Masturbation (gratification behavior) is rarely seen in young children. It occurs in children between the age of 3 months and 3 years with a second peak incidence at about the adolescent age. A 26-month-old child presented to us with gratification behavior. On evaluation, she did not have any physical illness mimicking gratification behavior. The parents were counseled, and 6 sessions of behavior therapy were carried out. Gratification behavior in young children is not pathological. Waxing and waning of the symptoms may be present.

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Thyroid hormones play an important role in the regulation of physiologic processes. Thyroid dysfunction is the second most common glandular disorder of the endocrine system and is increasing predominantly among women. Thyroid disease can lead to imbalance in the homeostasis of the body and affect the healing capacity of tissues. However, limited data are available regarding the relationship between thyroid hormone imbalance and periodontal health. This case report presents the influence of thyroid hormone dysfunction and its impact on periodontal disease progression, systemic health of the patient, and the management of periodontal disease. The report emphasizes the need for frequent professional evaluations, patient education, and consistent educational reinforcement by health care providers in patients with hypothyroidism.

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Button batteries, also known as disc batteries, are tiny, round batteries commonly present in numerous household electronic gadgets such as watches, calculators, cameras, hearing aids, penlights, remote control devices, and certain toys. Because of their easy accessibility to children, they pose a serious menace of accidental ingestion or inhalation. Most of the ingestions are benign. However, large-sized button batteries when ingested can become impacted in the esophagus or elsewhere in the gastrointestinal tract with life-threatening repercussions. We report a 4-year-old female child brought to our setup by her parents with an alleged history of ingestion of a button battery of the watch approximately about 2 h back. The child, apart from being anxious, was asymptomatic. An initial radiograph of the chest and abdomen was taken, which showed the battery at the distal end of the stomach. Considering the small size of the battery cell and after seeking the gastroenterologist's consultation, it was decided that the child would be managed conservatively with oral antacids and serial abdomen skiagrams were obtained. The button battery was eventually detected in the stools after 2 days.

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Calcium sulfate has multifaceted properties and has versatile use in the field of periodontal practice. Calcium sulfate can function as a resorbable space filler, a resorbable barrier (compatible with guided tissue regeneration principles), as a combination with other bone grafts in intrabony defects and in socket preservation procedures for implant placement. This review is an attempt to shed light on various applications of this bone graft in periodontal regeneration.

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Aim: To determine whether square-edge polymethyl methacrylate (PMMA) intraocular lens (IOL) is superior in preventing clinically significant posterior capsule opacification (PCO) and better visual outcome when compared with round-edge PMMA IOL in manual small-incision cataract surgery (MSICS). Settings and Design: Tertiary care hospital-based randomized controlled clinical trial. Materials and Methods: A randomized clinical trial of 1 year in which 128 patients were randomized into two groups to receive round-edge IOLs (Group A) or square-edge IOLs (Group B) after MSICS and followed up for 10 months; during follow-up, the best corrected visual acuity, grades, and type of PCO were documented. Statistical Analysis Used: Data analysis was done using chi-square test. Results: Out of 128 patients, the incidence of PCO was 83.6%, out of which 85.9% were in Group A and 81.2% were in Group B. Visual outcome was better in Group B, which was statistically significant (0.003). The fibrous type of PCO was the commonest type seen in the study irrespective of the group. There was less incidence of PCO in capsulorrhexis (with relieving incisions) and complete cortical cleanup cases. Difference in neodymium-doped yttrium aluminum garnet; Nd:Y3Al5O12 (Nd:YAG) laser capsulotomy rates were not statistically significant between the two groups (P = 0.784). Conclusions: This study showed that square edge PMMA IOLs had less clinically significant PCO rates and better visual outcome when compared to round-edge PMMA IOLs.

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Tricyclic antidepressants (TCAs), such as amitriptyline, have many side effects. But extrapyramidal tract symptom is an uncommon side effect of these drugs. Here, we report a case of a 28-year-old male who is suffering from amitriptyline induced cervical dystonia. Though rare, this side effect is an uncomfortable condition and may influence drug compliance. So clinicians should be aware of this side effect while treating a patient with amitriptyline.

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Teratoma is a neoplasm with tissue components derived from more than one germ layer - ectoderm, mesoderm, and endoderm. They are commonly found in ovaries, testes, retroperitoneum, and sacrococcygeal region. Mediastinal teratomas are relatively rare comprising of only 8-13% of all tumors in mediastinum and only 1-10% of germ cell tumors occurring in mediastinum. We are presenting a case of a 1-year-old male who came with a history of on and off fever and frequent cough and cold since 3-4 months. On x-ray chest, differential diagnosis of congenital diaphragmatic hernia and left pleural effusion were given and computed tomography (CT) scan of abdomen and chest were advised, which revealed symptoms of mediastinal germ cell tumor. Final diagnosis of mature teratoma was given on histopathology. The case is being presented here because mediastinum is a rare site for teratoma and children are less commonly affected.

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Although the skeletal system is a common site for metastatic disease, metastasis to the calcaneus is very rare, especially from a lung primary; furthermore, calcaneal metastasis as the presenting symptom of a malignant process is rarer still. Only two cases of calcaneal metastasis from a primary lung cancer have previously been reported. The presenting symptom of metastatic lesions of the calcaneus is typically plantar-heel pain; idiopathic plantar-heel pain is a common complaint in and of itself, which obfuscates the diagnosis of metastatic cancer. As a result, calcaneal metastases are difficult to diagnose. We present the rare case of a patient with calcaneal metastasis from a primary lung adenocarcinoma along with a review of literature as a reminder that occasionally, though common things are common, uncommon things do occur.

