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In comparison to the worldwide burden of asthma, although India contributes to 13% of the total asthma prevalence, it has a threefold higher mortality rate and more than twofold higher DALYs, indicating a substantial gap in asthma diagnosis and treatment. Asthma causes significant suffering, affecting people's quality of life and draining the country's resources; therefore, we must devise ways and means to fill these gaps. The most successful and cost-efficient strategy to battle asthma is to form strong partnerships between patients, the general public, the government, the pharmaceutical industry and non-governmental organisations. This necessitates a comprehensive approach that involves raising awareness, developing universally applicable recommendations, increasing access to high-quality asthma care, and other measures. The purpose of this article was to review the existing scenario of asthma management in India and the factors that contribute to it and devise unique and all-encompassing strategies to fill these gaps. [ABSTRACT FROM AUTHOR]

Background: Mycobacterium w (Mw), an immunomodulator, resulted in better clinical status in severe coronavirus infectious disease 19 (COVID-19) but no survival benefit in a previous study. Herein, we investigate whether Mw could improve clinical outcomes and survival in COVID-19. Materials and Methods: In a multicentric, randomized, double-blind, parallel-group, placebo-controlled trial, we randomized hospitalized subjects with severe COVID-19 to receive either 0.3 mL/day of Mw intradermally or a matching placebo for three consecutive days. The primary outcome was 28-day mortality. The co-primary outcome was the distribution of clinical status assessed on a seven-point ordinal scale ranging from discharged (category 1) to death (category 7) on study days 14, 21, and 28. The key secondary outcomes were the change in sequential organ failure assessment (SOFA) score on days 7 and 14 compared to the baseline, treatment-emergent adverse events, and others. Results: We included 273 subjects (136 Mw, 137 placebo). The use of Mw did not improve 28-day survival (Mw vs. placebo, 18 [13.2%] vs. 12 [8.8%], P = 0.259) or the clinical status on days 14 (odds ratio [OR], 1.33; 95% confidence intervals [CI], 0.79-2.3), 21 (OR, 1.49; 95% CI, 0.83-2.7) or 28 (OR, 1.49; 95% CI, 0.79-2.8) between the two study arms. There was no difference in the delta SOFA score or other secondary outcomes between the two groups. We observed higher injection site reactions with Mw. Conclusion: Mw did not reduce 28-day mortality or improve clinical status on days 14, 21 and 28 compared to placebo in patients with severe COVID-19. [ABSTRACT FROM AUTHOR]

Mycobacterium indicus pranii (MIP) vaccine is widely used in dermatology as immunotherapy for warts as well as in patients with leprosy. During the COVID-19 pandemic, a positive role of MIP as an immunomodulator in SARS-CoV-2 disease was reported after pilot research, with minor adverse effects. We report a case of a 65-year-old male, presenting with skin lesions suggestive of noninfective granulomatous dermatitis for 4 months, at the sites of MIP intradermal injections, allegedly received during a hospital stay for severe COVID-19 disease. The patient presented with nonhealing nodulo-ulcerative lesions at the sites of injection, which persisted for 4 months associated with intermittent serous discharge and showed no signs of healing despite supportive treatment. The patient was started on a combination therapy of ofloxacin 400mg/day and clarithromycin 500mg 12 hourly for 2 months. At the end of 2 months, all the lesions showed complete healing with a resolution of discharge and nodularity, leaving behind postinflammatory hypopigmentation and atrophic scarring. The patient was followed up for 4 months after stopping treatment during which time he had no relapse of the lesions. This case has been reported to the India Pharmacopoeia. [ABSTRACT FROM AUTHOR]

Mycobacterium indicus pranii (MIP), previously called Mw vaccine, is a one-of-a-kind immunomodulatory vaccine. It was indigenously developed in India for use in leprosy. MIP is heat-killed Mycobacterium w, which is a non-pathogenic atypical mycobacterium belonging to Class IV of Runyon classification. It shares epitopes with Mycobacterium leprae and Mycobacterium tuberculosis, which forms the rationale behind its use in leprosy and tuberculosis. MIP activates both innate and acquired immunity. It induces a Th1 and Th17 immune response along with downregulation of Th2 pathway and activates macrophages and dendritic cells. MIP vaccine is safe with adverse effects such as local site erythema, swelling, and rarely fever and other systemic reactions. Apart from leprosy, MIP has been used in dermatological diseases such as warts and psoriasis. Clinical trials have evaluated the efficacy of MIP in a plenitude of non-dermatological conditions such as category II tuberculosis, Gram-negative sepsis, non-small cell lung cancer, human immunodeficiency virus (HIV), muscle-invasive bladder cancer, and very recently, coronavirus 2019 (COVID-19). In vitro and animal studies have also demonstrated its utility in leishmaniasis, melanoma, and as a vaccine for the prevention of pregnancy. The PubMed database was searched using "Mycobacterium indicus pranii, MIP, Mycobacterium w" as the keyword in title. This comprehensive review provides useful information for healthcare professionals about immunotherapeutic potential of MIP vaccine, its composition, dosing schedule, administration, and side effects besides its efficacy in various indications other than leprosy. [ABSTRACT FROM AUTHOR]

This research letter discusses a study on the use of intravenous administration of heat-killed Mycobacterium w (Mw) in patients with gram-negative sepsis. Gram-negative sepsis is a major cause of mortality in intensive care units in India. Previous studies have shown that intravenous Mw administration is safe and effective, and this study aims to further evaluate its efficacy and safety. The study included 20 patients and found that Mw, along with standard care, was well tolerated and did not result in any major adverse events. However, the study had limitations and further research is needed to evaluate the efficacy of Mw in a larger trial. [Extracted from the article]

