Title: A Rare Case Of Ipsilateral Clavicle Fracture with Contralateral Acromioclavicular Joint Dislocation - Case Report
Authors: M. Chandrasekaran, Ravichandran Subbaraj Vineet T A, R.Nanda kumar
Shoulder girdle injuries are among common cause of disability. Fractures of the clavicle and acromioclavicular joint injuries are among the commonest injuries around the shoulder. However ipsilateral clavicle fracture with contralateral acromioclavicular joint dislocation is a very rare type of injury and so far no case has been reported in the English literature. Here we present such a rare case presented to us with such injury and how we managed the patient.
Key words: clavicle fracture, acromioclavicular (AC) joint, dislocation, shoulder girdle injuries
Associate Professors of Orthopedics
Mahatma Gandhi Medical College and Research Institute
Title: Sclerosing Adenosis : A Dignostic Pitfall In Breast Carcinoma
Authors: Meenu Gill, Pansi Gupta, Padam Parmar, Rajeev Sen
Sclerosing adenosis (SA) is a proliferative lesion that is commonly found in benign breast biopsies. The identification of increased cancer risk for patients with SA suggests that tumorigenic alterations may be associated with the pathogenesis of this lesion. We here report a case of old female who presented with a breast lump. Trucut biopsy proved it to be a case of sclerosing adenosis, later on lumpectomy evidence of mixed Ductal and Lobular carcinoma.
Key words: Benign breast disease, Breast carcinoma, Sclerosing adenosis, Ductal carcinoma, proliferative breast disease
Dr. Pansi Gupta
Department of Pathology
Pt.B.D.S.Post Grauate Institute of Medical Sciences
Rohtak – 124001 (Haryana) India
37, PG Block, Girls hostel
PGIMS, Rohtak, Haryana- 124001
Title: Differential Diagnosis of Alzheimer’s Disease and other Types of Dementia with Development of Neuroimaging Techniques (PET, SPECT, and MRI)
Authors: Mwahib Sid Ahmed Mohammed Osman Aldosh
Number of neurodegenerative diseases that cause dementia, such as Alzheimer’s disease, dementia with Lewy bodies, and frontotemporal dementia. In medical diagnosis many peoples can not differentiate between Dementia and Alzheimer’s disease, neuroimaging has played a variety of roles in the study of Dementia and Alzheimer disease (AD) over the past four decades. Initially, computed tomography (CT) and then magnetic resonance imaging (MRI) were used diagnostically to rule out other causes of dementia. recent study have shown the value of neuroimaging techniques including Structural MRI( Magnetic resonance imaging) and functional imaging by SPECT(Single Photon Emission Computerized Tomography) as well as 18FFDG PET (Positron Emission Tomography) which are widely used in the diagnosis of Alzheimer’s disease to delineate the differential diagnosis with other types of Dementia . These modalities and their particular utilities are discussed in this review The aim of the study is to evaluate functional differences that might reflect differences in the distribution of their respective pathologies. These evaluation is very important because extensive neuropathological damage occurs before clinical diagnosis, so preclinical discrimination between people who will and will not ultimately develop AD is critical for treatment of the disease in its earliest stages.
Key Words: Alzheimer’s disease; Dementia ; SPECT; PET; MRI; differential diagnosis
Mwahib Sid Ahmed Mohammed Osman Aldosh
Ph. D, Assistant Professor
Co-ordinator of Radiological Sciences Department
Applied Medical College - Najran University- Kingdom of Saudi Arabia
Title: Oglivie’s Syndrome- Acute Colonic Pseudo Obstruction (ACPO)
Authors: Dr Rupa Talukdar, Group Captain JC Sharma, Brig SPS Kochar, Col D Arora , Lt Col Urmila Prasad, Dr Namrita Sandhu
A 23 yrs old unbooked primigravida at 31 weeks of gestation with triplet pregnancy presented with anaemia and PIH., she had inadequate ANC care.. she was admitted on 14/07/13 at 2200 hrs for ANC care for triplet pregnancy, treatment of anemia and ,mild PIH. She was already on antihypertensive labetalol 200mg TDS and haematinics. . Her menstrual history was regular with cycle of 3-4/ 30 days, LMP WAS 20 /12/12 & EDD was on 27/09/13.she had conceived spontaneously . the re was significant past history. She was a home maker and belonged to low socioeconomic status and was literate. There was no significant family history. On admission she was asymptomatic with mild ithing on abdomen and limbs . no history /clinical feature suggestive of pre eclamlsia, hyperteision, renal disease and hepatic diseases.
Local anesthetic have a wide range of applications ranging from acute pain during labour to heart and lung surgeries. Newer local anesthetics have been developed with longer duration of action and the drawbacks of traditional local anesthetic like bupivacaine. This article describes in brief the newer local anesthetics and their mechanisms.
Keywords: local anesthetic ,history, mechanism of action, chemical structure, ropivacaine, levobupivacaine
Title: Large Stone in Oesophagus in a Two Month Old Premature Infant
Authors: SPS Yadav, Kamal N Rattan, Priya Malik
We report a rare case of large stone in esophagus of a 2 month old premature male causing obstructive and respiratory symptoms. Although foreign body oesophagus is not uncommon, however unusual age and circumstances involving the ingestion of the foreign body prompted us to report this case.
Keywords: Child, foreign body, ingestion, Foreign bodies, Esophagus
Title: Hunter disease: A Report of Two Siblings
Authors: Fairy Susan Varghese, Dnyaneshwar Patil, Sunil K Agarwalla
Hunter disease (MPS-2), an X-linked recessive disorder is caused by deficiency of iduronate-2-sulfatase (I2S) enzyme. Coarse facial features, short stature, dysostosis multiplex, joint stiffness, mental retardation manifest between 2 - 4 years of age. Skin manifestations, male affection, absence of corneal clouding are strong pointers to the diagnosis. We report an interesting case of two male siblings-6 years and 10 months of age with history and examination indicative of a storage disorder. Investigations revealed mucopolysacchariduria in both cases, dysostosis multiplex on skeletal survey of elder sibling; a strong clincher to the diagnosis. Our diagnosis was ascertained by the unique affection of male siblings, unaffected female sibling, clinical characteristics, urinary GAG levels and skeletal survey. Purpose of this case report is to highlight the distinctive presentation of Hunter disease, to enable earlier detection, to discuss the treatment options and the role of genetic counselling.
