iosr-JDMS   Volume-13 ~ Issue-8 ~ August-2014

Abstract: An asymptomatic 52 year old lady with Atrial Septal Defect of Ostium Secundum type with mild Pulmonary Hypertension was admitted in our hospital with complains of menorrhagia. After a thorough pre-operative evaluation, adequate preparation she underwent total abdominal hysterectomy under combined epidural and general anaesthesia. By providing proper intraoperative and postoperative care, patient was managed without any complication and was discharged home within a week.

Keywords: Atrial Septal Defect, Pulmonary Hypertension, Total Abdominal Hysterectomy, General Anaesthesia, Epidural Anaesthesia.

1] Harrison principles of internal medicine, 17th edition: 1459
[2] Alan D Kaye, Tyler B Stout, Ira W Padnos, Brian G Schwartz, Amir R Baluch, Charles J Fox et al. Left-to-right cardiac shunt: Perioperative anesthetic considerations. MEJ Anesth. 21(6) 2012
[3] AT Lovell. Anesthetic implications of grown up congenital heart disorders. Br J Anaesth. 2004;93:129-139
[4] Patrick A Calvart, Andrew A klein. Anesthesia for percutaneous closure of ASD. Continuing Education in Anaesthesia, Critical Care and Pain. 2008,Vol 8,No1
[5] Kaplan: Essentials of cardiac anaesthesia, 1st edition
[6] Pediatric cardiac anaesthesia 4th edition 2005

Abstract: Oral submucous fibrosis {OSMF} has been well established in Indian medical literature since the time of Sushruta, a renowned Indian physician who lived in the era 600 B.C and was termed as "Vidari".1 This condition was first described in the modern literature by Schwartz in 1953, who coined the term "Atrophica idiopathica mucosa oris". Joshi subsequently coined the termed oral submucous fibrosis for the condition in 1953.2 However there are various synonyms proposed by different authors such as "Diffuse oral submucous fibrosis", "Idiopathic scleroderma of the mouth", "Idiopathic palatal fibrosis", "Sclerosing stomatitis" and "Juxta-epithelial fibrosis".3Pindborg (1966) defined oral submucous fibrosis as, "An insidious, chronic disease affecting any part of the oral cavity and sometimes the pharynx. Although occasionally preceded by and/or associated with vesicle formation, it is always associated with juxta-epithelial inflammatory reaction followed by fibroelastic change of the lamina propria, with epithelial atrophy leading to stiffness of the oral mucosa and causing trismus and inability to eat

[1]. Schwartz J. Atrophia idiopathica (tropica) mucosa oris. Demonstrated at the 11th International Dental Congress, London 1953.
[2]. Joshi SG. Submucous fibrosis of the palate and pillars. Indian J Otolaryngol 1953; 4:1-4.
[3]. Pindborg JJ, Sirsat SM. Oral submucous fibrosis. Oral surg Oral med Oral pathol 1966 Dec; 22(6):764-779.
[4]. Rajendran R. Oral submucous fibrosis: etiology, pathogenesis, and future research. Bulletin of the World Health Organization 1994; 72(6):985-96.
[5]. Pindborg JJ, Chawla TN, Srivastava AN, Gupta D, Mehrotra ML. Clinical aspects of oral submucous fibrosis. Acta Odontologica Scandinavica1964 Dec;22:679–91.
[6]. Chiu CJ, Chang ML, Chiang CP, Hahn LJ, Hsieh LL, Chen CJ. Interaction of collagen-related genes and susceptibility to betel quid-induced oral submucous fibrosis. Cancer Epidemiol Biomarkers Prev. 2002 Jul; 11(7): 646-53.

