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Background: Pityriasis alba (PA) is a common, benign skin disorder occurring predominantly in children and adolescents. It is characterized by the presence of multiple, ill-defined, hypopigmented patches with fine scaling particularly over the face. Aims and objectives: To study the clinical characteristics and epidemiologic parameters in the context of current scenario in a rural tertiary care hospital in central India. Materials and methods: We conducted a descriptive observational study over a period of 1 year. We studied 100 clinically diagnosed patients with PA of the age group 2 to 15 years during this study. Results: Most common age group of patients observed was 6 to 10 years. About 87% patients had Fitzpatrick skin type IV followed by type III (7%) and type V (6%). Male to female ratio was 1.17:1. Maximum patients belonged to class III (50%) followed by class IV (37%) and class V (10%) according to the modified Kuppuswamy socioeconomic status scale (2018). Maximum patients had age of onset ranging from 6 to 10 years. Clinical characteristics revealed that maximum patients had 0 to 5 patches, with a duration of 1 to 2 months most commonly over cheeks. Associated features such as itching, scaling, and erythema were present in 18%, 98%, and 1% of the patients, respectively. Pallor was observed in 28% patients. However, significant history of atopy was elucidated in only 21% of patients. Around 6% patients showed positive family history of having PA and 14% having a positive history of atopy in first-degree family members. Conclusion: Due to the easily visible hypopigmented patches most commonly over face, PA is a common cause of concern in pediatric age group. In recent times, possibility of multiple factors other than atopy should be kept in mind while thinking of the associating or implicating factors which will lead to proper management of this pigmentary disorder.

Background: Prisoners fall in the most vulnerable population group, but the health issue of this group is the most understudied. The various dermatological conditions that hamper their overall health and quality of life needs to be identified and serious measures should be undertaken for preventing them. Objectives: This study is one of the rare studies that aim to identify the dermatosis pattern and to relate with its etiological factors and suggest preventive methods to be undertaken for it. Materials and Methods: Total three visits were made to the district jail located in Central India over a period of 8 months, and the prison inmates were clinically examined. The data was recorded and results were drawn. Results: Scabies accounted for 31.51% while dermatophytes accounted for 30.83%. Other dermatoses seen were acne vulgaris (5.17%), allergic contact dermatitis (ACD) in 5.03%, pyoderma (2.71%), urticaria (2.86%), and tinea versicolor (2.62%). These were followed by the other dermatoses such as milia (1.81%), alopecia areata (0.5%), and irritant contact dermatitis (0.5%); viral infections such as herpes labialis (0.45%) and molluscum contagiosum (0.45%); and pigmentary disorders such as vitiligo (0.65%) and melasma (1.16%). Three new cases of Hansen's disease were diagnosed clinically (1.75%). Conclusion: We found that common dermatoses were scabies and fungal infections which are due to the overcrowding and poor hygiene facility in the prison premises. During the subsequent visits, the number of dermatophyte infections declined which may be attributed to patient counseling and awareness regarding hygiene and general cleanliness which was provided by us to the inmates in all previous visits. A detailed look into the matter may improve the overall dermatological health of the inmates.

Background and Objectives: Diabetes mellitus (T2DM) and obstructive sleep apnea (OSA) are common disorders that not only often coexist but also have a bidirectional association where each condition exacerbates the other. The present study was performed to ascertain the occurrence and predictors of risk factors of OSA in patients with type 2DM. Materials and Methods: A cross-sectional hospital-based study recruiting 164 patients for over 2 months was conducted, in which each diabetic patient was assigned to complete a questionnaire on various variables followed by a general physical examination for associated comorbidities diabetic complications (neuropathy, nephropathy, and retinopathy). Their fasting blood glucose (FBG) and hemoglobin A1c (HbA1c) levels were recorded, following which they were administered and assessed using Berlin Questionnaire and Epworth Sleepiness Score for risk category and daytime sleepiness. Patients with already diagnosed OSA including ones receiving treatment for it were excluded from the study. Results: Of the 164 diabetic patients recruited in the study, 64 (39%) were at high risk for OSA in contrast to the 100 (61%) who were at low risk for OSA. Neck circumference, waist circumference, presence of hypertension and more than one comorbidities along with patients who experienced witnessed apnea at least three times a week, excessive daytime sleepiness, and habitual snorers found to be significant risk factors and practices in posing DM patients at a higher risk for OSA. Patients with body mass index ≥25 were more likely to have a high risk of OSA. FBG and HbA1c were not significant risk factors for OSA. Conclusions: OSA has a high prevalence in subjects with T2DM which reinforces the clinicians to remain observant for signs and symptoms of OSA in diabetic patients and monitor their compliance in terms of weight management, diet control, and medication adherence.

