Background: Nonalcoholic fatty liver disease (NAFLD) is commonly associated with type 2 diabetes mellitus (DM) though its prevalence is not well studied. We conducted a prospective study of prevalence of NAFLD in patients with type 2 DM and its relation with Insulin Resistance. Materials and Methods: 100 patients of Type 2DM attending Tertiary care center in South Gujarat were evaluated. Abdominal ultrasonography was performed to determine the presence of fatty liver. For assessment of Insulin Resistance, Homeostasis Model Assistant - Insulin Resistance (HOMA-IR) and Quantitative Insulin Sensitivity Check Index (QUICKI) were calculated. A probability value of P < 0.05 was considered statistically significant. Results: The study group (n = 100) was divided into a NAFLD group (n = 45) and a non-NAFLD group (n = 55). The prevalence of NAFLD was 45%. The NAFLD subgroup had higher prevalence of obesity (measured by BMI), central obesity (measured by waist circumference and waist hip ratio), higher HbA1c, higher triglyceride levels. HOMA-IR and QUICKI indexes for Insulin Resistance were significantly higher in NAFLD group than Non NAFLD group (P value 0.03, 0.04). Conclusion: The prevalence of NAFLD is high in patients of Type 2 DM. Insulin resistance seems to be correlated with the presence of NAFLD among T2DM patients.

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Benign retroperitoneal and presacral neural sheath tumors of lumbosacral plexus in patients without Von-Recklinghausen's disease are quite rare with only few sporadic case reports. We report a case of giant unilateral plexiform neurofibroma of lumbosacral plexus extending into the thigh up to the level of knee joint in a patient without neurofibromatosis-1. Large unilateral retroperitoneal neurofibromas are rare while extension of the same up to the level of knee joint has not been reported yet. The purpose of the report is to highlight the characteristic imaging features in an unusual case of retroperitoneal neurofibroma extending up to the knee joint and thus avoiding unnecessary biopsy. Further imaging helps in defining presurgical extent of lesion, which in our case is essential as the lesion is seen extending along the entire course of the involved femoral nerve.

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We present a case of an adult male who presented with herniation of soft tissues of temporomandibular joint into the external auditory canal (EAC) through a persistent foramen tympanicum. The patient was referred for computed tomography (CT) for suspicious mass in the left EAC. Multidetector CT helped in correctly characterizing the lesion with retraction of the soft tissue mass in open mouth biopsy and thereby avoiding unnecessary biopsy.

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Tuberculosis (TB) is one of the leading causes of morbidity and mortality, and about one-third of the world population is suffering from this disease. It has been reported in many body parts, but the involvement of thyroid by TB whether primary or secondary is extremely uncommon. We report a case of 60-year-old female presenting with thyroid swelling since 4 weeks. Diagnosis of thyroid TB was made after fine-needle aspiration cytology and confirmed by the detection of acid-fast bacilli by Ziehl–Neelsen stain. The patient was put on antitubercular therapy following which he showed dramatic clinical improvement with resolution of the nodular swelling.

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Spontaneous rectus sheath hematoma occurs commonly in patients with coagulation disorder or as a complication of anticoagulant therapy. Glanzmann's thrombasthenia (GT) usually presents with mucocutaneous bleed, menorrhagia, hematoma/hemarthrosis and, rarely, as visceral hematoma. We report a case of spontaneous rectus sheath hematoma as an emergency in a patient of GT, a very rare presentation. In this case, a 14-year-old girl presented with acute pain abdomen and a palpable mass at the left lower abdomen. She was investigated and was found to have GT, which presented as rectus sheath hematoma.

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Background: Endotracheal and tracheostomy tube (TT) blockage is a common airway accident in Intensive Care Unit (ICU). Although tube blockage is rarely fatal, it has a major impact on the quality of ICU care and the family of the patient. The present study is aimed to assess the tube accidents; primarily, the number, timing, the cause of tube blockage in intubated patients and its impact along with the risk of blockage in relation to respiratory diseases, demography, and on-tube duration. Materials and Methods: After the Ethical Committee approval, the study was conducted in a mixed ICU. Data were collected retrospectively from the ICU assessment record of patients admitted from November 2012 to October 2014. The total numbers of intubated patients and the duration of intubation were recorded. Patients who were intubated for >24 h were evaluated for risk analysis. Data were analyzed using InStat software with Fisher's exact test and unpaired t-test. Results: There were 105 episodes of tube blockage in 72 out of 975 intubated patients during 3797 tube days resulting in five cardiac arrests and one death. Endotracheal tube tubes tend to get blocked earlier than TT tubes (6.30 vs. 8.09 days). The risk of tube blockage increases significantly in patients having ventilator-associated pneumonia (VAP) and who have been intubated for 5 days or more (P < 0.0001). Conclusions: Fatality from tube blockage is rare but causes preventable death. Hence, tube change for ongoing airway management between 5 and 7 days is probably justifiable, especially in patients with VAP.

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Fixed flexion deformity of the neck due to postburn contracture results in the nonalignment of oral, pharyngeal, and laryngeal planes for intubations. Airway management is a challenge to anesthesiologist in these cases. Awake fiberoptic intubation if available is the gold standard in such cases. The design of ProSeal laryngeal mask airway (LMA) is such that it provides a good alternative to the endotracheal tube and its insertion does not require the visualization of the vocal cords. We present the successful airway management of a patient with severe fixed flexion deformity of the neck by an awake ProSeal LMA insertion.

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Crohn's disease (CD) is a chronic relapsing inflammatory disorder with symptoms such as fatigue, unfitness, or decreased quality of life (QoL). Physical exercise may be potentially beneficial for recovering physical condition and improving QoL in populations suffering from chronic conditions, but little is known about its effects on patients suffering from CD in Indian population. Hence, herein we have described the effects of physical exercise in a male participant diagnosed with CD and referred for pain in the knee, ankle, and back. After 12 weeks of aerobic and strengthening exercises, an improvement was seen in QoL, pain, aerobic capacity, and other symptoms of CD.