Keywords- Hunter disease, iduronate-2-sulfatase, dysostosis multiplex, mucopolysaccharides, corneal clouding.
Title: Drug susceptibility of Uropathogens: Need for New Antimicrobial Guidelines
Authors: Dr. BV Shamsundar, Dr.Archana, Dr .Venkatesha.D
Background: There is increased prevalence of drug resistant strains responsible for community acquired urinary tract infection. To know the drug susceptibility of uropathogens to routinely used antibiotics.
Material and Method: The midstream urine specimen was collected from clinically suspected cases of urinary tract infection they were subjected for standard processing protocol to isolate the pathogen and study their susceptibility.
Results: Of the 1057 urine samples were studied over a period of one year out of which 234 samples (22%) yielded significant growth of single organism In the present study E.coli(55%), Klebsiella species (16%), Enterococcus fecalis, (09%) Staphylococcus aureus, (04%) , Nonfermenters excluding Pseudomonas spp (3%),Citrobacter spp (3%),Streptococcus spp (2%), Pseudomonas spp (2%), Proteus spp (2%) Enterobacter spp (2%),coagulase negative Staplococcus spp(01%) and Providentia spp(0.5%)
Antibiotic sensitivity and resistance analysis was performed by the disc diffusion method employing multiple antibiotic discs. E.coli showed variable antimicrobial resistance to different antibiotics as 85%,70%, 40%,and 28% of the isolates were found to be resistant to ampicillin ciprofloxacin , gentamicin, amikacin respectively. Klebsiella species showed resistance to various betalactam antibiotics 62%-100% ciprofloxacin 71%, gentamycin 67% and Nitrofurantoin 57%cefatoxime 80%
Staphylococcus isolates showed high resistance rate against ampicillin (82% ), norfloxacin (82%),ciprofloxacin (70%) ,ceftriaxazone (73%), cefatoxime (67%) and cotrimaxazole (65%) all were sensitive to vancomycin and linozolid Non fermenters (excluding pseudomonas species) showed high degree of resistance to almost all the antibiotics used routinely.
Pseudomonas isolates were found to be resistant to gentamycin(80%)cotrimaxozole(100%),norfloxacin(100%),and amikacin(100%) Enterobacter spp were 100% sensitive to Nitrofurantoin and these isolates were almost resistant to other group of antibiotics.
Antibiotic susceptibility data revealed that majority of the isolates were resistant against 3 or more antibiotics that is 95% of the bacterial pathogens are multidrug resistant and the percentage of ESBL producers detected among E.Coli and Klebsiella species were 26%&40% respectively.
Title: Disorders of Sex Development: Molecular Versus Clinical and Cytogenic Studies and their Correlation with Diagnostic Outcome and Sex of Rearing in A Local Community
Authors: Manal Mohammed Kadhim , Mohammed Joudi Aboud
BACKGROUND: This study aimed to support clinical professionals in the initial evaluation and diagnosis of children with suspected DSD ,to provide a framework to standardize laboratory and clinical practice, and to acquire more knowledge on the molecular mechanism of sex determination .
METHODS:This was a single center, prospective case review. A total of 42 patients with DSD were referred to our Pediatric Surgery Unit at the Maternity and Child Teaching Hospital . We examined Barr bodies and karyotype for all patients. PCR amplification was also performed for the detection of SRY and ALT1 gene loci on Y and X chromosomes, respectively. Statistical analyses were performed using SPSS version 20 computer software.
RESULTS: A pure 46XX karyotype was identified in 35.7% of cases, while a pure 46XY karyotype was identified in 50% of cases. The SRY locus identified by PCR was tested for its validity in predicting a pure 46XY DSD karyotype. The test was 100% sensitive and 85.7% specific. Among the group of male social sex, the mean internal masculinization score was significantly higher in those with a pure 46XY karyotype (5.9) compared with those with a pure 46XX and those with a mixed karyotype (3.5).
CONCLUSIONS:The management of children with DSD and a lack of diagnostic facilities still remain major challenges in Iraq. Multicenter studies, including larger population sizes, using molecular genetic analyses to detect the actual incidence of genital anomalies and DSD in our community, are required to serve these patients and their families.
Keywords: DSD, polymerase chain reaction, karyotype, diagnostic outcome.
Title: Retrograde Jejunogastric Intussusceptio: A case Report
Authors: Shah NA, Kadla SA, Khan BA, Javed A Basu
Jejunogastric intussusception (JGI) is a rare, very serious complication of gastrojejunostomy or Billroth – II reconstruction. Since gastrojejunostomy with vagotomy are on a declining trend, it is extremely rare to come across such a complication. Only about 250 cases have been reported in literature to date. The condition is not difficult to diagnose, if an endoscopy is performed by someone familiar with this complication. The condition can be acute and life threatening or chronic and disabling. We report such a case with review of literature.
Title: Gestational Trophoplastic Disease in Babylon Maternity and Paediatrics Teaching Hospital a Prospective Study
Author: Dr.Bushra J. Al- Rubaiey
Background: Gestational trophoblastic tumours arise from the cells of conception and form a range of related conditions, from the benign partial mole to the aggressive malignancies of choriocarcinoma and placental site tumours. Despite the rarity of them, patients with molar pregnancies requiring additional treatment after evacuation can expect cure rate 100%.
Objectives: In the present study, we evaluated six years period of trophoblastic diseases in women attending Babylon Maternity and Paediatrics Teaching Hospital in prospective study.
Patients & Method: This study was a descriptive observational study, conducted from January 2008 until January 2014 in Babylon Maternity and Paediatrics Teaching Hospital, all cases with molar pregnancy been involved, after diagnosis been treated and followed up. Those with persistent high hCG referred for chemotherapy.
Results: Our study involved 83 patients with trophoblastic disease.The overall mean age was (28.40±8.89) years old and (24.1%) of patients were older than 35 years. In our study 83 patients with trophoblastic disease 74 of them were having complete hydatidiform mole (89.2%), four patients (4.8%) having partial mole, four patients with invasive mole (4.8%) and one patient with choriocarcinoma (1.2%).Regarding parity ranged from (0 – 8)para, 28 patients (33.8%) their parity were less than three, meanwhile 55 patients (66.3%) their parity more than three.About patient’s residence in our study 56 patients (67.5%) were from rural area, meanwhile, 27 patients (32.5%) were from urban area.In this study, 83 women with trophoblastic disease six of them ended by hysterectomy(7.2%), 74 women with complete hydatidiform mole suction curettage performed for them only one patient ended with hysterectomy. Regarding chemotherapy 16 patients (19.3%) out of 83 received chemotherapy eleven after complete hydatidiform mole for persistent high hCG forming (8.14%), four patients with invasive mole and one case choriocarcinoma, while 67 patients (80.7%) did not received any chemotherapy.Regarding serum B-hCG levels pre-evacuation in our study for complete hydatidiform mole mean (29540+-26151) mIU/ml, for partial mole more than 20000mIU/ml, for invasive mole more than 30000 mIU/ml and for choriocarcinoma more than 100000 mIU/ml.
