Onuorah Samuel   Igwemadu Nkiruka   and Odibo Frederick   

Ogbaru Communities are usually submerged by intense flood during the rainy season, but such flood recedes during the dry season. This natural occurrence makes the quality of the borehole water in the area questionable. The total bacterial, total coliform, faecal coliform and Vibrio cholerae counts of samples from fifteen boreholes in the communities were determined during both seasons using standard analytical methods. The values were 100-270 cfu/100ml;10-42cfu/100ml;0-28 cfu/100ml and 0-13cfu/100ml for total bacterial, total coliform, faecal coliform and Vibrio cholerae counts respectively during the dry season and 130-450 cfu/100ml; 25-86 cfu/100ml; 0-75 cfu/100ml and 0-18 cfu/100ml for the total bacterial, total coliform, faecal coliform and Vibrio cholerae counts respectively during the rainy season. Salmonella typhi (53.3%), Enterobacter aerogenes (53.3%), Pseudomonas aeruginosa (46.7%), Proteus vulgaris (46.7%), klebsiella variicola (26.7%), Escherichia coli (26.7%), Staphylococcus aureus (13.3%) and Vibrio cholerae (33.3%) were isolated during the dry season while S. typhi (60.0%), E. aerogenes (60.0%), P. aeruginosa (53.3%), P. vulgaris (46.7%). K. variicola (33.3%), E. coli (26.7%), S. aureus (13.3%), V. cholerae (46.7%) and Providencia sneebia (6.7%) were recovered during the rainy season. S. typhi occurred most frequently during both seasons. Total bacterial, total coliform and Vibrio cholerae counts were significant at 5% significance level using t-distribution. The boreholes analysed were polluted by bacteria and need adequate treatment such as sand filtration, chlorination and boiling before drinking to avert a public health hazard.

Yaguo-Ide Lucy Eberechukwu   and Awopeju Abimbola Temitayo Oluwajenyo   

A retrospective study of children presenting with symptoms suggestive of malaria between 2006 and 2011 was carried out in the University of Port Harcourt Teaching Hospital. Sociodemographic data, clinical information and laboratory investigations were retrieved from the laboratory records of the medical microbiology department. Chi-square analysis was used to assess the prevalence of malaria in the different age groups and sexes. The results showed a 70% prevalence of malaria out of the 23698 patients reviewed. Malaria was significantly higher (= 18.66, p<0.0001) in male patients compared to female patients There was a significantly higher (= 6.76, p =0.0093) prevalence (72.70%) of malaria among children under 5 years and 593 (3.47%) patients had severe malaria (≥3+ parasitemia). Severe anaemia, fever and bronchopneumonia were mostly associated with severe malaria. There was an average prevalence of 70.61% from 2006 to 2011. The annual prevalence of malaria declined from 76.7% in 2009 to 60.6% in 2011. The study showed a high prevalence of malaria among the patients, with children under 5 years being the most significantly affected.

Mervat Saeed   Yasemin Zer ‎   and Zehra Bozdağ   

High-risk human papillomaviruses (HR-HPVs) ‎have been implicated in ‎the aetiology of a variety of human ‎cancers, including cervical, colorectal, and head and ‎neck ‎‎(HN); also, (HPVs) may be important risk factors for breast ‎carcinogenesis and ‎metastasis. Previous studies that ‎evaluated the prevalence of HPVs in breast cancer ‎have ‎generated considerable controversy. Based on this ‎hypothesis, we aimed to investigate ‎the prevalence of HPV ‎infection in invasive breast cancer tissues. ‎Our study included 80 paraffin ‎blocks taken from breast ‎cancerous tissue specimens of ‎Turkish female patients and 13 controls (cervical ‎cancerous ‎tissue specimens) in Research and Practice Hospital- ‎Sahinbey -Gaziantep ‎University, using PCR (HPV Genotypes ‎‎14 Real-TM Quant / Italy) to detect the HR-‎HPV DNA. ‎In our results: HR-HPV DNA was evidenced in (10%) of the breast ‎cancer and in (92.3%) of ‎the controls (p < 0.05). HPV (45-56-68) were the most prevalent genotypes in ‎breast ‎cancer cases. Also HPV co-infection was high (75%) in ‎positive breast cancerous ‎samples.‎ Our data propose Human papilloma viruses ‎may play a role as a possible ‎causal relationship, or ‎mediation or even as a cofactor in the development of some ‎types ‎of breast cancer, this still needs to be confirmed by prospective studies.

