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This write-up is a brief reflection of a rural doctor couple, Dr. Himmatrao Saluba Bawaskar (HSB) and Dr. Pramodini Himmatrao Bawaskar (PHB), working in the remote area of Maharashtra state of India during COVID-19 pandemic. During the pandemic, rural doctors are routinely exposed to symptomatic COVID-positive cases in the outpatient as well as indoor setting. The authors, both husband and wife, were in compulsory quarantine for twice at home and experienced social stigmas attached to a positive case. Here is a report the details of COVID-19 pattern and its management learned from the published scientific papers on COVID-19, and severe acute respiratory syndrome due to SARS-CoV-2 from December 2019 and their own experience in rural setting and the current literature shared in the form of personal narration. Apart from the personal experience of patients experience regarding quarantine period, COVID-19 is discussed in detail for the benefit of rural practitioners. [ABSTRACT FROM AUTHOR]

Background: India accounts for a quarter of the world cervical cancer burden. Cervical cancer is highly preventable. However, low level of participating women in screening is one of the major issues. The aim of this work was to study the factors that influence women to participate in cervical cancer screening by providing menstrual pads for human papillomavirus (HPV) testing. Methods: Menstrual clothes were collected from two different populations from the rural areas of Maharashtra state for HPV testing to screen for cervical cancer. For this study, out of 945 participated women, 557 (58.9%) provided their menstrual pads. Multivariate logistic regression was applied to calculate the odds ratio (OR) and 95% confidence interval (95% CI). Results: The probability of providing the menstrual pads was high among the women who were highly educated compared to those with less education (OR: 1.4; 95% CI: 1.0–1.9), having mobile phone facilities as compared to those with no mobile phones (OR: 1.4; 95% CI: 1.0–2.0), who were using new cloths as menstrual pads compared to those who did not use the same (OR: 8.5; 95% CI: 5.0–14.3), who did not have tobacco habit as compared to those who had tobacco habit (OR: 1.4; 95% CI: 1.1–1.9) and in the village where health worker was stationed as compared to the village where health worker was not stationed (OR: 1.8; 95% CI: 1.4–2.5). Conclusion: Factors including health worker availability, using mobile phones for communication and high education level facilitate women’s participation. To improve the participation, there is need to apply special strategies for older age group, less educated women and women having tobacco habit. [ABSTRACT FROM AUTHOR]

Introduction: In 2019, the Central Drugs Standard Control Organization (CDSCO) introduced the New Drugs and Clinical Trials Rules 2019 (NDCTR), which separated the research guidelines for "Clinical Trials" and "Biomedical and Health Research." As a result, guidelines issued by Indian Council of Medical Research were stated to apply to academic clinical trials (ACTs). This change is important because academic studies are crucial for scientific advancement and repurposing of approved drugs in health-care industry. However, conducting an ACT can pose challenges. We assessed the level of awareness, knowledge, and challenges faced by investigators. Our aim is to overcome some of these challenges and encourage more academic studies for the betterment of healthcare and scientific knowledge in India. Methodology: The study was conducted in two phases after obtaining approval from the Institutional Ethics Committee (EC) of three tertiary care hospitals in Mumbai. In the first phase, the number of ACTs was assessed from the clinical trial registry India website, while the number of registered and re-registered ECs were assessed from the CDSCO website. The second phase involved assessing investigator awareness and knowledge about ACTs using a prevalidated questionnaire with a content validity index score of 0.93. Results: In 2020, the highest numbers of studies were registered, with the highest numbers of registered and re-registered ECs from Maharashtra. All participants completed the questionnaire and were aware of the need to follow guidelines for clinical trials. Sixty-seven percent of participants knew that the guidelines for ACTs differed from those of sponsored clinical trials, but only 58% were aware of the exact definition of an ACT as per NDCTR, 2019. Eighty-five percent of participants knew who could initiate an ACT, but only 27% knew about the applicability of results of an ACT and 33% had in-depth knowledge about the required approvals, while only 10% knew the archival period. Although 71% of participants had knowledge about serious adverse event reporting, few answered in-depth questions correctly. Only 31 participants reported facing varied challenges. Conclusion: To conduct ACTs effectively and contribute to healthcare and scientific advancement, it is crucial to enhance investigators' existing knowledge about ACTs. [ABSTRACT FROM AUTHOR]

