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Background: Despite efforts to improve healthcare infrastructure and service delivery, significant disparities in healthcare utilization persist, leading to suboptimal health outcomes and hindering progress toward achieving universal health coverage. This research article aims to conduct a qualitative exploration of the under-foot fall in utilization of health services, shedding light on the barriers and challenges faced by individuals in accessing and utilizing health care to inform targeted interventions and improve health service utilization., Methods: This qualitative study employed free listing, pile sorting, and focus group discussions (FGDs) as data collection methods. Representatives from various stakeholders involved in the primary healthcare delivery system were selected based on their vocalness, knowledge, willingness to participate, and heterogeneity of responses. Subsequently, FGDs and key informant interviews (KIIs) were conducted to further explore the identified barriers. The collected transcripts underwent manual thematic analysis using coding rules and theme generation procedures., Results: A total of 30 participants, including healthcare providers, community leaders, and individuals from the local community, took part in the qualitative exploration. The themes encompassed limited awareness and knowledge, geographical and infrastructural barriers, socioeconomic constraints, trust and perceptions of the healthcare system, and cultural and social factors. These findings provide valuable insights into the multifaceted barriers hindering healthcare utilization and can guide the development of targeted interventions and policies to improve healthcare access and delivery in the study area., Conclusion: The identified barriers, including limited awareness and knowledge, geographical and infrastructural challenges, socioeconomic constraints, trust and perceptions of the healthcare system, cultural and social factors, and gender disparities, are consistent with the existing literature., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Family Medicine and Primary Care.)

Abstract: The breast can be affected by a variety of specific and unique disorders during pregnancy and lactation. One of these disorders is spontaneous infarction of the breast which is a rare condition seen in physiologically hyperplastic mammary tissue associated with pregnancy and lactation. The causes and mechanism of the development of breast infarct remain largely unknown. Only 25 cases of breast infarct have been reported in the English literature. Phyllodes tumor is uncommon in pregnant women, and to date, only one report of spontaneous infarction of the phyllodes tumor has been reported in a postpartum woman. In this report, we describe the first case of coexistent infarction of the hyperplastic breast parenchyma with infarction of phyllodes tumor in a 25-year-old female., (Copyright © 2023 Indian Journal of Pathology and Microbiology | Published by Wolters Kluwer – Medknow.)

Background: Aging is a normal biological process, and its dynamic changes are beyond the control of human beings. The role of depression, fear, and anxiety in old age is preoccupied with unhappy thoughts, and loneliness leads to early deterioration in their cognitive performance which makes it difficult to perform daily activities and hence affects their quality of life., Aim: The present study was done to assess the effectiveness of cognitive retraining in elderly depressives and its effect on their quality of life., Materials and Methods: The study was done on a sample of 20 depressive elderly patients with an age range above 60 years diagnosed with ICD-10 criteria. The study was pre- and post-intervention, and the sampling method was purposive. Firstly to screen handedness, Annet's hand preference battery was used, to assess the depression in elderly, the geriatric depression scale was done, and for attention and memory, Digit Span Test (WAIS-R) and Wechsler Memory Scale (WMS) were administered, respectively. WHO-QOL BREF was done to know the quality of life of the patient. After preassessment, cognitive retraining tasks were introduced to the patients. A total of 15 sessions were taken within three months of follow-up and after that to evaluate the efficacy of an outcome of the cognitive retraining, post-assessment was done., Results: Improvement was noticed in elderly depressive patients in the area of cognitive domain, i.e., attention, recognition, shifting, fixedness, recall, and planning which showed improvement in quality of life and daily activities., Conclusion: In the remediation of cognitive deficits, cognitive retraining plays a very important role, and it helps the elderly population to live their life healthily and hence enhance their coping skills., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Industrial Psychiatry Journal.)

India aims to provide universal health coverage to all individuals and communities thus ensuring accessibility, promotive, curative, preventive, rehabilitative, and palliative health services to all. Healthcare technologies play a critical role in ensuring eliminating healthcare disparities and encouraging quality healthcare at all levels. Technology solutions such as indigenous medical devices and diagnostic products, telemedicine, artificial intelligence, and drone technology can best integrate rural needs, improve health outcomes, patient safety, and healthcare quality and experience for patients' values and strengths and can therefore be important contributors to advancing rural health equity. These technologies can transform India's healthcare system by providing quality care and mitigating the risk of catastrophic financial hardship., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Family Medicine and Primary Care.)

