iosr-JDMS   Volume-18 ~ Issue-8 ~ August-2019

Abstract: The real debt of modern science in the field of Medicine , is the knowledge about the structure of haemoglobin.In 1959, Max Preutz determined, molecular structure of haemoglobin by X-ray crystallography. The haemoglobin molecule is composed of four separate polypeptide chains of amino acids, two alpha chains and two beta chains, as well as four iron bearing heme groups that bind oxygen.The alpha chains are coded for by two similar genes on chromosome 16 ; the beta chains by a single gene on chromosome 11. Mutations and deletions in these genes......

[1]. A. C. Gorakshakar, M. S. Sathe, S. R. Shirsat and H. M. Bhatia, ―Genetic Studies in Ratnagiri and Sindhudurg Districts of Maharashtra—Incidence of ABO, Rh (D), Ina Antigens, G-6PD Deficiency and Abnormal Haemoglo- bins,‖ Journal of the Indian Anthropological Society, Vol. 22, 1987, pp. 38-46.
[2]. A. E. Kulozik, B. C. Kar, R. K. Satapathy, B. E. Searjeant, G. R. Searjeant and D. J. Weatherall, ―Foetal Haemoglo-bin Levels and βS Globin Haplotypes in an Indian Popula-tion with Sickle Cell Disease,‖ Blood, Vol. 69, 1987, p. 1742
[3]. Agarwal MB. The burden of haemoglobinopathies in India - Time to wake up J Assoc Physicians India 2005;53:1017-8.
[4]. Agarwal S, Naveed M, Gupta UR, Kishore P, Agarwal 34. SS. Characterization of β-thalassaemia mutations in 57 β-thalassaemia families seen at Lucknow. Indian J Med Res 1994; 100 : 106-10
[5]. Ajmani M, Sharma A, Talukder G, Bhattacharyya DK. Genetic 19. interaction of beta-thalassaemia (Hb βT-) & haemoglobin E (Hb βE) in populations of Eastern India. Indian J Exp Biol 1977; 15 : 455-7..

Abstract: Bipolar affective disorder(BPAD) is a recurrent chronic disordercharacterized by fluctuations in mood state and energy. It affects more than 1% of the world's population irrespective of nationality, ethnic origin, or socioeconomic status.[1] There were 32.7 million cases of bipolar disorder globally in 1990 and 48.8 million in 2013; equivalent to a 49.1% increase in prevalent cases, all accounted for by population increase and ageing.[2] Bipolar disorder is one of the main causes of disability among young people, leading to cognitive andfunctional impairment and raised mortality.[1] Bipolar disorder accounted for 9.9 million Disability Adjusted life Years (DALYs)..........

[1]. Grande I, Berk M, Birmaher B, Vieta E. Bipolar disorder. Lancet. 2016 Apr 9;387(10027):1561-72
[2]. Ferrari AJ, Stockings E, Khoo JP, Erskine HE, Degenhardt L, Vos T, Whiteford HA. The prevalence and burden of bipolar disorder: findings from the Global Burden of Disease Study 2013. Bipolar Disord. 2016 Aug;18(5):440-50.
[3]. Mazaheri M, Gharraee B, Shabani A, Lotfi M. Studying the predictive factors of suicide attempts in patients with type 1 bipolar disorder. Psychiatry Res. 2019 May; 275:373-378.
[4]. Vaingankar JA, Rekhi G, Subramaniam M, Abdin E, Chong SA. Age of onset of life-time mental disorders and treatment contact. Soc Psychiatry Psychiatr Epidemiol. 2013 May;48(5):835-43.
[5]. Yeh HH, Westphal J, Hu Y, Peterson EL, Williams LK, Prabhakar D, Frank C, Autio K, Elsiss F, Simon GE, Beck A, Lynch FL, Rossom RC, Lu CY, Owen-Smith AA, Waitzfelder BE, Ahmedani BK. Diagnosed Mental Health Conditions and Risk of Suicide Mortality. Psychiatr Serv. 2019 Jun 12..

