Depression may result in far reaching adverse health outcomes in addition to impaired sociooccupational or quality of life. Depression is commonly associated with greater cardiovascular morbidity and mortality. Dysregulated inflammation has been suggested as one of the plausible underlying mechanism relating the two. Several studies have reported elevated levels of proinflammatory cytokines and acute phase proteins in depression patients. The proinflammatory cytokines have been shown to alter various signaling pathway relevant to depression such as neurotransmitter metabolism, neuroendocrine dysfunction, and synaptic plasticity after reaching the brain. Potential pathways which have been implicated in mediating the depression and inflammation include the tryptophan-kynurenine pathway, hypothalamic-pituitary-adrenal axis dysregulation, and neuronal plasticity. Inflammation appears to play a pivotal role in the pathophysiology of depression but only in subset of depressive patients. It may prove to be an effective target to develop several treatment modalities and thus open avenues for development of potential therapeutic strategies in vulnerable at risk depressive patients.

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Aim: To study prescribing pattern, comorbidities, and cost analysis in elderly hospitalized patients. Materials and Methods: A prospective, observational study was conducted to assess the prescribing pattern, drug utilization, and cost analysis in elderly patients at a tertiary care hospital in Pune. Data of 120 patients were used to carry out the analysis. Result: A total of 120 elderly inpatients were included in the study. Of these 120 patients, 62 were male and 58 were female; among them, maximum number of patients belong to 60-74 years age group. Common comorbidities found were anemia, lower respiratory tract infections (LRTI), urinary tract infection, hypertension, diabetes mellitus, etc. Mostly hospitalized patients were hypertensive (27.5%), diabetic (18.33%), and anemic (15.83%) followed by respiratory tract infections such as pulmonary Koch's, pneumonia, and LRTI. Two comorbid conditions were found in 33.33% of patients followed by 25% with one comorbid condition and 24.16% had three comorbid conditions; on an average, three comorbidities were found in a total number of patients. Major classes of drugs prescribed for treatment were cardiovascular drugs (22.60%), antibiotic (20.13%), antiplatelet (7.26%), and antidiabetic drugs (6.43%). The average cost per patient was calculated 5016.48 international normalized ratio, which includes physician, nursing, bed charges, and therapy cost. Conclusion: This study concludes that the prescribing pattern of elderly patients with age group 60-74 years were commonly prescribed for cardiovascular drugs and antibiotic, whereas this proportion was low compared to patients with age >74 years and prescribing pattern also resulted in financial burden on patients healthcare cost.

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Negative pressure pulmonary edema (NPPE) is one of the common complications of upper airway obstruction seen by anesthesiologist during either in induction or emergence sometimes both. Patients who have experienced NPPE are generally healthy without comorbidities. NPPE is a result of marked decrease in intrathoracic pressure caused by ventilator efforts against a closed glottis resulting in disruption of normal intravascular Starling mechanism, leading to transudation of intravascular protein, and fluids into the pulmonary interstitium. The onset of NPPE is usually rapid and without prompt recognition and intervention, the outcome can be fatal. This case report is of a 40-year-old female adult, who underwent right-sided percutaneous nephrolithotomy for stone in the right kidney otherwise uncomplicated surgical procedure.

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Wolfram syndrome is a rare autosomal recessive disorder characterized by a constellation of disorders also known as diabetes insipidus, diabetes mellitus (DM), optic atrophy, and deafness. Patients present with DM and optic atrophy in the first decade, diabetes insipidus and sensorineural deafness in the second decade, and renal outflow tract anomalies and other neurological manifestations later in life. We report a case of a 14-year-old boy who was diagnosed with insulin-dependent DM and subsequently discovered to have optic atrophy, sensorineural hearing loss, and cardiovascular defect with a positive family history. Such cases need to be evaluated thoroughly with respect to Wolfram syndrome and its associated anomalies.

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A male patient presented with horizontal diplopia and conjugate gaze palsy. Magnetic resonance imaging (MRI) revealed acute infarct in right facial colliculus which is an anatomical elevation on the dorsal aspect of Pons. This elevation is due the 6th cranial nerve nucleus and the motor fibres of facial nerve which loop dorsal to this nucleus. Anatomical correlation of the clinical symptoms is also depicted in this report.

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Nicolau syndrome (NS) is a rare injection-related local complication. Some drugs have been implicated to cause this syndrome. Several cases were previously reported in the literature. In this paper, an interesting case of NS in a 30-year-old male patient after intramuscular self-injection of diclofenac was presented.

