iosr-JDMS   Volume-14 ~ Issue-9 ~ September-2015

Abstract: The Ministry of Health & Family Welfare, Govt. of India launched a national initiative - Janani Shishu Suraksha Karyakram (JSSK) on June,2011 to reduce infant & maternal mortality. However, the utilization of any scheme depends on the awareness among the beneficiaries. Objective: To study the level of awareness about various entitlements of JSSK among pregnant mothers and to examine the association between different socio-demographic factors and awarenesslevel. Methodology: It was a community based, observational,descriptive study; cross-sectional in design; conducted in three villages under Banspool sub-centre, North 24 Parganasduring May - July of 2015.All Antenatal Care registeredpregnant women ofthe study area during the study period constituted the study population. Mothers were selected applying inclusion and exclusion criteria.

[1]. Ministry of Health & Family Welfare. Guidelines for Janani-Shishu Suraks a Karyakram (JSSK). National Rural Health Mission , Maternal Health Division, Government of India, NirmanBhavan, New Delhi, June 2011
[2]. KabitaBarua. Awareness and utilisation of Janani ShishuS uraksha Karyakram (JSSK) in rural areas of Kamrup District, Assam.(Unpublished)
[3]. Johnson AR, Rock B, Catherin N, Berlin Sr, Rupini R, Kasthuri A. Awareness of Government Maternity Benefit Schemes among women attending antenatal clinic in a rural hospital in Karnataka, India. Int J Curr Res Aca Rev 2015; 3:137-43
[4]. Vikram K, Sharma AK, Kannan AT. Beneficiary level factors influencing Janani Suraksha Yojana utilization in urban slum population of trans-Yamuna area of Delhi. Indian J Med Res 2013;138: 340-6
[5]. Singh VS, Chavan SS, Giri PA, Suryavanshi SR. Study on awareness and knowledge regarding Janani Suraksha Yojana (JSY) among ANC registered women in a primary health centre of tribal area of Thane District of Maharashtra. Int J Res Med Sci 2014;2:122-6.

Abstract: Objectives: To know the aetiologies of dyspepsia, for patients who present with uninvestigated dyspepsia to surgical OPD. Material and Methods: The present study was conducted in M.K.C.G Medical College Hospital, Berhampur, in the department of Surgery during the period from September '06 to September '08. All the patients who presented with upper abdominal symptoms with or without alarm features were studied. Patients were withdrawn from all medications causing dyspepsia. Endoscopy was done in patients above 40 years of age, patients with dyspepsia more than one month, or in younger patients after treating them with empirical antisecretory therapy for one month and in whom symptoms persist.

[1]. Oralia V. Bazaldua, Pharm. D, et al, evaluation and management of dyspepsia, American family physician, October 1999.
[2]. Guidelines for the management of dyspepsia.NJ Talley, N. Vakil, and the practice parameter committee of the American College of Gastroenterology, American Journal of Gastroenterology, 2005, 100
[3]. M. Sarve, N.Osden, N. Turken et al, functional dyspepsia relationship between clinical subgroups and helicobacter pylori status, Brazilian Journal of medical and biological research, 2003
[4]. Shah SS, Bhatia SJ, Mistey FP, epidemiology of dyspepsia in general population in India, Indian Journal of gastroenterology, 2001, Vol-20, Issue-3
[5]. New guidelines on endoscopic treatment of dyspepsia, American Society for gastrointestinal endoscopy, Dec 2007.
[6]. Numans ME, van der Graaf Y, de Wit NJ, De Melker RA, how useful is selection based on alarm systems in requesting gastroscopy ? an evaluation of diagnostic determinants for gastroesophageal malignancy Scand J. gastroenterology, 36;437;2001.
[7]. Wallace MB, Durkalski VL, Vaughen J et al, age and alarm symptoms don't predict endoscopic findings among patient with dyspepsia, a multi center data base study, Gut 49,29,2001.

Abstract: Biofungicides are a viable alternative to chemical fungicides that decrease the risk of pathogens developing resistance in agriculture.Fungicide ingestion vary enormously in their potential for causing adverse effects in livestock but no data is available on human ingestion/poisoning.We report a case of Biofungicide poisoning containing plant alkaloids in a student following suicidal consumption manifested as pale peripheries,cyanosis,bluish discoloration of blood(ABG sample) and saturation gap.Methemoglobinemia was suspected which was successfully managed with Oxygen Supplementation,Inj.Methylene blue and other symptomatic management.

[1]. Managing Plant Diseases WithBiofungicides.Cathy Thomas,Integrated Pest Management Program, Pennsylvania Department ofAgriculturehttps://pubs.ext.vt.edu/2906/2906-1298/2906-1298.html
[2]. Edward J.Benz, Jr. Disorders Of Hemoglobin. In: Kasper DL, Loscalzo,Fauci AS, Hauser SL, Longo DL, Jameson JL, editors. Harrisons principles of internal medicine. 18th ed. McGraw-Hill; 2012. pp. 857–858.
[3]. The AyurvedicPharmacopedia of Indiab.Indian medicine plants acompendium of 600 species - PK Warier et al. c.Indian medicinal plants CP Ghare et al.http://www.medicinalplantdatabase.com/index.php/item/adhatoda-vasica
[4]. Khanna L. S.; Prakash R. (1983). Theory and Practice of silviculturalSystems. International Book Distributions.
[5]. "Global Invasive Species Database". Retrieved 2014-03-22 issg.org.uk.

