iosr-JDMS   Volume-11 ~ Issue-6

Abstract: Background: One of major contributing factors for the growing burden of cardiovascular disorders is increasing prevalence of hypertension and involvement of younger people. Despite its high prevalence in the population, hypertension in women has received less attention than hypertension in men. The primary objective of this study was to assess the sociodemographic and clinical profile of young female hypertensives. Methodology: This was a cross sectional study carried out in the Cardiology OPD of a tertiary care hospital in Kolkata, West Bengal. Six forty six young female hypertensives patients (aged between 20 to <40 years) were interviewed and their blood pressure was measured. Results: The mean systolic blood pressure and mean diastolic blood pressure was 144.1± 24.6 mmHg and 79.9± 12.4 mmHg respectively. Newly detected hypertensives were 21.4%, out of which 39.1% were stage 1 hypertensives and 60.9% were stage 2.Conclusion: Though men are more commonly affected by hypertension, a significant number of females are also affected. By modification of lifestyle, diets, regular exercise and by use of appropriate drugs at right time, majority of hypertensive cases in females specially in the young age group of below 40 years can be controlled and thus major complications can be prevented. Keywords: Hypertensives, young females, clinicosocial profile

[1] National Cardiovascular Disease Database, Sticker No: SE / 04 / 233208, www.whoindia.org(accessed on July 10,2011)

[2]. Gupta R. Trends in hypertension epidemiology in India. J.Hum Hypertens. 2004;18 (2) :73 –8.

[3]. Calhoun DA, Oparil S. The sexual dimorphism of high blood pressure. Cardiol Rev 1998; 6: 356–362.

[4]. Robitaille NM. Hypertension in women.Can J Cardiol 1996; 12 (Suppl D): 6D–8D.

[5]. Kaplan NM. The treatment of hypertension in women.Arch Intern Med 1995; 155: 563–567.
[6]. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: Page 11-12, www.nhlbi.nih.gov(accessed on July 10, 2011)

[7]. Pickering TG. Ambulatory monitoring and the definition of hypertension. J Hypertens 1992; 10: 401–409.

[8]. Myers MG, Reeves RA. White coat effect in treated hypertensive patients: sex differences. J Hum Hypertens 1995; 9: 729–733.

[9]. Hanes DS. Strategies for the treatment of hypertension in postmenopausal women. J Clin Hypertens 1999;1:62–71.

[10]. Hickson Stacey, Miles Karen, McDonnell Barry, Yasmina , Cockcroft John, Wilkinson Ian, McEniery Carmel. Use of the oral contraceptive pill is associated with increased large artery stiffness in young women: The ENIGMA Study. Journal of Hypertension 2011; 29 (6): 1155–59

Abstract: Central Venous Cannulation is a routine procedure done in the Operation Theatre and the Intensive Care Unit. Malpositioning is a very common occurance with the regular anatomical landmark technique. As the central venous catheters are essential in various critical care scenarios, hence any misplacement can hamper its purpose. Here we have three cases where in we saw the migration of the Right Subclavian Vein Catheter into the Ipsilateral Internal Jugular Vein, Contralateral Subclavian Vein and into the Ipsilateral External Jugular Vein radiologically. Hence a thorough knowledge of normal and variant anatomy is required for the proper positioning of Central Venous Catheters. Also radiological techniques like ultrasound guided cannulation may avoid inadverdent arterial puncture but may not be able to avoid malpositioning.

Keywords: Central Venous Catheter, Malposition, Right Subclavian Vein.

[1]. Samar Harris and Harris V. K. Naina. Central Venous Catheterisation – Subclavian Vein. N Engl J Med 2008; 358: 1758 – 1760.
[2]. Ashutosh Chauhan. Malpositioning of Central Venous Catheter: Two Case Reports. Indian Journal of Anaesthesia 2008; 52: 337 – 9.
[3]. Muhm M et al. Malposition of central venous catheters. Incidence, management and preventive practices.Wien Klin Wochenschr. 1997 Jun 6; 109(11): 400 – 5.
[4]. Pikwer A, Baath L, Davidson B, Perstoft I, Akeson J. The incidence and risk of central venous catheter malpositioning: a prospective cohort study in 1619 patients.Anaesth Intensive Care. 2008 Jan; 36(1): 30 – 7.
Chapters in Books:
[5]. Jonathan Chantler. Applied Anatomy of the central vein. Helen Hamilton and Andy Bodenham (Ed.) Central venous Catheters(A John Wiley & Sons, Ltd, Publication 2009):14 – 34.
[6]. Robert E. Kuminsky. Complications of Central Venous Catheterization. Journal of the American College of Surgeons April 2007; 204(4): 681 – 696.