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Rarity of ipsilateral femoral neck and shaft fracture qualifies it as a difficult fracture to diagnose as well as treat. No ideal treatment option has been defined, and no ideal implant has been assigned for the management of such fractures. Fixation of ipsilateral fractures of femoral neck and shaft are technically demanding. They are also associated with complications such as osteonecrosis of femoral head, delayed union, varus malunion, and nonunion. Treating such complicated fractures in a level V trauma center such as rural mission hospital with limited resources multiplies the difficulty of managing such fracture. This case report highlights the outcome and challenges in treating a patient with ipsilateral femoral neck and shaft fracture in a mission hospital in rural central India.

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Objective: Dysmenorrhea is a widespread medical problem among young females. Hypnosis has been successfully tried for alleviation of different types of pain. In this randomized control trial, we compared it with nonsteroidal anti-inflammatory drug (NSAID), which is a standard treatment, for primary dysmenorrhea. Method: Out of 116 female nursing students, 50 having dysmenorrhea were selected and divided into mild, moderate, and severe pain category based on visual analog scale (VAS) score. Each category was randomly divided into two groups. One group was offered hypnosis and the other was offered Ibuprofen for pain relief in each menstrual cycle, for three consecutive cycles. They were followed for next three cycles (i.e., 4 ^th , 5 ^th , and 6 ^th cycle) without any treatment. Evaluation of pain score was done at the end of each cycle in both the groups. Wilcoxon Signed Rank Test and Mann-Whitney U-test were used for statistical analysis. Results: Compared to baseline, the improvement in pain scores was statistically significant in all six cycles in hypnosis group (P < 0.0001); whereas in NSAID group, the improvement was found during first three cycles only (P < 0.0001). Comparing the VAS scores of the same menstrual cycle in both the groups, it was less in NSAID group than hypnosis group for the first three cycles. This shows the instant effect of NSAID on pain relief. However, for the remaining cycles, pain scores were less in hypnosis group compared to NSAID group. Conclusion: For dysmenorrhea, hypnosis produces lasting pain relief compared to NSAID.

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Background: Satisfaction can be defined as the extent of an individual's experience compared with his or her expectations. Client satisfaction is one of the commonly used outcome measures of patient care and is an important indicator of quality of primary care and healthcare performance. Objective: To assess the satisfaction with the services among Janani Suraksha Yojana (JSY) beneficiaries in a rural field practice area of Indira Gandhi Medical College (IGMC), Shimla, and to recommend measures for improvements of services being provided to the beneficiaries. Materials and Methods: A community-based, cross-sectional study was undertaken from April 2013 to March 2014 in the rural field practice area of IGMC, Shimla, among the JSY beneficiaries who delivered and received the services under the JSY Scheme in the previous 1 year. The data were collected using a pretested, predesigned, and semi-structured questionnaire and these data were analyzed using SPSS (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp). Results: The study observed that 49 (69%) of beneficiaries were found to be satisfied with services received at subcenter and the amount of JSY incentive received. It was also revealed that out of 64 beneficiaries who delivered at hospital, most 52 (81%) of them were satisfied with the services received at the place of delivery. It was found that 51 (65.38%) and 16 (20.5%) beneficiaries were found satisfied and dissatisfied with the behavior of health functionaries at subcenter, respectively. Conclusion: Client satisfaction is one of the most important determinants of health service utilization. There is a need for regular training program for health functionaries on improvement of communication skills and quality of care.

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Background: Dental waste is a subset of hazardous biomedical (BM) waste. It has been observed that most of the dental health facilities, the guidelines for proper management of dental waste are not adopted and not up to the prescribed standard. Aim: The aim of this study is to assess the knowledge, awareness, and attitude/behavior of BM waste generation, hazards, and legislation among the study subjects using self-structured questionnaire. Methodology: A cross-sectional study was conducted in 337 practicing dentists in Bengaluru city for the past 2 months. A self-structured questionnaire was used to obtain required data. The questionnaire was divided into three sections. The first section of the questionnaire contained questions regarding knowledge of BM waste generation, hazards, and legislation, whereas the second section contained questions regarding the level of awareness on BM waste management practice, and the third section contained questions regarding attitude/behavior toward BM waste. Results: Of 337 (100%) study participants, 176 (52.2%) were males and 161 (47.8%) were females. Among 337 (100%) study participants, more than three-fourth, i.e., 291 (88.4%) knew about BM waste generation and legislation, whereas 23 (6.8%) each did not know and were not aware of it. Conclusion: There is a good level of knowledge and awareness about BM waste generation hazards, legislation, and management among health care personnel in Bengaluru city. Regular monitoring and training are still required at all levels, and there is a need for continuing dental education on dental waste management practices to these dental practitioners.

