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Introduction: Pain is the most unpleasant subjective feeling comprising of innumerable emotional and psychological components that require medical advice for relief, regardless of the cause. Transversus Abdominis Plane (TAP) block and Erector Spinae Plane (ESP) block are effectively studied blocks that provide adequate pain control. Aim: To compare postoperative analgesic efficacy in pregnant women undergoing caesarean section under spinal anaesthesia with Ultrasound (USG)-guided TAP block and USG-guided ESP block. Materials and Methods: In this institution-based interventional randomised clinical study, two categories comprising 30 subjects in group I with USG-guided bilateral TAP block and group II with USG-guided bilateral ESP block using Ropivacaine were involved. Visual Analogue Scale (VAS) was used to compare analgesic efficacy. Other parameters for analysis included time of first rescue analgesia, total number of administrations of rescue analgesia within 24 hours, together with Adverse Drug Reactions (ADRs). Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 21.0. Student’s t-test and Chi-square test were used for data analysis. Results: Subjects in group I had a mean age of 24.9±4.66 years while those in group II were 25.5±3.99 years. The VAS score at 24 hours in group I was 7.22±0.89 and in group II was 6.8±0.83, which was statistically significant with a p-value of 0.0241. USG-guided ESP block was superior to USG-guided TAP block, providing analgesia for 24 hours. Following the first dose, there was a significant delay in rescue analgesia and a reduction in the total administration of rescue analgesia within 24 hours. The first rescue analgesia in group I was at 10.66±2.32 hours and in group II was at 16.66±2.53 hours, with a p-value of 0.0001 indicating a statistically significant difference. No ADRs were reported in either group of participants. Conclusion: ESP block provided a prolonged duration of analgesia, as shown by a decrease in the total VAS score. There was also a significant reduction in the total number of administrations of rescue analgesia within 24 hours when compared to TAP block, suggesting that ESP block provides superior analgesia. Hence, for pain relief in postcaesarean section individuals, ESP block can be regarded as a novel potent option.

Background: Early childhood development (ECD) is the foundation of future life starting from conception and depends on biological and environmental factors. Seventy-four percent of these children reside in villages; many are underserved and marginalized. Enabling young children to achieve their full developmental potential is a requisite for sustainable development, but globally, 43% of children are still at risk to do so. The problem of ECD is grave for underprivileged rural population in India. Objectives: The objective of the present study was to identify the key risk factors that are prevalent in a marginalized rural community in West Bengal and to observe the impact of these impeding factors on ECD, thereby helping in priority setting in service delivery to optimize ECD promotion. Methods: In this community-based cross-sectional observational study, a random sample survey of 609 households with children 0–6 years was conducted in Purulia district, West Bengal, India, using a Multiple Indicator Cluster Survey III-based questionnaire followed by data analysis. Results: Lack of stimulatory home environment, poor learning opportunities, and inadequate responsive parental care were major hindrances. The cumulative effect of multiple other health and hygiene factors was also hindering ECD. Most factors were strongly influenced by poor maternal education. Conclusion: Education of caregivers, especially parents by dedicated health workers on early learning opportunities, showed the path of applied sciences in pediatric clinical practice. To modulate socioeconomic adversities with responsive parental care, ECD can be fostered.

Background: The role of caregivers in grooming the neuro-developmental outcome of high-risk newborns and developmental challenges in children needs to be explored. Objectives: To find the knowledge and perception among parents regarding the neuro-developmental outcome of high-risk newborns, methods adopted to address these problems, and to identify areas on which awareness generation needs to focus. Materials and Methods: A questionnaire-based awareness survey was conducted to understand the knowledge, attitude, and practices of families of children with developmental challenges. Results: The study revealed that more than 70 percent of families lack information about child development, developmental challenges, and means to deal with them. They are unaware of the available health care services and other resources. One in three families has misconceptions on developmental disabilities; consider them as curse or jinx and consequently neglected. Female children with developmental problems are further ostracized due to gender inequity in families. About 10 percent of families have shown great openness toward acquiring new skills and knowledge for handling their children with developmental delays. Conclusions: This study is based on the précis research findings of our grass-root level fieldwork conducted in remote rural Bengal areas. The observation will be of interest and learning materials for general primary care practitioners, family physicians, and stakeholders to initiate appropriate intervention strategies for properly rehabilitating children with developmental delay at grass-root levels of primary health care.

Background: Many studies have shown the beneficial effect of prophylactic lidocaine or esmolol on hemodynamic response during laryngoscopic intubation. Although many studies observed a better effect of esmolol over lidocaine, some studies have drawn an impression of equal efficacy or even no benefit with the use of either of the drugs. Aims and Objectives: The study aimed to compare the heart rate (HR) at 1 min after intubation between the patients receiving lidocaine and esmolol. Other outcome measures were to compare HR at 3 and 5 min post-intubation and to compare the mean arterial pressure at 1, 3, and 5 min after intubation. In addition, the adverse events, if any, were noted. Materials and Methods: Fifty patients, 30–45 years, either sex, Mallampati grade 1–2, of the American Society of Anesthesiologists physical status I-II, posted for elective abdominal surgery requiring direct laryngoscopic endotracheal intubation were included. Patients were randomly allocated into two groups to receive esmolol 2 mg/kg (Group E, n=25) or 2% lidocaine 2 mg/kg (Group L, n=25), intravenously. HR and mean arterial blood pressure (MAP) were recorded at 1-, 3-, and 5-min interval post-intubation. Results: The mean HR at 1-min post-intubation was considerably lower using esmolol in comparison with lidocaine (91.7±9.7 vs. 107.7±5.1, P≤0.0001). The mean HR and MAP at 3-min and 5-min post-intubation were considerably lower with the use of esmolol compared with lidocaine. Conclusion: Esmolol is better than lidocaine in attenuating the hemodynamic response of intubation.

Background: COVID-19 pandemic demanded upgrading of laboratory medicine to limit morbidity, disability and mortality from moderate and severe SARS-COV-2 infections. Objective: To assess among moderate and severe COVID-19 patients, C-reactive protein (CRP), procalcitonin (PCT), ferritin, D-dimer, interleukin 6 (IL-6), lactate dehydrogenase (LDH), total and differential leucocyte count (TLC and DLC), neutrophil-to-lymphocyte ratio (NLR), absolute platelet count (APC), prothrombin time (PT), activated partial thromboplastin time (APTT) and international normalized ratio (INR) to find their interdependence and role in prognosis. Methods: This open label analytical cross-sectional noninterventional study evaluated array of independent biochemical, haematological and coagulopathy markers, viz. CRP, PCT, ferritin, D-dimer, IL-6, LDH, TLC, DLC, NLR, absolute platelet count, PT, APTT and INR on consecutive 100 patients with diagnosis of moderate and severe COVID-19 from July to August 2021. Results: In our study, on consecutive designated 100 cases (55 cases moderate and 45 cases severe), more severity were reported as the age progressed; gender difference was not noted. Among independent markers, CRP, PCT, ferritin, D-dimer, IL-6 and LDH had statistically significant relation in comparison with severity of the disease as Chi-square calculated value (P < 0.05). TLC, DLC and APC showed no significant relation in comparison with severity of the disease; NLR had highly significant relation. PT showed significant relation in comparison with severity, though APTT and INR did not show significant relation. Conclusion: Our research group felt that CRP, PCT, ferritin, D-dimer, IL-6, LDH and NLR should be in included in clinical practice guidelines to prognosticate COVID-19 cases. Furthermore, translational researches are needed at all levels of healthcare to improve validity for practices of primary care physicians.

