About a quarter of the world's population is infected with tuberculosis (TB), with new infection occurring every second. The global burden, particularly with multidrug resistance, is also increasing simultaneously and has become a major health challenge. Earlier and improved case detection, including smear-negative disease, often associated with HIV co-infection, and expanded capacity to diagnose multidrug-resistant TB are global priorities for TB control. Conventional laboratory methods are slow and cumbersome. Hence, novel technologies for rapid detection are the focus of TB research and development. GeneXpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) is one of them, currently unique in its simplification of molecular testing with amplification and detection based on real-time polymerase chain reaction. Xpert MTB/RIF detects MTB as well as RIF resistance directly from sputum within 2 h. This article focuses on the significance of new diagnostic test for TB.

The ongoing COVID-19 pandemic has been unstoppable across the globe and India. The application of strategy “test, track and treat” has not been sufficient in halting the pandemic. Arrival of vaccines on the horizon has raised hopes of termination of pandemic in the near future. It should be emphasized that epidemiological relevance, efficacy, safety, operational feasibility, and social acceptance are minimum prerequisites for successful implementation of a new vaccination campaign. The ambitious launch of COVID vaccination by India at the juncture of a declining pandemic needs to be discussed in relation to its timing, economic implications, and ramifications on public health. This article aims to analyze this vaccination strategy.

HIV continues to remain one of the major public health concerns for more than 3 decades and has accounted for the deaths of 35 million people till date. Despite making considerable progress in the response against the disease, it continues to pose major threats across all the regions. This is mainly because the reach of services is inadequate and that the scale up plan is also slow. Another major challenge is the rise in the incidence of a number of conflicts and other humanitarian emergencies, which not only jeopardize the health delivery system, but also forces the people to migrate to other regions, which might again pose a major pressure on the health system of the recipient nations. This is a high time to focus on the critical areas and further strengthen the existing momentum of the HIV response by the nations. In conclusion, HIV infection is a major public health concern and all the involved sectors and stakeholders have to work together to keep the infection under check and improve the quality of life of the infected people.

Introduction: Chronic suppurative otitis media (CSOM) is one of the common hearing problems which can cause many complications if not treated properly. Hence, the study aims to identify the bacterial isolates causing CSOM and to study their antimicrobial susceptibility pattern. Materials and Methods: The study was carried out in a tertiary care hospital in Kota from May 2019 to January 2020. Three hundred and seventy patients of CSOM with discharge attending the ENT outpatient department were included in the study. Swabs were taken and sent immediately to the microbiology laboratory and processed. Bacterial isolates were identified using standard methods and antibiotic susceptibility testing was done. Results: Pseudomonas was the most predominant bacteria isolated followed by Staphylococcus aureus, Coagulase-negative Staphylococcus, Enterobacter spp., Proteus spp., Streptococcus pneumonia, Klebsiella spp., Enterococcus and Acinetobacter spp. Conclusions: The present study helped in knowing the bacteriological profile of the cases of CSOM. Empirical treatment may not be successful in all cases because of the emergence of resistant organisms. Hence, it is advisable to do an antibiogram before starting the treatment.

Backgrounds: To compare the change in central macular thickness (CMT) using optical coherence tomography (OCT) in subjects undergoing uneventful phacoemulsification and small incision cataract Surgeries (SICS). Methods: In this prospective observational study, patients undergoing uneventful cataract surgery were subdivided into two groups. Forty-five patients who underwent SICS were included in Group S (n = 45) whereas patients undergoing uneventful phacoemulsification were included in Group P (n = 50). Findings of slit-lamp examination, best-corrected visual acuity (BCVA), and fundus examination were recorded for all cases on the first postoperative day as well as 6 weeks after surgery. CMT of participants was determined using spectral-domain OCT preoperatively and at 6 weeks' postoperatively. Results: Overall three patients had postoperative cystoid macular edema, one case in Group P and two cases in Group S. 98%of patients in Group P and 95.5% of patients in Group S achieved BCVA of 6/9 or more. In Group S, a significant difference was observed between preoperative and postoperative central subfield mean thickness (P < 0.01). In Group P preoperative and 6^th week, postoperative mean macular thickness showed a significant difference (P ≤ 0.03) only in the superior outer subfield. On comparing the change in CMT in the Group P with Group S, a significant difference was noted with markedly lesser chances of subclinical macular edema in the Group P. Conclusion: Although the increase in mean macular thickness postoperatively did not affect the final visual outcome in both the groups, Subclinical change in Group P was significantly lesser than that in Group S.

