This article describes the history and various milestones of rheumatology from ancient to modern times. The origin of rheumatology can be traced to ancient times. Diseases such as gout and osteoarthritis were prevalent in ancient people. Many ancient skeletons show signs of gout and osteoarthritis. The ancient book on Indian Medicine, Charaka Samhita, gives a vivid description of many variants of arthritis. Charaka, an eminent Ayurvedic physician, described rheumatoid arthritis (RA) in Charaka Samhitha as "Vishkantha," meaning painful joints. The word rheumatology has its origin in the word "rheuma," which means flowing, and is mentioned in Hippocratic corpus. Hippocrates made several observations about gout, popularly known as "aphorisms of gout." Many famous paintings in the medieval era depict joint diseases. Hand lesions resembling those of RA are found in paintings of the Flemish school. "The virgin with canon van der paele," a painting by Jan Van Eyck (1436), shows thickened arteries in the temple, suggestive of temporal arthritis. The famous portrait of Federigo de Montefeltre, thought to have been painted by Joos (Justus) van Gent, shows arthritis of the proximal interphalangeal joint of the left index finger. Rheumatology developed as a well-recognized specialty of medicine in the 20th century. American Physicians Bernard Comroe and Joseph Lee Hollander coined the term rheumatologist in 1940. Rheumatology has rapidly advanced during the last 50 years due to improved diagnosis as a result of progress in immunology, molecular biology, genetics and imaging.

Chronic alcoholism can have an adverse psychological impact on the family involved in caregiving and coping with the alcoholic. This article attempts to review and discuss relevant literature pertaining to the overall psychological impact of adult alcoholism on spouses and children. A literature search on various search engines like Pubmed, Psychinfo, OmniMedicalSearch, and WebMD was done using search words such as "psychological impact", "alcoholism", "family" "spouse", "parents," and "children". The articles perceived to be relevant have been reviewed and discussed. The literature search revealed significant problems in coping among family members. It was found that there exists a huge burden on the immediate family members of the chronic alcoholic. Recent studies have found high levels of psychological stress and depressive symptoms in spouses of alcoholics. Alcohol use has also been significantly linked to aggressive behaviors and intimate partner violence. Parentification and emotional caretaking were found in the children of chronic alcoholics. This can have a major impact on the psychological development of these children. Recent studies have shown that the offsprings of alcoholics are at a high risk for Conduct Disorders, Attention Deficit Hyperactivity Disorder, Major Depressive Disorder, and Substance Dependence. Marital and Family therapy may have a role in therapeutic as well as preventive care approaches in alcoholism.

Objective: To assess alcohol consumption practices amongst adult males in a rural block area. Materials and Methods: Using multi-stage random sampling frame, at least 12 households were identified from selected anganwadi centers (n = 27), and one resident adult male from each household was interviewed in confidence using pre-designed, pre-tested, semi-structured interview schedule after seeking informed consent. In households with more than one adult male respondent, the elder member was recruited. For operational purpose, a drinker was defined as a person who had consumed at least one alcoholic drink in 1 year immediately preceding the survey. Results: A total of 345 adult males were covered with a mean age of 46.6 (±14.2) years. Nearly 64.6% had 5 years of schooling, 46.4% were farmers, 54.2% lived in joint family system and 59.7% had monthly family income up to Rs 10,000. Nearly 150 (43.5%) subjects had some correct knowledge regarding adverse effects of alcohol consumption. Of all the study subjects, 326 (94.4%) males had consumed at least one alcohol-based drink and of which 66.3% consumed country liquor. Nearly 239 (73.3%) drank at either their respective homes or their friends' homes. Two hundred and eighty-one (86.2%) procured alcohol from a shop within the village; average expenditure per month was Rs 500-900 for 132 (40.5%) respondents; and 38.3% subjects did not consume any snacks with alcohol intake. Drinking had become a habit for 194 (59.5%) males; however, based on self-assessment, 131 (40.2%) considered alcohol consumption as a problem and intended to stop drinking. Conclusion: Within study limitations, high prevalence of alcohol consumption was noted in this study, which may not only eventually lead to health/social issues but also adversely influence the younger generation for easy and early uptake of alcohol.

