Lymph node tuberculosis (LNTB) is one of the most common extrapulmonary manifestations of tuberculosis. A high index of suspicion is needed for diagnosis of tuberculous lymphadenitis, which is known to mimic numerous pathological conditions. Availability of molecular technology has improved the ease of diagnosis. Molecular techniques are also useful for the early detection of drug resistance. With the advent of endobronchial ultrasound in the last decade, the diagnosis of mediastinal tuberculosis has also improved. Management of LNTB often has difficulties. However, most cases can be managed medically and surgical intervention is rarely required. The treatment is similar to pulmonary tuberculosis. However, paradoxical reaction, which is observed in 10–15% of immunocompetent and about 50% of human immunodeficiency virus positive patients needs a special mention for an appropriate management of LNTB.

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Objective: We compared the efficacy of Semont's maneuver with Epley's maneuver in the management of benign paroxysmal positional vertigo (BPPV).We conducted a randomized and prospective double-blind study. Materials and Methods: We included 60 diagnosed cases of BPPV. These patients were categorized into Group 1 and Group 2. Epley's maneuver was performed in 30 patients of Group 1. Semont's maneuver was performed in the rest of the 30 patients of Group 2. We included diagnosed patients of BPPV above 20 years of age of both genders. Patients having peripheral and central causes of vertigo and cervical spondylosis were excluded from the study. Results: The mean age in Group 1 and Group 2 were 50.07 and 44.87 years, respectively. Sixty five percent of the patients were females and 35% of the patients were males. A total of 26 out of 30 Group 1 (87%) patients and 17 out of 30 Group 2 (57%) patients showed improvement. Comparing the two groups on the basis of improvement after maneuver showed that Group 1had greater improvement (54%) compared to Group 2 (46%). Statistical tests such as Chi-square test and t-test were applied. Conclusions: Epley's maneuver is more effective in the treatment of BPPV than Semont's maneuver.

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Introduction: Health care workers are mentors to general populations for a healthy life. Life style disorders are not just limited to the general population but even the doctors and nurses who guide them on their prevention are also getting victimized. The current study was carried out to collect the data on the lifestyle-associated disorders among health professionals in India. Objectives: The aim was to assess the prevalence and associated risk factors (modifiable and non-modifiable) of lifestyle disorders among Health professionals. Materials and Methods: This was a hospital-based cross-sectional study carried out in a secondary level/block level hospital of north-west Delhi. A study tool based on the World Health Organization (WHO) STEPS questionnaire for assessing non-communicable diseases and their risk factors was used. Fasting venous blood sample was collected to assess the lipid profile and fasting blood sugar. Anthropometric measurements of the participants were also taken. Data were analyzed using SPSS version 17. Results: Of the total 100 participants who consented to participate, 60% were females and 40% were males. The prevalence of diabetes and hypertension among health professionals were 5% and 10%, respectively. There were 52 participants who had abnormal waist-hip ratio. According to the WHO classification for Asians, 42% were overweight, while 22% were found to be obese. Alcohol intake (P=0.005), gender (P=0.00), occupation (P=0.018), total cholesterol levels (P=0.038), and triglycerides levels (P=0.046) had a significant association with waist-hip ratio, whereas alcohol intake (P=0.01), hypertension (P=0.05), moderate intensity sports (P=0.025) were significantly associated with body mass index. Conclusions: The prevalence of risk factors for lifestyle diseases was high among the health professionals. Thus, there is a need to motivate them to practice healthy lifestyle for prevention against lifestyle diseases and that they can advocate their patients.

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There has been an ever-expanding list of isolation of organisms in the genus Mycobacterium. Leprosy and tuberculosis are specific diseases caused by mycobacteria; there are now several other mycobacteria that cause human diseases and can be widely found in the environment. These other mycobacteria are called as nontuberculous mycobacteria (NTM) or mycobacteria other than tubercle bacilli (MOTT) or atypical mycobacteria. They cause various human infections in the lungs, lymph glands, skin, wounds, or bone. They may also produce disseminated disease, especially in the immunocompromised. Various molecular, biochemical, and chemical techniques have been developed for rapid identification of these species. While it might be difficult to treat these infections, with duration of treatment longer than that for tuberculosis or leprosy, many drugs such as rifampicin, rifabutin, ethambutol, clofazimine, amikacin, new generation quinolones, and macrolides effective against mycobacterial infections are available that can be used in appropriate combinations and dosage to treat the NTM.

