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The most common primary liver tumour in children is hepatoblastoma, which is often diagnosed in the first three years of life. While the majority of hepatoblastomas are sporadic, some associations are reported with genetic disorders like Beckwith-Wiedemann syndrome and familial adenomatous polyposis. The annual incidence of hepatoblastoma in children has gradually increased during the past three decades. Babies born prematurely, weighing

Introduction: Audiovisual Distraction (AVD), as a behaviour management technique, has gained significant importance in aiding patient cooperation during routine dental procedures. However, the scale at which it makes a difference needs to be evaluated. Objective approaches like measuring heart rate and pulse rates are unreliable methods. The quantification can be done using salivary Chromogranin A (CgA), a stress marker. Aim: To evaluate the use of AVD for reducing stress in children aged 4-7 years during dental treatment using salivary CgA. Materials and Methods: The present quasi-experimental study was conducted within the Department of Paediatric and Preventive Dentistry, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Pune, Maharashtra, India, from January 2022 to March 2022 after obtaining ethical clearance from the Institute and consent from parents. Six uncooperative children who required two Class-I restorative treatments for occlusal caries involving enamel and dentin were included in the study. The sample size was estimated using G*Power software v3.1.9.2 and calculated using t-tests. The treatment plan was divided into two appointments. In the first appointment, the cavity was prepared without the use of AVD. In the second appointment, AVD was incorporated during the dental procedure using the patient’s favourite cartoon. Unstimulated salivary samples were collected during both appointments, before and immediately after the procedure, which were sent to the laboratory for evaluation of CgA levels to gauge the stress levels during each appointment and the effect AVD has on the same. Results: Within the group without AV aids used, the mean salivary CgA levels showed a significant increase from 0.23 pmol/mg pretreatment to 1.26 pmol/mg protein after treatment. Within the group with AV aids, salivary CgA levels showed a significant reduction (p≤0.05) from 1.08 pmol/mg before treatment to 0.43 pmol/mg protein after treatment. There was also a significant difference in the change in salivary CgA levels from pre- to post-treatment between the two study groups. Conclusion: The study shows quantitatively that AVD reduced stress levels during dental treatment and therefore can be used as an adjunct for behaviour management. It can also be seen that Salivary CgA is a reliable short-term stress marker and can be used objectively to evaluate and quantify stress levels in children.

Introduction: In routine dental practice, clinicians often face difficulty in selecting accurate interocclusal recording materials due to the introduction of numerous options in the market. Therefore, it is crucial to choose the appropriate material and use it correctly for the success of any prosthesis. Aim: To evaluate and compare the linear dimensional stability of three different types of interocclusal recording materials: polyvinyl siloxane bite registration paste (orangebite), polyether bite registration paste (ramitec), and bite registration wax (aluminium filled). Materials and Methods: An in-vitro study was conducted in the Department of Prosthodontics and Crown and Bridge, with microscopic evaluation performed at the Department of Oral and Maxillofacial Pathology and Microbiology at Maratha Mandal’s NGH Institute of Dental Sciences and Research Centre, Belagavi, Karnataka, India in September 2020 for a period of four days. A stainless steel die was used to make impressions, and materials were manipulated according to the manufacturer’s instructions. A total of 30 samples (10 for each material) were created. Three minutes after the respective setting time of each material, discs were separated from the die. The distance between two parallel lines was measured using a stereomicroscope at different time intervals: one hour, 24 hours, 48 hours, and 72 hours. Statistical analysis was performed using Analysis of Variance (ANOVA) and the Mann-Whitney test. Results: In the intragroup comparison of dimensional changes at different time intervals, all three materials showed statistically insignificant results (p>0.05). However, statistically significant results (p≤0.05) were found when comparing the materials at different time points. Polyether bite registration material exhibited better dimensional stability than polyvinyl siloxane and bite registration wax at one hour, 24 hours, 48 hours, and 72 hours. Conclusion: Polyether demonstrated superior dimensional stability compared to polyvinyl siloxane and bite registration wax. The dimensional stability was influenced by both the material used and the duration of time.

Introduction: Effective plaque control is important for proper oral health maintenance, and the toothbrush-dentifrice combination is essential for achieving this. Recently, herbal toothpastes have gained more popularity amongst people. Aim: To formulate a novel herbal toothpaste containing Myristica fragrans (nutmeg) and compare its antimicrobial efficacy and abrasivity with a commercially available herbal toothpaste. Materials and Methods: This in-vitro study was conducted on 24 non-carious permanent extracted teeth with intact coronal structure. These were equally divided into experimental and control groups (n=12). The nutmeg toothpaste was formulated using nutmeg powder, tulsi leaf powder, and clove powder as the main herbal ingredients. Dabur red was selected as the commercial herbal toothpaste. The zone of inhibition of both toothpastes was evaluated against Streptococcus mutans and Lactobacillus species using the agar well diffusion method. Enamel specimens measuring 5×5×5 mm were mounted on acrylic blocks and brushed for 28 days. Profilometric analysis was conducted on the 1st, 7th, and 28th day. Statistical analysis was performed using Statistical Package for Social Sciences(SPSS) version 23.0 software, and independent t-tests and Analysis of Variance (ANOVA) tests were used. Results: 24 teeth were used. A total of 6 samples of toothpaste were considered for antimicrobial testing. The zone of inhibition for the nutmeg toothpaste and Dabur red was 28 mm and 32.17±0.42 mm, respectively, against both organisms. The increase in surface roughness of enamel was not statistically significant between the two groups (p>0.05). Conclusion: Both toothpastes exhibited antimicrobial activity against the test microorganisms and significantly increased the surface roughness of enamel from baseline to the 28th day. The nutmeg toothpaste caused less enamel abrasion, but the difference was not significant.

Introduction: Team-based Learning (TBL) and Problem-based Learning (PBL), both active teaching methodologies, are known for improving problem-solving abilities, clinical reasoning, and motivating students for self-directed studies. Although both active methods, TBL and PBL, differ in methodology and required resources, it is always a challenge to choose active methods that are more feasible and effective in the undergraduate medical curriculum. Aim: To compare two active teaching strategies, viz., the effectiveness of TBL vs. PBL in first-year Bachelor of Medicine, Bachelor of Surgery (MBBS) students in terms of learning outcomes, development of critical thinking skills, and retention of knowledge. Materials and Methods: This quasi-experimental study was conducted at Department of Biochemistry, NKP Salve Medical College and RC Nagpur, Maharashtra, India from August 2017 to October 2017. A total of 150 first-year MBBS students were included in the study. TBL and PBL were performed following the protocols of their respective methodologies, and scores for learning gain and critical thinking were compared between the TBL and PBL groups. Student perception regarding the procedures was collected using a prevalidated structured questionnaire. The retention of knowledge was assessed by comparing scores from a pretest and a test conducted two months later. Data were statistically analysed using the Wilcoxon signed-rank test and the Mann-Whitney U test. Results: In the present study, the mean age of the participating students was 20±2 years. Post-test results, obtained just after the intervention, demonstrated a significant learning gain in students using both methods, with a statistically higher gain in TBL (p-value

Cerebral Palsy (CP) is a group of non-progressive brain disorders causing movement, posture, and motor function impairments. Cerebral Visual Impairment (CVI) affects visual pathways, affecting clarity of vision, visual fields, and occulomotor incoordination. Symptoms vary in nature and severity due to the complexity of the visual cortex. Physiotherapy (PT) is essential for treating CP, promoting physical, mental, and social well-being. Physical therapists also teach parents, how to care for their children at home, including feeding, bathing, dressing, and other activities. CVI is often linked to CP and can lead to various visual problems, including reduced visual guidance of movement. To effectively manage this condition, a multidisciplinary approach is required, as children with CVI often have neurological deficits in addition to their visual problems. Visual function assessment involves measuring thresholds or limits for each eye, while functional vision assessment is conducted in the child’s environment with both eyes open. Levels of vision can be classified into light perception, intermittent fixation, reliable focus, constant attention to small objects, and reliable visual acuity. Children with Visual Difficulties (CVI) exhibit distinct visual behaviours and require proper training. Sensory room training improves gross and fine motor abilities, and early intervention reduces issues associated with these diseases. Physical therapy interventions are very important for this population’s health and wellness, which can be focused on acquiring and improving independence in motor abilities, visual function, coordination, balance and general health improvement. Children with CVI are at danger of developing neurological dysfunction. An early intervention and adequate training for young CP children with CVI can improve motor abilities and reduce issues associated with these diseases. The following review will help to understand briefly about visual impairments in patients with CP, mainly focusing on new therapeutic interventions following visual impairments that are effective and easily administered.

