Introduction: Urinary tract infection (UTI) continues to be the most common infection diagnosed in outpatients as well as in hospitalized patients. Citrobacter spp. is an emerging urinary pathogen. The present study assessed the prevalence and antibiotic sensitivity pattern of Citrobacter spp. in patients admitted to or attending outpatient departments with Complain of UTI in a tertiary care hospital. Materials and Methods: A total of 36,250 urine samples were included in the study. UTI was confirmed in 7099 samples. Of these 246 (3.46%) had UTI due to Citrobacter spp. Identification was by conventional biochemical methods. Antimicrobial susceptibility testing was performed using Kirby-Bauer disc diffusion method as recommended by Clinical and Laboratory Standards Institute M2-A9. Multidrug-resistant (MDR) was defined as resistance to more than two groups of drugs. Extended spectrum beta-lactamase (ESBL), AmpC, and metallo beta-lactamase (MBL) were detected by phenotypic methods. Results: Females predominated in the study 193 (78.4%) with 53 (21.5%) males. Most of the isolates were in the age group 21-30 and 31-40. 49 (19.9%) patients were inpatients, and 197 (80.08%) were outpatients. Aminoglycosides had a better spectrum of antimicrobial sensitivity (70.2%) with 85.2% isolates sensitive to amikacin. Fluoroquinolones had a poor activity against Citrobacter (46% sensitive). Ureidopenicillins had poor efficacy (15.4%). Out of the 246 strains, 129 (52.4%) were MDR, 61 (24.7%) of which were ESBL producers and 65 (26.4%) were AmpC producers. Most of the ESBL producing strains were isolated from inpatients. No MBL were identified in this study. Conclusion: Citrobacter though not uncommon isolate is posing a problem due to its MDR character. Infection control practices should be observed strictly, and any type of unnecessary instrumentation should be avoided.

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Introduction: Adolescent girls belong to vital age group, not only because they are the entrant population to motherhood but also because they are threshold between childhood and motherhood. The girls should be educated about significance of menstruation and development of secondary sexual characteristics, selection of sanitary menstrual absorbent and its proper disposal. Aims and Objectives: The objectives of the present study were to assess the existing knowledge and practice regarding menstrual hygiene among adolescent girls and to determine the co-relation of knowledge and practice score among the adolescent girls. Materials and Methods: The study conducted was a descriptive cross sectional study done on 100 adolescent girls from class 9th to 12th of Govt. Girls School in Shimla, Himachal Pradesh (Convenience sampling). Prior to the commencement of the study, they were explained the purpose and nature of the study. Information on demographic variables which include age, class, type of family, education of mother, family income, age of menarche were collected from the participants. Results: The data on knowledge scores revealed that 29% had adequate knowledge about menstrual hygiene, 71% had inadequate knowledge about menstrual hygiene. The data revealed on practice scores revealed that 19%, 69%, 12% samples had poor, fair and good score of practices regarding menstrual hygiene respectively. Knowledge and practice scores of participants shows positive correlation between the two scores (*P < 0.001). Conclusion: Lack of information about menstrual hygiene can be attributed to various factors which need to be studied separately. The above findings reinforce the need to encourage safe and hygienic practices among the adolescent girls and bring them out of traditional beliefs, misconceptions and restrictions regarding menstruation. The investigators improved the general awareness about cause of menstruation and the organs involved. Use of sanitary napkins was promoted and various schemes regarding menstrual health were briefed to the students. Early awareness can prevent students from suffering from the various reproductive tract infections.

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Dermatoglyphics is a study of configurations of epidermal ridges on certain body parts, namely, palms, fingers, soles, and toes. The term is derived from ancient Greek: derma = skin, glyph = carving. Dermatoglyphic patterns begin to develop in the 10^th week of gestation and are complete by the 24^th week. Fingerprints of both hands are not the same and persist lifelong unless dermis is damaged. They are mainly under genetic control and can be used in the diagnosis of congenital malformations. Their uniqueness has led to the analyses of one's potential and preferences. During development, various creases develop on the brain and are reflected on fingerprints representing various regions of the brain and are commonly being used in dermatoglyphics mental intelligence test. Some parents have started analyzing their children' fingerprints in early age to understand their innate characters and learning potential in terms of personal, educational, or for preference in any other enterprise.

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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.

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Seasonal variation in stroke occurrence is well described. However, correlation between sudden cold water exposure and stroke is not documented in literature. We report two cases of ischemic stroke on sudden cold water exposure. Case 1: A 73-year-old male developed sudden left face, arm and leg weakness immediately after taking a dip in the holy waters of Amritsar Golden Temple, during peak winter. Case 2: A 48-year-old male developed right side weakness and fell in bathroom while taking bath in cold water at 6am. Studies show that both stroke and atrial fibrillation peak in winter. Pathophysiologically, sudden cold water exposure increases sympathetic tone, which is mediated by thermo-receptors, activated by the rapid fall in skin temperature. Superimposed on the hyper-dynamic circulatory situation during short-term cold water immersion, it induces a further increase in blood pressure. Cold water immersion or simply an exposure might increase the propensity for stroke, especially in high risk individuals.

