Phyllodes tumor is a rare breast malignancy of stromal tissue. They are benign, borderline and malignant as per WHO criteria. The mainstay of treatment is surgery. These tumors mimic benign conditions and are tricky to diagnose. We are here reporting a rare case of Phyllodes tumor left breast in a 45-yr old female. She was treated with surgery for borderline Phyllodes tumor and owing to large size more than 10 cm and positive margins received adjuvant radiation therapy.

Background: Pulmonary Artery Hypertension (PAH), defined as a resting Mean Pulmonary Artery Pressure (MPAP) ≥25 mmHg. The present study was done to evaluate the Prevalence of Pulmonary Artery Hypertension (PAH) and its Association with socio-demographic variables among Interstitial Lung Diseases (ILDs) patients. Material and Methods: This cross-sectional study was conducted at Indira Gandhi Medical College, Shimla from July 2018 to June 2019. All consecutive patients of all types of ILDs, attending the outpatient services of the Department of Pulmonary Medicine, IGMC Shimla were enrolment and subjected to focused socio-demographic, Pulmonary artery hypertension (PAH) history. Data was analyzed using Epi info V7 software by applying appropriate statistical tests. Results: The present study includes 50 patients of different types of ILD. Out of 50 patients, 44 (88%) had PAH. Mean age PAH group and without PAH group was 60.07+13.15 years and 41.33+18.90 years respectively with a p- value of 0.003. In patients, those who had PH had an equal distribution of male and female with 22 (50%) each, with a p-value of 0.13. The majority of patients were from the rural background of 44(88%), with 38 (86.36%) patients had a PH with a p-value of 0.44. The majority patients who had PH belong to lower class i.e. sixteen (36.36%). Out of 50 patients, 26 (59.09%) patients had PH, who never smoked. In patients who had PH the mean duration of ILD was 3.29+ 2.66 year. Majority of patients of ILD were in PH group. IPF-23(52.27%), sarcoidosis-9(20.45%), SSc 6-(13.64%), SLE-ILD-2(4.45%), CPFE-1(2.27%) and HP -3(6.82%) respectively, with a p – value of 0.4. Among 50 patients 8 (16%) had a history of ATT, among them 7 (15.91%) had PH, with a p-value of 0.66. Out of 50 patients, 10 (20%) had a history of oxygen therapy, among them 9(20.45%) patients had PH with a p-value of 0.44. Conclusion: There was very high prevalence of PAH among ILD Patients. PAH was high in males, those having rural background, those belong to lower class, smokers, having history of ATT & Oxygen therapy and having IPF but there was no statistically difference among various socio-demographic variables.

Phlebitis refers to the clinical finding of pain, tenderness, swelling, induration, erythema, warmth and palpable cord like veins due to inflammation, infection, and or thrombosis. One of the most commonly done procedures in the patients admitted in the hospitals is the intravenous cannulation. Phlebitis can be due to mechanical, chemical, bacterial, and even post traumatic causes. Complications of superficial thrombophlebitis include deep vein thrombosis and pulmonary thromboembolism, both of which are graded as fatal. Hence it becomes imperative to manage superficial thrombophlebitis as early as possible. This article has been prepared with an objective of describing the management protocol of the patients suffering from superficial thrombophlebitis.

We report a case of 20 years old male with chondromyxoid fibroma antero-lateral aspect of left foot. The patient underwent wide local excision with extensor retinaculum repair with flap. Histopathological features suggestive of chondromyxoid fibroma and margins were involved, so patient was further taken up for local radiotherapy. 

Abdominal trauma is a major public health problem for all nations and all socioeconomic strata. In order to minimize mortality in cases of abdominal trauma, risk factors for mortality need to be systematically identified and studied. This study was done to determine the socio-Demographic and etiologic Profile of Blunt Trauma Abdomen patients in a tertiary care Hospital. Material & Methods: This Observational prospective study was conducted from July 2018 to December2019 and included all Blunt Trauma Abdomen (BTA) patients admitted in study period at advanced trauma center, PGIMER Chandigarh. Pattern, prevalence, non-operative versus operative management and outcome in term of mortality and morbidity were monitored. Results: Seventy-five patients admitted to ATC during study period were selected for the study. The most common age group affected was 16-30 years which constitute 42(56%) of total affected. Ninety two percent (n=69) of affected population were males whereas 8% (n=6) were females .Road side accident constitute most common mode of injury 59 (78.66%) of cases followed by fall from height 11(14.67%). Fifty two percent of blunt trauma abdomen cases were high velocity accidents. 7 patients (9.3%) had isolated injuries, while remaining 68 patients (91.7%) had associated injuries to other systems. Chest injuries were present in 33 patients (44%) followed by musculoskeletal injuries in 25 patients (33%). Solid Organ injured in 54(725) of cases, followed by hollow viscous injury 19(25.33%).Liver (40% n=30) followed by spleen 28(37.33%) are the most common organ injured in case of blunt trauma abdomen. Conclusion: Most of the BTA patients were male and from young and productive age group. Road traffic accident was the most common mode of injury and liver was the most frequently injured organ. High velocity remained another associated factor and most of patients had an associated injury.

The clinical signs and symptoms in snake bite are result of identification of antigenic protein and the non-protein component of snake venom by immune system and arousal of inflammatory response in the victim's body. The objective of the study was to assess the clinical profile of snake bite patients and treatment given with outcome of snake bite patients. A hospital-based observational study was conducted at Department of Pediatrics, IGMC, Shimla in the study over a period of one year among the patients attending the pediatric emergency. Most common hematologic abnormalities observed were hematuria and epistaxis. Proteinuria and acute kidney injury was also present in one-one case. Administration of Fresh frozen plasma (FFP) improved the outcome.Respiratory paralysis, ptosis and opthalmoplegia were the most common presentation in all patients with neuroparalytic envenomation. All symptomatic patients were given ASV as primary treatment out of which more than 50% patients required more than 10 vials of ASV.

Child survival strategies in developing countries focus on preventing under-5 mortality through interventions like promoting breastfeeding, managing neonatal conditions, and improving nutrition. Despite effective interventions, coverage remains low, emphasizing the need for integrated care packages from pregnancy to childhood. These packages should be delivered at all levels of the health system, from home to hospital. The Millennium Development Goals have been instrumental in reducing under-5 mortality, with significant progress made in several regions. Strengthening health systems and increasing coverage of interventions are crucial for further reducing child mortality.

Suicide has become one of the leading causes of deaths all over the world. It is considered as a global public health problem and a deviant behavior. People of different ages are committing suicide every day around the world for different reasons. University students, who are supposed to be the future of a country, are also accepting this path of deaths. Bangladeshi undergraduate students are also becoming the victims of suicide every day. In recent times, suicide ideation among the university undergraduate students is increasing. This article reveals the prevalence of suicide among the university undergraduate students and the factors associated with suicide ideation among the university undergraduate students of Bangladesh. It also focuses on the impact of these suicides on the family and society. To overcome this grave situation, some precautionary steps have been recommended at the end of this article.

Over the last two decades, studies about phlebitis have divided the risk  factors into four main groups: patient characteristics, therapy administered, health  professional practices and cannula characteristics. This study is aimed to identify the  associated risk factors attributing to thrombophlebitis in our hospital. All adult patients  admitted in Medicine wards and requiring intravenous cannulation over a period of one  year were included in this observational study conducted in the Department of Medicine,  Indira Gandhi Medical College (IGMC), Shimla, Himachal Pradesh. For quantitative  variables, means and standard deviations were calculated. Chi square test was applied to  determine the association between the use of different drugs and the occurrence of  thrombophlebitis. A p-value of less than 0.05 was considered to be statistically  significant. Based on our findings, we believe that if certain variables influencing the risk  of phlebitis (especially diabetes mellitus, infectious diseases and gender) are taken into  consideration, the rate of phlebitis can be reduced in high risk groups by: shortening the  intervals between catheter replacements, better supervision during insertion and  maintenance of catheters, use of milder irritant intravenous drugs, especially with respect  to antibiotics, and better control of underlying diseases. 
 

The use of organophosphates like Aluminum Phosphide and 2,2- Dichlorovinyl dimethyl phosphate compound (Sniper) also known as Dichlorvos has led to an increase in quantity and quality of Agricultural products. However, improper use of these chemicals can lead to poisoning. Suicides and deaths by accidental ingestion or inhalation of these chemicals are of great concern. Their toxicity is due to their ability to inhibit acetylcholine estarase at the cholinergic junction of the nervous system.

Breast cancer is the most common malignancy in females and second major cause of death among females. The most common sites of metastasis in breast cancer are bones, lungs, liver and brain. Very rarely breast cancer presents with metastasis to scalp. When metastasis to scalp is present, it is a sign of progression of disease. Here we are reporting a case of primary breast cancer treated radically presenting with scalp metastasis after ten years of treatment.

Background: Foreign body ingestion is most commonly seen in pediatric and psychiatric patients. Most common age group of children is 6 months to 3 years. In about 80% of cases, the ingested material passes uneventfully through the GI tract; endoscopy is performed in about 20% of cases; and surgery in less than 1% of cases. Commonly, majority of cases require no specific treatment and the swallowed objects pass through the digestive tract spontaneously without causing any significant complications. Overall risk of perforation is 1% and most common site is oesophagus. Other sites include pyiorus, duodenum, duodeno-jejunal flexture, ileo-caecal junction, Meckelʼs diverticulum or previous surgrical sites. Average time from foreign body ingestion to development of perforation was noted at 10.4 days in previous reports. Case Presentation: 22 years old male patient, known case of Schizophrenia presented with pain upper abdomen for one day. On per abdominal examination there was no tenderness, guarding and rebound tenderness .Abdominal plain film shows elongated radio opaque shadow in abdomen resembling knife. Exploratory laparotomy with entrotomy with retrieval of Fb (knife) from proximal jejunum with primary closure of entrotomy was done.

Mucositis is the breakdown of epithelial cells in the gastrointestinal tract. It is a common and painful side effect of treatment for many cancer patients. Oral cavity is a commonest site for mucositis however it can occur anywhere in the whole GI tract. Mucositis is very debilitating for patients and also lead to unwanted delays or dose reductions in life-saving treatments. Preventive strategies include good oral hygiene while treatment strategies mainly focus on the pain management. A stepwise treatment approach includes oral rinses, topical anaesthetics, and systemic analgesic agents.

