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Background The aim of our study was to determine the value of single-voxel proton MR spectroscopy (1HMRS) in distinguishing benign from malignant focal bone lesions in the peripheral skeleton. MRI and 1HMRS was performed in 50 focal lesions (> 1 cm size) detected on radiographs of peripheral skeleton.1HMRS was performed at 1.5 T with TE of 144 ms with automatic shimming and water suppression. Qualitative analysis for a discrete choline peak at 3.2 ppm was done. Significance of the presence of choline peak on 1HMRS in distinguishing benign from malignant lesions was calculated using histopathology as a gold standard. Chi-square test was used and p value Results Forty-one benign and 9 malignant lesions were confirmed by histopathological results. Amongst malignant lesions, choline peak was positive in all but 1 case of low-grade lymphoma. MR spectra of 11 benign lesions showed the presence of choline peak. All 7 benign giant cell tumors (GCT) were positive for choline peak. The sensitivity, specificity, PPV, NPV of proton MR spectroscopy in differentiating benign from malignant lesions were 87.5%,71%,38.8%, and 96.4% respectively. p value was significant ( Conclusion 1HMRS in focal bone lesions can help in the differentiation of malignant from benign musculoskeletal tumors. Although some benign lesions may show false-positive result, absence of choline peak is a reliable reassurance against malignancy. GCT is an exception amongst benign bone tumors as it consistently shows the presence of choline peak on 1HMRS.

Malformations of cortical development (MCD) are a heterogeneous group of disorders characterized by abnormal structure of the cerebral cortex. MCDs are an important cause of development delay and intractable epilepsy in children. In this review, we explore the embryological stages of development of neo-cortex, the imageology of various malformations which may occur during the journey of this development, the recent advances in imaging techniques used for diagnosing these malformations, and finally a simplified radiological approach to malformations of cortical development. We discuss the classification of MCD according to the embryologic stage of cerebral cortex at which the abnormality occurred and the unique imaging features of various malformations, including microcephaly, hemimegalencephaly, lissencephaly, focal cortical dysplasia, heterotopias, polymicrogyria, schizencephaly, and neonatal CMV infection. Also, a rare variant of hemimegalencephaly, namely posterior quadrantic dysplasia, is illustrated; the diagnosis of which is crucial for neurosurgeons to decide management. The technological advancement in the imaging of MCD has taken a leap in the recent years. Imaging now also plays an enormous role in mapping of the abnormalities, delineation of proper surgical boundaries, and quantifying risks of visual, language, and sensorimotor dysfunction. With the introduction of various motor-sparing surgeries and disconnection procedures, proper identification and delineation of these malformations have gained utmost significance. Knowledge of the wide imaging spectrum of MCD, familiarity with recent advances in imaging and an optimal radiological approach is essential for the general radiologist to accurately diagnose and prognosticate MCD as well as provide the best surgical approach to the operating surgeon.

Mycobacterium avium subspecies paratuberculosis (MAP) implicated in paratuberculosis (PTB) infection in animals and Crohn’s disease in human poses enormous economic loss to the farmers. The noticea...

Venous anomalies are the most common congenital vascular anomalies. The rarest of these is complete deep venous agenesis. Here,we report a case of a 15-year-old male patient evaluated on color Doppler and computed tomographic venogram with complete rightiliofemoral deep venous agenesis with the inferior vena cava continuing as the left common iliac vein and the right popliteal veindraining into superficial anomalous veins of the thigh. These superficial veins were seen to drain through a superficial suprapubicarcuate connector vein into the dilated left common femoral vein. Uniquely in our case, there was no persistent embryonic sciaticvein and no demonstrable reflux into the superficial connector vein, suggesting an uncommon embryological mechanism underlyingits pathogenesis. Surgical resection of the dilated superficial veins is absolutely contraindicated in cases of deep venous agenesis andhence accurate diagnosis by the radiologist is absolutely essential in such cases.

