iosr-JDMS   Volume-8 ~ Issue-3

Abstract:For adequate and appropriate distribution of health services, together with increasing financial pressures in the public sector, determination of staffing levels in the health facilities are important. The Workload Indicators of Staffing Need (WISN) method is one such method. It uses a form of activity analysis (activity standards), together with measures of utilization and workload to determine staffing requirements. The present study was conducted to calculate the nursing staff requirement and their work pressure in maternity ward of Medical College Kolkata. WISN method provides a useful mechanism for assessing priorities to address staff overloads or staff under-utilization.
Key words: WISN, activity standards, workload, hospital staffing

[1]. Hornby P, Forte P. Human resource performance indicators. WHO Document series. In press, 1999.
[2]. Hornby P, Ray DK, Shipp PJ, Hall TL. Guidelines for health manpower planning. Geneva: World Health Organization, 1980.
[3]. Shipp PJ. Internal report, Planning Bureau, Ministry of Health. Jarkata: Ministry of Health, 1984.
[4]. Kolehmainen-Aitken R-L, Shipp, PJ. Indicators of staffing need: assessing health staffing and equity in Papua New Guinea. Health Policy and
[5]. Planning 1990; 5:167-176.
[6]. Hossain B, Alam SA. Likely benefit of using workload indicators of staffing need (WISN) for human resources management and planning in the health sector of Bangladesh. HRDJ 1999; 3:99-111.
[7]. Shipp PJ. Workload indicators of staffing need (WISN): a manual for implementation (Version 1). Geneva: World Health Organization, 1989.
[8]. Serpil Ozcan, Peter Hornby. Determining Hospital Workforce Requirements: A Case Study. Human Resources for Health Development Journal (HRDJ). September - December, 1999;3(3): 210-20.
[9]. John F. Mugisha, Grace Namaganda. USING THE WORKLOAD INDICATOR OF STAFFING NEEDS (WISN) METHODOLOGY TO ASSESS WORK PRESSURE AMONG THE NURSING STAFF OF LACOR HOSPITAL. Health policy and development.2008; 6(1):1-15.
[10]. Lucie Blok, Susan van den Hof, Sayoki G Mfinanga, Amos Kahwa, Esther Ngadaya, Liesbeth Oey, Marjolein Dieleman. Measuring workload for tuberculosis service provision at primary care level: a methodology. Human Resources for Health 2012, 10:11.

Abstract: Objective: To evaluate the effect of oral versus parenteral therapy to improve the Hb level among antenatal women with iron deficiency anaemia. Methods: This was a randomized controlled study conducted in northern India among antenatal women with iron deficiency anaemia. The inclusion criteria were Hb concentration less than 11 gm/dl and gestational age 21-36 weeks. A total of 230 women were included in the study and divided randomly into 2 groups: Group-A was given 240 mg elemental iron as ferrous sulphate for 8 weeks. Group B was given parenteral iron at the same interval as in Group A. Results: The Hb level was significantly (p=0.0001) increased in both the groups from before (Group A=8.56±1.18, Group B=8.31±1.03) supplementation to after supplementation (Group A=11.77±1.20, Group B=12.20±1.70). The increase was lower among the women of Group A (27.3%) as compared to Group B (31.9%). There was no association between age & gestational age of women and percentage increase in Hb in both the groups. About one third of the women of both Group A (32.2%) and Group B (31.3%) women experienced constipation. CONCLUSION We found that the parentral iron therapy in the form of iron sucrose was better choice to reduce iron efficiency anaemia as compared to oral therapy. Early supplementation will help to decrease the risk of blood transfusion during the peripartum period.

