Introduction: Escherichia coli is one of the most common bacteria causing urinary tract infection. Accurate identification of urinary isolates is highly desirable and frequently challenging. Our study aims at identifying the “atypical” phenotype of E. coli by conventional, automated, and molecular methods and studying its prevalence among all the urinary isolates of E. coli. Materials and Methods: The present prospective study was conducted in the Department of Microbiology of a teaching tertiary care hospital of Central India for 6 months during the year 2014–2015. A total of 592 urine samples were processed. Identification of different urinary isolates was done by conventional and automated methods and by molecular method in special cases. Results: Two hundred and sixty-one uropathogens were isolated during the study. Among these, 110 (42.1%) isolates were E. coli, of which 4 (3.6%) isolates were confirmed as “atypical” E. coli by automated and molecular method. Conclusions: Our study highlights the challenges in the identification of atypical urinary isolates of E. coli. Accurate identification is essential for implicating proper antibiotic treatment.

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Double duct sign is an anatomical sign of combined dilatation of common bile duct and pancreatic duct. It is observed on imaging during endoscopic retrograde cholangio-pancreatography, magnetic resonance cholangio-pancreatography, computed tomography and ultrasound. The sign in a jaundiced patient is highly diagnostic of pancreatic carcinoma.

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Worldwide, head and neck squamous cell carcinoma is the sixth most common malignancy in men. The parts of Southeast Asia, head and neck squamous cell carcinoma is the most common malignancy, accounting for up to 50% of malignant tumors. Oral squamous cell carcinoma is believed to arise from a series of genetic changes induced by carcinogens, ultimately leading to clinical and microscopic changes summating to form an invasive neoplasm. The principal etiological factors such as tobacco and alcohol are responsible for DNA mutation activating oncogenes interfering with tumor suppressor genes and interacting with various epithelial growth factors. Slaughter in 1953 proposed the concept of field cancerization. He hypothesized that an area of epithelium is preconditioned by a carcinogenic agent. Such a carcinogenic influence if operative long enough in time and intense enough in exposure produce an irreversible change in cells and cell groups in a given area and so that the process toward cancer becomes inevitable. Thus, oral squamous cell carcinoma is multicentric in origin, through a process of field cancerization would seem to be an important factor in the persistence or recurrence of oral squamous cell carcinoma. As local and systemic therapies for primary tumor do not appear to prevent multifocally, the prognostic implications of field cancerization change may be substantial. The occurrence of second primary tumors may not be the major cause of mortality in the head and neck cancer patients but has a high impact on mortality and the treatment program of these patients. Careful screening procedures, carried out to detect multifocal tumors at an early stage, should improve survival in these patients.

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This manuscript reviews and describe the burden of cervical cancer in world and India, epidemiology of HPV infection, screening methods, prevention, control strategy, types of HPV vaccines, schedule, age of administration, dose, route, anatomical site of human papillomavirus vaccination, cold chain, vaccine coverage and roll out plan in Delhi, India.

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Warfarin is an anticoagulant used in the prevention of thromboembolism. Common clinical indications for warfarin use are atrial fibrillation, artificial heart valves, deep venous thrombosis. Common side effect of warfarin is hemorrhage. Intra-peritoneal hemorrhage is one of the complications, usually following trauma. We report spontaneous intra-abdominal hemorrhage secondary to warfarin therapy. A 79 year-old male patient was admitted to emergency clinic with the complaints of one day duration of abdominal pain. There was no history of trauma. He had been on warfarin for the prophylaxis of atrial fibrillation.The diagnosis of the spontaneous intra-abdominal bleeding secondary to warfarin was made and the patient was admitted internal medicine inpatient clinic.This case provides a learning lesson to the physicians to consider this rare but significant complication of warfarin in the differential diagnosis of all the cases of abdominal pain in patients who are on warfarin therapy.

