iosr-JDMS   Volume-16 ~ Issue-3 ~ March-2017

Abstract: Human immunodeficiency virus (HIV) has been associated with increased risk of cancer worldwide(1). Despite the proven efficacy of HAART, Death associated with cancer among the HIV infected has therefore remained a big challenge.(2) Cancer screening is a proven effective method of prevention and control in many populations.(16) We analyzed the type of cancers HIV infected patients presented with at some treatment facilities with a view to sensitize health worker to the need for routine cancer screening among HIV infected persons. This is a prospective data collection of HIV infected patients at two major treatment facilities in Plateau state over a three year period January 2013 to January 2016. A total of 343 participants were enrolled, 184(56.4%) males and 159(46.4%) females. Majority of reponndants 100(29.1%) were in the age group 37 - 47years, 83.4%(286) were married and 244(31.1%) were unemployed...........

Key words:-HIV/AIDS, Cancer, Defining, Screening

[1]. Bibliography. Cancer in AIDS. Current world literature. Current opinion in oncology. 2011;23(5):541-2.
[2]. Alcada J, Taylor MN, Shaw PJ, Janes SM, Navani N, Miller RF. High prevalence of malignancy in HIV-positive patients with mediastinal lymphadenopathy: a study in the era of antiretroviral therapy. Respirology. 2014;19(3):339-45.
[3]. Parkin DM, Sitas F, Chirenje M, Stein L, Abratt R, Wabinga H. Part I: Cancer in Indigenous Africans--burden, distribution, and trends. Lancet Oncol. 2008;9(7):683-92.
[4]. Bourcier V, Winnock M, Ait Ahmed M, Sogni P, Pambrun E, Poizot-Martin I, et al. Primary liver cancer is more aggressive in HIV-HCV coinfection than in HCV infection. A prospective study (ANRS CO13 Hepavih and CO12 Cirvir). Clinics and research in hepatology and gastroenterology. 2012;36(3):214-21.
[5]. Coghill AE, Newcomb PA, Madeleine MM, Richardson BA, Mutyaba I, Okuku F, et al. Contribution of HIV infection to mortality among cancer patients in Uganda. Aids. 2013;27(18):2933-42

Abstract: Systemic lupus erythematosus (SLE) and small-sized vessel vasculitis are usually two distinguishable autoimmune diseases. However, vasculitis may be found in the course of SLE but rarely corresponds to an antineutrophil cytoplasmatic antibodies (ANCA) associated vasculitis (AAV). We report a case SLE with lupus nepritis (LN) associated with perinuclear (p-ANCA). The frequency of this association seems not fortuitous. Although the etiopathogenic mechanisms of such association remain to be described, several clinical, histological and immunological features support the hypothesis of the existence of SLE-AAV overlapping syndrome. Moreover clinicians must be aware of such overlapping syndrome, notably because its initial presentation can be very severe.

Keywords: Systemic lupus erythematosus, antineutrophil cytoplasmatic antibodies, ANCA associated vasculitis.

[1]. Jaybhaye AP, Sutay NR, Chate SV, Rathod TN. Juvenile systemic lupus erythematosus: A diagnostic dilemma. J Nat Sci Biol Med 2011;2:229-31.
[2]. Maroz N, Segal MS. Lupus nephritis and end-stage kidney disease. Am J Med Sci. 2013;346:319–323.
[3]. Fauzi AR, Kong NCT, Chua MK, Jeyabalan V, Idris MN, Azizah R. Antibodies in Systemic Lupus Antineutrophil Cytoplasmic Erythematosus: Prevalence, Disease Activity Correlations and Organ System Associations. Med J Malaysia Vol 59 No 3 August 2004 372-377
[4]. Bitzan M. Glomerular Disease. In: Phadke K, Goodyer P, Bitzan M, editors. Manual of Pediatric Nephrology, 1st ed., Springer, London; 2014. 141-229.
[5]. Bosch X, Guilabert A, Font J. Antineutrophil cytoplasmic antibodies. Lancet 2006; 368:404-18.

