iosr-JDMS   Volume-12 ~ Issue-6

Abstract:Thyroid nodules are a common clinical problem. Epidemiologic studies have shown the prevalence of palpable thyroid nodules to be approximately 5% in women and 1% in men living in iodine sufficient parts of world[1]. Most of the thyroid nodules are benign and only less than 7% of thyroid nodules are malignant[2]. So it is very important to differentiate between benign and malignant condition preoperatively So the goal of diagnostic workup is to select those patients for surgery who have a high likelihood of harbouring malignancy in nodule. Many procedures are used in diagnostic workup of solitary nodule of thyroid- ie TFT, FNAC, USG
FNAC is considered as the most accurate and cost effective method for evaluating thyroid nodule. The sensitivity and accuracy of FNAC is as high as 95% in experienced hands. Positive predictive value of 90-98% and negative predictive value of 94- 99% established FNAC as a valuable diagnostic modality[3]. Although in our settings we usually found that FNAC results are usually not confirmatory
Ultrasound is considered as the imaging modality of choice for investigation of thyroid nodules.According to new ATA guidelines (AMERICAN THYROID ASSOCIATION) diagnostic ultrasound should be performed in all patients with a suspected thyroid nodule[4].Sensitivity of ultrasound has been demonstrated as high as 86.5% and specificity as high as 92.3%[5] The purpose of this study is to know the efficiency of ultrasound in evaluating solitary nodule of thyroid. It compares final histopathology and ultra sound findings to know the significance of ultrasound in evaluating solitary thyroid nodule. Keywords: fine needle aspiration cytology , malignancy, Solitary nodule thyroid, ultrasound thyroid.

[1]. The spectrum of thyroid disease in a community ;The whick-harm survey.clin Endocrinol(oxf)7:481-490
[2]. Risk of malignancy in non-palpable thyroid nodule;predictive value of ultrasound and color Doppler features.J clin Endocrinol metab 2002;87(5):1941-1946.
[3]. Ultra sound guided fine needle aspirating biopsy ,aspiration biopsy of thyroid nodules,comparison in efficacy according to nodule size.Thyroid 2009 jan ;19(1)27-31 American thyroid association guidelines 2009 Koike et al 2001
[4]. Belfiore A, La Rosa GL, La Porta GA et al: Cancer risk in patients with cold thyroid nodules. Relevance of iodine intake, sex, age and multinodularity. Am J Med 93:363-369, 1992.
[5]. Zygmunk HK: The thyroid gland and the thyroglossal tract in Russell RCG, Williams NS, Bulstrode CJK(eds): Bailey and Love's Short Practice of Surgery, 23rd edn. London: Arnold, 2000, p 713.
[6]. John BH: Thyroid in Courtney MT, Daniel RB, Mark B and et al. (eds): Sabiston Text book of Surgery, 17th edn. Philadelphia: saunders, 2004, p 961.
[7]. Khafagi F, Wright G, Castles H et al. screening for thyroid malignancy: the role of fine needle biopsy. Med J Aust, 1988:149:302-303, 306-307.
[8]. Okamota Yamashita T, Haraswara A et al: Test performances of the diagnostic procedures in evaluating thyroid nodules: Physical examinations, ultrasonography, and fine needle aspiration cytology, Endocr J 1994:41:243-247.
[9]. FratesMC, Benson CB, Charboneau JW, et al. Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement. Radiology2005; 237(3): 794–800. [10]. PapiniE, Guglielmi R, Bianchini A, et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J Clin Endocrinol Metab2002; 87(5): 1941–1946.

Abstract: Herpes Zoster Ophthalmicus(HZO) occurs from the reactivation of latent Varicella Zoster virus within the ophthalmic division of the Trigeminal nerve. Ophthalmic involvement has been considered the most important and potentially serious of all sites of Herpes Zoster. Objectives: 1.To study the modes of presentation and ocular manifestations of HZO. 2.To study the predisposing factors for the development of HZO. 3.To study the ocular complications of HZO after treatment with oral Acyclovir during a follow-up period of one year. Materials and Methods: This prospective clinical study was conducted with all patients who were clinically diagnosed to have HZO who attended the Outpatient Department of Ophthalmology. All the patients underwent a comprehensive ocular examination and were medically treated and followed up for one year. Results: 27 patients with HZO were studied. Advancing age was the most common predisposing factor. Acute neuralgia and skin lesions were the most common modes of presentation. Ocular involvement was seen in 16(59.25%) of the patients with HZO. Cornea was the most common ocular structure involved(62.5%). Conclusion: The potential ocular manifestations of HZO are numerous. Ocular complications were less frequent among patients who received prompt systemic antiviral therapy with oral Acyclovir started within 72 hours of skin rash. Among treated patients development of a serious inflammatory complication was associated with a delay in therapy.

Keywords: Acyclovir, Herpes Zoster, Herpes Zoster Ophthalmicus, Varicella Zoster virus.

