iosr-JDMS   Volume-16 ~ Issue-9 ~ September-2017

Abstract: Effects of neurological affliction of joints were first described by Charcot in 1868 [1]. Diabetes mellitus is currently the most common cause of neuroarthropathy [2]. Abnormal nociception and proprioception lead to progressive destruction of the joint. Management of Charcot's arthropathy by definitive surgical treatment remains a challenge despite technical advances in treatment modalities. In the diabetic population, ankle neuroarthropathy constitutes 3% to 10% of all cases. This leads to significant instability, fracture and collapse of ankle mortise and carries a high risk of amputation of the lower limb [3–7]............

[1]. Charcot JM. Sur quelquesarthropathies qui paraissentdependred′une lesion due cerveauou de la moelleepiniere. Arch Physiol Norm etPathol. 1868; 1:161–78.
[2]. Jacobs RL, Karmody A. Charcot foot. In: Jahss MH, editor. Disorders of foot. Vol. 2. Philadelphia: WB. Saunders; 1982. pp. 1248–65.
[3]. Cofield RH, Morrison MJ, Beabout JW. Diabetic neuroarthropathy in the foot: Patient characteristics and patterns of radiographic change. Foot Ankle. 1983;4:15–22.
[4]. Miller DS, Licthman WF. Diabetic neuropathic arthropathy of feet; Summary report of 15 cases. AMA Arch Surg. 1955; 70:513–8.
[5]. Sanders LJ, Mrdjenovich D. Anatomical pattern of bone and joint destruction in neuropathic diabetes. Diabetes. 1991; 40:529A

Abstract: Congenital anomalies areimportant causes of infant and childhood deaths,chronic illness and disability. They are characterized by metabolic , structural ,functional and behavioural disorders present at the time of birth .The etiological factors include chromosomal abnormality and mutation of various genes ,which gives rise to structural and metabolic defects .Thanatophoric dysplasia is a lethal skeletal muscle abnormality incompatible with life due to severe pulmonary hypoplasia.

Keywords-: congenital anomaly, skeletal muscle dysplasia, thanatophoric dysplasia, pulmonary hypoplasia

[1]. Nelsons Book Of Paediatrics.
[2]. the prevalence of thanatophoricdysplsia and lethal osteogenesis imperfecta typeII in northern Ireland –a complete population study ,
[3]. Deride E Donnelly,VivienneMcConrll,PatrickJMorrison Thanatophoric dysplasia @gene reviews NCBI bookshelf...

Abstract: Background And Objective: Cold chest pack is used as the first line of treatment in the management of cardiovascular and respiratory lifestyle disorders. Though cold chest pack is used for both rejuvenation as well as therapy its physiological effect is less understood. Hence this study aims to evaluate the physiological effect of cold chest pack on HRV. Materials And Methodology: 60 male and female healthy volunteers of mean age 22.2 were recruited for the study. Subjects were randomly allocated into two groups, group1cold chest pack for 30 min, group 2 sham chest pack for 30min. Assessments will be done 5min before and 5 min immediately after the intervention............

Keywords: Cold chest pack, Heart rate variability, Heart rate, Naturopathy, Sham chest pack

[1]. N.K Manjunath, Shirley Telles. Therapeutic Applications of a Cold Chest Pack in Bronchial Asthma. W.J Med Sci, 2006,1(1), 18-20.
[2]. J H Kellog. The Chest Pack, Techniques of hydrotherapy, Rational Hydrotherapy. (NIN, Pune, 2010).
[3]. Tanizni, M Okazaki et al. Spa therapy improves ventilatory function in the small airways of patients with steroid dependent intractable asthma. Acta Medica Okayama 1992; 46: 175-178.
[4]. Sathyaprabha T N, H Murthy and B.T.C. Murthy, Efficacy of naturopathy and yoga in bronchial asthma – A Self-controlled matched scientific study. Indian Journal Physiol. Pharmacol 2001; 45: 80-86.
[5]. Yildirir A, Kabacki G, Akgul et al. Effects of menstrual cycle on cardiac autonomic innervation as assessed by heart rate variability. Annals of Noninvasive Electro cardiology, 2002, 7(1), 60 –63.

Abstract: Background: Cognition declines with age is a known fact. Some studies suggest a positive correlation between the declinations of cognition with Diabetes. Studies on dementia have contributed diabetes as one of the possible causative factor for its early occurrence. During the management of diabetes, examination of cognitive functions are overlooked as a routine practice. This study attempts to examine the cognitive functions in established diabetics who are on treatment and correlate the same with duration of diabetes................

