Objective: Data on acute lymphoblastic leukemia (ALL) in Indian children being limited, we analyzed the clinical, immunophenotype and cytogenetic profile of ALL in our pediatric patients. Materials and Methods: This was a prospective and retrospective observational study in which data of 103 children with ALL, aged three months to 18 years were analyzed. Results: Definite male preponderance (70.87%) was observed, 58.25% patients were aged between two to five years. Common clinical features included fever (92.33%), pallor (87.38%), hepatomegaly (85.44%) and splenomegaly (83.50). central nervous system involvement was seen in 6.80% and tumor lysis syndrome in 32.04% patients. Hemoglobin was <5 gm/dl in 43.69%, between 5-10 gm/dl in 45.63% patients; white blood cell count between 5,000-50,000/hpf seen in 69.90%, >50,000 in 20.39% patients. Platelet count was <50,000 cells/hpf in 48.54%. Blast cells in peripheral smear present in 67.96% patients of 97 in whom immunophenotyping was done, 82.44% were Pre B cell ALL. Pre T and T cell ALL was seen in 15/97 (15.46%) patients. Karyotyping revealed hyperdiploidy in 9/89, hypodiploidy in 2/89, miscellaneous changes in 35 patients. FISH analysis in 63 patients revealed Philadelphia chromosome positivity in seven (11.11%). MLL gene was positive in 12.70%. TELAML was positive in 13.64% (3/22) patients. 97.06% patients went in to remission post induction. Conclusion: Most of our patients come under standard risk by their age, WBC count, immunophenotyping and cytogentic analysis. We suggest larger multi-centric studies even in developing countries to understand the clinical profile and RT-PCR technique in cytogenic analysis for better risk stratification to help in risk adopted therapy.

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Context: Ovarian tumours represent about 30% of all cancers of the female genital system. They manifest in a wide spectrum of clinical, morphological and histological features. Aim: To study the frequency of incidence of different histopathological types of ovarian tumours in our institute. Materials and Methods: This retrospective study included 257 cases of histopathologically proven ovarian tumours, reported in the Department of Pathology of a rural tertiary care referral hospital, over a 12 year period (January 2000 to December 2011). These were classified according to the WHO classification of ovarian tumours (2003). Clinical presentation of the patients was analysed from archived case records. Results: Of the 257 tumours studied, 162 (63.04%) were benign, 15 (5.84%) were borderline and 80 (31.12%) were malignant. Surface epithelial tumours were the most common (68.48%) followed by germ cell tumours (15.95%). Mucinous cystadenomas (32.69%) were the most common benign tumours, while serous cystadenocarcinomas (31.13%) were the most common malignant tumours. Most ovarian neoplasms (43.19%) occurred in the 21-40 years age-group. Dull abdominal pain was the most common clinical presentation. Conclusions: Benign ovarian tumours were more common than malignant ones across all age groups. Surface epithelial tumours were the most common histopathological type of ovarian tumour. Due to vague symptoms, patients present late. Development of methods for early diagnosis of ovarian neoplasia is therefore, a pressing need today. The relative frequency of incidence of different ovarian tumours shows regional variations, highlighting the need to identify region-specific risk factors.

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Introduction: This study is conducted to evaluate the seroprevalance of HIV, HBsAG, HBV and syphilis among blood donors at blood bank of medical college hospital along the five years. Material and methods: Study includes both voluntary and replacement donors. HIV, HBsAG and HCV were tested by ELISA methods approved by NACO and RPR was carried out for screening of Syphilis. Results: The seroprevalance of HIV, HBsAG, HCV and Syphilis was 0.08%, 0.3%, 0.07% and 0.17% respectively in voluntary blood donors while seroprevalance of HIV, HBsAG , HCV and Syphilis was 0.31%, 1.18%, 0.16% and 1.12% respectively in replacement blood donors. Conclusion: We observe that seroprevalance is higher in replacement donors than voluntary donors. These facts strongly indicate that we need more motivational and educational programmes to shift complete voluntary donation.

