Frequency Of Anomalies Research Articles

Ocular manifestations associated with takayasu arteritis: a multimodal imaging study

PurposeThe goal of this study was to describe ophtalmological features of Takayasu disease on fundus exam, in fluorescein angiography and OCT angiography.MethodsAll patients diagnosed with Takayasu disease and followed in la pitié salpétrière hospital from 2004 to 2016 were restrospectively included. They underwent a complete ophtalmological exam including best correct visual acuity, slit‐lamp biomicroscopy, fundoscopy and multimodality imaging including fluorescein angiography and SD OCT. Most patients underwent OCT angiography.The images were analyzed to evaluate perifoveal anastomotic capillary arcade disruption, capillary perifoveolar density, mivroaneurysms. The foveal avascular zone (FAZ) was measured for superficial (SCP) and deep (DCP) capillary plexus.Results26 eyes were included. Most frequent anomalies were retinal microaneurisms (6 patients). Stage I retinopathy was seen in 5 eyes; stage II in 10, stage III in 2 and stage IV in 3 eyes. 14 eyes underwent OCT Angiography. 11 eyes of 6 patients presented with ruptures of the perifoveal anastomotic capillary arcade in SCP. 5 eyes had microaneurysms. 11 eyes of 6 patients had rarefaction of the perifoveolar vascular density in SCP. The average measure of the SCP FAZ was increased to 0.34 mm2 (0.19–0.74) in takayasu patients compared to 0.27 mm2 (0.18–0.33) in the patients with no maculopathy.ConclusionsMacular abnormalities are uncommon in patients with Takayasu disease as the retinopathy signs are most likely located in the peripheric retina. This study reveals that most of our patients present an enlargement of the FAZ, even in the earliest stages of retinopathy with no macular abnormality on fluorescein angiography. The study finally highlights the relevance of using OCT A to evaluate the macular ischemia as a complement to usual retina global study in fluorescein angiography.

Quels sont les besoins de traitement chez l’adulte ? Une évaluation sur 258 cas par l’IOTN

The aim of this epidemiological study was to evaluate the need for orthodontic treatment in a sample of adults living in France. The indicator selected was the dental component, IOTN (index of orthodontic treatment need). Among the 258 adults evaluated, 37% of patients had a strong need and 21% had a moderate need; 29% of those aged 35 and under were in strong need for treatment compared with 47% of those over 35 years, with the need for treatment increasing with age. The most frequent occlusal anomalies were dental migrations following an uncompensated tooth extraction (a situation that involved 22% of subjects). It was the only occlusal anomaly whose frequency increased significantly with age. Among patients with uncompensated tooth extraction, two thirds experienced dental migrations requiring orthodontic treatment. Although the IOTN indicator is widely used in the literature, it is controversial since all the characteristics evaluated are liable to impact longevity and the functioning and esthetics of the dentition, thus excluding any other consideration. The need for treatment in adults in France would therefore appear to be greater than in adolescents and would seem to increase with age, mainly due to uncompensated dental extractions.

Polyhydramnios - frequency of congenital anomalies in relation to the value of the amniotic fluid index.

The aims of our study were to assess the correlation between the amniotic fluid index (AFI) value and the frequency and type of fetal anomalies. The material included 94 patients at the third trimester of pregnancy, 60 with mild polyhydramnios, 19 with moderate one, and 15 with severe one. Polyhydramnios was diagnosed if AFI was > 24 cm. All patients were divided into three groups based on the value of AFI: 1) mild polyhydramnios with AFI between 24.1 and 29.9 cm, 2) moderate polyhydramnios with AFI between 30-34.9 cm, and 3) severe polyhydramnios with AFI ≥ 35 cm. The incidence of fetal malformations correlated significantly with the degree of polyhydramnios and was the highest in patients with severe polyhydramnios (53.3%, p = 0.002). Congenital malformations of the gastrointestinal tract were the most frequent fetal anomalies in the whole group of patients (5.3%). Trisomy 18 was the most frequent aneuploidy found in women with polyhydramnios (2.1%). The incidence of fetal congenital anomalies significantly increases with the degree of polyhydramnios, being most frequent in severe one and rather rare in a mild one. Congenital malformations of the gastrointestinal tract were the most frequent anomalies in patients with polyhy-dramnios, especially in women with severe polyhydramnios.

