Search

Evidence concerning prescription audits conducted in developing countries like India is scarce, especially from the rural parts of the country. Therefore, the present prescription audit was undertaken in a rural tertiary care hospital to investigate prescriptions for their completeness, in format of prescription, legibility of writing and it was assessed against the World Health Organization (WHO) recommendation of core indicators for prescription writing in order to investigate the rational usage of drugs. A total of 200 prescriptions were randomly selected, irrespective of clinical departments, patient characteristics and diagnosis over a period of six months. All the prescriptions were prospectively analyzed and conferred to an assessment of the quality of prescribing practice, general details, medical components, WHO core drug use indicators and legibility. Amongst the 200 prescriptions precisely monitored, we found that 100% prescriptions had general details of the patients such as name, age, gender, OPD/IPD registration number, hospital name & address and consulting unit/department. While evaluating the handwriting of the doctors, 83.5% (177/200) of the prescriptions had legible handwriting, wherein the degree of legibility showed 68.5% (137/200) prescriptions with easy legibility, 20% (40/200) difficult legibility while 11.5% (23/200) were illegible. Along with the different types of drugs obtained from the selected prescriptions, we found that antibiotics were prescribed in 51.5% (103/200) of the prescriptions. A prescription audit is a good tool to systemically review the day to day work, maintenance of records and assessment of accuracy of the diagnosis given by doctors and also the outcome of the treatment received.

BACKGROUND Central neuraxial blocks, mainly spinal anaesthesia is the preferred anaesthesia over general anaesthesia in fracture of femur surgeries in elderly patients because of various side effects associated with general anaesthesia. However, the majority of the patients during positioning for spinal anaesthesia are associated with severe pain for which positioning becomes difficult. We wanted to assess the effectiveness of ultrasound (USG) guided femoral nerve block (FNB) to reduce pain during the positioning for spinal anaesthesia in fracture femur patients. METHODS It was a randomized control trial conducted on 80 elderly ASA I, II and III patients (45 - 70 years) posted for various femur surgeries under spinal anaesthesia having visual analogue scale (VAS) ≥ 4 during positioning. Patients in group FNB (N = 40) received USG guided femoral nerve block with 0.2 % ropivacaine and in control group (N = 40) didn’t receive any interventions preoperatively. All patients received injection fentanyl during positioning if VAS ≥ 4. Parameters recorded included VAS at baseline, 15 mins and during positioning, anaesthesiologist’s satisfaction (yes or no), total fentanyl consumption and patient’s satisfaction (Likert scale). RESULTS Demographic variables were comparable to each group. VAS in FNB at 15 mins and during positioning was 2.3 ± 1.042 and 3.025 ± 0.831 in comparison to 6.125 ± 0.607 and 7.2 ± 0.822 in control group respectively. Only 5 patients required injection fentanyl and total consumption was 142 ± 3.21 µg in FNB group while all patients in control group required injection fentanyl and total consumption was 1162 ± 4.43 µg. Anaesthesiologists and patients satisfaction were much higher in FNB group. CONCLUSIONS USG - guided FNB is very effective in controlling pain during positioning for spinal anaesthesia in fracture femur patients. KEY WORDS Ultrasound, Femoral Nerve Block, Spinal Anaesthesia, Ropivacaine, Fracture Femur

The current decade witnesses the regenerative potential of Stem Cells (SCs) based lifesaving therapies for the treatment of various disease conditions. Human teeth act as a reservoir for SCs that exist in high abundance in baby, wisdom, and permanent teeth. The collection of Stem cells from Human Exfoliated Deciduous teeth (SHED) is considered a simple process as it offers the convenience of little or no pain. In comparison to the SCs from dental or bone marrow or other tissues, the SHED offers the benefit of higher cellular differentiation and proliferation. Massive in vitro and in vivo studies reveal the regenerative potential of SHED in the engineering of the dental pulp tissue, neuronal tissue, root, bio root, cardiovascular tissues, lymphatic tissues, renal tissues, dermal tissues, hepatic tissues, and bone tissues. The current review describes the methods of collection/ isolation/storage, various biomarkers, and types of SHED. This review highlights the regenerative potential of SHED in the engineering of different tissues of the human body. As per the available research evidence, the present study supports that SHED may differentiate into the endothelial cells, neurons, odontoblasts, pancreatic β-cells, hepatocytes, renal cells, fibroblasts, osteoblasts, and many other types of cells. The present study recommends that further clinical trials are required before the clinical application of SHED-based therapies.

The current study aimed to characterize patients from a rheumatology referral center in north India, who satisfied the definition of interstitial pneumonia with autoimmune features (IPAF) as given by the American Thoracic Society and European Respiratory Society (ATS/ERS) consensus committee in 2015. Thirty-five adult patients aged 18 years and above, fulfilling the 2015 ATS/ERS criteria for IPAF were included in the study. The clinical and immunological profile, and radiologic findings on high-resolution computerized tomography thorax were noted. Antinuclear antibody (ANA) by indirect immunofluorescence at 1:320 titer and myositis-specific antibody (MSA) assays were performed. Non-parametric tests were used to compare variables between groups. The study cohort included predominantly female patients with a mean age of 50.6 ± 13 years and mean duration of disease of 38.8 ± 28.4 months. Majority of patients (49%) fulfilled the morphologic and serologic domains as per the IPAF consensus criteria and 31% patients had features in all three domains. Non-specific interstitial pneumonia was the most common pattern observed in 77% patients. Raynaud’s phenomenon and inflammatory arthritis were the predominant autoimmune features. Pulmonary arterial hypertension was documented in 60% of patients on echocardiography. Positive ANA at 1:320 dilution was present in all 26 patients tested, whereas extractable nuclear antigen and MSA assays detected autoantibodies in 49% and 51% of patients respectively. IPAF predominantly affected females in the age group of 50 years and above, with varied autoimmune manifestations and autoantibody profile. Supplementary Information The online version contains supplementary material available at 10.1007/s00296-021-04883-7.

Aim and objective We report a case of synovial sarcoma of the thyroid gland and review the literature of few such reported cases. Background Synovial sarcoma of the thyroid gland is exceedingly rare with aggressive features and very poor prognosis. Case description We report a case of 65-year-old man from Iraq who presented initially with a neck mass and was operated at the local hospital for total thyroidectomy, and a separate neck mass extending from the thyroid gland to the upper mediastinum was found. A re-excision of the mass was done with HPE showing malignant peripheral nerve sheath tumor. He was referred to our institute with relapse of the neck mass with compressive symptoms. The mass was excised with the HPE and IHC staining showing grade 2 biphasic synovial sarcoma. Within twenty days of surgery, he presented with severe respiratory distress and tumor with intraluminal tracheal growth. He died of compressive symptoms two weeks after the relapse. Conclusion The early diagnosis and margin-free resection give the best chance of survival for the patient. How to cite this article Lal RK, Hazarika B, Julaha M. Primary Synovial Sarcoma of Thyroid Gland: A Case Report. Int J Otorhinolaryngol Clin 2020;12(2):27–30.

