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Traditionally, diabetes is classified as type 1 and type 2 based upon the phenotypic differences. However recent research denotes that there are at least five well characterized subtypes.This classification provides novel insights in the natural history and treatment options for diabetes mellitus.

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Hyperkeratosis of the nipple is an uncommon, benign, asymptomatic, acquired condition of unknown pathogenesis. Most cases are bilateral, although unilateral cases had been reported. Breastfeeding is usually not affected. Physiologic changes of the nipple and areola during pregnancy include enlargement, hyperpigmentation, secondary areolae, erectile nipples, prominence of veins, striae, and enlargement of the Montgomery glands or tubercles (hypertrophied sebaceous glands). Women with unilateral primary hyperkeratosis of the nipple and/or areola (HNA) may have bilateral disease during pregnancy (secondary HNA). Pregnancy may also produce thicker, darker lesions. Here, we report a case of pregnancy-associated hyperkeratosis of the nipple in a primigravida. We counseled her about the benign nature of the condition and treated her with topical steroids and moisturizers.

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Background: Pemphigus is a group of autoimmune blistering disease of the skin and mucous membranes with an incidence of <2 cases per 100,000 population. The aim is to evaluate the clinical pattern and to study the correlation between clinical, histopathological, and immunofluorescence findings in pemphigus. Materials and Methods: All newly registered patients with flaccid blisters and erosions on the skin with/without oral erosions during 2 years from May 2009 to April 2011 were evaluated by detailed history, clinical examination, cytological, pathological, and direct immunofluorescence studies, and results correlated. Results: Of the 43 patients studied, 36 (83.72%) had pemphigus vulgaris and 7 (16.28%) had pemphigus foliaceus with maximum patients in the age group of 40–59 years and M:F ratio of 1:1.3. Cytologically, acantholytic cells were demonstrated in 88.37%, histopathological correlation was seen in 100% cases, and direct immunofluorescence was positive in 97.37% of the 38 cases in which it was performed. Conclusion: Clinico-immuno-histopathologic correlation is seen in most cases of pemphigus, and although a combination of clinical, cytological, histopathological, and immunofluorescence findings virtually eliminates the chances of error in the diagnosis of pemphigus, histopathology may suffice in most cases.

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Drug-induced acute anaphylactic reactions are rare in general. Antibiotics and anticholinergic agents are widely used for renal conditions such as hematuria and overactive bladder, respectively. However, anaphylactic reactions to this category of drugs are very rare, but many times fatal. These types of serious reactions are very important to watch for. Here, we are reporting levofloxacin and solifenacin-induced acute anaphylactic reaction in a 66-year-old male patient.

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Appetite for substances that are widely non-nutritive is termed Pica and commonly seen in patients with psychiatric disorders. Their clinical presentation may be delayed and include multiple foreign bodies. Most of such ingested bodies pass through gastrointestinal tract uneventfully and only on rare instances cause obstruction or perforation. The length and sharpness of an object govern its risk of perforation. Physicians are dependent upon imaging to detect a foreign body, especially if the history of ingestion is doubtful. We present a case of pica with multiple foreign bodies diagnosed on radiography and ultrasonography with the findings correlating with surgical retrieval of objects.

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Retroperitoneal lipomas have remained the essentially rare tumors seen in clinical practice. The tumors are rarer in children, with very few reported cases in surgical literature worldwide. We report the case of a 5-year-old child who presented with a giant retroperitoneal lipoma that was successfully managed by complete excision. There has been no recurrence noticed during follow-up. We present a rare case of giant retroperitoneal lipoma in a child. At laparotomy, a giant lipoma weighing about 6 kg was excised.

