iosr-JDMS   Volume-11 ~ Issue-4

Abstract: Efficient clinical management of patients definitely depends on both the competency of the treating Orthodontist and the cooperative ability of the patient. It was observed that the doctor patient relationship was affected when the patient was not compliant and cooperative with the orthodontist. The present study was an effort to evaluate the impact of patient's cooperation on the attitude of orthodontists. An email based survey comprising of a 13 item questionnaire was developed using the website www.surveyplanet.com. The questionnaire was mailed to about 1000 practicing orthodontists across the country. The first 100 responses obtained during the 1st week of study were included for analysis.

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Abstract: Variations in the structures at the root of neck are important in understanding many clinical and surgical conditions. Scalenus anterior, the key muscle in the neck, usually related to the roots of brachial plexus in its posterior aspect. This study was designed to evaluate the relations of roots of brachial plexus to the scalene muscles. Posterior triangles of neck on both sides were studied in 24 cadavers. In two cases C5 and C6 pierced scalenus anterior muscle and emerged from its anterior surface. In other specimen roots of C5, C6 and C7 entered scalenus muscle and exited anterolateraly in a sequential manner. Knowledge of such variations is important for anaesthetists and surgeons.

Key words: Scalenus anterior; Scalenus medius; roots of brachial plexus; variations

[1] Posniak HV, Olson MC, Dudiak CM, Wisniewski R and C O'Malley. MR imaging of the brachial plexus. American Journal of Roentgenology. 1993;161: 373-379.
[2] Winnie AP. Interscalene brachial plexus block. Anesth Analg. 1970; 49:455-466.
[3] Perlas A, Chan VW, Simons M. Brachial plexus examination and localization using ultrasound and electrical stimulation: a volunteer study. Anesthesiology. 2003; 99:429–35.
[4] De Andres J, Sala-Blanch X. Ultrasound in the practice of brachial plexus anesthesia. Reg Anesth Pain Med. 2002; 27:77–89.
[5] Chan VW. Applying ultrasound imaging to interscalene brachial plexus block. Reg Anesth Pain Med. 2003; 28: 340–343.
[6] Mukherji SK, Wagle A, Armao DM, Dogra S. Brachial plexus nerve block with CT guidance for regional pain management: initial results. Radiology. 2000 Sep;216(3):886-90 .
[7] Ting PL, Sivagnanaratnam V. Ultrasonographic study of the spread of local anaesthetic during axillary brachial plexus block. Br J Anaesth. 1989 Sep;63(3):326-9.

Abstract: Aims and objectives: Malaria, a devastating tropical disease, is very common in India and native countries. In West Bengal, the influence of falciparum and vivax malaria is so high, that each year, many people are affected by these parasites. Our aim is to evaluate the amount of hepatic dysfunction in case of plasmodium affected patients. Materials and methods: In clinically diagnosed 108 patients, admitted in our hospital in the years 2010-2013, confirmation were done thick and thin blood film and/or serology. After diagnosis, other hematological, serological and biochemical tests were carried out other diseases responsible for hepatitis. Then we compared bilirubin, SGOT, SGPT, alkaline phosphatase and hemoglobin as well as correlation between bilirubin and hemoglobin and liver enzymes amongst males (n=62) and females (n=46). Results: Mean values of bilirubin, SGPT and SGOT were significantly raised in males than females. Bilirubin showed significant positive correlation with SGPT and alkaline phosphatase and negative correlation with hemoglobin in both sexes, but positive correlation with males.

Conclusion: Plasmodium falciparum was mainly responsible for hepatic dysfunction in the form of raised liver enzymes rather than only hyperbilirubinemia due to ruptured parasitized or nonparasitized red blood cells (RBC). In future, large scale studies are required justify the above correlations.

