Objectives: To evaluate the association between time to treatment and to check the effect of various risk factors such as diabetes mellitus, hypertension (HTN), smoking, family history of coronary artery disease (CAD) and obesity on infarct size (IS), transmurality and ST-segment resolution (STR) with DE-MRI (delayed enhancement magnetic resonance imaging) on 3-month follow-up in patients treated for ST-elevated myocardial infarction (STEMI), with primary percutaneous coronary intervention (PPCI). Background: Early PPCI decreases IS and transmurality but increases STR. Materials and Methods: Fifty consecutive patients with STEMI treated with reperfusion therapy in the form of PPCI and underwent cardiac MRI at 3-month interval follow-up. The primary endpoint is final IS and transmurality as assessed by DE-MRI at 3-month follow-up. Results: IS and transmurality increase and STR decreases with increase in duration to percutaneous coronary intervention from the onset of symptoms. Similarly, the effect of various confounding factors such as diabetes mellitus, HTN, smoking, family history of CAD and obesity on IS, transmurality and STR was assessed which did not affect immediate prognosis during treatment. Conclusion: Primary angioplasty is the treatment modality of choice in the case of STEMI when available. Time to treatment directly influences STR, final IS and transmurality, that is, the earlier the intervention done, more will be STR and lesser will be final IS and transmurality. There is no significant effect of confounding variables such as cardiac risk factors except family history of CAD on immediate prognosis during treatment.

Background: Mineral bone disease (MBD) is a systemic disorder of mineral and bone metabolism due to chronic kidney disease (CKD). Bone disease in CKD is due to secondary hyperparathyroidism. Serum intact parathyroid hormone (iPTH) level estimation is a potential noninvasive method for the diagnosis of MBD at early stage. Aim: Treating renal bone disease should be one of the primary aims of therapy for CKD. Evaluation of the biochemical parameters of CKD-MBD (primarily phosphorus, calcium, parathyroid hormone, and Vitamin D levels) as early as CKD stage 3, and an assessment of bone status (by the best means available), should be used to guide treatment decisions. The adverse effects of high phosphorus intake relative to renal clearance (including stimulation of hyperparathyroidism) precede hyperphosphatemia, which presents late in CKD. Early reduction of phosphorus load may ameliorate these adverse effects. Evidence that calcium load may influence progression of vascular calcification with effects on mortality, should also be considered when choosing the type and dose of phosphate binder to be used. MBD in CKD has high morbidity and mortality and hence it is important to detect it at an early stage. iPTH levels can be highly sensitive and it is one of the useful noninvasive biochemical parameters to detect MBD in CKD. Materials and Methods: This was an observational study carried out in a tertiary care teaching hospital. The study involved 60 patients of CKD. Detailed history, physical examination, and biochemical parameters were assessed in all of them. Results: There was a significant association between hypertension, diabetes with nephropathy, and highly significant association between serum iPTH and raised blood urea levels in MBD group, however there was no significant association between duration of CKD, hemoglobin, creatinine, uric acid, phosphorous, calcium, and alkaline phosphatase with MBD. Conclusions: MBD in CKD can be detected at early stage by the use of noninvasive methods of estimation of serum iPTH levels.

Background: Avascular necrosis (AVN) of the femoral head is a progressive disease that generally affects patients in the third through fifth decades of life; if left untreated, it leads to complete deterioration of the hip joint. Treatments range from simple decompression of the femoral head, to bone grafting of the involved area, or by using a vascularized fibular graft with varying degree of success. In most instances, the disease progresses further causing secondary arthritis. We present a study of management of early stage AVN (stage I and II A/B of Ficat Arlet classification) with core decompression autologous cancellous bone grafting along with platelet rich plasma. Aims: To evaluate the results of the above modality in the management of AVN of the hip. Settings and Design: This prospective study of 30 cases was done during the period of 2011-2013. Materials and Methods: Patients with stage I and II A/B were treated with the above modality and were followed up for 1-year. The results were evaluated on the basis of progression or remission of the disease by radiographic studies, preoperative and postoperative Harris hip score (HHS), age and sex distribution. Statistical Analysis Used: Primer software for calculating the statistical data was used and paired t-test was applied to all the data. Results: Show males were more affected than females and average age group of presentation in stage I and II was 29 years (22-55). The most common cause was idiopathic followed by steroid use. Average preoperative HHS was 56.80 and postoperative HHS was 79.73. 60% (18) showed remission of the disease (radiographically) compared to preoperative stage at 1-year follow-up, in 30% (9) disease did not progress further and 10% (3) progressed and required arthroplasty. Conclusion: Management of stage I and II A/B AVN of femur showed good satisfactory results in terms of disease remission and prevention of the further progress of the disease by the above method at 1-year follow-up and further follow-up is awaited.

