Skeletal class III malocclusions are generally difficult to treat because of the complex nature of the skeletal and dental manifestations they produce and the uncontrolled development of the malformation due to complex interactions between genetic and environmental factors, However, if there are no significant soft tissue implications and the patient does not want to undergo orthognatic surgery, other treatment options may be considered. The current case report describes a compensatory alternative for Class III malocclusion therapy of a 41- year-old male patient, the total active treatment time was 21 months. His occlusion, smile esthetics, and soft tissue profile were significantly improved after treatment.

Primary ovarian carcinosarcoma is a rare entity and accounts for about 1-3% of all ovarian carcinomas. It is a mixture of both malignant epithelial and stromal components. It is rare in ovaries. Here we are reporting carcinosarcoma in a 65 year old female with complaint of pain abdomen. Laprotomy proceed surgical staging was done and diagnosis of poorly differentiated carcinoma was made. On immunohistochemical study it was primary ovarian carcinosarcoma.

We are reporting the largest phyllodes tumor ever seen in IGMC Shimla, a 51-year-old female presented on 29/7/21 with chief complaint of lump left breast since three months and had been gradually increasing. Initially it was of an almond size and was painless. It had then progressed to current size involving the whole breast with dull aching pain. On Inspection there was a lump of 25 x 25 cm involving whole of breast. The overlying skin was tense, shiny, visible dilated veins present. No visible discharge, ulceration, overlying skin is erythematous and striae were present over lump. On palpation temperature of the left breast was raised slightly. Breast tissues were not felt separately from the lump. The lump was involving overlying skin but not the underlying pectoralis muscle. On pressing the lump, no nipple discharge was present. It was oval in shape, had irregular surface with soft to firm areas in between. The consistency was firm to hard. After clinical history, general physical and local examination, provisional diagnosis of phyllodes tumor was made. Biochemical Investigations were within normal limits.  On Trucut biopsy of left breast, histo-pathological features were suggestive of fibroepithelial tumors and on imprint smear cyto-morphologic features were suggestive of ductal carcinoma left breast lump. On mammography bilateral breast, a large rounded ill defined mass occupying all of the quadrants of left breast with a radio-lucent halo. Diagnosis of phyllodes tumor (BIRADS IV) b left breast and BIRADS I right breast was made. Patient was admitted in surgery ward and total left mastectomy was done. The patient had an uneventful recovery. She was free of recurrence 3 months after surgery. We concluded that accurate preoperative pathological diagnosis is very important for management of phyllodes tumor, and allows correct surgical planning and avoidance of reoperation.

Abdominal penetration trauma is a life-threatening emergency. The difficulties inherent in managing an emergency department are amplified in the pediatric population. We present a 13-year-old boy's case of ileum perforation etc penetrating abdominal trauma. He had collapsed while setting up the tractor to plough the fields, and the iron in the machine's handle stabbed him in the stomach. Stabbing wounds to the abdomen were concealed by the omentum. He showed signs of peritonitis. Perforation of the ileum was discovered during laparatomy exploration of the abdomen. We performed a primary ileum repair by excising and suturing the perforation in the ileum. Postoperative recovery was unremarkable. There were no difficulties during the five-day follow-up period.

Gastroduodenal perforation is a serious condition that is deadly if not promptly recognized and treated. One possible cause of perforation is iatrogenic, including endoscopic retrograde cholangiopancreatography (ERCP) procedures. The classic presentation of gastroduodenal perforation is sudden intense abdominal pain, accompanied with tachycardia and abdominal rigidity, along with subdiaphragmatic free air on plain radiograph. However, this classic presentation does not always occur. We report a 73-year-old man with progressive abdominal pain. He had a history of obstructive jaundice treated with stenting via ERCP. Upon examination, the abdomen was tender with generalized guarding, although imaging studies were inconclusive. Exploratory laparotomy revealed a duodenal perforation, out of which protruded the biliary stent from one year prior. The stent was extracted and the perforation repaired. ERCP-related duodenal perforation is an uncommon potentially life threatening complication. The signs and symptoms may be nonspecific especially in elderly patients. Sound judgment and prompt treatment are essential to reduce morbidity and mortality.

