Introduction: Von Hippel-Lindau disease (VHL) is a multi-systemic disease characterized by abnormal multiplication of blood vessels, with haemangioblastomas and cysts, as well as other neoformations in the blood Several organs. We report the case of a patient; we try to put the point on this pathology. Case Report: 14-year-old patient, consults for a BAV of the OD whose examination finds an intra vitreous haemorrhage,retinal capillary haemangioma and a lower exudative retinal detachment. The patientreceived an IVT of anti VEGF initially followed by an endocular surgery. Postoperative visual acuity was not improved with a follow-up of 6 months. Discussion: The clinical definition of VHL disease is based on the presence of two major lesions, one of which is hemangioblastoma. The absence of family history, or a single injury in the presence of a family history. Complementary examination is based on angiographyto fluorescein. Complications can range from simple exudates to DR or even phtyse of the globe. The treatmentis essentially based on argon laser coagulation, cryotherapy, anti-VEGF and retinovitealstage of complications. Conclusion: VHL is a hereditary disorder with multi-systemic involvement, hence the interest of an examination complete follow-up, regular monitoring and genetic counseling in any patient suspected of having the diseaseas well as his family

Although each drug causes unique physiological and neurological effects, all drugs overlap in one important way, All drugs cause changes in the brain, some in ways that may be long-lasting or even permanent. These brain changes can have significant effects on mood and cause depression, ultimately lessening a person's ability to lead their best and healthiest life. Your brain regulates all the body's basic functions, including every breath and each heartbeat, while enabling you to interpret and respond to experience. It shapes thoughts and emotions and determines your behavior. Despite some commonality, the short- and long-term health effects of drugs are distinct, with each one potentially affecting life spans in a different way. Opioids include heroin and prescription pain relievers such as oxycodone, hydrocodone, codeine, morphine and fentanyl. All members of the same chemical family, these drugs interact with the opioid receptors on nerve cells in both the body and the brain. Out of everyone who tries heroin for the first time, nearly one in four become addicted. Repeated heroin use changes the physical structure Wang, X et al., (2012) and physiology of the brain, creating long-term imbalances in neuronal and hormonal systems that are not easily reversed Ignar, D. M et al., (1990) & Kreek, M. J et al., (1984). Studies have shown some deterioration of the brain’s white matter due to heroin use, which may affect decision-making abilities, the ability to regulate behavior, and responses to stressful situations Li, W et al., (2013), Qiu, Y et al., (2013) & Liu, J et al., (2011). Heroin also produces profound degrees of tolerance and physical dependence. Tolerance occurs when more and more of the drug is required to achieve the same effects

Replantation of the avulsed tooth immediately is the ideal emergency management. Accounting for about 0.5-16% of injuries caused by trauma in the permanent dentition creates a strenuous situation for the patient and dentist. Its prevalence is more common in children with maximum cases occurring in ages between 7 to 9 years old, when the development of root is incomplete and also the maxillary central incisors are the most common site involved, thus creating a negative psychological impact on the child as well as the parent owing to esthetic reasons. Therefore, esthetics and function of the avulsed tooth can be restored by immediate or delayed replantation. In the present case report we will discuss the management of an avulsed tooth in a 21 years male patient in maxillary anterior region. In this case after 18 months, replantation of avulsed tooth was successfully achieved even it has to be replanted in unfavorable conditions. The tooth was asymptomatic, firm and radiographically no signs of resorption or infection were observed.

The article is devoted to the study of the issues of determining the patterns of air pressure losses along the length of the pneumatic conveying pipeline for raw cotton, with different flow parameters and different diameters of the pipeline.

American writer Edgar Allan Poe and English writer Agatha Christie both are masters of detective novels. The former is the pioneer of detective stories and the latter is the “golden age” of detective novels. Both of them have achieved great successes and enjoyed a great reputation. The Mystery of Marie Roget and Five Little Pigs are representatives of the “armchair detective mode” novels written by Allan Poe and Agatha respectively. The former mainly uses the first person perspective and male narrative voice, and it realizes the transformation from "the first person external perspective" to "the first person internal perspective", while the latter mainly uses the third person perspective and female narrative voice, and it changes from zero focalization into internal focalization. By analyzing the differences between two novels regarding narrative perspectives and narrative voices, it shows that Edgar Allan Poe strictly upholds the "unity of effect" theory in his creation and Agatha Christie adheres to her simple feminist consciousness in her novels

