Accessory breast tissue is an uncommon condition which occurs in 0.4–6% of women. It is mostly located in the axilla where it can cause diagnostic difficulty, especially if it is unilateral and large. Usually it is bilateral and presents as an asymptomatic mass during pregnancy or lactation. The diagnosis of ectopic breast tissue is important as it can undergo the same pathological changes that occur in a normal breast, such as mastitis, fibrocystic disease and carcinoma. We present a case of unilateral accessory breast without nipple and areola over anterior chest wall with a fibroadenoma inside it in a 20 year old lady.

Introduction: Otitis externa is a common otologic problem affecting between 5% -20% of patients seen in an otolaryngological practice in the tropical and subtropical regions of the world, a general practitioner can expect to see 16 new cases per year. Objective: To assess the pattern of disease among the patients suffering from otitis externa in ENT outpatient department at shaheed ziaur rahman medical college hospital, bogura, Bangladesh. Materials and Methods: This prospective study was carried out on the patients suffering from aural symptoms suggestive of otitis externa in ENT outpatient department of Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh. Among 202 patients (222 affected ears) with the aural symptoms suggestive of otitis externa and 111 healthy control (222 ears), from January 2019 to December 2020. We also included age and sex matched 111 healthy individuals to serve as control, which provided total 222 control units. The patients having symptoms suggestive of otitis externa were randomly selected from the ENT outpatient department of SZRMCH. Results: Our study maximum 71(35.1%) patients were in the 21 -30 years age group followed by 47 (23.2%) were in the 11 -20 years age group. 30 (14.8%) patients were within 31 - 40 years. 18 (8.9%) patients were within both 41 -50 years and > 60 years of age groups. Out of the total 202 patients 113 (55.9%) patients were male and remaining 89 (44.0%) were female. The male -female ratio was 1.3:1. Shows that 106 (52%) patients were smoker and 96 (48%) patients were non-smoker. Maximum number of 169(76.1%) cases were acute otitis externa, which had been suffering for less than two months. Rest 53(23.8%) were chronic cases suffering for more than two months. Most of the ears had multiple complains of which commonest was itching in 203 (91.4%) affected ears, followed by earache in 177(79.7%) ears, sense of blocked ear in 132 (59.4%) ears, discharge in 114 (51.3%) ears, deafness in 26 (11.7%) ears and tinnitus in 17 (7.6%) affected ears. From the results of microscopic examination and culture of ear swab we detected pure bacterial growth in 48 (21.6%) acute cases and 10 (4.5%) chronic cases, pure fungal growth in 74 (33.3%) acute cases and 22 (9.9%) chronic cases, mixed bacterial and fungal growth in 16 (7.2%) acute cases and 10 (4.5%) chronic cases, no growth or contamination in 32 (14.4%) acute cases and 10 (4.5%) cases. Most of the ears were affected by fungal infection accounting 49.0% (109 cases), followed by bacterial infection in 31.9% ears. Out of 71 cases of otitis externa caused by bacteria 29 (40.8%) were due to Pseudomonas aeroginosa, 26 (36.6%) were due to Staphylococcus aureus, 10 (14.0%) were due to E.coli and 6 (8.4%) were due to Proteus mirabilis. Among the culture positive ears 13 (38.2%) were due to Aspergillus, 9 (26.4%) were due to Candida, 6 (17.6%) Penicillium, 3 (8.8%) Mucor and 3 (8.8%) were due to other fungal strains. The microbiological and culture finding of ear swabs among the healthy population of bacterial isolates of which 10 (16.6%) were Staphylococcus aureus, 26 (43.3%) were Staphylococcus epidermidis, 8 (13.3%) were Diphtheroids, 7 (11.6%) were E. coll. 3 (5.0%) were Proteus and 6 (10.0%) were Pseudomonas aeroginosa. Conclusion: From this study it is also evident that although bacteria could be detected from control cases but the isolation of fungus were negligible. Most of the bacteria were normal commensal. Whereas in diseased ear presence of fungus in the ear canal was highly significant, which signifies the prerequisite of an altered aural flora and fauna for the development of fungal infection.

Introduction: Touch imprint cytology is an economical, simple and quick intraoperative diagnostic procedure with good cytological clarity but cannot provide information on the depth of invasion. Frozen section is the standard method but is limited by its cost, need of qualified technical staff and the freezing arte facts. Thus, both the techniques have their own limitations and the combination of these two methods helps in achieving high diagnostic accuracy rates. Objectives: To assess the combined role of imprint cytology and frozen section in the diagnosis of tumours and surgical margin clearance of various organs and to compare the diagnostic accuracy of imprint cytology to frozen section individually verified by subsequent histopathological examination. Material and Methods: The present study was done in the pathology department of Dhaka Medical College Hospital for a period of one year. A total of 72 surgical specimens from various organs were received for imprint cytology and frozen section. The results of both the techniques were verified by the subsequent histopathological diagnosis as “gold standard’’. Results: Out of 72 cases, majority were ovarian neoplasms comprising of 29(40.3%) cases followed by soft tissue tumours (16.7%), breast (9.7%) and brain (8.3%) neoplasms. The majority of the cases were malignant (70.83% including metastatic) followed by benign (20.83%), and borderline (8.33%). The overall diagnostic accuracy of imprint cytology and frozen section in various organs were 95.8% and 97.2% respectively. The combined diagnostic accuracy was 98.6%. The combined accuracy of surgical margin clearance in epithelial tumours was 91.66% and it was higher than the accuracy of 66.66% in non-epithelial tumours. Conclusion: The combination of imprint cytology and frozen section helps in achieving high diagnostic accuracy rates in distinguishing benign and malignant lesions and the accuracy rate for assessment of surgical margin clearance is higher in epithelial neoplasms than that in non-epithelial neoplasms in intraoperative diagnosis.

