A 30-year-old painter developed pain in the right posterior shoulder region after 1 month of intensive work. Pain intensified as he continued his job, and finally he noticed weakness of the involved shoulder, which led him to seek medical advice.He was referred to Physical Medicine and Rehabilitation from orthopedics as a case of rotator cuff injury. Examination was normal except for atrophy of infraspinatus and supraspinatus muscle on the involved side and decreased strength of shoulder on abduction and external rotation. Routine X-ray were normal. Electromyographic examination demonstrated denervation of the right infraspinatus and supraspinatus muscle. A diagnosis of right suprascapular neuropathy was made. The patient is being treated conservatively since the past 3 months and has showed significant improvement in power and relief in pain.

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Contraception is essential for a woman as it helps to achieve autonomy in personal life and avoid unwanted pregnancy. Adequate contraception is even more essential for women with epilepsy (WWE) due to potential maternal and fetal risks of antiepileptic drugs (AEDs) and poor seizure control. There are several hormonal and nonhormonal contraceptive options available for WWE, with combined oral hormonal pills being used most commonly. The choice of contraception in WWE is influenced by many factors, chief among these being potential drug interactions between contraceptive hormones and enzyme inducing antiepileptic drugs (EIAEDs). While EIAEDs may increase metabolism of contraceptive hormones leading to contraceptive failure, contraceptive hormones in turn may increase metabolism of AEDs resulting in their faster elimination and breakthrough seizures. The co-administration of lamotrigine and oral hormonal pills is especially complicated by unpredictable interactions and requires several considerations. In this review, we try to address various issues concerning the use of different contraceptive modalities in WWE. In addition, we review the current guidelines for concurrent use of hormonal contraception and AEDs in WWE.

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Introduction: Pregnancy has a significant impact on thyroid gland and its function. Hypothyroidism, usually evident as subclinical hypothyroidism, occurs in approximately 2.5% of otherwise normal pregnancies, and is associated with various morphological, histological, and histochemical changes in the placenta. It is, therefore, obvious that hypothyroidism is associated with gross placental abnormalities that compromise placental function and hence fetal growth. Material and Methods: This prospective, observational study was conducted over a period of 1 year from August 2013 to July 2014 in a tertiary care teaching hospital in the state capital of Uttar Pradesh of India. Two groups were formed. Group A (euthyroid) included placenta of uncomplicated pregnancy with full-term delivery to serve as controls for comparison. Group B (hypothyroid) included placenta of patients with hypothyroidism (thyroid stimulating hormone level: ≥3.0 IU/L) diagnosed either before or during pregnancy. Each placenta was observed for shape, diameter, and number of cotyledons. Two groups were compared for these variables. Statistical analysis was performed using Statistical Package for Social Sciences version 15.0 statistical analysis software. The values were represented in number (%) and mean ± standard deviation. P value was calculated for each variable, and P value less than 0.05 was considered to be statistically significant. Results: A total of 70 subjects were included. Group A comprised of 20 and Group B of 50 subjects. Circular shape of placenta was more common in group B and the difference was statistically significant (P = 0.037). Mean diameter, cotyledon size, and mean thickness were higher in group B as compared to group A. Statistically, significant differences between the two groups were observed for mean diameter (<0.001), cotyledon size (<0.001), and thickness (<0.05) Conclusion: Placenta of hypothyroid mothers was usually circular in shape. It was found to be less heavy and thinner but larger in diameter with more cotyledons in comparison to normal.

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Acral peeling skin syndrome (APSS), a subvariant of peeling skin syndrome, is a rare autosomal recessive genodermatoses characterized by spontaneous, periodic, painless desquamation of the skin limited to the dorsa of hands and feet. Histologically, skin peeling occurs due to the separation of stratum corneum from stratum granulosum. Here, we describe a case of APSS in association with transgradient palmoplantar keratoderma, with similar history in two younger siblings. Familial acral peeling skin syndrome in association with transgradient palmoplantar keratoderma has not been reported in literature.

