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Background:Obsessive–compulsive disorder (OCD) is a chronic mental disorder that can be a source of emotional, financial and/or social burden for family caregivers. Few studies have investigated family caregiving for patients diagnosed with OCD in relation to the coping strategies being used from a theoretical perspective. This study evaluated the burden and coping strategies of family caregivers for people diagnosed with OCD. Methods: A cross-sectional study was conducted, in which 94 participants diagnosed with OCD and their caregivers were surveyed using Burden assessment schedule (BAS) used to measure burden among caregivers of patients of OCD. Results:The mean ages of the patients were 36.03 + 12.03 and the caregivers were 43.28 + 14.76. Only 46.8% of the caregivers were female, compared to 74.5% of the patients who were female. Patients spouses made up half of the caregivers (50%) and parents made up almost a quarter (22%) The average length of the illness was 8.10± 6.60 years, and the average length of the cure was 4.04 ±4.47 years. The mean BAS score for the caregiver was 39.52 ±12.99. The Relationship Between Sociodemographic, Clinical, Quality-of-Life, and Disease Burden of Patients The BAS scores of caregivers who had patients who thought their income was low were significantly higher than those of the other caregivers (p=0.013). Conclusions:Designing strategic interventions for family caregiver coping is necessary to support the unique burdens and coping mechanisms faced by family caregivers of people with OCD.

Background:Dissociative disorder is a stress-related disorder usually present in adolescent and younger age group. It is also accompanied with significant impairment in activity of daily living and family relationship. Family environment plays important role in initiation and maintenance of symptoms and this put significant burden on family. To assess different types of clinical presentations, level of stress and role of family environment among dissociative disorder patients and check for association between sex distributions. Material and Method:This cross-sectional descriptive study was carried out on patients with primary diagnosis of dissociative disorder as per ICD-10 criteria coming to psychiatry outpatient department of Sri Aurobindo Medical College and Postgraduate Institute, Indore a premier tertiary care hospital situated at northern part of India, covering, and serving a large catchment area, during the period of 18 months. 80 patients were recruited for the purpose of study. The procedure and rationale for the study was explained to all subjects and informed written consent were taken in their local language. Patients were included after fulfilling inclusion criteria from both inpatients and outpatient department of psychiatry. Result:In our study, majority of the patients (48.75%) belonged to the age group 18-30 years. The prevalence rates decrease with age. 37.5% of the patients were between the age group 31-40 years and 13.75% were over the age of 40 years. In a study of 80 patients with dissociative (conversion) disorder, 77.5% were females and 22.5% were male. There was female predominance. Conclusion:Dissociative disorders are more common in females than males. It always occurs in the background of increased stressful life events and in the presence of significant psychosocial stressors. Future studies should be undertaken in a large sample with a prospective design to examine the impact of disease duration and other mediators, such as family type and coping style. &nbsp

In the treatment of influenza, Neuraminidase inhibitors (NAIs) (Oseltamivir and Zanamivir) play a major role. The emergence of variants of influenza A (H1N1) pdm09 virus resistant to Oseltamivir is a matter of great concern as it limits its usage. Therefore, vigilant monitoring for Oseltamivir-resistant viruses has been recommended by the World Health Organization (WHO). Our study aimed to screen the influenza A (H1N1) pdm09 virus for NAI drug resistance during the outbreak of 2015-16 in North-Western India. A total of 640 H1N1pdm09 virus-positive samples were screened for drug resistance to Oseltamivir by WHO allelic discrimination real-time RT-PCR protocol. The allelic discrimination PCR protocol can detect the presence of single nucleotide polymorphisms (SNPs), the H275Y mutation is detected by this method which causes resistance to Oseltamivir. Sanger sequencing of partial fragment of NA gene (fragment IV), of 90 samples were performed to confirm the presence of NA-H275Y mutation. Neuraminidase susceptibility of 20 randomly selected isolates to Oseltamivir was tested using NA inhibition chemiluminiscence based assay. Among 640 H1N1pdm09 positive samples tested, H275Y mutation was detected in one sample (0.15%) by PCR and confirmed by Sanger sequencing also. All the 20 isolates tested for NAI susceptibility by NA star assay were found to be sensitive to Oseltamivir. WHO allelic discrimination PCR is an easy, rapid and sensitive method for high-throughput detection of resistance to Oseltamivir. Systematic regular drug resistance surveillance of Influenza A is essential to monitor the emergence and spread of drug-resistant strains.

