Innovative Journal of Medical and Health Sciences

Cerebrovascular accident (CVA) or brain attack or
STROKE as we commonly refer to is the sudden death of
neurons in a localized area of brain due to inadequate blood
supply. The mortality rate due to stroke in India is 22 times
that of malaria and 1.4 times that of tuberculosis. It’s a major
public health challenge not only for neuropharmacology
but the society in general.1 Patients suffering from stroke
are usually recipients of a long list of medicines where the
therapy continues for a long time, usually lifelong.
Comorbidities are major determinants in the treatment
of stroke which is common in patients with hypertension,
high blood cholesterol, Diabetes Mellitus, heart disease.
Heavy smoking and alcohol consumption are other causes
for Stroke.2 According to India stroke factsheet updated in
2012, the estimated age-adjusted prevalence rate for stroke
ranges between 84/100,000 and 262/100,000 in rural and
between 334/100,000 and 424/100,000 in urban areas.3 Recent
reports have shown a substantial increase of stroke in
younger population.4 50% of stroke is preventable by control
of modifiable risk factors and lifestyle changes (aerobic
exercise to counteract inactivity, weight loss in obesity,
glucose control in diabetics, smoking cessation, and
diet).5American Stroke Association (ASA) and the American
Heart Association (AHA) have recently published updated
guidelines for secondary prevention of stroke.6,7
The management of stroke should be individualized. As
proper drug utilization is a concern for various diseases, the
same is also important for stroke management. The drug
utilization in stroke care is of very much concern in developing
countries, as healthcare infrastructure is inadequate,
government has insufficient control on the system of drug
supply and also due to free availability of drugs on prescription
often illegally. The drug treatment strategy is involved
with proper selection of drugs like thrombolytics, anticoagulants,
antihypertensives (angiotensin converting enzyme inhibitors,
angiotensin II receptor blockers, diuretics), blood
lipid lowering agents (statins), antiplatelet drugs (aspirin
and clopidogrel), and neuro protectors.8
A patient’s psychological functioning and psycho-social
situation may be severely disrupted by the disease. The degree
of disturbance is usually determined by the severity of
the stroke and degree of cognitive deficits. Hence, studying
QOL in patients is also one of the aims of the study.9
Post-stroke cognitive impairment is very common, particularly
after recurrent stroke, which affects up to one-third
of stroke survivors.10,11 These comorbid motor and cognitive
impairments can significantly increase the risk of long
term functional disability as well as increase the healthcare
costs.12 Most of the patients recover in first 3-6 months after
the acute neurological event, with almost 70% of their
recovery in first 3 months after a stroke. After 6 months, the
recovery can be considered to be almost nil. However, for the
hemiplegics, physiotherapy can be a healthy source for gaining
the stairway to becoming physically fit.13 Thus, along
with medications functional recovery also depends upon institution
of early rehabilitation, which aims to enhance skill
learning which promotes plasticity

Cerebrovascular accident (CVA) or brain attack or
STROKE as we commonly refer to is the sudden death of
neurons in a localized area of brain due to inadequate blood
supply. The mortality rate due to stroke in India is 22 times
that of malaria and 1.4 times that of tuberculosis. It’s a major
public health challenge not only for neuropharmacology
but the society in general.1 Patients suffering from stroke
are usually recipients of a long list of medicines where the
therapy continues for a long time, usually lifelong.
Comorbidities are major determinants in the treatment
of stroke which is common in patients with hypertension,
high blood cholesterol, Diabetes Mellitus, heart disease.
Heavy smoking and alcohol consumption are other causes
for Stroke.2 According to India stroke factsheet updated in
2012, the estimated age-adjusted prevalence rate for stroke
ranges between 84/100,000 and 262/100,000 in rural and
between 334/100,000 and 424/100,000 in urban areas.3 Recent
reports have shown a substantial increase of stroke in
younger population.4 50% of stroke is preventable by control
of modifiable risk factors and lifestyle changes (aerobic
exercise to counteract inactivity, weight loss in obesity,
glucose control in diabetics, smoking cessation, and
diet).5American Stroke Association (ASA) and the American
Heart Association (AHA) have recently published updated
guidelines for secondary prevention of stroke.6,7
The management of stroke should be individualized. As
proper drug utilization is a concern for various diseases, the
same is also important for stroke management. The drug
utilization in stroke care is of very much concern in developing
countries, as healthcare infrastructure is inadequate,
government has insufficient control on the system of drug
supply and also due to free availability of drugs on prescription
often illegally. The drug treatment strategy is involved
with proper selection of drugs like thrombolytics, anticoagulants,
antihypertensives (angiotensin converting enzyme inhibitors,
angiotensin II receptor blockers, diuretics), blood
lipid lowering agents (statins), antiplatelet drugs (aspirin
and clopidogrel), and neuro protectors.8
A patient’s psychological functioning and psycho-social
situation may be severely disrupted by the disease. The degree
of disturbance is usually determined by the severity of
the stroke and degree of cognitive deficits. Hence, studying
QOL in patients is also one of the aims of the study.9
Post-stroke cognitive impairment is very common, particularly
after recurrent stroke, which affects up to one-third
of stroke survivors.10,11 These comorbid motor and cognitive
impairments can significantly increase the risk of long
term functional disability as well as increase the healthcare
costs.12 Most of the patients recover in first 3-6 months after
the acute neurological event, with almost 70% of their
recovery in first 3 months after a stroke. After 6 months, the
recovery can be considered to be almost nil. However, for the
hemiplegics, physiotherapy can be a healthy source for gaining
the stairway to becoming physically fit.13 Thus, along
with medications functional recovery also depends upon institution
of early rehabilitation, which aims to enhance skill
learning which promotes plasticity

Cerebrovascular accident (CVA) or brain attack or
STROKE as we commonly refer to is the sudden death of
neurons in a localized area of brain due to inadequate blood
supply. The mortality rate due to stroke in India is 22 times
that of malaria and 1.4 times that of tuberculosis. It’s a major
public health challenge not only for neuropharmacology
but the society in general.1 Patients suffering from stroke
are usually recipients of a long list of medicines where the
therapy continues for a long time, usually lifelong.
Comorbidities are major determinants in the treatment
of stroke which is common in patients with hypertension,
high blood cholesterol, Diabetes Mellitus, heart disease.
Heavy smoking and alcohol consumption are other causes
for Stroke.2 According to India stroke factsheet updated in
2012, the estimated age-adjusted prevalence rate for stroke
ranges between 84/100,000 and 262/100,000 in rural and
between 334/100,000 and 424/100,000 in urban areas.3 Recent
reports have shown a substantial increase of stroke in
younger population.4 50% of stroke is preventable by control
of modifiable risk factors and lifestyle changes (aerobic
exercise to counteract inactivity, weight loss in obesity,
glucose control in diabetics, smoking cessation, and
diet).5American Stroke Association (ASA) and the American
Heart Association (AHA) have recently published updated
guidelines for secondary prevention of stroke.6,7
The management of stroke should be individualized. As
proper drug utilization is a concern for various diseases, the
same is also important for stroke management. The drug
utilization in stroke care is of very much concern in developing
countries, as healthcare infrastructure is inadequate,
government has insufficient control on the system of drug
supply and also due to free availability of drugs on prescription
often illegally. The drug treatment strategy is involved
with proper selection of drugs like thrombolytics, anticoagulants,
antihypertensives (angiotensin converting enzyme inhibitors,
angiotensin II receptor blockers, diuretics), blood
lipid lowering agents (statins), antiplatelet drugs (aspirin
and clopidogrel), and neuro protectors.8
A patient’s psychological functioning and psycho-social
situation may be severely disrupted by the disease. The degree
of disturbance is usually determined by the severity of
the stroke and degree of cognitive deficits. Hence, studying
QOL in patients is also one of the aims of the study.9
Post-stroke cognitive impairment is very common, particularly
after recurrent stroke, which affects up to one-third
of stroke survivors.10,11 These comorbid motor and cognitive
impairments can significantly increase the risk of long
term functional disability as well as increase the healthcare
costs.12 Most of the patients recover in first 3-6 months after
the acute neurological event, with almost 70% of their
recovery in first 3 months after a stroke. After 6 months, the
recovery can be considered to be almost nil. However, for the
hemiplegics, physiotherapy can be a healthy source for gaining
the stairway to becoming physically fit.13 Thus, along
with medications functional recovery also depends upon institution
of early rehabilitation, which aims to enhance skill
learning which promotes plasticity

AIM: To assess the effect of CPP-ACP (Tooth mousse,GC INDIA) , CPP-ACPF
(Tooth mousse plus,GC INDIA) and Arginine containing paste (Sensitive pro relief
,COLGATE INDIA) remineralizing agents on enamel surface after erosive challenge.
MATERIALS AND METHODS: Buccal and lingual enamel surfaces of the selected
20 molar teeth were used, and embedded in acrylic resin and enamel surfaces were
ground flat with Silicon carbide paper disc. Samples were assigned into 4 groups with
10 samples each. Group1 was the control with no treatment, Group 2 of CPP-ACP,
Tooth mousse, GC INDIA, Group 3 of CPP-ACPF, Tooth mousse plus, GC INDIA
and Group 4 of Arginine containing paste( Sensitive pro relief, COLGATE INDIA).
The specimens were then exposed to erosive challenge and treatment. The surface
roughness’s of the samples were evaluated before and after erosive cycles using surface
contact profilometer.
RESULTS: There was no significant difference seen while comparing before and after
values for the groups. In intragroup comparison, significant difference for RA before
and RA after values in all 4 groups were seen.
Key words: Casein phosphopeptide-amorphous calcium phosphate–fluoride–dentin–
erosion–arginine containing paste

AIM: To assess the effect of CPP-ACP (Tooth mousse,GC INDIA) , CPP-ACPF
(Tooth mousse plus,GC INDIA) and Arginine containing paste (Sensitive pro relief
,COLGATE INDIA) remineralizing agents on enamel surface after erosive challenge.
MATERIALS AND METHODS: Buccal and lingual enamel surfaces of the selected
20 molar teeth were used, and embedded in acrylic resin and enamel surfaces were
ground flat with Silicon carbide paper disc. Samples were assigned into 4 groups with
10 samples each. Group1 was the control with no treatment, Group 2 of CPP-ACP,
Tooth mousse, GC INDIA, Group 3 of CPP-ACPF, Tooth mousse plus, GC INDIA
and Group 4 of Arginine containing paste( Sensitive pro relief, COLGATE INDIA).
The specimens were then exposed to erosive challenge and treatment. The surface
roughness’s of the samples were evaluated before and after erosive cycles using surface
contact profilometer.
RESULTS: There was no significant difference seen while comparing before and after
values for the groups. In intragroup comparison, significant difference for RA before
and RA after values in all 4 groups were seen.
Key words: Casein phosphopeptide-amorphous calcium phosphate–fluoride–dentin–
erosion–arginine containing paste

