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

Abstract: Objective: To study the clinical profile and obstetricaland neonatal outcome of cases of pregnancy related acute failure (PRARF)failure occurred in a tertiary care hospital of Rajasthan Materials and Methods:All patients with PRARF admitted in S.M.S medical college since July 2009 to July 2010 were analyzed Result:Total no of Acute Renal Failure cases was 60. Age range of cases was 19 years to 40 years, while mean age was 26.2±.56 yrs. In total cases, 61.7% were multipara and remaining 38.3% were primi. In 80% cases deliveries were conducted in hospital remaining 20 % delivered at home. 85%patients have attended antenatal clinic. PRARF was seen in 58.3% cases during post-partum period. During the 3rd trimesternumber of cases was 12(20%) followed by 13.3% and 8.3% in 2nd and 1st trimester. Total number of women with PRARF was 60, whereas, the total number of patients with acute renal failure (ARF) was 1557. The frequency of PRARF was 3.85% of all ARFPallor was present in 93.3% women. Bleeding per vaginum was complained by 46.7% women with acute renal failure. Edema was present in 41.7% cases. Sign of icterus was present in 21.7% cases. Various abnormal laboratory finding were noted among the pregnancy related acute renal failure cases, Anemia were present in 68.3% cases. Electrolyte disbalance were present among 38 (63.3%) of cases. Out of these hyponatremia was the commonest condition, in about 50% cases it was find out. Abnormal liver function test was present in 45% cases. Puerperal sepsis (31.7%) was the most common cause of pregnancy related acute renal failure followed by anti-partumhemorrhage (25%). PET/ Eclampsia were underlying cause among 16.7% cases. Post abortion sepsis was the cause of in 5% cases of pregnancy related acute renal failure. In half of the cases delivery were normal, in 23.4% cases LSCS were performed. D&E done in 15% cases while 5% pregnancy terminated as Abortion.Anuria was present in 21.7 % cases, while 65% suffered from oligouria. Mean creatinine level was 4.5±0.62. Mean duration of oligouria 18.2 ±12 days. Non oligouric condition was present in 8(13.3%) cases. Dialysis was needed in 36(60%) cases, hemodialysis was given to 26 cases, while 6 (10%) were on Peritoneal dialysis and 4(7.5%) on venovenous dialysis.19 cases were completely recovered, 20 cases partially, and remaining 21 died. In 12 cases operative procedure was done, in 8 cases evacuation and in 4 cases hysterectomy was done. As outcome of fetal survival out of total pregnancy 20 died and 40 survived. IUD was most common cause (60%) among fetal death.Conclusions:PRARF remains acritical situation in developing countries where sepsis is the most frequent etiology, followedby anti-partum hemorrhage (25%). PET/ Eclampsia were underlying cause among 16.7% cases. Post abortion sepsis was the cause of in 5% cases of pregnancy related acute renal failure. Prevention is the best and least expensive solution.
Keywords: Pregnancy Related Acute Renal Failure,Acute Renal Failure, Pregnancy.

[1]. NaliniArora, KirtiMahajan, Narayan Java, AbhijitTaraphder : Pregnancy –Related Acute Renal Failure In Eastern India Int J Of Gynae&Obstet 111 (2010) 213 -216.
[2]. Mohamed Arrayhani,RandaEiYoubi , And TarikSqalli :Prenancy –Related Acute Kidney Injury:Experience Of The Nephrology Unit At The University Hospital Of Fez ,Morocco:Isrn Nephrology Volume 2013(2013),Article Id 109034,5 Pages.
[3]. Rizwan,SyedFarhanUddin Obstetrical Acute Renal Failure:A Challenging Medical Complication .J Ayub Med CollAbottabad 2011;23(4).
[4]. Irfan Hassan ,Abdul MananJunejo And AnoharLalDawani ; Etiology And Outcome Of Acute Renal Failure In Pregnancy.Journal Of The College Of Physician And Surgeons Pakistan 2009,Vol.19:714-717.
[5]. Kilari Sunil Kumar,Chinta Rama Krishana, Vishanubhotla Siva Kumar :Pregnancy Related Acute Renal Failure J ObstetGynecol India Vol.56 ,No.4:July/August 2006 Pg 308-310.

