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Aluminium phosphide is used to control rodents and pests in grain storage facilities. It is readily available as a fumigant for stored cereal grains and sold under various brand names such as QuickPhos, Salphos and Celphos. It acts by causing cellular hypoxia by its effect on mitochondria, causing inhibition of cytochrome C and by free radicals induced injury with no available antidote. Aluminium phosphide affects various systems, more commonly causing gastrointestinal tract irritation causing marked abdominal pain, shock with refractory hypotension by direct toxicity to heart and various arrythmias, acute respiratory distress syndrome and respiratory failure. Less common features include hepatotoxicity, intravascular haemolysis with methemoglobinemia and/or renal failure. Here we present a case of 24-year-oldnon-alcoholic male, with history of ingestion of approximately6grams of Celphos. At presentation he was drowsy with 2 episodes of vomiting immediately after ingestion of toxin. On subsequent investigations patient was found to have acute pancreatitis which responded to standard fluid resuscitation and acute kidney injury for which 3 episodes of haemodialysis were required. His condition subsequently improved and did not require further dialysis. There have been only few case reports on aluminium phosphide poisoning primarily causing acute pancreatitis and acute kidney injury. In this case report, we present the case of a young man presented with consumption of aluminium phosphide and then developed acute pancreatitis and acute kidney injury without involvement of other organ systems including heart.

Neuromyelitis Optica (NMO) is a rare central nervous system demyelination syndrome predominantly targeting optic nerves and the spinal cord. Here we present a middle-aged female presenting with new onset quadriparesis and a history of persistent splenomegaly and pancytopenia, eventually being diagnosed as NMO along with autoimmune cirrhosis. The association of Neuromyelitis Optica spectrum disorders (NMOSD) with chronic liver disease has not been previously described in the literature. The purpose of this case report is to bring forward an unusual presentation and to ascertain whether it could be part of a heterogenous spectrum of an autoimmune disorder, or merely a co-incidence.

Background: The aim is to evaluate the intraocular pressure-lowering efficacy and tolerability of Ripasudil (0.4%) ophthalmic solution in patients of primary open-angle glaucoma/ocular hypertension.Material & Methods:In this prospective, interventional, single-arm, open-label study, 50 patients of POAG/ocular hypertension attending the Outpatient Department of Ophthalmology, Government Medical College, Patiala were included.Results:Mean value of numerical change in IOP at four weeks, at eight weeks, at twelve weeks in IOP were 3.61 ± 2.05, 3.98 ± 1.47, 4.44 ± 1.53 respectively. Among side effects, conjunctival hyperemia, blepharitis, and allergic conjunctivitis were reported among 62%, 10%, and 8% of the subjects at four weeks. Final results after 12 weeks showed that only conjunctival hyperemia was reported as a side effect among 16% of the subjects. Conclusions:Our present study showed significant IOP-lowering effects and safety of ripasudil (0.4%) over 12 weeks in patients with primary open-angle glaucoma/ocular hypertension. For the treatment of glaucoma and OHT, ripasudil is regarded as a possible second-line choice in spite of the high occurrence of conjunctival hyperemia.