Background: Foundation course is an integral part of MBBS course and curriculum introduced by the National Medical Commission (NMC) that is cogently grounded to bridge conceptual and contextual gap of medical education placed at beginning of curriculum. Objective: This feedback evaluation was conducted on the First year 2019 MBBS students as a part of the foundation course program promulgated by the NMC to get candid reflection. Methods: An unlinked anonymous self-administered pretested open-ended questionnaire on feedback of content and outcome was used on internalization of 169 First year MBBS students regarding the month-long foundation course. Qualitative responses were analyzed on ‘overall impression’ on the course; ‘best’, ‘worst’ and ‘unnecessary’ parts of the course; lastly open question on ‘How the Foundation course could have been better?. Results: Overall agreement on positive aspects was felt on schedule, facilitators, language of teaching, extracurricular activities. Best parts of the course were visits to the departments of College & Hospital including emergency and health centres, Basic Life Support, Immunization, History of Medicine, Taekwondo, Co-curricular physical activities, Communication, Interaction and Dedication of teachers, Cardiopulmonary resuscitation (CPR). Worst parts were Sports, Yoga, language class, strict 75% attendance. Unnecessary parts were Sports, Yoga, English compulsory class; Music, Computer. On ‘How the Course could have been better’ general comments was addition of subject specific classes and flexible attendance. Conclusions: This feedback analysis deduced acceptance and effectiveness of the course for undergraduate students to help them cope with stressful active professional learning later.

A 7-day-old male child presented with abdominal distention and jaundice. Radiological investigations revealed an encapsulated sac encasing three fetus-in-fetu (FIF) in the retroperitoneum. Laparotomy revealed a sac occupying almost the whole of the abdomen. The sac was stretching the duodenum and barely visible common bile duct, which were carefully separated. The rest of the bowel was displaced to the left. The sac containing three FIFs was excised intact. One of the fetuses was highly differentiated and had thoracic meningomyelocele, which has never been reported in FIF.

Background: The use of poly(adenosine diphosphate-ribose) polymerase (PARP) inhibitors for breast cancer (BC) therapy is the subject of debate, and there is an urgent need to understand much the expression and prognostic role of the PARP1 protein. In this study, we have compared the expression of PARP between BC and benign breast disease (BBD) patients and also analyzed the association of PARP expression with clinicopathological parameters in BC. Methods: The study consists of 30 patients with newly diagnosed operable BC who were planned for surgery without neoadjuvant chemotherapy and 15 patients of BBD as a control between 2019 and 2021. Immunohistochemical analyses were performed prospectively on tissue samples. Anti-human PARP1 rabbit polyclonal antibody gives strong nuclear positivity. Internal control was the adipose tissue and the BBD acted as the external control. PARP1 expression was evaluated using the multiplicative quickscore method. Results: The mean age for BC patients was 51.30 ± 10.694 years (range: 25–75 years) while BBD was below 30 years. Overexpression of PARP was present in 25 (83.3%) and weak expression in 5 (16.7%) of BC patients compared to BBD, only 2 (13.3%) patients demonstrated an overexpression of PARP, and 13 (86.6%) patients showed weak expression which showed significant association (P < 0.001). In BC, nuclear PARP (nPARP) overexpression was seen in 22 (73.3%) patients and weak expression of nPARP in 8 (26.7%), whereas 5 (16.7%) patients showed cytoplasmic overexpression. On comparing expression of PARP with clinicopathological parameters, PARP overexpression was significantly associated with older population (age >50 years) (P = 0.002), postmenopausal women (P = 0.029), higher TNM stage (Stage II and III) (P = 0.014), higher histological grade (grade 2) (P = 0.043), and presence of lymphovascular invasion (P = 0.015). Enhanced PARP1 expression is closely correlated with positive estrogen receptor status (P = 0.001) and PR status (P = 0.001). Overall PARP and nPARP overexpression was significantly associated with ER- (P = 0.006 and P = 0.008) and PR-positive (P = 0.006 and P = 0.008) patients. The PARP and nPARP overexpression was significantly associated with nontriple-negative BC patients (P = 0.001 and P = 0.001). Conclusion: We have not come across any study in the literature to compare PARP expression in BC and BBD patients. On the basis of our observations, we concluded that PARP overexpression is a poor prognostic marker in BC.

The reasons for high morbidity and mortality with Corona virus disease (COVID-19) disease remain unanswered with extremes of manifestation and uncertainty of modes of transmission for which biomarkers are urgently needed for early prediction of severity and prompt treatment. We have reviewed publications from PubMed (years 2019–2021) analysing the biochemical, immune-inflammatory, nucleic acid, and cellular biomarkers that predict infection, disease progression in COVID-19 with emphasis on organ-specific damage. Our analysis of 65 biomarkers assessing the impact of SCoV-2 infection on five organs (lung, liver, cardiac, kidney, and neural) reported that increased levels of CRP, TNF-α, ferritin, IL-6, D-dimer, Procalcitonin, Fibrinogen to Albumin Ratio (FAR), and decrease platelet count (PC), lymphocyte count, leukocyte count, and CD4+/CD8+ ratio shows promising association in the early diagnosis, prediction of prognosis and severity disease and also correlates with cytokine storm a cardinal feature of COVID-19 progression. In the above scenario, this review has put forth the most promising biomarkers for COVID diagnosis and prognosis based on the reported literature. In recent year's chemically synthesized antibody-like biomolecules, aptamers were also used in the diagnosis of COVID-19 which could be preferably used for diagnosis over antibodies. Biomarkers including increase in free DNA and Fibrinogen-to-Albumin Ratio, CRP, PCT, and Ferritin along with a consequential decrease of CD3+ T, CD4+ T, CD8+ T, NK cells with corresponding increase in CD4+/CD8+ ratio following SARS CoV-2 infection has been consistently correlated with disease severity. Despite the two waves of COVID-19 pandemic, currently there is no standard clinical practice guideline for evaluating the severity of the devastating pandemic of COVID-19, hence these biomarkers will have immense relevance for the third and subsequent wave of COVID-19 and related pandemic.

CoVID-19 is the most formidable unequaled global challenge invading 220 countries and territories in this millennium to uncountable saga of mortality, disability as humanity is witnessing devastation of socio-economy with more than 4 million deaths till date. The natural history of CoVID-19 from transmission through varied clinical features to overt complications is still under global research and research groups are on the run to trace its ramifications. This ranges from primary involvement of the pulmonary system to multisystem involvement through web of immunological pathways associated with susceptibility, clinical presentations, and severity of COVID-19. It has been hypothesized that the safe and effective mass vaccination program across the globe can ensure flattening of the pandemic curve to prepandemic normal life. This research group explored the basic and applied researches on molecular and immune mechanisms of SARS COV-2 virus. A sincere attempt has been made in futuristic research vision to find potential strengths, shortfalls, and efficacy of the plant-based immunotherapy, antibodies, and vaccine. Different research groups have hypothesized for the best possible use of these indigenous, stable, secure, efficacious natural products by searching their potential to accomplish emergency demands in this trying time. There is an urgent need to understand the inherent immunological predictors of the natural history of the disease spread over the spectrum from mild to severe forms of the disease and harp on these issues. In the wake of multiple waves with worse situations of evolving clinical features with the “variants of concern” and “variants of interest” and innovative interventions, this research group believes in optimum mix of microbial-derived biologicals with immune modifying drugs will broaden the preventive and curative spectrum.

