iosr-JDMS   Volume-17 ~ Issue-3 ~ March-2018

Abstract: Fistula In Ano Usually Presents With Pus Discharge Perianal Region, Sometimes With Mucus Discharge. Malignant Transformation In Fistula In Ano Very Rare Presentation1, And To Assess Preoperatively Is Almost Next To Impossible, It Requires A High Index Of Clinical Suspicion And Proper Workup. We Present A Very Rare Case Of Elderly Female Who Initially Presented With Pus Discharge And Pain In Perianal Region For 2-3 Months, On Through Clinical Examination And Investigation (Including MRI Fistulogram) Done, A Diagnosis Of Perianal Abscess And High Fistula In Ano Was Made. Fistulous Tract Which Was Sent For Histopathological Examination Turned Out As Nodular Type Of Basal Cell Carcinoma. Fistula In Ano Is A Benign Disease Usually Present With Pus Discharge, Very Rarely with Malignant Changes, A High Index Of Suspicion Should Be Kept If Presenting In Old Age, With Long Standing History Or With Recurrent History Or With History Of Mucus Discharge Or With Some Associated Mass.

[1]. Kyzer, S., Bayer, I., Turani, H. Chaimoff, C. Verrucous Squamous Carcinoma As Complication Of Recurrent Multiple Perianal Fistulae. Colo-Proctology 1985, 7: 104- 106.
[2]. Rossner, C. Relation Of Fistula-In-Ano To Cancer Of The Anal Canal. Trans Am Procsoc 1934, 65-70.
[3]. G.H. Welch And I.G. Finlay. Neoplastic Transformation In Longstanding Fistula-In-Ano. Postgraduate Medical Journal (1987) 63, 503-504
[4]. Kline, R.J., Spencer, R.J. Harrson, E.G. Carcinoma Associated With Fistula-In-Ano. Arch Surg 1964, 89: 989- 994.
[5]. Raghavaiah Nv. Colloid Carcinoma Arising In An Anal Fistula: Case Report With A Brief Review Of The Literature. Aust N Z J Surg. 1975 Feb;45(1):97-9

Abstract: Cervical lymphadenopathy is one of the common clinical condition which may be due to various causes like infection(especially tuberculosis in our country), inflammation and malignant conditions. The aim of our study is to evaluate the role and diagnostic utility of ultrasonogram and elastography to differentiate the benign and malignant causes of cervical lymphadenopathy as well as differentiating between various benign causes. Materials & Methods: It is a prospective study of 85 patients having cervical lymphadenopathy using Ultrasonogram and Elastography. Biopsy/ FNAC was done for all cases and the results were compared............

Key Words: Cervical lymphadenopathy, Strain elastography, Short to long axis ratio.

[1] Chan JM, Shin LK, Jeffrey RB. Ultrasonography of abnormal neck lymph nodes. Ultrasound Q. 2007;23(1):47–54. doi: 10.1097/01.ruq.0000263839.84937.45
[2] Ahuja AT, Ying M, Ho SY, Antonio G, Lee YP, King AD, et al. Ultrasound of malignant cervical lymph nodes. Cancer Imaging. 2008;8:48–56. doi: 10.1102/1470-7330.2008.0006
[3] Yusa H, Yoshida H, Ueno E. Ultrasonographic criteria for diagnosis of cervical lymph node metastasis of squamous cell carcinoma in the oral and maxillofacial region. J Oral Maxillofac Surg. 1999;57(1):41–8.
[4] Lee N, Inoue K, Yamamoto R, Kinoshita H. Patterns of internal echoes in lymph nodes in the diagnosis of lung cancer metastasis. World J Surg. 1992;16:986. PMid:1334300
[5] Lerner RM, Huang SR, Parker KJ. "Sonoelasticity" images derived from ultrasound signals in mechanically vibrated tissues. Ultrasound Med Biol. 1990;16:231–239.

Abstract: Central Diabetes Insipidus (CDI) following intraparenchymal hemorrhage of the brain has been described as a rare presentation. Posterior pituitary ischemia has also been postulated as a possible cause of idiopathic CDI. We encountered a young male with right sided capsuloganglionic bleed who had polyuria due to central Diabetes Insipidus, requiring Desmopressin therapy.

