Pseudoaneurysm of the visceral arteries is a rare condition. The common causes for pseudoaneurysm are pancreatitis, infection, autoimmune disorders, vascular intervention, surgery, and blunt trauma. Pseudoaneurysm is usually noticed during investigation in an emergency situation. Such rare cases involving superior mesenteric artery, gastroduodenal artery, and splenic artery were managed recently using endovascular techniques.

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Adrenal myelolipoma is a rare benign tumor composed of an admixture of adipose and hematopoietic tissue. Most tumors are asymptomatic, small in size, right-sided, and usually detected incidentally. Though they are often smaller than four cm in diameter, they can reach larger sizes. Giant adrenal myelolipomas are extremely rare tumors having only about 10 reported cases in the literature. Presently, a case is being reported in a 59-year-old lady who presented with abdominal distention and dragging sensation in the upper left abdomen. Computed tomography of the abdomen revealed a retroperitoneal tumor which was suspected to be a retroperitoneal sarcoma. Other fat containing retroperitoneal tumors such as a lipoma, myelolipoma and teratoma were also considered as possibilities. All hormonal studies related to adrenal gland were within normal limits. The patient underwent surgical resection of the tumor. The resected mass was 23 cm × 16 cm ×9 cm in size and weighed 3.3 kg. Histopathological examination revealed the tumor to be an adrenal myelolipoma. This present case of adrenal myelolipoma is unusual in view of its left-sided location and its large size which clinically and radiologically simulated a retroperitoneal sarcoma.

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Arytenoid swelling, especially in a male patient presenting with complaints of change in voice needs to be evaluated to rule out malignancy. We present the case of a 60 year old male with a change in voice, bilateral arytenoid swelling, which on further evaluation diagnosed as laryngeal tonsil. Lymphoid hyperplasia presenting with bilateral arytenoid swelling is very rare and should be considered in atypical presentations of larynx.

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Candida is a ubiquitous fungus and can lead to various forms of infection like superficial, subcutaneous, and systemic-to-invasive infection. There are more than 20 species of Candida which can cause infection; of which, Candida albicans is the most common species. Candida can also cause deep-seated infection that can be due to hematogenous spread or through the direct introduction. Here, we report a rare case of pancreatic abscess in a 32-year-old male patient presenting with abdominal pain and fever. The pus aspirated from the abscess yielded the growth of Candida tropicalis and Pseudomonas aeruginosa. The patient was started on fluconazole and imipenem along with surgical necrosectomy. The patient recovered with subsidence of fever and abdominal pain.

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Background: Microscopy detection of acid-fast bacilli (AFB) by Ziehl-Neelsen (ZN) method is a rapid and feasible method but has low sensitivity. Aims: To evaluate the efficacy of bleach method with cytological diagnosis and the conventional method. Methods: Five hundred and seventy-five patients with tubercular lymphadenitis were evaluated. The acid-fast positivity by routine staining was compared with modified bleach method of AFB staining. Result: Among 575 patients, 230 (40%) were positive for AFB on conventional ZN method, 310 (53.9%) on cytology and the smear positivity was increased to 365 (63.5%) by bleach method. Conclusion: The bleach method is simple and inexpensive. It clearly improves microscopic detection of AFB.

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Background: Maxillofacial injuries make up a large proportion of reported cases of trauma. The rise in the number of complex and high-energy injuries encountered among patients make it inevitable for one to be on the lookout for associated maxillofacial injuries. Aim: The aim of this study was to determine the pattern of maxillofacial fracture in patients who presented at the University of Uyo Teaching Hospital, Uyo, Nigeria. Methods: A 4-year retrospective review of maxillofacial fractures, from October 2008 to September 2012 in the University of Uyo Teaching Hospital, Uyo, Southern Nigeria is presented. Results: A total of 215 patients were seen in the period under review. 66.67% were males and 33.03% females, giving a male to female ratio of 2:1. The age of patients varied between 10 and 70 years. 67.9% of the patients were in the age bracket of 21-40 years, and the mean age of patients was 30 years. Road traffic accidents were responsible for the fractures in 80% of cases while 9% of fractures were due to falls. 66% of patients had mandibular fractures, with fractures of the body of the mandible accounting for 41.67% of mandibular fractures. 34% of the patients had maxillary fractures. Zygomatic fractures were the most common maxillary fractures accounting for 45% while Le Fort III fractures accounted for 2.82% of maxillary fractures. Conclusion: This study shows that road traffic injuries are the most common causes of facial fractures in our setting. Majority of the fractures in maxillofacial injury were found in the mandible (66%) followed by maxilla (44%).

