Psychiatric co-morbidities are commonly seen with pediatric epilepsy, which can be in the form of cognitive deficits like - inattention and intellectual disability, motor disturbances like - hyperactivity, emotional disturbances like - depression and anxiety disorders and behavioral problems like - impulsivity, aggression and even psychotic behavior. Anxiety disorders like - Obsessive compulsive disorder, posttraumatic stress disorder, social phobia, separation anxiety disorder, agoraphobia and panic attacks are commonly seen with pediatric epilepsy. Presence of co-morbid anxiety disorder in pediatric epilepsy is responsible for scholastic decline, peer maladjustment and poor quality of life. Management of anxiety disorders in children with epilepsy is always a challenge. Until, there is no general consensus regarding management of anxiety disorders in pediatric epilepsy. Despite its enormous impact on an individual's life, this area has not been addressed adequately through clinical research. This review focuses on psychiatric aspects of pediatric epilepsy with specific emphasis on anxiety disorders.

Background: Medical colleges in India usually follow a traditional curriculum, characterized by "discipline wise model" which compelled Medical Council of India to recommend a teaching approach characterized by maximal efforts to encourage integrated teaching (IT) between traditional subject areas. Objectives: To assess the feasibility of IT; to compare IT with traditional teaching (TT) and to analyze the student's feedback and faculty feedback about perception of IT. Materials and Methods: An interventional study was conducted among fifth semester students using pre- and post-test questionnaire and student and faculty feedback forms. Students were divided randomly into two groups. IT was introduced to Group I on the topic of tuberculosis (TB) by faculties of different disciplines; using methods of didactic lectures, seminars, role play, clinical case presentation, demonstration of Ziehl-Neelsen stain, Bacillus Calmette-Guerin vaccination and visit to Directly Observed Treatment Centre. Group II were exposed to TT on TB by faculties of Community Medicine using method of didactic lectures. Paired and un-paired t-test and effect size were used as statistical tests. Results : Statistically significant results were obtained using pre- and post-test questionnaire of IT. Similarly, statistically significant results were obtained using posttest results of IT and TT. Effect size that is: Cohen's d and Pearson correlation revealed large effect which indicates high influence on student achievement. The students and faculty showed a positive attitude about IT. Conclusion: The introduction of IT was found to be feasible and to be more effective and acceptable than TT.

Background: Though the fight against malaria continued to be on the increased, the disease still remains a major public health problem in many developing countries, especially in the rural areas. The extent of drug use and its effect is affected among other things by the pattern in which these drugs are prescribed by the health workers. Patients' assessment of the quality of care depends on their ability to judge whether health care providers are adhering to the defined standard of care, hence it is necessary to assess the views of patients regarding the quality of care they received from the primary health care (PHC) centers. Aim: This study aimed at evaluating consumer's perception of the quality of malaria treatment in PHC centers of Jos and environs. Materials and Methods: Nine PHC centers were selected by multi-stage random sampling, five from Jos North and four from Jos South Local Government Areas of Plateau State. Patients of both sexes within the age range of 18 years and above who visited the PHC centers for malaria treatment were considered eligible to participate in the survey, provided that they were able to understand and respond to the interview questions. A semi-structured interviewer questionnaire which was adapted from previous health survey studies was administered to all the 249 eligible participants. The data collected were analyzed using the Statistical Package for Social Sciences (SPSS) version 20.0 software programmer. Results: The result showed that there were no consistently significant differences (P > 0.05) regarding patient satisfaction between male and female patients across selected items in the various domains, that is, irrespective of respondents' sex, their perception of the quality of health services rendered by PHCs was similar. Conclusion: It was therefore concluded that there was similar satisfaction level between the male and the female, though some key health services were not readily available in the PHC; most services that were available were readily accessible.

