Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411210EnglishN2020May19HealthcareMorphological and Morphometrical Study of the Human Acetabulum and its Clinical Implications English0104Ina BahlEnglish Jyothi K CEnglish Shailaja ShettyEnglishBackground: The acetabulum is a cup-shaped depression on the hipbone. All three innominate elements, the ilium, ischium and pubis contribute to its formation unequally. The acetabular fossa articulates with the head of femur to form the hip joint. Objectives: To document the relationship between the depth and diameter of the acetabulum and to describe the anterior acetabular ridge morphology. Material and Methods: The study was conducted on 73 adult unpaired dry hipbones of unknown age and sex were assessed for two morphometric and one morphological character. The data of the acetabular depth and diameter was determined using Vernier calipers. The morphology of anterior acetabular ridge was evaluated and classified as curved, angular, straight and irregular. Results: The mean diameter of acetabular cavity on right side was found to be 48.3 ± 3.4mm and on the left side 48.9 ± 3.5mm. The mean depth on right side was measured to be 27.1 ± 3.4mm and on left side 27 ± 3mm. We observed positive co-relation between the mean and standard deviation of total diameter and depth of acetabular cavity. The Curved shape anterior acetabular ridge was the most predominant type (41.1%) and the least type was straight shaped (5.5%). Conclusion: The morphometric assessment of the acetabulum has a myriad of utilities for Anatomists, anthropologists, experts in forensic medicine and orthopaedic surgeons for better alignment of acetabular cup placement during total hip arthroplasty. Further, the anterior ridge morphology may be vital in diagnosing congenital acetabular dysplasia and during treatment of hip joint fractures. EnglishAcetabulum, Acetabular ridge, Morphology, Morphometric, Prosthesis, DysplasiaINTRODUCTION Age, stature, gender and ethnicity form the corner stone's of an individual’s biological identity. The distinct morphology of the human hip bone not only helps attribute these parameters to establish a person’s identity but is also fundamental from the orthopedic, anthropologic and forensic point of view 1. The acetabulum is a deep cup shaped, hemispherical depression on the outer surface of the hipbone. All three innominate elements that is the ilium, ischium and pubis contribute to its formation unequally 2. The central part of the acetabulum consists of the acetabular fossa surrounded by a curved articular lunate surface, which articulates with the head of femur to form the hip joint the major weight bearing joint of the body3. The shape of the acetabulum can be altered prenatally due to disruption in its development or during the postnatal period due to damage to the cartilage of lunate articular surface. Acetabular dysplasia is the most common developmental disorder of the hip bone, due to underdeveloped acetabulum, wherein acetabular roof remains shallow, superficial and vertically oriented.  This results in smaller surface area for weight bearing and hence receives much larger force per unit area while walking and may lead to early degeneration which is the indication for hip arthroplasty4. The anthropometric study of the acetabulum aids radiologists in diagnosing congenital hip dysplasia, and orthopaedicians for planning for an acetabular surgery, during hip arthroplasty and in the treatment of hip fractures. This study would also be beneficial in understanding the pathophysiology of the hip pathologies such as femoroacetabular impingement and preparing prosthesis of desirable sizes5. The present study becomes all the more vital as acetabular dimensions show regional variations and the study is crucial to provide valuable parameters in the Indian population which would exterminate the catastrophic consequences of prosthetic loosening or dislocation6. The aim and objectives of the present study would be To document the acetabular depth and diameter To demonstrate the relationship between the two parameters To describe the morphology of the anterior acetabular ridge MATERIAL   AND METHODS The study was conducted on 73 dry adult hip bones of unknown gender and age collected from Department of Anatomy bone bank, Ramaiah Medical College, Bangalore. Bones with gross damage or anomalies were excluded from the study. Vernier calliper was employed for the accurate measurements.  