Background: Melasma, an acquired hypermelanosis, is challenging to treat rural population more exposed to ultraviolet (UV) rays in Central India. Chemical peeling is a new, safe and cost-effective treatment with very few studies comparing Glycolic acid (GA) peel and Trichloroacetic acid (TCA) peel in pigmented patients (Fitzpatrick skin type IV and V) in melasma using both subjective and objective methods; melasma area severity index (MASI) of evaluation. Aim: To study the clinico-epidemiological profile and to compare the therapeutic efficacy of chemical peeling with 35% GA and 15% TCA in melasma patients. Methods: 50 epidermal melasma patients were enrolled divided into two groups, 25 patients in each. These groups were treated with 35% of GA (Group A) and 15% TCA peel (Group B), respectively. They were primed and test peeled. Three sessions of peeling two weeks apart with follow up after 3 months were evaluated using subjective response and MASI score. Results: The mean age of onset was 35.20±7.11 with male to female ratio was 1: 5. The mean duration of melasma was 3.57±2.58. Positive family history (32%) was present with centrofacial (56%) was the most common pattern. Subjective evaluation in the GA group and TCA group showed good and very good response in 92% and 84% respectively. The MASI score at baseline and at 3 month for Group A was 11.8 and 3.66, while it was 10.5 and 3.7 for group B. Conclusion: Both GA and TCA peels proved to be an equally effective treatment in epidermal melasma in our study.

Cutis marmorata telangiectatica congenita (CMTC) is an uncommon, congenital, vascular malformation first described by van Lohuizen in 1922. CMTC is an infrequently reported congenital cutaneous disorder and is usually present at birth but can appear up to 3 months to 2 years of age. Hereby, we report a case of a 2-day-old infant with CMTC involving trunk with rarely reported congenital anomaly involving multiple system, i.e., musculoskeletal, cardiovascular, pulmonary, ophthalmic, excretory, oropharyngeal, and reproductive system.

Neurofibromatosis (NF) is a genetic disorder with an autosomal-dominant inheritance mainly affecting the growth of the cells of the neural tissues. Segmental NF (SNF), a rare variant of NF (NF type V), is characterized by café-au-lait macules and freckles or neurofibromas limited to one segment or one region of the body. A 26-year-old married female presented with asymptomatic café-au-lait macules and freckles involving the left cervical and thoracic region. The lesions did not cross the midline. Family history was not positive. There was no history of consanguineous marriage. There was no systemic involvement. We report this case as a rare entity of NF along with multidermatomal involvement.

Hyperkeratosis of the nipple is an uncommon, benign, asymptomatic, acquired condition of unknown pathogenesis. Most cases are bilateral, although unilateral cases had been reported. Breastfeeding is usually not affected. Physiologic changes of the nipple and areola during pregnancy include enlargement, hyperpigmentation, secondary areolae, erectile nipples, prominence of veins, striae, and enlargement of the Montgomery glands or tubercles (hypertrophied sebaceous glands). Women with unilateral primary hyperkeratosis of the nipple and/or areola (HNA) may have bilateral disease during pregnancy (secondary HNA). Pregnancy may also produce thicker, darker lesions. Here, we report a case of pregnancy-associated hyperkeratosis of the nipple in a primigravida. We counseled her about the benign nature of the condition and treated her with topical steroids and moisturizers.

Patients with diabetes, a methionine-rich meat diet, or certain genetic polymorphisms show elevated levels of homocysteine (Hcy), which is strongly associated with the development of cardiovascular disease including diabetic cardiomyopathy. However, reducing Hcy levels with folate shows no beneficial cardiac effects. We have previously shown that a hydrogen sulfide (H2S), a by-product of Hcy through transsulfuration by cystathionine beta synthase (CBS), donor mitigates Hcy-induced hypertrophy in cardiomyocytes. However, the in vivo cardiac effects of H2S in the context of hyperhomocysteinemia (HHcy) have not been studied. We tested the hypothesis that HHcy causes cardiac remodeling and dysfunction in vivo, which is ameliorated by H2S. Twelve-week-old male CBS+/− (a model of HHcy) and sibling CBS+/+ (WT) mice were treated with SG1002 (a slow release H2S donor) diet for 4 months. The left ventricle of CBS+/− mice showed increased expression of early remodeling signals c-Jun and c-Fos, increased interstitial collagen deposition, and increased cellular hypertrophy. Notably, SG1002 treatment slightly reduced c-Jun and c-Fos expression, decreased interstitial fibrosis, and reduced cellular hypertrophy. Pressure volume loop analyses in CBS+/− mice revealed increased end systolic pressure with no change in stroke volume (SV) suggesting increased afterload, which was abolished by SG1002 treatment. Additionally, SG1002 treatment increased end-diastolic volume and SV in CBS+/− mice, suggesting increased ventricular filling. These results demonstrate SG1002 treatment alleviates cardiac remodeling and afterload in HHcy mice. H2S may be cardioprotective in conditions where H2S is reduced and Hcy is elevated.