Open versus closed surgical exposure of canine teeth that are displaced in the roof of the mouth.

Palatally displaced canines or PDCs are upper permanent canines, commonly known as 'eye' teeth, that are displaced in the roof of the mouth. This can leave unsightly gaps, cause damage to the surrounding roots (which can be so severe that neighbouring teeth are lost or have to be removed) and, occasionally, result in the development of cysts. PDCs are a frequent dental anomaly, present in 2% to 3% of young people.Management of this problem is both time consuming and expensive. It involves surgical exposure (uncovering) followed by fixed braces for two to three years to bring the canine into alignment within the dental arch. Two techniques for exposing palatal canines are routinely used in the UK: the closed technique and the open technique. The closed technique involves uncovering the canine, attaching an eyelet and gold chain and then suturing the palatal mucosa back over the tooth. The tooth is then moved into position covered by the palatal mucosa. The open technique involves uncovering the canine tooth and removing the overlying palatal tissue to leave it uncovered. The orthodontist can then see the crown of the canine to align it. To assess the effects of using either an open or closed surgical method to expose canines that have become displaced in the roof of the mouth, in terms of success and other clinical and patient-reported outcomes. Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 24 February 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (in the Cochrane Library, 2017, Issue 1), MEDLINE Ovid (1946 to 24 February 2017), and Embase Ovid (1980 to 24 February 2017). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. We included randomised and quasi-randomised controlled trials assessing young people receiving surgical treatment to correct upper PDCs. There was no restriction on age, presenting malocclusion or type of active orthodontic treatment undertaken. We included unilaterally and bilaterally displaced canines. Two review authors independently screened the results of the electronic searches, extracted data and assessed the risk of bias in the included studies. We attempted to contact study authors for missing data or clarification where feasible. We followed statistical guidelines from the Cochrane Handbook for Systematic Reviews of Interventions for data synthesis. We included three studies, involving 146 participants. Two studies were assessed as being at high risk of bias.The main finding of the review was that the two techniques may be equally successful at exposing PDCs (risk ratio (RR) 0.99, 95% confidence interval (CI) 0.93 to 1.06; three studies, 141 participants analysed, low-quality evidence).One surgical failure was due to detachment of the gold chain (closed group). One study reported on complications following surgery and found two in the closed group: a post-operative infection requiring antibiotics and pain during alignment of the canine as the gold chain penetrated through the gum tissue of the palate.We were unable to pool data for dental aesthetics, patient-reported pain and discomfort, periodontal health and treatment time; however, individual studies did not find any differences between the surgical techniques (low- to very low-quality evidence). Currently, the evidence suggests that neither the open or closed surgical technique for exposing palatally displaced maxillary canine teeth is superior for any of the outcomes included in this review; however, we considered the evidence to be low quality, with two of the three included studies being at high risk of bias. This suggests the need for more high-quality studies. Three ongoing clinical trials have been identified and it is hoped that these will produce data that can be pooled to increase the degree of certainty in these findings.

Cytogenetic effects induced by the fungicide Royal Flo to maize (Zea maysL.)

AbstractThe present study investigates the cytogenetic effects of the fungicide Royal Flo on mitotic cell division in maize (Zea mays L.) root cells. The maize grains were treated with various fungicide concentrations (50, 70, and 80%) for 20, 24 and 48 h exposure times. The results obtained indicate that the fungicide Royal Flo had some cytogenetic effects, by reducing the mitotic index and inducing various cytologic and chromosomal anomalies. These effects manifested differently, their intensity being proportional to the concentration and exposure time. The most frequent chromosomal anomalies were bridges, fragments and binucleated cells, but sticky chromosomes, rings chromosomes and cells with a micronucleus have also been seen. This study proves that the fungicide Royal Flo, even when administered in smaller quantities than generally recommended, reduces the germination and the mitotic index of maize cells and induces a large number of chromosomal anomalies, which suggests its toxic, mutagenic potenti...

