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

Abstract: A 20year old male patient presented with complaints of shortness of breath with exacerbations on exertion and was admitted in our hospital. He had a past history of organophosphorus poisoning for which he was mechanically ventilated through tracheostomy tube. He is now diagnosed with retrosternal tracheal stenosis and posted for tracheal reconstruction.
Keywords: Shortness of breath ,Tracheostomy ,Tracheal stenosis , Tracheal reconstruction.

[1]. Anesthesia for tracheal stenosis and reconstruction,anesthesiology clinic 2012 ,december ,30(4)709-30
[2]. Abdulkader MM, Mohammad RM, Mohammed KS, Murugan L. Anesthetic Management of a Patient with Severe Post-tracheostomy Stenosis. Oman Med J 2013 Jan; 28(1)

Abstract: Adult onset still diseases (AOSD) is an uncommon clinical entity that predominantly effects young adults. Usually present as fever of unknown origin. It is a multi systemic inflammatory disorder of unknown etiology characterized by spiking fever, skin rash, arthralgia/arthritis and myalgia.

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Abstract: Background: Sentinel lymph node biopsy in early breast cancer performed by intraparenchymal or intradermal injection of blue dye and/or radioactive colloid remains a highly acceptable method of identifying sentinel nodes largely because of its success rate. Aim: 1. To assess the efficacy of sentinel lymph node biopsy in detecting axillary metastases in cases of node negative early breast cancer. Material and Method: The study material consisted of 109 women with early breast cancer in stage T1/T2N0M0 who underwent modified radical mastectomy along with sentinel lymph node biopsy after subareolar injection of methylene blue dye at Dept. of General Surgery, SVRR Govt. General Hospital, Tirupati (AP). Results: This study showed that this simplified technique of identifying the sentinel nodes has sufficiently high identification rate.
Keywords: Axillary lymph node dissection (ALND), Breast Cancer, Methylene Blue, Sentinel lymph node (SLN), Sentinel lymph node biopsy (SLNB), Subareolar injection.

[1]. Louwman WJ et al, the rising trends of incidence and prognosis for breast cancer patients, 1975 – 2004: a long-term population-based study in southeastern Netherlands. Cancer Causes Control 2008; 19:97-106.
[2]. Schijven M, Rutten H, Roumen R. Implementation of the sentinel node biopsy: a survey among surgeons in the Netherlands. Eur J Surg Oncol 2000; 26:431-432.
[3]. McMasters K, Tuttle T, Carlson D, Brown CM et al. Sentinel lymph node biopsy for breast cancer: A suitable alternative to routine axillary lymph node dissection in multi institutional practice when optimal technique is used. J Clin oncol, 2000, 18:2560-2566.
[4]. Yu JC et al. Sentinel lymph node biopsy in early breast cancer in Taiwan. World J Surg, 2002, 26:1365-1369.

Abstract: Management of traumatic injuries often requires multidisciplinary approach, varying from simple restorations to extensive rehabilitation of multiple missing teeth and oral structures. Fractured teeth can be restored to function with the help of dowels and crowns, whereas avulsed and missing teeth are replaced by fixed dental prosthesis or removable partial denture. Implants are good adjuvant in rehabilitation of missing teeth. This case report describes a multidisciplinary management to restore the esthetics and functions following a dental trauma. A 24 year old male reported with missing /avulsed maxillary and mandibular incisors, fractured canines and premolars. The maxillary arch was rehabilitated with implant supported fixed dental prosthesis and the mandibular arch with cast post and core and porcelain fused to metal fixed dental prosthesis following orthodontic extrusion. The extrusion was performed with the help of a special custom cast device. This could help in the preservation of the natural root system and related periodontal architecture and also maintained adjacent tooth structure while retaining the options for future implant reconstruction. Such coordinated treatment proved to be effective for the establishment and maintenance of a pleasant smile.
Keywords: Crown root fracture, custom cast device, orthodontic extrusion, post and core, endosseous implants

[1]. Oisburgh S, Jacoby T, Krejci I . Crown fractures in the permanent dentition . Dent Traumatol 2002;18:130-15.
[2]. Andresson L. Tooth Ankylosis – clinical radiographic and histological assessment. Int J oral surgery 1984; 13:423-31
[3]. Mohanad Al-Sabbagh. Implants in the esthetic Zone. Dent Clin N Am 50 (2006).;391-407.
[4]. Zarb GA, Schmitt A. The longitudinal clinical effectiveness of osseointegrated dental implants in anterior partially edentulous patients. Int J Prosthodont 1993;6(2):180-8.
[5]. Buser D, Martin W, Belser UC. Optimising esthetics for implant restorations in the anterior maxilla: anatomic and surgical considerations. Ing. J Oral maxillo fac implants 2004; 19:43-61

Abstract: Aim: Meningitis is referred to as an inflammatory process of the leptomeninges and cerebrospinal fluid (CSF) within the sub-arachnoid space of the brain. globally distributed as either sporadic or epidemic forms. Meningitis can be caused by many infectious agents like bacteria, viruses and fungi, and non-infectious factors (like trauma The aim of the present study is to look for a simple, rapid, cost effective, non-invasive and fairly specific test in differentiating viral from other causes. Material and Methods: The present study was carried to evaluate the changes in biochemical parameters including glucose, protein, C-reactive proteins (CRP), electrolytes (sodium, potassium and chloride) and enzymes (ALT, AST, ALP, CK and LDH) in the CSF and serum samples of the viral meningitis patients (n=25) and compared with control subjects (n=25). Results: Our study shown that significant (p<0.001) increase in CSF glucose and protein levels in viral meningitis patients. The C-reactive protein was negative in all the cases of viral meningitis, as it is the diagnostic test to differentiate between viral and bacterial meningitis. Significant decrease (p<0.001) was observed in the CSF electrolytes concentration particularly in case of sodium and potassium levels while insignificant decrease was observed in the concentration of chloride. We observed extremely significant (p<0.001) high levels of all the enzymes (ALT, AST, ALP, CK and LDH in the CSF samples of viral meningitis as compared to their respective normal controls. Conclusion: It can be concluded that CSF CRP, CSF protein, glucose, electrolytes and enzyme profiles is not only simple, inexpensive and rapid but also fairly specificmethod for making a diagnosis, viral meningitis and also in differentiating it with other types of meningitis.
Keywords: Biochemical profile Cerebrospinal Fluids (CSF), viral meningitis.

