Community involvement is of utmost importance in the management of ongoing COVID-19 pandemic from compliance with lockdown, to the steps taken during easing restrictions, to community support through volunteering. Government of India used “Test, Track, and Treat” strategy to control the outbreak, which mainly focuses on strict legislative actions and capacity building. The strategies are predominately top-down, centralized, and government owned, where community participation and involvement were grossly missing. While visiting different high burden states of Maharashtra as members of central rapid response team, the researchers observed excellent community involvement models in some resource-poor settings, which were quite successful in controlling and managing pandemic at local level, and worth replicating in other settings. In this article, some of such evidences have been highlighted. This study also emphasized how community involvement could be more effectively used as a strategy to fight pandemic.

Coronavirus-causing pandemic flu known as COVID-19 originated in Wuhan, China, in December 2019 and since then has spread worldwide. It is a single-stranded RNA virus of betacoronavirus family ranging from 60 to 140 nm in diameter. Its genome is similar to that of SARS and MERS. Patients present with fever, cough, malaise, headache, etc., Various tests such as nucleic acid testing, reverse transcription-polymerase chain reaction, and antibody testing are available. Laboratory tests show leukocytosis with lymphopenia and occasionally thrombocytopenia. Few biomarkers such as ferritin, C-reactive protein, procalcitonin, lactate dehydrogenase, and interleukin-6 are under study to predict the outcome of patients. Mainly, the virus is seen affecting the lungs with hyaline membrane formation, resulting in acute respiratory distress syndrome. Cases affecting kidney and gastrointestinal system are also seen. Self-quarantine and social distancing are effective measures to prevent the spread of this disease. The spread of coronavirus has posed significant challenges for dentistry and medicine. Most of the dental procedures are aerosol producing called as bioaerosols which consist of particles from saliva, blood, dental plaque, calculus, gingival fluid, oronasal secretions and microparticles from tooth preparation. This review gives an insight on the ways to reduce aerosols, standard measures and protocols to be followed to maintain the hygiene levels in the operatory, and the ways to reduce the viral load in this COVID era to prevent the spread of SARS-CoV-2 via human-to-human transmissions.

As the Medical Council of India (MCI) implemented a new undergraduate curriculum from this academic session onward, the aim was to replace knowledge-centric traditional educational model to a more holistic community-based curriculum based on the domains such as knowledge, skills with emphasis on attitude, communication, and ethics. This implementation requires major reforms in the form of faculty development and resource generation for successful implementation of new course. However, COVID-19 pandemic possesses serious challenges to the implementation of curriculum and its success. This review discusses the possible challenges for the implementation of the new MCI curriculum in face of the coronavirus pandemic and possible strategies to counter it.

The principles of medication management include storing, ordering, dispensing, and administration of the medications. Each of these steps is equally important to achieve the maximum benefits of the medicines. However, self-medication is common across the globe where these principles are severely compromised. Self-administration of medication is an approach in which an individual uses a medicine or drug to treat any symptoms or diagnosed disorder. It is an individual's initiative to take medicines without consulting a doctor and commonly used to gain personal independence and autonomy to treat minor illness. Its prevalence in developing countries is significantly high and ranges from 12.7% to 95%. This review examines self-medication practices among students of various health-care courses. The search criteria included studies published from 2008 to 2018. All studies that explored the use of self-medication practices among the Indian students of various health-care professions were retrieved. Three major databases Google Scholar, PubMed, and Shodhganga were searched. The keywords used for search included “self-medication,” India, prevalence, students, medical, dental, nursing, pharmacology, and physiotherapy. In total, 106 articles were reviewed, 21 of these studies met the inclusion criteria. The number of total participants across all studies was 7271. Overall, 5875 (80.80%) participants were practicing self-medication. Analgesics, antipyretics, antibiotics, antacids, and anti-allergic drugs were commonly used drugs for self-medication. Some studies also revealed that students have poor knowledge regarding drug reactions, and this can significantly compromise patient safety. Whereas, the study reveals that the practice of self-medication among the students is alarmingly high. This presents a significant challenge to patient safety and also poses a threat to public health in view of ever-increasing antibiotics resistant. The government must take immediate actions to regulate over-the-counter medication availabilities and also ensure a wider education program for the public.

