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Introduction: Chronic venous insufficiency (CVI) may have an impact on the daily lives of afflicted individuals. Objectives: The study is aimed at identifying impact of CVI on patients’ quality of life (QoL) using Dermatology Life Quality Index (DLQI). Materials and Methods: A cross-sectional non probabilistic sampling study was conducted among 100 patients with Chronic venous Insufficiency over a period of 16 months. A sociodemographic survey and clinical grading using CEAP classification along with duplex ultrasound scanning was performed for each patient. DLQI questionnaires in English and the native languages of Kannada and Urdu were used. Statistical analysis was performed using Pearson’s chi-squared test. Results: 100 patients with a male to female ratio of 7.8:1 were assessed. Mean age was 48.5 years. Majority of the patients in the study belonged to CEAP clinical grade C4a. 66% of the patients had mild to moderate impact while 34% had great impact of the disease on their QoL. The disease severity showed positive correlation with DLQI score (p Conclusion: CVI has an adverse impact on various facets of life and the impact increases proportionately with severity of the disease. Hence incorporation of QoL assessment tools like DLQI helps in a multipronged management of the disease. G.S. Asha, Fairuza Abdu Nazir, Leelavathy B, T.N. Revathi, Shilpa K, Eswari L. Keywords: Chronic venous insufficiency, DLQI, Quality of Life.

Background: Health issues of postmenopausal women pose a significant challenge to public health. Menopause is an unspoken, unattended, reality of life, the cause of which is still deciphered completely by man. Objective: To compare the post-menopausal symptoms among rural & urban women . Methods: The present cross sectional study was conducted in the month of September 2014, which continued for 2 months in rural and urban area. Predesigned, pretested questionnaire was used to interview 500 participants who met the selection criteria. Data was analysed using SPSS software. Results: 250 from rural area and 250 from urban area. Nearly half 223 (44.6%) of them were in the age group of 55-64 years. Majority 161 (32.2%) of them belonged to the upper middle class, 346 (69.2) were pre obese according to WHO classification. Majority (385) 77% had no h/o gynecological problems. Almost all had one or the other menopausal symptom . Conclusions: The prevalence of postmenopausal symptoms was higher in urban women compared to the rural population.

Background: A facial paralysis is one of the most emotionally traumatic deficits a person can experience. It is essential to understand the cause and nature of nerve injury and undertake proper measures for restoration and rehabilitation of facial symmetry. The present study was conducted to evaluate the various aetiologies of lower motor neuron facial paralysis that presented to our department. The aim of the present study is to investigate into the demographic data and etiology associated with peripheral facial nerve paralysis and to assess the site of lesion, severity grade and treatment outcome of peripheral facial nerve paralysis.Methods: A prospective longitudinal study conducted in a tertiary care hospital, over a time period of one and a half years from November 2014 to April 2016. All the patients were assessed regarding the time of onset of symptoms, rapidity of progression, duration and completeness of paralysis. Topo diagnostic tests were done to assess the site of lesion and response to treatment monitored. Results: The most common cause for LMN facial nerve paralysis was external trauma and Bell’s palsy. The mean age group was 37.5 years with a male preponderance. Majority of the lesions were suprageniculate and had a House Brackmann grade IV severity score.Conclusions: Peripheral facial paralysis showed a good response to treatment and timely intervention would result in a full or partial recovery at the end of a follow up.

Chorangioma or placental hemangioma is a primary benign neoplasm of the placenta. It consists of vascular mass arising from chorionic tissue. Chorangiomas provide useful insights into pathophysiology and pathogenesis of fetal and maternal disorders .We herewith, present a case of giant extraplacental chorangioma associated with maternal preeclampsia and low birth weight baby.