Background: Resident or junior doctors and nursing staff make up the backbone of any public health care facility more so in cases of centers affiliated to teaching hospitals. Resident physicians have the most prolonged contact with patients as they represent the first communication interface between the attending physician and the patient. Similarly, the nursing staff has a critical role in patient care. Therefore, to minimize the morbidity and mortality due to Covid-19, it is important to be fully informed and compliant with measures to contain Covid-19. Objectives: To assess the perception of the junior doctors and nurses regarding the various aspects of Covid-19 disease. Methods: A preformed structured questionnaire with closed end questions was sent to the study subjects using the electronic media. In this study, questionnaire was sent to the convenient sample of 250 persons (100 junior doctors or residents and 150 nurses) working in the clinical departments of the hospital, from July 20 to 27th, 2020. This questionnaire was prepared after literature reviews based on information collected from CDC Atlanta, and Ministry of Health and Family Welfare (MOHFW), New Delhi and consisted of three sections: the demographic data, the knowledge and practices sections. The data were collected through anonymous, self-rated questionnaire that was distributed to all participants over the internet (WhatsApp and email). Results- The questionnaire was sent to 250 persons (100 junior doctors and 150 nurses) working in the clinical departments of the hospital, out of which,139 responded comprising 58 (41.73%) junior doctors and 81 (58.27%) nurses. Overall, 79.14% (n= 110) had sufficient knowledge regarding the disease and majority (94.96%) was practicing safe measures. In univariate logistic regression analysis of various variables with knowledge, the qualification was only variable which was found to be more significantly associated as far as knowledge and practices were concerned (junior doctors as compared to nursing staff). Conclusion- Adequate knowledge apart from defining day to day behavior of health care workers, also prepares them for coping strategies in cases of crisis in critical situation like the our world is experiencing now.

Aims and Objectives: To know the role of telemedicine in fighting the pandemic situation of Covid-19 in India and facing the double burden of diseases (Communicable and non-communicable). Material and Methods: Maintaining the norms of social distancing, we have tried to collect secondary data from different sources which will help us know how physicians and patients' consultations are being done in this pandemic situation through teleconsultation or telemedicine. Results: According to Bain and Company’s India Venture Report 2020, healthcare investments saw a rise in 2019 across wellness and health platforms, e-pharma, and even some telemedicine-focused players. Telemedicine space in India has gone up by almost 40 percent in 2019 – $178.4 million across 16 deals.Advancements in technology have enabled doctors from urban India to treat patients in rural areas remotely through video-call consultations. In addition,services like self-monitoring devices, disease screening solutions, and healthcare management solutions can be provided for newer threats like the recent novel coronavirus where video-call consultations aren’t enough. Conclusion: The entire healthcare system is under attack by the novel COVID-19 virus that has no proven treatment. Hospitals are being stretched beyond their capacity and healthcare workers are falling ill. Telehealth providers, enablers, and suppliers represent a tangible resource that can remove certain patients from the hospital setting by evaluating them remotely, tracking their progress, and helping all stakeholders remain in contact as the intensive efforts for a vaccine and effective treatment are underway. Telehealth is inappropriate for all COVID-19 patients, but some patients could be examined, treated, and followed up using a mix of virtual visits, remote patient monitoring (RPM) devices, and mobile health services, apps, and wearable devices.

Aim: To find the prevalence of choroidal tubercles in tuberculosis patients. Introduction: Tuberculosis is the most common cause of infectious cause of death especially in endemic countries. Tuberculosis infection spreads hematogenously from primary infection site to rest of the body. Ocular presentation manifests in the form of choroidal tubercles being the most common fundus change. Materials and Methods: It was a retrospective, observational hospital-based study. Total 100 tuberculosis patients were studied and their data were collected from Hospital record system from February 2020 to March 2021. Fundus examinations were reviewed and most common ocular presentation was found to be choroidal tubercles. Observations and Results: During the study period, out of 100 patients, 60% were females and 40% were males. Fundus changes were present in 14% patients and these were choroidal tubercles in 12% patients and papillitis in 2%. Choroidal tubercles were present in 7 females and 5 males. Conclusion: We concluded that choroidal tubercles is one of the most common form of ocular tuberculosis. Detection of choroidal inflammation can prevent visual loss as the ocular lesion resolves fully with timely management.

