iosr-JDMS   Volume-14 ~ Issue-11 ~ November-2015

Abstract: purpose:It is always seen that the difficulty is encountered by physician in arriving at definite diagnosis and etiology of Cervical Spondylotic Myelopathy. Accurate and early diagnosis is of paramount importance for proper treatment and better outcome. Clinical manifestation is different with some special signs such as Hoffman's sign, finger escape sign and inverted supinator sign which guide to further investigate patient with radiological modalities to understand its severity level and to decide possible management such as non-operative or operative

[1]. Abramovits, J. N., and Srinivasan M. : Painless arm weakness without leg symptoms in cervical spondylotic myelopathy. Poster exhibit at the Annual Meeting of the congress of Neurological Surgeons, Seattle, Washington, Sept. 24-29. 1988[1]
[2]. Epstein, J. A. : Management of cervical spinal stenosis, spondylosis, and myeloradiculopathy. In Contemporary Neurosurgery, edited by G. T. Tindall. Vol. 2, pp. 1-6. Baltimore, Williams and Wilkins, 1985.[PUBMED]
[3]. Hayashi, Haruki; Okada, Kozo; Hamada, Masayuki; Tada, Koichi; and Ueno, Ryozo: Etiologic factors of myelopathy. A radiographic evaluation of the aging changes in the cervical spine. C/in. Orthop., 214: 200-209, 1987.[PUBMED]
[4]. Okamoto, Noriaki; Murakami, Yumio; Baba, Itsushi; and Kubo, Takeshi: H-reflex of the upper extremities in cervical myelopathy Internat.Orthop.,4: 193-203. 1980.[PUBMED]
[5]. Crandall H, Gregorius FK. Long term follow-up of surgical treatment of cervical spondylotic myelopathy. Spine 1977;2:139-46.[SPINE]
[6]. Epstein JA. The surgical management of cervical spinal stenosis, spondylosis and myeloradiculopathy by means of the posterior approach. Spine 1988;13: 864-9.[PUBMED]

Abstract: Objective: To study the prevalence, etiological factors, maternal and foetal outcome in multiple gestation Methods: All women with multiple gestation admitted at Government Maternity Hospital, Tirupathi from January 2012 to August 2013 were studied. Results: Incidence of multiple pregnancies in present study was 1.09%.Of which 235 are twins, 6 triplets and 1
quadruplet. 60.3% of multiple pregnancies is found in age group of 21-25, 41.3% incidence is noted in primigravidas.7.36% have family history of multiple pregnancy ,5.3% in maternal side and 2.06% in paternal side.9.09% taken ovulation induction drugs, 3.3% had past history of twin pregnancy. Maternal complications were preterm labour 43.3%, anaemia 26.03%, hypertensive disorders 19.4%, and severe postpartum haemorrhage 2.4% were seen.

[1]. Anna dera,Grzegorz H. Breborowicz, Louis Keith: Twin Pregnancy – Physiology, complications and mode of delivery. Archives of
perinatal Medicine, 2007; 13(3): 7-16.
[2]. Joyce A.Martin, Brady Hamilton, Michelle J.K. Osterman: Three Decades of Twin Births in the United states, 1980-2009.NCHS
Data Brief No.80.Jan 2012.1-7.
[3]. Fernado Arias, Shirish N Daftary, Amarnath G Bhide :Multifetal Gestation chapter 12 , In Practical Guide to high risk pregnancy
and delivery-A south Asian perspective ,3rd edition, Elsevier ppublications, 2008, pg 293-322.
[4]. NaushabaRizwan, Razia Mustafa Abbasi, Razia Mughal: Maternal morbidity and perinatal outcome with in twin pregnancy. J Ayub
Med Coll Abbottabad 2010 ; 22(2) : 105-107.
[5]. Yuel Veronica Irene, Kaur Vaneet. An Analytical study of pregnancy outcome in multifetal gestation. J ObstetGynaecol India
Vol.57, No.6: Nov/Dec 2007. Pg 509-512.
[6]. Hung GiKweon, Jin Sin Lee, Woan Suk Cho,Geon O Kim, Ihn Goo Kang, Yong Tak Kim, et. al; : Statistical Analysis of Multi fetal
pregnancy for 6 years (1984 to 1989), Vol.35, No.5, May 1992 :
674-681.

Abstract: Tibial plateau fractures continue to be a challenge for the orthopaedic surgeons. Restoration of normal anatomy is the goal and results are dependent on timely intervention, good surgical technique and soft tissue condition . Preventing malunion is one of the major hurdle of treating tibial plateau fractures. Joint depression , angular malunion in coronal or saggital plane are commonly seen consequently, malunion will lead to instability and functional disability at knee joint. Prevalence of post traumatic osteoarthritis after tibial plateau fractures estimated to be 30%1.In such cases corrective surgery is necessary to improve functional status. The surgical approach and technique will depend on the direction and amount of the deformity, the presence of preexisting implants and the condition of the soft tissue. Corrective surgery for such cases are always challenging , strategy is to restore joint congruency and enhance stability through osseous alignment2. We would like to share our experience of treating such fractures in our institute

[1]. Combined intra-articular and varus opening wedge osteotomy for lateral depression and valgus malunion of the proximal part of the tibia. Surgical technique.Kerkhoffs GM, Rademakers MV, Altena M, Marti RK.J Bone Joint Surg Am. 2009 Mar 1;91 Suppl 2 Pt 1:101-15 [2]. Proximal tibial varus osteotomy. Indications, technique, and five to twenty-one-year results.Marti RK, Verhagen RA, Kerkhoffs GM, Moojen TM J Bone Joint Surg Am. 2001 Feb;83-A(2):164-70.
[3]. Open wedge osteotomy of the proximal medial tibia for malunited tibial plateau fractures . Harpreet Singh, Vikas Rajesh Singh, P Yuvarajan, Lalit Maini, VK Gautam Journal of Orthopaedic Surgery 2011;19(1):57-9 [4]. Opening-wedge osteotomy of the proximal tibia Acta Chir Orthop Traumatol Cech. 2005;72(5):308-12.