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[3]. Deborah Pavan-Langston. Herpes Zoster Ophthalmicus. Neurology 1995;45(suppl 8):S50-S51.
[4]. Schmader KE. Epidemiology of Herpes Zoster. In: Arvin AM, Gershon AA.Eds. Varicella-Zoster virus: Virology and clinical management. (Cambridge.UK: Cambridge University Press;2000).p.220-245
[5]. Liesegang TJ. Corneal complications from Herpes Zoster Ophthalmicus. Ophthalmology. 1985;92:316-324
[6]. Deborah Pavan-Langston.Viral diseases of the ocular anterior segment. Chap 14. In:Foster CS., Azar DT., Dohlman CH.eds. Smolin and Thoft's. The cornea. Scientific foundations and clinical practice. 4th edn.( Philadelphia:Lippincott Williams and Wilkins 2005); p297-397.
[7]. Pavan –Langston D. Viral disease of the cornea and external eye. In: Albert D., Jakobiec F., eds. Principles and practice of Ophthalmology. 2nd edn. (Philadelphia : WB Saunders, 2000):846-893.
[8]. Christopher E. Starr., Deborah Pavan-Langston.Varicella Zoster virus: Mechanisms of pathogenicity and corneal disease. Ophthalmol Clin N Am. 2002; 15:7-15
[9]. Womack L., Liesegang.TJ. Complications of Herpes Zoster Ophthalmicus. Arch Ophthalmol.1983;101:42-45.
[10]. McLeod SD. Infectious keratitis. Chapter 62. In: Yanoff M., Duker JS eds. Ophthalmology, 2nd edn. (St. Louis:Mosby;2004):p 479-481.

Abstract: Depression in old age is associated with genetic susceptibility, chronic disease and disability, pain, frustration with limitations in activities of daily living. The present hospital based cross sectional study was undertaken on 306 patients selected by systemic consecutive sampling from Geriatric O.P.D of Institute of Psychiatry, Kolkata to find out the prevalence of depression and associated factors among geriatric patients. 65.3% of the study population had depression (mild-36.2%, severe-29.1%) and the association of this depression with age (p<.001), gender (p<.001), residence (p=.027), marital status (p=.004), education (p<.001), occupation (p<.001), family type (p<.001) and economic dependency (p=.002), living condition (p<.001) was statistically significant. Social support group, local clubs and respective families should address the issue of depression among elderly. Family counselling for old age care, creation of a viable family and social environment will go a long way to improve the mental health of the elderly. Key Words: geriatric, depression, mental health, family.

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Abstract: Dental caries, also known as tooth decay or a cavity, is an infection, bacterial in origin, that causes demineralization and destruction of the hard tissues of the teeth (enamel, dentin and cementum). It is a result of the production of acid by bacterial fermentation of food debris accumulated on the tooth surface [1]. Dental caries and its consequences pose important and uncomfortable problems not only in developing countries but also in all industrialized countries since 1970s. Even increase in prevalence has been occurred in some countries [2]. In general, dental caries levels vary considerably between and within different countries, but population groups in the lower socio-economic status (SES) have higher caries levels than those in the upper SES and these differences are consistent in industrialized and urbanized developing countries. For treatment of dental caries there should be a balance between de-mineralization and re-mineralization that normally happen in the mouth. Sometimes, weak organization of tooth structures and alterations in diet, oral hygiene or bacterial activity can lead to the predominance of de-mineralizing agents, resulting in initial lesion formation and tooth decay. Dental caries will progressively develop in enamel and dentin as a result of frequently episodes of PH drop in the biofilm exposed to sugar [3]. Early diagnosis and the right approach can stop the progressive destruction and sometimes it is possible to repair and completely heal lesions.

[1]. Medline Plus Encyclopedia Dental Cavities
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[3]. Gonzalez-Cabezas C: the chemistry of caries: remineralization events with direct clinical relevance. Dent Clin North Am 2010;54:469-478.
[4]. Gianmaria F.Ferrrazzano, Ivana Amato, Tiziana Cantile, Giancarla Sangianantoni and Aniello Ingenito. In vivo re-mineralising effect of GC Tooth Mousse on early dental enamel lesions:SEM analysis.International dental journal 2011; 61:210-215.
[5]. Altenburger MJ, Gmeiner B, Hellwig E, Wrbas KT, Schirrmeister JF. The evaluation of fluorescence changes after application of casein phosphopeptides (CPP) and amorphous calcium phosphate (ACP) on early carious lesions. Am J Dent. 2010 Aug;23(4):188-92.
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[8]. Nakamura A, Sakuma S, Yoshihara A, Deguchi T, Yagi M, Miyazaki H. Long-term follow-up of the effects of a school-based caries preventive programme involving fluoride mouth rinse and targeted fissure sealant: evaluation at 20 years old. Int Dent J. 2009 Aug;59(4):215-21.
[9]. Reynolds EC, Cai F, Cochrane NJ, Shen P, Walker GD, Morgan MV, Reynolds C. Fluoride and casein phosphopeptide-amorphous calcium phosphate. J Dent Res. 2008 Apr;87(4): 344-8.
[10]. Andersson A, Sköld-Larsson K, Hallgren A, Petersson LG, Twetman S. Effect of a dental cream containing amorphous cream phosphate complexes on white spot lesion regression assessed by laser fluorescence. Oral Health Prev Dent. 2007;5(3):229-33.

