Search

Background: Measles is the leading cause of child mortality in India. MR vaccine provides immunity against measles & rubella and was offered in 2 doses – 9 completed months and 16-24 months of age. This study aims to assess the awareness among the parents of children (aged 9 months – 2 years) in Mangalore about the presence and the risks associated with measles and rubella and to determine how the parents perceive the MR vaccination drive launched by the Government of India in terms of its necessity and safety of their children. Methodology: This cross-sectional study was conducted among 188 parents of children between the age of 9 months – 2 years from health centers in Mangalore. The data was collected using a semi-structured questionnaire- consisting of 3 sections: 1) Socio-demographic information of study participants 2) Knowledge-based questions on measles and rubella 3) Perception of MR vaccination drive. Data was analyzed using SPSS version 21. Appropriate statistical tests were applied, and results were interpreted. Results: The study population mainly comprised individuals aged 23-30 years (37.8%), predominantly females (65.3%), they prefer government hospitals for child vaccination (71.5%), resulting in 73.1% of children being meeting national immunization targets by age 2 years. Only 33,4% of the parents have understanding of Measles and Rubella diseases and associated risks. Parents exhibit awareness of the MR vaccine drive (Overall 86.7%) through newspapers (46.0%) and schools (39.0%), supporting its mandatory status (76.0%). Doctors play a crucial role in addressing parental queries (59.5%) regarding the MR vaccination drive. Conclusions: Parents show awareness of the MR Vaccination Drive but lack understanding of Measles and Rubella diseases and associated risks. Despite limited knowledge, parent’s express receptiveness to the MR Vaccination, drive for their children’s safety, with some showing interest in learning more about the vaccine and diseases.

Background and Objectives: Anemia is an extremely common condition in pregnancy worldwide, which confers several health risks to mother and child. Iron deficiency is the most widespread micronutritional deficiency in the world and disproportionately affects females because of increased iron requirements during menstruation, pregnancy, and lactation. Hemoglobinopathies are a group of inherited disorders because of abnormalities in hemoglobin (Hb) synthesis or structure. Thalassemia and sickle cell anemia are the most prevalent hemoglobinopathies and a national health burden in India so identifying these disorders during the antenatal period is necessary to take appropriate measures. This study aimed to ascertain the prevalence and spectrum of thalassemia/hemoglobinopathy amongst antenatal patients and also to analyze the ability of red cell indices to differentiate beta thalassemia trait from mild iron-deficiency anemia (IDA). Methods: A prospective study of screening for Hb variants in Antenatal Patients due to low Hb and evaluation of other causes was performed for 1 year with 570 samples. In low Hb, patients’ complete blood count, Reticulocyte staining, and sickling test were performed. Hb analysis was done by high-performance liquid chromatography Bio-Rad Variant II. In IDA Serum ferritin and Serum Iron level were done and in megaloblastic anemia (MA) Vitamin B12 levels were done. Results: The prevalence of anemia in antenatal patients was 90.25%; in this, IDA presented at 84.21%, MA at 4.73%, and dimorphic anemia at 1.27%. The prevalence of hemoglobinopathies in the current study was 9.75%; in this beta-thalassemia minor presented at 5.08%, sickle cell trait at 4.03%, Hb D Punjab at 0.52%, and Hb Q India at 0.17%. Conclusion: Antenatal screening for genetic disorders, such as beta-thalassemia and sickle cell anemia, aims to reduce the burden of these diseases by offering information to individuals with a high likelihood of giving birth to affected babies and giving parents more choices regarding their reproductive decisions. For this, premarital and antenatal screening should be mandatory to prevent the birth of affected offspring.

Background and Objectives: Blood donation is a relatively safe procedure without any discomfort; however, if any unexpected or undesirable effects, i.e., an adverse donor reaction (ADR) does occur, it should be managed promptly and efficiently. The main aim of this study was to analyze the incidence of ADRs among blood donors. Methods: A prospective study was conducted from September 2020 to September 2022 at blood center. All ADRs in whole blood and apheresis donors were managed as per standard operating procedures. An ADR pro forma was filled, and the donor was given postdonation advice as per standard guidelines. The data collected were analyzed to find the incidence, risk factors, and causes of ADRs and to study its effect on repeat donation. Results: Among 83231 blood donations during the study period, ADRs were observed in 250 donors (0.30%). ADRs were most commonly noted in the age group of 18–30 years and were higher in first-time donors (69.6%) as compared to repeat donors (30.4%). The rate of ADR was higher in females (3.11/1000) as compared to males (3.00/1000) The most common type of ADR was vasovagal type (98%) followed by hematomas (2%). Conclusion: Younger, first-time, and female donors were more prone to ADRs in the present study. Better postdonation care and regular training of staff members in counseling, early identification, and management of ADR will aid in decreasing the severity and incidence of adverse reactions which further encourages repeat blood donations.

The null phenotype in the P1PK blood group, known as “p,” is extremely rare in the world. Such individuals lack the three high-incidence antigens P, P1, and Pk. Individuals of p phenotype spontaneously form anti-PP1PK isoantibody in the serum which is also known as anti-Tja against the missing antigens. We present the two cases of p phenotype with naturally occurring anti-PP1PK isoantibodies in an infant and a young female. Serological tests, including alloantibodies screening and identification, were conducted to demonstrate the phenotype in the P1PK blood group. Both cases were serologically confirmed by higher reference laboratory in India. A well-planned patient blood management strategy can manage the repeated transfusion needs of rare blood group patients. As one of the cases is a young female, monitoring the titer of anti-PP1PK and early initiation of medical intervention are essential after her pregnancy.

A prevalence study was carried out among 430 school children in Sarojini Nagar development block of Lucknow. Age and sex distribution of the study subjects, and different eye diseases including Vitamin A deficiency, refractory error and trachoma have been described.