[1]. Cognitive Dysfunction and Diabetes Mellitus Christopher T. Kodl and Elizabeth R. Seaquist
[2]. Diabetes mellitus and cognitive impairments ElhamSaedi, Mohammad Reza Gheini, FiroozehFaiz, and Mohammad Ali Arami
[3]. Cognitive impairment in diabetic patients: Can diabetic control prevent cognitive decline?
[4]. Takahiko Kawamura,*1,2Toshitaka Umemura,3 and Nigishi Hotta1
[5]. Cognitive Impairment and Diabetes Author: K. Dash, Sandip..

Abstract: Kisspeptin is a peptide hormone that appears to play a major role in the regulation of GnRH secretion,the researchaims to study the relationship between obesity and premature puberty touched by influence of kisspeptin concentration. The study was included 150girls and women divided into three groups. first group include fifty girls before menses with age range (9 -12years), twenty five girls were normal weight, the rest were obese girls .Second group with the same division system but these fifty women have normal menstrual cycle with age range (25 -45 years).Third group with age range (50 -60 years) after.............. .

Keywords: early puberty, kisspeptin, growth hormone, obesity, leptin

[1]. Harnois-Leblanc S, Trottier A, Leblanc S, Battista MC, Geller DH, Baillargeon JP. Evolution of metabolic alterations 5 Years after early puberty in a cohort of girls predisposed to polycystic ovary syndrome.ReprodBiolEndocrinol. 2017 Jul 24; 15(1):56.

[2]. Menk TAS, Inácio M, Macedo DB, Bessa DS, Latronico AC, Mendonca BB, Brito VN. Assessment of stress levels in girls with central precocious puberty before and during long-acting gonadotropin-releasing hormone agonist treatment: a pilot studyJPediatrEndocrinolMetab. 2017 May 23.2016-0425.

[3]. Mendle J, Ryan RM, McKoneKMEarly Childhood Maltreatment and Pubertal Development: Replication in a Population-Based Sample.J Res Adolesc. 2016 Sep;26(3):595-602

[4]. Kim SW, Kim YB, Lee JE, Kim NR, Lee WK, Ku JK, Kim EJ, Jung SH, Chung WY: The influence of gonadotropin releasing hormone agonist treatment on the body weight and body mass index in girls with

[5]. Idiopathic precocious puberty and early puberty Ann Pediatric EndocrinolMetab. 2017 Jun; 22(2):95-101..

Abstract: Introduction: Malrotation is a spectrum of anatomical abnormalities due to incomplete rotation and fixation of intestine during the embryonic development. The clinical presentation varies from off and on symptoms of high intestinal obstruction to life threatening mid gut volvulus with intestinal gangrene. The present paper shares our experience with presentation and subsequent management in patients presenting with a diagnosis of intestinal malrotation...............

[1]. Mall FP. Development of the human intestine and its position in the adults. Johns Hopkins hospital, Bull 9:197-208 1898.

[2]. Dott NM. Anomalies of intestinal rotation, their embryology and surgical aspects, with report of 5 cases. Br J surgery 11:251, 192

[3]. Ladd WE. Congenital obstruction of the duodenum in children. N Eng J Med 206; 277, 1932.

[4]. El-Chammas K, Malcolm W, Gaca AM, Fieselman K, Cotten CM. Intestinal malrotation in neonates with nonbilious emesis; J perinatol 2006 Jun; 26(6):375-7.

[5]. Powell DM, Othersen HB, Smith CD. Malrotation of the intestine in children: the effect of age on presentation and therapy; J Pediatr Surg 1989 Aug; 24(8):777-80...

Abstract: On the basis of my experience of more than twenty years surgical practice, I have found that a large number of patients suffer from persisting right lower abdominal pain after appendectomy. This perplexing situation created a lot of social and financial problems, particularly in a developing country like ours. This ultimately leads to a human tragedy and insult to medical science. I planned a research work to study this problem. Based on this work, I am of the opinion that it is largely a mismanagement on the part of surgeons which is the cause of this human suffering..............

