Background: Awareness of glaucoma is low in spite of being the second leading cause of preventable blindness in the world. Aim: To study the awareness and knowledge levels of glaucoma in a tertiary eye care hospital in a tier-2 city. Materials and Methods: This is a hospital-based crosssectional study. A total of 704 patients attending ophthalmology outpatient department of Sri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital (SDM) Dharwad, aged 40 years and above were administered a questionnaire after a written informed consent to assess their awareness and knowledge levels of glaucoma. Subjects "having heard of glaucoma" even before they were recruited for the study were defined as "aware", and subjects having some understanding of the eye disease were defined as "knowledgeable". Results: Out of 704 subjects recruited for the study, only 34 (4.8%) subjects were aware of glaucoma and 22 (3.1%) had some knowledge of glaucoma. Determinants of glaucoma awareness were higher levels of education, diabetes, or glaucoma and family history of glaucoma. Conclusion: Awareness and knowledge of glaucoma was very low among the subjects. The findings of the study stress the need for health awareness for effective prevention of blindness due to glaucoma.

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Background: Adolescence is a period of transition between childhood and adulthood. Nutritional requirements during this period increase tremendously compared to preceding years of growth. The nutritional status of adolescent girls, the future mothers, contributes significantly to the nutritional status of the community. The present study was aimed to assess the current nutritional status of the adolescent girls. Materials and Methods: This one-year community-based, cross-sectional study was undertaken at a village Peeranwadi of District Belgaum, Karnataka among 400 adolescent girls of 10 to 19 years. Information on socio-demographic variables was collected by an interview using pre-designed and pre-tested questionnaire. A 24-hour recall method was used to assess nutrient intake. The nutrient intake was calculated using tables of nutritive value of Indian foods. For the comparison of anthropometric data, National Center for Health Statistics and National Health and Nutrition Examination Survey standards were used. Results: The mean age among the study population was 12.9 ± 2.06 years. Majorities (73.5%) of them were Hindus, 98.5% were literate, and 90% were currently studying. Adolescent girls between 10 and 14 years were more stunted (63.82%) as compared to 15 to 19 years (40.84%) (P = 0.0003) and thin (60.79% vs. 39.43%; P = 0.0009). Overall, the mean calorie intake was observed to be 1272.20 ± 133.28 kcal/day, protein intake was 40.99 ± 3.32 gm, and iron intake was 14.42 ± 2.58 mg. Conclusion: Overall, majority of girls were having dietary intake less than 50% of RDA, and almost three fourth of girls were anemic.

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Context: Nephrectomy is a common procedure in surgical practice. It is indicated in patients presenting with a wide range of clinical conditions ranging from symptomatic chronic infections, obstruction, calculus disease, and severe traumatic injury to renal cell carcinomas. It is performed increasingly in the context of end-stage renal disease and to treat renovascular hypertension from non-correctable renal artery disease, or for severe unilateral parenchymal damage resulting from nephrosclerosis, pyelonephritis, vesicoureteric reflux, and congenital dysplasia. Objective: This study aimed to assess the patterns and morphology of lesions in nephrectomy specimens in a tertiary care hospital, observe variations if any from the conventional pattern, and clinico-morphological correlation for proper postoperative management. Materials and Methods: A hospital-based five-year study included all nephrectomy specimens received in the department over a period of five years (November 1, 2005 to October 31, 2010). Results: A total of 140 cases over a period of five years were studied. A wide range of lesions were found on histopathological examination. The histopathological analysis correlated well with the clinical diagnosis; however, few benign lesions like xanthogranulomatous pyelonephritis may be misdiagnosed clinically as malignant. Similarly, cases of cystic diseases of kidney, renal sarcomas, renal squamous cell carcinomas, and angiomyolipomas were confirmed on histopathological analysis only. Conclusions: The present study provides a fair insight into the histological patterns of lesions in nephrectomy specimens at our institution. In conclusion, a wide range of lesions are encountered on histopathology of nephrectomy specimens, many of which may be misdiagnosed clinically and radiologically; therefore, it is mandatory that every nephrectomy specimen be subjected to detailed histopathological examination for a clinico-morphological correlation to ensure proper management.

