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A 55-year-old male presented to us in the Department of General Medicine at Mahatma Gandhi Hospital Jodhpur, India with complaint of pain and swelling of left thigh since 10 days. He denied of trauma in recent past. He had no sternal tenderness, purpurae, petechiae, and ecchymosis on his body. His family history was not significant in relation to haematological disease. He was not suffering from any chronic illness and had no addictions. On examination patient had swelling of the left thigh not extending beyond knee joint. The left mid thigh girth was 70 cm as compare to right that was 57 cm. The swelling was warm to touch, soft, boggy and tender to palpate. Fundoscopy was normal. His vital parameters were within normal limits. Lungs were bilaterally clear and cardiac auscultation was normal. Splenomegaly was found on palpation. Lymph nodes were not palpable. Laboratory investigations revealed a haemoglobin (Hb) of 5.7 g/dL, total leukocyte count (TLC) of 3,20,000/mm 3 , and Platelets were 12,24,000/mm 3 with PBF showing normocytic normochromic anaemia with leukocytosis and thrombocytosis with few myelocytes and metamylocyte. The Bone marrow examination showed hypercellular marrow (myeloid hyperplasia) with M:E ratio of 49:1 and 28% myelocytes, 3% myeloblast, 7% promyelocyte , 14% metamyelocyte, 42% neutrophils, and 2% basophils, suggestive of CML [ Table/ ABSTRACTSpontaneous soft tissue haematomas are rarely found in haematological malignancies. Chronic myeloid leukemia (CML) is a myeloproliferative disorder which rarely present with thrombo-haemorrhagic phenomenon. It is a malignant clonal disorder of pleuripotent stem cells that results in increase in myeloid, erythroid and platelets cells in peripheral blood and marked myeloid hyperplasia in bone marrow. It is characterized by the presence of Philadelphia chromosome (Ph) with BCR -ABL 1 fusion gene. This gene is responsible for the formation of 210 KDa chimeric proteins with enhanced tyrosine kinase activity which leads to the abnormal bone marrow cell proliferation and to the clinical and morphologic manifestations of leukemia. Cutaneous and mucous membrane bleeding is common in CML whereas bleeding in deep soft tissue is rarely found because of qualitative and quantitative platelet abnormalities. Here, we report a case of CML (BCR-ABL rearrangement positive) who presented with large haematoma in the anterior as well as posterior compartment of left thigh and treated successfully with hydroxyurea and imatinib.on hydroxyurea, imatinib and allopurinol. On 15 th day of starting imatinib, and hydroxyurea, repeat CBC revealed Hb 8.6 g/dL, TLC 56,000/mm 3 and platelets were 4,50,000/mm 3 . Coagulation profile became normal. Haematoma managed conservatively and resolved completely in repeat MRI after 20 days and he became asymptomatic with normal hematologic parameters. He was discharged on imatinib 400mg with advice for further follow up.

The hemophagocytic syndrome is an atypical and rare manifestation of dengue fever (DF). We describe a 15-year-old girl developing DF associated hemophagocytic syndrome who responded with supportive treatment.

To Assess knowledge, attitude and practice towards cervical cancer and its screening among health service providers. Material and Methods: A cross-sectional study. Questionnaire was adapted from earlier studies related to cervical cancer and screening knowledge, attitude, and practices among female health care providers of Chennai cooperation 2013. Result: Out of 200 heath care providers 68.5% think that cancer cervix is a public health problem in India. 59% are aware about risk factors for acquiring cervical cancer.57% are aware of cancer cervix symptoms.30% are aware of its screening procedure.49.5% and 48% are aware of recommended age of screening and its interval respectively. 46.5% didn't think themselves susceptible for cervical cancer. 99% were willing to undergo screening.100% perceive the importance of educational camps and seminars and willing to propagate knowledge regarding cancer cervix and screening to general population. only 2% have ever undergone screening for cervical cancer. 21.5% Have done cancer screening and only 7% have undergone vaccination. Conclusion:Study identified misconceptions between Knowledge, Attitude and Practices towards cervical cancer and its screening among Health Service Providers.

A 40-year-old male presented with a history of low-grade fever, weight loss, night sweats and breathlessness of 3 months duration. On examination, the patient had freely mobile lump in left lumbar region. The lump was surgically excised. Histological examination and immunohistochemistry of the specimen were consistent with the diagnosis of plasma cell variant of the Castleman disease. The patient had polyclonal hypergammaglobulinemia, anemia, eosinophilia and elevated interleukin (IL)-6 level. The level of IL-5 was not measured; however, the presence of eosinophilia indirectly suggests an increased IL-5 level. He obtained complete remission after resection of lump and 20 months of surgery had no signs and symptoms of diseases recurrence with normal hematological parameters. We discuss the role of IL-5 in the pathophysiology of the Castleman disease along with dysregulated overproduction of IL-6.