The COVID-19 pandemic is one of its kinds of public health emergencies that the world is grappling with. The health-care workers (HCWs) were at the forefront of the battle against this scourge. As a result of continuous service delivery, they experienced stress and burnout which varied from the type of HCWs, gender, type of service, and the length of service rendered by them. Given the context, this systematic review assessed the prevalence and predictors of stress among different types of HCWs in India. The systematic review was conducted using PubMed search engine and 13 articles were selected for the purpose of review. Of the 13 studies identified, 11 studies were carried out predominantly in India or in some Indian states and 2 studies were multinational studies, in which samples were also drawn from India. Of these 13 studies, 6, 5, 3, 2, and 2 studies were conducted among the doctors, specialists, nurses, dentists, and allied HCWs in India, respectively. It was observed that the prevalence of stress among HCWs varied with age, gender, type of HCWs, place of work, and duration of work, and the predictors were long working hours, continuous contact with patients, fear of self-infection, stigmatization, and fear of carrying the infection to the family. Stress and burnout among HCWs are inevitable; however, there should be ways and means to have coping behavior else the same would affect the professionals' personal life and patient care. Hence, appropriate measures need to be taken to address this issue by the HCWs themselves, government, and other social sectors organizations. [ABSTRACT FROM AUTHOR]

Palatogingival grooves (PGGs) are developmental anomalies well known for causing endodontic and periodontal diseases to the teeth that have no evidence of caries or trauma. It is a rare developmental defect that frequently exhibits the palatal aspect of maxillary anterior teeth. The aim of this case report is to diagnose PGG using cone-beam computed tomography (CBCT) and manage it with an interdisciplinary approach by endodontic and periodontic intervention. A 20-year-old healthy female patient came with a chief complaint of foul smell and discharge of pus from the gum region. During clinical examination, a sinus opening and deep periodontal pocket were noticed with respect to the maxillary left lateral incisor. The tooth showed mild tenderness to percussion and a negative response to thermal and electric pulp testing. The intraoral periapical radiograph showed a vertical radiolucent line with periapical radiolucency, giving suspicion of PGG, which was confirmed by CBCT investigation. The diagnosis of pulp necrosis with chronic periapical abscess was made. After root canal treatment, surgical intervention was done and sealed the groove with Biodentine. This case report shows the successful outcome of a tooth associated with PGG after a 9-month follow-up. The tooth associated with this anomaly can be correctly diagnosed and planned with CBCT, and successfully treated using an interdisciplinary approach with a bioactive restorative material. [ABSTRACT FROM AUTHOR]

A 55-year-old female presented with recent exacerbation of the chronic cough, dyspnea, and copious expectoration. The symptoms worsened during the winter months. In the past, she was misdiagnosed with pulmonary tuberculosis. A computed tomography scan revealed bronchiectasis changes, high attenuated mucus, and hypereosinophilia. The diagnosis of Allergic Bronchopulmonary Aspergillosis (ABPA) with subacute invasion was confirmed through bronchoscopy and fungal culture. Treatment with oral voriconazole significantly improved lung function and quality of life. This case highlights the importance of considering invasive pulmonary aspergillosis in patients with exacerbations of asthma and bronchiectasis. Early diagnosis and appropriate treatment are essential for improved outcomes in such cases. [ABSTRACT FROM AUTHOR]

Some degenerations involving the peripheral retina can result in a rhegmatogenous retinal detachment. Currently, there are no clear guidelines for retinal screening and/or management of these peripheral retinal degenerations in patients with or without recent onset posterior vitreous detachment or in those prior to refractive surgery or intraocular procedures. This article aims to provide a set of recommendations for the screening and management of peripheral retinal degenerations based on a common consensus obtained from an expert panel of retinal specialists. [ABSTRACT FROM AUTHOR]

A palatogingival groove (PGG) is a developmental deformity that may cause a severe periodontal breakdown or combined endodontic and periodontal defect. In the present case, a 24-year-old patient reported a complaint of pain in the upper left front tooth region for 3 months. Clinical and radiological examination revealed a PGG in the permanent maxillary left lateral incisor. Cone-beam computed tomography showed multiple shallow grooves on the root surface and a deep palatal groove extending to the apex. Interdisciplinary management comprising endodontic therapy and intentional replantation was formulated. After endodontic procedure, tooth #22 was gently extracted. The shallow grooves were removed by odontoplasty. A Class II cavity was made in the deep palatal groove and was connected with the root-end preparation. The cavity was sealed with biodentin up to the cementoenamel junction and the coronal portion was sealed with light-cured glass-ionomer cement. The tooth was replanted in socket and splinted for 7 days. Follow-up visits revealed the functional status of tooth and complete bony healing. Tooth discoloration was successfully managed with intracoronal bleaching with sodium perborate. A 12-month radiographic follow-up revealed no evidence of root resorption or ankylosis. [ABSTRACT FROM AUTHOR]

Aims and Objectives: Haematological malignancy may show varied presentation in different regions of world, however, Uttarakhand lacks any recent data about them. The present study was therefore conducted to study the pattern of haematological malignancies on bone marrow examination in institute of Uttarakhand. Materials and Methods: This study was conducted at All India Institute of Medical Sciences, Rishikesh, Uttarakhand, over a period of 3 years. It included patients of haematological malignancies diagnosed on bone marrow examination. Patient's age, sex, clinical history and bone marrow diagnosis were noted for every case. All the data were entered into the excel sheet and statistically analysed. Results: The study included total 256 cases of haematological malignancies with male:female ratio of 1.13:1 and mean age of 39.3 years. Chronic myeloproliferative neoplasm (CMPN) was the most common haematological malignancy (49%) with chronic myeloid leukaemia (CML) being its most common type (40%). All the haematological malignancies showed male preponderance except for non-Hodgkin's lymphoma. Mean age of CMPN was 45.81 years and of acute myeloid leukaemia was 36.92 years. Bone marrow aspirate (BMA) and trephine biopsy (BMT) together were able to diagnose 81.3% of cases of haematological malignancies. Conclusion: The study concludes that haematological malignancies present at lesser age with male preponderance in Uttarakhand. CML is the most common haematological malignancy followed by acute lymphoblastic leukaemia. BMA and BMT are complimentary to each other for diagnosis of haematological malignancies and should be used together to avoid missing of any case. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to study the prevalence of dens invaginatus (DI) and palatogingival groove (PGG) in maxillary lateral incisors, and the occurrence of apical periodontitis in association with these anomalies in North Indian population. Methodology: Maxillary lateral incisors in 163 cone-beam computed tomography scans were assessed to determine the presence of DI and PGG. Anomalies identified were then classified as per Oehler's and Gu's classification, respectively. Their side and gender predilection and association with apical and lateral radiolucency was also studied. Statistical Analysis: Descriptive data were reported as percentages. Chi-square analysis was used to determine the association with gender and side predilection. Results: DI was present in 13.5% of the scans, while PGG was present in 7.3% of the scans. No significant gender and side predilection was observed. 6.67% of lateral incisors with DI and 25% of lateral incisors with PGG had an associated apical radiolucency. 33.33% of lateral incisors with PGG had an associated lateral radiolucency. Conclusions: There is a high prevalence of DI and PGG in maxillary lateral incisors. [ABSTRACT FROM AUTHOR]