Morphometric and Morphological features documented (Figure 1-4) The transverse diameter of the acetabulum- The maximum distance between the anterior and posterior ends of the acetabular cavity. The vertical diameter of the acetabulum -The greatest dimension between the Upper and Lower Margins of the Acetabular Cavity. The total acetabular diameter - the average of the transverse and vertical diameter. The depth of the acetabulum - the maximum vertical distance from the deepest point in the acetabular cavity to the horizontal plane touching the margins of the acetabular cavity. A plastic ruler was kept across the margins of the acetabular cavity and the depth of the acetabulum was measured on the Vernier calliper from the deepest point in the acetabulum to the ruler. The shape of the anterior acetabular ridge was classified as curved, angular, straight and irregular. (Fig 5) The relationship between the acetabular depth and diameter was also evaluated. RESULTS A comparison of 73 dry unpaired hip bones comprising 34 bones of left side and 39 bones of right side yielded the following results. Regarding the anterior acetabular ridge morphology, the commonest type was curved shape 31(41.10%), the least common was straight shape 4 (5.48%). (Table 1).  The mean values for acetabular diameter on right side was found to be 48.3 ± 3.4mm and on the left side 48.9 ± 3.5mm. The mean values for acetabular depth on right side was measured to be 27.1 ± 3.4mm and on left side 27 ± 3mm. (Table 2, 3). The mean and standard deviation of total diameter and depth of acetabular cavity are shown and a significant positive co-relation was found between them. DISCUSSION The acetabular morphology is very important for successful hip arthroplasty and for selecting a suitable prosthesis. The curved shaped acetabular ridges were found more frequently in our study. The comparison with other authors also showed same result. The percentage of irregular shape bones is significantly higher in the present study as compared to the study by Maruyama et al7.The percentage of bones with straight shape of anterior acetabular ridge is significantly lower as compared to the studies by Vyasa et al8, Prathiba et al9 and AKSU et al 10( Table 4).   The findings of measurements of Total Acetabular diameter and Depth of acetabular cavity in the present study are consistent with other studies. (Table 5) The knowledge of acetabular dimensions will help us in understanding the acetabular pathology and also in identifying disputed person through forensic expertise13. The differences observed between the values of present study and that of other studies could be attributed to ethnic and racial variations. However, it should be kept in mind, that the present study employed smaller number of hip bones, so it is worthwhile to perform similar studies on more number of hip bones for its theoretical and practical value in the coming years. CONCLUSION The findings of our study are vital for the accurate design of side specific prosthetic cups that replicate the curvaceous acetabular profile which would prevent prosthetic overlap, mechanical loosening and reduce the incidence of ilio-psoas impingement. The precise   knowledge about the variations in morphology and morphometry of acetabular cavity would help clinicians, orthopedic surgeons, prosthetic surgeons and radiologists for better understanding about the pathologies of hip region which aids  in accurate diagnosis and in planning a  suitable treatment. ACKNOWLEDGEMENTS Authors acknowledge the immense help received from Mrs  Radhika  our statistician for the statistical analysis. 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. SOURCE OF FUNDING: N/A CONFLICT OF INTEREST: Nil Englishhttp://ijcrr.com/abstract.php?article_id=2678http://ijcrr.com/article_html.php?did=26781. Dhindsa G S, singh P singh Z. Morphometry of the adult human dry hip bone International Journal of Pharmacy and Pharmaceutical Sciences  2013 ;5(2): 505-507. 2. Sinnatamby CS. 2006. Last’s Anatomy, Regional and Applied, 11th Edition, Edinburgh, Churchill Livingstone, 132. 3. Moore KL, Dalley AF, Agur AM. 2010. Pelvis and Perineum: Clinically Oriented Anatomy, 6th Edition, Philadelphia, Lippincott Williams and Wilkins, 328. 4.umer M, Thambyah A, Tan WTJ, das De S. Acetabular  morphometry for determining hip dysplasia in the Singaporean  population . J Orthop Surg 2006; 14: 21-31. 5. Ukoha U U , Umeasalugo K E, Okafor J I, Ndukwe G U, Nzeakor H C, Ekwunife. Morphology and Morphometry of dry adult acetabula in Nigeria. Rev Arg de Anat Clin 2014 jul, 6 (3): 150-155. 6. Tannast M, Siebenrock KA, Anderson SE. 2007. Femoroacetabular Impingement: Radiographic Diagnosis - What the radiologist should know, AJR 188: 1540-52. 