Background: Marital adjustment is considered as a part of social well-being. Disturbed marital relationship can directly affect the disease adjustment and the way they face disease outcomes and complications. It may adversely affect physical health, mental health, the quality-of-life and even economic status of individuals. Aim: The aim of this study was to compare the marital adjustment among patients with substance dependence, schizophrenia and bipolar affective disorder. Materials and Methods: The sample consisted of each 30 patients with substance dependence, bipolar affective disorder and schizophrenia, diagnosed as per international classification of diseases-10 diagnostic criteria for research with a minimum duration of illness of 1 year were evaluated using marital adjustment questionnaire. The data was analyzed using parametric and non-parametric statistics. Results: Prevalence of poor marital adjustment in patients with schizophrenia, bipolar affective disorder and substance dependence was 60%, 70% and 50% respectively. There was a significant difference on overall marital adjustment among substance dependence and bipolar affective disorder patients. There was no significant difference on overall marital adjustment among patients with substance dependence and schizophrenia as well as among patients with schizophrenia and bipolar affective disorder. On marital adjustment domains, schizophrenia patients had significantly poor sexual adjustment than substance dependence patients while bipolar affective disorder patients had significantly poor sexual and social adjustment compared with substance dependence patients. Conclusion: Patients with substance dependence have significant better overall marital adjustment compared with bipolar affective disorder patients. Patients with substance dependence have significantly better social and sexual adjustment than patients with bipolar affective disorder as well as significantly better sexual adjustment than schizophrenia patients.

Context: Satara district of western Maharashtra is in late expanding phase of demographic cycle. Postponement of first pregnancy with the use of reversible contraceptives is the need of the hour. Since 2007, Satara district is implementing a conditional cash transfer scheme second honeymoon package (SHP). Objectives: The objectives of this study are: (1) To find out the effect of conditional cash transfer on choice and utilization of contraceptives among participants of SHP. (2) To identify various barriers to the use of contraceptives. Materials and Methods: This was an evaluation study of a community based interventional program. Cases were the participants of SHP program while the controls were the couples residing in the same village as that of participants and married in the same year. Enquiries were made about their knowledge of contraceptives, reasons of postponement, choice of contraceptives, problems faced while using them, perceived benefits of participation, reasons for non-participation and non-use of contraceptives, etc. Results: This study has found out that 24.8% controls and 57.6% participant couples were having knowledge of contraception before their marriage. Amongst the participants of the scheme and controls, male condom was the most popular method used by 80.8% participants, followed by oral pills by 9.22% couples. Contraception prevalence rate among control couples was 17.6%, while that in participants was 91.8%. Resistance from family members, side-effects and failure of contraceptives were some of the barriers to their use. Conclusions: Conditional cash transfer has encouraged the use of contraceptives in acceptors of SHP. By participating in SHP and postponing first pregnancy 15.8% could complete their education, job/career betterment achieved by 16.4% and 19.3% adored marital pleasure.

Background : On 1 July 2012, a large number of cases of acute diarrheal episodes were reported in Vikas Nagar, Chandigarh. A rapid response team was sent to investigate this outbreak on 3 July 2012. Aim : To determine the reasons for the outbreak and to focus on the identification of a gap in the management of the epidemic by applying remedial measures in the Vibrio cholera outbreak in the Vikas Nagar area of Chandigarh district. Materials and Methods : A house-to-house survey of 2765 houses was performed with 20 teams of Auxillary Nurse Midwife ANM/Anganwadi workers. Information regarding age, sex, place of residence, occupation, date of onset and treatment history and laboratory finding were collected. Environmental investigation and laboratory investigation of the stool samples were also performed. As the study was conducted during an emergency response to the outbreak, and was designed to provide information to orient the public health response, ethical approval was not required. Remedial measures were implemented. Results : A total of 1875 patients reported to the various health facilities of the Vikas Nagar area with complaints of increased frequency of loose watery diarrhea and a few had vomiting episodes during the time period of 1 ^- 14 July 2012. Four deaths were reported. Three hundred eighteen (318) cases were found in the house-to-house survey of 2765 houses of the area. Twenty-six percent of the cases were in the age group of <5 years. Hospitalization was required in 12.9% of the cases, while 87.1% were managed in the Outpatient Department. Eight samples were found to be positive for Vibrio cholera El Tor Serotype, Ogawa in samples from the house-to-house survey. A coliform count of >1800 MPN/100 mL was reported from 10 water samples. Investigations revealed that the epidemic was waterborne. Leakages in the pipes were found at many places leading to mixing of water with drainage, and water samples collected from the houses of the cases were found to be positive for Vibrio cholerae. Conclusion : Among the identified gaps, delays in the initiation of the investigation of the epidemic and pipe leakages were the most important. In India, waterborne epidemics are usual occurrences during the year. In this scenario, proper monitoring of water sources, proper sewage disposal, sanitation measures and creating awareness among the people should be undertaken.