A 24-year-old girl presented to the Outpatient Department with multiple painless, insidious-onset swellings on the pubic area. Initially, they started as pin-head nodules when she was just eight years old and gradually increased in number and size. Apart from occasional itching in the area, she never experienced any noticeable symptoms over the years. However, as she grew older, concerns about cosmetic issues at marriage age compelled her to seek medical advice. Her past and family histories were not contributory. She had no addictions, medical co-morbidities, or local trauma.

Introduction: Cytological examination of body fluids is a commonly performed investigation that provides information about inflammatory and malignant lesions, aiding in the diagnosis of effusion aetiology and potential differential diagnoses. The cell block technique, combined with cytospin study, offers an additional advantage in such cases. Aim: To compare the diagnostic utility of cell block method and cytospin method in detecting malignancy in body fluids. Materials and Methods: This cross-sectional observational study was conducted for a period of two years at Bharati Vidyapeeth (DTU) Medical College Hospital and Research Centre in Pune, Maharashtra, India. A total of 100 body fluid samples were analysed, including 73 pleural fluids, 24 ascitic fluids, and 3 pericardial fluids. Each fluid sample was divided into two equal parts: one processed for cytospin (CYTOTEK), and the other processed to create a cell block. Four Immunohistochemistry (IHC) markers (Thyroid Transcription Factor-1 (TTF-1), Cytokeratin 7 (CK7), Cytokeratin 20 (CK20), and Calretinin) were applied as needed. Data analysis was performed using the Statistical Package for Social Sciences (SPSS) version 25.0, and results were calculated using the Chi-square test. Results: Of the total 100 fluid samples, 65 were negative, 17 were positive, and 18 were suspicious for malignancy using the cytospin method. In comparison, the cell block method identified 63 samples as negative, 29 as positive, and 8 as suspicious for malignancy. The cell block method exhibited a higher sensitivity (100.00%) and specificity (94.03%) than the cytospin method (81.82% and 88.06%, respectively) in this study. Conclusion: Cell block method accurately diagnosed 10 cases as positive for malignancy that were initially deemed suspicious on cytospin smear. Therefore, the cell block method proved to be a superior diagnostic tool for malignancy compared to cytospin smear. Given that cell blocks allow for longer storage and additional analysis such as IHC and microarray, they should be adopted in addition to cytospin for effusion cytology

Introduction: Thrombocytosis is characterised by an increased platelet count in the blood, defined as a count greater than 450,000 cells/μL. The incidental discovery of thrombocytosis often leads to unnecessary investigations and referrals, causing anxiety among physicians. Aim: This study aims to examine the presence, frequency, and etiological distribution of thrombocytosis in various disease conditions. Materials and Methods: This cross-sectional observational study was conducted at the Central Clinical Laboratory of MIMER Medical College and Dr. BSTR tertiary care hospital in Talegaon Dabhade, Pune, Maharashtra, India, from June 1st, 2021, to August 31st, 2021. Clinical and laboratory data were collected from adult patients with a platelet count greater than 450,000 cells/μL and entered into a Microsoft Excel sheet. The parameters studied included age, sex, clinical diagnosis, platelet count, Total Leucocyte Count (TLC), absolute neutrophil count, Neutrophil Lymphocyte Ratio (NLR), haemoglobin levels, and C-reactive protein (CRP). Pearson’s correlation coefficient was calculated using Statistical Package for the Social Sciences (SPSS) software version 26.0. Results: A total of 194 patients with a platelet count greater than 450,000 cells/μL were included in the study. The frequency of thrombocytosis was 8.50% (194 patients), with 113 cases in the Medicine Inpatient Department (IPD) and 81 cases in the Surgery IPD. The lowest platelet count observed was 454,000 cells/μL, while the highest was 855,000 cells/μL. Primary thrombocytosis was found in 2 (1.03%) patients, while secondary thrombocytosis was found in 192 (98.96%) patients. A statistically significant association was observed between thrombocytosis and ferritin (p-value=0.032). Additionally, significant associations were found between thrombocytosis and absolute neutrophil count (p-value=0.023) and NLR (p-value=0.047). Conclusion: Elevated platelet counts, discovered during routine blood examinations, carry diagnostic, prognostic, and therapeutic implications as they can be indicative of various clinical situations with diverse underlying aetiologies. It is essential to rule out secondary thrombocytosis before further investigating for primary thrombocytosis. Thrombocytosis warrants thorough investigations and careful clinical correlation.

Introduction: The vertical dimension of a face is crucial in determining facial aesthetics and harmony. It is important for the orthodontist to understand the relationship between dental arch width and facial morphology for correct diagnosis and proper treatment plan. Aim: To determine the relationship between the vertical face pattern, dental arch width and also, to compare arch widths among both untreated female and male adults. Materials and Methods: This quantitative cross-sectional study was conducted in the Department of Orthodontics and Dentofacial Orthopaedics, at Sharad Pawar Dental College, Sawangi, Wardha, Maharashtra, India. The duration of the study was 1 month, from June 2019 to July 2019. Dental casts and lateral cephalograms were collected from 50 untreated adults (25 males and 25 females), aged between 18 to 30 years, who had minimal spacing, crowding and no crossbite. On every patient’s cephalogram, the angle between the plane of the mandible to the cranial base anterior Sella Nasion (SN) angle was calculated. Intercanine, intermolar, and interpremolar widths were measured on dental casts. Females and males arch width were compared. The significance of the differences was assessed using Student’s t-test, one-way Analysis of Variance (ANOVA) test and regression analysis. Results: The mean age of male study participants in the study was 24.44±5.04 years, whereas, mean age of females was 24.88±3.08 years. There were 25 males and 25 females of 18-30 years with mean age of 24 and 25 years, respectively. Arch widths of males were found to be significantly greater than, those of females (p

Introduction: Extraction space closure is the foremost challenging procedure in the field of orthodontics which needs a robust understanding of biomechanics. There are two commonly used methods of space closure, one which involves friction, also called sliding mechanics, and the other is frictionless. The advantages of frictionless mechanics are there is no force loss due to friction and low anchorage taxing. The preferred method for the retraction of teeth is loop mechanics and which ensures controlled tooth movement. Aim: To evaluate and compare the Moment-to-Force (M/F) ratio of PRP loop with that of Opus loop and L loop by Finite Element Method (FEM). Materials and Methods: An in-vitro study was conducted by using FEM analysis in DMIHER University with technical assistance from the Department of Mechanical Engineering VNIT Nagpur. Computer models of Loops design were prepared on Analysis of Systems (ANSYS) version 10 (V10) software. Opus loop, L loop and Platelet-Rich Plasma (PRP) loop were modelled as SOLID 64 beam elements. Different pre-activation bends were given to the models in α and β nodes of the loop. Statistical analysis was done with Statistical Package for Social Sciences (SPSS) version 27.0 software to compare the mean of all three loops. Results: Total 36 FEM models were studied. PRP loop showed greater M/F ratio than Opus and L loop with 15ºα and 25ºβ pre-activation bends in both 0.017×0.025 and 0.019×0.025-inch Titanium Molybdenum Alloy (TMA) wire i.e., 9.09 and 9.12, respectively. On comparison of M/F ratio of PRP loop, Opus loop and L loop prepared with 0.017×0.025 and 0.019×0.025 TMA wire, at 15ºα and 25ºβ pre-activation bend in 0.019×0.025 TMA, PRP loop showed highest M/F ratio of 9.12 as compared to 0.017×0.025 TMA wire. Conclusion: The study concluded that PRP loop is an efficient retraction loop with ideal moment force ratio for translatory movement of tooth. PRP loops had highest M/F ratio than Opus loop and L loop, indicating that PRP can be used for translatory movement of tooth in wires of different materials. Therefore, for proper utilisation of PRP loop, it must be prepared with either 0.017×0.025 inch TMA or 0.019×0.025 inch TMA wire.

