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Introduction: In order to reduce the oral health disparities among school children in rural areas and provide a sustainable program, a pilot project using community health workers was planned. Aim and Objectives: The objectives of the study were to implement and evaluate community participatory oral health promotion and prevention program in school children from select rural population in Deshmukhwadi, Pune district, and also carry out knowledge, attitude and practice survey among health workers and school teachers about oral health. Materials and Methods: One hundred and thirty-nine students, aged 6–13 years, constituted the sample size. The program consisted of oral health education, atraumatic restorative treatment, scaling of teeth with hand scalers, and fortnightly fluoride mouth rinsing. The health workers who were commissioned into medical department by Tata Motors from the same village, after proper training and calibration performed the above-mentioned preventive procedures on children. Results: There was a significant improvement in gingival status (P < 0.001), caries status (P = 0.003), and incipient lesion (P = 0.01) after the program. In the present study, the health workers were successfully trained to provide basic oral care services in rural areas. Furthermore, the knowledge, attitude, and practice regarding oral health which was assessed among the health workers and school teachers improved after 16 months of the program. Conclusions: The community participatory oral health promotion and prevention program showed a significant improvement in the filled and initial lesion surfaces in the primary and permanent dentition and the bleeding sextants. Health workers and school teachers showed improvement in knowledge and practice after the program.

This paper investigates the differential binary modulation for decode-and-forward (DF) based relay-assisted free space optical (FSO) network under the effect of strong atmospheric turbulence together with misalignment error (ME). The atmospheric fading links experience K-distributed turbulence. First we derive novel closed form expression for average bit error rate (BER) and outage probability (OP) in terms of Meijer’s G function. Further, the OP of differential DF-FSO system with multiple relays is derived. We also analyze the asymptotic performance for the sake of getting the order of diversity and the coding gain. The power allotment term is utilized to examine the effect of different power allotment techniques on BER and OP. The simulation results have been used to validate the derived analytical results.

Abstract Background Coronavirus disease (COVID-19) predisposes patients to both arterial and venous thrombosis due to excessive inflammation, platelet activation, endothelial dysfunction, and stasis. Therefore, therapeutic anticoagulant therapy has been an integral part for management in patients with moderate to severe COVID-19 disease. We shall here discuss the concerns of starting anticoagulants in patients with COVID-19 disease who are already on antiplatelets, an unexplored area. Case presentation We herein report a case of 61-year-old patient with hypertension and diabetes mellitus type 2 with COVID-19 disease. Patient also had coronary artery disease and underwent CABG 4 years ago and was on aspirin 75-mg HS, clopidogrel 75-mg OD, and tab atorvastatin 40-mg HS. Patient was hemodynamically stable and was maintaining a saturation of 66% on room air and a saturation of 96% on 02 by high FiO2 partial rebreathing face mask. On auscultation, crepitations were present in bilateral lower lung fields. The patient was admitted under moderate category of COVID-19 SARS in the intensive care unit (ICU). Despite of standard care and treatment, in next 2 days, the oxygenation deteriorated Pa02/Fi02

Background: Ozone oil has both antimicrobial and antiinflammatory properties. This study was undertaken to compare the efficacy of ozone oil with chlorhexidine gluconate 1.0% w/w gel for the treatment of gingivitis. Methods: A triple-blind, controlled trial with parallel design was conducted for 28 days as a pilot study. Thirty participants aged 14–17 years were recruited. After baseline data collection involving gingival index (GI) and plaque index (PI), the products were distributed, scaling of teeth was done, and oral hygiene instructions were given. The participants were asked to apply the gel and oil topically and followed up on days 7 and 28. Results: A statistically significant difference (P < 0.01) was seen within the ozone and chlorhexidine groups at the end of 28 days, showing a reduction in the plaque and gingival scores. At day 28, the reduction in plaque and gingival score was significant for the chlorhexidine group. It was found that chlorhexidine gel showed a greater reduction in the clinical parameters than the ozone oil, which was statistically significant but clinically similar. Both the products showed a substantial reduction in plaque scores. The participants from both the groups showed an improvement, having mild gingivitis post intervention. Conclusion: Ozone oil showed a significant reduction in the clinical parameters of PI and GI similar to chlorhexidine gel, thereby signifying its antimicrobial and antiinflammatory effects on the gingival tissues without any adverse effects, implicating the possession of properties required by a chemotherapeutic agent.