Abstract: Primary soft tissue sarcoma of chest wall is an uncommon lesion. Mass of a chest wall should be considered as malignant until proven otherwise. Myxofibrosarcoma is one of the most aggressive types of soft tissue tumor. Due to its rarity over trunk wall and high possibility of malignancy, an early investigation and diagnosis is crucial. Subsequently, an early excision remains the mainstay of treatment. A multidisciplinary team approach for diagnosis and treatment is crucial.

[1]. Kachroo P, et al. Chest wall sarcomas are accurately diagnosed by image-guided core needle biopsy. Journal of Thoracic Oncology. 2012;Volume 7, Number 1.
[2]. Castronovo C, Arrese JE, Quatresooz P, Nikkels AF. Myxofibrosarcoma: A Diagnostic Pitfall. Rare Tumors 2013;5(2):60-61.
[3]. Hong NJL, Hornicek FJ, Raskin KA, et al. Prognostic Factors and Outcomes of Patients with Myxofibrosarcoma. Annals of surgical oncology. 2013;20(1):10.1245/s10434-012-2572-3.
[4]. Haglund K.E, et al. Recurrences pattern and survival for patients with intermediate and high grade myxofibrosarcoma. International Journal of Radiation Oncology Biology, Physics. 2012; Volume 82, p361-367.
[5]. Orabona GDA, et al. Head and neck myxofibrosarcoma : a case report and review of literature. Journal of medical case report. 2014; 8:468.

Abstract: Objective: This study was done to evaluate morbidity and mortality pattern amongst infant of diabetic mothers (IDMs). Material Methods: This study was conducted Prospectively at G. B. Pant Children hospital Srinagar between June 2014 to January 2015 which is tertiary care hospital and is associated hospital of Government Medical College Srinagar India. Data on delivery mode, Gestational age, birth weight, other associated morbidities, investigation results, treatment, duration of hospital stay and outcome were collected and compared with those of infants of non-diabetic mothers matched for gestational age and birth weight admitted within same period. Maternal data were collected and reviewed retrospectively. Results: 59.6% of the IDMs were born to mothers with gestational diabetes, while 40.3% were born to mothers with pre-gestational diabetes. 45 (78.8%) were born by caesarean section of which 22 (38.5%) were born by emergency caesarean section. There was no significant difference in emergency CS rates when compared with controls, but non- IDMs were delivered vaginally. The mean GA of IDMs was 37.84±1.88 weeks. 33 (57.8%) were macrosomic. The commonest morbidities were hypoglycemia (significantly higher in IDMs than non-IDMs) and hyperbilirubinemia in 35 (61.4%) and 30 (52.6%) respectively. There was no difference in morbidity pattern between infants of pre-gestational and gestational diabetic mothers. Mortality rate was not significantly higher in IDMs. Conclusion: The incidence of macrosomia in IDMs was high but high rates of emergency Caesarean Section (CS) was not peculiar to them. Hypoglycemia and hyperbilirubnemia were commonest morbidities in IDMs.
Keywords: Morbidity, Mortality, Infant of diabetic mothers, Gestational and pre-gestational diabetes mellitus.

[1]. Moore T. Diabetes in pregnancy. In: Creasy RK, Resnik R, Iams JD, editors. Maternal-fetal medicine: Principles and practice. 5th ed. Philadelphia. Saunders, 2004;1023-61.
[2]. Lucas MJ. Diabetes complicating pregnancy. Obstet Gynecol Clin North Am 2001;28:513-36.
[3]. Sermer M, Naylor CD, Farine D, Kenshole AB, Ritche JW, Gare DK, et al. The Toronto tri-hospital gestational diabetes project. A preliminary review. Diabetic Care 1998;2:33-42.
[4]. Beischer NA, Wein P, Sheedy MT, Steen B. Identification and treatment of women with hyperglycemia diagnosed during pregnancy can significantly reduce perinatal mortality rates. Aust. NZ J Obstet Gynecol 1996;239-247.
[5]. Casey BM, Lucas MJ, Mclntire DD, Leven KJ. Pregnancy outcomes in women with gestational diabetes compared with general obstetric population. Obster Gynecol 1997;90:869-73.

