Proper Clinical Evaluation Research Articles

A Case of Abdominal Discomfort for Long Duration

In our regular medical practice, we encounter a lot of patients with abdominal discomfort. Commonly every physician suspects this kind of symptoms as gaseous distension of gastro-intestinal tract or acidity. The most valuable thing is the proper physical examination to rule out any underlying pathology. Most common causes of epigastric pain are associated with gastritis, or hepatobiliary system and pancreas related disorders. Here we will describe a 47-year-old male patient who presented with abdominal discomfort for last 6 months. For last 2 months he developed an epigastric lump which was increasing in size and was associated with weight loss. After proper clinical evaluation and necessary relevant investigations, he was diagnosed having Non-Hodgkin’s Lymphoma (NHL). Non-Hodgkins Lymphoma represents monoclonal proliferation of lymphoid cells. The incidence of these tumors increases with age. Clinically the proliferation rate indicates whether it is a high- or low-grade tumor. The patient underwent some investigations like CT guided FNAC from the enlarged abdominal lymph node which confirmed high grade Non-Hodgkins Lymphoma and started with chemotherapy and responded well. As abdominal discomfort is one of the common complaints, we face during our regular medical practice so routine physical examination including abdominal examination is very crucial and informative for clinical diagnosis and Lymphoma is an important differential diagnosis in case of any abdominal lump. Bangladesh Crit Care J September 2024; 12 (2): 175-178

A case study on the management of Prathishyaya (Chronic Allergic Rhinitis) using Bharangi Arka Nasal Spray

The omnipresence of Prathishyaya among school-aged groups is overlooked until the complications like kasa, swasa and rajayakshma come into being. Pratishyaya if taken heed of in the initial stage, helps to frustrate the looming effects of its complications. Bharangi Arka is cited as an effectual remedy for Prathishyaya in the Arka Prakasha of Ravana. Prescribing medications for children is usually challenging as they often resist taking them and so, Ayurveda formulations when transmuted into more palatable forms can have salutary impacts on children than classical forms. This case study was carried out on an 8 ½ years old male child with sneezing, runny nose and chronic symptoms including nasal itching and obstruction in particular. Prathishyaya was diagnosed after a proper clinical evaluation. Bharangi Arka in the form of nasal spray was opted as the sole drug in the treatment. Assessment of symptoms was done using Total Nasal Symptom score on the 7th, 14th, 21st and 28th days of the first month of the treatment and at the end of the following two months. Subsidence of all the symptoms was observed in the patient almost in the 4th week. This corroborates the stupendous action of Bharangi Arka nasal spray on Pratishyaya and it could usher in a way for further research to be carried out on the potency of nasal sprays in Ayurveda.

Clinical and radiological spectrum of acquired inflammatory demyelinating diseases of the central nervous system in a tertiary care center.

Demyelinating diseases of central nervous system (CNS) are a broad spectrum of conditions with autoimmune process against myelin. In a resource limited country like India, it is imperative to perform proper clinical evaluation, neuroimaging to differentiate among various categories of CNS demyelinating diseases to decide regarding further workup and treatment. The objective of our study was to determine clinical presentation, imaging findings, serology results, diagnosis, and treatment outcome of primary demyelinating disorders of CNS. In this prospective study, a total of 44 patients were enrolled over a period of 1 year. After proper evaluation, patients were categorized into different groups applying newer diagnostic criteria. Patients were treated with steroids, appropriate immunomodulatory therapy, and outcomes were analyzed. The majority of cases were of neuromyelitis optica spectrum disorder (NMOSD) (45.5%) with an overall female-to-male ratio of 3.4:1 and mean age of presentation was 30.5 ± 11.15. Myelitis (52.3%) followed by optic neuritis (45.5%) was the most common initial presentation. The most common site of involvement on magnetic resonance imaging was the spinal cord (particularly the cervicodorsal cord). The majority showed good response to therapy (77.27%) and two patients did not survive. Higher disability observed among seropositive NMOSD patients warrants aggressive treatment during the first attack itself. It is important to suspect myelin oligodendrocyte glycoprotein antibody disease in patients with preceding viral infection. A good outcome in the majority is likely due to the availability of serological assays and aggressive immunomodulatory therapy.