Advanced diabetes mellitus (DM) may have both insulin resistance and deficiency (double DM) that accelerates diabetic cardiomyopathy (DMCM), a cardiac muscle disorder. Reduced cardiac miR-133a, a cardioprotective miRNA, is associated with DMCM. However, it is unclear whether increasing miR-133a levels in the double DM heart could prevent DMCM. We hypothesized that increasing cardiac levels of miR-133a could prevent DMCM in Akita, a mouse model of double DM. To test the hypothesis, we created Akita/miR-133aTg mice, a new strain of Akita where miR-133a is overexpressed in the heart, by crossbreeding male Akita with female cardiac-specific miR-133a transgenic mice. We validated Akita/miR-133aTg mice by genotyping and phenotyping (miR-133a levels in the heart). To determine whether miR-133a overexpression could prevent cardiac remodeling and cardiomyopathy, we evaluated cardiac fibrosis, hypertrophy, and dysfunction (P-V loop) in 13–15 week male WT, Akita, Akita/miR-133aTg, and miR-133aTg mice. Our results revealed that miR-133a overexpression in the Akita heart prevents DM-induced cardiac fibrosis (reduced collagen deposition), hypertrophy (decreased beta-myosin heavy chain), and impaired contractility (downregulated calcium handling protein sarco-endoplasmic reticulum-ATPase-2a). These results demonstrate that increased levels of miR-133a in the DM heart could prevent cardiac remodeling. Our P-V loop analysis showed a trend of decreased cardiac output, stroke volume, and ± dp/dt in Akita, which were blunted in Akita/miR-133aTg heart. These findings suggest that 13–15 week Akita heart undergoes adverse remodeling toward cardiomyopathy, which is prevented by miR-133a overexpression. In addition, increased cardiac miR-133a in the Akita heart did not change blood glucose levels but decreased lipid accumulation in the heart, suggesting inhibition of metabolic remodeling in the heart. Thus, miR-133a could be a promising therapeutic candidate to prevent DMCM.

Hyperkeratosis of nipple is uncommon, benign, asymptomatic, acquired condition of unknown pathogenesis. Most cases are bilateral, although unilateral cases had been reported. Breastfeeding is usually not affected. Physiologic changes of the nipple and areola during pregnancy include enlargement, hyperpigmentation, secondary areolae, erectile nipples, prominence of veins, striae, and enlargement of the Montgomery glands or tubercles (hypertrophied sebaceous glands). Women with unilateral primary hyperkeratosis of the nipple and/or areola may have bilateral disease during pregnancy (secondary hyperkeratosis of the nipple and/or areola). Pregnancy may also produce thicker, darker lesions. Here, we report a case of pregnancy-associated hyperkeratosis of nipple in a primigravida. We counseled her about benign nature of the condition and treated her with topical steroids and moisturizers.

Nonalcoholic steatohepatitis (NASH) is a chronic liver disease that can lead to cirrhosis, liver transplant, and even hepatocellular carcinoma. While liver biopsy remains the reference standard for disease diagnosis, analytical and clinical development of non-invasive soluble biomarkers of NASH are of great importance to advance the field. To this end, we performed analytical and clinical validation on a series of pro-inflammatory cytokines and chemokines implicated hepatic inflammation; IL-6, CRP, TNFα, MCP-1, MIP-1β, eotaxin, VCAM-1. Biomarker assays were validated for accuracy and precision. Clinical performance was evaluated in a random sample of 52 patients with biopsy-proven NAFLD/NASH. Patients were categorized into three groups according to their fibrosis stage; advanced (F3-F4), mild (F1-2) and no (F0) fibrosis. Serum IL-6 was increased in patients with advanced fibrosis (2.71 pg/mL; 1.26 pg/mL; 1.39 pg/mL p

A wide prevalence of socio-religious, cultural, and tribal practices in India often leads to a multitude of skin conditions, which can misled the dermatologists in arriving at a diagnosis. With increasing globalization and migration, the practice of indigenous customs and traditions are crossing boundaries, making it imperative for the dermatologists to be acquainted with the cutaneous side effects of these practices. Here, we report a unique case of thermal burn in a circumferential pattern over the umbilical region, a result of the placement of burning lamp over umbilicus to alleviate abdominal discomfort.

