iosr-JDMS   Volume-13 ~ Issue-9 ~ September-2014

Abstract: Conjoined twinning is rare, occurring in about 1% of monochorionictwins with an estimated incidence ranging from 1:30.000 to 1:2.00.000 live births and 1 In 650 to 900 twin deliveries. Hereby we present a case report on thorcoabdominopagus at 22 weeks admitted for termination of pregnancy.

Key Words: Abdominopagus,conjoined,monochorionic,monoamniotic, twins, thoracopagus

[1]. Saunitra A. Inamdar ,Shruthi S. Goel. Vaidehi S. Subhedar –A thoracophagus conjoinedtwins withmyelomeningocele: an unusual case.-International journal of Reproduction. Conception. Obstetrics and Gynecology.2012 dec;1(1):61-63.
[2]. Spencer R theoretical and analytical embryology of conjoined twins;part 1 embryogenesis.Clin anat.2000;13:36-53.
[3]. AysegulOksuzoglu, OzlemMoraloglu, AylaAktulay, Yap akEngin-Ustun, SevkiCelen, LeylaMollalahmutoglu.- Conjoined twins: A Case Report of Thoraco-abdominopagus-Ankara universitesi Tip FakuletsiMecmuasi 2011,64(3).
[4]. Chandima P Suriyarachchi-Surgical experience with conjoined twins.-Sri Lanka Journal of child health, 2010:39:64-66.
[5]. KiranTrivedi ,D DarukhshanAnjum-Thoracoomphalophagus twin presented as a case of rupture uterus.-SenC,CelikE,VuralA,KepkepK.Antenatal diagnosis and prognosis of conjoined twins a case report.JPerinat Med 2003:31:427-430.

Abstract: Background: Cryptosporidium is a protozoan parasite with worldwide distribution mainly affecting children and HIV infected individuals with low CD4 counts. The infection is self limiting in immunocompetent hosts but can be severe and persist in the immunocompromised and malnourished individuals. The aim of this study was to estimate the prevalence of Cryptosporidium infection in faeces among immunocompromised patients Methods Faecal samples from 113 immunocompromised patients with diarrhoea and without diarrhoea were examined for oocysts by microscopy and Cryptosporidium antigen test was performed using ELISA method. Results Of the 113 stool samples our study indicated, 20.3% Cryptosporidium infection prevalence in the immunocompromised participated population. Furthermore, Modified ZN staining(Kinyon's) detected 13(11.5%), wet mount by direct microscopy 2(1.7%)and concentration method 4(3.53%) stool samples positive for oocysts of Cryptosporidium parvum and Cryptococcal antigen by ELISA 23(20.3%) Stool samples were positive. Conclusion The present study confirmed the high prevalence of Cryptosporidium antigen in fecal samples of immunocompromised patients in the region. As no chemotherapeutic agents have yet proven, especially in immunosuppressed patients, therefore our results highlight the importance of preventive intervention in these groups.

Keywords: Cryptosporidium, Oocysts, Kinyon's staining Coproantigen, Immunocompromised patients, ELISA

[1]. Gerald DS, Larry SR. Foundations of parasitology. 7th. Mc Graw Hill Companies; 2006. pp. 141–42.

[2]. Havelar A, Boonyakarnkul T, Cunliffe D, et al. Guidelines for drinking water qulity, water born pathogens. Geneva: WHO; 2003. [3]. Abubakar I, Aliyu SH, Arumugam C, Usman NK, Hunter PR. Treatment of cryptosporidiosis in immunocompromised individuals: systemic review and meta analysis. Br J Clin Phamacol.2007;63(4):387–93. [PMC free article] [PubMed]

[4]. Mumtaz S, Ahmed J, Ali L, Frequency of Cryptosporidium infection in children under five years of age having diarrhoea in the North West of Pakistan, African Journal of Biotechnology, 2010; 9(8): 1230-35.