Abstract: 47 consecutive cases of fracture neck femur in patients older than 70 years were managed by cemented hemiarthroplasty with Austin Moore prosthesis at a tertiary care teaching hospital with the objectives of studying the short come outcome and to compare the results with standard studies using uncemented Austin Moore prosthesis, to determine if cementing the prosthesis improves clinical outcome. Patients who were available for follow up for a minimum of two years have been included in this study. Short term functional outcome was analyzed using the Harris hip scoring system. 44 patients were available for follow up at the end of study period. The patients were in the age group of 72 to 93 years with the mean age of 78.2 years. 59% of the patients were females with 88.6% of all cases sustaining the fracture following a trivial trauma. The functional outcome using the Harris hip score was excellent in 43.5%, good in 38.4%, fair in 11.3% and poor in 6.8% of the cases. There was no case of bone cement implantation syndrome. Hemiarthroplasty with Austin Moore prosthesis is a good option in elderly patients with limited physical demands and mobility. Cementing the prosthesis can achieve better control of thigh pain, improves mobility, allows early mobilization and lesser use of walking aids. The use of cement does not increase perioperative mortality or morbidity in patients without severe cardiopulmonary compromise.

Keywords: Bone cement, Femoral neck fracture, Frail elderly, Hemiarthroplasty, Prosthesis implantation

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[2]. Ioro R, Healy WL, Lemos DW, Appleby D, Lucchesi C, Saleh KJ, et al. Displaced femoral fractures in the elderly : outcomes and cost effectiveness. Clin Orthop 2001; 383: 229-242.
[3]. Bhandari M, Devereaux PJ, Swiontowski MF, Tornetta P, Obremskey W, Koval KJ, et al. Internal fixation compared with arthroplasty for displaced fractures of the femoral neck. J Bone Joint Surg Am 2003; 85-A:1673-1681.
[4]. Ioro R, Schwartz B, Macaulay W, Teeney SM, Healey WL, York S. Surgical treatment of displaced femoral neck fractures in the elderly: a survey of the American Association of Hip and Knee Surgeons. J Arthroplasty 2006; 21(8):1124-1133.
[5]. Swiontowski MF. Intracapsular fractures of the hip. J Bone Joint Surg Am 1994;76-A:129-138
[6]. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: Treatment by mould arthroplasty. An end result study using a new method of result evaluation. J Bone Joint Surg Am 1969;51-A:737-755
[7]. Duncan CP, Masri BA. Fracture of the femur after hip replacement. Inst Course Lect 1995; 44: 293
[8]. Dorr L, Faugere M, Mackel A et al. Structural and cellular assessment of bone quality of proximal femur. Bone 1993; 14: 231-42
[9]. Sharif KM, Parker MJ. Austin Moore hemiarthroplasty: technical aspects and their effects on outcome in patients with fractures of the neck of femur. Injury 2002; 33: 419-22.

Abstract: Objective: Normal Thyroid hormone level is essential in maintaining the normal fetal development. The objective of the study was to evaluate the thyroid hormone levels among healthy non-pregnant women with normotensive pregnant women and women with preeclampsia. Materials and methods: In these prospective study 90 women in the age group of 19 – 36 are divided into 3 groups consisting of 30 healthy non-pregnant women, 30 healthy normotensive pregnant women and 30 pregnant women with preeclampsia and evaluated for thyroid profile. Results: Serum TT4 and TT3 levels in normotensive pregnant women and preeclamptic women were significantly higher compared to the levels in non-pregnant women. In comparison to the normotensive pregnant women, women with preeclampsia had a non significantly higher TT4 level and significantly lower TT3. In preeclamptic women serum FT4 was marginally raised than in normotensive pregnant subjects but was significantly raised than in nonpregnant subjects. The FT3 level was significantly lower in preeclamptic women than in normotensive pregnant women compared to nonpregnant subjects. TSH levels were significantly higher in both preeclamptic and normotensive pregnant women. Conclusion: The main finding of our study indicates that there is a state of hypothyroidism in normal pregnancy and in preeclampsia and so raised serum TSH occurs. Detection of any changes in thyroid profile in preeclampsia may of health in preventing the development of preeclampsia.