Objective Infections due to nontuberculous mycobacteria (NTM) is increasing globally and may present as drug-resistant tuberculosis (DRTB). In India, data on NTM prevalence and species diversity is limited. Present study was conducted to detect the prevalence and profile of NTM among patients suspected of DRTB using paraffin slide culture (PSC)and mycobacteria growth indicator tube (MGIT) culture methods for isolation of NTM.Material and Method A total of 2,938 samples suspected of TB/DRTB were cultured on PSC and MGIT960. Species identification of mycobacterial isolate was done by sequencing of 16s ribosomal RNA gene.Result Among 2938 samples, 35 (1.19%) were found positive for NTM by PSC and 9 (0.30%) were found positive by MGIT. The diversity of NTM species was high (13 species). Out of 35 NTM isolates by PSC, maximum 34.29% (12) isolates were found to be Mycobacterium fortuitum, followed by 11.43% (4) Mycobacterium abscessus and Mycobacterium chelonae, and 42.85% (15) were other species viz. 8.57% (3) were Mycobacterium intracellulare and Mycobacterium kansasii, 5.71% (2) were Mycobacterium peregrinum, and 2.85% (1) were Mycobacterium flavescens, Mycobacterium farcinogenes, Mycobacterium moriokanese, Mycobacterium wolinskyi, Mycobacterium simiae, Mycobacterium goodii, and Mycobacterium terrae each. Coinfection of Mycobacterium tuberculosis(MTB) and NTM was found in 60% (21) samples.Conclusion Prevalence of NTM was low among multidrug resistant tuberculosis/TB suspected patients, similar to other studies done in India. PSC was found better than MGIT for the isolation of NTM, though poor separation of NTM and MTB on subculture may have led to false negativity in cases of coinfection. About 13 species were isolated; M. fortuitum was the most common of all. Since coinfection of NTM and TB can also occur, samples of patients suspected of NTM should be cultured on PSC even if positive for MTB.

Ethical aspect in pediatric dentistry starts when we as a dentist meet a child patient in the clinic, to whom we should provide a dental treatment & oral health needs with taking the patient's point of view into consideration. Thus, with professional ethical codes it is very much concern how we look upon children as individuals and as patients. Clinical Research in pediatric dentistry is incorporated to increase and revise the current knowledge.The aim of this review is improve the concept of clinical research in pediatric dentistry with pertinent ethical concern.In the current times where evidence-based dentistry is known for expertise studies with ethical papers without plagiarism, stress is been emphasized.Proper Knowledge about ethics while conducting a clinical research in pediatric dentistry is propitious to the researcher and also the dental community

SETTING: Patients with presumed multidrug-resistant tuberculosis (MDR-TB) and undergoing MDR-TB treatment from Rajasthan, India.OBJECTIVE: To compare the GenoType® MTBDRsl v.1.0 (MTBDRsl) assay capacity to detect resistance to ofloxacin, amikacin, capreomycin, kanamycin and ethambutol in Mycobacterium tuberculosis with phenotypic drug susceptibility testing (DST) using MGIT™960™ in sputum samples and isolates.DESIGN: Fifty-three smear-positive sputum samples were tested directly by MTBDRsl and 205 MDR-TB isolates were processed using MTBDRsl and DST for five drugs on MGIT960. DNA sequencing was performed in isolates with discordance in the results between the two methods for the gyrA, gyrB and rrs genes.RESULT: Sensitivity and specificity of MTBDRsl was found to be respectively 93.1% and 100% for fluoroquinoline, respectively 75–78% and 100% for aminoglycosides/cyclopeptides, respectively 70% and 92% for ethambutol and respectively 92.3% and 100% for extensively drug-resistant (XDR) TB detection. On sequencing eight discordant isolates for quinolones, mutations were seen in 12.5% of the gyrB gene and among 20 discordant isolates for aminoglycosides/cyclopeptides in the rrs gene in 15% isolates. The turnaround time was 2 days for MTBDRsl vs. 10 days for MGIT960.CONCLUSIONS: MTBDRsl can be used as an initial rapid test for detecting XDR-TB, resistance to quinolones and aminogycosides/cyclopeptides in smear-positive sputum samples.