Pancreatitis and pseudo-pancreatic cysts are frequently encountered entities; however, intrahepatic pseudocysts presenting as large number of liver cysts with absence of overt signs of pancreatitis has never been reported in literature. Here, we report an interesting case of multiple intrahepatic pancreatic pseudocysts (MIHPPs), a challenging diagnosis to be kept in mind while dealing with complex cystic lesions of liver. Pseudocysts are common complication of pancreatitis, often these are located within the vicinity of the pancreas in the lesser sac and the retroperitoneum. Extra pancreatic location of these cysts within the liver is a diagnosis often missed, with only 50 odd cases reported in literature till date. Most of these reported cases are either subcapsular in location or limited in number to one or two lesions. Although rare, possibility of MIHPPs is an important diagnosis that should be kept in mind while considering list of differentials for complex cystic lesions of the liver even in the absence of overt signs of pancreatitis.

8-Hydroxyquinoline (8-HQ) is a significant heterocyclic scaffold in organic and analytical chemistry because of the properties of chromophore and is used to detect various metal ions and anions. But from the last 2 decades, this moiety has been drawn great attention of medicinal chemists due to its significant biological activities. Synthetic modification of 8-hydroxyquinoline is under exploration on large scale to develop more potent target-based broad spectrum drug molecules for the treatment of several life-threatening diseases such as anti-cancer, HIV, neurodegenerative disorders, etc. Metal chelation properties of 8-hydroxyquinoline and its derivatives also make these potent drug candidates for the treatment of various diseases. This review comprises 8-hydroxyquinoline derivatives reported in the literature in last five years (2016-2020) and we anticipate that it will assist medicinal chemists in the synthesis of novel and pharmacologically potent agents for various therapeutic targets, mainly anti-proliferative, anti-microbial, anti-fungal and anti-viral as well as for the treatment of neurodegenerative disorders.

Trk receptors and gene fusions of NTRK are targets in precision oncology. Classical Trk signalling concepts fail to explain ligand-independent signalling of intracellular TrkB or NTRK fusion proteins. Here, we show that abundance of the intracellular domain of TrkB is sufficient for ligand-independent autophosphorylation. This constitutive TrkB signalling reduced actin filopodia dynamics, could phosphorylate FAK, and changed cell morphology. Mutating Y705 in the kinase domain of TrkB alone specifically blocked these pathways. Engineered intracellular kinase domain proteins and a cancer-related intracellular NTRK2-fusion protein (SQSTM1-NTRK2) also underwent constitutive activation. In migrating glioblastoma-like U87MG cells, self-active TrkB kinase reduced cell migration. Moreover, we found evidences for constitutively active, intracellular TrkB in tissue of human grade IV glioblastoma. Structural modelling of the kinase domain let us postulate that ‘release from cis-autoinhibition by abundance’ is sufficient for TrkB/FAK/Actin signalling via Y705. These constitutive signalling pathways could be fully blocked within minutes by clinically approved, anti-tumorigenic Trk inhibitors. In conclusion, our data provide an explanation and biological function for TrkB kinase domain signalling in the absence of a ligand.

How homeostatic ER calcium fluxes shape cellular calcium signals is still poorly understood. Here we used dual-color calcium imaging (ER-cytosol) and transcriptome analysis to link candidates of the calcium toolkit of astrocytes with homeostatic calcium signals. We found molecular and pharmacological evidence that P/Q-type channel Cacna1a contributes to depolarization-dependent calcium entry in astrocytes. For stimulated ER calcium release, the cells express the phospholipase Cb3, IP

Purpose There is a theoretical risk of injury to neurovascular structures during inside-out meniscal repair without a safety incision, although there are limited studies assessing this risk. This simulation study on archival MRI films was performed to assess the risk for the popliteal neurovascular bundle and the peroneal nerve during passage of needles for inside-out meniscus repair without a "safety incision", thereby defining a "safe zone" of the menisci that can be safely repaired using this technique. Methods Archival MRI scans (n = 50) were retrieved and axial sections through the menisci were used for simulation. The needle passage was simulated for different points on the posterior horn and body of lateral and medial menisci at "half-hour" intervals using clock method (15° intervals) with three different portals and two different needle cannulas, resulting in six different scenarios of needle passage for each point on the meniscus. The distance of the needle in each scenario was measured from popliteal vessels (n = 50) and peroneal nerve (n = 10). The value "mean-3SD" was calculated for positive means and "Mean + 3SD" was calculated if the mean was negative. An additional 2 mm was defined as "safe distance". Thus, simulation models in which the mean - 3SD was less than 2 mm (or mean + 3SD was greater than - 2 mm for negative means) were labelled as "unsafe". Results Needle passage through medial meniscus at and medial to 1 o'clock position for a right knee (or 11 o'clock position for a left knee) was safe, irrespective of the portal and needle type. For the lateral meniscus, only the equatorial region was found to be safe with this method. Conclusions The popliteal neurovascular bundle is safe during the inside-out medial meniscal repair without a safety incision. For the terminal-most part of the posterior horn, the AM portal and the straight cannula should be avoided. However, this method without safety incision cannot be recommended for lateral meniscus because of the risk to the popliteal vessels and the peroneal nerve. Instead, the inside-out method with a safety incision, or an all-inside method should be used for lateral meniscus. Level of evidence III.