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A middle-aged psychiatric woman was brought to the casualty by national health ambulance. The patient was a destitute and had psychiatric illness. Local examination revealed irreducible third-degree uterovaginal prolapse with necrotic ulcerated areas infested with maggots. The patient was managed conservatively with the removal of maggots with 100% turpentine oil, culture-sensitive antibiotics, and local antiseptics. With treatment, the prolapsed mass got free of maggots, the ulcerated areas healed, and prolapsed mass became reducible.

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Child and maternal nutritional and health status is a very much concerning issue of Bangladesh. To summarize the specific conditions of Bangladeshi child and maternal health and related issues. This is a descriptive review and overall analysis and description of the literature was done regarding child and maternal health of the general population living in Bangladesh. The evidence reflected that infant, child, and maternal mortality in Bangladesh have declined gradually at least over the past years. It is found that infant mortality 2 times, child mortality 6 times, and under five mortality rates 3 times declined comparatively than the last two decades but it is noted that maternal assassination circumstance has not declined. Knowledge on child and maternal health carries an important role in education. Health knowledge index significantly improve child and maternal health although differentially. It is obvious that poverty is one of the root causes that have led to a high child and maternal mortalities and morbidities faced by the people of Bangladesh. The requirement for socio economic relief for those living in rural Bangladesh remains one of the core issues. Recently, Bangladesh is successfully declining the total number of childhood and nutrition related mortalities despites various complexities, but maternal health status is not improving at the same pace. Nongovernment and government funded organizations and policymakers should come forward for running some effective programs to conquer the situation completely in Bangladesh.

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Tuberculosis (TB) is still among the most life-threatening infectious diseases, resulting in high mortality in adults. A significant proportion of patients (15-25%) exist in whom the active TB infection is manifested in an extrapulmonary site. Healthcare workers, including dentists, are at the frontline and can make an important contribution to the control of this infectious epidemic. Oral TB has been considered to account for 0.1-5% of all TB infections. Nowadays, oral manifestations of TB are re-appearing alongside many forgotten extrapulmonary infections as a consequence of the outbreak and emergence of drug-resistant TB and of the emergence of acquired immune-deficiency syndrome.

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Background: Interventions involving the middle meatus are commonly performed because the majority of the paranasal sinuses open into the osteomeatal complex. Therefore, the aim of the present study was to locate the level of maxillary sinus ostium (MSO), to measure the distances between MSO and different anatomical landmarks, to measure the different dimensions of maxillary sinus and to compare the morphology of maxillary sinus between the right and the left sides. Materials and Methods: The study involved 50 computed tomography (CT) images of normal paranasal sinus anatomy in coronal and sagittal planes from the Department of Radiodiagnosis. The location of the sinus ostium (upper, middle, or lower third) was observed. Perpendicular distance from the sinus ostium to the lower border of inferior turbinate and hard palate were measured. The maximum vertical, transverse, and antero-posterior diameters of the maxillary sinus were measured. Results: Of 50 CT images, the MSO was located in the upper third in 40 cases while in 10 it was located in the middle third. The most common location of MSO was in the upper third. The dimensions of the maxillary sinus indicated bilateral symmetry. Conclusion: The dimensions of the maxillary sinus indicated bilateral symmetry, and there were no significant gender differences when compared. However, the distances of the MSO from the major anatomical landmarks were significantly different between males and females which are seldom reported earlier. This knowledge about the variations in the lateral wall of the nasal cavity is crucial during the endoscopic interventions and for functional endoscopic sinus surgeries.

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Hepatorenal syndrome (HRS) is a form of kidney function impairment that characteristically occurs in patients with cirrhosis. The diagnostic criteria for this syndrome have been revised throughout the years, with recent revisions aimed at improving earlier diagnosis and treatment. HRS definition has been updated recently by the International Club of Ascites in accordance with Kidney Disease Improving Global Outcomes acute kidney injury (AKI) classification. Recent changes in terminology have led to acute or Type I HRS being referred to as AKI-HRS and chronic or Type II HRS as chronic kidney disease (CKD)-HRS. The contribution of systemic inflammation, a key feature of cirrhosis, in the development of HRS has been highlighted in recent years. The current standard of care for the management of HRS involves the use of vasoconstrictor therapy and volume expansion with albumin. All patients do not respond to treatment, and even in those who respond, early mortality rates are very high in the absence of liver transplantation (LT). LT is the only curative treatment of HRS.

