The literature and statistics on tuberculous dactilitis (TD) are scarce and most literature consists of isolated case reports. The aim of this case series is to examine trends and diagnostic difficulties faced by the clinicians in diagnosing this rare disorder. Google search engine and MEDLINE were searched for key words ‘tuberculous dactylitis’ and ‘spina ventosa’. From all published papers and unpublished reports, 58 cases were extracted and 61 cases, including the three presented by us in this review, were analyzed for a set of 16 parameters. There is re-emergence and increase in the incidence of this form of extra-pulmonary tuberculosis (EPTB) especially in the industrialized countries, which poses a diagnostic challenge to physicians in these countries, as they are not well versed with this entity. 

Epidermoid inclusion cysts are benign lesions that occasionally occur in the distal phalanges of the fingers. A 30-year-old man presented with swollen and tender distal phalanx  of the left middle finger. Radiographs showed an expansile lytic lesion in the tip of the distal phalanx with associated cortical erosions and minimal soft tissue component. CT scan revealed a well–defined lytic lesion with broken cortex at one place in the distal phalanx of the affected finger probably due to trauma. From clinical and radiological examination, a giant cell tumor, possibly aggravated by his injury, was suspected. The differential diagnosis included an inclusion cyst or a chronic infection. During operation, a cystic lesion containing creamy material was obtained from within the bone which was sent for culture and sensitivity. After aspiration of the creamy material, a thick, yellow rind within the bone was completely removed and sent for histopathology. Bone graft was taken from the ipsilateral proximal ulna and suitably shaped to fill the cavity left after thorough curettage. Histopathology showed findings consistent with inclusion dermoid cyst. The patient recovered uneventfully, with normal functional digit and satisfactory radiographs. Epidermoid cysts of the bone are rare and mainly involve skull and phalanges. Diagnosis of such lesions is challenging and misdiagnosis may result in an unnecessary digital amputation.

 Peripheral ossifying fibroma is a reactive gingival overgrowth occurring frequently in the anterior maxilla in teenagers and young adults. It is a non-neoplastic enlargement of gingiva. Due to its clinical and histopathological similarities, some POFs are believed to develop initially as a pyogenic granuloma that undergoes fibrous maturation and subsequent calcification. The peak incidence is found most frequently in teenagers and young adults. Trauma or local irritants such as dental plaque, calculus, micro-organisms, masticatory forces, ill-fitting dentures and poor quality restorations have been implicated in the etiology of peripheral ossifying fibroma. Here we present a case report of peripheral ossifying fibroma in a 35-year-old female. This case report comprises the growth that occurred in the maxillary anterior region with displacement of anterior teeth, its management and literature review. The lesion was asymptomatic, sessile, firm and pinkish-red in color. Excision biopsy of the lesion revealed histopathological features consistent with peripheral ossifying fibroma. Therefore, careful clinical examination and histopathological findings should be correlated to conclude the final diagnosis.

Emphysematous pyelonephritis is a rare but serious bacterial infection of renal parenchyma and perirenal tissue characterized by gas formation. This article presents the report of a 63-year-old diabetic male in whom the disease was detected promptly and managed conservatively.

Firearm injuries can lead to grave consequences, especially if suffered to the facial region. Patients who survive these injuries have an enduring impact on their quality of life. In this article, we present a case of a 35-year-old police officer who suffered a firearm injury to his face after being attacked by bandits. He was subsequently managed at our hospital with multiple procedures. At one-year follow-up visit, he was found to have major depressive disorder, facial deformity, difficulty chewing solid foods and inability to resume his job. We describe how firearm injuries in the facial region have profound psychological and socioeconomic implications for the patient, extending wider than the physical damage and are easily overlooked.

Spinal tuberculosis is common in endemic regions. Psoas abscess associated with lumbosacral tuberculosis is a common finding in long standing cases. But vague symptoms and signs make the clinical diagnosis of psoas abscess with tuberculous spondylodiscitis a challenge. A 22-year-old married female presented with low backache, anorexia and bilateral swellings in the flank regions. The swellings extended to the upper medial quadrant of the buttocks bilaterally. Abdominal ultrasonography showed bilateral psoas abscesses above inguinal ligaments and extending into buttocks bilaterally after iliac bone erosion Magnetic resonance images showed diffuse spondylodiscitis from L1 to S1 and bilateral psoas abscesses, erosion of the iliac bones and a large subfascial abscess over the gluteal muscles. The communication of the buttock abscess into the retroperitoneum and with the psoas abscess was evident. Operative drainage of abscesses was performed and histological examination showed caseaous necrosis confirming the clinical diagnosis of tuberculosis. Anti-tuberculous therapy was started and continued for 12 months with complete recovery.