Graduate student training in global trauma and disaster psychology requires engagement with stressful learning contexts of both an academic and practical nature. These learning contexts require exposure to traumatic academic and practical material, and considerations of vicarious traumatization of graduate students are crucial. In this article, literature describing the potential negative impact of trauma exposure in the mental health field and in training is presented. Developmental concepts from attachment theory such as felt security that is enhanced by a secure base are then suggested to inform graduate training approaches of this nature. These concepts shed light on educational (i.e., teaching and supervision) strategies that may buffer against the negative impact of trauma exposure and promote student resilience, learning engagement, and skill development in global trauma and disaster psychology. Recommendations that may further graduate student trainee felt security in classroom and in supervision contexts domestically and internationally are suggested that may inform a trauma-informed educational approach to graduate training in this challenging global field.

Purpose: To evaluate the spectrum of magnetic resonance imaging (MRI) findings in pediatric patients with anorectal malformation (ARM) and compare the accuracy of MRI and distal cologram (DC) findings using surgery as reference standard. Materials and Methods: Thirty pediatric patients of age less than 14 years (19 boys and 11 girls) with ARM underwent preoperative MRI. MRI images were evaluated for the level of rectal pouch in relation to the pelvic floor, fistula, and development of sphincter muscle complex (SMC). Associated spinal and other anomalies in lumbar region and pelvis were also evaluated.DC was done in 26 patients who underwent colostomy. Ultrasound of abdomen and pelvis was also done for associated anomalies. Results: Overall accuracy of MRI and DC to detect the exact level of rectal pouch including cloacal malformation was 93.33% and 76.9% respectively. MRI and DC could correctly identify presence or absence of fistula in 76.6% and 76.9% cases respectively. MRI and DC correctly identified the anatomy of fistula in 76% and 65% cases respectively. On MRI, correlation of development of levator ani and puborectalis with the level of rectal pouch as found on surgery was significant (P = 0.008; 0.024 respectively). Subjective assessment of sphincter muscle development on MRI correlated well with the surgical assessment [P = 0.019 and 0.016 for puborectalis and external anal sphincter (EAS) respectively]. Lumbosacral spine anomalies were present in 33.3% of patients and were most common in high type of ARM. Vesicoureteric reflux and renal agenesis were the most common renal and urinary tract anomalies and were present in 40% of cases. Conclusion: MRI allows reliable preoperative evaluation of ARM and should be considered as a complementary imaging modality for preoperative imaging in ARM.

Posterior quadrantic dysplasia (PQD) is a rare cause of pediatric intractable epilepsy. It is a sporadic cortical development malformation that involves the posterior three lobes of a single hemisphere and spares the frontal cortex. Very few cases have been reported in the literature, mostly as anecdotal reports or as a part of large series of refractory epilepsy. It is essential to know about this lesser known entity and differentiate it from other more common similar anomalies such as multilobar cortical dysplasia and hemimegalencephaly as new motor-sparing neurosurgical disconnective procedures have led to dramatically reduced mortality and morbidity rates, apart from gifting the affected children a better quality of life. Magnetic resonance imaging (MRI) is pivotal in astute diagnosis of the condition and accurate delineation of boundaries of the lesion to aid in neurosurgical management. We report one such case of PQD presenting with refractory epilepsy, which was diagnosed on MRI.

A clinical experience of an Asian Indian therapist working with a client of a similar ethnic background is analyzed. The relational dynamics in the therapy and the impact of a perceived shared identity are examined. Transference and countertransference processes are emphasized. A shared perceived ethnic identity created complexities in the therapeutic relationship and affected the therapy in surprising ways. Assumptions related to a shared ethnic identity affected the ability to form a therapeutic alliance.

