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

Abstract: Surgical literature is laden with idioms. This case report is aimed at drawing attention to the aphorism "No two pathologies can co-exist". We report an unusual presentation of acute appendicitis coexisting with ileal tuberculosis. Although gastrointestinal tuberculosis is a common clinical entity, tuberculous ileal perforation in post appendicectomy peri operative period has not been reported. The patient was a 20yr old male who was referred to our centre following open appendicectomy with features of peritonitis. On exploration, we found perforation of terminal ileum for which ileal resection was done. Biopsy revealed tuberculosis of resected specimen.

[1]. Leung VK, Law ST, Lam CW, et al. Intestinal tuberculosis in a regional hospital in Hong Kong: a 10-year experience. Hong Kong Med J. 2006;12:264–271. [PubMed]
[2]. Sundre p, ten Dam G, Kochi A. Tuberculosis: a global overview of the situation today. Bull World Health Org 1992; 70:49-59.
[3]. Keystone JS, Keystone DL, Proctor EM. Intestinal parasitic infections in homosexual men: prevalence, symptoms and factors in transmission. Can Med Assoc J 1980; 123: 512-4.
[4]. Clark RM, Frost PG. Fulminating necrotizing amebic colitis with perforation: case report and review. Can Med Assoc J 1983; 128: 1424-7.
[5]. Palaez M, Villazon A, Sieres Zaraboso R. Amoebic perforation of the colon. Dis Colon Rectum 1966; 9: 356-362.
[6]. Vajrabukka T, Dhitavat A. Kichananata B, Sukonthamad Y, Tanphiphat C, Vongviriyathams S. Fulminating amoebic colitis: a clinical evaluation. Br J Surg 1979; 9: 356-62.

Abstract: Endothelial dysfunction is an early event in atherosclerosis and is known to appear long before the formation of structural atherosclerosis changes. Flow mediated dilation (FMD) is known to depend on ability of the endothelium to release NO in response to shear stress and can be used reliably as an estimate of endothelial function in various disease states. Methodology: Endothelial function was assessed non-invasively by high resolution Duplex Doppler Ultrasound of Brachial Artery in 50 cases of Type 2 diabetes with or without microvascular or macrovascular complication and 20 controls who were healthy subjects. FMD was calculated as percentage increase in brachial artery diameter in response to increase in brachial artery flow.

[1]. Bhargava K, Hansa G, Bansal M, Tandon S, Kasliwal RR. Endothelium- dependent brachial artery mediated vasodilation in patients with diabetes mellitus and without coronary artery disease. JAPI 2003; 51: 355-358.
[2]. Simon BC, Noll B, Maisch B. Endothelial Dysfunction-Assessments of current status and approaches to therapy. Herz 1999; 24 (1): 62- 71.
[3]. Prakash C. Deedwania. Mechanisms of endothelial dysfunction in the metabolic syndrome. Current Diabetes Report 2003; 13: 25-34.
[4]. Vallance Patrick, Chan N. Endothelial function and nitric oxide: Clinical relevance. Heart 2001; 85: 342-350.
[5]. Guerci B, Schwartz AK, Bohme P, Zannad F, Drouin. Endothelial dysfunction and Type 2 Diabetes. Diabetes Metab 2001; 27: 425-434.

Abstract: Non-fatal suicidal behaviour (NFSB) includes all these behaviour except the competed suicide. Deliberate self-harm (DSH) or parasuicide is an umbrella term for any self-harm behaviour with or without the intent to kill self, while suicide attempt has definite intent to kill self. Research suggests that if you have self-harmed before then you are likely to repeat some form of self-harm. A significant association was found between repetition of an act of deliberate self-harm and the perception of an unsympathetic attitude within the family.