Abstract: Aims: In this study, we evaluated the pre-operative administration of pregabalin sufficiency and security in relieving post-operative pain after lower limb surgery and reducing the need for opioids and their possible side-effects. Also we evaluated the use of perioperative dose of dexamethasone in relieving post-operative pain and effects on adverse effects in adult surgical patients undergoing lower limb surgery under spinal anaesthesia. Methods: This study is a randomized control trial. It was performed on 75 patients under lower limb surgery by spinal anesthesia. Patients were randomly allocated to three groups, Groups were named, Group C: No drug given, Group P : Tab. Pregabalin 300 mg given orally 1 hour before surgery, Group D: Inj. Dexamethasone 8 mg i.v.+ Tab. Pregabalin 300 mg given orally before 1 hour of surgery. In all three groups at 0, 2, 4, and 24 h after surgery, the patients were evaluated and the pain score, the score of sedation, incidence of nausea and vomiting was recorded. The results between the three groups were analysed statistically using "P‟ value obtained by "chi square test" and "unpaired t test". Results: Visual analog pain scores at all hours in pregabalin group significantly reduced compared to the placebo group. Also, in the pregabalin group nausea, vomiting and opioids consumption have significantly been reduced. Conclusion: A pre-operative oral dose of pregabalin reduces opioid consumption, improves postoperative analgesia, and yields higher patient satisfaction levels in patients undergoing lower limbs surgery.

Keywords: Pregabalin, Post operative pain, Opioid sparing effects.

[1]. MATHIESEN.O, .JACOBSEN.L.S, HOLM.H,.RANDALL.S, ADAMIECE.L, M LMSTROEM,B.K.GRAUNGAARD et al : pregabalin and dexamethasone for postoperative pain control,a randomized controlled study in hip arthroplasty; Br J Anaesth 2008;101:535-41.
[2]. V.SARASWAT,ARORA.: Preemptive gabapentin vs pregabalin for acute postoperative pain after surgery under spinal anesthesia,Indian J Anaesth 2008 ;52(6):829-834
[3]. Elina M. Tiippana, Katri Hamunen, Vesa K. Kontinen, Eija Kalso. Do Surgical Patients Benefit from Perioperative Gabapentin/Pregabalin? A Systematic Review
[4]. Scott S. Reuben, Asokumar Buvanendran, Jeffrey S. Kroin, Karthik Raghunathan, The Analgesic Efficacy of Celecoxib, Pregabalin, and Their Combination for Spinal Fusion Surgery. International Anaesthesia Research Society.2006;103(5):1271-1277
[5]. Romundstad L, Stubhaug A. Glucocorticoids for acute and persistent postoperative neuropathic pain: what is the evidence? Anesthesiology 2007; 107: 371–3

Abstract: Objective: To evaluate the awareness and practices regarding management of avulsed teeth among paediatricians in a district of north India. Methods: A multiple choice questionnaire comprising of 10 items was formulated to assess the knowledge, attitude and practices of medical professionals regarding first aid and management of "tooth loss" (Avulsion). The study involved a sample of 314 medical doctors who were either attached to the institutes or into private practice in the district of Lucknow, UP, India. Questionnaires were electronically mailed to 400 participants followed by a reminder email after fifteen days. If did not respond after 30 days, they were excluded from the study. The results are presented in percentages. Results: About one third (34.7%) of the participants had experienced children visiting to them with tooth avulsion. A large number of 62.7% participants stated that it would be wise to seek an immediate consultation with the dentist on the contrary to a small 15% who believed consultation was not required. Out of those participants who had witnessed patients reporting in their practice with avulsed tooth, 48.6% of them referred such patients to dentists immediately without intervening however, a small number of participants (17.4%) opted to place the tooth back into the socket and refer patients to dentists. Conclusion: A small percentage of practising about the avulsion teeth by the practitioners in this study indicates a serious problem for dental health. There is a need an educational campaign regarding this.

Key words: Avulsed teeth, Awareness, Paediatricians

[1]. Judd PL. Paediatric dental trauma: a hospital survey. Ont Dent 1985; 62(6):19-20,23.
[2]. Borum MK, Andreasen JO. Sequelae of trauma to primary maxillary incisors. I. Complications in the primary dentition. Endod Dent Traumatol 1998; 14(1):31-44.
[3]. Onetto JE, Flores MT, Garbarino ML. Dental trauma in children and adolescents in Valparaiso, Chile. Endod Dent Traumatol 1994; 10(5):223-7.
[4]. Kinoshita S, Mitomi T, Taguchi Y, Noda T. Prognosis of replanted primary incisors after injuries. Endod Dent Traumatol 2000; 16(4):175-83.
[5]. Heithersay GS. Replantation of avulsed teeth. A review. Aust Dent J. 1975 Apr;20(2):63-72.