7. Maruyama M, Feinberg JR, Capello WN, D’antonio JA.. Morphologic features of the acetabulum and femur: anteversion angle and implant positioning. Clin Orthop 2001;1: 52-65. 8. Vyas K, Shroff B, Zanzrukiya K. 2013. An Osseous study of morphological aspect of acetabulum of Hip bone. Int J Res Med 2013; 2(1): 78-82. 9. Pratibha K, Hema L, Devishankar. Acetabulum of the hip bone: A morhometric study in south coastal region. International Journal of Recent Trends in Science and Technology 2015; 17(2): 136-139. 10. Aksu FT, Ceri NG, Arman C, Tetik S. Morphology and morphometry of the acetabulum. DEÜ Tip Fakültesi Dergisi 2006; 20(3): 143-148. 11. Govsa F, Ozer MA, Ozgur Z. Morphologic features of the acetabulum. Arch Orthop Trauma Surg 2005;125:453-461. 12. Chauhan R, Paul S, Dhaon BK.. Anatomical Parameters of North Indian Hip joints – Cadaveric Study. Journal of Anatomical Society of India 2002; 51: 39-42. 13. Parmar G, Rupareliab S, Patel SV, Jethvaa N, “Morphology and morphometry of Acetabulum.” Int J Biol Med Res 2013;4(1):2924-2926.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411210EnglishN2020May19HealthcareState of the Art Study on Epidemiology of Chronic Dacryocystitis in Rural Community English1013Pallavi Bangalore AcharluEnglish Sujatha VijayalekshmiEnglishIntroduction: Infective and Inflammatory pathology of Lacrimal sac which is located between the medial canthus of the eye and nose is called as Dacryocystitis. It is an important cause of ocular morbidity in India. It has higher incidence among lower socio economic status. Objective: The goal of the present study was to find the occurrence of Chronic Dacryocystitis in rural area and to correlate it with socioeconomic status. Material & Methods: Our study is a cross-sectional hospital based study conducted from January 2019 to December 2019 in MVJ Medical College and Research Hospital, Hoskote. Results: The Present study shows maximum number of patients belonged to the age group of 61-70 years (26.4%). Females were affected predominantly (52.8%). Most of the patients belonged to class III (39.6%) & V (35.8%) of Revised B.G Prasad Socio-economic classification update 2019. Conclusion: There is a correlation between Chronic Dacryocystitis with Low Socioeconomic status. EnglishChronic Dacryocystitis, Epidemiology, Epiphora, Socio-economic statusIntroduction Infective and Inflammatory pathology of Lacrimal sac which is located between the medial canthus of the eye and nose is called as Dacryocystitis. It is an important cause of ocular morbidity in India[1]. It can involve both sides. The Lacrimal drainage system consists of the opening known as puncta(Upper and lower) which continuous as upper and lower canaliculus, which in turn opens into the lacrimal sac via the common canaliculus. Lacrimal sac continues down to become the nasolacrimal duct which opens into inferior nasal meatus. Obstruction anywhere along the lacrimal passage leads to Epiphora. Obstruction of the drainage of tears can be classified into functional and anatomical. Along the lacrimal drainage pathway anatomical obstruction can occur at any point, which can be either congenital or acquired. The acquired nasolacrimal duct obstruction is of two types: Primary or Secondary. Primary acquired nasolacrimal duct obstruction is an obstruction caused by mucosal inflammation of unknown etiology that eventually leads to fibrosis. Secondary acquired lacrimal drainage obstruction may result from a wide variety of infections, allergies, inflammatory, neoplastic, traumatic or mechanical causes[2]. Acquired Dacryocystitis can be acute, subacute or chronic[3]. Chronic Dacryocystitis is commonly encountered by an ophthalmologist accounting for 87.1% of Epiphora, which causes social embarrassment due to chronic watering from eyes [4-5]. It commonly affects females over 40 years of age with peak incidence in 60 to 70 years [6]. It is more common in Whites than in Negros and more common in India as being tropical country. It has higher incidence among people of lower socioeconomic status [6]. Occupational history is important where in the people working in factories with lot of smoke, fumes and irritants are there and proper protective measures are not there. In rural India one of the most common modes of cooking, boiling water in bath room is still firewood / Chullah and the female population is exposed to the fumes and the irritants of the charcoal. Studies done on the epidemiological factors contributing to Dacryocystitis in Indian population are few[2,7]. Most of the people consider watering from eyes as minor discomfort and avoid themselves