Background: Histological subtypes of lung carcinoma vary between gender and age groups. Younger age group has more predilections for adenocarcinoma (ACC) while squamous cell carcinoma (SCC) is more common in older age group. Gender wise, ACC is more frequent among females as compare to males. Aim: Present study analysed the distribution of histological subtypes among different age groups (younger vs. older) and gender (male vs. females) to find out predominance of any particular subtype or a specific pattern relating to age and gender in Indian population. Materials and Methods: Data of 342 patients were retrospectively analysed in terms of age, gender and pathological diagnosis. The patients were grouped into two, younger age group (≤50 years) and older age group (>50 years). Results: There were 280 (81.87%) male and 62 (18.12%) female patients. Male:female ratio was 4:51. There were 134 patients (39.18%) in younger age group and 208 (60.81%) patients in older age group. Majority of the patients (272) were nonsmall cell lung carcinoma (NSCLC) (79.53%) while 70 patients had small cell lung carcinoma (20.46%). Out of 272 patients with NSCLC, 130 (38%), were SCC, 92 (26.90%) patients had ACC and rest 50 (14.61%) patients were of large cell lung carcinoma. No significant predilection for a particular histological subtype in younger and older age group was observed. In males SCC was the most common subtype (42.14%, P = 0.0014) and in females ACC was most frequent (48.38%, P = 0.0001). Conclusion: Squamous cell carcinoma in males, ACC in females and overall SCC is the most common histological subtype. No significant correlation with age was found.

Background: Immunofluorescence microscopy is a vital tool for the diagnosis of glomerular diseases. This study was carried out to study patterns of glomerulonephritis (GN) and to record the sensitivity of direct immunofluorescence (DIF) in renal lesions. The DIF findings were correlated with clinical and histopathology findings and discrepancies were analyzed. Materials and Methods: The cross-sectional analytical study was conducted during the period July 2011 to July 2013 at a tertiary care Hospital, Department of Pathology. A total of 75 renal biopsies were received for routine and immunofluorescence studies in which histopathology and clinical data were reviewed and analyzed. Results: The sensitivity of DIF was 87.9% and specificity was 70.5%. The maximum number of cases were seen in the age group 41-50 years. The pattern of GN by DIF was minimal change disease (MCD) in 24%, IgA nephropathy in 13%, focal segmental glomerulosclerosis in 9% and membranoproliferative glomerulonephritis in 8% of the cases. Twelve histopathologically proven cases of GN were negative on DIF. One case of MCD on histopathology was diagnosed as IgM nephropathy based on DIF. Conclusion: Direct immunofluorescence forms an important diagnostic tool in reaching the exact diagnosis in various types of GN presenting with overlapping clinical and histomorphological features.

Introduction: Neck dissection has been a well-established procedure used to eradicate metastases to the regional lymph nodes of the neck. Most of the complications are inevitable, and various efforts have been made to try and reduce complications by modifying the aggressive surgical procedure. A systematic review of 82 patients who underwent neck dissections has been done. The objective of this study is to report the various complications, complication rates in various neck dissection procedures and to seek improved patient care and outcome. Materials and Methods: A retrospective analysis of complications in 82 patients who underwent neck dissection from May 1, 2010 to December 31, 2013. Results: Out of 82 patients 16 (19.51%) experienced some complication and 7 (8.53%) patients had significant complications that required surgical revision. No major vessel rupture was observed. Conclusion: A careful preoperative assessment, meticulous surgical technique, high-quality postoperative care and appropriate rehabilitation are the cornerstones of preventing and managing complications.

Context: Safety of blood transfusion. Aims: The study was conducted to assess the overall prevalence of hepatitis B surface antigen (HBsAg) in blood donors (BDs), to know the gender differences in prevalence and to understand the implications. Settings and Design: Blood bank of a tertiary care hospital. Observational study. Materials and Methods: Data of 17,976 voluntary BDs who donated blood between January 2006 and December 2012 was evaluated. Fresh serum samples of all BDs were screened for HBsAg using HEPALISA (3 ^rd generation ELISA method, manufactured by J. Mitra & Co. Pvt. Ltd., New Delhi, India). Statistical Analysis Used: Statistical analysis was performed using the Chi-square test, df and P value. Results: Totally 17,976 BDs were studied, of which 16,972 (94.4%) were males and 1,004 (5.6%) were females. The male to female ratio was 16.8:1. Among HBsAg-positive BDs, 230 (98.7%) were males and 3(1.3%) were females. The HBsAg prevalence was - overall 1.3%, males - 1.3%, females - 0.29%. The difference in prevalence of HBsAg in males and females was statistically significant (χ² = 8.29, df = 1, P = −0.004). The rate of HBsAg positivity showed a slight decline over last 5 years. Conclusions: The study region has a low prevalence for HBsAg. Low prevalence in women makes them better donors; hence they could be encouraged to donate blood voluntarily. Increase in proportion of women in BDs can minimize transmission of hepatitis B virus by transfusion.

