A Clinical Study Of Blunt Injury Abdomen In Tertiary Care Hospital

BACKGROUND : Blunt abdominal trauma is the 3rd most common form of injury in road traffic accidents after orthopaedic injuries and head injuries and the victims mostly are young, productive adults and hence it has got enormous 8 socio-economic impact. METHOD : Aprospective detailed study and analysis of 125 cases of abdominal trauma those admitted in this tertiary care centre over a period of 2 years from 2017 -2019 was undertaken with the review of the medical literature. RESULTS : Blunt injury abdomen is a major cause of morbidity and mortality in young age patients with Road traffic accident being the most commoncause.Males are affectedmore thanfemales.Inourstudy,Liverismost commonlyinvolvedorganthanspleenwhichis contrasttoliterature. CONCLUSION : Early diagnosis reduces the mortality rates and safety measures in roads prevent the injuries , both play a major role in good outcome.

Prevalence of protein energy malnutrition among children: a cross sectional study

Background: In the world, hunger and malnutrition are most significant threat. Malnutrition is global risk factor for significant death among infants and pregnant woman. malnutrition increases the chances of several infections.Methods: A cross sectional study was undertaken in children age group of 1 to 18 years, suffering from protein energy malnutrition, attending Department of Paediatrics, tertiary care hospital, Bangalore during the period January 2016 to December 2016.'Results: In the present study, maximum number of cases (44) belongs to age group of 1-5 years, followed by 32 cases belongs to 6-12-year age group and 24 cases belong to 13-18-year age group. Maximum cases (59) belongs to female with male female ratio is 1:1.4. In the present study out of 100 cases, 81 cases came positive for protein energy malnutrition. Out of 81 cases positive for PEM, 34 cases belong to grade I followed by 24 cases belongs to grade II, 13 cases belong to grade III and 1o cases belongs to grade IV protein-energy malnutrition (PEM).Conclusions: Malnutrition is like an iceberg, most people in the developing countries live under the burden of malnutrition.

Incidence of urinary tract infection in febrile children

Background: Urinary tract infection is diagnosed by the growth of many organisms of a single specimen in the urine with presence of many symptoms. bacteriuria is defined as growth with a colony of >105/ml of a single species in a midstream clean catch urine sample.Methods: A cross sectional study was undertaken in febrile children with urinary tract infection attending Department of Paediatrics, tertiary care hospital, Bangalore during the period January 2017 to December 2017.Results: Out of the 200 children studied, 93 children belonged to the age group of 6 year to 12 year and 57 children belong to 1 year to 6-year age group and 50 children belongs to 12 year to 18-year age group. 97 children showed significant pyuria in centrifuged urine sample of which 49 were males and 48 were females. Majority 45 children were belonging to age group of 6 year to 12 year. Out of 97 children showed significant pyuria in centrifuged urine sample of which 46 children 5-10 cells/HPF and 27 children showed > 10 cells/HPF and 24 cases showed < 5cells / HPF. Out of 200 children, in 29 cases urine culture showed E. coli growth and 51 cases showed no growth.Conclusions: Urinary tract infections are common in childhood. Nearly all UTIs are caused by bacteria that enter the opening of the urethra and move upward to the urinary bladder and sometimes the kidneys.

Nutrition assessment of elderly residing in urban areas and urban slum: A hospital based comparative study

Background: In Maharashtra the elderly population is 9.9 % of the total state population (Census 2011). There is a need to highlight the nutritional problems being faced by the elderly in India. Early detection of malnutrition and timely interventions can help to reduce morbidity in the long run. Aims &Objectives: To find the prevalence of malnutrition in elderly and compare nutritional status of elderly residing in an urban area and urban slum. Material & Methods: This was a cross sectional hospital-based study. Data was collected from the civil OPD and ex-service men OPD of the hospital each having a catchment population from urban slum and urban area respectively. A total of 331 patients > 60 years of age were included. Nutritional status was assessed using the MNA, MUST and GNRI. Serum albumin levels were measured using colorimetric method. Results: The overall prevalence of malnutrition and at risk as per MNA score was 168 (50.7%). Out of 331 subjects, 209 belonged to urban slums and remaining 122 were from urban area. The gender and age distribution were comparable in both groups. The mean BMI of subjects from slum area was significantly lower as compared to urban group (22.3+ 5.3 vs 26.3+ 4.5) p<0.001. Proportion of elderly who had MNA score below 24 was significantly higher in the slum area (p<0.05). Proportion of elderly with mid arm circumference and calf circumference below the cut off of 22 cm and 31 cm respectively was significantly higher in slum area (p<0.05). Serum albumin levels were comparable in both groups. Mean BMI of elderly in urban area was >25Kg/m2. Conclusion: The overall prevalence of malnutrition was high. The nutritional status of elderly in urban slum was significantly worse than that of elderly in urban area.