Consenso del grupo de trabajo de los trastornos de la conducta alimentaria de SENPE (GTTCA-SENPE). Evaluación y tratamiento médico-nutricional en la anorexia nerviosa. Actualización 2023

Anorexia nervosa (AN) is a multifactorial disorder. A possible role of the social network and the gut microbiota in pathogenesis has been added. Exogenous shocks such as the COVID19 pandemic have had a negative impact on patients with AN. The potential medical and nutritional impact of malnutrition and/or compensatory behaviors gives rise to a complex disease with a wide range of severity, the management of which requires a multidisciplinary team with a high level of subject matter expertise. Coordination between levels of care is necessary as well as understanding how to transition the patient from pediatric to adult care is essential. A proper clinical evaluation can detect possible complications, as well as establish the organic risk of the patient. This allows caregivers to tailor the medical-nutritional treatment for each patient. Reestablishing adequate nutritional behaviors is a fundamental pillar of treatment in AN. The design of a personalized nutritional treatment and education program is necessary for this purpose. Depending on the clinical severity, artificial nutrition may be necessary. Although the decision regarding the level of care necessary at diagnosis or during follow-up depends on a number of factors (awareness of the disease, medical stability, complications, suicidal risk, outpatient treatment failure, psychosocial context, etc.), outpatient treatment is the most frequent and most preferred choice. However, more intensive care (total or partial hospitalization) may be necessary in certain cases. In severely malnourished patients, the appearance of refeeding syndrome should be prevented during renourishment. The presence of AN in certain situations (pregnancy, vegetarianism, type 1 diabetes mellitus) requires specific care. Physical activity in these patients must also be addressed correctly.

A rare case of synovial chondromatosis of the foot

Background: Synovial chondromatosis is a benign rare condition affecting synovial tissue. It has a preference for males with a ratio of 2:1. Also, synovial chondromatosis has a prevalence of 1 in 100,000. Initially, it starts asymptomatically then develops pain, and swelling with or without a restricted range of motion as the disease progresses. In addition, the imaging options are an x-ray and then an MRI. To confirm the diagnosis, a biopsy with histopathologic evaluation is needed. Finally, conservative management options are NSAIDs and intraarticular steroids. Surgery is considered after the failure of conservative management. Case Presentation: A case of synovial chondromatosis of the left foot in a 37-year-old female with no prior medical or surgical history was presented. The patient came with no signs or symptoms and was admitted as a case of elective mass excision. Histopathologic evaluation of the mass confirmed the diagnosis of synovial chondromatosis. Initially, perioperative spinal anesthesia was performed. After the patient had been sedated, a vertical incision directly over the dorsolateral aspect of the foot, over the lesion, was made. Subsequently, a lateral incision and a midline horizontal incision at a 90-degree angle to the initial surgical incision were made. Finally, the mass was excised completely with no remnants. Conclusion: Synovial chondromatosis is a frequently sub-diagnosed disease and has not been fully understood, so proper clinical evaluation ought to be done earlier for better outcomes.

Isolation of Salmonella enterica Serovar Typhi from Infected Intracranial Dermoid Cyst: A Case Report

Salmonella Typhi is a versatile pathogen that can infect almost all organs of its host. There has been an increase in the number of cases of extraintestinal infection caused by Salmonella species during the past decade. Present case is of a 17-year-old immunocompetent female admitted to the hospital with complaints of a general tonic-clonic seizure and diagnosed with a Suprasellar hypodense lesion with Hydrocephalus (HCP) documented on a Computed Tomography (CT) scan of the head. Magnetic Resonance Imaging (MRI) revealed signs of an intracranial dermoid cyst. Placement of a right Ventriculoperitoneal (VP) Shunt was performed, followed by a right craniotomy with decompression, during which 5 mL of pus was collected from the lesion. The pus was received in the Department of Microbiology and subjected to culture, which grew Salmonella enterica serovar Typhi. The patient had been empirically receiving injection cefoperazone-sulbactam 2g/2g twice daily and injection vancomycin 1g 12 hourly before the isolation of Salmonella Typhi. She had also been receiving injection levetiracetam 500 mg i.v. twice a day and inj. phenytoin 500 mg i.v. thrice a day. Following the positive culture report, injection ceftriaxone 2 g daily was started. The patient was discharged on the fifth postoperative day while on injection ceftriaxone, oral levetiracetam 500 mg, and phenytoin 100 mg and was asked to report to the neurosurgery department after seven days for follow-up. On follow-up, she showed improvement, and there were no complaints of fever, seizure, or loss of consciousness. In conclusion, proper clinical, radiological, and microbiological evaluation is very much necessary, and clinicians should be aware of the relatively rare manifestations of Salmonella Typhi infections.