Lymphatic system imaging has been a challenging field in Radiology. We here describe a case of a 26-year-old male who presented with complaints of left-sided inguinoscrotal swelling and was subsequently diagnosed with abdomino-thoracic cystic lymphangiomatosis. Detailed imaging evaluation across the modalities of ultrasonography, computed tomography scan and magnetic resonance imaging evaluation revealed extensive involvement and diagnostic imaging appearance of the unique lymphatic system abnormality. Imaging findings were confirmed on histopathology.

Humanity currently faces one of its biggest challenges, created by a tiny quasi-life form, the severe acute respiratory syndrome coronavirus 2. The rapidity of spread and the enormous burden placed on public health infrastructure by the coronavirus disease 2019 (COVID-19) pandemic has forced researchers to look for quick answers for therapy. Drug repurposing is probably the quickest way to develop an effective therapy in a very short time. With additional input from artificial intelligence (AI), drug repurposing may emerge as one of the major techniques by which humanity can overcome this as well as future challenges. The field of rheumatology has been one of the biggest benefactors of drug repurposing. This article reviews the various ways drugs used in rheumatological disorders are being repurposed for possible COVID-19 treatment. An overview of other nonantiviral drugs being repurposed is also undertaken, and the role of AI in drug repurposing is touched upon.

The presence of more than one autoimmune disease in a patient can complicate not only the diagnosis but also pose a therapeutic challenge to the treating physician. Myasthenia gravis (MG) is a rare disorder which may overlap with a number of other autoimmune conditions. It is important to recognize its co-presence since the management of the accompanying autoimmune condition may need to be tailored accordingly. In this article, we describe two cases with MG overlap, one with primary Sjogren's syndrome and the other with Takayasu arteritis. Herein, we review the literature and clinical approach and management of such patients.

Background The orbit is an anatomically complex structure comprising the globe, extraocular muscles, fat, vascular, nervous, glandular, and connective tissues. A wide variety of neoplasms can arise from different orbital structures, which can create a diagnostic challenge to the pathologists. No formal study has been conducted in this regard in North East India. Aim and Objectives This article aims to document the pattern and prevalence of orbital tumors in our institute and assess the utility of histopathological examination (HPE) and immunohistochemistry (IHC) in the precise diagnosis of these neoplasms. Materials and Methods A retrospective analysis of orbital tumors was performed over a period of 5 years from 2013 to 2018 in the department of pathology at a tertiary cancer center of North East India following all the guidelines of the institutional ethics committee. Results A total of 35 cases of orbital neoplasms, evaluated by HPE and IHC, were found, all of them being malignant tumors. The age range was 4 months to 85 years. Male to female ratio was 1.5:1. The most common tumor found was lymphoma, accounting for 10 cases (28.6%), all of which were non-Hodgkin lymphoma (NHL). All these cases except one occurred in adults, thus making it the most common tumor in adults in this study. Diffuse large B cell lymphoma, not otherwise specified, was the most common NHL, followed by follicular lymphoma, mature T cell NHL, extranodal marginal zone lymphoma, and B cell lymphoblastic lymphoma. Rhabdomyosarcoma and poorly differentiated/undifferentiated carcinoma jointly were the second most common tumors, totaling seven cases (21.21%) each. This was followed by melanoma (three cases), myeloid sarcoma (three cases), Ewing sarcoma/peripheral neuroectodermal tumor (PNET) (three cases), neuroblastoma (one case), and angiosarcoma (one case). Among these, rhabdomyosarcoma, granulocytic sarcoma, Ewing sarcoma/PNET, and neuroblastoma exclusively troubled the children. IHC markers including the lymphoma panel, and soft tissue ones were crucial in the precise diagnosis of the neoplasms encountered. Conclusion A variety of malignant orbital tumors may be seen in clinical practice. Management of these tumors requires a multidisciplinary approach. HPE in conjunction with IHC evaluation is of utmost importance in the veracious recognition of orbital tumors for their proper management.

Purpose To describe the morphological patterns of keratic precipitates (KPs) in vitreoretinal lymphoma (VRL) using in vivo confocal microscopy (IVCM). Methods Six eyes of three biopsy-proven VRL patients were included. KPs were identified and analyzed on IVCM. Results On examination, pigmented KPs in four eyes, white central KPs in two eyes and anterior chamber cells with flare in six eyes and pseudo hypopyon in one eye were identified. A typical floral pattern of KPs on IVCM was noted in all eyes. Three eyes each showed the complete and incomplete floral patterns, respectively. Resolution of KPs on IVCM was noted after chemotherapy. Conclusion In addition to the routinely used clinical and imaging markers like the visual acuity, presence of lymphomatous cells in the vitreous and optical coherence tomography findings, the presence and appearance of KPs on IVCM can also be considered as a useful, diagnostic and treatment monitoring marker in VRL.

Introduction Minimal access surgery has altered the field of surgery with its revolutionary advancements with respect to laparoscopy wherein the latter has been elevated to a safer procedure than ever before. However, along with its benefits, minimally invasive surgical procedures have detrimental environmental implications as well. Further, the overall bio-economics of carbon emissions during the surgery is another important factor. Aim The present article makes an effort to discuss and analyse the carbon footprint of minimal access surgery and to understand the co-benefits and co-costs in terms of environmental safety and bio-economics. Results The findings indicate that carbon footprint in these surgical procedures are rarely studied which otherwise bear significant negative relations with respect to the environment. Conclusion The study concludes that work on improving the design of these technologies is to be done so that apart from reducing the costs improvement of safety, comfort and better impact on future generation can also be achieved.

Acute renal infection or acute pyelonephritis (AP) denotes the process of inflammation of the renal parenchyma and its collecting system and the urothelium following infection. Uncomplicated AP commonly affects otherwise healthy, young women without structural or functional urinary tract abnormalities and without relevant comorbidities. More severe and complicated AP occurs in patients with a structurally or functionally abnormal genitourinary tract, or in persons with a predisposing medical condition like immune compromised state and diabetes. Complicated AP is characterized by a broader spectrum of clinical presentations, a wider variety of infecting organisms, and a greater risk of progression to a complication, such as intrarenal or perinephric abscess or emphysematous pyelonephritis and has the capacity to damage the organ and at times maybe life threatening. Role of imaging in renal infection is secondary, and in most situations, imaging is done to confirm the clinical diagnosis, map progression of disease in immune-compromised group of patients, or to evaluate for potential complications and therapeutic interventions. This article attempts to discuss the pathophysiology of AP from the standpoint of medical imaging and also brings out illustrative examples of various manifestations of AP and its complications. It provides imaging insight into various stages of inflammation, development of complication, and a roadmap for understanding AP through cross-sectional imaging.