Paper Type	:	Research Paper
Title	:	Knowledge and Practice of Exclusive Breast Feeding Among Mothers in Gbarantoru Community, Bayelsa State, Nigeria
Country	:	Nigeria
Authors	:	Oliemen Peterside, Onyaye E. Kunle-Olowu, Chika O Duru
	:	10.9790/0853-1263440

Abstract: Background: Exclusive breast feeding for the first six months of life significantly improves the growth, health status and survival of infants. However in spite of all the evidence in support of this practice, its prevalence in the developing world has remained low. Aim: To determine the knowledge and practice of exclusive breastfeeding among mothers of infants aged 7 to 24 months in Gbarantoru Community, Bayelsa State, Nigeria in order to derive information to be used for future breast feeding enlightenment programmes in the sub-region. Methodology: During a medical outreach organized by the Nigerian Medical Association, Bayelsa State Branch, 134 mothers of infants aged 7 to 24 months were interviewed on their knowledge and practice of exclusive breastfeeding. Results: 59.7% of the mothers knew the correct definition and duration of exclusive breastfeeding. The major source of their breast feeding knowledge was health workers (80.6%), followed by the mass media (10.4%). All (100%) the mothers breast fed their babies in the first 6 months of life however only 26.9% of them practiced exclusive breast feeding for 6 months. Exclusive breast feeding rate increased with increasing maternal age and education. Mothers who knew the benefits of exclusive breast feeding were more likely to breast feed exclusively compared to those who did not.

Key words: Exclusive breast feeding, knowledge, practice, benefits, mothers.

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[9]. HortaBernado L, Bahl R, Martinez Hose C, Victoria Cesar G. evidence on the long term effects of breast feeding: systematic reviews and meta-analysis. World Health Organization 2007. Available at: http://whqlibdoc.who.int/publications/2007/9789241595230_eng.pdf.
[10]. Gupta N, Katende C, Bassinger R. an evaluation of post-campaign knowledge and practices of exclusive breastfeeding in Uganda. J Health PopulNutr 2004; 22(4): 429 - 439.

Paper Type	:	Research Paper
Title	:	Dedifferentiated Liposarcoma - A Case Report
Country	:	India
Authors	:	Shaista Choudhary, H. T. Jayaprakash, B. S. Ramesh, Sida Tagore, Samiksha Ray
	:	10.9790/0853-1264143

Abstract: Lipasarcomas are mesenchymal tumors and most common type of sarcomas occuring in adults.Dedifferentiation can occur in liposarcoma as a progression of disease or in recurrent cases.We present a case of dedifferentiated liposarcoma of thigh where dedifferentiation was seen in primary tumor itself which suggested that it was a long duration tumor.The varied histopathological findings are the hallmark of this case.

Keywords: dedifferentiated liposarcoma, malignant tumor, thigh mass.

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[7]. Turkoglu M A, Elpek G O,Dogru V,Calus H, Ucar A, Arici Cumhur. An unusual case of primary colonic dedifferentiated liposarcoma.International jour of surg case reports.2013
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[9]. Yong il kim,Eun Sil Yu,keun Wook Lee, Eui U Park,Hyung Geun Song.Dedifferentiated liposarcoma of the liver.Cancer1987;60:2785-2790.
[10]. Rugvedita S Parakh,Meera P Zawar,Pradeep A Gadgil,Neeraja S Kaujalagi.Dedifferentiated liposarcoma of the retro-peritoneum:histologically low grade type.Indian Jour of Pathol & Microbiology2010;53(2):353-355.

Paper Type	:	Research Paper
Title	:	A Case Report of Swelling of the Left Side of the Face Invading Masseter - An Enigma
Country	:	India
Authors	:	Dr. Nagalaxmi V., Dr. Naga Jyothi M., Dr. Sridevi U., Dr. Kotya Naik M.
	:	10.9790/0853-1264449

Abstract: Keratocystic Odontogenic Tumor has been defined by the World Health Organization as a benign intraosseous neoplasm of odontogenic origin with characteristic lining of the parakeratinized squamous epithelium. Due to variable features of this lesion pertaining to clinical and biologic behaviour, this tumor is been studied extensively even today with respect to its molecular aspects to resolve many enigmatic features of it to arrive at a more successful treatment aspects at the genetic level. This paper aims to present a case of non-syndromic keratocystic odontogenic tumor in a 50 year old male that involved the entire ascending ramus of the mandible not associated with the impacted tooth invading to the masseter muscle by destroying the bony cortices of the left mandible. The presentation of this case resembles a neoplastic variant with aggressive features causing difficulty in complete excision of the lesion due to ill-defined margins with soft tissue extension.

Key words: Keratocystic odontogenic tumor, Benign cystic neoplasm, Recurrence.