Abstract: Fingerprints are classified and documented on the basis of ridge patterns. The impressions made by the pattern of any individual remain unchanged throughout life. The study was carried out on 400 individuals among which 200 were males and 200 were females subjects having different ABO blood groups, all the 10 fingerprints were divided into loops, whorl and arches. The results showed that majority of the subjects belonged to blood group O. The finger print pattern of loops had the highest frequency while arches were the least. Blood group O were mostly associated with the loop pattern while AB had the least frequency in all the fingerprint patterns. Males had the highest number with the loops and whorls while females had the highest number of arches. It was concluded that there was an association between distribution of fingerprint patterns, blood group and gender and thus prediction of gender and blood group of a person was possible based on the fingerprint patterns.

Keywords: Blood group, Fingerprints, Gender, Pattern, Relation

[1]. G. M. Bhat, M. A. Mukhdoomi, B. A. Shah and M. S. Ittoo, Dermatoglyphics: in health and disease - a review, International Journal of Research in Medical Sciences 2(1), 2014, 31-37.
[2]. S. S. Gornale, C. D. Geetha, and R. Kruth, Analysis of Fingerprint Image for Gender Classification. American International Journal of Research in Science, Technology, Engineering & Mathematics 1(1), 2013, 46-50.
[3]. V. J. Pillay, Textbook of Forensic Medicine and Toxicology (15th Ed. Hyderabad: Paras Medical publishers, 2009), 53-94.
[4]. T Kanchan, and S. Chaltopadhyay, Distribution of Fingerprint Among Medical Students. Journal of Indian Academy of Forensic Medicine 28(2), 1996, 65-68.
[5]. K Vij, Textbook of Forensic Medicine and Toxicology (3rd Edition, New Delhi: Elservier, 2005), 89-91.

Abstract: A case of Kyrle's disease in a known patient of Type 2 DM and CKD presented with left ventricular failure is reported. He had papulo-nodular brown lesions in both arms and legs on extensor surface characterized by central keratin plugs. Lesions were non-tender and numerous. Intense pruritus was present. He recovered with anti-failure regime and hemodialysis. Dermatological lesions were treated by Isotretinoin, vitamin A, Tretinoin cream and oral antihistamines.
Key Words: papulo-nodular lesions, keratin plug, pruritus, Isotretinoin,

[1]. Moss HV. Kyrle's disease. Cutis. 1979; 23: 463-466. PMID: 154994
[2]. Saray Y, Seçkin D, Bilezikçi B. Acquired perforating dermatosis: clinicopathological features in twenty-two cases. J Eur Acad Dermatol Venereol 2006;20:679-88. PMID: 16836495
[3]. Hinrichs W, Breuckmann F, Altmeyer P, Kreuter A. Acquired perforating dermatosis: a report on 4 cases associated with scabies infection. J Am Acad Dermatol 2004; 51: 665-667. PMID: 15389212
[4]. Faver IR, Daoud MS, Su WP. Acquired reactive perforating collagenosis. Report of six cases and review of the literature. J Am Acad Dermatol 1994;30:575-80. PMID: 8157784
[5]. Petrozzi JW, Warthan TL. Kyrle's disease. Treatmentwith topically applied tretinoin. Arch Dermatol 1974; 110: 762-765. PMID:4419046

Abstract: Ovarian torsion encountered during pregnancy carries significant risk to a pregnant woman and intrauterine foetus. In this case we report a 24 -year-old secondgravida with 14 weeks of pregnancy presenting with torsion of the left ovarian cyst. She presented to the Gynae. emergency with acute pain abdomen. She was diagnosed to have torsion of ovarian cyst with pregnancy and later emergency laparotomy followed by cystecomy was carried out. Her histopathology report showed a benign mucinous cystadenoma. Her pregnancy was followed up. She delivered a healthy female baby at term. Although the safety of antepartum surgical intervention has been accepted, abdominal surgery will always carry some risks to a pregnant woman and unborn foetus and so, before management , risks involved must be taken into consideration.

