Background: Resistance to broad-spectrum beta-lactams, mediated by extended-spectrum beta-lactamases (ESBL), AmpC beta-lactamase, and metallo-beta-lactamase (MBL) enzymes, is an increasing problem worldwide. Aim of the study: This study was undertaken to detect ESBL, AmpC beta-lactamase and metallo-beta-lactamase producing Pseudomonas aeruginosa and Acinetobacter species from the endotracheal aspirates. Materials and Methods: A prospective study was performed over a period of 15 month in a tertiary care hospital. A total of 26 clinical isolates of P.aeruginosa and 40 of Acinetobacter species were tested for the presence of ESBL, AmpC beta-lactamase, and metallo-beta-lactamase enzyme. Detection of ESBL was done by the combined disk diffusion method as per Clinical and Laboratory Standards Institute (CLSI) guidelines, and MBL was detected by imipenem-Ethylenediaminetetraacetic acid (EDTA) combined disk method. Isolates showing reduced susceptibility to cefoxitin (30 μg) disk were considered 'screen positive' for AmpC beta-lactamases and selected for detection of plasmid-mediated AmpC by the AmpC disk test. Results : 42.30% isolates of P.aeruginosa were positive for ESBL while 53.85% were MBL producers. Among 39 isolates of Acinetobacter baumannii, 43.59% were AmpC producers while 48.72% were MBL-producing strains. Conclusion: The study emphasizes the high prevalence of multidrug-resistant P.aeruginosa and A.baumannii producing beta-lactamase enzymes of diverse mechanisms. Thus, proper antibiotic policy and measures to restrict the indiscriminative use of cephalosporins and carbapenems should be taken to minimize the emergence of this multiple beta-lactamase-producing pathogens.

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Background: Awareness of glaucoma is low in spite of being the second leading cause of preventable blindness in the world. Aim: To study the awareness and knowledge levels of glaucoma in a tertiary eye care hospital in a tier-2 city. Materials and Methods: This is a hospital-based crosssectional study. A total of 704 patients attending ophthalmology outpatient department of Sri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital (SDM) Dharwad, aged 40 years and above were administered a questionnaire after a written informed consent to assess their awareness and knowledge levels of glaucoma. Subjects "having heard of glaucoma" even before they were recruited for the study were defined as "aware", and subjects having some understanding of the eye disease were defined as "knowledgeable". Results: Out of 704 subjects recruited for the study, only 34 (4.8%) subjects were aware of glaucoma and 22 (3.1%) had some knowledge of glaucoma. Determinants of glaucoma awareness were higher levels of education, diabetes, or glaucoma and family history of glaucoma. Conclusion: Awareness and knowledge of glaucoma was very low among the subjects. The findings of the study stress the need for health awareness for effective prevention of blindness due to glaucoma.

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Background: Adolescence is a period of transition between childhood and adulthood. Nutritional requirements during this period increase tremendously compared to preceding years of growth. The nutritional status of adolescent girls, the future mothers, contributes significantly to the nutritional status of the community. The present study was aimed to assess the current nutritional status of the adolescent girls. Materials and Methods: This one-year community-based, cross-sectional study was undertaken at a village Peeranwadi of District Belgaum, Karnataka among 400 adolescent girls of 10 to 19 years. Information on socio-demographic variables was collected by an interview using pre-designed and pre-tested questionnaire. A 24-hour recall method was used to assess nutrient intake. The nutrient intake was calculated using tables of nutritive value of Indian foods. For the comparison of anthropometric data, National Center for Health Statistics and National Health and Nutrition Examination Survey standards were used. Results: The mean age among the study population was 12.9 ± 2.06 years. Majorities (73.5%) of them were Hindus, 98.5% were literate, and 90% were currently studying. Adolescent girls between 10 and 14 years were more stunted (63.82%) as compared to 15 to 19 years (40.84%) (P = 0.0003) and thin (60.79% vs. 39.43%; P = 0.0009). Overall, the mean calorie intake was observed to be 1272.20 ± 133.28 kcal/day, protein intake was 40.99 ± 3.32 gm, and iron intake was 14.42 ± 2.58 mg. Conclusion: Overall, majority of girls were having dietary intake less than 50% of RDA, and almost three fourth of girls were anemic.

