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Ayurveda is the science that talks about the longevity of life, maintenance of health and destroying the disease. Amongst diseases, Jwara (Fever) is the first to affect mankind which comes in tamas form at the time of birth and death. It is crucial among all diseases as it affects not only human beings but also all living creatures. Ayurveda explains about many Dravyas (substance) to reduce fever. Amongst them Guduchi [Tinospora Cordifolia (Willd.) Miers] of family Menispermaceae, is a climbing shrub found throughout tropical India. The plant is having its reference in most of the Ayurveda literature, which is indicated in Jwara, Vataraktha (Gout) Kushtha (skin Dis- eases), Prameha (diabetes)etc. Presently Ayurveda has come close to humans that it has become a human science. Through this paper an effort is made to know more about the Dravya Guduchi, with its mode of action on Jwara with relevance to Dravya Prabhava, Guna Prabhava and Dravya Guna Prabhava Keywords: Ayurveda, Guduchi, Jwara

A drastic shift in the market environment was observed with the pandemic situation spread all around the world. The number of people at the workplace or marketplace also shrunk from thousands to hundreds, tens, and one-digit numbers with the thought of avoiding the crowd and being in isolation or separations to avoid contact. This rapid change in situation has brought huge overnight changes in the shopping behaviors of the customers from bulk buying in a physical market or family shopping to online shopping of all fast-moving consumer goods. There are beginnings of a shift in this approach in India. The study emphasizes the factors influencing online shopping, benefits, and challenges faced by the customers, and the preferred mode of buying for listed products along with the mode of payment. Suggestive measures to bring positive change are also discussed in the paper.

Mucormycosis is a rare but an opportunistic fungal infection. It has recently gained awareness due to its association with covid-19. The main cause is filamentous fungus Rhizopus, which can be inhaled through the nasal passage, oral cavity or even through a cut in the skin, leading to black masses and destruction of bone in hard palate, nasal cavity and skull. Patients suffering from covid-19 are on steroids, which interferes with the patient’s immunity and blood sugar levels leading to spread of black fungus. Hence precise knowledge about black fungus, its mode of transmission and precautions to prevent the infection is considered utmost priority in recent times.

Oral medicine is principally considered as medical specialty but ended up in dentistry and now suffers an “Identity crisis”, bestriding both dentistry and medicine. We discuss the toil faced by the subject and the specialists in India and Internationally in the curriculum, at awareness level and the perseverance to change the consequence. Automated searches of Medline, Pubmed and the Cochrane Library were conducted for data collection; additional searches of main oral medicine journals were done manually using the keywords Growth and future of Oral medicine, Trends in oral disease, awareness of Common Oral Diseases, career preferences in dentistry, referral pattern to an oral medicine unit and survey of oral medicine practice. Several recent reviews have discussed the nature and extent of training the Oral Medicine specialists currently receive and the need for further enhancement of dental curriculum. Despite these apprehensions, we are quite passionate about the future. This enthusiasm is balanced by the realization that some impairments lie in our path. These collective signals are a clear wake-up call for our discipline. Key words: Curriculum, Dentistry, Oral disease, Oral Medicine.

