Boerhavia diffusa L. (Family: Nyctaginaceae), is commonly known as Horse Purslane, Hogweed, Punarnava, Raktapunarnavaa etc. in various languages. It is a perennial creeping weed having small pinkish flowers and distributed throughout the India, tropical and subtropical Asia, Africa and America. Leaves and roots of B. diffusa are edible in many regions of India. It is widely used for the treatment of several human ailments for example, anaemia, asthma, blood impurity, body pain, cough, rheumatism, gall bladder stone, joint pain, heart disease, enlargement of liver and spleen etc. in both codified and non-codified traditional systems of medicine. The plant has also shown to possess antioxidant, anti-inflammatory, antidiabetic, adaptogenic, hypolipidemic, antimicrobial, hepatoprotective, antiproliferative, anticonvulsant, nootropic, immunomodulatory activities in various in vitro and in vivo studies.

01-07

Euglycemic Diabetic Ketoacidosis (EGDKA) is somewhat a masked illness. It is a diagnostic challenge for the treating physician, as it can hide behind the most important factor leading to a suspicion of a ketoacidosis state – Hyperglycemia. Normal sugar levels, along with symptoms such as nausea, vomiting, and normal or decreased appetite should also raise a strong suspicion. SGLT-2 Inhibitor is already widely reported as the most common etiological factor leading to EGDKA. But we report a somewhat uncommon presentation of EGDKA in a patient with Adrenal Insufficiency. Much less reported but still prevalent, Adrenal Crisis induced EGDKA is a severe condition, but easily manageable if identified early and treated aggressively.

08-10

Nevus unius lateralis is a benign hamartomatous proliferation of the skin caused due to mosaicism and develops at birth or within few months of life. It is classified under epidermal nevus and characterized by multiple, small, hyperpigmented, verrucous plaques along lines of Blaschko present over unilateral side of the head, neck, trunk, limbs and rarely over the face, scalp and earlobes. It may or may not be associated with systemic abnormalities. We hereby report two cases of nevus unius lateralis, case one with neurological and skeletal abnormalities and case two with no associated comorbidities.

11-14

Poly-substance users can benefit significantly from the pharmacological treatment, but adherence to treatment can be challenging on the outpatient treatment basis. However, motivation to change has been implicated as a crucial element in substance use treatment outcomes. Motivational Enhancement Therapy (MET) is an approach that is used to increase intrinsic motivation to change by resolving patients’ ambivalence and is the most effective psychosocial treatment for substance use disorders. The aim of reporting this case study was to evaluate the effect of higher sessions of MET in poly-substance or multiple drug use disorder. The patient presented with a long history of substance abuse with multiple treatment failures and therefore multiple sessions of high intensity MET were planned.

15-18

As a dictum it is said that bilious vomiting in a new born until proven otherwise is a case of malrotation. Intestine malrotation commonly associated with duodenal atresia, abdominal wall defects or diaphragmatic hernia. Other than this malrotation also described with 100 of syndromes and combination but association with mesenteric cyst is rarely described in literature. Approximately one-third of mesenteric cysts usually occur in children younger than 15 years of age and are slightly more common in males.4 Mesenteric cyst in females is rare presentation. We report a 28-days-old, full-term female baby with atypical presentation of malrotation with midgut volvulus and associated mesenteric cyst.

19-21

Nasopharyngeal cyst or Thornwaldt cyst is a rare entry situated at nasopharyngeal wall (posterior). Most common ones are small and does not present with symptoms, but some are large and can cause nasal obstruction, eustachian tube obstruction, post nasal drip and headache. The diagnosis can be made by routine nasal endoscopy in outpatient department, but MRI is the investigation of choice to confirm the diagnosis. For large and symptomatic cyst surgery by Marsupialization is the treatment of choice and small and asymptomatic cyst is usually left for observation. The author here has discussed about the small and symptomatic cyst present in the nasophraynx as it is rare and sometimes diagnosed incidentally while doing routine nasal endoscopy.

22-25

The eye is an important sensory organ and a vital structure for the facial expressions. Loss of sight in either or both eyes can lead to disturbance to person’s social, physical and psychological health. The aim of an ophthalmic surgeon is to protect the sight at the earliest by rapid diagnosis by deciding the choice of investigations and operative procedure to restrict any further damage including infection to other structures and to prevent subsequent complications. The objective of this report is to study the requirement of evisceration surgical procedure in management of a case of ocular trauma.

26-28

Tetanus is a global infectious disease that occurs due to the tetano-spasmin neurotoxin secreted by “anaerobic clostridium tetani”. Brain stem and spinal cord are affected by this tetano-spasminneurotoxin, and if patient does not gets proper treatment in time then morbidity and mortality is very high. High risk population for tetanus in the US includes the elderly, diabetics, injection drug users and “unvaccinated” individuals.

29-40

41-44

Vitamin B12 and folic acid are key maternal micro nutrients that work together either as enzyme or as co-enzyme for erythropoiesis, DNA methylation, histone modification, microRNAs regulation and proper functioning of iron in the body. Also, these two micro nutrients works with vitamin B6 and vitamin B9 to maintain homocysteine level in blood. They are used in combination for the treatment or prevention of variety of diseased conditions such as infertility, diabetes, cancer, liver diseases, anaemia, dermatitis etc. Non-vegetarian products are rich source of vitamin B12 whereas folic is present in natural food such as green leafy vegetables, fruits, grains etc. Deficiency of both the Vitamin B12 and folic acid significantly affect DNA synthesis which is indicative of delayed nuclear maturation and an altered cell division in megaloblastic anaemia. Megaloblastic anaemia also results from microcytosis in bone marrow due to the deficiency of Vitamin B12 and folic acid. The reason behind the deficiency in every age group is poverty and lack of awareness. Several studies strongly support the reason behind megaloblastic anaemia due to impaired DNA synthesis is deficiency of the folate and vitamin B12. Though studies has been also reported that folate and vitamin B12 deficiency alter the epigenetics regulation leading to cancers. But this hypothesis is no strongly supported by any researchers. So, further more study is required to explore the relationship between megaloblastic anaemia, nutritional deficiency and epigenetic regulations.

45-54

55-56