Abstract: Maxillary Prognathism as defined as overextended maxillary bone in sagittal plane is a very common complaint encountered in the everyday orthodontic office. They can be addressed either by retraction of the maxillary dentition or orthopaedic movement of the basal bone or by the combination of both the methods. The problem becomes complex when prognathism gets accompanied by vertical maxillary excess (VME). Vertical malocclusion results from interplay of many etiological factors during growth period. These growth factors include growth of maxilla and mandible, variations in rate of growth in both the maxillary suture and mandibular condyles and dentoalveolar development with the eruption of the teeth.

[1]. Stephen F.Caldwell,T Alan Hymas."Maxillary traction splint: A cephalometric evaluation" - Am J Orthod Dentofacial Orthop 1984; 85(5): 376-384.
[2]. Stephen A. Schendel, Jerome Eisenfeld."The long face syndrome: vertical maxillary excess" - Am J Orthod Dentofacial Orthop 1976; 70(4): 398-408.
[3]. Stephen A. Schendel, Albertt E Carlotti Jr."Variations of total vertical maxillary excess" - Am J Orthod Dentofacial Orthop 1985; 43(8): 590-596.

Abstract: Communicable diseases are slowly getting controlled in low and middle income countries, and on the other side there is a significant rise in the numbers of non communicable diseases, including but not restricted to diabetes. As per the International Diabetes Federation (2013), approximately 50% of all people with diabetes live in just three countries named China (98.4 million), India (65.1 million) and the USA (24.4 million). The low levels of education and poor awareness of the disease in the country make its impact on health of their population.

[1]. World Health Report. Geneva: WHO [Internet]. 2002 [Last access: 2015 July 29] Available from http://www.who.int/whr/2002/en/ [2]. Bhusal CL, Singh SP. Prevalence of non-communicable disease in Nepal hospital based study.1st ed. Nepal Health Reasearch council; Dec; 2010.
[3]. Nahla KR Ibrahim, Hijazi NA. Prevalence and Determinants of Prehypertension and Hypertension among Preparatory and Secondary School Teachers in Jeddah; J Egypt Public Health Assoc Vol. 83 No. 3 & 4, 2008
[4]. Erick PN, Smith DR. Prevalence of tobacco smoking among school teachers in Botswana. Erick and Smith Tobacco Induced Diseases 2013. Available from: http://www.tobaccoinduceddiseases.com/content/11/1/24
[5]. Bhagyalaxmi A, Trivedi A, Jain S. Baseline survey for the assessment of prevalence of risk factors of NCDs in the gandhinagar district. j health popul nutr 2013 Mar;31(1):78-85
[6]. Khosropanah SH, Tahmasebi J, Zibaeenezhad MJ, Heydari ST, Zamirian M, Aghasadeghi K. Prevalence of Coronary Artery Disease Risk factors in Teachers Residing in Shiraz-Iran 2009. Iranian Cardiovascular Research Journal Vol.4, No.2 , 2010

Abstract: Objective: The aims of this study is to analyze the prevalence of anemia and evaluate the hematological parameters of subjects involved and study the type of anemia in various age groups. Methods: This study was carried out in Sir T Hospital Bhavnagar in January 2013 for a period of 1 month. Total 1350 cases were studied. The cases were indoor patient admitted in various wards in Sir T Hospital Bhavnagar. The sample for test were collected in EDTA tube. The slides were prepared and stained with field stain. The sample were run in hematology cell counter ABOTT CELL DYN 3700 and Abacus for hematology indices and other parameters. Microscopic examination of slides was done for peripheral smear examination and complete blood count estimation.

[1]. Kumar, Abbas, Fausto, Aster,Robins and Cotran, Pathologic Basis of Disease, Eight edition, Chapter 14.
[2]. WHO, UNICEF, and UNU, Iron Deficiency Anaemia: Assessment,Prevention and Control, A Guide for Programme Managers, WHO, UNICEF, UNU, Geneva, Switzerland, 2001, http:// www.who.int/nutrition/publications/micronutrients/anaemia iron deficiency/WHO NHD 01.3/en/index.html.
[3]. R. D. Baker, F. R. Greer, andCommittee onNutritionAmerican Academy of Pediatrics, ―Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0–3 years of age),‖ Pediatrics, vol. 126, pp. 1040–1050,2010.
[4]. World Health Organisation, Iron Deficiency Anaemia Assessment, Prevention, and Control, A Guide for Programme Managers, WHO, 2001.
[5]. World Health Organization. Definition of an older or elderly person. Retrieved August 29, 2010. http://www.who.int /healthinfo/ survey/ageingdefnolder /en/index.html.
[6]. Ferrucci L, Semba RD, Guralnik JM, Ershler WB, Bandinelli S, Patel KV et al. Proinflammatory state, hepcidin and anemia in older persons. Blood. 2010;115:3810-26.

Abstract: Maternal health care includes Antenatal, Intranatal care and Postnatal care. Quality intranatal care is critical to achieve the aim of a healthy mother and a healthy baby at the end of a pregnancy which is available only at health facility. Distance to reach the health facility is an important barrier for the institutional delivery. GVK Emergency Management and Research Institute (GVK EMRI), is emerge as blessings for expectant mothers to remove this kind of distance barrier. This study is done to know utilization of 108 EMRI Services and practice about health seeking behavior for institutional confinements in Gandhinagar district.