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Background and Objective: Despite the widely recognized role of physiotherapy in the management of cerebral palsy, limited literature is available on its efficacy in cerebral palsy. This report describes the impact of physiotherapy service utilization on the physical and functional status of children with cerebral palsy. Methodology: A cross sectional survey of 248 children with cerebral palsy of age group 3-13 years in Jalandhar district of Punjab was conducted using Physical examination of child and scheduled interview of parents. The physical and functional statuses of these groups were compared using t - test and Chi square. Result and Discussion: 55.6% children received physiotherapy whereas 44.4% children did not receive any physiotherapy. Total and domain wise gross motor function (GMFM) and fine motor function (QUEST) scores of the group not exposed to physiotherapy was significantly( P < 0.001) less than those exposed to physiotherapy. Deformity score of non exposed group (9.45 ± 6.87) was significantly higher (P <0.001) than exposed group (5.22 ± 4.60). Non exposure to Physiotherapy was significantly (P < 0.001) associated with reduced functional abilities in the area of ambulation (OR = 4.51) and eating (OR = 2.89) drinking (OR = 3.31) toileting (OR = 3.52) washing (OR = 3.45) and dressing (OR = 4.61). Conclusion: This report provides evidence that provision of physiotherapy positively affect the physical as well as functional status of children with cerebral palsy.

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A hernia surgeon may encounter unexpected intraoperative findings. It is important to be prepared to detect them and apply the appropriate treatment. We retrospectively studied twenty patients with inguinal swellings who were admitted to our surgical department over a 2-year period including patients without a definitive diagnosis of inguinal hernia upon admission. Our aim was to present our experience with the unexpected findings during inguinal hernia surgery, either unusual hernial contents or pathologic entities, such as neoplastic masses, masquerading as a hernia.

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In this era of the latest diagnostic technologies, meticulous clinical examination of the patient still is the golden principle of medical science and will never lose its importance. This case report highlights that detailed physical examination of the patient would have led to the identification of the etiology quite earlier and the significance of evaluating a child as a whole and not based on symptoms alone.

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Binder's syndrome (BS) or Maxillo-nasal dysplasia is a congenital malformation described first by Noyes. The syndrome was not recognized until Binder's comprehensive report of three unrelated children in 1962. In patients with BS, the mid-face appears flattened, the columella is short and the upper lip slants backward. We hereby present a case with these typical findings of BS in a male patient.

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We report an extremely rare case of neuroendocrine carcinoma (NEC) of the stomach, which is known for its aggressive behavior and poor prognosis. To the best of our knowledge, only a few cases have been reported in the world till date and our case may be one of the very few of this rare pathology. A 42-year-old male presented with vague abdominal pain and significant weight loss. Upper gastrointestinal endoscopy revealed ulceroproliferative growth in the pylorus. Computed tomography of the abdomen showed thickening of the pylorus with locoregional lymphadenopathy. Positron emission tomography scan showed localized disease. A distal gastrectomy with D1 dissection was performed. Postoperative histopathology revealed high grade NEC of the stomach with cytokeratin-20, epithelial membrane antigen, chromogranin, and CDX-2 positivity on immunohistochemistry. He was treated with adjuvant chemotherapy followed by locoregional radiotherapy with significant response to treatment. Presently on regular follow-up without any evidence of recurrence or distant metastasis.

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In the modern era of globalization, a remarkable increase in the number of people who are migrating every year has been reported. In the recent couple of years, the European region is facing an ever-rising challenge of meeting with the health needs of thousands of migrants and refugees, in a timely and effective manner. The migrants and refugees remain a difficult population sub-group to handle for the local program managers, owing to the existence of multiple challenges or barriers. In order to improve the quality of life of migrants, there is an enormous need for health system preparedness, careful planning, capacity building, comprehensive epidemiological data, and training of health professionals. To conclude, as migrants and refugees represent a vulnerable section of society, none of the planned interventions can provide sustainable results unless strengthening of the primary health care and consideration of the socio-cultural beliefs of the migrants are taken into account in the planned interventions.

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In rural India most of the surgical patients become impoverished due to surgical treatment pushing several families below poverty line. We describe the various methods that we tried to help these patients pay for the surgical procedures without becoming impoverished. Some of them were successful and many of them were not so successful. The large turnover and innovative methods helped the mission hospitals to serve the poor and the marginalized. Some of these methods might not be relevant in areas other than Northeast India while many could be used in other areas.

