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Introduction: Otitis media (OM) is a major health issue involving mainly middle ear and is quite prevalent in developing countries in the low socioeconomic group. The aim of this study was to isolate the organisms associated with chronic suppurative otitis media (CSOM) and to detect the antibiogram of the aerobic isolates. Methods: A total of 150 patients clinically diagnosed with CSOM were enrolled in the study and the samples were obtained from each patient using sterile cotton swabs and cultured for microbial flora. Drug susceptibility testing for aerobic isolates was conducted using Kirby-Bauer disc diffusion method. Results: Out of the 119 (79.33%) were culture positive, of which 93 (78.15%) were pure bacterial isolates and 26 (27.95%) were mixed cultures. Bacterial isolates in pure cultures were Staphylococcus aureus in 46 isolates (49.46%), Pseudomonas aeruginosa 22(23.6%). Antimicrobial profile of aerobic isolates revealed maximum sensitivity to amikacin (95.5%), ceftriaxone (83.4%) and gentamicin (82.7%). Conclusions: Knowing the etiological agents of CSOM and their antimicrobial susceptibility is of essential importance for an effective treatment, prevention of both complications and development of antibiotic resistance and finally, the reduction of the treatment costs. Keywords: Attico-antral, Chronic suppurative otitis media, Pseudomonas aeruginosa, Staphylococcus aureus.

Objective The aim of this study is to investigate the effects of gemcitabine maintenance on progression-free survival (PFS) in patients with metastatic gallbladder cancer (GBC). Materials and Methods Sixty patients with unresectable or metastatic GBC having ongoing response to treatment with initial six cycles of gemcitabine and a platinum-based doublet chemotherapy were prospectively randomized on day 21 of the 6th cycle in 1:1 fashion to receive either maintenance gemcitabine 1 g/m2 intravenously on day 1 and day 8 of three weekly cycle or observation. Survival analysis was performed using the Kaplan–Meier method and comparisons by the log-rank test. A p-value < 0.05 was considered as statistically significant. Results Of 60 patients, a total of 56 were available for final analysis. The median PFS was 4.7 months (3.1–6.3) in gemcitabine arm and 2.6 months (2.4–2.8) in observation arm, hazard ratio (HR) 0.196 (95% confidence interval [CI]: 0.1–0.39), p < 0.001. Median overall survival in gemcitabine arm was 12.4 months (9.15–15.6) as opposed to 9.9 months (8.29–11.5) in observation arm, HR 0.76 (95% CI: 0.43–1.35), p = 0.354. The grade 3 or 4 side effects in maintenance arm were transaminitis (17.9%), thrombocytopenia (17.8%), neutropenia (14.2%), and febrile neutropenia (7.1%). Conclusions Maintenance gemcitabine therapy in unresectable/metastatic GBC patients responding to first-line gemcitabine and platinum treatment contributes to increase PFS with minimal and manageable side effects.

Background Long-lasting insecticidal nets (LLINs) remain a cornerstone of malaria control, but strategies to sustain universal coverage and high rates of use are not well-defined. A more complete understanding of context-specific factors, including transmission intensity and access to health facilities, may inform sub-district distribution approaches and tailored messaging campaigns. Methods A cross-sectional survey of 2190 households was conducted in a single sub-county of western Uganda that experiences highly variable malaria transmission intensity. The survey was carried out approximately 3 years after the most recent mass distribution campaign. At each household, study staff documented reported LLIN use and source among children 2 to 10 years of age and performed a malaria rapid diagnostic test. Elevation and distance to the nearest health facility was estimated for each household. Associations between parasite prevalence and LLIN use were estimated from log binomial regression models with elevation and distance to clinic being the primary variables of interest. Results Overall, 6.8% (148 of 2170) of children age 2–10 years of age had a positive RDT result, yielding a weighted estimate of 5.8% (95% confidence interval [CI] 5.4–6.2%). There was substantial variability in the positivity rates among villages, with the highest elevation villages having lower prevalence than lowest-elevation villages (p p Conclusions LLIN use and sourcing was correlated with household elevation and estimated distance to the nearest health facility. The findings suggest that current facility-based distribution strategies are limited in their reach. More frequent mass distribution campaigns and complementary approaches are likely required to maintain universal LLIN coverage and high rates of use among children in rural Uganda.

AIMS: The real-world data regarding the response rates, tolerability, and toxicities of immunotherapy is very limited. The aim of this study is to analyze these characteristics in patients who have received immunotherapy for metastatic renal cell carcinoma (RCC) or urothelial cancer (UC). Methods: Retrospective review of patients over a year from 2017–2018 diagnosed with metastatic RCC and UC in our institute who received checkpoint inhibitors was done. PFS and OS were calculated. Results: A total of 16 patients, 11 with metastatic RCC and 5 patients with Metastatic UC were included in this study. All patients were male and Median age was 57.5 years. Median Number of cycles administered was 6. 50% of patients had a partial response to treatment, 16.6% of patients had stable disease and 33.3% of patients had progressive disease. There were no complete responses to therapy. Median Follow up was 9 months. The median PFS of the whole cohort was 6 months, while in RCC was 6 months and in UC was 1 month. Median OS of the whole cohort is 7 months, while the median OS for RCC and UC were 7 months and 3 months respectively. Fatigue was the most common adverse effect noted and Anaemia was the most common hematological side effect seen with immunotherapy in this study. Conclusion: This is real-world data of the use of the immune checkpoint inhibitors in the resource-limited setting. The benefit of Immune checkpoint inhibitors may in advanced renal cell cancers and Urothelial cancers may be different from that seen in the Western population.

Introduction: Dermatophytosis is a superficial infection, which varies according to the geographic region wise, socio-economic level of the population, time of study, climatic variations, presence of domestic animals and age. Aim: To determine the clinical profile of dermatophytic infections and causative fungal species in the various clinical presentations. Materials and Methods: A total of 105 samples of clinically suspected dermatophytosis were collected. Direct microscopy by Potassium Hydroxide (KOH) and culture on Sabouraud’s Dextrose Agar (SDA) and Dermatophyte Test Medium (DTM) was done. Statistical analysis was done using SPSS 19.0 software. Results: Out of 105 clinically suspected cases of dermatophytosis, Tinea corporis 47 (44.8%) was the commonest clinical type followed by tinea cruris 19 (18.09%), Commonest age group affected was 31-40 years (27.6%) with male to female ratio of 2.38:1. Of the dermatophytes isolated, T. rubrum 19 (51.35%) was the most common followed by T. mentagrophyte 16 (43.24%) and E. floccosum 2 (5.4%). Conclusions: The major types of tinea were tinea corporis and tinea cruris. Among dermatophytosis, T. rubrum was the predominant etiological agent present and DTM being a good screening medium in the laboratory diagnosis of dermatophytosis when compared to SDA with antibiotics. Keywords: Dermatophyte test medium, Dermatophytosis, Sabouraud dextrose agar, Tinea.

