Asthma is common, affecting around 500 billion people worldwide. It is a complex disease influenced by both genetic and environmental factors. Upper respiratory tract infections with viruses commonly precipitate severe and sustained asthma exacerbations (AEs). Exacerbations are responsible for the enormous amount of emotional and economic stress apart from imposing risk of hospitalization and even death. Hence, agents targeting these infections can contribute toward decreasing asthma morbidity and associated financial burden. Over the past years novel, pharmacological therapies are evolved for the treatment of asthma, but their exact role in exacerbations is still unclear. This article reviews the role of respiratory viral infections in AEs and discusses role of new therapeutic approaches to overcome it. Medline, Medscape, EMBASE, Cochrane database, Scopus and clinicaltrials.gov were searched using terms such as "asthma," "AE" and "viral respiratory infections." Journal articles published from 2000 to 2013 describing AEs were screened.

Background: Psychological disorders can have a direct impact on family functioning. Family dysfunction is an indirect factor leading to the relapse of psychological disorders. Literature on family dysfunction in anxiety disorder is limited. Role of family and its functioning in obsessive-compulsive disorder (OCD) may help in better understanding of the role of social factors in OCD. Aim: The aim was to compare family functions in patients with OCD and compare with controls. Materials and Methods: The sample included 30 cases and 30 age and sex-matched controls. The patients were diagnosed as having OCD using ICD-10 DCR criteria. Yale-Brown Obsessive Compulsive Scale was used to assess the severity of OCD among patients. General Health Questionnaire was used as screening instruments for psychiatric disorder among the control population. Family function was assessed in cases and control using the Family Interaction Patterns Schedule (FIPS). Statistical analysis was performed using SPSS software. Results: Obsessive compulsive disorder patients in comparison controls had significantly increased total FIPS score (P = 0.001). Conclusion: Families with OCD are more significantly impaired in multiple domains of family dynamics than families without member suffering from OCD. It is, therefore, essential that family-based structure effective assessment be sought in the psychosocial management of OCD.

Background: A fever is a temporary increase in the body temperature, indicating that something out of the ordinary is going on in the body. Fever is a common sign of changes in the body of patients and a common cause of hospital visits, especially for children. Occurrence of fever in most cases is due to self-limiting viral infection or serious bacterial or other microbial infections. Aim: The study is aimed at assessing the current level of knowledge and attitudes of Jos residents about what fever is all about, its treatment and prevention. Materials and Methods: The study was cross-sectional in design, which involved a two-stage cluster random sampling procedure. Jos is divided into districts and in each districts, the area was broken down to sub-districts from which three zones where selected; based on population within the selected zones, households were randomly numbered and houses assigned odd number were identified. A semi-structured interviewer questionnaire was then administered to the respondents and the finally filled questionnaires were then retrieved and analyzed using the SPSS version 20.0 software programmer. Result: Out of the 400 respondents, 66.5% falls within the age range of 21-49 years with females constituting 56.5% of the study population. Educationally, 45.9% of the respondents had completed secondary schools while 39.6% had bachelor degree. 67.2% of the respondents agreed that malaria was the common conditions that come with fever, followed by typhoid fever (19%). 26.5% of the respondents agreed that personal preventive/environmental hygiene remain the mainstay when it comes to fever prevention, with 26.5% also believing that the use of pesticides/rodenticides was another preventive measure, whereas 20.6% agreed that chemoprophylaxis was another option. Conclusion: The study showed that the residence of Jos had good knowledge of conditions that are associated with fever and its management, which might be due to the literacy levels of the study population; there is still need to improve their knowledge on the other conditions that comes with fever and their preventive measures.

