iosr-JDMS   Volume-13 ~ Issue-1 ~ January-2014

Abstract:Carcinoma of the pancreas is a common gastrointestinal neoplasm all over the world. It is the fourth most common cause of cancer related deaths in the United States of America. Though the disease is not as common in Africa compared to America and Europe, the incidence is however on the increase in Africa. Generally,the prognosis is poor especially in Africa, mainly because of late presentation. We reviewed the pattern of presentation and management outcome of patients with obstructive jaundice 20 to carcinoma of the pancreas from a prospectively kept data basein a dedicated Hepato-Pancreato-Biliary (HPB) Surgery Unit over a four year period (July, 2008 – June, 2012).A total of fourteen patients were seen with this condition during the study period. There were more females than males with a ratio of 2.5:1. The age range was 40-80years with a mean age of 58yrs. The commonest mode of presentation was a combination of jaundice, pruritus and weight loss. The presence of jaundice with pruritus were the principal symptoms that brought these patients to the hospital. Late presentation is common in our environment and prognosis is poor.
Keywords: Calabar, HPB surgery unit, obstructive jaundice, Pancreatic cancer.

[1] A BLowenfels, PMaisonneuve.Epidemiology and Prevention of Pancreatic Cancer.JpnJ. Clin. Oncol.34 (5),2004,238-244.
[2] EQ Archampong. Pancreas.In :EA Badoe, EQ Archampong, JT da-Rocha-Afodu,eds. Principles and Practice of Surgery –Including Pathology in the Tropics. 4th Ed. Accra: Assemblies of God Literature Centre Ltd. 2009, 783-787
[3] CA Onyekwere, JC Ojukwu: The Epidemiologic profile of pancreatic cancer and management outcome in Lagos, Nigeria. Pak J Med Sci, 24(2),2008,340-343
[4] OG Ajao, AA Abioye. Pancreatic Carcinoma. J Nati Med Assoc 72(6),1980,580-596
[5] S Bhattacharya. The Pancreas. In NS Williams, CJK Bulstrode,P R O'Connell ,eds. Bailey and Love's Short Practice of Surgery,25thEd. London: Edward Arnold 2008,1148-1152 .
[6] J Smith III , C Baugh , T Reppun. Obstructive Jaundice Secondary to Pancreatic Adenocarcinoma in a seven year old male. J Pediatric Surg,20(2): 184 – 185
[7] E K Wiredu, H B Armah. Cancer Mortality Patterns in Ghana: a 10-year review of autopsies and hospital mortality. BMC Public Health ,6,2006, 159
[8] M L Steer. Exocrine Pancreas.In M Courtney ,R Beauchamp ,B Evers ,K Mattox ,eds.Sabiston Textbook of Surgery,17thEd.Elsevier Saunders 2004,1667-74
[9] OI Alatise, OO Lawal, OT Ojo.Challenges of Pancreatic Cancer Management in a Resource Scarce Setting.East and Central African Journal of Surgery 15( 2),2010 52-58
[10] F G El Kamar, M L Grossbard ,P SKozuch.Metastatic Pancreatic Cancer: Emerging Strategies in Chemotherapy and Palliative Care.The Oncologist ,8(1),2003,18-34.

Abstract: Background: Anterior abdominal wall fibroid is uncommon and could be a cause of pain and discomfort. Very few cases have been reported in the literature but none from our region. Case presentation: Hence we present an uncommon case of a 45 year old para 2+2 who presented with a one year history of a right iliac fossa mass, had surgical removal of the mass and histology report revealed Leiomyoma. Conclusion: Abdominal wall fibroid is a good differential diagnosis to be considered in any woman of reproductive age with an anterior abdominal mass with previous uterine surgery, including laparoscopic surgeries, which is very rare entity in tubectomy
Keywords: Leiomyoma, Anterior abdominal wall.

[1] Porter KB, Tsibris JC, Nicosia SV, Murphy JM, O'Brien WF, Rao PS, et al. Estrogen- induced guinea pig model for uterine leiomyomas: do the ovaries protect? Biol Reprod 1995, Apr; 52(4):824-832.10.1095/biolreprd52.4.824.

[2] Lalor PF, Uribe A, Daum GS. De novo growth of a large preperitoneal lipoleiomyoma of the abdominal wall. Gynecol Oncol 2005. May;97(2):719-721.10.1016/j.ygyno.2005.01.050.

