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Background: Eczema of foot adversely impacts daily activities, work productivity, and interpersonal relationships. Materials and Methods: This cross-sectional, questionnaire-based study collated epidemiological data of 70 outpatients of foot eczema, evaluated their quality of life by 10-item dermatology life quality index (DLQI) questionnaire, and undertook the correlation thereof. Results: Cases were predominantly males (48; 68.5%); 26 (37.1%) belonged to fifth decade of life and 47 (67%) presented within 12 months of onset. Dorsa of feet was involved in most (59; 84.2%) cases. Itching was a universal complaint followed by scaling (51; 72.9%), dryness (22; 31.4%), and oozing (21; 30%). History of atopy was reported by 15 (21.4%) patients; tobacco and/or alcohol abuse 32 (45.7%) patients; past treatment was received by 37 (52.9%) patients; and winter aggravation in 9 (12.3%) patients. Mean DLQI score was 13.64; with very large effect (11--20) on QoL in 38 (54.3%) patients; moderate (6--10) in 15 (21.4%) patients; extremely large (21--30) in 9 (12.9%) patients; and small (2--5) in 8 (11.4%) patients. Mean scores of questions of DLQI tool were 2.46 in first question (symptoms), 1.99 in fifth (social activities); 1.81 in seventh (working/studying); and 0.17 in fourth (clothes) question. Significant (P < 0.05) impairment of quality of life emerged with respect of burning, scaling, oozing, history of atopy, seasonal variation, and past treatment. Conclusion: Our study reports significant association of atopy, winter aggravation, past treatment, burning, scaling, and oozing with adverse quality of life in our study on cases of foot eczema and appears to be first study from India. [ABSTRACT FROM AUTHOR]

Background and Purpose: Dengue can present with variable neurological complications including encephalitis, encephalopathy, acute disseminated encephalomyelitis (ADEM), and ischemic and hemorrhagic stroke. Our study describes a pattern-based approach to recognize different brain MRI findings in dengue-seropositive patients with neurological symptoms.Materials and Methods: Thirty-six serologically proven dengue patients with neurological symptoms and undergoing brain MRI over a 6-month period were included in this study. The diagnosis of dengue encephalopathy or encephalitis was established by presence of signs/symptoms of acute encephalitic syndrome with the presence of Immunoglobin M (IgM) antibody against dengue antibody in the serum and/or presence of dengue antigen (NS1) in serum. The MRI brain along with diffusion weighted imaging and susceptibility weighted imaging sequences were evaluated by an experienced neuroradiologist.Results: Eleven patients had normal MRI finding. In the rest 25 patients, 12 were found to have encephalitic pattern, 4 had encephalopathic (seizure related/metabolic) pattern, 3 had features of ADEM, and isolated micro- or macro-hemorrhages were found in 6 patients. In the encephalitis group, eight had concomitant involvement of brainstem, cerebellum, and ganglio-thalamic complexes with additional involvement of cortex and subcortical white matter (WM) found in three. Isolated brainstem and cerebellar involvement were seen in three in this group, whereas one had isolated cerebellar involvement. Interspersed hemorrhage was noted in the structures involved in eight patients in encephalitis group.Conclusion: Radiologists should be aware of various MRI brain findings in dengue and a pattern recognition approach often helps in reaching the correct diagnosis albeit after exclusion of other differentials based on laboratory studies. [ABSTRACT FROM AUTHOR]

Two hundred of 450 patients, who were on venturi mask and non-rebreathing mask, were shifted from MGPS supply to oxygen concentrators and portable oxygen cylinders. Introduction The coronavirus disease-2019 (COVID-19) first outbreak in India in September 2020 led to hospitals augmenting ventilator numbers and oxygen outlet enabled beds.[[1]] Simultaneous assessment of required increase in the supply of medical oxygen, emergency oxygen manifold, augmenting the storage capacity of liquid medical oxygen (LMO), and capacity of medical gas pipeline system (MGPS) was required.[[2]] The present case scenario highlights the insufficiency of hospital MGPS, consequent to augmentation of ventilator and oxygen outlet enabled beds in hospital. [Extracted from the article]

Background: In April 2018, the Government of India launched 'Nikshay Poshan Yojana' (NPY), a cash assistance scheme (500 Indian rupees [~8 USD] per month) intended to provide nutritional support and improve treatment outcomes among tuberculosis (TB) patients. Objective: To compare the treatment outcomes of HIV-infected TB patients initiated on first-line anti-TB treatment in five selected districts of Karnataka, India before (April–September 2017) and after (April–September 2018) implementation of NPY. Methods: This was a cohort study using secondary data routinely collected by the national TB and HIV programmes. Results: A total of 630 patients were initiated on ATT before NPY and 591 patients after NPY implementation. Of the latter, 464 (78.5%, 95% CI: 75.0%–81.8%) received at least one installment of cash incentive. Among those received, the median (inter-quartile range) duration between treatment initiation and receipt of first installment was 74 days (41–165) and only 16% received within the first month of treatment. In 117 (25.2%) patients, the first installment was received after declaration of their treatment outcome. Treatment success (cured and treatment completed) in 'before NPY' cohort was 69.2% (95% CI: 65.6%–72.8%), while it was 65.0% (95% CI: 61.2%–68.8%) in 'after NPY' cohort. On adjusted analysis using modified Poisson regression we did not find a statistically significant association between NPY and unsuccessful treatment outcomes (adjusted relative risk-1.1, 95% CI: 0.9–1.3). Conclusion: Contrary to our hypothesis and previous evidence from systematic reviews, we did not find an association between NPY and improved treatment outcomes. [ABSTRACT FROM AUTHOR]

