002; 26: S 39–45.
[2]. National Institutes of Health: Third Report of the National Cholesterol Education Program Export Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III), NIH Publication 01-3670, 2001.
[3]. Najarian RM, Sullivan LM. Metabolic syndrome compared with type 2 of DM as risk factors for stroke. Arch Intern Med J. 2006; 166 (13): 1418-19.
[4]. Liese AD, Mayer- Davis EJ, Haffner SM et al. Development of the multiple metabolic syndromes: an epidemiologic perspective. Epidemiol Rev, 1998; 20: 157- 172.
[5]. Lakka HM, Laaksonen DE, Laka TA et al. The metabolic syndrome and total cardiovascular disease mortality in middle-aged men. JAMA, 2002; 288: 2709-2716.

Abstract: Background: Foot care is one of the most important ways for patients with diabetes type II toavoid complications by proper and functioning foot care. Aim of Study: to assess foot care knowledge among Type II DM patients as well as to find the mean difference of foot care assessment score by patients' socio-demographic characteristics and medical history in a cross-sectional study at Merjan Teaching Hospital in Al-Hilla City. Materials and Methods: Ahospital-based cross sectional study design was carried out on (200) patients with Type II DM seen between January 2014 and June 2014in Merjan Teaching Hospital.Categorical variables were presented as frequencies and percentages. Continuous variables were presented as mean with their 95% confidence interval (CI) and standard deviation. Independent sample t-test was used to compare means between two groups. One Way Analysis of Variance (ANOVA) was used to compare among more than two groups. A p-value of ≤ 0.05 was considered as statistically significant.

Key words: Type II Diabetes Mellitus(DM), Foot care, Foot problem

[1]. Quittenbaum S. Diabetes. N. Grefberg& L-G. Johansson (Red.), 2007.
[2]. World Health Organization. What is Diabetes? Geneva: World Health Organization, 2009. From http://www.who.int/diabetes/en/
[3]. Magnusson P. Diabetes Type 2. 2010. http://www.1177.se/artikel.asp?CategoryID=37513
[4]. Wild S, Roglic G, Green A, et al. Global Prevalence of Diabetes: Estimates for the year 2000 and projections for 2030. Diabetes Care, 2004; 27 (5): 1047-1051.
[5]. Cockram CS. The epidemiology of diabetes mellitus in the Asia-Pacific region. Hong Kong Medical Journal, 2000; 6 (1): 43-52.
[6]. American College of Foot and ankle surgeons. Foot health facts -healthy feet for an active life. 2010, from American College of Foot and ankle surgeons, http://www.foothealthfacts.org/footankleinfo/diabetic-guidelines.htm

Abstract: In periodontitis, one of the major pathologic patterns is an increased production of reactive oxygen species (ROS). Reactive oxygen species are produced by polymorph nuclear cells as an inflammatory response to invading pathogenic bacteria. This imbalance among the production of free radicals and local antioxidants results in periodontal tissue destruction and a state of oxidative stress develops. In recent years, beneficial effects of antioxidants against various chronic disorder induced by oxidative stress have received much attention. This review is intended to summarize the role of dietary antioxidants in prevention of periodontal disease.

Keywords: antioxidant, oxidative stress, periodontitis, ROS,

[1]. Halliwell B, Gutteridge JM. Role of free radicals and catalytic metal ions in human disease: An overview. Methods Enzymol 1990; 186: 1–85

[2]. Poli G, Leonarduzzi G, Biasi F, et al. Oxidative stress and cell signaling. Curr Med Chem 2004; 11: 1163–82

[3]. Chapple IL, Matthews JB. The role of reactive oxygen and antioxidant species in periodontal tissue destruction. Periodontol 2000. 2007; 43: 160–232.

[4]. Lee M-I, Shoji H, Yoshino F. The role of free radicals on oral inflammatory disease. Presented at IADR/AADR/CADR 82nd General Session: March 10-13, 2004, Honolulu, Hawaii. Abstract 2444.

[5]. Ritchie, Christine et al. Nutrition, inflammation, and periodontal disease. Nutrition and Oral Health, 2003; 19: 475-476.