Abstract: During the dissection of foetuses( obtained from gynecology and obstetric dept of KGH), we observed a foetus showing polycystic horse shoe kidney (cysts of size varing from 1mm --- 5mm ) fusion seen in lower pole. The right kidney is smaller and pertained to pelvic region, (suprarenal gland not seen)The left kidney extended up to diaphragm and left suprarenal gland is disc like due to compression. Ureters seen to arise from hilum of both kidneys but are fused in pelvic region and opened into the urinary bladder . The anal agenesis (anal atresia) is observed and anal opening absent (imperforate anus )The rectum opened into the urinary bladder.
Keywords: Polycystic horse shoe kidney, Anal atresia

[1]. Sadler T W. Langman's Medical Embryology. 9th edition. Philadelphia: Lippincott Williams and Wilkins; 2004. p. 79. McCoy MC, Chescheir NC, Kuller JA, et al. A fetus with sirenomelia, omphalocele, and meningomyelocele, but normal kidneys. Teratology. 1994;50:168–171. PubMed. [PubMed [2]. Alan G Fantel and Thomas H Shepard Potter (1975). Syndrome Nonrenal Features Induced by Oligoamnios. American Journal of Diseases of Children 129(11) 1346-1347. [3]. Arun K Pramanik, Geoffrey Altshuler, Irwin J Light and James M Sutherland (1977). Prune-Belly Syndrome Associated With Potter (Renal Nonfunction) Syndrome: American Journal of Diseases of Children 131(6) 672-674. [4]. Edith L Potter (1946). Facial characteristics of infants with bilateral renal agenesis. American Journal of Obstetrics and Gynecology 51 885-888.
[5]. Preus M, Kaplan P and Kirkham TH (1977). Renal anomalies and oligohydramnios in the cerebrooculofacio-skeletal syndrome. American Journal of Diseases of Children 131(1) 62-4. Prouty 7.LA and Myers TL (1987). Oligohydramnios sequence (Potter's syndrome): case clustering in northeastern Tennessee. Southern Medical Journal 80(5) 585-92.

Abstract: Introduction:Enteric fever is still a major health problem in developing countries.The term enteric fever includes typhoid and paratyphoid which is characterised by generalised infection of the reticuloendothelial system and intestinal lymphoid tissue accompanied by sustained fever and bacteremia.Hepatic involvement was known for a long time and it was first described by osler in 1899 who documented cases of typhoid fever with jaundice and hepatomegaly.Aims and objectives:This study was undertaken to observe the hepatic manifestations and study the LFT abnormalities during the course of enteric fever and analyse their clinical significance. Settings: A tertiary hospital based study Patients And Methods: The present prospective study was conducted at M.S.Ramaiah Medical Teaching Hospital.50 patients of enteric fever diagnosed on the basis of clinical history, physical examination, blood culture and widal test were included in the study.:A detailed evaluation of the patients was done with particular reference to hepatic dysfunction. A past history of fever was looked.A detailed clinical examination was carried out particularly for the presence of jaundice, pallor, hepatosplenomegaly, altered sensorium, perforation and bleeding tendencies.The Investigations done were complete hemogram, Liver function tests which included total proteins, albumin, total and direct bilirubin, aspartate amino transferase, alanine amino transferase, alkaline phosphatase and prothrombintime.Urine for routine examination and presence of urobilinogen, bile salt and pigments.Routine blood tests for sugar, urea and creatinine,Blood Culture, Stool Culture, Urine culture.WidalTest.Chest X-ray.Peripheral smear for malaria parasite, Brucella agglutination test and Hepatitis B surface antigen. Bleeding and clotting times. Ultrasonography of abdomen were done in clinically indicated cases. Results: In the present study age of the patients ranged from 14yrs to 60 yrs with a mean age of 21.9yrs and male:female ratio being 3.5:2.Analysis of Liver Function Tests:Serum AST was normal in 28 patients, elevated (More than 2 fold) in 22/50(44%) patients and the range of AST is 4 U/L to 301 U/L.Out of 50 cases of enteric fever, elevated AST of more than two fold was seen in 2 cases in 1st week, 13 cases in 2nd week and 7 cases in 3rd week. There is statistically significant association between duration of fever and AST levels(X2 7.2219; df = 2; P<0.05).Serum ALT was normal in 29 patients, elevated (more than 2 fold) in 21/50(42%) patients and the range of ALT is 3 U/L to 368 U/L was seen in 2 cases in 1st week, 12 cases in 2nd week and7 cases in 3rd week. There is statistically significant associated between duration of fever and ALT levels (x2 = 6.3557; df -2 ; P < 0.05).Serum Alkaline Phosphatase (ALP):ALP was normal in 31 patients, elevated to more than 2 fold in 19/50(38%) patients and the range of ALP in 13 U/L to 628 U/L.Out of 50 cases of enteric fever, elevated ALP levels of more than two fold was seen in 2 cases in 1st week, 11 cases in 2nd week and 6 cases in 3rd week. There is statistically significant association between duration of fever and serum alkaline phosphatase. (x2 = 8.3882; df-2 ; P<005).Serum Bilirubin level in the study group:Hyperbilirubinemia was found in 5/50(10%) patients (>1.8mg/dl) and the range of bilirubin in these patients is 1.8 to 5.6 mg/dl and predominantly had conjugated hyperbilirubinemia. Serum Albumin :Albumin levels of more than 3 gm/dl were seen in 32 patients, and levels less than 3 gm/d were seen in 18/50(36%) patients.ProthrombinTime:Prothrombin time was done for patients who had total bilirubin >1.8mg/dl. One patient had prothrombin time of more than 1.5 times of control. Conclusion: Abnormal LFT S in enteric fever is seen more commonly in patients presenting in 2nd and 3rd week of illness.Hepatic dysfunction is common in enteric fever.Salmonella hepatitis was seen in patients with prolonged illness and inappropriate antibiotic use.It increases morbidity and prolongs hospital stay.
Keywords: Liver function tests,salmonellahepatitis,enteric fever cour

