Brain-derived neurotrophic factor (BDNF) is a protein found in human beings. This protein is a member of the neurotrophic family of growth factors that relates to the canonical nerve growth factor (NGF). Its main biological process in human is on neurons of the central nervous system and the peripheral nervous system. This protein supports the survival of neurons and promotes growth and differentiation of new neurons and neurological synapses. This protein plays a role in many clinical disorders, including Alzheimer's disease, epilepsy, and aging. In this review, the authors summarize and provide insight into the molecular characteristics and clinical association with the objective to highlight and explore the potential clinical usefulness of BDNF in clinical medicine. The alteration of BDNF is seen in many disorders, especially for neurological diseases. The change of BDNF level is associated with clinical presentation of the patients. The increases or decreases of BDNF expression occur and further play a role in phenotypic expression, the clinical presentation. BDNF might be a new useful laboratory investigation for managing of patients, especially for those with neurological problems.

Perforation of the colon with or without transanal extrusion of the distal ventriculoperitoneal shunt (VPS) catheter is a well-known but a serious complication after VPS insertion done for the treatment of hydrocephalus. The objectives were to review the demographics, clinical characteristics, operative procedures performed, postoperative complications, and the final outcome of the published cases, relating to the transanal extrusion of the distal VPS shunt catheter. Electronic database search was performed to retrieve the published/available literature relating to the transanal extrusion of VPS catheter. The manuscripts relating to the above-mentioned complication were retrieved from 1966 to December 2020. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines are followed for this review. This review included 210 cases comprising 142 (67.6%) males and 68 (32.3%) females. In two-third (n = 141) of the cases, the indication for the initial VPS insertion was the congenital hydrocephalus. In 60% of the cases, the initial VPS insertion was done during infancy. In 70% of the cases, the interval from VPS insertion to the diagnosis of transanal extrusion of the distal VPS catheter was within 12 months. Transanal extrusion of the distal VPS catheter was the chief complaint. In two-third of the cases, it was asymptomatic transanal extrusion of distal VPS catheter. In remaining one-third of the cases, it was symptomatic transanal extrusion of the distal VPS catheter, and they had either symptoms relating to the central nervous system or gastrointestinal tract. Three-fourth of the cases were managed by the removal of the entire or the distal VPS catheter with or without external ventricular drainage (EVD). Fifty percent of the above-mentioned complication was managed by doing percutaneous surgical procedures, and another one-third of them were managed by doing laparotomy. Complications were also evident in 16 (7.6%) of the cases during the postoperative period. This review revealed only 6 (2.8%) deaths. Transanal extrusion of the distal VPS catheter occurred across all the age groups. Eighty percent of the complications occurred in children below the age of 10 years. Three-fourth of the cases were managed by the removal of the entire or distal VPS catheter with or without EVD. In three-fourth of the cases, repair of the perforated bowel/colon was not done and that healed spontaneously after the removal of the extruded VPS catheter.

As the field of medicine is complex, the students have to be encouraged to shift from rote learning to meaningful learning and a wide range of teaching-learning methods can be employed for the same. Concept mapping has been identified as one of the ways to expedite the learning of conceptual knowledge through better understanding, improved retention, and improved performance. An extensive search of all materials related to the topic was carried out in the PubMed search engine and a total of seven articles were selected based upon the suitability with the current review objectives. Moreover, it can be looked upon as an innovative approach for students' motivation and active engagement. In conclusion, concept mapping should be employed in the field of medical education across different participants to facilitate teaching-learning and assessment. The employment of the tool makes the learning process interactive and encourages deep learning.

The branch of medicine is dynamic and keeps changing with each day, and thus, it is a big responsibility of the teachers to train medical students to fulfill the roles expected of them. The current review was carried out to understand the role of movies in medical education and the working model that can be adopted for its smooth integration within the existing curriculum. An extensive search of all materials related to the topic was carried out in the PubMed search engine, and a total of 10 articles were selected based upon the suitability with the current review objectives and analyzed. The employment of cinemas or movies in medical education has a special place, considering the rationale that watching and listening a video establish a sense of reality that is more conducive to learning. The use of movies creates a platform for the delivery of medical care in a humanistic, empathetic, and patient-centered manner and that makes the entire process of teaching efficient and effective. The introduction of movies and videos as a part of the medical curriculum delivery is a positive approach to ensure that students learn both cognitive and noncognitive skills. Considering the need that we have to appeal to all the learning domains, all the medical colleges should formulate a potential plan to introduce the use of movies and videos in teaching-learning and thereby benefit all types of learners.