[1] HE Veenstra-Knol, JH Scheewe, GJ van der Vlist et al., Early recognition of basal cell naevus syndrome, Eur J Pediatr, 164, 2005, 126-130.
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Paper Type	:	Research Paper
Title	:	Rapid Diagnosis of Tuberculous Pleural Effusion by IS6110 Sequence Based PCR
Country	:	India
Authors	:	Dr. G. Kalaiselvi, Dr. K. Rajendran
	:	10.9790/0853-1265054

Abstract: Diagnosis of EPTB has always been a challenge. PCR-based assays using the insertion-like sequence element IS6110 have shown considerable promise in clinical studies. The present study was undertaken to evaluate the role of PCR in the laboratory diagnosis of Tuberculous pleural effusion in comparison to conventional bacteriological techniques in Indian settings. One hundred and five, non- repeated clinical samples from patients who fulfilled the inclusion criteria were collected and were processed for Ziehl-Neelsen (ZN) staining for acid fast bacilli (AFB) and culture on Lowenstein-Jensen medium and Middle brook 7H9 medium. All the sampled were also processed for IS6110 based PCR amplification with primers targeting 123 bp fragment of insertion element IS6110 of the M.tuberculosis complex. Of these 105 samples, four (3.8%) were positive for acid fast bacilli by ZN staining, 21(20%) were positive for Mycobacteria by Culture and 73 (70%) were positive for M.tuberculosis complex by IS6110 based PCR. Our studies reveal that the IS6110 based PCR methodology for the detection of the M. tuberculosis complex in the pleural fluid is a highly sensitive, specific and reproducible method for early diagnosis of TPE. PCR targeting IS6110 can be applied when there is strong clinical suspicion, especially when the conventional techniques are negative.

Key words: Acid fast bacilli, Extra pulmonary tuberculosis, Mycobacterium tuberculosis, Non - tuberculous Mycobacterium, Polymerase chain reaction, Tuberculous pleural effusion.

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Paper Type	:	Research Paper
Title	:	Changing trends in resistance pattern as an alarm by bacteria before it's too late to treat
Country	:	India
Authors	:	Sumit Gupta, Reshma Agarwal, Suneel Bhooshan, Manish Kumar Diwakar, Ankur Goyal, Arti Agrawal
	:	10.9790/0853-1265560

Abstract: Background- Urinary Tract Infection is one of the most common site of bacterial infection particularly in female accounting for 2o – 3o % of women. UTI in men are less common and primary occur after 5o years of age. It is important to know the causative organisms in the hospital and community for optimum management of UTI. Objectives-To investigate the prevalence and antimicrobial susceptibility of bacterial uropathogens from the patients attending S.N Medical College, Agra. Methods and Material-The retrospective study involved 1022 UTI patient. Out of these 60% were females and 4o% males. Clean catch mid-stream urine from symptomatic UTI cases were analyzed in the microbiology laboratory, S.N Medical College, Agra. Bacterial isolate were identified using biochemical reaction. Antimicrobial susceptibility testing was performed by the Kirby- Bauer disc diffusion method as described in CLSI guidelines 2010.

Key-words: Antimicrobial Susceptibility Pattern, Prevalence, Urinary Tract Infection.

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Paper Type	:	Research Paper
Title	:	Ulnar Nerve Passing Through Triceps Muscle – Rare Variation
Country	:	India
Authors	:	Chandrika G Teli, Nilesh N. Kate, H. S. Kadlimatti
	:	10.9790/0853-1266162

Abstract: During routine dissection for undergraduate students, right upper limb of 45 year old male showed variation in the course of ulnar nerve. The ulnar nerve arose as a continuation of medial cord, descended down along medial side of axillary and brachial artery. As the nerve travelled upper third of arm, it pierced the medial head belly of triceps muscle, passing through it for 4-5 cm ,emerged out of it to reach near the medial epicondyle. Then the nerve passed behind the medial epicondyle to follow its normal course and distribution. This kind of variation is not been described in the literature.

Keywords: lunar nerve, variation in course, entrapment neuropathy.

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Paper Type	:	Research Paper
Title	:	Pulmonary Artery Catheter Knotting and its Successful Removal
Country	:	India
Authors	:	Ayaskant Sahoo, Mohammad Omar Shah, Rakesh M Gangadhar, Harish R. Nair, M. S. Moosabba, S. Padmanabha, Narasimha Pai
	:	10.9790/0853-1266365

Abstract: Pulmonary artery catheter(PAC) was introduced by Swan Ganz and colleagues in 1970 for hemodynamic assessment of patients with acute myocardial infarction. PAC's provide invasive monitoring of many hemodynamic parameters which cannot be reliably estimated by clinical signs and symptoms. Use of PAC's is associated with many different complications and various studies have been done to weigh its advantages and disadvantages. Here we report one of the rarer complications of PAC knotting and its method of removal.

Keywords: Pulmonary artery catheter, Knot.

