Surgical management of plexiform ameloblastoma presenting as exophytic growth ­ A rare entity

Ameloblastoma is locally aggressive neoplasm of odontogenic origin comprising about 1% among tumours and cysts that usually occurs in the vicinity of the mandibular molars or ramus of the mandible. Predominantly occurring in third to fifth decade, with no gender propensity. Inadequate treatment may lead to recurrence in certain cases. Even though benign in growth, they are locally aggressive and can occasionally metastasize. Of them, a unique exophytic presentation of plexiform ameloblastoma in a 22-year-old male patient is documented as follows.

To Evaluate Sono-Elastography Features of Inguinal Lymph Node in cases of Carcinoma Penis

Introduction: Inguinal lymph nodes are the commonest siteof penile metastasis whose incidence varies from 50% to 70%depending on the stage of disease . To differentiate reactionaryto metastatic lymph node fine needle aspiration cytology, trucut needle biopsy and dissection of inguinal lymph node hasbeen used. We tried to evaluate sono-elastography features ofinguinal lymph node in cases of Carcinoma Penis. Study aimedto evaluate sono-elastography, B-mode ultra-sonography andtheir combination for characterization of palpable inguinallymph node in patients of carcinoma penis.Material and method: 34 lymph node evaluated with sonoelastography for elastogram and strain ratio, B-mode ultrasonography and their combination which were compared withtrucut needle biopsy taken as gold standardResults: The overall sensitivity, specificity and accuracyof B-mode ultra-sonography, sono-elastography and theircombination is 78%, 82%, 86%; 84%, 80%, 81% and89%, 73%, 79% respectively. Sensitivity and specificity ofelastography strain ratio by taking 2.3 as cutoff is 89.5% and86.7% respectively.Conclusion: US elastography appears to be a promising toolfor differentiating benign and malignant lymph nodes. Furtherstudies are needed to fully standardize the clinical applicationof this technique with large sample size at multiple centers.

Incidence of Side-effects After Weekly Iron and Folic Acid Consumption Among School-going Indian Adolescents

Objective: To estimate incidence of side effects after weekly iron and folic acidsupplementation (WIFS) in Delhi and Haryana. Methods: In this cross-sectional school-based study, data were collected from 4,183 adolescents on WIFS consumption and sideeffects experienced first time of receipt of WIFS (week 1), and in last two consecutive weeks(week 2,3). Week 3 was 48 hours preceding the survey. Results: WIFS consumption in week1, 2 and 3 was 85%, 63% and 52%, respectively. Side effects reported were highest in firstweek (25%) and reduced to 7% (week 2) and 5% (week 3). Side effects most reported wereabdominal pain (80%) and nausea (10%). Adolescents (45%) who faced a side-effect in week1 did not consume WIFS in subsequent week. Conclusion: Incidence of side effects was low,but it affected compliance. Positive reinforcement to students who face side effects requiresstrengthening by teachers.

Oral Cancer: A Review

Oral cancer, undoubtedly, is among the most common malignancies worldwide, therefore early detection and treatment is imperative. The relatively poor prognosis associated with oral cancer highlights the importance of awareness towards the disease. New research is revealing trends that are changing the way we approach its screening, diagnosis and treatment. Limited access to cancer care, relative lack of trained healthcare providers and financial resources are some of the challenges to the management of oral cancer in India, despite improvements in diagnostic techniques and management strategies. The purpose of this article is to review the research relevant to this association, including epidemiologic studies, diagnostic screening procedures, prevention as well as treatment modalities.

Morphological Features and Morphometric Parameters of Human Fetal Thymus Glands.