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Introduction: Search for newer markers to enhance sensitivity and specificity of the existing sepsis screen and attempts toward this has been in place for a long time. Platelet indices are one such marker. Materials and Methods: Babies with signs and symptoms or born with risk factors for sepsis were enrolled. Those with positive culture or with clinical sepsis as per Centre for Disease Control definition were classified under the group “cases” (n = 188), whereas all neonates initially suspected to have sepsis but who had a negative blood culture and no clinical sepsis as per definition were classified under the group “control” (n = 188). Blood culture, sepsis screen, and platelet indices [platelet count, mean platelet volume (MPV), platelet distribution width (PDW)] were performed on all these babies. Results: The platelet count was decreased, whereas PDW and MPV were increased in septic babies (P < 0.0001). Thrombocytopenia and increased MPV were frequently observed in babies with late-onset sepsis (P = 0.012). Thrombocytopenia was the most predictive marker for culture positivity in septic babies (83.08%), and when all the platelet indices (MPV + PDW + PC) or (MPV + PDW) were combined (46.34%) it was found to be highly specific marker for prediction of sepsis. Platelet indices had a better sensitivity (83.08%) than sepsis screen (60%). When sepsis screen and platelet indices were combined, it increased the specificity (62.6%). The receiver operating characteristics curve suggested that MPV is a good marker having highest area under curve. Conclusion: Although data on platelet indices are still nascent, platelet indices may be used as a sensitive marker and combined with sepsis screen to exclude a non-septic case.

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Objectives: The highest incidence of epilepsy in children coupled with the need of long-term antiepileptic treatment could lead to development of metabolic complications at an early age. Phenytoin and valproic acid are commonly used antiepileptic drugs in children. This study aimed to assess the serum lipid profile and liver function tests in children with epilepsy on phenytoin or valproic acid monotherapy for 6 months and beyond. Materials and Methods: This prospective descriptive study recruited children from the pediatric outpatient department of a tertiary care GB Pant Children Hospital, Srinagar, Kashmir, India from August 2009 to September 2011. All consecutive children diagnosed with epilepsy as per International League Against Epilepsy definition aged 3–18 years on phenytoin or valproic acid monotherapy for 6 months or beyond were enrolled. After baseline clinical and anthropometric evaluation (including body mass index [BMI]), the fasting blood samples were analyzed for serum lipid profile and liver enzyme changes. Results: Total of 75 children were enrolled. There were 25 patients each in phenytoin, valproic acid, and control group. We observed statistically significant high mean total cholesterol and alkaline phosphatase levels in group receiving phenytoin when compared with valproic acid or control group. Conclusion: The lipid and liver enzyme abnormalities may be observed in children on phenytoin or valproic acid therapy, which warrants careful screening and monitoring.

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Objective: This prospective study was planned to study the prognostic value of time to presentation to the hospital, clinical scales and examination, hematological and biochemical parameters as predictive factors of mortality in ischemic stroke. Materials and Methods: In this study, 188 consecutive patients of ischemic stroke were included. The patients were subjected to relevant history taking, clinical evaluation, blood investigations (total leukocyte count [TLC], capillary blood sugar, potassium, high-sensitivity C-reactive protein (hs-CRP), troponin I (Trop I)), electrocardiogram (ECG) and neuroimaging. The patients were followed up till their final outcome in the hospital, and patients who expired were grouped as 'Mortality Group' and the rest as 'Discharged Group'. Logistic regression analysis was carried out among the significant parameters to identify independent predictors of mortality in cases of ischemic stroke. Results: After statistical analysis, it was found that late presentation to the hospital, pyrexia (temperature >99°F), low diastolic blood pressure at the time of admission, hypoxia (saturation of oxygen [sPo2] <94%), National Institute of Health Science scale (NIHSS) score >15, modified Rankin score (MRS) greater than 3, Glasgow coma scale (GCS) less than 8, hyperglycemia (random blood sugar >200 mg/dL), raised total leukocyte count and hs-CRP (>10 mg/L), are positive predictive factors of mortality in cases of ischemic stroke. Conclusion: Late presentation to the hospital, pyrexia (temperature >99°F), low diastolic blood pressure at the time of admission, hypoxia (sPo2 <94%), more severe stroke (NIHSS score >15, MRS >3, GCS <8), high TLC estimated at the time of hospitalization, are the most important predictive prognostic factors of in-hospital mortality in cases of ischemic stroke.

