Introduction: Dysphagia is a common reason for gastroenterology consultation. Esophageal manometry is recommended for the exploration of dysphagia, when gastroscopy is normal and esophageal biopsies are negative. The advent of high-resolution manometry (HRM) has led to the development of a new classification of esophageal motor disorders. The goal of this study is to evaluate the frequency and identify the type of esophageal motor disorders in dysphagic patients with normal upper digestive endoscopy. Materials and Methods: 141 patients with dysphagia with normal upper gastrointestinal endoscopy, negative esophageal biopsies and HRM were included. Esophageal motor disorders have been identified according to the Chicago classification. Results: HRM was pathological in 87 cases (61.7%). It revealed achalasia in 74 patients (52.5%). It was a type I achalasia in 23 patients (16.3%), type II in 44 patients (31.2%) type III in 7 cases (5%). It showed motor disorders that could correspond to scleroderma in 6 patients (4.2%), obstruction of the oesogastric junction in 4 cases (2.8%), and a jackhammer oesophagus in 3 cases (2.1%). HRM was normal in 54 patients (38.3%). Conclusion: The HRM of the esophagus represents an undeniable progress in the exploration of the motor system of the esophagus, mainly dysphagia with normal endoscopy. Achalasia, which can now be classified into 3 types according to HRM results, remains the most frequently found primary motor disorder.

Objective: To evaluate the characteristics of central corneal thickness (CCT) in glaucoma patients followed a military hospital in Rabat. Patients and methods: This is a retrospective study of glaucoma patients followed in the military hospital ophthalmology flap service between January and December 2018. All subjects underwent a complete ophthalmic examination that included measures of CCT with an ultrasonic pachymeter. Results: A total of 205 patients (123 men and 82 women) were included in this study corresponding to 410 eyes. The age of patients ranged between 19 and 79 years. The average central corneal thickness was 519.54 ± 27.52µm in the right eye and 520.71 ± 27.99 µm in the left eye. Comparing the CCT between men and women and between the right eye and the left eye the other hand finds no statistically significant difference. Thus, the average age of the patients was 50.74 ± 12.7 years, with a mean central corneal thickness of 520.12 ± 27.75 microns. Discussion and conclusion: Compared to the Caucasian patient, our glaucoma patients differ in the early glaucoma and the thinness of the cornea, and are close to black African patients. This may induce a potential error in the measurement of intraocular pressure in glaucoma patients where our interests of Forever correlate intraocular pressure with pachymetry.

Introduction: Plummer-Vinson syndrome (PVS), also known as sideropenic dysphagia, is a very rare entity that combines a classic triad: iron deficiency anemia, dysphagia and upper esophageal diaphragm. Its association with celiac disease has been rarely reported. The goal of this work is to determine the clinical characteristics of patients with PVS, in celiac disease, thus the evolutionary profile. Materials and Methods: This is a descriptive retrospective study covering a period of 26 years, from January 1993 to January 2019, collecting all patients followed in the service of Medecine C at the University Hospital Ibn Sina of Rabat-Morocco for PVS who have systematically benefited from jealousy biopsies in search of celiac disease. Results: Out of a total of 149 patients followed in the PVS unit, the prevalence of celiac disease was 6.1% (10 cases). 8 cases diagnosed as part of the etiological assessment of PVS, the diagnosis of celiac disease was concomitant with PVS in 2 cases. These were 8 women and 2 men with a sex ratio of 0.25. The average age was 28 years [19- 56 years]. All patients had organic dysphagia, five cases (62.5%) had clinical anemic syndrome associated with malabsorption diarrhea. Upper GI fibroscopy showed a ring at the killian's mouth in all cases. After oesophageal dilation by candles of different diameters, fibroscopy showed a rarefaction of duodenal folds in 9 cases (90%) and a duodenum of normal appearance in one case (10%). The anatomopathological study of duodenal biopsies showed intraepithelial lymphocytosis (IEL) > 30% in all cases, moderate atrophy of the villus in 6 cases and severe atrophy in 4 patients. All our patients have received martial treatment in combination with a gluten-free diet (GFD). The progression was favourable in 8 patients after a single dilation session and a well-followed GFD; 2 patients with poor GFD compliance also had a recurrence of dysphagia. Conclusion: PVS on celiac disease remains rare, found only in 3.5% in our series; good compliance with the GFD has improved signs of malabsorption and the disappearance of dysphagia in 80%.