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Background: Resistance to broad-spectrum beta-lactams, mediated by extended-spectrum beta-lactamases (ESBL), AmpC beta-lactamase, and metallo-beta-lactamase (MBL) enzymes, is an increasing problem worldwide. Aim of the study: This study was undertaken to detect ESBL, AmpC beta-lactamase and metallo-beta-lactamase producing Pseudomonas aeruginosa and Acinetobacter species from the endotracheal aspirates. Materials and Methods: A prospective study was performed over a period of 15 month in a tertiary care hospital. A total of 26 clinical isolates of P.aeruginosa and 40 of Acinetobacter species were tested for the presence of ESBL, AmpC beta-lactamase, and metallo-beta-lactamase enzyme. Detection of ESBL was done by the combined disk diffusion method as per Clinical and Laboratory Standards Institute (CLSI) guidelines, and MBL was detected by imipenem-Ethylenediaminetetraacetic acid (EDTA) combined disk method. Isolates showing reduced susceptibility to cefoxitin (30 μg) disk were considered 'screen positive' for AmpC beta-lactamases and selected for detection of plasmid-mediated AmpC by the AmpC disk test. Results : 42.30% isolates of P.aeruginosa were positive for ESBL while 53.85% were MBL producers. Among 39 isolates of Acinetobacter baumannii, 43.59% were AmpC producers while 48.72% were MBL-producing strains. Conclusion: The study emphasizes the high prevalence of multidrug-resistant P.aeruginosa and A.baumannii producing beta-lactamase enzymes of diverse mechanisms. Thus, proper antibiotic policy and measures to restrict the indiscriminative use of cephalosporins and carbapenems should be taken to minimize the emergence of this multiple beta-lactamase-producing pathogens.

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This article provides an insight towards diagnosing and managing thalassemias. It begins by describing the structure of normal hemoglobin and elaborates on our understanding of the pathophysiology of thalassemia. An overview of transfusion therapy and its complications including endocrinopathies and cardiomyopathy has also been discussed.

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Background: Aerobic non-fermenting Gram-negative bacilli (NFGNB) once considered as contaminants now associated with life-threatening infections and emerging as multi drug resistant nosocomial pathogens. Aim: Isolation and identification of NFGNB in all the clinical samples and to determine antibiotic susceptibility pattern of the isolated NFGNB. Materials and Methods: This study has been conducted in the Department of Microbiology at a tertiary care teaching hospital over a period of 2 months from September to October 2013. NFGNB were isolated and identified from clinical specimens by standard procedure and antibiotic sensitivity test was performed. Results: NFGNB isolation rate in the present study was 3.58%. Male to female ratio was 2.125. Pus was the most common specimen (21%) followed by tracheal aspirate (17%). Pseudomonas aeruginosa was the most common isolate (60%) followed by Acinetobacter baumannii (22%) and Acinetobacter lwoffii (12%). P. aeruginosa has shown good sensitivity to amikacin (83.3%), imipenem (80%) and piperacillin-tazobactam (73.3%) whereas A. baumannii showed multidrug resistance. Conclusion: It is necessary to identify NFGNB and to monitor their susceptibility pattern to guide the clinician for better care and management of patients. NFGNB are now emerging as organisms of nosocomial infections. Hence, antibiotic sensitivity testing and infection control measures are needed to prevent the emergence and spread of multi drug resistant NFGNB in health care settings.

