Kupipakwa Rasayanas are unique, widely prescribed, and highly therapeutic pharmaceutical preparations in ayurvedic therapeutics prepared in Kachkupi (glass bottle). Sameera Pannaga Rasa (SPR) is one such an arsenical compound formulation first cited in Rasa Chandanshu classic. It contains Parada (Hg), Gandhaka (S), Somala (As2O3), Haratala (As2S3), and Manahshila (As2S2) as integral components. Much diversity was seen in Rasa classics regarding its ingredients and duration of heating required for its preparation. Considering this, many studies have been carried out at different centers of India. The aim of the present study was to compile such available research works and relevant information from different Rasa classics and published literature from different databases to provide brief information about pharmaceutical, analytical, pharmacological, and clinical studies. Screening of literature revealed that Manahshila is not an ingredient of SPR in Rasa Chandanshu but added in recent treatises such as Ayurveda Aushadhi Guna Dharma Shastra and Ayurvedic Formulary of India. Totally seven references are found pertaining preparation of Sameer Pannaga Rasa in ayurvedic classics. It is recommended in the management of Tamaka Shwasa (bronchial asthma), Sandhivata (osteoarthritis), Amavata (rheumatoid arthritis), neurological disorders, etc.

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Blood cancers such as leukemia are a public health crisis globally. 2018 cancer statistics reveal 437,033 new cases with leukemia accounting for 2.6% of all cancers, worldwide. Conventional medical science manages the disease quite effectively by targeting the signaling pathways causing leukemogenesis, but with serious side effects as it also damages healthy cells. In this context, a systematic review was carried out to understand the role of Ayurvedic interventions for the management of Rakta arbuda in context to leukemia. Articles were searched using the keywords “only Raktarbuda or leukemia” and “Ayurveda” and “management” or “case report” or “case series” or “in vivo” or “in vitro” “research or review” or “leukemia and Ayurveda” and their different combinations and permutations. Articles from 2000 to 2018, published in only English language, and related to the topic were screened for their contents, and finally, 88 articles were included in this review, which was studies exclusively focused on leukemia done using an Ayurvedic intervention in the form of case reports or case series, in vivo, in vitro studies, or review article. Some case reports were found which documented the beneficial effect of Ayurvedic interventions in the management of leukemias. Scientific researches documented that drugs such as Withania somnifera (Ashwagandha), Tinospora cordifolia (Guduchi), Curcuma longa (Haridra), Zingiber officinale (Adrak), Berberis aristata (Daruharidra), and Moringa oleifera (Sahijan) are efficient inducers of apoptosis. Cell line studies have demonstrated the efficacy of Andrographolide and methanolic extracts of Andrographis paniculata (Kalmegh), Semecarpus anacardium (Bhallataka), and Curculigo orchioides (Kali musli) against leukemia cell lines.

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Introduction: In India, with the introduction of the new Competency-Based Medical Education curriculum in 2019, the “Foundation Course” has become mandatory for the newly admitted medical undergraduates. “Professional Development, including Ethics” which is an important part of this course, has dedicated 40 h of teaching. Materials and Methods: This was a descriptive cross-sectional questionnaire-based study conducted in August 2019 during the “Foundation Course” for the 1^st-year medical students of Army College of Medical Sciences. A well-structured module validated by the members of the Medical Education Unit was used for teaching “Professional Development including Ethics.” At the end of 40 h of teaching, the students' perception about the “Professional development, including Ethics” module was taken with the help of an anonymous validated feedback questionnaire. Results: Most of the students (94.19%) felt that professionalism and ethics are very important for doctors and should be taught. About 90.7% felt that the care of the patient should be the first concern of a doctor. The students (94.19%) also felt that teaching of “Ethics” should be included in the curriculum, 89.53% felt that it will influence and improve the behavior of doctors, and 91.86% felt that it will finally lead to improvement of the patient-doctor relationship. Conclusion: The study concludes that “Professional Development including Ethics” incorporated in the foundation course, is a much-needed necessity for the students entering into the medical profession. The teaching of professionalism and ethics will definitely lead to more awareness of these values in our future doctors.

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Alcohol dependence is a complex medical, social, and psychological problem. It affects the family life adversely. However, if family takes the lead role, this problem is easily controlled at home level with medical support. A middle-aged male, the only breadwinner of the family, had alcohol dependence for more than 20 years. With family support, he overcame the dependence. The management of this illness has the greatest role of the family and society in addition to medical. Symptomatic management of alcoholism is only a tiny part of the treatment. Once the patient's symptoms are managed, the arduous journey to prevent relapse banks upon the persons own resolve and the support offered by their family. This is a peculiar case where medical aid and family support are playing an important role in the elimination of alcohol dependence. The family support models will helpful to the primary health-care physician to reduce alcohol dependence.