A comparative study of 075% ropivacaine and 05% bupivacaine for epidural anesthesia in patients undergoing lower abdominal and lower extremity surgeries

Background: Regional anaesthesia has come to occupy an important part in clinical anaesthesiology today. As with other fields, regional anaesthesia too has undergone major developments both in techniques and drug availability. Aim: To study and compare the effect of 0.75% Ropivacaine with 0.5% Bupivacaine for epidural anaesthesia in patients undergoing lower abdominal and lower extremity surgeries with respect to the following factors, Onset and Duration of Sensory Block and Onset and Duration of Motor Block. Materials and Methods: To conduct this study, it was decided to consider a random sample of at least sixty (60) patients of either sex between the age of 20-65 years belonging to the American Society of Anaesthesiologists (ASA) physical status I or II scheduled to undergo elective surgery. The study was conducted to compare 0.75% Ropivacaine and 0.5% Bupivacaine for epidural anaesthesia in lower abdominal and lower extremity surgeries across the following parameters; Time taken for the onset of sensory block T12, Time taken for maximum height of sensory block T6, Time C. Geetha, L. Umapradeepa, K. Chandra Prakash, R. Pandu Naik. A comparative study of 0.75% ropivacaine and 0.5% bupivacaine for epidural anesthesia in patients undergoing lower abdominal and lower extremity surgeries. IAIM, 2017; 4(11): 250-258. Page 251 taken for two dermatome segment regression, Time taken for regression up to T12, Time taken for the onset of maximum motor block and Duration of motor block. Results: The onset time for sensory block up to T12 and up to the maximum height of T6 were found to be statistically insignificant; there was no difference in the effect of both the drugs. The two dermatome segment regression and regression up to T12 were statistically significant; it was prolonged in the case of Ropivacaine compared to Bupivacaine. The onset of motor block was statistically significant and was found to be faster in the case of Bupivacaine. The duration of the motor block was also statistically insignificant and it was the same for both the drugs. Conclusion: From these results, this study provides a reasonable ground to conclude that Ropivacaine and Bupivacaine differ in terms of their onset and duration of both sensory and motor block in epidural anaesthesia. Thus Ropivacaine with its higher efficacy, prolonged sensory blockade, lower propensity for motor blockade, proven reduced potential for CNS toxicity and cardiotoxicity, appears to be an important option for regional anaesthesia, management of post-operative pain, labour pain making it the current local anaesthetic drug of choice

Study of Dexmedetomidine as an intrathecal adjuvant to ropivacaine for postoperative analgesia

Background: Knowledge and use of adjuvant drug therapy has rendered neuraxial analgesia more effective in the management of both acute and chronic pain conditions. α-2 adrenergic agonists have both analgesic and sedative properties when used as adjuvant in regional anaesthesia. Aim: To study the effects of intrathecal dexmedetomidine added to ropivacaine for surgeries under spinal anesthesia. Materials and methods: This clinical study was conducted on 50 patients of ASA PS 1 and 2 in the age group of 18 -50 years of either sex posted for elective lower limb orthopaedic and lower abdominal surgeries under spinal anaesthesia after taking informed consent, study done over a period of 12 months. Results: All demographic details are insignificant. Average duration of surgery was 94.4 min ± 34.4 min. 76% (n= 38) of subjects belonged to ASA grade 1 and 34% (n=12) subjects belonged to ASA grade 2. Mean duration for onset of Sensory block was 4.12 minutes (SD: ± 1.69) and the mean duration for onset of motor block was 10.12 minutes (SD: ± 2.89). Pulse rate in all the patients was maintained in normal range during the observation period. Mean pulse rate was 76 ±4.3 beats per min. average mean systolic pressure was 117.7 ± 14.3 mm Hg and diastolic pressure 68.7± 4.6 mmHg. Tailam Tanmayee, P. Raghunath, D. Anuradha, R. Pandu Naik. Study of Dexmedetomidine as an intrathecal adjuvant to ropivacaine for postoperative analgesia. IAIM, 2017; 4(11): 241-249. Page 242 Mean values of SBP and DBP were maintained in the study population. However, when considered individually, Hypotension was observed in 3 patients after SAB (Fall in SBP > 20%). The hypotension was mainly observed after 4 to 6 min after SAB. The mean Ramsay sedation scale was 2.08 with SD 0.27. Side effects observed were mainly hypotension, nausea and shivering. Conclusion: To conclude, 5 microgram dexmedetomidine seems to be an attractive alternative as an adjuvant to spinal ropivacaine in surgical procedures, especially those requiring long time. This combination (ropivacaine and dexmedetomidine) provides very good quality of haemodynamic stability. It has excellent quality of postoperative analgesia with minimal side effects.