Breast cancer (BC) is the second most common cancer and the second leading cause of mortality among women globally. Approximately 20 to 25% of BC patients have amplification of the human epidermal growth factor receptor 2 (HER2) genes, a marker of poor prognosis. However, the introduction of anti-HER2-therapies (trastuzumab, followed closely by lapatinib, pertuzumab, trastuzumab emtansine, and neratinib) has changed the natural history of HER2-positive BC and improved the outcome in HER2-positive BC patients. The preeminence of anti-HER2 combination therapy in achieving complete inhibition of the various HER receptor dimers has been demonstrated in clinical studies. However, despite these therapeutic advances, tumors expressing estrogen receptor have poorer responses to targeted therapy and are more likely to relapse. A better understanding of resistance to existing anti-HER2 agents, along with the role played by the microenvironment and of interconnected signaling pathways, can permit tailor-made therapeutic options for each patient. This review aimed to evaluate treatment approaches for BC patients with HER2-positive disease in the adjuvant and neoadjuvant settings, also exploring the possibilities of extended duration of anti-HER2 maintenance therapy.

Peripherally inserted central catheters (PICC) are widely used in oncology for administration of chemotherapy. However, sometimes there may be complications associated with them such as infections, thrombosis and rarely fracture of catheter and embolization of the catheter fragments. Here we report a case of 59-year old gentleman with locally advanced carcinoma of head of pancreas, who had spontaneous fracture of a silicon based PICC and later migration of the catheter fragment through the heart and further into the right pulmonary arterial system. The embolized catheter fragment was retrieved through a vascular snare from the right femoral venous route. This case highlights the fact that silicon PICCs are fragile and have a high risk of spontaneous dislodgement and should be replaced by better alternative polyurethane PICCs.

Spleen is a very infrequent site of metastasis despite the fact that it is the most vascular organ in the body. Even if systemic metastasis occurs, splenic metastasis largely remained asymptomatic due to its large functional reserve, and most often, the metastasis is detected incidentally on follow-up scan. Many cases of asymptomatic splenic metastasis detected on follow-up scans are reported in literature from different primary sites. Herein, we report a similar case of a 33-year-old male who presented with isolated splenic recurrence after a long treatment-free interval following curative treatment of adenocarcinoma jejunum. As stated, there are few previous reports of isolated splenic metastasis from carcinoma colon, but considering small intestinal adenocarcinoma, this is the first unique case reported to the best of our knowledge. Due to rarity of clinical scenario and lack of established guidelines, the treatment of such cases varies from patient to patient, and the knowledge, whatever we owe, is on the basis of case reports only.

Introduction: Scaphoid fractures are very notorious to unite. These fractures are usually undiagnosed or overlooked, thus presenting late as non-union. Non-Union Scaphoid is a common complication of Scaphoid fracture which is quite challenging to treat. Casts or Closed reductions or even open reduction with simple bone grafts are generally not enough, so we did pronator quadratus osteomuscular transposition flap to revascularise the non-union Scaphoid. A series of 7 cases treated using vascularized bone graft. Material and Methods: This study was done on seven cases of non-union Scaphoid with Pronator Quadratus vascularized bone graft. Alnot classification and Herbert classification was use. Postoperatively cases were assessed clinically and radiologically. Results: Six out of total 7 cases had satisfactory clinical outcome and 1 case complained of restricted and painful wrist movements. Conclusion: Vascularized bone grafts have excellent results in otherwise difficult to treat non union Scaphoid.

Background The Democratic Republic of the Congo (DRC) bears a large share of global malaria burden despite efforts to control and eliminate the disease. More detailed understanding of individual and household level characteristics associated with malaria are needed, as is an understanding of how these characteristics vary spatiotemporally and across different community-level malaria endemicities. An ongoing study in Kinshasa Province is designed to address gaps in prior malaria surveillance in the DRC by monitoring malaria across seasons, age groups and in high and low malaria sites. Across seven sites, 242 households and 1591 individuals are participating in the study. Results of the enrollment questionnaire, rapid diagnostic tests and PCR testing of dried blood spots are presented. Results Overall malaria prevalence in the study cohort is high, 27% by rapid diagnostic test and 31% by polymerase chain reaction, and malaria prevalence is highly varied across very small geographic distances. Malaria prevalence is highest in children aged 6–15. While the majority of households own bed nets, bed net usage is less than 50%. Conclusions The study cohort will provide an understanding of how malaria persists in populations that have varying environmental exposures, varying community-level malaria, and varying access to malaria control efforts.

Aims: The primary objective of this study was to determine the response rates of the gemcitabine and cisplatin combination chemotherapy in treatment naive patients with inoperable gall bladder cancer. The secondary objectives were to evaluate the toxicity, progression free survival (PFS), and overall survival. Materials and Methods: Treatment naive patients with histologically proven inoperable gallbladder cancer treated with gemcitabine and cisplatin chemotherapy between March 2010 and December 2014 were included in this retrospective study. The dose of gemcitabine and cisplatin was 1 g/m2 on day 1 and 8, and 75 mg/m2 on day 1, in a 21-day cycle respectively. Computed tomography scan was used for response assessment. Results: There were 32 men and 59 women with a median age of 52 years (range 30–67 years). Of the 91 patients, 9 (9.9%) patients achieved a complete response and 41 (45.1%) patients achieved a partial response for an overall response rate of 55%. The median number of chemotherapy cycles administered were 6 (range 1–9). The median progression free survival (PFS) was 5.4 months [95% confidence interval (CI) 3.9–7.9 months], with one year survival rate of 34.1%. Common toxicity criteria grade 3 or 4 anemia was seen in 4 (4.4%) and 2 (2.2%) patients respectively. Grade 3 neutropenia and thrombocytopenia was observed in 10 (10.9%) and 9 (9.9%) patients respectively. Conclusion: The combination of gemcitabine and cisplatin is active in advanced gallbladder carcinoma with mild toxicity.