The SARS-CoV-2, a highly infectious positive strand RNA virus first identified in December 2019, has produced multiple genetic variants that have rapidly and sequentially spread worldwide during the coronavirus disease 2019 (COVID-19) pandemic. Genetic changes in SARS-CoV-2 for greater infectivity, replication and transmission were selected during the early stages of the pandemic. More recently, after widespread infection and vaccination, SARS-CoV-2 variants that evade antigen-specific adaptive immunity, have begun to be selected. This article provides an overview of the molecular immunological and virological factors underlying the origin and global spread of important SARS-CoV-2 variant lineages.

Background: Diabetes distress associated with diabetes is an important under-appreciated domain of diabetes management. The aim of the study is to assess the prevalence of diabetes distress among T2DM patients in Jhajjar district of Haryana, using widely accepted DDS-17 scale along with testing the scale's reliability through Cronbach's α., Material and Methods: This observational study with cross-sectional design was carried out among 503 T2DM patients in district, Jhajjar, Haryana. DDS-17 scale was used for diabetes distress assessment. Data entry and analysis were performed using appropriate software., Results: 37.97% subjects had diabetes distress either in moderate (DDS-17 Score ≥2) or severe (DDS-17 Score ≥3) form. English version of DDS-17 scale showed good internal consistency reliability (α = 0.79)., Conclusions: This study conclusively showed that diabetes distress is very common among T2DM patients as more than one third of the T2DM patients had diabetes distress and diabetes distress scale (DDS-17) is an easy, well-accepted questionnaire with good reliability., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Family Medicine and Primary Care.)

Aim: To identify the characteristic pattern/parameter among diabetic post-covid mucormycosis patients which may further help in identifying such susceptible patients in a much earlier course of the disease., Materials and Methods: The study was done with 30 diabetic patients (21 males and 9 females) admitted in RIMS Ranchi during the second wave of Covid-19 for post-covid complications. Palm and fingerprint pattern was taken by ink and pad method to measure the qualitative and quantitative parameters., Result: Diabetic post-covid mucormycosis patients were found to have predominantly whorl pattern in males, loop in females, and C-line pattern absent in 36.6%. Proximal axial triradii with ulnar deviation was 76.6%. All the ridge counts (except ab ridge count of right hand) when compared with hypothesized value were found to be significant with P value (<0.005). None of the three angles measured were found to be significant., Conclusion: All the ridge counts (except ab ridge count of right hand) were found to be a reliable parameter for the diagnosis of diabetic post-covid mucormycosis. ATD angle known to be the most reliable parameter for diagnosis of diabetes mellitus in dermatoglyphics is found to be nonreliable with respect to diabetes post-covid mucormycosis., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Family Medicine and Primary Care.)

Background and Objectives: Pathology is a broad subject consisting of various branches, such as hematology, clinical pathology, biochemistry, histopathology, cytology, blood banking, and others. All the subspecialties are difficult to cover in depth in a 3-year MD Pathology course and curriculum. Hence, it was decided to investigate whether the MD Pathology curriculum is able to meet the challenges of today's laboratory medicine practice. So, a survey was conducted among newly qualified pathologists who have passed their exam within last 5 years. Purpose was to know their views about MD Pathology curriculum with special emphasis on challenges they face during their day-to-day practice., Materials and Methods: Study is designed as cross-sectional survey conducted via web-based Google forms questionnaire. Study population is pathologists qualified within last 5 years. A convenience sample of eligible pathologists was taken by sending a web-based Google form to various pathology groups on social media apps. Data were collected in the Google spreadsheet software and various responses were summarized as percentages, graphs, and pie-charts as necessary. Chi square test was used to find the significance of difference in responses from government, private, and deemed university respondents., Results: Different numbers of responses were received to different survey questions. Out of 187 respondents, 65 (34.8%) worked in a hospital-based laboratory, 61 (32.6%) did jobs in a private laboratory, 49 (26.2%) worked in a medical college, and 37 (19.8%) worked in their own private laboratories. Out of 193 respondents, 158 (81.9%) were working in hematology, 149 (77.2%) in clinical pathology, 139 (72%) in cytopathology, 118 (61.7%) in histopathology, whereas 103 (53.4%) worked in clinical biochemistry, and least number of respondents, i.e., 38 (19.7%) were working in blood bank. Almost all the respondents had overlapping work in hematology and other areas. The level of confidence rated by the respondents was best in hematology, followed by clinical pathology; it was least for clinical biochemistry and blood bank. Out of 192 respondents, 64.1% (123) felt that the curriculum does not equip them for lab management and administration, 21.9% (42) felt that the curriculum somewhat equipped them; whereas only 14.1% (27) felt that curriculum equips them for this task. There were 191 responses to the question regarding satisfaction with MD Pathology curriculum; out of which, 51.8% (99) were not satisfied, 24.6% (47) said they may be satisfied, whereas 23.6% (45) were satisfied with the curriculum. There was no significant difference in responses from government, private, and deemed university respondents., Conclusions: The graduating MD Pathology students expressed confidence in reporting routine cases of hematology, clinical pathology, routine cytology, and histopathology. However, there is difficulty in clinical biochemistry, blood banking, and reporting of malignancies. The laboratory management and administration, communication skills, and quality assurance are also other areas of weakness. MD Pathology program needs more focus on these weaknesses, so that newly qualified graduate would feel confident in day-to-day laboratory working., Competing Interests: None