[1]. M Gupta, D Mavalankar, P Trivedi. A Study of referral system for Emoc in Gujarat. Research and Publications, Indian institute of Ahmedabad; June 2009.
[2]. Health Statistics Gujarat 2010-11. Vital statistic division. 2012.[Internet- Last access: 2015 July 25] Available from: http://www.gujhealth.gov.in/images/pdf/health_statistics_2010-11.pdf
[3]. Anna Jallow, Johanne sundby. Why is there low institutional delivery rates in the Gambia? Women's opinion. Thesis; May 2007
[4]. Priyanka Chaman. Impact of emergency medical support services on public health delivery system in Goa. BMC Proceedings .2012; 6 (Suppl 1):P.14
[5]. A S Singh. Health Delivery System and Utilization Pattern of Health services; 2013 Chapter 5
[6]. Navaneetham K., and Dharmalingam, A. Utilization of maternal health care services in Southern India. Social Science & Medicine; 2002; p.55.

Abstract: Objective: (1) To Find out the percentage of postmenopausal women attending gynaecological out patients department (OPD).(2) To find out the various gynaecological disorder and their incidence. Material and Methods: A prospective study was conducted at Kamineni Institute of Medical Sciences, Narketpally.One hundered fifty nine patients were included during study period. Data was analysed. Results: The most common gynaecological disorder was postmenopausal bleeding (n=80,50.31%) followed by urogenital infections (n=27, 16.98%) and pelvic organ prolapse (n=19, 11.95%).Out of total 80 patients with postmenopausal bleeding, 54 were benign and 26 malignant causes.Carcinoma of the cervix was the commonest malignancy in our study.

[1]. Census of india 2001. Available from: http://www.censusindia. gov.in/Census_Data_2001/India_at_glance/broad.aspx. Accessed 2 October 2009.
[2]. World Health Organization. Available from: www.whoindia. org/.../Health_Care_for_the_Older_INTRA_Country_Profile. pdf. Accessed 2 October 2009.
[3]. Lidor A, lsmajovich B, Confino E, David MP. Histopathological findings in 226 women with postmenopausal uterine bleeding. Acta Obstet Gynecol Scand 1986; 65:41-43.
[4]. Gredmark T, Kvint S, Hovel G, Mattson IA. Histopathological findings in women with postmenopausal bleeding. British J of Obstet & Gynecol 1995; 102:133-136.
[5]. Singh A &Arora S. The Red alert-postmenopausal bleeding. Obs& Gynae Today.2005; 10:592-93.
[6]. Opmeer BC, van Doom HC, Heintz AP, Burger CW, Bossuyt PM, Mol BW. Improving the existing diagnostic strategy by accounting for characteristics of women in the diagnostic work up for post menopausal bleeding. BJOG 2007; 114: 51-8.

Abstract: Fractures of the distal radius constitute about 15 % of all fractures treated in emergency department. Closed reduction and cast immobilization has been the mainstay of treatment of these fractures, but invariably it results in malunion, poor functional and cosmetic outcome.This study was conducted to examine the functional outcome of non comminuted extra-articular distal end radius fractures treated with closed reduction and percutaneous K-wire fixation with immobilization and early physiotherapy.

[1]. Bucholz RW, Heckman JD, Brown CM. Vol. 1. Philadelphia: Lippincot Williams and Wilkins; 2006. Rockwood and Green's Fractures in Adults; p. 910.
[2]. Gofton W, Liew A. Distal radius fractures: Nonoperative and percutaneous pinning treatment options. OrthopClin North Am. 2007;38:175–85. [PubMed]
[3]. Fernandez DL, Jupiter JB. New York, NY: Springer-Verlag; 1996. Fractures of the distal radius: A practical approach to management.
[4]. Fernandez DL. Correction of post-traumatic wrist deformity in adults by osteotomy, bone grafting and internal fixation.J Bone Joint Surg Am. 1982;64:1164–78. [PubMed]
[5]. Fernandez DL. Radial osteotomy and Bowers arthroplasty for malunited fractures of the distal end of radius. J Bone Joint Surg Am. 1988;70:1538–51. [PubMed]
[6]. Slagel BE, Luenam S, Pichora DR. Management of post traumatic malunion of fractures of distal radius. OrthopClin North Am. 2007;38:203–16. [PubMed]

Abstract: Osteoarthritis Affecting the Knee joint is the major cause of disability among elderly. It causes pain, Physical disability and reduced quality of life. This case study involving a 66 Year old obese man with Bilateral OA knees, of Grade II, following treatment with selective Yoga postures and Resisted Exercises using Physioball gets significant in that along with Weight reduction, Improved Strength of Hips and Knees, improved WOOMAC scale score, he is now able to perform floor level activities and walk for more than ½ an hour. Hence combining Physioball Exercises with Yoga is effective in promoting quality of life in subjects with OA Knee.