Background: Hypoxemia-induced endothelial dysfunction leads to microalbuminuria. Microalbuminuria (MAB) has also been used as a parameter to assess the risk of cardiovascular events in an individual. The aim of this study was to observe the relationship of MAB in patients with chronic obstructive pulmonary disease (COPD) and to correlate MAB with different stages of COPD. Materials and Methods: This cross sectional study included 140 patients with COPD selected according to GOLD guidelines based on COPD test assessment score and the number of exacerbations who had smoking pack years of more than 10 years. Urine albumin creatinine ratio (UACR) more than 30 mg/gm represents MAB. Results: The UACR increases as the severity of groups of COPD increases with significant differences in UACR values among different COPD groups. Significant differences were seen among various groups of COPD when compared for different clinical parameters such as SPO2, PaO2, PaCO2, pH, and C-reactive protein (CRP). Pearson correlation analysis revealed that UACR was significantly inversely related with PaO2 (r = -0.514, P < 0.001), SPO2 (r = –0.397, P < 0.001) and FEV1 (r = –0.441, P < 0.001) and it was significantly positively correlated with PaCO2 (r = 0.675, P < 0.001). Conclusion: This study indicates that there is strong relationship of MAB in patients with COPD and the levels of MAB increase as the severity of COPD increases due to hypoxia and endothelial dysfunction. As MAB is a marker for cardiovascular risk, patients with COPD can be routinely evaluated for the urine test of MAB specially who are at increased risk for cardiovascular events. [ABSTRACT FROM AUTHOR]

The COVID19 pandemic is an unprecedented disaster. In India, the spread of COVID19 infection and the subsequent lockdown coincided with a crucial period of the annual examination in almost all educational institutions. The pandemic has created hurdles in the conduct of examination due to many reasons, some of which are spread of infection and associated safety issues, lack of public transport for patients as well as the postgraduates in outstation and examiners, and lack of workforce due to round-the-clock service for rendering health services leading to difficulty in arranging logistics at the examination center. Currently, there are no guidelines or policies on how examinations need to be carried out during such a pandemic. Hence, there is an urgent need to look at solutions within the profession for the completion of examination. Teachers of psychiatry play an important role in the national mental health services. Their expertise can be valuable for finding solutions that work. This article has compiled suggestions from Indian teachers of psychiatry. [ABSTRACT FROM AUTHOR]

Background: Worldwide, hypertension is considered as an important health issue due to its unbearable complication of cardiovascular, renal, and nervous system diseases. Aims and Objective: The aim was to find the prevalence and inadequately treated undiagnosed hypertension in the general population attending the Outpatient Department (OPD) of the Department of Oral and Maxillofacial Surgery, King George's Medical University, Lucknow. Materials and Methods: A total of 2500 patients were enrolled in the study within the age group of 20–60 years, attending dental clinics. For every patient, blood pressure (BP) was taken three times, and all the readings were grouped into four categories including normal, prehypertensive stage, Stage 1, and Stage 2 of hypertension. In the dental clinic, the BP assessment was done considering parameters such as sex, smoking and alcohol, the effect of local anesthesia, gutkha chewing, age group, and regular exercise. Results: About 24.39% of undiagnosed hypertensive patients were found among all who attended the OPD of the department of oral and maxillofacial surgery. It was observed that the rise in BP was 16.71% and 2.35% in Stage 1 and Stage 2, respectively, after giving the local anesthesia. Conclusion: This study reveals that early diagnosis of undiagnosed and inadequately treated hypertension among general people notified by dentists is an important role, and this should be promoted and emphasized to restrict fatal life complications. [ABSTRACT FROM AUTHOR]

In the current examination, the ingestion and inhalation dose measurements for the particular body organs in light of the intake of radon through ground water used by the inhabitants have been surveyed in the various locations of Amritsar province, India, using an electrostatic collection type radon monitor (RAD7) analyzer with RAD-H2O accessory. The mean radon activity level in water was seen to be 5.93 ± 2.34 BqL-1. However, the radiation dose received by all different body organs significantly less than the UNSCEAR and WHO suggested a level of 100 μSvY-1. The annual effective dose for the diverse body organs in view of the intake of radon was additionally ascertained and found the maximum dose for lungs than other organs. The radiation dose received by bronchial epithelium by the means of inhalation was likewise high when contrasted with that by stomach walls through ingestion. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to assess the incidence and determinants of electroconvulsive therapy (ECT)-induced delirium. Materials and Methods: Using a retrospective study design, data of 488 patients undergoing modified ECT were evaluated for the development of new-onset prolonged delirium. Demographic and clinical parameters of patients who developed delirium and those who did not develop delirium were compared. Results: 5.7% of the patients developed prolonged post-ECT delirium. The use of quetiapine in higher doses and the lack of use of antidepressants while receiving ECT were associated with the development of prolonged post-ECT delirium. None of the other clinical and ECT-related parameters emerged as a significant factor associated with the development of prolonged post-ECT delirium. Conclusions: A small proportion of patients undergoing ECT develop post-ECT prolonged delirium. [ABSTRACT FROM AUTHOR]

