Brucellosis is infection of animals caused by organisms of the genus brucella. Many animal species are affected but domestic pets are the most common source of infection to man. Human brucellosis is a zoonotic disease of worldwide distribution. It is prevalent in developing countries where humans and animals live in close proximity. Prevalence in humans is directly proportional to animal disease. Animal handlers are specifically more susceptible due to their occupation. It is associated with lot of morbidity and loss of man days. Vaccination is the most important method for prevention of animal brucellosis. Control of animal brucellosis is influenced by various factors and hence, prevalence keeps on changing. Animal brucellosis is highly prevalent in many states of India. There is no collaboration between the veterinarians and the clinicians. Lack of awareness among clinicians, low index of suspicion and sometimes non availability of diagnostic tests can lead to missed diagnosis. Brucellosis is characterized by protean clinical manifestations though it commonly presents as pyrexia of unknown origin or osteoarticular disease. Other manifestations include glomerulonephritis, pneumonitis, encephalitis and hepatitis. The diagnosis can be established by blood culture and/or serology. The disease is easily treatable and completely curable, but failure to diagnose leads to non institution of appropriate treatment. This leads to chronic morbidity adding to the patient's misery. High index of suspicion, prompt diagnosis, appropriate and adequate treatment can cure the patient, prevent chronic morbidity, and loss of many days. This review aims to review the global and Indian scenario of brucellosis and increase awareness amongst the clinicians.

General hospital psychiatry has grown significantly over the years. It has led to the changes in our understanding to provide a comprehensive and holistic approach to the physically and mentally ill. The developments in the West and in India have been traced with an attempt to understand and appreciate the evolving patterns of referral in facilitating the management of the mentally ill in a holistic manner.

Purpose : To evaluate the correlation between diabetic retinopathy (DR) and duration of diabetes mellitus (DM). Materials and Methods : A cross-sectional study was carried out in 500 patients who were reported diabetics or newly diagnosed diabetics referred for screening for DR. Patients with posterior segment disease in whom posterior segment was not visualized were excluded from the study. A detailed evaluation of patients diabetic and hypertensive status was done along with their detailed ophthalmological examination. All patients were investigated for blood sugar levels, urine sugar levels, and HbA ₁ C. Grading of DR was done by the ETDRS grading system. Results : Total prevalence of DR is 32%. Among these, non-proliferative diabetic retinopathy (NPDR) is seen in 71.88% and proliferative diabetic retinopathy (PDR) in 28.12% patients. This study shows an increasing prevalence of DR with increasing duration of DM. The prevalence of DR was seen to be 9.44% when duration of diabetes detected was less than 5 years and was 76.47% in patients with diabetes of more than 20 to 25 years. Conclusion : There is an increasing prevalence of DR with increase in duration of DM. All patients having diabetes of more than 25 years were found to have retinopathy.

Background: Atypical manifestations of dengue infection with liver involvement have frequently been reported, ranging from mild elevations of aminotransferase levels to fulminant hepatitis. Materials and Methods: An analysis of 27 serologically confirmed cases of dengue infection at our tertiary care hospital was made. Patients with normal aminotransferase levels were categorized into Grade A, those with at least one of the enzymes raised to less than 3 times the reference range as Grade B, those with at least one of the enzymes elevated more than 3 times but less than 10 times as Grade C and those with elevations more than 10 times as Grade D. Results: 89% of the cases had alterations in the aminotransferase levels, with 37% categorized into Grade B, 30% into Grade C, and 22% as Grade D or acute hepatitis (P < 0.001). Aspartate aminotransferase (AST) levels were higher compared to the levels of alanine aminotransferase (ALT) (mean: 390.7 U/l and 296.9 U/l, respectively). Conclusion: Liver damage with alteration of aminotransferases is a common complication of dengue infection and valuable marker for monitoring these patients.