[1] Moscicki E K, Identification of suicide risk factors using epidemiological studies. Psychiatric Clinics of North America, 20(3), 1997, 499-517.
[2] Campbell, R.G. (2004) campell's psychiatric dictionary: 8thEdn., 60, New York; oxford University Press . [3] Winchel RM, Stanley M., Self-injurious behavior: A review of the behavior and biology personality disorders: Psychological and biological correlates. American Journal of Psychiatry ,148(3), 1991, 306–317.
[4] Isacsson G, Wasserman D, Bergman U., Self-poisoning with antidepressants and other psychotropics in urban area of Sweden. Ann Clin Psychiatry, 7(3),1995 Sep, 113-8 [5] Harkavy Friedman JM, Asnis GM, Boeck M, DiFiore J., Prevalence of specific suicidal behaviors in a high school sample. Am J Psychiatry, 144(9), 1987, 1203–1206.

Abstract: A structured questionnaire was used to assess the knowledge of diabetic complications and its prevention among type 2 diabetes patients. Among 100 individuals included in the study, 68% were females. Individuals with educational qualification below primary school certificate (66%), monthly income less than Rs.5000/- (35%) and housewives (15%) were least aware of the complications of diabetes. Only 66% of the study group were aware about diabetic nephropathy and only 59% were aware of diabetic retinopathy. Majority of the study population (49%) considered heart disease as the most serious complication of diabetes.Only seventy eight patients (78%) acquired the information of diabetic complications from the physicians of the tertiary care centre.

[1]. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004;27:1047–53
[2]. Joshi SR, Parikh RM. India- Diabetes Capital of the World: Now Heading Towards Hypertension. J Assoc Physicians India 2007;55:323-4
[3]. O'Sullivan EP, Bhargava A, O'Callaghan M, Buckley U, De Faoite T, Moynihan K, et al. Awareness of diabetes complications in an Irish population. Ir J Med Sci2009;178(4):401-6
[4]. Sabri AA, Qayyaum MA, Saigol NU, et al. Comparing knowledge of diabetes mellitus among rural and urban diabetics. Megill J Med 2007;10(2):87-89.
[5]. Anand AC, Ranji C, Narula AS, Singh W. Histopathological changes of liver in malaria: a heterogenous syndrome? Natl Med J India 1992;5:59–62.

Abstract: The hemodynamic response during laryngoscopy and intubation is a unwanted side effect during securing the airway for conducting safe anaesthesia. This study was done to compare the varying doses of Intravenous Esmolol in attenuating the hemodynamic stress responses to laryngoscopy and endotracheal intubation. 60 patients were enrolled in a prospective, randomized and double blind study. The three doses of esmolol studies were 0.5mg/kg, 1.0mg/kg, 1.5mg/kg. We found that even though there was a rise in hemodynamic parameters but the patients treated with esmolol showed greater resistance to abrupt excursions of heart rate and blood pressure. The dosage of 1.5mg/kg was found to be the most efficacious in attenuating the pressor response.

Keywords: Esmolol, Laryngoscopy, Intubation, Pressor response.

[1]. Vucovic. M, Pordy G. M., Ellid F.R (1992). Esmolol hydrochloride for management cardiovascular response to laryngoscopy and tracheal intubation; British Journal of Anaesthesia (1992). May; 68 (5) 529 -30.
[2]. Ebert T.J. Bernstein, J.S.Sodwe, D.F, Roerig.D.(1990). Attenuation of hemodynamic response to rapid sequence induction and intubation in healthy patients with a single bolus of Esmolol. Journal of Clinical Anaesthesia 1990. Jul- Aug; 2 (4) : 243-52.
[3]. Sheppard et al (1990). A bolus dose of Esmolol attenuating tachycardia and hypertension after tracheal intubation. Canadian Journal of Anaesthesia 1990 Mar (27): 202-5.
[4]. Miller.D.R, Maurtineaux R.J, Wynands J.E, Hill J (1991). Bolus administration of Esmolol for controlling the hemodynamic response to tracheal intubation.- The Canadian Multicenter trial Canadian Journal of Anaesthesia 1991 Oct. 38 (7) 849-58.
[5]. Ganbatz C.L., Wehner R.J (1991). Effect of Esmolol and Fentanyl in controlling rise in heart rate and blood pressure during intubation. AANA Journal 1991 Feb. 59(1): 19-26.
[6]. Sharma. S et al (1996). Esmolol blunts the hemodynamic response to tracheal intubation in treated hypertensive patients. Canadian Journal of Anaesthesia 1996 Aug. 43 (8): 728 – 32.