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Introduction: Multidrug-resistant tuberculosis is of increasing public health concern and a rapid and inexpensive drug susceptibility test is needed in resource limited settings. Aim: This study aims to compare the efficacy of drug susceptibility testing (DST) of Mycobacterium tuberculosis using nitrate reductase assay (NRA) on solid Lowenstein–Jensen (LJ) medium with proportion method on LJ medium as reference standard. Materials and Methods: From November 2011 to July 2012, 100 isolates of M. tuberculosis were tested for susceptibility to first-line drugs on LJ medium by proportion method and NRA using LJ with potassium nitrate. Results: For various drugs, the sensitivity and specificity by NRA on solid medium were as follows: streptomycin 96.6% and 98.5%; isoniazid 96.87% and 97%; rifampicin 96.3% and 96%; and ethambutol 78.9% and 91.4%, respectively. The concordance for rifampicin and isoniazid between NRA method and LJ proportion method was found to be >95%. Conclusion: NRA was found to be a rapid and sensitive method for DST of M. tuberculosis.

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Background: Endophthalmitis is an infrequent but devastating intraocular infection. The objective of the present study was to detect the incidence of endophthalmitis in posttherapeutic keratoplasty patients. Materials and Methods: The study was conducted at a secondary-level government eye care center at Rajkot, Gujarat. The study included 71 eyes of 71 patients prospectively from January 2013 to December 2014. All the patients who underwent therapeutic keratoplasty for suppurative keratitis and descemetocele were included in this study. The study excluded all the patients who underwent optical penetrating keratoplasty and posttraumatic keratoplasty. The patients were followed up on the 1^st, 7^th, 15^th, and 45^th postoperative days for signs and symptoms of endophthalmitis. Results: There were 71 eyes of 71 patients including 44 (62.0%) males and 27 (38.0%) females. The mean age of the patients was 53.4 ± 18.9 years (range: 8–98 years). Out of the 71 eyes, 51 had preoperative ocular history including foreign body fall (15 [21.1%]), vegetative material trauma (20 [28.2%]), nonvegetative material trauma (11 [15.5%]), and previous keratoplasty (5 [7.0%]). Predominantly, bacterial infection was reported in 28 (39.4%) patients. Iritis was reported in all patients after keratoplasty followed by conjunctivitis (9.9%) and vitritis (7.0%). During follow-up examination on the 1^st, 7^th, 15^th, and 45^th postoperative days, zero incidence of endophthalmitis was reported. Conclusion: The present study reported zero incidence of endophthalmitis in therapeutic penetrating keratoplasty patients. Therapeutic penetrating keratoplasty is effective in the management of eye with suppurative keratitis and descematocoele.

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Background: Bleeding in early pregnancy is a common occurrence, but very little is known about the outcome of pregnancy complicated by bleeding during the early part of the gestation. This prompted me to explore these in a prospective cohort study over a period of 12 months. Objectives: The aim of this study is to determine the mode of presentation and the materno-fetal outcome in pregnancies complicated by early pregnancy bleeding and compare with a group without such complication. Materials and Methods: A total of 72 cases were observed and these patients were matched with a control group in maternal age in years (+2), parity and gestational ages in weeks. Thus, a total number of 144 patients were studied. Results: Pregnancy loses or abortions occurred in 12 patients (16.6%) in the study group compared with 3 patients (4.1%) in the control group (P < 0.05), 14 patients (19.4%) had preterm deliveries in the study group, compared with four patients (5.5%) in the control group (P < 0.05) and low birth weight was observed in 15 patients (20.83%) among the study group compared with 5 patients (6.94%) in the control group (P < 0.05). All the three outcome measures above had statistically significant differences when compared in between the two groups. These poor outcomes were observed among those who bled in the second trimester, those who had episodes of bleeding in both the first and the second trimesters or recurrent vaginal bleeding throughout the pregnancy. Conclusion: The outcome of this study showed that bleeding in early pregnancy, especially during the second trimester or recurrent bleeding in both the first and the second trimesters correlates with poor pregnancy outcomes.

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Absorption of drugs is more in human oral cavity. Humans get daily exposure to the additives of dentifrices which contain toxic chemicals. The practice of using commercial dentifrices can cause toxic problems to user, and this issue is unfortunately not in public domain and also ignored by the Government. The best way is to avoid it, is to use natural safe tooth cleaners.

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