AIM: To assess the effect of CPP-ACP (Tooth mousse,GC INDIA) , CPP-ACPF
(Tooth mousse plus,GC INDIA) and Arginine containing paste (Sensitive pro relief
,COLGATE INDIA) remineralizing agents on enamel surface after erosive challenge.
MATERIALS AND METHODS: Buccal and lingual enamel surfaces of the selected
20 molar teeth were used, and embedded in acrylic resin and enamel surfaces were
ground flat with Silicon carbide paper disc. Samples were assigned into 4 groups with
10 samples each. Group1 was the control with no treatment, Group 2 of CPP-ACP,
Tooth mousse, GC INDIA, Group 3 of CPP-ACPF, Tooth mousse plus, GC INDIA
and Group 4 of Arginine containing paste( Sensitive pro relief, COLGATE INDIA).
The specimens were then exposed to erosive challenge and treatment. The surface
roughness’s of the samples were evaluated before and after erosive cycles using surface
contact profilometer.
RESULTS: There was no significant difference seen while comparing before and after
values for the groups. In intragroup comparison, significant difference for RA before
and RA after values in all 4 groups were seen.
Key words: Casein phosphopeptide-amorphous calcium phosphate–fluoride–dentin–
erosion–arginine containing paste

With interest we read the article by Grochowski et al.
about an investigation of the optic nerves in 6 patients
with Leber’s hereditary optic neuropathy (LHON) receiving
idebenone and 9 LHON patients not receiving idebenone by
means of a Zero Echo Time (ZET) 7T MRI sequence with
an Adiabatic Spectral Inversion Recovery (ASPIR) fat suppression
pulse (silent-MT 7T-MRI) [1]. It was concluded
that the technique confirms known pathology of the optic
nerve in LHON [1]. We have the following comments and
concerns.
We disagree with the notion that ‘LHON is a disorder of
the optic nerve. LHON is pirmarely a disorder of the retinal
ganglion cells (RGCs), which is why it can be diagnosed by
the ophthalmologist. Secondarily, LHON affects dendrites
and axons of RGCs resulting in asymmetric optic atrophy.
There are no striking conclusions from this study. The
only results were that the silent-MT at 7T depicts the optic
nerve with high quality and artefact-free, that quantitative
measures of the optic nerve can be obtained, and that
LHON optic nerves showed focal hyperintensities.
The authors do not differentiate b etween L HON and
LHON plus [2]. LHON exclusively affects t he retina,
whereas LHON plus is characterised by multiorgan involvement,
affecting i n p articular t he e yes b ut a lso t he brain,
endocrine organs, bone marrow, arteries, kidneys, peripheral
nerves, and the heart [2]. We should know how many
of the included patients had LHON and how many LHON
plus. This is crucial as it may determine the outcome of
these patients [3].

With interest we read the article by Grochowski et al.
about an investigation of the optic nerves in 6 patients
with Leber’s hereditary optic neuropathy (LHON) receiving
idebenone and 9 LHON patients not receiving idebenone by
means of a Zero Echo Time (ZET) 7T MRI sequence with
an Adiabatic Spectral Inversion Recovery (ASPIR) fat suppression
pulse (silent-MT 7T-MRI) [1]. It was concluded
that the technique confirms known pathology of the optic
nerve in LHON [1]. We have the following comments and
concerns.
We disagree with the notion that ‘LHON is a disorder of
the optic nerve. LHON is pirmarely a disorder of the retinal
ganglion cells (RGCs), which is why it can be diagnosed by
the ophthalmologist. Secondarily, LHON affects dendrites
and axons of RGCs resulting in asymmetric optic atrophy.
There are no striking conclusions from this study. The
only results were that the silent-MT at 7T depicts the optic
nerve with high quality and artefact-free, that quantitative
measures of the optic nerve can be obtained, and that
LHON optic nerves showed focal hyperintensities.
The authors do not differentiate b etween L HON and
LHON plus [2]. LHON exclusively affects t he retina,
whereas LHON plus is characterised by multiorgan involvement,
affecting i n p articular t he e yes b ut a lso t he brain,
endocrine organs, bone marrow, arteries, kidneys, peripheral
nerves, and the heart [2]. We should know how many
of the included patients had LHON and how many LHON
plus. This is crucial as it may determine the outcome of
these patients [3].

With interest we read the article by Grochowski et al.
about an investigation of the optic nerves in 6 patients
with Leber’s hereditary optic neuropathy (LHON) receiving
idebenone and 9 LHON patients not receiving idebenone by
means of a Zero Echo Time (ZET) 7T MRI sequence with
an Adiabatic Spectral Inversion Recovery (ASPIR) fat suppression
pulse (silent-MT 7T-MRI) [1]. It was concluded
that the technique confirms known pathology of the optic
nerve in LHON [1]. We have the following comments and
concerns.
We disagree with the notion that ‘LHON is a disorder of
the optic nerve. LHON is pirmarely a disorder of the retinal
ganglion cells (RGCs), which is why it can be diagnosed by
the ophthalmologist. Secondarily, LHON affects dendrites
and axons of RGCs resulting in asymmetric optic atrophy.
There are no striking conclusions from this study. The
only results were that the silent-MT at 7T depicts the optic
nerve with high quality and artefact-free, that quantitative
measures of the optic nerve can be obtained, and that
LHON optic nerves showed focal hyperintensities.
The authors do not differentiate b etween L HON and
LHON plus [2]. LHON exclusively affects t he retina,
whereas LHON plus is characterised by multiorgan involvement,
affecting i n p articular t he e yes b ut a lso t he brain,
endocrine organs, bone marrow, arteries, kidneys, peripheral
nerves, and the heart [2]. We should know how many
of the included patients had LHON and how many LHON
plus. This is crucial as it may determine the outcome of
these patients [3].

With interest we read the article by Burgin et al. about a
study on the effect of the p eroxisome proliferator-activated
receptor (PPAR) activator pioglitazone together with deoxyribonucleosides
on ATP production in cybrid cells. containing
>90% of the m.3243A>G mutation [1].The authors
found that pioglitazone increased mtDNA copy number,
oxygen Konsumption rate, and mitochondrial mass in cybrid
cells and controls but did not affect cell proliferation
[1]. Pioglitazone decreased the number of mtDNA
encoded transcripts, further reducing the already reduced
transcript levels [1]. Pioglitazone did not increase the
steady state levels of mature respiratory chain complexes
[1]. We have the following comments and concerns.

With interest we read the article by Burgin et al. about a
study on the effect of the p eroxisome proliferator-activated
receptor (PPAR) activator pioglitazone together with deoxyribonucleosides
on ATP production in cybrid cells. containing
>90% of the m.3243A>G mutation [1].The authors
found that pioglitazone increased mtDNA copy number,
oxygen Konsumption rate, and mitochondrial mass in cybrid
cells and controls but did not affect cell proliferation
[1]. Pioglitazone decreased the number of mtDNA
encoded transcripts, further reducing the already reduced
transcript levels [1]. Pioglitazone did not increase the
steady state levels of mature respiratory chain complexes
[1]. We have the following comments and concerns.

With interest we read the article by Burgin et al. about a
study on the effect of the p eroxisome proliferator-activated
receptor (PPAR) activator pioglitazone together with deoxyribonucleosides
on ATP production in cybrid cells. containing
>90% of the m.3243A>G mutation [1].The authors
found that pioglitazone increased mtDNA copy number,
oxygen Konsumption rate, and mitochondrial mass in cybrid
cells and controls but did not affect cell proliferation
[1]. Pioglitazone decreased the number of mtDNA
encoded transcripts, further reducing the already reduced
transcript levels [1]. Pioglitazone did not increase the
steady state levels of mature respiratory chain complexes
[1]. We have the following comments and concerns.

The Current COVID-19 pandemic threatens the medical community with several theories.
Because of its higher rate of transmission, the clinical and epidemiological findings
of COVID -19 remain vague. On COVID-19, their understandings are expressed
from every corner of the world but the meaning of those understandings is still uncertain.
The development of timely, cost-effective, reliable and non-invasive diagnostic
methodologies is now an important activity for both clinicians and scientists. Detecting
early-stage pathologies may have a major effect on patient pain, prognosis, clinical
intervention, survival rates and recurrence. As a diagnostic fluid, saliva has tremendous
potential and provides an advantage over other biological fluids, as its method
of processing does not entail invasive, costly procedures and is useful for monitoring
systemic health. The scientific community is in desperate need of an important review
of this COVID-19 hypothesis. In this prospective review we will discuss the saliva as
a source of markers for local, systemic and infectious disorders and its importance. In
addition, we will discuss the current state of salivary diagnostics and related tools, future
expectations, and potential as the chosen route for disease identification, control,
and prognostics.
Key words: COVID-19–Saliva–Biomarker

The Current COVID-19 pandemic threatens the medical community with several theories.
Because of its higher rate of transmission, the clinical and epidemiological findings
of COVID -19 remain vague. On COVID-19, their understandings are expressed
from every corner of the world but the meaning of those understandings is still uncertain.
The development of timely, cost-effective, reliable and non-invasive diagnostic
methodologies is now an important activity for both clinicians and scientists. Detecting
early-stage pathologies may have a major effect on patient pain, prognosis, clinical
intervention, survival rates and recurrence. As a diagnostic fluid, saliva has tremendous
potential and provides an advantage over other biological fluids, as its method
of processing does not entail invasive, costly procedures and is useful for monitoring
systemic health. The scientific community is in desperate need of an important review
of this COVID-19 hypothesis. In this prospective review we will discuss the saliva as
a source of markers for local, systemic and infectious disorders and its importance. In
addition, we will discuss the current state of salivary diagnostics and related tools, future
expectations, and potential as the chosen route for disease identification, control,
and prognostics.
Key words: COVID-19–Saliva–Biomarker