[6]. Chapple ILC. Role of free radicals and antioxidants in the pathogenesis of inflammatory periodontal diseases. Clinical Molecular Pathology 1996; 49: 247-255

Abstract: Studies have demonstrated that plaque microorganisms are the primary etiologic factors associated with human periodontal disease, plaque must be removed on a consistent basis as a preventative measure. Unfortunately, routine use of oral hygiene aids (e.g. toothbrush, floss, etc.) to control plaque have not been entirely successful. Accordingly, the search for alternative methods, such as chemotherapeutic agents, to control plaque has been extensive. Of the many chemical agents that have been evaluated to determine their effects on plaque, gingivitis and adult periodontitis, Chlorhexidine (CHX) have been successfully introduced and extensively researched. Chlorhexidine have been used to aid in controlling plaque build- up. They have been used to complement, not replace mechanical therapy.

Keywords: Antiseptic, Chlorhexidine, Dental Plaque, Periodontitis, Tooth Discolouration

[1]. G. Davies, J. Francis, A. Martin, F. Rose, G. Swain, 1:6 Di-4'-chlorophenldiguanidohexane. Laboratory investigation into a new antibacterial agent of high potency, Br J Pharmacol, 9, 1954, 192-196.
[2]. T. Hennessy, Some antibacterial properties of chlorhexidine, J Periodont Res, 8(suppl.), 1973, 61-67.
[3]. C. Emisilon, Susceptibility of various microorganisms to chlorhexidine. Scand J Dent Res, 85, 1977, 255-265.
[4]. ME. Ryan, Nonsurgical approaches for the treatment of periodontal diseases, Dent Clin N Am, 49, 2005, 611–636.
[5]. T. Hennessy, Antibacterial properties of Hibitane, J ClinPeriodontol, 4, 1977,36-48.
[6]. D. Grenier, Effect of chlorhexidine on the adherence properties of Porphyromonasgingivalis, J ClinPeriodontol, 23, 1996, 140-142.
[7]. P. Hull, Chemical inhibition of plaque, J ClinPeriodontol, 7, 1980, 431-442.

Abstract: Polycystic ovarian disease is a lifestyle disorder that has no specific aetiology and manifests as a group of symptoms making its diagnosis difficult. It affects about 30-40% of young girls in their reproductive age in India. The exact cause of PCOS is unknown however it has been linked to hormonal imbalance, insulin resistance resulting in hyperinsulinaemia as well as genetic factors though specific genes have not been identified so far. The sedentary lifestyle, dietary variations, lack of exercise and stress etc. are also the contributory factors. Contemporary and traditional management together can improve this condition. This paper critically reviews the contemporary and ayurvedic perspectives of polycystic ovarian syndrome (PCOS) and recommends adoption of a holistic treatment, good lifestyle with appropriately balanced diet along with Yoga, Pranayam, Meditation and a stress-free living which can prove to be an effective management for PCOS.
Key words: Ayurved, Lifestyle, PCOS, Yoga

[1]. SteinIF,LeventhalMN.AmenorrhoeaassociatedwithbilateralPolycysticOvaries.AmericanJournalofObstetricsand Gynaecology1935; 29:181.
[2]. Knochenhauer ES.et al.PrevalenceofPolycysticOvarianSyndrome.Journal of Clinical Endocrinology & Metabolism, 1998; 83(9):3068-3082.
[3]. NidhiR et al. Prevalence of Polycystic Ovarian Syndrome in Indian adolescents. Journal of Paediatric Adolescent Gynaecology 2011 Aug;24(4):223-227.
[4]. AzzizRetal.The prevalence and features of Polycystic Ovarian Syndrome inanunselectedpopulation.Obstetrics and Gynaecology2004Jun;89(6):2745-2749.
[5]. Guttmann-Bauman I.The prevalence and features of Polycystic Ovarian Syndrome in paediatric endocrine community in the USA . Journal of PaediatricEndocrinology& Metabolism,2005

Abstract: Background: Autoimmune diseases` incidence had increased significantly by 1995-as compared to 1983, by when tubectomy, contraception was being steadily implemented; hence an altruistic correlation was sought after. Methods: Data of 64 people with varied autoimmune diseases spread over 1989 -2012 from 7 geographical locations, each separated by ~500 km distance, was tabulated into 3 age groups, namely 20-35 years, 35-50 years, >50 years and association with contraception status, consumption of fish without scales, gills, shell fish, was analyzed by bio informatics, retrospectively in 2012. In 2002, 2003 data of 105 patients from the community and hospital was analyzed for association of contraception status, prevalent diseases and estrogen levels. Results: Contraceptive users demonstrated 15 fold increase in auto-immune diseases among 20-35 years [p <0.0005]; 40 fold increase in auto-immune diseases among 35-50 years [p <0.0005]; 5 fold increase in autoimmune diseases were seen with consumption of fish without scales and gills in non contraceptive users also.

