Introduction: Cerebral palsy (CP) is emerging as one of the main causes of childhood disability in India. Care provided to children with disability largely depends on the awareness, beliefs, and socioeconomic status of the community. This study examines the influence of awareness, beliefs, concerns, and socioeconomic status of the families having children with cerebral palsy in Jalandhar District as one of the cities of state Punjab, Northern India, on the service utilization pattern. Materials and Methods: The study has been approved by BPSAR, Punjabi university, Patiala. Personal interview of 248 families of the children with cerebral palsy using semi structured questionnaire has been the tool for data collection. Results: The awareness of key legislative acts on disability has been nil, though 16.1% parents know about Right to Education (RTE) act and have some knowledge of disability certificate, travelling concession, and benefits and tax rebates available to parents of children with disability. Close to 70% families believe that the condition of the child is so because of the deeds of parents in their previous life and almost an equal number accuse the mother for present condition of her child. Care of child after the demise of parents and the scattered facilities of rehabilitation were the main concerns. Massage has been the most common service utilized by 57.6% followed by physiotherapy (55.6%) and orthoses (38.70%). Speech therapy and special education has been utilized for just 4% of the children belonging to upper and middle classes only and none of the children of any class has received occupational therapy. Conclusion: The awareness level and pattern of service utilization was significantly (P < 0.05) associated with the socio-economical status of family and awareness of rehab services requirements. The findings of the study reinforce that it is essential that concrete steps should be taken to sensitize the community and medical professionals about the needs and methods of rehabilitation of cerebral palsy.

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Dengue hemorrhagic fever (DHF) and Dengue shock syndrome manifest in various forms, ranging from petechial skin hemorrhage to life threatening cerebral, pulmonary, gastrointestinal and genitourinary hemorrhages. However it is very rare to have muscle hematomas in DHF. We report a rare case of spontaneous Iliopsoas hematoma complicating Dengue hemorrhagic fever.

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Objective: The acromion process is associated with a variety of ailments in the shoulder. Therefore, the aim of this study was to record and study all the morphometric values of the acromion process and its morphological features. Materials and Methods: The study was carried out on 50 unpaired dried scapulae. The length, width, and thickness of the acromion process were measured, and the length and width of scapula was also measured using vernier calipers. The acromiocoracoid and acromioglenoid distances were also measured. The shape, type of acromion process, and the presence of enthesophytes were noted and whether the anterior 2/3 ^rd of inferior surface of acromion process is rough or smooth was also noted. Results: The mean length, width, and thickness of acromion process were 4.21, 2.42, and 0.73 cm, respectively. The mean length and width of scapula were 13.93 and 10.14 cm, respectively. The mean acromiocoracoid distance and acromioglenoid distance were 3.09 and 2.47 cm, respectively. The most common shape of the acromion process noted was quadrangular in 40% of scapulae. In 90% of scapulae, the anterior 2/3 ^rd of inferior surface was rough and in 80% scapulae, enthesophytes were present. Conclusions: This study will help the clinicians in understanding and curing various shoulder joint disorders.

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Background: Bloodstream infections (BSIs) are one of the serious infections causing significant morbidity and mortality among hospitalized patients. Large numbers of cases of treatment failure are being reported due to emergence of drug resistance. Early microbiological diagnosis and determination of antimicrobial susceptibility pattern have been shown to improve treatment outcome. The present study was aimed to determine the bacterial and antimicrobial resistance profile of BSIs in a major tertiary care hospital. Materials and Methods: Blood samples in brain heart infusion (BHI) broth submitted to the microbiology laboratory for culture and sensitivity during a period of 1 year were included in the study. Samples were processed as per standard protocol of laboratory for isolation and identification. The antimicrobial susceptibility profile of bacterial isolates was determined by the disc diffusion method as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: Out of 4862 blood samples, 494 (10.16%) isolates were obtained. Of these isolates, 256 (51.82%) were Gram-negative and 230 (46.56%) were Gram-positive bacteria. The most commonly identified organism was coagulase-negative Staphylococcus (CoNS) (25.91%) followed by Acinetobacter spp. (20.24%) and Escherichia coli (14.98%). Gram-negative bacteria showed a higher rate of resistance as compared with Gram-positive bacteria. Conclusion: High prevalence of antimicrobial resistance was noted in this study, especially in Gram-negative bacteria. Hence, appropriate treatment of BSIs should be based on the current knowledge of bacterial resistance profile as provided by microbiology laboratory. It would be advisable for the clinicians to mandate antimicrobial sensitivity testing for suspected cases of BSIs.