Key Words: Diabetes Insipidus, Stroke, Polyuria

[1]. Kraus J, Heckmann JG, Druschky A, Erbguth F, Neundorfer B. Ondine's Curse In Association With Diabetes Insipidus Following Transient Vertebrobasilar Ischemia. Clin Neurol Neurosurg 1999; 101:196-8.
[2]. Thompson CJ 1989 Polyuric States In Man. Baillieres Clin Endocrinol Metab 3:473–49.
[3]. Jayaraman M, Kumar S, Ahmad F. Transient Central Diabetes Insipidus Following Ischemic Stroke. Indian J Endocr Metab 2013;17:S152-4.
[4]. Maghnie M, Altobelli M, Di Iorgi N, Genovese E, Meloni G, Manca-Bitti ML, Et Al. Idiopathic Central Diabetes Insipidus Is Associated With Abnormal Blood Supply To The Posterior Pituitary Gland Caused By Vascular Impairment Of The Inferior Hypophyseal Artery System. J Clin Endocrinol Metab 2004;89:1891-6.
[5]. Yu CH, Cho JH, Jung HY, Lim JH, Jin MK, Kwon O, Et Al. A Case Of Transient Central Diabetes Insipidus After Aorto-Coronary Bypass Operation. J Korean Med Sci 2012;27:1109-13.

Abstract: Among the allergic diseases, asthma is one of the most common chronic pulmonary disorders. For asthma there is no cure but its symptoms can be controlled with effective treatment and management. Asthma is a disease characterized by recurrent attacks of breathlessness and wheezing that vary in severity and frequency from person to person. It is a respiratory condition marked by attacks of spasm in the bronchi of the lungs, causing difficulty in breathing. It is usually connected to allergic reaction or other forms of hypersensitivity. This condition is due to inflammation of the air passages in the lungs and affects the sensitivity of the nerve endings in the airways so they become easily irritated. In an attack, the lining of the passages swell causing the airways to narrow and reducing the flow of air in and out of the lungs (Godfrey, 1985). Allergy involves the production of a special class of antibody called immunoglobulin E. (IgE) which has only been found in mammals. These antibodies are bound to specific cells called mast cells, found in the skin, lungs and in many other tissues...............

[1] Bolliger CT, Fourie PR, Kotze D, Joubert JR. Relation of measures of asthma severity and response to treatment to outcome in acute severe asthma. Thorax. 1992; Nov; 47(11):943-7.
[2] Auerbach I, Springer C, Godfrey S. Total population survey of the frequency and severity of asthma in 17 year old boys in an urban area of Israel. Thorax.1993; 48:139–141.
[3] Asthma Management Handbook, National Asthma Campaign. South Melbourne, Australia: National Asthma Council Australia Ltd. 1998; ACN 058 044 634.
[4] Ahmed EA, Habour AB, Musa A.A. Chest. Childhood asthma risk and triggering actors (Thesis) Journal Gezira Univ. 1999; 4 suppl 2.116: p. 250S.
[5] B Richard, C Julian, Christopher K.W. Lai, P Neil. Prevalence and etiology of asthma.[Internet] 2000.The Journal of Allergy and Clinical Immunology [homepage on internet]. [Updated 2014 Jan; cited 2014 Jan]. Available from: http://www.jacionline. Org/article/S0091-6749(00)90044-7/abstract

Abstract: Tissue Regeneration In The Oral Cavity Is Regulated By Signalling Molecules, Cells And By Matrix Formation. A Balance Between Bone Resorption And Bone Formation Is Key For Maintenance And Regeneration Of Alveolar Bone And Supporting Structures Around Implant And Tooth. Periodontal Tissue Engineering Focuses On Regenerating Form And Function Of Hard And Soft Tissues Using Signalling Molecules Scaffolds And Cells. Bony Defects May Vary In Size From Small Intrabony Defects To Large Horizontal And Vertical Bone Defects In Periodontal Diseases That Prove Critical For Implant Rehabilitation. Over Decades, Efforts Are Being Made To Achieve Predictable And Reliable Bone Regeneration Using Various Methods. This Review Focuses On Various Materials And Methods That Are Being Used And Which Are In Research Stage For 3 D Printing Of Patient-Specific Custom-Made Scaffolds For Periodontal Regeneration.

Keywords: Periodontal Regeneration, 3 D Scaffolds , Bony Defects.

