Background: Recently, hydroxychloroquine (HCQ) has been advocated by the Indian Council of Medical Research for prophylaxis of COVID-19, and the Food and Drug Administration has given emergency use authorization for its use in the treatment of severe COVID-19 disease in hospitalized patients. HCQ is generally well tolerated; however, concerns about adverse effects in adults prescribed with HCQ for prophylaxis remain. Our study was designed to investigate the adverse drug reaction (ADR) profile of HCQ in prophylactic doses for COVID-19 prophylaxis among doctors. Materials and Methods: This was a cross-sectional study carried out among doctors taking HCQ prophylaxis for COVID-19. The study was carried out over 1 month from April 1, to April 30, 2020. Data regarding age, sex, comorbidities, number of doses taken, concomitant drug therapy, adherence to drug schedule, need for treatment of ADRs, and possible adverse effects were obtained from the patients. The participants were administered an online pretested, validated questionnaire to ascertain the adverse effects they noticed while taking HCQ. Results: One-hundred and forty doctors were included in the study group. Sixty-nine adverse events were documented in 44 participants (31%). The most frequently reported symptoms were headache followed by nausea, dizziness, abdominal cramps, and loose stools. Hypoglycemia was seen in three participants, all with diabetes. Sixteen participants required medication to treat the adverse effects (most commonly ibuprofen for headache), while four participants discontinued the drug due to adverse effects (two each because of hypoglycemia and one each because of nausea and loose stools). There was no statistically significant difference of age, gender, number of doses taken, or comorbidities on adverse effects. Conclusion: Almost a third of the participants reported adverse effects. Utmost care is necessary before using HCQ prophylactically for chemoprophylaxis of COVID-19.

Introduction: Hematuria following iatrogenic trauma or renal vascular malformations is less common but important causes warranting definite emergency procedure in cases not responding to conservative management. Endovascular embolization is accepted as an effective technique for the treatment of acute intractable hematuria. Considering the need of microcatheter for selective embolization, its use during the procedure increases the procedural cost significantly. The purpose of the present study is to assess the effectiveness and safety of selective renal artery embolization in patients with intractable hematuria using a 4-F glide catheter (GC). The microcatheter usage during our study was intended to be restricted to cases where the GC was not navigable to the optimal site for embolization. Materials and Methods: A retrospective analysis was done for 21 cases with acute intractable hematuria referred to our center between January 2015 and February 2019. Fifteen male and 6 female patients were included. Seventeen cases followed iatrogenic injury during a renal biopsy, 2 cases were due to renal neoplasm, and 1 each due to PCN and abdominal trauma. Embolization was carried out after selective catheterization of the feeding artery, with a 4-F GC using polyvinyl alcohol (PVA) particles in combination with pushable coils in all cases. Results: The source of bleeding was identified as arteriovenous fistula (AVF) in 14, AVF with pseudoaneurysm (PA) in 3, PA alone in 2, and abnormal tumor vascularity in 2 patients. In all but 2 cases, the hematuria stopped within 24 h after embolization. In the remaining 2 cases, hematuria stopped completely within 72 h. One patient developed minor puncture site bleed with no major procedural complications or recurrence on follow-up. Conclusion: Endovascular embolization is a highly effective minimally invasive technique for the treatment of acute intractable hematuria. Good results were achieved without using any microcatheter (hence cost-effective) with no clinically significant nontarget embolization.

