Introduction: This study aims to compare obstetric results of pregnancies in adolescents and advanced age mothers, which is a significant Mother-Child health problem in developing countries. Methods: This retrospective study included mothers and infants, over a 10-year period, with babies born at full-term by spontaneous vaginal birth to adolescent mothers who were 18 years and younger, and to mothers who were 40 years and older. Both groups were investigated for abnormalities, gender, height, weight, head circumference and birth weight of newborns. Results: Over the 10-year period from 1 March 2003 to 31 March 2013, there were a total of 29981 normal spontaneous vaginal deliveries. 818 pregnant women aged 18 years and younger(2.73%) and 972 pregnant women aged 40 years and older(3.23%) were determined. When the abnormalities and stillbirth rates of newborns are examined, there was no statistically significant difference identified between the two groups. There was statistically significant difference found between height-birth weight-head circumference of infants of advanced age mothers and adolescent mothers. In both groups when the SGA(<2500 g) and LGA(>4000 g) infants are compared, SGA infants were observed to be significantly higher for adolescent mothers, while LGA infants were found to be significantly higher for advanced age mothers. When the correlation between mothers age and birth weight was investigated, it was observed that infants of advanced age mothers were heavier, while infants born to adolescent mothers had lower birth weights. Conclusion: This study showed that adolescent and advanced age pregnancies form high risk groups. In both groups to improve pregnancy results, social support, education and regular monitoring should be provided.

Background: Blood transfusion has profound role to play in specific illness, but still due to unsafe and careless practices the peril of transfusion transmissible infections (TTIs) such as human immunodeficiency virus (HIV), hepatitis C virus (HCV), hepatitis B virus (HBV), syphilis and malaria prevails. Objective: To study the seroprevalence of TTIs in healthy blood donors in specific Kuppuswamy's socio-economic scale at a Blood Bank of a tertiary care teaching hospital in north India, to enhance the awareness about transfusion related risks and to implement better strategic measures to prevent TTI, in high risk groups. Material and Method: Total 10,569 blood units were collected from Jan-2014 to Septmeber-2015. All donors were categorised according to the Kuppuswamy's Socio-economic Status Scale (KSESS) followed by screening of all sera samples for hepatitis B surface antigen (HBsAg), antibodies to HCV, HIV types 1 and 2 using enzyme-linked immunosorbent assays (ELISA) and for malaria antigen and Treponema pallidum by using immunochromatographic tests and Rapid Plasma Reagin test (RPR) respectively. All the samples found reactive for HIV, HBsAg, and HCV were again confirmed by second ELISA. Results: The overall seroprevalence was HCV 2.06 % (218/10569) > HBV 1.71% (181/10569) > HIV 0.03% (3/10569). No donor was found positive for Malaria and VDRL. The prevalence of transfusion transmissible diseases in specific socio economic class was as follows-:Upper lower class (IV) 248/2261 (10.96%) > Lower class (V) 34/483 (7.03%) > Lower Middle class (III) 97/5789 (1.67%) > Upper middle class (II) 22/1552 (1.42%) > Upper class (I) 1/484 (0.20%) and seroprevalence of transfusion transmissible diseases in each socio economic class, out of total donations was as follows-: Upper lower class (IV) 248/10569 (2.35%)> Lower middle class (III) 97/10569 (0.92%) >Lower class (V) 34/10569 (0.32%)> upper middle class (II) 22/10569 (0.21) >Upper class (I) 1/10569 (0.009%). Conclusion: Maximum positive TTIs had association with low socio-economic status people with increased medical and behavioral risk factors. Hence, we conclude that awareness among the high risk population group, strict and skillfulness selection of donors and use of effective laboratory screening tests is the prerequisite for the safe donation!!

Objective: To assess whether cooling to 10°C can reduce neurological injury during 75 minutes of hypothermic circulatory arrest (HCA) compared to cooling to 18°C. Methods: Twelve domestic swine were used for this prospective blind randomized study. The animals were divided into 2 groups: Group A (n=6) underwent hypothermic circulatory arrest at 18oC for 75 min, and Group B (n=6) underwent hypothermic circulatory arrest at 10oC for 75 min. At the end of the experiment, the brains were removed and immersed in paraformaldehyde. All brains were dissected in the sagital plane. Tissue blocks from the left hemisphere were cut to encompass the sensory neocortex. Results: The selected area was identified with a dissecting microscope. Samples were examined in a blind fashion using electron microscope. Two investigators were instructed to find 10 representative neurons and analyze electron micrographs of these neurons for evidence of nuclear and cytoplasmic changes. Similarly, each investigator was instructed to examine the perinuclear neuronal mitochondria for abnormalities in mitochondrial distribution. Significant differences were observed between the 2 groups in mitochondria and rough endoplasmic reticulum (RER). In 5 of the 6 animals treated with 18oC HCA, neurons had slightly dilated RER, Golgi apparatus and mitochondria. In all 6 animals treated with 10oC HCA, the structure of the cytoplasmic organelles was intact, with no apparent dilatation (p=0.015). Conclusion: This study adds further support that hypothermia at 10°C exerts better cellular protection than hypothermia at 18°C, as evidenced by these electron microscopy findings.

Introduction: First rank symptoms (FRS) are considered to be pathognomic for Schizophrenia. However, FRS is not distinctive feature of Schizophrenia. It has also been noticed in affective disorder, albeit not inclusive in diagnostic criteria. Its existence in the first episode of bipolar disorder may be predictor of poor short-term outcome and decompensating course of illness. Objective: To determine the frequency of first rank symptoms in manic patients. Method: The cross sectional study was done at psychiatric services of Aga Khan University Hospital, Karachi, Pakistan. 120 manic patients were recruited from November 2014 to May 2015.FRS was assessed by administration of validated Urdu version of Present State Examination (PSE) tool. Result: The mean age of the patients was 37.62 ± 12.51, and the patient less than 35 years had 69.6% FRS with p-value of 0.009. The mean number of previous manic episode was 2.17 ± 2.23. 11.2% males and 30.6% females had FRS. This association of first rank symptoms with gender in patients of mania was found to be significant with a p-value of 0.008. All-inclusive, 19.2% exhibited FRS in their course of illness. 43.5% had thought broadcasting, made feeling, impulses, action and somatic passivity. 39.1% had thought insertion, 30.4% had auditory perceptual distortion, and 17.4% had thought withdrawal. However, none displayed delusional perception. Conclusion: The study confirms the presence of FRS in mania in both male and female, irrespective of the duration of current manic illness or previous number of manic episodes. A substantial difference was established between both the genders and association of younger age with FRS.