Background: Newborns undergo a physiological nadir in serum calcium levels by 24-48 h of age. We have compared the ionic calcium levels in serum of normal as well as high-risk pregnant mothers before delivery, in cord blood of newborns and in neonates at 48 h of age. Materials and Methods: This is a prospective study of 500 pregnant women. One hundred and twenty-two pregnant women did not receive any calcium supplementation antenatally while 378 pregnant women received calcium supplementation antenatally. Results: A statistically significant correlation was found between ionic calcium levels in mothers and in cord blood in the study population and preterm and term babies (coefficient of correlation, r = 0.83, 0.86 and 0.83, respectively). Ionic calcium in baby's blood at 48-h age better correlated with cord blood (r = 0.67) than with maternal blood (r = 0.51). With calcium supplementation antenatally, the mean values for serum calcium of maternal blood, cord blood and baby's blood at 48 h of age were higher than those without antenatal calcium supplementation. Conclusions: Antenatal calcium supplementation may prevent hypocalcemia in the newborn thus preventing neonatal morbidity.

Background: Infectious diseases can be transmitted in various ways . Indirect transmission or vehicle-borne transmission of infection can occur through various agents like instruments, utensils, water, or food. In hospital settings, transmission of infection through contaminated medical devices is always a possibility. Stethoscope is the symbol of health professionals. However, the diaphragm and bells of the stethoscopes have been shown to harbor pathogenic and nonpathogenic microorganisms. Aims: 1) To determine the degree of contamination of stethoscopes used by clinicians and nurses. 2) To identify various microbes from such contaminated stethoscopes and to assess their role as potential pathogens. 3) To determine the effectiveness of 70% ethanol as a disinfecting agent. Materials and Methods: Stethoscopes of 50 healthcare workers from different departments were included in the study. Bacteriological cultures of the samples were done on blood agar and MacConkey agar plates. Organisms were identified by conventional phenotypic methods. Antibiotic sensitivity test (ABST) of the microorganisms was performed by Kirby-Bauer disk diffusion method. Results: Average number of colonies on each stethoscope was 30 . Pathogenic microorganisms including Staphylococcus aureus, Acinetobacter species, Citrobacter species, Pseudomonas stutzeri, Bacillus species, and Aspergillus fumigatus were identified. Among the potential pathogenic organisms, coagulase-negative staphylococci were isolated. Numbers of colonies were highest among the stethoscopes sampled from surgery ward and Medical Intensive Care Unit MICU. Conclusion: Stethoscopes harbor potential pathogens capable of surviving on their surfaces. Despite their best intentions, health professionals can act as a vector for transmission of disease. Disinfecting procedures may be necessary between consecutive patients. Attention to simple preventive strategies can reduce the disease transmission rate.

Aim: The aim of this study was to determine the role of the magnetic resonance imaging (MRI) in patients with atraumatic knee pain. Background and Objectives: Knee pain is one of the most common problems faced by people from time immemorial. There is a wide range of disease ranging from traumatic to degenerative causing knee pain in which articular cartilage is involved. Over the past 15 years, MRI has become the premier, first-line imaging study that should be performed in the evaluation of the painful knee in particular in tears of menisci, cruciate and collateral ligaments, osteochondral abnormalities (chondromalacia, osteoarthritis and osteochondral defects), synovial cysts and bone bruises. MRI, by virtue of its superior soft-tissue contrast, lack of ionizing radiation and multiplanar capabilities, is superior to more conventional techniques for the evaluation of articular cartilage. Materials and Methods: A prospective study was carried out on 150 patients in the Department of Radio-diagnosis, Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune over a period of 2 years from June 2011 to May 2013. Patients having fracture or dislocations of the knee joint were also excluded from the study. Detailed clinical history, physical and systemic examination findings of all patients were noted in addition to the laboratory investigations. All patients were subjected to radiograph of knee anterior-posterior and lateral view. MRI was performed with Siemens 1.5 Tesla MAGNETOM Avanto machine. Results: In our study of 150 patients with knee pain, articular cartilage defect was found in 90 patients (60%). Out of 90 patients with articular cartilage defect, 30 patients (20%) had full thickness cartilage defects. Subchondral marrow edema was seen beneath 30 patients (20%) with articular cartilage defects. 32 patients (21.1%) had a complex or macerated meniscal tear. Complete anterior cruciate ligament tear was found in seven patients. Joint effusions were detected in 70% (105) of the knees. Large Baker cysts were observed in 6.1% of the knees. Conclusion: In conclusion, individual with acute or chronic knee pain without any definite history of trauma should be subjected to MRI study of the knee provided radiographs are non-informative or non-diagnostic. The study not only outlines the tendons, ligament and cartilage status, but also demonstrates subtle underlying bony pathologies causative for patient complaints.

