Epidemiology is defined as "the study of the distribution and determinants of health-related states or events (including disease) in specified populations and the application of this study to control health problems." This article gives an overview and an introduction to epidemiology and explains the main study designs. The article also discusses the key ethical issues in epidemiological studies and its applications to modern day medicine.

Breast cancer is the commonest cancer in women, with around a million new cases diagnosed each year worldwide. Adjuvant radiotherapy (RT) is an important component of therapy for many women with early-stage breast cancer. With improving survival rates following breast cancer, patients are increasingly likely to die of other causes. As a result, long-term adverse effects of treatment are of major concern. To determine which treatment is optimal, clinician need to be aware of long-term risks and benefits of adjuvant therapies. An awareness of the potential cardiotoxicity of RT led to the application of improved RT techniques that minimize the irradiation to the heart. Although new techniques, including intensity-modulated RT combined with free breathing gating and helical tomotherapy may further reduce radiation-induced cardiac toxicities, the most important factors in limiting cardiac radiation are associated with the techniques used and the skill of the radiation oncologist.

The phenomenon of cell cannibalism refers to the engulfment of cells within other cells. It is an unusual phenomenon associated with poor prognosis of high-grade cancers. It has been suggested that cannibalism may represent a sort of "feeding" activity aimed at sustaining survival and progression of malignant tumor cells in an unfavorable microenvironment. There is a paucity of literature relevant to cell in cell phenomenon associated with oral cancer. In this review, an attempt has been made to unveil the intricacies of cellular engulfments.

Context: Diagnostic services have a very important role to play in medical decision-making, which have an impact on the nation's health status. The understanding of Indian diagnostic services provisioning has certain literature gaps. Aims: This study focused on understanding the functioning of provision of diagnostic services by Indian diagnostic laboratories. Materials and Methods: Exploratory field visits and literature review were used as tools to understand the Indian health system. Results: Indian diagnostic laboratory can be classified into various categories based on the type of services provided and governance. The difference in their financing, resources, quality assurance of services and patient access to services was found in these different laboratories. Conclusions: It was concluded from the study that patient's access to laboratory services is affected by the functioning of laboratories in terms of governance, financing, resources, quality assurance of services and patient services.

Background: The mobile dental service (MDS) at Ludhiana is a unique model of oral health care delivery which enables rural communities to develop their own creative system through partnerships, for ensuring consistent oral health care delivery in the underserved areas. Objectives: The objective of this study was to assess the satisfaction among the stakeholders participating in the MDS program of a premier Dental College in Ludhiana. Methodology: A cross-sectional survey was conducted in 12 villages of Ludhiana district in Punjab where the MDSs were being provided. Four hundred and fifty patients, 50 organizers and 40 service providers were interviewed separately with pretested questionnaires. Results: About 98.4% of the patients were completely satisfied with the overall care provided. 71.1% of the patients felt there was increased times in services and 76.7% felt that there was inadequate referral network. Most patients were satisfied with the communication skills of the doctors. 57.5% of the organizers felt that the overall care provided in the MDSs was consistently good and high quality in spite of challenging infrastructure. 100% of the health care providers felt that working in the MDS was a good learning experience in spite of the heavy workload and infrastructure challenges. Conclusion: The study reveals that the MDS is a satisfactory mode of dental care delivery for all the stakeholders involved. Despite the challenges, this partnership program can be nurtured as a successful model of oral health care delivery in underserved areas.

Background: According to World Health Report 2002, cardiovascular diseases (CVDs) will be the largest cause of death and disability by 2020 in India. In 2020, 2.6 million Indians are predicted to die due to coronary heart disease, which constitutes 54.1% of all CVD deaths. Nearly half of these deaths are likely to occur in young and middle-aged individuals (30-69 years). We undertook this study with objectives to evaluate the cardiovascular risk profile in asymptomatic individuals with moderate risk factors and to understand the effect of the short-term (3 weeks) exercise over cardiovascular risk factors. Materials and Methods: A randomized controlled trial was conducted with a total of 34 subjects comprising of 17 subjects in each group. Subjects underwent biochemical tests like fasting lipid (total cholesterol [TC], triglyceride, high-density lipoproteins [HDLs], low-density lipoproteins [LDLs]) and fasting blood glucose. Other outcome measures were VO _{2 max,} body mass index and body fat % (BF%). Results: This study suggested that 3 weeks of moderate intensity aerobic training has a beneficial effect in lowering the cardiovascular risk profiles in adults with moderate risk factors. This training reduced TC, improves HDL, reduced LDL and improved aerobic capacity by improving VO _{2 max} and reducing BF%.