The ultimate goal of medical education across heterogeneous settings is to produce a competent medical graduate. It is important to remember that this vision cannot be complete without incorporating observation, assessment, and documentation of the students' performance while they are involved in patient care throughout the duration of the course. The present review was planned to explore the utility of clinical work sampling (CWS) tool in the process of assessment of competencies. An extensive search of all materials related to the topic was carried out in the PubMed search engine, and a total of 15 articles were selected based upon the suitability with the current review objectives and analyzed. To ensure that the students are directly observed while at work, the use of workplace-based assessment tools has been strongly advocated owing to the high reliability, validity, feasibility, and better educational impact. CWS is an effective teaching-learning and assessment tool that involves observation and simultaneous scoring of different domains of patient interaction and management. In conclusion, the assessment method of CWS is based on the direct observation of clinical performance of the students in the workplace. Owing to the high validity and reliability of the tool, it is the need of the hour to employ the same as a part of clinical teaching and assessment in heterogeneous settings.

Intraoral scanners that record impressions digitally have been playing a major role in the field of prosthodontics. The classic method for recording impressions always included using of traditional impression materials and methods used with its basic understanding as per their manufacturer's instructions. However, the scope keeps expanding with the evolution in the field of impression by digitalization. All the data related to digital impressions as well as traditional impressions have been taken into consideration. The excluded literature includes the review kinds of literature that have already been done. This review article includes the pros and cons of digital impressions and information of the various systems that are available in the market.

Background: The purpose of the study is to evaluate surgically induced corneal astigmatism and visual outcome in patients undergoing small-incision cataract surgery (SICS) by modifying incision site on the basis of type of regular astigmatism. Material and Methods: This is a prospective study including 100 patients, having senile immature cataract, divided in two groups of 50 patients each according to the type of preoperative corneal astigmatism over a period of January 2018 to June 2019. A detailed preoperative evaluation was done including automated refractokeratometry, on the basis of which patients having steeper vertical axis (90° ±30°), i.e., “with the rule” astigmatism placed in Group A and subjected to superior SICS, and those having horizontal steeper axis (150°–180° and 0°–30°), i.e., “against the rule” astigmatism, were placed in Group B and subjected to temporal SICS. All surgeries were performed by a single ophthalmic surgeon with a similar technique of a 6.00 mm superior or temporal scleral straight incision. Surgically induced astigmatism (SIA) was calculated by a computer application SIA calculator version 2.0 on the 45^th postoperative day and compared. Results: Present study showed mean SIA was significantly less in the temporal group (1.09 ± 0.42 D) as compared to the superior group (1.38 ± 0.62 D). Conclusion: Modification of incision site in SICS as per preoperative astigmatism produces comparable results to other sophisticated techniques such as phacoemulsification, and hence, it provides an alternative path to attain better visual outcome and reduced SIA with limited resources available in most of the developing countries.

Introduction: Human milk banking (HMB) is a service established for collection, screening, processing, storage, and distribution of donated human milk. HMB is the best way of ensuring a safe supply of human milk to all the needy neonates. It helps to decrease infections, neonatal sepsis, and necrotizing enterocolitis, thus reduces neonatal morbidity and mortality. Methodology: This is a short-term student research project conducted as an observational, comparative, cross-sectional study. It was conducted in the neonatal intensive care unit (NICU) and HMB of a tertiary care hospital in a metropolitan city, conducted after approval from the Ethics Committee of the Institute. A total of 50 neonates from the NICU who had received pasteurized donor human milk (PDHM) were enrolled in one group (Group I – PDHM). The data of 50 newborns from NICU of the same institute were also collected retrograded for comparison before the establishment of HMB, as they had not received PDHM and enrolled in another group (Group II – non-PDHM). Results: It was observed that in Group I (PDHM), 55% of neonates were full term and 42.5% were preterm, and in Group II, 45% were full terms and 57.5% were preterm. Sepsis was seen in 30% of Group 1 and 54% of Group 2 and hyperbilirubinemia was seen in 22% of Group 1 and 42% of Group 2. There was a 24% decrease in sepsis and 20% decrease in hyperbilirubinemia in PDHM group. Mortality was seen in 40% of Group 1 and 60% of Group 2. A decrease in mortality was seen in PDHM group. Conclusions: HMB is imperative for the reduction of neonatal morbidity and mortality. It is a feasible, cost-effective option and a boon for neonates, particularly in developing countries like India.

Objective: The aim is to study respiratory diseases in children staying in a stone quarry. Methods: Prospective longitudinal study. All 85 children staying in the stone quarry near Pune were followed for respiratory symptoms and nutritional status by monthly visits for a period of 18 months. At the time of enrolment, Hemogram, Chest X- ray Postero-anterior view (PA), Tuberculin Test (TT), Peak Expiratory Flow Rate{PEFR }(Of children age: 5-12 yrs.) was done. Results: In those 85 children, there were 394 episodes of respiratory infections (3.09 episodes per child per year). They had 53 episodes of pneumonia requiring admission. TT test was positive in 9.4%of children. Eosinophilia was present in 16.47% of children. PEFR in these children was significantly lower than that of children of the same height (P < 0.05); 64.2% of all children were malnourished; 42.8% had moderate malnutrition and 21.4% had severe malnutrition. None of them had received even vaccines provided under EPI completely. Conclusion: Children staying in the stone quarry have frequent respiratory infections. They have a higher rate of pneumonia requiring admission. TT positivity is high. They have a lower PEFR. Immunization coverage is poor.