Background: Satisfaction of patients is an important segment of dental care and it may be influenced by individuals’ socio-demographic characteristics. Prosthodontists must understand that esthetic issues are common and have major importance for their patients. Aims of the study: This study was to know the patient satisfaction, who visited the College of Dentistry Clinic for prosthodontics needs. Material and methods: This was an observational analytical cross-sectional study, which was carried out on the patients, visited for the replacement of teeth. The patients above the age of 14 years were selected from the CBCT register that was scheduled for treatment of implant, fixed or removable partial denture prosthesis. Total of 139 patients (75 males and 64 females) were included in the study. The questionnaire consists of basic information about age, gender, educational level, nationality, smoking habits, visit of treatment and the treatment providers and also asked satisfaction on treatment provided. Results: Out of 75 male patients, 60 (80%) were satisfied and 54 females out of 64 patients (84%) were satisfied with the treatment provided (P = 0.329). Seventy-six (79%) Saudis and only 38 (59%) non-Saudi satisfied with the treatment. There was no difference in satisfaction among age-wise of patients. New visitors and who went to get treatment from students and interns were more satisfied with their visit to the college clinic. Conclusion: The patients who were new and got treatment with students and interns were more satisfied. There was not much difference of satisfaction among age differences of the patients.

As the age increase the comorbidities also increases and also chance of polypharmacy. Polypharmacy is termed as the concurrent use of multiple medications (5 or more drugs), whether prescription or over-the-counter, by a single patient. The use of multiple drugs increases the risk of inappropriate pre¬scribing and significantly lowers adherence to drug regimens and results in DDIs. The main aim of study to find drug interactions in elderly patients as a result of polypharmacy and also determine the drug use. A retrospective, observational study was carried out to find among elderly in-patients age above or equal to 60 years for over a period of 3 months. Data was collected from medical record department (MRD) in a pre-designed format which includes demographic details, drugs prescribed, drug per prescription and drug- drugs interactions (DDIs) encountered, DDIs are calculated using drugs.com. during the study we found that average number of drugs are 8.9 (±5.6) and mean age was 70.69 ± 6.89 year between the range 60 -88 years. Drugs involving moderate drug interaction (66.95%) were predominately seen when compared to minor (20.87%) and major (12.18%) drug interactions. The study reveals that there is statistically significant (p<0.05) between the number of drugs per prescription and frequency of drug interactions. Highest number of inappropriate drug combinations are seen between aspirin and anticoagulants like enoxaparin and heparin. Polypharmacy is a risk factor in elderly which will results in serious consequences like ADRs and DDIs. These problems can be overcome by strictly monitoring which will helps in maintaining the quality of life in elderly

Chronic renal failure (CRF) is a life-threatening disease in which a patient needs a long-term treatment such as hemodialysis, kidney replacement to save his life. Aim: this study was aimed to identify the relation between stressors, self efficacy and level of hope for patients with CRF, undergoing hemodialysis. Design: a descriptive correlation research design was utilized in this study. Setting: The study was conducted at King Fahd unit for hemodialysis at, ELManial hospital, Cairo University. Subjects: a purposive sample of 160 patients with CRF undergoing hemodialysis. Tool of data collection: Socio-demographic datasheet,hemodialysis stressor scale(HSS) ,self efficacy scale &Herth hope scale. Results: Showed that more than two thirds of the studied subjects undergoing hemodialysis for more than 24 months less than two third of them were suffering from moderate degree of stress, more than fifty percent of the studied subjects had high levels of hope, while less than fifty percent of them had a moderate level of hope. Conclusion: The highest percentage of the studied subjects were suffering from moderate degree of psychosocial stressors, such as depression, sadness, changed in family responsibility and dependence on others, statistically significant negative correlation was found between stress and self-efficacy. Moreover, a negative correlation was found between stress and level of hope while, there is no, statistically significant correlation between self-efficacy and level of hope. Recommendation: Supportive and therapeutic intervention program should be provided for both patients with chronic renal failure and their families to alleviate their stress ,increase sense of hope and improve their quality of life.

Vernal conjunctivitis is a bilateral, recurrent inflammation of conjunctiva that tends to occur in children.The prominent features are itching, photophobia, redness, tearing, mild ptosis and thick ropy yellow mucoid discharge. The main clinical signs are cobblestone papillary hypertrophy, hyperemia of upper tarsal conjunctiva localized edema and Trantas dots. The three forms of vernal conjunctivitis are palpebral, limbal and mixed. Wide range of treatment modalities are now available for vernal keratoconjunctivitis.This study included 80 patients of both sex in the age group 5-25 years with any form and severity of vernal keratoconjunctivitis. Patients were randomly divided into two groups A and B. Group A patients were given cyclosporine (0.05%) eye drops and group B patients were given fluorometholone (0.1%) eye drops. The results were statistically analyzed by Mann Whitney Test and p value of <0.05 was taken as statistically significant. Maximum numbers of patients were below 15 years of age in both the groups and, in both groups; males were more than females.Most of the eyes presented with palpebral type of disease in both groups.Patients had maximum symptomatic relief at the end of fourth week in both the groups. Response to fluorometholone (0.1%) was significantly better than cyclosporine (0.05%)