Onaolapo A Y   and Onaolapo O J   

Autism spectrum disorders (ASDs) are a range of neurodevelopmental disorders whose aetiologies are largely unknown. In the past few decades, studies have demonstrated that ASDs occur globally, and that the numbers of recorded cases are rising; however, determining the true prevalence figures is still a major challenge, especially in developing nations. Also, subtle differences in cultural norms might impede timely/accurate diagnosis and categorisation of patients. In this review, we examine the globally-available data on the prevalence of ASD and discuss some of the challenges of data acquisition, with reference to how these may impact the reliability of figures obtained. Some of the facts, fallacies and limitations relating to the presently-available figures are also highlighted.

Jude Ogechukwu Okoye   Charles Erinle   Nnodimele Onuigbo Atulomah   and Oluwaseun Kelechi Adeleke   

This study determined the prevalence of breast cancer in relation to age, reproductive status and population of Ogun State. Out of a total of 816 human cancer presentations observed between 2012 and 2016, 334 (40.9%) female breast cancer (with age range= 23 to 95 years and mean age= 50.3 years) were retrospectively reviewed. Result revealed five breast cancer types: Invasive ductal carcinoma (IDC), ductal carcinoma in situ (DCIS), Paget cell disease, medullary carcinoma and mucinous carcinoma. Invasive ductal carcinoma was the predominant breast cancer type (94.9%) while year 2016 had the highest number of breast cancer presentations (47%) at p<0.001). Result also showed that age range of 41-50 years and 61-70 years had the highest prevalence and incidence of breast cancer, respectively (p<0.001). Reproductive age (23-45 years) had the highest frequency of invasive ductal carcinoma and Paget cell disease when compared with other age groups (p<0.001). Result also showed interesting differences in prevalence of breast cancer types in Ogun State compared with other regions. The result revealed that IDC, DCIS, Medullary carcinoma, Mucinous carcinoma and Paget's cell disease are more prevalent in South-West, South-East, North-West, South-East, North-Central regions, respectively. In conclusion, our findings suggest that breast cancer occurrence is greatly influence by age, reproductive status and location.

Muhammad Ahmed Alamgir   Ishfaq Ahmed   Hashim Raza   and Faridudin   

Objectives: The study aims at comparing the changes of serum lipid levels in premenopausal women with that of postmenopausal counterparts. Study Design: An observational comparative and prospective study. Subjects and Method: One hundred healthy subjects (fifty each pre and postmenopausal women) between ages from 25 to 65 years, were selected for the study. They were nonsmoker, non-addict and not user of any hormonal contraceptive. The subjects were arranged in two age ranges of 25 - 45 years (group A) and 45 -65 years of age (group B). The quantitative data were collected and applied accordingly. The fasting serum lipids samples consisting of total cholesterol (TC), high density lipoproteins (HDL-C), and triglyceride (TG) were estimated calorimetrically using the enzymatic method. NCEP ATPIII criterion was used to determine their values in normal or high risk category. According to their recommendations, in healthy females, total cholesterol should be < 200mg/dl .The quantitative variables were displayed as mean ± standard deviation and percentage. The statistical difference for lipoproteins at 5% significance level was assessed by applying one sample "t" test. Results: In subjects of group A, the mean total cholesterol and HDL-C levels were 158.14±28.77mg/dl and 38.98±8.48 mg/dl respectively. Triglycerides level was 142.24±88.387 mg/dl and within normal range. In females with age group B, the mean concentration of total cholesterol and HDL-C were 210.74±59.156mg/dl, 32.94±7.582.mg/dl respectively. Triglycerides level was 160.68±68.131 mg/dl. So in subjects of group B, all lipid values were in high risk category when compared to cut off values determined by NCEP/AHA. Conclusion: Menopause leads to changes in lipid profile by reducing HDL, and elevating total cholesterol (TC), and triglycerides (TG), thus increasing the risk for cardiovascular events.

