Context: Majority of falls are multifactorial and results from a complex interplay of predisposing and precipitating factors. Falls and their sequelae are potentially preventable. Aims: To determine the risk factors for falls among the elderly. Settings and Design: A community-based cross-sectional study in urban part of Bengaluru. Subjects and Methods: Study conducted for a period of 1-year, among elderly population 60 years and above, were residents since 1-year. Complete enumeration by census methodology applied. A pretested semi-structured questionnaire was administered to collect information about falls. Statistical Analysis Used: Univariate and multivariate logistic regression employed using SPSS version 18. Results: Of the 416 elderly persons studied, prevalence of falls rate 29.8%. The rate of fall for medical factors varied 33.3% diabetes mellitus to 71.4% foot problems. Among the people with behavioral factors, higher fall rate seen among those who were underweight 77.7%, abnormal finding in balance test 59.5%, abnormal gait 51.4%, low Mini Mental State Examination score 50%, Obese 50%, those who had difficulty with steps/stairs 45.3%, habit of smoking 45.1%, low activities of daily living score 45.4%, persons with abnormal get up and go test 43.8% and those who were on alcohol 43.1%. Logistic regression analysis revealed elderly with backache, nonsteroidal anti-inflammatory drugs, visual problem, difficulty in getting on/off toilet, smoking, cataract, TCA's loose slipper outside home were at higher risk of fall, was found to be statistically significant. Conclusions: Majority of the falls in the elderly are due to medical, behavioral factors which are predictable and preventable.

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Hypercementosis is a nonneoplastic thickening of the cementum. It may be restrained to the apex of the root, on one side of it, or involve it entirely. Hypercementosis is coupled with a number of etiological factors, which may be local or systemic in nature. It is decisive that the general dental practitioner is aware of these factors and is able to distinguish presentation due to a local cause from that of a systemic disease process. We report a first case of generalized hypercementosis with multiple missing teeth in a young Saudi female.

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Background: For identification, stature can be estimated from body parameters using regression equation or multiplication factor. However, regression equations and multiplication factors are specific for the region only and same formulae cannot be used in all population. Aim: To formulate regression equation and multiplication factor for estimation of stature from hand length (HL) and hand breadth (HB) for a region in Maharashtra, India. Materials and Methods: It was a cross-sectional study and 400 students of three Government Medical Colleges of Maharashtra, aged 18-24 years were enrolled for the study during 2011-2013. Stature, HL, and HB were measured and subjected to statistical analysis. Unpaired t-test and simple linear regression were used. Results: Stature, HL, and HB of 400 medical students (219 males and 181 females) were measured. Subjects were divided into six groups depending upon age. Simple regression equation and multiplication factor for male and female, and for each age group were derived for estimation of stature. We found correlation coefficient (R) of 0.74 for right HL (RHL), 0.75 for left HL (LHL), 0.45 for right HB and 0.46 for left HB in male, and 0.75 for RHL, 0.74 for LHL, 0.56 for right HB and 0.55 for left HB in female by using simple regression, which showed strong correlation between stature and HL, and HB. Conclusion: Stature can be accurately estimated from HL and HB by using simple regression equation or multiplication factor.

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Hereditary hemochromatosis (HH) is manifested as an iron overload in different organs due to homozygosity of a single autosomal mutation. If untreated it leads to conditions such as liver cirrhosis, type 1 diabetes mellitus, hypogonadotropic hypogonadism, cardiomyopathy, arthritis, and bronze coloring of the skin. Hemochromatosis affects as many as 1 in every 200 people in the United States, but in India the reports of genetic study are rare and virtually unexplored. It is also possible that in India clinical hemochromatosis could be masked by iron deficiency. Patients with HH may be either asymptomatic or symptomatic. When symptomatic, there is a wide range of symptoms and a high index of suspicion based on the symptoms is necessary to diagnose the entity. We report an interesting and rare case of HH in a 35-year-old male of Indian origin, who presented with icterus and fever of acute onset with negative HFE genetic mutations.

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Rosuvastatin is an anti-lipaemic drug belonging to the class of statins that competitively inhibits hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase that catalyzes the conversion of HMG-CoA to mevalonic acid, the rate-limiting step in cholesterol biosynthesis. Cholesterol lowering agent myopathy (CLAM) is well recognized among physicians and patients. Less well known are the small number of patients on statins who have shown signs of peripheral neuropathy, either in addition to or separately from CLAM. Here we report a case of a 45-year-old lady who stared experiencing periorbital tremors shortly after introduction of rosuvastatin. While the pathophysiology of statin-induced myopathy remains unclear, we hope that this case will encourage others to report similar symptomatology, perhaps enabling to gain more insight on the cases of iatrogenic myopathies. Hence, pharmacogenetics study may prove to be useful for personalized therapy.