[1]. Gracia. S, baleen. D, Obesity Risk factor and predictors of on Lijec Vjesn 2009; 131:22-6.
[2]. Altmen RD, Early management of OA, Amj Manag Care 2010; 16 541-7.
[3]. Gohlam. A Ghasemi, Ainal of Hata yoga on Knee OA, Intjpremed 2013:4, 5133-5138.
[4]. Lawren K. King, Lyn Moych Anqrthila Ananda Coomarasamy 2013 obesity and Osteoarthritis, IJ med Rej 138, Aug 2013, PP 185-193.
[5]. Coggon, D, Reading I, Croft P, MC Laren M, Barrett D, Cooper C, Knee Osteoarthritis and Obesity. Int J Obes related Metabolism disorder 2001; 25:622-7.
[6]. Z Hang w, Nuki G, Markowitz RW etal, OARSI re communication for the management of Hip and Knee OA. Part III changes in evidence following systematic cumulative update of research Jan 2009, OA cartilage 2010: 14(4): 479-99.

Abstract: Background and Objectives: Organophosphorous compound [OPC] poisoning is an acute medical emergency , more commonly encountered in India and other developing countries. Due to its easy availability and usage as a pesticide in agricultural fields , OPC poisoning is seen more among farmers. The present study aims to describe the clinico-epidemiological profile and outcome of patients of OPC poisoning reported to a tertiary care hospital , Puducherry. Materials and Methods: This retrospective study evaluated the case records of patients above 12 years with OPC poisoning admitted to our hospital over last 3 year and data regarding age, gender, socioeconomic status, type of Organophosphorous compound , severity of clinical presentation, incidence of paralysis, treatment modalities, complications, duration of hospitalization and mortality were entered into a pre-defined proforma. The data was analyzed using SSPS software.

[1]. Ballantyne B. Marrs TC. Overview of the biological and clinical aspects of organphosphates and carbamates. In : Ballantyne B. Marrs TC, editors. Clinical and experimental toxicity of organphosphates and carbamates. Oxford. Butterworth Heineman, 1982;3-14.
[2]. Eddleston M. Patterns and problems of deliberate self poisoning in the developing world. QJ Med 2000;93:715-31.
[3]. Leon-s- Fidas E, Pradilla G et al : Neurological effects of organophosphorous pesticides. BMJ 1996; 313 : 690-691.
[4]. Semir Nouira, Fekri Abroug , Souheil Elatrous, Rafik Boujdaria , Slah Bouchoucha. Prognostic value of serum Cholinesterase in Organophosphorous Poisoning in patients of University Hospital. Chest 1994;106;1811-1814. Doi 10.1378/chest.106.6.1811.106
[5]. Eddleston.M, Mohamed, Davies, Eyer P, Worek, Sherrif, Buckley. Respiratory failure in acute Organophosphorous pesticide self-poisoning . A randomized controlled trial. Q J Med 2006; 99:513-522. Doi:10.1093/qjmed/hcl065.
[6]. Murat Sungur, Muhammed Guven. Intensive care management of organophosphate insecticide poisoning . A retrospective study from Turkey. Crit Care. 2001; 5[4]: 211-215. Published online 2001 may 31.

Abstract: Background: Keloids are the most commonly encountered cases for a plastic surgeon. They result from an abnormal fibrous wound healing process in which tissue repair and regeneration-regulating mechanism control is lost. These abnormal fibrous growths present a major therapeutic dilemma and challenge to the plastic surgeon because they are disfiguring and frequently recur. Objective: To study the various methods of management of keloids of the ear lobe like intra-lesional triamcinolone injections, surgery or in combination and their outcome in patients of plastic surgery and dermato-venereology department at Osmania General Hospital, Hyderabad, Telangana, India between the years 2012-2015.

[1]. Dolores Wolfram, MD, Alexandar Tzankov, MD, Petra Pu¨ Lzl, MD, And Hildegunde Piza-Katzer, MD. Hypertrophic Scars and KeloidsFA Review of Their Pathophysiology, Risk Factors, and Therapeutic Management: Dermatol Surg 2009; 35:171–181
[2]. Segev F, Jaeger-Roshu S, Gefen-Carmi N, Assia EI. Combined mitomycin C application and free flap conjunctival autograft in pterygium surgery. Cornea 2003; 22:598–603.
[3]. English RS, Shenefelt PD. Keloids and hypertrophic scars. Dermatol Surg 1999; 25:631–8.
[4]. Nemeth AJ. Keloids and hypertrophic scars. J Dermatol Surg Oncol 1993; 19:738–46.
[5]. Jalali M, Bayat A. (2007) Current use of steroids in management of abnormal raised skin scars. Surgeon. 5:175–80.
[6]. Boyadjiev C, Popchristova E, Mazgalova J. (1995) Histomorphologic changes in keloids treated with Kenacort. J. Trauma. 38:299–302.

Abstract: Background: Diabetic cheiroarthropathy is a term derived from the Greek word "cheiros" meaning "of the hand", It is characterized by stiff hands with distinctively thick, tight, and waxy skin, especially on the dorsal aspects of the hands. It is part of long term complication of diabetes and many suggest it is associated with microvascular complication. The aim of the study was to determine the prevalence of diabetic cheiroarthropathy in Iraqi patients with diabetes, and to study its association with diabetic retinopathy and glycemic control.

