Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241109EnglishN2018May5HealthcareFine Needle Aspiration Cytology English0001Dr. Sachin B. IngleEnglishFNAC (Fine Needle Aspiration Cytology) is a simple, inexpensive, easily performed outpatient procedure which can provide a rapid diagnosis. It has been widely used in Europe for decades, mainly in Scandinavian countries. A technique which is safe, rapid, relatively pain free, cost effective and accurate is always a clinician’s first choice and this is what FNAC is about. It is eminently suitable as first line investigation for almost all superficial palpable swellings as well as many deep seated lesions. FNAC was initially conceived as a means to confirm a clinical suspicion of local recurrence or metastasis of known cancer without subjecting the patient to further surgical intervention. FNAC is a time tested simple office procedure having a high degree of diagnostic accuracy and precision. The specificity and sensitivity of diagnostic precision lie in range of 60% and 80% respectively. The acceptance both by surgeons and pathologists itself speaks of the tale of comfort which it allows. The art of medicine is practiced within a community of caregivers who are perched on innumerable speciality branches and these braches intersect each other at various times. Clinical consultations help to acquaint cytopathologist about probable diagnoses possible for any lesion. Often a major surgical biopsy can be avoided by performing a needle aspiration instead. Surgeons are always impressed by the help of FNAC to make diagnoses which affect treatment of patient in a wide manner. Many tumours being diagnosed high grade on FNAC make the surgeon to go for chemotherapy before surgical intervention. Conclusion – Fine needle aspiration cytology has an utmost importance in the current era of surgical practice in the preoperative stage as it guides the clinician a lot in the treatment plan and mostly clear the pathological aspects of the disease avoid untoward complications related to disease and treatment for the sake of pathological diagnosis. Many times it avoids unnecessary surgical intervention. Englishhttp://ijcrr.com/abstract.php?article_id=2478http://ijcrr.com/article_html.php?did=2478

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241109EnglishN2018May5HealthcareInterleukin 10/ Interleukin-10R Mutations Causing Very Early Onset Inflammatory Bowel Disease English0205Asfia Banu PashaEnglish Swarna Latha EkyoluEnglish Guo HongmeiEnglish A unique disease entity called Very early onset inflammatory bowel disease [VEO-IBD] in which the affected patients show a complex genetic susceptibility. Various monogenic mutations which contribute to the pathogenesis of VEO-IBD have been attributed by gene sequencing techniques, including mutations in Interleukin 10 (IL-10) and Interleukin 10 receptor (IL-10R). The IL-10 pathway has an inhibitory effect on the release of several cytokines and hence, has an anti-inflammatory effect on the gastrointestinal tract. Among the reported patients with VEO-IBD in the world literature, mutations in the genes encoding for IL-10 and IL-10R have been detected. These patients present with symptoms of bloody diarrhea, significant weight loss, growth retardation and recurrent perianal abscesses, fistulas and  fissures. Some patients may also have respiratory infections and folliculitis. As the therapeutic efficacy of immunosuppressive drugs is poor in these patients, it has been reported that allogenic hematopoetic stem cell transplantation (HSCT) can improve the symptoms significantly. However, in order to verify the efficacy and safety of this treatment, and the long term prognosis of VEO-IBD patients with IL-10/IL-10R mutations , further study and exploration is yet requires. In this article, we would conclude the importance for physicians to recognize the clinical phenotype of VEO-IBD and a mutational analysis of the IL-10/IL-10R can help in confirming the diagnosis and start early and effective treatment of this disease. EnglishInflammatory Bowel Disease, Very early onset, Interleukin 10, MutationsIntroduction Inflammatory bowel disease (IBD) comprises of a group of chronic disorders of the gastrointestinal disorders which includes ulcerative colitis (UC) and Crohn's disease (CD). There have been a wide variety of factors responsible for the pathogenesis of these disorders, which are yet to be clarified. However, many studies have revealed that a variety of environmental factors trigger the chronic inflammation of the gut in genetically susceptible individuals which lead to IBD. IBD with a disease onset before 6 years of age has been termed very early onset IBD (VEO-IBD). Whereas on one hand, exogenous environmental factors are considered to play a major role in adolescent-and adult-onset IBD, in VEO-IBD, on the other hand, genetic susceptibility is considered to play a major role in its pathogenesis [1]. GWAS (Genome wide association studies) have found out as many as 201 loci of gene mutations related to IBD [2]. Although GWAS can detect common genetic variants, it cannot identify low frequency monogenetic variants, which are more relevant to VEO-IBD [3]. These limitations of GWAS may be overcome by genetic linkage analysis and exome gene sequencing. By these new gene sequencing techniques, at-least 58 susceptible genes have been studied which have shown to be responsible for the pathogenesis of VEO-IBD [4]. Of all these susceptible genes, IL (Interleukin)-10 and IL-10R have been broadly studied and investigated. This article focusses on the review of the present literature on the mutations of IL-10 and IL-10R in the pathogenesis of VEO-IBD. Physiology of IL-10 in the Gut A very important anti-inflammatory cytokine, IL-10, is secreted by monocytes, macrophages, dendritic cells, mast cells, epithelial cells, T and B lymphocytes. It inhibits Tumor necrosis factor-alpha (TNF-α) release, and hence, maintains the immune homeostasis in the gastrointestinal tract [5]. IL-10 binds to its receptor, IL-10R. IL-10R is a tetrameric complex which consists of two alpha subunits of IL-10R1 that is encoded by IL-10RA; and two beta subunits of IL-10R2 encoded by IL-10RB [6]. IL-10R1 only binds IL-10 but IL-10R1 binds to other cytokines as well (IL-22, IL-26, IL-28, IL-29) [7]. When IL-10 binds with its receptor, it leads to the activation of Janus kinase 1 (JAK1) and tyrosine kinase 2 (Tyk2), which in turn leads to the phosphorylation of STAT-3 (signal transducer and activator of transcription 3), activation of the downstream target genes, and finally, the anti-inflammatory effectors are expressed [8]. IL-10 and IL-10R Mutations in VEO-IBD The defects in the IL-10 and IL-10R signaling pathway can cause severe enterocolitis in humans [9], which has been observed in some cases of VEO-IBD. Mutations in IL-10 and IL-10R genes can lead to disturbance in the anti-inflammatory response. About 60 cases and more of VEO-IBD are documented in the present literature after the initial report by Glocker et al in 2009 [10]. Majority of the cases have been reported from Europe in which it was noticed that IL-10R mutations were more predominant than mutations in IL-10. 22 cases have been reported in East Asia, of which 21 cases showed IL-10RA mutation with only 1 case showing IL-10RB mutation. This is a contrast to the European cases in which IL-10RA and IL-10RB mutations were almost equal [10-27]. According to the available statistics, IBD accounts for approximately 20-25% of pediatric patients, with about 5%  of patients being less than 10 years of age and 1%  being less than 2 years old [1]. About 15%  of the total pediatric IBD patients have been classified under VEO-IBD [27]. The Frequency of IL-10 and IL-10R mutations varied in the available cohort studies of VEO-IBD. Or example, in a report from the United Kingdom, 8.1%  of IBD cases in patients below 2 years of age were confirmed to have mutations of IL-10 and IL-10R [28]. Similarly, a report from Germany sowed that 24.2%  of IBD cases less than 5 years old were verified to have IL-10 or IL-10R mutations [13]. A report from the United States showed about 4.8%  of IBD patients with IL-10 mutations [24]. In Asian countries, it was noticed that VEO-IBD cases have higher rate of mutations of IL-10/IL-10R. A report from Korea showed 50%  of children below 1 year of age with IL-10RA mutations [20]. In a report by Xiao et al [27] from China, it was verified that 38.5%  of IBD cases were due to IL-10RA /IL-10RB mutations. This strikingly high frequency of mutations may be due to the small cohort study with only 13 VEO-IBD cases. However, from this currently available data from the case reports suggests that the frequency of gene mutations of IL-10/IL-10R is not low. Yet, multi center studies are necessary to determine the role of genetic mutations of IL-10/IL-10R in the pathogenesis of VEO-IBD and to identify the definite clinical phenotype of the disease. This could be used as a screening tool to diagnose VEO-IBD patients with mutations in IL-10/IL-10R. Clinical Presentation in case of VEO-IBD associated with IL-10/IL-10R Mutations The clinical features of VEO-IBD are different compared to that of adult-onset IBD. VEO-IBD shows more resistance to immunosuppressive therapy and has as severe clinical course. VEO-IBD associated with mutations of IL-10/IL-10R show an even more severe and complicated course of disease. These patients present with repeated episodes of bloody diarrhea, significant weight loss, growth retardation and recurrent perianal abscesses, fistulas and fissures [29]. Additionally, in patients with IL-10RB mutations which interrupts the binding between IL-10R1 and IL-22, results in the immune defects of the skin and lung epithelium due to IL-22 signal pathway abnormality, leads to folliculitis and refractory pneumonia [13,25]. Furthermore, this disease is also resistant to the various immunosuppressive drugs like corticosteroids, azathioprine, methotrexate and infliximab, either used as a single therapy or in combination. Treatment with these drugs results in either no improvement or only a mild improvement of the clinical features. Due to poor efficacy of treatment and drug resistance, some patients have undergone bowel resection and ileostomy or colostomy [22]. As a matter of fact that IL-10 has a predominant action on the immune and hematopoetic cells, an attempt has been made to use Allogenic