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Introduction: Pain is a complex subjective sensation that is difficult to quantify in a repeatable manner. Surgical pain is observed to be more intense post-surgery and then fades in the next 24 h. Epidural anesthesia/analgesia is the most widely used technique for lower limb surgeries because of its good sensory and motor block property, reduces stress response, and maintains sufficient spontaneous respiration and hemodynamic stability. Materials and Methods: The study looked at 100 individuals between the ages of 20 and 60 who underwent elective lower limb surgery and were classified as ASA I and II. The patients were split into two 50-person groups. The adverse effects of nausea, vomiting, respiratory depression, urine retention, and pruritus, as well as the quality and duration of postoperative analgesia, were investigated. The patient was monitored for 48 h after surgery. Results: A total of 100 patients were included in the study, where the least age of the patient was 19 years and the greatest age was 75 years. In group T, maximum patients belong to the age group of 26–35 years, whereas in group F maximum patients belong to the age group of 36–45years. In group T, 41 (82%) were males and 9 (18%) were females. In group F, 37 (74%) were males and 13 (26%) were females. Conclusion: Our findings show that epidural tramadol and epidural fentanyl are equally effective, except for fentanyl’s shorter duration of action. Fentanyl also has a moderate sedative effect, which is beneficial in the postoperative period.

Baclofen is primarily a gamma-aminobutyric acid-Β receptor agonist. It is used in patients with dystonia and to reduce spasticity in neuromuscular disorders. It has dopaminergic antagonist properties that reduce craving in alcohol dependence. Somnolence, dizziness, and fatigue are common side effects. Rarely paresthesia, rigidity, dystonia, dysarthria, or seizures are reported. We hereby report a rare case of baclofen-induced dystonia and tremors in a patient with alcohol dependence. An alcohol-dependent patient was admitted and withdrawal symptoms were managed. Twenty mg baclofen was advised to reduce craving. He developed dystonia and tremors within a few hours of the first dose. On evaluation, magnetic resonance imaging of brain revealed non-specific changes and electroencephalography was normal. To our knowledge, this is one of the first case reports of drug-induced dystonia attributable to baclofen. The underlying pathophysiological processes involved remain unclear. Baclofen decreases pre-synaptic dopamine release in the nigrostriatal pathway, which may be the possible mechanism for dystonia.

Background: Fine needle aspiration cytology is a simple investigation to evaluate the malignant tumors of the breast when compared to tru-cut biopsy. It is invaluable in the diagnosis of the common invasive carcinoma of the breast including its subtypes. The morphology of the uncommon subtypes and other rare tumors are the source of diagnostic confusion. Aims: The objective of this study is to assess the role of FNAC in diagnostically challenging malignant lesions of the breast. Methods and Material: The study included 526 female patients with palpable breast lumps subjected to FNAC for one year from November 2015 to October 2016 in the department of pathology. The cytology features of these patients were studied and correlated with histopathology. Results: Diagnostic difficulty was encountered in certain tumors having either bland cytology or a predominant discrete pattern or a combination of extracellular mucin and papillary pattern. These were reanalyzed in correlation with histopathology, clinical findings, radiology and immunohistochemistry. Conclusions: Awareness of the morphology of these rare lesions improves the diagnostic accuracy making cytology a more efficient tool for the preoperative assessment of malignant breast tumors.

Background: Immunotherapy (IT) was first described by Noon and Freeman in 1911. The mechanism underlying successful immunotherapy is however not known. The protection from allergy is achieved long before IgE levels are de-creased, and they are indeed not frequently increased. Continued therapy may decrease IgE and skin reaction, although it may take years. Objective: The evaluation of effect of immunotherapy with specific pollen Gyn-andropsis gynandra. Material & Methods: Clinical subjects like skin test response, symptoms score, drugs intake and total sIgE levels were studied in sixty patients. Results: Both immediate and delayed skin test responses were highly significant. The intensity of symptoms score and medication was reduced and total sIgE levels were inconsistent after the course of IT. Conclusion: The decrease in clinical subjects may be attributed to the beneficial effect of immunotherapy with Gynandropsis gynandra.