[5]. Shrihari Narayan et. al. The Prevalence of Cryptosporidiosis in HIV Seropositive individuals and detection of Cryptosporidium parvum Oocysts by Modified Ziehl-Neelsen staining, Giemsa staining and Sheather sugar flotation technique in a Tertiary Care Hospital, JPBMS, 2011, 12 (09)

Abstract: Introduction: Primary osteoarthritis(OA) of the elbow is a rare condition, characterized by painful stiffness, mechanical symptoms, and the presence of hypertrophic osteophytes. Elbow osteoarthritis typically affects middle-aged men who engage in strenuous manual activity. We hereby present a case of bilateral primary elbow osteoarthritis and discuss its various treatment options. Case report: A 45 years old male patient presented to outpatient department with complaints of pain in both elbows since one year. There was no history of previous trauma or other complaints pertaining to elbow. He was a manual laborer working in farms. He had tenderness on deep palpation of elbow. All movements at elbow (extension, flexion, supination and pronation) were terminally restricted. X-rays of both elbows revealed osteoarthritis of elbow. After thorough discussion of treatment options with patient, he opted for non-operative management. Key massage: It requires a high index of suspicion to diagnose primary OA of elbow. Best treatment option involves capsular release and removal of impinging osteophytes but non-operative treatment remains the first step in the early management of elbow osteoarthritis.

Key words: primary elbow osteoarthritis, bilateral, management Case Report

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[3]. Schmitt H, Hansmann HJ, Brocai DR, Loew M. Long term changes of the throwing arm of former elite javelin throwers. Int J Sports Med. 2001;22: 275-279.
[4]. Bauer M, Jonsson K, Josefsson PO, Linden B. Osteochondritis dissecans of the elbow. A long-term follow-up study.ClinOrthopRelat Res. 1992;284: 156-60.
[5]. Stanley D. Prevalence and etiology of symptomatic elbow osteoarthritis. J Shoulder Elbow Surg. 1994;3: 386-9.
[6]. Minami M. Roentgenological studies of osteoarthritis of the elbow joint. Nippon SeikeigekaGakkaiZasshi. 1977;51: 1223-36. Japanese..

Abstract: To evaluate the diagnosis and treatment and long term follow up of cesarean scar pregnancy. Methods: From January 2008 to December 2013, 12 cases of Cesarean scar pregnancy were diagnosed using transvaginal grey scale and color doppler ultrasound and managed by various approaches. Incidence, gestational age, ulrasound findings, serum beta-human chorionic gonadotropin ( beta-hCG) levels, flow profiles of transvaginal color doppler ultrasound, and different methods of treatment were recorded. Results: The incidence of cesarean scar pregnancy was 1:2051. Gestational age at diagnosis ranged from 5 weeks + 2days to 10weeks + 4 weeks. The time interval from the last cesarean section to the diagnosis of Cesarean scar pregnancy ranged from 5 months to 8 years. Patients were treated by different methods as follows: transvaginal ultrasound-guided injection of methotrexate(MTX) into the gestational sac (n = 1), systemic methotrexate administration alone (n = 2), dilatation and curettage (n = 3), or local resection of the gestation mass (n =6 ). After local or systemic MTX, high-velocity and low-impedance subtrophoblastic flow (resistance index (RI) = 0.35) persisted until beta-hCG returned to normal. One of 3 patients, treated by dilatation and curettage, underwent a hysterectomy because of uncontrolled profuse vaginal bleeding. The scar pregnancy mass took 2 months to 8 months for regression after treatment. None of the patient had uterine rupture. Conclusion: Sonography guided methotrexate injection and/or systemic methotrexate are the treatment of choice to manage cesarean scar pregnancy less than 6-8 week's gestation without fetal heart activity. Dilatation and curettage leads to profuse vaginal bleeding and not recommended for cesarean scar pregnancy due to high morbidity. Those patients having persistent pain and recurrent bleeding, surgical resection for removal of mass and repair of defective site should be recommended.
Keywords: cesarean scar pregnancy, scar pregnancy, ectopic pregnancy.