Key Words: Pregnancy, Preeclampsia, T3, T4, TSH

[1] Cunnigham FG, Leveno KL, Bloom SL Hauth JC, Gilstrap LC and Wenstrom KD.et al.Hypertensive disorders in pregnancy. In: Cunnigham FG, Leveno KL, Bloom SL, editors. Williams Obstetrics. 22nd ed. NewYork; McGraw-Hill; 2005: chap 34, 1237.
[2] Sibai 8, Dekker G, Kupferminc M. Pre-eclampsia. Lancet. 2005; 365:785-99.
[3] Bellany, L., Casas, J.P., Hingorani, A.D and Williams, D.J.: Preeclampsia and risk of cardiovascular diseased cancer in later life: systematic review and meta-analysis. Br. Med. J., 335, 974- 974, 2007.
[4] Solomon, C.G and Seely, E.W.: Brief review: Hypertension in pregnangcy : A manifestation of the insulin resistance syndrome ? Hypertension, 37 ; 232-239, 2001.
[5] Kumar, A., Ghosh, B.K and Murthy, N.S.: Maternal thyroid hormonal status in preeclampsia, Indian J.Med. Sci., 59, 57-63, 2005.
[6] Qublan, H.S., Al-Kaisi, I.J., Hindawi, I.M., Hiasat, M.S., Awamleh, I and Hamaideh, A.H., et al.: Severe preeclampsia and maternal thyroid function. J. Obstet. Gynaecol., 23, 244-246, 2003.

Abstract: Drug induced gingival enlargement is a gingival condition which is one of the common side effect with consumption of the drug phenytoin sodium. It is of vital importance to make the patients aware of the possibility of gingival overgrowth as soon as they are prescribed these drugs and inform them about the possible treatment options available. The main aim of the treatment is to minimize the growth and also the inflammatory component which can be achieved by surgical methods after assessment of the patient's medical condition. The choice of treatment lies in the hands of the dentist and it should be decided after careful assessment of all the factors associated with the disease. This case report documents a case of gingival enlargement associated with periodontitis in a patient under pheytoin sodium for the past 15 years, along with brief review of literature discussing the etiopathogenesis, and provides a brief protocol for its clinical management.

Keywords: Case report, drug induced gingival overgrowth, flap surgery, gingivectomy, phenytoin sodium

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[6]. Marshall RI, Bartold PM, A clinical review of drug-induced gingival overgrowth, Aust Dent J, 44, 1999, 219-232
[7]. Keith, D.A., Paz, M.A. and Gallop, P.M, The effect of diphenylhydantoin on fibroblasts in vitro, J.Dent. Res. 56 (10), 1977, 1279 – 1283.
[8]. Angelopoulos, A.P, Diphenylhydantoin gingival hyperplasia: A clinicopathologic review, J.Can. Dent. Assoc, 41, 1975, 103 – 106.

Abstract: Diaphragmatic Eventration ( DE) is a rare condition where the muscle is permanently elevated but retains its continuity and attachments to the costal margins. It is seldom symptomatic and often requires no treatment. We present a 65yr old man with previously undiagnosed left sided congenital eventration who presented with predominantly abdominal symptoms and required elective plication

Keywords : Congenital diaphragmatic Eventration, Diaphragmatic Hernia

[1]. Frederick C.Ryckman and Thomas H. Inge [ Eventration of the diagphragm ] Mastery of surgery 5th edition vo1l chapter 53
[2]. Diaphragmatic eventration.Groth SS, Andrade RS. Thorac Surg Clin. 2009 Nov;19(4):511-9. doi: 10.1016/j.thorsurg.2009.08.003.
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Abstract: A rare case of schwannoma originating from cervical portion of the accessory nerve is reported. The tumor was diagnosed by C.T. Scan and confirmed by Surgery. Tumor was small and located in left posterior triangle of neck without causing any detectable neurological deficit.

Keywords; Accessory nerve, Schwannoma

[1]. Surgical Neurology 2003;59(4):217-222
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Abstract: Orthodontic retention is the maintenance of teeth in the ideal position after active orthodontic treatment. Success of treatment is measured by the orthodontist achieving the intended objectives, maintaining the teeth during retention and satisfying the patient. Retention can be achieved by various appliances. It can be divided into removable retention and fixed retention. The aim of the review is to find out if a fixed orthodontic retainer has better retention capability in post orthodontic treatment.