from presenting to ophthalmologist as they are unaware of the deleterious complications. Early diagnosis and treatment is always warranted to avoid complications and need for surgical intervention[7]. The goal of the present study was to find the occurrence of chronic Dacryocystitis in rural area and to correlate it with socioeconomic status. Material and Methods Our study is a cross-sectional hospital based study conducted from January 2019 to December 2019 in MVJ Medical College and Research Hospital, Hoskote. Informed consent was taken. Inclusion criteria: All patients complaining of watering or discharge in the eyes who were diagnosed for primary acquired nasolacrimal duct obstruction or Chronic Dacryocystitis were included in the study. Exclusion criteria: Patients below 20 years of age. Patients who had undergone any surgical intervention in the past like Dacryocystorhinostomy, and Congenital Dacryocystitis. Patients with Acute Dacryocystitis. The patients presenting to outpatient department of Ophthalmology belonging to inclusion criteria were interrogated for the following details after taking the informed consent. Demographic profile (Name, Age, Sex, Occupation and Address) --All the patients falling under our inclusion criteria were enrolled for the study. Their name, age, sex, residence and occupation were recorded. Socioeconomic status according to Revised Modified B.G. Prasad’s classification update 2019[8] (Table 1). The advantage with Prasad's classification is that it takes into consideration only the income as a variable and it is simple to calculate. This can be applied to assess the socioeconomic status in both rural and urban areas. Chief Complaints, medical history, treatment history and surgical history were recorded. Thorough detailed examination of eyes and ocular adnexa was performed using diffuse torch light and slit lamp. Regurgitation test and Sac syringing Regurgitation Test: It is done by applying pressure over the lacrimal sac area with either thumb or index finger and observing the puncta. In chronic Dacryocystitis the contents of the sac shall regurgitate through the lower or upper punctum or both. In chronic Dacryocystitis due to pump failure, the contents of the sac shall empty in the nose. In chronic Dacryocystitis with encysted mucocele, there is no regurgitation of the contents. Sac Syringing: Local anaesthic eye drops is instilled into the eye before performing the procedure. Patient is asked to look up; lower eyelid is pulled down gently to visualize the punctum. A saline filled 2ml syringe attached with a canula is introduced into the lower punctum. The saline is gently pushed through the punctum. Nasolacrimal passage is open if the patient perceives salty taste. In case of block in pathway saline regurgitates either from the same or both punctum. All the details were collected prospectively and analyzed using Statistical Package for the Social Sciences (SPSS) Software and conclusion was derived based on observations. Results Table 2 presents Age distribution of Chronic Dacryocystitis. It is observed that the Chronic Dacryocystitis was seen in all age groups, majority in 61-70 years (26.4%) followed by 41 -50 years (22.6%) and 51-60 years (20.8%). In our study, Chronic Dacryocystitis affected more in females. There were 28 females (52.8%) and 25 males (47.2%) as shown in Table 3.  Table 4 presents the Laterality of Dacryocystitis. It is observed that out of 53 patients the highest incidence of Chronic Dacryocystitis was seen on right side eye i.e. in 24 patients (43.3%), bilaterally in 16 patients (30.2%) and left side eye in 13 patients (24.5%). Table 5 presents the Occupation and Socioeconomic status of the study population. It is observed that High Incidence of Chronic Dacryocystitis was seen in patients who belonged to class III & V as per the Classification. It is observed more in House wives and wage laborer followed by farmers. Table 6 presents the Symptoms of Chronic Dacryocystitis. It was observed that Epiphora (64.2%) was the leading presenting symptom in Chronic Dacryocystitis. Discussion Chronic Dacryocystitis is a common problem of lacrimal drainage system, treated efficiently in recent years with advances in investigative operational technique pertaining to solve the problems associated with it[2]. Epiphora is the most annoying symptom in about 64% cases, followed by discharge (20.8%) and swelling (15.1%). Our study consisted of 53 patients of Chronic Dacryocystitis who presented at our institute during the month of January 2019 to December 2019. Patients of Chronic Dacryocystitis were studied with respect to their age, sex, occupation and socioeconomic status. The following observations were noted.  