Background: Pediatricians and pediatric dentists coincide in the great importance of breastfeeding during the first 6 months of life for the correct development of the mouth and for occlusion, breathing and swallowing during childhood. Lower prevalence and severity of malocclusions in breastfed children, in comparison with those that were bottle fed, have been reported. There exists substantial documentation that further credits breastfeeding with enhanced oral development and the formation of proper swallowing technique. Aim: The aim of the study was to evaluate the influence of infant feeding patterns on the deciduous second molar relationship in 3-5-year-old children of selected preschools in and around Mangalore. Materials and Methods: Semi-structured questionnaires were given to parents of children between the ages of 3 and 5 years. Clinical examination was performed with the children comfortably seated, and the molar relationship was checked in maximal habitual intercuspation. Results: The results were statistically analyzed using Chi-square. There was a significant difference between children who were breastfed (84.09% mesial step) and those who were bottle fed (22.2% mesial step). Among the bottle-fed children, the conventional nipple group showed 23.52% of mesial step occlusion while in the physiologic nipple group, 55.26% had a mesial step occlusion. Conclusion: This study supports a correlation between infant feeding methods and primary molar relationship. Exclusively breastfed children showed better development of dental arches with a higher incidence of mesial step occlusion when compared to bottle-fed children.

Background: Interventricular, intraventricular, and atrioventricular dyssynchrony (AVD) have been reported in patients with dilated cardiomyopathy (DCM). However, the causes of DCM vary with the regional distribution in various etiologies, with expected differences in the pattern and frequency of cardiac dyssynchrony. Objective: The aim of this study was to evaluate cardiac dyssynchrony in patients with DCM by conventional echocardiographic assessment. Materials and Methods: Fifteen patients with DCM were studied. All patients underwent conventional Doppler echocardiographic evaluation including septal-to-posterior wall motion delay (SPWMD), interventricular motion delay (IVMD), and diastolic filling period. Results: Cardiac dyssynchrony was present in 13 of the 15 patients (86.7%). The overall frequencies of intra-left ventricular dyssynchrony (intra-LVD), interventricular dyssynchrony (inter-VD), and AVD are 38.5%, 30.8%, and 53.9%, respectively. Conclusion: The prevalence of dyssynchrony in our patients with DCM was significant. This raises the need for the development of local expertise in interventional cardiology including cardiac resynchronization therapy (CRT).

Background: In India about 0.1 million children are living with HIV and most of these infections are acquired by perinatal transmission. The prevention of parent-to-child transmission (PPTCT) program aims to prevent the perinatal transmission by interruption of transmission at different levels. This study was conducted to see the trend of HIV seropositivity among children after the implementation of the PPTCT program. Aims: The aim of this study was to investigate the magnitude of pediatric HIV seropositivity and its time trend in last 11 years at a tertiary care hospital in Rajasthan. Materials and Methods: Children of aged less than 14 years attending the Integrated Counseling and Testing Centre (ICTC) were screened for HIV antibodies. A detailed history about age, sex, HIV serostatus of the parents, and history of blood transfusion was recorded. Statistical Analysis: The level of significance was recorded using P value. Results: Out of the 17,612 subjects, a total of 887 (5.03%) children were positive for HIV infection. Out of these 887 subjects, 567 were male children (m:f = 1.77:1) and most of them (59.9%) were of age less than 5 years. Perinatal transmission was the commonest mode of transmission. A decreasing trend of HIV seropositivity is observed among children of age less than 14 years after year 2005 (x ² for trend = 503.445, P< 0.001). Conclusion: Despite all this, combined efforts are still needed to prevent new HIV infection, to keep their mothers healthy and alive, and to improve the diagnosis and treatment of HIV for children.

