Non-target lung embolization during portal vein embolization due to an unrecognized portosystemic venous fistula: A case report.

BACKGROUND: Portal vein embolization (PVE) is an effective and relatively safe procedure performed prior to major hepatic resection to enhance future liver remnant. Non-target embolization during PVE is rare, and if it occurs, it usually affects the future liver remnant. Intrahepatic portosystemic venous fistulas are extremely rare in non-cirrhotic livers. We report a case of non-targeted lung embolization during PVE due to an unrecognized intrahepatic portosystemic fistula. CASE SUMMARY: A 60-year-old male presented with metastatic colon cancer of the liver. The patient underwent preoperative right PVE. During the embolization procedure, a small amount of glue and lipiodol emulsion was embolized to the heart and lungs through an unrecognized intrahepatic portosystemic fistula. The patient remained clinically stable and underwent the planned hepatic resection after 4 wk, with an uneventful postoperative course. CONCLUSION: Conventional portograms and careful evaluation prior to PVE are advisable to avoid such complications.

Exploring an Association between Body Mass Index and Oral Health-A Scoping Review.

BACKGROUND: Basal metabolic index (BMI) is a unique anthropometric indicator used to define the relative amount of body fat on an individual's frame. There are many diseases and conditions associated with obesity and underweight. Recent research trials suggest that there is a significant association between oral health indicators and BMI as both are attributed to common risk factors such as dietary, genetic, socioeconomic, and lifestyle issues. OBJECTIVES: The main objective of this review paper is to emphasize the association between BMI and oral health with available literature evidence. METHODOLOGY: A literature search was conducted using multiple databases comprising of MEDLINE (via PubMed), EMBASE, and Web of Science. The terms used for the search were "body mass index", "periodontitis", "dental caries", and "tooth loss". RESULTS: In total, 2839 articles were obtained from the analysis of the databases. Unrelated articles from the available full text of 1135 articles were excluded. The main reasons for excluding the articles were: they were dietary guidelines and policy statements. A total of 66 studies were finally included in the review. CONCLUSION: The presence of dental caries, periodontitis and tooth loss may be associated with a higher BMI or obesity, whereas, improved oral health might be associated with lower BMI. Promoting general and oral health should be a hand in hand feature, as common risk factors can be embattled.

Monitoring pond water quality to improve the production of Labeo rohita (Hamilton, 1822) in Bannu Fish Hatchery of Bannu district, Khyber Pakhtunkhwa province; An Implications for artificial fish culture

Abstract The water quality parameters of a fish pond are essential to be managing properly under control for successful operations of fish culture. Improper management of pond water quality during the juvenile stages can create stressful conditions to produce various harmful diseases, which may decrease the fish quality and results in low profits. The present study was aimed to monitored important water quality parameters of nursery ponds of Labeo rohita culturing in Bannu fish hatchery. The study duration was 75 days extends from 10th June to 24th August 2019 for the successful culture of this specie which can play a significant role in breeding season. Furthermore, the concentration of some heavy metals like copper (Cu), nickel (Ni), manganese (Mn), iron (Fe), cadmium (Cd), and zinc (Zn) in pond water and fry stages of this species was also determined. The data obtained from all water quality parameters were analyzed expressed as range, mean and standard deviation using MS Excel 2013. The obtained results of 75 days study revealed that the water pH & temperature, electric conductivity, total dissolved solids (TDS), and total dissolved oxygen (DO) of pond water samples were found within a tolerable limit except salinity and dissolved ammonia concentration were not permissible for fish growth. The average concentration of heavy metals in pond water exhibited descending order Fe>Ni>Mn>Zn>Cd>Ni, which was found in acceptable ranges. Whereas, the average values of heavy metals in fry stages were in the order of Zn>Fe>Ni>Cu>Cd>Mn, and found within the recommended values of WHO/FAO. Thus, it was concluded from this study that good water quality is a precondition, maintaining balanced levels of water quality parameters is fundamental for both the health and growth of fish culture which is quite necessary for assuring increased fish productivity. It is recommended to monitor and assess water quality parameters on a routine basis for promoting healthy fish culture.

