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Background: An undergraduate curriculum begins with anatomy, the importance of this knowledge is essential for understanding and contextualizing clinical pathophysiology. Didactic lecture and cadaveric dissection have been the mainstay of anatomical learning. Temporal bone is the complicated bone of the skull and lodges middle ear. Middle ear surgeries requires complete evaluation of middle ear surgical anatomy, mainly posterior tympanic cavity, as it contains many irregular spaces, removal of complete cholesteatoma is a challenge that surgeons face regularly. Endoscopic dissection is the innovative way and aids in viewing of nook and corner of middle ear. To compare theObjective: learning effectiveness of students through model teaching and endoscopic teaching of middle ear anatomy on cadaver specimen. Currently wet sagittal section of face and POP model of middle ear are theMethods and Materials: materials used for the study. For the new innovative approach, third year MBBS students were divided into two groups containing 30 in each group. Assessment of both the groups was done with questionnaire. Both the groups were assessed with same questions and scoring was done. In group A, maximum score was 11 and minimum was 3.25 out of 18.Results: In group B, maximum score was 17.5 and minimum was 5 out of 18. In group A, according to scaling, students fell into poor and average category whereas in group B , students fell into good and very good category as well. Conclusions: Analysis identified, statistically significant increase in performance for the endoscopic method compared to model teaching.Overall, the endoscopic approach to middle ear anatomy education is associated to an improved gain in knowledge and more efficient as compared to model teaching
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Background: Thymectomy has been identified as Constructive and active strategy for patients with Myasthenia gravis and thymic masses which have been done classically by Open Sternotomy technique and nowadays new Minimally invasive approaches have also been introduced. In this paper , Subxiphoid Uniportal VATS(Video Assis Method : ted Thoracoscopic Surgery) Thymectomy through a single port technique by utilizing the Subxiphoid approach has been discussed. I have improvised my technique pertaining to the requirements and better recovery and better post operative outcome of the patient .This procedure is indicated for all anterior mediastinal masses and maybe extended to lung cancer.The patient was placed in supine position instead of classical lithotomy position .Carbon dioxide insufflation was not used which led to faster recovery after the surgery.After dissection and resection of thymus Bilateral pleural drain were placed which was removed usually on Post Operative day 4 or 5 and patients were discharged afterwards. Several benefits of this Results: approach were observed and documented including reduced postoperative pain, Early extubation, better post operative outcome, and better dissection . In the near future ,the Subxiphoid approach has the potential to become Conclusion: GOLD STANDARD for Thymectomy and various other conditions
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Background@#Surgical extraction of impacted mandibular third molars is the most common procedure performed by oral surgeons. The procedure cannot be performed effectively without achieving profound anesthesia. During this procedure, patients may feel pain during surgical bone removal (at the cancellous level) or during splitting and luxation of the tooth, despite administration of routine nerve blocks. Administration of intraosseous (IO) lignocaine injections during third molar surgeries to provide effective anesthesia for pain alleviation has been documented. However, whether the anesthetic effect of lignocaine is the only reason for pain alleviation when administered intraosseously remains unclear. This conundrum motivated us to assess the efficacy of IO normal saline versus lignocaine injections during surgical removal of impacted mandibular third molars. The aim of this study was to assess the efficacy of IO normal saline as a viable alternative or adjunct to lignocaine for alleviation of intraoperative pain during surgical removal of impacted mandibular third molars. @*Methods@#This randomized, double-blind, interventional study included 160 patients who underwent surgical extraction of impacted mandibular third molars and experienced pain during surgical removal of the buccal bone or sectioning and luxation of the tooth. The participants were divided into two groups: the study group, which included patients who would receive IO saline injections, and the control group, which included patients who would receive IO lignocaine injections. Patients were asked to complete a visual analog pain scale (VAPS) at baseline and after receiving the IO injections. @*Results@#Of the 160 patients included in this study, 80 received IO lignocaine (control group), whereas 80 received IO saline (study group) following randomization. The baseline VAPS score of the patients and controls was 5.71 ± 1.33 and 5.68 ± 1.21, respectively. The difference between the baseline VAPS scores of the two groups was not statistically significant (P > 0.05). The difference between the numbers of patients who experienced pain relief following administration of IO lignocaine (n=74) versus saline (n=69) was not statistically significant (P > 0.05). The difference between VAPS scores measured after IO injection in both groups was not statistically significant (P >0.05) (1.05 ± 1.20 for the control group vs. 1.72 ± 1.56 for the study group) @*Conclusion@#The study demonstrates that IO injection of normal saline is as effective as lignocaine in alleviating pain during surgical removal of impacted mandibular third molars and can be used as an effective adjunct to conventional lignocaine injection.