Our results showed 45.3% of the patients belonged to seventh decade of life that is between 61- 70 years of age, which is similar to Surendra P W et al[7] study. Whereas in Jacobs BH et al [4] Study, the maximum incidence was seen in between the age of 40-55 years, Sarda et al [9] noted maximum incidence in the third and fourth decade. Saxena R.C et al [10] and Duke Elder S [11] stated maximum incidence in the fourth decade. In our study, the incidence of Chronic Dacryocystitis was more commonly noted in the females (52.8%), which was similar to Dalgleish R et al[12]. Higher incidence of 61.6%, 67.86% and 84.6% were noted in Payal Katre et al[2], Surendra P et al[7] and Saxena R C et al [10] respectively. The possible reasons for females to be more affected are due to changes in the mucus membrane of the lacrimal apparatus secondary to menopause suggested by Pico et al[13], higher vascular congestive factor and a narrower bony nasolacrimal canal was suggested by Meller[14]. According to Ramamani et al[15] Kitchen droplet fumes and cosmetic lining of eye lid & margin might contribute to the possible female predilection.             In our study of 53 cases, 15 cases (28.3%) were left sided obstruction and 38 cases (71.7 %) were right side obstruction. This is in accordance to the studies done by Reddy et al[16], Jacob et al [2], Pandya et a [17] and Ramamani et al[15]. Unilateral incidence is due to the anatomical narrowing of one side of the nasolacrimal duct making it more prone for obstruction compared to the normal or more spacious contralateral nasolacrimal duct[15]. In our study, epiphora was the commonest presenting symptom in 34 patients (64.2%) followed by the symptom of discharge in 11 patients (20.8%) and swelling near the medial canthus in only 8 patients (15.1%). Zilelioglu G et al [18] reported the incidence of epiphora in 86% and discharge in 3% cases. The prevalence of Dacryocystitis is also determined by socioeconomic status to correlate its impact on quality of life of living standard. In our study, people belonging to class III & V were affected more, similar to Surendra et al [7]. This can be attributed to poor hygienic conditions and low living standards. Conclusion This paper presents the Epidemiology of Chronic Dacryocystitis. The authors have studied the correlation of Chronic Dacryocystitis with Low Socioeconomic status using modified B.G Prasad socioeconomic classification update 2019. It was observed that Chronic Dacryocystitis was commonly seen in 7th decade. Epiphora was the most common clinical presentation, preponderance in females. The study included more of patients belonging to Socio economic status of Class III & V. To solve the enigma of Chronic Dacryocystitis in the people of low socioeconomic group with poor hygiene and low standard of living in rural area, awareness should be created. Financial support: Nil Conflict of interest: Nil Acknowledgement The authors would like to thank Dr V K Srivastava, HOD, Dept. of Ophthalmology, MVJ Medical College and Research Hospital, Hoskote, Bangalore. 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. Englishhttp://ijcrr.com/abstract.php?article_id=2680http://ijcrr.com/article_html.php?did=2680 Shah CP, Shantani D.A. Comparative bacteriological profile and antibiogram of Dacryocystitis. Nepal Jr of Opthalmology 2011;3(6):134-139. PayalKatre et al. Epidemiological study of dacryocystitis in rural population Panacea Journal of Medical Sciences, January-April, 2017;7(1): 11-14. Myren Yanoff, Jay S. Duker. Ophthalmology, 5th Edn.: The lacrimal Drainage system, Chapter-12.2,  P.1338-1339 . Jacobs, H.G. Symptomatic epiphora. Brit. J. Ophth. 1959; 43:415-421. Mal R, Banerjee AR, Biswas MC, Mondal A, Kundu PK, Sasmal NK. Clinico-bacteriological study of chronic Dacryocystitis in adults. J Indian Med Assoc., 2008;106(5):296–98. Gillil GD. Texas Ophthalmic Plastic, Reconstructive Orbital Surgery Associates eMed Space. Ophthal Lacrimal August 18, 2009 Wadgaonkar Surendra P, Patil Preeti A. Epidemiology of chronic dacryocystitis with special reference to socioeconomic status: A rural hospital study. Indian Journal Of Clinical And Experimental Ophthalmology 2016;2(1) 52-56.  Pandey V K, Agarwal P, Kakker. Modified B G Prasad Socio Economic Status Classification update 2019, Indian Journal of Community Health 2019; 31(1):123-125. Sarda, R. P. Dacryocystorhinostomy. Brit. J. Ophth.1961;45:138-143. Saxena, R. C. Garg, K. C.: Scope of Dacryocystorhinostomy, J. of All-India Ophthal. Soc.,17,55-58.