Introduction: Cancer is associated with multiple renal manifestations like Acute Kidney Injury (AKI), Chronic Kidney Disease (CKD), proteinuria, and electrolyte imbalance. The reason behind renal dysfunction in cancer patients is multifactorial and can be attributed to underlying cancer and treatment modalities, in addition to co-morbidities surgical procedures and infections. Aim: To assess the spectrum of renal involvement in cancer patients presenting at a tertiary care hospital. Materials and Methods: The cross-sectional descriptive study, was conducted in the Department of Medicine of University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India. One hundred consecutive patients referred for nephrology consultation with diagnosed cancer, irrespective of cancer aetiology between the age group of 15-70 years with deranged kidney function test were recruited. Detailed medical and treatment history, including the type of cancer-solid or haematological, cancer status-cured or continuing, treatment given-chemotherapy, radiotherapy or surgery or a combination and associated co-morbidities like diabetes mellitus and hypertension were recorded. Routine investigations and special investigations, including assessment of estimated Glomerular Filtration Rate (eGFR) and estimation of Albumin-Creatinine Ration (ACR) was done. Patients were then segregated, based on their kidney function test into groups with AKI or CKD and underlying cause was valuated. Summary statistics was presented as mean, median or frequency and data analysed using Statistical Package of Social Sciences (SPSS) version 24.0. Results: The mean age of the study population was 53.73±12.20 years with 63% male and 37% female participants; 87% patients had solid cancers, while 13% had haematological cancers. The median duration, since the diagnosis was seven months and the patients were undergoing chemotherapy, radiotherapy or a combination of both; seven patients had surgery for underlying malignancy and an additional six had received chemotherapy or radiation therapy along with surgery. At the time of recruitment, 78% patients had AKI and 22% patients were diagnosed with CKD. Chemotherapy-induced nephropathy was the most common cause of AKI (n=46). In the CKD group diabetes (n=7) was the most common aetiology. Conclusion: The kidneys in cancer patients can be involved in a number of ways, as a consequence of the cancer itself, its treatment, superimposed infections or associated co-morbidities. Chemotherapy-induced nephropathy is the most common cause of AKI, whereas, diabetes is the most common cause of CKD in cancer patients.

Introduction: Vaccine wastage is an expected component of any immunisation program. Wastage is defined as “loss by use, decay, erosion or leakage or through wastefulness”. Vaccine wastage in unopened vial is mostly attributed by cold chain and stock management problem. Vaccine wastage in opened vial is mostly due to discarding of remaining dose at the end of the session, not being able to draw the number of doses in a vial, submergence of opened vials in water and poor vaccine administration practices. Aim: To assess the vaccine wastage in an immunisation clinic of a tertiary care centre in western Odisha, India. Materials and Methods: A record based descriptive cross-sectional study was carried out at Immunisation Clinic, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Odisha, India. The information regarding children and pregnant women vaccinated were retrieved from immunisation register for the study period 1st October 2019 to 30th September 2020. Vaccine wastage rate at the immunisation clinic was calculated by taking into account the number of doses of vaccines wasted divided by the total number of the doses of vaccines issued multiplied by 100. Results: Vaccine wastage rate and wastage factor was found to be highest in case of Measles-Rubella (MR) vaccine (wastage rate 65% and wastage factor 2.85) and lowest in Hepatitis B vaccine (wastage rate 1.67% and wastage factor 1.01). Wastage rate for 10 dose vial was 28.37% followed by 19.72% for 25 dose vial and 10.11% for 20 dose vial. Wastage rate and wastage factor was found to be higher in lyophilised vaccines when compared to liquid vaccines and the difference was statistically significant. Wastage rate and wastage factor was found to be higher for oral vaccines when compared to injectable vaccines and the difference was statistically significant. Conclusion: It was seen that in case of MR vaccine (supplied as 10 dose/vial), vaccine wastage was more as it didn’t follow open vial policy and less number of beneficiary came for MR vaccine per immunisation session. The vaccine wastage can be reduced in lyophilised vaccines if they are supplied in less doses per vial.

Introduction: Oral Squamous Cell Carcinoma (OSCC) commonly seen in 6th to 8th decades of life, when occurring in younger age group under 45 years its prediction and aggression is questioned due to subjective data in literature. Various histopathological grading systems of OSCC have been discussed in the literature, but the reability of such grading systems is controversial. However, Bryne’s invasive tumour front grading system has a high prognostic value since it provides diagnostic and predictive information of OSCC. Aim: To compare the histopathological parameters of OSCC by Bryne’s grading in different age groups. Materials and Methods: This was a retrospective archive study conducted in the Department of Oral Pathology and Microbiology, MIDSR Dental College, Latur, Maharashtra, India, from June 2010 to December 2020. Total 90 histopathologically diagnosed cases with OSCC were included in the study. These patients were divided into three groups: Group I included 30 patients below 40 years of age; Group II included 30 patients who were between 41 to 60 years of age; and Group III included 30 patients who were above 60 years of age. Formalin fixed paraffin embedded blocks of OSCC were used to prepare Haematoxylin and Eosin (H&E) stained section and graded based on Bryne’s invasive tumour front grading system. Chisquare test was applied to evaluate the significant difference among different age groups. Results: Out of 90 cases of OSCC included in the study among different age groups, 70 (77.77%) were males and 20 (22.22%) were females. This study found 93.33% (28 patients) in group III followed by 76.66% (23 patients) in group I and 63.33% (19 patients) in group II had score 2 nuclear polymorphism. When the three groups were compared using chi-square test, a p-value of 0.024 was obtained which was found to be a statistically significant in the nuclear polymorphism among different age groups by Bryne’s grading. The comparison between other histological parameters of Bryne’s grading degree of keratinisation (p-value=0.169), pattern of invasion (p-value=0.422), number of mitosis (p-value=0.107), and lymphoplasmacytic infiltration (p-value=0.252) revealed no significant differences. Conclusion: Outcomes of the study result showed differences in nuclear polymorphism were more obvious among old patients (group III) when compared to young patients (group I).

Introduction: Enamel demineralisation is common in the patients undergoing orthodontic treatment with fixed appliance and bonding of the orthodontic brackets on demineralised enamel surfaces compromises clinical outcome. Aim: To compare the effect of flouride varnish, Casein Phosphopeptide-Amorphous Calcium Phosphate Fluoride (CPP-ACPF) and resin infiltrant on Shear Bond Strength (SBS) of adhesives used to bond orthodontic brackets on demineralised enamel. Materials and Methods: This comparative in-vitro study was conducted in the Faculty of Dentistry, MAHSA University, Kuala Lumpur, Selangor, Malaysia, from September 2017 to March 2018. A total of 60 premolars were exposed to three cycles of demineralisation-remineralisation for 18 days and were grouped equally into four groups. Group I was without any enamel pretreatment while group II was treated with Fluoride varnish (Duraphat), group III with CPP-ACPF (GC Tooth Mousse Plus) and group IV with resin infiltrant (Icon). The orthodontic brackets were bonded to buccal surface of premolars with Transbond XT, conventional orthodontic light cure adhesive system and SBS (MPa) was measured following mechanical shearing of bracket under universal testing machine. Statistical comparisons were done using Welch Analysis of Variance (ANOVA) and Games Howell Post-hoc Test. Results: The highest SBS values were found in group IV (16±5.2 MPa) followed by group I (13.5±6.6 MPa), group III (9.8±2.8 MPa) and group II (3.4±2.7 MPa). Pairwise comparison of SBS scores between following groups were found statistically significant i.e., Group I and group II (p-value< 0.001), group II and group III (p-value< 0.001), group II and group IV (p-value< 0.001), and between group III and group IV (p-value= 0.004). The SBS scores between group I and group III (p-value=0.212) and between group I and group IV (p-value=0.671) were not significantly different from each other. Conclusion: Demineralised enamel pretreated with resin infiltrant (Icon) showed highest SBS among all the groups while fluoride varnish application showed lowest SBS. To prevent remineralisation during orthodontic treatment, Icon can be used as prophylaxis agent before brackets are bonded to teeth with enamel lesion.