Objective: To review genetic cause of developmental disorders. Methodology: A survey consisting of 70 children with developmental disorder was done for genetic evaluation of these disorders through case history and interview of the parents. Results: The cause was found to be combination of genetic variation with environmental risks due to which epigenetic changes might have taken place in prenatal stages in 81% of the cases in the survey. Only 16% of cases showed mendelian inheritance. Conclusion: The results indicate that developmental disorders are of epigenetical nature rather than mendelian inheritance.

Aim: Since early diagnosis and treatment of melanoma can significantly improve patients' prognosis, discovering new criteria to help differentiate between benign and malignant melanocytic lesions is of significance. In this study we aim to clarify the relationship between the presence of intracytoplasmic eosinophilic inclusion bodies inside melanocytes and the nature of the melanocytic lesion. Methods: Medical records and pathology slides pertaining to 187 patients with melanocytic lesions who had undergone biopsy in Razi Hospital between March 2014 and March 2015 were gathered. Slides were re-examined by a dermatopathologist using a light microscope. Clinical and pathological data were analyzed using SPSS. Results: A total of 196 specimens from 187 patients were studied. The median age of our patients was 42.26 years and 61.5% of them were female while 38.5% were male. The specific eosinophilic intracytoplasmic inclusion bodies were observed in 14 specimens; 8 of which were intradermal nevi and the remaining 6 were from compound nevi. These bodies tended to be present in lesions with congenital features. We found no correlation between age, sex or location of the lesion with the presence of aforementioned bodies. Conclusion: Eosinophilic inclusion bodies present in the cytoplasm of melanocytes are associated with benign melanocytic lesions and are mostly observed in cells with abundant vacuolated cytoplasm and in lesions with congenital features. Therefore these bodies can be helpful in diagnosing benign and longstanding lesions and differentiating them from malignancies.

Objectives: To identify the potential benefits of pre-donation screening of blood. Study design: Retrospective. Place and Duration: Prisons in the Punjab province. From January 2011 t0 September 2013. Background: Prisoners, as a high risk group, are not recommended for blood donations. In Pakistan, however, prisoners are legally allowed to donate blood and get thirty days remission. Methodology: Volunteer prisoners, after examination and verification by a physician for their physical fitness, were tested for Hepatitis C Virus (HCV) and Hepatitis B Virus (HBV) by Rapid Test Kit before bleeding. Data was analyzed by Epi-Info. Results: A total of 5894 male volunteer prisoner donors were screened and 1038 (17.6%) were rejected because of hepatitis infection. The mean age was 28 years (range; 17 - 70 years). Of 5894 prisoners, 857 (14.5%) were HCV positive and 222 (3.8%) were HBV positive. Co-infection of HCV and HBV was present among 41 (0.7%). Hepatitis infection, among convicted- prisoner blood donor, is significantly associated with higher seroprevalence for HCV (OR 1.35, 95% C.I. 1.17-1.57) while under-trial- prisoner is significantly associated with higher seroprevalence for HBV (OR 1.40, 95% C.I. 1.06-1.85). Conclusion: Hepatitis B and C viruses were responsible for almost 18% prisoner blood donor rejection. Pre-donation screening of blood donors is an effective intervention to improve the safety and limit the cost of blood. Treatment of identified infected prisoners may contribute to public health. In the international scenario this study findings necessitate the amendments in the relevant prison rules.

Objective: To evaluate the cytogenetics abnormalities in pediatric ALL cases and to correlate the cytogenetics Philadelphia chromosome - positive with the Fluorescence In - Situ Hybridization results. Methods: Retrospective cytogenetics and FISH analysis of the Bone marrow samples of both adult and pediatric patientswere done. However, since the inclusion criteria for this study was pediatric ALL, only the data of the pediatric patients were taken for this study. For the prospective samples, the cytogenetic analyses and Fluorescence in - Situ Hybridization were performed on the procured samples. The cytogenetics and FISH test were performed as per the standard protocol of our lab and were analysed as per the standard guideline. The cytogenetics Philadelphia chromosome - positive were correlated with the Fluorescence In - Situ Hybridization results and vice versa. Results: In our study of 50 pediatric ALLB patients, two patients showed low Ph+ by FISH. A confirmatory test by conventional cytogenetics revealed a rare association of Philadelphia chromosome positive along with the cytogenetics abnormality involving the MLL gene as well. One of the patient showed a karyotype of 46,XY,del(9)(p21),t((10;11)(p12;q21)[7]/46,XY,del(9)(p21)[9]/46,XYdel(22)(q11.2)[3] and the other patient showed 46, XX, t(9;11) (p13;q23)),?del(22)(q11.2)[6]/46,XX,del (11) (q23) [8]/46, XX[5] which were confirmed by cytogenetics and Fluorescence In - Situ Hybridization (FISH). Two patients showed complete Ph+ve and one patient showed normal karyotype along with tetraploidy. The rest of the cases showed either a normal karyotype or an insignificant abnormality. Conclusion: In our study of 50 pediatric ALL patients, two cases showed a rare association of Philadelphia chromosome positive along with a cytogenetics abnormality involving the MLL gene. Apart from the rare findings in our study, emphases is also made on the confirmatory test by cytogenetics incidence of low Ph+ve by FISH and vice versa and a need for larger collaborative studies and intense follow up of the treatment and the prognosis of this subset of patients to determine the prognostic pattern to improve the treatment options for these kind of rare patients.