Abstract: Upper gastrointestinal symptoms like heartburn, belching, dyspepsia are increasing in modern world due to changes in food habits and increased use of refined food. In this regard Upper gastro intestinal endoscopy (UGIE) carries utmost importance in diagnosis and treatment and is a common indication inpatients of upper gastrointestinal complaints with normalultrasonography/CT abdomen. Since theprocedure is done with local anesthetic, it can be done on all patients who come with upper gastrointestinal symptoms on outpatient basis. Upper gastrointestinal scope is flexible fiber optic cable with camera attached at tip, which is insertedthrough mouth and is passed.........

[1]. Ageely H. Indications and Findings of Upper Gastrointestinal Endoscopy (UGIE) in Patients of Gizan-Saudi Arabia: A Retrospective Study. World Family Medicine Journal: Incorporating the Middle East Journal of Family Medicine. 2015 Dec;99(3029):1-7.
[2]. Veldhuyzen van Zanten SJ, Flook N, Chiba N, Armstrong D, Barkun A, Bradette M, Thomson A, Bursey F, Blackshaw P, Frail D, Sinclair P. An evidence-based approach to the management of uninvestigated dyspepsia in the era of Helicobacter pylori. CMAJ: Canadian Medical Association Journal. 2000 May 3;162.
[3]. kovachTOG,Jensen DM. initial management of UGI bleeding in portal hypertension.in Rutherford rb ,ed vascular surgery,5thed.philadelphia : saunders 1999;117:59-70.
[4]. Ayoola EA, Al-Rashed RS, Al-Mofleh IA, Al-Faleh FZ, Laajam M. Diagnostic yield of upper gastrointestinal endoscopy in relation to age and gender: a study of 10112 Saudi patients. Hepato-gastroenterology. 1996;43(8):409-15.
[5]. Al-Romaih WR, Al-Shehri AM. Appropriateness of upper gastrointestinal endoscopy referrals from primary health care. Annals of Saudi medicine. 2006 May;26(3):224-7...

Abstract: The alveolar bone loss around posterior teeth can result in furcation involvement of posterior teeth, which affects survival of the teeth. While resective osseous surgery or extraction of the tooth with grade III and grade IV furcation involvements may be feasible periodontal surgical options, grade II furcation with deep two- or three-walled components is suitable for periodontal regenerative therapy. This article presents two case reports in management of grade II furcation involvement with different extensions of two or three bony wall components via periodontal regeneration. Case 1 treated the buccal furcation involvement of the maxillary right first molar via autogenous bone.........

[1]. Sims T, Takei HH. Furcation: Involvement and Treatment. In: Newman MG, Takei HH, Klokkevold PR, Carranza FA, eds. 12th Editi. Carranza's Clinical Periodontology. St. Louis, Missouri: ELSEVIER SAUDERS; 2015:621-627.
[2]. Lang-Hua BH, Mcgrath CPJ, Lo ECM, Lang NP. Factors influencing treatment decision-making for maintaining or extracting compromised teeth. Clin Oral Implants Res. 2014;25(1):59-66. doi:10.1111/clr.12142
[3]. Nibali L, Sun C, Akcalı A, Yeh YC, Tu YK, Donos N. The effect of horizontal and vertical furcation involvement on molar survival: A retrospective study. J Clin Periodontol. 2018;45(3):373-381. doi:10.1111/jcpe.12850
[4]. Wylam JM, Mealey BL, Mills MP, Waldrop TC, Moskowicz DC. The Clinical Effectiveness of Open Versus Closed Scaling and Root Planing on Multi-Rooted Teeth. J Periodontol. 1993;64(11):1023-1028. doi:10.1902/jop.1993.64.11.1023
[5]. Tsao Y-P, Neiva R, Al-Shammari K, Oh T-J, Wang H-L. Factors Influencing Treatment Outcomes in Mandibular Class II Furcation Defects. J Periodontol. 2006;77(4):641-646. doi:10.1902/jop.2006.050133.

