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Association of gestational diabetes with maternal disorders of glucose metabolism and childhood obesity. Dear Editor, Puneeta Gupta et al. underscore one of the drawbacks of modern medical science, or of the way it's now practised: unnecessary, costly, avoidable and potentially harmful care.[[1]] They correctly state that at the beginning, medical science used to deal with only diseased patients by diagnosing and treating them. Risk factors, mortality, and cardiovascular outcomes in patients with type 2 diabetes mellitus. [Extracted from the article]

Risk factors and outcome among COVID-19 exposed and quarantined healthcare workers: A study on the status of existing practices of standard precautions. Dear Editor, Kumar et al. analyze risk factors and outcome among Covid-19 exposed and quarantined healthcare workers. [Extracted from the article]

The atrophic rolling and boxcar acne scars [Figure 2]a were lifted by intradermal injection of PRP gel filler resulting in a marked improvement in the appearance of atrophic scars [Figure 2]b due to tissue augmentation and remodeling of the extracellular matrix.{Figure 1}{Figure 2} Though there is a solitary report of the use of PRP gel as a dermal filler for prominent nasolabial folds by aesthetic surgeons,[[2]] it has not been used previously as a filler in patients with atrophic acne scars. Platelet poor plasma (PPP) gel has been used as a dermal filler for the correction of facial wrinkles, tear trough deformity and recently for the boxlike scars of chickenpox.[[1]] Solution We have devised a cost-effective autologous platelet-rich plasma (PRP) dermal filler gel for the correction of rolling and boxcar subtypes of soft atrophic acne scars based on the thermal denaturation and polymerization of plasma proteins. Tissue augmentation by PRP dermal filler gel in the case of soft atrophic acne scars not only has a volume effect with an immediate improvement in contour but may also induce remodeling of extracellular matrix by the activation of platelet-derived growth factor and various cytokines. [Extracted from the article]

An increase in length, curling, pigmentation, or thickness of eyelashes is termed eyelash trichomegaly. It may be inherited as an isolated trait or as a feature of a congenital syndrome such as Oliver-McFarlane syndrome or oculocutaneous albinism. Acquired conditions associated with eyelash trichomegaly include HIV infection, connective tissue disorders, and the administration of drugs such as cyclosporine and topical latanoprost. We hereby report a rare case of acquired eyelash trichomegaly with diffuse hair loss and "lupus hairs" on the scalp in a 16-year-old female diagnosed with systemic lupus erythematosus. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented on the topic of airway management using high flow nasal cannula to increase safe apneic period and securing the airway with an awake fiberoptic bronchoscope in the case of a 72-year-old male with left ventricular ejection fraction of 20 percent.

Background: To evaluate the effectiveness of surgical intervention in managing empyema thoracis in children. Patients and Methods: A total of 70 patients aged 1-14 years diagnosed to have empyema thoracis and who underwent tube thoracostomy from January 2010 to December 2013 were studied. All patients of which 12 patients needed decortication. Results: The mean age of the study group was 5.44 years and 48.6% were male and 51.4% were female. The most common symptoms at admission were fever (90%), dyspnoea (73%), cough (70%) and chest pain (23%). Pleural fl uid cultures were sterile in 60% of patients. The most frequently identifi ed micro-organisms was Staphylococcus aureus (34.2%). Treatment with chest tube drainage was successful in 55 (78.6%) patients. Three patients got expired. Twelve patients had decortications, all of which were successful. The lung re-expansion time was 8.00 ± 1.68 days (range: 5-13 days) in those patients in whom chest tube drainage was successful, whereas it was 7.50 ± 2.623 days (range: 4-14 days) in patients in whom decortication was done. The post-procedure stay was 10.00 ± 1.809 days (range: 7-15 days) in patients with successful chest tube drainage and 9.5 ± 2.902 days (range: 6-17 days) in case of decortication cases. Conclusion: Tube thoracostomy should be done in all cases of empyema thoracis regardless of stage, as this leads to reduction in septic load. Decision of decortication should be taken without any delay. [ABSTRACT FROM AUTHOR]