Purpose of the Study: This study was conducted to detect and characterize the genes encoding extended spectrum β-lactamases and associated β-lactamases (carbapenemases and Ambler Class C β-lactamases). Patients and Methods: In 2011, out of the 65 non-duplicative Klebsiellapneumoniae collected from blood culture at Charles Nicolle hospital of Tunisia, 36 were resistant to 3^rd generation cephalosporin. Results: All strains showed a double disk synergy test positive. They were mainly isolated in intensive care unit (31%). They were frequently resistant to most antibiotics tested, except colistin and tigecyclin. Five isolates (13%) showed reduced susceptibility to carbapenems. bla_CTX-M-15 was harbored by 35 strains and bla_SHV-12 by one. bla_CTX-M-15 were associated with bla_TEM-1 (n=21), bla_OXA-48 and bla_CMY-2 (n=1) and bla_OXA-48and bla_TEM-1 (n=4). The conjugation wassuccessfulfor4/5 strains (3 harboring bla_CTX-M-15 and one bla_SHV-12). The plasmids carrying the bla_CTX-M-15 were assigned to IncN or IncL/M only for 2 strains. The remaining bla_CTX-M-15-carrying plasmid was negative for all of the replicons tested as well as the bla_SHV-12-carrying plasmid. Conclusion: Our results confirm the spread of CTX-M-15 in our institution. To our knowledge, this is the first report of K. pneumoniae coproducing CTX-M-15, CMY-2 and OXA-48. The implementation of preventive measures against the spread of these multiresistant bacteria is needed.

Introduction: ECG changes are presented in about 90% of patients with cerebral aneurysm that results subarachnoid hemorrhage (SAH). The most common site of these lesions among the cerebral arteries is anterior cerebral artery which supplies Autonomic cardiovascular centers. However it seems that the location of aneurysm influences critically on changes of ECG, which has not been studied grossly in literatures and there is no definite data to mention that. Materials and Methods: Here, a cross sectional, retrospective study was done on 500 patients presenting SAH due to cerebral aneurysm which patient´s angiography detected the location of pathology. ECG of these patients was taken two times, one on admission and other on discharge after 3^rd week of admission. Results: The mean age of patients was 57.3 years old and this group included 271 male and 229 females. 388 cases had ECG changes; some of them had more than one changed factor. QRS changes were seen in 18 cases on the day of admission, QTc changes were observed in 258 cases, and changes of ST distance were observed in 126 cases. Among all of them, the location of the aneurysm was in Anterior cerebral artery in 142 cases, in communicating arteries in 84 cases, in Middle cerebral artery 64 in cases, in ICA in 36 cases and in Posterior cerebral artery in 52 cases. Conclusion: In cases which their brain angiography showed cerebral aneurysm, the frequency of ECG changes was more seen. Patients with the anterior cerebral artery aneurysms had more ECG changes. According to the obtained results, ECG of patients with SAH could be a recognized as a factor to understand better the situation of brain after SAH and be useful for managing and treating patients with SAH.

Objective: Tuberculosis is the second leading cause of death in developing countries among all infectious diseases. Globally, drug resistance strain of Mycobacterium tuberculosis is a public threat. Due to diagnostic delay, inadequate infection control and poor drug supply there is a emergence of MDR- TB and XDR- TB. Our aim was to isolate and identify the drug resistant strain of M. tuberculosis by using newer diagnostic modalities. Methods: Sputum sample and BAL fluid from 70 suspected cases were collected and analysed for Mycobacterium by Ziehl – Neelsen staining and liquid culture with molecular detection of drug resistant strain of M. tuberculosis. Result: In our study, among the 70 patients 27 (38.5%) were positive for AFB by microscopy. On testing for Mycobacterium by BacT/Alert 3D system, 54 were found to be positive. On performing further identification and susceptibility of 54 isolates towards rifampicin and isoniazid by molecular method, 5 isolates (9.25%) were resistant to both rifampicin and isoniazid confirming as multidrug resistant. 5 isolates (9.25%) were sensitive to rifampicin and resistant to isoniazid and 2 isolates (3.70%) were resistant to rifampicin and sensitive to isoniazid. Whereas 5 isolates (9.25%) found to be negative for M. tuberculosis. Conclusion: Our investigation highlights the importance of newer diagnostic modalities for isolation and identification of drug resistant strain of M. tuberculosis. Which ensure early and accurate diagnosis of patients with prevention of further transmission of disease.

Introduction: It is possible that immunological factors, including the heat shock protein family, are involved in the development of the different forms of dementia. We aimed to compare the levels of serum HSP27 in patients with Alzheimer's disease and vascular dementia. Materials and Methods: Thirty patients with grade 2 Alzheimer's disease, 30 patients with grade 2 vascular dementia and 30 normal subjects as a control group were recruited during November 2011 to November 2013. Diagnoses were based on DSM-IV-TR criteria. MMSE was conducted on all patients for assessing the severity of disease. Biochemical parameters, including HSP27 were measured in all subjects. Demographic characteristics were collected for all subjects. Results: There were no statistically significant differences in age, gender and the levels of HSP27 between males and females in all groups. However there was a significant association between HSP27 with the severity and duration of dementia in patients groups. HSP27 levels were lower in the vascular dementia compared to those with Alzheimer's dementia, but were higher than for controls. Conclusion: HSP27 antibody titers were positively related to the severity and duration of both Alzheimer's and vascular dementia and may be indicative of the role of this protein in the pathology of dementia.