Key words: Iron sucrose, antenatal women, Hb, anaemia

[1]. http:\UNICEF\UNO\WHO Geneva 2001. Iron deficiency anaemia, assessment, prevention and control.
[2]. Cutner A. Failed response to treat anaemia in pregnancy reasons & evaluation. J Obstet Gynacol 1999 (Suppl): 523-7.
[3]. Theresa OS. Iron status during pregnancy: setting the stage for mother and infant. Am J Clinc Nutr 2005:81; 1218S-22S.
[4]. Bayoumeu F, Subiran-Buisset C, Baka NE, Legagneur H, Monnier-Barbarino P, Laxenaire MC. Iron therapy in iron-deficiency anemia in pregnancy: Intravenous route versus oral route. Am J Obstet Gynecol Mar 2002;186(3):518-22.
[5]. Khan MM. Effects of maternal anemia on fetal parameters. J Ayub Med Coll Abbottabad 2001;13:38-41.
[6]. Halterman JS, Kaczorowski JM, Aligne CA, Auinger P, Szilagyi PG. Iron deficiency and cognitive achievement among school-aged children and adolescents in the United States. Pediatrics 2001;107:1381-86.
[7]. Algarin C, Peirano P, Garrido M, Pizarro F, Lozoff B. Iron-deficiency anemia in infancy: Long-lasting effects on auditory and visual system functioning. Pediatr Res 2003;53:217-23.
[8]. International Anemia Consultative Group (INACG). Why is iron important and what to do about it?: A new perspective. Report of the 2001 INACG Symposium; Feb 2001, 15-16; Hanoi, Vietnam 2002;1-50.
[9]. Vijayaraghavan K, Brahmam GNV, Nair KM, Akbar D, Rao Pralhad N. Evaluation of national nutritional anemia prophylaxis programme. Indian J Pediatr 1990;57:183-90.
[10]. Centers for disease control and prevention (CDCP). Recommendations to prevent and control iron deficiency in the United States. Morbidity and mortality weekly report 1998;47(RR-3):1-29.

Abstract: Generally, Left Lung is divided into two lobes by a deep oblique fissure and right lung is divided into three lobes by oblique and horizontal fissures. But in our case study during the routine undergraduate dissection of the Thoracic region of a sixty five year old male cadaver in the department of Anatomy, Gandhi Medical College, it was incidentally observed that the left lung is divided into three lobes by oblique and horizontal fissures and incomplete horizontal fissure in the right lung. This type of variation is observed only once in our routine dissection in Anatomy Department and hence presented for its clinical importance.

Keywords – Horizontal Fissure in Left Lung, incomplete horizontal fissure in Right Lung, variation of Fissures in Lungs

[1] Romanes GJ., Cunningham's Manual of Practical Anatomy Vol-II Thorax and abdomen 15th Edition 2003 Oxford University Press
[2] Vishram Singh, Anatomy of upper limb and thorax Vol-III 2009 Reed Elsevier India Pvt Limited, New Delhi.
[3] Larsen WJ. Human Embryology. New York: Churchill Livingstone; 1993: 111-30.Churchill Livingstone; 1993: 111-30.
[4] Medlar EM. Variations in interlobar fissures. AJR 1947; 57: 723-25.
[5] Craig SR, Walker WS. A proposed anatomical classification of the pulmonary fissures. J R CollSurg (Edin) 1997; 42: 233-34.
[6] Tarver RD. How common are incomplete pulmonary fissures, and what is their clinical significance? AJR 1995; 164: 761.

Abstract: Introduction: Hypertension is a common disease associated with high mortality and morbidity. Hypertension could have its origin in childhood and go undetected unless specially looked for during this period. With globalization bringing more lifestyle modifications, adolescents are exposed to multiple risk factors including obesity, diet, academic stress, lack of physical work apart from hereditary risk factors. Early diagnosis of hypertension is an important strategy in its control, effective treatment and prevention of complications.

Objectives: To estimate the prevalence of hypertension among school children in the age group of 13- 17 years and study the determinants.