Cardiovascular epidemiology and disease prevention encompasses an extensive field investigating the distribution and variation of CVD conditions, most notably coronary heart disease and stroke, their risk factor determinants, and strategies at the population and individual level aimed at preventing the development or recurrence of CVD. Epidemiological approaches to studying CVD provide us with the tools for preventive efforts at the individual and population level.

Dermatofibrosarcoma protuberans (DFSP) is a rare slow growing cutaneous tumor of fibroblast origin. This tumor accounts for about less than 0.01%of all malignancies. DFSP mostly affects people in age group of 25-5yrs.These tumors have a long clinical history, usually are highly locally recurrent and rarely metastasize. DFSP are located mainly on the extremities and trunk area. The treatment of DFSP consists of surgical resection mainly by Moh’s technique or wide local excision. DFSP is mainly located on the extremities, and a wide local excision may result in functional or cosmetic compromise. After a resection if the margins are positive there are high chances of recurrence. Radiotherapy is a good option in such conditions as an adjuvant modality. Radiation doses of 60-66 Gy have been reported to be effective in some studies, however detailed data is still insufficient. Here we are reporting a case of DFSP shoulder treated with wide local excision with positive margins and treated with radiotherapy as an adjuvant with a dose of 66 Gy.

Calcified coronary artery lesions, especially with severe calcification, are challenging to intervene due to difficulty in deploying coronary stents and their full expansion. Different studies have shown that the calcified lesion is associated with increased mortality and a lower rate of complete revascularization. ^[6,7]   Different treatment modalities that evolve over time are currently available ranging from non-compliant balloon angioplasty to the newer addition of intravascular lithotripsy to tackle this challenging clinical entity. In this article, we reviewed different options available to treat coronary calcium.

Choledochal cysts are cystic dilatations of both intrahepatic and extra-hepatic bile ducts, leading to bilear obstruction and progressive biliary cirrhosis. The etiology of choledochal cysts is unclear. Infections with pancreatic fluid or reflux may be a causal factor. Anomalies may develop in the formation of the bile pancretic ducts in which the pancreatic ducts coalesce with the bile ducts at a more proximal site beyond the ampulla vater, which may lead to reflux of pancreatic enzymes, also can ultimately cause damage to the duct wall and the occurrence of dilatation. This case report presents a boy 9-years-old, The patient is a referral of Karanganyar General Hospital, with complaints of lumps in the patient's stomach. Patients' complaints are also accompanied by yellow eyes. Vomiting history (+) white mucus, fever (+). Urine is yellow as thick as tea, feses is pale white. Because the complaint did not go away, the patient's family was taken to Karanganyar General Hospital, the patient was treated by Pediatrics, but due to limited facilities, the patient was referred to Dr. Moewardi Hospital. Then, a Roux-en-Y was performed to manage this patient. The diagnosis of choledochal cysts can be seen from symptoms as well as radiological examinations of ERCP and MRCP. A Roux-en-Y hepaticojejunostomy is needed to manage patient with choledochal cyst. Complications of choledochal cysts are obstruction of bile, cholangitis, liver abscess, rupture and malignant changes.

