iosr-JDMS   Volume-15 ~ Issue-1 ~ January-2016

Abstract: Background: Rabies, an almost 100% fatal condition can be prevented by timely management e.g. local wound treatment, application of vaccine and immunoglobulin where indicated. Objectives: To ascertain the profile of animal bite cases , to find the practices of community after animal bite before attending the hospital and also to ascertain treatment of animal bite cases in the rural health care centre. Methodology: Patients or their guardians were interviewed with the help of predesigned and pre tested questionnaire after clinic attendance in a block primary health centre of Burdwan district of West Bengal.

1]. A H Suryakantha. Community Medicine with recent advances.3rd edition. Jaypee Brothers Medical Publishers (P)Ltd. New Delhi.2014.p 490
[2]. Sudarshan MK, Mahendra BJ, Madhusudana SN, Ashwoath Narayana DH, Rahman A, Rao NS, X-Meslin F, Lobo D, Ravikumar K, Gangaboraiah. Assessing the burden of human rabies in India: results of a multi center epidemiology survey. International journal of infectious diseases.2007; 11:29-35. [3]. WHO.Rabies fact sheet Fact Sheet N°99Updated September 2015.Available from:http://www.who.int/mediacentre/factsheets/fs099/en/.accessed on 25.11.2015
[4]. Sudarshan MK, Mahendra BJ, Madhusudana SN, Ashwoath Narayana DH, Rahman A, Rao NS, X-Meslin F, Lobo D, Ravikumar K, Gangaboraiah. An epidemiological study of animal bites in India: results of a WHO sponsored national multi-centric rabies survey. J Commun Dis. 2006 ;38:32-9

Abstract: Objective: To evaluate the clinical profile of Diffuse Parenchymal Lung Diseases with reference to the presenting symptoms and clinical course in a tertiary care teaching institution. The diagnosis of specific form of interstitial lung disease and management of the same to achieve stabilization of the disease is quite challenging to the clinicians. The present study was undertaken in view of the paucity of clinical data on Interstitial lung disease (ILD).

[1]. American Thoracic Society, European Respiratory Society. American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias. Am J RespirCrit Care Med.2002;165:277-304.
[2]. Travis WD, Costabel U, Hansell DM et al. An official American Thoracic Society/European Respiratory Society statement: Update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J RespirCrit Care Med.2013;188:733-48.
[3]. Palat P, Parmar HD. Recent trends in interstitial lung disease: Study of 25 cases. Int J Med Sci Public Health.2013; 2(1): 52-55.
[4]. SK Jindal et al. Fibrosingalveolitis- a report of 61 cases seen over past 5 years. Indian journal of chest disease and allied science.1979;21: 174.
[5]. Sen T,UdwadiaZF.Retrospective study of interstitial lung disease in a tertiary care centre in India.Indian J Chest Dis Allied Sci.2010 Oct-Dec;52(4):207-11

Abstract: Background: Atrial fibrillation is a relatively common arrhythmia often seen in patients with permanent pacemakers. In patients with underlying left ventricular dysfunction, single chamber right ventricular pacing increases the incidence of heart failure and atrial fibrillation [1]. But, in patients with normal baseline cardiac function, these effects are not clearly defined. Therefore, with this background in mind we aimed to assess the incidence, predictors and time frame of appearance of new onset atrial fibrillation in patients with normal baseline cardiac function who underwent single chamber VVI pacemaker implantation.

[1]. Wilkoff BL, Cook JR, Epstein AE et al; Dual Chamber and VVI Implantable Defibrillator Trial Investigators. Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial. JAMA. 2002 Dec 25;288(24):3115-23.
[2]. Hesselson AB, Parsonnet V, Bernstein AD et al. Deleterious effects of long-term single-chamber ventricular pacing in patients with sick sinus syndrome: the hidden benefits of dual-chamber pacing. J Am Coll Cardiol. 1992 Jun;19(7):1542-9.
[3]. Karin H. Humphries et al. New-Onset Atrial Fibrillation: Sex Differences in Presentation, Treatment, and Outcome: Circulation. 2001;103:2365-2370. [4]. Kusumoto FM, Goldschlager N. Cardiac pacing. N Engl J Med 1996; 334: 89–97. [5]. Kosakai Y, Ohe T, Kamakura S, et al. Long term follow-up of embolism in sick sinus syndrome after pacing (abstr) PACE, 14 (1991), p. 680..

