iosr-JDMS   Volume-16 ~ Issue-11 ~ November-2017

Abstract: In our society there is significant underreporting of cases of sexual offence. Even if a case is reported, it is already late. And when the medical examination of the victim is done more time elapses. Thus important findings are lost, which is one of the important reasons of low conviction rate. This low conviction rate leads to a social perception, that even if there is reporting of cases of sexual offence, conviction cannot be done. A vicious cycle of more underreporting of cases is thus established. An important step to increase conviction rate in the cases of sexual offence is early medical examination of the victims. In this background, an Observational Descriptive study was conducted at the Upgraded Department of Forensic and State Medicine, Medical College, Kolkata, for a period of one year to find out the cause and duration of delay in medical examination of the victims of sexual offence.

Keywords –Sexual offence, medical examination, delay

[1]. A. Nandy, Principles of forensic medicine including toxicology (Kolkata, New Central Book Agency (P) Ltd, 2010)
[2]. Ministry of Home Affairs, National Crime Records Bureau, Compendium2011, Crime in India, 87
[3]. Gostin LO et al. HIV testing, counselling, and prophylaxis after sexual assault. Journal of the American Medical Association, 1994,
271:1436–1444
[4]. Preventing intimate partner and sexual violence against women: taking action and generating evidence. Geneva, World Health
Organization, 2010
[5]. Guidelines for medico-legal care for victims of sexual violence© World Health Organization 2003, 1.

Abstract: The human papillomavirus (HPV) is an unenveloped double stranded deoxyribonucleic acid (dsDNA) virus capable of infecting humans and inducing cervical carcinoma in females. HPVs can also be grouped to high-risk and low-risk HPV types. Low-risk HPV types include types 6, 11, 42, 43, and 44. High-risk HPV types include types 16, 18, 31, 33, 34, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, and 70. HPV16 and 18 have been implicated as the commonest aetiologic agent in this disease. Various methods have been used in testing the presence of human papillomavirus including histology, pap smear, polymerase chain reaction and hybridization technique. Pap has been used for cervical carcinoma screening worldwide. Cervarix and Gardasil are effective vaccines against the human papillomavirus type 16 and 18

Keywords: Carcinoma, human papillomavirus, vaccine, hybridization, Pap smear.

[1]. Xavier C. Natural history and epidemiology of HPV infection and cervical cancer. Gynaecol Oncol 2008; 110 (3): 2.
[2]. Ellenson LH, Pirong EC. Cervix: Premalignant and malignant neoplasm. In :Kumar V, Abbas AK, Fausto N, Aster JC (editors) Pathologic basis of disease. 8th edition. Philadelphia: Elsevier 2010; 1018-1024.
[3]. Mohammed A, Ahmed SA, Oluwole OP, Avidine S. Malignant Tumours Of The Female Genital Tract in Zaria, Nigeria: Analysis of 513 Cases, Ann of Afr Med 2006; 5(2): 93-96.
[4]. Tavassoli FA, Devilee P. Tumour of the uterine cervix, pathology and genetics: tumours of the breast and female genital organs, World health organization classification of tumours, Lyon, IARC Press 2003: 260-279
[5]. Clifford GM, Smith JS, Plummer M, Munoz N, Franceschi S. Human papillomavirus types in invasive cervical cancer worldwide: A meta-analysis, British J of Cancer 2003; 88(1): 63-73..

Abstract: Diabetic retinopathy is the most common cause of vision loss among people with diabetes and the leading cause of vision impairment and blindness among working age adults.Maintenance of HbA1c levels as close as possible to the near normal range results in considerable reduction in long-term complications of diabetes. Elevated Blood pressure was also found to be a risk factor for worsening diabetic retinopathy. So this study is conducted to correlate Hba1c levels and blood pressure with sight threatening diabetic retinopathy. Materials And Methods: A total of 300 type 2 diabetes.............