Abstract: Psychosis is a mental disorder in which the patient loses contact with reality and surroundings. These disorders are increasing day by day and so the patients are regularly treated with antipsychotic drugs. These drugs are also causing severe adverse effects causing decreased quality of life and economical burden . So the pharmacovigilance studies will be useful to identify and prevent these adverse drug reactions(ADRs) Hence the objective of this study is to identify ADRs to antipsychotic drugs reported to ADR monitoring centre in a tertiary care centre. Among them, the commonest Adverse drug reactions(ADRs) reported are extrapyramidal symptoms, diabetes, salivation, and constipation and the common drugs causing these ADRs are resperidone and olanzapine.

Key Words: Adverse drug reaction (ADR), pharmacovigilance programme of india(PvPI), ADR monitoring centre(AMC),

[1]. Murthy R S. National mental health survey of India 2015–2016. Indian J Psychiatry [serial online] ;59:21-6. Available from: http://www.indianjpsychiatry.org/text.asp?2017/59/1/21/204430
[2]. Robert O.Messing, Eric J.Nestler, Victor I. Reus "Psychiatric and addiction disorders "- Harrisons principles of internal medicine,19th ed. Vol.2 section 5 chapter466,pg 2708-2732

[3]. Jayanthi CR, Divyashree M, Sushma M. Adverse drug reactions in psychiatry outpatients: clinical spectrum, causality and avoidability. Journal of Chemical and Pharmaceutical Research. 2013:5:128-35.
[4]. World Health Organization. Requirements for adverse reaction reporting. Geneva, Switzerland: World Health Organization; 1975.
[5]. Szabo CP. Common adverse drug reactions with psychiatric medications and an approach to their management. CME. 2011;29:230-2.

Abstract: Introduction: As per UNICEF, there are 153 million orphans worldwide. The number of orphans in India is 55 million and the number in Kashmir stands at 2.14 lakh orphans as per the report of 'Save the Children'. UNICEF estimates that 2.2 million children worldwide live in orphanages where they have to face repeated neglect, abuse and fear thus leaving them physically and emotionally vulnerable. Psychiatric morbidity especially PTSD and MDD are common in the present day orphanage setting in Kashmir. This study was conducted with the aim of assessing suicidal ideation and PTSD like symptoms among the orphanage inmates and the associated factors.........

Key Words: Orphans, orphanage, suicidal ideation, PTSD

[1]. D Skinner. Defining Orphan and Vulnerable Children, HSRC Publications South Africa 2008. p.8.
[2]. United States Government. Fifth Annual Report to Congress on PL 109-95. World's Vulnerable Children (2010). Retrievable at: Accessed on http: //pdf.usaid.gov/pdf_docs/PDACU307.pdf. Accessed on 15/06/2013.
[3]. UNICEF, HIV / AIDS, JUNPO. Children on the brink 2002; A joint report on orphan estimates and program strategies. UNICEF 2002.
[4]. GCM India, h.g.o.o.h.h (Producer). Retrieved from http: //gcmindia.org/orphan-homes.html Accessed on 08/07/2013.
[5]. UNICEF. The state of the world's children 2006; excluded and invisible.United Nations Publications 2005

Abstract: Transfusion of blood has saved millions of lives, improves the quality of life of multi transfused patients like thalassemia, hemophilia etc. Blood transfusion reduces morbidity and mortality in clinical conditions which cannot be prevented or managed otherwise. Even though blood saves lives, unsafe transfusion practices can put many people at risk of transfusion-transmissible infections (TTIs). Morbidity and mortality resulting from the transfusion of infected blood have far-reaching consequences, not only for the recipients themselves, but also for their families, their communities and the wider society .The most prior objective of Blood transfusion services(BTS) is to ensure safety(elimination of TTIs), adequacy, accessibility and efficiency of blood supply at all levels...........