Abstract: Statins are very fast becoming one of the most frequently prescribed drugs worldwide [1, 2]. Statin therapy is linked to variety of adverse effects especially associated with muscular disorders, the major cause being direct myotoxicity [3]. Statin-associated myopathy represents a broad spectrum of disorders from insignificant myalgia to fatal rhabdomyolysis. The frequent use of the drug has resulted in an increased incidence of statin induced rhabdomyolysis. Most often the condition typically resolves with drug discontinuation, hence the prompt diagnosis of the condition will be life saving [3]. But treating physicians should be aware of different presentations of the condition as some unusual presentation can be misleading and pose difficulty in diagnosis leading to a delay in withdrawing the drug. Here we present two cases of statin induced myopathy both differing in clinical presentation that posed a challenge in diagnosis.

[1]. Ioannidis JPA. More than a billion people taking statins? potential implications of the new cardiovascular guidelines. JAMA 2013;94305:E1.
[2]. Pencina MJ, Navar-Boggan AM, D'Agostino RB, Williams K, Neely B, Sniderman AD, et al. Application of new cholesterol guidelines to a population-based sample. N Engl J Med 2014;370(15): 1422_31. doi: 10.1056/NEJMoa1315665.
[3]. Mohassel P, Mammen AL. The spectrum of statin myopathy. Curr Opin Rheumatol 2013; 25(6): 747_52. doi: 10.1097/01.bor.0000434673.85515.89.
[4]. Fernandez G, Spatz ES, Jablecki C, Phillips PS. Statin myopathy: a common dilemma not reflected in clinical trials, Cleve Clin J Med 2011;78:393–403.
[5]. Black DM. A general assessment of the safety of HMG CoA reductase inhibitors (statins). Curr Atheroscler 2002;4:34-41.
[6]. Federman DG, Hussain F, Walters AB. Fatal rhabdomyolysis caused by lipid lowering therapy. Southern Med J 2001 ; 94 : 1023-1026.

Abstract: Megaloblastic anemia is becoming most common forms of anemia in adolescents during recent years .In India limited studies are available on megaloblastic anemia. Objectives: To study the etiology by relative prevalence of vitamin B12 and folate deficiency and varied clinical presentations in adolescent with megaloblastic anemia. Methods: Hospital-based cross-sectional observational study among 40 Adolescents(age 10-19 years) conducted in the Department of Pediatrics, institute for mother and child health (Niloufer hospital) Hyderabad, India during September 2013 to September 2014 with megaloblastic anemia in whom detailed history, relevant physical examination and anthropometry (height and weight) were recorded. Diet pattern of all the patients were noted. Cobalamin and folic acid assays were done.

[1]. Adolescents Nutrition –UNICEF [2]. Sanjeev M Chaudhary, Vasant R Dhage. A study of anemia among Adolescent females in the urban area of Nagpur. Indian J Community Med. 2008 Oct; 33(4): 243-245 [3]. Megaloblastic anemia: back in focus .Jagdish Chandra et al. department of pediatrics, Lady Hardinge medical college, and Kalawati saran children's hospital, New Delhi, India. Indian journal of pediatrics 2010 July: volume 77. [4]. Patra S, Pemde HK, Singh V, Chandra J, and Dutta A. Profile of adolescents with severe anemia admitted in a tertiary care hospital in northern India. Indian J Pediatr. 2011 Jul; 78 (7): 863-5. [5]. Green R, Miller JW. Folate deficiency beyond megaloblastic anemia: Hyperhomocysteinemia and other manifestations of dysfunctional folate status. Semin Hematol 1999; 36: 47-64. [6]. Casterline JE, Allen LH, Ruel MT. Vitamin B12 deficiency is very prevalent in lactating Guatemalan women and their infants at three months postpartum. J Nutr 1997; 127: 1966-1972 [7]. Shankar Reddy Dudala, Arlappa N. An Updated Prasad's Socio Economic Status Classification for 2013. Int J Res Dev Health. Apr 2013; Vol 1(2): 26-28.