BACKGROUND: The premenstrual syndrome (PMS) is common in younger age women and present a significant public health problem. Previous studies have reported that up to 90% women of child-bearing age experience premenstrual symptoms. This study aims to estimate the prevalence of PMS in women of reproductive age and its association with socio-demographic factors in an urban medical center in Islamabad, Pakistan.

METHODS: This was a cross-sectional study conducted during a three months period. Four hundred and twenty two women between the ages of 15 and 45 years, who were seen in the gynecology outpatient department, maternal child health (MCH) centre Pakistan Institute of Medical Sciences, Islamabad, were recruited. Of these, 350 (83%) respondent women were interviewed on pre-tested and validated questionnaire. Various social, demographic, and clinical variables were compared between women with and without PMS using chi-square test.

RESULTS: Of the 350 participants, 167 had diagnosis of PMS; 51% had mild, 37% had moderate and 12% had severe symptoms. Women with PMS were statistically significantly different in age, residence and income from women without PMS. The prevalence of abdominal bloating, headache, breast tenderness, anxiety and depression and anger outburst was higher in women with PMS than those without PMS.

CONCLUSION: Significant proportion of reproductive age women group suffer from PMS. However, routine screening might help in early diagnosis and management of this problem on time.

BACKGROUND: India has one of the largest medical education systems in the world but approximately one-third of fresh medical graduates leave India every year for residency training or practice abroad, with approximately 2.5-5% leaving for the United States. Although physician ‘brain drain’ has long been recognized, various interventions designed to address it has been constrained by a limited understanding of this migration, usually stemming from the unavailability of detailed data. This study was conducted to analyze the career trends of recent medical graduates and to identify the reasons behind those trends.

METHODS:  A questionnaire was emailed to recent medical graduates from a medical school asking about the preference for further training, and reasons for their preference including the relative importance of each reason (very important, slightly important or not important). Statistical analysis was performed using SPSS v.17.

RESULTS: The questionnaire was e-mailed to 100 students. Sixty-six responses were deemed appropriate for analysis. Forty-four students (66.7%) choose to do post-graduation in India, with 22 (50%) of them wishing to go abroad in future for further studies and 5 (11.36%) agreeing to change decision if they could go back in time. Twenty-two students (33.3%) choose to go to the United States, with 14 (63.6%) wishing to return back to India after completion of studies while 8 (36.4%) wished to settle abroad, and 2 (9.1%) agreeing to reverse decision if they could go back in time. There was no statistical difference in demographic profiles of students preferring training in India versus the United States.

CONCLUSION: This study found that many students (33.3%) prefer going abroad for post-graduation training. The reasons considered most important for choosing to go abroad included better job opportunities, better quality of life, better hospital infrastructure and facilities, and a comparative difficulty to get into desired sub-specialty in the home country (India). This is the first study that examines the preference of medical students and reasons for deciding a particular career path.

BACKGROUND: The role of a general practitioner (GP) in the early recognition, assessment and management of transient ischemic attack (TIA) is vital to prevent subsequent stroke. The aim of this study was to determine the GPs knowledge of TIA recognition, assessment, and management

METHODS:  The study comprised a questionnaire survey of 228 GPs in all 19 towns of Karachi, Pakistan. The questionnaire consists of demographic details and case scenarios based questions which had three responses (yes, no, do not know). Case scenarios were based on the typical neurological cases seen in general practice. The sections covered risk stratification, investigations, and management of TIA. Questionnaire were provided and briefed to GPs by two-trained research assistants. Statistical analysis was performed using SPSS (IBM SPSS Statistics 20.0). Data were expressed in frequencies for all questionnaire responses and calculated for all variables in numbers and percentage. Cross tabulation was performed to determine, if there was a relationship between subgroups. Chi-square test was used for comparative analysis.

RESULTS: All 228 GPs responded to the survey. Most of the GPs responded correctly to the stratification of risk of TIA, and early risk of subsequent stroke. Majority of the GPs correctly responded to the investigations and the management of TIA. Difficulty in accessing neurological consultation was not identified as a barrier (74%). 

CONCLUSION: This study concludes that, GPs can recognize TIA reasonably which is a major contribution to the assessment and management of TIA in the community. This is due to the continuous medical education and training in dealing with the specialized groups of patients.