Background : About 10 to 15 % of the Indian population is known to suffer from major allergic disorders such as Asthma, Rhinitis, Atopic Dermatitis and Urticaria. Aeroallergens play a major role in the pathogenesis of respiratory allergic diseases. Among the aeroallergens, pollens are major causative agents. The predominance of pollen allergens necessitate the need to assess the specific immunotherapy (SIT) in allergic patients. Objective : To evaluate the effect of immunotherapy based on the presence of IgG and its subclass antibodies towards whole pollen antigen of Gynandropsis gynandra (G.gynandra) and its fractions. Material and Methods : A study was conducted in 30 bronchial asthma patients on immunotherapy, by assessing the levels of IgG and its subclasses specific to G. gynandra pollen. Results : There was a significant increase in IgG and its subclass antibodies to whole pollen antigen and its fractions i.e.> 90kD, 46-37kD and 36-32kD after the course of IT. Conclusion : The use of peptide fractions may be more appropriate instead of the whole pollen antigen to test the effect of immunotherapy.

Cherubism is a rare non-neoplastic disease of the bone characterized by bilateral painless enlargement of the jaws giving a cherubic appearance to the patient. It is an autosomal dominant disorder but may occur sporadically. In this paper, we have tried to explain about the clinical, radiological and histopathologic features of cherubism by presenting a case study. A case study of a 7 year old male patient, who first presented with mandibular bilateral swellings to our department in 1998, has been presented. In-depth clinical, radiological and histopathologic examination was done. An extensive long-term follow-up till 11 years was maintained. When presented for the first time, radiological investigation showed characteristic multilocular lytic lesions of the mandible bilaterally. Histopathological examination of the biopsy specimen showed proliferating fibrous connective tissue interspersed by multinucleated giant cells. It was diagnosed as a case nonfamilial cherubism. Follow-up after 5 years showed involvement of the maxilla as well, which was then corrected by surgical methods. Upon follow up 11 years after the first presentation, it was seen that the lesion was regressing by itself and there was improvement in facial contour. The natural course of Cherubism through its progression, stabilization and involution of the disease after puberty, has been highlighted in this case. More, in-depth studies to understand the nature and the pathogenesis of this condition better are required.

Background: Endometrial cancer is the most common disease of the female reproductive system. Vaginal cuff brachytherapy (VCB) has intrinsic advantages compared to external beam therapy when treated with radiation. A single-channel cylinder is a standard applicator in VCB. The present study aims to estimate a change in the dose to vaginal mucosa due to air pockets between the cylinder and vaginal mucosa by calculating with the Acuros BV algorithm and comparing it to the Task Group 43 (TG-43) algorithm. Materials and Methods: Patients who presented with air packets were included retrospectively. For each patient, three plans were created: the first plan used TG-43, the second plan used dose recalculation with Acuros BV, and the third plan was generated by re-optimization by Acuros BV. On the same axial computed tomography image, the point doses at the cylinder's surface and the displaced mucosa were recorded and the ratios were then estimated. Results: The average volume of air pockets was 0.08 cc (range of 0.01–0.3 cc), and 84% of air pockets displaced the vaginal mucosa by ≥0.2 cm. The average ratios of dose were 0.77 ± 0.09 (1 standard deviation [SD]) and 0.78 ± 0.09 (1 SD) for TG-43 and Acuros BV algorithms, respectively. Due to the air pocket, mucosa received a reduced dose by an average of 22.72% and an average of 23.29% for TG-43 and Acuros BV, respectively. The maximum displacement of mucosa and the ratio of doses were negatively correlated for both. In the Optimized Acuros BV plan, total dwell time increased by 1.8% but no considerable change in the dose ratios. Conclusion: The calculated dose of mucous membrane forced out of the cylinder surface by air pockets by the Acuros BV algorithm was nonsignificantly different from TG-43. Therefore, even in the presence of air pockets, the TG-43 algorithm for calculating the VCB dose is appropriate.