Onuorah Samuel   Ogbonna Victoria   and Obika Ifeanyi   

The prevalence of asymptomatic bacteriuria among the pregnant women receiving antenatal care at Federal Medical Centre Owerri, Nigeria was studied using one hundred and forty urine samples from the pregnant women in the in-patient and out-patient departments. Thirty-five of the women had significant bacteriuria, with a prevalence rate of 25%. The bacteria in the samples were Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa and Proteus mirabilis. Escherichia coli occurred most frequently (40%) while Pseudomonas aeruginosa had the lowest frequency of occurrence (14%) in the samples. The infection was most prevalent among the women aged between 21 and 30 years (38.1%) and lowest among those between 41 and 50 years of age (9.4%). The prevalence was highest among the pregnant farmers and lowest among the pregnant civil servants in both the in-patient and out-patient departments. Pregnant women in the out-patient department had a higher prevalence than the women in the in-patient department. Pregnancy promotes the progression of asymptomatic to symptomatic bacteriuria with its consequences such as pyelonephritis, urinary tract infections and increased foetal mortality, therefore regular urine analysis of all pregnant women by certified health authorities is recommended.

Peter Shigoli   Gunturu Revathi   Elusah Juliet   and Kimang'a Nyerere   

Background: We evaluated the performance of Statens Serum Institut enteric medium (SSI) for detection of enteric pathogens in stool in two routine diagnostic laboratories in Nairobi to determine if the detection in stool would be most sensitive and specific in our culture protocol. Methods: Salmonella-Shigella agar (SS), Statens Serum Institut enteric medium (SSI), Deoxycholate Citrate Agar (DCA) and MacConkey media were prepared according to the manufacture's institutions. Diarrheal stool specimens received at the laboratory for routine diagnosis were streaked directly and after enrichment in Selenite F onto the test media and incubated for 24 hours at 37º Centigrade. After incubation, the growth characteristics and chemical reactions was compared with the manual given. Results: SSI medium was a more productive medium in the detection of enteric pathogens in comparison to the other three media (F=2.729, d.f=3 at p≤0.005). It also shows that enrichment of the specimens in Selenite F enhances recovery. Conclusion: SSI enteric medium yields differentiating biochemical reactions that allow direct identification of a range of enteric pathogens thus saving on time and costs. Our revised/modified protocol, where we plated stool samples after enrichment in selenite F broth onto SS and SSI, achieved a high sensitivity of detection and optimal isolation.

Carlos Ramos-Matos   and Wilfredo López-Ojeda   

Clandestine drug production, use, and exploitation present a social issue afflicting millions across the globe. "Designer opioids," some known to the street as "China White" for their alleged purity, have been unveiled in the past years; noted to possess properties that can compromise well-being in a remarkably novel way. This class of designer opioids, the 4-phenylpiperidines, seems to be generating significant medical concerns due to its deadly clinical manifestations; which may be further complicated by the ease of access and its potent addictive properties. The potential drug adulteration with other chemical formulations further complicates the medical scenario, posing a serious challenge in the management of presumed overdoses. Furthermore, if the key clinical manifestations are overlooked due to the presence confounding signs and symptoms to medical practitioners, patient's mortality may potentially increase even stronger. Thus, the purpose of this communication is to create awareness about these novel agents and their potentially devastating clinical complications. We strongly support the empiric treatment with naloxone per the currently established guidelines. In addition, we urge practitioners to carefully document findings relating to recovery time and historical data to aid in early detection, and precise decision-making in suspected intoxications cases.

Mohamed Hamid Awadelsied   

Anterior cruciate ligament (ACL) is considered as an intra-capsular extra-synovial ligament, primarily responsible for resisting anterior displacement of the tibia on flexion and extension. Magnetic resonance imagining (MRI) has been applied to musculoskeletal patho-anatomy and has been shown to be an effective tool for definition and characterization of knee pathology, regarding the knees subjected to MRI examination, measurement was done for length from femoral to tibial attachment site and thickness at the mid-portion. Comparison between the data obtained in the present study with data obtained from Kowen results there is variable length and thickness. Concluded that for the anterior cruciate ligament the length and thickness of the native ACL played an important role for choosing the type of graft and for the preparation of the graft and dimensions of the native ACL have to be considered in graft selection for anatomic ACL reconstruction.