Purpose: Suddenly, many cases of fever with jaundice were reported from Sodala area at Jaipur. This outbreak of acute hepatitis at Jaipur Rajasthan was investigated for aetiology and subsequent phylogenetic analysis. Methods: Blood samples were collected from 106 symptomatic patients of acute hepatitis and 39 pregnant females (with or without symptoms of hepatitis) during an outbreak at Jaipur. The samples were tested for hepatitis A virus (HAV) and hepatitis E virus (HEV) by serological and molecular methods (polymerase chain reaction [PCR]). Sequencing of nested PCR product was done for phylogenetic analysis. Hepatitis B surface antigen (HBs antigen), anti-hepatitis C virus (HCV), anti-Leptospira and anti-scrub typhus IgM enzyme-linked immunosorbent assay (ELISA) was done for patients negative for HEV and HAV. Results: Among 106 symptomatic patients, HEV IgM was positive in 84/106 (79.2%) patients and HEV RNA in 72/106 (67.9%) patients. Among pregnant women, 6/39 (15.4%) were HEV IgM positive and 5/39 (12.8%) for HEV RNA. One (2.5%) pregnant woman died due to hepatitis. All the isolates belonged to genotype 1A of HEV. All HAV, HEV-negative samples were negative for HBs antigen, HCV antibody, Leptospira and scrub typhus IgM ELISA. Conclusion: The outbreak was due to HEV genotype 1A. The municipal water supply was contaminated and sanitary conditions and waste disposal were poor in the area. Boiling of drinking water, fixing the water supply pipes and frequent hand washing helped in controlling the outbreak.

BACKGROUND: Coinfections of human immunodeficiency virus (HIV) with hepatitis viruses may affect the progress of disease and response to therapy. OBJECTIVES: To study the incidence of hepatitis B virus (HBV) and hepatitis C virus (HCV) coinfections in HIV–positive patients and their influence on HIV–1 viral load and cluster of differentiation 4+ (CD4+) T–cell counts. MATERIALS AND METHODS: This pilot study was done on 179 HIV–positive patients attending antiretroviral therapy (ART) centre. Their blood samples were tested for HIV-1 viral load, CD4+ T–cell counts, hepatitis B surface antigen, anti–HCV antibodies, HBV DNA and HCV RNA polymerase chain reaction. RESULTS: Among the 179 patients, 7.82% (14/179) were coinfected with HBV and 4.46% (8/179) with HCV. Median CD4+ T–cell count of HIV monoinfected patients was 200 cells/µl and viral load was 1.67 log10 copies/µl. Median CD4+ T–cell counts of 193 cells/µl for HBV (P = 0.230) and 197 cells/µl for HCV (P = 0.610) coinfected patients were similar to that of HIV monoinfected patients. Viral load was higher in both HBV and HCV infected patients but statistically significant only for HCV (P = 0.017). Increase in CD4+ T–cell counts and decrease in HIV–1 viral load in coinfected patients on 2 years of ART were lower than that in HIV monoinfected patients. CONCLUSION: HBV/HCV coinfected HIV patients had similar CD4+ T–cell counts as in HIV monoinfected patients, higher HIV viral load both in chemo–naive patients and in those on ART as compared to HIV monoinfected patients. However, this study needs to be done on a large scale to assess the impact of coinfection on CD4 count and HIV viral load with proper follow–up of patients every 6 months till at least 2 years.

Background & objectives: Hepatitis A virus (HAV) infection is a major cause of childhood hepatitis, prevalent worldwide. HAV is classified into seven genotypes I-VII; genotypes III and I are the most common among humans. The present work was carried out to identify the genotypes prevalent in children suspected to have acute viral hepatitis (AVH), hospitalized at a tertiary care centre in northwest India. Methods: A total of 1269 blood samples from children (0-15 yr of age) clinically suspected of viral hepatitis were screened for anti-HAV IgM. Acute phase serum was processed for RNA extraction and amplified by nested polymerase chain reaction (PCR) followed by sequencing of representative samples. Results: Among the 1269 samples tested, 642 (50.59%) were positive for anti-HAV IgM; among the positive samples, 171 patients having a history of less than seven days were tested by PCR, of whom 141 (82.45%) were found to be PCR positive. Nucleotide sequencing of a representative 44 samples showed high homology; all the samples were found to be of genotype IIIA. Interpretation & conclusions: Hepatitis A was prevalent during July to September and in predominantly children less than five years age. Only genotype IIIA was detected in all the samples.