Keywords: HbA1c , NPDR, PDR,RBS, STDR

[1]. De Boer IH, Rue T C, Clearly P A , Lachin JM, Molitch ME, Steffes M W et al.Long term renal out-comes of patients with type 1 diabetes mellitus and micro albuminuria: An analysis of the diabetes control and complication trial .Archives of internal medicine.2011 Mar 14;171(5):412-420
[2]. Kobrin Klein BE. Overview of epidemiologic studies of diabetic retinopathy. Ophthalmic epidemiology. 2007 Jan 1;14(4):179–83
[3]. U K Prospective Diabetes Study Group.Intensive blood-glucose control with sulphonyl ureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes(UKPDS 33).The lancet.1998 Sep 12;352(9131):837-53
[4]. The Diabetes Control and Complications Trial Research Group.The effect of intensive treatment of diabetes on the development and progression of long term complications in insulin-dependent diabetes mellitus.NEngl J Med.1993 Sep 30;1993(329):977-86
[5]. Nathan DM, Turgeon H, Regan S. Relationship between glycated haemoglobin levels and mean glucose levels over time.Diabetolgia.2007 Nov 1;50(11):2239-44

Abstract: Stroke is one of the leading causes of death and disability throughout the world.The incidence of this disease is increasing with the gradual increase in obesity, diabetes mellitus, hyperlipidemia, hypertension and other cardiac problems. Hyperhomocysteinemia has also been proposed as an important risk factor for stroke especially ischemic stroke. This study was aimed to evaluate the homocysteine levels inischemic stroke patients in comparison to apparently healthy controls and to explore the association betweenhomocysteine and stroke severity (assessed by NIHSS scoring). Materials And Methods: Study included 30 patients of ischemic stroke and 20 apparently healthy controls. Plasma homocysteine and serum lipid profile were estimated in all individuals. NIHSS and GCS scoring was done in all patients............

Keywords: Homocysteine, ischemic stroke, NIHSS.

[1]. Biller J, Love BB, Schneck MJ. Vascular Diseases of the Nervous System. In: Bradly WG, Daroff RB, editors. Neurology in Clinical Practice. 5th ed. Philadelphia: Butterworth-Heinemann; 2008. p. 1165.

[2]. M Modi, S Prabhakar, S Majumdar, M Khullar, V Lal, CP DasHyperhomocysteinemia as a risk factor for

[3]. ischemic stroke: An Indian scenario Neurology India | September 2005 | Vol 53 | Issue 3.

[4]. NahidAshjazadeh, MD, MortezaFathi, MD, and AbdohamidShariat, MD Evaluation of Homocysteine Level as a Risk Factor among Patients with Ischemic Stroke and Its Subtypes Iran J Med Sci. 2013 Sep; 38(3): 233–239.)
[5]. Tan NC, Venketasubramanian N, Saw SM, Tjia HT. Hyperhomocyst(e)inemia and risk of ischemic stroke among young Asian adults.Stroke. 2002;33:1956-62. doi: 10.1161/01.STR.0000021899.08659.C8. PubMed PMID:12154245.

Abstract: This is a hospital based prospective randomized study conducted at department of Obstetrics and Gynaecology , Guntur, Andhra Pradesh. Objective: Postpartum hemorrhage is one of the leading causes of maternal mortality.Our study aims to evaluate and compare the effectiveness of sublingual misoprostol (600mcg) versus intramuscular oxytocin (10 IU) in prevention of postpartum hemorrhage. Conclusion: Misoprostol is as effective as intramuscular Oxytocin(10IU). Misoprostol has advantage of ease of administration by unskilled health personnel. Side effects of this drug are also not severe and it can be used safely in third stage of labour for prevention of atonic postpartum hemorrhage.

Keywords: Misoprostol , Oxytocin , Post partum hemorrhage , Sublingual route , Active management of third stage of labour.

[1]. http://nrhm.gov.in/nrhm-components/rmnch-a/maternal-health/janani shishusurakshakaryakram/background.html?tmpl=component&print=1&page=(Accessed on 27/09/2014).
[2]. http://www.censusindia.gov.in/vital_statistics/SRS_Bulletins/MMR_Bulletin-2010-12.pdf(Accessed on 19/10/2014).
[3]. Kane TT, el-kady AA, Saleh S, Hage M, Stanback J, Potter L. maternal mortality in Giza, Egypt: magnitude , causes and prevention. Stud Fam Plann 1992;23:45-57.
[4]. G.A.Dildy 111," Postpartum hemorrhage :new management options", clinical obstetrics and gynaecology,2002:45(2):330-344.
[5]. Abou Zahr C.Global burden of maternal death and disability.Br Med Bull 2003;67:1-11..

