Scalp defects and lacerations present a reconstructive challenge to plastic surgeons. Many methods have been described from the use of skin grafting to rotation flaps. Here we present a method of closure of a contaminated scalp wound with the use of Kirschner wires. In our case, closure of scalp laceration was made possible with the use of 1.4 Kirschner wires and cable tie/ zip tie fasteners. The duration to closure of wound was 10 days. In reconstructing the scalp defect, this method was found to adhere to principles of scalp reconstruction. There were no post operative complications found from the procedure. On initial application on the edge of the wound, tension applied caused the K wires to cut through the wound edge. On replacement of K wires 1cm away from wound edge the procedure was not plagued by any further complication. In conclusion we find scalp closure with Kirschner wires are a simple and effective method for scalp wound closure.

Objective: To investigate the antibacterial activity and phytochemical screening of the hexane, chloroform, ethyl acetate, ethanol and aqueous stem extract of Dalbergia coromandeliana (D.coromandeliana ). Methods: The antibacterial activity of stem extracts of D. coromandeliana were evaluated by agar well diffusion method against four selected bacterial species. Results:The presence of alkaloids, saponins, coumarins, tannins, steroids, flavonoids, quinones, proteins and carbohydrates in the different stem extracts was established. Conclusions: The results in the present study suggest that D. coromandeliana stems can be used in treating diseases caused by the tested organisms.

Polycystic ovary syndrome (PCOS) is a hormonal disorder found in reproductive age women without a finite cause of existence. While clinical aspects of the study attribute itself to a more significant part of the research, there is also a need to understand patients' perception of better design interventions. The purpose of this study was to perform a preliminary qualitative study to analyse and apprehend the feelings, expressions, perceptions, and experiences expressed by patients associated with the PCOS. The study exercised in-depth interviews with women between 18 to 35 years in Kollam district, Kerala, India. The study results reveal that psychosocial aspects such as lifestyle changes, coping mechanisms, attitudes and beliefs, awareness levels, and physician-patient relations are affecting women among this population. The study concluded that for any behavioural intervention to work for women affected by PCOS, it is essential to take into account the aforementioned psychosocial aspects.

The prolapse of the intervertebral disc is most common cause of sciatica; rare causes of sciatica are pelvic fractures, pelvic tumors, piriformis syndrome, a rupture of medial head of gastronemius and sacroiliac joint dysfunction. We report the case of a 30-year-old male with a paralabral cyst of the hip joint with an acetabular labral tear causing sciatica. Our patient had an acetabular labral tear caused by a repetitive micro-trauma and external rotation injury. The diagnosis of the paralabral cyst with acetabular labral tear was based on clinical examination and histopathological examinations, and Magnetic resonance imaging findings. The patient underwent successful surgical excision of paralabral cyst and surgical repair of an acetabular labral tear. The present case reinforces the need for clinicians to be vigilant about rare causes of sciatica.

Diets containing high proportions of fruits and vegetables reduce the risk of onset of chronic diseases.The role of herbal medicines in improving human health is gaining popularity over the years,which also increases the need for safety and efficiency of these products.Green leafy vegetables(GLVs)are the richest source of phenolic compounds with excellent antioxidant properties. Increased consumption of diets containing phenolic compounds may give positive and better results to human health and significantly improves the immune system.Highly selective,susceptible and versatile analytical techniques are necessary for extraction,identifica-tion, and quantification of phenolic compounds from plant extracts, which helps to utilize their important biological properties. Recent advances in the pre-treatment procedures, separation techniques and spectro-metry methods are used for qualitative and quantitative analysis of phenolic compounds.The online coupling of liquid chromatography with mass spectrometry(LC–MS)has become a useful tool in the metabolic profiling of plant samples.In this review,the separation and identification of phenolic acids and flavonoids from GLVs by LC–MS have been discussed along with the general extraction procedures and other sources of mass spectrometer used. The review is devoted to the understanding of the structural configuration, nature and accumulation pattern of phenolic acids and flavonoids in plants and to highlighting the recent developments in the chemical investigation of these compounds by chromatographic and spectroscopic techniques.It concludes with the advantages of the combination of these two methods and prospects.

Background: Student-to-student administration of local anesthesia (LA) has been widely used as the teaching modality to train preclinical dental students. However, studies assessing students’ outlook towards their first injection were limited. Therefore, this study aims to evaluate students’ perception and anxiety levels towards their first LA injection. Methods: Sixty three pre-clinical dental students swapped their roles as both operator and respondents in relation to their first supraperiosteal injection. After being injected, the students conferred their opinion and experiences to the questionnaire based on the five point Likert’s scale and indicated their anxiety levels based on the Interval Scale of Anxiety response (ISAR). Their perception was described using frequencies and percentages and anxiety levels were statistically analysed using one way analysis variance and paired t test. Results: Students learning LA techniques directly on human subjects depicted not only greater confidence in them but also increased anxiety levels. The anxiety levels were found to be high before and during injection in both operator and respondent. Conclusion: The students’ preferred the use of preclinical models rather than student to student administration for their first LA injection exercise. Based on the results obtained, we recommend the need of preclinical simulation model in LA training program.