Trends and characteristics of fetal and neonatal mortality due to congenital anomalies, Colombia 1999–2008

Objective: To describe fetal and neonatal mortality due to congenital anomalies in Colombia.Methods: We analyzed all fetal and neonatal deaths due to a congenital anomaly registered with the Colombian vital statistics system during 1999–2008.Results: The registry included 213,293 fetal deaths and 7,216,727 live births. Of the live births, 77,738 (1.08%) resulted in neonatal deaths. Congenital anomalies were responsible for 7321 fetal deaths (3.4% of all fetal deaths) and 15,040 neonatal deaths (19.3% of all neonatal deaths). The fetal mortality rate due to congenital anomalies was 9.9 per 10,000 live births and fetal deaths; the neonatal mortality rate due to congenital anomalies was 20.8 per 10,000 live births. Mortality rates due to congenital anomalies remained relatively stable during the study period. The most frequent fatal congenital anomalies were congenital heart defects (32.0%), central nervous system anomalies (15.8%), and chromosomal anomalies (8.0%). Risk factors for fetal and neonatal death included: male or undetermined sex, living in villages or rural areas, mother’s age >35 years, low and very low birthweight, and <28 weeks gestation at birth.Conclusions: Congenital anomalies are an important cause of fetal and neonatal deaths in Colombia, but many of the anomalies may be preventable or treatable.

Input of organic matter to the Buor-Khaya Gulf (Laptev Sea)

We present results of study of organic matter in the coastal and bottom sediments of the Laptev Sea (Buor-Khaya Gulf). The study has shown the regularities of organic-matter distribution in the shelf zone adjacent to the glacial coast. The coast composed of a glacial rock complex supplies the largest amount of organic material to the sea as compared with other types of the coast. The average content of organic matter in these strata is ~2-3%. The bottom sediments of the shallow littoral zone are significantly depleted in organic carbon (0.1-0.3%) as a result of their active rewashing and the transition of finely dispersed material (mainly organic one) toward the deep sea zones. The content of organic carbon in the bottom sediments increases to 1-2% as the sea deepens to 7-10 m at 5-12 km from the coast. There are frequent local anomalies of organic-carbon contents (up to 4-5%) in the deltaic zones of the sea. The highest contents of organic carbon (up to 3%) have been found in the recent marine sediments in the central, relatively deep zones of the bays.

Skeletal anomalies in reared Senegalese sole Solea senegalensis juveniles: a radiographic approach.

Reared Senegalese sole Solea senegalensis Kaup show a high incidence of vertebral anomalies; however, little is known about its skeletal anomaly profile in the later farming phases. The purpose of this study was to provide a detailed description and quantification of the most common skeletal anomalies in reared Senegalese sole in the juvenile stage by means of computed radiography. A total of 374 Senegalese sole were classified according to the external morphology of the fish as normal or altered and then radiographed in latero-lateral and in dorso-ventral projections. Radiographic evaluation of anomalies focused especially on vertebral body anomalies (VBA) and vertebral column deviations (VCD). The 2 orthogonal projections provided a more complete visualization of the skeleton. Approximately 75% of the individuals showed at least 1 anomaly, while VBA and/or VCD were detected in 48.9% of the specimens. Regarding external morphology, 88% of the fish were categorized as normal, although about 72% of these normal fish displayed abnormalities in radiographies. The most frequent anomalies consisted of deformations of the caudal complex plates (hypurals, parhypural and epural), preurals and caudal vertebrae. Scoliosis was the most prevalent among VCD, affecting the caudal area in almost 15% of the individuals. The anomaly profile at the juvenile stages showed some differences compared to what has been reported previously in earlier stages of development. In light of these results, further investigation into the progression of skeletal anomalies over time and the causative factors at later stages is required.