Background: Despite the availability of alternative homogenous assays for LDL-C measurement, most of the laboratories still use Friedewald Equation (FE). However, various novel equations have shown better performance than FE specific to a particular population. Besides, no equation has been devised for use in Sub-Himalayan population. Methods: A cross-sectional laboratory data-based study was conducted by recruiting lipid profiles of 1851 samples to validate 10 different equations for calculating LDL and to devise a novel Modified Friedewald Equation (MFE) specific for Sub-Himalayan population. Results: The novel MFE is presented as: LDL-C = -2.421 + (0.752 × TC) - (0.047 × TG) - (0.350 × HDL). A significant difference was observed between direct LDL-C (118.84 ± 40.39 mg/dL) and all other equations except MFE (118.84 ± 37.96 mg/dl, P > 0.999) and Puavilai Equation (117.99 ± 49.05 mg/dL, P = 0.138). Additionally, MFE showed lowest mean percentage bias of 0.14% with 95% limits of agreement within ± 2SD on Bland-Altman analysis. On ROC analysis at cut-offs of clinical decision limits of 100 mg/dl, 130 mg/dl, 160 mg/dl, and 190 mg/dl, MFE outperformed all other equations with highest AUC (0.974, 0.978, 0.982, and 0.995) respectively with specificity >95% at higher levels. MFE also showed highest correlation (r = 0.954, P < 0.001) and least rMSE (13.8) with direct LDL although all the equations showed significant positive correlation with direct LDL (p < 0.001). Conclusion: MFE derived in this study showed a better diagnostic performance as compared to other 10 equations taking Direct LDL-C as gold standard for Sub-Himalayan Population and may be used as a substitute for FE in the study population. [ABSTRACT FROM AUTHOR]

Bronchopleural fistulas may be peripheral or central, and bronchoscopy is the best diagnostic tool to size a central fistula.[[4]] Treatment is done by various surgical and nonsurgical techniques, but no standard of care exists. A CT thorax [Figure 1]b revealed a fistula involving the pneumonectomy stump [Figure 1]b. [Extracted from the article]

Introduction: Cervical lymphadenopathy is a common clinical presentation in various departments of clinical practice. Fine needle aspiration cytology (FNAC) is usually the first choice to diagnose superficial cervical lymphadenopathy. However, FNAC sometimes does not yield information for precise diagnosis, and the risk of false-negative and indeterminate diagnosis is always present. In order to overcome these problems, cell block technique has been resorted to make the best use of the available material. Objective: The aim of this article is to evaluate whether there are any diagnostic advantages of cell block histopathology over conventional smear cytology by corroborating with excisional biopsy. Materials and Methods: A descriptive study with cross-sectional design was performed among 106 cases with clinical suspicion of malignancy. FNAC was performed without anesthesia, and the aspirated material was flushed on slides and then fixed immediately. The remaining materials were processed into cell blocks followed by HE staining. The data obtained were analyzed using SPSS (IBM Statistics, Version 20.0, SPSS, Chicago, IL, USA) statistical software. Ethical approval was obtained from the Institutional Ethics Committee, and informed consent was taken from all the participants before the procedure. Results: Out of the 106 cases, 101 (95.28%) cases were diagnosed as malignant lesions and 5 (4.72%) cases diagnosed as non-malignant lesions. The majority of the patients were in the 40–59 year age group and were males. The sensitivity of cytology to provide specific diagnosis in malignant lesions was 90.57%, whereas those of cell block histopathology and cell block histopathology with cytology were 94.34% and 98.11%, respectively. Conclusion: Cell block as an adjunct to FNAC can be a useful diagnostic technique in cervical lymphadenopathy. Compared with FNAC, it gives more accurate diagnostic architecture and apparent histopathological features. [ABSTRACT FROM AUTHOR]

Aim: This study aims to investigate the prevalence of palatogingival groove (PG) in anterior maxillary teeth in an Indian cohort using cone beam computed tomography (CBCT) scans. Study Design: Retrospective study. Materials and Methods: Analysis of 119 CBCT scans (64 males, 55 females, and mean age 31.6 ± 13.5 years) was performed. The data of 636 anterior maxillary teeth (220 canine, 212 lateral incisor, and 204 central incisor teeth) were studied for PG's presence. Demographic details of patients and characteristics of PG, i.e., location, extension, depth, and type were recorded. Results: Out of the 636 anterior maxillary teeth studied, PGs were detected in 12 (1.88%) teeth (3 [1.47%] central incisors, 9 [4.2%] lateral incisors, and 0 canines). All the teeth were categorized as having either type I (Seven teeth) or type II (Five teeth) radicular groove. Two of the 12 PGs were present in the mesial, six in the mid-palatal, and four were present in the distal portion of the palatal surface of the teeth. Conclusions: The prevalence of PG in maxillary incisors in this Indian cohort is 2.88%. Maxillary lateral incisors are the most affected teeth. [ABSTRACT FROM AUTHOR]