[1]. Sharma N et al., ( (1)Braunwald E, Longo DL, Jameson JL. Infectious diseases. In: Braunwald E, (editor). Harrison's Principles of Internal Medicine. 15th ed. New York:Mc Graw-Hill; 2001.
[2]. Rajnik M, Ottolni MG. Serious infections of central nervous system: encephalitis, meningitis and brain abscess. Adolesc Med. 2000; 11: 401-25.
[3]. Romero JR, Newland JG. Viral meningitis and encephalitis: Traditionaland emerging viral agents. Semin Pediat Infect Dis. 2003; 14(2): 72-82.
[4]. Thomas k.e et al.the diagnostic accuracy of kernigs sign,brudzinsfkis sign and nuchal rigidity in adults with suspected meningitis.clin infect dis.july,2002 :35;46-52.
[5]. Shelburne C, Statler M. (2008). Meningitis: distinguishing the benign from the serious. JAAPA. 21:54–59.

Abstract: Escherichia coli is a part of normal intestinal flora. When it enters into unnatural sites, it can cause infections such as urinary tract infections (UTI), wound infections, lower respiratory tract infections (LRTI) etc. This is achieved by some virulence factors such as production of beta-haemolysin, biofilm & extended spectrum beta lactamase (ESBL) which endow its ability to survive, multiply & cause disease. This study was done to isolate E. coli from extraintestinal clinical samples, to assess their virulence factors such as β-haemolysin & biofilm production and to determine antibiotic susceptibility pattern & ESBL production by phenotypic method. A total of 52 E. coli isolates were obtained from urine(28), pus(22) & sputum(2) samples. All isolates were identified as per standard procedures. Beta-haemolysis using 5% sheep blood agar & biofilm production by tube method were determined. Antimicrobial susceptibility testing was done by Kirby Bauer disc diffusion method. ESBL production was evaluated by screening and phenotypic double disc synergy test as per CLSI guidelines. Out of 52 isolates, 13(25%) produced Beta-haemolysis of which 8(61.5%) were from urine samples. 38(73%) produced biofilms of which 21(55.2%) were from urine samples. 28(53.8%) produced ESBL of which 14(50%) were from urine samples. Most isolates were sensitive to amikacin and resistant to cefotaxime. It concludes that biofilm producing organisms are difficult to treat as they are resistant to commonly used antibiotics. Evaluation of Beta-hamolysin, biofilm and ESBL production should be employed in routine evaluation of E. coli isolates for early detection and prompt treatment.
Keywords: Beta haemolysis, Biofilm, Extended spectrum beta lactamase, Escherichia coli.

[1]. J R Johnson, A Gajewski, A J. Lesse and T A Russo, Extra-intestinal pathogenic Escherichia coli as a cause of invasive non-urinary infections, Journal of Clinical Microbiology, 41(12), 2003, 5798–5802.
[2]. J D.D.Pitout,Extraintestinal pathogenic Escherichia coli: a combination of virulence with antibiotic resistance, Frontiers in Microbiology, 3(9), 2012, 1-7.
[3]. R Naveen, E Mathai, Some virulence characteristics of uropathogenic Escherichia coli indifferent patient groups, Indian Journal of Medical Research,122, 2005, 143-147.
[4]. P S Grover, R Bareja, V K Narang, S C Jaryal, Incidence of fimbriated strains amongst haemolytic Escherichia coli, International Organization of Scientific Research- Journal of Dental and Medical Sciences, 4(3), 2013, 69-72.
[5]. EA George, S Sankar, M V Jesudasan, C Sudandiradoss, B Nandagopal, Incidence of extended spectrum beta lactamase producing Escherichia coli among patients, healthy individuals and in the environment, Indian Journal of Medical Microbiology, 32(2), 2014, 172-174.

Abstract: Pertrochanteric fractures are common in old age group but it is not uncommon in younger age group. These fractures unite readily with conservative line of treatment and there is no fear of complications like avascular necrosis of head and its sequel of osteoarthritis . In trochanteric fractures treated without surgical interventions malunion and coxa vara resulting in shortening of limb and limp. The primary goal of the treatment has to be early mobilization to avid secondary complications. Pertrochanteric femur fractures may be repaired with either a sliding hip screw or a recon nail. The hip screw has been considered the device of choice because fracture union predictably occurs. A problem with sliding hip screws is collapse of the femoral neck leading to loss of hip offset and shortening of the leg. Therefore a new intramedullary device-Recon nail was designed in the early 1980s which gives an advantage of minimally invasive surgery avoiding Complications of sliding Hip Screw.

[1]. Parker MJ, Handoll HH: Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane Database Syst Rev 2005, 19(4):CD000093.
[2]. Schipper IB, Marti RK, Van der Werken C: Unstable trochanteric femoral fractures: extramedullary or intramedullary fixation. Review of Literature. Injury 2004, 35(2):142-151.
[3]. Stromsoe K: Fracture fixation problems in osteoporosis. Injury 2004, 35(2):107-113. Gibbons CL, Gregg-Smith SJ, Carrell TWG, et al.: Use of the Russell-Taylor reconstruction nail in femoral shaft fractures. Injury 1995, 26(6):389-392.
[4]. Kang S, McAndrew MP, Johnson K: The Reconstruction Locked Nail for complex fractures of the proximal femur. J Orthop Trauma 1995, 9(6):453-463.
[5]. Garnavos C, Peterman A, Howard P: The treatment of difficult proximal femoral fractures with the Russell-Taylor reconstruction nail. Injury 1999, 30(6):407-415.

Abstract: Pregnancy is associated with several changes in platelet count and platelet indices arising from increased platelet consumption in the uteroplacental circulation and haemodilution. Reports have shown that the platelet count (PLT) and the plateletcrit (PCT) decrease, while the mean platelet volume (MPV) and the platelet distribution width (PDW) increase with gestational age. These physiologic changes should be noted while interpreting the results of platelet parameters as they are helpful in the early detection of states of super-imposed platelet consumption like pre-eclampsia, ectopic pregnancy, preterm labour and the HELLP syndrome. This study was aimed at deriving normal platelet parameters in pregnancy in Port Harcourt using the haematology auto analyser, PCE 210 (N) ERMA. The mean platelet count for the pregnant women was 212.74 ± 63.28 x 109/L; the mean MPV 9.99 ±1.94fL; the mean PCT was 0.21 ± 0.05% and PDW was 12.68 ± 1.91fL. Our study also confirmed the concept of platelet consumption in pregnancy.
Keywords: Mean platelet volume, Platelet count, Plateletcrit, Platelet distribution width, Pregnancy.