[3] Stewart EA, Friedman AJ. Steroidal treatment of myomas: Preoperative and long term medical therapy. Semin Reprod Endocrinol 1992;10:344-357.10.1055/s-2007-1018893.

[4] Ostrzenski A. Uterine leiomyoma particle growing in an abdominal-wall incision after laparoscopic retrieval. Obstet Gynecol 1997. May;89(5 Pt 2):853-854.10.1016/S0029-7844(97)81428-7.

[5] Abdominal Wall after Laparoscopic Myectomy. Fertil Streil. 2008 Apr 12. Epub Ahead of Print.

[6] Kumar S, Sharma JB, Verma D, Gupta P, Roy KK, Malhotra N. Disseminated peritoneal leiomyomatosis: an unusual complication of laparoscopic myomectomy. Arch Gynecol Obstet 2008. Jul;278(1):93-95.10.1007/s00404-007-0536-9.
[7] Schindle M, Birner P, Losch A, Breitenecker G, Joura EA. Preperitoneal Lipoleiomyoma of the Abdominal wall in a postmenopausal woman. Maturitas 2001;30:189.10.1016/S0378-5122(01)00271-7.

[8] Nair S, Al-Hendy A. Adipocytes enhance the proliferation of human leiomyoma cells via TNF-á Proinflammatory cytokine. Reprod Sci 2011;8(12):1186- 192.10.1177/ 1933719111408111.

[9] Wada Hiraike O, Yamamoto N, Osuga Y, Yano T, Kozuma S, Taketani Y, Aberrant implantation and growth of uterine leiomyoma in the abdominal wall after laparoscopically assisted myomectomy. Fertil.Sterilit. 2009; 92(5):1747.e13-1747.e15.

[10] Yamaguchi T, Imamura Y, Yamamoto T, Fukuda M. Leiomyomatosis peritonealis disseminata with malignant change in a man. Pathol Int 2003. Mar;53(3):179-185.10.1046/j.1440-1827.2003.01452.x11. Berhan Y, Isehak A, Legesso S, Tsegaye B. Pseudo-Meig's syndrome: parasitic leiomyoma with ascites in a 52-year old lady. Ethiop Med J 2003. Oct;41(4):363-366.

Abstract: Anchorage in orthodontics is always a challenging situation. Use of mini-screw implants in orthodontics has solved this problem to the large extent. Here is a case of 22 years old male patient with critical anchorage that requires intrusion& retraction of upper incisors and lower left molar protraction which was in end-on relation with upper molar. Case treated successfully using mini-screw implants by simultaneous intrusion, retraction & protraction to achieve class I molar relation and pleasant profile.
Keywords: Anchorage, Intrusion, Mini-screw Implants, Protraction, Retraction.

[1] Lincoln AA. Anchorage in Orthodontia. D. Items Interest 1936;42:381–384
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[5] M. Bae, H. S. Park, H. M. Kyung, O. W. Kwon, and J. H. Sung, "Clinical application of micro-implant anchorage. Journal of Clinical Orthodontics2002; 36:(5)298–302.

[6] A. Carano, S. Velo, P. Leone, and G. Siciliani, "Clinical applications of the Miniscrew Anchorage System. Journal of Clinical Orthodontics2005;39: (1) 9–24.

[7] H. S. Park, "A new protocol of the sliding mechanics with micro-implant anchorage (MIA)," Korean Journal of Orthodontics 2000; 30:677–685.

[8] H. S. Park, O. W. Kwon, and J. H. Sung, "Microscrew implant anchorage sliding mechanics," World Journal of Orthodontics 2005; 6: 265–274,.

[9] M. H. Jung and T. W. Kim, "Biomechanical considerations in treatment with miniscrew anchorage. Part 1: the sagittal plane," Journal of Clinical Orthodontics 2008; 42: 79–83.
[10] Kyung H, Park H, Bae S , Sung J, and Kim I. Development of orthodontic micro-implants for intraoral anchorage. Jr. ClinOrthod2003; 37:321–328.

