Phobias occur in several forms. The two main types of phobias are social phobia and specific phobia. A marked specific fear of an object or situation is called a specific phobia. Ombrophobia or pluviophobia is a type of natural environmental subtype of specific phobia. We report a case of ombrophobia in a lady with an interesting psychopathology and treatment outcomes.

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Implantation of a permanent cardiac pacemaker is a frequently used therapeutic modality in bradycardia. Cardiac pacemakers have evolved from single chamber non-programmable devices to dual chamber devices with extensive programmability. The implantation of the device is only the initial step in the lifelong management of the patient with a pacemaker, and long -term follow-up is vital not only for the safety of the patient but is also the key to optimal utilization of the pacing system. We lack any pacemaker implantation data in Bihar. The retrospective study was conducted to know the demographic profile, various indications and mode of permanent pacemakers implanted at IGIMS, Bihar.

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Introduction: The Institute of Medicine’s report in 2000, To Err Is Human: Building a Safer Health System, highlighted the seriousness of medical errors in the U.S. health care system. Retained surgical items (RSIs) (any tools or materials used in surgical procedures that are unintentionally left inside a patient^[1]) is one of these errors. The problem of RSIs has been with us since the practice of surgery began. RSIs are a surgical patient safety problem and are generally preventable. RSIs incidents can result in significant harm to patients that may only be experienced months or years later and often result in claims being brought against hospitals, nurses and surgeons. The cause of these incidents is frequently an error in counting. Developing and implementing effective count processes and maintaining an environment of shared accountability for the prevention of RSIs are key. We are discussing a case series of RSIs which were diagnosed and treated at IGIMS, Patna, a tertiary care centre in eastern part of India between June- December 2016.

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Background: This study was done to investigate the association between tumor markers cancer antigen 15-3 (CA 15-3) and clinic-pathological parameters and patient outcomes in breast cancer i.e.to evaluate its diagnostic and prognostic potential. Materials and methods: A total of 148 patients with breast lump either benign or malignant had pretreatment CA 15-3 concentration measured. Univariate and multivariate analyses were used to investigate associations between marker concentration and clinic-pathological parameters and patient outcomes. Results: Among 148 patients, elevated preoperative levels of CA 15-3 identified in 41 (28%). Tumor size (>5 cm), node metastases (≥4), and advanced stage (≥lll) were associated with higher preoperative levels. Elevated CA 15-3 was associated with poor prognosis along with significant diagnostic potential of cal5-3 for breast carcinoma. Conclusion: High CA 15-3 level may reflect tumor burden and is associated with advanced disease and poor outcome but not a good diagnostic marker for early disease. Measuring preoperative levels of CA 15-3 can be helpful for predicting outcome.

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Orthodontics is the most popular specialty of Dentistry in modern era. At present practice of any discipline is based on the theory of evidence base treatment, and the orthodontic and dentofacial orthopedic branch of Dentistry is also not an exception. This case series is presented with an aim to depict the spectrum of Orthodontics treatment, starting from preventive to interceptive Orthodontics, removable Orthodontics to complex Orthodontics in the Department of Orthodontics at Indira Gandhi Institute of Medical Sciences, Patna.

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30 year old female admitted in emergency department with complaints of difficulty in breathing. She was a known case of systemic lupus erythematosus and had undergone lower segment cesarean section 6 month back. In postpartum period she developed post partum haemorrhage leading to acute renal failure which was managed by hemodialysis. Later her echocardiography confirmed massive pericardial effusion with temponade effect. Pericardiocentesis was tried to relieve the symptoms but during this procedure the needle was broken from its base, and even an attempt of needle retrieval could not be succeeded and it was presumed that it dropped down inside pericardial sac, which was removed by exploring the thoracic cage under general anaesthesia. She stayed in the hospital ward for one week and then discharged uneventfully.

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Ecthyma gangrenosum (EG) is a rare necrotising cutaneous manifestation of invasive infection typically caused by Pseudomonas in patients with compromised immune systems such as those of neutropenia. We encountered a case of Ecthyma gangrenosum caused by invasive Acinetobacter baumannii in a patient of Aplastic anemia with severe neutropenia. A fifteen year young boy presented with fever and a rapidly evolving 4x4.5 cm^[2] well circumscribed wound with black eschar and perilesional erythema on left leg. The patient showed response to intravenous Ceftazidime. Although Pseudomonas is common causative organism in Ecthyma gangrenosum, other microbes and bacteria including Acinetobacter baumannii should also be considered in differential diagnosis of Ecthyma gangrenosum.