Burn injuries, although largely preventable, continue to pose a significant global health burden and substantially contribute to morbidity and mortality. This study emphasises the pivotal role of timely and effective burn care in mitigating the adverse consequences of these injuries. General physicians often serve as frontline responders to burn incidents, highlighting the importance of proficiency in burn management for accurate diagnosis, prognosis and appropriate referral to specialised burn units. Prompt initiation of acute burn care is paramount, with first-aid interventions playing a crucial role in shaping patient outcomes and reducing morbidity and it highlights the essential principles of burn care that general physicians should apply to enhance patient care outcomes. This emphasises the critical role of general physicians in implementing these principles effectively. In addition, it underscores the necessity of a multidisciplinary approach, advocating collaboration between general physicians and specialised burn care teams to ensure comprehensive patient management and rehabilitation. Ultimately, effective burn care enhances individual patient outcomes and reduces the overall burden of burn injuries on healthcare systems and society.

Background: There are no recent studies with a focus on the histopathology of erythema nodosum leprosum (ENL). Objectives: To describe the histopathological spectrum of ENL. Materials and Methods: Digital records from the pathology department were searched, and 125 slides were included. The histopathologic findings were recorded using a pre-designed proforma. Results: Several patterns were noted with the most common being a superficial and deep, perivascular and peri-appendageal, well-circumscribed dermal infiltrate that was seen in 70 (56.0%) biopsies. Other dermal patterns included a similar but loose infiltrate in 19 (15.2%) biopsies, diffuse dermal involvement in 9 (7.2%), top-heavy in 9 (7.2%), and bottom-heavy infiltrates in 12 (9.6%). Subcutaneous tissue was included in 107 biopsies. Extension of dermal infiltrates to the subcutis was noted in 71 (66.4%) biopsies and predominant involvement of the subcutis was noted in 6 (4.8%) biopsies, with lobular involvement in 60 (56.1%), septal involvement in 3 (2.8%), and septo-lobular involvement in 14 (13.1%). In 30 (28.0%) biopsies, the subcutaneous fat was uninvolved. The infiltrates contained neutrophils and foamy histiocytes in variable proportions, along with lymphocytes and plasma cells. Eosinophils were noted occasionally. Medium and/or small vessel vasculitis was noted in 11 (8.8%) biopsies. Fite-Faraco staining was available for 112 biopsies and revealed mainly fragmented and granular acid-fast bacilli (AFB) in 29 (25%) biopsies. Limitations: Our study had a retrospective design; we could not compare the lesional age and clinical characteristics of patients with the histological features. Conclusion: ENL is characterized by dermal infiltrates composed of foamy histiocytes and neutrophils in varying proportions arrayed in different dermal patterns. Extension of dermal infiltrates into the subcutis was frequent but absent in some. Predominant or exclusive involvement of the subcutis was rare. Vasculitis was noted in a small minority, while AFB were demonstrated in about a quarter of cases.

Introduction: Laparoscopic sleeve gastrectomy (SG) is the most common bariatric surgical procedure worldwide. Approximately 20%–30% of patients present with weight loss failure or reflux following SG, which might require reoperative surgery. We present the surgical outcomes and complications following reoperative bariatric surgery at a tertiary care centre. Patients and Methods: Prospectively collected data of all patients undergoing reoperative bariatric surgery from 2008 to 2021 were analysed retrospectively. Weight loss, resolution of comorbidities and complications following reoperative surgery were evaluated. Results: Twenty-six patients were included in the study. The mean age was 38.8 (10.8) years. The primary procedure performed was laparoscopic SG in all cases. Nine patients underwent Roux en Y gastric bypass (RYGB) (one banded RYGB) and 14 underwent one anastomosis gastric bypass (OAGB) (three-banded OAGB). Three patients underwent resleeve. The most common indication was weight loss failure (65.3%). Fifteen patients were diagnosed to have hiatal hernia intraoperatively and concomitant repair was performed. The mean body mass index before revision surgery was 42.7 (9.8). It was 32.6 (5.7) kg/m2 and 33.0 (6.1) kg/m2 at 1 and 3 years, respectively. Age and pre-revision surgery excess weight correlated with weight loss (r = −0.79 and r = 0.99, respectively). Leak and bleeding occurred in one and two patients, respectively. There were two band-related complications and one 30-day mortality. Conclusion: Re-operative bariatric surgery following SG has adequate weight loss with acceptable complication rates. Band placement in re-operative surgery might lead to a higher complication rate.

Aim: The aim of this umbrella review was to systematically review the systematic reviews on antagonist enamel wear opposing zirconia crowns compared to other ceramics and natural enamel. Settings and Design: This was an umbrella review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Materials and Methods: An electronic search of PubMed, Cochrane Central, EBSCOhost, and Google Scholar search engines for articles published from January 1, 2013, to January 1, 2023, was conducted using keywords “enamel wear,” “zirconia,” “feldspathic,” “dental ceramics,” and “Y-TZP” to identify systematic reviews on antagonist enamel wear opposing zirconia crowns compared to other ceramics and natural enamel. Statistical Analysis Used: Qualitative analysis. Results: A total of 86 articles were obtained through electronic search, of which four articles were selected after abstract screening that met the inclusion criteria for evaluating antagonist enamel wear. As compared to feldspathic groups, zirconia had substantially less antagonist wear, while surface polishing exhibited less enamel wear than glazing. Because of the heterogeneity in study design, measurement methods, and outcome variables, a meta-analysis was not possible. Conclusions: Over time, the opposing enamel wear caused by polished monolithic zirconia will be either equal to or less than that of natural enamel wear. Polished monolithic zirconia also maintains lower values of enamel wear compared to metal ceramics, feldspathic porcelains, and lithium disilicate.

Angiolipoleiomyoma is a benign mesenchymal mass composed of smooth muscle, mature adipose tissue, and abnormal blood vessels. It is rarely diagnosed in uterine masses and its prevalence among benign uterine lesions is 0.06%. We report the case of a 40-year-old female presenting with a complaint of heavy menstrual bleeding. Computed tomography scan revealed a large uterine mass with the right ovarian cyst. Histopathological examination confirmed the nature of the lesion as a benign angiolipoleiomyoma with a dermoid cyst of the right ovary. This rare association is reported to apprise gynecologists to consider this unusual tumor during the management of uterine masses.

Endosalpingiosis is a nonneoplastic lesion defined by the presence of tubal epithelium at ectopic sites such as the peritoneum, bladder, appendix, and even uterus. They may be asymptomatic and detected incidentally on ultrasonography. However, cystic endosalpingiosis is also known to be a mimicker of ovarian neoplasms. It is crucial for both the clinician and the pathologist to be aware of this benign lesion so that overdiagnosis and overtreatment can be avoided. We report a case of endosalpingiosis of the uterine serosa in a 45-year-old woman which was misdiagnosed as an adnexal cyst on radiological investigations.