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“Both Tughlaq and his enemies initially appear to be idealists; yet in the pursuit of the ideal, they perpetrate its opposite. The whole play is structured on these opposites: the ideal and the real: the divine aspiration and the deft intrigue.” These opposites constitute the main charm of the structure of Tughlaq. P. Bayapa Reddy highlights the specialized technique, which Karnad employed in Tughlaq to uphold the theatrical appeal of the play for the spectators:“
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Introduction: Forensic odontology is an important and evolving branch. It has been established for critical issues like medi- colegal cases and identification of a dead person. Radiographic assisted documentation will provide objective information including the precise recording of the uniqueness of every individual where it has been used extensively in dental identification based on anatomy and by comparing maxillofacial skeletal landmarks in antemortem and post mortem records. Main body: Human Identification is mainly based on a dead body decomposition state. More likely of missing persons and the identification of individuals in conditions like criminal investigations and mass disasters. Odontological method for human identification is used commonly as it is simple by comparing with other methods, but complex in execution and requires skills and expertise. There are so many radiological techniques for forensic purposes like Computer tomography, cone-beam com- puter tomography, Orthopantomogram, 3D facial reconstruction, Radiovisiography, and Virtopsy. Objectives: This review highlights the different radiographic techniques and procedures and its application in forensic odon- tology. Source search criteria: Data were obtained and analyzed from previously published literature and electronic database search- es of relevant published literature from PubMed and Google Scholarfrom the 2001 to 2021 year. Conclusion: Imaging technologies and radiographs have become a vital component of modern medical practice and foren- sic odontology. The application of any of the mentioned techniques depends on the availability of previous images, data, or skeletal findings for Identification. So forensic radiology has a potential for crime-solving and is useful in conventional dental identification based on anatomy and by comparing maxillofacial skeletal landmarks in antemortem and post-mortem records, as they have become a crucial part of dental practice as well as in forensic odontology for diagnosis of disease, treatment plan- ning, identification of tooth structures, and age estimation.
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Tolstoy was born at Yasnaya Polyana. His family estate was at hundred miles south of Moscow. He made attempts to apply his radical moral beliefs to his own life and became the most prominent novelist and story writer in an age and place of great authors. In all his works we ?nd a con?uence of moral and intellectual errors that he perceived in modern life and thought at the turn of the twentieth century. We can keep Tolstoy's activity in threefold. He was an artist, who produces ?ctions in various genres and with various ends in view. He was a religious thinker and publicist, who develops and explains a philosophical system with ethical in its emphasis. More importantly, he was an aesthetician, who elaborates a theory of universal comprehensible art
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Anita Nair is a novelist, poet, travel writer, essayist, short story writer and writer of stories for children. Her novels enforce cross cultural endeavors. They enlighten experiences having transcendental and inexhaustible diversity of forms such as barriers of language, cultures and identities. She is popular female writer who depict the present condition of women in society. She uses wit and humour. She has an exceptional and quite beautiful art of storytelling. She dives deep into human psyche to lead the reader to a wonderful journey. Her novels contain a very nebulous world which absorbs readers to a great extent. Her novels have stories of colorful and unique characters. She weaves experiences from day-to-day life into her charming stories. He r third novel 'Mistress' deals with human relationships, man- woman relationship and analyses pre-marital, marital, extra-marital relationships and estrangement between husband and wife.
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Susceptibility to low temperature stress is the major threat to papaya cultivation. Here, we studied a low temperature stress tolerance in papaya plant. We have investigated the effect of different low temperature regimes, 28°/18°C (day/night) to 16°/06°C (day/night) with a gradual decrease of 2°C on every two days and one set with direct exposure to the low temperature of 18°/08°C (day/night), called the acclimatized plant, in five diverse papaya genotypes (Pusa Nanha, Red Lady P-7-2, P-7-9, and P-7-14) and cold tolerant wild relative of cultivated papaya genotype (Vasconcellea cundinamarcensis V.M. Badillo) under controlled regulated conditions. It was observed that there were significant variations in the physiological and biochemical parameters like photosynthetic gas exchange parameters, chlorophyll content, fluorescence parameters, relative water content (RWC), membrane stability index (MSI), total sugars content, total soluble proteins content, lipid peroxidation, and proline accumulation in leaf tissues. Maximum stomatal conductance, chlorophyll fluorescence, RWC, MSI, total sugars, total soluble proteins, proline and lowest MDA contents were observed in Vasconcellea cundinamarcensis followed by inbred P-7-9 as compared to other genotypes under low temperature stress. Among all the papaya genotypes, P-7-9 showed more adaptability to low temperature stress and it further give new insights for developing low temperature tolerant papaya genotypes, especially under changing climate situations.