[1]. Lopes MC, de Cleva R, Zilberstein B, Gama-Rodrigues JJ. Pulmonary artery catheter complications: report on acase of a knot accident and literature review. Rev HospClinFac Med Sao Paulo. 2004;59(2):77-85.
[2]. Boyd KD, Thomas SJ, Gold J, Boyd AD. A prospective study of complications of pulmonary artery catheterizations in 500 consecutive patients. Chest. 1983;84(3):245- 249.
[3]. Huang L, Elsharydah A, Nawabi A, Cork RC. Entrapment of pulmonary artery catheter in a suture at the inferior vena cava cannulation site. J ClinAnesth. 2004;16:557-559.
[4]. Eshkevari L, Baker BM. Occurrence and removal of a knotted pulmonary artery catheter a case report. AANA J. 2007;75:423–8.
[5]. Kao MC, Lin SM, Yu YS, Huang YC, Ting CK, Tsai SK. Knotted continuous cardiac output cardiac output thermodilution catheter diagnosed by intraoperative transesophageal echocardiography. Br J Anaesth. 2003;91:451-452
[6]. England MR, Murphy HI, Yakirevich V, Vidne B. A knotty problem. J Cardiothoracic VascAnesth. 1997;11:682-683
[7]. Colbert S, O'Hanlon DM, Quill DS, Keane P. Swan Ganz catheter- all in a knot. Eur J Anaesthesiol. 1997;14:518-520
[8]. Tan C, Bristol PJ, Segal P, Bell RJ: A technique to remove knotted pulmonary artery catheters. Anaesth Interns Care. 1997;25:160-162.

Paper Type	:	Research Paper
Title	:	Zirconia a Bio-inert Implant Material
Country	:	India
Authors	:	S. Kanchana, Dr. Sharmila Hussain
	:	10.9790/0853-1266667

Abstract: Implant ology has become a choice for replacement of missing teeth. Replacements in the anterior zone where aesthetic concern are important were new aesthetic materials are being used. Traditionally Titanium which has been used for past three decades has limitations like hypersensitivity and lack of aesthetics. Zirconia is now being introduced as an aesthetic alternative for implant placement. This paper discusses the properties of zirconia and reviews studies done as an implant material.

Keywords: Zirconia, Mechanical properties, tetragonal-to-monoclinic transformation, Biocompatibility, Animal studies.

[1]. Cranin AN, Schnitman PA, Rabkin SM, Onesto EJ. Alumina and zirconia coated vitallium oral endosteal implants in beagles. J Biomed Mater RES1975: 9: 257-262.
[2]. Morena R, Lockwood PE, Evans AL and Fairhurst CW: toughening of dental porcelain by tetragonal zro2 addition. J Am Ceram soc 69: C75, 1986
[3]. Christel P, Meunier A, Heller M,Torre JP, Peille CN. Mechanical properties and short-term in vivo evaluation of yttrium oxide-partially-stabilized zirconia. J Biomed Mater Res 1989;23:45–61.
[4]. Piconi C, Maccauro G. Zirconia as a ceramic biomaterial. Biomaterials 1999;20:1–25.
[5]. Gupta TK, Lange FF, Bechtold JH. Effect of stress-induced phase transformation on the properties of polycrystalline zirconia containing metastable tetragonal phase. J Mater Sci 1978;13:1464–1470.

[6]. Kelly, J. R. & Denry, I. (2008). Stabilized zirconia as a structural ceramic: An overview. Dent Mater, Vol. 24, No. 3, (Mar, 2008) pp. 289-298, ISSN 0109-5641.
[7]. Kelly, P.M.; Francis Rose, L.R. (2002). The martensitic transformation in ceramics-its role in transformation toughening. Prog Mater Sci, Vol. 47, (Mar, 2002) pp. 463-557, ISSN 0079-6425.
[8]. Quinn, J.B.; Sundar, V.; Lloyd, I.K. (2003). Influence of microstructure and chemistry on the fracture toughness of dental ceramics. Dent Mater, Vol. 19, No. 7, (Nov, 2003) pp. 603-611, ISSN 0109-5641.
[9]. Akagawa y, ichikawa Y, Nikai H, Tsuru H. Interface histology of unloaded and early loaded partially stabilized zirconia end osseous implant in initial bone healing. J Prosthet Dent 1993:69:599-604.
[10]. Currey, J. (1998). Mechanical properties of vertebrate hard tissues. Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine, Vol.212, No.6, (1998), pp. 399-411, ISSN 09544119.

Paper Type	:	Research Paper
Title	:	Review of Fournier's Gangrene
Country	:	Nigeria
Authors	:	Tabowei B. I., Kombo B. B.
	:	10.9790/0853-1266873

Abstract:This paper reviews 15 cases of Fournier's gangrene (FG) seen in our facility (NDUTH) over a period of 5 years .2002-2007. All patients in our study were males. No female patient was found. The youngest was a two weeks old male who was delivered by breech. No known etiological factor was found in 9 of the case. Four were diabetics; one patient was HIV sero positive while the other was the neonate who had a traumatic delivery. Polymicrobial organism was isolated in all. No anaerobic culture was done. Four of the patients died- two diabetics, the HIV sero-positive patient and the neonate from severe sepsis. No skin grafting was performed.