Resumo Os parâmetros de qualidade da água de um viveiro de peixes são essenciais para um manejo adequado e sob controle para operações bem-sucedidas de piscicultura. O manejo inadequado da qualidade da água do tanque durante os estágios juvenis pode criar condições estressantes para a produção de várias doenças nocivas, o que pode diminuir a qualidade do peixe e resultar em baixos lucros. O presente estudo teve como objetivo monitorar importantes parâmetros de qualidade da água de viveiros de cultivo de Labeo rohita em incubadora de peixes Bannu. A duração do estudo foi de 75 dias, estendendo-se de 10 de junho a 24 de agosto de 2019 para o sucesso do cultivo dessa espécie que pode desempenhar papel significativo na época de reprodução. Além disso, a concentração de alguns metais pesados como cobre (Cu), níquel (Ni), manganês (Mn), ferro (Fe), cádmio (Cd) e zinco (Zn) na água do tanque e estágios de fritura dessa espécie também foram determinados. Os dados obtidos de todos os parâmetros de qualidade da água foram analisados expressos como faixa, média e desvio padrão usando o MS Excel 2013. Os resultados obtidos de 75 dias de estudo revelaram que o pH e temperatura da água, condutividade elétrica, sólidos totais dissolvidos (TDS) e total de oxigênio dissolvido (OD) das amostras de água do lago foram encontrados dentro de um limite tolerável, exceto salinidade e concentração de amônia dissolvida não eram permitidas para o crescimento dos peixes. A concentração média de metais pesados na água da lagoa apresentou ordem decrescente Fe > Ni > Mn > Zn > Cd > Ni, que foi encontrada em faixas aceitáveis. Já os valores médios dos metais pesados nos estágios de fritura foram da ordem de Zn > Fe > Ni > Cu > Cd > Mn, e encontrados dentro dos valores recomendados pela OMS/FAO. Assim, concluiu-se deste estudo que a boa qualidade da água é uma condição prévia, manter níveis equilibrados dos parâmetros de qualidade da água é fundamental para a saúde e crescimento da piscicultura, o que é bastante necessário para garantir o aumento da produtividade piscícola. Recomendam-se monitorar e avaliar os parâmetros de qualidade da água em uma base rotineira para promover a piscicultura saudável.

An expansion of phenotype: novel homozygous variant in the MED17 identified in patients with progressive microcephaly and global developmental delay.

Global developmental delay (GDD) is a lifelong disability that affects 1-3% of the population around the globe. It is phenotypically variable and highly heterogeneous in terms of the underlying genetics. Patients with GDD are intellectually disabled (ID) manifesting cognitive impairment and deficient adaptive behavior. Here, we investigated a two-looped consanguineous family segregating severe ID, seizure, and progressive microcephaly. Magnetic resonance imaging (MRI) of the brain showed mild brain atrophy and myelination defect. Whole exome sequencing (WES) was performed on the DNA samples of two patients and a novel homozygous missense variant (Chr11:g0.93528085; NM_004268.5_c.871T > C; p. Trp291Gly) was identified in the MED17 gene. Sanger sequencing revealed that the identified variant is heterozygous in both parents and healthy siblings. This variant is conserved among different species, causes a non-conserved amino acid change, and is predicted deleterious by various in silico tools. The variant is not reported in population variant databases. MED17 (OMIM: 613668) encodes for the mediator of RNA polymerase II transcription complex subunit 17. Structure modeling of MED17 protein revealed that Trp291 is involved in different inter-helical interactions, providing structural stability. Replacement of Trp291Gly, a less hydrophobic amino acid loses the inter-helical interaction leading to a perturb variant of MED17 protein.

Plain X-ray findings of post sleeve gastrectomy gastric leak.

Gastric leak following sleeve gastrectomy (SG) is a rare but significant cause of morbidity and mortality. A high clinical index of suspicion is the most sensitive approach to detect gastric leaks. Computed tomography (CT) is the gold standard diagnostic technique, although it might not be performed due to unavailability, and the inability to image superobese patients due to limited CT gantry space. Early detection and management are critical for attaining a better prognosis. The following pictorial review discusses the various plain X-ray radiographic findings that indicate a gastric leak. These findings may be overlooked, however, they remain valuable in patients with clinically suspected gastric leaks. This pictorial review illustrates the spectrum of findings related to post-SG gastric leak encountered in plain X-ray radiography.

The Impact of Systemic Health Parameters on Intraocular Pressure in the Western Region of Saudi Arabia.