Introduction : The most serious complication of laparoscopic cholecystectomy (LC) is injury to common bile duct (CBD). LC has a 0.3% - 0.5% morbidity rate due to major biliary injuries. A safe triangle of dissection approach is used in this study, called the “Triangle of Safety” method. The approach involves a blunt dissection of the top half of Calot's space, which is suitable for a safe dissection because it usually does not contain arterial or biliary anomalies. Methods: We applied the "Triangle of Safety" approach in a retrospective study. 54 patients were evaluated during January 2017 – December 2019 at Moewardi General Hospital Surakarta. The patients with symptomatic cholelithiasis and calculous cholecystitis were included in this study. Intraoperative complications (such as bile duct injuries and bleeding) and postoperative morbidity were recorded. Results: Triangle of Safety method was performed in 54 patients. 2 patients needed conversion to open approach (3.7%) because of firm adhesions. Males with 16 patients (29.6%), and females were 38 patients (70.4%). Patients age were primarily between 51 until 60 years old (29.62%). The main surgical indication for cholecystectomy was symptomatic cholelithiasis and calculous cholecystitis. All patients have biliary colic as the main complaint. No complications occurred in terms of bleeding or biliary injuries. Conclusion: Based on this study, we conclude that dissection at the Triangle of Safety is a safe approach for demonstrating the cystic duct and may assist to prevent bile duct damage consequences in LC patients.

The aim of the present research work is to formulate a transfersomal gel of Econazole for deeper penetration into skin via topical route. Optimization of transfersomes and their characterization for different parameters are performed. The optimized preparation is evaluated for in vitro efficacy. The selected research work was divided into three phases. The first phase comprised of selection of drugs and excipients, Preformulation studies, preparation, optimization and in vitro characterization of selected carriers, nanovesicular transfersome. Drugs selected were Econazole and nanovesicular carriers selected. In the second phase of work, preparation and characterization of transfersomal gel formulation containing selected novel carrier was carried out. In third phase, prepared delivery system was evaluated for in vitro studies to ensure the behavior of delivery system. The entrapment efficiency percent of deformable vesicles was detected to be in the range of 61.84% ±3.15% to 79.87% ±2.35%. The formula F4 showed the highest percent encapsulation entrapment (79.87±2.35%), small particle size (179.5 nm) and good release pattern. Accordingly, the formula F4 was used to be incorporated to formulate gel. Use of certain skin permeation enhancers with transferosomal Econazole gel is available and potentiates the permeation of the drug. This technique can serve as a potential tool for delivery of various topical drugs without altering the skin structure.

Aim: To open the possibility of using vitamin D in cases of idiopathic lymphopenia. Background: In addition to its participation in the homeostasis of calcium and phosphorus, vitamin D has immunomodulatory mechanisms, so, its deficiency, apart from being associated with bone abnormalities, accompanies the development of certain autoimmune diseases. Case Description: It is a case of leukopenia associated with idiopathic lymphopenia of four years of evolution, in a 51-year-old woman, with history of hemithyroidectomy and osteopenia in the lumbar spine. Management initially consisted in supplementation with calcium and ibandronic acid. However, in the presence of hypercalciuria, vitamin D deficiency was suspected, so its serum levels were quantified, confirming the deficiency, then calcitriol was added to the treatment. Five months after the first dose of calcitriol, the leukocytes and lymphocytes levels were within normal range. Conclusion: There are many therapeutic schemes to treat vitamin D deficiency, however, nowadays no cases have been reported confirming the positive effect on lymphocytes count after vitamin D supplementation. Clinical Significance: Until now, cases of idiopathic lymphopenia have not been given any specific therapeutic alternative, and vitamin D could have a positive effect if there is an autoimmune component, and perhaps even offer a greater spectrum of benefits.

Anisocoria is a rare postoperative finding amongst the patients operated on for various spinal pathologies in the prone position. We present a unique case of a 71-year-old woman who was operated on for her first lumbar vertebra compression fracture. Bilateral D11-L3 pedicle screw fixation was done in a surgery lasting three hours. Postoperatively, the patient developed anisocoria with left pupillary dilation. With no visual complaints, anisocoria resolved spontaneously in 48 hours. Only two such cases have been reported in the literature. Although rare, preoperative scrutiny of patients can help obviate many distressing ocular complications.