Objectives: Benzodiazepines (BZDs) are the first-line drugs in alcohol-withdrawal syndrome (AWS). Baclofen, a gamma-aminobutyric acidB (GABAB) agonist, controls withdrawal symptoms without causing signifi cant adverse effects. The objective of this study was to compare the cost-effectiveness of baclofen and chlordiazepoxide in the management of uncomplicated AWS. Materials and Methods: This was a randomized, open label, standard controlled, parallel group study of cost-effectiveness analysis (CEA) of baclofen and chlordiazepoxide in 60 participants with uncomplicated AWS. Clinical efficacy was measured by the Clinical Institute Withdrawal Assessment for alcohol (CIWA-Ar) scores. Lorazepam was used as supplement medication if withdrawal symptoms could not be controlled effectively by the study drugs alone. Both direct and indirect medical costs were considered and the CEA was analyzed in both patient's perspective and third-party perspective. Results: The average cost-effectiveness ratio (ACER) in patient's perspective of baclofen and chlordiazepoxide was Rs. 5,308.61 and Rs. 2,951.95 per symptom-free day, respectively. The ACER in third-party perspective of baclofen and chlordiazepoxide was Rs. 895.01 and Rs. 476.29 per symptom-free day, respectively. Participants on chlordiazepoxide had more number of symptom-free days when compared with the baclofen group on analysis by Mann-Whitney test (U = 253.50, P = 0.03). Conclusion: Both study drugs provided relief of withdrawal symptoms. Chlordiazepoxide was more cost-effective than baclofen. Baclofen was relatively less effective and more expensive than chlordiazepoxide. [ABSTRACT FROM AUTHOR]

Background: The relatively safe nature and cost-effectiveness of herbal extracts have led to a resurgent interest in their utility as therapeutic agents. Therefore, this prospective, double-blind, randomly controlled clinical trial was designed to compare the antiplaque and antigingivitis effects of newly formulated mouthrinse containing tea tree oil (TTO), clove, and basil with those of commercially available essential oil (EO) mouthrinse. Materials and Methods: Forty patients were selected for a 21-day study period and randomly divided into two groups. The test group patients were given newly formulated herbal mouthrinse and the control group patients were given commercially available EO mouthrinse. The Plaque Index (PI), Gingival Index (GI), and Papillary Marginal Attachment (PMA) Index were recorded at baseline, 14 days, and 21 days. The microbial colony forming units (CFU) were assessed at baseline and 21 days. Results: Test group patients using herbal mouthrinse showed significant improvement in GI (0.16), PI (0.57), and PMA (0.02) scores. These improvements were comparable to those achieved with commercially available EO mouthrinse. However, the aerobic and anaerobic CFU of microbiota were reduced with the herbal mouthrinse (P = 0.0000). Conclusion: The newly formulated herbal mouthrinse and commercially available mouthrinse were beneficial clinically as antiplaque and antigingivitis agents. Newly formulated mouthrinses showed significant reduction in microbial CFU at 21 days. So, our findings support the regular use of herbal mouthrinse as an antiplaque, antigingivitis, and antimicrobial rinse for better efficacy. [ABSTRACT FROM AUTHOR]

Background and Purpose: Posterior inferior cerebellar artery (PICA) like other intracranial arteries is prone to aneurysm formation. Aneurysms usually arise from the vertebral artery (VA) - PICA junction and the proximal segment of the PICA. The use of endovascular treatment as an alternative treatment to surgery has been increasing. We present our last 5 years experience in treating the ruptured proximal PICA aneurysms. Materials and Methods: Retrospective analysis of records of all patients with ruptured VA-PICA junction aneurysms treated at our referral center between July 2008 and July 2013 was performed. Over the last 5 years, we came across 17 patients who had aneurysms of proximal PICA or VA-PICA junction out of which 13 patients underwent endovascular treatment for ruptured saccular VA-PICA junction aneurysms and were the focus of this research. Follow-up studies ranged from 6 months to 3 years. Results: All the patients presented with an acute intracranial hemorrhage on NCCT. All the aneurysms were at VA-PICA junction with partial or complete incorporation of PICA origin in the sac. Endovascular treatment of all the 13 aneurysm was successful in the first attempt. Aneurysms were treated with balloon assisted coiling either by placing the balloon across the VA-PICA junction (n = 3) or in the vertebral artery proper (n = 9). Stent assisted coiling VA-PICA was performed in one aneurysm (n = 1). There was no intra-procedural rupture of the aneurysms. Conclusion: Endovascular therapy of ruptured proximal PICA aneurysms is possible and safe with the use of adjuvant devices and should be considered as first line treatment. [ABSTRACT FROM AUTHOR]

