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Background: Premature rupture of membranes (PROM) is the loss of integrity of membranes before onset of labor. PROM occurs in approximately 5–10 % of all pregnancies. and is a significant obstetric problem and is important cause of maternal and neonatal morbidity. When PROM occurs at term, labor typically ensues spontaneously or is induced within 12 to 24 hours Objectives: To compare the expectant and aggressive management and its neonatal and maternal outcomes. Material and Methods: This is a prospective study carried out in the Obstetric and Gynecology Department of J.J.M Medical College, Davangere, Karnataka. Results: There were 573 cases of PROM giving incidence of 8.15%. The incidence was found to be higher in case of rural, young, primigravida. Out of these PROM cases 81.5% were managed aggressively (group A), 18.4% were managed expectantly (group B). Mode of delivery was as follows. Group A (Expectant management) Vaginal delivery in 70.75%, LSCS in 29.25 %. Group B (Aggressive management) Vaginal delivery 83.7% LSCS 27%. Perinatal mortality, Group A 7.54 %, Group B 1.28%. Perinatal morbidity, Group A 7.54 % group B 4.49%. Maternal morbidity, Group A was 18.86% Group B 1.07%, Matrenal mortality Group A 0.94% one, Group B was zero Conclusion: Aggressive management by induction of labor within 12 hours in PROM reduced the time of delivery and the rates of chorioamnionitis, endometritis, and admission to the neonatal intensive care unit. A proposed plan of "Aggressive management" is the final answer to decrease maternal and neonatal morbidity and mortality.

1. Larranaga-Azcarate C, Campo-Molina G, Perez-Rodrı´guez AF et al. Dinoprostone vaginal slow release system compared to expectant management in the active treatment of premature rupture of the membranes at term: impact on maternal and fetal outcome.Acta obstetrica. 2008; 87:195–200. 2. Duff P. Premature rupture of membranes in term patients: induction of labor versus expectant management. Clin Obstet Gynecol. 1998; 41:883–91. 3. Ozden S, Delikara MN, Avci A et al. Intravaginal misoprostol vs expectant management in premature rupture of membranes with low bishop scores at term. Int. J. gynaecol obstet. 2002; 77:109–15. 4. Hoffmann RA, Anthony J, Fawcus S. Oral misoprostol vs. placebo in the management of prelabor rupture of membranes at term: Int. J. of gynec obstet. 2001; 72:215–21. 5. Ayaz A, Saeed S, Farooq MU et al. Pre-labor rupture of membranes at term in patients with an unfavorable cervix: active versus conservative management. Taiwan. J. obstet gynecol. 2008; 47:192–6. 6. Shah Krupa Doshi Haresh et al. Premature Rupture of Membrane at Term: Early Induction Versus Expectant ManagementThe Journal of Obstetrics and Gynecology of India (March–April 2012) 62(2):172–175 7. Akyol D, Mungan T, Unsal A et al. Prelabour rupture of membranes at term: no advantage of delaying induction for 24 hours. Aust N Z J Obstet Gynecol. 1999;39:291–5

Introduction: Extra-osseous, epidural tuberculoma are extra-pulmonary manifestations of tuberculosis involving the central nervous system. Material and methods: We are reporting 5 patients of extra-dural tuberculoma ranging in age from 21yrsto 64 yrs. All patients had varying degree of paraparesis at the time of presentation. Only two patients had spinal tenderness and bone involvement could not be seen in plain radiographs in all five cases. All patients underwent magnetic resonance imaging and only three had no osseous involvement. Exploration through posterior approach by laminectomy with posterior instrumentation done in all cases and the epidural mass had been sent for histo-pathological examination which confirmed the diagnosis. Results: All patients healed clinico-radiologically with anti tubercular therapy and been followed for minimum 2 years. Conclusion: Extra-dural tuberculoma should be considered as a differential diagnosis in compression myelopathy due to spinal tumor syndrome.

Introduction: Extra-osseous, epidural tuberculoma are extra-pulmonary manifestations of tuberculosis involving the central nervous system. Material and methods: We are reporting 5 patients of extra-dural tuberculoma ranging in age from 21yrsto 64 yrs. All patients had varying degree of paraparesis at the time of presentation. Only two patients had spinal tenderness and bone involvement could not be seen in plain radiographs in all five cases. All patients underwent magnetic resonance imaging and only three had no osseous involvement. Exploration through posterior approach by laminectomy with posterior instrumentation done in all cases and the epidural mass had been sent for histo-pathological examination which confirmed the diagnosis. Results: All patients healed clinico-radiologically with anti tubercular therapy and been followed for minimum 2 years. Conclusion: Extra-dural tuberculoma should be considered as a differential diagnosis in compression myelopathy due to spinal tumor syndrome.

Garden biomass (GB), a potential cellulosic resource for bio energy is commonly found in urban waste. Quantification and characterization of GB would help in disposing this waste properly besides opening avenues to reap energy from it. In this context, the present investigation was carried out in Nagpur, India to quantify and characterize GB in urban waste and to assess its potential as a substrate for bioenergy production. 25 samples were collected from different locations in Nagpur city. Physical and chemical parameters were analyzed in the laboratory. The result showed that the average quantity of GB generation in the urban waste of Nagpur city as 1.68 % with a moisture content of 50.77%. The major (61.17%) portion of garden biomass was fallen leaves followed by cut grasses and small twigs. The characterization of GB samples revealed that it contained 37.33% of cellulose, 26.02% of hemicellulose and 28.39 % of lignin in it. The quantity of biomass in its cellulosic content in the urban waste of Nagpur city warrants its suitability as a promising feedstock for energy generation.

1. Chandrappa R, Das BD, Waste Quantities and Characteristics. Solid Waste Management, Environmental Science and Engineering, (Springer-Verlag Berlin Heidelberg) 2012,DOI: 10.1007/978-3-642-28681-02. 2. Chanakya HN, Ramachandra TV, Vijayachamundeeswari M, Anaerobic digestion and reuse of digested products of selected components of urban solid waste, Technical report of Centre for Ecological Sciences and Centre for Sustainable Technologies, Indian Institute of Science Bangalore,2006. 3. Jian Y, Heiko S: Microbial utilization and biopolyester synthesis of bagasse hydrolysates: Bioresource Technology.2008; 99;8042-8048. 4. Shan T H, Hsiung W H:A novel composting process for plant wastes in Taiwan military barracks:Resources Conservation and Recycling.2007;51;408–417. 5. Gajalakshmi S, Ramasamy E V, Abbasi S A: Composting–vermicomposting of leaf litter ensuing from the trees of mango (Mangiferaindica):Bioresource Technology.2005;96;1057–1061. 6. Singh J, Gu S:Biomass conversion to energy in India—A critique: Renewable and Sustainable Energy Reviews.2010;14;1367–1378. 7. Srinivas R: State of the environment report and action plan. Karnataka, 2003. 8. Lemieux P M, Lutes C C, Santoianni D A: Emissions of organic air toxics from open burning: a comprehensive review:Progress in energy and combustion science.2004;30;1-32. 9. Olufunke C, Bradford A A: Organic Waste Reuse for Urban Agriculture. Case study of Ouagadougou city in Burkina Faso, 2006. 10. Hua-Shan T, Wei-Hsiung H:A novel composting process for plant wastes in Taiwan military barracks: Resources, Conservation and Recycling.2007;51;408–417. 11. Modak P R, Nangare P B: Quantitative and qualitative assessment of municipal solid waste for Nagpur city: Journal of Engineering Research and Studies.2011;2;55-61. 12. Nelson D W, Sommers L E, Total carbon, organic carbon and organic matter, in Page, A.L. (Ed.), Methods of Soil Analysis Part II., pp 539–579.American Society of agronomers, Madison,1982. 13. Liu S, Analysis and measurement in papermaking industry (Chemical Industry Press Beijing, China) 2004. 14. Rimaitytė I, Denafas G, Martuzevicius D, Kavaliauskas A:Energy and Environmental Indicators of Municipal Solid Waste Incineration: toward Selection of an Optimal Waste Management System:Polish J. of Environ. Stud.2009; 5;989-998. 15. Greer D, Biocycle, Creating Cellulosic Ethanol: Spinning Straw into Fuel, eNews Bulletin, May 2005. 16. Ivanova G, Rákhely G, Kovács K L: Thermophilic biohydrogen production from energy plants by Caldicellulosiruptor saccharolyticus and comparison with related studies: International Journal of Hydrogen Energy.2009; 34;3659-3670. 17. Agrawal P C, Yadav V:Evaluation of Potential of Energy from Jabalpur Municipal Solid waste(MSW) for ECO-Sustainability: International Journal of Scientific Engineering and Technology.2012;1;197-202. 18. Sharholy M, Ahmad K, Vaishya R, Gupta R: Municipal solid waste characteristics and management in Allahabad, India:Waste Management.2007;27;490–496. 19. Census of India, Online, 2011. 20. Nagpur Municipal Corporation (NMC): City Sanitation Plan. Department of Urban development, Govt. of Maharashtra, Mumbai, March 2011. 21. Times of India (TOI),pg 4,12 Oct.2010, 22. Chiemchaisri C: Greenhouse Gas Emission Potential of the Municipal Solid Waste Disposal Sites in Thailand:Air and Waste Manage Assoc.2008;58;629–635. 23. McKendry P: Energy production from biomass (part 1): overview of biomass: Bioresour Technol.2002; 83;37–46. 24. Rowell R M, The chemistry of solid wood, American Chemical Society, Washington, DC, 1984. 25. Narayana T: Municipal solid waste management in India, from waste disposal to recovery of resources?: Waste Manag.2009;9;1163–1166. 26. Jacobus P H, Wyk V: Biotechnology and the utilization of biowaste as a resource for bioproduct development: Trends in Biotechnology.2001;19;5. 27. Lino FAM, Ismail KAR: Analysis of the potential of municipal solid waste in Brazil: Environmental Development.2012; 4; 105–113. 28. Prasad S, Singh A, Joshi H C: Ethanol as an alternative fuel from agricultural, industrial and urban residues: Resources, Conservation and Recycling.2007; 50;1–39. 29. Williams P T, Waste Treatment and Disposal. Wiley, 1998. 30. Yadav J P, Singh B R: Study on Future Prospects of Power Generation by Bagasse, Rice Husk and Municipal Waste in Uttar Pradesh: S-JPSET.2011;2;2229-7111. 31. Ministry of Environment and Forests (MOEF), Govt. of India 2000, MSW (Management and Handling Rules 2000) available on line at www.mnef.nic.in. 32. Ministry of New and Renewable Energy (MNRE), Govt. of India, National programme on energy recovery from urban wastes online at www.mnes.nic.in.