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In the last few decades, hydroxyapatite (HA) has become one of the most highly prized biominerals in the biomedical industry for orthopedic and dental applications. The focus of this research was to synthesize biomimetic HA from Tridax procumbens (TP) leaf extract and investigate their antibiofilm properties. The HA was made using the sol-gel method and the HA-TP biocomposite was made by precipitation method. The d.nm size of HA and HA-TP biocomposite was determined as 193.28 and 258.14 d.nm, respectively. The zeta potential of HA and HA-TP biocomposite was determined as ?21.2 and ?18.3 mV, respectively, and found highly stable. The FTIR study revealed that phytochemicals of TP were successfully impregnated into HA-TP biocomposite. The HA and HA-TP biocomposite were found spherical and agglomerated from SEM analysis. In HR-TEM analysis, the average diameter of the HA and HA-TP biocomposite were 16.57 – 64.22 nm and 51.71 – 138.68 nm, respectively. According to the EDX analysis, HA is primarily composed of calcium, oxygen, and phosphate, whereas, HA-TP biocomposite is primarily composed of calcium, phosphate, oxygen, and carbon. In the antioxidant assay, the IC50 value (concentration required to scavenge 50% of free radicals) of HA-TP biocomposite was determined as 156.69 ± 14.02 and 180.21 ± 12.84 µg/mL in DPPH and ABTS free radical scavenging assays, respectively. The MIC (minimum inhibitory concentration) and MBC (minimum bactericidal concentration) of as-synthesized HA-TP biocomposite against Staphylococcus aureus – ATCC 13565 and Escherichia coli – MTCC 41 were observed as 181.09 ± 21.47 and 317.30 ± 41.03, and 157.59 ± 32.18 and 264.03 ± 21.58 µg/mL, respectively. The as-synthesized HA-TP biocomposite has detrimentally affected the biofilm formation of both the tested bacteria S. aureus – ATCC 13565 and E. coli – MTCC 41. The study concluded that the as-synthesized HA-TP biocomposite could be highly helpful in the biomedical field for alleviating oxidative-stress-related disorders and inhibiting microbial biofilm formation.
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Introduction: Stroke is one of the leading causes of death and disability in India. Stroke survivors may suffer from lifelong physical and cognitive frailty. There is a need for more studies on the prevalence and determinants of this debilitating disease at the national level. Thus, assessing the factors associated with stroke is vital to developing appropriate preventive strategies in India. Methods: Data from the Longitudinal Aging Study in India wave 1 (2017–2018) are utilized for this analysis. The survey collected demographics, social, economic, and health data, including lifestyle factors and stroke, from 65,900 older adults ?45 years representing all states and union territories. Stroke prevalence was calculated for each independent variable, and the differences were compared using the ?2 test. An unconditional multivariable logistic regression model was used to obtain the adjusted odds ratios (AOR) and 95% confidence intervals (CIs) of each lifestyle and socioeconomic variable for stroke prevalence. Results: The prevalence of self?reported stroke was 1.71% (95% CI: 1.61–1.80). Older adults with hypertension (AOR=3.69, 95% CI: 2.95–4.62), family history of stroke (AOR=3.09; 95% CI: 2.33–4.12), arrhythmias (AOR=2.27; 95% CI: 1.20–4.29), physical inactivity (AOR=1.91; 95% CI: 1.55–2.34) were strong contributors of stroke. Diabetes and high cholesterol individuals have 1.5 times more odds for stroke than those without those conditions. Increasing age (AOR=1.57 for 55–69 older adults, and AOR 2.05 for ?70 years), male sex (AOR=1.75; 95% CI 1.36–2.26), and rich (AOR=1.58; 95% CI: 1.21–2.06) were also associated with increased odds for stroke. Conclusion: The prevalence of stroke was high among adults aged ?45 years in India. Hypertension, family history of stroke, arrhythmias, and low physical activity were significant contributors to stroke. The findings suggest that preventing and controlling these lifestyle conditions and behaviors may help prevent stroke.