[1]. Cardiovascular epidemiology in the Asia–Pacific region, Geok Lin Khor PhD, Department of Nutrition and Health Sciences, Malaysia,Serdang,
[2]. Tracking of Blood Pressure Among Adolescents and Young Adults in an Urban Slum of Puducherry MB Soudarssanane et al,Indian journal of community medicine-Vol. 33, Issue 2, April 2008.
Prevalence and determinants of hypertension among urban school children in the age group of 13- 17
www.iosrjournals.org 20 | Page
[3]. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114(2 suppl 4th report):5:555-576.
[4]. Sorof JM, Alexandrov AV, Cardwell G, Portman RJ. Carotid artery intimal-medial thickness and left ventricular hypertrophy in children with elevated blood pressure. Pediatrics. 2003;111:61-66.
[5]. McNiece KL,Poffenbarger TS, Turner JL, Franco KD, Sorof JM, Portman RJ. "Prevalence of hypertension and pre-hypertension among adolescents."Department of Pediatrics, Division of Pediatric Nephrology and Hypertension, University of Texas-Houston, School of Medicine Journal of Pediatr. 2007 Jun; 150(6):640-4, 644..
[6]. Marit Stray-Pedersen Ragnhild M Helsing, Luz Gibbons Gabriela Cormick Turid L Holme, Torstein "Weight status and hypertension among adolescent girls in Argentina and Norway" BMC Public Health 2009
[7]. Gomes Bda M, Alves JG "Prevalence of high blood pressure and associated factors in students from public schools in Greater Metropolitan Recife, Pernambuco State, Brazil, 2006" Pubmed 2009
[8]. Manu Raj, K.R. Sundaram et al. Obesity in Indian Children: Time trends and Relationship with hypertension. The National Medical Journal of India. Vol. 20. No. 6. 2007
[9]. Mohan B, Kumar N, Aslam N et al. Prevalence of sustained hypertension and obesity in urban and rural school going children in Ludhiana. Indian Heart J 2004, July – Aug; 56 Vol (4) page 310 – 4
[10]. Anand NK, Tandon L, Prevalence of hypertension in school going children. Indian Pediatrics. ISSN, 1996, vol 3, Page 377-381

Abstract: Objectives: To determine the safety of immediate post-placental intrauterine device insertion at the time of caesarean delivery. Method: This study was conducted in the Department of Obstetrics and Gynecology, Bundelkhand Medical College and associated Tili hospital, Sagar, from September 2010 to August 2011. Patients undergoing caesarean section for varied indications were counselled regarding intra-operative CuT380A insertion and those who agreed were allocated to the study group and the rest were allocated to the control group. The patients were observed during the post-operative period for complications associated with either caesarean section or intrauterine device insertion. Result: During the study period, 100 patients underwent CuT380A insertion immediately after removal of the placenta during caesarean delivery. There was no significant difference in the post-operative complication rates between both the groups. The rates for post-operative bleeding being 15% in both the groups and that of post-operative infection being 5% and 7% in the study and control groups respectively.

Keywords: Complications, Intracaesarean, Intrauterine device insertion, Postplacental, Acceptance.

[1]. Grimes DA, Lopez LM, Schulz KF, Van Vliet HA, Stanwood NL. Immediate postpartum insertion of intrauterine devices. Cochrane Database Syst Rev. 2010 May 12 ;( 5): CD003036. Review.
[2]. Xu JX, Connell C, Chi IC. Immediate postpartum intrauterine device insertion. AdvContracept. 1992 Dec;8(4):281-90. Review.
[3]. Penny G, Brechin S, deSouza A, et al. (2004) The copper contraception device as long-term contraception. J FamPlannReprod Health Care 30:29-41, quiz 42. Erratum in: J FamPlannReprod Health Care 2004;30:134.
[4]. Alvarez Pelayo J, BorbollaSala ME. IUD insertion during caesarean section and its most frequent complications. GinecolObstet Mex. 1994 Nov; 62:330-5. Spanish.
[5]. Levi E, Cantillo E, Ades V, Banks E, Murthy A. Immediate post placental Intrauterine device insertion at caesarean delivery: a prospective cohort study. Contraception 2012 Jan 20.
[6]. Kapp N, Curtis KM. Intrauterine device insertion during the postpartum period: a systematic review. Contraception. 2009 Oct, 80(4): 327-36.Epub 2009 Aug 29.

Abstract: Background; Laparoscopic appendicectomy (LA) has always generated controversy due to its expensive and time consuming nature. Open appendicectomy (OA) on the other hand is cheaper and faster to perform but lacks the advantage of visualising the rest of the peritoneal cavity for associated pathologies. Laparoscopically assisted appendicectomy (LAA) in comparison combines the benefits of the other methods at a cheaper rate than the laparoscopic appendicectomy but is performed mainly in children. This study was aimed at evaluating the feasibility of LAA in adults compared to LA and OA. Methodology-This was a combined prospective and retrospective evaluation of patients that underwent appendicectomy using three different methods. Results The prospective arm of the study consisted of a total of 64 patients, 28 of whom had laparoscopic appendicectomy while 36 had laparoscopically assisted appendicectomy. The retrospective arm included 40 patients that had open appendicectomy. The costs of the procedures were $315 (OA), $630(LAA) and $1260 (LA). The mean operating time for the different methods were 30, 33 and 60 minutes for OA, LAA and LA respectively while the duration of hospital admission were 24hours each for OA and LAA but 48 hours for LA. Associated intra-abdominal pathologies were found in 13 patients (20.3%) that had LAA and LA while none was documented for OA. Conclusion Laparoscopically assisted appendicectomy (LAA) in adults can be done at a significantly reduced cost and shorter operating time when compared to Laparoscopic appendicectomy (LA), and has the ability to detect other intraabdominal pathologies as opposed to open appendicectomy.