Abstract: Preeclampsia (PE) is a pregnancy specific disorder occurring only in humans and high apescharacterized by development of hypertension, proteinuria and edema. Sometimes this disease progresses to multi organ dysfunction and further result in long term morbidities like chronic hypertension, diabetes, and obesity and remains the leading cause of maternal and perinatal mortality and morbidity.

[1]. N. Bhattacharya, P. Stubblefield (eds.), Fetomaternal Cell Trafficking: A Window into the Long-Term Health Effects of Treating Disease with Fetal Cell/Tissue Transplants? Human Fetal Tissue Transplantation. DOI 10.1007/978-1-4471-4171-6_2 [2]. Rockwell LC, Vargas E, et al. Human physiological adaptation to pregnancy: inter- and intraspecific perspectives.Am J Hum Biol. 2003 May-Jun; 15(3):330-41.
[3]. Mor G, Cardenas I. The immune system in pregnancy: a unique complexity. Am J ReprodImmunol 2010; 63: 425–433
[4]. Alicia Martínez-Varea, BegonaPellicer et.al,Relationship between Maternal Immunological Response during Pregnancy and Onset of Preeclampsia Journal of Immunology Research Volume 2014, Article ID 210241, 15 pages
[5]. S.-J.Chen, Y.-L. Liu, andH.-K.Sytwu, ―Immunologic regulation in pregnancy: from mechanism to therapeutic strategy for immunomodulation,‖ Clinical and Developmental Immunology, vol. 2012, Article ID258391, 10 pages, 2012.
[6]. J. Zhang, Z. Chen, G. N. Smith, and B. A. Croy, ―Natural killer cell-triggered vascular transformation: maternal care before birth?‖ Cellular andMolecular Immunology, vol. 8, no. 1,pp. 1–11, 2011.

Abstract: To compare the combined diagnostic value of SD-OCT & fundus photography and SD-OCT alone in the detection of Age related Maculae Degeneration Setting: Assam Medical College &Hospital,Dibrugarh. Study design: Comparative, non-randomized study.

[1]. Klen R, Klin BEK, Davis MD. The Epidemiology of Age Related Degeneration. AMJ Ophthalmol 2004.
[2]. Bressler NM. Age-related macular degeneration is the leading cause of blindness. JAMA. 2004; 291: 1900–1901
[3]. Hutchinson J, Tay W. Symmetrical central choroid-retinal disease occurring in senile persons. R Lond Ophthalmic Hosp Rep J Ophthalmic Med Surg 1874; 8: 231-44
[4]. Haab O. Etkrankungen der Macula Lutea, CentralbatAugenheilkd 1885; 9: 384-391. Duke Elder S. System of ophthalmology, Vol.9.London: kimpton; (1966)
[5]. Catherine B.Smith, R.Theodore Smith- Autofluorescence of basal laminar drusen. Retina.2007 October; 27(8): 1101-1106.
[6]. Gass J, Jallow S, Davis B. Adult vitelliform macular detachment occurring in patients with basal laminar drusen Am J Ophthalmol 1985. 99(4): 445-459.

Abstract: Introduction: Circle of Willis is the balancing mechanism of blood supply to the brain between vertebrobasilar and carotid systems. Literature say, the incidence of absent internal carotid artery in Western population is .01%. This study is to find the incidence of absent internal carotid artery in Circle of Willis among South Indian population. Materials and methods: 246 cadaveric brains are utilized in this study at various medical colleges in and around Puducherry. Routine dissection instruments were used. The Circle of Willis was studied and photographed..