Introduction: The study was conducted to determine the association of Helicobactor pylori with endoscopic and histological parameters of gastroesophageal reflux disease (GERD). Materials and Methods: A cross-sectional study was undertaken. A total of 79 patients were evaluated prospectively in the endoscopic unit of a gastroenterology department for symptoms compatible with GERD. In all cases, routine endoscopy and Los Angeles grading of GERD were performed. In each subject, biopsies were taken from 3 cm above the squamocolumnar junction and from the antrum and assessed histologically. Results: Majority of the patients presented with complaints of heartburn (84.8%) and regurgitation (75.9%). Nonerosive reflux disease was present in only five patients. Endoscopically, the remaining 74 cases were graded as follows: 25 had GERD A, 10 had GERD B, 35 had features of Barrett's esophagus, and 4 had miscellaneous findings. H. pylori positivity was present in 33.3% of patients with GERD A and 4.8% of those with GERD B. Majority of the histological parameters such as elongation of lamina propria papillae, intraepithelial inflammatory infiltrate, ballooning degeneration, lack of surface maturation, and dilatation and congestion of lamina propria capillaries did not show statistically significant association with H. pylori. The overall H. pylori prevalence was found to be 26.58% (21/79). Conclusion: On endoscopy, with the increased GERD severity, H. pylori incidence decreased. H. pylori was found to have no significant association with majority of the histological parameters.

Background: Anthropometric parameters are useful for indexing cardiovascular variables. Objectives: This study aimed at determining the association between anthropometric parameters and autonomic cardiovascular indices (ACIs) among young adults. Materials and Methods: It was a cross-sectional descriptive study involving 204 healthy young adults who were residents of Ile-Ife. The weight (kg) and height (m) were measured with health scale while body mass index and body surface area were calculated using Quetelet index and Mosteller formula, respectively. Each participant was evaluated through a battery of procedures; systolic blood pressure (SBP) response to standing, diastolic blood pressure (DBP) response to sustained handgrip (SH), resting heart rate (RHR), heart rate (HR) variability during Valsalva maneuver, deep breathing, and change of posture while the ACIs were derived as outcome of the procedures. The relationship between the anthropometry and ACI was determined by correlation. Results: Height positively correlated with SBP response to posture (r = 0.107, P = 0.128), DBP response to SH (r = 0.143, P = 0.041), and heart rate response to deep breathing (HDB) (r = 0.043, P = 0.540). Height negatively correlated with Valsalva ratio (r = −0.022, P = 0.759), 30:15 ratio (r = −0.009, P = 0.902), and RHR (−0.152, P = 0.030). Weight correlated positively with postural change in SBP (r = 0.096, P = 0.172), DBP response to SH (r = 0.091, P = 0.197), and 30:15 ratio (r = 0.005, P = 0.948). Weight negatively correlated with HR response to deep breathing (r = −0.114, P = 0.105) and RHR (r = −0.153, P = 0.029). Conclusion: Anthropometric parameters correlated weakly with most indices of cardiac autonomic function except RHR.

Background: Hospitalization and surgery are stressful experiences for children and their parents. Parents are disturbed and anxious when their child is hospitalized and waiting for a surgery. Objective: To assess the impact of preoperative education program on parental anxiety. Materials and Methods: A quasi-experimental study with a time-series design was conducted in a selected hospital. Using purposive sampling technique, 12 parents of children undergoing surgery were selected as study participants and were segregated into two groups–experimental and control groups – with six participants in each group. The experimental group received preoperative education program, whereas the control group received routine care. Parental anxiety was measured using state trait anxiety inventory on admission, prior to shifting the child to the operation theatre (OT), 6 h, 24 h, and 48 h after the surgery, respectively. Results: The mean anxiety score of parents were less in the experimental group compared to the control group after the intervention. A significant change was observed in the mean score of parental anxiety over the period of time in the experimental group (F_(4,20)= 58.628, P = 0.001). The calculated t-value was significant at the time points, that is, from admission to prior to shifting the child to the OT (P = 0.001), from admission to 6 h after the surgery (P = 0.000), from admission to 24 h after the surgery (P = 0.001), and from admission to 48 h after the surgery (P = 0.004) between the groups. Conclusion: The preoperative education program has shown to be effective in reducing parental anxiety and can be effectively used in pediatric surgical units to support the parents.