Introduction: Appendicitis is one of the more common surgical emergencies and it is one of the most common causes of an acute abdomen. Left untreated, appendicitis has the potential for severe complications. Despite initial optimism, it has become apparent that in most units the normal appendix rate remains 15-30%. In view of this scenario, this study was undertaken to assess the role of intra-abdominal pressure (IAP) in the diagnosis and prognosis of acute appendicitis. Materials and Methods: A total of 200 patients with initial diagnosis of appendicitis were evaluated. Patients were grouped according to the final diagnoses as appendicitis (acute and acute on chronic), perforated appendicitis and negative exploration for appendicitis. A simple fluid column manometry system through the Foley's catheter is used to measure the IAP. Results: Out of a total of 200 cases 104 were female and 96 were male in the age range of 7-74 years. A normal appendix was found in 18 patients and 124 patients had appendicitis. A total of 58 cases were of appendicular perforation. The mean pre-operative values of IAP for cases of normal appendix, appendicitis and appendicular perforation were 3 ± 0.4, 8.2 ± 0.4 and 9.6 ± 0.3 respectively (P < 0.001). Post-operative 1 ^st day and 2 ^nd day values of the IAP for appendicitis, perforated appendicitis and normal appendix groups were 3 ± 0.2 and 1.0 ± 0.1, 4.2 ± 0.1 and 1.5 ± 0.1, 0.8 ± 0.6 and 0.5 ± 0.6 cm H ₂ O respectively. Conclusion: IAP increases among patients with appendicitis and a further increase is encountered among patients with perforated appendicitis. Therefore, addition of this parameter to support the clinical diagnosis of acute appendicitis and perforative appendicitis is advocated specially in a rural setting. However, randomized controlled trials are required to support our findings.

Background:peptic ulcers were earlier believed to be caused by dietary factors, gastric acid, and stress. However, in 1983, Warren and Marshall identified the correlation between Helicobacter pylori (H. pylori) and peptic ulcers. It is now well established that most of the peptic ulcers occur as a result of H. pylori infection. But the co-relation between perforated peptic ulcer and H. pylori infection is not yet fully established. Aims and objectives : to study the prevalence of H. pylori infection in patients with perforated peptic ulcer. Materials and methods: this was a prospective study carried out in all cases of perforated peptic ulcer reporting in surgical wards of a medical college during 2008-2010. A total of 50 cases, presenting as acute perforation of duodenum and stomach during this period, formed the study group. After resuscitation, all the cases were subjected to emergency exploratory laparotomy. The exact site of perforation was identified, biopsy was taken from the ulcer margin from 2-3 sites and the tissue was sent for H. pylori culture and histopathological examination. Simple closure of perforation, omentoplasty, thorough peritoneal lavage and drainage was carried out. Results: out of the 50 cases of perforated peptic ulcer, 38 happened to be males, and only 12 were females. The age of the patients ranged from 20 to 70 years. All the patients underwent only emergency laparotomy. As many as 46 cases (92%) turned out to be positive for H. pylori and only four cases (8%) were negative for this infection. Postoperatively, patients who were found to be positive for H. pylori were put on anti-H. pylori treatment. Conclusion: there was a high prevalence of H. pylori infection in patients with perforated gastroduodenal ulcers.