[1]. Yuda M, Ishino T et al. Liver invasion by malarial parasite.Cellular Microbial 2004; 6(12): 1119-1125.
[2]. Nadeem M, Ali N, Qamar MA et al. Hematological findings in acute malarial infection.Biomedica 2002; 18:62-65.
[3]. Donald, Krogstad et al. Plasmodium species (Malaria). Mandell, Doughlas and Bennetts. 5th Edition. 1995; pp 2817-2830.
[4]. Baheti R, Laddha P, Geholt RS et al. Liver involvement in falciparum malaria—A histopathological analysis. JIACM. 2003; 4(1):34-38.
[5]. Harinasuta T, Bunnag D et al. The clinical features of malaria in:Malaria: Principles and Practice of Malariology. Vol 1; Wersdorfer WH and McGreogor 1A (eds). Edinburgh Churchil Livingstone 1988; p 721.
[6]. Kochar DK, Agarwal P, Kochar SK, Jain R, Rawat N et al. Hepatic dysfunction and hepatic encephalopathy in plasmodium falciparum malaria. Q J Med 2003; 96: 505-512.
[7]. Garba IH, Ubom et al. Serum alkaline phosphatase activity as a potential biomarker for the integrity of the hepatic draining system in acute falciparum malaria infection. International J of Infectious Diseases. 2005; 4(2).
[8]. Abro AH, Ustadi AM, Abro HA, Abdou As, Younis NJ, Akaila SI. Jaundice with hepatic dysfunction in P. Falciparum Malaria. J of the college of Physician and Surgeons Pakistan. 2009; 19(6):363-366.
[9]. Sowunmi A et al. Renal function in acute falciparum malaria. Arch Dis Childhood. 1996; 74:293-298.
[10]. Kausar MW, Asif KMN, Rizwi F, Raza S. Correlation of bilirubin with liver enzymes in patients of Falciparum Malaria. International Journal of Pathology. 2012; 8(2):63-67.

Abstract: Background: Self-medication is defined as selection and use of medicines by individuals to treat self-recognized or self-diagnosed conditions or symptoms. Self-medication can lead to various health problems like adverse drug reactions, prolonged suffering, and drug-dependence and increase resistance among various pathogens. Very few studies have evaluated its pattern and prevalence in nursing students.

Key words: drugs, nursing students, Self-medication, students

[1]. Hughes CM, McElnay JC, Fleming GF. Benefits and risks of self-medication. Drug Saf 2001; 24: 1027-1037.
[2]. WHO guidelines for the regulatory assessment of medicinal products for use in self-medication, 2000. Available fromwww.who.int/medicines/library/qsm/whoedm-qsm-2000-1/who-edm-qsm-00_1.htm.
[3]. Figueiras A, Caamaño F, Gestal-Otero JJ: Sociodemographic factors related to self-medication in Spain. Eur J Epidemiol 2000; 16:19-26.
[4]. James H, Handu SS, Al Khaja KAJ, Sequeira RP. Evaluation of the knowledge, attitude and practice of self-medication among first year medical students. Med Princ Pract 2006; 15: 270–275.
[5]. World Self-Medication Industry: Responsible self-care and self-medication. A worldwide review of consumer surveys. http://www.wsmi.org/pdf/wsmibro3.pdf.
[6]. World Health Organization: The role of the pharmacist in self-care and self-medication. Available from: http://www.apps.who.int/medicinedocs/pdf/whozip32e/whozip32e.pdf [Last accessed on 2012 Dec 23].
[7]. Badiger S, Kundapur R, Jain A, Kumar A, Patanashetty S, Thakolkaran N, etal. Self-medication patterns among medical students in South India. AMJ 2012; 5: 217-220.
[8]. Buke C, Limoncu M, Ermevtcan S, Ciceklioglu M, Tuncel M, Kose T, et al. Irrational use of antibiotics among university students. J Infect 2005; 51: 135-9.
[9]. Vucic VA, Trkulja V, Lackovic Z. Content of home pharmacies and self-medication practices in households of pharmacy and medical students in Zagreb, Croatia: findings in 2001 with a reference to 1977. Croat Med J 2005; 46: 74-80.
[10]. Lau GS, Lee KK, Luk CT. Self-medication among university students in Hong Kong. Asia Pac J Public Health 1995; 8: 153-7.

Abstract: Objective: The purpose of this study is to determine the patterns of requests and findings of MRI of the lumbo-sacral spine in our locality and to compare with work published by other researchers as it is clear that there is a paucity of data from this locality Materials and methods: This study was carried out in the University of Maiduguri Teaching Hospital from May 2007 to May 2013. A Siemens Magnetom concerto MR Syngo version 2004A with a 0.2Tesla magnetic field strength. Reports were reviewed by two residents and reported by a consultant radiologist. Data from 357 patients who had MRI of the lumbo-sacral region between May 2007 and May 2013 were retrospectively retrieved from the MRI record book of department of Radiology. Results: A total of 357 patients consisting of males (65.8%) and females (34.2%) had lumbosacral MRI done over the period of study. The male: female ratio was 1.9:1. Low back pain was the highest requests (36.5%). Disc prolapse was the most frequent finding in 45.24% of cases. 4.31% patients had normal studies. The most affected age group was 40-49years representing 26.61% and L4/L5 inter-vertebral disk was found to be the most affected level, followed by L5/S1 Conclusion: We observed that low back pain was the commonest request and disk prolapse the most frequent finding. This data is the first documentation of the requests and findings of MRI in our locality and will serve as a future reference for further research work.

