Anemia is very commonly encountered in general clinical practice among all age groups. The more commonly used way to classify anemia has been to categorize it as being microcytic (mean corpuscular volume [MCV] <80 fL), normocytic (MCV 80-100 fL), or macrocytic (MCV >100 fL), which in turn allows for a more practical way to attempt to come up with a cause for any decrease in hemoglobin. Microcytic anemias are usually due to iron deficiency (in turn, a result of a number of different etiologies ranging from decreased intake, malabsorption, or blood loss), hemoglobinopathies (thalassemic syndromes), and some cases of severe anemia resulting from chronic disease. Normocytic anemia is often a result of anemia of chronic disease, hemolysis, or secondary to bone marrow failure. Macrocytic anemias are frequently caused by deficiencies of folic acid and/or Vitamin B12, exposure to toxic agents like drugs that interfere with DNA metabolism and alcohol, as also bone marrow failure states, such as from myelodysplastic syndrome. A comprehensive history, physical examination, and directed laboratory evaluation will help to identify a specific cause for anemia.

Background: Inflammatory bowel disease (IBD) including ulcerative colitis (UC) and Crohn's disease is an immune-mediated chronic intestinal condition. The arthritis accompanying the IBDs are included in the family of spondyloarthritis. Peripheral arthritis develops in about 15-20% of IBD patients. Asymmetric oligoarthicular large joint involvements have inflammatory characteristics at these patients and occur in upper and lower extremities. Aim: The aim of the study was to analyze the pattern of joint involvement in 15 patients with UC during 2 years from January 2011 to December 2013. Subjects and Methods: This is a retrospective study of UC patients with acute and chronic arthritis during 2 years from January 2011 to December 2013 that refers to rheumatologic Clinic of Mazandaran University of Medical Sciences. Data were analyzed using the SPSS version 20. Variables analyzed include age, sex, presence of arthritis/periarthritis, the number of involved joints, kind and pattern of arthritis. Results: In these study 15 patients with UC and acute arthritis refers to BAGHBAN rheumatologic clinic. All of the patients were adults between 18 and 42-year-old with median age of 31.5 years old. Ten patients (66%) were female, and five patients (33%) were male. The media duration of UC was 3.9 years. Periarthrtis occurred in 7 (46%) patients in association with arthritis. The most commonly involved join was ankle in 11 (73%) cases. Another involved joints were knee in 5 (33%), wrist in 2 (12%), MTPs in 3 (20%), MCPs in 1 (6%) and hip in 1 (6%) of cases. In 4 (27%) patients arthritis were monoarthicular, and eight (53%) of patient's arthritis were oligoathicular in 3 (20%) cases, arthritis was polyarthicular. All of the arthritis were inflammatory. In 2 (13%) of patients, arthritis were symmetric and in 9 (60%) of cases were asymmetric. Conclusion: Inflammatory joint disease including arthritis and periarthrtis are important findings in UC. Asymmetric lower extremity large joint arthritis especially in ankles are common kind of peripheral arthritis of this disease.

Aim: Limited information is available on the status of mental distress among chronic disease subjects attending primary care settings in India. This study aimed to assess the pattern of mental distress among chronic disease subjects. Materials and Methods: This facility based cross-sectional study was carried out among chronic disease subjects attending urban health center attached to a Medical Institution in Puducherry, India. Mental distress was assessed by general health questionnaire-12. Data on associated factors were collected by structured questionnaire. Results: Mean age of the subjects was 58.2 ΁ 12.8 years. Around 80% of the subjects found to have mental distress. Mental distress was comparatively more among females, educated more than middle school, person living in the nuclear family and suffering from joint pain (P < 0.05). Subjects who had both diabetes and hypertension reported more mental distress. Females had comparatively more mental distress after adjusting for potential confounders. Conclusion: Mental distress among chronic disease subjects in this setting is high especially among females screening of this high-risk group may help in taking appropriate interventional measures.

Background: This study was a cross-sectional survey of children and their mothers in specialist Hospital Gombe, Nigeria. Objective: Anthropometric assessment of nutritional status of the children (0-12 months) and a survey of mothers' opinion on malnutrition. Population: Children and mothers attending immunization sessions in specialist hospital Gombe, Nigeria. Materials and Methods: Hundred children (0-12 months) attending immunization sessions were purposefully sampled and measured using sensitive anthropometric tools and techniques, while on the other arm of the study structured interviews were administered on the children's consenting mothers (100) who turned in for their wards' immunization. Only 97 out of 100 data collected on the children were used. Anthropometric indices used were height-for-age, weight-for-height, weight-for-age, and mid-upper arm circumference. Results: The study revealed a higher prevalence of moderate stunting in male (46.9%) than in female (33.3%) children (P < 0.05). All (100%) children within the age group of >11 exhibited both severe and moderate forms of underweight. Among infants 3-5 months, moderate wasting was found to be less prevalent (4.2%). And despite the fact that 90% of their mothers showed a positive attitude toward exclusive breastfeeding, only 44% of them breastfed their infants exclusively from birth to the 6 ^th month of life. Conclusion: In order to address the various forms of nutritional derangements detected among the children, mothers should be targeted for infant nutritional education and authorities should institute poverty alleviation measures so as to address underlying causes of malnutrition.

