iosr-JDMS   Volume-14 ~ Issue-5 ~ May-2015

Abstract: Triplication of the gallbladder is a very rare congenital anomaly of the biliary tract; there are only eleven reported cases to date. Gallbladder multiplications are not likely to be discovered unless associated with cholelithiasis, sludge, cholecystitis and carcinoma. we hereby report an incidentally diagnosed triplicate gallbladder in a patient with abdomen pain; two of the triplicate gallbladder were demonstrated with ultrasound and was confirmed on MRCP , and an additional galballder was also appreciated. When a triplicate gallbladder is encountered, complete dissection of Calot's triangle and intraoperative cholangiographic evaluation should be performed to prevent damage to the biliary duct system. All three gallbladders should be removed to avoid unnecessary reoperation. All of this can be accomplished readily by laparoscopic surgery.

[1]. Muhammad Tahir Khadim, AmmaraIjaz, Usman Hassan, ShahnawarGulzarand SajidMushtaqTriple Gallbladder: A Rare EntityThe American Journal of Gastroenterology 106, 1861-1862 (October 2011) | doi:10.1038/ajg.2011.163 [2]. Nanthakumaran S1, King PM, Sinclair TSLaparoscopic excision of a triple gallbladder.SurgEndosc. 2003 Aug;17(8):1323. Epub 2003 Jun 13.AUTHOR(S)PUB. DATE
[3]. Khadim, Muhammad Tahir; Ijaz, Ammara; Hassan, Usman; Gulzar, Shahnawar; Mushtaq, SajidTriple Gallbladder: A Rare Entity American Journal of Gastroenterology;Oct2011, Vol. 106 Issue 10, p1861
[4]. BanuAlicioglu, An incidental case of triple gallbladder Department of Radiology, Trakya UniversitySchool of Medicine, Edirne 22030, Turkey43.sok, Edirne 22030, Turkey. World J Gastroenterol2007 April 7; 13(13): 2004-2006www.wjgnet.com World Journal of Gastroenterology ISSN 1007-9327

Keywords: Aim and objective: To study the factors affecting stage of diagnosis of breast cancer Methodoly: Descriptive observational study was carried out in a tertiary care center for the period of a whole year. Patients were interviewed using a semi structuredquestionnaire by the researcherhimself. Data was analyzed using SPSS v 20 software. Results and Discussion:More than 90% cases presented at stage 2and three .and only 3.3 % of cases presented at stage 1.which is considered as a stage at which cancer can be completely cured. When stage at presentation is categorized according to age of patient in our study, mean age at diagnosis is 54.71 years, 48.96 years, 52.43 years and 48.2 years at stage I, II, III and IV simultaneously.

[1]. World Health Organization. Ten statistical highlights in global public health. World Health Statistics 2007. Geneva: World Health Organization;2007.
[2]. Dollinger. M..Rosenbuam, EH. and Cable G. Dollinger. M., and Rosenbaiirn. EH.. (1991). Understanding cancer in: Everyones guide to cancer therapy ( pp 1 -9. .Universal Press Synd. Company, New York,. 1991;1–9.
[3]. Executive summary and overview. health , Health and Family Welfare Statistics in India 2013,Available from https://nrhm-mis.nic.in/familywelfare2013.html
[4]. GLOBOCAN Cancer Fact Sheets: Breast Cancer [Internet]. WHO Int. Agency Res. Cancer. 2008 [cited 2013 Oct 29]. p. 1 –4. Available from: http://globocan.iarc.fr/factsheet.asp
[5]. Selected health statistics of india [Internet]. Heal. Stat. india. 2008 [cited 2012 Oct 22]. Available from: 1. http://www.ucms.ac.in/Selected health statistics of India- October 2012.pdf

Abstract:Intra-abdominal desmoids are rare neoplasms. The aggressive nature of these tumours and the potential for major morbidity secondary to resection can present a difficult surgical dilemma. We report an unusual giant mesenteric desmoid fibromatosis which involved both ileum and transverse colon,which is first of its kind case . A 58year old female presented with vague fullness in lower abdomen and ill defined mass on ultrasound abdomen. Diagnostic laparoscopy was done. A giant desmoid was localized in mesentery of ileum and abutting anterior wall of transverse colon. Complete resection of tumour was accomplished along with involved ileum and part of transverse colon.
Key Words: Desmoid fibromatosis, ileum and transverse colon, laparoscopy,complete resection.