Key word: Fournier's gangrene

[1]. Morpurgo E. Fournier's gangrene. Surg Clin N Am 2002;82: 1213-24.
[2]. Shi-Guo L, Hong-Hwa C et al. Fournier's gangrene in female patients. J Soc Colon Rectal Surgeon(Taiwan) 2008; 19: 57-62.
[3]. Fournier's J A. Gangrene foudroyant de loa verg. Med Pract Paris 1883; 4: 589-597.
[4]. Efem SE. The features and eatiology of Fournier's gangrene. Postgrad Med J 1994, 70,568-571.
[5]. Yanar H, Taviloalu K, et al. Fournier's gangrene: risk factors and strategies for management. World J Surg, 2006 ; 30(9): 1750-4.
[6]. Katusic J, Stimac G et al. management of Fournier's gangrene: case report and literature review. Acta Clin 2010; 49(4): 453-7.
[7]. Meleny F L. Haemolytic streptococcal gangrene. Arch Surg 1924, 9: 317-364.
[8]. Cullen T S .Progressive enlarging ulcers of abdominal wall involving the skin and fat, following drainage of abdominal abscess apparently of appendical origin. Sur Gynecol Obstet, 1924, 38: 579-582.
[9]. Wilson B. Necrotising fasciitis. Am J Surg 1953 18: 416-431.
[10]. Adams J R, Jr Mata JA ea al. Fournier's gangrene in children. Urology 1990, 35: 439-441.

Paper Type	:	Research Paper
Title	:	Manifestation and Management of Paraquat Intoxiction. A deadly poison?
Country	:	India
Authors	:	Tanveer H. banday, Sadaf bashir, Shasikant bhat, Ashwin K., Praveen, Jagadeesh S. G.
	:	10.9790/0853-1267476

Abstract: Paraquat is a bipyridilium herbicide, is a bright green corrosive liquid with pungent smell that needs to be diluted before agricultural use. Globally it is the second highest-selling weed killer used and is available in a 20% solution form.[1] Its herbicidal properties were discovered in 1950s and first marketed in 1962. Most cases of intoxication especially in third-world countries are due to suicidal attempts instead of homicidal or accidental exposure, because of its widespread availability and relative low cost. The lethal dose /toxic dose is very low 35mg/kg that is (10 mL or 2 teaspoons is enough to kill) . It is a highly toxic compound and has multisystemic effects which include are pulmonary edema, convulsions, cardiac, renal, and hepatic failure[2].

Key words: Paraquat, Herbicide, Acute respiratory distress syndrome andmulti organ failure.

[1]. Arts J, Schuit G, Schipper A, Kleij van der B. A case report of paraquat poisoning. Eur J Hosp Pharm.2006;12:22–4.

[2]. Chen HW, Tseng TK, Ding LW. Intravenous paraquat poisoning. J Chin Med Assoc. 2009;72:547–50.

[3]. Revkin, A. C. "Paraquat: A potent weed killer is killing people". Science Digest1983, 91 (6) : 36–38.

[4]. Huang CJ, Yang MC and Ueng SH: Subacute pulmonary manifestation in a survivor of severe paraquat intoxication. Am J Med Sci 330: 254-256, 2005.

[5]. Dinham, B. (1996). "Active Ingredient fact sheet, Paraquat". Pesticide News 32: 20–21.

[6]. Dinis-Oliveira RJ, Duarte JA, et al. Paraquat poisonings: Mechanisms of lung toxicity, clinical features, and treatment. Crit Rev Toxicol. 2008;38:13–71.

[7]. Dinis-Oliveira RJ, Sarmento A, Reis P, Amaro A, Remiao F, Bastos ML, et al. Acute paraquat poisoning: Report of a survival case following intake of a potential lethal dose. Pediatr Emerg Care.2006;22:537–40.

[8]. Ekins BR, Geller RJ. Paraquat and diquat. In: Ford M, Delaney KA, Ling L, Erickson T, eds. Clinical Toxicology. W.B. Saunders; 2001:841–847
[9]. Chen KW, Wu MH, Huang JJ, Yu CY. Bilateral spontaneous pneumothoraxes, pneumopericardium, pneumomediastinum, and subcutaneous emphysema: a rare presentation of paraquat intoxication. Ann Emerg Med. 1994;23(5):1132–1134.
[10]. Tungsanga K, Chusilp S, Israsena S and Sitprija V: Paraquat poisoning: evidence of systemic toxicity after dermal exposure. Postgrad Med J 59: 338-339, 1983.