Samreen Riaz   

A worldwide epidemic exists with respect to diabetes mellitus because of increased rates of obesity. There is a significant correlation between obesity and insulin resistance and obesity causes the increase in the severity of the disease. The adipose tissues in the visceral region function as an endocrine organ that produces certain proteins with role in glucose homeostasis. The expression level of some of these proteins is increased in diabetes and can serve as specific marker of the disease. The study was performed to check the effect of various physical and biochemical parameters of obesity on the development and progression of diabetes mellitus. In our study the serum samples of diabetics were collected and were further categorized into two groups i.e. diabetic obese and diabetic non obese, on the basis of BMI, waist circumference and waist to hip ratio. The fasting blood sugar level, the total protein content, along with the complete lipid profile was performed. A marked increase in the total protein content and lipid profile was observed in diabetic obese as compared to diabetic non obese and control group. The results were found to be significant with p < 0.05. The lipid profile of diabetic obese was characterized by high cholesterol, LDL and VLDL concentration and low HDL concentration while that of control was characterizes by high HDL level and low cholesterol, LDL and VLDL level. The adipose secreted proteins whose expression is thought to increase in diabetes are studied. For this purpose the protein profile of serum was obtained on 10% SDS PAGE and the gels were stained with coomassie R-250 and silver salts. The proteins with exacerbated expression in diabetic obese individuals were studied. The expression of proteins such as leptin (16000 dalton), C reactive protein (25039 dalton), TNF alpha (25644 daltons), apolipoprotein E (34000 dalton), alpha 2 macroglobulin (163278 dalton) and apolipoprotein B (250000 dalton) was observed to be increased in diabetic obese as compared to diabetic non obese and control. There inflammation proteins secreted by adipose tissues cause the increase in the severity and progression of diabetes mellitus in the population.

Syed Zahid Ali Shah   M. S. Khan   and Sher Hayat Khan   

The study was conducted to explore the effect of two herbal drugs, Caesalpinia crista and Nigella sativa in comparison with Oxfendazole in broilers experimentally induced with Ascaridia galli infection .A total of 130 day old broiler chicks were divided into five groups i.e. A, B, C, D and E each group having 26 birds. Group E was kept as negative control, while all other groups were induced with experimental Ascardia galli infection on 15th day. Group A was kept as positive control and groups B and C were treated with Caesalpinia crista and Nigella sativa as methanolic extract orally once @50mg/kg body weight and group D was medicated with Oxfendazole @10mg/kg body weight orally once on 25th day post infection. On 25th day post infection before treatment 4 birds from each group were slaughtered, and worm count was done. The efficacy was confirmed by counting the worm, slaughtering all the bird on 30th day post infection. The mean worm count was significantly different (p<0.05) between the treated and non treated groups. The efficacy of the plant extracts were less as compare to Oxfendazole. The efficacy of Caesalpinia crista and Nigella sativa was 70.83% and 57.5% respectively while the efficacy of Oxfendazole was 90.83%.In vitro treatment at 37±1℃ revealed that a serial dose of the plant extract caused dose-dependent vermicidal effect on the worm (significant efficacy at P<0.05), except at the lowest dose (i.e. 5 mg/mL). The efficacy of drugs was calculated on the basis of reduction in total worm count after treatment.

Vyas P. P.   and Singhal H. K.   

Encysted hydrocele is a condition usually affecting children. A case of encysted hydrocele of right cord in 3 year old male child was reported. The diagnosis was made Encysted hydrocele on the basis of signs & symptoms and Ultra sonography. . The patient was suggested for the surgery, by the eminent pediatricians. Surgery was not preferred by parents of the patient. The patient has shown interest to follow, Ayurveda treatment, willingly. An Ayurveda medicinal management was done and found effective in the case of Encysted Hydrocele with abnormally enlarged scrotum. Patient was advised to follow the Ayurveda management for 1 month. Follow up report has shown encourageous result. The size of right testicle was significantly reduced and returned to almost normal size.

Amitabh Suman   

Background: Outcome after transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) is highly variable. Aims: To identify factors affecting outcome after TACE for HCC. Methods: We conducted a retrospective analysis of HCC patients treated with TACE from January 2001 to December 2010 at the VA Medical Center, Gainesville, Florida using Fisher’s exact test and Mann Whitney U testfor univariate analysis and the Kaplan-Meier method and Cox proportional hazard models to compare survival. Results:Of the 82 patients included in the analysis, 45 received doxorubicin drug eluting beads (DEB TACE) and 37 received conventional (CON) TACE. The two TACE groups had similar characteristics except for MELD score being higher in the CON TACE. Univariate analysis showed survival to be associated with type of TACE (p= 0.022), Child-Pugh (CP) class (p= 0.038), MELD score (p= 0.028), AFPmax (p=0.0002) and response after first TACE (p= 0.006). Kaplan Meier analysis showed significant survival benefit (p=0.014) in the DEB TACE group over the CON TACE group -26.4 months VS 15.8 months respectively and in patients with lower MELD scores (p=0.005). A multivariable analysis showed a significant interaction between type of TACE and MELD score ( p=0.395), with DEB TACE patients experiencing a better survival than CON TACE patients but the effect diminishing as MELD scores increased. In addition the risk of death increased significantly with AFPmax (Hazard ratio 1.15, 95%CI= [1.06, 1.26], p=0.0001). Conclusions: Survival after TACE for HCC is better after DEB TACE, in CP class A, with lower MELD score and lower AFPmax.