The Current COVID-19 pandemic threatens the medical community with several theories.
Because of its higher rate of transmission, the clinical and epidemiological findings
of COVID -19 remain vague. On COVID-19, their understandings are expressed
from every corner of the world but the meaning of those understandings is still uncertain.
The development of timely, cost-effective, reliable and non-invasive diagnostic
methodologies is now an important activity for both clinicians and scientists. Detecting
early-stage pathologies may have a major effect on patient pain, prognosis, clinical
intervention, survival rates and recurrence. As a diagnostic fluid, saliva has tremendous
potential and provides an advantage over other biological fluids, as its method
of processing does not entail invasive, costly procedures and is useful for monitoring
systemic health. The scientific community is in desperate need of an important review
of this COVID-19 hypothesis. In this prospective review we will discuss the saliva as
a source of markers for local, systemic and infectious disorders and its importance. In
addition, we will discuss the current state of salivary diagnostics and related tools, future
expectations, and potential as the chosen route for disease identification, control,
and prognostics.
Key words: COVID-19–Saliva–Biomarker

Background: The Arab Spring, a wave of demonstrations and protests that had
taken place in the Arab world since December 18, 2010, had also affected Syria. The
number of Syrian refugees who have migrated to Turkey is over 3.5 million.
Objective: The aim of this study was to evaluate the demography, clinical features
and invoice amounts of Syrian refugee patients who were operated in an orthopedic
and traumatology clinic of a healthcare institution far from the Syria district region.
Materials and Methods: For this purpose, 329 Syrian patients who underwent
surgery in the field of orthopedics and Traumatology between June 2011 and 2018
were enrolled in the study. The records of Syrian refugees have been retrospectively
examined.
Results: Male applicants (76.3%) were more than females (23.7%).%). It was observed
that the highest number of applications were in the field of microsurgery (21.3%),
followed by trauma (20.7%) and pediatric orthopedics (14.6%), respectively. Including
the non-emergency trauma patients, 90% of the patients underwent elective surgeries
while 10% underwent emergency surgeries. It was determined that the average invoice
amount was 4987 TL (min: 207 TL, max: 87541 TL) and the highest cost was in the
field of vertebral surgery (average 19384 TL). The rate of emergency applications has
shown a significant increase in 2016 and later (2016-2017-2018) compared to 2015 and
before .
Conclusion : The main Syrian refugees patient profile of the health centers far from
the war zone is composed of elective cases and their costs.
Key words: Health Services Accessibility–Hospital Costs–Orthopedic Procedures–
Refugees–Syria

Background: The Arab Spring, a wave of demonstrations and protests that had
taken place in the Arab world since December 18, 2010, had also affected Syria. The
number of Syrian refugees who have migrated to Turkey is over 3.5 million.
Objective: The aim of this study was to evaluate the demography, clinical features
and invoice amounts of Syrian refugee patients who were operated in an orthopedic
and traumatology clinic of a healthcare institution far from the Syria district region.
Materials and Methods: For this purpose, 329 Syrian patients who underwent
surgery in the field of orthopedics and Traumatology between June 2011 and 2018
were enrolled in the study. The records of Syrian refugees have been retrospectively
examined.
Results: Male applicants (76.3%) were more than females (23.7%).%). It was observed
that the highest number of applications were in the field of microsurgery (21.3%),
followed by trauma (20.7%) and pediatric orthopedics (14.6%), respectively. Including
the non-emergency trauma patients, 90% of the patients underwent elective surgeries
while 10% underwent emergency surgeries. It was determined that the average invoice
amount was 4987 TL (min: 207 TL, max: 87541 TL) and the highest cost was in the
field of vertebral surgery (average 19384 TL). The rate of emergency applications has
shown a significant increase in 2016 and later (2016-2017-2018) compared to 2015 and
before .
Conclusion : The main Syrian refugees patient profile of the health centers far from
the war zone is composed of elective cases and their costs.
Key words: Health Services Accessibility–Hospital Costs–Orthopedic Procedures–
Refugees–Syria

Background: The Arab Spring, a wave of demonstrations and protests that had
taken place in the Arab world since December 18, 2010, had also affected Syria. The
number of Syrian refugees who have migrated to Turkey is over 3.5 million.
Objective: The aim of this study was to evaluate the demography, clinical features
and invoice amounts of Syrian refugee patients who were operated in an orthopedic
and traumatology clinic of a healthcare institution far from the Syria district region.
Materials and Methods: For this purpose, 329 Syrian patients who underwent
surgery in the field of orthopedics and Traumatology between June 2011 and 2018
were enrolled in the study. The records of Syrian refugees have been retrospectively
examined.
Results: Male applicants (76.3%) were more than females (23.7%).%). It was observed
that the highest number of applications were in the field of microsurgery (21.3%),
followed by trauma (20.7%) and pediatric orthopedics (14.6%), respectively. Including
the non-emergency trauma patients, 90% of the patients underwent elective surgeries
while 10% underwent emergency surgeries. It was determined that the average invoice
amount was 4987 TL (min: 207 TL, max: 87541 TL) and the highest cost was in the
field of vertebral surgery (average 19384 TL). The rate of emergency applications has
shown a significant increase in 2016 and later (2016-2017-2018) compared to 2015 and
before .
Conclusion : The main Syrian refugees patient profile of the health centers far from
the war zone is composed of elective cases and their costs.
Key words: Health Services Accessibility–Hospital Costs–Orthopedic Procedures–
Refugees–Syria

Background and objective: posterior canal BPPV is one of the common cause
for vertigo. Well established treatment methods such as semont liberatory maneuver
(SLM) and epley maneuver (EM) are choice of treatment in most patients. These
maneuvers are contraindicated in certain group of patients with neck, back and hip
mobility issues where in gans repositioning maneuver (GRM) is tried. This study
intends to assess the efficacy of this technique.
Methodology: Total of 30 patients including 15 male and 15 female patients were
included in the study. All the patients underwent GRM as a definitive treatment
modality. Patients who responded within 2 attempts were considered successful treatment.
Results: Out of 30 patients 27 patients (90%) were treated successfully within two
attempts of GRM. 3 patients (10%) were considered unresponsive. Male patients responded
better (93.3%) compared to female patients (86.7%). None of the patients
had any discomfort during the procedure.
Conclusion: This study shows that GRM is an effective method in treatment of posterior
canal BPPV and results are comparable to outcome of similar studies conducted
by various authors using other maneuvers such as EM and SLM. Further studies which
include patients with neck, back and hip mobility issues can prove its safety.

Background and objective: posterior canal BPPV is one of the common cause
for vertigo. Well established treatment methods such as semont liberatory maneuver
(SLM) and epley maneuver (EM) are choice of treatment in most patients. These
maneuvers are contraindicated in certain group of patients with neck, back and hip
mobility issues where in gans repositioning maneuver (GRM) is tried. This study
intends to assess the efficacy of this technique.
Methodology: Total of 30 patients including 15 male and 15 female patients were
included in the study. All the patients underwent GRM as a definitive treatment
modality. Patients who responded within 2 attempts were considered successful treatment.
Results: Out of 30 patients 27 patients (90%) were treated successfully within two
attempts of GRM. 3 patients (10%) were considered unresponsive. Male patients responded
better (93.3%) compared to female patients (86.7%). None of the patients
had any discomfort during the procedure.
Conclusion: This study shows that GRM is an effective method in treatment of posterior
canal BPPV and results are comparable to outcome of similar studies conducted
by various authors using other maneuvers such as EM and SLM. Further studies which
include patients with neck, back and hip mobility issues can prove its safety.

Background and objective: posterior canal BPPV is one of the common cause
for vertigo. Well established treatment methods such as semont liberatory maneuver
(SLM) and epley maneuver (EM) are choice of treatment in most patients. These
maneuvers are contraindicated in certain group of patients with neck, back and hip
mobility issues where in gans repositioning maneuver (GRM) is tried. This study
intends to assess the efficacy of this technique.
Methodology: Total of 30 patients including 15 male and 15 female patients were
included in the study. All the patients underwent GRM as a definitive treatment
modality. Patients who responded within 2 attempts were considered successful treatment.
Results: Out of 30 patients 27 patients (90%) were treated successfully within two
attempts of GRM. 3 patients (10%) were considered unresponsive. Male patients responded
better (93.3%) compared to female patients (86.7%). None of the patients
had any discomfort during the procedure.
Conclusion: This study shows that GRM is an effective method in treatment of posterior
canal BPPV and results are comparable to outcome of similar studies conducted
by various authors using other maneuvers such as EM and SLM. Further studies which
include patients with neck, back and hip mobility issues can prove its safety.

ABSTRACT
Acute respiratory distress syndrome is a fatal lung condition defined by direct alveolar
epithelial injury or indirect capillary endothelial injury resulting in increased permeability
and plasma leakage, non-compliant lungs, refractory hypoxemia and shunt,
pulmonary hypertension and right ventricular failure. Lung-protective ventilation is a
time-proven strategy for its management. Numerous modes of ventilation have been
tried in the last few years such as airway pressure release ventilation, biphasic positive
airway pressure, high frequency oscillatory ventilation, proportional assist ventilation,
adaptive support ventilation, and neurally adjusted ventilatory assist. Each of these
modes has its own merits and demerits which they have been reviewed in this article.
Key words: ARDS–modes–ventilation–refractory hypoxemia

ABSTRACT
Acute respiratory distress syndrome is a fatal lung condition defined by direct alveolar
epithelial injury or indirect capillary endothelial injury resulting in increased permeability
and plasma leakage, non-compliant lungs, refractory hypoxemia and shunt,
pulmonary hypertension and right ventricular failure. Lung-protective ventilation is a
time-proven strategy for its management. Numerous modes of ventilation have been
tried in the last few years such as airway pressure release ventilation, biphasic positive
airway pressure, high frequency oscillatory ventilation, proportional assist ventilation,
adaptive support ventilation, and neurally adjusted ventilatory assist. Each of these
modes has its own merits and demerits which they have been reviewed in this article.
Key words: ARDS–modes–ventilation–refractory hypoxemia

ABSTRACT
Acute respiratory distress syndrome is a fatal lung condition defined by direct alveolar
epithelial injury or indirect capillary endothelial injury resulting in increased permeability
and plasma leakage, non-compliant lungs, refractory hypoxemia and shunt,
pulmonary hypertension and right ventricular failure. Lung-protective ventilation is a
time-proven strategy for its management. Numerous modes of ventilation have been
tried in the last few years such as airway pressure release ventilation, biphasic positive
airway pressure, high frequency oscillatory ventilation, proportional assist ventilation,
adaptive support ventilation, and neurally adjusted ventilatory assist. Each of these
modes has its own merits and demerits which they have been reviewed in this article.
Key words: ARDS–modes–ventilation–refractory hypoxemia