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Childhood glaucoma is a rare disease associated with significant pressure related visual loss and ocular comorbidity. It consists of a heterogeneous group of diseases which can be classified based on etiopathogenesis and morphology. Global incidence of childhood glaucoma accounts for 2%–6% of blindness in children. Although glaucoma in children is rare compared to adults yet the burden of blindness is significant. Hence, early diagnosis and treatment is of paramount importance to save vision. The classical triad of signs is blepharospasm, epiphora, and photophobia which may be missed in the infants unless corneal edema and buphthalmos manifests. Attention to these minute details makes detection of the disease possible even by the primary treating physician. Unlike adult glaucoma, the cupping in these cases is reversible. Therefore, the diagnosis and classification of the disease plays an important role in deciding the treatment protocol. Treatment for childhood glaucoma is primarily surgical management and requires a long-term follow-up. The prognosis is better if the disease is diagnosed and treated earlier. In developing countries delay in diagnosis, availability of limited surgical expertise, frequent follow-up and lifetime rehabilitation adds to the stress on parents and burden to the community. Relevant data regarding congenital glaucoma were researched on by the qualified ophthalmologists through Google Search, Bing, and Opera Mimi search engines from PubMed, Scopus, and Copernicus indexed journals. Emphasis was given on including hand searched articles after going through the hard copies of certain articles and the appropriate references have been cited in the text. This article highlights the epidemiology, classification, genetics and current management of this disease with emphasis on future strategies and planning to reduce the rate of avoidable blindness in children due to glaucoma.

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Pyoderma gangrenosum (PG) is a rare neutrophilic inflammatory skin condition which affects up to ten cases per million people per year. It mostly presents in the second to sixth decades of life with female preponderance. There are only a few reports of this condition following obstetric and gynecological procedures. The current article aims to highlight that PG should be kept as a differential in case of a nonhealing surgical site wound, misdiagnosis of which results in physical and psychological morbidity.

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Context: The war against coronavirus disease-2019 (COVID-19) continuing. Prevention is the best method to deal with the disease. The success of preventive measures is influenced by behavior of the population which in turn depends on knowledge, attitude, and practices (KAP) of the community. Aims: The aim is to evaluate knowledge, attitude, and practices toward COVID-19 of general population who are using internet. Settings and Design: Cross-sectional study in general population using Google Forms. Methods: The KAP questionnaire previously used in Chinese study adopted here after modifying for content and cultural appropriateness. The questionnaire included the following domains: (i) demographic information, (ii) knowledge about COVID-19, (iii) attitude toward COVID-19, and (iv) preventive practices. The questionnaire was circulated through social media to general population through Google forms. Statistical Analysis Used: Chi-square test for association, independent t-test for comparison of two groups, one-way ANOVA for comparison of more than two groups. The statistical significance was set at 5%. Results: A total of 2193 participants took part in the study. Most of our participants were well educated and were either postgraduates or graduates 1913 (87.23%). The mean knowledge score of the participants was 10.36 (standard deviation: 1.27, median: 11.00). Most of the participants avoided crowded places, washed hands repeatedly, did not shake hands with any one. Majority of the participants were not taking any prophylaxis medications. Conclusions: The population has very good KAP about the disease which is helpful for preventive measures. This may be the reason for better control of the disease till now.

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Background: Type-2 diabetes mellitus (T2DM) or noninsulin-dependent diabetes is an endocrinological disease of impaired metabolism of carbohydrates. T2DM is increasing both nationally and worldwide at an alarming rate. In intermediary metabolism, including enzyme activities, electrical gradients and cellular function Vitamin D, calcium and phosphorus play an important role. Disturbances in the levels of Vitamin D, calcium, and phosphorus were found to be associated with T2DM. The present study is aimed to evaluate the levels of Vitamin D, calcium, and phosphorus levels in 300 patients, of which 150 were nondiabetic healthy individuals (control) and 150 were T2DM patients. Materials and Methods: A volume of 5 ml of the blood sample was taken after 12 h of overnight fasting by complete aseptic means from the antecubital vein with the sterilized disposable syringe for fasting plasma glucose (FPG), postprandial plasma glucose (PPPG), glycated hemoglobin, serum 25 hydroxy (OH) Vitamin D (25[OH]D), calcium, and phosphorus. Results: Of 150 type-2 diabetic and 150 nondiabetic group, there was a significant statistical difference between the diabetic and nondiabetic group for FPG (P < 0.001), PPPG (P < 0.001), 25(OH) D (P < 0.001), calcium (P < 0.001), and phosphorus (P < 0.001). 25(OH) D, calcium, and phosphorus levels were decreased in T2DM patients as compared to the control group. Conclusion: This study revealed that there is a significant decrease in the levels of Vitamin D, calcium, and phosphorus in Type-2 diabetic patients, which may be an important factor in the early onset of the disease in susceptible individuals.