[1]. Einstein DM, Taglaibue JR, Desai RK, Abdominal desmoids:CT findings in 25 patients. AJR1991;157:275-279].
[2]. Fletcher CDM, Unni KK, Mertens F.Pathology and Genetics of Tumours of Soft Tissue and bone.World Health Organization Classification of Tumours. Lyon, France: IARC Press; 2002:83-84.
[3]. Hosalkar HS, Torbert JT, Fox EJ et al .Musculoskeletal desmoids tumorsJ Am AcadOrthop Surg. 2008 Apr; 16(4):188-98.
[4]. Pakos EE, Tsekeris PG, Goussia AC.Desmoidtumours of extremities and trunk: a review of literature.IntOrthop. 2005 Aug;29(4):210-3.
[5]. Stollwerck P.L., Namdar T, Bartscher T.Stang, F.H.et al.A rare desmoids tumour of the shoulder -excision,implantation of brachytherapy applicators and wound closure by pedicle musculuslatissimus dorsi flap. P. GMS German Medical Science.2011; 9.

Abstract: Background: Studies prove that epidural analgesia is superior to other modes of labour analgesia. However the rising concerns of side effects has overshadowed its merits. Objectives: Study A: To compare the cases of assisted vaginal delivery and matched controls of spontaneous vaginal delivery and to study its association with mode of analgesia. Study B: To compare the cases of caesarean section delivery and matched controls of Spontaneous vaginal delivery and to study its association with mode of analgesia.

[1]. Moir DD, Extradural analgesia for caesarean section, British Journal of Anaesthesia, 51(2), 1979, 79-80 [2]. American College of Obstetricians and Gynecologists Committee on Obsteteric Practice,Analgesia and cesarean delivery rates. [3]. ACOG Committee Opinion No. 339, June 2006. Obstet Gynecol 2006;107:1487
[4]. Reynolds F, Sharma S K, Seed PT, The effects of maternal labour analgesia on foetus, Best Practices and Research Clinical Obstetric and Gynaecology,24(3), 2010, 289-302
[5]. C.R.Cambic and C.A. Wong, Labour analgesia and obstetric outcomes, British Journal Of Anaesthesia, 105(1), 2010, 150-160 [6]. Young Shin, MD; Weijia Yan, MD; Philip Balestrieri, MD; Joseph Collea, MD, Effect of Epidural Induced Motor Blockade on Intrauterine Pressure during Maternal Expulsive Efforts, Anesthesiology, 93(3A), 2000, A-1095

Abstract: Laughter and Humour are unique evolved human characteristics with neurobehavioral influences. Pain was induced among 25 Male adolescent subjects by cold pressor test during which pain appraisal and pain threshold were recorded for 3 consecutive trials as before, during, after watching a humorous video. Smiling efficiency and VAS (visual pain analogue scale) which reflects the pain experience was noted. Sense of humour score was assessed and the data was analyzed using SPSS software 15.0.

[1]. (Mosby‟s dental dictionary, 2nd Ed , 2010)
[2]. Margaret Stuber; Laughter, Humor and Pain Perception in Children: A Pilot Study, Advance Access Publication 5 October 2007; 2009;6 (2) 271–276.
[3]. May McCreaddie, Humour in health-care interactions: a risk worth Taking, 2011 Blackwell Publishing Ltd Health Expectations Owen H lynch, humorous communication finding a place for humor in communication research, International communication association, November 2002,Pg. no;423-445
[4]. Graeme Ritchie,Current Directions in Computational Humour, 7th IEEE International Workshop on Robot and Human Communication, Takamatsu, Japan, October 1998.

Abstract: Abstract :Objective of the study:to analyse the effectiveness of the treatment procedure for congenital hernia in our hospital.Material and methods:all cases of congenital hernias operated betweenjanuary 2008 to march 2011 were analysed(both elective and emergency).various factors like age, sex ,presentation ,side, pre op evaluation, anesthesia, duration of surgery, and post operative period were compared and analysed .conclusion:elective open hernia repair is a safe peocedure for children ,and this study indicates quick elective surgery immedietly after diagnosed gives good results.

