Acute Undifferentiated Fever (AUF)  is used to denote fevers that usually do not extend beyond a fortnight, and lack localizable or organ-specific clinical features.  It   typically includes   fever, without any localized source of infection, of 14 days or less in duration. The Objective of our study was to determine the clinical parameters of the study participants admitted in the Internal Medicine ward at Indira Gandhi Medical College, who were suffering from any kind of Acute Undifferentiated Febrile Illness. The mean age of the study participants in our study was found to be 38 years. The mean duration of stay in the hospital was 5.30 days and the mean duration of fever before hospitalization was 8.38 days. The most common comorbidity among the patients admitted for AUFI was Hypertension followed by Diabetes Mellitus.

Objectives: Describe the epidemiological profile of purulent pleurisy and its management. Patients and Methods: Retrospective, descriptive and analytical study during three years at the University Hospital of Libreville. The files retained were those of purulent pleurisy, all etiology combined. Tumors and other pleuropulmonary conditions, as well as incomplete records were excluded. Results: The prevalence of pleurisy was 1.3%, for a sex ratio of 0.78. The majority of the population consisted of infants (65.6%), with a median age of 2 years and an interquartile range of [1-3]. The mean time to consultation was 14.5±9.9 days. Dyspnea (71.8%) and fever (100%) were the main reasons for consultation. The pleurisy was of right localization (53.1%) and of great abundance (75%) in most cases. The culture was only 25% positive, including 18% for Staphylococcus aureus. Decortication thoracotomy, in case of drainage failure alone, provided favorable results in 31.2% of cases. Conclusion: Purulent pleurisy is a rare pathology in our country, especially in our structure. His hospital care is marked by satisfactory results. However, the epidemiology and ecology of this pathology have yet to be developed, ideally through prospective studies.

Objective: Pancreatic tumors are the most common tumors of the periampullary region and have a poor prognosis. Whipple's operation is the only curative treatment option for these tumors. It is a complex surgery and the complication and mortality rates are still high. The aim of this retrospective study is to evaluate patients who underwent Whipple's operation for pancreatic tumors. Material and Methods: Twenty patients who underwent Whipple's operation for pancreatic tumor at Istanbul Medipol University Medical Faculty Hospital Hepatopancreatobiliary Surgery Department between March 2015 and March 2018 were retrospectively analyzed. Demographic characteristics, clinical characteristics, surgical results and factors that may affect the mortality of these patients were evaluated. Results: The mean age of the patients was 61.6±12.5 years. Twelve (60%) of these patients were male and 8 (40%) were female. Twelve (60%) of the patients were early stage (Stage1-2), 8 (40%) were advanced (Stage 3-4). Standard Whipple's operation was performed for all patients. Postoperative complications (pancreatic fistula, bleeding, gastrojejunostomy leak) were detected in 5 (25%) patients. The mean follow-up time was 10.8±10.3 (1-36) months. During the follow-up period, the overall mortality rate was 40%. Mortality was seen mostly in advanced-stage patients. Conclusion: We think that attention should be paid to advanced-stage patients with high mortality risk after the Whipple's operation.

Background: There is a growing need to evaluate adverse effects of ART on patients, so it is important to document adverse effects of antiretroviral therapy for early diagnosis, proper management and prevention in future and hence this was planned to study the toxicity profile towards the commonly used first-line antiretroviral drugs. Material and Methods: This study was conducted in a tertiary care hospital of Shimla, Himachal Pradesh from 1st July 2019 to 30th June 2020. All consecutive patients presenting in the ART center of IGMC Shimla were recruited. A detailed history with duration of symptoms was taken and recorded as per the case recording format. The data was entered in Microsoft excel sheet and was analysed using Epi-info software. Results: There were a total of 103 patients enrolled for the study. There were 56 (54.4%) males and 47 (45.6%) females.18-35 years age group was the most common age group affected with 45 (43.7%) patients in this age group. The most common ADRs were haematological ADRs (46; 44.66%) with 15 cases of anemia, 9 cases of leukopenia, 7 of thrombocytosis and 10 and 5 cases of microcytosis and macrocytosis respectively. There were 27 (26.21%) cases of gastrointestinal ADRs, the most commonly seen ADR in literature, with 15 (14.5%) cases of nausea and 12 (11.65%) cases of gastrointestinal intolerance. Other reported ADRs were rash, headache, neuropathy, fatigue, pancreatitis, renal and liver toxicity. Conclusion: Early detection and management of ADRs will reduce the economic burden and improve the medication adherence resulting in better therapeutic outcomes.