Keywords: Adult laparoscopic assisted appendicectomy, cheaper, faster, detects other pathologies

[]1] Gauderer MW. An individualized approach to appendectomy in children based on anatomico-laparoscopic findings. Am Surg. 2007 Aug;73(8):814-7.
]2] Casanelli JM, Keli E, N'Dri J, Aboua G, Keita M, Meneas G, et al. [Evaluation of a four-year experience with laparoscopic surgery in Abidjan, Ivory Coast]. Med Trop (Mars). 2007 Oct;67(5):481-4.
]3] Roviaro GC, Vergani C, Varoli F, Francese M, Caminiti R, Maciocco M. Videolaparoscopic appendectomy: the current outlook. Surg Endosc. 2006 Oct;20(10):1526-30.
]4] Kargar S, Mirshamsi MH, Zare M, Arefanian S, Shadman Yazdi E, Aref A. Laparoscopic versus open appendectomy; which method to choose? A prospective randomized comparison. Acta Med Iran. 2011;49(6):352-6.
]5] Scott-Conner CE, Hall TJ, Anglin BL, Muakkassa FF. Laparoscopic appendectomy. Initial experience in a teaching program. Ann Surg. 1992 Jun;215(6):660-7; discussion 7-8.
]6] Baraza R. Re: laparoscopic appendicectomy. East Afr Med J. 2004 Mar;81(3):164-5; author reply 6.
]7] Shalaby R, Arnos A, Desoky A, Samaha AH. Laparoscopic appendectomy in children: evaluation of different techniques. Surg Laparosc Endosc Percutan Tech. 2001 Feb;11(1):22-7.
]8] Patel SC, Jumba GF, Akmal S. Laparoscopic appendicectomy at the Aga Khan Hospital, Nairobi. East Afr Med J. 2003 Sep;80(9):447-51.
]9] Harbrecht BG, Franklin GA, Miller FB, Smith JW, Richardson JD. Acute appendicitis--not just for the young. Am J Surg. 2011 Sep;202(3):286-90.
]10] McGrath B, Buckius MT, Grim R, Bell T, Ahuja V. Economics of appendicitis: cost trend analysis of laparoscopic versus open appendectomy from 1998 to 2008. J Surg Res. 2011 Dec;171(2):e161-8.

Abstract: Civilian populations are increasingly vulnerable to ballistic injuries resulting from firearms or from bomb blasts. Injuries of the extremities are most common with firearm- related violence and wounds of greater complexity are seen with explosive devices. Initial management is targeted to dealing with life-threatening conditions and stabilizing the patient followed by subsequent care in a well-equipped setting. In this paper, we review and discuss various management modalities specifically for ballistic soft tissue injuries which include conservative or surgical management, appropriate wound care, use of antibiotics and definitive management and reconstruction of soft tissue injuries. Initial evaluation can usefully classify the ballistic injury into a high-risk or a low-risk category and this influences subsequent management. Low-risk ballistic injuries can benefit from conservative non-surgical management. Experience acquired from the treatment of military ballistic wounds can be used in civilian settings especially in the case of wound debridement and use of antibiotics. Definitive management of soft tissue injuries usually involves the use of flaps for reconstruction.

Keywords - ballistic injuries, reconstruction, soft tissue injuries, wound care

[1] Richmond TS, Cheney R, Schwab CW. The global burden of non-conflict related firearm mortality. Inj Prev 2005; 11(6): 348–352. [2] Davies MJ, Wells C, Squires PA, Hodgetts TJ, Lecky FE. Civilian firearm injury and death in England and Wales. Emerg Med J 2012; 29(1):10-4.