[1] Brouwer KM, Lundvig DM, Middelkoop E, Wagener FA, Von den Hoff JW. Mechanical cues in orofacial tissue engineering and regenerative medicine. Wound Repair Regen.2015; 23(3):302–311
[2] Webber MJ, Khan OF, Sydlik SA, Tang BC, Langer R,. A perspective on the clinical translation of scaffolds for tissue engineering.Ann Biomed Eng.2015; 43(3):641–656.
[3] Rios HF, Lin Z, Oh B, Park CH, Giannobile WV. 2011. Cell and gene based therapeutic strategies for periodontal regenerative medicine.J Periodontol.2011;82(9):1223–1237.
[4] Bartold PM, Gronthos S, Ivanovski S, Fisher A, Hutmacher DW.Tissue-engineered periodontal products. J Periodontal Res [epub ahead of print 21 Apr 2015] in press. doi:10.1111/jre.12275.
[5] Van Dyke TE, Hasturk H, Kantarci A, Freire MO, Nguyen D, Dalli J, Serhan CN. .Proresolving nano medicines activate bone regeneration in periodontitis. J Dent Res.2015;94(1):148–156.

Abstract: Background: ischemic heart disease is one of the commonest mortality and morbidity in India and in the World. It is imbalance between oxygen supply and demand to the heart. Material and methods: In our study we had collected fasting samples from 50 cases and 50 age and sex matched controls. We have estimated serum magnesium and uric acid in ischemic heart disease patients and normal subjects. Results: All the parameters are significantly elevated when compared to controls which may be direct or indirect cause for the development of ischemic heart disease. Conclusion: Both the serum magnesium and uric acid levels are significantly elevated when compared to controls .Both the serum magnesium and uric acid should be evaluated further to establish its role in IHD.

Keywords: AMI: acute myocardial infarction, ACS: acute coronary syndrome, BMI: body mass index, CAD: coronary artery disease, CCS: chronic coronary syndrome, IHD: ischemic heart disease, LDL: low density lipoprotein, MI: myocardial infarction, ROS: reactive oxygen species

[1] World Health Organisation Global Status Report on Non Communicable Diseases 2014, 2014 World Health Organisation, Geneva, Switzerland.
[2] Pathophysiology of Ischemic heart disease: an overview. AACN Clin issues. 1995Aug6(3):369 -74
[3] Janet M. Torpy, MD; Alison E. Burke, MA; Richard M. Glass, MD; Coronary Heart Disease Risk Factors JAMA. 2009;302(21):2388. doi:10.1001/jama.302.21.2388
[4] Libby P, Theroux P: Pathophysiology of coronary artery disease. Circulation 2005;111:3481–3488
[5] Naghavi M, Libby P, Falk E, Casscells SW, Litovsky S, et al.: From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part II. Circulation 2003;108:1772–1778

Abstract: Background: Anchovy (Stolephorus Sp.) Is One Of The Best Calcium Resources. Calcium Plays An Important Role In The Formation And Stabilization Of Alveolar Bone So That Its Function And Use Are Optimal. Anchovies Can Be Recommended To Be Consumed As It Is Useful For Bone And Tooth Growth And Capable Of Preventing Osteoporosis. Bone Is Living Tissues Consisting Of Calcium Intracellular Material Such As Bone Matrix And Three Kinds Of Cells, Namely Osteocyte, Osteoblast And Osteoclaclast. Osteocyte Is The Osteoblast Buried In Lacuna And Mineralized In Bone Matrix By Stellate Morphology. Method: This Is A Laboratorial Experimental Research........

Keywords: Anchovy, Calcium, Osteocyte, Bone Density.

[1] Alexander GR, Alesha BC, Charles HT, 2006. Biomechanical and molecular regulation of bone remodelling. Annu Rev Biomed Eng;8:455-98.
[2] Allen M.R., Burr, D.B, 2013. Techniques in Histomorphometry. In : Burr, D.B.,Allen, M.R., editors. Basic and Applied Bone Biology. 1st Ed. London.Elsevier Science and Technology Books. p. 135 – 7.
[3] Applemen-Djikstra NM, Papapoulus SE, 2015. Modulating bone resorpstion and bone formation in opposite directions in the treatment of postmenopausal osteoporosis. Drugs;75(10):1049-58.