Objectives: DiabCare India 2011 was a cross-sectional study in patients with diabetes mellitus, undertaken to investigate the relationship between diabetes control, management and complications in a subset of urban Indian diabetes patients treated at referral diabetes care centres in India. Materials and Methods: This was a cross-sectional, multicentre (330 centres) survey in 6168 diabetes patients treated at general hospitals, diabetes clinics and referral clinics across India. Patient data, including medical and clinical examination reports during the past year were collected during their routine visit. The patients' and physicians' perceptions about diabetes management were recorded using a questionnaire. Results: A total of 6168 subjects with diabetes (95.8% type 2), mean age 51.9 ± 12.4 years and mean duration of diabetes, 6.9 ± 6.4 years were included. Mean HbA1c was 8.9 ± 2.1% and the mean fasting (FPG), post prandial (PPG) and random (RBG) plasma glucose levels were 148 ± 50 mg/dl 205 ± 66 mg/dl and 193 ± 68mg/dl respectively. Neuropathy was the most common complication (41.4%); other complications were: Foot (32.7%), eye (19.7%), cardiovascular (6.8%) and nephropathy (6.2%). The number of diabetic complications increased with mean duration of diabetes. Most (93.2%) of the patients were on oral anti-diabetic drugs (OADs) and 35.2% were on insulin (±OADs). More than 15% physicians felt that the greatest barrier to insulin therapy from patient's perspective were pain and fear of using injectable modality; 5.2% felt that the greatest barrier to insulin therapy from physician's perspective was the treatment cost; 4.8% felt that the major barriers to achieve optimum diabetic care in practice was loss to follow-up followed by lack of counselling (3.9%) and treatment compliance (3.6%). Conclusion: DiabCare India 2011 has shown that type 2 diabetes sets in early in Indians and glycaemic control is often sub-optimal in these patients. These results indicate a need for more structured intervention at an early stage of the disease and need for increased awareness on benefits of good glycaemic control. It cannot be overemphasized that the status of diabetes care in India needs to be further improved. (ClinTrials.gov identifier: NCT01351922) [ABSTRACT FROM AUTHOR]

Background: Calcium phosphate cements (CPC) are a group of biomaterials possessing wide scope of use in various branches of medical science. These materials have been proposed to be highly biocompatible and osteoconductive. This study is based on a newly developed CPC formulation (Chitra-CPC) and is aimed at the evaluation of its biocompatibility through an Endodontic Usage Test in a porcine study model. Objective: To evaluate the periapical tissue reaction to Chitra-CPC when used as a root canal sealer/filler material in comparison with a resin sealer, AH Plus (Dentsply). Materials and Methods: The procedure was done on porcine animal model following the ISO 7405 criteria. The material was implanted intentionally into the periapical area of 36 teeth through a root canal procedure carried out in six animals which were divided equally among 1-month and 3-month time periods. Results were based on the histological evaluation of the autopsied specimens after the prescribed time periods. Results: Mild to moderate periapical tissue reaction was found in Chitra-CPC samples belonging to the 1-month time period, whereas majority of the 3-month CPC samples showed an absence of inflammation. Samples of AH Plus in 1-month period showed severe to moderate inflammation, whereas 3-month AH Plus samples had a mild to moderate inflammation. Conclusions: Chitra-CPC is a biocompatible material. [ABSTRACT FROM AUTHOR]

J Family Med Prim Care 2020;9:4505-6. 2 Yasir S, Kumar H. India bans 118 Chinese apps as Indian soldier is killed on disputed border. India - a tale of one country, but stories of many states. "Where the mind is without fear & the head is held high" - Rabindranath Tagore (1861-1941) in Gitanjali, Nobel Laureate in Literature 1913 Dear Editor, On this Independence Day of India, Raman Kumar narrates story of indefatigability, resilience & diversity of our civilization.[[1]] Recent past saw invasion & then occupation of our land & people & only 73 years ago we got freedom from those colonial masters. [Extracted from the article]

REFERENCES 1 Garg S, Gangadharan N, Bhatnagar N, Singh MM, Raina SK, Galwankar S. Telemedicine: Embracing virtual care during COVID-19 pandemic. - Albert Einstein, Nobel Laureate in Physics (1921), aphorism 1945-46, Einstein archives 36-570 Dear Editor, Garg et al. inform us the benefits & pitfalls of embracing virtual care during Covid-19 pandemic. [Extracted from the article]