Introduction: Nasal polyps are defined as prolapsed lining of the nasal sinuses. They may be present as simple inflammatory polyps or neoplastic tumors and neoplastic tumors further divided in benign or malignant types. Objectives: This study was undertaken to note the various histopathological patterns of nasal masses, their classification and relative distribution of various lesions with regard to age and sex in our setting. Materials and Methods: in this study, 70 patients are selected who presented in our hospital with nasal masses and having multiple types of clinical presentations. Time period of study is 2 years. Results: Nonneoplastic nasal masses formed the largest group of lesions; 50 cases (71.43%), followed by 20 cases (28.57%) of neoplastic nasal masses, in neoplastic masses we found 14 benign and 6 malignant cases. Conclusion: Nasal obstruction and rhinorrhea are the most common symptoms of presentation, simple inflammatory nasal polyps are the most common histological pattern seen in our environment, and surgery is the best modality of treatment.

Introduction: Safest blood a patient can receive is his own. Quest for safe blood transfusion has remained of prime concern. To meet this aspiration, various forms of autologous blood transfusions can be practiced. It is especially suitable for patients with rare blood groups and religious sects such as Jehovah's witness autologous transfusion is extremely safe. Cross matching is not required; iso-immunization to a foreign body is excluded. Fear of transfusion transmissible disease can be ignored. Therefore, autologous blood transfusion is required to be revisited. Materials and Methods: This is a prospective study carried out at Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune between July 2010 and May 2012. Study comprised of 100 patients divided into two groups, autologous and homologous. Benefits of autologous transfusion were studied. Results: There was no significant change in hematocrit and blood parameters after blood donation. That is mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration (P < 0.001) after blood donation. Only one complication of vasovagal syncope was observed at the time of blood donation. Conclusion: Autologous blood transfusion is safe. Easy alternative to be practiced in elective surgeries, especially in patients with rare blood group or believers of Jehovah's witness faith. It helps to reduce the shortfall in national blood inventory. Autologous blood donation should be practiced whenever possible.

Context: Psoriasis affects about 1.5% to 3% of world's population. Other papulosquamous dermatoses are Pityriasis rosea, Lichen planus, Seborrheic dermatitis, Pityriasis rubra pilaris and Parapsoriasis. Drug eruptions, tinea corporis, and secondary syphilis may also have papulosquamous morphology. Because all papulosquamous disorders are characterized by scaling papules, clinical confusion may result during their diagnosis. Separation of each of these becomes important because the treatment and prognosis for each tends to be disease-specific. Aim: To study the pattern of clinical and histopathological features of psoriasis of the skin with clinicopathological correlation. Material and methods: The present study of 42 cases of psoriasis of the skin was carried out in the Department of Pathology of a tertiary care centre from December 2009 to October 2011. In this study, the patients which were clinically diagnosed as psoriasis of skin, before starting the treatment and attending the outdoor skin department were selected. Histopathological findings were interpreted in light of clinical details. Results: Out of 42 cases of psoriasis 24 (57.14%) were males, 18 (42.86%) were females with male to female ratio of 1.33:1. Mean age was 34.45 years. Maximum number of cases 22 (52.38%) were encountered in 3rd and 4th decade of life. Histopathological findings: parakeratosis, acanthosis, suprapapillary thinning, Munro microabscesses and hypogranulosis were noted in most of the cases. Conclusion: Histopathology serves as a diagnostic tool and rules out other lesions which mimic psoriasis. The most accurate diagnosis is the one that most closely correlates with clinical outcome and helps to direct the most appropriate clinical intervention.

Introduction: Schwannoma is a benign tumor that originates from the Schwann cells of the peripheral nerves. Schwannomas are usually a solitary, slow growing benign neoplasm, and well-encapsulated. The present study was carried out to know the cranial and extracranial presentations of schwannoma at various locations in the body. Materials and Methods: This was a retrospective and prospective study carried out for a period of 2 years, on patients who underwent excision of the tumor at different locations, which were diagnosed as schwannoma on microscopy. Cases were analyzed in detail regarding clinical history and other findings. Results: A total of 28 cases were diagnosed as schwannoma, among them 20 cases were located at cerebellopontine angle. Male:female ratio was 1:1.8. Youngest age group was 28 and eldest was 70 years in our study and the most common age group affected was between 30 and 40 years. Conclusion: Schwannoma should be considered as one of the differential diagnosis for swelling over the body as schwannoma can present extracranially also. Classical schwannoma was the most common and plexiform schwannoma was the least common variant in our study.

