Head and neck mass lesions are frequently found in clinical practice. A spectrum of pathological lesions ranging from simple benign lesion to highly malignant manifestation is observed. Objectives: To make clinicopathological correlation of head and neck lesions and to assess the frequency of incidences of different sites, age groups, sex, and distribution among inflammation and neoplastic lesion. Materials and Methods: A retrospective study was conducted from January 2011 to April 2012. Fine-needle aspiration diagnosis was correlated with details of relevant clinical findings and investigations. Patients aged between 1 and 70 years were included in the study. A total of 200 patients with the swellings of head and neck underwent fine-needle aspiration cytology (FNAC). Results: Out of 200 fine-needle aspiration procedures, 52% were of thyroid, 28.50% were of lymph node, 11% from salivary gland, and 4% from soft tissue and miscellaneous swellings. There were 4.5% cases in which diagnosis was not possible. In inflammatory swelling (33%), tuberculous lymph node (42.12%) involvement is common than all other sites with male preponderance (55%). Conclusion: FNAC is a simple, quick, inexpensive, and minimally invasive technique to diagnose different types of head and neck swellings. It could differentiate the infective process from neoplastic one and avoids unnecessary surgeries. Thus, FNAC can be recommended as a first line of investigation in the diagnosis of head and neck swellings.

Objective: Adverse drug reactions (ADRs) are associated with significant morbidity and mortality and have a major impact on public health. Pharmacovigilance helps in early detection of ADRs and identification of risk factors. Underreporting of ADRs can be improved by imparting knowledge regarding pharmacovigilance to healthcare professionals. This study was aimed at investigating the knowledge and attitude of resident doctors about ADR reporting and suggesting possible ways of improving ADR reporting. Materials and Methods: This study was a cross-sectional, questionnaire-based survey conducted in a tertiary care teaching hospital. The respondents were resident doctors. Study instrument was a self-developed, pre-validated, semi-structured questionnaire consisting of open- and close-ended items. Results: A total of 84 questionnaires were considered for analysis, giving a response rate of 93.33%. In all, 64.28% of the respondents were aware about pharmacovigilance, 52.38% were aware of ADR reporting system in India, 83.33% opined that only serious ADR with any medicine should be reported, and 35.72% believed that ADRs should be reported only for newly marketed agents. Although 67.85% of respondents observed an ADR, only 25% reported it; 44.04% were aware about the complete procedure of ADR reporting. General attitude of the respondents about ADR reporting was as follows: ADR reporting should be compulsory (15.19%), voluntary (41.66%), remunerated (3.57%), identity of prescriber should be concealed (21.42%), and identity of reporter should be concealed (29.7%). Conclusion: Increasing awareness about pharmacovigilance will be helpful in improving the status of ADR reporting. Other measures such as making ADR reporting guidelines available in the form of booklets and displaying posters can also play a useful role.

Background: Advances in the use of laparoscopic surgery, especially in the biliary apparatus interference makes the need to revise the anatomical data of the gallbladder (GB) more important. Variations of the extra-hepatic biliary apparatus are characterized by large varieties of configurations. Objective: The aim of this article was to study the morphology of the GB in Sudanese subjects and review the common variations. Materials and Methods: Dissection of formalin-fixed cadavers' abdomens. Results: GB is larger in Sudanese subjects than what is described in the standard text books. Conclusion: Congenital anomalies and anatomical variations of the extra-hepatic biliary tree, although not uncommon, can be of clinical importance. There are some differences in the only size of GB in Sudanese.

Background: Aluminum phosphide (AlP) is also known as "rice tablet" in Iran. Due to the high incidence of acute AlP poisoning and its associated mortality in Iran, the authorities banned AlP-containing tablets in 2007. The aim of this study is to evaluate the trend of acute fatal AlP poisoning subsequent to this restriction. 0Materials and Methods: 0 This is a retrospective chart review of patients with acute "rice tablet" poisoning who were admitted to Loghman Hakim Hospital Poison Center, Tehran, Iran, from 2007 to 2010. Collected information included gender, age, type of poisoning, marital status, duration of hospitalization, and outcome. Results: There were 956 cases with a mortality rate of 24.06%. The incidence of fatal AlP poisoning was 2.1 and 5.81 per one million populations of Tehran in 2007 and 2010, respectively. In 223 of the fatal cases (97%) and 697 of the non-fatal cases (96%), the poisoning was intentional. The male to female ratio in the fatal and non-fatal cases was 1.04:1 and 1:1.3, respectively. Most of the fatal cases (n = 122, 53%) were unmarried. The mean age was 27.32 ± 11.31 and 24.5 ± 8.19 years in fatal and non-fatal cases, respectively. In 196 (85.2%) of the fatal cases and in 577 (79%) of non-fatal cases, the duration of hospitalization was less than 24 hours and between 48-72 hours, respectively. Conclusion: The results of this study showed the incidence of "rice tablet" poisoning, and its mortality increased since 2007 in spite of the ban. It seems that legislative means alone without other interventions, such as suicide prevention and public education, will not always be able to control or prevent acute intentional poisonings.