Nutrition plays a significant role in maintaining the immune system to prevent pathogen manifestation. There is no particular prevention or treatment folio for SARS-CoV-2 infection which is also referred to as COVID-19, yet most of the cases are concerned with symptomatic therapeutic strategies and supportive management. Nutrition, infection, and immunity are interlinked together. The risk along with the severity of infections is often determined by nutrients from various foods effecting immune competence, hence nutrition is the core of human health well-being. It is essential to improve self-resistance and elevate the body’s immunity. Diversified and adequate nutrients intake with a healthy lifestyle is the key approach to boost-up an individual’s immunity. Many macronutrients, micronutrients, and other nutrients in foods and diet usually promote healthy immune responses of individuals. Balanced nutrition including adequate vitamin C, vitamin A, vitamin D, and zinc have shown promising immune-boosting roles in viral respiratory infections and SARS-CoV-2 management.

The research aims to find out the appropriate type of anesthesia in carotid artery resection and evaluation of complications after the operation, as 200 patients were collected from Kirkuk General Hospital, Kirkuk, Iraq. Relying on local and general anesthesia in surgery. Information and demographic data were collected from age, gender, in addition to the presence of patient-related diseases, coronary artery disease, and peripheral arterial disease, in addition to conducting a comparative study on the awake patient under anesthesia and with regard to complications that occur after surgery. There are slight moral differences between the types of anesthesia. General anesthesia is considered a safe and effective method in this process and reduces complications. Carotid endarterectomy is a surgical procedure in which plaque is removed from the carotid artery, Plaques are areas of fat accumulation in blood vessels. The plaque can narrow the opening in the carotid artery, reducing blood flow to the brain and increasing the risk of clots breaking up plaques and moving through the brain's vessels to cause a stroke.

Chylothorax is characterised by accumulation lymphatic fluid in the pleural cavity. Thoracic duct injury and resulting chylothorax, due to penetrating injuries of neck are very rare. We describe a case of chylothorax with surgical emphysema left side chest extending to neck post accidental stab wound zone1of neck left lower anterior region.

Dry eyes or dry eye syndrome is a condition in which the eyes do not produce enough tears .It is one of the most common eye conditions worldwide and a primary reason for visits to the ophthalmologist. Researchers reported that the prevalence of dry eyes ranges from 5 percent to as high as 50 percent in different populations across the world. Dry eye syndrome is caused by a chronic lack of sufficient lubrication and moisture on the surface of the eye. Consequences of dry eyes range from subtle but constant eye irritation to significant inflammation and even scarring of the front surface of the eye. Many factors can contribute to dry eye, such as the tears drying too quickly, the body not producing enough tears, eyelid problems, the use of certain drugs, and some environmental factors. In many cases, routine use of artificial tears and minor behavioral modifications (for example, taking frequent breaks during computer use) can significantly reduce dry eye symptoms. In other cases, doctor might recommend eye medications to help the body to secrete more tears and to decrease eye irritation and inflammation.

The 21st century has given way to a society increasingly dependent on a variety of digital technologies in personal, occupational, and institutional settings. Naturally, this has led to rising daily exposure to digital screens, such as desktops, smart phones, televisions, and tablets. Use of computers and display devices with a screen decreases the number of eye blinks, leading to incomplete blinking and evaporation of tears. So it’s probably not a big surprise that too much screen time can impact the vision and the health of eyes & subsequently leads to dry eye disease and rise in the prevalence of ocular complaints. Common visual symptoms include dryness and irritation, sensations of burning, asthenopia, epiphora, hyperemia, blurred vision, diplopia, glare sensitivity and transient deceptions in color perception. It affects millions of people across the globe. Therefore identifying and managing its underlying causes can help improve physical wellbeing and workplace productivity.

Extrapulmonary tuberculosis (EPTB) describes the various conditions caused by Mycobacterium tuberculosis infection of organs or tissues outside the lungs. There are many forms of EPTB, affecting every organ system in the body. Some forms, such as TB meningitis and TB pericarditis, are life-threatening, while others such as pleural TB and spinal TB can cause significant ill-health and lasting disability. Diagnosis of EPTB in rural areas itself is a challenge and bears considerable patient cost and time. Regional hospitals like ours have limited diagnostic facilities and patients have to travel to tertiary levels for further work up, diagnosis and management. Purpose of the study is to evaluate the spectrum of disease, its demographic profile and effectiveness of various modalities used in patient workup and diagnosis.

The Occupational Health and Safety Regulation defines musculoskeletal injury (MSI) defines musculoskeletal injury as a bodily lesion at the organic level, resulting from acute exposure to energy in amounts that exceed the threshold of physiological tolerance. The present study was designed with an aim to determine the pattern of musculoskeletal injuries presenting in district Kangra. Age group 45-60 years was most common age to suffer the traumatic musculoskeletal injuries. Outside home was the most commonplace for occurrence of injury. Road traffic accidents were the most common cause of injuries followed by fall from height.

Injury is the second leading cause of death among all age groups in rural India. Road traffic accidents, self harm and other mechanical forces were the leading cause of these injuries. 10-30 % admissions are due to road traffic accidents, most belonging to the poorer socio economic status with majority being pillion riders, motorcyclists and pedestrians. In road traffic accidents males with fracture of the femur are the commonest injuries followed by skull fractures. In this article we discuss the epidemiological pattern of the patients suffering from musculoskeletal injuries.

Borderline ovarian carcinomas account for about 16% of all epithelial ovarian malignancies. Of them most common is the serous subtype. It is a rare entity, difficult to differentiate from malignant carcinoma and good prognostic. Here we are reporting a case of serous borderline tumor in a 70 year old female treated with surgery alone and now on follow up.

Background: Owing to nutrition transition, faulty eating habits (increased consumption of sugar and salt, diet high in energy, fat, refined grains, and other processed foods, sweets, and savoury snacks), there is a rapid rise in NCDs. This study was done to evaluate the pattern of Visible Salt, Sugar & fat (Ghee/Oil/butter) consumption among the adult population of District Shimla. 

Methods: A descriptive cross sectional survey was conducted amongst the participants in the age group of 18 to 60 years, using google forms. The questionnaire was circulated among residents of district Shimla for responses. 

Results: A total of 400 respondents including 194 (48.5%) females and 206 (51.5%) males from district Shimla were participated in the study. Majority of their family 149 (37.3%) were taking 1 Kg of salt, 124 (31.0%) were taking 2 Kg of sugar and 125 (31.3%) were taking 1 Kg of visible fat (oil, ghee, butter) in a month. Mean salt consumption per person per day was 8.74± 5.592 gm. In males salt consumption was lower (8.66± 5.889 gm) than females (8.81±5.272 gm). Similarly salt consumption was lower in rural areas (8.47± 5.424 gm) as compared to urban areas (8.92± 5.711 gm). Mean sugar consumption per person per day was 20.23± 13.035 gm. In males sugar consumption was statistically higher (22.13± 14.637gm) than females (18.21±10.759 gm). Similarly sugar consumption was statistically higher in rural areas (23.44± 14.580 gm) as compared to urban areas (17.97± 11.327gm). Mean visible fat (oil, ghee, butter) consumption per person per day was19.19± 12.170 gm. In males visible fat (oil, ghee, butter) consumption was statistically higher (20.58±13.222 gm) than females (17.72±10.784 gm). Similarly visible fat (oil, ghee, butter) consumption was statistically higher in rural areas (21.00± 13.985 gm) as compared to urban areas (17.92± 10.562 gm). 

Conclusion:  Public health interventions to facilitate behavioral change to reduce salt sugar and oil intake must be instituted and encouraged.

Phyllodes tumor is a rare breast malignancy of stromal tissue. They are benign, borderline and malignant as per WHO criteria. The mainstay of treatment is surgery. These tumors mimic benign conditions and are tricky to diagnose. We are here reporting a rare case of Phyllodes tumor left breast in a 45 yr old female. She was treated with surgery for borderline Phyllodes tumor and owing to large size more than 10 cm and positive margins received adjuvant radiation therapy.

Abuse of legal substances in India includes alcohol and tobacco, which are the major risk factors for various non-communicable diseases and deaths. This study was done to evaluate the pattern of Smoking and Alcohol consumption among adult population of District Shimla. Methods: A descriptive cross-sectional survey was conducted amongst the participants in the age group of 18 to 60 years, using google forms. The questionnaire was circulated among residents of district Shimla for responses. Results: A total of 400 respondents including 194(48.5%) females and 206(51.5%) males from district Shimla were participated in the study. Among the participants of the majority 189(47.3%) were in age group of 31-40 years, 159(39.8%) were in Govt Job,338(84.5%) were graduate & above, 235(58.8%) were from urban area and 387(96.8%) were belong to Hindu Religion. Among the total 400 study participants, majority 45 (11.3%) were smokers. Majority of them (26) smoke daily. Most of the them (23) smoke 2 cigarettes daily on an average. Among the 194 females in the study, 3(1.5%) were smokers while among 206 males 42(20.4%) were smokers. So, males were significantly more smoker statistically. Among the total 400 study participants, majority 81 (20.3%) were alcoholic. Majority of them (46) took alcohol once weekly. Most of the them (31) took 3 pegs of alcohol on an average in one time. Among the 194 females in the study, 5(2.6%) were alcoholic while among 206 males 76(36.9%) were alcoholic. So, males were significantly more alcoholic statistically. Conclusion: To prevent the burden from legal substances like tobacco and alcohol abuse, a cost-effective non-pharmacological approach is required.

Trauma is a major public health problem worldwide leading to morbidity and mortality. Approximately one third of trauma patients have abdominal trauma.1 Trauma is reported to be the leading cause of death, hospitalization, and long-term disabilities in first four decades of life. In developing countries trauma in general and abdominal trauma in particular is increasing at a fast rate due to increase in urbanization, motorization, civil violence, wars and criminal activities & sports. The etiological spectrum and mechanism of injury in abdominal trauma, varies from one part of the world to another part due to variations in infrastructures, civil violence, wars and crime. In this article, we describe the involvement of the organs involved during the abdominal injuries.

Primary angiosarcomas of the breast are extremely rare tumors that constitute about 0.05% of all breast carcinoma. They are highly malignant with difficult diagnosis and poor survival. Here we are reporting a case of primary angiosarcoma breast in a 44 year old female. She was presented with a lump right breast for 2 months diagnosed with angiosarcoma breast. She underwent mastectomy for this. She is now receiving chemotherapy at our centre.

One hundred samples were collected from Baghdad Hospital. It was intended to know the detection, efficiency, and safety of intubation protocol with flexible bronchoscopy in patients with a difficult airway. METHODS: Models reviewed the medical records of patients diagnosed with airway difficulty who underwent flexible bronchoscopy for intubation on spontaneous ventilation and anesthesia with fentanyl, with a mean age of 40.3 ± 8.2 patients with airway difficulty (45%) Endotracheal intubation is the tube placement into the windpipe, either through the mouth (intubation tracheostomy) or nose (endotracheal intubation). Although airway maintenance and adequate ventilation are not synonymous with intubation, this secures and protects the airway while providing a closed ventilation system. Although intubation is a reasonably safe procedure in a stable patient and adequately oxygenated, it is not a technique without serious complications.