Background: Lower abdominal surgeries are associated with significant visceral, somatic, and neuropathic pain in postoperative period. Transversus abdominis plane block (TAP) is a technique used in the management of surgical abdominal pain by injecting local anesthetic in the plane between internal oblique and transversus abdominis muscles. We compared utility of TAP block using ropivacaine alone and also in combination with fentanyl for patients undergoing abdominal surgeries. Aim: To compare ropivacaine (0.2%) versus ropivacaine (0.2%) plus fentanyl (1 mcg/kg) used in transversus abdominal plane for the management of postoperative abdominal pain. Objective: To evaluate quality and duration of analgesia in the management of patients. Materials and Methods: Thirty patients undergoing abdominal surgeries were equally divided into two groups. Group-I received ropivacaine (0.2%) and Group-II received ropivacaine (0.2%) along with fentanyl (1 mcg/kg) as transversus abdominal block. Patients with stable hemodynamic parameters, American Society of Anesthesiologists grade I and II, and undergoing elective procedures were included in the study. Patients with significant comorbidities and emergency procedures were excluded. Vitals were recorded intraoperatively and subsequent to the procedure. Visual analog scale was recorded at 2^nd, 4^th, 12^th, and 24^th h postoperatively. Results: The hemodynamic parameters including blood pressure and heart rate were similar in both the groups with nonsignificant difference. Time to rescue analgesia in the form of injection tramadol was significantly earlier in the group that received ropivacaine alone. Patients receiving ropivacaine significantly had a higher severity pain at all the time points. No serious adverse events were noted in the either of the groups. Conclusion: TAP block using ropivacaine along with fentanyl may provide a higher quality of analgesia in patients undergoing abdominal surgeries in postoperative period.

Background: Infertility affects close to 10%–15% of all couples in reproductive age group. A myriad of life style variables including consumption of alcohol, smoking along with increased exposure to electromagnetic waves emitting from cell phones and personal computers for prolonged durations, have had a negative impact on the quality of semen in males. Materials and Methods: This cross-sectional study was conducted on 250 male patients under evaluation for infertility. Physical and macroscopic examination was carried out followed by in detail microscopic examination according to the World Health Organization 2010 guidelines. Results: Fertility scoring was done for all 250 subjects and 67.2% of cases were found to be fertile, 14.4% were subfertile, and 18.4% of cases were found to be infertile. Among the 168 fertile subjects, majority 75.6% of cases were young in the age group of 20–30 years, 85.1% of cases did not consume alcohol, and 86.3% of cases did not smoke. Among the 46 infertile subjects, majority 54.3% of cases were in the age group of 20–30 years, 84.8% of cases consumed some amount of alcohol, and 54.3% of cases had a history of tobacco smoking. Majority 64.1% of the subjects having a combination of all three lifestyle factors were found to be infertile, whereas only 2.6% of such subjects were found to be fertile. Conclusion: This study shows that the consumption of alcohol and cigarette smoking has a significant deleterious effect on the process of sperm production and male reproductive potential; therefore, counseling regarding this negative impact needs to be focused upon by all clinicians and infertility specialists while handling such cases.

Background: Medical education is one of the most stressful academic curricula across the globe and it is important for all students to have leadership and management skills because all physicians need to take responsibility as team leaders. Aims: To evaluate the leadership skills, personality types, leadership styles, and mental health status and study the correlation between mental health and leadership skills of first-phase MBBS students in a peripheral Medical College in West Bengal. Methodology and Participants: This study was conducted among first-phase MBBS students after taking institutional ethical clearance and informed consent of the participants. The participants were provided with two recorded YouTube videos which included mental health, leadership, and professionalism. Live interactive sessions were conducted. The participants had to fill up six questionnaires for assessment of leadership skills, personality types, leadership styles, perceived stress scores (PSSs) levels, mental health literacy levels, and DASS-21 scores. Feedback was taken from students. Results: One hundred and thirty-seven students could complete all tasks and so they were only included for analysis of data. One hundred and six students had PSS levels below 20 and thirty-one students had PSS levels of 20 or above. Mean ± SD of the different parameters assessed were as follows: PSS levels: 16.92 ± 4.16; Mental health literacy scores: 99.54 ± 15.31; Authoritative score: 7.85 ±1.45; Democratic score: 9.35 ± 1.7; Facilitative score: 9.52 ± 1.59; Situational score: 9.29 ± 2.54; Leadership skills test scores: 63.85 ± 14.59. DASS 21 scores: Depression: 11.45 ± 4.03; Anxiety: 12.3 ± 4.35; Stress: 15.1 ± 3.29. PSS was negatively correlated with leadership skill test scores and mental health literacy scores. Leadership skill test scores were positively correlated with mental health literacy scores. There was no significant difference between male and female students in respect of PSS levels, mental health literacy scores, leadership skill scores, authoritative scores, democratic scores, facilitative scores, and situational scores. Conclusions: Increased mental health literacy and decreased perceived stress levels were two causes of improved leadership skill test scores in the present study. Students were satisfied with the leadership skills taught to them and this study increased awareness about mental health and leadership among first-phase MBBS students.