Lung infections are an important cause of morbidity and mortality, particularly because of the rising antimicrobial resistance. According to the clinical setting, they can be categorized as community-acquired pneumonia and hospital-acquired pneumonia. Radiological patterns of lung infections are lobar consolidation, bronchopneumonia, interstitial pattern, and nodular pattern. In addition, typical imaging features of several infections serve as “red flag signs” in reaching a diagnosis or altering the management. It would be prudent for the radiologist to be well informed regarding these aspects of lung infections to be able to make a valuable contribution to the management.

Spinal dysraphism is an umbrella term describing herniation of meninges or neural elements through defective neural arch. They can be broadly categorized into open and closed types. MRI is the investigation of choice to study neural abnormalities and to assess the severity of hydrocephalus and Chiari malformation. Knowledge of the embryology of these disorders is valuable in correctly identifying the type of dysraphism. The aim of surgery is untethering and dural reconstruction. Accurate depiction of the abnormal anatomy in cases of spinal dysraphism is of utmost importance for surgical management of these patients. MRI makes this possible due to its excellent soft tissue contrast resolution and multiplanar capability, allowing the radiologist to evaluate the intricate details in small pediatric spinal structures. Imaging enlightens the surgeons about the status of spinal cord and other associated abnormalities and helps detect re-tethering in operated cases. Besides, antenatal surgery to repair myelomeningoceles has made detection of open dysraphisms on fetal MRI and antenatal ultrasound critical. The purpose of this review is to describe the development of spine, illustrate the myriad imaging features of open and closed spinal dysraphisms, and enlist the reporting points the operating surgeon seeks from the radiologist.

Background: Laparoscopic ventral hernia repair has revolutionized treatment of ventral hernia by offering shorter recovery time, decreased pain, reduced wound complications and lower recurrence rates as compared to conventional open hernia repair. But intra-abdominal mesh placement is associated with a high risk of complications including adhesions, bowel obstruction and fistula formation. Many different types of meshes with adhesion barriers have been developed to overcome these problems. This prospective observational study evaluated the outcomes of laparoscopic repair of ventral hernias in terms of Intra-abdominal adhesion formation with composite mesh using ultrasound.Methods: The study was conducted from August 2017 to February 2019. All patients underwent standard laparoscopic ventral hernias repair using composite mesh secured with tackers. Omentum was interposed between the mesh and underlying bowel. At a mean follow-up of one year, all patients were subjected to ultrasound examination using visceral slide technique to detect Intra-abdominal adhesions.Results: Our study included 50 patients with a mean age of 43 years (range 26-59 years) and mean body mass index of 29.07±2.35 kg/m2 (range, 24-33 kg/m2). Mean fascial defect size of hernia was 13.4±3.77 cm2 (range12-16 cm2). There were no mesh-related complications and recurrence during the follow-up period of 1 year.Conclusions: Laparoscopic ventral hernia repair using composite mesh seems to be a promising technique for treating ventral hernias. However, longer follow-up periods are needed to confirm effectiveness and safety of the composite mesh.

Background: The objective of the study was to identify practice and pattern of self-medication use among new patients attending ophthalmology OPD in a tertiary care hospital of north India. Self-medication practice is a common phenomenon all over the world but it has been reported to be very common in the developing countries especially in India. When consumers self-medicate without consulting the eye care giver, the issues of safety and irrational use of drugs arise. Methods: A cross-sectional questionnaire based, observational study was planned among the patients reporting for the first time to Ophthalmology OPD in ASCOMS, Jammu. The patients enrolled in the study were randomly selected in the age group ≥18 years. Detailed history regarding self-medication prior to reporting to OPD was obtained. A questionnaire elucidating details of self-medication regarding history of ocular self-medication, type of ocular medication used, their reasons for resorting to ocular self-medication etc. was provided to them. All participants were informed about the scope and purpose of the study. An informed consent was obtained in every case prior to being given the questionnaire. Results: A total of 296 responders were interviewed. Among these 122 (41.2%) admitted to have used eye medicines before coming to hospital. Redness in 38 (31.1%) cases was the most common complaint for which the patients opted self-medication. 49 (40.2%) patients did not know what drug they had used. Among the various drugs used, the commonest was the antibiotic eye medication in 33 (27%) patients followed by steroids 13 (10.7%). Among the responders 9 (7.3%) experienced side-effects after self-medication. Main factors influencing self-medication were advice from friends/relatives, living far from hospital and high cost of treatment at the hospital. Conclusions: Self-medication with eye medicines is common among the population interviewed. Educating the public about the dangers of self-diagnosis and treatment, possibly leading to delay in detection of more serious underlying ailments is essential.