Introduction: The growing prevalence of urticaria in children over the last decade and the importance of determining the involved pathogenic mechanisms as well as of detecting the etiologic factors are some of the aspects that led to the choice of research topic. Materials and Methods: The early diagnosis and the establishment of the therapeutic and prophylactic conduct in the urticaria are a necessity. There have been evaluated through a retrospective questionnaire, anamnesis and biochemical evaluation a number of 246 children diagnosed with chronic IgE and non IgE mediated urticaria, and prick tested for a wide range of food allergens. The assessment of the intensity of the eruption was done by calculating the urticaria activity score (UAS), both at diagnosis and at subsequent evaluations to assess the response to the treatment. The immunological investigations which were carried out included the determination of the IgA, IgG, IgM, total IgE and specific IgE to food allergens and airborne allergens, as well as the determination of the IgG4-type antibodies to 20 food allergens by means of enzyme immunoassay. The ELISA method was used for dosing the total IgE, while the CLA System Quanti Scan method (Innogenetics, Heiden, Germany) was used for determining the serum-specific IgE for 20 of the most common food allergens and airborne allergens (Innogenetics, Heiden, Germany). Results: Positive statistical correlations have been made with IgE and non IgE mediated reactions, also with IgG4 antibodies. The result of the multivariate analysis shows that the existence of the atopy represents a risk factor which significantly influences the allergic sensitisation (HR = 3.186→95% CI: 2.57-5.96), followed in the order of importance by food diversification before the age of 6.months (HR = 2.157→95% CI: 1.86-5.35), natural feeding before 3.months of age (HR = 1.78→95% CI: 1003-4581) and artificial or mixed feeding (HR = 1.56→95% CI: 1056-3861). Conclusion: There have been reported different correlations between specific IgE and IgG4 with different food allergens and the period of time between the onset and the duration of chronic urticaria. The regression of specific IgE has a predictive value upon the remission of urticaria (AUC=0.557, p=0.447, 95%CI: AUC→0.398–0.717). The logistic regression for analysis of the predictives factors for the regresson of urticaria showed several factors involved:.Speciphic IgE values, compliance for the eliminating diet and treatment, allergic antecedents and the eventual polisensitivisation.

Aim: CAM- ICU is instrument for brief delirium screening in the intensive care unit (ICU) for ventilated and non-ventilated patients. The aim of this study was to translate, validate and evaluate the applicability of this instrument in the Serbian speaking area. Methods: Translation of the CAM-ICU was made according to International Society for Pharmacoeconomics and Outcomes Research guidelines. In this prospective cohort study, CAM-ICU was applied to 301 adult surgical ICUs by two different raters. We tested CAM-ICU for interrater reliability by correlation between them. The scale was validated by comparison with the reference evaluation, wich was done by a psychiatrist using the Diagnostic and Statistical Manual of Mental Disorders V (DSM-V). Interrater agreement was measured using weighted kappa (k) and correlation used Spearman´s test. Results: The Spearman correlation coefficient was highly significant for rater 1 (r=0.672, p<0.001) and for rater 2 (r=0.625, p<0.001). The inter-rater reliability expressed by the kappa coefficient between rater 1 and rater 2 was highly significant (k= 0.859, 95% CI, 0.910-0.99, p<0.001). Conclusion: CAM- ICU, the first validated instrument for early detection of delirium in the Serbian speaking area, is reliable, valid and easily applied in daily clinical practice.

Objective: Pituitary function and hypopituitarism have not been well evaluated in adult patients with non-pituitary brain cancer. Methods: Thirty-one (31) patients treated with primary or postoperative radiotherapy (RT) for various cancers in the brain region without pre-existing hypothalamic pituitary (HP) disorder from other causes were prospectively evaluated. Serum samples were obtained from the patients to determine levels of growth hormone (GH), thyroid-stimulating hormone (TSH), and free thyroxine (FT4). Serum samples were measured before treatment, 3 and 6 months after completion of radiation therapy (RT). The hypothalamus-pituitary axis (HPA) and dose volume histograms (DVH) of the patients were derived from their computed tomography-based treatment plans. Results: Clinical hypopituitarism was not observed, but 83% of patients who tested for hypopituitarism demonstrated subclinical hypopituitarism after a median interval of 6 months. Subclinical GH and TSH deficiency were observed in 17 (54%) and 9 (29%) participants, respectively. Significant declines in TSH (p < 0.021), FT4 (p < 0.009), and T4 (p < 0.036) levels after the RT course that can be interpreted as subclinical central hypothyroidism were observed. Adjuvant chemotherapy and surgery did not significantly influence the hypopituitarism (p = 0.698, p = 0.287, respectively). The doses of radiation to the HPA region ranged from 241 to 5941 cGy (2.4-59.4 Gy). The mean received dose (D_mean) and biological effective dose (BED) to the pituitary were 36 and 59.6 Gy, respectively. Subclinical findings of late radiation effects were observed in the HPA. Conclusion: Radiation-induced hypopituitarism and central hypothyroidism are regarded as primary damage to the pituitary gland. Time after therapy is critical and so with time the incidence of growth hormone deficiency and thyroid stimulating hormone deficiency is likely to significantly increase and to no longer be subclinical. Neuronal cell death and degeneration because of the direct effects of radiation seem to play basic roles.

Introduction: Cases of Pertussis increase every year with special morbidity and mortality in early infants. The objective was to evaluate results of a program of vaccination of pregnant women launched in our center in 2013. Methods: This is an observational retrospective study. We reviewed all cases of Pertussis disease in our center (2011-2015) and compared clinical data between two groups of age: Early infants (<3 months of age) and Other Groups (>3 months). We also compared perinatal events in vaccinated versus non vaccinated pregnant women. Results: During the period 2011-2015, 63 cases (9 in Early Infants; 54 Other Groups) were treated. All cases in Early Infants required hospitalization (100% vs. 3,70%; p<0,05) with more days of hospitalization (10,2 days vs. 0,36 days; p<0,05) and need of oxygen (66,67% vs.3,70%; p<0,05). No differences were seen in response to Azithromycin (87,5% vs. 97,91%; p>0.05) nor in incidence in close relatives (44,44% vs. 27,45%; p>0,05). No differences were observed in Perinatal events in vaccinated vs. non vaccinated in terms of duration of pregnancy (279 days vs. 278 days; p>0,05), weight at birth (3290gr vs. 3220gr; p>0,05), admission at NICU (1,58% vs.1,87%; p>0,05) and Apgar test score <7 at 5 minutes (0,27% vs. 0%; p>0,05). Proportion in early infants affected lowered from 40% in 2011 to 3,85% in 2015. Conclusions: Maternal immunization with Tdap vaccine seems to be a good strategy to reduce incidence of pertussis in the offspring. Additional measures such as vaccinating relatives should be considered.