Key words: ovarian cyst torsion, pregnancy, mucinous cystadenoma

[1]. Kolluru V, Gurumurthy R, Vellanki V, Gururaj D.Torsion of ovarian cyst during pregnancy: a case report.Cases Journal 2009;2:9405. http://dx.doi.org/10.1186/1757-1626-2-9405 PMid:20090873 PMCid:2809077
[2]. Ventolini G, Hunter L, Drollinger D, Hurd WW: Ovarian torsion during pregnancy. [http://www.residentandstaff.com/issues/arti cles/2005-09_04.asp].
[3]. Lee CH, Raman S, Sivanesaratnam V:Torsion of ovarian tumors:a clinicopathological study.Int JGynaecol Obstet1989, 28:21-25.
[4]. Hart WR (January 2005). "Mucinous tumors of the ovary: a review". Int. J. Gynecol. Pathol. 24 (1): 4– 25. PMID 15626914
[5]. Yen CF, Lin SL, Murk W, Wang CJ, Lee CL, Soong YK, Arici A: Risk analysis of torsion and malignancy for adnexal mases duringpregnancy. Fertil Steril 2009, 91(5):1895-902

Abstract: Infancy and childhood are important landmarks in human physiology. This is the time when all the systems (including peripheral nervous system) of our body develops and gradually matures, to attain the normal state of adults. Peripheral nervous system development, is age dependent and begins in utero, hypo-developed at birth and attains maturity at the age of 5-6 years of age1. Electro physiologic values, therefore, change significantly in different age groups in first few years of life and are different from adult values2. However there is very little information about the progress of evolution of the peripheral nerves with its correlation with nerve conduction parameters3 Standard values of nerve conduction parameters are essential in evaluating normal development and infantile neuromuscular disorders4.

[1]. Shin J Oh, Clinical electromyography and nerve conduction studies Baltimore : University Park Press, 1984, P 107 – 139.
[2]. Parano Enrico , Uncini Antonio, De Vivo DC,. Lovelace Robert E ,: Electrophysiologic correlates of peripheral nervous system maturation in infancy and childhood, J. Child Neurol, 1993; 8 : 336-338.
[3]. Sertel H., Sosa M. De , Moosa A. : Peripheral nerve maturation in English, West Indian and Turkish newborn infants, Developmental Medicine and Child Neurology, 1976; 18 (4) : 493- 497.
[4]. Berciano J, Garica A, Calleja J, Antolin FM, : Peripheral motor and sensory conduction studies in normal infants and children, Clin Neurophysiol., 2000 ; III : 513 – 520.
[5]. Vecchierini-Blineau MF, Guiheneuc P. , : Motor nerve conduction velocity in children : normal values and application to a few pathologic cases, Rev. Electroencephalogr Neurophysiol Clin. 1984 Apr ; 13 (4) : 340- 348.
[6]. Kyoung Ja. Cho : Motor nerve conduction velocity in newborn infants and Children , Yansei Medical Journal, 1987; 28 (3) : 172-175.

Abstract: Kimura's disease is a chronic inflammatory disorder of unknown origin usually seen in adult males The most common clinical feature of this disease is an asymptomatic unilateral soft-tissue mass in the head and neck, frequently involving major salivary glands and lymph nodes. Bilateral involvement is rare. We herein report an uncommon presentation of this disease where an elderly female presented with bilateral auricular masses with multiple swellings in head and neck. Treated medically with steroids and antihistamine and no recurrence of the disease on follow up till date.