Background: Infectious diseases such as measles and rubella (MR) spread quickly to infect vulnerable populations, especially children below 5 years. Mass vaccination had been implemented to prevent it and its success has been observed through decreasing numbers of cases. The Government of India started MR campaign in February 2017, and Maharashtra was one of the selected states for it. The study was planned to find out the trend of measles cases before and after MR campaign and also to find out the effect of lockdown due to pandemic on vaccine usage. Aim: The aim of this study is to find out the trend of MR cases before and after MR campaign. Materials and Methods: A Descriptive observational study was done in tertiary care center for 2 years. Measles cases from the past 5 years were taken, and the impact of MR campaign was seen. Lockdown due to COVID-19 pandemic had an impact on the vaccination drive. To find out the impact, data for different vaccines were collected from different health centers, and analysis was done in Epi-info. Results: Post MR campaign, there was a sharp decrease in measles cases. Measles mostly targeted children below 6 years, and infants were seen having the longest stay in hospital due to the infection. At the onset of lockdown due to pandemic, vaccine consumption has gone down everywhere in the study. Conclusion: Vaccination is a proven weapon to prevent vaccine-preventable diseases, and measles is no different from other infectious diseases. Lockdown hindered the process of mass vaccination of vaccine-preventable diseases and which has gone down everywhere. [ABSTRACT FROM AUTHOR]

Context: The anthropometric facial clinical proportions are used in the field of orthodontics, maxillofacial and plastic surgery for aesthetic or abnormality corrections. There is lack of enough literature on the facial profiles of Indians. Aim: To assess correlations between facial parameters and stature of young Maharashtrian women by using anthropometry. Settings and Design: It is a cross-sectional observational pilot study at Maharashtra Institute of Dental Sciences & Research, after approval from the Institutional Ethical Committee. Methods and Material: The study included 15 students of 21-23 years age selected by simple randomisation. The facial parameters were measured by sliding vernier calipers after identifying facial landmarks by stickers. Facial height (FH) in thirds; upper FH (UFH), middle FH (MFH) and lower FH (LFH); facial width (FW) and stature or overall height (OH) were calculated to define average facial features. Statistical Analysis: Multiple pairwise statistics and simple linear regression analyses were done for various dependent variables. Results: The means of UFH, MFH, LFH and total facial heights (TFH) were found to be 5.2 ± 0.54, 5.35 ± 0.34, 5.16 ± 0.44 and 15.7 ± 0.98 cm, respectively. The TFH showed a moderate correlation with stature (P = 0.05, r = 0.64) and a strong correlation with lower lip length (P = 0.001, r = 0.78). Facial width showed a negative correlation with facial shape (P = 0.05). Conclusions: The selected sample showed the statistically insignificant difference between UFH, MFH and LFH indicating equitable distribution among Indian women of Maharashtrian origin of 21-23 year age group. Longer TFH is positively correlated with higher stature and longer lower lip length. [ABSTRACT FROM AUTHOR]

Objectives: Globally, the prevalence of obesity is increasing at an alarming rate. Obese patients often suffer from chronic dyspeptic symptoms. The aim of the study was to know the gross and histologic upper gastrointestinal mucosal changes and the prevalence of Helicobacter Pylori (H. Pylori) infection in overweight and obese dyspeptic patients. Materials and Methods: A cross-sectional, observational study was done on 100 patients with dyspepsia and a body mass index (BMI) of ≥25 kg/m2. The study was done between August 2019 and September 2021 at a tertiary care hospital in Maharashtra, India. Statistical Analysis: Chi-square test, Mann-Whitney test, and Fischer exact tests were applied to study the association between categorical variables. A P value of < 0.05 was considered statistically significant with a confidence level of 95%. Results: There were 59 males and 41 females. The mean age of the study subjects was 41.95 ± 12.32 years and the age range was 19–67 years. The maximum number of patients (36%) were in the age group of 50–59 years. Hypertension (45%) and type 2 diabetes mellitus (T2DM) (30%) were the common comorbidities present. Heartburn and regurgitation were the most common symptoms, present in 37% and 35% of the subjects, respectively. Inflammatory lesions oesophagitis (28%) and gastritis (43%) were the common findings in upper gastrointestinal endoscopy (UGIE). The stomach was the most common site with lesions. On histopathological examination, erosive gastritis (33%) and oesophagitis (28%) were confirmed. A total of 86% of obese subjects had at least one grossly abnormal finding. The prevalence of H. Pylori was 32%. Obese subjects had significantly more abnormal findings on UGIE compared to overweight subjects (P < 0.05). Obese patients suffering from type 2 diabetes mellitus had significantly abnormal findings on UGIE compared to non-diabetic obese patients (P < 0.05). Obese patients with higher body mass index (BMI) and the presence of H. Pylori infection were more likely to have abnormal UGIE findings. Conclusions: Inflammatory and erosive lesions of the stomach and oesophagus are more common in obese dyspeptic patients. UGIE should be the investigation of choice and should be performed in overweight and obese patients with dyspepsia to predict and prevent Gastrointestinal (GI) disorders and their related complications. [ABSTRACT FROM AUTHOR]