Keywords: Bonded retainer, Orthodontic retention, Relapse, Removable retainer, Stability

[1] Littlewood SJ, Millett DT, Doubleday B, Bearn D, Worthington HV. Retention procedures for stabilizing tooth position after treatment with orthodontic braces. Cochrane Database Syst. Rev. 2004; (1): CD00SS83 Review.

[2] Proffit WR, and Fields HW. Contemporary Orthodontics, (New York: Mosby Inc, 2005).

[3] Reitan K. Clinical and histologic observations on tooth movement during and after orthodontic treatment. Am J Orthod 1967; 53: 721–45.

[4] Hawley, C. A. (1919). "A removable retainer." Int J Ortod. Oral Surg.(5): 291-305.

[5] Zachrisson, BU: Long-term experience with bonded retainers: update and clinical advice. J Clin Orthod. 41, 2007, 728–737. [6] Zachrrison B U 1977 Clinical experience with direct-bonded orthodontic retainers . American Journal of Orthodontics 71: 440-448

[7] Zachrisson B U , Büyükyilmaz T Bonding in orthodontics . In: Graber L W (ed). Orthodontics: current principles and techniques, (4th ed. Mosby , St Louis , 2005) pp. 621 – 659

[8] Littlewood S J , Millett D T , Doubleday B , Bearn D R , Worthington H V 2006 Retention procedures for stabilising tooth position after treatment with orthodontic braces . Cochrane Database of Systematic Reviews 1 : CD002283

[9] Boese LR. Fiberotomy and reproximation without lower retention, nine years in retrospect: Part I. Angle Orthod 1980; 50: 88–97.

[10] Edwards, JG. A surgical procedure to eliminate rotational relapse. Am J Orthod 1970; 57: 35-46.

Abstract: This is an explorative study, rarely conducted in Iraq relied on sample of women with breast tumors to measure the possible contribution of chromium(Cr) and selenium(Se)values in the serum and hair to breast tumor genesis. Serum and hair samples were taken from 59 females with age from 25 to 60 years. Thirty four females with breast tumor were grouped according to the type of tumor into two groups (malignant: 20 and benign: 14) and twenty five were apparently healthy. The result demonstrated that scalp hair of patients with malignant breast cancer were significant increase of hair content of Cr with significant decrease of hair Se, compared to benign and healthy controls. The levels of serum Se were significantly decreasedin both malignant and benign groups, compared to controls. A Significant decrease in hair contents of Se was seen in malignant tumor groups, compared to controls. Non-significant increase in the level of serum Cr in the malignant and benigngroups, compared to controls.

Keywords: Trace elements, Hair , Serum, Breast Tumors.

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[9] Glad MJ, Kaminksy M.V: Accuracy of hair mineral analysis (letter) .JAM ,285 (12): 1577 (2001). [10] Seidets, S. Keroulizer, R. Smith, D.: Assessment of commercial laboratories performing hair minerals analysis JAMA, 285 : 67-72. (2001).

Abstract: Diabetes mellitus (DM) is a clinical syndrome characterized by hyperglycaemia due to absolute or relative insulin deficiency and it affects multiple system of body including the skin. The objective of our study was to evaluate the frequency of skin manifestations in patients with diabetes mellitus. A total of 240 diabetic (type 1 & 2) patients were examined in detail for skin manifestations of the disease. Number of patients with uncontrolled disease was 144 and 96 patients showed adequate glycaemic control. 150 patients i.e. 62.5% had cutaneous manifestations comprising of 126 (52.5%) type 2 and 24 (10%) type 1. The skin manifestations observed were: skin infection 42%, xerosis 12%, diabetic dermopathy 8%, vitiligo 8%, acanthosis nigricans 4%, diabetic thick skin 4%, keratosis 4%, senile purpuras 4%, lichen planus 2.67%, granuloma annulare 2.67%, lypodystrophy 2.67% , skin tags 2% of patients.

Key Words: Diabetes mellitus, Insulin, Cutaneous manifestations

[1]. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projection for 2030. Diabetes Care 2004; 27: 1047- 1053.

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[4]. Urbach E. Skin diabetes (hyperglycodermia) without hyperglycemia. JAMA 1945; 129: 433.