Background: The length of the papilla is usually measured by bone probing under local anesthesia, might cause discomfort to the patients and possibly damage the delicate gingival unit. The purpose of this study was performed to assess the topography of the interdental papilla in different age groups by ultrasound. Materials and Methods: A total of 90 subjects in the age group of 15-40 years were randomly selected. In this study, the measurement of length, width and thickness of the interdental papilla of maxillary and mandibular central incisors were measured by ultrasound. Results: The length of the interdental papilla in maxillary and mandibular central incisors in all the three groups was found to statistically nonsignificant. The width and thickness of the interdental papilla in between maxillary central incisors was found to be more than mandibular interdental papilla. Analysis of variance shows that difference in length and width of interdental papilla in maxillary and mandibular central incisors in the three groups was statistically nonsignificant and the difference in thickness of interdental papilla in maxillary central incisors in the three groups was statistically significant and in mandibular central incisors was not significant. Conclusion: The finding of this study indicates that the length, width and thickness of the interdental papilla does not change with age. Ultrasound procedure is a promising and accurate method for the determination of the interdental papilla noninvasively, reproducibly and avoid radiation hazards.

Aims: The aim was to determine the prevalence of retinal changes in pregnancy-induced hypertension (PIH) and any association between the retinal changes and age, parity, blood pressure, proteinuria, and severity of the disease. Settings and Design: Hospital-based cross-sectional study. Materials and Methods: All the patients admitted with a diagnosis of PIH were included in this study. Age, gravida, gestation period, blood pressure, and proteinuria were noted from the case records. Fundus examination was done with a direct ophthalmoscope. The findings were noted and were analyzed using SPSS program. Results: A total of 150 patients of PIH were examined. The mean age of patients was 25.1 years. The gestation period ranged from 27 weeks to 42 weeks; 76 (50.67%) were the primi gravida. 92 (61.33%) patients had gestational hypertension, 49 (32.67%) patients had preeclampsia, and 9 (6%) had eclampsia. Retinal changes (hypertensive retinopathy) were noted in 18 (12%) patients - Grade 1 in 12 (8%) and Grade 2 in 6 (4%). Hemorrhages or exudates or retinal detachment were not seen in any patient. There was statistically significant positive association of retinal changes and blood pressure (P = 0.037), proteinuria (P = 0.0005), and severity of the PIH (P = 0.004). Conclusions: Retinal changes were seen in 12% of patients with PIH. Occurrence of hypertensive retinopathy in PIH cases has been decreased due to better antenatal care and early detection and treatment of PIH cases. There is a greater chance of developing retinopathy with increase in blood pressure, severity of PIH, and proteinuria in cases of PIH.

Context: Sutures or fibrin glue have been used to fix a conjunctival graft after pterygium excision. A new surgical technique of using patient's own blood to affix the conjunctival graft after excision of pterygium has been introduced. This technique is safe, economical and reduces complications related to the use of foreign materials. Aim: The aim was to evaluate the surgical technique of a sutureless and glue-free graft for pterygium surgery in terms of complications such as loss of graft, graft dehiscence, and recurrence. Materials and Methods: This was a prospective interventional study. All patients that came to the outpatients department from July 2012 to December 2012 were included in the study. Pterygium excision with conjunctivolimbal autografting without using suture or glue was carried out in all patients. Patients were followed-up postoperatively up to 6 months. They were examined mainly for postoperative complications. Results: A total of 79 eyes of 74 patients underwent suture less glue-free autologous conjunctivolimbal graft after pterygium excision. There were 53 female (mean age-46.85 years standard deviation (SD) 10.59) and 26 male (mean age-45.04 years SD 17.27) patients. There were 77 cases of primary pterygium and two cases of recurrent pterygium. Medial edge recession of the graft was seen in one case (1.2%), whereas two cases (2.5%) had lost graft on the first postoperative day. There were no recurrences at the end of 6 months. Conclusion: The surgical technique of using a sutureless and glue-free conjunctivolimbal autograft is safe and cost-effective. However, this technique is associated with few complications such as medial edge recession and loss of graft.