[1]. Crispin JC, Alcocer-Varela J, Rheumatologic manifestations of diabetes mellitus. Am. J. Med. 2003;114: 753– 57.
[2]. Sauseng S, Kästenbauer T, Irsigler K. . Limited joint mobility in selected hand and foot joints in patients with Type 1 diabetes mellitus: A methodology comparison. Diabetes Nutrition and Metabolism, 2002; 15: 1−6.
[3]. Smith LL , Burnet SP, McNeil JD . Musculoskeletal manifestations of diabetes mellitus. Br. J. Sports Med. 2003;37: 30–35
[4]. Rosenbloom AL . Skeletal and joint manifestations of childhood diabetes. Pediatr. Clin. North Am.1984; 31, 569–589.
[5]. Rosenbloom AL, Silverstein JH. Connective tissue and joint disease in diabetes mellitus. Endocrinol Metab Clin North Am
[6]. 1996;25:473–83.

Abstract: The study reports the abnormal origin of the left vertebral artery from the aortic arch during routine dissection of a male cadaver aged about 40 years. The right vertebral artery originated from the subclavian artery and had normal course and branches. The left vertebral artery originated from the aortic arch between the origin of left subclavian and left common carotid artery. Thus, the aortic arch had four branches: left subclavian artery, left vertebral artery, left common carotid artery and brachiocephalic trunk. The diameter of the vertebral artery was smaller than the other branches of the aortic arch. The left vertebral artery had normal course upwards towards the foramen transversarium of the 6th cervical vertebra. The length of the prevertebral segment of the left vertebral artery was about 9 cm.

[1]. Moore KL. The Developing Human. Clinically Oriented Embryology. 3rd Ed. WB Saunders, Philadelphia. 1982; 291–318.
[2]. Matula C, Trattnig S, Tschabitscher M, Day JD, Koos WT. The course of the prevertebral segment of the vertebral artery: anatomy and clinical significance. Surg Neurol. 1997; 48: 125–131.
[3]. Gluncic V, Ivkic G, Marin D, Percac S. Anomalous origin of both vertebral arteries. Clin Anat. 1999; 12: 281–284.
[4]. Mahmutyazicioglu K, Sarac K, Boluk A, Kutlu R. Duplicate origin of left vertebral artery with thrombosis at the origin: color Doppler sonography and CT angiography findings. J Clin Ultrasound. 1998; 26: 323–325.
[5]. Nonami Y, Tomosawa N, Nishida K, Nawata S. Dissecting aortic aneurysm involving an anomalous right subclavian artery and isolated left vertebral artery: Case report and review of the literature. J Cardiovasc Surg (Torino). 1998; 39: 743–746.

Abstract: Background and aims: Clonidine is added to intrathecal local anaesthetics to improve intraoperative analgesia and to increase the duration of sensory and motor block. Aim of this study was to evaluate and compare the effect of addition of two different doses of clonidine {25microgram and 50 microgram} to 15mg hyperbaric bupivacaine in patients undergoing surgeries under spinal anaesthesia. Material and Methods: Ninty patients enrolled in the study were randomly divided into three group of 30 each. Group A received 15 mg hyperbaric bupivacaine, where as group B and C received 25 mcg and 50 mcg clonidine respectively as an adjuvant to 15 mg hyperbaric bupivacaine. The volume of solution was kept constant to 3.5ml by adding saline wherever needed.

[1]. Fogarthy DJ, Carbine UA, Milligan KR. Comparison of analgesic effects of intrathecal Clonidine & intrathecal morphine after spinal anaesthesia in patients undergoing total hip replacements. British Journal of Anaesthesia 1993;71,661-4.
[2]. Yaksh TL, Reddy SV. Studies in primate on the analgesic effects associated with intrathecal action of opiates, alpha adrenergic agonist & baclofen. Anaesthesiology 1981;54:451-67.
[3]. Liu S, Chiu AA, Neal JM, et al. Oral Clonidine prolongs lignocaine anaesthesia in human volunteers. Anaesthesiology 1995;82:1353-9.
[4]. Butterworth JF, Brownlow RC, Leith JP, et al. Bupivacaine inhibits CAMP production : a possible contributing factor to cardiovascular toxicity. Anaesthesiology; 85:336-342
[5]. David LB. Spinal, epidural and caudal anesthesia. In:Miller RD,editor. Millerʹs Anesthesia,6th ed,vol.2.Philadelphia: Churchill Livingstone;2005.p.1653-83.

Abstract: Introduction: We wish to present an interesting case of a male patient who consumes alcohol occasionally and with history of diabetes since 4 years. He came to our OPD with complaints of gradually increasing abdominal distension since two months. Methods: The patient was admitted for evaluation. Clinical examination revealed moderate ascites. There was no other significant findings. All routine investigations were done. Ascitic fluid cell count was 8640 cells/cu.mm with 60% lymphocytes. Ascitic fluid Adenosine Deaminase (ADA) was 34.5U/L (cut off 30U/L). US abdomen was suggestive of gross ascites and mild coarsening of liver echotexture. MRI abdomen was suggestive of chronic liver disease with moderate ascites and omental thickening.