Abstract: Material sciences have experienced immense progress in the evolvement of new materials, especially in the past 30 years. Some of the materials like Glass Ionomer, Composite, Mineral trioxide aggregate have proved their excellence but hunt for a material which could fulfill all the requirements in dentistry is still going on. Materials used in the replacement of tissues have come a long way from being inert to compatible, and now regenerative. Larry Hench developed a material using silica (glass) as the host material, incorporated with calcium and phosphorous to fuse broken bones.

[1] Hench LL, Wilson J. An introduction to bioceramics. Singapore: World Scientific Publishing, 1993.

[2] Hench LL, Bioceramics, J. Am. Ceram. Soc. 1998; 81: 1705-1728.

[3] Xynos ID, Edgar AJ, Buttery LDK, Hench LL, Polak M, Gene expression profiling of human osteoblasts following treatment with the ionic products of BioglassR 45S5 dissolution, J Biomed Mater Res, 2001; 55:151-7.

[4] Paolinelis G, Banarjee A, Watson TF. An in vitro investigation of the effect and retention of bioactive glass air-abrasive on sound and carious dentine. Journal of dentistry 2008;36:214-18.

[5] Andersson OH, Karlsson KH, Kangasniemi K. Calcium phosphate formation at the surface of bioactive glasses in vivo. J Non-Cryst Solids 1990;119:290-6.

[6] Hench LL, Wilson J. Surface-active biomaterials. Science 1984;226:630-6.

Abstract: Diabetes ketoacidosis is a well known acute complication of Diabetes Mellitus presenting with hyperglycemia, ketoacidosis and electrolyte abnormalities. Similar presentation may be seen with normal blood sugars where the patient presents with nausea, vomiting and abdominal pain, features suggestive of ketoacidosis. This condition is diagnosed by finding metabolic acidosis and ketosis/ ketonuria in presence of normal blood sugars. If hyperglycemia is always considered for diagnosis and further workup, one may miss this condition. We report 2 cases of euglycemic ketoacidosis in Diabetic patients.

Keywords: diabetes mellitus, euglycemic ketoacidosis.

[1] Melmed S, Polonsky KS, Larsen PR, Kronenberg HM. Williams Text Book of Endocrinology. 12th edition. Saunders - Elsevier 2011; 1453-4.
[2] Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J. Harrison's Principles of Internal Medicine. 18th edition. McGraw - Hill 2012; 2996-7.
[3] Kitabchi AE, Umpierrez GE, Murphy MB, Kreisberg RA. Hyperglycemic crises in adult patients with diabetes: a consensus statement from the American Diabetes Association. Diabetes Care. 2006; 29:2739–48. [4] Joseph F, Anderson L, Goenka N, Vora J. Starvation-induced true diabetic Euglycemic Ketoacidosis in severe depression. J Gen Intern Med. 2009 Jan; 24(1):129-31.
[5] Munro JF, Campbell IW, McCuish AC, Duncan LJ. Euglycaemic diabetic ketoacidosis. Br Med J. 1973; 2:578–80.
[6] Jenkins D, Close CF, Krentz AJ, Nattrass M, Wright AD. Euglycaemic diabetic ketoacidosis: does it exist? Acta Diabetol. 1993; 30:251–3.

Abstract: Ureteral injuries during surgeries cause significant postoperative morbidity particularly pelvic and abdominal surgical procedures with challenging complications and interventions. The study was done with the intent to analyse the demographic profile, causes of iatrogenic ureteric injuries, various clinical presentation, identification, diagnosis, and management of iatrogenic ureteric injuries in various non urological surgical procedures.

[1] Assimos D, Patterson L, Taylor C. Changing incidence and etiology of iatrogenic ureteral injuries. J Urol 1994;152:2240-6. [2] Gill H, Broderick G. Urological complications of gynecological surgery. American Urologists Association Update Series 1994;13:lesson 32. [3] Neuman M, Eidelman A, Langer R, Golan A, Bukovsky I, Caspi E. Iatrogenic injuries to the ureter during gynecologic and obstetrical operations. Surg Gynecol Obstet 1991;173:268-71. [4] Iatrogenic ureteral injuries: a 20 year experience in treating165 injuries.SelzmanAA, SpirnakJP.J Urol1996; 155:878–81

Abstract: Introduction: Hernias, anomalies of the external genitalia, including circumcision mishaps are common cases that we see in our health facility. We have recently seen an increase in paediatric patients presenting with these conditions. Hence we decided to find out their true incidence in the community. Objectives: The specific objectives of the study were: 1. To find out the types and incidence of ventral hernias and anomalies of the external genitalia that are common among primary school pupils in the area. 2. To find out if these disease conditions are associated with each other.

