Introduction: Low incidence of liver toxicity has been anticipated with the clinical use of ifosfamide (IFO); however, there is possible hepatotoxic concern with its use. There is a paucity of effective drugs that can protect liver or regenerate hepatocytes during damage. In this light, the protective effect of lycopene (LYP) was examined against a rat model of IFO-induced liver injury. Materials and Methods: Forty adult albino rats were randomized into eight groups (A–H). Group A (control) was orally treated with water, whereas groups B–D were orally treated with 10–40 mg/kg of LYP daily for 7 days, respectively. Group E was treated with 150 mg/kg of IFO on the 7^th day intraperitoneally (ip), whereas groups F–H were pretreated orally with 10, 20, and 40 mg/kg of LYP daily, respectively, before treatment with IFO on the 7^th day (ip). On the 8^th day, rats were sacrificed, blood was collected, and serum was separated and evaluated for biochemical parameters. Rats were dissected; liver was collected, weighed, and evaluated for biochemical parameters and histology. Results: Significant (P < 0.001) increases in aminotransferases, total bilirubin, conjugated bilirubin, gamma-glutamyl transferase, lactate dehydrogenase, and malondialdehyde levels with significant (P < 0.001) decreases in superoxide dismutase, glutathione, catalase, and glutathione peroxidase levels were obtained in IFO-treated rats when compared to control. Liver of IFO-treated rats showed periportal and pericentral necroses of hepatocytes. However, The aforementioned parameters were significantly restored in a dose-dependent manner at 10 mg/kg (P < 0.05), 20 mg/kg (P < 0.01) and 40 mg/kg (P < 0.05) of LYP-pretreated rats. Conclusion: This study showed that IFO-induced liver damage was restored in a dose-dependent manner by pretreatment with LYP.

Background: The burden of noncommunicable diseases (NCDs) is high with significant impact on households in the form of out-of-pocket expenditure. Provision of NCD services through public health facilities is considered as cost-effective and efficient means. Aim: The study aimed to assess the proportion of individuals using NCD services provided through public health facilities and identify the factors associated with its use in Kasaragod district of Indian state of Kerala. Materials and Methods: A cross-sectional survey of 375 individuals was conducted in Kasaragod District of Kerala state. The data obtained were analyzed using descriptive and analytical statistical methods using Statistical Package for the Social Sciences version 20. Results: About 56.28% of individuals with NCD, received NCD services from public health facilities; these services were primarily comprised screening services. In addition, 40.69% of total individuals with NCDs received treatment services from government health facilities. Insurance coverage, perception about quality, perceived barriers in accessing health services, health worker visit, knowledge about NCD services, and information provided by frontline health workers were significantly influencing NCD service utilization in public health facilities. Conclusion: Individual's usage of screening services provided by government facilities is higher than that of treatment services. Overall, the utilization of NCD services provided through the public health system could be said to be less than satisfactory. It could be improved by addressing the perceived barriers with respect to the quality of services provided in public health facilities. In addition, employing the frontline health workers to bridge the awareness gap in NCD service provision could help in improving NCD service utilization.

Background: Pulmonary pathologies constitute a major ailment in terms of morbidity and mortality. Recent technological advancements provide cytological analysis that accentuates accurate diagnosis, early intervention, management, and ease of clinical follow-up with improved outcomes. This study aimed to correlate the sensitivity and describe advantages and disadvantages of the various cytological means of the diagnosis of lung pathologies along with the sequential approach. Materials and Methods: This was a prospective study performed during the period of January 2013 to January 2015. Samples of sputum and bronchoscopy-mediated bronchoalveolar lavage (BAL) fluid, air-dried and alcohol-fixed smears of bronchial brushing (BB), transbronchial needle aspiration (TBNA), and formalin-fixed bronchial biopsy tissues were received, processed, and analyzed from all clinically and radiologically suspected cases of pulmonary pathologies. Results: Two hundred cases of lung lesions were included with all the four cytological sampling interventions and tissue biopsy in the present study with an age range of 21–90 years and male:female ratio of 2.45:1. There were 111 neoplastic and 89 nonneoplastic cases. The diagnostic sensitivity was maximum with BB cytology for nonneoplastic as well as neoplastic lesions. The overall diagnostic utility observed in 200 cases reveals sputum cytology as least sensitive and BB cytology as most sensitive investigation. Conclusion: Sputum cytology is used in patients who are unfit for bronchoscopy and inpatients for their routine evaluation of underlying infection. BAL enhances yield from intraluminal lesions, and TBNA enhances yield in submucosal and mediastinal lesions. The proposed protocol for cytomorphological diagnosis should be as sputum > BAL > TBNA > BB in order of ease.