Background: Toothbrushes that are used regularly can accumulate a high amount of microorganisms, which have the potential to cause infections or reinfections. There is a need for toothbrush disinfection methods which are effective and can be easily implemented. The present study assessed the antimicrobial efficacy of different disinfectants on contaminated toothbrushes in healthy and chronic periodontitis patients. Materials and Methods: Sixty patients were taken who were divided into two Groups A and B: Group A consisted of 30 healthy patients who were further subgrouped as Group A1 (control group), Group A2 (1% sodium hypochlorite), Group A3 (1% vinegar), and Group A4 (ultraviolet [UV] sanitizer) and Group B consisted of 30 patients with mild-to-moderate generalized chronic periodontitis who were further subgrouped as B1, B2, B3, and B4 based on the different disinfection processes. Microbial counts were assessed and compared. A paired sample t-test was used for statistical analysis, and the level of significance was set at P < 0.001. Results: All disinfectants showed a statistically significant reduction in microbial load on contaminated toothbrushes in both the groups (P < 0.001). There was no statistical difference between the efficacies of vinegar and sodium hypochlorite when compared with UV sanitizer in both the groups (P = 0.115 and P = 0.205). Conclusion: The study concluded that UV sanitizer can be used as a preferable toothbrush disinfection method.

Liver transplantation is the ideal treatment of choice for Familial amyloid polyneuropathy (FAP). It is known that during transplantation surgery, this explant liver which will be removed from amyloid patient can be used as a domino graft for another suitable recipient. Even after successful results of domino liver transplantation in deceased donation setting this procedure is always seen with a fear of putting both the recipients at risk due to technical challenge. With living donor as the liver donor for the amyloid patient, the challenges faced are even higher. Only few centres have done similar surgeries and there are no standard guidelines for the same. The anatomical prerequisites, technique, and indications of domino orthotopic liver transplant (D-OLT) in live donation settling are still evolving. We here report a case of live donor liver transplant from a 38 year old with a Right lobe graft for a 40 year old with FAP along with D-OLT for a 52 year old with HBV related decompensated chronic liver disease with HCC. We have described the technical challenges and learnings in our first case which is one of few cases done in the Indian Subcontinent.

Background and Aim: Kidney dysfunction is reported in significant number of beta thalassemia major children. The aim of this study was to determine the prevalence of glomerular dysfunction in beta-thalassemia major children on regular blood transfusion (BT) and chelation therapy, and to find the correlation between glomerular filtration rate (GFR) estimated by Schwartz formula and Technetium 99m diethylenetriaminepentaacetic acid (99mTc-DTPA) renogram with ferritin level and cumulative transfusion load. Materials and Methods: An observational cross-sectional study conducted was done on 110 children diagnosed with beta-thalassemia major receiving regular BT and chelation therapy. Clinical examination, biochemical investigations (serum creatinine, ferritin) and DTPA renal scan were done. Estimated GFR calculation was done by Schwartz method and 99mTc-DTPA scan. The normal values of GFR were taken from the standard value as per KDIGO guidelines. P < 0.05 was considered statistically significant. Results: The prevalence of glomerular dysfunction by Schwartz formula and DTPA renogram was 44% and 24%, respectively. The GFR calculation (Schwartz formula and DTPA renogram) were weakly positively correlated (r = 0.126, P = 0.547). There was significant association between GFR Schwartz and duration of iron chelation, as children with abnormal GFR had significantly more duration of iron chelation >5 years (28% vs. 4%, P = 0.003). GFR (Schwartz formula and DTPA renogram) showed no association with cumulative transfusion load and disease duration (P > 0.05). GFR Schwartz formula and GFR–DTPA showed no correlation with serum ferritin with r = 0.179, (P = 0.392) and r = 0.278 (P = 0.178). Conclusion: There is a significant derangement in the renal function of children of beta-thalassemia major on chronic BT and iron chelation therapy. GFR holds a direct correlation with the increasing duration of iron chelation.

Chemical leukoderma is an acquired depigmentary skin disorder, caused by repeated exposure to specific chemical compounds or secondarily to allergic contact dermatitis or through direct toxic effects, sharing similar clinical and histological features with vitiligo. We report a case of widespread allergic contact dermatitis with chemical leukoderma which later became a persistent light reactor.

Purpose: To find a correlation between the clinical (vision–inflammation–strabismus–appearance [VISA] score) and radiological (apparent diffusion coefficient [ADC] values) scores for evaluating disease activity in patients with thyroid-associated orbitopathy. Design: A prospective comparative study. Methods: Our study was performed for consecutively diagnosed thyroid-associated orbitopathy (TAO) patients. Clinical evaluation included the VISA classification system with the basic thyroid workup. An inflammatory score of

Purpose: To study the correlation between diurnal fluctuations of intraocular pressure and progression of chronic simple glaucoma. Introduction: Out of all the risk factors for glaucoma, only modifiable risk factor is intraocular pressure. A lot of studies have been done to determine the relationship between the behavior of diurnal intraocular pressure (IOP) and progression of glaucoma. The results varied and are inconclusive because the visual field damage could have occurred at a time when the IOP was high, although it was low at the time of measurement. Materials and Methods: A prospective study was conducted on all patients diagnosed or suspected CSG with office IOP

Background: Respiratory distress (RD) is one of the common indications of hospitalisation in the neonatal intensive care unit. Due to recent advances in clinical diagnosis and treatment, there is a need for data on the current profile and outcome of neonatal RD (NRD). Aims: To determine the clinical presentation, causes, risk factors, severity, and outcome of NRD. Patients and Methods: All neonates who presented with signs of RD were enrolled. Neonatal data such as birth weight, mode of delivery, gestational age, saturation on room air, mode of oxygen therapy, and onset and severity of RD were noted in predesigned pro forma. The severity of RD in term and pre-term neonates was assessed by Downe's score and Silverman–Anderson's score, respectively. Relevant investigations and treatment were started as per standard protocol. Results: The most common cause of NRD was RD syndrome (29%). Chest indrawing was the most prevalent sign of RD (90.0%). There was no significant association of gestational age with the severity of RD (P = 0.140), but the birth weight was significantly associated with the severity of RD (P = 0.002). Severe RD was associated with extreme prematurity, meconium-stained amniotic fluid and birth weight of