Background/Aim: Minimal hepatic encephalopathy (MHE) impairs health.related quality of life and driving ability of the patient. Objective: We assessed the utility of the inhibitory control test (ICT), critical flicker frequency (CFF), and psychometry in the diagnosis of MHE. Patients and Methods: Consecutive patients with cirrhosis underwent number connection tests A and B (NCT.A, B), digit symbol test (DST), line tracing test (LTT), serial dot test (SDT), CFF, and ICT at baseline and after four hours. Fifty healthy subjects served as controls for the ICT test. Results: Fifty patients with cirrhosis (43.4 ± 10.2 yrs, M: F 42:8) underwent psychometric tests [NCT.A (48.3 ± 17.7 vs. 42.6 ± 17.3 sec, P = 0.001), NCT.B (85.7 ± 40.1 vs. 90.2 ± 37.0 sec, P = 0.18), DST (23.5 ± 9.3 vs. 23.0 ± 8.7, P = 0.45), LTT (96.6 ± 48.2 vs. 96.8 ± 46.8 sec, P = 0.92), SDT (88.0 ± 39.5 vs. 83.4 ± 37.2 sec, P = 0.02)] at baseline and after four hours. Target accuracy of ICT was lower in patients with cirrhosis compared with controls (88.4 ± 5.6 vs. 95.6 ± 2.1, P = 0.01), whereas ICT lures were higher (18.3 ± 4.2 vs 10.2 ± 2.8, P = 0.01). Patients with cirrhosis showed a reduction in lures in the second evaluation compared with the first (18.3 ± 4.2 vs. 17.1 ± 4.3, P = 0.003) but no change in target accuracy (88.4 ± 5.6 vs. 88.4 ± 5.3, P = 0.97). Control subjects did not show any change either in lures (10.2 ± 2.8 vs. 10.3 ± 2.1, P = 0.65) or target accuracy (95.6 ± 2.1 vs. 95.5 ± 2.2, P = 0.82). The sensitivity and specificity of ICT test for the diagnosis of MHE at lure rate >16.5 was 88.5 and 56%, respectively. CFF in patients with MHE (38.4 ± 1.8 vs. 38.6 ± 1.5, P = 0.3) and non MHE (40.6 ± 2.2 vs. 40.8 ± 2.2, P = 0.6) did not show any difference after four hours as in controls (41.9 ± 2.4 vs. 42.1 ± 2.0, P = 0.3). Thirty one (31%) patients preferred psychometric tests, 57 (57%) preferred CFF and only 12 (12%) preferred ICT (P = 0.001). Conclusions: ICT, CFF, and psychometric tests are useful tools to assess MHE, and CFF was preferred by this study cohort. [ABSTRACT FROM AUTHOR]

The article discusses the study with an aim to assess the effect of behavior change communication (BCC) package among pregnant women regarding neonatal care. The study shows that increase in BBC packages and significant improvement was found in intervention group with regard to knowledge of danger signals, physiological variants, management of breastfeeding-related problems. It concludes that BCC package had favorable impact on behavior of mothers for neonatal care in intervention group.

Background: Controversy persists with regard to how best we can categorize symptomatic dimension of Schizophrenia. Aim of the study was to compute factorial dimensions in Indian subset of schizophrenic patients and to compare them with five factor pentagonal model extracted in western studies. Materials and Methods: 150 inpatients of Schizophrenia with acute exacerbation were subjected to PANSS rating within one week of admission and statistical calculation done based on exploratory factor analysis. Results: Five factors namely negative, autistic, activation, positive and depression were extracted wherein negative factors showed highest percentage of total variance supporting five factor modal of western literature Conclusion: A consensus is gradually emerging regarding symptomatic dimensions of Schizophrenia. [ABSTRACT FROM AUTHOR]