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Background: Effective keloid management is still a distant dream in spite of many recent modalities being tried for the same. Although many treatment protocols have shown efficacy of varying degrees, there are few systematic randomized trials comparing them. Objective: To compare the efficacy of intralesional 5-Fluorouracil versus Triamcinolone acetonide in the treatment of Keloids. Materials and Methods: This randomized controlled trial was conducted on 30 patients with keloids, randomly divided into two groups of 15 each, treated with intralesional 5-fluorouracil (Group A) or triamcinolone acetonide (Group B). The groups were compared for reduction in the size of keloid, pain relief, and the incidence of adverse effects. Statistical analysis was done using the unpaired student t- test and test of proportion. Results: The reduction in the size of the keloid was found to be significantly better in Group B (71.23%) than in Group A (57.48%) with a P value of 0.04. The difference in the reduction of pain, as assessed by the visual analog scale, between Groups A (18%) and B (24%), was found to be insignificant (P value - 0.47). Although the incidence of complications in Group A was three times higher than those in Group B, the difference was not statistically significant (P value - 0.13). Conclusion: Reduction in the size of the keloid, which was the main aim of this study was significantly better in those treated with triamcinolone acetonide than those treated with 5-fluorouracil. The other parameters like reduction of pain and the incidence of adverse effects were comparable in both the groups.

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Teratoma is a neoplasm with tissue components derived from more than one germ layer - ectoderm, mesoderm, and endoderm. They are commonly found in ovaries, testes, retroperitoneum, and sacrococcygeal region. Mediastinal teratomas are relatively rare comprising of only 8-13% of all tumors in mediastinum and only 1-10% of germ cell tumors occurring in mediastinum. We are presenting a case of a 1-year-old male who came with a history of on and off fever and frequent cough and cold since 3-4 months. On x-ray chest, differential diagnosis of congenital diaphragmatic hernia and left pleural effusion were given and computed tomography (CT) scan of abdomen and chest were advised, which revealed symptoms of mediastinal germ cell tumor. Final diagnosis of mature teratoma was given on histopathology. The case is being presented here because mediastinum is a rare site for teratoma and children are less commonly affected.

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Masturbation (gratification behavior) is rarely seen in young children. It occurs in children between the age of 3 months and 3 years with a second peak incidence at about the adolescent age. A 26-month-old child presented to us with gratification behavior. On evaluation, she did not have any physical illness mimicking gratification behavior. The parents were counseled, and 6 sessions of behavior therapy were carried out. Gratification behavior in young children is not pathological. Waxing and waning of the symptoms may be present.

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Introduction: The stone disease in children shows wide geographic variations, and its incidence has increased worldwide in children of all ages. Percutaneous nephrolithotomy (PCNL) has gradually emerged as one of the standard treatment options for the management of renal stones >1.5 cm in pediatric cases. PCNL just like in adults has been performed in the prone position. Of late observing the successful use of supine position for PCNL in adults, pediatric urologists have been encouraged to use the supine access for PCNL in children. We report our early experience with supine PCNL in children. Materials and Methods: All children with symptomatic renal stones presenting to the pediatric urological services of our hospital were prospectively included into the study to undergo supine PCNL. Children with skeletal anomalies, bleeding diathesis, and active urinary tract infection were excluded from the study. Results: Ten children (six males and four females) with a mean age of 11.48 ± 2.08 years (9–18 years) underwent supine PCNL. The mean size of the stone was 22 mm (range 17–47 mm). The initial stone-free rate was 90% immediately after a single PCNL session. One child needed an additional extracorporeal shockwave lithotripsy session to clear a 7-mm fragment. The average operative time (from the beginning of the puncture trial to nephrostomy tube insertion) was 70 ± 5 min. Conclusions: Supine PCNL in children is feasible, safe, and an effective means for management of renal stones in the pediatric population.

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Introduction and Objectives: The brachial plexus is highly variable, in its formation and branching pattern thus, knowledge of its anatomical patterns, may be insufficient for the surgeon operating on or around these nerves or for the regional anesthesiologist working in this area. Therefore, the present study was an attempt to study further about variations of brachial plexus encountered during routine dissection classes. Materials and Methods: The present descriptive study was carried out by dissection of 60 upper limbs of 30 cadavers, in the age group of 18 to 85 years, obtained during a study period of 2 years from the Department of Anatomy. The plexus was studied in its entire course commencing from the formation in cervical region, course through root of the neck and axilla, up to the main terminal branches of the upper extremity. During the dissection, variations of brachial plexus pertaining to its formation from the roots, trunks, divisions and cords and the branching pattern were observed and data was collected. Results: Out of the 60 cadaveric upper limbs studied for the anatomical variations of the brachial plexus, 2 limbs (3.33%) were pre-fixed plexuses. Fusion of adjacent trunks was detected in 2 limbs (3.33%). Variations in branches of lateral cord were detected in 8 limbs (13.33%). Among Posterior cord variations 2-thoracodorsal nerves were detected in 2 limbs (3.33%). All the other branches from brachial plexus had been found to have no anatomical variations. Conclusion: In the present study, an attempt has been made to know the possible variations of the brachial plexus. Though the variations mentioned may not alter the normal functioning of the limb of the individual, but knowledge of the variations is of prime importance to be kept in mind, during anaesthetic and surgical procedures.