Abstract: With the advent of various advances in medical technology in twenty first century, many techniques have been tried to heal chronic leg ulcers. Although there exists no ideal wound dressing in the management of chronic wounds especially diabetic ulcers, several methods of wound dressing is being used and still evaluated. Hence we conducted the following study to evaluate the efficacy of Epidermal Growth Factor over conventional dressings in the healing of diabetic ulcers..........

Keywords: Epidermal Growth Factor, Conventional dressings, Diabetic ulcers ,Wound healing.

[1]. Hardwicke J, Schmaljohann D, Boyce D, Thomas D. Epidermal growth factor therapy and wound healing—past, present and future perspectives. The Surgeon. 2008 Jun 30;6(3):172-7.

[2]. Carpenter G, Cohen S. Epidermal growth factor. Annual review of biochemistry. 1979 Jul;48(1):193-216

[3]. Loots MA, Kenter SB, Au FL, Van Galen WJ, Middelkoop E, Bos JD, Mekkes JR. Fibroblasts derived from chronic diabetic ulcers differ in their response to stimulation with EGF, IGF-I, bFGF and PDGF-AB compared to controls. European journal of cell biology. 2002 Mar 31;81(3):153-60.

[4]. Berlanga-Acosta J. Gavilondo-Cowley J. Lopez-Saura P. Gonzalez-Lopez T. Castro-Santana MD. Lopez-Mola E, et al. Epidermal growth factor in clinical practice—a review of its biological actions, clinical indications and safety implications. Int Wound J.2009;6:331.

[5]. Kondo S. Kuroyanagi Y. Development of a wound dressing composed of hyaluronic acid and collagen sponge with epidermal growth factor. J BiomaterSciPolym Ed.2012;23:629.

Abstract: Background: Systemic sclerosis is a chronic connective tissue disease of unknown aetiology that causes widespread microvascular damage and excessive deposition of collagen in the skin and internal organs. There is variability among patients in terms of involvement of skin and internal organs. The heart is involved in 40-70% of cases. The male to female ratio is 1:3 and the incidence increases with age and peaks at 3rd to 5th decade. We report a case of systemic sclerosis complicated by pulmonary hypertension. Case Presentation: A 35 year old woman presented with recurrent breathlessness, dry cough and leg swelling of 4 years duration following child birth which were associated with orthopnoea, easy fatigueability, presyncope weight loss, dysphagia and swollen painful digits.........

Keywords: Systemic sclerosis, pulmonary hypertension, interstitial lung fibrosis.

[1]. Hinchcliff M, Varga J.Systemic sclerosis/scleroderma: a treatable multisystem disease. Am Fam Physician 2008; 78: 961-968.
[2]. Ferri C, Emdin M, Giuggioli D, et al. Autonomic dysfunction in systemic sclerosis: time and frequency domain 24 hour heart rate variability analysis. Br J Rheum 1997; 36: 669-676.
[3]. Follansbee WP, Miller TR, Curtiss EI et al. A controlled clinicopathologic study of myocardial fibrosis in systemic sclerosis (scleroderma). J Rheumatol 1990; 656-662.
[4]. Hachulla E, Gressin V, Guillevin L, et al. early detection of pulmonary arterial hypertension in systemic sclerosis. Arthritis Rheum 2005; 52: 3792-3800

[5]. Lawrence RC, Helmick CG, Arurett FC, et al. estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum 1998; 41: 778-799..

Abstract: Accurate knowledge of foetal growth is clinically relevant to aid evaluation of diagnostic measurements of foetal growth and to identify potentially compromised gestations so as to enable timely intervention and management protocols. Intrauterine growth retardation is most commonly defined on the basis of a weight below the 10th percentile for gestational age. Growth retarded foetuses are at increased risk for perinatal morbidity and mortality. The evaluation of individual thigh circumference measurements and identification of foetuses with reduced soft tissue mass require definition of a growth curve for this in normally growing foetuses which the present study intends to achieve.............