[1]. M K Goshal , M Bhattecharyya . Overview of Platelet Physiology: Its Hemostatic and Nonhemostatic Role in Disease Pathogenesis. The Scientific World Journal 2014, 1-16.
[2]. Article ID 781857. http://dx.doi.org/10.1155/2014/781857.
[3]. M Valera , O Parant , C Vayssiere , JO Arnal JO,and B Payrastre . Physiologic and Pathologic changes of platelets in pregnancy. Platelets, 21 (8), 2010,587-595.
[4]. Dundar , P Yoruk , and L Tutuncu . Longitudinal study of platelet size changes in gestation and predictive power of elevated MPV in development of preeclampsia. Prenat Diag.28, 2008, 1052-1056.
[5]. J Piazze , S Giola , A Spagnuolo , and A Cerekja . Platelets in pregnancy. Journal of Prenatal Medicine, 5 (4), 2011, 90-92.

Abstract: 32 year old lady came to accident and emergency department with drug overdose. Wide bore nasogastric tube was inserted for gastric lavage. While removing the nasogastric tube there was a resistance.(1) It was removed under direct vision by otolaryngologist. The nasogastric tube was knotted.
Keywords: Gastric lavage, nasogastric tube, rapid removal of tube, knotted tube.

[1]. Dasani B, Sahdev P. Knotting of a nasogastric tube: a case report. Am J Emerg Med. 1991;9(6):565.[PubMed]
[2]. Dinsmore RC, Benson JF. Endoscopic removal of a knotted nasogastric tube lodged in the posterior nasopharynx. South Med J. 1999;92:1005–7. [PubMed]
[3]. Santhanam V, Margarson M. Removal of self-knotted nasogastric tube: technical note. Int J Oral Maxillofac Surg. 2008;37:384–5. [PubMed]

Abstract: Osteogenesis imperfecta is a genetic disorder of connective tissue origin with the trademark clinical feature of bone fragility as evidenced by long-bone fractures. Other major clinical features may include skeletal deformity, blue sclerae, hearing loss and fragile, opalescent teeth. We are presenting here a case of a 6 years old boy presented with type III Osteogenesis Imperfecta with clinical features of large skull and wormian bones; pinched-lookin face, grey Sclerae, dentinogenesis imperfect, respiratory problem with old healed fracture in left proximal femur. Patient presented with acute history of pain right thigh which on radiography showed pathological fracture of proximal femur. Fracture reduced under sedation and kept in skin traction for 3 weeks and following that hip spica applied. Spica removed after 6 weeks. Pamidronate intravenous injection (single dose) was given as supportive treatment with calcitriol, calcium , vitamin C and vitamin D. Conclusion: Osteogenesis Imperfecta type III is classical, but not the most common form of it, presents with multiple fractures since birth. It is sporadic or autosomal recessive in inheritance . Usually patient has poor quality of life, with few surviving to adulthood.
Key words: calcitriol, hip spica, Osteogenesis Imperfecta type III, pathological fracture, pamidronate.

[1]. Eastwood D, Solomon L, Genetic disorders, skeletal dysplasia and malformations in: Solomon L, Warwick D, Nayagam S. Apley's system of orthopaedics and fractures 9th edition;Hodderarnold, 2010,172-4.
[2]. Canale S T, Osteochondrosis or epiphusitis and other miscellaneous affections in : Canale ST, Beaty J H . Campbell's operative orthopaedics 4th edition; Mosby Elsevier, 2013, 1181-82.
[3]. Herring J A, metabolic and endocrine bone diseases: Herring J A. Tachdjian's paediatric orthopaedics 4th edition;Saunders elesvier, 2008, 1944-3204
[4]. Morcuende J A , Dobbs M B, Idiopathic and heritable disorders in : Turek's orthopaedics 6th edition; Lippincott willians and Wilkins, 2005, 252-3.
[5]. Robert P. Huang, Catherine G A, Elroy S, Richard J. Functional Significance of Bone Density Measurements in Children with Osteogenesis Imperfecta. J Bone Joint Surg Am, 2006 Jun; 88 (6): 1324 -30.

Abstract: Gallstone ileus is well described but enteroliths which rarely form within gastrointestinal tract, except in certain pathological conditions like Crohn's disease or blind loop syndrome may some times cause intestinal obstruction. There are few reported cases of primary enteroliths causing small bowel obstruction. We report a rare case of a primary calcified enterolith causing ileal obstruction.

[1]. Singleton JM.Calcific enterolith obstruction of the intestine.Brit J Surg, 1970;57 : 234-236.
[2]. Klinger PJ, Seelig MH, Floch NR, et al. Small intestinal enteroliths: unusual cause of small intestinal obstruction: report of three cases. Dis Colon and Rectum,1999 ;42: 676-679.
[3]. Shocket E, Simon SA. Small bowel obstruction due to enterolith (bezoar) formed in a duodenal diverticulum : a case report and review of literature. Am J Gastroenterol, 1982 ;77 : 621-228.
[4]. Gupta SK, Shirbhate NC, KhannaNN et al. Enterolithiasis.J Postgrad Med, 1982; 28 : 225-228.
[5]. Lopez PV, Welch JP. Enterolith intestinal obstruction owing to acquired and congenital diverticulosis: report of two cases and review of literature. Dis Colon Rectum, 1991; 34:941-944.