Epidemiology and molecular characterization of Eimeria was carried in goats reared under semi-arid region of west Uttar Pradesh, India. A total of 1285 faecal samples from different goat breeds (Jamunapari, Jakhrana and Barbari) were examined for presence of Eimerian oocysts over a period of eight months along with faecal oocysts count. All raw data of faecal oocyst counts (FOC) were transformed by loge (OPG+ 100) before analysis. All fixed effects like breed, age, months of sample collections along with their interaction were considered in analysis. The overall prevalence of Eimeria infection in goats was 73.85%. Breed wise prevalence in Barbari, Jamunapari and Jakhrana breed was 68.62, 79.70 and 72% respectively. Prevalence observed in 2-6M, 6-12M and >12M was as 70.83, 79.88 and 71.74% respectively. Gender wise prevalence as observed in male and female goats was 71.95 and 74.43% respectively. In oocyst per gram (OPG) data analysis the fixed effects like breed, age, months of sample collection and age versus gender interaction had significant effect on log transformed faecal oocysts counts (LFOC). The overall least square means of OPG was 4.673±0.007 (1403OPG). Of the three goat breeds, Jamunapari had highest OPG (2886OPG) compared to Jakhrana (875OPG) and Barbari (523OPG). Mean OPG in 2-6month age goats was significantly higher than the corresponding values in 6-12 and >12months, significant variation was found among monthly OPG means and wet months showed higher faecal oocysts discharge. Nine Eimeria species were identified infecting goats and E. arloingi and E. ninakohlyakimovae were most frequent and predominant species. Molecular characterization for coccidial infection was conducted using two genes i.e. 18S rDNA and ITS-1 genes which amplified 637bp and 500bp (E. christenseni and E. alijevi) respectively. The ITS1 gene was analysed by sequencing, E. christenseni was found showing nucleotide similarity with E. bovis and E. ellipsoidalis whereas 3' end of the sequence were highly conserved. The ITS1 gene of E. ninakohlyakimovae was found more homologous to E. bovis, E. ellipsoidalis and E. zuernii but for 33rd nucleotide thymidine residue deletion and 5th position G→A mutation. The 18S rDNA sequences of E. ninakohlyakimovae and E. christenseni were studied for evolutionary divergence analysis and maximum divergence was noticed between E. ninakohlyakimovae and E. christenseni (0.0605). The phylogenetic tree showed E. ninakohlyakimovae was placed in same clade with other Eimeria spp. compared, but E. christenseni being placed in a different clade as an out-group.

Context: Acute encephalitis syndrome (AES) is a serious public health problem, caused mainly by viruses. However, the profile of viruses causing AES in Rajasthan is not well characterised. Aims: The present study was undertaken to identify the viruses causing AES and develop diagnostic algorithm so as to help in improved diagnosis, treatment, prevention and control. Settings and Design: The present study is a hospital-based descriptive, observational study. Samples were processed at Grade-1 DHR/ICMR Viral Research and Diagnostic Laboratory at SMS, Jaipur. Subjects and Methods: Cerebrospinal fluid (CSF) samples were processed for IgM antibody detection by enzyme-linked immunosorbent assay (ELISA) for mumps virus (MPV), measles virus (MV), Rubella virus (RV), Japanese encephalitis virus (JEV), West Nile virus (WNV) and Dengue virus using commercial kits. Nucleic acid was extracted from CSF using automated extraction system. Real-time polymerase chain reaction was done using specific primers and probes for Herpes simplex virus (HSV), Varicella-zoster virus (VZV), Epstein-Barr virus (EBV), cytomegalovirus (CMV) and enterovirus (EV). Statistical Analysis Used: Statistical analysis was done using ANOVA. Results: Among 3088 patients, 702 (22.7%) patients were positive for one or more viruses. HSV (261;8.45%) was the most common followed by EBV (173;5.6%), VZV (97;3.1%), CMV (68;2.2%), EV (32;1.03%), MPV (27;0.9%), DV (28;0.9%), MV (19;0.6%) and RV (6;0.2%). Conclusions: AES occurred sporadically in Rajasthan, samples should be tested first for herpes group of viruses followed by EV or/and for arboviruses depending on season or measles, mumps and RVs in children.