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The periodic paralyses (PPs) are a group of rare neuromuscular disorders related to muscle ion channels, presenting with episodes of sudden muscle weakness. The majority of cases of PP are inherited, resulting from genetic mutations in the subunits of channel proteins of the sodium, potassium, or calcium channels or the SCL4A1 protein. We describe two siblings, a 15-year-old male and an 11-year-old male, presenting with complaints of weakness. Both patients had consumed a large carbohydrate-rich meal the previous night with a history of similar episodes of weakness suggesting a diagnosis of PP. Laboratory investigations were unremarkable except for hypokalemia in both patients, and they were started on potassium supplementation, which resulted in the resolution of symptoms. The elder sibling was started on acetazolamide for prophylaxis, but due to non-response, was put on spironolactone which he tolerated well. Genetic mutation analysis confirmed the diagnosis of familial hypokalemic periodic paralysis (FHPP) with a p.Arg672His mutation in the sodium channel, gene SCN4A (17q23.3) in both siblings. The diagnosis of PP is important to consider in patients with sudden recurring episodes of weakness or paralysis, especially in otherwise healthy adolescents/young adults. The treatment of FHPP is challenging, with cautious potassium supplementation for acute attacks. Workup for other causes should be performed, and genetic analysis is recommended to confirm the diagnosis.

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Background: Growth monitoring under Integrated Child Development Services (ICDS) program is an essential strategy for the prevention and control of malnutrition. Objective: To assess growth monitoring activities done by Anganwadi workers (AWWs), the influencing factors related to it and perception of mothers about growth monitoring service. Materials and Methods: A cross-sectional study was conducted in all the Anganwadi canters of urban field practice area of Community Medicine Department of Bankura Sammilani Medical College. Qualitative data collection methods were employed which comprised of nonparticipant observation of growth monitoring activities, in depth interview (IDI) of AWWs, and focus group discussion (FGD) with mothers of enrolled children. While the checklists had been compiled in Microsoft Excel, transcripts of IDIs and FGDs were analyzed based on the thematic analysis. Results: Growth chart plotting, interpretation of growth curve, and discussion regarding child's growth had been carried out diligently, but preparation for weighing, putting child in the pants and actual weighing of the child were not properly done in all cases. AWWs mentioned logistic issues such as nonavailability of Taring scale and short supply of growth registers, perceived pressure of register maintenance, inadequate infrastructure, lack of periodic training, and supervision among the difficulties. Most of them were satisfied about community participation in growth monitoring process. Many mothers knew about weighing process, but the use of a growth chart had been reiterated by only a few. Conclusion: Logistic and infrastructural issues needed redressal while supportive supervision was essential to ensure the quality of the growth monitoring process. Mothers should also be made more involved in this key activity of ICDS.

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Background and Aims: When compared with direct laryngoscopes, videolaryngoscopes can provide a significantly better view of the larynx. There are no studies in children directly comparing Airtraq^™ and C-MAC^® videolaryngoscopes. We aimed to compare intubating characteristics between these two devices in pediatric patients. The primary outcome measure was the time needed for successful intubation and secondary outcome measures were the number of attempts to intubate, ease of intubation, percentage of glottic opening (POGO) score, optimization maneuvers and complications such as airway trauma and esophageal intubation. Materials and Methods: One hundred and twelve children aged 1–12 years undergoing elective surgery under general anesthesia are quiring tracheal intubation were enrolled. Children were randomized into two groups using computer generated randomization sequence. The t-test was used for analyzing quantitative data, nonparametric data were analyzed using Mann–Whitney test, and categorical data were analyzed using the Chi-square test. Results: Time to tracheal intubation was significantly longer with Airtraq^™ (41.0 s) compared to C-MAC^® (23.4 s); P < 0.001. The number of attempts at tracheal intubation was more with Airtraq^™ (P = 0.008). Seventy-five percent of anesthesiologists found C-MAC^® easy to use. POGO score was >90% in both groups without maneuvers. Conclusion: The study found that in pediatric patients with normal airways, time to intubation was faster with C-MAC^® as compared to Airtraq^TM. C-MAC^® also performed better in aspects like the number of attempts and ease of intubation.

