Introduction: The serious complication of influenza infection during pregnancy has been recognised for over a century. Because it is associated with high morbidity and mortality, we decided to undertake this study. Objectives: To assess maternal and perinatal outcome in women with H1N1 infection in pregnancy. Materials and Methods: This was a 1-year retrospective study conducted in Christian Medical College (  CMC) and Hospital, Ludhiana. All women infected with H1N1 virus anytime during pregnancy were included in the study. Results and Analysis: A total of 26 patients were included in our study. A majority of patients were in the age group of 20-25 years (84.61%). A total of 61.54% were primigravida and 69.23% were in the third trimester. Comorbidities like diabetes, asthma, and obesity were present in 19.23% patients. The commonest symptoms were cough (92.37%), sore throat, and breathlessness. The commonest maternal complication was preterm labor (30.76%), and fetal complication was intrauterine death (19.23%). The majority delivered vaginally (57.7%). There were seven maternal deaths in our study. Conclusions: H1N1 remains a grave risk in pregnancy, underlining the need for greater awareness, early diagnosis, and prompt treatment.

Background: Hormonal levels influence dynamic lung function parameters. Significant increase in both progesterone (37%) and estradiol (13.5%); where as, no change in plasma follicle stimulating hormone (FSH) and luteinizing hormone (LH) was observed in exercising women in previous studies. Therefore, this study was intended to see the limitations of the pulmonary system in adaptability to exercise in proliferative phase of menstrual cycle in perimenopausal women. Material and Methods: The present study was conducted as a part of cardiopulmonary efficiency studies on two groups of nonathletes (n = 10) and athletes (n = 10) comparable in age and sex. Menstrual history was ascertained to confirm proliferative phase of menstrual cycle. Dynamic lung functions were measured in both groups before exercise and immediately after exercise. Results: It was observed that exercise per se does not cause a statistically significant change in dynamic lung function parameters maximum mid-expiratory flow (MMEF), peak expiratory flow rate (PEFR), and MEF 25-75% in either of the groups. Conclusion: This finding supports the hypothesis that the respiratory system is not normally the most limiting factor in the delivery of oxygen even under the predominant influence of estrogen in proliferative phase, which is further accentuated by exercise.

Background: Abnormal uterine bleeding (AUB) is a common gynecological complaint associated with considerable morbidity and significantly affects the patient's family, personal and social life. The aim of the study was to analyze the histomorphological patterns of endometrium in patients presenting with AUB and also to determine the incidence of AUB in various age groups. Materials and Methods: This is a prospective study, conducted in the Department of Pathology, in a tertiary care teaching hospital, Mangalore from October 2011 till date. All cases of AUB with a probable endometrial cause were included in the study. Data was entered in Microsoft Excel and managed in Statistical Package for the Social Sciences (SPSS) version 16. Analysis was done in the form of percentages and proportions and represented as tables where necessary. Results: A total of 156 cases were analyzed. Patients' age ranged from 23-78 years. AUB was most prevalent in the perimenopausal age group. The most common presenting complaint was menorrhagia (47%). Endometrial hyperplasia was the most common histopathological finding and was seen in 25% patients, followed by secretory endometrium in 16.7% patients, and proliferative phase pattern and disordered proliferative endometrium were seen in 12.2% patients each. Malignancy was detected in 6.4% of cases and endometrial carcinoma was the most common lesion (4.5%). Conclusions: Histopathological evaluation of endometrial samples is especially indicated in women over the age of 35 years to rule out malignancy and preneoplasia. Among the patients with no organic pathology, normal physiological patterns with proliferative, secretory, and menstrual changes were observed. The most common endometrial pathology in this series was endometrial hyperplasia.

