iosr-JDMS   Volume-4 ~ Issue-6

Abstract: Isolated duodenal injury in abdominal trauma is extremely rare. A diagnosis of isolated duodenal injury may be very difficult to make out in abdominal trauma, even with the availability of Ultrasound and CT scan. Delays in diagnosis due to late clinical presentation, and intra operative dilemmas due to retroperitoneal location of the duodenum, its proximity to important abdominal structures, lead to difficulties in management and considerably increase morbidity and mortality in these patients We report a case of fall from height with a puncture wound over the right loin presented after 20 hours with pain abdomen.USG abdomen ,CT abdomen ,DPL show minimal hemoperitoneum which prompted us to doDiagnostic laparoscope .except a small mesenteric injury solid and hollow viscera were found normal, 4 days later patient had greenish discharge from the puncture wound back evaluated and diagnosed as duodenocutaneous fistula by contrast and upper GI scope .patient was treated with simple gastrojejejunostomy and keeping ryle's tube inafferent loop for decompression of duodenum and feeding jejunostomyfor nutrition. Fistula healed and patient was discharged on 11th postop day A small punctured wound over the back in a trauma abdomen presenting as to duodeno-cutaneous fistula after 96 hours is an unusual presentation.

Key words: Trauma abdomen ,duodenal injury,

[1] Pandey S, Niranjan A, Mishra S, Agrawal T, Singhal BM, Prakash A, Attri PC. Retrospective analysis of duodenal injuries: A
comprehensive overview. Saudi J Gastroenterol 2011;17:142-4
[2] Allen GS,Morre FA,Coscs Jr,Mhall JR,Duke JH.(1998) Delayed diagnosis of blunt duodenal injury:an avoidable complication.J Am
Coll surg oct;187(4):393-9
[3] B Bozkrut,B A Ozdemir,B unal, M Dolapci,O Cengiz.(2006) operative approach in traumatic injuries of duodenum .Acta Chir
Belg;(106):405-8
[4] Jeong Hee Han, M.D., Sung Il Hong, M.D., Hae Sung Kim, M.D., Byoung Yoon Ryu, M.D., Hong Ki Kim, M.D. Multilevel
Duodenal Injury after Blunt TraumaJ Korean Surg Soc 2009;77:282-286
[5] Miller LA, Shanmuganathan K. Multidetector CT evaluation of abdominal trauma. Radiol Clin North Am 2005;43:1079-95.
[6] Jennifer K. Lee, M.D.1 and Sharon L. Stein, M.D.Radiographic and Endoscopic Diagnosis and Treatment of Enterocutaneous Fistulas Clin Colon Rectal Surg. 2010 September; 23(3): 149–160.
[7] R R Ivatury.M nallathambi,J Gaudiano, M Rahman, and w w stahl (1985).penetrating duodenal injuries :analysis of 100 consecutive
cases .Ann Surg .Aug;202(2):153-8

Abstract: Objective: To identify the influence of sputum grading on conversion and cure rate Methodology: It is retrospective study. The new smear positive patients their initial smear grading, conversion and outcome were recorded. The data were collected and analyzed with Excel and Epi info Result: Total number of TB patients collected 208 out of which sputum grading scanty 14%, 1+ 43%, 2+ 21% and 3+ 22%. The conversion rates for Scanty 83%, 1+ 84%, 2+ 81% and 3+ 72% p. value >.05 while the success rate is scanty 93%, 1+ 89%, 2+ 88% and 3+ 72% with p. value <.05. The mortality rate among sputum grading, scanty 0%, 1+ 3%, 2+ 7% and 3+ 15% P. value <.05. Conclusion: The conversion rate of sputum is associated with initial sputum grading. The conversion rate is reduced in sputum grade of 3+ although there was increase in the conversion rate from scanty to 1+. The success rate in treatment of TB reduces with increase in the grading and mortality increases. It may be necessary to consider the sputum grading in the treatment of patients. Key words: Sputum conversion, outcome, smear grading and tuberculosis

[1] Raviglione MC, Snider DE, Jr, Kochi A. Global epidemiology of tuberculosis: morbidity and mortality of a worldwide epidemic.
JAMA. 1995;273:220–6.
[2] Murray GDL, Styblo K, Rouillon A. Tuberculosis in developing countries: burden. intervention and cost. Bull Int Union Tuberc
Lung Dis. 1990;35:25–35.
[3] Murray CJL, Styblo K, Rouillon A. Tuberculosis in developing countries: burden, intervention and cost. Bull Int Union Tuberc lung
Dis. 1990;65:6–24.
[4] WHO. TB fact sheet. http://www.who.int/tb/publications/factsheets/en/index.html
[5] Hsien- Holin, David Dowdy, Christopher Dye, Megan Murry, Ted Cohen: The impact of new tuberculosis diagnostics on
transmission: why context matters: WHO Bulletin 2011 pg 1-10 http://www.who.int/bulletin/volumes/90/10/11-101436.pdf
[6] . Singla R, Singla N, Sarin R, Arora VK. Influence of pretreatment bacillary load on treatment outcome of pulmonary tuberculosis
patients receiving DOTS under the Revised National Tuberculosis Control Programme. Indian J, Chest Dis and Allied Sci
2005;47:19-23.
[7] Gopi PG, Chandrasekaran V, Subramani R, Santha T, Thomas A, Selvakumar N, et al. Association of conversion and cure with
initial smear grading among new smear positive pulmonary tuberculosis patients treated with Category I regimen. Tuberculosis
Research Centre (ICMR) Chennai, India. Indian J Med Res 2006;123:807-14.
[8] .Mukherjee A, Singla R, Saha I, Sarkar A , Bhattacharyya P. Difference in the Outcome of Patients with Different Grades of
Initial Sputum Positivity under the Revised National Tuberculosis Control Programme .Indian J Chest Dis Allied Sci 2011;53:241-
242.
[9] . Bawri S, Ali S., Phukan C, Tayal B and Baruwa P. A Study of Sputum Conversion in New Smear Positive Pulmonary Tuberculosis
Cases at the Monthly Intervals of 1st, 2nd & 3rd Month Under Directly Observed Treatment, Short Course (Dots) Regimen.
http//www.ncbi.nlm.nih.gov/pmc/articles/pmc2822329 8.
[10] . Mfinanga GS, Ngadaya E, Mtandu R, Mutayoba B, Basra D, Kimaro G, et al. The quality of sputum smear microscopy diagnosis of pulmonary tuberculosis in Dares Salaam, Tanzania. Tanzan Health Res Bull. 2007; 9:164-168.

