Was achieved by following the manufacturer instruction from BD MGIT 320 guidelines and test was carried out using the standard strains of M. tb complex H37 RV and ATCC strains.

Fine needle aspiration was performed under aseptic precautions using 18-21 G. needle and slides were fixed in alcohol, followed by Haemotoxylin and Eosin staining and microscopy. Other cytological material were processed and stained with H & E followed by microscopy. Body fluids cytology was taken to be suggestive of tuberculosis when it was exudative with protein >3 gm% and predominant lymphocytes. FNA cytology of tuberculosis was evidenced by predominant lymphocytosis, necrosis, hypocellularity, and epitheloid granuloma with or without multinucleated giant cells with and without acid fast bacilli.

Various body fluids were analysed biochemically for proteins, sugar, Lactate Dehydrogenase and Adenosine deaminase levels. Biochemical findings were suggestive of tuberculosis when protein was >3 gm%, sugar less than two thirds of the blood levels, ADA with cut off > 20 IU/L and LDH > 130 IU/L.

Of the 147 extrapulmonary tuberculosis suspects analysed bacteriologically using microscopy and culture as various methods for diagnosis, thirty nine 26% of the samples were found to be positive bacteriologically i.e. by either direct microscopy, culture or by both smear and culture. Smear alone was positive in 13 [9%] of the specimens, culture alone was found to be positive in 14 [9.5%] and culture and smear both were positive for 12 [8%] specimens. Overall, culture positivity was around 18%. In the present study MGIT 320 system and LJ media together could detect 6 of the 26 or 23% isolates; LJ media alone could detect 2/26 or 8%. MGIT alone could detect 18/26 or 69% of the isolates. Of the 26 strains of M.tb complex isolated and confirmed by MPT64 antigen test. Four strains were showing resistance to first line anti– tuberculosis drugs. That drugs you can find in Canadian HealthCare Company website (canadianhealthmall.com) The rest of the strains were pan susceptible.

No significant variation in the gender ratio was observed in the number of samples submitted for processing. Around 77/147 or 52% were females and 70/147 or 48% were males. Anyhow female’s outnumbered males in laboratory confirmed extra pulmonary tuberculosis cases; a difference of 2.25 in gender ratio was noticed. Females being 18/26 [69%] and males 8/26 [31%]. The mean age for males in suspects was 46.11±23.46 and for females 39.42±27.74 .In the laboratory confirmed cases mean age for females was 35±22.77 and for males 39.75±16.83 respectively.
It is noted that young adults less than thirty five years of age accounted for the majority of the suspects 66/147 [45%] and of culture positive cases 21/26 [73%]. Therefore, it is evident that the disease is more prevalent in the economically active and reproductive age group of the society.

The majority of the samples received for test were pleural effusion accounting for 72/147 [49%] followed by peripheral lymph nodes accounting for 39/147 [27%], gastrointestinal accounting for 17/147 [12%], osteo articular accounting for 11/147 [7%], pus accounting for 5/147 [3%] and genitourinary in 3/147 [2%], respectively. In the present study, lymph node tuberculosis was the predominant type having 12/26 [46%] of the positive cases followed by pleural effusion in 5/26 [19%], osteo articular in 4/26 [15%], pus in 2/26 [8%], gastrointestinal in 2/26 [8%] and genito urinary in 1/26 [4%].

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In the present study, biochemical analysis of 89 body fluids in the form of pleural, peritoneal/ ascitic fluid showed that proteins were >2 gm% in 50%, none were having protein >3 gm%. Sugar was <2/3 of blood sugar in 100% of the cases and ADA & LDH were raised significantly in all i.e. 100% of the cases. Microbiologically only 26% of the specimens were positive for tuberculosis.

Of the total 147 specimen submitted for cytological diagnosis of extra pulmonary tuberculosis in pathology laboratory during the study period, seventy two were pleural fluids, thirty nine lymph node material obtained by FNA, seventeen were peritoneal fluids, five were pus samples, eleven were osteo articular and three genitourinary. Cytology was suggestive of tuberculosis in 99 [67.34%]. Twenty percent of the specimens were positive by both cytology and culture. And smear and cytology was positive for 21 [21%]. The remaining 58 [59%] were only cytology positive.

Women often become stuck in their career roles despite their capabilities and potential as men continue to climb the ranks of success within companies and corporations. The number of women CEOs and top executive positions of Fortune 500 and 1000 is below 3.6 percent.

In addition to this, women are also less likely to be placed in managerial positions when compared to men and are continuing to be paid less, despite the fact that women are accounting for a higher percentage of degree holders on a continuum.

Dour and Theran (2011) refer to this occurrence as maladaptive perfectionism, and it is considered to be a risk factor for issues related to poor body image and eating disordered behaviors.

