Trichobezoar is a very rare condition that is usually diagnosed at a late stage due to etiology of the condition. It is usually seen in young females who invariably have a psychiatric disorder like trichotillomania, trichophagia or depression. Here we report a case of trichobezoar which presented in the surgical out-patient department of our hospital.

After 3 days of treatment, the patient's fever resolved. The renal function returned to normal on day 12 (Table 1). The proteinuria decreased 1.02 g/L at third week (Table 2). Microscopic hematuria persisted after 24 weeks (Table 3). Conclusions: There was rapid improvement of the nephrotic proteinuria, normalization of renal function and persistent microscopic hematuria with our therapeutic approach. Discussion: Mycobacterium tuberculosis (MT) infection has already been reported as an infection related to the occurrence of IgA nephropathy in 10 cases between 1983 and 2016 [16]. Our case represents the 11th that described the discovery of Ig A nephropathy associated with pleural tuberculosis. The treatment of the majority of cases was anti-tubercoulous chemotherapy alone (Table 4). Referring to studies, the antigen of MT can stimulate ƴdT cell activation and proliferation on the human mucosal surface to secrete TGF-b1 wich stimulates B cells to produce defective IgA1 [22, 23, 24, 25, 26]. The IgA1 deposition in the mesangial cause IgAN. Whereas glucocorticoids can block TGF-b production [27], this medication could be useful for decreasing production of IgA1. Furthermore the antitubercoulous drugs can reduce the blood load in MT. These pathophysiological explications could explain the good evolution of our patient by using concomitantly anti-tuberculous chemotherapy with corticosteroids. Further studies are needed to evaluate this therapeutic approach.

BACKGROUND AND OBJECTIVES: Duodenal ulcer perforation is one of the acute abdominal emergencies in the surgical field. Duodenal ulcers are often caused due to imbalance between mucosal defences and acid /peptic injury. the cases of duodenal ulcer perforation in surgically treated patients were thoroughly studied with respect to trends in age, distribution of occurance, risk factors, seasonal variation, outcome of operative and non-operative modalities of treatment and factors influencing the prognosis of the disease. The current study summarizes epidemiology, risk factors, Pathophysiology, pathogenesis, clinical features, investigations, modalities of treatment and prognostic determinents of duodenal ulcer perforation in BTGH, Gulbarga.

| Introduction: Symmetrical Peripheral Gangrene (SPG) is defined as a symmetrical distal ischemic injury at two or more locations without any large vessels blockade. Malaria has been reported as one of the causes of SPG, although only 36 cases have been complicated with Symmetrical peripheral gangrene till date. Case Report: A 30-year male presented to us 15 days after the onset of malaria with gangrene of all four limbs with superadded infection. His wounds were debrided and amputated. Once the infection was controlled and gangrenous parts demarcated, amputations were done again for the lower limbs. Discussion: In P. falciparum infections, the processes of cytoadherence, rosetting, and agglutination are the factors responsible for the pathogenesis of SPG. It's vital to identify this rare, quickly developing complication. Heparin is being tried; blood transfusion has also been explored in the management of some of the patients but not found to be effective. If allowed to advance, surgical intervention is unavoidable.

Squamous papilloma of the renal pelvis is an extremely rare entity. To the best of our knowledge, no case has been reported till date. A 45-year-old female presented to us with flank pain for two months. She had undergone left-sided percutaneous nephrolithotomy three years ago. Preoperative evaluation suggested the presence of a transitional cell tumor arising from the left renal pelvis. Diethylene-triamine-pentaacetic acid renogram showed a non-functional left kidney. She underwent left nephroureterectomy. Histopathology showed squamous papilloma of the renal pelvis. Subsequent follow-ups have been uneventful.