Background: Time since death (TSD) is an important parameter to the forensic expert. Only a fewer studies are available in the literature to determine the relationship between vitreous K ⁺ concentration and TSD especially among injury (trauma) cases and thus information on the same is patchy and scanty. Objective: To determine the relationship between changes in vitreous K ⁺ concentration with increasing TSD among injury (trauma) cases. An additional objective was to derive a formula for determining TSD from changes in levels of vitreous K ⁺ in the study subjects. Materials and Methods: In this study, autopsy cases brought to the mortuary of Department of Forensic Medicine and Toxicology of a tertiary care center, were the subjected for collection of vitreous humor for determination of vitreous potassium. Data of 55 such cases where autopsy confirmed the cause of death as injury (trauma), were included in this study. Determination of potassium level in the collected sample was done using ion-selective electrode method (Biolyte 2000 auto analyzer). Results: A linear relationship was observed between vitreous potassium concentration and TSD in both the eyes. External factors like seasonal variations and temperature, gender difference and age had no appreciable effect on the concentration of vitreous potassium in either eye. In this study, the linear regression equations obtained from potassium concentration (y) verses time (x) for the two groups among injury (trauma) cases were as follows: For right eye: Regression line (y) = −5.040 (x) = +1.989, for left eye: Regression line (y) = −5.223 (x) = +2.005. The potassium levels are found to increase up to 40 h after death. Conclusion: The study highlighted the usefulness of relationship between vitreous potassium concentration and TSD in both the eyes. The formula calculated from the current study could prove to be more appropriate as it is based on a more recent study and more reliable tests.

Introduction: Colles' fractures continue to be one of the most common skeletal injuries of middle aged and elderly population. Compressive neuropathy is one of the most important complications of Colles' fractures and usually involves the median nerve. The objective of our study was to investigate the impact of malunion of Colles' fracture on the anatomy and dimensions of the carpal tunnel and the median nerve. Materials and Methods: Fifty cases of Colles' fracture were included in this study, which was conducted for a period of 2 years. Radiographic and ultrasonographic evaluation was done in all patients. Nerve conduction studies were done in four patients diagnosed with carpal tunnel syndrome (CTS). Results: From our study, it was seen that there was a significant decrease in the dimensions of the carpal tunnel and median nerve in Colles' fracture based on ultrasonographic evaluation and the loss of radial length and volar shift were the two parameters significant in patients suffering from a CTS, based on radiographic evaluation. There was also an increase in the motor and sensory nerve conduction latency on nerve conduction studies of the median nerve. Conclusion: The loss of radial length and presence of a volar shift of the distal radius are the two deformities when left uncorrected may predispose to a CTS.

Aim: The aim was to determine the incidence of discordant HIV infection in pregnant women and their husbands in late 1990s. Study Design: Retrospective analysis. Settings: Pediatric and perinatal HIV clinic from 1993 to 2000. Materials and Methods: All husbands of 729 HIV-infected pregnant women were tested for HIV. A husband was determined to be HIV negative if he had a negative HIV ELISA test at baseline and also 6 months later. Incidence of discordant couples was determined and analyzed to see whether there was an increasing trend of discordance over a period of years. Results: Forty-nine husbands (6.7%) were HIV negative. The probable causes of HIV in the lady were unknown in 38 couples (78%), through blood transfusion in 8 women (16%) and artificial insemination, surgery and 2 ^nd marriage in one woman each (2%). Incidence of discordance among the couples did not show an increasing trend (P = 0.34). Conclusion: Incidence of discordance among couples with HIV positive women and HIV negative husband did not show an increasing trend over a period of years, which may indirectly reflect the extra-marital situation.