Keywords-: Right iliac fossa pain, Appendectomy, Syndrome, Investigations

[1]. Tanushree Chakraborty, Snehansu Pan: The menace of persisting right iliac fossa pain after appendectomy – are we over doing it? Journal of evolution of medical and dental sciences: vol 6/ issue 21/march 13, 2017/ p 1731 – 1735.
[2]. Dr Snehansu Pan: Horseshoe kidney presenting as appendicitis: IOSR Journal of dental and medical sciences: vol 15/ issue 9 (version – xl )/p- 5-7.
[3]. [ 3, 4, 5] Snehansu Pan: Personal unpublished collections

Abstract: Background: Blood lead has been associated with an elevated risk ofmiscarriage.The plasmaticfraction of lead represent the toxicologically active fraction of lead.Women with tendency to have a higher plasma lead for a given whole blood leadratio could tend toward an elevated risk of miscarriageand would consequently have history of spontaneous abortion. Objectives: The main objective of this study is to evaluate the role of plasma / whole blood lead ratio as a cause of Abortion in the first trimester..........

Keywords: SES –bortion , plasma lead , whole blood lead , plasma / whol.

[1]. Scroggins KM,Smucker WD ,Krishen AE. Spontaneous pregnancy loss; evaluation and medical counseling.prim care .2000; 27; 153_67.
[2]. CreininMD, Schwartz JL, Guido RS, PymarHC.Early pregnancy failure.ObstetGynecol Surv.2001;56;105_13

[3]. Li DK,Liu L, Odouli R .Exposure to NSID drugs during pregnancy and pregnancy ;population based cohort study .BMJ .2003 ;327;368.
[4]. Donders GG,VanBulck B ,CaudronJ,Londers L ,VereeckenA,Spitz B .Relation of vaginosis and mycoplasma to risk of abortion Am J Obstet and Gynecol 2004;10;143-6.
[5]. Gerhard I , Monga B ,Wald brenner A ,Runnebaum B .Heavy metals and fertility . Toxicol Environ Health 2004;54:593-611..

Abstract: Lasers are used in various periodontal applications which include calculus removal, soft tissue excision, incision and ablation. Other uses incorporate implants; biostimulation; bacteria reduction lastely bone removal.This article deals with the implications of lasers in periodontal surgery.

Keywords: Laser, Implants, Periodontal surgery

[1]. Maiman TH. Stimulated optical radiation in ruby.Nature.1960;187:493–4.

[2]. Sanders, J. H. , Phys. Rev. Letters, 3, 86 (1959).
[3]. An Overview of Laser Principle, Laser-Tissue Interaction Mechanisms and Laser Safety Precautions for Medical Laser Users.International Journal of Pharmacology, 7: 149-160.

[4]. Ashour, H.S., 2006. Tuning semiconductor laser diode lasing frequency and narrowing the laser linewidth using external oscillating driving field. J. Applied Sci., 6: 2209-2216.
[5]. Laser Radiation as an Adjunct to Nonsurgical Treatment of Periodontal Disease Periodontal Diseases - A Clinician's Guide

Abstract: Perinatal deaths are responsible for about 7% of the total global burden of disease. The present study was conducted in tertiary referral institute in Western Maharashtra, India, with a aim to study the frequency, classify the types and analyse the risk factors associated with perinatal mortality. Total number of perinatal mortality and analysis regarding maternal and fetal particulars, the mode of delivery, period of gestation, associated maternal risks, fetal parameters such as sex, birth weight, apgar score were recored. The total number of births during the study period was 6460, with 249 perinatal............

Keywords: Neonatal mortality, perinatal mortality,perinatal mortality rate, still births.

[1]. Moss W, Darmstadt GL, Marsh DR, Black RE, Santosham M. Research priorities for the reduction of perinatal and neonatal morbidity and mortality in developing country communities. J Perinatol 2002;22:484-95.
[2]. Park, J. and Park, K. (2000). Park's textbook of preventive and social medicine. 24th ed. Jabalpur, India: Banarsidas Bhanot;2000.
[3]. Registrar General of India. Sample registration system (SRS) statistical report 2013. New Delhi: 2013.
[4]. Who.int. (2017). WHO | Maternal and perinatal health. [online] Available at: http://www.who.int/maternal_child_adolescent/topics/maternal/maternal_perinatal/en/ [Accessed 15 Aug. 2017].
[5]. Bhave SA. Trends in perinatal and neonatal mortality and morbidity in India

Abstract: Health care personnel should show compliance to guidelines of Infection control practices and antimicrobial stewardship programme to prevent nosocomial transmission of infectious pathogens. Main aim of the study is to prevent spread of the infection from person to person or from contaminated health care objects which anticipated contact with blood, body fluids, secretions, excretions etc., and also reduce the transmission blood borne pathogens. Compliance to infection control practices were observed among healthcare personnel in a secret basis without knowing to them before and after giving training activities. Spillage management, care of non critical items, changing sheets on couches...........