Background: Facial nerve palsy is a common intra-temporal complication of untreated chronic suppurative otitis media (CSOM) causing erosion of the fallopian canal and its pressure effects leading to facial weakness. There is a less favorable outcome in patients of CSOM with diabetes as they are more prone to neural degeneration. In such patients, early surgical decompression of the facial nerve helps in resolving facial palsy to some extent. In our study of 22 patients, we analyzed the prognosis and advantage of doing early surgical facial nerve decompression along with modified radical mastoidectomy in patients of unsafe CSOM with diabetes mellitus. Materials and Methods: We present a retrospective study of 22 patients with a squamosal type of CSOM with diabetes mellitus who came to the outpatient department, from June 2019 to March 2021, with complaints of ear discharge and facial palsy grades 3–5, in whom we did early surgical facial nerve decompression along with modified radical mastoidectomy. We observed the incidence of facial palsy and recovery after facial nerve decompression with limited use of steroids in patients with diabetes mellitus. Results: In our retrospective study of 22 patients with squamosal type of CSOM with diabetes mellitus with complaints of facial palsy, 10 were males and 12 were females. Patients were assessed clinically using House–Brackmann grading: 55% are of grade III, 31% are of grade IV, and 14% are of grade V. About 82% of the patients from our study had lesions at the tympanic segment, 9% patients had lesions at the vertical segment, 4.5% patients had lesion at the first genu, and 4.5% patients had lesion at the second genu. In our study, 95% of the patients from the study improved with early facial nerve decompression along with modified radical mastoidectomy, 55% of the patients improved to grade I, 36% of the patients improved to grade II, and 9% of the patients improved to grade III. Conclusion: In squamosal-type CSOM patients with facial palsy, early facial nerve decompression along with modified radical mastoidectomy within 12 weeks of development of facial palsy provides better results than just modified radical mastoidectomy as it increases recovery rate and reduces the need for post-operative steroids which is an advantage in diabetics.

Introduction: Drugs are considered as double-edged weapons with the potential to cause benefit as well as harm. Recent studies reveal that adverse drug reactions (ADRs) imply a remarkable burden on the length of hospital stay, healthcare facilities, and sometimes they require additional investigations and drug therapies for the treatment of symptoms and diseases caused to the patient. So, further local studies are required to understand the scenario and to improve the safety of prescribing and monitoring drugs and improved patient adherence to medication. Objectives: To evaluate and assess the pattern of adverse drug reactions reported to the ADR Monitoring Centre, Rangaraya Medical College, Kakinada, India. Materials and Methods: The current study was a retrospective and an observational type of study carried out at the ADR Monitoring Centre of a tertiary care hospital. Total ADRs reported during the two years from June 2016 to June 2018 were included in the study. Each ADR was analyzed for demographic data, relationship to drugs as per causality assessment, and frequency of ADRs. Microsoft Excel 2019 and SPPS version 20 were used for data analysis. Results: The most common group of drugs showing ADRs were anti-retroviral therapy (ART) drugs, followed by anti-microbial agents. Most of the ADRs were probable and mild. Rash was the most frequently occurring ADR. Conclusion: The study of ADRs in a particular institute using demographic patterns will contribute to patient safety by sensitizing the clinicians in that particular institute.

The World Health Organization declared COVID-19 disease as a pandemic after the first cases from China were reported in December 2020. COVID-19, caused by SARS-CoV2 (severe acute respiratory syndrome), spreads by contact with infected droplets. The incubation period ranges from 2 to 14 days with initial symptoms of fever, sore throat, cough, fatigue, malaise, and breathlessness. In patients with co-morbidities and the elderly, it progresses to pneumonia, acute respiratory distress syndrome, and multi-organ failure. Regarding the impact of the environment on the spread of the corona virus, more research is going on. Environmental factors including atmospheric temperature, ventilation, climate change, and humidity have been studied to understand the effect of these factors on COVID-19 spread. We have evaluated studies to date related to the environmental effect on COVID-19 and summarized them for better understanding.