Background: The torsion of an undescended abdominal testis is not a common entity. A mechanical large gut obstruction due to compression of large gut by a torsed intraabdominal testis is still an unreported entity in the literature to the best of our knowledge. Case presentation: A 27 years male presented in our emergency with abdominal pain for last 48 hours. The pain was gradually increasing in intensity along with a history of non-passage of stools for last 2 days. On examination, there was slight tachycardia with abdominal distension. Tenderness could be elicited in his right lower abdomen without any evidence of rebound tenderness and rigidity. His total leucocyte count was 12600/cmm along with a neutrophil count of 80.6 %. Ultrasonography revealed dilated gut loops with minimal peristaltic activity. Mild free fluid was also reported in the peritoneal cavity. His abdominal x ray reflected multiple air fluid levels suggestive of an acute intestinal obstruction. An emergency exploratory laparotomy was done. Intraoperatively, whole of small intestine and colon proximal to sigmoid colon were dilated due to compression of the later by a gangrenous right intraabdominal testis. The abdomen was closed after right orchidectomy and manual gut decompression. The patient had an uneventful postoperative recovery. Conclusions: It has been a challenging task to diagnosis a torsed intraabdominal testis preoperatively for the surgeons all over the globe. A quick history taking, missed scrotal examination and inability to use better diagnostic tools in time constrained emergency situations are the common lacunae reported in these cases. A high index of suspicion particularly in young cases of abdominal emergencies is the need of the hour for the better management of torsed intraabdominal testis.

Aim: An approach to atypical presentation of neurobrucellosis and have high index of clinical suscpicion of infective endocarditis in patient presenting with high degree fever. Background: Neurobrucellosis is an endemic zoonotic infection caused by bacterial genus Brucella. Transmission to humans is by infected animals (sheep, cattle, goats, pigs and dogs), urine and by unpasteurized milk. Clinical features usually include headache, fever, joint pain, along with neurologic symptoms such as confusion, meningo-encephalitis, myelitis, peripheral and cranial neuropathies. Case Description: A 48-year-old female presented with two days history of fever, occasional headache, nausea and giddiness and development of decreased hearing in both ears after two days of admission. On detailed work up patient was found to have 8^th nerve deafness with polyradiculopathy and proximal myopathy features suggestive of neurobrucellosis. As patient was having high degree fever, differential diagnosis of infective endocarditis was made, as blood culture showed evidence of CoNS , repeated 2D ECHO scans were done with high clinical suspicion, 3^RD 2D ECHO showed evidence of vegetations and final diagnosis of infective endocarditis was made. Conclusion: Here we present a case of middle-aged female who presented with neurobrucellosis and simultaneously diagnosed with infective endocarditis. Clinical significance: Brucellosis is a multi-system infectious disease and neurobrucellosis is a rare neurological complication of brucellosis and it may pose a diagnostic challenge in patients with low agglutinin titres and short duration of symptoms. High clinical suspicion with a focus on searching foci of infection is of foremost importance and proper and complete course of IV antibiotics is of prime importance.

Achondroplasia refers to the absence of cartilage development, and was first described in 1878. Achondroplasia is the most prevalent type of human short-limbed dwarfism caused by FGFR3 gene abnormalities, affecting one in every 30,000 live births worldwide. This case report describes a case of a 21 years old male patient with Achondroplasia with lumbar spinal stenosis of vertebrae Th12-L1, L1-L2, L2-L3 and kyphotic deformity. Patient had a surgical treatment with decompression laminectomy and posterior stabilization fusion. There was no neurovascular complication following the surgery. Mean VAS score of the leg pain improved from 5 to 2. ODI scores also improved consecutively from 18 out of 45 (40%) to 8 out of 45 (17,7%). The sensory function at the Th12 and L3 dermatome region of the leg was improved, as well as the radiological evaluation.