Background: The incidence of non neoplastic lesions are much more common in epididymis. Clinically, epididymal nodules are easily accessible to fine needle aspiration cytology (FNAC) procedure. There are very few literature reports documenting the role of cytology in evaluation of epididymal nodules. Thus, we studied patients presenting with palpable epididymis nodules in the out patient department (OPD) from a tertiary care general hospital. Aim: This study is aimed to put forth the diagnostic utility of FNAC in palpable lesions of epididymis. Materials and Methods: A total of 40 palpable epididymal nodules were aspirated as a routine OPD procedure as part of this study. Smears were fixed in isopropyl alcohol and air dried. In all the cases, wet fixed papanicoloau stained and air dried giemsa stained smears were studied. Zeihl Neelsen stain was performed in cases which yielded caseous aspirate. Results: Except for two cases of adenomatoid tumor of epididymis all other lesions were nonneoplastic and included 14 cases (35%) of tuberculous granulomatous inflammation, 10 (25%) cystic nodules (9 spermatoceles and 1 encysted hydrocele), 5 (12.5%) of nonspecific inflammations, 3 (7.5%) filarial infection, 3 (7.5%) sperm granulomas and 3 (7.5%) adenomatous hyperplasia of rete testes. Except for the two tumors, one adenomatous hyperplasia and one tuberculous lesion, no other lesion was excised. Follow up and response to therapy was available in 78% patients and resolution indicated appropriateness of the diagnosis. Conclusions: Thus, as most of the lesions in epididymis are non neoplastic responding to medical line of treatment and FNAC served to aid diagnosis of non specific inflammation and avoid surgical excision in most cases.

Hyperglycemia and insulin resistance are common among critically ill patients and occur in patients with or without a history of diabetes mellitus. All patients undergoing critical illness are at risk for stress-induced hyperglycemia. Some patients may be at greater risk for hyperglycemia than others when considering underlying disease states and iatrogenic factors. Many recent studies demonstrate that tight glucose control can decrease morbidity and mortality associated with critical illness. This article reviews the pathophysiology behind stress-induced hyperglycemia, the evidence to support tight glycemic control, and the importance of an intensive insulin therapy protocol to standardize treatment among critical care patients.

Tuberculous involvement of the heart though not common has been reported in literature. Pericardium is commonly involved followed by the myocardium. Endocardial involvement is rare. We would like to report a case of a 14-year-old female with florid and extensive involvement of all the layers of the heart by tuberculosis.

Background: Childhood obesity as a rampant public health problem as it is affecting both developed and developing countries. Understanding the trends in obesity prevalence among children, contributing factors and developing strategies for successful interventions is the need of the hour. Hence the present study was aimed at understanding the implication of dietary and socio-demographic factors influencing overweight and obesity among 10-15 year old school children.Methods: The study was a cross sectional study, undertaken in eight private schools of Belgaum City, Karnataka from January 2010 to December 2010. School children of sixth to tenth standard aged between 10 to 15 years were included. Children were interviewed by the investigator. Examination was carried out which included general physical examination, measurement of height, weight, waist circumference, hip circumference, blood pressure and other vital signs. Overweight and obesity were defined basing on Based on WHO and International obesity task force (IOTF) BMI cut-off standards for Asia and India.Results: A total of 600 children were included of which 52.33% were males. Majority of the study subjects belonged to socio economic class I and II. About 65.67% of students belonged to nuclear family. The prevalence of overweight and obesity was 18.83% in study population. Out of this overweight contributed 11.33% and obesity contributed 7.5%.The odds of overweight and obesity was higher in females (OR=1.19), In children aged 13 years (OR=3.21), in children belonging to Sikh community (OR=6.26) and in children with socio economic class II (OR=1.65). Children from joint family (OR=0.70) and third generation family (OR=0.29) had lower odds of overweight and obesity compared to children from nuclear families. Daily consumption of snacks between meals (OR=2.42), sweets (OR=1.985), ice-cream (OR=1.667), fast foods (OR=3.062) and beverages (OR=4.80) were strongly associated with increased risk of overweight and obesity in study population. Daily consumption of fruits (OR=0.095) and vegetables (OR=0.166) and pulses (OR=0.690) was associated with reduced risk of overweight and obesity in study population (Table 4).Conclusions: Overall the study findings reveal that children had a relatively higher prevalence of overweight and obesity. Regular intake of fast foods, beverages, snacks between the meals and ice creams was associated with higher risk of obesity in study population. Regular consumption of fruits, vegetables and pulses had strong negative association with overweight and obesity in study population.