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Objectives: The present study was undertaken to assess the antibiotic susceptibility patterns of Pseudomonas aeruginosa isolated from healthcare associated infections at a tertiary care hospital. Due to significant changes in microbial genetic ecology, as a result of indiscriminate use of anti-microbials, the spread of anti-microbial resistance is now a global problem. Materials and Methods: A total of 290 Pseudomonas aeruginosa isolates from various clinical samples like urinary catheters, tips of endotracheal tube, and central venous catheter were tested for antibiotic sensitivity pattern using disk diffusion method as per Clinical and Laboratory Standards Institute guidelines. Results: The highest number of Pseudomonas infections was found in urinary catheters, followed by endotracheal tips and central venous catheters. Maximum resistance was seen to cefotaxime and gentamycin (40%) followed by ciprofloxacin (39%), amikacin (26%), cefoperazone- sulbactum (22%), piperacillin-tazobactum (16%), and imipenem (14%). Conclusion: Over all we have observed that there is increased antibiotic resistance which may be due to the selective pressure from the use of anti-microbial agents is a major determinant for the emergence of resistance strains. Antimicrobial surveillance should be done periodically to monitor the current susceptibility patterns in local hospitals.

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Calcium sulfate has multifaceted properties and has versatile use in the field of periodontal practice. Calcium sulfate can function as a resorbable space filler, a resorbable barrier (compatible with guided tissue regeneration principles), as a combination with other bone grafts in intrabony defects and in socket preservation procedures for implant placement. This review is an attempt to shed light on various applications of this bone graft in periodontal regeneration.

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Tricyclic antidepressants (TCAs), such as amitriptyline, have many side effects. But extrapyramidal tract symptom is an uncommon side effect of these drugs. Here, we report a case of a 28-year-old male who is suffering from amitriptyline induced cervical dystonia. Though rare, this side effect is an uncomfortable condition and may influence drug compliance. So clinicians should be aware of this side effect while treating a patient with amitriptyline.

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Background: Infant feeding is a major determinant of survival, future nutrition and health status of children. Breast-feeding is an unequalled way of providing ideal food for the healthy growth and development of infants. It is also an integral part of the reproductive process with important implications for the health of mothers. Exclusive breast feeding (EBF) is superior to non-exclusive breast-feeding with a protective effect against both morbidity and mortality. This study was aimed to explore the breast feeding practice and affecting factors in Bhaktapur, Nepal. Materials and Methods: Community based cross-sectional study was carried out from February to May 2007 in a rural area of Bhaktapur, Nepal. Total 333 lactating mothers having a child less than 6 months were interviewed using pretested questionnaire with her written consent. Analysis was performed in Statistical Pakage of Social Science-13 version applying appropriate statistics. Results were presented in tabular and narrative forms. Results: Among 333 mothers (mean age ± standard deviation 24.68 ± 4.16 years), majority (76.6%) were 20-30 years. Almost 83.0% were Hindus, 25.8% illiterate, 62.8% house-wives and 53.5% from joint family with low economic status. About 48.0% had a baby of 2-4 months, 86.0% avoided pre-lacteal feeding, 87.1% fed colostrums, 27.9% fed the first milk within half an hour and 55.0% practiced exclusive breast-feeding for 6 months. Child's age, education, religion, occupation, family type and knowledge level were significant (P < 0.05) factors affecting to breast feeding. Conclusion: Despite the high proportion of women initiated breast-feeding early after birth, the prevalence of EBF for 6 months was very low and a large portion had poor practice of breast feeding. Education, relationship of mother with a family member and level of knowledge were found most significant factors. Appropriate measures such as public awareness and effective counseling will support to increase better breast feeding practice.