Radiation recall dermatitis (RRD) is an acute skin inflammatory reaction at previously irradiated area that is induced by the administration of certain agents after radiotherapy (Burris III, H. A., & Hurtig, J. 2010). Chemotherapeutic, non-chemotherapeutic agents and a few anti bacterials have been reported to induce RRD (Hird, A. E. et al., 2008). Tamoxifen and radiotherapy are used in breast cancer treatment all over the world. Here we report a case of radiation recall dermatitis induced by tamoxifen.

Cardiovascular disease (CVD) is the largest contributor to non-communicable diseases (NCDs) that are now responsible for the largest share of morbidity and mortality worldwide. The incidence of CVD, including coronary heart disease, heart failure, and stroke, as well as the prevalence of key risk factors, varies greatly according to geographical region, gender, and ethnic background. Multiple longitudinal epidemiological studies have provided valuable insights into the natural history and risk factors associated with the development and prognosis of CVD. Through this article, we describe the risk factor assessment for cardiovascular diseases.

Cardiovascular system consists of three components: heart, blood vessels and blood, and participates in maintaining of internal body homeostasis in many aspects: transport of oxygen, carbon dioxide, nutrients, metabolism waste products, and hormones to and from every single cell in the body. The blood vessels are composed of three separated layers: intima, media and adventitia. The intima consists of single layer of endothelial cells that have crucial role in regulation of blood flow. Media is dominantly composed of vascular smooth muscle cells, and represents the thickest layer. The adventitia is outer layer made of connective and fat tissue that have protective role of other inner layers. Blood vessels differ depending on part of circulation to which it belongs (arterial, capillary or venous), or of specific needs and functions of tissues and organs in which it is located.

Background: Malnutrition is a health problem which develops as a result of insufficient food nutrients supplied to the body. Mothers are responsible for baby’s nourishment; with sufficient knowledge, they can protect their children from this health problem. Present study was carried out to evaluate the knowledge towards malnutrition among mothers having under 5 children residing in rural areas of District Sirmaur. 

Methods: This cross sectional study was conducted between March 2021- August 2021 among postnatal mothers who came in Pediatric OPD in civil hospital Dadahu selected by convenience sampling technique. Data was collected through face-to-face interviews using a semi-structured questionnaire. Data was analyzed using epi info v7 software using appropriate statistical tests. 

Results: A total of 400 Mothers came to Pediatric OPD and having children aged less than 5 years were selected after explaining the purpose of the study. Among the total mothers, maximum 246(61.5%) were having age between 26-30 years, educated up to Matric & Senior Secondary 182(45.5%) Hindu 329(82.25%), Housewife 359(89.75%), Multigravida 309(77.25%) and delivered in government hospitals 282(70.5%). In the present study 11.75%(47) mothers’ had very good knowledge (16-20 marks) towards malnutrition , 67.0%(268) having good knowledge  (12-15 marks), 13.0%(52) having fair knowledge  (8-11 marks) and 8.25% (33) having poor knowledge  (<8 marks). 

Conclusions: The present study concludes that the mothers have a good knowledge toward malnutrition. Appropriate education emphasizing timely initiation of breastfeeding, complementary feeding and meal diversity is necessary to improve the nutritional status of under 5 children.

Human T-lymphotropic viruses (HTLV) and human immunodeficiency viruses (HIV) are two distinct family members of Retroviridae causing significant infections worldwide. These viruses have common modes of transmission and share an in vivo tropism for cells of the immune system particularly T lymphocytes, resulting into co–infections of a number of individuals worldwide. The study was conducted to determine the seroprevalence of HTLV 1/2 infection among HIV patients. ELISA kit (Nanjing Pars Biochem, China) was used to detect the presence of HTLV 1/2 antibodies. A total number of 381 HIV patients consisting of males (123) and females (258) aged 18-59 years were tested. Of the 381 HIV patients tested, 288 (75.6%) were positive for HTLV 1/2 using ELISA kit. The prevalence of HTLV 1/2 was significantly higher among patients in the 30-39 years’ age group (24.4%). The prevalence of HTLV 1/2 was significantly higher among female’s HIV patients 195 (51.2%) than males 93 (24.4%). This study indicates a high prevalence of Human T-Lymphotropic virus 1/2 infection among HIV patients although there was a limitation in this study because a confirmatory test using a molecular test was not performed due to lack of financial capability and time factor. Finding from this study may justify the need for a further research and study of HTLV 1/2 among HIV patients to know if there is co-infection between the two. And also a more sensitive and specific assay should be used to confirm it like PCR or Western Blot or LIA test.

Background: Pulmonary artery Hypertension (PAH) Is a Common Complication of Interstitial Lung Diseases (ILDs), Particularly in Idiopathic Pulmonary Fibrosis and ILD Associated with Connective Tissue Disease. The present study was done to evaluate the association of clinical symptoms and signs with Pulmonary artery hypertension (PAH) among Interstitial Lung Diseases (ILDs) patients. Material and Methods: This cross-sectional study was conducted at Indira Gandhi Medical College, Shimla from July 2018 to June 2019. All consecutive patients of all types of ILDs, attending the outpatient services of the Department of Pulmonary Medicine, IGMC Shimla were enrolment and subjected to focused socio-demographic, Pulmonary Artery Hypertension (PAH) & clinical history. Data was analyzed using Epi info V7 software by applying appropriate statistical tests. Results: The present study includes 50 patients of different types of ILD. Out of 50 patients, 44 (88%) had PAH. Among 50 patients, majority were dyspnoea of grade II 9(43.3%) and grade III 21(47.7%) with PH group with a p value of 0.35. Out of 50 patients, 43 (97.73%) patients had a cough, with PH group with a p -value of 0.88. Out of 50 patients, 17 (34%) had chest pain among these 17 (38.84%) patients had PH with a p -value of 0.06. Out of 50 patients, 16 (32%) had exertional syncope, 13 (29.55%) were in PH group, with a p-value of 0.28. Out of 50 patients 32 (64%), patients had clubbing, 30 (68.18%) patients were in the PH group, with a p- value of 0.11.Out of 50 patients, 11(22%) had raised JVP, 9(20.45%) patients were in the PH group, with a p-value of p of 0.25.Out of 50 patients, 29 (58%) had velcro crackle on occultation, 27 (61.36%) were in the PH group, with a p- value of 0.19. Conclusion: There was very high prevalence of PAH among ILD Patients. Clinical sign and symptoms like dyspnoea, cough chest pain, exertional syncope, clubbing, raised JVP, velcro crackle was more prominent among patients of PAH as compared to those who didn’t had PAH. But there was no statistically difference among various clinical sign and symptoms.

Background: The trend of delaying pregnancy is present worldwide, in both low and high income countries. The purpose of this study was to determine the socio-demographic factors associated with elderly gravida which would help us subsequently, in delineating the management of elderly gravid. Material & methods: This prospective study was carried out in the department of Obstetrics and Gynaecology at Kamla Nehru State Hospital for Mother and Child, Indira Gandhi Medical College, Shimla for one year period from 1st July 2018 to 30th June 2019. All participants were divided into two groups Group1 (Study Group) had consisted of all pregnant women with age 35 years or more while Group 2 (Control Group ) consisted of Every pregnant woman with age ≥20 to ˂35 years, who gets enrolled in the labor room admission register next to a case, was taken as a control. Comparative data of the two groups was subjected to statistical analysis. Results: There were 6922 deliveries out of which 415 subjects were >35 years, the incidence was 6.00%. It the study group, 349(84.10%) were between 35-39 years and 66(15.90%) were 40 years and above. Out of 415 subjects in the control group, 117(42.65%) were of 20-24 years, 148(35.66%) were of 25- 29 years and 90 (21.69%) were of 30- 34 years. Maximum (76.87%) were booked in the study group as compared to control group (92.77%). More number of women in the study group (26.99%) belonged to urban area as compared to control group (23.86%). A higher number of women were professional or employed (10.12%) in the control group and was as compared to study group (5.34%).Comparable number of women in the study group (4.82%)were graduates or post graduates as compared to control group (5.78%). Multi-parity was more in the study group (91.33%) as compared to control group (31.57%).Majority of women (68.43%) in the control group were primiparas as compared to study group (8.67%). Conclusion: The incidence elderly pregnancy was low in the present study. Maximum numbers of subjects were booked, literate, from rural areas and were housewives. Multiparty was more in the study group as compared to control group.

Bacterial conjunctivitisis an inflammation of conjunctival tissue of the eye cause by bacteria. This study aimed to isolate and identify the bacteria causing conjunctivitis and their antibiotic susceptibility, among patients of different age groups attending some eye clinics in Sokoto. Conjunctival swabs were collected from 410 patients attended to Specialists Hospital and Noma children Hospital Sokoto. The swabs were directly inoculated onto blood agar, MacConkey agar, mannitol salt agar and chocolate agar. All isolated organisms were identified by standard biochemical methods and tested for their in vitro antimicrobial susceptibility against various antibiotics using Kirby-Bauer disk diffusion method. The percentage prevalence of bacterial conjunctivitis in the study population is 30.9%. The highest prevalence occurred among infants and children of age group less than 15 years 58.8%. Various bacterial agents isolated includes Staphylococcus aureus, coagulase negative Staphylococci, Escherichia coli, Pseudomonas aeruginosa and Proteus mirabilis. Staphylococcus aureus showed the highest prevalence 47.1%. All bacterial agents isolated were sensitive to gentamicin, ciprofloxacin and chloramphenicol, while Staphylococcus aureus and coagulase negative Staphylococci were resistant to tetracycline, erythromycin and ampicillin. Hence, Gentamicin, Ciprofloxacin and Chloramphenicol are appropriate antibiotics.