Abstract: Acute confusional state is characterized by a disturbance of consciousness and a change in cognition that develops over a short period of time. It is a frequent cause of hospital admission in the elderly. Recognition and prompt treatment is crucial to decrease the morbidity and mortality associated with it. Materials and Methods: In this prospective study, we determined the etiology and prognostic factors of an acute confusional state. A total of 81 patients of acute confusional state were clinically evaluated. All patients were also subjected to a battery of biochemical examination, cerebrospinal fluid analysis and neuroimaging. Results: The mean age of our cohort was 64.31± 5.63 years. 39(48.14%) patients were male. In 74 patients, we were able to identify possible precipitating cause of an acute confusional state. In the rest of the 7 patients results of all the tests were normal. Leukocytosis and hyponatremia were frequent factors associated with delirium. Patients without a precipitating cause for acute confusional state and multiple co morbidities had significantly higher mortality. 38 (46.91%) of our patients died, of these in 6 patients we could not find a precipitating cause and 17 patients had multiple co morbidities.

[1] Gensini GG: Cornaray angiography .New York:Futura,1975;241-320

[2] Jenkins,PJ,Happer RW :Severity of coronary atherosclerosis related to lipoprotein concentration.Br med journal 1978;2:388-391.

[3] Friesinger GC,Page EE,Ross RS: Prognostic significance of coronary angiography .Trans Assoc Am Physicians 1978;83:78-92

[4] Abrahams JP, Nash DT, Gensini GG, Arno T. Relation-ship of age and biomedical risk factors to progression of coronary artery disease. J Am Geriatr Soc. 1978;26:248–252.

[5] Alderman EL, Corley SD, Fisher LD, et al. Five-year angiographic follow-up of factors associated with progression of coronary artery disease in the Coronary Artery Surgery Study (CASS). CASS participating investigators and staff. J Am Coll Cardiol. 1993;22:1141–1154

[6] Berry C, Noble S, Gregoire JC et al. Glycaemic status influences the nature and severity of coronary artery disease. Diabetologia 2010; 53: 652–658.

Abstract: A review of maxillary sinus floor elevation as a fundamental part of restoring the posterior maxilla is discussed. The related anatomy of the area and the lateral sinus lift technique is reviewed. This classic lateral antrostomy pioneered by Tatum appears to be the most common sinus lift procedure. There is importance of Lateral Sinus Lift in current implantology. After comparing it with alternative procedures, it is inferred that Lateral Sinus Lift, despite having some disadvantages, is the most effective method for implantation into dorsal parts of the maxilla.

Keywords: Dental implants, posterior maxilla, lateral antrostomy, crestal approach, pneumatized maxillary sinuses.

[1]. Tatum OH. Maxillary and sinus implant reconstruction. Dent Clin North Am. 1986;30:207–229.
[2]. Simunek A, Kopecka D, Brazda T, Somanathan RV. Is lateral sinus lift an effective and safe technique? Contemplations after the performance of one thousand surgeries. Implantologie Journal. 2007;6:1-5.
[3]. Boyne P, James RA. Grafting of the maxillary sinus floor with autogenous marrow and bone. J Oral Maxillofac Surg. 1980;17:113–116.
[4]. Cordioli G, Mazzocco C, et al. Maxillary sinus floor augmentation using bioactive glass granules and autogenous bone with simultaneous implant placement. Clinical and histological findings. Clinical Oral Implants Research. 2001;12:270–278.
[5]. Strietzel FP, Nowak M, et al. Peri- implant alveolar bone loss with respect to bone quality after use of the osteotome technique: results of a retrospective study. Clinical Oral Implants Research. 2002;13: 508–513.
[6]. Jakse N, Seibert FJ, et al. A modified technique of harvesting tibial cancellous bone and its use for sinus grafting. Clinical Oral Implants Research. 2001;12:488–494.
[7]. Tadjoedin ES, de Lange GL, et al. High concentrations of bioactive glass material (BioGran) vs. autogenous bone for sinus floor elevation. Clinical Oral Implants Research. 2002;13:428–436.