Keywords: Requests, Findings, MRI, Lumbosacral spine

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[4]. Jindal G, Pukenas B. Normal Spinal Anatomy on Magnetic Resonance Imaging. Magn Reson Imaging Clin N Am 19 (2011) 475-488
[5]. Younis F, Shahzad R, Rasool F. "Correlation of Magnetic Resonance Patterns of Lumbar Disc Disease with Clinical Symptomatology of Patients" Annals 2011; 17: Jan – Mar
[6]. Buckwalter J. Aging and degeneration of human intervertebral disc. Spine 1995;20:1307-14
[7]. Martin BI, Deyo RA, Mirza SK, et al. Expenditures and health status among adults with back and neck problems. JAMA 2008; 299: 656-664
[8]. Sreedhar CM, Sree Ram MN, Alam A, Indrajit IK, Shanmuganandan K. Sacroiliitis in Routine MRI for Low Back Ache. Ind J Radiol Imag 2006 16;4:643-649
[9]. Irurhe NK, Adekola OO, Quadri AR, Menkiti ID, Udenze IC, Awolola NA. The Magnetic Resonance Scan Findings in Adult Nigerian with Low Back Pain. World J Med Sci 2012; 7 (4): 204-9.
[10]. Ibe M. Surgially Treated Symptomatic Prolapsed Lumbar and Sacral Intervertebral Discs in Females: A Comparative Study of Incidence and Causative Factors and Treatment. Niger J Surg 2012; 18:61-7

Abstract: Introduction: The guidance given to young children in tooth brushing is important not only for preventing caries and gingivitis but also for teaching young children the concept of oral hygiene, as a first step towards acquiring regular hygienic habits in their daily lives. Aim: To evaluate the tooth brushing ability in children aged 3 to 12 years and its relation to type of grip used, and the duration of brushing. Method : 100 participants including boys and girls aged 3 to 12 years who sought treatment at the Department of Pedodontics and Preventive dentistry, Darshan Dental College – Udaipur were selected. Children were divided in to three groups according to age: 3-6 years, 7-9 years and 10-12 years. We then investigated the association between grip type and plaque removal, using plaque scores obtained before and after brushing. Result: The most common grip used was distal oblique with more efficient plaque removal and Precision grip being the least efficient in all age groups. The statistical data was significant with p=0.000 and Mean brushing duration for most children was 2.19 min. Conclusion: Distal oblique grip and less than 2 min duration of brushing has more plaque removal efficacy and there was no significance found in plaque removal among different age group.

Keywords: Oral hygiene, Grips, Brushing, Plaque.

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[4] Mentes A, Atukeren J. A study of manual toothbrushing skills in children aged 3 to 11 years. J Clin Pediatr Dent ,27,2002,91-94.
[5] Sharma S, Yeluri R, Jain A and Munshi A. Effect of toothbrush grip on plaque removal during manual toothbrushing in children. Journal of Oral Science,54,(2), 2012,183-190.
[6] Rugg-Gunn AJ, Macgregor ID. A survey of toothbrushing behavior in children and young adults. J Periodontal Res,13,1978,382-389.
[7] Das UM , Singhal P. Tooth brushing skills for the children aged 3-11 years. J Indian Soc Pedod Prev Dent,27,2009,104-107.
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Abstract: Human immune deficiency virus [HIV] infected seropositive patient suffer from a lot of opportunistic infection because of defective immune response. The defective immune response in HIV seropositive patient is due to the depletion of CD4 lymphocytes with advancing stages of HIV infections. Oral candidiasis is commonly affecting opportunistic infections in patients. The predominant species affecting is candida albicans. Oral candidiasis is seen in increasing frequency in reduced CD4counts.this article gives an attempt to an over view of oral candidiasis in HIV relationship of oral candidiasis with CD4count.various modalities of diagnosis and treatment of oral candidiasis.

Keywords: candidiasis, candida albicans, fungal infection, HIV, opportunistic infection,