Background: Breast feeding is vital for the health of baby & mother. It is of advantage to baby, mother, family, society and nation. However, despite strong evidences in support of breast feeding its prevalence has remained low worldwide especially in developing countries. Present study was carried out to evaluate the knowledge towards breast feeding among postnatal mothers in Agartala city. Methodology: A cross-sectional descriptive study was carried out among 400 randomly selected postnatal mothers from 20 municipal wards selected randomly in Agartala city. Data was collected through face-to-face interview using a semi-structured questionnaire The data was analyzed using epi info v7 software and presented as frequencies and percentages. Results: Among the total 400 Post Natal mothers, maximum 208(52%) were having age between 26-30 years, educated up to Matric & Senior Secondary 68(42%), Hindu 333(83.25%), housewife 362(90.5%), Multigravida 266 (66.5%) and delivered in government hospitals 262(65.5%). In the present study 12.75% (51) postnatal mothers had very good knowledge (16-20 marks) towards breast feeding, 67.25% (269) having good knowledge (12-15 marks), 18.75% (75) having fair knowledge (8-11 marks) and 1.25% (5) having poor knowledge (<8 marks). Conclusion: Every Mother should be counseled and provided proper education regarding breastfeeding during antenatal period and all the misconceptions regarding breast feeding should be appropriately addressed.

With interest we read the article by Koike, H., & Katsuno, M. [1] about considerations on the relation between SARS-CoV-2 and Guillain-Barre syndrome (GBS) and the effect of SARS-CoV-2 vaccination on the prevalence of SARS-CoV-2 associated GBS (SAG) [1]. The authors plea for vaccinations if the overall benefit outweighs the risk [1]. The review is appealing but raises the following comments and concerns. GBS manifests not only as acute, inflammatory, demyelinating polyneuropathy (AIDP), acute, motor axonal neuropathy (AMAN), or acute, motor and sensory axonal neuropathy (AMSAN), but also as Miller-Fisher syndrome (MFS), mono- or polyneuritis cranialis, (MNC/PNC), as cervico, pharyngo-cervico-brachial (PCB) variant, or as Bickerstaff encephalitis (BFE) [2]. Though the latter are infrequently reported, they should not be neglected in terms of prevalence figures. We do not agree with the statement that SARS-CoV-2 associated GBS is rare [1]. In a recent review, 300 patients with SAG were collected [Finsterer, submitted]. In this data set, all age groups were affected (7-94y) and there was male preponderance. Latency between onset of COVID-19 and onset of SAG ranged between -10 and 90 days. The most common GBS subtype in this cohort was AIDP (n=171), followed by AMAN (n=24), AMSAN (n=16), MFS (n=8), MNC/PNC (n=3), PCB (n=1), and BFE (n=0) [Finsterer, submitted]. Only in one patient was SARS-CoV-2 RNA detected in the CSF. Most patients received intravenous immunoglobulins (IVIG) (n=241), followed by plasmapheresis (n=28), and steroids (n=7).

Most patients achieved only incomplete recovery (n=163). Seventeen patients died. It should be also considered that many patients with SAG go either undetected or are not published, why the prevalence of SAG is supposedly higher than usually estimated. 

The authors do not consider that SARS-CoV-2 vaccinations itself are not harmless and can cause GBS [3]. In a recent review about post-vaccination GBS, 19 cases have been collected as per the end of June 2021 [Finsterer, submitted]. These patients aged 20-86y and there was gender balance. All patients developed post-SARS-CoV-2 vaccination GBS (PSVG) after the first vaccine dose. Most frequently the ASZ vaccine was given (n=14), followed by the Pfizer vaccine (n=4), and the J&J vaccine (n=1) [Finsterer, submitted]. Most PSVG patients benefited from IVIG (n=13), Six patients required artificial ventilation. Nine patients achieved partial recovers and only 1 patient complete recovery.

Concerning the effect of SARS-CoV-2 vaccinations on the prevalence of GBS, no valid data have been published yet. In a recent review about the number of publications and number of SAG patients reported in the second half of 2020 and the first half of 2021 (after introduction of SARS-CoV-2 vaccinations) it could be shown that the number of SAG patients declined from 192 to 75, thus by 61% [submitted]. Whether this reduction is attributable to a vaccination effect or other factors remains speculative, but a benefit of vaccinations with regard to the prevalence of SAG cannot be excluded.