Background: Diabetes mellitus is a chronic disease with microvascular and macrovascular complications. Effect of diabetes on lung capacity has been reported previously but with controversial results. This study will help to reassess whether or not Pulmonary Function Tests should be done in diabetics or not. Aim and Objective: Our study aimed to evaluate pulmonary function testing in patients of type 2 diabetes mellitus (T2DM). Study Design: Randomized Case control study. Materials and Methods: 50 diabetics and 50 matched apparently healthy volunteers taken for this study. After taking an informed consent, all underwent screening with detailed history, anthropometry, blood sugar (fasting and post parandial), and pulmonary functions (using medspiror). Statistical Analysis: Student t test was used to compare PFTs of diabetic and control groups. Frequencies were generated for categorical variables and compared with chi square test. Results: There was significant reduction in all the PFT parameters (FVC%, FEV1% and FEV1/FVC) in diabetics as compared to controls. Thus, mixed obstructive-restrictive pattern of pulmonary dysfunction is seen in diabetics. Also strong positive correlation was seen between fasting blood sugar and FEV1/FVC in diabetics. Although body mass index (BMI) was more in study group versus control group, but the difference was not significant. Conclusion: Lungs are indeed effected in patients of diabetes and pulmonary function testing should be mandatory in diabetics in order to prevent complications thereby improving quality of life.

Background: Mucocele belongs to the category of reactive lesions affecting the salivary gland related to obstruction or trauma of the salivary glands. These are pseudocysts formed due to the accumulation of pooled mucus. Objectives: To evaluate the clinicopathologic features including variations of 50 oral mucocele cases Materials and Methods: Archival review for the 50 cases reported as mucoceles was performed, and data for the following parameters were recorded: Age, gender, history of trauma, site and clinical presentation, variation in histology, treatment mode, and recurrence. Results: A total of 50 cases of mucoceles were retrieved for the archives for study. All were extravasation phenomenon (100%), no retention phenomenon was found, seen in the second (36%) and third (46%) decade, with male preponderance (male:female 19:6). Most common locations were lower lip (96%), floor of the mouth (6%), and ventral tongue (4%). Commonly presented as soft, fluctuant, bluish swelling associated with history of trauma. Variations included superficial mucocele (10%), clear cell change (4%) and papillary infoldings (2%) and 6% of recurrence cases. Conclusion: Although it is a benign lesion which is commonly encountered and excised in dental practice, the classic clinical presentation of soft, fluctuant swelling accompanied by history of evolution of the lesion does not pose much difficulty in diagnosis. Special variants of oral mucoceles occur infrequently; it is important to recognize these variants to avoid misdiagnosis, it is always wise to subject it to histopathological confirmation owing to its close clinical resemblance to neoplastic condition.

Context: Avulsion injury is a severe form of dental trauma. Due to the complexity of this injury, the neurovascular supply is severely compromised and usually results in the loss of pulp vitality. A variety of factors can influence the success of replantation especially the storage media and storage period. Casein phosphopeptides are derived from casein which accounts for 80% of the total protein in bovine milk. They can function as carriers for several minerals especially calcium and also have known to have antibacterial properties. Aim: The purpose of this study is to evaluate the efficacy of GC Tooth Mousse Plus in comparison with chilled Homogenous pasteurized whole milk as a storage media. Materials and Methods: Thirty healthy premolars that are extracted for orthodontic purpose will be divided into three groups: (1) Group A: Control (Saline), (2) Group B: Positive control (Chilled Homogenous milk), (3) Group C: Experimental (GC Tooth Mouse Plus). These groups were further divided into two subgroups, each indicating storage period of 30 min and 60 min. The periodontal ligament (PDL) cell viability will be checked using tryphan blue staining. Results: Data were analyzed using Student's t-test. Conclusion: GC Tooth Mousse Plus can be used as a storage media to prevent desiccation of PDL cells up to the duration of 60 min.

The huge burden of sickle cell disease (SCD) coupled with a correspondingly high morbidity and mortality, particularly in Sub-Saharan Africa, has made it really imperative to invest more in ways of reducing the prevalence of this disorder. The SCD genetic counseling and testing have been shown to educate individuals on SCD and also offer those at risk the opportunity of making informed decisions on marriage and pregnancy. We reviewed available data on genetic counseling and testing for SCD, using the PubMed, PubMed Central, Google Scholar, and African Index Medicus search engines, through a combination of words and phrases relevant to the subject and attempted to highlight how this can be better applied in a resource-poor setting such as Nigeria, with a huge disease burden. More advanced countries with significant population of patients with SCD and other hemoglobinopathies have evolved functional genetic and counseling protocols, with remarkable impacts on disease epidemiology; this feat however does not appear to be replicated in a number of African countries. This paper reviewed genetic counseling and testing for SCD in countries with high disease burden, with particular emphasis on Nigeria, which has a disease prevalence and carrier rate of 2-3% and 20-30%, respectively.