Introduction: Antibiotic resistance is a worldwide problem. Organisms are developing resistance not only to commonly used antibiotics but also to high end and less commonly used antibiotics. Aim: The present study has been designed to find out the recent trend of antibiotic resistance profile of uropathogens as urinary tract infection is one of the commonest infections among outdoor and indoor patients. This will help clinicians to select most appropriate antibiotics to treat their patients empirically. This will also help in not only preventing the development but also reducing the spread of antibiotic resistance. Material and Methods: The study was conducted in the Microbiology Department, F.H. Medical College, Etmadpur, Agra, India, from March 2019 to August 2019. Mid-stream urine samples were collected from patients and transported within an hour and were inoculated on blood agar and MacConkey agar. After incubation at 37°C for 24 h, organisms were identified and sensitivity test was done by Kirby Bauer's disc diffusion method using Mueller Hinton Agar. Results: Members of the Enterobacteriaceae family showed resistance to almost all groups of antibiotics except piperacillin-tazobactam, imipenem, and nitrofurantoin while gram-positive organisms were found to be sensitive only to vancomycin, teicoplanin, linezolid, and nitrofurantoin. Situation with nonfermenters (Pseudomonas aeruginosa and Acinetobacter spp.) was alarming as they were found resistant to ceftazidime, cefepime, piperacillin, gentamicin and ciprofloxacin, and also significant resistance with imipenem was seen. Only colistin, polymyxin B and piperacillin-tazobactam showed satisfactory results and could be considered for use in empirical treatment. Conclusion: Present study shows how serious the problem of increasing antibiotic resistance is and emphasizes the need of continuous surveillance of antibiotic susceptibility of uropathogens that will help to formulate an effective antibiotic policy to guide the clinicians.

Background: Ensuring the effective participation of both public and private healthcare providers is essential to fulfill the goals of universal access to tuberculosis (TB) care. Objectives: The objective was to assess the knowledge, attitude, and practice about TB, Directly Observed Treatment Short (DOTS) program and Public-Private Mix-DOTS course (PPM-DOTS) strategy among allopathic private practitioners (PP) and to explore their extent of involvement in PPM-DOTS strategy in the diagnosis, notification, and management of TB in Puducherry, India. Materials and Methods: A sequential explanatory mixed-method study was conducted from November 2017 to February 2018 with quantitative survey using a pretested semistructured questionnaire followed by in-depth interview (IDI) using field guide. Descriptive manual content analysis was performed after verbatim transcription of the manuscripts from IDIs. Results: Qualitative data based on survey revealed that 97.66% of PPs were aware of subjecting patients with cough for more than 2 weeks for sputum examination and 93.75% were aware of mandatory TB notification. About 88.28% preferred to get the investigation done for presumptive TB cases from nearby DOTS centers. About 89.06% preferred to refer TB cases to nearby primary health centers whereas only 20.31% preferred to notify TB cases. IDIs revealed that PPM-DOTS was not utilized optimally due to the following reasons: minimal TB caseload to collaborate and function with DOTS centers, fear of losing the patient, distrust in PP, busy schedule, availability of Anti-tubercular treatment (ATT) in the nearby pharmacy, breach of confidentiality while notification and finally the easy referral mechanism due to nearby DOTS centers. Conclusions: Involvement of PPs in PPM-DOTS remains sub-optimal. Strategies such as conducting regular workshops, providing timely information about policy changes, and constructive communications individually with PPs to dispel any misconceptions might enhance PPM-DOTS.

Context: Menopause is an overall increase in body's response to inflammation. Periodontium is no such exception leads to periodontitis, tooth loss may occur if not treated timely. Pre and postmenopausal conditions are more or less critical for inflammatory changes. This study aimed to determine both conditions which one was oppressive? and which reciprocated more to scaling? Materials and Methods: This is a cross-sectional interventional study. Sixty female subjects aged between 40 and 50 years with periodontitis were recruited. Equated into two groups of 30 patients each, Group I being premenopausal and Group II postmenopausal women. Plaque Index, Periodontal Index (PDI), and Sulcular Bleeding Index were compared at baseline and 3 months after scaling. IBM SPSS version 21 software was used. An independent sample t-test was applied for percentage decrement and intergroup comparison with paired t-test. Results: Significant reduction in all the above parameters in both the groups was noted based on intragroup comparison from baseline to 3 months (P < 0.001). However, the intergroup showed no significance except PDI at baseline. Conclusions: There was a remarkable effect of scaling on inflammatory conditions such as menopause and periodontitis. If women undergo periodontal therapy in premenopause stage, it can prevent future aggressive inflammatory changes in the postmenopausal stage.