[1]. Lee Goldman, Andrew I Schafer, Guadalupe Garcia-Tsao: Cirrhosis and its sequelae;Cecil text book of medicine;chapter 156:999-1006 25th edition, Saunders An Imprint of Elsevier.
[2]. Longo, Fauci ,Kasper, et al., editors. Harrison‟s principles of internal medicine 18th ed. New York McGraw Hill 2012.
[3]. Tuberculosis In Liver Cirrhosis:Rajesh Upadhyay, Aesha Singh, Delhi Medicine Update 2012 volume 22 pages 476-478
[4]. Peritoneal tuberculosis K. Mimidis, K. Ritis, G. Kartalis Annals Of Gastroenterology, 2005, 18(3):325-329
[5]. F. M. Sanai & K. I. Bzeizi Systematic review: tuberculous peritonitis – presenting features, diagnostic strategies and treatment Division of Hepatology, Department of Internal Medicine, Riyadh, Saudi Arabia Aliment Pharmacol Ther 2005; 22: 6
[6]. Dineen P, Homan WP, Grafe WR. Tuberculous peritonitis:43 years‟ experience in diagnosis and treatment. Ann Surg 1976; 184: 717–22.

Abstract: The purpose of this study was to determine the prevalence of plaque, gingival bleeding and amount of calculus in a group of patients attended department of periodontics at University of Sulaimani/ School of Dentistry in 2013. Methodology: data collected from patient's records, the study sample consisted of 301 patients attended to Department of Periodontics - the School of Dentistry at University of Sulaimani, 169 male and 132 female, aging from 15 to 60 years old. The sample was divided into several groups according to age and sex, Plaque index, bleeding index and calculus index were used to determine the periodontal health condition for the sample.

[1] Nancy A, Bossahardt DD. Structure of periodontal tissues in health and disease. Periodontology 2000 2006; 40:11-28.
[2] Hughes FJ, Seymour KG, Turner W, Shahdad S, Nohl F. Clinical problem solving in periodontology and implantology. 1st ed. Churchill Livingstone: Elsevier; 2013.
[3] Nield-Gehrig JS. Dental plaque biofilms. Journal of dental hygiene: 2005; 14(1): 13-17
[4] Rosen PS. Treatment of plaque-induced gingivitis, chronic periodontitis, and other clinical conditions. J Periodontol 2001;72:1790-1800.
[5] Savage Amir, Eaton KA, Moles DR, Needleman I. A systematic review of definitions of periodontitis and methods that have been used to identify this disease. J Clin Periodontol 2009; 36: 458–467.
[6] American Academy of Periodontology. Parameter on Plaque-Induced Gingivitis. J Periodontol 2000;71:851-852.

Abstract: Recurrent respiratory papillomatosis (RRP) is caused by Herpes papilloma virus (HPV) infection of the throat. RRP is categorized into juvenile-onset (JORRP) and adult-onset (A0RRP) based on diagnosis before or 12 years of age respectively. The incidence rate of RRP a disease of larynx estimated to be 4.3 per 100,000/year for juvenile-onset and 1.8 per 100,000/year for adult-onset. The disease has been observed in patients during postnatal period and in patients as old as 84 years. Respiratory papillomatosis is the most common benign neoplasm of the larynx in children with tendency to recur and spread to the respiratory tract. Rapid growth of lesions often necessitates surgical incision to avoid asphyxiation. Children are frequently misdiagnosed as asthma, bronchitis or croup.

[1]. National Institute of Deafness and other Communication Disorders .http: // www. nidcd.nih.gov/health/voice/laryngeal.asp.
[2]. James William D,Berger Timothy G,etal.Andrews' Diseases of the Skin:ClinicalDermatyology.Sanders Elsevier.2006. ISBN 0-7216-2921-0.
[3]. Goon P,SonnexC,Jani P.et al.Recurrent respiratory papillomatosis:an over view of current thingking and treatment.Eur Arch 0torhinolarygol.2008;265:147-51.
[4]. Dickens P,SrivastavaG,LokeSL,etal.Human Papillomavirus 6,11,and 16 in laryngeal papiollomas.J.Path.1991;165:243-6.
[5]. DerkayCS.Task force on recurrent respiratory papilloma.Arch 0tolaryngol Head NeckSurg.1995;121:1386-91.
[6]. DerkayCS,DarrowDH.Recurrent respiratory papillomatosis.Am 0tolaryngol.2006;115:1-11.

Abstract: Trauma remains a major social and health problem. Abdominal injuries have existed as long as the mankind. It can be concluded from thisstudy that blunt trauma abdomen due to road traffic accidents was found to have peak incidence in young population with male preponderance which shows that such accidents are common in persons with more outdoor activities. Urban population was more involved as compared to rural population. Common modes of injury were fall either from two wheeler or four wheeler, striking of pedestrian by two wheeler and two & four wheeler collision.

[1]. WHO data's: Internet source – http:/www.emedicine.com/EMERG/topic
[2]. Murray CJ, Lopez AD .Alternative projections of mortality and disability by cause 1990 – 2020: Global Burden of Disease Study. Lancet. May 24 1997; 349 (9064):1498-504, 1269-76.
[3]. Feliciano DV. Diagnostic modalities in abdominal trauma. Peritoneal lavage, ultrasonography, computed tomography scanning, and arteriography. Surg Clin North Am 1991; 72:241-56.
[4]. Powell DC, Bivins BA, Bell RM. Diagnostics peritoneal lavage. Surg Gynec, Obstet. Aug 1982; 155 (2):257-64.
[5]. Root HD, Hauser CW, Mc Kinley CR, et al. Diagnostic peritoneal lavage. Surg May 1965; 57:633-7.
[6]. Engrave H, Benjamin CI, and et al. Diagnostic peritoneal lavage in blunt trauma abdomen .J of Trauma 1975; 15:854.