Objective: Venous malformation involving head and neck region is a rare entity. Hence, application of precise and leading diagnostic techniques, gives the accurate localization of the source vessel allowing for making treatment plan more satisfactory. Methods: We present a case of 30-year-old male patient with venous malformation involving head and neck region. We update the review of literature and also discuss the leading diagnostic aids for this rare entity disease so that iatrogenical accidents can be lessened. Case description: Our patient presented with solitary swelling in the left lower cheek region, left side of lateral border of tongue and 2 – 3 small nodular swellings at the lateral border of the neck, lined obliquely over the sternocleidomastoid muscle. All the swellings were soft in consistency and non-tender, with no rise in temperature except for the swelling on the tongue. The lesion was confirmed by a radiograph which showed phleboliths. The ultrasound shows heterogeneously hypoechoic with multiple anechoic sinusoidal spaces (longitudinal plane) with mild vascularization and spectral analysis shows monophasic venous flow. This was later confirmed by direct puncture venography of the left cheek. Conclusion: The spectrum of vascular malformations is too vast; hence it becomes challenging to diagnose the lesion and fit it in the spectrum. These lesions are termed as intramuscular venous malformations based on clinical imaging and pathologic criteria and hence dentists must be aware of the clinical expression of these lesions in order to prevent iatrogenically related accidents and to minimize potential spontaneous crises for the patient. Having said that and keeping in mind the broad spectrum of vascular malformation, we present a clinically well diagnosed case of venous malformation, which illustrates phleboliths. Key words: Venous malformations (VMs), Arteriovenous malformation (AVM), Phleboliths, sclerotherapy, Venography and Hemangioma.

Summary Background Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding National Institute for Health Research Health Services and Delivery Research Programme.

Orofacial granulomatosis is a clinical entity presenting with swelling of the facial and/or oral tissues in association with histologic evidence of noncaseating granulomatous inflammation. Exclusion of other entities like sarcoidosis, mycobacterial infections, foreign body reactions and biopsy helps to establish a correct diagnosis. Here with reporting a case of lip swelling in 35-year old female along with palatal lesion, which was treated lucratively with steroids.

A 91-year-old lady presented with an 8-month history of a slow growing keratotic nodule on the forehead, which was excised. Histological examination showed a well-defined lesion with marked cellular pleomorphism. Numerous mitoses were present. The cells stained positively with CD10 and CD68 and weakly with smooth muscle actin. However, the tumor was negative for cytokeratins (AE1/AE3), epithelial membrane antigen (EMA), S100, Melan A, HMB45, leukocyte common antigen (LCA), desmin, and CD31. Therefore, the lesion was designated as atypical fibroxanthoma (AFX) by exclusion. Within the AFX, there was also a cyst lined by squamous epithelium showing pilar keratinization. The epithelium showed full-thickness dysplasia with increased mitotic activity and was stained positively with AE1/AE3, thus supporting our view of carcinoma in situ within the wall of the cyst. To the best of our knowledge, this article describes the first case of trichilemmal cyst with carcinoma in situ arising within an AFX.

The working conditions in the developing world necessitate the development of many adaptations and improvizations of accepted anaesthetic techniques to improve patient care. Subcutaneous tunnelling of caudally placed epidural catheters is one such improvization to prevent the soiling of the catheter by urine and faeces. This study compares the duration of retention of catheter in a group with tunnelled catheters with an untunnelled group. The absence of a catheter emerging through skin at the site of catheter insertion hastens healing thus prolonging the retention of catheter in the tunnelled group and soiling ceases to be a major problem.

Summary A substantial mediastinal mass in a small infant can create a dilemma regarding the safest mode of airway management. To ensure safety at all times, we adopted one lung ventilation for fear of compression of the carina and/or both main bronchi. Anaesthesia was maintained at a very light plane by the use of local nerve blocks to secure the airway and epidural analgesia for surgery until the tumour was moblized.

To provide updated evidence of the outcome of breast lesions of uncertain malignant potential (B3) and suspicious of malignancy (B4) diagnosed on needle core biopsy (NCB) and analyse the outcome of the different types of intraductal epithelial atypia.One-hundred and forty-nine B3 and 26 B4 NCBs diagnosed over a 2-year period (2007-2008) were compared with those diagnosed over a previous 2-year period (1998-2000). The proportion of B3 diagnoses increased from 3.1% to 4.5%, and the positive predictive value (PPV) of malignancy of a B3 core decreased from 25% to 10%. Increased diagnosis of radial scar and reductions in the PPV of lobular neoplasia and of atypical intraductal proliferation may explain the reduction in the PPV of the B3 group as a whole. There were no significant changes in the proportion of B4 diagnosis (1.1% and 0.8%) or the PPV of B4 (83% and 88%). Review of cores with intraductal atypia showed a wide range of PPVs, from 100% for suspicious of ductal carcinoma in situ, to 40% for atypical ductal hyperplasia categorized as B3, and 14% for isolated flat epithelial atypia.The study has found a decrease in the PPV for a B3 diagnosis and suggests possible explanations.