Garden biomass (GB), a potential cellulosic resource for bio energy is commonly found in urban waste. Quantification and characterization of GB would help in disposing this waste properly besides opening avenues to reap energy from it. In this context, the present investigation was carried out in Nagpur, India to quantify and characterize GB in urban waste and to assess its potential as a substrate for bioenergy production. 25 samples were collected from different locations in Nagpur city. Physical and chemical parameters were analyzed in the laboratory. The result showed that the average quantity of GB generation in the urban waste of Nagpur city as 1.68 % with a moisture content of 50.77%. The major (61.17%) portion of garden biomass was fallen leaves followed by cut grasses and small twigs. The characterization of GB samples revealed that it contained 37.33% of cellulose, 26.02% of hemicellulose and 28.39 % of lignin in it. The quantity of biomass in its cellulosic content in the urban waste of Nagpur city warrants its suitability as a promising feedstock for energy generation.

Garden biomass (GB), a potential cellulosic resource for bio energy is commonly found in urban waste. Quantification and characterization of GB would help in disposing this waste properly besides opening avenues to reap energy from it. In this context, the present investigation was carried out in Nagpur, India to quantify and characterize GB in urban waste and to assess its potential as a substrate for bioenergy production. 25 samples were collected from different locations in Nagpur city. Physical and chemical parameters were analyzed in the laboratory. The result showed that the average quantity of GB generation in the urban waste of Nagpur city as 1.68 % with a moisture content of 50.77%. The major (61.17%) portion of garden biomass was fallen leaves followed by cut grasses and small twigs. The characterization of GB samples revealed that it contained 37.33% of cellulose, 26.02% of hemicellulose and 28.39 % of lignin in it. The quantity of biomass in its cellulosic content in the urban waste of Nagpur city warrants its suitability as a promising feedstock for energy generation.

Objective: To study the awareness, knowledge and attitude to eye donation among the residents of Thiruvananthapuram, Kerala State, India. Materials and Methods: After obtaining informed consent, subjects aged 16 or above selected from the residents of Thiruvananthapuram district were asked to fill up a validated objective type questionnaire on eye donation. Data was analyzed using appropriate computer statistical software tools. Results: A total of 557 subjects participated in the study. The awareness of eye donation was 90.5%. The awareness was significantly less among the illiterate (63.6%) (p<0.05), those with monthly income less than 1000 rupees (79.3%) (p<0.05) and females (78.4%) (p<0.05). Only 70.6% were willing to donate their eyes or have already pledged their eyes. Among those who were unwilling to donate eyes, 48.2 % believed that their body would be disfigured (p< 0.05). 25% thought that persons with cataract could not donate eyes. Audiovisual and print media were the major sources of information (58%). Government publicity measures accounted for only 1.8%. Conclusion: Although Thiruvananthapuram has a high level of awareness about eye donation, significant number of people are unwilling to donate their eyes mainly due to their misconceptions. To increase the availability of corneas for transplantation, more effective publicity measures are needed to properly educate the residents about eye donation.

1. Neena J, Rachel J, Praveen V, Murthy GV, Rapid Assessment of Avoidable Blindness India Study G: Rapid assessment of avoidable blindness in India. PLOS One 2008, 3(8):e2867. 2. Dandona L, Dandona R, Srinivas M, Giridhar P, Vilas K, Prasad MN, et al. Blindness in Indian state of Andhra Pradesh. Invest Ophthalmol Vis Sci. 2001; 42: 908–16. 3. Saini JS, Reddy MK, Jain AK, Ravinder MS, Jhaveria S, Raghuram L. Perspectives in eye banking. Indian J Ophthalmol. 1996; 44:47–55. 4. National Programme for the Control of Blindness website available at http://npcb.nic.in/writereaddata/mainlinkfile/File292.pdf [accessed March 2, 2021] 5. Dandona R, Dandona L, Naduvilath TJ, McCarty CA, Rao GN. Awareness of eye donation in an urban population in India. Aust N Z J Ophthalmol. 1999; 27:166–9. 6. Priyadarshini B, Srinivasan M, Padmavathi A, Selvam S, Saradha R, Nirmalan PK: Awareness of eye donation in an adult population of southern India. A pilot study. Indian J Ophthalmol 2003, 51(1):101-104. 7. Krishnaiah S, Kovai V, Nutheti R, Shamanna BR, Thomas R, Rao GN: Awareness of eye donation in the rural population of India. Indian J Ophthalmol 2004, 52(1):73-78. 8. Yew YW, Saw SM, Pan JC, Shen HM, Lwin M, Yew MS, Heng WJ: Knowledge and beliefs on corneal donation in Singapore adults.Br J Ophthalmol 2005, 89(7):835-840. 9. Bhandary S, Khanna R, Rao KA, Rao LG, Lingam KD, Binu V: Eye donation: Awareness and willingness among attendants of patients at various clinics in Melaka, Malaysia. Indian J Ophthalmol 2011, 59(1):41-45. 10. Venkata Ramana Ronanki, Sethu Sheeladevi, Brinda P Ramachandran and Isabelle Jalbert : Awareness regarding eye donation among stakeholders in Srikakulam district in South India. BMC Ophthalmology 2014, 14: 25 11. Gupta A, Jain S, Jain T, Gupta K: Awareness and perception regarding eye donation in students of nursing college in Bangalore. Indian J Community Med 2009, 34(2):122-125. 12. Tandon R, Verma K, Vanathi M, Pandey RM, Vajpayee RB: Factors affecting eye donation from postmortem cases in a tertiary care hospital.Cornea 2004, 23(6):597-601. 13. Verble M, Darcy K, Penta JG, Worth J: Telephone requests for donation: concerns expressed by families and impact of donor registry. Prog Transplant 2013, 23(1):92-98. 14. Census 2011 India available at http://www.censusindia.gov.in/2011- Documents/CRS_Report/CRS_Report_2010.pdf page 93 [ accessed March 5, 2021 ] 15. Gogate B, Gogate P: Eye donation: mere awareness and willingness not enough. Only a catalyst can improve corneal harvesting rates. Indian J Ophthalmol 2011, 59 (4):332-333.

Background: Obesity is a chronic and complex disease defined as an excess of body fat. Adipose tissue accumulation increases the incidence and risk of adverse metabolic events and diseases. Many techniques have been developed for assessing and/or determining body fat or adiposity. A new index of adiposity, namely the body adiposity index (BAI) has been developed. Metabolic syndrome is a group of abnormalities that confers an increased risk of developing atherosclerotic cardiovascular diseases and type 2 diabetes mellitus. Aim: To determine BAI levels in metabolic syndrome, to analyse correlation of BAI with metabolic risk factors and to determine what appropriate cut-off value of BAI would be most closely predictive of the metabolic syndrome. Materials and Methods: A cross-sectional study was undertaken in M S Ramaiah Medical College and Hospitals, Bangalore. A detailed personal and clinical history, blood pressure, anthropometric measurements were recorded and a fasting blood sample was drawn from each of the 90 subjects selected. The serum samples were analyzed for Fasting Blood Sugar and lipid profile. Results: BAI levels in subjects with metabolic syndrome was 30.29% ±4.36 and 27.97 %±3.72 in controls without the presence of a single risk factor for metabolic syndrome. BAI showed a significant positive correlation with Serum triglycerides, Systolic and diastolic blood pressure in both the cases and controls and a significant negative correlation with Serum High Density Lipoprotein (HDL). A cut-off of 26.76% for BAI had an optimal sensitivity and specificity to be most closely predictive of the metabolic syndrome. Conclusion: BAI can be used as an additional marker in screening populations for metabolic syndrome in field studies; however its validity needs to be demonstrated in field studies with larger populations, before accepting it as a new marker to predict cardiovascular and other health risks.

Background: Obesity is a chronic and complex disease defined as an excess of body fat. Adipose tissue accumulation increases the incidence and risk of adverse metabolic events and diseases. Many techniques have been developed for assessing and/or determining body fat or adiposity. A new index of adiposity, namely the body adiposity index (BAI) has been developed. Metabolic syndrome is a group of abnormalities that confers an increased risk of developing atherosclerotic cardiovascular diseases and type 2 diabetes mellitus. Aim: To determine BAI levels in metabolic syndrome, to analyse correlation of BAI with metabolic risk factors and to determine what appropriate cut-off value of BAI would be most closely predictive of the metabolic syndrome. Materials and Methods: A cross-sectional study was undertaken in M S Ramaiah Medical College and Hospitals, Bangalore. A detailed personal and clinical history, blood pressure, anthropometric measurements were recorded and a fasting blood sample was drawn from each of the 90 subjects selected. The serum samples were analyzed for Fasting Blood Sugar and lipid profile. Results: BAI levels in subjects with metabolic syndrome was 30.29% ±4.36 and 27.97 %±3.72 in controls without the presence of a single risk factor for metabolic syndrome. BAI showed a significant positive correlation with Serum triglycerides, Systolic and diastolic blood pressure in both the cases and controls and a significant negative correlation with Serum High Density Lipoprotein (HDL). A cut-off of 26.76% for BAI had an optimal sensitivity and specificity to be most closely predictive of the metabolic syndrome. Conclusion: BAI can be used as an additional marker in screening populations for metabolic syndrome in field studies; however its validity needs to be demonstrated in field studies with larger populations, before accepting it as a new marker to predict cardiovascular and other health risks.