Introduction: Seizure is the most common paediatric neurological condition with an increased predilection for early childhood. The recent definition of epilepsy includes first-onset seizures with an increased probability of future episodes. Thus, stringent evaluation of the initial episode of seizure is essential. Hence, this study estimated the aetiology, clinical profile, treatment and outcome of the first seizure episode in children at a tertiary hospital. Materials and Methods: This prospective observational study was carried out at a tertiary hospital in Barabanki, India. Children in the age group of 1 month to 12 years who presented with the first seizure episode and those admitted for other illnesses and developed the first seizure episode during hospital stay were included. Data collected were sociodemographics, clinical presentations, laboratory tests, brain imaging studies, electroencephalography (EEG), diagnosis, treatment and short-term outcomes. Results: A total of 113 patients were enrolled presenting with first-onset seizures. There were 78 (69%) males, 86 (76.1%) were below 5 years of age and 60 (53.1%) presented with fever. Most seizures had a generalised onset (58.4%). Febrile seizures (29.2%) were the most common type, followed by neurocysticercosis (20.3%). Central nervous system (CNS)-infective aetiology (58.7%) was the most common etiological classification. Abnormal findings were observed in cerebrospinal fluid examination of 24 out of 56, in brain imaging of 53 out of 80 and in EEG of 70 out of 113 cases examined. Anti-seizure medication (ASM) was prescribed to 68 patients, of which 10 had a recurrence in the 6-month follow-up period. Conclusion: The first episode of seizure in children usually had a generalised onset, with younger children of the male sex at an increased risk. CNS infections and febrile seizures were common causes. Complete history and neurological evaluation can guide the relevant investigations. ASM tailored to the aetiology controls the seizures in most cases.

Sebaceous carcinoma is a ra malignant tumor of adnexal origin arising from sebaceous glands. It is most commonly seen arising from the eyelids and head and neck. It is predominantly seen in females with an average age of around 65 years. Apocrine differentiation in sebaceous carcinomas is rare but has been reported in the literature. Here, we present a case of sebaceous carcinoma with apocrine differentiation in a 62-year- old female who was a diagnosed case of basal cell carinoma.

Background: The mixed dentition stage in children is a critical period for orthodontic assessment and intervention. This study investigates the effects of interceptive orthodontics on dental and skeletal development in children with mixed dentition, aiming to evaluate the potential benefits of early orthodontic treatment. Materials and Methods: A retrospective analysis was conducted on a cohort of 150 children with mixed dentition (aged 7–11 years), who received interceptive orthodontic treatment. Dental and skeletal records, including cephalometric radiographs and dental cast models, were collected before and after treatment. A control group of 150 untreated children with mixed dentition was also assessed for comparison. Various dental and skeletal parameters, such as dental alignment, overjet (OJ), overbite (OB), and cephalometric measurements, were recorded and analyzed. Results: The results of this study indicate significant improvements in dental alignment and occlusion in the group of children who received interceptive orthodontic treatment. The average reduction in OJ was 3.5 mm, and the OB correction averaged 2.1 mm. Cephalometric analysis showed positive changes in skeletal relationships, with a mean reduction in the angle formed by point A, nasion (N) and point B. (ANB) angle of 2.8 degrees. These improvements were statistically significant compared to the control group (P < 0.05). Conclusion: Early orthodontic intervention, such as interceptive orthodontics, has a positive impact on dental and skeletal development in children with mixed dentition.

A subluxated lens is often associated with zonular weakness, which makes surgery with lens extraction and implantation of an intraocular lens particularly challenging. A 40-year-old healthy male presented with idiopathic partial anterior subluxation of lens without any signs of pupillary block glaucoma, corneal endothelial damage, or uveitis. Due to the absence of adequate zonular support, lens extraction with anterior vitrectomy and retropupillary iris claw lens implantation was done in this patient with good visual outcome. Lens extraction with anterior vitrectomy and retropupillary iris claw implantation can be a good surgical option in such cases.

Yoga is an ancient wisdom comprising a multitude of physical and mental practices that are aimed toward a state of optimum physical, mental, social, and spiritual health. Neuropathic pain (NP) is caused by a lesion or disease of the somatosensory nervous system that is often unresponsive to currently available modes of treatment, portending an inferior quality of life for patients. This systematic review and meta-analysis aim to investigate the effect and the potential role of yoga in NP syndromes. PubMed, Scopus, Elton Bryson Stephens Company (EBSCO), and Cochrane Library were screened for randomized controlled trials (RCTs) assessing the effects of yoga in patients on NP. Usual care, no treatment, or any active treatments were acceptable as control interventions. Primary outcome measures were objective or subjective assessment measures of pain intensity. For each outcome, standardized mean differences and 95% confidence intervals (CIs) were calculated. A total of four studies were included for qualitative synthesis. Meta-analysis of three studies revealed an overall effect (Z) in the favor of yoga as an intervention for NP, when compared to controls, although the effect was not statistically significant (three RCTs; Z = 1.10 [P = 0.27]; Heterogeneity: τ2 = 0.37; χ2 = 27.78, df = 2 [P < 0.00001]; I2 = 93%). This review divulged the overall favorable effect of yoga in NP, although it was not statistically significant. It highlights the promising role of yoga on pain intensity and quality of life in NP syndromes while showing that yoga has the advantage of being an inexpensive and easily accessible mode of therapy. Extensive research on the efficiency and safety of yoga must be conducted using robust RCTs with rigorous methodologies.