Background: Energy production and consumption ratio form the hallmark of the economic prosperity of a country. To keep up with the demand and supply of energy a major switch to biofuels is reasoned but the cost associated with production and the choice of raw material forms two major economical and ethical concerns, especially in the under-developed and developing countries where the food is not sufficiently available to everyone. In this scenario, the use of food sources as raw material becomes unjustified. Purpose: To address these issues, here we made an effort to obtain bioethanol from a non-edible and easily available resource that requires a modest cost of production i.e., a locally available algal bloom. Also, different methods of pre-treatment were employed and scrutinized for their efficacy. These methods of pre-treatment are very cost-effective and easy to administer. Materials and Methods: The algal biomass was pre-treated separately in three ways viz., freeze-thawing, mechanical disruption and rotten wood treatment. The algal cake left out after extraction of lipid content for biodiesel production was also used as a fourth sample. After pre-treatment, the supernatant was collected and estimated for reducing sugar content and allowed to ferment using Saccharomyces cerevisiae. A distillate was obtained and checked for ethanol percentage through gas chromatography. Results: The mechanically disrupted sample yielded the highest percentage of ethanol followed by algal cake, freeze-thawing and rotten wood treatment. Conclusion: Given present food scarcity, the non-edible algae could be a better alternative for bioethanol production as compared to the use of conventional food crops. Through this study, we have found that a better yield can be achieved if the algal biomass is pre-treated via mechanical disruption.

Introduction: An ectopic pregnancy occurs when a fertilized egg attaches somewhere outside the uterus.There are many risk factors for ectopic pregnancy. This study will help us to prepare a list of risk factors associated with ectopic pregnancy in our state. In addition, it will help implement a risk-reduction counseling program before conception, which will help us screen high-risk patients and reduce and manage ectopic pregnancy. Materials and methods: The present study was conducted in our department for two years, from August 2018 to July 2019. Cases included all patients with ectopic pregnancy admitted in labor. A total of 192 cases were taken, out of which 8 cases refused to participate in the study, so 184 patients were included in the study. Results: Patients with previous ectopic pregnancy have 6.34 times increased risk of a repeat ectopic pregnancy (odds ratio 6.34, confidence interval 1.40-28.77), and this association was highly significant (p = 0.006). The risk of ectopic pregnancy is 3.02 times increased (odds ratio 3.10; 95% confidence interval, 1.16-7.84) if the patient once had the pelvic inflammatory disease and is statistically significant (p = 0.01). The study also revealed that 17 (10.3%) patients with ectopic pregnancy had a history of tubal ligation or some other tubal surgery done in the past compared to 3 (2.2%) patients among controls, and this finding is statistically highly significant (p = 0.001). Conclusions: In the present study, we found that the main risk factors for incidence of ectopic pregnancy are prior ectopic pregnancy, prior tubal ligation, and prior pelvic/abdominal surgery. In addition, ectopic pregnancy was positively related to the previous history of ectopic pregnancy, abortion, cesarean section, and infertility. These findings can be helpful for early diagnosis of ectopic pregnancy to pursue proper medical therapy instead of unnecessarily surgical treatment.

Tuberculosis (TB) is the leading cause of mortality among infectious diseases with estimated 1.5 million deaths from TB in 2018 -19 and presented as a public health concern. In 1897, the Frenchman Antonin Poncet first described Poncet's disease (PD) as a rare syndrome, where polyarthritis in an acute stage of TB, resolved without joint damage. Similar reports on patients of tuberculosis and joint pain led authors to improve the definition, and in 1978, PD was described as a para infective arthritis by Bloxham and Addy. Regardless of its doubtful existence, cases have been continued to be reported over the years. Poncet's disease is a form of reactive arthritis which is characterized by articular affection in patients diagnosed with TB where there is immune reaction to the tuberculous protein but there is no direct invasion by the micro-organism.1,2 PD is to be differentiated from tuberculous arthritis where there is monoarticular and direct tubercular involvement of the joint. Before more obvious features develop, the sole manifestation of the disease is joint involvement. Crippling pain is experienced during polyarthritis which limits the mobility and activities of patients. Polyarthritis can also occur in common causes such as rheumatological diseases as a symptom and thus can be easily misdiagnosed. Polyarthropathy, that is multiple large and small joints involvement in the body, is the one of the rarest presentations in both active pulmonary and extrapulmonary tuberculosis. This polyarticular impairment observed in patients with active TB, a form of reactive arthritis is known as Poncet’s disease. Since there is no direct bacillary invasion of the joints, it is an aseptic form of arthritis. It is not to be confused with tuberculous arthritis, which is usually monoarticular and where there is direct tuberculin infection. Poncet's disease remains a diagnosis of exclusion. Since case reports are very rare even in countries where tuberculosis is common thus no accepted diagnostic criteria is set for Poncet's disease. This diagnostic possibility becomes increasingly important as the use of corticosteroids, immune suppressants or biologicals can risk further dissemination of the disease. We describe the case of a 50-year-old woman, who presented with active tuberculosis where polyarthralgia was the first and only symptom for four months. Polyarthritis patients were being treated with both non-steroidal anti-inflammatory drugs and antitubercular therapy and to the surprise patients with antitubercular treatment had complete resolution of symptoms after 6-week therapy whereas non-steroidal anti-inflammatory drugs (NSAIDS) offer no benefit. The total duration of therapy was 6 months.

