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Dextrocardia is one of the rare cardiac positional anomalies, in which heart is located in the right side of thorax with its base-to-apex axis positioned to the right side. Dextroposition is different than dextrocardia where the heart is displaced to the right secondary to extracardiac causes like eventeration of diaphragm and right lung hypoplasia. The term situs solitus is used when heart and abdominal viscera are normally placed with the cardiac apex, spleen, stomach, and aorta are placed on the left side and inferior vena cava and liver placed on the right side, whereas situs inversus has mirror-image of the organs relative to their position in situs solitus. Dextrocardia, cardiac dextroposition, and situs inversus generally remain asymptomatic and are detected incidentally by imaging studies done for reasons other than cardiovascular system related problems. This article shares our experience of five cases of cardiac malposition that presented with atypical features of common medical problems. It highlights the importance of basic clinical examination in these patients which helps in making a bed side diagnosis of cardiac malposition and also prevents any mishap which can arise if any emergency intervention is done in patients of dextrocardia with or without situs inversus.

Studies reporting on the recurrence rate after laparoscopic repair of large hiatal hernias (HH), including anatomical asymptomatic recurrence, are scarce. So far, the impact of telematic surgical approach in Gastroesophageal Reflux Disease (GERD) is still obscure. In this prospective study, we analyzed the da Vinci Intuitive Surgical robotic system for antireflux surgery. In August 2012, we set up a pilot study to evaluate the efficacy of laparoscopic telerobotic surgery using the three-arm da Vinci system. Optimal trocar positions, operating and setup times, conversion rate, intraoperative complications, and perioperative morbidity, as well as mortality rate, were analyzed.

Upper extremity deep vein thrombosis commonly refers to thrombosis of the axillary and/or subclavian veins. This condition may lead to some serious complications like pulmonary embolism if the diagnosis and treatment are delayed. We introduce here one such case where the diagnosis of this rare condition was difficult because of the atypical clinical manifestation but the chylous ascites provided a valuable clue which led to early diagnosis and treatment of this patient.

We present the transesophageal echocardiographic findings in two adult patients with right-sided aortic arch: one without dissection and the other with traumatic aortic injury (dissection). In both patients, the branching pattern was the left common carotid artery and then the right common carotid artery, followed by the right and left subclavian arteries. The technique for the diagnosis of this anomaly and the identification of adjacent vascular structures using contrast echocardiography is described. Three-dimensional reconstruction of the aortic arch also was performed in both patients.

Background: Effective transfusion and chelation have prolonged the quality and longevity of life in thalassemics, who now survive into adulthood. Hence, adult physicians need to be aware of their clinical and laboratory profile and the problems faced by them. Aim: The present study was aimed to evaluate the clinical profile of adult thalassemics. Materials and Methods: Adult (>18 years) thalassemia major patients (n=19) were evaluated clinically and fasting pretransfusion blood samples were analyzed for complete blood counts, kidney and liver function tests, plasma glucose, serum ferritin, and thyroid hormone levels. Results: Average age was 21.65±2.47 years (range 19–28 years), 42.1% had Body mass index (BMI)

Cutaneous drug reactions are frequent in hospitalized patients and vary from simple manifestations like rash and erythema to severe life threatening conditions like angio-oedema, erythroderma, Stevens-Johnson syndrome and toxic epidermal necrolysis. However drug eruptions with antitubercular drugs are largely unknown except few case reports. We highlight here one similar case which presented with pleomorphic cutaneous manifestations after taking anti tubercular therapy and closely mimicked vasculitis. But when the offending drugs were stopped the lesions disappeared and the patient improved.

Disorders of smell and taste are both neglected as well as underreported problems of hypothyroidism. A 35-year-old male presented with intolerance to cold, dryness of skin, and swelling of both feet and some foul smelling odor from his feet. When we examined his feet we found that instead of wearing his shoes properly he had just slipped his feet inside the shoe so that the odor from his feet is not smelled by us. Although this symptom was largely ignored by many doctors, the literature mentions that patients of hypothyroidism may perceive dysosmia (distortion of smell) and hyposmia (elevated threshold for detection of smell).

