Background: Irrational usage of antibiotics increases the risk for the antimicrobial resistance, leads to increase morbidity, mortality, and economic burden for health care. India is a lower-middle income developing country in south Asia that has high potential for overuse and misuse of antibiotics and has less public awareness of antimicrobial resistance. The World Health Organization (WHO) developed the prescribing indicators to measure the rational usage of drugs in primary care and to assess the prescribing pattern of antibiotics. Aim: The aim of the study was to assess the prescribing pattern of antibiotics in pediatric patients of Anantapur district, Andhra Pradesh, India. Subjects and Methods: A cross-sectional and prospective study was carried out in private pediatric specialty hospitals in urban areas of Anantapur district. Sample size was calculated using single population proportion formula. A total number of 845 pediatric in-patients were included for the study. Patients' demographic characters, diagnosis, and drugs prescribed were recorded in a prestructured and validated data collection form. Results: An average of 3.53 drugs prescribed per patient encounter, which was higher than WHO prescribed indicator standard value 2. The present study reveals that the percentage of encounters with antibiotics was 50.05% (423), which was higher than WHO standard (20.0-26.8%). Among 423 antibiotic prescriptions, 23.43% (198) prescribed with generic names and 91.48% antibiotics were prescribed from essential drug formulary list. Conclusion: Prescription patterns and usage of antibiotics in this study was inappropriate in comparing our results with WHO prescribing indicators. Effective interventions are required to reduce inappropriate antibiotic prescriptions.

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Introduction: The middle of the 20^th century has often been described as a golden age of scientific advancement and miraculous medical breakthroughs. In spite of a lot of awareness and many health education programs, still some traditional treatment exists in many places in our country including Central India. In some villages of Madhya Pradesh, many horrifying therapies such as iron rods branding are well known for a few common diseases such as ascites, headache, pneumonia, common cold, or hernia. Bruise marks can be seen on the bodies of a majority of villagers. Main reasons behind such therapy are lack of money for medical treatment, lack of medical facilities, and the unwillingness of medical officers to stay in small villages. Besides this, illiteracy compels them to follow old customs and practices. All these strengthen the faith of villagers in such treatments. It is all due to lack of education and proper awareness. Many female patients come to hospital with complications of iron rods branding suggest that despite being educated, strong cultural beliefs forces people to undergo branding as a treatment of many common diseases in India even in the 21^st century. Aims and Objectives: To study the reasons and complications of hot iron branding. Materials and Methods: Sample size was 30. Thirty patients with old, healed (within 1 year), or recent scars of iron branding were included in the study. Patients were evaluated for the sociodemographic details and the information of underlying disease, pattern of lesions, and complications of branding. Results: Hot iron branding is still carrying on as traditional treatment in Central India. It is commonly seen in females of age 20–50 years. It is mostly found in illiterate patients of low socioeconomic status who have chronic disease and chronic pain. Conclusion: Skin branding which still has therapeutic uses in some cultural societies have severe medical complications in Central India.

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Holoprosencephaly is a complex developmental abnormality of the brain arising from the failure of cleavage of the prosencephalon. The condition termed “holoprosencephaly” includes cyclopia, cebocephaly, ethmocephaly, and median cleft. We present two cases of antenatally diagnosed alobar holoprosencephaly with multiple associations, which were confirmed after termination of pregnancy. One of them had a proboscis and a single midline eye. The other had multiple facial abnormalities such as hypotelorism, median cleft lip and palate, and preauricular skin tag.

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Since ages, human beings suffer from the dental problems. With the journey as time elapsed the person treating the teeth changed (i.e., from barbers and monks to present dentists), equipment changed (i.e., from bow drills to airotor and laser handpieces), materials changed (i.e., from ground mastic alum/honey to tooth colored composite and ceramics). There has been drastic change in treatment planning from extraction to the conservation of teeth and from manual restoration to computerized restorations computer-aided design/computer-aided manufacturing. Thus, this review is an attempt to have an insight into major milestones of the dental timeline.