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Background: Assessment is a critical component of medical education because tests have a powerful influence on student learning. Multiple choice question (MCQ) tests have been established as a part of undergraduate and postgraduate medical education. A notable concern of many health professionals is that they are frequently faced with the task of constructing tests with little or no experience or training in how to perform this task. Objective: The aim of the study was to point to a need for capacity building in the assessment of medical students, and MCQs were chosen as a surrogate for that. Materials and Methods: Residents posted at the Department of Community Medicine contributed a total of 166 questions independently on different topics to a question bank in 3 days' duration. Once the data bank on questions was secured, a basic 2-h workshop on developing MCQs was conducted with the residents. After this, the data bank of questions was handed over to the residents for any modifications that they wanted to incorporate into their set of questions within 2 days. Results: The modifications were recorded with the residents. A total of 16.8% (28/166) of the questions were changed in their entirety. The total change in questions amounted to 34.3% (57/166). Conclusion: Training is an important contributor in effective development of MCQs for the purpose of assessment.

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Sclerosing peritonitis (SP), also known as abdominal cocoon, is a rare form of peritoneal inflammation involving both the visceral and parietal surfaces of the abdominal cavity. It has an unknown etiology, resulting in an intestinal obstruction due to complete or incomplete encapsulation of the small bowel by a fibrocollagenous membrane. A high index of clinical suspicion is needed for its preoperative diagnosis. It is not easy to make a preoperative diagnosis since the early clinical features are not specific. Repeated episodes of small intestinal obstruction, relevant imaging findings, and absence of other plausible etiologies may aid in clinical suspicion. We are presenting the case of a 14-year-old girl presenting with pain in the abdomen since 5-6 days, vomiting since 2 days, and passing worms per vomitus since 2 days. Diagnosis of SP was done. This case is being highlighted for the rarity of its occurrence and distinct morphological spectrum.

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Objectives: To assess the incidence and predictive factors and outcome of seizures after ischemic stroke. Materials and Methods: Clinical data of 67 patients with post-stroke seizures treated between January 2009 to June 2013 was evaluated. Results: There were 1194 patients with ischemic stroke during the study period among whom 855 (71.6%) were in anterior circulation, 316 (26.5%) in posterior circulation and 23 in both anterior and posterior circulations. Sixty-seven of these patients (males 49, females 18) had post-stroke seizures (5.6%). Fifty patients had anterior circulation stroke (middle cerebral 46, anterior cerebral 3, internal carotid 1), 14 (25%) patients had posterior circulation stroke and three had border zone infarct. Twelve patients (17.9%) had cardiogenic embolism. Three patients (4.5%) had hemorrhagic transformation. Thirty-four patients had partial seizures with or without generalization whereas 33 patients had generalized tonic clonic seizures without partial onset. Among the whole group with ischemic stroke, early onset seizures were seen in 22 (1.8%) patients and ten patients (0.8%) developed status epilepticus. Majority (83.6%) had cortical with or without sub-cortical infarcts, 16.4% had sub-cortical infarction. Seizures were controlled with single antiepileptic medication in 40 patients; two drugs in 21 and five required multiple drugs. One patient died of status epilepticus. Conclusion: Occurrence of post-stroke seizures in patients with ischemic stroke was 5.6%. Seizures occurred more commonly in anterior circulation cortical ischemic strokes. Seizures occurred more frequently in late phase of post-stroke period compared to early onset and majority could be controlled with single drug.

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Sinonasal carcinoma is a rare tumor, which is highly invasive and presents in an advanced stage often invading the skull base. Tumor arises from the mucosal lining of the nasal cavity and paranasal sinuses. Total surgical removal of the tumor when invading the skull base, along with radiotherapy, is the mainstay of treatment. Our patient underwent total excision of the tumor followed by radiotherapy.

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A 14-year-old boy from Southern parts of West Bengal, India presented in a Tertiary Care Hospital of West Bengal with high-grade fever and acute flaccid paralysis, later proved to be a case of Japanese encephalitis. His clinical course was also complicated by an unexpected occurrence of seizure-induced pneumothorax. The patient received supportive therapy and ultimately discharged from hospital with residual flaccid paralysis of lower limbs as the only neurological impairment. We hereby report these two rare accompaniments of Japanese encephalitis, a common occurrence in Asian countries.

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Ossification as a secondary change in a seminoma is a rare entity and has been described only once in the literature. We describe such a rare case in a 40-year-old patient, arising from an undescended testis, which was clinical masquerading as acute abdomen. Laprotomy revealed a left iliac mass, which on histopathological examination showed features of ossifying seminoma of the testis. We report this case for its rarity with a brief review of the literature.

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Cervical thymic cysts are rare cysts presenting in the first decade of life. We present a cervical thymic cyst clinically manifesting as a lateral neck mass. The histological features were diagnostic. Addtionally, a small focus of ectopic parathyroid tissue in the wall of the cyst was present which has been rarely reported in literature. Thymic cyst can be diagnosed only by histopathology and the knowledge of this entity will prevent its misdiagnosis.

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