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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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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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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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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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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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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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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The pituitary gland is embryologically divided into two main lobes: adenohypophysis (anterior) and neurohypophysis (posterior). Last five decades have witnessed changes in the tumor classifications – anterior pituitary in 2017 and posterior in 2016, based on hormonal immunohistochemistry, molecular profiles, and pituitary specific transcription factors. Few newer entities/terms have been added and at the same time certain terms have been modified/discarded. In this article, relevant anatomy, development, histology, incidence, and clinical manifestations of pituitary tumors evolution of various classification systems and recommended current classification of pituitary tumors; the genetic alterations and the diagnostic implications for today's pathologist have been reviewed in a comprehensive manner.

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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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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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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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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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Genetic neuromuscular diseases are caused by defective expression of nuclear or mitochondrial genes. Toxic mutant protein may cause cell death, and thus, strategies that reduce mutant gene expression may provide therapeutic benefit. Synthetic antisense oligonucleotide (ASO) has been known to recognize cellular RNA and control gene expression. In recent years, advances in ASO chemistry, creation of designer ASO molecules to enhance their delivery and safety, and design of clinical trials to judge therapeutic efficacy have ushered into an era of plausible application of ASO technology to treat currently incurable neuromuscular diseases. The US Food and Drug Administration has recently approved two ASO therapies in genetic neuromuscular diseases. This brief overview examines the recent advances in ASO technology, evolution, and use of synthetic ASOs as therapeutic platform, and the mechanism of ASO action by exon-inclusion in spinal muscular atrophy and exon-skipping in Duchenne muscular dystrophy, with attention to their advantages and limitations.

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Introduction: Syndicate learning is a form of peer learning involving small groups of 5-6 students working in semi-independent groups toward achievement of a collective goal. Methods: Eighty final Bachelor of Dental Surgery (BDS) students were enrolled. Pre-test was conducted for regular batches posted for clinical posting in Oral Medicine and Radiology. Each batch was randomized into two equal sub-groups. Sub-group A and B were exposed to syndicate and traditional learning methods, respectively. Post-test was carried out. Crossover was done. Pre-test was again conducted. Sub-group A and B were exposed to traditional and syndicate learning, respectively. Post-test was again carried out. Results: In round one, scores of post-test were significantly better than pre-test in both subgroups A (pre-test - 2.40 ± 0.98, post-test - 4.45 ± 0.71) and B (pre-test - 2.47 ± 0.96; post-test; 3.57 ± 0.87). In round two after crossover, scores of post-test were significantly higher in both subgroup A (pre-test-2.30 ± 1.09; post-test-3.72 ± 0.84) and subgroup B (pre-test - 2.37 ± 1.12; post-test - 4.50 ± 0.59). Further, when subgroup A was compared with B, scores of post-test were significantly higher in the syndicate group compared with traditional group, before and after crossover. Conclusions: Syndicate groups can make learning experience more interesting; generate many opportunities for creative interchange of ideas and lively, meaningful participations and discussion among students.

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Background and Objectives: Urinary tract infections (UTIs) are commonly seen in clinical practice and are most often caused by Escherichia coli (E. coli). To administer appropriate antibiotic therapy and reduce morbidity, it is crucial to know the local resistance patterns of E. coli. This study aims to show long-term changes in the resistance of E. coli to commonly used antibiotics over the past two decades in a hospital in southern India. Materials and Methods: This study was carried out at Dr. Jeyasekharan Medical Trust, a multispeciality teaching hospital in southern Tamil Nadu. It analyzed data from records of all urine samples received, cultured, and tested for resistance in its microbiology laboratory between 1991 and 2012. Results: A total of 44% of the urine cultures grew organisms. E. coli was present in 73% of the positive cultures. A trend of increasing resistance to gentamicin, fluoroquinolones, and cephalosporins was noted over the study period. The development of resistance was faster with the fluoroquinolones and cephalosporins than gentamicin. Chloramphenicol resistance showed a downward trend. Amikacin and nitrofurantoin were the most effective antibiotics with 10% and 28% resistance levels, respectively, over the period that they were used. The levels of resistance to second-line antibiotics did not show any definite trend. Interpretation and Conclusions: This study shows changing patterns of E. coli resistance over a period within an institution. Monitoring urinary cultures and resistance patterns regularly can assist in developing guidelines for selecting appropriate first guess antibiotics, thereby optimizing patient outcome.

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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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Background: Mental health among anaesthesiologists has been studied in India in a limited manner. In this study, we aim to assess the same in a group of trainee anesthesiologists. Methods: A cross sectional study was undertaken among all the anesthesiology registrars doing their post graduation at the Christian Medical College and Hospital, a tertiary care hospital in southern India. The mental health was assessed using General Health Questionnaire - 28 (GHQ 28). Results: 43% of the study group was found to have higher levels of emotional distress. Significant correlation was found for female registrars and those between 20 and 30 years of age. Conclusion: While nearly half of trainee anaesthesiologists were found to have higher levels of emotional distress, the association was most marked among women and, individuals under 30 years of age.

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