[1]. Perez Lara F J, Del Rey Moreno A, Oliva Munoz H. Do we really know the symptoms of inguinal hernia? Hernia. 2014 Nov 7. [Epub ahead of print]
[2]. Kayvan Ansari, Mohammad Reza Keramati, Kiara Rezaei Kalantari, et all. Gross hematuria as the presentation of an inguinoscrotal hernia: a case report. Journal of Medical Case Reports 2011, 5:561.
[3]. Ohene-Yeboah M, Abantanga F A. Inguinal hernia disease in Africa: a common but neglected surgical condition. West Afr J Med. 2011 Mar-Apr; 30(2):77-83.
[4]. Stewart BT, Pathak J, Gupta S, et all.An estimate of hernia prevalence in Nepal from a countrywide community survey. Int J Surg. 2015Jan;13:111-4. doi: 10.1016/j.ijsu.2014.12.003. Epub 2014 Dec 9.
[5]. Tomas Wester; Hernias ; In Pediatric Surgery Diagnosis and Management; Ed. PremPuri, Michael Hollwarth, Springer , 2009, Pg 498.
[6]. ShahramGooran, FaramarzFezeli, Majid Asghari – Sheikhi, ArashAskari- Nooghani, AlirezaDashipour, Mohsen Rajabnia- Chenari. Prevalence of Inguinal Hernias and Genital Abnormalities among Elementary School – Boys. Zahedan J Res Med Sci 2014 Jan; 16(1) 28-31.

Abstract: The technique of cervical epidural anaesthesia (CEA) was first described by Dogliotti in 1933 for upper thoracic procedures. Cervical epidural anaesthesia can be administered in surgeries of neck, upper arm and chest. It has gained popularity due to its safety, relative bloodless field, stable hemodynamic, minimal morbidity and early postoperative recovery. The technique has become popular as it avoids the potentially arrythmogenic and myocardial depressant effects of anaesthetics and airway instrumentation during general anaesthesia (GA), specially in patients with cardio respiratory disorders. We selected this technique of CEA for open reduction and internal fixation (ORIF) of Clavicle fracture (left) in an adult patient, as the patient was unwilling for general anaesthesia, there was anticipated difficult airway (Mallampati grade- IV) For CEA, a mixture of 10ml 0.25% Bupivacaine and 1ml 50 mcg Fentanyl was administered into cervical epidural space at the level of C7-T1 space through 20G epidural catheter placed by 18G Tuohy needle.

[1] Khanna R, Singh DK. Cervical epidural anaesthesia for thyroid surgery. Kathmandu Univ Med J 2009;7:242-5.

[2] Bonnet F ,Derosier JP, Pluskwa F,Abhay K,Gaillard A.Cervical epidural anaesthesia for carotid artery surgery. Can J Anaesth1990;37;353-8.

[3] Michalek P,David I,Adamec M,Janousek L.Cervical epidural anaesthesia for combined neck and upper limb procedures .Anesth Analg 2004;99:1833-6.

[4] Asano Y,Hasuo M,Shimosawa S et.al.Carotid endarterectomy under cervical epidural anesthesia.No.Shinkei Geka.1993;21:787-91

[5] Guevara-López U, Bárcenas-Olivares J, Gutiérrez- Sougarret B, Aldrete JA, Olascoaga-Ortega G. Cervical epidural anesthesia for upper extremity surgery using three different formulations of local anesthetics. Cir Cir 2005;73:273-81.

[6] Biboulet P, Deschodt J, Capdevilla X, Landreau L, Aubas P, Du Cailar J, et al. Hemodynamic effects of 0.375% bupivacaine versus 0.25% bupivacaine during cervical epidural anesthesia for hand surgery. Reg Anesth 1995;20:33-40.

Abstract: Aims: To compare the results of Fine needle aspiration cytology ( FNAC) and trucut needle biopsy (TCNB) in breast lumps with histopathological examination in Karpagavinayaga Institute of Medical Sciences & Research Centre , Tamilnadu. Design: Prospective study Materials &Methods: In this study , 65 patients having breast lumps were subjected to FNAC & TCNB as outpatients during the period from august 2014 to February 2015 were compared with tissue diagnosis. Variables like age , marital status , duration ,size , menstrual status & site were analysed using statistical analytical tests.

[1]. Berner A , Davidson B , Sigstal E, Risbey B . FNAC Vs Core biopsy in diagnosis of breast lesions . Diagn.Cytopathol.2003 Dec :29(6):344-8
[2]. Poole GH, Willsher PC , Pinder SE, Robertson JF, Elston CW, Blamey RW Diagnosis of breast cancer with core biopsy and FNAC . AustNZ J surg 1996 Sep :66(9):592-4
[3]. Ballo MS ,Sneige N , can core needle biopsy replace fine needle aspiration cytology in the diagnosis of palpable breast carcinoma ? Cancer 1996:78: 773-7
[4]. Dennison G , Anand R, Makar SH, Pain JA , A prospective study of role of FNAC and core biopsy in diagnosis of breast carcinoma. Breast J. 2003 Nov- Dec;9(6):491-3
[5]. Homesh PG , ISSA MA, El – Sofiani HA . The Diagnostic accuracy of FNAC Vs core needle biopsy for palpable breast lump . Saudi Med J 2005 Jan :26(1);42-6
[6]. Westened PJ , Sever AR, Beckman-Devolder HJ , Liem SJ . A comparison of aspiration cytology and core needle biopsy in the evolution of breast lesions . Cancer 2001 Apr25 ;93(2);146-52

Abstract: Herpes simplex virus (HSV) is a well known etiological agent, rarely has been observed as a causative agent for Guillain Barre Syndrome. HSV has been associated with various neurological disorders like encephalitis & aseptic meningitis. Finger countable cases are reported of HSV associated with acute polyradiculopathy / GB Syndrome in the world literature 1,2,3. We have an opportunity of observing a fatal case of acute polyradiculopathy developed after short recovery with Acyclovir.

