Introduction: The arteriovenous fistula (AVF) is the preferred access in patients starting on maintenance hemodialysis. The vasculature of the upper limb has a dominant role in determining the successful outcome of AVF surgery. Hence, we aimed to determine the various vascular parameters both preoperatively and postoperatively at prespecified intervals and their impact on AVF outcomes. Materials and Methods: It was a prospective observational study done during 18 months period. Ultrasound with doppler color flow evaluation was done to look for radial artery diameter, cephalic vein diameter, radial artery flow, and peak systolic velocity both preoperatively and postoperatively at postoperative day 1 (POD) 1, 8 weeks, and 3 months. Results: A total of 120 patients were evaluated with a mean age of 50.2 ± 12.01. The male: female ratio was 2.75:1. The etiology of the end-stage renal disease was diabetes-related in 41.6% and the remaining 58.4% were of nondiabetic. The overall success rate was 68.3%, with 31.7% failure rate. On comparison between the successful and failed AV fistula groups, a statistically significant difference was found in relation to the pre and post procedural vascular diameter and flow rates between the groups. The mean cephalic vein diameter in those with successful AVF was 2.17 mm and 1.90 mm in those with a failed AVF. Conclusion: In our study, the Cephalic vein size, radial arterial diameter, peak systolic velocity, radial artery flow rate preoperatively, and increase in flow rate at POD1 and POD 8 along with the increase in cephalic vein diameter were the predominant factors determining the success of the radiocephalic fistula. This is strong evidence that routine preoperative duplex ultrasonography reduces the rate of primary fistula failure and unnecessary surgical exploration when used for selection of vessels for AVF preoperatively as well as postoperative monitoring of AVF during the period of follow-up. A minimum arterial diameter of 2 mm is associated with successful fistula formation. Below this diameter, the ability of an artery to increase flow and dilate will determine fistula success.

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Background and Aims: Head and neck cancer is the most common type of cancer in word wide and Oral squamous cell carcinoma (OSCC) accounts for 90% of oral cancers and it represents the sixth most frequent malignant tumour world wide. The main etiological factor causing oral squamous cell carcinoma is tobacco consumption in the form of chewing or smoking, there are few virus such as Human Papilloma virus, Herpes simplex virus and Epistein barr virus are also contributory factor for causing oral squamous cell carcinoma. Among these viruses, Epstein Barr virus shown that increased risk of oral cancer. The present study was conducted to see association between Epstein Barr virus and oral squamous cell carcinoma using polymerase chain reaction technique. Methods: A total of 20 archival tissue blocks which are histopathologically confirmed OSCC and twenty cases of healthy mucosal tissue from retro molar area of the oral cavity. For all these cases DNA extraction was done and subjected to polymerase chain reaction. The results were analysed using statistical package for social sciences (SPSS) version 20.0. Results: Among twenty cases of OSCC twelve were males and eight were females. The mean age ranges from 51.25 ± 2 years in OSCC cases. Out of 20 cases of OSCC, 4 cases (20%) were positive and 16 cases (80%) were negative for EBV. Whereas the mean age ranges from 30.9 ± 2 years, and 11 were males and 9 were females in control group. Among 20 controls, 10 controls (50%) were positive and 10 controls (50%) were negative for EBV. Conclusion: The prevalence of EBV was significantly high in controls than OSCC cases. These observations suggest that location such retro molar area is one of the important factors for considering prevalence of EBV. Further studies with large sample size required to draw the role of location, habits in pathogenesis of EBV causing OSCC.

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Organophosphate (OP) compound poisoning is a global public health problem and is a social calamity, especially in a developing country like India. Acute cholinergic crisis and intermediate syndrome after OP compound consumption are well-known and well-documented. Delayed neurological complications of organophosphate compound poisoning are rare. In the following case report, we present a case of a middle-aged man who was treated successfully for organophosphate compound poisoning and subsequently readmitted after two weeks with features of weakness of both upper and lower limbs suggesting delayed neuropathy.