[1]. Gulati PD, Sexana SN, Gupta PS, et al. Changing pattern of typhoid fever. Am J. Med 1968: 45: 444-448.
[2]. Wicks ABC, Holmes GS, Davidson L. Endemic typhoid fever. Q.J Med 1971; 40: 341-354.
[3]. Osler W. Heptic complications of typhoid fever. Johns Hopkins. Hosp. Rep. 1899; 8: 373 – 377.
[4]. Khosla SN. Typhoid hepatitis. Postgrad Med J 1990; 66: 923-925
[5]. Khosla SN, Singh R, Singh GP, et al. The spectrum of hepatic injury in enteric fever. Am J Gastroenterol 1988; 83: 413-416.

Abstract: Introduction: "Fasting is primarily a willing abstinence from food, drink or both for a period of time". As we know our country is a land of different religions and in every religion, fasting is practiced in one way or the other. From religious point of view- It inculcates in man the spirit of abstinence from sins and cultivation of virtues. From scientific point of view-Fasting is said to occur as long as fat and carbohydrates are used as energy source. The 3 scientifically proved advantages being- it promotes detoxification, enhances healing process, and increases life expectancy. Aims& Objective: To assess how far it affects the various dimensions of health namely physical, social, psychological and spiritual and thus our lives and to know the impact of socio economic status of people as well as education on fasting. Methodology: - A cross-sectional observational study was carried out by Door to door survey and data was collected by interview method over 300 randomly selected people of different localities of Indore (Lalaram Nagar, Bakhtawarram nagar, Tilak Nagar, KanchanBagh, Geetabhavan,jaora compound) for duration of four months(oct-13 to jan-14). Study tool consists of a questionnaire mainly contained questions related to demography, physical, psychological, social and spiritual aspects of fasting. The questionnaire was pre tested life expectancy. by conducting a pilot study involving a small sample from the community. Inclusion criteria includes the People who observed either short term fasting (<10 days) or long term fasting (>10 days). Peoples who did not observe fast were excluded from this study. Conclusion: Most of the people did fasting due to spiritual and religious cause and became more aware of their family traditions. It was found from the study that social interaction. Brotherhood and communal harmony is increased amongst people and they indulged themselves more in charity and other religious activities. Most of the people had no bad effects on their health like no indigestion, weight loss, weakness and other health related issues. However, some people continued their fasting in spite of worsening of their health problems might be due to social or religious reasons. Some people prioritize religion more than their health during fasting.
Keywords: Willing Abstinence, Religious, Detoxification, Healing process, Life expectancy.