Dental anomalies: prevalence and associations between them in a large sample of non-orthodontic subjects, a cross-sectional study

BackgroundTo analyze the prevalence and associations between dental anomalies detectable on panoramic radiographs in a sample of non-orthodontic growing subjects.MethodsFor this cross-sectional study, digital panoramic radiographs of 5005 subjects were initially screened from a single radiographic center in Rome. Inclusion criteria were: subjects who were aged 8–12 years, Caucasian, and had good diagnostic quality radiographs. Syndromic subjects, those with craniofacial malformation, or orthodontic patients were excluded and this led to a sample of 4706 subjects [mean (SD) age = 9.6 (1.2) years, 2366 males and 2340 females]. Sample was subsequently divided into four subgroups (8, 9, 10, and 11–12 year-old groups). Two operators examined panoramic radiographs to observe the presence of common dental anomalies. The prevalence and associations between dental anomalies were also investigated.ResultsThe overall prevalence of dental anomalies was 20.9%. Approximately, 17.9% showed only one anomaly, 2.7% two anomalies, while only 0.3% had more than two anomalies. The most frequent anomalies were the displacement of maxillary canine (7.5%), hypodontia (7.1%), impacted teeth (3.9%), tooth ankylosis (2.8%), and tooth transposition (1.4%). The lower right second premolar was the most frequent missing teeth; 3.7% had only one tooth agenesis, and 0.08% had six or more missing tooth (Oligodontia). Mesiodens was the most common type of supernumerary tooth (0.66%). Two subjects had taurodontic tooth (0.04%). Tooth transpositions and displacement of maxillary canine were seen in 1.4 and 7.5%, retrospectively (approximately 69 and 58% were in the 8 and 9 year-old groups, retrospectively). Significant associations were detected between the different dental anomalies (P < .05).ConclusionsThe results of our study revealed significant associations among different dental anomalies and provide further evidences to support common etiological factors.

PREVALENCE OF CONGENITAL ANOMALIES AND THEIR ASSOCIATED FACTORS IN NEWBORNS IN THE CITY OF SÃO PAULO FROM 2010 TO 2014.

ABSTRACTObjective: To study the prevalence of congenital anomalies in newborns in the city of São Paulo from 2010 to 2014, as well as to analyze other variables associated with the anomalies.Methods: Data was collected from the Ministry of Health’s Live Births Information System (SINASC) from 2010 to 2014 in São Paulo City. The variables analyzed were length and type of pregnancy, maternal age, and ethnicity and sex of the newborn. The absolute and relative frequencies of congenital anomalies were verified, and the variables associated with them were calculated with the odds ratio (OR) and a 95% confidence interval.Results: A total of 819,018 live births occurred in the city of São Paulo, and in 14,657 (1.6%) of them, some congenital anomaly was reported. The most frequent congenital anomalies found were those related to osteoarticular system followed by those related to the cardiovascular system. Risks associated with the presence of congenital anomalies were observed in the following factors: maternal age over 40 years (OR=1.59; 95%CI 1.47-1.71), multiple pregnancies (OR=1.28; 95%CI 1.19-3.77), and low birth weight (OR=3.35; 95%CI 3.21-3.49). The female gender was considered a protective variable (OR=0.78; 95%CI 0.75-0.81).Conclusions: Congenital anomalies are responsible for morbidity and mortality in the neonatal period. Their early diagnosis is important for planning and resource allocation of specialized health services directed toward the families and infants.