Objectives: Maladaptive cognitive schemas can lead to biases during clinical assessment or psychotherapeutic interventions. This study aimed to explore the cognitive schemas among mental health professionals. Materials and Methods: 100 mental health professionals, of both genders, equally divided between psychiatrists, psychologists, social workers, and psychiatric nurses, were approached and administered the Young Schema Questionnaire - Short Form after written informed consent. Results: Males had higher maladaptive schemas than female respondents across all schema domains, viz., disconnection/rejection, impaired autonomy, impaired limits, other-directedness, and overvigilance (P ≤ 0.05). Psychiatrists had higher maladaptive schemas than psychologists (P ≤ 0.05). Age was weakly but positively corelated with the schemas of self-sacrifice (P = 0.038) and unrelenting standards (P = 0.002). Conclusions: Mental health professionals also may have maladaptive schemas, which needs to be addressed through schema therapy. [ABSTRACT FROM AUTHOR]

Melanoma of the oral cavity is a rare malignant disease. On account of the presence at relatively obscure areas in the oral cavity, most of oral malignant melanomas are diagnosed at a late stage. Early diagnosis is essential for successful treatment and perhaps is the key factor in improving the prognosis of oral malignant melanoma. However, no large clinical series exist, and in fact, clinical cases are the sole key source of information. We hereby present a series of four cases of primary oral malignant melanoma of South-East Asian ethnic origin, with long-term, regular follow-up. The age of the patients ranged between 40 and 70 years, with equal sex predilection, and the gingiva was found to be the most common site of its occurrence. Based on clinical and histological parameters, all the cases were diagnosed as primary malignant melanoma, which were further confirmed by using immunohistochemical markers. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate the pharmacognostic characters of an important medicinal plant, Holoptelea integrifolia (H. integrifolia) Roxb. Methods: The pharmacognostic studies were carried out in terms of organoleptic, microscopic, macroscopic and fluorescence analysis. Results: The characteristic microscopic features of leaves were observed as trichomes, multicellular trichomes, xylem cells, phloem cells, collenchyma, vascular bundles, spongy parenchyma and palisade cells. The characteristic microscopic features of root bark included cork cambium, primary cortex, phloem fibers, medullary rays, endodermis, pericycle and lignified fibers in the transverse section and longitudinal section. The characteristic microscopy of root bark powder showed the presence of cortex cells, sieve tubes, calcium oxalate crystals and lignified fibers. Macroscopic study showed that leaf shape–oval, apex–acute, base–cordate and leaf margin was entire with glabrous surface, bitter taste and characteristic odour. The morphological features of root bark showed deep fissured, rough and firm surface with rhitydome and the periderm parallel to cambium. Conclusions: Various pharmacognostic characters observed in this study help in the identification and standardization of H. integrifolia. [Copyright &y& Elsevier]

In 2009, consensus guidelines were published on intensification of insulin therapy using the premix analog biphasic insulin aspart (BIAsp) 30 in the treatment of type 2 diabetes, based on the recommendations of an international, independent expert panel. The guidelines included recommendations and titration algorithms for intensification from basal insulin once (OD) or twice daily (BID) to BIAsp 30 BID, from OD BIAsp 30 to BID, and from BID BIAsp 30 to three times daily (TID). Building on these recommendations, the objective was to develop similar, simple and effective guidelines for intensiication switch from a BIAsp 30 to a mid-/high-ratio premix regimen for the vast majority of patients with type 2 diabetes. A panel of independent experts with extensive clinical experience in premix analog therapy met in October 2009 to review the therapeutic role of mid- and high-ratio premixes (BIAsp 50 and 70, respectively). The panel outlined a series of algorithms for intensifying BIAsp 30 BID and TID with mid-/high-ratio premixes, along with practical suggestions relating to intensiication for individual patients. A simple tool to aid dose adjustment was also developed. The guidelines suggested here should assist physicians in introducing mid-/high-ratio premixes to optimize the insulin therapy of patients with type 2 diabetes who are failing to achieve glycemic targets on a BIAsp 30 BID or TID regimen. [ABSTRACT FROM AUTHOR]