Practical recommendation for rash and diarrhea management in Indian patients treated with tyrosine kinase inhibitors for the treatment of non‑small cell lung cancer.

Tyrosine kinase inhibitors (TKIs) are a pharmaceutical class of small molecules, orally available with manageable safety profile, approved worldwide for the treatment of several neoplasms, including lung, breast, kidney and pancreatic cancer as well as gastro‑intestinal stromal tumours and chronic myeloid leukaemia. In recent years, management of lung cancer has been moving towards molecular‑guided treatment, and the best example of this new approach is the use of the tyrosine kinase inhibitors (TKIs) in patients with mutations in the epidermal growth factor receptor (EGFR). The identification of molecular predictors of response can allow the selection of patients who will be the most likely to respond to these tyrosine kinase inhibitors (TKIs). Gastrointestinal (GI) adverse events (AEs) are frequently observed in patients receiving EGFR tyrosine kinase inhibitor therapy and are most impactful on the patient’s quality of life. Dermatologic side effects are also relatively common among patients treated with EGFR inhibitors. Evidence has emerged in recent years to suggest that the incidence and severity of rash, positively correlated with response to treatment. These skin disorders are generally mild or moderate in severity and can be managed by appropriate interventions or by reducing or interrupting the dose. Appropriate and timely management make it possible to continue a patient’s quality of life and maintain compliance; however if these adverse events (AEs) are not managed appropriately, and become more severe, treatment cessation may be warranted compromising clinical outcome. Strategies to improve the assessment and management of TKI related skin AEs are therefore essential to ensure compliance with TKI therapy, thereby enabling patients to achieve optimal benefits. This article provides a consensus on practical recommendation for the prevention and management of diarrhoea and rash in Non‑Small Cell Lung Cancer (NSCLC) patients receiving TKIs.

Association between occupational history of exposure to tobacco dust and risk of carcinoma cervix: A case‑control study.

CONTEXT: Cervical cancer is the second most common malignancy among women in India. There is thus a need to identify unexplored risk factors such as occupational exposure to tobacco dust to justify its increasing trend so as to recommend suitable preventive measures. AIMS: The aim was to study the association between occupational exposure to tobacco dust with development of carcinoma cervix. SETTINGS AND DESIGN: Case‑control study done in two tertiary care hospitals in Mangalore. METHODOLOGY: 239 histologically confirmed new cases of cervical cancer and the equivalent number of age‑matched controls from 2011 to 2012 were interviewed about occupational history of beedi rolling and related factors. STATISTICAL ANALYSIS: Chi‑square test, unpaired t‑test, logistic regression. RESULTS: Exposure rate to tobacco dust following beedi rolling was 63 (26.4%) among cases and 38 (15.9%) among controls (P = 0.005, odds ratio [OR] =1.893). The latent period from occupational exposure of tobacco dust subsequent to beedi rolling and development of cervical cancer was found to be 26.5 ± 8.5 years. Adjusted OR of beedi rolling with development of cervical cancer was found to be 1.913 (P = 0.005) after controlling the confounding effect of tobacco usage and was 1.618 (P = 0.225) after controlling the effects of all confounders. Three‑quarters of beedi rollers were working in conditions of inadequate ventilation and hardy anybody used face mask during work. About a quarter of participants underwent voluntary screening for cervical cancer. CONCLUSION: Occupational exposure to tobacco dust was found to be associated with risk of developing cervical cancer. Measures to promote awareness, timely screening of this disease along with the improvement in working conditions is required for improving the health status of beedi rollers and to minimize the incidence of carcinoma cervix in the community.

Genomic profiling in a homogeneous molecular subtype of non‑small cell lung cancer: An effort to explore new drug targets.