Abstract: Inflammatory pseudotumour is a rare cause of intussusception. It consists of a localized, usually polypoid mass that is composed of inflammed fibrous and granulation tissue.[1] We report a case of 42-year - old woman who presented with abdominal pain, vomiting and distention of abdomen since one day. X ray abdomen (erect) did not show air fluid level. CT abdomen showed target sign suggestive of intussusception. Emergency exploratory laparotomy revealed jejuno-jejunal intussusception caused by a polypoidal mass. Resection and end to end anastomosis of jejunum was performed. Subsequent histopathology confirmed the mass to be an inflammatory pseudotumour of jejunum. Inflammatory pseudotumour of jejunum as a cause of intussusception has rarely been reported. Among adults presenting with obstruction, inflammatory pseudotumour should be considered in the differential diagnosis. Surgeons need to be aware of this condition because complete surgical excision is the treatment.

Key Words: Inflammatory Pseudotumour, Jejunum, Intussusception.

[1] Samter TG, Alstott DF, Kurlander GJ. Inflammatory fibroid polyps of the gastrointestinal tract. A report of 3 cases, 2 occurring in
children. Am J Clin Pathol l966; 45: 420-36.
[2] Rehman S, Gamie Z, Wilson TR, Coup A, Kaur G. . Inflammatory fibroid polyp (Vanek's tumour), an unusual large polyp of the
jejunum: a case report. Cases Journal 2009; 2:7152
[3] Talley NJ: Gut eosinophilia in food allergy and systemic and autoimmune diseases. Gastroenterol Clin North Am 2008;37:307-32.
[4] Vanek J. Gastric Submucosal Granuloma with Eosinophilic Infiltration. Am J Pathol 1949; 25: 397–411.
[5] Fuentes GA, Suárez M, Osorno A, Jerkov J, Espitia F, Manauta J. Vanek's polyp or inflammatory fibroid polyp. A case report and
review of the literature. Cir Cir 2011;79:242-45
[6] Feldman M. Friedman LS, Sleisenger MH, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, WB
Saunders Co; 2010.
[7] Cawich SO, Harding HE, Leake PA, Arthurs M: Inflammatory Polyp as a Lead Point for Jejunal Intussusception. The Internet
Journal of Surgery. 2009 Volume 18 Number 2
[8] Johnstone JM, Morson BC. Inflammatory fibroid polyp of the gastrointestinal tract. Histopathology 1978 ; 2 : 349-61.
[9] 9. Shimer GR, Helwig EB. Inflammatory fibroid polyps of the intestine. Am J Clin Pathol 1984 ; 81 : 708-14.
[10] Bays D, Anagnostopoulos GK, Katsaounos E et al. Inflammatory fibroid polyp of the small intestine causing intussusception : a
report of two cases. Dig Dis Sci 2004 ; 49 : 1677-80.

Abstract: An eighty year old male presented in the hospital with history of sudden onset weakness of the limbs and slurring of speech, features suggestive of stroke. The detailed clinical work up and radiological investigations revealed the presence of brainstem tuberculoma with hydrocephalus. He was treated with urgent ventriculoperitoneal shunt surgery and antitubercular chemotherapy. Patient had clinical and radiological improvement following surgery. After a period of one year of anti tubercular therapy and follow up, patient recovered completely and CT scan brain did not reveal any evidence of tuberculoma. The goal of this article is to enlighten readers about the possible presentations of Brainstem tuberculosis along with review of literature.

Keywords - Brainstem tuberculoma, CNS TB, Stroke

[1] Arseni, C. Two hundred and one cases of intracranial tuberculosis treated surgically. Journal of Neurology Neurosurgical Psychiatry,
1958; 21:308-11.
[2] Wasay M., Kheleani BA, Moolani MK, et al. Brain CT and MRI findings in 100 consecutive patients with intracranial tuberculoma.
Neuroimaging. 2003; 13(3):240-47.
[3] Wang KC, Lin SM, Chen, Y., Tseng, S.H. Multiple tuberculous brain abscesses. Scandinavian Journal of Infectious Diseases, 2002;
34(12):931-34.
[4] Skendros, P., Kamaria, F., Kontopoulos, V. et al. Intradural, extramedullary tuberculoma of the spinal cord as a complication of
tuberculous meningitis. Infection, 2003; 31(2):115-17.
[5] Maurice-Williams RS: TIberculomas of the brain in Britain. Postgraduate Medical Journal, 1972; 48:678-81.
[6] Dastur, H.M., Desai AD. A comparative study of brain tuberculomas and gliomas based on 107case record of each. Brain, 1965;
88:375.
[7] Ramaruthi, B., Varadajan MG. Diagnosis of tuberculomas of the brain. Journal of Neurosurgery, 1961; 18:1-7.
[8] Donmez FY, Coskun M, Guven G. Medu

Abstract: Background and Objectives: Otitis media with effusion (OME) is an important and common condition in paediatric age group.It is the leading cause of hearing loss and a social morbidity in children which has long-term consequences for speech and language development. Adenoid hypertrophy is an important etiological factor in the causation of OME. The objective of this study is to study the course of the disease with respect to resolution of effusion post adenoidectomy. Methods: This is a prospective study.The patients who presented with symptoms of adenoid hypertrophy were further evaluated for associated OME. A total of 50 patients who had adenoid hypeprtrophy and OME confirmed with preoperative PTA and tympanometry were included in the study. All patients underwent adenoidectomy under General anaesthesia. Follow up was done with repeat pure tone audiometry and tympanometry at 3rd and 6th months. Results: In this study, Tympanometry showed type B curve in 54% of ears. Postoperative audiometric assessment showed mean hearing gain at 3rd and 6th months being 5.32 and 4.09dB respectively. At 6th month follow up, 25 ears had A type curve, only 8 ears had B type curve and 67 ears C type curve . Conclusion: Adenoidectomy is effective in clearing middle ear effusion and causing hearing improvement in children with hypertrophied adenoids and OME.