Background A normal intraocular pressure (IOP) is essential for maintaining the normal structure and function of the eyes. Furthermore, an elevated IOP is a known risk factor for glaucoma. As the results from studies addressing the relationship between IOP and systemic health parameters are conflicting, researchers have not reached a consensus. This study aimed to evaluate the relationship between IOP and health parameters among non-glaucomatous participants in the western region of Saudi Arabia. Method We retrospectively reviewed the medical records of 255 participants aged 20 years and above who had not received any medical treatment for ocular hypertension or glaucoma at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia, from January 2019 to April 2021. The patients were categorized into age groups, divided by decades (ranging from 20-29 years to 80+ years); the most prevalent age group was 60-69 years. The data were entered using Microsoft Excel 2016 (Microsoft Corporation, Redmond, Washington), and Statistical Package for the Social Sciences (SPSS) software was used for univariate analysis. The relationship between continuous variables was analyzed by the Pearson correlation coefficient. The differences between continuous and categorical variables were assessed by the t-test and one-way analysis of variance (ANOVA) test, respectively. Results The mean (standard deviation) IOP in the right and the left eyes was 15.7 mmHg (4.0) and 15.6 mmHg (3.9), respectively. There were no significant associations between IOP and lipid profile parameters (p > 0.05). There was a statistically significant difference in the right IOP, in relation to the age groups (p = 0.006). Moreover, the mean IOP in the left eye was significantly higher among patients with diabetes than in the patients without diabetes (p = 0.007) as well as in patients with hypertension than in the patients without hypertension (p = 0.023). Conclusion The effect of total cholesterol, triglyceride (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), BMI, and sex on IOP could not be established in our study. However, over the past years, people's diets have incorporated higher cholesterol and fat content, leading to higher BMI levels. Therefore, further studies of the association between BMI and IOP are critical to determine if BMI is certainly a significant risk factor for increased IOP and glaucoma.

Monitoring pond water quality to improve the production of Labeo rohita (Hamilton, 1822) in Bannu Fish Hatchery of Bannu district, Khyber Pakhtunkhwa province; An Implications for artificial fish culture.

The water quality parameters of a fish pond are essential to be managing properly under control for successful operations of fish culture. Improper management of pond water quality during the juvenile stages can create stressful conditions to produce various harmful diseases, which may decrease the fish quality and results in low profits. The present study was aimed to monitored important water quality parameters of nursery ponds of Labeo rohita culturing in Bannu fish hatchery. The study duration was 75 days extends from 10th June to 24th August 2019 for the successful culture of this specie which can play a significant role in breeding season. Furthermore, the concentration of some heavy metals like copper (Cu), nickel (Ni), manganese (Mn), iron (Fe), cadmium (Cd), and zinc (Zn) in pond water and fry stages of this species was also determined. The data obtained from all water quality parameters were analyzed expressed as range, mean and standard deviation using MS Excel 2013. The obtained results of 75 days study revealed that the water pH & temperature, electric conductivity, total dissolved solids (TDS), and total dissolved oxygen (DO) of pond water samples were found within a tolerable limit except salinity and dissolved ammonia concentration were not permissible for fish growth. The average concentration of heavy metals in pond water exhibited descending order Fe>Ni>Mn>Zn>Cd>Ni, which was found in acceptable ranges. Whereas, the average values of heavy metals in fry stages were in the order of Zn>Fe>Ni>Cu>Cd>Mn, and found within the recommended values of WHO/FAO. Thus, it was concluded from this study that good water quality is a precondition, maintaining balanced levels of water quality parameters is fundamental for both the health and growth of fish culture which is quite necessary for assuring increased fish productivity. It is recommended to monitor and assess water quality parameters on a routine basis for promoting healthy fish culture.

Complications and Risk Factors of Patients Undergoing Computed Tomography-Guided Core Needle Lung Biopsy: A Single-Center Experience.

Objectives To determine the risk factors and complications of transthoracic computed tomography (CT)-guided core needle lung biopsy. Methods This is a retrospective study of 124 patients who underwent CT-guided core lung biopsy in King Khalid University Hospital (KKUH), Riyadh. This retrospective study was conducted between January 2016 and January 2020. Patient data were collected using a standardized data form that was entered into an Excel sheet in accordance with the variables. The Statistical Package for the Social Sciences software (SPSS, version 24.0 [SPSS Inc., Chicago, IL, USA]) was used to compute for the risk of complications after CT-guided core lung biopsy and perform all statistical comparisons, and the results were reported. Results The overall complication rate due to CT-guided core needle biopsy was 34.7% (43) (P<0.001) of the total sample. Of the total complications, 69.76% (n = 30) had pneumothorax, 20.94% (n = 9) had hemorrhage, 6.98% (n = 3) had both pneumothorax and hemorrhage, and 2.32% (n = 1) had both air embolism and pneumothorax. Of all patients who developed pneumothorax, 20% (n = 6) required chest tube insertion. Patients with secondary chronic obstructive pulmonary disease (COPD) had a complication rate of 80% among the whole sample. Lung lesions less than 3 cm had a complication rate of 48.8% (P<0.034). The needle size showed a higher rate of complications between 20 and 18 gauge with 47.4% (n = 9) and 32.4% (n = 34), respectively. Conclusions We conclude that CT-guided lung biopsy is a well-established low-risk procedure that is less invasive. However, it still carries a risk of complications with some risk factors, such as small lung lesion size and secondary COPD.

