Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524164EnglishN2014February20General SciencesECOTYPIC VARIATIONS IN INDIAN POPULATIONS OF ERYNGIUM FOETIDUM L. English0106Thara Saraswathi K.J.English Chandrika R.English Jayalakshmi N. R.English Mythri B.EnglishAim: The ecotypic variations with respect to total phenolics, flavonoid, tannin and Vitamin-C content in three different populations of E. foetidum collected from Andaman, Darjeeling (West Bengal) and Hassan (Karnataka) have been studied. Methodology: The total phenolic and total tannin content was estimated by FC method against standard pyrogallol and gallic acid respectively. Vitamin C was extracted with 4% oxalic acid solution and estimated using 2, 4- dinitrophenyl hydrazine reagent alongside standard ascorbic acid. The total flavonoid content was determined by Aluminum chloride colorimetric method with standard Quercitin (1mg/ml). The values were expressed as mg/g equivalents of respective standards. Results: A significant difference (p= 0.05%) in the concentration of secondary metabolites among all the studied populations was observed. The total phenolic content was highest in the Darjeeling population, flavonoid and tannin content was maximum in Andaman population and Vitamin C content was predominantly high in the Karnataka population. Conclusion: The variations in phytochemical constituents could be attributed to the possible interaction of the plant populations with their geographical location and their subsequent adaptations to the same. EnglishE. foetidum, ecotypes, total phenols, flavonoid, tannin, vitamin C.INTRODUCTION Eryngium is a large and taxonomically complex genus of the family Apiaceae comprising nearly 250 species distributed in many parts of Asia, America, Africa and Australia (Worz et al, Calvino et al). Eryngium foetidum L. commonly named as “wild coriander” (Seaforth et al) is the most popular herb under this genus extensively used for seasoning of a variety of continental dishes like salads, soups, sauces, noodles, and ceviche owing to its unique, pungent corianderlike aroma in most of the tropical regions. The herb has a wide range of usage in traditional medicine for treating cold, cough, fever, seizures, ear ache, hypertension, worms, infertility complications, snake bites, arthritis and malaria (Mitchelle et al, Shavandi M A et al). The scientific validation for the medicinal properties of the plant has been established for analgesic and anti-inflammatory properties (Garcia et al, Saenz et al, Mekhora C et al ), anti-helminthic (Forbes WM,2009) and anti-clastogenic activity (Promkum C et al). The essential oil distilled from this plant has also been valued in perfumery industry for its aromatic properties in international and domestic markets (Wong et al, Pino et al, Ignacimuthu S et al., 2004). In recent years, much attention has been given to the intake of phenolic acids, tannins, flavonoids and vitamin C in the human diet and analyzing the possible health benefits due to their antioxidant nature. These secondary metabolites are believed to be responsible for the wide spectrum of pharmacological activities seen in many plants. Nowadays, these are receiving considerable attention because of their reported protective role against cancer, heart disease, health promoting effects like anti-inflammatory, anti-microbial, antioxidant, prevention of osteoporosis, as well as protection of plants from pests and diseases. Vitamin C (a water soluble vitamin) acts as a coenzyme for large number of metabolic activities in the living organisms and also possess antioxidant property (Amina Abd El – Hamid ALY 2010, Daniel Modniki, Maciej Balcerek, 2009; Daniel Modniki, Maciej Balcerek 2009, Min B.R et al., 2008). In India, occurrence of E. foetidum is rare, endemic and is localized to small pockets of Tamil Nadu, Kerala, Karnataka, North East India and Andaman Island (Chandrika R et al., 2011, Kar and Borthakur 2007). The restricted distribution of the plant is attributed to the long dormant period before seed germination and the dependence of vital phenological events on first showers of monsoon (Chandrika et al, 2013). Hence, the present study was conducted to observe the effect of ecological variations and its impact on the production of secondary metabolites (total phenolics, flavonoids, tannin and vitamin C) in various Indian populations. MATERIALS AND METHODS Plant collection The populations of E. foetidum were collected from Hassan, Karnataka ( 12°. 967N and 75°.783 E), Andaman Islands (16° to 14° N and 92° to 94° E) and West Bengal, Darjeeling (27° 01´ 59´´ N and 88° 16´ E) during August-September 2012. The climatic conditions of all the locations were recorded for purpose of interpretation of the present experimental findings (Table 1). The plants were identified and a voucher specimen of each population was deposited at the Regional Research Institute, Bangalore. Preparation of plant extract: About 20g of dried plant material was extracted with 200 ml of methanol with occasional agitation at RT for 24 h. The extract was filtered, centrifuged at 8000g for 10 min, supernatant collected, rotary evaporated at 250 C and stored in air tight bottles at 40 C till further use. Determination of total phenolic, total tannin and total flavonoid content: The total phenolic and total tannin content was estimated by F-C method as according to Singleton VL and Rossi JA (1965) N and Tamilselvi et al., (2012) with 1mg/ml of pyrogallol and gallic acid as a standard. The unknown extract values are expressed as mg/g of pyrogallol and gallic acid equivalents. The total flavonoid content was determined by Aluminum chloride colorimetric method (Chang C. et al). Quercitin (1mg/ml) was used as a standard and the values are expressed as mg/g of Quercitin equivalents. Extraction and estimation of total Vitamin C content: Vitamin C was extracted with 4% oxalic acid solution and estimated by using 2, 4- dinitrophenyl hydrazine reagent with A540 nm (S Sadashivam and A Manickam, 1997). Standard ascorbic acid at 5mg/ml was used to derive a calibration curve and the results are expressed as mg/g of ascorbic acid equivalents. Statistical analysis The variation in secondary metabolite content was statistically analyzed by applying ANOVA followed by Tukey HSD test and results are expressed as mean ± S.E (n=10) with p=0.05 as a limit of significance. RESULTS The mean variations in secondary metabolites from different populations are represented in Table 2 and graphically in Fig. 1 with Tukey HSD analysis at 0.05% level of significance. The total phenolic content in the dried plant extract was significantly high in Darjeeling population followed by Andaman and least in Karnataka population. Likewise the total flavonoid and tannin content was elevated in Andaman, followed by Darjeeling and lowered in Karnataka. Finally, the total vitamin C content was notably high in Karnataka population followed by Andaman and least in Darjeeling. In comparison with other secondary metabolites, Vitamin-C content was found to be quantitatively high in all the populations studied. DISCUSSION The variations among the ecotypes for Vitamin-C and secondary metabolite content are due to the biological diversity of E. foetidum populations in India. In the present study, all the ecotypes of E. foetidum showed very high concentration of Vitamin-C when compared to other secondary metabolites (total phenolics, flavonoid and tannins). Vitamin C is found to be the major constituent distributed in the plant leaves of E. foetidum (Campos et al. 2007; Promkum et al. 2012). Vitamin C was higher in the Karnataka population with significant difference (P < 0.05) compared with other two ecotypes. The Darjeeling population showed significantly lower Vitamin-C content than the other ecotypes. Variations in the content of Vitamin-C have been reported by Koziol (1992) while studying Chenopodium quinoa Willd ecotypes. According to Jimenez et al. (2009) the variations can be attributed to genetic or environmental growth conditions. Lee and Kader (2000) reported more Vitamin- C production when grown under cool temperatures rather than extreme hot and cold temperatures. The variation in Vitamin C content has also been observed with extended storage, higher temperature, low relative humidity, physical damage, chilling injury, large genotypic variations and climatic conditions (Lee and Kader, 2000; Dumas et al., 2003; Xu et al., 2008). According to Wall (2006), the levels of Vitamin-C in plants is directly proportional to the availability of light to the plant. In contrast, an excess of soil Nitrogen or Phosphorus tend to decrease ascorbic acid content. Hence it is possible to infer that the Karnataka population growing in a favorable moderate climatic condition contained high Vitamin-C content. Whereas, Darjeeling region with extreme cold conditions and limited supply of sun light yielded considerably low yield of Vitamin- C. The climate of Andaman Islands being hotter with high precipitation and humidity levels would have favored relatively higher production of Vitamin- C content in the populations of that region. The high Vitamin- C content reported among the populations in this investigation was similar to the data