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Background: It has been proved by different research works that examination is a stress factor for students. Medical curriculum is as such stressful for students. Thus, in this study, researchers proposed to observe the changes in blood sugar level owing to examination stress in medical students. Materials and Methods: A general questionnaire was distributed among 1^st year MBBS students for selection of subjects. The questionnaire included demographic data, history of diseases, history of drug abuse, and family history of diseases. After the return of questionnaires, 49 1^st year MBBS students were selected for this study. Baseline data of heart rate (HR), blood pressure (BP), and fasting blood sugar (FBS) were observed 1 month before beginning of the first professional examination. Then, the second setting of the same data as baseline was observed on the day of practical and viva examination. Data analysis was done by paired t-test to find out the effect of examination on different parameters. P< 0.05 was considered to be significant. Results: Examination stress was responsible to raise HR, systolic and diastolic BP, and FBS from baseline significantly at P< 0.001. Conclusion: As shown in results, the effect of examination raises HR and BP from baseline, confirming that examination creates some stress on students. Thus, it was assumed that examination stress is responsible to raise blood sugar level that is essential to supply extra energy to vital organs.

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Background: Cigarettes and other tobacco products act 2003 (COTPA) is the principal law governing tobacco control in India. However, enforcement of the provisions under the law is still a matter of concern. The desired impact and level of enforcement of the COTPA legislation and the gutka and pan masala ban in Himachal Pradesh need assessment. Objective: The objective of this study was to assess the knowledge and attitudes about the ill effects of tobacco use and COTPA among the adult male population of Shimla City. Materials and Methods: This study was a cross-sectional community-based survey carried out in Boileauganj, Shimla. Data were collected using a structured schedule by interviewing 100 participants. Proportions, percentages were calculated, and the Fischer's exact test was applied for the categorical variables. Results: About 58% had heard of ban on smoking in public places and 53% knew that Himachal Pradesh has been declared as a no smoke state. Only 50% of the participants had heard of COTPA. Conclusion: These dismal findings suggest average knowledge levels of male adults about COTPA, which calls for a sensitization workshop and advocacy for all the stakeholders.

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Background: A fast and accurate diagnosis is necessary to control and eliminate tuberculosis (TB). There have been various studies evaluating the efficacy of polymerase chain reaction (PCR) testing in clinical practice. Most of these studies have found PCR as a useful tool to diagnose TB and more so for the extra-pulmonary cases. Aims and Objectives: The aim of the study was to evaluate the results of TB by real-time PCR versus the conventional methods of diagnosis in a tertiary care center in Punjab. Materials and Methods: This study was done in a tertiary care center of Punjab to look for the results of clinical samples tested for TB using PCR, Ziehl–Neelsen staining and culture on Lowenstein–Jensen medium. 16S rRNA gene was used for Mycobacterium tuberculosis detection in PCR. This study included all samples tested for TB from July 2015 to October 2015. Results: A total of 214 samples were tested for TB using smear microscopy, culture and PCR (including 194 [90.6%] extra-pulmonary and 20 [9.3%] pulmonary samples). These included 76 cerebrospinal fluid, 30 pleural fluid, 42 tissues, 17 ascitic fluid, 13 urine, 15 bronchoalveolar lavage (BAL), 16 pus, and 5 sputum samples. Smear microscopy was positive in a total of 4 samples out of 214 (1.8%), which included 2 sputum, 1 tissue, and 1 ascitic fluid samples, while culture was positive for 6 samples (2.8%) which included 2 sputum, 1 pus, 1 BAL, 1 tissue, and 1 ascitic fluid sample. The TB PCR results were positive in a total of 71 (33.1%) samples out of 214. In addition, three samples also tested positive for Mycobacteria other than TB. Conclusion: PCR is a very rapid and accurate diagnostic tool for early detection of TB in particularly for extrapulmonary TB.

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Aim: To alleviate the patient's symptoms and promote periapical healing in teeth with failure of root canal treatment, without the removal of previous obturating material using lesion sterilization and tissue repair (LSTR) 3 MIX-MP noninstrumentation endodontic treatment (NIET). Materials and Methods: Fifteen single-rooted teeth with a history of root canal treatment 1–2 years previously, requiring retreatment, with pain, sinus tract, swelling and periapical lesions, and having acceptable obturation were included in the study. The previous coronal restoration was removed, and a medication cavity was prepared for placement of 3MIX MP; this was followed by lining with Glass ionomer cement and a coronal restoration with composite resin. Results: At 8 weeks, all patients did not have either pain, tenderness on vertical percussion, pain on biting, or swelling (asymptomatic). Radiographically, the periapical lesions had reduced by 1 mm in five cases. In six patients, the lesion size remained unchanged. Conclusion: LSTR NIET is an excellent, inexpensive, less traumatic, and least time-consuming alternative to treat symptomatic teeth requiring endodontic retreatment.