Recently US Food and Drug Administration (FDA) approved valsartan/sacubitril is the first angiotensin receptor/neprilysin inhibitor (ARNI) that offers a new standard of treatment to physicians for the patients of heart failure with reduced ejection fraction. Sacubitril is a prodrug which gets activated to sacubitrilat and this inhibits the enzyme neprilysin which is a membrane bound endopeptidase and which in turn is responsible for the degradation of various natriuretic peptides. The action of Valsartan which selectively blocks the angiotensin II type-1 receptor is needed in addition to sacubitril because inhibition of neprilysin is accompanied by the activation of renin-angiotensin system. The combination appears to be a suitable alternative for patients of heart failure with persistent symptoms or with recent exacerbation or hospitalization while on standard optimized treatment. The availability of this novel sacubitril/valsartan combination is an important development in the heart failure management.

Agenesis of urinary bladder is an extremely rare condition with only 60 cases and 22 live births being reported previously. Ureteric ectopia is a must for survival. We present a unique case of bladder agenesis detected in adulthood where bilateral single system ureters were draining ectopically in a grossly dilated vagina in normally developed female genital tract.

Cystic hygroma is a congenital malformation of the lymphatic system that mostly presents at birth. Though the classic treatment of this condition is surgical excision, recent alternative treatment modalities such as injection of sclerotherapeutic agents (e.g., bleomycin and OK-432) into the lesion has gained popularity due to its safe and effective response profile with minimal side effects. We report a rare complication of repeated bleomycin sclerotherapy in a follow-up patient of cystic hygroma, where the lesion underwent fibrolipomatous conversion with insinuation into multiple fascial planes, causing mass effect by encasement and compression of major vascular and airway structures. This is the first time such a complication of bleomycin sclerotherapy has been reported in literature. Such an unusual presentation reminds us that, in any patient presenting with recurrent gradually increasing swelling with worsening of symptoms following bleomycin sclerotherapy, a possibility of fibrolipomatous conversion of cystic hygroma should be borne in mind.

The WHO Integrated Management of Childhood Illnesses-HIV (IMCI-HIV) algorithm and its regional adaptation have shown variable performance in clinically identifying HIV-infected children with lack of validation in low prevalence areas. Addition of certain 'parental factors' (proxy indicators of parental HIV) may improve its utility. In this study, children aged 2 months to 5 years were enrolled into Group A (n = 1000, 'suspected symptomatic HIV infected' children as per the IMNCI-HIV algorithm) and group B (n = 50, children newly diagnosed with HIV infection). Parental factors were asked and HIV infection was tested for in Group A. For Group B, retrospective data were collected regarding IMNCI-HIV algorithm signs and parental factors. Utility of individual and various combinations of IMNCI-HIV signs and parental factors to predict HIV status was evaluated. Results showed that incorporating parental factors to IMNCI-HIV algorithm improved its sensitivity and positive predictive value in identifying HIV-infected children while maintaining the same sensitivity.

Colloidal particles at complex fluid interfaces and within films assemble to form ordered structures with high degrees of symmetry via interactions that include capillarity, elasticity, and other fields like electrostatic charge. Here we study microparticle interactions within free-standing smectic-A films, in which the elasticity arising from the director field distortion and capillary interactions arising from interface deformation compete to direct the assembly of motile particles. New colloidal assemblies and patterns, ranging from 1D chains to 2D aggregates, sensitive to the initial wetting conditions of particles at the smectic film, are reported. This work paves the way to exploiting LC interfaces as a means to direct spontaneously formed, reconfigurable, and optically active materials., 8 pages, 6 figures. Supplementary Materials: 3 pages, 3 figures

Unicornuate uterus with rudimentary horn occurs due to failure of complete development and partial fusion of one of the Mullerian ducts. Pregnancy in a non-communicating rudimentary horn is extremely rare, with a reported incidence of 1 in 76 000-150 000 pregnancies, and usually terminates in rupture during the first or second trimester. Clinical diagnosis of rudimentary horn pregnancy in a woman with history of normal vaginal delivery in prior gestations is difficult. The role of sonography, and more recently, magnetic resonance imaging, in the presurgical diagnosis of rudimentary horn pregnancy is established. We present a case of magnetic resonance imaging diagnosis of 20-week pregnancy in the unruptured non-communicating rudimentary horn in a patient with previous history of two full-term normal vaginal deliveries. The novelty of the case lies in the fact that there was associated torsion of the gravid rudimentary horn and ipsilateral ovary, which has not been reported previously.