Introduction: Occupational hazards such as accidental exposure to sharp, cuts, and splashes are common among health-care workers (HCWs). Aims and Objectives: To determine the occurrence of self-reported occupational exposures to these hazards and to know the prevalent practices following the exposure. The second aim was to know the baseline antibody levels against hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) immediately after these accidents. Methods: An observational prospective study was done in the HCWs of a tertiary care academic health organization of North India from January 2011 to December 2013. At the time of self-reporting of injury, a questionnaire was administered. Blood sample of HCWs and of the source, if identified, was collected for baseline HBV, HCV, and HIV serum markers. The exposed HCWs were followed up and repeat testing was done after 3–4 weeks for seroconversion up to 6 months. Results: A total of 476 injuries were reported. Needlestick injury of fingers was the most common. Doctors were found to have the highest exposure rate (73.7%) distantly followed by nurses (19.1%). A significant number of the HCWs (125, 26.3%) vaccinated in past had hepatitis B surface antibody (anti-HBs) titers ≥10 mIU/mL (protection defined as anti-HBs level ≥10 mIU/ml). Only 44 sources were found to be seropositive (11 for HIV, 9 for HCV, and 24 for HBV). No seroconversion was seen in any of the exposed HCWs after 6 months. Conclusions: The incidence of needlestick and sharp injuries is most often encountered in emergency wards. Anti-HBs titers were suboptimal in many of the HCWs requiring a booster dose of HBV vaccination.

BACKGROUND: Gemcitabine plus cisplatin has been established as a standard chemotherapy regimen for advanced biliary tract cancers (BTCs) based on the phase III UK ABC-02 study, which included all types of biliary cancers. There is very limited data regarding the effectiveness of known chemotherapeutic regimens especially in IHCC. METHODS: Records of 63 patients diagnosis of IHCC who received Gemcitabine and Carboplatin (G-C Regimen) chemotherapy as a first line were retrospectively reviewed. The primary aim of this study was to assess the response rate of gemcitabine carboplatin-based chemotherapy as a first line therapy in advanced intrahepatic cholangiocarcinoma (IHCC). The secondary objectives were to assess toxicity, progression free survival and overall survival. RESULTS: There were 38 men and 25 women in our study with a median age of 56.75 years (range 31–78 years). Of the 38+25= 63 patients, 21 patients (33.8%) progressed, 5 patients (8.06%) had complete response, 25 patients (40.3%) had partial response, 12 patients (19.3%) had stable disease. Overall response rate was 48.36% and tumor control rate was 67.6%. Progression free survival was 5.3 months and overall survival of 10.3 months was seen. The most common grade 3–4 toxicities were anemia, neutropenia, and thrombocytopenia. Most common nonhematological toxicity was fatigue. CONCLUSION: Gemcitabine in combination with carboplatin has activity against advanced IHCC. Our results are comparable with other gemcitabine carboplatin studies as well as gemcitabine cisplatin-based studies.

Brain metastasis is a rare manifestation of any gynecological malignancy. Brain metastasis from ovarian cancers is rare but increasing in the post-chemotherapy era due to increased survival. We report a rare case of ovarian malignancy who had recurrence as an isolated brain metastasis soon after cytoreductive surgery followed by adjuvant chemotherapy. The management of such cases should be individualized based on site and extent of disease, which usually includes multimodality approach with surgery, radiation and chemotherapy.

IntroductionMalawi’s malaria burden is primarily assessed via cross-sectional national household surveys. However, malaria is spatially and temporally heterogenous and no analyses have been performed at a subdistrict level throughout the course of a year. The WHO recommends mass distribution of long-lasting insecticide-treated bed nets (LLINs) every 3 years, but a national longitudinal evaluation has never been conducted in Malawi to determine LLIN effectiveness lifespans.MethodsUsing District Health Information Software 2 (DHIS2) health facility data, available from January 2018 to June 2020, we assessed malaria risk before and after a mass distribution campaign, stratifying by age group and comparing risk differences (RDs) by LLIN type or annual application of indoor residual spraying (IRS).Results711 health facilities contributed 20 962 facility reports over 30 months. After national distribution of 10.7 million LLINs and IRS in limited settings, malaria risk decreased from 25.6 to 16.7 cases per 100 people from 2018 to 2019 high transmission seasons, and rebounded to 23.2 in 2020, resulting in significant RDs of −8.9 in 2019 and −2.4 in 2020 as compared with 2018. Piperonyl butoxide (PBO)-treated LLINs were more effective than pyrethroid-treated LLINs, with adjusted RDs of −2.3 (95% CI −2.7 to −1.9) and −1.5 (95% CI −2.0 to −1.0) comparing 2019 and 2020 high transmission seasons to 2018. Use of IRS sustained protection with adjusted RDs of −1.4 (95% CI −2.0 to −0.9) and −2.8% (95% CI −3.5 to −2.2) relative to pyrethroid-treated LLINs. Overall, 12 of 28 districts (42.9%) experienced increases in malaria risk in from 2018 to 2020.ConclusionLLINs in Malawi have a limited effectiveness lifespan and IRS and PBO-treated LLINs perform better than pyrethroid-treated LLINs, perhaps due to net repurposing and insecticide-resistance. DHIS2 provides a compelling framework in which to examine localised malaria trends and evaluate ongoing interventions.

Background Altretamine has been approved for the treatment of ovarian cancer around four decades back. But still this agent is not used widely by medical oncologists in the view of controversial results reported in literature. Aim The aim of this study was to assess the anti-tumor activity (time to treatment failure) and toxicity profile of altretamine. Methods Patients of advanced ovarian carcinoma were included in this study that had undergone surgery, failed at least one chemotherapy regimen and completed at least one month of altretamine (150mg/m 2 /day for 14 consecutive days of a 28 day cycle with prophylactic anti-emetic agents). Results A total of 13 patients were evaluated. The median age at presentation was 55 years (46–83 years) and performance status ECOG I 8/13 (61.6%); ECOG II 2/13 (15.4%); ECOG III 3/13 (23.1%). 7.7% of patients (1/13) failed to respond to one chemotherapy regimen; 46.2% (6/13) to two CT regimen; 15.4% (2/13) to three CT regimen, and 30.8 (4/13) to four CT regimens. 0 patient showed complete response (CR), 2 partial response (PR), 7 had stable disease (SD). This led to overall disease control rate (CR+PR+SD) of 9/13 (69%) patients. The median time of treatment failure was 8.17 months (95% CI 6.87–9.47). In hematological toxicity only one patient (1/13) 7.7% had grade II anemia. No patient had significant neutropenia/thrombocytopenia. Conclusion Altretamine demonstrates meaningful prolongation of lifetime to disease progression in advanced pretreated carcinoma ovary patients with favorable toxicity profile.