[1]. Aravindshetti, Ishitagupta et al "oral candidiasis aiding in diagnosis of HIV"case reports in dentistry 2001, pg 4(article id-929616).
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[7]. Pfaller ma, DiekemaDJ."Rareand emerging opportunistic fungal pathogens: concern for resistance beyond candida albicans and aspergillusfumigates"jclin microbial 2004; 42:4419-31.
[8]. Hajjeh RA, sofair an, HarrisonLH, etal."incidence of blood stream infection due to candida species and in vitro susceptibilities of isolates collected from 1998 to 2000 in a population-based active surveillance program".jclin microbiology 2004;42;1519-27.
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Abstract: The purpose of this study was to compare patient's perception on gingival depigmentation using diode laser and scalpel technique. 20 Patients took part in the study, control sites were treated with a scalpel blade and test sites were treated with Diode laser in contact mode. VAS scale was used for pain perception after surgery. A questionnaire was used to assess esthetics change postoperatively at 1 week and at 3 months, patient's expectation of the procedure and repetition of treatment if needed. 90% subjects complained of no pain in the laser group whereas 45% subjects complained of no pain in scalpel technique which showed VAS scale to be statistical significant between the two groups. Comparison of patient opinion regarding the esthetic change, patient expectation and retreatment of the two surgical procedures were at par with one and another. The application of semiconductor diode laser and scalpel procedure appeared to be an effective treatment for gingival melanin hyperpigmentation.

Key words: Diode laser, hyperpigmentation, melanin, scalpel.

[1] Holtzclaw D., Toscano J.N., Tal H., A case report - Spontaneous Pigmentation of Non-Pigmented Palatal Tissue after Periodontal Surgery, J Periodontol 2010; 81:172-176.
[2] Tal H., Oegiesser D., Tal M., Gingival depigmentation by Erbium: YAG Laser: clinical observations and patients responses, J Periodontal 2003; 74:1660-1667.
[3] Lagdive S., Doshi Y., Marawar P.P., Management of Gingival Hyperpigmentation Using Surgical Blade and Diode Laser Therapy: A Comparative Study, J Oral Laser Applications 2009; 9: 41-47.
[4] S. Pirnat, Versatility of an 810 nm Diode Laser in Dentistry: An Overview, Journal of Laser and Health Academy 2007; 2007; 4: 1–9.
[5] Mani A., Mani S., Shah S., Thorat V., Management of Gingival Hyperpigmentation Using Surgical Blade, Diamond Bur and Diode Laser Therapy: A Case Report, J Oral Laser Applications 2009; 9: 227-232.

Abstract: Aims and objective: Making of a definitive, secondary or wash/final impression of displaceable flabby tissues with minimum or no displacement of tissue by using window impression technique. Background: Denture fabrication on flabby ridges is testing situations for a clinician as it adversely affects retention and stability of complete dentures. The difficulties encountered in these patients need to be overcome by modified techniques in denture fabrication that are not time consuming and make use of materials that are easy to use. Materials and Methods: This window impression technique, uses a custom tray with a window over flabby tissues and a mucostatic impression material to minimize distortion of tissues while making a impression. First, an accurate record of the denture supporting and limiting structures is made except for the mobile tissues which are recorded in second step using light body Polyvinyl siloxane impression material in the window area of special tray. Conclusion: The use of window impression technique helps in maintaining the contour and recording the details of the tissues without displacing the flabby tissues. Hence, it improves the prognosis for complete denture without surgical removal of hyperplastic tissues.

Keywords: Window impression technique, flabby ridge, Polyvinyl siloxane, hypermobile tissues, mucostatic, light body impression material.

[1]. C.D. Lynch, P.F. Allen. Management of the flabby ridge: Using contemporary materials to solve an old problem. British Dental Journal; 2006; 200:258-261.
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[4]. Osborne J. Two impression methods for mobile fibrous ridges. British dental journal 1964; 117: 392-394.
[5]. Watson RM. Impression technique for maxillary fibrous ridge. British Dental Journal 1970; 128:552.
[6]. Freeman SP. Impressions for complete dentures. Journal of American Dental Association 1969; 79: 1173-86.
[7]. Stephen F Rosenstiel, Contemporary Fixed prosthodontics, 4th edition 2007, Elsevier, page no. 444.
[8]. Basker R M, Davenport J C. Prosthetic treatment of the edentulous patient. 4th edition. Oxford: Blackwell, 2002.
[9]. Edward M. Appelbaum, Rita V. Mehra. Clinical evaluation of polyvinyl siloxane for complete denture impressions. Journal of Prosthetic Dentistry 1984; 52:537-539.

Abstract: Sexual violence has profound impact on the physical and mental health, as well as social wellbeing of the victims. Factors increasing women's vulnerability are individual factors, relationship factors, community factors and societal factors .A detail study on the socio demographic profile of victims of sex offences may lead us to determine the risk factors which in turn may enable us to institute preventive measures at all levels. An cross sectional study was conducted at the Upgraded Department of Forensic and State Medicine, Medical College, Kolkata, for a period of one year using pre designed ,pre tested semi structured questionnaire on the victims of sexual offence referred for examination. It was observed that most of the victims were urban Hindu adolescents. 33.3% of the study population stated their age as below 16 years (the age of consent for sexual intercourse).The level of education in 52.4% was low and 4.8% were School dropouts. Most of the respondents were unmarried belonging to nuclear families. 76% of them were from lower middle or poor socio economic group. Most of the respondents (73%) in the study population bonded well with their family members and 76.2 % of the respondents in the study population had adequate social exposure.

