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Favus is an uncommon chronic inflammatory dermatophyte infection of the scalp. Predominantly, a disease of childhood, uncommon reports of adult cases are described. For the most part, this infection is characterised by invasion of hair shaft clinically presenting as yellowish scaly plaques, alopecia and/ or inflammatory lesions. We hereby present an immunocompetent adult presenting with a psoriasiform plaque over glabella, culturally referred to as ’bindi’ area. No involvement of the scalp or other hair-borne areas was seen. As she did not agree to undergo a skin biopsy, a last resort of simple stains like potassium hydroxide was done confirming favus. Systemic itraconazole was initiated and complete clinical and mycological resolution was seen with no relapse. Such atypical presentations in adults can cause a diagnostic dilemma and simple stains still hold their ground in making a diagnosis in resourcepoor settings. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction: Anti-Retroviral Therapy (ART) initiation in patients leads to increase in CD4 counts and decrease in the Plasma Viral Load (PVL). However, some patients fail to achieve a significant increase in CD4 count despite undetectable PVL. In spite of complete viral suppression, patients have immunological failure; this is referred as “immunological discordance”. This study is a retrospective analysis of PVL in cases of immunological failure in Human Immunodeficiency Virus (HIV) patients and aims to find out the rate of discordance and associated co-morbid conditions. Aim: To carry out a retrospective analysis of PVL in HIV patients with immunological failure on ART in a tertiary health care centre in Nagpur, Maharashtra, India. Materials and Methods: This study was carried out at the ART centre in Government Medical College and Hospital, Nagpur, Maharashtra, India. Patients (>16 years of age) of immunological failure (458) who started second-line ART during the period 2012-2017 were included in the study. The data was coded using MS-Excel 2013 and statistical softwares OpenEpi (Version 3.01) and STATA (Version 10.1-2011, Texas, USA) were used for analysis. Results: The most common co-existing condition seen was tuberculosis. Risk of low (

Purpose: To identify optical coherence tomography-angiography (OCT-A) findings to predict treatment response during anti-vascular endothelial growth factor (VEGF) therapy in eyes with para foveal telangiectasia (PFT) group II. Methods: In this retrospective series, Twelve eyes of seven patients diagnosed with PFT group II without evidence of sub-retinal neovascular membrane (SRNVM) clinically or on spectral domain-OCT (SD-OCT) were included. All patients underwent OCT-A on the Topcon DRI OCT Triton® with 4.5 mm macula scans. The patients with abnormal vascular nets were further classified into type A and B nets and administered intravitreal anti-VEGF therapy. Visual acuity and size of type A and B nets were evaluated pre- and post-injection. Paired t- test and intraclass correlation were used to analyse data. Results: Patients with type A net showed significant improvement in visual acuity (logMAR 0.38, P = 0.0047). The size of type A net showed statistically significant decrease (P = 0.0008) on 6 month follow up. Type B net did not show statistically significant difference in visual acuity or size following anti-VEGF therapy. Conclusion: OCT-A plays an important role in early detection of possible neovascular nets (type A), in the absence of obvious SRNVM. Treatment decisions based on OCT-A may be helpful to achieve better visual outcome.

Background: Primary infertility is a serious health issue that has profound socioeconomic and health implications on both the individual and society. Despite the important consequences of infertility, estimation of its prevalence is limited. Objective: The objective of the study is (1) to estimate the prevalence of primary infertility among women of reproductive age group in urban population of Central India and (2) to study its associated risk factors. Material and Methods: In a community-based cross-sectional study, all married women between 15 and 49 years of age in urban field practice area were included. The data were collected by face-to-face interview with the help of predesigned and pretested questionnaire. Results: The majority of the women (39.3%) belonged to 25–29 years of age group. The overall prevalence of primary infertility among reproductive age group women was 8.9% (51/570). Sociodemographic factors that had statistically significant association with infertility were age at marriage more than 25 years (P < 0.05), nuclear family (P < 0.05), higher education level (P = 0.04), employed women (P < 0.05), high socioeconomic status (P = 0.01), and family history of infertility (P < 0.05). Physiological factors that had statistically significant association with infertility were obesity (P = 0.03), age at menarche more than 14 years (P < 0.05) and irregular menstruation pattern (P < 0.05). Depression (P = 0.01) and stress (P < 0.05) were the psychological factors significantly associated with infertility. Conclusion: The prevalence rate of primary infertility in urban population of Central India was lower than reported trends of infertility from developing countries. Sound knowledge about various factors related to infertility can help health-care providers and policymakers to design and implement various policies.