[1]. Olivarius BF, Buhl M. Herpes simplex virus and Guillan-Barre polyradiculitis. Br med J 1975; 1:192-3.
[2]. Gerken G, trautmann F, Kohler H, Falke D, Bohl J, Nix W, Meyer zum Buschenfelde K H.rare association of herpes simplex virus IgM-specific antibodies and Guillain-Barre syndrome successfully treated with plasma exchange and immunosuppression. Klin wochenscr.1985; 63:468-74.
[3]. HANS J J A BERNSEN, ANTON M VAN LOON,RIK F J POELS,WIM I M VERHAGEN,COR W G M FRENKEN .Herpes simplex Virus specific antibody determined by immunoblotting in cerebrospinal fluid of a patient with the Guillain- Barre syndrome. Journal of Neurology, Neurosurgery,and Psychiatry 1989;52: 788-791
[4]. Cleator Graham, Manchester royal infirmary and revised by Dr Davies Nick, Chelsea and Westminster Hospital, London. Herpes simplex encephalitis, The Encephalitis Society. FS008V1, May 2003/ review date April 2015.
[5]. B.C.Jacobs,P.H Rothbarth, Van der Meche et al The spectrum of antecedent infections in Guillain-barre syndrome. Neurology Journal ,October 1998 vol.51 no.4, Page 1110-15.

Abstract: Trauma is very common among pregnant patients. Both blunt and penetrating trauma may frequently injure the uterus. Blunt trauma as a result of automobile collision is the most frequent form of serious injury involving pregnant women. However penetrating trauma abdomen is also of common occurrence. Case Report: We describe the anesthetic management of a 25-years-old second gravida at 36 weeks gestation of pregnancy presenting at the emergency ward in haemorrhagic shock sustained due to a penetrating trauma abdomen and uterine cavity due to an arrow. A multispecialty team approach resulted in adequate timely resuscitation of the mother followed by operative treatment and urgent cesarean delivery to save the mother andbaby. The patient recovered well postoperatively and was discharged along with her baby.

[1]. SR Raty,Mattox LK,Munnur U,Miller AD,Podovei M. Trauma during pregnancy maternal resusciation, rapid response team, and protocols. Anaesthesia for obstetrics 2013;5TH Edition:711-722. [2]. Barraco RD, Chiu WC, Clancy TV, et al. EAST Practice Management Guidelines Work Group. Practice management guidelines for the diagnosis and management of injury in the pregnant patient: the EAST Practice Management Guidelines Work Group. J Trauma. 2010 Jul;69(1):211–214. [PubMed] [3]. Fildes J, Reed L, Jones N, et al. Trauma: the leading cause of maternal death. J Trauma. 1992 May;32(5):643–645. [PubMed]
[4]. Brown H. Trauma in pregnancy. Obstet Gynecol 2009;114(1):147-160.
[5]. Fisgus JR, Tyagraj K, Mahboobi SK. In:Smith CE, ed.Trauma Anaesthesia. 1st ed. NewYork,NY:Cambridge University Press:2008:402-416.

Abstract: We report a case of transurethral resection of prostrate syndrome in a 56 year old man, who underwent transurethral resection of prostrate (TURP) under spinal anaesthesia for a duration of 150 minutes using glycine as the irrigant solution and developed nausea vomiting hypoxaemia , pulmonary oedema intraoperatively and later in the post of period had profound hypotension, frank pulmonary oedema. Serum electrolyte report showed sodium was 118 meq/L. Medical management consisted of diuretic therapy, volume restriction, treatment of pulmonary oedema , mechanical ventilation. Patient received proper and timely treatment and was finally discharged.

[1]. Patel SN, Patel ND. Serum sodium and serum potassium changes during transurethral resection of prostate gland in patients under subarachnoid block. National journal of medical research 2014;4: 322-325.
[2]. Weir JF, Larson EE, Rowntree LG. Studies in diabetes insipidus water balance. Arch Intern Med 1922;29:306.
[3]. Hawary A, Mukhtar K, Sinclair A,Pearce I. Transurethral Resection of the Prostate Syndrome: Almost Gone but Not Forgotten. Journal of endourology, december 2009;23(12): 2013-2020.
[4]. Zepnick H, Steinbach F, Schuster F. [Value of transurethral resection of the prostate (TURP) for treatment of symptomatic benign prostatic obstruction (BPO): An analysis of efficiency and complications in 1015 cases.] (Ger) Aktuelle Urol 2008;39:369–372.
[5]. Reich O, Gratzke C, Bachmann A, et al. Morbidity, mortality and early outcome of transurethral resection of the prostate: A prospective multicenter evaluation of 10,654 patients. J Urol 2008;180:246–249.

Abstract: Cytodiagnosis of bony lesions are mainly done where cortical destruction and soft tissue infiltration is evident. Cytodiagnosis of osteolytic lesions with intact cortex is an uncommon procedure, and open bone biopsy is the preferred diagnostic modality. We have done a prospective cytopathological study of such lesions on patients who had come to a Tertiary Teaching Hospital in between February 2012 to January 2014 and we have made cytological diagnosis in 76 cases. The study was done by using 20 G bone marrow aspiration needle under image guidance. The smears were stained by PAP, H&E and air-dried MGG stain and evaluated, followed by histopathological correlation.

[1] Leopold G Koss, Diagnostic cytology and its Histopathological bases (4th Ed, J.B Lippincott Philadelphia, Vol-II 1373-77, 1992). [2] Orell SR, Sterrett G, Walters M, Whitaker D, In Manual and atlas of fine needle aspiration cytology (3rd Ed 1999 London). Journal Papers:

[3] Layfield LF, Glasgow BJ, Anders KH, Mirra JM, Fine needle aspiration cytology of primary bone lesions, Acta Cytol; 31:177-84; 1987.