[5]. Urbach K, Lentz JW. Carbohydrate metabolism and skin. Arch Dermatol Syphilol 1965; 52: 301-304

[6]. Pastras T, Beerman H. Some aspects of dermatology in diabetes mellitus. Am Med J 1964; 247: 563- 566.
[7]. Bashier AH, Kordofani YM. Clinico-epidemiological study of cutaneous manifestations of diabetes mellitus in Sudanese patients. Sud J Dermatol 2004;2(2):54–60.
[8]. Majeed M, Iqbal F, Mehboob A. Cutaneous manifestations in type-1 and type-2 Diabetes Mellitus (A study profile of 200 patients). Proceeding Shaikh Zayed Postgrad Med Inst 2004;18(2):63–8.
[9]. Miracle LS, Barreda BF. Cutaneous manifestations of diabetes mellitus, a clinic manner for identify the disease. Rev Endocrinol Nutr 2005;13(2):75–87.
[10]. Mahmood T, Ul-Bari A, Agha H. Cutaneous manifestations of dibetes mellitus. J Pak Assoc Dermatol 2005;15:227–32.

Abstract:Blood culture although continues to be the gold standard for diagnosis of typhoid fever, its applications for routine diagnosis of typhoid fever is restricted because of several limitations. Widal test has been used extensively as a laboratory tool for diagnosis of typhoid fever in most laboratories, but it is laborious, time consuming and may not be positive in early stages and is to be interpreted judiciously. In the recent times, several other serological tests other than Widal test have been described and evaluated. In the present study, we evaluated Enterocheck WB, an immunochromatographic rapid test for diagnosis of typhoid fever, in Widal positive cases. This test detected IgM antibodies and was found to have a sensitivity of 90% and a specificity of 94.6%. The positive and negative predictive values of Enterocheck WB was 84.9% and 96.5% respectively. The test serves as an useful alternative to other conventional tests for rapid diagnosis of typhoid fever.

Key words: Enteric fever, Enterocheck, Rapid test , Typhoid fever

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[5] Jacob S. Dengue: Emergence as a global public health problem and prospectus for control. Trans R Soc Trop Med Hyg 200; 94: 7-8. [6] Mathai E, Lloyd G, Cherian T, Abraham OC, Cherian AM. Serological evidence for continued presence of human Rickettsiosis in Southern India. Ann Trop Med Parasitol 2001; 95: 395-8.

[7] Bharati AR, Nally JE, Ricaldi JN, Matthais MA, Diaz MM, Lovett MA, et al. Leptospirosis: a zoonotic disease of global importance. Lancet Infec Dis 2003; 3:757-71.

[8] Jesudason MV, Anbarasu A, John TJ. Septicaemic meliodosis in a tertiary care hospital in south India. Indian J Med Res 2003; 117: 119-21.

[9] WHO. Background document: The diagnosis, treatment and prevention of typhoid fever. WHO/V&B/03.07 . 2003 Page 4.

[10] Sherwal BL, Dhamija RK, Randhawa VS, Jais M, Kaintura A, Kumar M. A comparative study of typhiDot and Widal test in patients of Typhoid fever. J Indian Acad Clin Med 2004; 5(3): 244-6.

Abstract: A prospective, comparative study was done in the Dept. of ENT , Pravara Rural hospital , Loni to compare efficacy & tolerability of oral montelukast & nasal azelastine and to compare their effect on eosinophil count in patients of allergic rhinitis from Sept 2009 to 2011 with follow up upto 6 weeks. Total 100 patients with allergic rhinitis were enrolled in two categories, A (n=50) & B (n= 50) Both drugs were found to be highly effective & safe in treatment of allergic rhinitis as well as equally efficacious in reducing rhinorrhea . However, azelastine was found to be more effective for sneezing & nasal congestion , more efficacious in the first 3 weeks of treatment and better than montelukast for reduction of ABEC. Montelukast was found in my study to be a better drug for treatment of symptom of itchy nose . However , sedation was noted with montelukast which needs further evaluation . All in all in the present study , Azelastine unequivocally came out as the effective & safe drug in treatment of allergic rhinitis for the first 3 weeks while Montelukast can be added for patients with symptoms of itchy nose in allergic rhinitis .Montelukast stands out as the more efficacious and safe drug for later weeks of treatment of allergic rhinitis .In view of these results Azelastine is recommended for the acute treatment of allergic rhinitis and Montelukast for the late phase of treatment of allergic rhinitis.

