Aim: Shunting in carotid endarterectomy (CEA) is a controversial issue, which remains to be clarified in patients with contralateral carotid occlusion (CCO). In our clinic, CEA is performed under general anesthesia and without shunting. The present study aimed to discuss 30-day mortality and morbidity outcomes of CEA performed without shunting on 53 CCO cases. Materials and Methods: In our clinic, 415 CEA procedures were performed on 376 patients between the years 2005 and 2013. Among these patients, 53 (39 males and 14 females) with CCO who underwent isolated CEA were included in the study. All patients were operated on without shunting and under general anesthesia. Results: Of the patients, 31 were symptomatic (mean age, 63.2 ΁ 5.1 years) and 22 were asymptomatic (mean age, 63.1 ΁ 6.7 years). One (1.9%) patient died of postoperative myocardial infarction. Another patient (1.9%) developed stroke due to intracranial hemorrhage on the postoperative 6 ^th day. Transient ischemic attack was observed in 2 (3.8%) patients. Eight (15.1%) patients developed ipsilateral transient peripheral nerve injury, 1 (1.9%) patient developed hoarseness, and 5 (9.4%) patients developed organic brain injury. Conclusion: It was observed that CEA without shunting could be performed with an acceptable risk ratio under general anesthesia in cases with CCO.

Background: Iron inhibits megakaryopoiesis so iron deficiency anemia (IDA) leads to microthrombosis. Iron therapy ameliorates thrombocytosis. In this study, we investigated whether young, active, and large platelets are released into peripheral blood during iron treatment. Mean platelet volume (MPV) was measured as an indicator for the presence of these platelets. Materials and Methods: A total of 80 patients (10 males and 70 females) with IDA were included in this retrospective study. IDA was defined as ferritin level <50 ng/mL with a transferrin saturation <20% or ferritin <15 ng/mL. Daily ferrous sulfate (270 mg iron II sulfate and 80 mg of elemental iron) was given orally to patients. We evaluated retrospectively the hematologic and biochemical parameters prior to and 1 month after iron treatment. Results: the mean ferritin level of the pretreatment group was 6.5 ± 4.0 ng/mL, MPV was 7.9 ± 1.5 fL, hemoglobin (Hb) was 9.8 ± 1.5 g/dL and the mean cellular volume (MCV) was 71.2 ± 7.2 fL. The mean ferritin level of the posttreatment group was 40.3 ± 15.2 ng/mL, MPV was 8.6 ± 2.0 fL, Hb was 12.5 ± 6.6 g/dL, and MCV was 77.6 ± 5.4 fL. The levels of ferritin (P < 0.001), MPV (P < 0.001), MCV (P < 0.001), and Hb (P < 0.001) were significantly higher in the posttreatment group compared to the pretreatment group. Conclusion: There may be an increase in thrombotic events due to hypercoagulability related to microthrombosis during IDA. Even though thrombosis is corrected during iron treatment, the therapy increases the release of large and active thrombocytes into the peripheral blood.

Context: Tuberculosis is a major public health priority in the world with 8-10 million new cases added every year. Aims: To obtain information about drug resistance pattern of patients registered as re-treatment cases and its causes along with source of previous drug exposure. Settings and Design: This is a prospective study done at a tertiary care center. Materials and Methods: A total of 100 patients of re-treatment cases who gave oral informed consent were registered as subjects. Results: Drug resistance was identified as 25% mono drug and 22% multidrug resistance among retreatment cases. Isoniazid (25%) was the most common drug against which drug resistance was identified. Conclusions: Multidrug resistance is a significant health problem. Majority of these patients were drug defaulters. Our study identifies drug intolerance, ignorance about advised treatment, early symptomatic relief as the predominant causes of defaulting.

Ewing's sarcoma (ES) is a malignant, small cell tumor of skeletal system seen in young adults and children. The prognosis is very poor in this type of tumor, which has a metastasis potential at an early stage. It is rarely seen in head and neck region; mandible is involved relatively frequent while paranasal involvement is very rare. Furthermore, ES arising from base of nasal cavity and hard palate is extremely rare. The aim of this report was to discuss a 14-year-old girl with ES arising from base of nasal cavity and extending to nasopharynx in the light of literature.

Neonatal empyema thoracis is a rare infection, it may follow chest infection, and staphylococcus aureus is the predominant organism implicated; however the case of a 4-day-old boy who presented with persistent fever and worsening difficulty in breathing with oxygen desaturation in which the offending organism was unidentified but responded remarkably following chest tube insertion and drainage of the pus is reported.

Urethral calculi are extremely rare, especially in female patients, and usually associated with genitourinary tract abnormalities such as urethral stricture or diverticulum. Primary calculus of the urethra is very rare and usually associated with congenital diverticulum. Secondary urethral calculus, often originate from the kidney or bladder. However, primary calculus of the urethra is very rare and is usually associated with congenital diverticulum. Diagnosis of urethral calculus is difficult due to location, and failure of the diagnosis may cause urethral injury, incontinence or renal insufficiency. Herein, we report the computed tomography, clinical and surgical findings of a urethral calculus in a female patient without any urogenital anomaly.

Fibroepithelial polyps are a benign growth of mesodermal origin that usually arises in the urinary tract. A 38-year-old man presented with painless polypoid penile mass at tip of penis. He had been using a cloth in the form of pad to clean urine from tip of glans for past 3 years. Wide local excision was done. The histopathologic diagnosis was fibroepithelial polyp. A fibroepithelial polyp of the penis is very rare and is strongly linked with long-term condom catheter use. We present a case of fibroepithelial polyp of the glans that has no link with condom catheter use.

The World Health Organization (WHO) has revealed that a persistent rise has been seen in most of the infectious diseases, non-communicable diseases (NCD), and nutritional disorders, especially in developing countries. Owing to the impending globalization, developments in the health care delivery system, and rising level of awareness among the people, maintaining a sustained level of quality of care which is accessible and available to all is of prime importance. Accreditation is described as a systematic process by which a recognized body, assesses and recognizes that a health care organization meets predetermined standards. Multiple benefits have been documented secondary to the accreditation of a hospital or a health care establishment. To conclude, accreditation is an international phenomenon and thus should be designed, regulated, and monitored properly to ensure expansion of the health sector and delivery of quality assured health care services to all.