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Background: The Integrated Child Development Services (ICDS) scheme is the largest program for promotion of maternal and child health and nutrition. Aims: The present study is aimed to evaluate ICDS program in terms of infrastructure of anganwadi centers (AWCs), characteristics of anganwadi workers (AWWs), coverage of supplementary nutrition (SN), and preschool education (PSE) to the beneficiaries. Methods: A total of 39 AWCs from a rural area and 15 from the urban area were surveyed. AWWs were interviewed, and records were reviewed. Information was collected using a predesigned and pretested questionnaire. Results: In the selected AWCs, 88.9% were running in Pucca buildings, 38.9% had electricity, 35.1% had a separate kitchen, 1.8% had cooking gas, and toilets were available in 59.3% AWCs. All the AWW have received job training, 83.3% AWW have received refresher training. 38.8% AWW have received orientation training, 37% have received skill training in World Health Organization growth standards and 18.5% AWW have received skill training in mother and child health. 86.9% registered pregnant women, 90.7% registered lactating women, 72.6% registered adolescent girls were availing SN. 95.4% registered children 6 months to 3 years and 92.4% registered children 3-6 years of age were availing SN. Interruption in SN in last 6 months was seen in 22.2% AWCs. Appropriate and adequate PSE material was available in 59.2% AWCs. Conclusion: There are program gaps in the infrastructure of AWCs, training of AWW, coverage of SN, interruption in the supply of SN.

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Atrial fibrillation is the most common cause of cardiogenic emboli in stroke, responsible for over 50% cases of total stroke patients. Myxoma is responsible only in few cases. A stroke caused by left atrial myxoma commonly occur in young females. This patient presented with the repeated attack of stroke in the age of 80 years. However, it is the most common benign cardiac tumor found more frequently. In young adults with stroke or transient ischemic attack than in older patients. Age of the patient and unusual cause of recurrent stroke make this case report interesting. An 80-year-old male with no other conventional vascular risk factors such as hypertension, diabetes, or hyperlipidemia presented with left hemiparesis. Infarction over the right middle cerebral artery was disclosed on a magnetic resonance imaging study. The patient was a known case of right hemiparesis 3 years back, which was improved. The cause of repeated attack of stroke was left atrial myxoma, diagnosed by two-dimensional echocardiography.

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Conjoined twins are rare variants of monozygotic twins, which result from an incomplete late division of the embryonic disc. Here, we report a rare case of conjoined twins of cephalothoracoomphalopagus variety where the line of fusion extended from the cranium up to the level of the umbilicus. The crown-rump length of each twin was 23 cm, which corresponded to the prenatal age of week 24 in a normal gravidity. The anatomical features of these conjoined twins were observed and external anomalies such as indefinite single nostril and male hypoplastic genitalia were described and documented. The old formalized specimen was studied to reveal anomalies by using current imaging techniques, thus keeping it intact for posterity. Computed tomography (CT) findings suggest cephalothoracopagus twinning, with the gestational age being 24 weeks (approximately). An attempt was made to correlate the findings on embryological basis.

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We report a female case who developed hypothyroid in the course of multibacillary multidrug therapy regimen for leprosy. The evaluation was made to rule out the possible cause of rifampicin induced hypothyroidism in Hashimoto's thyroiditis.

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Mesenteric panniculitis is a rare, benign, and complex disorder. This is a chronic inflammatory process of mesenteric adipose tissue of unknown etiology. Based on the histopathological spectrum seen i.e., chronic inflammation, fat necrosis, and fibrosis, they are grouped into mesenteric panniculitis, mesenteric lipodystrophy, and sclerosing mesenteritis. Diagnosis is suggested by radio imaging modalities such as computed tomography scan that has to be confirmed by histopathological examination (HPE). Mesenteric panniculitis is usually seen in adults with an average age incidence of 60 years. Males are more affected compared to females. We present two cases of mesenteric panniculitis presenting at a young age of 16 and 20 years, respectively. Many benign and malignant conditions of abdomen mimic mesenteric panniculilitis clinically, which stress on the importance of HPE for definitive management.