Keywords: Otitis media effusion; Pure tone Audiometry; Tympanometry; Adenoidectomy

[1] Cummings - Andrew F. Inglis Jr. George A. Gates Cummings Otolaryngology – Head and Neck surgery,4th edition, Elsevier Mosby,
2005, vol - 4,Pg – 4445-4464
[2] George Browning ,Scott-Brown's Otorhinolaryngology - Head and Neck Surgery, 7th edition, Hodder Arnold, 2008,vol – 1,pg- 877
- 882
[3] Eavey RD. Abnormalities of the neonatal ear: otoscopic observations, histological observations, and a model for contamination of
the middle ear by cellular contents of amniotic fluid. Laryngoscope 1993; 103: 1-31
[4] Parikh, SR; Coronel, M; Lee, JJ & Brown, SM. (2006). Validation of a new grading system for endoscopic examination of adenoid
hypertrophy. Otolaryngology - Head and Neck Surgery, Vol.135, No.5, pp. 684-687.
[5] Vogler RC, Ii FJ, Pilgram TK. Age-specific size of the normal adenoid pad on magnetic resonance imaging. Clinical
Otolaryngology and Allied Sciences. 2000; 25: 392-5.
[6] Paradise et al. OM in 2253 Pittsburgh-area infants: Prevalence and risk factors during the first 2 years of life. Pediatrics 1997; 99:
318.
[7] N A Blac et al. randomised controlled trial of surgery for glue ear, BMJ Vol 300 16 June 1990;300:1551-6
[8] Dempster JH et al. Tympanometry in detection of hearing impairments associated with OME. Clin Otolaryngol 1991; 16: 157-159.
[9] Maw AR and Herod F. Otoscopic impedance and audiometric findings in glue ear treated by adenoidectomy and tonsillectomy. A
prospective randomized study. Lancet; I 1986; 1399-1402.
[10] Bluestone CD and Klein JO. Otitis media in infants and children. 2nd edition ed. Philadelphia. WB Saunders Company 1995; 11:7-
11

Abstract: Streptococcus mutans is a gram-positive bacterium in oral cavity which metabolism produces acid as the common cause of dental caries (tooth decay). In order to prevent the growth or kill Streptococcus mutans, antibacterial agent is required. White pepper (Piper nigrum L.) is suspected to contain antibacterial substances such as alkaloid, phenol, tannin and coumarine. This research is conducted to prove the antibacterial effect of white pepper on growth activity of Streptococcus mutans in vitro. An experimental study using post test only control group design is carried out to Streptococcus mutans with tube dilution method and streaking on the Brain Heart agar plate. The treated groups are groups treated with white pepper extract with a range of concentration from 5%; 7,5%; 10%; 12,5%; 15%; 17,5%; and 20%. The control groups consist of bacteria control and white pepper extract control. Result of the research indicates that Minimum Inhibitory Concentration (MIC) is found at concentration 10% of the white pepper extract, where as the Minimum Bactericidal Concentration (MBC) is found at concentration 12,5% of the extract. Data analysis is conducted with non parametric test of Kruskal Wallis. Kruskal Wallis test shows at least there is a difference of the number of colonies as the given concentration (p < 0,05). The correlation test of Spearman reveals a very strong reciprocal correlation between concentration of white pepper extract and the number of Streptococcus mutans colonies growth (Correlation, r = -0,986; p < 0,05). The conclusion is white pepper extract has effect on the growth also as antibacterial agent on Streptococcus mutans in vitro, with MIC at concentration 10% and MBC at concentration 12,5%. The higher concentration of white pepper extract, the lower growth rate of Streptococcus mutans. Keywords - antibacterial, Streptococcus mutans, white pepper extracts

[1] Abdus Salam, M., et al. Establishment of an Animal Model Using Recombinant NOD, B10, D2 Mice to Study Initial Adhesion of Oral
Streptococci. Clin. Diagn. Lab. Immunol. 11: 379-386, 2004.
[2] Tanzer, J.M., Livingstone, J., Thompson, A.M. The Microbiology of Primary Dental Caries in Humans. J.Dent. Educ. 2001, 65,
1028-1037.
[3] Mayooran, B., Robin S., John, R.T. Dental Caries in Preventable Infectious Disease. Aust. Dent. J. 2000, 45, 235-245.
[4] Samaranayake, Lakshman. 2007. Essential Microbiology for Dentistry. Philadelphia : Elsevier.
[5] Baum, Lloyd., Phillips, Ralph., Lund, Melvin. 1997. Buku Ajar Ilmu Konservasi Gigi (Textbook of Operative Dentistry). Edisi III.
Jakarta : EGC.
[6] Hargono, D.J.1996. Sekelumit Mengenai Obat Nabati dan Sistem Imunitas. Pusat Penelitian dan Pengembangan Farmasi. Badan
Penelitian dan Pengembangan Kesehatan. Depkes RI. Jakarta. Majalah Cermin Dunia Kedokteran no. 108. Jakarta. Hal 5-9.
[7] Dorman HJD and Deans SG. 2000. Antimicrobial Agents From Plants: Antibacterial Activity Of Plant Volatile Oils. J.Applied
Microbiology, 88(2): 308.
[8] El-Hamss R, Idaomar M, Alonso-Moraga A, Munos SA. 2003. Antimutagenic Properties of Bell and Black Pepper. Food chem.
Toxicol. 41(1): 41-47.
[9] Trivedi, Manisha N., Khemani, Archana, Vachhani, Urmila D., Shah, Charmi P., Santani, D.D. 2011. Pharmacognostic,
Phytochemical Analysis and Antimicrobial Activity of Two Piper Species. International Journal of Comprehensive Pharmacy, 7(05).
[10] Agnol, R.Dall, Ferraz, A., Bernardi, A.P., Albring, D., Nor, C., et al. 2003. Antimicronial Activity of Some Hypericum Species. Brazil: Tanac SA. p 511-516

Abstract: The poor quality denture bearing area like markedly resorbed ridges and flabby tissues…Displaceable, or 'flabby ridges', present a scrupulous difficulty and may give rise to complaints of pain or looseness relating to a complete denture that rests on them. Surgical intervention, most of the time may not be a viable options. This article describes a technique for making a definitive impression for highly displaceable residual ridges. The choice of the impression materials, as well as the design of the impression tray, focuses on preventing distortion of the displaceable residual ridges during impression making. thus resulting in stable and retentive denture along with other qualities.