Asymptomatic phimosis is normal in young children which self-corrects itself but leads to parental anxiety. Topical steroids lead to correction of this physiologic phimosis avoiding the need of circumcision. Six male children aged between 3 and 14 years presented with asymptomatic tight phimosis present since birth. All the children were advised application of small amount of clobetasol propionate cream at night along with manual retraction during bath. At the end of 2 months, all the children had fully retractable prepuce. By the first visit (2 weeks), all the patients showed at least partial retractability of the prepuce. Till the follow-up period of 6 months, there was no recurrence in any patient. No side effects were observed.

A 31-year-old male presented with decreased vision in the right eye associated with an active plaque-like serpiginoid choroiditis. The lesion showed a unique feature of dual margins of hyperautofluorescence of the lesion on fundus autofluoresence (FAF) imaging. Systemic investigations suggested a tubercular etiology. He was started on antitubercular treatment and a conventional dose of oral corticosteroids (1mg/kg body weight). However, the lesions showed paradoxical worsening and required increased immunosuppression in the form of local steroids and oral immunomodulators. The presence of dual margins of hyperautofluorescence could suggest increased inflammatory activity leading to paradoxical worsening on treatment requiring increased immunosuppression.

Abstract Background Families play a critical role in supporting the health and well-being of children with chronic illnesses, who face a lifetime of responsibility for self-management of their condition. Our goal was to investigate whether the novel Patient-Reported Outcomes Measurement Information System® (PROMIS®) Pediatric Family Relationships measure, developed primarily within the general pediatric population, reflects the experiences of family relationships for chronically ill children and their parents. Methods We conducted semi-structured qualitative interviews with children (aged 8–17) with common chronic conditions: asthma (n = 6), type 1 diabetes (n = 5), or sickle cell disease (n = 5), and separately with one of their parents (n = 16). Interviews were recorded, and two team members independently coded the written transcripts facilitated by Nvivo 10. The systematic content analysis used a combination of: 1) pre-specified themes corresponding to the six facets of the domain identified during measure development and reflected in the content of the items (i.e., Sense of Family; Love and Caring; Value and Acceptance; Trust, Dependability, and Support; Communication; Enjoyment), as well as 2) open-coding, allowing participants to define important concepts (i.e., disease impact). Results Family relationships were conceptualized in a similar way to the general population, as evidenced by child and parent responses to open-ended questions about family relationships and to specific probes that corresponded with the item content in the Family Relationship 8-item short form. Children spontaneously discussed the impact of their disease on family relationships less often than parents did. Although participants described how living with a chronic illness positively and negatively impacted aspects of family relationships, nearly all participants believed their responses to the PROMIS® Family Relationships items would not change if they (or their child) did not have a chronic illness. Conclusions Among a sample of families of children with one of 3 chronic illnesses, participants described family relationships in a way that was consistent with the facets of the PROMIS® Family Relationship domain. This study adds to the content validity of the measure for children with chronic illness.