Introduction: Various pathogens cause respiratory tract infections in children of

Hydatid disease is a worldwide zoonosis and is localized in the liver in most cases. Its complications are numerous and include those related to the compression of adjacent viscera, infection of the cyst's contents or perforation of the cyst. Spontaneous rupture of the hepatic hydatid cyst into colon is an extremely rare complication. The communication is, typically, not discovered until surgery. We present a case of a liver hydatid cyst communicating with the hepatic flexure of colon. The surgical treatment of the lesion and its complications was complex but successful and included partial cystectomy with prolonged external tube drainage.

SETTING: High-resolution melting curve analysis (HRMA) can be used to screen for mutations in genes without the need for specific probes, with low turnaround time and high cost-effectiveness. OBJECTIVE: To detect the sensitivity and specificity of a line-probe assay (LPA) and HRMA in comparison with BACTEC™ MGIT™ 960 for the detection of rifampicin (RMP) resistance. DESIGN: A total of 219 Mycobacterium tuberculosis isolates tested by MGIT 960 for RMP susceptibility were tested with HRMA and LPA. Discordant samples were processed for sequencing of the RMP resistance-determining region (RRDR) of the rpoB gene. RESULTS: HRMA identified 93 of 103 (90.3%) isolates that were resistant and 113/116 (97.4%) that were susceptible on MGIT 960, with a sensitivity and specificity of respectively 90.3% and 97.4%. HRMA identified 117/119 (98.3%) LPA-susceptible and 94/100 (94%) resistant isolates, with 98.3% specificity and 94% sensitivity. Two isolates that were susceptible on LPA but resistant on HRMA showed silent mutations at 539 and 541 codons on sequencing, while 6 isolates that were susceptible on HRMA but resistant on LPA showed D516V (n = 4) and H526C/D (n = 2) mutations. Four isolates (3.9%) that were resistant on MGIT were susceptible on all three genotypic methods, which could be due to mutations outside the RRDR or efflux pumps. CONCLUSION: HRMA shows good potential as a rapid screening tool for the detection of drug resistance.

Respiratory syncytial virus (RSV) causes high mortality and morbidity in infants. The study was planned to determine the trends of RSV sub-types in hospitalised children. Nasopharyngeal aspirate and throat swabs were collected from the hospitalised children up to 5 years of age. Viral nucleic acid was extracted using easyMAG automated extraction system, and real-time reverse transcription polymerase chain reaction was performed. Total positivity for RSV was found to be 25.40%, predominantly for RSV B (20.03%), followed by RSV A (2.90%) and RSV AB mixed infections (2.47%). Palivizumab prophylaxis can be planned to be given to infants from post-monsoon to end of winter.

Sclerosing mesenteritis is a rare, benign, and chronic fibrosing inflammatory disease with unknown etiology that affects the mesentery of small bowel and colon. The disease has two well-established histological types: the acute or subacute form known as mesenteric panniculitis and the chronic form known as retractile or sclerosing mesenteritis. Because sclerosing mesenteritis lacks special clinical manifestations and typical signs, the patients are very easily misdiagnosed. The correct diagnosis of sclerosing mesenteritis depends on pathological examination after laparotomy. We report a case of sclerosing mesenteritis in a 55-year-old male who presented with chronic abdominal pain and intra-abdominal mass. He was misdiagnosed as lymphoma by Computed Tomography and then underwent exploratory laparotomy. Histopathological examination revealed it to be sclerosing mesenteritis. This patient went well and lives without recrudescence till date.

MANET is an infrastructure less ad hoc network in which nodes can move freely between specific regions. In this region multiple nodes can communicate with each other. Due to this heavy movement of nodes the topology of the connections is continuously changing within a specific transmission range of the network. To handle this dynamic behaviours or node, efficient topology control mechanism has to be selected according to the environment requirements. These mechanisms can be separated according to their use like mobility sensitive, energy awareness, QoS based etc. An efficient protocol is that which dynamically handles all this issues effectively with better use of bandwidth. This work proposes a new CDTRB based topology control mechanism satisfying the QoS requirements. During the work a survey on various algorithms which is based on above parameters is measured. At the initial level of research the approach seems to provide effective result in near future.