Chronic myeloid leukemia may commonly present with atypical manifestations such as hearing loss or chloromas where the underlying diagnosis is revealed only on subsequent blood investigations. This case presented in the medicine emergency with one of the unusual complications of CML and so the diagnosis of CML was not suspected on the first instance. Prompt and comprehensive management of the patient not only saved him but also reiterated the fact that a rare presentation like priapism can sometimes forewarn of a more critical clinical condition.

Sir, Medical profession is amazing. The duties of this profession are vast varying from caring of ill patients, updating the knowledge and skills for professional competence, and, importantly, imparting their skills and knowledge to the next generation.[1] Because of these challenging expectations, this pious profession attracts many students to choose it as their carrier. After tough entrance tests, the students get admissions in medical schools where they sometimes face unexpected success and failures, which prepare them for future requirements of this profession.[2] The students clear their four professionals believing that this will mark an end to their ordeal; however, with the end of MBBS exams, there begin a new experience called internship. The internship is expected to provide an overview of various clinical specialties and helps students to acquire practical skills of treating patients. Somehow, long working hours and demanding responsibilities from seniors make this training a nightmare for most of the trainees.[3,4] And. at the end of one year of completion of their internship, students and their parents realize that the real struggle is ahead for competing for post-graduation. Some of the lucky graduates end up in getting post graduation of their choice, and some bury their dreams of carrying stethoscope by switching over from the medical profession.[5] This gambling continues, and these postgraduates are rocked and rolled in their final exam before awarding them with their degrees. The ordeal which began eight years before continues, as now they are most qualified doctors, but unfortunately, many of them still waiting for the satisfactory job.[6] Some of them specialize further for another three years to add to their existing misery, and some do senior residency and remain satisfied while looking for a teaching job in a medical school with a hope that this will end their struggle of settlement, which began 11 years back. The teaching of medical students is one aspect of the vast noble aspects of this profession. Doctors should not forget that their primary function is not to dish out pills but to teach and counsel, not just our patients, but also the next generation of doctors. Teaching the next generation is an important obligation of the professional. The accessibility to e-learning can help in acquiring knowledge of science much easily, but the art of medicine needs to be nurtured in the clinics, with the seniors acting as mentors.[7] Not only this helps the students to acquire the experience of teachers, but it also adds to the teaching experience of the faculty, which the faculty requires for further promotions. The newly opened medical college looks as a dream land for these qualified professionals where they are recruited initially as assistant professors. But, the unfortunate part begins if the new college is not recognized by the Medical Council, which is the governing body for every medical institute. The newly recruited doctors then have to wait for years for both, the students to teach and the experience to gain. The life of doctors is tough often complicated by psychological stress of studying at medical schools and struggling for a job settlement.[8,9,10] The patience earned over the years by them help them to face such hardships in personal life and remain strong while treating patients in professional life. Further, the bylaws should be such as to encourage more doctors to carry the teaching legacy forward so that the noble profession does not lose its identity and the young doctors are not carried away by the corporate world.[11,12]

Amoebic liver abscess is a common problem in tropical countries. However, its protean manifestations sometimes pose diagnostic dilemma leading to delay in starting appropriate therapy. We report here one interesting case of an amoebic liver abscess where the patient developed some uncommon features like bilateral pedal edema and bilateral pleural effusion. Although unilateral effusion is well known in such patients, the cause of bilateral involvement of pleura in this patient remained largely unknown. The cause of edema turned out to be compression of inferior vena cava by the large-sized abscess, rather than any cardiopulmonary abnormality. This case has global relevance because many of the migrant populations from tropical countries are settled all over the world, particularly in Europe and America. It would only be appropriate that the treating physicians are aware of this unfamiliar association.