iosr-JDMS   Volume-16 ~ Issue-5 ~ May-2017

Abstract: Introduction: Ocular abnormalities are unseen morbidity due to iron overload in thalassemia patients which is being brought into light by our study. Aim & objectives: To study the ocular manifestations in transfusion dependent beta-thalassemia major patients and correlate serum ferritin levels and oral chelation therapy with ocular manifestations. Study Design: Cross sectional observational study. Methods: 52 thalassemia major patients of 5 to 14 years were selected as case group and 30 age matched anaemic patients were taken as a control group. Full medical history, physical and ophthalmological examination including visual acuity, slit lamp examination, fundoscopy. We computed ocular findings with mean serum ferritin level and duration of iron chelating agent. Minitab version 17 was used for computation of statistics...............

Keywords: Chelation Therapy, Ferritin, Thalassemia, ocular abnormalities.

[1]. Aksoy A, Aslankurt M, Aslan L, Gul O, GaripardM, Celik O, OkumuS, Ozdemir M, Ozdemir G. Ocular findings in children with thalassemia major in Eastern Mediterranean.Int j ophalmol.2014;7(1) :118-121.
[2]. Mohammad Hosein Nowroozzadeh,Zahra Kalantari ,Khadije Namvar ,Mohammad Hassan Meshkibaf.Ocular refractive and biometric characteristics in patients with thalassaemia major.Clin Exp Optom 2011; 94(4):361–366
[3]. Dewan P, GomberS, Chawla H .Ocular changes in multi-transfused children with β-thalassaemia receiving desferrioxamine:A case-control study,SA Journal of Child Health 2011; 5 (1):11-14.
[4]. Gaba A, Souza PD, Chandra J, Narayan S, Sen S. Ocular abnormalities in patients with beta Thalassemia. Am J Ophthalmol. 1998;108:699-703.
[5]. Taneja R, Malik P, Sharma M, Agarwal M C. Multiple transfused thalassemia major: Ocular manifestations in a hospital –based population.Indian Journal of Opthalmology2010; 58:125-130..

Abstract: Introduction: Double J (DJ) stent removal requires local anesthesia and is done using rigidcystoscope. Patients experience significant pain during and after the procedure. We assessed the efficacy of preemptive oral diclofenac in analgesia for patients undergoing DJ stent removal by rigid cystoscopy compared to placebo. Methods:Only male patients undergoing DJ stent removal under local anesthesia between March 2015 and July 2016 were enrolled. Patients were randomized to receive 75 mg oral diclofenac (Group A) or placebo (Group B) 1 hour before procedure by randomization. Intraurethral 2% lignocaine gel (25 ml) was used in both groups. Pain during rigid cystoscopy, pain at the first void, and at 1 day after cystoscopy was assessed using visual analog scale (VAS) (0–100). Adverse reactions to diclofenac and episodes of acute urinary retention, if any, were assessed...........

Keywords: Analgesia ,Double J stent,Diclofenac

[1]. Kobayashi T, Nishizawa K, Mitsumori K, Ogura K. Instillation of anesthetic gel is no longer necessary in the era of flexible cystoscopy: A crossover study. J Endourol 2004;18:483-6.
[2]. Chen YT, Hsiao PJ, Wong WY, Wang CC, Yang SS, Hsieh CH. Randomized double-blind comparison of lidocaine gel and plain lubricating gel in relieving pain during flexible cystoscopy. J Endourol 2005;19:163-6.
[3]. McFarlane N, Denstedt J, Ganapathy S, Razvi H. Randomized trial of 10 mL and 20 mL of 2% intraurethrallidocaine gel and placebo in men undergoing flexible cystoscopy. J Endourol 2001;15:541-4.
[4]. Herr HW, Schneider M. Outpatient flexible cystoscopy in men: A randomized study of patient tolerance. J Urol 2001;165(6 Pt 1):1971-2.
[5]. Komiya A, Endo T, Kobayashi M, Kim W, Araki K, Naya Y, et al. Oral analgesia by non-steroidal anti-inflammatory drug zaltoprofen to manage cystoscopy-related pain: A prospective study. Int J Urol 2009;16:874-80

Abstract: Disorders of the biliary tract affect a significant portion of the world's population. Over 95% of the biliary tract disease is attributable to cholelithiasis.Gall stones afflict 10 to 20% of adult opulation in developed countries necessitating hospitalization and cholecystectomy. The bile content play crucial role in the formation of gallstones. Gall bladder secretes mucin which is a high molecular weight glycoprotein. . Gallbladder mucin shares with other epithelial mucins the ability to bind lipids and bile pigment. This gallbladder mucin has long been recognized as an important factor contributing to initiation and formation of gall stones .Many studie have been done to see if there is any relationship between pathological changes in diseased gall bladder and gall stones formation............