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Objective: The objective of this study is to assess the smokeless tobacco (SLT) use among online-app based cab drivers in Pune city and recommended measures for tobacco cessation from the literature. Materials and Methods: A descriptive, cross-sectional survey was conducted during February 2019 to October 2019 among the morning shift cab drivers in Pune city. A total of 360 drivers using SLT were recruited for the study. A standard checklist was used to collect the information such as the time of use of SLT, reasons for the use of SLT, and reason for the cessation of the habit. Approval was obtained from the Scientific and Institutional Ethics committee before starting. Results: Majority 62.8% (n = 226) of the drivers used SLT while driving, followed by 14.4% (n = 52) who preferred it only before driving and 8.9% (n = 32) used anytime during the day. Among the major reasons for the use of SLT, 80.3% (n = 289) reported it helps to improve concentration, whereas 67.5% (n = 243) used it under peer pressure. Participants (n = 90) declared that they have attempted to quit the habit and the main reason for quitting of the habit was burning sensation in the mouth among 64.4% (n = 58) followed 26.7% (n = 24) by self-motivation. Conclusion: This study serves as an evidence to plan and execute the cessation programs for the driver cohort by its company. It is proposed that the successful tobacco cessation measures from the literature can be implemented and evaluated for its effectiveness in the future studies.

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Nephrotic syndrome (NS) is a common clinical entity encountered in children and adults. Steriod Dependent Nephrotic Syndrome(SDNS) is one of the most common pediatric glomerular diseases. However, a significant chunk of cases follows a relapsing and remitting course. Various modalities such as cyclophosphamide, cyclosporine, tacrolimus, mycophenolate mofetil (MMF), levamisole, and rituximab have been tried in patients with steroid-dependent or frequently relapsing NS (FRNS). We describe our experience of using levamisole in nine patients with steroid-dependent NS. We used the regimen of levamisole dosing at 2.5 mg/kg on alternate days, along with alternate dosing of steroids at the lowest possible doses to achieve remission. During follow-up, two of the patients were switched over to a calcineurin inhibitor (tacrolimus). All the remaining seven patients responded to levamisole and attained remission. At 18 months follow-up, four patients were on a minimal dose of steroids (prednisolone 0.25 mg/kg alternate day) with levamisole 2.5 mg/kg, whereas three patients were on prednisolone 0.5 mg/kg/alternate day with levamisole 2.5 mg/kg alternate day. Among the patients with steroid-sensitive NS, 30%–60% are frequently relapsing or steroid-dependent forms of NS. Corticosteroids have well recognized and potentially serious adverse effects. A lot of steroid-sparing agents such as MMF, rituximab, alkylating agents like cyclophosphamide, and calcineurin inhibitors have been used in clinical medicine, to mitigate the above mentioned adverse effects of prolonged use of corticosteroids, with varying success. But these medications have significant side effects and toxicity profiles of their own. Our case series reiterates the role of levamisole in FRNS and SDNS patients without much risk of adverse events in patients and hence being a relatively less expensive treatment option.

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Background: Cancer is among the leading noncommunicable diseases and its screening, diagnosis, management, monitoring, and relapse involve the use of tumor markers. Tumor marker requisition adds to a major financial burden if not used rationally. Aim and Objectives: The aim was to study the rational use of tumor markers in various cancers with objectives to do requisition analysis of tumor markers with the existing national guidelines by the Indian Council of Medical Research (ICMR) and to assess its financial impact. Materials and Methods: A total of 355 cases were screened and 221 were included in the study. The patient's laboratory requisition form raised by the ordering physician as a part of the screening, diagnosis, management, monitoring, and relapse for different conditions including cancers were studied retrospectively over a period of 5 months, and data were analyzed. Results: Two hundred and twenty-one requisitions for various tumor markers were ordered for screening, diagnosis, management, monitoring, and relapse of various cancers and other conditions. Only 10%–30% of requisitions were found as per the laid down guidelines of the ICMR for different cancers. Carcinoembryonic antigen was ordered in only 20% requisitions as per the ICMR guidelines but has affected maximally in terms of test cost by adding up 88% to the budget of the test. Conclusion: Rational use of tumor markers in different cancers can cut down the cost factor directly. It prevents the physician in overdiagnosing due to multiple requisitions in diagnosed cancers and hence avoiding undue medical procedures thus further reducing the financial burden on the patients and their family.

