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

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 amenorrhea described in this review can minimize the risk of diagnostic error as well was decrease test volume, cost, and time to diagnosis.aim of the study is to evaluate the cause of secondary , management and outcome of secondary amenorrhea using an algorithmic approach in 100 cases patients of secondary amenorrhea who attended gynaecological OPD.

Key words: secondary amenorrhea , algorithmic approach

[1]. Berek & Novak,s Text Book Of Gynaecology 14th edition 2009,1036.
[2]. Baker ER, Mathur RS, Kirk RF, Williamson HO. Female runners and secondary amenorrhea; : correlaton with age, parity mileage, and plasma hormonal and sex-hormone-binding globulin concentrations. Fertility and Sterility. 1981 ; 36(2). 183-7.
[3]. Kleinbaer DL, Neol Gl, Frantz AG. Galactorrhea a study of 235 cases, including 48 with pituitary tumors. New England Journal of Medicine 1977; 296: 589-600
[4]. Tolis G, Bertrand G, Carpenter S, Mckenzie JM, Acromegaly galactorrhea- amenorrhea with two pituitary adenomas decreting growth hormone or prolactin. Annals of Inter Medicine 1978: 89 3455-348.
[5]. Caldwell G, Kellet HA,Gow SM, Beckett GJ, Sweeting VW, seth J, et al. A new strategy for thyroid function testing Lancet. 1985; 1: 1117-9.

Abstract: Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. It is always a subjective experience. Regional anaesthesia has been used widely for upperlimb surgeries because it provides good post operative analgesia. Brachial plexus block has evolved into a valuable and safe alternative to general anaesthesia for upperlimb surgery. The main drawback of long acting drugs was delayed onset of action. To overcome this ,an attempt was made to compare the effects of adding potassium chloride and sodium bicarbonate to Bupivacaine for the onset time and duration of sensory and motor blockade following supraclavicular brachial plexus block was carried out.

[1]. Morgan. G.E Clinical Anaesthesiology.3rd edition. Lange medical books.
[2]. McGrawn - Hill medical publishing division;2002,311
[3]. Singer C. Underwood EA. A short history of medicine.2nd ed.
[4]. Oxford:Clarendon;1962.349
[5]. Cousins MJ and Bridenbaugh PO. Neural blockade in clinical anaesthesia and management of pain.2nd ed. Philadelphia JB Lippincott Company;1988,296.

Abstract: This prospective study was conducted in SNCU of GMCH to find out the bacteriological profile of neonatal sepsis and their sensitivity. In 93 (13.64%) neonates out of 682 neonates, organisms were isolated. 56(60.22%) neonates had early onset sepsis and 37(39.78%) neonates had late onset sepsis. CoNS was the commonest organism causing both early (in 48.21%) and late ( in 54.05%) onset sepsis respectively, followed by E. coli in EOS and Klebsiella species in LOS. 48.80% and 27.66% of CoNS were sensitive to linezolid and vancomycin respectively. All (100%) S. aureus were sensitive to vancomycin and linezolid, 80% were sensitive to ciprofloxacin and 60% were sensitive to gentamycin and amikacin. 40% of Klebsiella sp were sensitive to vancomycin and ciprofloxacin. 54.54% and 27.27% of E. coli were sensitive to vancomycin and ciprofloxacin respectively. 60 % of gram.............

[1]. http://data.unicef.org>child-survival
[2]. Liu L, Oza S, Hogan D, Perin J, Rudan I, Lawn JE et al. Global, regional and national causes of child mortality in 2000-13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet 2015; 385 (9966): 430-440.
[3]. Liu L, Johnson HL, Cousens S, Perin J, Scotl S, Lawn JE et al. Global, regional and national causes of child mortality : an updated systematic analysis for 2010 with time trends since 2000. Lancet 2012; 379; 2151-2161.
[4]. National Neonatal Perinatal Database. Report for the year 2002-03. Available at http;//www.newbornwhocc.org/pdf/nnpd_report_2002-03.PDF.
[5]. Bang AT, Bang RA, Baitule S, Deshmukh M, Reddy MH. Burden of morbidities and the unmet need for health care in rural neonates a prospective observational study in Gadchiroli, India. Indian Pediatrics 2001; 38:952-965.