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Background: Severe acute malnutrition (SAM) continues to be the reason for increasing hospitalization and also a major killer disease. Objectives: Identify socio-epidemiological determinants among both groups of SAM and evaluate impact of nutritional rehabilitation center (NRC) in its management. Methodology: A prospective observational study was conducted in a medical college on SAM children aged 6 months to 5 years over 1 year. Socio-epidemiological risk factors were compared in both groups. Therapeutic nutrition was provided as per World Health Organization guidelines. Serial weight monitoring and response criteria were analyzed at the time of discharge. Cases were followed up serially at 1, 2, 3, and 6 months for weight monitoring to assess long-term impact of NRC. Results: A total of 91 cases were enrolled; (Group 1: Group 2: 43: 48). Assessment of risk factors in SAM groups revealed a significant association between late initiation and lack of exclusive breastfeeding with group 1 SAM. Significant referrals (P : 0.001) from anganwadi centers included group 1 SAM. Majority responded to NRC management. Statistically significant weight gain noted at each follow-up in both types of SAM. At the end of 6 months, the recovery rate of group 1 SAM was statistically significant (P : 0.023), total defaulter rate was high (29.6%) and none had relapsed. Conclusion: Though NRC was effective in improving nutrition in SAM, results were not sustained in view of high defaulter rates at follow-ups. There is a need to improvise health education to caregivers, link NRC centers with community health centers for better follow-up and address modifiable socioepidemiological risk factors.

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Mucormycosis is a type of opportunistic fungal infection which most commonly involves structures in the maxillofacial region such as paranasal air sinuses, maxilla, orbit and in advanced stages it may affect the brain. The most common route of its entry is through inhalation. Common predisposing condition is diabetes mellitus leading to immunocompromised state. We present a case of 63-year-old female patient with widespread maxillary osteomyelitis following teeth extraction later diagnosed as mucormycosis.

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Leiomyomas are quite common in women of childbearing age however usually seen in uterus or cervix. Vaginal location is very rare for leiomyomas with only about 300 cases reported until date. Leiomyomas at vaginal location usually present with swelling at introitus with or without urinary symptoms. These lesions show varied imaging features and are reported to possess high malignant potential. We report a patient having both uterine and vaginal leiomyomas. The uterine leiomyoma showed magnetic resonance imaging features of a typical leiomyoma, but vaginal leiomyoma showed magnetic resonance imaging characteristics indistinguishable from Schwannoma.

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Gout (Podagra) is a disorder of purine metabolism characterized by the deposition of monosodium urate crystals in joints and connective tissue and risk of deposition in kidney interstitium. Although acute gouty arthritis is familiar for most physicians, chronic gouty arthritis, which affects small joints of the hands can be difficult to distinguish from other common interphalangeal arthropathies such as rheumatoid arthritis (RA), psoriatic arthritis, and erosive osteoarthritis because of very similar presentations. Here we describe a 60-year-old male diabetic patient with pandigital, extensive subcutaneous tophaceous gout presented with uremic encephalopathy and joint deformities. He had been treated mistakenly as RA for 10 years.

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Background: Gall bladder diseases are prevalent worldwide and present with a diverse clinical and histopathological spectrum. Cholelithiasis is associated with inflammatory as well as neoplastic diseases of the organ. This study was undertaken with a purpose to determine the demographic profile along with the diverse spectrum of histopathological lesions encountered in electively resected cholecystectomy specimens in this part of the world. Materials and Methods: This is a retrospective study conducted on 732 cholecystectomy specimens received in the Department of Pathology of a Hospital Associated with a Medical College in Lucknow, over a period of 28 months from February 2012 to June 2014. Clinical details and histopathological data were retrieved from the hospital records. Results: There were 732 cases in total, consisting of 205 males (28.0%) and 527 females (72.0%). Male: female ratio was 1:2.6. Age of the patients ranged from 12 to 81 years with a mean age of 43.2 ± 13.3 years. Maximum number of patients were in fourth decade of life (27.2%). Cholelithiasis was present in 697 (95.2%) patients in total. Microscopically, the most common pathology noted was chronic cholecystitis, seen in 711 cases (97.1%). However, no cases of gall bladder carcinoma were evident. Conclusion: This study emphasizes the need of a meticulous intra-operative as well as macroscopic examination to rule out gall bladder malignancy. It, however, in no way undermines the importance of a routine histopathological examination of all electively resected cholecystectomy specimens.

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To review the possible association between methotrexate (MTX) intake and increased toxicity. A MEDLINE literature search MEDLINE (1980-August 2014) was performed using the search terms MTX, antifolate, MTX toxicity, glucarpidase, and leucovorin. Additional references were identified from a review of literature citations. All English-language observational studies and case reports were considered. Methotrexate (meth" oh trex' ate) is an antifolate and antimetabolite that is used extensively in the therapy of leukemia, lymphoma, and several solid organ tumors. It also has potent activity against psoriasis and has immunomodulatory activity against inflammatory bowel disease and the inflammatory arthritidies. It exhibits a wide range of toxic effects profile. Leucovorin is indicated to diminish the toxicity and counteract the effect of inadvertently administered overdosages of MTX. In post marketing experience, overdose with MTX has generally occurred with oral and intrathecal administration, although intravenous and intramuscular overdose have also been reported. Supporting care strategies, extracorporeal measures, and glucarpidase are some of the means to overcome MTX overdosage. At present, pharmacogenomics tends to contribute toward the emergence of adverse effects following the widespread use of MTX for various indications.