Abstract: We present a case of a 15-year-old male patient with anaplastic ependymoma of the spinalcord. The patient presented with limbs weakness and urinary incontinence. These symptoms led to a CT brain followed by MRI radiological intervention which revealed intramedullary spinal lesion in C2 to T4. He had tumour resection done. Unfortunately his condition deteriorated post operation and died one month later. Our diagnostic experience in the management of this case may provide a good references for others.

Keywords: anaplastic ependymoma;spinal cord;adolescent.

[1]. GODFRAIND, C. 2009. Classification and controversies in pathology of ependymomas. Childs NervSyst, 25, 1185-93.
[2]. GUPPY, K. H., HOU, L., MOES, G. S. & SAHRAKAR, K. 2011. Spinal intradural, extramedullary anaplastic ependymoma with an extradural component: Case report and review of the literature. SurgNeurolInt, 2, 119.
[3]. LEFTON, D. R., PINTO, R. S. & MARTIN, S. W. 1998. MRI features of intracranial and spinal ependymomas. PediatrNeurosurg, 28, 97-105.
[4]. MCLENDON RE, W. O., KROS JM, KORSHUNOV A, NG HK 2007a. Anaplastic Ependymoma. In: LOUIS D, O. H., WIESTLER OD, CAVENEE WK (ed.) WHO Classification of Tumours of the CentralNervous System. 4th ed. Lyon: International Agency for Research on Cancer (IARC).
[5]. MCLENDON RE, W. O., KROS JM, KORSHUNOV A, NG HK 2007b. Ependymoma. In: LOUIS D, O. H., WIESTLER OD, CAVENEE WK (ed.) WHO Classification of Tumours of the Central NervousSystem. Lyon: International Agency for Research on Cancer (IARC).

Abstract: Background: Dental health care procedures generate significant amount of waste materials which could be potentially harmful to environment and community health. Aims and Objective: The present study has been undertaken to assess the concern of dental health care providers at Hyderabad, India towards handling and disposal of dental waste generated. Material and Methods: A structured questionnaire of 18 questions was handed over to 294 participants. The study population included undergraduate students (Group 1) and post graduate students (Group 2), dental practitioners (Group 3) and auxiliary staff (Group 4). The data was analysed using chi square test.

[1]. Government of India, Ministry of Environment and Forests. Bio-Medical Waste (Management and Handling) Rules. Gazette of India. 1998 (27 Jul). Available from:http://envfor.nic.in/legis/hsm/biomed.html
[2]. Government of India, Ministry of Health and Family Welfare (MoHFW). National Guidelines on Hospital Waste Management Based upon the Bio-Medical Waste (Management and Handling) Rules, 1998. New Delhi: MoHFW; 2002.
[3]. Botelho A. The impact of education and training on compliance behavior and waste generation in European private healthcare facilities .Journal of Environmental Management 2012; 98: 5-10.
[4]. Schaefer ME. Hazardous waste management. Dental Clinics of North America 1991; 5:383-390.
[5]. Kizlary E, Iosifidis N, Voudrias E, Panagiotakopoulos D. Composition and production rate of dental solid waste in Xanthi, Greece: variability among dentist groups. Waste Manage2005; 25:582–591.
[6]. Palwankar PV, Singh A. Safety and measures for auxiliary staff associated with hospital waste disposal. Indian Journal of Dental Sciences 2012; 4:104-106.

Abstract: Introduction: Removal of impacted wisdom teeth is a commonly performed procedure in oral and maxillofacial surgery ,but there is a considerable debate among the surgeons, regarding the technique used for osteotomy Objective: To Study the efficacy of piezoelectric device in impacted mandibular third molar surgery. Material and methods: Special designed performa was used to collect the data, conducted in Department of Oral and Maxillofacial Surgery, Babu Banarsi Das College of Dental Sciences, Babu Banarasi Das University, Lucknow

[1]. Grossi GB, Maiorana C, Garramone RA,et al. Assessing postoperative discomfort after third molar surgery: A prospective study. J Oral Maxillofac Surg. 2007; 65;901
[2]. Baqain ZH, Karay AA, Sawair F, et al: Frequency estimates and risk factors for postoperative morbidity after third molar removal: A prospective cohort study. J Oral Maxillofac Surg.2008; 66; 2276
[3]. Beziat JL, Bera JC, Lavandier B, Gleizal A. Ultrasonic osteotomy as a new technique in craniomaxillofacial surgery. Int J Oral Maxillofac Surg. 2007 Jun;36(6):493-500.
[4]. Sivolella S, Berengo M, Scarin M, Mella F, Martinelli F. Autogenous particulate bone collected with a piezo-electric surgical device and bone trap: A microbiological and histomorphometric study. Archives of oral biology. 2006;51(10); 883-891.
[5]. Gruber RM, Kramer FJ, Merten HA, et al. Ultrasonic surgery – An alternative way in orthognathic surgery of the mandible. A pilot study. Int J Oral Maxillofac Surg.2005; 34;590

Abstract: Mucinous cystadenocarcinoma of the breast is an unusual primary malignancy of breast which bears striking resemblance to mucinous cystadenocarcinoma of the pancreas and the ovary. To our knowledge, only 6 cases have been reported1-3A case of a 65year old woman with an unilateral mucinous cystadenocarcinoma of breast is reported and the literature is reviewed.