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This article provides an insight towards diagnosing and managing thalassemias. It begins by describing the structure of normal hemoglobin and elaborates on our understanding of the pathophysiology of thalassemia. An overview of transfusion therapy and its complications including endocrinopathies and cardiomyopathy has also been discussed.

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Context: Nephrectomy is a common procedure in surgical practice. It is indicated in patients presenting with a wide range of clinical conditions ranging from symptomatic chronic infections, obstruction, calculus disease, and severe traumatic injury to renal cell carcinomas. It is performed increasingly in the context of end-stage renal disease and to treat renovascular hypertension from non-correctable renal artery disease, or for severe unilateral parenchymal damage resulting from nephrosclerosis, pyelonephritis, vesicoureteric reflux, and congenital dysplasia. Objective: This study aimed to assess the patterns and morphology of lesions in nephrectomy specimens in a tertiary care hospital, observe variations if any from the conventional pattern, and clinico-morphological correlation for proper postoperative management. Materials and Methods: A hospital-based five-year study included all nephrectomy specimens received in the department over a period of five years (November 1, 2005 to October 31, 2010). Results: A total of 140 cases over a period of five years were studied. A wide range of lesions were found on histopathological examination. The histopathological analysis correlated well with the clinical diagnosis; however, few benign lesions like xanthogranulomatous pyelonephritis may be misdiagnosed clinically as malignant. Similarly, cases of cystic diseases of kidney, renal sarcomas, renal squamous cell carcinomas, and angiomyolipomas were confirmed on histopathological analysis only. Conclusions: The present study provides a fair insight into the histological patterns of lesions in nephrectomy specimens at our institution. In conclusion, a wide range of lesions are encountered on histopathology of nephrectomy specimens, many of which may be misdiagnosed clinically and radiologically; therefore, it is mandatory that every nephrectomy specimen be subjected to detailed histopathological examination for a clinico-morphological correlation to ensure proper management.

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Background: Aerobic non-fermenting Gram-negative bacilli (NFGNB) once considered as contaminants now associated with life-threatening infections and emerging as multi drug resistant nosocomial pathogens. Aim: Isolation and identification of NFGNB in all the clinical samples and to determine antibiotic susceptibility pattern of the isolated NFGNB. Materials and Methods: This study has been conducted in the Department of Microbiology at a tertiary care teaching hospital over a period of 2 months from September to October 2013. NFGNB were isolated and identified from clinical specimens by standard procedure and antibiotic sensitivity test was performed. Results: NFGNB isolation rate in the present study was 3.58%. Male to female ratio was 2.125. Pus was the most common specimen (21%) followed by tracheal aspirate (17%). Pseudomonas aeruginosa was the most common isolate (60%) followed by Acinetobacter baumannii (22%) and Acinetobacter lwoffii (12%). P. aeruginosa has shown good sensitivity to amikacin (83.3%), imipenem (80%) and piperacillin-tazobactam (73.3%) whereas A. baumannii showed multidrug resistance. Conclusion: It is necessary to identify NFGNB and to monitor their susceptibility pattern to guide the clinician for better care and management of patients. NFGNB are now emerging as organisms of nosocomial infections. Hence, antibiotic sensitivity testing and infection control measures are needed to prevent the emergence and spread of multi drug resistant NFGNB in health care settings.

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Teratoma is a neoplasm with tissue components derived from more than one germ layer - ectoderm, mesoderm, and endoderm. They are commonly found in ovaries, testes, retroperitoneum, and sacrococcygeal region. Mediastinal teratomas are relatively rare comprising of only 8-13% of all tumors in mediastinum and only 1-10% of germ cell tumors occurring in mediastinum. We are presenting a case of a 1-year-old male who came with a history of on and off fever and frequent cough and cold since 3-4 months. On x-ray chest, differential diagnosis of congenital diaphragmatic hernia and left pleural effusion were given and computed tomography (CT) scan of abdomen and chest were advised, which revealed symptoms of mediastinal germ cell tumor. Final diagnosis of mature teratoma was given on histopathology. The case is being presented here because mediastinum is a rare site for teratoma and children are less commonly affected.