Different body positions have different effects on the health status of preterm neonates. However, results of the previous studies are an area of ongoing doubt. In this regard, a study was undertaken to evaluate the effect of left lateral positioning versus right lateral positioning on gastric emptying and selected physiological parameters in terms of heart rate, respiratory rate, oxygen saturation among neonates admitted in NICU/SNCU of Medical College and Hospital, Kolkata, West Bengal. The conceptual framework adopted for the study was ‘Prescriptive model’. Among the population of admitted neonates, 45 neonates were selected as sample, by using non-probability purposive sampling (Left lateral group-15, Right lateral group-15 and Control group-15). A quasi-experimental time series design was used. Ethical permission was taken from the Institutional Ethics Committee.  a 5 ml disposable syringe, pulse oximeter, and record sheet were used as tools. Final data has been collected from October 2019 to December 2019. On each observation day,  garbage feeding was given to the neonates. After feeding, they were placed in left lateral position (Exp-I) and right lateral position (Exp-II). After 2 hrs.of positioning, at first, physiological parameters were assessed. Then, the gastric residual volume was measured and recorded. The result  revealed from ANOVA that, in right lateral position the gastric residual volume was less, than left lateral position in all the observations, which is evident from ‘F’ value [F=3.290*,4.942*,3.365*]and [F=8.546*,7.986*,9.620*] at P<0.05 . But, there was  no significant difference in physiological parameters. Furthermore, ‘t value df (28)=1.70 p<0.05 also showed the significant difference of gastric residual volume between two groups. The study concludes that gastric emptying is faster in right lateral position than left lateral position; and, no effect of any position on physiological parameters. The study has great implications in nursing practice by placing the neonate in the right lateral position after feeding for adequate gastric emptying. Similar study can be conducted with a larger sample and with different study design for generalization.

Background: Decline in fertility and an increase in pregnancy wastage with advancing age present a new challenge for the clinician treating infertility. The purpose of this study was to assess the Infertility and Early Pregnancy Outcome among Elderly Gravida. Material & Methods: This prospective study was carried out in the Department of Obstetrics and Gynecology at Kamla Nehru State Hospital for Mother and Child, Indira Gandhi Medical College, Shimla for one year period from 1st July 2018 to 30th June 2019. All participants were divided into two groupsGroup1 (Study Group) had consisted of all pregnant women with age 35 years or more while Group 2 (Control Group) consisted of Every pregnant woman with age ≥20 to ˂35 years, who gets enrolled in the labor room admission register next to a case, was taken as a control. Comparative data of the two groups was subjected to statistical analysis. Results: There were 6922 deliveries out of which 415 subjects were >35 years, the incidence was 6.00%. It the study group, 349(84.10%) were between 35-39 years and 66(15.90%) were 40 years and above. Out of 415 subjects in the control group, 117(42.65%) were of 20-24 years, 148(35.66%) were of 25- 29 years and 90 (21.69%) were of 30- 34 years. Multiparity was more in the study (91.33%) as compared to control group (31.57%). Majority of women (68.43%) in the control were primiparas as compared to study group (8.67%). History of infertility was present in 8.67% subjects in the study and 2.17% in the control group which was statistically significant. Use of assisted reproductive techniques was seen in30 (7.23%) subjects in the study group which was higher than that seen in control group 9(2.17%). Ectopic pregnancy was present in 39 (9.40%) subjects in study group and 9(2.17%) subjects in control group. 48(11.57%) subjects had abortion in the study group and 12(2.89%) subjects had abortion in control group. Conclusion: History of infertility, use of assisted reproductive techniques, ectopic pregnancy and history of abortion was significantly more in Elderly Gravida as compared to control group.

The research and study devote efforts to assess and know the Role of Vitamin 25-Hydroxy (D) In Promoting Health and Contributing to Iraqi Children; data on 70 children were collected from Karbala Health Directorate, Center Sector, Karbala, Iraq. The proportion was divided into two parts, 50 children, males, 20 children, women children. The children's ages ranged between 2 to 8 years, and through the statistical analysis program, the true value and the standard regression were identified to ages 5.3571 + 2.23954. The study was conducted in the period 3-4-2020 to 8-8-2020; in addition, in this article, we analyze the characteristics of vitamin D synthesis depending on the gender and age of patients.

Despite extraordinary advances, Cancer poses as a yet unmet threat to global public health with the number of cases surging drastically each year. At a time when conventional diagnostic and therapeutic modalities are challenged by the lack of target specificity, multi drug resistance, tradeoff between safety and efficacy, Cancer nanotechnology is an emerging branch that links nanotechnology and clinical research overcoming some of the most challenging impediments. Nanomaterials are characterized by a size of 1- 100nm and nanotechnology is the micromanufacturing by manipulating shapes and size at Nano length. Materials at nanoscale acquire high surface area, dominance of quantum effects and various electric, magnetic, thermal properties, while at the same time by the virtue of molecular scale, interact with biological systems at cellular level. Tailor made nanoparticles including carbon based, metallic, polymeric, surface functionalized, have shown target specificity, sensitivity and efficacy reaching otherwise unapproachable cancer targets. Quantum dots, nanowires, gold, magnetic nanoparticles have proven successful in enhanced imaging, detecting low concentration biomarkers providing prospects for early and accurate cancer detection. Nanotherapeutics, having improved half-life in blood, increased drug loading capacities, controlled release and multidrug delivery capacities has shown higher efficacy and better safety profiles. By integrating diagnostic and therapeutic functions into a single Nanoparticle formulation, theranostic nanomedicine offers a promising strategy providing prospects for future personalized medicine. However, there are barriers impeding clinical translation. Therefore, while addressing these limitations, this review aims to summaries developments in nanotechnology for cancer diagnosis and therapy for better patient outcomes in the future.

dMycosis Fungoides is the commonest cutaneous T cell lymphoma. Clinically it is characterized by patch, plaque, tumour nodules; erythrodermic and poikilodermas stages which may overlap. Based on clinical symptoms, histology and immunostaining, these patients are then diagnosed with Mycosis Fungoides. As it has similar clinical features with other diseases so early diagnosis in these patients is often difficult. In patients with a history of chronic and progressive dermatosis, regular observation and repeat biopsy is necessary.

We report a case of 20 years old male with chondromyxoid fibroma antero-lateral aspect of left foot. The patient underwent wide local excision with extensor retinaculum repair with flap. Histopathological features suggestive of chondromyxoid fibroma and margins were involved, so patient was further taken up for local radiotherapy.

In different fields of study cumulative growth models over time have played and still play an important role. The objective of the research was to compare the Weibull model with the ROR methodology based on the cumulative number of new cases of COVID-19 that affected Iraq in the year 2020. The cumulative daily new cases of the COVID-19 pandemic were modeled, where a linear mathematical model was obtained through the methodology of Regressive Objective Regression (ROR), which explains the behavior of the same, depending on 15 days in advance and was compared with the non-linear Weibull model for the same data. With the linear ROR methodology, better results were obtained, since the variance explained was 100% and the F statistic was also higher and the calculation of the Root Mean Square Error (RMSE) was improved by 72.38%; in addition, in six parameters the linear model outperformed the non-linear model. It is concluded that the cumulative cases of COVID-19 can be modeled with both models and even the cumulative cases of this new disease in the world can be predicted 15 days in advance by means of the mathematical modeling ROR, which allows reducing the number of dead, severe and critical patients for a better management of the pandemic, in spite of being the first time that a ROR model is applied to the processes of growth in the data with respect to time.

Mycosis fungoides is the commonest cutaneous T cell lymphoma. Clinically it is characterized by patch, plaque, tumour nodules; erythrodermic and poikilodermas stages which may overlap. Based on clinical symptoms, histology and immunostaining, these patients are then diagnosed with Mycosis Fungoides. As it has similar clinical features with other diseases so early diagnosis in these patients is often difficult. In patients with a history of chronic and progressive dermatosis, regular observation and repeat biopsy is necessary.

Exposures to arsenic and obesity (high BMI) have been associated with oxidative stress and health dysfunctions, but the severity of arsenic poisoning and susceptibility might depend on various factors, such as the body mass index (BMI), oxidative status, food supplementations etc. This study assessed the ameliorative potential of quercetin on arsenic induced health dysfunctions in normal and high BMI male Wistar rats. Forty eight apparently healthy rats were assigned into eight groups of six rats each based on their BMI. The rats were administered arsenic (40 ppm) for six weeks and subsequently quercetin (50 mg/kg bodyweight) for four weeks, such that; groups A and B were normal and high BMI respectively, administered distilled water; groups C and D were normal and high BMI rats respectively, administered arsenic; groups E and F were normal and high BMI rats respectively, administered quercetin; groups G and H were normal and high BMI rats respectively, co-administered arsenic and quercetin. Concentrations of reduced glutathione (GSH), oxidized-low density lipoprotein cholesterol (Ox-LDL-C), 8-hydroxydeoxyguanosine (8-OHdG), interleukin-1β (IL-1β), vascular cell adhesion molecule (VCAM-1) and monocyte chemoatracttant protein-1 (MCP-1) were determined in plasma. Organ to body weight ratios were insignificant (p>0.05) across the groups. Serum GSH level increased (p<0.05) in groups D and E, while Ox-LDL-C and 8-OHdG levels increased (p<0.05) in group G and H respectively. Concentrations of IL-1β and VCAM-1 were insignificant (p>0.05) across the groups and MCP-1 increased (p<0.05) in groups B, C, E, F, G and H. Histological assessments of the brain, heart and liver indicated mild to moderate alterations. The foregoing indicated that arsenic exposure induced dysfunctions in the oxidative indices and immunological proteins (health indices) that were exacerbated in the high BMI rats, and quercetin administration did not have ameliorative capabilities against arsenic and High BMI induced health dysfunctions.

Hepatoid adenocarcinoma of stomach is a rare and clinically aggressive tumor. Most of these cases are associated with increased production of alpha fetoprotein, but not all AFP producing tumors have hepatoid features histologically. We report a case of 64 years male, with elevated Alpha Fetoprotein levels. The patient underwent gastrectomy. HPE suggested a diagnosis of hepatoid adenocarcinoma. PAS staining also revealed PAS positive hyaline globules.

Context: The incidence of breast cancer is steadily rising in India. The management and prognosis of breast cancer requires evaluation of Estrogen Receptor (ER), Progesterone Receptor (PR) and HER-2/neu as they have a great influence on the clinical outcome. Receptor status has thus become most informative in the molecular classification of breast tumours and their clinical assessment for treatment and further outcome. Aims: To assess the age incidence, gender predilection along with incidence of ER, PR, HER-2/neu in breast cancer at our institution. Settings and Design: Study population comprised of all patients with carcinoma breast (women and men) which have been proved on histopathology. Study design: Prospective study. Methods and Material: About 151 cases of breast carcinoma received in the department of pathology of Indira Gandhi Medical College, Shimla over a period of 24 months (May 2014 to May 2016) were analyzed with reference to ER, PR and HER-2/neu reactivity pattern. The histological type and grade of the tumour were analyzed and correlated with receptor status. Statistical Analysis Used: Descriptive statistical analysis and presented in terms of percentage. Results:  Age of the patient varied from 23-92 years, the mean age being 49 years. 97.4% cases were female patient while, males constituting 2.6% cases. The mean age in male patients was 64.5 years. Majority of the tumours were infiltrating ductal carcinoma- Not Otherwise Specified (NOS) and histologically grade II predominantly. Majority of the cases belonged to luminal A category, followed by triple negative tumours. Conclusion: Prognostic accuracy improves with incorporation of IHC into the histopathology report along with the traditional TNM staging and histological grading. The determination of receptor status is also helpful in planning the appropriate treatment of the patient.