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Primary leiomyosarcoma of kidney is extremely rare tumour accounting for 0.12% of renal tumours. Radiological investigations are not able to differentiate between leiomyosarcoma and sarcomatoid renal cell carcinoma. Histopathological examination along with aid of immunohistochemistry is required to make a definitive diagnosis. We present a rare case of primary renal leiomyosarcoma occurring in a 50 years old female.

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Introduction:The tracheo-bronchial angles in the human fetus are of increasing relevance in perinatal medicine to determine both normal and pathological criteria. The present study was undertaken to calculate the inter-bronchial angle using a novel method by an image analyzer at different gestational ages. Materials and Methods:The present study was carried out using 24 human fetuses in the department of Anatomy, Kasturba Medical College, Manipal. The right and left bronchial, inter-bronchial and subcarinal angles were calculated by using an image analyzer named Image J. Results:The right bronchial angle ranged from 21.99° to 43.96°. The left bronchial angle ranged from 29.48° to 56.21°. The inter-bronchial angle ranged from 60.53° to 100.86°. Student t test was applied to compare the means of bronchial angles between the second and third trimesters which did not show any statistical significance. The subcarinal angle ranged from 41.69° to 74.88° with an average of 61.15 ± 9.73°. Conclusion:The present study analyses the inter-bronchial and subcarinal angles in different GA, the knowledge of which would be essential to understand the developmental changes of the respiratory passages.

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Pulmonary agenesis is a rare congenital anomaly presenting usually with recurrent chest infection in early childhood with an annual incidence of 1 out of 100,000 births. Nearly half of the cases were usually associated with congenital co-anomaly of other organ(s). Diagnosis in adulthood is very rare. We reported here an extremely rare case of left lung agenesis in a 19 year girl presenting with dry cough and breathlessness for one month with an abnormal chest x-ray. Diagnosis was made with the aid of contrast enhanced Computed Tomotram [CECT] thorax and fibre-optic bronchoscope. Prognosis depends on affected side, existing lung tissue and other anomalies (if present). However, we managed the case conservatively. We want to add this rare case into the pool of lung agenesis cases report.

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Gastric volvulus is a rare but potentially life threatening cause for upper gastrointestinal obstruction. It is an abnormal rotation of one part of the stomach around another which can manifest with acute, intermittent or chronic symptoms. Historically first reported case of gastric volvulus was in 1866 by Berti and the first operation for this condition was performed in 1897 by Berg. Since then there are approximately 400 cases reported in the literature. We report a case of acute gastric volvulus associated with eventration of left hemidiaphragm in a 60 years old female who presented with features of gastric outlet obstruction.

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Context: Evidence suggest that medical students' attitudes towards psychiatry are determined by multiple factors like previous experiences, training in medicine and psychiatry, globalization of education, medical school experiences, including influence of faculty, friends and family members. No previous work on Indian origin foreign medical graduate interns has been done in this area in India. Aims: To study the difference in attitude towards psychiatry among Indian and Indian origin foreign medical graduate interns. Settings and Design: Cross sectional study, conducted in a central government teaching hospital. Materials and Methods: Study was done on 261 medical interns who did their medical schooling in India and abroad during a period of one year. Balon et al. questionnaire was administered for attitude assessment. Statistical Analysis: Statistical package for social sciences (SPSS) for windows 20th revision was used. Descriptive statistics was used for analyzing discrete and continuous variables. Chi square test applied for comparing categorical variables. Results: Ninety five percent of FMG interns (N = 66) were from China and Russia. IMG interns considered teaching of psychiatry at their medical school to be interesting and good quality as compared to FMG interns. Both groups admit that family and friends discouraged them from entering psychiatry. Conclusions: Good training in psychiatry during medical school has overall positive effect on the attitude towards psychiatry. Internship is the appropriate period when the specific needs of the FMG interns to be addressed for their better integration into the Indian medical system.

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Uveitis occurs in relation with a wide variety of infectious, non infectious and immune-mediated disorders with. Besides these there are also some diseases which masquerade as uveitis, thus further complicating the issue and posing a diagnostic challenge. In such cases timely rapid and accurate diagnosis of the underlying cause as well as its correct management are of paramount importance in achieving a successful outcome. Here we report an interesting case of ocular cystecercosis, in a young lady who presented late with features of posterior uveitis and a severe loss of vision. She was managed aggressively and could be finally discharged with a significant visual improvement.