Assessment of knowledge, attitude, and practice regarding Deep Margin Elevation (DME) among dental practitioners in Riyadh, Saudi Arabia.

OBJECTIVES: To evaluate Knowledge, Attitude, and Practice (KAP) regarding deep margin elevation (DME) among dental practitioners in Riyadh city. MATERIALS AND METHODOLOGY: A cross-sectional study that comprised a total number of 535 dental practitioners: 255 (47.7%) were males and 280 (52.3%) females. A self-constructed 21 close-ended self-administered questionnaire was utilized in the study. The data were entered and analyzed by Chi-square test and descriptive analysis using Statistical Package for the Social Sciences (SPSS) software. RESULTS: Although the majority of the respondents have heard about DME, only 30.4% have utilized this technique in their clinical practice by having general practitioners and specialists utilize this technique more often than consultants. Among the participants, 65.4% of them have agreed that adhesion by bonding to deep cervical dentin is predictable and related to the success of the final restoration. CONCLUSION: The knowledge level of DME among the study participants was adequate. The findings of this study revealed that the total number of dentists who utilize the technique in restoring large subgingival defects of posterior teeth with proximal caries is very minimal. Thus, it is recommended that dental practitioners have this technique introduced in their dental clinics as an alternative to surgical crown lengthening. Although years of experience and dentist rank may influence the clinical decision, in-depth factorial analysis with a greater sample size is necessary.

V-FAT study - A correlation between novel markers of obesity and coronary artery disease severity assessed by Syntax score in patients presenting with acute coronary syndrome.

Our aim was to evaluate the role of traditional versus newer markers of obesity, in risk assessment of CAD. 50 consecutive ACS patients and 20 controls were enrolled.Visceral and Subcutaneous fat (VFAT and SFAT) analysis was done using multi-slice abdominal MRI. Syntax score was calculated from coronary angiogram. In our study, BMI and Waist/Hip ratios showed poor correlation with Syntax score. VFAT and SFAT showed strong correlation with Syntax score (p-0.01,0.03) and a more significant correlation was noted with their areas at L3-L4 levels (p-0.01,0.05). Statistically significant ROC- area under curve was observed with Indexed SFAT.

Assessment of Saudi parent's awareness towards space maintainers at Alkharj city: A cross-sectional study.

BACKGROUND: Premature extraction or loss of a tooth due in primary dentition may lead to malocclusion in permanent dentition. Space maintainers are very important to children in mixed and primary dentition for preventing problems of malocclusion. The utilization of space maintainers depends on parental knowledge and awareness about space maintainers. AIMS AND OBJECTIVES: To assess the of Saudi parent's awareness toward space maintainers in Alkharj city. MATERIAL AND METHODS: A descriptive cross-sectional questionnaire-based study was planned among Saudi parents who visited the College of Dentistry, Prince Sattam Bin Abdulaziz University. Questions related to space maintainers awareness, use, source of information, and utilization of space maintainers were asked. RESULTS: Around 312 (82.1%) parents were not aware of space maintainers and did not receive any information about the same. About 166 (43.7%) parents did not have any personal experience of a child's missing deciduous teeth. Only 115 (30.26%) respondents received some information about space maintainers. The majority of parents 298 (78.4%) were unaware whether space maintainers aid in the eruption of permanent teeth. Similarly, 73.7% did not know when to use space maintainers. CONCLUSIONS: Knowledge of space maintainers among Saudi parents is very less. Dental professionals hence need to create awareness of interceptive orthodontics rather than curative approaches, to achieve better oral health outcomes.

Computed Tomography-based Diagnosis of Post-laparoscopic Sleeve Gastrectomy Gastric Leak.