As the superwoman strives for perfection in all areas of her life, she not only wants to be the perfect wife, mother and employee; wanting to be attractive is also an important characteristic. As mentioned previously these roles are naturally conflicting; meaning that failure to achieve perfection is often likely to occur, thus affecting the superwoman in a negative manner.

The superwoman ideal includes the desire to be physically attractive and maintaining a thin physique, leading to the overall perception of one that is independent, successful and beautiful.

Hamacheck (1978) describes different levels of perfectionism on a continuum with normal perfectionists being able to reevaluate themselves when necessary, leading to less detrimental affects on the individual. He proceeds to describe neurotic perfectionism in which the individual is not able to accept failure and is driven more by this factor as opposed to the actual desire to achieve.

Superwomen display this neurotic perfectionism in their drive to have it all. Unfortunately as the superwoman adheres to a persona that is seen is smart, autonomous, nurturing and attractive, she is also putting herself at risk for various factors that can be both psychological and physiological. A prevalent link between perfectionism and adherence to the superwoman schema is the increased likely hood of poor body image and eating disordered behavior.

The superwoman ideal includes the desire to be physically attractive and maintaining a thin physique, leading to the overall perception of one that is independent, successful and beautiful.

Hamacheck (1978) describes different levels of perfectionism on a continuum with normal perfectionists being able to re- evaluate themselves when necessary, leading to less detrimental affects on the individual. He proceeds to describe neurotic perfectionism in which the individual is not able to accept failure and is driven more by this factor as opposed to the actual desire to achieve.

In this study 240 patients were male as compared to female 140 female patients. Age of the patients varies between 17-58 years with average age being 26.5 years. Most common presentation in this study was ureteric colic (70%) followed by burning micturition (50%) followed by vomiting (40%) and fixed renal pain in 30% cases. Most common sign was haematuria (80%).

A stone in the ureter usually arises in the kidney and enters in to the ureter subsequently. Most calculi are small and pass spontaneously. Typically most patients present with sudden onset of agonizing pain, which may radiate to the groin, sacrum, labia, scrotum and the anterior surface of thigh. Presence of stone in ureter does not necessitate the surgical intervention.

Important factors that decide spontaneous passage of stones are its size, location and degree of obstruction at the initial presentation. Conservative treatment or medical treatment is probably most effective for stone size of 3- 10mm.

Overall incidence of stone passage with medical treatment is >65%. Many randomized trials prove the efficacy of conservative or medical treatment and helps in reducing the pain and helps in stone passage. Thus overall rate of surgical intervention is reduced with medical treatment. Conservative treatment using medical therapy is found to be cost-effective before embarking upon surgical option.

Most stone that will pass spontaneously with conservative management, will pass within 4-6 weeks. According to meta-analysis done by Marlene Busko conclude that all patients with stone size up to 1 cm who are candidate for observation should be offered trial of medical therapy. Conservative or medical management should not be offered to patients with >1cm size stone, high grade obstruction or patients in sepsis.

According to Pak et al, high fluid intake in such ways that urine output remains above 3 liters per day, has shown that there is reduction in saturation of calcium phosphate, calcium oxalate thus decreasing the chances of stone formation. High fluid intake is associated with increase in inhibitory activity of Tamm-Horsfall protein.

Diuretics like Dicontin–K inhibits the sodium-potassium chloride channel in the ascending limb of loop of henle. It increases the urine output. Calcium channel blockers and α-blockers have been found to be associated with antegrade propulsion of stone by inhibiting ureteral spasm.

Diclofenac sodium inhibits the formation of prostaglandins and helps in relieving pain of stone colic. In addition to anti-inflammatory action, Diclofenac sodium interferes with auto-regulatory response by reducing renal blood flow and does not affects the renal function in normal kidney. Calcium channel blockers are smooth muscle relaxant. Few small prospective studies show that it facilitates spontaneous passage of stone if it is combined with prednisolone which is strong anti-inflammatory drug.

In this study, there was a male preponderance (60%) and median age of presentation was 26.5 years with age varies between 18-75 years. Ureteric stone was more common on right side as compared to left side (60% vs. 40%) in this study.

Most common presentation was ureteric colic in 280 patients (70%), followed by burning micturition in 200(50%) followed by vomiting (40%) and fixed renal pain in 30% cases. Most common sign was haematuria in 290 (80%) followed by urinary tract infection in 230(60%) of patients. Absence of haematuria does not rule out present the stone. According to one study, 67% of patients with ureteric stone had more than 5 RBC per high power field and 89% of patients had more than 0 RBC/hpf on urine microscopic examination.

Total number of patients with stone up to 4mm size were 210(52.5%), 5-6mm were 40(10%) and 7-10mm were 150(37.5%). Patients with stone size up to 4mm were offered regime 1 out of 210 ,120 patients had passed stone with regime 1& 30 patients were referred for surgery because of high grade obstruction they develop. Remaining 60 patients were switch over to regime 2, out of those 48 (80%) patients had passed stone.