[1]. Giri PA, Deshpande JD, Phalke DB, Karle LB et al-Seroprevalence of transfusion transmissible infections among voluntary blood donors at a tertiary care teaching hospital in rural area of India. J Fam Med Primary Care 2012;1:48-51.
[2]. Bhattacharya P,Chakraborty S,Basu SK et al-Significant increase in HBV,HCV,HIV and Syphilis infections among blood donors in West Bengal, Eastern India 20042005.Exploratory screening reveals high frequency of occult HBV infection. World J Gastroenterol 2007;13 : 3730-3733.
[3]. Yedlapati Bhawani, P Raghava Rao, V Sudhakar et al-Seroprevalence of transfusion transmissible infections among blood donors in a tertiary care hospital of Andhra Pradesh from. 2004–2009.Biology and Medicine 2010; 2 (4): 45-48.

[4]. Arora D, Arora B, Khetarpal A et al Seroprevalence of HIV,HBV,HCV and Syphilis in blood donors in Southern Haryana. Ind J Pathol Microbiol 2010;53:308-309.
[5]. Pallavi P,CK Ganesh,K Jayashree,GV Manjunath et al-Seroprevalence and Trends in transfusion transmitted infections among blood donors in a university hospital blood bank: A 5year study(2004-2008).Ind J Hematol Blood Transfuse (2011) 27(1):1-6...

Abstract: To ascertain if dentifrices have an effect on Streptococcus mutans count in orthodontic patients with self ligating brackets

[1]. Ryan KJ, Ray CG. Normal Microbial Flora. In SherrisMedical Microbiology: An Introduction to Infectious Diseases. McGraw-Hill, USA, 2004; 4:141–148.
[2]. Berardi V et al. Antimicrobial Efficacy of Different Toothpastes and Mouthrinses: An In Vitro Study.Dent Res J.2011; 8(2): 85–94.
[3]. Sukkarwalla A, Ali SM, Lundberg P. Efficacy of Meswak on Oral Pathogens Dent Res J.2013; 10(3): 314–320.
[4]. Botelho MA et al.Differential cytotoxicity: a component of neem oil whose action is exerted at the cell membrane level.Molecules.2008; 14:122-133.
[5]. Taha GIet al. The effect of Pomegranate Peels Extract against StreptococcusMutans and Adherence to tooth surface in Comparison to Chlorhexidine gluconate. Advances in Life Science and Technology. 2015; 35:23-31..

Abstract: To ascertain if dentifrices have an effect on Streptococcus mutans count in orthodontic patients with ceramic brackets .

[1]. Ryan KJ, Ray CG. Normal Microbial Flora. In SherrisMedical Microbiology: An Introduction to Infectious Diseases. McGraw-Hill, USA, 2004; 4:141–148.
[2]. Berardi V et al. Antimicrobial Efficacy of Different Toothpastes and Mouthrinses: An In Vitro Study.Dent Res J.2011; 8(2): 85–94.
[3]. Sukkarwalla A, Ali SM, Lundberg P. Efficacy of Meswak on Oral Pathogens Dent Res J.2013; 10(3): 314–320.
[4]. Botelho MA et al.Differential cytotoxicity: a component of neem oil whose action is exerted at the cell membrane level.Molecules.2008; 14:122-133.
[5]. Taha GIet al. The effect of Pomegranate Peels Extract against StreptococcusMutans and Adherence to tooth surface in Comparison to Chlorhexidine gluconate. Advances in Life Science and Technology. 2015; 35:23-31..

Abstract: Introduction: The median arcuate ligament syndrome (MALS) is a rare abdominal vascular compression condition of the coeliac trunk caused by a fibrous ligamentous band that, in different phases of respiration, restricts blood flow to the gastrointestinal tract, resulting in a clinical presentation of abdominal pain, mostly postprandial, and weight loss. Case report: We report a case of female patient with chronic epigastric pain which was initially investigated by computed tomography angiography(CTA) with ambiguous result. On duplex scan, a non-atherosclerotic stenosis with a hook-like appearance was identified.....