Background: In addition to tobacco and alcohol consumption, some infectious pathogens such as human papillomavirus (HPV) have been proposed as carcinogenic factors in oral cancer. Objective: The objective of the study is to assess the possible influence of HPV detection in oral squamous cell carcinoma (OSCC). Materials and Methods: A PubMed search through April 2018, using the following Medical Subject Headings terms, was performed: “mouth neoplasms” and “papillomavirus infections.” Studies with findings on HPV detection in OSCCs were assessed. From 77 studies with full-text availability, 59 were excluded for several reasons: no usable/irrelevant data (32), tonsils, base of tongue and non-OSCC cases studies (26), and animal testing studies (1). The data were analyzed using statistical software RevMan 5.3 (The Cochrane Collaboration, Oxford, UK). For dichotomous outcomes, the estimates of effects of an intervention were expressed as odds ratios (ORs) using Haenszel–Mantel method with 95% confidence intervals. Results: Eighteen studies on HPV detection in OSCCs were included in this meta-analysis. The mean percentage of HPV detection in OSCC was 37.1%. Oral cancer patients showed a higher risk of being infected with HPV than controls (OR: 4.85) and they were more likely to be infected with high-risk HPV (OR: 11.46). A larger number of smokers had HPV-infected tumors (OR: 1.45). Younger age, gender, tobacco and/or alcohol consumption, tumor differentiation degree, tumor size (T-status), and lymph node metastasis (N-status) were factors that did not have a significant influence on HPV-infected oral cancers. Conclusion: HPV infection, especially of high-risk HPV, is more frequent in patients with OSCC.

Introduction: Cutaneous amyloidosis can be a manifestation of a systemic disorder or can result from localized process confined to the skin. Involvement of apparently normal skin is known as primary localized cutaneous amyloidosis. Histopathologically, amyloid appears as amorphous, eosinophilic material with hematoxylin and eosin stain. Congo red staining with apple-green birefringence under polarized microscopy confirms the diagnosis. Materials and Methods: Thirty-nine patients with a differential diagnosis of cutaneous amyloidosis reporting to the dermatology outpatient department of our hospital from November 2015 to May 2018 were studied. Twenty-six cases showed features of amyloidosis on histopathology. These were categorized into morphologic types of amyloidosis and correlated with the available clinical history. Congo red staining and observation under polarized microscope were done. Results: We encountered lichen and macular types of cutaneous amyloidosis with slight female predominance. Majority of the lesions were pruritic with involvement of the pretibial region. A history of friction was given by a few. All cases diagnosed clinically were concordant histopathologically. However, a single case of lichen amyloidosis was diagnosed solely based on histology. Microscopically, hyperkeratosis, amyloid deposits in the papillary dermis, and perivascular inflammation were the most consistent findings. All the cases showed apple-green birefringence with Congo red stain under polarized microscope. Conclusion: Cutaneous amyloidosis can have a wide range of differential diagnosis due to its varied clinical presentation. Histopathology, with the use of special stains, helps in identifying amyloid with a high degree of accuracy.

Background and Objective: Despite liberal abortion law in India, majority of abortions are unsafe. Behavioral theory suggests that women's attitudes may influence their abortion decisions. The present study was conducted to find out women's attitude toward abortion and its predictors. Materials and Methods: A community-based cross-sectional study was conducted in Naxalbari block of Darjeeling district, West Bengal, India, among 420 women aged 15–49 years using a predesigned, pretested interview schedule. The women's attitude regarding abortion practices was determined based on Likert's three-point scale. Two-stage cluster analysis was used to classify the overall attitude of women. Binary logistic regression was used for finding out predictors of abortion attitude. Results: More than half (53.5%) of the women had an overall pro-life attitude and 46.5% women had an overall pro-abortion attitude. Women who were less educated with <5 years' schooling, unaware of legality of abortion, and never aborted had significantly higher odds of having overall pro-life attitude. Majority women viewed abortion as a sin (81.4%); 62.1% of women disagreed with abortion as a method of family planning; 87.4% disagreed with sex selection before abortion; and 57.4% women agreed on women's right to decide for abortion. Conclusion: Women's attitude of abortion depicted complex personal and moral choices marred with social stigma within which abortion decisions are made. For developing a pro-choice outlook, life skills education for women, creating supportive family environment, sensitizing young men through extensive awareness campaigns, and advocacy through health-care providers are needed.