[1]. Takahashi S, Ueda J, Furukawa T, et al. Kimura disease. CT and MR findings. AJNR Am J Neuroradiol 1996; 17:382–385
[2]. Kase Y, Ikeda T, Yamane M, et al. Kimura's disease. Report of 4 cases with a review of 130 reported cases. Otolaryngol Head Neck Surg 1990; 63:413–418
[3]. Li T-J, Chen X-M, Wang S-Z, et al. Kimura's disease. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;82:549–555 1978 HIWATASHI AJNR: 20, November/December 1999
[4]. Hirokawa Y, Ikeda K, Ha-Kawa SK, et al. A case of eosinophilic lymphoid granuloma with fibrosis. Jpn J Clin Radiol 1987; 42: 357–360
[5]. Weiss LM, Chan WC, Schnitzer B. Anderson's Pathology. 10th ed. St. Louis: Mosby; 1996:1137

Abstract: Adolescence is a journey from the world of childhood to the world of adulthood. In India adolescents constitute 21.4% of the population that comprises one-fifth of the total population. The health and nutritional status of the children is an index of the national investment in the development of future manpower. Thus present study was undertaken to assess the nutritional status of school going adolescent girls in semi urban area of West Bengal. This study was conducted among 746 school children of 11-18 years studying in four girls' schools in Hooghly district. School was selected by simple random sample in two municipality areas. Nutritional status was evaluated using anthropometric indicators recommended by WHO(World Health Organization) experts committee. Height for age below 3rd percentile of NCHS (National Centre for Health statistics) /WHO reference values was classified as stunting. Thinness was defined as BMI-for-age <5th percentile of WHO/NCHS standard data. Over weight and obese were defined as BMI-for –age >85th percentile and >95th percentile respectively. The present study highlight the duel burdens of underweight and overweight in semi urban adolescent girls. Overweight is more urgent problem than underweight. Lifestyle (physical activity and fast food intake habit) was one of the contributing factor of overweight. To minimized both forms of malnutrition, it is essential to educate and create awareness programmes at the community levels. Health education programmes and effective policies are urgently required to promote healthy eating and physical activity.

Keywords: Adolescent girl, nutritional status, fast food, physical activity

[1]. Parimalavalli R, Sangeetha M. Anthropometric measurements and nutrient intake of adolescent girls. Anthropologist. 2011; 13(2): 111-115.
[2]. Gopalon C, Sastri BP, Balasubramanian SC. Nutritive value of Indian foods. Hyderabad; National Institute of Nutrition (ICMR); 2001. .
[3]. Mukhopadhyay A, Bhadra M, Bose K. Anthropometric assessment of nutritional status of adolescents of Kolkata, West Bengal. J human Ecol. 2005; 18(5): 213-216.
[4]. Caballero B. The global epidemic of obesity: an overview. Epidemiologic review. 2007; 29(1): 1-5.
[5]. Doak CM, Adair LS, Monteiro C, Popkin BM. Overweight and underweight coexist within households in Brazil, china and Russia. J Nutr. 2000; 130(12): 2965-2971.

Abstract: Introduction: The aim of this study was to evaluate the opinions of a cross-section of 12-18 year - old Nigerians about dental aesthetics and to compare the report with their self – perceived need for orthodontic treatment. Methods: A structured questionnaire was administered to 612 12-18 year - old Nigerian adolescents who were randomly selected from 6 secondary schools in South- South Nigeria to assess their opinions of dental aesthetics, whilst the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN) was used to assess their self- perceived orthodontic treatment need. Results: Majority (78.1%) of the population expressed satisfaction with the arrangement of their teeth, whilst 82% did not perceive any need for orthodontic treatment (AC Grades 1-4). Their self – perceived orthodontic treatment need was found to increase as their satisfaction with the arrangement of their teeth decreased. Conclusions and recommendations: Although majority of the adolescents realized the importance of dental aesthetics, there was a general low awareness of the presence of their malocclusions. We are recommending that populations in this area be more enlightened on the presence and treatment of malocclusion.