Abstract: Osteosarcomas are malignant neoplasms arising from mesenchymal stem cells or their early progenitor cells.The incidence of osteosarcoma is low in malignant tumors; however it is the most common primary tumor of bone.Conventional osteosarcoma has been classified depending on the predominant type of extracellular matrix into subtypes - osteoblastic, chondroblastic, fibroblastic.Osteosarcomas of the jaws have a similar male and female pedilection. Mandibular lesions are more frequent than those in the maxilla. The radiographic appearance of Osteosarcoma depends on the proportions between bone destruction, calcification, new bone production and periosteal new bone formation. Tissue biopsy is needed for a definitive diagnosis. The specimen should be taken from the center of the lesion to avoid including reactive periosteal bone in the specimen.Surgery is the primary treatment for Osteosarcoma of jaws but it cannot be depended as the sole treatment modality.Chemotherapy (CT) has become an important therapeutic adjuvant in the treatment of osteosarcomas of all sites. Here we present a case of Fibroblastic Osteosarcoma of the Mandible with a review of Literature.

[1]. Klein MJ, Siegal GP. Osteosarcoma. American Journal of Clinical Pathology. 2006;125(4):555–81.
[2]. Garrington GE, Scofield HH, Cornyn J, Hooker SP. Osteosarcoma of the jaws.Analysis of 56 cases. Cancer. 1967;20(3):377–91.
[3]. Regezi JA, Zaro RJ, Mcclatchey KD, Courtney RM, Crissman JD. Osteosarcomas and chondrosarcomas of the jaws: Immunohistochemical correlations. Oral Surgery, Oral Medicine, Oral Pathology. 1987;64(3):302–7.
[4]. Marx RE, Stern D. Oral and maxillofacial pathology a rationale for diagnosis and treatment. Hanover Park, IL: Quintessence Pub. Co.; 2012.
[5]. Khan S, Barwar N, Kumar V. Surface osteosarcomas: Diagnosis, treatment and outcome. Indian Journal of Orthopaedics. 2014;48(3):255.

Abstract: There has been increasing incidence of Dilated Cardiomyopathy in India and especially in age less than 40 years and have been associated with serious complications and mortality. Because most of the cause under 40 years of age are reversible, thus arises the need for proper diagnosis and management. This study was taken to find out the most important etiology of Dilated cardiomyopathy in younger age group, using clinical symptoms, signs, ECG, echocardiography and blood investigations. This was a cross sectional study of 1 year, comprising of 60 patients of age group less than 40 years. The inclusion criteria was LVEF< 45%, LVED<3cm/body surface area, global hypokinesia and dilatation of all the chambers of the heart. The most important etiology was peripartum which included.............

Key Words: Dilated cardiomyopathy,Echocardiography,ECG, dyspnea.

[1] Zipes D, Libby P, Bonow R, Braunwald E. A Braunwald's heart disease Textbook of Cardiovascular Medicine: The cardiomyopathies. 7th Ed. Philadelphia: Elsivier Saunders; 2005.
[2] Anderson KM, Kannel WB. Prevalence of congestive heart failure in Framingham Heart study subjects. Circulation 1994 ; 13 : S107-S112
[3] Richerdson. WHO Report on classification of cardiomyopathy.Br. Heart J. 1980 ; 44 : 680-682.
[4] Rana Chirag Rathore ,Parag Chavda study on clinical profile of dilated cordiomypathy in Central Gujrat ,2014.
[5] Vijayraghavan G. API Text book of medicine.Disorders of myocardium. 7th ed Chap X.25: 490-491

Abstract: acute kidney injury is common in hospitalized children and this study characterizes acute kidney injury in hospitalized children in a tertiary care center. Identify the incidence and risk factors of acute kidney injury in hospitalized children. The study is prospective, institution based and observational. During the study period, 5348 children were admitted among which 68 children developed AKI with an incidence rate of 12.7/1000 admissions. Severe AKI was 64.7%. The mortality rate with AKI was 26.5% when compared with 8.7% without AKI. Age 5-14 years had a 1.2 times higher risk of developing AKI than children under five years (adjusted HR 1.22; 95% CI, 0.74-2.98). Females had 2.8 times higher risk of developing AKI (adjusted HR 2.79; 95% CI, 1.29-6.02) than males.......