Background: The i-gel is a novel supraglottic airway device, made up of medical grade thermoplastic elastomer. Its soft noninflatable cuff causes easier insertion, minimal tissue compression and stability after insertion. An integral gastric channel is provided for passage of gastric drainage tube to empty the stomach. Materials and Methods: We evaluated i-gel in sizes ranging from 1.5 to 2.5 in pediatric patients considered suitable for a supraglottic device. We assessed ease of insertion, insertion time, ease of insertion of gastric drain tube, adequacy of ventilation, oropharyngeal leak pressure and complications with the use of the device. Results: We studied the use of the i-gel in 120 anaesthetized children with a mean age 5.2 years and weight 16.96 kg to assess its safety and efficacy. First insertion attempt was successful in 94.11% of patients. The mean time to insertion was 9.5 s. Ease of insertion score of i-gel airway device was Grade I/Grade II/Grade III in 90.83%/8.33%/0.83% patients respectively. Ease of insertion score for gastric drainage tube through device was Grade I/Grade II in 99.16%/0.83% of patients. Mean oropharyngeal leak pressure was 20 cm of H ₂ O. Intraoperatively six patients required manipulation to improve the airway and two patients had minor complications in the postoperative period. Analysis of the difference among the three sizes of i-gel was performed using the Chi-square test, fisher's exact test and one-way ANOVA test. Statistical analysis revealed no significant difference in a number of insertion attempts, ease of insertion score for i-gel and gastric drainage tube, insertion time, intraoperative and postoperative complications among the various sizes of i-gel. Conclusion: The i-gel was inserted without complications, establishing a clear airway and enabling spontaneous and controlled ventilation in majority of patients. This device is easy to use and has low pharyngolaryngeal morbidity.

Introduction: Pseudomonas aeruginosa has acquired a new metallo-β-lactamase (MBL) resistance gene responsible for increased resistance to fluoroquinolones, cephalosporins and carbapenems. Thus, it is essential to know the antibiotic sensitivity pattern and follow the antibiotic policy. Objectives: The objective of this study is to detect MBL production in clinical isolates by combined imipenem-ethylenediamine tetra acetic acid (IMP-EDTA) disc test. Materials and Methods: This study was conducted for a period of nine months from April 2011 to December 2011. A total of 66 consecutive isolates of P. aeruginosa were subjected to susceptibility testing by disc diffusion assay. IMP drug resistant strains were screened for MBL production by combined IMP-EDTA disc test. Results: Ciprofloxacin resistance was seen in 66.6% isolates followed by piperacillin in 51.5%. Resistance toward amikacin, ceftazidime, and cefoperazone were noted in 43.9%, 40.9%, and 37.8% isolates, respectively. In 37.8%, IMP resistance was observed. All IMP resistant strains (n = 25) were screened for MBL production. All the 25 isolates (100%) were MBL producers, exhibiting more than 7 mm zone size enhancement in IMP-EDTA combined disc test. Conclusion: Emergence of P. aeruginosa as MBL producer is becoming a therapeutic challenge. There is a need to implement routine antibiotic surveillance and judicious use of antibiotics.

Dental agenesis is the most common developmental anomaly in humans, which can be either in the form of anodontia, oligodontia, or hypodontia. Oligodontia can occur either as an isolated finding or as part of a syndrome. Nonsyndromic oligodontia is rare. Management requires integrated multidisciplinary approach. Prompt intervention improves quality of life. Here, we report a case of isolated, nonsyndromic oligodontia in a 13-year-old female who allegedly had complete set of primary teeth but failed to develop complete permanent dentition. No other clinical feature, except oligodontia, was present that could suggest any syndromic association.

Schwannomas are rare tumors that arise from the Schwann sheath of nerves. They are commonly seen in the head and neck region and in both extremities. However, retroperitoneal schwannomas are a rare entity. We report a case of a 35-year-old female presenting with a lump in the right lumbar region. She had loss of sensations over the L3-L4 dermatomes. Computerized tomography of the abdomen and pelvis revealed a mass of size 7.1 cm 7.1 cm 8.3 cm posterior to the right psoas muscle extending superiorly to the lower pole of the right kidney with its anterior displacement. There was narrowing of the right L3-L4 neural foramina. The mass was completely excised. It was diagnosed as benign schwannoma on histopathology examination. Post-operatively, the patient had shown recovery. In a 1-year follow-up post resection, the patient has not shown any evidence of recurrence. Most of the schwannomas are benign and hence follow-up is necessary to detect and prevent recurrence.