Paper Type	:	Research Paper
Title	:	Assessment of Vitamin D status among senior executive managers in large scale industries in the 10th of Ramadan city, Egypt
Country	:	Egypt
Authors	:	El Tayeb IM, EL-Saghier EOA, Cheta S., Sabbah NA, Raafat N.
	:	10.9790/0853-1267783

Abstract: Background:Vitamin D deficiency, is an epidemic problem, and has been proved to be associated with low bone mineral density (BMD) especially in females even in most sunny countries. Solar ultraviolet (UV) rays is the main source of 25-hydroxyvitamin D (25(OH) vitamin D) ,so it has been hypothesized as a main factor affecting vitamin D status. There is a limited number of studies on males in the literature especially who are at risk of limited sun exposure as in senior executive managers. The objectiveof this study is to assess vitamin D25(OH) status in apparently healthy senior executive managers and its impact on BMD and to determine the potential influence of some related lifestyle and socioeconomic factors. Methods:This cross-sectional study involved 59 men aged 40-59 years working in the tenth of Ramadan city ,Egypt , who were randomly selected and medically examined. Men had their 25(OH)D, intact PTH, BMD (lumbar spine (L1-L4) and neck femur).Results: Mean serum level of 25(OH)D was an optimal level in 62.7% of the studied group 35.2(7.6) and 19(2.5) a hypovitaminsis state, which was found in 13.6% (insufficienct subjects) and 23.7% (deficient subjects) ,that reached a significant difference. A strong negative correlation of25(OH)D with PTH was found whilemoderate positive correlation of 25(OH)D with BMD was detected.Sun exposure was the main determining factor for 25 (OH)D level.Conclusion: Senior executive managers are vulnerable for vitamin D25(OH) deficiency, which can affect their BMD in a risky pattern.

Keywords: Vitamin D, Senior executive Manager, 10 thof Ramadan city, Egypt.

[1] Hossein-Nezhad A , Holick MF : Vitamin D for Health: A Global Perspective. Mayo Clinic Proceedings,Volume 88, Issue 7 , Pages 720-755, July,2013.

[2] LappeJM2011:The role of vitamin d in human health: A paradigm shiftJournal of Evidence-Based Complementary&Alternative MedicineJanuary vol. 16no. (1 (58-72,2011.a

[3] Mithal A, Wahl DA, Bonjour JP, Burckhardt P, Dawson-Hughes B, Eisman JA, El-Hajj Fuleihan G, Josse RG, Lips P, Morales-Torres J: Global vitamin D status and determinants of hypovitaminosis D. OsteoporosInt ,( 20):1807–1820, 2009.

[4] HewisonM : Vitamin D and innate immunity. CurrOpinInvestig Drugs 9:485–490,2008
[5] Christie FTE , Mason L: Knowledge, attitude and practice regarding vitamin D deficiency among female students in Saudi Arabia: a qualitative exploration. International Journal of Rheumatic Diseases , Aug;14(3):e22-9;2011.
[6] AL-TurkiHA,Sadate-Ali M ,AL-Elq AH,AL-Mulhim FA,AL-Ali AK :25 hydroxyvitamin D levels among Saudi Arabian Women .Saudi Med J , vol.29 ( 12):1765-1768 ;2008.

[7] HiraniV,TullK,AliA,Mindell j : Urgent action needed to improve vitamin D status among older people in England!Age Ageing, 39 (1): 62-68.2010
[8] Bouillon R, Van SchoorNM,GielenE,BoonenS,MathieuC,Vanderschueren D, Lips P: Optimal Vitamin D Status: A Critical Analysis on the Basis of Evidence-Based Medicine. The Journal of endocrinology and metabolism; August 1, vol. 98 no. 8 E1283-E1304,2013.
[9] LiuPT,StengerS,LiH,WenzelL,TanBH,KrutzikSR,OchoaMT,Schauber J, Wu K, Meinken C, Kamen DL, Wagner M, Bals R, Steinmeyer A, Zugel U, Gallo RL, Eisnberg D, Hewison M, Hollis BW, Adams JS, Bloom JR, Modlin RL : Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science; 311:170–173,2006.
[10] Holick MF: High Prevalence of Vitamin D Inadequacy and Implications for Health Mayo ClinProc ;81(3):353-373,2006.

Paper Type	:	Research Paper
Title	:	Penile Gangrene Due To Priapism: A Case Report
Country	:	Nigeria
Authors	:	Tabowei B. I., Kombo B. B.
	:	10.9790/0853-1268487

Abstract:Penile gangrene is an infrequently encountered clinical entity in medical practice. Penile gangrene complicating advanced caecal carcinoma is even a rarer disease in this part of the world. We present a case of a 54 year old that had resection of large bowel following carcinoma of the caecum. He presented 6 months later with priapism and gangrene of the gland penis. He had suprapubic cystostomy to relieve the urinary symptoms. Blood was transfused. He had antibiotics and analgesics administered. However, before the penectomy could be performed, he discharged himself again against medical advice.

Key Words: Priapism, penile gangrene, penectomy.