Hematopoetic Stem Cell Transplantation (HSCT) as a curative therapy for patients of VEO-IBD with mutations of IL-10/IL-10R [10,13,17,19,23,25,30]. Though the initial results have supported the curative role of HSCT in VEO-IBD patients with IL-1O/IL-10R mutations, yet its experience is limited because it has been used only in a few number of patients with a short follow-up period. HSCT yet proves a promising therapeutic modality but more studies are necessary to confirm its efficacy and long term safety in VEO-IBD patients with mutations of IL-10/IL-10R. CONCLUSION Though VEO-IBD was considered a rare disease, it is noted to be more frequent and is considered as an emerging disease. This makes it important for the clinicians to detect the phenotype of gene mutations of IL-10/IL-10R causing VEO-IBD by gene analysis for a prompt diagnosis and effective treatment of these patients. Moreover, in patients who are resistant to the standard available therapy with immunosuppressive drugs, an alternative treatment option is the use of allogenic HSCT which may prove efficacious in a setting of a clinical trial. ACKNOWLEDGEMENT I would like to extend my gratitude to my guide and professor, Dr. Guo-Ping Zhou for encouraging me for writing this article. I am thankful to the authors of all the cited references and the available literature related to this topic on the internet. SOURCE OF FUNDING – No funding CONFLICT OF INTEREST – No conflict of interest. Englishhttp://ijcrr.com/abstract.php?article_id=2479http://ijcrr.com/article_html.php?did=2479 Snapper SB. Very-Early-Onset Inflammatory Bowel Disease. Gastroenterol Hepatol (N Y) 2015;11(8):554-556. Loddo I, Romano C. Inflammatory Bowel Disease: Genetics, Epigenetics, and Pathogenesis. Front Immunol. 2015;6:551. Uhlig HH. Monogenic diseases associated with intestinal inflammation: implications for the understanding of inflammatory bowel disease. Gut. 2013;62(12):1795-1805. Bianco AM, Girardelli M, Tommasini A. Genetics of inflammatory bowel disease from multifactorial to monogenic forms. World J Gastroenterol. 2015;21(43):12296-12310. Hutchins AP, Diez D, Miranda-Saavedra D. The IL-10/STAT3-mediated anti-inflammatory response: recent developments and future challenge. BrifFunct Genomics. 2013;12:489-498. Ding Y, Qin L, Zamarin D, Kotenko SV, Pestka S, Moore KW, Bromberg JS. Differential IL-10R1 expression plays a critical role in IL-10-mediated immune regulation. J Immunol. 2001;167(12):6884-6892. Commins S, Steinke JW, Borish L. The extended IL-10 superfamily: IL-10, IL-19, IL-20, IL-22, IL-24, IL-26, IL-28, and IL-29. J Allergy Clin Immunol. 2008;121(5):1108-1111. Murray PJ. The primary mechanism of the IL-10-regulated antiinflammatory response is to selectively inhibit transcription. Proc Natl Acad Sci U S A. 2005;102(24):8686-8691. Engelhardt KR, Grimbacher B. IL-10 in humans: lessons from the gut, IL-10/IL-10 receptor deficiencies, and IL-10 polymorphisms. Curr Top Microbiol Immunol. 2014; 380: 1–18. Glocker EO, Kotlarz D, Boztug K, Gertz EM, Schaffer AA, Noyan F, Perro M. et al. Inflammatory bowel disease and mutations affecting the interleukin-10 receptor. N Engl J Med. 2009;361(21):2033–2045. Begue B, Verdier J, Rieux-Laucat F, Goulet O, Morali A, Canioni D, Hugot JP. et al. Defective IL10 signaling defining a subgroup of patients with inflammatory bowel disease. Am J Gastroenterol. 2011;106(8):1544–1555. Mao H, Yang W, Lee PP, Ho MH, Yang J, Zeng S, Chong CY. et al. Exome sequencing identifies novel compound heterozygous mutations of IL-10 receptor 1 in neonatal-onset Crohn's disease. Genes Immun. 2012;13(5):437–442. Kotlarz D, Beier R, Murugan D, Diestelhorst J, Jensen O, Boztug K, Pfeifer D. et al. Loss of interleukin-10 signaling and infantile inflammatory bowel disease: implications for diagnosis and therapy. Gastroenterology. 2012;143(2):347–355. Shim JO, Hwang S, Yang HR, Moon JS, Chang JY, Ko JS, Park SS. et al. Interleukin-10 receptor mutations in children with neonatal-onset Crohn's disease and intractable ulcerating enterocolitis. Eur J Gastroenterol Hepatol. 2013;25(10):1235–1240. Moran CJ, Walters TD, Guo CH, Kugathasan S, Klein C, Turner D, Wolters VM. et al. IL-10R polymorphisms are associated with very-early-onset ulcerative colitis. Inflamm Bowel Dis. 2013;19(1):115–123. Neven B, Mamessier E, Bruneau J, Kaltenbach S, Kotlarz D, Suarez F, Masliah-Planchon J. et al. A Mendelian predisposition to B-cell lymphoma caused by IL-10R deficiency. Blood. 2013;122(23):3713–3722. Pigneur B, Escher J, Elawad M, Lima R, Buderus S, Kierkus J, Guariso G. et al. Phenotypic characterization of very early-onset IBD due to mutations in the IL10, IL10 receptor alpha or beta gene: a survey of the Genius Working Group. Inflamm Bowel Dis. 2013;19(13):2820–2828. Galatola M, Miele E, Strisciuglio C, Paparo L, Rega D, Delrio P, Duraturo F. et al. Synergistic effect of interleukin-10-receptor variants in a case of early-onset ulcerative colitis. World J Gastroenterol. 2013;19(46):8659–8670. Murugan D, Albert MH, Langemeier J, Bohne J, Puchalka J, Jarvinen PM, Hauck F. et al. Very early onset inflammatory bowel disease associated with aberrant trafficking of IL-10R1 and cure by T cell replete haploidentical bone marrow transplantation. J Clin Immunol. 2014;34(3):331–339. Shim JO, Seo JK. Very early-onset inflammatory bowel disease (IBD) in infancy is a different disease entity from adult-onset IBD; one form of interleukin-10 receptor mutations. J Hum Genet. 2014;59(6):337–341. Lee CH, Hsu P, Nanan B, Nanan R, Wong M, Gaskin KJ, Leong RW. et al. Novel de novo mutations of the interleukin-10 receptor gene lead to infantile onset inflammatory bowel disease. J Crohns Colitis. 2014;VV8(11):1551–1556. Beser OF, Conde CD, Serwas NK, Cokugras FC, Kutlu T, Boztug K, Erkan T. Clinical features of interleukin 10 receptor gene mutations in children with very early-onset inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2015;60(3):332–338. Lu D, Xu Y, Chen Y, Zeng P, Chen H, Zeng H. [Interleukin-10 receptor mutations in children with neonatal onset inflammatory bowel disease: genetic diagnosis and pathogenesis] ZhonghuaErKe Za Zhi. 2015;53(5):348–354. Kelsen JR, Dawany N, Moran CJ, Petersen BS, Sarmady M, Sasson A, Pauly-Hubbard H. et al. Exome sequencing analysis reveals variants in primary immunodeficiency genes in patients with very early onset inflammatory bowel disease. Gastroenterology. 2015;149(6):1415–14 Yanagi T, Mizuochi T, Takaki Y, Eda K, Mitsuyama K, Ishimura M, Takada H. et al. Novel exonic mutation inducing aberrant splicing in the IL10RA gene and resulting in infantile-onset inflammatory bowel disease: a case report. BMC Gastroenterol. 2016;16:10. Oh SH, Baek J, Liany H, Foo JN, Kim KM, Yang SC, Liu J. et al. A Synonymous Variant in IL10RA Affects RNA Splicing in Paediatric Patients with Refractory Inflammatory Bowel Disease. J Crohns Colitis. 2016;10(11):1366–1371. 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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241109EnglishN2018May5HealthcareKnowledge and Attitude of Parents Regarding their Children's Oral Health in Buraydah City of Kingdom of Saudi Arabia English0610Manar Al-ShetaiwiEnglish AbrarAl- ShetaiwiEnglish Amal Al-HarbyEnglish Suad A. SamaraEnglishBackground: Parents can help their children to sustain health oral habits, provided they themselves have good knowledge about oral disease and methods of its prevention. Aim: To assess parent’s knowledge and attitude regarding oral health of their children in Buraydah City. Method: Across-sectional study was conducted through self-administered questionnaire which was distributed to around 500 parents in Buraydah city. Information regarding, mother education, children oral habits, feeding practicesand dental preventive measures, was obtained from caregivers by self-administered questionnaire. Results: Our result showed that most parents reported that their children did not brush their teeth and they also believed that primary teeth are not as important as permanent teeth and the main reason for the child’s visit to dentist was toothache. Conclusion: This study revealed significant association between child dental visit and family preventive measure knowledge with level of education and family monthly income. EnglishINTRODUCTION: Dental caries is a worldwide pandemic [1]. It affects about 60-90% of school children, and almost 100% of adults throughout the world [2]. In Saudi Arabia, significantly high prevalence of dental caries has been reported in children, adults and older individuals[3]. Children, adults, and elderly populations demonstrate a higher prevalence and greater severity of cariesrates over the past few decades in Saudi Arabia[3]. Evidence shows that most carious lesions remain untreated, and caries is the most common cause of primary tooth extraction in the Kingdom of Saudi Arabia [4]. The main risk factors of dental caries in children are sugar-rich diet, incorrect feeding practices and abundant dental plaque. Parents are directly responsible for the dental health of their offspring and can play an important role in preventing oral diseases for their children, as they can help their children to sustain healthy oral habits[5]. Increasing parental knowledge and utilizing preventive methods, as practiced in developed countries, may lead to decreased dental caries and improved health of their children[6] In 2012, a study was conducted to assess knowledge attitudes andbelieves of parents towards oral health and dental care of their children, the study included 620 parents of one to four years old preschool aged children, The result revealed that the lack of knowledge and awareness of importance of the primary teeth, dental fear of the parents and the myths associated with dental treatment, created barriers to early preventive dental care of preschool children [7]. Another study aimed to assess the knowledge and practices of mother on prevention of dental caries of young children aged 3 to 4 years old from Bialystok, Poland the study included 140 mothers, The result show that most of mothers (95.7%) knew about the importance of regular removal of dental plaque by brushing teeth, 85.7% knew of the role of fluoride-containing toothpaste and 82.8% indicated avoiding the consumption of sweets. They were also aware that oral healthrequired regular dental visits (89.2%). Most of them (87%) knew that deciduous teeth should be treated as