With interest we read the article by Müller et al. about a
study of 36 eyes of 18 patients with genetically proven maternally
inherited diabetes mellitus and deafness (MIDD)
for outer retinal atrophy (RORA) [1]. The authors concluded
that the development and progression of RORA can
be monitored by optical coherence tomography (OCT) and
that the morphological features of RORA in MIDD patients
resemble those of age-related macular degeneration
(AMD) [1]. We have the following comments and concerns.
A shortcoming of the study is that heteroplasmy rates of
the m.3243A>G variant was not provided. It is also unclear
in which tissue the MT-TL1 variant was detected. Since
heteroplasmy rates strongly determine the phenotype, it is
crucial to know the amount of mutated mtDNA in relation
to wild-type mtDNA in the most affected tissues. Since
the phenotype in MIDD patient is also dependent on the
mtDNA copy number (mtDNA depletion) [2], it is crucial
to know if any of the 18 included patients had a reduced
amount of mtDNA copies.
A further shortcoming is that the quality of the antidiabetic
treatment was not provided. Since retinal abnormalities
in diabetes strongly depend not only on the duration
of diabetes but also on the quality of the anti-diabetic control
[3], it is crucial to know the HbA1c values of each of
the 18 included patients.
Missing are also the current medication each patient was
regularly taking. Since the medication strongly influences
the HbA1c values, we should know the drugs each patients
was taking at the time of the ophthalmologic investigation.
Additionally, it should be mentioned if the included patients
adhered to the recommended anti-diabetic diet or not.
? Corresponding author.
y Email: fifigs1@yahoo.de
Though per definition, MIDD is phenotypically characterised
by diabetes and deafness, these patients may additionally
present with a myriad of other phenotypic manifestations
[4]. Not only the ears and the pancreas may
be primarily affected but also the central nervous system,
other endocrinological organs, the heart, the gastrointestinal
tract, the kidneys, and the eyes [4]. We should know
which of these additional phenotypic features were present
in the included patients, since they may strongly determine
the prognosis and outcome of these patients.
In the eyes, MIDD patients may not only manifest
with RORA, but also with optic atrophy [5], pigmentary
retinopathy [6], macular dystrophy [7], central retinal vein
occlusion [8], or choroidal atrophy [9]. Which of these features
were additionally present in the 18 included patients?
Recently, it has been shown that autoflourescence could
be a predictive parameter to monitor retinal pigmentary
epithelium atrophy [10]. We should know if autoflourescence
was applied to assess RORA.
Overall, this interesting study has some shortcomings
which should be solved before drawing final conclusions.
The genetic background of MIDD, the multisystem involvement,
and the drug treatment may determine the phenotype,
progression, and outcome also of the ophthalmologic
abnormalities in these patients.

With interest we read the article by Müller et al. about a
study of 36 eyes of 18 patients with genetically proven maternally
inherited diabetes mellitus and deafness (MIDD)
for outer retinal atrophy (RORA) [1]. The authors concluded
that the development and progression of RORA can
be monitored by optical coherence tomography (OCT) and
that the morphological features of RORA in MIDD patients
resemble those of age-related macular degeneration
(AMD) [1]. We have the following comments and concerns.
A shortcoming of the study is that heteroplasmy rates of
the m.3243A>G variant was not provided. It is also unclear
in which tissue the MT-TL1 variant was detected. Since
heteroplasmy rates strongly determine the phenotype, it is
crucial to know the amount of mutated mtDNA in relation
to wild-type mtDNA in the most affected tissues. Since
the phenotype in MIDD patient is also dependent on the
mtDNA copy number (mtDNA depletion) [2], it is crucial
to know if any of the 18 included patients had a reduced
amount of mtDNA copies.
A further shortcoming is that the quality of the antidiabetic
treatment was not provided. Since retinal abnormalities
in diabetes strongly depend not only on the duration
of diabetes but also on the quality of the anti-diabetic control
[3], it is crucial to know the HbA1c values of each of
the 18 included patients.
Missing are also the current medication each patient was
regularly taking. Since the medication strongly influences
the HbA1c values, we should know the drugs each patients
was taking at the time of the ophthalmologic investigation.
Additionally, it should be mentioned if the included patients
adhered to the recommended anti-diabetic diet or not.
? Corresponding author.
y Email: fifigs1@yahoo.de
Though per definition, MIDD is phenotypically characterised
by diabetes and deafness, these patients may additionally
present with a myriad of other phenotypic manifestations
[4]. Not only the ears and the pancreas may
be primarily affected but also the central nervous system,
other endocrinological organs, the heart, the gastrointestinal
tract, the kidneys, and the eyes [4]. We should know
which of these additional phenotypic features were present
in the included patients, since they may strongly determine
the prognosis and outcome of these patients.
In the eyes, MIDD patients may not only manifest
with RORA, but also with optic atrophy [5], pigmentary
retinopathy [6], macular dystrophy [7], central retinal vein
occlusion [8], or choroidal atrophy [9]. Which of these features
were additionally present in the 18 included patients?
Recently, it has been shown that autoflourescence could
be a predictive parameter to monitor retinal pigmentary
epithelium atrophy [10]. We should know if autoflourescence
was applied to assess RORA.
Overall, this interesting study has some shortcomings
which should be solved before drawing final conclusions.
The genetic background of MIDD, the multisystem involvement,
and the drug treatment may determine the phenotype,
progression, and outcome also of the ophthalmologic
abnormalities in these patients.

With interest we read the article by Müller et al. about a
study of 36 eyes of 18 patients with genetically proven maternally
inherited diabetes mellitus and deafness (MIDD)
for outer retinal atrophy (RORA) [1]. The authors concluded
that the development and progression of RORA can
be monitored by optical coherence tomography (OCT) and
that the morphological features of RORA in MIDD patients
resemble those of age-related macular degeneration
(AMD) [1]. We have the following comments and concerns.
A shortcoming of the study is that heteroplasmy rates of
the m.3243A>G variant was not provided. It is also unclear
in which tissue the MT-TL1 variant was detected. Since
heteroplasmy rates strongly determine the phenotype, it is
crucial to know the amount of mutated mtDNA in relation
to wild-type mtDNA in the most affected tissues. Since
the phenotype in MIDD patient is also dependent on the
mtDNA copy number (mtDNA depletion) [2], it is crucial
to know if any of the 18 included patients had a reduced
amount of mtDNA copies.
A further shortcoming is that the quality of the antidiabetic
treatment was not provided. Since retinal abnormalities
in diabetes strongly depend not only on the duration
of diabetes but also on the quality of the anti-diabetic control
[3], it is crucial to know the HbA1c values of each of
the 18 included patients.
Missing are also the current medication each patient was
regularly taking. Since the medication strongly influences
the HbA1c values, we should know the drugs each patients
was taking at the time of the ophthalmologic investigation.
Additionally, it should be mentioned if the included patients
adhered to the recommended anti-diabetic diet or not.
? Corresponding author.
y Email: fifigs1@yahoo.de
Though per definition, MIDD is phenotypically characterised
by diabetes and deafness, these patients may additionally
present with a myriad of other phenotypic manifestations
[4]. Not only the ears and the pancreas may
be primarily affected but also the central nervous system,
other endocrinological organs, the heart, the gastrointestinal
tract, the kidneys, and the eyes [4]. We should know
which of these additional phenotypic features were present
in the included patients, since they may strongly determine
the prognosis and outcome of these patients.
In the eyes, MIDD patients may not only manifest
with RORA, but also with optic atrophy [5], pigmentary
retinopathy [6], macular dystrophy [7], central retinal vein
occlusion [8], or choroidal atrophy [9]. Which of these features
were additionally present in the 18 included patients?
Recently, it has been shown that autoflourescence could
be a predictive parameter to monitor retinal pigmentary
epithelium atrophy [10]. We should know if autoflourescence
was applied to assess RORA.
Overall, this interesting study has some shortcomings
which should be solved before drawing final conclusions.
The genetic background of MIDD, the multisystem involvement,
and the drug treatment may determine the phenotype,
progression, and outcome also of the ophthalmologic
abnormalities in these patients.

BACKGROUND: The time between a child’s birth and 2 years of age is a critical
window of opportunity to ensure the child’s development through optimum feeding
practices.
OBJECTIVE: 1. To study the feeding practices in infants & children between 6-
23months.2. To study the impact of maternal education, occupation & type of family
of the child on the feeding practices. MATERIALS AND METHOD: It was a
hospital based cross sectional study conducted among 451 mothers having children of
age six months to twenty-three months attending Immunisation OPD of SCB Medical
College and Hospital, Cuttack during the month of October 2015 to March 2016 by
using predesigned, pre-tested questionnaire.
RESULT: 75.6% infants exclusively breastfed up to 6 months. 55.9% of the infants
were given colostrum at birth. Only 22.2% of the infants were fed on breast milk
within one hour of birth. 76.1% infants were breast fed on demand and 23.9% infants
were breastfed by clock.
CONCLUSION: About half of the mothers had given colostrum to their babies and
less than one fourth had initiated breast feeding within 1hr of birth which is much
lower to State average according to NFHS-4.
Key words: Immunisation OPD–Exclusive breast feeding–Colostrum–Demand feeding

BACKGROUND: The time between a child’s birth and 2 years of age is a critical
window of opportunity to ensure the child’s development through optimum feeding
practices.
OBJECTIVE: 1. To study the feeding practices in infants & children between 6-
23months.2. To study the impact of maternal education, occupation & type of family
of the child on the feeding practices. MATERIALS AND METHOD: It was a
hospital based cross sectional study conducted among 451 mothers having children of
age six months to twenty-three months attending Immunisation OPD of SCB Medical
College and Hospital, Cuttack during the month of October 2015 to March 2016 by
using predesigned, pre-tested questionnaire.
RESULT: 75.6% infants exclusively breastfed up to 6 months. 55.9% of the infants
were given colostrum at birth. Only 22.2% of the infants were fed on breast milk
within one hour of birth. 76.1% infants were breast fed on demand and 23.9% infants
were breastfed by clock.
CONCLUSION: About half of the mothers had given colostrum to their babies and
less than one fourth had initiated breast feeding within 1hr of birth which is much
lower to State average according to NFHS-4.
Key words: Immunisation OPD–Exclusive breast feeding–Colostrum–Demand feeding