Background: Neonatal sepsis (NS) is one of the leading cause of neonatal mortality. In order to decrease the morbidity and mortality associated with neonatal sepsis, treating pediatrician/neonatologist should have a keen knowledge of the existing microbiological flora and their drug-susceptibility pattern. Hence, the present study was conducted with the objective to investigate the etiological agents, pattern of antimicribial sensitivity, and risk factors for mortality in neonates with culture-proven neonatal sepsis. Methods: A retrospective/cross-sectional study was conducted over a period of 24 months in teaching Rural Hospital, Maharashtra, India. Demographic data, type of isolates, and its sensitivity pattern were recorded. Results: Of the 343 blood samples sent during the study period from neonatal intensive care unit, 84 (24.5%) samples grew organisms. Early-onset sepsis (EOS) occurred in 58.1% of cases. Of the 74 bacterial isolates, 55.4% were Gram-positive organisms and 44.6% were Gram-negative pathogen. Candida species were identified in 11.9% neonates. Staphylococcus aureus (21.6%) and coagulase-negative Staphylococcus (CONS) (21.6%) were predominant Gram-positive pathogen. Klebsiella pneumoniae was the main Gram-negative pathogen (29.7%) followed by pseudomonas (6.76%). Gram-positive organisms (Staphylococcus and CONS) showed maximum sensitivity to vancomycin and linezolid. Survival rate among neonates with culture-positive sepsis was 78.6%. Conclusions: This study highlights growing resistance to commonly used antibiotics/antifungal agents posing a great threat to neonatal survival and thereby warrants the modification of existing empirical therapy. Implementation of effective preventive strategies to combat the emergence of antibiotic resistance is urgently needed.

Introduction: The trophic ulcers are usually presented in the form of diabetic ulcer, leprotic ulcer, and pressure ulcer. The usual site for ulceration in trophic ulcer is the bony prominence on body part devoid of sensation. The chronic wounds management in health-care setting have significant impact on the patient's physical, mental, and financial health. In trophic ulcer management factors such as cause of ulcer, its location, size, and duration should be considered. Infection in such trophic ulcer leads to increase disease activity results delayed wound healing. Thus, a study was designed with aim to find relation between location of trophic ulcer and its infection status. Materials and Methods: This retrospective cross-sectional study includes 95 patients with infected trophic ulcers admitted between January 2015 and March 2020 from our tertiary care rehabilitation center. Cultured bacterial species were tested against following 23 drugs Amikacin, Gentamycin, Levofloxacin Ciprofloxacine, Piperacillin + Tazobactum, Ceftriaxone, Cefepime, Meropenem, Imipenem, Ampicillin, Ceftazidime, Amoxiclav, Cotrimoxazole, Cefotaxime, Erythromycin, Clindamycin, Tetracycline, Cefoxitin, Chloramphenicol, Colistin, Tobramycin, Vancomycin, and Aztreonam. Results: The common sites of trophic ulcer involvement were sacrum (32%), heel (29%), forefoot (17%), ischium (12%), knee (6%), and greater trochanter (4%). Eight different bacterial species were isolated, which were Staphylococcus aureus (26%), Enterococcus (9%) and six Gram-negative bacteria, which were Pseudomonas (24%), Proteus (17%), Klebsiella (11%), E. coli (7%), Enterobacter (3%), and Acinetobacter Baumani (3%). S. aureus was found most susceptible to Vancomycin (16%), followed by Amikacin (14%) and full resistant to ampicillin, tobramycin, and Aztreonam. Pseudomonas was found most susceptible to Meropenem (13%), followed by Amikacin (12%) and full resistant to Cotrimoxazole, Erythromycin, Clindamycin, Cefoxitin, Chloramphenicol, and Vancomycin. Overall, Amikacin followed by Meropenem was found susceptible against 56% and 52% of cases, respectively. Conclusion: The infected trophic ulcers which require either medical or surgical treatment, in both these situations antibiotics play vital role, thus, to avoid the development of antibiotics resistant, two drug regimens should be followed either by adding Amikacin or Meropenem to the primary single drug regime.