Background: Interrupted classes which gradually shifted to online mode isolating students from their friends during the COVID-19 pandemic has impacted the mental health status of the medical students. Objective: To assess the mental health outcomes among the health science students in Mangalore and the factors associated with these outcomes. Methodology: This cross-sectional study included 295 health science students of Kasturba Medical College, Mangalore. The sample size was calculated based on a study from Morocco, where 62.3% of the medical students experienced anxiety-related symptoms. Anxiety was assessed using the Generalised Anxiety Disorder (GAD-7) scale and Insomnia using the Insomnia Severity Index (ISI). The questionnaire was prepared in google forms and a link was generated which was disseminated to the students via social media platforms. Results: A higher proportion (n=179, 60.7%) of the participants in our study were females. In our study, 59% (n=173) of the participants had symptoms related to insomnia and 66% of the participants had anxiety-related symptoms. A higher proportion of participants who had anxiety-related symptoms were younger than 20 years of age, were females, belonged to MBBS course, and were not living with their family. However, none of the factors were found to be statistically significant. (P>0.05) Conclusion: The mental health status of the participants in our study was poor with the majority of the participants reporting symptoms of anxiety and insomnia.

Extraintestinal gastrointestinal stromal tumors (EGISTs) are rare stromal tumors involving mesentery, omentum, and retroperitoneum. EGISTs of the pelvic cavity are extremely uncommon, and till date, no case of pure epithelioid type arising from the pelvic cavity has been reported. They pose a diagnostic pitfall as they may mimic ovarian malignancy. We present a unique case of an epithelioid extraintestinal stromal tumor arising from the pelvic cavity. A 43-43-year-old woman presented with complaints of abdominal pain and menstrual irregularities. Ultrasound examination revealed a large well-defined hypoechoic mass in the right pelvic cavity with a possible site of origin from the right ovary. A total hysterectomy with bilateral salpingo-oophorectomy was done. Histopathological examination revealed an encapsulated tumor comprising predominantly of nests and lobules of epithelioid cells with round-to-oval nuclei, vesicular chromatin, and moderate amount of eosinophilic to clear cytoplasm. Mitotic activity was brisk along with focal areas of necrosis. On immunohistochemistry, tumor cells were diffusely and strongly positive for DOG1 and CD117. They were negative for smooth muscle actin, vimentin, S-100, and HMB-45. Based on these findings, a final diagnosis of the high-grade GIST epithelioid variant was made. It is crucial to make the correct preoperative diagnosis of GIST, since these patients may benefit from neoadjuvant imatinib, especially in case of large tumor size.

Background: The spectrum of neurological diseases encompasses a large number of disorders, including neuromuscular disorder (NMDs), ataxias, and muscular dystrophies. A detailed clinical examination, followed by electromyography and muscle biopsy, is a traditional diagnostic approach. However, it is never helpful in the identification of the subgroups of either neuropathies or muscular dystrophies apart from being a painful procedure. Aim: The present study was to assess the diagnostic yield of next-generation sequencing (NGS) in the diagnosis of neurological disorders. Materials and Methods: It was a cross-sectional study where consecutive neurological patients for whom NGS was done were included. These variants were classified as pathogenic/likely pathogenic, variants of uncertain significance (VUS), likely benign and benign. Results: Among the 45 cases included, 31 variants were identified in 30 genes, and in 15 patients, no variants were detected. Among 31 variants, 14 were previously reported for the causal of neurological disorder, including NMD, whereas 16 were novel variants (14 missense, 1 frameshift, and 1 splice donor). A definite molecular diagnosis was achieved in 21 cases that were either pathogenic/likely pathogenic, whereas 9 came to be VUS; however, the clinical manifestations correlated well. The phenotype-based sequencing showed a high diagnostic yield of 66% in the present study. Conclusion: NGS improves diagnostic efficiency with quicker and earlier diagnosis. In addition, it is a reliable and noninvasive technique that is effective in the detection of single nucleotide polymorphisms and small deletions.

Purpose: The present study aimed to investigate the current patterns of clinical presentation in the recent onset epidemic viral conjunctivitis in Eastern India. Methods: This hospital-based observational study was conducted from June 2023 to July 2023. All consecutive patients with presumed viral conjunctivitis were enrolled in the study. We performed a comprehensive ophthalmic evaluation to assess various signs and symptoms in every case. Data were statistically analyzed to study recent clinical patterns of viral conjunctivitis. Results: This study enrolled 2,640 patients with presumed viral conjunctivitis. The majority of the affected patients were males (59%). The mean age of the patients was 29.68 ± 15.84 years (range 6 months to 82 years). The highest number of cases (62.3%) was observed in patients aged more than 18 years. Most patients (62.7%) presented with symptoms in one eye, while 37.3% experienced symptoms in both eyes. Foreign body sensation and redness were the most common clinical presentations in 2,490 (94.38%) and 2,433 (92.1%) cases, respectively. Subconjunctival hemorrhage was seen in 47% of cases. Corneal involvement was noted in 43 (1.62%) cases. Resolution of symptoms was reported in most patients (84.4%) within a week. Conclusion: The current epidemic of viral conjunctivitis in Eastern India is self-limiting in nature with minimal corneal involvement. Early diagnosis, isolation of affected individuals, appropriate treatment, and adherence to personal hygiene practices are essential to curb the mass spread of conjunctivitis.

Background: Breast cancer is the most common cancer in women worldwide, with an estimated 2.26 million new cases diagnosed in 2020. The important genes associated include BRCA1, BRCA2, CHEK2, PTEN, TP53, and ataxia–telangiectasia mutated (ATM). ATM is responsible for repairing double-strand breaks in DNA making it a significant candidate in breast cancer predisposition. ATM variant, c.1066-6T>G, has been associated with an increased risk of breast cancer in some but not all studies. The Indian studies on the allele IVS10-6T>G are very limited. The present study was undertaken to evaluate the associations between c.1066-6T>G ATM gene variant and breast cancer incidence in Indian women and its correlation with histological grade, stage, and surrogate molecular classification. Materials and Methods: Routine histopathological processing was done after adequate fixation of the specimen followed by staining with hematoxylin and eosin and immunohistochemistry for ER, PR, Her2neu, and Ki67. Single-nucleotide polymorphism for ATM allele IVS10-6T>G was studied after DNA extraction, polymerase chain reaction amplification, and restriction enzyme digestion. Results: All cases were found to be negative for ATM allele IVS10-6T>G mutation. Maximum number of patients (19 cases; 52.78%) had pT2 stage tumor followed by 11 patients (30.56%) with pT3. Majority of cases were luminal B (11; 30.56%) followed by triple negative (10; 27.78%). Conclusion: Although the results obtained by mutational analysis in the present study are not in agreement with the previous study on Indian women it agrees with the numerous previous studies and meta-analyses done on women with breast carcinoma in the Western world.

