Objective: The objective of this study was to study the peak expiratory flow rate (PEFR) in healthy school going children between 8 and 12 years in Ernakulum district and derive a regression equation to predict expected PEFR. Methods: A cross-sectional study was done in schools of Ernakulum among healthy children between 8 and 12 years of age. Pro formas and consent forms were distributed to schools who gave their consent for participating in this study. Eligible children were examined, anthropometric measures were taken, and PEFR values were recorded using a Mini-Wright peak flow meter. The best of the three recordings was taken to compare against each variable. Statistical analysis was carried out using statistical package, SPSS (version 22.0.0.0). Results: A total of 954 students between 8 and 12 years were studied, of which 482 were boys and 472 were girls. The scatter diagram for PEFR and age, height, weight, body mass index, and chest circumference for boys and girls suggests that there is a significant positive correlation between PEFR and the studied variables. Based on the multiple regression analysis, only age and height have a significant effect on PEFR for both males and females. The regression equation based on both height and age is PEFR = −150.290 + 1.811 (height) + 10.831 (age) for males and PEFR = −149.623 + 1.813 (height) + 8.329 (age) for females. Conclusion: Among different factors affecting PEFR, height and age correlate better with PEFR than the other variables studied. The derived regression equations can be used to predict the regional reference value.

Background and Objective: Breast cancer is the second leading cause of cancer-related deaths in India. Immunohistochemical study helps to carry out a better management of the disease and to determine the prognosis. This study was conducted to correlate the histopathology of breast tumors, with reference to tumor grade, and common immunohistochemical (IHC) markers such as estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER-2) status. Materials and Methods: The present study was conducted in the pathology department at tertiary care hospital. One hundred patients of breast carcinoma who underwent mastectomy were included in this study. These specimens were evaluated for both histopathological and IHC study using ER, PR, and HER-2 markers. All the experimental data were analyzed for correlations with histopathological features of specimens and IHC status of the specimens. Results: There were a total of 100 patients ranging from 30 to 70 years of age. The peak incidence was between 40 and 50 years. The most common histologic type of breast carcinoma in our study was IDC (NOS) type (85%), majority of our patients presented with Grade 3 tumors (49%) followed by Grade 2 (43%) tumors. Maximum numbers of cases were ER+ PR+ HER-2-ve, followed by triple negative tumors. Conclusion: From the present study, it was concluded that incorporating immunohistochemistry-based classification of both ER/PR and HER-2/neu status into the histopathology report using the traditional tumor nodes and metastasis staging and histological grading of breast carcinoma would aid in better therapeutic management and increases the prognostic accuracy while also having the added advantage of being inexpensive and readily available.

Introduction: Breast cancer is the most common cancer in females worldwide. The presentations of breast cancer patients are varied, and available treatment options are many. Management of breast cancer has changed over the period of years from radical surgeries to more of conservative approaches. The present study was undertaken to evaluate the role of neoadjuvant chemotherapy therapy in downstaging large operable breast cancer (LOBC) in the Indian population and usefulness of less radical, breast conservative surgery (BCS) in these patients. Materials and Methods: A prospective nonrandomized study of 32 patients with LOBC was carried out between September 2014 and August 2015. Patients with stage IIIA disease of 18–70 years of age were included. Clinical tumor response was graded according to the World Health Organization Criteria for clinical tumor response. Locoregional management consisted of either BCS (wide local excision, complete axillary dissection, postoperative radiotherapy) or modified radical mastectomy (MRM), depending on feasibility for BCS and patients' choice about the type of surgery to undergo. Data collected was documented and analyzed. Results: The mean age of patients was 43.73 years. Most of the patients were premenopausal. About 75% of patients achieved maximal response after 4 cycles neoadjuvant chemotherapy. Statistically significant response was achieved in downstaging the breast cancer. Complete clinical response was seen in 12.5%, and partial clinical response (cPR) was seen in 75% patients after neoadjuvant systematic chemotherapy. Postneoadjuvant chemotherapy, 68.75% patients became feasible for BCS. There was no statistically significant association between age, initial tumor size, and menstrual status with tumor response to chemotherapy and feasibility for BCS. Conclusions: To conclude, Neoadjuvant Systemic Therapy is effective in the management of LOBC. BCS is feasible in the majority of LOBC after downstaging by Neoadjuvant Systemic Therapy, which otherwise would require MRM.