Background and Objective: Hyperbilirubinemia is the most common clinical condition requiring evaluation and treatment in the newborn and a frequent reason for hospital readmission during the 1^st week of life. Although generally a benign, postnatal, transitional phenomenon, a few neonates develop marked potentially hazardous bilirubin levels that can pose a direct threat of serious brain injury. The present study was conducted to investigate the predictability of pathological jaundice on cord blood bilirubin (CBB) values. Materials and Methods: This was a prospective observational study conducted on 289 healthy newborns. Babies were divided into two groups: Group A who developed physiological jaundice and Group B who developed pathological jaundice. CBB was estimated in all newborns who were then followed up to the 5^th day of life. Babies who developed jaundice requiring treatment were admitted in neonatal intensive care unit for phototherapy. Other neonates were checked regularly up to the 5^th day of life and values were recorded on the 5^th day by estimation of serum bilirubin. Results: Incidence of pathological hyperbilirubinemia in our study was 11.2%. A statistically significant correlation between CBB and development of pathological jaundice was observed. Gender, age, mode of delivery, and birth weight has no correlation with cord bilirubin and the subsequent development of jaundice. CBB <2.5 mg/dl when compared with subsequent development of jaundice has high specificity (83.92%) and negative predictive value (87.35%). Cord blood value of >3.5 mg/dl has high sensitivity (97.06%), specificity (99.22%), positive predictive value (94.29%), and negative predictive value (99.61%) in predicting future development of future pathological jaundice. Conclusion: The present study suggests that in healthy term babies (CBB ≤2.5 mg/dl), cord serum bilirubin can help to identify those newborns who are unlikely to require further evaluation and intervention. These newborns can be discharged with assurance to parents. Babies with CBB level ≥3 mg/dl should be followed more frequently. Thus, this study concludes that cord blood total bilirubin levels reliably predict the occurrence of pathological hyperbilirubinemia.

Objective: Comparative evaluation of McNamara's analysis in Class I, Class II, and Class III individuals of Central India in two different age groups. Materials and Methods: 240 individuals belonging to Central India were divided into two main groups: Group I comprised 120 children (10–14 years) and Group II comprised 120 adults (18–22 years). McNamara's analysis was used to assess skeletal, dental, and soft tissue parameters. Results: Statistically significant difference was found for facial axis angle, mandibular length, and maxillary length in children and adults in dental/skeletal Class I individuals. In Class II division 1 individuals, statistically significant difference was found in children and adults for maxillary length, mandibular length, and lower anterior facial height. In Class II division 2 individuals, statistically significant difference was found in children and adults in maxillomandibular difference and lower anterior facial height. In Class III individuals, the difference was in nasolabial angle. Conclusion: The growth of maxilla is usually completed by 10-14 years of age. The present study suggests that the growth of maxilla is continuous in adults, and nasolabial angle decreases with age in Class III individuals. Hence, planning of extractions in earlier age should be decided with caution.

Background: There is a rising trend in antibiotic use and misuse which contributes to antibiotic resistance. Objective: This cross-sectional, questionnaire-based study was to assess the knowledge, attitude, and awareness of antibiotic resistance among medical students. Materials and Methods: The study was conducted on medical students of all years (year 1–5) in a private university of Malaysia coincide with the “Antibiotic Awareness Week” of the World Health Organization. Results: Students in the clinical phase of their training had more awareness than the preclinical phase on the consumption of antibiotics over the counter without prescription (P = 0.008). Students of both the phases responded differently when asked whether the newer antibiotics were more effective in treating infection (P = 0.022). Only 43.5% of year 4 and 42.3% of year 5 students were aware (P = 0.036) about Antibiotic Awareness Week. Conclusion: The study concludes that medical students should have in-depth knowledge about antibiotic resistance and its underlying mechanisms to prevent the misuse of antibiotics.