(1969). Duke Elders S. Disease of lacrimal passages; system of ophthalmology. Vol. XIII part-II, Mosby Publication, 1974,675-724. Dalgleish R. Idiopathic acquired lacrimal drainage obstruction. Br J Ophtholmology, 1967;51:463. Pico g. A modified technique of external dacryocystorhinostomy, Am J Ophthalmol. 1971;72(4):679-90 Meller J. Diseases of lacrimal apparatus (1929): Transactions of Ophthalmic Society, UK 49:233 Ramamani Dalai, Rajashree Rout, Samarendramohapatra, Sumita Mohapatra. A Study on Clinical Profile and Outcome of Chronic Dacryocystitis in Adults in a Tertiary Care Center, Paripex. Indian Journal Of Research. 2019: 8(9). Reddy PS, Reddy BS. Dacryocystitis; Aclinico-pathological study, JIndian Med Assoc. 1955;1 :24:11 :413-6 Pandey R. Dacryocystorhinostomy and the superior-inferior flap technique. Indian J Ophthalmol. 1967;15:94-7.  Zilelioglu G, Tekeli O, Ugurba SH. Results of endoscopic endonasal non laser dacryocystorhinostomy. Doc Ophthalmol 2002 Jul; 105(1):57-62.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411210EnglishN2020May19HealthcareSynchronous Early Breast Cancer and Locally Advanced Primary Bladder Adenocarcinoma English1417Sepideh MeshgiEnglish Sahel Valadan TahbazEnglish Hossein YahyazadehEnglish Mahsa MohammadzadeEnglish Abdollah NasehiEnglish Saadat MolanaeiEnglishAim: Synchronous occurrence multifocal tumors across multiple tissues are common and mostly metastatic and sometimes include a small number of concurrent multiple primary tumors that are not metastatic poses so it is a difficult challenge to treatment, so we present a case of synchronous primary well differentiated adenocarcinoma of bladder and invasive ductal carcinoma of breast. Case report: A 59-year-old female patient presented to urology department with the complaint of pain and hematuria. There was no relevant family history for all type of cancers. Clinical examination was normal. The patient had no history of tobacco using and any other cancer in the past. Through core needle biopsy,the patient was diagnosed with invasive ductal carcinoma of left breast.Allsentinel lymph node of breast was sent to pathology and it revealed that the node is involved.Simultaneously, partial mastectomywas donefor patient, and then axillary lymph node dissection has been done; six lymph nodes were removed and sent to the lab. Discussion: A comorbid manifestation of breast and bladder carcinomas is rare, little similar case has been published so far. Synchronous primary cancers have rarely been reported, but it is believed that the incidence is rising. Prevention, making an early diagnosis and the treatment of multiple cancers will become even more important in the future. Conclusion: It is important to present this case because of many literature have been reported cases of bladder metastasis of the breast, but we presents a concurrent primary breast and bladder cancer report. EnglishSynchronous Cancer, Bladder Tumor, Breast Tumor, Adenocarcinoma, Malignancies Introduction The incidence of breast cancer in the early stages concurrent with the primary bladder tumor has rarely occurred in the literature and research papers. Bladder cancer has the highest prevalence rate among the urologic cancers1,2. Breast cancer is the most common malignant disease affecting women, after non-melanoma skin cancers, and the second reason for cause of death for cancer in women, mainly due to metastatic spread3,4. Common areas for breast cancer metastatic are lung, bone, liver, lymph nodes, and skin but rarely spreads to other sites, such as urinary bladder and retroperitoneum4. For the first time, Avicenna, Iranian (Persian-Muslim) philosopher and physician, reported primary multiple tumors (PMTs) as a case with bilateral mammary glands malignancies5 . Billroth et al. described the phenomenon of multiple primary malignancies (MPC) in a single individual, in the late 19th century6. Warren and Gates's criteria define the necessary condition which tumors must fulfill to be included in the MPCs. The criteria consist of: each tumor should belong to a specific malignancy and they should not be the result of metastasis from another tumor7. MPCs are categorized to either metachronous and synchronous, which the second one is rather rare8. Concurrent association of two primary malignancies or appearance of the second one within 6 months would be called synchronous cancer9. Among many cancers, bladder cancer has the highest incidence rate among the urologic cancers8.  