Conclusion: Trophoblastic diseases occur during the fertility age mostly, and there is an increased risk with extreme of age and more previous pregnancies;Hydatidiform mole was thecommonest type of trophoblastic disease in these patients.(19.3%) of the patients necessity to chemotherapy.
Key words: Gestational trophoblastic disease, hydatidiform mole.
Title: Delayed Presentation of Aspirated Foreign Body with Peculiar Symptoms
Author: Dr Ashley Solomon C, Srivengadesh Gopal
Aspiration of foreign body is a common problem in children but rarely seen in adults also. They present to the hospital as emergency and on most occasions are removed bronchoscopically. Some late presentation of aspirated foreign bodies are reported in literature. They usually present with recurrent chest pain and chronic cough which can mislead the treating physician. Our patient presented to us 4 years after inhalation of metallic screw that failed bronchoscopic attempt to remove it. He ignored it due to lack of symptoms initially. He presented with worsening symptoms of pain in the chest whenever he coughed and laughed as if something was hitting from inside. Chest X-ray and fluoroscopy revealed the foreign body had migrated to the right postero basal segment requiring a right posterolateral thorocotomy to remove it. The screw was removed with a wedge of lung that contained it. In conclusion, late presentation of inhaled foreign bodies are rarely seen and they mostly require thorocotomy for their retrieval due their remote location.
Title: Comparative Clinical Analysis of two Different Approaches of Cinematically Presented Oral Health Education Among Patients Seeking Prosthetic Rehabilitation
Authors: Aditya Kapoor, Rashmi Mittal, Khurshid A. Mattoo
Statement of the problem: Health education of the patient about his treatment is an essential part of comprehensive care. Every treatment has related information that patient has to follow. Advances in multimedia, especially in digital cinematography could be a valuable tool for effective communication between the doctor and his patients.
Purpose: Toevaluate the effectiveness of a video assisted education health program on patients using two different clinical approaches, one in which a video would be shown at the end of the treatment and the other in which education through a video would be started at the beginning of the treatment. The study also would investigate the possible analysis of both approaches on less literate subjects.
Materials and methods: All patient related information would be cinematographed in the form of a twenty one minute video, following which sixty completely edentulous patients were treated with complete denture prosthesis. Subjects were divided into two groups namely group C (h) and group C (t) and also into literate and illiterate. All the subjects were asked to recall the information at two subsequent follow up visits.
Results: subjects belonging to group C (t) showed better recall of information for both males and female patients at first (43% and 56%) and second appointments (43% and 56%) respectively. Illiterate subjects demonstrated almost equivalent results in both tested groups at both the appointments. Unpaired‘t’ test between two studied groups at both appointments showed significant values at p<0.05 whereas the Karl pearsons correlation coefficient between group C(h) and C(t) was significant for first appointment.
Conclusion: use of cinematography to educate patients is an effective means of delivering treatment related information especially when use of such mode is started during the treatment. With so many factors associated with effective communication further research is required in both means and approaches especially with the advent of social networking and satellite technology.
Key words: multimedia, treatment needs, patient responsibility, effective communication.
Title: Clinical Evaluation of Locally Delivered 10% Doxycycline Hyclate Gel as an Adjunct to Scaling and Root Planing In the Treatment of Chronic Periodontitis
Authors: Dr.Shweta Aggarwal, Dr. Arun Garg, Dr. Arvind Garg, Dr. Asmita Arora
To evaluate and compare the efficacy of locally administered 10 % doxycycline hyclate gel and scaling and root planing (SRP) in the treatment of chronic periodontitis. Randomized, controlled study was conducted involving 64 treatment sites in 32 patients suffering from chronic periodontitis. The selected two sites in each subject were randomized to two treatment groups: Group A – SRP + placement of 10% doxycycline gel immediately, and Group B – SRP alone. The gingival index (GI), plaque index (PI), probing pocket depth (PPD), and clinical attachment level (CAL) were recorded at baseline and subsequently after 1 month and 3 months. Significant improvement in GI and PI values in all the subjects were observed at 1 and 3 months (p<0.001) from baseline. Reductions in PPD values in Group A and Group B were significant (p <0.001) from baseline to 3 months, but was statistically non significant in Group B from 1 month to 3 months. Gain in CAL from baseline to 3 months was significant in both the groups (p<0.001), and was non significant (p =0.365) in Group B from 1 month to 3 months. On comparing Group A to Group B, reduction in PPD and gain in CAL were statistically significant (p <0.001) at the termination of study. SRP along with subgingival placement of doxycycline improves the clinical condition of periodontitis.
Key words: Doxycycline hyclate, local drug delivery, periodontal therapy, randomized clinical trial, scaling and root planning.
Title: Glandular Odontogenic Cyst with an Odontome: an Unusual Association
Authors: Dr Dinesh Baburao Rathod, Dr. J.D. Bhavthankar, Dr. S. R. Barpande
Glandular odontogenic cyst (GOC)is a relatively rare jaw cyst with frequency of only 0.2%. It is common in 5th -6th decade of life with mean age of occurrence of 45.7 years. It has slight male predominance (M: F; 1.3:1) and 70% of the cases occur in mandible.It is locally aggressive and tends to cause bone expansion, cortical perforation, root resorption and has high rate of recurrence. Previously it was thought to have glandular origin due to its histological similarities with low grade mucoepidermoid carcinoma and presence of intraepithelial duct like structures. With advances in modern immunohistochemicalmarkerssialogenic origin is now not supported and odontogenic origin is thought of,but these studies do not confirm the definite odontogenic origin of GOC due to overlapping of markers used. The additional support for their odontogenic origin is provided bytheir association with otherodontogenic tumours such as Ameloblastoma and keratocystic odontogenic tumour (KCOT). Reported here is a case of GOC in associationwith an odontome which will strengthen the odontogenic origin of this relatively rare jaw cyst.