A major trend in ulcer management currently is the role of nitric oxide (NO) and its agonists such as L-Arginine in ameliorating gastric ulcers. The current study focuses on the possible effects of L-Arginine supplementation on indomethacin-induced gastric ulcerations in rats. Male Wistar albino rats weighing between 150-180g were used and divided thus: Group I (Control) – saline, 8ml/kg, Group II- L-Arginine 1g/kg B.W for 3 days, Group III- L-Arginine 1g/kg B.W for 7 days. The effect of L-arginine supplementation was on indomethacin-induced gastric ulcerations, ulcer dimensions and histological profile of the gastric mucosa was examined. The result showed that arginine supplementation possesses capabilities of reducing ulcer formation as evident by the lower ulcer scores of the supplemented groups when compared with the Control. The 3-day supplemented group had a significantly lower ulcer score (p<0.05). Ulcer area and width were significantly reduced in the 3-day supplemented group (p<0.05) while the ulcer depth was significantly reduced in both supplemented groups (p<0.01). Histological examination of the gastric tissues showed that the 3-day supplemented group had greater reduction in the level of gastric disturbance than both Control group and the 7-day supplemented group. We proposed that a rapid angiogenetic activity in response to arginine supplementation which then wanes over time may be responsible for this pattern. This study provides evidence that arginine supplementation is beneficial in reducing the risk of gastric ulcer induced by NSAIDS and this is possibly mediated by direct enhancement of angiogenetic activity around the disturbed gastrum.

A simple, rapid, precise, stability indicating, isocratic reverse phase-high performance liquid chromatography method has been developed and validated for the determination of Zonisamide in bulk and pharmaceutical dosage form. The Chromatographic Separation was achieved by using Enable ODS reverse phase (250 x 4.6 mm, 5 μm particle size) C18G column. Mobile phase consists of mixture of 0.1% (v/v) ortho phosphoric acid and Methanol in the ratio of 30:70 (v/v) and was delivered at a flow rate of 1 ml/min, while the detection was monitored at a wave length of 285 nm. The developed method showed excellent linear response (r2>0.9999) in the range of 10-70 μg/ml. The retention time for Zonisamide was found to be 3.5 mins. The proposed method was validated as per ICH guideline and can be applied for estimation of Zonisamide in pharmaceutical dosage forms in routine analysis.

The aim of the present study was to study the efficacy and safety of Nebivolol and Metoprolol in post-myocardial infarction patient and to compare the efficacy and safety of Nebivolol and Metoprolol in post-myocardial infarction patients. This randomized, open-label and comparative study was done in the Department of General Medicine, Kakatiya Medical College, and MGM Hospital Warangal. A total of n=110 patients were selected based on inclusion and exclusion criteria. Patients were randomized to two groups N-groups of n=55, M-group to receive once-daily Nebivolol 5 mg and Metoprolol 50mg twice-daily respectively for 2 months. Clinical laboratory parameters were measured at day (0), and at day 56. Results The standing baseline mean systolic blood pressure 166±9 mmHg was reduced to 139±10 mmHg after 2 months treatment with Nebivolol, whereas in case of Metoprolol standing baseline systolic blood pressure 161±11 mmHg reduced to 143±14 mmHg after 2 months treatment. In case of standing, baseline mean diastolic blood pressure 103±7 mm Hg reduced to 84±4 mmHg after 2 months of treatment with Nebivolol, whereas with Metoprolol standing baseline diastolic blood pressure 100±6 mmHg reduced to 87±7 mmHg after 2 months treatment. Heart rate in case of N-group baseline 87±9 beats/min reduced to 74±6 beats/min after 2 months treatment, whereas in M-group baseline heart rate 82±7 beats/min reduced to 76±5 beats/min after 2 months treatment. Conclusion: it can be concluded that Nebivolol is superior to Metoprolol in control of blood pressure in post-myocardial infarction patients with hypertension. The distinct advantages of Nebivolol include lower incidences of adverse effects and since the dose is single there is better compliance as compared to Metoprolol