Background: The main goals of second professional MBBS pathology teaching are to provide a framework for the description of disease and to provide students with knowledge of the functional and structural changes in disease in order that clinical signs and symptoms are often understood and interpreted. Aims: It was a cross-sectional, descriptive study which aimed to find out the importance of pathology subject in MBBS curriculum as well as to assess the students perception regarding subject understanding, teaching methodology, and assessment criteria. Materials and Methods: Two hundred and sixteen students of 2^nd MBBS who had already completed 1^st year and were about to appear in the university examination in the year 2020 were included. An extensive questionnaire was prepared regarding 2^nd year pathology teaching. The feedback from the students was obtained and analyzed the SPSS software version 17.0. Results: 30.05% students found pathology subject as an interesting, 46.75% found it to be lengthy, whereas remaining (13.80%) found it as not only interesting but also lengthy as well and 9.4% found it boring and difficult. 70.8% students were able to apply the knowledge gained in the 1^st year while studying pathology. 76.7% students responded that knowledge gained in pathology helped them in clinical postings. 53.2% students opined that combination of teaching methods helped them for better understanding of subject. Written and viva voce examination was helpful for 74.14% and 79.62%, respectively, to evaluate them. Conclusion: Our study has emphasized the importance of pathology as a subject for understanding the clinical subject. As competency-based curriculum is starting from 2019 batch and onward, this elaborative study can act as a baseline to get access to the effectiveness of new curriculum in coming years.

Introduction: Contact tracing is an essential public health response to infectious disease outbreaks, principally in the early stages of an outbreak when specific treatments are limited. Importation of novel coronavirus (SARS CoV-2) from Hubei province China and elsewhere into the world highlights the need to recognize the power of contact tracing as a preventive measure. This study was performed to estimate the SARS CoV-2 transmission among the contacts of confirmed cases of coronavirus disease-19 (COVID-19). Methods: The present study included data from contact tracing performed on confirmed COVID-19 cases admitted in the tertiary care hospital of western Maharashtra. Contacts were categorized into high-risk and low-risk contacts. Contacts were quarantined in home or institute, and reverse transcription–polymerase chain reaction (RT-PCR) was done as per the COVID-19 testing strategy. Contacts were admitted once they were RT-PCR-confirmed COVID-19 positive. Results: Out of 471 COVID-19 cases, 104 (22.08%) were females and 367 (77.92%) were males. A total of 2617 contacts were traced with the mean (standard deviation) of 5.56 (8.52). Of these 2617 contacts, 289 (11.04%) contacts became RT-PCR-confirmed positive COVID-19 cases. Out of 471 COVID-19 cases, 271 (46.7) were the contacts of RT-PCR-confirmed COVID-19 cases, and from them, 92 (42.4%) were asymptomatic at the time of admission. Conclusion: The contact tracing strategy in India helped to identify a sufficient proportion of infected individuals, and due to that, subsequent spread of the disease could be prevented. However, the complete achievement will depend on the rapid detection of cases and isolation of contacts. With the increasingly large number of cases globally once in between the null period, this strategy can be effectively utilized to contain the spread of disease.

Context: There is an ever-growing concern for the safety of blood transfusion with regard to the transmission of human immunodeficiency virus (HIV), hepatitis C (HCV) virus, and hepatitis B virus (HBV). About 11 million blood units are being collected in India every year. Instances of viral transmission through transfusion still occur as a result of donations that take place while a donor is in the pre-seroconversion window phase. Aim: The aim of the study is to analyze 4 years data of nucleic acid testing (NAT) for our blood donor population and validate the benefits of implementing individual donor NAT (ID-NAT). Subjects and Methods: A total of 54,895 blood donor samples were tested by ID-NAT method between January 2016 and December 2019. ID-NAT results and corresponding serological test results were collected and correlated for the identification of ID-NAT yield cases (seronegative/NAT positive) to identify the potential infected samples which may not be detected by the serological testing. Results: Of the 54,895 samples tested, there were total 71 samples which were serologically negative but detected by ID-NAT (ID-NAT yield). Among these 71 ID-NAT Yields, 3 were HIV, 12 were HCV, 46 were HBV, and 10 cases were reactive for HBV-HCV co-infections. Our combined ID-NAT yield rate was estimated to be 1 in 773 donations tested. Conclusion: Higher incidence of NAT only reactive donors poses a risk of transfusion transmissible infections in blood centers not adopting NAT. HBV NAT displays the highest yield, thereby recommending the universal adoption of NAT for all three viral markers, namely HIV, HBV, and HCV in our country.