[1]. Fylstra DL, Pound-Chang T, Miller MG, et al. Ectopic pregnancy within a cesarean delivery scar: a case report. Am J Obstet Gynecol 2002;187:302-4.
[2]. Elizabith A, Baher M, Mindy M, et al. Caesarean delivery scar ectopic pregnancy. A case report. Ultrasound Quarterly 2010;26:106-8.
[3]. Jurkovic D, Hillaby K, Woelfer B,et al. First trimester diagnosis and management of pregnancies implanted in the lower uterine Caesarean section scar. Ultrasound Obstet GynecoL 2003;21:220–7.
[4]. Seow KM, Cheng WC, Chuang J, et al. Methotrexate for cesarean scar pregnancy after in vitro fertilization and embryo transfer: a case report. J Reprod Med 2000; 45:754–7.
[5]. C. M. Yan, "A report of four cases of caesarean scar pregnancy in a period of 12 months," Hong Kong Medical Journal 2007;13:141–3.

Abstract: Introduction: The aim of the study was to estimate the length of humerus from the measurements of proximal and distal segments in Telangana State population using regression equation. Helps archaeologists, anthropologists and forensic investigators,to estimate the stature &identity when a fragment of bone is available. In current studymeasurments of proximal and distal segments of humerus was dervied and the length of the humerus was estimated. Methods: A total of 30 humeri, 15 right and 15 left were used for this study. Maximum length of humerus, vertical and transverse diameter of proximal segment, transverse diameter and biepicondylar width of distal segment were measured using osteometric board & Vernier calipers. Results: With the obtained measurements - descriptive statistics, linear regressions and regression equations for both sides are done. In the right humeri, multiple linear regression of vertical diameter of superior articular surface alone showed significant changes in maximum humeral length contributing up to 85%. In the left humeri, multiple linear regressions of vertical diameter of superior articular surface as well as transverse diameter of inferior articular surface showed significant changes in maximum humeral length ( P<0.001). Conclusion: The result of our study concludes that the length of the humerus can be estimated from the measures of proximal and distal segments of humerus of both sides.

Key Words: Proximal and distal segments of humerus, Length, Regression equation, Telangana State population

[1]. Chavan K.D, Datir SB et al. Correlation of foot length with height amongst Maharashtrian population of India. Journal of Indian Academy of Forensic Medicine.2009; 31(4):334-337.
[2]. Patel S M et al. Estimation of height from measurements of foot length in Gujarat region. J AnatSoc India.2007; 56(1): 25-27.
[3]. Sanli SG, Kizilkanat ED et al. Stature estimation based on hand length and foot length.Journal of Clinical Anatomy.2005 Nov; 18(8):589-96.
[4]. Rastogi P, Nagesh KR et al. Estimation of stature from hand dimensions of north and South Indians. Leg Med (Tokyo). 2008 July; 10(4):185-9[2].
[5]. Dan Utpal,Mukhopadhy P.P.,Ghosh.T.K.,Biswas.S,Estimation of stature from fragment of long bone(Tibia) In Indian Benagalee population,J.Anat.Soc.India-2009;58(2);169-172.

Abstract: Background: Systemic inflammation is associated with impaired lung function and inflammation is a part of Obstructive Airway Disease (OAD). Chronic obstructive pulmonary disease (COPD) and bronchial asthma are the two most common OAD. In view of this, the present study was done with the objective of determining the relationship between the various grades of severity of airway obstruction in COPD and asthma with blood leukocyte counts. Methods: A cross-sectional study enrolling 40 COPD & 25 asthmatic patients of both sexes. Lung function was studied by computerized spirometer (Helios 402) and blood leukocyte counts (absolute neutrophil count, absolute eosinophil count, absolute basophil count, absolute lymphocyte count and absolute monocyte count) were determined by using suitable diluting fluids. Results: Grading of COPD and asthma severity was done according to GOLD and GINA guidelines respectively based on FEV1% predicted. With the increase in severity of airway obstruction, FEV1 was found to decline in both the groups. Out of 40 COPD patients, 12.5 % of patients had mild, 20% had moderate, 40% had severe and 27.5% had very severe COPD. Out of 25 asthma patients, 48% had mild, 32% had moderate and 20% had severe asthma. There was a significant increase in neutrophil count with the increase in COPD severity and with the increase in asthma severity, eosinophil count increases significantly. . Monocyte count was also increased with the decline in lung function in both the groups. Conclusion:Peripheral blood leukocyte counts are useful and can be used as an indirect & inexpensive marker of severity of functional lung impairment in OAD patients.