Abstract: Background: The thalassaemia syndromes are a heterogeneous group of inherited disorders of hemoglobin synthesis. Most common causes of microcytic and hypochromic anaemia are iron deficiency anaemia and thalassaemia traits. Methods: A longitudinal study was conducted in a tertiary care setup. Every 3rd alternate positive thalassaemia trait mother was selected & age, residence, socio economic status (SES) matched antenatal mothers was taken as control for this study. High performance liquid chromatography (HPLC) was used for screening of various types of hemoglobin variants (HbA0, HbF, HbA2) among the thalassaemia mothers. Result: It has been noted that, differences of mean Hb% are statistically significant in both the groups throughout the pregnancy and the differences have increased as pregnancy advances. 25% of thalassaemic trait mother had microcytic hypochromic anaemia while 15% of normal mother developed the same and the difference is not statistically significant. Discussion: Study did not observe any significant difference in estimated fetal weights in second trimester and third trimester. There was no significant difference observed among the two groups in regards of Apgar scoring, estimated liquor volume, birth weight and mean hemoglobin among new borns. Among thalassaemia traits during stress, like pregnancy refractory microcytic hypochromic anaemia results. During pregnancy, maternal hemoglobin levels may fall to some extent but severe anaemia does not result. Conclusion: Differences of mean Hb% are statistically significant in both the groups throughout the pregnancy and the differences have increased as pregnancy advances Thalassaemia trait does not have any significant influence over estimated fetal weight or liquor volume or perinatal outcome in respect to hemoglobin of baby, birth weight, one minute Apgar score.
Keywards: Anemia, Antenatal mother, thalassaemia, perinatal outcome, Hb%

[1]. Weatherall DJ. The Thalassemia Syndromes. 4th ed. Oxford: Malden, MA: Blackwell Science; 2001; 4: 167-9
[2]. Melissa Santiago MSN, BA, PNP ;Thalassaemia trait:What every NP should know; The American Journal of Primary Health Care, December 2009; 34(12): 14-21.
[3]. Chui DHK, Cunningham MJ, Luo H, Wolfe LC, Neufeld E J, Steinberg MH. Screening and counseling for thalassemia. Blood. 2006; 107(4): 1735-1737.
[4]. Modell B, Petrou M. The problem of haemoglobinopathies in India.Indian J Haematol 1983; 3: 1-5
[5]. Madan Nishi, Sharma Satendra, Sood SK; Frequency of beta thalassaemia trait and other hemoglobinopathies in northern and western India: Department of Pathology , University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi 1987; 6: 234-56

Abstract: The objective of the study is to predict the assessment of the fetal wellbeing , maternal well being and mode of delivery. Assessment of the fetal well being by electronic fetal monitoring of the fetal heart rate in the pregnant women who admitted in the labor room of the Siddhartha medical college during the year of 2013 from January to December with a period of gestation of >37 weeks, in active phase of labor with fetus in the cephalic presentation. Both high risk and low risk cases were subjected to an admission CTG ,which included a 20 minute recording of FHR and uterine contractions, High risk cases are compared with low risk cases in an aspect of fetal distress and mode of delivery.100 patients were included in the study. Out of 100,77 had reactive trace ,18 had suspicious traces , and 5 had ominous traces. The admission test can serve as an evidenced based tool to detect fetal distress already present or likely to develop and to predict the mode of delivery and fetal outcome.
Keywords: Cardiotocography(CTG), Admission test, Reactive , suspicious, ominous, mode of delivery.

[1]. Role of admission test asa screening test to predict fetal outcome and mode of delivery. Blessy David and K.Saraswathi, Reasearch Journal of Pharmaceutical, Biological and Chemical Sciences, nov2014 page No .295
[2]. Admission test and its association with perinatal outcome: A retrospective study from Mandya Institute of Medical Sciences, Mandya, Karnataka,India. Deepti.H.R1, Savitha.H.C2 Syeda Ayesha Siddiqua3, Lalitha Shivanna4.International Journal of Research in Health Sciences. Oct - dec 2014 vol-2 issue-4.
[3]. To study the association between the labor admission test and mode of delivery Richa Kansal1, Prerna Panjeta2, R.Mahendra International Journal of Pharmaceutical and Medicinal Research. 5 august 2014,2(4):109-112.
[4]. Efficacy of Admission cardiotocography to predict obstetric outcome.Dwarakanath.L, Lakshmikanth.G, ChaitraS.K . Journal of Evolution of Medical and Dental Sciences/volume2/issue5/feb4,2013 page418-421.
[5]. Admission cardiotocography: Its role in predicting fetal outcome in high riskobstetric patients. Hafizur Rahaman, PrachiRenihen, Sudipdutta, and SumitKar. Australian Medical Journal/oct 2012,1267.

Abstract: Persistent hyperplastic primary vitreous (PHPV) is a pathologic entity resulting from abnormal persistence of the fetal fibro vascular primitive stroma (hyaloid system) of the eye, [1,2] which should disappear by the time of birth. Exact incidence of PHPV is not known but is a rare entity. In our case it is associated with cataractous lens, hypo plastic iris and increase axial length of the eye ball. Usually PHPV is associated with decreased axial length.Such an atypical clinical presentation of Persistent Hyperplastic Primary Vitreous has been found unusual in the available text.

[1]. Castillo M, Wallace DK, Mukherji SK. Persistent hyperplastic primary vitreous involving the anterior eye. Am J Neuroradiol 1997;18:1526-8.
[2]. Kaste SC, Jenkins JJ 3rd, Meyer D, et al. Persistent hyperplastic primary vitreous of the eye: imaging findings with pathologic correlation. Am J Roentgenol 1994;162: 437-440.
[3]. Barkovich AJ. Pediatric neuroimaging. Philadelphia: Lippincott-Raven, 1996, pp 412-6.
[4]. Larsen WJ. Development of the eye. In: Human Embryology. New York: Churchill Livingstone 1993, pp. 341-51.
[5]. Mafee MF, Goldberg MF, Cohen SB, et al. Magnetic resonance imaging versus computed tomography of leukocoric eyes and use of in vitro proton magnetic resonance spectroscopy of retinoblastoma. Ophthalmology 1989;96:965-75.