Context: Dengue is the most common disease among all the arthropod-borne viral diseases. There is no specific treatment or vaccine available for dengue. The sole method of prevention and control is the knowledge attitude and practices (KAP) for the same. Although, dengue is considered an urban- and semi-urban disease, in recent years, due to water storage practices and large-scale development activities in rural areas, dengue has become endemic in rural areas of India as well. Aims: To assess the KAP regarding dengue. Settings and Design: Urban and rural field practice area of a Tertiary Care Teaching Hospital in Pune, India. Materials and Methods: A pre-tested, semi-structured questionnaire was used to study the knowledge, attitude, and practices regarding dengue. Stratified random sampling technique was used. A modified B. G. Prasad criterion was used for socio-economic classification. Statistical Analysis Used: KAP represented as proportion (%). Chi-square test was used as a test of significance. P value < 0.05 was considered as statistically significant. Results: 68.4% in urban areas and 40.4% in rural area knew that dengue is transmitted by mosquito. 62.6% in urban areas and 48% in rural areas respectively stated fever as a symptom of dengue. The use of anti-adult mosquito measures was 48.05% and 51.42% in urban and rural area respectively Conclusions: There is a definite need to increase the information education communication activities for dengue in the study area.

Background: Inguinal hernia is a leading cause of work loss and disability. Recurrence and other complications can occur after hernia repair. The aim of this study wasto evaluate the effectiveness of Modified Bassini's Herniorraphy in themodern days of surgery. Materials and Methods : This is a retrospective study carried out in the MGM HospitalKamothe from 2005 to 2010. Only unilateral uncomplicated inguinal hernia cases were included.All patients had undergone Modified Bassini's repair. They were followed for 3 years and the complication and recurrence rates were noted. Result: A total of 254 patients were operated by Modified Bassini's repair only and 241 patients were followed completely and included in the study. The average age was 52.12 + 17.22 years. The mean operation time was 25 + 5.9 min. The mean hospital stay was 3 + 1.1 days. Post-operative pain was minimal in all patients, and was controlled by simple analgesia. Return to work was after 4 weeks. Hematoma and seroma formation requiring drainage were observed in one and two patients, respectively. Scrotal swelling was observed in two patients, which subsided within 2 weeks. Five patients developed urinary retention. No hydrocele, ischemic orchitis or recurrence was found during the follow-up. Wound infection was noted in one patient, which was treated by dressing and oral antibiotics. Recurrence was noted in two (0.83%) patients in the follow-up period of 3 + 0.44 years. Conclusion: Tissue repairs are still used in economically poor patients who cannot afford mesh, with similar results of prosthetic material repair that are commonly used in modern hospitals.

Background: Tibia is the commonest bones to sustain open injury because of subcutaneous position. Treatment of open fractures requires simultaneous management of both skeletal and soft tissue injury. Intramedullary nailing with reaming is generally considered to be contraindicated for open fractures tibia, because it damages the endosteal blood supply which will lead to non-union, deep infection. However, recent studies with or without reaming in open fracture tibia shows no influence in healing of fracture. Purpose: To compare the clinical and radiological results of intramedullary interlocking nailing of open fractures of the tibial shaft after reaming versus unreamed medullary canal. Materials and Methods: Between 2008 and 2011, we have treated 40 patients with compound tibia fracture (type I, II, IIIA) by simultaneous care of wound and skeletal injury. Primary fixation for fracture stabilization was done by closed intramedullary interlock nailing either reamed or unreamed; the allocation to the two groups made on alternating basis. Wound was managed by thorough debridement with primary/delayed primary closure by suturing, split thickness skin grafting or fasciocutaneous flap cover. Active, non-weight bearing exercises were started from next post-op day. Partial weight bearing after suture removal was started on 12 ^th day. Further follow-up was done at 6 weeks interval for union. Results: Open fractures of shaft of tibia treated with unreamed/reamed interlocking nailing gave excellent results. In present series, 19 fractures (95%) treated by unreamed and 19 (95%) fractures treated by reamed technique, united within 6 months of injury. Delay in union was noticed in one patient treated by unreamed technique who had segmental and extensive soft tissue injury and in reamed nailing there was one patient with deep infection, which was treated with antibiotic coated nail. Conclusion: Time to complete union was similar in both groups. Adequate debridement of wound and adequate soft tissue coverage is the key to minimize deep infection irrespective of whether the bone is reamed or not.