Background: The quality of life (QOL) of the geriatric population in India is an important issue because of the lack of social security schemes and dilution of Indian culture which ensures due care and regard to the elderly. The primary health care physicians have to face more challenges in handling the elderly patients in comparison to the younger patients because the elderly have more physiological and emotional problems along with medical conditions and illnesses which, in turn, affect their QOL. The study aims to find out the determinants that affect the QOL of the elderly in a rural area of Haryana., Material and Methods: This observational study with a cross-sectional design was carried out among 400 elderly (60 years and above) in a rural area of district Jhajjar, Haryana. The world health organization quality of life scale (WHOQOL-BREF) scale was used. Data entry and analysis were performed using Statistical Package for Social Sciences (SPSS) version 20.0., Results: The mean score of the environmental domain was the highest (62.72 ± 14.18), followed by the physical health domain (60.77 ± 15.82). Education, age group, caste, marital status, occupation, and socioeconomic status exhibited significant relationships with different domains of QOL., Conclusions: With the advancement of age, QOL deteriorates. Higher education and higher socioeconomic status of the study participants help them to live a better QOL. Those participants who were married and were busy in any kind of work experienced a better QOL., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Family Medicine and Primary Care.)

Aim: The aim of this study is to elucidate the patterns of characteristic hypometabolism on 18 F-Fluoro Deoxy-glucose ( 18 F-FDG) Positron Emission Tomography/Computed Tomography (PET/CT) in the variants of Progressive supranuclear palsy (PSP) and its correlation with their core clinical features., Material and Methods: A retrospective analysis of 88 subjects with clinically suspected PSP was done. An institutional informed consent to participate in the study was taken from all the subjects. All the subjects had undergone a prior 99mTechnetium labeled Tropane derivative of dopamine transporter Single Photon Emission Computed Tomography (99mTc TRODAT-1 SPECT) study and had abnormal scans to confirm degenerative parkinsonism. The subjects were clinically examined by the neurologists using the Progressive Supranuclear Palsy Rating Scale proposed by the Movement Disorder Society and were further clinically segregated into eight subtypes. All the included subjects further underwent a detailed clinical analysis to obtain their individual Schwab and England activities of daily living scale and Modified Hoehn and Yahr staging by a neurologist. All the subjects underwent 18 F-FDG PET/CT scan after adequate preparation. The scans were analyzed both qualitatively (visually) and quantitatively using Statistical Parametric Mapping., Results: The frontal, limbic, and sensorimotor cortices represented the common areas of hypometabolism among all the subtypes of PSP. The subcortical regions showing the most significant hypometabolism were the thalami, mid-brain, nucleus accumbens, caudate, globus pallidus, and putamen in descending order. Multiple cortical and subcortical regions of hypometabolism were identified in different subtypes of PSP., Conclusion: The characteristic patterns of hypometabolism observed in the different subgroups were more apparent on quantification and based on visual analysis alone, it may not be possible to differentiate the different subtypes of PSP. A good correlation was seen between some of the core clinical features and hypometabolic clusters., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Annals of Indian Academy of Neurology.)