Background: Pain perception, expression, tolerance, and the healthcare provider’s evaluation and management of pain are affected by the gender of the patient. To the best of our knowledge, there is lack of gender-based evaluation of pain during cataract surgery under topical anesthesia. Aims: This study has been initiated to evaluate and determine pain experience during cataract surgery under topical anesthesia and to study the gender-based differences of the same. Settings and Design: Hospital-based study involving cataract surgery under topical anesthesia using standard cataract surgery. It was an interventional comparative case series. Materials and Methods: One hundred and sixty patients were included in four groups, according to the gender and choice of surgery. Patients underwent either phacoemulsification with foldable intra ocular lens (IOL) or manual small incision cataract surgery with rigid IOL under topical anesthesia. Patients ranked their pain experience on VAS scale after the surgery and the surgeon recorded the ease/difficulty accordingly using a questionnaire. Statistical Analysis Used: MedCalc version 10.2.0.0 (www.medcalc.be) for windows was used to analyze the results. Analysis of variance (ANOVA) test and Kruskal-Walis test were used to analyze the data. Results: The overall visual analog scale (VAS) score was 0.8 (SD 1.3 range 0-8), with no statistical difference among the groups (P=0.5). The average surgeon’s score was 3.3 (SD 0.71 range 3-7), with no statistical difference between the groups (P=0.37).There were no sight threatening complications during the surgery in any group. Conclusions: The outcome of the study demonstrates that the patients undergoing cataract surgery under topical anesthesia perceive comparable pain and discomfort irrespective of their gender. [ABSTRACT FROM AUTHOR]

During war, sharp high-speed missiles have been driven inside the brain; however, in civilian practice it is rare to see such episodes. An approximately 10-cm long nail was driven inside the brain in an attempt to commit suicide by a schizophrenic patient. The case is being reported for its rarity in civilian practice and as a case of clinical interest. After investigating the patient by plain X-rays and a CT scan, he was operated by a neurosurgical team and the nail was successfully removed. In post-operative phase, patient was given medical and psychiatric care along with psychological counseling. The patient made good uneventful recovery in the post-operative phase. [ABSTRACT FROM AUTHOR]

Background: The tension-free vaginal tape (TVT) procedure is based on the integral theory that the midurethra has an important role in the continence mechanism. Transobturator vaginal tape (TOT) is the same in concept as TVT but it differs from TVT in that, rather than passing through the retropubic space, sling materials are drawn through the obturator foramina. We prospectively compared TVT with TOT with respect to operation-related morbidity and surgical outcomes at a minimum follow up of 12 months. Materials and Methods: A total of 36 women with stress urinary incontinence (SUI) were alternatively assigned to the TVT group (18) or the TOT group. Preoperative evaluation included urodynamic study and I-QOL questionnaire. One year after operation the surgical result, patient satisfaction, incontinence quality-of-life questionnaire, long-term complications, and uroflowmetry were evaluated in both groups. Results: The patient characteristics in both the TVT and TOT group were similar. Mean operating time was significantly shorter in the TOT group likened to the TVT group. Conclusions: Both the TVT and TOT procedures are minimally invasive and similar in operation-related morbidity. TOT appears to be as effective as TVT, and safer than TVT for the surgical treatment of SUI in women at 12 months follow-up. [ABSTRACT FROM AUTHOR]

Background/Purpose: Anorectal malformations are one of the most common congenital defects. This study was undertaken to study the hospital incidence of anorectal malformations (ARM), frequency of various types of defects, their sex distribution and the spectrum of anomalies associated with ARM. The effect of presence of an associated defect on mortality and morbidity was also studied. Materials and Methods: One hundred consecutive children attending the pediatric surgery department were included in this study. A detailed history was taken, and examination was performed for the primary as well as the associated defects. Appropriate investigations like invertogram, cologram were done wherever indicated. Management was as per the standard protocol. The data was recorded and analyzed. Results: Out of the 100 patients, 51 were males and 49 females. One out of every 6.62 admission was for ARM. Twenty percent of the female babies had high, 76% intermediate and 4% had low anomalies, whereas 80.39% males had high, 3.92% intermediate and 15.6% showed low malformations. Ten percent of the patients had pouch colon. Associated anomalies were seen in 33 patients -- 20 males and 13 females; 19 in high, 10 in intermediate, 1 in low group and 3 children with cloacal malformations. Associated defects seen were urogenital (17%), cardiovascular (7%), gastrointestinal (9%), genital (5%) and limb defects (7%). There were 8 deaths, and complications were seen in 13 patients. Ten patients had two or more defects associated with ARM. Conclusions: Anorectal malformations occurred equally in males and females. Females had intermediate defects more frequently, rectovestibular fistula being the commonest. Males were more likely to have high lesions; anorectal agenesis without fistula was the commonest defect. The most common associated defects seen were vesicoureteric reflux and esophageal atresia. Complications were seen more commonly in males with high lesions. There was a significant association between presence of an associated defect and mortality and morbidity. [ABSTRACT FROM AUTHOR]