Introduction: Patients of Type 2 Diabetes Mellitus (T2DM) characteristically have platelets hyper-reactivity and accelerated turnover rates leading increased adhesion, aggregation and procoagulant activity. Half-life of aspirin is only 20 minutes and it, therefore, irreversibly inactivates limited number of platelets over this short duration, when given as a once-daily dose. Newly generated-active platelets enter circulation, thereafter, and weaken antiplatelet effect of aspirin. Therefore, single daily dose of 75 mg aspirin may be insufficient to provide 24 hours protection against cardiovascular events, in these patients. Aim: To study and compare antiplatelet efficacy of 75 mg aspirin twice a day (75 mg BD) versus 75 mg aspirin once a day (75 mg OD) in patients of T2DM and to study the effect of variation in glycated haemoglobin (HbA1c) levels on antiplatelet efficacy. Materials and Methods: This was a longitudinal, open label, comparative trial conducted at tertiary care hospital for a period of nine months. A total of 129 subjects, diagnosed with T2DM according to American Diabetes Association (ADA) criteria 2018 (N=129) were enrolled in the study, of which nine were lost to follow-up and antiplatelet efficacy of aspirin dosing was examined at baseline and three-monthly intervals thereafter, till nine months, using colorimetric method. Results: Mean age of enrolled patients was 62 years (Interquartile Range (IQR) 57-66). HbA1c levels of both the groups were comparable (p=0.77) at baseline. At the end of nine months, percentage platelet aggregability of the 75 mg B.D. group (29.30±10.39) was significantly lower (p

Introduction: Water, Sanitation and Hygienic (WaSH) practices are the major predictors of morbidity, mortality as well as nutritional status and are highly cost-effective. Their adequate implementation contributes to overall improvement of the population. Many communicable diseases can be effectively managed by improving the sanitation, hygiene and water usage practices. Globally, limited access to water and low level of sanitation and hygiene practices are responsible for 90% of diarrhoea-related mortality. Aim: To estimate the proportion of population having access to safe water, adequate sanitation and practice of hand hygiene among people at Koppal, Karnataka, India and also to determine their association with occurrence of diarrhoeal episodes. Materials and Methods: This community-based cross-sectional study was conducted in the field practice area of Urban Health Centre (UHC), Koppal, Karnataka, India, from March 2019 to July 2019. Simple random sampling technique was used for sample selection and a total of 410 households were included in the study. Data about source, availability, accessibility, treatment methods of water, availability of toilet, details about domestic hygiene, hand hygiene practices and also history of diarrhoeal episodes among members of the household were collected through interviews using pretested and semi-structured questionnaire. Statistical analysis was done using Epi info software version 3.5.4 {Centres for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America}. WaSH practices were presented as percentages and Chi-square test at 5% level of significance was applied to test the association between the occurrence of diarrhoeal episodes and the various environmental factors. Results: The primary source of drinking water in majority (314, 76.58%) of households was piped corporation water and majority (309, 75.36%) of households had individual toilets. Majority (390, 95.12%) of the respondents practiced to wash hands after using toilet followed by 349 (85.12%) respondents admitted to wash hands before taking meals. Diarrhoeal episodes among household members, were found to be significantly associated with piles of solid waste around their households. Conclusion: The present study finds that three out of four households had access to safe water and one out of three households treated water before drinking. More than nine among ten households had access to either individual or community toilet facilities. Similarly, nine out of ten participants admitted to wash their hands after using toilet and eight washed before taking meals. Solid waste piles around households were identified as risk factors for occurrence of diarrhoea both among adults and children.

Introduction: In the era of changing medical education system, our teaching methods are not able to cope up with ongoing evolution of medical education. There is a definite need of introducing newer techniques of teaching-learning methods to improve the learning process to higher levels of Bloom’s taxonomy. Aim: To explore the perceptions and attitudes of final year undergraduate medical students and teachers in paediatrics towards Flipped Classroom (FCR) model. Materials and Methods: The present prospective observational study was conducted at the Mahatma Gandhi Institute of Medical Sciences Sevagram, a rural tertiary care institute of central Maharashtra, India from December 2020 to November 2021. The full class strength of 100 undergraduate final year medical students and all eight faculty members participated to conduct FCR sessions on Paediatric infectious diseases. Prereading study material in the form of videos and reading materials was provided for asynchronous learning, while classroom time was spent on solving problem-based questions based on “think-pair-share” with the faculty as facilitators. Student and faculty feedback was recorded via a five-point Likert’s scale. Consequently, small-group discussions were carried out to know the students’ reflections. The data was analysed using Statistical Package for the Social Sciences (SPSS) version 21.0 software. Results: The students showed overall encouraging response to the flipped classroom method with active participation. Eighty two students (82%) were happy about the content of the reading material and time spent on preclass activity. More than 75% of students agreed it to be more interactive with peers and teachers and that it enhanced active learning with development of interest in the given subjects. Seventy-five students (75%) gave positive responses towards the utility of flipped model for future classes as it helped in self directed learning. The faculty members also enjoyed this activity, though they found it time-consuming. Conclusion: FCR is an effective way to motivate and enhance active and self-directed learning. Unlike didactic lectures, it helps the students in conceptual understanding of the subject and makes the teaching-learning experience enjoyable.

Introduction: Poor drug compliance affects clinical outcome and increases healthcare costs in various disease setting. Several type II diabetes mellitus patients, not controlled on oral hypoglycaemics eventually require insulin therapy. Antidiabetic treatment is to be taken lifelong and in such a setting insulin price variation imposes a huge economic burden on poor diabetic patients. Moderating drug cost is associated with improved adherence to the medication regimen. Aim: To study the variation in cost amongst various brands of insulin analogues. Materials and Methods: This was an observational, cross-sectional study. Data regarding the 116 formulations and cost of 18 types of insulin preparations was collected from sources like Current Index of Medical Specialties (CIMS), National Pharmaceutical Pricing Authority (NPPA), Government of India official website (https://nppaimis.nic.in/nppaprice/pharmasahidaamweb.aspx) and compared with its lowest counterpart. The cost ratio and percentage cost variation was analysed and expressed as percentages. Results: This study showed a noticeable variation in the prices of insulin analogues. The highest percentage of cost variation was found for Insulin (Highly Purified) Zinc-40 IU (135.17%), followed by Insulin (Analogue) Glargine-100 IU (109.31%). The lowest percentage were for: Insulin (Human-Isophane Recombinant)-40 IU (1.40%), and Insulin (Analogue) Aspart- 100 IU (6.26%). Conclusion: A noticeable variation in cost prices was observed especially in commonly used intermediate acting insulin that help basal glycaemic control. Similarly, the lowest variation was observed with recombinant counterparts as an effect of pre-existing high prices of each. Need for vital medication like insulin at affordable costs has incited national and global efforts to make it cheaper and accessible to maximum beneficiaries.