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Introduction: There is a need for a rapid and cost-effective technique for reliable diagnosis of tubercular lymphadenopathy, particularly in low-resource setting. In this study, we have used various diagnostic techniques including polymerase chain reaction (PCR) to diagnose clinically suspected cases of tubercular lymphadenopathy and compared the results to see which of the techniques are more sensitive, specific, and cost-effective. Materials and Methods: All patients having swelling in the neck, axillary, and inguinal regions were recruited for the study. Sputum for acid-fast Bacillus (AFB), fine-needle aspiration cytology, excision biopsy, DNA-PCR, AFB smear of the same material was done as per standard protocol. Results: 32% patients have granulomas with necrosis, whereas 30% have acute suppurative lesions and 24% and 14% patients were having only granulomas and only necrosis, respectively. A significant difference was observed between the PCR-negative and positive cases with respect to their cytomorphologic features. Positive AFB and tuberculosis-PCR (TB-PCR) results were significantly more common in the cases with chronic granulomatous inflammation in comparison to the cases showing chronic inflammation only. Sensitivity and specificity of TB-PCR were found to be 71.4% and 28.4%, respectively. Conclusion: PCR is a sensitive and rapid technique in the demonstration of Mycobacterium tuberculosis. It should be done in clinically suspected patients of tuberculous lymphadenopathy when their AFB stain is even negative.

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Background: Intestinal helminthiases present a major public health problem worldwide. In Africa, the prevalence varies in countries and within regions. The study aimed at assessing the prevalence of parasitism and poly-parasitism due to intestinal helminths in rural and urban settings. Settings and Design: A 6-month cross-sectional school-based study was undertaken in Nandi County, Kenya, to determine the prevalence of intestinal helminthiases in school children. Materials and Methods: A total of 2967 fecal samples were collected and analyzed to detect the presence of helminth ova, larvae, segments, or adults. Modified formal-ether concentration technique was used. Results: The study findings revealed that three helminth species were prevalent and were associated with intestinal helminthiases with an overall prevalence of ascariasis 55.8%, trichuriasis 26.9%, and hookworm disease 24.8%. There was no significant difference in the prevalence of intestinal helminth single infestations among the study sites and between sexes (P > 0.05). The prevalence of multiple infestations was established as 34.7% and was common in estates and villages (40-50%) than in towns (18%). Poly-parasitism involving 2-3 helminths was prevalent in 8.4-25.4% than those with 4-5 species of 0.07-0.7%. A statistically significant difference among the different types of poly-helminthic infestations was established (P < 0.05). However, no significant difference was established in the prevalence of poly-helminthism in the study sites (P > 0.05). Conclusion: The study confirmed that single and multiple helminth intestinal infestations were prevalent in rural and urban areas. Residential area was found not to be associated with multiple parasitism. The findings support the view that intestinal helminthiases require intervention. Recommendation: Strategic intervention in the form of mass diagnosis and treatment by the use of effective broad spectrum anthelmintic(s) and public health education are recommended.

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Context: Thyrotoxicosis is a common clinical problem, and the most common cause of thyrotoxicosis is Graves' disease and is 4 times more common than the other causes combined. Of late, the number of people incidentally detected to have biochemical thyrotoxicosis is increasing, and most patients are detected during health checkups, pregnancy planning, and surgical fitness. There are no data on the etiology and natural course of such cases and no guidelines for evaluation of such patients. Aims: The aim of this study is to evaluate the cause of thyrotoxicosis in patients incidentally detected to have biochemical thyrotoxicosis and to study the natural course of illness of these patients. Subjects and Methods: All patients who were incidentally detected to have biochemical thyrotoxicosis (during health checkups, pregnancy planning, and surgical fitness) were included and studied. Patients who had symptoms of thyrotoxicosis, or patients in whom thyrotoxicosis was suspected by the treating doctor were excluded from the study. All patients underwent an ultrasound thyroid and thyroid scan, and treatment was decided based on the results. All patients were followed up for a minimum period of 3 months. Results: A total of 57 patients were studied. The average age of the study population was 32.8 years, with male:female ratio of 1:3.3. Of 57 patients, 52 (91%) had subacute thyroiditis as the cause of thyrotoxicosis while Graves' disease was seen in 9%. None had toxic adenoma or toxic multinodular goiter. In the patients with subacute thyroiditis, 47 became euthyroid and 5 became subclinically hypothyroid (Stage b). Conclusions: The majority of patients with incidentally detected thyrotoxicosis had thyroiditis as the cause, which reverted to euthyroid state in most of the cases. Based on the study, it seems prudent to wait and follow up this group of patients rather than start antithyroid drugs, especially if facilities for uptake scan are not available or affordable.

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Occupational exposure comprises of needle stick injury (NSI) and mucosal splashes. A health care worker (HCW) is at a greater risk of developing blood borne virus infection while at work. Due to high prevalence of human immunodeficiency virus, hepatitis B surface antigen and hepatitis C virus in developing countries, there is a higher risk of infection after occupational exposure to HCW. Factors such as sub-optimal infection control practices and lack of equipment, increases the risk of acquiring NSIs. Reporting of each episode of occupational exposure should be mandatory in institutions. Postexposure management policies should be included among the institutional policies.

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