Abstract: Dental implants placed in extraction sockets gained maximum popularity because it reduces the treatment time drastically. Previously implants in extraction sockets were considered only in the anterior re-gion, the latest treatment protocols evolved in last decade, gives promising results to suggest the same in the posterior region. The teeth in the mandibular posterior region are in the most load bearing area and should be considered with caution. This research paper evaluates the merits and demerits of two different protocols for implant placements in lower molar extraction sockets.Group A - Two implants ,one each in mesial and distal sockets of mandibular molars immediately after extraction. Group B -One implant in inter radicular septum between mesial and distal sockets of mandibular........

Key words: Dental Implants, Fresh extraction sockets, Immediate implants, Immediate loading, Deep thread implants

[1]. One DC,BleakleyJE.Compromised first permanent molars An orthodontic perspective; Australian Dental Journal 2010:55:2-14

[2]. Shenoy VK , Single tooth implants Pre treatment considerations and pretreatment evaluation; Journal of Interdisciplinary Dentistry 2012 Vol 2 Issue 3 Page 149-157

[3]. Vignoletti Fabio ,Mariano Sanz , Immediate Implants at fresh extraction sockets: From myth to reality; Periodontol 2000.2014 October 66(1)

[4]. Cristalli MP et al , Immediate loading of post extractive single tooth implants a One year prospective study; Clin Oral Implants Res 2015 September 26 (9)

[5]. Romanos GE, Present status of immediate loading of Dental implants; Journal of Oral Implantology 30 (3), 189-197,2004

Abstract: Dhat syndrome is a culture-bound disorder which manifests in the form of preoccupation regarding semen loss among patients in the Indian subcontinent. It is associated with vague multiple somatic and psychological complaints such as fatigue, listlessness, loss of appetite, lack of physical strength, poor concentration and forgetfulness. 50 consecutive male patients diagnosed as suffering from Dhat Syndrome (according to ICD-10) by consultant Psychiatrist were taken for study. Hamilton rating scale for depression (HAM-D) was applied to record the severity of depression and Hamilton rating scale for anxiety (HAM-A)was applied for measuring the severity of anxiety. Majority of patients belonged to age group of 21 to 40 years (76%), were Hindus (88%), hailing from rural area (54%), were married (58%), having education middle or above class (90%), employed (46%) and middle socioeconomic status, 44% patients were having depression and 28% had anxiety disorder.

[1]. Bhatia MS; an analysis of 60 cases of culture bound syndrome. Indian J Med Science 1999;53:149–520.
[2]. Bhatia MS, Malik SC. Dhat syndrome. A useful diagnostic entity in Indian culture. Br J Psychiatry 1991;159:691.
[3]. Chadda RK, Ahuja N. Dhat syndrome: A sex neurosis of the Indian subcontinent. Br J Psychiatry 1990;156:577–9.
[4]. Chadda RK. Dhat syndrome: is it a distinct clinical entity? A study of illness behavior characteristics. ActaPsychiatry 1995:91:136-139.0 Munksgaard 1995.
[5]. Deb KS, Balhara YS. Dhat syndrome: A review of the world literature. Indian J Psychol Med 2013;35:326–31.
[6]. Grover S, Avasthi A, Aneja J, Shankar G, Mohan MR, Nehra R, Padhy S. Comprehensive Questionnaire for assessment of Dhat syndrome: Development and use in patient population. JSex Med in press..