Background and Aims: The paravertebral block (PVB) is an effective alternative to thoracic epidural analgesia for post-operative analgesia in thoracic surgeries. Despite the use of ultrasound in PVB, the search for a safer approach continues. This study was conducted to compare the analgesic efficacy of conventional and mid-transverse process to the pleura (MTP) approach of the PVB. Methods: Forty patients aged between 18-60 years, posted for video-assisted thoracoscopic surgery, were enroled for this study. Patients were randomised into two groups using a random number table, and group allocation was done by the sealed opaque envelope method. One group received PVB by conventional approach (group CP). In contrast, patients in the other group (group MP) received PVB by the mid-transverse process to pleura (MTP) approach before induction of general anaesthesia under ultrasound guidance. The study's primary aim was to compare analgesic consumption in the first 24 hours. Secondary aims were comparing the Visual Analogue Scale (VAS) score, block performance time, dermatomal spread, haemodynamic parameters such as heart rate (HR), oxygen saturation (SpO2), and non-invasive blood pressure (NIBP), patient satisfaction scores, and complications observed. Data were analysed using Statistical Package for the Social Sciences version 23. Results: Demographic parameters, block performance time, and dermatomal distribution were comparable in both groups. We did not find any statistical difference in the analgesic consumption in the first 24 hours (P = 0.38), VAS at rest or on movement, complication rates, and patient satisfaction scores between the groups. Conclusion: The MTP approach of the PVB is as effective as the conventional thoracic paravertebral approach for post-operative analgesia in video-assisted thoracoscopic surgeries. [ABSTRACT FROM AUTHOR]

Background: Doctors are often been judged negatively as a consequence of high expectation and demand from their job and face violence at workplace. Continuous worry of facing aggression at workplace may seriously affect job satisfaction and intention to job turnover. However, the association between workplace safety and job satisfaction had not been studied earlier in India. Methods: A cross-sectional survey was conducted among doctors from November 2019 to April 2020 using a pre-tested, semi-structured, anonymous "Google forms" based questionnaire among doctors working in private and/or public healthcare settings across India. Perception of safety was assessed by scoring in a scale. Cronbach's coefficient of the scale was calculated to be 0.88. Job satisfaction was assessed using the 5-item Brayfield and Rothe measure of job satisfaction. Cronbach's coefficient of the scale was 0.76. The data was coded and analyzed with the help of STATA-12. Results: 617 doctors practicing modern medicine participated in this study from all over India. 262 (42.5%) doctors were found to be satisfied at their job. Perception of safety at workplace was found to have 2.5 times greater influence on job satisfaction of doctors. 23.2% of the doctors expressed job turnover intention which was positively correlated with job satisfaction and perception of safety. Conclusion: Perception of safety from workplace violence was found to have significant effect on job satisfaction and turnover intention than actual violence. Appropriate strategy may be undertaken to address this apprehension at workplace. [ABSTRACT FROM AUTHOR]

Background and Purpose: Although imaging is the mainstay to differentiate ischemic stroke (IS) from intracerebral hemorrhage (ICH), these facilities are not available everywhere. The present study observed if any blood biomarker(s) could potentially help differentiate between ischemic stroke and intracerebral hemorrhage.Methods: 250 patients with acute stroke within 24 hours of onset (187 IS and 63 patients with ICH) were recruited in the present study. The blood samples were collected closest to the hospital presentation time, but within 24 hours of stroke onset. Blood was analyzed for five biomarkers [S100, glial fibrillary acidic protein (GFAP), N-methyl-D-aspartate receptor subunit antibody (NR2), interleukin 6 (IL6) and brain natriuretic peptide (BNP)] to assess discriminatory ability of each biomarker to differentiate ICH and IS.Results: S100 levels were statistically higher among patients with ICH compared with IS (8 pg/ml versus 4.2 pg/ml respectively, P = 0.003) and IL6 was higher in patients with IS compared with ICH (12.9 pg/ml vs 8.76 pg/ml, P = 0.02). The discriminatory ability to differentiate ICH from IS was better using a combination of the above two biomarkers. The overall discriminatory ability of all biomarkers were low (Area under curve for S100 65%; GFAP 56%; NR2 53%; IL6 59% and BNP 49.8%). Although the positive predictive value of each biomarker was low, the negative predictive value was higher for all biomarkers to diagnose ICH.Conclusions: S100 and IL6 are potential biomarkers for further study and validation. Newer biomarkers with higher discriminatory ability are required in the future for diagnostic use. [ABSTRACT FROM AUTHOR]

Purpose: Intracameral antibiotics are known to reduce the incidence of acute endophthalmitis. Various drugs are available for intracameral use. This prospective study was carried out to compare the efficacies of intracameral cefuroxime and moxifloxacin prophylaxis in reducing the incidence of acute endophthalmitis after cataract surgery in rural India.Methods: This was a prospective, nonrandomized, comparative, interventional study. Between October 2016 and March 2018, 15 eye care facilities spread over four Indian states were preselected to use either of the intracameral antibiotics, cefuroxime or moxifloxacin, following cataract surgery (phacoemulsification or manual small incision cataract surgery, SICS). The main outcome measure was the occurrence of acute clinical endophthalmitis within six weeks of the surgery. This was compared with the earlier rate of endophthalmitis in the same locations.Results: The study was done in 42,466 eyes. Of the total, 42.2% received intracameral cefuroxime and 57.8% received intracameral moxifloxacin. SICS was performed more often. Clinical acute endophthalmitis occurred in 15 eyes. This accounted to a 72.22% reduction, from the earlier 0.126% to 0.035%, of postcataract surgery acute endophthalmitis. The reduction in the incidence of endophthalmitis after intracameral cefuroxime was 0.017% and that after intracameral moxifloxacin was 0.049%. With either intracameral antibiotics, the reduction in incidence was statistically significant (P < 0.001), but not between the molecules. Intracameral cefuroxime showed 66.67% reduction and intracameral moxifloxacin showed 74.74% reduction.Conclusion: A 3.6-fold decrease in postcataract surgery endophthalmitis was observed upon the use of intracameral antibiotics in rural India. Both intracameral cefuroxime and moxifloxacin proved efficacious. [ABSTRACT FROM AUTHOR]