Tena Dischler   Jeffrey L. Alexander   Denice Curtis   and Michael Markson   

While large clinical trials have shown rare adverse side effects in post-menopausal women taking uninterrupted oral bisphosphonates (BPs), there is mounting evidence that longer-term treatment may be associated with osteonecrosis of the jaw (ONJ). There is a paucity of information regarding the causal relationship between extended oral BP treatment and ONJ, and the safety of non-surgical therapy of apical lesions and length of treatment in women on long-term BPs. We describe a post-menopausal woman on long-term oral BPs who developed ONJ without any contributory risk factors. Quantitative data was gathered through review of the patient’s medical record. Qualitative data was gathered from face-to-face interviews with patient and clinician. Analysis of the data revealed the patient did not feel it was important to report her use of BPs. Given the wide usage of antiresorptives dental clinicians should manage all post-menopausal women with the assumption they currently or have recently been treated with BPs. There is a need for a collaborative effort by medical and dental practitioners to reduce risk of ONJ, ensure proper BP dosing and length of treatment, identify contributory risk factors, and explore alternate modalities, such as Ca(OH) ₂ multi-visit palliative pulpectomy, to avert ONJ and improve treatment outcomes.

Ming Zhang   Emily Hill   and Adrianne Boyd   

Approximately 219,000 people worldwide have received cochlear implants (CI) as of 2010. This retrospective study uniquely investigated three important components together including pre-lingual CI recipients (the most difficult-to-treat CI population), speech recognition before and after CI, and factors that may be associated with positive or negative speech recognition outcomes. Eight cases of pre-lingual CI users were selected, including four subjects with relatively better scores and four subjects with relatively poor scores. To compare these two groups, eight factors were investigated: gender; etiology; age of implantation; type of implant device; communication mode (oral, speech reading, or sign); patient compliance (attending scheduled clinic follow-up); family/environmental influence; and frequency using the CI device. Although the finding from this investigation is not statistically conclusive like other similar studies, it appears that some factors, such as patient compliance, oral communication, family environment, and/or the frequency using the CI device, may contribute to positive speech recognition outcomes.

Annie Hahn   and Annesha Lovett   

E-prescribing has flourished due to the promise of improving efficiency and decreasing prescription errors caused by its handwritten counterpart, yet only 44% of doctor’s offices use paperless prescriptions. Many studies have assessed the value of e-prescribing in the clinical setting, yet there is no all-inclusive summation of these findings. The aim of this study was to review the literature within the last decade pertaining to the cost effectiveness, clinician adoption and limitations of e-prescribing. Journal articles from January 1, 2003 through May 1, 2013 were compiled through use of the search engines: PubMed, International Pharmaceutical Abstracts (IPA), and Google Scholar. A total of 56 peer-reviewed articles were included in this review. Trends show that most clinicians view e-prescribing positively despite some limitations. Limitations of e-prescribing include cost of implementation and maintenance, insufficient training, and lack of standardization. The cost to implement an integrated system with alerts and decision support is $29,000 per physician for the first year and $4,000 every year thereafter. Furthermore, e-prescribing has little disruption to workflow and no statistically significant increase in processing time. Although limitations exist, an expansion of e-prescribing is expected in the future. Efforts should be increased to promote clinicians adopting e-prescribing.