Introduction: Lipid abnormality is an important modifiable risk factor associated with the type 2 diabetes mellitus and prediabetes. Dyslipidaemia occurring in diabetic patients, has important role in development of macrovascular atherosclerosis and increases the risk of cardiovascular disease. Furthermore, prediabetes has also been found to be associated with an increased risk for cardiovascular disease. Considering the prevalence and increased risk of cardiovascular disease in diabetes, it is becoming necessary to diagnose prediabetic individuals and assess their lipid profile and prevent them from developing overt diabetes and the further complications. Also, data available on lipid abnormalities in prediabetics is relatively less in the Indian population. Aim: To compare lipid profile in prediabetic and non prediabetic adult off-springs of type 2 diabetics and to evaluate the association between lipid profile and prediabetes. Materials and Methods: This cross-sectional study was conducted on 150 healthy young adult (>18 years) off-springs of type 2 diabetic patients, willing to participate in the study in Government Medical College and Hospital, Miraj from January 2019 to December 2019. All the relevant information was collected by administering a structured case record form. Fasting blood samples were collected and fasting blood glucose level, lipid profile including Total cholesterol (TC), Triglycerides (TG), Low Density Lipoproteins (LDL), High Density Lipoproteins (HDL), Very Low-Density Lipoproteins (VLDL) were estimated and compared. Data collected was entered in the Microsoft Excel (2010), expressed as frequency and mean. Chi-square test and Fisher’s-exact test was applied to observe the association between different study parameters. A p-value

Introduction: Coronavirus Disease 2019 (COVID-19) pandemic has affected healthcare systems worldwide. Healthcare Workers (HCWs) form one of the most at-risk population groups for acquiring infection. Trend analysis of anti Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) antibody titres in vaccination naïve HCWs will give an insight into the role of natural protective immunity against reinfection. Aim: To understand the dynamics of anti SARS-CoV-2 antibody response and its protective role against reinfection in a cohort of HCWs. Materials and Methods: This observational longitudinal cohort study was conducted in a tertiary care hospital in Gurugram, Haryana, North India from June to December 2020. The study was approved by the Institutional Ethics Committee. Serum specimens from 230 HCWs were tested for anti-spike protein Immunogloublin G (IgG) antibodies by chemiluminescence immunoassay. The HCWs with positive antibody status and previous Polymerase Chain Reaction (PCR) confirmed infection (n=47) were followed-up over 180 days for serial antibody titres at four visits, each at a gap of 30-45 days. Participants were classified into asymptomatic (n=18), mild (n=17) and moderate (n=12) disease categories based on severity of previous COVID-19 illness. SPSS version 22.0 was used for statistical analysis. Intergroup comparison of means was done using Kruskal-Wallis test and Chi-square test. The p

Fungal infections like subcutaneous phaeohyphomycosis are uncommon but are increasing lately, especially in tropical regions like India. Identification of correct aetiologic agent is essential as different species can have different organ tropism. Here, a rare case of nodular subcutaneous phaeohyphomycosis in an immunocompetent 62-year-old male patient who developed nodule over right dorsum of foot is reported. After various diagnostic tests a rare dematiaceous fungus Medicopsis romeroi was identified as a causative agent in the nodular material by Internal Transcribed Spacer (ITS) sequencing. Surgical excision and antifungal therapy of itraconazole proved beneficial with no recurrence during a six months of follow-up. Medicopsis romeroi has been debated for its role in human infections however, it should be considered as one of the aetiologic agents of subcutaneous phaeohyphomycosis.

Congenital Heart Diseases (CHD) carry significant morbidity and mortality in paediatric patients. Transposition of Great Arteries (TGA) is a common cyanotic CHD. However, onset of Pulmonary Arterial Hypertension (PAH) is potentially severe and rare complication reported in 1-3% of newborns. Hypertrophic Cardiomyopathy (HOCM) is a primary disease of cardiac muscle usually recognised in adulthood. Neonatal HOCM without other congenital anomalies, no family history of HOCM, no history of exposure to corticosteroids or any inborn errors of metabolism is rarely recognised. Authors hereby report two cases of neonatal autopsy showing TGA with PAH (Grade 2) and another with HOCM without any primary cause received in our hospital. With this case report authors wish to stress on the importance of cardiac examination (heart and the associated vessels) in autopsy specimen which in turn requires training of pathologists in cardiac pathology along with routine fetal anomaly scanning in arriving successively at the final diagnosis and detecting the cause of death which helps in management of future pregnancies by the clinicians.

Intra-abdominal masses in children are usually malignant. Benign tumours at this location are not seen frequently. It is even rarer to find solitary myofibromas intra-abdominally as these tumours are known to have predilection for the head and neck region. We present an unusual case of solitary myofibroma with abdominal localisation in a six-year-old male child who presented with abdominal distension since six months. Computed Tomography (CT) abdomen revealed a complex solid-cystic mass extending from umbilicus to right iliac fossa and measuring 9×6×4 cm. Histopathological examination revealed a tumour displaying biphasic nodular pattern with the presence of lighter staining fascicles of mature myoid cells along with darker staining and more cellular areas of smaller primitive cells. On Immunohistochemistry (IHC), tumour cells were positive for vimentin and Smooth Muscle Actin (SMA) with variable reactivity for desmin while these were negative for CD34 and Anaplastic Lymphoma Kinase 1 (ALK). Based on the histopathological and immunohistochemical findings, final diagnosis of myofibroma was made. Recognition of these lesions is extremely challenging owing to their rare presentation intra-abdominally and also because of their close morphological overlap with other spindle cell tumours commonly found at this site. This case highlights the combined role played by histopathology and IHC in making a clear distinction between different entities. It is imperative for both clinicians and histopathologists to establish the correct diagnosis as excision of the solitary myofibroma is curative in most cases and offers better clinical course than the more commonly found malignant tumours at this site.

Introduction: Now-a-days quality is the key aspect of clinical laboratory services. The six sigma metrics is an important quality measurement method for evaluating the performance of the clinical laboratory. Aim: To assess the analytical performance of clinical biochemistry laboratory by utilising thyroid profile and cortisol parameters from Internal Quality Control (IQC) data and to calculate sigma values. Materials and Methods: Study was conducted at Clinical Biochemistry Laboratory, Dhiraj General Hospital, Piparia, Gujarat, India. Retrospectively, IQC data of thyroid profile and cortisol were utilised for six subsequent months (July to December 2019). Coefficient of Variation (CV%) and bias were calculated from IQC data, from that the sigma values were calculated. The sigma values 3 and >6 were indicated by poor performance procedure, good performance and world class performance, respectively. Results: The sigma values were estimated by calculating mean of six months. The mean sigma value of Thyroid Stimulating Hormone (TSH) and Cortisol were >3 for six months which indicated the good performance. However, sigma value of Triiodothyronine (T3), Tetraiodothyronine (T4) were found to be

Leiomyosarcoma (LMS) is a malignant tumour of smooth muscle origin commonly seen in genital and gastrointestinal location. However, its presence in the head and neck region in a young child is extremely rare. Authors present a unique case of LMS in a one year and five-month-old child who presented with a painless mass in the right temporal region of the head. Histopathological examination revealed a highly cellular tumour arranged in intersecting fascicles of spindle cells with brisk mitotic activity and interspersed areas of necrosis. On Immunohistochemistry (IHC), the tumour cells were positive for Smooth Muscle Actin (SMA), Desmin and Vimentin and negative for S100 and Myogenin. A diagnosis of LMS was thus, made. Head and neck sarcoma is a broad entity encompassing plethora of differentials with closely overlapping morphological features which renders them diagnostically challenging, this can be resolved by employing various immunohistochemical stains readily available in all laboratories. This case highlights the combined role played by histopathology and immunohistochemistry in arriving at the correct diagnosis. To the best of our knowledge, this is the first case of LMS reported in the temporal region of head and is distinct with respect to its rare incidence, location and age at presentation. LMS at this site may masquerade as deceptively benign painless mass and may not be suspected initially, however one should bear in mind that these are moderate-to-high grade tumours and any delay in management may portend poor prognosis. Timely and aggressive surgical management is thus, the mainstay of treatment and critical to patient survival.

Neuromyelitis Optica (NMO) is a demyelinating inflammatory disorder of the spinal cord and optic nerve. As per American Society For Apheresis (ASFA) guidelines, Therapeutic Plasma Exchange (TPE) is considered as a second-line treatment in patients with weak or no response to steroid therapy. A patient of NMO presented to the tertiary care institute with a sudden loss of vision in the right eye. The patient was resistant to steroid treatment and improved significantly with TPE. Hence, TPE may be an effective treatment modality in steroid-resistant NMO with vision loss.