According to the World Health Organization (WHO) Framework Convention for Tobacco Control (FCTC), tobacco cessation is a primary health-care service that should be provided not only to the people having adverse habits of consuming tobacco but also to the nonconsumer, as they can also be harmed due to its deleterious effects. Tobacco has been regarded as a potential risk factor for oral diseases such as oral potentially malignant disorders and oral cancers. Various aids of achieving cessation have been studied, including education of the ill effects of tobacco to the patient, behavioral counseling, and pharmacotherapy. Various pharmacological interventions are available nowadays but nicotine replacement therapy (NRT) is most widely used. The various types of NRT products results in general and breakthrough craving relief with immediate release of nicotine. All of these products have different levels of efficacy and variable rates of nicotine absorption. Knowledge of these will be beneficial for the patients, the budding dentist and the nation in the upcoming days ahead.

Background This study was performed to determine the bacteriological profile and antibiotic sensitivity pattern of culture samples of patients with cancer at our institute. The study was undertaken to formulate an antibiotic policy for the treatment of infection in these patients. Materials and Methods The study was performed in the Department of Microbiology of a regional cancer center during the period from January 2017 to December 2017. Samples were collected under all aseptic precaution, and they were processed as per the Clinical and Laboratory Standard Institute Guideline 2017. Results A total of 464 clinical samples (urine, blood, sputum, pus, etc.) were collected and processed for culture, of which 198 (42.67%) samples showed culture positive that were identified as per standard recommended procedures and antibiotic susceptibility testing was performed on isolates as per the Clinical Laboratory Standard Institute guidelines 2017. Escherichia coli (48), Staphylococcus aureus, (45) Klebsiella pneumoniae (52), Coagulase-negative Staphylococcus (17), and Pseudomonas aeruginosa (15) were most commonly encountered. Of the 132 Gram-negative isolates, 101 (76.5%) were extended-spectrum β-lactamase producers. Among the 45 staphylococcal isolates, 18 (40%) were methicillin-resistant S. aureus. Conclusion The present study reveals microbiological profile in patients attending our cancer institute.

BACKGROUD:Covid-19hasemergedhasanalarmingpublichealthcrisis,puttingthehealthcarefacilitiesacross theglobeat strain.Even after almost ten months of its identification,there exists only a few specific approved therapeutic agents for novel coronavirus disease.In this observational study,we have looked for any clinical benefits of convalescent plasma therapy in moderately severe cases of Covid-19,when added to a regimen consisting of Remdesivir,Dexamethasone and Heparin. METHODOLOGY: 528 moderately severe patients confirmed by RT-PCR test were enrolled. One dose of 200 mL of convalescent plasma (CP) derived from recently recovered donors with the neutralizing antibody titers above 1:640 was transfused to 268 patients as an addition to maximal supportive care and Remdesivir with steroid and heparin while 260 receivedRemdesivir with steroid and heparin. RESULTS:Theprimaryendpointwasmortalitybenefit.Thesecondendpointswerethereductionindaysofhospitalization,viral clearanceandimprovementofclinical symptoms.Themediantimefromonsetofillness toplasmatransfusionwas9.55d(range 6-24d).Nosevereadverseeffectswereobserved. CONCLUSION:Our studyshowedthatCPTcouldimprovesurvivalinpatientswhenaddedtothestandardtherapyinpatients with moderate Covid-19 infection. The add on therapy also significantly reduced the need for supplemental oxygen in the survivorsItcouldpotentiallyimprovetheclinicaloutcomesbesidesbeingawell-toleratedmodalityoftreatment.

Objective: To detect the prevalence pattern of Chikungunya virus in three states of Northeast India. Methods: A total of 1 510 samples were collected from different private and government hospitals of Assam, Arunachal Pradesh and Meghalaya. Serum was tested for the presence of IgM antibodies against Chikungunya virus followed by RT-PCR for amplification of Chikungunya E1 gene region using specific primers. Results: Overall, 11.83% (172/1 454) clinical samples were positive by MAC-ELISA and/or RT-PCR assay. Asymptomatic infection was seen in 17.86%. Males were more affected than females and age group 16-30 years was mostly affected. Fever (100.00%) was the primary symptom followed by headache (72.03%) and arthralgia (41.53%). Only 118 Chikungunya positive cases could be traced, of which 25.42% complained about sequelae of infection. In entomological investigation, Aedes aegypti was more predominant (92.10%) than Aedes albopictus (7.90%). No mosquito pools could be incriminated for Chikungunya virus. Conclusions: In this study, Chikungunya was observed to be prevalent in Assam, Arunachal Pradesh and Meghalaya. Though Chikungunya is a self-limiting infection, increasing morbidity by CHIKV infection is affecting social and economic status of individual. Thus, a community empowerment to effectively control mosquito population by employing different mosquito control measures along with personal protection is mandatory to tackle future outbreak of the disease.

Background Squamous cell carcinoma of the esophagus ranks as the most common cause of cancer incidence and mortality in males and the second most common in females. Surgery alone is associated with poor long-term survival. Neoadjuvant chemoradiation and perioperative chemotherapy without radiation have been tried to improve survival rates. Methods We retrospectively evaluated the neoadjuvant chemotherapy in forty-eight patients with non-metastatic, non-cervical squamous cell carcinoma of the esophagus with a docetaxel-based three-drug regimen to improve complete pathological response rates. Results The median age of presentation was 52 years, with male preponderance. All the patients received three cycles of docetaxel-cisplatin-fluorouracil-based chemotherapy. A complete pathological response to neoadjuvant chemotherapy was seen in 8 patients (17%). Rates of grade 3 hematological toxicities were seen in 12% of patients, with no observed grade 4 toxicity. The most common non-hematological toxicity was grade 3 alopecia (seen in 40%) and grade 2 nausea/vomiting in 8% of patients. At a median follow-up of 26.5 months, 2-year survival for the patients receiving chemotherapy and surgery is 66%. Conclusions Preoperative chemotherapy with a taxane-based triple-drug regimen is a reasonable approach in squamous cell carcinoma of the esophagus, associated with improvement in complete pathological response rates, increases complete resection rates, with manageable toxicity.

Plasmablastic lymphoma (PBL) is an aggressive lymphoma commonly associated with HIV infection. It most commonly presents in the oral cavity and rarely involves the kidney. Herein, we report a case of HIV positive male with renal involvement of PBL. The patient presented with unilateral severe hydronephrosis with unaltered renal functions. Despite aggressive management, there was an early relapse and the patient died within 2 years of the diagnosis. Despite the recent advances in the therapy of HIV-associated aggressive lymphomas, patients with PBL have a poor prognosis. Multimodal treatment with chemotherapy, newer targeted and biological agents, along with hematopoietic stem cell transplantation is essential for the treatment of PBL.