Kristopher R. Maday   

Critically ill patients have higher energy expenditure and increased nutritional needs compared to non-critically patients. This can lead to medical malnutrition if nutritional interventions are not implemented quickly and accurately in the disease course. Obtaining an accurate estimation of nutritional needs is paramount in establishing nutritional support. The literature review was designed to look at the numerous predictive equations and determine the accuracy among different critically ill patient populations. Data Sources: Using keywords energy estimation, nutritional predictive equations, and critical illness, systematic reviews, meta-analyses, and validation studies were identified through electronic database searches and citation tracking. Study Selection: Articles were selected that evaluated individual predictive equations in critically ill patients, their accuracy compared to indirect calorimetry, and their use in special patient populations. Data Extraction and Synthesis: A total of 12 articles were selected using the inclusion and exclusion criteria. Accuracy of the predictive equations was separated into overall accuracy among all patients, all ages, non-obese, young obese and non-obese, and elderly obese and non-obese. Conclusions: There are several validated predictive equations for estimating energy expenditure in critical illness. The most accurate equations are the 2003 Penn State equation, for obese and non-obese adult patients, and the 2010 Penn State equation, for elderly obese patients. Given the trend of obesity in the United States, further validated studies are needed to look at the individual classes of obesity and the accuracy with this specific patient population.

Campanati Luca   Coccolini Federico   Lotti Marco   Deho Federico   Deiana Gianfranco   Lazzareschi Daniel   Poiasina Elia   Pisano Michele   Magnone Stefano   Colaianni Nicola   Poletti Eugenio   Da Pozzo Luigi   and Ansaloni Luca   

A series of randomized studies have revealed comparable long-term results for both laparosopic and open resections in the treatment of renal and colonic neoplasms. From a purely oncological perspective, the benefit-detriment debate regarding synchronous laparoscopic resections remains a hotly disputed issue and continues to face scrutiny in today’s medical community. However, although this debate has become an important issue, there are few reports in mainstream literature discussing the simultaneous laparoscopic resection of renal and colorectal carcinomas. This report overviews two entirely laparoscopic procedures: a simultaneously performed right nephrectomy and left colectomy and a simultaneously performed left nephrectomy and left colectomy. The laparoscopic technique for simultaneous abdominal primary malignancy has proven to be safe, effective, and practicable. This paper will overview the authors’ experience with such procedures, outlining technical setbacks in the course of surgery and discussing the overall results of the operations.

Zati Iwani AK Ruziana Mona WZ Nor Idayu R and Wan Nazaimoon WM 

Background : Diagnostic marker to detect chronic kidney disease (CKD) at early stage is important as early intervention can slow the loss of kidney function. Plasma or serum Cystatin C (CysC) is said to be a superior marker for CKD compared to serum creatinine (SCr) to detect mild GFR reduction between 60 and 90 ml/min/1.73m². Methods: We analysed blood and urine samples from 418 normal subjects and 37 Type 2 diabetes patients (T2DM) with CKD. Estimation of glomerular filtration rate (eGFR) was determined using CKD-EPI. We compared the level CysC by CKD staging. Then, the correlation CysC and eGFR were compared between the normal subjects and the T2DM patients.Results : Plasma CysC level increase with the progression of CKD and was significantly elevated in CKD stage 2. CysC levels were highly correlated with eGFR in the T2DM patients. Conclusion: These results indicated that CysC have the potential of detecting early CKD especially in those with high risk such as the T2DM patients and also hypertension.

Brent Weinberg Lori Watumull Michael Landay and Hythem Omar 

Computed tomography (CT) guided percutaneous biopsy is a frequently performed procedure to establish a pathologic diagnosis in thoracic disease. While the most frequent complication of percutaneous chest biopsy is pneumothorax, hemothorax is a rare but potentially fatal complication. The purpose of this study is to assess the risk of post biopsy hemothorax, its associated consequences, and describe reasonable precautions for minimizing this risk. A retrospective chart review of all percutaneous thoracic biopsies completed at two affiliated institutions from January 1, 2006 to June 30, 2011 was performed to evaluate complications rates. A total of 830 biopsies were performed over a five and a half year period. The overall complication rate was 34.1%, with the majority being pneumothorax (32.5%). A total of 4 confirmed hemothoraces (0.5%) occurred. The onset of hemothorax was variable with three cases occurring immediately post-procedure while a fourth occurred 15 hours later. Treatments included observation, tube thoracostomy, and thoracotomy. In conclusion, hemothorax is a rare but serious complication of percutaneous biopsy which may be more common than previously reported.