Objective: This study was conducted to find anatomical variation of nasopalatine canal (NPC) and nasopalatine foramen (NPF) in different age and gender groups among Sulaimani population on cone beam computed tomography (CBCT) images. Subjects and Methods: The study included one hundred CBCT images obtained from patients visiting privet clinics with specialty in dental and maxillofacial radiology in Sulaimani city extended from 2014 to 2016. Subjects were divided into three age groups (18-34, 35-49, 50-75) years old. First group included 15 males and 15 females, second group 20 males and 20 females, and the third group included 15 males with 15 females. PaX i vatech digital CBCT machine, were used to obtain the images by the radiographers. The following measurements were estimated; number of openings of NPC at nasal fossa, mesio-lateral diameter 0f NPF at nasal fossa (axial section), mesio-lateral diameter of NPF at palatine fossa, antero-posterior dimension of NPC at: its upper boarder; middle level, and lower boarder, and lastly the height of NPC in sagittal section. Results: 100 subjects (50 males and 50 females) with age range 31 year were included in this study. 69% had single NPF at the nasal fossa. 23% had two openings and 8% had three openings. Mean and standard deviation (SD) of mesio-lateral diameter of NPF at nasal fossa, and palatine fossa were 2.60±0.69 mm, and 4.11±2.09 mm respectively. NPF diameter at the palatine fossa showed significant differences between genders (P value less than 0.05). But age group differences did not reach the significant level (P value more than 0.05). The means and SD of antero-posterior dimension of NPC was 3.46±1.53 mm. There were no significant difference between genders and among age groups concerning this dimension (P value was greater than 0.05). Mean and SD of height of NPC was 13.14±3.11 mm. Males demonstrated significantly greater length of NPC than females (P value was less than 0.05). Conclusion: It is concluded that there is anatomical variation in morphology and various parameters of NPC among sulaimani population. This should be considered in preoperative planning and to reduce the number of complications in implant and other maxillofacial surgeries in anterior palatine area. CBCT has important role to obtain accurate measurements of NPC different dimensions which has importance to differentiate between normal and abnormal NPC.

Aim of Work: To compare between the effects of clomiphene citrate, tamoxifen and letrozol as ovulation induction agents on endometrial thickness and blood flow as non-invasive parameters of endometrial receptivity in women with polycystic ovaries. Patients and Methods: One hundred and fifty cases meeting the selection criteria were prospectively randomized into three groups 1^st Group took 100 mg clomiphene citrate, 2^nd Group took 5 mg letrozol and 3^rd group took 40 mg tamoxifen. Transvaginal ultrasound and Doppler were done to measure endometrial thickness and endometrial blood flow both pulsatility index (PI) and resistance index (RI) at the day of the maximum follicular growth or at day 20 in the absence of the dominant follicle in the three groups. Results: Significantly thinner endometrium in the clomiphene citrate group as compared to the other two groups and lower impedance in the spiral arteries in both letrozol and tamoxifen groups (P value less than 0.001). Conclusion: Endometrium was thicker with lower impedance in the spiral arteries in both letrozol and tamoxifen groups as compared to clomiphene citrate group. Ovulation and pregnancy rates were not significantly different. Other studies are needed to measure the cumulative results of six cycles, increasing the dose in non-responders and the incidence of miscarriage.

Objective: The aim of this study was to determine the differences between Attachment Style and Personality traits in women who faced marital infidelity and those who didn't. Each component can play a significant role in promoting the marital relationships and reducing the marital infidelity. Methods: The present research is a casual-comparative study. The study sample consisted of all married women who refer to Welfare Divorce Reduce centers in Tehran province because of infidelity. Of these, 120 married women are selected among which 60 women experienced infidelity and 60 of them didn't experience marital infidelity. Data collection tool was short form of Adult Attachment Questionnaire (AAQ) and NEO-Five Factor Inventory (NEO –SF). Data analysis was performed by using SPSS software and using statistical descriptions (frequency, tendency to center of index and dispersion index) and statistical analysis method was ANOVA. Results: According to the results of this study, the hypotheses were confirmed. In other words, there is a significant different between the components of Attachment Style and Personality traits in women who had infidelity and those didn't face infidelity in their marriage. Each of the components of Attachment Style and Personality traits can be a predictor of marital dissatisfaction and infidelity. Conclusion: women with Avoidant attachment and Neuroticismtrait showed the highest percentage of entering into marital infidelity. It seems that determination of Attachment Style and Personality traits for each of the couples before marriage can be a contributing factors in improving marital relations.

Objective: Kashmir valley has witnessed an armed conflict from last three decades, with one of the studies suggesting the prevalence of trauma exposure of 58.69% in the general population and 15.9% prevalence of Post-traumatic stress disorder (PTSD). The current study was undertaken to explore the socio demographic profile and psychiatric comorbidity in treatment seeking PTSD patients. Methods: This cross-sectional study was conducted at Government Psychiatric Diseases Hospital Srinagar, Kashmir from January 2006 to January 2007. A total of 100 PTSD patients were interviewed and screened for psychiatric comorbidity using DSM-IV diagnostic criteria and their socio demographic details were recorded using a proforma. Results: Most of the patients in our study had multiple comorbidities. Apart from depression and anxiety disorders, somatisation and peri-traumatic dissociation was highly comorbid. Conclusion: Post-Traumatic Stress Disorder is a complex diagnosis with commonly associated psychiatric comorbidity. The high comorbidity in our study sample could be due to repeated exposure to trauma, cultural expression of distress and the ongoing conflict situation which makes the recovery difficult. Recognizing the comorbidities early on may help to achieve an optimal treatment outcome. Finally, the lack of appropriate service provision results in increased morbidity and probable chronicity of the symptoms.