Keywords: Median arcuate ligament syndrome, Dunbar syndrome, coeliac stenosis, Doppler Ultrasound

[1] R. Tembey, A. Bajaj, P. Wagle, and A. Ansari, "Real-time ultrasound: Key factor in identifying celiac artery compression syndrome" Indian J. Radiol. Imaging, vol. 25, no. 2, p. 202, 2015.

[2] P.T. Harjola, "A rare obstruction of the coeliac artery. Report of a case" Ann. Chir. Gynaecol. Fenn., vol. 52, pp. 547–550, 1963.

[3] K. M. Horton, M. A. Talamini, and E. K. Fishman, "Median Arcuate Ligament Syndrome: Evaluation with CT Angiography" RadioGraphics, vol. 25, no. 5, pp. 1177–1182, 2005.

[4] T. Sunkara, M. E. Caughey, K. C. Zhen, B. Chiong, and V. Gaduputi, "Dunbar syndrome-A rare cause of foregut ischemia" J. Clin. Diagnostic Res., vol. 11, no. 7, pp. OD13–OD14, 2017.

[5] A. Ozel, G. Toksoy, O. Ozdogan, A. S. Mahmutoglu, and Z. Karpat, "Ultrasonographic diagnosis of median arcuate ligament syndrome: A report of two cases" Med. Ultrason., vol. 14, no. 2, pp. 154–157, 2012...

Abstract: Introduction:Iron, an essential element for cell growth and proliferation, is a component of fundamental processes such as DNA replication and energy production.Human lactoferrin (hLf), an 80-kDa multifunctional iron-binding cationic glycoprotein. Prevalence of iron deficiency anemia is roughly 38% of pregnant women, 29% of non-pregnant women and 29% of all women of reproductive age have anemia globally. Methods:This study as part of The Nutritional Assessment of Medical Students of Ain Shams University (NAMS/ASU).They will be randomly allocated to three arms of clinical trial. All the project 1225 students were investigated by CBC; Serum Iron, Transferren..........

Keywords: Lactoferrin, Ferrous Sulfate, Iron Deficiency Anemia

[1]. Abu Hashim H, Foda O, Ghayaty E. Lactoferrin or ferrous salts for iron deficiency anemia in pregnancy: A meta-analysis of randomized trials. Eur J ObstetGynecolReprod Biol. 2017 ; 219:45-52.
[2]. Carmine Nappi, Giovanni Antonio Tommaselli, IlariaMorra, Mariangela Massaro, Carmen Formisano& Costantino Di Carlo Efficacy and tolerability of oral bovine lactoferrin compared to ferrous sulfate in pregnant women with iron deficiency anemia: A prospective controlled randomized study ActaObstetricia et Gynecologica. 2009; 88: 1031-1035.
[3]. Chen Ke Ph.D., Zhang Lan B.D., Li Hua B.D., Zhang Ying B.D., XieHumina B.D., Shang Jia B.D., Tian Weizheng B.D., Yang Ping B.D., Chai Lingying Ph.D., Mao Meng Ph.D., Iron metabolism in infants: influence of bovine lactoferrin from iron-fortified formula Nutrition. 2015; 31: 304-9.
[4]. Cutone A, Rosa L, Lepanto MS, Scotti MJ, Berlutti F, Bonaccorsi di Patti MC, Musci G, Valenti PLactoferrin Efficiently Counteracts the Inflammation-Induced Changes of the Iron Homeostasis System in Macrophages. Front Immunol. 2017; 8:705.
[5]. Friedman AJ, Shander A, Martin SR, Calabrese RK, Ashton ME, Lew I, Seid MH, Goodnough LT. Iron deficiency anemia in women: a practical guide to detection, diagnosis, and treatment. ObstetGynecolSurv. 2015; 70:342-53...