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Background: The etiological pattern of obstructive jaundice varies from one region to another due to higher incidence being noticed in the Northern region of India. Very limited studies have been carried out in the western regions of Uttar Pradesh. The various etiological parameters ranges from malignant biliary stricture, stone in the CBD and even secondaries lymph node compression at porta hepatis. Due to the transition from open surgery to the minimum invasive laproscopic surgery. The etiology related to surgical jaundice also become more common in relation to procedure related complications like CBD injury that leads to surgical jaundice.Material & Methods:This present study has been conducted in the department of general surgery in TMMC and RC of a Tertiary Care hospital. In this observatory study the patients having clinical records of surgical jaundice who had attended the surgical Out Patient Department are going to be included. The time period of the study was from 1 jan 2020 to 30 sept 2021 . Overall, 44 patients were being considered. The selection of subject was done randomly and any type of special consideration regarding the gender of the patients was not being considered while selecting for the study.Results:In our study from 44 patients according to frequency distribution of etiology maximum of the subjects were having choledocholitheasis along with cholelitheasis that are 34.5 % and choledocholitheasis with obstructive jaundice was the 2ndmost common cause with 31.78%.The 3rdmost common etiology was found carcinoma of gall bladder with 11.35%.Conclusions:It can be concluded that for the cases of malignant surgical jaundice good survival benefit usually depends upon the detection of the disease early during the course period. It has also been found that in malignant cases the stage of disease with jaundice were advanced. As per our study results it has been observed that there are various etiological factors contributing to development of surgical jaundice which needs multiple modes of precise investigations and further evaluations further studies and research needed to cover various factor responsible for surgical jaundice.
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Background: Overall incidenceof seizure is found to be 0.2-0.6 per 1000 population per year. A first seizure mandates individual counselling about the risk of recurrence, the pros and cons of drug treatment. Seizures are usually a manifestation of an underlying pathology which may be genetic, structural or metabolic.Objectives of current study wereto study the clinical profile of new onset seizures in adults (greater than 19 years) attending to tertiary care Centre, Mysore and to determine the etiology of new onset seizures in adults reporting to tertiary care centre, Mysore.Methods:All participants fulfilling the inclusion criteria were interviewed as per proforma. Participant抯 demographic, social and medical details were recorded in proforma sheet and patients were subjected to neuroimaging studies, EEG and other necessary blood investigations. In all cases the seizure type is classified according to ILAE Classification 2017.Results:Among 100 cases evaluated for new onset, Majority of the patients were 41 to 60 years. Generalised seizures (95%) were more common than focal seizures.Among neurological etiological causes, vascular causes (34%) were most common. Most common Non-neurological cause for seizures was alcohol withdrawal (46.67%).Conclusions: If proper analysis of etiologyis made, seizures can be treated accordingly thus reducing the morbidity and mortality associated with it. Primary care physicians play a pivotal role in identifying patients with adult onset seizures and should encourage these patients to undergo neuroimaging so as to arrive at an appropriate etiological diagnosis.
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Objective: To assess prevalence of overweight/obesity, hypertension and its risk factors among women from North-eastern States of India. Methods: A community based cross-sectional study was carried out in two north-eastern States. Information was collected on household's socio-economic & demographic particulars. Height (cm), weight (kg), waist and hip circumferences and blood pressure were measured on all the selected women. Association between overweight/obesity, hypertension with socio-demographic variables was tested using Chi-square and logistic regression was done. Total 1047 women were covered from both the states. Results: The prevalence of chronic energy deficiency was 19% & 10%, overweight/obesity (BMI_x0001_23) was 17.5% & 26% and hypertension was 15% & 17% (age adjusted 19.6% & 17%) respectively among women from Meghalaya & Nagaland. The prevalence of pre-hypertension was observed more among women from Nagaland (36.5%) as compared to Meghalaya (18.3%). Only 31% women were aware of hypertension and 6% had history of hypertension and 82% of them were on treatment. The prevalence of hypertension was observed high among 36e49 years and among overweight/obese women. On logistic regression, only age, BMI and use of additional salt was observed to be significantly associated with hypertension, while living in pucca house was associated with overweight/obesity. Conclusions: The prevalence of hypertension was similar in both the states (15e17%) and prehypertension was high among women from Nagaland. This is warning sign for women in Nagaland. There is an urgent need to undertake more health & nutrition education sessions along with regular check-up for early diagnosis and treatment of hypertension.