Keywords: Congenital hernia, inguinal hernia

[1]. Groff D, Nagaraj HS, Pietsch JB. Inguinal hernias in premature infants who were operated on before their discharge from the neonatal intensive care unit. Arch Surgery. 1985;120:962 [2]. Grosfeld JL, Minnick K, Shedd F, West KW, Rescorla FJ, Vane DW. Inguinal hernia in children: the factors which affected the recurrence in 62 cases. Journal of Paed Surgery.1991:283–87. [3]. Sawicka E1, Boczar M, Stankiewicz J, Walczak-Wojtkowska I, Woynarowska M.Inguinal hernia in preterm infants - therapeutic problem for neonatologist, anaesthesiologist and paediatric surgeon. ku Rozwoj. 2008 Jan-Mar;12(1):449-55.
[4]. Lym L1, Ross JH, Alexander F, Kay R. Risk of contralateral hydrocele or hernia after unilateral hydrocele repair in children. J Urol. 1999 Sep;162(3 Pt 2):1169-70
[5]. Tim Bax, Brett C. Sheppard, Richard A. Crass. Surgical Options in the Management of Groin Hernias. Am Fam Physician. 1999 Jan 1;59(1):143-156.

Abstract: Dry eye has become one of the most important factors influencing quality of Life (QOL) in elderly patients. Cataract surgery is the most successful and rewarding surgery in the field of ophthalmology. In spite of a perfect cataract surgery and a good Snellen's visual acuity the patients may remain dissatisfied due to aggravation of dry eye disease after surgery. Objectives: To find out the clinical profile of the patients undergoing cataract surgery and to compare the visual acuity before and after cataract surgery of these patients.

[1]. Srinivasan, R, Agarwal V, Suchismitha T, and Kavitha S. Dry eye after Phacoemulsification. AIOC Proceedings. 2008.
[2]. Cho YK, Man Soo Kim. Dry Eye After Cataract Surgery and Associated Intraoperative Risk Factors. Korean J Ophthalmol. 2009 June; 23(2): 65–73.
[3]. Li XM, Hu L, Hu J, and Wang W. Investigation of Dry Eye Disease and Analysis of the Pathogenic Factors in Patients after Cataract Surgery. Cornea. 2007; 26(Suppl. 1): S16-S20.
[4]. Ram J, Sharma A, Pandav SS, Gupta A, Bambery P. Cataract surgery in patients with dry eyes. J. Cataract Refract Surg. 1998 Aug; 24(8): 1119-24.
[5]. Ram J, Gupta A, Brar GS, Kaushik S, Gupta A. Outcomes of phacoemulsification in patients with dry eye. J Cataract Refract Surg. 2002 March; 28: 1386-1389.

Abstract: Long bone fracture fixation has undergone a series of developments over the years, with the use of locked intramedullary nails now being widely accepted as the treatment of choice for most long bone fractures. The challenge in the use of these locked nails has been in the accurate targeting of the screw holes to enable passage of the locked screws. The use of intraoperative imaging such as the C arm is a tool used to assist accurate screw hole targeting. Incentres that do not have such imaging assistance, the use of external jig systems are employed for screw hole targeting.

[1]. Moor BK, Ehlinger M, Arlettaz Y. Distal locking of femoral nails. Mathematical analysis of the appropriate targeting range. Orthopaedics & traumatology, surgery & research : OTSR. 2012;98(1):85-9.
[2]. Anastopoulos G, Ntagiopoulos PG, Chissas D, Papaeliou A, Asimakopoulos A. Distal locking of tibial nails : a new device to reduce radiation exposure. Clinical orthopaedics and related research. 2008;466(1):216-20.
[3]. Babis GC, Benetos IS, Zoubos AB, Soucacos PN. The effectiveness of the external distal aiming device in intramedullary fixation of tibial shaft fractures. Archives of orthopaedic and trauma surgery. 2007;127(10):905-8.
[4]. Gugala Z, Nana A, Lindsey RW. Tibial intramedullary nail distal interlocking screw placement: comparison of the free-hand versus distally-based targeting device techniques. Injury. 2001;32 Suppl 4:SD21-5.
[5]. Baltov A, Mihail R, Dian E. Complications after interlocking intramedullary nailing of humeral shaft fractures. Injury. 2014;45 Suppl 1:S9-S15.

Abstract: Acne vulgaris is one of the most prevalent skin disease affecting face and the single most common reason for visits to dermatologists.1Various modalities of treatment like topical, systemic anti-bacterials, retinoids, sebostatics, have been used in the treatment of acne and nowadays, clinicians seek to employ new technologies in acne care like chemical peeling. Many clinicians have used various chemical peels for treatment of post acne scarring and hyperpigmentation mainly in lighter skin types. Mandelic acid peel is a newer modality for acne vulgaris and hence, it is worthwhile to study the efficacy of mandelic acid peels.