Background: The salivary gland lesions constitute around 3–6% of all head-and-neck lesions and have always posed a diagnostic riddle for the cytopathologists around the world. Since the majority of these lesions need surgical excision, it is, therefore, important to diagnose these lesions with utmost precision to prevent over or under stage procedures. The recent adaption of Milan system of reporting aims to establish a uniform, accurate, and consensual reporting system which bridges the communication between the pathologists and the clinicians. Aims and Objectives: The current study aims to assess the diagnostic application of Milan system and aims to reclassify the lesions according to it. Materials and Methods: The current study was conducted at our institute during 1 year period. All salivary gland swellings presenting to the fine-needle aspiration cytology (FNAC) section during this period were included in the study. Along with this, records and slides of cases of salivary gland lesions were retrospectively assessed. All relevant data and radiologic findings were retrieved from the case records. FNAC was done using 23 G needle. The slides were stained with both Leishman and Papanicolaou stain wherever possible. Quantitative data were expressed as mean and standard deviation and percentages. All the 83 lesions were reclassified as per the Milan system. Histopathology was available in 42 cases. Inclusion criteria: All the samples of the patient having salivary gland lesion(s) whose FNAC were performed in the department of pathology. Statistical Analysis: Data were be entered into Microsoft Excel spreadsheets. For quantitative data, mean and standard deviation were calculated. For qualitative data, percentage and proportion were calculated. Sensitivity, specificity, and spearman correlation between FNAC and histopathology were calculated. P

Introduction: Metaplastic Carcinoma of Breast (MCB) is a rare heterogeneous neoplasm characterised by a mixture of adenocarcinoma with dominant areas of spindle cells, squamous and other mesenchymal differentiation. The reported incidence is 0.2% of all breast cancers. Aim: To study the clinicopathological presentation, pathologic features and differential diagnosis of MB. Materials and Methods: This retrospective cross-sectional descriptive study included 10 cases of MCB who underwent mastectomy and biopsies at BPS GMC Khanpur Kalan, Sonipat, Haryana, India from March 2013 to February 2020. Data were analysed by Microsoft Office Excel Datasheet 2019. Results: Out of 10 cases, five cases were MCB Not Otherwise Specified (NOS) type, four cases were MCB with mesenchymal differentiation and one case showed rhabdomyosarcomatous differentiation. The right breast was involved in nine cases. The mean size of tumour was 8 cm with range of 3 to 16 cm. Five patients were treated by modified radical mastectomy and axillary dissection, four patients had lumpectomy and one patient underwent mastectomy. Half of the patients were below 40 years with the mean age being 36.8 years and range of 21-60 years. On Immunohistochemistry (IHC), 90% (9/10) cases were triple negative. Conclusion: The MCB, although rare has to be diagnosed and excised at the earliest as the prognosis is predicted to be worse similar to other triple negative breast carcinomas. Ductal Carcinoma in Situ (DCIS) at the tumour periphery and co-expression of vimentin and cytokeratin would help to clinch the diagnosis in difficult situations.

Introduction: Breast carcinoma demands attention as it causes high morbidity and mortality. It is important to recognise benign lesions to distinguish them from in situ and invasive breast cancer and to assess a patient’s risk of developing breast cancer, so that the most appropriate treatment modality for each case can be established. The p63 has been characterised as a reliable marker of myoepithelial cells of lactiferous duct. It is exclusively expressed in myoepithelial cells of normal breast tissue. Hence, p63 can be of great help in the differential diagnosis involving benign lesions. Also, p63 may aid in distinguishing benign from malignant lesions. Aim: To study the Immunohistochemistry (IHC) expression of p63 in benign and malignant breast lesions. Materials and Methods: The prospective study was conducted on 76 breast specimens for a period of one year, from 1st December 2018 to 30th November 2019 in the Department of Pathology, Bhagat Phool Singh, Government Medical College for Women, Khanpur Kalan, Sonepat, Haryana, India. IHC assessment for p63 nuclear protein was performed. The intensity of p63 expression was evaluated as continuous positive, discontinuous positive and negative. The extent was scored on the basis of percentage of positive cells and assigned a score of negative (0%), 1 (