Keywords: OAD, COPD, asthma, spirometer, FEV1% predicted, FEV1, leukocyte counts

[1]. Nadel JA. Obstructive diseases: General Principles and Diagnostic Approach. In: Murray JF, Mason RJ, Boushey Jr HA, Nadel JA, editors. Textbook of Respiratory Medicine. 3rd Ed. Philadelphia: WB Saunders Company; 2000. p. 1173-184.
[2]. Grippi MA, Tino G. Pulmonary Function Testing. In: Fishman AP, Elias JA, Fishman JA, Grippi MA, Sevior RM, Pack AI, editors. Fishman,s Pulmonary Diseases and Disorders. 4th Ed, Vol 1, USA: McGraw Hill; 2007.p. 602.
[3]. Global Initiative for asthma (GINA): Global strategy for asthma management and prevention. 2011. Available from: http://www.ginaasthma.org. Accessed on May 7, 2012.
[4]. Global initiative for chronic obstructive lung disease. Global strategy for the diagnosis, management, and prevention of COPD (revised 2011). 2011. Available from: http://www.goldcopd.org. Accessed on October 12, 2012.
[5]. Snider GL. Understanding Inflammation in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med. 2003; 167: 1045-49.

Abstract: Introduction: The femur is longest and strongest bone in the body. Sex determination from unidentified human skeletal elements is a challenge for forensic investigators and anthropologists. Aim of the Study: To correlate different osteometric parameters of femur for anthropological and forensic practise. Materials & Method: Study was conducted with 40 femora (right 28 and left 12) of unknown sex from the Department of Anatomy, Kamineni Institute of Medical Sciences, Narketpally. Femora were subjected for measuring length, anterio-posterior diameter of shaft at upper, middle and lower segment using osteometric board and vernier calliper. Results: Mean length of femur was 43.26 cm and mean antero-posterior diameter of shaft at upper segment was 24.67 mm, middle segment was 25.1 mm and lower segment was 25.77 mm. Conclusion: The knowledge of morphometric values is helpful to anthropological and forensic practice.

Key words: Sexual dimorphism, Anthropological practise, Osteometric measurments.

[1]. Krogman, W. M. and Iscan, M. Y. Human Skeleton in Forensic Medicine. 2nd Edition, Charles C. Thomas, Springfield, 1986.
[2]. Asala . S.A. et al 2004 Discriminant function sexing of fragmentary femur of South African blacks, vol 145, issue 1. p. 25-29
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[4]. Taner Ziylan2002 An Analysis of Anatolian Human femur Anthropomet6ry, Turkey Journal of Medical Sciences, Vol – 32, P. 231-2
[5]. Strecker W, Keppler P, Gebhard F, Kinzl L. Length and torsion of the lower limb. J Bone Joint Surg Br. 1997; 79(6):1019-23.
[6]. Parsons, F.G. The character of the English thigh bone. Journal of Anatomy and physiology 1914; 48: 238-267

Abstract: Dilatation and curettage (D &C) sometimes causes uterine perforation. Unsafe abortions performed by unskilled persons, may further complicate the condition. Here we report a case of small intestinal prolapse through uterine perforation caused by D&C, requiring intestinal resection. D&C was performed by an unskilled person. As it was a 2nd trimester abortion (3 and ½ month amenorrhea), bony part of foetus (foetal skeleton) was left in the uterine cavity. Further attempt to remove the foetus resulted into uterine perforation and intestines were prolapsed through it. Laprotomy was performed, major part of gangrenous small intestine was resected and anastomosis done. This was one of the rarest to rare life threatening complication of an unsafe abortion. Only few cases are reported in literature so far and none from Rajasthan.