The hand is the most used and versatile part of body is of great scientific importance to investigators in the field of anthropometry, forensic pathology, orthopedic surgery and ergonomics. The aim of the present study is to provide an authentic data database on right and left hand length, hand breadth and hand shape indices of two different ethnic groups of a particular age and sex. And study its correlation with handedness and sexual dimorphism. The study was conducted on 300 Haryanvi Brahmins (150 each of either sex) and Kashmiri Pandits (150 each of either sex) of age group 18 year and above. The values for hand-length, hand breadth and hand shape indices were calculated for both the hands. Hand preference was established according to Edinburg inventory and five hand-preference determination groups were constituted after calculation of laterality score. The result were tabulated and subjected to statistical analyses. Mean values for hand-length handbreadth and hand shape indices in males are more, when assessed by sex. These values were found statistically significant (p≤00.1). when relationship between laterality score(indicator of hand preference) and hand-length, handbreadth, and shape indices were examined, the values were found to be positively correlated for right hand-length, left hand-length, left shape index but the correlation was no statistically significant. Laterality score was negatively correlated with right hand breadth, left hand breadth and right shape index in Haryanvi Brahmins where as in Kashmiri Pandits it was positively correlated with right hand length, left hand length and left hand shape index. But the correlation was statistically significant in case of right hand breadth (p≤0.01) and right shape index (p≤0.01).

1. A baseline data on hand anthropometry has been established in males and females of two different endogamous groups (Haryanvi Brahmins and Kashmiri Pandits) which will be helpful to anthropologists and forensic experts in cases of mass disasters for personal identification. 2. The mean values of right and left hand lengths were significantly higher in Haryanvi Brahmins. 3. Since the mean values of hand parameters were significantly different between males and females, right-handers and left-handers, hence the hand tools should be designed separately to fit the males and females in both the endogamous groups (Haryanvi Brahmins and Kashmiri Pandits). 4. Since majority of the subjects use their right hand, it is usually found to be shorter and noticeably wider than the left hand in both the endogamous groups irrespective of handedness of an individual. 5. Males usually have broader and coarser hands as compared to females. In Haryanvi Brahmins this is true for both the right and left hands whereas in Kashmiri Pandits this is true only for the left hands. This suggests that environmental factors are also influential in hand anthropometric measurements. 6. Hand breadth and shape index were found to be greater in the right hand disrespected to preference groups in Haryanvi Brahmins and Kashmiri Pandits. 7. No significant difference in hand parameter values on right and left hand were obtained among ambidextrous subjects except in case of hand breadth in Haryanvi Brahmins. 8. Left hand preference groups displayed irregular and heterogeneous characteristics with regard to hand parameters. 9. When relationship between laterality score and hand parameters was examined the values for right hand breadth, right shape index, right and left were found to be indicators of hand preference in Kashmiri pundits only. REFERENCES 1. Choudhary S, Singh H and Gupta N. 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Pheochromocytoma is a potentially lethal catecholamine containing tumor of chromaffin tissues.The classic triad of headache, palpitation and diaphoresis is present in up to 70% of the cases and only 50% have sustained hypertension. The best approach for pheochromocytoma treatment is surgical excision of the affected adrenal gland. Although uncommon type of tumor, pheochromocytomas present a great challenge to the Anaesthesiologist, since it has unspecific clinical symptoms, complex detection tests and possibility of unfavorable results, including death when not previously diagnosed. The perioperative course and anesthetic management of patients with catecholamine-secreting pheochromoytoma has typically been reported only in small case series because of the infrequent incidence of these tumors. In this report, we describe a successful management of a case of Normetanephrine secreting bilateral adrenal and Rt Subhepatic region & Lt Paravertebral region pheochromocytoma that underwent excision with favorable outcome. Because of surgical approach for excision by thoracotomy, one lung ventilation (OLV) was established which is itself a challenge for the Anaesthesiologist.

1. Vuguin P, Perez N, Monsalve MM. Pheochromocytoma. Web article from eMedicine Specialties>Pediatrics>Oncology. Last updated: June 5, 2006. eMedicine from WebMD. www.emedicine.com/ped/topic1788.htm 2. Prys-Roberts C. Pheochromocytoma - recent progress in its management. Br J Anaesth 2000; 85:44-57. 3. Singh G, Kam P. An overview of anaesthetic issues in Pheochromocytoma. Ann Acad Med Singapore 1998; 27:843-8. 4. Kariya N, Nishi S, Hosono Y, Hamaoka N, Nishikawa K, Asada A. Cesarean section at 28 weeks' gestation with resection of pheochromocytoma: periopertive antihypertensive management. J Clin Anesth 2005; 17:296-9. 5. Kinney MA, Narr BJ, Warner MA. Perioperative Management of Pheochromocytoma. J Cardiothorasc Vasc Anesth 2002; 16:359-69. 6. Schif RL, Welsh GA. Perioperative evaluation and management of the patient with endocrine dysfunction. Med Clin N Am 2003; 87:17592. 7. Pheochromocytoma Anesthetic Management, Daniel D. Kim, Christiano Matsui, Judymara L. Gozzani, Ligia A. S. T. Mathias, Open Journal of Anesthesiology, 2013, 3, 152-155 8. Kinney MA, Narr BJ, Warner MA. Perioperative Management of Pheocromocytoma.J Cardiothoracic Vascular Anesthesia;2002;16;359-69. 9. Hull CJ. Pheocromocytoma:Diag,pre-op prep and anaes management.Br J Anaes 1986;58:1453-68. 10. Gosh S, Latimer R.D, Thoracic anaesthesia : Principles and practice. Oxford :Butterworth Heinemann;1999

Bartter syndrome is a rare renal tubulopathy first described by Frederic Bartter in 1962. The primary pathogenic mechanism is defective transepithelial chloride reabsorption in the thick ascending limb of loop of Henle (TALH). The disease is characterized by hypokalemia, metabolic alkalosis, and secondary hyperaldosteronism with normal to low blood pressure due to renal loss of sodium and hyperplasia of juxtaglomerular apparatus. The two distinct presentations of Bartter syndrome are antenatal bartter syndrome (ABS) and classical Bartter syndrome.We present a rare case of antenatal bartter syndrome.

1. F. C. Bartter, P. Pronove, J. R. Gill Jr., and R. C. MacCardle, “Hyperplasia of the juxtaglomerular complex with hyperaldosteronism and hypokalemic alkalosis. A new syndrome,” American Journal of Medicine, vol. 33, pp. 811–828, 1962. 2. K. M. Dell and E. D. Avner, “Bartter-Gitelman syndromes and other inherited tubular transport abnormalities,” in Nelson Textbook of Pediatrics, 3. W.Proesmans, “Bartter syndrome and its neonatal variant,” European Journal of Pediatrics, vol. 156, no. 9, pp. 669–679, 1997. 4. Y. R. Bhat, G. Vinayaka, R. Vani, K. A. Prashanth, and K. Sreelakshmi, “Antenatal Bartter syndrome: a rare cause of unexplained severe polyhydramnios,” Annals of Tropical Paediatrics, vol. 31, pp. 153–157, 2011. 5. H. W. Seyberth and K. P. Schlingmann, “Bartter and Gitelman-like syndromes: salt-losing tubulopathies with loop or DCT defects,” Pediatric Nephrology, vol. 26, pp. 1789–1802, 2011. 6. P.R. Rodrıguez and T. Hasaart, “Hydramnios and observations in Bartter’s syndrome,” Acta Obstetricia et Gynecologica Scandinavica, vol. 61, pp. 477–478, 1982. 7. G. Massa, W. Proesmans, H. Devlieger, K. Vandenberghe, A. van Assche, and E. Eggermont, “Electrolyte composition of the amniotic fluid in Bartter syndrome,” European Journal of Obstetrics & Gynecology and Reproductive Biology, vol. 24, pp. 335–340, 1987. 8. B. Dane, M. Yayla, C. Dane, and A. Cetin, “Prenatal diagnosis of Bartter syndrome with biochemical examination of amniotic fluid: case report,” Fetal Diagnosis and Therapy, vol. 22, no. 3, pp. 206–208, 2007. 9. J. Rodríguez-Soriano, “Bartter and related syndromes: the puzzle is almost solved,” Pediatric Nephrology, vol. 12, no. 4, pp. 315–327, 1998. 10. A. Ohlsson, U. Sieck, W. Cumming, M. Akhtar, and F. Serenius, “A variant of Bartter's syndrome. Bartter's syndrome associated with hydramnios, prematurity, hypercalciuria and nephrocalcinosis,” Acta Paediatrica Scandinavica, vol. 73, no. 6, pp. 868–874, 1984. 11. W. Proesmans, H. Devlieger, and A. Van Assche, “Bartter syndrome in two siblings - Antenatal and neonatal observations,” International Journal of Pediatric Nephrology, vol. 6, no. 1, pp. 63–70, 1985. 12. M. H. Winterborn, G. J. Hewitt, and M. D. Mitchell, “The role of prostaglandins in Bartter's syndrome,” International Journal of Pediatric Nephrology, vol. 5, no. 1, pp. 31–38, 1984. 13. D. Landau, H. Shalev, M. Ohaly, and R. Carmi, “Infantile variant of Bartter syndrome and sensorineural deafness: a new autosomal recessive disorder,” American Journal of Medical Genetics, vol. 59, no. 4, pp. 454–459, 1995. 14. G. Madrigal, P. Saborio, F. Mora, G. Rincon, and L. M. Guay-Woodford, “Bartter syndrome in Costa Rica: a description of 20 cases,” Pediatric Nephrology, vol. 11, no. 3, pp. 296–301, 1997. 15. J. Rodriguez-Soriano, “Tubular disorders of electrolyte regulation,” in Pediatric Nephrology, E. Avner, W. Harmon, and P. Niaudet, Eds., pp. 729–756, Lippincott Williams and Wilkins, Philadelphia, Pa, USA, 5th edition, 2004. 16. J. Rodriguez-Soriano, “Bartter's syndrome comes of age,” Pediatrics, vol. 103, no. 3, pp. 663–664, 1999. 17. B. Dane, C. Dane, F. Aksoy, A. Cetin, and M. Yayla, “Antenatal bartter syndrome: analysis of two cases with placental findings,” Fetal and Pediatric Pathology, vol. 29, no. 3, pp. 121–126, 2010. 18. M. E. Norton, J. Merrill, B. A. B. Cooper, J. A. Kuller, and R. I. Clyman, “Neonatal complications after the administration of indomethacin for preterm labor,” New England Journal of Medicine, vol. 329, no. 22, pp. 1602–1607, 1993. 19. I. Amirlak and K. P. Dawson, “Bartter syndrome: an overview,” QJM, vol. 93, no. 4, pp. 207–215, 2000. 20. E. Puricelli, A. Bettinelli, N. Borsa et al., “Long-term follow-up of patients with Bartter syndrome type i and II,” Nephrology Dialysis Transplantation, vol. 25, no. 9, pp. 2976–2981, 2010. 21. S. Reinalter, H. Devlieger, and W. Proesmans, “Neonatal Bartter syndrome: spontaneous resolution of all signs and symptoms,” Pediatric Nephrology, vol. 12, no. 3, pp. 186–188, 1998