We describe here an extremely rare case of synchronous double primary cancer involving the bladder and breast. Therefore, we report a remarkable case of completely synchronous primary bladder and breast cancer. Case Reports: A 59-year-old female patient presented to our urology department in Milad General Hospital, a part of Iran Social Security Organization, with the complaint of pain and hematuria. In urine analysis, RBC was found to be 25-30 units with trace protein, hyaline casts, and pus. There was no relevant family history for all type of cancers. Clinical examination was normal. The patient had no history of tobacco using and any other cancer in the past. In the CT scan, tumor mass was confined to the bladder, and there was no lymphadenopathy in the pelvic (Figure. 1). The patient underwent transurethral resection (TUR). TUR results showed well differentiated adenocarcinoma (Figure 2.A) and no thickness of invasionwas reported in pathology comments.Inimmunohistochemistry staining, which its findingswere consistent that CK7, GATA3, ER, PR, HER-2, CD15, CA125, B-Catenin, and Vimentin were negative; CDX2 (Figure 2.B), CK20,and EMA were positive (Figure 2.C). Figure 2: (A), The pathologic features of the bladder tumor (H&E stain, ×100); (B), CDX2 biomarker in bladder tumor is positive (H&E stain, ×100); (C), CK7biomarker in bladder tumor is positive; (D),CK20 biomarker in bladder tumor is positive. The microphotograph showed well differentiated adenocarcinoma with bladder origin. In checking of primary origin and for excluding metastatic bladder adenocarcinoma of gastrointestinal origin, after colonoscopy and endoscopy was conducted, so results confirmed that the malignancy didn't in gastrointestinal (GI) origin.(Figures3A and 3B).   Figure 4: Mammography image, (A), Cranio-caudal view; (B), Mediolateral view. Mammogram showing nodular irregular homogenous density present in left breast. Through core needle biopsy, the patient was diagnosed with invasive ductal carcinoma of left breast. All sentinel lymph node of breast was sent to pathology and it revealed that the node is involved. Simultaneously, partial mastectomy was done for patient, and then axillary lymph node dissection has been done, six lymph nodes were removed and sent to the lab. According to laboratory reports, one of the nodes was involved and the tumor size was 2.5 ×2×2 cm (T2).The TNM stage of breast tumor determined as pT2N1M0 (stage IIIA). That axillary lymph node was sent to the lab for immunohistochemistry examination. As a results of IHC tests; ER (Figure 5.B), PR were positives, and HER-2 was(+2) but the result of FISH test was negative. Ki67 was positive in 5% of cells Figure 5: (A),The pathologic features of the breast tumor that ERpositive in breast tumor;(B),PRpositive in breast tumor; (C), Haematoxylin and eosin staining, x100 magnification of breast tumor. Histopathology slide with immunohistochemistry stain showing ductal carcinoma of breast cancer. Finally, the patient was returned to urology department and partial cystectomy was done for her. Microscopic findings supported that she had well-differentiated adenocarcinoma and tumor was invaded to serosal layer and peripheral fat but all margins were free and no lymphadenopathy was performed.TNM stage of the bladder tumor was pT3NxM. Tumor marker tests indicated serum levels of CA15-3, CA125-ECL, CEA-ECL AFP- Tumor marker ,and Beta HCG which they were respectively 39.4 U/ml (High Level), 5.6 U/ml, 1.8 ng/ml, 4.5 IU/ml ,and Englishhttp://ijcrr.com/abstract.php?article_id=2681http://ijcrr.com/article_html.php?did=26811.            Mydlo JH, Gerstein M. Patients with urologic cancer and other nonurologic malignancies: analysis of a sample and review of the literature. Urology. Dec 2001;58(6):864-869. 2.            Jiang W, Ding Y, Shen Y, et al. Identifying the clonal origin of synchronous multifocal tumors in the hepatobiliary and pancreatic system using multi-omic platforms. Oncotarget. Jan 17 2017;8(3):5016-5025. 3.            Arjunan R, Kumar D, Kumar KV, Premlatha CS. Breast Cancer with Synchronous Renal Cell Carcinoma: A Rare Presentation. J Clin Diagn Res. Oct 2016;10(10):XD03-XD05. 4.            Cormio L, Sanguedolce F, Di Fino G, et al. Asymptomatic bladder metastasis from breast cancer. Case Rep Urol. 2014;2014:672591. 5.            Zhai C, Cai Y, Lou F, et al. Multiple Primary Malignant Tumors - A Clinical Analysis of 15,321 Patients with Malignancies at a Single Center in China. J Cancer. 2018;9(16):2795-2801. 6.            Billroth T. [General surgical pathology and therapy. Guidance for students and physicians. Lecture]. Khirurgiia (Mosk). Oct 1991(10):136-143. 7.            