[3] Home Office. "Homicides, Firearm Offences and Intimate Violence 2010/11: Supplementary Volume 2 to Crime in England and Wales 2010/11‟.

[4] Bellamy RF, Zajtchuk R: The evolution of wound ballistics: a brief history. In: Textbook of Military Medicine, Office of the General Surgeon. Department of the Army. Washington, DC. 1989; 83-106.

[5] Mauffrey C. Management of gunshot wounds to the limbs: A review. The Internet Journal of Orthopedic Surgery 2006; 3(1).

[6] Onuminya JE, Ohwowhiagbese E. Pattern of civilian gunshot injuries in Irrua, Nigeria. S Afr J Surg 2005; 43(4):170-2.

[7] Belmont PJ, Schoenfeld AJ, Goodman G. Epidemiology of combat wounds in Operation Iraqi Freedom and Operation Enduring Freedom: orthopaedic burden of disease. J Surg Orthop Adv 2010; 19(1): 2-7.

[8] Bruner D, Gustafson CG, Visintainer C. Ballistic injuries in the emergency department. Emerg Med Pract 2011 Dec; 13(12): 1-30.

[9] Rozen N, Dudkiewicz I. Wound ballistics and tissue damage. In: Lerner A, Soudry M Ed, Armed conflict injuries to the extremities. Berlin Heidelberg: Springer-Verlag. 2011; 21-33.

[10] Wang ZG, Feng JX, Liu YQ. Pathomorphological observations of gunshot wounds. Acta Chir Scand Suppl 1982; 508: 185-195.

Abstract: Angiomyofibroblastoma is a rare,usually small benign mesenchymal tumor that occurs mainly but not exclusively in the vulval region of premenopausal women. Patients often present with non specific symptoms. It is a well circumscribed lesion that clinically is often thought to represent a Bartholin's gland cyst. Diagnostic confusion often arise between angiomyofibroblastoma and other tumors arising in the vulval region like aggressive angiomyxoma and cellular angiofibroma because of overlapping histological features. Differentiating between angiomyofibroblastoma and cellular angiofibroma is not of clinical significance.Aggressive angiomyxoma is a more infiltrative lesion that has a high propensity for local recurrence. Immunohistochemistry is not of much help in distinguishing these entities. Sincere efforts should be made to differentiate angiomyofibroblastoma from aggressive angiomyxoma, which has a potential to metastasize or recur.

Key words: Angiomyofibroblastoma,Vulva,aggressive angiomyxoma

[1]. Giannella L, Costantini M, Mfuta K, Cavazza A, Cerami LB, Gardini G et al. Pedunculated angiomyofibroblastoma of the vulva: case report and review of literature. Case reports in medicine 2011;vol 1: 1-4
[2]. Lim KJ, Moon JH, Yoon DY, Cha JH, Lee IJ, Min SJ. Angiomyofibroblastoma arising from the posterior perivesical space: a case report with MR findings. Korean J RADIOL 2008;9: 382-385
[3]. Kim SW, Lee JH, Han JK, Jeon S. Angiomyofibroblastoma of the vulva. J Ultrasound Med 2009;28: 1417-1420
[4]. Omori M, Toyoda H, Hirai T, Ogino T, Okada S. Angiomyofibroblastoma of the vulva:A large pedunculated mass formation. Acta Med Okayama 2006;vol 60(4): 237-242
[5]. Hjalmer S, Svennevik MS, Fai CK, Andua KT. Angiomyofibroblastoma and aggressive angiomyxoma.Two rare tumors of the vulva. Journal of pelvic medicine and surgery 2006;vol 12(4): 225-228
[6]. McCluggage WG. Angiomyofibroblastoma of the vagina. J Clin Pathol 2000;53: 803-806
[7]. Hisoaka M, Kouho H, Aoki T, Daimaru Y, Hashimoto H. Angiomyofibroblastoma of the vulva:A clinicopathologic study of seven cases. Pathology International 1995;vol 45(7): 487-492
[8]. Fletcher CDM, Tsang W, Fisher C, Lee KC, Chan J.Angiomyofibroblastoma of the vulva:A benign neoplasm distinct from aggressive angiomyxoma. Am J Surg Pathol 1992;vol 16(4): 364-372
[9]. Vasquez MD, Ro JY, Park YW, Tornor CS, Ordofiez NG, Ayale AG. Angiomyofibroblastoma: A clinicopathologic study of 8 cases and review of the literature. Int J Surg Pathol july 1999;vol7(3): 161-169
[10]. .Nagai K, Aadachi K, Saito H. Huge pedunculated angiomyofibroblastoma of the vulva. Int J Clin Oncol 2010;15: 201-205