Overall, the benefit risk ratio regarding SARS-CoV-2 vaccinations is higher than one but we should find out which patients are at risk to develop GBS. A risk factor so far identified is previous GBS. 

The recent report by Liang et al. describes a 15-month-old male presenting with Leigh syndrome associated with the mitochondrial DNA variant m.13513G>A. While the case is clinically relevant, several limitations restrict the strength of the conclusions. Review of the literature shows that this variant has been reported in at least 33 individuals, exhibiting a wide phenotypic spectrum ranging from Leigh syndrome and Leigh-like presentations to MELAS, LHON, PEO, and non-syndromic manifestations such as optic atrophy, myopathy, cardiomyopathy, seizures, or ataxia. Reported heteroplasmy rates vary markedly across tissues (0–86%), underscoring the need for comprehensive multisystem evaluation. In the index patient, essential clinical information is missing, particularly regarding the cause of respiratory failure, cardiac evaluations, long-term rhythm monitoring, and therapeutic interventions for Wolff-Parkinson-White syndrome. Additionally, the extent of multisystem involvement was insufficiently explored despite the multisystemic nature of mitochondrial disorders. No biochemical analyses or muscle investigations were performed to assess respiratory chain function, which is particularly relevant given the expected complex I deficiency associated with ND5 mutations. The authors’ recommendation to specifically screen Chinese patients with Leigh syndrome and WPW for the m.13513G>A variant appears too narrow; instead, full mitochondrial DNA sequencing followed by exome analysis, when necessary, represents a more appropriate diagnostic approach due to the considerable genetic and phenotypic heterogeneity of Leigh syndrome. Addressing these gaps would strengthen the conclusions and clinical relevance of the report.

Penetrating injuries through the abdomen and thorax have a higher impact on morbidity and mortality than injuries inside one of them. Resuscitation and Handling properly in early stages will bring good results to the patient.

Objective: The treatment of caroticocavernous fistula is a challenge due to various anatomical and hemodynamic characteristics of a fistula.  The most frequent complaints involve the orbital region. Carotid cavernous fistulas (CCFs) are rare potentially sight-threatening abnormal connections between carot­id artery and cavernous sinus. We present the use of digital subtraction angiography for caroticocavernous fistula involving orbital region. Material and Method: We report two cases of caroticocavernous fistula involving orbital region. The first patient suffered swelling on his right eye in the last 4 months after he hit a tree. The second patient suffered from a massive swelling on her left eye after she underwent craniotomy procedure. Result: Both patients underwent digital subtraction angiotherapy for diagnosing CCF and were planned for CCF occlusion. The first patient’s follow-up post-caroticocavernous fistula occlusion showed good results in the functional aspect and no significant neurological deficit. The second patient showed a spontaneous resolution of caroticocavernous fistula while waiting for occlusion. There was no recurrence of fistula during short term follow-up.  Conclusion: Digital Subtraction Angiotherapy is a safe option for treating caroticocavernous fistula which is manifested at ocular region. This technique has the advantage of preserving visual function without significant neurological deficit.

Jejuno-ileal atresia (JIA) is the commonest type of intestinal atresia and accounts for around 1 in 5000 to 1 in 14,000 live births. Meckel's diverticulum (MD) is an outpouching or bulge of the small intestine. MD has also been found along with JIA as a result of intrauterine vascular accident. This case report presents a 3-day-old neonate who was then diagnosed with jejunal atresia with distal ileal volvulus caused by Meckel’s diverticulum. Presented with bloated abdomen, vomited clear yellowish fluid and not defecated after meconium passage within 24 hours. The diagnose was supported with specific characteristic on physical examination, laboratories and imaging results. Patient underwent explorative laparotomy to be found that the proximal ileum had jejunal atresia where the distal part had adhesion. Adhesiolisis, resection and anastomosis of the bowel surgery was done, after confirmed the passage was clear and viable. Intestinal atresia is one of the main causes of intestinal obstruction, as in our patient was found MD during surgery for JIA with volvulus. MD can cause vascular accident and necrotic bowel with volvulus as its clinical manifestation. Such patients are treated with resection of the atresia and anastomosis. However, when intestinal atresia and volvulus present together, the anastomotic leakage and mortality rate are significantly higher.