Objective: To assess knowledge and practices related to menstruation and reproductive health amongst college going adolescent girls. Materials and Methods: Cross-sectional study done on 323 adolescent girls admitted in the year 2012 to professional colleges belonging to the health sciences faculty of a private university in Pune, India, using self-administered proforma. Results: Mean age of onset of menarche was 13.35 years. Many girls (86.65%) had knowledge of menstruation prior to menarche. For 68% of girls, mother was a source of menstrual information. Half of the girls reported some form of restriction in activities during menstruation due to religious reasons. 11% girls suffered from some form of reproductive tract infections (RTIs). Practices related to menstruation revealed that cloth piece is used for menstrual protection by 3% of girls. Soaked sanitary pads were disposed sanitarily by 96% of girls. Adolescent of medical faculty had significantly more knowledge than nursing faculty adolescents regarding emergency contraceptives (P < 0.05). Only four girls reported a history of sexual contact, of these, three were aware of emergency contraceptives, while one used them to prevent pregnancy. Conclusions: Adolescent girls received knowledge of menstruation prior to menarche from their mothers. Restriction in activity during menstruation due to religious reasons is practiced by many girls. Sanitary pad was used by almost all girls, and all disposed the same in a sanitary manner. More than half of the girls were aware about emergency contraceptives. Prevalence of RTI was found to be low and very few girls reported history of sexual exposure.

Context: Tobacco consumption among females is on rise and is increasing at an alarming rate. This epidemic among the females is emerging as an important public health problem especially in slums. Aim: Study was conducted to find out association between sociodemographic factors and tobacco consumption. Settings and Design: Community-based cross-sectional study was carried out among females (15-49 years) in an urban slum of Pune during February 12 to April 13. Materials and Methods: Sampling frame was prepared from records of urban health center. Required sample size was selected by simple random method. Data collected using pretested validated structured questionnaire after obtaining informed consent. Statistical Analysis: Statistical analysis was performed using SPSS 20, and Chi-square test was used for determining association. Results: Of 305 females studied, 31.5% of them were currently consuming tobacco. Most common form of tobacco consumption was smokeless that is, Mishri application 55.2%. About 64% females started using tobacco before 20 years of age. Most of them (32%) consuming tobacco for increasing concentration at work. Tobacco consumption was found to be significantly more common among ever-married and Muslim females. Lack of will power and ignorance about the harmful effects of tobacco were major hindrances (51%) for quitting tobacco Conclusion: Tobacco consumption was found to be prevalent in almost one third of females (15-49 years) residing in an urban slum of Pune. Most of them used smokeless tobacco, mainly Mishri. Tobacco consumption was directly associated with age, marital status and religion.

Introduction: Worldwide incidence of obesity is rising. Genetic predisposition, urbanization, sedentary lifestyle, television watching, food habits, and lack of exercise are contributing factors. They result in obesity-related morbidity like metabolic syndrome, stroke in young, coronary artery disease, and diabetes. Materials and Methods: A cross-sectional study was undertaken among 1000 adolescents of both genders, aged 12-19 years in three schools of Pimpri, Pune, after obtaining approval from Institutional Ethical Committee. The criterion used to diagnose metabolic syndrome was International Diabetes Federation definition. The Chi-square test was used to explore the association between metabolic syndrome and various predictors. A P value of 0.05 was accepted as the level of statistical significance. Results: In the study sample, the prevalence of metabolic syndrome was 16/1000. Females were more likely to have metabolic syndrome (male:female = 7:9). Factors associated were body mass index (BMI), waist-hip ratio (WHR), birth weight, skin fold thickness, body fat percentage, faulty dietary habits, and sedentary lifestyles (P < 0.05). Among all, the components of metabolic syndrome, raised triglyceride (75%), and fasting blood sugar level (75%) were more prevalent than high-density lipoprotein-cholesterol (44%) and hypertension (37.5%). Conclusion: Metabolic syndrome was found to be more prevalent in females of age group 16-19 years, among the obese population, associated with birth weight, BMI, and WHR.