The large-scale celebration of National Pathology Day on the birth anniversary of Dr. VR Khanolkar would help pathologists to showcase their role in patient care, medical education, and research, change the image of pathology, and bring this specialty to the forefront., Competing Interests: None

Background and Objectives: Infertility is a sensitive subject carrying with it economic, social, and psychological implications. Work up of male infertility is often hampered by a lack of infrastructure and facilities, as well as inadequate training of pathology residents. The purpose of this research survey was to evaluate the current status of semen analysis practices and compare them to the standards laid down by the World Health Organization (WHO)., Materials and Methods: A web-based questionnaire was designed consisting of questions related to semen analysis practices and procedures being followed currently by pathologists in India. A total of 194 pathologists responded. Questions regarding the procedures followed for semen collection, sperm count, volume, normal range, lower normal limit of sperm count, morphology, etc., were included in the survey. These data were recorded. The differences and gaps in the practice with respect to the WHO standards were analyzed., Results: The survey revealed that the printed instructions for semen analysis were available with 38.7% of the respondents; 58.8% of the respondents had a separate room for semen collection; 95.9% performed the analysis manually, and; only 4.1% used automated analyzers. Only 53.6 and 52.6% of the respondents were correctly reporting the normal range of semen volume and sperm counts, respectively. Only 19.6% stated as having read the WHO manual and were also practicing its guidelines, while 14.4% had not read the WHO manual even once., Conclusion: The present study showed a large gap between the practice of semen analysis by respondents from various parts of India and standard procedures as laid down by the WHO. Many laboratories do not follow the standard instructions. There is a need to improve the quality of practice related to semen analysis in this country through appropriate teaching and training in medical institutions as well as through Continuing Medical Education (CMEs) or regular update programs., Competing Interests: None

We present a case of Anti-IgLON 5 encephalitis with Lewy body dementia. 18 F fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scan and 99 mTc-TRODAT-1 SPECT/CT scan were done. 99 mTc-TRODAT-1 scan findings revealed severely reduced concentration of dopamine transporter in bilateral basal ganglia, suggestive of a degenerative parkinsonian disorder. 18F-FDG PET scan findings were suggestive of moderate-to-severe hypometabolism in the bilateral parieto-temporal and bilateral occipital cortices including the primary visual cortices, supporting Lewy body spectrum disease with associated hypermetabolism in the bilateral sensorimotor cortices, bilateral basal ganglia, thalami, brain stem, and bilateral cerebellar hemispheres suggestive of inflammatory pathology., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Indian Journal of Nuclear Medicine.)

Background: Individuals who suffered from COVID-19 remain stressed and worried about anxiety issues for significant changes in daily living activities, causing strong emotional distress., Aim: The aim of this study was to assess the efficacy of psychological intervention in patients with post-COVID-19 anxiety., Materials and Methods: Thirty patients recovered from COVID-19 were selected for the study of age group 20-45 years of both the sexes. Initially, sociodemographic data sheet was filled, and after that, Mental Health Inventory (MHI) was administered. The patients who scored less on MHI were taken for the study, and psychoeducation, relaxation exercises, and activity scheduling were given to them. The goal of intervention was to prepare the patients to learn, interpret, and react to physical and psychological symptoms related after recovering from COVID-19 infection. The intervention was done for 30 min twice a week for 1 month, after that again postassessment was done to see the efficacy of psychological intervention., Results: Result reveals a significant improvement in mental health-related issues after psychological intervention as assessed by the MHI., Conclusion: Psychological intervention resulted in significant improvement of post-COVID-19 anxiety and related mental health issues., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Industrial Psychiatry Journal.)

Pediatric colorectal carcinomas are extremely rare with an incidence of nearly 1.3 per million. Diagnosis is usually delayed following a lack of suspicion at this age. Increasing incidence as well as awareness provides an insight into the disease entity. Two cases of childhood colorectal carcinoma, one in an 11 and another in a 19-year-old boy are presented. However, they have been reparted to carry a forarable outcome. Both the cases showed mucin and signet ring cells which indicates an aggressive behavior. The presentation highlights the clinical characteristics and genetic implications in most of the patients. However, both our cases did not show any predisposing or genetic predisposition. These cases are presented to make aware the readers as to how the common dictum can be reversed and adolescents can also be affected by cancer, a disease of the elderly. Early diagnosis can provide a better management and prognosis.

