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We report a 70 years old female, who presented with huge swellings over the left forehead, left clavicular region, anterior neck, occipital region and the right side of the scalp. The first swelling appeared 8 years back. She had deranged thyroid function tests and highly raised serum thyroglobulin levels. Her T3 level was 300.75 ng/dl (normal range: 40–181 ng/dl); T4 level was 6.7 µg/dl (normal range: 5–10.7 µg/dl) and thyroid stimulating hormone (TSH) level was 0.09 µIU/ml (normal range: 0.5–8.9 µIU/ml). Her serum thyroglobulin level was 30,000 ng/ml (normal range: 0.73–84 ng/ml). We have reported this case due to the unusual presentation of the patient with massive metastatic lesions from a primary thyroid cancer with highly raised serum thyroglobulin levels. Metastatic tumors to the skull are most often from breast, lung and prostate malignancies. In thyroid cancer, Nagamine et al. reported skull metastasis in only 2.5% of the cases. Along with radioactive iodine therapy, curative resection of solitary bone metastasis, wherever possible, is associated with improved survival, especially in younger patients of metastatic thyroid cancer. Only the light of knowledge and health education can dispel the darkness of ignorance. This rare case report highlights the importance of educating the masses, especially the people living in villages, so that it does not take 8 years, as in our case, to present oneself to a tertiary health care facility.

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Introduction: Adverse drug reactions (ADRs) are among the leading causes of morbidity and mortality globally. The college has recently been recognized as an Adverse Drug reaction Monitoring Center under the National Pharmacovigilance Program. This study was conducted to assess the knowledge, attitude, and practice (KAP) about pharmacovigilance among healthcare providers and medical students of the college and associated hospital. Materials and Methods: A cross-sectional, questionnaire-based survey was conducted. A pretested, validated questionnaire for assessing the KAP of pharmacovigilance among the healthcare providers and medical students was used. Results: The knowledge and attitude of healthcare providers toward reporting of ADRs was satisfactory. Awareness about the pharmacovigilance activities in the institution was less as only 27.8% were aware. More than 90% participants agreed that reporting of ADRs is important, should be made mandatory, and believed that it would help patient safety in the long term. Less than 50% healthcare providers reported regular ADRs. The reasons for not reporting ADRs included difficulty in knowing whether an ADR has occurred or it is a symptom of disease, lack of time, ADR is already well known, managing the patient is more important, or ADR is mild. Training on how to report an ADR during their professional course was received by 60.4% of the healthcare providers. The pharmacists were less aware, whereas the medical students were well aware about the importance of pharmacovigilance. Conclusion: There is a need to improve the culture of reporting ADRs among the healthcare providers in the institute. The first step would be to increase awareness about facilities and processes in place for reporting ADRs. Incorporation of training about pharmacovigilance in the curriculum of all the healthcare providers may help in increasing awareness and practice of reporting ADRs.

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Tachylalia is defined as extremely rapid output of speech. A case of delayed development of tachylalia 4 years following sustaining a closed craniocerebral injury is reported. We suggest that the management of communication disorders should always be considered as a part of treatment and rehabilitation of traumatic head injury. In a detailed PubMed and Medline search for late-onset tachylalia, development following traumatic craniocerebral injury did not yield even a single report in the literature. The multidisciplinary approach in management of such rare event is highly crucial.

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Introduction: Obesity is a lifestyle disease that has been significantly increasing in the recent years. Body mass index (BMI) is recommended by the WHO to classify obesity and is used as a tool to identify patients or individuals at risk for adverse health outcomes. Waist circumference (WC) is also an important risk factor for lifestyle diseases and it can also be used to measure body fat distribution. Our study, therefore aims to determine the prevalence of overweight and obesity among the preclinical students in a Malaysian medical university, correlate the relationship of BMI and WC and evaluate the knowledge and perception of obesity of obese and overweight students. Method: A descriptive cross sectional study was performed involving 93 second year medical students. The BMI and WC were recorded of all the participants. The obese and overweight participants were identified and asked to answer a close-ended self-administered questionnaire. Results: Out of 93 students who participated in the study, 23 (25%) were overweight and 21 (22%) were obese. Pearson correlation analysis between BMI and WC values showed that the two variables strongly correlate with each other. The questionnaire identified gaps in the knowledge of the students and poor perception among overweight students. Conclusion: Hence, our study concludes that the prevalence of obese and overweight individuals is on the rise and there a gap in the knowledge. Based on our study results it is recommended that appropriate measures are taken to address the issue.