Introduction: The aim of the study was to evaluate the hearing loss in geriatric hemodialysis patients. Materials and Methods: The study was performed on 16 geriatric hemodialysis patients (age minimum: 65, maximum: 86 years) and 16 volunteers (age minimum: 65, maximum: 86 years) as a control group. The patients' pure tone audiometry values between 250 and 8000 Hz frequencies were analyzed. Results: In our study, statistical significance was found between hearing loss and serum urea levels (P = 0.001). Hearing loss values were not statistically significantly different between the study and control groups (P = 0.786). High frequency hearing thresholds were found to be significantly higher in the geriatric hemodialysis patients (P = 0.032). Normal hearing levels at all levels were found in 5 patients in the study group. Mild to moderate hearing loss was found in 11 patients. Conclusions: In our preliminary study, we found statistically significant differences between the increase in hearing thresholds and uremia. Statistically significant changes in hearing thresholds at high frequencies were found between the two groups. Long-term hemodialysis treatment of 10 years or more is a risk factor for hearing loss. Hemodialysis treatment is a risk factor for hearing loss in geriatric patients who are at a risk of presbyacusis.

Introduction: The formal lecture is among the oldest teaching methods that have been widely used in medical education. Delivering a lecture is made easy and better by use of audiovisual aids (AV aids) such as blackboard or whiteboard, an overhead projector, and PowerPoint presentation (PPT). Objective: To know the students preference of various AV aids and their use in medical education with an aim to improve their use in didactic lectures. Materials and Methods: The study was carried out among 230 undergraduate medical students of first and second M.B.B.S studying at Malla Reddy Medical College for Women, Hyderabad, Telangana, India during the month of November 2014. Students were asked to answer a questionnaire on the use of AV aids for various aspects of learning. Results: This study indicates that students preferred PPT, the most for a didactic lecture, for better perception of diagrams and flowcharts. Ninety-five percent of the students (first and second M.B.B.S) were stimulated for further reading if they attended a lecture augmented by the use of visual aids. Teacher with good teaching skills and AV aids (58%) was preferred most than a teacher with only good teaching skills (42%). Conclusion: Our study demonstrates that lecture delivered using PPT was more appreciated and preferred by the students. Furthermore, teachers with a proper lesson plan, good interactive and communicating skills are needed for an effective presentation of lecture.

Introduction: Acute appendicitis is the most common cause of an acute abdomen requiring surgery, the clinical presentation is typical in 50% of the cases, but the decision to explore the patient can sometimes be challenging. The diagnosis is based on history, clinical examination, and few laboratory investigations. To help the surgeon make diagnosis with certainty and reduce negative laparotomy rate, a number of clinical scoring systems are in vogue. The present study was undertaken to evaluate the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score in the diagnosis of acute appendicitis. Materials and Methods: A prospective study was undertaken among 100 cases presenting with signs and symptoms suggestive of acute appendicitis. Validity of RIPASA score as a diagnostic test for appendicitis was established by calculating its sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) along with 95% confidence intervals (CIs), using intraoperative diagnosis confirmed by histopathology as gold standard. Results: RIPASA had sensitivity of 82.61% (95% CI 72.02, 89.76) and specificity of 88.89% (95% CI 67.2, 96.9). It had a PPV of 96.61% (95% CI 88.46, 99.07), NPV of 57.14% (95% CI 39.07, 73.49), and a diagnostic accuracy rate of 83.91% (95% CI 74.78, 90.17). Conclusion: The RIPASA score is a simple scoring system with a reasonable sensitivity and specificity for the diagnosis of acute appendicitis.