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A middle-aged male presented with gradually progressive fatigue and dementia. He was anemic, jaundiced, had cardiomegaly, a multinodular goiter, diffuse muscle wasting, Lhermitte's sign, and features of neuropathy. Patient was found to be Vitamin B12 deficient as a part of anemia evaluation with associated subclinical hyperthyroidism. Anti-thyroid peroxidase antibody was positive. Pernicious anemia as a part of polyglandular syndrome could not be proven as Schilling's, and other tests were not available. Magnetic resonance imaging of the spinal cord was done to evaluate the muscle wasting which showed myelopathic changes. B12 correction was started which reversed jaundice and anemia. Echocardiogram showed dilated cardiomyopathy probably due to chronic anemia and subclinical hyperthyroidism. The patient was symptomatically better at discharge. On follow-up, the patient had markedly improved symptomatically as well as biochemically. The fact remains that a simple problem might be compounded by a multitude of findings while a major diagnosis and its management would solve a majority of problems faced by the patient.

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Mesothelial cysts are rare intra-abdominal fluid-filled cysts that are detected commonly in females on radiological evaluation. Porta hepatis is an uncommon site for these lesions. A 40-year-old female presented with abdominal pain of 2 months duration. Her computed tomography abdomen showed a cystic lesion at the porta hepatis in close proximity to hepatic artery and magnetic resonance imaging showed normal bile duct with a separate cystic lesion at the porta hepatis. Since there were no features of malignancy, a laparoscopic approach was used for cyst excision. With careful dissection, cyst could be excised laparoscopically leaving a small rim of tissue adjacent to hepatic artery. Histological examination showed calretinin positive cells lining the cyst consistent with the mesothelial cyst. At 6 months of follow-up, patient is doing well without signs of recurrence.

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Postpartum complications are diverse. Electrolyte imbalance with hypernatremia can occur secondary to underlying postpartum complication or can arise de novo. Hypernatremia causes demyelination similar to hyponatremia but predominantly involves extra-pontine structures. Here, we present two cases, one classical and another a variant of a recently described entity called postpartum hypernatremic encephalopathy with osmotic demyelination. The more classical appearance is altered signal intensity changes in the posterior limb of internal capsules, external capsule, crus cerebri, corticopontine tracts, middle cerebellar peduncle, hippocampus, fornix, and cerebellar white matter with classical wine glass appearance on coronal T2-weighted images. The nonclassical case shows a different and atypical imaging finding of the same disease with small focal transient altered signal intensity changes in the splenium of corpus callosum. Both the patients recovered with conservative management of the electrolyte imbalance.

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Background: In the emergency department (ED), patients with no prior history of diabetes and with hyperglycemic capillary blood glucose (CBG) levels, an opportunity exists to detect undiagnosed diabetes. High glycosylated hemoglobin (HbA _1c ) levels in these patients could indicate underlying diabetes or prediabetes. Aim: To determine whether hyperglycemia in patients coming to ED without a history of diabetes is associated with elevated HbA _1c levels. Methods: A prospective correlational study of adults aged 18 years and more, presenting to ED with random CBG more than 140 mg/dL were enrolled. The patients with a history of diabetes were excluded. HbA _1c levels were checked in these patients and correlation was analyzed. Results: A total of 107 patients were enrolled and CBG levels were correlated with HbA _1c levels (r = 0.71, P < 0.0001). The median glucose and median HbA _1c levels were 201 mg/dL and 6.3%, respectively. The median time elapsed since last meal was 5 h (25-75% interquartile range, 4-9 h). Overall, 42.1% of the cases had elevated HbA _1c levels ≥6.5% while as 40.2% showed HbA _1c levels between 5.7% and 6.4%, which means 82.2% were either diabetic or prediabetic by HbA _1c criteria. Conclusion: CBG has a good correlation with HbA _1c . Therefore, in ED, HbA _1c should be considered in patients with CBG more than 140 mg/dL with no prior history of diabetes in order to uncover hidden diabetes/prediabetes and to exclude stress hyperglycemia.

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