Background: Benign prostatic hyperplasia (BPH) and adenocarcinoma account for considerable morbidity in aging men. Prostate-specific antigen (PSA) is a useful biomarker in the diagnostics along with digital rectal examination and transrectal ultrasonography. Objective: To analyze various clinicopathological features in benign and malignant prostatic lesions and correlate the histologic findings with pre-operative PSA level for confirmation of diagnosis in cases with a diagnostic dilemma. Material and Methods: The study included 112 prostatic tissue specimens received in the Department of Pathology, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, over the period of 2-year from October 2014 to September 2016. Relevant clinical data and serum PSA value was recorded, and Gleason’s microscopic grading was used to grade malignant lesions. Results: Mean age of presentation was 66.5 ± 10.67 years with maximum incidence in the seventh decade of life. BPH (68.79%) was the most common lesion followed by adenocarcinoma (25%). Other lesions encountered were Prostatitis (2 cases), high-grade prostate intraepithelial neoplasia (2 cases), adenosquamous carcinoma (1 case), atypical small acinar proliferation (1 case), and retention cyst (1 case). The most common Gleason score was score 7 (55.17%) followed by score 9 (10.34%) and score 6 (6.9%). Pattern 4 was most common predominant pattern. Serum PSA level was correlated in benign and malignant lesions. Conclusion: With increasing awareness and life expectancy in the current era, histopathological evaluation of prostatic biopsies is mandatory to avoid pitfalls in clinical diagnosis aided by serum PSA assay and other investigations.

Hematopoietic stem cell transplantation (SCT) is a therapeutic option for patients with bone marrow failure, certain malignancies and inborn errors of metabolism. Complications requiring intensive care are frequent, and intensivists need to be familiar with the transplantation process and the disorders that are unique to these patients. The transplant process involves the use of high dose chemotherapy or radiation, followed by intravenous infusion of stem cells matched with the recipient at the human leukocyte antigen (HLA) loci. Full recovery of a normal immune system can take a year or more, so following transplantation, patients are exquisitely susceptible to infections. Moreover, complications such as graft versus host disease, idiopathic pneumonia syndrome, sinusoidal obstruction syndrome and transplant associated thrombotic microangiopathy are common in the first hundred days after stem cell infusion. Respiratory failure is a common presentation necessitating intensive care admission and may be due to infectious or non-infectious causes. Mechanical ventilation may be needed along with broad spectrum anti-microbial coverage; corticosteroids are commonly used if graft versus host disease is present. Acute graft versus host disease is most frequent in children receiving grafts from unrelated donors and results in significant morbidity. Increased immunosuppression is the cornerstone of therapy for graft versus host disease, and protection of the children from infection is essential to survival. Sinusoidal obstruction syndrome and transplant associated thrombotic microangiopathy may lead to multiple organ failure with limited therapeutic options, but both disorders can resolve with good supportive care during the period of organ failure. Outcomes for patients who develop multiple organ failure following SCT remain poor despite aggressive supportive care, however, children with failure of a single organ can do well. Integrated multi-disciplinary care between intensivists and transplant physicians, and other specialists such as nephrologists and pulmonologists leads to improved outcomes.

Objective: The objective was to study the pathological features of emphysematous pyelonephritis (EPN). Materials and Methods: A total of 11 nephrectomy specimens of EPN received in the surgical pathology section of a tertiary hospital in a metropolis city during the period 2005-2014 are included in this study. Clinical details were obtained from the patients' records. All the patients had undergone total nephrectomy. All the specimens were fixed in 10% buffered formalin and processed for paraffin wax sectioning. The sections were stained with hematoxylin and eosin stain. Results: The most common symptoms were fever and costovertebral pain. Diabetes mellitus was present in 9 out of 11 cases and one case had calculus in the pelvis. One patient had underlying diabetes which was undiagnosed during the nephrectomy. Diagnosis of EPN was confirmed by the presence of gas and fluid in the renal tissue by computed tomography. The left kidney (nine cases, 81%) was more frequently affected than the right kidney (two cases, 19%). EPN occurred in 40-60 years of age (mean age 51.5%), and out of 11 patients, 8 (81%) were female. Escherichia coli was the commonly isolated organism from urine. Eight cases were of Type II EPN and three cases were Type I EPN. Histopathologic examination of all the cases of EPN showed acute suppurative (necrotizing) inflammation of renal parenchyma and perirenal tissues associated with vasculitis of vessels and infarction. Conclusion: EPN is most commonly seen in patients with diabetes mellitus, and E. coli is the most common causative organism.

A male patient of 32 years was referred for surgical drainage and orchidectomy of the right testis following a cycling injury. A Venereal Disease Research Laboratory (VDRL) test was requested by the surgery department to rule out secondary syphilis. Although serum samples gave a negative result in the VDRL test, qualitative screening was performed for Brucella antibodies, as per hospital policy, since brucellosis is endemic in this region. Following a positive reaction, a quantitative standard tube agglutination test was carried out yielding titres that were exceptionally high (STAT = 40 960 IU ml(-1); 2-ME = 1 : 5120). This finding correlated with the patient's history which included a number of predisposing factors for contracting brucellosis including exposure to cattle, consumption of raw milk and assisting in the parturition of cattle. Consequently, surgery was postponed and treatment was changed from injections of ceftriaxone to the WHO regimen for the treatment of brucellosis: 1 g streptomycin once daily, administered intra-muscularly, plus 100 mg doxycycline twice daily, taken orally. Following 3 days of this treatment, the testicular swelling reduced considerably and orchidectomy was not required. Indeed, after a week, swelling was completely resolved and the patient was discharged. To our knowledge, this is the first case of such high titres in a patient as a result of epididymo-orchitis without the typical clinical presentation of fever and joint pain that is normally associated with brucellosis.