[1]. e-Study Guide for: Principles of Anatomy and Physiology. https://books.google.co.in/books?isbn=1497034485 accessed on 04 Oct 2013.
[2]. e-Study Guide for Linne & Ringsrud's Clinical Laboratory https://books.google.co.in/books?isbn=1490271074 accessed on 04 Oct 2013
[3]. Perfect Health: February 2011 perfecthealth-rui.blogspot.com/2011_02_01_archive.html accessed on 06 Oct 2013
[4]. benefits of the one-day fast - Libra Rising www.librarising.com/health/onedayfast.html accessed on 04 Oct 2013
[5]. Fasting benefits for health: Weight loss, Healing, and Detoxmedicapharm.com/fasting-benefits-weight-loss-detox.html accessed on 06 Oct 2013

Abstract: Neuroaxial Anaesthesia is safe for lower limb orthopaedic surgeries. But duration of sensory and motor block dose not beyond 3 hours with local anaesthetic alone. For prolongation of regional anaesthesia, adjuvants are added to local anaesthetic agents. Clonidine is a frequently used adjuvant to local anaesthetics. Objectives: (1) This study was under taken to assess onset and duration of sensory and motor block. (2) Intra and post operative pain and adverse effects. Study Design: It is retrospective study. Study Area: Government General Hospital, Guntur Medical College, Guntur, AP. Study Subjects : Patients of Lower Limb orthopaedic cases admitted in Govt. General Hospital for Surgery. Sample Size: 60 lower limb orthopaedic cases. Study Period: September 2014 to February 2015. Methods: Sixty adult ASA Grade I and Grade II. Patients were matched into two cohorts, study cohort (Bupivacaine with Clonidine) and control cohort (Bupivacaine + 0.5 normal saline) of either sex posted for lower limb orthopaedic surgeries. Study Cohort: 3ml of 0.5% Bupivacaine + 30 g Clonidine. Results: We observed mean duration of motor block significantly higher in study cohort (281.9 + 1.126) as compared with control cohort (191.03 + 1.091). Significant difference in duration of sensory block was noted between study cohort (291.4 + 1.60) and control cohort (181.4 + 1.054). Duration of Post operative analgesia was significantly higher in study cohort as compared to control cohort. Conclusion: The findings in this study suggested that use of Clonidine 30 g added to Bupivacaine for spinal anaesthesia effectively increased the duration of motor block and duration of analgesia.
Keywords: Spinal Anaesthesia, Bupivacaine, Clonidine.

[1]. Racle JP, B.A., Poy JY, Gleizal B. Prolongation of isobaric bupivacaine spinal anesthesia with epinephrine and clonidine for hip surgery in the elderly. Anesth Analg.1987;66:442–6.
[2]. Prakash S, Joshi N, Gogia AR, Prakash S, Singh R. Analgesic efficacy of two doses of intrathecal midazolam with bupivacaine in patients undergoing cesarean delivery. Reg Anesth Pain Med. 2006;31(3):221-6.
[3]. Gustafsson LL, Schildt B, Jackobson K. Adverse effects of extradural and intrathecal opiates:Repor t of a nationwide survey in Sweden. Br J Anaesth 1982; 54: 479-86.
[4]. Roelants F. The use of neuraxial adjuvant drugs (neostigmine, clonidine) in obstetrics.Curr Opin Anaesthesiol. 2006;19(3):233-7.
[5]. Sethi BS, Samuel M, Sreevastava D. Efficacy of analgesic effects of low dose intrathecal clonidine as adjuvant to bupivacaine. Indian J Anesth. 2007;51:415.