Context: Soil-transmitted helminths (STH) infections are among the most common and widespread infections in developing countries where sanitation facilities are inadequate. Aims: This study aimed to estimate the prevalence of STH infections in prenatal mothers in two states in India. Settings and Design: A cross-sectional survey was conducted in Maharashtra and Rajasthan state of India. We randomly selected one municipal corporation and one rural block from a selected district in each state. Methods and Material: Out of 2400 contacted, 2206 pregnant women gave stool samples for microscopy for parasitological study. The response rate was 89.91%. Stool specimens were transported to an accredited lab and examined microscopically within 24 hrs. Results: Prevalence of STH was 8.34 (95%CI 7.22–9.57). The prevalence in rural and urban areas was 10.01% (95%CI 8.51–11.74) and 5.76% (95%CI 4.39–7.52), respectively. Ascaris lumbricoides (34.7%) were the most common, followed by Entamoeba histolytica (30.43%), and 20.1% were mixed infections. Higher age, walking barefoot, weight gain during pregnancy were significantly associated with STH (p < 0.05). The mean hemoglobin value in women with STH was significantly less (8.75 gm%; SD 4.04) compared to those without STH (10.23 gm%; SD 1.23) (p < 0.05), and average weight gain during pregnancy was significantly less among women with STH (3.80 kg; 4.11) compared to women without STH (8.45 kg; 2.83); (p = 0.000). Conclusion: The study provides valuable insights into the burden and intensity of STH in pregnant women that may support the policy recommendation for deworming during pregnancy. [ABSTRACT FROM AUTHOR]

Objective: To investigate the causes and contributory factors of perinatal mortality by verbal autopsy in Maharashtra. Materials and Methods: Rural and urban areas in six districts in Maharashtra were selected by Probability proportional to size sampling. Verbal autopsies for perinatal deaths were conducted using standard tools and by visiting households; cause of death was assigned according to the International Classification of Diseases-10 using a standard algorithm. Statistical analysis was done using the SPSS-11 version software. Results: A total of 83 perinatal deaths (31 stillbirths and 52 early neonatal deaths) were investigated out of which cause of death for perinatal deaths could be assigned in 96.4% deaths. The leading causes of perinatal deaths were prematurity (19.3%) and complications of placenta, cord and membranes (12.9%) among stillbirths, while low birth weight (36%) and prematurity (26%) accounted for early neonatal deaths. [ABSTRACT FROM AUTHOR]

Background: Psychiatric problem is as common as among the 25% of the general population and 15% patients attending specialty clinic. Majority of the cases are dealt by primary care physician at the first contact, but there is only 2 weeks of clinical posting and 20 h of theory classes during MBBS course. Earlier studies have reported low attendance during the posting and theory classes. There are few studies on this aspect. On this background, the present study was planned. Methodology: One hundred 8th semester students of MBBS from two medical colleges (Group A government aided college and Group B from Private college under autonomous university) from the same locality of Central Maharashtra were selected for the study after due approval by the Institutional Ethical Committee. Questionnaire was prepared by the psychiatric faculty of both institutes and administered to the individual students. The data were analyzed using suitable statistical methods (Chi-square test and t-test). Results: Only 27% of the students in Group A attended 25%–30% of clinical posting, whereas none of them attended a single theory class. While in Group B, 1/3rd of students attended 30%–40% of clinical posting and 20%–25% of theory class. No separate examination in the subject (88%–94%) and adjustment of attendance in the other major subjects (64–86%) were cited as main reasons for nonattendance among the majority of the students in both the groups. Conclusion: Strict adherence to the attendance by the institutional authority, increase in the training hours and separate examination in the subject at undergraduate level may help in improving the attendance and change in attitude of the students toward psychiatry. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The study aimed at evaluating the dental prosthetic status and its need among the geriatric population of Central India reporting to the dental colleges. Materials and Methods: A descriptive cross-sectional study was carried out to evaluate prosthetic status and needs among geriatric individuals in Wardha city, Maharashtra reporting to dental colleges. A detailed inspection of the oral cavity of the study subjects was done using Basic Oral Health Surveys, World Health Organization (WHO) 1997. Results: A total of 110 individuals were evaluated for the study. A total of 26.36% study participants had some prosthesis at the time of examination, whereas 79.99% needed prosthesis. A total of 51.82% needed complete dentures. About 12.71% of the participants needed combination prosthesis. Conclusions: The result of this study concluded that the prosthetic status of the geriatric individuals in Wardha city (MH) of Central India is poor and needs prosthetic rehabilitation. A well-structured approach is required to fulfill these needs. [ABSTRACT FROM AUTHOR]