In India one of every three rural households depends on kerosene based lighting systems that are characterized by low illumination and hazardous smoke. Given the existing and foreseeable gap between demand and supply, universal modern energy access can only be achieved in the short to medium term through a combination of grid and off-grid approaches. The paper presents a case study of solar photovoltaic based micro-grids (generating 75 W–1 kW) used to meet basic lighting requirements of 30 rural communities during peak demand hours (6–10 pm). The communities have adopted micro-level solar-based off-grid systems, which are owned and managed by local entrepreneurs with a 45% equity stake. Case study analysis of this project, in the state of Uttar Pradesh in India shows that: 1. Grid-connected (and even unconnected) rural communities without assured lighting offer a latent market for decentralized alternatives. 2. Access to finance networks at the local level facilitates private investments in off-grid solutions. 3. Technology innovation and customization is necessary for customer satisfaction and management efficiency. 4. Affordable off-grid solutions based on solar energy can be an economically viable and socially acceptable alternative to fossil fuel systems. Analysis of the project output concludes that decentralized solutions and private investments can play a major role not only in providing universal modern energy access but also in enhancing livelihood options at the village level.

Background Severe acute respiratory infections in children can be fatal, rapid identification of the causative agent and timely treatment can be life saving. Multiplex real time RT-PCR helps in simultaneous detection of multiple viruses saving cost, time and labour. Commercially available multiplex real time RT-PCR kits are very expensive. Therefore the aim of the present study was to develop a cost effective multiplex real time RT-PCR for the detection of 18 respiratory viruses and compare it with an in-vitro diagnostics approved Fast Track Diagnostic Respiratory Pathogens 21 Kit (FTD). Methods Nasopharyngeal aspirates and throat swabs were collected and processed for extraction of nucleic acid using an automated extraction system and multiplex real time RT-PCR was performed using the FTD kit and a custom assay on 356 samples. Results Custom and FTD assays detected one or more respiratory viruses in 268 (75.29 %) and 262 (73.60 %) samples respectively. The concordance between the custom assay and the FTD assay was 100 % for HCoV OC43, HCoV 229E, HPIV-1, HPIV-2, HBoV, HPeV, Flu A, and Influenza A(H1N1)pdm09 and 94.66 – 99.71 % for the remaining viruses; Flu B (99.71 %), HRV (99.71 %), HPIV-3 (98.87 %), HPIV-4 (99.43 %), HCoV NL63 (99.71 %), HMPV A/B (99.71 %), RSV A/B (94.66 %), EV (98.31 %), HCoV HKU1 (99.71 %), HAdV (99.71 %). Major discrepancy was observed for RSV A/B, which was over detected in 18 samples by the custom assay as compared to the FTD assay. The custom assay was much cheaper than the FTD assay and the time taken was only 29 min more. Conclusion The custom primer and probe mix was found to be comparable to the FTD assay with good concordance but was much cheaper and the time taken for reporting was only 29 min more. The low cost custom multiplex RT-PCR can be a useful alternative to the costly FTD kit for rapid identification of viral aetiology in resource limited settings.

Close to three billion people globally and over 800 million in India are dependent on direct combustion of unprocessed solid biomass fuels in inefficient traditional mud stoves. Current cooking practices, besides causing serious health problems, are also being linked to emissions of climate change and pollution agents such as black carbon and ozone precursors. In India several initiatives have been taken up to tackle the problem but the present trajectory of limited technical and social change in cooking energy use is nonetheless persistent in rural areas. In order to develop and scale up alternative cooking technology options, we have analyzed, using the principles of strategic niche management, two projects implemented by The Energy and Resources Institute (TERI) in nine villages in India. The assessment, while highlighting reasons for stability of the current cooking regime, also points to triggers that can destabilize the regime. The focus is also on assessing the influence of protection in the form of subsidies on the process of transition. User preferences relating to social and technical aspects have been analyzed, pointing to forced draft cookstoves as the preferred option notwithstanding cost reductions to address affordability concerns. The assessment indicates that while it is critically important to understand and address the preferences of users and to improve the technology, scaling up will depend on stove cost reduction through further research. Creativity in effective financing schemes and support structures put in place by fostering public–private partnerships are also needed.