Abstract: Objective: This study was undertaken to assess the prevalence and severity of Dental Fluorosis among children aged 12 -17 years in an endemically affected area in Rural Bangalore and to determine the public health significance of Dental Fluorosis. Introduction: Ground water has been a significant water source for domestic, irrigating, and industrial purposes in India. More than 85% of rural and 50% of urban domestic water requirements is met from ground water resources [1]. Presence of excess amount of fluoride in drinking water leads to dental fluorosis. Methodology: This was a cross sectional study conducted in the rural field practice area of RajaRajeswari Medical College and Hospital Bangalore. A total of 250 study subjects belonging to the age group of 12 to 17 years were studied. The dental Fluorosis was assessed in the mixed dentition and was graded using Dean's index and Community Fluorosis Index calculated.

[1]. Shruthy Narayanmurthy, Anil Navale Santhuram. Prevalence of dental Fluorosis in school children of Bangarpet taluk, Kolar district. Journal of Oro facial sciences.2013;5(2):105-8.
[2]. Shivayogimath C B, Hiremath M N, Shivalingappa S N. Prevalence of dental Fluorosis among residents of nine villages in and around mundaragi of Gadag district in Karnataka, India. Elixir International Journal.2012; 410-3.
[3]. Sunil V Gitte, kmable K M, Ramanath N sabat. Study of Prevalence of Fluorosis in endemic village of Kankar district of Chhattisgarh state, India. National Journal of Community Medicine. 2014; 5(4):486-9.
[4]. Saravanan S, Kalyani C, Vijayarani M, Jayakodi P, Felix A, Nagarajan S, et al. Prevalence of dental fluorosis among primary school children in rural areas of Chidambaram Taluk, Cuddalore District, Tamil Nadu, India. Indian J Community Med 2008; 33:146-50.
[5]. Isaac A, Silvia WDCR,Somanna SN, Mysorekar V, Narayana K, Srikantaiah P. Prevalence and manifestations of water-born Fluorosis among schoolchildren in Kaiwara village of India: a preliminary study. Asian Biomedicine 2009; 3(5):563-6

Abstract: Introduction: Garlic is one of the historical age-long spice used as food especially as condiments and therapeutic purposes. However, its effect on the reproductive health of man is sometimes not considered by man. This study is aimed at investigating the possible effect caused by consumption of aqueous garlic extract on the histology of the testis and ovary using adult albino wistar rat as a model.

[1]. Amagase H., Petesh B. L., Matsuura H. (2001). Intake of Garlic and Its Bioactiv Components.Journal of Nutrition. 131 (3): 9555-9625.
[2]. Amagase H, (2006). Significance of Garlic and its Constituents in Cancer andCardiovascular Disease.Clarifying the real bioactive constituents of garlic.Journal of Nutrition. 136: 716 – 725.
[3]. Anthony L. M., (2010). Junqueira's Basic Histology Text and Atlas, 12th edition: 371-389
[4]. Aqel M. B., Gharaibah M. N., Salhab A. S. (1991). Direct relaxant effect of garlic juice on smooth and cardiac muscle. Journal of Enthropharmacol.33:13-19.
[5]. Banerjee S. K., Maulik K. (2002). Effect of garlic on cardiovascular disorders: Nutritional Journal: 1-4.
[6]. BehnazHajiunon (2014). Effect of Garlic (Allium sativum) Hydroalcoholic Extraction on Estrogen, progesterone and testosterone levels in rats exposed to cell phone radiation. Zahedan Journal of Research in Medical Sciences.16: 1.
[7]. Belman S. (1983): Onion and garlic oils inhibit tumor promotion. Carcinogenesis. 8:1063-1065.
[8]. DaftaryShirish,ChakravartiSudip. (2011). Manual of obstetrics. 3:1-18.
[9]. EL-Demerdash F.M. (2008).Dietary garlic and onions reducedtheincidenceoftherieogenic diet-induced cholesterol gallstones in experiment mice.British Journal of Nutrition. 5:1-9.