Background: Metabolic syndrome (MS) is a spectrum of disorders that includes dysglycemia, dyslipidemia, central obesity, and hypertension. South Asian Indians are more prone to harbor MS at a younger age compared to Caucasians. However, there is a lack of large-scale data correlating menopause to MS in South Asian settings. Aims and Objectives: The study aimed to determine the prevalence of MS and its components in pre- and postmenopausal women. It also assessed the relationship of age, menopausal status, personal and family history, anthropometric parameters, and biochemical markers to MS. Materials and Methods: It was an interim analysis of a multicountry cross-sectional study in the South Asian Federation of Menopause Society (SAFOMS) countries: India, Pakistan, Bangladesh, Nepal, and Sri Lanka conducted through both online and physical methods. The survey questionnaire consisted of questions about details of personal history, demographics, and family history related to MS. Anthropometric measurements such as height, weight, basal metabolic index (BMI), waist circumference, and blood pressure readings were noted. Relevant history, history of polycystic ovarian syndrome, hypertensive disorders of pregnancy, and vasomotor symptoms were enquired. Biochemical evaluation of markers associated with MS was undertaken. Results: In this interim analysis, 638 women were recruited. Out of them, 406 (63.6%) women were premenopausal and 232 (36.4%) were postmenopausal. 392 (61.4%) women had MS, while 246 (38.6%) women did not have MS. Increasing age, BMI, and visceral adiposity (waist circumference) were significantly correlated with incidence of MS. Raised fasting blood sugar, hemoglobin A1C, total cholesterol, low-density lipoprotein, serum triglyceride, and reduced high-density lipoprotein levels were significantly associated with the incidence of MS in both pre- and postmenopausal women. Peri- and postmenopausal hot flashes, night sweats, and sleep disturbances were also significantly associated with MS. Personal history of hypertension, diabetes, and dyslipidemia were the strongest factors to be associated with MS with a significantly high odds ratio. Conclusion: The study has highlighted the role of BMI and waist circumference as the first warning signs, which will encourage to go for regular biochemical screening through lipid profile and fasting blood glucose measurements. Our study is a stepping stone for all future studies for relation of menopause to MS.

Objective: To derive a clinical score from parameters that favor remission of Cushing's disease (CD) after pituitary surgery. Methods: This is an analysis of 11 clinical, hormonal, and post-operative parameters that each favored remission in a cohort of 145 patients with CD treated by trans-sphenoidal surgery (TSS). Each parameter was designated as a categorical variable (presence/absence), and several favorable parameters present for each patient were calculated. From this, a median parameter score (clinical score) of the entire cohort was derived, which was then compared to the event of remission/persistence of CD. Results: The median number of favorable parameters present in the entire cohort was 3 (0–7). The significant count of patients in remission increased with the increasing number of parameters. The receiver-operator characteristic curve showed that the presence of ≥3 parameters was associated with remission in CD with a sensitivity of 84.2% and a specificity of 80%. Patients with a clinical score ≥3 had significantly higher remission rates (88.9%) than those who had persistent disease (27.3%; P = 0.001).Conclusion: A clinical score of ≥3 predicts remission in CD treated by TSS; however, it requires validation in other large cohorts. Rather than assessing individual parameters to predict remission in CD, an integrated clinical score is a better tool for follow-up and patient counseling.

Aim: The aim of the study is to evaluate and compare the effect of access cavity designs on the polymicrobial biofilm disinfection of root canal system. Methods: One hundred and twenty molar teeth were selected and randomly divided into four groups (n = 30) on the basis of access cavity design: traditional access cavity (TEC), contracted access cavity (CAC), truss access cavity (TAC), and caries-driven access cavity (CDAC). After access preparation, the samples were contaminated for 2 weeks to grow polymicrobial mature biofilm. Microbial sampling from the root canals was performed with sterile paper points before and after instrumentation to determine the bacterial load. The bacterial reduction was counted as CFU/ml and analyzed statistically. Results: Both maxillary and mandibular molars with different cavity designs showed significant decreased in the number of Enterococcus faecalis, Staphylococcus aureus, and Candida albicans postinstrumentation. TEC group showed significantly higher microbial reduction for all tested microorganisms than TAC and CDAC groups (P < 0.05). However, insignificant difference (P > 0.05) was observed between TEC and CAC and TAC and CDAC. Conclusion: In both maxillary and mandibular molars, complete elimination of microbes (E. faecalis, C. albicans, and S. aureus) could not be achieved with any access cavity design. Highest microbial reduction was achieved with TEC and lowest in CDAC. Both TEC and CAC resulted in equal microbial reduction and were superior to TAC and CDAC.

Introduction: Acute encephalitis syndrome (AES) or acute febrile encephalopathy is a clinical condition characterized by altered mental status occurring after or along with a short febrile illness. In developing countries, infections are the predominant cause of AES. Prominent infections known to cause AES include viruses (such as herpes simplex virus [HSV], Japanese Encephalitis [JE] virus, dengue, enteroviruses [EVs]), bacteria, fungus, and parasites. In the present study, we aim to analyze the etiology, clinical features, and predictors of mortality in patients presenting with acute febrile encephalopathy or acute encephalitic syndrome. The present study was a prospective observational study conducted at Post Graduate Institute of Medical Education and Research a tertiary care center in Chandigarh, India. Methods: A total of 105 patients with ≥18 years of age with fever (body temperature >101° F for duration ≤14 days) and altered sensorium (Glasgow coma scale [GCS] score ≤10) lasting for more than 24 h, either accompanying the fever or following it were enrolled. Demographic and clinical details were recorded on pro forma. Cerebrospinal fluid (CSF) analysis was performed for all the enrolled patients at admission for cytology, CSF glucose to blood glucose ratio, protein levels, gram stain and culture sensitivity, adenosine deaminase levels, polymerase chain reaction for HSV/EV/mycobacterium tuberculosis (TB) and immunoglobulin M Enzyme-linked immune assay for JE. Computed tomography of the brain was done in all patients while magnetic resonance imaging (MRI) of the brain was carried out in 75 patients. Results: Among the 105 patients, tubercular meningitis was seen in 27 (25.7%) patients followed by acute pyogenic meningitis in 18 (17.1%) patients. Probable viral encephalitis was present in 12 (11.4%) cases. Septic encephalopathy (n = 10) and scrub typhus encephalitis (n = 8), HSV encephalitis (n = 6), dengue encephalitis (n = 4), leptospirosis (n = 3) were the other infections causing acute febrile encephalitis in our study. In addition to fever and altered sensorium common symptoms observed were headache (52.4%), vomiting (35.2%), and seizures (29.5%). The factors predicting increased mortality were female gender, fever of more than 38°C at admission, GCS