Context: Organ transplantation can save thousands of lives as it is one of the greatest advancements of modern medical science but the process of organ donation and transplantation is very complex and multi-factorial, interplaying with- medical, legal, ethical, organizational and above all social factors. The future doctors can take up the role of promoting organ donation activity, especially the heart. Settings and Design: This cross-sectional questionnaire based survey study was conducted amongst the undergraduate medical students of our Institute, to ascertain their knowledge and ethical perception regarding orthotropic heart transplantation. Methods and Material: Students were approached in lecture halls and were asked to fill the questionnaire after explaining them the importance of this study in brief. Written consent for participation was taken from all of them. A total of 197 undergraduate students gave consent and filled the questionnaire. Statistical Analysis Used: All the quantitative variables were analyzed using mean and standard deviation and all the qualitative variables were described as numbers and percentages. Results: Nearly all the students knew the term organ donation and heart transplantation but in-depth knowledge of medical students on this topic was not good enough. Most participants (75%) considered "Internet" as their major source of information, while only 01% regarded academic books as their source of information. This strongly highlights the point that the undergraduate medical books with curriculum is largely lacking in basic aspects of organ donation and heart transplantation. Very few medical students (4.5%) knew about the Non-Governmental Organization (NGOs) working for transplant activity and also majority (82.2%) are unaware of legal aspects related to organ donation. Conclusions: Currently heart transplantation is a totally neglected topic in undergraduate medical curriculum. Inclusion of this complex but interesting topic by a short lecture or interactive seminar for undergraduate medical students may be the most cost-effective and durable innovation for the future. [ABSTRACT FROM AUTHOR]

Context: India has adopted active case finding (ACF) as an additional strategy to find its missing tuberculosis (TB) cases since 2017. Treatment outcomes of patients identified through ACF may be similar or different from those detected through routine passive case finding (PCF); currently, there are limited studies on this in India. Aim: The aim of this study was to assess differences in treatment outcomes of patients detected through ACF and PCF under the national TB program. Study Design: A study was conducted in six TB units of Haridwar district where ACF campaigns were conducted in 2017–2018. Methods: Data from patients detected by ACF (n = 72) and PCF (n = 184) were extracted from program records. Results: Of 72 patients detected by ACF, only 54 (75%) were initiated on treatment. A high proportion of initial loss to follow-up (25% vs. 0%) and delay in treatment initiation (4 days vs. 0 days) was observed in ACF patients as compared to PCF. The proportion of unsuccessful treatment outcome was 33% (n = 18) among ACF patients compared to 14% (n = 25) among PCF patients (adjusted relative risk: 2.6, 95% confidence interval: 1.7–4.0). Conclusion: High initial loss to follow-up, delay in treatment initiation, and poor treatment outcome among ACF patients are a major concern. The study results call for active follow-up after diagnosis and close monitoring during treatment for patients detected by ACF. [ABSTRACT FROM AUTHOR]

Context: Urodynamic study (UDS) and ultrasonography (USG) both are established investigations to assess the patients of benign prostatic hyperplasia (BPH). It is known that the prostate mass (PM) and post-void residual urine volume (PVR) are not significantly related to the patients' symptoms and degree of obstruction; however, the relation between the UDS, USG and patient's International Prostate Symptom Scoring (IPSS) has not been defined. Aims: To correlate the urodynamic parameters with IPSS, PM and PVR in patients with lower urinary tract symptoms (LUTS) suggestive of BPH. Settings and Design: An observational study carried out as a thesis project. Methods and Materials: Thirty male patients aged more than 40 years with LUTS suggestive of BPH were selected and underwent USG, UDS and IPSS. In UDS, the parameters studied were the maximum flow rate (Qmax), detrusor pressure (Pdet) and bladder compliance (BC). PM and PVR were studied in the USG. Statistical Analysis Used: IBM Statistical Package for the Social Sciences (SPSS) software version 16 (SPSS Inc., Chicago, USA). Pearson's correlation and two-sided significance levels were determined. Results: 1. Significant negative correlation between Qmaxand PVRUSG (r = −0.404, P= 0.027); PMUSG (r = −0.655, P= <0.001) and IPSS (r = −0.563, P= 0.001). 2. Significant positive correlation between Pdetand PVRUSG (r = 0.535, P= 0.002); PMUSG (r = 0.719, P= <0.001) and IPSS (r = 0.649, P= <0.001). 3. Significant negative correlation between BC and PVRUSG (r = −0.490, P= 0.006); PMUSG(r = −0.654, P= <0.001) and IPSS (r = −0.667, P= <0.001). Conclusions: UDS has a significant correlation with IPSS and USG findings and urodynamic parameters give a more specific diagnosis in BPH patients when it is combined with USG and IPSS. [ABSTRACT FROM AUTHOR]

Context: Eczema of hand or foot though not life-threatening, not only impacts daily activities and work productivity adversely, but also impairs interpersonal relationships. Materials and Methods: Cross-sectional study of 100 outpatients of hand and foot eczema at a tertiary care teaching institute. Epidemiological data was collated and quality of life (QoL) evaluated by dermatology life quality index (DLQI) score. Results: Forty seven had hand eczema, 45; foot eczema and 8; both. Peak incidence of hand eczema (38.2%) was in fourth decade and foot eczema (33.3%), fifth decade. Hand eczema was more frequent in females (32; 68%) and foot eczema in males (32; 71.1%). Hand eczema was more common among housewives (14; 29.7%) and foot eczema among manual labourers (26; 57.7%). A persistent course was seen in foot (44; 83%) whereas recurrent course in hand eczema (21; 38.1%). Aggravation on contact with irritants/allergens was associated more with hand (32; 58.1%) than with foot eczema (18; 33.9%). Association with atopy was not significant. Substance abuse was associated more with foot eczema (25; 47.1%). Impairment in QoL was significantly higher in hand eczema (mean DLQI, 16.33) as compared to foot eczema (12.83). Conclusion: Hand eczema prevalent among females showed a high rate of recurrence whereas foot eczema in males, has a persistent course. Atopy is not significantly associated. The impairment in QoL is much greater in hand eczema as compared to foot eczema. The studies on comparative analysis of hand vis-à-vis foot eczema do not appear to exist in literature whereas studies of QoL impairment on hand eczema are abound. [ABSTRACT FROM AUTHOR]