BACKGROUND: Patients’ who are positive for kinase domain activating mutations in epidermal growth factor receptor (EGFR) gene, constitute 30–40% of non‑small cell lung cancer (NSCLC), and are suitable candidates for Tyrosine Kinase Inhibitor based targeted/personalized therapy. In EGFR non‑mutated subset, 8–10% that show molecular abnormalities such as EML4‑ALK, ROS1‑ALK, KIP4‑ALK, may also derive the benefit of targeted therapy. However, 40% of NSCLC belong to a grey zone of tumours that are negative for the clinically approved biomarkers for personalized therapy. This pilot study aims to identify and classify molecular subtypes of this group to address the un‑met need for new drug targets in this category. Here we screened for known/novel oncogenic driver mutations using a 46 gene Ampliseq Panel V1.0 that includes Ser/Thr/ Tyr kinases, transcription factors and tumor suppressors. METHODS: NSCLC with tumor burden of at least 40% on histopathology were screened for 29 somatic mutations in the EGFR kinase domain by real‑time polymerase chain reaction methods. 20 cases which were EGFR non‑mutated for TK domain mutations were included in this study. DNA Quality was verified from each of the 20 cases by fluorimeter, pooled and subjected to targeted re‑sequencing in the Ion Torrent platform. Torrent Suite software was used for next generation sequencing raw data processing and variant calling. RESULTS: The clinical relevance and pathological role of all the mutations/variants that include SNPs and Indels was assessed using polyphen‑2/SIFT/PROVEAN/mutation assessor structure function prediction programs. There were 10 pathogenic mutations in six different oncogenes for which annotation was available in the COSMIC database; C420R mutation in PIK3CA, Q472H mutation in vascular endothelial growth factor receptor 2 (VEGFR2) (KDR), C630W and C634R in RET, K367M mutation in fibroblast growth factor receptor 2 (FGFR2), G12C in KRAS and 4 pathogenic mutations in TP53 in the DNA binding domain (E285K, R213L, R175H, V173G). CONCLUSION: Results suggest, a potential role for PIK3CA, VEGFR2, RET and FGFR2 as therapeutic targets in EGFR non‑mutated NSCLC that requires further clinical validation.

Outbreak of Burkholderia cepacia complex bacteremia in a chemotherapy day care unit due to intrinsic contamination of an antiemetic drug.

Background: In the end of 2009, a large number of patients with cancer undergoing chemotherapy at the day care unit of a private hospital in Mumbai, India developed Burkholderia cepacia complex (BCC) blood stream infection (BSI). Objective: The objectives were to identify the source of the outbreak and terminate the outbreak as rapidly as possible. Materials and Methods: All infection control protocols and processes were reviewed. Intensive training was started for all nursing staff involved in patient care. Cultures were sent from the environment (surfaces, water, air), intravenous fl uids, disinfectants and antiseptics and opened/unopened medication. Results: A total of 13 patients with cancer with tunneled catheters were affected with BCC BSI. The isolates were of similar antimicrobial sensitivity. No signifi cant breach of infection control protocols could be identifi ed. Cultures from the prepared intravenous medication bags grew BCC. Subsequently, culture from unused vials of the antiemetic granisetron grew BCC, whereas those from the unopened IV fl uid bag and chemotherapy medication were negative. On review, it was discovered that the outbreak started when a new brand of granisetron was introduced. The result was communicated to the manufacturer and the brand was withdrawn. There were no further cases. Conclusions: This outbreak was thus linked to intrinsic contamination of medication vials. We acknowledge a delay in identifying the source as we were concentrating more on human errors in medication preparation and less on intrinsic contamination. We recommend that in an event of an outbreak, unopened vials be cultured at the outset.

Prevalence of KRAS mutations in metastatic colorectal cancer: A retrospective observational study from India.

