iosr-JDMS   Volume-17 ~ Issue-4 ~ April-2018

Abstract: Ameloblastoma Is A Neoplasm Of Odontogenic Epithelium, Principally Of Enamel Organ-Type Tissue That Has Not Undergone Differentiation To The Point Of Hard Tissue Formation It Accounts For About 1% Of All Oral Tumors And About 9-11% Of Odontogenic Tumors. It Is Generally A Slow-Growing But Locally Invasive Tumor. Its Peak Incidence Is In The Third To Fourth Decades Of Life And The Male: Female Ratio Is 1:1. Ameloblastoma Accounted For 60.3% Of All Odontogenic Tumors In Indian Population, With A Mean Age Of Presentation Of 30.2 Years. A Slight Male Predilection And Major Occurrence In The Mandibular Molar-Ramus Area Were Elicited. They Are Classified As Unicystic, Multicystic Or Solid, 86% Of Cases Are Multicystic Ameloblastomas. Ameloblastoma In The Mandible Can Progress To Great Size And Cause Facial Asymmetry, Displacement Of Teeth, Malocclusion, And Pathologic Fractures.

[1] Nakamura N, Mitsuyasu T, Higuchi Y, Sandra F, Ohishi M. Growth Characteristics Of Ameloblastoma Involving The Inferior Alveolar Nerve: A Clinical And Histopathologic Study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;91:557–62. [Pubmed] [2] Becelli R, Carboni A, Cerulli G, Perugini M, Iannetti G. Mandibular Ameloblastoma: Analysis Of Surgical Treatment Carried Out In 60 Patients Between 1977 And 1998. J Craniofac Surg. 2002;13:395–400.[Pubmed]

[3] Larsson A, Almerén H. Ameloblastoma Of The Jaws. An Analysis Of A Consecutive Series Of All Cases Reported To The Swedish Cancer Registry During 1958--1971. Acta Pathol Microbiol Scand A. 1978;86A:337–49. [Pubmed]

[4] Shear M, Singh S. Age-Standardized Incidence Rates Of Ameloblastoma And Dentigerous Cyst On The Witwatersrand, South Africa. Community Dent Oral Epidemiol. 1978;6:195–9. [Pubmed]

[5] Krishnapillai R, Angadi PV. A Clinical, Radiographic, And Histologic Review Of 73 Cases Of Ameloblastoma In An Indian Population. Quintessence Int. 2010;41:E90–100. [Pubmed]

Abstract: The Chorda Tympani Nerve (Branch Of Cn Vii,The Facial Nerve) Travels Through The Middle Ear Where It Is Very Vulnerable To Damage In Middle Ear Disease. There Are Many Studies Reporting Ctn Function Alteration After Middle Ear Surgeries But Very Few Reports On The Effect Of Middle Ear Disease On Ctn Prior To Surgery. Our Study Aims To Assess The Ctn Function By Examining The Type And Severity Of Gustatory Alteration In Patients With Middle Ear Disease And To Find Out Any Relation Of Ctn Dysfunction With The Duration And Type Of Csom. This Study Was Conducted In Patients With Chronic Middle Ear Disease Attending Opd In Department Of Otorhinolaryngology In A Period Of One Year. A Total Of 125 Cases With Chronic Middle Ear Disease Were Included In The Study................

[1] Kumara A, Nigam R, Jain Ak. Original Research Article-Chronic Suppurative Otitis Media- A Clinicopathological Study At A Tertiary Care Hospital. International Journal Of Applied Research 2015; 1(10): 235-240.
[2] Loy Ah, Jan Al. Lu Pk Microbiology Of Chronic Supparative Otitis Media In Singapore. Singapore Medical Journal. 2002; 43(6)296-9.
[3] Mansoor T, Musani Ma, Khalid G, Kamal M. Pseudomonas Aeruginosa In Chronic Suppurative Otitis Media: Sensitivity Spectrum Against Various Antibiotics In Karachi, J Ayub Med Coll Abbottabad. 2009; 21(2):120-123.
[4] Vikram Bk, Khaja N, Udayashankar Sg, Venkatesha Bk, Manjunath D, Clinico Epidemiological Study Of Complicated And Uncomplicated Chronic Suppurative Otitis Media, The Journal Of Laryngology & Otology. 2008; 122:442-446.
[5] Landis Bn, Beutner D, Frasnelli J. Gustatory Function In Chronic Inflammatory Middle Ear Disease. Laryngoscope. 2005;115:1124-7.