Key Words: Era of Contraception; smashed fragmentation of germ cells; autologous germ cell replant; subsets of population with, without contraception

[1]. Marshall S E: Immunological factors in disease; Davidson`s Principles and Practice of Medicine 21st edition 2010 ;page-85
[2]. Betty Diamond ,Peter E Lipsky: Auto immunity and auto immune disease; Harrison`s Principles of Internal Medicine;18th edition, 2012 volume 2 , page 2721
[3]. Bevra Hannahs Hahn: Systemic Lupus Erythematosus; Harrison`s Principles of Internal Medicine 18th Edition 2012, volume 2, page 2725
[4]. Stephen L Hawser, Douglas S :Multiple Sclerosis and other demyelination diseases; Harrison`s Principles of Internal Medicine 18th edition, 2012 volume 2 page 3395
[5]. Ankoor Shah, E William St.Clair: Rheumatoid Arthritis; Harrison`s Principles of Internal Medicine ,18th edition, 2012 volume -2, page2738
[6]. Frank Austen K :Allergies, Anaphylaxis, disorders of immune mediated injury; Harrison`s Principles of Internal Medicine 18th edition volume-2,page-2711

Abstract: prevention of carcinoma cervix is one of the most successful strategy of cancer control and prevention. In developing countries still carcinoma cervix is one of the most common cause of death, the incidence being 99/100000 in India.Hence the importance of screening and treatment of benign cervical lesions like cervical erosion ,a common gynaecological finding which has inflammatory or neoplastic origin . In 2009 WHO updated the recommendation of cryosurgery in CIN and cervical erosion. AIMS AND OBJECTIVES: To compare the effect of cryosurgery and albothyl solution in cases of cervical erosion after ruling out CIN3 and malignancy by Pap smear .To study the efficacy and time taken for healing of the lesion and the number of applications required.MATERIAL AND METHODS :60 cases attending the gynaec OPD at Adichunchangiri institute of medical sciences , Bellur over a period of one year were included in this study. After exclusion of malignancy by Pap smear 30 cases were treated with cryo and 30 cases with albothyl solution.CONCLUSION :Cervical erosion which is one of the commonest gynaecological problem characterised by vaginal discharge, post coital bleeding , low backache can be maximally benefited by cryo as well as local appliction of albothyl solution . cryo has 90% success rate whereas albothyl solution scores over cryo in being cheap and accessible to patients.

Keywords: Cervical erosion , Carcinoma , Cryosurgery , Albothyl solution

[1]. Goldacre MJ, Loudon, Wall B et al , epidemiology and clinical significance of cervical erosion in women attending family planning clinic BMJ 1978;1.748-50
[2]. Machado Junior LC, Whitaker DalmasoAS, De Carvalho HB; Evidence for benefits from treating cervical ectopy; literature review saopulo med j 2008;126:132-9.
[3]. Simms, Doltomak D, The cytologic progression from benign to malignant changes in cervical erosion; gynec 1966;162(1); 48-56.
[4]. Sarkar PK, Steel PRM; routine colposcopy prior to treatment of cervical ectopy;is it worthwhile?. Journal Obs gyn,1996:16:96-7
[5]. Dinshaw KA, ShastriSS ; Screening for cervical cancer in India NaH Med J India,2001;14(1):1-3.