Context: Accurate diagnosis may be challenging in nonneoplastic lung diseases. Newer techniques such as bronchoalveolar lavage (BAL), bronchial brushing (BB), and transbronchial needle aspiration (TBNA) have been studied mainly in lung cancers. Aim: This study assesses the efficacy of BAL, BB, and TBNA in non-neoplastic lung diseases, against a gold standard of transbronchial lung biopsy (TBLB). Settings and Design: Three-year prospective study in a tertiary care center in North India. Methodology: Adult patients (n = 137) with nonimproving respiratory complaints and clinical and radiological suspicion of having a pulmonary pathology were recruited. Patients of malignancy were excluded. Patients for whom all four samples of BAL, BB, TBNA, and TBLB were unavailable were excluded. Statistical Analysis Used: Sensitivity (SN), specificity (SP), positive predictive value, and negative predictive value for all tests were computed and represented with 95% confidence intervals. TBLB was taken to be the gold standard. Two or more tests taken in combination were also analyzed. Results: We studied the patients of tuberculosis, interstitial pneumonia, acute and chronic nonspecific inflammation, sarcoidosis, fungal infection, interstitial lung disease, eosinophilic pneumonitis, and pulmonary alveolar proteinosis in this study. TBNA had higher SN and SP (59.8% and 96.7%) than BB (57.0% and 93.3%) or BAL (54.2% and 86.7%). When combined, SN increased to 68.2% and SP decreased to 76.7%. Diagnostic yield for interstitial pneumonia and chronic inflammation was relatively high but poor for tuberculosis and sarcoidosis. Conclusions: TBNA had the highest SN and SP in diagnosing the various nonneoplastic lesions. However, BAL and BB are useful and complementary tools in the definitive diagnosis of localized and diffuse pulmonary infections.

Introduction: Thalassemia is the most common single gene disorder globally and has high burden in India. Education to eligible couples about the risk of conceiving a child with thalassemia is important for its prevention as well as for reducing psychosocial impact on them and improving family health. Objectives: To assess the knowledge, attitude, and practice regarding thalassemia among eligible couples residing in a slum of Kolkata and to find out the determinants of inadequate knowledge, negative attitude, and bad practice among them. Materials and Methods: A descriptive cross-sectional study was carried out in a slum in Kolkata, from October-December 2019 among 300 study population using a pre designed, pretested structured schedule by face-to-face interview method. All statistical analyses were conducted using SPSS version 16.0 and correlation of variables was seen using Pearson's Chi Square Test and Odds Ratio. Results: About 53.33% of the study population had adequate knowledge; 50.33% had positive attitude but only 9.67% had good practice. Conclusion: Eligible couples lack adequate knowledge on thalassemia; their attitude was positive but practice was bad. Significant determinants of inadequate knowledge were female gender, level of education and socio-economic status; of negative attitude-religion, level of education and socio-economic status whereas of bad practice – age, level of education and socio-economic status.

Background: Granulomatous disorders of the skin are commonly encountered and pose a diagnostic challenge due to its diverse etiology with several histological patterns. Granulomatous diseases of skin comprise a large family sharing the common histological finding as of granuloma formation. The various histological types of granulomas can be identified on the basis of the constituent cells and other changes within the granulomas. However, significant overlap exists in histopathological findings of different granulomatous reactions. Thus, morphology alone is seldom specific and cannot be used as a diagnostic tool for the identification of specific diseases. A keen understanding of the manifestations, workup, and subsequent treatment of both infectious and noninfectious cutaneous granulomatous lesion is essential for every practicing clinician and dermatopathologist. Materials and Methods: A 2-year retrospective study involved all the skin biopsies. Detailed clinical and histopathological features were analyzed and were categorized according to the type of granuloma. Special stains were used in few cases for diagnostic purposes. Cases were reviewed and analyzed. Results: In histopathological subtyping, tuberculoid granuloma was the most common type and the most common etiology was leprosy. Others were cutaneous tuberculosis, foreign body granulomas, fungal lesions, cutaneous leishmaniasis, and granuloma annulare. Conclusion: Histopathology when combined with special stain can serve as a gold standard investigation for diagnosis, categorization, and clinicopathological correlation in such cases.