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Background & Aim: Roux-en-Y hepaticojejunostomy (RYHJ) is the most common treatment done for benign biliary strictures and as a part of for post CDC excision biliary drainage. In the long term follow up, RYHJ stenosis is a dreaded complication, both for the patients and the attending surgeon, in view of the complexity and difficulty in its management. This is traditionally managedby a combination of medical, radiological and open surgical techniques. There are only a few reports describing the management of strictured biliary anastomosis by a laparoscopic technique. The aim of the present study is to describe our experience of laparoscopic re- establishment of biliary continuity(Re-do hepatico-jejunostomy) Methods: Retrospective analysis of prospectively collected data of RYHJ stenosis post benign biliary stricture (BBS) repair and choledochal cyst (CDC) excision, treated by laparoscopic re-do RYHJ, between January 2018 to December 2018 in the department of GI Surgery, GB Pant Institute & Maulana Azad Medical College. Results: 6 patients underwent laparoscopic Re-do RYHJ during the study period. 4 patients developed RYHJ stenosis post open BBS repair and 2 after open CDC excision. The presenting complaints was repeated episodes of fever with jaundice, refractory to medical management. Three patients also had hepatolithiasis.
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Background: Pancreaticoduodenectomy is a standard procedure for periampullary tumours. Pancreatic anastomosis is the Achilles heel of the procedure with a significant leak rate and the associated high morbidity. We adopted a modified pancreatic stump drainage with pancreato-gastrostomy - pancreatic stump mobilization with invagination into the lumen of the stomach via posterior gastrotomy and fixation with two U shaped sutures to the posterior wall of the stomach traversing across the pancreatic parenchyma. Materials and Methods: We did a retrospective analysis of a prospectively maintained database of patients who underwent Laparoscopic Whipple’s pancreaticoduodenectomy (WPD) from November 2017 to March 2019 in our department, a tertiary referral centre of Northern India. A total of 34 patients underwent totally laparoscopic Whipple’s pancreatoduodenectomy with the modified Pancreatogastrostomy. Results: A total of 34 patients underwent totally laparoscopic WPD during this study period. The median age was 50 years (27 to 70 years) with 17 male and 17 female patients. Of these patients, 23 patients had their tumours arising from the ampulla, 6 from the duodenum, 3 from the pancreas, 1 SCN head of pancreas and 1 from the distal common bile duct. All patients had R0 resection with a median lymph node yield of 13 (6-19). 9 patients had stage 1 disease, 10 patients had stage 2 disease and 14 patients had stage 3 disease. 31 patients had moderately differentiated adenocarcinoma while 2 patients had well-differentiated tumour morphology. 14 patients had pancreato-biliary differentiation with the remaining 19 patients having intestinal differentiation. The overall number of significant complications according to Clavien-Dindo classification was 17.6% (Grade 3 and higher) . Conclusion: Laparoscopic WPD is a feasible procedure in the hands of a well-trained laparoscopic surgeon. Modified P-G as described, simplifies the pancreatic drainage with a low incidence of post-operative pancreatic fistula and its attendant complications.
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BACKGROUND@#Full thickness burn wounds are lack of angiogenesis, cell migration, epithelialisation and finally scar tissue formation. Tissue engineered composite graft can provide sustained release of growth factor and promote the wound healing by cell migration, early angiogenesis and proliferation of extracellular matrix and wound remodeling. The objective of this study was to evaluate the gene embedded (pDNA-platelet-derived growth factor, PDGF-B) porcine acellular urinary bladder matrix with transfected mesenchymal stem cells (rBMSC) on healing of full thickness burn wound in rat model. @*METHODS@#Full thickness burn wound of 2 9 2 cm size was created in dorsum of rat model under general anesthesia.Burn wounds were treated with silver sulfadiazine; porcine acellular urinary bladder matrix (PAUBM); PAUBM transfected with pDNA-PDGF-B; PAUBM seeded with rBMSC; PAUBM seeded with rBMSC transfected with pDNA-PDGF-B in groups A, B, C, D and E respectively. The wound healing was assessed based on clinical, macroscopically, immunologically, histopathological and RT-qPCR parameters. @*RESULTS@#Wound was significantly healed in group E and group D with early extracellular matrix deposition, enhanced granulation tissue formation and early angiogenesis compared to all other groups. The immunologic response against porcine acellular matrix showed that PDGF-B gene activated matrix along with stem cell group showed less antibody titer against acellular matrix than other groups in all intervals. PDGF gene activated matrix releasing the PDGF-B and promote the healing of full thickness burn wound with neovascularization and neo tissue formation. PDGF gene also enhances secretion of other growth factors results in PDGF mediated regenerative activities. This was confirmed in RT-qPCR at various time intervals. @*CONCLUSION@#Gene activated matrix encoded for PDGF-B protein transfected stem cells have been clinically proven for early acceleration of angiogenesis and tissue regeneration in burn wounds in rat models.