Ashfaq U Hassan Ghulam Hassan Zahida Rasool and Zubeida   

In the modern era, especially in the elderly males, the geriatric age group, people come with complaints of the prostate gland. The frequency of the prostate disorders has been on the increase and disorders such as prostatitis, Benign Prostatic Hyperplasia and Prostatic Cancer have been on the rise. To study the various changes the prostate undergoes during its development as the age passes by is a topic of immense interest and I have made an attempt to study the same. Most of the complaints to a doctor are because of problems in the abdomino pelvic region. It has been found that of all the cases in out patients department 75 percent people complain of symptoms in the region of abdomen and pelvis. Especially in case of males the complaints in the pelvic region are comparable to females. As we have predominantly symptoms related to ovaries and cervix in case of females similarly we have growing concerns problems concerning prostate in males. Being a very important organ of the male genito urinary system and the rapid progress made in the field of Anatomy, Histology, Pathology Surgery, Radiology the finer details about the organs makes our study more interesting and mind absorbing.

Roberta SL Cassani Selma FC Cunha Andre LG Freitas Carla B Nonino and Julio S Marchini 

The intake of processed foods of high calorie density is associated with weight gain and changes in lipid and cardiovascular metabolism. However, the modification of eating habits is possible due to, among other factors, information provided to patients about the foods/nutrients ingested. The present investigation observed the impact of nutritional counseling on anthropometric and on biochemical indicators in a blind controlled study. Therefore, a single investigator counseled obese workers divided into three groups over a period of 42 days. A control group (CG) received no counseling. GLi50 received 60 g/d linseed and 50% of the energy supply as carbohydrates; GRi50 received 60 g/d raw ground rice and 50% of the energy supply as carbohydrates, and GLi32 received 60 g/d linseed and 32% of the energy supply as carbohydrates. A total of 118 vo-lunteers started the protocol and 52 completed it. The most consumed foods were rice, beans, bread, manioc flour, soy oil, red meat, and eggs. CG did not show any modifications. The remaining groups, regardless of diet composition, showed a reduction of anthropometric measurements, be-sides reduced glycemia, cholesterolemia, triglycerides and insulinemia, as well as reduced peripheral resistance to the action of insulin. More important than supplementation or the proportion of carbohydrates ingested, nutritional coun-seling was the common factor for adequacy of energy intake, weight loss and improved biochemical indicators. Nutrition counseling can be a viable and economically strategy for helping patients with life style diseases.

Ashfaq Ul Hassan Villayat Buch and Pervez Shah 

The most common symptom leading to a doctors clinic is pain and Pain is the most common symptom that makes any patients to seek medical advice and assistance. Grading pain and failure to respond to conventinal and non convential drugs leads to Neurosurgical intervention for the relief of pain which is indicated when primary intervention for the disease in question does not lead to adequate comfort. Surgical procedures to reduce pain are grouped broadly into two categories: neuroablative and neuroaugmentative. Taking account of the Neuroanatomy, Ablative procedures can be done anywhere along this pathway. Neuroaugmentation refers to the use of chronic infusion of opioid agonists or stimulation, which is believed to activate intrinsic modulating systems that reduce or alter sensory input.

Hany Y Atallah MD Dilani Weerasuriya MD Jeremy Hess MD MPH Debra Houry MD MPH Daniel Wu MD and Leon L Haley Jr.,MD,MHSA 

Background: Studies have reported mixed findings regarding timing of antibiotic delivery in patients admitted for pneumonia and clinical outcomes. We hypothesized that there is no association between the time to antibiotics and the hospital length of stay (LOS) for patients admitted from the emergency department (ED) to the hospital for pneumonia. Objective: To compare the hospital LOS of patients admitted from the ED to the hospital for pneumonia based on the interval between ED arrival and first dose of antibiotics categorized to four hours or less, four to six hours, and greater than six hours. Methods: We conducted a retrospective chart review at a single inner city ED on patients who had admitting and discharge diagnoses of pneumonia and received antibiotics in the ED over a 17 month period. Using structured abstraction sheets, a trained reviewer identified cases and abstracted data on hospital LOS, time of arrival to first antibiotic dose, admission bed type, and other patient factors. The primary outcome was hospital LOS. Data were analyzed using descriptive statistics, ANOVA, and linear regression. Results: Nine hundred ninety nine cases were identified and541 met inclusion criteria. Four hundred eighty three (89%) were African American, 240 (44%) were female, the average age was 52 years old (SD 15), and 186 (34%) were HIV positive. There was no significant difference in LOS based on time to antibiotics. Controlling for patient factors including pneumonia type (community or health care associated) did not result in a significant difference in LOS across the time to antibiotic categories. Conclusions: In this population of pneumonia patients admitted to the hospital from the ED, time to first antibiotic dose was not significantly correlated with hospital LOS. Controlling for demographics and disease severity did not affect the observed relationship.