Introduction: Thymus is one of the central lymphoid organs. It plays an important role in the differentiation, selection and maturation of T-lymphocytes. In the recent years morphology and morphometry of the thymus gland in the newborn is gaining significance as it demonstrates great variability between individual infants and in the same infant at different times. Materials and methods: In the present study 45 thymus specimens from aborted human fetuses of 16 to 40 weeks gestational age and both sexes were studied by autopsy for morphological and morphometric features. The morphometric parameters were measured using pachymeter. Results: The thymus gland was located in the superior mediastinum. 60% (27/45) specimens showed cervical extensions. Brachiocephalic vein anterior to thymus was observed in 3 cases which is an important anomaly to be observed in thymectomy procedure. Thymuses were greyish pink to greyish brown in colour. Variations were also observed in the number of lobes of glands in which one is single lobed, most of the glands are bilobed and few are trilobed. There is progressive increase in all morphometric dimensions of the thymus in relation to gestational age. Most of the specimens were less than 4cm in length. Half of the specimens were below 2cm in width and other half were 2.0 to 5.0 cm in width. For 90% of the specimens thickness of the organ was less than 0.5cm. The thymus gland was 0.2% of fetal body weight. Conclusion: The morphological observations of thymus gland shows great variations which has to be considered in thymectomy. In addition to anthropometric parameters of fetus, morphometric parameters of thymus glands present significant relation to the gestational age of fetuses. It is possible to determine the thymic morphometric parameters in relation to gestational age.

Vitamin A Status of Low and Normal Birth Weight Infants at Birth and in Early Infancy.

Serum retinol levels of low birth weight (LBW; birth weight <2500g) and normal birth weight (NBW; birth weight ≥2500g) infants were evaluated at birth and 3 months using high performance liquid chromatography. At birth, levels were 13.3±8.2 μg/dL in LBW (n=146) and 14.0±6.2 μg/dL in NBW infants (n=79; p=0.51), with 41.1% of LBW and 24.1% of NBW infants having vitamin A deficiency (VAD, <10 μg/dL; P=0.01). At follow up, levels were 18.0±9.4 μg/dL in LBW (n=83) and 20.0±7.3 μg/dL in NBW infants (n=51; P=0.19), with 18.1% of LBW and 3.9% of NBW infants having VAD (P=0.02).

Clinical profile of pediatric somatoform disorders.

OBJECTIVES: To study the prevalence, pattern, clinical and socio-demographic characteristics of somatoform disorders in children. METHODS: From Aug 2004 to July 2005, children up to 18 years with unexplained physical symptoms were evaluated prospectively using DSM-IV criteria. Detailed evaluation followed for those meeting criteria. RESULTS: The prevalence of Somatoform disorders was 0.59% and 0.78% among out-door and in-door patients respectively. Among 124 children (40 boys and 84 girls) meeting criteria, conversion disorder was the commonest (57.3%), followed by undifferentiated somatoform disorder (25.2%). Girls were significantly more represented among conversion disorder patients compared to other groups of somatoform disorders (78.9 vs. 52.8 %, P=0.002). In conversion disorder, 2/3rd patients presented within 3 months, whereas in other somatoform disorders, 2/3rd patients presented within 3 months after symptoms. Fainting attacks (52.1%) and ataxia (43.7%) in conversion disorder and pain abdomen (52.8%) and headache (52.8%) in other somatoform disorders, were the commonest symptoms. Stressors were identified in 73.4% and acute precipitating stressors were present in 14.4% children. Boys had significantly higher rates of poor inter-personal relations and communication problems within the family (72.5% vs. 41.7%, P=0.001), while girls had significantly higher rates of conflicts with the parents and other family members (21.4% vs. 5%, P=0.02). CONCLUSION: Somatoform disorders, particularly conversion disorder is commoner in girls. Important stressors are poor inter-personal relations and communication problems within the family in boys, and conflicts with family members among girls.

Modes of presentation and reasons of hospitalization for patients with decompensated chronic liver disease at civil hospital Karachi