Aim: The objective was to evaluate and compare the oral health-promoting activities (WHO 5 key points) undertaken in the schools of Pune city belonging to the different boards. Materials and Methods: A descriptive cross-sectional study was conducted from January 2018 to August 2018 among the different board schools in Pune. A total of 50 schools based on quota sampling were selected as follows: Central Board of Secondary Education (CBSE) (n = 17): Indian Certificate of Secondary Examination (ICSE) (n = 5): International Board (n = 1): Cambridge Assessment International Education (n = 1): State Board (n = 26). English medium schools representing the respective board and those willing to give consent for interviews were included in the study. Convenience sampling was used to recruit the required number of schools for data collection. A 5-item checklist was prepared for collecting the information through an interview with the school principals. Approval was obtained from the Scientific and Institutional Ethics committee before starting. Results: Of 50 schools, data were collected from only 44 schools. Among the CBSE schools, 64.7% (n = 11) reported of having oral health policy for the school children, followed by 42.3% (n = 11) of State Board schools. About 100% (n = 17) CBSE and ICSE (n = 1) and 53.84% of State Board schools (n = 15), respectively, were providing the supportive environment to enhance the good oral health. There was no statistically significant difference between CBSE and other boards with regard to school oral health policy (P = 0.19), developing good oral habits (P = 0.52), encouraging children to pass the oral health message to family and community (P = 0.49), and the presence of oral health-care provision (P = 0.19). Conclusion: The school authorities are aware of the dental health problems faced by the children. Some schools are conducting health education programs to educate children about the maintenance of oral hygiene through the involvement of dental colleges and the dentists from the surrounding area. However, they need to emphasize on oral health-promoting concept to incorporate healthy habits to prevent dental diseases at earliest.

Introduction: The potency of vaccines depends on maintaining the cold chain, that is, a prescribed temperature range during distribution from manufacture to use. The paramedical staff of any hospital plays a pivotal role in cold chain maintenance. Hence, the study aims to assess knowledge and practice of cold chain maintenance of vaccines by paramedical staff. Materials and Methods: A cross-sectional questionnaire-based study was conducted among paramedical staff in a tertiary health care of western Maharashtra, from June 15, 2019, to August 30, 2019. The data were collected using interview schedule. Results:A total of 115 paramedics were enrolled. The final data analysis was done on 91 respondents. Participants' knowledge about maintenance of refrigerators with respect to place of vaccine storage (54; 59.34%), temperature recording in a day (54; 59.34%), and preferable place of deep freezer (62; 68.13%) was satisfactory. A total of 42 (46.15%) participants had knowledge about shake test; however, only 38 (41.75%) participants knew about demonstration of shake test, suggesting that awareness about testing the frozen vaccine was poor among paramedical staff. Full form and use of vaccine vial monitor (VVM) in participants were satisfactory, being 70 (76.92%) and 59 (64.83%), respectively. Participant's knowledge about correct site and route of administration of vaccines were satisfactory. Conclusion: The study demonstrates the gap in knowledge in cold chain maintenance of the paramedical workers. Regular training may be conducted for the paramedical workers to improve their understanding of the cold chain management.

Context: Obstetric fistula is the most frequently found complication in the obstetric care facility in Bangladesh. In addition to physical illness, this life-long complication is also associated with the declined mental status of the sufferer. Aims: The aim of the study was to find the associated factors in the occurrence of obstetric fistula and their effect on the mental health status of women of the reproductive age group. Settings and Design: This was a cross-sectional study. Subjects and Methods: A total of 108 women aged between 15 and 35 years were interviewed with a semi-structured questionnaire to explore their sociodemographic, obstetric, and mental status domain. Statistical Analysis Used: The frequencies of the different variables were analyzed using SPSS 20 software, and the Chi-square test was done to observe the associations. Results: The average age of the participants was 23 years. Over 40% of women had their first delivery between the ages of 16–18 years and the same percentage of them had never taken antenatal checkup during their pregnancy. Obstetric fistula was found in nearly 45% of the women after their first delivery. Over two-thirds of the women were found to have a severe depression after the incident. Despite being common in the younger age group, patients older than 25 years were more prone to the severity of depression. Conclusions: The present study strongly supports the association of having obstetric fistula with reduce mental health ranging from having moderate-to-extreme depression.

