iosr-JDMS   Volume-14 ~ Issue-3 ~ March-2015

Abstract: Pregnancy is characterised by an increase in white blood cell count (WBC) arising mainly from neutrophilia, and to a lesser extent, monocytosis. This neutrophilia is attributed to physiologic stress and it is known to increase with gestational age. While humoral immunity is unaltered in pregnancy, cell mediated immunity is depressed. The neutrophilia of pregnancy is postulated to be a compensatory boost in innate immunity to offset the attenuation in specific immunity. It is important to note that leucocytosis even with a mild left shift and some toxic granulations may not necessarily indicate an infection in pregnant women. The aim of this study was to evaluate WBC count in pregnant women compared with non-pregnant controls and to determine any change in the values in the three trimesters of pregnancy using an automated haematology analyser, PCE 210 (N) ERMA. Our results show a significant increase in leucocytes in pregnant women compared to non-pregnant controls 6.86 ±1.54 Vs 5.80 ± 1.41(p = 0.001). We also demonstrated a progressive increase in WBC count with gestational age: First trimester; 6.38 x 109/L ± 1.76, second trimester; 6.81 x 109 /L ±1.52; and third trimester, 7.36 x 109/L±1.49.

Keywords: Pregnancy, Trimester, White Cell Count.

[1]. Ravandi F and Hoffman R (2005). Phagocytes. In Hoffbrand AV, Catovsky D, Tuddenham EGD, Eds. Postgraduate Haematology. 5th Edition, Blackwell Publishing Oxford, UK; 277-302.
[2]. Chandra S, Tripathi AK, Mishra S, Amzarul M, Vaish AK (2012). Physiological Changes in Hematological Parameters During Pregnancy. Indian J Hematol Blood Transfus; 28 (3): 144-146.
[3]. Canzoneri BJ, Lewis DF, Groome L, Wang Y (2009). Increased Neutrophil Numbers Account for Leukocytosis in Women with Preeclampsia. Am J Perinatol; 26 (10): 729-732.
[4]. Crouch SP, Crocker IP, Fletcher J (1995). The effect of pregnancy on polymorphonuclear leukocyte function. J Immunol; 155 (11): 5436-5443.
[5]. Crocker IP, Baker PN, Fletcher J (2000). Neutrophil function in pregnancy and rheumatoid arthritis. Ann Rheum Dis; 59 (7): 555-564.
[6]. Bjorksten IM, Soderstrom T, Damber M-G, Schoultz B, Stigbrand T(1978). Polymorphonuclear leucocyte function during normalpregnancy. Scand J Immunol; 8 (3): 257-262.

Abstract: Metformin is a widely prescribed antidiabetic drug that has been implicated as a cause of hemolytic anemia. We report a case of hemolysis that was associated with initiation of metformin as treatment for diabetes..

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Abstract:Objectives: With the increase in reports of the failure of Paracetamol as antipyretic in pediatric patients and the increase in the use of Mefenamic acid+paracetamol combination, the study was undertaken to recommend best among the both antipyretics by comparing the efficacy and tolerability of both these drugs.
Methods: It was a prospective, active treatment controlled study with follow up upto 72 hours done over a period of 2 months. Total 124 pediatric patients with fever admitted to a private nursing home at Visakhapatnam having a body temperature >101.30 F and fulfilling the inclusion and exclusion criteria were included. Patients included were categorized into two groups – group A and group B and administered Paracetamol and Mefenamic acid paracetamol combination in the doses 15 mg/kg and 4 mg/kg body weight respectively. The parameters essential for comparing the efficacy and tolerability were observed and recorded. The collected data were subjected to 'paired test' of significance and was analyzed statistically.

[1]. Jagdish Chandra and Shishir Kumar Bhatnagarr. Antipyretics in Children. Indian JPediatr. 2002; 69 (1) : 69-742.
[2]. Avtar Let al. Antipyretic Effects of Nimesulide, Paracetamol and Ibuprofen-Paracetamol. Indian Journal of Paediatrics.2000; 67 (12): 8653.
[3]. Alexander KC et al. Fever in childhood.Canadian Family Physician.1992; 38: 1832-364.
[4]. K. Rajeshwari. Antipyretic Therapy Indian Pediatrics. 1997; 34 : 409-4115.
[5]. B S David. Fever panic. Sri Lanka Journal of Child Health, 2000; 29: 976.
[6]. S Balasubramanian, A Sumanth. Mefenamicacid – Role as Antipyretic. Indian paediatrics.2010; 47: 4537.
[7]. Autret E et al. Evaluation of Ibuprofen versusaspirin and paracetamol on efficacy andcomfort in children with fever. Eur J ClinPharmacol. 1997 ; 51: 367-3718.

Abstract: The frenum is a normal anatomical landmark in the oral cavity which attaches the lip and the cheek to the alveolar mucosa, gingiva and the underlying periosteum. The aberrations or abnormalities in the frenal attachment at times, may pose problems to gingival and periodontal health either due to an interference in the plaque control or due to a muscle pull. In addition to this,an abnormal frenum attachment can cause aesthetic and functional problems such as a midline diastema, localized gingival recession and loss of sulcus depth Therefore management of aberrant frenum is important. In thepresent case report the sequelae and management of aberrant frenum has been discussed.

Keywords: Aberrant frenum, Frenectomy, Labial frenum.