Abstract: Quest for newer material are never ending especially in the field of dental science. Various materials have been formulated, tested, and standardised to obtain maximum benefits for good clinical performance .One such new material which was introduced is Biodentine which has numerous clinical applications. An ideal orthograde or retrograde filling material should seal the pathways of communication between the root canal system and its surrounding tissues. It should also be non toxic, non cariogenic, biocompatible, insoluble in tissue fluids, and dimensionally stable. Since existing materials did not have all these ideal characteristics, a new bioactive cement – Biodentine was introduced with all these ideal properties. It overcomes the drawbacks of Calcium hydroxide and Mineral trioxide aggregate. It is a promising material for repair of perforations of the pulpal floor, apexifications, open immature tooth, retrograde filling, pulp therapy. In this article the availability, composition, manipulation, mechanism of action, properties, clinical implications of biodentine has been reviewed.

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[2] Tay et all 2007,Reyes-Carmona et al. 2009, Torabinejad&parirokh 2010.
[3] About I: Bioactivity of BiodentineTM: A Ca3Si05-based Dentine Substitute. Oral session, IADR Congress, Barcelona 2010.
[4] Till Dammaschke et al.THE dentist SEPTEMBER 2011;Direct pulping.
[5] Biodentine induces TGF-Beta 1 release from Human pulp cells and early dental pulp mineralization: DOI: 10.1111/j. 22 DEC 2011 1365-2591.2011.01995.x.
[6] Saidon et al., 2003 Shayegan et al., 2010.
[7] Laurent P, Camps J, About I,.Biodentine induces TGF-ϐ1 release from human pulp cells and early dental pulp mineralisation. Int Endod.J, 45(5),2010,439-48.
[8] Marjorie Zanihi, Jean Michel Sautier, Ariane Berdal, Stephane Simon.,Biodentine Induces Immortalized Murine Pulp Cell Differentiatiion into Odontoblast-like cells and Stimulates Biomineralisation. Journal of Endodontics.;38(9) Sep2012,1220-1226.
[9] Clinical evaluation of the performance and safety of a new dentine substitute, Biodentine, in the restoration of posterior teeth- a prospective study DOI 10.1007/s00784-012-0701-9.
[10] L.grech, B.Mallia, J.Camilleri.,Investigation of the physical properties of tricalcium silicate cement based root end filling materials. Dental Materials, 29(2), Feb2013, 20-28.

Abstract: In the present case of chronic cough, sputum sample was sent to laboratory to rule out fungal etiology. An interesting structure was observed on 10% KOH preparation and was categorized as exoskeleton of nymphal stage of Pediculus capitis. Though an artifact, a literature search revealed no such observation so far from sputum.
Keywords: sputum examination, exoskeleton of Pediculus capitis.

[1]. Longo, Fauci, Kasper, Hauser, Jameson and Loscolzo: Harrison's Principle of Internal Medicine 18th ed, Vol 1. Mc Graw Hill Medical ;2012, p.1340
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[3]. Burgress IF. Current treatments for pediculosis capitis. Curr Opin Infect Dis 2009; 22: 131-136.
[4]. Georgia Department of Public Health; Head Lice Manual; pages 5-7; pdf on internet accessed on 15/3/2013
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[6]. Pariser DM, Meinking TL, Bell M, Ryan WG: Topical 0.5% Ivermectin Lotion for Treatment of Head Lice. ; N Engl J Med. 2012;367:1687-1693.

Abstract: Flexible endoscopy is most commonly used & sensitive technique for early diagnosis of patients presenting with upper GI (gastrointestinal) symptoms & has got therapeutic potentials also. Aim of the study: Prospective analysis of 500 cases of upper GI endoscopy done at Tata main hospital to know about its diagnostic efficacy and prevalence of H. (helicobacter) pylori in upper GI diseases. Materials & methods: a prospective study was conducted in the department of surgery at Tata main hospital from Aug07 to Aug09. All patients presenting with various upper GI symptoms such as dyspepsia, dysphagia, haematemesis, malaena, recurrent vomiting & features of gastric outlet obstruction underwent endoscopy on OPD basis & data analysed. Results: Among the 500 cases,53.2% had duodenitis,48.2% had gastritis,18.6% had duodenal ulcer,6.6% had gastric ulcer,21.4% had erosive duodenitis & gastritis,15.6% had esophagitis,8.4% had esophageal varices,1.2% had duodenal polyps,2.2% had ca esophagus,2.8% had ca stomach & 1.4% had hiatus hernia. Among the 322 cases sent for crush smear for H.pylori 67.4% were positive and 2.4% of the H. pylori positive cases had failure of the triple regimen therapy.
Keywords: Efficasy, endoscopy, helicobacter pylori, prevalence, prospective.