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Background: Effective keloid management is still a distant dream in spite of many recent modalities being tried for the same. Although many treatment protocols have shown efficacy of varying degrees, there are few systematic randomized trials comparing them. Objective: To compare the efficacy of intralesional 5-Fluorouracil versus Triamcinolone acetonide in the treatment of Keloids. Materials and Methods: This randomized controlled trial was conducted on 30 patients with keloids, randomly divided into two groups of 15 each, treated with intralesional 5-fluorouracil (Group A) or triamcinolone acetonide (Group B). The groups were compared for reduction in the size of keloid, pain relief, and the incidence of adverse effects. Statistical analysis was done using the unpaired student t- test and test of proportion. Results: The reduction in the size of the keloid was found to be significantly better in Group B (71.23%) than in Group A (57.48%) with a P value of 0.04. The difference in the reduction of pain, as assessed by the visual analog scale, between Groups A (18%) and B (24%), was found to be insignificant (P value - 0.47). Although the incidence of complications in Group A was three times higher than those in Group B, the difference was not statistically significant (P value - 0.13). Conclusion: Reduction in the size of the keloid, which was the main aim of this study was significantly better in those treated with triamcinolone acetonide than those treated with 5-fluorouracil. The other parameters like reduction of pain and the incidence of adverse effects were comparable in both the groups.

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Introduction: The stone disease in children shows wide geographic variations, and its incidence has increased worldwide in children of all ages. Percutaneous nephrolithotomy (PCNL) has gradually emerged as one of the standard treatment options for the management of renal stones >1.5 cm in pediatric cases. PCNL just like in adults has been performed in the prone position. Of late observing the successful use of supine position for PCNL in adults, pediatric urologists have been encouraged to use the supine access for PCNL in children. We report our early experience with supine PCNL in children. Materials and Methods: All children with symptomatic renal stones presenting to the pediatric urological services of our hospital were prospectively included into the study to undergo supine PCNL. Children with skeletal anomalies, bleeding diathesis, and active urinary tract infection were excluded from the study. Results: Ten children (six males and four females) with a mean age of 11.48 ± 2.08 years (9–18 years) underwent supine PCNL. The mean size of the stone was 22 mm (range 17–47 mm). The initial stone-free rate was 90% immediately after a single PCNL session. One child needed an additional extracorporeal shockwave lithotripsy session to clear a 7-mm fragment. The average operative time (from the beginning of the puncture trial to nephrostomy tube insertion) was 70 ± 5 min. Conclusions: Supine PCNL in children is feasible, safe, and an effective means for management of renal stones in the pediatric population.

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COVID-19 is an infectious respiratory disease caused by a novel virus severe acute respiratory syndrome corona virus 2. Clinical manifestations of COVID-19 range from asymptomatic or flue such as symptoms to severe dyspnea or breathlessness. The combination of the symptoms such as anosmia, persistent cough, fever, fatigue, diarrhea, abdominal pain, and lack of appetite are commonly found in CVOID-19 patients. The symptomatology due to otorhinolaryngological manifestations is often by respiratory tract infections and predominantly found for consultation at otorhinolaryngology clinic. Otorhinolaryngological manifestations are usually associated with aerosol producing symptoms and so highly contagious in very short period. It is need to identify the patient with symptoms and rightly pinpoint to infect individuals. This review article focuses on the otorhinolaryngological manifestations and its implications in early transmission of the COVID-19 along with the preventions. This article will surely increase awareness among the frontliner clinicians and help them to protect themselves along with early suspicion of cases before spreading the diseases to community.

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Masturbation (gratification behavior) is rarely seen in young children. It occurs in children between the age of 3 months and 3 years with a second peak incidence at about the adolescent age. A 26-month-old child presented to us with gratification behavior. On evaluation, she did not have any physical illness mimicking gratification behavior. The parents were counseled, and 6 sessions of behavior therapy were carried out. Gratification behavior in young children is not pathological. Waxing and waning of the symptoms may be present.