BACKGROUND: One of the genetic alterations implicated in tumor progression in colorectal cancers (CRCs) are abnormalities in Kristen Rat Sarcoma (KRAS) gene. Evaluation of KRAS mutation status is an important prognostic factor and has predictive value in deciding first line therapy based on monoclonal antibodies such as Cetuximab and Panitumumab in metastatic CRCs. MATERIALS AND METHODS: In this retrospective study, we analyzed 7 different somatic mutations in Exon 2 of KRAS gene in 299 unselected incidental CRC patients who visited the hospital for clinical management during the period 2009–2013. Most of the tumors were primarily originating from colon and rectum; nevertheless, there were a few from rectosigmoid, sigmoid, ceacum and anal canal in the study group. Genomic DNA extracted from paraffin embedded tumor tissues was screened for 7 point mutations located in Codons 12 and 13 of KRAS gene, using Scorpions amplified refractory mutation system real time polymerase chain reaction technology. Statistical analysis was performed to assess bivariate relationship between different variables that includes: mutation status, mutation type, tumor location, tumor morphology, age and sex. RESULTS: Prevalence of mutation in Codons 12 and 13 was 42.8% in the study group. Well‑differentiated tumors had significantly more mutation positivity than moderately and poorly differentiated tumors (P = 0.001). 92% of the mutations were from Codon 12 and 8% in Codon 13. Glycine to Arginine was relatively more common in rectosigmoid followed by ceacum, while Glycine to Alanine mutation was relatively more prevalent in sigmoid, followed by rectum and rectosigmoid. CONCLUSION: The results suggest a prevalence of KRAS mutation at 42.8% in Indian population indicating that this testing is very crucial for targeted therapy management in metastatic CRC in India. Further analysis on mutation status of other homologues such as NRAS and downstream partner, v‑raf murine sarcoma viral oncogene homolog B1, would add value to understanding the role of anti‑epidermal growth factor receptor therapy in CRC management.

Effect of Polyherbal Formulation on Metabolic Derangements in Experimental Model of High Fructose Diet Induced Metabolic Syndrome.

High fructose diet induces metabolic syndrome. Therefore an attempt has made to evaluate the effect of Polyherbal formulation in male Wistar rats by oral administration of 350 mg/Kg body weight (HF1) and 500 mg/ Kg body weight (HF2). The clinical symptoms established in high fructose diet induced metabolic syndrome were ameliorated by Poly herbal formulation. Food, water intake was increased in high fructose diet fed rats. Body weight, abdominal waist and Body mass index were increased in only high fructose fed rats whereas reduced with poly herbal formulation. Atherogenic index and Blood pressure were increased in only high fructose fed rats but reduced in rats supplied with polyherbal formulation (HF1 and HF2) along high fructose. Biochemical components like fasting blood glucose levels, triglycerides, total cholesterol, LDL, VLDL, SGOT, SGPT, Uric acid, Malondialdehyde (MDA) were increased in only high fructose fed group rats whereas these components were reduced and normalised in groups of rats fed with high fructose diet for 7 weeks in association with Herbal formulation HF1, HF2 for last three weeks separately.HDL-C levels were found increased in rats even though supplied with polyherbal formulation. Histopathology results of pancreas and liverof only high fructose fed rats indicated the infiltration of inflammatory cells and fat accumulation which was ameliorated with HF1 and HF2.

Formulation and evaluation of esomeprazole magnesium dihydrate multiple unit particulate system ( pellets) as a delayed release dosage form.

The present study was an attempt to formulate and evaluate enteric coated tablets for Esomeprazole magnesium dihydrate delayed release multiparticulate to reduce the Gastrointestinal tract side effects.The delayed release multiple units were prepared by using fluid-bed werster technology.These multiple units are selected by seal coating, drug coating and enteric coating.These Esomeprazole magnesium dehydrate were evaluated for assay, acid resistence, drug release,dissolution, Kinetic studies of Innovator and Optimized formulation, Stability studies of Optimized formulation. This study concluded Esomeprazole magnesium dihydrate can be prepared by using combination of polymers studied and we can reduce the GI tract side effects.

Epidermal growth factor receptor mutation in non-small-cell lung carcinomas: A retrospective analysis of 1036 lung cancer specimens from a network of tertiary cancer care centers in India.

BACKGROUND: Epidermal growth factor receptor (EGFR) mutation plays a vital role in the prognosis of patients with lung cancer. However, there is a dearth of studies on EGFR mutation in Indian population. In this retrospective study conducted at a network of tertiary cancer care centers across India, we evaluated the proportion of EGFR mutation in patients with non‑small‑cell lung carcinomas (NSCLC). MATERIALS AND METHODS: A total of 1036 cases of non‑small lung cancer were assessed for EGFR mutation status using Scorpion amplified refractory mutation system real time polymerase chain reaction method from fine needle aspiration cytology core biopsy, pleural fluid and cell blocks. For a few cases, macro dissection of tumor from H and E slides was also performed for EGFR analysis. EGFR Status was assessed for the most commonly known driver mutations in Exons 18, 19, 20 and 21, which contributes to a total of 29 somatic mutations including the resistance mutation T790M. RESULTS: Around 39% of the cohort was female and 61% were male. Mutation was positive in 40.3% and negative (wild type) in 59.7%. There was 1.8% mutation in exon 18, 24.6% in exon 19, 1.6% in exon 20 and 12.8% in exon 21. 38.2% had a mutation in a single site and 1.1% had a mutation in two sites. Overall mutation was significant in females (50.5% vs. 33.9%) compared with males (c2 = 28.3, P < 0.001). Mutation was significant in exon 21 (16.8% vs. 10.3%, c2 = 9.44, P = 0.002) and exon 19 (30.7% vs. 20.7%, c2 = 13.2, P < 0.001) in females compared with males. CONCLUSION: EGFR is expressed differentially/ mutated in patients with NSCLC. Further studies to unravel the predictors for acquired genetic alterations of EGFR are needed.