Keywords: Infection control, Outpatient department.

[1]. DG. Maki, CJ Crnich. History Forgotten is History Relived: Nosocomial Infection Control is also Essential in the Outpatient Setting. Arch Int Med, 165, 2005, 2565-2567.
[2]. WR. Jarvi, Infection control and changing health-care delivery systems, Emerg Infect Dis, 7, 2001, 17-173.
[3]. PS. Barie, Infection Control Practices in Ambulatory Surgical Centers, JAMA, 303, 2010, 2295-2297.
[4]. https://www.cdc.gov/infectioncontrol/pdf/outpatient/guide.pdf
[5]. http://www.smp-council.org.hk/mlt/english/mlt_message_infection_e.pdf...

Abstract: Aim: To assess the sleep pattern and burden of sleep problems among 1st year MBBS students. Materials and Methods: This cross-sectional study was conducted at GIMSH, Durgapur, West Bengal, India from February to April 2017 among 77 first year MBBS students. Pittsburgh Insomnia Rating Scale (PIRS): a 65 item self-administered open source questionnaire to note sleep patterns of previous week was used. Results : >51% students have mild to moderately high sleep distress score. There's no significant difference in................

Keywords-: sleep study, sleep pattern, sleep habits, undergraduate medical student, undergraduate college students.

[1]. S Taheri, L Lin, D Austin, T Young, E Mignot,Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index, PLoS Medicine, 1(3), 2004, 210-217.
[2]. NS Simpson, S Banks, DF Dinges, Sleep restriction is associated with increased morning plasma leptin concentrations, especiallyin
[3]. women, Biological Research for Nursing, 12(1), 2010, 47-53.
[4]. GK Zammit, J Weiner, N Damato, GP Sillup, CA McMillan, Quality of life in people with insomnia,Sleep, 22(suppl. 2), 1999, S379-S385.
[5]. G. Curcio, M. Ferrara, L DeGennaro, Sleep loss, learning capacity and academic performance, Sleep Medicine Reviews,10(5), 2006, 323-337...

Abstract: Introduction: Major challenges to control TB in India include Strengthening of primary health-care infrastructure in rural areas of country. Medical College & hospital in rural area is definite hope in improving diagnosis and treatment of TB. Study done to know Prevalence of TB in patients attending Chest OPD of Medical College in rural area of North Maharashtra. Methods: We analyze 1 year Retrospective data of chest opd in Rural Medical College & Hospital. Total 18829 patients came to chest OPD in study period, among them 503 were symptomatic for TB. These patients were subjected for investigation and results were recorded...............

Keywords: Prevalence TB, Smear AFB Positive rate, Extra-pulmonary TB, Chest opd, rural medical college, North Maharashtra.

[1]. World Health Organization. Global Tuberculosis Report 2016 [Online][cited on 2016Oct]
[2]. Tuberculosis key facts.[Online][cited 2012 Feb];Available from:URL:http://www.tbcindia.org/key.asp
[3]. World Health Organization: The potential economic benefits of the DOTS strategy against TB in India; WHO/TB/96.218.
[4]. Chadha VK, Jagota Pchallenges and strategies for control of tuberculosis among agricultural workers NTI Bulletin 2002, 38/l &2,1 l-1 7

[5]. 5.Sarpal SS, Goel NK.Gender disparities in retreatment patients of tuberculosis:A north Indian study J Nat Sci Biol Med. 2015 Jan-Jun; 6(1):63–66. doi: 10.4103/0976-9668.149087.

Abstract: Background: Dermatological manifestations are very common in HIV-related opportunistic events and are usually initial markers of immunodeficiency. OBJECTIVE: To study the various dermatological manifestations in children with HIV in our institute and to correlate with clinical staging (WHO) and CD4 T-cell count. Material & Methods: This was a hospital based study where all HIV paediatric age group were studied for dermatological manifestations over a period of 1 year. Clinical profile and CD4 counts with other lab investigations were performed to derive any correlation. Statistical analysis was done with SPSS software where p value <0.05 was considered significant.........