Case series: Using laryngeal mask airway to enhance the radiological evaluation and staging of cancers involving the larynx: A novel technique

AbstractThe diagnosis and staging of head and neck tumors requires proper clinical, endoscopic, and radiological evaluation. Currently, imaging techniques such as Magnetic Resonance Imagining (MRI) and Computed Tomography (CT) are used for head and neck tumors but are limited in showing involvement of different hypopharyngeal sub‐compartments. Several maneuvers have been developed to improve visualization of the head and neck area; however, they demonstrated minimal benefit. In this case series, patients with tumors involving the hypopharynx are studied. A laryngeal mask airway was used to stent the hypopharynx to assess the extent of the disease by creating real space between mucosal surfaces. This case series aims to describe the impact of using laryngeal mask airway on the evaluation of cancers involving the hypopharynx.

Correlation between Orbital Computed Tomography Scan Measurements and Clinical Enophthalmos in Acute Isolated Orbital Floor Fractures

Abstract Purpose: To analyze the correlation between orbital computed tomography (CT) scan measurements including the fracture area (FA), the fracture location, the soft-tissue herniation volume (HV), the fractured orbital volume ratio (OVR) to the normal orbit, and the clinical enophthalmos in acute isolated orbital floor fractures. Methods: We enrolled 100 patients with acute isolated unilateral orbital floor fractures from May 2017 to January 2021. Based on the CT scan findings, we measured the FA, HV, OVR, and fracture site. We assessed enophthalmos using both clinical (CE) and radiographic (RE) measurements. Additionally, we investigated the correlation between CE and the measured parameters, along with the relationship between the pattern of diplopia and the fracture site. Results: We identified enophthalmos in 81% and diplopia in 78% of the patients with an acute blowout orbital floor fracture. CE was moderately correlated with the FA (R 2 = 0.4341, P < 0.001). CE was weakly correlated with the HV (R 2 = 0.2861, P = 0.04). Anterior fractures caused diplopia in both vertical gazes, but posterior fractures were mostly associated with diplopia in the up gaze. OVR was strongly associated with RE (R 2 = 0.663, P < 0.0001) and moderately associated with CE (R 2 = 0.4378, P < 0.0001). The univariate regression analysis also showed that OVR could significantly predict CE and RE. Conclusions: OVR surpasses other CT scan measurements such as FA and HV in the prediction of clinical enophthalmos. Thus, OVR could be utilized to estimate clinical enophthalmos at the time of presentation, especially when the acute clinical setting prohibits the proper clinical evaluation.

Comparision Between Provisional Diagnosis made in Emergency Department vs Final Discharge Diagnosis at Ramkrishna Care Hospital, Raipur C.G

Objective/Hypothesis: Objective of this study was to find out the diagnostic accuracy made by emergency physician, this will ensure improvement in patients care and will help to implement better accuracy in determining diagnostic accuracy. Background: Department of emergency medicine is a specialized care facility in tertiary health care centre whose main function is to take care of patients with immediate and emergent health issues. In view limited literature in EM in India a study between PD vs FD was performed for future reference in continuous quality improvement. Methods: A prospective, observational study was done among 200 patients between provisonal diagnosis made in emergency department vs final discharge diagnosis. Results: Majority of the patients (n=153, 76.5%) were from the age group of patients between 15-64 followed by (n=40, 20%) in the age group with patients of >65 years age, followed by (n= 7, 3.5%) in the age group of 1-14 years. Most matched diagnosis were from department of internal medicine (18.5%) followed by department of cardiology (16%), followed by department of neuromedicine (13%). It was found that 81% (n=162) cases were accurately matched) diagnosed during Emergency department admission, while there was unmatched diagnosis of 19% cases (n=38). Conclusion: Result obtained suggests that the provisional diagnosis was made by the emergency physicians were mostly matched with final discharge diagnosis that was made by the concerned specialist doctors. This shows that the choice of treatment done in the ER were a prompt and accurate treatment. This has a positive effect on the prognosis, mortality and outcome in patients. Department of internal medicine had more diagnostic errors. Improving history taking of patients with proper clinical evaluation correct diagnosis in the ER. Early availability in blood reports during emergency stay will help as a better diagnostic interpretation of disease. it is required to upgrade clinical skills of emergency physicians in diagnosing pediatric age group.