With the development of feminism, the works of American ethnic female writers’ works has received a lot of attention. Discovering and interpreting the subjectivity in these works are of great importance to female readers. Here, the author made an effort in exploring the subjectivity contained in female writers’ works. The exploration is based on the women’ voice in The Bluest Eye and The Joy Luck Club. The author explained how the works represented the rising of female consciousness and how the figures are portrayed in this paper, trying to get a better understanding of subjectivity, the author relates her findings with gender issues.

This paper aims to highlight several points on the topic of relative clause of Indonesian and Java Language. The method used on this study is descriptive analysis. The focuses are on finding on several outcomes from previous papers on how these two languages share the similarity and differences as well as how the two languages differ from English. This found Indonesian relative clause of Bahasa Indonesia known as yang is typical and different from the structured English counterparts. In the meantime, there is a tendency that Javanese always uses construction passive to relativize noun phrases or nouns in complex sentences.

Malnutrition has been implicated as a possible indicator of development of atherosclerotic cardiovascular disease in hemodialysis patients. Recently a new quantitative scoring system, called MQSGA (Modified Quantitative Subjective Global Assessment) has been developed to assess dialysis malnutrition. Study was conducted with following objectives 1) To assess the nutritional status in hemodialysis patients by the MQSGA scoring. 2) To correlate the MQSGA score with biochemical marker of malnutrition- Albumin and inflammatory marker hs CRP (High Sensitive CRP). 50 patients in the age group of 20-70 years diagnosed as having chronic kidney disease undergoing hemodialysis were studied. MQSGA score was calculated using 7 features- weight change, dietary intake, GI symptoms, functional capacity, co-morbidity, subcutaneous fat and signs of muscle wasting. Serum albumin levels were estimated using end point colorimetric method and hsCRP using Immunoturbidimetric method. MQSGA scores in the present study was found to be 17.32+4.37 in males and 16.2+4.81 in females with a total 17.19+4.4. hsCRP levels was found to be significantly raised (16.59+21.4mg/L). Serum Albumin levels were low (3.27+0.67 g/dl), in both males (3.28+0.69) and females (3.22+0.153). There was a significant positive correlation between serum hsCRP levels and MQSGA scores of the subjects (p=0.0418, r=0.3156). To conclude Nutritional status of the patients undergoing dialysis is frequently ignored. Present study shows moderate degree of malnutrition in CKD patients. Simple methods of nutritional assessment and diet modification could have a favorable impact on the patient management.

Aims and Objectives: The study aimed to investigate dental undergraduates’ studying in Riyadh colleges of Dentistry and Pharmacy, Riyadh, Saudi Arabia to evaluate their self-reported experience and perceived clinical confidence in pediatric dentistry. Methodology: 236 students from Riyadh colleges of Dentistry and Pharmacy, Riyadh, Saudi Arabia responded to a structured questionnaire to evaluate their experience and their confidence for various treatment procedures in pediatric dentistry during their course. Results: The results of this study suggest that gender differences existed in the confidence levels in various procedures in pediatric dentistry. Of all the procedures in pediatric dentistry, Preventive procedures (pit and fissure sealants, PRR and topical fluoride application) is ranked the first in the confidence and least is the selection of patient for general anesthesia and conscious sedation. Conclusion: Undergraduate students have concluded that they have adequate training in both theory and clinics regarding pediatric dentistry. Students are exposed to various clinical procedures and are confident in most of the pediatric clinical procedures. Students universally reported a lack of confidence in patient selection for conscious sedation and general anesthesia and this is the one area that the pediatric dentistry department will now be targeting for enhanced student learning.