Aim: The aim was to identify the indications for a bone-marrow aspiration study, to correlate between peripheral blood smear findings and those of bone-marrow aspiration; and to assess the diagnostic value of bone-marrow aspiration examination. Settings and Design: A retrospective study was done on patients referred for bone-marrow aspiration in a tertiary care hospital for a period of about 3 years. Materials and Methods: Stained bone-marrow aspirate smears were examined. Records regarding the clinical indication for the procedure, peripheral blood smear reports, blood counts and significant findings on bone-marrow aspiration examination were retrieved. The role of bone-marrow aspiration in the diagnosis of hematological and nonhematological disorders was reviewed in the study. Results: Of a total of 153 cases, 24 (15.68%) were from the pediatric age group and 129 (84.32%) were adults. Male:female ratio was 1.3:1. The indications were anemia for evaluation (33%), evaluation of pancytopenia (26%), suspicion of malignancy (17%), fever (10%) and thrombocytopenia (3%). Bone-marrow aspiration yielded a diagnosis of hematological malignancy in a total of 11 cases. However, peripheral blood smear examination was able to pick up only seven of these cases. Furthermore, one case of metastatic deposits was seen in a case of carcinoma of unknown primary. The bone-marrow findings correlated with the peripheral blood smear findings in 54 (43.2%) out of 125 of the total cases. Conclusion: This study shows that bone-marrow aspiration is a valuable diagnostic tool and aids in diagnoses and etiology of various hematological findings such as anemia and pancytopenia.

Objectives: The aim was to evaluate the effect of parenteral testosterone on penile length, preputial hood, vascularity of dartos pedicle in patients with hypospadias. Materials and Methods: A total of 42 patients with hypospadias were included in this study. Injection aquaviron (oily solution each ml containing testosterone propionate 25 mg) was given deep intramuscularly in three doses with an interval of 3 weeks before reconstructive surgery at the dose of 2 mg/kg body weight. Preoperatively penile length, transverse preputial width and diameter at the base of the penis were measured. Basal testosterone levels were obtained before the institution of therapy and on the day of operation. Results: Following parenteral testosterone administration, the mean increase in penile length, transverse preputial width and diameter at the base of penis was 1.01 ± 0.25 cm (P < 0.001), 1.250 ± 0.52 cm and 0.61 ± 0.35 cm, respectively, (P < 0.001). Serum testosterone level after injection was well within normal range for that age. Conclusion: Parenteral testosterone increased phallus size, diameter and prepuce hypertrophy without any adverse effects. However, due to lack of a control group we cannot make any inferences. Controlled studies are required to establish the benefits of parenteral testosterone.

Filariasis is a major disease of the tropics. Frequently, lymphatics of the lower limbs, retroperitoneal tissues, spermatic cord, epididymis, and mammary glands are involved. Simultaneous filariasis along with another underlying disease is rare. We present a rare case of filariasis of the axillary lymph node in a modified radical mastectomy specimen, which also showed metastatic deposits of ductal carcinoma breast. The case is presented due to its rarity.

Cardiac metastasis is more frequent than primary tumors, with low absolute incidence reported. Cardiac metastases are common secondary to malignant melanoma, carcinoma of the lung, lymphoma, and carcinoma of the breast. Cardiac metastasis secondary to thyroid carcinoma is very uncommon. Among the thyroid malignancies, anaplastic carcinoma is the most aggressive and metastases to the heart has rarely been described in the literature. We report a case of a 60-year-old female with right ventricular outflow tract obstruction secondary to anaplastic carcinoma of the thyroid. An extensive literature search till date was unfruitful in finding a similar case. Thus, we focus the importance of regular echocardiography screening for all cases of thyroid malignancy, especially anaplastic carcinoma for recognizing cardiac involvement antemortem rather than postmortem.

Schwannoma is one of the most common benign tumors of the nerve sheath. In thoracic region, mediastinum is the prime site for the occurrence of schwannoma. Here, we present a case of chest wall schwannoma, which presented as incidentally detected chest wall tumors. Schwannoma being a slow growing benign tumor is incidentally detected on chest imaging done for vague complaints. Computerized tomography scan supports the diagnosis of schwannoma and is essential to assess the extent of the tumor. Treatment of choice is surgery. Now a day's thoracoscopic approach is preferred in suitable cases.