Abstract: Tuberculosis (TB) is major public health problem worldwide. The problem of drug default is as old as chemotherapy itself. It has been encountered in all those diseases where the drugs have to be administered for a long time. However, it assumes a social significance in tuberculosis, because a drug defaulter in this diseases poses a threat not only to himself, but also to the community he lives in, by spreading the drug resistant organisms. For the T.B. clinics, it poses many additional problems e.g. default actions, retrieval of defaulters and reorganization of the chemotherapeutic schedule. Treatment failure was defined as a patient who is still sputum smear positive five months or more after the commencement of treatment. A defaulter was defined as a patient whose treatment was interrupted for two consecutive months or more. Objectives: The aim of this study was to investigate reasons underlying failure to complete DOTS treatment in TB patients in Nandyal urban, Kurnool dist.

[1]. B.K. KHANNA, Ind, J. Tub., Vol. XXIV, No. 3
[2]. WHO, 2007. Global tuberculosis control – surveillance, planning, financing. Accessed January 2007 www.who. int/tb/en
[3]. National Tuberculosis Centre, 2000/01 Annual Report of Tuberculosis Control Programme Govt. of Nepal Moran M. Medicines sans Frontiers, 2004 Campaign for access to Essential Medicines, Geneva.;(3):1-32
[4]. Kim HJ, Hong YP, 2001. Ambulatory treatment of multi –drug resistant pulmonary tuberculosis patients at a chest clinic. International Journal of Tuberculosis and Lung Disease;5(12): 1129-1136.
[5]. Editorial. Tuberculosis and Poverty, 2002. International Journal of Tuberculosis and Lung Disease; 6(9):745-746.
[6]. Kumar M, Singh JV, 2002. Factors affecting the Non-Compliance in directly observed short course chemotherapy in Lucknow district. Indian Journal of Community Medicine; xxvii (3):114-117.

Abstract: The aim was to study the susceptibility pattern of Pseudomonas aeruginosa in hospitalized patients so as to enable the clinician to select appropriate regimen at lower rate of side effects of side effects of antibiotics & decreased health care cost &to control the spread of drug resistance. Pseudomonas aeruginosa is one of the most common pathogen causing nosocomial infections.Acquired drug resistance is frequent in nosocomial isolates of Pseudomonas aeruginosa. Acquired Metallobetalactamase (MBL) has recently emerged as one of the most worrisome resistance mechanism. The study was conducted at Department of Microbiology, D. Y. Patil Hospital & Research Centre during the period from January 2012 to December2012.The percentage of MBL Producer in Pseudomonas aeruginosa isolates in the present study by Double Disc Synergy Test (DDST) & Modified EDTA Sunergy Test (MEDST) were 23%. We have observed that both the methods showed 100% correlation. Keywords: Pseudomonas aeruginosa, Metallobetalactamase

[1]. Shenoy S, Baliga S, et al. Antibiotic sensitivity Of Pseudomonas aeruginosa strains isolated from various clinical specimens. Ind J Med Sci 2002; 56: 427-30.
[2]. Aggarwal R., Chaudary U. Extended spectrum β-lactamases (ESBL) – an emerging threat to clinical therapeutics. Indian J. Med Microbiol 2004; 22 (2): 75-80.
[3]. Anupurba S, Bhattacharjee A, Garg A, Ranjan sen M. Antimicrobial susceptibility of Pseudomonas aeruginosa isolated from wound infections. Indian J Dermatol 2006; 51(4): 286-288.
[4]. Rashid A, Chowdhury A, et al. Infections by Pseudomonas aeruginosa and antibiotic resistance pattern of the isolates from Dhaka Medical College hospital Bangladesh J Med 2007; 1(2): 48-51.
[5]. Saderi H, Karimi Z, Owlia P et al. Phenotypic detection of Metallo-beta-lactamase producing Pseudomonas aeruginosa strains isolated from burned patients. Iranian J of Pathology 2008; 3(1): 20-24.
[6]. Varaiya A, Kulkarni N, Bhalekar P et al. Incidence of metallo-beta-lactamase producing Pseudomonas aeruginosa in ICU patients.Ind J Of Med Res 2008; 127: 398-402.