A prospective study on early enteral feeding v/s Nil by mouth was done on 74 patients in two groups. The study mainly focused on incidence of surgical site infection, post-operative complications, such as pulmonary complications, anastomotic leakage, abdominal distension, vomiting, and cost of treatment in both groups. It was observed that maximum patients in our study were in the age group of 31-40 years with male preponderance having an average of 12 gm % hemoglobin levels and average BMI of 23, which were divided in two groups. In our study, early enteral feeding has less incidence of surgical site infection with most infection by Klebsiella pneumonia in both groups, clinically less complications and less cost incurred. The incidence of vomiting was increased in early enteral fed group but did not lead to cessation of feeding. Early mobilization of patient and early establishment of bowel sounds are the other factors noticed in patients of early enteral fed groups in our study. Cost of treatment is emphasized in our study. Myth of patients keeping nil by mouth after surgery is to be discouraged. Early enteral feeding enhances recovery and can be safely given after all major gastrointestinal surgeries.

Background: Percutaneous or transthoracic fine needle aspiration cytology (FNAC) is a rapidly emerging diagnostic modality to assess the nature of radiologically demonstrated lung lesions. Aims: The present study was conducted to evaluate the usefulness of computed tomography (CT)-guided FNAC in the diagnosis of pulmonary mass lesions. Materials and Methods: The present prospective study was carried out on 74 cases of radiologically diagnosed pulmonary mass lesions involving the periphery of the lung parenchyma with strong clinical suspicion of pulmonary neoplasm. CT-guided transthoracic fine needle aspiration was performed and cytology smears were stained with May-Grόnwald-Giemsa (MGG) stain and conventional Papanicolaou (Pap) stain. Smears were broadly categorized into unsatisfactory, benign, suspicious of malignancy and malignant lesion. The cytological diagnosis was compared with subsequent histopathology report where it was necessary. Results: A total of 74 cases of pulmonary mass lesions were included in the present study, of which 58 were males (78.4%). The mean age of the patients was 51.6 years, but the mean age in case of malignant lesions was 62.5 years. Cough was the most common respiratory symptoms (100%) followed by weight loss (91.9%) and fever (62.2%). Maximum cases of benign lesions were chronic non-specific inflammation (10.8%; 8 cases) followed by tuberculosis (8.1%). Regarding the malignant categories, non-small cell carcinoma, not otherwise specified (NOS) (13.5%; 10 cases) was the most common malignancy followed by adenocarcinoma (10.8%; 8 cases), small cell carcinoma (8.1%; 6 cases) and squamous cell carcinoma (6.7%, 5 cases) respectively. All the 38 cases of malignant lesions were confirmed by histopathology. Out of 10 cases of non-small cell carcinoma, NOS 4 cases were diagnosed histopathologically as poorly differentiated adenocarcinoma, 2 cases as high grade squamous cell carcinoma, 2 cases as large cell carcinoma, 1 case as pleomorphic carcinoma and 1 case as adenosquamous carcinoma. Conclusion: CT guided FNAC is a less expensive, simple, fast and reliable method for diagnosis of pulmonary mass lesions.

Background: Coronary heart disease (CHD) is one of the major causes of mortality and morbidity in developed countries as well as developing countries. If the coronary arteries are narrowed, the blood supply to the cardiac muscle is reduced. Coronary angiography is a radiological procedure to visualize the coronary arteries. The coronary bypass surgery has become common for the treatment of patients with unstable angina and myocardial infarction. That's why the knowledge of the coronary artery and their predominant pattern is necessary for the management of CHD. Materials and Methods: In the present study, 75 adult human hearts were collected and preserved in 10% formalin. The hearts were dissected carefully to observe the posterior inter-ventricular artery in the posterior inter-ventricular sulcus of each hearts. Results: Among 75 heart specimens, 46 showed right predominance, 18 showed left predominance and 11 showed balanced type of heart. Conclusion: According to this study, the right coronary artery is the predominant artery in majority of the cases in the cadaver of North Karnataka origin. So these people are less likely to be affected by the cardiac problems. This study might help cardiologists and radiologists for the better understanding and management of cardiac diseases.