reported by Campos et al. (2007) in E. foetidum, Ruales and Nair (1993) and Dini et al. (2010) in Chenopodium quinoa Willd. All the ecotypes of E. foetidum presently studied showed that the variation in secondary metabolite production. Previous studies by Shui et al. showed that variation in secondary metabolite was related to the balance between carbohydrate source and sink. The greater the source-sink ratio, higher the production of secondary metabolites, which is directly linked to the plant growth in a particular ecotype. The presence of higher primary nutrients in the soil like nitrogen, phosphorous and potassium increases the secondary metabolite production (Tucker, 1999) and an even minor variation significantly varies the concentration of these metabolites (Jaleel et al. 2008).This implies that the increased nutrient content in the soil could have enhanced the production of total non structural carbohydrates which in turn would have contributed towards higher production of secondary metabolites (Ibrahim MH, 2010) in E. foetidum populations from Darjeeling and Andaman populations. CONCLUSION In the present study the variation in the polyphenol and vitamin C contents in E. foetidum populations from India were determined. This finding helps us to know the importance of secondary compounds showing significant variation among different ecotypes. The significance involved in relating external and edaphic factors to trace out the performance of secondary metabolite production in the ecotypes needs further emphasis. ACKNOWLEDGEMENT Dr. K.J. Thara Saraswathi is thankful for the financial support under UGC grants. The authors wish to thank the Post Graduate Department of Studies in Microbiology and Biotechnology, Jnana Bharathi Campus, Bangalore University, Bangalore for providing the necessary facilities. Englishhttp://ijcrr.com/abstract.php?article_id=949http://ijcrr.com/article_html.php?did=9491. Amina Abd Ei, Hamid ALY (2010). Biosynthesis of phenolic compound and water soluble vitamins in cilantro (Eryngium foetidum L.) plantlets as affected by low doses of gamma irradiation. Analele Universitaii din Oradea – Fascicula Biologie., 17(3): 356-361. 2. Calvino, Carolina, I.; Martinez, Susana, G.; Downie, Stephen, R., 2008: The evolutionary history of Eryngium Apiaceae, Saniculoideae Rapid radiations, long distance dispersals, and hybridizations. Molecular Phylogenetics and Evolution. 46(3): 1129-1150. 3. Chandrika R, Thara Saraswathi KJ, Shivakameshwari MN (2013). Phenological events of Eryngium foetidum L. from Karnataka, India. International Journal of Plant Reproductive Biology., 5(1) : 89-91. 4. Chandrika R, Vyshali P, Saraswathi KJT, Kaliwal BB (2011). Rapid multiplication of mature flowering plant of Eryngium foetidum L. by in vitro technique. International Journal of Biotechnology Applications. 3(4):114-117. 5. Chang, C.C., Yang, M.H., Wen, H.M, Chern, J.C., (2002): Estimation of total flavonoid content in propolis by two complementary colorimetric methods. Journal of Food and Drug Analysis, 10: 178-182. 6. Daniel Modnicki, Maciej Balcerek (2009). Estimation of total polyphenols contents in Ocimum basilicum L., Orgianum vulgare L. and Thymus vulgaris L. commercial samples. Herba Polinica. 55(1): 35-42. 7. Dini, I., G.C. Tenore, and A. Dini. 2005. Nutritional and antinutritional composition of Kancolla seeds: an interesting and underexploited Andine food plant. Food Chemistry 92:125-132. 8. Dini, I., G.C. Tenore, and A. Dini. 2010. Antioxidant compound contents and antioxidant activity before and after cooking in sweet and bitter Chenopodium quinoa seeds. LWT- Food Science and Technology 43:447-451. 9. Dumas, Y., M. Dadomo, G. Di Lucca, and P. Grolier. 2003. Review: Effects of environmental factors and agricultural techniques on antioxidant content of tomatoes. Journal of the Science of Food and Agriculture 83:369-382. 10. Forbes WM and Steglich C 2009 Methods of treating infectious diseases, Patent Application Number-20090047342. 11. Ibrahim MH, Jaafar HZ, Rahmat A, Rahman ZA.Molecules. 2010 .The relationship between phenolics and flavonoids production with total non structural carbohydrate and photosynthetic rate in Labisia pumila Benth. under high CO2 and nitrogen fertilization. 29; 16(1):162-74. 12. Ignacimuthu S, Arockiasamy S, Antonysmay M, Ravichandran P (1999). Plant regeneration through somatic embryogenesis from mature leaf explants of Eryngium foetidum, a condiment. Journal of Plant Cell, Tissue and Organ Culture., 56:131-137. 13. Jaleel C. A., Sankar B., Sridhara R. and Panneerselvam N. R. 2008. Soil alinity alters growth, chlorophyll content, and secondary metabolite accumulation in Catharanthus roseus. Turk J Biol; 32 : 79-83 14. Jiménez, M.E., A.M. Rossi, and N.C. Sammán. 2009. Phenotypic, agronomic and nutritional characteristics of seven varieties of Andean potatoes. Journal of Food Composition and Analysis 22:613-616. 15. Kar A and Borthakur SK 2007 Wild vegetables sold in local markets of Karbi Anglong, Assam, Indian J. Traditional Knowledge 6(1) 169-172. 16. Koziol, M.J. 1992. Chemical composition and nutritional evaluation of quinoa (Chenopodium quinoa Willd.) Journal of Food Composition and Analysis 5:35-68. 17. Lee, S.K., and A.A. Kader. 2000. Preharvest and postharvest factors influencing vitamin C content of horticultural crops. Postharvest Biology and Technology 20:207-220. 18. Min BR, Pinchak WE, Merkel R, Walker S, Tomita G, Anderson RC (2008). Comparative antimicrobial activity of tannin extract from perennial plants on mastitis pathogens. Scientific Research and Essay. 3(2): 066-073. 19. Mitchell SA, Ahmad MH (2006). A review of medicinal plant research at the University of the West Indies, Jamica, 1948- 2001. West Indian Med J, 55, 243-69. 20. Mohammad Amin Shavandi, Zahra Haddadian, Mohd Halim Shah Ismail (2012). Eryngium foetidum L. Coriandrum sativum and Persicaria ordorata L : A Review. Journal of Asian Scientific Research. 2(8): 410-426. 21. Pino J A, Rosado A and Fuentes 1997 Composition of leaf essential oil of Eryngium foetidum L. from Cuba J. Essential oil Res. 9 467-468. 22. Promkum C, Butryee C, Tuntipopipat S, Kupradinun P. 2012. Anticlastogenic effect of Eryngium foetidum L. assessed by erythrocyte micronucleus assay. Asian Pac J Cancer Prev.; 13(7):3343-7. 23. Ruales, J., and B.M. Nair. 1993. Contents of fat, vitamins and minerals in quinoa (Chenopodium quinoa Willd.) seeds. Food Chemistry 48:131-137. 24. Sadashivam S,Manickam A (1997). Vitamins – Ascorbic acid, Colorimetric analysis. Biochemical methods. New age International Publishers., pp.184-186. 25. Saenz MT, Fernandez MA and Garcia MD 1997 Anti-inflammatory and analgesic properties from leaves of Eryngium foetidum L. (Apiaceae), Phytotherapy Res. 11(5) 380-383. 26. Seaforth C, Tikasingh T (2005). 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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524164EnglishN2014February20HealthcareDETERMINING MALE ATTITUDE AND BEHAVIOR ON DECISION MAKING AND SPOUSAL COMMUNICATION IN FAMILY PLANNING: A STUDY CONDUCTED AMONGST LITERATE MALES OF PUNJAB, INDIA English0714Aditya SoodEnglish Parika PahwaEnglishBackground: Men play a key role in bringing about gender equality, since in most societies men exercise dominance in nearly every sphere of life, so male involvement in family planning not only helps accepting a contraceptive, but also ensures its effective use and continuation. Objective: This study was undertaken to know the attitude and behavior of literate males on Family Planning, spousal communication and decision making power sharing equation in Punjab, India. Method: A Cross- sectional descriptive study was conducted with 225 males; both married and unmarried, 75 were selected each from 3 districts of Punjab by random sampling method. A semi structured self administered questionnaire was used as a tool for data collection. Result: It was found that 95% of our respondents were aware about condoms followed by Withdrawal (84%), Emergency contraceptive pills (81%), and Tubectomy (79%) respectively. Out of all the available modern FP methods; Female and Male Sterilization usage is just around 19% and 1% respectively. In merely 23% cases, wives initiated discussion on Reproductive Health matters and for majority of the couples, FP discussions starts after the birth of 1st child. The major reasons for non communication between couples on FP were “shyness” and “male perception that this is an unnecessary talk”. Further it was found that only 65% men reported being comfortable if the female partner initiates discussion on the total number of children the couple should have. Conclusion: Spousal communication and power sharing on decision making plays an important role in promoting shared responsibilities and parenthood and our study reveals that it is lacking in the literate society of Punjab and in order to change this scenario; Community based organizations, Non Governmental organizations and Women self help groups should emphasize on spousal communication and sensitization of men on their female partners reproductive health needs. EnglishFamily Planning, Contraceptives, Male, Attitude, BehaviorINTRODUCTION India being the second most populous country in the world, launched