Due to limited clinical data in paediatric Ewing’s sarcoma, the aim of this study was to evaluate the demographic characteristics and identifying prognostic factors for survival. We retrospectively reviewed 66 patients with paediatric Ewing’s sarcoma. Median age of presentation was 10 years. Male: Female ratio was 1:1.Femur was the most common site of involvement 13.6% (9/66). The median survival in this study was 52 months. Three and five year survival rate of these patients was 52% and 45% respectively. One out of the 7 patients (14.2%) who did not initiate treatment was alive at the time of analysis whereas 4 out of 8 (50%) patients were alive with incomplete treatment and 35 out of 51 patients (68.6%) were alive who completed treatment and this difference was statistically significant (p

The COVID-19 has swiftly overtaken medical infrastructures as noticed all over the world and this outbreak is expected to heighten. Cancer patients are immunocompromised and patients undergoing cancer treatment are at a higher risk of contracting the disease as compared to the general population. It is of paramount importance to adhere to the standard guidelines in order to prevent the transmission of the disease among the patients as well as health care providers. As internees of Medical physics in the department of Radiation Oncology, we faced many difficulties which hampered our internship program during this unexpected crisis. This article we want to share our experience during this pandemic and how it affected patient related services and our academics.

Renal emphysema, as described by Kelly and MacCallum in 1898, refers to the spontaneous generation of gas within the renal parenchyma and surrounding tissues. Since its initial description, it has become apparent that the spectrum of radiologically visible renal and perirenal gas includes three distinct clinical entities: (1) emphysematous pyelonephritis, a necrotizing infection associated with gas formation in the renal parenchyma, (2) emphysematous pyelitis, in which gas is confined to the renal pelvis and calyces, and (3) gas-forming perinephric abscess. In this article, we will review gas-forming infections of the urinary system in terms of radiological features, clinical manifestations, predisposing factors, and appropriate management guidelines.

Plerixafor is a stem cell mobilising agent, and when administered along with G-CSF has been shown to improve CD34+ stem cell collections in lymphoma and multiple myeloma patients compared to G-CSF alone. Patients who failed to mobilize 6 cells/kg on Day 1 collection received Plerixafor and G CSF for further collections. Study population was divided into two groups as plerixafor yes (PY) who are poor mobilizers and Plerixafor No (PN) who are good mobilizers. Out of 49 patients, 28 patients were in PY group and 21 patients in PN group. Median value of apheresis CD34 of day 1 was 1.75 (range 0.258 to 8.52) in PY group and 2.63 (range 1.06 to 6.29) in PN group and that of day 2 was 3.845 (range 0.317 to 13.89) in PY group and 3.18 (range 0.88 to 6.348) in PN group. Median value of total apheresis CD34 was 8.10 (range 4.33 to 18.66) in PY group and 7.58 (range 4.06 to 9.8) in PN group. Median day of neutrophil engraftment was 11.5 (range 9 - 22) in PY group and 11 (range 9 - 36) in PN group whereas median day of platelet engraftment was 14 (range 9 - 98) in PY group and 13 (range 11 - 98) in PN group. It can be concluded that the use of plerixafor not only enabled poor mobilizers of Lymphoma and Multiple Myeloma to collect adequate stem cells to proceed to ASCT, but also had early neutrophil and platelet engraftment which was comparable with good mobilizers.

Context: Trauma-induced coagulopathy (TIC) is life-threatening in head injury patients, and there is a lack of Indian data on its incidence and outcome. Aims: In this study, incidence and outcome related to coagulopathy were assessed in patients with moderate-to-severe isolated traumatic brain injury (iTBI). Settings and Design: A prospective observational study carried out in patients admitted within 24 h of injury. Materials and Methods: One hundred patients with moderate-to-severe iTBI were included. Samples for coagulation tests (prothrombin time [PT], PT index [PTI], international normalization ratio [INR], activated partial thromboplastin time, and platelet count) were collected at 5 points of time for 72 h. TIC was diagnosed if any three readings were abnormal during this period. Patients were also followed up posthospital discharge using the Glasgow Outcome Score (GOS) at 1 and 3 months. Statistical Analysis: Data were analyzed using SPSS ver. 21. Logistic regression analysis was employed to determine individual coagulation test as best predictors for mortality. P < 0.05 was considered statistically significant. Results: The incidence of TIC was found to be 62%; it was 63.75% in severe head injury and 55% in moderate head injury patients. Deranged INR at the time of hospital admission (odds ratio [OR] 4.38) and PTI at 24 h (OR 3.913) are highly predictive of mortality. There was no significant difference in GOS score at 1 and 3 months. Conclusions: The incidence of TIC in our study was 62% among iTBI patients. It contributes to increased mortality at 1 and 3 months. However, the neurological outcome was not different in between the groups.

Brucellosis is an important zoonosis worldwide. In livestock, it frequently causes chronic disease with reproductive failures that contribute to production losses, and in humans, it causes an often-chronic febrile illness that is frequently underdiagnosed in many low- and middle-income countries, including India. India has one of the largest ruminant populations in the world, and brucellosis is endemic in the country in both humans and animals. In November 2017, the International Livestock Research Institute invited experts from government, national research institutes, universities, and different international organizations to a one-day meeting to set priorities towards a "One Health" control strategy for brucellosis in India. Using a risk prioritization exercise followed by discussions, the meeting agreed on the following priorities: collaboration (transboundary and transdisciplinary); collection of more epidemiological evidence in humans, cattle, and in small ruminants (which have been neglected in past research); Economic impact studies, including cost effectiveness of control programmes; livestock vaccination, including national facilities for securing vaccines for the cattle population; management of infected animals (with the ban on bovine slaughter, alternatives such as sanctuaries must be explored); laboratory capacities and diagnostics (quality must be assured and better rapid tests developed); and increased awareness, making farmers, health workers, and the general public more aware of risks of brucellosis and zoonoses in general. Overall, the meeting participants agreed that brucellosis control will be challenging in India, but with collaboration to address the priority areas listed here, it could be possible.

Acne vulgaris, a common and chronic disorder of the pilosebaceous unit, affects up to 85% of adolescent and young adults. While a lot is already known about acne and its treatment, still the gaps in our understanding of acne remains. This article will review the emerging evidence in the complex pathogenesis of acne and provide an overview of the potential future therapy in management of acne vulgaris.Key points

Pathogenesis of diabetes mellitus involves scores of different factors, out of which Glucagon like factor-1 (GLP-1) plays a foremost role. GLP-1 is a peptide-hormone of the incretin system. It exhibits glucagonostatic as well as glucose dependent insulinotropic action. GLP-1 augments regeneration of β-cell, boost secretion of insulin and trim down weight gain in type-2 diabetes. GLP-1 discharge from the L cells of intestine is mediated by neural and hormonal factors which are stimulated by the occurrence of nutrients in the gastrointestinal tract. Conversely, GLP-1 is instantaneously shattered by enzyme dipeptidyl peptidase-IV. GLP-1 is also cleared by renal clearance. Diminished GLP-1 leads to attenuated insulin release leading to type-2 diabetes. Substitution of GLP-1 regularizes the insulin release and prevents type-2 diabetes. However, GLP-1 holding infinitesimal plasma half life limits its therapeutic effects. To surmount the limitations of indigenous GLP-1, several GLP-1 receptor agonist like Exenatide are been developed. Modifications in pharmaceutical formulation are also been made to meet the patients adherence to the medication of GLP-1 agonist.