Keywords- Flabby Ridge, Hypermobile Tissues, Impression Technique.

[1] Fenlon MR, Sherriff M, Walter JD. Comparison of patients' appreciation of 500 complete dentures and clinical assessment of quality.
Eur J Prosthodont Rest Dent 1999; 7: 11–14.
[2] Basker RM, Davenport JC. Prosthetic treatment of the edentulous patient. 4th edn. Oxford: Blackwell, 2002.
[3] Carlsson GE. Clinical morbidity and sequelae of treatment with complete dentures. J Prosthet Dent 1998; 79: 17–23.
[4] Xie Q, Nähri TO, Nevalainen JM et al. Oral status and prosthetic factors related to residual ridge resorption in elderly subjects. Int J
Prosthodont 1997; 55: 306–313.
[5] Lamb D J. Problems and solutions in complete denture prosthodontics. London: Quintessence,1999, pp 57-60.
[6] Grant A A, Heath J R, McCord J F. Complete prosthodontics:problems, diagnosis and management. pp 90-92. London:Wolfe, 1994.
[7] Allen P F, McCarthy S. Complete dentures: from planning to problem solving London: Quintessence, 2003, pp 48-51.
[8] Osborne J. Two impression methods for mobile fibrous ridges. Br Dent J1964;117: 392-394.
[9] Devlin H. A method for recording an impression for a patient with a fibrous maxillary alveolar ridge. Quint Int 1985; 6: 395-397.

Abstract: Thirtyfive patient with unstable fractures of the lower thoracic and lumbar spine managed uniformly with Hartshill fixation and sublaminar wiring were analyzed. On admission, 18 patients had complete neurologic deficit and 17 had incomplete lesions. The neurologic recovery and functional activities were assessed after an average follow up for 20.4 months. Improvement of neural function was seen in 71 % patients. Positive correlation was found between the level of injury and Frankel grades. The cord lesions tended to demonstrate more severe neurologic deficit than cauda equina lesions. A component of dislocation to the injury also resulted in a more severe neural deficit. The complications were minor. Stable fixation of thoracolumbar spine fractures was helpful in decreasing hospital stay and recumbency period, thereby facilitating early rehabilitation of the spine injured patients.

Keywords: Thoracolumbar spine - fracture- neurologic outcome- posterior fixation.

[1] Akalm S, Kis M, Benli IT, Citak M, Mumcu EF, Tuzuner M. Results of the AO spinal internal fixator in the surgical treatment of
thoracolumbar burst fractues. Eur Spine J 1994; 3 : 102-106.
[2] McAfee PC, Yuan HA, Lasda NA. The unstable burst fracture. Spine 1982 ; 7 : 365-373.
[3] Tasdemiroglu E, Tibbs PA. Long-term follow-up results of thoracolumbar fractures after posterior instrumentation. Spine 1995 ; 20
: 1704-1708.
[4] Sullivan JA. Sublaminar wiring of Harrington distraction rods for unstable thoracolumbar spine fractures. Clin Orthop 1984; 189 :
178-185.
[5] Ferguson RL, Allen BL. A mechanistic classification of thoracolumbar spine fracture. Clin Orthop 1984; 189 : 77-88.
[6] Sjostrom L, Jacobsson O, Karlstrom G, Pech P, Rauschning W. Spinal canal remodelling after stabi lization of thoracolumbar burst
fractures. Eur Spine J 1994; 3 : 312-317.
[7] Kim NH, Lee HM, Chun IM. Neurologic injury and recovery in patients with burst fracture of the thoracolumbar spine. Spine 1999
; 24 : 290-294.
[8] Bradford DS, McBride GG. Surgical management of thoracolumbar spine fractures with incomplete neurologic deficits. Clin
Orthop North Am 1987 ; 218 : 201-216.
[9] Dall BE, Stauffer ES. Neurologic injury and recovery patterns in burst fractures at the T12 or L1 motion segment. Clin Orthop
North Am 1988 ; 233 : 171-176.
[10] Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine 1983 ; 8 : 817
- 831.

Abstract: Background: Nonspecific and overlapping microscopic features often pose diagnostic challenges in routine dermatopathology practice. Objectives: To detect additional findings on step sections of routine skin biopsies and study the significance of the same in improving the diagnostic accuracy. To formulate possible prerequisites to order step sections and study the economical aspects and turn around time alterations. Settings:Tertiary Hospital based Dermatopathology practice. Materials and Methods:Routine skin biopsies received in department of pathology, Dr B.R.Ambedkar Medical College/Hospital(BRAMCH) were processed. Initial sections were interpreted and step sections were ordered in lesions which showed nonspecific features, clinically non correlating importantly those with clinical suspicion of malignancy. Step sections obtained at different levels at 50 μ intervals were reinterpreted and compared with the initial sections (retrospective step sections). Results: Of the 70 cases studied additional diagnostic findings were present in 23 cases (38.3%) including 2 cases of Squamous cell carcinoma and1 case of Basal cell carcinoma. Diagnosis of 18(30%) cases were revised following step sections analysis including 2 cases of Squamous cell carcinoma and 1 case of dcis with invasion. The possible prerequisites for ordering step sections included nonspecific histopathological features and clinical non correlation. Retrospective step sections promise to be economy friendly and more effective. No significant turn around time changes were observed with respect to dermatopathology practice. Conclusions: This study highlights the essential utility of retrospective step sections to improve diagnostic accuracy and to discover hidden malignancies in routine dermatopathology practice without compromising on economy and turnaround time.

Key words: step sections, skin biopsies,diagnostic accuracy,economy,turnaround time.