Key words: Prolapsed Bowel, Uterine Perforation, Unsafe Abortion

[1]. Bhattacharyya S K, Saha S P, Bhattacharya S, Pal R. Consequences of unsafe abortion in India- a case report. Proceeding in obstetrics and gynaecology, 2011 November; 2(2):12
[2]. Singh R, Tandon I, Sujata. Vagino-peritoneal fistula a rare complication of unsafe abortion- a case report: J Obstet Gynecol India Vol.59,No.3:May/June 2009:253-254.
[3]. Kaniz Z N and Muhammad M E. The horror of unsafe abortion: case report of a life threatening complication in a 29 years old woman. Patient safety in Surgery 2013; 7:33
[4]. Agrawal R, Radika AG, radhakrishnan faeces per vaginum; A Combined gut &uterus complication of unsafe abortion. J.Obstet Gynacol Index. 2013 March ,April;

Abstract: Aims: To analyze the maternal mortality with its causes and it's possible contributing risks factors at Burdwan Medical College Burdwan, West Bengal. Setting &Design: This study was carried out at Obstetrics and Gynecology department of Burdwan medical College from January 2009 to December 2013. This is a retrospective case series study. Methods & Materials: This study was conducted by analyzing death records of all maternal death that died over period of five years from January 2009 to December 2013. The demographic record included age, parity, booking status and education, the cause of death and possible contributing factors were evaluated. Concslusion: Eclampsia, hemorrhage and Sepsis are still the major killers. Factors which need urgent improvement include education, antenatal booking, early diagnosis and referral to tertiary care centre.

Key words: Maternal mortality, Eclampsia, Hemorrhage, Sepsis

[1]. Maternal Mortality in 2000. Estimates developed by WHO, UNICEF and UNFPA, Geneva, Switzerland, WHO; 2004.
[2]. Onah HE, Okara JM, Umh U, Chigbu CO. Maternal mortality in health institution with emergency obstetric care facilities in Enugu state, Nigeria. J Obstet Gynecal 2005; 25:569-74.
[3]. India Millennium Development Goals report 2006. Planning commission, Govt. of India.
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Abstract: Extraction Vs Non-extraction controversy covers the major part of orthodontic debate since years. Premolar extractions are one of the simplest methods to relieve crowding in majority of the cases. However soft tissue profile, an integral part of orthodontic diagnosis and should be given equal consideration while treatment planning. In this case with severe crowding, where initial diagnosis gave an impression of all first premolar extraction case, considering other factors like cephalometric analysis and soft tissue profile, this case was treated by non-extraction philosophy with distalization using Jone's Jig. This case was completed with good occlusion, maintaining soft tissue profile. Treatment plan should not only base on model analysis or cephalometric numbers without giving much importance to photographic analysis and soft tissue contours. In fact treatment plan should be based on clinical features, model analysis, cephalometric readings, photographic analysis and soft tissue contours.

Keywords: Extraction Versus non-extraction, Distalization, Jone's jig

[1]. Jones RD, White JM. Rapid Class II molar correction with an open-coil jig. J ClinOrthod 1992;26:661-4.
[2]. Pancherz H, Anehaus-Pancherz M. The headgear effect of the Herbst appliance: a cephalometric long-term study. Am J Orthod 1993;103:510-20.
[3]. Muse DS, Fillman MJ, Emmerson WJ, Mitchell RD. Molar and incisor changes with the Wilson rapid molar distalization. Am J Orthod 1993;104:556-65.
[4]. Gianelly AA, Vaitas AS, Thomas WM. The use of magnets to move molars distally. Am J Orthod 1989;96:161-7
[5]. Hilgers JJ. The pendulum appliance for Class II non-compliance therapy. J ClinOrthod 1992;26:706-14