Abstract: Background: Use of exfoliative cytology and cyto-analysis is a useful early diagnostic method for epithelial atypia and for human oral neoplasm. A rare occurrence of cytological atypia appeared to be anuran tadpole larva, named as keratinized tadpole cell (KTC) is analyzed cytomorphometrically with a cytodiagnostic approach. Materials and Methods: In a case- control study, exfoliated scraped cytosmears were collected from the affected sites of the clinically diagnosed 136 oral cancer patients over the pre-cleaned microslides and immediately fixed in acetoalcohol. Cytosmears were stained with routine Papanicolaou's stain and counterstained with the Giemsa's solution. One thousand cells were observed and the KTCs were scored from each stained sample following standard criteria. Findings were statistically analyzed, interpreted and correlated with the oral sites, sex and nature of addiction. Results: Keratinized tadpole cells (KTCs) exhibit both cytological and nuclear pleomorphism. Almost all KTCs are moderately differentiated with a well defined head and tail in each. Usually, nucleus is confined to the head part of the cell and tail contains cytoplasm only. Keratinized cytoplasm, nuclear pleomorphism, presence of nuclear haloes, micronucleation, multinucleation and increased nuclear-cytoplasmic ratios (N/C) in keratinized tadpole cells are the clear indication of malignancy so far as cytopathology is concerned. Conclusion: Appearance of KTCs in the epithelia of oral neoplasm has a practical utility in early detection and diagnosis of the oral cancer patients.

Key words: Cytodiagnosis , cytopathology, cytosmear, exfoliative cytology, keratinized tadpole cell, nuclear-cytoplasmic (N/C) ratios, pleomorphism

[1] J. Ferlay, HR Shin, F Bray, D Forman, C Mathers, D.M. Parkin, GLOBOCAN 2008 v1.2, Cancer Incidence and Mortality Worldwide: IARC Cancer Base No. 10 [Internet]. Lyon, France: International Agency for Research on Cancer, 2010. Available from: http://globocan.iarc.fr.

[2] K.R. Coelho, Challenges of the Oral Cancer Burden in India, Journal of Cancer Epidemiology, 2012, 1-17.

[3] R. Mehrotra, S. Yadav, Oral squamous cell carcinoma: etiology, pathogenesis and prognostic value of genomic alterations, Ind J Cancer, 43(2), 2006, 60-66

[4] S.C. Miller, A. Soberman, S.S. Stahl, Study of cornification of oral mucosa in young male adults, J Dent Res, 30, 1951, 4-11.

[5] P.W. Montgomery, E. von Hamm, Study of exfoliative cytology in patients with carcinoma of the oral mucosa, J Dent Res, 30, 1951, 308-313.

[6] H.G. Ahmed, A.M. Idris, S.O. Ibrahim , Study of oral epithelial atypia among Sudanese tobacco users by exfoliative cytology, Anticancer Res, 23, 2003, 1943-1949.

Abstract: Oral cancer is one of the leading causes of human morbidity and mortality especially in developing countries like India. Tobacco consumption in smokeless and smoking form along with alcohol is considered as the primary risk factors. Tobacco is a major health challenge with various tobacco products available for use which are known to have deleterious effects on the oral mucosa. The oral lesions caused by tobacco are inclusive of those that are less likely to progress to cancer; lesions with increased tendency to develop into cancer and cancerous lesions. In India, tobacco use is incredibly linked to poverty and accounts for the high public health costs of treating tobacco-related diseases. In India, major population resides in rural areas and most of the cancers are found in the oral cavity, due to inadequate medical facilities, no proper primary care infrastructure or cancer screening tools and high levels of illiteracy all contribute to poor oral cancer (OC) outcomes.

Keywords: Oral cancer, oral health, tobacco cessation, tobacco.

[1]. Patel P, Patel V. Oral mucosal lesions among residents of a town in North Gujarat. National J Med Res 2011; 1:3-6.
[2]. Sudhakar S, Praveen Kumar B, Prabhat MP. Prevalence of oral mucosal changes in Eluru, Andhra Pradesh (India) - An institutional study. J Oral Health Comm Dent 2011; 5:42-6.
[3]. Saraswati TR, Ranganathan K, Shanmugam S, SowmyaRamesh, Narasimhan PD, Gunaseelan R. Prevalence of oral lesions in relation to habits: Cross sectional study in south India. Indian J Dent Res 2006; 17:121-5.
[4]. Kaur J, Jain DC. Tobacco control policies in India: Implementation and challenges. Indian J Public Health 2011; 55:220-7.
[5]. World Health Organization (WHO). Fresh and alive: MPOWER, WHO report on the global tobacco epidemic, Geneva, Switzerland: WHO; 2008