[1]. Taylor MB. Summary of Mandelic Acid for the Improvement of Skin Conditions. Cosmetic Dermatol. June1999:26-28.
[2]. Garg VK, Sinha S, Sarkar R. Glycolic acid peels versus Salicylic-Mandelic acid peels in active acne vulgaris and post-acne scarring and hyperpigmentation. Dermatol Surg. 2009; 35:59-65.
[3]. Thomas DR. Psychosocial effects of acne. J Cutan Med Surg. 2004; 8suppl4:3-5.
[4]. Al Robaee AA. Assessment of general health and quality of life in patients with acne using a validated generic questionnaire. ActaDermatovenerol Alp PanonicaAdrait. 2009; 18(4):157-64.
[5]. Kim RH, Armstrong AW. Current state of acne treatment: Highlighting lasers, photodynamic therapy, and chemical peels. Dermatol Online J. 2011; 17(3):2

Abstract: Objective: To determine the risk factors and to find out the obstetric and perinatal outcome in patients with placental abruptio. Study Design: Retrospective observational study. Materials and Methods: In present study 124 patients with abruptio placentae in third trimester were included. A detailed obstetrics history was obtained and maternal high risk factors were noted. Examination, investigation and detail of intrapartum, postpartum period and associated complications were recorded.

[1]. Tikkanen M. Placental abruption: epidemiology, risk factors and consequences. Acta Obstet Gynecol Scand 2011; 90:140.
[2]. Jabeen M, Gul F. Abruptio placenta: Risk factors and perinatal outcome. J Postgrad Med Inst 2004;18(4):669-679.
[3]. Pariente G,Wiznitzer A, Sergienko R, et al. Placental abruption: critical analysis of risk factors and perinatal outcomes. J Matern Fetal Neonatal Med 2011; 24:698.
[4]. Ananth CV, Oyelese Y, Yeo L, et al. Placental abruption in the United States, 1979 through 2001: temporal trends and potential determinants. Am J Obstet Gynecol 2005; 192:191.
[5]. Willium A,Lieberman E, Mittendorf R et al: Risk factors of abruption placentae. A J of Epidemiology 1991 ;134(9):965-72

Abstract: Sacrococcygeal pilonidal sinus is a source of one of the most common surgical problems among young adult. Pilonidal Sinus is associated with small midline pits behind the canal and over the sacrum and coccyx. The condition principally affects young people after puberty is more common in men than in women, principally affects while and rare in Black or Asian patients. Male gender, obesity,occupations requiring prolonged sitting, deep natal clefts, excessive body hair,poor body hygiene and excessive sweating were the main risk factors.

[1]. Armstrong J H Barcia P J: Pilonidal sinus disease. The conservative approach Arch Surg. 1994; 129914-17.
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[4]. Kronbag O Christiansen KZimmermann-Nielson C: Chronic pilonidal sinus disease: randomized trials with complete three year follow up Br. J Surg. 1985; 72; 303-304.
[5]. Hodges R M pilonidal Sinus,Boston Med, SurgJ; 103; 485-486,1880.

Abstract: Cerebral venous thrombosis is a rare but potentially fatal complication of pregnancy and the postpartum period. Pregnancy related risk factors include delivery by caesarean section, pre-eclampsia and eclampsia. The presenting symptoms can mimic those of a post-dural puncture headache and are easily misdiagnosed, especially in a parturient who has undergone regional anaesthesia.

[1]. Laros RKJ, Alger LS. Thromboembolism and pregnancy. Clin Obstet Gynecol 1979;22(4):871 – 878.
[2]. Flessa HC, Glueck HI, Dritschilo A. Thromboembolic disorders in pregnancy: pathophysiology, diagnosis, and treatment, with emphasis on heparin. Clin Obstet Gynecol 1974;17: 195 – 235.
[3]. Greer IA. Thrombosis in pregnancy: maternal and fetal issues. Lancet 1999;353: 1258 – 1265.
[4]. Department of Health, Welsh Office, Scottish Office Department of Health, et al. Why Mothers Die. Report on Confidential Enquiries into Maternal Deaths in the United Kingdom 1994–1996. London : TSO, 1998.
[5]. Coon WW. Epidemiology of venous thromboembolism. Ann Surg 1977;186: 149 – 164.
[6]. De Swiet M.. Thromboembolism. Clin Haematol 1985;14: 643 – 660.