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Introduction: Antibiotic resistance is an increasing concern worldwide, specially in Gram negative bacilli where there is a paucity of new and effective antimicrobial agents. Pseudomonas aeruginosa is inherently resistant to different antimicrobial agents who are responsible for increase in morbidity and mortalities found in all types of patients. The purpose of this study was to evaluate the antibiogram of Multi drug resistant (MDR ), Extremely drug resistance (XDR) and Pan drug resistant (PDR) Pseudomonas aeruginosa. Aims and objectives: To find out the frequency and resistance pattern of MDR, XDR and PDR Pseudomonas aeruginosa. Materials and Methods: This is six month retrospective study, conducted in department of Microbiology a tertiary care hospital and teaching institute. During the study period (July-Dec 2013) routine samples were tested to standard microbiological procedure. Isolates were identified up to species level, Pseudomonas aeruginosa were picked up for further studies. Antibiotic sensitivity testing (AST) was performed by the Kirby-Bauer disc diffusion method, Carbapenemase production was screened by Hodge test and Modified Hodge test, extended spectrum beta lactamse (ESBL) production and AmpC presence were screened by two disc method. According to the sensitivity pattern, the strain was identified as MDR, XDR and PDR Pseudomonas aeruginosa. Results: During the study Pseudomonas aeruginosa were isolated from 198 (21.85%) samples. Among 198, 12 (6.06%) were identified as PDR, 23 (11.6%) were XDR whereas 49 (24.7%) were MDR. Out of 198, 98 (49.49%) were ESBL, 40 (20.20) were Carbapenemase producer and 4 (2.02) were AmpC producer. Conclusions: Though Pseudomonas aeruginosa is inherently resistance to different antimicrobial agents, irrational and inappropriate use of antibiotics is also responsible for the development of resistance to antibiotic. Hence, there is a need to emphasize the "rational drug" to minimize the misuse of antimicrobials. To minimize morbidity and mortalities due to Pseudomonas aeruginosa infection, prior AST is essential to provide specific treatment.

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Apert syndrome is a developmental malformation characterized by craniosynostosis, a cone shaped calvarium, midface hypoplasia, pharyngeal attenuation, ocular manifestations and syndactyly of the hands and feet. The complex craniofacial and systemic deformities seen in Apert syndrome mandate a multidisciplinary approach to improve the quality of life of patients. This paper presents the case of a 27-year-old male patient who presented with the complaints of malaligned teeth, difficulty in chewing food, facial deformity along with syndactyly of the hands and toes, and was diagnosed as a case of Apert syndrome.

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Background: Peak Expiratory Flow Rate (PEFR) reflects the strength and condition of respiratory muscles and the degree of airflow limitation in large airways. PEFR shows hour to hour variation that follows a specific pattern in asthmatics and healthy individuals. Adequate data is not available for the diurnal variation in normal individuals who are students in professional courses and had a sedentary life style. Hence, this study was undertaken to study the diurnal variation in peak expiratory flow rates in healthy adult female subjects in South India. Materials and Methods: Peak expiratory flow rate was recorded in 50 adult healthy female students aged 18-23 years and studying in professional courses. Mini Wright's peak flow meter was used to measure the peak expiratory flow rate. PEFR were recorded at 7-8 a.m., 10-11 a.m., 1-2 p.m., 4-5 p.m., and 7-8 p.m. for two consecutive days. Results: On analysis of PEFR records of individual subjects, it was seen that there was an overall dip in the morning at 7-8 h PEFR, which increased in the daytime, peaking in the afternoon at 1-2 p.m. and eventually decreased in the night. Subjects did not show the peak PEFR values at the same time point, 10% of subjects had a rise in PEFR in the early morning, afternoon (1-2 p.m.) peak was observed in 48% subjects and evening (4-5 p.m.) peak was observed in 16% subjects. 14% subjects showed a peak in the night time (7-8 p.m.) PEFR values. Conclusion: This study provided the preliminary reference data of diurnal variation of peak expiratory flow rate in healthy adults. Since, there is a variation in the peak expiratory flow rate recorded during different time points of the day; hence, to compare the PEFR between individuals it is advisable to record the PEFR at the same time point.