Several methods have been proposed to increase bonding of zirconia with resin. However, we are still to find the Holy Grail. A systematic literature review was performed through PubMed on international literature from January 2000 to May 2021 with relevant Medical Subject Headings terms. 56 articles were found to be relevant. Of all the different methods proposed, mechanochemical pretreatment of zirconia surface with alumina oxide and use of 10-methacryloyloxydecyl dihydrogen phosphate were found to be most effective as per majority of studies. New methods that require further research also surfaced.

Berry crops, a nutrient powerhouse for antioxidant properties, have long been enjoyed as a health-promoting delicious food. Significant progress has been achieved for the propagation of berry crops using tissue culture techniques. Although bioreactor micropropagation has been developed as a cost-effective propagation technology for berry crops, genetic stability can be a problem for commercial micropropagation that can be monitored at morphological, biochemical, and molecular levels. Somaclonal variations, both genetic and epigenetic, in tissue culture regenerants are influenced by different factors, such as donor genotype, explant type and origin, chimeral tissues, culture media type, concentration and combination of plant growth regulators, and culture conditions and period. Tissue culture regenerants in berry crops show increased vegetative growth, rhizome production, and berry yield, containing higher antioxidant activity in fruits and leaves that might be due to epigenetic variation. The present review provides an in-depth study on various aspects of phenotypic variation in micropropagated berry plants and the epigenetic effects on these variations along with the role of DNA methylation, to fill the existing gap in literature.

Circulating inflammatory markers may predict the broad clinical spectrum of traumatic brain injury (TBI). The present study aimed to illustrate the role of leukocytes, precisely neutrophil and lymphocytes, in neuroinflammation as a new vista in neuro-critical care. Search terms were: elevations in peripheral blood leukocytes counts, neutrophil, lymphocyte with precisely neutrophil to lymphocyte ratios, associated with adverse outcomes of traumatic brain injury, pre and post-operative conditions of intracerebral haemorrhage, seizures, delirium, non-convulsive status epilepticus, confusion, aphasia, agitation, coma, disability and death. As a result, we identified 16 publications describing leukocyte biomarkers associated with neuroinflammation following TBI from PubMed, Cochrane Registry of Controlled Trials, Medline and Embase (Ovid) on randomised controlled trials (RCTs), non-RCTs and cohort studies published in the last decade. This study concluded that elevations in peripheral blood leukocyte and neutrophil to lymphocyte ratios could predict adverse outcomes of a cerebral haemorrhage.

Background: The present study was undertaken to identify various prognostic biomarkers related to coagulation that may predict the outcome of mild to moderate CoVID-19 patients. Objectives: The biomarkers aPTT, PT, INR, D-Dimer, Procalcitonin, Ferritin were studied with their interdependence on each other and with their severity in the CoVID-19 patients. Methods: An analytical cross-sectional study was conducted at the department of Biochemistry, and Indoor medical wards of Medical College & Hospital, Kolkata from June 2020 to December 2020 among 120 adult consecutive consenting mild to moderate patients with documented history and diagnosis of CoVID-19. Statistical analysis was done to find association of these coagulation parameters and their significant correlation to prognosticate severity of CoVID-19. Results: Highest numbers of cases were from 51-60 years age group, followed by 21-30 and 31-40 years with almost equal gender distribution; unfavourable findings were more in males in all age groups except 31-40 years, not statistically significant. Activated partial thromboplastin time (aPTT), Prothrombin time (PT), Procalcitonin (PCT), D-dimer levels were significantly higher in mild and moderate CoVID-19 cases; gender-wise difference was significant only in PCT and D-dimer levels. Ferritin levels were higher, with no significant differences in age and gender. Conclusions: Procalcitonin and D-dimer were superior biomarkers to predict severity in COVID-19 patients. These observations need further evaluation with systems approach.

Hirschsprung’s disease (HD) is a common congenital paediatric disorder. The gold standard for its diagnosis is the demonstration of the absence of ganglion cells on H&E stained sections from a spastic segment of the bowel, still at times; conclusive diagnosis of HD is difficult. This study was done to assess the accuracy of rapid Hematoxylin & Eosin (H&E) staining and AChE histochemistry in combination for the diagnosis of HD, especially in frozen section specimens. Samples from 36 clinically suspected HD cases were evaluated for the presence or absence of ganglion cells on H&E staining on both fresh-frozen and paraffin-embedded sections, whereas AChE staining was done on frozen sections only. Of the 36 cases of frozen section specimens from the spastic region of the colon, GCs were absent in 28 cases on H&E staining while positive staining patterns on AChE histochemistry were observed in 29 cases. Formalin-fixed paraffin-embedded sections showed the absence of GC on H&E staining in 28 cases. The sensitivity and specificity of frozen sections with rapid H&E were 77.78% and 81.82% while the sensitivity and specificity of AChE histochemistry were 80.56% and 81.82% respectively in the diagnosis of HD. Application of AChE histochemistry as an ancillary technique on frozen sections specimens of HD in combination with rapid H&E staining is very useful for definitive diagnosis of HD.

COVID-19 disease caused by the SARS-CoV-2 virus affects almost all the organ systems of the body leading to multisystemic morbidities and typical complications hitherto unheard of in seasonal “flu” or SARS-CoV-1 epidemic. Acute life-threatening complications range from unabated pneumonia and respiratory failure to “cytokine release syndrome” or “cytokine storm,” cardiovascular and cerebrovascular morbidities leading to multiorgan failure, followed by death. The prepathogenesis, pathogenesis, and the clinico-demographic characteristics of SARS-CoV-2 infection have shown a wide variation across different populations, geographical regions, race, and ethnicities. While there are some commonalities, there continues to be a lack of consensus on several aspects of this infection such as its natural history, infectivity, transmission, and its mutagenic strains. Further, newer aspects of the disease have continued to emerge with passing time since its first appearance in December 2019 in Wuhan, China. The initial case descriptions varied from asymptomatic to mild illness requiring minimal monitoring and support to severe COVID-19 disease requiring admission to intensive care facilities and a higher morbidity and mortality. Only subsequently it was recognized that even after the clinical recovery from illness, the infection may persist for a longer time, with continuing damage to some organ systems and sequelae that compromise the quality of life. These have been called the long-term complications or “chronic COVID” infection, and they may be noted even months after recovery from the acute form of disease. While thus far the global efforts have been rightfully directed at combating the acute illness in the pandemic and maximizing recovery, it is possible that we may soon be faced with the challenge of a “secondary pandemic” with a significant burden of chronic COVID and sequelae. This will be a strain on the palliative care, rehabilitative care, and domiciliary care network essentially supported by the primary health-care providers or first-contact physicians worldwide. This approach is in alignment with an emphasis that the WHO placed on the third clinical outcome indicator “functioning” in addition to the two indicators “cure” and “death.” The present review discusses the pathophysiology, clinical aspects, and implications of long-term effects of SARS-CoV-2 infection. It is expected to help in sensitizing the health-care workers and policymakers for preparing adequately and timely for dealing with these effects.