Background: Hanging is a very common mode of deliberate self-harm (DSH) used by patients. The spectrum of the triggers and methods used vary from play to place. Objective: To study the profile and outcome of near hanging. Methods and Materials: A retrospective descriptive study was conducted on patients presenting with near hanging to the Emergency Department (ED) between January 2017 and December 2018. Data were obtained from the triage registry of the ED. Results: During the study period, 1821 presented with DSH with 144 cases of near hanging. The mean age (SD) was 33 (12.9) years and the sex distribution was equal. One-tenth (9.7%) of them had a known psychiatric illness, whereas a quarter of them (22.9%) were under the influence of alcohol at the time of the incident. The most common material used was saree (52.8%). Eight patients were intubated elsewhere and referred to ED, whereas 79% required emergency intubation in ED, with the majority being hypoxic at arrival (84.7%). Of the 144 patients, 58.4% were admitted to the hospital, whereas 20.8% were discharged stable after 24 hours of observation. Among in-patients, the majority (92.7%) were discharged stable, 4.8% left against medical advice, and 2.3% died in the hospital. Conclusions: Hanging as a method of self-harm is used by a tenth of patients who present to the ED with DSH. Saree and rope are the most common materials used for this act. One-fifth of our patients had a bad outcome that was independent of most underlying baseline factors.

Background: Substantial proportion of bipolar affective disorder (BPAD) patients are symptomatic more than half of their lives despite receiving pharmacological treatment leading to functional impairment and disability. Objectives: To study the correlation of disability with socio-demographic and clinical variables in euthymic patients with BPAD. Methods: A hospital-based cross-sectional study was conducted on 100 euthymic patients of BPAD using purposive sampling. Data were collected using semi-structured proforma and diagnostic categorization of patients was done according to ICD-10 research criteria, Hamilton's Rating Scale for Depression (HAM-D), and Young Mania Rating Scale (YMRS). Indian Disability Evaluation Assessment Scale (IDEAS) was administered for disability assessment. The variables were analyzed using appropriate tests, namely, analysis of variance (ANOVA) test, two independent sample t test, Fisher's exact test, and Spearman's correlation coefficient. Results: 81% patients of BPAD had a mild disability and 19% patients had a moderate disability. The total duration of illness score (mean 3.8) was the major determinant of disability on IDEAS. There was a statistically significant association of age (P < 0.001), gender (P = 0.027), subsyndromal manic features (P < 0.001), and number of previous episodes (P < 0.001) with disability, and there was no association of socioeconomic status, marital status, occupational status, duration of illness, age of onset, and number of previous hospitalizations with disability. Conclusion: Bipolar affective disorder is associated with mild-to-moderate disability on evaluation using IDEAS instrument. There is a need for further studies on the utility of IDEAS and its individual domains in the assessment of disability due to bipolar affective disorder.

Context: The ultrasound-guided reduction by saline enema is a preferred nonsurgical procedure for intussusception. In a government setup where bedside ultrasound and round-the-clock trained radiologist facilities are unavailable, bedside saline enema reduction (without ultrasound guidance) may be an option. Aims: To evaluate the efficacy of bedside hydrostatic saline enema reduction in the treatment of pediatric intussusception; the secondary aim was to identify the patient subset in which it is more useful. Settings and Design: A retrospective study was conducted from January 2019 to May 2021 in all children with ultrasound-confirmed intussusception at our center. Subjects and Methods: All children were considered for non-operative bedside reduction with saline enema, excluding those with signs of peritonitis and shock. We allowed a maximum of three attempts of saline enema reduction. Results: There were 375 patients admitted with the diagnosis of intussusception in our institute. Out of these, 42 patients were subjected to bedside hydrostatic saline enema reduction. The patients in this group were in the age range of 5 months to 14 years. The success rate of bedside hydrostatic saline enema reduction was 90.47% (38 out of 42 cases). No perforations occurred during the procedure. The duration of symptoms and age of the patients did not influence the successful reduction in our series (p > 0.05). The duration of admission attained a statistically significant difference (p < 0.05) between those who had a successful non-operative reduction and those who subsequently had an operative intervention, that is, reduction or resection. There was no mortality. Conclusion: Bedside hydrostatic normal saline enema reduction of intussusception is a suitable non-operative technique of managing childhood intussusception in the carefully selected subset of patients. The technique is simple, safe, and cost-effective in a resource-limited setup.