[4] Bommer K, Ramzy I, Mody D, Fine Needle Aspiration Biopsy in the Diagnosis and Management of Bone Lesions – A study of 450 cases, Cancer (Cancer Cytopathology) June 25, 1997/Volume 81/Number 3; 1997.

[5] Bhatia A, Problems in the interpretation bone tumors with fine needle aspiration (letter). Acta Cytol; 28:91-92; 1984.

[6] Ayala AG, Zornosa J, Primary bone tumours: Percutaneous needle biopsy. Radiol; 149:47-50; 1983.

Abstract: Positions of acetabular component generally are considered to be major causative factors of dislocation in total hip replacement.Accurate positioning is important to prevent wear and dislocation.In this study Transverse acetabular ligament is used as a reference in acetabular component positioning.In 50 patients undergoing total hip replacement, acetabular component positioning was done using transverse acetabular ligament as a guide.The anteversion of acetabular component was measured postoperatively with ct scan.The mean anteversion was 17.8 degrees this was within the safe zone as described by Lewinnek.Our study concludes the use of transverse acetabular ligament in acetabular component positioning.

Keywords: Transverse acetabular ligament,acetabular anteversion,total hip replacement

[1]. Hirohito Abe, Takashi Sakai, Toshimitsu Hamasaki, Masaki Takao, Takashi Nish, Nobuo Nakamura, and Nobuhiko Sugano. Is the transverse acetabular ligament a reliable cup orientation guide? Acta Orthopaedica 2012; 83 [5]: 1–7 .
[2]. H. A. P. Archbold, B. Mockford, D. Molloy, J. McConway, L. Ogonda, D.Beverland. The transverse acetabular ligament: an aid to orientation of the acetabular component during primary total hip replacement. J Bone Joint Surg [Br] 2006;88-B:883-6.
[3]. Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg [Am] 1978; 60-A:217-20.
[4]. Nishii T, Sugano N, Miki H, et al. Influence of component positions on dislocation: computed tomographic evaluations in a consecutive series of total hip arthroplasty. J Arthroplasty 2004; 19:162-6.
[5]. Murray DW. The definition and measurement of acetabular orientation. J Bone Joint Surg Br. 1993; 75[2]:228-232.

Abstract: This study aimed to compare the accuracy of Conventional Radiographs, Spiral computed tomography and Cone Beam computed tomography in detecting vertical root fractures. Material And Methods- Sixty extracted single rooted teeth were selected. The roots were divided into two groups. Group-1had teeth with induced root fracture and Group2 had teeth with no fracture. In the first group, the crack was made by Instron system. All samples were imaged with three imaging modalities and were statistically analysed. Results- CBCT gave the most accurate diagnosis with 90% sensitivity and a false negative of 10% in the group with fractured teeth and 80% specificity and a false positive of 20% in teeth with no fracture.

[1]. BarkhordarRA.Treatment of vertical root fracture: a case report.Quintessence Int. 1991 Sep;22(9):707-9.
[2]. Wenzel A, Kirkevang LL. High resolutioncharge-coupled device sensor vs. medium resolutionphotostimulable phosphor plate digital receptors fordetection of root fractures in vitro. Dent Traumatol2005;21:32-6.
[3]. Kositbowornchai S, Sikram S, Nuansakul R, Thinkhamrop B. Root fracture detection on digital images: effect of the zoom function. Dent Traumatol 2003; 19: 154–9.
[4]. Hannig C, Dullin C, Hülsmann M, HeidrichG.Three-dimensional, non-destructive visualization ofvertical root fractures using flat panel volumedetector computer tomography: an ex vivo in vitrocase report. IntEndod J 2005;38:904-13.
[5]. Cotton TP, GeislerTM,Holden DT, Schwartz SA, Schindler WG Endodontic Applications of Cone-Beam Volumetric Tomography. JOE 2007;33(9):1121-32.
[6]. Hassan B. Detection of Vertical Root Fractures in Endodontically Treated Teeth by a Cone Beam Computed Tomography Scan. Journal of Endodontics 2009;35(5):719-22.

Abstract: Cytodiagnosis of bony lesions are mainly done where cortical destruction and soft tissue infiltration is evident. Cytodiagnosis of osteolytic lesions with intact cortex is an uncommon procedure, and open bone biopsy is the preferred diagnostic modality. We have done a prospective cytopathological study of such lesions on patients who had come to a Tertiary Teaching Hospital in between February 2012 to January 2014 and we have made cytological diagnosis in 76 cases. The study was done by using 20 G bone marrow aspiration needle under image guidance. The smears were stained by PAP, H&E and air-dried MGG stain and evaluated, followed by histopathological correlation.

[1]. Orme S, Ralph SG, Birchall A, Lawson-Matthew P, McLean K, Channer KS. The normal range for inter-arm differences in blood pressure. Age Ageing. 1999; 28: 537–54
[2]. HeTie C, Luo Y, Wen Z, et al. Development of the synchronous sphygmomanometer for four limbs – technical basics and medical practice. Chin J Biomed Eng 2002; 21: 182–186.
[3]. Agarwal R, Bunaye Z, Bekele DM. Prognostic significance of between-arm blood pressure differences. Hypertension 2008; 51: 657–662.
[4]. Clark CE, Taylor RS, Shore AC, et al. The difference in blood pressure readings between arms and survival: primary care cohort study. BMJ 2012; 344: e1327–e1340.
[5]. Clark CE, Greaves CJ, Evans PH, et al. Inter-arm blood pressure difference in type 2 diabetes: a barrier to effective management? Br J Gen Pract 2009; 59: 428–432.
[6]. Banks MJ, Erb N, George P, et al. Hypertension is not a disease of the left arm: a difficult diagnosis of hypertension in Takayasu's arteritis. J Hum Hypertens 2001; 15: 573–575.