Background: Bronchoscopic device closure plays a significant role in the nonsurgical management of bronchopleural fistulae (BPF). Herein, we describe our 10-year experience in the management of postoperative BPF using various device closure modalities. This is the largest series of bronchoscopic device closure of BPF being reported from India. Materials and Methods: This was a retrospective analysis of data of patients who underwent bronchoscopic device closure with various techniques for the management of postoperative BPF. In total, 11 patients (six males and five females) with a mean age (±standard deviation) of 42.72 ± 14.40 years with BPFs were treated with various bronchoscopic interventions for BPF closure. We used various devices such as endobronchial coils, occluder devices, and covered tracheobronchial self-expandable stents for BPF closure depending on the size of air leaks. We describe the various devices used, technique, and outcome of bronchoscopic management of BPF. Results: All our patients had developed BPFs postoperatively. Pulmonary tuberculosis was the most common etiology seen in nine of our patients. All the devices were placed using a fiberoptic bronchoscope, and all patients were followed up for a minimum duration of 6 months. We successfully localized and closed BPFs in nine (81.81%) of our patients. Conclusions: Bronchoscopic device closure can be a successful strategy to manage postoperative BPF with minimal complications. [ABSTRACT FROM AUTHOR]

Background: There are multiple economic, psychological, and physical consequences of high job stress, low job satisfaction and burnout in faculty of a teaching hospital in South India. Data from developing countries on these domains are sparse. Materials and Methods: In a cross-sectional study we assessed the prevalence and sources of perceived job stress, job satisfaction and burnout in faculty, as well as ways of coping with stress among consenting faculty of a large, private, charitable, teaching hospital in India using standardized, self-rated questionnaires. Results: A total of 304 respondents, 156 (51.3%) were Assistant Professors; 71 (23.4%) were Associate Professors, and 77 (25.3%) were Professors. The majority (175; 58%) were male, younger than 45 years (235; 76%) and from clinical departments (248; 81.5%) A third (96; 31%) reported high overall levels of perceived job stress. In multivariate analyses, age less than 45 years, designation as Assistant or Associate Professor, and working in a clinical department were associated with perceived high job stress; reporting high perceived job satisfaction was protective. Nearly two-thirds (217; 71.4%) of faculty reported high levels of job satisfaction. In multivariate analysis, age less than 45 years and reporting high job stress were associated with low perceived job satisfaction. Causes of stress and satisfaction differed by age, gender and designation. On the Maslach Burnout Inventory (MBI), 88 (29%) had high scores on the emotional exhaustion subscale, 63 (20.8%) had high scores on the depersonalization subscale, and 90 (29.7%) had low scores on the personal achievement subscales. High job stress and low job satisfaction were significantly associated with burnout on the three domains. Conclusions: High job stress and low job satisfaction were inversely related in this survey of medical faculty and were significantly associated with levels of burnout. The sources of job stress and job satisfaction identified provide insights that could inform formal institutional mechanisms to prevent burnout in doctors. [ABSTRACT FROM AUTHOR]

Introduction: Job satisfaction is a multidimensional response to work and workplace environment. It depends on many factors, and affects the behavior of employees that, in turn, affects organizational functioning. The aim of the study was to measure job satisfaction among different categories of healthcare providers from the Punjab government health services and to determine the factors that affect job satisfaction the most. Methodology: The study was conducted between September 2015 and February 2016 and included 462 participants working under the Punjab Government health services. Multi-stage random sampling was used, and participants were interviewed telephonically. The study instrument comprised the sociodemographic data and questions from Job Satisfaction Scale (JSS). Results: Three-fourth of the respondents (75.3%) were dissatisfied by their working conditions, followed by fringe benefits facet (34%), promotion facet (25.4%), and contingent rewards facet (23.7%). But they felt satisfied concerning relations with their coworkers (97%), nature of their work (93.3%), supervision (91.2%) and communication facet (80.6). Ambivalence was seen in a range of 2.8% (coworkers facet) to 54.8% (contingent rewards facet). Conclusion: Job satisfaction affects future career goals, social relationships, and personal health. An extremely demanding workplace can make workers susceptible to feelings of uncertainty and low self-esteem. It is recommended to beef up the policies related to healthcare providers and their working conditions regularly. Job responsibilities should have a scope of change to avoid monotony and loss of interest. A conducive working ecosystem can have a positive effect on the evolving health system of a country. [ABSTRACT FROM AUTHOR]

Children are believed to be the most vulnerable group to infection with Mycobacterium leprae due to their immature or nascent immunity and exposure to intrafamilial contacts. The child proportion among newly detected cases of leprosy is a strong indicator of continued transmission of the disease and one of the main targets of the current World Health Organization strategy is "to reduce transmission of the disease and reduction of grade-2 disability among new child cases." Despite an effective treatment and global achievement of leprosy elimination, the childhood leprosy proportion has not improved significantly. Leprosy in children does not just affect a child's health like other diseases; they can be stigmatized, bullied, and shunned for their lives. Hence, effective planning to bring down the incidence of leprosy and its complications in children should become a top priority. Regular school surveys and annual contact surveys for early detection of cases is therefore an important tool in achieving the goal of elimination of leprosy. In addition to continuing to administer multidrug therapy to patients, new preventive approaches need to be considered to break the chain of transmission and reach zero disease status. [ABSTRACT FROM AUTHOR]

Pulmonary lymphangitis carcinomatosa occurs due to dissemination of cancer cells in pulmonary lymphatics. It is only rarely seen with urological malignancies and portends a grave prognosis. Its presence in patients with urothelial carcinoma of the urinary bladder is uncommon. We present a case of a nested variant of transitional cell carcinoma of the urinary bladder associated with pulmonary lymphangitis carcinomatosa. We also discuss the symptoms and radiological features that might aid in timely diagnosis of this entity. [ABSTRACT FROM AUTHOR]