Introduction: HIV infection represents a major public health problem for both developing and developed countries as it has grown to global pandemic. Spectrum of clinical presentation of HIV can greatly vary with geopolitical, socioeconomic and cultural environment. Aims: The aim of this study was to estimate the prevalence, socio-demographic conditions, clinical presentations, opportunistic infections and the possible associated risk factors for acquiring HIV infection. Materials and Methods: An observational prospective study was conducted from January 2010 to December 2014 at our centre situated in north India. As per the strategy and policy prescribed by NACO, tests were performed on the serum samples. Results: Out of the total 35369 clients tested for HIV infection, 292 were found to be HIV-1 seropositive. Two HIV-2 cases were found among the studied population. The seroprevalence of HIV was found to be 0.83% (294/35369). Mean age of the study group was 30 ± 5.65 (range: 02 - 80) years. Overall positivity rates among attendees were found to be 0.97% (138/14098), 0.96% (35/3610), 0.82% (7/850), 0.78% (22/2810) and 0.65% (92/14001) in the years 2010, 2011, 2012, 2013 and 2014 respectively. Heterosexual route of transmission was the major route of infection in 78.2 % patients. At the time of presentation, it was observed that Tuberculosis (14.9%) was the most common opportunistic infection. Conclusion: The study shows that there is a decreasing trend in the HIV prevalence in North India. However, the number of HIV cases is still significant and suggests the need for focused prevention efforts in high-risk groups.

Background: Significant burn injuries induce a state of immunosuppression that predisposes patients to infectious complications, thus the rate of nosocomial infections are higher. Rapidly merging multidrug resistant among the various isolate in indoor burn patients are depending on time-line becoming serious threat for managing therapeutically. Objective of this study is to determine the aetiological factor, prevalence, antimicrobial susceptibility pattern and emerging nosocomial pathogens.Methods: A prospective study was carried in burn ward of K.L.E.’s Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum for the period of 1 year. Pair of wound swab were collected from patient having burnt more than 30% (RULE OF NINE) on 3rd day of stay. Sample were collected aseptically from 30 patients and processed by convectional culture and biochemical identification procedures and tested against commonly used antibiotics.Results: 30 patients that fall under inclusive criteria were enrolled in the study. The total burn surface area (TBSA) ranges from 30-82%. The ratio of female to male patient suffering burn wound in our study is 1.5:1. Aetiology of burn is heat (moist/dry) mostly. Depending upon degree of burn, most of patient suffered from 20 degree (superficial to deep) injury. From 30 swab cultures, 42 isolates were identified during the study in which mixed were 66.66% and one is fungi. The most commonly isolated is Pseudomonas aeruginosa (45.24%) then Klebsiella pneumoniae (19.04%), Acinetobacter spp. (14.28%), Staphylococccus aureus (11.90%). Among gram positive isolates, isolates are found to be most resistant to Erythromycin (100%) and Co-trimoxazole (100%) and sensitive to Vancomycin (71.42%). Among gram negative isolates are found to be most resistant to Gentamicin (91.65%), Ciprofloxacin (82.35%), Ceftazidime (82.35%) and sensitive to Meropenem (52.95%), Piperacillin (35.30%), Carbenicillin (29.41%).Conclusions: Pseudomonas aeruginosa was found to be the most common isolate. The nature of microbial wound colonization and flora changes with time should be taken into consideration in empirical antimicrobial therapy.

4042 Background: Colorectal cancers are 3rd most common cause of cancer globally however studies of rectal cancers alone in younger patients are scarce. Rectal cancers in Asian patients present at a younger age and has an aggressive tumor biology. This study looks at rectal cancer in young patients, ≤30 years old, with the aim to report clinico-epidemiologic profile and treatment outcomes in this subgroup. Methods: Retrospective analysis was conducted at a tertiary care centre. Of total 845 rectal cancer patients between 2012-2017, 103 patients of young rectal cancers were enrolled. Kaplan Meier method was used for survival analysis and cox regression analysis was done to identify factors affecting survival. Results: Young rectal cancer patients constituted 12.2% of the total rectal cancer patients. Male: Female ratio was 2.3:1 and the mean age was 24.7 ± 3.9 years. Around 73.8 % patients had locoregional disease (stage I/II/III) at presentation.CEA levels were elevated in 36.9% of patients, while most common histology was signet ring cell histology which was present in 51.5% of patients. Of 76 patients with locoregional disease, 75% received neoadjuvant chemoradiotherapy, 7.9% received neoadjuvant chemotherapy alone while 3.9% received neoadjuvant radiotherapy alone. Of 76 patients with locoregional disease, 55 patients underwent surgery of which 53.9% underwent low anterior resection while 18.4% underwent abdomino-perineal resection. Pathologic CR rates were seen in 13.3%, while recurrences were seen in 55.4% of non-metastatic patients. Overall 5-year survival for the whole study group was 19.5%, while 1-year PFS and 3-year DFS for metastatic and non-metastatic disease were 5% and 43.8% respectively. On regression analysis elevated CEA levels and not achieving a pathologic CR (pCR) with neoadjuvant therapy had a trend towards worse overall survival (HR 2, 95% CI 1-4, p = 0.063), (HR 4.7, 95% CI 0.64-35.1, p = 0.125) respectively. Conclusions: Rectal cancers in Asia present at younger age and this younger population is associated with advanced stage, increased CEA at presentation, aggressive histology and poor survival. CEA raise and not achieving pCR were associated with trend towards worse survival.

Background: Healthcare Associated Infections (HAIs) are a major cause of high morbidity, disability, mortality and rising costs for health systems. Preventing the HAI risk by planning and implementing effective preventive strategies is important to safeguard patient health. Handwashing is one of the fundamental measures for preventing transmission of hospital-acquired infections.Methods: This cross-sectional observational study was conducted in the surgical ICU from January to February 2018 to evaluate the presence of adhesion to the different aspects of HH. Inclusion criteria included all nurses and allied healthcare workers of surgical ICU while all other HCWs were excluded. Two observers collected all HH data. During this analysis, 3000 HH opportunities were observed. HH compliance was tested for all 5 moments as per WHO guidelines. Data thus collected were entered into a computer-based spreadsheet for analysis using SPSS statistical software (version 20) (IBM Corp., NY, USA).Results: Overall hand hygiene compliance observed as per WHO Guidelines was 79.8%. Nurses had an adherence rate of 77.8%; allied staff adherence was 81.8%. Nurses’ compliance after touching patient surroundings was lowest at 60.7%. 96% staff was aware of the facts like diseases prevented by hand washing, ideal duration of HH, reduction of health care associated infections.Conclusions: Overall, the involved ICUs showed low levels of adherence to best hygiene practices with overall compliance of 79.2%. This suggests the need to implement immediate strategies for infection control in the ICUs. A multidisciplinary intervention could be effective in preventing and control the HAI risk.

