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Ankylosing spondylitis is a debilitating disease afflicting the joints. This disease is a major cause of functional impairment and disability in younger population with the mean age of onset around 26 years. The disease is characterized by chronic back pain and limited spinal mobility due to slowly occurring inflammation and later ankylosis of joints. Temporomandibular joint (TMJ) involvement is one such presentation of this disease with the incidence reported 4–35% among different case series. We describe a case of severe ankylosing spondylitis with TMJ involvement in a 27-year-old female patient.

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BACKGROUND Gallstone disease is the most common gastrointestinal problem associated with gallbladder affecting millions of people throughout the world. The gallstones are solid crystalline precipitates in the biliary tract, usually formed in the gallbladder. Cholesterol and calcium bilirubinate are the two main substances involved in gallstone formation. Based on their chemical composition, gallstones are classified as cholesterol, pigment and mixed stones. (1) The colour of gallstones may be white, yellow, brown, black and green. Cholesterol stones are usually yellow, but are sometimes white in colour. Mixed stones are usually smaller, multiple in numbers and occur in various colours and shapes. Pigment gallstone may be brown or black, which mainly consists of bilirubin and calcium salts such as calcium carbonate. (2) The incidence of this disease shows substantial geographical variation with higher incidence in North Indian people as compared to South Indian people. (3) Dietary habits and lifestyle of the patient are going to influence the formation of gallstone. (4) High biliary protein and lipid concentration are risk factors for the formation of gallstones, while gallbladder sludge is thought to be usual precursor of gallstone formation. Age, gender and ethnicity are the most important factors predisposing its prevalence in population. (5) Gallstone disease is related to several cardiometabolic risk factors such as obesity, dyslipidaemias (Hypertriglyceridaemia and low-high-density lipoprotein and high cholesterol), diabetes, unhealthy diet and sedentary lifestyle. High-risk factor for the cholesterol dominant gallstones is the obese individuals with a body mass index of 30 kg/sq. metre. (6) People with diabetes are at higher risk for gallstone disease and gallbladder disease may progress more rapidly in patients with diabetes who are obese and tend to have infection. (7) This study was aimed to confirm the prevalence of various types of gallstones in rural population of Lucknow region with concern to most common age group and sex including common clinical features manifested during the course of the disease. MATERIALS AND METHODS This study is a retrospective descriptive study, which included 132 patients over a period of 18 months (from July 2015 to December 2016) with diagnosis based on abdominal ultrasound report and further confirmed by biochemical test. Detailed history of all patients was taken with reference to dietary habits, age, sex and metabolic diseases (Diabetes) and lab reports from MR department. These cases were systematised to find out the cumulative prevalence rate of gallstone disease among rural population of Lucknow region, because TSM Hospital caters services mostly to rural patient. Previous records of abdominal ultrasound were reviewed, which were available in MR department of hospital during July 2015 to December 2016. Data was tabulated separately and cases for positive and negative for gallstones disease were identified and gallstones of patients available in pathology department ...