Background and Objectives: The enigma COVID-19 pandemic already involved major parts of the globe with a toll of 3,175,207 victims and 224,172 deaths from 215 countries/territories as on May 1, 2020. It cripples nations by the loss of human resources, economic decline, hunger, unemployment insecurities giving way to mental morbidities, and still many others to be discovered. A systematic search about correlates of its killing attribute is urgently warranted. Materials and Methods: A cross-sectional survey for 3 weeks (03/5/2020–23/5/2020) was conducted in a teaching institution at Kolkata aiming to describe the magnitude and correlates of COVID-19 mortality. Data pertaining to COVID-19 cases, deaths of affected countries, and their potential correlates were retrieved from various public domains, for example, https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports, worldpopulationreview.com, data.worldbank.org. Results: Multiple linear regressions analysis through forward method revealed a maximum R² of 57.7% (P = 0.03) and a significant model fit (P = 0.000) for COVID-19 mortality rate per million which was revealed to have a positive association with median age of the population of the country (β = 0.073), proportion of population sustaining obesity (β = 0.051) and %of population consumed alcohol over the past 12 months (β = 0.018). It meant for 1 year increase in median age COVID-19 mortality would be increased by 8.0%. Similarly, COVID-19 mortality would be increased by 2.0% and 5.0% by inclusion in the model of 1% alcoholic, and 1% obese individual, respectively, Conclusion: Notwithstanding variations in testing, reporting, and patients' management strategy the findings of this research have some implications to the scientific fraternity and policymakers.

Introduction: Vata (Ficus benghalensis Linn.) is a sacred medicinal plant since Vedic times. It spread all over by its hanging or supporting roots, hence called as Vata. Aims: The aim was to study the macro- and microscopic characters, physiochemical and high-performance thin-layer chromatography (HPTLC) profile of Vata (F. benghalensis Linn.) Jata (aerial roots). Materials and Methods: Experiments were performed on authenticated plant materials, following standard procedures. Macroscopic and microscopic pharmacognostical characters of aerial roots and histochemical studies were noted. Results: Externally, the aerial root is gray and rough along with transverse rows of lenticels. Inner part of the aerial root is reddishbrown fibrous nature in bark portion. The powder microscopy study revealed the presence of fragment of simple fiber without lumen, stone cells with tannin, simple starch grain with hilum, compound starch grain, fiber with denim contents, latex contents, tannin contents rhomboidal crystal 2, rhomboidal crystal 3, group of stone cell with tannin, and fiber passing through medullary rays. Discussion: Transverse section of aerial root showed outer interesting exodermis followed by cork and cortex. Cortex region abundantly enriched by calcium oxalate crystal and tannin content are the diagnostic characters. Conclusion: Results of pharmacognostical and physiochemical analysis including HPTLC on aerial roots will help in further standardization.

Introduction: Pressor response to laryngoscopy and endotracheal intubation has been associated with sympathetic and parasympathetic responses which can be attenuated by alpha 2 receptor agonists. Aims: The present study aimed to compare and evaluate the effectiveness of dexmedetomidine in attenuating hemodynamic response to endotracheal intubation and also on the induction dose of propofol. Materials and Methods: It was a prospective, randomized, double-blinded, parallel group, placebo-controlled study in tertiary care hospital. A total of 50 patients aged 18–60 years, American Society of Anaesthesiology 1 and 2, scheduled for elective surgeries under general anesthesia (GA). Each patient in Group 1 received a loading dose of dexmedetomidine at 0.001 mg/kg over 10 min before induction of anesthesia and Group 2 received 20 ml normal saline over 10 min. Hemodynamic parameters prior to laryngoscopy and up to 10 min after intubation were measured. The requirement of induction dose of propofol was also calculated. Results: Dexmedetomidine showed significant efficacy in suppressing pressor response during endotracheal intubation. Furthermore, lesser dose of propofol was required for induction of GA. Conclusion: Dexmedetomidine can be used as an adjuvant in GA to prevent pressor response during intubation and decrease the requirement of intravenous induction agent propofol.

Fahr's syndrome is a rare neurodegenerative condition characterized by the deposition of calcium in various parts of the brain, mostly the basal ganglia. Fahr's disease is an idiopathic condition, whereas Fahr's syndrome is secondary to systemic conditions, including endocrine and autoimmune causes. Hypoparathyroidism is an important cause of this condition. Clinical features of Fahr's syndrome depend on the site of involvement and are usually neurological.