Collision tumour is defined as the presence of two distinct tumours in the same organ without any histological intermixing. Such tumours involving ovaries are extremely rare. We are presenting report of two cases of ovarian collision tumour. Our first case revealed features of mature cystic teratoma with mucinous cystadenoma. The second case showed components of both mature cystic teratoma and serous cystadenoma. Correct diagnosis of collision tumour will guide the surgeon towards proper treatment and favorable prognosis of patient.

BACKGROUND: Dental education is considered a challenging and taxing program as on successful completion one is required to attain unique and diverse competencies. There is an established perception that students do not enjoy their experiences in the dental institution and they always demand for certain amendments. Therefore, a dental education perceptions and metacognition assessment tool (DEPMAT) was developed for Indian undergraduate and postgraduate dental students for assessing their learning in Deemed University versus Maharashtra University of Health Sciences in Pune, Maharashtra. MATERIALS AND METHODS: This cross-sectional study was conducted among students of four dental colleges of two types of universities in Pune, India, using a 31-item DEPMAT based on Dundee Ready Education Environment Measure and metacognition awareness inventory using five subscales. Psychometric properties were also tested for this new tool. Data were analyzed using the SPSS software. RESULTS: Of 512 participants, 498 (96.88%) students had duly returned the questionnaire. Cronbach's alpha coefficient value for reliability was found to be 0.87 which indicated good internal consistency and test-retest reliability was found to be kw = 0.76, which indicated substantial agreement. Significant difference was found among undergraduates in domains regarding their perception toward academics, infrastructure and learning environment, and health and stress. CONCLUSION: This study suggested that the general perception toward learning among final year postgraduate students was positive in both the universities. However, the perception of final year undergraduates toward learning was negative and students have suggested certain amendments in both the universities. This study also suggested the new tool was effective in assessing the attitude of practice of both undergraduate and postgraduate students.

Background: Dental Council of India in its 3rd amendment regulations-2011 had incorporated 3 months of compulsory rural posting for the dental interns to sensitize them toward social responsibility through community outreach program. Objective: The objective of the present qualitative study was to understand in-depth the perceptions and attitudes of the interns of dental colleges in Pune district, India, toward community outreach programs. Materials and Methods: Focused group discussions were conducted for each group of ten interns separately in one college for about 1 hour, based on a well-designed but flexible topic guide through a moderator and a note-taker. Results: Most of the interns were aware of need for outreach programs in the community. It helps the interns in sharpening their clinical as well as communication skills outside the traditional dental school settings. Since most of the dentists prefer to practice in urban or financially stable areas, such programs can increase the exposure of dental students to underserved population and sensitize them toward their oral health needs. Conclusion: Thus, dental profession must develop strategies to provide new graduates with professional and personal support to retain the rural dental workforce.

Background: The knowledge of the parents toward the oral hygiene care might get affected by the family structure. Objective: Trend of capsular families in Urban India has led to change in infant oral health practices. Hence, the study was carried out to evaluate the knowledge, attitude, and practice about infant oral care among professional working mothers in Pune city, India. Methods: A 28-item semi-closed, closed-ended questionnaire was administered to 111 professional working mothers in Pune city, India. The data for demographic details, knowledge, attitude, and practice regarding infant oral care were collected with the help of this predesigned self-administered questionnaire from working professional mothers attending outpatient department of Pediatric Hospitals in Pune city. Results: An average, there was limited knowledge among mothers regarding oral health. However, only 13.5% mothers were aware about commercially available tooth wipes, 18% knew when the infant's first dental visit should be scheduled. About 22.5% had practice of bottlefeeding before nap time and 16.2% mothers added sugars/additives in milk while bottlefeeding. Conclusion: All the mothers had overall limited knowledge, positive attitude, and practices were inadequate about infant oral care.