Inequality in the provision of income under Article 8 PP 10/1983 Jo PP 45/1990 because the PP is strongly influenced by the current ruling authorities up to the legal product Conservative /Orthodox/elitist, law as a Political tool, Government tool, law closed because of the role and participation of small communities. In the reform era, the second provision of PP was irrelevant. The purpose is Article 8 PP10 / 1983 Jo PP45 / 1990 to prevent the divorce of civil servants and to create discriminatory law and injustice. Both of these Government Regulations (PP) are contrary to the principles of human rights, basic values of living and developing in the midst of society such as the appropriate Islamic law as ground norms, the 1945 Constitution Article 28D Jo Article 29 and the principle of modern democratic state (welfare state), the expectation of the article is for the smooth running of civil service duties, and as a means of enhancing the discipline of civil servants. However, both Articles of the two PPs substantially complicate marriage and civil servant divorce such as (UUP) because it restricts the marriage and civil servants divorce with strict requirements. The purpose of this study is to describe and analyze the background and the purpose of setting one-third of the salary of a husband to a former postdivorce wife. This present study uses the legal constructivism method with non-positivistic paradigm (ontological, epistemological and axiology where the author is a facilitator). With the socio-legal research approach, and using primary and secondary data sources, primary legal materials, secondary legal materials, and non-legal materials.

Depression is a real illness that impacts the brain: It is a serious illness caused by changes in brain chemistry. Research tells us that other factors contribute to the onset of depression, including genetics, changes in hormone levels, certain medical conditions, stress, grief or difficult life circumstances. Any of these factors alone or in combination can precipitate changes in brain chemistry that lead to depression’s many symptoms. Preliminary results suggest a relationship between vitamin B12 deficiency and increased levels of fatigue and depression in stroke patients. If these findings could be replicated in a larger and general stroke sample, this would open treatment options and may improve quality of life after stroke. High vitamin B-12 status may be associated with better treatment outcome of depression. One possible connection is the effect of vitamin B-12 on the levels of serotonin in your brain, in addition to other chemicals. Serotonin helps to regulate your mood. Low levels of serotonin may be linked to depression. However, recent research has suggested that serotonin may play a smaller role in depression than previously thought. Background/Objective: Recent literature has identified links between vitamin B12 deficiency and depression. We compared the clinical response of SSRI-monotherapy with that of B12-augmentation in a sample of depressed patients with low normal B12 levels who responded inadequately to the first trial with the SSRIs. Methods: Patients with depression and low normal B12 levels were randomized to a control arm (antidepressant only) or treatment arm (antidepressants and injectable vitamin B12 supplementation). The researchers suggest people with depression take a 1-milligram supplement of B-12 daily. More research is needed to fully understand the link between B-12 and depression. Results: A total of 100 depressed patients were screened. Out of 76 patients with low normal B12 levels (76%) were randomized to the treatment group while 24 (24%) were randomized to the control arm. At three months follow up 100% of the treatment group showed at least a 20% reduction in HAM-D score, while only 69% in the control arm showed at least a 20% reduction in HAM-D score (p<0.001). The findings remained significant after adjusting for baseline HAM-D score (p=0.001). Hamilton Rating Scale for Depression the Hamilton Rating Scale for Depression (HRSD), also called the Hamilton Depression Rating Scale (HDRS), abbreviated HAM-D, is a multiple item questionnaire used to provide an indication of depression, and as a guide to evaluate recovery

Background: The morphometric parameters of mandibular ramus play an important role in predictive variable in sex determination of mandible. Aim: to study the morphometric predictability of mandibular ramus in sex determination of mandible. Materials and Methods: 40 dry human mandible bones of unknown sex were utilized to study the height and breadth of the ramus of mandible and its accuracy factor in sex determination. The dry mandible bones were collected from the Department of Anatomy as well as from the undergraduate students of Santhiram Medical College & Hospital, Nandyal. The parameters like height, breadth of the mandibular ramus were measured by using sliding calipers. Results: The height of the ramus of mandible on the right side was 108.85 + 9.84 and on the left side, it was 108.82 + 9.89 in the present study. The maximum breadth of ramus was 43.62 + 5.09. The minimum breadth of ramus was 57.85 + 8.08. Conclusion: Morphometric variations of mandibular ramus may be an important anatomic factor for sex determination and unfavorable anatomic factor in difficult laryngoscopy.