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Solitary neurofibroma in the absence of neurofibromatosis is of rare occurrence and very few have been reported in the literature till now especially in the inferior orbit. A case of solitary neurofibroma of the inferior orbit is presented here. 32 year old male patient presented to us with history of swelling below the left lower lid since 2 years. After the detailed clinical and radiological examination patient underwent anterior orbitotomy and excision of the mass. Histopathological examination confirmed the diagnosis of neurofibroma of the inferior orbit which is of very rare occurrence.

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Pulmonary alveolar microlithiasis (PAM) is an uncommon chronic disease characterized by calcifications within the alveoli and a paucity of symptoms in contrast to the imaging findings. It occurs sporadically and it is regarded as an autossomal recessive lung disease. The pathogenesis of PAM has yet to be elucidated. The disorder has a protracted course and there is no treatment available. We report a case of 21 years-old male who presented to us with complaint of exertional breathlessness since childhood. Diagnosis of pulmonary alveolar microlithiasis was made on the basis of clinical features and laboratory findings.

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Congenital retinoschisis is an X linked retinal dystrophy characterized by splitting of neural retina leading to defective vision. A 12-year-old male child came with defective vision since childhood. On examination his best-corrected visual acuity was 6/24 and 6/12 in right and left eye respectively. Indirect ophthalmoscopy showed silver grey retinal reflex and bilateral cartwheel like macular degeneration. Fundus fluorescein angiography was normal. Electroretinogram showed reduction in b-wave amplitude for combined response and normal a-wave and reduced photopic response. Optical coherence topography showed cystic lesions in the inner nuclear and outer plexiform layer of retina. With all the above findings diagnosis of retinoschisis was made out. Hence it is important for early investigation for child with defective vision and start treatment or there will be permanent loss of vision.

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Ethno-medicine refers to the study of traditional medical practice which is concerned with the cultural interpretation of health, diseases and illness and also addresses the healthcare-seeking process and healing practices. Headache is one of the common symptom for consultation with a doctor. Several patients visiting doctors and specialists with the complaint of headache, attribute the cause to gastritis, gas or to any similar terminology in their local language. Since, the cause connects between head and stomach the condition is known as "gastric headache". The knowledge of gastric headache and its description details were greatly contributed by the medical traditions of ancient Greece, Persia Egypt, India, and China. The possible causality of the gastrointestinal diseases in inducing headaches has been little investigated. We do see a significant proportion of patients visiting varied specialists attributing headache to gas/gastritis. We believe that attribution patterns, explanatory models and research is needed to study gastritis/gas as a cause for headache in different cultures. The difference in the understanding and beliefs of the illness between the clinician and patient can result in inappropriate assessment or dis-satisfaction.

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Objectives: 1. To study Gleason grade and sum. 2. To study the morphological criteria and their significance. 3. To correlate morphological features with Gleason pattern. Materials and Methods: We studied 411 prostatic specimens, 342 benign and 69 neoplastic cases which were received over a period of two years duration at our Institution. The neoplastic cases were further categorized for occurence of the important morphological criteria with regard to Gleason Grade. Results: Out of the 69 cases of adenocarcinoma prostate, 3 cases were well differentiated adenocarcinoma (Gleason sum 2-4), 35 cases were moderately differentiated adenocarcinoma (Gleason sum 5-7) and 31 cases were poorly differentiated adenocarcinoma (Gleason Sum 8-10). Nucleomegaly was seen in 73%, prominent nucleoli in 60.8%, amphophilic cytoplasm in 19%, intraluminal crystalloids in 62%, collagen micronodules in 36%, chronic inflammation in 64%, perineural invasion in 91%, tumour infiltration was seen in 76%, retraction clefting in 66% cases and necrosis in 49% of the cases. Conclusion: Perineural invasion, Infiltrative pattern and Necrosis have significant correlation with higher Gleason Sum. Morphologically nucleomegaly, nucleolar changes, amphophilic cytoplasm and collagenous micronodules are important additional features which help in clinching the diagnosis.