Background and Aim: Preservative free tramadol has been used as an adjuvant to intrathecal bupivacaine. However, the effect of the addition of tramadol on intrathecal isobaric ropivacaine has never been studied. Material and Methods: This prospective, randomized, double-blind study was conducted in 50 adult male American Society of Anesthesiologists grade I or II patients, aged 18-60 years, being operated for unilateral femur fractures. An epidural catheter was inserted in L2-L3 interspace and subarachnoid block was given in L3-L4 space. The patients were randomized to receive 0.5 mL normal saline (group R) or 0.5 mL (25 mg) preservative free tramadol (group RT) with 2.5 mL of 0.75% intrathecal ropivacaine. Hemodynamic parameters, sensory level, motor block, sedation and side-effects were recorded. Statistical analysis was done using Student's t-test, Chi-square test, Fischer's exact test and repeated measures ANOVA. Results: The time of sensory block onset was 9.2 ± 4.9 min and 8.6 ± 5.3 min (P = 0.714) in group R and group RT, respectively. The motor block onset was also comparable in both the groups (P = 0.112). The duration of sensory block was 147.2 ± 37.4 min in group R and 160.4 ± 40.9 min in group RT (P = 0.252). The median maximum block height achieved in both the groups was T6 and the time to achieve the maximum block was also comparable statistically (P = 0.301). Conclusion: The addition of intrathecal tramadol 25 mg to the isobaric ropivacaine does not alter the block characteristics produced by intrathecal ropivacaine alone.

Introduction: Supervised toothbrushing program at schools have indicated limited improvement in oral hygiene among children. Aim: The aim of this study is to evaluate whether the use of an intra-oral camera as a reinforcement tool in a supervised tooth brushing program at school can improve plaque control. Materials and Methods: A double-blind, parallel, two arm interventional study was conducted among 120 school children from 2 schools, aged 12-year in Pune. The study group received an intervention of supervised toothbrushing and reinforcement sessions for 30 days using intra-oral camera. The control group received only supervised toothbrushing. Evaluation for plaque control was performed at the end of 30 days, 3 months, 6 months, and 12 months. Analysis of co-variance was used to find the intergroup difference at different time intervals. Analysis of variance was used to find the intragroup differences of the plaque scores. Post hoc Bonferroni test was used to find the pairwise changes in plaque scores between different time intervals. Results: In the study group, the mean plaque score was reduced to a significant extent from baseline to 30 days and 3 months (P < 0.05) and then the plaque score remained stable until the end of 12 months. While in the control group, the plaque score increased compared to baseline. There was a statistically significant difference between the mean plaque scores of study and control group at each time interval (P < 0.05). Conclusion: Intra-oral camera can be effectively used as a reinforcement tool in supervised toothbrushing program at school for achieving higher plaque reduction.

Carcinosarcoma is an extremely rare tumor of the breast comprising of two distinct cell lines i.e. the epithelial and mesenchymal. It is a highly aggressive tumor with a poor prognosis compared to other breast cancers with a reported incidence of less than 1% of all the breast cancers. A 35 year old female presented to surgical outpatient with a fungating mass in the right breast where cytological analysis from the affected areas revealed spindle cells of malignant potential. A modified radical mastectomy was performed and following histopathological examination of the excised tissue, a final diagnosis of carcinosarcoma of breast was concluded. Immunological staining done showed a negative staining for PR and positive staining for ER, Her-2/neu and CK receptors, as against the conventional triple negative staining pattern. Along with a rare staining pattern of this rare tumor reported in literature, this case merits presentation owing to its diagnostic and therapeutic challenges.

Squamous cell carcinoma, a rare malignancy of upper urinary tract accounts for 1.4% of all renal malignancies [1]. These tumours are mostly seen in the adults and less commonly in the pediatric age groups. Most of the cases present incidentally because they are masqueraded by pyonephrosis or hydonephrosis which occurs at an advanced stage of the disease and hence poor prognosis. A screening CT for long stand renal stone or newer imaging modalities are required for early detection and improving prognosis of the patients. Here we present a case of renal squamous cell carcinoma in 55 yrs old male with a staghorn calculus.