[1]. Kawther A. Hafez, Nahla M. Afifi, Fardous Z. Saudi;Anatomical Variations of the Circle of Willis in Males and Females on 3D MR Angiograms.The Egyptian Journal of Hospital Medicine. 2007: Vol 26, 106 – 121
[2]. Fu-Yu Lin,Bang-Bin Chen; Cerebral Infarct Due to Concomitant Anterior Cerebral Artery Dissection and Dissecting Aneurysm.Acta Neurologica Taiwanica, December 2009:Vol 18, p 4
[3]. Given II, Curtis A., Huang-Hellinger, Frank, Baker, Michael D., Chepuri, Neeraj B., Morris, P. Pearse; Congenital Absence of the Internal Carotid Artery. Case Reports and Review of the Collateral Circualtion. AJNR Am J Neuroradiol. 2001: 22: 1953-1959.
[4]. Luk Y S, Man E M W, Sy A N L;Bilateral hypoplasia of the internal carotid arteries.Singapore Med J. 2010: 51(9) e163
[5]. M.Sreedhar,Kalyan reddy,Manish K Agarwal,Case report.Bilateral agenesis of internal carotid arteries associated with aneurysmally dilated vessels of posterior cranial fossa,Indian J Radiol Imaging, 2007:vol (17),issue 3.
[6]. N Lath, M Taneja,Bilateral Congenital Hypoplasia of the Internal Carotid Arteries,case report.J HK Coll Radiol. 2008;11:129-131JUN

Abstract: Scheuthauer –Marie –Sainton Syndrome is a rare autosomal dominant skeletal dysplasia which is commonly known as cleidocranial dysplasia. General manifestations of scheuthauer-marie-sainton syndrome includes open or delayed closure of fontanel, hypoplastic or aplastic clavicles, short stature and tooth abnormalities. Dental manifestation includes retention of multiple deciduous teeth, impaction or delayed eruption of permanent teeth, presence of supernumerary teeth. Here is a case report of 13 year old female child suffering from scheuthauer-marie-sainton syndrome and a chief complaint of missing upper front teeth which was treated by operculectomy.

Keywords: Cleidocranial dysplasia, Operculectomy, Scheuthauer- Marie- Sainton Syndrome.

[1]. Marie P, Sainton P: Sur la dysostose cleido-cranienne hereditaire. Rev Neurol 1898, 6:835-838.
[2]. Nagarathna C, Bethur S S, Mathew S, Krishnamurthy N H ,Yumkham R. Cleidocranial dysplasia presenting with retained
deciduous teeth in a 15 year old girl; a case report. Journal of Medical Case Reports 2012, 6:25.
[3]. S Rizvi, H Raihan, T Rizvi. Cleidocranial dysplasia –A case report. Biomedical Research 2006; 17 (2): 129-132.
[4]. W. Kim Seow, J Hertzberg. Dental development and molar root length in children with cleidocranial dysplasia. Pediatric Dentistry-
17:2,1 995.
[5]. TKN Park, K Vargervik ,S Oberoi. Orthodontic and surgical management of cleidocranial dysplasia. Korean J Orthod. 2013 Oct;
43(5): 248–260.
[6]. Turek's Orthopaedics: Principles And Their Application. Lippincott Williams & Wilkins. 2005. pp. 251–252.
[7]. Saraswathivilasam S. Suresh, A Family With Cleidocranial Dysplasia And Crossed Ectopic Kidney In One Child, Acta Orthop.
Belg. 2009, Vol. 75; 4:.521-527.

Abstract: Malaria is the most important mosquito borne disease in humans and has been a major health problem worldwide. Detection of parasites by conventional microscopy is considered gold standard for diagnosis but low parasitemic conditions exhibiting only hemozoin pigment remains a challenge. Peripheral parasite density of Plasmodium falciparum is used as an indicator of disease severity, but does not quantify central sequestration. Detection of hemozoin pigment within parasite and the cytoplasm of phagocytic cells by microscopy is considered an important tool for the diagnosis of Malaria and its severity.