Systemic lupus erythematosus (SLE) is an autoimmune disorder with multifactorial etiology involving vital organs like the heart and causing rare complications like cardiac tamponade which are indeed difficult to manage especially in a setting of macrophage activation syndrome (MAS) with flare. A case of 25-year-old female with flare having high.grade fever and breathlessness on exertion to begin with. Subsequently, she developed pericardial effusion leading to cardiac tamponade and was managed with pericardiocentesis. With the rising ferritin levels, raised triglycerides, and cytopenia, she was diagnosed as MAS, along with reactivation of tuberculosis. She was discharged on oral steroids and anti-tubercular therapy with regular follow-up. Clinical suspicion, keeping in mind, the rarest complications such as cardiac tamponade, and timely employability of biochemical tests can help in early diagnosis of MAS and can lead to early therapeutic intervention in SLE patients preventing fatal outcomes.

A 9-year-old male child diagnosed to have achalasia cardia when he presented with a history of vomiting of undigested food particles with poor weight gain. He underwent lap Heller myotomy and Dor fundoplication. The immediate postoperative period was uneventful. After discharge, he presented with peritonitis and septic shock. On contrast-enhanced computed tomography abdomen, leak at the lower end of esophagus with intra-abdominal pus collection was identified. After intra-abdominal pus drainage and stabilizing the child, endoscopic covered stent was placed. He recovered well. Endoscopic esophageal covered stent placement is a viable and best option for a sick child with esophageal leak post-Heller myotomy.

Neonatal hepatitis (NH) and biliary atresia (BA) are the most common causes of cholestasis in infancy. NH is a nonobstructive type of neonatal cholestatic syndrome manifesting with hepatitis. BA is an obstructive inflammatory syndrome of the extrahepatic biliary tract. BA accounts for 40% of cholestasis in infancy, and NH accounts for 10%–15% cases of neonatal cholestasis. Choledochal cyst is a congenital abnormality characterized by cystic dilatation of the biliary tree. The clinical presentation of these two conditions is very much similar and hence poses a challenge for diagnosis. Radiological studies are beneficial for the preliminary diagnosis of BA and choledochal cyst. BA and choledochal cyst are amenable to surgical treatment, while NH is not. Histopathological examination of the liver biopsy helps differentiate BA from NH.

Hypertrophic cardiomyopathy (HCM) is a primary disease affecting the cardiac muscle and is characterized by heterogeneous genetic, morphological, functional and clinical features. The clinical presentation of HCM varies widely. Patients may be completely asymptomatic and identified incidentally. Atrial fibrillation is present in nearly 1 of 5 patients accompanied by significant risk of stroke. Symptoms of HCM are most commonly exertional dyspnoea, chest pain, fatigue, and pre-syncope or syncope. A small subset of patients will experience sudden cardiac death. Here we present a case of hypertrophic cardiomyopathy in 38 years old male died of sudden cardiac death.

Levamisole-induced thrombocytopenia and vasculitis are rare entities in children. Here, we report a 5-year-old male who presented with complaints of purpuric rashes and nasal and gum bleeding for 24 h following intake of single high-dose levamisole for presumptive treatment of helminthiasis. No preceding symptoms of viral infection or bleeding into closed spaces were noted. He was clinically stable except for maculopapular and patchy purpuric rashes on the face, neck, and trunk. No hepatosplenomegaly or lymphadenopathy was observed. Full blood count and blood film showed severe thrombocytopenia of 6.00 × 10⁹/L and platelets left shift with dysplastic neutrophils. He was commenced on prednisolone and transfused with fresh whole blood. The patient improved remarkably and showed reversal of hematological parameters within 48 h. Further, full blood count examination showed reactive thrombocytosis. Levamisole induces reversible thrombocytopenia by immune-mediated cytotoxic destruction of the platelets and white blood cells.

The clinical spectrum of dengue fever is ever increasing as we encounter more cases of this disease regularly for the past few years. Dengue fever continues to surprise us with its myriad presentations and combinations with other disease entities. Catastrophic antiphospholipid antibody syndrome (APS) is uncommon and often a fatal form of primary APS. Here, we present a 37-year-old lady who presented with catastrophic APS with dengue fever. The coexistence of these two conditions has not been reported earlier, to the best of our knowledge.