permanent ones, but only 65.7% were convinced that a direct relationship of the condition of deciduous and permanent dentition exists. The survey revealed a discrepancy between the knowledge of principles of dental caries prevention and their implementation ineveryday life among mothers of young children from Bialystok, Poland [5] In India Suresh et al, conducted a study to assess mother’s knowledge about the oral health in preschool aged children, the study included 406 mothers with mean age children 3.8 years, the result shows that 73.8% of mothers have a good knowledge about dietary practices, while only 27% and 25% of mother were found to have good knowledge about oral hygiene practices and the primary teeth importance respectively. The study found that mothers with high education knowledge had a better knowledge about their children's oral health[8]. Other study assessed the relationship between parental education and socioeconomic status in prevention of dental caries among Lithuanian children, the study include 1248 parents of 7, 9, and 12year-old children from 5 largest Lithuanian cities. The result showed that the parents with a high educational level and those receiving sufficient income cared about education on oral hygiene and regular preventive dental check-ups more than those with a low educational level and insufficient income [10] In the light of above mentioned facts, this study was planned to assess parent's knowledge and attitude regarding oral health of their children in Buraydah city in Kingdom of Saudi Arabia. Specific Objective of the study include: 1. To assess children's oral health habits. 2. To assess parents knowledge about feeding habits 3. To assess parents knowledge about dental preventive measures. Materials & Methods: A Cross sectional study was conducted in Buraydah city, which is the largest Governorate in Al-Qassim area. According to the general census conducted in 2010, it has an estimated population of 614,093[9]. 500 Parent's Knowledge and attitude regarding their children's oral health was assessed by self-administered questionnaire living in Al-Qassim region. Results: The statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 17. Anova test were performed, The P-value will be determined as ≤0.05 as a criterion of statistical significance with 95% confidence interval. This study included 500 parents, around 35 questionnaire was excluded due to incomplete answers. Most of participants were mothers 92% fig(1), with bachelor degree 56% fig(2), most of families with high monthly income 47% fig(3), When asking the parents about their believe if they have the most important role to guide their children in oral health care, most of parents answered yes 96% fig(19), regarding their knowledge  about  fluoride effect in prevention of dental caries most of parents answered yes 65%, while 29% don't know fig(16), significant association where found between family education level and their believe that fluoride  application can protect their child teeth from dental caries 65% answered  yes it protect while 29% they don't know, When asking about fissure sealant 54% of parents reported that they don't know about it fig(17), Regarding teeth brushing 40% answerd that their child didn't brush their teeth and only 18% brush twice daily fig(10), Furthermore when answering the questions if they know that oral health can affect their child general health most of parent answering with yes 92% fig(4), and 47% of parent don't believe that the bacteria which cause the dental caries transmitted from mother to child fig(7), Regarding the ideal age for the first dental visit most parent answered when the permanent teeth erupt 53%  while only 17% reported when the first primary teeth erupt 16% fig(13), 18% of parent answered the reasons behind  their child don't visit dental clinic, While 10% answered due to dental treatment high cost fig(15), significant association found between child dental visit and family monthly income (0.03), When asking parent if they believe that primary teeth important in their  child development 80% agree with this Fig(5), Regarding if the problem or dental caries in primary dentition may affect the permanent teeth 63% agree with this fig(6), no significant association where found between education level and the awareness of the  importance of primary teeth and their effect. When asking parents about frequent sugar consumption may cause dental caries 99% agreed with this, fig(9), and most parent reported that bed time bottle affect their child teeth 69% while 20% answered with no fig (8). Discussion: To our knowledge there is lack in studies in Saudi Arabia presenting parental knowledge and attitudes regarding the oral health. Increasing parental knowledge and utilizing preventive methods, as practiced in developed countries, may lead to decrease dental caries and improved health of their children [6]. Our study revealed significant association between child dental visit and family monthly income, which is in agreement with previous study conducted by Kristina Sald?nait? et al, reported that the parents who reported sufficient-family income scored their child's and their own health significantly better than those reporting insufficient-family income. This may be explained that children with high family income have the chance to better access to dental care, furthermore this study reported that parents with a high educational level cared more about dental  preventive measure.[10] This is in agreement with our study that showed significant association with knowledge about fluoride importance as preventive measure. Our result showed that most parents reported that their children did not brush their teeth and they didn't believe that primary teeth importance as permanent teeth and the main reason to visit dentist is toothache. Conclusion: This study revealed significant association between child dental visit and family preventive measure knowledge with level of education and family monthly income. There was significant lack of knowledge about the importance of dental care of primary teeth. Programs for Family education on proper oral health should be available for parents'. Dental health insurance would definitely encourage the parents for their child's dental treatments. Englishhttp://ijcrr.com/abstract.php?article_id=2480http://ijcrr.com/article_html.php?did=2480 Edelstein BL. The dental caries pandemic and disparities problem. BMC Oral Health 2006; Volume 6, Number Suppl 1, Page S2 World Health Organization. Oral health. Available from: http://www.who.int/mediacentre/factsheets/fs318/en/. [Last accessed on 2014 Jul 11]. Al-Ansari Asim A; Severity, and secular trends of dental caries among various Saudi populations: A literature review: 2014; Volume 2 ; Issue : 3;Page : 142-150 Bagramian RA, Garcia-Godoy F, Volpe AR. The global increase in dental caries. A pending public health crisis. Am J Dent 2009; 22:3-8 Dawidowicz A, Krajewska K, Krajewska-Kulak E, Kulikowski M, Szyszko-Perlowska A, Rolka H; Women's knowledge of health behaviors in the puerperium. Wiad Lek. 2004; 57 Suppl 1:70-3. Hashem Khan, Khalid Rahman, Ghulam  Rasool; Awareness of  parents about dental knowledge and their prevention in children. Pakistan Oral and Dental Journal Vol 29, No. 1; June 2009 Chhabra N, Chhabra A. Parental knowledge, attitudes and cultural beliefs regarding oral health and dental care of preschool children in an Indian population: a quantitative study. Eur Arch Paediatr Dent. 2012; 13(2):76-82. Suresh BS, Ravishankar TL, Chaitra TR, Mohapatra AK, Gupta V. Mother's knowledge about pre-school child's oral health. J Indian SocPedodPrev Dent. 2010;28(4):282-7 https://en.wikipedia.org/wiki/Buraidah Slabsinskiene, E. Vasiliauskien et al; The role of parental education and socioeconomic status in dental caries prevention among Lithuanian children. Medicina, 50(3), 156-161.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241109EnglishN2018May5HealthcareVariation in Beliefs Towards Low Back Pain between Physiotherapy and Nursing Students English1114Deepali ShethEnglish James GhagareEnglishVariation in beliefs towards low back pain between physiotherapy and nursing students The objective of this study was to find out the variation in beliefs between physiotherapy and nursing students towards low back pain. Method: Physiotherapy (n=100) and nursing (n=100) students from various colleges in Pune city completed the survey. Fear Avoidance Beliefs Questionnaire (FABQ) was used. The participants filled up the Fear Avoidance Beliefs Questionnaire. Result: Student Physiotherapy students had significantly lower Fear Avoidance Beliefs Questionnaire scores (p≤ 0.05) than nursing [CI 95%] students. Conclusion: Physiotherapy students had less negative beliefs towards low back pain than nursing students. EnglishBack pain, Beliefs, Physiotherapy students, Nursing studentsIntroduction: Chronic low back pain (LBP) is a serious global public health problem[1]. In fact, it is considered to be the leading cause of absence from work and limitation of activity all over the world [2]. Physicians' attitudes and beliefs regarding low back pain could potentially influence their patients' attitudes and beliefs. Indeed, ample evidence demonstrates that the clinicians' attitudes and beliefs regarding low back pain seem to affect the beliefs of their patients [3‚4].  Physicians' attitudes and beliefs also appeared to influence their recommendations regarding low back pain patients' activities and work [5, 6]. Physiotherapists and nurses also spend a lot of time with patients, so their beliefs can influence the patients' beliefs regarding back pain too.  Given the influence that healthcare practitioners have on a patient's recovery, there has been relatively little study on the attitudes and beliefs held by student healthcare professionals towards low back pain [7]. There has been some investigation into this area which has looked at student nurses and physiotherapists separately [8, 9, 10, 11]. Surprisingly, there is just one study which compares student nurses and physiotherapists[11], it showed that beliefs about the consequences of low back pain and fear avoidance behaviors were more negative in student nurses compared to student physiotherapists.  