Keywords: Gall bladder , mucin , histochemistry , cholecystectomy, histopathology, inflammation, fibrosis

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[3]. Womack N, Zeppa R, Irvine G.L The anatomy of gallstones. Ann surgery 1963;157: 670-686.
[4]. Maki T, Matushiro T, Suzuki N and Nakamura N. Role of sulphated glycoprotein in gallstone formation surgery, gynaec, obstetrics. 971; 132:846-854.
[5]. Esterly JR, Spicer SS. Mucin histochemistry of human gall bladder: changes in adenocarcinoma, cystic fibrosis and cholecystitis. J Nat: cancer inst 1968; 40:1-11.
[6]. Lee SP, J. LaMonte T and Carey MC Role of gall stone, mucus hypersecretion in the evaluation of cholesterol gall stone studies in the prairie dog. J.CLIN invest 1981 ;67: 1712- 1723

Abstract: Objectives: The aim of this study was to determine and compare the radiological appearance of pulmonary tuberculosis (PTB) and its correlation with CD4 count in groups of patients with and without human immunodeficiency virus (HIV) infection in ART & CHEST clinic in kilpauk Medical College Hospital, Chennai, Tamilnadu, Chennai. Materials and Methods: A total number of 60 patients of HIV + ve TB and 30 patients HIV –veTB were enrolled in this study. The diagnosis of PTB was made on the basis of clinical history, physical examination, Ziehl-Neelsen microscopy on three sputum samples and chest radiography. The following issues were recorded for each radiograph: the number of zones involved with consolidation, cavitation, pleural effusion, bronchopulmonary pattern of spread; milliary disease; hilar and mediastinal lymphadenopathy............

[1]. Corbett EL, Watt CJ. Walker N, Maher D, Williams BG. The growing burden of tuberculosis; global trends and interactions with HIV epidemic ( Archives of int medicine 2003, 163;1009-1021)
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[3]. UNAIDS- Updated on Global facts and figures (Dec 2006).
[4]. http://data.unaids.org/pub/epi report/2006.
[5]. WHO Global tuberculosis control: surveillance, planning, financing report 2007, Geneva, WHO, 2007(WHO/HTM/TB/2007/376)
[6]. TB India 2007-RNTCP status Report published central TB division, directorate general of public services, Ministry of Health & Family Welfare, New Delhi.

Abstract: Most of the patients seeking orthodontic treatment have one wish that is Need for Speed. In order to reduce duration of orthodontic treatment, many methods have been introduced in the literature. One of the most recent technique is Dento-Alveolar Distraction-DAD technique.This article explains the concept of dentoalveolar distraction in rapid distalization of canine in orthodontic cases requiring first premolar extraction.

Keywords: Accelerating orthodontics, dentoalveolar distraction, distraction Osteogenesis

[1]. Vig P, Weintraub JA, Brown C, Kowalski CJ. Duration of orthodontic treatment with and without extractions. Am J Orthod Dentofacial Orthop 1990;97:45-51.
[2]. Fink DF, Smith RJ. The duration of orthodontic treatment. Am J Orthod Dentofacial Orthop. 1992;102:45–51.3. Geiger AM, Gorelick L, Gwinnett AJ, Benson BJ. Reducing white spot lesions in orthodontic populations with fluoride rinsing. Am J Orthod Dentofacial Orthop. 1992; 101:403–407.
[3]. Segal GR, Schiffman PH, Tuncay OC. Meta analysis of the treatment-related factors of external apical root resorption. Orthod Craniofac Res. 2004;7:71–78.
[4]. Royko A, Denes Z, Razouk G. The relationship between the length of orthodontic treatment and patient compliance. Fogorv Sz. 1999;92:79–86.
[5]. Proffit WR, Fields HW: Fixed and removable appliances, in Proffit WR, Fields HW (eds): Contemporary Orthodontics (ed 2). St Louis, MO, Mosby-Year Book, 1993, pp 317-373

Abstract: Objectives: The aim of the study was to compare the left ventricular mass in hypertensive patients with diabetes mellitus and without diabetes mellitus and to compare these two groups with controls in kilpauk medical college hospital,Chennai. Materials And Methods: A total number of 150 subjects (50 Hypertensive cases + 50 Cases of both hypertension and diabetes + 50 controls) are investigated by following measures.Proper history and past medical history and demographic details were collected.General examination, vitals monitoring includes blood pressure and pulse rate ,Body Mass Index,Fasting and Post Prandial Blood Sugar ,Complete hemogram,Blood Urea, Serum Creatinine and Serum Electrolytes...........