Introduction: Hospital-acquired infection (HAI) rates were reported to have declined in healthcare settings during the Covid-19 pandemic. Needless to mention that HAI is of paramount interest and relevance to a primary care physician who need to care from womb to tomb inside pandemic. Objectives: This study was conducted to find the impact of Covid-19 pandemic on the four parameters of HAIs, namely, catheter-associated urinary tract infections (CAUTI), central-line-associated bloodstream infections (CLABSI), ventilator-associated pneumonia (VAP) and surgical site infections (SSIs) with hand hygiene compliance rates among healthcare workers. Materials and Methods: This retrospective data mining was undertaken in a 700 bed multispecialty teaching hospital in the Eastern India which was a Government of Bihar approved speciality Covid Care Hospital. Data from the monthly routine infection control monitoring and surveillance activities was collated from January 2019 to December 2020. Control charts with upper and lower control limit set at mean ± 1 SD were used to monitor monthly trends of HAIs. Results: The CAUTI rates reduced by 28.01%; the CLABSI rates declined by 37.61%, the SSI rates reduced by 62.39%, while the highest VAP rates were reported in November 2019 (1.9 per 1000 ventilator days). The hand hygiene compliance rates from January 2019 to December 2020 among different healthcare staffs showed a sharply rising trend. Conclusion: Covid-19 pandemic highlighted paramount importance regarding compliance to hand hygiene and implementation of standard infection control practices as recommended by World Health Organisation and Centres for Diseases Control and Prevention (CDC), which can drastically reduce range of HAIs.

Cancer arising out of diets and protective role of diet from cancers to preserve health and nutritional status is a debate in the healthcare arena. In search of perennial conflict on diet and cancer, researchers of this review emphasized conceptual and contextual details from commonly used dietary items and practices for optimum healthcare model. Twenty-four research studies were identified from 91 potentially relevant data bases and published literatures to collate an updated idea of diet and cancer. Studies were selected on, first; all emerging nutritional plans and related reports on cancer among published literature were sketchily searched. Second, “diet” and 'cancer control was also sourced from different journals, conference proceedings, and different media reports, Third, published reports from apex bodies of global importance like different professional national and international organizations were given due weightage. We have assembled diversity of opinion on prevention and control of cancer in different academic sources. Although there is no paucity of quantitative and qualitative data on diet and cancer, there is dearth of scientific and valid suggestions from scholars on this sensitive issue. In a holistic approach, we require more translational research about diet and cancer with definitive and conclusive evidences for day-to-day application in medical practice for the improvement in clinical approach of this complex debatable paradigm.

Clinical practice guideline on anticoagulation is intended to manage patients undergoing neurosurgical procedures for the best possible short and long-term outcomes. In the clinical office practice, anticoagulation is offered to prevent thromboembolism with Warfarin, Heparin, Novel Oral Anticoagulants. The management approach starts with the mitigation plans from a reversal of pre-procedural anticoagulants for impending neurosurgical procedures by estimating procedural bleeding risk on the patients. The haemorrhage criteria and the timing of procedures are best assessed by the proceduralist during and after the intervention, standing on ground situations. Yet, intra- and post-procedure anticoagulant therapy should induct a multidisciplinary consultation paradigm for the best outcome in any emergent scenario. Further, each anticoagulation event should be monitored closely with competence in the optimum reversal process. Different neurosurgical procedures also should be weighed for their inherent hazards along with the probabilities of the bleeding and thromboembolism. The treating team should also concur to suggest a resumption of the pre-procedure anticoagulant therapy which may have been in place for altogether different morbidities. Regarding the anticoagulant agent, there are special conditions and recommendations to bear in mind in the daily medical practice for patient management. In the clinical practice guidelines for neurosurgical procedures, decisions about initiation and continuation of anticoagulants require experience and thorough internalization of the planned procedure, to avoid the risks of inherent risks of bleeding and thromboembolism.

Background: Hypothyroidism is commonly associated with Diabetes Mellitus Type 2, and can affect glycemic control and alteration of lipid profiles with increase in the downstream end-organ related morbidities. Objectives: To find the changes in parameters of glucose and lipid metabolism in Diabetes Mellitus Type 2 in presence of hypothyroidism before and after replacement therapy with L-thyroxine. Methods: In consecutively diagnosed new patients with Diabetes mellitus Type 2, Thyroid screening was done viz. T3, T4, TSH, fT3, fT4. Then Fasting Plasma glucose (FPG), HbA1c, Total Cholesterol (TC), Triglycerides (TG), Very low-density cholesterol (VLDL), Low-density cholesterol (LDL), High-density cholesterol (HDL) were compared among two study groups viz. in Diabetics with hypothyroidism (n=50) and Diabetics without hypothyroidism (n=50) before and after thyroxine replacement and metabolic parameters were analyzed in relation to euthyroid-euglycemic Control group of healthy volunteers. Results: Mean FPG and HbA1c were significantly higher in Diabetics in presence of hypothyroidism compared to euthyroid diabetics. Lipid profiles were also noted to have been compromised in Diabetics in presence of hypothyroidism. After achievement of euthyroid status and with management of diabetes, diabetics achieved significantly reduced FPG and HbA1c along with significantly normalised lipid profile echelons. Conclusion: Our study suggested that we should have high index of suspicion of association of hypothyroidism in diabetics. We need to improve systems approach of routine thyroid screening as Standard Operative Procedure in patients with Diabetes Mellitus Type 2.

There is abundant literature on domestic safe water supply and hygienic sanitation. Yet, there is a paucity of research studies on adequate supply of safe drinking water and toilet facilities in places of population movement and congregation in India. This study stresses on the importance of availability of safe water and sanitation facilities in all the places of human congregation and movement in India. 49 research studies were identified from 169 potentially relevant publications. Studies were selected: first, all protocols of water and toilet facilities among published literature were meticulously searched. Second, information sources on sanitation facilities in public life, viz., railways, roadways, waterways, market places and shopping complexes, schools, and other higher educational institutions, fairs and festivals, entertainment establishments, healthcare facilities, were explored from publications of various resources of different levels. Third, published reports from apex bodies of national and international importance like Indian Council of Medical Research, World Health Organization (WHO), UNICEF, USAID, etc. were given due weightage. Of late, the concept of cleanliness and making communities free from open defecation are in limelight as the Government of India has taken up Swachh Bharat Mission (SBM); even then, contextual gaps remain. This is the cause for concern as both safe water supply and basic sanitation are directly linked to health promotion of the community. Further, this research group have noted that due importance has not been integrated in the planning of SBM regarding availability of safe water and scientific sanitation facilities in all the places of human movement and congregation. Hence, there is more need for creating awareness among general population as well as stakeholders regarding this aspect of cleanliness. It is noted that despite considerable improvement in safe water and sanitation facilities in domestic life, there is considerable population left, who are still lacking access to these facilities in public space.

Any and all advances made by medical science cannot solve the problem of road traffic injuries (RTIs) in school-going children, especially if the only concerned people are those of the medical fraternity. Children are a vulnerable part of the traveling population and thus have been persistent due to the callous nature of the citizens and policy makers toward road safety and injury prevention. In our multicultural and multilingual country, there is a need for multistakeholder initiative with a countrywide presence if we are to stem the rise of mortality and morbidity due to these accidents. The first question we need to ask is how to prevent road traffic accidents and improve the condition of our roads. Pediatric RTIs are eternal problem of industrial revolution with complications and effects that may affect individual and society with increase in the number of motorized communications. Dedicated capacity building is urgently need who should be able to provide the necessary care to the injured children at the road crash spot as well as should be informed where to take the injured child and whom to contact in the dedicated injury care center while transporting the victims of situations.