Background & objectives: Gallbladder (GBC) is an aggressive form of cancer and most patients present with advanced unresectable disease due to lack of early signs and symptoms. This retrospective study was conducted to present the treatment outcomes with three lines of chemotherapies in a subset of patients with advanced, unresectable GBC with the primary objective to determine the response rates with nab-paclitaxel as the third-line chemotherapy after failure of the first-line gemcitabine and platinum and the second-line FOLFOX-4 (oxaliplatin, leucovorin and 5-FU) therapy. Another objective was to evaluate the toxicity, progression-free survival (PFS) and overall survival (OS). Methods: Treatment-naive patients with histologically proven inoperable GBC treated with gemcitabine/platinum, FOLFOX-4 and nab-paclitaxel as the first-, second- and third-line chemotherapy were included in this study. The dose of gemcitabine and cisplatin or carboplatin was 1 g/m[2] on days 1 and 8 and 75 mg/m[2] (or target AUC of 5) on day 1, in a 21-day cycle. FOLFOX-4 was administered every two weeks and nab-paclitaxel was administered as 125 mg/m[2] on days 1, 8 and 15 in a 28-day cycle. Results: There were eight men and 13 women with a median age of 57 yr who received nab-paclitaxel therapy. The overall response rate of the first-, second- and third-line chemotherapy was 61.9, 57.1 and 52.4 per cent, respectively. The median PFS for the gemcitabine/platinum, FOLFOX-4 and nab-paclitaxel therapy was 5.5, 5.4 and 2.9 months, respectively. The median OS with three lines of therapies was 14.0 months. Common Terminology Criteria (CTC) grade 3 or 4 haematological toxicities were observed in 28.6, 38.1 and 23.8 per cent of patients on gemcitabine/platinum, FOLFOX-4 and nab-paclitaxel therapy, respectively. Interpretation & conclusions: Our study suggests the clinical benefit of nab-paclitaxel chemotherapy in prolonging OS in a selected subgroup of advanced, unresectable GBC patients after failure of the first-line gemcitabine and platinum and the second-line FOLFOX-4 therapy.

The 2014–2015 Ebola epidemic is the largest in history, affecting multiple countries in West Africa. In late July 2014, the World Health Organization (WHO) declared the outbreak a Grade 3 emergency, its highest level of any emergency response. In early August, they declared it a public health emergency of international concern, meaning it is a serious public health event that endangers international public health. Indeed, by the end of September 2014, the United Nations stated the outbreak is “a threat to international peace and security.” Guinea located on the Atlantic coast of West Africa, is the first country in this geographical region in which an outbreak of Ebola virus disease has occurred. Cases having been confirmed in other countries include Guinea, Liberia, and Sierra Leone. There were a small number of cases reported in Nigeria and Mali and a single case reported in Senegal; however, these cases were contained with no further spread in these countries. Confirmed imported cases have occurred in the United States, Italy, Spain, and the United Kingdom. The WHO declared the end of the Ebola outbreak in Liberia on May 9, 2015 but on June 29, routine surveillance again detected a new confirmed case of Ebola in Liberia. On November 18, 2014, India has quarantined a man who was cured of Ebola in Liberia. As of August 21, 2015, the cumulative number of probable, suspected, and laboratory-confirmed cases attributed to Ebola virus (EBOV) is 28,036, including 11,301 deaths. Zaire EBOV strain has been identified as causative agent for 2014 Ebola epidemic.

Aim Dengue fever and its complications are poorly described in the cancer patients. Moreover, diagnosis of dengue fever is a challenge in these patients. There is extremely limited number of such cases reported in the literature till date. Methods We undertook a retrospective observational study of 28 cases of dengue fever in cancer patients in a tertiary care center in India. 19 (67.85%) patients were of solid neoplasm and 9 (32.14%) patients of hematological malignancy. Results Delay in diagnosis of dengue occurred by a mean of 7.9 days (range 5–15 days). Twenty (71.42%) patients presented with persistent fever and myalgia, in rest 8 (28.57%) patients fever had subsided at the time of presentation. Sixteen (57.14%) patients had simple dengue fever, 9 (32.14%) patients had dengue hemorrhagic fever while 3 patients (10.71%) presented with dengue shock syndrome. At presentation, 10 (35.71%) patients had a platelet count Conclusion In majority of adult cancer patient, dengue fever follows a benign course. Still, early diagnosis of dengue fever may help physicians in modifying treatment decisions about the judicious use of antifungal and antibiotic therapies.

INTRODUCTION: Timely treatment of urinary tract infection (UTI) with appropriate antibiotic administration is of immense importance in children to reduce the consequences. AIMS AND OBJECTIVES: The aim and objective of this study was to assess the temporal changes in the microbiological profiles and antimicrobial resistance patterns of uropathogens in pediatric community-acquired UTI. MATERIAL AND METHODS: This is a retrospective analysis of data collected over a Scattered period of 5 years. The baseline data collected were from January to December 2009, and the second period considered for comparison was from January to December 2014. Urine specimens from children ( RESULTS: In the year 2009, 340 of 2104 (16.15%) urine specimens yielded significant colony count, whereas in 2014, it was 407 of 2212 (18.39%) (P = 0.051). Escherichia coli was the predominant pathogen and was significantly more prevalent in girls than in boys (P < 0.0001) during both periods. There was a significant overall increase in resistance to ampicillin (from 40.29% to 58.72%), amoxyclav (from 26.17% to 40.54%), nitrofurantoin (from 28.82% to 39.06%), and norfloxacin (from 30% to 41.42%). However, the maximum increase in the resistance was noted for co-trimoxazole from 35.58% in 2009 to 63.39% in 2014 (P = 0.0000058). The prevalence of extended-spectrum beta-lactamases (ESBLs) has also significantly increased from 21.7% to 33.16% (P = 0.0045). CONCLUSION: Although E. coli remains the prime pathogen in pediatric UTI, the prevalence of resistance has dramatically increased over the 5-year study period. Our study highlights the emergence of community-acquired ESBL-producing uropathogens in children proclaiming treatment challenges.