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[3]. D. Gover R.Zak K. G. Nair biochemical correlates of cardiac hypertrophy. Circulation. 1969; 25: 473-485
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[5]. Meerson F Z. The myocardium in hyperfunction, hypertrophy and heart failure. Circ Res. 1969; Jul; 25 2-163.
[6]. Laks MM Norepinephrine, the producer of myocardial cellular hypertrophy and/or necrosis and/or fibrosis. Am Heart J 1977; 94 394-399.

Abstract: The most common problems among long term denture wearers is the unstable complete mandibular denture .Complete dentures are primarily mechanical devices, but since they function in the oral cavity, they must be in harmony with normal neuromuscular function, oral functions such as speech, mastication, swallowing, smiling, and laughing which involves the synergistic actions of the tongue, lips, cheeks, and floor of the mouth. . In order to have a favourable prognosis for the denture therapy, impression technique selected should be proper. In Neutral Zone Technique, the forces exerted by muscles of tongue and the cheek will tend to stabilize the denture rather than unseat it

Keywords: Stability, Mandibular denture, Neutral Zone, Impression

[1]. Peterson PE, Bourgeois D. The global burden of oral diseases and risks to oral health. Bull World Health Organ 2005;83:661-9.
[2]. Basker R M, Harrison A, Ralph J P. A survey of patients referred to restorative dentistry clinics. Br Dent J 1988; 164: 105–108
[3]. Atwood D A. Post extraction changes in the adult mandible as illustrated by micrographs of midsagitall sections and serial
cephalometric roentgenograms. J Prosthet Dent 1963; 13: 810–824.
[4]. Philip GB, Thomas V. The Neutral Zone . Dent Impact 2013;5:105-8.
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Abstract: The aim of the study is to find a suitable teaching method that focuses on both students and teachers and that focuses on both students and teachers and that yields the best out of the teaching learning process. A cross-sectional study on 168 MBBS students of different semesters conducted with a well structured questionnaire and the results were analyzed. There has been more students opting for audio visually aided teaching and participatory group discussion type of learning............

Keywords: Group Discussion, Lecture, Medical Education, Seminars, Tutorials

[1]. Hafeez, K., Khan, M. L. Z., Jawaid, M., &Haroon, S. Low attendance in lectures at medical colleges of Karachi – A cross sectional
survey. Journal of Postgraduate Medical Institute. 2014; 28 (2): 161-164.
[2]. Sumera, A. Large group teaching, an effective and efficient teaching methodology. Journal of Asian Scientific Research. 2014; 4
(1), 1-5.
[3]. Held, S., &McKimm, J. Improve your lecturing. British Journal of Hospital Medicine. 2009; 70 (8), 466-469.
[4]. Irby DM. What clinical teachers in medicine need to know. Acad Med. 1994; 69: 333–342.
[5]. Angelo TA, Cross KP. Classroom Assessment Techniques: A Handbook for College Teachers. Second Edition. San Francisco:
Jossey Bass Publishers, 1993.

Abstract: This study was carried out to examine vitamin A deficiency using conjunctival impression cytology and to find out the effect of vitamin A supplementation in vitamin A deficient children attending out door patient of Ophthalmology Department, ANMMCH, Gaya. The study comprised of 200 children with complaint of night blindness and ocular changes. Conjunctival impression cytology was performed in all the children with the help of Millipore filter material. Children were given 200000 IU oil miscible vitamin A orally. They received an additional oral dose next day and cytology was repeated after 4 weeks. Maximum number of male (62.93 per cent) and female (65.47 per cent) children showed abnormal cytology at initial............