Background Enzyme linked immunosorbent assay (ELISA) test is used for screening of transfusion transmitted infections (TTI) in blood donors. Consecutive reactive results in ELISA is due to sample/reagent carryover or donor related. In this study we tried to find out the possibilities of family history/close contacts with patients of hepatitis among these consecutive reactive donors. Aim To analyze the consecutive reactive results in ELISA tests for TTI testing on samples of healthy blood donors. Material and methods A retrospective observational study was conducted from January 2016 to July 2018 in a tertiary care hospital, North India. Consecutive reactive results by fourth generation ELISA for TTIs screening were evaluated for possible reasons. Confirmation tests were not done. Reactive donors were contacted telephonically for relevant history of close contact with infected personnel. Results Out of 53,740 donations 1,061 were reactive for TTIs during our study period. Prevalence of Hepatitis B (HBV), Human Immunodeficiency (HIV) and Hepatitis C (HCV) virus infection in blood donors were 1.27%, 0.20% and 0.50% respectively. Consecutive reactive results for HBV were 9.20% (63/685), for HCV 6.0% (16/266) and nil for HIV. There was no sample carryover in this. Out of 79 consecutive reactive donors 69 donated for same patients and 32 were related with infected patient which are statistically significant (p Discussion This study recommends that in analysis of consecutive positive results in ELISA along with looking for procedure/sample error, there is also a need to take retrospective history of donors for close contact with infected patients.

Summary Cutaneous amyloidosis can be a part of a systemic disease or can result from a localized process limited to the skin. It usually presents as pruritic hyperpigmented macules, papules or nodules, which are notoriously resistant to treatment. We performed a hospital-based pilot case series to assess the efficacy and safety of sequential salicylic acid (SA) and glycolic acid (GA) chemical peels. Patients underwent sequential chemical peel therapy with SA 20% and GA 35% used alternately each week for a total of 6 weeks. At subsequent follow-up visits, good clinical outcome and long-term maintenance was observed. This study highlights the promising role of chemical peels in this difficult and distressing disorder.

Introduction Hansen’s disease is a chronic infectious disease caused by Mycobacterium leprae. India declared the elimination of leprosy in December 2005, but a slow resurgence of the disease still continues in several parts of India. The diagnosis of leprosy is primarily clinical but slit-skin smear microscopy aids in an accurate diagnosis. There are very few studies on clinico-bacteriological patterns of leprosy at this post-elimination phase. Aim This study aimed to analyze the clinical and bacteriological findings of newly diagnosed cases of Hansen’s disease in the post-elimination era. Materials and methods This is a descriptive, hospital-based, retrospective study of newly diagnosed cases of Hansen’s disease, enrolled in the Hansen’s disease clinic attached to the dermatology outpatient department (OPD) of a tertiary care hospital in North India. A retrospective chart review of newly diagnosed cases of leprosy for a period of one year was done. Information about demographics, clinical characteristics, spectrum of disease, and slit skin smear data of patients were collected. Statistical analysis was performed using SPSS Version 16.0 (Chicago, IL, SPSS Inc.). Result A total of 116 patients were included of which 68.1% (79) were males. The age of patients ranged from 7 to 72 years and children (

Summary: Antibiotic-resistant bacteria are emerging threat to the global public health. Estimates suggests >10 million deaths by 2050 due to AMR alone. Six Indian institute collaborated along with 4 UK universities to address the issue of antimicrobial resistance (AMR) through One Health approach under NEOSTAR project jointly funded by Department of Biotechnology (DBT), Government of India and UK Research and Innovation (UKRI), United Kingdom. To address a question “Dose AMR in livestock contributes to AMR in people? A pilot study was conducted which is a collaborative effort to collect archival microbial isolates of Escherichia coli, Klebsiella spp., Staphylococcus aureus and coagulase negative S. aureus (CoNS). The current study deals with E. coli isolates collected from ICAR-NIVEDI, ICAR-CIFT, ICAR-IVRI, ICAR-RCNEH, IIT-Delhi and GMCH and were subjected to QC analysis at ICAR-NIVEDI’s BSL2+ facility, these isolates were further segregated into 5 components viz., Animal origin (including aquaculture) (n=50) food of animal origin (n=30), Human (community settings) (n=3), Hospital origin (n=15) and Environment origin (n=14). A total of 112 E. coli isolates sequenced for whole genome through Illumina’s HiSeq 2500 platform at Sangers Institute, UK and paired end libraries were generated for all the 112 isolates were assembled and subjected to genome characterization and gene mining through various bioinformatics tools revealed the frequency of resistance, co-resistance, and resistant genes are high and similar across Human-Animal-Aquaculture-Environment continuum in India. This emphasizes the need to collaborate and mitigate antibiotic resistance with a ‘One Health’ approach.

[ ]New York's stop and frisk program was associated with poorer physical and psychological health in men and boys in areas where more police stops occurred 8 Police killings of unarmed Black Americans also cause widespread harm, damaging the mental health of Black Americans who are not directly affected 4 In the wake of George Floyd's death, there has been growing attention to delineating the appropriate role of law enforcement In many jurisdictions, however, violations of these public health orders are criminal offenses punishable by fines and, potentially, jail time 10 Consequences like these disproportionately affect individuals with low income and people of color, exacerbating health inequities 11 For example, a law that imposes a $250 fine for a violation can affect a person's ability to pay rent, feed family, or meet other essential needs-all consequences that harm health [ ]some populations may experience challenges to compliance;for example, immigrants may lack access to information in their preferred language In San Francisco, California, for example, the police department has stated that stay-at-home orders will be enforced through multilingual education and voluntary compliance, with criminal penalties as a last resort 10 Tying enforcement to public health education that acknowledges and addresses the challenges of physical distancing and the importance of mask wearing are less likely to exacerbate existing risk factors driven by poverty and lack of access to resources, such as overrepresentation in low-wage essential jobs and overcrowded housing 12 To ensure that graduated enforcement schemes consider equity, jurisdictions should articulate options directly in emergency orders, where permissible, instead of relying on informal guidance from police departments or other enforcement officials Furthermore, creating opportunities for community members to participate in the development and implementation of enforcement provisions is likely to increase compliance 15 Because the impact of COVID-19 restrictions is so far-reaching-affecting family life, businesses, and access to a range of services, including medical care-policymakers should include a transdisciplinary range of stakeholders (e g , individuals who are more likely to experience the medical and economic effects of the pandemic, communitybased organizations, local businesses, housing advocates, public health organizations, and criminal justice advocates)