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Extracranial primary sinonasal meningioma is of a very uncommon occurrence. It can give rise to myriad of nasal symptoms, but proptosis as a result of the same is relatively lesser known. The definitive diagnosis is made only on histological examination. The importance of complete surgical removal is indubitable. Our case report citing the rarity of this tumor involving primarily the sinonasal cavities, leaving the brain undisturbed adds to the already small number of cases reported globally.

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Superior mesenteric artery (SMA) syndrome is a rare cause of duodenal obstruction due to compression of the third part of duodenum between SMA and aorta. Clinical suspicion and radiological findings are playing important role in the diagnosis of SMA syndrome. We report here the clinicoradiologic findings in a case of 66-year-old Indian male. In our case, abdominal aortic tortuosity in an elderly patient was the cause for SMA syndrome.

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We report here a case of lipoblastoma in a 14 year old boy along with a brief review of literature. He presented with multiple soft tissue swellings averaging 1 to 2 cm in maximum dimension over his right thigh and upper limbs with no other apparent constitutional symptoms. These were present since 2 years and were slowly enlarging. Ultrasonography revealed lipoid like density of these masses. Excision of one of his thigh swellings was carried out and histopathological examination revealed presence of lipoblasts in a myxoid background, which was unusual at this age of presentation. The final diagnosis was made as mature benign lipobastoma. Myxoid liposarcoma was considered as a differential diagnosis, however, it was ruled out on account of absence of any nuclear atypia or pleomorphism. Patient was subsequently discharged with no evidence of recurrence at the excision site even at one year of follow up.

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Gastrointestinal stromal tumors (GISTs) of the duodenojejunal flexure are rarely reported. Diagnosis can be elusive and their management is difficult. Definitive surgery remains the main stay of treatment for patients with localized GIST. The radical resection should be followed by adjuvant treatment only for a group of patients with adverse factors indicative of significant risk of recurrence. Our case report aims to highlight some issues related to the diagnosis and management of GISTs at this uncommon site.

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The presence of miliary nodular shadows in the chest radiograph although points to the classical diagnosis of miliary tuberculosis in endemic areas, persistence of these shadows on treatment and the disease presentation may alter the diagnosis. The combination of miliary mottling on chest radiograph along with the high-resolution computed tomography appearance of crazy-paving pattern with calcifications along the interlobular septa in the correct clinical context is considered diagnostic of pulmonary alveolar microlithiasis (PAM). The combination of above radiological features in one such case is presented here where histopathological examination of the lung proved the diagnosis of PAM.

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Pachydermoperiostosis (PDP) is a rare hereditary syndrome manifesting clinically as pachydermia, digital clubbing, and radiologically as symmetrical periostitis of long bones. It is primary idiopathic form of hypertrophic osteoarthropathy. Enlargement of the paranasal sinuses is uncommonly seen in PDP. We report here our experience in a 20-year-old Indian male patient of a PDP with enlarged paranasal sinuses.

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Flexor digitorum accessorius is one of the muscles present in the second layer of sole. After its origin from calcaneus, it gets inserted into the tendon of flexor digitorum longus. Its name implies that it assists flexor digitorum longus in straightening its pull on toes. A variation in its morphology is not uncommon. Its variations like high origin have been implicated in the causation of tarsal tunnel syndrome. In routine dissection of 10 lower extremities we observed unilateral variation in flexor digitorum accessorius in the left sided sole of a male cadaver. This muscle was supplied as usual by a branch from the stem of lateral planter nerve. This type of variation is important not only to anatomist, but also to clinicians, sport's player and physiotherapist.

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Background: Hypoglycemia is a side effect of stringent diabetes control especially in the geriatric population above sixty, who constitute approximately 90 million of the Indian population. This study was undertaken to explore the risk factors of hypoglycemia in elderly inpatients. Methods: Fifty patients who were found to have hypoglycemia either at admission or while admitted were enrolled. Their risk factors were compared with fifty age- and sex-matched inpatients admitted to medical wards who did not experience hypoglycemia. Results: The duration of diabetes was significantly longer (12.2 ± 7.9 vs. 9.4 ± 6.7 years; P = 0.023) in the group which experienced hypoglycemia. The mean glycated hemoglobin was significantly lower in the group which experienced hypoglycemia (6.73 ± 1.02 vs. 7.57 ± 1.39; P = 0.001). Of the fifty patients who developed hypoglycemia 26 were asymptomatic. Infection and renal failure were significantly higher in the study group. On multivariate analysis, infection was the only significant precipitating factor. Conclusion: With stringent blood glucose control elderly patients are at high risk of hypoglycemia. The risk is higher if the patients have renal failure and infection. Attempts should be made to identify such patients and to tailor their diabetic therapy to prevent hypoglycemic episodes.

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Urolithiasis is as old as human civilization. Ancient Egyptian mummies and Indian Ayurvedic descriptions are testimony to this fact. Despite such an old association with humanity pathogenesis of renal stone disease remains far from fully understood. Randall's plaques were believed to be as initiating lesions for calcium oxalate stone since Randall's original description in 1937. However, the origin of Randall's plaque is not fully understood. Till recently, it was thought that excursion of calcium oxalate crystals into basolateral membrane of tubular cells initiates inflammation and leads to calcification. Many exciting new papers though not denying this hypothesis point toward a role of vascular injury-atherosclerosis – calcifying nanoparticles in pathogenesis of Randall's plaque. Hence, renal stone disease may be a harbinger of cardiovascular pathology and vice versa.

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