Introduction: Adults working in full time sedentary jobs spend 75% of their job time sitting, in terms of total time of sedentary behaviour of individuals. This population is at a greater risk of sedentary behaviour, due to elevation in the prevalence of sedentary office work and leisure time habits, resulting in 9-11 hours of total sitting time per day. Some of the occupations have adapted a sedentary behaviour, they demand long hours of being in one position. Adults adapt to faulty postures due to prolonged hours of work leading to muscular imbalances which highly contribute to the increased risk of musculoskeletal disorders. These disorders mainly occur due to weakening of the “core” musculature i.e. the central musculature of the body. This in turn may lead to excessive load on the lumbar spine, back, poor endurance of muscles, muscle imbalance and lower extremity disorders. Aim: To find out the prevalence of core weakness in bank employees with respect to their gender, age and Body Mass Index (BMI). Materials and Methods: A total of 99 healthy bank employees (67 males and 32 females), who were physically inactive for 6-8 hours daily and exercising for less than 2 hours per week, with their age between 20-50 years, were selected for the assessment of their core for finding its weakness. To find whether the bank employees had core weakness, outcome assessment was done by using a Chattanooga Pressure Stabilizer™. Results: In this study, statistically significant difference was noted within individuals with normal BMI (18.5-24.99 Kg/m2 ), whereas with respect to the age and gender, no statistically significant difference was noted. Conclusion: The prevalence of core weakness in bank employees was found to be 72.73%; majority of core weakness was found within the age group of 45-50 years (23.6%) which was relatively higher than other age groups. Prevalence of core weakness was found to be more in male population (65.3%) and in individuals with normal BMI (52.8%).

Introduction: The Left Hepatic Vein (LHV) and the Middle Hepatic Vein (MHV) presents with wide variations, the knowledge of which is very important during various surgeries of the left lobe as well as right lobe of liver. Aim: To study about the variations in the branching pattern of LHV and the MHV draining the left lobe of liver. Materials and Methods: A total of 60 adult human livers were dissected manually. The LHV and the MHV were typed into five types. Further, few of these types were again divided into subtypes. Results: The incidence of presence of common trunk of LHV and MHV was 76.6% (n=46). In 20% (n=12) livers these veins were present as separate trunks. In 3.33% (n=2), no trunk of the LHV was seen and the left medial vein and the left lateral vein were found to drain independently into the Inferior Vena Cava (IVC). Conclusion: Appropriate knowledge of the anatomy of liver is very important, for different surgical procedures for treatment of malignancies or other ailments of liver.

Introduction: In India alone in year 2000 there were 30 million people to suffered with Coronary Heart Diseases (CHD). CHD has 3% prevalence and incidence of Heart failure with CHD is about 0.4% to 2.3% per year. There are many traditional and nontraditional risk factors that are associated with cardiovascular diseases (CVD). Atherosclerosis is not only a lipid disorder but it is the process of active communication between endothelial dysfunction, sub-endothelial inflammation and wound healing process of vascular smooth muscle cells. Inflammation leading to atherosclerosis results in a CAD where innate and adaptive immune systems play a major role. Interleukin-1 (IL-1) also has a major role in the development of atherosclerotic CAD by promoting atherogenesis. Aim: To determine serum IL-1β levels for detecting CVD patients from Western Maharashtra population. Materials and Methods: We recruited 229 cases of CVDs (16 cases of complete heart block, one case of congenital heart disease, 22 cases of heart failure, 169 cases of myocardial infarction, one case of myocarditis and 20 cases of rheumatic heart disease) who were enrolled at Cardiology and Medicine Department of Lokamanya Tilak Municipal General Hospital, Sion, Mumbai along with 229 age and sex matched healthy controls were included in this case control study. Serum IL-1β was measured with commercially available ELISA kit. Cut-off level for estimation of IL-1β was done with Receiver Operative Curve (ROC) analysis. Statistical analysis was carried out using SPSS version 16.0 and Microsoft Excel 2007. Results: The median and Inter Quartile Range (IQR) level of IL-1β in CVD group was significantly higher than control group (p-value

Introduction: India plays host to a number of vector-borne diseases, including dengue and chikungunya. Both diseases demonstrate a synchronised peak, and present with similar findings. An early accurate distinction between them is valuable for effective treatment and prevention of complications. Currently used diagnostic methods estimate either antibodies or antigens; the former are absent in the first week of disease, and testing for the latter is expensive. Aim: To compare clinical profiles (history, examination) and laboratory parameters of patients with dengue fever and chikungunya fever. Materials and Methods: Pre-diagnosed patients of dengue (50) and chikungunya (50) were studied to elicit patterns in clinical, haematological and biochemical profiles which may be used for differentiation. The time taken for resolution of symptoms, and complications, were studied prospectively. The data were analysed using Z-test. Results: In both the diseases, patients present with short pyrexia (3 times) elevations were significant for dengue. Conclusion: It may be concluded that the two diseases, despite their synchronised peak during post-monsoon season, and overlapping presenting symptoms, can be distinguished on the basis of clinical profiles of the patients, and a few basic laboratory tests. On studying a larger sample size, the presence of these associations could be determined with more certainty.

Introduction: Phytonutrients like polyphenols, carotenoids, glucosinolates and phytoestrogens may not be as essential as micronutrients. But, these have been useful to prevent disease and keep the fitness of the body. Amla (Indian Gooseberry), guava, kokum and purple grapes are highly nutritious seasonal fruits, rich in these phytonutrients and micronutrients. Regular consumption of these fruit-based beverages can improve the antioxidant status and health of the young adults. Aim: The aim was to study efficacy of two formulations (F1 and F2) as health beverages made using juices of amla and dark grapes as main ingredients to be assessed as antioxidant rich natural fortificants. Materials and Methods: Fourty-eight healthy volunteers were recruited (age 18-35 years) and randomised in a double blind trial of four weeks comprising of three groups (placebo, F1 and F2). Placebo was pineapple flavoured sugar syrup, F1 was amla based syrup containing water extracts of tulsi, brahmi, bael and jambhul juice while F2 had purple grape juice as major ingredient along with guava, pomegranate and kokum juices in sugar syrup. Results were assessed using Two-way ANOVA followed by paired t-test and p-value

Angiomyoma is a benign tumour arising from smooth muscle of blood vessel walls. These tumours are usually found in the lower extremities presenting as a painful mass. Angiomyoma of the preauricular area is rare, and only a few cases have been reported. Here, we report the case of a 56-year-old male patient with preauricular swelling for 30 years mimicking benign parotid neoplasm. A diagnosis of angiomyoma of the preauricular area was made on the basis of histopathology.

Sclerosing Lipogranuloma (SLG) is a rare disease that affects many organs, with male genitourinary system being the most common site. It is a benign disease which occurs due to a granulomatous reaction of fatty tissue in this area. In most cases, it occurs secondary to exogenous foreign bodies. However, endogenous lipid degeneration can occur due to infection, trauma, and allergic mechanisms. We describe a 34-year-old male patient who presented with a growing, painless scrotal mass on physical examination. Clinical suspicion of paratesticular tumour was made and on cytological examination, possibility of adenomatoid tumour was considered. Histopathological evaluation confirmed the diagnosis of paratesticular SLG.

Eagle’s syndrome is a symptomatic anomaly due to elongation of styloid process or calcification of stylohyoid ligament manifesting as a pain in cervicofacial region. The present report is of a 45-year-old female who presented with bilateral cervical pain and vague throat complains, not relieved by medical line of management. She was diagnosed with bilateral elongated styloid process on radioimaging. Intraoral styloidectomy was performed, following which she was completely relieved of her symptoms. This is a rarely performed approached for removal of elongated styloid procedure due to the grave vascular complications, but it has several advantages including minimally invasive, scarless, cost-effective technique with good patient compliance.