the National family welfare programme in year 1951 with the objective of reducing Total Fertility rate to the extent necessary to stabilize the population, consistent with the requirements of the national economy.2 One of the main objective of the program was to spread knowledge of family planning methods and develop a favorable attitude of contraceptive methods among the people.3 Although from the efforts of this programme, the contraceptive usage has been increased over a period of time but still there is poor acceptance of contraceptive methods either due to ignorance, fear of complications and lack of male support of their female partner. Traditionally, most family planning programs had focused only on women. The basic assumption was “since women are the ones who bear children; it will be enough to concentrate on women only to bring down the fertility levels.” However, childbearing is the outcome of a participation of both partners in a conjugal union and men together with women play key roles in reproductive health decision-making including family planning. In fact, men not only take decisions for them but also often play the dominant roles in decisions crucial to the reproductive health of women. Reproductive health of women largely depends upon knowledge, attitude and behavior of men towards family planning4 . Involving men in matters related to reproductive health is an indispensable strategy to contain the incidence of unwanted pregnancies and spread of RTIs, STDs and HIV/ AIDs which are evidences of men&#39;s risky sexual behavior. Realization of the need to focus on men had resulted at the 1994 International Conference on Population and Development (ICPD) in Cairo as well as at the 1995 World Conference on Women in Beijing5 . It was understood that special efforts should be made to recognize men as equal partners with women in all matters pertaining to reproductive health and family planning. It is now clear that the target of reducing MMR to 100 by 2015 will not be met without the concerted efforts of all involved. Men, as partners, fathers, husbands, policy makers and community leaders have a critical role to play in safeguard the health of women during pregnancy and beyond6 . Male involvement in family planning and reproductive health may improve equality in gender relation, promoting better relationship between men and women through which they can take decision regarding family planning jointly and equal responsibility of sexual behaviour7 . There is limited literature available specifically of Punjab on male involvement that examines their role in reducing maternal mortality and ensuring safe motherhood. Keeping all these facts in view, a study was carried out with main objective to assess the knowledge, attitude and practices of contraceptive methods among literate males of Punjab. MATERIALS AND METHODS A cross sectional descriptive study was carried out in three districts of Punjab namely Ludhiana, Ferozepur and Mohali in the month of April and May 2012. The relevance of choosing these 3 districts was that Ludhiana is the most populous city of Punjab with good literacy rate and economic development, Mohali is situated at the periphery of State Capital i.e. Chandigarh which has access to all the health facilities and Ferozepur is the border city located at international border with Pakistan. Literate married and unmarried men of age group 18-60 years and education qualification above 10th standard were included in the study. A total of 225 males, 75 from each district irrespective of caste, religion or socioeconomic status were selected by random sampling method. All the participants were clearly explained the purpose of the study and signed written consent form was taken from them. The pretested self administered semi structured questionnaire was used for collection of data. For collecting the data, private and government banks, corporate offices, private companies, government offices, schools, and BPO’s of these districts were targeted and selected randomly. Respondents were asked about their socioeconomicand demographic profile; knowledge attitude perception and practice of family planning, decision making power regarding various aspects of family planning etc. A maximum of three visits were made at places before the required sample size was obtained. Data analysis was done with the help of excel and SPSS 16. The data was tabulated in terms of frequency distribution of different variables. Chi-square test of significance was employed for testing associations. P_Englishhttp://ijcrr.com/abstract.php?article_id=950http://ijcrr.com/article_html.php?did=9501. Varma G.R., Rohini A.: Attitude of spouse towards Family Planning: A study among married Men and Women of a rural Community in West Godavari District, Andhra Pradesh. Anthropologist, 2008, 10 (1): 71-75. 2. Abdul Nasir J., Tahir M.H., Zaidi A.A: Contraceptive attitude and behavior among University men: a study from Punjab, Pakistan. J Ayub Med Coll Abbottabad, 2010 Jan-Mar;22(1):125-8 3. Kamal M et al : Determinants of Male Involvement in Family Planning and Reproductive Health in Bangladesh. American J of Human Ecology, 2013; 2(2): 83-93. 4. Narang H., Singhal S.: Men as partners in maternal health : an analysis of male awareness and attitude. International J. of Reproduction, Contraception, Obstetrics and Gynecology, 2013 Sep; 2(3):388-392. 5. Narang H., Singhal S.: Men as partners in maternal health : an analysis of male awareness and attitude. International J. of Reproduction, Contraception, Obstetrics and Gynecology, 2013 Sep; 2(3):388-392. 6. Kamal M et al : Determinants of Male Involvement in Family Planning and Reproductive Health in Bangladesh. American J of Human Ecology, 2013; 2(2): 83-93. 7. Brachett, J.W. 1978. “Family planning in four Latin American countries-Knowledge, Use and unmet need- Some findings from World Fertility Survey.”International Family Planning Perspectives 14 (40): 116-23) 8. Greene EM, Mehta M, Julie P, Deirdre W, Bankole A, Singh S: Involving Men in reproductive health; contributions to development. 2009. www.unmillennium project.org/documents/Greene_et_al-final.pdf. (Cited on 11/04/2011) 9. Toure L: Male involvement in family planning a review of selected program initiatives in Africa. 1996. http://pdf.usaid.gov/pdf_docs/PNABY584.pdf (Cited on 28/05/2013) 10. Janine L, Barden OF, Ilene S, Speizer: Indonesian Couples’ pregnancy ambivalence and contraceptive use. Int Perspect Sex Reprod Health 2010,36(1):36–4 11. International Journal of Reproduction, Contraception, Obstetrics and Gynecology Narang H et al. Int J Reprod Contracept Obstet Gynecol. 2013 Sep;2(3):388-392 www.ijrcog.org ) 12. Salem R. Men&#39;s surveys: New Findings. Population Report. Series M No 18 Baltimore, Johns Hopkins Bloomberg School of Public Health. The INFO Project Spring. 2004.) 13. Mbizvo MT, Bassett MT. Reproductive health and AIDS prevention in sub-Saharan Africa: the case for increased male participation. Health Policy Plan. 1996 Mar;11(1):84-92.)

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524164EnglishN2014February20HealthcareA RARE CASE OF EARLY PREGNANCY WITH PARAGANGLIOMA OF URINARY BLADDER English1520Girija Malavalli KempasiddaiahEnglish Renuka ThimmaiahEnglish Mallikarjuna Gurappa DesaiEnglishThe paraganglia are the neuroendocrine tissues which are symmetrically distributed along the para vertebral axis from the base of the skull to the neck of the pelvis. Tumors of these paraganglia are called as Paraganglioma. It is a neuroendocrine tumor, majority of them are benign. Paraganglioma affecting the urinary bladder in pregnancy is extremely rare condition. An early diagnosis of Paraganglioma, in the 1st trimester will result in a good outcome, if treated by surgical intervention and these patients can be delivered vaginally instead of caesarean section. EnglishParaganglioma, pregnancy, neuroendocrine, urinary bladderINTRODUCTION Paraganglioma is a neuroendocrine neoplasm, occurring at various sites in the body. 97% of paraganglioma are benign and 3% malignant neoplasm. Prevalence of paraganglioma in urinary bladder is Englishhttp://ijcrr.com/abstract.php?article_id=951http://ijcrr.com/article_html.php?did=9511. Demirkesen O, Cetinel B, Yaycioglu O, Uygun N, Solok V. Unusual cause of early preeclampsia : bladder paraganglioma. Urology. 2000; 56(1):154. 2. Onishi T, Sakata Y, Yonemura S, Sugimura Y: Pheochromocytoma of the urinary bladder without typical symptoms. Int J Urol 2003, 10(7):398-400 3. Kirmani S, Young WF. Hereditary Paraganglioma-Pheochromocytoma Syndromes. 2008 May 21 [Updated 2012 Aug 30]. In: Pagon RA, Adam MP, Bird TD, et al., editors. GeneReviews™ [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2013. Available from: http://www.ncbi.nlm.nih.gov/books/NBK154 8/ 4. Lee KY, Oh Y, Noh HJ, Lee YJ, Yong H,Kang E, Kim KA,Lee NJ. Extraadrenal Paragangliomas of the Body: Imaging Features. AJR 2006; 187:492-504. 5. Wald O, Shapira OM, Murar A, Izhar U. Paraganglioma of the mediastinum: challenges in diagnosis and surgical management. J Cardiothorac Surg. 2010; 5:19.