Introduction: As a new healthcare market force and first point of contact, family physicians (FPs) play a key role in healthcare delivery system. It is vital to understand issues that affect performance and satisfaction with their practices and working environment. The objectives of this study are to assess the level of professional satisfaction and to compare and identify the factors potentially associated with professional satisfaction/dissatisfaction among FPs of two regions. Materials and Methods: A comparative cross-sectional study on FPs working in primary healthcare centers under Ministry of Health was conducted in two regions (Jeddah and Eastern region) to assess job satisfaction and dissatisfaction among them. Validated close-ended questionnaire was emailed. Overall satisfaction along with the associated factors was identified. Chi-square and multivariate regression analyses were performed to test the association between job satisfaction and predictors. Results: A total of 237 FPs completed the survey and an overall 62% of them were satisfied. Male doctors were less in number yet more satisfied (71%). FPs of eastern region were slightly more satisfied (63.4%) when compared with 59.2% of Jeddah. Factors significantly associated with professional dissatisfaction included FPs having the opinion that they were not respected by community members [odds ratio (OR) 2.7, confidence interval (CI): 1.24–5.97, P = 0.012] and FPs' own perception of being inferior to other specialties (OR 13.59, CI: 4.98–37.07, P < 0.001). Conclusion: More than half of the FPs were professionally satisfied; however, the majority had perception of being inferior to other specialties. Improving self-esteem, working environment, and addressing other identified factors for dissatisfaction can help FPs overcome their stresses, leading to better healthcare delivery. [ABSTRACT FROM AUTHOR]

Background: : Malignant melanoma is a tumor of melanocytic origin. Although uncommon in India as compared with the west, its prevalence is increasing.Objectives: To document the pattern of clinicopathological features of malignant melanoma cases attending in a regional cancer center in eastern India.Material and Methods: The present study was a retrospective study of 182 cases diagnosed histopathologically as malignant melanoma during 2011-2016.Results: Out of the total cases, 170 (93.4%) were cutaneous and 12 (6.6%) were noncutaneous melanoma. The most common age group was sixth decade with a male predominance. Conventional melanotic melanomas were 176 (96.70%), and only 6 cases (3.30%) were amelanotic melanoma. Among noncutaneous melanomas, 6 were in anorectum, 2 in conjunctiva, and 1 case each in nasal cavity, palate, gingivo-buccal sulcus, and vagina. The acrallentigenous type was the most common variety, and the mixed epithelioid and spindle cell type was the most common histopathological pattern. Clark's level III was the most common level of invasion.Conclusion: The lower extremity is the most common site for melanoma, whereas extracutaneous melanomas are exceedingly rare and aggressive neoplasms. Melanoma can metastasize to regional lymph nodes, however, visceral metastasis to liver can also occur. In the absence of pigment in amelanotic melanoma, immunohistochemical markers such as HMB 45 can be used for definitive diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: Metabolic syndrome (MetS) is responsible for 2.5-fold increase in cardiovascular mortality and a 5-fold higher risk of developing diabetes. Materials and Methods: A community-based cross-sectional study was conducted during 2015–2016 in District Nainital. A list of all villages was developed. From this list, thirty villages were identified using population proportionate to size sampling method. From each village, thirty geriatric subjects (GSs) were selected. The study population included 979 GSs aged 60 years and above. The data were collected on anthropometry, blood pressure, blood glucose, and lipid profile from all the enrolled subjects. The prevalence of MetS was estimated using International Diabetes Federation criteria. Univariate and multivariate analysis was done to identify factors associated with MetS. Results: The prevalence of MetS was found to be 28.6%. Step-wise multivariate logistic regression analysis found that female gender, higher income, and body mass index ≥25 were significant and independent risk factors of MetS amongst GP. Conclusion: There is a need for screening of GP living in high altitude region so that efforts can be initiated to prevent complications of MetS. [ABSTRACT FROM AUTHOR]

The global leprosy situation has changed significantly over the last four decades after the introduction of multidrug therapy (MDT) in 1982 with a reduction in prevalence from over 5 million cases in the mid-1980s to less than 200,000 at the end of 2016. The programme in India also saw a reduction from a prevalence rate of 57.8/10,000 in 1983 to less than 1/10,000 by the end of 2005 when India declared to have reached the World Health Organization (WHO) target of elimination as a public health problem. Post 2005, major changes in the programme were made by the National leprosy eradication programme (NLEP) and the global leprosy programme, which may have affected the new case detection (NCD), disability, and child leprosy trends, which continue to show no appreciable regression. This article reviews the current global and Indian leprosy scenario to bring out its achievements and successes, including the impact of Leprosy Case Detection Campaigns (LCDC) on leprosy numbers. The basis and expected benefits of recent introduction of chemo and immune-prophylaxis in the programme are also discussed. It also discusses the shortcomings, the areas of concern, and the need for an inclusive strategy in the Indian leprosy programme that includes an intersectoral collaboration within the country for reaching the desired goal of leprosy eradication. [ABSTRACT FROM AUTHOR]

PURPOSE: The purpose of this study was to determine the incidence, severity, and associated risk factors of retinopathy of prematurity (ROP) in a district in South India. METHODS: This was a prospective, observational, cohort study involving babies at risk of ROP conducted in five Neonatal Intensive Care Units in a district in Tamil Nadu, South India. All babies with gestational age at birth of ≤36 weeks and a birth weight (BW) of ≤1900 g with a follow‑up period of at least 6 months were enrolled for the study. Neonatal and maternal risk factors were assessed and univariate and multivariate logistic regression analysis performed to examine the predictors of ROP. RESULTS: A total of 325 infants were screened. ROP was identified in 210 eyes of 106 (32.6%) babies with severe ROP (stage ≥3 ROP) occurring in 14 (13.2%) babies. Low BW (LBW) was the only significant risk factor for ROP on multivariate logistic regression analysis. The mean BW was 1285 and 1452 g for babies with and without ROP, respectively. Treatment was indicated in 22 eyes of 14 (13.2%) infants. CONCLUSIONS: The incidence of ROP was fairly high and strongly associated with LBW. A relatively low incidence of severe ROP was, however, observed. More effort is, therefore, required towards the prevention of preterm births while the present gains in neonatal care should be sustained to reduce the incidence of ROP and thus childhood blindness in the country. [ABSTRACT FROM AUTHOR]