Introduction: Co-testing performance for detection of high grade Cervical Intraepithelial Neoplasia (CIN) has not been adequately addressed from Low Resource Countries (LRCs). Where isolated tests do not have adequate performance, further explorations are recommended. Aim: To evaluate the co-testing of conventional cervical screening tests such as Papanicolaou (Pap) and Visual Inspection Cervix with Acetic Acid (VIA), with care HPV on Cervical Samples (CHPV) or on Vaginal Samples (VHPV) in the detection of high grade CIN. Materials and Methods: The cross-sectional study was conducted on ever married women of age 30 to 59 years in a rural community of Dadri. Women were screened by CHPV, VHPV, and Pap and VIA methods. Confirmation of screen positives was done by histology. Sensitivity, Specificity and likelihood ratios of different combinations of test determined to evaluate the performance. Results: Total eligible women, 66.2% (5032/7604) responded for screening. Analysis was performed on 4658, after excluding those who did not complete all screenings. Co-testing of CHPV (OR=246) or VHPV (OR=278) with Pap had highest association. Positive likelihood ratios of CHPV and VHPV with Pap in CIN II+ detection rates were 13.0 and 11.8 and in CIN III+ the detection rates were 18.0 and 16.0 respectively. Higher sensitivities and specificities were observed in co-testing for CIN III+ detection as against CIN II+ lesions. Conclusion: Choice of co-testing in a pair of tests for detection of high grade CIN is likely to depend on whether screening is targeted for developed or low resource country. VIA in isolation might not yield optimal results for LRCs.

Introduction: Modification of initial Antiretroviral Therapy (ART) program is an important issue in HIV infected patients as the number of ART regimens available is limited. Hence, there is a need to understand the factors that affect modification and therefore, the durability of the initial antiretroviral regimen. Aim: To study the type of modification of first line ART in treatment-naive HIV positive patients and factors influencing it. Materials and Methods: A retrospective observational study was carried out in the HIV clinic of a tertiary care hospital, using data obtained from the case records of the subjects who were initiated on ART between January 2012 to December 2014. Data on patient baseline characteristics, proportion of patients who required modification, type and time of modification was collected. The determinants of time to modification were analysed using Chi-square test. Binomial logistic regression was utilized to assess independent risk factors for change in regimen. Results: Out of 200 case records analysed, 54 patients had to undergo a modification in their initial regimen. The mean age of patients was 44.68 ± 11.31 years. Majority of the patients were males. The most common reason for modification was Adverse Drug Reactions (ADRs) (79.63%) followed by treatment failure (9.25%). In 85.18% cases, modification involved substitution. Occurrence of ADRs and non-tenofovir based first-line regimens were associated with higher likelihood of substitution in regimen (p

Introduction: Cellular mobile phones are a major cause of distraction especially while driving. The aggressive and inappropriate use of cellular mobile phones has increased the risk of accidents. Similar alerts are available in literature for certain substances and drugs (e.g. second generation anti H1 drug –Cetirizine) which also derange psychomotor performance and parameters of alertness. Aim: This study measured variations in hand-eye coordination and visual acuity due to use of cellular mobile phone in comparison to that of commonly used antihistaminic drug viz., single dose Cetirizine 10 mg. Materials and Methods: It was a single blind, single dose, interventional study, 100 healthy human volunteers divided into two groups. Baseline readings of all volunteers were noted. Group-I (n=50) was Cetirizine group (10mg orally stat), Group –II (n=50) Cellular mobile phone user group. Alertness was tested on hand– steadiness tester (Reaction Time Index = RTI) and on Flicker–fusion apparatus (visual acuity - Critical Flicker Fusion Frequency per second= CFFF/sec). Baseline readings of all volunteers were noted before intervention. Baseline was compared with readings at three hour post-intervention and was analysed by paired t-test. Inter-group comparison of parameters was also done and was analysed by unpaired t-test. Results: The baseline RTI (95.46±41.74, 85.11±39.05) and CFF low and high (40.07±9.970, 40.76±9.309 and 40.42±9.035, 40.48±9.863) respectively, in Cetirizine group and Mobile user group were comparable. The RTI increased significantly (116.4±51.46, 102.8±49.26) in both the groups after intervention. However, there is no significant change in CFF intensity from baseline in either group post-intervention. Conclusion: Concurrent use of mobile phone while performing tasks, showed significant impairment of hand–steadiness which was comparable to that produced by single dose Cetirizine 10 mg and this may be one of the factors contributing to their close association with road traffic accidents.

Introduction: Clonidine an alpha 2 adrenoceptor agonist possesses analgesic properties and has been used as an adjuvant in epidural analgesia. The addition of clonidine to other analgesics may result in enhanced analgesia through additive mechanisms or synergistic mechanisms. The enhanced analgesia may lead to a decrease in the dosage of analgesic drugs along with reduction of side effects. Aim: The purpose of this study was to evaluate the effect of adding clonidine to epidural ropivacaine and fentanyl mixture in terms of quality of analgesia and side effects in patients of total knee replacement surgery. Materials and Methods: A prospective randomised double blind study was conducted on 60 patients of ASA physical status I, II and III who underwent unilateral total knee replacement surgery under combined spinal epidural anaesthesia. Patients were divided into two Groups A and B randomly. Postoperatively Group A received continuous epidural infusion of ropivacaine 2 mg.ml -1 and fentanyl 2 μg.ml -1 along with clonidine 2 μg.ml-1 in the range of 3-7 ml.hr-1 while Group B received the ropivacaine and fentanyl epidural solution. The postoperative VAS scores, haemodynamic parameters, motor block, sedation, nausea, vomiting and any other significant side effects were noted. The two groups were compared with student's t-test, Pearson’s Chi square test and t-test using SPSS statistical software. Results: Visual analog scale scores were lower in Group A (3.38) than in Group B (3.72). The average infusion rate was lower in Group A (4.7 ± 0.7 ml.hr -1 ) than in Group B (5.5 ± 0.7 ml.hr-1 ). Patients in Group A required less dosage of rescue pain medication Paracetamol (1g i.v.), diastolic pressure and heart rate were lower in Group A. The groups were comparable in terms of sedation, motor block and nausea vomiting. Conclusion: Clonidine added to a ropivacaine and fentanyl mixture augmented the postoperative epidural analgesia without significant side effects.

Congenital Lobar Emphysema (CLE) is a developmental anomaly, characterized by hyperinflation of one or more pulmonary lobes. It presents in infancy with variable degree of respiratory distress due to compression atelectasis. It is most often associated with mediastinal shift with subsequent hypoxia. CLE poses a diagnostic and therapeutic dilemma. We report a case of five-monthold infant of CLE requiring left lobectomy, who was previously being treated for pneumonia which was unresponsive to medical therapy. Anaesthetic challenges experienced during the case and a brief review of literature is presented.

Primary Plasma Cell Leukaemia (pPCL) is a very rare and aggressive subtype of plasma cell dyscrasias with a very poor outcome and characterized by presence of >2x109 /l circulating plasma cells. Overall incidence being 1%-2% of all malignant plasma cell diseases and 0.9% of all acute leukaemias. Patients with primary and secondary PCL have similar clinical features but differences do exist. Here we report a rare and interesting case diagnosed as primary PCL in a 44-year-old female with unusual clinical presentation and complex karyotyping. Her serum electrophoresis showed a monoclonal IgG component and immunohistochemistry of bone marrow plasma cells showed CD 38 positive and CD 20 negative. The patient initially responded partially for combination chemotherapy, but succumbed after 20 days of diagnosis. We are presenting this case to highlight the importance of early diagnosis of such haematological malignancies in settings where treatment options like stem cell transplantation are limited.

Refractory Status Epilepticus (RSE) not responding to any therapy and not associated with any aetiology has been termed as New Onset Refractory Status Epilepticus (NORSE). Guidelines for optimal management of cryptogenic NORSE are not clearly defined so far in the literature. Other than common medication, use of high-dose steroids, IV immune globulins, and plasma exchanges in NORSE of unknown aetiology have been scarcely described. Immunomodulatory therapy like plasmapheresis is based on the fact that a pathological substance exists in the plasma that contributes to the disease process and its symptoms, which gets removed. We report a case of young female patient diagnosed as NORSE who responded to treatment with plasma exchange after becoming refractory to antiepileptic therapy and treatment with anaesthetic agents for recurrent seizers.