Traditionally, fluid administration during kidney transplant surgery is guided by central venous pressure (CVP) despite its limited reliability as a parameter for assessing intravascular fluid volume, particularly in patients with cardiovascular diseases. The recommended goals at graft reperfusion are a mean arterial pressure of 90 mm Hg and a CVP of 12-14 mm Hg. This approach may increase the risk of significant adverse effects due to volume overload. Perioperative fluid therapy guided by dynamic indices of fluid responsiveness has been shown to optimize intravascular volume and prevent complications associated with overzealous administration of fluids in major abdominal surgeries. We hypothesized that pulse pressure variation (PPV)-guided fluid administration would result in better optimization of intravascular fluid volume compared with a CVP-guided strategy during kidney transplant surgery.In this single-centre randomized double blinded trial, 77 end-stage renal disease patients, who underwent kidney transplant surgery under general anesthesia with epidural analgesia, were randomized to receive either CVP-guided (n = 35) or PPV-guided (n = 35) fluid therapy using predefined hemodynamic endpoints. The primary outcome was the total volume of intraoperative fluids administered. Secondary outcomes were intraoperative hemodynamic changes, serum lactate levels, serum creatinine, need for dialysis within the first week, creatinine elimination ratio, and incidence of immediate and delayed graft dysfunction.Results were analyzed for 70 patients. Eighty percent of the patients underwent living-related donor allograft kidney transplant. Operative variables related to donor characteristics, duration of surgery, graft cold ischemia time, and blood loss were comparable in both groups. The mean (standard deviation) volume of intravenous fluids administered intraoperatively was 1,346 (337) mL in the PPV-guided group vs 1,901 (379) mL in the CVP-guided group (difference in means, 556 mL; 95% confidence interval, 385 to 727; P = 0.001). There were no significant differences in secondary outcomes between the two groups.Pulse pressure variation -guided fluid administration significantly decreased the total volume of crystalloids compared with CVP-guided fluid therapy during the intraoperative period in patients who underwent kidney transplant surgery. Nevertheless, our study was underpowered to detect differences in secondary outcomes.www.ctri.nic.in (CTRI/2018/01/011638); registered 31 January 2018.RéSUMé: CONTEXTE: Traditionnellement, l’administration liquidienne pendant une chirurgie de transplantation rénale est guidée par la pression veineuse centrale (PVC) et ce, malgré sa fiabilité limitée en tant que paramètre d’évaluation du volume liquidien intravasculaire, en particulier chez les patients atteints de maladies cardiovasculaires. Les objectifs recommandés lors de la reperfusion du greffon sont une tension artérielle moyenne de 90 mmHg et une PVC de 12–14 mmHg. Cette approche pourrait augmenter le risque d’effets indésirables importants dus à une surcharge volémique. Il a été démontré que la thérapie liquidienne périopératoire guidée par des indices dynamiques de réponse au remplissage optimisait le volume intravasculaire et prévenait les complications associées à l’administration liquidienne exagérée lors de chirurgie abdominale majeure. Nous avons émis l’hypothèse qu’une administration liquidienne guidée par la variation de pression différentielle (VPD et delta PP) entraînerait une meilleure optimisation du volume liquidien intravasculaire par rapport à une stratégie guidée par la PVC pendant une chirurgie de transplantation rénale. MéTHODE: Dans cette étude randomisée monocentrique à double insu, 77 patients atteints d’insuffisance rénale terminale, qui ont bénéficié d’une greffe rénale sous anesthésie générale avec analgésie péridurale, ont été randomisés à recevoir une administration liquidienne guidée soit par la PVC (n = 35) ou par la VPD (n = 35) en utilisant des critères hémodynamiques prédéfinis. Le critère d’évaluation principal était le volume total de liquides peropératoires administrés. Les critères secondaires comprenaient les variations hémodynamiques peropératoires, les taux sériques de lactate, la créatininémie, le besoin de dialyse au cours de la première semaine, le taux d’élimination de la créatinine et l’incidence de dysfonctionnement immédiat et retardé du greffon. RéSULTATS: Les résultats ont été analysés pour 70 patients. Quatre-vingts pour cent des patients ont subi une allogreffe de rein provenant d’un donneur vivant apparenté. Les variables opératoires liées aux caractéristiques du donneur, la durée de la chirurgie, le temps d’ischémie froide du greffon et les pertes sanguines étaient comparables dans les deux groupes. Le volume moyen (écart type) de liquides intraveineux administrés en peropératoire était de 1346 (337) mL dans le groupe guidé par VPD vs 1901 (379) mL dans le groupe guidé par PVC (différence de moyennes, 556 mL; intervalle de confiance à 95 %, 385 à 727; P = 0,001). Aucune différence intergroupe significative n’a été observée dans les critères d’évaluation secondaires. CONCLUSION: L’administration liquidienne guidée par la variation de pression différentielle a significativement diminué le volume total de cristalloïdes par rapport à la thérapie liquidienne guidée par la PVC pendant la période peropératoire chez les patients ayant bénéficié d’une greffe de rein. Néanmoins, notre étude ne disposait pas de la puissance suffisante pour détecter les différences dans les critères d’évaluation secondaires. ENREGISTREMENT DE L’éTUDE: www.ctri.nic.in (CTRI/2018/01/011638); enregistré le 31 janvier 2018.

The study aims to estimate the prevalence of hydroxychloroquine (HCQ) retinopathy in a cohort of Indian patients and analyse the associated factors. Adult patients with rheumatological disorders aged ≥ 18 years using HCQ for more than 5 years and/or having received a cumulative dose > 400 g were included. Demographic and clinical data were collected and all underwent ophthalmological tests which included Humphrey automated visual fields (AVF) and spectral domain optical coherence tomography (SD-OCT). The various clinical characteristics of the patients were compared. The study included 110 patients with a mean age of 43.5 ± 10.1 years and predominantly females. Eleven patients (10%) were diagnosed with definite HCQ retinopathy. The mean daily dose of HCQ (mg/kg of real body weight) was significantly different in the groups with and without retinopathy (5.7 ± 0.9 vs 5.1 ± 0.8, p = 0.04). Patients with retinopathy had significantly more colour vision abnormalities (odds of 16.9; confidence interval 4.1–69.1, p = 0.0001) and higher prevalence of both parafoveal and perifoveal thinning (p