BackgroundThe SARS-CoV-2 virus has become pandemic for the last 2 years. Inflammatory response to the virus leads to organ dysfunction and death. Predicting the severity of inflammatory response helps in managing critical patients using serology tests IgG and IgM. We conducted a longitudinal study to correlate serum SARS-CoV-2 IgM and IgG serology with clinical outcomes in COVID-19 patients.MethodsWe analyzed patient data from March to December of 2020 for those who were admitted at AIIMS Rishikesh. Clinical and laboratory data of these patients were collected from the e-hospital portal and analysed. Correlation was seen with clinical outcomes and was assessed using MS Excel 2010 and SPSS software.ResultsOut of 494 patients, the mean age of patients was 48.95 ± 16.40 years and there were more male patients in the study (66.0%). The patients were classified into 4 groups; mild-moderate 328 (67.1%), severe 131 (26.8%) and critical 30 (6.1%). The mean duration from symptom onset to serology testing was 19.87 ± 30.53 days. In-hospital mortality was observed in 25.1% patients. The seropositivity rate (i.e., either IgG or IgM >10 AU) was 50%. There was a significant difference between the 2 groups in terms of IgM Levels (AU/mL) (W = 33428.000, p = ConclusionSerology (IgM and IgG) levels are high in RTPCR positive group compared to clinical COVID-19. However, serology cannot be useful for the prediction of disease outcomes except few situations. The study also highlights the importance of doing serology at a particular time as antibody titres vary with the duration of the disease.

There is a new public health crises threatening globally with the emergence and spread of 2019 novel coronavirus or the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It is the seventh member of the coronavirus (CoV) family, which infects humans and to which the Middle East Respiratory Syndrome CoV (MERS)-and SARS-CoV also belong. SARS-CoV-2 is a newly emerging human infectious CoV that causes COVID-19, which has been recognized as a pandemic by the World Health Organization on March 11. The most recent outbreak initially presented as pneumonia of unknown etiology as COVID-19 is a pneumonia-like disease with a group of symptoms including fever, dry cough and shortness of breath in a cluster of patients in December 2019 Wuhan, China. The body's immune system tries to protect the body from this pathogen. And as due to its surge in the body, various respiratory and other system-related complications increased. Therefore, in this article, COVID-19 immunopathogenesis is briefly reviewed. Through this review, we try to explain the molecular immune pathogenesis and diagnosis of COVID-19 (SARS-CoV-2) infection, based on the recent research progress of SARS-CoV-2 and the knowledge from researches on SARS-CoV and MERS-CoV.