The Influence of Pathological Situations on Churches’ Functionality: An Approach Based on Historical Records

ABSTRACTThis study identifies the main anomalies that may occur in historical buildings, analyzing their related causes, and estimating the influence of pathological situations on the buildings’ functionality. This information is essential to support qualified, conscientious, and sustainable rehabilitation interventions on sets of heritage buildings with homogeneous constructive characteristics. A fuzzy expert system was used to estimate the serviceability of buildings, performed based on historical records, over a long period of time, evaluating the influence of the pathological situations to establish the rehabilitation actions. The methodology includes 17 variables, (vulnerabilities and external risks damages), which determine a functionality index of the constructions analyzed. The application of historical data allows knowing the past behavior and performance of the buildings. These data can provide useful information for the definition of preventive maintenance plans, considering financial, social, and environmental requirements and their more frequent anomalies. A total of 390 records in a sample of 20 parish churches located in southwestern Spain were gathered. This study discussed the effects of the most common anomalies observed in these buildings, concluding that controlling moisture and timber-related anomalies is crucial to ensure the building’s serviceability over time.

Epigenetic Alterations in Parathyroid Cancers.

Parathyroid cancers (PCas) are rare malignancies representing approximately 0.005% of all cancers. PCas are a rare cause of primary hyperparathyroidism, which is the third most common endocrine disease, mainly related to parathyroid benign tumors. About 90% of PCas are hormonally active hypersecreting parathormone (PTH); consequently patients present with complications of severe hypercalcemia. Pre-operative diagnosis is often difficult due to clinical features shared with benign parathyroid lesions. Surgery provides the current best chance of cure, though persistent or recurrent disease occurs in about 50% of patients with PCas. Somatic inactivating mutations of CDC73/HRPT2 gene, encoding parafibromin, are the most frequent genetic anomalies occurring in PCas. Recently, the aberrant DNA methylation signature and microRNA expression profile have been identified in PCas, providing evidence that parathyroid malignancies are distinct entities from parathyroid benign lesions, showing an epigenetic signature resembling some embryonic aspects. The present paper reviews data about epigenetic alterations in PCas, up to now limited to DNA methylation, chromatin regulators and microRNA profile.

Congenital heart disease at Laos Children's Hospital: Two year experience.

Management of congenital heart disease (CHD) in developing countries is challenging because of limited access to health-care facilities and socioeconomic limitations. The aim of this study was to describe the recent experience with CHD at Children's Hospital, Vientiane, Laos, the only pediatric referral hospital in the country. From July 2013 to November 2015, 1009 echocardiograms were carried out in 797 individuals who visited Children's Hospital, in whom CHD was identified in 213. Demographic characteristics, echocardiography and age at first CHD diagnosis on echocardiogram were compared by residential area. Among the 213 patients, the most frequent anomalies, in descending order, were ventricular septal defect, atrial septal defect, patent ductus arteriosus, and tetralogy of Fallot. Moderate or severe CHD requiring surgery or intervention was detected in 137 patients; median age at initial diagnosis was 6.0 months (IQR, 1.5-29.8). Among those with moderate or severe CHD, 89 patients were from rural areas and 48 from the capital area. The proportion of patients from rural areas older than 1 and 3 years at diagnosis was 46.1% and 32.6%, respectively. In contrast, patients from the capital area were diagnosed at a significantly earlier age: 16.7% at age >1 year and 6.2% at age >3 years (both P < 0.001 vs rural areas). Diagnosis of CHD requiring surgery is delayed in Laos, especially in rural areas. Better education and training of local medical staff, and greater access to medical advice are required to improve CHD care in Laos.

Cryopreservation of epididymal semen of domestic cat

Domestic cat (Felis silvestris catus) is used as a model species for developing effective methods of wild felids’ semen cryopreservation. The present study represents a comparison of domestic cat semen cryopreservation with two commercially available cryoprotectant agents (CPAs): CaniPlus Freeze (CPF) and SpermFreeze (SF). Semen was collected from the caudal epididymises of adult males and frozen with CPF and SF, correspondingly. The viability of frozen-thawed spermatozoa was evaluated by VitalScreen kit, staining with hematoxylin and eosin was performed for analysis of the spermatozoa morphology; both analyses were combined with the light microscopy. The viability rate of the frozenthawed semen cryopreserved with CPF and SF did not differ: 32.3±4.4 % for CPF and 43.3±4.0 % for SF. Total percentage of morphologically normal spermatozoa after freezing and thawing domestic cat semen was 26.0±2.3 % for CPF and 23.9±1.9 % for SF. In both cases, there were no differences from non-frozen semen, in the latter group the total percentage of spermatozoa with normal morphology was 29.0±4.1 %. The most frequent anomalies were the anomalies of tail, and the rarest anomalies were head defects. The percentages of spermatozoa with anomalies of the head, mid piece, tail and combined did not differ in these three groups. Taken together these results suggest that both CPAs are suitable for the purpose of domestic cat semen freezing and cryopreservation, although CPF was designed for Canidae semen cryopreservation and SF was developed for human semen freezing and so far was used exclusively in reproductive medicine. It might be concluded that these two commercially available cryoprotectant media are applicable for the purposes of domestic cat breeds’ semen cryopreservation.