[1]. Newman, Takei, Klokkevold,Carranza, Periodontal Plastic And Estheticsurgery,InF.A.Carranza(Ed),Carranza's Clinical Periodontology,10( Missouri:Saunders: An Imprint Of Elsevier Science 2006) 1023-1024.
[2]. M. Priyanka ,R. Sruthi, T.Ramkrishnan, P.Emmadi, N.Ambalavanan N. An Overview Of Frenal Attachments. J Indian Soc Periodontol 2013; 17: 12-15.
[3]. S.M.Mintz,M.A.Siegel, P.J.Seider. An Overview Of Oral Frena And Their Association With Multiple Syndromes And Nonsyndromic Conditions. Oral Surg Oral Med Oral PatholOralradiolendod2005;99:321-324.
[4]. SW Henry ,MP Levin , Tsaknis PJ. Histological Features Of Superior Labial Frenum. J Periodontol 1976;47:25-28
[5]. Anubha N, Chaubey KK, Aroravk, Narula IS. Frenectomy Combined With A Laterally Displaced Pedicle Graft. Indian J Dentsci 2010;2:47-51.

Abstract: Amelogenesis imperfecta has been defined as a group of hereditary enamel defects which may or may not be associated with some other dental and skeletal developmental defects. It can be characterized by enamel hypoplasia, hypomaturation, or hypo-calcification of the teeth. This clinical report describes the oral rehabilitation of a twenty two year old female patient with amelogenesis imperfecta complicated by periodontal problems . The specific objectives of this treatment were to enhance aesthetics, eliminate tooth sensitivity and restore masticatory function.

Keywords: Full mouth rehabilitation; Amelogenesis Imperfecta .heriditary enamel defects

[1]. Niloufar Khodaeian,1 Mahmoud Sabouhi,2 and Ebrahim Ataei An Interdisciplinary Approach for Rehabilitating a Patient with Amelogenesis Imperfecta: A Case Report Case Reports in Dentistry Volume 2012 (2012), Article ID 432108, 8 pages doi:10.1155/2012/432108
[2]. Weinmann JP, Svoboda JF, Woods RW. Hereditary disturbances of enamel formation and calcification. J Am Dent Assoc 1945;32:397-418.
[3]. Aldred MJ, Savarirayan R, Crawford PJM. Amelogenesis imperfecta: a classification and catalogue for the 21st century. Oral Diseases 2003;9:19-23.
[4]. Neville BW, Damm DD, Allen CM, Bouquot JE. Oral and maxillofacial pathology. 2nd ed. Philadelphia: Elsevier; 2002. p. 89-94. [5]. W. K. Seow, "Clinical diagnosis and management strategies of amelogenesis imperfectavariants,"Pediatric Dentistry, vol. 15, no. 6, pp. 384–393, 1993.
[6]. Coffield KD, Phillips C, Brady M, Roberts MW, Strauss RP, Wright JT.The psychosocial impact of developmental dental defects in peoplewith hereditary amelogenesis imperfecta. J Am Dent Assoc 2005;136:620-30.

Abstract: Objective: To determine the gestational age at first antenatal booking at the federal medical centre, Yenagoa. Materials and methods: This was a prospective cross sectional observational study carried out at the booking clinic of the Federal Medical Centre, Yenagoa with structured close-ended questionnaire. Information sought included gestational age at booking, factors that encourage early and late booking, awareness and knowledge on the importance of antenatal care by respondents. Results: The mean gestational age at booking for antenatal care was 20.86 ± 6.39 weeks. Thirty seven (15.4%) booked for antenatal care in the first trimester, 190 (70.5%) of respondents in the second trimester while 52 (21.9%) registered for care in the third trimester..

[1]. Adekunle DA, Isawumi AI. Late Antenatal Care Bookings and its predictors Among Pregnant Women in South-West Nigeria. Online J Health Scs. Available at http://www.ojhas.org/issue25/2008-1-4,htm
[2]. Omigbodun AO. Preconception and antenatal care. In: Kwawukume EY, Emuveyan EE,editors. Comprehensive Obstetrics in the Tropics. Accra: Asante and Hittscher. 2002. PP 7-14.
[3]. Ekwempu CC. The influence of antenatal care on pregnancy outcome. Tropical Journal of Obstetrics and Gynaecology. 1998; 1: 67-71.
[4]. Yousif E.M, Abdul Hafeez, A.R. The effect of antenatal care in the probability of neonatal survival at birth. Wad Madeni Teaching Hospital, Sudan. Sudanese Journal of Public Health, 2006; 1(4): 293-297.

Abstract: A rare development anomaly, characterized by under development of lower respiratory tract resulting in fibrosis and malfunctioning of lung. Thoracic congenital malformations may go unnoticed until adulthood. The developmental anomalies of lung at the 4th and 24th weeks may cause Broncho Pulmonary Foregut abnormalities. Congenital anomalies are increasingly diagnosed in the adulthood, as they mimic other thoracic pathologies or asymptomatic in the childhood. This article presents a case of primary pulmonary hypoplasia which masqueraded as cystic bronchiectasis, hence misdiagnosed for several years..

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Abstract: 50 Patients Attending Ghccd With Complaints Of Cough,Haemoptysis ,Chest Pain And Shortness Of Breath With Chest Xray Suggestive Of Mass Lesion Were Taken. Cect Chest Was Done.Depending Upon The Chest Lesion, Ct Guided/Transthoracic Or Bronchoscopic Guided Fnac/Biocpsy Done And Specimen Sent For Cytohistopathological Examination.The Results Were Analysed.Male Patients Aged 41-60yrs Were More When Compared To Female Patients. Common Histopathological Patterns Are Adeno Carcinoma And Squamous Cell Carcinoma. Smoking Was A Major Risk Factor.