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Objective: The aim of this study was to assess the frequencies of different kinds of vertigo patients in our vertigo clinic. Materials and Methods: A retrospective review of 149 walk-in patients at a specialized neurotology clinic in dizziness at a tertiary referral center is presented. Results: A total of 149 patients were included in the study, of which 57 (38.3%) were males and 92 (61.7%) were females. Seventy six (51%) patients were suffering from benign paroxysmal positional vertigo (BPPV), 37 (24.8%) were suffering from Meniere's disease, 23 (15.4%) were suffering from migrainous vertigo, and 8 (5.4%) were suffering from vestibular migraine. Five (3.4%) patients were suffering from vestibular neuronitis. Conclusion: BPPV was the most common cause of dizziness in this series. Awareness of this condition and a proper Dix–Hallpike test would aid in diagnosis and reduce unnecessary investigations and referrals. Re-evaluation and regular follow-up may sometimes be necessary if the diagnosis is elusive. Although central causes are not common, it is important that these conditions are excluded.

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Objectives: The purpose of this study was to find out incidence of renal cortical scintigraphy done with Technetium-99m (Tc-99m) dimercaptosuccinic acid III (DMSA-III), scan to diagnose cortical scarring in patients undergoing staged reconstruction of exstrophy bladder. Patients and Methods: We retrospectively reviewed 29 post operative patients who were referred to our department for Tc99m-DMSA scan to look for renal cortical scarring from January 2012 to April 2016. Tc-99m DMSA(III) scan was done in all 29 patients (58 kidneys). Tc-99m DTPA and Tc-99m L, L-EC scans were done in 9 (18 kidneys) and 2 (4 kidneys) patients respectively. Results: Out of 29 patients male comprised 69% of cases (n = 20) and female comprised 31% of cases (n = 09).The mean age of the presentation of patients with exstrophy bladder was 7.8 years. Tc-99m DMSA(III) scan was done in 29 patients (58 kidneys).Scarring was noted in 28/58 kidneys (48.27%) on Tc-99m DMSA(III) scan. Tc-99m DTPA scan was done in 9 patients (18 kidneys). In Tc-99m DTPA scan mean GFR (standardized Gates gamma camera method) was 71.91ml/min. Micturating cystouretherography(MCU) was done in 10 patients which revealed vesicoureteric reflux(VUR) in all the patients. DRCG was done in 1 patient which showed unilateral high grade VUR. Ultrasonography (USG) was done in 29 patients. Eighteen patients were found to have normal USG findings. Four patients had bilateral hydroureteronephrosis (HDUN) and one had unilateral HDUN. Three had mild hydronephrosis (HDN) and 3 had gross HDN. Conclusion: Preservation of renal function is one of the major goals of staged reconstruction of bladder exstrophy. Renal cortical scintigraphy with Tc-99m DMSA-III has become the “the gold standard” for renal cortical scarring imaging. Hence Tc-99m DMSA scan offers a significant diagnostic advantage over other diagnostic modalities to diagnose and follow up renal cortical scarring in patients with exstrophy bladder thus help in management.

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Introduction: Psoriasis is a common chronic inflammatory disease of the skin which is relatively less studied in children. Materials and Methods: A retrospective analysis of records of children (≤18 years of age) with psoriasis over a period of 5 years was conducted in the department of Dermatology of a tertiary care center. The results were described as percentages. Results: Out of a total of 1350 cases of psoriasis attending the Dermatology department, there were 171 (12.7%) children ≤ 18 years of age. Mean age of the cases was 12.0 ± 5.0 years. Mean duration of illness was 24.7 ± 32.9 weeks. Infection was the most common (8.8%) aggravating factor. Plaque-type psoriasis (60.2%) was the most common type of psoriasis, followed by guttate psoriasis (11.7%). Erythrodermic and pustular psoriasis were seen in 5.8% and 2.3% of the patients, respectively. Lower limb (67.2%) was the most commonly involved site followed by upper limb (55.5%). Nails were involved in 38% of the patients, pitting being the most common finding. Joint involvement was present in 3.5% of the patients. The body surface area involvement ranged from 0.3 to 95% (10.5 ± 21.9). The psoriasis area and severity index ranged from 0.3 to 39.2 (6.5 ± 7.9). Most of the patients (37.4%) were managed with topical therapy alone. Systemic therapy was used in the form of methotrexate in 5.3% patients and oral antibiotics in 4.6% patients. Conclusion: Psoriasis in children is not very common. In children also, plaque-type psoriasis is the most common presentation. Severe forms of psoriasis and joint involvement are less frequent. In general, psoriasis is relatively mild in children. Topical treatment is sufficient to control the disease in most of the cases.