Key words: Sexual violence, risk factors of sexual violence, victims, sexual offence, socioeconomic status

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[2]. World report on violence and health2002, WHO, Chapter-6,149
[3]. Park K, Park's Textbook of Preventive and Social Medicine, 21st Edition, 2011.
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[6]. Evaluation and management of the sexually assaulted or sexually abused patient. Dallas, TX, American College of Emergency Physicians, 1999.
[7]. Guidelines for medico-legal care for victims of sexual violence, World Health Organization 2003, 1
[8]. Preventing intimate partner and sexual violence against women: taking action and generating evidence. Geneva, World Health Organization, 2010.

Abstract: The leakage of bacteria through endodontic repair materials is a matter of great concern in dentistry, as the success of repair of furcation perforations or root ends lies in the seal provided by the material against bacterial infiltrations. In vitro microleakage techniques (like dye penetration and fluid filtration) are used to assess the sealing ability of repair materials. However, such microleakage results cannot be correlated with migration of microbes in real situations. The quest for obtaining clinically relevant data prompted researches to develop bacterial leakage models. Various custom set ups had been developed for the purpose. We report a new model for studying bacterial leakage through repair materials, which could be applied universally for teeth of any size and shape. It consists of a cast of the repaired tooth in poly methyl methacrylate (PMMA), incorporated in microbiological test set up. The cast is modified to get a delivery chamber in the upper portion and the lower portion is appropriately sized to allow the repaired part come in contact with the culture medium. The inoculum is delivered to the upper chamber and the leakage of the bacteria is identified through the colony formation in the medium. This model is close to clinical condition and provides reliable and repeatable results. Minimum error parameters, ease of working and reliability are additional features.

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Abstract: Objective: The objective of the study was to compare the changes in lipid profile in normal pregnancy and in preeclampsia. Study Design: A case control study. Method: In this case control study total 180 study subjects were evaluated, 90 normotensive pregnant woman as control group and 90 pre-eclamptic subjects as study group. Fasting venous blood samples were collected and serum levels of triglycerides (TG), Total cholesterol (TC), low density lipoprotein- cholesterol (LDL-C), and Very low density lipoprotein – Cholesterol (VLDL-C), High density lipoprotein cholesterol (HDL-C) were measured. Result: Results showed that in pre-eclamptic group serum triglyceride (212.75 ± 50.29 mg/dl) was increased significantly (p < 0.02) as compared to normotensive pregnant woman (185.60± 40.67 mg/dl). Other parameters TC, LDL-C, VLDL-C and HDL-C were not changed significantly. Conclusion: The findings of the present study are consistent with previous studies, suggesting increased level of serum triglyceride as an important factor in the pathological process of pre-eclampsia.

Keywords: Pre-eclampsia, Lipid profile, Triglyceride.

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[10]. Enquobahrie, DA, Williams MA, Butler CL, Frederick IO, Miller RS and Luthy DA. Maternal plasma lipid concentrations in early pregnancy and risk of preeclampsia. Am J Hypertens.2004; 17(7):574-81

Abstract: Background: Seizure is one of the common causes of childhood hospitalization with significant mortality and morbidity. There is limited data regarding acute seizures episodes form the developing countries. Current study aims to find the common etiology of seizure and classify seizure types and outcome in children presenting to a tertiary center in kanchipuram in south India. Methods: This was a hospital based prospective study carried out in the Department of Pediatrics, Meenakshi medical college and research institute, kanchipuram from 1st Jan 2010 to 31st Dec 2012.Variables record were demographics, clinical presentations, laboratory tests, brain imaging studies, electroencephalography, diagnosis and hospital course. Results: A total of 520 patients were admitted for seizures with 300 (57.7%) males and 220 (42.3%) females. Among these patients, 268(51.5%) presented with fever and 388 (74.6%) of children were less than 6 years of age. Generalized seizures were the most common seizure type (50.2%). Febrile seizures (36.5%), seizure disorder (33.2%), symptomatic seizures (20%) and space occupying lesions were common etiologies. Abnormal brain images were noted in (25%) of 424 patients and most common abnormality in space occupying lesion was neurocysticercosis (4%).

Keywords: children, febrile convulsions, generalized seizures, kanchipuram, neuroimaging

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[7]. Birbeck GL. Seizures in rural Zambia. Epilepsia. 2000; 41:277–281.