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Abstract: Objectives:(1) To assess the incidence of bacteremia in patients with chronic tonsillitis who underwenttonsillectomy by dissection method. (2) To identify the aerobic organisms involved in bacteremia during tonsillectomy and their antibiotic sensitivity. Materials And Methods: This descriptive study was conducted on patients who presented to the ENT OPD in YENEPOYA MEDICAL COLLEGE HOSPITAL over a period from October 2013 to October 2014. 42 patients who underwent elective tonsillectomy by dissection method, for chronic tonsillitis were selected.During tonsillectomy, within 2 minutes of removal of the first tonsil,blood samples were taken from the peripheral veins in accordance with the techniques of sterile bloodcollection.Samples were subcultured on suitable media under aerobic conditions for 24hrs, 72hrs and 5 days.

[1]. Brodsky L, and Koch RJ, Bacteriology and immunology of normal and diseased adenoids in children,Archives of Otolaryngology–Head & Neck Surgery, 119(8), 1993, 821-829.
[2]. Okur E, Aral M, Yildirim İ, Kılıç MA and ÇiragilP,Bacteremia during adenoidectomy,International journal of pediatric otorhinolaryngology, 66(2), 2002, 149-153.
[3]. Wells CL, Maddaus MA and Simmons RL, Proposed mechanisms for the translocation of intestinal bacteria, Review of Infectious Diseases, 10(5), 1988, 958-979.
[4]. Mikelsaar M and Türi E, Effect of antibacterial drugs and dental surgery on the translocation of digestive tract microflora, Microecology and Therapy, (20), 1990, 93-97.
[5]. Francois M, Bingen EH, Lambert-Zechovsky NY, Mariani-Kurkdjian P, Nottet J-B and Narcy P, Bacteremia during tonsillectomy,Archives of Otolaryngology–Head & Neck Surgery, 118(11), 1992, 1229-1231.
[6]. Gaffney R, Walsh M, McShane D andCafferkey M, Post-tonsillectomy bacteraemia,Clinical Otolaryngology & Allied Sciences,17(3), 1992, 208-210.

Abstract: Background: Supracondylar fractures are one of the commonest fractures encountered in high velocity trauma which are associated with high morbidity and mortality.Isolated fracture can itself lead to complications such as ARDS and pulmonary embolism.this necessitates early stabilization of fractures.Internal fixation is the choice of treatment in supracondylar fractures(AO type – A).Retrograde supracondylar nail has shown to give one of the best results in terms of recovery,fracture union, return to work and the functional outcome.

Methods: 20 patients with supracondylar fracture femur were studied (AO type-A).Supracondylar fractures femur were treated by closed reduction and internal fixation by Retrograde supracondylar nail inserted through inter-condylar notch between July 2012 to September 2014 at our institution.The patients were evaluated clinically and radiologically for outcomes.All patients were followed up for an average of 12 months.Outcome was assessed using NEER'S SCORE.

[1]. Wilson JN. Watson Jone's Fractures and Joint injuries. 6th ed, pg. 1003-1070 (1982).
[2]. Charnely John. The closed treatment of common fractures. 3rd ed, pg 197-204.
[3]. Hugh Owen Thomas. Quoted by Rockwood CA, Green DP. Fractures in adult, 4th ed, Vol. II, pg. (1972-1993) (1996).
[4]. Fritz Steinmann. Quoted by Rockwood CA, Green DP. Fractures in adult, 4th ed, Vol. II, pg. (1972-1993) (1996).
[5]. Mahorner and Bradburn. Quoted by Stewart MJ, Sisk TD, Wallace SL Fractures of distal third of femur – A compression method of treatment. JBJS, 48-A, pg. 784-807 (June 1966).
[6]. Weil Kuenher, Henry. Quoted by Stewart MJ, Sisk TD, Wallace SL. Fractures of distal third of femur – A compression method of treatment. JBJS, 48-A, pg. 784-807 (June 1966).
[7]. Tees. Quoted by Stewart MJ, Sisk TD, Wallace SL. Fractures of distal third of femur – A compression method of treatment. JBJS, 48-A, pg. 784-807 (June 1966).

Abstract: Dorsal dislocation of the interphalangeal joint of great toe is rare.Most reported cases are of dislocation of metatarsophalangeal joint of great toe due to greater mobility and longer lever arm.Dorsal dislocation of IP joint of hallux results from hyperextension injury.Closed reduction is the first line of treatment and the standard treatment of Open reduction is used when closed reduction is failed .We report a case of Miki type 2 dislocation and review the literature pertaining to this condition.

[1]. Miki T,Yamamuro T, kitai T.An irreducible dislocation of the great toe.Report of two cases and review of the literature.Clin Orthop Reat Res.1988;230:200-6.
[2]. Eibel P.Dislocation of the interphalangeal joint of the big toe with interposition of a sesamoid bone.J Bone Joint Surg Am .1954;36;880-2.
[3]. LeungHB ,Wong WC.Irreducible dislocation of the hallucal Interphalangeal joint.Hong Kong Med J.2002;8:295-9
[4]. Colin Yi-Loong Woon,Dislocation of the Interphalangeal joint of the Great toe:Is percutaneous reduction of an incarcerated sesamoid an option .JBJS Am.2010;92:1257-60
[5]. SJ Ward,Ray P Sheridan ,I G Kendall.Sesamoid bone interposition complicating reduction of a hallux joint dislocation.J Accid Emerg Med1996;13:297-298
[6]. Dave D,Jayaraj VP,James SE.Intra-articular sesamoid dislocation of the interphalangeal joint of the great toe.Injury 1993;24:198-9
[7]. Campbells Operative Orthopaedics 12th ed.