Background: Chronic and recurrent vesiculation over the palms and soles is termed chronic vesicular dermatitis. Its etiology is multifactorial and contact allergy plays an important role. Aim: The aim of the study is to evaluate the clinical relevance of patch test reactivity to common contact allergens in chronic palmoplantar vesicular dermatitis. Materials and Methods: An observational study was conducted enrolling 152 patients of chronic palmoplantar vesicular dermatitis. Patch testing was carried out with the Indian Standard Battery and also with the materials used by patients. Statistical analysis was carried out using SPSS software. Results: Among 152 patients, 91 were female and 61 male. The peak incidence was in the 14–24 years age group. Their occupations included housewives 48, laborers 26, factory workers 16, farm workers 14, and shopkeepers 12. Patch tests were positive in 79 (52%) patients, including 43 (28.3%) female and 36 (23.7%) male. Patch test reactivity was observed with nickel in 25 (16.4%); potassium dichromate in 21 (13.8%); fragrance mix in 17 (11.2%); p-phenylenediamine in 14 (9.2%); black rubber in 10 (6.6%); mercaptobenzothiazole in 8 (5.3%); and parthenium in 8 (5.3%) patients. Clinical relevance of positive patch tests was determined in 47 (59.5%) patients. Conclusions: Though patch test reactivity was higher in females as compared with males, the difference was not statistically significant. Clinical relevance of positive patch tests was established with nickel in 9 (19.1%) patients; antigens associated with rubber including black rubber, mercaptobenzothiazole, and thiuram mix in 7 (14.9%); potassium dichromate in 7 (14.9%); p-phenylenediamine in 6 (12.8%); and parthenium in 4 (8.5%) patients. [ABSTRACT FROM AUTHOR]

Scrub typhus, a mite-borne zoonotic disease, is endemic in several parts of India. It may cause multisystemic disease involving lungs, heart, spleen, liver, hematological system, and nervous system. Neurological involvement may include meningoencephalitis, cerebellitis, cranial nerve palsies, plexopathy, transverse myelitis, muscle dysfunction, neuroleptic malignant syndrome, parkinsonian syndrome, and Guillain–Barre syndrome. Here, we report a rare patient of scrub typhus, who developed meningoencephalitis followed by long-segment myelitis and axonal polyneuropathy, with hepatic, renal, hematological, and pulmonary involvement, following acute febrile illness with associated neurocysticercosis. He gained consciousness with a resolution of almost all of his complaints, with the exception of muscular power, which showed partial improvement following treatment with doxycycline, azithromycin, and steroids. What needs to be explored is whether the existence of neurological scrub typhus with neurocysticercosis is the coincidental price paid for living in the tropics or there is something more to it as in case of Japanese encephalitis and neurocysticercosis co-infection. [ABSTRACT FROM AUTHOR]

Preliminary results of ambient indoor and outdoor gamma dose rates estimated in 20 distinct areas of Amritsar city, Punjab, are exhibited by utilizing Dosimeter-Radiometer MKS-03 (SARAD). This study was planned in such a way to get a uniform and representative distribution of estimations. The indoor to outdoor dose rate ratio was ascertained which showed that the indoor gamma dose rate as contrasted with outdoor gamma dose rate has elevated levels of exposure due to confined space and poor ventilation. The indoor and outdoor annual effective dose rate was likewise estimated from the exposure point of view, and it varied from 0.35 to 1.61 mSv/y and from 0.11 to 0.44 mSv/y. The average values of outdoor and indoor effective dose rate levels in all of these locations were well below the world average value prescribed by the United Nations Scientific Committee on Effects of Atomic Radiations. [ABSTRACT FROM AUTHOR]

In the present study, the radon mass and thoron surface exhalation rates have been measured in the soil samples collected from the villages of the Amritsar and Tarn Taran districts of Punjab using the active portable device, i.e., SMART RnDuo monitor to quantify the level of rate of radon and thoron exhalation. The average values of radon mass exhalation rate were 20 ± 7 mBq kg−1 h−1 and 23 ± 5 mBq kg−1 h−1 in Amritsar and Tarn Taran districts, respectively. Similarly, the average value of thoron surface exhalation rate was 664 ± 237 Bq m−2 h−1 and 1531 ± 1503 Bq m−2 h−1 in Amritsar and Tarn Taran districts, respectively. [ABSTRACT FROM AUTHOR]

Melanoma is an aggressive skin cancer with high mortality. The sole of the foot is an uncommon site where it may remain unnoticed or be misdiagnosed. Melanoma-associated leukoderma (MAL) may be an early sign and a high index of suspicion in late-onset vitiligo may result in early diagnosis. We present a case of MAL with acral lentiginous melanoma (ALM) in an elderly female. [ABSTRACT FROM AUTHOR]

The article present a case study of a 41-year-married male with three episodes of depression and one hypomanic episode in the lifetime. It mentions that initially he was treated with antidepressants in the form of selective serotonin reuptake inhibitors. It also mentions that his routine investigations, electroencephalogram, and magnetic resonance imaging of the brain did not reveal any abnormality.