Background: Cerebellopontine angle (CPA) tumors are usually benign, and they are divided into extra-axial, intra-axial, extradural, and petrous axis tumors. CPA pathologies can be asymptomatic or it may present with vertigo, tinnitus, or unilateral hearing loss depending upon the site of tumor origin and displacement of the neurovascular structure. Aim and Objectives: To evaluate the role of magnetic resonance imaging (MRI) aided with contrast-enhanced MRI as an imaging modality for diagnosis of CPA lesions. Materials and Methods: Analysis of 36 patients of CPA lesions over a period of 2 years was done. MRI was performed on Siemens 1.5 Tesla MAGNETOM Avanto Machine. Conclusion: There are spectrums of pathologies, which can present with these symptoms, which includes tumors, vascular malformations, and vascular loop compressing vestibulocochlear nerve or mastoid pathology so it is important to investigate the patient by MRI. Contrast-enhanced MRI is the most sensitive investigation in the evaluation of the CPA lesions, its characteristic, and its extent.

Periodic paralysis is a rare neuromuscular disorder, related to a defect in muscle ion channels, characterized by episodes of painless muscle weakness, which may be precipitated by heavy exercise, fasting, or high-carbohydrate meals. Hypokalemic periodic paralysis may be familial (primary) or secondary. Here, we report three cases of secondary causes of hypokalemic periodic paralysis. On evaluation, case 1 had distal renal tubular acidosis (RTA) due to Sjogren's syndrome, case 2 had drug induced proximal RTA (Fanconi's syndrome) and case 3 had thyrotoxicosis. Clinician must be aware of causes of secondary PP as recognition and diagnosis can completely prevent further attacks of periodic paralysis. Each of the above case is rare, but completely treatable if diagnosed. Low dose steroids with bicarbonate replacement in case 1, stopping tenofovir in case 2 and carbimazole therapy in case 3 prevented further attacks of periodic paralysis and cardiopulmonary complications.

Diaphragmatic hernia of Bochdalek (BH) and intra-thoracic kidney (IK) are both rare congenital, developmental anomalies. In some extremly rare occasion, these two congenital anomalies can be associated in the same patient. The kidney typically exits the retroperitoneal space through the foramen of Bochdalek. The majority of IK and BH are discovered incidentally. A conservative approach can be proposed in asymptomatic cases. In this report, the case of a 35-year-old man presenting with 1-week of acute abdominal pain is presented. Chest radiography revealed a posterior mass in the right hemithorax, which was later confirmed by chest computed tomography and magnetic resonance imaging to be a congenital IK associated with a BH.

Ambiguous external genitalia could cause parental emotional trauma especially in an African setting where early gender assignment is an integral part of our culture. The most common cause of ambiguous external genital in Nigeria is 21-hydroxylase deficiency and depending on the severity of the enzyme deficiency, it may present with an isolated ambiguous external genital while in severe cases it may manifest with electrolyte deficiency and hypoglycemia; however its association with microcephaly is a rare phenomenon. Therefore, the case an 8-month old child whose parents had lost two other children to similar disorder is reported.

Herpes zoster (HZ) is an acute infectious viral disease result from reactivation of the DNA varicella-zoster virus, which occurs more frequently among older adults and immunocompromised persons. The most common complication of HZ is postherpetic neuralgia, a chronic often debilitating pain condition that can last months or even years. Deaths attributable to zoster are common among immunocompromised persons. Prompt treatment with the antiviral drugs, corticosteroids and analgesics decrease the severity and duration of acute pain from HZ. Here, we report a treated case of HZ in 35-year-old male involving all three branches of the trigeminal nerve without any complication.

Epithelial-myoepithelial carcinoma (EMC) is a low-grade malignant tumor of the salivary glands. It is extremely rare neoplasm accounting for <1% of all salivary gland neoplasms. It is most commonly seen in parotid gland, but has also been described in the submandibular gland, minor salivary glands and extra oral sites. It is most commonly seen in females; with a peak occurrence in the seventh decade. We present a case of EMC of parotid gland in a 55-year-old male patient presented with painless swelling of 8 cm × 8 cm in preauricular region since 1-year. There was no history of fever and no palpable cervical lymphadenopathy. Facial nerve function was intact. All other findings in general examination were within normal limit. As EMC is a very rare tumor having high rate of recurrence we must aware of this entity while giving diagnosis on histopathological examination. Surgeons and oncologist must focus on the best treatment approach to prevent the recurrence of this tumor. Wide local excision, followed by radiotherapy remains the treatment of choice.