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Background: Burn injuries rank among the most severe types of injuries suffered by the human body with an attendant high mortality and morbidity rate. In previous studies, incidence, severity and deaths due to burn were found higher in young married women in India. Study to find out mortality pattern in burn patient was not carried out in this part of country. Objective: To identify demographic and sociocultural factors, type, modes, causes and risk factors for burn injuries and their gender-wise association. Materials and Methods: It was a retrospective study. Data were collected from all burn patients who admitted and died while on the treatment from 2004 to 2009. A total of 586 patients were included in this study. Data were gathered from hospital records and entered in the excel sheet. Analysis of data was done by using SPSS version 17 statistical software. Results: The mean age of patients was 22.66 years (range 1 m to 80 years). Episodes of burn were 4.63 times common in female (82.25%) than in male (17.75%). It was statistically significant in females of age group 21-30 years (93.93% vs. 15.33% P < 0.0001). Married females (86.80%) burned more commonly than married males (13.19%) P < 0.0001. Flame burn was the major cause of death (95.56%). Kerosene was the most common (69%) source of flame burn. Clothes caught fire while working on Chullha were 25% cases ( P < 0.0001). Accidental (86.44%) burn was the most common intention of injury. The majority of burn deaths (68%) occurred within one week of the incident due to septicemia (57%). Conclusion: Factors associated with an increase in mortality were accidental burns, burn size, young age, married women, and flame burns. For planning and implementing prevention programs, the approach has to be multidisciplinary and coordinated.

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Calcium sulfate has multifaceted properties and has versatile use in the field of periodontal practice. Calcium sulfate can function as a resorbable space filler, a resorbable barrier (compatible with guided tissue regeneration principles), as a combination with other bone grafts in intrabony defects and in socket preservation procedures for implant placement. This review is an attempt to shed light on various applications of this bone graft in periodontal regeneration.

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A 60-year-old male patient came to ENT OPD with complaints of left nasal obstruction from the last 5 years and moderate quantity of epistaxis from the last 4 months. It was associated with foul smelling mucopurulent rhinorrhea. On clinical examination, a fleshy mass was seen occupying the posterior part of left nasal cavity and displacing the septum on the right side. The mass was relatively painful, soft, and bleeding on touch. The provisional diagnosis of "vascular-tumor-like" angiofibroma was suspected. Diagnostic nasal endoscopy and CT scan PNS were done which revealed a mass occupying the left nasal cavity arising from the posterior part of septum along the choanae till the anterior part of sphenoid sinus. Biopsy of the same revealed an adenoid cystic carcinoma. Adenoid cystic carcinoma is uncommon and that too of the nasal cavity. The cases of the adenoid cystic carcinoma involving the nasal cavity usually involves the lateral wall and the involvement of the posterior part of nasal septum is extremely rare. Thus the presentation of this uncommon disease is discussed here.

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Purpose: Pyrazolines and its derivatives are reported to possess a wide spectrum of biological activities. Many class of chemotherapeutic agents containing pyrazoline nucleus are in clinical use. The purpose of this present study was to examine whether the molecular modification might result in detection of new potent anti-tubercular agent. Materials and Methods: A series of 2-pyrazoline compounds (P13-P24) have synthesized by treating N-(substituted aryl)-acrylamide (C13-C24). The starting material was synthesized from substituted P-aminoacetophenone and substituted benzaldehyde. Their structure was confirmed by infrared and ¹ H NMR spectral data. The synthesized compounds were screened for anti-tubercular activity by Microplate Alamar Blue Assay method. Results: Compound P ₁₅ and P ₂₀ have shown excellent anti-tubercular activity; compound P ₁₆ and P ₂₂ have shown significant activity as compared with the standard and rest of them have shown moderate to low anti-tubercular activity. Conclusion: These compounds may result in the potent anti-tubercular entity with molecular modification and manipulations.

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Context: Incidence of non-Hodgkin's lymphoma (NHL) is increasing in all parts of the world, especially over the past few decades. An insight into the clinical presentation may help in the prevention, control, and treatment of NHL. Aim: To observe the clinicopathological patterns of NHL among patients in Northeast India. Subjects and Methods: A retrospective case study on 100 proven cases of NHL registered at the Regional Institute of Medical Sciences, Manipur, during the period January 2013–May 2017 was conducted, and data were reviewed and analyzed. Statistical Analysis Used: Data were analyzed using SPSS-21 and results were presented in percentages and simple frequency. Results: Majority (43.0%) of the patients were in the age group of 41 and 60 years. The mean age was 54.01 ± 18.1 years. Male:female ratio was 1.2:1. The most common presenting symptom was neck swelling (57.0%), and peripheral lymphadenopathy (76.0%) was the most common sign. Primary site distribution was nodal (57.0%) and extra-nodal NHL (43.0%). Most common nodal site involved was cervical lymph nodes (65.0%), and gastrointestinal tract (17.0%) was the most common extranodal subsite. Majority of the patients were in stage II (36.0%) at the time of diagnosis. B-cell NHL accounts for 66.0% compared to T-cell lymphoma (23.0%). Diffuse large B-cell lymphoma was the most frequent B-cell lymphoma (45.0%), and anaplastic large cell lymphoma was the most common T-cell variant (15.0%). Conclusions: A thorough insight into the clinical spectrum of NHL is necessary for optimum management and improved treatment outcome.