Corrosive Poisoning.

Corrosive poisoning is a common emergency as corrosive agents are easily available for household use. Emetics and neutralizing agents should be avoided in treatment. Management of corrosive poisoning includes parenteral hydration and nutrition, H2-receptor antagonists or proton pump inhibitors. Upper gastrointestinal (GI) endoscopy should be done once the patient is hemodynamically stable and there are no signs of perforation. Urgent surgery is required in the event of perforation. Patients with Grade 0-1 injuries do not need hospitalization, while patients with Grade 2 and 3 injuries require intensive care unit (ICU) management.1

Effect of environment on genetic parameters of hybrid rice.

Field experiments were conducted using 68 hybrids, 17 parents and four checks across two different agroclimatic zones of Andhra Pradesh, South India during Kharif, 2008 and rabi-2008-09 to estimate the genetic variability parameters for yield and yield contributing characters. Pooled analysis over the environments, genotype and environment interactions were significant for traits like panicle weight, flag leaf length, flag leaf width, productive tillers per plant, filled grains per panicle, 1000 grain weight and grain yield per plant, implies differential behavior of genotypes under the four environments for these characters. The estimates of phenotypic coefficient of variation (PCV) were slightly higher than those of genotypic coefficient of variation (GCV) for all the traits studied across the seasons. Slight differences were observed for all the characters with regard to variability coefficients, heritability and genetic advance % of mean in different environments. Panicle weight, flag leaf length, flag leaf width, grains per panicle, yield per plant, 1000 grain weight and productivity per day were recorded moderate to high GCV, PCV, heritability, genetic advance % of mean, characters could be transmitted to the progeny and phenotypic based selection would be effective.

Comparative effectiveness of tepid sponging and antipyretic drug versus only antipyretic drug in the management of Fever among children: a randomized controlled trial.

OBJECTIVE: To compare the effectiveness of tepid sponging and antipyretic drug versus only antipyretic drug among febrile children. DESIGN: Randomized controlled trial. SETTING: Tertiary care hospital. PARTICIPANTS: 150 children 6 mo - 12 yr age with axillary temperature 101F. INTERVENTION: Tepid sponging and antipyretic drug (Paracetamol) (n=73) or only antipyretic drug (Paracetamol) (n=77). MAIN OUTCOME MEASURES: Reduction of body temperature and level of comfort. RESULTS: The reduction of body temperature in the tepid sponging and antipyretic drug group was significantly faster than only antipyretic group; however, by the end of 2 hours both groups had reached the same degree of temperature. The children in tepid sponging and antipyretic drug had significantly higher discomfort than only antipyretic group, but the discomfort was mostly mild. CONCLUSION: Apart from the initial rapid temperature reduction, addition of tepid sponging to antipyretic administration does not offer any advantage in ultimate reduction of temperature; moreover it may result in additional discomfort.

Melanocytoma of cerebellum.

Melanocytomas are rare melanocytic tumors of the central nervous system. We report a rare case of melanocytoma in the cerebellum of a 35-year-old male patient. Computed tomography scan showed a cystic lesion with an enhancing solid component arising from the cerebellum. The lesion was resected and a histological diagnosis of melanocytoma of the cerebellum was made.

Pancreatic mucinous cystadenoma.

We report here the case of a 75-year-old lady who presented to us with a 4-month history of abdominal symptoms. The computed tomography scan revealed a cystic lesion in the tail of the pancreas. Distal pancreatectomy was done and biopsy showed a benign mucinous neoplasm. Because this is potentially malignant it is vital to diagnose it before it becomes malignant; identification of this entity remains a diagnostic and therapeutic challenge.