Keywords: Paediatric, Cytology, Vitamin A deficiency, Supplementation

[1]. Aggarwal K. Eliminating vitamin A through early supplementation. Indian J Pediatr 2007;74:963-964.
[2]. Bloem MW, de Pee S, Darnton-Hill I. New issues in developing effective approaches for the prevention and control of vitamin A deficiency. Food and Nutrition Bulletin, 1988;19(2):137-148.
[3]. Arlappa N. Vitamin A deficiency control measures: importance of vitamin A supplementation as a public health policy in the Indian context. J Public Health Policy. 2013; 34: 538-548.
[4]. Benn CS, Aaby P, Arts RJ, Jensen KJ, Netea MG, Fisker AB. An enigma: Why vitamin A supplementation does not always reduce mortality even though vitamin A deficiency is associated with increased mortality. Int J Epidemiol 2015;44:906-918.
[5]. Robert E Black, Cesar G Victora, Susan P Walker, Zulfiqar A Bhutta, Parul Christian, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 2013;382:427-451.

Abstract: Purpose: To find out relationship of mean ocular perfusion pressure(MOPP), Systolic ocular perfusion pressure (SPP) & diastolic ocular perfusion pressure with occurrence of primary open angle glaucoma(POAG) Study Design: Hospital based cross sectional study Study period: August '2016- February '2017. A period of 6 months. Setting: Sankara eye hospital, krishnankoil, tamilnadu. Method: In a period of 6 months we examined total 836 patients of 40-80 years age group from southern part of Tamilnadu, of which 431 patients were male & 405 were female. All patients are evaluated with dilated fundus bio microscopy with +90D lens,IOP measurement by applanation tonometer,gonioscopy by goldman 4 mirror goniolens& Humphrey 30-2 perimetry test.............

Keywords: POAG, MOPP, ocular perfusion pressure, SPP, DPP

[1]. Hayreh SS. Blood flow in the optic nerve head and factors that may influence it. Prog Retin Eye Res. 2001;20:595–624.
[2]. Distribution of Ocular Perfusion Pressure and Its Relationship with Open-Angle Glaucoma: The Singapore Malay Eye Study. Yingfeng Zheng, Tien Y. Wong, Paul Mitchell et al, Investigative_ophthalmology_visual_science. DOI: 10.1167/iovs.09-4867 • Source: PubMed.
[3]. Ocular Perfusion Pressure in Glaucoma, Robert N. Weinreb, MD, David S. Greenfield, MD, November 1, 2015
[4]. Nicolela MT, Walman BE, Buckley AR, Drance SM. Ocular hypertension and primary open-angle glaucoma: a comparative study of their retrobulbar blood flow velocity. J Glaucoma. 1996;5:308– 310
[5]. Paul J Foster, Ralf Buhrmann, Harry A Quigley, Gordon J Johnson, The definition and classification of glaucoma in prevalence surveys. 3 August 2001, British journal of ophthalmology.

Abstract: Dyslexia is defined as difficulty in learning to read despite conventional instruction, adequate intelli-gence, and socio-cultural opportunity.1, 2 The term dyslexia has been accredited to Professor Rudolf Berlin.3 It is derived from the Greek prefix 'dys' and the root-word 'lexis'. The former means 'difficulty' whereas the latter means 'word or language'. It can be best translated as 'difficulty with words' 4,5 It is a 'hidden' disability as there are no obvious external signs for people to recognize.6 Lack of assessment may result in low self-esteem as compared to non-dyslexic students.7,8 and lack of appropriate help and support can have long-term effects on people with dyslexia when reaching adulthood.9

[1]. Critchley, M., & Critchley, E. Dyslexia Defined. London: Heinemann. 1978
[2]. Fawcett, A.J., & Nicolson, R.I.Naming. Speed in Children with Dyslexia, Journal of Learning Disabilities.1994;27(10):641-646.
[3]. Aaron, P.G., Joshi, R.M., Gooden, R. & Bentum, K.E. Diagnosis and Treatment of Reading Disabilities Based on the Component Model of Reading. Journal of Learning Disabilities.2008;41(1):67-84.
[4]. Hornsby, B. Overcoming Dyslexia (2nd ed.) (London, Optima). 1992
[5]. Ott, P. How to Detect and Manage Dyslexia: A Reference and Resource Manual. Oxford: Heinemann.1997

Abstract: Introduction: Present study was conducted to assess the demographic characteristics, risk factors, causative spectrum, clinical features, natural course and outcome in patients of fulminant hepatic failure. We also tried to study the outcome in relation to risk factors, etiology, clinical and biochemical parameters and derive prognostic indicators that would be relevant to fulminant hepatic failure patients. Materials & Methods: A total of 36 diagnosed cases of Fulminant hepatic failure, fulfilling our inclusion and exclusion criteria were selected for the study. The detailed clinical history, complete general, systemic examination, central nervous system examination and investigation findings was noted in a predesigned proforma. The baseline functional status (motor, sensory, autonomous)...........