Testori A, Cioffi U, De Simone M, et al. Multiple primary synchronous malignant tumors. BMC Res Notes. Nov 27 2015;8:730. 8.            Komiyama S, Nishio E, Ichikawa R, et al. Asymptomatic synchronous quintuple primary cancers. Gynecol Obstet Invest. 2012;74(4):324-328. 9.            Jiao F, Yao LJ, Zhou J, Hu H, Wang LW. Clinical features of multiple primary malignancies: a retrospective analysis of 72 Chinese patients. Asian Pac J Cancer Prev. 2014;15(1):331-334. 10.          Pastore AL, Palleschi G, Autieri D, et al. Synchronous primary neoplasms of the bladder, skin and breast in a male patient: a case report. World J Surg Oncol. Oct 20 2013;11:282. 11.          Makis W, Ciarallo A, Lisbona R. Three synchronous primary malignancies detected by F-18 FDG PET/CT: breast, rectal, and urothelial bladder carcinomas. Clin Nucl Med. Sep 2011;36(9):791-794.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411210EnglishN2020April16Healthcare A Study on Opinion of Parents on Introducing Coding at School Level in Ranga Reddy District of Telangana State English1821Paripally ShankarEnglish Introduction: The use of computer programming is spread into schools worldwide in the 70s and 80s of the last centuries, but it disappeared from the educational landscape in the early 90s. With the development of visual programming languages such this movement has emerged again in recent years, as parents, at all educational levels and from different disciplines consider that the use of programming enhances learning in many subjects and allows students to develop important skills. Objectives/Aim: The present investigation is taken up with aim to assess the opinion of parent’s on introducing coding at school level in Ranga Reddy District. Method: This investigation is employed by descriptive survey method. Sample: Sample size of 100 drawn through simple random sampling. Tool: A researcher developed tool was employed to gather data to study. This tool consists of 40 statements, where respondents are instructed to opt any options from Yes, Can’t Say and No. Data analysis is done by using Descriptive including percentages, Mean & SD and inferential statistics including t-test and ANOVA were used. Discussion: The study findings revealed that the majority of the responses (77.65%) unveils positive opinions of on introducing coding at school level in Ranga Reddy District. Conclusion: There is a significant difference in opinion of parent’s on introducing coding at school level with regard to gender i.e., male and female of Ranga Reddy District. EnglishComputer Programming, Coding, Digital Learning, programming languages, Parents, Ranga Reddy District, Technologyhttp://ijcrr.com/abstract.php?article_id=4770http://ijcrr.com/article_html.php?did=4770 1. Connelly S. Top skills you need in your arsenal to ride the augmented reality wave. 2017 Retrieved November 2, 2018 2. Crane GE. Leveraging Digital Communications Technology in Higher Education: Exploring URI’s Adoption of Google Apps for Education 2015. 3. Creswell JW. Educational research: Planning, conducting and evaluating quantitative and qualitative research (4th Ed.). London: Pearson Publications Ltd. 2014 4. Dickes, AC, Sengupta, P. Learning natural selection in 4th grade with multi-agent-based computational models. Res. Sci. Educ. 2013; 43(3): 921–953. 5. Grover S, Pea R, Cooper S. Designing for deeper learning in a blended computer science course for middle school students. Comput. Sci. Educ. 2015; 25(2) 199–237. 6. Han B, Bae Y, Park J. The effect of mathematics achievement variables on scratch programming activities of elementary school students. International Journal of Software Engineering and Its Applications (IJSEA). 2016; 10(12): 21–30. 7. Heggart KR, Yoo J. Getting the Most from Google classroom: A pedagogical framework for tertiary educators. Aust. J. Teach. Educ. 2018; 43(3): 9. 8. Hsia LH, Huang I, Hwang GJ. A web-based peer-assessment approach to improving junior high school students’ performance, self-efficacy and motivation in performing arts courses. Br J Educ Technol. 2016; 47(4): 618–632. 9. Kafai YB, Burke Q. Computer programming goes back to school. Phi Delta Kappan 2013; 95(1): 61–65. 10. Klein R, Orelup R, Smith M. Google apps for education: Valparaiso University’s migration experience. In Proceedings of the 40th annual ACM SIGUCCS conference on User services.2012; 203-208 11. Koul R, Fraser B, Nastiti H. Transdisciplinary instruction: Implementing and evaluating a primary-school STEM teaching model. International Journal of Innovation in Science and Mathematics Education (IJISME) (formerly CAL-laborate International), 2018; 26(8): 17–29.