Abstract: As the call for enhanced collaboration among healthcare professionals continues to rise, there is a need for students to acquire the necessary knowledge & skills for a collaborative practice in their preregistration education. Individuals from different professions learn together in InterProfessional Education (IPE). IPE had started developing about 30 years before and in India it is still in infancy. The aim of IPE is to provide students and practitioners an opportunity to learn and develop attributes and skills required to work in an effective collaborative manner. Working together, learning with from and about each other, developing mutual respect and enhancing practice within profession are some of the characteristics of IPE. IPE provides a balanced milieu for students to share their views emphasizes the importance of multidisciplinary team approach and increases the critiquing and reflecting skills in students.
Keywords: Inter Professional Education (IPE), Health Professions education (HPE), Collaborative practice, Team Learning

[1]. Barr, H., Freeth, D., Hammick, M., Koppel, I., & Reeves, S. (2005). Effective Interprofessional Education: Argument, Assumption and Evidence: Oxford: Blackwell
[2]. Barwell, J., Arnold, F., & Berry, H. (2013). How interprofessional learning improves care. Nurs Times, 109(21), 14-16.
[3]. Bradshaw, M. J., & Lowenstein, A. J. (2008). Innovative Teach Strategies In Nursing and Related Health Professions (6 ed.): Jones & Bralette.
[4]. Centre For The Advancement Of Interprofessional Education. (2006). CAIPE reissues its statement of the definition and principles of interprofessional education (Vol. 26).
[5]. Centre for the Advancement of Interprofessional Education. (2008). Defining IPE. Retrieved 12th March 2015 from CAIPE website: http://www.caipe.org.uk/about-us/defining-ipe

Abstract: A uterine rupture is an obstetric catastrophe accounting for as many as 9.3% of maternal deaths1. A uterine rupture typically occurs during labor, but can also occur during antenatal period. There has been an observed shift in etiology from obstructed labour and multiparty towards rupture of cesarean section scar. Hence, we felt the need to study the rupture uterus in the hospital population, its etiological factors, complications, and treatment strategies, maternal and fetal outcome. All cases of rupture uterus managed in the Government Maternity Hospital (GMH), S.V. Medical College, Tirupati were studied during 2007-2009. Both complete and incomplete rupture uterus are included in the study. The incidence was 1 in 435 (0.23%) of all hospital deliveries. It was more in the Unbooked cases, those belonging to low socio economic status and in women with scarred uteri. The most common etiology was rupture of previous Lower Segment Cesarean Scar Lower Segment Cesarean Scar (LSCS) scar, followed by spontaneous and traumatic rupture. The most common form of management was rent repair with or without bilateral tubectomy (BT), followed by subtotal hysterectomy (STH) and total hysterectomy (TH). A Perinatal mortality of 58% with no maternal deaths was observed. The commonest cause of rupture was separation of previous cesarean scar in 62% of all rupture uterus cases. The incidence of rupture uterus in previous cesarean section deliveries was 1.4%. Early diagnosis and active surgical management will go a long way in reducing maternal and fetal mortality.
Key words: Lower Segment Cesarean Scar (LSCS), Rupture Uterus, Rent repair, Sub Total Hysterectomy (STH) and Unscarred Uterus

[1]. P. Rajaram, A. Agarwal and S Swami.. Determinants of maternal mortality: a hospital based study from South India. Indian J Matern Child Health 6(1),1995, 7–10.
[2]. Sahu Latika A. 10 year analysis of uterine rupture at a teaching institution. J Obstet Gynecol India . 56 ( 6), 2006, 502-506.
[3]. G.Justus Hofmeyr, L. Say and Metin Gülmezoglu. A. Systematic review: WHO systematic review of Maternal mortality and morbidity: the prevalence of uterine rupture. BJOG: An International Journal of Obstetrics & Gynaecology. 112, 2005, 1221–1228.
[4]. Ian Donald. Practical obstetric problems, BI publications Pvt Ltd, New Delhi 5th ed , 795 – 804 , (1996).
[5]. P.R Myercough. Munroker's Operative Obstetrics,441-52.

Abstract: Dentofacial appearance is the major determinant of over all physical attractiveness. Smile attractiveness includes a number of important components. Smile Arc includes the relationship of curvature of incisal edges of maxillary incisors and canines to curvatures of lower lip in posed smile. An ideal smile arc has maxillary incisal edges parallel to curvature of lower lip. This study carried out comparative analysis of different age group with smile arc and tooth arc for maxillary anteriors esthestics.150 dentate patients of 3 groups (50 each) of different age groups were selected . Photographs taken with a digital camera showing the subjects with a posed smile were used for this study. Adobe photoshop and Math GV FREEWARE Version 4.1 parabolas used to determine the best fit for tooth and lip arcs. There were statistically significant differences due to ethnicity and gender. Mean lip arc had greater curvature than mean tooth arc.
Keywords: Math GV FREEWARE Version 4.1 parabolas.