Aim: To analyze the clinical and laboratory features of multiple myeloma (MM). Settings and Design: A cross-sectional study of 20 newly diagnosed patients with MM over a period of 1 year in a tertiary health-care center. Materials and Methods: Based on Salmon-Durie criteria, newly diagnosed 20 patients of MM were selected for the study. Routine hematological and biochemical investigations, bone marrow examination, serum protein electrophoresis and urine for Bence Jones protein were done. Radiological investigations conducted to look for osteolytic lesions, extramedullary involvement and other pathologies. Results: Out of total 20 patients, 10 were males and 10 were females with sixth decade as the common age group at presentation. Common clinical symptoms were bone pains, localized body swelling, fever, generalized weakness and fatigue and motor weakness of lower limbs. Clinical examination revealed pallor in 80% patients, bony tenderness in 85% patients and 55% patients presented with infections. All patients had a presence of M band on serum protein electrophoresis, whereas 30% patients had urinary Bonce Jones protein positive. Among skeletal system spine and skull were the common sites of involvement 60% and 55%, respectively. Nearly, 85% patients had osteolytic lesions. Conclusions: Among 20 patients; various clinical presentations observed were infections, renal impairment, paraplegia and extramedullary plasmacytosis in addition to anemia and bony pains.

Staphylococcal scalded skin syndrome (SSSS) is a toxin-mediated exfoliating skin condition predominated by desquamation and blistering. Retrospective analysis of cases between 2010 and 2012, over a period of 2 years identified eight cases with SSSS. All cases identified were under 1 year of age. Erythema and exfoliative lesions were the initial symptoms followed by fever. Blood culture was positive for Staphylococcal aureus in 25% cases and pus culture positive in 37%. No methicillin-resistant S. aureus were found and all responded to common antibiotics. Due to early identification and antibiotic treatment, all the cases recovered completely.

Malignant melanoma or melanocarcinoma arising from melanocytes is one of the most rapidly spreading malignant tumor of the skin can occur at all ages, but is a rare before puberty. Malignant melanoma is relatively common neoplasm that not long ago was considered almost uniformly deadly. The great preponderance of melanomas arises in the skin; other sites of origin include the oral and anogenital mucosal surfaces, esophagus, meninges and notably the eye. Breast is a very uncommon site for malignant melanoma; here, we present a case of malignant melanoma of male breast with nodal metastasis.

Distant metastasis of renal cell carcinoma (RCC) to the sartorius muscle is extremely rare, particularly as an initial presentation. In the present study, we report a rare case of sartorius muscle metastasis from RCC as an initial presentation in a 48-year-old male who presented with a hard painless lump in the right thigh region. Investigation revealed RCC in the right kidney. A radical nephrectomy with wide excision of metastasis was performed. Unusual features on MRI helped in suspecting and further evaluating the metastatic RCC.

Bardet - Biedl syndrome (BBS) is a rare autosomal recessive disorder, characterized by central obesity, retinal pigmentation, polydactyly, mental retardation, hypogonadism, and renal dysfunction. Other features may include deafness, diabetes mellitus, genitourinary abnormalities, short stature, hormonal abnormalities, developmental defects, and speech problems. We report a case of BBS who presented with night blindness, marked central obesity, polydactyly, syndactyly, hypogonadism, micropenis, and behavioral problems, along with a brief review of the literature.

Anti-neutrophil cytoplasmic antibodies (ANCA) associated vasculitis is the most common primary systemic small-vessel vasculitis occurring in adults. Although the etiology is not always known, the incidence of vasculitis is increasing, with a variability of clinical expression. We are reporting a case of un-specified small vessel vasculitis, which was diagnosed on the basis of positive perinuclear anti neutrophil cytoplasmic antibodies (ANCA) P MPO done by Enzyme Linked Immunosorbent Assay (ELISA).

Secretory carcinoma (SC) is one of the least common types of breast carcinoma. The tumor has distinctive histologic features with prominent secretory activity similar to lactational change and minimal nuclear atypia. As the cytomorphologic features of SC overlaps benign breast lesions with lactational change and apocrine change, the initial diagnosis of SC may be missed on cytology in some cases. A 29-year-old woman presented with a lump in the left breast since 9 months. The fine needle aspiration cytology (FNAC) suggested proliferative breast disease without atypia. Excision biopsy showed secretory carcinoma. The case is presented to highlight the cytologic features of SC, which may overlap with lactational change and apocrine change.

Supraorbital neuralgia is one of the rare types of neuralgias where there is persistent pain in the supraorbital region and forehead with occasional sudden shocklike paresthesia in the distribution of the supraorbital nerve. The primary treatment is identification and removal of anything causing compression over the supraorbital nerve. A brief trial of simple analgesics alone or in combination with gabapentin should be considered for patients who do not respond to the above-mentioned treatments. Supraorbital nerve block using local anesthetics and steroids is the next step.