Objective: Thyroid gland is the first endocrine gland to start developing in the embryo. It is well-known for its developmental anomalies such as persistence of pyramidal lobe, thyroglossal duct, agenesis of isthmus, agenesis or hemiagenesis of thyroid gland, or aberrant thyroid glands. These anomalies may cause clinical functional disorders and should be kept in mind while doing surgery on the gland. Materials and Methods: A study was conducted on 37 cadavers to look for the anomalies of thyroid gland. Results: We observed six cases of agenesis of the isthmus of the thyroid gland. Four cases were of agenesis of isthmus alone, fifth case had isthmus agenesis with duplication of the thyroglossal duct remnant and a pyramidal lobe, and sixth one had isthmus agenesis with a thyroglossal duct which divides before entering the two lateral lobes. Conclusion: Such knowledge is very essential for the surgeon while performing thyroid surgeries. Understanding the surgical anatomy of the thyroid gland and its possible variations is essential for safe and effective surgery.

Introduction: Medical education is highly challenging and often places heavy demands on the mental health of the students. Stress is an external constraint which upsets an individual both mentally and physically. The postgraduate students suffer from higher stress that definitely affects the mental wellbeing of these students. Study Design: It is a cross-sectional, observational study. Objectives: The objective of the present study was to explore the level of stress, anxiety and depression among the postgraduate medical students. The secondary objective was to find out the factors affecting the stress, anxiety and depression level in these students. Materials and Methods: Fifty post graduate medical students of Government Medical College were selected. Depression, anxiety and stress scale 42 questionnaires were given for assessment of stress level. A completed scale was taken for assessment from the students. Result: The mean depression score was 6.26 ± 6.00, the anxiety score was 10.34 ± 3.91 and the mean stress score was 15.30 ± 3.93. The present study showed mild anxiety level and moderate level of stress in postgraduate students. The study showed a difference in stress level when compared for age and gender, but it was not statistically significant. When the stress level was compared for clinical and non-clinical departments; the difference was statistically significant. Conclusion: The present study concluded that a high level of stress is seen in postgraduate medical students. The study further concluded that there are various factors which can affect the level of stress. These factors should be assessed separately for the further study.

Background and Objectives: Uveitis, a complex intraocular inflammatory disease results from several aetiological entities. The cause of inflammation might be infectious agent or trauma, but in most cases the underlying mechanism appears to be autoimmune in nature. Anterior uveitis is most common form of uveitis and accounts for an annual incidence rate of about 17 cases/1,00,000 population. Objective of this study is to evaluate the aetiological pattern, treatment and its outcome and complications of anterior uveitis. Methods: A prospective clinical study was done in the Department of Ophthalmology, Karnataka during December 2012 to May 2014. All patients between 20 and 80 years of age clinically presenting with anterior uveitis were studied. A thorough clinical evaluation followed by investigations was done to determined aetiology. Patients were put on specific and nonspecific treatment and were followed up for a period of 6 months. Complications were noted. Results: The aetiology of uveitis remained unknown in most cases (42%). Most common cause was observed to be blunt trauma (20%) followed by phacolytic (12%). Most cases responded well to treatment. Commonest complication was posterior persistent synechiae (23.64%), and cataract was the second common (14.54%). Interpretation and Conclusion: Aetiological diagnosis remains undetermined in majority of cases. A thorough examination and investigation are required in each case to facilitate a final diagnosis. Prompt treatment ensures good visual outcome. Ocular morbidity is common in chronic and recurrent cases.

Phenol is a constituent of coal tar and is formed during the natural decomposition of organic materials. The effect of phenol-contaminated water on the liver of rats was investigated. Activities of some liver enzymes, alkaline phosphatase, acid phosphatase, alanine transaminase, aspartate transaminase, and gamma-glutamyl transpeptidase were determined alongside some serum indices of liver function such as serum bilirubin, albumin, globulin and serum enzymes. The total bilirubin of rats treated with phenol-contaminated water was observed to be 8.4 ± 0.8 g/l while that of control rats was 5.6 ± 0.5 g/l. Serum albumin of test rats was found to be 15 ± 2 g/l while that of control rats was 7 ± 3 g/l. Activity of all the enzymes studied reduced significantly in the liver of test rats compared with the control (P < 0.05). However, serum enzymes activity, with the exception of serum aspartate transaminase, of test rats increased significantly (P < 0.05) relative to that of test rats. It is viewed that phenol-contaminated water is hazardous to health as it may be responsible for the leakage of enzymes into the serum and may impair liver function as portrayed by reduced serum globulin and albumin.