Abstract: An Epidemiological study was carried out to assess various tobacco related habits and their associated oral mucosal lesions within Nagpur district – Rural / Urban populations. . 4 rural and 4 urban clusters were taken for this study A cluster random sampling technique was used in this study with 100 subjects examined form each cluster. Sample size was 800 subjects including both Rural / Urban populations... Data was collected by conducting interviews and clinical examination. The statistical analysis was done by using SPSS 14.It was observed from this study that, various tobacco related habits were more from rural sectors than urban. Habit of smoking was very common among rural population when compared to smoking in urban population. Habit of chewing tobacco was common in rural population when compared to urban. Increased prevalence of habits of both smoking and chewing were observed among Men. Only few females had the habit of smoking, though the prevalence for chewing tobacco was more than smoking. To conclude from this study, chewing and smoking tobacco habits are existing within our society. Tobacco related oral lesions are also alarmingly high from this study group.

Key words: chewing tobacco , oral lesions,population, smoking tobacco ,tobacco habits,

[1]. Scott L. Tomar;. Dentistry's role in tobacco control JADA, Vol. 132, November 2001)
[2]. Tobacco habits in india.pdf
[3]. Tobacco GATS India Report 2009-2010, The Global Adult Survey (GATS) India, 2009-2010.Ministry of Health and Family Welfare, Government of India, New Delhi.
[4]. Vivek Gupta, Kapil Yadav, Anand K ;Pattern of tobacco use across rural, Urban, and urban- slum population in a North Indian Commuity Indian Journal of Community medicine/ vol 35/issue2/april 2010.
[5]. Gupta PC, Ray CS.; Smokeless tobacco and health in India and South Asia Respirology 2003; 8: 41 431
[6]. Vendhan Gajalakshmi, Samira Asma, Charles W Warren; Tobacco Survey Among Youth in South India Asian Pacific J Cancer Prev, 5, 273-278 )
[7]. Dhirendra N Sinha , Prakash C Gupta; Tobacco Use among school personnel in Orissa ; Indian Journal of Public Health Vol XXXXVIII No.3 July-Sept. 2004 )
[8]. P.C. Gupta ; A study of dose-response relationship between tobacco habits and oral leukoplakia; Br. J. Cancer (1984), 50, 527-531)
[9]. Naresh R. Makwana, Viral R. Shah, Sudha Yadav ; A Study on Prevalence of Smoking and Tobacco Chewing among Adolescents in rural areas of Jamnagar District, Gujarat State ; JMSR • SEPTEMBER 30, 2007 • 1 (1)
[10]. Raj Narain, Sarita Sardana, Sanjay Gupta* & Ashok Sehgal Age at initiation & prevalence of tobacco use among school children in Noida, India: A cross-sectional questionnaire based survey ; Indian J Med Res 133, March 2011, pp 300-30.

Abstract: We report three cases of Posterior Reversible Encephalopathy Syndrome in different settings. First case was associated with systemic lupus erythematosus with gestational hypertension and lupus nephritis. Second case had no history of hypertension while third patient had only transient rise of blood pressure during & soon after an episode of seizures. All three cases had complete recovery. Posterior Reversible Encephalopathy Syndrome is a clinical-neuroradiological term, often associated with delayed postpartum eclampsia & classical imaging features usually in the form of bilateral, symmetrical, reversible white matter oedema involving commonly the posterior cerebral circulation. Diagnosing these lesions early & providing appropriate treatment is important to achieve an optimal neurological outcome.

[1] Williams Obstetrics book, 23rd edition, Pregnancy Hypertension, page 708-709.

[2] Sibai bm. Diagnosis prevention and management of eclampsia, Obstet Gynecol. 2005 Feb; 105(2):402-10.

[3] Lubarsky SL, Barton JR, Friedman SA, Nasreddine S,Ramaddan MK, Sibai BM, Late postpartum eclampsia revisited. Obstet Gynecol 1994;83:502–5.