Abstract: Nowadays, exposure to electromagnetic fields emitted by electronic devices, especially smart cell phones and laptops, is inevitable. The World Health Organization has classified electromagnetic waves in class 2B (possibly carcinogenic) in terms of carcinogenesis. In this study, the magnetic field of laptop HP 4530S and smart cell phone SONY Z2 was measured using the portable measurement device of magnetic fields, model HI 3603. Then, the magnetic fields of the two devices were compared using the statistical test of independent sample T test. The mean magnetic field of smart cell phone SONY Z2 in the ringing mode and internet connected ringing mode is respectively equal to 0.34±0.0038 mG and 0.4±0.0049 mG.

[1]. Nakatani‐enomoto, s., et al., effects of electromagnetic fields emitted from w‐cdma‐like mobile phones on sleep in humans. Bioelectromagnetics, 2013. 34(8): p. 589-598.
[2]. Joseph, w., et al., comparison of personal radio frequency electromagnetic field exposure in different urban areas across europe. Environmental research, 2010. 110(7): p. 658-663.
[3]. Bellieni, c., et al., exposure to electromagnetic fields from laptop use of "laptop" computers. Archives of environmental & occupational health, 2012. 67(1): p. 31-36.
[4]. Hauri, d.d., et al., exposure to radio-frequency electromagnetic fields from broadcast transmitters and risk of childhood cancer: a census-based cohort study. American journal of epidemiology, 2014: p. Kwt442.
[5]. Organization, w.h., extremely low frequency fields environmental health criteria. World health organization, 2007. 238.
[6]. Silny, j., et al., health effects from radiofrequency electromagnetic fields of mobile phones and other new communication systems. Umwelt med forsch prax, 2004. 9(3): p. 127-136.

Abstract: Ichthyosis refers to a relatively uncommon group of skin disorders characterized by the presence of excessive amounts of dry surface scales. Autosomal recessive congenital ichthyosis (ARCI) encompasses several forms of nonsyndromic ichthyosis. Although most neonates with ARCI are collodion babies, the clinical presentation and severity of ARCI may vary significantly, ranging from harlequin ichthyosis, the most severe and often fatal form, to lamellar ichthyosis (LI) and (nonbullous) congenital ichthyosiform erythroderma (CIE). This is a case report of congenital (Harlequin) ichthyosis which is also called harlequin fetus, a lethal keratinising disorder. An externally thickened keratin layer of skin and diffuse plate like scales characterize it. Prenatal sonographic diagnosis has been described, with 2D findings of a persistently open mouth, echogenic amniotic fluid and fixed flexion deformity of the extremities.

[1]. Akiyama M. The pathogenesis of severe congenital ichthyosis of the neonate. J Dermatol Sci 1999; 21:96-104.
[2]. Bongain A, Benoit B, Ejnes L, Lambert JC and Gillet JY. Harlequin fetus: three-dimensional sonographic findings and new diagnostic approach. Ultrasound Obstet Gynecol 2002; 20:82-85.
[3]. Meizner I. Prenatal ultrasonic features in a rare case of congenital ichthyosis (harlequin fetus). J Clin Ultrasound 1992; 20:132–134.
[4]. Watson WJ, Mabee LM Jr. Prenatal diagnosis of severe congenital ichthyosis (harlequin fetus) by ultrasonography. J Ultrasound Med 1995; 14:241–243.
[5]. Montague E, Fox R, Mann R. Intra-amniotic debris identified at ultrasound scanning: a feature of congenital ichthyosis. Ultrasound Obstet Gynecol 1997; 9:350–351.
[6]. Nidhi V, Burton R, Smith–Levitin M. Three–dimensional Sonographic Findings in Congenital (Harlequin) Ichthyosis. J Ultrasound Med 22:737– 739, 2003.

Abstract: Diabetes mellitus is the most common metabolic disorder affecting the people all over the world. Obesity is a physiological variant which leads to various pathological complications including Type 2 diabetes mellitus. Type 2 diabetes mellitus, obesity and dyslipidemia are considered as independent risk factors for coronary heart disease and cerebrovascular disease. Present study is to compare lipid profile in Type 2 diabetics with obesity and non diabetic obese people, the control group.

[1]. Assamang G, Schute H: The prospective Cardiovascular Minister (procam) study; Prevalence of hyperlipidemia in persons with hypertension and/or diabetes mellitus and the relationship to coronary heart disease: American Heart Journal 1988; 116:1713

[2]. Dan L. Longo … [et al.]. Harrison‟s Principles Of Internal Medicine. 18th edition, 2012, chapter 344, pages 2995 to 2998.chapter 77, page 628.

[3]. Bijani PK, Shah Kokila, Reheja BS, HDL Cholesterol in Diabetes JAPI; 1984:32 [4]. Enas A Enas, MD, FACC –How to beat the Heart disease epidemic among south Asians Chapter - 3.2:85-91,6.3:228-230,6.4:231,6.7:243-249.

[5]. Richard A. Harvey, Pamela C. Champe, Lippincott‟s Illustrated Reviews Biochemistry 3rd edition: 217- 233.

