BackgroundAdrenocortical carcinoma (ACC) is a rare malignancy with poor prognosis. Data on the incidence of ACC, however, are scarce and not recent. The purpose of this study was to characterize the tumor and the patients developing ACC over the last four decades using a large population based database.MethodsWe identified all cases of ACC diagnosed between 1973 - 2014 from the Surveillance, Epidemiology, and End Results-18 registry. Descriptive analyses were used for all extracted demographic, clinical, pathological, therapeutic and survival data, and were compared between the four time periods of 1973 to 1984, 1985 to 1994, 1995 to 2004 and 2005 to 2014 using Chi-square tests for categorical variables and one-way analysis of variance for continuous variables.ResultsThere were a total of 2,014 cases of ACC between 1973 and 2014 with an age-adjusted incidence of 1.02 per million populations. The median age at diagnosis was 55 years with the majority of them being females and whites. The proportion of cases by different genders, races and age at diagnosis had not changed significantly over time. These malignancies were mostly the only primary malignancy, unilateral and of high grades at diagnosis. Surgical resection of the tumor remained the mainstay of treatment. However, there was a significant increase in the use of adjuvant radiotherapy, adjuvant chemotherapy and chemotherapy alone in recent times. The median survival time was 17 months, but continues to decrease in recent time periods.ConclusionsACC continues to be a rare malignancy in the United States. However, most cases continue to be diagnosed only in advanced stages and are associated with poor survival. These findings underline the need for specific diagnostics tools with new and more effective treatment options.

Association of thymoma with myasthenia gravis, pure red cell aplasia, and aplastic anemia is well documented. However, thymoma complicated by acquired amegakaryocytic thrombocytopenia (AAMT) is rarely reported. Here, we present a case of a 60-year-old male with past medical history of recurrent invasive thymoma who presented with cough and blood in sputum. He was found to have severe normocytic normochromic anemia and thrombocytopenia that did not improve with intravenous steroids or multiple transfusions of red cells and platelets. Subsequent bone marrow biopsy showed severely depleted megakaryocytes and erythroid precursor cells with relative myeloid hyperplasia suggestive of amegakaryocytic thrombocytopenia and red cell aplasia. He was started on oral cyclosporine but subsequently developed leukopenia and refused any further treatment or diagnostic procedures and left the hospital against medical advice. AAMT, thus, may be a very early presentation of impending aplastic anemia, and treating physicians need to be aware of this entity.

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IntroductionUnderstanding the lifestyle factors associated with obesity is critical to create a successful intervention that would prevent or reduce the obesity beforehand. However, these factors have not been assessed among Nepalese youths thus far. This study aims to determine the prevalence of obesity and to explore the potential lifestyle risk factors in young university students of Nepal.MethodsWe included in the study 384 young students aged between 17 and 24 years, pursuing medicine at Tribhuvan University, Institute of Medicine, in this cross-sectional study. A self-administered questionnaire to collect information about age, sex, smoking, alcohol consumption, meat consumption, fast-food consumption, and sedentary lifestyle was employed. Anthropometric measurements were taken to calculate body mass index (BMI) and waist-to-hip ratio (WHR).ResultsThis study revealed that the current, episodic heavy alcohol consumers, current cigarette smokers, and individuals with a sedentary lifestyle had a statistically significant higher BMI and WHR as compared to age and gender-matched healthy subjects. Meat consumers as well had a statistically significant higher BMI. However, there has been no statistically significant difference in BMI and WHR in those who consume fast food from those who don’t.ConclusionOur study shows a high prevalence of obesity among young university students of Nepal, making it necessary to develop effective preventive measures to reduce their exposure to the risk factors associated with obesity. Early interventions to encourage lifestyle changes can be a worthwhile and effective strategy to prevent and/or reduce the risks for the development of cardiovascular diseases (CVD) and other comorbidities.