Abstract: Bone loss following open fracture or infected gap nonunion is a difficult situation to manage. There are many modes of treatment such as bone grafting, vascularized bone grafting and bone transport by illizarov and monolateral fixator. We evaluated the outcome of rail fixator treatment in reconstructing bone and limb function. We felt that due to problems such as heavy apparatus, persistent pain, deformity of joints and discomfort caused by an Ilizarov ring fixator, rail fixator is a good alternative to treat bone gaps.

[1]. TOLÓN-BECERRA A, LASTRA-BRAVO X, FLORES-PARRA I. NATIONAL AND REGIONAL ANALYSIS OF ROAD ACCIDENTS IN SPAIN. TRAFFIC INJ PREV 2013;14:486-95.
[2]. Wani N, Baba A, Kangoo K, Mir M. Role of early Ilizarov ring fixator in the definitive management of type II, IIIA and IIIB open tibial shaft fractures. Int Orthop 2011;35:915-23.
[3]. Dinh P, Hutchinson BK, Zalavras C, Stevanovic MV. Reconstruction of osteomyelitis defects. Semin Plast Surg 2009;23:108-18.
[4]. Ashman O, Phillips AM. Treatment of non-unions with bone defects: Which option and why? Injury 2013;44 Suppl 1:S43-5.
[5]. Pemberton C, Swanepoel S. Ilizarov fixation. Br J Theatre Nurs 1993;3:4-5.
[6]. Catagni MA, Guerreschi F, Holman JA, Cattaneo R. Distraction osteogenesis in the treatment of stiff hypertrophic nonunions using the Ilizarov apparatus. Clin Orthop Relat Res 1994;301:159-63.
[7]. Saleh M, Royston S. Management of nonunion of fractures by distraction with correction of angulation and shortening. J Bone Joint Surg Br 1996;78:105-9.

Abstract: Fractures of shaft of femur are among the most common fractures encountered in orthopaedic practice. The femur is the largest and strongest bone in the body articulating with hip joint proximally forming knee joint with tibia at its distal end. As industrialization and urbanization are progressing year to year with rapid increase in traffic, incidence of high energy trauma increasing with same speed. Femoral shaft fractures result from high energy trauma, commonly road traffic accidents, gunshot injuries, fall from height.

[1]. Robert A, Hansen .T. segmental fracture s of shaft of femur treated by closed intramedullary nailing. T.JBJS Vol 60A 934-939. Oct 1978.
[2]. Funk.J, wells .R et al supplementary fixation femoral fractures. Clin.ortho. 60; 4-49.1978.
[3]. Thorensen B O Acho A;Ekeland A.Stanroe K Follersch.Haulko A 1985 IL IM nailing in femoral shaft fractures -a report of 48 cases JBJS 67A(9)1313-1320
[4]. Wiss.D.A,Chrlstopher H.Fleming.Joel M.Matta, And Couglas Clark,Comminuted and Rotationally Unstable Fractures of the Femur treated with an Interlocking nai!1986,212; 35-47.
[5]. Thorensen BO- Intramedullary nailing of femoral fractures - report of 48 cases 67 A 1313-1320,1985.

Abstract: Cigarette smoking is a risk factor for cardio vascular events. This detrimental effect is not only limited to active smoking but also to passive smoking s which causes vascular endothelial dysfunction, which is an early key event of impaired arterial dilatation, atherogenesis and thrombus formation, which leads to serious cardiovascular complications. Nitric oxide is an index of endothelial dysfunction, because it is synthesized by endothelial cells from L-arginine by endogenous system nitric oxide synthase(NOS). So it is otherwise known as endothelium derived relaxing factor(EDRF). NO regulates resting vascular tone, local blood flow and tissue perfusion.

[1]. celermajerr DS,Adams MR, Clarkson P et al.passive smoking and impaired endothelial dependent arterial dilatation in healthy young adults. N Engl J Med1996 334: 150-154.
[2]. Ross R. The pathogenesis of atherosclerosis:an update. N Engl J Med 1986;314;488-500.
[3]. Ross R. The pathogenesis of atherosclerosis: a perspective for the 1990s.Nature 1993;362:801-809.
[4]. Heitzer T Yla- Herttuala S, Luoma J etal. Cigarette smoking potentiates endothelial dysfunction of forearm resistance vessels in patients with hyper cholesterolemia, Role of oxidized LDL. Circulation 1996;93:1346-53.
[5]. DM Vasudevan Text book of Biochemistry. 7th Edition, pages (223-34).

Abstract: The identification of parathyroid gland tissue and its distinction from surrounding structures such as thyroidgland, lymphoid, fibroadipose, and, rarely, thymic tissues on frozen section (FS) may be challenging owingto freezing artifact and small biopsy sent for FS. Intraoperative cytology (IC) provides valuable complementary morphologic details. We evaluated a case by IC alone, followed by interpretation with FS to reach a final interpretation using IC and FS together. IC is a valuable adjunct to FS during intraoperative consultation for evaluation of tissue in a parathyroid location. We present a rare case of parathyroid adenoma which was evaluated by relatively faster procedure of squash cytology first and then confirmed on FS for effective diagnosis. The present study infers that a combined approach of IC and FS is preferable to using FS or IC alone.

Keywords: Parathyroid adenoma, Intraoperative Squash Cytology (IC) and Frozen Sections (FS).

[1]. Silverberg SG. Intraoperative cytology: promise, practice and problems. Diagn Cytopathol. 1995;13:386-7.