Introduction: Polycythemia in Newborns is well known now a day to pediatricians. It is not uncommon and is a potentially serious disorder of newborns. By definition, it is an increase in the circulating red blood cells above normal values and corresponding increase occurring in hemoglobin and hematocrit or packed cell volume. Alternatively it is an increase in red cell mass per unit of body weight. Various risk factors such as birth asphyxia, toxemias of pregnancy (preeclampsia/eclampsia), twin pregnancies, hypertension, postmaturity, suspected intrauterine growth relation, maternal diabetes etc have been reported by various authors. Aims and Objectives: To study the incidence of polycythemia in newborns with high risk antenatal history and various factors associated with it. Materials and Methods: In the present study newborn with various high risk antenatal factors were enrolled. A detailed antenatal (medical and obstetric), intrapartum history of mother was recorded on a prestructured proforma. Complete clinical examination was done in newborns. Cord blood hematocrit determined was done by Wintrobe's hematocrit method from each of the newborns. Results: The incidence of polycythemia was found to be 10.5% at sea level. Birth asphyxia, twin pregnancy, toxemias of pregnancy and intrauterine growth retardation are the commenest risk factors which predispore for the development of polycythemia and hyperviscosity syndrome. Polycythemia is more common in small for gestational age babies than appropriate for gestational age babies. Out of total 21 newborn with polycythemia, 19 were delivered by spontaneous vaginal delivery. Conclusion: The incidence of polycythemia in newborn with high risk antenatal history was 10.5%. Birth asphyxia, twin pregnancy and IUGR were the most common risk factors associated with polycythemia.

1. Stevens K. And Worth F. H., incidence of neonatal. Hyperviscosity at sea level, J. paved., 97:116:1980 2. Wirth F. H., Goldberg K. E., and lubchenco L. O., Neonatal Hyperviscosity l, incidence, paediatrics, 63:823:1979 3. Merchant R. H., Agarawal M. B., Joshi N. C. And parekh S. R., neonatal polycythemia, a potentially serious disorder, Ind. Paed., 50:149:1983. 4. Pildes R. S., A personal communication from Chicago,1970, in connection with Worth's articles No.84, paed 63:833:1979 5. Wood S. L., plethora in newborn infant associated with cynosis and convulsions, J. Paed., 54:143:1959 6. Philips, Yes and Moothedan, placental transfusion as an intrauterine phenomenon in deliveryies complicated by fetal distress, Br. J. Of Med. Sc., 2:11:1969. 7. G. Engleson and G. Tooth, dyamaturity and polycythemia, Arch. Did. Childhood, 33:123:1958. 8. Humbert H. R., Abelson H., Hathaway W. E. And Battalgia F. C., polycythemia in small for gestational age infants, J. Paed, 75:812:1969 9. Seigal S. and Usher R. H., symptomatic neonatal plethora, Biol. Neonates, 32:62: 1977 10. Brans Y. W. and rammurthy R. S., Neonatal polycythemia II plasma, blood and red cell volume estimated in relation to homatocrit levels and quality of intrauterine growth, Paed., 68:175:1982 11. Black V. D. and Lubchence L. O., Neonatal Hyperviscosity syndrome, Paed., 69:426:1982. 12. Assali H. S., Blood pressure and circulation in chesley L. C. (ed), hypertensive disorder in pregnancy, new York, Appleton century crofts, 119:153:1978. 13. Gatti R. A.and Muster A. J., neonatal polycythemia with transient cyanosis and cardiorespratory abnormalities, J. Paed., 69:1063:1966 14. Hawarth and colleagues, Relation of blood glucose to hematocrit and growth restarted infants, J. paed., 90:458:1977.

The authors report their experience with Management of Burn wound with Camphor and Coconut Oil in 2000 Patients, From January 2000 to January 2014. The patients having superficial burns involving 30% or less than 30% were selected for the study. There were no major complications and no mortality in the series. The advantages exceed that of conventional dressing methods. Advantages like decreased duration for wound healing, decreased pain, decreased hospital stay with early return to routine activities and finally better cosmesis were seen. It also decreased the cost compared to other methods which needs costly dressing materials.

1. Sushrutsamhita 2. Dravya gun widyan 3. BranskiK. L., Al-Mousawi A., Rivero H., JeschkeM. G., A.P. Sanford, and Herndon D.N. Emerging Infection in burns. Surg. Inf. vol 10. (2009). 5:389-397. 4. Raghad Q. Majeed :Department of Biology, College of Science, University of Baghdad , Baghdad , Iraq, Prophylactic effect for the sesame oil and camphor oil on the infected burn skin of mice ,Tikrit Journal of Pure Science 17 (4) 2012 ISSN: 1813 – 1662 5. AtiyehB.S., Gunn S. W., HayekS.N.State of the artin burn treatment. World J. Surg. (2005).29:131-48. 6. Paul M.I., Beiler J.S., King T.S., Clapp E.R., Vallati J., Berlin C.M."Vapor Rub, Petrolatum, and Tikrit Journal of Pure Science 17 (4) 2012 ISSN: 1813 – 166233 7. Gopalkrishna et al, Coconut oil: Chemistry, Production and Its application – a review ,Indian coconut journal, CSIR, Mysore, 15-26 8. P. Dawes and I. Haslock.; Visual Analogue Scales, Ann Rheum Dis. Aug 1982; 41(4): 434-435 9. Regina fearemonti et al, division of plastic surgery DUMC, Durham, NC: A review of scar scales and scar measuring devices: open access journal of plastic surgery. www.eplaty.com June 21.2010. 10. Ahmad sukarhalim et al; biologic and synthetic skin substitute: an overview, Indian j plassurg, Sep 2010, 43 (suppl) s23-s28. 11. Sujatasarabhi: recent advances in topical wound care; Indian j of plastic surgery;2012,may-aug,45(2), 397-387

Bambusa arundinacea belongs to the family poaceae is highly reputed ayurvedic medicinal tree commonly known as Bamboo. It plays a significant role in human civilization since ancient times and still contributing to the subsistence of over two billion people living in tropical and subtropical belts in Asia, latin America and Africa. Traditionally bambusa leaves, stem and root were used as astringent, laxative, diuretics and also it has anti-inflammatory, anti microbial, antifertility, antispasmodic, antidiabetic and antiulcer activity. Leaf buds are used to treat menstrual problems. Roots are used to treat cirrhosis and tumors of liver, spleen and abdomen.. The information on the phytochemicals of bambusa arundinacea seed is limited. The objective of this research work was to evaluate phytochemicals of Bambusa arundinacea seeds. Preliminary phytochemical evaluation of seed extract bambusa arundinacea reveals the presence proteins, carbohydrates, flavanoids, phenols and tannins.