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524164EnglishN2014February20HealthcarePLACENTA PRAEVIA: CORRELATION WITH CAESAREAN SECTIONS, MULTIPARITY AND SMOKING English2125Madulika SharmaEnglish Jaya ChoudharyEnglishObjective: This study is planned to assess the various risk factors of placenta previa such as with multi-parity, previous caesarean section and smoking. Methodology: This study conducted at the department of obstetrics and gynaecology, J.L.N.Medicalcollege, Ajmer from Oct 2009 to September 201. Detailed obstetrical and surgical history were documented. All those attending antenatal clinic in third trimester of pregnancy, 32 weeks onwards with or without symptoms of placenta previa and showing placental implantation in lower uterine segment and In the obstetric ward all the patients presented in emergency (unbooked) with antepartum haemorrhage and diagnosed as case of placenta previa by Ultrasound examination, were documented. Statistical analysis was performed using the Vasserstats software, Chi square test; Risk ratio and Percentage of incidence were used to show association of risk factors with PP, where appropriate. Results: Out of total admissions, 4000 patients at random were taken for the study.150 patients were diagnosed as placenta previa of various degrees. Out of the 150 PP patients, 72 were multipara, 65 were grand multipara and rest were primigrvida.400 patients had previous history of one or more caesarean section.85 patients are those who smoked, having placenta previa. Conclusion: The data of this study is concluded that there is a good association between increasing incidence of placenta previa with the increase in parity (pEnglishPlacenta previa, Caesarean section, smoking.INTRODUCTION When placenta is attached in lower uterine segment called as placenta praevia.(1) In general It take place in the second or third trimester but sometimes it can observed in the later part of the first trimester. It is an important obstretic complication which can cause of antepartum haemorrhage (vaginal bleeding). It involve about 0.4-0.5% of all labours.(2) Traditionally four types of placenta previa recognised.(2, 3, 4) 1. Total placenta previa: internal cervical os is completely covered with placenta. 2. Partial placenta previa: internal cervical os partially covered with placenta previa. 3. Marginal placenta previa: edge of placenta does nat cover but lie in close proximity to the internal cervical os. 4. Low lying placenta: edge is not near os, but can be palpated by examining finger introduced through the os, generally 2 cms from os. Placenta previa currently, can be classified on the basis of usg findings as (5) Group 1: Placental edge reached or overlapping internal os. Group 2: Placental edge was from 0.1 to 2cms from internal os. Group 3: Placental edge was more than 2cms from internal os. The overall incidence is 1/200 births, and 1/1,000 are grade IV with placenta over the entire cervix. (6) The overall prevalence of placenta praevia was 5.2 per 1000 pregnancies (95% CI: 4.5–5.9). However, there was evidence of regional variation (P = 0.0001); prevalence was highest among Asian studies (12.2 per 1000 pregnancies). The prevalence of major placenta praevia was 4.3 per 1000 pregnancies (95% CI: 3.3–5.4).(7) Surgical disruption of uterine cavity is a potential risk factor for placenta previa.(8) Cesarean delivery is the most common operative procedure in practice of OBG,which is known to cause lasting damage to myometrium and endometrium,and thus increases the incidence of PP.(9) In United States, Placenta previa occurs in 0.3-0.5% of all pregnancies. The risks increase 1.5- to 5-fold with a history of caesarean delivery. (10) In India, according to P. M. Singh, A. N. Gupta, C. Rodrigues, overall incidence of placenta previa 1.9 per cent but the incidence in cases with previous cesarean section (C.S.) was found to be 3.9 per cent. (p Englishhttp://ijcrr.com/abstract.php?article_id=952http://ijcrr.com/article_html.php?did=9521. AbramowiczJS,SchienerE.inutero imaging of placenta;importance for diseases of pregnancy.Placenta 2007 ;28 (Suppl.A):S14- 22. 2. Bhide A,ThilaganathanB,Recent advances in the management of placenta previa. Curr Opin Obstet Gynaecol 2004;16:447-51 3. Oyelese KO,Smulian JC. Placenta previa,placenta accrete,and vasa previa. Obstet Gynecol 2006;107:927-41. 4. Timor-Tritsch IE,MONteagudoA, Diagnosis of placenta previa by transvaginal sonography. Ann med 1993;25:279-83 5. Amarnath Bhide, Federico Prefumo, Jessica Moore, Brian Hollis, Basky Thilaganathan: Placental edge to internal os distance in the late third trimester and mode of delivery in placenta praevia.BJOG: an International Journal of Obstetrics and GynaecologySeptember 2003, Vol. 110, pp. 860–864. 6. Neilson JP; Interventions for suspected placenta praevia. Cochrane Database Syst Rev. 2003;(2):CD001998. 7. Jenny A. Cresswell, CarineRonsmans,Clara Calvert, Véronique Filippi;Tropical Medicine and International Health;Volume 18, Issue 6, pages 712–724, June 2013. 8. BarettJM,BoehmFH,KillamAP;induced abortion, a risk factor for placenta previa;AmJ Obstet Gynecol 1981;141:769-72. 9. Morris H. Surgical pathology of the lower uterine segment caesarean section scar: is the scar a source of clinical symptoms? Int J GynecolPathol 1995;14:16-20. 10. US Census Bureau, Population Estimates, 2004. 11. P. M. Singh M.D.,C. Rodrigues , A. N. Gupta, Placenta previa and previous cesarean section. Acta Obstetricia et GynecologicaScandinavica;2011;60(4):367– 368. Article first published online:2011 12. Marianne S. Hendricks;Y. H. Chow;B. Bhagavat;Dr. Kuldip Singh; Previous Cesarean Section and Abortion as Risk Factors for Developing Placenta PreviaJournal of Obstetrics and Gynaecology Research, 1999;25:2,137–142. 13. Yoshio Matsuda, Kunihiko Hayashi ,Arihiro Shiozaki, Yayoi Kawamichi, Shoji Satoh, Shigeru Saito ; Comparison of risk factors for placental abruption and placenta previa: Casecohort study.Journal of Obstetrics and Gynaecology Research.2011;37(6):538–546. 14. Abu Hijja AT,EI Jallad,ZiadehS, Placenta previa, effect of age, gravidity, parity, and previous c-sections.Gynecol ObstetInvestb1999;47:6-8. 15. G. Monica, C. Lilja: Placenta previa, maternal smoking and recurrence risk. Acta Obstetricia et GynecologicaScandinavica,1995;74(5):341– 345. 16. Faiz AS, Ananth CV. Etiology and risk factors for placenta previa: an overview and metaanalysis of observational studies. J Matern Fetal Neonatal Med 2003;13:175-90. 17. Clark SL, Koonings PP, Phelan JP. Placenta previa / accrete and prior cesarean section. Obstet Gynecol 1985;66:89-92. 18. Mc Mohan McMahon MJ, Rongling L, Schenck AP, Olshan AF, Royce RA. Previous caesarean birth, a risk factor for placenta previa? J Reprod Med 1997;7:409-12. 19. Christianson RE. Gross differences observed in the placentas of smokers and nonsmokers. Am J Epidemiol 1979; 110:178 87. 20. Spira A, Philippe E, Spira N, et al. Smoking during pregnancy and placental pathology. Biomedicine 1977;27:266-70 21. Suzuki K, Minei LJ, Johnson EE. Effect of nicotine upon uterine blood flow in the pregnant rhesus monkey. Am J Obstet Gynecol 198O;136:1OO9-13

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524164EnglishN2014February20HealthcareSTUDY OF NEWER INVASIVE AND NON-INVASIVE METHODS OF HAEMOGLOBIN ESTIMATION IN BLOOD DONOR SCREENING - A STUDY ON 200 DONORS English2630Pankaj MalukaniEnglish M. D. GajjarEnglish R. N. GonsaiEnglish Nidhi BhatnagarEnglish H. M. GoswamiEnglishBackground: Despite the wide range of methods available for measurement of haemoglobin (Hb), no single technique has emerged as the most appropriate and ideal for a blood donation setup. To cater to this need both invasive and non-invasive techniques of haemoglobin estimation were analysed. Aims and Objectives: To compare invasive and non-invasive methods of haemoglobin estimation in terms of accuracy, sensitivity and donor satisfaction. Materials and Methods: A prospective study utilizing 200 blood samples was carried out in a blood donation setting for quality evaluation of five methods of haemoglobin estimation: Haematology cell analyser (reference), DiaSpect, CuSO4, HemoCue and NBM-200. Results: Mean value of HemoCue (mean ± SD = 13.8 ± 1.7 g/dl) was higher by 0.26 compared to reference (mean ± SD = 13.54 ± 1.52 g/dl). DiaSpect proved to be the best technique (sensitivity 99.4%, specificity 94.4% and likelihood ratio 17.75). CuSO4 proved to be good with Negative Predictive Value close to 91.4%. NBM-200 shows wide variation but the mean of the difference being statistically not significant. Conclusion: CuSO4 method gives accurate results, if strict quality control is applied. HemoCue and DiaSpect are too expensive to be used as a primary screening method in an economically restricted country like India, but are accurate. NBM-200 is a non-invasive method and gives good result with better compliance and donor satisfaction. EnglishBlood donation, haematology cell analyser, DiaSpect, HemoCue, NBM-200, CuSO4INTRODUCTION Pre-donation haemoglobin (Hb) screening is vital for blood donor selection with the main intention of preventing blood collection from an anaemic donor and for protecting the health of potential blood donors. It is therefore essential, that there should be an accurate and reliable method for haemoglobin determination. According to the Indian Drugs and Cosmetics Act, 1940 for blood donation, the minimum acceptable haemoglobin (Hb) is 12.5 g/dl or haematocrit (Hct) of 38% for both males and females.