[1] K Andrea Bruecks, M Jill Shupe and J Martin Trotter. Prospective step sections for small skin Biopsies. Arch patch lab
med,131,2007,107-111.
[2] Ravikanth Manyam, K Reena, TR Saraswathi, Role of deeper sections in diagnostic oral histopathology. A retrospective study.
Indian journal of dental research 22, 2011,62-65
[3] R.Henrycarag,MD,G.Victorprieto,MD,Phd,S.LizaYballe,MD,R.ChristopherShea,MD: Utility of step sections; Demonstration of
additional pathological findings in biopsy samples initially diagnosed as Actinic Keratosis,.Arch Dermatol.136(4),2004,471-475.
[4] RB Jr Lane, CG Lane, KA Mangold , MH Johnson, WC Jr Allsbrook. Needle biopsies of the prostate: What constitutes adequate
sampling?, Arch pathol lab med, 122,1998,833-835.
[5] AA Renshaw ,Adequate sampling of breast core needle biopsies. Arch path lab med,125 ,2001, 1055-1057
[6] YV Luo, TJ Prihoda, FE Sharkey, Number of levels needed for diagnosis of cervical biopsies. Arch path lab med, 126,2002,1205-
1208.
[7] YK Chitkara, CL Eyre, Evaluation of initial and deeper sections of esophageal biopsy specimens for detection of intestinal
metaplasia.AmJ clin Pathol , 123,2005,886-888. a b
[8] CP Maingi, KF Helm, Utility of deeper sections and special stains for dermatopathology specimens. J Cutan pathol 25,1998,171-
175.
[9] D Weedon. A reappraisal of melanoma in situ. J.Dermatol surg oncol. 18,1982,774-775.
[10] AD Rabinawitz , DN Silvers. Dermatopathology standards. J cutan pathol. 123,1996,194-196

Abstract: Diabetes mellitus is a global epidemic with rapidly rising incidence all over the world. There is clear evidence of effect of obesity, exercise, drug adherence, and presence of comorbid conditions, on level of diabetic control. But there is no clear data regarding effect of gender on glycemic control, with conflicting data from different studies. In India, in particular, there are very few such studies till date. Literature suggests that diabetic control depends on various variables and that younger patients, women, and those with comorbidities require particular clinical attention to reduce diabetic-distress and its negative impact on prognosis. Our study aims at comparing differences in glycemic control between men and women with emphasis on diabetes distress in each gender.

Key words: Diabetes mellitus; Glycemic control; HbA1c, diabetes distress

[1] Frank B. Hu, MD, PHD Globalization of Diabetes The role of diet, lifestyle, and genes. Diabetes Care June 2011 vol. 34 no.
6 1249-1257
[2] Chan JC, Malik V, Jia W, et al Diabetes in Asia: epidemiology, risk factors, and pathophysiology. JAMA 2009;301:2129–2140
[3] Ramachandran A, Mary S, Yamuna A, Murugesan N, Snehalatha C . High prevalence of diabetes and cardiovascular risk factors
associated with urbanization in India. Diabetes Care 2008;31:893–898
[4] Maysaa Khattaba, Yousef S. Khaderb C, Abdelkarim Al-Khawaldehd, Kamel AjlounidFactors associated with poor glycemic
control among patients with Type 2 diabetes.. Journal of Diabetes and Its Complications 24 (2010) 84–89
[5] Ciechanowski PS, Katon WJ, Russo JE. Depression and diabetes: impact of depressive symptoms on adherence, function, and costs.
Arch Intern Med. 2000;160:3278–3285
[6] Scott KM, Bruffaerts R, Tsang A, Ormel J, Alonso J, Angermeyer MC, et al. Depression– anxiety relationships with chronic
physical conditions: results from the World Mental Health Surveys. J Affect Disord. 2007;103:113–120
[7] Power F and Snoek FJ. Association between symptoms of depression and glycaemic control may be unstable across gender.
Diabetic Med 2001;18: 595-598
[8] Kobayashi J, Maruyama T, Watanabe H, et al. Gender differences in the effect of type 2 diabetes on serum lipids, pre-heparin
lipoprotein lipase mass and other metabolic parameters in Japanese population. Diabetes Res and Clin Pract 2003; 62:39-45
[9] Pomerleau J, McKeigue PM and Chaturvedi N. Relationships of fasting and postload glucose levels to sex and alcohol consumption.
Diabetes Care 1999; 22:430-433
[10] Position statement, Standards of Medical Care in Diabetes—2012, Diabetes Care, 35 (1), 2012, S11-S63

Abstract: Aim:The aim of this study was to assess the ability of Protein to Creatinine ratio from random urine samples to rule in or rule out proteinuria in patients with Chronic Kidney Disease. Chronic renal failure is a clinical syndrome resulting in the progressive loss of renal function. The symptoms of chronic renal failure result not only from simple excretory failure but also from the onset of regulating failure, the kidney's failure to regulate certain substances, such as sodium & water.Design/Methods:The conducted study was a Correlation study.Chronic kidney disease patients were selected on the basis of serum creatinine levels.Serum creatinine >2.5mg/dl values were considered to be having chronic kidney disease. Results:The present study shows a very good correlation between 24hr urine protein loss and protein to creatinine ratio (PCR) in second void, third voids and early morning urines, and these correlations were very similar for each of the three urine aliquots.Conclusion:The tests are to be used for monitoring the level of proteinuria in established renal disease, they can then be used as surrogates for 24hr measurements.

Key words: Creatinine, Proteinuria, Protein to Creatinine Ratio,Chronic kidney disease(CKD).

[1] Clinical chemistry (theory, analysis, correlation) by Lawrence A. Kaplan, Amadeo J. Pesce, Stanen C. Kajmiercjak. 4th edition, page -
486.
[2] Harrison's Internal Medicine Vol.2, 17th edition, page - 1762.
[3] Tietz text book of clinical chemistry and Molecular diagnosis 4th edition page – 822, 1241-45, 1687-89,1694.
[4] Mark Guy, Joanna K Borzomato Ronald G Newall, Philip A Kalra and cheistopher P Price. Protein and albumin to creatinine ratios
in random urines accurately predict 24 hours protein and albumin loss in patients with kidney disease. Ann.ClinBiochem 2009;
46:468/476.
[5] Anne-Marie Côté, Mark A Brown, Elaine Lam, Peter von Dadelszen, TabassumFiroz, Robert M Liston and Laura A
Magee.Diagnostic accuracy of urinary spot protein: creatinine ratio for proteinuria in hypertensive pregnant women: systematic
review. BMJ. 2008 May 3; 336(7651): 1003–1006.
[6] Wahbeh AM, Ewais MH, Elsharif ME. Comparison of 24hour urinary protein and protein-to-creatinine ratio in the assessment of
proteinuria. Saudi J Kidney Dis Transpl.2009May;20 (3):443-7.
[7] Morgenstern BZ, Butani L, Wollan P, Wilson DM, Larson TS. Validity of protein-osmolality versus protein-creatinine ratios in the
estimation of quantitative proteinuria from random samples of urine in children. Am J Kidney Dis. 2003 Apr;41(4):760-6.
[8] Cathei Lane, Mark Brown, William Dunsmoir, John Kelly and Ge0rge Mangos.Can spot urine protein/creatinine ratio replace 24 h
urine protein in usual clinical nephrology? Nephrology (Carlton) 2006Jun:11(3):245-9.
[9] Ayman M Wahbeh, Mohammad H Ewais, Mahamed E Elsharif. Comparison of 24-hour urinary protein and protein-to-creatinine
ratio in the assessment of proteinuria. . Saudi J Kidney Dis Transpl Year : 2009 | Volume : 20 | Issue : 3 | Page : 443-447
[10] Christopher P. Price, Ronald G. Newall and James C. Boyd. Use of Protein:Creatinine Ratio Measurements on Random Urine
Samples for Prediction of Significant Proteinuria: A Systematic Review Clinical Chemistry 51: 1577-1586, 2005.