Keywords: dermatological manifestations, paediatric patients, CD4 count.

[1]. Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants: Recommendations for a public health approach. 2010 version. World Health Organization. Available from: http://whqlibdoc.who.int/publications/2010/9789241599818_eng.pdf. [Accessed July 7, 2011]
[2]. Simoes EA, Babu P G, John T J. et al Evidence for HTLV III infection in prostitutes in Tamil Nadu (India). Indian J Med Res 198785335-338. [PubMed]
[3]. Shubber Z, Mishra S, Vesga JF, Boily MC. The HIV Modes of Transmission model: a systematic review of its findings and adherence to guidelines. J Int AIDS Soc. 2014 Jun 23;17:18928. doi: 10.7448/IAS.17.1.18928. eCollection 2014.

[4]. Antiretroviral therapy oh HIV infection in infants and children in resource-limited settings, towards universal access: Recommendations for a public health approach (2006 revision) WHO 2006 ART of HIV infection in infants and children in RL settings.

[5]. Centres for Disease Control and Prevention. 19994 Revised classification system for human immunodeficiency virus infection in children less than 13 years of age. MMWR 1994, 43(RR- 12): 1-7..

Abstract: sigmoid volvulus is a surgical emergency and significant cause of large bowel obstruction .The disease is more prevelant in India ,especially in rural population.The study analysed the etiological factors wich predisposed to sigmoid volvulus , clinical presentations , different modality of treatments and outcome.The duration of the study was 3 years between January 2013 to December 2016 at Government General Hospital ,Guntur. Results : The mean age of sigmoid volvulus was 48 years and male to female ratio was 4:1 comparitively less frequent in less than in 20 years and above 70 years. Distention of abdomen (100 %) followed by constipation were the commonest mode of presentation..

Keywords-:Sigmoid volvulus ,abdominal distention , Resection and anastamosis , Hartmanns procedure.

[1]. Ballantyne GH. Review of sigmoid volvulus. Clinical patterns and pathogenesis .Dis colon rectum .1982:25:823-830
[2]. AKinkuotu A, Samuel JC,Msiska N,Mvula C,Charles AG . The role of the anatomy of the sigmoid volvulus : a case- control study .clin Anat.2011 :24:634-637
[3]. Zheng L, Da Y. Appropriate treatment of acute sigmoid volvulus in the emergency setting .World L Gastroenter 1. 2013:19(30):4979-83.
[4]. Mulas C , Bruna M, Garcia – ArmengoI J,Roig JV. Management of colonic volvulus .Experience in 75 patients.Rev Esp Enferm Dig . 2010:102:239-248
[5]. Safioleas M, Chatziconstantious C,Felekouras E, Stamatakos M, papaconstantinou I,Smirnis A, safioleas P,Kostakis A. Clinical considerations and therapeutic strategy for sigmoid volvulus in the elderly : a study of 33 cases .WORLD j Gastroenterol . 2007:13:921-924.

Abstract: Background: Mastalgia and fibrocystic breast diseases are common in women. Ormeloxifene is a weak oestrogen receptor (ER) agonist, a strong ER antagonist (SERA) and therefore a selective ER modulator (SERM) used in the treatment of this disease. Aim of study was to see the role of ormeloxifene in women with pain in breast associated with or without fibrocystic breast disease............

Key words: Mastalgia, Fibrocystic, SERM, Ormeloxifene

[1]. Cooper A. Illustrations of the Diseases of the Breast, Part 1. London, England: Longman, Rees, Orme, Brown & Green; 1829.
[2]. Ader DN, South-Paul J, Adera T, Deuster PA. Cyclical mastalgia: Prevalence and associated health and behavioural factors. J Psychocsom Obstet Gynecol. 2001;22:71–6.
[3]. Didsbury W. Aetiological factors in benign breast disease. Br J Surg. 1994;81:788–9.
[4]. Smith RL, Pruthi S, Fitzpatrick LA. Evaluation and management of breast pain. Mayo Clin Proc. 2004;79(3):353-72.
[5]. Srivastava A, Mansel RE, Arvind N, Prasad K, Dhar A, Chabra A. Evidence-based management of mastalgia: A meta-analysis of randomised trials. Breast. 2007;16:503–12...

