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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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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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In the current Indian medical practice, consent is not well understood, and practical obstacles tend to hinder meaningful applications of the concept. Consent cannot simply be bolted onto existing practices; old models of decision-making need to change, and now is the time to examine the underlying ethics. India in many ways is at a crossroad in terms of how clinical decisions are made, when and in particular, by whom. Some difficulties are structural, having to do with health care delivery and resources within the public sector; others are more subtle, having more to do with attitudes and cultural norms. Either way, there are no “quick fixes,” although detailed guidance on standards of consent would surely be a help, backed up by educational interventions for health care professionals on autonomy and consent. As an aid to this process, a flowchart for clinicians is included at the end of the paper, with potential applications for use in end-of-life, intensive care, and other clinical settings.

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Over half million cases of multidrug-resistant (MDR) tuberculosis (TB) occur every year globally, and a significant number of them are affected by extensively drug-resistant (XDR) strains of Mycobacterium tuberculosis. There is limited access to reliable diagnostic facilities to drug-resistant (DR) TB in most developing countries. The treatment of MDR/XDR-TB is unfortunately very expensive, long, and toxic and the success rate is largely unsatisfactory (<50% among MDR-TB and <20% among cases with resistance patterns beyond XDR).The aim of this review is to summarize the available evidence-based updated international recommendations to diagnostic methods and treatment of MDR/XDR-TB, and briefly discuss the shorter MDR-TB regimen and the role of newly developed drugs as well as repurposed drugs. This review will help the reader to formulate treatment regimen for DR-TB patients based on currently available newer rapid diagnostic tests.

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Derived from the Latin term ule, which means scarring, ulegyria is a manifestation of hypoxic ischemic encephalopathy. Recognizable on the magnetic resonance imaging sequences because of its characteristic features, the diagnosis is critical from the standpoint of clinical management. Seizures caused by ulegyria are refractory to pharmacotherapy and often do well with surgery.

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We report a case of an anomalous unilateral single right pulmonary vein resembling a scimitar sign on chest X-ray. Only a few cases have been reported in the literature describing this interesting rare anomaly that is often confused with arteriovenous malformation and hypogenetic lung syndrome (scimitar syndrome). This report briefly discusses the embryology of the pulmonary veins, classification of the pulmonary venous anomalies, and various causes of scimitar sign.

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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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Introduction: Human cysteine rich secretory protein 3 (CRISP3), also known as specific granule protein (SGP28) is a small 28kDa protein. CRISP-3 is widely expressed in salivary glands, pancreas (particularly in pancreatic disease), lachrymal glands, prostate, myeloid precursors, human epididymis, ovary, thymus and colon. Human CRISP3 share similarity with snake venoms as well as Glioma Pathogenesis Related protein GLIPR1. Here we are reporting the extent of alignment of human CRISP3 protein with pancreatic enzymes and snake venom proteins and presence of GLIPR1 and CRISP3 genes containing conserved GHYTQVVW motifs in clinical samples of pancreatitis and pancreatic cancer. Material and Methods: Protein sequences with accession numbers for Human CRISP3, Snake Venom and enzymes present in pancreatic juices i.e. Trypsinogen, Cathepsin, Lipase, Amylase and Elastase were retrieved from swissprot, protein database. These sequences were aligned in silico for demonstrating the presence of 16 conserved cysteine residues and other motifs i.e. GENL and GHYTQVVW. The multiple sequence alignment (MSA) was performed. Presence of CRISP-3 conserved motifs in clinical samples of pancreatitis and pancreatic cancer was evaluated by PCR. DNA extracted from a small piece taken from inflamed pancreatic tail biopsy with confirmed diagnosis for pancreatitis and an excised pancreatic cancer tissue was subjected to PCR to conform presence of CRISP3 and GLIPR1 genes. Results: Our results show conservation of 9 Cysteine residues out of 16 Cysteine residues in majority of pancreatic enzymes and notable conservation of GENL and GHYTQVVW motifs across snake venom proteins. PCR yielded desired amplicon of expected size with the primers spanning conserved residues and core consensus motifs specifically designed to amplify CRISP3 gene in clinical samples of pancreatitis and pancreatic cancer. We also detected presence of GLIPR1 gene sequence in the DNA extracted from clinical samples of pancreatitis and pancreatic cancer thus confirming similarity between the pathogenesis related protein and CRISP3. Conclusion: Notable conservation of cysteine residues across pancreatic enzymes, snake venom and Human CRISP3 opens avenues of further research to evaluate the likely clinical potential of the conserved residues as putative biomarkers in exocrine pancreatic diseases. To the best of our knowledge this is the first report where primers designed around conserved GHYTQVVW motifs to amplify CRISP3 gene and its structural similarity with GLIPR1 gene sequence in clinical samples of pancreatitis and pancreatic cancer has been validated.