Abstract: Background: Perforated duodenal ulcer is one of the commonest causes of acute abdomen. The incidence of perforation in duodenal ulcer is around 15%. Early diagnosis and surgical intervention definitely decreases the morbidity and mortality of patients with perforated duodenal ulcer. Aim: To study the clinico epidemiological features of duodenal perforation. 2. To study the prognostic factors influencing the outcome in patients with perforated duodenal ulcer. Material and Method: The study material consisted of 100 patients with duodenal perforation who presented as acute abdomen and were managed in Dept. of General Surgery in SVRR Govt. General Hospital, Tirupati. Results: Morbidity in duodenal perforation was inversely proportional to the duration of symptoms, age of patient, severity of dehydration and peritoneal cavity contamination.

Keywords: Abdominal pain, Perforated duodenal ulcer.

[1]. Boey J, Wong 1, Ong GB. Prospective study of operative risk factors in perforated duodenal ulcers, Ann Surg 1982;195:265.
[2]. Gray JG, Roberts AK et al Definitive emergency treatment of perforated duodenal ulcer. SurgGynecol Obstet. 1996 Dec; 143 (6) : 890-4.
[3]. Jordan PH, Thornby. Perforated Pyloroduodenal ulcers. Ann Surg 1995;221:479.
[4]. Sugawa K, Koyanagi N, Hashizume M, et al. Therapeutic strategies in performing emergency surgery for gastroduodenal perforation in 130 patients over 70 years of age. Hepatogastroenterology 2001;48:156.
[5]. Ripin V et al in 1999 showed that surgical treatment of perforated gastroduodenal ulcer showed excellent results (95.5%) where suture of perforation and selective proximal vagotomy were performed.

Abstract: This study attempts to investigate and identify the problems facing the students regarding the past simple and the past continuous tenses and to suggest suitable remedial procedures. In this study the researcher takes the students of semester eight at the Faculty of Arts who study English as a foreign language at the University of Shendi as a sample to carry out this study. A test was given to 40students who represent the whole class of the semester. The test results were analyzed by using (SPSS).

[1]. Anne SeatonandY. H. Mew (2007) Basic English Grammar (book 1) USA, Saddleback Educational Publishing
[2]. Eckersley C.E. & Eckersley J. M. 1981, a comprehensive English Grammar, Hong Kong, Longman group Limited.
[3]. Greenbaum S &Nelson G. (2002), An introduction to English Grammar, Pearson Education Limited
[4]. Martin Hewings, 2005, Advanced Grammar in Use, Cambridge University press, U.K.
[5]. Raymond, Murphy&Roann Altman, 1998, Grammar in Use, Cambridge University press, U.K.
[6]. Richard Side &Guy Wellman 2000, Grammar & Vocabulary, Pearson Education Limited, England
[7]. T. J. Fitikides1980, Common Mistakes in English, Longman group limited. London

Abstract: Colonoscopic perforation (CP) is widely recognized as one of the most serious complications following lower gastrointestinal endoscopies. Although CP is a rare complication, it is associated with a high rate of morbidity and mortality[1-5]. This unpleasant complication could result in operation, stoma formation, intraabdominal sepsis, prolonged hospital stay, and even death.

[1]. Lohsiriwat V, Sujarittanakarn S, Akaraviputh T, Lertakyamanee N, Lohsiriwat D,Kachinthorn U. Colonoscopic perforation: A report from World Gastroenterology Organization endoscopy training center in Thailand. World J Gastroenterol 2008; 14: 6722-6725

Abstract: The present study was conducted during the period from 1 December 2012 to 1 March 2013 and included eighty nine (89) samples of blood collected from pregnant women living in Diyala province. The result showed that thirty five (39.3%) pregnant women had the antibody immunoglobulin (IgG), and the highest ratio of rubella virus IgG was found in the age group 18-28 years. The results revealed that fourteen (40%) pregnant women had a one abortion and showed the highest titer of IgG, and 18 of them were from rural areas (51.4%) and 17 from urban areas (48.6%). The present study recommends that Rubella virus vaccination should be considered carefully in developing countries, due to the high seropositivity to rubella in our region but we do not recommend rubella vaccination in early childhood. Routine screening of ,mm,rubella is recommended for pregnant women in Iraq and all women whose rubella vaccination history is unreliable or those lack laboratory evidence of immunity should receive measles, mumps, and rubella vaccine (MMR vaccine) upon completion or termination of pregnancy and vaccinated women should be informed to avoid pregnancy for 28 days after vaccination.