[1] There are various methods of haemoglobin estimation which vary from simple CuSO4 method to measurement by photometer, each with its own advantages and limitations. The copper sulphate (CuSO4) specific gravity method[2] is the traditional method being used for donor screening at many blood centres. Though a cheap and easy method, it does not provide an acceptable degree of accuracy[3],[4]. In recent years, portable, point-of-care (POC) devices have become the standard to measuring Hb levels. This form of measurement is applied in settings such as blood banks due to quicker test results with smaller blood samples, typically from a capillary source at the fingertip. The HemoCue and DiaSpect test systems are portable, battery-operated photometric device for rapid determination of haemoglobin[6]. Both tests involve digital needle puncture to obtain samples, leading to blood donor discomfort and complaints. Recently, a new method to determine Hb levels has been developed, using the principle of occlusion spectroscopy[8] which exempts the donor from finger prick and makes the procedure more comfortable. This could therefore contribute to greater donor retention. The aim of this study was to analyse the feasibility of the use of this new non-invasive method. We also compared results of routinely used invasive haemoglobinometer with that of automated blood analyser (reference). MATERIAL AND METHODS This prospective study was conducted on 200 consecutive blood donors attending routine donor sessions at a tertiary care hospital based blood centre in Ahmedabad, Gujarat. Informed consent was obtained explaining the need of a venous blood sample and also the application of the device on their finger to perform the Hb measurements using the new method. The non-invasive Hb determination was performed using a NBM-200 (Orsense Ltd., Nez Ziona, Israel), based on occlusion spectroscopy. Briefly, a pressure is applied by a ring-shaped multi wavelength sensor probe containing a pneumatic cuff that temporarily occludes the blood flow in the base of the finger and generates a strong optical signal, yielding a high signal-tonoise ratio that is wholly blood specific. Analysis of the signal in the wavelength range of 600 to 1500 nm provides the necessary sensitivity for measuring Hb concentration and pulse rate. The test is performed in 90 seconds, according to manufacturer’s instructions. Two ml of venous blood sample in dipotassium EDTA under identical conditions were drawn from apparently healthy donors. Samples were analyzed using four different methods of Hb estimation: Automated haematology cell analyzer (Sysmex KX 21, Sysmex America, Inc. Lincolnshire), CuSO4 specific gravity method, Hemocue (Hemocue B - haemoglobin photometer; Angelholm, Sweden), DiaSpect T system (DiaSpect Medical AB Uppsala, Sweden). Testing on CuSO4, Diaspect and HemoCue was done without delay while samples were run on the automated cell analyser (reference haemoglobin value) immediately or within 30-60 minutes of collection. To avoid inter-observer variability, blood sampling and analysis of Hb was performed by a single trained operator. The working CuSO4 solution was prepared (specific gravity 1.053) and standardized every day using standard operating procedure (SOP). Quality control and calibration of automated haematology analyser was done as per SOP using manufacturer provided stabilized control reagents. Results of CuSO4 were interpreted as “pass” or “fail” at Hb cut-off of ≥ 12.5 g/dl. Statistical Analysis Statistical analysis was performed using SPSS 12.0 for Windows (Microsoft, Seattle, WA, USA). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of each method was calculated and results were compared with automated cell analyser (gold standard). RESULTS The gender distribution of 200 donor population predominantly consisted of males with only 4% female representation [Table 1]. A total of 35 (17.5%) donors were deferred due to low Hb. A comparison of different methods used in the present study against the reference haematology analyzer is summarized in [Table 2]. We assessed the Hb values (mean ± standard deviation) for 200 venous samples tested with each method. Hb values by HemoCue and Diaspect showed quite similar results against the reference. However, mean Hb value of HemoCue (13.8 ± 1.7 g/dl) was higher by 0.26 when compared with reference (13.54 ± 1.53 g/dl). The mean Hb values for NBM were 13.5 ± 1.4 g/dl. DiaSpect was found to be most accurate technique (sensitivity 98.8%; specificity 97.14%). CuSO4 also gave good results with overall 8% (16/200) false results, sensitivity of 96.36%, but specificity of 71.43%, PPV of 94.08% and NPV of 80.65% [Table 3]. The CuSO4 screening test inappropriately passed 5% (10/200) donors. Out of these, 6 donors had Hb values between 12.4-12.0 g/dl when tested by reference method [Table 4]. The results by NBM shows wide variation when compared to reference but the mean of the difference is not significant (P > 0.05). NBM (non-invasive) also gave good results with overall 4.5% (9/200) false results with sensitivity of 97.6%, specificity of 88.2%. DISCUSSION For blood collection an appropriate Hb screening method should be available so as to accept as many suitable donors as possible and to prevent any inappropriate deferrals. Any new method to be introduced for Hb screening should save time and expenditure and should be validated against ICSH standards.[5][7] It is true the capillary method, unlike venous sampling method of Hb estimation in field conditions for DiaSpect/CuSO4/HemoCue is more practical. But, as our reference method was based on venous samples, to maintain homogeneity and to have near true values only venous samples were used in this study. Additionally, donor acceptance policies are based on venous Hb standards and not on capillary Hb values. To avoid multiple sampling we used only single venous sampling in our study. In our study CuSO4 method inappropriately passed 5% of prospective donors, of which a majority (70%) were within 1.0 g/dl of threshold against the reference values. This finding was quite similar to the observations made by James et al.[9] Similarly Boulton et al. observed more inappropriate passes by CuSO4 method with inappropriate passes being within 1.0 g/dl of the threshold for their gender.[10] CuSO4 has been a traditional way of donor Hb screening despite its limitations. To ensure correct results, CuSO4 solution of accurate specific gravity should be used besides taking other technical precautions. Each drop of blood added to the solution affects the specific gravity, therefore changing the solution daily or at least after 25 tests has been recommended.[12] The CuSO4 method has also been found to give inappropriate deferral and significant number of such deferred donors could be recovered by using an alternative screening method. [13] Using a secondary method of screening, many donors could be retained that would otherwise be inappropriately deferred. We found CuSO4 inappropriately deferred 3% (06/200) of the prospective donors in comparison to 1% (02/200) of inappropriate deferral by using HemoCue. HemoCue is an easy, rapid and reliable method of donor screening.[14] However its use adds extra expense in a donor screening program if implemented as a primary Hb screening method.[7] The DiaSpect system compared well with established methods of blood donor screening, producing similar readings as the reference analyser, with highest sensitivity, specificity and likelihood ratio. NBM is precise than the routine accepted CuSO4 in use, preventing donation by anaemic donor (1.5% inappropriately passed). On the other hand, this could lead to unnecessary donor deferral (3% false deferral). Being non-invasive it exempts donor from finger prick and does not involve biohazard material handling. CONCLUSION DiaSpect is the best method for donor screening. HemoCue is a good method with high accuracy.NBM-200 seems to be a good method in terms of precision and feasibility for anaemia screening of blood donors as well as being much more comfortable for donors. CuSO4 method is cheap and gives accurate results, if strict quality control is applied. This method can be retained as the primary screening method; however, to save inappropriate deferrals, subsequent testing can be done with more precise method (i.e, HemoCue / DiaSpect / NBM). Englishhttp://ijcrr.com/abstract.php?article_id=953http://ijcrr.com/article_html.php?did=9531. The Drugs and Cosmetics Act, 1940 and the Drugs and Cosmetics Rules 1945, Amendment upto 30th September, 1999. 2. Philipps RA, VanSlyke DD, Hamilton PB, Dole VP. Measurement of specific gravities of whole blood and plasma by standard copper sulphate solutions. J Biol Chem 1950;183:305-30. 3. Ross DG, Gilfillan AC, Houston DE, Heaton WA. Evaluation of haemoglobin screening methods in prospective blood donors. Vox Sang 1986;50:78-80. 4. Radtke H, Polat G, Kalus U, Salama A, Kiesewetter H. Haemoglobin screening in prospective blood donors: Comparison of different blood samples and different quantitative methods. Transfus Apher Sci 2005;33:31-5. 