Abstract: Diminision of visual acuity in association with diabetic retinopathy most commonly results fromdiabeticmacular oedema. Traditional method of assessing DME include 78D/90D slit lamp biomicroscopy, indirectophthalmoscopy, fundus flouorescein angiography and fundus stereophotography. The efficacy of these methods to quantify DME is limited. OCT is an objective method of evaluation of DME with effectiveness in both quality and quantity. Retinal vascular diseases, in particular diabetic retinopathy and retinal venous occlusive disorders, are important causes of visual loss and blindness. Other important retinal vascular diseases which can affect visual function include arterial occlusive disease, parafoveal telangiectasis, Coat's disease, vasculitides, macroaneurysms, and hypertensive retinopathy...........

[1]. Retinal Vascular Disease A.M.Joussen·T.W.Gardner·B.Kirchhof· S.J. Ryan (Eds.)
[2]. Optical coherence tomography in macular diseases and glaucoma, 1st edition, pg no 83
[3]. The Diagnostic Function of OCT in Diabetic Maculopathy - Bartosz L. Sikorski,1 Grazyna Malukiewicz,1 Joanna Stafiej,1 Hanna Lesiewska-Junk,1 and Dorota Raczynska2
[4]. Macular Edema in Diabetes Treatment & Management - Emmanouil Mavrikakis, MD, PhD; Chief Editor:
[5]. Ampton roy , sr, Md Phd,more…

Abstract: Pregnancy is a stressful condition with considerably altered physiological and metabolic functions. Severalauthors have reported that oxygen consumption increases by 30-40% during pregnancy. Maternal ventilation and blood gases undergo substantial changes in pregnancy. During pregnancy, the rib cage undergoes structural changes in response to progressive relaxation of the ligamentous attachments of rib increasing the subcostal angle from 68° to 103°. In pregnancy, the diaphragm is elevated by about 4 cm, and the lower ribcage circumference is increased by about 5 cm. Hence, the functional residual capacity (FRC) and residual volume are reduced in pregnancy. Decreased FRC with increased oxygen demand lowers oxygen reserve of the mother. The increased metabolic rate...........

Keywords: Oxygen Saturation; Pregnant Women; Pulse Oximeter

[1]. Tiwari D, Akhtar S, Garg R, Manger PT, Khan MM. A comparative study of oxidative status in pregnant andnon-pregnant women. Int J Basic Appl Med Res. 2016;5(3):225-30.
[2]. Morcos E. Pregnancy: Respiratory changes. In: Cannors DF, editor; 2003-2004. Available from: http://www.circabook.com/ pregnancy-changes-ehab-morcos-md. [Last accessed on 25 Jan 2017].
[3]. McAuliffe F, Kametas N, Krampl E, Ernsting J, Nicolaides K. Blood gases in pregnancy at sea level and at high altitude. BJOG. 2001;108(9):980-5.
[4]. McCormack MC, Wise RA. Respiratory physiology in pregnancy. In: Bourjeily G, Rosene-Montella K, editors. Pulmonary Problems in Pregnancy. Leberian University; 2009. p. 419. DOI: 10.1007/978-1-59745-445-2_2. Available from: http://www.springer.com/978-1-934115-12-1. [Last accessed on 25 Jan 2017].
[5]. LoMauro A, Aliverti A. Respiratory physiology of pregnancy: Physiology masterclass. Breathe (Sheff). 2015;11(4):297-301.

Abstract: Pott's puffy tumour (PPT), first described by Percival Pott in 1760, refers to a doughy, indolent swelling over the forehead caused by an underlying subperiosteal abscess of the frontal bone. Osteomyelitis of the frontal bone associated with subperiosteal abscess collection is termed Pott's puffy tumour. It typically affects adolescent male subjects with frontal sinusitis and presents to ENT or neurosurgeons. However, we describe an unusual case occurring in a 9-year-old child and presenting with periorbital oedema with frontal sinusitis.