Objectives: To assess the impact, timing, the intra and early post-operative complications and the survival outcome of tracheostomy in critically ill neurosurgery patients. Methods: This study was a retrospective data mining where data was collected from hospital records from 175 consecutive patients who underwent tracheostomy in the department of Neurosurgery at the Narayna Medical College Hospital, Nellore, India from Jan 2016 to April 2018. A proforma was used to note down the details on the patient status before and after tracheostomy: Glasgow coma scale (GCS), procedure and intra and post-operative complications, type of tracheostomy cannula, details of decannulation, respiration difficulties, and problems with wound, swallowing difficulties, and voice difficulties, stay in intensive care unit (ICU) and hospital and survival status of the patient. Results: In our series, mean age of TBI cases was 47.42±16.62; mean hospital stay and ICU stay was 18.81±10.22 and 12.58±7.36 days respectively. In all age groups, more tracheostomy was needed in cranial injury cases and surgery was major intervention. Commoner complications were mucous deposition (6.86%), blockage of tracheostomy canula (6.29%), bleeding from multiple attempts (6.06%), excessive bleeding (2.94%). Cranial injury needed tracheostomy more in all age groups and more done at operation theatre without significant improvement of GCS score. Survival was statistically higher after tracheostomy irrespective of GCS status or venue of intervention. Conclusion: Tracheostomy should be considered as soon as the need for airway access is identified during intervention of the critically ill neurosurgical patients.

In this systematic review, we detailed the current understanding and controversies on venous thromboembolism as the sequel following traumatic brain injury (TBI). The review was conducted on the literature survey to find the thromboembolic morbidities in TBI patients. This review presented the thromboembolic sequel of patients with TBI by a comprehensive focused assembly of research publications by searching various resources. A search strategy with specific inclusion criteria was performed in PubMed, Cochrane, Web of Science, and the WHO Global Health Library. TBI is related with the incremental presence of spectrum of thromboembolic disorders from primary and secondary injuries by the significant increases in the concentrations of the initiating factors of the coagulation cascade. The incidences of thromboembolism vary on factors like the severity of TBI, methods of prophylaxis used or the processes to diagnose embolic involvement. The most effective time for the initiation of antithrombotic therapy chemoprophylaxis should be initiated after 24 h or after 72 h in patients with brain trauma is still a controversial issue. Patients with brain injury are at increased risk for thromboembolism for which prophylaxis and timely management are highly recommended, and this should be available in all levels of care.

Background: Anterior cervical discectomy and fusion (ACDF) is a well-described surgical approach for symptomatic degenerative cervical disc disease which does not respond to conservative management. In the present study, we assessed clinical presentation and outcomes of ACDF. Materials and Methods: The present study was conducted from October 1, 2015, to October 31, 2017, in the Department of Neurosurgery, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, among 100 consecutive adult patients who underwent single- or two-level ACDF for degenerative cervical disc disease. Results: The mean age was 47.2 ± 12.8 years (range: 20–74 years). Majority of the patients were male (86/100). Presenting symptoms were neck pain (77%), limb weakness (73%), paresthesias (53%), radicular pain (49%), stiffness in limbs (16%), and bladder involvement (13%). Fusion was done with stand-alone titanium cage/bone graft or titanium cage/bone graft with anterior cervical plate. At the time of discharge, significant improvement in preoperative symptoms (neck pain [47/77-61%], radicular pain [31/49-63%], limb weakness [53/73-72.6%], paresthesias [44/53-83%], stiffness in limbs [13/16-81%], and bladder symptoms [8/13-61%]) was reported by majority of these patients. Majority of these patients also reported improvement in preoperative sensory deficits at the time of discharge. Postoperative complications were hoarseness of voice (22%), dysphagia (16%), deterioration of motor power (8%), and postoperative hematoma (7%). Conclusions: A significant proportion of patients with degenerative cervical disc disease show remarkable recovery after ACDF.

Background: Effective health education consequently improves knowledge, attitude, and practices (KAP) leading to better glycemic control and is widely accepted as an integral part of comprehensive diabetes care for affected individuals and their families in primary care settings. Aims: To assess the impact of health education on knowledge, attitude, practices, and glycemic control in type 2 diabetes mellitus patients. Settings and Design: This case control study was conducted in the department of Medicine of a tertiary care teaching hospital. Methods: The study was conducted on 100 diabetic subjects aged more than 40 years comprising of 50 cases and 50 controls. Cases were given education on their disease, drugs, dietary, and lifestyle modifications along with patient education leaflet at baseline and at first follow-up, while controls received neither of these. Subjects were assessed for KAP by administering KAP questionnaire and for glycemic control by measuring glycated hemoglobin (HbA1C) at baseline and at the end of the study. Results: In this study, end mean knowledge, attitude, practice, and KAP SUM scores of cases (10.28 ± 1.78, 3.46 ± 0.93, 3.14 ± 0.86, and 16.82 ± 3.40, respectively) showed significant increase from the baseline (3.86 ± 0.93, 1.00 ± 0.83, 0.40 ± 0.64, and 5.26 ± 2.10, respectively) compared to controls, accompanied by significant reduction in HbA1C of cases at the end of the study compared to the controls. Conclusions: Effective health education improves knowledge, attitude, and practices, particularly with regard to lifestyle modifications and dietary management, culminating into better glycemic control that can slow down the progression of diabetes and prevent downstream complications.

Background: Therapeutic diet is an important concept in health and disease, and should be taught at all levels ranging from healthcare providers, stakeholders, and to healthcare seekers equally, without any prejudice, which is not done at present; so this review is applicable for the current scenario and will help sensitise readers regarding this crucial issue. Objective: A narrative review was taken up, which was very much required for a concerted all round application for a fruitful teaching-learning. Methods: Thirty-six research studies were identified from 73 potentially relevant articles. Studies and data bases were selected on, firstly, all therapeutic nutritional plans and corresponding diets in disease among published literature were sketchily searched, secondly, ‘Therapeutic diets’ impacting diagnosis and prognosis in different morbidities were identified, thirdly, published reports from apex bodies of global importance like World Health Organization (WHO), Centre for Disease Control (CDC), Atlanta USA and others were given due weightage for their multi-authored authenticity. Results: In spite of substantial growth in healthcare, the quality of research on therapeutic diets is sparse and often restricted to discharge from hospital and not reported in structured form without any research on compliance on dietary advices. In this review, various diets in different diseases and health conditions have been discussed in detail by especially taking up their pros and cons for the best possible outcome. Conclusions: In the current scenario we felt that nutrition is an orphan chapter in the healthcare field and we require more research about therapeutic diets as it is very useful in daily medical practice from primary level to tertiary care levels for the improvement in clinical approach and treatment in patients with diverse diseases.