Seasonal variation plays an important role in the occurrence of diarrheal diseases and distinct seasonal occurrence of diarrheal diseases, with bacterial diarrhea occurring more during the warm seasons and viral diarrhea occurring during the drier cool months, has been observed due to seasonal variation. Time-series cross-sectional study was conducted from January to December 2018 among 553 under-five children to assess seasonal variation of diarrheal diseases and its association with the drinking water quality in a resettlement colony of Delhi. The prevalence of diarrhea was 40.7% and was highest during the rainy season (67.6%). Majority of the water samples were found to be unsatisfactory for human consumption during the rainy and summer seasons. Significant and moderate relationship was found between the seasonal variation and occurrence of diarrhea (r = 0.728, P < 0.05) and most probable number count (r = 0.50, P < 0.05), respectively. Understanding the environmental factors that influences the occurrence of diarrheal diseases is warranted., Competing Interests: None

Background: Significant blood loss and requirement of allogenic blood transfusion during or after total knee replacement (TKR) have been reported. Incidence of blood transfusion in TKR is highly variable and depends on several factors. We investigated the blood utilization in patients undergoing TKR in our hospital and depicted the important risk factors that determine the need of allogenic blood transfusion in primary unilateral TKR., Materials and Methods: The study included 1241 consecutive patients undergoing primary unilateral total knee arthroplasty. All the surgeries were performed by a single surgical team of orthopedists following standard procedure. Patient and disease details were obtained from patient file and hospital information system. Compatibility test was performed in blood bank before blood reservation following mandatory guidelines. Details of test, blood issue, and blood transfusion were documented in the blood bank., Results: Of 1241 enrolled patients, 1069 (86.2%) were female. The median age of patients was 66 years with mean preoperative hemoglobin of 9.9 g/dL. Allogenic blood transfused was needed in 223 (17.9%) patients. Diabetes mellitus, hypertension, thyroid disorders, and chronic heart diseases were the major comorbid conditions. Risk factors such as gender, American Society of Anesthesiologists score, preoperative hemoglobin, and intraoperative and postoperative blood losses were significantly associated with blood transfusion., Conclusion: The risk factors determining blood transfusion in TKR vary between studies, however, all centers should establish standard operating procedures describing the surgical procedure and transfusion support in TKR. In addition, each center may develop specific blood management strategy to rationalize blood transfusion in TKR and overall successful care in TKR., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Asian Journal of Transfusion Science.)

Background: Patients with schizophrenia manifests a broad array of cognitive impairments, including impaired performance on measures reflecting attention, information processing, executive functions, memory, and language capabilities., Aim: This study aims to assess neurocognitive deficits and their correlation with positive and negative symptoms in patients with schizophrenia., Materials and Methods: Sample was collected from private clinic of Jabalpur, Bhopal, and Patna. Selection of sample was purposive sampling. The sample size consists of 60 diagnosed cases of schizophrenia on the basis of (International Classification of Diseases-10 [ICD-10] Diagnostic Criteria for Research criteria) and 30 normal controls. Annet's Hand Preference Battery was used to screen handedness and only right-handed male were included in this study. After screening according to inclusion and exclusion criteria, 60 diagnosed (ICD-10 criteria) schizophrenia patients were selected which was further divided into two groups on the basis of positive and negative syndrome scale, i.e. schizophrenia with positive and negative symptoms. Thirty matched normal controls having scores <2 scores on General Health Questionnaire-12 were selected for the study. After filling of sociodemographic details Luria-Nebraska Neuropsychological Battery (LNNB-I) was administered on both schizophrenia group and normal control., Results: Cognitive functions are severely impaired in schizophrenia compared to normal control and within schizophrenia groups negative schizophrenia had poor performance on LNNB-I than positive schizophrenia. Regarding the correlation of neurocognitive deficits, both schizophrenia groups were correlated but negative symptoms of schizophrenia were strongly correlated with neurocognitive deficits., Conclusion: Cognitive functions are severely impaired in schizophrenia as compared to normal control and within schizophrenia groups, negative schizophrenia had poor performance on LNNB-I than positive schizophrenia. Regarding the correlation of neurocognitive deficits, both schizophrenias groups were correlated but negative symptoms of schizophrenia were strongly correlated with neurocognitive deficits., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Industrial Psychiatry Journal.)