Objectives: To evaluate whether the use of barbed sutures during laparoscopic hysterectomy for vaginal cuff closure has reduced the surgical difficulty and incidence of post-operative complications as compared to polyglactin 910 suture. Materials and Methods: This is a randomized comparative study conducted at a tertiary care hospital and research institute where 100 patients were divided into two groups (50 each) and underwent vault closure using barbed suture/Polyglactin 910. Data collected include demographic details, indication for surgery, mean suturing time, degree of surgeon difficulty, and the incidence of postoperative complications when followed up to 12 weeks and were compared statistically using Chi square test and Independent-t test. Results: The use of barbed suture has significantly reduced the suturing time (5.39 min vs. 6.9 min, P < 0.0001) and surgical difficulty. The incidence of minor complications is similar to that of polyglactin 910. There were no cases of vaginal cuff dehiscence or bowel obstruction reported in our study. Conclusion: With the advantages of reduced suturing time and technical difficulty, and incidence of complications similar to conventional suture material, barbed sutures are to be considered as an excellent alternative to conventional suture materials.

Background: Stress and depression among medical students are the prevalent and global concern these days. Stress is a critical risk factor for depression as it can contribute to depression through various pathways. Stress is multifactorial in causation which can be associated or attributable to depression. Aims: The aim of this study is to evaluate and elicit the levels of stress and depression in association with various recent factors, accounting and resulting to stress and depression. Subjects and Methods: This is a cross-sectional study conducted among medical students of a well-recognized medical college. Analysis sheets consisting of Beck's Depression Inventory (BDI), Perceived Stress Scale (PSS), and other criteria comprising demographic details such as gender, age, year of studying and some associated factors which include appetite, gastrointestinal (GI) problem, sleep, social feelings, body mass index (BMI), and hair fall adding to stress and depression were made to fill by 288 medical students of a medical college. Results: Majority of the study participants have moderate-or-high levels of stress but no depression. Nearly 46.5% of the study participants have normal values of BMI, and 42.7% are over the levels of their normal BMI. Nearly 59.7% of the total students have hair fall, 76.7% have normal sleep-wake cycle, 77.4% have normal social feelings, 75.6% have normal appetite, and 84.7% do not have any GI problems. When the relation between stress and these study variables was observed, the association between BMI and hair fall was found to be significant. Conclusions: First-year students feel more stressed that could be due to their recent entry into the course. Female students are more prone to these stressors and depressors. Juniors are more stressed when compared to senior students.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of the respiratory coronavirus disease 2019 (COVID-19). Coronaviruses are a large family of enveloped, positive-sense, single-stranded RNA viruses, which infect a broad range of vertebrate animals. The SARS-CoV-2 is spread primarily between people through close contact and through respiratory droplets produced from coughs or sneezes by the infected individuals. After entering into the human body, it enters human cells by binding to the angiotensin-converting enzyme 2 receptors, prominently present in lung, kidney, and gastrointestinal tract. Older people and people of all ages with severe chronic medical conditions such as diabetes, lung disease, and heart disease seem to be at higher risk of developing serious COVID-19 illness. There have been four pandemics caused by the emergence of new influenza viruses in the past century such as H1N1 Spanish flu (1918), H2N2 Asian flu (1957), the H3N2 Hong Kong flu (1968), and the H1N1 Swine flu (2009). Community interventions are important response strategies that can reduce the impact of disease. Widespread transmission of the virus could translate the situation into large numbers of people needing medical care at the same time. Better understanding of the complexity and dynamics of influenza pandemics reduces the further risk effect of such critical situations. Global efforts in tackling the virus at this time are focused all together on lessening the spread and impact of this virus.