OBJECTIVE: Gastric leak post-laparoscopic sleeve gastrectomy may appear as a variety of computed tomography (CT) findings. We aimed to review the various CT findings sensitivity and specificity in confirmed cases of gastric leak. MATERIALS AND METHODS: A retrospective review was performed for all patients who underwent sleeve gastrectomy, CT, and endoscopy for suspected leak between 2011 and 2018. All patients with positive CT findings for gastric leak were included in the study. RESULTS: A total of 152 consecutive patients underwent CT for suspected post-sleeve gastrectomy gastric leak. Out of 152 patients, 88 had positive CT findings for gastric leak and underwent endoscopy. The CT findings sensitivity and specificity of perigastric collection without oral contrast leak were 61% and 88.8%, oral contrast leak were 28% and 100%, and gas leak were 10% and 77.7%, respectively. CONCLUSIONS: Perigastric fluid collection without contrast leak and with variable wall enhancement and gas content is the most common CT findings of post-sleeve gastrectomy gastric leak. Among various CT findings, it exhibits good diagnostic accuracy with 61% sensitivity and 88.8% specificity.

Tuberculous esophagomediastinal fistula with concomitant mediastinal bronchial artery aneurysm-acute upper gastrointestinal bleeding: A case report.

BACKGROUND: Esophagomediastinal fistula is a very rare complication of tuberculosis in otherwise healthy adults, and mediastinal bronchial artery aneurysm is even rarer. In this case report, we describe a rare case of tuberculosis complication that presented with acute upper gastrointestinal (GI) bleeding. It also highlights the benefits of chest computed tomography (CT) as an excellent adjunct diagnostic tool to endoscopy and bronchoscopy and the role of trans-arterial embolization as a minimal invasive therapy alternative to surgery. CASE SUMMARY: A 19-year-old medically free male patient presented with acute multiple episodes of hematemesis for 1 d. Upper GI endoscopy, bronchoscopy, and chest CT with IV contrast confirmed esophagomediastinal fistula with mediastinal bronchial artery aneurysm. After resuscitating patient with IV fluid and blood product transfusion, trans catheter embolization was performed for mediastinal bronchial artery aneurysm. CONCLUSION: We successfully treated a patient with acute upper GI bleeding due to tuberculous esophagomediastinal fistula and mediastinal bronchial artery aneurysm using transcatheter coil embolization.

Computed Tomography-guided Pulmonary Nodule Microcoil Localization Technique, Misplacement Errors, and Complications: A Pictorial Essay.

Computed tomography-guided pulmonary nodule microcoil localization is done preoperatively to fluoroscopic-guided video-assisted thoracoscopic surgical resection. This pictorial essay explains and illustrates the microcoil localization technique, various microcoil placement errors, intraoperative fluoroscopy-guided resection, and postmicrocoil localization complications.

The use of endo-vascular balloon tamponade technique for the removal of a misplaced nephrostomy tube in the inferior vena cava: A case report.

INTRODUCTION: Inadvertent placement of a nephrostomy tube into the inferior vena cava (IVC) is an extremely rare complication with few reported cases in the literature. CASE PRESENTATION: We present a lady with obstructive uropathy in a solitary kidney in whom an attempt by the community radiologist to place a nephrostomy tube was complicated by wrong insertion into the IVC. This report illustrates how a safe non- surgical removal of this tube using an intravenous balloon tamponade technique was successfully applied. DISCUSSION: Intravenous placement of nephrostomy catheters into the inferior vena cava is extremely rare complication. A few case reports have been published in the literature. The majority of these cases were removed in the operating room under general anesthesia. Using Intravenous balloon tamponade technique for removal has not been previously reported. CONCLUSION: Intravenous balloon tamponade technique is effective and is a good minimally invasive alternative to surgical removal of misplaced nephrostomy tube from IVC.

Uterine leiomyoma with spontaneous intraleiomyoma hemorrhage, perforation, and hemoperitoneum in postmenopausal woman: Computed tomography diagnosis.

Spontaneous intraleiomyoma hemorrhage, perforation, and hemoperitoneum are very rare complications of uterine leiomyoma. We report a case of postmenopausal woman who presented with acute abdomen found to have intraleiomyoma hemorrhage, perforation, and hemoperitoneum. Our case also illustrates the computed tomography findings of such complications of uterine leiomyoma.

Multiple pulmonary and systemic ectopic emboli following endoscopic injection sclerotherapy for gastric fundal varices.