Keywords: Opinion, Dental attractiveness, Treatment need, Nigeria

[1]. Shaw WC. The influence of children's dentofacial appearance on their social attractiveness as judged by peers and lay adults. Am J Orthod 1981; 67: 399- 415.
[2]. Shaw WC, Rees G, Dawe M, Charles CR. The influence of dentofacial appearance on the social attractiveness of young adults. Am J Orthod 1985; 87: 21- 26.
[3]. Helm S, Petersen PE, Kreiborg S, Solow B. Effect of separate malocclusion traits on concern for dental appearance. Community Dent Oral Epidemiol 1986; 14: 217-220.
[4]. Kerosuo H, Hausen H, Laine T, Shaw WC. The influence of incisal malocclusion on the social attractiveness of young adults in Finland. Eur J Orthod 1995; 17:505-512.
[5]. Mugonzibwa EA, Kuijpers-Jagtman AM, Van't Hof MA, Kikwulu EN. Perceptions of dental attractiveness and orthodontic treatment need among Tanzanian children. Am J Orthod Dentofacial Orthop 2004; 125:426- 434.

Abstract: Background: India contributes one fourth of total world maternal deaths. Millennium Development Goal set to reduce maternal mortality upto or less than 109 per lakh of total live births which is far away from present level specially in Rajasthan2 Objective: To know the trend of maternal deaths occurring in last five year (2005-2009). Materials and Methods: Records of verbal autopsies of maternal deaths occurred in Mahila Chikitsalya Jaipur since 1st Jan. 2005 to 31st Dec. 2009. Available data in the autopsy records of maternal deaths were collected and then these data were entered in MS Excel 2007 worksheet. These data were classified and presented in percentage and proportion. Chi-square and ANOVA test of significance were used to interpret data. Results: Overall 193 maternal mortality per lakh of total live births was observed in year 2005-2009 with maximum MMR in 2008 (236/lakh TLBs) and minimum MMR in Year 2009 (133/lakh TLBs) which has significant variation. Total 133 maternal deaths occurred in study period of five years. Although maximum maternal deaths (69 i.e. 51.88%) occurred in 21 to 25 years group but age-wise variation was not found significant (p>0.05). Maternal deaths were significantly more in un-booked cases, within 24 hours of addimission and in post-partum period with rural predominance than unbooked cases, after 24 hours of addimission, in other maternal death period and urban females respectively. Conclusions: Maternal deaths were found to significantly vary with time but not with season and age of mother. These deaths were also found significantly more in un-booked cases, within 24 hrs of addimission and in post-partum period with rural predominance than their counterparts

Key words: Maternal deaths, Trend, Verbal Autopsy, MMR, TLBs

[1]. Murthy BK, Murthy MB, Prabhu PM. Maternal mortality in a Tertiary care Hospital: A 10 year Review. Int J Pre. Med; 2013 Jan 4(1): 105-9

[2]. World Health Organization (WHO), UNICEF, UNFPA, and The World Bank estimates. Trends in maternal mortality: 1990 to 2010. Department of Reproductive Health and Research WHO; 2012

[3]. World Health Organisation: Health and millennium development goals. Geneva: World Health Organisation; 2005.

[4]. IIPS (2010) District level household and facility survey (DLHS-3) 2007–2008: India. Mumbai: International Institute for Population Sciences

[5]. Barros AJD, Ronsmans C, Axelson H, Loaiza E, Bertoldi AD, et al. (2012) Equity in maternal, newborn, and child health interventions in countdown to 2015: a retrospective review of survey data from 54 countries. Lancet 379: 1225–1233. Doi: 10.1016/s0140-6736(12)60113-5