Clinical applications of next-generation sequencing in the diagnosis of genetic disorders in Korea: a narrative review

Background: Next-generation sequencing (NGS) technologies have revolutionized genetic testing and enabled efficient screening of various genetic conditions in clinical settings. However, the clinical application of genetic test results presents numerous significant challenges. This review aims to provide a comprehensive overview of key concepts for the clinical application of NGS, including (1) technical aspects and limitations, (2) variant classification, (3) clinical interpretation, (4) familial testing and genetic counseling, and (5) ethical considerations.Current Concepts: In short-read-based NGS, several limitations exist in detecting genomic variations, including repetitive sequences or complex structural variations. The variant classification process can be influenced by suspected genomic conditions and the accessibility of genomic databases. Therefore, the final genetic diagnosis depends on the physician’s discretion, which relies on the genotype-phenotype correlations and reverse phenotyping through additional evaluations. Familial testing can help trace the origin of variants and allele segregation and aid in variant interpretation, risk assessment, disease prevention, and family planning. In addition to addressing the clinical impact of genetic results, genetic counselors should also consider potential consequences related to ethical, legal, and social issues, including family dynamics.Discussion and Conclusion: NGS-based genetic testing is a promising diagnostic tool for genetic disorders, but proper variant interpretation and clinical evaluation are crucial for optimal clinical practice. Notably, ethical considerations and regulatory measures are required to prepare for the next era of genomic medicine.

Right Hemifacial Paralysis in a 6-Year-Old Boy: An Overlooked Case Report of Bell’s Palsy in Children

This study focuses on a case of Bell's Palsy in a 6-year-old boy. Bell's Palsy is the most common type of facial nerve paralysis in children. The causes can be either congenital factors (traumatic malformations, symptomatic, non-syndromic, or hereditary conditions) or acquired factors (infections, inflammations, neoplastic, or traumatic factors). Bell's Palsy is commonly caused by viral infections, especially the herpes simplex virus. In this case, a child experienced rapid-onset right hemifacial paralysis, and he had no history of trauma or other systemic symptoms. A diagnosis of Bell's Palsy was made, and the child received treatment with corticosteroids and a rehabilitation program. The results of this study indicate that treatment with methylprednisolone for 3 days and a rehabilitation program involving relaxation exercises and massages to reduce muscle stiffness yielded a good response. Proper clinical observation and evaluation are crucial in diagnosing Bell's Palsy in children. A multidisciplinary approach through collaboration between pediatricians and physiotherapists plays a significant role in managing such cases. Good follow-up is necessary to reduce the risk of prolonged facial nerve paralysis in the future.

Condensing Osteitis – A Review and Case Report

Condensing osteitis is pathological lesions of the maxillomandibular region which is seen in root apex of long standing untreated carious lesions or tooth having inappropriate endodontic treatment and generally occurs as a result of body’s defence mechanism against the infection. Dense trabeculae formation is seen within the bone marrow which appears as a radiopaque lesion near the apex of the affected tooth. Diagnosis of condensing osteitis depends on proper clinical and radiographic evaluation. In the present case report, condensing osteitis in a 12-year female is reported and with adequate endodontic procedure, healing and regression were seen after 6 months of follow-up.

Frequency of Various Congenital Anomalies and Associated Maternal Risk Factors, an Experience at Tertiary Care Hospital