Keywords: Absolute blood eosinophil count ( ABEC ) , Allergic rhinitis

[1]. G. K. Scadding et al. BSACI guidelines for the management of allergic and non-allergic rhinitis. Clinical and Experimental Allergy 2008; 38: 19-42.
[2]. Jayant M Pinto and Seema Jeswani. Rhinitis in the geriatric population. Allergy, Asthma & Clinical Immunology 2010; 6:10.
[3]. Anand Ghimire et al.Comparative efficacy of steroid nasal spray versus antihistamine nasal spray in allergic rhinitis. Nepal Medical College Journal 2007; 9(l):4-7.
[4]. Michael Benninger et al. Evaluating approved medications to treat allergic rhinitis in the United States.An evidence-based review of efficacy for nasal symptoms by class. Ann Allergy Asthma Immunol. 2010; 104:13-29.
[5]. Vipan Gupta and Prithpal Singh Matreja. Efficacy of Montelukast and Levocetirizine as treatment for Allergic Rhinitis. J Aller Ther an open access journal Volume 1.Issue 1:16-28.
[6]. M. Kurowski et al. Montelukast plus cetirizine in the prophylactic treatment of seasonal allergic rhinitis, influence on clinical symptoms and nasal allergic inflammation.Allergy 2004;59: 280-288
[7]. William storms et al. Allergic rhinitis induced nasal congestion: its impact on sleep quality. Primary Care Respiratory Journal (2008); 17.
[8]. Merck and co. highlights of prescribing information - Singulair: Revised: April 2011:3-21
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[10]. Shailen shah et al. Efficacy and safety of azelastine 0.15% nasal spray and azelastine 0.10% nasal spray in patients with SAR. Allergy Asthma proc 2009 ; 30 : 628 -633

Abstract:Aim of the work: The objectives of this study were to evaluate the efficacy and toxicity of combination chemotherapy with cisplatin and gemcitabine in patients with inoperable or metastatic pancreatic cancer. Patients and Methods: the study included patients with histologically or cytologically confirmed inoperable or metastatic pancreatic adenocarcinoma. Gemcitabine was given by IVI at a dose of 1000 mg/m2 over 30 min on days 1 and 8 and cisplatin was given by IVI at a dose of 80 mg/m2 over 150 min on day 1, of a 3-week cycle. Results: Twenty-five patients with previously untreated, unresectable or metastatic pancreatic cancer were enrolled in this study between August 2003 and December 2005 at the Kasr Al-Aini Center of Radiation Oncology and Nuclear Medicine (NEMROCK), Faculty of Medicine, Cairo University. The median age was 52 years; (range 36 -68). There were no complete responses. Five (20%) patients had partial responses, 16(64%) patients and 4(16%) patients had Stable and progressive disease, respectively. The median overall survival was 7.1 months; the median TTP was 4.6 months and 1- year survival was 20%. The Clinical benefit response was observed after the second cycle of chemotherapy, 8 of 19 patients (42%) experienced decreased pain intensity and reduced the daily dose of analgesics .At the same time, (33.3%) and (23.8%) patients experienced gain their weight and improvement in Kranofsky PS , respectively. The most common toxicities were myelosuppression, especially neutropenia and thrombocytopenia. Grade 3–4 neutropenia and thrombocytopenia occurred in 52 and 48% of the patients, respectively. Conclusion: The combination of cisplatin and gemcitabine produced a good response rate associated with moderate but manageable toxicities in patients with inoperable or metastatic pancreatic cancer.

Key words: cisplatin, gemcitabine , pancreatic cancer

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Abstract: Over one year, 80 OPD patients with corneal ulcers were scraped from the margins & base of the anaesthetized cornea & smear prepared for Gram staining & 10% KOH preparation. Blood agar for both aerobic & anaerobic, Mac-Conkey Agar, Chocolate Agar were inoculated. Turbidity in brain heart infusion were identified by Gram Stain & subsequently sub-cultured in Mac-Conkey & blood agar. Anaerobic jar containing the blood agar plates were incubated at 37oC & examined after 48-72 hrs, & finally for 5 days & examined on alternative days before discarding. Further microbiological identification done as per standard protocol. All the isolated bacteria tested against different antimicrobial agents by standard disc diffusion method in accordance with CLSI guideline 2012. Out of 80 cases, corneal ulcer showed male preponderance (3:1) the highest no.19 (23.75%) cases were in the age group of 51-60 years. A total of 40 positive cultures were aerobes.12 specimens for anaerobic culture showed no growth. Among the isolates 19 (46.34%) were Staphylococcus aureus, 13 (31.7%) were CONS, 5 (12.19%) were Pseudomonas, 3 (7.31%) were E. Coli & 1 (2.43%) was Klebsiella. Gram positive cocci were maximally sensitive to Vancomycin, Tobramycin with highest resistance to Ciprofloxacin (55.87% sensitive). Gram negative isolates were maximally sensitive to Chloramphenicol & Moxifloxacin & resistant to Norfloxacin (44.44% sensitive). Routine microbiological examination of corneal ulcer is necessary to analyse & compare the changing trends in the microbial etiology & their susceptibility pattern to formulate a proper & appropriate antibiotic response against corneal ulcer.