It is important to know the beliefs of physiotherapists and nurses while they are students so that they can be trained and educated regarding the same as education about back pain does have an effect on the attitudes and beliefs of healthcare students [12]. It is also important to find out whether there is any variation in beliefs towards low back pain between physiotherapy and nursing students which may lead to a difference of opinion and possibly the recovery in patients suffering from low back pain. Materials and Methods: Study design: A cross sectional survey was done amongst the physiotherapy and nursing students in Pune city who had completed at least 3rd year in their respective courses. Procedure: Ethical approval from the institutional ethical committee was taken for this study.  101 physiotherapy and 101 nursing students from different colleges in Pune city participated in this study.  Written consent was taken from each of the participant and they were explained that participation in this study was completely voluntary and that confidentiality would be maintained. They then filled up the Fear Avoidance Beliefs Questionnaire.  Statistical methods: The data collected was then analyzed using Microsoft Excel and IBM Statistical Program for the Social Sciences (SPSS) version 20.0 (SPSS Inc, Chicago, IL). Average of the Physical Activity subsection and Work Activity subsection of the questionnaire was taken out for both the groups and compared [graph 1]. The scores of both the groups were compared using the Mann Whitney test. A non-parametric 0.95 confidence interval accompanies these estimates as does the ‘p’ value of 0.00 [Tables 1, 2]. Results: Physiotherapy students had significantly lower Fear Avoidance Beliefs Questionnaire scores than nursing students [p≤ 0.05]. Hence, physiotherapy students have less negative beliefs towards low back pain than nursing students. [graph 1] Discussion: The results of this study indicate that student nurses had more negative beliefs about the inevitable consequences of low back pain, as well as displaying more fear-avoidant tendencies about physical activity in their day-to-day lives when compared to their physiotherapy counterparts.  Similar results were found in a study which reported that nursing students had significantly more negative back pain beliefs than physiotherapy students [12]. These differing attitudes and beliefs may be rooted in a number of factors, including level of pain knowledge, as physiotherapy students had a greater knowledge of chronic pain mechanisms when compared to nursing students[7]. Furthermore, this study indicates that the nursing students had significantly more negative beliefs than physiotherapy students regarding the work activity and how it might affect the individual. As more negative beliefs are observed amongst nursing students, finding out the reason for this is important.  Nurses are an integral part of the healthcare team and considering the influence a clinician has on the attitudes and beliefs of patients'‚ it is important to know their beliefs towards low back pain [15, 16].  Different methods have been used to improve the attitudes and beliefs of student healthcare professionals and general population in the past, such as campaigns on back pain [17, 18], teaching modules [19] and information booklets[20].  It has been found previously that a module devoted to low back pain helps improve the attitudes and beliefs of physiotherapy students [19], it can be investigated in the future whether this would also pertain to other healthcare degree students, especially nursing. This might not only improve the perceptions of low back pain amongst nursing students, but also, in turn, be of benefit to patients they manage in the future[7]. Limitations: Generalizability of results is a limitation of this study. Only one city in one country is represented in this study, limiting generalizability.  Confounding factors such as curricula and level of pain knowledge were not accounted for, and factors which can in turn shape the beliefs and attitudes an individual may hold about low back pain[19]. Conclusion: Results from this study show that differences exist in the beliefs of physiotherapy and nursing students toward low back pain. Physiotherapy students had less negative low back pain beliefs while nursing students had more negative beliefs.  This finding highlights the need for education for nurses to promote positive beliefs towards low back pain. Further research is required to provide evidence based recommendations of how to address these contrasting beliefs. Acknowledgements: We thank support from Dr. Rachana Dabadghav (Assistant Professor and research coordinator at Sancheti Institute College of Physiotherapy), Dr. Ashok Shyam (MS Ortho) and Dr. Parag Sancheti (Chairman of Sancheti Hospital) for their expert guidance.  The authors wish to acknowledge all the participants of this study for their co-operation, giving us their valuable time and allowing us to conduct this study. Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Lastly, I would like to make a special mention for the active technical support by my mother, Prof. Pragna Sheth and my colleague Mr. Deep Shah. Source of funding: none Conflict of interest: none Englishhttp://ijcrr.com/abstract.php?article_id=2481http://ijcrr.com/article_html.php?did=2481 Regina W. S. Sit, Benjamin H. K. Yip, Dicken C. C. Chan, Samuel Y. S. Wong. Primary Care Physicians’ Attitudes and Beliefs towards Chronic Low Back Pain: An Asian Study.  PLOS ONE 2015, DOI:10.1371/journal.pone.0117521 Hoy D, Brooks P, Blyth F, Buchbinder R (2010) The epidemiology of low back pain. Best Practice and Research in Clinical Rheumatology 24:769–781. doi: 10.3928/01913913-20150114-01 PMID: 25608279 Parsons S, Harding G, Breen A, Foster N, Pincus T, et al. (2007) The influence of patients' and primary care practitioners' beliefs and expectations about chronic musculoskeletal pain on the process of care: A systematic review of qualitative studies. Clin J Pain; 23: 91–98. PMID: 17277650 Darlow B, Fullen BM, Dean S, Hurley DA, Baxter GD, et al.(2012). The association between healthcare professional attitudes and beliefs and the attitudes and beliefs, clinical management, and outcomes of patients with low back pain: A systematic review. European Journal of Pain; 16: 3–17. doi: 10.1016/j. ejpain.2011.06.006 PMID: 21719329 Holden MA, Nicholls EE, Young J, Hay EM, Foster NE(2009) UK-based physical therapists' attitudes and beliefs regarding exercise and knee osteoarthritis: Findings from a mixed-methods study. Arthritis &Rheumatism; 61:1511–12.doi:10.1038/ki.2014.403 PMID: 25608049 Ostelo RW, Stomp-vanden Berg SG, Vlaeyen JW, Wolters PM, deVet HC (2003) Healthcare provider's attitudes and beliefs towards chronic low back pain: The development of a questionnaire. Man Ther; 8: 214–22. PMID:14559044 Norlee Kennedy, John Heasly, Kieran O’Sullivan. The beliefs of third-level health care students towards low back pain. Pain Research and Treatment 2014; 2014, Article ID 675915 P. H. Ferreira, M. L. Ferreira, J. Latimer et al.‚“Attitudes and beliefs of Brazilian and Australian physiotherapy students towards chronic back pain: a cross-cultural comparison‚” Physiotherapy Research International 2004; 9(1):13–23. S. Poiraudeau, F. Rannou, G. Baron et al.‚“Fear-avoidance beliefs about back pain in patients with subacute low back pain‚” Pain 2006; 124(3):305;11. T. Mitchell, P. B. O'Sullivan, A. Smith et al.‚“Biopsychosocial factors are associated with low back pain in female nursing students: a cross-sectional study‚” International Journal of Nursing Studies 2009; 46(5);678–88. C. Ryan, D. Murphy, M. Clark, and A. Lee ‚“The effect of a physiotherapy education compared with a non-healthcare education on the attitudes and beliefs of students towards functioning in individuals with back pain: an observational, cross-sectional study‚” Physiotherapy 2010; 96(2):144–50. A. Burnett, C. C. Sze, S. M. Tam et al., A cross-cultural study of the back pain beliefs of female undergraduate healthcare students, Clinical Journal of Pain 2009; 25(1):20–28. Esther Williamson, University of Warwick, UK, Fear Avoidance Beliefs Questionnaire(FABQ). Australian Journal of Physiotherapy 2006; 52. Waddell G, Newton M, Henderson I, Somerville D, Main CJ. A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain 1993; 52:157-168 R.M.A. Houben, R.W.J. G. Ostelo, J.W.S. Vlaeyen, P. M. J. C. Wolters, M. Peters, and S. G. M. Stomp-van Den Berg‚“Health care providers’ orientations towards common low back pain predict perceived harmfulness of physical activities and recommendations regarding return to normal activity‚” European Journal of Pain 2005; 9(2):173–83. E. Coudeyre, F. Rannou, F. Tubach et al. ‚“General practitioners’ fear-avoidance beliefs influence their management of patients with low back pain,” Pain 2006; 124(3): 330–337. D. P. Gross, R. Ferrari, A. S. Russell et al., “A population-based survey of back pain beliefs in Canada,” Spine 2006; 31(18): 2142–2145. R. Buchbinder, D. Jolley, and M. Wyatt, “Population based intervention to change back pain beliefs and disability: three part evaluation,” British Medical Journal 2001; 332(7301): 1516–1520. J. Latimer, C. Maher, and K. Refshauge, “The attitudes and beliefs of physiotherapy students to chronic back pain,” Clinical Journal of Pain 2004; 20(1): 45–50.  A. K. Burton, G. Waddell, K. M. Tillotson, and N. Summerton,, “Information and advice to patients with back pain can have a positive effect: a randomized controlled trial of a novel educational booklet in primary care,” Spine 1999; 24(23): 2484–2491.