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Purpose: Pyrazolines and its derivatives are reported to possess a wide spectrum of biological activities. Many class of chemotherapeutic agents containing pyrazoline nucleus are in clinical use. The purpose of this present study was to examine whether the molecular modification might result in detection of new potent anti-tubercular agent. Materials and Methods: A series of 2-pyrazoline compounds (P13-P24) have synthesized by treating N-(substituted aryl)-acrylamide (C13-C24). The starting material was synthesized from substituted P-aminoacetophenone and substituted benzaldehyde. Their structure was confirmed by infrared and ¹ H NMR spectral data. The synthesized compounds were screened for anti-tubercular activity by Microplate Alamar Blue Assay method. Results: Compound P ₁₅ and P ₂₀ have shown excellent anti-tubercular activity; compound P ₁₆ and P ₂₂ have shown significant activity as compared with the standard and rest of them have shown moderate to low anti-tubercular activity. Conclusion: These compounds may result in the potent anti-tubercular entity with molecular modification and manipulations.

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Objectives: To evaluate the relationship between symptoms, clinical severity, neurophysiological characteristics with median nerve cross-sectional area (CSA) at the level of carpal tunnel inlet at ultrasonography (USG) and its utility in diagnosis of carpal tunnel syndrome (CTS). Materials and Methods: Prospective study of 30 patients with symptoms of CTS, attending to the Neurology out patient department (OPD) at University Teaching Hospital. A multidimensional assessment of CTS was done using historic and objective scale (Hi-Ob scale) for clinical severity, Boston carpal tunnel questionnaire (BCTQ) for patient-oriented measures, neuro physiologic studies of median nerve at wrist and USG to measure median nerve CSA at carpal tunnel inlet. Results: Thirty patients included in the study (22 women and 8 men). Mean of CSA was 12.69 mm ² (SD2.67). Association between BCTQ score value and inlet values was assessed by Karl Pearson correlation coefficient ( r = 0.376, P = 0.04). There was positive association with BCTQ scores and CSA of median nerve at carpal tunnel inlet. To compare clinical severity scale (Hi-Ob) and USG CSA, analysis of variance was performed (F value) and Scheffe's multiple comparison test was used to find group difference (grades 1 and 2 P < 0.001, grades1 and 2P P < 0.001, grade 2 differs with grade 2P P < 0.006). As the number of patients is less in minimal, mild and severe groups, the difference between neurophysiological groups and mean of CSA was not statistically significant. Conclusion: A positive correlation exists between USG findings and all the conventional measures of CTS severity.

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Ureteric injury is rare in gynecological practice. The introduction of laparoscopy to gynecologic surgery has allowed for newer innovations, advancements, and also new challenges in the field. As the complexity of laparoscopically approached gynecologic cases continues to increase, it is imperative for surgeons to be aware of the risk of ureteral injury. Although rare, ureteral complications of laparoscopic gynecologic surgery are quite morbid and may have serious implications in relation to litigations. The incidence of ureteric injury varies between 0.1% and 30%, depending on the type of surgery. Prevention can be attempted by preoperative and intraoperative precautions, although the effectiveness of these measures has not been fully evaluated. Diagnosis of ureteric injury may be made intraoperatively, but 70% are diagnosed postoperatively. Management depends on the timing of diagnosis, the etiology, the length and location of the injury, the extent of the causative operation, and the condition of the woman. In this article, we have reviewed the incidence, etiology, preventive strategies, diagnosis, and management of ureteric injury. Knowledge about their prevention, diagnosis, and management is of utmost importance.