[8]. Waruiru CM, Newton CR, Forster D, New L, Winstanley P, Mwangi I, Marsh V, Winstanley M, Snow RW, Marsh K. Epileptic seizures and malaria in Kenyan children. Trans R Soc Trop Med Hyg. 1996; 90:152–155. [9]. Iloeje SO. Febrile convulsions in a rural and an urban population. East Afr Med J. 1991;68:43–51.

[10]. Owusu-Ofori A, Agbenyega T, Ansong D, Scheld WM. Routine lumbar puncture in children with febrile seizures in Ghana: should it continue? Int J Infect Dis. 2004; 8:353–361.

Abstract: AIM: To compare efficacies of Amoxicillin and Moxifloxacin in prevention of bacteremia following dental extraction. MATERIAL & METHOD: Thirty patients were randomly selected and allocated into 3 groups. Group 1: subjects receiving no antibiotics (controls); Group 2: subjects receiving capsule Amoxicillin (AMX); and Group 3: subjects receiving tablet Moxifloxacin (MXF). A peripheral venous blood sample (6 ml) was drawn 30 seconds and 1 hour after dental extraction and microbiological analysis was carried out. RESULT: At baseline, the percentages of positive blood cultures detected were 40% in the control group, 40% in the AMX group, and 30% in the MXF group. The prevalence of bacteremia immediately after completion of the dental extraction was 80% in the control group, 70% and 60% in AMX and MXF groups respectively which were statistically significantly (P< 0.001) when compared to the control group. The prevalence of bacteremia at 1 hour after completion of the final dental extraction was 70% in the control group, 50% and 30% respectively in AMX and MXF groups respectively which were statistically significantly when compared to the control group. Significant differences were observed in the percentages of positive blood cultures between the control group and the AMX and MXF groups (63.33% versus 53.33% and 40%, respectively). CONCLUSION: Moxifloxacin was found to be clinically efficacious for the prevention of bacteremia after dental manipulations whereas Amoxicillin was observed to be unsatisfactory in this regards.

Keywords: Antibiotics, Amoxicillin, Moxifloxacin, Bacteremia, Tooth Extraction,

[1]. Lake R. Aural Bacteremia, with Illustrative Cases: (Abstract). Proc R Soc Med. 1918; 11:47-53.

[2]. Kuppermann N. Occult bacteremia in young febrile children. Pediatr Clin North Am. 1999; 46(6):1073-109.

[3]. Manford M, MatharuJ, Farrington K. Infective endocarditis in a district general hospital. J R Soc Med 1992; 85:262-266.

[4]. Bouza E, Menasalvas A, Muñoz P, Vasallo FJ, del Mar Moreno M, García Fernandez MA. Infective endocarditis—a prospective study at the end of the twentieth century: new predisposing conditions, new etiologic agents, and still a high mortality. Medicine (Baltimore) 2001; 80:298-307.

[5]. Cecchi E, Forno D, Imazio M, Migliardi A, Gnavi R, Dal Conte I, et al.. New trends in the epidemiological and clinical features ofinfective endocarditis: results of a multicenter prospective study. Ital Heart J 2004; 5:249-256.

[6]. Heiro M, Helenius H, Mäkilä S, Hohenthal U, Savunen T, Engblom E, et al. Infective endocarditis in a Finnish teaching hospital: a study on326 episodes treated during 1980-2004. Heart 2006; 92:1457-1462.

[7]. Fiehn NE, Gutschik E, Larsen T, Bangsborg JM. Identity of streptococcal blood isolates and oral isolates from two patients with infective endocarditis. J Clin Microbiol 1995; 33:1399-1401.

[8]. Heiro M, Helenius H, Mäkilä S, Hohenthal U, Savunen T, Engblom E, et al. Infective endocarditis in a Finnish teaching hospital: a study on326 episodes treated during 1980-2004. Heart 2006; 92:1457-1462. [9]. Horacio Casabé J, Deschle H, Cortés C, Stutzbach P, Hershson A, Nagel C, et al. Predictors of hospital mortality in 186 cases of active infective endocarditis treated in a tertiary medical center (1992-2001). Rev Esp Cardiol 2003; 56:578-585.

[10]. Hoen B, Alla F, Selton-Suty C, Béguinot I, Bouvet A, Briançon S, et al. Changing profile of infective endocarditis: results of a 1-yearsurvey in France. J Am Med Assoc 2002; 288:75-81.

Abstract: Partial anamolous pulmonary venous circulation is a cyanotic congenital heart disease and is responsible for as many as 0.6% of all cases of congenital heart diseases of which the incidence in adulthood without correction is extremely rare(0.007%). Complications like recurrent brain abscess always remain a risk. Incidental finding such as dextrocardia with ketonuria and being exposed to endosulphan makes our case much more complicated. We are hereby reporting the anaesthetic management of such a case with good outcome.