Introduction:  Osteoporosis is a common metabolic bone disease characterized by increased bone fragility, yet underdiagnosed and undertreated. With the increase in longevity of the populace, it is becoming an urgent and serious global epidemic. This being a preventable disease, has no clinical manifestations until there is a fracture. Early diagnosis and treatment are of dire necessity. Hence the aim of our study is to find the prevalence of osteoporosis among adults attending a tertiary care hospital-based on calcaneal quantitative ultrasound. Methods: This descriptive cross-sectional study was done in a tertiary care hospital, from 15th July 2019 to 15th October 2019 after receiving ethical approval from the Institutional Review Committee (Registration number: 2075 / 76 / 119). Convenient sampling was done. Data collection and entry was done in Microsoft excel, point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data.    Results: Out of 464 participants the overall prevalence of osteoporosis was 38 (8.2%) at a 95% confidence interval (5.7-10.7). Among the participants, 141 (30.4%) were male and 323 (69.6%) were female. The mean age of the participant was 41.02±14.96 years. Osteoporosis was more common in the older age group 11.66 (30.7%) in 60 years above Women were found to be more osteoporotic than men, 3.42 (9.0%) and 2.43 (6.4%) respectively. Bone mineral density and osteoporosis had a bimodal distribution, underweight 5.01 (13.2%) and obese group 5.32 (14.0%) were the two peaks. Conclusions: The prevalence of osteoporosis in our study is high and is consistent with other South Asian studies. Early detection of osteoporosis using calcaneal quantitative ultrasound can be a good screening tool.

Introduction: Age estimation is an important aspect in forensic anthropology, as it can aid in the identification of the deceased, and can be used in cases of immigration, child abuse and criminal prosecution in living individuals. Dental age estimation is considered reliable and accurate, since tooth development is least affected by environmental factors compared to somatic growth.Methods: In total, 150 pre-orthodontic treatment radiographs from healthy individuals were assessed. These individuals were aged between 8 to 19 years. Dental age for these individuals was calculated by two methods: Demirjian’s eight teeth method and Willems method. For Willems method, seven teeth on the left side of mandible (except the third molar) were staged according to Demirjian’s staging, and for Demirjian’s eight teeth method, all eight teeth were staged.Results: The mean chronological ages were 13.6961±1.94384 years in males and 13.9204±2.63541 years in females. The mean estimated ages by Demirjian’s eight teeth method were 12.1856±1.73478 years and 11.7906±2.32344 years in males and females respectively. Similarly, the mean estimated ages by Willems method were 12.8958±1.46838 years in males and 12.6926±2.27807 years in females.Conclusions: Willems method and Demirjian’s eight teeth method underestimated the chronological age in the given population. Both methods showed excellent correlation with chronological age indicating their applicability in dental age estimation, with development of population specific scores.

While splenic complications like hypersplenism, sequestration crisis, and infarction are commonly reported in sickle cell variants like sickle cell beta-plus thalassemia, splenic rupture with hematoma is rare. We present a case of a 32-year-old young male who presented with dull left upper quadrant pain who was found to have multiple subcapsular splenic lacerations and hematoma on abdominal imaging. Hemoglobin electrophoresis confirmed sickle cell beta-plus thalassemia in the patient. There was no history of trauma, and rest of the workup for possible cause of spontaneous rupture of spleen was negative. With the patient refusing splenectomy, he was managed conservatively. Clinicians need to be aware of this rare complication of sickle cell variants.

Objective The shape of the condyle, coronoid, and the intervening sigmoid notch is unique due to attachments and direction of pull of temporalis muscle, different chewing habits, hormones, etc. So morphometric variation of these mandibular landmarks can be used in individual identification. Material And Methods The study was carried out on 500 panoramic view images. Visual tracing assisted assessment of thousand sides (left and right) was done. Sexual dimorphism of left and right mandibular ramus parts (sigmoid notch bordered by coronoid and condylar process). The shape of coronoid process, condyle, and sigmoid notch were interpreted. Results The most prevalent shape of sigmoid notch was wide variant (41.2%), condyle was convex type (50%) and coronoid was round (53.4%). Condyle and coronoid showed asymmetry between right and left with p-value 0.001 and 0.019, respectively. This study has illustrated that triangular-shaped coronoid was more in females (p-value 0.012). Conclusion Sexual dimorphism is observed in the shape of the mandible due to masticatory activity at the point of insertion of temporalis muscle, biting force, hormones, and various genetic reasons. The results have exemplified that the morphometric variation of condyle, coronoid and sigmoid notch can be used as a tool for personal identification.