Introduction: The indoor hospital use of antibiotic irrationally has been a growing concern in the recent past. For the patients and providers of health care services this kind of drug consumption account for a major chunk of the budget. Aim: To assess the outcome of restriction on the use of parenteral antibiotics with respect to their utilization and monetary benefits, in a tertiary care hospital in India. Materials and Methods: Data details were collected regarding drug utilization two months before and after restriction respectively. A total 1605 patient records assessed. Drug utilization was expressed as DDD/100 patient bed days. Use of Carbapenems were restricted to culture positive cases only. Antibiotics started for patients as per clinical judgment were issued for only five days. Culture sensitivity reports verified physically on a special indent form, before every antibiotic issued thereafter. Results: Piperacillin-tazobactum (DDD/100 BD 1.72 before and 1.29 after restrictions) was the commonly used antibiotic. Considering values expressed in DDD/100 BD before and after restriction respectively, substantial decrease in consumption of antibiotics like Imipenem- Cilastin (0.22 to 0.16), meropenem (0.30 to 0.09), piperacillin-tazobactum (1.72 to 1.29), teicoplanin (0.24 to 0.05) and vancomycin (0.69 to 0.40) was observed. An increase in consumption of amoxicillin-clavulanic acid (0.90 to 1.04) and clarithromycin (0.44 to 0.55) noted, pointing to a shift in antibiotic use. Restriction decreased expenditure burden on these antibiotics by INR 1,45,911 (17.31%). Conclusion: Restriction of antibiotics cuts down consumption and benefits hospital budget immensely.

Diabetes Mellitus (DM) is a metabolic disorder characterized by relative or absolute deficiency of insulin, resulting in hyperglycemia. Subcutaneous insulin and Oral Hypoglycaemic Agents (OHA) constitute the main treatment option for DM. Insulin is administered by injection or continuous infusion to control glucose levels mainly in Type I diabetes. Newer routes both oral and non oral, for insulin administration are current direction of insulin research as insulin injection therapy is burdensome and painful for many patients. Inhalational insulin is an attractive alternative for systemic administration of insulin given its accessibility and large alveolar-capillary network of lungs for drug absorption. Afrezza, inhaled insulin has been recently approved by Food and Drug Administration (FDA). It is a new, quicker acting inhalable insulin with a different and safer pharmacokinetic profile in comparison to previously failed inhaled form of insulin.

Background: Dengue has been known to be endemic in India for over two centuries. There is a need to assess the magnitude of dengue virus establishment in the state of Rajasthan. A surveillance study was conducted to analyze dengue seropositivity among patients with clinical suspicion of dengue fever like illness, who presented to or were admitted at a tertiary care private hospital at Jaipur. Methods: Serum samples from 2169 suspected dengue cases (1356 males and 813 females) were received in the Serology lab over the four year study period (2008-2011). The samples were subjected to a rapid immuno-chromatography assay with differential detection of IgM and IgG antibodies. A primary dengue infection was defined by a positive IgM band and a negative IgG band, whereas a secondary infection was defined by a positive Ig G band with or without an IgM band. Result: Among the 2169 patients who were screened; 18.99% (412) were dengue specific IgM positive cases. 64. 49% (1399) cases were negative for dengue specific antibodies, 5.67% (123) were primary dengue cases, and 23.51% (510) were total secondary dengue cases. During the study period, the Dengue IgM seropositivity was highest in the year 2009 and was lowest in the year 2011. Most of the cases occurred in the post-monsoon season, with a peak in the month of October, each year. Conclusion: A detailed and continuous epidemiological surveillance is required, for monitoring the incrusion and spread of dengue viruses. This will help in undertaking and implementing effective control and management strategies.

Introduction: Glaucoma is the leading cause of blindness in India and the numbers of the patients are increasing every day. The prevalence of glaucoma depends upon various factors like racial and ethnic factors, the socioeconomic status, etc. Aim: To study the pattern of glaucoma distribution among the patients in a tertiary care hospital. Materials and Methods: A retrospective analysis of 1500 glaucoma patients was done, who presented between 2007 and 2012 in TMMC and RC, Moradabad, U.P, India. The age and the gender distribution of glaucoma was studied along with its subtypes in different religious groups (mainly among Hindus and Muslims). Results: The mean age of the glaucoma patients was 52.7 years. Glaucoma was diagnosed in 882(58.8%) Muslim and in 561(37.4%) Hindu patients. The prevalence of POAG (33.0%) was almost equal to that of PACG (32.7%). POAG was the most common type of glaucoma in males (16.8%), while PACG was very common among females (18.8%). In Hindu patients, POAG (40.8%) was the commonest form of glaucoma, while in Muslims, PACG (40.1%) was the highest form of glaucoma. Conclusion: Glaucoma is a major ocular disease which is prevalent in the Muslim population of the western Uttar Pradesh region.

ABSTRACT Background: The extensive use of the β-lactam antibiotics in hospitals and in the community has created major resistance problems which has led to increased morbidity, mortality and healthcare costs. The use of the β-lactamase inhibitors in combination with the β-lactam antibiotics is currently the most successful strategy used for circumventing the resistance mechanisms. Objective: To evaluate the in-vitro activity of six commercially available β-lactam/β-lactamase inhibitor combinations against Gram Negative Bacilli (GNB). Materials and Methods: A total of 384 non duplicate, consecutive, gram negative bacilli (278 Enterobacteriaceae and 106 non fermenters) isolated from various clinical samples were subjected to antimicrobial sensitivity testing by the KirbyBauer method. The following β-lactam/β-lactamase inhibitor combinations were tested: amoxycillin-clavulanic acid, ampicillinsulbactam, cefoperazone-sulbactam, piperacillin-tazobactam, cefepime-tazobactam and ticarcillin-clavulanic acid. Results: Against the Enterobacteriacae, the sensitivity of Cefepime- tazobactam was 90. 64%, followed by Cefoperazonesulbactam (84.89%) and Piperacillin - tazobactam (53.95 %). The sensitivity of the non fermenters was the highest for Cefepimetazobactam (49.04%) and was least for Ampicillin-sulbactam and Amoxycillin-clavulanic acid (4.71% each). Cefepime-tazobactam was sensitive for all the extended spectrum β-lactamase (ESBL) isolates. Conclusion: Among the six β-lactam/β-lactamase inhibitor combinations tested, Cefepime-tazobactam exhibited the best in-vitro activity against the gram negative bacilli isolated at our centre.

ABSTRACT Context: Use of information technology hardware given new heights to professional success rate and saves time but on the other hand its harmful effect has introduced an array of health related complaints causing hazards for our human health. Increased use of computers has led to an increase in the number of patients with ocular complaints which are being grouped together as computer vision syndrome (CVS). In view of that, this study was undertaken to find out the ocular complaints and the factors contributing to occurrence of such problems in computer users. Aims: To evaluate the factors contributing to Ocular complaints in computer users in Teerthanker Mahaveer University, Moradabad, U.P. India. Settings and Design: Community-based cross-sectional study of 150 subjects who work on computer for varying period of time in Teerthanker Mahaveer University, Moradabad, Uttar Pradesh. Materials and Methods: Two hundred computer operators working in different institutes offices and bank of were selected randomly in Teerthanker Mahaveer University, Moradabad, and Uttar Pradesh. 16 were non responders 18 did not come for assessment and 16 were excluded due to complaints prior to computer use making no response rate Twenty-one did not participate in the study, making the no response rate 25%. Rest of the subjects (n = 150) were asked to fill a pre-tested questionnaire, after obtaining their verbal consent Depending on the average hours of usage in a day, they were categorized into three categories viz. 6 hrs of usage. All the responders were asked to come to the Ophthalmic OPD for further interview and assessment. Statistical Analysis Used: Simple proportions and Chi-square test. Results: Among the 150 subjects studied major ocular complaint reported in descending order were eyestrain. (53%). Occurrence of eye strain, ( 53.8%), itching ( 47.6%) and burning (66.7%) in subjects using computer for more than 6 hours. distance from computer screen with respect to eyes, use of antiglare screen, taking frequent breaks, use of LCD monitor and adjustment of brightness of monitor screen bear a significant association with these ocular complaints in computer users. Conclusions: Eye strain is the most common ocular complaints among computer users working for more than 6 hours a day. We also found that maintaining ideal distance from screen, keeping level of eyes above the top of screen, taking frequent breaks, using LCD monitors and using antiglare screen and adjusting brightness levels according to workplace reduced these ocular complaints to a significant level.