Keywords: rubella, pregnant women, abortion, Diyala, Iraq.

[1]. Hay-JR, W.W., Levin, J.M., Sondheim, J.M., Deterding, R.R. (2007). Rubella. In: Current Diagnosis and Treatment in pediatrics. Sydor, A.M., Lebowitz, H. and carr, P.19th Ed. The MC Graw-Hill companies , Inc, pp: 1132-1133.
[2]. Levinson, W. (2006). Rubella. In: Review of Medical Microbiology and Immunology. Malley, J., pancotti, R. and Davis, K. 9th Ed. The McGraw-Hill companies , Inc, pp: 277-278.
[3]. Signore , C. (2001). Rubella. Journal of Pub Med, 8: 133-137.
[4]. Duszak, R.S. (2009). Congenital rubella syndrome-major review. Journal of the American Optometric Association, 80: 36-43.
[5]. Samantha Cooray, Li Jin and Jennifer M. Best. (2005). The involvement of survival signaling pathways in rubella-virus induced apoptosis, Journal of Virology, 2: 1.
[6]. Brooks, G.F., Butel, J.S. and morse, S.A. (2001). Rubella In: Medical Microbiology. Brooks, G.F., Butel, J.S. and Morse, S.A. 22th Ed. MC Graw - Hill, pp: 484-487.
[7]. Hockin, J.C, Macleod, E.B., Macphail, M. (1988). Immunity to rubella in prepubertal girls in prince Edward Island. Canadian Medical Association Journal, 139: 308-310.

Abstract: Background: Diabetes mellitus (DM) is a chronic and potentially disabling disease which is reaching an epidemic proportion in many parts of the world. The biggest impact of the disease is on adults of working age, particularly in developing countries and UTI is a common infection observed in diabetic patients and also associated with increased risk of certain complicated UTIs such as emphysematous pyelonephritis, emphysematous xanthogranulomatous pyelonephritis, renal/perirenal abscess. Such conditions are potentially life-threteaning and require early identification and prompt evaluation as well as management. AIM: The present study was an attempt to find out the clinical profile and complications of UTI in diabetic patients, in relation to the duration of diabetes mellitus.

[1]. Fauci AS, Kasper DS, Longo DL, Braunwald E, Hauser SL, Jameson JL, et al. Harrison's principles of internal medicine. United States; McGraw Hill: 2008.
[2]. Arul Prakasam KC, Dileesh Kumar KG, Vijayan M. A Cross Sectional Study on Distribution of Urinary Tract Infection and Their Antibiotic Utilisation Pattern In Kerala. Int J Pharm Tech Res 2012;4(3):1309-16.
[3]. Freiha FS, Messing EM, Gross DM. Emphysematous pyelonephritis. JCE Urol 1979;18:9.
[4]. Jayanth Kumar B, Manju Sri CH. Clinical evaluation of Urinary Tract Infections in patients with Diabetes mellitus. American Journal of Pharm Tech Research 2014; 4(3):335-43.

Abstract: During routine dissection, a liver from a cadaver of a female aged about 20 years who died in the peuriperial period was observed to have an anomalous right lobe; the shape, size and location of which differentiates it from Reidel's lobe. On posterior surface, an accessory caudate lobe was present to the left of main caudate lobe. It was separated by well-defined fissure from caudate lobe. The fissure for ligamentum venosum was present to the left of accessory caudate lobe. Porta hepatis was present below the new lobe. Prominent papillary process continued with caudate process which in turn is fused with right lobe of the liver. These developmental anomalies of liver may cause confusion during procedures like biopsy, transplantation, and lobectomies. This knowledge may be of immense use to clinicians for the diagnosis and management of hepatic diseases, morphologists and anatomists for new variant, and to embryologists for new developmental defect.

Keywords: Accessory caudate lobe, Anomalous hepatic lobe, Caudate lobe, Liver.

[1]. Susan Standring. Gray's Anatomy, The Anatomical Basis of Clinical Practice, 40th edition Churchil Livingstone; 2008
[2]. Z. A. Aktan, R. Savas, Y. Pinar, and O. Arslan, "Lobe and segment anomalies of the liver," Journal of the Anatomical Society of India, vol. 50, no. 1, pp. 15–16, 2001.