Background: Treatment of humeral shaft fractures with intramedullary nailing compared with dynamic compression plating leads to comparable results. No single treatment option is superior in all circumstances for a particular fracture and each case has to be individualized . Objectives: Comparative assessment of results of plating and Intramedullary Nailing in a rural set up so that proper management techniques can be provided for better functional outcome and minimum complications. Materials and Methods: This prospective study was conducted over a period of three years on sixty patients with closed acute humeral shaft fracture requiring operative interventions. Results: Forty percent of cases were in the age group 31-40 years with males outnumbering females. Motor vehicle accidents (63.3%) were most frequent cause. Right humerus was more frequently (66.6%) involved. Maximum patients (40%) were operated within 4-6 days after injury. Out of 30 patients of plate group complications were: Infection-6.6%; delayed union-13.3%; shoulder movement restriction-13.3%; elbow movement restriction-6.6%. Out of 30 patients of nail group complications were: Splintering of fracture end-6.6%; infection-6.6%; delayed union-26.6%; shoulder movement restriction-13.3%; elbow movement restriction-6.6%; shoulder pain-46.6%. Maximum number of fractures (73.3% in plating group and 60% in nailing group) clinically united in the interval of 11-13 weeks. Maximum number of patients had radiological union in period of 12-16 weeks (73.3% plate group and 66.6% nail group). There was no significant difference between the two groups. On functional assessment, excellent results were obtained in 22 patients (73.3%) in locking plate group and 18 patients (60%) in locking nail group. Conclusion: For patients requiring surgical treatment of mid shaft humeral fractures, locking plating and interlocking intramedullary nailing both provide statistically comparable results but a higher rate of excellent and good results and a tendency for earlier union was seen with locking plating group in the present series.

Background: The details about the research productivity in the cardiology specialty from India are lacking. Aim : The aim of this study was to analyze the publishing trends and the research productivity of cardiology articles in the Journal of the Association of Physicians of India (JAPI). Materials and Methods : We carried the bibliometric analysis of cardiology articles from JAPI published between 2000 and 2011. Data were derived from the journal's website and the articles were analyzed for type (Original Article, Case Reports etc.), disease (ischemic, congenital etc.) place of origin and timelines for publication. Results : Out of 2977 articles published, 215 (7%) articles belong to cardiology. Original articles (42.8%) and Case Reports (33.5%) are common than Correspondence (9.3%) and Images (14.4%). Ischemic heart disease (IHD) and hypertension (51%), cardiomyopathy and valvular diseases (23%) account for the majority of research productivity. Mumbai (19%), Delhi (14%), and Chennai (8%) are the top three contributors. Original Articles and Case Reports took about 14 months for publication, when compared to 6-9 months for an image or Letter to the Editor (P = 0.0011). Conclusion : Cardiology specialty contributes an average 15% of articles per annum in JAPI. Metro cities contribute the majority of articles pertaining to the clinical research on IHD and hypertension.

Background: Cervical lymphadenopathy is a common clinical problem that confronts us in daily clinical practice. The causes vary from simple treatable infections to malignancies that require highly specialized institutional management. It therefore needs to be speedily investigated. Fine needle aspiration cytology (FNAC) is simple, quick, inexpensive and minimally invasive technique that can be used as an outpatient procedure to diagnose them. Aims and Objectives: To assess the various causes of cervical lymphadenopathy through FNAC, and to see the distribution of lesions with respect to age and gender . Material and Methods: A retrospective study was conducted over a period of 10 months in a major laboratory. The cyto-morphologic features seen in the aspirates were critically analyzed and correlated with their aetiology. Results: In this study, 214 cases of cervical lymphadenopathy were analyzed. The age of the patients ranged from 9 months to 84 years of which 59% were males and 41% were females. Maximum incidence of cervical lymphadenopathy was observed in the age group of 21 to 40 years. The maximum numbers of patients (47.67%) were diagnosed as tuberculous lymphadenitis, followed by reactive lymphadenitis (44.39%), lymphomas (4.2%) malignant metastatic deposits (2.8%), and granulomatous lymphadenitis (0.94%). Conclusion: Our study concluded that FNAC is simple, quick, minimally invasive, and inexpensive technique to diagnose cervical lymphadenopathy. It can differentiate a neoplastic from a non-neoplastic process and therefore influence patient management preventing patient from being subjected to unnecessary surgery.