BACKGROUND: In squamous cell carcinoma of the head and neck (SCCHN), epidermal growth factor receptor is expressed at very high levels. Hence, we have done this study to assess the response and tolerability of cetuximab and platinum-based chemotherapy in recurrent and metastatic (R/M) head and neck squamous cell cancer (HNSCC) in view of paucity of data from the Indian subcontinent. MATERIALS AND METHODS: In this prospective study, patients of R/M SCCHN were randomly enrolled from September 2012 to April 2015. Chemotherapy (cisplatin/carboplatin/5-fluorouracil) and cetuximab-based treatment were administered up to 6 cycles or unacceptable toxicity. The response rates (RRs), progression-free survival (PFS), and overall survival (OS) were analyzed. RESULTS: In total, fifty patients were enrolled. The median age was 51.0 years. A total of 255 cycles of treatment were administered (median = 6 cycles/patient). Four patients (8.0%) experienced complete response and 21 (42.0%) experienced partial response. Twenty-one patients (42.0%) had stable disease and four patients (8.0%) experienced progressive disease. The disease control rate was 92.0%. Median PFS was 5.3 months (95% confidence interval [CI]: 4.52–6.14 months). Median OS was 9.933 months (95% CI: 8.58–11.28 months). There was statistically significant correlation between overall response and Eastern Cooperative Oncology Group performance status (P = 0.014), site of tumor (P = 0.027), and histological grade of tumor (P = 0.001). The main Grade 3/4 side effects seen were hematological in 44 (88%) and gastrointestinal in 28 (56%) patients. CONCLUSIONS: The RR of cetuximab plus chemotherapy of >45% and the promising PFS rates are strong arguments for clinically testing this combination and this treatment schedule further in R/M HNSCC.

Ductal adenocarcinoma of pancreas is the most common pancreatic neoplasm and is the third leading cause of death due to cancer, with a 5-year survival of 8% only. Although pancreatic neoplasms are broadly classified into endocrine and exocrine variety based on cell of origin, on imaging they are classified into solid and cystic types. Pancreatic giant cell tumor (PGCT) is a very uncommon and aggressive pancreatic neoplasm. We report a case of PGCT presenting as a pancreatic tail mass and liver lesions with a morphological overlap with other cystic benign and malignant lesions of pancreas on imaging.

Surgical procedures for recurrent anterior dislocation of the shoulder include using capsuloligamentous or bone blocks to create barriers and active interventions using muscle actions. Fracture of glenoid acts as a barrier for bone block procedures. Boytchev procedure, though outmoded, yet acts as simple and effective procedure in this condition. Here we report a 44 year old male with recurrent anterior dislocation with glenoid fracture treated by Boytchev procedure. The patient is on regular follow up since 3 years with no episode of shoulder dislocation till now with full range of movements. To conclude, Boytchev procedure is technically simple and effective method in patients with recurrent anterior shoulder dislocation with fracture of glenoid.

Tuberculosis is quite common in India. Shoulder tuberculosis although rare among the skeletal tuberculosis needs to be kept in mind for diagnosis and proper treatment of cases of Carries Sicca. Twenty year old female presented with non traumatic pain in right shoulder with severe restriction of shoulder Range of Movements (ROM), not responding to treatment. On detailed examination turned out to be a case of Caries Sicca. Thorough debridement along with sufficient immobilization and Anti Tubercular Treatment (ATT) gives excellent results. High suspicion is needed to diagnose the cases of Carries Sicca. Early diagnosis and proper treatment gives wonderful results. Only ATT with or without immobilization and debridement are sufficient enough in majority of cases.

361 Background: Fatigue is one of the most disabling phenomenon among patients receiving anti cancer treatment, which has profound effect on their Quality of life (QOL). Although clinicians across the globe acknowledge the importance of regular assessment of fatigue, however it is seldom being assessed and documented in clinical practice in India and very few studies have reported Cancer Related Fatigue among Indian population. Methods: For this study an exploratory design was adopted, using a purposive sampling method. Patients (N=206,) undergoing chemotherapy at Rajiv Gandhi Cancer Hospital and Research Center, Delhi, India; aged 18-83 years were included. The level of fatigue was assessed using 16- item Multidimensional assessment of Fatigue (MAF) scale and a semi structured in depth interview schedule. These interviews were recorded, transcribed and analyzed. Results: Irrespective of age, and education, 81% patients experience clinically significant fatigue. Extreme level of fatigue was reported by 29% patients requiring immediate clinical intervention while 52% patients reported moderate level of clinically significant fatigue. Top four psychosocial issues reported were: apprehension of CT side effects (23.5%), fear of pain (19%), Loss of appetite (17.5%) and anxiety during CT (13.5 %), followed by financial issues (11%). Among all patients, (49.5%) were aware of their diagnosis of which 8% were either fully aware or partially aware about the prognosis (23%). Conclusions: Fatigue remains one of the most important clinical parameters among majority of Carcinoma Urinary Bladder patients receiving chemotherapy, and is neither assessed by clinicians nor reported by majority of the patients. While almost one fourth of the patients report fear of chemotherapy as their pressing psychosocial concern, others report fear of pain, loss of appetite, manifest anxiety symptoms or report financial and logistics issue during CT. Various exercise, educational material and psychotherapeutic interventions should be developed to prepare and support them during their treatment for better preparedness of side effects and their management, reduced symptoms and better quality of life.