[1]. 1.Goldstein RE. Study of need for esthetics in dentistry. J Prosthet Dent 1969;21:589-98.
[2]. 2. Chalifoux PR. Practice made perfect. J Esth Restor Dent 1996;8:189-92.
[3]. 3.Kokich VO Jr, Kiyak HA, Shapiro PA. Comparing the perception of dentists and lay
[4]. people to altered dental esthetics. J Esthet Dent 1999;11:311-24.
[5]. 4.Kokich V. Esthetics and anterior tooth position: an orthodontic perspective, Part I:

Abstract: Variations of the branches of aortic arch are due to alteration in the development of certain branchial arch arteries during embryonic period. Knowledge of these variations is important during aortic instrumentation, thoracic, and neck surgeries. In the present study we observed these variations in 42 cadavers from North coastal Andhra Pradesh . In 40 cadavers, the aortic arch showed classical branching pattern which includes brachiocephalic trunk, left common carotid artery, and left Subclavian artery. But one cadaver showed Brachiocephalic trunk and Left subclavian artery are the only branches . Left common carotid is seen as a branch of brachiocephalic trunk. The aim of this study was to determine the anatomical basis needed for its surgical procedures. The branching pattern of the aortic arch was studied; diameters of its branches and the distance from their origin to the mid-vertebrae line were measured. In all of the cases, the brachiocephalic trunk, left common carotid and left subclavian artery originated independently. One of the variants had two branches, the left subclavian artery and a common trunk which incorporated the brachiocephalic trunk and left common carotid. There was a significant correlation between the diameters of brachiocephalic trunk and left subclavian artery. A significant strong positive correlation between the distances from the origins of left common carotid and left subclavian artery from the mid vertebrae line was found. The results in this study provide accurate information considered vital for vascular surgery.
Keywords: Variation, Aortic arch, Mid-vertebrae line.

[1]. H. A. Alsaif and W. S. Ramadan, ―An anatomical study of the aortic arch variations,‖ Journal of King Abdulaziz University, vol. 17, no. 2, pp. 37–54, 2010.
[2]. I.-Y. Shin, Y.-G. Chung, W.-H. Shin, S.-B. Im, S.-C. Hwang, and B.-T. Kim, ―A morphometric study on cadaveric aortic arch and its major branches in 25 Korean adults: the perspective of endovascular surgery,‖ Journal of Korean Neurosurgical Society, vol. 44, no. 2, pp. 78–83, 2008. View at Publisher ·View at Google Scholar · View at Scopus.
[3]. K. S. Satyapal, S. Singaram, P. Partab, J. M. Kalideen, and J. V. Robbs, ―Aortic arch branch variations—case report and arteriographic analysis,‖ South African Journal of Surgery, vol. 41, no. 2, pp. 48–50, 2003.View at Scopus
[4]. J. S. Gielecki, R. Wilk, B. Syc, M. Musiał-Kopiejka, and A. Piwowarczyk-Nowak, ―Digital-image analysis of the aortic arch's development and its variations,‖ Folia Morphologica, vol. 63, no. 4, pp. 449–454, 2004. View at Scopus
[5]. K. I. Natsis, I. A. Tsitouridis, M. V. Didagelos, A. A. Fillipidis, K. G. Vlasis, and P. D. Tsikaras, ―Anatomical variations in the branches of the human aortic arch in 633 angiographies: clinical significance and literature review,‖ Surgical and Radiologic Anatomy, vol. 31, no. 5, pp. 319–323, 2009.View at Publisher · View at Google Scholar · View at Scopus