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Iatrogenic procedural accidents occurring during the root canal procedure may lead to failure of the root canal treatment and removal of the teeth. Advances in dentistry as well as increased desire of patients to maintain their dentition have led to the treatment of teeth that once would have been removed. Hemisection maneuver has given the dentist the choice to preserve the maximum toot structure with good retention in future. This case report describes the preservation of mandibular molar through hemisection after iatrogenic furcal perforation and ledge formation.

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Moyamoya disease is a chronic, progressive occlusion of the circle of Willis arteries that leads to the development of characteristic collateral vessels seen on imaging, particularly cerebral angiography. The disease may develop in children and adults, but the clinical features differ. Moyamoya disease occurs predominantly in Japanese individuals but has been found in all races with varying age distributions and clinical manifestations. As a result, moyamoya disease has been under-recognized as a cause of ischemic and hemorrhagic strokes in the Indian subcontinent. At this time, there is no known cure, and existing treatment options are controversial. We here describe the case of a 27-year-old Indian presenting as right-sided hemiparesis with accelerated hypertension.

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Background: The concept of insulin resistance initially proposed in diabetic patients requiring high doses of insulin is now known to be associated with major public health problems, including obesity, hypertension, coronary artery disease, and metabolic syndrome. Serum uric acid (SUA) values are also elevated in the above conditions and proposed to reflect the insulin-resistant state. Objective: To determine whether SUA levels can be used as a surrogate for insulin resistance calculated as homeostatic model assessment insulin resistance (HOMA-IR) in apparently healthy, normal weight, overweight, and obese population. Materials and Methods: A cross-sectional study done in 150 subjects of both genders aged 20-40 years was divided equally based on their body mass index into three groups namely normal weight, overweight, and obese as per National Institutes of Health classification. Fasting plasma glucose, fasting serum insulin, and SUA were estimated. HOMA-IR was calculated. Results: Mean waist circumference, waist-hip ratio, fasting insulin, fasting glucose, uric acid, and HOMA-IR were found to be elevated in both overweight and obese groups. Mean uric acid levels were 4.9 mg/dL, 5.4 mg/dL, and 6.3 mg/dL and mean HOMA-IR values are 2.2, 3.3, and 7.3, respectively, in normal weight, overweight, and obese subjects. Significant correlation of uric acid with insulin resistance calculated as HOMA-IR was not found in any of the three groups. Conclusion: There was an incremental increase in fasting glucose, fasting insulin, uric acid, and HOMA-IR from normal weight to overweight to obese subjects in a systematic proportion. Significant correlation of uric acid with fasting insulin and insulin resistance was not seen and hence cannot be used as the surrogate marker for insulin resistance in the apparently healthy population.

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Poorly differentiated thyroid carcinoma (PDTC) is a neoplasm of follicular cell that show limited evidence of structural follicular cell differentiation. They occupy both morphologically and behaviorally an intermediate position between differentiated (follicular and papillary) and undifferentiated (anaplastic) carcinomas. Preoperative fine-needle aspiration cytology can be helpful in planning treatment options and patient management. According to WHO, the occurrence is around 4-7% of all the clinically evident thyroid tumors. We report a case of PDTC with clinicopathological correlation.

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Neurofibromatosis-1 (NF-1) or von Recklinghausen's disease is the most common disease inherited by a single gene and is multisystemic in nature. Anesthesia is required for excision of neurofibromas, which may cause cosmetic disfigurement, pressure effects (obstructive uropathy, hydronephrosis, kyphoscoliosis, hydrocephalus, proptosis, and superior vena cava syndrome) and may undergo malignant change. We report here the anesthetic management of an NF-1 patient with a malignant change in a nasopharyngeal neurofibroma requiring left maxillectomy and split skin grafting.

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Leptospirosis and tuberculosis (TB) are widely prevalent in the tropics, with the former presenting acutely ranging from a flu-like illness to severe hepatorenal dysfunction (Weil's disease) and hemorrhage. TB is a smoldering illness, which rarely presents acutely as community-acquired pneumonia or acute lung injury. We present a 35-year-old farmer who had acute onset breathlessness and oliguria following a short febrile illness, which required mechanical ventilation and renal replacement therapy. His diagnostic workup revealed concomitant pulmonary TB and anicteric leptospirosis which improved with appropriate antibiotics and supportive care.

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Rosai-Dorfman disease (RDD) also known as sinus histiocytosis with massive lymphadenopathy is an uncommon benign condition of histiocytes of unknown etiology, most often misdiagnosed as lymphoma. Patients have bilateral cervical lymphadenopathy with the variable clinical presentation. We report a 37-year-old male presenting with massive painless bilateral cervical lymphadenopathy, turned out to be RDD after several misdiagnoses.

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