Background: Diffusion-weighted imaging (DWI) provides added value to conventional MRI imaging in diagnosing and differentiating various benign and malignant musculoskeletal tumors. Objective: The study aims to evaluate the diagnostic efficacies of diffusion-weighted imaging along with the conventional MRI sequences for differentiating benign and malignant musculoskeletal tumors using sensitivity and specificity. Materials and methods: This retrospective study was carried out on 73 histopathologically proven patients of various musculoskeletal tumors who presented to a tertiary care center between March 2017 to October 2018. Relevant clinical examinations and MRI scan of the requested body part of the musculoskeletal system were performed. Mean apparent diffusion coefficient (ADC) values were calculated in the bone as well as soft tissue tumors after placing uniform-sized region of interest (ROI) in the non-necrotic portion of the tumor. Statistical analysis: Independent t-test and one-way analysis of variance (ANOVA) test were used to compare the mean ADC values of the various tumors with the histopathology. Receiver operating characteristic (ROC) curve analysis was done to determine the cut-off mean ADC values in the various bone and soft tissue tumors. Results: Of 73 patients with musculoskeletal tumors (benign=20, malignant = 53), 47 patients were bone tumors (benign=12, malignant=35) and 26 patients were soft tissue tumors (benign=eight, malignant=18). Mean ADC value of benign bone tumor was 1.257±0.327[SD] x 10-3mm2/s and malignant was 0.951 ± 0.177[SD] x 10-3mm2/s. The mean ADC value of benign soft tissue tumor was 1.603±0.444[SD] x 10-3mm2/s and malignant was 1.036 ± 0.186[SD] x 10-3mm2/s. The cut-off mean ADC value was 1.058 x 10-3mm2/s for differentiating benign from malignant bone tumor with a sensitivity of 83.3%, specificity of 66.7% and accuracy of 78.7% while the cut-off mean ADC value of 1.198 x 10-3mm2/s for differentiating benign from malignant soft tissue tumors with a sensitivity of 83.3%, specificity of 87.5% and accuracy of 84.6%. Conclusions: DWI with ADC mapping can be used as an additional reliable tool along with conventional MRI sequences in discriminating benign and malignant musculoskeletal tumors.

Introduction Onychomycosis is the most prevalent nail disease. Although clinical diagnosis of onychomycosis is easy, fungal culture as a confirmatory test requires an equipped laboratory and is time-consuming. Onychoscopy is a simple, quick, and inexpensive technique and may help clinicians increase the diagnostic accuracy of onychomycosis. The aim of this study was to identify common onychoscopic patterns of onychomycosis and correlate them with clinical subtypes of onychomycosis. Methods This study was performed in the dermatology outpatient department of a tertiary care hospital in northern India for 6 months. Clinically diagnosed cases of onychomycosis were confirmed by potassium hydroxide (KOH) mount. After obtaining informed written consent, these patients underwent onychoscopy with DermLite II hybrid m, 3Gen, polarized mode, 10× magnification. The common onychoscopic patterns were recorded and the data analyzed. Results The study included 60 confirmed cases of onychomycosis. The common onychoscopic patterns observed were jagged edges with spikes of the onycholytic area in 65.5% of cases, longitudinal striae in 77.6%, distal irregular termination or a "ruin pattern" in 82.7%, and chromonychia in 62.1%. Clinical types of onychomycosis showed a statistically significant association with chromonychia (p = 0.000), jagged edges with spikes (p = 0.015), and distal irregular termination (p = 0.016). Conclusions Onychoscopy can be a complementary tool in clinical diagnosis of onychomycosis to alleviate the need for direct microscopy and culture.

Background & Aims: A procoagulant state with pulmonary micro-thrombosis has been described in COVID-19, which contributes to pathophysiology of respiratory failure along with diffuse alveolar damage. Cytokine storm and systemic inflammation in COVID-19 generates endogenous heparinoids from the endothelium which leads to secondary organ failures. We prospectively studied the dynamic association of the coagulation abnormalities with respiratory failure and mortality in patients with COVID-19. Methods: We did a prospective observational study in adults aged between 18-80 years with COVID 19 pneumonia requiring intensive care (ICU) admissions in a tertiary care hospital in North India. All patients received standard medical therapy based on best available evidence. Patients were categorized based on the oxygen support therapy into low flow, high flow and invasive ventilation groups. In patients considered to be at risk of thromboembolic or bleeding phenomena, paired coagulation tests were performed at days 1 and 3 with, Sonoclot ® (glass beaded and heparinase-treated). All patients were consecutively followed for inflammatory markers, ventilator requirements and survival. Activated clotting time (ACT) 75 units were used as the cut-off for hypercoagulable state. The heparin like effect (HLE) was considered by a correction of ≥ 40 s in hACT (heparinized treated ACT). The trial is registered with ClinicalTrials.gov (NCT04668404). Results: A total of 2324 patients with COVID-19 were screened from August 2020 to November 2020. Two hundred and fifteen patients requiring ICU admission were assessed and 74 patients with a median age of 54(42-67) years were enrolled. A procoagulant profile was seen in 45.5%, 32.4% and 20.7% in low-flow, high-flow, and invasive ventilation. Paired Sonoclot ® assays in 33 patients demonstrated HLE in 17 (51.5%) and 20 (62.5%) at days 1 and 3 respectively. In multivariate analysis, the presence of HLE (HR 1.02; CI 1.08-1.6; p 131 s, clot rate 96.7 mg/l at admission predicted mortality. Conclusions: HLE contributes to hypocoagulable effect, need for invasive ventilation and mortality in patients with COVID-19. Trial Registration: The trial is registered with ClinicalTrials.gov (NCT04668404). Funding Statement: None Declaration of Interests: None Ethics Approval Statement: Ethical clearance was obtained from the Institutional Review Board (PGI/IEC/2020/000997 dated 24 August 2020)

The clinical course of coronavirus disease 2019 (COVID-19) infection is highly variable with the vast majority recovering uneventfully but a small fraction progressing to severe disease and death. Appropriate and timely supportive care can reduce mortality and it is critical to evolve better patient risk stratification based on simple clinical data, so as to perform effective triage during strains on the healthcare infrastructure. This study presents risk stratification and mortality prediction models based on usual clinical data from 544 COVID-19 patients from New Delhi, India using machine learning methods. An XGboost classifier yielded the best performance on risk stratification (F1 score of 0.81). A logistic regression model yielded the best performance on mortality prediction (F1 score of 0.71). Significant biomarkers for predicting risk and mortality were identified. Examination of the data in comparison to a similar dataset with a Wuhan cohort of 375 patients was undertaken to understand the much lower mortality rates in India and the possible reasons thereof. The comparison indicated higher survival rate in the Delhi cohort even when patients had similar parameters as the Wuhan patients who died. Steroid administration was very frequent in Delhi patients, especially in surviving patients whose biomarkers indicated severe disease. This study helps in identifying the high-risk patient population and suggests treatment protocols that may be useful in countries with high mortality rates.

Data on the long-term use of methotrexate (MTX) causing liver fibrosis in patients with rheumatoid arthritis (RA) is sparse. Liver biopsy is the gold standard to assess fibrosis but is an invasive procedure. Transient elastography (TE) by Fibroscan is a noninvasive validated tool to detect and quantify liver fibrosis. The present study aimed to assess the prevalence of liver fibrosis by Fibroscan in patients with RA on long-term MTX therapy and its correlation with cumulative dose of MTX. This cross-sectional study included adult patients (≥ 18 years age) of RA who had been on MTX for ≥ 3 years. The patients’ records were reviewed, and the cumulative dose of MTX was calculated. Liver fibrosis was assessed by TE method, and the cutoff value of 7.1 kPa (kilopascal) was considered abnormal (liver fibrosis). Spearman’s rank test was used to assess the correlation between the cumulative dose of MTX and Fibroscan score. Seventy-five patients were enrolled of which 69 were females (92%). The mean age was 47.2 ± 11.3 years. The mean body mass index and waist circumference were 24.8 ± 3.9 kg/m2 and 91.6 ± 9.9 cm, respectively. The median duration and cumulative dose of MTX were 336 weeks (interquartile range,144–912 weeks) and 6300 mg (interquartile range, 2400–22,000 mg), respectively. The mean liver stiffness was 5.22 ± 2.03 kPa. Twelve patients (16%) had Fibroscan score ≥ 7.1 kPa, of which 3 patients had severe liver stiffness (9.5 to 12.5 kPa) and one patient had liver stiffness in the range of cirrhosis (> 12.5 kPa). Fibroscan scores significantly correlated with cumulative dose of MTX (r= 0.30, p = 0.008). Long-term MTX therapy in RA was associated with increased liver stiffness on Fibroscan.