Abstract: The mermaid of Greek and Roman mythology, was depicted as having the head and upper body of a human and the tail of a fish. It was considered to be one of the most beautiful creatures that ever lived but in truth, the mermaid baby also known as syrinomelia is almost always lethal. It is a severe form of caudal regression syndrome that results in a fusion of the lower extremities, which is not compatible with life. A spectrum of anomalies affects primarily the musculoskeletal, genitourinary, cardiovascular and gastrointestinal systems. Sirenomelia is a rare congenital malformation with an incidence of 1.5 - 4.2 per 100,000 births. It has a relative risk of 200-250 in diabetic pregnancies
Keywords: Sirenomelia , caudal regression syndrome, congenital anamoly, diabetes mellitus

[1]. Sirenomelia- The Mermaid Syndrome: A Case Report Naveena ., Mrudula ,Associate professors, MD, Department of anatomy, Apollo institute of medical sciences and Research, Hyderabad MD,
[2]. The Sirenomelia Sequence: A Case History Anis Fadhlaoui1, Mohamed Khrouf1, Soumaya Gaigi2, Fethi Zhioua1 and Anis Chaker 1Department of Gynecology and Obstetrics, Aziza Othmana Hospital, Place du Gouvernement, La Kasba, Tunis, Tunisia.Department of Histology and Embryology, Medical University of Tunis, Tunis
[3]. SIRENOMELIA: MERMAID SYNDROME Ollie G. Goodlow, MD, Roslind 1. McCoy Sibley, MD, Bonnie G. Allen, Saa Kamanda, MD, Allyce C. Gullattee, MD, and William C. Rayfield, MD Washington, DC
[4]. Sirenomelia:a case report. Ind J Pathol Microbiol 2007; 50 (2): 359-61 3.

Abstract: Introduction: Inlay retained bridges represent a conservative approach to restore single missing posterior tooth. Objective: To evaluate the clinical performance and survival rate of inlay retained fixed partial dentures. Materials and methods: A total of 12 patients were included in this clinical study. The patient selection, preparation technique as well as restoration fabrication followed current principles in this science. Patients were evaluated after the final cementation at 3, 6, 12, 24 and 36 months as follow-up period. The evaluation criteria were includes, post-operative sensitivity, de-bonding of the retainer, secondary caries, fracture of the retainer and fracture resistance. Results: A high rate success was observed during the different evaluation periods. Post-operative sensitivity during 3 months and de-bonding of the retainers during the 36 month follow-up was observed in single independent cases. Conclusions: Inlay retained bridges with adhesive cement appear to be an effective restoration in a single posterior missing tooth. Practitioners should consider its use as an alternative to other restorative options.

Key Words: Inlay-retained bridges, Adhesive cement, Survival rate

[1]. Joshi P. Prosthetic rehabilitation in partially edentulous patient with lost vertical dimension: a clinical report. NJMS 2013; 2:77-80.
[2]. Mazurat NM, Mazurat RD. Discuse before fabricating: communicating the realities of partial denture therapy. Part I: Patient expectation. J Can Assoc 2003; 69: 90-94.
[3]. AGÜLOĞLU S, AYNA E, ÖZDEMİR E. A Fiber-Reinforced Fixed Partial Denture on a Hemisectioned Tooth: a Case Report. Int Dent Res 2011; 1: 38-41.
[4]. Monaco C, Cardelli&Özcan M. Inlay-Retained Zirconia Fixed Dental Prostheses: Modified Designs for a Completely Adhesive Approach. J Can Dent Ass 2011; 77: 86-91.
[5]. Glesia-Puig MA & Arellano-Cabornero A. Inlay Fixed Partial Denture as a Conservative Approach for Restoring Posterior Teeth. A Clinical Report.J Prosth Dent.2003; 89: 443-445.