1. Vishal soni, Arun kumar Jha,Jaya Dwivedi:Traditional uses, Phytochemistry and Pharmacological of Bambusa arundinacea Retz:a review.Association of Humanitas Medicine :August 2013,Vol 3(3),PP.20.1-20.6. 2. Rathod jaimik D,Pathak Nimish L,Patel Ritesh G,Jivani N.P,Bhat nayna M:Phytopharmacological Properties of Bambusa arundinacea as a Potential Medicinal Tree:An Overview:Journal of Applied Pharmaceutical Science.01(10);2011:PP.27-31. 3. Marchala S.P,Venkateswarlu G,Gowrisankar N.L,Sathishkumar Dinakaran, Santosha dasarapu, Nagulu malothu: AntiDiabetic Activity of Bambusa arundinacea Seed Extracts on Alloxan Induced Diabetic Rats:International Journal of Pharmaceutical Research and Development(IJPRD),July 2011,Vol 3(5),PP 83-86. 4. Ajay kumar Rathaur: Bambusa arundinacea (vanshlochan):An Overview: International Journal of Research in Pharmacology andPharmacotherapeutics:2013,vol 2(1)PP 48-56. 5. Kiruba S,Jeeva S,Sam Manohar Das, Kannan D:Bamboo seeds as a means to sustenance of the indigenous community:Indian Journal of Traditional Knowledge:Jan 2007,Vol 6(1),PP 199-203. 6. Ashok Sharma, Asish K.Sharma,Tara Chand,Manoj Kharadiya:Preliminary Phytochemical Evaluation of Seed Extracts of Cucurbita Maxima Duchense:Journal of Pharmacognosy and Phytochemistry:2013,2(3):62-65. 7. Bele AA,khale A:Standardization of herbal drugs:A review.International journal of Pharmacy.2011:2(12):56-60. 8. Khandelwal KR,Practical Pharmacognosy.16 Ed,Nirali prakashan,Pune,2007,149-156. 9. Tiwari P,Kumar B,Kaur G,Kaur H.Phytochemical Screening and Extraction:A review.Internationale Pharmaceutica Sciencia 2011:1(1):98-106. 10. Singh GK,Bhandari A, Text book of Pharmacognosy.1st Ed,CBS Publisher and Distributor. New Delhi,2005,39-62.

Introduction: Rabies continues to be a major public health problem in India, with an estimated 20,000 people dying of this disease every year. Rabies is an almost 100% fatal disease and at the same time it is almost 100% preventable. Medical graduates constitute a key source of medical care for antirabies treatment to the victims of animal bites. Aims and Objectives: To assess the knowledge among the medical students in a rural tertiary care institute regarding awareness of rabies and its prevention. Materials and Methods: A cross sectional study was conducted during January 2015 among 96 final year medical students to assess the knowledge regarding rabies and its prevention. A pretested structured questionnaire was administered after obtaining the consent. The data were entered and analyzed using Microsoft excel. Results: Our study found that less than half of the study subjects were aware of the mode of transmission and incubation period of rabies. Two third of them knew soap and water should be used for cleaning the wound after a bite and 36.5% of the subjects were of the opinion that bandaging has to be done in selective cases of uncontrolled bleeding. The knowledge regarding intramuscular and intradermal schedule, dose and site was 28.1% and 9.4% respectively. Conclusion: There is a need for emphasizing the public health importance of rabies and its prevention which can be done by sensitizing the students during internship and Continued Medical Education programmes at regular intervals.

1. World Health Organization. WHO Expert Consultation on Rabies: Second Report. Geneva: World Health Organization, 2013. 2. World Health Organization. Rabies vaccines: WHO position paper.WklyEpidemiol Rec 2010; 32(85):309–320. 3. Sudarshan MK, Mahendra BJ, Madhusudana SN, et al. An epidemiological study of animal bites in India: results of a WHO sponsored national multi-centric rabies survey. J Commun Dis. 2006; 38:32-39. 4. Ichhpujani RL, Mala C, Veena M, et al. Epidemiology of animal bites and rabies cases in India: a multicentric study. J Commun Dis. 2008; 40:27-36. 5. Nayak RK, Walvekar PR, Mallapur MD. Knowledge, attitudes and practices regarding rabies among general practitioners of Belgaum city. Al Ameen J Med Sci 2013; 6(3):237–42. 6. Maroof KA. Burden of rabies in India: the need for a reliable reassessment. Ind J Comm Health, 25(4); 488 – 491 7. Chatterjee S, Riaz H. Rabies: beware of the dog. BMJ 2013; 347:f5912. 8. Singh A, Bhardwaj A, Mithra P, Siddiqui A, Ahluwalia SK. A cross-sectional study of the knowledge, attitude, and practice of general practitioners regarding dog bite management in northern India. Med J DY PatilUniv 2013; 6:142–5. 9. Shankaraiah RH, Bilagumba G, Narayana DHA, Annadani R, Vijayashankar V. Knowledge, attitude, and practice of rabies prophylaxis among physicians at Indian animal bite clinics. Asian Biomed 2013; 7(2):237–42. 10. Bhalla S, Mehta JP, Singh A. Knowledge and practice among general practitioners of Jamnagar city regarding animal bite. Indian J Community Med 2005; 30(3):94–6. 11. Garg A, Kumar R, Ingle GK. Knowledge and practices regarding animal bite management and rabies prophylaxis among doctors in Delhi, India. Asia Pac J Public Health 2013; 25(1):41–7. 12. Shah SF, Jawed M, Nooruddin S, Afzal S, Sajid F, Majeed S, et al. Knowledge and practices among the general practitioners of Karachi regarding dog bite management. J Pak Med Assoc 2009; 59(12):861–4.

Introduction: Urinary tract infection (UTI) is one of the most common problems warranting medical attention. The purpose of this study was to determine the usefulness of routine urine analysis in predicting UTI, to facilitate presumptive treatment. Data of 500 culture positive urine samples were collected. The colony counts were correlated with physical, chemical and microscopic parameters of the urine sample. Of particular interest were tests for nitrites (NIT) and leukocyte esterase (LEU). Sensitivity, specificity and predictive values were calculated with regard to NIT, LEU and a combination of both (NIT+LEU). Chi square test was used to calculate p-value and thereby association of culture positivity with various above mentioned parameters. Most parameters showed significant correlation with colony count (p value <0.05). Sensitivity of NIT, LEU and (NIT+LEU) to detect infection was 22.33%, 66.1% and 50% respectively. Specificity of NIT, LEU and (NIT+LEU) was 90.9%, 54.3% and 92.7% respectively. In our study (NIT+LEU) had higher specificity and positive predictive value and are therefore useful in predicting the presence of UTI.

Introduction: Urinary tract infection (UTI) is one of the most common problems warranting medical attention. The purpose of this study was to determine the usefulness of routine urine analysis in predicting UTI, to facilitate presumptive treatment. Data of 500 culture positive urine samples were collected. The colony counts were correlated with physical, chemical and microscopic parameters of the urine sample. Of particular interest were tests for nitrites (NIT) and leukocyte esterase (LEU). Sensitivity, specificity and predictive values were calculated with regard to NIT, LEU and a combination of both (NIT+LEU). Chi square test was used to calculate p-value and thereby association of culture positivity with various above mentioned parameters. Most parameters showed significant correlation with colony count (p value <0.05). Sensitivity of NIT, LEU and (NIT+LEU) to detect infection was 22.33%, 66.1% and 50% respectively. Specificity of NIT, LEU and (NIT+LEU) was 90.9%, 54.3% and 92.7% respectively. In our study (NIT+LEU) had higher specificity and positive predictive value and are therefore useful in predicting the presence of UTI.

Introduction: Laryngoscopy and intubation is associated with sympathoadrenal stimuli and heightened cardio respiratory and neurological reflexes such as tachycardia, hypertension, bronchospasm and increased intracranial pressure. These reflexes are potentially harmful for the patients more so in patients with hypertension, ischemic heart disease or associated neurological problem. Clonidine and dexmedetomidine are alpha 2 agonists acting in the central nervous system to reduce the sympathetic outflow. Aim: To compare clonidine and dexmedetomidine in attenuating the hemodynamic response to laryngoscopy and intubation when given as a infusion before induction. Material and Methods: A prospective double blinded randomized study involving patients coming to the operation theater for surgery under general anesthesia. Patients were divided into two groups, group C n=30 received clonidine 1µgm/kg intravenously 10 minutes as infusion before intubation and group D n=30 received dexmedetomidine 1µgm/kg intravenously 10 minutes as infusion before intubation. The hemodynamic variables were noted at 1, 3 and 5 minutes after intubation. Statistical Analysis: The obtained data were analyzed using the independent sample t-test. Results: There was no statistically significant difference between the two groups with respect to the heart rate, systolic and diastolic blood pressure, mean arterial pressure or the rate pressure product. Conclusion: Clonidine and dexmedetomidine are equally effective in reducing the stress response to Laryngoscopy and intubation.