Keywords:Pott'spuffytumour,frontalsinusitis,seizure

[1]. Feder Jr HM, Cates KL, Cementina AM. Pott puffy tumor: a serious occult infection. Pediatrics 1987; 79: 625–629. | PubMed |

[2]. Bambakidis N, Cohen A. Intracranial complications of frontal sinusitis in children: Pott's puffy tumor revisited. Pediatr Neurosurg 2001; 35: 82–89. |

[3]. Gupta M, El-Hakim H, Bhargava R, Mehta V. Pott's puffy tumour in a pre-adolescent child: the youngest reported in the post-antibiotic era. Int J Pediatr Otorhinolaryngol. 2004; 68(3): 373–378.

[4]. Babu RP, Todor R, Kasoff SS. Pott's puffy tumour, the forgotten entity. Case report. J Neurosurg. 1996;84:110-112.

[5]. Bagdatoglu C, Güleryüz A, Ersöz G, Talas DÜ, Kandemir Ö, Köksel T. A Rare Clinical Entity: Pott's Puffy Tumor. Pediatr Neurosurg. 2001; 34:156-158.Doi:10.1159/000056011

Abstract: Laparoscopy is the art of examining the abdominal cavity and its contents without making large incisions. The first step in laparoscopic surgery is LE and creation of pneumoperitoneum. This is a very important step because it allows easy and safe insertion of the other ports under direct vision through the telescope 2. Aims & Objectives : To assess time of establishment of pneumoperitoneum in Direct Trocar Insertion technique, To assess complications in Direct Trocar Insertion technique. Material and Method: Among 50 patients,Direct Trocar insertion technique was used, complications were assessed...............

Keywords: Direct trocar insertion, Laparoscopy, Pneumoperitoneum

[1] Jansen FW, Kapiteyn K, Trimbos-Kemper T, Hermans J, Trimbos JB. Complications of laparoscopy: A prospective multicentre observational study. Br J Obstet Gynaecol. 1997; 104: 595-600.

[2] Nutan Jain, Sweta Sareen, Swati Kanawa, e t al .A new safe portal for laparoscopic entry in previous surgery cases.Journal Of Human Reproductive Sciences. 2016; 9(1): page 9-17.

[3] Tinelli A, Malvasi A, Schneider AJ, et al. First abdominal access in gynecological laparoscopy: which method toutilize? [in Italian]. Minerva Ginecol. 2006; 58(5): 429–440.

[4] Tinelli A. Laparoscopic Entry: Traditional Methods, New Insights and Novel Approaches. London, UK: Springer, 2012.

[5] Dr. A.S. Mudholkar et al. Direct Primary Trocar Entry for Laparoscopic Procedures: our Experience. INDIAN JOURNAL OF APPLIED RESEARCH. 2014; 4(10): 487-89.

Abstract: Granulosa Cell Tumours (GCTs) of the ovary are rare and account for 2-5% of all ovarian cancers. They are divided into juvenile and adult types. Adult types constitute 95% of all GCTs. GCTs secrete large amounts of sex steroids such as estrogen. Prolonged elaboration of high levels of estrogen by adult GCTs may be associated with proliferative breast disease, endometrial hyperplasia and rarely endometrial carcinoma (EC). We report a case of 59 year old woman referred to our hospital on account of 3-month history of vaginal bleeding with 18-day history of abdominal swelling and pains. Histopathologic evaluation of surgical biopsies obtained from her confirmed ovarian GCT with extensive omental and peritoneal spread and associated Grade 2 endometrioid adenocarcinoma. The rarity of this association and the unique pattern of this case are highlighted to stimulate a high index of suspicion for such among clinicians in our environment.

Keywords:Adult, Endometrial Carcinoma, GCT (Granulosa Cell Tumour), Ovarian

[1]. Evans AT 3rd, Gaffey TA, Malkasian GD Jr et al. Clinicopathologic review of 118 granulosa and 82 theca cell tumors. ObstetGynecol 1980;55(2): 231-238.
[2]. Unkila-Kallio L, Tiitinen A, Wahlstrom T, Lehtovirta P and Leminen A: Reproductive features in women developing ovarian granulosa cell tumour at a fertile age. Hum Reprod 2000;15: 589-593.
[3]. Schumer ST, Cannistra SA. Granulosa cell tumor of the ovary. J ClinOncol 2003;21: 1180-1189.
[4]. Stenwig JT, Hazekamp JT and Beecham JB.Granulosa cell tumours of the ovary.A clinicopathological study of study of 118 cases with long-term follow-up.GynaecolOncol1979;7: 136-152.
[5]. Young RH. Sex cord-stromal tumors of the ovary and testis: their similarities and differences with consideration of selected problems. Mod Pathol 2005;18 (Suppl 2):881-989.