[1] Avunduk C, Barry B, Kim J, Aversa F, Warnock CJ, Gast P, editors. manual of gastroenterology: diagnosis & therapy.3rd ed. Lippincott William's & Wilkins; 2002. p. 14-19
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Abstract: Worldwide, the risk for infectious vaginitis in young women generally starts as sexual activities begin. These infections may lead to long-term sequels including pelvic inflammatory disease, infertility, and cervical cancer. So the study aimed to establish the different prevalence of lower genital tract infections in symptomatic non-pregnant females complaining infertility attending gynecology clinic. We analyzed total 920 women for the presence of Gardnerella vaginalis, Trichomonas vaginalis, Candida species, Streptococcus agalactiae, Enterobacteriaceae and Enterococci. Their association with presence of lactobacilli and polymorphs were also seen. In our study population, high percentage of isolation of Enterobacteriaceae, Streptococcus agalactiae, and Enterococci with high percentage of antimicrobial resistance against routinely used antibiotics, suggest the importance of vaginal discharge culture and sensitivity in routine practice. We observed highest prevalence of bacterial vaginosis in our study population. Mono-microbial infection was more common than multi-microbial infection. Moreover absence of lactobacilli and presence of polymorphs came out to be important indicators for presence of these infections and to consider the health status of female urogenital tract. Our findings suggest that symptomatic female should be screened for these infections as the consequences may be up to infertility.
Keywords: Vaginitis; Infertility; Lower genital tract infection; Symptomatic females.

[1] Casari E, Ferrario A, Morenghi E, Montanelli A. Gardnerella, Trichomonas vaginalis, Candida, Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum in the genital discharge of symptomatic fertile and asymptomatic infertile women. New Microbiologica 2010;33:69-76.
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[6] McClelland RS. Trichomonas vaginalis Infection: Can We Afford to Do Nothing? The Journal of Infectious Diseases 2008;197:487–9.
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[8] Sciarra J. Infertility: an international health problem. Int J Gynaecol Obstet 1994;46:155–63.
[9] Honig E, Mouton JW, Van Der Meijden WI. The epidemiology of vaginal colonisation with group B streptococci in a sexually transmitted disease clinic. Eur. J. Obste. Gynecol. Reprod. Biol. 2002;105(2):177- 180.
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Abstract: Computer science has evolved into the field of dentistry many years ago. Newer addition is CADCAM. In this study we assessed the knowledge of dental undergraduate in Chennai towards the technology and mechanics of CADCAM.
Methods: In this study we considered 600 undergraduate students in studying in different institutions in Chennai to participate in a questionnaire survey on knowledge of CADCAM. Pearson Chi square test was used for analysis. The students were categorised into 3 groups namely Interns, Final years and Third years. Results: 525 responders were considered valid for analysis. The level of knowledge was significantly higher in Interns (p<0.001). Moreover the knowledge and awareness of CADCAM has improved with the increase in grade.
Keywords: CADCAM, Questionnaire study, undergraduate dental students, History.

[1] Icons of dentistry: Dr Leon Eisnebud: J.Oral Implantology, 2006;32(2):53-4
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[8] Miyazaki T, Hotta Y, Kunii J, Kuriyama S,Tamaki Y. A review of dental CAD/CAM:current status and future perspectivesfrom 20 years of experience. Dent Mater J 2009;28:44-56.
[9] Daniel J. Poticny and James Klim; CAD/CAM In-office Technology: Innovations After 25 years for predictable, Esthetic Outcomes. JADA 2010;141(suppl 2):5S-9S.
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Abstract: Duchenne muscular dystrophy (DMD) is a life threatening disease which mostly occurs due to deletions in the dystrophin gene. The deletions are reported to be clustered in two main regions in the gene involving nearly one fourth of exons. These regions also represent major meiotic recombination hotspots. The detection of deletions/mutation-hotspots in the coding sequences (exons) is not much possible till date due to the gene specific-potential variations or the complex organization of introns and exons in the gene. A Digital signal processing (DSP) method based on antinotch filter that exploits the period-3 property of a DNA sequence is applied for the identification of exons in DNA sequences by providing concerned peaks in magnitude-plot. A two digit numerical representation has been proposed for generating indicator sequence. In our approach to detect deletion in DMD gene, all-exon-sequence was taken and analyzed through digital filter to obtain normal peaks in the plot, which was than compared with the plots obtained after deletion of hotspot exons one by one. It was found that most of the hotspot exons share the peaks and deletions are marked by significant modifications in peaks. Thus, it was known that the peaks in filter-plot of DMD gene are associated with the location of the hotspots and their modifications/absence can be utilized to detect the deletions of exons.
Keywords: Exon, exon-deletion, hotspot, DMD, antinotch filter.