[1]. World Health Organization malaria fact sheet 2012.
[2]. Murray CK, Gasser RA Jr, Magill AJ, Miller RS. Update on rapid diagnostic testing for malaria. Clin Microbiol Rev 2008; 21:97-110.
[3]. Krudsood S, Wilairatana P, Mason DP, Treeprasertsuk S, Singhasivanon P, Looareesuwan S. Hidden Plasmodium falciparum infections. Southeast Asian J Trop Med Public Health 1999 Dec; 30(4):623-4.
[4]. Rudzinska MA, Trager W, Bray RS, 1965 Pinocytotic uptake and the digestion of hemoglobin in malaria parasites. J Proto- zool 12: 563–576
[5]. Nguyen PH, Day N, Pram TD, Ferguson DJ, White NJ, 1995. Intraleucocytic malaria pigment and prognosis in severe malaria. Trans R Soc Trop Med Hyg 89: 200–204.

Abstract: Snake-bite is a life-threatening medical emergency. Snake bite treatment in developing countries is a complex issue with many exacerbating problems, such asunscientific indigenous management, long travel time and resource scarce health care setting. As time is very crucial, it's very essential that treating physician should have adequate knowledge to save precious lives of the victims.West Bengal has a long-standing reputation for having a serious snakebite problem.

[1]. Warrell DA. The clinical management of snake bites in Southeast Asian region.Southeast Asian J Trop Med Public Health1999; 30 (Suppl 1):1–67.
[2]. Hati AK, Mandal M, Mukherjee H, Hati RN. Epidemiology of snake bite in the district of Burdwan, West Bengal. J Indian Med Assoc 1992;90:145–147.
[3]. Smith MA., The fauna of British India Ceylon and Burma including the whole of the Indo-Chinese sub-region. In: Reptilia and Amphibia Vol. III. Serpentes London: Taylor and Francis; 1943.
[4]. Simpson ID. Snakebite management in India, the first few hours: a guide for primary care physicians. J Indian Med Assoc 2007;105:324–335.
[5]. Auerbach, P. S. and R. L. Norris. Disorders caused by reptile bites and marine animal exposures. In: E. Braunwald, AS. Fauchi, DL. Kasper, eds. Harrison's Principles of Internal Medicine 16th ed New York, NY McGraw-Hill. 2004. 2593–2600.

Abstract: The role of inj. Ketamine i.v. as a pre-emptive analgesia for laparotomies under general anaesthesia before giving skin incision. Aim: To evaluate the role of inj. Ketamine (0.3mg/kg) intravenously, before skin incision for laparotomies under general anaesthesia as a pre –emptive analgesic, compared to normal saline. "-A prospective randomised, controlled and double blinded study Methods: The study was carried out in Guntur medical College and Government General Hospital. Guntur .After approval from the medical ethics committee, 50 patients of either sex posted for laparatomies under general anaesthesia were selected. The groups were allocated according to randomization into 2 groups of 25 each . Study group (Ketamine) received intravenous ketamine in the dose of 0.3mg / kg body wt made up to 5 ml with normal saline and placebo (Normal saline ) group received 5ml of normal saline pre- incisionally.

[1]. Aida S, Yamakura T., Pre emptive analgesia with low dose intravenous ketamine with epidural morphine in gastrectomy patients. Anaesthesiology.2000;92;1624-23
[2]. Fu ES, Miguel R., Preemptive ketamine decreases postoperative narcotic requirements in patients undergoing abdominal surgery. Anaesthesia Analgesia1997: 1086-90.
[3]. Gilabert MA , Sanchez PC., Effect of low dose intravenous ketamine in postoperative analgesia for hysterectomy and adnexectomy. Rev Esp Anestesiol Reanim. 2002;49: 47-253.
[4]. Schmid et al., Ketamine is an effective analgesic in post operative surgical patients. Ketamine has analgesic properties that is mediated by a number of mechanisms (Pain .1998;82:111-25).
[5]. Cliff,jenkins.postoperative pain and anaelgesia required with Ketamine. Anaesthesia analgesia.2005;100:757-77.
[6]. Ghazi al Saidi, Hajipur etal. Effects of preemptive Ketamine on post caesarean analgesic requirement. Acta Medica Iranica. 2002,Vol 40.