BACKGROUND: The time between a child’s birth and 2 years of age is a critical
window of opportunity to ensure the child’s development through optimum feeding
practices.
OBJECTIVE: 1. To study the feeding practices in infants & children between 6-
23months.2. To study the impact of maternal education, occupation & type of family
of the child on the feeding practices. MATERIALS AND METHOD: It was a
hospital based cross sectional study conducted among 451 mothers having children of
age six months to twenty-three months attending Immunisation OPD of SCB Medical
College and Hospital, Cuttack during the month of October 2015 to March 2016 by
using predesigned, pre-tested questionnaire.
RESULT: 75.6% infants exclusively breastfed up to 6 months. 55.9% of the infants
were given colostrum at birth. Only 22.2% of the infants were fed on breast milk
within one hour of birth. 76.1% infants were breast fed on demand and 23.9% infants
were breastfed by clock.
CONCLUSION: About half of the mothers had given colostrum to their babies and
less than one fourth had initiated breast feeding within 1hr of birth which is much
lower to State average according to NFHS-4.
Key words: Immunisation OPD–Exclusive breast feeding–Colostrum–Demand feeding

INTRODUCTION: Intravenous cannulation is insertion of cannula into the vein, so
that infusion can be directly infused into the blood stream. They are primarily used
for therapeutic purposes such as administration of medications, intra venous fluids,
blood and blood products. More than 85% of patients admitted in the hospital need
peripheral intravenous cannulation for administration of medications. Objectives:
1.To determine the patency of peripheral intravenous cannula within 72 hours, 2.To
assess the effect of normal saline flush and routine care on patency of peripheral
intravenous cannula, 3. To find out the association between the patency of peripheral
intravenous cannula with selected background variables in experimental group.
Material And Methods: True experimental design was used in this study. After
obtaining IRB approval the study was registered in clinical trial registry – India as per
ethical committee suggestion. The trail was registered on 20/7/2017 and trail number
was obtained (CTRI Number – CTRI/2017/07/009085). Study was conducted
among 30 participants who had newly inserted peripheral intravenous cannula and
received intravenous medication twice daily. 30 study participants were separated
into two groups using computer generated random table as experimental group and
control group. Experimental group participants received 2ml (0.9%) normal saline
flush after administering medication. Control group participants did not receive the
normal saline flush, only medication was administered and cannula was locked as per
the routine practice. The background variables of study participants were collected
from the participant’s case record and the peripheral intravenous cannula blocks were
assessed twice daily from 0 – 72 hours using the observational checklist for assessing
the patency of peripheral intravenous cannula. Descriptive Statistics (Frequency
& Percentage) and Inferential Statistics (fisher exact test) were used to analyze the
data. Results: The study result revealed that, in experimental group, among 15 study
participants all of them had their peripheral intravenous cannula patent for first 24
hours, 13 (86.7%) study participants had their peripheral intravenous cannula patent
upto 48 hours and 8 (53.4%) study participants had their peripheral intravenous cannula
patent upto 72 hours. In control group, among 15 study participants 13 (86.7%)
of them had their peripheral intravenous cannula patent for first 24 hours, 7 (46.7%)
study participants had their peripheral intravenous cannula patent up to 48 hours and
1 (6.7%) study participant had peripheral intravenous cannula patent up to 72 hours.
There is a statistically significant difference between experimental and control group
(p = 0.03) in maintaining the patency of peripheral intravenous cannula There was
no association found between the patency of PIVC with selected background variables
in the experimental group.
Conclusion: The findings of the study revealed that there is a significant difference
between the experimental and control group in maintaining the patency of peripheral
intravenous cannula by using the (0.9%) normal saline flush after medication administration.
Hence it is proved that flushing and locking the peripheral intravenous
cannula with 2ml of (0.9%) normal saline is effective method to maintain the patency
of peripheral intravenous cannula.
Key words: Peripheral intravenous cannula–Flush–Blockage–Patency

INTRODUCTION: Intravenous cannulation is insertion of cannula into the vein, so
that infusion can be directly infused into the blood stream. They are primarily used
for therapeutic purposes such as administration of medications, intra venous fluids,
blood and blood products. More than 85% of patients admitted in the hospital need
peripheral intravenous cannulation for administration of medications. Objectives:
1.To determine the patency of peripheral intravenous cannula within 72 hours, 2.To
assess the effect of normal saline flush and routine care on patency of peripheral
intravenous cannula, 3. To find out the association between the patency of peripheral
intravenous cannula with selected background variables in experimental group.
Material And Methods: True experimental design was used in this study. After
obtaining IRB approval the study was registered in clinical trial registry – India as per
ethical committee suggestion. The trail was registered on 20/7/2017 and trail number
was obtained (CTRI Number – CTRI/2017/07/009085). Study was conducted
among 30 participants who had newly inserted peripheral intravenous cannula and
received intravenous medication twice daily. 30 study participants were separated
into two groups using computer generated random table as experimental group and
control group. Experimental group participants received 2ml (0.9%) normal saline
flush after administering medication. Control group participants did not receive the
normal saline flush, only medication was administered and cannula was locked as per
the routine practice. The background variables of study participants were collected
from the participant’s case record and the peripheral intravenous cannula blocks were
assessed twice daily from 0 – 72 hours using the observational checklist for assessing
the patency of peripheral intravenous cannula. Descriptive Statistics (Frequency
& Percentage) and Inferential Statistics (fisher exact test) were used to analyze the
data. Results: The study result revealed that, in experimental group, among 15 study
participants all of them had their peripheral intravenous cannula patent for first 24
hours, 13 (86.7%) study participants had their peripheral intravenous cannula patent
upto 48 hours and 8 (53.4%) study participants had their peripheral intravenous cannula
patent upto 72 hours. In control group, among 15 study participants 13 (86.7%)
of them had their peripheral intravenous cannula patent for first 24 hours, 7 (46.7%)
study participants had their peripheral intravenous cannula patent up to 48 hours and
1 (6.7%) study participant had peripheral intravenous cannula patent up to 72 hours.
There is a statistically significant difference between experimental and control group
(p = 0.03) in maintaining the patency of peripheral intravenous cannula There was
no association found between the patency of PIVC with selected background variables
in the experimental group.
Conclusion: The findings of the study revealed that there is a significant difference
between the experimental and control group in maintaining the patency of peripheral
intravenous cannula by using the (0.9%) normal saline flush after medication administration.
Hence it is proved that flushing and locking the peripheral intravenous
cannula with 2ml of (0.9%) normal saline is effective method to maintain the patency
of peripheral intravenous cannula.
Key words: Peripheral intravenous cannula–Flush–Blockage–Patency

Objective: To report our contemporary experience in operative management of complex
upper urinary tract obstruction in solitary kidney patients. Material and
method: From January 2014 to December 2018 , we have performed 9 cases of
ureterocalycostomy in which 6 cases were of primary PUJ(Pelviureteric junction) obstruction
with complete intrarenal pelvis with minimal hydronephrosis, 2 cases were
post PCNL(Percutaneous Nephrolithomy) and one case of post RIRS(Retrograde Intrarenal
surgery) proximal upper ureter stricture All patients subjected to ureterocalycostomy
after control of sepsis .
Open Flank approach was performed. Due to hypertrophy of kidney and intra renal
pelvis, Guillotine lower pole partial nephrectomy was performed in all the cases.
Ureterocalycostomy was done with the most dependent calyx over 6/26 DJS (Double
J stent) followed by omental wrapping. Standard postoperative monitoring done. The
recorded data included demographic profiling. Results: All the patients presented
with pain, raised creatinine levels and sepsis. Patients mean age of presentation was
20.1 years, 6 were male and 3were female. Mean operative time was 129.5 minutes,
mean blood loss was 100ml, mean cold ischemia time 30 minutes and mean hospital duration
was 9.1 days. Out of two patients one patients had grade 1(clavein –dindo) and
second had grade 3 (clavein –dindo) complications. All patients were asymptomatic
for next 1 year follow up. Conclusions: Primary ureterocalycostomy with Guillotine
lower pole partial nephrectomy, has resulted in satisfactory outcomes in patients with
complex upper urinary tract obstruction and having solitary functioning kidney ,who
are not candidates for other procedures, such as pyeloplasty.
Key words: Solitary Kidney–Ureter–Ureteral Obstruction

Objective: To report our contemporary experience in operative management of complex
upper urinary tract obstruction in solitary kidney patients. Material and
method: From January 2014 to December 2018 , we have performed 9 cases of
ureterocalycostomy in which 6 cases were of primary PUJ(Pelviureteric junction) obstruction
with complete intrarenal pelvis with minimal hydronephrosis, 2 cases were
post PCNL(Percutaneous Nephrolithomy) and one case of post RIRS(Retrograde Intrarenal
surgery) proximal upper ureter stricture All patients subjected to ureterocalycostomy
after control of sepsis .
Open Flank approach was performed. Due to hypertrophy of kidney and intra renal
pelvis, Guillotine lower pole partial nephrectomy was performed in all the cases.
Ureterocalycostomy was done with the most dependent calyx over 6/26 DJS (Double
J stent) followed by omental wrapping. Standard postoperative monitoring done. The
recorded data included demographic profiling. Results: All the patients presented
with pain, raised creatinine levels and sepsis. Patients mean age of presentation was
20.1 years, 6 were male and 3were female. Mean operative time was 129.5 minutes,
mean blood loss was 100ml, mean cold ischemia time 30 minutes and mean hospital duration
was 9.1 days. Out of two patients one patients had grade 1(clavein –dindo) and
second had grade 3 (clavein –dindo) complications. All patients were asymptomatic
for next 1 year follow up. Conclusions: Primary ureterocalycostomy with Guillotine
lower pole partial nephrectomy, has resulted in satisfactory outcomes in patients with
complex upper urinary tract obstruction and having solitary functioning kidney ,who
are not candidates for other procedures, such as pyeloplasty.
Key words: Solitary Kidney–Ureter–Ureteral Obstruction

Objective: To report our contemporary experience in operative management of complex
upper urinary tract obstruction in solitary kidney patients. Material and
method: From January 2014 to December 2018 , we have performed 9 cases of
ureterocalycostomy in which 6 cases were of primary PUJ(Pelviureteric junction) obstruction
with complete intrarenal pelvis with minimal hydronephrosis, 2 cases were
post PCNL(Percutaneous Nephrolithomy) and one case of post RIRS(Retrograde Intrarenal
surgery) proximal upper ureter stricture All patients subjected to ureterocalycostomy
after control of sepsis .
Open Flank approach was performed. Due to hypertrophy of kidney and intra renal
pelvis, Guillotine lower pole partial nephrectomy was performed in all the cases.
Ureterocalycostomy was done with the most dependent calyx over 6/26 DJS (Double
J stent) followed by omental wrapping. Standard postoperative monitoring done. The
recorded data included demographic profiling. Results: All the patients presented
with pain, raised creatinine levels and sepsis. Patients mean age of presentation was
20.1 years, 6 were male and 3were female. Mean operative time was 129.5 minutes,
mean blood loss was 100ml, mean cold ischemia time 30 minutes and mean hospital duration
was 9.1 days. Out of two patients one patients had grade 1(clavein –dindo) and
second had grade 3 (clavein –dindo) complications. All patients were asymptomatic
for next 1 year follow up. Conclusions: Primary ureterocalycostomy with Guillotine
lower pole partial nephrectomy, has resulted in satisfactory outcomes in patients with
complex upper urinary tract obstruction and having solitary functioning kidney ,who
are not candidates for other procedures, such as pyeloplasty.
Key words: Solitary Kidney–Ureter–Ureteral Obstruction

Aim: The study aimed to compare calcium hydroxide, mineral trioxide
aggregate (MTA), biodentine and platelet rich fibrin (PRF) as direct pulp
capping agents in permanent mandibular molars.
Materials and methods: 60 permanent mandibular molars with symptoms of
reversible pulpitis were divided into 4 groups according to the agent used (n
= 15): calcium hydroxide, MTA, Biodentine, PRF according to the direct
pulp capping agent used. The patients were recalled after 1 week, 1,3 6 and 12
months for pain and periapical status assessment.
Results: After a follow - up of 12 months PRF showed maximum dentine
thickness formation.
Conclusion: PRF can be used as an alternative to MTA for direct pulp
capping in teeth with reversible pulpitis.
Keywords: Platelet rich fibrin, direct pulp capping, tertiary dentine,
Biodentine.