Primary malignant cardiac tumours are extremely rare. They count for a quarter of all possible cardiac tumors, and are mostly sarcomas. For a long time, their diagnosis was made post mortem, and they were only reported through autopsy series. Since then, diagnostic and therapeutic advances have been made, making clinical diagnosis of this entity more accessible ante mortem. Nevertheless, due to their rarity, cardiac sarcomas suffer from a lack of therapeutic guidelines. Their treatment is modelled on that of sarcomas developed in other organs of the body. We report an interesting case of a 74-year-old female patient operated on for an infiltrating sarcomatous tumour of the left atrium revealed by dyspnoea associated with cardiac palpitations. Thoracic angioscan and transthoracic echocardiography led to the diagnosis of a cardiac tumour, and the thoracic-abdominal-pelvic Computed Tomography (CT) scan did not reveal any other extracardiac lesions except for a minimal non-neoplastic bilateral pleural effusion. The patient underwent an incomplete surgical procedure with R2 resection followed by adjuvant chemotherapy with doxorubicin monotherapy. The evolution under this treatment was marked by a locoregional progression of the disease with further progression in the atria, mediastinum and dorsal spine after 4 courses. A second line of chemotherapy with Dacarbazine monotherapy was initiated, but the patient died shortly after receiving two courses of the new treatment.

Introduction: Acne vulgaris is a common skin disorder that affects 79% to 95% of the young population. In United States, 40% to 45% of men and women older than 25 years of age have some degrees of facial acne that continues to the middle age in 12% of women and 3% of men. Acne vulgaris (acne) is one of the most common chronic dermatological diseases among adolescents, affecting about 80% of young people between 12 and 18 years of age. Obesity is one of the biggest problems in western life style but nowadays, the problem is increasing even in low and middle-income countries. Body Mass Index (BMI) is used to accurately measure obesity. Objective: To find out the association between different categories of BMI and severity of acne. Materials and Methods: This was a cross sectional prospective study conducted in the outpatient Department of Dermatology, Shaheed M. Monsur Ali Medical College Hospital, Sirajganj, Bangladesh from January to March 2022. All the newly diagnosed patients with acne were included in the study. Height and weight of the patients was recorded and BMI was calculated. BMI was categorized as underweight, normal weight, overweight and obese. Type of lesions were noted and severity of acne was graded from 1 to 4. Statistical analysis was performed using SPSS version 21 for windows. One-way Analysis of Variance between groups (ANOVA) test was applied. P value of less than 0.05 was considered significant. Results: A total of 125 patients with acne were included in the study. Age of the patients ranged from 10 to 50 years with mean age of 20.82 ±5.9 years. Most of the patients were in the age group of 11-20 years. There was slightly a female preponderance with female: male ratio of 1:1.4. According to BMI, 65.5% were normal, 12% were overweight, 20.5% were underweight and 2% of patients were obese. Majority of the patients had Grade 2 acne (52.8%). There was no significant association between the BMI and severity of acne (p=0.129). Maximum number of obese patients had grade 4 acne, maximum number of overweight patients had grade 2 acne and maximum number of underweight patients had grade 1 acne. But there was no significant association between the BMI categories and grades of acne (p=0.129). Similarly, there was no significant association between the age and grades of acne (p=0.61). Conclusion: The prevalence of acne with severity more than moderate was much lower in patients who were underweight (BMI less than 18.5). However, this study showed no statistically significant difference in BMI among people with different severities of acne. Population-based studies, as well as age restriction of the participants, can lead to more accurate and reliable results in this regard. There was no significant association between BMI and severity of acne. However, a larger population-based study is indicated to validate our finding.

Motor neuron disease (MND), often known as amyotrophic lateral sclerosis, is a degenerative neurological illness for which there is no recognized cause (ALS). Increased muscular weakening and bulbar dysfunction lead to respiratory failure, which is the most common cause of mortality [1]. It may be difficult to establish the diagnosis until all of the clinical signs and symptoms are present. One should always get a professional neurology opinion for all types of ailments since there is a wide differential diagnosis to consider, including treatable conditions. Though it is possible that only a small percentage of people with familial ALS can be shown to have an inherited gene disorder, research into the molecular basis of genetic subgroups is yielding vital discoveries that might one day lead to medications for those with sporadic cases [2]. A multidisciplinary team provides supportive care in the absence of a cure or treatment that may alter the course of the illness. Motor neuron illness may be caused by a combination of genetic and environmental factors, and future treatment may involve a combination of molecular medications and stem cell transplantation. A progressive degenerative disease, such as MND or ALS, has no known cause in the patients who suffer from it. When examining the differential diagnosis of motor neuron illnesses, it is necessary to consider the relative involvement of upper and lower motor neurons.