A 20-year male college student, nonsmoker, nonalcoholic, average built presented with sudden onset cough since last 1 day along with diffuse swelling in the neck, difficulty in swallowing both liquids and solid since 1 day. There was history of rhinorrhea alternating with nasal block intermittently with change of seasons since last 3-4 years. There was no history of weight lifting, drug intake, tuberculosis or trauma, or family history of allergy. A case report of self-limiting spontaneous pneumomediastinum following a sudden bout of coughing with no underlying lung lesion is being reported.

Stomatocytes are erythrocytes with a central slit or mouth-shaped (stoma) area of central pallor when examined on dried smears. In wet preparations, they are uniconcave rather than biconcave, giving them a bowllike appearance. In vitro, stomatocytes are produced by drugs that intercalate into the inner half of the lipid bilayer, thereby expanding the inner lipid surface area relative to that of the outer half of the bilayer. Hereditary stomatocytosis (also known as hereditary hydrocytosis, or overhydrated stomatocytosis) refers to a heterogeneous group of autosomal dominant hemolytic anemias caused by altered sodium permeability of the red cell membrane. We present the first case report of hereditary stomatocytosis in a 10-year-old male from the valley of Kashmir. Only eight families with this condition have been described worldwide.

Coats disease is a congenital retinal vascular disease, which is seen commonly in childhood and remits and exacerbates throughout life. However, it is not rare for coats disease to present in adulthood for the first time. This has been referred to as adult onset coats disease. We do hereby present a rare case of adult onset coats disease in a 56-year-old male patient who presented with visual acuity of 20/200 in the left eye. Fundus findings typical of coats disease included telangiectasis, macular exudation and edema. Fluorescein angiography revealed peripheral capillary nonperfusion areas and telangiectasis. Optical coherence tomography showed cystoid macular edema. After the treatment with intravitreal injection of bevacizumab (1.25 mg in 0.05 ml) and sectoral panretinal photocoagulation to the area of capillary nonperfusion the macular edema was reduced by 100 microns, which translated to a visual acuity of 20/80, proving the point that the prognosis in these cases is not as grave as in classical coats disease.

Tracheo-esophageal fistula (TEF) without associated esophageal atresia or H-type fistula is a rare congenital anomaly. H-type fistula is usually missed in the neonatal period as the presenting symptoms are either of recurrent pneumonia or gastro-esophageal reflux which always lead to delay in diagnosis and infant undergoes unnecessary treatment. We report a case of H-type of TEF, diagnosed within 12 days of birth based upon choking and cyanosis on the first trial of spoon feeds. Diagnosis was confirmed with contrast esophagogram. The infant was operated for it and was successfully discharged.

Ureterorenoscopy is very effective treatment of upper urinary tract pathologies such as stones, ureteral strictures, ureteropelvic obstruction, and upper urinary tract carcinomas. The incidence of ureterorenoscopy' complications has been decreased because of significant technological advancement and worldwide use of ureterorenoscopy. The complication rate of ureterorenoscopy is <5%. Most complications are classified as minor which require observation. Major complications may require advanced procedures to prevent serious consequences. Subcapsular renal hematoma is a very rare complication after ureterorenoscopy procedures. Bansal et al. had reported this complication after ureterorenoscopy as a first. We presented a case of subcapsular renal hematoma after ureterorenoscopy procedure who was treated conservatively.

Craniosynostosis is a condition of premature intrauterine fusion of sutures causing abnormal skull shape, neurological abnormalities and increased intracranial pressure. It can occur as an isolated condition or may be part of a syndrome. The key to treating an infant with craniosynostosis is early diagnosis and accurate treatment as untreated craniosynostosis can affect mental development and visual abnormalities which are linked to raised intracranial pressure. In this case, we describe the anesthetic management of a 13-month-old baby, a case of nonsyndromic craniosynostosis involving sagittal, metopic and coronal sutures posted for strip craniectomies.