Introduction: Hepatitis B infection is caused by hepatitis B virus (HBV), an enveloped
DNA virus belonging to family Hepadnaviridae that infects the liver and
causes hepatocellular necrosis and inflammation which are serious public health problem
worldwide. Transmission of HBV from carrier mothers to babies can occur during
perinatal period and is important factor in determining the prevalence of infection in
highly endemic areas.
Aims and Objectives: To study the prevalence of Hepatitis B virus infection among
pregnant female in North India and to compare seropositivity of Hepatitis B infection
among pregnant and non –pregnant women.
Methods: The Present study was conducted in the department of microbiology on
568 pregnant female. The serums were obtained by centrifugation & test was done.
The Hepatitis B surface Ag was detected by using HEPACARDS kit.
Results: In our current study on 568 pregnant female were screened for HBsAg and we
found that 1.8% pregnant female were reactive with HBsAg in serum and 98.2% were
Non reactive with HBsAg out of 568 pregnant female. Higher prevalence of HBsAg
was reported in most sexually active age group.i.e.25-30 years (55.4%).
Conclusion: In the light of current study, it can be concluded that the Hepatitis B
virus infection is a public health issue in this region, the prenatal counseling on HBV
infection should be instituted within antenatal care clinic as it could help to raise
awareness of disease among pregnant female either through health care workers or the
Government.
Key words: Hepatitis B infection–Prevalence–Pregnant female

Introduction: Hepatitis B infection is caused by hepatitis B virus (HBV), an enveloped
DNA virus belonging to family Hepadnaviridae that infects the liver and
causes hepatocellular necrosis and inflammation which are serious public health problem
worldwide. Transmission of HBV from carrier mothers to babies can occur during
perinatal period and is important factor in determining the prevalence of infection in
highly endemic areas.
Aims and Objectives: To study the prevalence of Hepatitis B virus infection among
pregnant female in North India and to compare seropositivity of Hepatitis B infection
among pregnant and non –pregnant women.
Methods: The Present study was conducted in the department of microbiology on
568 pregnant female. The serums were obtained by centrifugation & test was done.
The Hepatitis B surface Ag was detected by using HEPACARDS kit.
Results: In our current study on 568 pregnant female were screened for HBsAg and we
found that 1.8% pregnant female were reactive with HBsAg in serum and 98.2% were
Non reactive with HBsAg out of 568 pregnant female. Higher prevalence of HBsAg
was reported in most sexually active age group.i.e.25-30 years (55.4%).
Conclusion: In the light of current study, it can be concluded that the Hepatitis B
virus infection is a public health issue in this region, the prenatal counseling on HBV
infection should be instituted within antenatal care clinic as it could help to raise
awareness of disease among pregnant female either through health care workers or the
Government.
Key words: Hepatitis B infection–Prevalence–Pregnant female

Key Phrases: Novel Business Model, nCoV-19 Dual , Universal Rapid Immunologic
Test, Identity Tag, Rapid Unpacking, Units of Population, Lockdown,
Socioeconomic Shock

Key Phrases: Novel Business Model, nCoV-19 Dual , Universal Rapid Immunologic
Test, Identity Tag, Rapid Unpacking, Units of Population, Lockdown,
Socioeconomic Shock

Key Phrases: Novel Business Model, nCoV-19 Dual , Universal Rapid Immunologic
Test, Identity Tag, Rapid Unpacking, Units of Population, Lockdown,
Socioeconomic Shock

Background

Premedication in pediatric anesthesia is a challenge for Anesthesiologist. Anxious children have higher incidence of negative postoperative behaviors for up to two weeks after surgery. Hence, right premedication is the eternal search for anesthesia fraternity.

Aims and Objectives

To compare oral midazolam (0.5mg/kg) with oral clonidine (4 micrograms/kg) as a pre medication in children

Material & Methods

This study was carried out on 30 children who were admitted to Yenepoya Medical College & Hospital for surgical intervention under general anaesthesia during the period from 01-10-2009 to 30-11-2011.

Result

In the midazolam group the sedation score after 30 mins and 90 mins, 80% of the subjects were awake . In the Clonidine group it was found that 66.7% are drowsy at 30 mins and 70% are drowsy at 90 mins. The difference between to the groups was statistically highly significant.

In the midazolam group parental separation were good only in 56% of the subjects where as it was 93.3% in the Clonidine group which is statistically highly significant.

In the midazolam group the mask acceptance was good in 86.7% of the subjects . In the Clonidine group 100% of the subjects had good acceptance.

Conclusion

Present study showed that premedication oral clonidine appeared to superior than oral midazolam.Oral clonidine produces significantly better sedation than oral midazolam

Background

Premedication in pediatric anesthesia is a challenge for Anesthesiologist. Anxious children have higher incidence of negative postoperative behaviors for up to two weeks after surgery. Hence, right premedication is the eternal search for anesthesia fraternity.

Aims and Objectives

To compare oral midazolam (0.5mg/kg) with oral clonidine (4 micrograms/kg) as a pre medication in children

Material & Methods

This study was carried out on 30 children who were admitted to Yenepoya Medical College & Hospital for surgical intervention under general anaesthesia during the period from 01-10-2009 to 30-11-2011.

Result

In the midazolam group the sedation score after 30 mins and 90 mins, 80% of the subjects were awake . In the Clonidine group it was found that 66.7% are drowsy at 30 mins and 70% are drowsy at 90 mins. The difference between to the groups was statistically highly significant.

In the midazolam group parental separation were good only in 56% of the subjects where as it was 93.3% in the Clonidine group which is statistically highly significant.

In the midazolam group the mask acceptance was good in 86.7% of the subjects . In the Clonidine group 100% of the subjects had good acceptance.

Conclusion

Present study showed that premedication oral clonidine appeared to superior than oral midazolam.Oral clonidine produces significantly better sedation than oral midazolam

Background:
Understanding various learning styles and framing teaching strategies accordingly has become a cornerstone of good teaching practice.
Grasha and Riechmann (1996) consider learning styles as social interactions. They classify them into six categories: Independent, Avoidant,
Collaborative, Dependent, Competitive and Participant, each of which
has its own characteristics.
Hence, the present study was planned and conducted to evaluate the
preferences in learning styles among the undergraduate medical students of a South Indian medical college, using the GRSLSS.
Methodology: The GRSLSS inventory was used for the assessment of
learning style preferences among the participants. The survey questionnaire comprised of 60 questions, amongst which, ten questions were
grouped for each of the six mentioned learning styles. The sum of
the scores for the specified ten questions of each learning style was
calculated and then averaged. The mean scores were calculated and
compared using the Kruskal Wallis Test.
Results: Among the 134 participants, there was a statistically significant difference in the distribution of learning style patterns among
individuals.(p<0.01) There was a dominance of Collaborative and
Dependant learning type, followed by the Independent style. The
Participant and Competitive learning styles were sparsely distributed
among the individuals.
Discussion: A mismatch between the teaching style of a teacher and
the learning style of a student can render the teaching/learning process
less effective. The present study highlighted that the student’s learning
process and academic performance can be improved by tailoring the
instructional modality to the student’s preference or style, whenever
feasible.
Keywords: Grasha Reichman, Learning Scale, Learning Style, Student
centered learning.

Background:
Understanding various learning styles and framing teaching strategies accordingly has become a cornerstone of good teaching practice.
Grasha and Riechmann (1996) consider learning styles as social interactions. They classify them into six categories: Independent, Avoidant,
Collaborative, Dependent, Competitive and Participant, each of which
has its own characteristics.
Hence, the present study was planned and conducted to evaluate the
preferences in learning styles among the undergraduate medical students of a South Indian medical college, using the GRSLSS.
Methodology: The GRSLSS inventory was used for the assessment of
learning style preferences among the participants. The survey questionnaire comprised of 60 questions, amongst which, ten questions were
grouped for each of the six mentioned learning styles. The sum of
the scores for the specified ten questions of each learning style was
calculated and then averaged. The mean scores were calculated and
compared using the Kruskal Wallis Test.
Results: Among the 134 participants, there was a statistically significant difference in the distribution of learning style patterns among
individuals.(p<0.01) There was a dominance of Collaborative and
Dependant learning type, followed by the Independent style. The
Participant and Competitive learning styles were sparsely distributed
among the individuals.
Discussion: A mismatch between the teaching style of a teacher and
the learning style of a student can render the teaching/learning process
less effective. The present study highlighted that the student’s learning
process and academic performance can be improved by tailoring the
instructional modality to the student’s preference or style, whenever
feasible.
Keywords: Grasha Reichman, Learning Scale, Learning Style, Student
centered learning.

INTRODUCTION: Ventilator-associated pneumonia (VAP) is a type of hospital-acquired pneumonia that occurs in patients who are mechanically ventilated for more than 48 hours. VAP is the leading cause of nosocomial infections in patients in intensive care units (ICUs). The pathogenesis of VAP originates from microbial pathogens that are aspirated through the tracheal tube cuff and into the lower respiratory tract. Subsequent colonization and overwhelming of the host's mechanical, body fluids, and cellular defense mechanisms leads to the development of VAP.  Objectives:1. To assess the compliance on VAP care Bundle by staff nurses in critical care units.2. To identify the reason for the non-compliance on VAP care bundle.3.To associate the level of compliance on VAP care bundle with demographic variables.