Keywords: Clinical Spectrum, Fulminant Hepatic Failure, Mortality, Sepsis, Viral Hepatitis

[1]. C Trey, LS Davidson. The management of fulminant hepatic failure. H Popper, F Schaffner (Eds.), Progress in liver diseases, Grune and Stratton, New York (1970), pp. 282–298.
[2]. Ostapowicz G, Fontana RJ, Schiodt FV, Larson A, Davern TJ, Han SH, et al. Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med 2002; 137: 947–954.

[3]. OPTN/SRTR 2003 Annual report: transplant data 1993–2002. HHS/HRSA/SPB/DOT; UNOS; URREA. Available at http://www.ustransplant.org. Accessed March 2005
[4]. Dhiman RK, Seth AK, Jain S, Chawla YK, Dilawari JB. Prognostic evaluation of early indicators in fulminant hepatic failure by multivariate analysis. Dig Dis Sci 1998; 43: 1311–1316.
[5]. Batra Y, Bhatkal B, Ojha B, Kaur K, Saraya A, Panda SK, Acharya SK. Vaccination against hepatitis A virus may not be required for schoolchildren in northern India: results of a seroepidemiological survey. Bull World Health Organ 2002; 80: 728–31.

Abstract: Intention of our study is to demonstrate that when Athlete's foot is not well treated or neglected at all, many bacterial attacks may occur, especially by Staphylococcus aureus, especially in persons who for sake of their hard job have to wear amphibious work boots in summertim, The disease becomes more and more severe and important and thus we have discovered that instead of using antimycotic agents only (because it is evident that there is even a microbial co-existence), it is better to employ massive dosages of antimycotic agents and Neem oil and Silver citrate, apt to combat Staphylococci..

Keywords: Athlete's foot, Tinea pedis,Staphylococcus aureus, Neem oil, Silver citrate.

[1]. Chalmers L; Manuf.Chem. 1972, 43 (1),33

[2]. Al Hasan M, Fitzgerald SM, Saoudian M , Krishnaswamy G; Dermatology for the practicing allergist: Tinea pedis and its complications; 2004:Clin Mol Allergy. ; 2: 5.

[3]. Khan AV, * Ahmed QU, Mir MR, Shukla I, Khan AA:Antibacterial efficacy of the seed extracts of Melia azedarach against some hospital isolated human pathogenic bacterial strains;2011:Asian Pac J Trop Biomed. ; 1(6): 452–455.

[4]. Jung WK, Koo HC, Kim, KW,, Shin S, Kim SH, Park YH;Antibacterial Activity and Mechanism of Action of the Silver Ion in Staphylococcus aureus and Escherichia coli; 2008:▿Appl Environ Microbiol;; 74(7): 2171–2178..

Abstract: Introduction: Depression is the leading global cause of disability and approximately, 350 million people suffer from depression worldwide. Despite the availability of numerous psychopharmacological treatments, evidence indicates that only 60–70% of persons who tolerate antidepressants will respond to first-line drug therapy for major depressive disorder. Resistance to the antidepressant medication is the main indication for ECT. However, the use of ECT remains controversial due to concerns about memory impairment in persons with depression who receive acute ECT. The present study was planned toevaluate the effectiveness of ECT in severe depression and its effect on retrograde and anterograde amnesia or any change in their level due to ECT. Materials & Methods: A total of 30 consecutive patients diagnosed with Severe Depressive Episode as per International Classification of Diseases (ICD-10) Diagnostic Criteria for Research and satisfying the eligibility criteria were taken in the study after informed consent................

