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Acute myeloid leukemia (AML) is a malignant disease of the bone marrow in which hematopoietic stem cells fail to differentiate. Overproliferation of these abnormal cells results in suppression of the normal components of the bone marrow. Aleukemic leukemia is a type of leukemia in which abnormal (or leukemic) cells are absent in the peripheral blood. We put forth a unique case of aleukemic leukemia presenting as gingival enlargement, that was diagnosed by immunophenotyping and flow cytometery as acute monoblastic leukemia (AML FAB 5a).

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Two or three notches on the superior border of spleen are not an uncommon presentation. As many as seven notches were observed in a spleen of 32 year old female in Rural Medical College, PIMS, Loni, Maharashtra, India, during autopsy. Along the superior border of spleen six notches were present and one notch was observed on the broad anterior pole. A 2.8 cm long fissure was also seen on the renal visceral surface of the specimen. This unusual anatomical variation may lead to difficulty while distinguishing the spleen from adjoining organs in patients of splenomegaly. The variation is explained on the basis of embryological development. A sound knowledge of such variation is essential for physicians, surgeons, radiologists, and of course the anatomists.

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Flail chest in thoracic injuries can be a cause of concern, as in the presence of associated injuries; it carries high morbidity and mortality. Flail chest injuries usually result from deceleration injuries and may be associated with sternal fracture, aortic and tracheobronchial disruption. Flail chest influences the morbidity encountered in multiple injured patients. The clinical presentation of the flail chest depends on the size of the flail segment, the intrathoracic pressure gradient during breathing, and the associated injury to the lung and thoracic wall. Treatment of these patients depends on the physiologic impairment caused by the flail segment and the severity of other associated injuries.

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The evolution of modern neurosurgical techniques in traumatic brain injury has been ongoing for the last two centuries. However, it has always been a challenge to obtain an effective clinical outcome, especially in those following severe traumatic brain injuries. Other than the well-established procedures for acute and/or chronic subdural hematomas and depressed skull fractures, newer avenues for the development of surgical techniques, where indicated, have been minimal. The study proposes to apply the principles of microvascular surgery and skull base surgery in selected cases of severe traumatic brain injuries.

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Introduction: Cholelithiasis is the most common biliary pathology, with prevalence of 10-15%. In 1992, National Institute of Health consensus development stated that laparoscopic cholecystectomy "provides a safe and effective treatment for most patients with symptomatic gallstones" and it is the treatment of choice for cholelithiasis. This study is undertaken to determine the predictive factors for difficult laparoscopic cholecystectomy. Methodology: A prospective open-labeled study was carried out at Padmashree Vasant Dada Patil, Government Hospital Sangli, a tertiary center and teaching hospital in Western Maharashtra that is attached to Government Medical College, Miraj. All patients presenting with upper abdominal pain, or vomiting or dyspepsia or jaundice from January 1, 2011 to December 31, 2013 were screened for cholelithiasis. Ninety-nine cases diagnosed with cholecystitis following exclusion criteria and undergoing laparoscopic cholecystectomy were considered for the study. They were evaluated with following risk factors: age >50 years, male gender, body mass index (BMI) 25.1-27.5 and >27.5, previous surgery, prior hospitalization, palpable gall bladder, gallbladder wall thickening, impacted stone, and pericholecystic collection. Each risk factor was given a score preoperatively. The total score up to five predicted easy, 6-10 difficult and >10 very difficult. Statistical analysis was performed using Fischer's Test for qualitative data and unpaired t-test for quantitative data. Results: BMI >27.5 history of prior hospitalization, palpable gallbladder, impacted stone and pericholecystic collection are significant predictors of difficult laparoscopic cholecystectomy. Conclusion: The proposed scoring system had a positive prediction value for easy prediction of 94.05% and for difficult prediction of 100%.