Epidermolysis Bullosa Simplex (EBS) has been subclassified into various subtypes on the basis of clinical features and histopathology predominantly into three divisions: Simplex, Junctional and Dystrophic. EBS is characterised by inter-epidermal blistering with minor internal engrossment. It’s always inherited in an autosomal dominant fashion and is also the least severe type of EB. More recently a recessive form of EBS has been described. The Koebner type of EBS (EBS-K), also known as the non-dowling meara or more recently the other generalised form, is usually presented at birth and is one of the rare presentations of EBS. Though always present with an extensive family history EBS-K is very rarely associated with de novo mutation.

Peutz-Jeghers syndrome is inherited as an autosomal dominant disorder presenting as hamartomatous polyps in small bowel with mucocutaneous pigmentation. We here present a case of 14 years old male presenting with symptoms of intestinal obstruction and mucocutaneous pigmentation along with family history of similar rashes, in both his mother and brother.

Background: In elderly patients, use of adjuvant with small doses of local anesthetics is a preferred technique for spinal anesthesia for lower limb surgeries. This study tested the hypothesis that addition of small doses of clonidine augments the spinal block levels produced by hyperbaric bupivacaine in elderly without affecting the side-effects if any of clonidine in these patients. Materials and Methods: This was a prospective, randomized, double-blind study. Above 60 years male patients were allocated to three equal groups. Group C received 9 mg hyperbaric bupivacaine without clonidine while Group C 15 and Group C 30 received 15 μg and 30 μg clonidine with hyperbaric bupivacaine respectively for spinal anesthesia. Effect of clonidine on sensory block levels was the primary study outcome measure. Motor blockade and hemodynamic parameters were also studied. Results: A significantly higher median block levels were achieved in Group C 15 (P < 0.001) and Group C 30 (P = 0.015) than Group C. Highest median sensory block level, the mean times for sensory regression to T 12 level and motor block regression were statistically significant between Groups C 15 and C and between Groups C 30 and C. On comparison of fall in systolic blood pressure trends, there was no significant difference in the clonidine groups as compared with the control group. Conclusions: In elderly patients, clonidine when used intrathecally in doses of 15 μg or 30 μg with bupivacaine, significantly potentiated the sensory block levels and duration of analgesia without affecting the trend of systolic blood pressure as compared to bupivacaine alone. Clonidine in doses of 30 μg however facilitated the ascent of sensory level block to unexpectedly higher dermatomes for a longer time.

Background: Continuous thoracic paravertebral block (TPVB) provides effective analgesia for unilateral multiple fractured ribs (MFR). However, prolonged infusion of local anaesthetic (LA) in high doses can predispose to risk of LA toxicity, which may be reduced by using safer drugs or drug combinations. This study was conducted to assess efficacy and safety of paravertebral infusion of ropivacaine and adrenaline with or without fentanyl to provide analgesia to patients with unilateral MFR. Methods: Thirty adults, having ≥3 unilateral MFR, with no significant trauma outside chest wall, were studied. All received bolus of 0.5% ropivacaine 0.3 ml/kg through paravertebral catheter, followed by either 0.1-0.2 ml/kg/hr infusion of ropivacaine 0.375% with adrenaline 5 μg/ml in group RA or ropivacaine 0.2% with adrenaline 5 μg/ml and fentanyl 2 μg/ml in group RAF. Rescue analgesia was provided by IV morphine. Results: Statistical analysis was performed using unpaired Student t-test, Chi-square test and repeated measures ANOVA. After TPVB, VAS scores, respiratory rate and PEFR improved in both groups with no significant inter-group differences. Duration of ropivacaine infusion, morphine requirements, length of ICU and hospital stay, incidence of pulmonary complications and opioid-related side-effects were similar in both groups. Ropivacaine requirement was higher in group RA than group RAF. No patient showed signs of LA toxicity. Conclusion: Continuous paravertebral infusion of ropivacaine 0.375% with adrenaline 5 μg/ml at 0.1-0.2 ml/kg/hr provided effective and safe analgesia to patients with unilateral MFR. Addition of fentanyl 2 μg/ml allowed reduction of ropivacaine concentration to 0.2% without decreasing efficacy or increasing opioid-related side-effects.