[6]. Misra A, Vikram NK. Insulin resistance syndrome (metabolic syndrome) and obesity in Asian Indians: evidence and implications. Nutrition 2004; 20: 482–491

Abstract: Causative correction of skeletal malocclusions is achieved through bite–jumping by various means. Numerous animal experiments yielded evidence of rebuilt temporomandibular structures after mandibular protrusion. However, the mode and extent of structural and/or topographic changes of the disco-condylar relation after functional orthopaedic treatment is still an issue at stake. A problem exists in defining the physiologic (centric) position of the condyles and the proper disco-condylar relation which is tentatively determined by various methods particularly in MRI studies. Despite the high resolution provided, the results have to be interpreted with caution, as osseous resorption and apposition can not be assessed by visual evidence. In this article a prospective study is presented which proves the effectiveness of the "Wuerzburg concept", i.e. bionator plus extraoral traction and up-and-down elastics, and its impact on the temporomandibular joint. The underlying reactions are studied by means of MR images obtained from sucessfully treated patients.

Keywords: Disc displacement, internal derangement, posterior disc displacement, temporomandibular disorders

[1]. Acadamy of Prosthodontics 1994 Glossary of prosthodontic terms. Journal of Prosthetics Dentistry 71: 41-112
[2]. Armstrong N M 1971 Controlling the magnitude, duration and direction of extra oral force. American Journal of Orthodontics 59: 217-243
[3]. Bakke M, Paulsen H U 1989 Herbst treatment in late adolescence: clinical, electromyographic, and radiographic anaysis of one case. European Journal of Orthodontics 11: 397-407
[4]. Baume L J, Derichsweiler H 1961 Is the condylar growth center responsive to orthodontic therapy? An experimental study in Macaca mulatta. Oral Surgery 14: 347-362
[5]. Bell W H, Yamaguchi Y 1991Condyle position and mobility before and after intraoral vertical ramus osteotomies and neuromuscular rehabilitation. International Journal of Adult-Orthodontic-Orthognathic-Surgery 6: 97-104

Abstract: Patient satisfaction is influenced by patient factors and service-provider factors. The cultural, social and economic conditions of the people living in the region affect the perceptions, attitude, and understandings of the persons, which has a bearing on the satisfaction they derive from the hospitals and its services. The study aims to find the relationship between patient satisfactions focusing on the patient's socio-demographic characteristics. Methods: This is a cross-sectional study, which was conducted from 1st July, 2012 to 15th August, 2012 among the patients admitted to a private surgical hospital in Bhopal, India. A structured, validated questionnaire form was distributed using simple randomization method. The patients themselves or their representative filled up the questionnaire. Data was analyzed and appropriate statistical tests applied.

[1]. Quintana JM, Gonzalenz N, Bilbao A, et al. Predictors of patient satisfaction whit hospital health care. BMC Health Serv Res 2006; 6: 102
[2]. Parker JM. Patient or customer? Collegian 1999; 6: 16-23
[3]. Horak BJ. Strategic planning in healthcare: building a quality-based plan step by step. 1st ed. New York: Quality Resources 1997; pp: 17-37
[4]. Juran JM, Gryna FM. Quality planning and analysis. 3rd ed. New York: McGraw Hill 1993; pp: 1-27
[5]. Horovitz J. The seven secrets of service strategy. 4th ed. Great Britain: Prentice Hall 2004; pp: 61-80
[6]. Khamse M, Aqili R, Moghadam, Arabi A. Patients' satisfaction with outpatient services at Firoozgar Endocrinology and Metabolism Clinics, Payesh J 2006; 1: 71-4. Available at: http://www. payeshjournal.ir/ UploadedFiles/ ArticleFiles/PHM856171.pdf [in Persian]

Abstract: Endoscopes have been contaminated with organic material from a prior procedure something healthcare workers call "bioburden." While most of these cases are recognized before the devices reach the patient, in some instances these soiled instruments have contaminated the sterile field. Due to the nature of endoscopes, with small lumens and a combination of mechanical and electrical components and complexity of materials, effective reprocessing can be challenging to practically achieve. Endoscopic procedures carry a risk of causing infection.

[1]. L Hookey, D Armstrong, R Enns, A Matlow, H Singh and J Love, Summary of guidelines for infection prevention and control for flexible gastrointestinal endoscopy, Canadian Journal of Gastroenterology, 27 (6), 2013, 347-350.
[2]. KW Chiu, LS Lu and SS Chiou, High-level disinfection of gastrointestinal endoscope reprocessing, World journal of experimental medicine, 5 (1), 2015, 33-39.
[3]. ZH Ali and NM Taha, Effect of Infection Control Training Program on Nurse's Performance and Microbial Results on GIT Endoscopes, Advances in Life Science and Technology, 27, 2014.
[4]. Public health agency of Canada, Infection Prevention and Control Guideline for Flexible Gastrointestinal Endoscopy and Flexible Bronchoscopy‖. Internet : http://www.phac-aspc.gc.ca/nois-sinp/guide/endo/pdf/endo-eng.pdf
[5]. AM Noronha and S Brozak, A 21st century nosocomial issue with endoscopes, BMJ, 2014, 348.

Abstract: Research Question: What is the morbidity profile in primary school children and is there any relation of their illness with socioeconomic determinants. Methodology: A cross sectional study carried out in six randomly selected Municipal Corporation Primary schools in Visakhapatnam city. Study population were children aged 6-11 years enrolled in class 2 to class 5. A sample of 1029 children who attended the school on the day of study were included. Study tools include questionnaire for obtaining information on socio-demographic data, education and income of their parents, h/o of episodes of illness and anthropometric parameters. Data was analysed using SPSS.