Introduction: Certain building design and environmental factors are important to characterize in critical building environments, such as psychiatric hospitals, because they influence occupant's comfort, health, indoor environmental quality, and duration of admission. Lighting has its critical importance in hospitals. A sufficient level of daylight is essential to carry out the necessarytasks. Carefully designed daylighting can transform the appearance of the ward and make it attractive, welcoming and even restful. The Aim of Work: In this study is to find the associations between sufficiency in daylight inside psychiatric hospital wards and patient satisfaction with mental healthcare services. Methods: Inpatient wards of psychiatric hospitals were screened for patient's satisfaction towards health care services. Measuring the daylight intensity was performed by using a building performance tool (BPS tool) called Autodesk Ecotect as well as by professional lux meter to ensure the accuracy of the measurements. Measuring the patient's satisfaction was done by using a questionnaire designed by the research team which included six subscales: personal information, care from the staff, overall rating of hospital experience, rating the exterior spaces, rating the interior spacing and patient's enjoyment of life over the last week. Results: Daylight readings and patient's questionnaire were correlated together. In the form of tables, the 1^st correlation between daylight intensity and patient's subjective opinion about daylight. The 2^nd correlation was between daylight sufficiency and patient's enjoyment of life questionnaire. The 3^rd correlation was between window-wall ratio in the ward and patient's visual and thermal comfort. Conclusion: Many positive relationships like daylight intensity with patient's life enjoyment, and WWR with visual and thermal comfort were found.

Purpose: CYP3A4 (cytochrome P450, family 3, subfamily A, polypeptide 4) is an important enzyme in the body. The purpose of this enzyme is to oxidize small foreign organic molecules such as drugs or toxins. The different genetic variants CYP3A4 present in individuals such as CYP3A4*4. The cytochrome P450 3A subfamily have an important role in the catabolic reactions like many of peroxidative, oxadative, and reductive biotransformation reactions of common drugs such as Carbamazepine, Hydroxylations and Nevirapine. Methods: In this study, the prevalence of CYP3A4*4 in healthy subject of Iran were analyzed. Three hundred healthy unrelated subjects were chosen. After DNA extraction, genotypes were analyzed by PCR-RFL Pand PCR-sequencing. Results: No mutation was detected for CYP3A4*4 (Ile118Val) in these individuals. This study can be a background for future studies specially pharmacogenomic investigations and association studies. In addition, this data could be help clinicians optimize therapy or recognition persons who have risk of adverse drug reactions. Conclusions: Our results show that the frequencies of the CYP3A4*4 polymorphism in Iranian population were almost similar to the other populations such as Malaysian, Indian, Taiwanese, Tepehuan Amerindians and Mestizo Mexicans. CYP3A4*4 mutation causes decrease enzyme activity in vivo because the Ile118Val mutation may affect the substrate binding and cause decrease in CYP3A4 activity. Therefore, lack of the CYP3A4*4 mutation among Iranian population renders the consumption of drugs whose metabolismis done by CYP3A4, harmless.

Purpose/Objective(s): In India > 1 million new cases of cancer diagnosed every year. 40-50% of these cases are of head and neck cancer because of tobacco overuse. In our institute we have almost 1000-1300 new cases of Carcinoma Buccal Mucosa reported every year. From which 70-75% are surgically operable. For post-operative Radiotherapy treatment, we treat most of our patients by 2 Dimensional conventional treatments. Purpose of this study is to assess toxicity & long term results of postoperative carcinoma buccal mucosa cases treated by 2 Dimensional conventional treatment planning. Materials/Methods: From January 2009 to January 2012, almost 1980 postoperative cases of Carcinoma Buccal mucosa were referred for radiotherapy treatment. From which 1584 cases were suitable for postoperative 2 Dimensional Conventional planning. In selected cases, 71%, 18%, 11% cases were of Stage IV, III, II (close margin) respectively. Postoperative chemotherapy and radiotherapy was indicated in 475 patients. For all patients Plaster of Paris cast was prepared & X-ray was taken on Simulator machine. Target volume was drawn on x-ray & treatment plan generated on contour drawn with 90-95% isodose line covering the target, with hot spot of +10% on 2D Plato treatment planning system. All patients were treated with unilateral Anterior Posterior Lateral wedge pair technique for buccal mucosa and unilateral lower neck was given in indicated patients. Dose prescribed was 60 Gy/30#, 2Gy/#, 5 days a week, total 6 weeks treatment. Treatment plan verified on day 2 and treatment started. In patients where postoperative chemotherapy and radiotherapy was used, chemotherapy was given Cisplatin 30mg/m^[2] every weekly for 6 weeks. In most of the patients, treatment break was not required. All patients completed treatment successfully. Patients were assessed for locoregional control, acute & late toxicity and followed up for 3 years for disease free survival and overall survival. Results: Grade II & III acute mucositis was 82% & 18% respectively in 1109 patients who received only postoperative radiotherapy. For patients who received postoperative radiotherapy and chemotherapy Grade II and Grade III acute mucositis was seen in 75% & 25% respectively and side effects related to Cisplatin were managed conservatively. Almost all patients had Grade II skin reactions. Grade III skin reactions were observed in 8% of patients on post operative radiotherapy alone and 19% of patients on postoperative radiotherapy and chemotherapy but were manageable. All patients tolerated treatment well. For 1584 patients, follow up dropout rate was 20%. None of the patients developed significant late toxicity. As opposite parotid spared, no late complication of xerostomia observed. For 1268 patients, 1-, 2-, 3- year locoregional control rates were 82%, 75%, 68% respectively. Disease free survival rate was 63% (799 patients) & overall survival was almost 55% (697 patients) at median follow up for 40 months. Conclusion: 2D Conventional Radiotherapy Treatment Planning in our set up has shown very good results with almost 50% survival rates. It is less toxic treatment with fewer complications & less time consuming. It is highly cost effective treatment approach & results are very much encouraging.

Objective: This brief research was initiated to search for cytotoxic effect of bio surfactant produced by Leuconostocmesenteroidesssp. cremoris isolated from raw cow's milk. Methods: Extraction of extracellular bio sufactant was completed and partially purified by cold acetone precipitation, bio surfactant were tested against two cell lines, AMN3 (cancer cell line of mice mammary gland) and REF (noon cancerous normal cell line transformed) specifically regarding cell viability and proliferation. Results: Bio surfactant was found to decrease viability of AMN3 cancer cell line studied at concentrations 1:3,2:2 and 1:3 V/V (biosurfactant: free serum media), the inhibition percentage were 56.4%, 56.8% and 51.8% respectively, without affecting normal fibroblasts growth. Conclusion: The results gathered in this work are very promising regarding the bio surfactant potential for cancer treatment and encourage further work with other cell lines.