Introduction: Discharge time, a crucial quality indicator, is dependent on several other factors like clearance time and patient-related issues. The present study analyzes these determinants and presents measures to control the discharge time. Materials and Methods: This cross-sectional study was conducted during May-June 2013 at a large multispecialty hospital. During initial 15 days, that is, the pilot study, data was collected across various steps where time was consumed during discharge process and initiatives were taken to increase the number of planned discharges. For the main study, discharges were classified as planned/unplanned and patients as insured and uninsured. Results of pilot study and main study were compared. We computed one-sample t-test on overall discharge time, clearance time, and independent sample t-test on discharge time consumed for types of discharges. All results with P < 0.05 were considered statistically significant. Results: Out of 105 discharges, 75 were included wherein mean discharge time of 177.6 (± 613) min was significantly lower than the mean time of 285.42 (±105.46) min taken for 35 discharges during pilot study (P < 0.01). Mean discharge time of 572 (±1378.4) min for the 14 insured patients was significantly higher (P < 0.0001) than the 61 uninsured patients where discharge time was 88 (±84.7) min. Mean discharge time for planned discharges (n = 18) was 85 (±87.9) min that was significantly lower than unplanned discharges (n = 57) with a mean of 524 (±1446.6) min (P < 0.01). ther patient-related factors like, delay in bill payment, request for discounts further increased the discharge time. Conclusion: Planning the discharges reduced the total time of discharge process substantially. Discharge time was substantially high for insured patients that need to be controlled. Departmental clearance and patient-related factors also impact the discharge time.

Context : The health care and social welfare needs of persons with mental illness and differently abled persons should not be ignored. Aim: The aim of the study is to assess the socio-demographic and morbidity profiles of the inmates in the special school and to explore the reasons that have contributed to their admission in the school. Materials and Methods: A cross-sectional descriptive study of six months duration (September 2013 to February 2014) was conducted in a special school for mentally ill and differently abled people of Kanchipuram district in Tamilnadu. All the inmates staying in the school during the study period were included as study participants. The socio-demographic profile of the inmates was obtained with the help of caretaker/family members/records maintained by the center while their morbidity profile was explored with the help of specialists from different departments. Statistical analysis was done using SPSS version 18 and the frequency distributions and percentages were calculated for all the variables. Results: Most of the study participants, 31 (56.4%) were from the 40-60 years age group. Overall, 51 (92.7%) inmates were suffering from some type of mental disorders with/without multiple disabilities while 4 (7.2%) inmates were enrolled in the special school because of their old age. The unwillingness of the family members to take care of the affected person was cited as the most common cause in 32 (58.1%) of the inmates for enrolling in the special school. Conclusion: Most of the inmates of the special school were suffering from mental illnesses with/without multiple disabilities. A definite improvement in the quality of life of inmates has been observed after the extension of healthcare services by the medical college.

Introduction: Hypertension is a chronic asymptomatic disease, often goes unnoticed for decades before it presents to the medical fraternity with devastating consequences. Low patient adherence is amenable for modification for better control of hypertension, if factors contributing to it are understood. Study was undertaken with the aims of assessing the factors responsible and their relative contributions toward nonadherence among hypertensives. Materials and Methods: We conducted a prospective observational study from August 2013 to August 2014. We included those, who attended the medicine outpatient department with a diagnosis of essential hypertension of more than 1 year duration. Results: A total of 516 patients were enrolled in the study, of which 132 (25.58%) were nonadherent. Marital status (P = 0.017), socioeconomic status (P = 0.000), level of education (P = 0.034), such as, illiteracy was associated with highest level of nonadherence compared with those with pre-matric and undergraduate education, whereas those with post graduate level of education showed absolute adherence to drugs and domiciliary status (P = 0.045) had statistically significant association with nonadherence. Other factors like younger age and male sex were associated with a higher degree of nonadherence, however statistical significance could not be obtained.

Deltamethrin intoxication is uncommon throughout the globe and more so the oral ingestion. The toxicity of pyrethroids is considered much less than the intoxication caused by other insecticides, especially organophosphates. This report describes a case of a 14-year-old female child who was admitted to the emergency room (ER) with dyspnea, cyanosis, tetany, seizures and coma following deltamethrin ingestion in a suicidal attempt. Deltamethrin ingestion should be considered as a differential diagnosis in patients presenting to ER with nonspecific neurological symptoms.