[2]. Shidham VB, Gupta D, Galindo L, et al. Intraoperative scrape cytology: comparison with frozen section using

[3]. probabilistic statistical method. Diagn Cytopathol.2000;23:134-9.

[4]. Shidham VB, Dravid NV, Grover S, et al. Role of scrape cytology in rapid intraoperative diagnosis: value and

[5]. limitations. Acta Cytol. 1984;28:477-82.

[6]. Wilkerson JA, Bonnin JM. History of intra-operative cytology. In: Wilkerson JA, Bonnin JM, eds. Intra-operative Cytology: An Adjunct of Frozen Sections. New York, NY: Igaku-Shoin;1987:1-8.

Abstract: MRSA is an important hospital pathogen the incidence of which is increasing every year specially in high risk groups. The present study was performed in patients admitted to a the tertiary care hospital in Maharashtra, India. The proportion of MRSA isolates among Staphylococcus aureus was 28.37% Iisolation rate of MRSA was found highest in IRCU/ICCU (78.57%), MICU (70.97%)

Keywords – Methicillin resistant Staphylococcus aureus (MRSA), Methicillin sensitive Staphylococcus aureus (MSSA ), cefoxitin.

[1]. Klutmans J,Belkum AV,Verburg H. Nasal carriage of S.aureus: Epidemiology, Underlying mechanisms and associated risk.Clin Microbiol Rev. 1997;vol 505-520
[2]. S. Vidhani, PL Mendiratta,MD Mathur. Study of methicillin resistant S.aureus (MRSA) isolates from high risk patients.IJMM.2001;19 (2):13-16
[3]. Baird D. Staphylococcus Micrococcus:Cluster forming Gram positive cocci In: Collee JG, Fraser AG, Marmion BP, Simmons A, editors. Mackie and McCartney Practical Medical Microbiology, 14th edition. Edinburg; Churchill Livingstone; 2008: 245-262.
[4]. Performance & standards for Antimicrobial susceptibility testing Twentieth informational supplement. Clinical and laboratory standards institute. 2010; 30 (1). Table 2 C,Staphylococcus spp M02 & M07.60-69.
[5]. Hussain S, Shams R, Ahmad K, Perveen R, Riaz B. Prevalence of Methicillin Resistant Staphylococcus Aureus (MRSA) in Surgical Site Infections in aTertiary Care Hospital. International Journal of Pathology. 2005; 3(2): 81-85
[6]. Narezkina A , Edelstein I , Dekhnich A , Stratchounski L, Pimkin M, Palagin I .Prevalence of methicillin-resistant Staphylococcus aureus in different regions of Russia: results of multicenter study. Poster # P481.In:12th European Congress of Clinical Microbiology and Infectious Diseases24–27 April, Italy, Milan.

Abstract: Radiation protection is the science and art of protecting people and the environment from the harmful effects of ionizing radiation. Ionizing radiation in medical imaging is one of the powerful diagnostic tools, and accurate knowledge of radiation protection will affect the radiographers safety behaviors during practice. This is a preliminary descriptive study aimed to evaluate radiographers knowledge and performance towards radiation protection during hospital practice in three hospitals in Taif city ,Saudi Arabia.Total of 75 radiographers who work in various hospitals were participated in this study and data was collected through well structured pretested self administered questionnaire by one of this paper authors , during the period from Sep to Nov 2014. Regard to the situation in Taif city, there is no similar study done on this issue so far to the best of our knowledge. In this study there were (69.3%) male and (30.7%) female. Diploma holders were (54.7%), bachelor degree (44%) and PhD holders were only (1.3%). Majority of the participants (98.7%) were know that doors and walls consists from lead and they were periodically used to check their exposed radiation dose from their Thermal Luminance Dosimeters (TLDs), while (72%) using lead apron while taking radiographs.

Keywords: Knowledge , Performance , Practice , Ionizing , Radiation , Protection.

[1]. Johnston J, Killion JB, Veale B, Comello R. U.S. technologists' radiation exposure perceptions and practices. Radiol Technol. 2011; 82: 311-20. [2]. The International Commission on Radiological Protection; Annuals of the ICRP 2011. Draft report on radiological protection in fluoroscopically guided procedures performed outside the imaging department. Available from http: //www. icrp. org/ docs /Radiological protection in fluoroscopically guided procedures performed outside the imaging department, pdf.
[3]. Gower-Thomas K, Lewis MH, Shiralkar S, Snow M, Galland RB, Rennie A. Doctor's knowledge of radiation exposures is deficient. Br Med J 2002;324:919.
[4]. European Commission. Radiation protection 116. Guidelines on education and training in radiation protection for medical exposures. Luxembourg: European Commission. Directorate-General for the Environment , 2000. Available at: http://ec.europa.eu/energy /nuclear/ radiation_ protection/doc/publication/116.pdf. Accessed August 16, 2009.

Abstract:A case report of 60 yrs old male presented with fever, neck stiffness and vomiting. CSF was sent for bacteriological examination. Motile gram negative bacilli with yellow pigmented colonies on blood agar were further subjected for biochemical reaction and Antibiotic suspeceptibility testing. It was suspected to be Enterobacter species and yellow pigmented colonies on blood agar raised doubt of Enterobacter sakazakii. The isolated was sent to BJMC Pune where it was confirmed to be Cronobacter sakazakii (previously known as Enterobacter sakazakii) by Phoenix 100 ID/AST system(Becton Dickinson Co.,Sparks,MD).
Keywords: Cronobacter sakazakii, Enterobacter sakazakii, Pott"s spine, Yellow colonies.