[4] Felz MW, Barnes DB, Figueroa RE. Late postpartum eclampsia 16 days after delivery: case report with clinical,radiologic, and pathophysiologic correlations. J Am BoardFam Pract 2000;13:39-46

[5] Bartynski WS. Posterior reversible encephalopathy syndrome, part 1: fundamental imaging and clinical features, AJNR 2008;29(6):1036-42.

[6] V. L. Stott, M. A. Hurrell, T. J. Anderson, Reversible posterior leukoencephalopathy syndrome: a misnomer reviewed, Internal Medicine Journal 2005; 35: 83–90

[7] Bartynski WS, Boardman JF, Zeigler ZR, et al , Posterior reversible encephalopathy syndrome in infection, sepsis and shock. AJNR 2006; 27:2179-90.

[8] Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, Pessin MS, Lamy C, Mas JL, Caplan LR, A reversible posterior leukoencephalopathy syndrome, NEJM, 1996 Feb 22; 334(8):494-500.

[9] W.S. Bartynskia and J.F. Boardmana, Distinct Imaging Patterns and Lesion Distribution in Posterior Reversible Encephalopathy Syndrome, AJNR, August 2007; 28: 1320-1327

[10] Silvia Pugliese, V. Finocchi, M. L. Borgia, C. Nania, B. Della Vella, A. Pierallini , A. Bozzao, Intracranial hypotension and PRES: case report, J Headache Pain (2010) 11:437–440

Abstract: Strenuous physical activity like marathon race put a lot of strain on the heart with its attendant physical and psychological view point. This individual often dies suddenly as most of them are with sub-clinical to over heart diseases and; at times with brain lesion like ruptured aneurysm.1 Ruptured aneurysm is the most frequent extracardiac cause for sudden death arising in the cardiovascular system. These always arises on the cerebral vessels as a result of artheroma formation on the vessels which obstructs free flow of the blood with its extensive narrowing of the blood vessels plus attributed to consequences. This type of aneurysm often resides at the circles of willis at the bifurcation and links together.2 Most are giant type and are in form of fusiform/dissection type occurs in traumatic dissection or congenital ateriopathy and arteriosclerosis.3-6 However, organic diseases like hypertension and few other conditions like smoking, gender males at younger to middle aged adults are more prone to aneurismal deaths.7,8 The case is a young man of 32 years who is on 32km marathon race as part of fitness criteria for promotion who suddenly slumped and was brought in the hospital; though certified dead already (brought in dead).

Keyword: Race, Male, Hypertension, Death. There is no conflict of interest among the authors.

[1]. Knight's Forensic Pathology: The pathology of sudden death 3rd edition chapter 25 page 509-11
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[4]. Nakayama Y, Tanka A, Kumate S, Tomonaga M et al. Giant frusiform aneurysm of the basilar artery: Consideration of its Pathogenesis. Surg. Neurol 1999; 51: 140-145
[5]. Anson JA, Lawton MY and Spetzler RF.Characteristics and Surgical Treatment of dolicholectatic and fusiform aneurysms. J Neurosurg 1996; 84: 185-93
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[8]. Connolly ES, Chondhri TF, et al. Influence of smoking, Hypertension and Sex on the phenotypic expression of familial intracranial aneurysms in siblings. Neurosurgery 2001; 48: 64-69.
[9]. Vincent Dimaio, Suzanna Dana. Handbook of Forensic Pathology, 2nd Edition page 40.

Abstract: This is to assess the level of abortion in a tertiary hospital over a period of time with emphasis in the prevailing age of occurrence/months and maternal mortality and morbidity outcome. Materials & Methods: A cross sectional study of 123 samples of all proceeds from the abortion (evacuation from the uterus) sent over the period were analyzed as results were obtained in the record of the department. All results were analyzed using SPSS version 16. These were displayed as per year of study and emphasis on actual age vulnerable with the highest months of occurrence. Results: The study showed the vulnerable age that is usually in search of abortion to be 30-40 years; closely followed by 20-30 years age group. Conclusion: It showed that despite the illegality attached to the procedure some clients still seek the attention from various ways resulting to the high morbidity and mortality seen in our study.