Background: Percutaneous coronary intervention (PCI) has been effective in increasing the longevity of patients with cardiovascular disease. Notwithstanding paucity of Indian studies on the psychological effects of PCI, there have been conflicting evidences with regard to improvement of quality of life in patients undergoing angioplasty. Aim: To evaluate change in the quality of life and emotional factors like depression, stress, and anxiety in patients undergoing angioplasty. Methods: This prospective longitudinal study was carried out at a tertiary care hospital and research centre in the western part of Maharashtra in a semi-urban location on 70 consecutive patients undergoing angioplasty from July 2019 to July 2021. Besides sociodemographic data patients were assessed with Type D Scale-14 (DS14), Depression Anxiety Stress Scale, and The MacNew heart disease health-related quality of life Questionnaire. After 15 days of the procedure, patients were re-evaluated with the same scales. Results: Mean age of our study population was 58.67 years of which 77.14% were men. The prevalence of Type D personality was 28.57%. There was a significant reduction in anxiety and stress scores and significant improvement in emotional and physical sub scales of Quality of life post angioplasty. On multiple regression analysis, anxiety and social inhibition emerged as predictors of depression. Conclusion: Angioplasty is associated with significant improvement in anxiety, stress, and emotional and physical subscales of Quality of life. Social inhibition, which is a component of Type D personality, anxiety, and loss of libido are significant predictors of depression in patients undergoing angioplasty.

Lyme borreliosis is a multisystem disease transmitted by the bite of vector, Ixodes tick and caused by the strains of spirochete Borrelia burgdorferi sensu lato. The Centers for Disease Control and Prevention has listed it as a reportable disease since 1991. Although the three classical cutaneous manifestations are primary erythema migrans, borrelial lymphocytoma, and acrodermatitis chronica atrophicans, secondary disseminated erythema migrans is a rare presentation. Reported atypical erythema chronicum migrans (ECM) lesions include vesicles, erythematous papules, purpura, and lymphangitic streaks. We report a case of a female patient who was clinically, serologically, and histopathologically diagnosed as a case of Lyme disease (LD) with disseminated secondary erythema migrans with atypical edematous lesions. Only four confirmed cases of ECM have been reported in India before this report. The case highlights this atypical and rare presentation of LD in India.

Molluscum contagiosum (MC) is a benign cutaneous viral infection caused by the MC virus belonging to the poxviridae family. The disease is self-limiting in immunocompetent individuals, while it is severe and prolonged when associated with Human Immunodeficiency Virus infection. Dermoscopic examination shows the presence or absence of an orifice and the vascular pattern of vessels. Henderson-Patterson bodies on histopathology, representing intracytoplasmic assemblies of the virus, are pathognomonic. Here, we present a 33-year-old unmarried male with extensive papulonodular lesions over the face, genitals, and groin, for 6 months. Dermoscopy, cytology, and histopathology were consistent with MC. His CD4 count was 9 cell/cu.mm, and HIV-1 and 2 antibodies were reactive. Thus, the diagnosis of giant MC was confirmed, and he was started on anti-retroviral therapy, cryotherapy, and topical imiquimod 5% cream over the lesions.

Leprosy is a chronic infectious disease caused by Mycobacterium leprae (M. leprae), mainly affecting skin and nerves. Lucio leprosy (LuLp) is a pure primitive diffuse nonnodular form of leprosy. Lucio phenomenon (LP) is a type of necrotizing reaction seen in untreated or inadequately treated cases of LuLp. We present a case of LP in a patient of lepromatous leprosy. A 55-year-old male presented with hemorrhagic bullae, angulated ulcers with jagged margins on lower limbs, purpuric patches on extremities, trunk, and face, and erythematous plaques with intact sensations on back. LP was diagnosed on the basis of clinicohistopathological features.

We are reporting a case of 28-year-old young lady who presented with sensory stroke. Magnetic resonance imaging (MRI) of brain showed bilateral watershed infarcts in middle and anterior cerebral territories. Brain angiography showed stenosis of supraclinoid portion of both internal carotid arteries (ICAs) without any moyamoya vessels (collaterals). Contrast MRI of brain showed enhancement of vessel wall in supraclinoid portion of both ICAs suggestive of inflammation. She was a known case of hyperthyroidism on irregular treatment. Work up for vasculitis was negative. Temporal artery biopsy was normal. She was diagnosed as a case of moyamoya syndrome associated with Graves' disease. She showed good response to immunosuppressants, aspirin, and treatment of hyperthyroidism. She had no ischemic events for 6 months but was later lost to follow-up. After 1 year she again presented with two episodes of transient ischemic attacks. Repeat imaging showed reduction in the wall thickening and enhancement and no new infarcts.