Over the last two decades, studies about phlebitis have divided the risk  factors into four main groups: patient characteristics, therapy administered, health  professional practices and cannula characteristics. This study is aimed to identify the  associated risk factors attributing to thrombophlebitis in our hospital. All adult patients  admitted in Medicine wards and requiring intravenous cannulation over a period of one  year were included in this observational study conducted in the Department of Medicine,  Indira Gandhi Medical College (IGMC), Shimla, Himachal Pradesh. For quantitative  variables, means and standard deviations were calculated. Chi square test was applied to  determine the association between the use of different drugs and the occurrence of  thrombophlebitis. A p-value of less than 0.05 was considered to be statistically  significant. Based on our findings, we believe that if certain variables influencing the risk  of phlebitis (especially diabetes mellitus, infectious diseases and gender) are taken into  consideration, the rate of phlebitis can be reduced in high risk groups by: shortening the  intervals between catheter replacements, better supervision during insertion and  maintenance of catheters, use of milder irritant intravenous drugs, especially with respect  to antibiotics, and better control of underlying diseases. 
 

Thrombophlebitis is the inflammation of the vessel wall due to the formation  of blood clot. Clinical signs of phlebitis are localized redness, warmth, swelling and  palpable venous cord . Over the last two decades, studies about phlebitis have divided the  risk factors into four main groups: patient characteristics, therapy administered, health  professional practices and cannula characteristics. This study was aimed to identify the  associated risk factors in patients admitted in the medicine department at I.G.M.C Shimla.  Chi square test was applied to determine the association between the use of different  drugs and the occurrence of thrombophlebitis. A p-value of less than 0.05 was  considered to be statistically significant. Male gender, presence of Type 2 Diabetes  Mellitus, Consumption of alcohol and smoking status, and the presence of BMI more  than 23 were found to be strong independent risk factors for thrombophlebitis among our  study participants. Control of these factors might prove useful in reducing the incidence  of Thrombophlebitis. 

Background: The initial clinical assessment of patients with Blunt trauma Abdomen (BTA) is often difficult and notably inaccurate. So, this study was done to determine the socio-Demographic and etiologic Profile of Blunt Trauma Abdomen patients in a tertiary care Hospital. Material & Methods: This Observational prospective study was conducted from July 2018 to December2019 and included all Blunt Trauma Abdomen (BTA) patients admitted in study period at advanced trauma center, PGIMER Chandigarh. Pattern, prevalence, non-operative versus operative management and outcome in term of mortality and morbidity were monitored. Results: Seventy-five patients admitted to ATC during study period were selected for the study. The most common age group affected was 16-30 years which constitute 42(56%) of total affected. Ninety two percent (n=69) of affected population were males whereas 8% (n=6) were females. Pain abdomen was the most common chief complaint (93.3%, n=70) in patients of blunt trauma abdomen followed by abdominal distension in 58.7% of patients (n=44). 81.3% patients had GCS of 15 and 14.6% of patients had GCS of 12 to 14. 3.99% patients had GCS of 9 to 10.Abdominal tenderness was the most common sign present in 76% (n=57) of cases followed by Rigidity (46.67%, n=35) .In the study, 22 patients had tachycardia and 20 had hypotension. Maximum BTA patients 26 (34.7%) had Abbreviated injury scale (AIS) score of 2& 3 each. Conclusion: Abdominal pain was the most common presenting symptom and abdominal tenderness was most common sign at presentation. Tachycardia and Hypotension was present in quarter of patients at presentation Maximum BTA patients had AIS score [2,3].

In this paper a combined exponential ratio- type estimator has been proposed for estimating population mean of characteristic under study. The expressions for bias and mean square error have been derived up to first order of approximation and found that the optimum mean square error of proposed estimator is equal to the mean square error of combined linear regression estimator. Efficiency of proposed estimator is compared theoretically with existing estimators and supported by numerical illustration.

The epigenetic modification is necessary to decondense the DNA in the transcription region so that the further transcription process can proceeds. Acetylation by HAT causes the activation of the transcription and deacetylation by HDAC causes the deactivation of the transcription process. So, the epigenetic modification can act as a switch to turn on and turn off the transcription. Gene regulation can be control by this switching mechanism. The imbalance in acetylation and deacetylation can leads to several disorders which cause many diseases such as cancer, tumours, cardiological and vascular disease, neurological disease. HAT and HDAC inhibitors are now being utilised in clinical research and medication development.

The study was conducted in Al-Hussein Teaching Hospital, Thi-Qar, Iraq. With the development of surgery, it became apparent that laparoscopic operations, including appendectomy, are a good alternative open operation, including in pregnant women. This paper aims to improve the way video laparoscopy in pregnant women with acute appendicitis. Data were collected for pregnant women who underwent appendicitis surgery from Al-Hussein Teaching Hospital, Thi-Qar, Iraq. 10 women who underwent appendectomy and surgical intervention were separated. Treatment of acute appendicitis during pregnancy is also a challenge for surgeons. There is a large number of papers indicating the risks and benefits of both open and laparoscopic appendectomy. The main risk is associated with abortion after laparoscopy. The article discusses the safety issues of diagnostic procedures and laparoscopic interventions during pregnancy, surgical tactics in acute appendicitis, and independent risk factors for abortion.

Background: Ophthalmic manifestations of HIV infection are diverse. Both anterior and posterior segments of the eye can be involved and it may even lead to blindness. Keratoconjunctivitis sicca or dry eye occurs in later stages of the disease in 10 -20% of the patients. Aim: Present study was planned to see the correlation between level of CD4 count with the severity of dry eye in HIV seropositive patients. Material and Methods: The study was a hospital based cross – sectional study where 120 HIV-positive patients between 18 to 50 year of age group, registered at the ART centre and referred to Ophthalmology OPD for ocular complaints were included in the study. Subjects were investigated for dry eye with ocular surface disease index score (OSDI), Rose Bengal staining, Schirmers test 1 with and without anaesthesia & Tear Film Break Up Time (TBUT). Results: Significant mild positive correlation was seen between CD4 count and Schirmer-1 test without anaesthesia score (r value =0.23; p value <0.001), Schirmer -1 with anaesthesia score (r value =0.22; p value <0.001), Tear Film Breakup Time (TBUT) (r value =0.28; p value <0.01) but no correlation was seen with OSDI score (r value = -0.01; p value =0.83). Conclusion: Dry eye in people with HIV should not be looked down upon and should be treated for the same. CD4 count can also give indication severity of dry eye.

Spinal anesthesia involves the use of small amounts of local anesthetic injected into the subarachnoid space to produce a reversible loss of sensation and motor function. Spinal anesthesia is often used for orthopedic surgery especially in lower limb surgeries. However, because of the high prevalence of hypotension and bradycardia risk is always there especially in elderly age group because of their compromised hemodynamic status. If it was possible to limit anesthesia for the surgical field, certain undesirable effects of spinal anesthesia could be avoided. a conventional unilateral spinal anesthesia technique can only result in a motor hemiblock and a sensory block preferential to one side but achieving unilaterality is not an easy task as numerous factors come into play.

We read with interest the article by Allen et al. about four patients experiencing bifacial muscle weakness with paresthesias within 3 weeks after vaccination with a vector-based SARS-CoV-2 vaccine being classified as Guillain-Barre syndrome (GBS) variant [1]. Three patients profited from intravenous immunoglobulins (IVIGs) or steroids, and one recovered without treatment [1]. It was concluded that neurologists should stay vigilant for GBS in patients having been vaccinated with a SARS-CoV-2 vaccine [1]. The study is appealing but raises comments.

Development of a GBS in response to a SARS-CoV-2 vaccination is rare but has been previously reported [2,3,4,5]. Post-SARS-CoV-2 vaccination GBS has been found in a 32yo male who developed GBS, subtype acute, inflammatory, demyelinating polyneuropathy (AIDP), eight days after the first dose of a vector-based SARS-CoV-2 vaccine [2]. This patient had a previous history of AIDP 14 years earlier from which he recovered completely. He profited from two IVIG cycles and plasmapheresis but is still handicapped and currently undergoing immune-adsorption [2]. A second case refers to a 69yo female who developed AIDP 39d after the first dose of a vector-based SARS-CoV-2 vaccine and 15d after having been tested positive for SARS-CoV-2. In a 86yo female GBS was diagnosed one day after having received the first dose of an mRNA-based SARS-CoV-2 vaccine [3]. She recovered only partially under IVIGs [3]. A further patient with SARS-CoV-2 vaccination associated GBS concerns a 82yo female who developed GBS two weeks after the first dose of an mRNA-based SARS-CoV-2 vaccine [4]. Since she had not undergone nerve conduction studies, no GBS subtype could be defined. GBS. Seven patients with SARS-CoV-2 vaccination associated GBS were reported from India (table 1). All of these patients had cranial nerve involvement [5]. The VAERS registry does not list GBS as an adverse reaction to SARS-CoV-2 vaccinations. 

A further limitation of the study is that the outcome of the four presented cases was not described in detail. We should be told if IVIGs or steroids were beneficial and if four patients recovered completely or incompletely.

Another limitation of the study is that patient four did not undergo nerve conduction studies (NCSs). Diagnosing GBS according to the validated Brighton criteria requires application of NCSs. For diagnosing GBS according to the Brighton criteria CSF cell counts <50 cells/ml are required. 

Overall, the interesting study has some limitations, which challenge the results and their interpretation.

The aim of postoperative pain management is to provide subjective comfort in addition to inhibiting trauma-induced nocioceptive impulses to blunt autonomic and somatic reflex responses to pain. The brachial plexus supraclavicular block is extremely useful in patients with significant co-morbidities such as severe respiratory and cardiovascular disease, morbid obesity and in those with potential airway difficulties. It provides a superior quality of analgesia and avoids the common side-effects associated with general anesthesia such as postoperative nausea and vomiting. Out of various agents which are used for brachial plexus block, levobupivacaine is the agent which not only prolongs motor and sensory blockade but is also less cardiotoxic and neurotoxic.

The aim of postoperative pain management is to provide subjective comfort in addition to inhibiting trauma-induced nocioceptive impulses to blunt autonomic and somatic reflex responses to pain. The brachial plexus supraclavicular block is extremely useful in patients with significant co-morbidities such as severe respiratory and cardiovascular disease, morbid obesity and in those with potential airway difficulties. It provides a superior quality of analgesia and avoids the common side-effects associated with general anaesthesia such as postoperative nausea and vomiting. Out of various agents which are used for brachial plexus block, levobupivacaine is the agent which not only prolongs motor and sensory blockade but is also less cardiotoxic and neurotoxic.