Background: Burnout is an occupational hazard prevalent in people-oriented services and is characterized by emotional exhaustion (EE), depersonalization (DP), and reduced sense of personal accomplishment (PA). Objective: The research was conducted to determine the occurrence of burnout and its associated factors among doctors and nurses at the University of Port Harcourt Teaching Hospital, South-South Nigeria. Materials and Methods: A descriptive, cross-sectional study design was used on a sample of 320 doctors and nurses at the University of Port Harcourt Teaching Hospital that were selected using a multistage sampling technique. A self-administered questionnaire containing the Maslach Burnout Inventory Survey among others was used to collect data. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 22 and statistical significance was set at 0.05. Results: Of 320 respondents, 76 (23.8%), 90 (28.1%), and 154 (48.1%) had high, moderate, and low EE, respectively. Furthermore, 47 (14.7%), 67 (20.9%), and 206 (64.4%) had high, moderate, and low DP, respectively while 96 (30%), 77 (24.1%), and 147 (45.9%) had low, moderate, and high PA, respectively. The prevalence of burnout syndrome was 4.7%. Significant factors associated with burnout included monthly earning (P = 0.020), professional grouping (P = 0.008) and days off work (P = 0.037). Specifically, doctors had higher levels of EE in comparison to the nurses (P = 0.005). Furthermore, those that were not satisfied with their jobs had high EE and high DP compared to those that had job satisfaction (P < 0.05). Conclusion: The prevalence of burnout syndrome was low and work-related characteristics played a significant role in the development of the phenomemon of burnout syndrome. Employers of health workers will need to create an enabling workplace environment where undue stress is minimal.

Background: In health-care services, when bare upper arm blood pressure (BP) measurement is impractical, the forearm may be used as a surrogate for traditional upper arm BP. Objective: This exploratory study aimed to determine the significant difference and correlation between the upper versus forearm BP measurements among low-risk prenatal women. SMaterials and Methods: A total of 156 low-risk prenatal women in the third trimester of pregnancy attending antenatal clinics at Municipal Maternity Corporation Hospitals, Bengaluru, were recruited by purposive sampling. Upper and forearm noninvasive BP (NIBP) measurements obtained by mercury sphygmomanometer, thrice at an interval of 15 min were averaged. The main outcome measures were the significant difference and correlation between the upper arm and forearm BP measurements. Results: The mean systolic BP (SBP) (117.14 ± 3.041 mmHg) and diastolic BP (DBP) (69.31 ± 8.461 mmHg) in the forearm was significantly higher than the upper arm SBP (111.72 ± 5.53; P = 0.002) and DBP (61.46 ± 6.014 mmHg; P = 0.016). The mean difference in SBP between upper and forearm was 5.42 ± 2.016 mmHg and in DBP 7.85 ± 3.204 mmHg. Upper versus forearm BP measurements had revealed a significant positive linear correlation in SBP (r = 0.849; P = 0.013) and DBP (r = 0.816; P = 0.021) by Pearson product-moment correlation coefficient. Clinically 94 (72.31%) had a significant BP measurements difference in forearm versus upper arm by approximately 6–10 mmHg. None of the maternal characteristics were independent predictors for the mean difference in SBP and DBP measurement. Conclusion: Forearm NIBP measurements are higher than the BP obtained at the upper arm location. This must be taken into consideration whenever the forearm is used as an alternative site for the upper arm BP.

Introduction: Venous duplex ultrasound (VDU) is the diagnostic standard for deep venous thrombosis (DVT); however, modern venous practice requires information for a variety of other venous disorders. Protocols and standards may not have kept pace with these demands. Our aims were to (1) identify disease-specific study standards, (2) survey the community practice of VDU, and (3) consider if there is a practice gap. Methods: A web-based search was conducted to identify standards for VDU studies under the headings of DVT, superficial vein thrombosis (SVT), chronic venous insufficiency (CVI), venous reflux (VR), venous mapping, and prevenous ablation studies. Only those returns that gave specific protocol recommendations were included for analysis. Fifty VDU reports from six community facilities were analyzed using an audit tool; these were compared to a specialized “index” laboratory. Gaps were identified by comparing the recommendations to the interpretation reports. Results: The search returned approximately 50,000 citations (range 855–21,000). Recommendations from recognized authorities (Society for Vascular Ultrasound, Intersocietal Accreditation Commission Vascular Laboratory (ICAVL), College of Physicians and Surgeons of Ontario, and Radiological Society of North America) and peer-reviewed publications were used to define appropriate study protocols. Studies used a “DVT protocol” (38/50 = 76%), regardless of the indication; all studies in the index laboratory used focused protocols. For SVT, it was not related to connections to the deep system (0%); index laboratory 100%. For CVI, VR level was noted in 25%; index laboratory 100%. For patients with venous ulceration, arterial assessments were not added to the venous study. For patients with other nonvenous findings, these were not described in the studies. The comparison of findings from the community laboratories to the index laboratory confirms practice gaps in the assessment of all areas of venous disease. Venous mapping and prevenous ablation studies were only done in specialized facilities. Conclusion: A significant gap is present between community VDU practice and recommended standards and index laboratory protocols for the spectrum of venous disease. Advocacy for established standards and redefined study protocols is required for appropriate VDU practice and quality care of these patients.