Colonic lipomas are nonepithelial tumors usually detected incidentally during abdominal surgery or colonoscopy. Lipomas generally remain asymptomatic, when they exceed 2 cm of diameter they may cause abdominal pain, obstruction, or intussusception. Here, we present a case of an elderly woman referred by her general practitioner to minimally access surgery outpatient department presented with complaints of passing loose stools 7–8 times a day. Triphasic computed tomography scan confirmed the diagnosis. To reduce the risk of malignancy, laparoscopic-assisted excision of lipoma was done. Histopathological examination of the specimen confirmed the diagnosis of lipoma sigmoid colon.

Accessory spleen or splenunculi is a rare entity and usually near the spleen's hilum and in the tail of the pancreas. The accessory spleen may be formed during embryonic life, and they rise from the left side of the dorsal mesogastrium as a result of the imperfect fusion of separate splenic masses. Here, we are presenting a case of retroperitoneal mass who presented with pain in the upper abdomen, evaluated and worked up and was diagnosed as a large retroperitoneal mass along with two small globular structures likely splenunculi. The patient underwent diagnostic laparoscopy and excision of the retroperitoneal mass. The specimen sent for histopathological examination confirmed the diagnosis as splenunculi.

Inflammatory breast carcinoma is a rare rapidly progressive form of breast carcinoma. The nature of lesion often mimics inflammatory lesions such as mastitis which leads to the delay in diagnosis and treatment. Here, we report a case of a young lactating female patient who presented with features of mastitis. However, fine-needle aspiration cytology and further histopathological examination of the core biopsy revealed it as carcinoma. The patient was then advised neoadjuvant chemotherapy. Thus, the awareness and recognition of this rare entity, which mimic various inflammatory and nonmalignant causes, are of utmost importance.

Endometrial hyperplasia has crucial clinical significance for its obvious association as a precursor lesion to endometrial adenocarcinoma. It almost always occurs in a setting of prolonged estrogen exposure unopposed by progesterone, and hence, the endometrium is mostly, if not always, proliferative in morphology, but rarely, the hyperplastic glands show secretory changes. Endometrial hyperplasia with secretory changes has diagnostic difficulties due to its benign and malignant mimickers. Benign mimickers such as Arias-Stella reaction can be ruled out by clinical signs of gestation, while malignant lesions can be ruled out by histological evidence of stromal or myometrial invasion. Diagnostic difficulty is more pronounced in cases with late secretory endometrium, endometrial polyps with secretory changes, mucinous metaplasia, and hormone-induced changes. In these cases, clinical history with histological workup will be of most value to establish the diagnosis.

Acrodermatitis enteropathica (AE) is a rare genetic autosomal recessive disorder of zinc deficiency which manifests in infancy with triad of peri-orificial skin rash, alopecia, and diarrhea. We report the case of an 8-month-old infant with dermatological features of AE being managed as a case of candidial-intertrigo and diaper dermatitis who showed excellent response to oral zinc.

Invasive papillary carcinoma (IPC) of the breast is a rare entity, comprising approximately <1%–2% of all breast cancers. It is most commonly seen in postmenopausal females and rarely seen in males. IPC is arising from the dilated duct or large duct. They are low-grade tumors microscopically consisting of well-circumscribed solid nodules of the neoplastic cells separated by fibrovascular cores. It has excellent prognosis, so exact diagnosis is necessary. We report a case of a 68-year-old postmenopausal female, who came with complaints of a lump in the left breast for the past 2 months, modified radical mastectomy was done, and the specimen was sent for histopathological examination. Immunohistochemistry was done estrogen receptor and progesterone receptor positive with human epidermal growth factor receptor 2 negative. The case is presented due to its rarity.

Herpes zoster (HZ) is rarely found in healthy children but may be attributed to immunocompromised children. Latent varicella-zoster virus (VZV) might have source from intrauterine exposure, chicken pox vaccination, or exposure to wild VZV. A 2 ½-year-old healthy boy presented with a painful red vesicular rashes with blisters on the right upper cheek, periorbital area, temporal and nasal area extending over the dermatomes V1 and V2 of 3 days' duration. There was an involvement of the right eye causing conjunctivitis. He had persistent frontal and temporal headache on the day 10 of the disease. Computed tomography scan of the brain reveals no abnormality. The child responded well to symptomatic management and routine skin care. Medications such as cetrizine, sup acyclovir, and local acyclovir ointment and emollients were given. Acyclovir was used orally in a dose of 20 mg/kg body weight every 6 hourly for 7 days. The patient recovered well in 10 days of treatment. HZ is a rare presentation in healthy children and needs a high index of suspicion to diagnose in cases with vesicular eruptions. In our case, the intrauterine infection is the source of latent VZV. HZ may not indicate that the child is immunocompromised.

The incidence of secondary neoplasms of the testis has been reported at 0.02%–2.5%. The testis is a rare metastasis site for prostatic adenocarcinoma. A 62-year-old gentleman presented with neck swelling and testicular swelling. On evaluation, he was found to have metastatic carcinoma of prostate on 68-Gallium prostate-specific membrane antigen study with disseminated metastasis along with right testicular metastases. The patient underwent bilateral orchidectomy as part of the hormonal treatment, and the histopathological examination revealed the metastatic deposits on both the testis with the left testis showing only micrometastasis. Only few cases of bilateral testes metastases from the prostatic carcinoma are reported in the literature.