Keywords: Ultrasound, foetal thigh circumference, IUGR

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1986;14:99-.
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[4]. Vintzileos AM et al. Ultrasound foetal thigh -calf circumferences and gestational age-independent fetal ratios in normal pregnancy.
J Ultrasound Med. 1985(4).
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Abstract: Chronic subdural haematoma is predominantly a disease of the elderly. The general aim of the study was to evaluate the effect of management of CSDH after burrhole evacuation with or without subgaleal drainage. Grouping of study population were divided into 2 groups such as: Group-A (Control): The first case and every alternative cases which were operated with drain and Group-B (Case): The second case and every alternative cases which were operated without drain.70 cases of CSDHs haematoma were identified in different age groups. They were diagnosed by no-contrast CT scan of head. All patients were followed until discharged from the hospital. The age ranges of both groups were from 10 to 90 years and mean age 58.71% and 56.14%. Male predominate in both groups............

Keywords: Chronic subdural haematoma, Elderly, Subgaleal,Drainage, Markwalder scale, Evacuation

[1]. TH Aung, WK Wong, HP Mo, CS Tsang, Management of chronic subdural haematoma: burr holedrainage, replacement with Hartmann's
solution, andclosed-system drainage, HKMJ, 5(4), 1999; 383-6.
[2]. Mark S Greenberg, Chronic subdural hematoma: hand book of neurosurgery (7th edn), 2010, p. 899-902.
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[4]. Weigel R, Schmiedek P, Krauss JK. The outcome of contemporary surgery for chronic subdural hematoma: evidence-based review. J Neurol
Neurosurg Psychiatry, 74(7), 2003, 937-43.
[5]. Sambasivan M, An overview of chronic subdural hematoma: experience with 2300 cases. Surg Neurol 47,1997, 418–422. doi:
10.1016/S0090-3019(97)80756-2. pmid:9131021.

Abstract: Objectives: To evaluate the use of p53 as indicator of tumour prognosis in routine biopsies of oral squamous cell carcinomas and its comparison with a well established grading system for histopathological malignancy. Materials and methods: A total of 20 patients with age ranging from 45-70, diagnosed as clinically malignant and 20 normal controls were selected for the study. One group of sections of the biopsy specimens was stained for routine H & E and the other group was used for immunohistochemical study The technique used in this kit is based on the labeled streptavidin-biotin method............

Keywords: Oral Squamous cell carcinoma, p 53protein, Immunohistochemistry, Malignancy grading system.

[1]. A.J. Levine et al., "The p53 tumour suppressor gene" Nature 1991; 351; 453-55.
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[4]. Kaur J. Srivatsava et al., "Over expression of p53 protein in betel and tobacco related human oral dysplasia and squamous cell
carcinoma in India". Int. J. of cancer: 1994: 58: 340-345.
[5]. J.K. Field et al., over expression of p53 gene in head and neck cancer linked with heavy smoking and drinking". Lancet – 1992;
339: 502-503..

Abstract: Objective: To prospectively assess the value of MR urethrography compared to conventional Retrograde urethrography in the surgical management of obliterative anterior urethral stricture. Materials And Methods: 15 male patients along with 2 controls in the age group of 20-65, who presented to the radiology department with symptoms of urinary retention and in whom conventional retrograde urethrography (RUG) had been performed were taken up for study.MR urethrography (MRU)was performed in these patients after a time interval of about 1 week, were analysed and it was focused on location, number, length and the signal intensity of the stricture.Anterior urethral stricture is measured along the long axis of the fibrotic segment shown as low signal intensity on the sagittal T2-weighted images.............

Keywords:MRUMR Urethrography RUGRetrograde Urethrography RARERapid acquisition with relaxation enhancement HASTEHalf Fourier Acquisition of Single Shot Turbo Spin Echo sequences Anterior urethral stricture Sagittal T2 weighted image. Periurethral fibrosis Fistulas, sinus tracts etc. Roof of the penile bulb

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[3]. Y Osman - European Urology, MR Urethrography in Comparison to Retrograde Urethrography in Diagnosis of Male urethral
strictures 50/3,587-594, September 2006.
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Jul;154(1):72-6.
[5]. Dixon CM, McAninch JW. MR imaging of urethral defects and pelvic crush injuries.Urol 1992;148:1162-5..