Abstract: Infected pathological fracture is always a great problem for the treating clinician. No definite treatment policy has been drafted yet. We have used inflatable self-locking nail in six cases of pathological fracture due to Osteomyelitis (OM) in diaphysis of femur. Though the series is short, uniformly good result has prompted the author to promote this procedure as a new addition to existing ways of management of such fractures.

Keywords: Inflatable Nail, Pathological Femoral Diaphyseal Fractures, Osteomyelitis

[1]. Levin PE, Schoen RW Jr, Browner BD. Radiation exposure to the surgeon during closed interlocking Pascarella R, Nasta G, Nicolini M, Bertoldi E, Maresca A, Boriani S. The Fixion nail in the lower limb. Preliminary Results: ChirOrganiMov 2002;87:169-74
[2]. Lepore L, Lepore S, Maffulli N. Intramedullary nailing of the femur with an inflatable self locking nail: comparison with locked nailing. J OrthopSci 2003;8:796-801
[3]. Shasha N, Blumberg N, Tauber M, Dekel S. An Expandable Intramedullary Nail for Fixation in Osteoporotic Bone. In: An YH, editor.Internal Fixation in Osteoporotic Bone. New York: Thieme; P.301-9.
[4]. Steinberg EL, Geller DS, Yacoubian SV, Shasha N, Dekel S, Lorich DG. Intramedullary Fixation of Tibial Shaft Fractures Using an Expandable Nail: Early Results of 54 Acute Tibial Shaft Fractures. J Orthop Trauma 2006;20:303-9
[5]. Lepore S, Caupano N, Lepore L, Janneli P. Clinical and Radiolographic Results with the Fixion Intramedullary Nail: A Inflatable Self-Locking System for Long Bone Fractures. Osteo Trauma Care 2002;10:S32-5..

Abstract: Aim of the systematic review : The aim of the study is to systematically review the implants in auricular prosthesis. Objectives : 1.To find out the number of people with ear defects and its cause., 2. Total number of cases rehabilated with implant supported prosthesis, 3.Over all success rate and success rate in non radiated bone and radiated bone. 4. Type of attachment system used for auricular prosthesis. Methodology: Studies considered for inclusion were searched in MEDLINE (PubMed) and relevant journals were hand-searched. The search was restricted to studies published in English from ,1 January 1987 to 1 January 2017.The key words are - Implants for ear prosthesis , Auricular prosthesis , Follow up studies on implant supported ear prosthesis , Attachment in auricular prosthesis...........

Keywords: Auricular defects ,implant in maxillofacial prosthesis ,implant supported auricular prosthesis

[1] K.M.Holgers, Soft tissue reactions around percutaneous implants : A clinical study on skin –penetrating titanium implants used for bone anchored auricular prostheses Int J Oral Maxillofac Implants 1987 Vol .2 , No 1 (35-39).
[2] .Stephen M .Parel ,The United states and Swedish experience with osseointegration and facial prostheses, Int J Oral Maxillofac Implants 1991 ; 6:75-79.
[3] Magnus Jacobsson ,A retrospective study of osseointegrated skin – penetrating titanium fixtures for retaining facial prosthesis Int J Oral Maxillofac Implants 1992;7:523-528.
[4] John .F.Wolfaardt ,Craniofacial osseointegration :The Canadian experience , Int J Oral Maxillofac Implants 1993;8:197-204 .
[5] Eleni Roumanas, Craniofacial defects and osseointegrated implants :Six – year follow up reports on the success rate of craniofacial implants at UCLA . Int .J Oral Maxillofac Implants 1994 ;9:5:579-585.

Abstract: Primary Pyodermas are one of the commonest clinical conditions encountered in dermatological practice especially in paediatric age group. This pattern of causative organisms of this common condition changes constantly. Aims: 1.To study the clinical and epidemiological patterns of primary pyodermas in children. 2. To know the causative microorganisms.3.To study the predisposing factors of primary pyodermas in children. Material and Methods: A total of 100 patients with primary pyodermas under the age of 12 years attending DVL OPD at SVRR Govt. General Hospital, Tirupati were studied............