[1] A.G. Engel and E. Ozawa, Dystrophinopathies, in A.G. Engel and L. C. Franzini-Armstrong, (Ed.) Myology. Basic and clinical, 3rd ed. Vol 2. (New York: McGraw Hill, 2004) 961-1025.
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[6] A.P. Monaco, R. L. Neve, C. Colletti-Feener, et al., Isolation of candidate cDNAs for portions of the Duchenne muscular dystrophy gene, Nature, Oct 16-22. 323(6089), 1986, 646-650.
[7] M. Koenig, E. P. Hoffman, C. J. Bertelson, et al., Complete cloning of the duchenne muscular dystrophy (DMD) cDNA and preliminary genomic organization of the DMD gene in normal and affected individuals, Cell, 50, Issue 3, 1987, 509-517.
[8] A. H. Ahn, L. M. Kunkel, The structural functional diversity of dystrophin, Nature Genetics, 3(4), 1993, 283-91.
[9] J. Yan, J. Feng, C. H., Buzin, et al., Three-tiered noninvasive diagnosis in 96% of patients with Duchenne muscular dystrophy (DMD), Hum Mutat., 23, 2004, 203–204.
[10] K. M. Dent, D.M., Dunn, A. C. von Niederhausern, et al., Improved molecular diagnosis of dystrophinopathies in an unselected clinical cohort, Am J Med Genet A, 134, 2005, 295–298.

Abstract: Local debridement in the diseased pulp space is the main step in root canal treatment to prevent the tooth from being a source of infection. In this review article, requirements for irrigating solutions, chlorhexidine as an endodontic irrigant, its mechanism of action, characteristics like substansivity, adhering property to dentin and new formulations which are chlorhexidine based are spelled out. Chemical and toxicological concerns related to their use are discussed, including different approaches to enhance local efficacy without increasing the caustic potential. Based on the actions and interactions of currently available solutions, a clinical irrigating regimen is proposed.
Keywords: Chlorhexidine, ChlorXtra, Chlor plus, QMiX, Substansivity.

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Abstract: Aim: Extended spectrum β-lactamases are transferable plasmid mediated resistance mechanisms found mainly among Enterobacteriaceae which confer resistance to numerous β-lactam antibiotics. The aim of the study was to determine the rate of rectal colonization of surgical patients with Escherichia coli carrying extended spectrum β-lactamases. Subjects and methods: We collected and cultured rectal swabs from 192 surgical patients in the University of Calabar Teaching Hospital, Calabar, Nigeria. Escherichia coli isolates were identified and antibiotics susceptibility performed using Modified Kirby-Bauer disc diffusion technique. Isolates showing zones of inhibition to third generation cephalosporins below Clinical and Laboratory Standard Institute recommended break-points were screened for ESBL-production by the double-disk synergy method.
Keywords: ESBL, Escherichia coli, Hospital Acquired Infections, Infection Control, Surgical Sites Infections.

[1] Egbebi, AO, Famurewa OJ. Prevalence of extended spectrum beta-lactamase (ESBL) production among Klebsiella isolates in some parts of South West Nigeria. Microbiol Biotech Res 2011;1(2):64-68.
[2] Lopez- cerero L, de Cueto M, Saenz C, Navarro D, Velasco D, et al. Meningitis caused by CTX-M-32 –producing E.coli isolate. J Med Microbiol 2008;57:1303-1305.
[3] Iregbu KC, Anwaal U. Extended spectrum β-lactamase producing Klebsiella pneumoniae septisemia outbreak in the neonatal intensive care unit of a tertiary hospital in Nigeria. Afr J Med Sci 2007;36 (3):225-228.
[4] Metri BC, Jyothpi P, Peerapur BV. ESBLs among Enterobacteraceae. J Clin Diagn Res 2011;5(3):470-475.
[5] Shobha KL, Gowrish RS, Sugandhi R, Sreeja CK. Prevalence of Extended Spectrum Beta-Lactamases in Urinary Isolates of Escherichia coli, Klebsiella and Citrobacter Species and their Antimicrobial Susceptibility Pattern in a Tertiary Care Hospital. Indian J Pract Doc 2005;3(6):50-51.
[6] Kiratisin P, Apisarnthanarak A, Laesripa C, Saifon P. Molecular characterization and epidemiology of extended-spectrum β-lactamase producing Escherichia coli and Klebsiella pneumoniae isolates causing health care-associated infection in Thailand, where the CTX-M family is endemic. Antimicrob Agents Chemother 2008;52(8):2818-2824.
[7] Olowe AO, Aboderin BW. Detection of extended spectrum β-lactamase producing strain of (Escherichia coli) and (Klebsiella sp.) in a tertiary health center in Ogun state. Int J Trop Med 2010;5(3):62-64.

