Anal fissure

Studies show microplastics are increasingly found in human blood. Select the major source you believe contribute to microplastic exposure in the bloodstream.

Obese people often have vitamin D deficiency. However, not everyone with obesity will experience a vitamin D deficiency, but the chances are more.

A 33-year-old male has a history of tubercular meningitis and had brain surgery in Dubai. An implant (don't know the detail) was placed in the brain 7 years back. Post surgery he came to India and was put on steroids and anti-tubercular drugs which he stopped taking 1 year back. He is still not able to walk properly after these many years. But goes for 15-20 minutes' walk 2-3 times a day. He also complaints of left hand swelling with pain and right knee pain often (for 1-2 days in a week), which gets relieved with pain killers to some extent. He is a well-educated intellectual person, sometimes he forgets things which happened 1 hour or a day ago and has Slutter speech. He doesn't remember any details about the time of surgery and was in coma for many days. I don't have much detail about the case, I might arrange if you have any doubt. MRI at the point is not possible as he can't tolerate long MRI scan. What do you think about this case and its prognosis doctors?

Diabetic gangrenous toe *Chief Complaints* Pain less Foul smelling toe with discolouration of toe *History* Known case of diabetic since 15 years history of Ingrowing toe since 15 years *Vitals* Stable *Physical Examination* Pain less toe with discolouration of toe *Investigations* Routine blood test all r stable for amputation *Diagnosis* Dry Gangrene *Management* Amputation

BILATERAL OVARIAN MASSES *Chief Complaints* 48 year old female presented with noticing mass per abdomen over a period of one year. Associated with abdominal discomfort. *History* Patient was case of previous one Caesarean section who presented with mass per abdomen for one year and abdominal discomfort . No bowel bladder disturbances. No history of distension of abdomen . No loss of weight. Patient was perimenopausal. *Vitals* Pulse 84/ min. BP 126/80 mmHg. *Physical Examination* Per abdomen there was mass palpable arising from pelvis arpund 26 weeks size of gravid uterus occupying hypogastric , right ileac fossa , right lumbar region and umbilical region. Vertical infra umbilical scar noted. No guarding / rigidity/ free fluid / tenderness Per speculum cervix vagina normal Per vaginal examination mass felt as felt in abdominal examination plus one more mass felt in pouch of Douglas around 8*8 cm. Appeared impacted in POD. *Investigations* CA 125 was 32. Ultraound showed bilateral ovarian masses Right side 18*15*10 cm and left side 9*8 cm. CECT abdopelvis showed same findings. *Diagnosis* Bilateral ovarian neoplasm *Management* Patient was taken for laparotomy and proceed. OT findings. Uterus normal size. Right side cystic mass around 20*18 cm. No surface excrescences. Capsule intact. No mural nodule. No solid areas noted. Left ovary normal. Left paraovarian cyst 8*8 cm with torsion along fallopian tube axis of two and half turns. No free fluid. Omentum, undersurface of diaphragm and liver normal. No palpable intra abdominal lymphadenopathy. TAH with Bilateral salpingo ovariotomy done.