Current technique of airway management for impaled knife in the back includes putting the patient in lateral position and intubation. We present here a novel technique of anesthesia induction (intubation and central line insertion) in a patient with impaled knife in the back which is simple and easily reproducible. This technique can be used for single lung ventilation using double lumen tube or bronchial blocker also if desired. [ABSTRACT FROM AUTHOR]

Fungi are a relatively uncommon cause of brain abscess in neonates and early infancy. They are usually associated with predisposing factors like prematurity, low birth weight, use of broad-spectrum antibiotics, and prolonged stay in the intensive care unit. Candida tropicalis (C. tropicalis) is rapidly emerging as a nosocomial threat in the neonatal intensive care settings. This case report describes a neonate with C. tropicalis brain abscess who was diagnosed early and managed aggressively with a favorable outcome. Inadvertent use of intravenous antibiotics can have serious complications such as invasive fungal infection. Correct microbiological diagnosis is the key to successful treatment of deep-seated pyogenic infection. Fungal etiology should always be studied in relevant clinical settings. [ABSTRACT FROM AUTHOR]

Idiopathic eruptive macular pigmentation (IEMP) is an uncommon, rather under-reported disease entity of the pediatric age characterized by asymptomatic, brownish hyperpigmented macules involving the neck and trunk with no preceding inflammation or exposure to drug. Here we report this case to increase awareness of this entity among dermatologists, dermatopathologists and pediatricians. A 11-year-old healthy boy presented with brownish-gray to dark, discrete, asymptomatic macules on the face, trunk, neck and limbs of insidious onset. Histopathologic examination showed melanophages, mild perivascular lymphohistiocytic infiltrate in the papillary dermis and papillomatosis. The natural course of the disease is spontaneous remission without treatment, which was so even in our patient. IEMP is a benign entity with an excellent prognosis as it exhibits spontaneous resolution. It falls into the differential diagnoses of asymptomatic hyperpigmentatory disorders in pediatric population. Awareness of the entity leads to avoidance of unnecessary aggressive damaging treatment. [ABSTRACT FROM AUTHOR]

Madelung deformity is a rare inherited disorder associated with endocrine disorders like Turner's syndrome, pseudohypoparathyroidism, but can be seen with short stature homeobox deficiency conditions such as Leri-Weill dyschondrosteosis (LWD) and Langers mesomelic dysplasia. It has also been reported following trauma to the distal radius epiphysis neoplasia mucopolysaccharidosis (MPS) and achondroplasia. Madelung deformity is an abnormality of distal radial epiphysis where in progressive ulnarand volartilt of the articular surface occurring in association with distal subluxation of ulna. A13-year-old girl was referred to us for evaluation of bilateral deformity of wrist and short stature. There was ulnar deviation and dorsal tilt of bilateral hands without history of pain to the joint trauma and family history of similar illness. On X-ray, wrist showed malformed distal radial epiphysis with dorsal and ulnar shift and with increased length of phalanges suggestive of Madelung deformity. X-ray spine was normal. Ultrasound abdomen showed normal uterus and ovary and her follicle stimulating hormone. Luteinizing hormone was normal and so was urine MPS screening. Based on the above points the diagnosis of LWD was made. [ABSTRACT FROM AUTHOR]

Aims and objectives: All public-private mix (PPM) facilities caring for tuberculosis (TB) patients in Lahore city, Pakistan, under four models: PPM1 (general practitioners), PPM2 (non-governmental organizations), PPM3 (private hospitals) and PPM4 (others). To assess the pre-treatment loss to follow-up (LTFU), defined as patients documented in the laboratory registers but not in the treatment registers of any PPM facility, among sputum smear-positive TB patients diagnosed during January–March 2015, and unfavorable treatment outcomes among patients registered for treatment and associated factors. Methods: This was a retrospective cohort study reviewing existing program records. Poisson regression was used to identify factors associated with outcomes. Data collection, variables and sources: The data were extracted from the TB laboratory registers and TB treatment registers maintained in the PPM facilities. The variables included type of PPM model, laboratory serial number, patient's name, age, sex, date of diagnosis and treatment start, smear grade, type of TB and treatment outcome. The data were collected using a structured proforma. Two electronic databases were created. Results: The two databases were then electronically matched for Results: Of 2473 patients diagnosed, 1590 (64%) were lost to follow-up before treatment. This was higher among males (68%) and the elderly (79%), and lower among 'high positives' (smear grading 2+ or 3+, 53%) and in the PPM1 model (34%). Of 883 patients started on treatment, 165 (19%) had unfavorable outcomes: 8% LTFU, 5% treatment failure, 3% died and 3% not evaluated. Previously treated patients (34%) and children (44%) had the worst outcomes. Conclusion: Pre-treatment LTFU was alarmingly high and requires urgent attention, including the development and institution of mechanisms for patient tracking using information and mobile phone technology, and making TB notification mandatory in the private sector. [ABSTRACT FROM AUTHOR]