Those patients of 5-6mm and 7-10 mm were offered regime 2.out of 190 patients,114 patients had passed stone with success rate of 60%.comparing the efficacy of regime 1 to 2, regime 2 was found to be more effective for upper 1/3rd(P:0.011) and lower 1/3rd (p=0.000). For middle 1/3rd, there was no statistical significant difference was found (p:=0.676).Overall success rate with regime 2 was 80%.

Stone passage rate was highest in the lower ureter 1/3rd (80%) followed by middle 1/3rd (45%) and upper 1/3rd (40%). According to Ueno et al, width is a critical determinant of spontaneous passage of stone. So we considered width as a parameter for patient’s selection. We found that stones measuring 5 mm or smaller in size will usually pass spontaneously in 80% cases, while stones measuring 6mm or larger in size will pass spontaneously in 60% cases.

Though Stone size and location is very important predictor of stone passage, many other factors decide the fate of stone. It is known that the larger the stone lower the probability of spontaneous passage. With regard to the location of stone, our study showed that if a stone was present in the upper 1/3rd of ureter at the time of diagnosis, the overall frequency of spontaneous passage was 40%. The frequency of spontaneous passage of stones in the distal 1/3rd of ureter was significantly higher than that of stones in the upper 1/3rd (80%).

A review of the literature published by Hubner et al in 1993 included 2,704 cases derived from six studies; they reported frequencies of spontaneous passage of 12% for proximal ureteral stones, 22% for mid ureteral stones, and 45% for distal ureteral stones. Review by Singh et al show that medical treatment using either α-blockers or calcium channel blockers improve the stone passage rate for moderately sized distal ureteral stones. Adverse drug reactions were noted in 4% of those taking α-blockers and in 15.2% of those taking calcium channel blockers.

Meta-analysis by Hollingsworth et al also concludes that medical therapy with either calcium channel blockers or α- blockers may increase the chance of spontaneous passage of stone. Steroid has also found to important in the conservative management of ureteric stone. Addition of steroid to α blocker has been found to shorten the time for spontaneous passage.

Overall success rate is 70.5% in this study for stone up to 10 mm in size (282 patients have passed stone out of 400) In our study, higher stone clearance rate was noted with regime 2. Those patients who were not responded to regime-1 were switch over to regime-2 and responded very well (80%). There was a statistically significant difference was noted with regime 2 for at least lower 1/3rd (p=0.000) and upper 1/3rd calculus (p=0.011). Better response rate was probably because of addition of calcium channel blockers and steroids.

Only those patients who required intervention were admitted to the hospital. All other patients were managed at home by medical treatment. No patients in our study showed any significant side effects associated with drugs.

Medical expulsive therapy using calcium channel blocker and steroid is a rational approach for management of ureteric calculi. It is cost effective and patients can be treated on outpatients’ basis. Patients can carry out his day to day work with medical expulsive therapy without significant side effect.

Medial epicondylitis can occur in patients of all ages, but predominantly affect patients in the fourth and fifth decades of life with no gender predominance. Potential etiology of the injury includes overuse and repetitive microscopic or macroscopic avulsion injuries of the common flexor tendon, most commonly the flexor carpi radialis and pronator teres, or from a single traumatic event.

In the latter, the patient may recall hearing a “pop” around the site of the medial epicondyle following some stress in which an object was pulled from the patient’s hand. Medial epicondylitis is diagnosed by point tenderness just distal and anterior to the medial epicondyle as well as pain that is reproduced by resisted flexion and pronation of the wrist. The two most common problems that can mimic medial epicondylitis are cubital tunnel syndrome and medial ulnar collateral ligament insufficiency.

There is both an acute and chronic phase of medial epicondylitis; the former is characterized by symptoms mostly during activity while the chronic consists of constant, dull pain that may only slightly worsen with activity Risk factors for medial epicondylitis include smoking, obesity, repetitive movements for at least 2 h daily, and activities which place more than 20 kg of force on the arm.

Surgical intervention for medial epicondylitis is considered the last line of treatment for the condition and is only attempted after conservative treatment has failed to relieve the patient of pain. Most clinicians consider persistent pain for more than 6-12 months an indication for surgical treatment.

The purpose of this study was to determine whether the Z-lengthening approach for common flexor tendon debridement is a viable option for cases of medial epicondylitis refractory to non-surgical treatment based on patient satisfaction, visual analog scale (VAS) pain score, Nirschl and Pettrone clinical assessment, disability of the arm, shoulder, and hand (DASH) score, and the McGowan grading system. The authors hypothesized that patients treated with the Z-lengthening approach for common flexor debridement will experience significant pain relief and adequate function post-operatively.