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Internuclear ophthalmoplegia is due to involvement of medial longitudinal fasciculus and bilateral Internuclear ophthalmoplegia is most commonly associated with Multiple sclerosis. Here the author report a case of sudden onset bilateral Internuclear ophthalmoplegia with micro bleeds in the Pons. His internuclear ophthalmoplegia gradually improved over ten days and a eye movement are completely normal after four months.

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Toe Tourniquet syndrome is a rare condition which leads to ischaemic injury to the involved appendage. Emergency intervention is needed to salvage the involved digit. We present the case of an infant with this syndrome and stress upon the importance of prompt diagnosis and urgent intervention in such cases.

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Lipoma is a common benign tumor com-posed of adipose tissue. Its incidence in head and neck region is 20%. However, involvement of oral cavity and moreover pal-ate is extremely rare. Usually asymptomatic, it produces symptoms when huge. We pre-sent one such rare case of huge oral lipoma located in palate and extending to tonsillar fossa.

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Apple peel jejunal atresia is a rare congenital anomaly. A number of techniques have been described for intestinal anastomosis. This condition presents at birth as an intestinal obstruction, is diagnosed by X-rays and confirmed by laparatomy. Resection of the dilated proximal intestine and end to back anastomosis is one of the technique. We report three cases of atresia with apple peel deformity and its successful primary management.

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The study was intended to study the thyroid dysfunction in diabetic population. The association between thyroid and diabetes has long been recognised. This was an observational, prospective hospital based study conducted on 200 patients in medicine opd of IGIMS, Patna from May 2015 to April 2016. Among 200 patients 57 patients was found to be of thyroid dysfunction. 34 were female and 23 were male accounting to 28.5% of prevalence. Mean TSH,T4 and T3 among diabetics were 3.79μLU/πml, 8.38μg/dl and 1.34ng/dl respectively; and among diabetics with thyroid dysfunction were 30.44 μΐυ/ml, 8.11μg/dl and 1.40ng/dl respectively. Mean FBS, PPBS and HbA1C among diabetics were 124.87mg/dl, 179.98mg/dl and 7.98% respectively; and among diabetics with thyroid dysfunction were 128.80mg/dl, 182.85mg/dl and 8.13% respectively. Mean TC, TG, LDL and HDL among diabetics were 192.79mg/dl, 188.07mg/dl,110.19mg/dl and 44.35mg/dl respectively; and among diabetic with dyslipidemia were 191.63mg/dl, 202.33mg/dl, 109.15mg/dl and 42.78mg/dl respectively. This study suggest that TSH and TG levels were significantly higher among diabetics with thyroid dysfunction.

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Uterine leiomyoma is the commonest benign tumor of female genital tract. We report here a case of parasitic leiomyoma in a multiparous woman who presented with a history of pain, lump lower abdomen and menorrhagia. On examination, uterus was bulky and a firm mass in the lower abdomen was palpable which was moving with the movement of uterus. At laparotomy a pedunculated fundal fibroid attached to the small bowel and acquiring blood supply from the small bowel was found. The fibroid was first separated from the pedicle and then resected from the bowel. Total abdominal hysterectomy was done. Histopathological examination reported as leiomyoma.

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Gullain barre syndrome is an immune mediated polyneuropathy characterised by symmetric weakness and absent or diminished deep tendon reflexes. Here we report a case of Gullain barre syndrome which presented with exaggerated deep tendon reflexes.

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Tracheal intubation is the technique of choice to control the airway with the help of direct laryngoscopy in patient with normal condition. But, there is certain condition where direct laryngoscopy and orotracheal intubation is not possible. Temporomandibular joint ankylosis is one of such condition in which there is always a challenge of orotracheal intubation for anaesthesiologist particularly when fibre-optic bronchoscope is not available. In this condition retrograde naso-tracheal intubation may be very useful. Here we report a case of TMJ ankylosis with successful retrograde naso-tracheal intubation.

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Neurotoxicity is a lesser known complication of Cefepime, a fourth generation Cephalosporin. Cefepime is primarily excreted unchanged via kidney. We report here a patient placed for VP Shunt surgery with mild renal impairment who developed seizure with single dose Cefepime.

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Meningoencephalocele is hernial protrusion from congenital bony defect in skull of part of meninges and neural elements in a sac. The large head size and other anticipated congenital abnormalities posses a great challenge for anaesthesiologists. Endotracheal intubation may be difficult or impossible due to improper positioning and limited neck extension. As the resources were limited we planned a unique position for securing airway. We kept the child on a pillow with the head beyond its edge. The head was supported with two cushioned head rings made up of cotton rolled with gauge bandage. The central hole size of the head ring was kept just greater than the circumference of the mass. With this unique positioning the head was stablised in line to the body and also the head extension for intubation became easier. So we suggest this positioning for securing airway in such patients with large menigoencephalocele.

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