Roads are considered a sign of development bringing colossal benefits to community as socioeconomic and logistic facilitator. Yet, growth of road network has brought road crashes leading to civic pain from premature deaths of productive age group. In 2017, 16 citizens were killed and 53 injured every hour on Indian roads as per officially reported data, while a fair number go unreported. This is unacceptably high when compared with international standards. Risk correlates of road traffic injuries (RTIs) need to be redefined so as to form a continuum with other confounding factors that impact to take lives on road. Risk factors impacting RTIs vary from human components to the roles and responsibilities of healthcare stakeholders. We should have made roads safer for all citizens because a large percentage of population – children, pedestrians, cyclists, motorcyclists, and the elderly – are most vulnerable. A taskforce was set up by the Academy of Family Physicians of India to scientifically analyze the literature available to assess risks and put forward appropriate recommendations.

The risk and outcome of deep vein thrombosis (DVT) in patients who sustained spinal cord injury (SCI) remain a challenge. We aimed to assess the incidence, risk, burden, and prophylaxis of DVT after SCI. Thirty-nine studies were identified from among 250 relevant articles based on firstly, broad criterion of DVT among SCI cases. secondly, “risk factors” impacting DVT, thirdly, published reports from apex bodies of global importance such as World Health Organization, Centre for disease control, Atlanta USA, and others were given due weightage for their authenticity. SCI is characterized by loss of motor, sensory, and autonomic function with partial or total damage of the anatomical structure leading to increased risk of thrombogenesis. SCIs present a higher risk of venous DVT constituting 9.7% of deaths in the 1st year of follow-up. Currently, prophylaxis with mechanical methods, vena cava filters and antithrombotic chemoprophylaxis in SCI are interventions for the management of DVT. DVT in SCI patients is not uncommon and needs a high index of suspicion and implementation of institutional prophylaxis protocol.

Abstract Background Oncogenic Human papillomavirus (HPV) infections are closely associated with anal cancer which is high among human immunodeficiency virus (HIV) infected males. There are no data regarding anal HPV infection and cytological abnormalities in HIV positive males receiving free therapy in the national program. Thus, this cross-sectional study was performed to assess the prevalence and risk factors of anal HPV infection and cytological abnormalities in HIV positive males. Methods We screened 126 HIV-positive male patients attending the antiretroviral treatment center (ART) between 2014 and 2015 with anal papanicolaou smear cytology and HPV-DNA testing. HPV-DNA was detected by using polymerase chain reaction (PCR) method with two consensus primer sets E6 and MY09/11 and further analyzed for the presence of various HPV genotype by Sanger sequencing. Risk factors associated with anal cytological abnormalities and HPV infection was analyzed by using univariate and multivariate logistic regression models. Results Out of 126, 52 were on antiretroviral therapy. 91% were married to female partners but during the study 48 (38%) gave positive history of anal intercourse with other men. Anal cytology was done in 95 patients, out of which 60 (63.15%) had cytological abnormalities. LSIL (low-grade squamous intraepithelial lesions) was present in 27 (45%), ASCUS (atypical squamous cells of undetermined significance) in 31 (52%) and ASC-H (atypical squamous cells cannot exclude a high-grade squamous intraepithelial lesion) in 2 (3.33%). In multivariate analysis, the risk factors for cytological abnormality were presence of history of anal intercourse (OR, 6.1; 95% CI, 2.0–18.7) and WHO stage III & IV (OR, 2.7; 95% CI, 1.1–7.5). HPV-DNA was detected in 33/119 (27.73%) patients. The most prevalent HPV type in the study was HPV-16 (10.08%), other HPV types detected were 18,31,35,17,66,72,52,68 and 107 (17.65%). Conclusions High prevalence of anal cytological abnormalities in our study suggests that regular anal Pap smear screening should be done in HIV positive males in the ART center.

Introduction: Breast cancer is a heterogeneous disease that may differ in therapeutic response and prognosis despite similarities in histopathologic types, grade and stage. Molecular studies have identified distinct subtypes of breast carcinoma each having unique recognisable phenotypes and clinical outcomes. Aim: To study the histomorphological features and Immunohistochemical (IHC) profile of breast cancer, to study the distribution of molecular subclass, and to study the morphological features of different molecular subclasses and to determine the association between the pathological features associated with adverse prognosis with the molecular subclass. Materials and Methods: Present study was a prospective crosssectional observational study based on mastectomy specimens of 122 cases of consecutive cases of invasive breast cancer submitted from June 2012 to February 2014 in Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India. On IHC staining with Estrogen Receptors (ER), Progesterone Receptors (PR), Human Epidermal growth factor Receptor 2 (HER2), Cytokeratin (CK5/6) and Epidermal Growth Factor Receptor (EGFR) these cases were classified into Luminal A, Luminal B, HER2 overexpression, basal like and normal breast like molecular subclass. All statistical analysis were performed using Statistical Package for the Social Sciences (SPSS) version 16 (SPSS, Inc., Chicago, IL, USA). Results: The proportion of each subytpes detected in present study were: Luminal A-28.69% (35), Luminal B-17.21% (21), HER2 over expressing-25.41% (31), Basal Like Breast Carcinoma (BLBC)-26.23% (32) and the rest unclassified category (normal breast like)-2.46% (3). The following variables were significantly associated with molecular breast cancer subtypes. The tumours of BLBC and HER2 overexpressing were larger, poorly differentiated, higher mitotic index, more number of positive lymph nodes and with more geographic and central necrosis than Luminal A group. These features were statistically significant (p

Background: Anterior cervical discectomy and fusion (ACDF) is the most commonly performed surgical procedure for symptomatic cervical disc disease. In this study, we analysed the upper and lower limb motor functions after ACDF for disc prolapse in patients with degenerative cervical disc disease. Methods: One hundred consecutive adult patients who underwent ACDF for single or two-level cervical disc prolapse during the study period (October 2015 to October 2017) were included in the study. Results: Preoperative motor deficits in limbs were noted in 73% (73/100) of the patients. Enhance recovery of motor deficits was noted in 72.6% (53/73) of these patients and persisting motor deficits in the remaining patients (20/73- 27.4%). Five patients (5/27- 18.5%) without any preoperative motor deficits developed motor deficits after ACDF. Detailed pre and postoperative (at the time of discharge) motor power (graded by MRC grade) in all 4 limbs (Shoulder abduction/adduction/flexion/extension, elbow flexion/extension, wrist flexion/extension, hip abduction/adduction/flexion/extension, knee flexion/extension, ankle flexion/extension) was recorded. Statistically significant improvement in motor power (as recorded at the time of discharge) was noted in all the tested muscle groups after ACDF. Conclusion: Early improvement in preoperative motor deficits can be expected in the majority of the patients with cervical PIVD following ACDF.

The Universal Immunization Programme in India have been incorporating newer vaccines so that the immunization schedule has been changing rapidly, though varying from one state to another. The number of diseases being protected against has increased from 6 to 14 in the past few years. It should be emphasized that we must ensure all the age appropriate vaccination to each and every child as vaccination is birth right of every child. In spite of almost everyday addressing common people at different levels at different places on different days creating awareness on how provision of immunobiologicals and vaccines by the governmental agencies protect and saves lives of children and, still we are far behind the required immunization coverage in India. It is heartening to know that immunisation program as 'Intensified Mission Indradhanush' re-launched by Government of India in 2017 and supported by UNICEF to vaccinate each and every child reaching the target close to 90% coverage by 2020.