Abstract: Periodontal disease is defined as an inflammatory reaction to a microbial infection associated with dental plaque that, results in tissue loss. Neutrophils or polymorphonuclear leucocytes (PMNs) play a critical role as a part of the innate immune response acting as a first line of defense against these invading microbes[1]. The presence of leucocytes in the oral cavity has attracted interest for many years. Calonius in 1958 compared the salivary leucocyte count in patients with healthy and inflamed gingiva and edentulous patients and found that the levels were least in edentulous patients and highest in patients with gingivitis thus suggesting that leucocytes enter the saliva through the gingival sulcus[2]. This was also confirmed by studies done by Schiott and Loe in1970[3]. In the healthy periodontium of both humans and experimental animals, PMNs have been demonstrated migrating towards or residing within the sulcular and junctional epithelium and within the underlying connective tissue[4]. With plaque accumulation and the development of clinical inflammation there is an increase in the number of leucocytes present in the lesion[5,6,7]. The location of PMNs at the plaque interface, their phagocytic activity and signs of lysosomal enzyme release give morphological evidence that these cells, may on one hand, protect the tissue from bacterial attack but on the other hand, may induce tissue damage and increased inflammation via release of lysosomal enzymes. Thus, high numbers of subgingival leucocytes could possibly indicate an active periodontal lesion[8]. Subgingival leucocyte counts maybe useful in identifying sites with active periodontal disease.Many efforts have been made to find reliable parameters for the diagnosis and prognosis in periodontology.

[1]. Dyke TE, Vaikuntum J. Neutrophil function anddysfunction in periodontal disease. CurrOpinPeriodontol1994; 28:19-27.
[2]. Calonius PEB. The leucocyte count in saliva. Oral Surg1958;11: 43-6.
[3]. Schiott CR, Loe H. The origin and variation of number ofleucocytes in human saliva. J Periodont Res 1970; 5: 36-41.
[4]. Attstrom R. Presence of leucocyte in crevices of healthyand chronically inflamed gingivae. J Periodont Res 1970;5:42-7.
[5]. Shroeder HE, Graf-de Beer M, Attstrom R. Initial gingivitisin dogs. J Periodont Res 1975;10:128-42.
[6]. Lindhe J, Rylander H. Experimental gingivitis in young dogs.Scan J Dent Res 1975; 83: 314-26.
[7]. Payne WA, Page RC, Ogilvie AC, Hall WB. Histologicalfeatures of initial and early stages of experimental gingivitisin man. J Periodont Res 1975; 10: 51-64.

Abstract: An enterocutaneous fistula (ECF) is a potentially catastrophic postoperative complication. Although the morbidity and mortality associated with ECF have decreased over the past 50 years with modern medical and surgical care, the overall mortality is still surprisingly high, up to 39% in recent literature. It seems prudent, then, for every surgeon to have a thorough grasp of optimal treatment strategies for ECF to minimize their patients' mortality. Ultimately, the algorithm must begin with prevention. Once an ECF is diagnosed, the key to managemnet is to resuscitate and treat sepsis, to control fistula output, to optimize the patient medically and nutritionally and definitive restoration of gastrointestinal continuity. Special mention is given in this article to complicated fistulas such as those with high output,abdominal sepsis and large abdominal defects.There is stress on diversion of fecal matter through ileostomy at a normal site of intestines at a distance of fistula site and damage/devitalized and inflammed gut(Proximal loop ileostomy) and fistula repair at comparatively early stage to prevent the further complications of sepsis and malnutrition.This plan gives a framework for the difficult task of successfully treating the postoperative ECF with a multidisciplinary approach.

Keywords: Enterocutaneous fistula, nutritional support, sepsis, Proximal loop ileostomy

[1]. Kumar P, Maroju NK, Kate V. Enterocutaneous fistulae: etiology, treatment, and outcome - a study from South India. Saudi J Gastroenterol. Nov-Dec 2011;17(6):391-5.
[2]. Berry SM, Fischer JE. Classification and pathophysiology of enterocutaneous3.fistulas. SurgClin North Am. Oct 1996;76(5):1009-18.
[3]. Edmunds LH Jr, Williams GH, Welch CE. External fistulas arising from the gastro-intestinal tract. Ann Surg. Sep 1960;152:445-71.
[4]. Fischer PE, Fabian TC, Magnotti LJ, et al. A ten-year review of enterocutaneous fistulas after laparotomy for trauma. J Trauma. Nov 2009;67(5):924-8.
[5]. Falconi M, Sartori N, Caldiron E, et al. Management of digestive tract fistulas. A review. Digestion. 1999;60Suppl 3:51-8.