Material and Methods: A Descriptive study conducted in critical care units at a tertiary teaching hospital at Puducherry. Institutional review board permission was obtained. The data collection period was one month in the year 2018. The population was nurses who are taking care of mechanical ventilator patients. Samples were selected by census method. The sample size was 50. After getting group consent (verbal consent) from each staff nurses, they were observed by using observational checklist to assess the compliance of VAP care bundle in critical care units. After continuous 3 observations, the participant information sheet was provided and written consent was obtained from each staff nurses. After that the data related to demographic variables and self administered questionnaires on compliance of VAP care bundle was administered over a period of 20 minutes for every participant. Results: In the present study majority 76% (38) staff nurses had average level of compliance to VAP care bundle, 72% (36) of the staff nurses belongs to the age group of 22-25 years,86% (43) of them were females ,96% (48) had completed BSc Nursing,46% (23) of them had 13-36 months of working experience and 58%(29)  had not attended CNE regarding VAP care bundle. Conclusion: The present study assessed the level of compliance of VAP care bundle by staff nurses in critical care units. The practices were observed by using observational checklist and the reasons for non compliance to VAP care bundle given by staff nurses were expensive equipment, lack of awareness and dependence on doctor’s order. The study concludes that the level of compliance among majority of staff nurses were average, so there is need for improvement in nurses performance in implementing VAP care bundle protocol in critical care units.

INTRODUCTION: Ventilator-associated pneumonia (VAP) is a type of hospital-acquired pneumonia that occurs in patients who are mechanically ventilated for more than 48 hours. VAP is the leading cause of nosocomial infections in patients in intensive care units (ICUs). The pathogenesis of VAP originates from microbial pathogens that are aspirated through the tracheal tube cuff and into the lower respiratory tract. Subsequent colonization and overwhelming of the host's mechanical, body fluids, and cellular defense mechanisms leads to the development of VAP.  Objectives:1. To assess the compliance on VAP care Bundle by staff nurses in critical care units.2. To identify the reason for the non-compliance on VAP care bundle.3.To associate the level of compliance on VAP care bundle with demographic variables.

Material and Methods: A Descriptive study conducted in critical care units at a tertiary teaching hospital at Puducherry. Institutional review board permission was obtained. The data collection period was one month in the year 2018. The population was nurses who are taking care of mechanical ventilator patients. Samples were selected by census method. The sample size was 50. After getting group consent (verbal consent) from each staff nurses, they were observed by using observational checklist to assess the compliance of VAP care bundle in critical care units. After continuous 3 observations, the participant information sheet was provided and written consent was obtained from each staff nurses. After that the data related to demographic variables and self administered questionnaires on compliance of VAP care bundle was administered over a period of 20 minutes for every participant. Results: In the present study majority 76% (38) staff nurses had average level of compliance to VAP care bundle, 72% (36) of the staff nurses belongs to the age group of 22-25 years,86% (43) of them were females ,96% (48) had completed BSc Nursing,46% (23) of them had 13-36 months of working experience and 58%(29)  had not attended CNE regarding VAP care bundle. Conclusion: The present study assessed the level of compliance of VAP care bundle by staff nurses in critical care units. The practices were observed by using observational checklist and the reasons for non compliance to VAP care bundle given by staff nurses were expensive equipment, lack of awareness and dependence on doctor’s order. The study concludes that the level of compliance among majority of staff nurses were average, so there is need for improvement in nurses performance in implementing VAP care bundle protocol in critical care units.

Asthma is a chronic inflammatory condition that affects the airways. The features of the disease include narrowing of the airways, recurrent episodes of breathlessness, chest tightness and wheezing. The condition is one of the most common chronic illness in not only children but also in adults and aged individuals (Asthma Australia 2017). In Australia, the prevalence of Asthma among children is among the highest across the globe. One out of every nine Australians suffers from asthma. The condition is more common among males aged between 0-14, but more common among females aged 15 years and over. The disease is prevalent among individuals living in poor neighbourhoods and rural areas. Every person living with asthma should have a written action plan. However, only people aged 15 and over have a written action plan (Asthma Australia 2017). Only 41% of children who have developed the condition have an action plan (Asthma Australia 2017). In the United States, over 23 million individuals have the condition, with children projected to be about 6.8 million, or rather, an average of 1 out of every 10 school aged children (McCarty and Rogers 2012).

1 INTRODUCTION
SIR – We wish to comment on a Letter by Soichiro Yasuda
and colleagues „ Dystrophic heart failure blocked by membrane
sealant poloxamer“ (Nature, 436:1025-1029;2005M).
How can control (C57BL) and mdx-mice be compared
if they differed considerably at baseline concerning endsystolic
volume, end-diastolic volume, end-systolic pressure,
stroke volume, and dP/dtmin?
Left ventricular (LV) end-systolic diameter, LV enddiastolic
diameter, and LV-mass increase and fractional
shortening decreases with age and by age 42w all mdx-mice
have dilated cardiomyopathy. It is not mentioned if all of
the investigated mice had the same age.
Also gender of the investigated mdx-mice is not given.
Gender might be relevant since sex-associated changes in
response to calcium were reported in mdx-mice.
Different parts of the myocardium are differentially affected
by the dystrophic process and myocardial fibrosis in
mdx-mice. It is not mentioned from which part of the heart
cardiomyocytes were taken. Were they taken from the left
or right atrium or ventricle? Was the location of biopsy the
same in control and mdx-mice?
Mdx-mice develop progressive LV dilatation and by age
42 weeks all have dilated cardiomyopathy. How to explain
that in the present study end-diastolic-volume was smaller
in mdx-mice compared to control mice and that there was
diastolic instead of systolic dysfunction? Did any of the
mdx-mice develop dilated cardiomyopathy or restrictive
haemodynamics?
Mdx-mice develop ECG abnormalities, like tachycardia,
similar to those in DMD. Were ECGs registered during the
experiments and did the frequency of ECG abnormalities
differ between P188-treated and untreated mdx-mice? Why
did P188 not affect the heart rate? How to explain heart
rates of 582-600bpm in anaesthetised control and mdxmice
whereas previous studies reported heart rates of 350-
380bpm in anaesthetised C57BL mice?
How to explain that P188 only increases LV end-diastolic
volume without affecting LV end-diastolic pressure? If
P188 actually improves the diastolic function, expressed as
dP/dtmin, a decrease in LV end-diastolic pressure would be
expected.
Since the end-diastolic-pressure did not differ between
control and mdx-mice at baseline, the latter do not seem to
have diastolic dysfunction. Increase in end-diastolic pressure
after P188 indicates ineffectiveness of the agent concerning
diastolic function.
Why was dobutamine chosen as a cardiac stressor, since
isoproterenol or aortic constriction have been acknowledged
as appropriate cardiac stressors in mdx-mice? The study
referenced for giving dobutamine actually used aortic constriction
and isoproterenol, but not dobutamine. How can
one be sure that myocardial P188 concentrations were high
enough after local or intravenous application to be effective?
Differed hearts morphologically or functionally between
control and mdx-mice? What were the pathoanatomic and
histological findings in hearts of P188-treated and untreated
mdx-mice? Did they differ from control mice? Was there a
difference in the amount of damaged cardiomyocytes and
fibrosis? Were there any cases with LV hypertrabeculation/
noncompaction? Why was no echocardiography or cardiac
MRI carried out to monitor the therapeutic effect of
P188?
The presented data do not justify to claiming a
therapeutic effect of P188 for mdx cardiomyopathy
because the study groups were unequal, cardiac changes
after treatment were equivocal, and because of various
other methodological uncertainties.

1 INTRODUCTION
SIR – We wish to comment on a Letter by Soichiro Yasuda
and colleagues „ Dystrophic heart failure blocked by membrane
sealant poloxamer“ (Nature, 436:1025-1029;2005M).
How can control (C57BL) and mdx-mice be compared
if they differed considerably at baseline concerning endsystolic
volume, end-diastolic volume, end-systolic pressure,
stroke volume, and dP/dtmin?
Left ventricular (LV) end-systolic diameter, LV enddiastolic
diameter, and LV-mass increase and fractional
shortening decreases with age and by age 42w all mdx-mice
have dilated cardiomyopathy. It is not mentioned if all of
the investigated mice had the same age.
Also gender of the investigated mdx-mice is not given.
Gender might be relevant since sex-associated changes in
response to calcium were reported in mdx-mice.
Different parts of the myocardium are differentially affected
by the dystrophic process and myocardial fibrosis in
mdx-mice. It is not mentioned from which part of the heart
cardiomyocytes were taken. Were they taken from the left
or right atrium or ventricle? Was the location of biopsy the
same in control and mdx-mice?
Mdx-mice develop progressive LV dilatation and by age
42 weeks all have dilated cardiomyopathy. How to explain
that in the present study end-diastolic-volume was smaller
in mdx-mice compared to control mice and that there was
diastolic instead of systolic dysfunction? Did any of the
mdx-mice develop dilated cardiomyopathy or restrictive
haemodynamics?
Mdx-mice develop ECG abnormalities, like tachycardia,
similar to those in DMD. Were ECGs registered during the
experiments and did the frequency of ECG abnormalities
differ between P188-treated and untreated mdx-mice? Why
did P188 not affect the heart rate? How to explain heart
rates of 582-600bpm in anaesthetised control and mdxmice
whereas previous studies reported heart rates of 350-
380bpm in anaesthetised C57BL mice?
How to explain that P188 only increases LV end-diastolic
volume without affecting LV end-diastolic pressure? If
P188 actually improves the diastolic function, expressed as
dP/dtmin, a decrease in LV end-diastolic pressure would be
expected.
Since the end-diastolic-pressure did not differ between
control and mdx-mice at baseline, the latter do not seem to
have diastolic dysfunction. Increase in end-diastolic pressure
after P188 indicates ineffectiveness of the agent concerning
diastolic function.
Why was dobutamine chosen as a cardiac stressor, since
isoproterenol or aortic constriction have been acknowledged
as appropriate cardiac stressors in mdx-mice? The study
referenced for giving dobutamine actually used aortic constriction
and isoproterenol, but not dobutamine. How can
one be sure that myocardial P188 concentrations were high
enough after local or intravenous application to be effective?
Differed hearts morphologically or functionally between
control and mdx-mice? What were the pathoanatomic and
histological findings in hearts of P188-treated and untreated
mdx-mice? Did they differ from control mice? Was there a
difference in the amount of damaged cardiomyocytes and
fibrosis? Were there any cases with LV hypertrabeculation/
noncompaction? Why was no echocardiography or cardiac
MRI carried out to monitor the therapeutic effect of
P188?
The presented data do not justify to claiming a
therapeutic effect of P188 for mdx cardiomyopathy
because the study groups were unequal, cardiac changes
after treatment were equivocal, and because of various
other methodological uncertainties.