Abstract: Background: FESS – Functional endoscopic sinus surgery, a minimally invasive surgery, has become the main stay for treatment of patients with sinus pathology. However, Intraoperative bleeding, which reduces operative field visibility is the major problem in FESS. This study compare the effects of preoperative Clonidine, Metoprolol and Tranexamic acid with Intraoperative Nitroglycerin in patients undergoing FESS on Quality of surgical field , Intraoperative blood loss ,Hemodynamics and duration of surgery. Methods: In this study 90 patients assigned to undergo FESS were randomly allocated to three groups of 30 each. Group 1 patients were premedicated orally with Metoprolol 12.5 mg and Clonidine150mcg. Inj.Tranexamic Acid 30 mg/kg i.v. was given half an hour prior to surgery..................

Keywords: FESS, Metoprolol, Clonidine, Tranexemic acid, Nitroglycerin

[1]. Josephson JS. Current advances in therapy for sinus disease. Adv.Ther 1992 Jul-Aug; 9(4):255-264

[2]. Teichgraeber JF, Riley WB, Parks DH. Nasal surgery complications. PlastReconstr Surg. 1990; 85:527–31
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[4]. Boezaart AP, van der Merwe J, Coetzee A. Comparison of sodium nitroprusside- and esmolol-induced controlled hypotension for functional endoscopic sinus Surgery. Can J Anaesth. 1995; 42(5 Pt 1):373–376.

[5]. Cincikas D, Ivaskevicius J. Application of controlled arterial hypotension in endoscopic rhino surgery. Medicina (Kaunas). 2003; 39(9):852–9..

Abstract: Ulcerative colitis is a chronic disease of the bowel that results in inflammation and ulceration of the colon and rectum. It presents with loose stools mixed with mucous and blood. The exact etiology is unknown. The factors considered frequently are life style changes, smoking, food habits, sanitation, exposure to infections, occupation, disordered immune response and genetic factors. The incidence in Indians is rising. Considering the varied clinical profile in different geographical distribution, it is worth investigating the clinical profile. Indian studies are few in number..............

Keywords: clinical profile, Diarrhea, Inflammatory Bowel disease, Rectalbleeding, Ulcerative colitis

[1]. Amosy E. M'Koma. Inflammatory Bowel Disease: An Expanding Global Health Problem. Clinical Medicine Insights: Gastroenterology. 2013; 6:33-47.
[2]. A Sood, V Midha, N Sood, AS Bhatia, G Avasthi. Incidence and prevalence of ulcerative colitis in Punjab, North India.Gut.2003; 52:1587 – 1590.
[3]. Weronica E. Eka, Mauro Amatoa, Jonas Halfvarsonb. The history of genetics in inflammatory bowel disease. Annals of Gastroenterology.2014;27:294-303.
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Abstract: Introduction: Adnexal lesions present in 2.6 per 1,00,000 of adolescents and is a source of concern for the patient and her parents. They usually present with pain abdomen and rarely mass per abdomen. Adnexal lesions in adolescents are usually benign but rarely can be malignant . Some lesions regress spontaneously but others which cause severe discomfort to the patient need to be managed surgically in which laproscopic surgery is considered beneficial...............

[1]. Dotters-Katz SK, James AH, Jaffe TA (2014) Paratubal/Paraovarian Masses: A Study of Surgical and Non-Surgical Outcomes. Med J Obstet Gynecol 2(1): 1019.

[2]. Gordts S, Puttemans P, Gordts S, Brosens I. Ovarian endometrioma in the adolescent: a plea for early-stage diagnosis and full surgical treatment. Gynecol Surg. 2015;12(1):21-30.
[3]. Laufer, M. and Goldstein, D. Benign and malignant ovarian masses. Pediatric and adolescent gynecology. Lippincott Williams & Wilkins, Philadelphia,2000, 685-728.
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[5]. Pfeifer, S, Gosman, G Evaluation of adnexal masses in adolescents. Pediatric Clinics of North America,1999;46,573-92

Abstract: Background: Diabetes Mellitus is a leading health problem with increasing incidence and associated with cardiovascular, renal, neurological complications etc. Elevated serum uric acid plays an important risk factor for the development of cardiovascular, renal, ophthalmological, neurological and metabolic disturbance. Elevated levels of serum uric acid in type 2 DM increases risk of developing all complications especially chronic kidney disease. Aim and Objectives: To study the impacts of serum uric acid in type 2 diabetes mellitus, and its relation with development of complications..............