[3]. P. A. Wakefield, "Congenital malformation of the liver- absence of the lobus spigelii, rudimentary quadrate and left lobes with enlargement of the right lobe," Journal of Anatomy and Physiology, vol. 33, no. 1, pp. 50–53, 1898.

[4]. P. S. Friedman, L. Solis-Cohen, and S. Levine, "Accessory lobe of the liver and its significance in roentgen diagnosis," American Journal of Roentgenology, vol. 57, pp. 601–603, 1947. [5].

[5]C. G. Fraser, "Accessory lobes of the liver," Annals of surgery, vol. 135, no. 1, pp. 127–129, 1952.

Abstract: Background:Physiotherapy is a health care profession and Physiotherapist now a days working in a wide range of health related problems and dealing health related problems of every aspect in society and improving quality of life people. Physiotherapist needs autonomous authority in their field for independent practice. Physiotherapists are required to make independent referral and treatment decision and there is need for open referral in which patient will passed direct from physiotherapist from medical practitioners for physiotherapy treatment of patients

[1]. Odebiya, D.O, Evaluation of the mode of referral of physiotherapy by physicians, AJPARS,vol.2,no.1,june 2010,pp.14_20.
[2]. Apurv shimpi, Role of Physiotherapy in India",IMJ vol2 issue 2,may_aug 2014.
[3]. Jancis k .Denizs, Decisions made by physiotherapists: A study of private practitioners in Victoria hospital Australia, vol.33,no.3,1987.
[4]. Wai pong, Changes in medical referrals to an outpatient physiotherapy department, APJ,vol 40, no1, 1994.
[5]. Ann L Clawson, Content of physician Referrals to Physical Therapists at Clinical Education sites in Indiana, PTJ, vol 74, number 4/April 1994.

Abstract: Musculoskeletal disorders of the upper limb are a most important cause of ill-health, incapacity and health care expenditure. The purpose of this study is to determine the prevalence of Upper Limb Disorders associated with awkward posture and psychosocial factors among Universiti Putra Malaysia (UPM) workers. Simple random sampling was used to draw 271 participants from six faculties of the university. The use of a structured question was employed for data collection.

[1]. Leah, C. (2011). Exercises to reduce musculoskeletal discomfort for people doing a range of static and repetitive work. Norwich, England: HSE Books.
[2]. Bernaards, C. M., Ariëns, G. A., Simons, M., Knol, D. L., & Hildebrandt, V. H. (2008). Improving work style behavior in computer workers with neck and upper limb symptoms. Journal of Occupational Rehabilitation, 18(1), 87-101.
[3]. HSE (2013) Musculoskeletal Disorders in Great Britian 2013. Health and Safety Executive, Great Britian.Retrived (2014-12-10) from:http://www.hse.gov.uk/statistics/causdis/musculoskeletal/msd.pdf
[4]. Borle, A., Gunjal, S., Jadhao, A., Ughade, S., &Humne, A. (2012). Musculoskeletal morbidities among bus drivers in city of Central India. Age (Years), 46(06.69), 28-57.
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Abstract: Bilateral Sagital Split Osteotomy (BSSO) is one of the most common surgeries for the management of mandibular retrognathism. However, nerve damage and lip paresthesia is possible after the surgery. The aim of the present study was to evaluate the incidence of neurosensory disturbance after BSSO surgery. 42 patients in need of mandibular advancement participated in this study. The sensory status was evaluated by means of two point discrimination test (TPD) prior the surgery, 3 and 6 months after surgery. Data were analyzed in SPSS software using t-test and repeated measures tests. 41 patients with mean age of 22 years completed the study. TPD was significantly increased after 3 months (P-value < 0.05). However, TPD was reached the level of preoperative value after 6 months (P-value > 0.05). The main trigger annoyance in paresthesia was touching. Based on the results of the present study, neurosensory disturbance after mandibular advancement with BSSO technique was transitory and mostly resolved after 6 months.

Keywords: Bilateral Sagital Split Osteotomy, Lip Paresthesia, Mandibular Advancement, Neurosensory Disturbance, Two Point Discrimination Test.