Needle-through-needle combined spinal-epidural (CSE) may cause significant delay in patient positioning resulting in settling down of spinal anaesthetic and unacceptably low block level. Bilateral hip flexion has been shown to extend the spinal block by flattening lumbar lordosis. However, patients with lower limb fractures cannot flex their injured limb. This study was conducted to find out if unilateral hip flexion could extend the level of spinal anaesthesia following a prolonged CSE technique. Fifty American Society of Anesthesiologists (ASA) I/II males with unilateral femur fracture were randomly allocated to Control or Flexion groups. Needle-through-needle CSE was performed in the sitting position at L2-3 interspace and 2.6 ml 0.5% hyperbaric bupivacaine injected intrathecally. Patients were made supine 4 min after the spinal injection or later if epidural placement took longer. The Control group patients (n=25) lay supine with legs straight, whereas the Flexion group patients (n=25) had their uninjured hip and knee flexed for 5 min. Levels of sensory and motor blocks and time to epidural drug requirement were recorded. There was no significant difference in sensory levels at different time-points; maximum sensory and motor blocks; times to achieve maximum blocks; and time to epidural drug requirement in two groups. However, four patients in the Control group in contrast to none in the Flexion group required epidural drug before start of surgery. Moreover, in the Control group four patients took longer than 30 min to achieve maximum sensory block. To conclude, unilateral hip flexion did not extend the spinal anaesthetic level; however, further studies are required to explore the potential benefits of this technique.

Deepti Agarwal1, Suprabha Sharma2, Shyamoli Dutta1, Rani Bansal2, Seema Awasthi1, Anjali Khare2, Maryem Ansari11Department of Pathology, Teerthanker Mahaveer Medical College, Moradabad, India; 2Department of Pathology, Subharti Medical College, Meerut, IndiaBackground: Fine needle aspiration (FNA) biopsy is a well accepted diagnostic procedure and considered to be a valuable test for initial assessment of head and neck swellings in adults. The technique has gained popularity in the pediatric population over the last decade, with varying degrees of acceptance rates, accuracy, and results among pathologists.Objective: This study was performed to evaluate the utility of aspiration cytology as a first-line diagnostic tool in palpable head and neck masses in children, taking into account the diversity of lesions observed in this subset of the population. Cytologic analysis was correlated with histologic results for evaluating diagnostic accuracy wherever possible. The applicability of FNA biopsy in diagnosing pediatric malignant lesions was also evaluated.Methods: This retrospective study conducted from January 2008 to December 2009 screened all pediatric cases referred to the departments of pathology at two tertiary care hospitals in India. Data from a total of 662 children aged 0–15 years presenting with head and neck masses who underwent FNA biopsy were collected. Cytologic results were interpreted and analyzed according to anatomic site. The lesions were then categorized into inflammatory, infective, and neoplastic.Results: Of the 662 lesions, 23 cases were excluded due to inadequate material, thus the data for 639 cases were finally evaluated. Lymph node lesions predominated, accounting for 570 cases (89.2%), of which 412 (72%) cases were diagnosed as reactive and 91 (16%) cases as tubercular lymphadenitis. Other lesions aspirated were thyroid (18 cases, 2.8%), salivary gland (12 cases, 1.8%), and miscellaneous surface lumps (39 cases, 6.1%). Of all the cases, 628 (98.27%) were reported as benign and 11 (1.67%) as malignant. The positive predictive value of cytologic analysis in diagnosing malignancy was 100%, although exact typing of lesions was possible only on histopathologic examination.Conclusion: FNA biopsy is a sensitive and minimally invasive first-line investigation in the diagnosis of head and neck masses in children. It is highly accurate in isolating and determining potentially neoplastic lesions, thus guiding the way for cases which truly require excision biopsy or other second-line investigations.Keywords: fine needle aspiration, biopsy, tubercular, lymphadenopathy, thyroid