[1]. Rosen PP, Scott M. Cystic hypersecretory duct carcinoma of the breast. American Journal of Surgical Pathology.1984;8:31–41.
[2]. Koenig C, Tavassoli FA. Mucinous cystadenocarcinoma of the breast. American journal ofSurgical Pathology.1998;22:698–703.
[3]. Domoto H, Terahata S, Yamazaki T, Sato K, Takeo H, Tamai S. Mucinouscystadenocarcinoma of the breast showing sulfomucin production. Histopathology.2000;36:567–569.
[4]. I.O.Ellis, S.J.Schnitt, X.SastreGarau. Invasive Breast Carcinoma.World Health Organisation Classification of tumours,Pathology&Genetics,Tumours of the Breast & Female genital organ;IARCPress,Lyon 2003;31-32.
[5]. Toikkanen S, Kujari H. Pure and mixed mucinous carcinomas of the breast:aclinicopathologic analysis of 61 cases with long-term follow-up. Human Pathology1989;20:758–764.

Abstract: Melanin, carotene and haemoglobin are the most common natural pigments contributing to the normal colour of the gums. Although physiologic and ethnic melanin pigmentation is not a medical problem, complains about "black gums" are common. Melanin hyperpigmentation usually does not present a medical problem, but patients usually complain of dark gums as unaesthetic. Many techniques have been used for gingival depigmentation. Recently, Laser Ablation has been recognized as one of the most effective, pleasant and reliable techniques. Effective depigmentation of the gingival requires removal of all or most of the melanocytes from the basal layer of the gingival epithelium. Using non-specific radiation means ablation of all the epithelial cell layers, as well as connective tissue rete pegs, leaving behind only remnants of the epithelial rete ridges.

[1]. Dummett CO. Clinical observation on pigment variations in healthy oral tissues in the Negro. J Dent Res. 1945;24:7-13.
[2]. Dummet CO, Barens G. Oromucosal pigmentation: an updated literary review. J Periodontol. 1971 Nov;42(11):726-36. Review.
[3]. Dummett CO. Oral tissue color changes (I). Quintessence Int. 1979 Nov;10(11):39-45.
[4]. Amir E, Gorsky M, Buchner A, et al. Physiologic pigmentation of the oral mucosa in Israeli children. Oral Surg Oral Med Oral Pathol. 1991 Mar;71(3):396-8.
[5]. Gorsky M, Buchner A, Fundoianu-Dayan D, et al. Physiologic pigmentation of the gingiva in Israeli Jews of different ethnic origin. Oral Surg Oral Med Oral Pathol. 1984 Oct;58(4):506-9. 6. Patsakas A, Demetriou N, Angelopoulos A. Melanin pigmentation and inflammation in human gingiva. J Periodontol. 1981 Nov;52(11):701-4.

Abstract: Background: Periodontitis is a group of inflammatory diseases affecting the supporting tissues of the tooth. The prevalence of periodontal diseases varies in different regions of the world according to the definition of periodontitis and study population, and there are indications that they may be more prevalent in developing than in developed countries Objective: To determine the prevalence of chronic periodontitis among a group of patients attended department of periodontics during the year (2013-2014), School of Dentistry University of Sulaimani.

[1]. Rosania AE, Low KG. McCormick CM, Rosania DA. Stress, Depression, Cortisol, and Periodontal Disease. J Periodontol. 2009; 80(2):260-6.
[2]. Williams RC. Understanding and managing periodontal diseases: a notable past, a promising future. J Periodontol. 2008; 79(8):1552–9. [3]. Seymour GJ, Ford PJ, Cullinan MP, Leishman S,Yamazaki K. Relationship between periodontal infections and systemic disease. Clin Microbiol Infect. 2007; 13(4):3-10.
[4]. Armitage GC. Development of a classification system for periodontal diseases and conditions. Ann Periodontol. 1999; 4(1):1-6.
[5]. Ramfjord SP. Maintenance care and supportive periodontal therapy. Quintessence Int. 1993; 24(7):465-71.

Abstract: Technology is rapidly growing in today's world and the advent of lasers has proved to be an innovative tool in various fields of dentistry. Nowadays soft tissue lasers are widely used among clinicians for various procedures. Likewise, smoking has become a growing trend especially among the youth paving way to oral mucosal lesions commonly, leukoplakia. The improvement in therapeutics have gained patient confidence for assuring better healing and cure of the lesions through these procedures.

Keywords: Diode Lasers, Laser, Leukoplakia, Proliferative Verrucous Leukoplakia, Soft Tissue Laser

[1]. Reshma et al, Laser management in the intraoral oral soft tissue lesions- A review of literature, IOSR-JDMS, Volume 13, Issue 1 Ver. X. (Feb. 2014), PP 59-64
[2]. Panat SR, Lasers in Oral Medicine – An Update, J Dent Sci Oral Rehab 2014, 5(4) 200-204
[3]. Harbindar et al, Lasers – An emerging trend in dentistry, International Journal of Advanced Health Sciences | August 2014 | Vol 1 | Issue 4
[4]. Bhandari et al, Soft tissue applications of lasers: A review, International Journal of Dental Research, 2 (1) (2014) 16-19
[5]. Rakhi Issrani et al, Oral proliferative verrucous leukoplakia: A case report with an update, Contemporary Clinical Dentistry | Apr-Jun 2013 | Vol 4 | Issue 2