Restrictive dermopathy is a rare, autosomal recessive, lethal congenital skin disorder. This congenital genodermatosis could be mistaken for various other similar skin disorders. Diagnosis is a must in the context of genetic counseling for the subsequent pregnancy. We herein report a preterm male neonate with restrictive dermopathy, with additional feature of multiple bone fractures. [ABSTRACT FROM AUTHOR]

The article presents a case study related to 73-year-old male presented to our stroke emergency unit with complaints of acute onset of left upper limb weakness and aphasia. Topics include the thrombus migration in the intracranial circulation is a rare phenomenon and is seen mostly in the cases of middle cerebral artery (MCA) occlusion, the literature available suggests that the thrombus migration has associated with fragility, and the failure to achieve thrombolysis in cerebral infarction.

Background: Pseudoaneurysms (PSAs) of the internal carotid artery (ICA) are uncommon lesions. Various surgical and endovascular options are available for the management of these lesions. We describe our experience in using a spectrum of endovascular management strategies for ICA-PSA and present their outcome.Aims: To evaluate the role and efficacy of endovascular intervention in the management of ICA PSA.Materials and Methods: The clinical and angiographic data of 20 ICA PSAs from January 2008 till July 2016 were reviewed retrospectively. A meticulous evaluation of all the patients regarding their clinical symptoms, imaging findings (Ultrasound Doppler/CTA/MRI) and the endovascular techniques was performed. Clinical and imaging follow up for at least 1 year was also assessed.Results: There were 15 (75%) male and 5 (25%) female patients, with their age ranging from 11 months to 60 years. Eleven patients (55%) were of the paediatric age group. PSAs were seen in the cervical ICA in 12 patients (60%) and in the intracranial ICA in 8 patients (40%). The most common causes of PS formation were iatrogenic (n = 8), followed by trauma (n = 7), and infection (n = 5). Parent artery occlusion was performed in 10 patients (50%), stenting in 7 patients (35%), and PSA coiling in 3 patients (15%). Immediate and complete obliteration of the PSAs was achieved in all cases without any major procedural complication. Recurrence was diagnosed at 2 years, in one patient who had undergone parent artery occlusion. This was successfully retreated. None of our patients had immediate or delayed major neurological deficits.Conclusions: Endovascular treatment provides a safe and minimally invasive management option in patients with ICA PSA. It helps in the prevention of rupture of the PS and also its thromboembolic complications. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer is the second most commonly diagnosed cancer in India. The mother's awareness about the symptoms and risk factors has a large impact on the daughter's knowledge and attitude. Mother and adolescent daughter duos were selected as the sample as they are the target population at risk for suffering from carcinoma cervix. Mothers are the prime information providers and in an excellent position to aware their adolescent daughters about cervical cancer. Objectives: The aim of this study is to determine knowledge and attitude of adolescent girls and their mothers regarding cervical cancer and to find the association between the education of the mothers and their knowledge about risk factors. Materials and Methods: A community-based cross-sectional study was conducted among 100 duos of adolescent daughters along with their mothers residing in Balmiki Basti (Delhi), using a predesigned, pretested, semi-structured interview schedule. The collected data were analyzed using SPSS-22 version. Results: Only 61% of mothers and 52% of daughters have heard about cervical cancer. Inter-menstrual bleeding was the most common symptom recognized by the mother (50%) and daughter (44%) duos followed by postmenopausal bleeding (47% of mothers and 33% of daughters). Most common risk factors recognized by mothers and their daughters were promiscuity and tobacco and smoking. About 81% of mothers and 68% of daughters have a positive attitude toward internal examination by a gynecologist at least once in 3 years. Human papillomavirus infection was recognized as a risk factor by 13 among which 8 were educated till graduation (P < 0.05). Conclusions: Study revealed a low-level knowledge about cervical cancer among adolescent daughters and their mothers. Therefore, there is an urgent need to empower the women by educating them on this issue. Furthermore, there is a need to encourage the mothers to communicate the right information to their adolescent daughters. [ABSTRACT FROM AUTHOR]

Background: Several competing priorities with health and development sector currently deter research, and as a result of which evidence does not drive policy- or decision-making. There is limited operational research (OR) within the India's National Tobacco Control Programme, as it is in other middle- and low-income countries, primarily due to limited capacity and skills in undertaking OR and lack of dedicated funding. Few models of OR have been developed to meet the needs of different settings; however, they were found to be costly and time-consuming. Objective: To elucidate a cost-effective and less resource arduous training model for building capacity in OR focused on tobacco control. Materials and Methods: This 5½-day partly funded course enrolled 15 participants across the country and nine facilitators. The facilitator-participants interactions were initiated 2 weeks before the course, which enabled them to develop possible research questions and a plan for data analysis. Results: This article presents the new OR model along with experiences of the participants which will provide useful insights on lessons learned for planning similar courses in the future. While we faced several challenges in the process and the outputs were modest, several lessons were learned which will be instrumental in the future courses that we are planning to conduct. Conclusion: This low cost and less time intensive model can be applied in similar settings across range of public health issues. [ABSTRACT FROM AUTHOR]

Background: The histological spectrum of explant liver pathology and their prevalence has not previously been reported from the Indian subcontinent. (1) The study was performed to provide new insight into the prevalence of explant liver pathologies in this part of the world by retrospective analysis of the spectrum of histological changes, (2) to study the etiopathological association of cirrhosis, (3) to study the etiopathogenesis for development of hepatocellular carcinoma (HCC), and to analyze whether there is any association of macroregenerative and dysplastic nodule with HCC. Materials and Methods: Written records of all explant liver pathology service were entered into an electronic database. Retrospective analysis of the liver explants was performed from May 2015 to July 2016 at a tertiary-care center in India. Results: Maximum (97.2%) number of liver explants showed cirrhosis. Hepatitis C virus (HCV)-related chronic liver disease was the most common etiological factor for the development of cirrhosis in this part of the world followed by HBV and alcohol. The association between HCC and HBV was found to be statistically significant with a value of P = 0.009. The association between dysplastic nodules and HCC was also found to be significant. Conclusion: This is the first study to describe the histological spectrum of explant liver pathology from India. HCV forms the major disease burden for the chronic liver disease. There is a significant association of dysplastic nodules with HCC postulating their role as a precursor lesion in HCC. [ABSTRACT FROM AUTHOR]