Abstract: Prevalence of lowback pain increases and peaks between 35 and 55 years (Joshi and Chopra 2009). Benefits of yoga are better than exercise alone as it offers a combination of physical exercise with mental focus, self awareness with good posture, self care along with relaxation (Helen etal 2005). Physiotherapy intervention is a common form of conservative management for chronic lowback pain (Gold by etal 2006). There are also many other treatment modalities (Traction, massage, tens, inter ferrential therapy and low level laser therapy) which lack scientific evidence regarding their efficiency in the treatment of CLBP (Van middle Koopetal 2011)

[1]. Fair bank JCT and pynent, PB (2000). The obesity disability index, spine 25(22):2940-2953. Davidson M and Keating J (2001) A Comparision of five low back disability questionnaires: reliability and responsiveness physical therapy 2002, 82: 8-24.
[2]. Joshi VL chopra A, population survey in pune, India, using COPCORD BHIGWAN MODEL J of Rheum 2009:36:614 – 22.
[3]. Helen E, Til brook, Relencox, Catherine E Hewitt, Arthur Ricky kangombe, etal 2005: comparing yoga, exercise and a self care book from chronic LBA ARCT Ann Intern Med:143 (12): 849- 856.
[4]. Van Middle Koop M, Rubenstein SM, Kuijpers T, uerhagen AP, ostlelo R, Koes BW, Van Tuder MW 2011. A systemic review on the effectiveness of physical and rehabilitations for chronic non specific low back pain 2011. European spine journal 20:19-39.
[5]. Gold by LJ, Moore AP, Doust J etal 2006, and ARCT investigating the efficiency of Musculo skeletal physiotherapy on chronic low back disorder spine 31 (10): 1083-93.
[6]. Guzman J, Esmail R, Karjalairen K etal 2007, multi disciplinary bio- psycho- social rehabilitation for chronic low back pain. Cochrane data base systematic reviews 18(3): CD000963.

Abstract: Small bowel volvulus is a life threatening surgical emergency presenting as small bowel obstruction. We present a 31 year old lady, who developed intestinal obstruction due to ileal volvulus causing displacement of right lobe of the liver as evident in the pre-operative X ray of abdomen and CECT. A CT scan on 10th post-operative day showed liver in the normal anatomical position. To our best knowledge, there are no previous reports of ileal volvulus causing the liver displacement and therefore we report this case. Keywords: Volvulus, Small bowel volvulus, Displacement of liver.

[1]. 1.Saich F .the high incidence of intestinal volvulus in Iran 1969;10;838-41
[2]. 2. Ellis H. Acute intestinal obstruction. In Schwartz SI, Ellis H, ed.
[3]. Maringot's Abdominal Operations, 9th Edition. Volume 1, Chapter [4]. 3.The Royal College of Surgeons of Edinburgh, J.R.Coll.Surg.Edinb.,44; 3: 150-5
[5]. 4.Deutsch AA, Eviator E, Gutman H, Reiss R. Small bowel obstruction: a review of 264 cases and suggestions for management. Postgrad Med J 1989; 65: 453-67

Abstract: Corticotomy-assisted orthodontic treatment is an established and efficient orthodontic technique that has recently been studied in a number of publications. Corticotomy facilitated orthodontics have been employed in various forms over speed up orthodontic treatment It involves selective alveolar decortication in the form of decortication lines and dots performed around the teeth that are to be moved. It is done to induce a state of increased tissue turnover and a transient osteopenia, which is followed by a faster rate of orthodontic tooth movement.