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Background: Mental disorders occupy a premier position in the matrix of causation of suicide. Suicidal ideation among psychiatric patients is a less explored topic in India. Aim: The aim of this study is to study the prevalence and clinical correlates of suicidal ideation in patients attending psychiatry outpatient department (OPD). Materials and Methods: This cross-sectional study was conducted in the psychiatry outpatient department of a tertiary care hospital. Beck's suicide intent scale was used to quantify suicidal ideation. Beck's Hopelessness scale and Depression, Anxiety and Stress Scale were used to study levels of hopelessness, depression, anxiety, and stress in patients. Groups with and without suicidal ideations were compared on different variables. Results: Suicidal ideation was present in 36% of psychiatry OPD patients. Out of these 13% patients had previous suicidal attempts. Most of them attempted suicide once. Majority had either fleeting suicidal ideas or passive death wish, with poisoning noted as the most common method of attempted suicide. Suicidal ideation had a statistically significant association with levels of depression, anxiety, and stress. Highest stress levels were found in anxiety disorders. Suicidal ideation was commonly observed in patients with depression and other mood disorders and those with previous attempts. More than half of the patients with suicidal ideation never sought help. Conclusion: Increasing levels of depression, anxiety, stress, and hopelessness were associated with increased suicidal ideation. Substance use, history of psychiatric illness, triggering stressor, and low perceived social support were also associated with suicidal ideation in psychiatric patients.

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Background: Assessment of multidimensional locus of control (MLOC) will reveal the effect of professionalization among dental students. The aim of this study was to know the possible factors with effect health locus of control (HLC) of Indian dental students. Methodology: The study population comprised 230 dental students. MLOC was recorded using Form type C with 18 questions. The significance level was set at P ≤ 0.05. Results: Comparison of the mean scores for the three-multidimensional health locus of control subscales (Internal, Chance, and Powerful Others) from the first year to the final year showed that the mean score for the Internal subscale was consistently higher, followed by the mean scores for powerful others and chance in all the years of study. The Internal subscale mean increased from the first year to the second year of study and then decreased from the third year to the final year of study (P = 0.004). Conclusion: Internal HLCs dominated the study population, and the mean internal scores increased from the first BDS to the final year.

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Frank conjunctival bleeding in an adult male is a very rare presentation. There are so many causes of conjunctival bleedings; hence, a detailed medical history along with investigations apart from ocular, ENT, and a systemic evaluation is very important to find the exact etiology. Here, we present a case of frank conjunctival bleeding in an 18-year-old boy with a history of acne disorder and hematemesis. Detailed ocular, dermatological, and systemic examination has shown a correlation between acne disorder, meibomian gland dysfunction, dry eye syndrome, and Helicobacter pylori (HP) gastritis in this case. HP infection along with androgen hormone overactivity has been thought to be responsible for the pathophysiology of this frank conjunctival bleeding in this case.

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Persistent left superior vena cava (PLSV) is an abnormality of drainage of the embryological left cardinal vein, persisting as left superior vena cava and commonly emptying into the right atrium through the coronary sinus. Other drainage patterns include draining into the left pulmonary vein or into the left atrium through its roof and sometimes through the coronary sinus when the defect exists between the coronary sinus and the left atrium. The aim of this report is to indicate the existence of PLSV in this environment and as one of the rarest abnormal venous connections limitedly reported in Nigeria. PLSV is a systemic venous drainage abnormality. Although it may be asymptomatic, it can also present with cardiac failure and severe life-threatening arrhythmias. Dilated coronary sinus during transthoracic echocardiography should be a pointer to a suspected PLSV.

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Background: WHO declared SARS-CoV-2 infection as pandemic on March 11, 2020. As cases recovered, it became important to know the rate of re-infection from the same virus and its severity. Therefore, the study was done to find out re-infection rate among the previously infected individuals. Aim: To find out re-infection rate among already exposed and nonexposed individuals. Materials and Methods: A cohort study was done over 5000 previously serosurveyed individual. They were followed up via telephone. Data was collected using a questionnaire with questions regarding infection post-serosurvey, severity of infection among relatives and vaccination status. Thus information collected was uploaded in Google form. Results: Re-infection rate among previously exposed individuals was 1.2%; at the same time period, 6% of nonexposed individuals got infected. All the re-infection cases were mild, whereas 80.74% of individuals who got infected for the first time had mild symptoms. Exposure to SARS-CoV-2 in relatives who were staying with participants was found to be 3.23% and 4.22% among previously exposed and non-exposed individuals respectively. 17% of previously nonexposed individuals were fully vaccinated, whereas 0.65% of exposed individual got fully vaccinated. Conclusion: Re-infection rate in the study was less and mild on the basis of severity. Infection rate among the nonexposed was at a higher side stating that chances of getting re-infected are much lesser. Previously exposed individuals did not show the same type of interest for vaccination compared to previously nonexposed individuals.