Keywords: acute kidney injury, AKIN, Ethiopia

[1] Goldstein SL: Acute kidney injury biomarkers: Renal angina and the need for a renal troponin I. BMC Med 9: 135, 2011
[2] Xue JL, Daniels F, Star RA, Kimmel PL, Eggers PW, Molitoris BA, Himmelfarb J, Collins AJ: Incidence and mortality of acute renal failure in Medicare beneficiaries, 1992 to 2001. J Am Soc Nephrol 17: 1135–1142
[3] Vachvanichsanong P, Dissaneewate P, Lim A, McNeil E: Childhood acute renal failure: 22-year experience in a university hospital in southern Thailand. Pediatrics 118: e786–e791, 2006
[4] Flynn JT. Choice of dialysis modality for management of pediatric acute renal failure. Pediatric nephrology. 2002; 17(1):61-9.
[5] Palmieri T, Lavrentieva A, Greenhalgh D. An assessment of acute kidney injury with modified RIFLE criteria in pediatric patients with severe burns. Intensive care medicine. 2009; 35(12):2125-9.

Abstract: Background :Pseudoexfoliation is an age related microfibrillopathy that targets ocular tissue through gradual depositon of fibrillary residue from lens & iris pigment epithelium mainly on lens,ciliary body,zonules,corneal endothelium & iris. It has only been recently recognized to be the overall most common identifiable cause of glaucoma.Aim :To assess the demographic features intraoperative, postoperative complications & visual outcome of cataract surgery following primary IOL implantation in patients with cataract &pseudoexfoliation.Methods :62 eyes of 62 patients with cataract &pseudoexfoliation are posted for primary IOL implantation.........

Keyword: Pseudoexfoliation,Slit lamp examination,Anterior capsulotomy,Anterior chamber reaction,Zonular dehiscence,Intraocular lens impantation,Posterior capsular rent, Posterior capsular opacity,Decentration of intraocular lens,Best corrected visual acuity.

[1]. R R. Exfoliation syndrome-the most common identifiable cause of open-angle glaucoma. - PubMed - NCBI [Internet]. Ncbi.nlm.nih.gov. 2017 [cited 1 December 2017]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19920577
[2]. Bialasiewicz AA, e. (2017). [Patients with secondary open-angle glaucoma in pseudoexfoliation (PEX) syndrome among a population with high prevalence of PEX. Clinical findings ... - PubMed - NCBI . Ncbi.nlm.nih.gov. Retrieved 1 December 2017, from https://www.ncbi.nlm.nih.gov/pubmed/
[3]. 3.Chen, V., & Blumenthal, M. (1992). Exfoliation Syndrome after Cataract Extraction. Ophthalmology, 99(3), 445-447. doi:10.1016/s0161-6420(92)31955-4
[4]. 4.G, D. (2017). Pseudoexfoliation of the lens capsule: relation to true exfoliation of the lens capsule as reported in the literature, and role in the production o... - PubMed - NCBI . Ncbi.nlm.nih.gov. Retrieved 1 December 2017, from https://www.ncbi.nlm.nih.gov/pubmed/13216790

Abstract: To study the use of partogram in the analysis of labour in eclampsia with cephalic presentation. Methodology: -Partographic analysis of labour was done in 50 patients of eclampsia in labour and 10 normotensive primigravidae and 10 normotensive multigravidae as control. Partographic variables are plotted and the rate of cervical dilatation was measured. Maternal and neonatal outcomes were studied in each patient. Result:– Amongest the 50 eclampsia patients in labour analysed 37(74%) were primigravidae and rest 13 (26%) were multigravidae. Mean duration of active phase was 3.29 hrs. and 2.53 hrs. in primigravidae and multigravidae study group compared to 5.14 hrs and 4.27 hrs in control primigravidae and multigravidae respectively. Rate of cervical dilatation in active phase was 3.26 cm/ hrs, 4cm / hrs, 1.96cm/ hrs and 2.40cm /hrs in primigravidae eclampsia, multigravidae eclampsia, primigravidae normotensive and multigravidae normotensive respectively. Forceps delivery were 29 (58%) and normal vaginal delivery in 21 (42%) cases in eclampsia group........

Keywords: Active phase, cervical dilatation rate (CDR), eclampsia, labour, partogram

[1]. Dangal G. Preventing prolonged labour by using partogram. Internet J Gynecol obstet, 2007: 7 (1) ISSN 1528- 8438.
[2]. Friedman EA . The Graphic analysis of labour. 1954; Am. J. Obstet & Gynace , 68 : 1568-1575.
[3]. O' Driscol et al 1973: Br. Med. J. 1977, 3: 135-137
[4]. Sharda Jain 1986 – J. Obst: & Gynac, India 37:537
[5]. Sarla Mukherjee 1987, PG obstet and Gynac 3rd edition: Page no – 9, 40-53.