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Introduction: Rickettsial infections, one of the re-emerging diseases are increasingly underdiagnosed due to nonspecific symptoms, absence of reliable and affordable diagnostic test and contribute substantially to the acute febrile burden and preventive illness in many populations. A delay in diagnosis and therapy are associated with increased morbidity and mortality. Objectives: To determine and categorize rickettsial disease titers by Weil Felix test, and to know the frequency of rickettsial diseases in febrile patients presenting to a tertiary hospital. Materials and Methods: In a prospective study, a total of 100 samples were tested by Weil Felix test from patients with fever and results were analyzed. Results: Out of 100 samples 64 were positive. Male preponderance was seen. The most common clinical symptom were fever, rash followed by hepatomegaly and splenomegaly. One patient with a high titer of more than 1280 died of encephalitis. Conclusion: In the absence of availability of a good reliable serological or molecular evidence, Weil Felix test can be used in the laboratories mainly due to cost and technical aspects of other reliable tests for diagnosis.

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Mobile surgical services have the inherent advantage that surgical conditions can be diagnosed and treated in a cost effective way in rural as well as remote areas. The Surgical Services Initiative comprises a group of doctors who have joined hands to help the poor and marginalized sections of the population by making modern surgical treatment available to them. The experience and details of one such surgical camp held over one month is presented in this article. The diagnostic and surgical camp model is also described here.

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Introduction: Tobacco use among school going children is becoming a serious public health issue in developing countries like India. According to the study conducted by S.K. Jindal in 2004, in the northern states of India, prevalence of tobacco use was lowest in Punjab because smoking is strongly against the Sikh tenets. However, a recognizable change in trends has been observed recently. Aim: To determine the prevalence of tobacco use, the age of initiation, factors leading to initiation, and the knowledge about the health hazards caused by tobacco use among adolescents in the city of Ludhiana, Punjab. Materials and Methods: A cross sectional study was conducted among 400 adolescents between the ages of 13 to 19 years in Ludhiana using a self-administered questionnaire. Result: In all, 12.75% of the students were found to be tobacco users. The age of initiation was around 15 years. Majority of the students were initiated into this habit by friends or by immediate family members. In total, 78.64% of the students reported to be aware of the harmful effects of tobacco use. Conclusion: This study demonstrated a relatively high prevalence of tobacco use among adolescents in Ludhiana, Punjab. Peer pressure was the main factor in the initiation of this habit. Strict laws need to be passed and interventions designed to reduce the use of tobacco among adolescents.

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Tumoral calcinosis is a rare disorder of unknown etiology characterized by the deposition of calcified masses within the peri-articular soft tissues of large joints, and sometimes in small joints but rarely involves the scalp. Masses of soft tissue calcification around the joints sometimes cause limitation of movements and disabilities requiring surgical intervention. Involvement of scalp is extremely rare. We are presenting a case report of a young girl who presented with soft tissue calcification of large joints along with scalp involvement.

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A 13-year-old boy presented to our ophthalmology outpatient department with gradual loss of vision in both eyes for past 6 months and the best-corrected visual acuity in right eye was 6/12 and left eye was 6/18. Anterior segment examination was within normal limits. Fundus examination showed right eye partially absorbed egg yolk like lesions in macula and left eye macula shows yellowish scrambled egg like lesions. Electro-oculogram showed reduced Arden's ratio. Patient was diagnosed to have best disease and as best disease is a bilateral macular dystrophy with autosomal-dominant inheritance it can occur in family members and therefore his parents and siblings were called for ocular examination and were found to have the best disease. So genetic counselling and screening of family members should be carried out or the disease can be missed out.