Keywords: Partial anamolous pulmonary venous circulation, Recurrent Brain Abscess, Dextrocardia, Ketonuria , Endosulphan, General Anaesthesia .

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[2]. Oshita S, Uchimoto R, Aka H et al: Correlation between arterial blood pressure and oxygenation in the tetrology of Fallot. J. Cardiothorac Anaesth; 1998, 3: 597.

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[4]. David Frankiville: Anaesthesia for non cardiac surgery in children and adults with congenital heart diseases. In paediatric cardiac anaesthesia, ed Carol L lake, 2nd edition. Appleton and Lange, pages 485-494.
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[6]. Ammash NM, Connolly HM, Abel MD, Warnes CA. Noncardiac surgery in Eisenmenger syndrome. J Am Coll Cardiol 1999; 33: 222–7

[7]. Babik B, Deak Z et al; Induction of anaesthesia in tetrology of Fallot- pitfalls to the maintenance of optimal oxygen saturation. Professional information, ASA Newsletter, 2000.

[8]. Laishley RS, Bossows FA et al: Effect of anaesthetic induction regimens on oxygen saturation in cyanotic congenital heart disease. Anaesthesiology, 1986, 65: 673-677.

[9]. Irish CL, Murkin JM, Cleland A et al: Neuromuscular blockade significantly decreases systemic oxygen consumption during hypothermic cardiopulmonary bypass. J. Cardiothoracic vas. Anaesth, 1991, 5: 132.

[10]. Lindhal SGE; Oxygen consumption and carbon dioxide elimination in infants and children during anaesthesia and surgery. British J. Anaesth, 1989, 62: 70.

Abstract: Introduction: Periodontitis is a chronic infectious as well as inflammatory condition that has been vastly associated with various systemic conditions. There has been a lot of conflicting data regarding the relationship between anemia and periodontitis. The objective of the present study is to investigate the relationship between anemia and periodontal disease.

Key words: periodontal disease, periodontal medicine, cytokines

[1]. Enhos S, Duran I, Erdem S, Buyukbas S. Relationship between iron-deficiency anemia and periodontal status in female patients. J Periodontol. 2009;80:1750–1755.
[2]. Mustapha IZ, Debrey S, Oladubu M, Ugarte R. Markers of systemic bacterial exposure in periodontal disease and cardiovascular disease risk: A systematic review and meta-analysis. J Periodontol. 2007;78:2289–2302.
[3]. Sim SJ, Kim HD, Moon JY, Zavras AI, Zdanowicz J, Jang SJ, Jin BH, Bae KH, Paik DI, Douglass CW. Periodontitis and the risk for non-fatal stroke in Korean adults. J Periodontol. 2008;79:1652–1658.
[4]. Wimmer G, Pihlstrom BL. A critical assessment of adverse pregnancy outcome and periodontal disease. J Clin Periodontol. 2008;35(Suppl. 8):380–397.
[5]. Mealey BL, Rose LF. Diabetes mellitus and inflammatory periodontal diseases. Compend Contin Educ Dent. 2008;29:402–408. 410, 412–413.
[6]. Gokhale SR, Sumanth S, Padhye AM. Evaluation of blood parameters in patients with chronic periodontitis for signs of anemia. J Periodontol. 2010;81:1202–1206.
[7]. Hutter JW, Van der Velden U, Varoufaki A, Huffels RA, Hoek FJ, Loos BG. Lower numbers of erythrocytes and lower levels of hemoglobin in periodontitis patients compared to control subjects. J Clin Periodontol. 2001;28:930–936.
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[10]. Johnson MA. Iron: nutrition monitoring and nutrition status assessment. J Nutr. 1990;120:1486–1491.

Abstract: Rheumatoid arthritis (RA) is not commonly reported in Nigeria, a cross sectional survey of 520 inhabitants in a rural setting in the south east of the country found the disease in approximately 17.7% 1, a recent review of 200 consecutive RA patients diagnosed in a rheumatology clinic over a seven year period, concluded that it is not a rare disease in Nigeria 2.The aetiology RA is still unclear, accumulating evidences are clarifying the involvement of genetic and environmental factors in the disease, or the pathogenic mechanism of perpetuating proliferative synovitis and bone destruction3.Presenting primarily as articular and bone disease, it is the extra articular presentation and complcations however that are responsible for most fatalities