Hemophagocytic lymphohistiocytosis (HLH) is a potentially fatal hyper inflammatory condition, which occurs as either primary (genetic) or secondary (acquired) due to impaired or absent function of natural killer cells and cytotoxic cells. Common secondary causes include viral and bacterial infections, autoimmune diseases, and hematological malignancies. Extensive phagocytosis of blood cells by histiocytes in bone marrow, spleen, liver and lymphnodes result in peripheral blood cytopenias, hepatosplenomegaly, and lymphadenopathy. We evaluated a case of pyrexia of unknown origin and found out that he fulfilled the criteria for diagnosing HLH. He was started on immunochemotherapy with etoposide, cyclosporine and steroids, but he succumbed to illness within 2 weeks of treatment. High index of suspicion is needed to diagnose HLH and prompt treatment on diagnosis can be lifesaving.

Iatrogenic meningitis is a rare, but potentially fatal condition. We report four cases of meningitis after spinal anesthesia and review the possible etiological factors of post spinal meningitis. An important cause include mainly break in sterile technique with direct introduction of bacteria. However, usually clustering of cases by single anesthesiologist is reported. We report a series of cases in short duration by different anesthesiologists' in different operation theatres of the same hospital even with maximum sterile barrier. The difficulty in differentiation between aseptic and bacterial meningitis is noted. Finally, since delay in the diagnosis may result in morbidity and mortality, it is crucial to rule out rarest of the causes with thorough investigations and high index of suspicion.

Snake bite is common in Rajasthan, particularly in rural areas and in the rainy season. In the majority of cases, we usually get compatible history and clinical sign and/or symptoms. However, sometimes, there may be inconsistent history and fang marks may not be appreciable. Here, we report a case wherein snake passed over the body of the patient, no clear history of biting, without any fang marks and patient presented with neuroparalysis within 2-3 h. After ruling out other possible causes, diagnosis of krait envenomation was kept. Anti snake venom was given along with symptomatic and supportive measures, and the patient was discharged home with no residual neurological deficit.

Spinal cord compression is a rare but serious complication of malignancy in the children. Sarcoma presented with epidural mass, and spinal cord compression is very rare. We present a case of paraspinal and epidural rhabdomyosarcoma (RMS) causing acute spinal cord compression. Parents of an 18-month-old male child brought him with complaints that the child had difficulty in standing and he was unable to walk. There was a soft swelling on the upper back. Ultrasonography was done which showed a soft tissue mass. Radiograph also showed a swelling on the upper back. Magnetic resonance imaging was advised for further evaluation, and it was detected an epidural and left paraspinal mass which was causing severe spinal cord compression. Diagnosis of sarcoma was suggested; differential diagnosis of RMS and Ewing's sarcoma was given. Biopsy was done, and it showed RMS. Partial excision of epidural mass was done, and then chemotherapy and radiotherapy was done.

Lipomas of the gastrointestinal tract (GIT) are rare. They are usually submucosal, but rarely involve the muscle layer or serosa. Most ot submucosal lipomas of GIT are present in the colon (65-75%), small intestine (25%) and rarely in stomach or jejunum. These lesions are usually asymptomatic and rarely are incidentally found in autopsies. During lifetime, they are detected when they cause intussusceptions and obstructive symptoms. These lesions can also rarely become ulcerated causing symptoms that come to notice. The present case report is of submucous lipoma in the terminal ileum. A 45-year-old female came complaining of pain in the abdomen, gradually increasing over a period of 4 days. Computerized tomography scan revealed a mass in the submucosa. She was operated, and histopathology examination confirmed the mass as lipoma in the submucosa as well as within the muscle layer of the small intestine.

Late onset of fungal sepsis in very low birth weight (VLBW) infants is common and has a high mortality and morbidity. Many of these infants were also receiving fluconazole prophylaxis. Amphotericin is often started when invasive neonatal candidiasis is suspected and has significant side effects. Antifungal susceptibility testing can be extremely useful in deciding optimal antifungal therapy. We report a case of successful treatment of fungal sepsis due to Candida famata in a VLBW infant where fluconazole was continued in therapeutic dose following sensitivity testing. This case report highlights the growing number of cases arising due to nonalbicans Candida infections in the neonatal intensive care units and the usefulness of antifungal susceptibility testing in deciding optimal antifungal therapy and preventing the emergence of drug resistance.