Aim: To study haematological parameters, haematological ratios and serum total lactate dehydrogenase (LDH) levels in normal pregnant women and in women with preeclampsia. Materials & Methods: 30 women with preeclampsia and 30 normotensive pregnant women admitted to the Department of OBG were recruited for the study. Blood samples were collected and analysed for CBC, serum LDH and ALP in the Clinical Biochemistry & Pathology Laboratory of MVJ Medical College. Statistical tests were employed to evaluate the significance of the differences obtained between the groups. Results: Serum LDH and Neutrophil – Lymphocyte ratio (NLR) showed a significant difference between control group and preeclampsia group. Platelet count showed a negative correlation with systolic blood pressure and serum LDH levels and serum ALP showed a positive correlation with serum LDH levels in the patient group. Conclusion: These simple markers might be used as predictors of preeclampsia if analysed routinely in the third trimester of pregnancy. The study needs to be replicated with a larger sample size and prospective study design to validate the findings and implement these in clinical practice

Peripheral giant cell granuloma is one of the reactive hyperplastic lesions of the oral cavity, which originates from the periosteum or periodontal membrane following local irritation or chronic trauma. This article reports about the management of peripheral giant cell granuloma in 57 year old male with surgical excision.

Fibroids are common benign tumours arising in the uterus. Myomectomy is the surgical treatment of choice for womenwith symptomatic fibroids that prefer or want uterine conservation. Myomectomy can be performed by laparoscopy or open myomectomy. Aim of study is to determine the benefits and harms of laparoscopic myomectomy compared with open myomectomy. It is a comparative study conducted over 1 year in Department of Obstetrics and Gynecology, GMC, Akola, Maharashtra. 50 patients were included in study that was having uterine fibroid. Subjects were explained about surgery as treatment. 30 subject undergone Laproscopic myomectomy and 20 subjects undergone open myomectomy. The clinical data of patients who underwent OM and LM was analyzed. The data recorded comprised patient demographic information and clinical characteristics including age, weight, type, and size of myoma and myomectomy indications; and perioperative data including estimation of blood loss, duration of surgery, complications, and length of hospital stay. Our morbidity analysis in this study favored LM in terms of blood loss, short duration of hospital stay, and less postoperative complications

Oral submucous fibrosis is a chronic debilitating disease associated with restricted mouth opening and poor oral hygiene. The treatment aims at good release of fibrosis and to provide long term results in terms of mouth opening. With the increasingly widespread application of reliable microvascular free tissue transfer techniques for oral cavity reconstruction, the routine need for a variety of local and regional flaps has decreased. Various local grafts have been used to cover the buccal mucosal defects after the fibrotic bands are released in oral submucous fibrosis. Successful use of inferiorly based nasolabial flaps in the management of oral submucous fibrosis is projected. In this article, the focus is on the utility of the pedicled nasolabial flap to achieve this goal. Care was taken for post-operative physiotherapy, and was followed up regularly for one year. Flap healed without evidence of infection, dehiscence, or necrosis. The inferiorly based nasolabial “islanded” flaps provide reliable coverage of defects of the buccal mucosa and improves mouth opening

Yawning reflex occurs in many animals and humans. It is believed to be the symbol of tiredness or boredom. It is said to be a contagious phenomenon. Scientific research is limited regarding the causes and purpose of yawning. The present study is planned to determine different yawning patterns in adolescents. After taking informed consent, the questionnaire with 6 point likert scale was given to 76 dental students (66 girls & 10 boys). They were asked to answer accordingly without revealing their identity. The results were represented graphically. Most of the students answered that they yawn “somewhat” or “not at all’. A positive response of yawning “very much” was given by 68.42% of students when they lack sleep. 73.68% & 71.05% students “don’t yawn at all” during an interview and while taking this survey respectively. Yawning is said to be contagious, but only 23.68% replied that they “yawn a lot” while seeing others do it. It can be concluded that the study group is probably alert and active as they expressed their yawning patterns at the base level.