A 57-year-old diabetic male, presented with altered sensorium since 2 days. He had a history of weight loss, loss of appetite, intermittent low-grade fever of 6 months duration. He had been administered empirical antituberculous therapy some months ago with no alleviation of symptoms. On examination, he was asthenic, normotensive, and anemic with hepatosplenomegaly. Ultra-sonography abdomen revealed bilateral enlarged adrenals with hepatosplenomegaly. Clinically impression was of tuberculosis disseminated malignancy. He expired within 2 days of admission. At autopsy, both the adrenals were markedly enlarged showing extensive areas of necrosis on the cut surface. Histology showed them to be brimming with colonies of yeast-forms of Histoplasma capsulatum. These organisms were also seen in the spleen, lungs and kidneys. The patient had died of septicemia following disseminated histoplasmosis that was, unfortunately, not diagnosed during his life. Histoplasmosis is amenable to treatment with Amphotericin B. Prompt diagnosis and treatment could have helped in salvaging this patient.

Fallopian tube prolapse post hysterectomy is rarely reported complication which can lead to doubts in the mind of young and experienced surgeons alike. This leads to patient morbidity and gets different medical treatments ranging from antibiotics to local applications of copper sulphate, without relief. The use of proper surgical technique, prevention of post operative hematoma and infection go a long way in its prevention.We hereby present two cases, which were manged successfully to relieve the patients of their agony.

Pulmonary artery agenesis is the complete absence of the right or left pulmonary artery. This lesion is commonly associated with other cardiac anomalies and is usually diagnosed incidentally. Unilateral absence of pulmonary artery with lung hypoplasia is very rare. Ipsilateral hypoplastic or absent central pulmonary artery in these patients will have a systemic arterial supply to peripheral pulmonary arteries of the affected lung from the descending thoracic or upper abdominal aorta. These findings are usually characterized as pulmonary veno lobar syndrome or scimitar syndrome when associated with ipsilateral total or partial anomalous pulmonary venous return from the lower lobe which drains into the inferior vena cava or less commonly to the hepatic, azygous, or portal vein, or into the right atrium and lung agenesis/hypoplasia.

Localized anterior arthrofibrosis (cyclops lesion) is having around 1-9.8% frequency rate after anterior cruciate ligament (ACL) reconstruction. It has been reported to be a significant cause of loss of knee extension after reconstruction of the ACL of the knee. We present a case report of a patient with prior ACL reconstruction who presented with pain and loss of extension following surgery. MR imaging revealed the typical features of cyclops lesion. Repeat arthroscopy excision of the lesion is the only treatment to reduce the morbidity of the patient.

Solid-pseudopapillary tumor (SPPT) of the pancreas is an uncommon low-grade exocrine pancreatic malignancy. An 11-year-old male child presented with pain in the abdomen. He had a history of fall 1-week back for which a computerized tomography (CT) scan was advised. A pancreatic mass was incidentally detected on CT scan and diagnosed as pancreatic pseudocyst. Explorative surgery was performed that revealed a solid-cystic tumor in the tail of the pancreas. The histopathological examination reported the features of pancreatic SPPT which was also the final diagnosis.

A 65-year-old woman presented with swelling and pain at the superomedial aspect of the right eye that was associated with proptosis, ptosis and restriction of eye movements superiorly and medially since 1 month. Considering the age and clinical presentation of the patient, a differential diagnosis of orbital cellulitis, thyroid orbitopathy, ocular myasthenia, orbital neoplasm, lymphoproliferative disorder and idiopathic orbital inflammatory syndrome (IOIS) was considered. Relevant laboratory investigations were performed, which were normal. Computed tomography, magnetic resonance imaging and biopsy were suggestive of IOIS. The patient was started on oral steroids and had a favorable outcome.