A letter to the editor discussing the case of traumatic pseudo-aneurysm of the frontopolar branch of anterior cerebral artery (ACA) managed by intra-arterial embolization is presented.

Carbamazepine and other anticonvulsants are commoner cause of severe adverse cutaneous drug reactions such as erythema multiforme, toxic epidermal necrolysis (TEN), and Stevens-Johnson syndrome (SJS). We report a case of SJS rapidly progressing to TEN with a combination of haloperidol and carbamazepine in a patient with bipolar affective disorder. The pathophysiological mechanism underlying this reaction is discussed. [ABSTRACT FROM AUTHOR]

A 57-year-old diabetic and hypertensive man presented with a short history of fever, dry cough and right side chest pain. A chest radiograph showed right pleural based homogenous shadow in middle and lower zones with obliteration of right costo-phrenic angle suggestive of right side effusion. Aspiration of pleural fluid revealed frank pus for which inter-costal tube drainage was performed. Due to persistence of empyema, the patient was subjected to thoracoscopy. Thoracoscopy showed multiloculated empyema. Thoracoscopic pleural biopsy and fluid showed septate fungal hyphae. Thoracotomy and parietal pleurectomy, with resection of part of right lower lobe, was carried out. Pleural fluid, pleural and lung tissue culture grew Aspergillus fumigatus. The patient showed good recovery with voriconazole after thoracotomy. [ABSTRACT FROM AUTHOR]

The article presents a case study of a fatal anatomic variation of a bilateral retropharyngeal internal carotid artery (ICA) in a 45-year-old female patient. The patient underwent contrast-enhanced computed tomography (CT) for staging of non-Hodgkin lymphoma and detecting enlarged lymph nodes in the neck. It mentions that angiographic images were made, confirming the anatomical variation of retropharyngeal course of the ICA.

The article presents a case study of a 21-year-old patient diagnosed with spinal dysraphism masking the presence of an early-onset variant of spinal dural arteriovenous fistula (SDAVF) through Magnetic resonance imaging (MRI). Topics discussed include categories of spinal vascular malformations such as congenital lesions and acquired lesions, the patient's history of swelling in the lower back and categories of spinal AVMs such as Dural arteriovenous fistula (AVFs) Type one.

The article discusses the case of waxing and waning tracheal tube obstruction in a 26-year-old road traffic accident victim who was presented to the emergency department in an unconscious state with nasal bleeding. When the oral cuffed polyvinyl chloride (PVC) endotracheal tube (ETT) was removed, it was found that it has impacted blood clot covering the tube tip and Murphy's eye. The cases of ETT obstruction due to blood clot as reported by FS Xue and colleagues are also cited.

The article describes the case of a 40-year-old man who was diagnosed with hypertrophic olivary degeneration (HOD). The patient presented with complaints of headache of nine months duration. A magnetic resonance imaging resonance was performed which showed multiple cavernous angioma. It notes that HOD, which is found in lesions involving the dentatorubro-olivary system, has characteristic imaging and temporal evolution.

The article presents a case study of a 62-year-old male patient diagnosed as peri ampullary carcinoma. He complained of hyperpigmentation over nose, hand and few areas of foot preceded by pain in these areas. It was found that patient had received two cycles of Capecitabine. The patient was diagnosed as a case of hand and foot syndrome. Palmar‑plantar erythrodysesthesia (PPE) is a distinctive and relatively frequent toxic reaction. Pyridoxine is the most useful treatment.

A letter to the editor is presented regarding a case which demonstrates a floating lens sign in traumatic lens dislocations due to blunt trauma.