Giant cell tumor of tendon sheath arises from the synovium of tendon sheaths, joints, or bursae, mostly affects adults between 30 and 50 years of age, and is slightly more common in females. We report the case of a 32-years-old male presenting with pain in both ankles without any history of trauma. On clinical examination, tenderness on both tendoachilles and local thickening were observed. Ultrasonography showed thickening of local tendinous area with increase in anteroposterior diameter, and Doppler demonstrated increased flow in peritendinous area. MRI findings showed that most of the tumor had intermediate signal intensity and portions of the tumor had low signal intensity. Fine needle aspiration cytology confirmed the diagnosis of giant cell tumor of tendon sheath. Excision biopsy was done with no recurrence on five month follow-up. Review of literature did not reveal any similar result; so, bilateral giant cell tumor of tendon sheath of tendoachilles is a rare presentation.

Pleural effusion can occur due to a variety of causes such as infectious, neoplastic, inflammatory, autoimmune, traumatic, etc. Recurrent pleural effusions have always been a diagnostic challenge. Here, we present a case of recurrent exudative pleural effusion in a male patient, which was the first clinical manifestation of rheumatoid arthritis. Of note was the absence of articular involvement at the onset of the disease. The low glucose concentration, low pH and low C4 level in the pleural fluid were the most valuable findings to distinguish it from tuberculous and malignant pleural effusions. Pleural biopsy also helped in making such a distinction. Thus, in a patient with recurrent pleural effusion, rheumatoid etiology should also be kept in mind as a differential diagnosis.

Isolated cortical vein thrombosis is quite less common than dural venous sinus thrombosis. Its diagnosis is difficult and needs high index of suspicion clinically and on magnetic resonance imaging (MRI). A 38-year-old man presented with the history of three episodes of generalized seizures and weakness and sensory loss in the both upper limbs with headache. MRI brain with magnetic resonance venography (MRV) was performed. MRI brain showed hemorrhagic infarcts in bilateral frontoparietal region. Gradient echo sequence showed hypo-intense signal within thrombosed cortical veins. MRV showed paucity of cortical veins in involved areas suggestive of cortical vein thrombosis.

Among the many infective causes of cerebral venous thrombosis (CVT), viral hepatitis is been regarded as a rare associated condition. We report on a 46-years-old man presenting CVT associated with hepatitis B infection. Hepatitis C being a rare cause of CVT is well documented in the literature. There is also mention of association of hepatitis B being associated with CVT to the best of our knowledge. Both these conditions are hypothesized as thrombogenic agents in the available literature, and further research is required to confirm the same. We suggest that virus B serology should be performed in the cases of cerebral venous thrombosis with unknown etiology.

Submitral aneurysm (SMA) is a rare congenital out-pouching of left ventricular wall, invariably occurring adjacent to the posterior leaflet of mitral valve. We describe a patient who had rare co existence of SMA, rheumatic heart disease and HIV infection. Our patient presented with acute rheumatic fever in acute decompensated heart failure (ADHF) profile B. Patient was also detected to be having HIV infection. On echocardiography submitral left ventricular aneurysm posteriorely below the posterior mitral leaflet (PML) was detected.

Hereditary spherocytosis (HS) is a familial hemolytic disorder with marked heterogeneity of clinical features, ranging from an asymptomatic condition to a fulminant hemolytic anemia. In severe cases, the disorder may present in early childhood, but in some cases it may go unnoticed until later in adult life. We present a 32-year-old male who presented with anemia, jaundice, splenomegaly, and gallstones. Seven of his family members had similar illness in the past. The Mother died of similar illness at the age of 40. The Blood film showed spherocytosis and reticulocytosis. There was increased osmotic fragility and a negative direct coomb's test. He was given folic acid supplements and was advised for splenectomy and cholecystectomy. This case is reported due to its rarity in Indian population.

Friedlander's bacillus (Klebsiella pneumoniae) is among the most common Gram-negative bacteria encountered by physicians world-wide. Here, we report 31 years immunocompetent male who presented with fever, productive cough, hemoptysis, breathlessness and multi-organ failure with radiological evidence of total right upper lobe consolidation. Sputum microscopy, culture and blood culture - all confirmed Friedlander's bacillus as the etiology of this severe community acquired pneumonia with fatal outcome.