Aconitine, a plant alkaloid is a usual constituent of various over-the-counter herbal remedies and is an uncommon cause of deliberate poisoning. Herein, we describe an unusual case of poisoning in a young male due to accidental ingestion of aconitine tincture. On presentation, his electrocardiogram documented ventricular arrhythmias for which amiodarone was administered promptly. This led to considerable improvement in heart rhythm. The patient recovered gradually with this management and achieved normal sinus rhythm. He was completely asymptomatic within 5 days of treatment and subsequently discharged. Our management with amiodarone narrates the importance of this drug in aconitine poisoning, which can prove to be fatal in the absence of any intervention or delay in diagnosis. Nonexistence of specific antidote also establishes amiodarone as a standard remedy.

For a significant period of time in the field of medical education, delivery in India emphasis has been given toward didactic lectures, practical, and tutorials. Among the five goals laid down for an Indian Medical Graduate, being a lifelong learner is what we are aiming for as the field of medicine is changing with each day. This cannot be accomplished if we do not encourage self-directed learning (SDL) among the students, and this need has been realized and has been given due weightage in the recently adopted competency-based undergraduate medical curriculum. However, it is important to acknowledge that the success of SDL depends on the readiness of the students to adopt the same and to accomplish that we have to strategically deal with all the existing challenges, which comes along with it. In conclusion, SDL has an extensive scope and application in the delivery of undergraduate medical education in India. However, there are challenges pertaining to its planning and evaluation, and there lies the role of a faculty member, who has to be more proactive in ensuring that it is implemented effectively and the students are benefited.

Programmatic assessment has been advocated in the field of medical education as it advocates for the continuous collection and analysis of the findings of the formal assessments with a solitary intention to improve the learning and enable the teachers to take an evidence-based high-stakes decision. In most of the postgraduation courses, there are no exams in the 3 years duration of the course and finally, at the end of the course, a summative assessment is conducted, which defines the fate of the students. This is regardless of the fact of how a student has been professionally in the entire course period, and it is very much possible that a deserving candidate might not pass due to a wide range of factors related to students, examiners, and pattern of examination, etc. In conclusion, the introduction of programmatic assessment in postgraduate courses is the need of the hour to neutralize all the subjectivity and unorganized assessments which is prevailing at present. The concept of programmatic assessment can very much justify the process of certification of a student by ensuring that all the core competencies are acquired by the student.

Introduction: Communication skills are an important component in building a good doctor − patient relationship. Imparting knowledge on it to medical students, during their formative years of training, help to overcome issues that arise due to communication gaps with patients. Materials and Methods: Twenty-four 1^st-year postgraduate resident doctors in the department of medicine in a tertiary care teaching hospital were evaluated regarding their communication skills. Residents were taught how to communicate properly with patients when taking their informed consent prior to a procedure. Results: Competency of residents and patient satisfaction, evaluated using the Kalamazoo Essential Elements Communication Checklist and Interview Satisfaction Questionnaire, respectively, showed improvements following such training. Conclusion: Formal assessments and training in communication skills for medical residents aid significantly to improve physician competence and patient satisfaction.

The effective delivery of a lecture class poses a major challenge for the faculty members, especially in the field of medical education due to the involvement of vast knowledge and complicated concepts. The “flipped classroom” has emerged as one of the most effective ways to impart curricular delivery during a large group teaching session. The teaching is termed as flipped classroom as acquisition of the knowledge/content is shifted to outside class and is then subsequently followed by the application of the gained knowledge in the class within the presence of a teacher. In conclusion, flipped classroom encourages the role reversal, wherein it is the responsibility of the students to acquire knowledge before coming to the class, while the application part becomes the responsibility of the teacher. Even though it is quite an effective approach of teaching–learning, the implementation of the same requires careful planning and support from the faculty members.

The best way to deliver effective medical education in large or small group teaching sessions is by ensuring that the sessions are interactive and interesting for the students so that they actively participate in the sessions. However, it is important to acknowledge that a teacher has to do a proper preinstructional planning for this to happen. A teacher has to specify the specific learning objectives of their session and convey the students what they expect students to take away from the session. At the same time, the teacher has to carefully decide on the method of assessment during the interactive session, as the selected method should drive learning, easy to administer, and should not extend the overall duration of the session. The assessment method can target any of the domains of learning depending on the nature of the topic and should aim to test different levels of learning in each domain. In conclusion, assessment and feedback play an instrumental role in the entire process of teaching–learning. Thus, it has to be encouraged as it offers a wide spectrum of benefits to the students as well as the teachers.