Background: Sheehan's syndrome (SS) or postpartum pituitary necrosis though rare, still remains one of the commonest causes of hypopituitarism in the Indian subcontinent. The clinical presentation is often variable with abrupt or insidiously onset pituitary insufficiency after heavy intrapartum or postpartum hemorrhage. Aims: To study the demographic profile, hormonal profile, as well as the quality of life of patients of SS, and the effect of hormonal replacement therapy on outcome. Materials and Methods: All patients previously diagnosed with Sheehan's syndrome or newly admitted during the study period of 2011-2013 were enrolled in the study after obtaining informed consent. Their clinical, biochemical, hormonal, radiological and bone mineral density (BMD) data were collected. The quality of life (QoL) was assessed using the disease-specific questionnaire both before and after hormone replacement therapy. Result: Twenty three patients were enrolled in the study, the mean age of diagnosis was 43.4 ± 14.2 years; mean diagnostic delay was 13.2 ± 7.4 years. Secondary amenorrhea and lactation failure were the most common clinical presentations. The mean total tetraiodothyronine (T4), peak stimulated cortisol, stimulated growth hormone (GH), and prolactin (PRL) levels were low. The gonadotropins [follicle stimulating hormone (FSH) and luteinizing hormone (LH)] were inappropriately normal in the presence of amenorrhea. Anemia was the most common hematological abnormality seen in 69.5% of patients, while 39.1% of patients had hyponatermia. BMD assessment (n = 23) was suggestive of low bone mass. The QoL improved significantly (P < 0.05) in patients after one year of hormonal replacement therapy. Conclusion: Sheehan's syndrome resulted in multiple pituitary hormone deficiencies in all patients. Anemia, hyponatremia, and low bone mass were frequently seen in patients with Sheehan's syndrome. The QoL improved significantly (P < 0.05) after hormonal replacement therapy.

Background: Viral hepatitis B and C are a global public health problem. For better targeting their detection and prevention, nursing professionals' should have adequate knowledge and skills. Aims and Objectives: This study aimed at developing a "viral hepatitis questionnaire" and then validating it among nursing professionals' working in a Medical College of North India. Materials and Methods: A fifteen-item questionnaire was developed by the principal investigator. This was based on a systematic search in database namely "PubMed" "IndMed" "Directory of Open Access journals" and "Google scholar". It was then administered to 318 nursing professionals'. The psychometric properties of the questionnaire were assessed in terms of construct validity and reliability. Results: The average age of the study subjects was 23.4 years (SD = 17.2, range = 18 years-54 years). Sampling adequacy as measured by Kaiser-Meyer-Olkin (KMO) test was 0.82. This indicated relevance of the factorial model. Varimax rotation revealed that all items had achieved the required loading of 0.3. The internal consistency ranged from 0.81 to 0.87. The intra class correlation coefficient ranged from 0.67 to 0.71. Conclusion: " Viral hepatitis questionnaire" (VHQ) appears to be a reliable and valid measure of assessing nursing professionals' knowledge about viral hepatitis B and C. Its periodic use can serve the purpose of assessing nursing professionals' training needs. It is further recommended that it should be tested among nursing staff in different healthcare facilities of India, in order to assess its wider performance.

Background: Transfusion-transmissible infections HIV, HBV, and HCV are among the greatest threats to blood safety for transfusion recipients. Seroprevalence among blood donors is a useful source of information on their prevalence in the community. The present study was undertaken to determine the profile of the seropositive blood donors attending the blood bank at Christian Medical College, Ludhiana, Punjab. Materials and Methods: This was a 3-year cross-sectional study, (1 ^st January 2008 till 31 ^st December 2010) whereby the data of the blood donors screened during this time were analyzed. We further studied the epidemiological profile of the seropositive donors. Results: There were a total of 32,829 donations. Seroprevalence of HIV, HBV, and HCV were 0.27%, 1.11% and 1.53%, respectively. Most of them were males (96.76%) and were in the age group of 18-30 years. Replacement donors constituted 95.75%. Occupation of seropositive donors included business, various services, and agriculture. There were 89 students who were seropositive. Conclusions: Seroprevalence among blood donors has shown a significant (P value for HIV 0.05, HBV < 0.001, HCV 0.004) decreasing trend over the 3 years. The professional distribution reveals the shift in seroprevalence from the high-risk group to the general population. Introducing pre test and post test counselling in blood banks will identify patients at an earlier stage where treatment would be more effective. The need to shift the burden to voluntary blood donation cannot be overemphasised.