Keywords: Diabetes mellitus, complications, serum uric acid.

[1]. Liese AD, Hense HW, Lo¨wel H, Do¨ring A, Tietze M, Keil U. Association of serum uric acid with all-cause and cardiovascular disease mortality and incident myocardial infarction in the MONICA-Augsburg cohort: World Health Organization Monitoring Trends and Determinants in Cardiovascular Diseases. Epidemiology 1999; 10:391–397
[2]. Kanellis J, Kang DH. Uric acid as a mediator of endothelial dysfunction, inflammation, and vascular disease. SeminNephrol 2005;25:39–42
[3]. Fukui M, Tanaka M, Shiraishi E, Harusato I, Hosoda H, Asano M, Kadono M, Hasegawa G, Yoshikawa T, Nakamura N. Serum uric acid is associated with microalbuminuria and subclinical atherosclerosis in men with type 2 diabetes mellitus. Metabolism 2008;57:625-629
[4]. Chen JH, Chuang SY, Chen HJ, Yeh WT, Pan WH. Serum uric acid level as an independent risk factor for all-cause, cardiovascular, and ischemic stroke mortality: a Chinese cohort study. Arthritis Rheum 2009;61:225–232
[5]. Saggiani F, Pilati S, Targher G, Branzi P, Muggeo M, Bonora E. Serum uric acid related factors in 500 hospitalized subjects. Metabolism 1996;45:1557–1561

Abstract: Presenting an unusual case of asymptomatic central cemento-ossifying fibroma in missing first mandibular molar region (measuring about 1cm in its maximum dimension) discovered incidentally on routine radiographic examination. Based on the above case and by literature review, treatment protocol for small asymptomatic radiolucencies in oral cavity has been put forward.

Keywords: Asymptomatic radiolucency, cemento-ossifying fibroma, missing tooth,residual cyst.

[1]. SaritaMagu, Raj Kumar Airon, Daya Shankar Mishra, Rohtas K Yadav, VikasKakkar,Cemento-ossifying fibroma of the maxilla, Indian J Radiol Imaging,10(2), 2000,103-104.
[2]. Hashmi G. Sarwar, M. K. Jindal, SamshadAhmad. A Case Report of Cemento-Ossifying Fibroma,J. Maxillofac Oral Surg , 9(2) , June 2010,178–181.
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[4]. So Lyung Jung, Kyu Ho Choi, Young Ha Park, Hyun Chul Song and MiSeon Kwon. Cemento-Ossifying Fibroma Presenting as a Mass of the Parapharyngeal and Masticator Space. AJNR Am J Neuroradiol , October 1999,20,1744–1746.
[5]. Demetrio Tamiolakis, VasiliosThomaidis, IoanisTsamis. Cemento-ossifying Fibroma of the Maxilla: a Case Report. ActaStomat Croat,39(3), 2005,319-321.

Abstract: Diaphragmatic hernia (cdh) is a defect in the dome of diaphragm, more often in left and postero-lateral that permits the herniation of abdominal contents into the thorax. The lungs hypoplasia, pulmonary hypertension and persistent foetal circulation are important determinant of survival. The incidence is 80%.The aetiology of diaphragmatic hernia is unclear, although 2% is familial and 15% of patients have chromosomal abnormalities. Experimental evidence suggests that pulmonary hypoplasia is the primary defect in diaphragmatic hernia.6 failure of separation of the thoracic and abdominal compartments of the body by closure of embryonic pleuroperitoncal canal during eighth week of gestation results congenital diaphragmatic hernia (bochdalek's type). The affected lung is intrinsically abnormal..

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[2]. the history of congenital diaphragmatic hernia from 1850s to the present. J perinatol 2002, 22: 242-6.
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Abstract: The objective of this study was to evaluate the diagnostic value of skull radiograph alone in young children in screening of skeletal dysplasias and dysostoses in comparison with whole skeletal survey. It is a retrospective study which includes 1000 high risk children who undergone whole skeletal survey. 20 patients were diagnosed as dysplasia/dysostoses out of which 18 patients had skull abnormalities. The sensitivity, specificity, positive predictive value and negative predictive value for skull Xray alone was 90%,100%,100% and 99.8% respectively in making correct diagnosis..........