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Context: Aging, in forensic context, is necessary both for the dead and the living. Kvaal et al. introduced a method of age estimation by indirectly measuring secondary dentin deposition on radiographs. Cameriere et al., later, put forth a method based on radiographic estimation of pulp/tooth area ratio (AR) in specific teeth of the dentition. Aim: The purpose of the present study was to assess the validity of Kvaal's and Cameriere's methods of age estimation in a specific populace of Marathwada origin. Materials and Methods: A total number of 110 patients aged between 15 and 75 years were selected and the variables P = complete pulp length/root length (from enamel-cementum junction [ECJ]-root apex), r = complete pulp length/complete tooth length, a = complete pulp length/root width at ECJ level, b = pulp/root width at midpoint level between ECJ level and mid-root level, and c = pulp/root width at mid-root level; and pulp/tooth AR were recorded as devised in Kvaal's and Cameriere's methods of age estimation, respectively. Statistical Analysis: Statistical analysis was performed with SPSS (version 10.5) package. Mean comparison of morphological variables was carried out using Student's t-test. Intra- and inter-observer reproducibility of measurements was studied using the concordance correlation coefficient. Results: Of all the morphological variables, variables P, r, mean (M), length (L), and pulp/tooth AR of Kvaal's and Cameriere's methods correlated significantly with age with variable P correlating the best among them. Conclusion: Variables associated with width ratios rather than length ratios of Kvaal's and Cameriere's methods correlated best with chronological age in the populace of Marathwada origin.

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Background: Hemophilia center, treatment center (TC), hemophilia TC (HTC), and Hemophilia Comprehensive Care Center (CCC) are terminologies used to describe centers caring for persons with hemophilia (PWH). These are based on their capability to provide multidisciplinary care and laboratory services. Widely described are the European HTCs (EHTCs) and the European Hemophilia CCCs (EHCCCs). However, most centers in developing countries providing care for PWH have variable clinical expertise and laboratory facilities, which do not qualify for the existing models. Materials and Methods: This cross-sectional study was done to evaluate the laboratory and clinical care facilities available in HTCs in India. The survey questionnaire was sent to 62 HTCs in India. Laboratory and clinical care facilities were categorized based on a predefined stratification model. Level IV being the minimum and Level I the maximum were used to define clinical and laboratory facilities. Results: Fifty-two (85%) centers responded representing 17 states in India. Only 28 HTCs had attached laboratory services. Although all the centers cared for acute bleeds, only half managed chronic joint disease (Level III) while one-sixth could perform surgeries (Level II). Only one-third of the laboratories had instituted quality control measures and performed factor assays. Only four centers qualified for EHTC criteria and two for the EHCCC criteria. Conclusion: This HTC stratification model provides assessment and differentiation of the clinical and laboratory services. It allows an individual HTC to identify the standard of care and provides a framework for objectively planning, implementing, and evaluating its services.

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Primary tuberculosis (TB) of the skull is a very rare entity scantily described in literature with 0.2%–1.3% of cases. The different radiological forms of calvarial TB described are - circumscribed lesions of the sclerotic and lytic type and diffuse TB of the cranium. Treatment for skull TB includes antituberculous therapy along with appropriate surgical intervention. Here, we present a case of calvarial TB presenting as multiple osteolytic soft tissue lesions.

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Apexification is a treatment protocol well recognized and accepted by clinicians worldwide for the management of an immature tooth with necrotic pulp. With the advent of newer biomimetic and bioactive materials in the market, these treatment protocols have succeeded in achieving more predictable, successful treatment outcomes. The case report details the successful treatment of a 33-year-old male patient with nonvital maxillary central incisor that had open apex, with biodentine for apexification procedure, and 1-year follow-up exhibiting progressive involution of periapical radiolucency and satisfactory healing of the periapical tissues.