Abstract: Study Objective: To compare the disease response,disease free survival,overall survival and toxicity profile to neoadjuvant chemotherapy followed by radiotherapy(CT-RT group) versus radiotherapy alone(RT alone) in locally advanced carcinoma cervix. Materials and Method:Between July 2007 and August 2008, 113 patients with squamous cell carcinoma, adenocarcinoma and adenosquamous carcinoma cervix, FIGO stage IIB-IIIB, were randomized to receive either two cycles of cisplatin and 5- flourouracil(CT) followed by radiotherapy(RT) (CT-RT group ,n=58) or RT alone (RT alone group , n=55)..

Key words: Carcinoma cervix, Locally advanced,Neoadjuvant chemotherapy, Radiotherapy and Survival.

[1] Parkin DM, Pisani P, Ferlay J,(1993). Estimates of the worldwide incidence of eighteen major cancers in 1985. Int J Cancer, 19,54,
594-606.
[2] National Cancer Registry Program. Biennial report 1988-89(1992):An epidemiological study,Indian Council of Medical Research
New Delhi, India, 23-25.
[3] FIGO staging for cancer cervix uteri(1987).UICC manual for classification of malignant tumors, Springer - Verlag, Berlin
[4] Thar T, Million R and Daly J(1982). Radiation treatment of carcinoma of cervix, semin. Oncol.9, 299-311.
[5] Kumar L and Bhargava L,(1991). Chemotherapy in recurrent and advanced cervical cancer. Gynecol.Oncol, 40,107-111.
[6] NCI Issues Clinical Announcement on Cervical Cancer,Chemotherapy Plus Radiation Improves Survival.
http://www.nih.gov/news/pr/feb99/nci-22.htm
[7] Lukka H, Hirte H, Fyles A, et al (2002) Concurrent cisplatin-based chemotherapy plus RT for cervical cancer: A meta-analysis. Clin
Oncol (R Coll Radiol) 14:203-212.
[8] Negi RR, Gupta M, Kumar M, Gupta MK, Seam R, Rastogi M,( 2010) Concurrent chemoradiation in locally advanced cervix
patients. J Can, Res Ther, 6,159-66.
[9] ECOG, Common toxicity criteria. Available from http://ecog.dfci.harvard.edu/general/ctc.pdf. Last accessed from 2007 Dec 10.
[10] Green J, Kirwan J, Tierney J, et al.(2001) Concomitant chemotherapy and radiation therapy for cancer of the uterine cervix.
Cochrane Database, CD002225.

Abstract: The size of the gallbladder varies between the fed and fasting states. In healthy adults, it is said to vary with age, gender, body size indices and diet. There is also a noticeable variation from country to country. A prospective study of 141 consecutive healthy adult, aged eighteen years and above was carried out. They were weighed and then scanned with a 2 dimensional (2D) ultrasound machine after eight to twelve hours of fast to determine their fasting gallbladder volume (FGBV). The subjects were grouped into four weight categories with a range of 20kilograms (kg) and the mean fasting gallbladder volume for each group was calculated. The variation in volume with body weight was assessed and a positive correlation was observed. The overall mean FGBV is 27.7 +/- 12.3 cm3 Keywords: Adults, Body weight, Fasting gallbladder volume, Ultrasonography.s

[1] S. Ryan, M. McNicholas and S.J. Eustace Anatomy for diagnostic imaging, (2nd Ed). 5 (Toronto: W.B Saunders Company Ltd., 2004), pp. 179.
[2] A.A Van Bodegraven, C.J. Bohmer, R.A. Manoliu et al., Gallbladder contents and fasting gallbladder volumes during and after
pregnancy, Scandinavian Journal of Gastroenterology, 33(9), 1998, 993 - -997.
[3] N.C. Gourtsoyiannis, J.E. Damilakis, N.Z. Charoulakis, A.S. Bakautaki, J.G. Viahonikolis, E. Xynos. Relationship of gallbladder
contour, fasting volume and emptying to body size indices in normal subject and patients with gallstones. Digestion. 1995; 56(5): 395
– 399.
[4] S. Guliter, S. Yimazs, T. Karakan. Evaluation of gallbladder volume and motility in non-insulin dependent D.M patient using real time ultrasound. J Clin Gastroenterol 2003 Oct; 37(4): 288 – 91.
[5] P.C Van de Meeberg, P. Portincasa, F.H Wolfhagen et al. Increased gallbladder volume in primary sclerosing cholangitis. Gut 1996
Oct; 39(4): 594 – 9.
[6] D.M. Mclntosh, H.F. Penny. Gray scale ultrasound as a screening procedure in the detection of gallbladder disease. Radiology.1980
Sept; 136(3): 725 – 7.
[7] R. Starinsky, Z. Alon. Gallbladder size: Is it affected by the oral intake of water or dilute contrast medium. J Med. 1994 Jun; 13(6):
435 – 8.
[8] H. Nazaroglu, C. Akgul, Y. Bukte, A. Bilici, M. Simsek. Volume Changes in the gallbladder in association with various radiological
examination. J. Clin USS. 2005 Jun; 33(5): 214 – 7.
[9] K. Romanski. Methods of estimating gallbladder volume. Wiad Lek. 2006;59(1 -2): 140 – 5 (ISSN: 0043 – 5147).
[10] W.J. Dodds, W.J. Groh, R.M.A. Darweesh et al. Sonographic measurement of gallbladder volume. AJR AmJ. Roentgenol.1985 Nov; 145(5): 1009 – 11.