Keywords: Primary pyoderma , staphylococcus aureus, Impetigo, folliculitis, streptococcus

[1] Adarsh Chopra, Ramesh Puri, Mital R.R., Shashikantha, Bhatia R: Ind. J. Dermatol. Venerol. Leprol. 1994:60:200-202
[2] Sugeng MW, Aug P, Tau HH, Gou CL. Characterstics of bacterial skin infections in children at a tertiary dermatological centre. International Journal of Dermatology. 1999: 38-58, 2-6 (Pub Med)
[3] Sadick NS. Current aspect of bacterial infections of skin. Dermatolclin 1997; 15:341-9 (Pub Med)
[4] MathhewMS, Garg BR, Kanungo R. A clinic bacteriological study of primary pyodermas in children in Pondichery. Indian Journal of DVL 192:58 P 183-187.
[5] Kar, P K Sharma et al. bacteriological study of pyodermas in children. Indian Journal Dermatology 1985. 51:325-327..

Abstract: Waardenburg syndrome is characterised by a pigmentary auditory genetic disorder including white fo-relock and heterochromia of the iris . It may also manifest as a congenital condition. The range and severity of associated symptoms and findings may vary greatly in presentation. It affects an estimated incidence of 1 in 40,000 of General population .There are 4 types documented in literature. Types I and II are the most common forms of Waardenburg syndrome, while types III and IV are rare1. Waardenburg syndrome is usually inherited in an autosomal dominant pattern, which means one copy of the altered gene in each cell is sufficient to cause the disorder. In most cases, an affected person has one parent with the condition. A small percentage of cases result from new mutations in the gene; these cases occur..........

........

Abstract: Edentulous patients with continuous residual ridge resorption often experience problems with their conventional dentures due to their instability and lack of retention, leaving the patient dissatisfied and insecure with functional results and aesthetics.¹ Over the years, implant supported overdentures have constituted a predictable and a secure therapeutic alternative affording a patient's satisfaction due to simpler hygiene and good chewing efficiency.2 They represent a cheaper treatment than fixed prosthesis and in some cases with loss of lip support, with interocclusal spaces larger than 15mm; their use will prevent future aesthetic or phonetic problems.3 However, rehabilitation of completely edentulous maxilla using osseointegrated implant has always tested the ability of clinician and laboratory technician............

1. Doundoulakis JH, Eckert SE, Lindquist CC, Jeffcoat MK. The implant supported overdenture as an alternative to the complete mandibular denture. J Amer Dent Assoc 2003;134.
2. Fein JS, De Grandmont P, Boudrias P, Brien N, LaMarche C, Tache R. Within-subject comparisons of implant supported mandibular prosthesis: choice of prosthesis. J Dent Res 1994:73:1105-11.
3. Azorin JF. ML, Andres GS, Lopez JF, Panadero RA. Rehabilitation with implant-supported overdentures in total edentulous patients: a review.
4. Mc Cracken's Removable Partial Prosthodontics. C V Mosby Company, St. Louis, MO 1993, Chapter 10, 143- 149.
5. Pan YH, Ramp LC, Liu PR. Patient responses to dental implant-retained mandibular overdenture therapy: A 6-year clinical study. Chang Gung Med J 2007;30:363-369..

Abstract: Approximately 3% of upper limb fractures occur in the proximal humerus1 and the injury affects both younger and older populations. Need and AO classification however could not incorporate technical impli-cations of surgery, its prognostic outcome. A morphological classification developed by Dutch et al addressed prognostic or technical implications of the variable morphology found in these fractures. In the present study, the perspective of early investigation and to provide the basis for the evaluation and management of these inju-ries. Furthermore, the morphological classification, evaluation, treatment, and results are reviewed in the con-text of the current approach to the management of isolated greater tuberosity fractures. Morphological classifi-cation of isolated greater tuberosity fractures may serve as an adjunct to the Neer and AO classifications with no additional cost or radiation exposure for implementation. Isolated greater tuberosity fractures can be ma-naged conservatlvey managed only when minimally displaced and significant displacement over 5 mm needs surgical intrervention.