The Department of Neurosurgery was founded in the Grant Medical College, Mumbai, in the year 1958, and is celebrating its 60th anniversary. The history of Neurosurgery in this Institute is synonymous with the history of Neurosurgery in the state as this was one of the first government medical colleges to start a Neurosurgery Department within the state. The students after undergoing their rigorous training in the department, went on to establish advanced neurosurgical centers throughout Maharasthra and in several other parts of the country. The patients opt for this institution to get a standard of care that may be comparable with the highest standards prevalent, and the students achieve their goal of getting excellent education in Neurosurgery at par with the best institutes of the world. The department has, therefore, over the years, established its place in the country as a premier training facility and an epitome of medical excellence. This article traces the illustrious history of the Department of Neurosurgery, Grant Medical College and Sir J.J. Group of Hospitals, Mumbai, and also of the eminent faculty members and residents, who helped in advancing the standards of Neurosurgery in the region as well as the rest of India. [ABSTRACT FROM AUTHOR]

Background: Leprosy a chronic infectious affliction, is a communicable disease that posses a risk of permanent and progressive disability. The associated visible deformities and disabilities have contributed to the stigma and discrimination experienced by leprosy patients, even among those who have been cured. Aims and Objectives: 1) To assess the knowledge, attitude and belief about leprosy in leprosy patients compared with community members. 2) To find the perceived stigma among leprosy patients. 3). To evaluate the quality of life in leprosy patients as compared to community members using WHO Quality of Life assessment questionaire (WHOQOL- BREF). Materials and Methods: A cross sectional study was conducted at Leprosy Rehabilitation Centre, Shantivan, Nere in Panvel Taluka, district Raigad from October - December 2009. A pre-designed and pre-structured questionaire was used to evaluate knowledge, attitude and perceived stigma among leprosy patients and community members. WHO Quality of life questionaire (WHOQOL-BREF) was used to assess quality of life in leprosy patients and controls. Data analysis was done with the help of SPSS package. Result: Among the cases and control, 43.13% of cases were aware that leprosy is an infectious disease compared to 20.69% of control. 68.62% of cases had knowledge of hypopigmented patches being a symptom of leprosy compared to the 25.86% in control. There was overall high level of awareness about disease, symptoms, transmission and curability in leprosy patients as compared to control. Among control group, 43.10% of population said that they would not like food to be served by leprosy patients as compared to 13.73% in study group. It was seen that the discrimination was much higher in female leprosy patients as compared to male leprosy patients. The mean quality of life scores for cases was significantly lower than those for control group in physical and psychological domain but not in the social relationship and environmental domain. The mean quality of life scores for male cases were lower in each domain as compared to male control group but the difference was not significant except in the physical and enviornmental domain. The mean quality of life scores for female cases were lower in each domain as compared to female control group and the difference was not significant except in the psychological domain. Conclusions: There was a significant difference in physical domain in male leprosy patients and psychological domain in female leprosy patients as compared with their respective gender controls. The leprosy patients were more aware about the infectious nature of the disease, symptoms, transmission, and curability than the control group. A negative attitude was seen towards the leprosy patients in the society. [ABSTRACT FROM AUTHOR]