Background: post-operative wound dehiscence, being an unfortunate and a very serious surgical complication which is associated with a high morbidity and mortality rate despite the most sophisticated intensive care. The present study was done to compare the rate of abdominal wound dehiscence by using continuous Vs Interrupted X suture technique in closure of rectus sheath after midline laparotomies. Material and Method: The present cross-sectional study was conducted in the Department of General Surgery, Indira Gandhi Medical College and Hospital, Shimla, Himachal Pradesh from June 2018 to December 2019. The patients who require midline laparotomy either as emergency or elective procedure were randomized into two groups, Group 1 and Group 2. The patients included in Group 1 underwent closure of rectus sheath with conventional continuous closure technique and patients included in Group 2 underwent closure of rectus sheath with interrupted X suture technique.  A total of 100 patients were included in each group. Results: In current study the common indication of midline laparotomy was hollow viscus perforation and D1 perforation i.e perforated duodenal ulcer was the most common indication in both groups. In this study there were 79% males and 21% females in Group -1 while there were 89% males and 11% females in Group 2. In group 1, age of the patients varied from 18–75 years with a mean age 47.08 years and SD ± 15.81. In group 2, age of the patients varied from 18-75 years with a mean age of 45.65 years and SD ± 14.93 In Group 1, out of 100 patients wound dehiscence occurred in 32  cases while in Group 2, out of 100 patients wound dehiscence occurred in 6 cases.  Patients with age group of 56-65 years found to have highest 10 (26.32%) incidence of abdominal wound dehiscence. Conclusion: Patients with age group of 56-65 years found to have highest incidence of abdominal wound dehiscence. Using interrupted X suture technique in sheath closure; the risk of wound dehiscence can be reduced up to quite an extent.

300 Down syndrome patients and 50 control groups were collected from AL-Hussein Medical City, Karbala, Iraq, which study aimed to Describe COVID 19 effectiveness on Down syndrome. The samples were divided into two groups. The first group was ISARIC4C individuals with Down syndrome, and the second group was T21RS individuals with Down syndrome. The questionnaire was relied on to know the answers from the infected patients, and the period of study was between 4 April 2020 to 3 February 2021. Among the deaths with Down syndrome, 40% of deaths were associated with the Coronavirus, while among people without the syndrome, it was only 20%. Considering cardiovascular and respiratory diseases, the scientists found that the risk of hospitalization associated with COVID-19 for Down syndrome was four times higher, and deaths related to COVID-19 - 10 times.

Background: Mammographic density has been shown to be a strong independent predictor of breast cancer and a causative factor in reducing the sensitivity of mammography. The risk of breast cancer related to changes in breast density over time, including its regression and persistence, remains controversial. The present study was done to evaluate the impact of malignancy on Breast Density. Material and Methods: Present study was conducted in the Department of General Surgery and Radio diagnosis IGMC Shimla from 1st July 2018 to 30 June 2019. A total of 60 were included and evaluated in the present study. These patients were divided into two groups. Group (A) included 30 patients with biopsy proven carcinoma of the breast while Group (B) included 30 patients with benign breast lesions or pain breast. Results: The mean age of patients presenting in Group A was 55.4±10.9 years and the mean age of the patients presenting in Group B was 54±9.84years respectively. In Group A of 30 cancer patients, majority of patients i.e 21patients (70%) had breast density of Type B. In Group B also, majority 20 patients (66.7%) had breast density Type B. In Group A out of 30 cancer patients, 10patients (i.e.33.3%) were BIRADS 4,14 patients (46.7%) were BIRADS 5 and 6 patients (20%) were BIRADS 6. In Group B out of 30 patients, 6 patients (i.e.20%) were BIRADS 1,12 patients (40%) were BIRADS 2 and 12 patients (40%) were BIRADS 3. In Group A of 30 cancer patients ,27 patients were diagnosed with duct cell carcinoma (90%) while 2 patient were reported as lobular carcinoma (6.7%) and 1 patients was diagnosed with tubular carcinoma(3.3%) . In Group B out of 30 patients, 2 patients (6.7%) were diagnosed as acute mastitis, 19 patients (63.3%) were diagnosed as Fibro-adenoids, 3patients (10%) were diagnosed as Fibro-adenoma. Conclusion: Maximum patients in this study were in the age group of 40-60 year. Most breast cancer patients had higher BIRADS 5 and 6 , had breast density of Type B and majority of were reported as Duct Cell Carcinoma. Most of the benign breast disease patients had BIRADS2 and 3, had breast density of Type B and majority of were reported as Fibro-adenoids.

In the present article, we have proposed a modified ratio-cum-product type estimator for estimating population mean of the characteristic under study in simple random sampling scheme. The expressions for the bias, mean square error and optimum mean square error are derived up to the first degree of approximation and found that the optimum mean square error of the proposed estimator is equal to the mean square error of the linear regression estimator. The theoretical and empirical studies carried out reveals that the proposed estimator performs better than the estimators provided in the article.

Introduction: The management of concomitant gall bladder and CBD stones has evolved significantly over the past 20-30 years. In the era of open surgery, open CBD exploration (choledocholithotomy) used to be performed if any common bile duct stones were identified at cholangiography. Following the introduction of ERCP, open CBD exploration was reserved for patients with failed ERCP. Material and Methods: This cross-sectional study was carried out in the department of General surgery in concordance with Department of Gastroenterology Indira Gandhi Medical College Shimla (H.P.) on patients admitted with diagnosis of Cholelithiasis with choledocholithiasis from 1-August-2018 to 31-July-2019. Results: Out of 108 patients of Cholelithiasis with choledocholithiasis, seventy-two patients (66.67%) underwent ERCP. Out of seventy-two patients 60 patients (83.33%) were cleared of CBD stones and underwent cholecystectomy. Out of Sixty patients laparoscopic cholecystectomy was performed in 52 patients (86.67%) and 8 patients (13.33%) were subjected to open cholecystectomy. Conclusion: Cholelithiasis with choledocholithiasis is a common condition worldwide. Associated CBD stones are seen in 10-15% of patients with cholelithiasis. ERCP for the management of CBD stones followed by cholecystectomy is the most common modality of treatment. Presently it is a convenient, safe and cost-effective procedure with a success rate of 83.33%.

Diabetes Miletus (DM) is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The chronic hyperglycemia of DM is associated with long-term damage, dysfunction, and failure of different organs, e.g. eyes, kidneys, nerves, heart, and blood vessels. The underlying causes of the DM are genetic and environmental factors e.g. urbanization and industrialization, increased longevity, modern sedentary lifestyles, and over-consumption of energy-dense foods. This study investigated the spatial variation in the spread of DM incidence in eleven wards in the city of Makurdi which are; Ankpa/Wadata, Bar, Fiidi, Central Southern Mission, Clerks, Modern Market, North Bank I, North Bank II, Wailomayo, Mbalagh and Agan to unravel their underlining causes. Bar ward had the highest number of DM incidence at 19.1%, Wailomayo ward 18.6%, and Fiidi had 18.1%. Type 2 DM had the highest incidence at 95% while type 1 DM accounted for 4.5% and gestational DM accounted for 0.5% of the total incidence. The high rate of type 2 DM is a result of an unhealthy diet (fast food, excess refined sugar, excess salt, low fiber), overweight/obesity, lack of regular physical exercise, excessive use of alcohol, advancing age, hypertension, family history, etc. The distribution of DM in Makurdi metropolis is clustered in Bar (19.1%), Wailomayo (18.6%), and Fiidi (18.1%) wards and across the major hospitals in the city which are the Federal Medical Centre (FMC) and the General Hospital (GM), 63% of DM incidence was reported at FMC with Fidi ward having 83.3% of the cases while 37% of DM patients reported at GM had 79.2% cases from North Bank I. One Way Analysis of Variance (ANOVA) result revealed a significant variation in the incidence of DM across different residential densities in Makurdi metropolis (F2, 196 = 3.341; p<0.05).

Systemic Lupus Erythematosus (SLE) is a multisystem autoimmune inflammatory disorder with varied manifestations ranging from benign skin manifestations to life threatening renal manifestations. Epidemiological data suggests geographical and ethnical differences pointing towards role of both genetic and environmental factors playing their role in phenotypic expression of disease. Various autoimmune markers in the form of autoantibodies have been discovered which correlate with phenotypic expression of disease. There is scarcity of epidemiological data in India of Systemic Lupus Erythematosus owing to lack of studies. This review article is intended to study epidemiological characteristics of the disease in Indian context.

This study aimed to investigate the bacteriological quality of river Rima, kwalkwalawa, Wamakko Local Government Area of Sokoto State, Nigeria. Standard plate count and Most Probable Number (MPN) methods were used in the study. The identification of the organisms was determined by their morphology, culture characteristics, and biochemical profile. A total of 27 river water samples were randomly collected for 3 months .Result ofbacterial count ranged from 3.x106 CFU/ml to 7.2x106 CFU/ml. The total coliform counts ranged from 120 to 250 MPN/100ml. Coliform bacteria identified were Escherichia coli, Enterobacter cloacae, Salmonella typhi, Serratia mercensces, Proteus mirabilis, and Vibrio cholera. Based on World Health Organization (WHO) standard for the coliform count, all the samples were contaminated with microbes exceeding regulatory limits (100 coliforms 100/mL).However, on the density and isolates, the water is unfit for human consumption. Hence it can be suggested that the water from River Rima is not potable based on bacteriological quality except when treated using suitable treatment techniques such as chlorination and boiling Background: Access to portable water remains a major global concern due to the increased rate of water pollution contributed by climate change and human activities. Rivers and streams have been exposed to toxic and pathogenic pollutants released from untreated organic and inorganic waste that causes water pollution and is detrimental to aquatic plants, animals, and human consumers who depends on such a valuable ecosystem. Control of water-borne diseases is of primary importance in developed and developing countries.

Background: Hollow visceral injury refers to blunt force injury specific to the gastrointestinal system extending from the gastro-esophageal junction, stomach, small and large intestine including the rectum. This study was done to determine the Pattern of hollow visceral Injury among Blunt Trauma Abdomen patients in a tertiary care Hospital. Material & Methods:  This Observational prospective study was conducted from July 2018 to December2019 and included all Blunt Trauma Abdomen (BTA) patients admitted in study period at advanced trauma center, PGIMER Chandigarh. Pattern, prevalence, non-operative versus operative management and outcome in term of mortality and morbidity were monitored.