Scrotal dermatitis is a very common condition that has been easily overlooked by most dermatologists and treating physicians. The condition is easily mistaken for the common skin disorders affecting the area, like fungal infections. Scrotal dermatitis is not considered a separate disease entity and is usually considered a condition similar to the contact dermatitis occurring elsewhere. This article attempts to classify the condition as a separate disease entity and explains the various etiological factors and the pathogenesis of the condition. The various stages of the condition are also explained in detail. Newer treatment modalities like the use of narrow band UVB for the management of scrotal dermatitis is also highlighted in this article.

Background : Leprosy involves peripheral nerves sooner or later in the course of the disease leading to gross deformities and disabilities. Sadly, by the time it becomes clinically apparent, the nerve damage is already quite advanced. However, if the preclinical damage is detected early in the course of disease, it can be prevented to a large extent. Materials and Methods: We conducted an electrophysiological pilot study on 10 patients with clinically manifest leprosy, in the Dermatology Department of Mahatma Gandhi Institute of Medical Sciences, Sewagram. This study was done to assess the nerve conduction velocity, amplitude and latency of ulnar and median nerves. Results and Conclusion: We found reduced conduction velocities besides changes in latency and amplitude in the affected nerves. Changes in sensory nerve conduction were more pronounced. Also, sensory latencies and amplitude changes were more severe than motor latencies and amplitude in those presenting with muscle palsies. However, further studies are going on to identify parameters to detect early nerve damage in leprosy.

Introduction: The physical effects of the arthropod bites on human skin receive less attention, especially in the rural areas where the per capita income is less. Ours is a rural-based hospital, the vicinity having more of plants, trees, and forests; we undertook the study to find out the relation of insect bite dermatitis in a rural area. Materials and Methods: The study was carried out in the Dermatology outpatient department of our institute on 100 subjects of insect bite dermatitis who were questioned retrospectively about the sequence of events besides their environmental and living conditions. They were examined thoroughly and the relevant clinical findings were noted, also taking into account the prior treatment taken by them, if any. Results and Conclusions: It was found that insect bite dermatitis has no age or gender preponderance, and the protective factors for the same are use of full sleeve clothes and keeping the doors and windows closed at night. On the contrary, the risk factors are residence in areas of heavy insect infestation, use of perfumes and colognes, warm weather in spring and summer and the lack of protective measures. However, there was no direct association of atopy with increased risk of developing insect bite dermatitis.

Background: Acute respiratory infections (ARI) are leading global cause of under-five mortality and morbidity. Objective: To elicit the prevalence and risk factors associated with ARI among under-five children. Materials and Methods: A community-based cross-sectional study was undertaken in 21 registered urban slums of Guwahati in Assam to determine the prevalence and risk factors associated with ARI among 370 under-five children from 184 households and 370 families. Results: The prevalence of ARI was found to be 26.22%; infants and female children were more affected. Majority of the ARI cases were from nuclear families (84.54%), living in kutcha houses (90.72%) with inadequate ventilation (84.54%), overcrowded living condition (81.44%), with kitchen attached to the living room (65.98%) and using biomass fuel for cooking (89.69%). ARI was significantly associated with ventilation, location of kitchen in household; presence of overcrowding, nutritional status, and primary immunization status also had impacts on ARI. Conclusion: The present study had identified a high prevalence of the disease among under-fives. It also pointed out various socio-demographic, nutritional, and environmental modifiable risk factors which can be tackled by effective education of the community.

Background: We conducted a study to assess the impact of small group teaching (SGT) among students by feedback analysis to identify intricacy so that learning can be facilitated. Materials and Methods: This cross-sectional study was undertaken among 182 MBBS students studying at a teaching hospital at Gangtok. Students were provided with a questionnaire following an assignment on a scheduled topic. Students were asked to provide feedback on the modes of teaching-learning practiced in community medicine with the parameters of evaluation including assessment of presentation by faculty member in reference to relevance, sequencing, depth, interaction, etc., to the overall rating of presentations in different teaching-learning methods. Results: The faculty members were on the positive evaluation by the students in the SGT, which was preferred over "lectures" as the teaching-learning methods. Among SGTs "tutorials" were graded better than "practical," "seminar" and "field posting" on the basis of longer duration at a stretch. Among the parameters for evaluation, relevance, depth, and interaction in regard to scheduled topic of presentations, the rating was significantly higher in SGT than different other teaching-learning methods. Largely the students noted that the time devoted and number of hours/sessions allotted for each topic was adequate. Conclusion: All forms of SGT were on the positive appraisal by the students on their learning experience and were considered as a comprehensive tool for in-depth teacher-student interaction.