Introduction: Brucellosis is a zoonotic disease of public health importance having an impact on animal husbandry and dairy industry. Isolation of bacteria from blood cultures is very low, and diagnosis mainly depends on serology and molecular methods. The aim of this study is to know the impact of various serological tests on the diagnosis of brucellosis. Materials and Methods: In a prospective study, a total of 180 samples, 90 from pyrexia of unknown origin (PUO) and 90 from high-risk group comprising veterinarians and animal handlers were serologically tested by Rose Bengal plate test, standard tube agglutination (STA) test and enzyme-linked immunosorbent assay (ELISA) and results were analyzed. Results: Out of 90 PUO cases, 28 were positive for brucellosis and in high-risk group, out of 30 veterinarians three were positive and out of 60 animal handlers 14 were positive. Male preponderance was seen. Rose Bengal and STA tests were still efficient methods for brucellosis serodiagnosis. The ELISA was observed to be more efficient in both acute and chronic brucellosis. Conclusion: All the three methods used are efficient methods for detecting Brucella antibody. Rose Bengal card test is the best suited for rapid diagnosis in rural endemic area as STA test is laborious and time-consuming. ELISA is the most sensitive test.

Objectives: Arterial arches of the hand are very important for orthopedic surgeons as well as microvascular surgeons while doing surgeries on hand. The greatest risk associated with harvesting the radial artery for coronary artery bypass grafting is ischemia of the soft tissues of the hand. There may be numerous variations in the formation of these arterial arches which will be important for the surgeons. So, for the above-mentioned reasons the following study was undertaken to look for the pattern of superficial arches in hands and its variations. Materials and Methods: The study was done on 75 formalin fixed upper limbs from the Department of Anatomy. Incision was given according to Cunningham manual of anatomy and superficial palmar arch was exposed, and its formation from different branches was noted down. The variations were noted down in the formation of superficial palmar arch to provide a database of the normal and variant anatomy. Results: In 77.3% of specimens superficial palmar arch was complete and in 22.6% of specimens it was incomplete. Conclusion: The variations found in this study will help not only the anatomists, but also orthopedics and microvascular surgeons who do surgery on hands. Current progress in the microsurgical procedures for reconstructive hand operations needs the understanding of variant arterial arches, the comprehensive knowledge of which is vital for the surgical interventions and successful outcome of the surgeries.

Primary malignant melanoma of the oral cavity is a rare neoplasm. It is very rare aggressive neoplasm arising from a benign melanocytic lesion or de novo from melanocytes within normal skin or mucosa. It is deadly, biologically unpredictable with worst prognosis. These tumors tend to metastasize or locally invade tissue more readily than other malignant tumors in the oral region. The survival of patients with mucosal melanomas is less than for those with cutaneous melanomas. Tumor size and metastases are related to the prognosis of the disease. Early detection, therefore, is important. The paper presents such a rare case that occurred in a young patient.

Herein, we report a patient with polymyositis (biopsy proved) with dysphagia that did not improve with conventional treatment. An upper gastrointestinal (GI) endoscopy showed esophageal stricture and a biopsy taken from the site revealed evidence of squamous cell carcinoma.

Double lip is a rare developmental oral anomaly, affecting the lips. It is also referred to as "macrocheilia," in which a fold of excess or redundant labial tissue is apparent at rest or on smiling. It usually involves the upper lip, less frequently the lower lip either unilaterally or bilaterally, but rarely both the lips are affected as in the presented case. It may interfere with speech and esthetics; surgery may be indicated for cosmetic reasons only. In this article, the authors report a rare case of non-syndromic congenital double upper and lower lip in a 70-year-old male patient, with a brief review of literature.

Infections due to Strongyloides stercoralis are unusual in western Uttar Pradesh. We report a case in which S. stercoralis was isolated from the sputum of an immunocompetent female patient who presented with fever and hemoptysis. No elevation of eosinophils had been shown during peripheral blood smear examination. Microscopic examination of sputum for acid-fast bacilli with light emitted diode (LED) microscope and stool revealed the larval form of S. stercoralis. The patient was treated with ivermectin and recovered gradually.

Organophosphorus (OP) compounds have been widely used as pesticide in India. Because of wide use and easy availability, it is the most common poisoning. OP compound poisoning can lead to cardiac complications. Here we report a case of 26-year-old female who presented after ingestion of unknown quantity of chlorpyrifos. She had cardiogenic shock, 1° heart block with prolonged QTc interval, and sinus bradycardia. She recovered completely after treatment with atropine and pralidoxime.