Background: The benefit of administering chemotherapy directly into the peritoneal cavity is supported by preclinical, clinical and pharmacokinetic data. In view of paucity of data from the Indian subcontinent, we decided to study the response and tolerability of intraperitoneal (I/P) chemotherapy in carcinoma ovary in Indian population. Methods: In this observational study, from March 2013 to June 2015, the efficacy and tolerability of adjuvant I/P chemotherapy in optimally cytoreduced stage III epithelial ovarian cancer patients were assessed. Treatment consisted of 135 mg/m2 of i.v. paclitaxel over a 3-hours period on day 1 followed by AUC 5 carboplatin i.v. on day 2 and 60 mg/m2 of i.p. paclitaxel on day 8 every 3 weekly for six cycles. Results: Total 50 patients were enrolled. The median age of patients was 53 yrs (32 yrs – 67 yrs). Out of a total of 240 I/P cycles, 225 cycles (93%) were completed. 30 patients (75%) received all the 6 cycles by IP route, 6 patients completed 5, 3 patients completed 4 cycles and 1 completed 3 I/P cycles. 4 Out of 30 patients who completed all 6 cycles of I/P chemotherapy, had one or more adjustment including delay while in 3 patients (7.5%) dose had to be reduced. after median follow up of 14 months, 8 patients (12.5%) had local or systemic recurrence, 2 patients (5%) had progression during treatment and died due to disease. median progression free survival not reached yet. One patients had vaginal leak. Catheter block was seen in five cases. Two cases had needle displacement and extravasations of drug around the port chamber. 6 patients had severe abdominal pain and cramp (grade 3) after infusion of saline. Hematologic toxicity was evaluated in all patients and in all cycles. Grade 3 or 4 Leucopenia was experienced by 25 patients (50%) but Febrile Neutropenia occurred in only 5 (10%) patients. Grade 3 or 4 anemia occurred in 17 (42.5%) and grade 3 or 4 thrombocytopenia was experienced by 6 patients (15%). Renal complication present in 3 patients (7.5%) and transient transfusion reaction developed in 5 patients. mucositis present in 21 patients. Conclusions: Adjuvant I/P chemotherapy in optimally cytoreduced epithelial ovarian cancer is active and well tolerated in Indian patients.

Introduction: Squamous cell carcinoma of lower gingivobuccal complex and tongue are the most common cancer in the Indian sub-continent. The value of imaging in the staging of Oral Squamous Cell Carcinoma (OSCC) is in judging operability, assessment of the prognostic characteristics and dimensions of the primary tumour, depth of tumour invasion, the presence of cervical metastasis and detection of bone infiltration. Aim: This study evaluated squamous cell carcinomas of the oral cavity (tongue and gingivo-buccal complex) on the basis of their appearance, soft tissue extent, depth of tumour invasion and staging. Further, this study assessed the accuracy of MRI in the detection of cervical lymph nodal metastasis on the basis of ADC values on diffusion weighted MR sequence. Materials and Methods: T1- and T2-weighted MR, diffusionweighted sequences and post contrast T1W sequences were performed in various planes on biopsy proven squamous cell carcinomas (61 cases) involving tongue and/or gingivo-buccal region. Depth of tumour invasion was calculated on axial images of post contrast T1W images. The Apparent Diffusion Coefficient (ADC) was measured by using two b factors (500 and 1000 s/mm2 ). MRI findings were compared clinically and histopathologically. Results: Average depth of invasion calculated on MRI was 8.47mm and by histopathology was 6.85mm. Pearson's correlation coefficient was 0.988. Shrinkage factor was 0.8. A 71% of patients with depth of invasion greater than 9mm showed evidence of cervical lymph nodal metastasis at one or another levels. Cut-off value to discriminate between malignant and benign lymph nodes was 1.038 x10-3 mm2 /s in the present study. Conclusion: Depth of tumour invasion in oral malignancies can be measured reliably on MRI which helps in predicting cervical lymph node metastasis. Benign or malignant cervical lymph nodes can be differentiated on diffusion-weighted imaging of MRI on the basis of their ADC values.

Majority of the urinary bladder cancers are transitional cell carcinomas (TCC). Transitional cell carcinoma (TCC) of the bladder typically metastasizes to the pelvic lymph nodes and to visceral sites including the lungs, liver, and bones. Other sites include the brain, especially after systemic chemotherapy. To our knowledge, we report the first case of TCC metastatic to the soft tissue of the hard palate and discuss common and unusual sites of metastasis in TCC. JMS 2017;20(1):47-48.

Objective There is no standard second-line chemotherapy after progression on first-line therapy including gemcitabine and platinum combination in advanced gall bladder cancer patients. So this study was undertaken to assess the efficacy and safety of FOLFOX-4 regimen in this setting. Methods In this observational study, patients with performance status ≤2, who progressed on first-line therapy, were enrolled from May 2010 to June 2014. FOLFOX-4 based treatment was administered until progression, unacceptable toxicity or up to 12 cycles. Results A total of 66 patients were enrolled in this study. The median age of patients was 52.5 years (32-66 years),of which 24 (36.36%) were males and 42 (63.63%) were females. The median number of cycles could be given were 9.5 (2-12). Only 43.93% patients in this study completed full 12 cycles of chemotherapy. Sixteen patients (24.24%) in this study required the dose reduction at least in one cycle of chemotherapy due to toxicities. Disease control rate was seen in 39 (59.09%) patients, with complete response in none, partial response in 16 (24.24%), stable disease in 23 (34.84%) and progressive disease in 27 (40.90%) patients. The median progression free survival was 3.9 months; median overall survival was 7.6 months. The main Grade 3/4 side effects seen were hematological in 31.81% (n = 21) and gastrointestinal in 25.75% (n = 17) patients. Majority of patients (46%) had Grade 1/2 peripheral neuropathy. Conclusions FOLFOX-4 is an effective and well-tolerated regimen as a second-line treatment in advanced gall bladder cancer patients. Further studies are required, especially in the Indian subcontinent.

Background: Still over 2 million children die each year from the six vaccine preventable diseases, some of which can be eradicated and all of which are preventable. Methods: Cross sectional study done on 385 infants residing in Urban Health Centre, Khasbag, Karnataka, India. Results: The study revealed that 373 (96.88%) of the infants were fully immunized, 9 (2.34%) were partially immunized and 3 (0.78%) were unimmunized. There were multiple reasons for partial and non-immunization. The main causes were unaware of need for immunization, unaware of need to return for 2 nd and 3 rd dose and wrong ideas about contraindications. Other causes were postponement of immunization for another time and the major obstacles were illness of child, mother too busy and family problems. Conclusions: Child illness and lack of information are major causes of non-immunization and partial immunization.

Overview: Nonunion scaphoid is a common complication of fracture scaphoid which always remains a difficult surgical problem. Most of the cases present late with persistent pain and disability, not responding to conservative treatment. Simple bone grafts are generally not enough in cases with evidence of decreased vascularity of proximal fragment, so pronator quadratus osteomuscular transposition flap to revascularize the nonunion scaphoid gained popularity. A series of 11 cases treated using vascularized osteomuscular graft. Materials and Methods: This study was done on eleven cases of nonunion scaphoid with pronator quadratus vascularized bone graft. Herbert and Alnot classification was used and postoperative evaluation done by scaphoid outcome score. Results: Postoperative scaphoid outcome score was excellent in 4 cases, good in 4 cases, fair in 2 cases, and poor in 1 case. One case developed scaphoid nonunion advanced collapse and wrist arthritis and revision surgery with proximal row carpectomy was done in it. The mean follow-up period was 22 months. Conclusion: Bone grafting is the mainstay treatment for non-union scaphoid. Vascularized bone grafts using pronator quadratus osteomuscular flaps have proved to be more biological and more successful treatment option.