The present report is a case of fibrous dysplasia of the proximal femur with pathological fracture neck of femur treated by single-stage surgery of curettage, internal fixation, nonvascularized fibular grafting and tensor fascia latae-based muscle pedicle bone grafting. At latest (2.6 years) follow-up, fracture is united without any evidence of local recurrence and patient is pain free with good clinical and functional results.

Morel-Lavallée lesion is a degloving injury occurring at the interface of the subcutaneous fat and the underlying fascia. The lesion usually results from shearing forces due to trauma separating the skin and subcutaneous tissue. We report here a case of a patient diagnosed with Morel-Lavallée lesion in the hip region.

Cirsoid aneurysm of scalp is a rare arteriovenous malformation (AVM) of external carotid branches and scalp veins. This malformation of scalp is also synonymously called as plexiform angioma, aneurysma racesomsum, and aneurysm cirsoide, aneurysma serpentinum. This AVM can be congenital or acquired; a congenital form will be present at birth, however, becomes overt only after puberty. Superficial temporal artery is the feeder in approximately 70-80% of the cases, followed by occipital and supraorbital artery. Multidetector computed tomography angiography reconstructed images can provide excellent detail of the feeders, draining veins and their soft tissue relations. Volume rendering data sets in computer workstations we can actually perform virtual dissection layers of the lesion for operative planning. Well planned surgical excision can have least surgical recurrence rates and complications.

Local anesthesia is commonly used to perform cataract surgery. We present a case in which local anesthesia systemic toxicity, which occurred after peribulbar block. It is a life-threatening complication if it is not recognized early and appropriately resuscitated can be fatal. This case report attempts to highlight the need for trained personnel, with suitable monitoring and recent guidelines in the management of local anesthesia systemic toxicity surgery under a regional technique.

Cluster headache (CH) is characterized by recurrent attacks of short-lasting excruciating pain accompanied by signs of autonomic dysfunction. Although neuroimaging results are usually normal in primary headaches, rarely structural lesions may be associated with CH like presentation. Most symptomatic CH is due to pituitary tumors and less commonly due to arteriovenous malformations (AVM) and aneurysms. Here we describe a case of 44-year-old male who presented to us with new onset episodic CH with headache features typical. Initially, headache responded to treatment, but later the headache became continuous, severe in intensity and refractory to treatment. Since magnetic resonance imaging was normal, he was subjected to digital substraction angiography (DSA) to rule out aneurysm or AVM. DSA revealed indirect carotid-cavernous fistula (CCF). Once the fistula was obliterated with onyx embolization, headache subsided completely. MRI brain is often routinely performed in CH to rule out secondary causes. When MRI brain is normal, detailed vascular imaging with DSA must be performed in patients with CH with especially in those with atypical features. Like continuous pain refractory to treatment, sudden increase in severity in the first episode, minimal or absent autonomic features and abnormal physical findings like persistent ptosis in the headache-free period. Although many cases of symptomatic CH have been reported in literature we report the first case of CCF presenting as CH. Early identification is essential as it is completely curable with endovascular treatment.

The Rapunzel syndrome is an extreme form of trichobezoar found in patients with a history of psychiatric disorders, like trichotillomania (habit of hair pulling) and trichophagia (morbid habit of chewing the hair). The signs and symptoms are nonspecific and include vomiting, early satiety, abdominal pain, abdominal mass, and weight loss. Diagnosis can be established with a thorough history combined with radiography and endoscopy with high index of suspicion. Treatment options include combination of laparoscopy and/or laparotomy with long-term psychiatric treatment and monitoring. We report the case of an 17-year-old female, who presented with an abdominal pain, fullness after meals, nausea, vomiting and significant weight loss due to a trichobezoar with a long, 130 cm tail into the small bowel. The patient had an uneventful postoperative outcome after laparotomy and removal of trichobezoar.