Thyrotoxic periodic paralysis (TPP) is a medical emergency characterised by sudden onset of muscle weakness with hypokalemia that resolves with the treatment of hyperthyroidism. We report three cases of thyrotoxic periodic paralysis seen at the Accident and Emergency Care Department, University of Malaya Medical Centre in a period of four months. We also review the clinical presentation, pathophysiology, biochemical features and management of TPP. All three patients were young Asian males, presenting with muscle weakness of sudden onset. The first patient presented with lower limb weakness and had symptoms of thyrotoxicosis and goitre. He had a previous similar episode which resolved spontaneously. The second patient presented with quadriplegia, respiratory acidosis and had no signs and symptoms of thyrotoxicosis. The electrocardiogram of this patient showed normal sinus rhythm with U wave in V3 and a flat T wave, which are characteristic of hypokalaemia. The third patient, who was a known case of thyrotoxicosis, was admitted thrice for hypokalemic paralysis during the study period. All cases had low serum potassium, suppressed TSH and elevated T4 confirming thyrotoxic periodic paralysis. Potassium therapy was useful during the crisis; however prophylactic potassium has not been shown to prevent attacks as seen in one of our cases. Conclusion: Thyrotoxic periodic paralysis should be considered in the differential diagnosis of sudden onset paralysis in young male patients. Determination of the plasma potassium levels and thyroid hormones help in the diagnosis. The definitive treatment for TPP is the achievement of euthyroid state.
Thyrotoxic periodic paralysis ; Patients ; Paralysis ; Review [Publication Type] ; Thyrotoxicosis

The effect of Manganese (Mn) addition on the Vickers hardness and relative density of nanocrystalline hydroxyapatite (HA) dense bodies were studied. The starting Mn doped HA powders was synthesized via sol-gel method with Mn concentration varies from 2 mol% up to 15 mol% Mn. The Mn doped HA disc samples were prepared by uniaxial pressing at 200MPa and subsequently sintered at 1300 degrees C. Characterization was carried out where appropriate to determine the phases present, bulk density, Vickers hardness of the various content of Mn doped HA dense bodies. The addition of Mn was observed to influence the color appearance of the powders and dense bodies as well. Higher Mn concentration resulted in dark grey powders. It was also found that the hardness and relative density of the material increased as the Mn content increased and influenced by the crystallinity of the prepared Mn doped HA powders.

Introduction: Diabetic nephropathy is a microvascular complication and is the leading cause of diabetes related morbidity, mortality and important cause of end-stage kidney disease. Both microalbuminuria and macroalbuminuria are associated with increased risk of cardiovascular disease. Evidence has been accumulating from clinical trials that assessing the levels of apolipoprotein B (ApoB), a constituent of atherogenic lipoproteins: ApoA1, a component of anti-atherogenic high density lipoprotein (HDL) cholesterol; and the ApoB/ApoA1 ratio will provide better prediction of future cardiovascular events than measuring serum low-density lipoprotein (LDL)-cholesterol levels. There is paucity of published data linking ApoB/ApoA1 ratio to diabetic nephropathy especially from developing countries, hence this study was carried out. Materials and Methods: The present study was conducted in the Department of Medicine, CSM Medical University, Lucknow between August 2009 and July 2010. Patients with type 2 Diabetes Mellitus (DM) attending the Diabetic and Medical Out-Patient clinics or who were admitted to the medical wards of Gandhi Memorial and Association Hospital CSM University, Lucknow were included. One hundred patients were enrolled; 64 of those were cases (Micro- and Macroalbuminuria groups) and 36 without nephropathy (Normoalbuminuria) were controls. The cut-off value for higher ApoB/ApoA1 ratio for male was 0.97 and for female was 0.86. Results: Older age, durations and control of DM were significantly correlated with degree of albuminuria. Fifty-six patients (56%) had raised ApoB/ApoA1 ratio, 19.4% in the Normoalbuminuria group (n=7/36), 71.4% in the Microalbuminuria group (n=30/42), and 86.4% in the Macroalbuminuria group (n=19/22). There were no statistical differences in the mean total cholesterol, HDL, LDL, triglycerides among the groups. Conclusion: In our study higher ApoB/ApoA1 ratio was significantly correlated with diabetic nephropathy.
Apolipoprotein A-I ; Apolipoproteins B ; Complications ; Diabetes Mellitus ; Kidney Diseases

Cerebral amyloid angiopathy (CAA) accounts for approximately 10–20% of spontaneous intracerebral haemorrhage (ICH). This figure is thought to be higher in the elderly population. With the increasing life expectancy of our population, we anticipate that the prevalence of CAA- related ICH will increase in tandem. Although CAA-related ICH and hypertension-related ICH are distinct entities based on histopathology and imaging, the clinical presentation of the two conditions is similar. The use of brain computed tomography (CT) scans remain the ICH imaging modality of choice in Malaysia due to its availability, cost, and sensitivity in detecting acute bleeds. On the other hand, the use of brain magnetic resonance imaging (MRI) with susceptibility-weighted imaging (SWI) sequencing enables the clinician to determine the presence of chronic blood products in the brain, especially clinically silent microbleeds associated with CAA. However, the use of brain MRI scans in our country is limited and leads to a blurring of lines when differentiating between hypertension-related ICH and CAA-related ICH. How this misrepresentation affects the management of these conditions is unclear. In this study, we present two cases of ICH to illustrate this point and to serve as a springboard to question current practice and promote discussion.