Background: Global prevalence of thyroid cancer has been on the rise in recent decades. Objectives: To study the clinical presentations to reach an agreement for diagnosis and optimal management of incidentally revealed thyroid swellings for early diagnosis. Materials and Methods: A prospective study was carried out on 178 cases of incidentally detected thyroid swelling attending a tertiary care teaching institute of Kishanganj Bihar. All the cases were subjected to a thorough clinical examination followed by evidence-based interventions. Fine needle aspiration cytology was done in all the cases preoperatively as out-patients basis and histopathologically confirmed postoperatively. Results: The highest incidence of thyroid swelling (75.84%) was found in the age group of 20-40 years; a female preponderance was noted in the ratio 4:1. The duration of swelling ranged from six months to three years. Difficulty in swallowing and breathing was complained by 23 (12.9%) and 18 (10.1%) of the patients respectively. Typically the swellings were located in the right lobe. Commonly the subjects in our study were in euthyroid state (90%) and were with firm swellings (66.7%). Follicular and anaplastic carcinoma was important postoperative cytological findings. Majority of surgical intervention was hemithyroidectomy (55.06%). Conclusion: Incidentally revealed thyroid swelling was quite high in eastern India for which we need a consensus line of intervention.

Hypoxanthine guanine phosphoribosyl transferase-1 (HGPRT-1) leading to Lesch-Nyhan syndrome (LNS) is one of the important causes of self-mutilation. Hereby, we report a case of LNS in a three and half-year-old male child, who presented with characteristic self-mutilating behavior. He had history of developmental delay, difficulty in social interaction, attention deficit and features of autism. His serum blood biochemistry was normal except for low hemoglobin levels and raised serum uric acid levels. With a diagnosis of LNS, the child was treated with allopurinol. With various modalities of physical restraint, his self-mutilating behavior came under control and currently the patient is being followed up.

Neurofibromatosis type 1 is an autosomal dominant disorder which primarily affects the growth and development of neural cell tissues. It presents as multiple tumor-like growths over the skin that arises from the nerves and is associated with other abnormalities like pigmentation over the skin and bone deformities. Becker′s nevus or hairy pigmented epidermal nevus is a benign cutaneous hamartoma which is characterized by hyperpigmented macule with hypertrichosis. It is rarely associated with neurofibromatosis. We report a 22-years-old male with coexistent Becker′s nevus and type 1 neurofibromatosis.

Vogt-Koyanagi-Harada syndrome (VKH syndrome) is named after ophthalmologists Alfred Vogt from Switzerland and Yoshizo Koyanagi and Einosuke Harada from Japan. It is an uncommon multisystem disorder characterized by chronic, bilateral, diffuse granulomatous uveitis with associated dermatological, neurological and auditory manifestations. It is an autoimmune disease directed against melanocytes. We report a case presenting with vitiligo, auditory defect with additional dextrocardia.

Background : Diabetes mellitus is an emerging global health problem. It is a chronic, noncommunicable, and expensive public health disease. Aims and Objectives : To determine the prevalence and the risk factors of type 2 diabetes mellitus among the adult population of Puducherry, South India. Materials and Methods : This was a population-based cross-sectional study carried out during 1 st May 2007-30 th November 2007 in the rural and urban field practice area of Mahatma Gandhi Medical College and Research Institute, Puducherry. Simple random sampling technique was used for the selection of 1370 adult 20 years of age and above. Main outcome measures were the assessment of the prevalence of prevalence and correlates of diabetes among the adult population. Predesigned and pretested questionnaire was used to elicit the information on family and individual sociodemographic variables. Height, weight, waist, and hip circumference, blood pressure was measured and venous blood was also collected to measure fasting blood glucose, blood cholesterol. Results : Overall, 8.47% study subjects were diagnosed as diabetic. The univariate analysis and multivariate logistic regression analysis showed that the important correlates of diabetes mellitus were age, blood cholesterol, and family history of diabetes. The findings were found to be statistically significant. Conclusions : In our study we observed that adults having increased age, hypercholesterolemia, and family history of diabetes mellitus are more likely to develop diabetes mellitus.

Background: Prevalence of methicillin-resistant Staphylococcus aureus (MRSA) strains is reported to be increasing globally. Objectives: The study was conducted to find the magnitude and antibiotic susceptibility pattern of MRSA infection in a referral tertiary care teaching hospital of Sikkim, India. Materials and Methods: In this cross sectional study, 827 clinical specimens were collected from different departments of Central Referral Hospital. One hundred and ninety-six carrier screening nasal swabs were obtained from health care workers of the hospital. Subsequently, the antimicrobial susceptibility test was performed for the confirmed MRSA isolates as per Clinical and Laboratory Standards Institute (CLSI). Results: Methicillin resistance was seen in 152 isolates of S. aureus - 111 from clinical specimens and 41 from carrier screening samples. MRSA positivity among males was significantly higher than females. Extremely significant MRSA-positive cases were observed from ages less than 30 years, in-patient cases, particularly with a stay of more than 15 days and with a previous history of intake of broad spectrum antibiotics. Incidentally, there was no significant difference of MRSA positivity with a previous history of hospitalization. The extent of MRSA and drug resistance pattern was significantly different among various samples of S. aureus-positive isolates. The strains tested exhibited decreased susceptibility to vancomycin and imipenem. Most vulnerable of the carrier were the cleaners, that was a significant observation. Incidentally, there was no resistance in the carriers to both vancomycin and imipenem. Conclusion: MRSA is prevalent in our hospital and strains resistant to methicillin and vancomycin were quite high.