Key words: Corneal ulcer, Aerobes, Antimicrobial agents.

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Abstract: Prospective study of 40 cases of subtrochanteric fracture treated either extramedullary fixation intramedullary fixation in Sri Ramachandra medical center April 2011to June 2013. Inclusion criteria are all traumatic subtrochanteric fractures, exclution criterias are all open fractures paediatric fractures, pathologic fractures. We had 20 extramedullary and 20 intramedullary fixations we used schatzker and Lambert scoring system, mean follow up for 2 years. The most important factor to prevent the failure of fixation may be due to inadequate initial reduction. The most important factor to prevent the failure of fixation is anatomical reduction of fracture and restoration of medial buttress. In our comparative analysis of intramedullary versus extramedullary fixation of subtrochanteric fractures. Intramedullary devices give superior results than extramedullary devices. But the most important factor to prevent the failure of fixation is Anatomical reduction of fracture at time of surgery.

Keywords: Anatomical reduction, Extramedullary, Intramedullary, Subtrocahnteric femur fractures, schatzker and Lambert scoring system,

[1]. Paul R.T. Kuzyk, MASc, MD, FRCS(C), Mohit Bhandari, MSc, MD, FRCS(C), Michel D. McKee, MD, FRCS(C), Thomas A. Russell, MD and Emil H. Schemitsch, MD, FRCS(C). Intramedullary versus extramedullary fixation for subtrochantric femur fractures.
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Abstract:A total 1163(10.12%) staphylococcus aureus were isolated from 11496 clinical specimens (2009 - 2012) among which 379 (32.6%) were MRSA. In our retrospective study, we found a continuous increase in MRSA prevalence over the time which was 16.5% in 2009; increased to 22.2% in 2010, 34.6% in 2011 and 37.5% in 2012? The average MRSA prevalence observed during this period was 27.7 %. The overall MRSA prevalence was 3.3% among all clinical specimens tested. No resistance was seen for Vancomycin, Teicoplanin and Linozolid. The highest sensitivity was observed by Doxycyclin (79.04%) & Amikacin (96%) where as the least was by erythromycin (21.18%) & Chloramphenicol (52.2%) for MRSA and MSSA isolates respectively. Females were more prevalent (62%) as compared to males (38%) for MRSA infections.

Keywords: Antimicrobial Sensitivity, disc diffusion, Methicillin resistant Staphylococcus aureus [MRSA], Methicillin sensitive Staphylococcus aureus [MSSA],

[1] Anupurba S, Sen MR, Nath G, Sharma BM, Gulati AK, Mohapatra TM. Prevalence of methicillin resistant Staphylococcus aureus in a tertiary referral hospital in eastern Uttar Pradesh. Indian J Med Microbiology. 2003. 21. 49-51.
[2] Salaria M, Singh M. Methicillin resistant Staphylococcus aureus. Indian Pediatrics. 2001. 38. 29-36.
[3] Pai V, Rao IR, Rao SP. Prevalence and Antimicrobial Susceptibility Pattern of Methicillin-resistant Staphylococcus Aureus [MRSA] Isolates at a Tertiary Care Hospital in Mangalore, South India. Journal of Laboratory Physicians. 2010. 2(2). 82-84.
[4] David MZ and Daum RS. Community-Associated Methicillin-Resistant Staphylococcus aureus: Epidemiology and Clinical Consequences of an Emerging Epidemic. Clinical microbiology review. 2010; 23(3): 616–687.
[5] Tiemersma EW, Bronzwear LAM, Lyytikainen O, degener JE, Schrijnemakers P, Bruinsma N, Monan J, Witte W, Grundmaun H. Methicillin resistant Staphylococcus aureus in Europe 1999-2002. • www.cdc.gov/eid • Emerge infect Disease. 2004; 10(9):1627-1634.
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[7] Salgado CD, Farr BM, Calfee DP. Community acquired methicillin resistant Staphylococcus aureus: A meta-analysis of prevalence and risk factors. Clin. Infectious Disease. 2003; 131-139.
[8] Verma S, Joshi S, Chitnis V, Hemwani N, Chitnis D. Growing problem of methicillin resistant staphylococci - Indian scenario. Indian J Med Sciences. 2000; 54:535-40.