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Background: The objective of this study was to assess the student's perceptions/observation of team-based learning (TBL) in a 2^nd year MBBS Pharmacology teaching using the TBL Student Assessment Instrument (TBL-SAI). Methodology: The TBL strategy was administered to 100, 2^nd year MBBS Pharmacology students with the help of TBL-SAI surveys. The survey includes 33 items, each rated from one (strongly disagree) to five (strongly agree) and measures three subscales: students' perception/observation of accountability, liking for lecture or TBL, and student satisfaction. Results: Total TBL-SAI score for each component fell above the neutral point score. About 77.9% of the students have felt accountable to participate in the learning. Majority (89.5%) showed a preference for TBL comparable to lecture instruction. In addition, 85.6% of the students were satisfied with the course. Conclusion: The TBL design has been effectively implemented in learning of analgesics and antiulcer drugs in pharmacology with the key objectives of encouraging and perceiving student accountability, satisfaction, TBL versus lecture and student engagement. TBL enhances the student teacher interact and is helpful to students who learn in group activities and is a feasible active-learning academic strategy for large student-faculty ratio. This could be effortlessly tailored for other topics, courses, and programs.

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A community refers to a group of people who share the same stakes and concerns, the members of which knows and interact with each other. The process of diagnosing the health, health-related problems and their determinants, in a community is called community diagnosis, whose ultimate aim is to identify where the community is now?, where does it want to be?, and how it will get there? The principles of community diagnosis have been tried and found of extreme utility in developing countries where multiple health problems are prevalent, but only scarce resources are available. To conclude, the process of community diagnosis enables developing countries in reaching a consensus about the priority health problems in their individual communities and in developing strategies to address the identified issues.

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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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Context: A quality patient diagnosis and clinical management are largely depending upon the availability of reliable medical diagnostic equipment. However, in Indian scenario, the lack of preventive maintenance, nonavailability of technology and spare parts, and nonavailability of required funds for maintenance are mainly responsible for the failure of equipment maintenance, and hence, their proper utilization. Aims: This study was focused to find out the deficiency in the utilization coefficient (UC) of medical diagnostic equipment and the various factors causing the under-utilization of these equipment. Materials and Methods: This study was conducted in a tertiary health care setup at Chandigarh. Approximately, 30 medical diagnostic equipment were studied for their UC and simultaneously a perception based analysis was conducted, where the faculty and staff members concerned with the administrative matters and use of that particular medical diagnostic equipment were concerned. Factors such as low accessibility, obsolescence, break-down, affordability, availability of trained manpower, nonavailability of consumables and spares, maintenance delays, limited working hours, and restricted availability were taken into account. Results: On an average, 23% of these medical diagnostic equipment were not adequately utilized due to one reason or the other. Conclusions: It was concluded that the most crucial factors affecting the utilization of medical diagnostic equipment as per the perception of the respondents were obsolescence, nonavailability of spares, and maintenance delays.

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Context: Diagnostic services have a very important role to play in medical decision-making, which have an impact on the nation's health status. The understanding of Indian diagnostic services provisioning has certain literature gaps. Aims: This study focused on understanding the functioning of provision of diagnostic services by Indian diagnostic laboratories. Materials and Methods: Exploratory field visits and literature review were used as tools to understand the Indian health system. Results: Indian diagnostic laboratory can be classified into various categories based on the type of services provided and governance. The difference in their financing, resources, quality assurance of services and patient access to services was found in these different laboratories. Conclusions: It was concluded from the study that patient's access to laboratory services is affected by the functioning of laboratories in terms of governance, financing, resources, quality assurance of services and patient services.

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Background: Abnormal uterine bleeding (AUB) is a common gynecological complaint associated with considerable morbidity and significantly affects the patient's family, personal and social life. The aim of the study was to analyze the histomorphological patterns of endometrium in patients presenting with AUB and also to determine the incidence of AUB in various age groups. Materials and Methods: This is a prospective study, conducted in the Department of Pathology, in a tertiary care teaching hospital, Mangalore from October 2011 till date. All cases of AUB with a probable endometrial cause were included in the study. Data was entered in Microsoft Excel and managed in Statistical Package for the Social Sciences (SPSS) version 16. Analysis was done in the form of percentages and proportions and represented as tables where necessary. Results: A total of 156 cases were analyzed. Patients' age ranged from 23-78 years. AUB was most prevalent in the perimenopausal age group. The most common presenting complaint was menorrhagia (47%). Endometrial hyperplasia was the most common histopathological finding and was seen in 25% patients, followed by secretory endometrium in 16.7% patients, and proliferative phase pattern and disordered proliferative endometrium were seen in 12.2% patients each. Malignancy was detected in 6.4% of cases and endometrial carcinoma was the most common lesion (4.5%). Conclusions: Histopathological evaluation of endometrial samples is especially indicated in women over the age of 35 years to rule out malignancy and preneoplasia. Among the patients with no organic pathology, normal physiological patterns with proliferative, secretory, and menstrual changes were observed. The most common endometrial pathology in this series was endometrial hyperplasia.