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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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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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Introduction: Kangaroo Mother Care (KMC) is a nonconventional low-cost method of newborn care. We tried to understand the difficulties faced by mothers during KMC and profile the corrective action. Materials and Methods: Over 3½ years, mothers of inborn low birth weight babies were taught and motivated by clinical nurse researcher to implement KMC. Gross congenital abnormality or nonconsenting mothers were exclusion factors. After demonstration sessions, KMC was implemented for 1 h on 1st day, 2 h on 2nd day, 3 h on 3rd day and then scaled up for as long as a mother felt comfortable. After discharge, KMC was continued at home till the infant attained 2500 g weight or 40 weeks corrected gestational age. Difficulties being faced both in hospital and at home were probed and remedial measures suggested accordingly. Results: Of 300 mother-baby pairs studied, 35 (11.67%) mothers could not implement KMC satisfactorily in hospital itself. Causes of failure related to mother, infant or socioeconomic factors, such as mother not feeling well enough, need to visit toilet, feeling hungry, lack of self-motivation, soiling of nappies, and interfering family members (especially maternal grandmother). To overcome these problems, both mother and father, and when required, other family members were counseled. Mother was instructed to visit the toilet just before KMC session and to take adequate food beforehand. Before discharge family support person was identified. After discharge, 6 (2%) additional mothers faced problems from lack of privacy, discouragement by mother-in-law or neighbors, lack of time and uncomfortable summer environment. Motivation and counseling at every follow-up visit rescued the situation. Conclusion: Regular supervision and counseling along with adequate initial demonstration are necessary for successful implementation of KMC.

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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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Objective: The aim of this study was to assess the frequencies of different kinds of vertigo patients in our vertigo clinic. Materials and Methods: A retrospective review of 149 walk-in patients at a specialized neurotology clinic in dizziness at a tertiary referral center is presented. Results: A total of 149 patients were included in the study, of which 57 (38.3%) were males and 92 (61.7%) were females. Seventy six (51%) patients were suffering from benign paroxysmal positional vertigo (BPPV), 37 (24.8%) were suffering from Meniere's disease, 23 (15.4%) were suffering from migrainous vertigo, and 8 (5.4%) were suffering from vestibular migraine. Five (3.4%) patients were suffering from vestibular neuronitis. Conclusion: BPPV was the most common cause of dizziness in this series. Awareness of this condition and a proper Dix–Hallpike test would aid in diagnosis and reduce unnecessary investigations and referrals. Re-evaluation and regular follow-up may sometimes be necessary if the diagnosis is elusive. Although central causes are not common, it is important that these conditions are excluded.

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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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Background: Allergic Rhinitis (AR), a common health problem, imposes a substantial burden on public health. New evidence suggests a possible link between AR and Vitamin D deficiency. This study was done with the purpose of determining whether serum Vitamin D levels are altered in AR as opposed to healthy controls and whether such alterations modify the severity of the disease. Materials and Methods: A cross-sectional study was done on 100 adults aged 18–50 (50 clinically diagnosed with AR and 50 age and sex matched controls). They were evaluated clinically and by determining serum levels of 25-hydroxyvitamin D [25(OH) D]. Results: The most common symptom was paroxysmal sneezing (96%). The mean concentration of serum 25(OH) D was 16.52 ng/ml in test patients and 22.47 ng/ml in controls. This study demonstrated a statistically significant Vitamin D deficiency (defined as serum 25(OH) D, <20 ng/mL) among patients with AR as compared to healthy controls (P = 0.001). The deficiency was significantly more (P = 0.01) in patients with moderate–severe AR (n = 28, mean serum 25(OH) D = 12.36 ng/ml) than that in mildly symptomatic patients (n = 22, mean serum 25(OH) D = 21.82 ng/ml). Conclusions: A strong association exists between low serum Vitamin D levels and AR in this population sample of AR patients, suggesting that suboptimal levels of Vitamin D may modify the disease behavior. Supplementation can be a useful therapeutic adjunct.