Background: Diabetes mellitus is a disease of complications, which is rapidly increasing in prevalence worldwide. The total population affected by diabetes is projected to rise from 171 million in 2000 to 366 million by 2030. Approximately 20% of all diabetics who visit the hospital are admitted for foot problems. Diabetic foot ulcers and amputations continue to cause considerable morbidity among persons with diabetes throughout the world. Amputations are considered as a very debilitating complication of diabetes. Vast majority of diabetic foot complications resulting in amputation begin with formation of skin ulcers. Objectives: The main objective of this study is to examine various risk factors to predict lower extremity amputation in diabetic patients and to understand various measures which will reduce the level of amputation. Subjects and Methods: Fifty diabetic patients with foot lesion admitted in our hospital from September 2016 to August 2018 were studied by taking detailed history and thorough clinical examination. Grading of the foot lesions was done by Wagner's staging. Results: The incidence of foot lesion was higher in 51–60 years' age group in males and females. Majority of the patients (38, 76%) had a history of trauma as a predisposing factor to diabetic foot. Out of 20 patients walking barefoot, 12 people (60%) had amputations. Conclusions: It is concluded that rural origin of the patients was found to be another predisposing factor for the development of diabetic foot. This is due to the illiteracy of the patients regarding diabetes and its complications, unavailability of proper health-care facilities, and late presentation to the hospital.

Background: Anatomy is the initial, basic and foundational subject of the medical and dental curriculum. It is thought to be the toughest subject in the initial days of the medical and dental course of study. This toughest subject is made little easier through practice of dissection. Objectives: The cardinal purpose of this study is to evaluate the attitude and manner of dissection, also to explore the views and perspectives towards cadaver and dissection among medical, dental and paramedical students. Methods: This is a cross-sectional study carried out at a reputed and well-recognised medical college. Study population is made of 546 students (medical, dental and paramedical students). They were given a well-prepared student questionnaire (made of 35 questions) and the responses were obtained and analysed. Results: Among 546 students (224 males and 322 females); 328 are MBBS, 127 are paramedical and 91 are BDS students. Four best questions were selected in the distributed questionnaire based on significance as P values, in which the question asked “Are you interested in cadaveric dissection” is extremely significant with a P value of 0.0092. Conclusions: Many of the students opted for the use of pre-dissected human specimens, instead of cadaveric dissection. They felt that dissection can help them to work as a team and improves their group discussion ability. Though most of the students are interested in cadaveric dissection, they touch the cadaver less often.

BACKGROUND: Epilepsy is one of the most common chronic disorders of the central nervous system. The quality of life of children with epilepsy is influenced by various factors including their sleep. To assess the quality of life and sleep habits among children with epilepsy and to determine the association of QOL and sleep habits, with sociodemographic and clinical variables. MATERIALS AND METHODS: A cross-sectional study was carried out among 50 epileptic children aged 4–18 years, recruited using a convenient sampling technique from the IPDs and OPDs of the Paediatrics department of a tertiary care hospital in Eastern India. The data were collected using QOLCE-16 and CSHQ from parents of children with epilepsy. The collected data were analyzed using descriptive and inferential statistics such as ANOVA and Pearson correlation test. RESULTS: The overall mean score of QOL was 50.78 ± 17.98, with the cognitive domain having the highest mean score of 65.50 ± 27.79 and the social domain having the lowest mean score of 29.87 ± 22.81. The overall mean sleep score was found to be 56.98 ± 8.13. Daytime sleepiness, parasomnias, and bedtime resistance were found to be frequent sleep problems in children with epilepsy. There was a significant negative correlation between QOL and sleep disturbances in children with epilepsy (r = −0.65, P ≤ 0.001). CONCLUSION: The QOL of children with epilepsy should be improved to reduce the effect of sleep problems. Epilepsy children should be treated appropriately with due focus on medication compliance as it was found to be one of the determinants in improving their QOL.