Introduction: Concurrent chemo-radiation is the main treatment in locally advanced cervical cancer. The change of bladder and rectum volume may lead to change in the positions of these structures and target volume during MUPIT implant which may lead to variation in dose to the organ at risk and target. Materials and Methods: Ten patients of gynecological malignancy were included. MUPIT template was positioned under anesthesia. CT scan was done for the contouring of bladder, rectum, and target and for planning purpose which generates plan (P1). CT scan was repeated before the third fraction of the treatment (CT2). The resultant plan (P2) was analyzed qualitatively and quantitatively. Results: Bladder volume variations of 88.18% to -68.15% were noted. This change in volume lead to differences in the maximum dose in bladder between fractions. The maximum dose variation ranged from 62.53% to -21.49%. The rectal volume variation ranges 11.71% to -46.20% due to the rectal filling. High variation in maximum dose to the rectum were observed which might be due to rectal filling. CTV volume is increased by 19.48% while in other by 19.05% and in all other patients the volume is decreased. CTV volume maximum decreased by 30.54% which might be due to decrease in edema developed during procedure. The volume variation in CTV is in range of 19.48% to -30.54%. Conclusion: It is proposed that re-planning using repeat CT scan is required before third fraction implementation.

Objectives: The study attempt to assess the effectiveness of Benson's relaxation therapy on reduction of stress among primigravid mothers attending the outpatient department in a selected hospital at Kannur, with the objectives of evaluating the stress among the primigravid mothers before and after the Benson's relaxation therapy and to associate the level of stress with selected demographic variables. Methods: A total of 30 primigravid mothers after third month of gestation were selected for the study. The information regarding background data were collected from the primigravid mothers by self-administered rating scale and the level of hemoglobin status was noted from the health records. Selected primigravid mothers were given pretest questionnaire and Benson's relaxation therapy was administered to all group members for 20 minutes and instructed to continue this for a period of 15 days. Post-test using rating scale was conducted 15 days after the administration of Benson's relaxation therapy. Result: The result of the study shows that the post-test mean stress score was less than the pre-test mean stress score. The obtained mean difference between the pre-test and post-test regarding stress score was statistically significant. Hence research hypothesis “there will be a significant difference in the stress scores before and after Benson's relaxation therapy among the primigravid mothers” has been retained. Conclusions: It was inferred that primigravid mothers who practiced Benson's relaxation therapy had significant decrease in post-test stress score. Also there was significant association with the level of stress and some demographic variables.

Introduction: Chemo-radiation preceded by induction chemotherapy is reported valuable alternative to laryngectomy in laryngeal cancer for larynx preservation.This study was performed to assess the influence chemo radiation on preservation of larynx. Materials and Methods: Two hundred and fifty sequential patients treated from January 2012 to December 2012 in our institute were reviewed and who were available for follow-up in this retrospective study. Total dose of 66-70 Gray was used at 2 gray per fraction daily for five days week were used. Larynx preservation rate at 3 years of median follow-up were analyzed. Results: Among 250 patients, larynx preservation was possible in 170 patients (68%). With chemo-radiation, excellent preservation of larynx was achieved in stage II (78%) disease, while in advanced stage III and stage IVA, larynx preservation was 67.06% and 64.35%, respectively. Conclusion: Chemo-radiation (either neoadjuvant chemotherapy followed by chemo-radiation or concurrent chemo-radiation) has better larynx preservation rate in early as well was advanced laryngeal cancer patients.

Currently there is an emphasis on developing Integrated Care pathways for mental health problems. The concept of pathways draws heavily from principles of lean thinking and is therefore based on improving the efficiency of the system to provide quality services to persons with health problems. Development of pathways for schizophrenia, along with depression and dementia is high priority in Ontario, Canada. This is an exciting development, especially as this might trigger radical changes in the health system to improve the care of those with schizophrenia. As the pathways are fully developed in England, we have tried to highlight the issues that can facilitate or hinder the development and implementation of the pathways in Ontario, compared with England. Development of pathways offers unique opportunities, that might lead to substantial improvement in care of persons with psychosis.

In the last decades, the treatment of obsessive-compulsive disorder (OCD) has dramatically improved with the introduction into the clinical practice of the selective serotonin reuptake inhibitors (SSRIs). However, a large part of patients do not respond to first-line drugs and different augmentation strategies have been proposed. More recently, some non-pharmacological techniques have been proposed, but the evidence of effectiveness is just preliminary. In this paper, the most recent works on pharmacological and alternative treatments of OCD will be reviewed.

Exposure to androgen deprivation therapy (ADT) by prostate cancer (PCa) patients is increasing, either in early-stage and in metastatic disease. Frequently, ADT becomes a long-term treatment, lasting even more than 10 years, starting with gonadotropin releasing hormone (GnRH) agonists or antagonists, until the newest hormonal treatments as Abiraterone and Enzalutamide. As a consequence, ADT related adverse events occurred. We reviewed the medical literature using Pubmed search terms “prostate cancer”, “androgen deprivation”, “metabolic syndrome”, “cardiovascular diseases” and “psychological assessment”. The search was limited to manuscripts published in English language between 1999 and 2016, preferring more recent review articles. Metabolic syndrome, diabetes and cardiovascular diseases, rather than PCa itself, are the most common causes of mortality, particularly in early stage PCa patients. All these adverse eff ects synergistically increase morbidity in patients taking ADT. Psychological-cognitive implications emerging during ADT result in a significant reduction of health-related quality of life of PCa patients. ADT is associated with several adverse events, which physicians andpatients should evaluate when recommending ADT. Multidisciplinary approach, with diff erent clinicians such as Urologist, Radiotherapist, Oncologist, Endocrinologist, Cardiologist, Psychologist, is mandatory for the suitable clinical management of patients with PCa submitted to ADT. Abbreviations: ADT: androgen deprivation therapy, BMI: body mass index, CV: cardiovascular, GnRH: gonadotropin releasing hormone, HDL: high-density lipoprotein, LDL: low-density lipoprotein, LHRH: luteinizing hormone releasing hormone, MS: metabolic syndrome, PCa: prostate cancer