Introduction: Prakriti (body constitution) is the essential fundamental of Ayurveda. In female physiology, it plays a crucial role in determining the age of menarche and menopause. Recent research has shown that early menopause occurs in tribal women. Vagbhata states that a kapha dosha pradhan prakriti female has a longer menstrual life [i.e., reproductive period] compared to the vata and pitta prakriti females. This study was done to estimate prakriti in females who attain early and premature menopause in the tribal population to provide optimal care for tribal women through primary and whole health systems. Materials and Methods: This cross‑sectional questionnaire survey study was carried out in four villages of Nagpur district territory of Eastern Maharashtra, the central zone of India after seeking permission from IEC. A multistage sampling technique was used to select the 80%, and above tribal people, 169 married women who attained early or premature menopause were included. Post‑menopausal women were selected for the study, and females with hysterectomy, secondary amenorrhea, and other major illnesses were excluded from the study. Data were collected by survey method with the help of a pre‑validated questionnaire. Observation and Result: Out of 169 females 57.98% of females were of vata prakriti, 24.85% of females were of pitta prakriti, and 17.15% of females were of kapha prakriti. The prevalence of early or premature menopause of vata prakriti females is 57.98. Discussion: Vata dosha characteristics such as ruksha, laghu, sheeta, and khara in vata prakriti females lead to early or premature menopause. To avoid early or premature menopause in tribal females, ghee (ghrit) and milk can be included in dietary habits, lifestyle modification, and awareness counseling may prove beneficial. Conclusion: Early or premature menopause is observed largely in vata prakriti females of Nagpur district, Eastern Maharashtra, tribal zone of Central Inda. [ABSTRACT FROM AUTHOR]

Background and Aim: Although there are national initiatives such as the National Mission for Sustainable Agriculture and the Millet Mission, there is a significant knowledge gap present among the people related to the importance and advantages of millets, inculcating their use in practice. Hence, the present study was conducted to assess the knowledge about the health benefits of millets and practices regarding its consumption and to determine the association between sociodemographic factors and the consumption of millets. Materials and Methods: Following institutional ethics committee approval, a semi-structured, pretested, prevalidated questionnaire was used to collect data via interviews of patients coming to the general outpatient department of a district hospital. Besides sociodemographic information, it also covered questions related to the participant's knowledge and practices regarding the consumption of millets. Results: Only 23% of the participants had consumed any kind of millets. The most common reason for nonconsumption was the nonavailability of the millets followed by the family custom of not eating. Only 20.2% had moderate-to-good knowledge regarding the health benefits of millets. A statistically significant association was found between the consumption of millets and the type of family and level of education (P < 0.05). Conclusion: A significant knowledge gap was present among the population related to the health benefits of millets. The proportion of consumption of millets among the population was found to be low. [ABSTRACT FROM AUTHOR]

Objective: Computer vision syndrome is a major global public health concern affecting >60 million individuals globally. Yoga and naturopathy practices can reduce visual fatigue and strain. The present study attempted to explore the effect of trataka that is, a yogic cleansing technique and cold eye pack on visual strain and fatigue. Subjects: Three hundred volunteers from an IT company were recruited following inclusion and exclusion criteria. Intervention: The subjects were randomly distributed in three groups, that is, trataka, cold eye pack, and waitlist control group with an allocation ratio of 1:1:1. Outcome measure: Visual Fatigue Scale and Visual symptoms checklist (VSC) was administered at baseline and end of 2 weeks. Repeated measures analysis of variance (RM-ANOVA) with Bonferroni corrections was used to test the difference across the groups. Results: All the variables were similar at the baseline among the groups. Significant changes in the within-group analysis occurred in both the trataka and cold eye pack groups. The RM-ANOVA revealed significant differences in the VAS and VSC (p = 0.001) and the post hoc analysis suggested that there were significant differences in both the trataka and cold eye pack group when compared with the control group (p = 0.001); however, there was no differences between the trataka and cold eye pack group in both the scales (p = 1). Conclusions: The results of the present study suggest that a trataka and cold eye pack for 14 days improves self-rated visual strain and fatigue among IT professionals with computer vision syndrome. Clinical Trial registration number: CTRI/2020/11/029003 [ABSTRACT FROM AUTHOR]