[1]. Biering, G., Karlsson, S., Clark, N.C., Jonsdottir, K.E., Ludvigsson, P., and Steingrimsson, O. 1989. Three cases of neonatal meningitis caused by Enterobacter sakazakii in powdered milk. J Clin Microbiol. 27(9):2054-6.
[2]. Nazarowec-White & Farber et al, 1997a;. Enterobacter sakazakii: a
review. International Journal of Food Microbiology, 37: 103-113.
[3]. BUCHANAN, J.G. (co-ed) & GIBBONS, N.E. (co-ed). 1974. Bergey's Manual of Determinative Bacteriology 8th edition. Baltimore, Md.: Waverly press in Farmer et al 1980.
[4]. Winn WC, Allen SD, Janda WM, Koneman EW, Precop GW, Schreckenberger PC. Koneman's color atlas and textbook of diagnostic microbiology. Chap. 7. 6th ed. New York: Lippincott; 2006. p. 303-91.
[5]. Food and Agriculture Organization. 1994 Codex Alimentarius: code of hygienic practice for foods for infants and children. CAC/RCP 21-1979. Food and Agriculture Organization of the United Nations, Rome, Italy.
[6]. Friedemann, M. "Enterobacter sakazakii in food and beverages ( other than infant formula and milk powder)". International Journal of Food Microbiology. 2007. Volume 116 (1). p. 1-10.

Abstract: With time the treatment modalities have evolved from a non conservative approach to an era of conservation and preservation of tooth structure for its better function and retention in the arch for a longer duration as a functionally active unit. Patients also desire to conserve teeth which are deemed to have a questionable prognosis. Teeth having severe bone loss involving the furcation area and poorperiodontal conditions can be retained in the oral environment by the various alternative procedures for their management. The present article will deal with the already established treatment procedures like bicuspidization which involves the splitting of the multirooted tooth along with the crown which serves as single unit into the separated double unit. The second modality is root resection which involves the complete removal of only the root portion of amultirooted tooth.

Keywords: Bicuspidization, Bisection, Root resection, Root separation,Radisection,Radisectomy,Furcation involvement.

[1]. Vandersall DC, Detamore RJ. The mandibular molar Class III furcation invasion. A review of treatment options. J Am Dent 2002; 133: 55-60.
[2]. Tarnow D, Fletcher P. Classification of the vertical component of furcation involvement. J Periodontol 1984; 55:283-84.
[3]. Frankln S. Weine.Text book of Endodontology.Sixth edition.
[4]. ParmarG,Vashi P. Hemisection: A case report and review.Endodontol 2003; 15:26-9.
[5]. A m e r i c a n A c a d e m y o f Periodontology. Glossary of Periodontal Terms. Chicago: A m e r i c a n A c a d e m y o f Periodontology; 2001:45.
[6]. Farrar JM. Radical and heroic treatment of alveolar abscess by amputation of roots of teeth. Dental Cosmos 1884;26:79.

Abstract:Impalement injury of the rectum with bladder perforation has been rarely reported. A high index of clinical suspicion is required to make the diagnosis of bladder perforation while assessing patients presenting with rectal impalement. Despite delay our case was successfully treated by staged surgery. Introduction:Impalement injury is a specific type of trauma defined as a penetrating wound caused by an object with a blunt tip and is mostly related to falls, sexual activity and slipping with a strong external force. Combined rectal and bladder injuries after impalement remain a rare condition because of deep bladder position within the bony pelvis.Here in we present a case of successfully treated impalement recto-vesical injury.
(Keywords: Bladder Perforation, Laparatomy, rectal impalement)

[1]. Jona JZ. Accidental anorectal impalement in children. PediatrEmerg Care. 1997;13:40-3 (PubMed:9061736).
[2]. Mammadov E, Altan A, Mehmet E and SinanC .Self induced penetrating rectal perforation byforeign body: an unusual event in childhood. Ann PediatricSurg 2011,7:25-26.
[3]. Bailey & Love's: Short Practice of surgery 25th edition, edited by Norman S Williams, Christopher JK Bulstrode& P. Ronan O' Connell. 2008 Edward Arnold (Publishers) Ltd. London. Part 11. Abdominal chapter 68- the rectum. Page 1222.
[4]. Benielloun EB, YounessAhalal, Khalid Khatala et al. Rectal impalement with bladder perforation: A review from a single institution.Urol Ann, 2013 Oct-Dec; 5(4):249-254.
[5]. Afshar MA, Mangele F and Nakheai A. A rare case of Anorectal injury with ruptured bladder and rectum but normal anal sphincter. J clin case Rep 2012, 2:14-1000204.

Abstract: Glaucoma is the second leading cause of world blindness. It has multifactorial causation and hypertension is one of the risk factors for primary open angle glaucoma(POAG).A hospital based cross sectional study was carried out to study the occurrence of POAG in systemic hypertensive patients. A total of 400 patients with systemic hypertension between 40-70 years of age attending Department of Ophthalmology, Assam Medical College and Hospital or referred here for evaluation were screened for POAG and complete ocular and clinical examination were performed. The significance of study parameters between two or more groups was determined by Chi square test and Correlation Coefficient analysis done to find out relation between intraocular pressure(IOP) and blood pressure level. In this study 3.75% of POAG cases were present in the systemic hypertensive population (as compared to 2.56% in normal population) and IOP was found to be significantly correlated with blood pressure levels .Among the cases diagnosed as POAG, 4.05% were males and 3.27% were females. Hence, patients of systemic hypertension should be screened for POAG and monitoring of IOP and blood pressure levels to be done at regular intervals.