Perioperative management of severe pulmonary hypertension (PH) is challenging. Anaesthesiologists come across perioperative management of such cases during incidental surgeries, surgery for various congenital heart diseases and valvular heart diseases and for caesarean section or painless labour in pregnant patient with Eisenmenger syndrome. Knowledge of pathophysiology of PH and novel drugs acting through different mechanisms is paramount in managing such patients. This review will help understanding pathophysiology of PH, anaesthetising patients with PH, use of novel drugs for PH and use of new mechanical devices for rescue of failing right ventricle. [ABSTRACT FROM AUTHOR]

REFERENCES 1 Gupta N, Anwar A, Varun N, Paneesar S, Nigam A. Adolescent sexual behaviour and its determinants: A hospital-based study. Dear Editor, Gupta I et al. i analyse adolescent sexual bahaviours and its determinants by conducting a hospital-based study.[[1]] Because of higher exposure to modern day communication devices, adolescents have access to those contents which were inaccessible just a generation ago. The researchers state that they assess for the first-time the route of intercourse, frequency of sexual activity and place preferred by the adolescents to engage in the lustful exercise. [Extracted from the article]

Lee et al.[[2]] suggested a surveillance bronchoscopy within 4-6 weeks of stent placement regardless of symptomatic status and indication for stent placement. Sir, Although self-expandable metallic stents (SEMS) are effective in palliation of symptoms, stent-related complications are not uncommonly reported in 40%-60% of cases.[[1]],[[2]],[[3]] The main complications of SEMS include the development of granulation tissue, tumor in-growth, re-stenosis, hemorrhage, migration, infection, and fracture. Airway stent complications: The role of follow-up bronchoscopy as a surveillance method. [Extracted from the article]

The exposure of natural background radiation imparts a major contribution to inhalation doses received by the public, and its amount depends on the lithology, altitude, and building construction materials. The preliminary results of indoor and outdoor gamma-ray dose rate of Udhampur district, Jammu and Kashmir, India are presented. Indoor radon and thoron gas concentration have also been measured by using the LR-115 based pin-hole detectors in the same villages and the estimated concentrations are within the recommended level of the International Commission of Radiological Protection. For the outdoor environment, the minimum and maximum gamma dose rate were 0.06 and 0.4 μSvh-1, whereas for indoor environment, the minimum and maximum gamma dose rates were 0.09 and 0.21 μSvh-1, respectively. Effects of lithology on indoor radon/thoron concentration and also on gamma dose rates have also been investigated. The average values of annual effective dose from background gamma radiations were well within the safe limit and does not cause health hazard to the inhabitants. [ABSTRACT FROM AUTHOR]

Background and Aim: Post-transplant liver biopsies form a critical part of management of complications arising post-transplant. The objective of this study was to analyze the Indian experience in pathologic diagnosis of liver biopsies after orthotopic liver transplantation (OLT) with special emphasis on cases presenting with intrahepatic cholestasis (IHC). Type, incidence, and timing of major complications were analyzed. All cases with IHC were retrospectively analyzed with clinical inputs to look for cryptic clues in subclassifying such cases. Materials and Methods: Forty-five post-transplant liver biopsies from 39 OLT patients were retrospectively analyzed from May 2015 to May 2016. All biopsies were stained with hematoxylin and eosin and Masson's Trichrome, and other stains were performed as required. Results: The number of liver biopsies performed for each patient ranged from 1 to 3. The timing of these biopsies varied from 5 days to >4 years post-transplant. Of the 39 patients who underwent post-transplant liver biopsies, most common etiology of a liver transplant was hepatitis C virus (HCV)-related chronic liver disease in 66.6% cases. The common complications post-transplant were acute cellular rejection (ACR) (33.3%), biliary stricture (13.3%), HCV recurrence (11.1%), plasma cell hepatitis (4.4%), chronic hepatitis (4.4%), IHC (22.2%), and others. On analysis of post transplant biopsy cases with IHC, we found that patients with high baseline HCV RNA levels had recurrences presenting only with prominent IHC without fibrosis and ballooning of hepatocytes. These changes might represent early stages of fibrosing cholestatic hepatitis (FCH). Conclusions: This study evaluated the types, incidence, and timing of major complications occurring after OLT. ACR remains major complication following transplant. The presence of IHC on biopsy, especially in HCV-positive patients, should prompt anti-HCV therapy even if other features of FCH were not found. [ABSTRACT FROM AUTHOR]