One of the competencies expected of all doctors posted in coronavirus disease 2019 (COVID-19) wards, is ECG rhythm identification, interpretation, and intervention for immediate management of patients. This study was undertaken to evaluate the effectiveness of the ECG training module as a component of preparedness training to combat COVID-19.This was a cross-sectional study conducted during training on ECG rhythm identification, interpretation, its management in COVID-19 patients. Study participants included faculty, senior residents, junior residents, and interns of medical, surgical, and paraclinical disciplines. The training session included one hour of didactic lecture and one and half hours of interactive session during which case scenarios were discussed. An objective assessment was conducted through pre-test and post-test. Mean of pre and post-test scores were compared using paired t-test for evaluating statistical significance. Feedback was also taken from participants.Out of the 800 participants who gave consent, only 682 who completed both pre and post-test were included in the final analysis. Mean pre-test and post-test scores were 9.29/15 (61.9%) and 11.63/15 (77.5%), respectively, with a mean improvement of +2.34/15 (+15.6%). Of the participants, 38.6% obtained low scores in pre-test and 82% of respondents agreed that knowledge and skills gained from training would be useful in providing patient care. Low baseline knowledge on ECG highlights the need for re-training doctors posted in COVID-19 care on cardiac rhythm identification and interpretation. Interactive training is effective in improving ECG interpretative skills among doctors across disciplines and is the appropriate method to retrain/reskill, especially for large-scale capacity building.

Diabetic ketoacidosis is a relatively common and potentially life-threatening complication of insulin deficiency. The prevalence of DKA is relatively common in patients with Type 1 diabetes mellitus in comparison with Type 2 diabetes mellitus. The prevalence of DKA is seen in 0–128 cases per thousand population in Type 1 diabetes mellitus while Type 2 DM has a prevalence of 18% of the total population. Abdominal pain is the most common and specific symptom of DKA which is reported at around 46%. The two most common infections precipitating DKA are community-acquired pneumonia and UTI which correspond to around 30–50% of the total burden. Meanwhile, any infection or sepsis can precipitate DKA, the splenic abscess is rare, and there have been reported only a few cases. In patients with poor glycemic control, absence of urinary tract infection, and community-acquired pneumonia, deep organ abscesses should be screened for. Here, we present a case report of patient with non-resolving DKA who presented with splenic abscess.

Data plays the most important role in the development of industries, small businesses. Even world leaders need the data to make analyses and make better policies for people. In almost every field where the work process is digitized need to store data and then retrieve it. According to statistics most of the data is stored in the relational database and for manipulations of the data, Structured Query Language(SQL) is commonly used. So for handling databases a person need to have specialized knowledge regarding the queries and had to remember the syntax of many complex queries. So to enhance data manipulation using SQL and to efficiently get the required query, the paper proposes a method for the generation of SQL query from natural language input, spoken(audio input) by the user. The model is constructed on NLP (Natural Language Processing) and Neural Networks (Deep Learning) technologies. Long Short Term Memory(LSTM) Model is used for predicting queries and is trained on the dataset with natural language as input and returns outline skeletal structure of the query as output. Then the output will be processed and the final query will be displayed to the user. The project also aims to benefit the people who are suffering from Repetitive Stress Injury (RSI), causing pain in the finger joints, which has been attributed to work requiring a long period of typing and also to those who are not familiar with SQL queries. As this system will readily provide the required query.

Introduction: Obesity is strongly associated with other metabolic disorders including Hypertension (HTN), diabetes and Cardiovascular Diseases (CVD). High Blood Pressure (BP) is ranked as the third most important risk factor for attributable burden of disease in South Asia. Aim: The aim of present was to study the association between BP and obesity indices in medical student’s population. Materials and Methods: A cross sectional study was conducted on a group of 100 healthy young medical students. BP, pulse and Hb O2% was measured by using sphygmomanometer, pulse oximeter. Obesity indices were measured by using weighing machine, stadiometer, measuring tape and impedance based Body Composition Analyser (BCA). Results: There was poor correlation of Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) with Total Body Fat (TF) and the association was not significant. SBP and DBP were mildly correlated with BMI. Whole body Visceral Fat (VF) correlation of SBP was moderate and significant. DBP was correlated with whole body VF and correlation was significant. But the whole body, trunk, leg Skin Fat (SF) and Muscle Fat (MF) were not having significant correlation with SBP and DBP. Finger to heart distance was positively correlated with SBP (p