[8] Chaudhary U, Aggarwal R. Extended spectrum β-lactamases (ESBL) – An emerging threat to clinical therapeutics. Indian J Med Microbiol 2004;22(2):75-80.
[9] Viswanathan R, Sigh KA, Basu S, Chatterjee S, Sardar S, et al. Multi-drug resistant Gram negative bacilli causing early neonatal sepsis in India. Arch Dis Child Fetal Neonatal Ed 2012;97(3):182-187
[10] Shin SY, Kwon KC, Park J W, Song JH, Ko YH, et al. Characteristics of aac(6′)-Ib-cr Gene in Extended-Spectrum β-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae Isolated from Chungnam Area. Korean J Lab Med 2009;29:54 1-50.

Abstract: Concomitant hypo-hyperdontia a term introduced by Camerilli, describes a case where hypodontia (absence of one or more teeth) and hyperdontia (supernumerary teeth) are seen in the same individual. Few cases have been reported in literature,frequently associated with syndromic findings. Here we have reported the findings of CHH, in a 13 year boy suffering from UCLP, which is non syndromic , and hence a very very rare finding.

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Abstract: Cracked tooth syndrome is a major diagnostic challenge in clinical practice. It presents with bizarre of signs and symptoms which is frustrating for both the dentist as well as the patient. Successful diagnosis lies in the awareness of its presence and appropriate diagnostic tests. This article will explain the various diagnostic procedures to detect cracks, as well as to diagnose its extent through the nature of pain elicited, followed by appropriate treatment modalities.
Keywords: Bite tests, crack detection, cusp fracture, pain mechanism, vertical root fracture.

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Abstract: In the past 15yrs a dramatic improvement in adhesive technology and resin composite formulations has occurred.[1] The utmost goal of bonded restorations is to achieve a marginal and internal seal.[4]
The term nano-lekage was introduced by Sano, et al in 1995,[13] to describe a specific type of leakage, which exists even in the absence of marginal gaps. this leakage occurs laterally, through sub-microns porosities (estimated to be about 20 to 100mm in width) at the base of hybrid layer, which have not been left poorly polymerized.[14,15] This de-mineralized but not fully hybridized dentin layer can be considered a weak point in the adhesion mechanism that could allow dentinal fluid to slowly permeate the interface, and this is believed to degrade the adhesive resin.

[1]. B Simi and BS Suprabha. Evaluation of micro leakage in posterior nanocomposite restorations with adhesive liners. J Conservative Dentistry-2011. Aprl-JUN 14(2), 178-181.
[2]. Silmara Aparecida Milori Corona, Maria Cristina Borsatto, Renata Andrea Salvitti de sa Rocha, Regina Guenka Palma-Dibb .Micro-leakage on class v glass ionomer restorations after cavity preparation with aluminiu, oxide air abrasion. Braz.Dent J vol 15 no.1 aprl 2005.
[3]. Van Meerbeek B, De Munck J,Yoshida Y, Inoue, Vargas M, Van Landyut K et al. Adhesion to enamel and dentin: current status and futurechallenges. Oper Dent. 2003;28:215-35.
[4]. E. H Mobarak, LE Daifalla. Long term nano-leakage depth and pattern of cervical restorations bonded with different adhesives. Operative Dentistry 2012, 37-1, 45-53.
[5]. Patrica de Britto Pereira Garcia DUARTE, Edurdo Moreira da SILVA. Nano leakage phenomenon on deproteinized human dentin. J Appl Oral Sci 2 007; 15 (4); 285-91.
[6]. 3M ESPE Filtek Silorane – low shrink posterior restorative, silorane system adhesive – self-etch primer & bond.
[7]. L Shi, X Wang, Q Zhao, Y Zhang, L Zhang, YRen, Z Chen. Evaluation of packable and conventional hybrid composites in class-I restorations: three-year esults of a randomized, double-blind and comtrolled clinical trial. Operative Dentistry, 2010, 35-1, 11-19.
[8]. VV Gordan, IA Mjor. Shortg and long term clinical evaluation of post-operative sensitivity of a new resin based restorative material and self-etching primer. Operative Dentistry, 2002, 27, 543-548.
[9]. Wolfgang Weinmann, Christoph Thalacker,Rainer Guggenberger. Siloranes in dental composites. Dental materials, 2005, 21, 68-74.
[10]. Fahad Umer, Farah Naz and Farhan Raza Kjan. An in vitro evaluation of microleakage in class-v preparations restored with hybrid versus silorane composites. J Conserv Dent 2011Aprl-Jun; 14 (2) 103-107.