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Aim: This study was done to determine the minimum inhibitory concentration (MIC) of imipenem for multidrug-resistant (MDR) clinical isolates and identify carbapenemase-producing organisms among these MDR isolates. Materials and Methods: The antibiotic susceptibility of clinical isolates was determined by Kirby–Bauer disc diffusion method. MDR isolates showing resistance or reduced susceptibility to carbapenems were further tested for MIC with imipenem and carbapenemase production by Modified Hodge test (MHT). Results: A total of 65 MDR isolates were tested, of which 46 (70.77%), 15 (23%), and 4 (6.15%) had MIC in resistant, sensitive, and intermediate range, respectively. MHT was positive for 37 (57%) isolates. The most common carbapenemase producers in order of frequency were Acinetobacter baumannii, Klebsiella pneumoniae, Enterobacter aerogenes, Escherichia coli, Pseudomonas spp. Conclusion: Phenotypic tests such as MHT are simple, cost-effective, and easy to perform and hence can be used in any microbiology laboratory to detect carbapenemase production and applied clinically to guide the antimicrobial therapy, especially in severe and life-threatening infections.

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Background: The risk of cardiovascular disorders is high among the Indian population; however, the awareness about it seems to be a concern. Aim: It was intended to study the feasibility of assessing the awareness of cardiovascular risk at a community level and providing the related information about remedial measures through a Health Passport approach. Methods: Consecutive 38 individuals attending health camp were assessed for specific personal and family history of obesity, hypertension, diabetes, and heart disease. Current risk factors such as exercise, smoking, drug use, stress, and depression were ascertained, and body mass index (BMI), waist circumference (WC), blood pressure were measured to assess the cardiovascular risk based on Framingham criteria. The individualized information along with some key health facts were provided to the participants in a document termed as Health Passport for their reference. Results: There was a general lack of awareness regarding the cardiovascular risk factors in the studied sample. Most participants were above the threshold for blood pressure (65.8%), BMI (71.1%), and WC (73.7%) requiring specific action and more than half (57.9%) had higher cardiovascular risk. The assessment completed in a community set up with basic facilities could provide information regarding the existing risks prompting health actions. The participants considered the Health Passport as a comprehensive initial step toward improving their awareness. Conclusion: It was feasible to assess the awareness about cardiovascular risk and provide individualized health-related information through the Health Passport approach which appears adaptable in health care setups and may improve the awareness.

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Adrenocorticotropic hormone (ACTH) producing pheochromocytoma is the rare cause of Cushing's syndrome (CS). Herein, we present a 53-year-old female patient with ectopic ACTH-dependent Cushing's syndrome due to pheochromocytoma. ACTH secreting pheochromocytoma is a rare but important source of ectopic ACTH secretion. Early diagnosis of pheochromocytoma with CS needs a high index of suspicion. The scenario provides clues for a detailed discussion about the pitfalls and diagnostic difficulties in establishing the underlying cause of ACTH-dependent CS. It demonstrates relative contributions of clinical, biochemical, and radiological clues in arriving at the correct underlying cause of CS.

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Amebiasis is a common cause of dysentery in India and can have an atypical fulminant course with negative serological tests in immunosuppressed individuals such as chronic kidney disease (CKD). We present a patient of CKD on dialysis who presented with features of dysentery with negative blood and serology workup. The diagnosis of amebic colitis was made after colonoscopy and histopathology which revealed amebic trophozoites and her symptoms abated after appropriate therapy. This case report illustrates the need for colonoscopy and histopathology for definite diagnosis of fulminant presentation of amebic colitis in an immunosuppressed individual such as CKD.

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