Background: Life expectancy of Indian population is gradually increasing day by day as a consequence of which proportion of elderly people living in India is also increasing. In spite of a National Program on control of blindness, there is huge number of elderly people who are blind often due to avoidable and preventable causes. Objective: The objective of this study is to find out the proportion of common ocular morbidity and associated factors among elderly population in a slum at Chetla, Kolkata. Materials and Methods: It was a community-based observational study cross-sectional in design carried out in a slum of Kolkata among elderly population of age ≥60 years residing at Chetla. The calculated sample size was 154, and the study was conducted for a period of 3 months. Results: Among the study participants, ocular morbidity was 73 (47.4%). 44 (28.5%) were diagnosed to have cataract followed by 31 (20.1%) having visual impairment Category 1 and 18 (11.6%) Category 2, in univariate logistic regression, significant association was found between ocular morbidity with age odds ratio (OR) (confidence interval [CI]) 2.44 (1.25–4.73), sex OR (CI) 4.63 (2.34–9.15), education OR (CI) 2.55 (1.32–4.91), economic dependency OR (CI) 5.47 (2.72-11.03), and PCI OR (CI) 2.11 (1.11–4.02). In final, multivariable logistic regression significant association was found with age-adjusted odds ratio (AOR) (CI) 3.70 (1.64–8.35), sex AOR (CI) 3.22 (1.28–8.10), and economic dependency AOR (CI) 2.83 (1.03–7.76). Conclusion: Majority of causes of blindness among the study group in this survey was avoidable, cataract being the leading cause. Government initiatives such as ensuring good quality geriatric eye health-care services at the primary level with cataract operation facilities and health education to raise awareness about preventable and curable eye diseases would further help to tackle this preventable disease burden of the elderly. This will contribute whole heartedly to marked improvement of the quality of life of the elderly population of India.

Background: Cryptococcal meningitis (CM) is an important public health problem, and causes around 10%–30% mortality among people living with HIV/acquired immune deficiency syndrome (AIDS). Combination therapy with Amphotericin B and Fluconazole has improved the outcomes. Objectives: The purpose of this study is to determine clinical presentation, hospital course, response to treatment, complications, and recurrence of CM. Materials and Methods: An observational study from a tertiary care center. From the diagnosed cases of CM, demographic data, clinical profile, investigations, treatment received, complications, and recurrence on follow-up were noted. Results: Twenty patients diagnosed to have CM with HIV infection were analyzed. 12 patients (60%) had CM as the presentation of AIDS. The prevalence of unmasked immune reconstitution inflammatory syndrome (IRIS) (30%) was more than paradoxical IRIS (10%). Fever (85%), headache (90%), and altered sensorium (40%) were the most common symptoms. Mean CD4 in our study was 119.3. Cerebrospinal fluid (CSF) analysis showed oligocellular response in 12 patients. CSF cryptococcal antigen test and fungal culture were positive in all cases. Most common finding on neuroimaging was meningeal enhancement (60%) followed by cryptococcomas (26%). 17 patients survived, whereas 3 patient died during treatment. Three patients had relapse of CM, all of them were noncompliant to maintenance fluconazole therapy. Conclusion: Considering variable presentation of CM in HIV-infected individuals and the presence of high load of undiagnosed cases, high suspicion is required for clinching early diagnosis which might improve the outcome.

Introduction: Much have been achieved in improving the quality of life of asthmatic children such as providing efficient treatment and preventive measures; however, acceptability of these treatments such as metered-dose inhalers (MDI) by caregivers desires to be studied. Materials and Methods: This study was cross-sectional involving caregivers of asthmatic children aged 5–14 years. Results: One hundred and nineteen caregivers were recruited, consisting of 93 mothers (78.1%), 22 fathers (18.5%), and 4 relations (3.4%). However, 88 (73.9%) of the respondents believed asthma was inheritable. Sixty-five (54.6%) of the respondents had counseling on asthma but majority of the respondents will accept MDI if prescribed for their wards; however, among the 33 (27.7%) that will reject, majority believed MDI will make asthma chronic (51.5%). However, 69.7% of them agreed to accept MDI if properly counseled on the advantages and effectiveness of MDI. Although majority of those that had counseling on childhood asthma would accept MDI, this observation was not statistically significantly (χ² = 2.741; df = 1; P = 0.11); however, most of those with a family history of asthma would accept MDI and this observation was statistically significant (χ² = 14.312; df = 1; P = 0.00). Similarly, maternal education showed statistically significant association with willingness to accept MDI (Fisher's exact test = 15.444; P = 0.01). Oral medications were the preferred route by the respondents (66.4%) if given the choice to choose. Conclusion: Most respondents believed that asthma is heritable, and majority will accept MDI if prescribed by a physician but they will prefer oral medication as a matter of choice; however, maternal education had significant relationship with the willingness to accept MDI.