Objective: The study objective was to study successful graft uptake and hearing gain by using different graft materials in pediatric tympanoplasty. Materials and Methods: Patients younger than 16 years of age who had undergone tympanoplasty between January 2016 and February 2019 were included in this study. Temporalis fascia or perichondrium was used as the graft material in tympanoplasty. Patient details such as age, sex, side of operated ear, operation technique, audiological profile before and after surgery, and the status of postoperative graft were noted. An intact graft and air–bone gap (ABG) ≤25 dB were considered as successful outcome after postsurgical period. Preoperative audiogram and audiogram after 6 months of surgery were advised for comparison.Results: Thirty-six pediatric patients were included in our study. Temporalis fascia graft was used as the graft material in 22 patients and cartilage graft was used as the graft material in 14 patients. The successful graft uptake was 89% in the temporalis fascia group, whereas it was 96% in the cartilage group. In temporalis fascia group, ABG before surgery was 35.53 dB, ABG after surgery was 17.12 dB, and the postoperative gain was 18.41 dB. In the tragal cartilage group, preoperative ABG was 32.42 dB and postoperative ABG was 15.13 dB, with a postoperative gain of 17.29 dB. The comparison between the temporalis fascia and the tragal cartilage groups was statistically significant for successful graft uptake (P = 0.0119) and hearing outcome (P = 0.0484). Conclusion: Temporalis fascia gives better hearing outcome, whereas tragal cartilage gives better graft uptake in pediatric tympanoplasty.

Background: Hypothyroid patients may have reduced sodium levels, but the strength of such a link is still not clearly defined. Aims: This study aims to evaluate the significance of hyponatremia in hypothyroidism in an urban young female population of eastern India. Materials and Methods: This cross-sectional study was conducted on 200 hypothyroid patients in Burdwan Medical College in a period of 12 months after taking Institutional Ethical Clearance. 100 controls were taken for the study. Serum thyroid-stimulating hormone (TSH), free thyroxine (FT4), and sodium levels were estimated. The individuals were age matched. The computer software Statistical Package for the Social Sciences, version 16.0 was used for analyzing data. Results: 200 hypothyroid patients were enrolled for the study. 31 hypothyroid patients presented with reduced serum sodium level (15.5%). Significant difference was observed between controls and hypothyroid patients for mean TSH (P < 0.0001), mean FT4 (P < 0.0001), and mean sodium (P < 0.0001). No significant difference of age was observed between two groups. Serum sodium level was negatively correlated with TSH (r: -0.59, P < 0.00001), and serum sodium was positively correlated with serum FT4 (r: 0.29, P: <0.0000). Conclusions: Hypothyroid females in reproductive age group may have significant decrease in serum sodium levels as compared to normal individuals, and serum sodium needs to be estimated in hypothyroid patients for better management of patients.

Context: Central venous catheters (CVCs) have become integral in the pediatric intensive care setting as well as in the operating room (OR). In the OR, these lines are usually used without prior confirmation of correct position, and a chest radiograph is performed postoperatively, several hours later. Hence, it is desirable to confirm the correct CVC position immediately after placement. Aim: This observational study was designed to evaluate the accuracy of electrocardiography (ECG) guidance on correct CVC positioning in pediatric population. Settings and Design: This was a prospective observational study. Subjects and Methods: Patients till 12 years of age were included in the study. Ultrasound was used to guide initial cannulation of the vessel. Certodyn^® universal adaptor was connected to the guidewire via a sterile alligator clip. The CVC along with the guidewire was advanced till it lies in the right atrium which was seen by an increase in the amplitude of P-wave on the intracardiac ECG. The CVC was then withdrawn slowly until the P-wave morphology returned to normal or preprocedural configuration. Statistical Analysis Used: Data were expressed as percentage. Results: Out of the 68 patients, the percentage of patients having appropriate position of CVC tip was 95.5% (65 patients). Out of the three patients with incorrect tip position, in two patients, the tip was distal to the appropriate position and in one case, the ECG changes could not be appreciated. Conclusions: ECG-guided CVC placement has high accuracy of correct positioning in infants and children.