Abstract: To determine the risk factors, microbiological features, clinical features and other epidemiological characteristics of Nocardia asteroides, we evaluated 500 patients with suspected pulmonary and extra pulmonary tuberculosis seen over a period of 18 months. Samples were subjected to microscopy and culture using standard protocols. Out of 500 samples, 5 (1%) were found to be positive for Nocardia asteroids on the basis of growth characteristics and biochemical reactions. All the 5 (100%) cases were detected by McClung's Carbon free broth by paraffin baiting technique. Paraffin baiting technique had significantly higher efficacy (p<0.0001) as compared to Nutrient agar, Sabouraud's dextrose agar, Lowenstein-Jensen medium, paraffin agar and Gelatin agar. Antimicrobial susceptibility testing was done by disk diffusion method in blood agar and Mueller-Hinton agar plates, as recommended by the National Committee for Clinical Laboratory Standards. Amikacin and imipenem showed the 100% sensitivity. A diagnosis of nocardiosis may have direct benefits to the patient and physician by providing a clinical diagnosis and limiting extensive diagnostic evaluations. It may also reduce the use of empirical therapy, which could be ineffective and potentially harmful.
Keywords: Antimicrobial susceptibility testing, Nocardia asteroides, Pulmonary and extra pulmonary tuberculosis, Paraffin baiting technique.

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[8] M.R. Shivaprakash, P. Rao, J. Mandal, M. Biswal, S. Gupta, P. Ray, and A. Chakrabati, Nocardiosis in a tertiary care hospital in north India and review of patients reported from India, Mycopathologia, 5, 2007, 267-274.
[9] V. Chopra, G.C. Ahir, G. Chand, and P.K. Jain, Pulmonary nocardiosis mimicking pulmonary tuberculosis, Indian J. Tuberculosis, 48, 2001, 211-213.
[10] R. Chaudhary, A. Aher, V. Rastogi, and T.K. Prabhu, Case of mixed pulmonary infection by Nocardia and Mycobacterium tuberculosis, I.J.P.M., 52, 2009, 295.

Abstract: Conventional intubation with Macintosh laryngoscope is either difficult or is often not the first choice for intubating a patient with traumatic and ankylosed cervical spine. This is mainly to prevent further cervical spine dislocation and damage caused by neck extension or merely because problems encountered while intubating such patients may end up with failure to intubate or orophayngeal and dental trauma. A skillfully executed Fiber optic intubation avoids above complications. We hereby report a similar scenario of "expected difficult intubation" in a patient suffering from ankylosing spondylitis presenting for emergency cervical spine surgery following traumatic C5-C6 subluxation.
Keywords: airway management, ankylosisng spondylitis, traumatic cervical spine.

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[2]. Saringcarinkul A. Anesthetic considerations in severe ankylosing spondylitis. Chiang Mai Med J. 2009;48(2):57-63.
[3]. Shirgoska B, Netkovski J, Malcharek MJ, Rogos B, Watzlawek S, Sorge O, et al. New techniques and devices for difficult airway management.ActaClin Croat. 2012;51(3):457-61.
[4]. Bonhomme V, Hans P, Manninen PH, Jose GB, Lukitto K, Venkatraghavan L, et al. Management of the unstable cervical spine: elective versus emergent cases.CurrOpinAnaesthesiol. 2009;22(5):579-85.
[5]. Bandi V, Munnur U, Braman SS. Airway problems in patients with rheumatologic disorders. Crit Care Clin. 2002;18(4):749-65.