Background: Failure to recognize comorbid alcohol use disorders in medical-surgical inpatients may adversely affect their management. Aim: The aim of this study was to assess the stressful life events and severity of alcohol consumption in medical and surgical inpatients. Materials and Methods: This cross-sectional, hospital-based study included 100 consecutive medical and surgical patients admitted to a tertiary care center and 100 matched normal controls. For the collection of demographic data, a questionnaire was prepared which was administered to all patients. For studying stress, the Armed Forces Medical College life events scale was used. Michigan alcohol screening test (MAST) was applied for screening patients with alcohol dependence. Results: Medical and surgical patients experienced significantly more number of life events in their lifetime as compared to matched normal controls. The medical and surgical group experienced significantly more life change units both in 1-year prior as well as in lifetime period. Analysis revealed that significantly higher number of the medical and surgical patients scored above the cutoff score on the MAST compared to the controls (9% vs. 2%). Conclusion: Medical-surgical patients have significantly more stressful life events and higher prevalence of alcohol dependence than normal controls.

Background: Suicide is a threat to the existence of humankind. Many biological, psychological as well as social factors contribute to the causation of suicide. A lot of researches have been carried out to understand the psychodynamics of suicide from different perspectives. Aims: This study aims to study the suicide notes with diagrammatic contents through qualitative analysis. Materials and Methods: A total of 1710 victims who had undergone autopsy in 2013 were screened. A total of five cases were found eligible as per the selection criteria of our study. The suicide notes were subjected to qualitative analysis of their written content and drawings. Results: The drawings analyzed here were consisting of human and other inanimate object figures. The semantic characteristics of the written contents, especially the intense emotions, were well-reflected in the drawings. Conclusion: Drawings were more helpful in ascertaining psychopathology, intrapsychic factors, and personality aspects of the committed suicide cases.

Aim and Objective: Motor-evoked responses using transcranial magnetic stimulation (TMS) have been studied in India in various diseases. However, no normative data are available for young healthy Indian adults. The aim was to generate normative data for young healthy Indian adults in our laboratory so that it can be used as normative data for comparison in various disorders. Materials and Methods: Motor-evoked responses using TMS in 15 young healthy Indian adults (mean age 32.8 years, mean height 166 cm) was studied using circular flat coil capable of delivering 1.5 tesla magnetic energy. Various parameters such as cortical threshold (CT), cortical latency (CL), central conduction time (CCT), root latency (RL), and amplitude of motor-evoked potentials (MEP) were studied. Results: The mean CT was 830 standard deviation (SD) 45 mv (55%) for abductor pollicis brevis (APB), 930 SD 65 mv (62%) for biceps brachii, and 1260 SD 52 mv (84%) for extensor digitorum brevis (EDB). The mean CL was 21.2 SD 1.14 ms for APB, 11.5 SD 0.1 ms for biceps, and 37.6 SD 0.75 ms for EDB. The mean RL was 14.7 SD 0.96 ms in APB, 6.12 SD 0.78 ms in biceps, and 21.33 SD 1.30 ms in EDB. The mean CCT was 6.53 SD 1.02 ms in APB, 5.6 SD 1.1 ms in biceps, and 16.7 SD 0.92 ms in EDB. The mean MEP amplitude was 4.20 SD 2.14 mv in APB, 3.21 SD 1.37 mv in biceps, and 1.10 SD 0.38 mv in EDB. The mean normal value of MEP/MAP ratio for APB was 0.29 SD 0.09, for EDB 0.12 SD 0.03. Conclusion: Various studies have been done using TMS to study motor-evoked responses. However, there has been a slight difference in values among them due to the type of coil used, energy delivered, and interobserver difference. Every electrophysiology laboratory should have its own value to act as a baseline for comparison with that in disorders of nervous system. No data for normal values in Indian population is available.

Ischemic stroke following viper bite is rare. We report a case of stroke with multiple ischemic infarctions following viper bite in a previously healthy man. Soon after being bitten by the snake, he developed local swelling followed by loss of consciousness 1 h later. On examination, he had decreased movement of the right upper and lower limb with bilateral extensor plantar response. Computed tomography scan of the brain showed multiple infarctions involving left frontotemporal lobe, right basal ganglia, right thalamus, occipital lobe, and cerebellar region. The patient improved partially with anti-snake venom therapy.

Malignant mesothelioma of the testis is a rare condition. It usually affects the elderly. The common clinical manifestations include painless testicular mass. The tumor markers are normal. Ultrasonography helps in differentiating it from testicular tumors as these are situated at the periphery of the testis. Inguinal orchidectomy is diagnostic. Staging is usually done with abdominal computed tomography scan and chest X-ray. Role of adjuvant chemotherapy, radiotherapy, and lymph node dissection is controversial.