[1]. Nworie O, Ezeifeka G.O, Okpara C, Ugbogu O.C, Ubi B,Ibiam O.A, Cross Sectional Study on Rheumatoid Arthritis in Itim Edda Community in Afikpo South L.G.A Ebonyi State, Nigeria, Nigerian Journal of Microbiology, 2008; Vol. 22 (1) 1737 -1741.
[2]. Adelowo O.O ,Ojo O,Oduenyi I,Okwara C.C, Rheumatoid arthritis among Nigerians: the first 200 patients from a rheumatology clinic,Clinical Rheumatol. 2010; 29(6):593-597
[3]. Yoshitomi H,Sakaguchi S, Aetiology of rheumatoid arthritis,Nihon Rinsho, 2005 Sep;63(9):1517-21(Pub med Abstract accessed 31/10/1013)
[4]. Koivuniemi R, Paimela L, Suomalainen R, Leirisalo-Repo M, Amyloidosis as a cause of death in patients with rheumatoid arthritis, Clinical and Experimental Rheumatology ,2008; 26: 408-413.
[5]. Suzuki A, Ohosone Y,Obana M, Mita S, Matsuoka Y ,Irimajiri S, Fukuda J, Cause of death in 81 autopsied patients with rheumatoid arthritis,J.Rheumatol. 1994 Jan; 21(1):33-6.
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[7]. Bѐly M, Apàthy A, Lethal complications and associated diseases of rheumatoid arthritis--a retrospective clinicopathologic study of 234 autopsy patients, Orv.Hetil, 2006 Jun 11;147(23):1063-76(Pub Med abstract downloaded on 9/10/2013)
[8]. Tanaka F, Migita K, Honda S et al.: Clinical outcome and survival of second- ary (AA) amyloidosis. Clin Exp Rheumatol 2003; 21: 343-6.
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Abstract: Objective:To evaluate the efficacy of problem based learning as a teaching learning method and its evaluation by medical students Keywords:active learning ,case scenario,evaluation,medical education,problem based learning,small group learning Method:A small group of 13 medical students of second year were selected. A pretest was given on the topic selected for problem based learning .They were given the problem-case scenario. During active learning process,group discussion,brain stroming ,library and internet searches with the help of the facilitator was done.The students analyzed the problem,formulated learning objectives,and post test on the same topic was given andthe students perception towards problem based learning was noted by a 10 point questionnaire with percentage positive responses. Results: The pretest score was 2.88+/-0.74,the post test score was 7.80+/-2.12 which was statistically significant,(p value<0.0001). the students perception questionnaire on the outcome of problem based learning was 69.22% positive response which also suggested significant value.

Conclusion: These findings suggest that problem based learning is an efficient teaching learning method with a good outcome perception of medical students

[1]. Hmelo-Silver CE. Problem-based learning: What and How Do Students Learn? Educational Psychology Review 2004;16(3):235-66.
[2]. Shields HM, Guss D, Somers SC, Kerfoot BP, Mandell BS, Travassos WJ, Ullman SM, Maroo S, Honan JP, Raymond LW, Goldberg EM, Leffler DA, Hayward JN, Pelletier SR, Carbo AR, Fishman LN, Nath BJ, Cohn MA, Hafler JP. A faculty development program to train tutors to be discussion leaders rather than facilitators. Acad Med.2007;82:486-92.
[3]. Dolmans DH, De Grave W, Wolfhagenm IH, van der Vleuten CP. Problem-based learning: future challenges for educational practice and research. Med Educ. 2005;39:732-41.
[4]. Hmelo-Silver CE, Barrows HS. Goals and strategies of a problem-based learning facilitator. Interdisciplinary Journal of Problem-based Learning. 2006;1:21-39.
[5]. Edens KM. Preparing Problem Solvers for the 21st Century through Problem-Based Learning. College Teaching 2000;48(2):55-60.
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[8]. Taylor D, Miflin B. Problem-based learning. Where are we now? Med Teach. 2008;30:742-63.
[9]. Problem-Based Learning Curriculum A Success for Medical School. University of Missouri-Columbia. Available via http://www.medicalnewstoday.com /releases/55419.php (Accessed 8 July 2012)
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Abstract: Objective: A prospective study was conducted in the department of ENT to see the incidence, Prevalence, Symptoms, signs and etiopathogenesis in relation to ophthalmic manifestations in ENT diseases and various ENT surgical procedures (iatrogenic).

Conclusion: A variety of ENT diseases & surgical procedures can present with orbital complications due to anatomical association of orbit with the surrounding head and neck structures. Orbital involvement must be ruled out whenever an ENT patient presents with orbital complaints .Rapid diagnosis and treatment is necessary for preserving vision and life in these patients. Teamwork between ophthalmologist and the otolaryngologist is required for the appropriate management of such lesions.

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