Choledocholithiasis has an incidence of 10-15% in patients with cholelithiasis. Cholelithiais and Choledocholithiais have affected mankind since time immemorial. Cholelithiasis with choledocholithiasis is a disease of young and middle age. In patients having concomitant gall stones with common bile duct stones, Cholecystectomy generally is recommended in patients after bile duct clearance to decrease the risk of future cholecystitis and recurrent biliary colic. The obvious goal of therapy in choledocholithiasis is to achieve ductal clearance with the fewest number of interventions, lowest cost and least morbidity.

With interest we read the article by Hixon et al. about a study of three patients with posterior reversible encephalopathy syndrome (PRES) in the context of severe SARS-CoV-2 infections [1]. Additionally, 32 other cases with SARS-CoV-2 associated PRES were discussed and it was concluded that early recognition of the condition is warranted as only half of the patients achieved full recovery by the time of publication. The study is appealing but raises concerns and comments.

The main limitation of the study is the diagnosis “PRES” [1]. PRES is diagnosed upon the clinical presentation and upon the MRI findings [2]. The most common clinical manifestations include headache, seizures, encephalopathy, visual disturbances, and focal neurologic deficits [2]. On MRI lesions associated with PRES are usually located in the occipital areas and show up as hyperintensity on diffusion weighted imaging (DWI) and hyperintensity on apparent diffusion coefficient (ADC) maps (vasogenic edema). Vascular irregularities are frequently seen. PRES is additionally characterised by spontaneous resolution of these lesions within a few days [3]. However, less than 50% of the included patients recovered until the time of reporting, thus not fulfilling a major diagnostic criterion of PRES. Furthermore, DWI hyperintensity was detected in only a small portion of the cohort. Further arguing against the diagnosis “PRES”. Two of the three patients presented in detail had visual impairment even 12 months after diagnosing COVID-19 respectively PRES.   

A further limitation is that among patients diagnosed as PRES but without spontaneous resolution of the lesions, differentials were not appropriately excluded. Differentials of PRES include acute demyelinating encephalopathy (ADEM), immune-encephalitis, viral encephalitis, ischemic stroke, stroke-like lesions, cerebral vasculitis, drug-induced leukoencephalopathy, and pontine and extra-pontine myelinolysis. Missing in this respect are cerebro-spinal fluid (CSF) investigations, imaging with contrast medium, EEG, and angiography of cerebral arteries. Considering differentials is crucial as treatment and management varies considerably between these entities.

The number of patients with SARS-CoV-2 associated PRES exceeds 32. As per the end of June 2021 an additional amount of at least 12 further patients had been reported (table 1). Age of these patients ranged from 10y to 90y. Seven patients were male and 5 female (table 1) Latency between onset of COVID-19 and onset of PRES ranged between 1 and 70 days (table 1). The most frequent presentation of PRES was seizures, confusion and cognitive impairment.

PRES is hypothesised to be a syndrome of disordered autoregulation and endothelial dysfunction resulting in preferential hyperperfusion of the posterior circulation [2]. Disturbed auto-regulation and endothelial dysfunction are triggered by renal failure, preeclampsia and eclampsia, autoimmune conditions, or immunosuppression [2]. We should be told which of these triggers were present in the 35 patients of the index study.

In the results section the observational period is wrong [1]. Most likely the authors mean “26^th February 2021”. 

Overall, the study has several limitations which challenge the results and their interpretation. These limitations should be addressed before drawing final conclusions.

With interest we read the article by Birtel et al. about the retinal abnormalities in 21 patients with a syndromic (n=9) or non-syndromic (n=12) mitochondrial disorder (MID) [1]. Among the syndromic MIDs, 7 were diagnosed with chronic progressive external ophthalmoplegia (CPEO), 1 with mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome, and 1 patient with neuropathy, ataxia, and retinitis pigmentosa (NARP) syndrome [1]. Three retinal phenotypes were differentiated in the 21 patients: type 1 was characterised by mild, focal pigmentary abnormalities, type 2 was characterized by multifocal white-yellowish sub-retinal deposits and pigment changes limited to the posterior pole, and type 3 was characterised by widespread granular pigment alterations [1]. Advanced type 2 and 3 retinopathy deteriorated to chorio-retinal atrophy that typically started in the peri-papillary and para-central areas with foveal sparing [1]. It was concluded that distinct subtypes of mitochondrial retinopathy can be delineated even in the absence of clinical manifestations and that recognition of these subtypes may facilitate the diagnosis of a MID [1]. The study is appealing but raises comments and concerns.

Seven of the 21 patients carried the m.3243A>G variant in MT-TL1 with heteroplasmy rates ranging from 10 to 64% [1]. The most frequent phenotype of this genotype is MELAS. However, none of these 7 patients was diagnosed with MELAS. We should be told if the absence of the typical phenotype was attributable to the low heteroplasmy rates in 6 of these patients or to the fact that heteroplasmy rates were determined in blood lymphocytes, which are usually not affected. We should know if these seven patients manifested with features other than diabetic retinopathy, retinal dystrophy, myopathy, acute, posterior, multifocal, placoid pigment epitheliopathy, or age-related macular degeneration. Common phenotypic features of m.3243A>G carriers include stroke-like episodes (SLEs), seizures, cognitive decline, confusion, headache, hypoacusis, fatigue, myopathy, nausea/vomiting, and lactic acidosis [2].

Nine patients carried single mtDNA deletions, which were classified as sporadic [1]. Though single mtDNA deletions are sporadic in the majority of the cases, they are maternally transmitted in 4% of the cases [3]. Thus, we should know in how many of the nine patients carrying single mtDNA deletions the family history was positive for a MID. Single mtDNA deletions manifest phenotypically as CPEO, Pearson syndrome, or Kearns-Sayre syndrome (KSS). However, only 7 of these patients manifested with CPEO. We should know if the two remaining patients manifested with features other than ptosis, retinopathy, or “muscular dystrophy” [1]. Particularly we should be told if these two patients with a non-syndromic phenotype presented with features of Pearson syndrome or KSS.

The most frequent phenotype of the variant m.8344A>G is myoclonic epilepsy with ragged-red fiber (MERRF) syndrome [4]. However, the patient carrying the m.8344A>G variant, manifested with MELAS [1]. This is not unusual but surprising given the high heteroplasmy rate of 85% [1]. We should be told if patient 3 presented with any of the four canonical features of MERRF (myoclonic epilepsy, ataxia, myopathy, myocloni).or other features of MERRF plus.

Missing is an in-depth discussion of macular abnormalities in m.3243A>G carriers, which include peri-macular and peri-papillary retinal pigment epithelium abnormalities with mottled dye auto-fluorescence and retinal pigment epithelium atrophy and deposits on optic coherence tomography [5].

Overall, the interesting study has several limitations which challenge the results and their interpretation. An explanation should be provided why m.3243A>G carriers and mtDNA deletion carriers manifested minimally and non-syndromically. 

Coronavirus disease 2019(COVID- 19) was first identified in December 2019 and declared by World Health Organisation(WHO) as a pandemic in March 2020 (Chan, K. H. et al., 2020). This is caused by the Severe Acute Respiratory Syndrome-Corona virus 2(SARS-Cov-2) which initially affects the respiratory tract producing influenza-like symptoms but subsequently involves multiple organ systems resulting in many complications. One of them is arterial and venous thrombosis which can lead to stroke, acute coronary syndrome, acute limb ischemia, and acute mesenteric ischemia (Bhayana, R. et al., 2020). Acute mesenteric ischemia caused by the virus can be due to multiple reasons. The exact pathophysiological mechanism is not well understood, possibilities can be attacking of angiotensin-converting enzyme 2 receptors on enterocyte by the virus leading to inflammation of endothelium and subsequent vascular damage (Escher, R. et al., 2020). Others are hypercoagulability, increase in von Willebrand factor, or shock (Parry, A. H. et al., 2020). Patients having acute mesenteric ischemia can present with abdominal pain, nausea, vomiting, abdominal distension, guarding, or rigidity requiring prompt diagnosis and treatment. Diagnosis can be made by imaging techniques like abdominal radiography, ultrasonography, and computed tomography of abdomen. Among all computed tomography (CT) of abdomen plays an important role and findings like thickened, edematous, dilated bowel and pneumatosis intestinalis are suggestive of bowel ischemia (Fitzpatrick, L. A. et al., 2020). Once the diagnosis is made immediate measures for the management of the patient should be taken. In this case series, we describe five Covid patients who presented with abdominal pain, nausea, vomiting, abdominal distension along with cough, fever, and shortness of breath. Exploratory laparotomy was done in 2 patients in whom the diagnosis was made peroperatively, remaining 3 patients were kept only on anticoagulant therapy. Only one patient survived and 4 patients succumbed to the various complications of the disease.

During attaining adulthood the life is divided into 3 critical age groups, viz the children under five years, the next five years and finally adolescence. The most important indicators of health status of under-5 children relate to their mortality, morbidity, nutrition, growth, and development. There are two main types of interventions. The first, promote health and prevent specific disease conditions. The second are case management interventions which help reduce severity of illness thereby improving health and survival. In this article we will be discussing the first aspect, that is, promoting health and preventing diseases among the under-5 children. Poor health and survival are linked to social and economic dis- advantages. Child deaths are unequally distributed in the world. Global progress in child health is attributable to a broad range of factors that include high coverage of good quality effective interventions, development programming, and strategic delivery of health services, along with improvements in education, child protection, respect for human rights, and economic gains in developing countries. In this article we wish to draw attention towards the issues of child health and solutions thereafter.

India is estimated to have the highest snakebite mortality in the world. The estimated total deaths in India are approx. 50,000 year. This study was planned to the time, place and person distribution of the snake bite child patients. Data collected was entered and analyzed using Epi Info (Version 7.2.2.6). Data was expressed in its frequency and percentage. The study was conducted in the Department of Paediatrics of IGMC Shimla. Data analysis was done by necessary descriptive and inferential statistics.  Appropriate descriptive statistical technique like mean, median, mode, percentile and standard deviation was used for data analysis and analyzed data was presented in form of tables, diagram and graphs based on findings. Most of the patients were resident of rural areas and most of them belonged to middle socioeconomic status. Most (56.7%) of the snake bites occurred between 6pm to 12am and most of them were non provocative.

Snake bite in children is a medical emergency that occur frequently in Himachal Pradesh. Due to abundant forest cover and favorable climate a wide variety of venomous snakes are distributed throughout the state. Most people including children residing in rural areas still follow traditional ways of living by rearing animals and collecting firewood from forests, hence they are at a great for snake bite envenomation. A total of 30 cases were enrolled in this study. 56.6% of the subjects were males and 43.3% were females. Maximum snake bites were reported between May to November and peak time was during month of August to September (rainy season). Most (56.7%) of the snake bites occurred between 6pm to 12am and most of them were non provocative. Children may be educated in this regard not to unnecessary explore holes and crevices. Hence awareness can be created in this regard to reduce the snake bite incidence in rural areas by educating the children to wear high boots during travel at night time.