Abstract: Objective: Dental caries is a global public health problem. Untreated caries lay a debilitating impact on the work ability, functions and emotional factors of individuals resulting in poor oral health related quality of life. The co relation between PUFA index and oral health related quality of life (OHRQoL) has not been documented so far in India and thereby the need for this study. Aim of the study was to assess the relation between PUFA index (objective) and the self- perceived oral health quality of life (subjective) among the patients attending the OPD in Dental College, Greater Noida, India. Methods: The PUFA index records the presence of severely decayed teeth and the Severity of OHIP was determined using a self-administered questionnaire comprising of 14 questions. Patients from Out Patient Department of ITS dental college, Greater Noida were recorded using Convenience sampling.........

Key Words: PUFA,OIDP,Dental Caries.

1. Bhoopathi Haricharan, Praveen et al.: Co Relation between PUFA Index and Oral Health Related Quality of Life of a Rural Population in India: A Cross-Sectional Study. Journal of Clinical and Diagnostic Research. 2015 Jan, Vol-9(1): ZC39-ZC42.

2. Einarson S, Gerdin EW, . Oral health impact on quality of life in an adult Swedish population.Acta Odontol Scand. 2009;67(2):85-93. 3. Jain K,Singh B et al Clinical Assessment of Effects of Untreated Dental Caries in School Going Children Using PUFA Index Chettinad Health City Medical Journal 2014; 3(3): 105 – 108.

Abstract: Multiple Impacted Supernumerary Teeth Especially In Maxilla Poses A Challenge To Maxillofacial Surgeons. Often, There Is Alack Of Sufficient Information Regarding The Accurate Anatomic Localization And Proximity Of Impacted Teeth To Adjacent Normally Erupted Tooth Or Its Roots, Maxillary Sinus, Nasal Floor Or Other Essential Anatomic Structures From Conventional Radiographs Like Orthopantomogram(OPG). These Technical Shortcomings Can Be Overcome By The Use Of 3D Imaging Like Cone Beam Computed Tomography(CBCT). The Cone-Beam Computed Tomography (CBCT), Compared To The Conventional Radiography, Has A Greater Potential To Provide Complementary Information Because Of Its Three-Dimensional (3D) Images, Reducing The Amount Of Bone Loss And Failures In Surgical Procedures..........

KEYWORDS: Impacted Supernumerary, Cone Beam Computed Tomography

[1] VecchioneGurgel C, Soares Cota Al, Yuriko Kobayashi T, Moura Bonifácio Silva S, Aparecida Andrade Moreira Machado M, Rios D, Et Al. Bilateral Mesiodens In Monozygotic Twins: 3d Diagnostic And Management. Case Rep Dent. 2013;2013:193614.
[2] Liu Jf. Characteristics Of Premaxillary Supernumerary Teeth: A Survey Of 112 Cases. Asdc J Dent Child. 1995;62:262–5.
[3] Proff P, Fanghänel J, Allegrini S, Jr, Bayerlein T, Gedrange T. Problems Of Supernumerary Teeth, Hyperdontia Or DentesSupernumerarii. Ann Anat. 2006;188:163–9.
[4] Shah A, Gill Ds, Tredwin C, Naini Fb. Diagnosis And Management Of Supernumerary Teeth. (514-6).Dent Update. 2008;35:510–2. 519-20.
[5] Rajab Ld, Hamdan Ma. Supernumerary Teeth: Review Of The Literature And A Survey Of 152 Cases. Int J Paediatr Dent. 2002;12:244–54.

Abstract: Background: Allogeneic Haematopoietic Stem Cell Transplant (Hsct) Is Panacea Of Cure For Various Malignant And Non-Malignant Haematological Conditions In Medicine Today. Chimerism Study Is A Valuable Tool In Monitoring Graft Outcomes In Allo-Hsct Recipients. This Study Outlines Usefulness Of Chimerism Studies As Predictor Of Graft Rejection Or Disease Relapse In Cases With Mixed Chimerism And Also As Surrogate Marker Of Clinical And Haematological Variables In These Patients. Methods: A Total Of 57 Recipients Of Allo-Hsct Were Followed Up With Chimerism Study As Per Protocol. Multiple Short Tandem Repeat (Str) Amplification Using Fluorescence Labelling Polymerase Chain Reaction (Pcr) Combined With Capillary Electrophoresis Was The Method Employed...........