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A 60-year-old male patient came to ENT OPD with complaints of left nasal obstruction from the last 5 years and moderate quantity of epistaxis from the last 4 months. It was associated with foul smelling mucopurulent rhinorrhea. On clinical examination, a fleshy mass was seen occupying the posterior part of left nasal cavity and displacing the septum on the right side. The mass was relatively painful, soft, and bleeding on touch. The provisional diagnosis of "vascular-tumor-like" angiofibroma was suspected. Diagnostic nasal endoscopy and CT scan PNS were done which revealed a mass occupying the left nasal cavity arising from the posterior part of septum along the choanae till the anterior part of sphenoid sinus. Biopsy of the same revealed an adenoid cystic carcinoma. Adenoid cystic carcinoma is uncommon and that too of the nasal cavity. The cases of the adenoid cystic carcinoma involving the nasal cavity usually involves the lateral wall and the involvement of the posterior part of nasal septum is extremely rare. Thus the presentation of this uncommon disease is discussed here.

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Giant fibroids are known to arise from the uterus, although very rarely from extra-uterine sites. Among extra-uterine fibroids, broad ligament fibroids generally achieve enormous size and generally present with pressure symptom like bladder and bowel dysfunction. Myxoid degeneration is a rare complication of benign fibroid, where presence of cystic changes mimics the metastatic malignant ovarian tumor. We report a case of true broad ligament fibroid measured about 13 kg. This case is reported for its rarity and the diagnostic difficulties in differentiating malignant ovarian tumor and benign fibroid with myxoid degeneration.

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Background: Burn injuries rank among the most severe types of injuries suffered by the human body with an attendant high mortality and morbidity rate. In previous studies, incidence, severity and deaths due to burn were found higher in young married women in India. Study to find out mortality pattern in burn patient was not carried out in this part of country. Objective: To identify demographic and sociocultural factors, type, modes, causes and risk factors for burn injuries and their gender-wise association. Materials and Methods: It was a retrospective study. Data were collected from all burn patients who admitted and died while on the treatment from 2004 to 2009. A total of 586 patients were included in this study. Data were gathered from hospital records and entered in the excel sheet. Analysis of data was done by using SPSS version 17 statistical software. Results: The mean age of patients was 22.66 years (range 1 m to 80 years). Episodes of burn were 4.63 times common in female (82.25%) than in male (17.75%). It was statistically significant in females of age group 21-30 years (93.93% vs. 15.33% P < 0.0001). Married females (86.80%) burned more commonly than married males (13.19%) P < 0.0001. Flame burn was the major cause of death (95.56%). Kerosene was the most common (69%) source of flame burn. Clothes caught fire while working on Chullha were 25% cases ( P < 0.0001). Accidental (86.44%) burn was the most common intention of injury. The majority of burn deaths (68%) occurred within one week of the incident due to septicemia (57%). Conclusion: Factors associated with an increase in mortality were accidental burns, burn size, young age, married women, and flame burns. For planning and implementing prevention programs, the approach has to be multidisciplinary and coordinated.

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Background : Anencephaly is a lethal neural tube defect which is due to the defective closure of rostral pore of neural tube. In more than 50% of cases it is associated with other systemic anomalies. Hence this study was undertaken to assess pathological parameters associated with anencephaly in particular attention to associated systemic anomalies. Materials and Methods: It is a study on 41 anencephaly fetuses conducted in the Department of Pathology. The period of study is from January 2001 to December 2011. Results: Out of 41 cases, 30 (73%) cases showed presence of systemic anomalies, 48.5% of the cases were observed in primigravida. Most common associated anomaly was spina bifida followed by gastrointestinal anomalies. Conclusion: Pathological examination of the abortus is essential to document the associated anomalies.

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Introduction to the use of Mitomycin C in ophthalmology was a significant development in the 1960s. Its use and application in ophthalmology has been increasing in recent years, because of its modulatory effects on wound healing. Current applications of this drug in ophthalmology include pterygium surgery, glaucoma surgery, corneal refractive surgery, cicatricial eye disease, conjunctival neoplasia, dacryocystorhinostomy surgeries, squint surgeries, and allergic eye disease. Although it has been used successfully in these conditions, it has also been associated with significant complications. This article reviews the current trends and uses of mitomycin C in the eye and its reported complications.

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