In newly diagnosed patients with diabetes with poor glycemia, presentation is sometimes acute onset monoparesis, which eventually improved with good glycemic control. To report an unusual patient with newly diagnosed diabetes whose initial manifestation was acute onset monoparesis. A 58-year old female patient with new onset type 2 diabetes mellitus with diabetic ketoacidosis (DKA) who presented to us with acute onset monoparesis (right lower limb) lower motor neuron (LMN) type without bladder involvement, secondary to poor glycemia which eventually resolved with good glycemic control.

Background: The increasing clinical incidence of antibiotic-resistant bacteria is a major global health care issue. Among MDR pathogens, Klebsiella pneumoniae (KP) is one of the world's most dangerous superbugs; and becoming resistant to virtually every antibiotic available today. The objective were to study the clinical characteristics of neonatal sepsis caused by KP and the antibiotic sensitivity pattern of Klebsiella pneumoniae in a neonatal intensive care unit (NICU) in northern india.Methods: This observational study was conducted with neonates who were admitted in NICU of Government Medical College (GMC) Jammu (Jammu and Kashmir) India and whose blood culture showed growth of KP in a study period of 1 year between 1st January 2018 to 31st December 2018. The data was entered into a register and presented by descriptive statistics.Results: Twenty four neonates were included in the study. The clinical presentations include refusal of feed (83.3%), lethargy (79.2%), respiratory distress (70.8%), shock (70.8%), fever (37.5%) or hypothermia (58.3%), apnea (29.2%) and abdominal distension (33.3%). Most common perinatal risk factor was prolonged labor (>24 h) seen in 79.2% of cases. C-reactive protein (CRP) level was positive in 95% of the cases. The mortality was 25%. KP strains were sensitive to colistin, polymyxin B, cotrimoxazole and tetracyclines.Conclusions: The clinical manifestations of neonatal sepsis caused by KP are usually non-specific. CRP detection is valuable for early diagnosis of sepsis. Neonatal sepsis persists as a cause of mortality in this region. Regular antimicrobial surveillance for empirical treatment remains an important component of neonatal care.

Background: Neonatal hypothermia is increasingly recognized as a risk factor for newborn survival. World Health Organization (WHO) recommends maintaining a warm chain and skin-to-skin care for thermo-protection of newborn children. Since little is known about practices related to newborn hypothermia, this study’s goal was to assess the knowledge of mothers of newborns especially LBW babies on prevention of hypothermia and to provide them the knowledge of cost-effective thermal protection measures.Methods: It was a cross-sectional study using pre-tested, pre-structured questionnaire. 108 postnatal mothers having LBW babies admitted in postnatal wards of Government Medical College, Jammu, Jammu and Kashmir, India were included in the study and analysed using SPSS version 20.Results: Out of 108 mothers, maximum mothers were of age less than 25 years (51%), 60% were from rural area, residing in nuclear family were 62%. Mothers attended hospital for confinement were 95% and 85% started breast feeding their babies. 45% had knowledge of keeping the baby warm by immediately wiping the baby and only 3% mothers had knowledge of Kangaroo Mother Care (KMC).Conclusions: Understanding and addressing community-based practices on hypothermia, prevention and management might help to improve newborn survival in resource-limited settings. Possible interventions include the implementation of skin-to-skin care in rural areas and the use of appropriate, low-cost newborn warmers to prevent hypothermia and support families in their provision of newborn thermal protection. Training family members to support mothers in the provision of thermo-protection for their newborns could facilitate these practices. Those who fail to fully attend antenatal clinics should be targeted for newborn care education.