To determine different modes of presentation and reasons that need hospitalization of patients with established chronic liver disease [CLD] and associate the presenting features with age, and severity of disease with the co-morbidity. Cross sectional, observational study. The study was conducted at Medical Wards of Civil Hospital, Karachi from July, 2006 to December, 2006. Patients who were admitted to the Medical Wards of Civil Hospital, Karachi and who already had established diagnosis of chronic liver disease were included in the study. Patient's charts were reviewed, Demographic information was noted from the charts and for more clarification, patients or their attendants were interviewed. The reason of hospitalization was noted. Different modes of presentations of chronic liver disease were analyzed and were compared with different demographic and clinical characteristics, using chi-square test. A total of 427 patients' charts were reviewed. Average ages of patients was 48.7 years. Hepatitis C was most common cause of CLD [64.6%]. Other causes included Hepatitis B [23.7%], both Hepatitis B and C [3%] and others [8.7%]. Majority of patients with CLO were hospitalized due to more than one signs and/or symptoms [63.5%], Common reasons of hospitalization in decreasing order were altered sensorium, hematemesis, abdominal distension, fever, abdominal pain and melena. More signs and symptoms of decompensation were seen in age groups 45-70 years [p=0.032]. Patients with any co-morbidity presented with greater number of sign and symptoms of decompensation when compared to patients without any co-morbidity [p=0.002]. No statistically significant association was found when presenting features of CLD were compared with duration of CLD and different co-morbidities. Hepatitis C was the common cause of CLD in this study. The reasons of hospitalization were a combination of neurological and gastrointestinal clinical features. These features did not associate with the duration of CLD or the cause of CLD

Physico-chemical characteristics of groundwater at Churu tehsil, Rajasthan, India.

Groundwater samples were collected from different locations in Churu tehsil, Rajasthan (India) for their physico-chemical studies. Laboratory tests were performed for analysis of samples for total dissolved solids, electrical conductivity and major ions, e.g. calcium, magnesium, nitrate, fluoride, sodium and potassium. This paper highlights the analytical results for main ions contributing towards total dissolved solids. On comparing the results against drinking water quality standards laid by Indian Council of Medical Research (I.C.M.R.), it is found that most of the water samples are non potable for human beings due to high concentration of one parameter or the other. Most of the samples have total dissolved solids values much higher than the maximum permissible level stipulated by I.C.M.R., which is 1500 ppm. The high values of these parameters may have health implications and therefore these need attention.

Subfertility: experience in a tertiary care hospital

To determine the frequency of different causes responsible for subfertility in our setup. Prospective cross-sectional study from March 2005 to March 2006. Oupatients Dept. [OPD] of Gynaecology and Obstetrics [Unit 111], Civil Hospital, Karachi. All patients who were diagnosed as subfertile. Amongst the 156 women included in the study, 85 [54.5%] had primary and 71 [45.6%] secondary subfertility. Majority [59%] of cases were between 21-30 years of age; 78 [50%] complained of subfertility only, while 26 [17%] had history of vaginal discharge, 34 [21%] menstrual disorders and 12 [8%] weight gain. Nineteen [14%] cases had family history of subfertility, 18 [12%] of congenital anomaly and 3[2%] of genetic disorders. Abnormal hormonal profile was seen in 37 [27%] patients, whereas 63 [40.3%] had positive findings on pelvic ultrasound and 43 [27%] patients tubal blockage on hysterosalphinography. Out of 156 women, 27 [17.3%] had Ovarian factor in the form of anovulation, polycystic ovarian syndrome and premature ovarian failure and 51 [32.7%] had Tubo-Ovarian factor in the form of tubal blockage, endometriosis, endometritis and uterine fibroid; in 19 [12.2%] cases both the partners had abnormality, in 40 [25.6%] the male partners had semen abnormality [25.6%], while in 19 [12.2%] no cause could be found. A significant number of patients had secondary subfertility, mostly due to previous surgical interventions, and were suffering from anaemia and vaginal infection. Tubal blockage and male factors were the predominant causes of subfertility

Lymphoepithelioma-like carcinoma of urinary bladder: [LELCA]

Lymphoepithelioma-like carcinoma of the bladder [LELCA] is an uncommon neoplasm of the urinary bladder and up till now only 49 cases have been reported in the English literature. It is imperative to distinguish between lymphoepithelioma-like carcinoma and malignant lymphoma as primary bladder lymphoma is extremely rare. We report a case of a 55 year old lady who presented with the complaint of burning micturition and gross hematuria for the past 5 months. There were no other known co-morbids. Pelvic ultrasound was normal. Cystoscopy showed a 4x4 cm sessile mass in the bladder. Histopathological examination was consistent with the diagnosis of lymphoepithelioma like carcinoma of the urinary bladder