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Introduction: Pulmonary tuberculosis remains one of the most dangerous communicable diseases. More than two billion people are estimated to be infected with Mycobacterium tuberculosis. In 2017, approximately 10 million individuals became ill with tuberculosis,among them 2.79 million individuals were active cases, 1.6 million died among which 0.3 million died with coexistent HIV infection. Prompt diagnosis of active tuberculosis facilitates timely therapeutic intervention and minimize the community transmission. As tuberculosis is a global problem, for eradication of the disease, early diagnosis, timely identification and improved detection is essential. The diagnosis of tuberculosis is challenging in cases of insufficient sputum and paucity of bacilli. With this background, this study was planned to compare Ziehl-Neelsen's stain, Fluorescent stain and CBNAAT (Cartridge based nucleic acid amplification test) as per RNTCP guidelines. Material and Methods: A prospective interventional study was carried out using 188 sputum samples of suspected pulmonary tuberculosis. All 188 samples were subjected to three methods Ziehl-Neelsen's stain, fluorescent stain and CBNAAT. They were compared for sensitivity and specificity in terms of qualitative results. The data recorded was then analyzed statistically. Results: In our study out of 188 cases 124 were males, 64 were females. Out of 188 samples, the smear positivity rate of ZN stain was 33.5%, fluorescent stain was 40.9%, and the positivity rate of CBNAAT was 51.1%. Conclusion: CBNAAT is more sensitive and specific in detection of pulmonary TB. An additional feature of rifampicin resistance can also be detected by CBNAAT.

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Background: Fine needle aspiration cytology is a simple investigation to evaluate the malignant tumors of the breast when compared to tru-cut biopsy. It is invaluable in the diagnosis of the common invasive carcinoma of the breast including its subtypes. The morphology of the uncommon subtypes and other rare tumors are the source of diagnostic confusion. Aims: The objective of this study is to assess the role of FNAC in diagnostically challenging malignant lesions of the breast. Methods and Material: The study included 526 female patients with palpable breast lumps subjected to FNAC for one year from November 2015 to October 2016 in the department of pathology. The cytology features of these patients were studied and correlated with histopathology. Results: Diagnostic difficulty was encountered in certain tumors having either bland cytology or a predominant discrete pattern or a combination of extracellular mucin and papillary pattern. These were reanalyzed in correlation with histopathology, clinical findings, radiology and immunohistochemistry. Conclusions: Awareness of the morphology of these rare lesions improves the diagnostic accuracy making cytology a more efficient tool for the preoperative assessment of malignant breast tumors.

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Technology cannot replace clinical acumen. Think of complete androgen insensitivity syndrome (CAIS) in a female child with inguinal hernia. Diagnosis was missed in our patient when she presented with inguinal hernia the first time. Karyotyping should be done. Sex of rearing in CAIS is female. Chances of tumor development in retained testis are low. Testis helps in development of female secondary sexual characters and avoids estrogen replacement therapy early in life. Gonadectomy is done in early adulthood.

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Plexus-chorioideuscarcinomataor malignant plexus papillomas are very rare malignancy; only few cases have been described in the literature. A 2.5-year-old girl, known case of choroid plexus carcinoma, presented with complaints of weakness of right upper limb and lower limb, decreased activity, altered sensorium and vomiting. After re-evaluation, she underwent re-excision of tumor and chemotherapy started.

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The most common presentation of papillary carcinoma thyroid is a solitary thyroid nodule but it is also known to present as cystic metastatic deposits in the neck. It has an indolent course and good prognosis. Although ultrasound is a commonly used modality to detect thyroid nodules, it should be followed by Fine needle aspiration cytology (FNAC) of the thyroid, especially when they are associated with cystic lesions of the neck. We report a rare case of papillary thyroid carcinoma presenting as a cystic mass in the neck and associated with lymphangioma.