Aim and Background: Antibiotic resistance currently spans most of the known classes of natural and synthetic antibiotics; limiting our options for treatment of infections and demanding discovery of new classes of antibiotics. Much effort is being directed towards developing new antibiotics to overcome this problem. Success in getting novel chemical entities from microbial sources depends essentially on novelty of its habitat. The diversity of geographical location decides the type of micro-flora. In the past various terrestrial and aqueous microorganisms have provided several novel bio active secondary metabolite's of pharmaceutical importance. Hot-springs have not been as extensively exploited as other terrestrial resources. However, perseverance with such microbes augment the probability of getting novel bio active compounds. Materials and Methods: Hot-springs soil samples were collected from Hot-springs in Maharashtra. Actinomycetes and other eubacteria were isolated from these soil samples by selective methods and purified. They were classified based on gram’s nature and morphology. Six representative morphological strains were screened for their anti-infective potential by agar well diffusion method as reported by Nathan P. et al (1974). The bioactivity of the active microbes was confirmed. Results: Seventy three strains of bacteria encompassing eight actinomycetes, and 65 eubacteria were isolated and purified. Among the actives eubacteria PPVWK106001 showed broad spectrum antibacterial activity encompassing both gram positive and gram negative bacterial test models. The extract was active against resistant bacteria such as MRSA and VREs. Activity was very specific as there was no activity against fungi even at 100 fold concentration. The active principle was extractable in butanol. Conclusions: The study showed that Hot-springs exhibit diverse bacteria and it serves as potential reservoirs for bacteria of antimicrobial importance with diverse facet of activities. Thus Hot-springs microbes have ability to address issue of resistant bugs. [ABSTRACT FROM AUTHOR]

Objective: The main objective of the prescription audit of the secondary level government hospitals under the Maharashtra Health Systems Development Project (MHSDP) was to develop a list of essential drugs. Other objectives were to articulate measures for improving the prescription practices and to generate information on the core prescribing indicators proposed by the World Health Organization (WHO). Materials and Methods: The study was conducted among a representative sample of 31 secondary level hospitals under MHSDP. A copy of the prescription was obtained with the help of a pre-inserted carbon, in a special format. Data for only 'first encounter prescriptions' was collected for all patients attending the Outpatient Department (OPD). Results: About 77 percent of the prescriptions contained only one diagnosis. The average number of drugs per prescription was 3.1. About 60 percent of the drugs were prescribed by generic names and about 23 percent of the prescribed drugs were in combination. About 25 percent of the prescriptions contained at least one injection, while 35 percent contained at least one antibiotic. In 16 percent of the prescriptions a vitamin or tonic was prescribed. About 46 percent of the single ingredient formulations were as per the WHO 2003, Essential Medicines List (EML). Based on the findings of the Prescription Audit an EML was prepared for each category of the secondary level hospitals, for use in the OPD. Conclusions: Prescription audits are useful in generating data on morbidity, which forms the basis for preparing the list of essential medicines. Mechanisms necessary for improving prescription practices are suggested. [ABSTRACT FROM AUTHOR]

Background: Age is an important variable in epidemiological studies and an invariable part of community-based study reports. Aims: The aim was to assess the accuracy of age data collected during community surveys. Settings and Design: A cross-sectional study was designed in rural areas of the Yavatmal district. Materials and Methods: Age data were collected by a house-to-house survey in six villages. An open-ended questionnaire was used for data collection. Statistical Analysis: Age heaping and digit preference were measured by calculating Whipple's index and Myers' blended index. Age Ratio Scores (ARS) and Age Accuracy Index (AAI) were also calculated. Results: Whipple's index for the 10-year age range, i.e., those reporting age with terminal digit "0" was 386.71. Whipple's index for the 5-year range, i.e., those reporting age with terminal digit 0' or '5' was 382.74. Myer's blended index calculated for the study population was 41.99. AAI for the population studied was 14.71 with large differences between frequencies of males and females at certain ages. Conclusion: The age data collected in the survey were of very poor quality. There was age heaping at ages with terminal digits '0' and '5', indicating a preference in reporting such ages and 42% of the population reported ages with an incorrect final digit. Innovative methods in data collection along with measuring and minimizing errors using statistical techniques should be used to ensure the accuracy of age data which can be checked using various indices. [ABSTRACT FROM AUTHOR]