Background: HIV infection has a chronic course and long-term involvement associated with social stigma in India leading to serious psychological problems manifesting as depression, loss of insight, agitation, insomnia which are remain undiagnosed and untreated. Objectives: This study was done to assess psychological problems among HIV positives. Methods: A cross sectional observational study was conducted on 180 patients who were on anti-retroviral therapy selected through systematic random sampling technique in two Teaching Institute of West Bengal and Bihar. Hamilton Rating Scale for Depression and Anxiety for Psychological problems was used to measure the psychological problems. Results: The study group had 64.44 percent males, among males maximum (56.03%) were between 30-40 yrs. Among females, majority (48.44%) were from age 18-29 years. Among males, 65.52 percent were married followed by divorced (27.59%). Among females, 59.44 percent were married followed by widowed (37.5%). Among the participants majority had education up to secondary level. Depression was more common among females (76.56%) compared to males (53.45%); Insomnia was more frequent finding (83.3%) among separated; Illiterates showed lower frequency of depression. Substance abuse was not associated with insomnia. Conclusions: Identification of psychological problems is important for a better outcome of people living with HIV/AIDS.

Background: Ethanol (commonly phrased as Alcohol), in spite of presence of so many ‘recreational drugs’, is the most common drug exploited throughout the world. Objectives: This study explored the deleterious role of alcohol, effect of its consumption and their legal implications in a systematic manner. Method: To assess the toxic role of alcohol with the effects of its consumption and their legal implications a systematic review was done through an extensive search in the books, indexed literature and website-based reports, 14 reported literatures were identified of alcohol use. Results: Alcohol acts as a central nervous system depressant of specialised and sensitive cells of cerebral cortex. Its adverse effects like decrease in cognitive and psychomotive skills are well documented, with special regard to driving performance. In presence of lacunae in the implementation of legal enforcements alcohol related road safety has to be research interest to reduce this preventable morbidity. Ethanol and its role as a central nervous system depressant is well documented. In the last decade, drastic changes in the age of initiation as well as the bridging of gender based gap in alcohol use have been observed. Conclusion: Alcohol related road traffic injuries are major threat to civilization including premature deaths on road with uncountable quantity and quality of socioeconomic effects on family as well as the community that need to be prevented by the holistic approach.

Cardiovascular dysfunction frequently complicates outcomes of traumatic brain injury (TBI), resulting in higher morbidity and mortality. TBI results in dysfunctions of the autonomic nervous system (mediated by catecholamines), altered systemic circulation homeostasis medicated by neurogenic stimuli, electrocardiographic, echocardiographic abnormities, and change in serum cardiac enzyme levels (not attributed to primary cardiac pathology). The present review attempts to find cardiovascular alterations following TBI, management to these patients, and their outcome.

BACKGROUND: Dyslipidemia is common metabolic abnormality in thyroid disorders overt or subclinical and diabetes mellitus (DM) with a marked increase in circulating low-density lipoprotein (LDL-C). OBJECTIVES: This study was carried out to find variations in dyslipidemic patterns in type 2 DM (T2DM) with hypothyroidism (HY). METHODS: Total cholesterol (TC), triglycerides (TG), very low-density cholesterol (VLDL), low-density cholesterol (LDL), and high-density cholesterol (HDL) were compared among the three study groups at a tertiary care teaching hospital of Bihar in eastern India. Group A: T2DM. Group B HY, and Group C: having both T2DM and HY and control group. RESULTS: The lipid profile of patients with diabetes showed TC (316.18 ± 4.299 mg/dl), TG (358.36 ± 5.544 mg/dl), LDL (214.70 ± 4.192 mg/dl), VLDL (71.67 ± 1.109 mg/dl), and HDL (29.80 ± 0.348 mg/dl). Mean lipid profile values in HYs were TC (314.38 ± 1.739 mg/dl), TG (322.46 ± 2.429 mg/dl), LDL (208.69 ± 1.665 mg/dl), VLDL (64.29 ± 0.5591 mg/dl), and HDL (41.20 ± 0.3647 mg/dl). Patients suffering from both diabetes and HY had TC (337.92 ± 4.793 mg/dl), TG (350.02 ± 5.127 mg/dl), LDL (236.17 ± 4.093 mg/dl), VLDL (70.01 ± 1.026 mg/dl), and HDL (31.74 ± 0.285 mg/dl). LDL value was markedly high in diabetic HY patients. All the lipid profile parameters were significantly increased except HDL among the patients with diabetes and HY patients. Increase was more in cholesterol and LDL values among patients suffering from both diabetes and HY. HDL levels were lowest among the patients with diabetes and also decreased among the diabetic HYs. CONCLUSIONS: In this study, on patients with diabetes and HY, dyslipidemia was more in two variables, namely, cholesterol and LDL; there was a distinct difference in lipid profile patterns between single and dual morbidities.

Sustainable Development Goals (SDGs) benefited through the valuable lessons learned from Millennium Development Goals (MDGs) by forwarding the unfinished agenda of MDGs from 2015 onwards. India has also made tremendous improvements during implementations in concurrence with the MDGs, yet lacks in various fields. In 2017 National Health Policy (NHP 2017) was launched by Government of India (GOI) replacing National Health Policy 2002. There is much positive step forward in NHP 2017, but in combination with inadequacies regarding approaches to many key objectives necessary policy corollaries are much needed; otherwise many goals will remain unattainable. This new health policy will help keep improving the maternal and child health but still is unspecific about ‘Health as a fundamental right’ and many burning issues including, the emerging problems of non communicable diseases (NCD), violence on women, sanitation and most importantly ignoring the dire need of long term financial vision of primary health care as well as public health sector in the country.

In this systematic review, we summarize the current understanding and controversies on cognitive sequelae after traumatic brain injury (TBI) to understand the cognitive deficits such as memory, attention, executive functions, and unawareness of their deficits in TBI patients. This review presents the cognitive sequel of patients with moderate-to-severe TBI by a comprehensive focused conglomeration of research publications by searching various resources. A search strategy with specific inclusion criteria was performed in PubMed, Cochrane, Web of Science, and the WHO Global Health Library. This review noted that TBI is related with increase of various neurological and non-neurological disorders including problems with attention, inability to concentrate, speech and language dysfunctions, learning and memory impairment, impaired reasoning, impaired planning and problem-solving. This review found that patients' cognitive deficits are common in victims of moderate to severe TBI often as the long-lasting sequalae. The present review suggests that there is a need for further research to develop unique rehabilitation methods that will help to enhance brain plasticity and process of recovery after TBI.

Tuberculosis (TB) continues to be a major public health problem in developing countries. Approximately 10% of patients with extrapulmonary TB have skeletal involvement. The spine is the most commonly affected skeletal site. The neurologic manifestations of spinal TB are most often secondary to bone involvement but can also be due to neural and perineural tissues involvement. TB may involve any level from the cervical to lumbosacral region. Extradural tubercular granuloma without vertebral involvement is uncommon. The authors reported an uncommon case of isolated intraspinal extradural TB lesion without osseous involvement of the thoracic spine in an adult man. Surgical intervention along with chemotherapy is one of the preferred treatments for intraspinal extradural tubercular lesion.