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241109EnglishN2018May5HealthcareHistopathological Pattern of Ovarian Tumours – An Experience English1521Manzoor Ahmad SofiEnglish Nusrat BashirEnglish AfshanEnglish Arvind KhajuriaEnglish Nausrat AliEnglishBackground: Ovarian neoplasms exhibit a wide variation in structure and biological behaviour. There are numerous types of ovarian tumours, and over all they fall into benign, borderline, and malignant categories. Ovarian carcinoma represents the sixth most common female cancer and the fourth leading cause of death due to cancers in women. Aims: To study the clinical presentation and pathological patterns of ovarian tumours. Materials and Methods: The clinicopathological study was at ASCOMS Sidra Jammu, in the department of pathology. This was a prospective observational study conducted over a period od 1 year (Nov 2014 to Oct 2015). Results: A total of 189 cases of ovarian lesions were studied, of which 119 were neoplastic and 70 were non-neoplastic. Maximum cases 26.1% were reported in the age group of 41-50 years. Among 70 non-neoplastic lesions, luteal cyst was commonest comprising 48.5% of total non-neoplastic lesions. Of 119 neoplastic lesions 56.3% were benign, 1.7% were borderline and 42% were malignant. Tumours were classified as per WHO classification 2003. The surface epithelial group formed the largest group constituting 74.8% of all the ovarian neoplasms, followed by germ cell tumours (16%), metastatic tumours (5.9%), sex cord stromal tumours (1.7%) and miscellaneous (0.84%). Among the individual neoplasms, serous tumours were the commonest (59.7%), followed by teratomas (13.4%). One case each of endometriod carcinoma, clear cell carcinoma, mixed epithelial carcinoma, thecoma, fibroma, yolk sac tumour, struma ovarii and lymphangioma was also reported in the present study. Conclusion: Ovary is a frequent site of primary and metastatic tumors. Due to its complex structure, primary ovarian neoplasms are of diverse histological types. Our observations and results proved to be valuable baseline information regarding patterns of ovarian tumors in our population. More studies, to define the risk factors in our population and to identify specific etiological factors, are recommended. EnglishOvarian, Histopathology, NeoplasmsIntroduction: Ovaries are paired pelvic organs that lie on either side of the uterus close to lateral pelvic wall, behind the broad ligament and anterior to the rectum1. During the reproductive period, there average size is 4 X 2 X 1 cm, and there average weight is 5 to 8g; after menopause, they shrink to one half or less of this size2. Ovarian neoplasms exhibit a wide variation in structure and biological behaviour3.  There are numerous types of ovarian tumours, and over all they fall into benign, borderline, and malignant categories4. Benign ovarian cysts may occur at any point in life but they are most common during childbearing age and constitute about 90% of ovarian tumours. These occur mostly in young women between the ages of 20 and 45 years, borderline tumours occur at slightly older ages. Malignant tumours are more common in older women, between the ages of 45 and 65 years5. Ovarian carcinoma represents the sixth most common female cancer and the fourth leading cause of death due to cancers in women6. It varies widely in frequency among different geographic regions and ethnic groups, with a high incidence in Northern Europe and low incidence in Japan7. In United States it accounts for 4% of all cancer in women and 5% of estimated cancer deaths.  In Eastern India, the fourth most frequent reported malignancy in females was ovarian8. Asian countries and Japan have rates of 2–6.5 new cases per 100,000 women per year 9.   The majority of cases are sporadic, and only 5-10% of ovarian cancers are familial7. A number of epidemiologic studies have evaluated a variety of risk factors for ovarian tumour. To date, these risk factors include: age´ chronic inflammation and non-steroidal anti-inflammatory drug (NSAID) use, diet, ethnicity, hysterectomy, infertility, drug use, obesity, low parity, smoking, and talc use/asbestos exposure. Use of combined oral contraceptive pills is a protective factor. According to the National Cancer Institute (NCI), a woman without a family history of ovarian cancer has a 1 in 55 lifetime chance of developing ovarian cancer10. This risk increases 10-fold when known familial/hereditary conditions exist11. As such, patients with a history suspicious for a hereditary breast-ovarian cancer syndrome (BRCA1 or BRCA2) or hereditary nonpolyposis colorectal cancer syndrome, are at increased risk for development of a malignant mass12. Early diagnosis of ovarian tumours is a challenge to the gynaecologists, mainly due to the fact that symptoms in early disease are vague and non-specific5.  Although some of the specific tumours have distinctive features and are hormonally active, most are non- functional and symptom free with non-specific signs until they attain a large size7. By the time an ovarian malignancy is diagnosed, about two-thirds of these have already become far advanced3. The present study is undertaken to study the frequency and diverse histomorphological patterns of ovarian lesions in this part of region. This information will hopefully help in arriving at specific diagnosis which will improve the quality of treatment and prognosis of the patient. Materials and methods: This clinicopathological study was conducted at ASCOMS sidhra Jammu, J and in the Department of Pathology. This was a prospective observational study conducted over a period of 1year (Nov,-2014- Oct , 2015). Inclusion  criteria All the specimens of ovarian lesions both neoplastic as well as non-neoplastic were included. The detailed clinical information of all of these patients was collected as per the pro-forma. Methodology             The specimens obtained after surgical exploration of patient were examined  grossly and then sectioned by conventional method after overnight fixation by 10% formalin. Gross photographs of the specimens were taken to represent various tumour types. Minimum of four sections from the tumour were taken. The tissue was processed as per standard procedure. The lesions were studied and classified as per the WHO classification of ovarian tumours (2003). Microphotographs of tumours were taken to represent various histological variants of ovarian tumours. Results: The present study was a one year prospective observational study conducted in the Department of Pathology at ASCOMS Jammu  from Nov 2014 to Oct , 2015. A total of 189 cases of ovarian lesions were studied, of which 119 were neoplastic and 70 were non-neoplastic. Of the 119 neoplastic ovarian specimens evaluated, 67 (56.30%) harboured benign ovarian tumour; 2 cases (1.70%) were having borderline tumours whereas 50 cases (42.0%) had malignant lesions. (Table-1). The ages of patients ranged from 1 month to 70 years. Maximum cases, 31 (26.1%) were reported in the age group of 41-50 years. Malignant tumours presented in higher age group than benign tumours. 58.2% of benign ovarian neoplasms were seen in patients less than 40 years of age where as 58% of malignant neoplasms were seen in patients more than 40 years of age. Non-neoplastic lesions occurred in all groups but majority occurred in the age group of 20-40 years, accounting for 68.6%. The commonest symptom with which the patients presented was abdominal pain/discomfort, 77 cases (64.7%). Abdominal swelling/distension was present in 64 patients (53.8%). Ascites was seen in 26 patients (21.8%). All the cases with ascites were associated with malignancy except for one benign mucinous cystadenoma (Fig-1a,Fig1b) which had ruptured. Associated menstrual disturbances in the form of amenorrhea, polymenorrhea, dysmenorrhea and metrorrhagia were seen in 8.4% of cases. (Table-2). Among non-neoplastic cases majority, 30 (42.6%) were asymptomatic and came to attention when being investigated for an unrelated condition. Among the symptomatic cases majority presented with pain (40%) followed by Pain with menstrual irregularity (8.6%). The occurrence of ovarian tumour is more among nulliparous (25.2%) and those with parity of less than 3 (49.6%) as compared to those with parity of more than three (25.2%). Out of 119 cases 101 cases (84.9%) had unilateral involvement. Of these, right sided tumours, 71 cases (59.7%) were more common than left sided tumours, 30 cases (35.7%). There were 18 cases (15.1%) which were having bilateral ovarian involvement. Among the benign tumours 63 cases (94.0%) were unilateral and 4 cases (6%) were bilateral. Thirty six (72%) malignant tumours had unilateral involvement with 25 cases (50%) showing right sided involvement. Bilateral involvement was seen in 14 cases (28%). The frequency of bilateral tumours was more for malignant tumours i.e. 14 cases (11.8% of all the ovarian neoplasms) while 4 cases (3.4% of all ovarian neoplasms) were benign. For non –neoplastic lesions majority of the  cases, 88.6%, were unilateral. About 60% of the total non-neoplastic tumours were on the right size and 28.6% were on the left. Bilateral tumours comprised 11.4% of the total non-neoplastic lesions.             Most commonly occurring malignant lesion was serous cystadenocarcinoma (7 cases), comprising 38.9% of bilateral ovarian neoplasms. The most common benign lesion was benign serous cystadenoma (2 cases), comprising 11.1% of bilateral ovarian neoplasms. On gross examination tumours ranged in size from 1 to 30 cm with majority, 76 (63.8%) falling in the range of 1-10 cm. The smallest tumour measured 1X1X1cm in size and was diagnosed as benign serous cystadenoma. The largest tumour measured 30x25x22 cm and was reported as benign mucinous cystadenoma (Fig 2a,Fig 2b). Out of 119 neoplastic lesions 49.6% were cystic neoplasms, 16.8% were solid and 33.6% showed mixed consistency. Among non –neoplastic tumors 94.3% of the cysts ranged in size from 1-10 cm. Minimum size of the tumour was 2.5 cm and maximum was 15 cm. Tumours arising from the surface epithelium formed the largest group, 89 cases comprising 74.8% of total ovarian neoplasms. These were followed by 19 cases of Germ cell tumours (16.0%). 2 cases (1.7%) were reported as sex cord stromal tumour.  7 cases (5.9%) of metastatic ovarian tumour were also reported. Benign surface epithelial tumours constituted 73.1% of all benign neoplasms and its malignant counterpart constituted 76.0% of all malignant neoplasms. Table-3 shows detailed analysis of  histopathological pattern of ovarian neoplasms in our study as per WHO system (2003). Discussion:             The ovary is a frequent site for both primary and metastatic tumours. Due to its complex structure, the neoplasms arising from the ovary inherit a wide spectrum of histogenesis, clinical behaviour and histological types. In recent years, WHO (2003) has proposed a classification for tumours of the ovary based upon its histogenesis. Wider application of this classification has made the clinicopathological data more meaningful.             The observations and analysis of the present study provide a fair insight into the clinical presentation and histopathological pattern of ovarian tumours. The current study presents the data on 189 consecutive cases of ovarian lesions diagnosed in the Department of Pathology, from a tertiary care centre  over a period of 1year (Nov , 2014 to Oct , 2015) Out of 189 cases of ovarian lesions studied, 119 were neoplastic and 70 were non-neoplastic. Out of 119 neoplastic ovarian lesions, 67 i.e. 56.30% were labelled as benign, 2 i.e. 1.7% as borderline and 50 i.e. 42.0% as malignant.              