Objective: To determine frequency of congenital anomalies in children and associated risk factors of mothers. Setting: Department of obstetrics and gynecology Rai Medical College Sargodha. Study design: Descriptive observational study. Duration: July 2022 to December 2022. Methodology: All babies with congenital anomalies born within study duration and their mothers were included in this study. Anomalies of neonates were evaluated after proper clinical evaluation by a neonatologist. A questionnaire was designed to evaluate maternal risk factors. All collected data was analyzed using SPSS version 20. Results: Total 1900 babies delivered during this study period and out of them congenital anomalies were found in 31 (1.6%) cases. Most common anomaly was hydrocephalus in 10(32.2%) and meningomyelocele in 6(19.3%) cases. Most common maternal risk factor was consanguineous marriage in 15(48.3%) cases. Most commonly mothers with the age of 19-30 years were having babies with congenital anomalies. Practical Implication: This study helps us to understand the importance of avoiding consanguineous marriages, screening of high risk cases using various diagnostic techniques like ultrasonography during 16-20 weeks, use of folic acid supplements and in case of detecting congenital anomalies option of selective termination of pregnancy can be offered to the parents. Proper awareness of the parents and their counselling after birth of a baby with anomaly can prevent its recurrence in their future pregnancies Conclusion: Most common congenital anomaly reported in this study was hydrocapahlus followed by meningocele and most common maternal risk factor associated with these anomalies was consanguineous marriage. Keywords: Congenital anomaly, consanguineous marriage, Maternal risk factor, Neural tube defects

COMPARISION BETWEEN PROVISIONAL DIAGNOSIS MADE IN EMERGENCY DEPARTMENT VS FINAL DISCHARGE DIAGNOSIS AT RAMKRISHNA CARE HOSPITAL, RAIPUR C.G

Objective/Hypothesis:Objective of this study was to find out the diagnostic accuracy made by emergency physician , this will ensure improvement in patients care and Will help to implement better accuracy in determining diagnostic accuracy . Background:Department of emergency medicine is a specialized care facility in tertiary health care centre whose main function is to take care of patients with immediate and emergent health issues.In view limited literature in EM in India a study between PD vs FD was performed for future reference in continuous quality improvement . Methods:A prospective,observational study was done among 200 patients between provisonal diagnosis made in emergency department vs final discharge diagnosis. Results:Majority of the patients ( n=153 , 76.5%) were from the age group of patients between 15-64 followed by (n=40 , 20% ) in the age group with patients of >65 years age , followed by (n= 7 , 3.5%) in the age group of 1-14 years .Most patients were from department of internal medicine (18.5%) followed by department of cardiology (16%) , followed by department of neuromedicine (13%).it was found that 81% (n=162) cases were accurately ( matched ) diagnosed during Emergency department admission , while there was unmatched diagnosis of 19% cases (n=38). Conclusion:Result obtained suggests that the provisional diagnosis was made by the emergency physicians were mostly matched with final discharge diagnosis that was made by the concerned specialist doctors. This shows that the choice of treatment done in the ER were a prompt and accurate treatment . This has a positive effect on the prognosis , mortality and outcome in patients.Department of internal medicine had more diagnostic errors. Improving history taking of patients with proper clinical evaluation will improve diagnosing patients in the ER. Early availability in blood reports during emergency stay will help as a better diagnostic interpretation of disease. it is required to upgrade clinical skills of emergency physicians in diagnosing pediatric age group.

THE STUDY OF THE IMMUNE STATUS IN POST-COVID SYNDROME BY FLOW CYTOMETRY

A novel coronavirus infection was described in 2019 in Wuhan, China. From the first months of the spread of the infection around the world, evidence began to appear that patients after recovery had various symptoms. Duration, intensity, and variability of symptoms vary among patients and are often not associated with the severity of the most acute illness. Recently the concept of post-COVID syndrome (post-COVID or long-COVID in the English-language literature) has acquired increasingly clear diagnostic criteria. Persistent symptoms and / or the appearance of delayed complications after 4 weeks or more from the onset of symptoms of an acute illness are commonly called post-COVID syndrome. The wide range of symptoms that can occur in patients with post-COVID syndrome is now a major health concern worldwide. A proper clinical evaluation will help determine the etiology and build a treatment plan. Longer studies aimed at identifying the effects of COVID-19, possible risk factors for their development, a detailed study of the pathogenetic mechanisms of SARS-CoV-2, and the development of treatment and rehabilitation methods to improve the mental and physical health of surviving patients are relevant elements of study for the foreseeable future. T-lymphocytes are a poorly studied population of T lymphocytes. These cells are more often localized in the mucous membranes of the body which have the properties of innate and acquired immunity. The main biological functions are cytolysis, immunoregulation which indicates an important immunocompetent role of this type of cell population in severe infectious diseases. This article provides information on the fraction of T-lymphocytes during the formation of adaptive immunity in patients with post-COVID syndrome.