Abstract:Introduction: Acquired immunodeficiency syndrome (AIDS) is currently one of the worst global health pandemics in recorded history.Due to the implementation of prenatal HIV testing and highly active antiretroviral therapy (HAART) there is increase in number of people living with chronic HIV infection and thus associate with co-morbidities affecting pregnancy. Aim And Objectives:
1. To know maternal and fetal outcome in HIV infected pregnant women.
2. The incidence of HIV infected pregnancy.
Material And Method: A retrospective study carried at Cheluvamba Hospital, Mysore Medical College and Research Institute during 2009 to 2013. The hospital records of all HIV infected pregnant women were collected. Mother and Babies follow up details were obtainedfrom ICTC centre. Results: Total deliveries 63959. Of these 334 pregnant women were HIV positive. 59.3% primegravida. 73.1% had CD4 count of >200. 59.2% wereprimegravida. 10.2% were not on Antiretroviral Therapy (ART). 73.7% delivered vaginally. 50.8% hadbaby birth weight of >2.5 kg. 65.2% preferred breast feeding. 97.8% neonates received nevirapine .65infant died.6babies turned HIV positive. Conclusion: Care of HIV infected pregnant women is enhanced by having multidisciplinary team approach frequent visits and discussion regarding adherence to medication regimens to reduce perinatal transmission and to prevent drug resistance.
Keywords: Antiretroviral Therapy (ART), HIV in pregnancy,

[1]. Centersfor Disease Control andPrevention: AIDS Surveillance Trends, Slide Set. 2011a.
[2]. Operative Guidelines For Lifelong ART For All Pregnant Women Living With HIV For Prevention Of Parent To Child Transmission (PPTCT) Of HIV In India,NACO, December 2013.
[3]. Koutis AP, Bultreys M, Nesheim SR, Et Al; Understanding the Timing Of HIV Transmission From Mother To Infant, JAMA, 285:709, 2001.
[4]. Kourtis AP, Jamieson DJ, de Vincenzi I Et Al: Prevention of Human Immunodeficiency Virus 1 Transmission to the Infant through Breastfeeding: New Development. Am J ObstetGynecol 197; S113, 2007a.
[5]. Cotter AM, Brookfield KF, DuthelyLM,Et Al: Duration Of Membrane Rupture And Risk Of Perinatal Transmission Of HIV 1 In The Era Of Combination Antiretroviral Therapy. Am J ObstetGynecol 207: 482 el, 2012.

Abstract: Nasal lobular capillary haemangioma is benign,vascular lesion commonly affecting skin, mucosa of oral cavity, tongue and rarely nasal cavity mucosa. It commonly occurs following traumatic or hormonal changes particularly in pregnancy.We present a case of young male who presented with left nasal mass along with episodes of left nasal bleed for 3 months.Mass was excised and sent for histopathological examination,which confirmed it to be lobular capillary haemangioma. Our case gathers significance due to its presentation in an adolescent male and we stress to keep capillary haemangioma as differential diagnosis in a bleeding nasal mass.
Keywords: Lobular capillary heamangioma; Pyogenic granuloma; Nasal obstruction.

[1]. Mills SE, Cooper PH, Fechner RE: Lobular capillary haemangioma;the underlying lesion of pyogenic granuloma. A studyof 73 cases from the oral and nasal mucous membrane. Am JSurg Pathol 1980, 4:470-479.
[2]. Ozcan C, Apa DD, Gorurk: Paediatric lobular capillary hemangioma of the nasal cavity. Eur Arch Otorhinolarygol 2004,261:449-451.
[3]. Kartaran H, Uraldi C, Ark N, Aktas D: Lobular capillary hemangioma of the middle turbinate. Acta Otolaryngol 2006, 126:442-444.
[4]. Neves-Pinto RM, Carvalho A, Araujo E, Alberto C, Basilio-De-Oliveira, De Carvalho GA: Nasal septum giant pyogenic granuloma after a long lasting nasal intubation; Case report.Rhinology 2005, 43:66-69.
[5]. Park YW. Nasal granuloma gravidarum.Otolaryngol Head Neck Surg 2002; 126: 591-2.

Abstract: Background: Diabetes mellitus (DM) is a systemic condition that has been long associated with an increased risk and severity of periodontal disease(PD).Host responses to PD include the production of many intracellular enzymes, that are released outside cells after destruction of periodontal tissue . Aims of the study: To determine theperiodontal health condition and the salivary levels of creatin kinase (CK) and lactate dehydrogenase (LDH) enzymes among chronic periodontitis (CP) patients with or without controlled or uncontrolled type2 diabetes mellitus (T2DM) and the correlations of these enzymes with the severity of CP.
Materials and Methods: The salivary levels of (CK & LDH) enzymes and clinical periodontal parameters (plaque index PLI, gingival index GI, bleeding on probing BOP, probing pocket depth PPD and clinical attachment level CAL) were measured from 75 males divided into four groups,the study groups are(GroupI:(20) CP patients with controlled T2DM, GroupII:(20) CP patients with uncontrolled T2DM, GroupIII:(20)CP patients without DM)andGroupIV:(15)systemically healthy subjects with healthy periodontium as control group. Results: Uncontrolled T2DM with CP patients showed the highest mean values of (CK & LDH) enzymes, PLI, GI and percentages of( B0P sites, CAL (≥6mm) and PPD(≥6-8mm)&(≥9mm)). Inter groups comparisons revealed significant differences for CK & LDH enzymes levels as well as all clinical periodontal parameters except between groups I with III regarding PPD, CAL and BOP sites which demonstrated non-significant differences.Strong positive correlations were demonstrated between (CK & LDH) enzymes levels with clinical periodontal parameters in all study groups, except the correlations between BOP sites with both CK & LDH enzymes at groups II and III respectively and LDH enzyme with PPD(≥4-5mm) at group I, which werenon significant positive. Conclusion: The present study generally demonstrated strong positive correlations between salivary enzymes (CK & LDH) levels with the severity of CP patients with T2DM and measuring these biomarkers can use to evaluate the effect of T2 DM and glycemic control on periodontal health status.
Keywords: Salivary enzymes, periodontitis, Diabetes mellitus.

[1]. Michael G. Newman, Henry Takei, Perry R. Klokkevold and Fermin A. Carranza. Carranza's Clinical Periodontology, 12th Edition, 2014. Elsevier, Saunders.
[2]. Newman Taki, Klokkevold& Carranza FA, Clinical periodontology ,10th Edition, 2011.
[3]. Mealey BL. Periodontal disease and diabetes: A two way street. JADA. 2006; 137(10): 26-31.
[4]. Ozmeric N. Advances in periodontal disease markers. ClinchimActa. 2004; 343:1-16.
[5]. Diabetes Care.Diagnosis and Classification of Diabetes Mellitus.American Diabetes Association. 2014;37(1): 14-80.