Background: Ovarian cancer is the 8th most common cancer in women worldwide. Tumor budding is defined as a type of invasive growth in carcinomas with either a single tumor cell or a cluster of up to four cells at the invasive tumor front and is associated with epithelial–mesenchymal transition. A reactive stroma rich in cancer-associated fibroblasts is associated with higher tumor grade and poorer prognosis in breast, colorectal, and oral cancers. Aims and Objectives: The present study was conducted to highlight the prognostic significance of tumor budding and fibrotic cancer stroma in malignant ovarian surface epithelial tumors with known prognostic parameters. Materials and Methods: This was a retrospective cross-sectional study conducted over a 2-year period, in which all histologically diagnosed cases of malignant ovarian surface epithelial tumors who underwent surgery were included. The fibrotic stroma was classified into three distinct categories – mature, intermediate, and immature. The number of tumor buds was counted at the invasive front of the tumor and graded based on the number of buds – 0–5, 5–9, and ≥10 buds. Results: Among the 50 cases, 32% (16 cases) had mature stroma, whereas 30% (15 cases) and 38% (19 cases) had intermediate and immature stroma, respectively. Although a significant association could not be established between tumor budding and stroma grade, a fair agreement was established between them. A significant association could be established between histological grade with both tumor budding (P = 0.03) and fibrotic stroma grade (P = 0.02). Conclusion: The study highlighted the role of stromal response in malignant surface epithelial tumors of the ovary since a higher-grade tumor was associated with an immature stroma, whereas a lower-grade tumor was associated with a mature stroma.

Background and Aims: The supraglottic airway device, i-gel, is used in obese patients for short- to medium-duration surgical procedures. Insertion techniques have contributed to the successful and proper placement of i-gel in the first attempt. This study aims to compare two techniques for successfully inserting i-gel in the first attempt in overweight and obese patients as measured by oropharyngeal leak pressure (OLP). Methods: This interventional, randomised, controlled study was conducted after ethical approval, and trial registration in overweight and obese patients. Patients were randomised into two groups: In Group C, the conventional technique was used, while in Group R, the reverse technique was used to insert i-gel. OLP, successful placement, required manipulations, time taken for insertion, number of attempts, and intraoperative and postoperative complications were studied. The collected data were analysed statistically. Results: The mean OLP (30.46 ± 3.76 vs. 32.12 ± 3.10 mmHg, P = 0.018) and the mean time of insertion (16.42 ± 1.86 vs. 13.98 ± 1.97 s, P = 0.001) for conventional and reverse techniques, respectively, were statistically significant and favourable for Group R compared to Group C. Successful placement of i-gel at the first attempt, ease of insertion, number of attempts and all the manipulations except withdrawal and advancement were comparable in both the groups. No postoperative complications were noted. Conclusion: The reverse technique significantly favoured the actual OLP values and the mean insertion time. Successful placement of i-gel at the first attempt was observed with both conventional and reverse techniques.

Background and Aims: Thromboprophylaxis practice patterns are quite diverse in neurocritical care patients. The risk of venous thromboembolism remains high in this group due to prolonged immobilised status, extended length of stay and multiple comorbidities. The aim was to comprehend the thromboprophylaxis practices among neurocritical care practitioners in India. Methods: The cross-sectional online questionnaire-based survey was undertaken among the neurocritical care practitioners. Two investigators framed two sets of 15 questions in the first stage and reviewed them with experts. In the second stage, a set of 22 questions was prepared by a third investigator and pretested among ten experts. The questions were emailed to the participants with a link to the survey. The responses were analysed using Statistical Package For The Social Sciences software. Results: Of the 185 responses, 53% reported that thromboprophylaxis is practised less often in neurocritical care than in general critical care. The usage of pharmacoprophylaxis among neurosurgical cases, traumatic brain injuries and brain strokes varies widely. There was a preference to use pharmacoprophylaxis in patients with Glasgow Coma Scale (GCS) below nine among many (68.2%), and low molecular weight heparin (LMWH) was the preferred choice in such cases. The reluctance to use heparin because of fear of bleed was high (82%). Most (78.9%) believed pharmacoprophylaxis could reduce venous thromboembolic events (VTEs) and mortality. Conclusion: Thromboprophylaxis practices among neurocritical care patients remain quite heterogeneous. There is a dilemma in patients with intracranial haemorrhagic lesions regarding pharmacoprophylaxis.

Scrub typhus infection is reemerging leading cause of acute febrile illnesses in post-rainy or monsoon season in Southeast Asia. It is caused by Orientia tsutsugamushi and spread by the bite of chiggers, larval forms of trombiculid mites. The clinical picture can range from simple acute febrile illness to multiorgan dysfunction. Neurological manifestations also vary from aseptic meningitis, meningoencephalitis, cerebral infarction, acute disseminated encephalomyelitis, transverse myelitis, and psychiatric manifestations. Here, we present a case series of eight cases of scrub meningoencephalitis diagnosed based on clinical, laboratory, and radiological criteria.

Advances in prenatal diagnostic techniques have enabled early detection of potentially correctable foetal anomalies. Here, we summarise recent developments in anaesthesia for foetal surgery. Types of foetal surgery include minimally invasive, open mid-gestational and ex-utero intrapartum treatment (EXIT) procedures. Foetoscopic surgery avoids hysterotomy, with risk of uterine dehiscence, preserving the possibility of subsequent vaginal delivery. Minimally invasive procedures are performed under local or regional anaesthesia; open or EXIT procedures are usually done under general anaesthesia. Requirements include maintenance of uteroplacental blood flow, and uterine relaxation to prevent placental separation and premature labour. Foetal requirements include monitoring of well-being, providing analgesia and immobility. EXIT procedures require maintenance of placental circulation till the airway is secured, requiring multidisciplinary involvement. Here, the uterine tone must return after baby delivery to prevent major maternal haemorrhage. The anaesthesiologist plays a crucial role in maintaining maternal and foetal homeostasis and optimising surgical conditions.