Context: One health concept relies on the principle of human health, animal health, and environmental health. Mass gatherings challenge all of them and warrant the transmission of infectious diseases, physical injuries, and an impact on local and global health systems and services. Thereby, a robust and coordinated management of various sectors is solicited to mitigate the challenges of health care in the pop-up townships of mass gathering. Aims: The aim of the study is to evaluate the curative, preventive, promotive, and medicolegal health services of the pilgrims. Settings and Design: A descriptive epidemiological study with cross-sectional design was conducted in the Gangasagar Mela 2019. Subjects and Methods: The observational epidemiological study was done through interaction with the concerned authorities: transect walk and survey of curative, preventive, and medicolegal health services using all enumeration techniques. Statistical Analysis Used: The data were analyzed using the principles of descriptive statistics. Results: Outpatient department attendance at five temporary hospitals was 6176 patients. Predominant complaints were respiratory ailments followed by gastrointestinal complaints. Inpatient department (IPD) including field-level high dependency unit and trauma care center admissions were 190 patients, of whom 25 were referred to higher facilities and 2 deaths occurred. Conclusions: The study provided an opportunity to generate an evidence base for generation of solutions and recommendations for the prevention and control of infectious diseases and accidents during the mass gatherings. This could provide information on the development of context-specific methods for the improvement and sustainment of optimum health and sanitary conditions for the visitors during Gangasagar Mela or any other mass gatherings across the globe.

Background: Dichrostachys cinerea Wight. and Arn. of Mimosaceae family commonly called as Veerataru in Ayurveda. Traditionally, it has been used in diabetes, rheumatism, urinary calculi, renal problems, and menstrual disorders. The plant has been reported to possess diuretic, antiprotozoal, antihelmintic, anticancer, antibacterial, antidiarrheal, and hepatoprotective activity, etc., Although it is an important plant, till date, no reported anatomical, chromatographic data are available on roots. Aim: The present study is aimed to establish anatomical characters of fresh roots of D. cinerea followed by antihyperglycemic and chromatographic studies of various fractions of hydroalcoholic extract of roots. Materials and Methods: Morphoanatomical studies were carried out according to the quality control standards of Ayurvedic Pharmacopoeia of India. Hydroalcoholic extract was subjected to fractionation with nonpolar-to-polar solvents. Antihyperglycemic studies were carried out by glucose tolerance test. Results: Transverse section of the fresh root shows the presence of suberized cork, parenchymatous cells containing numerous starch grains. Ethyl acetate fraction has produced significantly (P < 0.01) highest antihyperglycemic activity (52.32%) at a dose of 400 mg/kg among all fractions. High-performance thin-layer chromatography analysis also confirmed the presence of phenols in ethyl acetate and butanol fractions. Conclusion: The current anatomical and chromatographic analysis can be considered as reference standards for future studies on D. cinerea roots. A traditional claim on antidiabetic activity of roots has been scientifically established.

Background: Dengue is a viral fever commonly seen in the Southeast Asia. It is spread by Aedes mosquito and is health menace, in our country. Dengue during pregnancy can affect the mother and the fetus. This study was done to study the effect of dengue fever on the fetomaternal outcome. Aim and Objectives:The aim was to study the effect of dengue during pregnancy on fetomaternal outcome. Materials and Methods: A prospective observational study was done to include the patients who were diagnosed with dengue using enzyme-linked immunosorbent assay based test, for a period of 2 years. Results: A total of 31 cases of dengue were diagnosed during a period of 2 years. Nine patients required platelet transfusions. Five patients were admitted to the intensive care unit (ICU) and nine newborns were admitted to neonatal ICU (NICU). Conclusion: Dengue during pregnancy leads to obstetric complications such as preterm labor, oligohydramnios, and NICU admissions.

During the pandemic of coronavirus disease (COVID 19), anecdotal reports have been emerging all over the world that cases of acute cardiovascular emergencies such as ST-elevation myocardial infarction (MI) have decreased to the extent of 30%–70% at various hospitals. The number of primary percutaneous interventions has significantly decreased all over the world including developed nations. We present case reports of acute coronary syndromes (ACS) who presented to our hospital after the period of lockdown during the COVID-19 pandemic. These patients presented late to the hospital when we compare the ACS presentation before the lockdown period. Because of the late presentation, these patients developed heart failure and other complications leading to their death.