Introduction: Dengue cases continue to be reported every year in India despite various measures being taken for the prevention. In the absence of an effective vaccine and a specific treatment, protective behavior at individual level is of paramount importance. This case–control study was undertaken to find the association of some important behavioral risk factors with dengue fever. Methods: The study included all consecutive patients of dengue fever >15 years of age visiting a tertiary care hospital in Pune during 2018 confirmed by laboratory investigation as cases. Healthy individuals living in the same locality as cases were selected as controls. Cases and controls were interviewed using a pretested semistructured questionnaire called Dengue Risk Assessment to Initiate Control to collect information on behaviors for increased vulnerability to dengue infection. Relevant data were collected and compiled using Microsoft Excel and the data were analyzed using Statistical Package for the Social Sciences version 20 (IBM, USA). Results: A total of 30 cases (mean age 30.2, standard deviation [SD] 9.2) and 60 controls (mean age 30.08, SD 7.7) were recruited in the study. The results showed that cases were more likely to have certain behaviors associated with dengue than controls, namely, not practicing container management at home during the last 2 weeks (odds ratio [OR] = 3.57 and 95% confidence interval [CI]: 1.20–10.63), not using repellents (OR = 2.89 and 95% CI: 1.16–7.19), not wearing full-sleeve shirt/trousers (OR = 6.14 and 95% CI: 1.75–23.8), and absence of source reduction practices in the surrounding area (OR = 8.84 and 95% CI: 1.10–71.42). A significantly larger proportion of cases had lower practice scores (≤7) for dengue prevention than controls (OR = 5.20 and 95% CI: 1.41–19.23). Conclusion: This study found that odds of not practicing conventional personal protective measures and container management were higher among dengue fever individuals than controls.

Introduction: Benign breast diseases are often considered as aberrations of normal development and involution. The increasing campaigns for breast health have increased awareness among women causing an increase in the number of cases detected. Around 70%–80% of the biopsies performed are of benign nature. The most common complaints are lump, pain, and discharge. Aim: Our primary aim was to study the clinicopathological correlation of benign breast disease and view it in the context of other similar studies in the past. Materials and Methods: Sixty patients attending the Outpatient and Inpatient Department of Surgery at a tertiary care hospital from June 2011 to December 2012 was carried out. Various parameters such as age, sex, disease pattern, lesion types, histopathological diagnosis, and clinical diagnosis were studied and compared. Cramer's V test was applied. Results: In our study, fibroadenoma (66.7%) was the most common lesion which occurred in patients in the age group of 21–30 years, followed by fibroadenosis (16.7%) which occurred mostly in the age group of 21–30 years. The lesion mostly occurred in the age group between 21 and 30 years (40%). The most common complaint in women was lump (73.33%), followed by lump and pain. Conclusions: Epidemiology of benign breast diseases still remains the same when analyzed with a past and recent study on benign breast diseases. Triple assessment remains the key in the evaluation of breast lumps.

Background: The global burdens of cardiovascular diseases (CVDs) and obesity are rising, producing enormous losses of life and disability-adjusted life-years in both developed and developing nations. Stress is a modifiable risk factor for the development of CVD. Postmenopausal women with osteoarthritis (OA) of knee joint may often report episodes of knee instability limiting their daily activities and this causes an added stress. Aims: To evaluate the effects of mindfulness-based meditation on functional outcome of OA knee and to study the effect of mindfulness-based meditation on perceived stress scores (PSSs) and markers of obesity in postmenopausal women. Materials and Methods: This interventional study was conducted on forty postmenopausal women in a tertiary care hospital of Eastern India after taking institutional ethical clearance and informed consent of the patients. Presumptive stressful life events scale (PSLES) scores and PSSs of the patients were assessed. Patients with PSLES scores more than 200 were included in the study. They were all on nonvegetarian diet and came from the middle socioeconomic class. Patients were randomly allocated into two groups and received either balancing exercises and mindfulness-based meditation (Group A) or balancing exercises (Group B). Patients of both groups were age matched. Body mass index (BMI) and waist/hip ratios were measured. The outcome measures were visual analog scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. Results: There was no significant difference in age, PSLES and PSS scores, and WOMAC and VAS scores between the two groups before intervention. AGE Group A 62.4 ± 4.16 versus Group B 62.15 ± 3.75, P = 0.85; BMI Group A 26.6 ± 1.97 versus Group B 26.2 ± 1.002, P = 0.41; waist/hip Group A 0.833 ± 0.033 versus Group B 0.832 ± 0.03, P = 0.96; PSLES Group A 296.3 ± 34.95 versus Group B 291.8 ± 25.2, P = 0.65; PSS Group A 33.38.1 ± 1.97 versus Group B 32.8 ± 2.86, P = 0.185. PSS scores (20.75 ± 1.9 vs. 27.1 ± 1.65; P < 0.0001) and waist/hip ratio were significantly less in Group A as compared to Group B following intervention. Group A had significantly lower WOMAC (38.1 ± 4.03 vs. 50.8 ± 3.78; P < 0.0001) and VAS (4.35 ± 0.77 vs. 5.75 ± 0.68; P < 0.0001) scores as compared to Group B after practice of balancing exercises along with mindfulness-based meditation. Waist/hip ratio was significantly less in the group practicing mindfulness-based meditation (Group A) as compared to Group B. Conclusion: The results of the present study indicate that balancing exercises when practiced along with stress relaxation exercises are more effective in improving the functional ability of OA knee in postmenopausal women.