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PEGylated-l-asparaginase (PEG-ASNase) is a chemotherapeutic agent used to treat pediatric acute lymphoblastic leukemia (ALL). Its use is avoided in adults due to its high risk of liver injury including hepatic steatosis, with obesity and older age considered risk factors of the injury. Our study aims to elucidate the mechanism of PEG-ASNase-induced liver injury. Mice received 1500 U/kg of PEG-ASNase and were sacrificed 1, 3, 5, and 7 days after drug administration. Liver triglycerides were quantified, and plasma bilirubin, ALT, AST, and non-esterified fatty acids (NEFA) were measured. The mRNA and protein levels of genes involved in hepatic fatty acid synthesis,
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BACKGROUND@#Full thickness burn wounds are lack of angiogenesis, cell migration, epithelialisation and finally scar tissue formation. Tissue engineered composite graft can provide sustained release of growth factor and promote the wound healing by cell migration, early angiogenesis and proliferation of extracellular matrix and wound remodeling. The objective of this study was to evaluate the gene embedded (pDNA-platelet-derived growth factor, PDGF-B) porcine acellular urinary bladder matrix with transfected mesenchymal stem cells (rBMSC) on healing of full thickness burn wound in rat model. @*METHODS@#Full thickness burn wound of 2 9 2 cm size was created in dorsum of rat model under general anesthesia.Burn wounds were treated with silver sulfadiazine; porcine acellular urinary bladder matrix (PAUBM); PAUBM transfected with pDNA-PDGF-B; PAUBM seeded with rBMSC; PAUBM seeded with rBMSC transfected with pDNA-PDGF-B in groups A, B, C, D and E respectively. The wound healing was assessed based on clinical, macroscopically, immunologically, histopathological and RT-qPCR parameters. @*RESULTS@#Wound was significantly healed in group E and group D with early extracellular matrix deposition, enhanced granulation tissue formation and early angiogenesis compared to all other groups. The immunologic response against porcine acellular matrix showed that PDGF-B gene activated matrix along with stem cell group showed less antibody titer against acellular matrix than other groups in all intervals. PDGF gene activated matrix releasing the PDGF-B and promote the healing of full thickness burn wound with neovascularization and neo tissue formation. PDGF gene also enhances secretion of other growth factors results in PDGF mediated regenerative activities. This was confirmed in RT-qPCR at various time intervals. @*CONCLUSION@#Gene activated matrix encoded for PDGF-B protein transfected stem cells have been clinically proven for early acceleration of angiogenesis and tissue regeneration in burn wounds in rat models.
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Adult Still’s disease is rare and may present as pyrexia of unknown origin. Due to lack of expertise, diagnosis may be delayed inadvertently. The patient usually presents with spiked fever, polyarthralgia or arthritis, evanescent skin rash, non-purulent pharyngitis, lymphadenopathy and hepatosplenomegaly. Leukocytosis, predominantly of neutrophils, elevated erythrocyte sedimentation rate and C-reactive protein without obvious infection are the hallmarks of the disease. Delay in diagnosis may expose the patient to the side effects of antibiotics as they are repeatedly prescribed in view of elevated leukocytes. The majority of patients report pain in the throat without evidence of infection. This was an important clue to our diagnosis of this patient. Grossly elevated serum ferritin is diagnostic of adult onset still's disease. As the white cell counts are grossly elevated, a bone marrow examination to rule out hematological malignancy may be mandatory. Serum ferritin value has prognostic value too. Minor illness may respond to non-steroidal anti-inflammatory drugs (NSAIDs), but steroids are the mainstay of the treatment. Methotrexate is of additional value for those presenting predominantly with arthritis. Anakinra, Infliximab and Tocilizumab are other options. Those patients presenting with severe disease and organ involvement require high dose intravenous steroids followed by high dose oral steroids.