Sclerema neonatorum (SN) is a rare condition with high mortality, usually prevalent in preterm newborns. SN is an infant panniculitis, in which adherence of skin, subcutaneous tissues with underlying muscles, and bones are seen. SN is more common among preterm newborns with high sepsis and the survival of the infants diagnosed with SN was very low. In this case report, we are presenting a case of SN in a preterm baby associated with early-onset neonatal sepsis.

Allergic bronchopulmonary aspergillosis (ABPA) is a fungal infection of lung predisposing in long-standing bronchial asthma and cystic fibrosis patients. Due to its similar clinical and radiological findings of other pulmonary diseases such as pulmonary tuberculosis and pneumonia, ABPA is commonly misdiagnosed. The usage of anti-tubercular drugs for ABPA is exploited due to misdiagnosis. We illustrate a case of ABPA, which was misdiagnosed to be pneumonia.

Health-care database is a collection of health-care data organized for storage, accessibility, and retrieval. Health-care database serves to replace the paper documents, filing cabinets of old, and file folders, which will be more convenient and immediate. At present, health-care system is in a transition from a patient care perspective toward information-based medicine requiring data from various sources such as laboratory tests, genetic tests, medical images, family histories, and patient medical records, which need to be easily stored, integrated, and analyzed. The most commonly used database in health care is the online transaction processing (OLTP) database among different types of databases available. OLTP database is the one that is a single computer application runs on, and the main strength of it is quick and real-time transaction processing. Electronic health record is a prime example of the OLTP, and practitioners enter routine clinical and laboratory data into them during usual practice as a record of the patient's care. Data can be stored externally in a secure place and can be backed up to prevent data loss with these health-care databases. The back-end data can therefore become more accurate and standardized because of the front-end software providing tip text and enforce data. Furthermore, the health-care database allows the rapid processing of classical transactions such as laboratory results and payment claims as the data are computerized.

Background: Fast food generally refers to food that people intend to consume quickly either on- or off-site. Junk foods are foods that contain little or no proteins, vitamins, or minerals but are rich in salt, sugar, and fats and are high in energy (calories). Excess consumption of fast food has been linked with a variety of health problems including obesity and type II diabetes. Fast foods tend to contain high trans-fat levels which tend to raise amounts of low-density lipoprotein in the human body leading to ill effects on health. Aim: The aim of this study was to know the knowledge, attitude, and practice of medical, paramedical, and dental students toward consumption of fast foods. Materials and Methods: This study is carried out at Konaseema Institute of Medical Sciences and Research Foundation for 2 months among 658 students from medical, dental, and paramedical courses. Students were asked to fill a self-administered questionnaire, and acquisition of data from those filled questionnaires was done. Data entry and assessment were done in MS Excel and depicted as required. Results: Six hundred and fifty-eight students of medical, dental, Bachelor of Physiotherapy (BPT), and nursing courses participated in this study, out of which 421 (64%) are MBBS, 165 (25%) are BDS, 39 (6%) are BPT, and 33 (5%) are nursing students. Conclusion: Hygienic practices should be maintained at fast-food outlets and restaurants. A law postulating to label nutritional information for unpacked foods before serving should be implemented.

Wilkie's syndrome, also called as superior mesenteric artery syndrome (SMAS), is an extremely uncommon condition, which is evident in only 0.1%–0.3% of the population. This is a case of a 55-year-old female who presented to our hospital complaining of abdominal discomfort for 20 days, vomiting of two episodes per day for 20 days, constipation for 20 days, decreased appetite for 20 days, and significant weight loss. After further examination and investigations, it was diagnosed as SMAS and managed surgically through duodeno-jejunostomy followed by duodeno-jejunal and jejuno-jejunal anastomosis. She was later followed through conservative management and discharged from the hospital in a stable condition.