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Forensic facial reconstruction (FFR) is the technique that combines art and science to recreate the antemortem appearance of an individual in order to recognize and identify the decedent. Over the years, many techniques of FFR and imaging modalities that provide the basic data for FFR have evolved. There is always a considerable debate and confusion regarding the advantages and limitations of these techniques. The aim of this review is to summarize the different techniques of FFR and emphasize the role of radiological techniques including cone beam computed tomography in it.

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Epithelial myoepithelial carcinoma is a rare low-grade salivary gland malignancy of presumed intercalated duct origin comprising <1% of all salivary gland tumors. We report two cases of this carcinoma in middle aged persons, diagnosed as pleomorphic adenoma on cytology but later found out to be epithelial myoepithelial carcinoma on histopathology. More than 24 months post-surgery, patients stay free from tumor.

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Background and Objectives: Serratiopeptidase is available as an oral preparation. The effectiveness of this enzymatic preparation is questionable. Despite this fact, serratiopeptidase is prescribed for a variety of inflammatory conditions. The study was conducted to determine the availability, cost and rationality of serratiopeptidase preparations available in Indian market. Materials and Methods: Serratiopeptidase preparations were assessed for total number, composition, strength and cost. Data were collected from ‘The Drug Today’ of the years 2009 (October–December) and 2015 (April–June). The rationality of preparations was assessed on validated 6-point scoring criteria. An extensive literature search was made using evidence-based print and electronic databases for the studies on efficacy and safety of serratiopeptidase. Results: A total of 642 serratiopeptidase preparations were available in the year 2009, which increased to 647 in 2015. Eighty percent preparations were fixed-dose combinations (FDCs) with either non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics, muscle relaxants or miscellaneous drugs. Of all FDCs, 96% preparations were combinations with one or more NSAIDs. Single drug preparations showed a decline from 19.9 to 12.3%. Serratiopeptidase was available in strengths from 2.5 to 50 mg. The cost of 10 mg dose of serratiopeptidase preparations ranged between Rs. 1.35 and Rs. 8.16. The cost of FDCs was more than that of single non-serratiopeptidase agent. FDCs scored poorly on rationality assessment scale in both years, and an increase in irrational preparations was observed. Conclusion: Too many serratiopeptidase preparations are available. Evidence on their efficacy and safety is lacking. The rationality of available FDCs of serratiopeptidase is poor. The availability of expensive FDCs of unknown efficacy and safety is an important contributory factor for the irrational use of drugs.

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In recent years, improved diagnostic tools have broadened the concept of disease therapeutics to encompass and cater all possible etiologies to a particular disease. Cardiovascular diseases are one of the most prevalent disorders in both developing and developed countries. Hence, it is the need of the hour to develop efficient and targeted treatment protocols for them. Holistic management of any disorder is possible only when we are clear with the grass-root level origin and cause of a particular disease. Earlier concepts of pathogenesis of atherosclerosis and cardiovascular events like acute coronary artery syndromes had lipid centric view of etiology. However, in recent years, there has been a shift towards importance of inflammatory processes in the body to be responsible for the disease. Periodontitis is a chronic inflammatory disease with prime bacterial etiology that leads to destruction of supporting structures of teeth. Present is a brief review of the possible mechanisms by which periopathogens can elicit cardiovascular risk and how treatment of periodontal infections can improve systemic health.

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Being able to communicate and modulate host metabolism, the tens of trillions of bacteria that inhabit our gut have been shown to affect traits, which vary from host’s gene expression to behavior, being responsible for maintaining health and exerting influence on the development of a number of diseases. This review shows the changes that occur in the gut microbiota composition along the lifespan, and how the communication with the immune system and central nervous system can be modified as years go by. These changes, most of the times, favor the appearance of inflammatory signals (in older adults), and may contribute to the development of neurodegenerative diseases. Finally, there is a consideration of manipulating the gut microbiota with probiotic therapy as an important option to prevent and treat diseases related to gut microbiota modifications.

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