Keywords: Blood pressure, primary open angle glaucoma, intraocular pressure, hypertension .

[1]. Tsatsos M and Broadway D. Controversies in the history of glaucoma: is it all a load of all Greek. Br J Ophthalmol. Nov 2007; 91(11): 1561–1562.
[2]. Ray K. and Mookherjee S. 2009 Molecular complexity of primary open angle glaucoma: current concepts J. Genet. 88, 451–467.
[3]. Weinreb RN, khaw PT, primary open angle glaucoma ,Lancet , 2004;363: 1711-20
[4]. Jayachandra Das, Sharad Bhomaj, Zia Chowdary; Profile of Glaucoma in major eye hospitals in north India. Indian journal of Opthal; 2001; 49: 25-30.
[5]. Leske et al: Risk Factors for Incident Open-angle Glaucoma: The Barbados Eye Studies. Ophthalmology 2008;115:85–93
[6]. F.Memarzadeh, M Ying Lai, J Chung, SP Azem, R. Varma. Blood pressure, perfusion pressure and open angle glaucoma: The Los Angeles Latino Eye Study, Invest Ophthalmol Vis Sci June 2010, Vol.51, No.6, p.2872-2877.

Abstract: Background: Staphylococcus aureus is associated with different infections ranging from skin and soft tissue infections to endocarditis and fatal pneumonia. S. aureus is still the most common bacterial species isolated from inpatient specimens and the second most common from outpatient specimens. The aims of this project were out to estimate the prevalence of vancomycin resistant Staphylococcus aureus(VRSA) and also to determine which genes are responsible for VRSA phenomenon. Methods: A total of 123 methicillin resistant S. aureus (MRSA) were isolated from 200 clinical samples. The VRSA were tested using the Kirby-Bauer disc diffusion method.

[1]. A.Van Belkum and H. Verbrugh, 40 years of methicillin-resistant Staphylococcus aureus. MRSA is here to stay - but it can be controlled. BMJ. 323, 2001, 644–5.
[2]. Deresinski S (2005). Methicillin-resistant Staphylococcus aureus: an evolution, epidemiologic and therapeutic Odyssey. Clin Infect Dis. 40:562–73.
[3]. Maranan MC, Moreira B, Boyle-Vavra S and Daum RS (1997). Antimicrobial resistance in Staphylococci. Epidemiology, molecular mechanisms, and clinical relevance. Infect Dis Clin North Am. 11:813–49.
[4]. Wootton M, Howe RA, Hillman R, Walsh TR, Bennett PM and Mac-Gowan AP (2001). A modified population analysis (PAP) method to detect hetero-resistance to vancomycin in Staphylococcus aureus in a UK hospital. J AntimicrobChemother. 47:399–403.
[5]. Cui L, Iwamoto A, Lian JQ, Neoh HM, Maruyama T, Horikawa Y, et al (2006). Novel mechanism of antibiotic resistance originating in vancomycin intermediate Staphylococcus aureus. Antimicrob Agents Chemother. 50:428–38.

Abstract: Congenitally missing lateral incisors create an esthetic problem with specific orthodontic and prosthetic considerations. Selecting the appropriate treatment option depends on many factors, such us the malocclusion, the anterior relationship, specific space requirements, bone volume, root proximity, the condition of the adjacent teeth, and esthetic prediction mainly when the canine must be reshaped. The aim of this paper is to address specific criteria for treatment options when replacing the agenesic lateral with either a single tooth implant or with tooth supported restorations, and to highlight the importance of interdisciplinary treatment planning to achieve optimal esthetics and long-term predictability. There are several treatment options for this anomaly: orthodontic space closure or orthodontic space opening followed by tooth supported restoration, or single tooth implant. The space opening has been performed in two cases in order to replace the missing lateral by an implant supported crown. This treatment option could be managed in the first case and declined in the second one where the bone volume was insufficient, and bone graft was rejected. Clinical conditions were in favour of a mini invasive treatment option where the resin bonded bridge was performed. When, the canine is mesially positioned and needs to be reshaped, associated with several edentulous spaces and deep occlusion, full coverage fixed restorations is a suitable option. A variety of prosthetic approaches is available from the least conservative to the non-invasive one.

Keywords: Agenesis, implant supported prosthesis, fixed partial denture.

[1]. Kavadia S, Papadiochou S, Papadiochos I, Zafiriadis L. Agenesis of maxillary lateral incisors: a global overview of the clinical problem. Orthodontics: the art and practice of dentofacial enhancement. 2010;12:296-317.
[2]. Pinho T, Lemos C. Dental repercussions of maxillary lateral incisor agenesis. The European Journal of Orthodontics. 2011:cjr084.
[3]. Closs L, Reston E, Tessarollo F, Freitas M, Broliato G. Multidisciplinary approach in the rehabilitation of missing lateral incisors: a new trend in daily practice. Operative dentistry. 2012;37:458-63.
[4]. de Avila ÉD, de Molon RS, de Assis Mollo Junior F, de Barros LAB, Capelozza Filho L, de Almeida Cardoso M et al. Multidisciplinary approach for the aesthetic treatment of maxillary lateral incisors agenesis: thinking about implants? Oral surgery, oral medicine, oral pathology and oral radiology. 2012;114:e22-e8.
[5]. Kinzer GA, Kokich VO, Jr. Managing congenitally missing lateral incisors. Part II: tooth-supported restorations. Journal of esthetic and restorative dentistry : official publication of the American Academy of Esthetic Dentistry [et al]. 2005;17:76-84.