[1]. Warner J, Costouros J, Gerber C. Fractures of the Proximal Humerus. In: Bucholz RW, Heckman JD, Court-Brown C, eds. Rockwood & Green's Fractures in Adults. sixth ed. Philadelphia: Lippincott Williams and Wilkins, 2006;1162–1209.
[2]. Gruson KI, Ruchelsman DE, Tejwani NC. Isolated tuberosity fractures of the prox- imal humeral: current concepts. Injury 2008;39:284–298.
[3]. Court-Brown CM, Garg A, McQueen MM. The epidemiology of proximal humeral fractures. Acta Orthop Scand. 2001;72:365–71
[4]. 4.Neer CS 2nd. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg [Am] 1970;52-A:1077–1089.
[5]. Neer CS 2nd. Displaced proximal humeral fractures. II. Treatment of three-part and four-part displacement. J Bone Joint Surg [Am] 1970;52-A:1090–1103..

Abstract: Acute Respiratory Distress Syndrome occur in response to a variety of insults and are characterised by the development of non cardiogenic pulmonary edema, impaired gas exchange and bilateral infiltrates on the chest radiograph. Acute Lung Injury and ARDS are the major causes of acute respiratory failure that are associated with high mortality and morbidity. Present study aims to analyse the prognostic determinants and outcomes of acute respiratory distress syndrome (ARDS).Patients that fulfilled the Berlin definition for ARDS and who were mechanically ventilated for more than a twenty four hour period were selected for the study and were analysed. PaO2/FIO2 is a strong predictor outcome of mortality in ARDS. Clinical scores – SOFA, maxSOFA, SAPS II and LIS had a statistically significant association with mortality and hence are validated methods to predict outcome of ARDS. CRP and Procalcitonin are not significant predictors.

[1]. Ashbaugh DG, Bigelow DB, petty TL, Levine BE; Acute respiratory distress in adults. Lancet 1967, 2:319-323
[2]. ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA 2012;307:2526-33.
[3]. VillarS, karmarek RM :The American-European consensus conference definition of acute respiratory distress syndrome is dead, longlive positive end expiratory pressure Med intensiva 2012,36:571-575
[4]. Villar,S Perez-Medezl, Lopez j, et al; An early PEP/fio2 trial identifies different degrees of lung injury in patients with acute respiratory distress syndrome. AMJ respiratory care med 2007;176:795-804.
[5]. Definition task force ARDS, Ranieri VM, Rubenfeld GD, et al; Acute respiratory distress syndrome: The Berlin definition JAMA 2012;307;2526-33.

Abstract: Magnesium is fourth most common cation in the body and second most common intracellular cation after potassium, yet its deficiency in critically ill-patients is frequently overlooked. Some authors have called Mg "the forgotten electrolyte" [5,6], because, although Mg alterations are common, hypomagnesemia is an important but underdiagnosed electrolyte abnormality. There is a paucity of data in Indian literature, addressing this common, but underdiagnosed electrolyte deficiency. Present study was to assess the magnitude of magnesium deficiency and its influence on the outcome of critically ill-patients with emphasis on the implications of hypomagnesemia and on treatment...........

[1]. Quamme GA, de Rouffignac C. Epithelial magnesium transport and regulation by the kidney. Front Biosci. 2000;5:D694–711.

[2]. Fawcet WJ, Haxby EJ, Male DA. Magnesium physiology and pharmacology. Br J Anesth. 1999;83:302–20

[3]. Deheinzelin D, Negri EM, Tucci MR, Salem MZ, da Cruz VM, Oliveira RM, et al. Hypomagnesemia in critically ill cancer patients: A prospective study of predictive factors. Braz J Med Biol Res. 2000;33:1443–8.

[4]. Tong GM, Rude RK. Magnesium deficiency in critical illness. J Intensive Care Med. 2005;20:3–17.

[5]. Gonzalez W, Altieri PI, Alvarado S, Banchs HL, Escobales N, Crespo M, Borges W. Magnesium: the forgotten electrolyte. Bol Asoc Med P R. 2013;105(3):17–20

Abstract: Controversy persists regarding surgical management of long bone injuries in the agebetween 6 to 16 years. Titaniumela sticnail (TEN) fixation was original lymeanta sanideal treatment method for femoral fractures, but was gradually applied to other long bone fractures in children, asitre presents acompromise between con servative and surgical the rapeuticap proaches with satis factory results and minimal complications. The present study is a retrospective analysis of 34 children who were operated for humerus diaphysial injuries with TENS system. Results were analysed and discussed in the study. Results favoured operative management diaphysial injuries of humerus in children aged 6-15 years with TENS, for early mobilisation, ease of care of injured extremity and for its advantages with no major complications and technical ease of surgery, and also minimal damage to tissues in view of it being a closed percutaneous method.