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Fine needle aspiration (FNA) biopsy is commonly used in the diagnosis of thyroid diseases. Serious complications are rare and this procedure is generally safe. Acute suppurative thyroiditis (AST) after FNA has been seldom reported. We report a case of a 57-year-old women without any comorbidities, who developed AST after FNA. The patient was successfully treated by sonographically-guided percutaneous drainage and intravenous antibiotics as per Gram stain and culture sensitivity report. Percutaneous ultrasonography-guided aspiration can be performed as an alternative to surgical drainage in patients developing AST.

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Background: Demographic and economic changes in the past two decades and the resultant increase in noncommunicable diseases such as cancer, diabetes, heart disease, and mental and neurological conditions has burdened the developed, developing, and underdeveloped countries alike. Cancer deaths that occurred in developing countries alone contributed to 55% of all the cancer deaths that occurred in the year 1990. It is pointed out that there is a noticeable gap in cancer treatment in India in terms of diagnostics and management of the disease. In the preceding context, the present paper analyzes the emerging trends in cancer research in India and identifies the issues and challenges of access and equity in health innovations related to cancer treatment. Materials and Methods: The empirical analysis is performed on a unique dataset of publications and clinical trials related to oncological research. It was constructed from the Web of Science and Clinical Trial Registry of India databases. Results: With the application of emerging technologies, Cancer research and innovations exhibit new trends such as shift in the site of research, new funding patterns, collaboration pattern, and the emergence of new actors such as the contract research organizations. Conclusion: These trends have several implications for the access and affordability of medical innovations in cancer treatment.

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The dysembryoplasticneuroepithelial tumor (DNT) is an uncommon lesion characterized by a mixedpopulation of neurons, astrocytes, and oligodendroglia-like cells. It is important to be aware of this entity because it can mimic an oligodendroglioma orneurocytoma which needs more aggressive therapeutic interventions. We present two cases of DNT with unusual radiologic findings and discuss the literature review.

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The present case report reports hemangiomas of the interpectoral region presenting as unilateral gynecomastia in a young male of 16 years of age. On investigations, ultrasound and computed tomography of the chest revealed a soft tissue tumor with multiple spotted calcifications. After further investigations, excision was done and a final diagnosis of cavernous hemangioma was made by histopathological examination. Interpectoral hemangioma appears to be rare and should be included in the differential diagnosis of males presenting with unilateral gynecomastia and chest wall swellings.

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Heterotopic pregnancy is a rare complication of pregnancy. It can be a life threatening condition and can be easily missed if the diagnosis is overlooked. There is an increase in cases of heterotopic pregnancy in the last decade due to an increase in the incidence of pelvic inflammatory disease, tubal surgeries, pharmacologic ovulation stimulation, and assisted reproductive techniques. A timely diagnosis and intervention can save the life of the patient as well as the intrauterine pregnancy, which can be continued for a successful outcome. Here, we present three cases of heterotopic pregnancy that presented to our hospital over a period of 6 years with different clinical presentations who were treated with successful outcome.

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In this report we present four cases of unusual presentation of tuberculosis, one presenting as tubercular affection of thyroid, one as leukemoid reaction, one as peripheral neuropathy and one as thrombocytopenia followed by a hypercoagulable state leading to DVT.In a country like India where is incidence of tuberculosis is high, one should keep such unusual presentations of tuberculosis in mind while addressing the differential diagnosis of the case.

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