syndrome (PTS, brachial neuritis or neuralgic amyotrophy), is a clinical syndrome typically characterized by acute onset of unilateral severe pain in the shoulder and upper arm, followed by weakness in the proximal mid-arm or distal upper limb, often in the distribution of individual nerves (multiple mononeuropathies). 1,2 Symptoms are commonly preceded by a triggering event, such as infection, surgery, or less commonly, vaccination. 2-4 Initial trials on safety and LETTERS TO THE EDITOR E3

Objectives: The purpose of the present study was to study the clinical profile and aetiology of anaemia in elderly more than 60 years of age at a tertiary care centre. Methods:147 elderly patients were studied during one year period, who fulfilled the inclusion criteria of age more than 60 years with anaemia, as per World health organisation. A detailed history, thorough clinical examination and symptom analysis, was done in all the patients. Haematological investigations including peripheral smear and biochemical investigations were done in all patients. Morphological pattern of anaemia was classified based on red cell indices and peripheral smear. From preliminary investigation, further studies were planned according to the probable cause of anaemia. The severity of anaemia was assessed according to the WHO Classification. Results: Elderly patients ranged from 60 years to 98 years, with a mean age of 68.29 ± 6.25 years. The number of males in the study group was 88 (59.9%), and females were 59 (40.7%), which was statistically significant (p-value <0.05). The most common type of morphological anaemia among elderly patients was found to be normocytic anaemia followed by microcytic anaemia. Anaemia of chronic disease was found to be the most common etiological type of anaemia followed by iron deficiency anaemia, vitamin B12 deficiency and anaemia due to acute blood loss. Conclusion: Hospitalised patients have more severe anaemia compared to populationbased studies where mild anaemia predominates. The morphological and etiological type of anaemia proportions is identical in both population and hospital-based studies.

Transitioning autistic youth from pediatric to adult healthcare requires coordination of multiple stakeholders, including youth, caregivers, and pediatric and adult care providers, whose interests at times overlap but often differ. To understand barriers and facilitators to inclusive transition experiences, we conducted thematic analysis of interviews with 39 stakeholders from the same large, integrated healthcare system. We identified three major themes: (1) Navigating the healthcare transition without guidance, (2) Health consequences of a passive healthcare transition, and (3) Strategies for inclusion and continuous engagement. Facilitators included gradual transition planning, a warm handoff between providers, and support of shared healthcare decision-making. Providers also sought clinical tools and logistical supports such as care coordinators and longer transition-specific visit types to enhance patient-centered care.

Rationale Radiolucent lesions over the angle–body region of the mandible are frequently difficult to diagnose but crucial to provide patient-centred care. Patient Concerns An elderly female presented with a painless slow-growing swelling over her left lower face for one year, radiographically appearing as a well-defined unilocular radiolucency over the left body of the mandible. Diagnosis Aspiration was negative, and biopsy was inconclusive. Further imaging, bone marrow biopsy, immune profile and serum electrophoresis confirmed the diagnosis of multiple myeloma. Treatment She was referred to Medical Oncology for chemotherapy of lenalidomide, bortezomib and dexamethasone regimen cycle that was repeated every 21 days. Outcomes There was no increase in swelling, and radiographically ‘punched-out’ lesions were reduced significantly. Take- Away Lessons Maxillofacial clinicians should be attentive to the oral manifestations of underlying disease, have a high index of suspicion and start the treatment promptly to increase chances of a favourable outcome.

Aim: To increase awareness among clinicians about the enigmatic entity to be considered during diagnosis of unknown source of pain and its intervention. Materials and Methods:Local anesthesia, syringe, diagnostic instruments (mouth mirror, probe), no.15 bard parker blade and no.3 handle, molts no.9 periosteal elevator, Austin retractor, micromotor handpiece attachment with straight fissure bur, Warwick James elevator, 10% betadine, 0.9% normal saline, 3-0 silk, needle holder and suture cutting scissors, sterile gauzes. Results:The conclusion of total of 12 articles which had mentioned the occurrence of mandibular distomolars, stated that the incidence of supernumerary tooth is 0.1-3.8% and still lower, 0.021% chance of occurrence of mandibular distomolar in population. Conclusion:The impacted distomolars are a completely separate entity which is accidental radiographic finding if asymptomatic.In symptomatic cases where source of pain is enigma Orthopantomography is indicated to rule out the presence of such entity.Thorough anatomical knowledge plays huge role in the diagnosis and treatment relies on the risk benefit ratio and patient consent.

Corynebacterium striatum is considered to be notoriously associated with multidrug resistant nosocomial infections with high mortality. This article encases an unusual case of C. striatum associated postoperative surgical site infection in post-operative case of oral submucous fibrosis. The prognosis depends majorly on meticulous debridement and regular dressing with concomitant anti-microbials. Patient factors such as immunodeficiency and debilitating comorbidities contribute equally to final outcome.

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Proliferating intraoral mass, biopsy of which twice revealed benign fibromatous lesion. But excisional biopsy of involved bone confirmed chondroblastic osteosarcoma. Considering this deviation from actual diagnosis, this article is an attempt to answer the age old question of biopsy site determination and its impact on patient diagnosis, treatment and prognosis.