Objectives: The present study aimed to assess the validity of Indian Diabetes Risk Score (IDRS) and its association with body mass index (BMI) and glycosylated hemoglobin (HbA1c) for screening of diabetes and obesity. Methodology: A cross-sectional study was designed, and samples were randomly enrolled from Lucknow and its adjoining areas. Totally, 405 subjects were included in the study. We used diabetes risk factors (age, waist circumference, physical activity, and family history of diabetes) for screening of diabetes and abdominal obesity (AO) and BMI for screening of general obesity. HbA1c was used for confirming the diabetes patients in this population. Statistical analysis was applied to all data using SPSS software (version 20.0). P < 0.05 was considered statistically significant. Results: All 405 subjects were assessed for diabetic risk factors, BMI, and glycated hemoglobin. Of these, 56.3% subjects were aged =50 years. 1° and 2° AO was found in 47.9% and 40% subjects, respectively. About 27.1% subjects were found to have sedentary lifestyle, and 72.6% were found to have no family history of diabetes. According to IDRS, 272 subjects (67.2%) were found at high risk of diabetes (score =60). Based on BMI calculation, 198 subjects were obese, of which 79.3% were found at high risk for diabetes. A significant association was found between subjects with higher risk score and BMI (P < 0.001). Assessment of HbA1c showed that 97 (23.9%) were prediabetic and 204 (50.4%) were diabetic, of which 63.9% and 77%, respectively was at high risk for diabetes as per IDRS. A significant association was found between subjects with higher risk score and HbA1c (P < 0.001). Conclusion: Our study fully supports the validity of IDRS, as it can be used as a cost-effective tool for primary mass screening of diabetes. Moreover, its combination with BMI value and HbA1c can be used for strict monitoring for diabetes and obesity at primary health care centers to reduce the early development of diabetes complications and severe obesity comorbidities. [ABSTRACT FROM AUTHOR]

Background and Aims: Premedication is an integral component of paediatric anaesthesia which, when optimal, allows comfortable separation of the child from the parent for induction and conduct of anaesthesia. Midazolam has been accepted as a safe and effective oral premedicant. Dexmedetomidine is a selective alpha-2 agonist with sedative and analgesic effects, which is effective through the transmucosal route. We compared the efficacy and safety of standard premedication with oral midazolam versus intranasal dexmedetomidine as premedication in children undergoing elective lower abdominal surgery. Methods: This was a prospective randomised double-blinded trial comparing the effects of premedication with 0.5 mg/kg oral midazolam versus 1 μg/kg intranasal dexmedetomidine in children between 2 and 12 years undergoing abdominal surgery. Sedation scores at separation and induction were the primary outcome measures. Behaviour scores and haemodynamic changes were secondary outcomes. Student's t-test and Chi-square were used for analysis of the variables. Results: Sedation scores were superior in Group B (dexmedetomidine) than Group A (midazolam) at separation and induction (P < 0.001).The behaviour scores at separation, induction and wake up scores at extubation were similar between the two groups. The heart rate and blood pressure showed significant differences at 15, 30 and 45 min in Group B but did not require pharmacological intervention for correction. Conclusion: Intranasal dexmedetomidine at a dose of 1 μg/kg produced superior sedation scores at separation and induction but normal behavioural scores in comparison to oral midazolam in paediatric patients. [ABSTRACT FROM AUTHOR]

Context: Raising tax on tobacco products is one of the key tobacco control strategies. Globally, it has led to decrease in overall cigarette consumption but on the other hand contributed to increased sale and purchase of loose cigarettes. These loose cigarettes have many important public health implications. Aim: To assess the association between practice of buying loose cigarettes and intensity of smoking. Materials and Methods: A secondary analysis of Global Adult Tobacco Survey, India 2009-2010 data was performed in May 2014, on adult population age 15 years and above. The key outcome variable was "intensity of smoking" defined as average number of cigarettes smoked per day, whereas the key exposure variable was "practice of purchasing loose cigarettes." Descriptive statistical analysis was performed using EpiData software (version 2.2.2.182) and STATA version 12.1. Results: Nearly, 57% of current cigarette smokers (approximately 3.46 million) bought loose cigarettes. The proportion of buying loose cigarettes decreased with increasing level of education and wealth index as well as least among government employees. The intensity of smoking was 70% less among loose cigarette buyers than nonbuyers (odds ratio [OR]: 0.29, 95% confidence interval [CI]: 0.24-0.34). It was found to be significantly lower in rural areas (OR: 0.81, 95% CI: 0.68-0.97) and among homemakers and those who had formal schooling. Conclusion: This study showed that loose cigarette buying is associated with decreased in smoking intensity. This may be due to increased taxes leading to increased buying of single cigarettes. These findings, therefore, highlight a need for a comprehensive policy and further studies on loose cigarette selling. [ABSTRACT FROM AUTHOR]

Background: Cognitive behavior therapy (CBT) involving exposure and response prevention is the gold standard psychotherapeutic intervention for obsessive-compulsive disorder (OCD). However, applying traditional CBT techniques to treat patients with predominant obsessions (POs) without covert compulsions is fraught with problems because of inaccessibility of mental compulsions. In this context, we examined the efficacy of mindfulness-integrated CBT (MICBT) in patients with POs without prominent overt compulsions. Materials and Methods: Twenty-seven patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of OCD were recruited from the specialty OCD clinic and the behavior therapy services of a tertiary care psychiatric hospital over 14 months. Patients had few or no overt compulsions and were free of medication or on a stable medication regimen for at least 2 months prior to baseline assessment. All patients received 12--16 sessions of MICBT on an outpatient basis. An independent rater (psychiatrist) administered the Yale--Brown Obsessive-Compulsive Scale (YBOCS) and the Clinical Global Impression Scale at baseline, mid- and post-treatment, and at 3-month follow-up. Results: Of the 27 patients, 18 (67%) achieved remission (55% reduction in the YBOCS severity score) at 3-month follow-up. The average mean percentage reduction of obsessive severity at postintervention and 3-month follow-up was 56 (standard deviation [SD] = 23) and 63 (SD = 21), respectively. Conclusions: Our study demonstrates that MICBT is efficacious in treating patients with POs without prominent overt compulsions. The results of this open-label study are encouraging and suggest that a larger randomized controlled trial examining the effects of MICBT may now be warranted. [ABSTRACT FROM AUTHOR]