[1]. R.J. NAPLES, J.E. VAN SICKLES, D.L. JONES, LONG-TERM NEUROSENSORY DEFICITS ASSOCIATED WITH BILATERAL SAGITTAL SPLIT OSTEOTOMY VERSUS INVERTED "L" OSTEOTOMY, ORAL SURG ORAL MED ORAL PATHOL, 77, 1994, 318-21.
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Abstract: The haematological parameters of newborn are amenable to certain changes under the influences of fetal, maternal & environmental factors. Here we analyse the effect of diverse fetal & maternal factors on haematological parameters of cord blood. A prospective study was undertaken for a period of 2 years. Different haematological parameters like Hb, TRBCs, TLC, PCV, TPC, MCV, MCHC, MCH, Reticulocyte count & nucleated red blood cell count were evaluated from 300 samples of cord blood. Cord bloods from babies delivered by NVD, at term & with birth weight of ≥2.5kg were taken as control group. Then the effect of factors like sex, parity, birth weight, gestational age, mode of deliverey & maternal haemoglobin on haematological parameters of cord blood were evaluated. Hb concentration, TRBC & PCV were having significant lower trend in case of female sex, multipara, ECS group & in preterm neonates. Higher MCH & MCHC values were observed in ECS group compared to NVD. High MCV values were observed in small for date, Preterm babies & early parity. Significant higher reticulocyte count & NRBC were observed in preterm & in ECS cases. Higher TLC was seen in preterm, SFD, NVD babies & early parity. Preterm showed significant lower TPC. This study showed that neonates are born with fairly constant haematological parameter with few variable parameters those affected by diverse fetal & maternal factors. Keywords: Cord blood, Fetal, Haematological, Maternal, Parameters.

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Abstract: The human body is a real work of art and the more one learns about the details of its function, the more awed one becomes. The thyroid gland is a perfect example of the magnificence of the human body and physiology. The thyroid is a small hormone producing gland in the body that produces just one important hormone – the thyroid hormone. It secretes active hormones influencing the diversity of metabolic process [1]. Diseases of the thyroid, includes a vast array of developmental, inflammatory, hyperplastic and neoplastic disorders are exceedingly common in clinical practice.

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[5]. Isabella Borget, Philippe Veilh, Sophie Leboullex, Mark Allyn, sylviane Iacobelli, Martin Schlumberger, Gerard de Pouvourville. Assessment of the cost of Fine- Needle Aspiration Cytology as a Diagnostic Tool in Patients with Thyroid nodules. Am J Clin Pathol 2008; 129: 763-71.

Abstract: To evaluate the capability of CT quantitative analysis reflecting the degree of ischemic necrosis and glucose metabolism level of non small cell lung cancer. Methods: 52 NSCLC cases, measuring the ischemia necrosis CT quantitative value (INCTQ) for NSCLC tumor on early enhancement CT images before surgery. Tumor specimen expressions of glucose transporter (Glut1) carbonic anhydrase (CAⅨ) were detected by immunohistochemistry.

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[5]. Airley R, Evans A, Mobasheri A, et al. Glucose transporter Glut-1 is detectable in perinecrotic regions in many human tumor types but not normal tissues: Study using tissue microarrays[J]. Ann Anat; 2010, 192 (3):133-138.

Abstract: Pharyngitis is the common disorder more in children than adults. Pharyngitis is common in the developing countries. In the United States pharyngitis is diagnosed in 11 million patients in emergency department and ambulatory setting annually. Viruses are frequently cause of viral pharyngitis, withadenovirus,rhinovirus,enterovirus,influenza A and B parainfluenza viruses.Streptococcuspyogenes group A(GAS) or group A beta hemolytic streptococcus(GABS) is the bacterial agent of acute pharyngitis.Fusobacteriumnecrophorum and Mycoplasma pneumonia also been reported. Virulence factors leads to pharyngitis,invasivedisease,acute rheumatic fever, and acute glomerulonephritis.Bacterial signs include pharyngealerythema,tonsillarenlargement, and grayish-whitish exudate covering the posterior pharynx and tonsillar pillars. Symptoms such as conjunctivitis, coryza,oralulcers,cough and diarrhea suggest a viral cause. Modified Centor score may be used for diagnosis. A 10 days course of penicillin remains treatment of choice, macrolide for penicillin allergic patients, amoxicillin has the advantage of less frequent dosing. Use of broad spectrum antibiotics thought to contribute to antibiotic resistance. Role of tonsillectomy or adenoidectomy in GBHS pharyngitis incidence is poorly understood.

Keywords: Pharyngitis, Pharyngotonsilitis,Rheumatic fever, Diagnosis, and Treatment.

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