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Introduction: Maintaining oral hygiene and handwashing is critical in preschool children for disease prevention; however, limited information exists on the educative value of interventional programs in increasing knowledge among preschool children. The current study evaluated the knowledge and practices of hand and oral hygiene before and after a health educational intervention in preschool settings in Malaysia. Methodology: In a cross-sectional interventional study, 168 preschool children from a kindergarten at Tadika Juju in Petaling Jaya, Malaysia, were included. A pretest questionnaire evaluated the knowledge across different domains of oral and hand hygiene techniques and habitus, followed by an interactive education intervention. Training was conducted via hands-on demonstration, audiovisual videos, posters, and images (handouts/flyers). The impact of educational intervention on knowledge was evaluated 1 month after the initial training using the same questionnaire as used in the pretest survey. Each evaluation form had 10-graded questions, and the cumulative maximal score that could be attained based on the adequate responses to individual questions was 25. The scoring for each participant was categorized into poor (score: 0–9), average (score: 10–19), and good (score: 20–25) based on their scores for their responses. The difference between the means of pre- and postintervention mean scores across the predefined ratings of poor, average, or good was assessed using a paired t-test. Results: Overall, a significant improvement in knowledge on oral health and hand hygiene after the intervention was noted in the study participants (P < 0.05). The improvement in mean test scores following intervention was evident across both male and female children. Conclusion: Intervention programs should be implemented to increase the awareness and knowledge of preschool children for adequate maintenance of oral and hand hygiene practices, thereby averting the burden of preventable infectious diseases.

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Objective: Patients of polytrauma due to road traffic accident, fall from height, sports injury with blunt chest trauma, as well as penetrating injury to chest were investigated for pneumomediastinum and pneumopericardium, which may prove life threatening. Material and Methods: This study was retrospective for three years and prospective for three years and was conducted in the department of cardiovascular and thoracic surgery at the Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir for six years. All patients who reported to the hospital as polytrauma were investigated by noncontrast computed tomography (CT) scan of the chest. We did 1,350 CT scans of the chest for blunt and/or penetrating chest trauma in the last six years as a part of emergency investigations. All chest CT scans were investigated for pneumopericardium, simultaneous with other traumatic pathologies. Results: Of the 1,350 chest CT scans, 930 were normal. Twenty-one patients had pneumomediastinum in addition to other primary surgical pathology. Of these 21 patients with simultaneous pneumomediastinum, eight patients had associated pneumopericardium; five patients with pneumopericardium had blunt chest trauma as etiology and three patients had penetrating trauma as etiology for pneumopericardium. Conclusion: To overcome the fatality of pneumopericardium, two important approaches need to be followed. The first is continuous monitoring of blood pressure and the second is the availability of an immediate facility for drainage of pneumopericardium. Pneumomediastinum is obligatory for pneumopericardium to occur.

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Giant fibroadenoma is an uncommon variant of fibroadenoma with an overall incidence of <4%. It is common in adolescent age group and is seldom seen in elderly. Often surgeons might encounter a diagnostic dilemma between phyllodes tumor (PT) of the breast and a giant fibroadenoma. We herein report a similar case of a middle-aged woman with an unusually large fibroadenoma of the breast mimicking a PT and emphasize the role of fine-needle aspiration cytology in differentiation of these two different breast entity.

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Cerebellar nodulus (lobule X) is an anterior and inferior structure of the vermis and is the epicenter of flocculonodular lobe (vestibulocerebellum). Nodulus coordinates with the vestibular nuclei through afferent Mossy and efferent Purkinje fibers and plays a pivotal role in maintaining balance and is responsible for vestibulo-ocular reflex. Any lesion disrupting these fiber tracts impairs the person's ability to control ocular movements during head tilting and posture while standing and walking. Isolated infarction of nodulus is extremely rare with only few cases been reported earlier. In this article, the authors present a case of an elderly female with severe giddiness and cerebellar signs and were diagnosed to have an isolated cerebellar nodulus infarction on imaging studies. Conservative management to which our patient responded well is also discussed.

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Depression is the most common psychological symptom in patients with systemic lupus erythematosus (SLE). A large fraction of these patients remains undiagnosed due to subclinical presentation or is missed in the routine workup of SLE. Many factors have been reported in the literature which can be used as predictor of depression in SLE. Lupus patients also have higher risk of suicidal tendencies than the general population. Pathogenesis of depression in SLE is multifactorial and involves complex interactions between cytokines, antibodies, genetic factors, etc. Approach to such patients consists of studies that establish diagnosis of SLE, distinguish between organic and functional etiologies, and exclude symptoms not due to SLE. Various hematological, cerebrospinal fluid investigations, electroencephalography, psychometric testing, as well as neuroimaging modalities are involved in diagnostic workup of lupus patients with depression. Patients with only psychological causes for depression are treated with antidepressants. While in case of organic disease, one treats with glucocorticoids, immunosuppressants, and antidepressants. Electroconvulsive therapy can be considered in very severe cases not responding to maximum therapy.