Abstract: Gastric ulcer perforation with peritonitis is a common presenting complaint of surgical emergency. The presence of fungal micro-organisms (Candida albicans) in peptic perforations is rare and carries grave prognosis. This was a prospective study of patients admitted to the Department of General Surgery, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India with a diagnosis of gastric perforation between October 2015 to September 2017. 47 patients included in the study. 5 cases of gastric perforation were found to be due to Candida albicans on histopathological examination of tissue taken from edge of the ulcer. Out of 5 cases, 4 were male and 1 female, 3 belongs to elderly age group (above 60 years). Most cases showed associated co-morbidities like diabetes mellitus and tuberculosis. Out of 5 cases, 3 cases died i.e. mortality was 60%..

Keywords: Gastric perforation, Candida albicans, immunocompromised, mortality

[1]. Bakhshi GD, Borisa AD, Shaikh AS, Thadeshwar NR, Kher Y, Kapadnis LA, et al. Invasive gastric candidiasis with perforation. Bombay Hospital Journal. 2011;53:264- 65.
[2]. Schulze J, Sonnenborn U. Yeasts in the gut: from commensals to infectious agents. Dtsch Arztebl Int 2009;106: 837-842.
[3]. Dupont H, Bourichon A, Paugam-Burtz C, Mantz J, Desmonts JM. Can yeast isolation in peritoneal fluid be predicted in intensive care unit patients with peritonitis? Crit Care Med 2003;31: 752-757.
[4]. Ginnis MR. Mycetoma. Dermatol Clin 1996 ;14 (1):97-104.
[5]. Buddington RK: Williams CH, Chen SC, Witherly SA. Dietary supplement of neosugar alters the fecal flora and the decreases activities of some reductive enzymes in human subjects. Am J Clin Nutr 1996; 63(5) :709-16...

Abstract: Tobacco smoking is one of the well known modifiable risk factors for atherosclerosis, coronary heart diseases, lung & oral cancers and chronic obstructive pulmonary diseases. Tobacco is consumed in many ways such as chewing, smoking. In India, tobacco kills 8–10 lakh people each year and majority of these deaths occur in young age. An estimate says that an average of five-and-a-half minutes of life is lost for each cigarette smoked. This study was designed to demonstrate the effects of smoking on lipid profile among south Indian smokers and to identify the differences between the lipid profiles of smokers. The study group comprised of........

Key Words: Tobacco smoking, lipid profile, high density lipoproteins

[1]. Mishra S, Joseph RA, Gupta PC, Pezzack B, Ram F, Sinha DN, et al. Trends in bidi and cigarette smoking in India from 1998 to 2015, by age, gender and education. BMJ Glob Health. 2016; 1(1):e000005.
[2]. Glantz S, Gonzalez M. Effective tobacco control is key to rapid progress in reduction of non-communicable diseases. Lancet. 2012;379(9822):1269–71.
[3]. Gupta PC, Ray CS. Tobacco, education & health. Indian J Med Res. 2007;126(4):289–99.
[4]. Chatterjee T, Haldar D, Mallik S, Sarkar GN, Das S, Lahiri SK. A study on habits of tobacco use among medical and non-medical students of Kolkata. Lung India Off Organ Indian Chest Soc. 2011;28(1):5–10.
[5]. Talhout R, Schulz T, Florek E, van Benthem J, Wester P, Opperhuizen A. Hazardous Compounds in Tobacco Smoke. Int J Environ Res Public Health. 201;8(2):613–28.

Abstract: Background: Osteoarthritis (OA) is the most prevalent musculoskeletal disorder and the most common form among various types of arthritis, affecting worldwide population. The prevalence of this condition increases with increasing age and functional disability due to pain in OA is one of the most common disabilities in the elderly population and accounts for approximately half of all chronic conditions in persons older than 65 years. Aim and objectives: the present study was done 1) To compare the efficacy of nabumetone and aceclofenac in patients with moderate to severe osteoarthritis of the knee. 2) To compare the safety of nabumetone and aceclofenac in patients with..........

Keywords - Osteoarthritis, nabumetone, aceclofenac, visual analogue scale

[1]. Diaz C, Rodriguez DLS, Geli C. Efficacy and tolerability of aceclofenac versus diclofenac in the treatment of knee osteoarthritis: a multicentre study. Eur J Rheumatol Inflamm 1996; 16 (1): 17-22.