Abstract: Objective: To analyze prevalence of Major depression in T2DM patients & its association with diabetic symptom burden. Method: Three hundred and twelve T2DM patients were evaluated. Socio-demographical & clinical profiling was done after due consent. Montgomery Asberg Depression Rating Scale (MADRS) was used to assess severity of depression & diagnosing Major depression. Several self-reported diabetic symptoms were compared in Major depression and No depression groups among the T2DM study sample. Impact of Major depression on reported diabetic symptoms was analyzed. Statistical analysis was done using SPSS version 14.0.

[1]. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes care. 2004 May;27(5):1047-53

[2]. Egede LE, Ellis C. Diabetes and depression: global perspectives. Diabetes research and clinical practice. 2010 Mar;87(3):302-12.

[3]. Gupta R, Misra A. Review: Type 2 diabetes in India: regional disparities. The British Journal of Diabetes & Vascular Disease. 2007;7(1):12-6.

[4]. DIaMoND JED. Medicine: diabetes in India. Nature. 2011;469(7331):478-9.

[5]. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global Burden of Disease and Risk Factors. Washington: The World Bank; 2006

[6]. Wulsin LR, Singal BM. Do depressive symptoms increase the risk for the onset of coronary disease? A systematic quantitative review. Psychosom Med. 2003; 65:201–210.

[7]. Rugulies R. Depression as a predictor for coronary heart disease. A review and meta-analysis. Am J Prev Med. 2002; 23:51–61. [PubMed: 12093424]

Abstract: Objective: Diabetes is a global epidemic with India estimated to have the highest prevalence of 79.4 million by 2030. RLS is a common yet undiagnosed comorbidity causing significant distress. We aimed to analyze association between restless legs syndrome (RLS) and type 2 diabetes. Method: One hundred fifty six Type 2 Diabetes mellitus (T2DM) and eighty eight non-diabetic control, were assessed at Mahatma Gandhi Medical College & Hospital, Jaipur, for RLS using the International RLS Study Group Rating Scale. Several patient clinical profiles along with laboratory parameters were compared in both groups. Diabetic polyneuropathy was evaluated for its role as risk factor in diabetic RLS subjects.

[1]. O'Keeffe ST, Gavin K, Lavan JN. Iron status and restless legs syndrome in the elderly. Age Ageing 1994;23:200-3.

[2]. Gigli GL, Adorati M, Dolso P et al. Restless legs syndrome in endstage renal disease. Sleep Med 2004;5:309-15.

[3]. Manconi M, Govoni V, De Vito A et al. Restless legs syndrome and pregnancy. Neurology 2004;63:1065-9

. [4]. Rutkove SB, Matheson JK, Logigian EL. Restless legs syndrome in patients with polyneuropathy. Muscle Nerve 1996;19:670-2.

[5]. Salih AM, Gray RE, Mills KR, Webley M. A clinical, serological and neurophysiological study of restless legs syndrome in rheumatoid arthritis. Br J Rheumatol 1994;33:60-3

Abstract: Primary bone lymphoma (PBL) is an uncommon tumor accounting for approximately 4-5% of extra nodal lymphoma and less than 1% of all non-Hodgkin's lymphoma (NHL). Disease may be complicated at presentation by pathological fracture or spinal cord compression. Diffuse large-B cell lymphoma (DLBCL) accounts for the majority of cases of PBL. Owing to its rarity, only a few retrospective series have been published in literature addressing the prognosis and treatment of PBL.We report our experience with three cases of PBL treated with chemotherapy and radiotherapy and review of literature to elucidate the optimal treatment of PBL.