Split-hand/split-foot malformation (SHFM), also known as ectrodactyly is a rare genetic condition characterized by malformation of the limbs with median clefts of the hands and feet and aplasia/hypoplasia of the phalanges, metacarpals, and metatarsals. It has a prevalence of 1:10,000-1:90,000 worldwide. It can occur as an isolated malformation or in combination with other anomalies, such as tibial aplasia, craniofacial defects, genitourinary abnormalities, and deafness. SHFM is a rare congenital anomaly. When present as an isolated anomaly, it is usually inherited as an autosomal dominant form. We report a rare case of SHFM with sensorineural hearing loss.

Accessory or supernumerary spleens are congenital in occurrence. Its presence may result in differential diagnosis or exhibit continued symptoms after therapeutic splenectomy. We report here a case of accessory spleen (AS), which was remarkably larger in size was found within the gastro-splenic ligament, adherent to its anterior layer. It received an independent vascular supply from splenic vessels supplying the main spleen (MS). Its histological architecture was in close resemblance to that of MS, but with the deficiency of white pulp. Failure to remove AS during main splenectomy done for pathological conditions may result in failure of resolving the condition due to which the pathological condition persists. Occurrence of ASs may also be confused for enlarged lymph nodes or neoplastic growth in the tail of pancreas, gastrointestinal tract and adrenal glands.

Metformin is commonly used in the treatment of type 2 diabetes mellitus (DM). Severe lactic acidosis is a rare side effect of this drug. We present a 45-year-old man who deliberately took 30 g of metformin, presumably with suicidal intent. He had not eaten the previous night and presented with altered sensorium and recurrent seizures. He had profound metabolic acidosis at presentation with a pH of 7.06 and a low blood sugar of 44 mgs/dl. The patient was admitted in intensive care unit (ICU) with the suspicion of metformin-associated lactic acidosis. He developed irreversible renal failure, neurological deterioration and anemia. Despite of daily intensive hemodialysis and other supportive measures the patient expired 14 days later. Metformin overdose with renal failure and severe lactic acidosis have high mortality; hence, urgent medical consultation and treatment can be life saving in these patients.

Neurological manifestations after dengue are not very common and acute disseminated encephalomyelitis (ADEM) following dengue infections is still more infrequent. Few cases have been documented in literature. Characteristic clinical presentation and typical lesions of ADEM on magnetic resonance imaging (MRI) brain along with serologic positivity for dengue usually confirms the diagnosis. The author reports a case of ADEM which developed as a neurological complication of dengue.

Rasmussen's encephalitis (RE) is a chronic neurological disorder, characterised by unilateral inflammation of the cerebral cortex leading to progressive neurological and cognitive deterioration. Advances in neuroimaging suggest that progression of the inflammatory process seen with magnetic resonance imaging (MRI) might be a good biomarker in RE. We present here a case of 8-year-old male child presented with repeated episodes of drug resistant seizures leading to intellectual impairment and cognitive deterioration. Further MRI was done which shows diffuse left cerebral atrophy.

Abscess of massetric region are frequently misdiagnosed as parotid abscess. Ultrasonography, particularly is of immense help to differentiate between these lesions. This case highlights the importance of ultrasonography in this particular context.

Worldwide, the goal of clinical research is to develop knowledge that improves human health or augments understanding of human biology. In biomedical research, two pillars have been identified - informed consent and independent review by an Ethics Committee. Informed consent is a consent given by a competent individual, who is willing to participate in a specific study after being informed about the study, and having made the decision without being subjected to force, undue influence or intimidation. The informed consent form consists of multiple elements, which should be incorporated in the form, and the completeness of the same should be assessed by the Ethics Committee. In conclusion, the practice of obtaining informed consent plays a crucial role in clinical research to safeguard the interests of the study subjects.

Context: International Statistical Classification of Diseases and Related Health Problems (ICD 10) define the universe of diseases that exist, and classify them according to specified criteria. World Health Organization (WHO) has mandated ICD 10 for health reporting by its member states. In India, few of the hospitals in the state are following the standard coding and reporting system. Ministry of Health and Family Welfare (MOHFW), India, have notified the electronic medical records standards to be followed by health care providers in August, 2013 and recommended ICD 10 as reporting standard for both mortality and morbidity. The current study was carried out to promote standard reporting practices and implementation of ICD 10 coding system as per WHO/MOHFW reporting norms in a 150 bedded mission hospital in Udupi District of Karnataka State and successfully implemented with VI phase project. The phases included awareness and knowledge interviews, orientation, training, implementation, and testing. Although the standards and notification have been put up in government MOHFW web pages, it is suggested that the authorized bodies to mandate standard reporting of disease by all types of healthcare providers and upgrading/training programs to be extended to private healthcare sectors as well.