Objectives: The objectives of this study were to investigate the influence of sublingual nitroglycerin (NTG) administration on peripheral vessel diameter, the number of evaluable segments, image quality, and adverse effects in patients with peripheral vascular disease (PVD) undergoing multidetector computed tomography (MDCT) angiography. Methods: A prospective randomized comparative interventional study was conducted on 48 inpatients with clinical diagnosis of PVD. The study patients were divided into two groups: one which was premedicated with 5 mg of sublingual NTG (NTG group) and the other without the use of NTG. MDCT images were recorded after 5 min of drug administration. The 10 segments of upper-limb vessels and 15 segments of lower-limb vessels were evaluated for diameter (mm), intraluminal contrast opacification (Hounsfield unit), collaterals, and stenosis (%). The data were entered in MS Excel and analyzed using SPSS. P < 0.05 was considered statistically significant. Results: The NTG group showed a statistically significant increase in diameter of radial artery (P = 0.01), common femoral artery, and all arterial segments of lower limb (P<0.05). The intraluminal contrast attenuation was higher in all segments (P < 0.05) in lower limbs. Good and continuous visualization of collateral vessels in segments with > 50% stenosis or occlusion was seen in the NTG group than the non-NTG group (P < 0.05). Conclusion: Sublingual NTG administration results in significant peripheral vessel dilatation, thus improving number of evaluable distal branches and collaterals with minimal side effects requiring no medical intervention. It helps increase the MDCT diagnostic accuracy and select appropriate treatment protocol.

Background: Delays in diagnosis of tuberculosis (TB) is still a problem at all levels of health care. Understanding the etiology of these delays is essential for all stakeholders involved in TB control. This study was done to find the delays related to health-care seeking behavior, diagnosis, and major contributors to such delays among newly diagnosed patients of TB. Methods: This cross-sectional study was conducted from August 1, 2018, to July 2019 among the patients of TB diagnosed at Indira Gandhi Medical College, Shimla. A consecutive sample of 105 patients was enrolled for the study. Newly diagnosed cases aged 18 years and above were included in the study. Prevalence ratio with 95% confidence interval was calculated for risk factors associated with the identified delays. Results: At the patient level around 55% reported a delay of more than 14 days in seeking care with a median delay of 45 days (interquartile range [IQR] of 30–60 days). Nearly 67% patients were found to have a diagnostic delay of more than 7 days at the health-care provider level (Median 30 days; IQR 12.5–54.7 days). Delayed initiation of treatment after 7 days of diagnosis was found in 6.6% cases (Median 10 days; IQR 8–15 days) and all of these were patients of extra pulmonary TB. Delay was significantly associated (P = 0.01) with patients who travelled <5 km to reach the health facility. Conclusion: Inter-sectoral coordination, refresher trainings of health-care providers, patient education and capacity building for diagnostics at peripheral institutions can reduce delay in diagnosis and treatment of TB.

Background: Maintenance of a clean environment in a hospital is challenging and at the same time crucial for patient safety. The importance of the hospital environment in patient care has received worldwide attention, especially in infection prevention and control. The Ministry of Health and Family welfare launched “Kayakalp Yojna,” an initiative to promote cleanliness and enhance the quality of public health facilities. Objective: This study was undertaken to assess the impact of the implementation of the Kayakalp initiative in public health-care facilities of Himachal Pradesh. Material and Methods: This analytical study was conducted to assess the impact of Kayakalp Yojna in six thematic areas; hospital/facility upkeep, sanitation and hygiene, waste management, infection control (IC), supportive services, and hygiene promotion in government hospitals using the Kayakalp assessment tool in the state of Himachal Pradesh in 2017–2018. Results: Post implementation of Kayakalp Yojna, there was an average improvement of 20% in the total scores of the hospitals from internal assessment to external assessment. Four of the 12 district hospitals, three of the 89 community health centers, and 26 of the 475 public health centers scored more than 70% in the external assessment. Conclusion: The Kayakalp assessment results give an insight to the problem areas and present a possibility to improve the public health facilities.