Abstract: Background: Intraoperative diagnosis of surgically removed specimens can be achieved by gross examination with the help of frozen sections & or cytologic examinations. Various cytologic techniques including imprint, fine needle aspiration, image guided aspiration cytology; squash smears and scrape cytology may be used for intraoperative evaluation of tumors & surgical margins. Histopathology remains the ultimate gold standard in the tumor diagnosis. Aims / Objectives: To evaluate the role of scrape cytology for rapid intraoperative diagnosis of tumors. It can be utilized as a learning tool for cytopathologist and postgraduate students. Material and Method: In this study surgically removed specimens of tumors from various systems were studied. Scrapings were collected from each specimen before formalin fixation and the smears were stained with rapid H&E. Results: For surgical specimens studied by scrape cytology the diagnostic accuracy rate was 93.49 %. Out of 169 cases studied, 158 were correctly diagnosed as benign or malignant lesions. Conclusion: Intraoperative scrape cytology is a simple inexpensive, rapid, accurate cytodiagnostic technique, where frozen section facilities are not available. . It can also be used to assess the clearance of surgical margins.The material obtained from scrape cytology can be utilized as teaching material for post graduate students. Knowledge and expertise developed can also be used for interpretation of fine needle aspiration cytology.
Keywords: Intraoperative, Scrape cytology, FNAC.

[1]. Shidham VB, Dravid NV, Grover S, Kher AV. Role of scrape cytology in rapid intraoperative diagnosis. Value and limitations. Acta Cytol. 1984 Jul-Aug; 28(4):477-82.
[2]. Gal R. Scrape cytology assessment of margins of lumpectomy specimens in breast cancer. Acta Cytol. 1988; 32:838–9. 2.
[3]. Kolte SS and SatarkarRN Role of scrape cytology in the intraoperative diagnosis of tumor .J Cytol. Jul 2010; 27(3): 86–90.
[4]. Mair S, Lash RH, Suskin D, Mendelsohn G. Intraoperative surgical specimen evaluation: Frozen section analysis, Cytologic Examination, or Both? Am J Clin Pathol. 1991; 96:8–14.
[5]. Shirley SE, L scoffery CT. Usefulness of touch preparation cytology in postmortem diagnosis. A study from the University Hospital of the West Indies. Int. JP Patho 2005; 3:2.

Abstract: We report a case of ruptured liver abscess with massive right side pleural empyema. This patient presented with breathlessness, upper abdominal pain and generalised body weakness from last 10 days. On examination patients had tachypnea, tender hepatomegaly, with decreased breath sound to whole right hemithorax. USG suggestive of single large liver abscess with right side pleural effusion. Chest x-ray was also done which shows completely right hemithorax opaque which is very rare finding. Patients was managed on antimicrobial treatment with intercostals tuber drainage and other conservative treatment. Patients is doing well after treatment. We should keep differential of ruptured liver abscess in completely right hemithorax opaque with abdominal pain in country like India where amebiasis is frequent.

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Abstract: Flank pain is the basic problem in medicine. Finding the causes of flank pain can have important role on screening and treatment. Methods: This research was performed on 350 cases that referred with chief complain of flank pain in Shahid Motahari Hospital (Marvdasht, Iran) during 2013 to 2014. For each cases urinalysis and Ultrasonography is requested and the data was collected by questionnaire and frequency of different causes was investigated. Results: In 350 cases, 126 cases had urinary tract stones with hydronephrosis, 194 cases had musculoskeletal pain and 30 cases had pyelonephritis. Renal abcess, renal tumor, urinary pelvic junction obstruction, ureteral stenosis, acute renal infarction and renal vessels diseases did not have any frequencies. Conclusion: By this research we concluded that most people who refer to clinic of urology with chief complain of flank pain have musculoskeletal pain. So by screening of these patients before referring to the clinic of urology, we can differentiate the urologic causes and non urologic causes of flank pain and it is time and cost beneficial.
Keywords: Acute renal infarction, musculoskeletal pain, pyelonephritis, renal vessels diseases, renal abscess, renal tumor, urinary-pelvic junction obstruction, urinary tract stones, urethral stenosis.

[1]. Rucker, Creed M., Christine O. Menias, and Sanjeev Bhalla. "Mimics of Renal Colic: Alternative Diagnoses at Unenhanced Helical CT 1." Radiographics 24.suppl_1 (2004): S11-S28.
[2]. Thomas, A., and R. Andrianne. "[Excruciating flank pain:" acute renal colic"]." Revue medicale de Liege 59.4 (2004): 215-220.
[3]. Heidenreich, Axel, F. Desgrandschamps, and F. Terrier. "Modern approach of diagnosis and management of acute flank pain: review of all imaging modalities." European urology 41.4 (2002): 351-362.
[4]. Anderson, Kevin R., and Robert C. Smith. "CT for the evaluation of flank pain." Journal of endourology 15.1 (2001): 25-29.
[5]. Dalrymple, Neal C., et al. "Pearls and Pitfalls in the Diagnosis of Ureterolithiasis with Unenhanced Helical CT 1: (CME available in print version and on RSNA Link)." Radiographics 20.2 (2000): 439-447.

Abstract: T1 hyperintense structure in female pelvis can be either a hemorrhagic lesion or fat containing lesion. FATSAT technique is integral part of workup of any T1 hyperintense structures in female pelvis for differentiation of hemorrhagic lesion and fat containing mature ovarian teratoma for tissue characterization. We present a case of hematometra with blood in bilateral fallopian tubes due to cervical stenosis. The hemorrhagic content appear hyperintense on both T1WI and T2WI. An unexpected signal decrease in FATSAT T2WI inversion recovery sequence (STIR) was encountered. Suppression of signal in tissue with similar T1 relaxation time as fat can lead to diagnostic pitfall in T1WI and T2WI STIR pulse sequence. Also loss of signal on T2WI can be due to T2 "shading" in T1 bright ovarian endometrioma. Hence, fat specific spectral fat saturation on T1WI (FATSAT T1) is strongly recommended for tissue characterization in gynaecological diseases. This sequence is useful in cases of ovarian endometrioma and hematometra.
Keywords: MRI, hematometra, endometrioma, STIR, T1 FATSAT, female pelvis.