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We have used nonlocking nails in patients with small intramedullary canals for the fixation of segmental fractures of the radius and ulna. We report a patient with the Monteggia fracture dislocation (the ulnar shaft segmental fracture) treated by new simple unicortex locking intramedullary fixation.

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Pleomorphic adenoma is the most common salivary gland tumor. It can have a wide range of morphological spectrum. But extensive squamous metaplasia mimicking squamous cell carcinoma is quite uncommon. Palate is a common site for minor salivary gland tumor. Less than hundred cases of pleomorphic adenoma with extensive squamous metaplasia have been reported in English literature, thus making it a rare entity. A 60-year old female presented with a well-defined swelling in the soft palate. The histology was reported as pleomorphic adenoma of soft palate with extensive squamous metaplasia and focal adipocytic metaplasia. The histopathological identification of this entity is important as it can mimic malignancy, particularly squamous cell carcinoma. Correct diagnosis helps in unnecessary aggressive therapy.

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We report here a documented case of Febrile delirium in a child caused by Rickettsiae. Rickettsial infection is a relatively under-diagnosed entity in children with fever and rash, probably due to low index of suspicion and the lack of definitive diagnostic facilities. Rickettsial infections can be treated effectively with anti-microbials. Developing countries may use Weil Felix test as a diagnostic method, if they remain undiagnosed and untreated, they are associated with significant morbidity and mortality. This differential diagnosis should be considered when a child is seen with fever and rash.

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Gas gangrene is a term reserved for fulminant soft tissue infections caused by Clostridium species. The posttraumatic form of gas gangrene is caused by Clostridium perfringens. Nontraumatic, or spontaneous, gas gangrene is even more rare and is usually caused by Clostridium septicum in two-thirds of cases and by C. perfringens in one-third of cases; the underlying malignancy is often present. It also usually affects patients with some degree of underlying immunocompromised or vascular insufficiency. We report a case of a 30-year-old man with no history of prior trauma presented with pain, paresis of both lower limbs, and developed discolouration of both feet clinically diagnosed to be Leriche's syndrome with dry gangrene. Computed tomography angiography showed infrarenal aortoiliac occlusion and rapidly progressive gas gangrene involving even bladder wall and bone marrow, probably caused by Clostridium septicum. Although several case reports discuss the setting of bowel malignancy, our case illustrates acute onset of aortic iliac occlusion resulting in mesenteric infarction, which is the probable source for the infection.

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Background and Aims: The aim of this study is to evaluate the antimicrobial efficacy of synthetic obturating material (Zinc oxide eugenol) individually and combined with medicinal plant extracts (Triphala, Aloevera, Tulsi) against four bacterial strains (Streptococcus mutans, Enterococcus faecalis, Staphylococcus aureus, Escherichia coli). Methods: The herbal extracts were independently mixed in different ratios with zinc oxide powder, followed by mixing with eugenol to know the effective concentration using antibacterial assay. Initially different concentrations of each test material were placed into Agar diffusion wells and zones of inhibition were measured against the selected bacteria. The concentration with maximum zone of inhibition for each test material was assessed and grouped as Group I- Triphala and zinc oxide eugenol (80:20), Group II- Aloevera and zinc oxide eugenol (80:20), Group III- Tulsi and zinc oxide eugenol (50:50) and Group IV- Plain zinc oxide eugenol. Results: All the groups exhibited varied antimicrobial activity against test microorganisms which were statistically significant. Highest antimicrobial efficacy was noticed in the group I followed by group II, III and the least with group IV samples. Conclusion: The formulations obtained by incorporating Triphala, Aloevera, Tulsi in Zinc oxide exhibited substantial antimicrobial activity when compared to Zinc oxide eugenol alone. Even though, the tested materials showed good antibacterial activity in this in vitro study, clinical trials need to be conducted before recommending them as obturating materials in primary teeth.

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