In this study 30 patients with osteo-arthritis (OA) knee (total 55 knees) were given weekly injections of high molecular weight (HMW) hyaluronic acid (HA) for 3 weeks. The subjective parameter was Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC) score which improved from 97.67±21.4 at baseline to 61.03±24.8 at six months follow-up (p=0.0001). Also the mean range of motion (ROM) of the involved knees was 125.73± 10.8 degrees at baseline and it increased to 132.64±5.2 degrees after six months (p=0.0001) of injection treatment. The objective parameter of disease modification was MRI based semi-quantitive Whole-organ Magnetic Resonence Imaging Score (WORMS) score. The mean of total WORMS score in medial femorotibial joint (MFTJ) and patellofemoral joint (PFJ) improved from baseline (28.382±10.446; 22.64±5.969) to final follow up (27.46±10.32; 21.76± 6.182) which was quite significant (p=0.0321; p=0.0294) and implies a reduced rate of cartilage destruction after injection HA though there is no regrowth of cartilage as such.

Thanatophoric dysplasia is a rare, fatal form of skeletal dysplasia that affects fetus in utero. It is characterized by marked underdevelopment of fetal skeleton and short limbs. This disorder can be diagnosed antenatally and the couple should be counselled for termination of pregnancy. 20 years old female came in her second trimester carrying an ultrasound report which showed features of thanatophoric dwarfism. She was advised to terminate her pregnancy but she decided to continue with her pregnancy. She was induced after 40 weeks and she delivered a stillborn baby with dwarf like features, a condition identified as thanatophoric dwarfism. Early diagnosis can be done by ultrasound as early as 13 weeks of gestation and since babies born with thanatophoric dysplasia have a very poor prognosis, couples should be counselled regarding early termination of pregnancy. 3D ultrasound scan and molecular analysis can also help identify this disorder.

Background: Teaching methods has a major role to play in making a subject innovative, interesting and participatory for the students. In India still teaching is controlled by teacher centered classroom method. Apart from this one of the method adopted is organizing seminars for the students. Knowledge acquisition through seminars forms an essential part of medical training programme. The idea behind the seminar system is to familiarize students more extensively with the methodology of their chosen subject. Methods: A questionnaire was prepared containing ten questions and 1000 MBBS students of second, pre-final, final professional and 200 faculty members, were asked to fill up the questionnaire. It included ten questions. Results: Results showed that seminar methods of teaching-learning, is effective way of learning, which is relevant to self-development and is also interactive. It improves communication skills. Conclusions: Many of the students feel that this technique of seminar programme is helpful for them in the long run. Thus teaching by way of seminar could be an effective learning method as it involves the three major domains of teaching i.e., cognitive, affective and psychomotor skills and is thus well -accepted among the medical students.

Background Children living with HIV (CLHIV) commonly experience growth failure. We report growth parameters in CLHIV at baseline and during 3 years of antiretroviral therapy (ART). Methods Records of CLHIV who had completed at least 3 years on ART were reviewed after excluding subjects who died, were lost to follow-up or developed treatment failure to assess impact of sustained administration of ART. Height-for-age (HFA) and body mass index for age (BFA) Z scores were calculated, and proportion of CLHIV with wasting and stunting estimated at baseline, 6, 12, 24 and 36 months after starting ART using the linear mixed model. Factors influencing significant changes in growth parameters were assessed. Results HFA Z score improved steadily from -3.12 at baseline to -2.33 at 36 months of ART. The prevalence of stunting declined from 77.7% to 59.2% during this period. BFA Z scores improved from -1.2 at baseline to -0.4 at12 months on ART but declined to -1.0 at 36 months. The proportion of subjects with wasting was 29.3%, 9.7% and 16.7% at baseline, 12 and 36 months, respectively. Baseline clinical stage (1 + 2), absence of wasting and lower HFA Z score had significant positive influence on changes in HFA Z score, while younger age at ART initiation and a low baseline BFA Z score had a positive influence on catch-up in body mass index. Including data of children who died or developed treatment failure did not impact upon the results. Conclusion Majority of CLHIV are stunted at the start of ART. ART was only partially effective in countering malnutrition and growth failure in CLHIV.