Aim: To elucidate the patterns of characteristic hypometabolism on 18 F- fluorodeoxyglucose ( 18 F-FDG) positron emission tomography/computed tomography (PET/CT) in multisystem atrophy (MSA) and their correlation with the patterns of uptake on dopamine transporter imaging with 99m Tc TRODAT-1 SPECT., Material and Methods: A retrospective analysis of 67 patients with clinically diagnosed MSA was performed. All the subjects underwent 99m Tc TRODAT-1 SPECT and 18 F-FDG PET/CT scanning on two separate days. The 99m Tc-TRODAT-1 scans were analyzed visually for asymmetry and rostro-caudal gradient. The FDG uptake patterns were recorded, and areas of hypometabolism that were two standard deviations from the mean were considered abnormal., Results: All the subjects had an abnormal pattern of FDG uptake on PET scan, both on a visual inspection and semiquantitative analysis. In MSA-P subjects ( n = 29), diffuse predominant hypometabolism of the globus pallidus-putamen complex was noted, with relative sparing of the caudate nuclei. In MSA-C subjects ( n = 25), characteristic hypometabolism was noted in the cerebellum and brainstem. In mixed subtypes (n = 13), variable involvement of the basal ganglia, cerebellum, and brainstem was noted with frontoparietal hypometabolism. A statistically significant difference between MSA-P and MSA-C for gradient reduction and asymmetry with gradient reduction was observed., Conclusion: Dopamine transporter imaging with 99m Tc TRODAT-1 SPECT not only helps in confirmation of parkinsonian disorders but also demonstrates varying patterns of distribution in different subtypes of MSA. Characteristic patterns of hypometabolism in 18 F-FDG PET may help in the differentiation of the subtypes of MSA in the presence of clinically overlapping symptoms., Competing Interests: There are no conflicts of interest., (Copyright: © 2006 - 2021 Annals of Indian Academy of Neurology.)

Background and Aims: Emergence agitation (EA) in children is one of the most common postoperative problems encountered in the recovery room. Sevoflurane has been strongly associated with EA owing to its lower solubility and rapid recovery. Dexmedetomidine has been found to reduce the incidence of EA. This study was designed to evaluate the effectiveness of dexmedetomidine in two doses in reducing EA in children., Methods: This was a prospective double-blinded randomised study done on eighty children aged 5-14 years undergoing adenotonsillectomy/tonsillectomy under sevoflurane anaesthesia. Patients in Group A ( n = 40) received 0.3 μg/kg/h and patients in group B ( n = 40) received 0.5 μg/kg/h infusion after a bolus dose of 0.5 μg/kg of dexmedetomidine. The primary objective was to compare two different doses of dexmedetomidine on EA in the postoperative period. The secondary objectives were to assess the pain and perioperative haemodynamics in the recovery room. The anaesthesiologist blinded to the study charted the paediatric anaesthesia emergence delirium score (PAED), perioperative haemodynamic parameters, objective pain score and rescue medications if given. The data were analysed using Student's unpaired t -test, Chi-square test, repeated measures Analysis of Variance (ANOVA) and Mann-Whitney U test wherever appropriate., Results: The incidence of EA was comparable between both groups ( P = 0.960). The haemodynamic parameters ( P > 0.05) and the objective pain score ( P = 0.810) also did not show a statistically significant difference., Conclusion: A lower dose of dexmedetomidine (0.3 μg/kg/h) is equally effective as a higher dose (0.5 μg/kg/h) after a bolus dose of 0.5 μg/kg in decreasing EA., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Indian Journal of Anaesthesia.)

In recent clinical practice the molecular diagnostics have been significantly empowered and upgraded by the use of Artificial Intelligence and its assisted technologies. The use of Machine leaning and Deep Learning Neural network architectures have brought in a new dimension in clinical oncological research and development. These algorithm based software system with enhanced digital image analysis have emerged into a new branch of digital pathology and contributed immensely towards precision medicine and personal diagnostics. In India, gastric cancer is one of the most common cancers in males as well as in females. Various molecular biomarkers are associated with gastric cancer development and progression of which HER2 protein, a transmembrane tyrosine kinase (TK) receptor of epidermal growth factor receptors (EGFRs) family is of prime importance. The EGF receptor expression in gastric cancer is linked with its prognostics and theragnostics. These expressions are assessed by immunohistochemistry (IHC) and molecular techniques such as Fluorescence in-situ hybridization (FISH), as per recommendations for HER2 targeted immunotherapy. These have motivated the software giants like Google Inc. to produce innovative state of art technologies mimicking human traits such as learning and problem solving skill sets. This field is still under development and is slowly evolving and capturing global importance in recent times. A literature search on PubMed was performed to access updated information for this manuscript., Competing Interests: None