Key words: Glandular odontogenic cyst, Odontome.
Dr. Dinesh Kumar B. Rathod
Gov. Dental College and Hospital, Aurangabad, Maharastra- 431001
702 Trimurti Tower,Near Nageshwar Talav, Seawoods, Navi-Mumbai, Maharastra, 400706
Title: Periodontitis: A Risk Factor for Adverse Pregnancy Outcome?
Authors: Dr. Arun Garg, Dr. Shweta Aggarwal, Dr. Arvind Garg, Dr. Arindam Sarkar, Dr. Asmita Arora
To assess if there is any change in pregnancy outcome and incidence of preterm low birth weight babies (PLBW) when the non surgical periodontal therapy was done during the 3rd trimester of pregnant ladies having chronic periodontitis. Total 60 subjects were selected, of which 30 had normal periodontal health constituting Group I, and another 30 patients had moderate to advanced periodontitis, out of which 15 underwent non – surgical periodontal therapy constituted Group II A and the remaining 15 who refused for non – surgical periodontal therapy constituted Group II B. Within 1 hour of parturition the weight of the newborn was recorded in all the groups. The gestation age was recorded for the subjects. Serum CRP level and periodontal health status were also recorded within 48 hours of delivery. In Group I & group II the mean birth weight was 3.02±0.39 Kg and 2.45±0.30 Kg respectively. Group II B had a mean weight of 2.05±0.49 Kg. On analysis of GP II A to that of Group I it was statistically significant (p<0.001). Also, on comparing Group I it was statistically significant (p<0.001). On comparison of birth weight of Group II A & Group II B statistically significant results were obtained (p<0.05). Pregnant women with periodontitis who were treated by non surgical periodontal therapy when compared to pregnant women with periodontitis not receiving non surgical periodontal therapy showed statistical difference in weight of the new born babies and gestational age of mother indicating the influence of periodontal health status on PLBW.
Keywords:- Periodontitis, Preterm low birth weight (PLBW), Gestation period, C- Reactive protein (CRP),Non surgical therapy.
Deptt of Periodontics & Implantology
J.C.D Dental College
Sirsa, Haryana, India:- 125055
Title: Association of MDM2 SNP309 and TP53 Arg72Pro Polymorphisms with Risk of RA in the Algerian Population
Authors: Rym ABDERRAHMANE1*, Fatima Zohra MOGHTIT1, Wefa BOUGHRARA1, Amina BOUBKEUR1, Khadidja BNSEDDIK2, Abdellah BOUDJEMA1, Fouzia BENRRAHAL3, Meriem ABERKANE4, Mostefa FODIL1, Nadhira SAIDI- MEHTAR1, Lotfi LOUHIBI1.
This study examines two common, functional, single nucleotide polymorphisms (SNP) in the genes coding the human homolog of murine-double-minute-2 (MDM2) and P53 in patients with rheumatoid arthritis (RA) based on the hypothesis that P53 may be an important negative regulator of the pro-inflammatory transcription factor nuclear factor kappa b (NFkB).
Genomic DNA was obtained from 101 patients with RA who fulfilled at least 4 ACR criteria and from 91 healthy controls. Mdm2 SNP309 and p53 P72R were genotyped by polymerase chain reaction and restriction enzyme analysis.
In RA patients the frequencies of the p53 P72R, a significant difference in the frequencies of TP53 R72P genotypes or the 72P allele was observed between cases and controls (76.24% of 72 R/P and P/P genotype in cases and 20.88% in controls, p<0.05; 63% of 72P allele in cases and 12.09% in controls, p<0.05). Concerning MDM2 SNP309 G allele, it was associated with an increased risk of RA with OR of 1.80 (95% CI 1.20–2.70), p=0.004. A combined analysis of both polymorphisms revealed a statistically significant association was observed between the increased risk of RA and the combined genotypes of TP53 Arg/Pro +Pro/pro and MDM2 TT ; TP53 Arg/Pro +Pro/pro and MDM2 TG+GG (OR 3.9, 95%CI 1.30- 11.61, p= 0.01)
We can conclude that, there is an association of MDM2 SNP 309 G and/or p53 homozygous genotypes Pro/Pro with the risk of developing RA among Algerian patients.
Key words:Rheumatoid arthritis, TP53, MDM2, polymorphism, West Algerian population.
Laboratoire de Génétique Moléculaire et Cellulaire, Département de Génétique Moléculaire Appliquée, Faculté des sciences de la nature et de la vie, Université des Sciences et de la Technologie d’Oran- Mohamed BOUDIAF-USTOMB-, BP 1505 El M’naouer 31000, Oran, ALGERIA.
Tel : 00213661200101
Title: Endoscopic Presentation of Bronchogenic Carcinoma at a Tertiary Care Centre
Authors: Sonal P.Karpe, Gurudas S.Pundpal, Priti L.Meshram.
There is a change in the histology of bronchogenic carcinoma worldwide due to the increased awareness regarding the ill effects of smoking. Adenocarcinoma now ranks first amongst the most prevalent form of bronchogenic carcinoma worldwide. In India however the picture is different, in contrast to the rest of the world the histology shows a preponderance of squamous cell carcinoma which is closely related to smoking. We present various endobronchial manifestations of bronchogenic carcinoma at a tertiary care centre and the predominant histopathological types with regards to morphology, site and side of presentation.
As per our study the most common endobronchial manifestation of bronchogenic carcinoma is exophytic irregular surface growth, in right main bronchus and the histopathological type being squamous cell carcinoma. This study validates that in India there is still skewing of the bronchogenic carcinoma towards it being squamous cell carcinoma thereby emphasizing the fact that smoking remains the primary cause of the malignancy. This calls for better awareness regarding the ill effects of smoking amongst the Indian population.
Title: Histological Investigation of Gingival Reaction to Direct Polymethyl Methacrylate Provisional Restorations
Authors: Dalenda Hadyaoui, Amina Khiari, Mohamed Ben Khlifa, Mounir Cherif
Purpose: This investigation evaluated the possible histological reactions to chairside fabricated methyl methacrylate provisional restorations depending on the time span.