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Spinal lesions are broadly categorized as lesions encountered in the spine and epidural space, lesions of spinal meninges, lesions of spinal nerve roots, and lesions of spinal cord. These are further sub classified into congenital malformations, inflammatory disorders, degenerative and reactive processes, cystic lesions, vascular malformations, and neoplasms. This pictorial essay highlights the histopathology of these lesions along with the clinical and radiology findings, where relevant.

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We wish to highlight the importance of multi-modality imaging in patients with renal agenesis who may present with lower urinary tract obstruction symptoms. Our case features a rare entity comprising three associated urinary tract anomalies, namely, a blind ending ureter, ectopic uretrocele, and ipsilateral renal agenesis, in a 20-year-old male patient.

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Aim: To assess the impact of atopic dermatitis (AD) on quality of life (QoL) and the factor affecting QoL in Thai children and their families. Materials and Methods: This cross-sectional study was conducted on 86 AD patients at Siriraj Hospital. AD patients aged <16 years and their families were asked to complete the Thai versions of the Infants' Dermatitis Quality of Life Index (IDQoL), Children's Dermatology Quality of Life Index (CDLQI), and Dermatitis Family Impact Questionnaire (DFI). Results: Mean age of the patients was 6.5 ± 0.5 years old and 67.4% were females. The mean ± SD of QoL scores affected by AD was 8.88 ± 5.65. QoL score was high in the group of questions related to symptoms and feelings, followed by sleep problems. The mean ± SD score for DFI was 9.94 ± 7.49. Impact on QoL in Thai children and their families was significantly correlated with disease severity (P = 0.03, r = 0.24; and P= 0.01, r = 0.30, respectively). Factors that caused negative impact on QoL of patients were taking oral medications and disease severity (P = 0.01). Factors causing negative impact on QoL of families were disease severity (P = 0.01), positive for family member with allergic diseases (P= 0.01), start attending school (P = 0.02), and taking oral medications (P = 0.04). Limitation: The limitation of the study was the disadvantage of questionnaire-based study in collecting data. Conclusions: AD caused significant impact on QoL of Thai children and their families. QoL measurement should be included in the patient care assessment to improve effective management of AD.

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Aims and Objectives: To describe the diversity of clinical manifestations, laboratory findings, and outcome of scrub typhus in hospitalized patients of Tirumala Hospital, Vizianagaram, during 2014–2015. Materials and Methods: All cases of acute febrile illness diagnosed as scrub typhus were analyzed. Diagnosis was made by ELISA-based IgM serology. Observations and Results: A total of sixty patients were included in the study. All of them presented with fever; the other major symptoms were headache, cough, dyspnea, and myalgias. On examination, patients had hepatosplenomegaly, lymphadenopathy, and eschar. On investigation, elevated serum glutamic-oxaloacetic transaminase, serum glutamic pyruvic transaminase with normal and elevated bilirubin levels were the most common findings. Other laboratory findings were thrombocytopenia and deranged renal function tests.Other complications were multiorgan dysfunction syndrome, acute respiratory distress syndrome, hypotension, and meningoencephalitis. Majority responded to doxycycline. Conclusion: Scrub typhus though prevalent is under-reported in our country. It should be considered as an important differential diagnosis in a febrile patient with thrombocytopenia, deranged liver or renal functions, Early diagnosis and appropriate treatment is rewarding and prevents morbidity and mortality.