Abstract: Introduction-Tobacco is a serious threat to health and a proven killer and ranks second as a cause of death in the world taking its toll by killing some 5 million people globally.Tobacco use is an emerging pandemic marching forward relentlessly. In India tobacco kills 8–10 lakhs people each year and many of these deaths will occur in people who are very young. it is of utmost importance to understand the factors leading to its use and to plan strategies to reduce its intake. This is especially relevant for the developing countries like India, where tobacco use continues to be common notwithstanding the recognition of harmful consequences of its usage and reviews the patterns of tobacco use and its prevalence in adult age groups, role of Socioeconomic status, effect of tobacco use based on family composition and family users, and the steps taken by the State to control its use. understanding the role tobacco.........

[1]. Nichter M, Nichter M, Sickle DV. Popular perceptions of tobacco products and patterns of use among male college students in India. Soc Sci Med 2004;59:415-31.
[2]. Pradeep kumar AS, Mohan S, Gopalakrishnan P, Sarma PS, Thankappan KR, Nichter M. Tobacco use in Kerala: findings from three recent studies. Natl Med J India 2005; 18 : 148-53.
[3]. Rani M et al (2003) in their study reported that thirty per cent of the population 15 years or older 47% men and 14% of women either smoked or chewed tobacco.
[4]. Daniel AB et al (2008) conducted a cross-sectional survey on Prevalence and determinants of tobacco use in a highly literate rural community in southern India at Karnataka. Personal interviews was carried out on 832 individuals >15 years of age. The prevalence of tobacco use was 17.5%, being common among older persons.
[5]. Sharma R et al (2010) in their found that tobacco use was significantly associated people who were belonged to a nuclear family (OR 1.96)...

Abstract: Every person when talked about in this world to locate his heart points towards the left side of his chest but what if the heart is on the right side? And that too with a complex heart disease .The situation would be tricky and difficult to manage for each and every one including the operating surgeon. Here in this study we present to you a series of 6 different cardiac lesions with Dextrocardia and our experience. The intra thoracic location of the heart with base to apex axis directed towards the right not because of any disease causing pulling and pushing but because of congenital malposition is known as Dextrocardia. Mostly Dextrocardia is a common incidental finding but its association with complex congenital cardiac defects make it a challenging task to reach a definitive diagnosis and then to surgically correct the defect .Because of this it has become the subject of interest for pathologist and embryologist also recently including surgeons...........

Key words: Dextrocardia; Rare Case Series

[1]. Duru, C. Dextrocardia ,situsinversus and multiple congenital cardiac defects in a nigerian infant . The internet jounrnal of cardiology.2013;11(1): 1-5.
[2]. Joseph k, P.E.R.L.O.F.F. Cardiac malposition . In: Ariane j, M.A.R.E.L.L.I (ed.) CLINICAL RECOGNITION OF CONGENITAL HEART DISEASE. China: Saunders,elseveir; 2012. p. 15-40.
[3]. Maldijan, P.I.E.R.R.E.D, Saric, M.U.H.A.M.E.D. Approach to dextrocardia in adults:review. American journal of roentgenology. 2007;188(6): s39-s40
[4]. Sherawat, R.A.M.C.H.A.N.D.R.A, Sharma, A.N.I.L. A case of mirror-image dextrocardia and situsinversustotalis associated with tetralogy of fallot with patent ductusarteriosus with L-loop,av-va concordance, right aortic arch:main surgeon on assistance side. Heartindia. 2015;3(4): 112-5.
[5]. Garg , N.A.V.E.E.N. Dextrocardia: an analysis of cardiac structure in 125 patients . International journal of cardiology. may 2003;88(2-3): 143-155..

Abstract: Nosocomial transmission of infections is an established problem faced by most health-care set-ups around the world. Transmission of infections is most common by the hands of the health-care workers. It has been established that effective hand hygiene reduces the nosocomial transmission of infections. Hand hygiene is the single most important measure to reduce the risk of transmission of health-care related infections. Hand washing techniques have been propagated by most heath authorities. Hand washing techniques are included in the curricula of most health-care professionals during their training. However, a large section of health-care professionals do not follow this simple....... .