Cytogenetic Profile and FLT3 Gene Mutations of Childhood Acute Lymphoblastic Leukemia.

Background:Childhood acute lymphoblastic leukemia (ALL) is characterized by recurrent genetic aberrations. The identification of those abnormalities is clinically important because they are considered significant risk-stratifying markers.Aims:There are insufficient data of cytogenetic profiles in Saudi Arabian patients with childhood ALL leukemia. We have examined a cohort of 110 cases of ALL to determine the cytogenetic profiles and prevalence of FLT3 mutations and analysis of the more frequently observed abnormalities and its correlations to other biologic factors and patient outcomes and to compare our results with previously published results.Materials and methods:Patients—We reviewed all cases from 2007 to 2016 with an established diagnosis of childhood ALL. Of the 110 patients, 98 were B-lineage ALL and 12 T-cell ALL. All the patients were treated by UKALL 2003 protocol and risk stratified according previously published criteria. Cytogenetic analysis—Chromosome banding analysis and fluorescence in situ hybridization were used to detect genetic aberrations. Analysis of FLT3 mutations—Bone marrow or blood samples were screened for FLT3 mutations (internal tandem duplications, and point mutations, D835) using polymerase chain reaction methods.Result:Cytogenetic analysis showed chromosomal anomalies in 68 out of 102 cases with an overall incidence 66.7%. The most frequent chromosomal anomalies in ALL were hyperdiploidy, t(9;22), t(12;21), and MLL gene rearrangements. Our data are in accordance with those published previously and showed that FLT3 mutations are not common in patients with ALL (4.7%) and have no prognostic relevance in pediatric patients with ALL. On the contrary, t(9;22), MLL gene rearrangements and hypodiploidy were signs of a bad prognosis in childhood ALL with high rate of relapse and shorter overall survival compared with the standard-risk group (P = .031).The event-free survival was also found to be worse (P = .040).Conclusions:Our data are in accordance with those published previously, confirming the overall frequency of cytogenetic abnormalities and their prognostic relevance.

Correlation between Ophthalmic Disorders and Congenital Cardiac Disease in Children with Down Syndrome

Down’s syndrome (DS), one of the most frequent chromosomal anomalies, is associated with dysmorphic features, congenital malformations and intellectual disability. There are various clinical manifestations: congenital cardiac diseases are found in 40% of cases, gastrointestinal anomalies in 7% of cases, and intellectual disability can be present in a medium or serious form. Both congenital cardiac diseases and ocular problems are particularly frequent, regarding both structure and function, such as refractive defects, accommodation, strabismus and cataract are particularly frequent.

Role of Echocardiography in Prenatal Screening of Congenital Heart Diseases and its Correlation with Postnatal Outcome.