Keywords: Autobiographical Memory Interview, Electroconvulsive Therapy, Hamilton Rating Scale, Severe Depression, Wechsler Memory Scale – Third India Edition

[1]. The World Health Organization. The global burden of disease: 2004 update, table A2: burden of disease in DALYs by cause, sex and income group in WHO regions, estimates for 2004. Geneva, Switzerland: WHO, 2008. http://www.who.int/healthinfo/global_ burden_disease/GBD_report_2004update_AnnexA.pdf (accessed 6 Mar 2014)
[2]. S Saxena, A Dhawan. Disability and Burden of depressive disorders. The National Medical Journal of India; vol.12,No.2,1999
[3]. Souery D, Papakostas GI, Trivedi MH. Treatment resistant depression. J Clin Psychiatry 2006;67(Suppl 6):16–22.
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[5]. Kennedy N, Foy K. The impact of residual symptoms on outcome of major depression. Curr Psychiatry Rep. 2005;7(6):441-6..

Abstract: Aim: To study the efficacy of the limbal stem cell transplantation in the management of pterygium. Methods: In an interventional case series, 50 patients with pterygium underwent surgical excision with limbalstem cell transplantation on to bare sclera at Rajiv Gandhi Institute of Medical Sciences, kadapa .Patients were followed for 6 months and results were evaluated in terms of recurrent growth and other postoperative complications. Results: 50 eyes of 50 patients including 32 females and 18 males of mean age of 40±8 years were operated on the pterygia extended onto cornea for more than 2mm. Only two eye withlimbal stem cell transplantation( 4%) demonstrated recurrent pterygium growth.

Keywords: Pterygium,Limbal stem cell transplantation, Recurrence.

[1]. Goldberg L, David R. Pterygium and its relationship to the dry eye in Bantu.Br J Ophthalmol 1976;60:720‑1.
[2]. Alemworie M, Abebe B, Menen A. Prevalence of pterygium in a rural community of Meskan District, Southern Ethiopia. Ethio J Health Dev 2008;22:191‑4.
[3]. Asokan R, Venkatasubbu RS, Velumuri L, Lingam V, George R. Prevalence and associated factors for pterygium and pingencula in South Indian Population.OphthalmicPhysiol Opt 2012;32:39‑44.
[4]. Hirst LW. The treatment of pterygium. SurvOphthalmol 2003;48:145-177
[5]. Fernandes M, Sangwan VS, Gangopadhyay N, Sridhar MS, Garg P, AasuriMK,et al. Outcome of pterygium surgery: Analysis over 14 years. Eye,2005;19:1182‑90.

Abstract: Introduction: The most common cause of surgical emergencies in the world is Acute Appendicitis. Appendicitis when progressing to perforation , has a higher mortality and morbidity, hence appendicitis has to be operated if the diagnosis is probable but not to wait still it is certain. Acute appendicitis is diagnosed by thorough clinical examination.Modified Alvarado scoring system was designed so that to reduce negative Appendicectomy rate hence to reduce the morbidity and mortality. Aim Of The Study : To evaluate sensitivity and efficiency of "Modified Alvarado Scoring System" in diagnosis of "Acute Appendicitis" in Adults............

Keywords: Acute Appendicitis, Modified Alvarado score, early diagnosis

[1]. Hoffmann J, Rasmussen OO. Aids in the diagnosis of acute appendicitis. Br J Surg 1989; 76: 774-779.
[2]. John H, Neff U, Kelemen M. Appendicitis diagnosis today: clinical and ultrasonic deductions. World J Surg1993; 17:243 -249.
[3]. Jones PF. Suspected acute appendicitis: trends in management over 30 years.Br JSurg2001; 88:1570 -1577.
[4]. Lee SL, Walsh AJ, Ho HS. Computed tomography and ultrasonography do not improve and may delay the diagnosis and treatment of acute appendicitis. ArchSurg2001; 136:556 -561.
[5]. Fitz RH. Perforating inflammation of the veriform appendix: with special reference to its early diagnosis and treatment. Am. J. Med. Sci 1886; 92: 321-346..

Abstract: Secondary amenorrhea in women of reproductive age may be an indication of an undiagnosed, chronic condition and appropriate treatment is dependent upon accurate diagnosis of the underlying etiology. A thorough clinical assessment and a few common laboratory tests can easily identify the most frequent causes of secondary amenorrhea. However. in these cases, misdiagnosis is unfortunately common and often the result of poor laboratory utilization in the form of a failure to employ indicated tests, the use of obsolete tests, or erroneous interpretation in the face of interfering factors or co-morbidities. Consequently, the algorithmic approach to laboratory evaluation in the context of secondary...........

Keywords: secondary amenorrhea , algorithmic approach

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