We study the phases of hard-core-bosons on a two-dimensional periodic honeycomb lattice in the presence of an on-site potential with alternating sign along the different y-layers of the lattice. Using quantum Monte Carlo simulations supported by analytical calculations, we identify a weak topological insulator, characterized by a zero Chern number but non-zero Berry phase, which is manifested at either density 1/4 or 3/4, as determined by the potential pattern. Additionally, a charge-density-wave insulator is observed at 1/2-filling, whereas the phase diagram at intermediate densities is occupied by a superfluid phase. The weak topological insulator is further shown to be robust against any amount of nearest-neighbor repulsion, as well as weak next-nearest-neighbor repulsion. The experimental realization of our model is feasible in an optical lattice setup.

Tinnitus is a frequent clinical feature encountered during follow up of Traumatic brain injury (TBI) that can be incapacitating in the long run. Literature suggests that post-TBI carries a higher psychological burden than tinnitus patients presenting with other non-traumatic or unknown etiologic. Posttraumatic tinnitus is of longer duration, frequently associated with hyperacousis and occurs in younger age group. If the symptoms are severe post-traumatic tinnitus can affect quality of life of the patients. The management of these patients needs detail evaluation and comprehensive rehabilitation plan.

Background: Intervention to reduce intracranial pressure using External Ventricular Drain (EVD) is a common life saving measure in a neurosurgery intensive care unit(ICU). Objective: The present study was undertaken to assess the outcome of patients who underwent external ventricular drainage for intraventricular hemorrhage(IVH). Methods: The available data of the patients who underwent placement of external ventricular drain from February 2012 to May 2016 for intraventricular hemorrhage (IVH) at Narayana Medical College and Hospital, Nellore, was retrieved from the hospital case records and analyzed. Results: Total of 69 patients were included in this study. Mean age was 53.7 ±11.6 years. Clinical presentation included altered sensorium in 66 patients (96%), hemiparesis in 62 patients (90%) , vomiting in 40 patients (58%) and seizures in 9 patients (13%). Fifty two patients (75%) were known hypertensives and 10 patients (15%) were diabetic. Past history of smoking was recorded in 16(23%) patients and alcohol intake in 17 patients (25%). GCS at the time of admission was 3-8 (low) in 39 patients (57%), 9-12 in 23 patients(33%) and 13-15 in 7 patients (10%). At the time of admission, 60 patients ( 87%) had diastolic blood pressure more than 90 mmHg, 63 patients (91%) had systolic blood pressure more than 140 mmHg. Major site of hemorrhage was basal ganglia in 24 (35%), thalamus in 13 (19%), cerebellum in 5 (7%), brain stem in 3, frontal/temporal in 2 patients. SAH with IVH was noted in 12 patients (17%) and only IVH was noted in 10 patients (14%). Mean duration of external ventricular drainage was 4.6+1.7 days (Range 1-9 days). Mean hospital stay was 11.3±7.5 days and mean ICU stay was 8+5.4 days. Thirty eight patients (55%) died during hospital stay. At the time of discharge, poor out come (Glagow out come score 1-3) was noted in 52 patients (75%) and good out come (Glagow out come score-4,5) was noted in 17 patients. Among various parameters analyzed , poor GCS (3-8) at admission, history of smoking and alcohol intake were found to correlate significantly with poor outcome. None of the other factors like old age, site of bleed, pupillary asymmetry at admission, high blood pressure at admission, past history of hypertension and diabetes were found to correlate with poor outcome. Conclusions: Majority of the patients with intracranial hematomas with intraventricular extension presented in poor neurological condition (GCS= 3-8). Poor neurological condition at the time of admission, past history of smoking and alcohol intake were associated with poor outcome.

Background: Due to lack of pre-hospital care, direct admission of traumatic brain injury (TBI) patients to dedicated neurosurgical department remains difficult in many parts of world. Objective: The present pilot study was conducted to understand the referral pattern of patients to the neurosurgery department and to develop an algorithm to stratify the spectrum of cases as per the severity of condition and possibility of direct neurosurgical care. Materials and Methods: Details of referral patterns, demographic and clinical profile, management and outcome of consecutive TBI cases admitted in the Department of Neurosurgery were collected with pre-designed proforma. Results: Of total 55 cases, 40 (73%) were males; 26 (47%) between 36-55 years age; 26 (47%) referred directly to the center; 24 (44%) self-referred; 34 (62%) referred from Emergency department; mostly (32, 58%) admitted after 12PM; 22 (40%) admitted for 16-30 days. In the analysis of investigations, 37(67%) cases had CT, 15 (27%) had MRI, 4 (7%) had X-ray, 1 (2%) undergone all three investigations, while 8 (15%) didn’t have any; mostly (42, 76%) cases were referred for the management of TBI and 38 (69%) required operative interventions. Conclusion: Our findings strongly suggest that referral of TBI cases need improvement in this part of country where hindrances delay TBI cases to reach dedicated neurological intensive care leading to delay of committed care and optimization of strategy for reduction of case fatality.

Introduction: There are 15 high risk genotypes of Human Papilloma Viruses (HPV) which are associated with Carcinoma Cervix (CaCx), of which genotype 16 and 18 are the commonest. Aim: To evaluate nested multiplex Polymerase Chain Reaction (PCR) protocol for simultaneous detection of HPV, and typing of high risk genotypes mainly genotypes 16 and 18 in cervical scrape/biopsy samples. Materials and Methods: This prospective cohort study was done on 63 females in the age group 21-70 years attending outpatient Department of Gynaecology, Sir Sunderlal Hospital, BHU, Uttar Pradesh, India from March 2015 to August 2016. Cervical biopsy (n=14) and cervical scrape (n=49) samples from 63 females were subjected to histopathology/cytology and nested multiplex PCR for detection and typing of HPV. Further, in HPV positive tissue samples, in which virus was not typed as genotype 16 and 18, 142 bp consensus sequence of L1 capsid gene was amplified by nested PCR employing MY/GP+ primers and subjected for sequencing to ascertain the HPV genotypes. Results: On histological examination, 13 (92.8%) out of 14 biopsies were diagnosed as cases of Squamous Cell Carcinoma (SCC). Of the 13 cases of SCC of uterine cervix, all were HPV positive and yielded either 134 bp L1 capsid amplicons (n=12) or HPV 16 specific amplicon (n=1). On subjecting cervical scrape samples for the PCR, 24.3%, 100%, 57.1%, and 66.7 % cases with Negative for Intraepithelial Lesion or Malignancy (NILM), Atypical Squamous Cells of Undetermined Significance (ASCUS), Low Grade Intraepithelial Lesion (LSIL), and High Grade Intraepithelial Lesion (HSIL) respectively were positive for HPV. Conclusion: Detection of High Risk HPVs (HR HPV) in all the tissue samples of SCC of uterine cervix indicates the usefulness of the nested multiplex PCR protocol in detection and typing of HPVs in tissue samples of CaCx. Further, this protocol may be used to detect HPVs in scrape samples along with cervical cytology as a tool for screening CaCx.

Competency-based medical education inscribed in the Graduate Medical Education Regulations from Medical Council of India is cogently grounded by the Curriculum Implementation Support Programme throughout the country under the aegis of Medical Education Units and Curriculum Committees of the medical institutes. Global researchers on academic curriculum visualize paradigm of system based teaching–learning in evidence based medicine. This intermingled with participatory contribution from the learners in a non-threatening environment can inculcate philosophy of life-long learning mindset. Creative teaching-learning environments free the mind to freely learn to meet the challenges of the health needs of the country.