Keywords: Abortion, histology, infertility, death

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[3]. Sedgh G, Surgh S, Shah I. H, Abman E. et al. "Induced Abortion: Incidence and trends World Wide from 1995 to 2008" 2012 Lancet 379 (9816): 62-632 – doi: 10.1016/80140-6736(ii) 61786-8 PMID 22264435
[4]. Sedgh G, Henshaw SK, Surghs, Bankole A et al. Legal abortion World Wide: Incidence and Recent Trends. 2007 Family Plan Perspect 33 (3): 106-116. Doi: 101363/ifpp.33.10607 PMID. 17938093.
[5]. Culwell KR, Vekemans M, de silva U. et al. "Critical gaps in Universal Access to Reproductive Health: Contraception and Prevention of Unsafe Abortion". 2010 International Journal of Gynaecology and Abortion 110: 513-16 doi: 10-1016/j.jgo 2010.04.003 PMID 20451196.
[6]. Gao PP, Luyl, Gad XH, Yoing YP. Clinical Study on the Terminator of 388 High Risk Early Pregnancies with Mifepristone and Misoprostol. Reprod Contracept 1988; 9 (1): 19-26
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Abstract: Multiple and Recurrent Extra intestinal gastrointestinal stromal tumor (EGIST) in omentum and peritoneum - a case report Introduction: Gastrointestinal tumors are the intraabdominal tumors arising from muscular propia of gastrointestinal tract. Similar morphology, histopathological tumors rarely may arise from peritoneum, mesentry, or omentum and these tumors are called extra intestinal gastrointestinal stromal tumors. Case Presentation: 45-year male presented with lump over left flank and right hypochondrium region without bowel, bladder and biliary symptoms. Abdominal sonogram and computerized tomography of abdomen suggested two large tumors located separately at right sub-diaphragmatic and left lumbar regions. The pre-operative needle aspiration cytology was inconclusive. DISCUSSION: Diagnostic laparoscopy showed two tumors situated at different locations. Tumor at the right sub-diaphragmatic region was arising from peritoneum and another large tumor at the lumbar region from omentum. Excision biopsy and further immunohistochemistry revealed extra intestinal GIST Conclusion: Extra intestinal gastrointestinal stromal tumors arising from peritoneum and omentum in the same patient is rare occurrence.

Key Words: Extra intestinal gastrointestinal stromal tumors, omentum, peritoneum

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Abstract: A Free-floating ball valve thrombus in the left atrium is a rare clinical entity and has been reported infrequently in Indian literature despite the high incidence of Rheumatic mitral valve stenosis. Early diagnosis and prompt surgical intervention are mandatory otherwise it may lead to catastrophic consequence. We are presenting our experience with one such case which was diagnosed clinically and by Trans- Thoracic two dimensional echocardiography. This case report describe the clinical features and Trans- Thoracic two dimensional echocardiography(TTE) findings of a free – floating ball valve thrombus in the left atrium secondary to severe rheumatic mitral valve stenosis that was discovered incidentally in our symptomatic patient.

Key Words: Left atrium ball valve thrombus, Rheumatic heart diseases, Mitral valve stenosis.

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Abstract: Background-Elevated inflammatory markers such as high sensitivity C- reactive protein (hs-CRP), TNF-alpha, IL-6,serum amyloid A and leukocyte count are associated with future risk of development of type 2 diabetes and cardiovascular disease. Similarly Cardiac Autonomic Neuropathy (CAN) is also an early indicator of cardiovagal dysfunction. Objective- Obesity is an inflammatory condition. A study was conducted to evaluate the role of inflammatory markers and autonomic function in development of cardiovascular disease and Diabetes Mellitus in an obese population. Methods and Results- The study was conducted on 30 obese male students and 30 non obese male in the age range of 18-24 years, from Dr D. Y. Patil University, Pune. Leukocyte count, C- reactive protein (CRP) and cardiac autonomic function tests were carried out in all subjects. Results showed significant decrease in heart rate variability (HRV) in obese subjects. However, no significant difference was seen in the levels of CRP and leukocyte count in between obese and non obese subjects. Conclusion-The study showed early signs of autonomic imbalance in the obese subjects, but inflammation does not seem to play a role in this age group in the present set up.

Key words: Obesity, C-reactive protein, Leukocyte count, Cardiac Autonomic Neuropathy

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