Abstract: Case Report: We describe a rare case of a 27 year old man with a 7 days history of inability to actively flex his right elbow joint and loss of sensation over lateral surface of right forearm following a wrestling match .Clinical, radiological and nerve conduction studies showed it to be an isolated musculocutaneous nerve injury. The patient responded to conservative measures. An extensive search of the literature indicated the rarity of this type of injury. Conclusion : Isolated musculocutaneous nerve injury is very rare. Available literature does not reveal any case following wrestling.

Keywords - musculocutaneous nerve injury, nerve conduction studies, wrestling.

[1]. Dundore DE, DeLisa JA. Musculocutaneous nerve palsy: an isolated complication of surgery. Arch Phys Med Rehabil1979;60:130e3
[2]. Bach BR, O'Brien SJ, Warren RF, Leighton M. An unusual neurologic complication of the Bristow procedure. J Bone Joint Surg Am 1988 Mar;70(3):458e60..
[3]. Bateman JE. Nerve injuries about the shoulder in sports. J Bone Joint Surg Am. 1967;49:785-792.
[4]. Mendoza FX, Main WK, Main K. Peripheral nerve injuries of the shoulder in the athlete. Clin Sports Med 1990;9:331-342.
[5]. Kim SM, Goodrich JA. Isolated proximal musculocutaneous nerve palsy : case report. Arch Phys Med RehabiL 1984;65:735
[6]. Visser CP, Coene LN , Brand R, Tavy DL. The incidence of nerve injury in anterior dislocation shoulder and its influence on functional recovery. A prospective clinical and EMG study. J Bone Joint Surg 1999;81-B:679-85

Abstract: Increase in the prevalence of maternal obesity, anaesthetic implications in obese mothers for LSCS : a prospective study . Background and Objectives: the objective of the data gathering was to identify parturients with BMI>30kg/m2 undergoing caesarean sections, study the technical difficulties and anaesthetic complications, maternal and foetal outcome. Method: This is a prospective study of data of parturients with BMI>30 posted for operative delivery between June 2012 and June 2013 ; variables investigated included : age, weight, height, BMI, physical status[ASA], anaesthetic techniques , technical difficulties, hemodynamic complications and anaesthetic complications. Results: Two hundred and sixty two anaesthetic forms were evaluated. Mean age was 27.4 years, mean BMI 38.7 and majority of patients was classified ASA II[79%].

[1]. Regional Anesthesia for Cesarean Section in Obese Pregnant Women: A Retrospective Study Flávia Romano Rodrigues et al,Revista Brasileira de Anestesiologia 13 Vol. 61, No 1, January-February, 2011
[2]. Cesarean Section in Morbidly Obese Parturients: Practical Implications and Complications N Am J Med Sci. 2012 January; 4(1): 13–18.
[3]. Obesity and obstetric anaesthesia. Saravanakumar et al Anaesthesia 2006 Jan;61(1):36-48
[4]. Obesity in pregnancy. Davies GA et al. J Obstet Gynaecol Can 2010 Feb;32(2):165-73.
[5]. Obstetric anaesthesia outcome in obese and non-obese parturients undergoing caesarean delivery: an observational study International Journal of Obstetric Anesthesia Volume 18, Issue 3 , Pages 221-225, July 2009
[6]. Anästhesie zur Sectio caesarea bei Adipositas Der Anesthesist September 2003, Volume 52, Issue 9 pp 787-794

Abstract: Congenital Diaphragmatic Hernias (CDH) is a rare entity with incidence of 1:3000 live births. Late presentation is unusual and in most cases is diagnosed in adolescents or early childhood. Asymptomatic diaphragmatic hernia in the absence of trauma is very rare in adults. The finding of CDH in adults is mostly incidental. Left sided hernia i.e. Bochdelak hernia is more common. It is more commonly associated with other anomalies. The morbidity and mortality are mainly due to pulmonary hypoplasia. We report a case of CDH, posterolateral defect (Bochdelak type), with left lung hypoplasia in a middle aged man, who was asymptomatic throughout the life and presented to us incidentally when he was referred following an Orthopaedic trauma.We discuss the index case and other causes of diaphragmatic hernia.

Keywords: Congenital diaphragmatic hernia, Bochdalek hernia, diaphragm.

[1]. Gedik E, Tuncer MC, Onat S, AvcI A, TacyIldIz I, Bac B. A review of Morgagni and Bochdalek hernias in adults. Folia Morphol 2011;70(1):5–12. (Internet) [Last accessed on 13 January 2015].Available from http://www. czasopisma.viamedica.pl/fm/article/download/19322/15215
[2]. Anantharamakrishnan R, Senthil KK, Karunanithi R. Congenital Diaphragmatic Hernia (Bochdalek Hernia) in an Adult. Chettinad Health City Medical Journal. (Internet) [Last accessed on 14 January 2015]. Available from www.chcmj.ac.in/journal/pdf/vol1_no2/congenitaldiaphragmatic.pdf
[3]. Giannoulis K, Sutton R. Bochdalek hernia presenting in adult life:report of an unusual case and review of the literature. ANNALS OF GASTROENTEROLOGY 2004;17(1):109-12. (Internet) [Last accessed on January 2015]. Available from www.annalsgastro.gr/index.php/annalsgastro/article/download/275/243
[4]. Horton DB, Lieberman G. An Unusual Presentation of Diaphragmatic Hernia. (Internet) [Last accessed on January 2015]. Available from eradiology.bidmc.harvard.edu/LearningLab/gastro/Horton.pdf