1]. Köle H. Surgical operations on the alveolar ridge to correct occlusal abnormalities. Oral Surg Oral Med Oral Pathol. 1959;12:515–29.
[2]. Guilford SH. Orthodontia: Or Malposition of the Human Teeth, Its Prevention and Remedy. Philadelphia, PA: Spangler and Davis; 1893.
[3]. Hajji SS. The influence of accelerated osteogenic responses on mandibular de-crowding [thesis]. St. Louis, MO; St Louis University: 2000.
[4]. Suya H. Corticotomy in orthodontics. In: Hösl E, Baldauf A, eds. Mechanical and Biological Basis in Orthodontics Therapy.Heidelberg, Germany: Hütlig Buch; 1991:107-226.
[5]. Fitzpatrick B. Corticotomy. Aust Dent J. 1980;25:255–258.
[6]. Wilcko WM, Wilcko T, Bouquot JE, Ferguson DJ. Rapid orthodontics with alveolar reshaping: two case reports of decrowding. Int J Periodontics Restorative Dent. 2001;21:9–19.

Abstract: A periodontal abscess is a localized, purulent infection involving a greater dimension of the gum tissue, extending apically and adjacent to a periodontal pocket. The periodontal abscess is the third most common dental emergency, representing 6-14%of all dental emergencies.The periodontal abscess can be classified depending on their course, number, location and etiological criteria. Etiology of the periodontal abscess have been either directly associated to periodontitis or to sites without prior existence of periodontitis.Local andsystemic predisposing factors make patient prone to the periodontal abscess.

[1] A.J. Singer, and D.A. Talan, Management of skin abscesses in the era of methicillin-resistant staphylococcus aureus,N Eng J Med370, 2014, 1039-1047.

[2] H. Mohan, Inflammation-acute and chronic, in: H. Mohan (Ed.),Essentialpathology for dental students, 1(New Delhi: Jaypee Brothers MedicalPublishers (P) Ltd, 1996)68.

[3] B. Shalu, Periodontal abscess, in: B. Shalu, B. Manish (Ed.), Periodontics revisited, 1 (New Delhi: Jaypee Brothers Medical Publishers (P) Ltd, 2011) 173.

[4] G.C. Armitage, Development of a classification system for periodontal diseases and conditions,Ann Periodontol 4, 1999, 1.

[5] American Academy of Periodontology, Parameter on acute periodontal diseases,J Periodontol 71, 2000, 863-866.

[6] F.A. Carranza, P.M. Camargo, The periodontal pocket, in: M.G. Newman MG, H.H. Takei, F.A. Carranza (Ed.),Carranza's clinical periodontology, 9(Philadelphia: Saunder's Elsevier, 2003) 349.

Abstract: The patient was a 25-years-old Malaysian man whose chief complaints were unaesthetic appearance of the front teeth. A study model and radiograph were used to identify the problem and treatment options. Selection of the treatment options were explained to patient. However, bracket for fixed appliance cannot be attached to the teeth due to the anterior locked bite. Thus, removable appliance with posterior bite plane was use to raise the bite together with fixed appliance attachment. Although multiple appliances were used during treatment, the outcome was excellent which provide satisfaction to patient.

Key words: Class III malocclusion, locked bite, removable appliance, fixed appliance

[1]. Angle EH. Malocclusion of the teeth. Philadelphia. 1907;7:52
[2]. Proffit WR. Contemporary Orthodontics. 4th ed. St Louis,Mo: Mosby; 2007:689–707.
[3]. Edward E, James AM. Components of adults class III malocclusion. J Oral Maxillofac Surg 1984;42:295-305.
[4]. Jacobson A, Evans WG, Preston CB, et al: Mandibular prognathism. Am J Orthodont 1974;66:140
[5]. Sanbom RT: Differences between the facial skeletal patternsof Class III malocclusion and normal occlusion. Angle Orthodont 25208, 1955
[6]. Angelika SE, Christopher JL, Gabriele S. Treatment decision in adult patients with class III malocclusion: orthodontic therapy or orthognatic surgery? American Journal of Orthodontics and Dentofacial Orthopedics. 2002;122:27-38
[7]. Battagel JM. The aetiological factors in Class III malocclusion. Eur J Orthod 1993;15:347-70.

