A 52-year-old male patient of right sided tuberculous pleural effusion developed fever with chill and rigor 12 days following therapy with antituberculous drugs. After careful clinical evaluation and investigations, it was proved to be a case of drug-induced fever. Isoniazid (H) and rifampicin (R) were found to be the offending drugs in re-challenge test. He was subsequently put on a modified regimen excluding these drugs and he made an uneventful recovery. We are reporting this case because of very rare occurrence of drug-induced fever with both R and H and presence of few atypical manifestations of drug fever in this case. Drug induced fever should be considered in a patient of tuberculosis developing fever during chemotherapy. Drug fever may sometimes be produced by more than one drug simultaneously.

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Introduction: Microbial contamination of operating theaters (OTs) is a major cause of nosocomial infections (NIs). Purpose: Thus, the purpose of this systematic review was to determine the degree of contamination present on OTs and to evaluate the methodological quality of this evidence. Materials and Methods: Published studies from December 2000 to December 2012 were identified in nine major databases. Methodological quality was evaluated using a quantitative critical appraisal tool. Data were extracted and analyzed using four major outcome measures. Results and Conclusion: A total of 45 studies were identified investigating the levels of microbial contamination on OTs; of which 26 were included in the review. The included studies reported that 51.3% of all sampled air/articles/surfaces of OTs were contaminated. However, the majority of microbial contamination and hence any risk of acquiring a NIs can be reduced substantially by implementing the infection control measures. Further research is also required on the role of OTs in NIs.

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Variations in the circle of Willis are common. However, incomplete formation of circle of Willis due to bilateral abnormal origin of posterior cerebral arteries and bilateral absence of posterior communicating arteries is very rare. We report an unusual case of abnormal origin of the right posterior cerebral artery from the right internal carotid artery and continuation of basilar artery as left posterior cerebral artery in a 60-year-old male cadaver. The posterior communicating arteries were absent on both sides; hence, the arterial circle of Willis was incomplete. Furthermore, clinical and surgical importance of this case and relevant literature is discussed. The case of bilateral abnormal origin of posterior cerebral arteries, bilateral absence of posterior communicating arteries, and incomplete formation of posterior segment of circle of Willis is very rare. Precise knowledge of such variations in the cerebral vasculature is essential for anatomists, clinicians, and neurosurgeons.

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Background: Pseudomonas aeruginosa is an aerobic, motile, Gram-negative rod which is responsible for 10% of all hospital-acquired infections. Objectives: This study was conducted to determine the frequency, risk factors and antibiotic resistance pattern of P. aeruginosa isolated from various clinical samples. Materials and Methods: Present retrospective hospital record based cross-sectional study included a total of 6280 clinical samples collected from patients at a tertiary care hospital, South Odisha, India from January 2011 to December 2012. Samples were processed and identified by standard protocol. The P. aeruginosa was tested for antibiotic resistance by Kirby-Bauer disc diffusion method (according to Clinical and Laboratory Standards Institute guidelines). Results: From 6280 clinical samples, 3378 (53.8%) samples yielded significant growth and 327 samples were positive for (9.7%, 327/3378) P. aeruginosa (6.8% of nosocomial and 2.9% of community-acquired infections). Maximum 221 (67.6%) isolates were obtained from pus/swab, followed by urine 15% and blood (4.9%). Elderly, in-patients and invasive procedures were found to be significant risk factors in the setup investigated (P < 0.05). Out of 327 isolates, 277 (84.7%) isolates were multidrug-resistant, 99 (35.7%, 99/277) isolates were extensively drug-resistant. No pandrug-resistant isolate was obtained. Majority of isolates were sensitive to imipenem, meropenem and piperacillin/tazobactam, showed the least resistance rate of 6.4%, 8% and 11.3% respectively. Conclusion: This hospital based epidemiological data will help to implement better infection control strategies and improve the knowledge of antibiotic resistance patterns among clinicians. Thus, there is a need for periodical antimicrobial surveillance to monitor the resistance patterns in local hospitals.

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Aging of population due to downward trends in fertility and mortality is a major concern worldwide, particularly in developing countries. Due to prolonged life span there is a notable increase in the proportion of elderly patients who need dental care. Dental treatment should be adapted based on the age related oral mucosal changes and underlying systemic conditions. Dental professionals play a key role in diagnosing the oral manifestations of systemic diseases in older people. This paper reviews the effect of aging on oral tissues and the common oral and systemic conditions in geriatrics. The review of literature was done electronically as well as manually. For electronic search, various scientific journals and web-based search engines were used. The search terms were geriatrics, oral manifestations, systemic diseases, elderly. Cross references of relevant articles were also retrieved. The review focuses on the common oral conditions like oral mucosal disorders, oral infections, dental and periodontal diseases including salivary gland disorders. Dental treatment for patients with systemic diseases like hypertension, diabetes mellitus, cardiovascular diseases and neurological disorders are also highlighted. Oral diseases in the elderly people should be managed by regular professional and personal care and requires an understanding of the changes that occur with advancing age.