Osteocartilaginous choristoma of the tonsil is a rare entity with very few cases reported in the literature. We report two cases presenting with tonsillar enlargement. Histopathological examination revealed the presence of mature cartilage and bone within the tonsillar tissue.

Phlebectasia is an abnormal dilatation of an isolated vein, which may affect any vein, and is rarely symptomatic. Internal jugular vein phlebectasia (JVP) presents as fusiform neck mass during straining or triggered by Valsalva maneuver. Due to its rarity, it is often misdiagnosed and ignored. Most cases are reported in children and sometimes later in age. The authors here report a case of right internal JVP, with an unusual coexisting presentation of tongue deformity in an Indian female patient. The aim of documenting this case is to sensitize the oral physician of this rare neck mass which is seldom reported in the dental literature. Furthermore, phlebectasia should be one of the differential diagnosis of neck mass. Although there are rarely any complications recorded in the literature, thorough investigations (ultrasound with Doppler) are needed for correct diagnosis and referral if needed. Diagnosis would prevent unnecessary surgical interventions. The patients are generally followed up by conservative treatment.

Rhinosporidiosis is a rare granulomatous disease of mucous membranes caused by Rhinosporidium seeberi. Although the taxonomy is still debatable, it has recently been concluded that it belongs to a novel group of fish parasite referred to as the “DRIP” clade (Dermocystidium, rosette agent, Ichthyophonus, and Psorospermium). It usually involves the nasal mucosa, but the incidence of extranasal (atypical) sites such as lip, palate, uvula, larynx, trachea, buccal cavity, lacrimal sac, scalp, skin, penis, urethra, vulva, and bone has been reported. Simultaneous involvement of both nasal and extranasal sites, particularly larynx and trachea, is rare. Only a few such cases have been reported, mostly from South India and Chhattisgarh. We report such a case of a 46-year-old male with extensive laryngotracheal rhinosporidiosis, which was managed successfully with surgery.

A fibroepithelial polyp is an inflammatory hyperplastic lesion in response to chronic irritation. It is most commonly seen in the buccal mucosa where it is more prone to trauma. Clinically, the features of fibroepithelial polyp overlap with other lesions. Therefore, histopathological confirmation is necessary. The current study presents a case in which the fibroepithelial polyp was arising from the retromolar trigone which is not reported in English literature.

There is a lot of literature on psychiatric manifestations of thyroid disorders. However, it is uncommon for a thyroid disorder to present purely with psychiatric symptoms. In instances like this, where there is an absence of any symptoms or signs of the medical illness, it can be difficult to arrive at the diagnosis of the correct underlying medical disorder. This case report aims to highlight the diagnostic challenges in consultation-liaison psychiatry in a case of unusual presentation of hypothyroidism with hallucinations.

The practice of healthcare professionals is influenced by multiple circles and globally, these circles are drastically changing. These circles include national demographics, local needs, social accountability, public opinions/knowledge, pedagogy surrounding the training continuum, knowledge expansion (both in terms of the amount of knowledge itself and how readily the public can access it with technology – computer in a pocket aka smartphone/tablet) and social media forces. Currently, there are many forces at play within these circles; resulting in physician practice environments that are in a constant state of flux. In their previous article, Wooster and Maniate discussed these forces in detail. This article will expand on the influence of these forces on practicing physicians and the impact of uncertainty. The article will then address micro, meso, and macro level initiatives that can be taken to help physicians to manage uncertainty as well as providing support for trainees and practicing physicians alike. The article will conclude with a call for the development of a culture that is conducive to supporting physicians to deal with uncertainty and change that is inevitable.