Surgery is not always required in patients with spondylolisthesis. Meanwhile, surgical adverse events contribute significantly to postoperative morbidity. Restriction of the patient's activities, muscle rehabilitation, and other nonoperative measures, including the intermittent use of a rigid back brace, often are sufficient if the symptoms are minimal, and the slippage is mild. The study aimed to figure out the efficacy of conservative treatment using rigid brace in patients with degenerative spondylolisthesis. A total of patients (12 men and 18 women) who were hospitalized as a degenerative spondylolisthesis without neurological deficit at L4–L5 or L5–S1 from June 2015 to April 2017 underwent the rigid bracing. This study investigated pain, satisfaction, rate of reduction obtained according to the initial slip degrees, and degree of slip after the removal of immobilization at follow-up with radiographs of the patients with L4–L5 or L5–S1 spondylolisthesis. Twenty-eight patients (93.3%) complained no back pain and were satisfied with the rigid bracing. The complete reduction rate after reduction maneuver was 76.7% and after removal of the brace, in 15 patients, the slip disappeared at follow-up. Degenerative lumbar spondylolisthesis without neurological deficit can be treated successfully with rigid bracing with good outcomes.

Chronic dacryocystitis is a chronic infection of the lacrimal sac. In chronic dacryocystitis, there is obstruction of the nasolacrimal duct at the junction of lacrimal sac followed by stasis in the lacrimal sac, causing watering and discharge from the eye. In the present case report, a 24-year-old female patient suffered from this disease. She presented with the chief complaints of watering from both eyes for 6 months and mild swelling and pain over the lacrimal sac area in both eyes for 5 days. She was treated with Triphala Guggulu and Triphaladi Netra Parisheka, along with Mardana in lacrimal sac area for 1 month. After 1 month of treatment, the patient got relief from all the complaints. In lacrimal syringing, there was no any obstruction or regurgitation found. On analysis of all the data, it can be concluded that Ayurvedic management with Triphaladi Netra Parisheka and T. Guggulu along with Mardana in the lacrimal sac area offers effective result in the treatment of chronic dacryocystitis.

Anesthesia in pediatric patients with severe kyphoscoliosis presents a definite challenge to the anesthesiologists. Giving general anesthesia as well as regional anesthesia is quite tricky in such patients. Anesthesiologists must be prepared for general anesthesia even after giving subarachnoid blockade as chances of failure, patchy effect, and unilateral blocks are very high. Here, we report a pediatric case of kyphoscoliosis posted for inguinal hernia repair done successfully under subarachanoid blockade.

Congenital hernia of the umbilical cord (CHUC) is a rare, distinctive anomaly with variable presentation and conflicting terminology. We report two newborn infants who had fetal antenatal diagnosis as umbilical cord cyst and omphalocele, respectively, and were subsequently found to have hernia into the umbilical cord. The herniating mass in CHUC may vary greatly in size, making it difficult to differentiate with other conditions such as congenital umbilical cord cyst, cord hematoma, omphalocele, and gastroschisis. CHUC is prone to inadvertent cord clamping and injury to the gut. The failure of retraction of intestinal loops following physiological herniation has been postulated as the embryological basis of this entity. Overall prognosis is good.

Peliosis a rare condition characterized by multiple blood-filled cavities within the parenchyma of solid organs mainly organs of mononuclear phagocytic system. Peliosis is associated with tuberculosis, human immunodeficiency virus, disseminated cancer, previous thorium dioxide contrast injection, chronic hematological disorders, and many other conditions. Peliosis is usually asymptomatic and diagnosed as an incidental finding. Imaging modalities such as ultrasonography, computed tomography (CT), and magnetic resonance imaging are useful for diagnosis. On CT, hypoattenuating nodules with fluid-fluid levels are a unique feature for diagnosing peliosis. Although rare and asymptomatic most of the time, peliosis is an important condition to be aware of because rupture of the blood-filled cysts can lead to hemoperitoneum and ultimately be fatal. We reported a case of a 35-year-old male with isolated splenic peliosis with its rupture and resultant hemoperitoneum.