Introduction: Surgical site infection (SSI) continues to be a distressing problem since time immemorial, as it happens to be one of the major causes of post-operative morbidity and mortality. Many methods have been evolved to combat wound infection, but the rate of wound infection has been more or less static over the past few decades. The search for alternative modes of management is going on and one of the methods is intra-incisional infiltration of antibiotics. Aims and Objectives: To study the comparative efficacy of pre-operative intra-incisional antibiotic infiltration and prophylactic parenteral antibiotic therapy in reducing surgical site infection. Materials and Methods: This is a prospective randomized controlled study comprising of 120 patients divided in to three groups i.e. 40 in each group. Group A comprising 40 patients were subjected to local infiltration of 1 gram of Cefotaxime around the site of incision, 20 min before the induction of anesthesia. Group B comprising of 40 patients were administered a single dose of 1 gram of Cefotaxime intravenously 20 minutes before the surgical incision and Group C comprising of 40 patients were administered local infiltration of 1 gram of Cefotaxime as well as intravenous administration of 1 gram of Cefotaxime, 20 minutes before surgical incision. Inclusion criteria were patients in age group of 20-60 yrs, procedures that lasted for less than 2 hours, clean and clean contaminated surgical procedures. The exclusion criteria were patients with diabetes mellitus and those on steroid therapy. Incidence of SSI, type of organisms cultured in case of infection were studied. Results: Overall incidence of SSI in Group A was 10%, in Group B 18%, and Group C 2.5%. Frequency of infection due to gram positive bacteria was more as compared to gram negative in the cases that developed SSI. The commonest organism isolated was Methicillin Sensitive Staphylococcus aureus (MSSA). Conclusion: The incidence of SSI was lower in the group of patients who were subjected to intra-incisional antibiotic infiltration as compared to the group who received prophylactic intravenous (IV) antibiotic. There was significant reduction in incidence of SSI in the group, which received both Intra-incisional as well as IV antibiotics. There was no definite correlation between the duration of surgery to the development of SSI in this study.

Background: Irrational prescribing is a global problem. The present study was undertaken to identify the problem of irrational medicine use by Bachelor of Medicine and Bachelor of Surgery (MBBS) and Bachelor of Ayurvedic Medicine and Surgery (BAMS) doctors in outpatient setting, by using WHO prescribing indicators. Materials and Methods: This study was carried out in Vishrantwadi, Pune, India. 250 prescriptions were collected from MBBS doctors and 250 prescriptions were collected from BAMS doctors and their prescription pattern was analyzed using WHO prescribing indicators. Results: Average number of medicines per prescription was 2.4 for MBBS and 3.04 for BAMS doctors. Percentage of prescriptions with antibiotics and with injections was significantly more in BAMS doctors. Antibiotics, gastrointestinal system related medicines, vitamins and iron preparations were prescribed more by BAMS doctors. Percentage of irrational fixed dose combinations prescribed by BAMS doctors was more (57.2%) as compared to MBBS doctors (28.6%). Conclusions: In the present study, although the prescribing patterns of both MBBS as well as BAMS doctors are not satisfactory; the BAMS doctors seem to prescribe more irrationally as compared to MBBS doctors.