We report a case of brucellosis in a patient infected with the human immunodeficiency virus (HIV), who came to seek medical care at a tertiary care center in rural Uttar Pradesh. A 26-year-old male patient, milk salesperson by occupation who also used to rear his cattle as a routine, presented with complaints of longstanding fever accompanied with vomiting, giddiness, myalgia, and headache. No significant abnormality was detected on routine physical and laboratory investigations except reactive HIV antibodies. It was decided to conduct the serological tests for the evidence of brucellosis as clinical symptoms continued to persist. He had high titers of Brucella agglutinin, and responded to treatment with tetracycline and streptomycin. The isolates were confirmed at Indian Veterinary Research Institute, Izatnagar.

Paraquat (1, 1'-dimethyl-4, 4'-dipyridylium) is a bipyridilium herbicide used widely in our country and is a highly toxic compound. This compound is very notorious to cause rapid development of renal, liver, and respiratory failure with very high mortality due to lack of specific antidote and dearth of high-quality evidence-based treatment. Respiratory system involvement is the most common cause of death in these people. We hereby report a fatal case of a 30-year-old male with a history of paraquat consumption. The patient developed oliguric renal failure, deterioration of liver function, and acute respiratory distress syndrome over next few days. Different treatment modalities were tried to manage patient's condition. In this case, none of the strategies worked well, and death ensued due to multi-organ dysfunction syndrome.

Foreign body (FB) in esophagus is not a very rare entity. The main risks are to the children under 3 years of age. In this age group, the second molars have not yet developed, the child's grinding and swallowing mechanisms are poor, and glottis closure is immature. Some patients at risk for FB ingestion may not be able to give an accurate medical history of ingestion, either due to age or mental illness. Coins are the most commonly ingested FBs, with button batteries, fish bone, marble, stone, and pieces of meat, etc., being other forms of ingested FB. In the majority of cases, it is accidental in nature, but can be occasionally homicidal, as was probably in one of our patients. Patient can be asymptomatic or can present with dysphagia, drooling of saliva, FB sensation, vomiting or pain. Patients with long-standing esophageal FBs may present with weight loss, aspiration pneumonia, fever, or signs and symptoms of esophageal perforation including crepitus, pneumomediastinum, or gastrointestinal bleeding. Here, we present four case reports of unusual presentation of FB in esophagus that were successfully removed by rigid esophagoscopy without any complication

Foreign body ingestion is a common problem in children, coin being the usual offender in most of the cases. In the majority of the times, they pass through the esophagus without any complication. It is rare to have complications such as perioesphagitis, peri esophageal abscess, vascular fistula or carotid rupture and still rare to have the condition silent for 20 long years and presenting with acute symptoms. We report a case of retained esophageal foreign body presenting as recent onset dysphagia and mediastinal widening.

Diffuse esophageal leiomyomatosis is a rare hamartomatous disorder characterized by proliferation of smooth muscle cells in the esophageal wall causing circumferential thickening. Its incidence is essentially unknown with very few documented cases. It usually occurs in young adults and is found to be associated with Alport's syndrome. Here, we report this unusual entity in a 22-year-old female presenting with slowly progressive dysphagia with immunopathological study and brief review of the literature.

Takayasu's arteritis is a large vessel vasculitis in which the inflammatory process involves aorta and major branches. The cause is largely unknown. Dilated cardiomyopathy (DCM) is, however, reported to be seen in only 5-6% of cases of Takayasu arteritis. We report a rare case of DCM with renovascular hypertension secondary to Takayasu's arteritis.

We present a case of 32-year-old female patient with rheumatic mitral stenosis with sinus venosus atrial septal defect (ASD) and anomalous drainage of the right superior pulmonary vein into right atrium. Sinus venosus ASD are uncommon and constitute 2-3% of interatrial communication. However, sinus venosus ASD with mitral stenosis is an extremely rare condition which was treated successfully by patch closure with left atrialization of superior pulmonary vein and mitral valve replacement.