Introduction: Developing countries account for 70% of the world's population. In developing countries, medical and surgical health camps not only improve access to health care but also reduce pressure on hospitals and shift the balance of care from institutional-based to community-based services, thus reduce health service costs, but this health camp system yet not become popular because of its own disadvantage. Objective: The aim of this study was to find out the logistics of organizing such a mammoth camp along with long-term functional outcome of operative procedures done on orthopedically handicapped persons during camp. Materials and Methods: This retrograde observational study was conducted from June 2018 to December 2018 on a surgical disability camp (Rahat Camp) at Mandla district of Madhya Pradesh. This camp was organized in March 2010 over 8 days by the state government. During this follow-up study, all the patents were identified by arranging follow-up camp and personal home visits. All the patients and their family member were asked about their camp experience and it was assessed on subjective scale of satisfaction (0–10) and further classify as good (10, 9, and 8), fair (7, 6, and 5), poor (4, 3, and 2), and worse (1, 0) on the basis of score. Results: In this camp, 114 patients out of 5558 orthopedically handicapped patients (2%) were operated. After assessing all the records, conducting twice follow-up camp (September 25, and October 25, 2018), and home visits to camp patients, only 41 patients were traceable. On assessing camp experience among patients, 20% responded good, 45% responded fair, 25% responded poor, and 5% responded worse experience on the satisfaction scale. Conclusion: Surgical camps for orthopedic disabled require long-term follow-up and protocol-based rehabilitation by rehabilitation team for better outcomes.

Context: India has the highest number of cervical cancer cases in the world and also the second most leading cause of cancer among females. Early diagnosis along with appropriate treatment at an earlier stage is needed to combat the high burden of cervical cancer in our setting. Aim: The aim of the study is to study the awareness and practices about cervical cancer among women of self-help groups (SHGs) in rural Puducherry. Subjects and Methods: Community-based cross-sectional study was conducted among women in SHGs in the four villages under field practice area of Rural Health Training Center, Department of Community Medicine of our teaching hospital. Details on sociodemographic characteristics, awareness regarding cervical cancer, and source of information regarding cervical cancer were collected using a pretested questionnaire. Chi-square test was used to assess the significance of study findings. P < 0.05 was considered to be statistically significant. Results: Majority (57.6%) of the SHG women were homemakers and about one-third (31.2%) of them were involved in farming and daily wage labor activities. Around 37.6% have awareness on cervical cancer and almost all (99.2%) of SHG women have never undergone PAP smear examination nor heard about PAP smear/HPV vaccine. The study revealed that women's education and socioeconomic status were associated with the knowledge of the cervical cancer and the difference was statistically significant. Conclusion: The present study found that awareness about cervical cancer among the respondents was very less. It is found to be associated with maternal education, occupation, and socioeconomic status of the women.

Background: First rank symptoms (FRSs) are seen frequently in mania. There has been a scarcity of data published in consideration with the Indian population on the prevalence of FRS in mania. Aim: The aim of this study is to explore the pattern of occurrence of FRS and assess association between the presence of FRS and severity of mania. Subjects and Methods: A cross-sectional study was conducted in the psychiatry department of tertiary care institution of North India. Fifty patients selected by convenient sampling, diagnosed with mania as per Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) classification. Informed consent taken, semi-structured per forma used, present state examination-9 Hindi version used for FRS, Young Mania Rating Scale (YMRS) to assess severity of mania. Descriptive statistics were used. The Chi-square test was used for the comparison between the groups. Mann–Whitney U-test was used for the comparison between individual FRS and YMRS score. Results: Mean age FRS + was 35.32 years (±13.85), 71% were males; majority belonged to urban locality, married, residing in nuclear family, educated up to matriculation, and unemployed. There was no significant association of these variables with FRS. The Presence of ≥1 FRS was 62%; voices commenting on one's action (83.9%), voices arguing (77.4%), thought broadcast (38.7%), delusional perception (23.8%), thought withdrawal and thought echo (both 12.9%), made volitional acts, somatic passivity, and thought insertion (in 3.2% each). None had the presence of made feelings and made impulse/drives. Mean YMRS was 40.16 ± 7.91. No statistical significance found between FRS and YMRS scoring, except for thought withdrawal. Conclusions: The present study confirms FRS in substantial cases of mania. FRS in mania can lead to misdiagnosis of schizophrenia, leading to inadequate management, delayed appropriate treatment, and poor prognosis.