Technology is evolving to meet the demands of the current population in need of health promotion and education, and access to care in rural areas that are attacked with chronic illness. Physicians and nurses in hospitals are using telemedicine, telenursing, and e-nursing as advanced technologies. These technologies are continually expanding to develop new modes of medical care delivery. This article deals with telemedicine, telenursing, and e-nursing in terms of their applications and advantages.

Anthracyclines are indispensable for acute leukemia management and known to have immediate as well as late cardiac effects. Among the immediate effects, commonly described effects include arrhythmias and repolarization abnormalities. We report a rare electrocardiographic presentation of daunorubicin toxicity.

The occurrence of bilateral breast carcinoma is extremely rare with an incidence of 2-5% of all breast malignancies. We hereby report an unusual and interesting case of triple negative synchronous invasive ductal carcinoma (IDC) of bilateral breasts detected simultaneously in view of its rarity and therapeutic challenge it presented. A 55-year-old postmenopausal female presented with a history of lump bilateral breasts of 4 months duration. Fine needle aspiration cytology of both breast lumps showed IDC. Mammography showed Breast Imaging Reporting and Data System V both breasts. Metastatic workup was negative. She underwent bilateral modified radical mastectomy. Postoperative histopathology revealed IDC Grade III with estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2-neu negative on immunohistochemistry. She received adjuvant chemotherapy followed by locoregional radiotherapy to the right breast in view of nodal positivity. Presently on regular follow-up without any evidence of local recurrence or distant metastasis.

Oculosporidiosis or rhinosporidial infection of eye, a rarely encountered disease outside the endemic coastal areas of South India, is caused by Rhinosporidium seeberi. A 12-year-old patient presented with polypoidal conjunctival lesion of the right eye in a tertiary care hospital at West Bengal, India. Excision of the lesion followed by microbiological and histopathological examination confirmed the unique infectious etiology of the lesion. Oculosporidiosis should be included in the differential diagnosis of conjunctival polypoidal lesions even in nonendemic areas because misdiagnosis and improper management may lead to increased incidence in the same zones.

Fused tooth and talon cusp are both developmental anomalies affecting mainly permanent dentition. Talon cusp is more common on the palatal surfaces of the permanent maxillary anteriors. Here is a case report of the fusion of mandibular anteriors with both the labial and lingual talon cusps.

Genital self-mutilation (GSM) is a rare event that is commonly associated with psychotic disorders. However, such injuries have also been reported in nonpsychotic patients as a result of either bizarre autoerotic acts and attempts at crude sex-change operation by transsexuals or secondary complex religious beliefs and delusions regarding sexual guilt. We report a case of GSM in a human immunodeficiency virus (HIV)-positive individual who not only severed his penis, scrotum, and testes completely as a result of internal conflict and frustration but also refused any further treatment toward reconstruction owing to his guilt.

Metastatic tumors of the intestinal tract from extra-abdominal sites are rare. In cervical cancer, the liver, lung, and the bones are the most common distant sites of metastases. Metastasis to the small intestine is very rare. We report a rare case of metastasis of cervical squamous cell carcinoma to jejunum after a few months of chemoradiotherapy.

A 24-year-old lady presented to the emergency department with severe generalized abdominal pain and hematochezia of 2 days. Examination revealed absent bilateral radial, brachial, and carotid pulses. Rest of the peripheral pulses were normal. A bruit was heard over bilateral carotid, subclavian, and renal arteries. X-ray abdomen showed dilated bowel loops with multiple air fluid levels. Doppler study revealed intimal thickening in bilateral subclavian and common carotid arteries along with decreased flow. Computed tomography (CT) angiography was done urgently that showed critical narrowing of the bilateral subclavian, common carotid, coeliac trunk, superior mesenteric arteries, inferior mesenteric arteries, and bilateral renal arteries. We present a case of mesenteric ischemia in a patient of Takayasu arteritis (TA) leading to bowel gangrene involving entire small and large bowel and a fulminant outcome, which is an uncommon initial presentation of TA.

This teaching image highlights the CT abdominal imaging finding of 'crocodile jaw sign' which should raise concern about the presence of an incomplete annular pancreas which causes partial encasement of the duodenum.