Key Words: Chimerism Analysis,Haematopoietic Stem Cell Transplantation,Short Tandem Repeats,Polymerase Chain Reaction.

[1] Manuel B, Velasco Aj, Gomez Jr Et Al. Chimerism Status Is Useful Predictor Of Relapse After Allogeneic Stem Cell Transplantation For Acute Leukaemia. Haematologica, 2003; 88:801-810.
[2] Marco Ai, Manuela T, Mariarosa B Et Al. Relationship Between Mixed Chimerism And Rejection After Bone Marrow Transplantation In Thalassaemia. Blood Transfusion, 2006; 6:143-149.
[3] Jens G, Arwen S, Watz E, Jonas M, Michael U. Mixed Chimerism After Allogeneic Stem Cell Transplantation-Focus On Double Cord Blood Transfusion. Hematologic Oncology, 2012, S1:006.10, 4172/2155-9864.
[4] Matsuda K, Yamauchi K, Tozuka M Et Al. Monitoring Of Chimerism By Short Tandem Repeats And The Effects Of Cd Selection On Its Sensitivity. Clinical Chemistry, 2004; 12:50-53.
[5] Khan F, Agarwal A, Agarwal S. Significance Of Chimerism In Haematopoietic Stem Cell Transplantation: New Variations On Old Theme. Bone Marrow Transplantation, 2004; 34:1-12.

Abstract: Objective: Specifying Age Range And Gender Frequency Having Highest Incident Rate To Traumatic Brain Injury At Hospital As These Two Risk Factor Determination Contribute To The Management And Prognosis Of The Patient. Methodology: The Data Of 2373 Patients At Zhenjiang First Peoples' Hospital, Admitted As Head Injury Is Analyzed In Comparative Manner. The Patients' Ages Were The Most Focused Information And Matter Of Comparison. The Whole Number Of Patients' Data Is Analyzed. No Sampling Methodology Is Used. Simple And Clear Statistical Methodology Is Used Like Data Tabling, Percentile, Charting And Mean Measurement. Results: A Mean Of 396 Patients Are Admitted At Hospital For Each Year Because Of Head Trauma. The Common Age Range That Lie 66% Of Patients Is From Age 41 Years Old Patients To 70 Years Old Patients..............

Keywords: Traumatic, Brain Injury, Head Injury, Gender, Age Range, Frequency.

[1]. Mccaffrey RJ (1997). "Special Issues In The Evaluation Of Mild Traumatic Brain Injury". The Practice Of Forensic Neuropsychology: Meeting Challenges In The Courtroom. New York: Plenum Press. Pp. 71–75.
[2]. Daisley, Audrey; Kischka, Udo; Tams, Rachel (2008). Head Injury. Oxford: OUP Oxford.
[3]. Indian Network For Health : Http://Www.Medindia.Net/Patients/Patientinfo/Headinjury_Causes.Htm
[4]. Remedy Health Media : Http://Www.Healthcommunities.Com/Traumatic-Brain-Injury/Risk-Factors.Shtml
[5]. Archive Of Head Injured Patients (2011). Zhenjiang First Peoples' Hospital.

Abstract: Bone Marrow Dosimetric Parameters And Acute Hematological Toxicity In Cervical Cancer Patients Undergoing Concurrent Chemoradiation. Objective:- To Study The Incidence Of Hematological Toxicity In Relation To Bone Marrow Dosimetric Parameters In Cervical Cancer Patients Undergoing Concurrent Chemoradiation. Material And Methods:- The Data Of 23 Cervical Cancer (Stage IIb-IIIb ) Patients Who Underwent Concurrent Chemoradiation During March 2017- June 2017 Were Analyzed. Radiation Was Delivered In A Dose Of 46gy In 23 Fractions With Weekly Cisplatin (40 Mg/M2) On Days 1,8,15 And 22 Of The Treatment. The Clinical Target Volume Consisted Of Uterus, Cervix, Vagina, Parametrial Tissue And Pelvic And Presacral Lymph Nodes. Pelvic Bone Marrow Was Defined Within The Treatment Field Which Comprised Of (I) Lumbosacral Spine (Ii) Ilium,Ischium,Pubis And (Iii) Proximal Femora.

