<p class="abstract"><strong>Background:</strong> Effect on sensorineural hearing loss by low dose ionizing radiation exposure in radiation workers has been rarely evaluated. A case control study was done among the radiation associated workers and normal subjects.</p><p class="abstract"><strong>Methods:</strong> The study was designed in low dose of radiation exposing healthy medical personnel. Age and sex matched healthy control group of subjects were selected. Groups were evaluated by normal otoscopic evaluation; normal tuning fork test and normal standard pure tone audiogram at frequencies from 250 to 8000 Hz. They underwent impedance audiometry, transient evoked otoacoustic emissions, and high frequency audiometry (from frequencies 10000 to 20000 Hz) was done.  </p><p class="abstract"><strong>Results:</strong> No statistically significant difference was found in the results of impedance audiometry, transient evoked otoacoustic emissions and standard pure tone audiogram from 250 to 8000 Hz between cases and controls. In the high frequency range, statistically significant difference was observed (p=0.0001). Mean thresholds were higher at all frequencies in cases compared to controls, except at 4000 Hz. A statistically significant correlation was found between duration of exposure and thresholds at 500 Hz (p=0.014) and 10000 Hz (p=0.048). Tinnitus, vertigo, ear block, hard of hearing and loss of appetite were seen more in cases, but was not significant.</p><p class="abstract"><strong>Conclusions:</strong> Taking account of the very low incidence of nerve and parathyroid injury in this series, the authors suggest that meticulous capsular dissection is superior to dissection of the entire nerve in avoiding transcient nerve damage as well as temporary hypocalcemia. However it is stated that a deliberate search for the nerve is definitely indicated in cases where there is likely to be distorted anatomy, as in infiltrating malignancies and recurrent thyroidectomies.</p>

Incidence of Peptic ulcer perforation in children and adolescents are very rare. Perforated gastric ulcer is extremely rare with only handful of cases reported worldwide in the same age group. Pneumoperitoneum and peritonitis due to gastric perforation is a very rare presentation in children and adolescents and it can often be overlooked with disastrous consequences. Even though in young patients, peptic ulcerations can happen in association with H. pylori infection, secondary to medications like non-steroidal anti-inflammatory agents, corticosteroids, rarely due to Zollinger Ellison syndrome, related to stress, post burns or head trauma it is seldom common. Among perforations gastric perforation is very rare. Here we discuss a case of 15-year-old school student who presented with acute abdominal pain and features of peritonitis which we initially thought probably due to perforated appendix but turned out to be a gastric perforation. Plain radiograph of the abdomen showed pneumoperitoneum. When an emergency midline laparotomy was performed, we found a perforation in gastric antrum anteriorly with peritonitis which was treated by thorough decontamination and Graham's live omental patch closure. H. Pylori tests were negative. At a time when acute presentation of peptic ulcerations or perforation as its complication is decreasing in incidence worldwide, this case has come as an eye opener. Thus, perforated gastric/duodenal ulcer in pediatric and young adult patient should not be overlooked in a young patient presenting with acute abdomen. Many times, there is no clear etiology and then it is spontaneous perforation. Emergency surgical management is the preferred mode of treatment.

Pure tone Audiometry (PTA) is one of the methods to evaluate the burden of hearing loss in any population and various studies have attempted to correlate PTA thresholds with specific conditions. However not many studies correlate the symptoms and signs with the PTA results.Objective: Analyze the data of those who underwent PTA in a secondary care hospital and to correlate their audiometric and clinical profile. Materials and M ethods: The data of 1002 patients with their demographic profile, symptoms, signs and PTA results were included. Incomplete data were excluded from the study. Statistical analysis was done to correlate the symptoms, signs and demographic profile with the type of hearing loss. Results: Gender did not have a statistically significant influence on the type of hearing loss (p> 0.05). Sensory Neural Hearing Loss (SNHL) was the commonest type found. It was commoner in the older age group. Influence of age on the type of hearing loss was statistically significant (p<0.05). Analysing the symptoms and signs, tinnitus, aural fullness and tympanic membrane perforation had a significant influence on the type of hearing loss (p<0.05). Conclusion:Symptoms and signs can be used as a screening tool in a population to identify those requiring evaluation by PTA. It is suggested that a standard symptom based questionnaire which can be either selfadministered or can be used by a community health worker to screen the population be framed.

Usually gastrointestinal malignancies present with low SAAG ascites. But when there is diffuse liver infiltration following malignancy, high SAAG ascites can occur. So liver infiltration can masquerade as cirrhosis. Malignant acanthosis and tripe palm are the paraneoplastic manifestations seen in GI malignancies. We are reporting a case which was initially managed as a  straightforward case of cirrhosis ,but later turned out to be a case with tripe palms, malignant acanthosis and carcinoma stomach as primary with diffuse liver infiltration having high SAAG ascites.

Background: Lymph node metastasis (LNM) is evident in about 20–50% of cases at presentation in papillary carcinoma thyroid (PTC). There are no clear recommendations for the need and extent of lateral and central compartment dissection in PTC. Methods: A total of 83 patients who underwent total thyroidectomy and bilateral selective neck dissection for diagnosed PTC from September 2011 to October 2017 were retrospectively analyzed. Results: Tumor site was bilobar or involving isthmus in 40 patients. Contralateral LNM was seen in 42 patients. Both radiological (median size 2.6 cm, P = 0.051) and pathological (median size 3.65 cm, P = 0.015) size of tumor, tumor involving isthmus or bilateral lobes (P = 0.006), and lymphovascular invasion (LVI) (P = 0.026) had significant correlation with contralateral LNM. Conclusion: Size and site of tumor, ipsilateral lateral compartment nodes involvement, and LVI status of tumor significantly increases the probability of contralateral LNM in patients of PTC.