Abstract: Aim: The purpose of this study is to investigate the changes in the levels of nucleic acid and polyamines and efficacy of combination of paclitaxel along with Di allyl sulfide against skin cancer in experimental animals. Skin cancer is the most common form of human cancer. It is estimated that over 1 million new cases occur annually. The annual rates of all forms of skin cancer are increasing each year, representing a growing public concern. The most common warning sign of skin cancer is a change in the appearance of the skin, such as a new growth or a sore that will not heal. Skin cancer is caused by chemical carcinogens and Papilloma virus infection. Design/Methods: Skin cancer was induced in rats by 7, 12 Di methyl benz(a) anthracene (DMBA) at the dosage of 5 μg dissolved in 100μl acetone and administered into experimental animals for 28 weeks. In this study, we demonstrated that combination of paclitaxel and Di allyl sulfide revert the changes in the rats from lethal dose of DMBA within 30 days. Results: The levels of Nucleic acid and polyamines in skin and liver were found to be increased in the cancer bearing animals when compared with control animals. Treatment of Paclitaxel along with Di allyl sulfide to cancer induced animals showed significant decrease in the levels of Nucleic acid when compared with cancer induced animals. Conclusions: The treatment with combination of paclitaxel and Di allyl sulfide effectively reduced nucleic acid and polyamines levels. So, from the obtained results it is concluded that paclitaxel and Di allyl sulfide is capable of restoring the skin architecture.

Key words: Paclitaxel, Di allyl sulfide, DMBA, Skin cancer.

[1] Ali M, Thomson M, Afzal M. (2000). Garlic and onions: their effect on eicosanoid metabolism and its clinical relevance.
Prostaglandins Leukot Essent Fatty Acids, 62, 55-73.
[2] Burton K. (1956). A study of the conditions and mechanism of the diphenylamine reaction for the colorimetric estimation of
deoxyribonucleic acid. Biochem. J., 62 : 315-323.
[3] Canizares F, Salinas J, Heras M. and Penafiel R. (1999). Prognostic value of ornithine decarboxylase and polyamines in human breast
cancer : correlation with clinicopathological parameters. Clinical Research. 5: 2035 - 41.
[4] Chanda R and Ganguly AK (1987). Diamine Oxidase activity and tissue histamine content of human skin, breast and rectal
carcinoma. Cancer let, 34; 207-212.
[5] Cipolla B, Guille F, Moulinoux JP, Quemener V, Staerman F, Corbel L and Lobel B. (1993).
[6] Polyamine and prostatic carcinoma : Clinical and therapeutic implications. Eur. Urol., 24: 124 -131.
[7] Ellis CN, Burnette JJ and Sedlack R (1991). Prognostic applications of DNA analysis in solid malignant lesions in humans. Surgery,
173: 329-342.
[8] Endo Y. (1978). A simple and sensitive method of analysis of histamine, putrescine and polyamines without the use of an amino acid analyser. Anal. Biochem., 89 : 235-246.
[9] Farriol M., Segovia ST., Venero Y and Orta X. (2001). Role of polyamines in cell proliferation in a colon carcinoma cell line.
Nutrition, 17 : 934-938.
[10] Leveque J, Foucher F, Bansard J, Havouis R, Grall J. and Moulinoux J. (2000) Polyamine profiles in tumor, normal tissue of the
homologous breast, blood, and urine of breast cancer sufferers. J. Breast Cancer. Res. Treat. 2: 99-105.

Abstract: Myasthenia gravis is an acquired chronic autoimmune disorder caused by decrease in functioning of acetylcholine receptors at the neuromuscular junctions owing to their destruction or inactivation by circulating antibodies. Disease manifests in the form of easy fatigability, weakness, difficulty in swallowing and even paralysis of respiratory muscles necessitating assisted ventilation. The clinical course of myasthenia gravis and its effect on pregnancy outcome is unpredictable. Worsening of symptoms can occur at any stage during pregnancy and also in post operative period. We are reporting a case of maternal myasthenia gravis who underwent caesarean section and developed respiratory distress after 20 minutes of spinal anaesthesia. Her baby also had a weak cry, hypotonia and tachypnoea. Baby was shifted to neonatal intensive care unit with continuous oxygen supplementation. Baby was kept under close observation and recovered well after two weeks.

Keywords - ENNS score, Myasthenia gravis, Pregnancy, Transient neonatal myasthenia.

[1] Cohen SE. Evaluation of the neonate: Shnider, Levinson G, editors. Anaesthesia for obstetrics: 1st Ed Baltimore: Williams and
Wilkins, 1981: 370-84.
[2] Conti-Fine BM, Milani M, Kaminski HJ. Myasthenia gravis: past, present, and future. J. Clin. Invest. 2006; 116(11): 2843–54.
[3] Drachman DB. Myasthenia gravis. New Engl. J. Med. 1994; 330: 1797-1810
[4] Bedlack RS, Sanders DB. How to handle myasthenic crisis. Essential steps in patient care. Postgrad Med.2000; 107(4): 211–4
[5] Rosenbaum RB, Donaldson JO. Peripheral nerve and neuromuscular disorders. Neurol Clin. 1994;12: 461-78.
[6] Eden RD, Gall SA. Myasthenia gravis and pregnancy: A reappraisal of thymectomy. Obstet Gynecol 1983; 62: 328-33.
[7] Roth TC, Raths J, Carboni G, Rösler K, Schmid RA. Effect of pregnancy and birth on the course of myasthenia gravis before or after
trans-sternal radical thymectomy Eur J Cardiothorac Surg 2006; 29: 231-5.
[8] To WK, Cheung RT. Neurological disorders in pregnancy. Hong Kong Med. J. 1997; 3: 400-8.
[9] Rowland JM, Hendrickx AG. Corticosteroid teratogenicity- Advances in Veterinary Science and Comparative Medicine. 1983; 27:
99–128.
[10] Bever CT, Aquino AV, Penn AS. Prognosis of ocular myasthenia. Annals of Neurology. 1983; 14(5): 516–519.
[11] Plausche WC. Myasthenia gravis in mothers and their newborns. Clin Obstet Gynaecol. 1991; 34: 82-99.
[12] Djelmis J, Sostarko M, Mayer D, Ivanisevic M. Myasthenia gravis in pregnancy: report on 69 cases. European Journal of Obstetr ics Gynecology and Reproductive Biology. 2002; 104(1): 21–25.
[13] Batocchi AP, Majolini L, Evoli A, Lino MM, Minisci C, Tonali P. Course and treatment of myasthenia gravis during pregnancy.
Neurology. 1999; 52(3): 447–452.
[14] Krucylak PE, Naunheim LS. Preoperative preparation and anaesthetic management of patients with myasthenia gravis. Seminars in
Thoracic and Cardiovascular Surgery. 1999; 11: 47-53.
[15] Ellison J, Thomson AJ, Walker ID, Greer IA. Thrombocytopenia and leucopenia precipitated by pregnancy in a woman with
myasthenia gravis. British Journal of Obstetrics and Gynaecology 2000; 107(8): 1052–1054.
[16] Klehmet J, Dudenhausen J, Meisel A, Course and treatment of myasthenia gravis during pregnancy, Nervenarzt 2010; 81: 956–962.