Context: Medical undergraduates, being away from their institutes due to the lockdown, are at a greater risk of being affected by the negative news, which may easily instill fear and panic among them. Therefore, the present study was planned with the objective to study the effects of media exposure on the psychological health of undergraduate medical students at a tertiary health institute. Aim: To assess the psychological effects of social media/media use and coping mechanisms adopted during the COVID-19 pandemic. Settings and Design: Tertiary care teaching Institute and Cross-sectional study. Material and Methods: It is a cross-sectional observational study performed among (under graduate) UG students, which was assessed using a pre-tested questionnaire including the pre-validated DASS-21 scale. Statistical Analysis: Data collected was entered in MS Excel. Descriptive statistics and correlation of the study variables were analyzed while controlling for demographics using Epi-info software version 7.2.2. Results: It was observed that around one-fifth of the participants have moderate depression, followed by mild 10.97%; one-fifth of the participants have moderate levels of anxiety 20.41% followed by extremely severe anxiety 13.27% and about two-thirds of the study participants having no stress 64.29% followed by mild stress 14.80% and moderate stress 9.69%. Conclusion: There was a significant psychological impact of the use of social media among young populations, particularly anxiety, stress, and depression with exposure to negative news and reports on social media platforms. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular events are known to be the leading cause of death among on-duty firefighters. Implementing fitness standards may help reduce the incidence of cardiovascular deaths; however, standards vary between firefighter type and states. We aimed to investigate the rate of cardiovascular events among firefighters across states. Methods: Using publicly available data from the United States Fire Administration, we explored the rates of cardiovascular deaths between firefighter type (e.g., career, volunteer, and wildland) and state. Specifically, we examined rates of cardiovascular deaths between California and Tennessee, which have fitness standards for all firefighters, and New York, which does not have fitness standards for volunteer firefighters. We used descriptive statistics and trend analysis to examine the data. Findings: Most cardiovascular events occur among volunteer firefighters (60.6%, n = 877). Volunteer firefighters had 7.5 (95% CI = [4.8, 11.7], p <.001) greater odds of cardiovascular events compared to wildland firefighters, who had the lowest incidence of cardiovascular events (1.7%, n = 24). New York reported the most cardiovascular events (n = 161), primarily among volunteer firefighters (73.9%, n = 119). After the passage of legislation mandating fitness standards in California, a downtrend in the number of volunteer firefighter fatalities is observed. However, a null effect was observed in Tennessee after the passage of similar fitness standards as in California. Conclusions/Applications to Practice: Volunteer firefighters are significantly more likely to die of a cardiovascular event than career and wildland firefighters, both of which have stricter fitness standards. However, the effect of legislation mandating stricter fitness standards among volunteers did not produce a clear benefit for preventing fatalities. Nurses need to promote cardiovascular health among volunteer firefighters. [ABSTRACT FROM AUTHOR]

Background: Community Medicine is a subject which receives relatively less attention in medical curriculum. Active participation of students in preparation of training modules for Community Health Workers (CHWs) could facilitate their learning in topics related to Community Medicine. This study aimed to involve medical students in the preparation of training modules for CHWs and assess the effects of their participation on their knowledge about targeted diseases. Methods: An interventional study where all 144 undergraduate fifth-semester students from Bharati Vidyapeeth University Medical College, Pune, India posted at Community Medicine Department participated in the preparation of training modules for CHWs on HIV/AIDS, tuberculosis, malaria and diabetes and completed pre- and post-intervention questionnaire. Each completed questionnaire was assigned a score based on a marking system. The data was analysed using paired t test. Results: Statistically significant improvement in knowledge was found (pre-test mean score: 5.79, post-test mean score: 14.15, t = 26.93, p

Background: There is very little evidence available on the effects of yoga-based breathing practices on response inhibition. The current study used stop-signal paradigm to assess the effects of yoga breathing with intermittent breath holding (YBH) on response inhibition among healthy volunteers. Materials and Methods: Thirty-six healthy volunteers (17 males + 19 females), with mean age of 20.31 ± 3.48 years from a university, were recruited in a within-subject repeated measures (RM) design. The recordings for stop signal task were performed on three different days for baseline, post-YBH, and post yogic breath awareness (YBA) sessions. Stop-signal reaction time (SSRT), mean reaction time to go stimuli (go RT), and the probability of responding on-stop signal trials (p [r/s]) were analyzed for 36 volunteers using RM analysis of variance. Results: SSRT reduced significantly in both YBH (218.33 ± 38.38) and YBA (213.15 ± 37.29) groups when compared to baseline (231.98 ± 29.54). No significant changes were observed in go RT and p (r/s). Further, the changes in SSRT were not significantly different among YBH and YBA groups. Conclusion: Both YBH and YBA groups were found to enhance response inhibition in the stop-signal paradigm. YBH could be further evaluated in clinical settings for conditions where response inhibition is altered.