This research aims to know the benefits of surgical intervention for women patients with the syndrome polycystic ovary. About 130 samples were collected from Bint Al-Huda Maternity and Children Hospital, Thi-Qar, Iraq and private clinics where the ovaries were drilled through the use of an endoscope, using a needle, as success rates ranged from 59% to 70%, as it helps in improving Efficient ovulation and the presence of endometriosis in more than 86% of cases, which has an impact on increasing the hypothesis of pregnancy and the chances of it continuing in the first trimester. The method of treating ovarian cysts laparoscopically is to remove most of the cysts that are located next to the ovaries or one of them in the same way as in the process of removing ovarian cysts by surgery, but the difference is that the abdominal area is not deformed by making a large opening, but it is limited to the doctor making a small wound.

Cholecystoenteric fistula is an abnormal communication between the gallbladder and the gastrointestinal tract. It is a rare complication of cholelithiasis. We report a case that was preoperatively thought of as cholelithiasis with choledocholithiasis but intraoperatively, a cholecystoduodenal fistula with impacted CBD stones was seen. Even though the CBD stones were present, the liver function tests were normal, perhaps due to the fistula and also as the stones were not completely obstructing the lumen. Due to presence of impacted stones in CBD which could not be retrieved in ERCP and a concomitant cholecystoduodenal fistula which was not diagnosed preoperatively makes this case a rare one and worthwhile publishing.

Background: The Red Cell Distribution Width (RDW) and Neutrophil/Lymphocyte Ratio (NLR) have a prognostic value in the cardiovascular diseases. We aim to investigate the correlation between cardiac functions and RDW and NLR in patients who underwent emergency splenectomy. Material and Methods: The demographics and biochemical parameters of 112 patients who had splenectomy for emergency trauma between January 2014 and December 2019 were evaluated retrospectively. Cardiac functions of 25 patients were examined by echocardiography. Results: Splenectomy was performed in 78 male (69.6%) patients. The most common additional organ injury was liver (40.2%) and complication was bleeding (62.5%). There were significant increases in blood ranks of RDW (p<0.01) and platelet (p<0.001) at the discharge. There was a significant correlation between RDW at admission and Tricuspid Annular Plane Systolic Excursion (TAPSE) and peak Pulmonary Artery Pressure (PAP); between ∆RDW and PA-TVI and RA; between ∆NLR and Left Ventricle End-Diastolic Diameter (LVED), Right Ventricle diameter (RV), Pulmonary artery time-velocity integral (PA-TVI), Apical 4 chamber right ventricle basal diameter (A4RVB) and apical 4 chambers right ventricle mid diameter (A4 RVM); between PLT at admission and RV, A4RVB and A4RVM; between ∆PLT and ∆Hemoglobin with Aortic root (Ao) (p<0.05). Patients who have pathological levels of A4RVB and A4RVM showed significant decreases in ∆NLR and PLT at admission. Conclusion: The ventricular dysfunction probably due to increased thrombocytosis might be observed during follow-up of trauma patients who underwent emergency splenectomy. The differences in NLR and RDW were considered to be correlated with the cardiac functions.

This is a case of a 54 year old gentleman with carcinoma of the left gingivobuccal sulcus, planned for 3-dimensional excision of the tumor with modified radical neck dissection. During neck dissection, a large vessel thought to be as the internal carotid artery was inadvertently injured, resulting in a large amount of bleeding. The vessel was controlled by ligation, but we were at a loss as to what to do next, as we had possibly ligated the left internal carotid, thereby permanently blocking the blood supply to the left brain. A careful perusal of the area, however, revealed that the vessel in question was arising from the external carotid artery, and the internal carotid artery was quite safe and untouched.

The internal carotid artery had a very long serpentine course running posterior the internal jugular vein. The hypoglossal nerve was seen to traverse anterior to the external carotid and its large branch. This confirmed that the injured vessel was not the ICA. Also, the ICA was confirmed by identifying the vagus which was lying adjacent to it. Thus this variation gave us quite a fright. We assume that the mistake was probably due to the abnormally large size of the vessel its location, which was near the area of the ICA. The vessel was later identified as a large occipital artery. As expected, the patient had no post-operative complications.