5. Zwart A, van Assendelft OW, Bull BS, England JM, Lewis SM, Zijlstra WG. ICSH Recommendations for reference method for haemoglobinometry in human blood (ICSH standards 1995) and specifications for international haemoglobincyanamyde standard. J Clin Pathol 1996;49:271-4. 6. Dacie JV, Lewis SM. Practical Haematology. 9 th ed. Edinburgh: Churchill Livingstone; 2001. p. 23. 7. Tondon R, Verma A, Pandey P, Chaudhary R. Quality evaluation of four hemoglobin screening methods in a blood donor setting along with their comparative cost analysis in an Indian scenario. Asian J Transfus Sci 2009;3:66-9 8. Weinstein A, Herzenstein O, Gabis E, Korenberg A. Screening of anemia using noninvasive occlusion spectroscopy sensor. Transfusion 2010;50:91a-2a. 9. James V, Jones KF, Turner EM, Sokol RJ. Statistical analysis of inappropriate results from current Hb screening methods for blood donors. Transfusion 2003;43:400-4. 10. Boulton FE, Nightingale MJ, Reynolds W. Improved strategy for screening prospective blood donors for anemia. Transfusion Med 1994;4:221-5. 11. Timan IS, Tatsumi N, Aulia D, Wangsasaputra E. Comparison of haemoglobinometry by WHO Haemoglobin colour scale and copper sulphate against haemoglobincyanide reference method. Clin Lab Haematol 2004;26:253-8. 12. Brecher MG, leger RM, Linden JV, Roseff SD. Blood collection, storage and component preparation. Technical manual. 15thed. Maryland: American Association of Blood Banks (AABB); 2005. p. 799-800. 13. Cable RG. Haemoglobin determination in blood donors. Transfusion Med Rev1995;9:131-44. 14. von Schenck H, Falkensson M, Lundberg B. Evaluation of HemoCue: A new device for determining haemoglobin. Clin Chem 1986;32:526-9. 15. Paddle JJ. Evaluation of the Haemoglobin colour Scale and comparison with the HemoCue haemoglobin assay. Bull World Health Organ 2002;80:813-6. 16. Lewis SM and Emmanuel J. Validity of the haemoglobin colour scale in blood donor screening. Vox Sanguinis 2001;80;28-53.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524164EnglishN2014February20HealthcareSUBMANDIBULAR SCHWANNOMA ARISING FROM LINGUAL NERVE - A CASE REPORT English3134Chandrakumar P. C.English Vishwanath S.English Ulhas PagaEnglish Bellara RaghavendraEnglishOur aim was to study a case of Schwannoma which is a benign peripheral nerve tumour of Schwann cell origin. Schwannomas arising from lingual nerve are rare. We report a rare case of Submandibular Schwannoma arising from lingual nerve with extension to floor of the mouth which was successfully treated by complete intraoral excision. The definitive diagnosis relies on clinical suspicion and histopathological confirmation. EnglishSubmandibular, Schwannoma, intraoral, lingual nerveINTRODUCTION Schwannoma is a benign neural tumour of ectodermal origin derived from spindle shaped Schwann cells or neural sheath1 . It is usually slow growing, solitary, well demarcated and encapsulated2,3. Schwannoma is usually a solitary lesion, but can be multiple lesions when associated with neurofibromatosis4 . Approximately 25-40% of all cases involve head and neck region and rarely extracranial region and extremely rare in the floor of mouth. Only 1% of Schwannoma are seen intraorally. Majority is painless, insidious in onset and slow growing. Only a few cases of Schwannoma arising from lingual nerve are reported. We report a rare case of Submandibular Schwannoma arising from lingual nerve extending to the floor of mouth. CASE REPORT A 21 year old male presented with a painless swelling in the right Submandibular region and on the right side of mouth since 5 years. It was increasing in size gradually without causing difficulty in swallowing and speech with normal sensory and taste sensations. Personal and family history was noncontributory. There was no cervical lymphadenopathy and general condition of patient was normal. The swelling was firm, non-tender, bi- manually palpable, measuring about 5x4 cms in size. Swelling was mobile from side to side (Fig.01,02). Per oral examination revealed a pinkish, smooth, swelling in the floor of right side of mouth opposite 1 st, 2nd, and 3rd molar tooth. The swelling was firm and non tender. Other relevant examination was normal. Mandibular occlusal XRay ruled out sialolith in the space. USG Neck showed mixed echoic lesion with areas of necrosis noted in deep part of right submandibular region. CT Neck showed well defined hypodense minimally enhancing mass lesion in right side of mouth and right submandibular region (Fig.03,04). Haematological and biochemical parameters were normal. FNAC of right submandibular region suggested inflammatory lesion in right sub mandibular region. Under general anaesthesia the swelling was excised in toto via transoral route. The swelling was seen to arise from the right lingual nerve. Meticulous dissection was carried out to preserve right lingual nerve and the swelling was dissected out completely (Fig.05,06) obviating the need of a right submandibular incision. The excised mass in toto was sent for histopathological examination. Intraoperative and postoperative period were uneventful, with good functional results. Histopathological examination of surgical specimen revealed a schwannoma, mainly composed of Antoni A pattern with Verocay bodies (Fig.07). Patient received a liquid diet and was discharged on third postoperative day. DISCUSSION A Schwannoma is a slow growing solitary encapsulated tumour attached to a nerve. Schwannoma may arise from any cranial or spinal nerve that has a sheath that is from any motor or sensory nerve other than the optic and the olfactory nerves which do not have the Schwann cell sheath. Approximately 25-45% of all the reported Schwannoma occur in the head and neck and most of them are in the eighth nerve5 . Schwannoma can affect all age groups, being most commonly found between 10 and 40 years of age without gender and race predilection. However Putney et al6 in their study quoted a sex difference of approximately 6:4 female male ratio. Ahad7 has reported a case of lingual nerve Schwannoma in the submandibular region. Schwannoma is usually a solitary soft tissue lesion which is slow growing encapsulated and often associated with nerve attached peripherally. Intraorally, the favoured site of occurrence is tongue followed by palate, buccal mucosa, jaws, gingival, vestibular mucosa and floor of mouth8 . The present case reports a solitary asymptomatic, slow growing, non-tender Schwannoma in right submandibular region with extension to floor of mouth. The preoperative diagnosis of Schwannomas in the head and neck region is difficult to establish. Cytology may help in differentiating benign and malignant tumours of soft tissue but is rarely accurate in the diagnosis of neural tumours9 as supported in our study also. CT with contrast enhancement can be recommended to demonstrate the degree of vascularity as some of the Schwannoma are very vascular10 . High resolution CT also helps to determine the size and extent of the tumours and to differentiate between benign and malignant lesions. Complete surgical excision of the benign tumours is the recommended treatment. Local recurrence after complete excision of the schwannoma is extremely rare11. Two microscopic pattern of Schwannoma are known to exist, Antoni type A and Antoni type B. Antoni type A is densely composed of elongated Schwann cells forming palisades (Verocay bodies). Type B has a myxoid, looser and disorganized arrangements. Immunohistochemical makers, S-100 and Len 7 used in most cases, confirm Schwann cell origin of these tumours and confirm diagnosis12. The tumour is radio resistant and the risk of malignant transformation is rare. Different authors have given divergent views regarding the approaches adopted for obtaining complete excision. We have adopted oral approach for complete excision of the tumours avoiding any nerve and great vessel injury. Vaid et al13 has also suggested transoral approach in his study for floor of mouth tumours. However the possibility of nerve injury should be kept in mind. CONCLUSION The significance of this case is unusual site of presentation in submandibular space with extension to floor of the mouth and complete removal of tumour arising from lingual nerve by oral approach. The preoperative diagnosis may be difficult. The diagnosis is often made after the surgery. The definitive diagnosis relies on clinical suspicion and histopathological confirmation. Malignant degeneration of Schwannoma is extremely rare. The tumour is radio-resistive; hence radiotherapy has no role in the treatment. Tumour recurrence is very rare when the tumour is completely excised. ACKNOWLEDGEMENT Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed Englishhttp://ijcrr.com/abstract.php?article_id=954http://ijcrr.com/article_html.php?did=9541. Kawakami R, Kaneko T, Kodoya M, Matsushital, Fujinaga Y, Oguchi K,et al. Schwannoma in the sublingual space. Dentomaxillofac Radiol, 2004;33:259-61 2. Van der Waal I, Snow GB. Benign Tumors and Tumour-Like Lessions. In: Cummings CW, Frederickson JM, Harker LA, et al, editors. Head and Neck Surgery. St. Louis:Mosby; 1998.pp.1407-17. 3. Neville BW, Damm DD, Allen C.Soft-Tissue Tumors. In: Neville BW, Damm DD, White DH, editors. Color Atlas of Clinical Oral Pathology. Hamilton:BC Decker;2003.pp.275- 312. 