[1]. Krinsky G1, Rofsky NM, Weinreb JC. Nonspecificity of short inversion time inversion recovery (STIR) as a technique of fat suppression: pitfalls in image interpretation. AJR Am J Roentgenol. 1996 Mar;166(3):523-6.
[2]. Ebara M1, Watanabe S, Kita K, Yoshikawa M, Sugiura N, Ohto M et al. MR imaging of small hepatocellular carcinoma: effect of intratumoral copper content on signal intensity. Radiology. 1991 Sep;180(3):617-21.
[3]. Froehlich JM1, Metens T, Chilla B, Hauser N, Hohl MK, Kubik-Huch RA. MRI of the female pelvis: a possible pitfall in the differentiation of haemorrhagic vs. fatty lesions using fat saturated sequences with inversion recovery. Eur J Radiol. 2012 Mar;81(3):598-602.
[4]. Siegelman ES1, Outwater EK. Tissue characterization in the female pelvis by means of MR imaging. Radiology. 1999 Jul;212(1):5-18.
[5]. Ribeiro SC1, Tormena RA, Peterson TV, Gonzáles Mde O, Serrano PG, Almeida JA et. al. Müllerian duct anomalies: review of current management. Sao Paulo Med J. 2009 May;127(2):92-6.

Abstract: Adjuncts to local anaesthetics for brachial plexus block enhances the quality and duration of analgesia. The purpose of this study was to compare two alpha-2 agonists clonidine and dexmedetomidine, when added as adjuvant to ropivacaine, in respect to onset, duration of sensory and motor block along with duration of analgesia. After informed consent, Sixty ASA I and II patients scheduled for elective upper limb surgeries under supraclavicular brachial plexus block in R L Jalappa Hospital were divided into two equal groups in a randomized, double-blinded fashion. To ropivacaine 29 ml (0.5%), Group C received clonidine 1 ml (50 μg) and Group D received dexmedetomidine 1ml (50μg). Onset and duration of sensory and motor block, duration of analgesia were studied in both the groups. Both groups were comparable with regard to age, sex distribution, pulse rate and mean arterial blood pressure. There was no statistically significant difference. Onset of sensory and motor blockade was faster in Group D, which is statistically significant. The Duration of sensory block and motor block, analgesia was also greatest in group D, which is statistically significant. There was no statistically significant difference between two groups in number of rescue analgesia requirement during first 24 hrs. There were no adverse events noted in either group. All patients were haemodynamically stable without requiring anaesthetist's intervention. Dexmedetomidine when added to ropivacaine in supraclavicular brachial plexus block had faster onset, greater duration of sensory and motor block and also, the duration of analgesia, than clonidine. Dexmedetomidine is better adjuvant than clonidine when added as adjuvant to ropivacaine in supraclavicular brachial plexus block.
Keywords: Ropivacaine, Dexmedetomidine, Clonidine, Supraclavicular Brachial plexus block.

[1]. Cousins MJ Bridenbaugh. Neural blockade in clinical anaesthesia and pain medicine. 4th ed.: Lippincott Williams and Wilkins; 2009.
[2]. McClure JH. Ropivacaine. British Journal of Anaesthesia 1996; 76:300-7.
[3]. Swami SS, Keniya VM, Ladi SD, Rao R. Comparison of dexmedetomidine and clonidine (α2 agonist drugs) as an adjuvant to local anaesthesia in supraclavicular brachial plexus block: A randomised double-blind prospective study. Indian J Anaesth 2012; 56:243-9.
[4]. Yoshitomi T, Kohjitani A, Maeda S, Higuchi H, Shimada M, Miyawaki T. Dexmedetomidine Enhances the Local Anaesthetic Action of Lidocaine via an α-2A Adrenoceptor. Anesth Analg 2008; 107:96 –101.
[5]. Saadawy I, Boker A, Elshahawy MA, Almazrooa A, Melibar S, Abdellatif AA, et al. Effect of dexmedetomidine on the characteristics of bupivacaine in a caudal block in paediatrics. Acta Anaesthesiol Scand 2009; 53: 251–256.

Abstract: Background: Increasing lack of attention among the medical students towards academic activities has become a matter of grave concern for the medical education system. Objectives: 1. To study the factors determining interest towards academic activities among Undergraduate Medical students. 2. To identify the reasons for lack of attention during class. 3. To identify the students' opinion to make classes more interesting. Methodology: This was a Cross-sectional study conducted among first year Medical students of a medical college of Tripura in January, 2015. Results:The study revealed that majority of the students considered that the mode of expression of the teacher (63.30%), and use of humor (57.10%) during the classes make the classes more interesting and availability of the topic in the book was the commonest reason (41.80%) for their lack of attention during class. Majority of students opined that use of pictures, video clips etc. could make lectures and demonstrations more interesting and tutorials should be used for tough topics only and every student must be allowed to do the practical by themselves. Conclusions: The present study provides insights into student's perceptions regarding lack of attention during classes and modes of making different classes more interesting.
Keywords: Academic activities, lack of attention, lack of interest, Medical Student, Tripura.

[1] Schreiber EB, Fukuta J, and Gordon F. Live lecture versus video podcast in undergraduate medical education: A randomised controlled trial. BMC Medical Education,10, 2010:68.
[2] Gorham J. The relationship between verbal teacher immediacy behaviors and student learning. Commun Edu, 37,1988,40-53.
[3] Revans R. Developing effective managers; a new approach to business education. (Praeger Publishers,1971).
[4] Bonwell C, Eison J. Active Learning: Creating Excitement in the Classroom AEHE-ERIC Higher Education Report No. 1. (Washington DC: Jossey-Bass, 1991)
[5] Renkl A, Atkinson RK, Maier UH and Staley R. From example study to problem solving: Smooth transitions help learning. J Exp Educ. 70, 2002,293–315.