Keywords: Dysplasia/dysostoses, High risk children, skull Xray, whole skeletal survey

[1]. Panda A, Gamanagatti S, Jana M, Gupta AK, Skeletal dysplasias: A radiographic approach and review of common non-lethal
skeletal dysplasias,World J Radiol, 6(10), 2014 Oct 28, 808–82.
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Information, RadioGraphics,24:2, 2004,507-522.
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Abstract: Aims and objectives: We conducted this study to evaluate the role of glutamine supplemented total parenteral nutrition (TPN) in severe acute pancreatitis. Methods: Forty patients with severe acute pancreatitis admitted at Rajendra institute of medical Sciences ,Ranchi, over a period of one year( July 2012 to June 2013) were randomly divided into two therapeutic groups. Patients in group 1( 19 in no) and group 2 (21 in no.) were treated with standard TPN and glutamine supplemented TPN respectively. Patients were assessed for nutritional parameters, the incidence of complications, mortality, length of hospital stay(LOS) and length of TPN.....

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[5]. Melis GC, ter Wengel N, Boelens PG, van Leeuwen PA. Glutamine: recent developments in research on the clinical significance of glutamine. Curr Opin Clin Nutr Metab. 2004;7:59-70..

Abstract: Aim: To study the adverse reactions for second line drugs in the treatment of MDR TB and its impact on adherence to the treatment Settings and Design: Department of TB & Chest diseases, Coimbatore medical college Hospital Prospective study Period of study: Jan 2014 to Dec 2014 Methods and Material: Adverse events in 109 patients of MDR-TB started on second line drugs in our tertiary care centre were observed from January2014 to December 2014. Lists of 11 adverse reactions were selected and the patients were assessed for adverse events during the 1st week of inpatient treatment and at the end of 1st month of treatment..........

Keywords: mdr-tb, genexpert, line probe assay.

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Abstract: Enteric (typhoid) fever is a systemic disease characterized by fever and abdominal pain and caused by the dissemination of S.typhi or S.paratyphi . The disease was initially called typhoid fever because of its clinical similarity to typhus. In the early 1880s typhoid fever was clearly defined pathologically as a unique illness on the basis of its association with enlarged peyer's patches and mesenteric lymph nodes. In 1869, given the anatomic site of infection , the term enteric fever was proposed as an alternative designation to distinguish typhoid fever from typhus. However, to this day , the two designations are used interchangeably...........

............

Abstract: HIV infection is most ofteen associated with renal abnormalities. This study was conducted in 100 HIV patients including newly diagnosed and on patients on ART. The study population were divided into 4 groups according to CD4 count and GFR. About 58% of study population were in the age group of 21-40 years and 38% of study population were in the age group of 41-60 years. Most of the population in the study group were in the age group of 21-36 years. Male population is around 77% and female population is around 23% in this study population. Most of the population were on ART therapy...............

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elevated serum creatinine and mortality in HIV-infected women.J Acquir Immune DeficSyndr. 2003;32:203–209.
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immunodeficiency virus-infected patients. Am J Kidney Dis. 1996;27:803–808.
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Abstract: Background: Epidural and spinal blocks are major techniques with long history of effective use for various surgeries and pain relief. Nevertheless, both technique have their drawbacks. Major disadvantage of subarachnoid blockade is precipitous hypotension and inability to obtain desired level. Epidural blockade with catheter insitu provides better control of analgesia and postoperative care. Although it has its own demerits like slower onset, large dose of local anaesthetic drug requirement, patchy anaesthesia. Combined spinal epidural techniques combines both features of subarachnoid block and continuous epidural anaesthesia. Purpose of this study is to compare combined epidural spinal technique with epidural alone technique in terms of onset, quality of analgesia, muscle relaxation and hemodynamic responses

Keywords: Epidural, combined spinal epidural, bupivacaine, analgesia.