Background: Hyaluronic acid is an extracellular constitute of the connective tissue that acts as both a barrier to plaque bacteria and fulfils a variety of extracellular functions that are vital to the maintenance of healthy gingival tissue. Recently, 0.2% hyaluronic acid is introduced as an anti-inflammatory agent for topical application in the treatment of gingivitis. Aims: To evaluate the therapeutic efficacy of 0.2% hyaluronic acid containing gel as an adjunct to scaling. Materials and Methods: Fifty patients belonging to both gender and ages ranging 15-40 years diagnosed with plaque-induced gingivitis were included in the study. They were divided into two groups of 25 each; Group 1 (scaling and with 0.2% hyaluronic acid) and Group 2 (scaling alone). Plaque, gingival, and papillary bleeding index of each patient were recorded at baseline, 1, 2 and 4 week periods. Statistical analysis: Data was analyzed using Student's t test. Results: Comparison of the two treatment modalities revealed a statistically significant improvement in the clinical parameters for both groups at 4 ^th week with mean reductions in Gingival Index (GI) was 1.13 ± 0.22 (Group 1) and 0.85 ± 0.17 (Group 2), respectively, which was statistically highly significant (P ≤ 0.001), Papillary Bleeding Index (PBI) was 1.22 ± 0.31 and 0.83 ± 0.24, respectively, which was statistically highly significant (P < 0.001). Conclusions : 0.2% hyaluronic acid containing gel is an effective agent for treating plaque-induced gingivitis as an adjunct to scaling as compared to scaling alone.

We present a case report of a young 35-year-old previously healthy male with simultaneous central retinal artery occlusion in the right eye and branch retinal artery occlusion in the left eye with visible calcific emboli in both eyes from calcified mitral valve diagnosed on trans-esophageal echocardiography. Patient underwent an urgent life-saving mitral valve replacement surgery within 2 days as Ophthalmologists immediately referred him to Cardiologist moment they visualized calcific emboli in both eyes with bilateral retinal artery occlusions on fundoscopy. Bilateral retinal artery occlusions suggest a source of emboli at the level of the heart or aortic arch. All patients with retinal ischemia should have a complete cardiovascular evaluation supplemented by Transesophageal echocardiography. Many times an Ophthalmologist might be the physician of first contact for patients with cardiac diseases and awareness of the disease is therefore important for all Ophthalmologists. Timely referral and management by Cardiologist/cardiac surgeon may protect patient against serious life-threatening complications.

Urethral diverticulum with distal stricture is a common entity. We are presenting a rare case of urethral diverticulum with proximal stricture. This is an uncommon case of a 55- year-old male paraplegic patient, who had urethrocutaneous fistula with distal urethral diverticulum and proximal urethral stricture. The patient was successfully managed by single-stage diverticulectomy and urethroplasty.

A 70-year-old female patient presented with left hip arthritis following longstanding painfully restricted hip movement for 2 years. X-rays showed protrusio acetabuli with avascular necrosis of head femur. The patient was operated for hip arthritis; hybrid total hip replacement was done with reconstruction of the medial wall with autologous bone graft of femoral head using stainless steel metal wire mesh on which cemented acetabular component with non-cemented femoral component was fixed. Cages and wire mesh are used to reconstruct the medial wall of acetabulum, but cage is a costlier option than wire mesh, with reproducible results. Very few cases have been reported, showing excellent results with the use of metal wire mesh.

Tuberous sclerosis complex is a genetic (autosomal dominant) disorder affecting cellular differentiation, proliferation, and maturation. This cellular process gets disarranged and results in hamartomas formation in multiple organs of body including, the kidneys. Kidney involvement is usually bilateral and asymptomatic. We report a case of bilateral renal angiomyolipomas who presented at late age with gross hematuria and pain.

Dentinogenic ghost cell tumors (DGCT) are uncommon lesions mainly with rare peripheral types. This report presents a case of peripheral DGCT on the left side of the mandibular alveolar ridge of a heavy smoker, a 68-year-old man, with main presenting feature as a mild pain. Submandibular lymphadenopathy and radiological "saucerization" were evident. Differential diagnosis included fibroma, neurofibroma, peripheral ameloblastoma, peripheral odontogenic fibroma, and peripheral giant cell granuloma. Histologically, ameloblastoma-like epithelial elements were seen in association with grouped ghost cells. Proliferating polyhedral cells and stellate reticulum-like cells with various densities were spread over a wide range of the field. The lesion was curetted and after 2 years of follow up, it did not recur.