[2]. Guccione AA, Felson DT, Anderson JJ, Anthony JM, Zhang Y, Wilson PW. The effects of specific medical conditions on the functional limitations of elders in Framingham Study. Am J Public Health 1994; 84:351-8.
[3]. Woolf AD, Pflegar D. Burden of major musculoskeletal conditions. Bull World Health Organ 2003; 81:646-56.
[4]. Bannwarth B. Drug induced musculo-skeletal disorders. Drugs. 2000; 1:17-23.

[5]. Laine L, Smith R, Min K, Chen C, Dubois RW. Systematic review: the lower gastrointestinal adverse effects of non-steroidal anti-inflammatory drugs. Aliment Pharmacol Ther. 2006; 24(5):751-67.

Abstract: Background: Diabetic neuropathy is one of the most commonly occurring micro vascular complications.Glycatedhaemoglobin (HbA1c) has been established as a marker of glycemic control and it also indicates the risk of developing small vessel complications.Nerve conduction studies are useful in early evaluation in diabetic peripheral neuropathy. Therefore, this study was undertaken to assess the nerve conduction study results among known cases of type II diabetes mellitus with uncontrolled glycemic (HbA1C elevated), diabetics with controlled glycemic (HbA1C at normal level) and to compare it with non-diabetic subjects. Methods:The study was conducted in 60 male subjects in age group of 30-45 years. Subjects were subdivided into 3 groups-Group 1: 20...........

Keywords –Type II diabetes mellitus, Nerve conduction velocity, amplitude, latency

[1]. Alvin C Powers. Editors: Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, et al. Diabetes Mellitus Harrison's Principles of Internal Medicine, 17th edition. New York: The McGraw-Hill, health professions division; 2008.p. 2275-304.
[2]. Walker BR, Colledge NR, Ralston SH, Penman I (Eds) Davidsons principles and practice of medicine. 22th edition. Churchil Livingstone: pp 797-828, 2014.
[3]. Mundet X, Pou A, Piquer N et al. Prevalence and incidence of chronic complications and mortality in a cohort of type 2 diabetic patients in Spain. Primary Care Diabetes 2: 135-140, 2008.
[4]. Tesfaye S, Stevens LK, Stephenson JM, Fuller JH, Plater M, Ionescu-Tirgoviste C et al. Prevalence of diabetic peripheral neuropathy and its relation to glycemic control and potential risk factors. The Euro Diab IDDM complications study. Diabetologia1996; 39: 1377-1384.
[5]. Wild S, Roglic G, Green A, Sicree R, King H (2004) Global prevalence of diabetes. Diabetes Care 27:1047–1053.

Abstract: Extra-oral disimpaction of ectopically placed third molar is an exceptional surgical procedure. Though ectopic impacted third molar more often is an accidental clinical finding when asymptomatic but may present as an idiopathic facial pain. This patient presented with left ectopically placed third molar in the mandibular ascending ramus and right distoangularly impacted third molar both associated with a dentigerous cysts. The positions of the impacted teeth were the determining factor in choice the surgical approach employed to extract the impacted teeth.

Keywords: Ectopic, impaction, mandibular third molar, ascending ramus, dentigerous cyst.

[1]. Bhat S, Ka F, Babu GS, Saidath K. Ectopic positions of third molar-maxilla and mandible. J oral Med Oral Surg Oral Pathol Oral Radiol 2015; 1(2): 80-82.
[2]. Findik Y, Baykul T. Ectopic third molar in the mandibular sigmoid notch. Report of a case and literature review. J Clin Exp Dent 2015; 7(1): e133-7. http:// www.medicinaoral.com/odo/volumenes/v7il/jcedv7ilpl33.pdf.
[3]. Martins LD, Osawa HK, Takahashi A, Gonçalves RCG, Zardo M. Ectopic mandibular third molar: Extraction by access. Rev Odonto Cienc 2012 Oct; 27(4): 344- 348.
[4]. Mamatha NS, Satheesh K, Narahari R . Extra oral mandibular third molar: A case report. IJRAMR, 2017 Mar; 4(3): 2379-2382.
[5]. Bello SA, Oketade IO, Osunde OD. Ectopic 3rd Molar Tooth in the Maxillary Antrum. Case Reports in Dentistry, 2014 July. Retrieved from http:// www.hindawi.com/journals/crid/2014/6..