Bites in which the fangs pierce the skin but no envenoming results are known as “dry bites”. Venomous snakebite can cause rapid and irreversible complications like shock, systemic bleeding, respiratory muscle paralysis, acute renal failure and necrosis of tissue at the site of the bite. This observational study was conducted at IGMC, Shimla over a period of one year among children up to 18 years of age with history of snake bite as confirmed by themselves or by a reliable witness admitted to the Pediatrics department. Most of the symptomatic patients were cases of hemotoxic envenomation as compared to neuroparalytic envenomation. 20% cases were graded as Grade 0, 13.3% were classified as Grade 1, 26.7% were classified as Grade 2, 23.3% were classified as Grade 3 and 16.7% were graded as Grade 4. Grading being a subjective process is not very good indicator of degree of envenomation and further prognosis. Hence, grading of envenomation may not be encouraged. Most of the symptomatic patients were cases of hemotoxic envenomation as compared to neuroparalytic envenomation. Twenty-minute whole blood clotting test (20WBCT), considered as a reliable test for coagulopathy.

Snake bites pose a significant health risk in India, with about 52 out of 256 snake species being venomous. Most bites occur in rural areas during the summer and rainy seasons. Children are particularly vulnerable, with most bites occurring on the lower limbs. Envenomation risk varies, with about 50% of bites resulting in venom injection. Venom composition includes enzymes, polypeptides, glycoproteins, and low molecular weight compounds, which can cause various complications including shock, bleeding, and respiratory paralysis. Factors affecting envenomation include age, bite site, snake species, and activity during the bite. Management involves providing Kangaroo Mother Care for infants, effective counselling, and close follow-up to monitor growth and development. Understanding the pathogenesis and clinical characteristics of snake bites is crucial for effective management and prevention of complications.

With interest we read the article by Beckmann et al. about a study of 11 patients with multiple sclerosis (MS) with atypical optic neuropathy (ON) [1]. Atypical ON was defined as bilateral ON, sequential ON, progressive visual loss, or no response to corticosteroid respectively plasmapheresis treatment [1]. Five of the 11 patients carried an mtDNA variant [1]. Only one primary Leber’s hereditary optic neuropathy (LHON) mutation (m.14484T>C) was detected in one of the five patients [1]. It was concluded that MS with atypical ON should undergo investigations for LHON mutations [1]. We have the following comments and concerns.

The main limitation of the study is that the pathogenicity of the non-primary LHOV variants m.14325A>G, m.3644T>C, m.14841A>G, m.9041A>G, and m.9448A>G was not demonstrated. Segregation of these variants with the phenotype within in a family or evolutionary conservation were not proven. Biochemical investigations attributable to these variants, or trans-mitochondrial cybrid studies were not carried out [2]. As long as this information is lacking, pathogenicity remains unproven. 

Another limitation of the study is that heteroplasmy rates of the mtDNA variants were not provided in the five MS patients who carried an mtDNA variant. Though primary LHON mutations are commonly in the homoplasmic state in LHON patients, occasionally these variants can be heteroplasmic. Knowing heteroplasmy rates and the tissue in which they have been obtained is crucial as they may strongly influence the phenotype, the outcome and genetic counselling of these patients. Missing in addition to heteroplasmy rates are mtDNA copy numbers.

A further limitation is that results of clinical and genetic investigations of first degree family members of the five patients carrying mtDNA variants were not provided. Knowing if other family members were clinically or subclinically affected is crucial for assessing if the variant has to be classified as pathogenic or benign.

A further limitation is that the five patients carrying mtDNA variants were not systematically investigated for multisystem disease [1]. Since MIDs are frequently multisystem diseases [3], either already at onset or with progression of the disease, it is crucial that all MID patients are systematically screened for multisystem involvement at onset and repeatedly during follow-up. Knowing the number of organs affected and the degree of affection is crucial for assessing the outcome of these patients.

Even LHON may manifest not only in the eyes but also in various other organs (LHON plus) [4]. 

Application of idebenone to all five MS patients carrying an mtDNA variant is not comprehensible. First the effect of idebenone in LHON patients is poor, second idebenone is expensive, and third the diagnosis LHON remains unproven in the 5 MS patients carrying mtDNA variants. 

Lastly, MS features on MRI in patients with a mitochondrial disorder (MID) are not unusual and have been early recognised as Harding’s syndrome [5]. MS features on imaging in MID patients are potentially attributable to affection of immune cells by the mitochondrial defect, by an immune response against mutated mitochondrial proteins, or by the accidental co-occurrence of MS and a MID. 

Overall, the study is appealing but has several limitations, which challenge the results and their interpretation. These limitations should be addressed to strengthen the conclusions.

Hip arthritis is a progressive degenerative condition that causes pain and stiffness in the hip joint. This study was undertaken with the objective to assess the awareness regarding risk and preventive factors for hip pain among Ortho OPD patients in civil hospital Rohru. Material & Methods: This cross sectional study was conducted between Aug- December 2020 among Ortho OPD patients in civil hospital Rohru selected by convenience sampling technique.Information regarding their socio-demographic characteristics and knowledge, regarding prevention of hip pain were obtained using a self-administered, pre-tested, semi-structured questionnaire. Data was analyzed using epi info v7 software using appropriate statistical tests. Results: In the present study 35% (140) of the patients fall were below 40 years of age while 65% (260) were above 40 years. 54% (216) of patients were male and 46% (184) were female. Among the total patients maximum 286 (71.5%) respondents told that abnormal gait while walking is the major risk factor for hip pain followed lack of physical activity/exercise 265(66.25%) and prolonged sitting 235(58.75%).Among the total, maximum 290 (72.5%) respondents told that maintaining normal gait while walking is the major preventive factor for hip pain followed by exercise of hip regularly 270 (67.5%), frequent position change and stretching while working 256 (64%), frequent breaks while working on chair 245(61.25%), and travelling long distances 242 (60.5%). Among the participants, 55(13.75%) didn’t know about any risk factors and 52(13%) didn’t know any preventive factors for hip pain. Conclusion: Clear understanding of risk and preventive factors of hip pain helps in prevention of complications.

In very simple language the word Dyspepsia mean bad digestion or you may said weak digestion. There are so many causes for dyspepsia and various types of dyspepsia. Most common type of dyspepsia is Functional Dyspepsia. In other words Functional Dyspepsia means Irritable stomach Syndrome. This syndrome includes symptoms of localized epigastric pain (between the navel and the xiphoid process) and the flanks and burning, feeling bloated after a meal ,early satiation ,distension in the epigastric region , Nausea, and vomiting. The symptoms of dyspepsia may be acute or chronic. In Homoeopathy patients are treated as per their symptoms both mental general, physical general and particulars. Most common drugs used are Nux. vom, , Pulsatilla, Carbo. Veg, Lycopodium, Cinchona, Hydrastis Canadensis and so many other. Among all in Homoeopathic practice Nux Vomica , Lycopodium and Hydrastis Canadensis is commonly used remedy for dyspepsia.

Uterus is a vital reproductive organ and is associated with various benign and malignant pathologies. Surgical removal of uterus is known as hysterectomy. It can be performed either through abdominal or vaginal route or with the help of minimal invasive surgical procedures like laparoscope. There is diagnostic and therapeutic significance of performing histopathological examinations of hysterectomy specimens or any surgically excised specimens. The aim of the study was to evaluate clinical indications for hysterectomy and the histopathological features of varied lesions of uterus and cervix and their distribution in relation to age at a tertiary care hospital. This is a retrospective observational study conducted in Department of Obstetrics & Gynecology, Rama Medical College, Hospital & Research Center from July 2019 to March 2020. A total 250 patients were included in the study with age range from 19-70 years. Histopathological examination reports were analyzed and compared with clinical diagnosis. Histopathological examination of all the surgically excised specimens should be done regardless of its benign indication as this helps to correlate with the pre-operative clinical diagnosis and provides the final diagnosis.

Inflammation is a key factor in pneumonia pathology, yet the benefits of corticosteroids remain uncertain. Community-acquired pneumonia (CAP) leads to hypoxia, respiratory failure, and increased mortality, with prognostic scales like CURB-65 and PSI failing to account for inflammatory responses. CRP and other biomarkers enhance severity assessment and guide steroid use. In COVID-19, early mortality prediction is challenging, but markers such as CRP, NLR, and D-dimer provide valuable prognostic insight. This retrospective single-center study analyzed 204 COVID-19 patients admitted between September and October 2020. Patients requiring remdesivir treatment were included, while those without CRP results within 48 hours of admission were excluded. Statistical analysis confirmed CRP’s predictive value for disease progression, with levels above 41.4 mg/L indicating adverse outcomes. Sensitivity and specificity analyses demonstrated CRP’s strong prognostic utility. Findings highlight CRP’s role as a simple yet effective indicator of disease severity and outcomes in both pneumonia and COVID-19. Its integration into clinical decision-making may improve patient management, particularly in identifying cases at risk for deterioration. The study underscores the need for biomarker-informed treatment strategies to enhance prognosis accuracy and optimize therapeutic interventions in inflammatory pulmonary diseases. 

The present study was carried out to compare neuro-cognitive correlates-Visual-Motor Functioning, Memory Functioning (Remote Memory, Recent Memory.  Mental Balance, Attention and Concentration, Delayed Recall, Immediate Recall, Retention of Similar Pair, Retention of Dissimilar Pair, Visual Retention and Recognition) Visuo-Constructional Ability, Response Inhibition and Perceptual Acuity between individuals with Schizophrenia and Normal population. Out of 30 individuals, 20 belonged to Normal Population and 10 belonged to Clinical Population. Within the Clinical Population, 6 exhibited florid symptoms and 4 were in Partial Remission Phase of Schizophrenia.GHQ-28 was used to screen Normal Population and PANSS was used to screen positive and negative symptoms of Schizophrenia. Tools used in the present study were Bender Visual Motor Gestalt Test -I, PGI-Memory Scale, Clock Drawing Test, Stroop Test and Nahor-Benson Test. Statistical analysis revealed significant differences between Normal and Clinical Population in areas of memory functioning, Visuo-Constructional Ability and Perceptual Acuity. Significant differences existed between Florid and Partial Remission Groups in Recent Memory, Attention and Concentration, Delayed Recall, Immediate Recall, Visual Retention and Recognition.

This article is picked from IJRH where the complicated and challenging subject of Nosode preparations is discussed and described with scientific background. Nosodes are always a controversial issue in homoeopathy. Hence this article is an attempt to satisfy the scientific needs of medical fraternity.