Introduction: Plantar fasciitis (PF) is one of the most common causes of heel pain in adults. Common causes of PF include prolonged standing, obesity, flat foot, and nerve entrapment. PF caused due to nerve entrapment is often left unnoticed when making a diagnosis or management for PF. Lateral and medial plantar nerves are the common nerves to get entrapped causing pain and tingling in the foot ultimately leading to PF. Aims: This study aimed to come up with the prevalence of PF of neural origin in community-dwelling adults. Settings and Design: A cross-sectional study was conducted on fifty patients with PF attending Department of Physiotherapy, Dr. D. Y. Patil College of Physiotherapy, Pimpri, Pune, over a 6 months period. Subjects and Methods: Patients were assessed based on their symptoms and whether they meet the criteria for diagnosing the condition as PF. Assessment for classifying PF of neural origin was done using Standard Neurodynamic Testing for Plantar nerves branch of tibial nerve. Statistical Analysis Used: Descriptive statistics was presented as frequency percentage. Results: The prevalence of neural origin PF among fifty patients was 54%. Forty-eight percent of them were females and 6% were males. Conclusion: This study concludes that the burden of PF of Neural Origin is more in Community Dwelling Adults yet goes undiagnosed due to the tendency of following a set battery of physical examination by physiotherapists which does not include neurodynamic tests.

Context: Chronic idiopathic urticaria (CIU) is a common clinical condition with a significant impact on the quality of life of its sufferies. Skin prick test (SPT) is a reliable method to detect the allergens and thereby contributing to diagnose of this Type I hypersensitivity. Aims: The aim of this study is to retrospectively analyze the incidence of positive SPT to various allergens in patients with CIU. Subjects and Methods: The data of patients of CIU who had undergone SPT in the dermatology department of a tertiary hospital during the period from July 1, 2018 to December 31, 2019 were reviewed. Evaluation of their history was done with respect to the possible causes and investigations excluding those with a documented history of anaphylaxis, asthma, atopic dermatitis, and dermographism. The results of SPT performed with a battery of 40 allergens (22 aeroallergens and 18 food allergens) obtained from Allergo SPT (Merck specialty Pvt. Ltd., Allergopharma, Darmstadt, Germany), were retrieved and analyzed. Statistical Analysis Used: The data of the 38 patients with CIU who had undergone SPT was entered in Microsoft Excel (MS Office 2016) and then analyzed with descriptive statistics. Results: Overall SPT positivity of these 38 patients was 73.68% and that to food allergens (10.53%), aeroallergens (26.31%), and both aero and food allergens (36.84%). Conclusions: Our study unlike earlier reports in literature ruled out those with clinical as well as laboratory evidence of a topic, disorders which secondarily cause urticaria, thus emphasizing SPT to be an important add-on diagnostic tool even in those cases of CIU which have no obvious exacerbating factors. A significant number of CIU patients of our study showed sensitivity to house dust mite, molds, pollen, food items, and animal epithelia on SPT.