[1] Park's text book of preventive and social medicine, 22nd Edition. [2] Health status of school children in Ludhiana city: P. Panda, AI. Benzamin, Shavinder singh, P. Zacharaiah. Indian journal of community Medicine, Oct-Dec 2000: Vol 25 No.4: 150-155. [3] A comprehensive study of morbidity in school age children Shanti Ananthakrishnan, S.P. Pani, P. Nalini. Indian Pediatrics September 2001: Vol. 38 1009-1016. [4] Bundy DAP, Guyatt HL. The health of school age children. Report of a work shop. Parasitology today 1005: 166-67. [5] N Saluja, S Garg, H Chopra. Prevalence Of Morbidity And Morbidity Pattern In School Children (5-11 Yrs) In Urban Area Of Meerut. The Internet Journal of Epidemiology. 2010 Volume 9 Number
[6] Deb S1, Dutta S, Dasgupta A, Misra R. Relationship Of Personal Hygiene With Nutrition And Morbidity Profile: A Study Among Primary School Children In South Kolkata. Indian J Community Med. 2010 Apr;35(2):280-4.

Abstract: Introduction and the succeeding acceptance and popularity of implants has made the choice of other restoration options a little less common. The resin bonded bridges, though an excellent alternative to less conservative procedure like complete coverage fixed bridges and economically dearer choice like implant, are still not embraced by the common dentist. However, in circumstances of a proper case selection and financial limitations on the part of the patient, the use of resin bonded bridge should not be avoided. The missing anterior tooth in young patients who cannot afford a more expensive option of implant has so far been the most ideal case choice for these prostheses. This article explains the restoration of a missing maxillary right central incisor in a young male with open bite, using resin bonded bridge.

[1]. K. A. Durey, P. J. Nixon, S. Robinson and M. F. W.-Y. Chan, Resin bonded bridges: techniques for success, British Dental Journal 211 (3), 2011, 113-118.
[2]. Buonocore, M.G., A simple method of increasing the adhesion of acrylicfilling materials to enamel surfaces. J Dent Res, 34, 1955, 849-853.
[3]. Rochette, A.L., Attachment of a splint to enamel of lower anterior teeth, J Prosthet Dent, 30,1973, 418-423.
[4]. Howe, D.F., Denehy, G.E., Anterior fixed partial dentures utilising the acidetchtechnique and a cast metal framework, J Prosthet Dent, 37, 1977, 28-31.
[5]. Livaditis, G.J., Cast metal resin-bonded retainers for posterior teeth, J Am Dent Assoc, 101, 1980, 926-929.
[6]. Livaditis, G.J., Thompson, V.P., Etched castings: an improved retentive mechanism for resin-bonded retainers, J Prosthet Dent, 47, 19822, 52-58.

Abstract: Wound dehiscence after laparotomy remains a serious complication. Postoperative complete wound dehiscence, being an unfortunate and also a very serious complication, is associated with a high morbidity and mortality rate despite the most sophisticated intensive care these patients receive today.
Aims: The present study was undertaken to assess the proportion of burst abdomen in post midline laparotomy patient using interrupted X suture versus continuous suture technique in sheath closure. Materials and Methods: A prospective randomised study was designed wherein a total of 100 patients undergoing midline laparotomy at one of the surgical units at S.M.S. Hospital Jaipur were recruited randomly after taking written informed consent. In the study group of 50 cases, sheath closure was done by using interrupted X suture and the same was compared with an equal number of control group (n = 50) in which sheath closure was done by continuous suture technique.

[1]. Mayo, Ch. W. and Lee, M. J.: Separations of Abdominal Wounds. A. M. A. Arch. Surg., 62:883, 1951.
[2]. Madden, J. L.: Atlas of Technics in Surgery. Volume 1. Second edition. New York, Appleton-Century-Croft, 1964.
[3]. Efron, G.: Abdominal Wound Distruption. Lancet, 19:1287, 1965.
[4]. Altemeier, W. A. and Berkich, E.: Wound sepsis and Dehiscence. In Hardy, J. D. (ed.) Critical Surgical Illness, Philadelphia, W. B. Saunders Company, 1971.
[5]. Hunt, T. K.: Wound Complications. In Hardy, J. D. (ed.) Management of Surgical Complications, Philadelphia, W. B. Saunders Company, 1975.
[6]. -Singh A, Singh S, Dhaliwal US, Singh S. Technique of abdominal wall closure: a comparative study. Ind J Surg 1981;43:785 – 90.

Abstract: Objectives: To determine the histopathological patterns of cutaneous malignant melanoma in Sudanese patients. Methods: This is a cross sectional laboratory based descriptive study that included all tissue slides presented during the study period. The tissue blocks and the slides of 55 cases were collected and re-examined by the principal investigator. Results: Males represented 57.1% of the cases. The majority of lesions (81.6%) were found in the lower limbs. The major clinic-pathological feature was the acrallentiginus type (in 75.5%). Microscopy showed epithelioid cell type (61.2%), spindle cell type (32.7%), extremely bizarre cells (4.1%), and mixed cell types (spindle and epithelioid) in 2.0% of all cases. Conclusion: The histo-pathological features of cutaneous malignant melanoma in Sudan are similar to previous findings in black people.

[1]. Garbe C, Leiter U. Melanoma epidemiology and trends. ClinDermatol 2009; 27: 3–9. [2]. Erdmann F, Lortet-Tieulent J, Schüz J, Zeeb H, Greinert R, Eckhard W. Breitbart E, Bray F (2012). International trends in the incidence of malignant melanoma 1953–2008—are recent generations at higher or lower risk? Int J Cancer 2013; 132(2):385-400.
[3]. Elwood JM, Jopson J. Melanoma and sun exposure, an overview of published studies Int J cancer 1997; 73:198-203.
[4]. Bevona C, Goggins W, Quinn T, Fullerton J, Tsao H. Cutaneous melanomas associated with nevi. Arch Dermatol 2003; 139:1620-1624.
[5]. Snell RS. Effect of alpha M.S.H. and estrogen on melanin pigmentation in the albino. J investDermatol 1965; 44:17-21.