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Objectives: To evaluate the relationship between symptoms, clinical severity, neurophysiological characteristics with median nerve cross-sectional area (CSA) at the level of carpal tunnel inlet at ultrasonography (USG) and its utility in diagnosis of carpal tunnel syndrome (CTS). Materials and Methods: Prospective study of 30 patients with symptoms of CTS, attending to the Neurology out patient department (OPD) at University Teaching Hospital. A multidimensional assessment of CTS was done using historic and objective scale (Hi-Ob scale) for clinical severity, Boston carpal tunnel questionnaire (BCTQ) for patient-oriented measures, neuro physiologic studies of median nerve at wrist and USG to measure median nerve CSA at carpal tunnel inlet. Results: Thirty patients included in the study (22 women and 8 men). Mean of CSA was 12.69 mm ² (SD2.67). Association between BCTQ score value and inlet values was assessed by Karl Pearson correlation coefficient ( r = 0.376, P = 0.04). There was positive association with BCTQ scores and CSA of median nerve at carpal tunnel inlet. To compare clinical severity scale (Hi-Ob) and USG CSA, analysis of variance was performed (F value) and Scheffe's multiple comparison test was used to find group difference (grades 1 and 2 P < 0.001, grades1 and 2P P < 0.001, grade 2 differs with grade 2P P < 0.006). As the number of patients is less in minimal, mild and severe groups, the difference between neurophysiological groups and mean of CSA was not statistically significant. Conclusion: A positive correlation exists between USG findings and all the conventional measures of CTS severity.

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Objectives: The present study was undertaken to assess the antibiotic susceptibility patterns of Pseudomonas aeruginosa isolated from healthcare associated infections at a tertiary care hospital. Due to significant changes in microbial genetic ecology, as a result of indiscriminate use of anti-microbials, the spread of anti-microbial resistance is now a global problem. Materials and Methods: A total of 290 Pseudomonas aeruginosa isolates from various clinical samples like urinary catheters, tips of endotracheal tube, and central venous catheter were tested for antibiotic sensitivity pattern using disk diffusion method as per Clinical and Laboratory Standards Institute guidelines. Results: The highest number of Pseudomonas infections was found in urinary catheters, followed by endotracheal tips and central venous catheters. Maximum resistance was seen to cefotaxime and gentamycin (40%) followed by ciprofloxacin (39%), amikacin (26%), cefoperazone- sulbactum (22%), piperacillin-tazobactum (16%), and imipenem (14%). Conclusion: Over all we have observed that there is increased antibiotic resistance which may be due to the selective pressure from the use of anti-microbial agents is a major determinant for the emergence of resistance strains. Antimicrobial surveillance should be done periodically to monitor the current susceptibility patterns in local hospitals.

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Introduction and Objectives: The brachial plexus is highly variable, in its formation and branching pattern thus, knowledge of its anatomical patterns, may be insufficient for the surgeon operating on or around these nerves or for the regional anesthesiologist working in this area. Therefore, the present study was an attempt to study further about variations of brachial plexus encountered during routine dissection classes. Materials and Methods: The present descriptive study was carried out by dissection of 60 upper limbs of 30 cadavers, in the age group of 18 to 85 years, obtained during a study period of 2 years from the Department of Anatomy. The plexus was studied in its entire course commencing from the formation in cervical region, course through root of the neck and axilla, up to the main terminal branches of the upper extremity. During the dissection, variations of brachial plexus pertaining to its formation from the roots, trunks, divisions and cords and the branching pattern were observed and data was collected. Results: Out of the 60 cadaveric upper limbs studied for the anatomical variations of the brachial plexus, 2 limbs (3.33%) were pre-fixed plexuses. Fusion of adjacent trunks was detected in 2 limbs (3.33%). Variations in branches of lateral cord were detected in 8 limbs (13.33%). Among Posterior cord variations 2-thoracodorsal nerves were detected in 2 limbs (3.33%). All the other branches from brachial plexus had been found to have no anatomical variations. Conclusion: In the present study, an attempt has been made to know the possible variations of the brachial plexus. Though the variations mentioned may not alter the normal functioning of the limb of the individual, but knowledge of the variations is of prime importance to be kept in mind, during anaesthetic and surgical procedures.