1. Kovac AL. Controlling the hemodynamic response to laryngoscopy and endotracheal intubation. J Clin Anesth 1996; 8:63-79. 2. King BD, Harris LC, Greifenstein FE, Elder JD, Dripps RD. Reflex circulatory sponses to direct laryngoscopy and tracheal intubation performed during general anesthesia. Anesthesiology 1951; 12:556-66. 3. Shribman AJ, Smith G, Achola KJ. Cardiovascular and catecholamine responses to laryngoscopy with and without tracheal intubation. Br J Anaesth 1987; 59: 295–9 4. Derbyshire, D. R., Chmielewski, A., Fell, D., Vater, M., Achola, K., and Smith, G. (1983). Plasma catecholamine responses to tracheal intubation. Br. J. Anaesth., 55, 855. 5. Stone JG, Foëx P, Sear JW, Johnson LL, Khambatta HJ, Triner L. Risk of myocardial ischaemia during anaesthesia in treated and untreated hypertensive patients. Br J Anaesth. 1988;61:675–9 6. Prys-Roberts C, Greene LT, Meloche R, Foex P. Studies of anaesthesia in relation to hypertension. II: Hemodynamic consequences of induction and endotracheal intubation. 1971. Br J Anaesth 1998; 80:106-22. 7. Kindler CH, Schumacher PG, Schneider MC, Urwyler A .Effects of intravenous lidocaine and/or esmolol on hemodynamic responses to laryngoscopy and intubation: a double-blind, controlled clinical trial. J Clin Anesth. 1996 Sep; 8(6):491-6. 8. Singh SP, Quadir A, Malhotra P. Comparison of esmolol and labetalol, in low doses, for attenuation of sympathomimetic response to laryngoscopy and intubation. Saudi J Anaesth. 2010 Sep; 4(3):163-8. 9. Figueredo E, Garcia-Fuentes E.M. Assessment of the efficacy of esmolol on the haemodynamic changes induced by laryngoscopy and trachal intubation: a meta-analysis. Acta Anaesthesiol Scand 2001; 45:1011-1022. 10. Mikawa K, Hasegawa M, Suzuki T, Maekawa N, Kaetsu H, Goto R, Yaku H, Obara H: Attenuation of hypertensive response to tracheal intubation with nitroglycerine. Journal of Clinical Anesthesia; 4(5):367-71, 1992. 11. Panda NB, Bharti N, Prasad S. Minimal effective dose of magnesium sulfate for attenuation of intubation response in hypertensive patients. J Clin Anesth. 2013 Mar; 25(2):92-7. 12. Neil, MJ (November 2011). "Clonidine: clinical pharmacology and therapeutic use in pain management.". Current Clinical Pharmacology 6 (4): 280–7. 13. Fazi, L; Jantzen, EC; Rose, JB; Kurth, CD; Watcha, MF (2001). "A comparison of oral clonidine and oral midazolam as preanesthetic medications in the pediatric tonsillectomy patient" Anesthesia and Analgesia 92 (1): 56–61. 14. De Noyer M, Laveleye F, Vauquelin G, Gobert J, Wülfert E. Mivazerol, a novel compound with high binding specificity for alpha α2 adrenergic receptors: binding studies on different human and rat membrane preparations. Neurochemistry International 1994; 24: 221–9. 15. Ghignone M, Quintin L, Duke PC, Kehler CH, Cavillo O. Effects of clonidine on narcotic requirements and hemodynamic responses during induction of fentanyl anesthesia and endotracheal intubation. Anesthesiology 1986; 64:36-42. 16. Yildiz M, Tavlan A, Tuncer S, Reisli R, Yosunkaya A, Otelcioglu S. Effect of dexmedetomidine on hemodynamic response to laryngoscopy and intubation; Perioperative hemodynamics and anaesthetic requirements. Drugs in R and D 2006:7:43-52 17. Bekker A, Sturaitis M, Bloom M, Moric M, Golfinos J, Parker E, et al. The effect of dexmedetomidine on perioperative hemodynamics in patients undergoing craniotomy. Anesth Analg 2008; 107:1340-7. 18. Pottu J, Scheinin B, Rosenberg PH, Viinamaki O, Scheinin M. Oral premedication with clonidine: Effects on stress response during general anesthesia. Acta Anaesthesiol Scand 1987; 31:730-4. 19. Reis,D.J.;Piletz,J.E.(1997) “ The imidazoline receptor in control of blood pressure by clonidine and drugs” (pdf).American journal of physiology 273(5):R1569-R1571. 20. Savola JM, Ruskoaho H, Puurunen J, Salonen JS, Kärki NT.Evidence for medetomidine as a selective and potent agonist at alpha 2-adrenoreceptors. J Auton Pharmacol 1986; 6:275-84. 21. Arindam S, R K Tripathi, Sanjay C, Bahadur S R, Shilpi A. Comparison of effects of intravenous clonidine and dexmedetomidine for blunting pressor response during laryngoscopy and tracheal intubation: A randomized control study, Year : 2014 | Volume: 8 | Issue Number: 3 | Page: 361-366 22. Mondal S, Mondal H, Sarkar R, Rahaman M. Comparison of dexmedetomidine and clonidine for attenuation of sympathoadrenal responses and anesthetic requirements to laryngoscopy and endotracheal intubation. Int J Basic Clin Pharmacol. 2014; 3(3): 501-506

Purpose: To determine the Prevalence of obesity in school children aged 6 to 15 years in co-educational schools of Jaipur and Evaluation of risk factors associated with obesity. Materials and Methods: The present study was conducted on 1250 school children of either sex aged 6 to 15 years in four schools of Jaipur. The height and weight of each child was measured and BMI was calculated. Children with BMI more than 95th percentile for that age and sex were considered as obese and from this prevalence of obesity was calculated. Various risk factors causing obesity were also evaluated. Results: The prevalence of obesity was found to be 7.6%. Overall prevalence among girls and boys was 9.34% and 5.69% respectively. The prevalence of obesity among those with positive family history, obesogenic diets, high socio-economic status, who did not exercise, was found to be 22.85%, 12.09%, 11.82%, 8.19% respectively. Conclusion: The sex, socio-economic status and physical activity have a bearing effect on obesity while family history and dietary habits have no effect. Obesity is an emerging health problem in school-age children belonging to affluent families in Jaipur.

1. Kapil U, Singh P, Pathak P, Dwivedi SN and Bhasin S. Prevalence of obesity amongst affluent adolescent school children in Delhi. Indian Pediatr 2002; 39:449-52. 2. Subramanyam V, Jayashree R and Rafi M. Prevalence of overweight and obesity in affluent adolescent girls in Chennai in 1981 and 1998. Indian Pediatr 2003; 40:332-6. 3. Sharma A, Sharma K and Mathur KP. Growth pattern and prevalence of obesity in affluent school children of Delhi Public Health Nutr 2005; 10(5):485-91. 4. Marwaha RK, Tandon N, Singh Y, Aggarwal R, Grewal K and Mani K. A study of growth parameters and prevalence of overweight and obesity in school children from Delhi. Indian Pediatr 2006; 43:943-52. 5. Khadilkar VV and Khadilkar AV. Prevalence of obesity in affluent school boys in Pune. Indian Pediatr 2004; 41:857-8. 6. Kumar S, Mahabalaraju DK and Anuroopa MS. Prevalence of obesity and its influencing factor among affluent school children of Davangere City. Indian Journal of Community Medicine 2007; 32(1): 15-7. 7. Kaur S, Sachdev HPS, Dwivedi SN, Lakshmy R and Kapil U. Prevalence of overweight and obesity amongst school children in Delhi, India Am Pm J Clin Nutr 2008; 17(4) :592-6. 8. Reilly JJ, Armstrong J, Dorosty AR, Emmett PM, Ness A, Rogers I et al. Early life risk factors for obesity in childhood: cohort study. BMJ 2005; 330: 1357-9. 9. Laxmaiah A, Nagalla B, Vijayaraghavan K and Nair M. Factors affecting prevalence of overweight among 12 to 17 years old urban adolescents in Hyderabad, India. Obesity 2007; 15:1384-90.

Abstract: Post partum haemorrhage is the single most significant cause of maternal death worldwide. More than half of all maternal deaths occur within 24 hours of delivery, most commonly from excessive bleeding. It is estimated that worldwide 1,40,000 women die of postpartum haemorrhage each year—one every 4 minutes1. Objectives: To assess and compare the efficacy of intramuscular oxytocin 10 IU and intravenous methergin 0.2 mg during active management of third stage of labour. Methods: 210 women delivering either vaginally or by caesarean were included and randomised into two groups. In Group I 100 women were given injection oxytocin 10 IU IM and in group II 110 women were given injection methergin 0.2 mg IV within one minute of delivery of the baby prophylactically. The main outcome measures were amount of blood loss, duration of third stage, need for MRP, incidence of PPH, need for repeated oxytocics and its side effects. Results: The mean blood loss at vaginal delivery in Group I was 354 ml and in group II was 162.72 ml with P value 0.00046, which was statistically significant .The mean blood loss at caesarean delivery in Group I was 741.66 ml and Group II was 492.7 ml with P value 0.036, which was statistically significant. The mean duration of third stage of labour in Group 1 was 7.35 min and Group 2 was 6.21 min. Conclusion: In the active management of third stage labour intravenous methergin is a better uterotonic when compared to intramuscular oxytocin to reduce the amount of blood loss at delivery and prevent complications like atonic PPH.

Abstract: Post partum haemorrhage is the single most significant cause of maternal death worldwide. More than half of all maternal deaths occur within 24 hours of delivery, most commonly from excessive bleeding. It is estimated that worldwide 1,40,000 women die of postpartum haemorrhage each year—one every 4 minutes1. Objectives: To assess and compare the efficacy of intramuscular oxytocin 10 IU and intravenous methergin 0.2 mg during active management of third stage of labour. Methods: 210 women delivering either vaginally or by caesarean were included and randomised into two groups. In Group I 100 women were given injection oxytocin 10 IU IM and in group II 110 women were given injection methergin 0.2 mg IV within one minute of delivery of the baby prophylactically. The main outcome measures were amount of blood loss, duration of third stage, need for MRP, incidence of PPH, need for repeated oxytocics and its side effects. Results: The mean blood loss at vaginal delivery in Group I was 354 ml and in group II was 162.72 ml with P value 0.00046, which was statistically significant .The mean blood loss at caesarean delivery in Group I was 741.66 ml and Group II was 492.7 ml with P value 0.036, which was statistically significant. The mean duration of third stage of labour in Group 1 was 7.35 min and Group 2 was 6.21 min. Conclusion: In the active management of third stage labour intravenous methergin is a better uterotonic when compared to intramuscular oxytocin to reduce the amount of blood loss at delivery and prevent complications like atonic PPH.

Traumatic optic neuropathy after craniofacial injury was first described by Hippocrates. The optic nerve is vulnerable to indirect and direct trauma causing functional impairment of vision. Optic nerve injuries occur in the setting of head injury which is often a consequence of road traffic accidents or falls. The diagnosis of optic nerve injury may be delayed by the presence of other life-threatening injuries .We report a case of 60 yrs old male patient who met with a road side accident and reported to us with sudden painless loss of vision left eye after 15 days. On MRI brain and optic nerve he had small Extradural haemorrhage (EDH) along left anterior frontal lobe and there was enlargement of left optic nerve sheath. Currently, there is no validated approach to the management of traumatic optic neuropathy. Thus, with numerous conflicting reports on the management of traumatic optic neuropathy, there is little world consensus on the optimal management of this condition. Keeping this in view we devised high dose steroids to the patient to which he regained his vision in left eye 6/60. The main aim of this article is to review the treatment modalities in a case traumatic optic neuropathy.