Abstract: Background: Many Studies Have Been Carried Out To Establish Possible Factors That May Affect Or Influence Weight Changes In The Immediate And Long Term Postpartum Period. Likewise, The Comparison Of Non-Obstetric Benefits Of Vaginal Delivery (VD) And Abdominal Deliveries (AD) Using Parameters Such As Hospital Stay, Cosmetics, Sexual Function, Urinary Incontinence Etc. Though Vaginal Delivery Is Accepted As The Safest Mode Of Delivery, However With Increased Safety Profile Of Caesarean Delivery, Its Incidence is On The Increase Partly Due To Preference By Pregnant Mothers Based On Certain Perceived Advantages. Aim: We Tried To Establish If There Was A Relationship Between Weight Loss And Mode Of Delivery By Comparing short Term Postpartum Anthropometric Changes Of A Group Of Mothers Who Had Abdominal Delivery (AD) And Another Group Who...........

Keywords: Mode Of Delivery, Weight Loss, Maternal Anthropometry, Nigeria.

[1] Dinas K, Mavromatidis G, Dovas D, Giannoulis C, Tantanasis T, Loufopoulos A, et al. Current caesarean delivery rates and indications in a major public hospital in northern Greece. AustN Z J ObstetGynaecol 2008;48:142-6.
[2] Hema KR, Johanson R. Caesarean section: Techniques and complications. CurrObstetGynaecol 2002;12:65-72.
[3] Panti AA, Tunau KA, Nwobodo EI, Ahmed Y, Airede L, Shehu CE. Caesarean morbidity and mortality in a tertiary health institution in Sokoto, North-West Nigeria. Orient J Med 2012;24:7-12.
[4] Ikeako LC, Nwajiaku L, Ezegwui HU. Caesarean section in a secondary health hospital in Awka, Nigeria. Niger Med J 2009;50:64-7.
[5] Efetie RE, Umezulike AC, Agboghoroma CO. Caesarean section at the National Hospital, Abuja, 1999-201. ANMINS 2006;3:34-9..

Abstract: Regional Anesthesia is the choice in lower abdominal and lower limb surgeries. Epidural anesthesia lasts longer with lesser complications compared to general anesthesia. Butorphanol is agonist-antagonist opioid that resembles Pentazocine, while producing stronger analgesia. Fentanyl is a phenyl piperidine-derivative synthetic opioid agonist that is structurally related to Meperidine.Aim: Comparison of Lumbar epidural block using 0.5% Bupivacaine with Butorphanol and 0.5% Bupivacaine with Fentanyl for lower abdominal and lower limb surgeries.Methods: Adult patients of ASA grade I & II belonging to 18-60 years posted for lower abdominal and lower limb surgeries Group 1: Bupivacaine (0.5) 10 ml with Fentanyl 20μg Group 2:Bupivacaine (0.5) 10 ml with Butorphanol 1μg

Keywords: Post Operative pain, Epidural route, Bupivacaine, Fentanyl, Butorphanol

[1] Dr.Nirvik Pal, Dr.Kiran Malhotra, Dr.Chitra et al. Effect of morphine on postoperative respiratory functions: Comparision between systemic and epidural routes. Indian J. Anaesth 2004;48(3):204-207.
[2] RG Wheatley, SA Schug, D. Watson. Combination of local anaesthetic and an opioid combination. Br J Anaesth 2001;87:47

[3] Egan, Talmage D. (2013). Pharmacology and physiology for anesthesia : foundations and clinical application. Philadelphia, PA: Elsevier/Saunders. p. 291. ISBN 9781437716795.

[4] Hamilton, Richart (2015). Tarascon Pocket Pharmacopoeia 2015 Deluxe Lab-Coat Edition. Jones & Bartlett Learning. p. 22. ISBN 9781284057560.

[5] Whimster, David Skinner (1997). Cambridge textbook of accident and emergency medicine. Cambridge: Cambridge University Press. p. 194. ISBN 9780521433792.