Type 2 diabetes (T2D) represents an escalating burden worldwide, particularly in China and India. Compared with Caucasians, Asian people with diabetes have lower body mass index, increased visceral adiposity, and postprandial glucose (PPG)/insulin resistance. Since postprandial hyperglycemia contributes significantly to total glycemic burden and is associated with heightened cardiovascular risk, targeting PPG early in T2D is paramount. Premixed insulin regimens are widely used in Asia due to their convenience and effectiveness. Data from randomized controlled trials and observational studies comparing efficacy and safety of biphasic insulin aspart 30 (BIAsp 30) with biphasic insulin lispro mix (LM 25/50) and versus other insulin therapies or oral antidiabetic drugs (OADs) in T2D demonstrated that BIAsp 30 and LM 25/50 were associated with similar or greater improvements in glycemic control versus comparator regimens, such as basal-bolus insulin, in insulin-naïve, and prior insulin users. Studies directly comparing BIAsp 30 and LM 25 provided conflicting glycemic control results. Safety data generally showed increased hypoglycemia and weight gain with premixed insulins versus basal-bolus insulin or OADs. However, large observational trials documented improvements in glycated hemoglobin, PPG, and hypoglycemia with BIAsp 30 in multi-ethnic patient populations. In summary, this literature review demonstrates that premixed insulin regimens are an appropriate and effective treatment choice in T2D. [ABSTRACT FROM AUTHOR]

Introduction Acute renal failure (ARF) is one of the most challenging medical problems in the tropics. Late or misdiagnosis and inadequate management often responsible for important complications including ARF. Material and methods This was a prospective study carried in a tertiary health care center of North India to study the profile and outcome of acute renal failure due to tropical infections (dengue, malaria, typhoid, and leptospira). The patients were followed up during the hospital stay and any morbid event or mortality or recovery was recorded and the data statistically analyzed. Results A total of 92 patients were included. Male to female ratio was 3:1. Mean age was 43.3 ± 18.2 years. Dengue fever was the most common etiology (45.7%) of tropical ARF followed by leptospira (27.2%). Oliguric acute renal failure was present in 85.9% and proteinuria in 46.7% of patients. 21% patients required dialysis. The overall mortality was 16% which was maximum in Plasmodium falciparum (25%) followed by dengue fever (23.8%). There was no significant correlation of sex, age, degree of renal failure, dialysis requirement, and peak serum creatinine between survivors and nonsurvivors. Comparing the variables among survivors and nonsurvivors the presence of proteinuria was significantly correlated to mortality ( p = 0.0096). Conclusion A significant number of patients develop acute renal failure due to tropical infections. A high index of suspicion will help in the etiological diagnosis, treatment and thus a favorable outcome of these patients. [ABSTRACT FROM AUTHOR]

Radon concentration has been estimated in drinking water samples of 17 selected locations in Amritsar city of Punjab, India. RAD7, an electronic solid state radon monitor has been used to evaluate the radon concentration in collected drinking water samples. The corresponding annual mean effective dose for ingestion and inhalation was calculated according to parameters introduced by UNSCEAR (2000) report. The radon concentration in drinking water samples has been found to vary from 0.53 ± 0.11 to 11.20 ± 1.40 Bql-1. The values of radon concentration in these samples were found below the recommended limit proposed by USEPA (1991) and European Commission (2001). The range of calculated annual effective dose varied between 1.45 and 30.57 μSvy-1. These values lie well within the safe limit prescribed by the WHO (2003) and European council (2005). The purpose of this study was to assess the radiological risk, if any, to human health due to consumption of drinking water that is available at Amritsar city. [ABSTRACT FROM AUTHOR]

We are reporting a case of superficial spreading melanoma (SSM) on left palm of a 37‑year‑old pregnant housewife. She had a small acquired melanocytic nevus on her left palm since childhood, which changed its consistency and color in the last 4 months. Dermoscopy of the lesion indicated malignant changes. The lesion was managed surgically using split‑thickness skin graft. The histopathology report was suggestive of SSM with positive HMB‑45 cells. SSM is very rare on the acral site, and it is very difficult to differentiate it from acral lentiginous melanoma. The rarity of the site (acral nonchronic sun damage) with evolution during pregnancy and importance of management approach are reasons for publishing this case. [ABSTRACT FROM AUTHOR]

Consent is a legal requirement of medical practice and not a procedural formality. Getting a mere signature on a form is no consent. If a patient is rushed into signing consent, without giving sufficient information, the consent may be invalid, despite the signature. Often medical professionals either ignore or are ignorant of the requirements of a valid consent and its legal implications. Instances where either consent was not taken or when an invalid consent was obtained have been a subject matter of judicial scrutiny in several medical malpractice cases. This article highlights the essential principles of consent and the Indian law related to it along with some citations, so that medical practitioners are not only able to safeguard themselves against litigations and unnecessary harassment but can act rightfully. [ABSTRACT FROM AUTHOR]

Oro-facial clefts are one of the most common birth defects and may be associated with other genetic anomalies. Aggressive periodontitis is a rare condition that progresses rapidly, but affects only a small percentage of the population. Most of the cases of aggressive periodontitis are familial. Even though, literature has documented the association of various genetic disorders with aggressive periodontitis, the aggressive periodontitis in patients with isolated cleft lip (CL) have never been addressed. Here, we report a rare case of isolated CL with generalized aggressive periodontitis. The concomitant presentation of isolated CL with aggressive periodontitis in an individual has clinical significance for multi-disciplinary care. [ABSTRACT FROM AUTHOR]