Purpose: Corneal hysteresis (CH) and corneal resistance factor was found to be less for patient wearing toric contact lens as compared to soft spherical CH was calculated as the difference in air pressures between force-in applanation (P1) and force-out applanation (P2), or (P1–P2). Materials and Methods: This was the prospective study, 40 eyes of 22 patients with mean age of 22.09 ± 4.05 years. Eleven eyes were fitted with soft toric contact lens and 29 eyes were fitted with soft spherical contact lens. Dry eye, keratoconic or any systemic pathology were excluded. Soft toric and soft spherical contact lenses (Comfilcon A, Coopervision, and Southampton, UK) were fitted. The Ocular response Analyzer (Reichert Ophthalmic Instruments, Depew, New York, USA) was used to measure CH before and after 3 months using soft toric and soft spherical contact lenses. Descriptive statistics were used to analyze the demographic data. Paired t-test was employed for analyzing the difference between the base line value of CH with soft toric and soft spherical contact lens wearers after 3 months. Independent t-test was used to find the association between CH and gender. Results: CH was found to be lesser after 3 months of soft toric contact lens wear, as compared with soft spherical contact lenses. Mean increase of CH was found to range from 10.44 ± 0.96to 10.80 ± 0.96 mmHg (P = 0.000). Conclusion: In this study, there was a decrease in CH after using soft toric contact lenses and increase after using soft spherical contact lenses for 3 months. The increased CH with soft spherical contact lens was reversible in nature. However, CH may differ between lens type and modality of wear which can lead to long-term changes in the corneal biomechanical properties.

The severe acute respiratory syndrome coronavirus 2 disease (COVID-19) pandemic is not just about medical management in intensive care units (ICUs). The old population and those with severe comorbidities and chronic illnesses are more prone to die due to COVID-19 infection and integrating palliative care support in ICUs is the need of the hour. However, during this pandemic, there is a clear lack of palliative care in ICUs due to several barriers which we will discuss in this particular case.

The differential diagnosis of mediastinal masses encompasses a vast spectrum ranging from benign tumors to notorious malignancies. Mediastinal lipoma is a very rarely encountered mediastinal mass. It is usually an incidentally unearthed finding. It has a classical radiographic countenance. Knowledge of its existence and presentation aids early diagnosis and can avert unnecessary invasive investigations for alternative diagnosis. The radiographic picture of cardiophrenic obliteration may be seen in a number of heterogeneous conditions such as loculated pleural effusion, pericardial effusion, diaphragmatic hernias, or in certain mediastinal masses. However, mediastinal masses are rarely kept as a differential of this radiological presentation due to a lack of awareness. This leads to performance of invasive tests like thoracocentesis. We herein report an interesting case of mediastinal lipoma incidentally picked up during a chest radiograph done as a part of preoperative evaluation for an unrelated diagnosis. The chest radiograph exhibited a lesion with an obliteration of the right cardiophrenic angle.

Sickle cell anemia is an autosomal recessive disorder resulting from insertion of the valine codon at position sixth of beta-hemoglobin gene instead of glutamate leading to the production of insoluble beta-hemoglobin chain. Although sickle anemia is mostly associated with bone pain and anemia, other manifestations also occur. Acute head syndrome is an uncommon complication resulting from skull bone infarction, cortical osteopenia, and rupture of tortuous periosteal blood vessels leading to extravasation of blood into the subgaleal space. This report therefore intends to create awareness that nontraumatic scalp swelling is an uncommon complication in sickle cell disease and no traditional practice or surgical excision should be employed in managing it.

Osteomyelitis of the sternal bone is very rare and is usually secondary to trauma or surgery. Primary sternal osteomyelitis and secondary sternal osteomyelitis commonly are caused by Staphylococcus spp, and in drug addicts by Pseudomonas aerugenosa, while in sickle cell anemic children, Salmonella spp are mostly implicated. We, therefore, present an unusual causative organism, Streptococcal spp in a sickle cell anemic child.

Opioid-based anesthesia is associated with unwanted adverse effects such as postoperative nausea and vomiting, respiratory depression, itching, and urinary retention. Opioid-free anesthesia is a combination of multimodal analgesia that aims to avoid perioperative opioids altogether. Various methods, such as regional blocks, and drugs, such as lignocaine, dexmedetomidine, and ketamine, can be used to evade the use of opioids. Here, in a series of five cases undergoing breast cancer surgery, we attempt to use a combination of analgesic techniques that result in complete avoidance of opioids during the intraoperative period.

Hyperhidrosis is excessive, visible sweating without physical activity, which is not associated with physiological homeostatic response to maintain body temperature. The severity can be assessed by the Hyperhidrosis Disease Severity Scale. Hyperhidrosis causes severe psychological impairment, and left untreated may cause cutaneous infections. Topical 20% aluminum chloride is the first-line treatment for all cases of primary, focal hyperhidrosis irrespective of disease severity. Here, we report a case of primary hyperhidrosis with no response to topical aluminum chloride, iontophoresis, and oral anticholinergics who was not interested in invasive treatment modalities. On developing symptoms of anxiety, the patient was subsequently referred to the psychiatry department and successfully treated with clonidine and oral escitalopram. Primary hyperhidrosis did not recur even when clonidine was tapered off, and the patient was maintained on escitalopram. The use of selective serotonin reuptake inhibitors as a long-term maintenance agent for hyperhidrosis requires further study.