1 INTRODUCTION
SIR – We wish to comment on a Letter by Soichiro Yasuda
and colleagues „ Dystrophic heart failure blocked by membrane
sealant poloxamer“ (Nature, 436:1025-1029;2005M).
How can control (C57BL) and mdx-mice be compared
if they differed considerably at baseline concerning endsystolic
volume, end-diastolic volume, end-systolic pressure,
stroke volume, and dP/dtmin?
Left ventricular (LV) end-systolic diameter, LV enddiastolic
diameter, and LV-mass increase and fractional
shortening decreases with age and by age 42w all mdx-mice
have dilated cardiomyopathy. It is not mentioned if all of
the investigated mice had the same age.
Also gender of the investigated mdx-mice is not given.
Gender might be relevant since sex-associated changes in
response to calcium were reported in mdx-mice.
Different parts of the myocardium are differentially affected
by the dystrophic process and myocardial fibrosis in
mdx-mice. It is not mentioned from which part of the heart
cardiomyocytes were taken. Were they taken from the left
or right atrium or ventricle? Was the location of biopsy the
same in control and mdx-mice?
Mdx-mice develop progressive LV dilatation and by age
42 weeks all have dilated cardiomyopathy. How to explain
that in the present study end-diastolic-volume was smaller
in mdx-mice compared to control mice and that there was
diastolic instead of systolic dysfunction? Did any of the
mdx-mice develop dilated cardiomyopathy or restrictive
haemodynamics?
Mdx-mice develop ECG abnormalities, like tachycardia,
similar to those in DMD. Were ECGs registered during the
experiments and did the frequency of ECG abnormalities
differ between P188-treated and untreated mdx-mice? Why
did P188 not affect the heart rate? How to explain heart
rates of 582-600bpm in anaesthetised control and mdxmice
whereas previous studies reported heart rates of 350-
380bpm in anaesthetised C57BL mice?
How to explain that P188 only increases LV end-diastolic
volume without affecting LV end-diastolic pressure? If
P188 actually improves the diastolic function, expressed as
dP/dtmin, a decrease in LV end-diastolic pressure would be
expected.
Since the end-diastolic-pressure did not differ between
control and mdx-mice at baseline, the latter do not seem to
have diastolic dysfunction. Increase in end-diastolic pressure
after P188 indicates ineffectiveness of the agent concerning
diastolic function.
Why was dobutamine chosen as a cardiac stressor, since
isoproterenol or aortic constriction have been acknowledged
as appropriate cardiac stressors in mdx-mice? The study
referenced for giving dobutamine actually used aortic constriction
and isoproterenol, but not dobutamine. How can
one be sure that myocardial P188 concentrations were high
enough after local or intravenous application to be effective?
Differed hearts morphologically or functionally between
control and mdx-mice? What were the pathoanatomic and
histological findings in hearts of P188-treated and untreated
mdx-mice? Did they differ from control mice? Was there a
difference in the amount of damaged cardiomyocytes and
fibrosis? Were there any cases with LV hypertrabeculation/
noncompaction? Why was no echocardiography or cardiac
MRI carried out to monitor the therapeutic effect of
P188?
The presented data do not justify to claiming a
therapeutic effect of P188 for mdx cardiomyopathy
because the study groups were unequal, cardiac changes
after treatment were equivocal, and because of various
other methodological uncertainties.

Patients carrying the m.616T>C variant in MT-TF may not only manifest with cerebral
disease and mitochondrial tubule-interstitial kidney disease (MITKD), but also
with phenotypic manifestation sin other organs if systematically looked for. Focal
epilepsy in MITKD may be a clinical manifestation of a stroke-like lesion (SLL). If
anti-seizures drugs (ASDs) fail to stop seizure activity in these patient, the ketogenic
diet should be tried. Patients with a mitochondrial disorder affecting the respiratory
chain may profit from the additional application of antioxidants and cofactors.
Key words: mtDNA–heteroplasmy–renal failure–MT-TF

Patients carrying the m.616T>C variant in MT-TF may not only manifest with cerebral
disease and mitochondrial tubule-interstitial kidney disease (MITKD), but also
with phenotypic manifestation sin other organs if systematically looked for. Focal
epilepsy in MITKD may be a clinical manifestation of a stroke-like lesion (SLL). If
anti-seizures drugs (ASDs) fail to stop seizure activity in these patient, the ketogenic
diet should be tried. Patients with a mitochondrial disorder affecting the respiratory
chain may profit from the additional application of antioxidants and cofactors.
Key words: mtDNA–heteroplasmy–renal failure–MT-TF

Patients carrying the m.616T>C variant in MT-TF may not only manifest with cerebral
disease and mitochondrial tubule-interstitial kidney disease (MITKD), but also
with phenotypic manifestation sin other organs if systematically looked for. Focal
epilepsy in MITKD may be a clinical manifestation of a stroke-like lesion (SLL). If
anti-seizures drugs (ASDs) fail to stop seizure activity in these patient, the ketogenic
diet should be tried. Patients with a mitochondrial disorder affecting the respiratory
chain may profit from the additional application of antioxidants and cofactors.
Key words: mtDNA–heteroplasmy–renal failure–MT-TF

respiratory chain, mtDNA, tRNA, heteroplasmy, pathogenicity, myopathy
Key words: respiratory chain–mtDNA–tRNA–heteroplasmy–pathogenicity–
myopathy

respiratory chain, mtDNA, tRNA, heteroplasmy, pathogenicity, myopathy
Key words: respiratory chain–mtDNA–tRNA–heteroplasmy–pathogenicity–
myopathy

respiratory chain, mtDNA, tRNA, heteroplasmy, pathogenicity, myopathy
Key words: respiratory chain–mtDNA–tRNA–heteroplasmy–pathogenicity–
myopathy

The classic signs of inflammation, which includes edema, erythema, pain and loss of
function, commonly occurs after a routine or difficult third molar surgical procedure.
The inflammatory process is necessary for the healing to occur, but often excessive
inflammation which causes the patient unnecessary pain, trismus and edema. Corticosteroids
reduce inflammation via the inhibition of phospholipase A2, which is the
first enzyme involved in the conversion of phospholipids into arachidonic acid, therefore
blocking the synthesis of other products such as prostaglandins, leukotrienes and
substances related to thromboxane A2. In essence, corticosteroids prevents the formation
of these end products which is a broth of potent inflammatory mediators
causing the signs and symptoms. This articles has focussed to review on submucosal
administration of corticosteroids in third molar surgery.
Key words: corticosteroid–submucosal–pain–swelling–trismus

The classic signs of inflammation, which includes edema, erythema, pain and loss of
function, commonly occurs after a routine or difficult third molar surgical procedure.
The inflammatory process is necessary for the healing to occur, but often excessive
inflammation which causes the patient unnecessary pain, trismus and edema. Corticosteroids
reduce inflammation via the inhibition of phospholipase A2, which is the
first enzyme involved in the conversion of phospholipids into arachidonic acid, therefore
blocking the synthesis of other products such as prostaglandins, leukotrienes and
substances related to thromboxane A2. In essence, corticosteroids prevents the formation
of these end products which is a broth of potent inflammatory mediators
causing the signs and symptoms. This articles has focussed to review on submucosal
administration of corticosteroids in third molar surgery.
Key words: corticosteroid–submucosal–pain–swelling–trismus

The classic signs of inflammation, which includes edema, erythema, pain and loss of
function, commonly occurs after a routine or difficult third molar surgical procedure.
The inflammatory process is necessary for the healing to occur, but often excessive
inflammation which causes the patient unnecessary pain, trismus and edema. Corticosteroids
reduce inflammation via the inhibition of phospholipase A2, which is the
first enzyme involved in the conversion of phospholipids into arachidonic acid, therefore
blocking the synthesis of other products such as prostaglandins, leukotrienes and
substances related to thromboxane A2. In essence, corticosteroids prevents the formation
of these end products which is a broth of potent inflammatory mediators
causing the signs and symptoms. This articles has focussed to review on submucosal
administration of corticosteroids in third molar surgery.
Key words: corticosteroid–submucosal–pain–swelling–trismus

Renal cell carcinoma (RCC) is a highly malignant neoplasm. Renal cell carcinoma
constitutes 3% of all adult malignancies and often presents insidiously.
The most common sites of metastasis in RCC are the lung, liver and bone; other less
common metastatic locations are lymph nodes, adrenal, opposite kidney and brain.[i]
Local recurrences of RCC are rare and reported in 3-4% of these cases[ii]. Metastasis
to the pancreas and gastrointestinal tract are rare.
Herein, we report our experience with a case of massive lower gastrointestinal bleeding
1.5 years after Right radical nephrectomy and removal of IVC thrombus. In our case,
colonoscopy and Computed tomography abdomen revealed heterogeneous soft tissue
mass in the right renal fossa invading the hepatic flexure of colon. He underwent right
Hemicolectomy and Ileo-transverse anastomosis. Locally recurrent right RCC with
colonic involvement presenting with life threatening Gastrointestinal bleed is rare and
is being presented.
Key words: Gastrointestinal bleed–metastasis–renal cell cancer–large bowel

Renal cell carcinoma (RCC) is a highly malignant neoplasm. Renal cell carcinoma
constitutes 3% of all adult malignancies and often presents insidiously.
The most common sites of metastasis in RCC are the lung, liver and bone; other less
common metastatic locations are lymph nodes, adrenal, opposite kidney and brain.[i]
Local recurrences of RCC are rare and reported in 3-4% of these cases[ii]. Metastasis
to the pancreas and gastrointestinal tract are rare.
Herein, we report our experience with a case of massive lower gastrointestinal bleeding
1.5 years after Right radical nephrectomy and removal of IVC thrombus. In our case,
colonoscopy and Computed tomography abdomen revealed heterogeneous soft tissue
mass in the right renal fossa invading the hepatic flexure of colon. He underwent right
Hemicolectomy and Ileo-transverse anastomosis. Locally recurrent right RCC with
colonic involvement presenting with life threatening Gastrointestinal bleed is rare and
is being presented.
Key words: Gastrointestinal bleed–metastasis–renal cell cancer–large bowel