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Introduction: Oral health is an important aspect of health for all children and is all the more important for children with special needs. Aim: To evaluate the oral health status of special health need children at Vidya Sudha, a day care centre in Chennai. Materials and Method: A modified WHO oral health assessment form was used to assess the caries experience, gingival, and oral hygiene status. Result: Data were analyzed using ANOVA and chi-square test. No statistical significant differences were found between the evaluated groups regarding age or gender, and medical conditions. Conclusion: Majority of the children had poor oral hygiene, showing high caries prevalence as well as moderate gingivitis.

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Idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri, may occur at any age but is primarily a disease of obese women between the ages of 15 and 40. Diagnosis is made based on modified Dandy criteria, which include normal neuroimaging studies, elevated intracranial pressure (ICP) on lumbar puncture, signs and symptoms of elevated ICP, and a non-focal neurologic examination aside from sixth nerve paresis. Presenting symptoms include headache, pulsatile tinnitus, transient visual obscurations, diplopia, and visual field constriction. Diagnosis may be delayed because headache from other causes such as migraine is much more common, and patients may be treated for this condition without improvement before the actual diagnosis is recognized. Ophthalmologic signs may include papilledema and esotropia (from the sixth nerve palsy) as well as visual field and even visual acuity loss; the latter two signs are very ominous, as they indicate severe and potentially permanent visual damage. Medical and surgical options vary depending on the severity of the disease and are used to control headache as well as to prevent vision loss. Because most IIH is associated with obesity, weight loss is an essential element of any treatment regimen, as retrospective as well as prospective studies have shown disease resolution with as little as 6% weight reduction. Secondary causes of high ICP are being recognized in a greater number of IIH patients, and the term "idiopathic" likely applies to fewer patients than in the past. The underlying pathogenesis of the disorder remains elusive.

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Rapid resolution of post-traumatic acute subdural hematoma is infrequently reported. We report a case of rapid spontaneous disappearance of post-traumatic acute subdural hematoma in one patient who was discovered to have a contralateral middle cranial fossa arachnoid cyst. The previously reported mechanisms responsible for the rapid spontaneous disappearance of post-traumatic acute subdural hematoma are reviewed and the contribution of the middle cranial fossa arachnoid cyst to the disappearance of the pos-traumatic acute subdural hematoma that has taken place in our case is discussed. To the best of our knowledge the association between spontaneous disappearance of post-traumatic acute subdural hematoma and arachnoid cysts has not been previously reported.

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Osteochondroma is the most common benign bone tumor and often diagnosed as an incidental finding. Most are asymptomatic, however significant pain, and pressure symptoms warrant excision. Most common location of solitary exostosis is metaphysics around the knee. We are reporting a case of a 14-year-old boy who presented with a swelling over the anterior aspect just below the mid-thigh level on the right side. Characteristic radiological features of exostosis were documented on plain radiograph and magnetic resonance imaging. Growth was excised, and diagnosis of solitary exostosis arising from diaphyseal region was confirmed on histopathology examination. This case report documents the uncommon diaphyseal location of solitary exostosis in an adolescent. Symptomatic lesions warrant excision.

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Introduction: India accounts for 274.9 million global tobacco users and approximately 120 million tobacco smokers. It is predicted that tobacco deaths in India may exceed 1.5 million annually by 2020. Considering the hazardous impact of smoking upon the health of an individual, we conducted this investigation to evaluate the magnitude of this increasingly distressing public health concern among youngsters enrolled in university courses at various educational institutes in the state of Andhra Pradesh, India. Methodology: A cross-sectional questionnaire based study was conducted among youngsters at various educational institutions in Andhra Pradesh, India. The structured questionnaire was developed to assess the number of youngsters habituated to smoking and to know their attitude, knowledge, and behavioral responses toward smoking tobacco. Results: A total of 4394 responses were collected from Andhra Pradesh. The mean age of the respondents was 20.4 ± 2.9 years and 67.6% were males. The overall smoking rate was found to be 41.03%. Of the total respondents, 1254 (28.5%) were enrolled in pre-university course, whereas graduates and postgraduates constituted 2348 (53.4%) and 792 (18.0%), respectively. A majority of smokers (72.6%) and nonsmokers (91.6%) stated that people adapt to smoking as a fashionable trend, while only a meager (12.1%) respondents thought stress as a stimulant to resort to smoking habits. 44.9% respondents felt smoking cigarettes in a group increased interaction among their peers; 81.1% confessed to initiation of smoking during their teenage years; About 66.8% admitted to smoking up to 5 cigarettes/day, while 76.2% were aware of the fact nicotine in cigarettes causes addiction. Of the suggested measures to quit smoking, 64.9% of the respondents recommended prohibition of smoking at public places, 66.1% advised cigarettes to be made expensive, 87.2% sought counseling by a physician or a pharmacist as a valuable resource to help youngsters curb their smoking habits and 77.1% thought the use of e-cigarettes could be a potential alternative measure to avoid tobacco smoking. Conclusion: A high percentage of youngsters admitting to smoking cigarettes as demonstrated from our survey highlights a poor indicator of national health status. Perhaps, it also reflects a failure of state government policies aimed to prevent tobacco use. The need to formulate stringent policies to guide youngsters to understand the deleterious effects of tobacco, including but not limited to, advertisements, banners, setting up of de-addiction and counseling centers, national wide campaign and broadcasting should be done.