Sertoli cell-only syndrome (SCOS) is not an uncommon finding in testicular biopsies that are performed in patients with infertility. The salient histopathologic feature of SCOS is the absence of germ cells. Many of these patients have a normal karyotype and normal secondary male sexual characteristics, yet are infertile and azoospermic or severe oligozoospermic. This case report describes a 29-year-old male patient who presented with primary infertility, normal physical characteristics and hormonal profile with SCOS detected on testicular biopsy.

The surgical management of maxillary pathosis results in direct communication between the oral and nasal cavity, imposing problems such as nasal regurgitation, unintelligent speech, difficulty in deglutition and compromised esthetics. A restoration of these defects is not always possible surgically, but prosthetic rehabilitation is an established treatment modality. Early rehabilitation can improve the quality of life and reduce the psychological trauma caused by surgical excision. Surgical and interim obturators placed during the initial phase can improve the outcome of the definitive prosthesis. This article presents a case report of a patient with partial maxillectomy who has been rehabilitated with a delayed surgical and an interim obturator.

Stenotrophomonas maltophilia is an aerobic, motile Gram-negative, nonfermentative bacillus considered as an opportunistic pathogen causing infection typically in individuals with immunosuppression, organ transplantation and malignancies. Contaminated water or medical devices in the hospital environment are the primary causes of infection. Here, we report a case of nonhealing leg ulcer infected with S. maltophilia in an immunocompetent individual.

Neuromyelitis optica (NMO) is an uncommon disease syndrome of the central nervous system that affects the optic nerves and spinal cord. NMO with endocrinopathies has been described as being unique to black Antillean and Afro-Brazilian women. We describe one case of NMO with hashimoto's thyroiditis in a young female, probably first case report in India.

Hemangioma is a common tumor characterized by the proliferation of blood vessels. It is often congenital in nature and usually but not invariably follows a benign course. Hemangioma is often present at birth, but may become more apparent later in life. Capillary hemangioma is known to have a significant predilection for lips, tongue, buccal mucosa, and palate. This case report describes a hemangioma at an unusual site which is seldom reported earlier in the published literature. Despite being benign in nature, hemangiomas are of clinical importance to the dental professionals as they may pose serious bleeding risk. Because of their uncommon clinical presentations they may mimic other gingival lesions; hence, dental practitioners need to be aware of these lesions.

Parasitic worms in eye is something which is not very uncommon these days. People who eat undercooked food and have pets at home are at more risk to have parasitic infections. Chemoparalysis has been reported in literature using either viscoelastics or preservative free lidocaine (intracamerally) to paralyze the worms that help in retrieval, but still one can face tricky situations while managing such conditions. Importance lies in the management of such cases as it can be really challenging at times and no report exists in the literature which mentions the importance of topical lidocaine along with viscoelastics or preservative free lidocaine for retrieval of the worm.

Xanthogranulomatous pyelonephritis (XGP) is an uncommon entity affecting predominantly females between the ages 45-55 years. The disease is usually associated with urinary tract infection and the patient presents with flank pain, dysuria and fever. It has to be differentiated from various benign and malignant conditions including tuberculosis (TB) and renal cell carcinoma. Surgery is the definitive treatment of choice. Hereby, a case of 45-year-old, hypertensive female, who presented with uncommon condition is being reported.

Survey of mission hospitals in North and Northeast India revealed that even the hospitals that had donated laparoscopic surgical equipment were unable to offer laparoscopic surgeries because of the high cost of the disposables involved. Although there are several studies comparing the disposable versus re-usable instruments (especially the ports) especially with respect to the costs, there is hardly any study looking at the re-use of disposable instruments. Although many might not admit it officially, it is a common practice in India to re-use disposable instruments. We present our findings with re-use of disposable laparoscopic items at the various mission and rural hospitals where our team has operated, and other issues related to laparoscopic surgeries in rural hospitals.

Recurrent pyogenic granuloma with satellite lesions is also known as Warner and Wilson-Jones syndrome. Local recurrences do occur but presenting with multiple satellite lesions is very rare. We provide a characteristic clinical image and microphotographs of a case of pyogenic granuloma with satellitoses in an 18-year-old male who presented with a painful erythematous nodule on his back in interscapular region. A punch biopsy was taken from the lesion and it showed features of pyogenic granuloma. Combining clinical and microscopic features, a final diagnosis of pyogenic granuloma with satellite lesions was made. Surgeons excised the lesion and skin grafting was done which healed well. Three years follow-up of the patient was uneventful