Abstract: The sugar substitutes also may also be called as alternative, artificial, high-intensity, or non-nutritive sweeteners, can replace the sweetness of sugar while providing few or no calories. In addition to the calorie savings, these sugar substitutes have the advantage of not promoting tooth decay, and they are useful in dietary planning for people who are coping with obesity or diabetes. Sugar substitutes includes both food ingredients with very strong sweetening power that provide zero or very few calories, which are used in very small amounts to sweeten foods, and bulk sweetening agents such as polyols, which can replace both the bulk of sugar and some of its sweetness. The availability of a variety of safe sugar substitutes is of benefit to consumers because it enables food manufacturers to formulate a variety of good-tasting sweet foods and beverages that are safe for the teeth and general health.

Keywords: artificial-sweeteners, aspartame, sugar-substitutes, xylitol, sucrose

[1]. Gordon Nikiforuk. Understanding dental caries. Karger publishing company: 204-22.
[2]. Norman O. Harris: Primary Preventive Dentistry 6th edition; 399-418.
[3]. Ernest Newbrun. Sugar substitutes and noncaloric sweetening agent.1989; cariology 3rd Edition; quintessence publishing; pp.136-166.
[4]. Brian A. Burt The Future of the Caries Decline. Journal of Public Health Dentistry. 1985; 45 (4), 261–269.
[5]. Isokangas P. Xylitol chewing gum in caries prevention. A longitudinal study on Finnish school children. Thesis, Proceedings of the Finnish Dental Society.1987; 83: (I) 1-117.

Abstract: Background:Hyaluronic acid showed the anti-inflammatory, anti- edematous, anti-oxidant, and bacteriostatic effect on periodontal disease; the potential benefits of the periodontal effect of a single dose of hyaluronic acid on the clinical parameters were evaluated in this study. Methods: Thirty patients with chronic periodontitis were recruited to participate in this study. They were divided into three groups; the first group (10 patients) was treated with SRP and 8% hyaluronic acid gel was additionally applied, the second group (10 patients) was treated with SRP, and the third group (10 patients) was treated with 8% hyaluronic acid gel only. The clinical parameters which include Plaque index (PLI),Gingival index (GI), Bleeding on probing(BOP) and Relative Attachment level wereassessed at base line , one week and four weeks post treatment. Hyaluronic gel was administered subgingivally in the test sites at baseline Results:The main results of the three treated groups was summarized as follows: 1. A significant reduction in bleeding on probing and RAL was observed in all groups after four weeks (P <0.05), 2. Significantly lower bleeding on probing were observed in the hyaluronan groups, group 1and 3 compared to group 2 after 4 weeks (P <0.05), 3. RAL reductions between the groups were statistically significant. Conclusion:The local applications of hyaluronan gel (0.8%) in conjunction with scaling and root planning or used it only have a beneficial effect on clinical periodontal parameter in patients with chronic periodontitis.

Key word: Hyaluronic acid; root planning; periodontitis

[1] F. A. Caranza, Clinicalperiodontology (9thedition.Philadelphia.WBSaundersCompany, 2009).

[2] J. Lindhe, T. Karring, and P. L. Niklans, Clinical periodontology and implant dentistry(Munksgaard,Copenhagen, 2008)

[3] K. E. Fenesy, Periodontal disease (An OverviewforPhysicians.MtSinaiJMed, 1987).
[4] V. W. Spolsky, Epidemiology of gingival and periodontal disease (In Clinical Periodontologyedt.ByCarranzaFandNewmanM.8thed.WBSaunders,USA, 1996).

[5] K. G. König andJ. M. Navia,Nutritional role of sugars in oral health. Am. J. Clin. Nutr. 1995 62: 275S-282S. Online ISSN: 1938-3207

[6] M. Nakamura, M. Hikida, T. Nakano, S. Ito, T. Hamano, S. Kinoshita,Characterization of water retentive properties of hyaluronan(Cornea, 1993).