Abstract:This article appraises the olfactory/gustatory mechanism, provides working concepts of different kinds of oral malodor, deconstructs OM deriving from direct-oral, and indirect non-oral causes, lists common causes of both, and reviews clinical measurement, diagnosis, management and treatment.

Key words: Cacogeusia, Fetor ex ore; halitosis, Halimeter, ozostomia, stomatodysodia, volatile sulfur compounds

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[6]. Halimeter (2013) Halimeter.com. © 2013 Interscan Corporation • ADDRESS: 4590 Ish Drive #110 • Simi Valley, CA 93063.Tel: (800) 458‑6153 (US & Canada) • PHONE: (818) 882‑2331 • FAX: (818) 341‑0642 • E-MAIL: info@halimeter.com
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Abstract:A kidney stone, also known as a renal calculus (from the Latin rēnēs, "kidneys" and calculus, "pebble") is a solid concretion or crystal aggregation formed in the kidneys from dietary minerals in the urine. The condition of having kidney stones is termed nephrolithiasis. Having stones at any location in the urinary tract is referred to as urolithiasis, and the term ureterolithiasis is used to refer to stones located in the ureters. The hallmark of stones that obstruct the ureters or renal pelvis is excruciating, intermittent pain that radiates from the flank to the groin or to the genital area and inner thigh [1]. This particular type of pain, known as renal colic, is often described as one of the strongest pain sensations known [2].

[1]. Preminger, GM (2007). "Chapter 148: stones in the urinary tract". In Cutler, RE. The Merck Manual of Medical Information Home Edition (3rd ed.). Whitehouse Station, New Jersey: Merck Sharp and Dohme Corporation.
[2]. Wolf Jr. JS (2011). "Background "Nephrolithiasis. New York: WebMD. Retrieved 2011-07-27. [3]. Shokouhi B, Gasemi K, Norizadeh E. Chemical composition and epidemiological risk factors of urolithiasis in Ardabil Iran. Research Journal of Biological Sciences 2008; 3(6): 620-626,
[4]. Collele J, Kochis E, Galli B, Munver R. Urolithiasis/Nephrolithiasis: What's it all about? Urologic Nursing. 2005; 25(6): 427-48

Abstract:Saliva as a diagnostic fluid offers distinctive advantages over serum because it can be collected non-invasively by individuals with modest training. Furthermore, saliva may provide a cost-effective approach for the screening of large populations. Whole saliva may be used for diagnosis of systemic diseases, because it contains serum constituents. This review explains the diagnostic application of saliva for hereditary disorders, autoimmune diseases, malignant and infectious diseases, and endocrine disorders, as well as in the assessment of therapeutic levels of drugs and the monitoring of illicit drug use, and also for forensic evidence and others. In future we are likely to see the increased utilization of saliva as a diagnostic fluid. As we enter the era of genomic medicine, sialochemistry will play an increasingly important role in the early detection, the monitoring and progression of the systemic and oral diseases.

Key words: Saliva. Sialochemistry, Caries, Disease, Diagnosis.

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[6]. Lee Y, Wong DT. Saliva: an emerging biofluid for early detection of diseases. Am J Dent 2009; 22:241-248.
[7]. Mittal S, Bansal V, Garg S, Atreja G, Bansal S. The diagnostic role of Saliva — A Review. J Clin Exp Dent. 2011;3(4):e314-20.
[8]. Slomiany BL, Aono M, Murty VL, Slomiany A, Levine MJ, Tabak LA. Lipid composition of submandibular saliva from normal and cystic fibrosis individuals. J Dent Res.982;61:1163–6.
[9]. Ueshiba H, Zerah M, new MI. Enzyme-linked immunosorbent assay (ELISA) method for screening of non-classical steroids 21-hydroxylase deficiency. Horm Metab Res. 1994;26:43-5.
[10]. Iwasaki K, Okawa-Takatsuji M, Aotsuka S, Ono T. Detection of anti-SS-A/Ro and anti-SS-B/La antibodies of IgA and IgG isotypes in saliva and sera of patients with Sjogren's syndrome. Nihon Rinsho Meneki Gakkai Kaishi. 2003;26:346-54.