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Background: While the hardships faced by children with cerebral palsy are well known, there is a crying need to understand if their caregivers also suffer both mentally and physically due to the disability of the children. Aim: To study the physical and mental health of the caregivers of children with cerebral palsy and how various factors may influence the same. Settings and Design: This was a descriptive study and was conducted in the Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi. Materials and Methods: Study sample consisted of 65 primary caregivers of children with cerebral palsy. Questionnaires about physical and mental health from family burden scale were used. Descriptive statistics and multiple regressions were used for data analysis. Results: Both physical and mental health of the caregivers were affected to some extent. A significant association was found between physical health of caregivers and duration of knowing the diagnosis, seizures, and mental retardation in the children. Moreover, impact on mental health was significantly associated with total number of children, duration of care giving, knowing the diagnosis, speech disturbance, seizures, and mental retardation in children. Conclusions: Caregivers of children with cerebral palsy experience some effects on their physical and mental health, which are associated with various factors. Therefore, healthcare professionals should also provide care and support to these caregivers, so that they can effectively and efficiently care for their children with cerebral palsy.

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Introduction: A wide variety of chemotherapeutic agents are currently in use for the treatment of hematological malignancies in children. A spectrum of mucocutaneous adverse effects has been attributed to these agents, however, the data largely consists of case reports and case series. Material and Methods: Proforma of all pediatric patients up to 18 years of age, with confirmed hematological malignancies (lymphoma and leukemia), undergoing chemotherapy, and attending the pediatric hemato-oncology clinic of a tertiary care hospital over a period of 2 years were analyzed. A detailed history, mucocutaneous examination and investigations were recorded as per  the proforma. The results are presented as mean ± standard deviation. The prevalence of various side effects of chemotherapy is presented as percentages. Results: The age of the patients ranged from 1.2 to 14 years (mean age: 6.6 ± 3.2 years). The duration of the disease ranged from 2 to 122 weeks. Mean duration of chemotherapy was 23.9 ± 24.7 weeks. The analysis consisted of 38 (76%) males and 12 (24%) females (M: F: 3.2:1). Seventy-four percent of the patients had B-cell acute lymphoblastic leukemia (ALL), 6 patients had T-cell ALL, 3 patients had Philadelphia chromosome (+) T-cell ALL, 3 patients had non-Hodgkins lymphoma (NHL) and one patient had hemophagocytic lymphohistiocytosis (HLH). Methotrexate (72%) was the most common agent used followed by vincristine (68%), 6-mercaptopurine (58%), daunomycin (48%), and asparaginase (30%). Hyper-pigmentation was the most common cutaneous side effect noticed in 6 patients. Three patients developed abscess. Two patients each developed tinea corporis, petechie, and thrombophlebitis. One patient each had scabies, pityriasis versicolor, miliaria rubra, allergic contact dermatitis, lip lick cheilitis, ear discharge, and conjunctivitis. One patient developed acute methotrexate toxicity. A total of 24 patients developed mucosal lesions, with aphthous ulcer (20%) being the most common, followed by oral candidiasis (12%) and herpes labialis (12%). Seventeen (34%) patients had diffuse anagen effluvium. Most common change affecting the nails among the study patients was Beau's lines for both fingernails (26%) and toenails (36%). Other less common changes included melanonychia, leuconychia, Mees lines, Muehrcke's nails, half and half nails, etc. Conclusion: The mucocutaneous manifestations associated with chemotherapy cause significant morbidity and possibly mortality in children. A proper knowledge of these manifestations can help in early identification and withdrawal of the offending agents and preventing the morbidity with appropriate and timely management.

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In many developed countries, tuberculosis (TB) is considered a disease of the past. However, the impact of this disease can be devastating even today, especially in resource poor countries suffering from high burdens of both TB and human immunodeficiency virus (HIV). One of the greatest threats to global TB control is the growing prevalence of drug-resistant bacilli. Correctly diagnosing drug-resistant TB patients is more problematic in resource-limited settings as there is no or limited infrastructure for drug susceptibility testing (DST) of TB bacilli. The conventional phenotypic DST method for TB takes weeks before declaring the results and initiating proper anti-TB treatment. The evolution of molecular diagnostic methods has revolutionized the TB diagnostics. These methods are accurate, rapid, easy to perform, and can solve controversial issues related to TB diagnosis as well as drug susceptibility. It is important to link these rapid molecular techniques with the conventional methods to determine the impact of the disease.