Introduction: Job satisfaction greatly determines the productivity and efficiency of human resources for health. The current study aims to assess the level of satisfaction and factors influencing the job satisfaction among regular and contractual health-care workers. Materials and Methods: A cross-sectional quantitative study was conducted from January to June 2015 among health care workers (n = 354) at all levels of public health-care facilities of Chandigarh. The correlation between variables with overall level of satisfaction was computed for regular and contractual health-care workers. Stepwise multiple linear regression was done to elucidate the major factors influencing job satisfaction. Results: Majority of the regular health-care staff was highly satisfied (86.9%) as compared to contractual staff (10.5%), which however was moderately satisfied (55.9%). Stepwise regression model showed that work-related matters (ß = 1.370, P < 0.01), organizational facilities (ß = 1.586, P < 0.01), privileges attached to the job (ß = 0.530, P < 0.01), attention to the suggestions (ß = 0.515, P < 0.01), chance of promotion (ß = 0.703, P < 0.01), and human resource issues (ß = 1.0721, P < 0.01) are strong predictors of overall satisfaction level. Conclusion: Under the National Rural Health Mission, contract appointments have improved the overall availability of health-care staff at all levels of public health facilities. However, there are concerns regarding their level of motivation with various aspects related to the job, which need to be urgently addressed so as to improve the effectiveness and efficiency of health services. [ABSTRACT FROM AUTHOR]

Objectives: This study was designed to prospectively investigate the effects of pericardiectomy via median sternotomy on intra- and postoperative hemodynamics by a new semi-invasive device (Flotrac/VigileoTM monitor) using arterial pressure waveform analysis. Patients and Methods: Thirty consecutive patients aged 15 to 55 years (mean+SD, 31.73 + 13.53 years), who had undergone total pericardiectomy via median sternotomy underwent serial hemodynamic evaluation. FlotracTM Sensor - derived stroke volume, stroke volume variation, systemic vascular resistance index (SVRI), cardiac index and right atrial pressure were measured just before and after pericardiectomy, at 12 hours, 24 hours, 48 hours, 72 hours and at discharge postoperatively. Results: Majority of patients (73.33%) exhibited statistically significant reduction of right atrial pressure and SVRI along with improvement in cardiac index and oxygen delivery in the immediate and late postoperative period. However, the stroke volume and stroke volume variation did not increase proportionately on completion of surgery. Patients with low cardiac output syndrome exhibited persistently high central venous pressure with reduced cardiac index and echocardiographically abnormal diastolic filling characteristics. Conclusions: We conclude that there is early normalization of hemodynamics following pericardiectomy via median sternotomy and the adequacy of pericardiectomy can be accurately assessed by the new semi-invasive arterial pressure waveform analysis device. Stroke volume variation is a non-predictor of fluid requirement during and after pericardiectomy. [ABSTRACT FROM AUTHOR]

Empyema thoracis is an accumulation of frank pus in the pleural space. Occurrence of complications such as bronchopleural fistula (BPF) following necrotizing pneumonia is not uncommon in pediatric patients. Failure to diagnose latent BPF is common. High level of suspicion and preventive measures to avoid likely complications is the key to success. This case report underscores the need to diagnose a latent BPF and also highlights the importance of one lung ventilation in an infant in suspected cases of BPF. [ABSTRACT FROM AUTHOR]

The author comments on the study about the use of one-lung ventilation (OLV) in pediatric patients. Topics discussed include the reason of using the OLV due to the incidence of thoracoscopy, the impact of managing the hypoxia with OLV to increase the inhaled oxygen and indications of OLV such as thoracic surgeries.

Aims and Objectives: Fine-needle aspiration cytology (FNAC) as the first line of investigation has assumed importance in diagnosing a variety of disease processes as it is rapid, simple, reliable, minimally invasive, and cost-effective procedure which can be used in outpatient setting. Lymphadenopathy is one of the most common clinical presentations of patients attending the outpatient department. This study was performed to find out the pattern of diseases in lymph node in the rural area of Bastar District of Chhattisgarh State. Materials and Methods: A prospective study of 310 cases of lymphadenopathy presenting to the Department of Pathology for 2 years from January 2014 to December 2015 was taken up for our study. FNAC was performed using a 22-24-gauge needle and 10 ml syringe. Two of the prepared smears were fixed in alcohol and stained with hematoxylin and eosin and Papanicolaou stain. Two smears were air-dried, one was stained with Leishman stain and the other kept unstained to be used for Ziehl-Neelsen staining whenever a cytological diagnosis of granulomatous disease was made and also in cases with abundant necrosis and suppuration. Results: Most common lesion found in our study was tubercular lymphadenitis, followed by granulomatous lymphadenitis and reactive hyperplasia. Conclusion: Our study highlighted the various cytomorphological patterns of lymphadenopathy and revealed a huge burden of tuberculous lymphadenitis in this region. [ABSTRACT FROM AUTHOR]

Background and Aims: Work-related stress is common among medical caregivers and concerns all perioperative care providers. Although anesthesiologists are known to experience stress, there are limited Indian data addressing this issue. This survey was conducted among Indian anesthesiologists to determine their awareness about work stress and views regarding prevention programs. Material and Methods: A survey questionnaire was distributed to delegates visiting the exhibits at the national anesthesiology conference in 2011. The questionnaire had ten questions on the work pattern, five on work-related stress, nine on opinion regarding the need and willingness to participate in stress-related programs. Results: There were 1178 responders. Forty-three percent were faculty in medical institutions, 26% were residents and 25% were in free-lance practice. Ninety-one percent of participants rated their stress as moderate-extreme. There was a significant correlation between the amount of stress and working for more than 8 h (P < 0.001), handling high risk patients (P = 0.002), working on weekends (P = 0.002), and carrying work back home (P < 0.001). Forty-one percent of respondents were very satisfied professionally. Seventy-six percent of doctors agreed that the questionnaire had made them think about work stress. Eighty-four percent of participants felt the need for stress management programs and 69% expressed their willingness to participate in the same. Conclusion: The majority of participants rated their stress as moderate-extreme and was higher in anesthesiologists working long hours, over the weekend and those handling high-risk patients. A majority of participants felt the survey made them think about work-related stress and expressed their willingness to participate in stress management programs. [ABSTRACT FROM AUTHOR]