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Abstract: Cutaneous and subcutaneous metastases are extremely rare in bladder carcinoma. The prognosis is generally poor. The present paper reports an interesting and rare case of extensive metastasis of a high grade carcinoma of th bladder. It is a case of a 72-year old man who had undergone a radical cystoprostatectomy with construction of Bricker bladder for a high-grade papillary urothelial carcinoma of the bladder. Two months later, he developed cutaneous and subcutaneous nodules. A skin biopsy confirmed the diagnosis of cutaneous metastasis of papillary urothelial bladder carcinoma. Chemotherapy was started. Clinicians should recognize the importance of thorough physical examination in patients with urothelial carcinoma.

Keywords: bladder, carcinoma, cutaneous metastasis, urothelial

[1] Mueller TJ, Wu H, Greenberg RE, Hudes G, Topham N, Lessin SR, Uzzo RG. Cutaneous metastases from genitourinary malignancies. Urology 2004; 63: 1021-6.
[2] Akman Y, Cam K, Kavak A, Alper M. Extensive cutaneous metastasis of transitional cell carcinoma of the bladder. Int J Urol 2003; 10: 103-4.
[3] Oosterlinck W, Lobel B, Jaske G, Malstrom PU, Stockle M, Sternberg C. Guidelines on bladder cancer. Eur Urol. 2002 Feb;41(2):105– 12.
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[5] Ohtsuki Y, Fukumoto T, Okada Y, Teratani Y, Hayashi Y, Lee GH, Furihata M. Immunohistochemical and ultrastructural characterization of the signet-ring cell carcinoma component in a case of urothelial carcinoma of the urinary bladder. Med Mol Morphol. 2010 Jun;43(2):96–101. doi: 10.1007/s00795-009-0463-x. Epub 2010 Aug 4.

Abstract: Basal cell carcinoma is most common skin cancer caused by prolonged exposure to ultraviolet rays.It is also called as rodent ulcer. It primarily affects individual with light eyes,hair and fair complexion but pigmented basal cell carcinoma has predilection for darker skinned population with dark brown eyes.Usually it presents as pigmented nodular mass over nose or malar region.It grows in slow and indolent fashion.Treatment of choice is surgical excision with 2mm of margin.Here we report a case of bilateral pigmented lesion on alae portion of nose..

Keywords: Basal cell carcinoma,Pigmented basal cell carcinoma,Ultraviolet radiation

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J 2013;4:1217
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Abstract: The purpose of this study was to compare the effect of Swiss Ball training verses Stable surface training on Functional performance in ambulatory Cerebral Palsy .Institutional ethical committee permission was taken before starting the study. A sample of 73 CP children were screened and 40 meeting the inclusion criteria were selected for study were then randomly divided into two groups one control other experimental i.e. 20 in each group by chit method. Both the groups were assessed with Pediatric Berg Balance Scale before and after the treatment. Control group were given Floor exercise and experimental group were be given Ball exercises for 10 repetition with.........

Keywords: Swiss Ball , stable surface ( Floor) , Cerebral palsy(CP) , PBBS (Pediatric Berg Balance Scale) , Functional performance.

[1]. Sophie Levitt : Treatmenent of Cerebral Palsy and Motor Delay,Fourth edition published
[2]. by Blackwell Publishing 2004
[3]. Shumway cookandwoolacolt : MOTOR CONTROL AND LEARNING 3rdedition
[4]. Copyright © 2007 ,Lippincott Williams & Wilkins , a Wolters ,Kluwer business
[5]. ISBN13 : 978-07817-6691-3 ; ISBN10 : 07817-6691-5.

Abstract: Purpose: Our aim was to evaluate role of anti VEGF Ranibizumab in diabetic CSME, Wet ARMD and retinal vein occlusion
Method: The present study was conducted in 100 patients who presented themselves in OPD of upgraded department of Ophthalmology ,N.S.C.B.Medical college, Jabalpur (M.P.) during the academic session October 2014 – September 2016.All selected patients were given Intravitreal Ranibizumab on monthly basis after full history as well as thorough clinical examinations followed by treat and extend norms.OCT evaluation for central retinal thickness and visual acuity measurement was done prior to, after each injection as well as after completion of therapy.......

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