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Objective: Helicobacter pylori infection and subsequent gastric atrophy and intestinal metaplasia (IM) are postulated to increase incidence of gastroesophageal cancers. Hence, this study was carried out with objective to study histomorphology of gastroesophageal lesions and correlate with H. pylori and mucin histochemistry. Materials and Methods: This is an observational, prospective study on 120 gastroesophageal biopsies for identification of H. pylori and mucin histochemistry for type of metaplasia in addition to routine histopathology. Results: Of 120 gastroesophageal biopsies, 58 were esophageal and 62 gastric. Various esophageal lesions comprised of esophagitis, Barrett's esophagus, dysplasia, and esophageal malignancies. H. pylori were detected in 1, 4, and 1 cases of esophagitis, Barrett's esophagus, and adenosquamous carcinoma, respectively. IM was seen in 2 cases of Barrett's esophagus and one each of adenocarcinoma and adenosquamous carcinoma of esophagus. Gastric pathologies comprised of chronic gastritis, gastric ulcer, hyperplastic polyp, Peutz–Jeghers syndrome, adenocarcinoma, and gastrointestinal stromal tumor. A study for H. pylori and mucin histochemistry revealed statistically significant association between H. pylori and gastric adenocarcinoma, chronic gastritis but not with gastric ulcer. 76.31% and 21.73% cases of adenocarcinoma and gastric nonneoplastic lesions showed IM with statistically significant association with gastric adenocarcinoma particularly intestinal type. Conclusion: Since there is significant role of H. pylori and gastroesophageal malignancies histopathology and early detection of the bacilli can help in timely treatment and prevention of gastroesophageal malignancy.

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Patient vitellointestinal duct (VID) is not very common because of its varied presentation and complication, and the prolapse of an inverted ileal loop through patent VID is an extremely rare presentation. Here, we report a case of a 4-month-old boy of patent VID through which distal half of the inverted ileal loop got prolapsed, appearing as Y loop. Emergency laparotomy was done. The ileal loop was reduced and resection anastomosis of the involved ileal segment was performed.

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Background: Rhinoscleroma (RS) is a chronic granulomatous disease due to infection of Klebsiella rhinoscleromatis. It often affects the respiratory mucosa, especially the nasal cavity and sometimes extends lower respiratory tract. RS is more common in certain geographical area than in others, but the pathogenesis and the risk factors of RS are still unclear. Materials and Methods: This was a retrospective study done between January 2014 and December 2019. The diagnosis of the RS was done on the basis of clinical presentations and histopathological findings. Details of clinical findings, investigations, and treatment were analyzed. Results: There were 13 cases of RS diagnosed after confirmation with histopathological examination. The female to male ratio was 1.6:1 with a mean age of 36 years. The most common clinical presentation was nasal obstruction. All were treated with ciprofloxacin. Relapse occurred in three cases which were confirmed by biopsy. Conclusion: RS is a rare clinical entity in Eastern India. Awareness of the clinical presentations of RS and early diagnosis will reduce the morbidity of this disease.

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While fever is a well-described precipitating factor of moyamoya-specific symptoms, moyamoya angiopathy (MMA) mimicking recurrent febrile seizures has never been reported before. Here, we report a case of MMA in a 4-year-old child who was misdiagnosed as simple febrile seizures on multiple occasions. This case underscores the importance of identifying early clinicoradiological clues of MMA for earlier diagnosis and better prognosis.

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Extra medullary involvement of multiple myeloma is a known phenomenon, but breast and thyroid are rarely involved. This patient presented in onco-surgery OPD with breast lump and thyroid enlargement. The diagnosis of multiple myeloma involving both organs was made in a retrograde fashion. FNAC played a key role in diagnosing this lesion. A thorough clinical, radiological evaluation, strong suspicion and immunohistochemistry helped confirm the diagnosis of multiple myeloma.

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