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Giant fibroids are known to arise from the uterus, although very rarely from extra-uterine sites. Among extra-uterine fibroids, broad ligament fibroids generally achieve enormous size and generally present with pressure symptom like bladder and bowel dysfunction. Myxoid degeneration is a rare complication of benign fibroid, where presence of cystic changes mimics the metastatic malignant ovarian tumor. We report a case of true broad ligament fibroid measured about 13 kg. This case is reported for its rarity and the diagnostic difficulties in differentiating malignant ovarian tumor and benign fibroid with myxoid degeneration.

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Background : Anencephaly is a lethal neural tube defect which is due to the defective closure of rostral pore of neural tube. In more than 50% of cases it is associated with other systemic anomalies. Hence this study was undertaken to assess pathological parameters associated with anencephaly in particular attention to associated systemic anomalies. Materials and Methods: It is a study on 41 anencephaly fetuses conducted in the Department of Pathology. The period of study is from January 2001 to December 2011. Results: Out of 41 cases, 30 (73%) cases showed presence of systemic anomalies, 48.5% of the cases were observed in primigravida. Most common associated anomaly was spina bifida followed by gastrointestinal anomalies. Conclusion: Pathological examination of the abortus is essential to document the associated anomalies.

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Background: Safe motherhood is a priority program in Nepal, aiming to restrain maternal deaths. Meanwhile, knowledge, practices, accessibility, and service quality are considered keys to improve service utilization. This study was conducted to identify knowledge and practices of maternal health care among mothers having < 1-year-old child in the Mid-western Development Region, Nepal. Materials and Methods: A community-based cross-sectional study was conducted during January-April 2011 in rural, Mid-western Development Region, Nepal. Three Village Development Committees (VDC) from Bardiya (plain) and two VDCs from each of the Salyan and Pyuthan (hill) and Jumla (mountain) districts were selected randomly. Hence, there were 81 clusters (1VDC = 9 clusters) and 7-8 participants were selected randomly from each cluster. Data were collected by interview using structured questionnaire and Focus Group Discussion Guideline (18 FGDs), analyzed by SPSS (16.0). CD recorded qualitative data were transcribed and narrated. Percent mean and standard deviation were calculated. Results: Three quarters of the participants had correct knowledge regarding minimum numbers of antenatal visits to be done by a pregnant woman (WHO guideline). Nearly two-fifth participants knew schedule of antenatal care (ANC) visits. Almost 60% had done ≥ 4 ANC visits during last pregnancy. Majority visited Sub Health Post/Health Post/Primary Health Care Centre for ANC Checkup. About 90% had taken Iron and folic acid tablets. About 57% were home deliveries (last childbirth), 40% deliveries were assisted by relatives/husband, and only 32% did postnatal health checkup. Conclusions: There were gaps in the knowledge and practices for health care during pregnancy, childbirth and in the postpartum period. A high rate of home deliveries with the low postnatal service utilization was prevalent. Intensive awareness progam and behavioral change interventions, regular pregnancy monitoring may promote the health service utilization.

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Introduction to the use of Mitomycin C in ophthalmology was a significant development in the 1960s. Its use and application in ophthalmology has been increasing in recent years, because of its modulatory effects on wound healing. Current applications of this drug in ophthalmology include pterygium surgery, glaucoma surgery, corneal refractive surgery, cicatricial eye disease, conjunctival neoplasia, dacryocystorhinostomy surgeries, squint surgeries, and allergic eye disease. Although it has been used successfully in these conditions, it has also been associated with significant complications. This article reviews the current trends and uses of mitomycin C in the eye and its reported complications.

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