Eccrine angiomatous hamartoma (EAH) is a rare, benign cutaneous tumor characterized by proliferation of the eccrine gland elements closely associated with capillary angiomatosis and proliferation of other dermal elements, such as adipose tissue, hair and epidermis. Patients usually present with a solitary nodule on the extremities appearing at birth or during the prepubertal years. However multifocal lesions or late onset of this condition may occur. Eccrine angiomatous hamartoma is usually sporadic, but one familial case of the multifocal variant has been reported. The clinical presentation ranges from a simple angiomatous nodule to erythematous--purpuric plaques. Eccrine angiomatous hamartoma is generally asymptomatic but may occasionally be associated with pain and hyperhidrosis. We report a rare case of the multifocal variant of EAH in a 13-year-old girl, with histological features suggesting trauma. Clinically, this condition must be differentiated from other angiomatoses and a definitive diagnosis is based upon histology. Eccrine angiomatous hamartoma is a benign slowly growing lesion for which aggressive treatment is not indicated. Simple excision is reserved for painful or cosmetically disfiguring examples.

Ameloblastic carcinoma is a rare malignant lesion with characteristic histologic features and behavior that dictate a more radical surgical approach than does a simple ameloblastoma. Clinically, ameloblastic carcinoma is more aggressive than most typical ameloblastomas with extensive local destruction, perforation of the cortical plate, extension into surrounding soft tissues, numerous recurrent lesions, and metastasis, usually to cervical lymph nodes. The radiographic appearance of ameloblastic carcinoma is consistent with that of ameloblastoma except for occasional presence of some focal radiopacities, apparently reflecting dystrophic calcification. Histologically, the tumor cells resemble cells seen in ameloblastoma but show cytologic atypia, cellular pleomorphism, nuclear hyperchromatism, mitoses, and vascular and neural invasion. These identifying features of ameloblastic carcinoma must be known and recognized by dental practitioners. It is probable that ameloblastoma, like other tumors (such as carcinoid tumors and epithelial tumors of the ovary), shows a spectrum of histologic and biologic behavior ranging from benignity at one end to frank malignancy at the other. A case of ameloblastic carcinoma of the maxilla in a 70-year-old man is reported.

INTRODUCTIONPerianal extra-mammary Paget's disease is a rare skin disorder of unknown aetiology, which is frequently associated with malignancy. This case report draws attention to this rare condition and comments upon its diagnosis and treatment.PRESENTATION OF CASEA 64-year-old otherwise fit man, presented to us in 2006 with one-year-long history of perianal irritation. On examination there was an erythematous discoid skin lesion in the right perianal area. The lesion was excised with wide margins and the defect closed with a local transposition flap. Histology confirmed extra-mammary Paget's disease (EMPD) with a focus of invasion showing a well-differentiated mucinous adenocarcinoma. Adjuvant therapy was not advised. On follow-up in 2011, a small irregular skin lesion, well away from the previous excision site was noted on the left perianal area. Biopsies from this lesion confirmed EMPD with no focus of invasion. Once again wide local excision with closure using local transposition flap was undertaken. Long term follow up has been advised.DISCUSSIONThe optimal treatment for Perianal Paget's disease (PPD) remains controversial. Surgery is the commonest modality used with wide local excision being the treatment of choice for resectable disease. We report herein a short review of various therapies reported so far in the management of this rare disorder.CONCLUSIONA thorough initial evaluation and long-term follow-up is essential to identify recurrence and the development of other related malignancies.