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Odontomas are the malformation of the dental tissues constituting for 22% of all the odontogenic tumors. Odontomas are benign, nonaggressive, sometimes interfering with the eruption of the associated tooth, leading to impaction or delayed eruption. They are usually painless with neuralgic symptoms presenting only on compression of nerves which is rare. Due to its limited growth potential, odontoma rarely shows their evidence, unless it is secondarily infected or causes complications such as displacement/uneruption of associated tooth, swelling, pus discharge, and esthetic problems which can be avoided on early diagnosis. The purpose of this article is to highlight on the notable presentation of complex odontoma with large swelling and abscess drainage in a very young patient.

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Introduction: The association between ABO blood groups and intracranial aneurysms is not well-understood. Many co-morbid factors are associated with intracranial aneurysms. The prevalence of different blood groups and associations with the risk factors in patients with intracranial aneurysms are reviewed. Methodology: A retrospective analysis was conducted on patients presenting with intracranial aneurysms and undergoing active neurosurgical intervention at the Louisiana State University Health Sciences Center between 1 ^st January 1993 and 31 ^st December 2012. A total of 1248 patients were identified for the analysis. Data pertaining to demographics and clinical characteristics of these patients were extracted from the electronic patient records by two authors independently. A univariate and multivariate analysis was performed to investigate the association of ABO blood groups with risk factors in patients with intracranial aneurysms. Results: The most common ABO blood group in our study population was O (543 cases, 43.5%), followed by group A (525 cases, 42%). Blood group A (46% vs. 35.5% patients; P = 0.01) and blood group B (18% vs. 7% patients; P = 0.000) were significantly associated with the development of intracranial aneurysms in Caucasians and African Americans, respectively. We found smoking (P = 0.01) and hypercholesterolemia (P = 0.006) to be an independent risk factor for the development of intracranial aneurysms in blood group O and blood group A, respectively . Conclusion: Racial disparity in the distribution of blood groups and risk factor association with blood groups in the development of intracranial aneurysm needs to be considered. The findings from our study may be useful in identifying patients at increased risk of developing intracranial aneurysms.

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We report a case of a 35-year-old male who presented to our emergency room with debilitating, complete, irreducible, edematous rectal prolapse along with retention of urine. Due to marked edema and inflammation, the reduction was unsuccessful under general anesthesia; hence a conservative approach was considered. With local sugar application for a week, the edema was reduced and via manual digital maneuver, the prolapse was reduced with anal encirclement the day after to maintain the reduction. With our experience, where laproscopic facilities were unavailable, we wish to highlight the role of nonsurgical/conservative conventional methods of management of such severe cases that are associated with edema and present to clinics/institutes where limited surgical facilities are available.

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Pulmonary hyalinizing granuloma (PHG) is a rare disorder and is a pertinent differential for lung diseases with multiple pulmonary nodules. Natural history of this disease is not known. Although the usual course is benign, a close follow-up of these cases is necessary. We herein report a case of PHG involving the diaphragm and the heart, detected on autopsy in a 57-year-old male who suffered a road traffic accident.

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Periodontal diseases are major causes of tooth loss and contribute to significant morbidity and healthcare costs. Therefore, identifying areas that deliver substantial returns with community-based preventive programs are a dire necessity. Planning and implementing preventive measures in periodontal oral care require identification of not only a population with current disease burden, but also of future susceptibility to disease. All major periodontal indices that have been used in community periodontal surveys are designed to identify either severity, prevalence, or treatment needs of periodontal diseases. No known index exists based on scientifically proven risk factors of periodontal disease to identify population susceptible to the disease, and to determine the need for preventive planning and interventions. In this article, a simple questionnaire-based index has been proposed to identify both individual and community susceptibility to periodontal disease.

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