Present study is comparable to the studies done by Gupta SC, et al (1986) 21 and Ahmed Z, et al 13. Yasmin S, et al (2008) 14reported lesser incidence of malignant tumours as compared to present study.             In the present study patients ranged in age from 1 month to 70 years, with peak incidence in 3rd and 4th decade i.e., 51 cases (42.8%).             Our study is in concordance with study done by Pilli,et al (2001) 15 and Ramchandran G,et al (1972) 16 where incidence of ovarian neoplastic lesions was more common in 21-40 years of age group.  Kar T,et al (2005) 17 reported highest incidence of ovarian tumours in 41-60 years of age group.             Age distributions among benign borderline and malignant ovarian tumours seen in the present study were compared with other studies.  In our study, the majority of benign tumours occurred in the age group of 20-39 years.  This finding is consistent with the studies by Ramachandran G, et al16 and Mehta and Purandare 18.             Majority of the malignant tumours in the current study were seen in the age group of 40-60 years which is comparable to study done by Ramachandran G, et al  16, Mehta and Purandare (1964) 18 and Arab M, et al 19. Commonest mode of presentation in our study was  abdominal discomfort / pain i.e. 64.7%.  Abdominal distension/swelling was observed in 52.0% of patients.  Many of the patients had a combination of symptoms. Other symptoms observed were menstrual disturbances, gastrointestinal symptoms and urinary symptoms             Our study concorded well with studies done by Pilli, et al   15and Yasmin S, et al 14  where pain abdomen was the commonest symptom followed by abdominal mass. Ascites was seen in 21.8% of patients.  Similar observation was also made in the above mentioned studies. Out of total 119 cases in our study, 101 were unilateral and 18 were bilateral.           The present study is concordant with the study done by Prabhakar and Maingi 20.  Among unilateral neoplasms right sided lesions(59.7%) were more common compared to left sided tumours. The results were comparable with the study done by Ramachandran G, et al   16 who reported 46.04% incidence of right sided lesions.             Out of 18 bilateral cases, 14 (77.8%) were malignant and 4 ( 22.2%) were benign.  None of borderline tumour was bilateral. This is comparable to the findings of former workers. In the study done by Prabhakar and Maingi 20  75.9% of bilateral ovarian neoplasms were malignant. These observations indicate a greater association of bilaterality with malignant tumours than with benign or borderline tumours.             Histologically, 119 neoplastic ovarian lesions were classified according to WHO classification.  Relative percentage of different histological types of ovarian tumours compared with other studies is shown in the table             Present study conforms to the patterns observed by Kar T, et al 17, Pilli,et al  15 , and less with Gupta SC, et al 21 who comparatively reported higher incidence of germ cell tumours.             In the present study, out of 119 neoplastic lesion 59% (49.6%) were cystic, 20 (16.8%) were solid and 40 (33.6%) had mixed consistency.              Observations in the present study are closer to those made by Couto F22 than with those made by Gupta SC, et al (1986)21             Majority of the benign tumours had cystic consistency (88.1%) and majority (64%) of malignant neoplasm had mixed consistency. Among the individual neoplasms, serous tumours were the commonest (59.7%), followed by teratomas (13.4%), mucinous tumours (12.6%),metastatic tumours (5.9%) and dysgerminomas (1.7%). One case each of endometriod carcinoma, clear cell carcinoma, mixed epithelial carcinoma, thecoma, fibroma, yolk sac tumour, struma ovarii and lymphangioma (Fig-4) was also reported in the present study. Table 4 shows relative percentage of different histological types of ovarian tumours in different studies and present study. . Among 70 non-neoplastic lesions, luteal cyst was commonest comprising 48.5% of total non-neoplastic lesions. Follicular cyst comprised 34.3% and endometriotic cysts comprised 17.1% of non-neoplastic lesions.  CONCLUSION  Ovary is a frequent site of primary and metastatic tumors. Due  to its  complex structure ,primary ovarian neoplasms are of  diverse histological types. Our observations and results proved to be valuable baseline information regarding patterns of ovarian tumors in our population. More studies, to define the risk factors in our population and to identify specific etiological factors are recommended. Englishhttp://ijcrr.com/abstract.php?article_id=2482http://ijcrr.com/article_html.php?did=2482 Kurman RJ, Ellenson LH and Ronnett BM. Bluestein's pathology of the female genital tract. 6th edition. Springer New York Dordrecht Heidelberg London. 2011. Rosai and Ackerman’s Surgical Pathology. 10th edition, Elsevier.2011. P.1553-1606. Howkins & Bourne. Shaw’s Text Book of Gynaecology, 15th.  Elsevier, A division of Reed Elsevier India Pvt. Ltd.,2011. Chapter 28,29:  p. 367-431. Ellenson LH, Edyta C and Pirog. The female genital tract. Robbins and Cotran Pathologic Basis of Disease. 8th edition., Elsevier, A division of Reed Elsevier India Pvt. Ltd., 2010. Chapter 22: p. 1005-1063. Wasim T, Majrroh A, Siddiq S. Comparison of clinical presentation of Benign and Malignant Ovarian Tumours. J Pak Med Assoc.2009;59: 18-21. Tortolero L, Mictchell FM, Rhodes HE. Epidemiology and screening of ovarian cancer. Obstetric Gynecologic Clin North Am 1994;21: 63-75 Holschneider CH and Berek JS. Ovarian cancer: Epidemiology, biology, and prognostic factors. Seminars in Surgical Oncology. 2000;19:  3-10. Sen U, Sankaranarayanan R, Mandal S, Ramanakumar AV, Parkin DM, Siddiqi M. Cancer  patterns in Eastern India:  The first report of Kalkata Cancer Registry. Int J Cancer 2002; 100: 86-91. Murad A. Ovulation induction and ovarian tumours: the debate continues. J Pak Med Assoc  1998 ;48:353-6. Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner M-J, editors. SEER Program, NIH Pub. No. 07-6215. National Cancer Institute; Bethesda, MD: 2007. SEER Survival Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988-2001, Patient and Tumour Characteristics. Pike MC, Pearce CL, Peters R, Cozen W, Wan P, Wu AH. Hormonal factors and the risk of invasive ovarian cancer: a population-based case-control study. Fertility and Sterility. 2004; 82 186–95 Elit L, Esplen MJ, Butler K, Narod S. Quality of Life and Psychosexual Adjustment after Prophylactic Oophorectomy for a Family History of Ovarian Cancer. Familial Cancer. 2001; 1: 149–56. Ahmed Z, Kayani N, Hassan SH, Muzaffar S, Gill MS. Histological patterns of ovarian neoplasms. J Pak Med assoc.2000;50: 416-9. Yasmin S, Yasmin A, Asif M: Clinicohistological pattern of ovarian tumours in Peshawar Region. J Ayub Med Coll Abbottabad 2008; 20: 11-13. Pilli GS, Suneeta KP, Dhaded AV, Yenni W: Ovarian tumours. A study of 282 cases. J Indian Med Assoc. 2002; 100 : 420,423-24, 447. Ramachandran G, Harilal KR, Chinnamma K, Thangavelu H. Ovarian neoplasms- A study of 903 cases. J Obstetric Gynecologic India. 1972;22: 309-315. Kar T, Kar A, Mohapatra P C. Intra-operative cytology of ovarian tumours. 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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241109EnglishN2018May5HealthcareA Study on Comparision of Diagnostic Efficiency between Modified Alvarado Score and Graded Compression Ultrasonography in the Case of Acute Appendicitis English2226Malay Kumar BarmanEnglish Kaustav DasEnglish Koel MukherjeeEnglishBackground: Several diagnostic aids have been developed to improve diagnosis in suspected acute appendicitis. Modified Alvarado Score includes signs and symptoms associated with ones degree of clinical suspicion. Graded Compression Ultrasonograpy is used in many institutions to aid the diagnosis of acute appendicitis. Aim: The aim of present study is to compare and evaluate diagnostic accuracy of Modified Alvarado Score and Graded Compression Ultrasonography in co-relation to histopathology report for diagnosis of acute appendicitis. Methodology: A cross-sectional study of 75 patients who underwent appendectomy for suspected acute appendicitis have been considered and were evaluated by Modified Alvarado Score and Graded Compression Ultrasonography, which was correlated with histopathological findings. Result: Out of 75 patients, 29 patients (38.66%) had acute appendicitis. In the present study, modified Alvarado Score has sensitivity of 76.86%, specificity 82.61%, positive predictive value 73.33%, negative predictive value 84.44%, diagnostic accuracy 80.0%, false positive error rate 17.39% and false negative error rate 24.11%. Graded Compression Ultrasonography has sensitivity of 82.76%, specificity 89.13%, positive predictive value 82.76%, negative predictive value 89.13%, diagnostic accuracy 86.67%, false positive error rate 10.87% and false negative error rate 17.24%. Conclusion: From the findings, the present study intended to conclude that it is highly clinically suggestive that the Modified Alvarado Score should be combined with Graded Compression Ultrasonography for better diagnosis of acute appendicitis. EnglishModified Alvarado Score, Graded Compression Ultrasonography, Acute appendicitisINTRODUCTION Abdominal pain is the primary presenting complaint of patients with acute appendicitis.1,2,3 The diagnostic sequence of colicky central abdominal pain followed by vomiting with migration of the pain to the right iliac fossa was first described by Murphy but may only be present in 50% of patients.4,2 It may progress to perforation which is associated with higher morbidity and mortality.5 Hence, surgeons are inclined to operate when diagnosis is probable rather than to wait till it is certain.6 Acute appendicitis is the most common cause of acute surgical abdomen with a lifelong risk of 7%.7 Despite its high incidence, classic clinical and laboratory findings usually allow for diagnosis which is not so easy due to atypical and frequently confusing presentation which leads to misdiagnosis.8 Therefore, diagnosis of Acute Appendicitis remains challenging despite improvement in history taking, clinical examination, and new computer aided decision support system, clinical diagnostic sourcing and new imaging technique.             