Abstract: Objective: The objective of this study was to test the effect of different bonding agents and surface preparation techniques on the shear bond strength values of metal orthodontic brackets on to polished nano-hybrid composite resin surface in vitro. Materials and methods: 90 composite resin discs were prepared and thermocycled, then they have been randomly divided into six groups, metallic orthodontic brackets were bonded to these composite discs using three bonding agents: Transbond XT primer, plastic conditioner and Assure Plus, each material was used with and without sandblasting with aluminum oxide particles. After thermocycling the samples again, Shear bond strength testing was done for all six groups using universal testing machine...........

[1]. Nattrass C, Sandy JR. Adult orthodontics--a review. British journal of orthodontics. 1995;22(4):331-7.
[2]. Klausner LH, Green TG, Charbeneau GT. Placement and replacement of amalgam restorations: a challenge for the profession. Operative dentistry. 1987;12(3):105-12.
[3]. Opdam NJ, Bronkhorst EM, Loomans BA, Huysmans MC. 12-year survival of composite vs. amalgam restorations. Journal of dental research. 2010;89(10):1063-7.
[4]. Sunnegardh-Gronberg K, van Dijken JW, Funegard U, Lindberg A, Nilsson M. Selection of dental materials and longevity of replaced restorations in Public Dental Health clinics in northern Sweden. Journal of dentistry. 2009;37(9):673-8.
[5]. Brunthaler A, Konig F, Lucas T, Sperr W, Schedle A. Longevity of direct resin composite restorations in posterior teeth. Clinical oral investigations. 2003;7(2):63-70.

Abstract: Study objective: To assess the correlation of single breath count and breath holding time with standard measures of pulmonary function testing, namely FEV1, FVC, FEV1/FVC and PEFR. Materials and methods: Design: Prospective observational study. Setting: Institute of Thoracic Medicine, Chetpet between January 2010 -May 2010. Sample size: 200 cases, which included patients greater than 12 years of age, with symptoms and signs of obstructive airway disease referred to Pulmonary function testing lab for assessment.............

Keywords-: SBC-single breath count, BHT-breath holding time, FEV1-Forced expiratory volume in one second, FVC-Forced vital capacity.

[1]. Gandevia B. Dr. John Hutchinson: the inventor of the spirometer. Aust Fam Physician. 1981 Jul;10(7):574-8.
[2]. Standardization of Spirometry, 1994 Update. American Thoracic Society. 152(3); 1995 AJRCCM.
[3]. V.C. Moore Breathe. Spirometry: step by step 2012 8: 232-240.
[4]. M. N. Awati, Akash Awati, Ahmedi Fathima. "Anesthetic Considerations in Chronic Obstructive Pulmonary Disease". Journal of Evidence based Medicine and Healthcare; Volume 2, Issue 10, March 09, 2015; Page: 1519-1533.
[5]. Bartfield JM, Ushkow BS, Rosen JM, Dylong K (1994) Single breath counting in the assessment of pulmonary function. Ann Emerg Med 24:256–259..

Abstract: Background: Psoriasis is a chronic inflammatory disease of the skin and is associated with an increased risk of cardiovascular atherosclerosis. Metabolic syndrome, a conglomerate of various clinical and biochemical parameters is a significant predictor of atherosclerotic disease and the associated risk for cardiovascular events in such patients. Aim: To investigate the prevalence of metabolic syndrome in patients with psoriasis.........

Abstract: Intestinal duplications are disorders which have varying presentations .These occur with a prevalence of 1:10000 births. There is usually no sex predilection. Most of the patients present during infancy or early childhood but few may escape this period and present in adulthood with obstruction or perforation.[1] They may be unexpectedly encountered during emergency surgery. We hereby present a case of ileal duplication who presented with a history of acute intestinal obstruction in whom despite various clinical methods and radiological investigations the diagnosis was made only at the time of surgery.

Keywords-: Intestinal duplication, Intestinal obstruction, Stricture

[1]. Yang MC, Duh YC, Lai HS, et al. Alimantry tract duplications. J Formos Med Assoc. 1196 May. 95(5):406-9. Bowwer RJ, Sieber WK, Kiesewetter WB. Alimentry tract duplications in children. Ann Surg 1978; 188:667-674. Bremer JL. Diverticula and duplications of the intestinal tract. Arch Patholog 1952; 38:132-140.
[2]. Ravitch MM. Hind gut duplications, doubling of colon and genital urinary tracts. Ann Surg 1953; 137:588-601.
[3]. Mellish RWP, Koop CE. Clinical manifestations of duplication of the bowel. Paediatrics 1961; 27:397-407.
[4]. Favara BE, Franciosi RA, Akers DR. Enteric duplications: Thirty seven- cases. A vascular theory of pathogenesis. Am J. Dis Child 1971; 122:501-506.
[5]. Fitz RH. Persistent omphalo mesenteric remains: Their importance in the causation of intestinal duplication, cyst formation and obstruction. Am J Med Sci. 1884; 88:30-57.