We report a case of a 40-year-old female with cirrhosis, hepatocellular carcinoma, and upper gastrointestinal bleeding who developed multiple pulmonary emboli after endoscopic injection sclerotherapy for gastric variceal bleeding. The patient did not have any respiratory symptoms after the sclerotherapy. A chest radiograph obtained one day after the procedure for the evaluation of fever showed few small nodular radio-opacities in both hilar regions. Computed tomography (CT) demonstrates the existence of multiple radio-opaque emboli within the pulmonary and left common iliac arteries with no evidence of associated pulmonary parenchymal changes. She had no further symptoms, and the radiologic opacities persisted on CT obtained 4 months later.

Female suicide rates in Ghizer, Pakistan.

Suicide is an understudied subject in Pakistan. There are many social, legal, and religious sanctions against it. National rates of suicides are not known. We calculated suicide rates of women in the Ghizer District of the remote Northern Areas of Pakistan. During years 2000 to 2004, 49 women committed suicide. Taking average mean population for women for 5 years as 65,783, we calculated annual crude suicide rates for women as 14.89/100,000/year. For women over the age of 15 years, rates were 33.22/100,000/year; age-specific rates for 15-24 years were 61.07/100,000 per year. These figures are considerably higher than suicide rates in other parts of Pakistan and may be related to high psychiatric morbidity in Pakistani women. This study underscores the need for a standardized system of registration of suicides in Pakistan. There is also urgent need to address high psychological distress in women in Pakistan.

Using a 308-nm excimer laser to treat vitiligo in Asians.

BACKGROUND: Current vitiligo therapies require many months of treatment and often result in disappointing outcomes. Treatment with a 308-nm excimer laser has shown promising results in patients with vitiligo. OBJECTIVE: This controlled prospective trial studied the effectiveness of the 308-nm excimer laser for treating vitiligo in Asians. METHODS: Thirty-four patients (14 males and 20 females) with localized vitiligo were enrolled in the study. Vitiligo patches were treated using a 308-nm excimer laser. Lesions were treated twice weekly for 13 weeks. The treatment was started with 50 to 100 mJ/cm2 (according to site) and increased by 50 mJ/cm2 in every session until erythema appeared. Patients were treated for 25 sessions, or until 100% repigmentation, whichever was achieved first. The overall response rate was assessed clinically and by comparison of photographs before and after treatment by two independent investigators. RESULTS: Twenty-nine patients (12 males and 17 females) completed the study. Lesions on the face responded better than elsewhere on the body. The least responsive areas were the hands and feet. The average number of treatment sessions prior to repigmentation was 11. Untreated control patches remained unchanged. In higher skin phototypes the response was more favorable. There was no significant correlation between the age of the patients and their response to treatment. CONCLUSION: The use of the 308-nm excimer laser for the treatment of vitiligo is effective, relatively safe, and more convenient compared to other available modalities of treatment for stable vitiligo with small patches. However, similar to other modalities of treatment, the therapeutic effect is mainly dependent on the location of vitiligo lesions.

Bisphosphonate associated osteonecrosis of the jaw.

In 2003, the first reports describing osteonecrosis of the jaw (ONJ) in patients receiving bisphosphonates (BP) were published. These cases occurred in patients with cancer receiving high-dose intravenous BP; however, 5% of the cases were in patients with osteoporosis receiving low-dose bisphosphonate therapy. We present the results of a systematic review of the incidence, risk factors, diagnosis, prevention, and treatment of BP associated ONJ. We conducted a comprehensive literature search for relevant studies on BP associated ONJ in oncology and osteoporosis patients published before February 2008.All selected relevant articles were sorted by area of focus. Data for each area were abstracted by 2 independent reviewers. The results showed that the diagnosis is made clinically. Prospective data evaluating the incidence and etiologic factors are very limited. In oncology patients receiving high-dose intravenous BP, ONJ appears to be dependent on the dose and duration of therapy, with an estimated incidence of 1%-12% at 36 months of exposure. In osteoporosis patients, it is rare, with an estimated incidence < 1 case per 100,000 person-years of exposure. The incidence of ONJ in the general population is not known. Currently, there is insufficient evidence to confirm a causal link between low-dose BP use in the osteoporosis patient population and ONJ. We concluded BP associated ONJ is associated with high-dose BP therapy primarily in the oncology patient population. Prevention and treatment strategies are currently based on expert opinion and focus on maintaining good oral hygiene and conservative surgical intervention.