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Recent epidemiologic and demographic public health data highlight the growing need for emergency medicine (EM) services in India and highlight its importance as a recognized medical specialty. Developing a comprehensive and recognized EM program for training physicians in India is of utmost priority and should not be neglected at any point of time. This review article attempts to highlight the development of a post-graduate program in EM in the country.

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Background: Hemangioblastomas are rare, benign, vascular neoplasm. According to the World Health Organization classification of tumors of the nervous system, hemangioblastomas are classified as meningeal tumors of uncertain origin and are Grade I neoplasm. Hemangioblastomas arise either in the setting of von Hippel-Lindau (vHL) disease or more often as solitary sporadic lesions. They account for 1-3% of primary central nervous system (CNS) tumors. The most common location is the cerebellum followed by spinal cord. Supratentorial lesions are rare. Aims: The aim was to study the prevalence of hemangioblastoma. Materials and Methods: A retrospective observational study of 7 years duration was carried out in the department of pathology of a tertiary referral center. The sample received was processed by standard formalin fixing, paraffin embedding method. Serial sections and special stains were studied as and when required. Results: During the period of 7 years, we reported total 679 cases of primary CNS tumors, of which 11 (1.62%) cases were of hemangioblastoma. Ten of them were intracranial, and one was spinal. There were seven male and four female patients that clearly indicate male preponderance. Conclusions: In our study, prevalence of hemangioblastoma was 1.62% (11 cases) out of 679 primary CNS tumors, which is low as per literature. There was a male predominance with male:female ratio 2:1. Cerebellum was the most frequent site (81.8%). No association with vHL disease was noted.

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Background: Axillary lymph nodes are surrogate markers for mapping the optimal management of axilla in breast cancer, and their assessment is pivotal to management and outcome. Until now, the assessment of axillary lymph nodes largely relies upon sentinel node biopsy (dual method) or conventional lymph node dissection. The morbidity of axillary lymph node dissection, however, is well known. Sentinel node biopsy is thus considered the standard of care in a node-negative axilla. However, developing economies face the dilemmas and challenges of matching up to the high cost of gamma probe, the vagaries of its learning curve, and, often, the advanced stage of disease at which the patients present. Also, with the advent of neo-adjuvant chemotherapy, the axilla can now be downstaged to a node negative status (N0). In this setting, a targeted four-node sampling (FNS) can offer a simple, reliable, and cost-effective approach for assessment of the axilla. Material and Methods: A total of 50 patients with locally advanced breast cancer who had received neo-adjuvant chemotherapy form the nucleus of this study. In each patient, axillary mapping was done using periareolar injection of 3 mL of methylene blue dye immediately before surgery. Four blue nodes from the specified anatomical site at level-I were picked up and subjected to frozen section. The axillary dissection was subsequently completed in a conventional manner in all patients irrespective of the outcome of frozen section and the entire specimen was the sent separately for histopathological examination. The outcome of frozen section was compared and correlated with the actual histopathological assessment of entire axilla to find out the sensitivity, specificity, and false negative rates of the technique. Results: The sensitivity and specificity of FNS were found to be 89.5% and 93.3%, respectively. The negative and positive predictive values were found to be 84.6% and 100%, respectively. Conclusions: It was observed that "targeted" FNS using methylene blue dye can serve as a reliable and inexpensive alternative to other techniques for addressal of axilla even in locally advanced breast cancers. This is particularly relevant in developing economies where majority patients still present as locally advanced; and high-end facilities, such as gamma camera and isotope studies, are scarce.

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Tumors of the central nervous system (CNS) exhibiting a papillary pattern constitute a remarkably diverse group of neoplasms that can occur at virtually any site and in patients of any age. Since the first classification of nervous system tumors in 1926, formulated by Percival Bailey and Harvey Cushing based on the presumed parallels between embryologic and neoplastic cells to the World Health Organization (WHO) classification of tumors of the CNS 2007, CNS tumors have come a long way. WHO classification of tumors of the CNS 2007, lists several new entities. However, despite the advancements and the rapid progress with various classification systems in place, as a first step, brain tumors are still characterized largely by the typical patterns and their histopathological features. This pictorial essay represents the histopathology of one of these patterns comprised of various papillary tumors of the CNS, highlighting the diagnostic approach.