Palliative Care (PC), is the set of actions and tools that seek relief from symptoms and suffering of patients and their families to diseases that threaten their lives. This support includes different types of resources covering the clinical, socio.economic, emotional, psychological and spiritual aspects. Due to increasing life expectancy of humans and the fact that chronic diseases account for 60% of premature death, mainly due to cardiovascular diseases, neurological and malignant tumors; has been the global need to create, implement, and enhance knowledge and PC local programs. In pediatrics, there are four main reasons why a child can and should receive pediatric palliative care.(PPC): Cancer, Cystic fibrosis, Metabolic or Mitochondrial and/or Progressive Muscle Diseases and Neurological Disorders. In this article we analyze synthetically the definition, types and basic definitions on the CPP matter. Also, we share the local experience about the first pediatric palliative care program focus in oncologic patients on the Dominican Republic. To review the basics and history of palliative care. To establish the goals and definition of pediatric palliative care, symptom management, terminal illness and integral support. To describe the local pediatric palliative care in oncology unit at Dr.Robert Reid Cabral Children's Hospital in Dominican Republic as the first PPC local program in the country for children with cancer.

Diabetic macular edema is a multi-pathogenic diseases which vascular endothelial growth factor (VEGF) may play the main role in most of the cases and treatment with Anti VEGF is warranted, where in long standing edema inflammation maybe the main pathogenic factor and treatment with Anti VEGF may not achieve optimum results and steroids can be used to address the inflammatory mechanism, there are three classes of intravitreal steroids which help us to individualize treatment for each patient never the less we have to take into account that all intravitreal steroids may cause cataract formation and glaucoma.

Introduction: Hydatid disease is a kind of parasitic infection which is caused by Echinococcus granulosus. It is commonly characterized by cystic formation. Almost all organs can be affected by the infection, however, cardiac and especially right ventricular hydatid cystic involvement, is very rare. Also pulmonary artery extension occurs rarely. Case Report: We report herein imaging findings of a -year-old asymptomatic male patient with cardiac hydatid cyst and pulmonary artery extension. He contour lobulation of paracardiac region in the chest. A film was the only clue for making diagnosis. Conclusion: Imaging modalities are heplful in detecting the pathology.

Introduction: Primary Intraventricular meningiomas are rare and occur in much younger age group than other the intracranial meningiomas. Calcified intraventricular meningioma in elderly has never been reported before. Case Report: Here we report the unique case of an 82 year-old female who presented for headache and vomiting following a traffic accident. The neurological examination disclosed no abnormalities. The CT scan revealed a calcified Intraventricular meningioma. Conclusion: Since the patient was aged over 70 years and was asymptomatic, the lesion was not removed. Follow-up imaging showed no changes in the tumor.

Introduction: Malignant pleural mesothelioma (MPM) is a rare neoplasm. It has closed association with occupational asbestos exposure. Symptoms are commonly due to local invasion of pleura and mediastinal structures. MPM may have local or rarely distant organ metastasis by haematogenous spread in different organs such as liver, adrenal gland, kidney and contralateral lung. However, gastrointestinal involvement is very rare. Case Report: We report herein a 58-year-old female patient who was presented with back painand finally was diagnosed as MPM with distant metastasis to the stomach. Conclusion: Clinical, imaging and histopathologic findings play an important role in influencing the prognosis as well as treatment.

Introduction: Ovarian Granulosa Cell Tumors (GCT) is a potentially malignant tumor. Accurate diagnosis requires histological and immunohistochemical study. The treatment of choice is surgical staging and debulking staging according to International Federation of Gynecology and Obstetrics (FIGO) criteria, preferred by laparoscopy. The therapeutic role of adjuvant therapy is unclear. Relapses arefrequent, usually late and insidious. Case Report: we report two cases of Ovarian Granulosa Cell Tumor. First case, a laparoscopic oophorectomy for complex adnexal cyst, intraoperative study does not differentiate between Granulosa Cell Tumor or clear cell carcinoma of the ovary, so we performed a complete staging surgery by laparoscopy. Second case aparaortic recurrence twenty years after first surgery. Non-steroidal anti-androgen therapy was useful to control progression of the disease, finally laparoscopic excision of the lesion. Conclusion: A complete surgery in the management of Granulosa Cell Tumor is recommended. Relapses can occur very late and response to chemotherapy is poor, so it is important to perform a careful initial staging or debulkingprocedure because intraoperative pathological diagnosis is difficult and confusing.

Introduction: Meckel’s Diverticulum is the most common congenital anomaly of the gastrointestinal tract (incidence: 0.6%-4%). Gastro Intestinal Stromal Tumors originate from multipotential stromal cells of Cajal (pacemaker cell of gastrointestinal tract). The GISTs of Meckel’s diverticulum are extremely rare,especially if you consider that only 2% of the population has this kind of diverticula confirmed by autopsy studies, with a percentage that varies between 0.4 and 4.5%. Case Reports: We report two cases, a 53 year old post menopausal lady and a 45 year old peri menopausal lady, both clinico radiologically diagnosed as ovarian masses, found to have a tumor arising from Meckel’s Diverticulum intraoperatively, that were histopathologically proven to be Gastro Intestinal Stromal Tumors. A thorough literature review was done and all the previously quoted case reports are listed. Our literature search revealed a total of 42 case reports of GIST of Meckel’s Diverticulum including ours. Perforation is the most common presentation of a Meckel’s GIST (13 case reports). Meckel’s GIST presenting as a pelvic mass mimicking an ovarian pathology has been reported in the literature (6 case reports). Conclusion: Meckel’s diverticular tumours, though rare, may mimic other pathologies of the abdomen, therefore should be taken into consideration during the differential diagnosis of abdominal and pelvic tumours, especially in cases where imaging modalities doesn’t pinpoint adefinitive diagnosis.