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Context: Clinicoradiological variability expansion in Dyke-Davidoff-Masson syndrome (DDMS) or hemiplegia, hemiatrophy and epilepsy (HHE) patients. Aims: To explore clinicoradiological features, associated abnormalities and refractoriness issues to antiepileptic drugs (AED) on such kind of epilepsy syndrome. Settings and Design: Prospective and retrospective observational hospital based cohort study. Materials and Methods: Thirty-two patients of HHE were enrolled and interviewed. They were divided into 4 groups congenital versus acquired and seizure control group (SCG) versus seizure refractory group (SRG). We used Naranjo adverse drug reaction (ADR) probability scale for analyzed phenytoin and other drugs adverse reaction. All patients underwent clinicoradiological examination, electroencephalograms, magnetic resonance imaging for parenchymal and skeletal changes. Statistical Analysis Used: Fisher's exact and Student's t-test applied for P value. Results: A total of 32 patients (21 males, 11 females) out of 1182 epilepsy patients were enrolled with mean age of 26.84 ± 9.71 (range: 8-42) years. Twenty-eight patients presented with DDMS, three Rasmussen encephalitis and two HHE syndromes. Congenital type and seizure refractory groups were common presentation. Left lateralization with holo-hemispheric atrophy, cerebellar atrophy, calvarial thickening with frontal sinus hyperpneumatization were significant (P < 0.05) magnetic resonance imaging (MRI) findings. Epileptiform activity was concordant to lesion. Phenytoin adverse effects were significantly (P < 0.03) associated with HHE patients. Remarkable findings of our study included cerebral hemispheric plus cerebellar atrophy (28.12%), hippocampal sclerosis (16%), dystonia, hemiparkinsonism, mirror movement and Dandy-Walker syndrome (DWS). Conclusions: DDMS/HHE can present protean clinicoradiological manifestation, cerebellar atrophy, hippocampal sclerosis and phenytoin intolerance may be one of them.

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Introduction: The integrated counseling and testing centre (ICTC) has proved to be an essential human immunodeficiency virus (HIV) infection prevention intervention, especially in nations where poverty, social inequality, and weak health infrastructure exist. Objectives : The study was conducted to (i) assess the performance of ICTC in a referral hospital over a period of 11 years (ii) understand the regional risk determinants of HIV-positive clients. Materials and Methods : In this record based hospital study, data from January 2000 to December 2010 of all ICTC attendees and HIV-positive clients (excluding pregnant women; surveillance in this group is being conducted routinely) was collected by reviewing the records, compiled, and analyzed. Results : A total of 19,234 clients were counseled, of which 17,411 were tested and 970 were detected positive for HIV. The HIV seropositivity amongst the total tested clients was 5.57%. The intake of clients attending ICTC consistently increased from 781 clients in 2000 to 5574 clients in 2010. Amongst the total 970 HIV positives the ratio between male and female positives was 3:2 (m = 584; f = 386). Of these, 42.1% were in the age group of 25-44 years and children (<15 years) accounted for 7.8%. The heterosexual route of transmission was documented in 77.4%. In 13.6% (n = 132) HIV-positive clients, the route of transmission was not identified. The provider initiated client visits increased significantly from 4.85% in 2006 to 82.05% in 2010 than the direct walk-in clients (P < 0.0000001). However, the HIV-positive clients were three times more in the direct walk-in clients than in the provider initiated clients (P < 0. 0000001). Conclusion : Increased utilization of ICTC reflects the overall attitudinal changes in behavior and heterosexual high risk behavior continues to be the major route of HIV transmission.