Glyphosate Surfactant is a nonselective widely used herbicide in agriculture, forestry, industrial weed control, lawn, garden and aquatic environments. They have favorable toxicity with occupational and accidental exposures. The toxicity in humans is mucosal and gastrointestinal irritation, hypotension, metabolic acidosis, pulmonary insufficiency, and oliguria. Patient may appear asymptomatic for many hours before slowly lapse into a hypotensive, apparently nonhypovolaemic shock that can often ends fatally. We hereby report a case of a 25-year-old male patient who was admitted to our tertiary care hospital following suicidal consumption of around 250-300 ml of herbicide containing glyphosate (glypho^; ). Initially, gastric lavage done and the patient was managed with intubation and mechanical ventilation. He also developed acute renal failure, and renal function reverted to normal after four sittings of hemodialysis. Patient was successfully treated and discharged home. This case report emphasizes on timely systemic supportive measure as the sole method of treatment since this poison has no specific antidote.

Lymphangioma is a congenital benign tumor caused by developmental malformations of the lymphatic system. These lesions are generally recognized at birth or in early childhood. The most common location is the head and neck region. Lymphangioma of the epididymis is very unusual as its occurrence in the adult age group. The correct diagnosis is essential for proper management. We report an unusual case of epididymal lymphangioma in a 46-year-old male presenting as a painful retrotesticular mass.

Fabry's disease is an X-linked multisystem disorder due to the deficiency of lysosomal enzyme α-galactosidase A, leads to accumulation of sphingolipids throughout the body. Key causes for premature death include cardiac and renal. Here, we present important clinical findings of such rare case.

The malignant pleural effusion in systemic sclerosis (SSc) is an uncommon condition than its common manifestation like interstitial lung fibrosis, pulmonary hypertension, and lung malignancy. We reported here a case of malignant pleural effusion in a 40-year-old female suffering from SSc with high serum tumor marker "cancer antigen-125 (CA-125)". Computed tomogram guided fine needle aspiration cytology from the lung nodule revealed adenocarcinoma lung. The frequency or reasons of an elevated level of a serum or pleural fluid CA-125 in this case are unclear. Excepting ovarian and lung malignancy, increased CA-125 level in serum, and pleural fluid is also detectable in nonmalignant conditions including SSc as a part of serositis. We emphasized here the malignant potential of SSc and the need for long-term follow-up to detect underlying malignancy. High CA-125 level might be interpreted cautiously.

Dengue is viral illness which manifests as high grade fever, myalgia, hemorrhagic manifestation and shock. Recently, dengue has been reported with rare presentations like encephalopathy, liver failure, and renal failure. We are presenting a case of acute fulminant liver failure due to dengue in which a 19-year-old previously healthy female who presented to us in the emergency department with complaints of high grade fever for past 3 days without chills and rigors, and altered sensorium past 1 day. The patient had icterus. On laboratory evaluation, her liver function tests were deranged while neuroimaging was normal. In view of presence of coagulopathy and altered sensorium, a diagnosis of dengue related acute hepatic failure was made. The patient was provided supportive and symptomatic management to which she responded and was discharged a few days later and is on regular follow-up.

Hernia of canal of Nuck is an extension of peritoneal fold through the inguinal canal up to the labia majora. Defective obliteration of this peritoneal fold leads to herniation of abdominal content into the inguinal canal. Incidence of ovary and fallopian tube as contents of henia is rare overall and very rare in middle age women. This hernia would require surgical intervention once diagnosed, but type of intervention may vary. Although mesh repair is acceptable worldwide with low recurrence rate, nonmesh repair still has a place specifically in developing countries wherein cost consideration without significantly affecting outcome will be an important factor. Two cases treated with nonmesh repair are reported.

Metastatic tumors of the omentum are common. In contrast, the primary tumors of the omentum are very rare. Primary benign tumors of the omentum include lipomas, myxomas, and desmoid tumors. Primary malignant tumors include leiomyosarcoma, liposarcoma, etc. We report here a case of a 32-year-old female who presented to our emergency department with pain in lower abdomen of 1-day duration. The patient underwent laparotomy and was found to have an irregular mass with bosselated surface arising from the omentum that had caused torsion of the omentum. Histopathology confirmed it to be a lobular capillary hemangioma (LCH) of greater omentum. The postoperative course was uneventful, and she has followed up for last 6 months without any recurrence. There is not yet a single reported case of LCH of omentum.