Varied Clinical Presentations of Allergic Fungal Rhinosinusitis-A Case Series.

Fungal sinusitis is broadly classified into invasive and non invasive types. Invasive type presents with fungal hyphae within the mucosa, submucosa, bone, or blood vessels of the paranasal sinuses and includes Acute Invasive Fungal Sinusitis, Acute Fulminant, Chronic Invasive Fungal Sinusitis, Chronic Granulomatous Fungal Sinusitis. Invasive forms of fungal rhinosinusitis are rare and confined to groups of patients who are immunocompromised (Key in Fungal rhinosinusitis). Noninvasive type shows absence of fungal hyphae within the mucosa paranasal sinuses. It includes Allergic Fungal rhinosinusitis, Fungus Ball (fungus mycetoma). The study was performed on a total of 30 patients, in Department of Otorhinolaryngology, at our hospital after getting approved by theInstituitional Human Ethical Committee. We selected 30 patients diagnosed with allergic fungal sinusitis and studied their varied clinical presentations and treatment for a period of 1year. It was a prospective case series type of study. Patients who presented with symptoms of allergic fungal rhinosinusitis were included. Patients who were referred with complaints of proptosis, diplopia were also included to rule out allergic fungal rhinosinusitis and its complications. Patients diagnosed with chronic granulomatous infection of nose and invasive fungal sinusitis were excluded. Evaluation of patients involved a detailed case history followed by clinical examination and radiologic investigation. After getting proper consent, we did a study of 30 patients who presented to our outpatient department with complaints of sinusitis. Our study included 12 male and 18 female patients. Among these patients, all of them had complaints of frequent allergic rhinosinusitis, nose block, facial heaviness. 12 among them had olfactory disturbances, reduced perception of smell. 4 patients presented with visual disturbances and proptosis which subsided after endoscopic sinus surgery was done.24 among these patients had presence of allergic fungal mucin in their nasal secretions and 10 patients had history of associated atopy and asthma and elevated Ig E levels. And 20 of these patients showed high eosinophil counts. All these patients in our case series were under the age group 22-70years. These patients were treated with a course of nasal sprays and preoperative steroids in case of extensive polyposis and were taken up for functional endoscopic sinus surgery. Polypoidal mucosa was removed, diseased tissue was cleared, sinus blockage was released and fungal mucin/tissue bits were sent for histopathological analysis, KOH mount and fungal culture. This study included a series of cases which showed a wide range of the various clinical presentations that occur in cases of allergic fungal rhinosinusitis, its diagnosis and treatment. The advantage of this study was we had analyzed a good number of cases with varied presentations. Since AFRS is closely related with EMRS, CRS a proper clinical, radiological and immunological evaluation of the cases help in knowing the correct diagnosis and treatment.

Angiokeratoma corporis diffusum − a rare case report

We report a case of a 22-year-old male patient with angiokeratoma corporis diffusum, which is a cutaneous feature of many lysosomal storage disorders, but we diagnosed it as Fabry disease (FD) as our patient had normal intelligence associated with coarse facies, acroparesthesia, ocular changes like dilated vessels in conjunctiva, and presence of vacuolated endothelial cells in histopathological examination. It is an X-linked inborn error of the glycosphingolipid metabolic pathway that is associated with protean manifestations and is a paradigm of a multi-system condition with symptoms expressing themselves in many organs. We report this rare case mainly to stress the importance of proper clinical evaluation in the diagnosis of FD in today’s era of costly investigations like enzyme assay, which is not feasible in our setting. It also shows the importance of proper dermatological assessment, which has a highly positive predictive value in terms of assessing systemic morbidity in FD.

INCIDENTAL CUTANEOUS METASTASIS OF RENAL CELL CARCINOMA – REPORT OF AN INTERESTING CASE.