VISION 2020: The Right to Sight (V2020) is a global program that was established in partnership in 1999 by the International Agency for the Prevention of Blindness (IAPB) and the World Health Organization (WHO) with the joint goal to eliminate avoidable blindness by 2020. The reduction in the global cases of blindness and visual impairment is a significant achievement of V2020, which promotes advocacy, carries out relevant research on ophthalmology and public health and promotes Community Eye Health (CEH) through workshops, training and partnerships with international, regional and local ophthalmologic societies. Though predating VISION 2020, control programs focusing upon both onchocerciasis and trachoma, are important aspects of the VISION 2020 global initiative.

A developed urban area that creates sustainable economic development and high quality of life by excelling in multiple key areas; economy, mobility, environment, people, living and government. Excelling in these key areas can be done so through strong human capital, social capital and ICT infrastructure. The smart cities is a collaboration of technology into strategic approach of sustainability. The program will provide the city where information technology is the principal infrastructure and the basis for providing the essential services to the residents. This article is focused on the comparison of success stories of the Swedish government in stepping forwards as the pioneers of giving smart city solutions to the world and comparing with an entirely different setting. The major focus of the article is on the solid waste management of Sweden and its comparison with the settings of a developing country such as India. In India, our prime focus is on finding out solutions for making Dharamshala as a smart city because waste generation is an inevitable consequence of industrialization and urbanization. Dharamshala has ample amount of land which can be utilized for managing solid waste. MC Dharamshala is currently dumping the waste in the outskirts of the city in the sanitary landfills. The state government along with the National Green Tribunal are formulating a plan for the appropriate reuse and recycle of the municipal waste. The plan of the Swedish waste management can be adopted provided that there is a desirable community participation, inter- sectoral collaboration and the availability of sufficient funds for provision of appropriate technology.  The will of the political leaders is the urgent need of the hour so that the city progresses in one direction, a direction of success.

Diabetes mellitus is characterized by hyperglycaemia (raised blood glucose) resulting from defects in insulin secretion, insulin action, or both. Insulin, produced by the beta cells of the pancreatic islets of Langerhans, is the main hormone regulating blood glucose levels, and is released in response to rising blood glucose following eating or drinking. With the rising number of new cases and many remaining undiagnosed, diabetes is indeed a public health problem of 21^st century. In this study, we have tried to demonstrate the modifiable and non-modifiable risk factors as well as the complications.

Elder abuse is a single or repeated act or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person. This study was conducted to estimate the prevalence of vulnerability of the elderly to abuse during the COVID 19 pandemic time in district Kangra, Himachal Pradesh. A semi structured validated questionnaire was use to collect data on demographic and socio-economic variables. Additionally, Vulnerability to Abuse Screening Scale (VASS), was used to collect data on vulnerability to abuse. VASS total score of>4 was considered as an indicator of presence of abuse. In our study, the prevalence of elder abuse was found to be 13.1%. the elderly are highly susceptible to abuse and most likely to feel lonely especially when they have been socially isolated during this time of pandemic.

A six-month bridge program in community health has been introduced in India for already qualified BSc Nurses. They are to be trained in primary health care to work as mid-level health care provider and are called as Community Health officers. We tried to ascertain their baseline knowledge of and attitude towards primary health care approach in health care delivery system. Methods: A cross-sectional study was conducted among 60 Community health officer aspirants (BSc Nurses) in an accredited centre in Himachal Pradesh. Results: All participants were female, majority being in the age group of 26-30 years (65%), with rural background (80%) and job experience of less than five years (71.7%). Mean knowledge and attitude score (as calculated in the scale of 0-100%) was found to be 62.7(±11.2) % and 69.2(±9.4) % respectively. Conclusion: Both baseline knowledge and current attitude of aspirants was found to be on the positive side which has to be sustained throughout the program and thereafter.