Lung carcinoma is a major cause of mortality worldwide. Small-cell lung cancer (SCLC) constitutes of about 10%–15% of cases of all lung cancer. It generally affects males more commonly than females and has smoking as a high-risk factor. It is generally a solid central tumor which spreads very rapidly to mediastinal lymph nodes and distant organs. It generally presents with mass effects such as cough, wheezing, superior vena cava syndrome and hemoptysis and also causes paraneoplastic syndrome. It is very rare for SCLC to present as isolated massive pleural effusion. Here in, we describe a case of massive pleural effusion which was diagnosed as small cell carcinoma with thoracoscopic pleural biopsy, and was managed with pleurodesis and cisplatin-based chemotherapy.

As the knowledge about coronavirus disease 2019 (COVID-19) is increasing day by day, we are learning about various manifestations of COVID-19. The disease is a systemic illness that also involves the gastrointestinal system including the pancreas. Here, we report the case of a 14-year-old girl who presented with a pancreatic type of pain abdomen. She was diagnosed with acute pancreatitis (AP) based on clinical symptoms, ≥3 times the elevation of serum amylase, and imaging evidence of AP. Her Bedside Index of Severity in AP was 2/5 and the Modified Computed Tomography Severity Index was 10/10. She had positive reverse transcriptase-polymerase chain reaction for COVID-19. Her workup for common and rare causes of AP was negative. She was managed conservatively as per standard protocol for the management of AP. The aim of this case is to highlight the importance of causal association of COVID-19 with AP.

Mucormycosis is a rare angioinvasive fungal infection commonly found in immunocompromised individuals, especially in an intensive care setting. Rhino-orbito-cerebral (ROCM) form is the most common presentation in patients with diabetes mellitus in India. A high index of clinical suspicion in picking up early subtle clinical signs such as periorbital edema, sinusitis, and ophthalmoplegia coupled with an aggressive management plan including systemic antifungals and surgical debridement of invaded tissue can often avert an otherwise fatal outcome in susceptible patients. We report a case of ROCM in a 37-year-old male with diabetic ketoacidosis.

Scrub typhus is one of the common causes of acute undifferentiated febrile illnesses in India. The manifestations are protean, are nonspecific, and may lead to multiorgan dysfunction syndrome and mortality if prompt recognition and treatment is not received. Identification of eschar through meticulous examination and consequent empirical use of doxycycline can save lives.

A 22-year-old university student presented to our hospital with a 7-year history of recurrent palpitation and easy fatigability, with occasional dry cough and no history of fever or weight loss. Examination revealed the presence of machinery murmur, and echocardiography revealed isolated patent ductus arteriosus (PDA). She had left thoracotomy and double ligation of the uncalcified PDA. Chest drain was inserted and she did well postoperatively, and she was discharged home on the 5^th postoperative day. Postoperative echocardiography revealed no residual PDA.

Among intensive care unit patients, lower respiratory tract infections (LRTI) are one of the most common infections to occur. The aim of this study was to determine the microbiological profile and antibiogram of pathogens isolated from tracheal secretions. Place of study. Dr. D. Y. Patil Medical college; Type of study - Retrospective study and cross-sectional study; Study period- April 2020 to September 2020 (6 months).152 isolates from non-repeated samples received for culture and sensitivity were considered for the study. Sample -Tracheal secretions. The sample was processed on blood and MacConkey's agar, identification done by standard biochemical tests, and antibiotic sensitivity was performed by disk diffusion (Kirby-Bauer test) method on Muller Hinton agar According to CLSI 2020 guidelines. Total- 152 tracheal aspirates; Positive samples- 148. The most commonly reported among the isolates was Klebsiella pneumoniae 51, (64.7%) followed by Acinetobacter Spp 45(30.40%) and Pseudomonas 37(25%). Alarming rate of resistance was seen in gram-negative isolates in tracheal secretions to carbapenems but good sensitivity was seen in tigecycline and colistin both. So, with a lack of new antibiotics, the current scenario presents a major threat in dealing with these pathogens in the future.