Background : Clear cell variant of renal cell carcinoma has highest risk of metastasizing. Cutaneous metastasis is however unusually rare. We report a case of an elderly male with a lesion on the chin, clinically suspected to be haemangioma, on histopathology diagnosed as cutaneous deposits of renal cell carcinoma, an incidental nding. A 75 year oldCase Report : male presented to the surgical OPD with a swelling on the chin, noticed after trauma whilst shaving. The painless lesion rapidly progressed over a period of one and half month with no associated pain. Swelling was surgically excised with clinical suspicion of haemangioma. With histopathological and immunohistochemical examination, a diagnosis of metastasis of clear cell carcinoma originating from the kidney was made. In the present case, the patient was an old male presenting with metastasis to the skin of chin, rapidly growing, an incidentalDiscussion : nding, search for the primary lesion revealed a renal mass diagnosed as renal cell carcinoma. Although cutaneous metastasis ofConclusion : Renal cell carcinoma to skin is rare specially in chin region, proper clinical evaluation with the help of radiological correlation must be done to nd out the primary lesion

A Study of Maternal and Foetal Outcome in Pregnant Women with History of First Trimester Vaginal Bleeding

BACKGROUND
 First trimester vaginal bleeding is an obstetric high-risk, early registration of pregnancy regular antenatal visits and good awareness to the pregnant women and their family members about first trimester vaginal bleeding and the sequelae and the early and remote obstetric and neonatal outcome are needed. The purpose of the study was to observe the effect of first trimester bleeding on maternal & foetal outcomes.
 METHODS
 This study involved all women attending the antenatal clinic at the Department of Obstetrics and Gynaecology with a history of vaginal bleeding in the first trimester or the second trimester or third trimester with prior history of first trimester bleeding at Basaveshwar and Sangameshwar Hospital, attached to MRMC, Kalaburagi. It included a total of 100 singleton pregnant women with vaginal bleeding in the first trimester of pregnancy that was confirmed ultrasonographically. Patients were closely observed and follow-up done 2 weekly up to 36 weeks and weekly after that till delivery. The maternal and foetal outcomes were studied.
 RESULTS
 In the present study, first trimester vaginal bleeding was seen maximum in the age group of 21-25 years about 47 %, seen more in Multigravida 52% than primigravida 44% and 4% in Grandmultipara. Maternal adverse outcomes such as abruption in 8 % of cases, placenta pravia in 15% of cases, placenta accreta in 2 % of cases, preeclampsia in 12 % of cases and PROM in 18 % of cases and preterm labour in 21 % of cases were observed. Among 63 live births, 38 were term babies, 19 were early preterm, 2 were late preterm babies, and 8 were IUGR babies.
 CONCLUSIONS
 In the first trimester, vaginal bleeding is one of the predictors of poor maternal and foetal outcomes later in pregnancy. Both maternal and foetal outcomes are studied considering pregnant women with first-trimester vaginal bleeding as a high-risk category. Proper evaluation of a pregnant woman with first-trimester vaginal bleeding, regular antenatal care, methodical evaluation of bleeding and regular follow-up with the lookout for maternal and foetal complications and awareness to the woman and family members and knowledge about warnings signs in pregnancy to be explained. Proper clinical examination and ultrasonographic evaluation & timely obstetric consultation and interventions play an important role in the management of patients with first-trimester vaginal bleeding.

A Case of Cleidocranial Dysplasia with Historical and Current Review

Introduction: This article discusses about our case of cleidocranial dysplasia and a review for dental manifestation and management of these cases. This disorder has a genetic background and general manifestations of CCD are outlined and an overview is presented. History: CCD is one of the best studies and documented disease whose history dates back to the prehistoric times with first case documented by Greig in 1933 in the museum of royal college of surgeons in Edinburgh. In the year of 1871, Scheuthauer published cranial and non – cranial findings of CCD. Case Report: We present a case of a 17 year old male patient who reported to our hospital with a complain of smaller and yellowish discolored teeth with spacing in the arch causing difficulty in chewing food. We have documented this case to the best of our understanding and with pictures depicting the patient and his clinical and radiographic findings. An interesting overview of the patient has been described. Discussion: We have researched different articles related to our patient and have documented the prominent features seen in these patients and correlated with the findings in our patient. There are reports of multiple patients who were diagnosed at a much earlier stage than our patient. Most of the clinical features described in the previous literature coincide with other findings, however additional clinical findings have been mentioned irrespective of their presence in our patient or not. Conclusion: We conclude that a proper clinical and radiographic evaluation can lead to early diagnosis of these patients and hence can aid in their management and education of the patient and his care takers. There are no reported cases of deficient IQ or abnormal life experienced by these patients except for that related to short stature.