Abstract: A young adult contains up to 450 lymph nodes of which 60-70 are found in head and neck,100 in thorax,250 in abdomen and pelvis. Lymph nodes are particularly numerous in the neck,mediastinum, posterior abdominal wall, abdominal mesenteries, pelvis, proximal region of limb.1 Enlarged lymph nodes are accessible for FNAC(Fine needle aspiration cytology) and are of importance to diagnose secondary or primary malignancies.2Lymph nodes harbouring malignant disease tend to be firm, non-tender, matted (i.e., stuck to each other), fixed (i.e, not freely mobile but rather stuck down to underlying tissue) and increase in size overtime.3Palpable nodes with metastasis are significantly larger than non-palpable nodes with metastasis4. FNAC(Fine needle...........

[1]. Sussan Standring .Gray's Anatomy: Anatomical basis of clinical practice. 39th Edition, Churchill Livingstone, New York, 2005.

[2]. Khajuria R Goswami KC,Singh K,Dubey VK.Pattern of lymphadenopathy on fine needle aspiration cytology in Jammu.JKSCI.2006;8:157-9.

[3]. Morland B. Lymphadenopathy. Arch Dis Child. 1995 Nov; 73(5): 476-9.

[4]. Van Overhagen H, Brakel K, Heijenbrok MW, Van Kasteren JH, Van de Moosdjik CN, Roldaan AC. Metastasis in supraclavicular lymph nodes in lung cancer: assessment with palpation, US, and CT,Radiology.2004; 232:75–80.

[5]. Ustun M, Risberg B, Davidson B, Berner A. Cystic Change in metastatic lymph Nodes: A common diagnostic pitfall in Fine-Needle Aspiration Cytology. Diagn Cytopathol. 2002 Dec; 27(6): 387-92..

Abstract: Background: Aim ofthe study is to see the patterns of benign breast disease in females and males and to co-relate with the various pathological findings. Benign breast diseases constitute a heterogeneous group of disease including developmental abnormality, epithelial and stromal proliferation, inflammatory lesions and neoplasms. Benign breast lesions deserve attention because of their increased prevalence and impact on patient's life and progression to cancer in some breast lesions. Methods:Two hundred patients with breast lesions who attended the Surgery Outpatients Department inSGT FMHS, UNIVERSITY,Budhera,Gurugramwith various forms of benign breast diseases during the period from July 2014 to July 2017, were studied. Early...........

Keywords: Benign Breast Disease, Fibroadenoma , Triple Assessment

[1]. Khemka A, Chakravarti N, Shah S, Patel V. Palpable breast lumps: Fine needle aspiration cytology versus histopathology, a correlation of diagnostic accuracy. Internet J Surgery.2009; 18:1.
[2]. Cole P. Mark Elwood J. Kaplan SD. Incidence rates and risk factors of benign breast neoplasms. Am J Epidemol.1978; 108: 112-20.
[3]. Hutchinson WB, Thomas DB, Hamlin WB et al. Risk of breast cancer in women with benign breast lesion. J Natl Cancer Inst. 1980; 65: 13-20.
[4]. Kelsey JL, Gammon MD. Epidemiology of breast cancer.Epidemiol Rev. 1990; 12: 228-40.
[5]. Sarnelli R, Squartini F. Fibrocystic condition and "at risk" lesions in asymptomatic breasts, a morphologic study of post-menopausal women. Clin Exp. Obstet Gynecol. 1991; 18: 271-79.