Background: Stress actually means body's psychological perception of pressure and its response to that pressure, involving multiple factors. The factors may be either external or internal/physical or biological. Stress-management is one of the most prevalent and popular topic of the latest times. Stress is mostly associated and leading to depression in the present juncture. Aims: The main objective of this study is to evaluate and elicit the levels of stress and depression in association with various recent factors accounting and resulting in them. Prevalence of stress and depression in relation to factors such as body mass index (BMI), social feeling, gastric problems, appetite, hair fall can also be assessed by this study. Materials and Methods: 298 engineering students of an engineering college were requested to answer up the analysis sheet comprising of Beck's Depression Inventory (BDI), Perceived Stress Scale (PSS) and other criteria comprising some selected factors adding to stress and depression. Analysis sheets were assessed, results were obtained and statistically analysed by GraphPad InStat Software. Results: The results of the present study indicate that majority of the students are having moderate and higher levels of stress, and no depression. Most of the people felt the higher levels of stress during the period of examinations. Conclusions: The students studying first year felt more stressed, which could be due to their recent entry into the course. Female students are more prone to these stressors and depressors. Juniors were more stressed when compared to senior students.

Many cases of Peutz Jeghers Syndrome presenting as intestinal obstruction with intussusception at various levels were reported in literature. This is a case of a 35 years old male farmer who presented to our hospital with the chief complaints of brown coloured stools since one month, pain in lower abdomen and bleeding per rectum since one week. All the findings of the examination were suggestive of intestinal obstruction. Further confirmation was made by Abdominal sonography, Contrast Enhanced Computed Tomography of abdomen and Sigmoidoscopy with colonic polyp biopsy. After going through all the investigations, a clinical diagnosis of multiple intestinal polyposis with ileo-colic intussusception and small bowel obstruction was made. Right hemicolectomy with ileo-colic anastomosis was performed and the specimen was sent for histopathological examination. A final diagnosis of Peutz Jeghers Syndrome was made based on Histopathology. Post surgical prognosis was good and the patient was discharged after 13 days. A regular follow up was recommended.

The burden of mental, neurological, and substance use (MNS) disorders increased by 41% between 1990 and 2010 and now accounts for one in every 10 lost years of health globally. This sobering statistic does not take into account the substantial excess mortality associated with these disorders or the social and economic consequences of MNS disorders on affected persons, their caregivers, and society. A wide variety of effective interventions, including drugs, psychological treatments, and social interventions, can prevent and treat MNS disorders. At the population-level platform of service delivery, best practices include legislative measures to restrict access to means of self-harm or suicide and to reduce the availability of and demand for alcohol. At the community-level platform, best practices include life-skills training in schools to build social and emotional competencies. At the health-care-level platform, we identify three delivery channels. Two of these delivery channels are especially relevant from a public health perspective: self-management (eg, web-based psychological therapy for depression and anxiety disorders) and primary care and community outreach (eg, non-specialist health worker delivering psychological and pharmacological management of selected disorders). The third delivery channel, hospital care, which includes specialist services for MNS disorders and first-level hospitals providing other types of services (such as general medicine, HIV, or paediatric care), play an important part for a smaller proportion of cases with severe, refractory, or emergency presentations and for the integration of mental health care in other health-care channels, respectively. The costs of providing a significantly scaled up package of specified cost-effective interventions for prioritised MNS disorders in low-income and lower-middle-income countries is estimated at US$3-4 per head of population per year. Since a substantial proportion of MNS disorders run a chronic and disabling course and adversely affect household welfare, intervention costs should largely be met by government through increased resource allocation and financial protection measures (rather than leaving households to pay out-of-pocket). Moreover, a policy of moving towards universal public finance can also be expected to lead to a far more equitable allocation of public health resources across income groups. Despite this evidence, less than 1% of development assistance for health and government spending on health in low-income and middle-income countries is allocated to the care of people with these disorders. Achieving the health gains associated with prioritised interventions will require not just financial resources, but committed and sustained efforts to address a range of other barriers (such as paucity of human resources, weak governance, and stigma). Ultimately, the goal is to massively increase opportunities for people with MNS disorders to access services without the prospect of discrimination or impoverishment and with the hope of attaining optimal health and social outcomes.