Keywords:- Cervical Cancer, Concurrent Chemoradiation, Haematological Toxicity, Dosimetric Parameters, Bone Marrow.

[1]. Green JA, Kirwan JM, Tierney JF, Et Al. Survival And Recurrence After Concomitant Chemotherapy And Radiotherapy For Cancer Of The Uterine Cervix: A Systematic Review And Meta-Analysis.Lancet. 2001;358:781-786
[2]. Mutyala S, Thawani N, Vainshtein J, Et Al. Dose Constraint Recommendations And A Predictive Nomogram Of Incidence Of Hematological Toxicity For Cervix Cancer Patients Treated With Concurrent Cisplatin And Intensity Modulated Radiation Therapy(IMRT). Int J Radiat Oncol Biol Phys. 2008;72:S359-S360.
[3]. Rose BS, Aydogan B, Liang Y, Et Al. Normal Tissue Complication Probability Modeling Of Acute Hematologic Toxicity In Cervical Cancer Patients Treated With Chemoradiotherapy. Int J Radiat Oncol Biol Phys. 2011;79:800-807
[4]. Lim K,Small Jr W, Portelance Consensus For Delineation Of CTV For IMPRT For Cervix Cancer ,IJROBP 2011,79,348-55
[5]. Gurjan OP,Mishra SP,Dosimetric Analysis Of IMRT Plans Having One Or More Pairs Of Parallel Opposed Beams Among Set Of Beams. Radiat Prot Environ 2013;36;135

Abstract: Dentistry has seen colossal advances in all its branches in the course of the last three decades. With these advances, the requirement for more exact analytic tools, specially imaging methods, have ended up plainly obligatory. These simple radiographic strategies experience the ill effects of characteristic confinements like: Two dimensional projection, superimposition, magnification, and distortion of anatomic structures. The advancement of 3D imaging modalities has made enhanced elucidation of auxiliary and biophysical changes, guarantees densitometric evaluations of dentoalveolar structures incorporating varieties in alveolar bone thickness, a periimplant bone mending all the more definitely. The aim of this review is to focus on the requirements, applications, advantages and disadvantages and artifacts of the currently available digital imaging techniques.

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[3]. Stuart C. White , Michael J Pharoah . Oral Radiology Principles and Interpretation 2009; 6 : 109 – 244
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Abstract: INTRODUCTION: Actinomycosis of upper gastrointestinal tract especially gastric region is extremely rare accounting for only 24 cases upto date in the literature(1,2,3). In gartrointestinal tract it commonly occurs in appendix and ileocecal region. Herein, we report a case of primary actinomycosis of gastric region in subtotal gastrectomy specimen.............

Keywords:- Actinomycosis,

[1]. Isik B, Aydin E, Sogutlu G, Ara C, Yilmaz S, Kirimlioglu V. Abdominal actinomycosis simulating malignancy of the right colon. Dig Dis Sci. 2005;50:1312–4.
[2]. Lee YM, Law WL, Chu KW. Abdominal actinomycosis. Aust N Z J Surg. 2001;71:261–3.
[3]. Oksüz M, Sandikçi S, Culhaci A, Egesel T, Tuncer I. Primary gastric actinomycosis: a case report. Turk J Gastroenterol. 2007;18:44–6.
[4]. Choi MM, Beak JH, Lee JN, Park S, Lee WS. Clinical features of abdominopelvic actinomycosis: report of twenty cases and literature review. Yonsei Med J. 2009;50:555–9.
[5]. Lee CM, Ng SH, Wan YL, Tsai CH. Gastric actinomycosis. J Formos Med Assoc., 1996;95:66–68.
[6]. Khaleel Al-Obaidy, Fatimah Alruwaii, Areej Al Nemer, Raed Alsulaiman, Zainab Alruwaii, Mohamed A Shawarby. Primary gastric actinomycosis: report of a case diagnosed in a gastroscopic biopsy.BMC Clin Pathol., 2015; 15: 2
[7]. Brown JR. Human actinomycosis: a study of 181 subjects. Hum Pathol. 1973;4:319–30.