ST-elevation myocardial infarction (STEMI), one of the complications of cardiovascular disease, which if not treated immediately using reperfusion therapy, carries a poor prognosis.Reperfusion therapy with thrombolysis remains the only option in most of the rural setting of India due to non-availability of required infrastructure including cardiac specialist. Those who were thrombolysed, they undergo it after great delays at different level subject to financial barriers, transportation problem, limited healthcare infrastructure and poor accessibility to medical services. We have identified various variables leading to the delay at facility level in initiating reperfusion therapy in case of ST-elevation Myocardial Infarction (STEMI). Time lost during registration process, Health protection card activation, transportation of patient from causality/OPD to CCU (non-availability of trolleys in causality), getting ECG done at OPD /causality/CCU and purchasing of thrombolytics can be significantly reduced. So we propose to implement a Fast-Track-Protocol for acute coronary syndrome (Chest pain/discomfort) patients in order to reduce door to needle time in ST-elevation myocardial infarction.

Corona virus disease – 2019 (COVID -19) is a viral disease caused by severe acute respiratory syndrome coronavirus -2 (SARS –Co-2). It is declared as a pandemic by World Health Organization on March 11, 2020. COVID – 19 has spread throughout the world, affecting more than 100 million people and more than 2 million deaths. Here we report a case of COVID – 19 induced acute pancreatitis who presented to us in emergency department.

Background: Acute Renal Injury(AKI) is a very common complication in critical patients [1]. The most recent guidelines state that Continuous Renal Replacement Therapy(CRRT) is the gold standard treatment in patients with severe AKI and hemodynamic instability, acute brain injury or increased intracranial pressure [2]. CRRT is, however, burdened by its high cost [3]. The present study was designed as observational and retrospective, and its objective was to calculate the costs and evaluate the effectiveness of CRRT in relation to the mortality outcome in Intensive Care Unit(ICU) and in the hospital 30 days after ICU discharge. Patients data were extracted from the “GiViTI–Italian Group for the evaluation of interventions in Intensive Care” database. All patients treated with CRRT in the years 2011-2014 in the Italian ICUs (189) and with a maximum SOFA score between 8 and 12, were enrolled (2599). Based on the SOFA Score, the expected mortality rate ranged between 22.5% and 48.5% [4]. We considered as unit cost the regional tariff (DRG) 3995.5 applied in the Perugia University hospital in 2015(€ 255.70). To get an approximation of the total cost for CRRT, the DRG was multiplied by the median duration of treatment (4 days) and the number of patients enrolled. The estimated total cost was € 2 658 257.20. The observed mortality in the ICU was 44.4%. The mortality rate 30 days after ICU discharge increased to 54.9% and was higher than predicted. Therefore, we suggest structuring a specific follow-up plan for patients who underwent CRRT in ICU as they have a higher mortality risk.

Background and Objective: Urinary tract infections (UTIs) are very common among children and could have long-term complications if not diagnosed and treated promptly. The aim of this study was to determine the prevalence of UTI caused by extended spectrum β lactamase (ESBL)-producing organisms in Lebanese pediatric patients between 2012 and 2017. Subjects and Methods: Data was collected from the medical records at Rafik Hariri University Hospital concerning some demographics, clinical and diagnostic characteristics of the patients. SPSS was used for statistical analysis using descriptive as well as tests like Chi-square, Fisher’s and independent samples Mann Whitney U test. Results: Out of the total 211 patients, the majority were females (70.2%), 47.3% were Lebanese, and 44.1% were Syrians. Mean age was 2.85 years. We found that 40.7% had systemic diseases, 41.8% were previously using antibiotics, 30.3% were pre-hospitalized within a month, 15.3% were immunocompromised, and only 3.9% had a past history of constipation. Also, 26.3% had a recurrent UTI. The major symptom (58%) was fever above 38.3 °C and 13.6% of the enrolled patients were admitted to ICU. The most common uropathogen was E. coli (70%) and 7% of the uropathogens were resistant to Carbapenem. Alarming resistances were noted for Ampicillin (90.3%) followed by Cefalotin (71.4%) while no resistance was noted for Colistin, and Fosfomycin (0%). Patients infected with ESBL had longer hospital length of stay than those with non-ESBL-producing E. coli (P-value = 0.002). Significant difference in hospital length of stay was noted between patients treated with Imipenem (Tienam®) or Meropenem (Meronem®) before culture results and those who weren’t (P-value < 0.001). Conclusion: UTI and the emerging resistance in ESBL-producing organisms are challenging as the antibiotic therapy options and being limited leading to increased hospitalization. Recommendations to guide the prescription of antibiotics and management of UTI are essential to prevent sequelae in pediatric UTI patients.