Background: End stage renal disease (ESRD) patients on maintenance hemodialysis undergo arterio-venous fistula (AVF) cannulation prior to each hemodialysis session for blood access. Prior to cannulation lidocaine infiltration is done, which is often perceived as painful. Eutectic mixture of local anesthetic (EMLA) has been found to significantly reduce pain associated with radial artery cannulation compared with lidocaine infiltration. Aims: To evaluate the efficacy of EMLA compared to infiltration of lidocaine in hemodialysis patients for AVF cannulation. Materials and Methods: A single-centre, crossover study of patients with an AVF on regular maintenance hemodialysis was performed in the dialysis unit of a tertiary care teaching hospital. The site of AVF, number of attempts for AVF cannulation and cannula insertion time were recorded. The patients were asked about the acceptability of application of the anesthetic, delay between anesthetic and cannulation and to score the pain on cannulation. Results: Fifty patients were included in the study. With the visual analog scale, pain score on infiltration was 4.8. Pain score on cannulation after topical application was 2.9 and after infiltration, 2.0. The number of attempts for cannulation and the cannula insertion time were similar. Anesthesia was more stressful in the injectable group rather than the topical group (P < 0.001). Delay between anesthetic and cannulation was unacceptable in the topical group (P < 0.001). Patient compliance was better during infiltration compared to topical (P < 0.005). Mean pain score during infiltration of anesthetic was significantly higher than cannulation pain after either anesthetic, although pain on cannulation was higher in the topical group (P < 0.001). Conclusions: EMLA offers a suitable alternative to lidocaine infiltration for patients using AVF for blood access.

Context: Medical students undergo tremendous stress during various stages of the Bachelor of Medicine, Bachelor of Surgery (MBBS) course. Academic examinations have been considered as one of the most acute stresses experienced by the students. Nitric oxide (NO) is an important physiological messenger and effector molecule in many biological systems. There is evidence that a sustained overproduction of NO via inducible NO synthase (iNOS) is responsible, at least in part, for some of the neurodegenerative changes caused by stress . Aims: To investigate the relationship if any between plasma NO and psychological stress caused by academic pressure in first year MBBS students. Settings and Design: A 2-year prospective longitudinal study. Materials and Methods: A total of 94 first year medical students after informed consent were enrolled in the study. They were evaluated twice during their first year academic program. First evaluation was done 2 months after their joining the MBBS course and second on the day of their first professional university practical exam. On each evaluation, a history was taken, general physical examination done, and a blood sample was drawn for plasma NO, which was measured using Griess reaction. Statistical Analysis Used: For comparison of means of plasma NO values between the two evaluations, the paired Student's 't'- test was used. A 'P' < 0.05 was considered as statistically significant. Results: The mean NO values increased from 14.76 ± 10.30 during first evaluation to 22.07 ± 13.02 during second evaluation. This increase was statistically significant (P = 0.000). Conclusions: Plasma NO showed a statistically significant increase in levels during the time of examination stress. As plasma NO had a positive correlation with stress, this can be considered as a suitable biomarker for academic stress assessment.

Ameloblastoma is categorized into four types; conventional solid (multicystic), unicystic, desmoplastic and peripheral varieties. Unicystic ameloblastoma (UA) may originate de novo as a neoplasm or from the epithelium lining of an odontogenic cyst. When UA arising from cystic epithelium reveals a plexiform pattern of epithelial proliferation without early ameloblastic changes, it is called as "plexiform unicystic ameloblastoma" (PUA). The purpose of this article is to report a case of PUA in 22-year-old male and to discuss its pathogenesis, clinical features and management. Also, an effort is made to review early literature on this entity.

Ataxia telangiectasia is a rare autosomal recessive multisystem disorder results in neurodegeneration, variable immunological abnormality that leads to recurrent sinopulmonary infection, febrile episodes, progressive cerebellar ataxia, ocular, and cutaneous telangiectasias. We report a case of 3-year-old Indian boy with recurrent episodes of fever and sinopulmonary infection and repeated hospitalization, rapidly progressive neurological symptoms. On clinical examination no ophthalmological or dermatological lesion was detected. On laboratory and immunological investigation polymorphonuclear leukocytosis with mild normocytic hypochromic anemia, IgA level of 39 mg/dl, alphafetoprotein level of 35 IU/L and normal interictal EEG was noted. Nerve conduction studies (NCS) was suggestive of wide spread early demyelinating polyradiculopathy. MRI shows a suprasellar tumor. The patient was diagnosed to be Ataxia telangiectasia (AT) according to diagnostic criteria of Ataxia-Telangiectasia Clinical Center. Patient was treated with pulse methyl prednisolone and IVIG. Further CD4/CD8 count, IgG subfraction estimation, leucocyte phagocytic activity and mutation analysis of ATM gene should be done to confirm the diagnosis.