Introduction: Many aspects of tuberculosis (TB) and its treatment can compromise patients' quality of life (QOL). Treatment of active TB requires prolonged therapy with multiple drugs that can lead to adverse reactions. There is considerable social stigma associated with TB, leaving the individual feeling shunned and isolated. Hence, it is necessary that for a thorough assessment of patients' health status, overall impact of TB on patient's QOL should be considered. Materials and Methods:Thirty newly diagnosed smear positive cases of pulmonary TB, of either gender were interviewed using - WHO QOL BREF, which is a 26-item scale designed by WHO. It has four domains viz.: Physical health, psychological health, social relationships, and environment. Interviews were conducted thrice: Before starting treatment, after 2 months, and after 4 months of treatment. Controls ( n = 30) were selected from the general population and interviewed using same questionnaire. Results:Before treatment, scores in all domains were significantly lower in patients than controls. Worst affected were physical domain followed by psychological. Gradual increase in scores was observed over the course of treatment, indicating positive effect of medical intervention on QOL. Despite improvements, the scores in physical and psychological domain after 4 months of treatment were still significantly lower in patients than in controls. Conclusion: Measurement of QOL in TB is essential to have an in-depth understanding of effect of disease on various dimensions of health. This would enable health care professionals to devise relevant interventions such as patient counselling which would be useful in further improving quality of TB control programs.

Familial hypercholesterolemia is a single gene disorder. It has autosomal dominant pattern of inheritance. We report a 28-year-old man who presented with acute myocardial infarction. He had xanthomas and an elevated serum low density lipoprotein cholesterol (LDL-C). His only sibling, 32-year-old brother have similar cutaneous lesions and lipid profile. His mother and maternal uncle died at a young age due to myocardial infarction. This report is to emphasize the need to clinically recognize xanthomas and its familial inheritance with elevated LDL-C, premature atherosclerosis. Early diagnosis and early initiation of treatment will save the affected individual and the other family members.

Evans Syndrome (ES) is the rare simultaneous or subsequent development of immune thrombocytopenia purpura (ITP) and autoimmune hemolytic anemia (AIHA). It portends a poorer prognosis and a more aggressive line of management than either condition presenting alone. Here we report a case of a young female who presented with both bleeding and acute decompensated anemia. Although she was successfully treated, mystery still shrouds the etiology, pathophysiology, as well as line of management of this rare and enigmatic disease.

Gastric antral vascular ectasia (GAVE) is a well-recognized albeit rare cause of gastro-intestinal (GI) bleeding. It classically presents in an elderly female as iron-deficiency anemia due to chronic blood loss. The association of GI blood loss with aortic stenosis (AS) has been popularized as Heydes syndrome (HS). We report a case of an elderly woman presenting as iron-deficiency anemia subsequently diagnosed with HS.

Bicuspid aortic valve is the most common birth defect affecting the heart and is present in 1-2% of the population. The abnormal valve structure leads to turbulent flow, fibrosis, calcification, and aortic stenosis. Aortic stenosis increases perioperative morbidity and mortality. Anesthetic techniques that reduce systemic vascular resistance (regional neuraxial techniques) must be used with extreme caution. Hashimoto's disease or chronic thyroiditis or autoimmune thyroiditis is the most common cause of hypothyroidism in adults. Regional anesthesia is preferred in patients with hypothyroidism as recovery from general anesthesia may be delayed by hypothermia, respiratory depression, or slow drug biotransformation. This is a case report of anesthetic management of a middle-aged female with co-existing aortic stenosis, hypothyroidism, and fibroid uterus posted for abdominal hysterectomy.

Although splenic involvement alone in hydatid disease is very rare, spleen is the third common organ involved in hydatid disease. It is endemic in cattle rearing areas but occurs worldwide. The rarity of splenic hydatid disease poses diagnostic challenge for clinicians. The case is presented as the investigation in the beginning which induced confusion among experienced clinicians but subsequently diagnosis of splenic hydatid cyst with peritoneal dissemination was confirmed by laparoscopy and histopathological examination. Hydatid disease of spleen should be considered in differential in every patient in endemic area with cystic lesion of spleen until proved otherwise as the hydatid cyst can present even as simple cyst without having classic serological and imaging features.