4. Wright BA, Jackson D. Neural Tumors of the Oral Cavity:A review of the spectrum of benign and malignant oral tumors of the oral cavity and Jaws. Oral Surg Oral Med Oral Patho 1980;49:509-22. 5. Balle VH, Greissen O. Neurilemmona of the facial nerve presenting as parotid tumor. Am Otol Rhinol Larryngeal. 1984;93:70-72. 6. Putneg FJ, Moran JJ, Thomas GK. Neurogenic tumors of the head and neck. Laryngoscope. 1964;74:1037-1059. 7. Ahad A. Schwannoma of submandibular region. Indian J Otolaryngol Head and Neck Surgery 1997;49(4):341-343. 8. Manoela DM, Luciane AJ, Kristianne F, Sandra KB, Saad AT, Macro TM. Intra-oral Schwannoma: A case report and literature review. Indian J dent Res 2009;20:121-5. 9. Dey P, Mallik MK, Gupta SK, Yasishta RK, Role by FNAC in the diagnosis of soft tissue tumors and tumor like leisons. Cytopathology.2004;15(1):32-37. 10. Rabitaille Y, Seemanger TAE1, Deiry A. Peripheral nerve tumours involving paranasal sinuses. A case report and review of literature. Cancer.1975;35:1254-1258. 11. Khanna S, Gupta SC, Sinh PA. Schwannoma of the maxillary sinus. Indian J Otolaryngal Head and Neck Surg.2003;55(2):132-135. 12. Hsu YC, Hwang CF, Hsu RF, et al. Schwannoma(neurilemmoma) of the tongue. Acta Otolaryngol 2006;126:861-5. 13. Vaid N, Puntambeker S, Bara M, Kothadia A. A transpalatal approach to the parapharyngeal space. Indian J Otolaryngol Head and Neck Surg.2001;53(4):307-308.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524164EnglishN2014February20HealthcareCASE BASED LECTURES VERSUS CONVENTIONAL LECTURES FOR TEACHING MEDICAL MICROBIOLOGY TO UNDERGRADUATE STUDENTS English3541Suvarna Sande TatheEnglish A. L. SinghEnglishBackground and Objectives: Routinely for teaching large number of students, didactic lecture (DL) is used which is a teacher centered process, promotes passive learning and fails to motivate the students. Case based lecture (CBL) is an interactive student centered approach and promotes active learning. Hence the present study was undertaken to assess whether CBL is an effective teaching tool for the Medical Microbiology and to evaluate students’ perception about this new methodology. Method: 78 students from second year MBBS fifth semester were included in the study. First they had conventional DL and next time they were exposed to CBL. Pretest and post test on DL and CBL topics were taken. Feedback regarding DL and CBL topics and CBL methodology were taken on Likert 5 point scale. Data from pre and post test scores was analyzed by paired t test. Result: The post test scores and gain in learning in CBL session were significantly higher than that of didactic lecture (p value Englishcase based lecture, medical microbiology, active learningINTRODUCTION In medical education, there are various methodologies of teaching and learning each having its own advantages and disadvantages. Routinely for teaching large number of students, didactic lecture (DL) is used. It is a teacher centered process, promotes passive learning and fails to motivate the students.1 Therefore in last few decades; concept of active learning has evolved. Case based learning is an interactive, student centered approach and promotes active learning.2 It engages students in discussion of clinical case that resembles real life situation and provides information such as history, physical findings and laboratory results.3 Students interact with each other and work together as a group to solve the case. The instructor’s role is that of facilitator. But this is a small group teaching method and requires large number of faculties. Hence the adaptation of this method is difficult where class size is large and number of faculties is small.4 In medical microbiology, students learn about various microorganisms and factors that lead to disease. In reality, patients present with various signs and symptoms which has to be correlated with infectious agents and host’s response.4 In pure didactic lecture, this correlation is not possible. Incorporation of case in didactic lecture can solve this problem. Here the case is used to teach content and connect the situation with real life data .It provides opportunities for the students to interact with each other and with faculty. They generate the knowledge, organize it in meaningful manner and try to solve the problem. This approach fits well with Kolb’s experiential learning model. 5 It recommends, opportunities should be provided for reflection and connection with existing knowledge and experimentation, in addition to content presentation. Hence the present study was undertaken to assess whether interactive case-based lecture (CBL) is an effective teaching tool for the Medical Microbiology and to evaluate medical students’ perception about this new methodology. MATERIALS AND METHODS This interventional study was conducted in Department of Microbiology and School of Health Professional Education and Research (S.H.P.E.R.). Topics chosen for didactic and case based lecture were from must know area and of same difficulty index. Validation of the entire questionnaire was done in advance and the project was approved by Institutional Ethics Committee. 78 students from second year MBBS fifth semester were included in the study. Written consent for participation in the study was taken from the students. First 78 students had conventional didactic lecture (topic- Candida). Pre test, post test and feedback regarding didactic lecture topic were taken. Next time, these 78 students were exposed to case based lecture (topic-Cryptococcus) Case based lecture 1) Case – 5minutes 2) Faculty learner interaction – 10 minutes 3) Routine Lecture -40 minutes 4) Faculty learner interaction on resolution of the case – 5 minutes Pretest and post test on case based lecture topic were taken. Feedback regarding the topic and methodology of case based lecture were taken on Likert 5 point scale. The marks obtained in pretest and post test in the topics covered during DL and CBL session were compared by using paired t test using SPSS 12.0.1version for windows.6 RESULTS In the present study, same students (n=78) participated in both the sessions. The pretest marks of both sessions were compared and the difference between them was found to be insignificant (p value > 0.05) indicating that the knowledge about both the topics was similar before lecture. The pretest and post test marks of DL and CBL sessions were compared (table1). The post test scores of both the sessions were significantly higher than that of pretest scores (p value < 0.001). The percentage of students with regards to various marks range in post test of both the sessions were compared (Figure 1). The percentage of students (67.94%) in higher mark range (7.5-10) in CBL session was more than the percentage of students (38.46%) in DL session. With regards to lowest mark range (0.5- 3), it was found that there was not a single student in CBL session. In contrast in DL session, we got 5 (6.41%) students in that range. The post test marks of DL and CBL sessions were compared (table 3). The post test scores of CBL session were significantly higher than that of didactic lecture (p Englishhttp://ijcrr.com/abstract.php?article_id=955http://ijcrr.com/article_html.php?did=9551. Sprawls P. Evolving models for medical physics education and training: a global perspective. Biomed Imaging intervention J. 2008;4:e16. 2. Thistlethwaite JE, Davies D, Ekeocha S, Kidd JM, MacDougall C, Matthews P, et al. The effectiveness of case-based learning in health professional education. A BEME systematic review: BEME Guide No. 23. Med Teach. 2012;34: e421–4. 3. Williams B. Case based learning: A review of the literature: Is there scope for this educational paradigm in prehospital education? Emerg Med J 2005;22: 577-81. 4. Neal R. Chamberlain, Melissa K. Stuart, Vineet K. Singh and Neil J. Sargentini. Utilization of case presentations in medical microbiology to enhance relevance of basic science for medical students.Medical Education Online vol.17, 2012. 5. KoIb, D. A. (1984) Experiential learning. Englewood Cliffs, NJ: Prentice-Hall 6. SPSS for windows, version 12.0.1.2001 Chicago: SPSS Inc. 7. Kumar V, Gadbury-Amyot CC. A case-based and team-based learning model in oral and maxillofacial radiology. J Dental Educ. 2012;76:330–7. 8. Yasin I. Tayem. The Impact of Small Group Case-based Learning on Traditional Pharmacology Teaching. Sultan Qaboos Univ Med J. 2013 February; 13(1): 115–120. 9. Ciraj AM, Vinod P, Ramnarayan K. Enhancing active learning in microbiology through case-based learning: Experiences from an Indian medical school. Indian J Pathol Microbiol. 2010;53:729–33. 10. Ochsendorf FR, Boehncke WH, Sommerlad M, Kaufmann R. Interactive large-group teaching in a dermatology course. Med Teach. 2006;28:697-701. 11. Blewett EL, Kisamore JL. Evaluation of an interactive, case-based review session in teaching medical microbiology. BMC Med Educ. 2009;9:56. 12. Tarnvik A. Revival of the case method: a way to retain student-centered learning in a postPBL era. Med Teach. 2007;29:e32–36.