Portal hypertensive vasculopathy (PHV) represents an increase in the pressure in the portal circulation. This increased pressure leads to changes in the mucosa that can be appreciated endoscopically as well as histopathologically. Lesions can be observed in the entire gastrointestinal tract (GIT) including stomach, duodenum, jejunum and colon. The histological changes are appreciated mainly in the mucosal and submucosal blood vessels. A knowledge of these lesions as well as the changes helps in separating them from other close differentials with specific treatment to be instituted. The pathogenesis of the hemodynamic changes is not well-understood. The underlying factor is increased portal pressure. Studies indicate, that besides increased portal pressure other factors in combination led to the observed changes. Portal hypertensive gastropathy (PHG) is seen in the gastric body and fundus, while varices are noted in the cardia and fundus. Changes may be seen in the small intestine and throughout the colon with anorectal varices. Histopathological changes include dilated, congested and ectatic capillaries and edema in the lamina propria besides a large spectrum of other histopathological changes. Mucosal capillaries with thick irregular wall show absence of red blood cells in the lumen. Thickening of the vessel wall serves as a better marker than the vascular diameter when portal hypertension (PHT) is considered. Long standing cases may show fibrosis in lamina propria. At times, these changes may lead to occult gastrointestinal bleeding. Important differentials need to be ruled out in all the cases as the treatment and the outcome of all differs. Endoscopically or histopathologically if the mucosal changes are observed they should not be overlooked and a detailed work-up must be carried out., Competing Interests: None

Background: Prospective recipients of liver transplant (LT) have a high prevalence rate of coronary artery disease (CAD) requiring revascularization. In patients of Child Turcot Pugh Class B and C performing LT prior to cardiac revascularization on cardiopulmonary bypass leads to a high risk of major adverse cardiovascular events (MACE). Whereas, isolated cardiac surgery prior to LT has perioperative risk of coagulopathy, sepsis, and hepatic decompensation. We present four cases of end stage liver disease who underwent concomitant living donor liver transplant (LDLT) with off pump coronary artery bypass graft (OPCAB) in an effort to decrease the morbidity and mortality., Methods: The cases were performed in a tertiary care centre over two years. Four patients scheduled for LDLT, who were diagnosed with significant CAD, underwent single sitting OPCAB and LDLT. Cardiac surgery was performed first and once patient was stable, it was followed by LDLT. The morbidity parameters in terms of duration of intubation, blood transfusion, hospital stay, ICU stay, requirement of dialysis, atrial fibrillation and sepsis was compared with similar studies., Results: The blood transfusion requirement (median 8 units PRBC), incidence of atrial fibrillation (25%), sepsis (25%), and renal dysfunction (0%) was less than the combined surgery conducted on cardiopulmonary bypass. The rate of median intubation time, length of ICU stay, hospital stay, and one year mortality rate was comparable with other studies., Conclusions: Morbidity with combined OPCAB and LDLT is less than combined on pump coronary artery bypass surgery with LDLT. Combined CABG with LDLT may be performed with acceptable outcomes in CTP class B and C cirrhosis.

Competing Interests: There are no conflicts of interest.

Background: Oxytocin administration regimens are arbitrary and highly subjective. Hence, it is essential to reinvestigate the appropriate dose for effective uterine contraction with minimal bleeding and adverse effects., Aim: To determine the optimal dose of bolus oxytocin for uterine contractions for elective caesarean section under spinal anaesthesia., Methods: Ninety term mothers (37 to 41 weeks) undergoing caesarean section electively under spinal anaesthesia were considered for the trial and divided into three groups to receive oxytocin bolus of one, two or three units. The uterine tone was assessed at 2 min after oxytocin administration. Intraoperative blood loss, mean arterial pressure, heart rate and possible side effects were also compared. Paired t-test, Kruskal-Wallis test, Chi-square test and analysis of variance (ANOVA) test with Scheffe multiple comparisons were used as inferential statistics., Results: Adequate uterine contraction was seen in 66% of participants who received one unit of oxytocin, and in 83.3% of participants who received two units of oxytocin. All those who received three units of oxytocin had an adequate uterine contraction. Blood loss was inversely related to the bolus dose of oxytocin., Conclusions: Lower bolus oxytocin doses of one and two units were inadequate for uterine contraction at elective caeserean section, while three units appeared to be effective in terms of adequate uterine contraction, reduced blood loss and stable haemodynamic system and absent side effects., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Indian Journal of Anaesthesia.)