Genetic variation in the cholinergic muscarinic-2 (M-2) receptor gene (CHRM2) has been associated with the risk for developing depression. We previously reported that M-2-receptor distribution volume (V-T) was reduced in depressed subjects with bipolar disorder (BD) relative to depressed subjects with major depressive disorder (MDD) and healthy controls (HCs). In this study, we investigated the effects of six single-nucleotide polymorphisms (SNPs) for CHRM2 on M-2-receptor binding to test the hypotheses that genetic variation in CHRM2 influences M-2-receptor binding and that a CHRM2 polymorphism underlies the deficits in M-2-receptor V-T observed in BD. The M-2-receptor V-T was measured using positron emission tomography and [F-18]FP-TZTP in unmedicated, depressed subjects with BD (n = 16) or MDD (n = 24) and HCs (n = 25), and the effect of genotype on V-T was assessed. In the controls, one SNP (with identifier rs324650, in which the ancestral allele adenine (A) is replaced with one or two copies of thymine (T), showed a significant allelic effect on V-T in the pregenual and subgenual anterior cingulate cortices in the direction AA < AT < TT. In contrast, in BD subjects with the TT genotype, V-T was significantly lower than in BD subjects with the AT genotype in these regions. The BD subjects homozygous for the T -allele also showed markedly lower V-T (by 27 to 37% across regions) than HCs of the same genotype. Post hoc analyses suggested that T homozygosity was associated with a more severe illness course, as manifested by lower socioeconomic function, poorer spatial recognition memory and a greater likelihood of having attempted suicide. These data represent novel preliminary evidence that reduced M-2-receptor V-T in BD is associated with genetic variation within CHRM2. The differential impact of the M-2-receptor polymorphism at rs324650 in the BD and HC samples suggests interactive effects with an unidentified vulnerability factor for BD. Molecular Psychiatry (2011) 16, 407-418; doi:10.1038/mp.2010.24; published online 30 March 2010

Objectives: Neuropsychological studies in subjects with bipolar disorder (BD) have reported deficits on a variety of cognitive measures. However, because the majority of subjects were medicated at the time of testing in previous studies, it is currently unclear whether the pattern of deficits reported is related to BD itself or to psychotropic medication. We addressed this issue by examining cognitive performance in a group of unmedicated, currently depressed subjects with BD. Methods: Forty-nine unmedicated subjects who met DSM-IV criteria for BD, depressed phase, and 55 control subjects participated in this study. Most patients were diagnosed with bipolar II disorder. Performance on emotion-dependent, or ‘hot’, and emotion-independent, or ‘cold’, cognitive tasks was assessed using tests from the Cambridge Neuropsychological Test Automated Battery. Results: The groups were well matched with respect to general intelligence and demographic variables. Deficits in the unmedicated depressed BD group were apparent on tests tapping ‘hot’ cognitive processing, for example the Cambridge Gamble task and the Probabilistic Reversal Learning task. However, other than a deficit on the Spatial Span test in the depressed BD subjects, the groups performed equivalently on most measures of ‘cold’ cognitive processing, for example visual memory, attention, and working memory. Conclusions: These data suggest that deficits on tests involving reward processing, short-term spatial memory storage, and sensitivity to negative feedback in depressed BD subjects represent an effect of the illness itself and not mood-stabilizing medication.