Hypertrophic pachymeningitis (HP) is a rare disorder of diverse etiology. This case presented with a nasal mass. Magnetic resonance imaging of brain revealed HP. All other differential diagnosis was ruled out to term it as idiopathic. Patient was treated conservatively on steroids and nonsteroidal antiinflammatory drugs. Patient showed improvement of symptoms on treatment. We report here a case of idiopathic HP presenting with nasal mass.

Omental torsion is an uncommon diagnosis for an acute abdomen. We present a case of a 45-year-old obese male who presented with acute pain on the right side of the abdomen for 2 days. Ultrasonography and computed tomography abdomen suggested an omental torsion, which was confirmed on laparoscopy. The omental infarct was resected, and the patient is asymptomatic for the past 15 months.

We report a rare case of massive maternal ascites complicating severe preeclampsia in a case of twin gestation. This complication developed in association with severe hypertension and marked proteinuria. Ascites has been reported at cesarean section delivery in pregnancies complicated by preeclampsia. Hypoproteinemia caused by the excretion of large amounts of protein in the urine seems to be a partial etiological factor aggravated by the renal retention of sodium and water. The onset of massive ascites causes respiratory compromise in all the patients. Careful antenatal assessment and informed anticipation may help in detecting more cases with this complication, which is often missed and thereby help in reducing both maternal and perinatal morbidity and mortality. The purpose of this report is to increase the awareness of such nonclassical and atypical features of preeclampsia.

Acute bilateral renal cortical necrosis following acute pancreatitis is extremely rare condition. Among all cases of acute renal failure, the incidence of renal cortical necrosis was 3.8% in one of the study in North India. Till date, only eight cases of bilateral cortical necrosis following acute pancreatitis were reported in the literature. We report a case of a 27-year-old male patient with abdominal pain, nausea and vomiting since 2 days duration and anuria since 24 h. Serum amylase and lipase were raised, and elevated serum creatinine was noted on admission. Contrast-enhanced computed tomography scan of the abdomen revealed changes of acute pancreatitis with hypoenhancement of renal cortex compared to medulla on both sides (reverse rim sign-stronger enhancement of the renal medulla compared to cortex), suggest an acute renal cortical necrosis.

Melanomas develop due to malignant transformation of melanocytes, which are derived from the neuroectoderm. Although the majority of melanomas are cutaneous, they occasionally arise from extra-cutaneous tissues as well which contain melanocytes, such as uvea, leptomeninges, or the mucosa. Melanomas can be melanotic or amelanotic. Approximately, 15-20% of all malignant melanomas arise in head and neck region and over 80% of these involve the skin. Mucosal malignant melanomas are very rare and may affect the upper aero-digestive tract (UADT). Their incidence is approximately as low as 0.5-3% of all malignant melanomas. Majority of noncutaneous head and neck malignant melanomas affect the ocular origin and only 6-8% originate in the mucous membranes of the UADT. Nasal mucosal melanomas account for <1% of all melanomas and <5% of all nasal tract neoplasms. The incidence of amelanotic melanomas (AMs) has been estimated to be between 1.8 and 8.1% of all melanomas. We present a case of 62-year-old lady presenting with epistaxis and a mass in left nasal cavity, diagnosed as AM and managed by wide local excision and primary reconstruction in our institution.

Hepatitis A virus (HAV) infection is a benign, self-limited gastrointestinal infection of the children belonging to the developing countries. Extra-intestinal, especially autoimmune hematological manifestations rarely develop during the course of infection in children. We describe two children, aged 8 months and 5 years who developed immune thrombocytopenic purpura (ITP) during the course of otherwise uncomplicated HAV infection. In both children, bleeding secondary to thrombocytopenia was the initial presentation. An 8-month-old infant was anicteric at presentation and HAV infection was discovered during the course of investigations. Both were treated with platelet concentrates and intravenous immunoglobulin therapy successfully. HAV should be included in the differentials in any child (including infants) who presents with ITP, even in the absence of well-recognized features of the disease.

Cardiovascular events are the leading cause of fatal outcome from tricyclic antidepressant (TCA) overdose; cardiotoxicity as dysrhythmias and hypotension. Electrocardiogram (ECG) abnormalities usually precede the development of significant, clinically evident cardiovascular disease, and so the ECG has manifests clinically emerged as a valuable tool in the assessment of TCA toxicity. Cardiac toxicity secondary to TCAs is due mainly to sodium-channel blockade and slowing of phase 0 depolarization of the action potential resulting in slowing of conduction through the His-Punkinje system and myocardium. Sinus tachycardia is the most common manifestation seen, other ECG changes, which are seen are premature ventricular contractions, ventricular tachycardia and fibrillation, supraventricular tachycardia with aberrancy, sinus arrest, idioventricular rhythm, pulseless electrical activity, QRS/QT/PR prolongation, rightward terminal QRS axis, increased amplitude of R _aVR , atrioventricular blocks, and uncommonly as bundle branch block. Here, we discuss the ECG alterations as a right bundle branch block in a patient who was intoxicated with amitriptyline.