Abstract: Fractures of the proximal femur in the elderly are common and occur mainly due to falls, osteoporotic bone, lack of care and due to pathological fractures. The timing of the surgery is a much debated topic and a scoring system is needed which can predict poor outcomes following surgery. The physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) is a scoring system that predicts postoperative morbidity and mortality.

[1]. Hapuarachchi KS, Ahluwalia RS, Bowditch MG. Neck of femur fractures in the over 90s: a select group of patients who require prompt surgical intervention for optimal results. J Orthopaed Traumatol 2014;15:13–9.
[2]. Siegmeth AW, Gurusamy K, Parker MJ. Delay to surgery prolongs hospital stay in patients with fractures of the proximal femur. J Bone Jt Surg Br 2005;87:1123–6.
[3]. Mohamed K, Copeland GP, Boot DA, Casserley HC, Shackleford IM, Sherry PG et al. An assessment of the POSSUM system in orthopaedic surgery. J Bone Jt Surg(Br) 2002;84B:735–9.
[4]. Moran CG, Wenn RT, Sikand M, Taylor AM Early mortality after hip fracture: is delay before surgery important? J Bone Jt Surg (American) 2005;87:483–9.
[5]. Kehlet H. Manipulation of the metabolic response in clinical practice. World J Surg 2000;24:690–5.
[6]. Hedstro¨m M. Hip fracture patients, a group of frail elderly people with low bone mineral density, muscle mass and IGF levels. Acta Physiol Scand 1999;167:347–50

Abstract: We wish to present 5 cases ofgall stone induced biliary sepsis/pancreatitis. These patients presented to our hospital in the emergency department either with abdominal pain, fever or shock. Emergency ERCP was successfully performed in 3 patients while two patients improved spontaneously. Methods:Of the 5 patients 3 were female with age between 35 to 76 years, while male patients were aged between 55 to 70 years. After admission all routine investigations were done. Of the 5 patients 3 were admitted to the ICUs. Remaining 2 patients were managed in the wards.

[1]. David Q,H. Wang ,Nezam H. Afdhal; Gall stone disease Sleisenger and Fordtran's Gastrointestinal and Liver Disease; editors Mark Feldman, Lawrence S Friedman, Lawrence J Brandt; Saunders And Elsevier: 10th edition
[2]. CS Pitchumoni Increasing prevalence of Gallstones ; Diagnostic and therapeutic OptionsMedicine Update 2010 Vol. 20
[3]. Di Kenan Buyukasik, Ahmet Burak Toros, Hasan Bektas,Aziz Ari, and MehmetMehdi Deniz Diagnostic and Therapeutic Value of ERCP in Acute Cholangitis Gastroenterology Volume 2013, Article ID 191729, 4 pages
[4]. Wada K , Takada T, Kawarada Y et al; Diagnostic criteria and severity assessment of acute cholangitis: Tokyo Guidelines. J Hepatobiliary Pancreatic Surg;2007; 14: 52-58
[5]. Dr. Moon-sing LAI Endoscopic Management of Biliary Obstruction Consultant Physician, Department of Medicine, North District Hospital MBBS, FRCP (Edin, Glasg & Lond), FHKCP, FHKAM (Medicine)Vol 14; No 11; November 2009
[6]. Evan L. Fogel, M.D., and Stuart Sherman, M.D. ERCP for Gallstone Pancreatitis N Engl J Med 370;2 nejm.org january 9, 2014
[7]. Sajida Qureshi, Shahriyar Ghazanfar, Fahad Tariq et al; Roleofpre cut sphincterotomy in difficult biliary cannulation; Journal of Surgery Pakistan (International) 13 (1) January - March 2008