Abstract: Today's orthodontic appliance has a move toward more aesthetic designs and materials. Thus, the purpose of this study was to investigate the adverse effects of two orthodontic treatment modalities - manual invisalign and fixed labial orthodontic appliances on the oral mucosa and periodontal health status. Patients and Methods: The study sample comprised 60 healthy patients (48 female and 12 male) attended an orthodontic private clinic in Sulaimani city- Iraq. This study was implemented to analyze and compare the adverse effects of two treatment modalities; manual invisalign (MIA) and fixed labial orthodontic appliances(FLOA) on oral health status using T-tests. Plaque index (PI), gingival index (GI) and probing pocket depth (PPD) were used for a periodontal evaluation, whereas oral mucosal lesions were evaluated via a thorough oral examination and a questioner based assessment. Results: Patients with manual invisalign appliances (MIA) presented significantly lower GI, PI and PPD compared to those with fixed labial orthodontic appliances (FLOA) (0.63, 0.83 and 1.66 mm) against (0.98, 1.21 and 1.99 mm) respectively. Furthermore, FLOA recorded total of (21) traumatic ulcers (70%) in opposition to 6 (20%) for MIA; these ulcers were mainly recorded from check and lips. Check and lip traumatic ulcers caused by FLOA were (15, 5) respectively against (2, 1) for MIA. Number of aphthous ulcers also found to be higher with FLOA than MIA (10 to 4) respectively. Additionally, the study recorded (4) cases of hyperkeratotic lesions beside (3) cases of mucosal overgrowth of the check for patients wearing FLOA. Conclusions: Patient treated with manual invisalign orthodontic appliances presented significantly fewer periodontal and oral mucosa lesions than patients with fixed labial orthodontic appliances.
Keywords: fixed labial orthodontic appliance, Manual invisalign, oral mucosal changes, and periodontal status.

[1] Impellizzeri A, Palaia G, Carpenteri F, et al. Secondaries problems of the oral mucosa during orthodontic treatment. Prevent Res, 2014.65. Available from http://www.preventionandresearch.com/
[2] Hohoff A, Stamm T, Goder G, Sauerland C, Ehmer U, Seifert E.Comparison of 3 bonded lingual appliances by auditive analysis and subjective assessment. Am J Orthod Dentofacial Orthop. 2003 Dec; 124(6):737-45.
[3] Nedwed V, Miethke RR.Motivation, acceptance and problems of Invisalign® patients. J Orofac Orthop. 2005 Mar;66(2):162-73
[4] Preoteasa C.T, Ionescu.E and Preoteasa.E (2012). Risks and Complications Associated with Orthodontic Treatment, InTech, Available from:http://www.intechopen.com/books/orthodontics-basic-aspects-and-clinical-considerations/risks-andcomplications-associated-with-orthodontic-treatment
[5] Jyothi B.M, Rakesh B.C, Pandey B. Brackets–A boon or a bane? Undesirable effects of Orthodontic Treatment. Journal of Dental Peers, 2013 Apr; 1(1):58-68.

Abstract: To compare the effects of intrathecal dexmedetomidine and fentanyl as adjuvants to hyperbaric bupivacaine with a control group with regards to time of onset of sensory and motor blockade, Duration of sensory blockade and motor blockade, Two segment sensory regression time, Duration of effective post-operative analgesia and incidence of side effects. A randomized, prospective study, after obtaining ethical committee approval in R.L. Jalappa hospital and research center and written informed consent of patients was conducted on 90 Adult Patients of either sex, aged between 20 to 45 years, of physical status ASA Grade I and Grade II undergoing elective lower abdominal and lower limb surgeries under spinal anaesthesia. Patients were divided into 3 groups of 30 each. Group D received 15mg hyperbaric bupivacaine with 10mcg dexmedetomidine in 0.5ml of normal saline. Group F received 15mg hyperbaric bupivacaine with 25mcg fentanyl. Group C received 15mg hyperbaric bupivacaine with 0.5ml of normal saline. The time of onset of sensory and motor blockade and the duration of two segment sensory regression time, sensory, motor blockade and duration of effective post op analgesia was statistically significant in group D compared to group C and F. Intrathecal Dexmedetomidine is associated with faster onset of sensory and motor blockade, with significantly prolonged sensory and motor blockade and less requirement of rescue analgesia compared to fentanyl and control group.
Keywords: α2, adrenoreceptor agonists, bupivacaine, fentanyl, spinal anaesthesia.

[1]. Saxena A K, Arava S K. current concepts in neuraxial administration of opioids and non-opioids: An overview and future prespectives. Indian J Anaesth. 2004; 48:13-24.
[2]. Ozkardesler S, Gurpinar T. Akan M, Kora et al. A possible perianaesthetic serotonin syndrome related to intrathecal fentanyl. J Clin Anaesth. 2008; 20: 143-145.
[3]. Eisenach James C, De Kock Marc, Klimscha, Walter. Alpha sub 2- adrenergic agonist for regional anesthesia. A clinical review of clonidine. Anesthesiology: 1996; 85:655-674.
[4]. Ralph Getler, Clieghton H Brown, Mitchel H, Silvius N. Dexmedetomidine:a novel sedative analgesic agent. Baylor University Medical Centre Proceedings. 2001; 14(1).
[5]. Kanazi GE, Aonad MT, Jabbour Khonry SI, AJ-Jazzar MD, Alameddine MM, AL-Yaman R, et al. Effect of small dose dexmedetomidine or clonidine on the characteristics of bupivacaine – spinal block. Acta Anaesthesiol Scand. 2005; 50: 222-7.

Abstract: Aim Of The Study: This study was undertaken to evaluate the fetomaternal outcome in pregnancies complicated by jaundice. Materials & Methods: Antenatal patients with jaundice attending TMMCRC, Moradabad, U.P. between January 2011 to January 2014 were included in the study. Results: 100 patients had jaundice in pregnancy. The incidence was 0.95 %. Most common cause of jaundice was viral hepatitis (49%). Most common complications were hepatic encephalopathy, DIC, ICU stay, thrombocytopenia. The mortality rate was 10 % .The perinatal mortality rate was 19 %. Conclusion: Jaundice in pregnancy has adverse fetomaternal outcome. Improvement in health awareness, education & routine and regular antenatal checkups ,early referrals can result in early diagnosis and treatment of jaundice in pregnancy thus reducing the fetal and maternal morbidity and mortality.
Key Words: jaundice, pregnancy, fetomaternal outcome, mortality, morbidity.

[1]. Ch'ng CI, Morgan M, Hainsworth I: Prospective study of liver dysfunction in pregnancy in South West Wales, 2002,.
[2]. Nagaria Tripti, Agarwal Sarita, Fetomaternal outcome in jaundice during pregnancy. Obstet Gynecol of India, 2005: 424-427.
[3]. Ian Donald's Practical Obstetric Problems, 7th edition.
[4]. Harrison's Principles of Internal Medicine, Vol 1, Section 6, chapter 42.
[5]. William's Obstetrics 23rd & 24th edition.