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524164EnglishN2014February20HealthcareSUBCUTANEOUS PHAEOHYPHOMYCOSIS - A RARE CASE REPORT English4245Atul K. JainEnglish Harsh KumarEnglish Banyameen IqbalEnglish Tushar KambaleEnglishPhaeohyphomycosis is a heterogeneous group of fungal infections caused by a variety of naturally pigmented fungi. A 53 year old woman presented with painless swelling over the lower one third of the left leg medial aspect, of one year duration. Local examination revealed a firm, fluctuant, mobile swelling measuring about 6×4 cm situated over the medial aspect of the lower left leg. It was not painful or tender. Microscopic examination revealed fungal granuloma (the causative organism morphologically identical to pheohypomycosis) EnglishFungal infections, Pigmented fungi, GranulomaINTRODUCTION The taxonomy and terminology of dematiaceous fungal infections are difficult. The term phaeohyphomycosis was first coined by Ajello in 1974.1 Earlier, some of the authors had proposed terms such as chloroblastomycosis.2 Later, this term was modified as chloromycosis.3 Phaeohyphomycosis is a heterogeneous group of fungal infections caused by a variety of naturally pigmented fungi. The aetiological agents of this mycosis, which include more than 80 genera and species, are common saprophytes found in soil, wood, and decaying vegetable matter.4,5 Phaeohyphomycosis is rare in humans, although it is more common in immunocompromised individuals.6 Phaeohyphomycosis affects either superficial tissues, such as the skin, cornea, and subcutaneous tissue, or deep tissues, such as the brain and cases of phaeohyphomycosis are classified accordingly.5 The infection typically follows traumatic implantation of the fungi by a wooden splinter or a thorn prick and manifests as a cystic lesion. Herein, we report a typical case of a subcutaneous phaeohypomcosis occurring in an elderly woman. CASE REPORT A 53 year old woman presented with painless swelling over the lower one third of the left leg medial aspect, of one year duration. Initially the swelling was small but gradually increased in size. The patient, a labourer had a thorn prick injury while clearing wild bushes one year ago. The Swelling was noticed a few months after the incident. On examination, her general condition was good. She was afebrile. Other systemic examination results were within normal limits. Local examination revealed a firm, fluctuant, mobile swelling measuring about 6×4 cm situated over the medial aspect of the lower left leg. It was not painful or tender. It was not attached to the underlying bone. USG of swelling suggested a differential diagnosis of thrombosed varicose veins, multiple chronic abscesses, Neoplasm. Haemoglobin level was 12.6, TLC 6800 gm/dl, platelet 2.8. PBS was normocytic normochromic, random, blood sugar 176%. The urinalysis results were normal. RFT, LFT was within normal limits. HIV and HBSag negative. Patient was a known case of hypertension and diabetes Mellitus. Pt was sent for FNAC – pus like material admixed with blood was aspirated. Stained smears showed mainly inflammatory cell chiefly polymorphs along with few giant cells in necrotic background. The features were suggestive of an inflammatory lesion or abscess and biopsy was advised. OPERATIVE FINDINGS During surgery the swelling was easily separated from the surrounding tissue and removed completely. When the excised cyst was cut open in the surgical theatre, it expelled purulent material. The cyst was immersed in 10% formalin and sent for histopathological examination. GROSS FINDINGS: The excised specimen was received as multiple tissue pieces, the largest measuring 5x1.2x1 cm. Other pieces altogether measured 3.5x3.2x1cm.The cut surface was soft to firm in consistency, homogenous, and greyishwhite in colour. MICROSCOPY: Multiple sections were taken, analysed and showed chronic granulomatous inflammation comprising of numerous epitheloid cell granulomas along with giant cells, macrophages and lymphocytes and areas of necrosis. In foci, pigmented, branching, septate fungal hyphae were visualised which were located within and in between the giant cells. These hyphae morphologically resembled pheohypomycosis species. Tissue sections were subjected to special stains. DISCUSSION Phaeohyphomycosis is an infection caused by a heterogeneous group of phaeoid fungi. The disease is more of a histopathological, rather than a clinical entity.7 More than 130 fungal species belonging to 70 diverse genera have been reported as causative agents in human and animal phaeohyphomycosis.8 Subcutaneous phaeohyphomycosis occurs throughout the world in all climatic conditions. In India, the climate ranges from tropical to temperate and the disease has been reported from the extreme north to south, except for the western and eastern regions.9 Males are commonly involved because of their outdoor occupation. In a review published in 2002, eighteen cases of subcutaneous phaeohyphomycosis were reported from India. The article documented involvement of the leg, foot, arm, toes, nails, waist, buttock, left thumb, hand, wrist while some patients had disseminated disease.9 Phaeohyphomycosis is more common in immunodeficient or debilitated hosts and rarely affect healthy individuals.6 Phaeohyphomycosis has been clinically divided into superficial (cutaneous and corneal), subcutaneous, and systemic phaeohyphomycosis by McGinnis.5 Subcutaneous phaeohyphomycosis usually results in a painless subcutaneous abscess or in verrucous plaques on the hand, arm, face, or neck. Although phaeohyphomycosis has distinct clinical features, it is occasionally confused with chromoblastomycosis There are significant clinical differences between chromoblastomycosis and phaeohyphomycosis. Typically, phaeohyphomycosis follows traumatic implantation of the fungus by a wooden splinter, or a thorn as in our case. Lymphangitis and regional lymphadenopathy are unusual. Hence, infective aetiology is often not considered. Our case was clinically suspected to be a multiple chronic absess or a neoplasm. The host reaction to phaeohyphomycosis is similar regardless of the aetiological agent and the anatomic site of involvement. The lesion is usually situated in the dermis and the subcutaneous plane and is characterised by cyst formation with dense collagenous connective tissue with central suppurative necrosis. The overlying epidermis is usually normal (In chromoblatomycosis epidermis is hyperplastic). The wall contains compact aggregates of epithelioid cell histiocytes and numerous giant cells. Pigmented moniliform (spherical and uniform segmentation) fungal elements are usually present inside the giant cells or extracellularly in the necrotic debris. In case of chromoblastomycosis, muriform (brick like cell with both longitudinal and transverse septa) with sclerotic bodies fungi may vary in their degree of pigmentation and may also appear as infrequently branching hyphae measuring 2–6 μm wide. The fungi are closely septate and constricted at their prominent septations.6 Our case exhibited the typical features of phaeohyphomycosis. Regarding the management of subcutaneous phaeohyphomycosis, excision of the localised lesion is usually curative.10 CONCLUSION Subcutaneous phaeohyphomycosis is a rare fungal infection. It’s caused by a broad variety of dematiaceous fungi. Simple excision is usually curative for localized lesions. When phaeohyphomycosis is suspected, the identification of the fungus by routine histopathological examination is offen sufficient to arrive at a diagnosis of phaeohyphomycosis. ACKNOWLEDGEMENT Authors acknowledge the immense help received from the scholars whose articles are cited and included in reference of the manuscript. The Authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been revised and discussed. Englishhttp://ijcrr.com/abstract.php?article_id=956http://ijcrr.com/article_html.php?did=9561. Ajello L, George LK, Steigbigel RT, Wang CJ. A case of Phaeohyphomycosis caused by new species of phialophora. Mycology 1974;66:490.8. 2. Terra F, Torres M, da Fonseca O. Novo type de dermative verrucosa mycose por: Acrothecacom association de leishmoniosa. Braz Med1992;2:363-8. 3. Moore M, de Alemeida F. Etiologic agents of chromomycosis (Chromoblastomycosis of Terra, Torres Fonseca and Leao 1992) of North and South America. Rev Bio Hyg 1935:6:94.7. 4. Fader RC, McGinnis MR. Infections caused by dematiaceous fungi: Chromoblastomycosis and phaeohyphomycosis. Infect Dis Clin North Am. 1998;2(4):925–938. [PubMed] 5. McGinnis MR. Chromoblastomycosis and phaeohyphomycosis: New concepts, diagnosis, and mycology. J Am Acad Dermatol. 1983;8(1):1–16. [PubMed] 6. Tendolkar UM, Kerkar P, Jerajani H, Gogate A, Padhye AA. Phaeohyphomycotic ulcer caused by Phialophora verrucosa: Successful treatment with itraconazole. J Infect. 1998;36(1):122–125. [PubMed] 7. Suh MK. Phaeohyphomycosis in Korea. Nippon Ishinkin Gakkai Zasshi 2005;46:67- 70. 8. Chandra J. Phaeohyphomycosis in Medical Mycology. 2nd ed. Mehta Publication; 2003. p. 147-54. 9. Sharma NL, Mahajan V, Sharma RC, Sharma A. Subcutaneous Phaeohyphomycosis in India: A case report and review. Int J Dermatol 2002; 41:16- 20. 10. Chandler FW, Watts JC. Phaeohyphomycosis. In: Connor DH, Chandler FW, Schwartz DA, Manz HJ, Lack EE, editors. Pathology of infectious diseases. Hong Kong: Appleton and Lange; 1997. pp. 1059–1066.