Competing Interests: None

Aims and Objectives: The aim and objective of this study is to detect invasive fungal infections (IFIs) early and with more sensitivity by the nested polymerase chain reaction (PCR) for fungus as compared to fungal culture in clinically suspected patients and also explore its correlation in reference to age, duration of symptoms, immunocompromised status, and other risk factors predisposing to IFIs., Materials and Methods: In this cross-sectional study, 50 suspected patients admitted in medical acute care unit/intensive care unit (ACU/ICU) of Sir Sunderlal Hospital, Banaras Hindu University, Varanasi, India, comprised the study. All cases were selected based on the predefined inclusion and exclusion criteria. A detailed history, clinical examination, and all required investigations were done in all suspected patients. Blood samples were taken for nested-PCR for fungus and culture. Nested PCR was performed on extracted DNA form samples collected from all participants under the study., Results: Our study comprised of 50 suspected immunocompromised patients of IFIs. Among the participants under the study, the most common risk factor was diabetes mellitus (28% cases). Nearly two-thirds (60%) of the cases were 50 years or more. Around 70% of the cases had a history of illness more than 2 weeks. Nested PCR for fungus came out to be positive in 21/50 patients (42%); however, fungal culture was positive in none. Among the admitted patient in ACU/ICU, 75% were neutropenic., Conclusions: IFIs are more common in immunocompromised individuals, patients with comorbidities, long history of symptoms, and elderly population. Nested PCR for fungus has a high sensitivity (as compared to the fungal culture), and also they are rapid in giving the results. Thus, nested PCR for fungus can be used in a cost-effective manner for the early and reliable diagnosis of clinically suspected IFIs., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Family Medicine and Primary Care.)

Background: Active case-finding is provider-initiated and implies systematic searching for TB in individuals who would not spontaneously present to a health service, and bringing them into care for diagnosis and treatment., Aim: The present study was carried out with the objective to assess the yield and feasibility of active case finding strategy among household contacts of newly diagnosed pulmonary TB cases and to determine risk factors in household contact., Methods: This community-based study with cross-sectional design was conducted among the household contacts of all newly diagnosed microbiologically confirmed pulmonary TB patients registered at Tuberculosis Unit (TU), Nuh. Investigator conducted house to house visit and met respective index case and his/her household contacts to build the rapport., Results: In the present study, there were 55 sputum smear-positive index cases and 356 household contacts of index cases. The most common symptom among screening positive household contacts was cough followed by weight loss. A substantial proportion (83.8%) of symptom positive household contacts were investigated for tuberculosis and among them, 18.9% were found to be positive for tuberculosis. The overall prevalence of TB cases among household contacts was found to be 1.97%., Conclusion: The present study concludes that household contact screening for active case finding for TB is a feasible and efficient tool that can potentially result in earlier diagnosis and treatment of active TB, thus minimizing the severity and decreasing transmission. It can also contribute toward improving treatment outcomes, health sequelae, and the social and economic consequences of TB., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Family Medicine and Primary Care.)

The entire world is under a devastating pandemic caused by COVID-19 with a high mortality rate. Knowledge of the viral structure, factors that help in its progression and spread, pathological findings, diagnostic methods and, treatment modalities helps in understanding the viral disease and also in treating the patients in a better way besides preventing the community spread of this deadly infection. The causative agent is a single- stranded RNA virus. The clinical spectrum varies in symptomatic and asymptomatic patients, who later become potential silent carriers, thus unknowingly spreading the virus. The virus constantly undergoes recombination, with reports of cross-species infections. Studies have indicated a strong immunological basis of COVID-19 infection. Not only does it weaken the immune system causing multi-organ involvement but also helps in its progression and spread to others.Multiple organs especially lungs, heart, kidney, gastrointestinal and hepatic system, brain and skin are affected varying in their severity. Similarly, persons with associated co-morbidities are likely to be affected more in terms of the number as well as in the severity. Real- time reverse transcription polymerase chain reaction confirms the presence of COVID-19 infection. Serological diagnosis helps in diagnosing an ongoing outbreak or retrospective infection. Furthermore, it also identifies individuals who have been infected or have recovered from the disease especially the asymptomatic. This helps in the development of an effective vaccine indicating the status of herd immunity in the community. Different treatment modalities are being tried and under trial. This review article thus highlights the global epidemiological status, characteristic of the virus, symptomatology of the patients, role of diagnostic tests available, organs affected including their morphological changes and the latest line of treatment of COVID-19.

New onset refractory status epilepticus (NORSE), is a rare, neurological condition characterised by prolonged periods of refractory epileptic seizure with no readily identifiable cause in otherwise healthy individuals. Anatomical imaging like MRI and serology is usually unremarkable. In patients who have underlying etiology as auto-immune encephalitis without any evidence of auto-antibodies FDG PET may help in early diagnosis and treatment response as it tends to accumulate in the neuronal tissue whenever there is increased blood flow, metabolic demand or increased electrical activity which reverts back with clinical recovery., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Indian Journal of Nuclear Medicine.)