An unusual penetrating chest injury was caused by high velocity road traffic accident. An 18-year-old had a four wheeler accident and was brought in emergency department with a 'bamboo' stick on the left side chest exiting through back. After the stabilization of vital parameters, an inter-costal tube drainage was done on the left side. Except the minor brochopleural fistula which healed by 10 ^th day, his recovery was uneventful. The outcome was consistent with current aggressive management of penetrating chest injuries. Management of penetrating chest injury involving pulmonary trauma is based on three principles. One is stabilization of hemodynamics of patient with proper clinical evaluation. Second, a mere intercostal tube drainage sufficient for majority of the cases. Third, post-operative active as well as passive physiotherapy is necessary for speedy recovery.

Calcinosis cutis circumscripta is a rare condition in which abnormal deposition of calcium seen in the dermis and subcutaneous tissue, it is associated with localized scleroderma. A 30-year-old female presented with an area of extensive calcification involving the right gluteal region, lateral aspect of right thigh and a small area on left thigh detected on radiograph with atrophy of subcutaneous tissue. Magnetic resonance imaging and computed tomography were done for further evaluation and the findings were of calcification and atrophy involving the skin and subcutaneous tissue.

Emphysematous pyelonephritis is a life threatening, necrotizing upper urinary tract infection associated with gas within the kidney and/or perinephric space. To prevent mortality from this fulminant infection, early diagnosis is essential. CT scan should be done early in patients with suspected emphysematous pyelonephritis. Here, we present a case of Type II Diabetes Mellitus complicated with left obstructive ureteric calculi, diagnosed on CT scan to have extensive bilateral emphysematous pyelonephritis of class 4. We treated conservatively with antibiotics and DJ stent. The patient responded and a repeat CT scan was done after 4 weeks which showed no evidence of emphysematous pyelonephritis.

Herpes zoster maxillaries following cataract surgery is rare. We report here a case of a 70-year-old male who presented with vesiculo-papulo-macular rashes with hyperpigmented crusts over right malar prominence of cheek, side, and tip of the nose and upper lip, 3 days after undergoing uneventful cataract surgery of the right eye. He was treated with systemic acyclovir with resolution of skin lesions.

Neurilemmomas are uncommon neoplasms. They are solitary encapsulated benign tumors usually occurring along the course of peripheral, cranial or sympathetic nerve. They are rarely malignant. Nasal and paranasalneurilemmomas are extremely rare and few cases have been reported. We report a case of neurilemmoma of nose because it is rare and it grossly appears similar to the benign mucous polyp of the nose. We report a 32-year-old male complaining of foreign body sensation in nose and difficulty in breathing. On examination it was clinically thought to be a mucous polyp, but on histopathological examination it was found to be neuroilemmoma.

A 55-year-old female patient presented with pain in upper-right abdomen region since 2 months, associated with vomiting and fever. USG abdomen revealed well-distended gall bladder with multiple small calculi along with large hyperechoic area sludge. A provisional diagnosis of Empyema of gall bladder with cholelithiasis was considered. Laparoscopic cholecystectomy was done. The histopathological findings were suggestive of infiltrating well-differentiated keratinizing squamous cell carcinoma of the gall bladder. Subsequently, diagnosis was confirmed by means of IHC studies.

Left ventricular (LV) thrombus is a serious complication of anterior wall myocardial infarction (MI), especially in patients with severe LV dysfunction. LV thrombus carries a high risk of causing stroke and other thromboembolic complications despite adequate anticoagulation therapy. There is a benefit of anticoagulation in patients with ischemic cardiomyopathy to reduce thromboembolic events or in resolution of LV thrombus. Two-dimensional (2D) echocardiography is the most commonly used technique for the diagnosis and follow-up of such cases. Our patient developed a chronic LV thrombus with ischemic cardiomyopathy post anterior wall MI and was managed well on anticoagulants to prevent the thromboembolic events under strict vigilance and follow-up.

