Isolated hypoglossal nerve palsy: a harbinger of malignancy

The hypoglossal nerve is an underrated nerve usually consigned to a few words in anatomical text books, under the last four cranial nerves. However, paralysis of this nerve may be the first indication of a serious underlying disorder. Excluding previous surgery, radiotherapy and trauma, 50 per cent of cases of isolated hypoglossal nerve palsy are idiopathic. A further 20 per cent are malignant, 20 per cent are vascular and 10 per cent are due to miscellaneous causes. Presentation of an isolated hypoglossal nerve palsy is therefore an ominous sign. There is confusion over both cause and investigation, and management protocols for isolated hypoglossal nerve palsy are ill-defined. We present a case of isolated hypoglossal palsy which was due to a metastatic skull base deposit. This case illustrates the fact that magnetic resonance imaging is the investigation of choice in assessing the entire course of the hypoglossal nerve.

Do citation classics in rhinology reflect utility rather than quality?

Citation rates have been suggested to be more of an indicator of utility than quality. The aim of this study was to apply measures of utility and quality to articles identified as citation classics in rhinology/anterior skull base surgery. There were 14 articles analysed in the study. The assessment of quality was performed by combining factors from previous publications on quality assessment and the various elements were categorised into four groups; quality of written article and publication, quality of research, quality of evidence-based methodology and quality of outcome. This study revealed that citation classics in rhinology/anterior skull base surgery were well-written and satisfied peer review in reputable journals in the specialty. Quality is satisfied by clarity of exposition and patient numbers. The research was generally asking an important question and the methodology overall was adequate and appropriate for the type of study performed. A good quality of research and outcome was demonstrated with a definite historical importance, and reports that stimulated further research and enquiry. Quality is not satisfied by the lack of randomised controlled trials, appropriate statistical analysis or patient criteria. In conclusion citation rates when considered as an individual measure, reflect utility rather than quality.

Nutritional evaluation of desi and kabuli chickpeas and their products commonly consumed in Pakistan

Physicochemical and nutritional quality of five improved cultivars of desi and kabuli chickpeas and their products were studied. The kabuli chickpea had larger seed (26 g/100 seeds) than desi type (21 g/100 seeds). The hydration capacity per seed of desi (0.16 g) was lower than kabuli type (0.26 g). A positive correlation (r = 0.87) between seed weight and hydration capacity was observed. The mean cooking time of dry desi vs kabuli seed (124.5 vs 113.8 min) was reduced to 37.5 vs 32.8 min and to 28.8 vs 22.5 min when soaked overnight in water and in 0.5% solution of sodium bicarbonate respectively. The mean value of protein (25.4 vs 24.4%), fat (3.7 vs 5.1%), carbohydrate (47.4 vs 55%), crude fibre (11.2 vs 3.9%), ash (3.2 vs 2.8%) and caloric value (327 vs 365 kcal/100 g) were for desi vs kabuli chickpeas respectively. There was no difference in the essential amino acid contents and in chemical scores of desi (65) and kabuli (67) chickpeas. The order of limiting amino acid was methionine+cystine, threonine and valine in both types. The chickpeas products contained 8.9-21.1% protein (N x 6.25), 3.1-21.8% fat, 53.4-75.9% carbohydrate, 1.6-11.1% crude fibre, 1.2-5.9% ash, 226-360mg Ca, 126-315 mg P, 3.8-8.2 mg Fe, 1.8-5.4 mg Zn, 1.5-5.4 mg Mn, 0.6-1.1 mg Cu and 370-490 kcal per 100 g. All chickpea products provided 7-23%, 7-40% and 52-78% of the total calories from protein, fat and carbohydrates respectively.(ABSTRACT TRUNCATED AT 250 WORDS)