Children diagnosed after the covid 19 epidemic began showed evidence of immune response to the virus, and had a higher rate of cardiac involvement. The covid 19 epidemic was associated with high incidence of a severe form of Kawasaki disease.  we describe a case of three and half year old child presented with typical features of Kawasaki and myocarditis tested positive covid-19. showing an association  between Kawasaki disease, myocarditis  and the covid 19 virus. , this case highlights the value of testing patients for COVID-19 during evaluation for Kawasaki disease (KD). So we decide to share this case in Iraq.Conclusion: Further investigation of wide ranging clinical features of COVID-19 in the pediatric population remains urgent. Possibility   of facing the emergence of COVID-19 post-infective complications is high, urges us to set a systematic clinical, biological and echocardiographic follow-up of all patients who had infected with COVID-19.

The gastrointestinal tract contains multiple and complex organs that play together a vital role in the life of humans. This tract may be affected by multiple diseases, either congenital or acquired during life. Congenital diseases commonly manifest during the infancy period, and it rarely remains masked until later in life especially those affecting the small intestine. Different radiological techniques are widely used for the diagnosis and, sometimes, for therapeutic purposes, in association with medical and surgical approaches. In this article, a rare case of duodenal volvulus with intestinal malrotation due to late presentation in a 9-year-old boy will be discussed.

Background: Salivary gland tumors represent 1% of head and neck tumors, with Pleomorphic adenoma the first highest rate of occurrence among all the salivary gland tumors followed by the Mucoepidermoid carcinoma (MEC), a malignant epithelial tumor. The study is a Descriptive, Retrospective and Multicenter analysis of a series of 15patients above 23 years to below 63years who were treated for salivary gland MEC in the Department of oral and maxillofacial pathology, oral surgery and oral medicine, Vishnu Dental College, Bhimavaram from 2002 to 2021. Method: Of the 15 cases of MEC, 1 male patient of age 35 was excluded, which was diagnosed as a High grade MEC since proper data could not be attained from the archival files and when communicated for the details he died in 2014.In the study H & E, PAS, Diastase and IHC markers like pan cytokeratin were used to know the nature of the lesion. Aim of the study: All the relevant clinical, radiological and histopathological information regarding the diagnosed cases of MEC were retrieved from the archival files and co-related for Clinicopathological findings. Conclusion: Clinical, radiological and pathological correlation is necessary for preoperative diagnosis of the high grade aggressive MEC. MEC is not only restricted to the children and adolescent age group but can affect any age group. Intraosseous minor salivary gland MEC are more prevalent in the maxillary and mandibular posterior region. While histology is playing a role of gold standard, the IHC is further aiding in the diagnosis of MEC.

Benign recurrent intrahepatic cholestasis (BRIC) is a rare autosomal recessive inherited disorder characterized by intermittent episodes of severe cholestatic jaundice. After researching the main causes of cholestasis: viral hepatitis, drug and toxic origin, and also eliminate a biliary obstructive cause. Benign recurrent intrahepatic cholestasis (BRIC) is characterized by repeated self-limited episodes of severe pruritus and jaundice that last from several weeks to months. Diagnosis is based on a compatible clinical presentation, laboratory parameters and histology with exclusion of other causes of cholestasis and confirmed by genetic testing. The objective of this clinical case report , is to focus on the diagnostic criteria and to recall the main characteristics concerning BRIC in the literature.