Background Altered serotonergic function is thought to play a role in the pathophysiology of major depressive episodes based upon evidence from neuroimaging, pharmacological, postmortem and genetic studies. It remains unclear, however, whether depressed samples that differ with respect to having shown a unipolar versus a bipolar illness course also would show distinct patterns of abnormalities within the serotonergic system. The current study compared serotonin transporter (5-HTT) binding between unipolar-depressives (MDD), bipolar-depressives (BD) and healthy-controls (HC) to assess whether the abnormalities in 5-HTT binding recently found in depressed subjects with BD extend to depressed subjects with MDD. Methods The 5-HTT binding-potential (BP) measured using positron emission tomography (PET) and [ 11 C]DASB was compared between unmedicated, depressed subjects with MDD ( n = 18) or BD ( n = 18) and HC ( n = 34). Results Relative to the healthy group both MDD and BD groups showed significantly increased 5-HTT BP in the thalamus (24%, 14%, respectively), insula (15%) and striatum (12%). The unipolar-depressives had elevated 5-HTT BP relative to both BD and HC groups in the vicinity of the periaqueductal gray (PAG, 20%, 22%, respectively). The bipolar-depressives had reduced 5-HTT BP relative to both HC and MDD groups in the vicinity of the pontine raphe nuclei. Depression-severity correlated negatively with 5-HTT BP in the thalamus in MDD-subjects. Conclusions The depressed phases of MDD and BD both were associated with elevated 5-HTT binding in the insula, thalamus and striatum, but showed distinct abnormalities in the brainstem. The latter findings conceivably could underlie differences in the patterns of illness symptoms and pharmacological sensitivity observed between MDD and BD.

Background: Globally, India was one among the most affected countries for cases and deaths of swine flu (influenza A H1N1) during 2009 influenza pandemic with lot of public hype and panic. Aims: This study was designed to assess the awareness, attitude, myths and practices regarding Swine flu among urban population of Belgaum district, Karnataka. Subjects and Methods: This study was conducted in an urban community of Belgaum, Karnataka during 2009. A total of 250 households were interviewed using a pretested questionnaire by systematic random sampling. One person from each household preferably head of the family was asked regarding knowledge, attitude and practice during swine flu pandemic. Results: Among the study population, 73.6% had previously heard of swine flu. More than half of the participants said mass media communication was found to be the major source of information. Around 82.6% of the participants said fever was the most common symptom and using facemask was accepted as the important mode of prevention by 81.5% participants. Only 19.0% were willing to leave their locality temporarily if any cases were seen around. Majority of the participants selected government hospital for treatment facilities if they get any symptoms of swine flu. Hand washing, as a mode of prevention was known to 92.4% of the respondents. Around 33.4% of the populations were ready to share knowledge to others if they were given health education regarding swine flu. Conclusions: Knowledge regarding swine flu pandemic was low among study participants. Most of the participants had health seeking behavior. Majority of the respondents were practicing hand washing. Strategies to create more awareness about pandemic through effective mass media are vital for containing the pandemic.

Context A variety of indirect evidence has implicated the central muscarinic-cholinergic system, and more specifically the type 2 muscarinic (M 2 ) receptor, in the pathogenesis of depressive symptoms arising in major depressive disorder and bipolar disorder. Objective To assess the binding potential of muscarinic2 receptors in vivo during depression in subjects with major depressive disorder or bipolar disorder. Design The M 2 receptor binding was compared between unmedicated subjects with major depressive disorder or bipolar disorder during depression vs healthy controls, using positron emission tomography and [ 18 F]FP-TZTP (fluorodopa F 18 [3-(3-[3-fluoroproply]thio)-1,2,5-thiadiazol-4-yl]-1,2,5,6-tetrahydro-1-methylpyridine), a selective M 2 receptor radioligand. Setting Outpatients at the National Institutes of Health. Participants Unmedicated subjects with current depression meeting DSM-IV criteria for either major depressive disorder (n = 17) or bipolar disorder (n = 16) and 23 healthy control subjects. Main Outcome Measures The primary outcome parameter was [ 18 F]FP-TZTP distribution volume, which is proportional to the product of receptor density and affinity and, in the case of [ 18 F]FP-TZTP, is known to be sensitive to endogenous acetylcholine concentrations. The relationship between illness severity, as rated using the Montgomery-Asberg Depression and Hamilton Anxiety Rating scales, and distribution volume also was assessed. Results The mean anterior cingulate cortex distribution volume differed across groups (F 55 = 3.4; P = .04), and this difference was accounted for by significantly lower binding in bipolar disorder compared with both major depressive disorder and control groups. Conclusions The mean M 2 receptor binding in subjects with bipolar disorder was reduced relative to both healthy controls and subjects with major depressive disorder, to an extent that correlated with depressive symptoms. The reduction in the bipolar disorder group could be accounted for either by a reduction in M 2 receptor density or affinity or an elevation in endogenous acetylcholine levels. To our knowledge, these data provide the first direct evidence that altered M 2 receptor function contributes to mood dysregulation in bipolar disorder.