Aim: The first index for the assessment of extrinsic stain was published by Lobene in 1986. Using the Lobene stain index in the field is very cumbersome as well it does not meet the general requirement of an index, i.e., the index is to be simple, rapid, highly reproducible, and sensitive enough to detect small changes in the staining level. Hence, there was a need to develop an alternative index for the same purpose. Hence, the only present study was undertaken to propose a modified stain index with more simplicity and clarity. Materials and Methods: An observational study was carried out among 16–44-year-old participants who had at least six natural teeth and were generally healthy. For the revised index, the criteria and codes for intensity were kept the same as MacPherson Index but the criteria for recording area were modified. The data scoring for each tooth was mentioned in the proposed table and was recorded for each of the surfaces according to the proposed area and intensity codes. Analysis was carried out using SPSS version 21 (IBM, Inc. Virginia, United States). Inferential statistics were performed using the Mann–Whitney U-test. Nonparametric tests were applied following the imposition of a numerical interval scale the same as the Lobene index. Results: No statistically significant difference was appreciated for the area, intensity, and product of area × intensity when compared for measurements recorded by two indices as P > 0.05. Hence, validating the proposed index for the clinical application. Conclusion: The proposed modified index may be advantageous over its conventional counterpart due to its ease of recording and concise scoring and also less complexity in the area to be recorded.

Context: The unpredictable nature of COVID-19 pandemic and the limited patient–doctor interaction led to the change in chronic pain management during the pandemic. Aims: The study aimed to compare pain scores and bio-psycho-social aspects of chronic pain in patients during prepandemic versus COVID-19 pandemic period. Settings and Designs: This was a prospective, cross-sectional observational trial conducted in a tertiary care hospital. Subjects and Methods: The study was conducted between September 2021 and January 2022 which corresponded with the end of the second wave and beginning of the third wave of COVID-19 pandemic. A set of 20 web-based questionnaires were sent to adult patients of both genders and who had visited pain clinic before the onset of pandemic. Statistical Analysis Use: Discrete categorical data were presented as n (%); continuous data were written either in the form of its mean and standard deviation or in the form of its median and interquartile range. All statistical tests were two-sided and were performed at a significance level of P < 0.05. Results: A total of 408 patients of chronic pain participated in the web-based questionnaire. The most common diagnosis was low back pain, facial pain, and knee pain. The patients continued to consume analgesics during the pandemic, had ≥2 burnout score, and reported “poor to fair” quality of sleep score. During the pandemic, pain score increased in those subsets of patients who earlier had no pain (odds ratio [OR]: 68.33, confidence interval [CI]: 24.10–193.72, P = 0.000), mild pain (OR: 22.78, CI: 9.49–54.64, P = 0.000), and moderate pain. On the contrary, chronic pain decreased or remained same in the population having moderate or severe pain before the pandemic. Patients with increased pain during the pandemic wanted the outpatient department to reopen for consultation with pain physician. The majority of the patients 350 (85.78%) who had participated in the study did not suffer from COVID-19 infection. Conclusions: Regular intake of analgesics during the COVID-19 pandemic reduced the number of patients experiencing severe pain. However, the patients suffering from moderate-to-severe pain during the pandemic had a direct correlation between higher pain severity and poor quality of sleep.

Aim: The aim of this study was to evaluate and compare the depth and percentage of sealer penetration into dentinal tubules using extracanal and intracanal heated NaOCl in the irrigation protocol using a confocal laser scanning microscope. Methods: Thirty extracted central incisors prepared till F4 ProTaper Gold were randomly distributed into three groups (n = 10 each) depending on the final irrigation protocol. Group C – nonheated 3% NaOCl, group EC – extracanal heated 3% NaOCl, and group IC – intracanal heated 3% NaOCl. Final irrigation with different warming protocols along with sonic activation was performed. Canals were obturated with standardized F4 Protaper Gold gutta-percha cone coated with AH Plus sealer labeled with Rhodamine B dye. The transverse sections of samples at different levels were examined on a confocal microscope and analyzed using IOB software. Unpaired “t” test and Mann–Whitney U test were used for intergroup comparison; P < 0.05. Results: The percentage of sealer penetration was significantly lower in group C as compared to group IC and EC at the coronal and middle third. Group C showed a lower depth of sealer penetration as compared to group EC and IC at all levels. The percentage and depth of sealer penetration were not significantly different between group EC and IC at all levels. Conclusion: Extracanal and intracanal heating of NaOCl significantly improves the percentage and depth of AH Plus sealer penetration in dentinal tubules.

Aims: The aim of this study was to determine the incidence of central line-associated bloodstream infections (CLABSIs) in the medical and surgical intensive care units (ICUs) of a tertiary care hospital. Materials and Methods: One hundred and twenty patients admitted to medical and surgical ICU with an indwelling, nontunneled central venous catheter (CVC) inserted at admission in the department of emergency medicine or at medical and surgical ICU for more than 48 h were monitored. The patients were followed up daily for the development of new-onset sepsis after 48 h of insertion of CVC, by analyzing the culture of two sets of blood samples, over a span of 24 h. The data were evaluated statistically using Microsoft Excel version 11 and SPSS version 17 (IBM, USA). Results: Among 120 patients hospitalized for an aggregate of 972 days, 7 patients had acquired CLABSI with an incidence rate of 7.2/1000 central line days. The organisms isolated were Staphylococcus aureus, Acinetobacter spp., Pseudomonas aeruginosa, and Klebsiella pneumoniae. Conclusion: The incidence rate of CLABSI in this study was in line with other studies on the CLABSI rate in India. The study found a significant association of CLABSI with duration of CVC catheterization, underlying comorbid conditions and diseases of patients, and indication of CVC insertion. However, there was no significant association of CLABSI with age of patients, their gender, and site of insertion.