Several different approaches have been developed to improve diagnosis in suspected acute appendicitis and to decrease negative appendectomies (removal of normal appendix in patients with other causes of abdominal pain) such as predictive scoring system, computer aided diagnosis, inflammatory marker, and computed tomography.9, 10, 11 Graded Compression Ultrasonography in diagnosis of acute appendicitis has greatly improved the ability to diagnose acute appendicitis with ultrasound, was first described in 1986 by J.B. Puylaert.11, 12, 13 It plays an important role in reducing the number of negative surgical exploration for acute appendicitis. Modified Alvarado Scoring system is a dynamic one allowing observation and critical evaluation of the clinical.14, 15, 16, 17 Its application improved diagnostic accuracy and reduces negative exploration and complication rates.18 The description of modified Alvarado scoring system was introduced in 1994 has greatly improved ability to diagnosis.19 OBJECTIVE To compare and evaluate diagnostic accuracy of Modified Alvarado Score and Graded Compression Ultrasonography in co-relation to histopathology report for diagnosis of acute appendicitis. METHODOLOGY The present study was a cross sectional study conducted in the Department of Surgery, North Bengal Medical College and Hospital during the period of April 2013 to August 2014. Total 75 Patients with age group 15-50 years, suspected clinically acute appendicitis and undergone appendicectomy in North Bengal Medical College, Siliguri were selected for the study. The clinical diagnosis of acute appendicitis was done by consultants of Department of Surgery, North Bengal Medical College and Hospital, Siliguri thorough evaluation of clinical details, investigation and Graded Compression Ultrasonography. The subjects were informed about the purpose of the study and the necessary ethical clearance has been obtained from ethical committee of the hospital before commencement of the present study. Then depending on the clinical details and investigation, Modified Alvarado Score has been administered which is as follows: 20 Modified Alvarado Score more than or equal to 7 were considered as acute appendicitis i.e. positive and scores less than or equal to 6 were considered as negative. On the other hand, the Graded Compression Ultrasonography findings were divided in two groups such as ultrasonography positive and ultrasonography negative.             True positive, true negative, false positive and false negative cases were obtained through Modified Alvarado Score, Graded Comparison Ultrasonography and histopathological report. Sensitivity, specificity, positive predictive value, diagnostic accuracy etc were calculated and compared between Modified Alvarado Score and Graded Comparison Ultrasonography. RESULTS: Total 75 patients were considered for the present study. The table No. 1 demonstrated sex distribution of studied population. Total number of cases in the present study were 75, out of which, 45(60%) were male and 30 (40%) were females. In the present study, the total number of patients has been categorized into four age groups, such as 15-20yrs, 20-30yrs, 30-40yrs and 40-50yrs. Maximum number of patients (50.66%) belonged to the age group 20-30yrs followed by the age group 30-40yrs (32%). Among the studied population, age group 40-50yrs exhibited minimum number of patients (4%). The table No. 3 demonstrated the histopathological findings of the present study where out of 75 patients undergone appendectomy, 29 (38.66%) were histologically positive for acute appendicitis and 46 (61.33%) were histologically negative. All the 75 patients were assigned modified Alvarado Score among which 40.00% were positive (≥ 7) and 60.00% were negative (≤ 6). In addition to that out of 30 Modified Alvarado score positive cases, 22 (73.33%) were histologically positive and 8 (26.66%) were negative. In the remaining 45 Modified Alvarado Score negative cases, 7 (15.55%) were histologically positive and 38 (84.44 %) were negative. In the present study all the patients were undergone for ultrasonography. Out of which 29 (38.66%) were sonographically positive cases and 46 (6) were sonographically negative cases which indicated more negative cases than sonographically positive cases. In the present study out of 29 sonographically positive cases, 24 (82.75%) were histologically positive and 05 (17.24%) were negative. In the remaining 46 sonographically negative cases 05 (10.86%) were histologically positive and 41 (89.13%) were negative. In the present study, Modified Alvarado Score has sensitivity of 76.86%, specificity 82.61%, positive predictive value 73.33%, negative predictive value 84.44%, diagnostic accuracy 80.00%, false positive error rate 17.39% and false negative error rate 24.11%. Graded Compression Ultrasonography had sensitivity of 82.76%, specificity of 89.13%, positive predictive value of 82.76%, negative predictive value of 89.13%, diagnostic accuracy of 86.67%, false positive error rate of 10.87%, and false negative error rate of 17.24%. The sensitivity of Graded Compression Ultrasonography is less than specificity, because of number of false negatives, some of which cannot be controlled (poor tolerance by the patient, obesity, presence of gas and unusual location of appendix).   DISCUSSION: The results of the present study have demonstrated evaluation of Alvarado Score and Ultrasonographic data separately and at the end comparison between these two diagnostic tool in case of acute appendicitis has been presented. When the results of present study are compared with contemporary studies, 21, 20 we observed that sensitivity, specificity, positive predictive value and negative predictive value are in corroboration with these studies. Whereas when compared with few other studies of Al-Hashemy et al; 22 Sooriakumaran et al 23 findings of low sensitivity have been found as these studies were retrospective studies. The present study has shown better sensitivity, as it is a cross sectional study and short comings of retrospective study are ruled out like good documentation is needed, lack of recording of Modified Alvarado Score may indicate in complete recording in case notes of some patients rather than true absence of Modified Alvarado Score finding. A meta analysis showed high sensitivity and specificity of Graded Compression Ultrasonography in diagnosis of acute appendicitis.24 Ultrasonographic data of the present study are compared to other research works where it was seen that sensitivity, specificity, positive predictive value and diagnostic accuracy of the present study is almost corroborative with those studies. 25, 26, 27 Furthermore, in present study, when Modified Alvarado Score and Graded Compression Ultrasonography were compared in terms of sensitivity, specificity, positive predictive value, diagnostic accuracy and false negative cases the results are almost same. Therefore, the result showed that neither one is significantly advantageous. Thus Modified Alvarado Score is a useful tool in clinical decision making especially when Graded Compression Ultrasonography is unavailable. As imaging technique is considered to be expensive in India, Scoring system should be used in selection of patients for further work-up. Ultrasound is unnecessary when ones degree of clinical suspicious is high. However the additional information provided by graded compression ultrasound does improve diagnostic accuracy in case of negative or equivocal Modified Alvarado Score. In the view of the finding of the present study, it can be said that the use of Graded Compression Ultrasonography along with Modified Alvarado Score will be most useful in increasing the diagnostic accuracy of acute appendicitis. It would be interesting to compare the assessment of these patients using Modified Alvarado Score one group and another group as Modified Alvarado Score combined with Graded Compression Ultrasonography in future study. CONCLUSION Thus it can be concluded that establishing diagnosis in cases of suspected acute appendicitis might require a combination of different diagnostic tools such as Modified Alvarado Score, investigative modalities such as ultrasonography and the indispensible clinical judgement. In other words, the Modified Alvarado Score should be combined with ultrasonography for the diagnosis of acute appendicitis. But nothing can replace careful evaluation by an experienced surgeon. ACKNOWLEDGEMENTS Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Authors are grateful to the participants for their kind cooperation. SOURCE OF FUNDING             Nil CONFLICT OF INTEREST None declared.   Englishhttp://ijcrr.com/abstract.php?article_id=2483http://ijcrr.com/article_html.php?did=2483 Hisham MFS. Cardiothoracic surgical critical care: Principles, goals and direction. Int. J Surg 2012; 10(3): 111-14. Humes DJ, Simpson J. Acute appendicitis. BMJ 2006; 333(7567):530-34. http://doi.org/10.1136/bmj.38940.664363.AE Andy P. Diagnosis of acute appendicitis. Int. J Surg 2012; 10: 115-19. Murphy J. Two thousand operations for appendicitis, with deductions from his personal experience. Am J Med Sci 1904; 128: 187-211. Cueto García J, Ribé Bello J, Giorgiana LA, Cervantes Llaca C. Morbidity and mortality of appendicitis. Rev Gastroenterol Mex 1977 (Sep-Dec); 42(3):126-38. Hoffmann J, Rasmussen O. Aids in the diagnosis of acute appendicitis. Br J surg 1989; 76:774-79. Hardin DM. Acute Appendicitis: Review and update. Am Fam Physician 1999; 60:2027-34. Becker T, Kharbanda A, Bachur R. Atypical clinical features of pediatric appendicitis. Acad Emerg Med 2007; 14(2):124-29. Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 1986; 15: 557-64. Shoshtari MHS, Askarpour S, Alamshah M, Elahi A. Diagnostic value of Quantitative CRP measurement in patients with acute appendicitis. Pak J Med Sci 2006; 22:300-03. Puylaert JB. Acute appendicitis: US evaluation using graded compression. Radiology 1986; 158(2);355-60. Jeffrey RB, Laing FC, Lewis FR. Acute appendicitis: High-resolution real-time US findings. Radiology 1987; 163: 11-14. Ramachandran P, Sivit CJ, Newman KD, Schwartz MZ. Ultrasonography as an adjunct in the diagnosis of acute appendicitis: A 4-year experience. J Pediatr Surg 1996; 31:164-69. Ohle R, O'Reilly F, O'Brien KK, Fahey T, Dimitrov BD. The Alvarado score for predicting acute appendicitis: a systematic review. BMC Med 2011; 9: 139. http://doi.org/10.1186/1741-7015-9-139 Soomro AG, Siddqui FG, Abro AH, Abro S, Shaikh NA, Memon AS. Diagnostic accuracy of Alvarado scoring system in acute appendicitis. J Liaquat Univ Med Health Sci 2008; 7: 93-96. Khan I, Rehman AU. Application of Alvarado scoring system in diagnosis of acute appendicitis. J Ayub Med Coll Abbotababad 2005; 17: 41-4. Limpawattanasiri C. Alvarado score for the acute appendicitis in a provincial hospital. J Med Assoc Thai 2011; 94: 441-48. Memon ZA, Irfan S., Fatima K., Iqbal M.S., Sami W. Acute appendicitis: Diagnostic accuracy of Alvarado scoring system. Asian J Surg 2013; 36(4): 144-49. Kalen M, Rich AJ, Talbot DR, Canlitie WJ. Evaluation of modified Alvarado score in the diagnosis of acute appendicitis. A prospective study. Ann R ColI Surg Engl 1994; 76: 418-9. Bhattacharjee PK, Chowdhary T, Roy D. Prospective evaluation of modified Alvarado score for diagnosis of acute appendicitis. JIMA 2002; 100(8): 310-12. Sabiston, David C, Townsend, Courtney M, eds. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. Philadelphia, PA: Elsevier Saunders, 2012. Print. Al-Hashemy AM, Seleem MI. Appraisal of the modified Alvarado score for acute appendicitis in adults. Saudi Med J 2004; 25(9): 1229-31. Sooriakumaran P, Lovell D, Brown R. A comparison of clinical judgment vs the modified Alvarado score in acute appendicitis. Int. J Surg 2005; :3 59-62. Orr RK, Porter D, Hartman D. Ultrasonography to evaluate adults for appendicitis;Decision making based on metanalysis and probabilistic reasoning. Acad Emerg Med 1995; 2: 644-50. Skaane P, Amland PF, Nordshus T, Solheim K. Ultrasonography in patients with suspected acute appendicitis. A prospective study. Br J Radio 1990; 63: 787-93. Tarjan Z, Mako E, Winternitz T, Kiss I, Kalman A. The value of ultrasonic diagnosis in acute appendicitis. Orv Hetil 1995; 136: 713-17. Chan I, Bicknell GS, Graham M. Utility and diagnostic accuracy of sonography in detecting Appendicitis in a community Hospital. AJR 2005: 184; 1809 -12.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241109EnglishN2018May5HealthcarePregnancy Induced Hypertension: A Study on Its Multisystem Involvement English2732Karanpreet BhutaniEnglish Chittranjan VijEnglish Manjeet KaurEnglish Gurdeep Kaur BediEnglishObjectives: To evaluate and compare Renal, Hepatic and Coagulation profiles in normotensive pregnant females at 20 weeks or more gestation and in cases of Pregnancy induced Hypertension at same gestation. Methods: The study was conducted on 100 pregnant females divided into two groups of 50 each: cases of PIH (Study group) and normotensive pregnant females (Control group) and all these females were at 20 weeks or more gestation. Blood sample was collected at the period of gestation when they attended Gynaecology OPD at Rajindra Hospital, Patiala. Blood Urea, S. Creatinine, S. Uric Acid, S. Transaminases and Platelet count were evaluated and compared. Results: The mean Blood Urea was 25.92±6.16 mg% (study group) compared to 24.60±3.21 mg% (control group) (p=0.1823). The difference did not attain statistical significance. The mean S. creatinine was 1.05±0.19 mg% (study group) compared to 0.71±0.20 mg% (control group) (pEnglishPregnancy induced hypertension, Renal, Hepatic, Coagulation ProfilesINTRODUCTION Pregnancy is a physiological process. To supply adequate nutrition to the growing fetus, maternal physiological adjustments of different organ systems occur in pregnancy. The adjustments are circulatory, metabolic and hormonal.[1] The term ‘Pregnancy induced hypertension' (PIH) is defined as the hypertension that develops as a direct result of the gravid state.[2] Pre-Eclampsia is a multisystem disorder of unknown etiology characterized by development of hypertension to the extent of 140/90 mm Hg or more with proteinuria after the 20th week in a previously normotensive and non-proteinuric patient with or without pathological oedema.[2] In addition to the elevated blood pressure and proteinuria, women with pre-eclampsia often have signs or symptoms indicating dysfunction of any of several organ systems, including the renal, gastrointestinal, coagulation and central nervous system. Cardiac complications are rare but heart failure may occur generally in women with preexisting heart disease. [3] Involvement of the renal system is characteristic of pre-eclampsia and the presence of proteinuria is part of the definition of this disorder. With increasing severity of disease, creatinine clearance declines; acute tubular necrosis and frank renal failure may occur. [3] Pathologic changes in the liver in woman with pre-eclampsia reflect ischemic damage. Transaminases elevation indicate hepatocellular necrosis. [3] Hematological manifestations which include Low platelet counts may complicate pre-eclampsia. Microangiopathic hemolytic anaemia may be present and is believed to be secondary to endothelial damage.[3] Pregnancy induced hypertension continues to be a major obstetric problem in present day healthcare practice. It presents a great medical dilemma because it affects not only maternal health but also puts foetal development at risk.[ 4] So in the background of altered renal, hepatic and hematological manifestations being potential risk factors for occurrence of PIH, the present study aims to evaluate and compare blood urea, S. creatinine, S.uric acid, Serum Transaminases (AST/ALT) and Platelet count in patients with PIH and normal pregnancy so that monitoring of blood parameters gives an indication on the severity and progress of the disease. MATERIALS AND METHODS The present study was conducted in the Department of Biochemistry, Government Medical College, Patiala on 100 pregnant females who were at 20 weeks or more gestation and were referred by the Department of Obstetrics and Gynaecology, Rajindra Hospital, Patiala. The study protocol was approved by the ethical committee of GMC, Patiala. Informed consent was taken from individual subjects. Study group: It comprised of 50 pregnant females at 20 weeks or more gestation with Pregnancy induced hypertension. The criteria to diagnose pre-eclampsia was Blood pressure ≥ 140/90mmHg after 20 weeks' gestation and Proteinuria > 300 mg/24 hours or ≥1+ dipstick as per National High Blood Pressure Education Program Working Group. Control group: It comprised of 50 normotensive pregnant females at same gestation with no proteinuria and without any other systemic disease. Exclusion Criteria: All cases of previous history of essential hypertension or chronic hypertension, known cases of renal, hepatic or any other systemic disorders. Specimen collection: 5 ml Blood sample was collected from these patients by venipuncture when they attended OPD at Rajindra Hospital, Patiala. The serum was then separated by centrifugation of the sample at room temperature and supernatant was taken in a separate test tube. This serum was then used for analysis of blood urea, S. creatinine, S.uric acid, serum transaminases which include Aspartate transaminase (AST) and Alanine transaminase (ALT) and platelet count in the laboratory. Methodology: Blood urea was done using Berthelot’s method [5], S. creatinine by Method of Brod and Sirota [6], S. Uric acid was done by colorimetric method of Caraway [7], AST/ALT using IFCC Kinetic method [8] and Platelet count using Newbauer counting chamber. [9] Statistical analysis : It was done by student’s t-test using SPSS version 10.0 RESULTS: Table 1 shows demographic characteristics of both the study and control groups. The mean age and period of gestation were comparable n both the groups. The mean SBP and DBP were significantly higher in the study group compared to the control group. The mean Blood Urea in the study group was 25.92±6.16 mg% compared to 24.60±3.21 mg% in the control group (p=0.1823). The difference did not attain statistical significance. The mean S. creatinine in the study group was 1.05±0.19 mg% compared to 0.71±0.20 mg% in the control group (pEnglishhttp://ijcrr.com/abstract.php?article_id=2484http://ijcrr.com/article_html.php?did=2484 Kumar, A., Ghosh, B.K. and Murthy, N.S. Maternal thyroidal status in preeclampsia. Indian J. Med. Sci., 2005; 59: 57-63. Dutta DC, Konar H (editors). Textbook of Obstetrics including perinatology and contraception. 6th Edition New Central Book Agency (P) Ltd. Calcutta. 2004; 221-222. Dutta DC, Konar H (editors). Textbook of Obstetrics including perinatology and contraception. 6th  Edition New Central Book Agency (P) Ltd. Calcutta. 2004; 221-22 Solomon CG and Seely EW. Hypertension in pregnancy. Endocrinol Metab Clin North Am 2006;35 (1):157-71,vii. Bellany L, Casas JP, Hingorani AD, Williams DJ. Preeclampsia and risk of cardio-vascular diseased cancer in later life: systematic review and meta-analysis. Br Med J 2007;335:97 Henry RJ. Clinical Chemistry. Principles and Techniques. New York : Harper and Row Inc. New York 1964;4:268. Brod J and Sirota JH. Renal clearance of endogenous creatinine in man. J Clin Invest 1948;27:645 Varley H. Non-Protein Nitrogen. In: Practical Clinical Biochemistry. 1980;5 (1):451-48 Moss DW and Henderson AR. Tietz Textbook of Clinical Chemistry. Burtis CA, Ashwood ER, eds. Philadelphia. Saunders and Company 1999;3:652. Jain KA. Determination of Platelet count. In: Manual of Practical Physiology. Avichal Publishing Company 2000;60-61. Vibha C, Krishna CSM, Mahadevappa KL. Lipids and Lipoprotein (a) [Lp(a)] in pregnancy Induced Hypertension. International Journal of Basic Medical Science 2011;2(2):73-77. Vural P, Akgul C, Canbaz M. Calcium and Phosphate Excretion in Preeclampsia. Turk J Med Sci 2009;30:39-42. Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY. Pregnancy Hypertension. In: Williams Obstetrics. McGraw-Hill 2010b;23(34): 706-56. Sibai BM. Hypertension. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics - Normal and Problem Pregnancies. Philadelphia, Pa: Elsevier Churchill Livingstone 2007;5:33. Burrows RF, Hunter DJS, Andrew M, Kelton JG. A prospective study investigating the mechanism of thrombocytopenia in preeclampsia. Obstet Gynecol 1987;70:334-338. Tubbergen P, Lachmeijer AM, Althuisius SM, Vlak ME, Van Geijn HP et al. Change in paternity : a risk factor for preeclampsia in multiparous women?J Reprod Immunol 1999;45:81-88.