Background: Tobacco use is highly prevalent and culturally accepted in rural Maharashtra, India. Aims: To study the knowledge, attitude, and practices (KAP) regarding tobacco consumption, identify reasons for initiation and continuation of tobacco use, identify prevalence of tobacco consumption and its relation with different precancerous lesions, provide professional help for quitting tobacco, and develop local manpower for tobacco cessation activities. Settings, Design, Methods and Material: The present study was conducted for one year in a chemical industrial unit in Ratnagiri district. All employees (104) were interviewed and screened for oral neoplasia. Their socio-demographic features, habits, awareness levels etc. were recorded. Active intervention in the form of awareness lectures, focus group discussions, one-to-one counseling and, if needed, pharmacotherapy was offered to the tobacco users. Results: All employees actively participated in the program. Overall, 48.08% of the employees were found to use tobacco, among which the smokeless forms were predominant. Peer pressure and pleasure were the main reasons for initiation of tobacco consumption, and the belief that, though injurious, it would not harm them, avoiding physical discomfort on quitting and relieving stress were important factors for continuation of the habit. Employees had poor knowledge regarding the ill-effects of tobacco. 40% of tobacco users had oral precancerous lesions, which were predominant in employees consuming smokeless forms of tobacco. Conclusions: Identifying reasons for initiation and continuation of tobacco consumption along with baseline assessment of knowledge, attitudes, and practices regarding tobacco use, are important in formulating strategies for a comprehensive workplace tobacco cessation program. [ABSTRACT FROM AUTHOR]

Aims: To study the strengths, weaknesses, opportunities, and threats of the Total Sanitation Campaign (TSC) in the Yavatmal district of Maharashtra. Methodology: Data was collected in December 2006 through interviews with stakeholders, house-to-house surveys, focus group discussions, and transect walks. Information in each category was finalized in a meeting after brainstorming and discussion with the TSC cell members. Results: The strengths of the campaign were innovations in Information Education and Communication, motivation through incentives, competitive spirit, active participation and partnerships, involvement of women, and universal coverage. The main weaknesses of the program were the absence of Rural Sanitary Marts/Production Centers, poor maintenance of Women Sanitary Complexes, lack of facilities for monitoring/ follow-up and a temporary focus of the campaign approach. There is an opportunity to tap additional resources, learn from other experiences, and institute backup agencies to support and guide the community in the post-TSC phase. A change in administration and local leadership and loss of priority and interest needed to sustain the momentum while scaling up the interventions are possible threats for the program. [ABSTRACT FROM AUTHOR]

The article reports on the results of a study regarding the implications of stigmatizing attitude prevalence among urban middle class in Maharashtra, India for HIV/AIDS education strategy. It states that there is correlation between the stigmatizing attitude and discrimination and the knowledge of people about HIV/AIDS.

Various addiction patterns, dietary habits, associated medical problems and socioeconomic status in gastro-intestinal malignancies: A prospective study in rural area of Maharashtra, India. Jain Vandana S., MD, Professor & Head Kawale Darshana, MBBS, Senior Resident Jain Shailendra M., MD, Professor Waghmare Chaitali, MD, Associate Professor Pemmaraju Gopal, MBBS, Senior Resident Abstract Background: Gastro intestinal (GI) malignancies (from Esophagus to anus) are increasing with advancing age, various addictions and poor dietary habits. Early detection is difficult till patient notices symptoms. Primary prevention by knowing various risk factors and early symptom awareness will help in the healthier outcome. Objectives: This study is carried out to see various addiction patterns, dietary habits, associated medical problems and socioeconomic status with various sites involved in GI malignancies, in a tertiary care teaching hospital of Western Maharashtra, India. Materials and Methods: This prospective study is designed to know about various addiction patterns, dietary habits, associated medical problems and socioeconomic status, along with age, sex, various sites and the stage at first visit of all histopathologically proven cases of gastrointestinal malignancies reporting in the Department of Radiotherapy & Oncology for treatment. Oral cavity to cricopharyngeal carcinomas is included in head and neck malignancies. Carcinoma esophagus, carcinoma stomach, carcinoma small intestine, colorectal (colon and Rectum) and anal canal carcinomas are considered in gastrointerstitial malignancies (and for this study). Data collection was done from Feb 2016 to Dec 2016 for the period of eleven months. A detailed questionnaire was filled after taking written informed consent from the patient. Once the target of 100 patients was achieved all the data was compiled and analyzed for the study. Patients unable to provide or not willing to give desired information are excluded from the study. Results and Conclusions: In this study out of total 100 registeredcases of GI malignancy, 61 were males and 39 were females, which show male preponderance. Most of the patients belonged to lower and upper lower class (64%) as per modified B G Prasad classification. Various histopathological types recorded were Squamous cell carcinoma (35), Adenocarcinoma (60), Adenosquamous carcinoma (2), Basaloid carcinoma (2) and Gastro intestinal stromal tumor (GIST (2)). Associated medical illnesses were rarely observed (only two cases with Diabetes Mellitus and three with Hypertension) and they were on regular treatment. One patient was on anti- retroviral therapy for HIV, two were positive for HBsAg and one for VDRL. The commonest site involved was Esophagus (41) followed by Recto sigmoid, colon & caecum, stomach & anal canal (29, 14, 13 & 2 respectively). Mean age was 59.1 years. The youngest patient was 28 years and oldest was 86 years old. 45 cases were above 60 years and only five were below 30 years of age. 85% of cases were in advanced stage of disease (III & IV). Details of various addictions alone and in combinations with duration of consumption are shown in table no-1. Commonest addiction for all sites was smokeless tobacco (SLT). 81% of cases were non-vegetarian; only 16% were pure vegetarian, details of dietary habits is shown in table-2. Gastrointestinal malignancy is showing increasing trends in India. This study gives an idea about various risk factors for the increasing trends of gastro-intestinal malignancy. The present study shows that carcinoma Esophagus is the commonest & cancer recto sigmoid in second commonest GI malignancy. Mostly the cases were addicted to one or other addiction and were taking regularly nonvegetarian diet. Awareness program for harmful effects of various addictions, the importance of vegetarian diet (high fiber) and about the early symptoms of GI malignancy will help in health promotion, prevention of various malignancies & early diagnosis of disease as well as better treatment outcome. [ABSTRACT FROM AUTHOR]