We report a case of a 14-year-old Indian girl, a diagnosed case of systemic lupus erythematosus (SLE) who developed generalized erythematous rash and joints pain for 15 days. She was prescribed hydroxychloroquin and low dose deflazacort for joint pains. Within 3 days of initiation of hydroxychloroquin she developed generalized eruptions in the form of tense, fluid-filled blisters, erosions, and crusting. Biopsy showed subepidermal blistering with a prominent neutrophilic infiltrate. Direct immunofluorescence (DIF) showed positive granular immunoglobulin (Ig)G deposition with C3 and C1q at the dermoepidermal junction which was consistent with bullous SLE (BSLE). The lesions responded dramatically to dapsone 100 mg daily.

Ventriculoperitoneal (VP) shunt used in the treatment for hydrocephalus is associated with several complications. Visceral/bowel perforation is an unusual but serious complication of VP shunt. A silent protrusion of distal end of VP shunt per anus is reported in an 8-month-old male child. Patient underwent right VP shunt at the age of 6 months for congenital hydrocephalous. Patient was afebrile and had no signs of peritonitis or meningitis. Exploratory laparotomy was done where shunt was found to penetrate antimesenteric border of sigmoid colon. Shunt was removed and patient is doing well at 6 months follow-up without revision of VP shunt. Etiopathogenesis and management issues are discussed with relevant review of literature.

Carbon monoxide poisoning is a life-threatening poisoning. In this case report neurological findings developed in carbon monoxide poisoning and the importance of multidisciplinary approach are discussed. The patient, 16-year-old male, was found unconscious following a 1-hour exposure to gas water heater poisoning and brought to our hospital after being intubated at the scene of the accident. After treatment for bicarbonate deficit, hepatamine infusion was started and hyperbaric oxygen treatment was performed. The patient was connected to mechanical ventilator in our department. The treatment were performed for cerebral edema. And hyperbaric oxygen treatment continued for 12 days. The patient was disconnected from the ventilator on the 36 ^th day of the follow-up. Medical history and clinical examination are very important in the diagnosis of carbon monoxide poisoning. The patient should be followed up with laboratory examinations and imaging methods such as magnetic resonance imaging in order not to overlook neurological sequelae or any organ injury. Additionally hyperbaric oxygen treatment performed in acute period and goal-directed therapy decrease mortality and morbidity.

Iodine is an essential micronutrient required for the synthesis of the hormones - thyroxine and triiodothyronine. Iodine insufficiency is prevalent throughout the world, and is rated as one of the most significant public health concern in more than 125 countries. An optimal intake of dietary iodine during pregnancy, lactation and early childhood period is crucial for ensuring proper development of the brain of the fetus/newborn. During the course of implementation of the strategy of universal administration of the iodized salt, a wide gamut of challenges has been identified. In order to combat the same and simultaneously enhance the coverage of universal administration of the iodized salt, many measures have been proposed, namely formulating clear plan with time-based targets; encouraging coordination amongst all stakeholders; strengthening of the existing infrastructure; and increasing consumer awareness and demand for adequately iodized salt. To conclude, iodine has a crucial role in ensuring the normal growth and development of the child. However, to expand the coverage of the universal iodized salt to the vulnerable population, sustained political commitment and transparent monitoring and evaluation mechanism is the need of the hour.

The word marketing if used in the context of rural hospitals raises many eyebrows. Business and corporate hospitals are comfortable with it, whereas in rural or mission setting, which is service-oriented, the word might even be considered "bad" word. However, marketing is essential for both rural and mission hospitals to enable the optimum use of the services that are provided. This article is about the marketing lessons learnt from the transition story of Burrows Memorial Christian hospital in Assam in northeast India and Samiti for Education, Environment, Social, and Health Action Karunya Community Hospital near Coimbatore. The diagnostic camp model is one of the best ways of marketing rural hospitals.

Tophi are deposits of monosodium crystals in people with long-standing gout. We report a case of a 34-year-old male presenting with joint pains and soft yellowish swelling over the web spaces of the toes. Aspiration of the same revealed monosodium crystals leading to a diagnosis of Tophaceous gout.