Aim : Eye morbidities with or without symptoms delineate a significant morbidity among adolescent schoolgirls in India. The study was undertaken to assess the extent of visual impairment and ocular morbidity to identify influencing factors and the impact on scholastic performance. Materials and Methods : A population-based cross-sectional study was undertaken among 3002 urban girl students of Surat in Gujarat, India. Overall prevalence of refractive error was found to be 15.22%; myopia affected 91.47%, hyperopia 4.60%, and astigmatism 0.04%. The prevalence of myopia and astigmatism was more in higher age groups, while hyperopia was more in lower age groups; even students with good vision reported ophthalmic symptoms. Of all spectacle users, in 29.73% cases the eyesight was not found to be with the best possible corrections. Refractive error was observed to be higher among the general caste (50.98%) and among Muslims (54.05%). Still, among those with problems of eyesight, 75.93% students had good academic performance. Associated ocular morbidity was noted in 20.35% participants along with the refractive error. Conclusion : This study highlighted the load of eye morbidities of adolescent Indian urban girls.

Objectives : The objective was to assess sociodemographic characteristics of men who use contraceptive and to compare them with men whose wives use contraceptive. Materials and Methods : Study design: A population-based cross-sectional study was performed. Study setting: It was performed in rural setting of the Sang PHC and Pakyong PHC service areas in Sikkim, India. Study participants: A total of 596 currently married men enrolled in the eligible couple registers. Interventions: No interventions occurred. Measurements: Sociodemographic correlates of contraceptive use were analyzed: occupation, religion, ethnicity, literacy, age, loss of children, and distance from health facility. Results : The use of contraceptive was high among the cultivators - men (44.45%), spouse (36.01%) followed by persons in Government service, respectively, 31.49% and 31.55%. Hindu men (55.42%), women (69.25%), and other backward communities (OBC) men (47.53%) and their wives (52.31%) were the majority users. A significantly higher number of users of contraceptive were literate men (72.33%) and their wives (86.17%) (χ2 =0.021, P> 0.05). Highest use was found in men and women (44.47%) in the 35 years and above (43.83) age group. But this difference was not significant. With the increase in the number of losses of children the contraceptive use declined among men and their spouses. Contraceptive users were higher at distances 1 hour and above from the health center compared to others. Conclusions : The finding of the research indicated that sociodemographic correlates determine the magnitude of the contraceptive use among couples in a rural community. A research agenda should define factors at both macro and micro levels that interact to adversely impinge on reproductive health outcomes.

Background : The geriatric health problems are related to chronic disease as a result of increasing life expectancy. Objective : This study was undertaken to assess the health problems of the elderly in Puducherry. Materials and Methods : This cross-sectional study was carried out on 214 elderly persons from the age group of 60 years and above using a pre-designed and pre-tested questionnaire that addressed the disease magnitude in comparison with the socioeconomic variables. Results : Overall, 43% of the participants were diabetic, 47.7% hypertensive, 86% anemic and 68.2% visually impaired. All the morbidities were noted to be higher in the 70-79 years age group. Diabetes was significantly higher in participants from urban areas, with family history and increasing waist-hip ratio, but significantly lower in the below poverty line areas. Hypertension risk was significantly higher among females, among those leading sedentary life, those eating vegetarian food, those addicted to tobacco and with abdominal obesity. Anemia was significantly lower among urban vegetarians. Overweight and obese were noted in 31% of the participants, and were higher in females (87.5%). Rural residence, female sex, living in joint family, literacy, sedentary life style, decreasing per capita income and decreasing body mass index (BMI) were significantly associated with visual impairment. Conclusion : This study highlights the burden of health problems of elderly individuals in South India.