Medical education focuses predominantly on the science of medicine neglecting the arts and human relationships. Medical humanities was developed to provide a “differing” perspective of the arts. Movies play an important role in the medical humanities and have been used to address various subjects such as medical ethics, doctor–patient relationship, clinical research, mental illness, and professionalism during medical school. Movies involve the affective domain, promote reflection, and link learning to experiences. Movies can teach empathetic behaviors, self-reflection, compassion, and other skills. Movies have been used in a variety of disciplines such as family medicine, psychiatry, internal medicine, and clinical pharmacology among others. Faculty should identify possible topics where movies can be used. Then, they have to create a shortlist of suitable movies and identify the movie to be screened. A list of suitable activities and exercises to promote critical analysis and reflection should be created. Before the screening, a brief introduction to the movie can be provided. The screening should be followed by group activities, presentations, and facilitator inputs. Movies have been used to address topics such as domestic violence, cultural medicine, and attitude toward chronic illness. Most published reports about the use of movies are from the USA. Reports from Canada, Europe, and Argentina are also common. Movies have been used in some Caribbean medical schools and are being increasingly used in South Asian medical schools. A variety of instruments can be used to obtain feedback. There are various databases and collections which will be helpful in choosing appropriate movies.

Depression is one of the most frequent comorbidities in patients with epilepsy affecting 1 in 4 patients, and this is due to psychological and neurobiological reasons. This is a narrative review of the epidemiological, neurobiological, and clinical aspects of depression in epilepsy. References have been identified through Medline/PubMed searches till February 2019 using the terms “epilepsy” AND “depression”. Additional articles were identified from the author's own files and from chosen bibliographies. Epilepsy and depression have a complex bidirectional relationship suggesting shared neurobiological mechanisms and the possibility that depression is a premorbid symptom of some epilepsy syndromes. The phenomenology of depression can be different from that seen outside epilepsy, but epilepsy-specific screening instruments, such as the Neurological Disorders Depression Inventory for Epilepsy, are now available to be used in routine clinical practice. Sertraline and citalopram can be considered first-line treatment in moderate to severe depression while psychological treatments should always be offered to mild to moderate cases.

Dermatophytes cause superficial skin infections of skin, nail, and hair known as dermatophytosis. It is commonly called as “ring worm” infection. There has been an emergence of an epidemic of recurrent and chronic dermatophytosis in India. Several reasons have been implicated that are related to the agent, host, and the treatment. Topical steroid misuse has been considered as an important contributor that has led to the persistence and atypicality of the infection. This article emphasizes on the salient features of the current dermatophyte epidemic to sensitize all physicians who treat the infections.

Diagnosis and treatment of psychiatric disorders has changed significantly over years. Our understanding of aetiology of psychiatric disorders has evolved from demonic possession to specific neurobiological mechanism. With the continuous growth in the knowledge of aetiology and advancement in medical technologies, the treatment too has progressed from removal of major parts of brain to targeting specific neurotransmitter and receptor. The present article highlights a brief history of psychosurgery which is currently an uncommon mode of treatment.

Laryngology has developed immensely as a subspecialty of otorhinolaryngology over the last three decades. Today, the ultimate goal of a laryngologist is preservation or restoration of good voice. Care of the professional voice is highly demanding and thereby phonosurgery is fast emerging as a superspecialty. This article takes you through the journey of voice from an era of destructive surgeries to an era of voice conservation.

Spinoglenoid notch ganglion cyst is a rare lesion located to the dorsum of glenohumeral joint, leading to entrapment of the suprascapular nerve causing infraspinatus atrophy. Other described features include weakness with external rotation and posterior shoulder tenderness. Here, we report a case of 34-year-old gentleman with vague shoulder pain exacerbated by overhead activities. MRI in patients with non-specific shoulder pain now makes earlier detection possible of lesions which may mimic rotator cuff tears.

Multiple system atrophy (MSA) is a term that represents a group of neurodegenerative diseases characterized by different levels of autonomic, cerebellar, parkinsonism, and pyramidal features. Hereinafter, we report a case of an elderly male who presented to our hospital with progressive gait instability and slurred speech. On examination, an orthostatic decrease of blood pressure of standing was observed. The neurological examination showed cerebellar signs and symptoms. A brain magnetic resonance imaging showed radiologic findings of MSA. The diagnosis of probable MSA with predominant cerebellar ataxia was made.

A case of mastoid surgery in which Korner's septum was identified is presented. Identification of this structure is important to make sure complete exenteration of the air cells of mastoid and thus reduce the tendency of recurrent mastoid disease.