Abstract: Malaria remains the most important human parasitic infection globally and continues to pose a major public threat in India. The WHO estimates that India accounts for 75% of all malaria cases in South-East Asia(21).Malaria presents a diagnostic challenge to laboratories(9).The present study was aimed at evaluating the sensitivity, specificity, positive predictive value and negative predictive values of QBC, Histidine rich protein-2 and plasmodium lactate dehydrogenase antigen detection test in comparison with peripheral smears in clinically suspected cases of malaria .Materials and Methods: Blood samples were collected from 256 clinically suspected cases of malaria of all ages and both sexes between November 2011 to April 2013 SV medical college. Thick and thin blood smears ,quantitative buffy coat examination and one step malaria antigen rapid test using plasmodium lactate dehydrogenase were performed on all the 256 patients..............

[1]. Panikar CKJ.Malaria parasites In :Textbook of medical parasitology.6th ed. New Delhi:Jayapee Brothers medical publishers;2007.p.65-95.
[2]. Park K. Park's text book of Preventive and Social medicine.21st edition.Epidemiology of communicable diseases-Malaria,pg.231-243.
[3]. Manjunath P.Salmani,Preeti B.Mindolli,Basavaraj V.Peerapur.Comparative study of peripheral smear,QBC and Antigen detection in Malaria diagnosis.
[4]. PL Bhandari,CV Raghuveer,A Rajeev,PD Bhandari;Comparative study of peripheral blood smear,quantitative buffy coat and modified centrifuged blood smear in malaria diagnosis;Indian journal of Pathology &Microbiology;2008;Volume :51;Issue :1 ;Page :108-112.
[5]. Guruprasad B.A Clinical Study of Hepatorenal and Hematological Profile in Malaria.Tumlur.2011

Abstract: Introduction: Cancer of the cervix is the second most common cancer among women. Worldwide cancer cervix accounts to 15% of all cancers diagnosed in women. Aim:The present study is aim to describe the socioeconomic and demographic status for cancer cervix among reproductive age women of the study population. Study design: Prospective randomized comparative study. Materials and Methods: A total of 1400 women in the reproductive age group (15-49 years) were selected for this study. A Proforma was designed based on the objectives. Information was recorded from each case on separate proforma. The study subjects (700 rural and 700 urban) were interviewed at their residence and relevant information was collected. Health education was imparted to them at the end of the interview............

Keywords:- Reproductive age women, Sociodemogrpahic factors

[1]. Devita,Hellaman, Rosenbergs, Cancer – Principles & Practice of oncology, Lippincott Williams &Wilkin, . 8(Hagerstown 2008) 1497-1507.
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[4]. WHO (1999): Health situation in the South East Asia Region, 1994-1997, Regional office for SEAR, New Delhi.
[5]. Bhugriyasmin, Pathoepidemiology of cancer cervix in Karachi South- Biomed experts patho epidemiology – 2007.

Abstract: Aims and objective: To compare plaque removal efficacy of two bristle designs of toothbrushes; zig-zag and flat trim. Materials and method: The study was an investigator blind, randomized, crossover design carried out on 13-15 year old school children to test the efficacy of two bristle designs of toothbrushes in single use plaque removal. The study was carried out in two test periods with a wash out period of 4 days between each test period. On day one of each test period plaque removal was carried out for all participants through oral prophylaxis following which they were asked to suspend oral hygiene practices for 24 hours. On the second day, the subjects were asked to brush with the allocated tooth brush for 2 minutes and were assessed for plaque using Turesky Gilmore modification of Quigley Hein plaque index both pre and post brushing................

Keywords:- toothbrush, bristle design, plaque control.

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Abstract: Objective: The aim of this study was to detect and describe the existence and incidence of anatomical variations of the renal artery by using dissection technique. Materials and Methods: 40 cadavers dissected, Department of anatomy S.M.S. Medical College, Jaipur. Results: We found that 45% cadavers had classical (Normal) anatomical presentation of Renal artery, whereas in 55% cadavers, variations existed in the same, using cadaveric method. Conclusion: A thorough knowledge of the variations in renal arteries has gained a lot of importance with the increasing number of renal transplants and other uroradiological procedures. The arterial variations should not be ignored. With an accurate knowledge on the anatomical variations, many operative and post operative complications can be avoided.