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Introduction: The aim of this study is to evaluate short-term and long-term outcomes of minimally invasive therapy in Type IV hiatal hernia (upside-down stomach). Patients and Methods: A retrospective study of 58 consecutively operated patients with Type IV hiatal hernia between 1998 and 2015 was conducted. Short-term outcome was evaluated using Clavien-Dindo classification and long-term outcomes using phone survey and subjective assessment of patients at least 1 year following surgery. Results: Laparoscopic hiatoplasty was performed in all patients, with gastropexy in 55.2%, fundoplication in 39.6%, and combination of fundoplication and gastropexy in 5.2%. Complications were observed in 6.9%. Two early reoperations (within 30 days) due to acute reherniation were necessary. Adverse events occurred in seven cases – pleural opening and peroperative bleeding. Three patients were reoperated laparoscopically 2–17 months after the first surgery due to receiving partial stomach herniation. In 67.2% of patients, long-term subjective quality of life assessment was available. Eighty percent of them were completely satisfied, without recurrence of preoperative symptoms. Conclusion: Elective laparoscopic surgery of hiatal hernia Type IV is a safe procedure, which has all the benefits of minimally invasive therapy with favorable short- and long-term results.

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Failure to root canal treatment can be attributed to inadequate treatment. Although highest standards are followed, still failure is inevitable. In most of the cases, the endodontic failure results from persistent or secondary intraradicular infection. Extraradicular infections may also be implicated in the failure of some cases. Paraendodontic surgery is warranted in periapical diseases treatment, when traditional endodontic therapy does not obtain satisfactory outcomes. The objective of this case report is to report a clinical case where an apicoectomy was indicated due to failure in conventional endodontic treatment followed by unconventional bone grafting using calcium sulfate.

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Aims: The aim of the present study was to characterize the E. coli isolates from surgical wounds, traumatic wounds, and from foot ulcers on the basis of virulence and drug resistance. Subjects and Methods: A total of forty E. coli strains isolated from wound infections were studied. Phylogenetic background, virulence factors (VFs), and antibiotic resistance profiles were determined by phenotypic and genotypic methods. Correlation between phylogenetic groups, VFs, and drug resistance pattern were analyzed. Results: Analysis of virulence gene possession among the isolates indicated that a maximum number were carrying the fimH (39 strains; 97.5%) gene, followed by iutA (27; 67.5%), papC (16; 4%), hlyA (5; 12.5%), cnf1 ( 5; 12.5%), and neuC (1; 2.5%), respectively. The phylogroups B2 (32.5%) and D (42.5%) were more common. Thirty isolates (75%) were found to be positive for extended-spectrum β-lactamase genes. CIT type of plasmid-mediated AmpC was seen only in 6 (15%) isolates. Most effective antibiotics were carbapenem and sulfamethoxazole-trimethoprim groups of drugs. Conclusions: Our findings indicate that adherence factors and iron uptake systems are two of the more important CFs expressed by such isolates, and such strains are also observed to exhibit a higher degree of drug resistance. Carbapenems and co-trimoxazole may be considered as reliable and successful alternative medications for these isolates.

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We present magnetic resonance imaging (MRI) brain picture of a 10-month-old child suffering from thalassemia major. The picture had changes that mimicked leukodystrophy. However, on taking detailed clinical history, the MRI picture fitted well into the chronic hemolytic anemia pathology, and the changes could be explained and corroborated with studies in the literature.

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Association of emphysematous pyelonephritis (EPN) with horseshoe kidney is rare. It is a life-threatening condition with variable mortality. Historically, the treatment consisted of early nephrectomy. One such patient managed conservatively by placement of percutaneous drainage (PCD) and appropriate antibiotic coverage, is reported. This patient responded well to the conservative approach of treatment by insertion of PCD under computed tomography guidance. Hence, insertion of PCDs is an effective way of treating EPN.

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