Key words: DLBCL, Primary bone lymphoma, Treatment outcome

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[2] Kitsoulis P, Vlychou M, Papoudou A, Karatzias G, Charchanti A, Agnantis NJ, et al. Primary lymphomas of bone. Anticancer Res 2006;26:325–37.
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[6] Heyning FH, Hogendoorn PC, Kramer MH, Holland CT, Dreef E, Jansen PM, et al. Primary lymphoma of bone: extranodal lymphoma with favourable survival independent of germinal centre, post-germinal centre or indeterminate phenotype. J Clin Pathol 2009;62: 820-24.

Abstract: Maxillonasal dysplasia or Binder's syndrome is an uncommon congenital condition characterized by a retruded mid-face with flat dorsum of nose. We report here five patients with maxillonasal dysplasia whose noses were corrected with costal cartilage graft using a combined oral vestibular and external rhinoplasty approach for nasal dorsal augmentation, columellar lengthening, and premaxillary augmentation. The cartilage graft was dipped in a solution of 100 ml 0.9% NaCl and one vial (80mg) gentamicin for 30 min to prevent warping. Right angled triangular struts were made and were fixed subperiostealy for nasal augmentation and columellar lengthening.

[1] Cechytwarzy w zespoleBinderaprzegladpismiennictwa. Facial features in Binder's Syndrome - Review of the Literature.AdvClinExp Med 2010, 19,6,765-769.
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[6] Munro IR .Maxillonasal dysplasia (Binder's syndrome). PlastReconstSurg 1979;41:536-42.
[7] Horswell BB, Holmes AD, Barnett JS, Lavant BA. Maxillonasal dysplasia (Binder's syndrome): A critical review and case study. J Oral Maxillofac. Surg 1987;45:114-22.

Abstract: The HELLP syndrome is a serious complication in pregnancy characterized by haemolysis, elevated liver enzymes and low platelet count occurring in 0.5 to 0.9% of all pregnancies and in 10–20% of cases with severe preeclampsia. Aim: The objective of the present prospective study is on incidence, diagnosis, and its variable presentations of HELLP syndrome in preeclampsia, eclampsia to analyze the severity and complications, as it is associated with maternal, perinatal morbidity and mortality. HELLP syndrome is difficult to diagnose when it presents with atypical clinical features like high blood pressure and no protienuria, flu like symptoms, malaise, fever, nausea, vomiting, epigastric pain.

[1]. Weinstein L. Syndrome of hemolysis, elevated liver enzymes and low platelet count: a severe consequence of hypertension in pregnancy. Am J Obstet Gynecol. 1982;142: 159–67.
[2]. Ching-Ming Liu et al 2006 Japan Society of Obstetrics and gynecology
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[4]. Isler CM et al Maternal mortality asso.with Hellp Syndrome. Am J Obs Gyn,1999
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Abstract: Thyroid cancer is the most common endocrine malignancy, accounting for 1.9% of all new malignant tumors diagnosed annually. Annual incidence rates vary by geographic area, age and sex, patient population and method of survey. So a cross sectional study was undertaken to evaluate the incidence of thyroid malignancy based on histopathological examination among those presenting with thyroid neoplasm in our Tertiary care centre. In our study it was observed that incidence of thyroid malignancy has increased in comparison to all head and neck malignancy. Also proportion of malignancy among thyroid neoplasm has increased. There was increase incidence in females and age group 21 -30 years.

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[4]. Hodder arnold /scott brown 7E CHAPTOR 197THYROID CANCER –page no 2672

Abstract: Krukenberg tumor is a metastatic adenocarcinoma of ovary [2]. It is rare, accounts for 30-40% of those tumors which secondarily metastasize to ovary. Metastasis is from gastric adenocarcinoma, specially from pylorus-70% followed by bowel-10%, breast-4%, biliary system-3%, appendix-3% and remaining 3% from lungs, pancreas, bladder, renal pelvis and rarely from cervix [1, 3]. 80% cases have bilateral ovarian involvement [4]. Radiological evaluation may mimic other metastatic or primary ovarian tumors thus leading to difficulty in diagnosis [1]. They commonly occur in age group between 30-40 years and after menopause. We present a case of 20 year old unmarried girl with gross ascites and pleural effusion with bilateral krukenberg tumor.

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