[1]. MetaizeauJP.Stableelasticnailingforfracturesofthefemurinchildren.JBoneJoint
[2]. Surg Br 2004;86:954-957
[3]. GamalEl-Adl,MohamedF.Mostafa,MohamedA.Khalil,AhmedEnan.Titanium elasticnailfixationforpaediatricfemoralandtibialfractures.ActaOrthop.Belg
[4]. 2009; 75: 512-520
[5]. Garg S, Matthew BD, Perry LS, Scott JL, Gordon JE. Surgical treatment of traumatic pediatric humeral diaphyseal fractures with titanium elastic nails. J Child Orthop 2009 April; 3(2): 121–127..

Abstract: The pyriformis syndrome is an uncommon and often under-diagnosed cause of buttock and leg pain. The knowledge regarding this syndrome is important especially for a clinician, as being unaware of this entity leads to delayed or misdiagnosis. The patient at times is referred for psychiatrist consult due to mismatch of symptoms and spinal MR findings. In the present study, we retrospectively reviewed charts of patients treated for pyriformis syndrome and their outcome. A total of 21 patients were treated for pyriformis syndrome by the senior author during the period. Of them, 14 were male patients and average age of the study group was 35.2 years (24-41 years). Average visit of patient to an orthopaedician before diagnosis of pyriformis syndrome was 3.6. Pyriformis syndrome is a relatively............

[1]. Peng PW, Tumber PS: Ultrasound-guided interventional procedures for patients with chronic pelvic pain - a description of tech-niques and review of literature. Pain Physician. 11 (2): 215-224, 2008
[2]. Huerto AP, Yeo SN, Ho KY: Piriformis muscle injection using ultrasonography and motor stimulation-report of a technique. Pain Physician 10 (5): 687-690, 2007
[3]. L. A. Boyajian-O'Neill, R. L. McClain, M. K. Coleman, and P. P. Thomas, ―Diagnosis and management of piriformis syndrome: an osteopathic approach,‖ The Journal of the American Osteopathic Association, vol. 108, no. 11, pp. 657–664, 2008.
[4]. Gonzalez P, Pepper M, Sullivan W, Akuthota V: Confirmation of needle placement within the piriformis muscle of a cadaveric specimen using anatomic landmarks and fluoroscopic guidance. Pain Physician 11 (3): 327-331, 2008
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Abstract: To create simplest PCNLpuncture trainer & understand principles of puncture.. Methods /Design:2 Transparent plastic boxes reformed to upper deck made of lids 3 cms apart & lower deck with bottoms glued 3cms apart with side slit. Keyboard flash LEDlight is moved through slit in lower deck with change in position varying 0-200 craniocaudal as well as lateromedial.Lids are hollowed like a window frame. White paper& transparent polythene sheet is taultly fixed by closing upper& lower lids which are adhered.PCS is made of clearstraw with ends closed with opsite The light facing upwards below the straw in alignment gives 0o as light moves out the angulation increase to 300& similarly when light source is moved caudally (towards bladder ).Puncture is done with spinal needle. Polythene sheet gives haptic feed back & stabilise the needle in position during puncture. White paper capture shadow & is seen directly for image interpretation & puncture Principles of Triangulation Method is used...........

[1]. Maneesh Sinha, Venkatesh Krishnamoorthy. Use of a vegetable model as a training tool for PCNL puncture . Ind . J Urol 2015 ;31(2):156-159
[2]. Lezrek M .Chinese shadows for initial learning of calyx puncture without radiation exposure. Urology 84 (4 Supplement 1)s158 Oct 2014.

[3]. Shankar Ram HS , Aby Madan ,Nazar M . Microbox white light PCNL puncture Trainer .2016 Nov . Journal of Endourology .Vol 30 .Supplement 2 .A-250
[4]. Self Making of Microbox . White light PCNL simulator .Video . https://youtu.be/Ucfe99z3kHg
[5]. S. Ram . Ideas and Innovations .SZUSICON 2016..