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Goldenhar syndrome is a rare congenital malformation characterized by ocular, auricular and vertebral abnormalities of varying severity. It occurs world-wide with no racial or sex predilection. Although its etiology remains unclear, maternal exposure to viruses, chemicals and abnormalities of the vascular supply to the first arch have been implicated. We, therefore, report a case of a 2-year-old child with Goldenhar syndrome whose mother had a history of repeated falls and vaginal bleeding during pregnancy

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Background: Most of the data documenting serum leptin levels in diabetes comes from Caucasians and a very limited data is available pertaining to non-Caucasian subjects. The aim of this study was to determine serum leptin levels in Pakistani subjects and its correlation with fasting blood sugar (FBS) among normal and type 2 diabetic adults. Settings and Design: It was a case-control study including type 2 diabetic patients having FBS >126 mg/dl. Exclusion criteria included the subjects from whom the written consent could not be taken, the patients with acute inflammatory disease in the last 15 days (as acute inflammation may lead to hyperleptinemia) or FBS between 101 and 126 mg/dl. Control group consisted of nondiabetic subjects when FBS was <101 mg/dl. Materials and Methods: An observational study was carried out at Shifa College of Medicine, Islamabad. Serum leptin by sandwich enzyme-linked immunosorbent assay (ELISA) method, FBS by glucometer were measured in 64 type 2 diabetic patients and compared with their age-, sex-, and body mass index ( BMI)-matched nondiabetic controls. Statistical Analysis Used: Independent t-test was used to find out whether there was any statistical significance in between the two groups. Statistical significance was set at the 95% confidence level (P < 0.05). Pearson's correlation was used to find out the relation between serum leptin and FBS in diabetics. Results: Serum leptin levels were significantly (P < 0.05) high in diabetics when compared with the control group. A significant positive correlation was found between serum leptin and FBS. Conclusions: On the basis of our results, we conclude that type 2 diabetic Pakistani subjects have high serum leptin which correlates positively with FBS.

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Actinomycosis of the breast is extremely unusual. Primary actinomycosis of the breast has been reported in patients who presented with a lump, clinically simulating malignancy. Literature search reveals very few cases of actinomycosis of breast. However, actinomycosis of breast associated with breast carcinoma is even more rare. We report a rare occurrence of actinomycosis of breast in a case of invasive duct carcinoma of the breast.

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Background: Idiopathic ventricular tachycardia (VT) accounts for approximately 10% of all patients referred for evaluation of VT. 3-D mapping system has proved very useful in ablation of complex arrhythmias e.g. atrial fibrillation and VT in structural heart disease. The aim of the current study is to evaluate safety and efficacy of new 3-D mapping system in idiopathic VT ablation and comparison of between contact (Carto™) and noncontact (EnSite Array™ Catheter) mapping systems. Materials and Methods: Study population included 62 patients with idiopathic VT. (27 female 35 male, mean age 43.5 ± 22.4 years). Six patients had previously undergone unsuccessful ablation in other centers using conventional method. Site of VT/PVCs origin was RVOT in 44 (70.9%), LVOT in 4 (6.5%) and LV cavity 14 (22.6%) patients. VT was successfully ablated in 54/62 (87.1%) patients and ablation was not successful in 8/62 (12.9%) patients. VT was successfully ablated in all (6/6) patients who had previous failed ablation with conventional methods. Four (6.4%) patients developed procedure related complications. No patient with successful ablation had recurrence at six months follow up and 6/8 patients in whom ablation failed had recurrence during follow up. There was no difference in safety and efficacy of two mapping systems (success rate was 90.9% in EnSite and 82.5% in Carto (p 0.6)). Conclusion: New 3-D mapping systems (Carto™, EnSite Array™ Catheter) are very useful in ablation of idiopathic VTs with good acute success and short-term follow up. These systems are particularly useful in patients with failed ablation by conventional methods. There is no difference the two systems with regards to acute success, recurrence and complications rate.

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Transfusion-related acute lung injury (TRALI) is a clinical syndrome typically presenting as an acute respiratory distress characterized by dyspnea, hypoxemia, and bilateral non-cardiogenic pulmonary edema, developing within 6 h of transfusion of as little as 50 mL of blood product. TRALI may occur as a result of passive transfer of antibodies against leukocytes or tissue antigens and/or biological response modifiers from any donor blood product, resulting in damage to the recipient's pulmonary vasculature. Although, in most of the cases, recovery is quick and complete, severe cases may require prolonged ventilatory support. TRALI can be fatal if urgent intervention is not undertaken and carries the highest fatality among all transfusion-related reactions. The blood banks need to identify donors whose plasma contains antibodies implicated in TRALI, in order to prevent its occurrence. We describe a case of TRALI following the transfusion of 200 mL of whole blood in a 35-year-old female diagnosed with an acutely ruptured ectopic pregnancy. She recovered after intensive management with ventilator and hemodynamic support.