[1]. Abduiwahab A, Ajape, Ahmad Bello. Penile gangrene: An unusual complication of priapism in a patient with Bladder carcinoma. Journal of surgical Technique and case report. 2011, vol 3,(1) 37-39.
[2]. Harris FC, Mydlo JH. Ischaemic and gangrene of penis. J Urol. 2003;169: 1795.
[3]. Kwok B, Varol C, Priapism and penile gangrene due to thrombotic thrombocytopenic purpura. Urology 2000;75:71-72.
[4]. Olaomi OO. Penile gangrene following cavernoglandular shunt for priapis: case report. Niger.J Surg Res 2002;4: 112-3.
[5]. Khoriaty N, Shick E. Penile gangrene :An unusual complication of priapism. How to avoid it?. Urology 1980; 16:280-3.
[6]. Keoghane SR, Sullivan ME, Millar MAW. The aetiology, pathogenesis and management of priapism. BJU international 2000; 90(2): 149-154.
[7]. Badmus TA, Adediran IA, Adesunkanmi AR,Katung IA. Priapism in southwest Nigeria. East Afr Med J, 2003 80(10)518-24.
[8]. Aghaji AE. Priapism in adult Nigerias. BJU int. 2000, 85(4): 493-5.
[9]. Guvel S, KilincF, Torun D, Egilmez T, Ozkardes H. malignant priapism secondary to Bladder cancer. Journal of Andrology 2003, 24(4): 499-500.
[10]. Brain F B, Joseph JP. Sickle cell trait and priapism: a case report and review of the literature. Cases J. 2008,1 : 429.

Paper Type	:	Research Paper
Title	:	Wandering Spleen-Case Report
Country	:	Nigeria
Authors	:	Tabowei B. I., Kombo B. B.,
	:	10.9790/0853-1268891

Abstract: Wandering spleen is a rare clinical entity. It can be complicated by torsion which is a surgical abdominal emergency. We report a case of wandering spleen which presented as an acute abdomen. Patient had laparotomy and did well postoperatively.

Key Words: Wandering Spleen, splenic torsion, splenectomy.

[1]. Desei DC, Hebra A, Davidoff AM, et al. wandering spleen: a challenging diagnosis. South Med. J 1997; 90: 439-43
[2]. Ugwu AC, Ogbonna CO et al. A wandering: A common presentation of an uncommon anomaly. SA Fam pract, 2010; 52(1): 42-43.
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[4]. E Broadis, M K Banda et al. paediatric wandering spleen in Malawi. Malawi Medical Journal ;2010; 22 (4): 120-121.
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[7]. Ferandex EM, Gonzales IA, Malagon AM,et al. An unusual case of hemoperitoneum owing to acute splenic torsion in a child with immoglobulin deficiency. J Postgrad Med 2006; 52: 42-42.
[8]. Singh I. essential of anatomy. New Delhi. Jaypee Brothers medical Publishers Ltd; 2002. P283.
[9]. Andley M S, Chibber P, Ravi B, kumar A. Internal herniation of wandering spleen; a rare cause of recurrent abdominal pain. Int Surg 2000; 322-324.
[10]. Horwitz JR, Black CT. Traumatic rupture of wandering spleen in a child: case report and literature review, J Trauma 1996; 41: 348- 350.

Paper Type	:	Research Paper
Title	:	Bilateral communication between musculocutaneous and median nerve
Country	:	India
Authors	:	Chandrika G.Teli, H. S. Kadlimatti, Nilesh N. Kate
	:	10.9790/0853-1269294

Abstract: The brachial plexus is the most variable part of the peripheral nervous system. The prevalence of variations ranges from 12.8 up to 53%. In this case we report variant communication between musculocutaneous and median nerve in both the upper limbs of a 50 year old male cadaver. The communicating branch arose from the musculocutaneous nerve. Without piercing coracobrachalis, musculocutaneous nerve gave motor braches to coracobrachialis muscle. At middle of arm musculocutaneous nerve gave three branches, one suppling brachialis, second passing between biceps brachii and brachialis which continued as lateral cutaneous nerve of forearm, third branch joined the median nerve. Such communications usually reported are unilateral, bilateral variant is reported here. We endeavour to discuss the relevance of embryogenesis and clinical significance of the condition.

Keywords: brachial plexus, musculocutaneous nerve, median nerve, communications.

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[2] Pandey SK, Shukla VK (2007) Anatomical variations of the cords of brachial plexus and the median nerve. Clin Anat 20(2):150–156
[3] Bhattarai C, Poudel PP (2009) Unusual variation in musculocutaneous nerves. Kathmandu Univ Med J 7:408–410
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[6] Arora L, Dhingra R (2005) Absence of musculocutaneous nerve and accessory head of biceps brachii: a case report. Indian J Plast Surg 38:144–146
[7] Venieratos, D. and Anangnostopoulou, S. (1998): Classification of communications between the musculocutaneous and median nerves. Clinical Anatomy. 11: 327-331.
[8] Williams, P.L., Bannister, L.H., Berry, M.M., Collins, P.,Dyson, M., Dussek, J.E. and Ferguson, M.W.J.: Gray's Anatomy In: Nervous system. 38th Edn; Churchill Livingston. Edinburgh. pp:1266-1274(1995). .
[9] Le Minor, J.M. (1992): A rare variant of the median and musculocutaneous nerves in man. Archieves Anatomy Histology Embryology. 73: 33-42.
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