Abstract: The difference of bronchial lability that is bronchial hyper-reactivity between normal men and women is studied by standard exercise using Harvard steps. Preclinical medical students (M=30, F=30) with mean age of 18.64 years were assessed. Students included were nonsmokers & with no personal history of allergy or any respiratory disease. Parameters compared were age, sex, height, weight & PFTs. Parameters i.e. PFTs were recorded before, during & upto 45 minutes after exercise with computerized spirometer & for PEFR Wright's Mini Peak flow meter was used. Exercise lability index (ELI), ELI % rise & % fall calculated. Resting FVC, FEV1, FEF25-75% & PEFR in men were significantly higher (p<0.05) but there was no significant difference of FEV1%. ELI-PEF was not significantly different (p>0.05) but there was greater ELI % rise in PEFR values in women during exercise & lesser decline after it.. Women have a greater increase and lesser decrease in flow rates & showed earlier recovery as compared to men. This respiratory response pattern could account for the lower incidence, morbidity & mortality from respiratory allergic diseases seen in women.

Keywords: bronchial labilty, exercise, normal men and women, pulmonary function tests.

[1] Simonsson BG. Clinical applications of bronchial hyperactivity.European Journal of Respiratory Disease 1980; 61(106): 7-18.
[2] Broder I, Higgins MJ, Mathews KP, Keller JB. Epidemiology of asthma and allergic rhinitis in a total community. Techumesh
,Michigan Journal of All 1974; 53: 127-138.
[3] Dickman ML, Schmidt, Gardner RM. Spirometric standards for normal children and adolescents. Age 5-18 years. American Review
of Respiratory Disease 1971; 104: 680-687.
[4] Konig P, Godfrey S, Abrahamov A. Exercise induced bronchial lability in children with history of wheezy bronchitis. Archives
Disease of Childhood 1972; 47: 578-580.
[5] Hayashi M, Huber GL.Quantitative differences in goblet cells in the tracheal epithelium of male and female rats.American Review
of Respiratory Disease 1977; 115: 595-599.
[6] Kalyani Premkumar, S. Walter. Exercise induced bronchial lability in normal men and women.Indian journal of Physiology &
Pharmacology 1993; 37(4): 308-312.
[7] Kagawa J, Kerr HD. Effects of brief graded exercise on specific airway conductance in normal subjects. Journal of Applied
Physiology 1970; 28: 138-144.
[8] Silverman M, Anderson SD. Standardization of exercise tests in asthmatic children. Archives disease of Children 1972; 47: 882-889.
[9] Chryssanthopoulos C, Barboriak JJ, Fink JN et al. Adrenergic responses of asthmatic and normal subjects to submaximal and
maximal work levels.Journal of All Clinical Immunology 1978; 61: 17-22.
[10] Gelb AF, Tashkin DP, Epstein JD et al. Exercise induced broncho-dilation in asthma. Chest 1985; 87: 196-201.

Abstract: Background: India was home to 62.4 million diabetics in the year 2011 and the incidence is on a continuous rise. It was projected that India will have the largest number of diabetics in 2025. So studying the risk factors for diabetes is much needed in India. Objectives: To assess the association between alcohol intake and diabetes mellitus in a study population and to assess the association between socio demographic profile and diabetes in a study population.

[1] Priya Shetty. India's Diabetic time bomb. Nature 2012; 485: 14-15.
[2] Raekha Prasad. Alcohol on the rise in India. Lancet medical journal vol 373 Jan 2009.
[3] Pattern of drinking in Kerala, Drugs information centre India (NGO), available from URL: http://
www.adicindia.org/publications.html
[4] Siobhan C Maty, Susan A Everson-Rose, Mary N Haan, Trivellore E Raghunathan and George A Kaplan. Education, income,
occupation, and the 34-year incidence (1965–99) of Type 2 diabetes in the Alameda County Study Int J Epidemiol. 2005 December
; 34(6): 1274–1281.
[5] Stringhini S, Tabak A , Akbaraly T, Sabia S , Shipley M, Marmot M et al. Contribution of modifiable risk factors to social
inequalities in type 2 diabetes: prospective Whitehall II cohort study. BMJ 2012;345:e5452
[6] Maty S, James S, Kaplan G. Life-Course Socioeconomic Position and Incidence of Diabetes Mellitus Among Blacks and Whites:
The Alameda County Study, 1965–1999 American Journal of Public Health 2010; 100: 137-145.
[7] Agarwal S, Ebrahim S. Prevalence and risk factors for self-reported diabetes among adult men and women in India: findings from a
national cross-sectional survey Public Health Nutrition: 15(6), 1065–1077.
[8] Kinra S, Lyngdoh T, Prabaharan D, Reddy K, Ramakrishnan L, Gupta R et al. Socio demographic patterning of non-communicable
disease risk factors in rural India: a cross sectional study BMJ 2010;341:c4974.
[9] Prabhakaran D, Chaturvedi V, Ramakrishnan L et al. Risk factors related to the development of diabetes in men working in a north
Indian industry. National Medical Journal of India. 2005;20(1):4-10.
[10] Dutt D, Roy G, Chatterjee P. Risk Factor Assessment for Type II Diabetes Mellitus in a Tertiary Hospital in Kolkata. Indian Journal of Community Medicine. 2004;29(4):169-170..