Brain abscess is a very rare form of central nervous system tuberculosis. It is particularly uncommon in immunocompetant individuals. Tubercular brain abscess along with liver abscess is a rare phenomenon especially in an immunocompetent patient. We hereby report this rare presentation in a young immunocompetant male patient. Recognizing this rare clinical entity early is essential, as timely institution of antitubercular therapy can save the life.

Incidence of malaria across the globe has constantly been on a rise, especially the tropics. Hence, it is of utmost importance to know its clinical presentation and complications including rare ones and treat them at the earliest. Spleen is a major organ affected by plasmodium. The changes in spleen because of malaria can range from asymptomatic enlargement to complications, such as splenic infarct, rupture, hemoperitoneum, hypersplenism, torsion, cyst, or abscess formation all of which are life-threatening if not treated. Splenic abscess due to any cause is a serious complication due to high-incidence of morbidity and mortality associated with it. Spleen abscess as a complication of malaria has been rarely described in the literature. We present to you a rare case of splenic abscess due to vivax species of plasmodium which was successfully treated conservatively.

Tuberous sclerosis complex (TSC) is a rare autosomal dominant disease. The prevalence of TSC is estimated to be 1 in 95,136 in general population and in those <6 years of age, it is 1 in 14,608. It is an autosomal dominant neurocutaenous disease and in about 80% of cases it is caused by a de novo mutation. The relationship between cardiac rhabdomyomas and TSC is well established. The cardiac rhabdomyomas may arise anywhere in the myocardium but are more commonly seen in the left ventricle. However, in our case an interventricular septal rhabdomyoma was seen. Angiomyolipomas (AMLs) occur in up to 80% of patients with TSC. Bilateral renal AMLs were seen in our case. There was evidence of systemic involvement in form of lymphangiomyomatosis and subependymal hamartomas.

Phyllodes tumors (PTs) with extensive squamous metaplasia is an uncommon biphasic fibroepithelial neoplasms of breast, comprising of <1% of all breast neoplasm's. In this article, we report a case of a 55-year-old female patient admitted to the General Surgery Department with a rapidly enlarging, palpable mass in right breast. After histopathological examination, it was diagnosed to be as benign PT with extensive squamous metaplasia. Metaplastic changes are known, but infrequent in these tumors. Extensive squamous metaplasia within PT is rare and may occur in benign, borderline and malignant subtypes. There are only a few cases reported in the literature. We therefore, aimed to present this case in view of its extremely rare nature.

Mixed germ cell tumors (GCTs) are aggressive tumors owing to poor response to therapy, frequent recurrence and metastasis. We present here a case of 29-year-old male with recurrent metastatic mixed GCT in the left parietal lobe, with right testicular primary. Interestingly, the recurrent tumor exhibited a seminomatous component, in addition to yolk sac tumor and embryonal carcinoma. The patient was treated with surgery, cranial radiotherapy and cisplatin-based chemotherapy. The metastatic intracranial tumor recurred twice and the patient died 18 months after the first appearance of central nervous system metastasis.

Head injury is considered one of the single most important causes of subdural hematoma. Other cause include bleeding diasthesis. We report here a case of 70-year-old female patient with chronic myeloid leukemia (CML) presenting with bilateral chronic subdural hematoma after an incremental high-dose of imatinib mesylate (IM) due to loss of complete molecular response. IM is useful to treat a wide range of diseases, including Philadelphia chromosome-positive CML, as it has high tolerability and low incidence of minor side effects. Hemorrhage is a rare complication of IM. IM is associated with reduced α2-plasmin inhibitor and platelet dysfunction. This case report emphasizes on the need to consider chronic subdural hematoma as atypical cause of headache in a patient of CML taking high-dose IM.