Cerebral metastases usually have a characteristic radiological appearance. They can be differentiated rather easily from any infective etiology. Similarly, positive medical history also guides the neurosurgeon towards the possible diagnosis and adds to the diagnostic armamentarium. However, occasionally, similarities on imaging may be encountered where even history could lead us in the wrong direction and tends to bias the clinician. We report a case of a 40-year-old female with a history of mastoidectomy for otitis media presenting to us with a space occupying lesion in the right parietal region, which was thought pre-operatively as an abscess along with the cerebritis. Surprisingly, the histopathology proved it to be a metastatic adenocarcinoma. Hence, a ring enhancing lesion may be a high grade neoplasm/metastasis/abscess, significant gyral enhancement; a feature of cerebritis is not linked with a neoplastic etiology more often. This may lead to delayed diagnosis, incorrect prognostication and treatment in patients having coincidental suggestive history of infection. We review the literature and highlight the key points helping to differentiate an infective from a neoplastic pathology which may look similar at times.

Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disorder of unknown etiology and pathogenesis, usually presenting with high spiking fever accompanied by several systemic manifestations. Pulmonary complications in AOSD are also rare. Only a few earlier pathologic reports exist describing AOSD with pulmonary involvement. AOSD presenting as non-resolving pneumonia is poorly reported in literature. We report one case of AOSD presented initially as non-resolving pneumonia. In this report, we conclude that every clinician must consider AOSD as a potential differential diagnosis of non-resolving pneumonia.

Actinomycosis in the pelvic region is an uncommon diagnosis. This infection is caused by Actinomyces israelii, a gram-positive anaerobic saprophyte bacterium that is a normal inhabitant of the upper intestinal tract in humans. Pelvic actinomycosis is difficult to diagnose pre-operatively and is diagnosed, in most cases, accidentally. Actinomycosis can mimic pelvic and abdominal malignancies. A case report of a 35-year-old female patient with a fixed pelvic mass is presented. Despite the broad use of tumor markers, sonography and computerized tomography, the differentiation between benign and malignant pelvic masses is still a clinical challenge. Accurate differential diagnosis is necessary because the treatment strategies vary greatly. A case of actinomycotic inflammatory disease, which was misdiagnosed as an advanced ovarian cancer, is reported.

We report a rare case of compound fracture of the first metacarpal with volar dislocation of second, third, and fourth carpometacarpal (CMC) joints of the right hand. These injuries were diagnosed early and treated successfully with debridement and open reduction and internal fixation using multiple Kirschner wires (K-wire) within 6 hours of injury. The functional results were good at 16 weeks follow up.

Polyarteritis nodosa (PAN) is a rare vasculitis with multisystem involvement. The definition, diagnostic criteria and validity of cutaneous polyarteritis nodosa (c-PAN) as a variant of classic PAN limited to skin have continued to remain disputed. We revisit the definition of c-PAN, comment on advances in its treatment and describe one such case, a 26-year-old male, whose affliction consisting of two episodes over a period of 2 years remains restricted - without any constitutional feature and systemic involvement - to skin over legs as multiple, discoloured, tender, subcutaneous-a few ulcerated-nodules healing promptly without scarring in response to oral corticosteroids. The aim of presentation is to emphasize to the non-dermatologists physicians regarding its usual optimistic prognosis.

Solid cystic tumor of the pancreas (SCPT), also known as Frantz tumor is a rare pancreatic tumor with an incidence less than 2% of all non-endocrine pancreatic tumors. Young women are more often affected than men. We report the case of a 28-year-old female who presented with vague abdominal pain of two-month duration. Ultrasonography (USG) and computed tomography (CT) scan revealed a large cystic mass which was seen to be arising from the tail of the pancreas and attached to the mesentery. Distal pancreatectomy was done, which on histopathological examination was diagnosed as SCPT. Due to its rareness and behavior, this tumor is often associated with diagnostic and management problems.

When we talk about severe malaria, we usually think of Plasmodium falciparum. However, in recent times, Plasmodium vivax has also been reported to cause severe multi-organ dysfunction and life-threatening disease similar to P. falciparum. We report here a case of P. vivax malaria in a young boy from an endemic zone, who developed acute renal failure, severe thrombocytopenia, and anemia and later developed spontaneous subarachnoid hemorrhage. Multisystem involvement in a patient with P. vivax is rare, and subarachnoid hemorrhage is an unusual presentation.