Neurological Manifestations of Chikungunya in North Maharashtra 2006 was a sad year for India. Villages, Towns, Cities were affected with Chikungunya. The epidemic occured from May to November-2006. Metroes were less affected than rural areas. Exact no. of patients is not available but easily more than a few Crores were affected. Almost all of peninsular India was affected. The cases presented with fever for 2-4 days followed by musculo-skeletal manifestations especially Joint pains & Joint swelling. Only a minority had Neurological manifestations/& Systemic manifestations. Varied Neurological manifestations were seen-affecting virtually all parts of the CNS & PNS except the Myo-neural junction. Meningitis, Meningo-Encephalitis. Encephalitis with predominant Parkinsonism or Extra-Pyramidal signs; 15 Encephalopathy; 03 Precipitation of Epilepsy/Seizures/Status Epilepticus; 05 Myelitis, Transverse Myelitis, Myelo-Radiculopathy; 10 Guillain Barre Syndrome; 15 Brachial Neuritis; 02 Carpal Tunnel Syndrome; 22 Myositis. 07 HIV & NEUROLOGICAL MANIFESTATIONS; 05 Multi-System involvement & Neurological Manifestations. 04 TOTAL 88 The above is an on-going study with patients still coming for follow up. Arthritis: It usually subsides over the subsequent weeks to months. However flare-up of Arthritis occuring after change of weather, other infections, exhaustion, Emotional lability has been noted. Hyponatremia: It has been noted especially with CNS manifestations. The patiets were very well investigated MRI, CT, EEG, EMG, CSF, Routine blood Tests, Virological Tests from Virus Research Center Pune, other Virological tests from standard private Laboratories. Treatment: Depending on which part of the CNS was affected, the treatment was tailored accordingly. Encephalitis: Dexamethasone, along with the usual treatment for Encephalitis. Methyl Prednisolone was used for Myelitis/Transverse Myelitis. IVIG/PLASMAPHARESIS/LOW DOSE Plasmapharesis: Guillain Barre Syndrome. Prednisolone for Myosistis. Prednisolone for Carpal Tunnel Syndrome NSAID, PARACETAMOL, HCQS-Hydrxoy-Chloroquine for Arthritis. Occassionally Steroids. Conclusions: Neurological Manifestations are uncommon in Chikungunya but certainly do occur. 4 deaths occured out of 88 patients. Deaths occurred in the elderly. Deaths were seen in Encephalitis with or without multi-system involvement. All GBS patients recovered well. All patients with Neurological manifestations did well over the next few weeks to months. HCQS or Hydroxy-Chloroquin is very useful for Arthritis along with NSAID, sometimes with short courses of Steroids. [ABSTRACT FROM AUTHOR]