Abstract: Aesthetics is an inseparable part of today's dental treatment and has influenced the management of dental maladies in varying degrees for many years.In recent year clinicians and dentist's aesthetic demand in dentistry have increased rapidly, driven by an enhanced awareness of beuty and esthetics.The ultimate goal in modern restorative dentistry is to achive" white and pink "esthetics in esthetically important zone.White esthetic is the natural restoration of dental hard tissue with suitable materials.Were as pink esthetics refers to the surrounding soft tissue which includes gingiva and lips that can enhanced or diminish the esthetic results.

Keyword: Periodontal Asthetics, Depigmentation, Gingivctomy, Crown lengthening, Root coverage, Gingival veneers

[1] Shankar Babu, KhushbuAdhikari. Periodontal approach to esthetic dentistryPakistan Oral & Dental Journal Vol 35, No. 1 (March
2015)
[2] Surgical esthetic correction for gingival pigmentation: Case seriesJournal of Interdisciplinary Dentistry / Sep-Dec 2012 / Vol-2 /
Issue-3
[3] Cicek Y, Ertas U. The normal and pathological pigmentation of oral mucous membrane: A review. J Contemp Dent Pract
2003;4:76-86.
[4] Carranza AC, Saglie FR. Clinical features of gingivitis In: Carranza FA. Glickman‟s clinical periodontology. Philadelphia: WB
Saunders Company; 1990. p. 109-25.

Abstract: Malrotation of the midgut is generally regarded as paediatric pathology with the majority of patients presenting in childhood. The diagnosis is rare in adults, which sometimes leads to delay in diagnosis and treatment. A high index of suspicion is therefore required when dealing with patients of any age group with abdominal symptoms. We present a case of a 55-year old man who presented with an acute abdomen with preoperative computed tomography scan and operative findings confirming midgut rotation. The duodenum, small bowel, caecum and appendix were abnormally located, with the presence of classical Ladd's bands. There was no evidence of intestinal volvulus. The patient underwent an emergency laparotomy with an uneventful postoperative recovery.

[1]. Torres AM, Ziegler MM. Malrotation of the intestine. World J Surg. 1993;17:326–331.

[2]. Matzke GM, Moir CR, Dozois EJ. Laparoscopic Ladd procedure for adult malrotation of the midgut with cocoon deformity: report of a case. J Laparoendosc Adv Surg Tech A. 2003;13:327–329.

[3]. Von Flue M, Herzog U, Ackermann C. et al. Acute and chronic presentation of intestinal nonrotation in adult. Dis Colon Rectum. 1994;37:192–198. doi: 10.1007/BF02047549.

[4]. Wang C, Welch C. Anomalies of intestinal rotation in adolescents and adults. Surgery. 1963;54:839–855.

[5]. Dietz DW, Walsh RM, Grundfest-Broniatowski S, Lavery IC, Fazio VW, Vogt DP. Intestinal Malrotation: a rare but important cause of bowel obstruction in adults. Dis Colon Rectum. 2002;45(10):1381–1386

Abstract: Any disturbance in the activity of heart can cause irregular heart rhythm known as cardiac arrhythmia. Electrocardiogram (ECG) is one of the most promising tools for classification of different types of arrhythmia, which is necessary until it goes fatal and causes loss of life. For ECG arrhythmia classification, a wide range of signal processing techniques extracting features from time, frequency domains have been reported in the literature. Since, ECG is a non stationary signal; frequency analysis can perform better than the conventional time analysis methods. But, development of a multi class arrhythmia classification method, which is simple yet effective, is still a challenging task. In this thesis, 1-D Discrete cosines transform (DCT) and 2-D DCT is proposed to form feature vectors. Each of the feature vector is fed to a Euclidean distance based classifier to classified different types of ECG arrhythmia .Simulations are carried out to evaluate the performance of the proposed method in terms of accuracy. It is shown that the propose method using 2-D DCT can perform better than 1-D-DCT thus providing superior efficacy..

Keywords: Arrhythmia, Electrocardiogram, Heartbeat..

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[2] C. Evans et al., ―Principles of human physiology.‖ Principles of human physiology, 9th Ed, 1945.
[3] F. Morris, W. Brady, A. Camm, and I. ebrary, ABC of clinical electrocardiography. BMJ Books, 2003.
[4] MIT-BIH arrhythmia data base. [Online]. Availabe:
[5] P. De Chazal, M. O'Dawyer, and R. Reilly, ―Automatic classification of heartbeats using ecg morphology and heart beats interval
features,‖ IEEE Transactions on Biomedical Engineeringvol.51,no.7,pp.1196-1206,2004..