Background: Ventilator-associated pneumonia (VAP) is a common complication of ventilatory support for patients with acute respiratory failure and is associated with increased morbidity and mortality. Aim of the Study: The present study was undertaken to do quantitative cultures of aerobic bacteria, perform the antibiotic susceptibility testing from the endotracheal aspirates and clinical outcome of the clinically suspected patients of VAP. Methods: A prospective study was performed over a period of one year in a tertiary care hospital, enrolling patients on mechanical ventilation (MV) for ≥48 hr. Endotracheal aspirates (ETA) were collected from patients with suspected VAP, and direct gram′s stain criteria was used to accept the sample. Quantitative cultures of ETA were performed with the threshold for microbiological diagnosis of VAP was taken as ≥10 5 colony forming units (cfu)/ml. Results: Out of 53 cases, 2 (3.77%) were polymicrobial. Multidrug resistant bacteria, mainly Acinetobacter baumannii 49.09% (27/55) and Pseudomonas aeruginosa 30.91% (17/55) were the most common pathogens isolated. Metallo-beta lactamases (MBLs) was produced by 47.06% (8/17) of Pseudomonas aeruginosa and 62.96% (17/27) of Acinetobacter baumannii. Conclusion: The bacteriological approach for the management of VAP helps the clinicians in choosing the appropriate antibiotics. This study showed that quantitative cultures of endotracheal aspirate at a cutoff point of 10 5 cfu/ml is one of the alternative to bronchoscopy in the diagnosis of clinically suspected ventilator associated pneumonia.

e17069Background: It has been demonstrated in few trials, that intraperitoneal and intravenous (IP/IV) chemotherapy improves survival in advanced stage ovarian cancer. But it has been associated wi...

Objective: This study investigated the different outcomes between alcohol-based and hypertriglyceridemia-based acute pancreatitis and then tried to find out the key factors that would aggravate the pathophysiological course of the disease. Methods: Feeding rats with alcohol or high-fat diet for 4 weeks, we induced acute pancreatitis models under the etiology-based conditions. Results: We found alcohol abuse caused firm fibrosis thus aggravated the lobule hypoxia and caused hypoxia inducible factor-1a activation of acinar cells. Moreover, alcohol led to intracellular lipid droplet accumulation and mitochondrial stress under acute pancreatitis while high-fat diet only caused slight endoplasmic reticulum stress. Alcohol also caused higher level of nuclear factor-kappaB DNA-binding activity and activation than HTG thus aggravated the inflammatory reaction. The alcohol or highfat diet pretreatment did not influence the amylase, interleukin-6, tumor necrosis factor-a production and secretion, however, alcohol pretreatment increased the serum macrophage inflammatory protein 1a and monocyte chemotactic protein 1 comparing with control group. Alcohol induced more extensive oxidative stress than HTG which was shown by the level of serum myeloperoxidase and lipid peri-oxidant. Conclusions: In conclusion, we speculated that alcohol aggravated the acute pancreatitis and led to more severe disease than HTG by the fact that alcohol caused firm fibrosis along the interlobular area and more severe intracellular stress, and all these contributed to the higher level of hypoxia inducible factor and nuclear factor kappaB than HTG. The activated hypoxia inducible factor and nuclear factor kappaB caused the more severe

OBJECTIVE: It has been demonstrated in few trials that intraperitoneal and intravenous (IP/IV) chemotherapy improves survival in advanced stage ovarian cancer (OC). However, in view of high treatment-related toxicities, various modifications in treatment schedules have been tried. In this study, response and tolerability of IP paclitaxel on day 8 with IV paclitaxel on day 1 and IV cisplatin day 2 in carcinoma ovary were evaluated. PATIENTS AND METHODS: In this prospective observational study, from March 2013 to December 2015, the efficacy and tolerability of adjuvant IP/IV chemotherapy in optimally cytoreduced Stage III epithelial OC (EOC) patients were assessed. RESULTS: Totally, sixty patients were enrolled. The median age of patients was 53 years (32–67 years). Out of a total of 360 IP cycles, 316 cycles (88%) were completed. Forty-five patients (76%) received all the 6 cycles by IP route. Eight out of those 45 patients had one or more adjustment including delay or dose reduction. After median follow-up of 22 months, eight patients (14%) had local or systemic recurrence. Median progression-free survival not reached yet. Catheter block was seen in five cases. Two cases had needle displacement and extravasations of drug around the port chamber. Six patients had Grade 3 abdominal pain and cramp. Grade 3/4 leukopenia was experienced by thirty patients (50%), but febrile neutropenia occurred in only 6 (10%) patients. Renal complication present in 4 (7%) patients. CONCLUSIONS: In Indian patients, adjuvant chemotherapy with day 8 I/P paclitaxel in optimally cytoreduced EOC is associated with comparable survival outcomes, less side effects and high treatment completion rate relative to literature published from Western countries.

e15101 Background: There is no standard second-line chemotherapy after progression on 1st line therapy Gemcitabine and platinum combination chemotherapy, in locally advanced (unresectable) and meta...

Epidermal growth factor receptor (EGFR) inhibitors have been widely used for the treatment of epithelial malignancies. A wide spectrum of skin toxicities have been described in patients receiving EGFR inhibitors. Trichomegaly, especially of the eyelashes is a rare side effect of this therapy. We report a case of trichomegaly of eyelashes in a 39-year-old male, a case of carcinoma pancreas. This side-effect of these medications gives prospects as a therapy to stimulate the growth of hair.

Human brucellosis is a multisystem and potentially lethal disease of zoonotic origin with highly variable and non-specific clinical presentation. We report here on a 4-year-old pediatric patient who was presented with fever, chills, frequency, urgency of urine, and pain in lower abdomen. Blood cultures yielded slow-growing gram-negative coccobacilli that were later identified as Brucella melitensis. To the best of our knowledge, this is one of the few rare case reports of Brucellosis with symptoms of urinary tract infection in a female child.