Abstract: A research questions: containing set of 20 questions were designed to assess the level of understanding of the radiologists regarding PCPNDT Act and their perspective about changes brought about by the PCPNDT act over the years. The Setting was urban area under Navi Mumbai Municipal Corporation. The study was a cross sectional study. The study population comprised of 100 radiologists. The doctors were selected from among private practitioners and also those attached to Medical College hospitals and corporate hospitals in Navi Mumbai. The private practitioners included radiologists having their own setup and / or those employed with the ultrasound clinics in Navi Mumbai. The cross sectional study was conducted in Navi Mumbai district from June to August 2014. Statistical analysis was done using simple percentages obtained on the basis of answers selected by the radiologists from a questionnaire. Result: This study observed that although there was a high compliance with the PCPNDT act, a significant percentage of doctors had only partially read the PCPNDT act .The knowledge regarding the PCPNDT act was imbibed mainly from whatever was instructed or informed by the appropriate authority and by their colleagues. Very few doctors understood the motive behind the rules laid down by law. Most doctors were of the opinion that the PCPNDT act should be continued although on its own it is not enough to curb female feticide.

Key words: Feticide, female child, sex ratio, PCPNDT act, Radiologists, Sonologists.

[1]. Maharashtra Population Census data 2011 ( cited on Dec 2012 ) . available from http://www.census2011.co.in/census/state/maharashtra.html
[2]. Handbook on pre-conceptional and pre-natal diagnostic techniques act and rules with amendments and Ministry of Health and Family Welfare. Government of India 2006.
[3]. Truti Borulkar, P. L. Bhanap. Knowledge and attitude of sinologists towards PCPNDT act 2003. Global Research Analysis, vol 2 : 8, 149-150, 2013.
[4]. Dhaduk KM, Paarmar DV, Yadav .S. A study on doctors' perspective on PNDT act. Indian J Community MED, 34:160-161, 2009.
[5]. Rabin Biswas/April 8, 2011/India. District wise distribution of population, sex ratio, density and growth rate of population in Maharashtra 2011 census

Abstract: The use of ultrasonography has significantly improved the evaluation of fetal growth and development and has permitted prenatal diagnosis of a variety of congenital malformations.Campbell et al in (1968) studied fetal cephalometry in the second trimester and determined that the fetal head can be measured from 13th week of pregnancy². BinholzJ.C(1982) studied the new born cerebellar size both in full term and in preterm babies. To estimate the gestational age of the fetus by measuring transcerebellar diameter in normal and Intrauterine growth retarded pregnancies by ultrasonography and to evaluate whether the transcerebellardiameter or other parameters like biparietal diameter, head circumference, abdominal circumference is accurate for the gestational age.

Key Words: Cerebellar measurements, Ultrasonography, Fetal age.

[1]. Bettelheim, I.Deutingerand G.Bernashek.Fetal sonographic biometry. A guide to normal and abnormal measurements.1997.p-32-35.
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Abstract: Aims And Objective: Objective of the present study is to evaluate and assess the role of computed tomography in patients with craniocerebral trauma in respect to:
 study the different traumatic lesions in trauma to the head
 to establish that CT has a significant role in management of patients with head injury
 to assess the prognostic significance of CT in outcome of patients of head injury.
Methods:This is a prospective analysis of 100 patients with craniocerebral trauma using computed tomography who were treated at our institution from Nov 2009 to Oct 2011. Findings of the computed tomography using Helical CT scanner, GE CT machine were computed and compiled. Result: The results of the study revealed that the incidence of craniocerebral trauma was more in male population. The peak incidence of age was found in the age group of 18-30 years. Although fractures and contusions constituted about 84.6% and 57% respectively, subdural hematoma was commonest cause of morbidity and mortality in craniocerebral trauma forming about 32.1% followed by extradural hematomas 12.5% Conclusion: Computed Tomography is one of the comprehensive diagnostic modality for accurate localisation of the site of injury in acute craniocerebral trauma. The early and timely diagnosis of the precise lesion by CT not only had substantial impact over instituting appropriate treatment and timely surgical intervention but also helped in predicting the ultimate outcome.

Key Words: Craniocerebral trauma, Computed Tomography, Fractures, Epidural Hematomas, Subdural Hematomas, Contusions

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