Materials and methods: Participants included 30 patients recruited for fixed restorations, where gingival recontouring was indicated to improve esthetics or retention. The teeth were prepared, and provisional restorations were performed by the direct technique to protect the residual tissue, and to be used as index for gingivectomy to harmonize the margins. The cut gingival band was utilized for histological assessment. Patients, who irregularly returned for surgical appointment, took longer periods with provisional restorations in the oral cavity, renewed an appointment for surgery and participated in the study too. The periods were marked and correlated with histological findings.
Results: Histological findings recorded a high rate of acute inflammation for gingiva surrounding provisional restorations of one to two months in the oral cavity (14 cases). Chronic inflammations were scored but with a low rate (6 cases). Only two cases showed no reactions. For a period of more than two months, no acute inflammation was recorded, but chronic inflammations (2cases) and candidiasis (1case). However, fibrosis and ulcerations were independent from the time span as recorded in periods less than 2 months and in a case of more than 3 months (1 case of fibrosis).
Conclusion: The histological analysis of gingiva surrounding polymethyl methacrylate provisional restorations fabricated directly in the oral cavity proves that it may induce various gingival reactions despite the exceptional absence of any tissular reaction in some cases. This corroborates the in vitro studies demonstrating the cytotoxicity of these materials.
Title: A Rare Case of Gorham’s Disease of The Radius With Implant In Situ: A Case Report
Author: Prof. Ravindra G. Khedekar, Prof. Sunil H. Shetty, Mishil S. Parikh, Pooja H. Mehta
Gorham disease is a rare condition characterized by intraosseous neoplastic proliferation of hemangiomatous tissue with progressive, massive osteolysis. We present a pathologically proved case of Gorham disease that involved the left parietal bone in a 35-year-old woman. Imaging studies included conventional radiography of the left wrist and distal forearm.
Gorham disease—also known as massive osteolysis of Gorham, disappearing bone disease, vanishing bone disease, phantom bone disease, and Gorham-Stout syndrome. Gorham’s disease is a rare disorder characterized by proliferation of vascular channels that results in destruction and resorption of osseous matrix. The precise etiology of Gorham’s disease still remains poorly understood. There is no malignant, neuropathic, or infectious process involved in the etiology of this disorder. In this report, we present the unique involvement of the distal radius with an implant in situ.
Key words: Gorham’s Disease, Massive Osteolysis, Implant In Situ, Radius
Dr Mishil Sandeep Parikh
Department of Orthopaedic Surgery, Pad.
Dr. D. Y. Patil Medical College, Hospital & Research Center, Nerul,
B/6, Anand Bhavan, Bajaj Road, Vile Parle (W),, Mumbai
Maharashtra 400056 India
Title: Seroprevalence of Hepatitis B in Male Blood Donors in Rural Teaching Hospital of Northern Maharashtra, India
Authors: Indu Bhushan, Vijay C. Ambade, Rashmi Sinha
Aim: This study was aimed to know the seroprevalence of hepatitis B infection in male blood donors.
Material & Methods:The present retrospective hospital record-based study was conducted at the blood bank of a rural tertiary care teaching hospital in northern Maharashtra, India over a period of 4 &1/2 years from January 2010 to June 2014. All the blood units collected were screened for HBV, HCV, HIV 1 and 2, syphilis and malaria. The data of HBsAg alone was analyzed with chi square test and results were considered significant if P value was < 0.05.
Results: The overall seroprevalence rate was 1.63% among the total 3920 blood donors included in this study. The correlations of seroprevalence rate among selected age groups and in voluntary and replacement blood donors were found to be statistically insignificant.
Conclusion: The lower seroprevalence rate in this study, further recommends strict abiding to donor selection criteria, comprehensive screening of blood donors, better awareness among donors and reintensification of prophylactic programmes at public level to ensure the safe blood donation.
Keywords: Blood donation, Hepatitis B, Hepalisa, Seroprevalence
Title: Analysis of Thiopurine S-Methyltransferase Genotype in Children with Acute Lymphoblastic Leukemia by Strip Hybridization
Authors: Dalal Mohammed Nasr Eldin El-Kaffash, Hoda M. Abou Elfotouh Hassab, Abla Ahmed Abou Zeid, Dalia Abd El Moaty Elneily, Ingy Ossama Ahmed Shaaban
Acute lymphoblastic leukemia (ALL) is the most common pediatric cancer. The thiopurines, 6-mercaptopurine (6MP) and thioguanine (TG), are the backbone of current therapy for childhood ALL. Since their introduction to leukemia treatment in the 1950s, they have played an essential role in treatment protocols for ALL. ThiopurineS-methyltransferase (TPMT) polymorphism represents a determinant of 6-MP response and ALL outcome and is well characterized in most populations. Four common polymorphic alleles are associated with impaired activity of the enzyme. These are TPMT*2 (238G>C), TPMT*3A (460G>A, 719A>G), TPMT*3B (460G>A) and TPMT*3C (719A>G).
Objective: The aim of the present study was to determine the frequency of the functional TPMT polymorphisms and their association with the occurrence of adverse events, in pediatric patients with standard risk ALL who are subjected to 6-Mercatopurine therapy for consolidation.
Patients and Methods: TPMT polymorphism was analyzed in 40 children diagnosed with acute lymphoblastic leukemia and 40 age and sex matched healthy controls. The frequency of TPMT genotypes was examined by PXG-TPMT StripAssay based on Polymerase Chain Reaction (PCR) and reverse hybridizationusing blood samples. Clinical follow up using complete blood picture and liver transaminases following 6-MP therapy for consolidation were then performed for patients in order to access drug toxicity.
Results: In the study sample, none had homozygous mutant TPMT genotypes (e.g. TPMT*3A/*3A, TPMT*2/*2, TPMT*3A/3C, etc.). Also neither the cases nor the controls in the study sample had TPMT*1/*2 and TPMT*1/*3B genotypes. In patients group, 39 (97.5%) were of the wild-type homozygous TPMT*1/*1 genotype, 1 (2.5%) patient only was of the heterozygous TPMT*1/*3A genotype and no patient had TPMT*1/*3C genotype. In the control group, we identified 36 subjects (90%) with wild-type homozygous TPMT*1/*1 genotype, 3 (7.5%) with heterozygous TPMT*1/*3A genotype and 1 (2.5%) heterozygous TPMT*1/*3C genotype. TPMT*3A was the most prevalent variant allele followed by TPMT*3C detected in the studied sample with an allelic frequency of 2.5% and 0.6%, respectively.The only patient with variant TPMT*1/*3A genotype did not show any evidence of thiopurine intolerance (hematotoxicity and hepatotoxicity).