Angiosarcomas are highly aggressive vascular tumors, which usually take origin from the endothelial cells of small blood vessels. They are extremely rare in the pleura and other serous surfaces such as the peritoneum and pericardium. These tumors are usually well localized, but may sometimes spread diffusely over the pleura and mimic mesotheliomas. Traditional histopathology alone, may not establish the diagnosis with certainty, and immunohistochemistry is essential to clinch the diagnosis. Outcome is usually grave and no formal guidelines exist for the exact therapy. We report this condition in a 22-year-old man who presented to us with a localized fluorodeoxyglucose-positron emissions negative pleural tumor, primarily suspected to be a solitary fibrous tumor, which was eventually diagnosed to be a primary pleural angiosarcoma.

Pilates, a popular form of exercise, greatly emphasizes on the strengthening of the core muscles; however, the efficacy of exercise program can be impaired in patients with cognitive impairments. To bridge this gap, mental practice of a desired task can help to mentally simulate a given action and retain many properties of the corresponding real action. This study tries to gain preliminary understanding on the effectiveness of the combination of mental practice and core-strengthening Pilates exercises. To explore the effectiveness of mental practice and Pilates-based training on core strength, balance and mobility in multiple sclerosis (MS) patients. This study highlights a single center case series describing the outcomes in ambulant patients with MS treated with mental practice and Pilates. Five volunteer ambulant individuals with stable relapsing-remitting MS participated in 20 individualized sessions, spread over 10-week duration. Pilates with mental practice session was delivered by a physiotherapist. Each session comprised 20 min of mental practice followed by 40 min of core-strengthening Pilates exercises. All the included patients were screened with Movement Imagery Questionnaire-Revised Second Version to determine if they are were able to effectively engage in imagery practice. A range of outcomes were measured: Timed up and go, chair stand test, curl-ups, the abdominal angle through leg raises, and the Activities-specific Balance Confidence Scale before and after the intervention. Group data analysis indicated significant improvement between baseline and post-intervention phases for all the tested parameters. This study provides preliminary insight into this novel combination technique to improve balance and mobility in ambulant people with MS. Mental practice played an important role in keeping the patient's compliance, which was analyzed through structured interviews. Variations in response to the intervention are evident.

Malignant mixed Mullerian tumor of the uterus, also called carcinosarcoma, is a very rare and aggressive type of malignancy with epithelial and mesenchymal components. Therefore, it is considered a metaplastic carcinoma. Predominantly these carcinomas are found in postmenopausal women presenting with uterine bleeding and uterine enlargement. We represent a case of a 60-year-old female with complaints of pain in the abdomen and bleeding per vaginum. Hysterectomy with bilateral salpingo-oophorectomy was performed and a diagnosis of malignant mixed Mullerian tumor of the uterus was made.

Endometrial stromal sarcomas (ESSs) are uncommon tumors of the uterus, and the cytologic features have only been reported in a number of case reports that mostly discuss the features of higher grade undifferentiated sarcomas. This article discusses the cytologic features of a unique case of hyaline vascular variant of low-grade ESSs (LGESS), which masqueraded as a ovarian tumor due to its massive extension into broad ligament. Touch imprint smears revealed bland cells occurring singly and small clusters, scant cytoplasm, small round or oval nuclei, fine chromatin pattern, and occasional small prominent nucleoli. Frequent metachromatic hyaline globules and plaques were seen between the tumor cells in all the smears. Histological examination of the tumor showed LGESS with extensive stromal and perivascular hyalinization.

Primary extra osseous osteogenic sarcoma is one of the rarest forms of malignant tumor of the breast. It can arise as a result of osseous metaplasia of a preexisting neoplasm or from a none-phylloides sarcoma of a previously normal breast. Due to its rarity, the natural history and optimal treatment methods remain unclear. Sixty-year-old patient presented to the surgical casualty with a large breast abscess. Abscess wall histology revealed an osteosarcoma of the breast. Left total mastectomy with axillary clearance was performed. Histology and subsequent imunohistochemical studies confirmed the diagnosis of osteogenic sarcoma without lymph nodal metastasis. Patient was referred to the oncologist for further management. Rare types of breast tumors can be presented as breast abscess. Incision and drainage together with wall biopsy aid to exclude associated sinister pathologies. Diagnosis of primary osteosarcoma of the breast was made using histological and immunohistochemical findings once the possible primary from the bones of sternum and ribs was excluded. Treatment is as for sarcomas affecting other locations and should comprise a multidisciplinary approach.