A 6-year- old child developed constrictive pericarditis 2 years after undergoing an open-heart surgery for a congenital cardiac disorder. No other cause of pericarditis was identified. The clinical condition improved after pericardiectomy. The case is reported for its rarity. [ABSTRACT FROM AUTHOR]

BACKGROUND: Bronchopleural fistula (BPF) complicating lung tumor ablation is rare but severe. The purpose of this article was to study its characteristics and treatments. MATERIALS AND METHODS: Two of 682 (0.3%) sessions of lung microwave ablation (MWA) were complicated with BPF and documented. Two electronic databases were searched for reported cases of BPF after lung tumor ablation. Case selection and data collection were done by 3 independent reviewers. RESULTS: A 56-year-old man and a 61-year-old woman developed BPF after MWA and died. Thirteen cases (mean age 63.8, 61.5% male) of BPF with adequate information were identified from 8 articles. Of the 13 cases, 5 (38.5%) had pulmonary co-morbidity, 3 (23.1%) had a history of pulmonary surgery, 7 (53.8%) had a target tumor adjacent or abutting pulmonary pleura, and 6 (46.2%) developed severe infections. After chest tube placement, pleurodesis, endoscopic therapy, surgery, and other treatments, 12 were cured and 1 died of BPF and pneumonia. CONCLUSION: BPF is a rare but severe complication of lung ablation, and the management needs a multidisciplinary and individualized treatment strategy. [ABSTRACT FROM AUTHOR]

Background: Bronchopleural fistula (BPF) complicating lung tumor ablation is rare but severe. The purpose of this article was to study its characteristics and treatments.Materials and Methods: Two of 682 (0.3%) sessions of lung microwave ablation (MWA) were complicated with BPF and documented. Two electronic databases were searched for reported cases of BPF after lung tumor ablation. Case selection and data collection were done by 3 independent reviewers.Results: A 56-year-old man and a 61-year-old woman developed BPF after MWA and died. Thirteen cases (mean age 63.8, 61.5% male) of BPF with adequate information were identified from 8 articles. Of the 13 cases, 5 (38.5%) had pulmonary co-morbidity, 3 (23.1%) had a history of pulmonary surgery, 7 (53.8%) had a target tumor adjacent or abutting pulmonary pleura, and 6 (46.2%) developed severe infections. After chest tube placement, pleurodesis, endoscopic therapy, surgery, and other treatments, 12 were cured and 1 died of BPF and pneumonia.Conclusion: BPF is a rare but severe complication of lung ablation, and the management needs a multidisciplinary and individualized treatment strategy. [ABSTRACT FROM AUTHOR]

Bronchopleural fistula (BPF) is a sinus tract between the bronchus and the pleural space that may result from a necrotizing pneumonia/empyema (anaerobic, pyogenic, tuberculous, or fungal), lung neoplasms, and blunt and penetrating lung injuries or may occur as a complication of procedures such as lung biopsy, chest tube drainage, thoracocentesis, or radiation therapy. The diagnosis and management of BPF remain a major therapeutic challenge for clinicians, and the lesion is associated with significant morbidity and mortality. Here, we present a 70-year-old male with acquired BPF due to chemical pneumonitis caused by aspiration of kerosene who presented with the symptoms of fever, cough with expectoration, breathlessness and signs of tachycardia, tachypnea, diminished breath sounds, and crepitations. After a 3-week course of culture-sensitive antibiotics with β-lactam and β-lactamase inhibitors, open drainage of the empyema was done following which the patient showed symptomatic improvement and was discharged. [ABSTRACT FROM AUTHOR]

Lungs are target organs for toxic effects of various drugs due to many reasons. Diphenylhydantoin (DPH) is reported to have many extrapulmonary side effects. We are presenting a case of acute hypersensitivity pneumonitis (HP) secondary to DPH, presenting with respiratory failure. Acute HP with respiratory failure is an uncommon drug side effect of the DPH therapy and is a diagnosis of exclusion. It requires detailed workup and exclusion of other causes along with evidence of improvement in the patient's condition after withholding DPH. [ABSTRACT FROM AUTHOR]

Resorption of tooth structures can occur as a result of physiological, pathological, and idiopathic factors. Early diagnosis and appropriate treatment can prevent its serious complications. This case report presents surgical endodontic management of a trauma-induced perforating external root resorption, which was diagnosed with the help of cone beam computed tomography. Following root canal treatment, intentional replantation of the tooth was performed so as to expose the opening of the resorption defect to allow for complete debridement and closure. Eighteen months follow-up showed arrest of root resorption, and progressive healing of the defect. [ABSTRACT FROM AUTHOR]

Background: Leptin, a 16 kDa peptide hormone synthesized and secreted specifically from white adipose cells protects neurons against amyloid β-induced toxicity, by increasing Apolipoprotein E (APO E)-dependent uptake of β amyloid into the cells, thereby, protect individuals from developing Alzheimer's disease (AD). The APO E e4 allele is a known genetic risk factor for AD by accelerating onset. It is estimated that the lifetime risk of developing AD increases to 29% for carriers with one ε4 allele and 9% for those with no ε4 allele. Objectives: To determine the levels of serum leptin, cholesterol, low density lipoprotein (LDL-C), and high density lipoprotein (HDL-C) in the diagnosed cases of AD and the association of them with cognitive decline and Apolipoprotein E (APO E) genotypes in AD. Materials and Methods: Serum levels of serum leptin, cholesterol, LDL-C, and HDL-C along with APO E polymorphism were studied in 39 subjects with probable AD and 42 cognitive normal individuals. Results: AD group showed significantly lower levels of leptin (P = 0.00) as compared to control group. However, there was no significant difference in cholesterol, triglycerides, LDL-C, and HDL-C levels in AD and control groups. The frequency of ε4 allele in AD (38.5%) was found to be significantly higher than in control (10.3%). ε3 allele was more frequent than ε4 allele in AD and control group. [ABSTRACT FROM AUTHOR]