Background: Postural drainage is used exclusively or in combination with other airway clearance techniques in the management of chronic pulmonary diseases. Postural drainage therapy helps to prevent accumulation of secretions in patients who are at high risk for pulmonary complications. It also helps to remove accumulated secretions from the lungs.The role of body positioning on lung function and the clinical implications of postural drainage has been identified in a variety of settings including intensive care units. There is dearth in literature on effects on postural drainage on vital parameters. Thus the objective of the study was to measure the vital parameters at different postural drainage positions in healthy asymptomatic adults. Methods: Twenty healthy subjects participated in the study. The instruments used in the current study included a Pulse oximeter, Sphygmomanometer, Stethoscope, Postural drainage table.The outcome measures of interest were heart rate, respiratoryrate, oxygen saturation, blood pressure and Borg’s scale of rate of perceived exertion. The changes in the vital signs were recorded at different head down titling position of 0°, 15° & 30° in both supine and prone lying positions Results: Statistical significant difference was found for Systolic Blood Pressure in prone lying at different degrees of tilt (p=0.001) and Diastolic Blood Pressure in prone lying (p=0.000). Conclusion: Postural drainage positioning should be given with caution and under proper monitoring as there is a risk of change in the blood pressure even in asymptomatic elderly population. The monitoring of vital signs should be done during the therapy to decrease the risk of complications.

OBJECTIVES: Diagnostic role of MRI in Mayer–Rokitansky–Kuster–Hauser (MRKH) syndrome is well documented. Recent studies have shown the relevance of MRI in detailing the pelvic anatomy, particularly small Mullerian remnants. The results are, however, not consistent and reproducibility of MRI features has not been confirmed. The aim of our study was to evaluate the detailed pelvic anatomy in patients with MRKH syndrome and to calculate the interobserver agreement of the MRI features. METHODS: The study was carried out on female patients, aged 15–30 years, with primary amenorrhea. Following clinical, gynaecological, endocrinological, ultrasound and chromosomal work-up and a provisional diagnosis of MRKH syndrome, MRI pelvis was performed on 25 patients using a 1.5 T scanner. MRI images were retrospectively reviewed by two radiologists for a detailed evaluation of Mullerian structures (uterine buds, fibrous bands, midline triangular soft tissue), vagina, and ovaries. κ coefficient was calculated as a measure of interobserver agreement. RESULTS: Interobserver agreement was good to excellent (κ: 0.7788 ± 0.2168 to 1 ± 0) for uterine buds and their characteristics, vagina, ovaries and associated renal/vertebral anomalies; poor to fair for fibrous bands (κ: 0.2857 ± 0.3273 to 0.6032 ± 0.2149) and good for midline triangular soft tissue (κ: 0.7826 ± 0.1474). CONCLUSION: MRI is capable of providing key pre-operative anatomical information in MRKH syndrome non-invasively. There is good to excellent interobserver agreement for MRI features of most of the surgical relevant structures. ADVANCES IN KNOWLEDGE: MRI features of salient preoperative anatomical structures are reproducible between observers.

Background: A package insert is a document approved by the administering licensing authority, which is provided with the package of a drug. A good package insert can prove to be of immense help to doctors as they are evidence based and are updated from time to time. The objective to study the awareness about package inserts among postgraduate medical students.Methods: The present study was a cross-sectional observational study carried out on 68 postgraduate medical students of Acharaya Shri Chander College of Medical Sciences and Hospital Sidhra, Jammu (J & K) in the month of February 2017 after taking approval from the institutional ethical committee. Pre-validated self-administered questionnaire was used to elicit responses from the students. The questionnaire consisted of specified questions regarding knowledge and opinion about package inserts.Results: In the present study, 86.7% of the students understand the relevance of Package inserts (PIs). About 72% of the students think that PIs are a necessary add-on to drug information and 70.6% of the students think that information given on package inserts is necessary for the patients. However, only 2.9% of the students had the knowledge of Drug Acts governing the information to be provided on PIs in India. About 86.8% of the students think that PIs should also be in regional language apart from in English language.Conclusions: It was found from the present study that the majority of the postgraduate students were aware about the package inserts available with the medicines but the information provided on package inserts was not optimally used by them. To achieve the target of optimally utilization of information provided in the package inserts, the PIs should be designed by considering the needs and information of two differently educated target groups i.e; patients and doctors.