Background and Aim: Concern about the grim nature of postoperative acid aspiration syndrome grew among the anesthesiologist over the years warranting the need for pre-emptive intervention. The aim of the study is to compare the effects of preoperative oral ranitidine versus pantoprazole given in regulating gastric pH in elective surgery. Methods: This prospective, parallel group, controlled, randomized, single-blind study was conducted at a tertiary care postgraduate teaching institute at Kolkata, involving 120 participants of either sex, aged 18-60 years of American Society of Anesthesiologists physical status I and II, who were scheduled for elective surgery under general anesthesia lasting for more than 2 h. The participants were divided into three groups. In group A (n=40) participants received placebo tablet, in group B (n=40) participants received ranitidine tablet while in group C (n=40), participants received pantoprazole tablet and their gastric pH estimated serially. Results: The participants in the three groups were comparable in terms of age, sex, body weight, duration of surgery and type of surgery distribution. In regard to changes in gastric pH trends, there was no statistically significant difference between serial pH values in group A (Friedman test; P>0.05) and group C participants. (P>0.05). However, the mean preoperative gastric pH values (7.140±.7652) were significantly lower than mean pH values (7.253±.7514) after 2 h postoperatively in group B participants (P

Background: Bacterial infections remain an important cause of pediatric mortality and morbidity. It might be possible to reduce these factors by early diagnosis and proper management. Aim: The aim of the study was to analyze the bacteriological profiles with their antibiogram, and to register the risk factors for septicemia in neonates and infants. Setting and design: This observational cross-sectional study was conducted in a tertiary care teaching hospital at Gangtok, Sikkim, India, and included clinically suspected cases of septicemia in neonates and infants. Materials and Methods: Blood culture reports were studied in 363 cases of clinically suspected septicemia in neonates and infants, using the standard technique of Mackie and McCartney. The antibiotic sensitivity was performed by Kirby-Bauer′s disc diffusion method. Risk factors for sepsis in the children were registered. Results: Blood culture was positive in 22% of cases. Gram-negative septicemia was encountered in 61% of the culture-positive cases. Pseudomonas and Enterobacter species were the predominant pathogens amongst gram-negative organisms. Most gram-negative organisms were sensitive to Amikacin, Ciprofloxacin, and Co-trimoxazole. The most common gram-positive organism isolated was Staphylococcus aureus (97%). More than 70% of Staphylococci isolated were resistant to Penicillin, but were sensitive to Clindamycin (70%) and Vancomycin (40%). The most important risk factors of septicemia in our study population were preterm birth (31%), followed by respiratory distress (5%) and low birth weight (4%). Conclusion: As the cultures showed variable antibiogram with complicated patterns of resistance, culture and sensitivity test should be performed in all cases of septicemia.

Background: Job stress has been linked to a wide range of adverse effects on mental, physical and organizational health. Objective: The objective of this study was to determine the impact of job stress on mental, physical and social health of the underground construction workers in Sikkim. Materials and Methods: The study population comprised of tunnel workers and a comparable group of controls. Using the interview technique, data was collected using the SF-36 General Health Survey Questionnaire. Results: The study population comprised of individuals of whom more than half were below 40 years of age and was comparable to the group of controls. Majority reported good health, while poor health was reported by 22 % of the subjects under study Compared to their health status last year, 52% rated their health as somewhat worse. Majority reported that their physical health problems limited them in activities of daily life, viz., running, lifting heavy objects, participation in strenuous sports, climbing several flights of stairs, bending, stooping or kneeling and walking more than a mile, during the past four weeks. More than half of them had severe body ache in the past four weeks that interfered with both work outside home and housework. This was true for emotional problems also, which interfered with their normal social activities involving family, friends, neighbors or groups. The associations of occupational stress with physical, emotional and social life and with limitation of day-to-day activities among tunnel workers were found to be statistically significant. Conclusion: The results emphasize the importance of assessment of the effects of job stress and of fulfilling the need of underground workers for optimum preventive measures.

Background: Solar radiations improve the microbiological quality of water and offer a method for disinfection of drinking water that requires few resources and no expertise and may reduce the prevalence of diarrhea among under-five children. Aims and Objectives: To find out the reduction in the prevalence of diarrhea in the under-five children after consumption of potable water treated with solar disinfection method. Materials and Methods: This was a population-based interventional prospective study in the urban slum area of Mazegoan, Jorethang, south Sikkim, during the period 1 st May 2007 to 30 th November 2007 on 136 children in the under-five age group in 102 households selected by random sampling. Main outcome measure was the assessment of the reduction of the prevalence of diarrhea among under-five children after consumption of potable water treated with solar disinfection method practiced by the caregivers in the intervention group keeping water in polyethylene terephthalate (PET) bottles as directed by the investigators. The data were collected by the interview method using a pre-tested questionnaire prepared on the basis of socio-demographics and prevalence of diarrhea. The data were subjected to percentages and chi-square tests, which were used to find the significance. Results: After four weeks of intervention among the study group, the diarrhea prevalence was 7.69% among solar disinfection (SODIS) users, while 31.82% prevalence was observed among non-users in that period; the reduction in prevalence of diarrhea was 75.83%. After eight weeks of intervention, the prevalence of diarrhea was 7.58% among SODIS users and 31.43% among non-users; the reduction in diarrhea was 75.88% in the study group. The findings were found to be statistically significant. Conclusions: In our study, we observed that the prevalence of diarrhea decreased significantly after solar disinfection of water was practiced by the caregivers keeping potable water in PET bottles in the intervention group.