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Background: Motor vehicle emissions constitute the most significant source of ultra particles in an urban environment. Traffic related air pollution is an occupational health hazard to individuals who live and work in an environment close to traffic. The present study intends to study the effect of air pollution on the pulmonary system in people who reside in areas exposed to automobile exhaust. Material and Methods: This study was conducted by performing pulmonary function tests (PFT) on 20 people who are exposed to automobile exhaust by virtue of their residence nearer to traffic junctions and comparing them with 20 others of age and gender matched and similar anthropometric profile people, who reside in a rural setting free from vehicular air pollution. Statistical analysis was done by Student's t-test (two-tailed, independent) for inter group analysis. Results: There was a statistically significant difference between the two groups as far as parameters like FVC, FEV ₁ , PEFR, FEV ₁ /FVC, FEF _25-75% . It can be seen that there is decline in dynamic pulmonary function parameters in the study group when compared to controls, which is statistically significant. Conclusion: The respiratory system are particulate matter (PM ₁₀ ) and sulphur dioxide (SO ₂ ) produced by the combustion of fossil fuels. These pollutants react with each other, forming hazardous acid sulfate particles, which are capable of reaching deep inside the tracheo-bronchial tree producing a bronchoconstrictor response, as their predominant site of action are the small airways. This was a comparative study to demonstrate the effect of air pollution due to automobile exhaust on pulmonary functions of people who reside in areas exposed to a polluted urban environment with a similar group in the rural relatively pollution free environment.

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Background: HIV infection is the strongest of all known risk factors for the development of tuberculosis. Tuberculosis is the most common opportunistic infection and the number one cause of death in HIV/AIDS patients in developing countries. Materials and Methods: The aim of this study is to assess and compare the outcome of pulmonary tuberculosis in HIV-seropositive and HIV-seronegative patients. This was cross-sectional, observational and prospective study conducted at tertiary care center in western Maharashtra from May 2010 to April 2012. A total 50, HIV-seronegative patients and 50 HIV-seropositive patients of both genders, with pulmonary tuberculosis fulfilling inclusion criterion (age > 18 years, newly detected pulmonary tuberculosis) were included in present cross-sectional, observational, prospective and comparative study. Results: Of the total 50 HIV-seropositive patients, 36 (72%) males were newly detected pulmonary tuberculosis (PTB) with mean age of 40.61 ± 8.74 years and 14 (28%) were females with mean age 37.72 ± 9.54 years. Of total 50 patients amongst HIV seronegative-group patients with PTB, 29 (58%) were males with mean age of 42.44 ± 5.79 years and 21 (42%) were females with mean age of 38.9 ± 7.91 years. A total 10/50 (20%) patients in HIV-seropositive group and 3/50 (6%) HIV-seronegative group had evidence of jaundice. There was a statistical difference between development of jaundices in HIV and HIV-seronegative group ['P' = 0.037]. Total 9/36 (25%) male patients and 2/14 (14.28%) females patients died in HIV-seropositive group with no death recorded amongst in HIV-seronegative groups with high mortality in HIV-seropositive group ['P' < 0.0001]. Total 4 male and 4 female patients had inflammatory response syndrome (IRIS). Total 40/50 (80%) patients were sputum negative at the end of 6 ^th month (2 ^nd follow-up) among HIV-seropositive group. Total 49/50 (98%) become a sputum negative at the end of 2 ^nd follow-up, 6 month among HIV-seronegative group there was a statistically significant difference between two group ['P' = 0.021]. Total 10/50 (20%) and 1/50 (2%) patients were diagnosed with multidrug resistant tuberculosis (MDR-TB) among HIV-seropositive group and HIV-seronegative group, respectively ['P' = 0.002]. There was high prevalence of middle and lower lobe lesions and bilateral extensive pulmonary tuberculosis (BEPT) in patients with HIV-seropositive group patients and upper lobe, miliary shadow and cavitary lesions in HIV-seronegative group patients ['P' < 0.02]. The cavitary lesions were significantly low in HIV-seropositive group with low CD+4 counts. Duration of stay was significantly more in HIV-seropositive group compared with HIV seronegative- seropositive group ['P' < 0.01]. Conclusions: We found high prevalence of MDR-TB pulmonary tuberculosis in HIV-seropositive patients. Mortality was significantly high in HIV-seropositive patients than HIV-seronegative patients. Jaundice was more prevalent in HIV-seropositive patients than HIV-seronegative patients. There was high prevalence of middle and lower lobe lesions and BEPT in patients with HIV-seropositive group patients and upper lobe, miliary shadow and cavitary lesions in HIV-seronegative group patients. The cavitary lesions were significantly low in HIV-seropositive group with low CD+4 counts. Duration of stay was significantly more in HIV-seropositive group compared with HIV-seronegative group. Success rate of directly observed treatment short-course was less (80%) in HIV-seropositive group.

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