Abstract: This paper discusses evaluation of Trans-Abdominal Ultra-Sound (TAUS) for the diagnosis of defects or abnormal thinning in the scarred lower uterine segment during 3rd trimester of pregnancy done as near to expected date of delivery (EDD) as possible so that selection of women for a trial of labor for vaginal birth after Caesarean Section (C-Section) (TOL-VBAC) can be done. The study population consisted of 103 women attending the antenatal clinic of this hospital. Of these, 22 were primigravidae (control group) and 81 were multi gravidae with 1 previous Lower Segment C-Section (LSCS) (test group). Each study included multiple measurements of the thickness of the anterior wall of Lower Uterine Segment (LUS) both in longitudinal and transverse sections. Minimum three readings were taken. An average of these was taken to be the thickness of LUS. Any asymmetry of the thickness of the LUS resulting in wedge defect was made. Patients were followed up to the time of delivery. Those delivered by LSCS were considered for the final analysis. During LSCS, the thickness of LUS was measured. The Ultrasound (U/s) and laparotomy findings were compared and the test parameters of TAUS were calculated. Positive and negative predictive value was 100%. An LUS with sonographic wall thickness < 3mm is abnormally thin. Study results suggest that TAUS is safe and reliable test with a high degree of specificity and sensitivity to diagnose defects, ballooning, and abnormally thin lower uterine segment. This will help obstetricians in deciding which patient may be allowed a TOL-VBAC.
Keywords: TAUS, LUS, Previous C-Sections, TOL-VBAC.

[1] F. Cunningham, Kenneth Leveno, Steven Bloom, et al, Williams Obstetrics (McGraw Hill Professional, 2014)
[2] Michaels WH, Thomson HO, Boutt A, et al, Ultrasound diagnosis of defects in the scarred LUS during pregnancy, Obstetrics and Gynecology, Journal of the American Academy of Obstetrics and Gynecology, 1988, 71: 112-120.
[3] Fukuda M, Fukuda K, Mochizuki M, Examination of previous Caesarean section scar by ultrasound, Archives Obstetrics and Gynecology, Springer International, 1988, 243
[4] Tanik A, Ustun C, Cil E, et al, Sonographic evaluation of the wall thickness of LUS in patients with previous Caesarean section. Journal of Clinical ultrasound, 1996
[5] Rozenberg P., Goffinet F., Philippe HJ, et al, Ultrasonographic measurement of LUS to assess risk of defects of scarred uterus, Lancet, 1996, 347.

Abstract: Yoga balances Autonomic nervous system: Autonomic nervous system consists of two limbs; sympathetic nervous system and parasympathetic nervous system. Although individual asan and pranayam practices can selectively affect sympathetic or parasympathetic nervous system, the overall effect of yoga practice is to bring a state of parasympathetic dominance. In present study effect of alternate nostril breathing (Nadishuddhi pranayama) for 12-weeks were studied in 60 healthy volunteers (both males and females). Alternate Nostril Breathing had beneficial effect on autonomic functions. There was no change in parasympathetic reactivity indicated by non-significant change in Valsalva ratio. Change in sympathetic reactivity was observed due to change in blood pressure response to hand grip test. Overall there is tilt towards parasympathetic dominance after practice of alternate nostril breathing. Considering the facts, it can be suggested that regular practice of type alternate nostril breathing can be prescribed to hypertensive patients (with proper monitoring) along with the medical therapy.
Keyword: Valsalva ratio, Alternate nostril breathing, Hand grip test, Blood pressure.

[1]. Sharma VK, Das S, Mondal S, Goswami U. Effect of Sahaj yoga on autonomic patients in healthy subjects and patients of major depression. Biomedicine 2008; 28: 139-141.
[2]. Raju PS, Madhavi S, Prasad KV. Comparison of effects of yoga and physical exercise in athletes. Indian J Med Res 1994; 100: 81-86.
[3]. Jain N, Srivastav R.D., Singhal A. The effects of Right and Left nostril breathing on cardiorespiratory and autonomic parameters. Indian J Physiol Pharmacol 2005; 49: 469-74.
[4]. Satyaprabha T.N., Murthy B.T.C. Efficacy of Naturopathy and Yoga in Bronchial Asthama, A self-controlled matched scientific study. Indian Journal of Physiology and Pharmacology 2001; 45(1): 80-86.
[5]. Vempati RP, Telles S. Yoga based guided relaxation reduces sympathetic activity judged from baseline levels. Psychol Rep 2002; 90: 487-494.