Due to the so-called ‘radical’ approach taken by writers of popular fiction, coupled with their subjects of interrogation, a debate over quality and relevance has raged on with scholars criticizing popular literature for being aesthetically wanting and incapable of commitment requisite of literature. Such works have been referred to as “...a trashy and scabrous imitation of brothel and [low-life] especially yearned for the [low-brow] reader in this country”. In this regard, the concept of ‘popular’ becomes ambiguous as it comes to the reader inscribed with the history of political and cultural struggles. It is not only a site of contested evaluation but the term ‘popular’ has also been used pejoratively. ‘Popular’ has been used as synonymous with low-class; and low-class with irrelevant. Literature forms a major avenue upon which knowledge can be passed. In Kenya, in particular, Literature is part and parcel of English; a compulsory subject. There is, however, a tendency to disregard popular literature in favour of canonical literature. The most obvious justification for this has been that canonical literature has more ‘serious’ knowledge to offer as compared to popular fiction/literature. Due to this relegation of popular fiction to the peripheries, very little attention has been accorded to its role in social commentary. This association of popular fiction with the “low-class” members of the society has led to the misconception that popular fiction has nothing “serious” to offer to the “elite readership”. To debunk this notion, this paper undertakes a holistic analysis of Meja Mwangi’s “Going Down River Road” and in so doing, argues for the fact that, from a post-modernistic viewpoint, this text provides verisimilitude to its fullest meaning. With use of adequate illustrations, the paper makes reference to the various tenets of post-modernism and: establishes the thematic concerns dealt with by Meja Mwangi; identifies and discusses the interplay between politics and literature as espoused in this text; and discusses the use of stylistics to capture the reality as lived by the characters in the text, and by extension, the author

Introduction: The aged have to cope-up with many physical and mental health problems with advancing age requiring constant attention. Depression, Hypertension, Arthritis, Dementia and Alzheimer’s are highly prevalent among the aged. Alzheimer’s disease is known to men only since 100 years, Alzheimer’s disease is a form of dementia. Dementia is derived from the Latin word de – “apart, away” and “mens” – mind. Dementia is a progressive brain dysfunction which result in a restriction of daily activities and in most cases leads in the long term to the need for care. Dementia is the most feared and divesting disorder of late life. Current estimates reveals that there are about 18 million cases of dementia in the world and by 2025, there will be about 34 million suffering from dementia. The overall prevalence of dementia ranges from 5 percent to 7 percent. Alzheimer’s disease is the most common dementing disorder accounting for 80 percent of all cases of dementia. Material & Methods: Anon-experimental, descriptivedesign was adopted to assess the knowledge of adult regarding Alzheimer’s disease in a view to develop information booklet.The study was conducted on 100adults, who are in the age group of between 21 – 50 years from mansarowar area of Jaipur city, who fulfill the inclusion criteria for the study. Data was collected from Jan 2014 to August 2014.A structured interview schedule was used to assess the knowledge of Alzheimer’s disease. Results: The data revealed that, there is significant association between level of knowledge and educational status, marital status and family .Major findings of study revealed that Out of 100 adults 16 percent had adequate knowledge 37 percent had moderate knowledge and 47 percent had inadequate knowledge on Alzheimer’s disease. The overall mean value of the adult’s knowledge regarding Alzheimer’s disease was 53.9 percent; mean were 16.17 and standard deviation of 15.5. Conclusion: After the detailed analysis of this study shows that nearly 50% of population does not have adequate knowledge about Alzheimer’s disease, hence information booklet will definitely help to increase their knowledge to facilitate better care for Alzheimer’s disease.

Estimated fetal weight has a great significance in obstetrical ultrasound, as this gives the information about fetal growth and assist in planning the mode of labour management. Various formulas are used for estimating the fetal weight. Vintzileos’ formula, in which there is an addition of fetal thigh circumference along with biparietal diameter, abdominal circumference and femur length correlates well with actual birth weight however it is slightly less accurate in predicting the birth weight than Hadlock’s formula. Objective: To correlate the fetal thigh circumference at 36-40 weeks ultrasonographically with birth weight. Method: A cross sectional analytical study involving 236 patients was conducting in the radiological department of Mansoorah Hospital, Lahore, Pakistan using Toshiba Nemio 30 with 2-5 MHz transducer. Results: Mean of actual birth weight is 3.3424 + 0.42374 which is different from the mean of EFW by Vintzileos i.e. 3.4504 + 0.08968 whereas it is similar to mean of Hadlock’s formula i.e. 3.3199 + 0.35452. Correlation between EFW by Vintzileos’ formula and actual birth weight is 0.319 more significant than the correlation between EFW by Hadlock’s formula and actual birth weight i.e. 0.300. Conclusion: Hadlock’ formula is more accurate in predicting the actual birth weight than the Vintzileos’ formula. However, due to its stronger correlation with birth weight thigh circumference can be used as an alternative parameter to biparietal diameter for estimating the birth weight at or near term when biparietal diameter becomes difficult to measure because of fetal head position down to pelvic bone.