Background: Migraine is a common debilitating headache the exact cause of which is not known. Efficient and proper treatment of migraine involves accurate diagnosis, educating the patients and to make them aware of the disorder and finding the best medication for the management of pain. This will also increases the patients’ adherence to medication and will help in improving their quality of life. The objective of the study was to assess the awareness of migraine patients towards various aspects of migraine in a tertiary care teaching hospital.Methods: This was a cross-sectional observational questionnaire-based study conducted from January to March 2017 in ASCOMS&H, Sidhra, Jammu. The self-administered pre-validated questionnaires pertaining to various aspects of migraine were distributed among the patients diagnosed of having migraine and attending the Neurology Out patient department (OPD). Patients of either sex with a diagnosis of migraine and age ≥18 years were included in the study. The data was analyzed with the help of descriptive statistics.Results: In the present study, majority of the patients suffering from migraine were in the age group of 18-40 years (58.6%) and females were more commonly affected about 60.9% than males. There was no family history of migraine in 78.1% of the patients. About 87.4% of the patients had 2-6 attacks of migraine per month. The most common triggering factor cited by the patients was lack of sleep in 29.9% followed by stress in 27.6% and less water intake in 26.4% of the patients.Conclusions: From the present study, it can be concluded that the patients were aware about the associated signs and symptoms but they had inadequate knowledge about all the aspects of the disease. Therefore, it is important to make patients more aware of the disease to increase their compliance to treatment and to improve their quality of life.

Background: Antibiotics are one of the commonest prescribing drugs in day to day practice. However indiscriminate and irrational use of antibiotics has given rise to the emergence of antibiotic resistance. Thus, intervention in the form of educating students and making them aware about this important concept should be initiated at the gross root level right from the beginning of medical profession. Objective was to assess the comparative awareness regarding antimicrobial resistance between first and second year MBBS students.Methods: This was a comparative, cross-sectional questionnaire based study. Two forty six undergraduate medical students, 118 students from 1st year and 129 students from 2nd year MBBS were included in the study to assess the extent of knowledge and about the problem of antibiotic resistance. Self-administered questionnaire was used to collect the data from respondents. The questionnaires of both the groups were analyzed for the responses of the students and were compared using student ‘t’ test and chi-square test.Results: Majority of the participants 63.6% and 72.9% had completed the full course of antibiotics as prescribed by the physician. Statistically significant difference (p

Background: In the recent years, large number of human pharmaceuticals have been introduced to the environment by landfill when household medications are thrown to trash and liquid medications gain access to the environment via liquid drainage systems. There is lack of knowledge and awareness in the general public regarding the safe disposal of unused and expired medicines. The objective was to assess the awareness regarding disposal of unused medicines among consumers at a tertiary care teaching hospital of north IndiaMethods: It was a cross-sectional observational questionnaire-based study carried out on 220 consumers in medicine outpatient department (OPD) of a tertiary care teaching hospital in North India for 3 months. All the participants were provided the pre-validated self-administered questionnaire. The final questionnaire consisted of twelve questions to assess participants’ knowledge and attitude towards disposal of the medicines. The data was analyzed with the help of descriptive statistics.Results: It is quite evident from the present study that majority of participants 56.36% stated 1-5 drugs were left-over drugs at their homes. Most of the leftover medicines were analgesics in 59.1% followed by antibiotics in 51.36%. Most common dosage form of these leftover medicines were tablets in 85.9% of respondents. Majority of the respondents (55.9%) were not aware of the adverse outcomes of the pharmaceuticals in the environment. The most common method followed by majority of the participants for disposing of the solid, semi-solid and liquid dosage forms was garbage in 95%, 91.4% and 76.4% of consumers respectively. About 9.31% of the participants were in favour of initiating a program to collect unused medications from home.Conclusions: It can be concluded from the present study that the consumers had poor knowledge regarding the safe drug disposal techniques. Therefore, efforts need to be done by the health care professionals to make people educate regarding the safe drug disposal techniques.