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Background: Infected pancreatic necrosis is associated with the risk of considerable morbidity and mortality. Preventing the development of infection in pancreatic necrosis may help reduce the poor outcomes in patients with severe acute pancreatitis (SAP). Aim : The aim of the current review was to determine the benefit of selective digestive decontamination (SDD) in improving outcomes in SAP. Materials and Methods: A systematic literature search was conducted using MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Database of Abstracts of Reviews of Effects and Health Technology Assessment, until June 2011 without any restrictions. Papers reporting on experimental animal studies and clinical studies on patients with acute pancreatitis (AP) who were treated with SDD, either alone or in combination with intravenous antibiotic and antifungals in comparison with other interventions, antibiotics, or placebo, were eligible for inclusion. Outcome data collected were duration and regimen of SDD used, short- and long-term morbidity and mortality rates, length of hospital stay, incidence and rates of bacterial/fungal infection. Results: A total of 53 articles were identified from the literature search of which 10 (7 animals, 3 humans) were eligible for inclusion in this systematic review. There was only one randomized controlled trial among the human studies. Most studies used a combination of SDD and intravenous antibiotics precluding a clear interpretation of the individual benefit of SDD. Although SDD significantly reduced pancreatic infection rates, its benefit on patient survival is unclear. Conclusion: Although SDD significantly reduced pancreatic infection rates and overall survival in experimental animal models, in human studies this benefit is not clearly appreciated owing to the confounding effects of concurrently administered intravenous antibiotics. Hence, further controlled studies are needed to determine the benefit of SDD in AP in humans.

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Study design forms a core component of research, mainly determined by the study objectives, and it in turn further decides the type of statistical analyses to be carried out. Observational studies are devoid of the investigator's control over assignment of a subject to the treated or control group, in contrast to interventional studies Even though randomized controlled trials are seen as the best study design, evidence shows that properly conducted observational studies give similar results, and is relevant in medical research where ethics and feasibility concerns assume great significance. Observational studies point out towards possible causal associations, are less resource intensive than trials and have a better external validity. This review article discusses various types of observational study designs such as case reports, cross sectional, cohort, case-control and nested case-control studies with real literature examples.

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Leprosy, an infectious disease, described since ancient times and endemic in India since then, has been eliminated (elimination defined as a prevalence of less than 1 case per 10,000 population) as a public health problem in December 2005. World Health Organization and National Leprosy Eradication Program (NLEP) have now focused on reducing the disease burden in the population. Data indicates that annual fresh case detection rate remains high with a high incidence of multibacillary cases. A review of present NLEP figures and those reported in a number of studies reflect a discordance and caution by dermatologists. A review of present policy, epidemiological status in the population, and our experience is presented. Data from Base Hospital, Delhi Cantonment, over the past 3 years, including patients treated as well as those on surveillance is presented. A higher incidence of paucibacillary cases was seen, with a high incidence of pure neuritic involvement (15%), reactions (24.7%), and deformities (28.37%). Tenosynovitis was observed with increasing frequency. Future challenges in containing the epidemic to reduce the disease burden in population will require regular assessment of treatment measures, especially the use of fixed drug therapy as well as rehabilitation of the affected. Dermatologists shall play a central role in any such endeavor in the management of this disease.

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Foreign bodies in maxillary sinus, whatever their origin or nature, are unusual. However unilateral unexplained chronic rhinosinusitis should arouse clinical suscipicion. The diagnosis is based on radiological findings. The range of such foreign bodies is wide; those of dental origin such as tooth roots, burs, dental impression material, root-filling materials, dental implants, and needles take precedence over all others, but rarely, they may relate to blast injuries and penetrating objects. This special report highlights the unusual case of a pressure cooker nozzle lodged in maxillary sinus of a 28-year-old female who suffered a facial injury caused by explosion of a pressure cooker at home. The acuteness of the event and the flight of the foreign body were such that neither the casualty felt the ingress of foreign body nor was the diagnosis entertained by the surgeon who first examined her. Each blast injury therefore must be thoroughly evaluated for such possibility. While a radiological examination can clinch the diagnosis, treatment lies in endoscopic or surgical foreign body removal, with Caldwell luc procedure being a preferred technique.

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