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Introduction: Ischemic stroke is a major cause of morbidity and mortality. However, the interface of various premorbid medical conditions, vascular risk factors prior, prior antithrombotic or statins medication use, and in-hospital complications in effecting outcomes is not clearly established. We attempt establishing factors associated with improved outcomes after an acute ischemic stroke (AIS). Materials and Methods: Using the prospectively collected database, University Health Consortium from 1999 to 2004, a national USA database, multivariate step-wise backward regression analysis was performed and we were able to define premorbid characteristics, and medications that affect the outcome of AIS. Results: Initial stroke severity and poststroke in-hospital complications were associated with a poor outcome, while prior antiplatelet drug use was associated with an improved outcome. Statin use demonstrated a trend toward an improved outcome.

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Contraception is essential for a woman as it helps to achieve autonomy in personal life and avoid unwanted pregnancy. Adequate contraception is even more essential for women with epilepsy (WWE) due to potential maternal and fetal risks of antiepileptic drugs (AEDs) and poor seizure control. There are several hormonal and nonhormonal contraceptive options available for WWE, with combined oral hormonal pills being used most commonly. The choice of contraception in WWE is influenced by many factors, chief among these being potential drug interactions between contraceptive hormones and enzyme inducing antiepileptic drugs (EIAEDs). While EIAEDs may increase metabolism of contraceptive hormones leading to contraceptive failure, contraceptive hormones in turn may increase metabolism of AEDs resulting in their faster elimination and breakthrough seizures. The co-administration of lamotrigine and oral hormonal pills is especially complicated by unpredictable interactions and requires several considerations. In this review, we try to address various issues concerning the use of different contraceptive modalities in WWE. In addition, we review the current guidelines for concurrent use of hormonal contraception and AEDs in WWE.

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Glaucomatous visual changes and defects are almost irreversible, with the visual field changes of glaucoma being noticed by the patient after significant disease progression due to a relative lack of alerting symptoms. Reduction of elevated intraocular pressure (IOP) is the only as yet proven approach to protect against visual field loss in patients with primary open-angle glaucoma (POAG) or ocular hypertension (OHT). When they first entered the ophthalmic market about 10 years ago, prostaglandins were viewed skeptically as a potential first-line therapy for glaucoma patients. Yet in less than a decade, glaucoma specialists' preferences have changed, with most reporting that they prefer prostaglandins over beta blockers as their patients' initial medication. Latanoprost has truly withstood the test of time and has indeed proved to be one of the best anti-glaucoma medications when used as monotherapy or as adjunctive therapy. Bimatoprost 0.01% has a similar overall safety profile, a favorable hyperemia profile, and less overall discontinuation compared with Bimatoprost 0.03%. In lieu of its poor efficacy, Unoprostone has lost its hold in the anti-glaucoma palate. Travatan Z (travoprost) is a new formulation of Travatan solution in which benzalkonium chloride is replaced with Sofzia, a robust ionic buffered preservative system that is gentle to the ocular surface. Tafluprost, the newest addition to the prostaglandin brigade, is a fluorinated analogue of prostaglandin-F 2α and is available as a sterile ophthalmic solution of 0.0015% (0.015 mg/ml) being approved by the US-FDA on 10th February, 2012. A new futuristic glaucoma therapeutic management paradigm where clinical success is no longer simply measured by achieved level of intraocular pressure control but also long-term preservation of visual function and patient's quality of life is expected to dramatically improve upon current treatment algorithms for ocular hypertension and glaucoma.

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Gastric cancer is generally associated with a dismal outcome. One of the major reasons for this is the fact that patients often ignore the early symptoms of the disease, which masquerade benign diseases such as reflux disease and gastritis, and hence present when the cancer is advanced or metastatic. Multidisciplinary management has emerged as an important determinant of outcomes in patients with gastric cancer. Complete surgical resection remains the cornerstone if cure is to be achieved, especially in those patients with non-metastatic disease. This article provides an updated review of the multidisciplinary management of patients with resectable gastric adenocarcinoma.

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Oral care is critical from the stand point of systemic health. No health preventive strategy is complete without taking into cognizance the significance of subgingival microbiota in causation of a number of systemic conditions. Clinical studies and etiopathogenetic models substantiate a distinct connect between chronic periodontitis and a host of cardiovascular, respiratory, endocrine, musculoskeletal, and reproductive system pathologies. A potent source of contagion, subgingival microbiota associated with periodontitis may act as a significant risk factor in atherosclerotic coronary disease, carotid atheromas, chronic obstructive pulmonary disease, rheumatoid arthritis, systemic osteoporosis, diabetes mellitus, premature labor and birth of preterm babies, head and neck squamous cell carcinomas, and a myriad of other conditions.

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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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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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