1. Chandwick J, Mann WN. The medical works of Hippocrates, Backwell, Oxford, England 1950. 2. Steinsapir KD, Goldberg RA. Traumatic optic neuropathy. Surv Ophthalmol 1994; 38(6): 487–518 3. Anderson RL, Panje WR, Gross CE. Optic nerve blindnessfollowing blunt forehead trauma. Ophthalmology 1982; 89:445–455. 4. Walsh FB, Hoyt WF. Clinical Neuro-ophthalmology, 3rd ed. Williams and Wilkins: Baltimore, 1969 p 2380. 5. Panje WR, Gross CE, Anderson RL: Sudden blindness following facial trauma. Otolaryngol Head Neck Surg 1981; 89: 941-48 6. Lessell S: Indirect optic nerve trauma. Arch Ophthalmoll 1989;07: 382-86 7. Levin LA, Beck RW, Joseph MP, et al. The treatment of traumatic optic neuropathy: The International Optic Nerve Trauma Study. Ophthalmology 1999; 106(7):1268-77. 8. Seiff SR: High-dose corticosteroids for the treatment of vision loss due to indirect injury to the optic nerve. Ophthalmic Surg 1990; 21: 389-95 9. Spoor TC, Hartel WC, Lensink DB, Wilkinson MJ: Treatment of traumatic optic neuropathy with corticosteroids. Am J Ophthalmol 1990; 110: 665-69 10. Wollin MJ, Lavin PJM: Spontaneous visual recovery from traumatic optic neuropathy after blunt head injury. Am J Ophthalmol 1990;09: 430 11. Chen YR, Breidahl A, Chang CN. Optic nerve decompression in fibrous dysplasia: Indications, efficacy and safety. Plast Reconstr Surg 1997; 99:22-30. 12. Eidlitz-Markus T, Shuper A, Schwartz M, Mimouni M. Delayed posttraumatic visual loss: A clinical dilemma. Pediatr Neurol 2000, 22:133-35. 13. Karakitsos D, Soldatos T, Gouliamos A, Armaganidis A, Poularas J, Kalogeromitros A. Transorbital sonographic monitoring of the optic nerve diameter in patients with severe brain injury. Transplant Proc 2006; 38:3700-06. 14. Tayal VS, Neulander M, Norton HJ, Foster T, Saunders T, Blaivas M. Emergency department sonographic measurement of optic nerve sheath diameter to detect findings of increased intracranial pressure in adult head injury patients. Ann Emerg Med 2007; 49(4):508-14. Epub 2006 Sep 25. 15. Rene C, Rose GE, Lenthall R, Moseley I. Major orbital complications of endoscopic sinus surgery. Br J Ophthalmol 2001; 85:598-603. 16. Sullivan KL, Brown GC, Forman AR, Sergott RC, FlanaganJC. Retrobulbar anesthesia and retinal vascular obstruction. Ophthalmology 1983; 90:373-77. 17. Hupp SL, Buckley EG, Burne SF, Tenzel RR, Glaser JS, Schatz NS. Posttraumatic venous obstructive retinopathy associated with enlarged optic nerve sheath. Arch Ophthalmol 1984; 102: 254-56. 18. Guy J, Sherwood M, Day AL. Surgical treatment of progressive visual loss in traumatic optic neuropathy. J Neurosurg 1989; 70: 799-801. 19. Levin LA, Baker RS. Management of traumatic optic neuropathy. J Neuroophthalmol 2003; 23(1):72-5.

Introduction: Obstetric anal sphincter injuries (OASIS) following vaginal childbirth are a major cause of fecal incontinence which can have tremendous impact on women’s quality of life. Unfortunately, these are often missed at the time of delivery. Recognition of potential risk factors may help increase awareness and detection rate of OASIS in routine obstetric practice. The objective of this study was to determine the prevalence of OASIS and associated risk factors in women undergoing vaginal childbirth Materials and Methods: This was a retrospective chart review of 8,475 women undergoing vaginal delivery at Department of Obstetrics and Gynecology, Siriraj Hospital during 2010 and 2012. Inclusion criteria were singleton, cephalic presentation, gestational age≥ 20 weeks, live births, no history of cesarean section and complete medical record. OASIS was defined as third- and fourth-degree perineal tears. Women’s baseline characteristics and factors potentially associated with OASIS were recorded. Chi-square and Student T-tests were used to demonstrate the correlation between OASIS and non-OASIS groups. Univariate and multiple logistic regression analyses were performed to determine significant predictors of OASIS. Observations and Results: Overall prevalence of OASIS was 5.4%. With two-step analyses, birth weight over 3,500 g was confirmed as the strongest predictor for OASIS (OR 6.26; 95% CI 3.79–10.32).Other risk factors included occiput posterior position (OR 5.54), instrumental delivery (OR 3.54), primiparity (OR 3.22), prolonged second stage of labor (OR 2.23), and short stature(OR 1.8) respectively. Conclusion: Preventive strategies and proper management during intrapartum and postpartum period are essential for all women at risk in order to avoid anal sphincter injuries.

1. Kettle C, Tohill S (2011) Perineal Care. Clin Evid 04:1401. 2. Sultan AH, Kamm MA, Hudson CN, Bartram CI (1994) Third degree obstetric anal sphincter tears: risk factors and outcome of primary repair. BMJ 308:887-891. 3. Fenner DE, Genberg B, Brahma P, Marek L, DeLancey JO (2003) Fecal and urinary incontinence after vaginal delivery with anal sphincter disruption in an obstetric unit in the United States. Am J Obstet Gynecol 189:1543-1550. 4. Royal College of Obstetricians and Gynaecologists (RCOG) (2007) The management of third- and fourth-degree perineal tears. Royal College of Obstetricians and Gynaecologists (RCOG), London. 5. MacArthur C, Bick DE, Keighley MRB (1997) Faecal incontinence after childbirth. Br J Obstet Gynaecol 104:46-50. 6. Sultan AH. Obstetric perineal injury and anal incontinence (1999) Clin Risk 5:193-196. 7. Committee on Obstetric Practice (2013) Obesity in pregnancy. ACOG Comm Opin 549:1-5. 8. Abnormal Labor. In: Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY (eds). Williams Obstetrics, 23rd edn. New York, McGraw-Hill Companies, pp 489-464. 9. Sooklim R, Thinkhamrop J, Lumbiganon P, et al (2007) The outcomes of midline versus medio-lateral episiotomy. Reprod Health 4(10):1-5. doi:10.1186/1742-4755-4-10 10. DiPiazza D, Richter HE, Chapman V et al (2006) Risk factors for anal sphincter tear in multiparas. Obstet Gynecol 107(6):1233-1237. 11. Helwig JT, Thorp JM, Jr, Bowes WA, Jr (1993) Does midline episiotomy increase the risk of third- and fourth-degree lacerations in operative vaginal deliveries? Obstet Gynecol 82(2):276-279. 12. Coats PM, Chan KK, Wilkins M, Beard RJ (1980) A comparison between midline and mediolateral episiotomies. Br J Obstet Gynaecol 87(5):408-412. 13. World Health Organization maternal and newborn health/safe motherhood unit (1996) Care in normal birth: a practical guide. Report of a Technical Working Group Doc. No. WHO/FRH/MSM/96.24:29. 14. Patterson D, Hundley AF. Perineal Lacerations in Teen Deliveries. Female Pelvic Medicine and Reconstructive Surgery 2010; 16(6):345-48.

Introduction: Rapid sequence induction and intubation involves securing the airway rapidly in the shortest possible time using a rapidly acting muscle relaxant in patients who present for emergency surgery with full stomach. succinylcholine is the drug which has been commonly used for this purpose because of its quick action in spite of few drawbacks. Rocuronium bromide a new muscle relaxant, an analogue of vecuronium is rapidly replacing succinylcoline. Aim: To compare the intubating conditions using two doses of rocuronium 0.6mg/kg and 1mg/kg at both 60 and 80 seconds. Material and Method: It is a prospective and double blinded study involving 80 patients who presented for the operation theater to undergo surgery under general anesthesia. Patients were divided into four groups group A n=20 were given 0.6mg rocuronium and intubated in 60 seconds, group B n=20 were given 0.6mg/kg rocuronium and intubated at 80 seconds, group C n=20 were given 1 mg/kg rocuronium and intubated at 60 seconds and group D n=20 were given rocuronium 1 mg/kg and intubated at 80 seconds. The intubating conditions were assessed using the scale followed by cooper et al. Statistical Analysis: the obtained data was analyzed using the one way analysis of variance test and chi-square test. Results: Group A produced excellent intubating condition in 50% of patients, group B 90% and group C and D 100%. Conclusion: Rocuronium at 1 mg/kg produced excellent intubating condition within 60 seconds.