1.AbstractObjectiveThe present study hospital based retrospective study aimed at investigating the dynamics of ORF1ab and N gene from hospitalized COVID-19 positive cohorts considering the Ct values of both genes.Study design and MethodologyRetrospective analyses of Ct values were done from 115 hospitalized COVID-19 positive patients in different time interval. Patients were admitted to the hospital either by RAT or/and RT-PCR and first RT-PCR testing were made after 9 days of incubation followed by testing in every 3 days of interval till negative, subsequently release of the patients.ResultsWe have looked into the dynamics of ORF1ab and N gene and found that N gene require longer duration of days with 12.68 (S.D.±3.24) to become negative than ORF1ab with 12.09 (S.D.±2.88) days and it differs significantly (p=0.012; pConclusionIn COVID-19 hospital positive cohorts, the persistent of positivity of N gene is significantly for more duration than ORF1ab. As the SARS-CoV-2 is a new virus and study on it is evolving, so, exhaustive study is required on the dynamic of N gene positivity persistent in relation to the other pathophysiological parameters for the management and control of COVID-19.

ObjectiveTo determine the prevalence and predictors of gestational diabetes mellitus (GDM) in rural Assam, India using a network of Mobile Medical Units.Study designA field-based cross-sectional study.SettingsRural areas of Assam state, India.ParticipantsA total of 1410 pregnant women in gestational age of 24–28 weeksInterventionIdentification of pregnant women in 24–28 weeks of pregnancy from villages and administering them Government of India recommended oral glucose tolerance test for GDM confirmation.Primary and secondary outcome measuresPresence of gestational diabetes among pregnant women, risk factors and predictors of GDM.ResultsA total of 1212 pregnant women underwent the oral glucose tolerance test. One hundred and ninety-eight women were ineligible due to existing chronic diseases or very high blood glucose level before the test. The overall GDM prevalence in Assam was 16.67% (95% CI 14.61% to 18.89%). Women aged 26–30 years (adjusted odds ratio, aOR 1.70; CI 1.14 to 2.52), who passed 10th class (aOR 1.58; CI 1.05 to 2.37), belonging to Muslim religion (aOR 1.52; 95% CI 1.05 to 2.21) and above poverty line (aOR 1.38; 95% CI 1.00 to 1.91) had significantly increased likelihood of developing GDM compared with respective baseline groups (pConclusionThe prevalence of GDM in rural Assam is high. The mobile medical units may play a significant role in the implementation of GDM screening, diagnosis, treatment to ensure better maternal and foetal health outcomes in rural Assam.

Introduction: Thyroid gland is the most superficial endocrine gland of the human body in the region of theneck and is easily accessible to both clinical and Radiological examinations. The thyroid masses must bediagnosed and managed as early as possible to avoid any malignancy.Objectives: To evaluate the socio-demographic profile of patient including age and gender distribution inthyroid lesions.Materials and Method: This prospective study was a cross-sectional descriptive one, which was conductedover the 50 subjects with thyroid masses. The collected data were subjected to a statistical analysis whichwas performed using a Statistical Package for the Social Sciences (SPSS) software version 20.0. Descriptivestatistical method were computed, and the statistical significance was tested by chi-square test and student’st-test. A p-value of less than 0.05 was considered statistically significant. Ethical clearance was taken fromethics committee (H).Results: There was a female preponderance of 70% associated with this disease entity, against its malecounterpart as 30%. The male to female ratio is 1:2:33. A maximum number of patients in our study is in theage group of 31-40 years of age, i.e. 40%. Most of the patients (76%) are from a rural area.Conclusion: Female preponderance of thyroid masses in the age group of 31-40 years was observed and wasmore in rural areas. The sociodemographic profile is useful for better future planning of the management ofthyroid masses.

Introduction: Thyroid gland is easily accessible to both clinical and radiological examinations. The thyroidmasses must be diagnosed and managed as early as possible to rule out malignancy. Thyroid masses aretypically found on physical examination or incidentally when other imaging studies are performed.Objectives: Evaluation of the clinical profile of thyroid masses with ultrasonography (UGC) of the patienthaving thyroid lesions with pathologic correlation.Materials and Method: This prospective study was a cross-sectional descriptive one, which was conductedover the 50 subjects with thyroid masses detected on USG, were further evaluated with Fine-needleAspiration Cytology (FNAC) and Histopathological Examination (HPE). The USG features such as internalcomposition, echotexture, shape, margins, presence or absence of peripheral halo, calcification and internalvascularity were correlated with the final diagnosis. The collected data were subjected to a statistical analysiswhich was performed using a Statistical Package for the Social Sciences (SPSS) software version 20.0.Descriptive statistical method were computed, and the statistical significance was tested by chi-square testand student’s t-test. A p-value of less than 0.05 was considered statistically significant. Ethical clearance wastaken from ethics committee (H).Results: In USG diagnosis, goitre is the most common benign lesion in 63% followed by benign cyst 16%.Follicular carcinoma, medullary carcinoma and undifferentiated carcinoma 1 case of each variety was alsodetected at USG. Cytological examination of 50 cases, 44 (88%) cases revealed benign nature of thyroidswelling and 6 (12%) cases as malignant. The malignant thyroid cases diagnosed clinically and cytologically.Conclusion: USG and FNAC with HPE are the primary diagnostic modalities a surgeon utilizes to determinethe extent of thyroid surgery.

Dermatology consultation was sought for a 55-year-old man with asymptomatic generalised skin nodules, admitted under haematology for suspected multiple myeloma (MM). On examination, multiple skin-coloured to erythematous to violaceous, shiny, discrete papules and dome-shaped nodules with a firm consistency and waxy smooth feel, measuring 1–5 cm, were seen on the limbs and trunk (figure 1A–G). Dermoscopy revealed a central homogeneous pink area studded with linear and serpiginous vessel network which was accentuated at the periphery forming a rim of vessel network (figure 2A). A 4 mm punch biopsy of cutaneous nodule over the trunk showed diffuse infiltration of the dermis by sheets of plasma cells, including immature, mature and binucleate forms (figure 2B). On immunohistochemistry, the plasma cells were positive for CD138 (figure …