Primitive neuroectodermal tumors (PNETs) are a group of highly malignant tumors composed of small round cells of neuroectodermal origin that affect soft tissue and bone. PNET of the larynx is extremely rare. We report a case of a 41-year-old male who presented with the complaints of progressively increasing stridor of 3 months duration, which was diagnosed as a case of neuroectodermal tumor in the subglottis. Patient was subjected to microlaryngeal surgery and the tumor was excised. Postoperatively, patient was given three cycles of chemotherapy comprising of ifosfamide, etoposide, and mesna, along with granulocyte colony stimulating factor, with 21 days interval. After chemotherapy repeat computed tomography scan showed no evidence of the tumor and no lymphadenopathy. Patient is symptom free for 18 months following completion of treatment. He is under regular follow-up and is undergoing monthly serial endoscopic evaluation.

Acral lentiginous melanoma (ALM) is the most common type of melanoma in dark skinned peoples and Asians. The mean age of ALM ranges from 55 to 68 years. We report a case of ALM in a 60-year-old male patient presented with growth over palmer surface of left thumb since 2 years. The prognosis of invasive acral melanoma is poor, but future studies are needed to know more about the clinical outcome of this malignancy.

Thyroid hemiagenesis (THG) is a rare congenital anomaly in which one lobe of thyroid gland fails to develop. Agenesis may be unilateral, total or isthmic. Left thyroid lobe is commonly involved than right lobe in hemiagenesis. Clinically patients can be euthyroid, hypothyroid or hyperthyroid. Often it is diagnosed as an incidental finding during ultrasonography (USG) study of neck, which easily diagnose this condition. Actual incidence of THG is unknown, most cases are diagnosed in patients admitted for thyroid scan or thyroid surgery because of suspicion of other thyroid abnormalities. This explains high frequency of association of hemiagenesis with other thyroid abnormalities such as multinodular goiter, adenoma, hyperthyroidism, hypothyroidism, chronic thyroiditis, and carcinoma. We report a case of 58-year-old male patient detected to have hemiagenesis of left thyroid lobe and isthmus when USG neck was performed for carcinoma right buccal mucosa with metastatic cervical lymphadenopathy.

The thyroid gland is the largest of all endocrine glands and is placed anteriorly in the lower neck in level with fifth cervical and first thoracic vertebrae. It is "H" shaped with two large lateral lobes, connected by a narrow isthmus in the midline. The gland bears very important clinical significance; both physiologically and pathologically and; a wide range of variations and anomalies of the gland have been reported. We report a case of complete agenesis of thyroid isthmus found during routine cadaveric dissection for the purpose of teaching learning of medial undergraduates at our department. This anomaly is quite uncommon and bears important clinical importance in wide fields of surgical and medical specialties. The embryological basis of the anomaly is high separation of a thyroglossal duct, which can give rise to two independent thyroid lobes with no isthmus.

Congenital pseudoarthrosis (CPT) of the tibia is rare congenital anomaly occurring 1 in 190,000 live births. It is one of the rare causes of limb shortening. A 8-year-old male child born of consanguious marriage came to orthopedic OutPatient Department with history of significant shortening of left leg since birth so much, so that patient cannot use his left leg for walking. His right leg was normal. Family history of neurofibromatosis-I (NF-1) is present. History, photographs and X-rays were taken and patient was diagnosed as a case of CPT of the tibia. Significant association between CPT of tibia and NF-I has been found. The case is of significance to orthopedicians and pediatrician from the management point of view.

Bone cement implantation syndrome is a known cause of intraoperative morbidity and mortality in patients undergoing cemented arthroplasty. It is a rare but potentially fatal complication. A case of elderly female patient is reported who developed this complication during hemi arthroplasty of right hip. Within a few minutes of cementation, she developed severe hemodynamic derangement and shock with hypoxemia. Aggressive and early resuscitative measures led to a favorable outcome. Risk factors, etiopathogenesis and management of this condition are discussed in brief.