A lady of 52 years with painful bladder syndrome/interstitial cystitis (PBS/IC) presented with chronic pelvic pain, irritative voiding with sphincter dominance on urodynamics. 3 yrs of oral analgesics, antispasmodics and intravesical therapy was ineffective. We surmised her pain, and irritative voiding to be secondary to constant straining against a dysfunctional pelvic floor. We treated PBS/IC as a neuropathic phenomenon with a combination of neuromodulator medications and continuous caudal epidural analgesia to reduce the pain induced peripheral and central sensitisation. Botulinum toxin type A injection into pelvic floor muscles appeared to address their dysfuction. Clinical and urodynamics response was encouraging.

Aims and Objectives: The aim was to investigate the correlation between histological and culture diagnosis of filamentous fungi. Materials and Methods: Tissue sections from biopsy samples stained with Hematoxylin and Eosin and special stains from samples of chronic invasive/noninvasive sinusitis and intracranial space occupying lesions during 2005-2011 diagnosed to have infection due to filamentous fungi were reviewed. The histopathology and culture diagnoses were analyzed for correlation and discrepancy. Results: There were 125 samples positive for filamentous fungi on biopsy. Of these 76 (60.8%) were submitted for culture and fungi grew in 30 (39.97%) samples. There was a positive correlation between histological and culture diagnosis in 25 (83.33%) samples that included Aspergillus species (16/19), Zygomycetes species (8/10) and dematiaceous fungi (1/1). The negative yield of fungi was more in Zygomycetes species (20/30) when compared to Aspergillus species (25/44). There was a discrepancy in diagnosis in 5/30 (16.67%) samples which included probable dual infection in two, and dematiaceous fungi being interpreted as Aspergillus species in three samples. Conclusion: Histopathology plays a major role in the diagnosis of infection due to filamentous fungi, especially when cultures are not submitted or negative. The discrepancy between histological and culture diagnosis was either due to dematiaceous fungi being interpreted as Aspergillus species or probable dual infection.

Cardiac arrhythmias and respiratory paralysis are among the common causes of death in electric shock victims. Emergency physicians face unique challenges in stabilizing airway and spine apart from fibrillating myocardium. Early and prolonged cardiopulmonary resuscitation may result in good outcome.

Background: Gastrointestinal stromal tumor (GIST), now the most common mesenchymal tumor of the gastrointestinal tract (GIT), has been frequently studied, especially with regard to its successful targeted therapy using imatinib mesylate. Aim: Our aim was to describe the clinicopathological features of a large number of cases from a tertiary care hospital in India and report on the follow-up after treatment of some of the cases, comparing them with series described in the west. Design: This is a retrospective study of cases encountered over a 7-year period (1999-2005). Results: Ninety-two cases of GIST were studied, which made up the largest group (52.8%) of mesenchymal tumors of the GIT, with smooth muscle tumors comprising 38.1%, the next large group. GISTs were almost equally prevalent in the stomach and the small intestine, unlike in most studies where stomach is the most common site. GIST may be considered as a cause of bleeding when upper and lower GI endoscopy is normal. Ninety-five percent of the GISTs were positive for CD117 (KIT), as is known. A majority of them (70.4%) were of the high-risk malignant category, unlike most studies where high-risk tumors make up 30-45%. Histologically, the majority had a pure spindle cell morphology and skenoid fibers were rare. Follow-up of 11 cases, the majority with high-risk tumor, treated with adjuvant imatinib for 6 months after surgical resection showed stable disease for periods from 2 to 5 years. However, 11 cases treated with imatinib for longer than 6 months had a poorer outcome due to recurrent, metastatic, or inoperable disease. Conclusion: In our study of a large number of GISTs, which were equally prevalent in the stomach and small intestine, the majority were of the high-risk malignant category and of pure spindle cell morphology. Limited numbers had follow-up after imatinib therapy, which showed in one group treated for 6 months, after resection of high-risk GIST, stable disease for periods ranging from 2 to 5 years. Molecular studies and larger numbers are required for meaningful conclusions to be drawn.