Chondroid syringoma is a rare benign adnexal skin tumor arising commonly in the head and neck regions. Literature on cytological findings of chondroid syringoma is scarce. We present a case of a 40-year-old male with a giant chondroid syringoma presenting as a slow growing, painless, firm mass on the anterior abdominal wall of 1 year 6 months duration. The case was diagnosed cytologically and later confirmed on histopathological examination.

Metastatic tumors of the intestinal tract from extra-abdominal sites are rare. In cervical cancer, the liver, lung, and the bones are the most common distant sites of metastases. Metastasis to the small intestine is very rare. We report a rare case of metastasis of cervical squamous cell carcinoma to jejunum after a few months of chemoradiotherapy.

Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is a neurodegenerative disorder characterized by late infantile onset spastic ataxia and other neurological features. Initially described in the Charlevoix-Saguenay region of Quebec, Canada, it is being increasingly reported from many other countries. Here, we present the case of a 20-year-old male from South India, who presented with progressive ataxia, spasticity, and peripheral neuropathy with imaging features and genetic testing suggestive of SACS gene-related ARSACS. The phenotypic variability from other cases and occurrence in a geographically distinct region is stressed upon to alert the clinicians to consider ARSACS in progressive ataxias.

The global prevalence of dementia is expected to double every two decades. Consequently, there is an urgent need for high-quality research to identify effective strategies for providing optimal care to people with dementia and their carers. Currently, research in dementia care is fragmented, which has resulted in a division between the fields of diagnosis and management of dementia including end-of-life care. For example, interventions which have been developed to improve the well-being of the person with dementia and their families focus on discrete elements of the person and their family's experience, such as symptom management, dealing with emotional issues, or planning for the future. A more integrated approach is needed to address gaps in care across the trajectory, while recognizing the multitude impacts on the person affected and their families. This approach will make a meaningful difference to the well-being of people with dementia and their carers, and reduce the burden of the disease on the individual, their family, and society.

The article provides an insight into the history of anatomy and anatomical teaching from the 17^th to 21^st century. A form of teaching that commenced by expressing the anatomical intricacy using paintings, sketches, and models evolved into museums with formalin-preserved specimens, corrosion casts, plastination, and finally culminating in the contemporary museums with electronic screens and audiovisual aids. Anatomical teaching has evolved with time from blackboard teaching to use of overhead projectors, imaging, demonstrations, and simulation. Anatomy is a science which, to be expressed in all its grandeur, requires a combined teamwork of anatomists, renowned artists, modelers, technicians, and computer experts. The latest three-dimensional viewing capabilities will certainly be applied to teaching anatomy in future. This will enable a medical student to understand anatomy more appropriately in all its dimensions.

Florence Nightingale, who was called as “the lady with the lamp,” by the sick and injured at Crimean war, has laid down strong foundational principles in nursing. Her multitasked role contributed significantly toward the development of nursing profession into structured institution. As an administrator, educator, researcher Nightingale's contributions moved nursing from disrespectable profession into replacing more of autonomy and evidence-based practice.

Armand Trousseau was born in 1801 in France. He was recognized for his work on yellow fever and laryngeal phthisis. He occupied several prestigious positions and won numerous laurels. He made several significant contributions to medicine such as Trousseau sign of latent tetany and Trousseau sign of malignancy. He was an excellent clinician and a revered teacher who appreciated the value of bedside observation. He died of visceral malignancy in 1867.

Paget's disease of bone is a debilitating condition affecting the skeletal system and sometimes presents with mono-ostotic pattern. A deformed bone is potential site for stress related injuries notably stress fracture. Diagnostic workup includes clinic-radiological co-relation with biochemical parameters and sometimes use of advanced imaging modalities. A mono-ostotic deformity of bone with thickened, coarse structure may warrant ruling out of this differential diagnosis. Early diagnosis and treatment including use of bisphosphonates have proved beneficial in recovery and good functional outcome.

Through this teaching image of gastroptosis in a 21 year old girl, we reiterate that Glenard's disease should be revisited since there are only very few reports in the existing literature.

This teaching image highlights the CT abdominal imaging finding of 'crocodile jaw sign' which should raise concern about the presence of an incomplete annular pancreas which causes partial encasement of the duodenum.