Background: The aim of the study was to compare the effect of propofol & sevoflurane with respect to hemodynamic changes, recovery profiles and complications in patients scheduled for various elective surgical procedures under general anesthesia. Method: Fifty ASA physical status I-II patients of either sex, aged between 18 and 60 years were randomly divided into two groups to receive either propofol infusion (group P, n=25) or sevoflurane (group S, n=25). Cardiovascular parameters, SpO2 and bispectral index (BIS) scores were recorded. Time to eye opening, hand squeezing and achieve modified Aldrete’s Score ≥ 9 and the incidence of complications were noted. Results: Early recovery times [eye opening, hand squeezing and achieve modified Aldrete’s Score ≥ 9] were significantly longer in group P (P 0.001). Cardiovascular parameters, SpO2 and bispectral index (BIS) scores were comparable between the groups (P > 0.05). The incidence of post-operative nausea and vomiting was significantly higher in group S. Conclusions: The present study which adjusted propofol infusion rate and sevoflurane concentration according to BIS scores revealed that maintenance of anesthesia with sevoflurane is associated with faster recovery than anesthesia with propofol. Propofol resulted in a significantly lower incidence of postoperative nausea and vomiting.

Hydatid disease, an endemic in the cattle grazing areas, particularly in the Asian region, is a parasitic infection which is caused by the cestode tapeworm, Echinoccocus granulosus. There is involvement of the intra–abdominal organs apart from the liver, in 10-15% of the cases. We are reporting a case, wherein the appendix was involved with this parasitosis and we have discussed the review of the literature regarding the diagnostic, surgical and the newer percutaneous approaches for the management of this disease.

Background: Thyroid disease is most common endocrine disorder and is different from other endocrine diseases because of its visible swelling and ease of diagnosis. If left untreated, thyroid disease makes a person more prone for heart disease, infertility and osteoporosis. In India, significant burden of thyroid diseases exist with an estimation of around 42 million cases. The thyroid status and autoimmune status of adult Indian population in the post iodinization phase is largely unknown. Aim: The main objective of this study was to generate valuable epidemiological data regarding the prevalence of thyroid disorders in rural population of Khanpur Kalan, Sonepat in the post-iodinisation era in India. To assess whether thyroid autoimmunity or goitrogens along with environmental factors play role in the development of thyroid.This paper is being presented in view that no such study has been carried out in the rural population of this region in Haryana. Materials and Methods: The present study was conducted in Department of Pathology, Bhagat Phool Singh Medical College for Women, Khanpur Kalan, Sonepat between August 2011 to July 2013. It included retrospective analysis of cytomorphology of fine needle aspiration cytology material of 206 patients presenting with thyroid nodule in the Department of Pathology. Results: The commonest age group affected was 31-40 yrs. The female patients (93.4%) outnumbered the male patients (6.6%). The cytomorphological analysis of 206 patients revealed 190 cases (92.2%) of neoplastic lesions, 10 cases (4.8%) were neoplastic and 6 cases (2.9%) had indeterminate cytomorphology. Maximum number (65.5%) of patients was suffering with goiter followed by lymphocytic thyroiditis (26.2%). Amongst the malignant cases three cases were of papillary carcinoma and one case of medullary carcinoma. Two out of the six cases of follicular neoplasm proved to be follicular adenoma on histopathology. Four patients with high T3 levels were under treatment with neomercazole. They showed change in cytomorphology from hyperplasia to colloid goiter. Only one case of acute suppurative thyroiditis was reported which shows rarity of its type. Conclusion: The increased prevalence of goiter in this post iodinisation era can be attributed to goitrogens, autoimmune thyroid disease and micronutrient deficiency of iron and selenium. Higher prevalence of autoimmune thyroiditis in females is linked with both genetic and environmental factors such as infection, stress.

Trichoepithelioma is an uncommon, benign hamartomatous tumor of the pilosebaceous follicle. Presenting as multiple papules and nodules on face and neck, they pose a significant cosmetic problem in affected individuals. Familial involvement of this dermatosis occurs in an autosomal dominant pattern, the locus being located on chromosome 9p21, which causes multiple facial lesions in family members and their kins. Here, we report a case of multiple familial trichoepithelioma causing considerable disfigurement of the face.