A mucocele or pyocele of a paranasal sinus is a cystic lesion with accumulation of mucus or pus within the sinus walls and is capable of expansion. The frontal sinus is most commonly involved, whereas ethmoidal, sphenoid, and maxillary mucoceles are rare. Floor of the frontal sinus is shared with the superior orbital wall which explains the early displacement of orbit in enlarging frontal mucoceles or pyoceles. Here, we report a case of frontal pyocele in a 62-year-old male patient who presented to us with nonaxial proptosis. The case was managed by external surgical approach successfully. Possible ocular manifestations of mucoceles or pyoceles and the diagnostic imaging techniques used are discussed. We stress that a multidisciplinary approach involving the ophthalmologists, otolaryngologists, and radiologists is essential for prompt diagnosis and management to avoid unwanted complications.

Uterovesical fistula without vaginal leakage of urine, cyclic hematuria and amenorrhea is a rare condition. It is referred to as Youssef's syndrome. The most common cause of this syndrome is trauma during cesarean section. Herein, a case is reported in which a P₄L₄ presented to the outpatient department with incisional hernia following four lower segment cesarean sections along with secondary amenorrhea and cyclic hematuria for the past 4 years. A diagnosis of the uterovesical fistula with incisional hernia was made. Cystoscopy and hysterosalpingography confirmed the diagnosis. Mesh hernioplasty with fistula repair was planned and done along with hysterectomy.

Bell's palsy affects pregnant women three times more often than nonpregnant women, with majority of cases occurring in the third trimester (71%) and early postpartum period (21%). Bell's palsy during pregnancy has been associated with preeclampsia, with 22% of these women developing preeclampsia. A 26-year-old G3P1 L1A1 diagnosed with Bell's palsy 2 weeks earlier, presented at 33-week period of gestation with a chief complaint of progressive bilateral pedal edema for 1 week, blood pressure (BP) - 150/100 mmHg and dipstick urine - 3+. Laboratory screening of HELLP syndrome was normal. Six days later, she had an episode of generalized tonic–clonic convulsion, magnesium sulfate was given, and emergency laboratory investigations revealed partial HELLP syndrome (platelet - 80,000, serum glutamic oxaloacetic transaminase/serum glutamic pyruvic transaminase - 281/222 U/L) with normal coagulation profile. Lower segment caesarean section was performed with delivery of a 2ks neonate with APGAR of 7/10 and 9/10 at 1 and 5 minute respectively. Postoperative day 3, all laboratory reports including magnetic resonance imaging brain were normal. BP was stabilized and she was discharged on the third postnatal day, with some right-sided residual facial weakness. All obstetricians must be aware of association of Bell's palsy with hypertensive disorders of pregnancy and aggressively screen for the same as soon as diagnosed, to prevent complications such as eclampsia and HELLP. Since Bell's palsy is not associated with adverse perinatal outcomes, it should not prompt obstetricians for hastening deliveries prematurely.

Ewing's sarcoma commonly reported in long bones and pelvis. Primary Ewing's sarcoma of the cranium is rare. They behave differently from their counterpart involving the long bones. They usually respond well to chemotherapy and radiotherapy. We are discussing a case of pediatric Ewing's sarcoma primarily involving the occipital bone which was diagnosed late due to the lack of associated clinical features.

Fetal gastroschisis and omphalocele are congenital defects of abdominal wall that are often diagnosed by prenatal ultrasound done for routine screening or for obstetric indications, such as evaluating an elevated maternal serum alpha-fetoprotein. Prenatal ultrasound could potentially identify the overwhelming majority of abdominal wall defects and accurately distinguish omphalocele from gastroschisis. Here, we report a case of gastroschisis diagnosed at routine prenatal ultrasound along with a thorough fetal autopsy which gives the final diagnosis of disease.

Schwannoma or neurilemmomas are benign, encapsulated, slow growing nerve sheath tumors of ectodermal origin derived from schwann cells of the nerve sheath. It is commonly seen in the head and neck region. It mainly arises from vestibulocochlear nerve (80%) and rarely in oral cavity (1%), tongue being the most common site in the oral cavity. Palate is a rare site for schwannoma. Herein, we report a rare case of schwannoma of the hard palate in a 21-year-old male. It was excised intraorally. A histopathological diagnosis of schwannoma was made. Immunohistochemistry with S-100 and vimentin were positive which confirmed the diagnosis of schwannoma.