Abstract: Introduction • Splenic artery aneurysms (SAA) are the third most common intra-abdominal aneurysm[1]. • Complications include invasion into surrounding structures often in association with preexisting pancreatic disease. • Traditionally, treatment of SAA was through surgery, but endovascular therapy is now established with minimal morbidity and mortality[2]. • Here by presenting a successful endovascular management of a splenic artery pseudoaneurysm, with a fistula between the pseudoaneurysm and the sigmoid colon in a patient with coexisting chronic pancreatic disease[3]. Results: - Post procedure patient doing well. At 2 months follow up patient is symptom free. Conclusion: - Patients presenting with haematochezia on a background of pancreatic disease should immediately alert the physician to the possibility of splenic artery aneurysm or pseudoaneurysm, complicated by gastrointestinal involvement............

[1]. Al-Habbal Y., Christophi C., Muralidharan V. Aneurysms of the splenic artery—a review. Surgeon.2010;8(4):223–231. doi: 10.1016/j.surge.2009.11.011.

[2]. Akbulut S., Otan E. Management of giant splenic artery aneurysm: comprehensive literature review.Medicine. 2015;94(27) doi: 10.1097/md.0000000000001016.e1016

[3]. Zhao J., Kong X., Cao D., Jiang L. Hematochezia from splenic arterial pseudoaneurysm ruptured into pancreatic pseudocyst coexisting with fistula to the colon: a case report and literature review.Gastroenterology Research. 2014;7(2):73–77. doi: 10.14740/gr607w.

[4]. Guillon R., Garcier J. M., Abergel A., et al. Management of splenic artery aneurysms and false aneurysms with endovascular treatment in 12 patients. CardioVascular and Interventional Radiology. 2003;26(3):256–260. doi: 10.1007/s00270-003-1948-y.

[5]. Pitton M. B., Dappa E., Jungmann F., et al. Visceral artery aneurysms: incidence, management, and outcome analysis in a tertiary care center over one decade. European Radiology. 2015;25(7):2004–2014. doi: 10.1007/s00330-015-3599-1

Abstract: Evans Syndrome Is A Rare Hematological Disease Commonly Defined As Coombs-Positive Hemolytic Anemia And Immune Thrombocytopenia. It Is Associated With Decreased Cluster Of Differentiation (CD)4+ T-Helper Cell Counts, Increased CD8+ T-Suppressor Cell Counts, A Decreased CD4/CD8 Ratio, And Reduced Serum Immunoglobulin G, M And A Levels - Indicating A Complex Immune Dysregulation. Association With Other Autoimmune Diseases Has Been Described With Evans Syndrome.We Describe A Case Of A 23-Years Old Female Affected By Autoimmune Hemolytic Anemia And Thrombocytopenia Successfully Treated With Steroids..

Keywords - Evans Syndrome, Autoimmune Hemolytic Anemia, Autoimmune Thrombocytopenia

[1] Evans RS, Takahashi K, Duane RT, Payne R, Liu C: Primary Thrombocytopenic Purpura And Acquired Hemolytic Anemia; Evidence For A Common Etiology. AMA Arch Intern Med 1951, 87:48–65.
[2] F. Porcaro Et Al.: Evans Syndrome: A Case Report. Ped. Med. Chir. (Med. Surg. Ped.), 2014, 36: 167-169
[3] Wang W, Herrod H, Pui CH, Presbury G, Wilimas J: Immunoregulatory Abnormalities In Evans Syndrome. Am J Hematol 1983, 15:381–390.
[4] Simon Et Al.: Evans Syndrome Associated With Sterile Inflammation Of The Central Nervous System: A Case Report. Journal Of Medical Case Reports 2013 7:262.
[5] Karakantza M, Moukaki A, Theodoropoulou M, Bussel JB, Maniatis A. Th 1 And Th2 Cytokines In A Patient With Evans' Syndrome And Profound Lymphopenia. British Journal Of Haematology 2000; 110, 968–970.