Background: Leprosy is a chronic infectious disease that is associated with serious morbidity and is a disease of public health concern because of the case load and the social stigma attached to the disease. Aim: To understand the knowledge of, and attitudes towards, leprosy amongst healthcare providers in Assam, India. Settings and Design: This cross-sectional study was conducted during March to June 2007 in different health institutions of the Kamrup district of Assam. Results: Among the program managers interviewed, only half were organizing training sessions, and 37.5% were involved in supervision of the program activities at the periphery level. Among the program managers who were involved with leprosy elimination, only half were organizing training session and 37.5% were involved in supervision of the program activities at the periphery level. Medical officers consistently demonstrated higher knowledge about leprosy, followed by health supervisors and multipurpose workers (MPWs), including nursing staff. Regarding training status with regard to leprosy, 90% of medical officers, 80% of health supervisors and around 87% of MPWs (83% of male MPWs and 89% of female MPWs) had attended training programs on leprosy. Regarding WHO MDT, 80% of health supervisors, 84.8% of male MPWs and 86.2% of female MPWs had an idea of MDT and treatment duration of various categories of patients. Conclusions: These observations suggest that there appear to be adequate knowledge and positive behavior among healthcare providers with regard to leprosy in this part of India. However, there is still a need to organize training programs at regular intervals to train new recruits, as well as reinforce and update the knowledge of those already trained.

Eccrine angiomatous hamartoma (EAH) is an exceedingly rare benign tumor-like lesion prevalent in childhood which may produce pain and marked sweating. The histological features include proliferation of eccrine sweat glands and angiomatous capillary channels. We report an 8-year-old girl who had a single lesion on her left lower leg. Physical examination revealed a slightly elevated, 4×7 cm erythematous plaque on the lateral aspect of left leg. Sweating in the lesion was evoked by physical work or emotional stress. There was no pain or tenderness associated with the lesion. The patient had no history of trauma to the site. These lesions were clinically angiomatous, and we obtained the diagnosis by histopathological examination. Histopathological examination of the lesion showed increased numbers of eccrine glands, as well as dilated vascular channels in the deep dermis and subcutaneous tissue. These findings are consistent with EAH.

Authors have attempted to discuss recently described "signs" in the field of dermatology.

Background: A lot of cosmetic and Ayurvedic products containing unlabeled depigmenting agent and steroids are available readily over the counter sale. The side effects of these products are not documented and can lead to adverse effects of continuous usage. Objective: By this study, we aimed to find out the true nature of the above problem and it′s implication in the Indian rural scenario. Methodology: All patients attending dermatology department during the period of 3 months from May to June 2013 for skin diseases were enquired about unsupervised use of any cosmetic product on their facial skin, duration of use, any side effect experienced through the prescribed questionnaire. Results: Total 50 patients were recruited for the study. Out of which, 48% were males and 52% were females. Seventy-four percent of people had applied topical products/steroids in an attempt of attainment of fair complexion, 14% for melasma, 8% for acne induced hyperpigmentation, and 4% for dark circles. About 80% people had obtained one or the other products over the counter sale, 8% had followed the attractive advertisements, 8% had started the application on the recommendation of friends/family while only 4% people had correctly gone through the proper channel to consult a dermatologist. Conclusion: The problem of topical products or steroids abuse is rampant and significant, and unless and until immediate steps are taken to root out this problem from our setup, the condition will become worse all the more.

Flagellate hyperpigmentation is a unique complication of systemic bleomycin sulfate therapy. It has an onset anywhere between 1 day and several months after administration for various indications and these eruptions are usually dose-dependent. The dose of bleomycin required to produce such an effect is usually more than 100 U but it can also occur at lower doses also. Herewith, we describe a case with clinical image of ovarian dysgerminoma that presented with typical linear and streaked pigmentation following a very low dose (30 U) of systemic bleomycin therapy which appeared within 24 h of administration and increased gradually after subsequent doses.

Erythema ab igne (EAI) is characterized by localized areas of reticulated erythema and hyperpigmentation due to chronic and repeated exposure to infrared radiation. Taking a good history plays an important role in coming to the diagnosis of the disease condition; and at the same time, the particular cultural practices of a place determine its occurrence in the local masses. Herein we report the case of a young lady in her early thirties who presented to us with a dusky hyperpigmentation over her right arm and leg. Her detailed history and cutaneous examination led to the diagnosis of erythema ab igne.