Purpose: The aim of this study is to establish the safety of storage and reuse of bevacizumab vials for 1 week with multiple vial punctures. Methods: This was an experimental microbiological study conducted at tertiary care hospital. The study samples included bevacizumab vials that had been used for injecting patients by the pooling method. Vials were stored and sampled in a manner that replicated their proposed clinical use. Contamination of vials was evaluated on the basis of microbial culture and validated by positive and negative controls. The probability of obtaining such results purely by chance was calculated. Results: A total of 210 samples from 30 vials were evaluated along with 210 positive and 210 negative controls. No growth was seen in any of the bevacizumab samples. The probability of obtaining 210 consecutive sterile samples just by chance is

Background: Dysfunctional uterine bleeding (DUB) is one of the most common gynecological disorders encountered in women during the reproductive age. Yoga therapy has shown promising benefits in several gynecological disorders. Methods: Thirty women between the ages of 20 and 40 years with primary DUB were randomly assigned to a yoga (n = 15) and a waitlist control group (n = 15). Participants in the yoga group received a 3-month yoga module and were assessed for hemoglobin values, endometrial thickness (ET), pictorial blood loss assessment chart (PBAC), State-Trait Anxiety Inventory, perceived stress scale, and Pittsburgh Sleep Quality Index (PSQI) before and after a 3-month follow-up period. Results: At the end of 3 months of intervention, the yoga group, unlike the control group, reported a significant reduction in the anxiety scores (P < 0.05) and perceived stress (P < 0.05). The PSQI scores indicated a reduction in sleep disturbances (P < 0.001) and the need for sleep medications (P < 0.01) and higher global scores (P < 0.001). However, there were no changes in PBAC and ET in both the groups. Conclusion: The results indicate that yoga therapy positively impacts the outcome of DUB by reducing the perceived stress and state anxiety and improving the quality of sleep. This warrants larger clinical trials to validate the findings of this pilot study.

The influence of the ratio of Eudragit® L100-55 or Kolliphor® P188 on the solubility, dissolution, and permeability of ritonavir was studied with a goal of preparing solid dispersions (SDs) of ritonavir. SDs were formulated using solvent evaporation or lyophilization techniques, and evaluated for their physical-chemical properties. The dissolution and permeability assessments of the functionality of the SDs were carried out. The preliminary functional stability of these formulations was assessed at accelerated storage conditions for a period of six months. Ritonavir: Eudragit® L100-55 (RE, 1:3) SD showed a 36-fold higher ritonavir solubility compared to pure ritonavir. Similarly, ritonavir: Kolliphor® P188 (RP, 1:2) SD exhibited a 49-fold higher ritonavir solubility compared to pure ritonavir. Ritonavir dissolution from RE formulations increased with increasing ratios of Eudragit® L100-55, up to a ritonavir: carrier ratio of 1:3. The ritonavir dissolution from RP formulations was highest at ritonavir: Kolliphor® P188 ratio of 1:2. Dissolution efficiencies of these formulations were found to be in line with, and supported the dissolution results. The permeability of ritonavir across the biological membrane from the optimized formulations RE (1:3) and RP (1:2) were ~76 % and ~97 %, respectively; and were significantly higher compared to that of pure ritonavir (~20 %). A preliminary (six-month) stability study demonstrated the functional stability of prepared solid dispersions. The present study demonstrates that ritonavir solubility, dissolution, and permeability improvement can be achieved with a careful choice of the carrier polymer, and optimizing the amount of polymer in a SD formulation.

Neonatal pemphigus is a transient, self-limiting entity featuring appearance of evanescent blisters in a neonate born to mother diagnosed with immuno-bullous blistering disorders. A case report of neonatal pemphigus born to a 30-year-old female with Pemphigus Vulgaris is being reported. Higher maternal antibody titre causing clinically evident blistering in neonate is not commonly reported. This report, thus, emphasises the need for diagnostic considerations and vigilant surveillance of neonatal pemphigus in neonates born to mothers with immunobullous disorders. Since the cases reported in the literature and the references assessed revealed that neonatal pemphigus is infrequent, but the understanding about the disease permits for an early diagnosis to be made.