Conclusions: Cases of myelosuppression in ALL pediatric patients treated with 6-MP cannot be all explained by the existence of TPMT alleles (*2, *3A, *3B and *3C). Other polymorphic alleles in TPMT gene or factors other than TPMT polymorphisms may be responsible for the development of toxicity.
Keywords: TPMT polymorphism, thiopurine toxicity, pediatric ALL.
Dalal Mohammed Nasr Eldin El-Kaffash
Clinical Pathology Department
Faculty of Medicine, Alexandria University
Title: Post Operative Floating Shoulder Rehabilitation: A Rare Case
Authors: Dr. Vijay Kage, Dr. Rakhi Ratnam
We present a case of shoulder instability following a traffic accident. Allman Type I midshaft clavicle, IDEBERG type scapular wing with multiple ribs fractures were diagnosed following radiologic examination. There were no signs of ligamentous injury. Mechanical instability was noted at the shoulder due to breakage of the supportive bony skeleton. The patient was treated surgically with plate and screw fixation. Surgical fixation allowed early postoperative physiotherapy and rehabilitation. This rare injury and its treatment options are discussed in the light of current literature.
Key Words: Floating shoulder, Scapula, Clavicle, Multiple ribs
Title: Visual Outcome after Cataract Surgery in School Going Age Children
Authors: Dr. A.Tarakeswara Rao, Dr. V.V.L.Narasimha Rao, Dr. S.Laxmi, Dr. V .Mahathi, Dr. M. Deepika
AIM: A prospective 1yr study from jan 2013 –dec 2013,to assess the visual outcome after cataract surgery in school going age children.
Materials & Methods:130 eyes included.Children from 4 to 15 yrs considered.Detailed slit lamp assessment,fundus evaluation,B scan,keratometry,A scan,Urine & blood tests done.
Procedure:SICS done in all cases with Rigid PMMA IOL implantation.wound sutured in children less than 8yrs
Results:Male to female ratio 3:1,Congenital cataracts 55%,developmental 30%,traumatic 15% noted
56.5% are of 5-10 years age and 44.5%, 10 -15 yrs.Nystagmus present in 40% cases.Visual outcome -6/18-6/9 in 10%, 6/24-6/36 in 27% & CFCF in 63%.
Conclusion:Eyes with good fixation achieved good vision.Unilateral cataracts & Nystagmus cases had poor outcome.However minimum improvement of vision in such cases, benefited children perform their daily activities.Childhood cataract imposes burden on economic and social development of the nation.School eye screening should be included as routine practice in all schools.Children in blind schools should be evaluated in order not to miss, those blind eyes due to cataract.
Title: Impact of Admission Hyperglycemia on Postmyocardial Infarction Left Ventricular Remodelling
Authors: Lobna F. Eltony, Salah A Argoon, Ahmad B. Elden
Objectives: This study aims to assess left ventricular (LV) remodelling in acute myocardial infarction (AMI) patients presented with admission hyperglycemia (AH) and to determine the association between AH and LV remodelling.
Patients and Methods: We conducted a prospective cohort study and we analysed LV remodelling in 122 AMI patients. AH was defined as a glycemia on admission ≥ 140 mg/dl. We divided the patients according to the admission plasma glucose and history of diabetes into three groups: 45 euglycemic patients, 36 diabetic patients and 41 hyperglycemic nondiabetic patients. Systematic echocardiographic study was performed at baseline and at 12 months later.
Results: The changes in LV end-diastolic volume (LVEDV) from baseline to 12 months follow up was 4.86 ± 13.20 cm3 in euglycemic group, 86.47 ± 65.53cm3 in diabetics and 149.40 ± 59.55cm3 in hyperglycemic nondiabetic patients (P=0.000 for all). When LV remodelling was defined as a ≥20% increase in LVEDV, it was observed in 17.1% in euglycemic patients, 91.7% in diabetics, and 100% in hyperglycemic nondiabetic patients (P=0.000 between euglycemic patients and both other groups, P=0.248 between diabetics and hyperglycemic nondiabetic patients).By multiple linear regression analysis, AH (P = 0.000), baseline segmental wall motion score (P =0.000), and partial reperfusion (P= 0.035) were independently associated with LV remodelling. By multiple logistic regression analysis, AH was an independent predictor of LV remodelling with adjusted Odd’s ratio=2.167(95%CI:2.001
Conclusions:We concluded that patients with admission hyperglycemia had a worse postmyocardial infarction LV remodelling than euglycemic patients, regardless of their diabetic status. Admission hyperglycemia was a major and independent predictor of postmyocardial LV remodelling.
Keywords: admission hyperglycemia, postmyocardial infarction remodelling.
Title: Non-Alcoholic Fatty Liver Disease: A New Urban Epidemic
Authors: Dr. Ketan Vagholkar, Dr. Abhijit Budhkar
Non-alcoholic fatty liver disease (NAFLD) comprises of a spectrum of pathological changes in the liver. It has become a very common disease in the urban population. Understanding the pathophysiological mechanisms underlying this disease is pivotal in planning a management strategy. The etiopathogenesis, clinical features, diagnosis and management is discussed in this paper.
Keywords: non-alcoholic, fatty, liver, disease, steatohepatitis
Dr. Ketan Vagholkar
MS, DNB, MRCS (Eng), MRCS (Glasg), FACS
Department of Surgery
Dr. D.Y.Patil Medical College, Navi Mumbai-400706, MS, India
ADD: Annapurna Niwas, 229 Ghantali Road, Thane 400602, MS, India
Title: New Onset of Seizures in Patients Age More than 40 yrs
Authors: Dr.Durga Hari Prasad Donkena
Seizures could be motor, sensory, autonomic, or psychic events although in practice, when a patient presents to a health care system with a seizure it is usually a convulsive (motor) seizure, either generalized or focal.Cumulative observations of many clinical investigators, along with adjunctive neurophysiological, imaging and genetic tools created a well-accepted diversity in the etiologies of seizures in various age groups.Interstingly, the highest incidence of seizures occur in early childhood and late adulthood. In older adults and elderly the frequent causes are cerebrovascular disease, brain tumors , alcohol withdrawal , metabolic disorders , degenerative diseases
AIM OF THE STUDY
To study the etiologic profiles of first onset seizures in patients aged more than 40 years of age. To analyze the age / sex distribution, presenting history, clinical findings and investigations at admission in the study group
MATERIALS AND METHODS
The study was done in the setting of the Institute of Internal Medicine. The study was observational in nature designed to analyze patients in age group more than 40 years of age and who presented with first onset-seizures.