In most developing countries, at the household level, traditional burning of biomass or use of inefficient technologies for domestic applications like lighting is common, triggering concerns related to fuel or technology switching. The paper focuses on opportunities to promote cleaner energy options through development of value chains delivering improved energy efficiency and access in developing countries. We discuss the example of Uttam Urja, a field project involving the dissemination of photovoltaic lighting technologies in rural areas of India. We focus on the challenges of introducing radical innovations into the residential energy sector in developing countries. For the purpose of this paper the Uttam Urja project is conceptualized as an ‘experiment’ and analysed using the Strategic Niche Management (SNM) framework. The paper emphasizes that to effect socio-technical transitions to clean energy options on the ground, it is desirable to focus on technology customization and innovative financing to cater to the needs and concerns of end users.

Objective To study the distribution of Human Parainfluenza viruses (HPIV) 1–4 and their trends in children ≤5 y of age, hospitalised at a tertiary care centre, Jaipur and co-infection with other respiratory viruses. Methods Nasopharyngeal aspirate and throat swabs were collected and processed for extraction of nucleic acid using automated extraction system and real time RT-PCR was performed using primers and probes specific to HPIV 1–4 and other respiratory viruses on 743 samples. Results Total positivity for Parainfluenza viruses 1–4 was found to be 69/743 (9.28 %), of which 50/533 (9.38 %) were boys and 19/210 (9.05 %) girls. Predominance of HPIV- 3 was observed [41/743 (5.52%)] followed by HPIV-1 in 13/743 (1.75%), HPIV-4 in 10/743 (1.34%) and HPIV-2 in 5/743 (0.67%) patients. Maximum positivity was observed in age group 25–36 mo (12.98%) followed by 13–24 mo group (11.96%). HPIVs were found to be circulating round the year and each year. Co-infections with other respiratory viruses were observed in 22/69 (31.88%) of HPIV positive patients. Conclusions All the four types of HPIV were found to be circulating in the index population during all the three years, predominantly during post monsoon and winter seasons. HPIV vaccination should be targeted for all types.

In India kerosene uses as primary source of lighting- 43% of rural and 7.1% of urban households, even most populated African countries (Uganda, Ethiopia, and Kenya) more than 60% of the population relies on kerosene as the primary lighting fuel. Though they have access to grid electrification the unreliable supply leaves them in complete darkness and hence compelling them to think of alternatives. Poor electrification and unreliable supply lead to usage of kerosene based lighting devices such as kerosene lamps, which not only provides lowly quality illumination but also results in hazardous smoke. Off-grid electrification can provide an alternative solution for many low demand users at lower cost than grid extension and market growth of rural energy service. Costs of off-grid technologies have decreased significantly over the last few years hence making it affordable. Morden micro grid has come up with a way to make lighting system accessible to most of the rural households. Solar based renewable energy technologies extensively development in the last decade, the Solar photo voltaic cell converts light energy into direct current using the photovoltaic effect. Battery devices storing the extra power generated at day time and used during nights. Inverters and power Store Electronic Systems are used to convert direct current power generated by solar photo voltaic systems to alternative current, and utilization of direct current /alternative current in renewable energy power system at higher capital cost. But the internal rate of interest makes it superior to other system. This paper a latest researcher’s review of assessment of Direct current (DC) and Alternative current (AC) based Solar Micro-grid in rural community. The paper is therefore structured as follows: overview of micro-grid AC and DC system with case studies. Sensibility analysis in Compression with decentralized Diesel Genset (DG) based on Net present value (NPV) Internal rate of interest (IRR) for DG set 92% (not included as environmental economics), the IRR for solar micro-grids 50% and solar micro-grids with Government subsidy 80%. Opportunities and challenges involved in the implementation of solar mini grid in rural energy infrastructure.