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Sertoli cell-only syndrome (SCOS) is not an uncommon finding in testicular biopsies that are performed in patients with infertility. The salient histopathologic feature of SCOS is the absence of germ cells. Many of these patients have a normal karyotype and normal secondary male sexual characteristics, yet are infertile and azoospermic or severe oligozoospermic. This case report describes a 29-year-old male patient who presented with primary infertility, normal physical characteristics and hormonal profile with SCOS detected on testicular biopsy.

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Aims and Objectives: 1 To study the prevalence of hypertension in Type-2 diabetic patients. 2 To study the association with hypertension and diabetic complications. Materials and Methods: A total of 250 diabetic patients coming to Vijayanagara Institute of Medical Sciences Hospital and College, Bellary were studied and evaluated for blood pressure (BP), and macrovascular and microvascular complication. Study Design: A cross-sectional study. Sample Size: 250. Inclusion Criteria: All Type-2 diabetic patients who are on treatment for diabetes. Exclusion Criteria: a. Newly diagnosed diabetes, b. Seriously ill patients, c. Refused to be a part of the study, d. Pregnancy, e. Type-1 diabetes mellitus. Results and Conclusion: Prevalence of hypertension noted in 64 (25.6%) patients. BP was normal in 55 (22%), 131 (52.4%) patients were prehypertensive, 45 (18%) patients were in stage-1 hypertension, and 19 (7.6%) had stage-2 hypertension. Macrovascular complications noted in 120 (48%) and microvascular complications noted in 60 (24%) patients.

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Self-injurious behavior (SIB) can be defined as the destruction or damage of body tissue without suicidal intent. Oral and perioral structures can be traumatized by SIB which involves biting of lips, cheek, lateral surface of the tongue, or buccal mucosa. Depending on its frequency and severity, SIB can lead to various degrees of self-injury. We hereby present a case of patient having lip lesion with positive history of lip chewing.

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Nonnutritive sweeteners (NNSs) are the substances having an intense sweet taste with no or very low calories and are used as substitutes for simple sugars for reduction of energy intake. The consumption of NNSs is increasing at an alarming rate because of the ever evolving pandemic of obesity and Type 2 diabetes mellitus. NNSs have various positive and negative metabolic consequences on the health of the consumers. There are misconceptions and myths regarding the use of NNSs for which various professional bodies have issued guidelines. However, the overall long-term effects of the NNSs are still an area of debate and discussion.

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Deltamethrin intoxication is uncommon throughout the globe and more so the oral ingestion. The toxicity of pyrethroids is considered much less than the intoxication caused by other insecticides, especially organophosphates. This report describes a case of a 14-year-old female child who was admitted to the emergency room (ER) with dyspnea, cyanosis, tetany, seizures and coma following deltamethrin ingestion in a suicidal attempt. Deltamethrin ingestion should be considered as a differential diagnosis in patients presenting to ER with nonspecific neurological symptoms.

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Aim: The study was to determine the normal fetal lateral ventricular diameter using ultrasound at different gestational ages (GAs). Materials and Methods: This is a prospective cross-sectional descriptive study of the fetal cerebral lateral ventricular diameter of 685 singleton fetuses. Measurement of the fetal lateral ventricular diameter was obtained from fetuses of pregnant mothers that met the inclusion criteria during the routine ultrasound scan in Calabar metropolis. A sufficient ultrasound gel was applied on the abdomen of the subject and scanning was done at different planes until a good ovoid shape of the fetal skull was achieved. Axial images at the level of the lateral ventricles were obtained. The widest part of the posterior lateral ventricle far from the transducer was measured more than once and the average value computed for each subject. Results: About 85.4% of the patients were multiparous while 14.6 were primipara. The ages of the pregnant mothers ranged from 20 to 35 years with a mean age of 28 ± 3 years. The male fetuses were 311 while the female was 374. The lateral ventricular diameter did not show any significant correlation with fetal characteristics such as gender, estimated fetal weight, and fetal head circumference throughout gestation. However, the fetal ventricular diameter had a weak but not statistically significant correlation with GA of the fetus (r, P = 0.13, 0.06). Conclusion: Our studies show that 10 mm is the acceptable upper limits of normal for fetal lateral ventricular diameter (FLVD) of fetuses in Southern Nigeria. Ventricular diameter out of this normal range in this region could be considered abnormal and may demand further investigations.

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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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