•Generalized seizures (71%) were the most common seizure type encountered in the study.
• Cerebrovascular accidents were the most frequent etiology for the first onset seizure after forty years of age in this study.
• CVA, tumors, metabolic causes and alcohol withdrawal formed 80% of the etiology of seizures
Title: Human Cataract Prevalence in the Non-Coastal Southern Districts of Kerala State
Authors: Dr. Aleyamma kuruvilla, Dr. Issac Thomas
A six year study was undertaken to compare the prevalence of cataract in Kottayam and Pathanamthitta districts of Kerala state, India. Hospital based study was conducted from April 2005 to March 2011 to find out the cataract prevalence among the total population, gender prevalence and prevalence in different age groups. The data was collected from registers of ophthalmology department of district hospitals and two private hospitals in Pathanamthitta and Kottayam district and from Directorate of Health, Thiruvananthapuram. Cataract prevalence among the total population in Kottayam district was significantly increased from 0.34% to 0.51%(p=0.000157), but in Pathanamthitta district prevalence significantly decreased from 0.40 % to 0.36% (p=0.0024). Gender prevalence is significantly higher in females in Kottayam (61.6%, 0.0000326) as well as in Pathanamthitta (59%, 0.00014) than in males, suggest that females have more cataract. A significantly highest prevalence recorded in the age group of 71-80 years in Kottayam (36.6%, 0.000072) and Pathanamthitta (33.6%, 0.000312) as compared with all other age groups. Prevalence of congenital cataract (0-15) is very less in Kottayam (1.2%) and Pathanamthitta(0.9%). The population decrease is found to be the main reason for decrease in the prevalence rate in Pathanamthitta district. Cataract blindness in Kerala can be effectively controlled only if effective strategies are developed to reduce the incidence of blinding cataract. The present study of cataract prevalence in the state of Kerala may to some extend throw light on the gravity of cataract incidence in the state of Kerala.
Key words: cataract, prevalence, districts.
Being a doctor, everyday I come in contact with so many patients but few of them we can not forget. Here I am sharing one of my experiences, which I will keep in mind forever.
A Comparative Study of Maternal and Neonatal Morbidities between Patwardhan Technique and Conventional Method for Caesarean Delivery in Second Stage of Labour
Authors: Titol Biswas, Nibedita Jana, Souvik Kumar Das
Objective: To compare the maternal and neonatal morbidities between the Patwardhan technique and the conventional method for extraction of the fetus in second stage caesarean sections.
Method: In this prospective study 80 caesarean sections in second stage of labour were analysed. All the cases were divided into two groups. One was Patwardhan technique group and another was conventional method group where baby was delivered as cephalic. Maternal and neonatal morbidities were compared between the two groups.
Results: In this study it was found that extension of uterine incision, uterine artery injury, excessive bleeding and need for blood transfusion were significantly less in patwardhan group. However, there were no differences in neonatal outcomes in both the groups.
Conclusion: Patwardhan technique is a safe, easy and preferred method of delivery during lower segment caesarean section in second stage of labour and needs to be employed more widely.
Key words: Patwardhan technique, Second stage caesarean sections.
Title: Frequency of HBV and HCV among Patients Undergoing Elective Surgery in a Tertiary Care Referral Hospital in Duhok, Iraqi Kurdistan
Authors: Muayad A. Merza, Wahid M. Hassan, Azad Salih Muhammad
Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections possess occupational hazard to health care workers (HCWs) particularly surgeons, anesthetists, nurses and theater staff. Reliable epidemiological data on frequency of HBV and HCV in hospitals are important for designing national control programs. Therefore, the aim of this study was to determine the frequency of hepatitis B and C among patients undergoing elective surgical operations in a tertiary care referral hospital in Duhok. In a cross sectional study conducted on all patients who underwent elective surgery from May 2013 – May 2014. A medical history and physical examination were recorded for all patients in the case notes. All patients underwent screening for hepatitis B surface antigen and antibody for hepatitis C, and Anti- human immunodeficiency virus using Elisa technique. Out of 4851 patients, 94 (1.93%) were found to be positive for HBV or HCV. Eighty seven (1.79%) were positive for hepatitis B and 7 (0.14%) were positive for hepatitis C. Among 87 HBV positive patients, 54 were males and 33 were females. Among 7 HCV positive patients, 5 were males and 2 were females. The frequency of hepatitis B and C (combined) was more in age group ranging between 26–50 years, regardless of gender. In conclusion, HBV and HCV infections should be a concern in the health care services. The higher frequency of HBV and HCV infections in the patients presenting for elective surgery strengthen the need for routine pre-operative screening for all patients before surgical operative procedures. High risk HCWs should be vaccinated against HBV.
Key words: Frequency, Hepatitis B, Hepatitis C, pre-operative screening.
Title: A Study of Haemolytic Disease of the Newborn Secondary to Rheseus Alloimmunisation in a Tertiary Care Hospital
Authors: Anil Shetty, Joylene D’Almeida
Neonatal Jaundice is the commonest cause of admission for newborns. Rh incompatibility is one of the etiologies responsible for neonatal jaundice. The objectives of the study wereto determine the incidence and associated risk factors for neonatal hyperbilirubinemia resulting from Rh incompatibility in a tertiary care hospital. A retrospective study was done for a 2 year period from January 2012. Data on mothers and babies blood group, direct coombs test, cord blood hemoglobin and bilirubin were analyzed. Gender, parity, birth weight and mode of delivery were also recorded.5589 live births were recorded in 2012 & 2013.There were 208 Rh incompatible deliveries,71 newborns required treatment for unconjugated hyperbilirubinemia. Jaundice was 3.2 times more likely in Rh positive babies born to multiparous Rh negative mothers. The incidence of Rh isoimmunisation resulting in Hyperbilirubinemia was high in our study and was more in multiparous women
Keywords: Neonatal Hyperbilirubinemia, Blood Group Incomaptibility, Rh Alloimmunisation.