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Background: Foot problems are the main manifestations of people with diabetes and the complex clinical presentation of foot problems such as ulcers, infections and neuropathic arthropathy in persons with diabetes is known as diabetic foot syndrome. Objective of the Study: The aim of this study was to perform a systematic review and quantitative analysis of articles on "foot or ankle" published in diabetes journals indexed in PubMed. Methodology: A total of 19 journals indexed in PubMed with "diabetes" and "diabetic" terms in their titles were obtained through advanced search feature. Search terms of (foot or feet [Title] or ankle or ankles [Title]) were used to obtain articles published from January 2011 to December 2011 through search filters option. The number of obtained articles was used to calculate the overall reporting rate, with respect to the total number of published articles. The journal-specific comparisons were also done for the number of authors per article, nationality of the corresponding author, type of article, type of approach, focus area, clinical manifestation and goals of care, model of care, study designs and center for evidence-based medicine levels of evidence. All categories and sub-categories were descriptively reported using frequencies. Results: The overall number of the author per article was 4.42 ± 2.75. There were more articles published from USA, more original articles, more articles on practice, more on ulcer, more on treatment, more on biological model, narrative reviews in level-5 evidence, both overall and between-journal comparisons. There were very few articles on prevention, education and research, biopsychosocial model, systematic reviews and randomized controlled trials. Conclusion: The overall reporting rate for "foot and ankle" articles in diabetes journals was 1.85% (63/3401). The study findings are important for existing journals to modify their editorial and/or publishing policies and for new journals in the field of diabetes and metabolism research.

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Pseudarthrosis of tibia is characterized by segmental osseous weakness, resulting in anterior angulation of the bone. We report a case of early changes of pseudoarthrosis on 3-Tesla magnetic resonance imaging (3T-MRI) in a pediatric patient with clinical manifestations of neurofibromatosis type 1. Early pseudarthrosis is seen as sheet-like soft tissue which is hyperintense on fat-suppressed T2 WI, isointense signal on T1 WI, and shows enhancement after administration of contrast material. This case highlights the utility of MRI which complements radiography in the diagnosis and follow-up of congenital pseudarthrosis of the tibia in pediatric patients as it helps in detecting and evaluating subtle soft-tissue changes. To best of our knowledge, findings of pseudarthrosis on 3T MRI have not been previously described.

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Context: Diabetic retinopathy (DR) is a serious eye complication of diabetes mellitus and a leading cause of blindness among the working population. The ophthalmoscopy can screen, detect, and follow-up DR. However; it appears medical practitioners (MPs) rarely do ophthalmoscopy on diabetic eyes. Aims: To determine the knowledge, attitude, and practice (KAP) of ophthalmoscopy in diabetics among MPs in Kebbi State, Nigeria. Settings and Design: KAP survey using participants' self-administered questionnaire. Subjects and Methods: A survey of 70 consenting MPs attending Continuing Medical Education (CME) in 2012 using self-administered structured questionnaire on ophthalmoscopy and eyes in diabetic patients. Statistical Analysis Used: The analysis was done using simple frequency proportions/cross tabulations and Fisher's exact test for significance. The P < 0.05 was considered as statistically significant. Results: Most MPs were affirmative on their knowledge (67, 95.7%; P = 0.055) and use (52, 74.3%; P = 0.028) of ophthalmoscope, and interest in being trained on how to use it (41, 58.6%; P = 0.201). However, two (2.9%) wrongly thought ophthalmoscope was used to measure intraocular pressure, one (1.4%) was oblivious of ophthalmoscope, 18 (25.7%) did not know how to use it, and 27 (38.6%) were uncommitted whether they wanted to be trained on how to use it. Most MPs (54, 77.1%) understood diabetic retinopathy (DR); however, 15 (21.4%) wrongly equated DR to all eye changes in diabetics and one (1.4%) admitted not knowing it (P = 0.649). Most (58, 82.9%) knew that diabetes mellitus affects the eye, 10 (14.3%) did not and two (2.9%) were uncommitted (P = 1.000). Most 68 (97.1%) thought ophthalmoscopy was necessary in all diabetics, while two (2.9%) did not (P = 0.709). Many (47.1%) had ever conducted ophthalmoscopy in diabetics, while 37 (52.9%) never (P = 0.036). Many MPs (34, 49%) always attended to diabetics; however, some 7/20 (35%) thought referring diabetics for eye consultations unnecessary. Conclusions: The surveyed MPs knew diabetes mellitus affects eye, but many never done ophthalmoscopy in diabetics and only few referred them for eye specialists' assessment. The need for MPs to pay particular attention to assessment of diabetic eye disease and refer appropriately underscored.

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The report describes the case of a 38-year-old woman with a giant inflammatory myofibroblastic tumor of the mesentery. She presented with a painful epigastric mass. The patient noticed a gradual increase in the size of the mass and worsening pain accompanied by nausea and infrequent vomiting for two weeks prior to consultation. Physical examination revealed a large, firm, slightly tender mass occupying the epigastric region and left hypochondrium. A computed tomography scan showed a huge abdominal mass displacing the bowel loops and encasing the mesenteric vessels. The mass was completely resected along with the infiltrated parts of the small intestine. The final histopathological diagnosis was inflammatory myofibroblastic tumor (IMT) originating from the mesentery. Follow-up for two years revealed no recurrence. Once a diagnosis of IMT is confirmed, adequate surgical resection should be performed to avoid local recurrence.

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