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Context: Alcoholism is a disease of the family. Alcoholism is linked to disrupted family role, violence, impaired family communication and physical and psychological illness. Several studies have shown that spouses of alcoholics often present significant rates of mental and physical problems, communication problems, low social activity and poor marital satisfaction. The inconsistent results from previous research clearly demonstrate the need for more evidence. Aims: To study the cognitive dysfunctions in the spouses of patients with alcohol dependence syndrome (ADS). Settings and Design: The data were collected from 30 spouses of patients admitted at the deaddiction centre and psychiatry ward of Father Muller Medical College Hospital Mangalore. Materials and Methods: Samples were selected from spouses of patients admitted consecutively, who met inclusion and exclusion criteria. Samples of the study were evaluated using Standardized Mini Mental State Examination (SMMSE), Trail Making Test B (TMT-B), Digit Symbol Substitution Test (DSST). Statistical Analysis Used: Conventional statistics were used to calculate mean and standard deviation (SD) for the parameters of the study. Results: It was found that 26.6% of the spouses were cognitively impaired showing decreased, impaired cognitive functions, of which 62.5% had history of alcohol consumption of the spouses for 6-10 years of duration. Conclusions: Study proved the decrease in cognitive functions in the spouses of patients with alcohol dependence syndrome.

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Context: There is an increased interest in stabilization of lumbar spine without fusion as an alternative to traditional fusion for treatment of degenerative lumbar spine disease. Aim: To analyze short term outcomes of pedicle-based dynamic stabilization system (DSS). Setting and Design: Retrospective study of a consecutive series of 42 patients. Materials and Methods: Between 2009 to 2012, 42 patients underwent DSS with or without decompression on total 214 pedicles for various indications and were followed up for 12 months. Clinical improvement was evaluated with the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). Post operative complications were noted and radiographic evaluation for screw positioning and loosening was done. Statistical Analysis: SPSS Version 21.0. Levene's Test for Equality of Variances, Chi square test and students T test. Results: Out of 66 stabilized segments in 42 patients accounting for 214 pedicles instrumented, 23(54.8%), 14(33.3%) and 5(11.9%) had 1, 2 and 3 segments stabilized respectively {L4-5 in 18, 42.86%, L4-5-S1 in 10, 23.81%, L5-S1 in 5, 11.90%, L2-3-4-5 and L3-4-5 in 3, 7.14% and L3-4 in 1, 2.38%}. Dynamic stabilization or an additional decompression procedure was done in 29 and 13 patients respectively. The VAS {7.40 ± 0.79 to 1.64 ± 0.93 (P < 0.05)} and ODI {65.92% ± 8.70% to 12.83% ± 6.73% (P < 0.05)} improved. One patient had wound infection, 2 had aseptic skin necrosis, 1 had DVT, 1 required screw repositioning and 1 required unilateral removal of implant for post-op radicular pain. Two patients had persistent sagittal imbalance. Conclusion: DSS is effective and safe in patients with various degenerative lumbar spine diseases.

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Objective: To evaluate the role of Fine needle aspiration cytology(FNAC) as a first line of investigation in space occupying lesions of liver and to study the various cytological patterns in hepatic lesions, categorizing them into non-neoplastic and neoplastic lesions. Materials and Methods: Retrospective study of a total of 138 guided Fine needle aspirations was done at Father Muller Medical College Mangalore, during the period of Jan 2011 to Dec 2013. Papanicolaou (Pap) and May-Grunwald-Giemsa (MGG) stained smears was reviewed and analysed under the microscope. Results: Age ranged from 22 to 85 yrs. 122 out of 138 were conclusive. 17 out of 122 were benign lesions, 8 cases were reported as negative for malignancy, 2 suspicious for malignancy, 95 were malignant cases of which 40 were primary in the liver. Metastatic lesions were 55 including squamous cell carcinoma, adenocarcinoma, malignant melanoma, neuroendocrine and small cell carcinoma. One case of spindle cell neoplasm was reported the histopathology of which was inconclusive. Conclusion : Guided FNA is a first line of investigation in space occupying lesions of liver as the procedure is safe, simple, rapid, effective and minimally invasive.

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