Background: Patients with bowel obstruction still represent some of the most difficult and vexing problems that surgeons face today. While the adage, “never let the sun rise or set on a bowel obstruction” remains true, there has been a trend towards selective non-operative management of this problem. Aims and objectives were to study the various causes and modes of presentation of intestinal obstruction and to evaluate the importance of different severity indicators of obstruction with early recognition, diagnosis and thus timely abdominal exploration.Methods: 2 years prospective study conducted in PDMMC college, Amravati, Maharashtra, India, from September 2013 to September 2015. Each intestinal obstruction patient was evaluated with specific severity indicators, scored and then analyzed.Results: The commonest cause of intestinal obstruction in adults in this study series was adhesions in 33.33% cases. Other causes were mesenteric ischaemia, i.e. 7 (11.67%), Koch’s abdomen, i.e. 5 (8.33%), sigmoid volvulus, i.e. 5 (8.33%) and carcinoma, i.e. 5 (8.33%). Resection anastomosis was most commonly performed procedure in 45.7 % cases, followed by adhesiolysis in 14% patients. 66.66% patients having a score less than 3 were managed conservatively, 95.83 % having a score of 3 or more where operated on.Conclusions: The evaluation of patients endeavours not only to confirm the diagnosis but also to determine the need for and timing of surgery. Certain severity indicators and scoring systems can help to optimize this timing of surgery and prevent mortality.

Volvulus is a special form of mechanical intestinal obstruction. It is most commonly seen in sigmoid colon. It results from abnormal twisting of a loop of bowel around the axis of its own mesentery. Small bowel volvulus (SBV) is a rare condition even though the incidence in Africa and Asia is high. It is of two types; primary and secondary. It requires emergency surgical intervention; more so as consuming time increases the risk of bowel getting gangrenous. Here is a case of primary small bowel volvulus in an elderly man with evidence of ischemic bowel and perforation who was managed surgically by resection and anastomosis.

The hospital records of patients undergoing major surgery for cancer of the larynx and hypopharynx at the Tata Memorial Hospital, Bombay, from 1981 to 1985 were reviewed. Different variables were correlated with the incidence of major complications and were analysed to find out significant factors contributing to increased complication rates. Complications included wound infection, pharyngocutaneous fistulae, flap necrosis, carotid blowout, and neo-esophageal stenosis. Postoperative deaths and delayed fatalities were also recorded. The overall fistulae rate was 34.7%, and wound infection occurred in 28% of patients. Prior radiotherapy and the need for pharyngeal reconstruction were found to be significant in determining postsurgical complications. Age, sex, site, stage, cartilage and soft tissue infiltration, preoperative tracheostomy, involvement of resection margins by tumor, and the dose of radiotherapy were not found to influence the complication rates.

Skin cancers are relatively uncommon malignancies; their incidence in India being less than 1% of all cancers. The incidence of malignancy in scar tissues is 0.1-2.5%. Squamous cell carcinoma of skin is second most common amelanotic malignancy next to basal cell carcinoma. The occurrence of this disease is noticed in various parts of the body but waist line skin is not a common site. Saree is a type of female costume and dhoti is a male costume which is unique to the Indian subcontinent. The persistent and long term wearing of this costume results in depigmentation and glazing of the skin, acanthosis, dysplasia, scar and ulceration and subsequent, but very slow, malignant changes. The exact mechanism of the malignant transformation is unknown, but recurrent trauma over a long period with consequent interference with the healing process is a possible explanation. We are presenting a rare case of left flank ulcero-proliferative growth in a 75 year old woman. Wide excision with primary skin closure was done. Histopathology showed pseudoepitheliomatous hyperplasia with marked dysplasia without microinvasion. It is a premalignant lesion. The case needs its reporting due to its rarity. Awareness of saree cancer among Indians is important to prevent malignant lesions at waistline. Multimodality management with surgery, chemotherapy and radiotherapy is ideal for good outcome.

A total of 226 cases of advanced gastric cancer which occupied only one third of the stomach were analyzed in order to clarify whether and how lymphatic spread differed according to the tumor location and gross type of tumor. Out of the 226 patients, 45 cases had tumor in the upper third, 74 cases had it in the middle third, and 107 cases had it in the lower third of the stomach. The incidence of lymph node metastasis was found to be much higher for the tumors located in the lesser curvature (51.6%), greater curvature and posterior wall (54.4%), as compared to the tumors located in the anterior wall (28.0%). The tumors located in the upper third of the stomach did not show any metastasis in the N3 node, while the tumors located in the lower third of the stomach did not show any metastasis in the left cardial nodes, short gastric nodes, and the nodes along the left gastroepiploic vessels. Similarly, the tumors from the middle third of the stomach did not invade the left cardial nodes.