Keywords:- Hilar renal artery, renal transplant, supernumerary renal artery, Accessory renal artery, polar renal artery.

[1]. Standring S. Gray's Anatomy; The Anatomical Basis of Clinical Practice 40th ed. Edinburg: Churchill and Livingstone, 2008: 1231-1233.
[2]. Sadler TW. Langman's Medical Embryology. 11th Ed., Baltimore, Philadelphia, New Delhi, Lippincot Williams and Wilkins. 2009;185–189.
[3]. McGregor A. I. : A Synopsis of Surgical Anatomy, 7th ed., p. 381, 1944.
[4]. Dhar P, Lal K. Main and accessory renal arteries--a morphological study. Ital J Anat Embryol. 2005; 110:101-10.
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Abstract: Background: Liver abscess is a common disease in the differential diagnosis of upper abdominal . These includes a recent increase in incidence reflecting more accurate diagnostic techniques especially after 1965 with the advent of radioisotopes scan and later on ultrasonography and CT scan. The reduction in mortality from 90% at the turn of century to the estimated 10-20% today cannot be ascribed to surgery alone. Methods: The study was conducted on 80 patients of liver abscess. Two compared modalities of percutaneous treatment of liver abscess were (1) needle aspiration and (2) pigtail catheter aspiration. All interventions were performed under ultrasonographic guidance. Only those patients having liver abscess/abscesses greater than 6 cm in at least one dimension, liquified & drainable were included in this study.............

Keywords:- Liver abscess, Pigtail catheter, USG

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Abstract: Objective: Craniopharyngiomas are epithelial tumours developing from Rathke's pouch. It represents 1% to 4% of all primitive intra cranial tumours and 5% to 10% in children.The objective of our work is to show the utility of endoscopy in craniopharyngioma surgery and and we will show detailed results of our series and a reivew of the literature. Patients and methods:This is a retrospective study of 22 patients with craniopharyngiomas operated by transsphenoidal endoscopic endonasal approach, extending from 2010-2016. The mean age was 34 years.The sex ratio was 9females/13males.Clinical signs were dominated by opto-chiasmatic syndrome with visualdeficits in90% of patients.Endocrinal syndrome was found in15 patients. All patients had an MRI preoperatively. Results:maximum tumour resection was obtained in 68.2% of cases (15 cases) while sub totaland partialresection was found in 31.8% of cases (07patients).............

Keywords:- Craniopharyngioma, endoscopic approach,skull base, total excision.

[1]. Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL: Expanded endonasal approach: the rostrocaudal axis. Part I Crista galli to the sellaturcica.Neurosurg Focus 19(1):E3, 2005 .
[2]. BuninGR,SurawiczTS,WitmanPA,Preston-MartinS,Davis F, Bruner JM: The descriptive epidemiology of craniopharyngioma.JNeurosurg 89-1998:547–551.
[3]. Jane JA Jr, Laws ER: Craniopharyngioma. Pituitary 9-2006:323– 326.
[4]. Karavitaki N, Cudlip S, Adams CB, Wass JA: Craniopharyngiomas.Endocr Rev 27-2006:371–397.
[5]. David N. Louis, Arie Perry, Guido Reifenberger, Andreas von Deimling, Dominique Figarella‐Branger, Webster K. Cavenee, Hiroko Ohgaki, Otmar D. Wiestler, Paul Kleihues, David W. Ellison: The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary, ActaNeuropathol 9 -2016.

Abstract: Medical tourism is commonly an encountered practice worldwide. More and more people choose to travel to find the best solution in solving their health care. They are looking for high quality medical services, quick access to certain medical procedures and care at more affordable prices than those charged for the same facilities in their internal medical system. For all those reasons, medical tourism is a growing branch in Romania, which through the natural beauty and the exceptional professionalism of the doctors, meets all the conditions to attract tourist-patients. This study will present a proper understanding of the concept of Medical Tourism and what does it include. In order to complete the research, the methodology has been achieved on a mixture of research methods, as primary and secondary data analysis, doubled by a qualitative analysis based on interviews and questionnaires..............

Keywords:- Dental tourism;health tourism; medical wellness; lifestyle limitations; supply chain performance; sustainable tourism.

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