Congenital Heart Defects (CHDs) are one of the most common forms of congenital anomalies. Fetal echocardiography performed during second trimester aims at early diagnosis of congenital heart disease which is instrumental in proper planning of delivery, perinatal care and counselling of parents. To evaluate the role of fetal echocardiography in prenatal screening of CHDs and to study the role of associated extracardiac anomalies. This was a hospital based prospective and correlative type of study, done over a period of one year. Antenatal screening of fetal heart was done in mid-trimester high and low risk pregnancies. The prenatal echo findings were co-related with postnatal findings in case of any abnormality detected. The extra-cardiac anomalies associated with positive cases were evaluated and studied for their impact on postnatal outcome. A total of 1200 pregnancies were screened out of which 672 were low risk and 528 were high risk. The cases with abnormal echo findings were followed postnatally. The overall incidence of CHD in study population was 15 per 1000. The incidence in high and low risk pregnancies were 16.3 and 13.25 per thousand respectively. Complete agreement of 68.17% was found between prenatal and postnatal findings. The most frequent Extra-Cardiac Anomalies (ECA) in cases with CHD was of musculoskeletal system. The CHD cases with ECA were significantly of low birth weight, born preterm and delivered by Lower Segment Caesarean Section (LSCS). Fetal heart is the most overlooked part in every routine anomaly scan. We conclude that fetal echocardiography should be an integral part of every second trimester anomaly scan for all pregnant females irrespective of their risk factors. The associated ECAs are another factor that causes increased mortality both in antenatal and neonatal life, again warranting an early fetal echo.

Identification of typology related to the coastal line changes in Bantul

Typology of coastal associated with landforms and shoreline changes. This study was conducted to determine the relationship typology of coastal especially on the parent material of a coastal with changing shoreline due to changes in the flow of ocean waves. Bantul coastal typology identified using remote sensing data to find the coastal character and patterns. Field surveys conducted for calibration areas undoubtedly result interpretation. The results of this study indicate coastal in Bantul Regency entirely included sandy beaches. The main factor of shoreline change caused by coastal erosion and sedimentation, frequent anomalies shoreline due to erosion and sedimentation. Abrasion occurred in Bantul district south coast will greatly affect reducing the shoreline because of its major parent material is sand. Sedimentation also play a dominant role in influencing increasing in the shoreline in Bantul because many large rivers that flow into the southern coast of Bantul.

Anomalous middle hepatic artery in laparoscopic cholecystectomy: Wolf in sheep's clothing.

Laparoscopic cholecystectomy is a simple but dangerous operation. The complex anatomy and frequent anomalies of the hepatic arterial and biliary system are often a shocking surprise to the laparoscopic surgeon. When these vital structures cannot be identified correctly, potentially crippling serious vascular and biliary injury can occur. A very rare case of middle hepatic artery encountered in the Calot's coursing over the gall bladder and travelling extraparenchymal into segment IV is reported. Identification and preservation of the middle hepatic artery is essential to prevent the possibility of hepatic artery thrombosis and to avoid ischemic cholangiopathy of segment IV duct. A comprehensive understanding of the hepatic arterial and biliary anatomy of the liver will empower laparoscopic surgeons to avoid crippling vascular and biliary injury.

Prevalence of congenital heart disease among children in Aljabal Alkhdhar region, Libya: An Echocardiographic study

Congenital heart diseases (CHD) are one of the most frequent malformations at birth. The aims of this study were to assess the prevalence of congenital heart disease, their different types, and their detection rate among children in Aljabal Alakhdar, Eastern part of Libya. The study was conducted during three-year period (September 2009- October 2012). The prevalence of CHD in Althawra Hospital Albaida was studied. The diagnosis of structural defects was based on echocardiographic study. Age groups from neonates till adolescent were included.In the study period, 342 children were found to have CHD; 299 patients were neonates and infants. Total prevalence of CHD over the study period was 8.9 per 1,000 live-born. The prevalence increased from 8.6 to 9.2 per 1,000 live births between 2009 and 2012. Isolated ventricular septal defect (34 %) was the most frequent non cyanotic anomaly, and Tetralogy of Fallot (3.5 %) was the most frequent cyanotic anomaly.The Prevalence rate of CHD in this region compare to the international standard is almost similar. Increasing incidence of CHD might be attributed to easier diagnosis with more regular and fixed dates of pediatrics cardiac clinic in the hospital in last few years or it may indicate a real increase in the defects, which might need further studies to know the possible causes.