Title: Viability of Clinical Staphylococcus aureus and Staphylococcus aureus ATCC 25923 under Different Preservation Methods
Authors: Sulaiman Nna Asma’u, Prof.J.B Ameh, Dr.H.I. Inabo
In this study, four methods of bacterial preservation methods: sterile soil, sterile distilled water, agar overlaid with mineral oil and lyophilisation were employed for maintaining clinical Staphylococcus aureus and Staphylococcus aureus ATCC 25923 for a period of six months (180 days). The morphology, Gram staining properties, biochemical characteristics and viability were monitored at regular intervals of one month (30 days) for six months (180 days).The spread plate colony count method was used to investigate the rate of recovery or viability of all the four organisms from equally inoculated bacterial suspensions (2.0 McFarland equivalent to 8.8 log10 cfu/ml) in differently prepared stock culture of each preservation method. Agar overlaid with mineral oil was found to be the best method for maintenance and preservation of both clinical Staphylococcus aureus and Staphylococcus aureus ATCC 25923 organisms.
Keywords: Staphylococcus aureus, Culture, Preservation, Lyophilisation, Viability
Title: Role of Insulin Resistance in Non Alcoholic Fatty Liver in Obese Type-2 Diabetic Subjects
Authors: Dharmveer Sharma, Sanjeev Kumar Singh, Poonam Gupta, Neelima Singh, Nivedita Singh
Non alcoholic fatty liver disease (NAFLD) is a fatty liver disease occurring in patients without alcohol consumption. It includes a broad spectrum of liver disease, from fatty infiltration, inflammation and cirrhosis and is associated with obesity, hyperlipidemia and diabetes mellitus.An increase in the BMI and levels of FBS, total cholesterol, triglycerides, HDL, LDL, VLDL, SGPT, ALP, GGT, fasting insulin and hs CRP level and a decrease in HDL was observed in non alcoholic fatty liver group. Obesity, hyperglycemia, dyslipidemia and elevated liver enzymes, fasting insulin and hs CRP level are seen more frequently in non alcoholic fatty liver in type-2 diabetic obese patients.
Keywords- NAFLD, BMI, ALT, ALP, GGT.
Title: Accidental Aspiration of Endodontic Instrument: An Endodontic Nightmare- A Case Report
Authors: Dr Rupal B. Gadodia, Dr. Girish Nanjannawar, Dr. Santosh Hugar, Dr Rutuja Chopade, Dr Sarad Kamat
Endodontic mishaps or procedural accidents are those unfortunate occurrences that happen during endodontic treatment, some owing to inattention to detail, others totally unpredictable. Aspiration or ingestion of endodontic file during treatment though uncommon, potentially is dangerous mishap. The aim of this case report is to highlight the complications, prevention & management of instrument aspiration.
Key words: Aspiration, endodontic file, endodontic mishaps.
Title: Pelvic Ewing’s Sarcoma Presenting with Adnexal Mass in an Adolescent Girl- A Case Report
Authors: N Biswas, G Mukhopadhyay
Adnexal masses are frequently observed finding in women attending gynecological OPD. An adnexal mass may be found in females of all ages- infants to elderly. The reported prevalence varies widely depending upon the population studied and criteria employed. Anatomically the adnexa consist of the ovaries, fallopian tubes, broad ligament, and the structures within the broad ligament. The adnexal mass most frequently involves the ovaries. Benign functional cysts of ovaries like follicular cyst, corpus luteal cyst, theca leutin cyst and polycystic ovaries may present with adnexal mass. Endometriomas, benign and malignant ovarian tumors are other ovarian causes of adnexal SOL. The mass may arise from the tubes and the uterus also. In certain instances, the mass is clinically indeterminate and may be due to nongynecological causes when arising from the bladder, bowel abdominal wall or retroperitoneum. Adnexal masses may be symptomatic or discovered incidentally during a routine pelvic examination in an asymptomatic patient. The correct diagnosis of the mass is of immense importance to decide upon the mode of treatment. Here we present a case of pelvic Ewing’s Sarcoma presenting with a big adnexal SOL in an adolescent girl where preoperative correct diagnosis could modify the mode of therapy she was given
Key words: Adnexal mass, Adolescent, Bone tumor, Pelvis, Ewing’s Sarcoma
Title: The Road in the Fulfillment of Maternal Instinct
Authors: Prof.Hiralal Konar, Dr.Rathindranath Ray, Dr.L Agrawal, Dr.Reena Ray (Ghosh), Dr.Chandrachur Konar
A 57yrs. aged housewife from suburbs of Kolkata, was seen for the problems of childlessness over last 17yrs. that they lived with normal conjugal relationship .They were thoroughly investigated for the problem and was counselled for help of Assisted Reproductive Technique[In vitro fertilization and embryo transfer] . First In vitro fertilisation(IVF) attempt was made 3yrs. back with double embryo transfer resulted in miscarriage at 12 weeks of gestation Nearly 18 months later she tried for pregnancy once again by IVF procedure with double embryo transfer. This transfer resulted in successful pregnancy. However her antenatal period was not uneventful. She had a complicated pregnancy with multiple intramural fibroids in the uterus. In late 2nd trimester oligohydramnios and placenta praevia were detected by USG. However to avoid adverse outcome, an emergency LSCS was done at 34 weeks of gestation. A male baby weighing 2.7 kg was delivered. Mother with her healthy baby was discharged on sixth (6th) postpartum day.
Title: Managing a Case of Sensitive Abutment Situations through Use of a Fixed Movable Prosthesis – A Clinical Report
Authors: Khurshid A. Mattoo, Shailesh Jain
Preserving a natural tooth that has strategic importance in the future planning of oral rehabilitation is clinical challenge which every dentist should manage successfully. This article deals with such a clinical partial edentulous situation that has a natural tooth in between two edentulous areas. Both the edentulous areas on either side of the abutment were restored with fixed prosthesis and the natural abutment was relieved of stresses by incorporating a unique design that allows stress breaking effect on the abutment. The patient was successfully rehabilitated with an esthetic fixed movable prosthesis, the designing of which has been described in this report.
Keywords: Kennedy class 3, Fixed partial denture, Pier abutment, free and bound saddle
The JMSCR is accepting manuscripts for its coming issues to be Publish December 2018 the JMSCR invites authors to submit manuscripts Reporting original medical research, original article, research article, case report, systematic reviews, or educational Innovations for publication for the coming issues that will be released in December 2018. Types of manuscripts suitable for JMSCR include: Medical research, Clinical research Educational Innovation, Brief Report, Reviews on Teaching In keeping with high quality scholarship, Read More.....