Abstract: Eustachian tube maintains middle ear pressure equal to that of atmospheric pressure and its functions is deranged due to various nasal, nasopharyngeal and palatal causes. Nasal polypi cause post nasal drip which is considered to cause Eustachian tube dysfunction. The present cross sectional study comprises of a total of 39 patients of Antrochoanal polyp with the aim to see the effect of antrochoanal polyp on middle ear pressure and to assess the status of middle ear pressure following surgery for antrochoanal polyp. Preoperative assessment of Middle Ear Pressure (MEP), revealed that, 31 subjects (79.5 %) had abnormal MEP in the ipsilateral ear, whereas 13 subjects(33.3%) in the contralateral ear to the nasal polyp. Three weeks after surgery, MEP was found to be in the normal range in 26 subjects(66.7 %) and 31 subjects (79.5 %) in Ipsi and Contralateral ear respectively. Chronic Nasopharyngeal obstruction has a detrimental effect on middle ear pressure. Middle Ear Pressure(MEP) is deranged in patients of Antrochoanal polyp, which comes back to normal after surgery, but in patients with extension of nasal polyp to nasopharynx there are more chances of irreversible damage and persistent abnormal MEP in both ears.

Keywords: Antrochoanal Polyp, Middle Ear Pressure (MEP), Nasopharynx

[1]. Johannessan J, Poulsen P. The influence of anterior nasal packings on middle ear pressure. Acta Otolaryngol 1984; 97:363-69.
[2]. Bonding P, Tos M. Middle ear pressure during brief pathological conditions of the nose and throat. Acta Otolaryngol 1981; 92:63-69.
[3]. Wake M, McCullough DE, Binnington JD. Effect of nasogastric tubes on Eustachian tube function. J Laryngol Otol 1990;104:17-19.
[4]. Sadia Chaudhry, Zafar Ahmad, Faraz Basharat Khan, Mohammad Afzal. Frequency of Otitis Media in Patients of Nasal Polypi. J Ayub Med Coll Abbottabad 2010; 22(2): 83-85.
[5]. Mohan C, Saxena RK, Chauhan PG. Effect of anterior nasal packing on middle ear pressure. Indian Journal of Otolaryngology 1990; 42(3): 130-131

Abstract: Cancer is attributed to be the second most common cause of morbidity and mortality in the world today after cardiovascular problems. Oral cancer comprises of a significant component of the global burden of cancer with an annual incidence of over 300,000 cases. Though efforts have been directed to tackle and curb the spread of cancer; little progress has been made in the regard and it continues to pose a threat. Numerous study methods have come to foray assisting and paving way to arrest cancer. Several new stream of drugs targeting molecular signalling pathways like those of growth signal transduction machinery in cancer cells, processes involved in cellular invasion and metastatic spread, apoptosis and the cell cycle, and tumour-related angiogenesis. Other approaches like tumour-specific antigens, targeted poisons, immunotherapy, gene therapy, telomerase therapy, DNA damage repair and nanotechnology have also come to horizon. With the advancements, in the fields molecular and biochemical analyses it has been proposed that drugs can alter and simultaneously activate several pathways that either positively or negatively regulate cell death induction. This review explains the different processes and pathways that can be targeted to strategize a treatment against head and neck squamous cell carcinoma. Keywords: molecular pathways, strategies, head and neck cancer, nanotechnology, apoptosis

[1]. Khan Z. An Overview of Oral Cancer in Indian Subcontinent and Recommendations to decrease its Incidence. Webmed Central Cancer 2012; 3(8):WMC003626
[2]. Fabricus EM, Wildner GP, Kruse-boitschenko U, Hoffmeister B, Goodman SL, Raguse JD. Immunohistochemical analysis of integrinsαvβ3, αvβ5, and α5β1 and their ligands, fibrinogen, fibronectin, osteopontin and vitronectin, in frozen sections of human oral head and neck squamous cell carcinomas. ExpTher Med 2011 Jan; 2(1): 9-19
[3]. Pich A, Chiusa L &Navone R. Prognostic relevance of cell proliferation in head and neck tumours. Annals of Oncology2004; 15:1319–1329
[4]. Daniel F.I, Fava M, Hoffmann R, Campos M, Yurgel L. Main Molecular Markers of Oral Squamous Cell Carcinoma. Applied Cancer Research 2010;30(3): 279-288.
[5]. Hanahan D, Weinberg RA. The hallmarks of cancer. Cell 2000; 100(1): 57–70.