[1]. Basurrah MM, Madani TA. Hand washing and gloving practice among health care workers in medical and surgical wards in a tertiary care centre in Riyadh, Saudi Arabia. Scand J Infect Dis. 2006;38(8):620-4.
[2]. Novoa AM, Pi-Sunyer T, Sala M, Molins E, Castells X Evaluation of hand hygiene adherence in a tertiary hospital. Am J Infect Control, 2007;35(10):676-83.
[3]. Randle J, Arthur A, Vaughan N. Twenty-four-hour observational study of hospital hand hygiene compliance. J Hosp Infect. 2010;76(3):252-5.
[4]. Creedon SA. Healthcare workers' hand decontamination practices: compliance with recommended guidelines. J Adv Nurs. 2005;51(3):208-16.
[5]. Patarakul K, Tan-Khum A, Kanha S, Padungpean D Jaichaiyapum OO. Cross-sectional survey of hand hygiene compliance and attitudes of health care workers nd visitors in the intensive care units at King Chulalongkorn Memorial Hospital. J Med Assoc Thai. 2005;88(4):287-93..

Abstract: The treament of systemic sclerosis has been far from satisfactory.This study aims at determining the safety and efficacy of Dexamethasone Cyclophosphamide Pulse for the treatment of systemic sclerosis.20 patients of systemic sclerosis who have undergone or are undergoing the treatment of Dexamethasone Cyclophosphamide Pulse therapy in our department were evaluated for improvement and side effects of the therapy. Patients were evaluated at baseline,after 6 cycles and after 12 cycles.

[1]. Rowell NR, Goodfield MJD. The connective tissue diseases. In:Rook/ Wilkinson/Ebling Textbook of Dermatology.Champion RH,Burton JL,Burns DA Breathnoch SM.eds.,61,edn,vol 3,Blackwell Science Publications, Oxford 1998;
2520-2545.
[2]. Bell PR, Briggs JD, Calman KC, Paton AM, Wood RF, Macpherson SG, et.al. Reversal of acute clinical and experimental organ rejection using large doses of intravenous steroid. Lancet 1971;i:876-80.
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[5]. Pasricha JS, Thamzam J, Khan UK. Intermittent high dose dexamethasone-cyclophosphamide therapy. Br J Dermatol 1988;119:73-7..

Abstract: Background: Reducing the maternal mortality rate in the third world countries is a challenge the approach of reducing maternal mortality has to be global, so the developed countries have a major role to play. Aim of the Work: to determine, outline, and assess the factors contributing to maternal mortality, especially the avoidable factors, and to evaluate the possibility of prevention of such factors to decrease the incidence of maternal mortality to the least possible value, and finally to make some recommendations to achieve this goal. Patients and Methods: this study is retrospective descriptive hospital based study that utilized all maternal deaths data which occurred at Embaba General Hospital and Bab El Shaarya university hospital during the period between "January 1, 2013" to..........

Key words: maternal mortality, general, university hospitals.

[1]. Abdel-Aziz.,H,ElrabyA.,Hamed R.,Sobhi H.,Elzanzty F.,Farag O.,Shawky S.,Aboulseoud N., and Nassar H., 2010:Egypt's progress towards achieving the millennium development goals, 2010.
[2]. Archana Bhosale, Shabnam Qureshi, Y. S.Nandanwar, 2011:Maternal Mortality at a Tertiary Institute: A five-year study. Bombay Hospital Journal, Vol. 53, No. 2, 2011.
[3]. Asamoah BO, Moussa KM, Stafström M, Musinguzi G, 2011: Distribution of causes of maternal mortality among different socio-demographic groups in Ghana; a descriptive study., BMC Public Health. 2011 Mar 10;11:159.
[4]. Bonnet MP, Deneux-Tharaux C, Bouvier-Colle MH, 2011:Critical care and transfusion management in maternal deaths from postpartum haemorrhage. Eur J ObstetGynecolReprod Biol. 2011 May 30.
[5]. (CMDE), The Confidential Maternal Death Enquiry, 1998:Assessing avoidable factors, Missed opportunities and sub-standard care.