Mild trismus after parotid gland surgery may be related to inflammation and fibrosis of the masseter muscle. We present a case of long standing trismus due to masseter muscle spasm caused by a recurrent pleomorphic adenoma. As the patient did not agree for removal of the pleomaorphic adenoma, owing to the risk of injuring the facial nerve, a masseter myotomy with inter-positioning of temporalis fascia was planned for symptomatic relief. Mouth opening showed significant improvement even 1 year post-operatively.

The vertebral artery (VA) generally arises from the first part of the subclavian artery on both sides. Multiple variations in the origin of the VA have been reported in the literature, the most common being directly from the arch of aorta, as a branch of the thyrocervical trunk or as a branch of the common carotid or external carotid artery. During routine dissection of the head and neck region in a 65-year-old male cadaver at the Padmashree Dr. D.Y. Patil Medical College, Pimpri, Pune, variation in the origin of the left VA was found. The right VA originated from the superior aspect of the first part of the subclavian artery while the left VA originated directly from the arch of aorta between the left common carotid artery and the left subclavian artery. The left VA varied in its origin topography. It was longer and narrower as compared with the right VA.

Circumcision is an age-long tradition in Africa. Both sexes are often circumcised; however, female circumcision has significantly reduced in some African societies while the practice of male circumcision still continues. Be that as it may, there are documented health benefits of male circumcision such as less risk of urinary tract infection, penile cancer, and transmission of human papilloma viral infection; however, if poorly done it may have severe complications such as bleeding, penile infections (tetanus) and abscess, and penile amputation. Circumcision is commonly done by traditional barbers in many African communities where health facilities are scares; therefore, if their practices are not regulated and improved the risk of complication is heightened. Though complications may set in following circumcision in hospital especially where proper patient preparation and infection control measures are not put in place. Penile abscess may occur in sickle cell anemic patients following priapism or its medical intervention; this may be due to haematogeneous bacterial seeding of necrotic penile tissues or direct inoculation following therapeutic intervention such as intracorporeal injection. However, a 6-year-old sickle cell anemic boy diagnosed with vaso-occlusive crisis but later noticed to have penile abscess following circumcision done in a hospital is reported.

Sentinel lymph node (SLN) biopsy has become increasingly accepted as a minimally invasive alternative to level I/II axillary dissection for the staging of breast cancer. We present a case of a patient with breast cancer with clinically negative axillary node and histologically negative sentinel biopsy. Intraoperatively, she had highly suspicious palpable level I and II axillary nodes though the sentinel biopsy wound, of which 9 out of 11 nodes removed were positive for malignancy.

Sebaceous carcinoma, an uncommon cutaneous tumor first described by Allaire in 1891. This arises mostly from sebaceous glands in the skin and thus may arise anywhere in the body where these glands exist. Approximately, 75% of these tumors arise in the periocular region, which is rich in sebaceous glands. Fewer than 120 cases of sebaceous cell carcinoma have been reported at the extraocular sites as in our case.

Kearns-Sayre syndrome (KSS) is a rare neuromuscular disorder. We report a case of a 14-year-old boy diagnosed and treated as myasthenia gravis for (4) years who was eventually diagnosed with KSS. He reported to us 3 years after initial presentation of mild drooping of eyelids with increased severity of ptosis, bilateral external ophthalmoplegia, and atypical retinitis pigmentosa. On multispecialty consultation, he was found to have right bundle branch block, wasting and weakness of limb muscles, and hearing loss. Sartorius muscle biopsy revealed ragged red fibres on trichrome stain. All these findings confirmed the diagnosis of Kearns-Sayre Syndrome (KSS). The take home message is to have a high index of suspicion for KSS when encountering cases of musculoskeletal disorders in subjects below 20 years of age in view of high morbidity and mortality associated with this syndrome.

Catatonic syndrome carries relatively high mortality. One of the causes of death is pulmonary embolism. Prolonged immobility, dehydration, use of low-potency antipsychotic drugs, and electroconvulsive therapy (ECT) increase the risk of venous thromboembolism. Evaluating the risk of catatonic patients is of paramount importance. Prevention of venous thromboembolism by reducing the risk factors and relieving catatonic symptoms early is essential.