1. Lee C: Good bye Suxamethonium. Anaesthesia; 2009, 64 (Supp. 1), pp. 73-81. 2. Ellis FR, Keaney NP, Harriman DGF, et al Screening for malignant hyperpyrexia. Br Med J 1972; 3:559-61. 3. Miller R. Will succinylcholine ever disappear? Anesth Analg. 2004;98:1674–1675 4. McCourt KC, Salmela L, Mirakhur RK, et al. Comparison of rocuronium and suxamethonium for use during rapid sequence induction of anaesthesia. Anaesthesia. 1998; 53:867-871. 5. Sluga M, Ummenhofer W, Studer W, Siegemund M, Marsch SC. Rocuronium versus succinylcholine for rapid sequence induction of anesthesia and endotracheal intubation: a prospective, randomized trial in emergent cases. Anesth Analg. 2005; 101:1356-1361. 6. Laurin EG, Sakles JC, Panacek EA, Rantapaa AA, Redd J. A comparison of succinylcholine and rocuronium for rapid-sequence intubation of emergency department patients. Acad Emerg Med. 2000; 7:1362-1369. 7. Perry JJ, Lee JS, Sillberg VAH, Wells GA. Rocuronium versus succinylcholine for rapid sequence induction intubation. Cochrane Database Syst Rev. 2008; CD002788. 8. Marsch SC, Steiner L, Bucher E, Pargger H, Schumann M, Aebi T, et al. Suxamethonium versus rocuronium for rapid sequence induction in intensive care. Crit Care. 2011; 15:R199. 9. Singh A, Bhatia PK, Tulsiana KL. Comparison of onset time intubating conditions achieved with suxamethonium and rocuronium. Indian J Anaesth. 2004; 48:129–33. 10. Misra MN, Agarwal M, Pandey RP, Gupta A. A comparative study of rocuronium, vecuronium and succinylcholine for rapid sequence induction of anesthesia. Indian Journal of Anesthesia 2005; 49 (6): 469 -475. 11. Kirkegaard-Nielsen, Hans, Caldwell, James E, Berry Peter D. Rapid tracheal intubation with Rocuronium. A probability approach to determining dose. Anesthesiology 1999; 91: 131-136. 12. Cooper R, Mirakhur RK, Clarke RSJ and Boules Z. Comparison of intubating conditions after administration of org 9426 (rocuronium) and Suxamethonium. British journal of Anaesthesia 1992; 69: 269-273. 13. Sparr HJ, Luger TJ, Heidegger T, Putensen-Himmer G. Comparison of intubating conditions after rocuronium and suxamethonium following “rapid-sequence induction” with thiopentone in elective cases. Acta Anaesthesiol Scand 1996; 40:425–30 14. Cooper R, Mirakhur RK et al. Comparison of intubating conditions after administration of ORG 9426 (Rocuronium) and Suxamethonium. Br J Anaesth 1992; 69: 269-273. 15. Pühringer FK, Rex C, Sielenkämper AW, et al. (August 2008). "Reversal of profound, high-dose rocuronium-induced neuromuscular blockade by sugammadex at two different time points: an international, multicenter, randomized, dose-finding, safety assessor-blinded, phase II trial". Anesthesiology 109 (2): 188–97.

This paper presents and describes a case of agenesis of isthmus of thyroid gland.It was found in an old aged male cadaver during routine dissection in the department of anatomy . There was no glandular tissue in the region of isthmus of thyroid gland. There was levator glandulae thyroidae extending from right lobe upto the lower border of hyoid bone.

1. Standring S,Borley, NR,Healy JC, JohnsonD, Patricia Collins, Gray’s Anatomy 40 Elsevier Churchil Livingstone Year 2008, 462-463. 2. Pastor VJF,Gill VJA, De Paz Fernandez FJ, Cachorro MB, Agenesis of thyhroid isthmus Eur. J. Anat. Year, 2006 108384. 3. Marshall CF, Variation in the form of thyroid gland in mam J. Anat. Physio. year 1895;29:234. 4. HarjeetA, SahniD, Jit, AgarwalAK, Shape, Measurements and weight of the thyroid gland in northwest Indian SurgRadiol Anat Year: 2004 26919510. 5. DixitD, ShilpaMB, HarshMP, RavishankarMV, Agenesis of isthmus of thyroid gland in adult human cadver a case series cases journal 2009(4 article 6640). 6. Devi Sankar K,Sharmila Bhanu P, Susan PJ et al Agenesis of isthmus of thyroid glnd with bilaterallevator glandulae thyroidae. Int. J. Anat.Variation,2009,2;29-30. 7. Kumar GP, SatyanarayananN, VishwakarmaN, Dutta Ak, sunithap, Agenesis of isthmus of thyroid gland and its embryological basis and clinical significance. A case report Nepal Medical College, J 2010;123(4);272-274. 8. Moore and Persaud, The developing human-Clinically oriented embryology 6th Edition-1998,230-233. 9. Duh QY, Ciulla TA,Clark OH;Primary parathyroid hyperplasia associated with thyroid hemiagenesis and agenesis of isthmus . Surgery 1994,115:257-263. 10. Sgalitzer KE Contribution to the study of the morphogenesis of the thyroid gland.J.Anat.,1941,75;389-405. 11. De Felice M,Di Lauro R Thyroid development and its disorders; genetics and molecular mechanism.Endocri.Rev,2004,25;722-746. 12. Dumont JE, Vassart G Thyroid dysgenesis;Multigenic or epigenetic,or both?Endocrinolgy J. 2005.146(12);5035-5037.

Background and objective: With the increase in the life expectancy, the incidence of diabetic ulcers is inevitable. In this study we compare the efficacy of topical silver preparation with conventional wound dressing in healing of diabetic ulcers, in terms of days required for healing, rate of granulation tissue formation, quality of graft bed, graft uptake, effect on bacterial growth and side effects of silver preparations. Method: 58 patients with diabetic ulcers were selected by purposive sampling technique in Father Muller Medical College and Hospital between august 2012 to September 2014. Data related to the objectives of the study were collected. Result: this study has shown better granulation tissue formation, graft uptake, negative bacterial growth and decreased hospital stay in patients receiving silver dressings than patients receiving conventional dressings. Conclusion: The study concludes that silver preparations are better than conventional preparation. They are also cheap, readily available and easy to use alternative with no side effect.

1. Lansdown ABG. A review of the use of silver in wound care: facts and fallacies. Br J Nurs. 2004; 13(6): S6-S19. 2. Parsons D, Bowler PG, Myles V, Jones S. Silver antimicrobial dressings in wound management: a comparison of antibacterial, physical, and chemical characteristics. Wounds. 2005; 17(8): 222-32. 3. Woodward M. Silver dressings in wound healing: what is the evidence? Primary Intention .2005; 13(4): 153-60. 4. Coates AR, Halls G, Hu Y. Novelclasses of antibiotics or more of the same. Br J Pharmacol. 2011; 163(1): 184-94. 5. Percival SL, Bowler P, Russell D. Bacterial resistance to silver in wound care. J Hosp Inf. 2005; 60: 1-7. 6. Jorgensen B, Price P, Andersen KE et al .The silver releasing foam dressing, contact foam promotes faster healing of critically colonized venous leg ulcers, randomized controlled study. INT wound journal. 2005; 2(1):64-73. 7. PHYSIOLOGY OF WOUND HEALING From: Habif: Clinical Dermatology, 5th ed.; Chapter 27 - Dermatologic Surgical Procedures. WOUND HEALING. 8. A. Willrich, M. Pinzur, M. McNeil, D. Juknelis, and L. Lavery, “Health related quality of life, cognitive function, and depression in diabetic patients with foot ulcer or amputation. A preliminary study,” Foot and Ankle International, vol. 26, no. 2, pp. 128–134, 2005 9. M. A. Loot, S. B. Kenter, F. L. Au et al., “Fibroblasts derived from chronic diabetic ulcers differ in their response to stimulation with EGF, IGF-I, bFGF and PDGF-AB compared to controls,” European Journal of Cell Biology, 2002:81; pp. 153–60 10. J. Apelqvist, G. Ragnarson-Tennvall, U. Persson, and J. Larsson, “Diabetic foot ulcers in a multidisciplinary setting. An economic analysis of primary healing and healing with amputation,” Journal of Internal Medicine. 1994:235; pp. 463–71.

Background/Aims: Cervical biopsies harbouring inflammatory and reactive conditions showed similar histology as that of early Cervical intraepithelial neoplasia (CIN) lesions making it difficult to distinguish both of them. This scenario paved the way for experimenting new specific biomarkers for high risk cervical lesions. p16INK4a is a cell cycle regulatory protein that has a negative influence on cell proliferation by sharing a reciprocal relationship with tumor suppressor protein, retinoblastoma gene product (pRB).This pRB is inactivated by human papillomavirus (HPV) oncoprotein E7 leading to inappropriate shifting of cell cycle directly into S phase. This results in reciprocal overexpression of p16INK4a which can be demonstrated immunohistochemically using monoclonal antibodiesMethods: A total of 100 cases of cervical lesions including inflammatory lesions(n=23),CIN I(n=5),CIN II(n=5),CIN III(n=31) and invasive carcinomas(n=36)were selected. For immunohistochemistry the CIN Tec Histology kit(Mur and Mur)was used.Strong nuclear and cytoplasmic positivity was considered a positive reaction.Results: Of the 23 cases of chronic cervicitis, 22 cases (95.6%) were negative for P16INK4a staining. Only one case was positive (4.3%)Of 5 cases of CIN I, 2 cases(40%)were positive for the stain whereas 3 cases(60%) were negative. Of the 5 cases of CIN II, 2 cases were positive (40%) and 3 cases (60%) were negative. In the CIN III group of 31 cases, 26 cases (83.8%) were positive for P16INK4a staining, but 5 cases (16.1%) were negative. All the 26 cases showed a100% full thickness positivity. In the category of Invasive squamous cell carcinoma, 29 cases(80.5%),out of the 36 showed a 100% full thickness positivity but 7 cases (19.4%) were negative. Statistical analysis was done and CHI SQUARE VALUE=45.05;P value <0.001Conclusions: The use of P16INK4a immunostain is a useful adjunct with Hematoxylin and Eosin(H&E) stained slides,as it aids to increase diagnostic accuracy and interobserver agreement in the diagnosis of high grade cervical intraepithelial neoplasia and carcinoma

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