Abstract: Endodontic treatment is a multi-phases procedure, we use a lot of materials and instruments during performing it. One of these important phases is the irrigation including all its benefits and errors during insertion inside the root canal system. This review will be about the properties of sodium hypochlorite, toxicity, prevention and management of sodium hypochlorite accident.

Keywords-: Irrigant , Cytotoxicity, Chlorine, Edema ,Accident, Profuse bleeding

[1]. Sjögren U, Figdor D, Persson S, Sundqvist G. Influence of infection at the time of root filling on the outcome of endodontic treatment of teeth with apical periodontitis. International Endodontic Journal,30 1997,297–306.
[2]. Vetucci FJ. Root canal anatomy of human permanent teeth. Oral Surgery, Oral Medicine, Oral Pathology,58,1984, 589–599.
[3]. Basrani B, Haapasalo M: Update on endodontic irrigating solutions, Endod Topics, 27, 2012,74.
[4]. Mohammadi Z: Sodium hypochlorite in endodontics: an update review, Int Dent J 58, 2008,329.
[5]. Rosenfeld EF, James GA, Burch BS: Vital pulp tissue response to sodium hypochlorite, J Endod ,4(5),1978,140.

Abstract: Allergic rhinitis affects at least 30% of individuals at some point in their life. Despite various pharmacotherapy options available for allergic rhinitis only immunotherapy has been found to modify the course in allergic rhinitis..

Keywords-: Immunotherapy, Serum IgE, Severe persistent allergic rhinitis, Visual analogue scale.

[1]. Scott –brown"s otolaryngology 7th edition
[2]. ,'Immunology 5th edition Riot, Brostoff
[3]. The otolaryngology clinics of north America 2008 –T he unified airway
[4]. Allergic rhinitis and its impact on asthma [ARIA] -2008 update[in collaboration with the world health organization ]
[5]. Task force report –Allergen immunotherapy :A practice parameter third update-JOURNAL OF ALLERGY CLINIC IMMUNOLOGY -Jan 2011

Abstract: Separation of anendodonticinstrumentintherootcanalisacommonmishapthatmay occurduring endodontictreatment. Itmayhaveapotential impactontheoutcome ofthetreatmentasithindercleaning and shapingoftherootcanal. Removaloftheseparatedinstrumentisoftenadvised butfactorslikepoor accessand visibility totheseparated instrumentmakesitdifficult andalsotheamount ofdentintoberemoved ismore. As analternativetoremoval,bypassingtechniqueisveryeffectiveandconservative. Thisarticledescribesthe management oftwopatientswithseparatedinstrument intherootcanal,bysuccessfully bypassingthose separatedinstrument..

Keywords-:Bypassing, coldlateralcondensation, finefile, obturation, separatedinstrument.

[1]. KerekesK,TronstadL:Longtermresultsofendodontictreatmentperformedwithastandardizedtechnique.JEndod.1979; 5(3):83-90
[2]. BahcallJK,CarpS,MinerM,SkidmoreL.Thecauses,prevention,andclinicalmanagementofbrokenendodonticrotaryfiles. DentToday.2005Nov;24(11):74, 76, 78-80
[3]. CrumpMC,NatkinE.Relationshipofbrokenrootcanalinstrumentstoendodonticcaseprognosis:aclinicalinvestigation.JamDentAssoc.1970Jun; 80(6):1341–1347.
[4]. GrossmanLI.Fate ofendodonticallytreatedteethwithfracturedrootcanal instruments.JBr EndodSoc.1968 Jul-Sep; 2(3):35–37. [5]. RuddleCJ.Nonsurgical retreatment.JEndod.2004Dec; 30(12): 827-845.
[5]. RuddleCJ.Brokeninstrumentremoval.Theendodonticchallenge.DentToday.2002Jul;21(7):70-72, 74, 76pasim.