Oral mucosal lesions are a common occurrence and very often dentists are called on to see such patients. Among many causes, trauma is one of the leading for oral mucosal diseases. Oral traumatic lesions are diverse in which some present as acute lesions while the majority are chronic lesions. Clinical presentation of traumatic lesions varies significantly and most of the occasions, the cause and the effect can be established with thorough history and clinical examination. Although biopsy of such lesions is not required in most of the occasions, some may warrant histological investigations to exclude conditions which clinically mimic traumatic lesions. This paper provides an overview of common and some rare traumatic conditions of the oral mucosa.

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The color of a lesion is due to its nature and to its histological substratum. To ease diagnosis, oral cavity lesions have been classified according to their color. In the oral cavity, jaundice is classified under yellow lesions as diffuse macular yellow lesions. This interpretation of the lesions by its color is the first step to diagnosis. It should be taken into account that, as happens with any other classification, the yellowish group of lesions includes items with different prognosis as well as possible markers of systemic disorders. In this case report, the author discusses the oral manifestations of a patient with icterus and its dental implications.

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Rheumatoid arthritis (RA), an auto-immune inflammatory disease is one of the challenging conditions for the physicians to handle due to its chronicity, incurability, complications, morbidity, etc. In spite of potent anti-inflammatory agents and powerful immune-suppressive agents, its prognosis is not good, as these drugs have certain limitations including dependency and other side effects restricting quality of life. Considering these inconveniences, alternatives are being searched from traditional systems. Ayurveda through its armamentarium can provide leads in the management of this condition that is similar to Amavata in its clinical presentation. Amavatari rasa is one of the familiar medicaments used throughout India by Ayurvedic physicians for Amavata. In the current study, a clinical experience with Amavatari rasa is placed. A 32-year-old female with diagnosed history of RA was treated by Amavatari rasa. She received 250 mg of Amavatari rasa thrice a day with lukewarm water for 8 weeks and at the end of the treatment, 35% improvement was observed in the overall effect of therapy.

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Introduction: Immunization is one of the most effective public health tools available to prevent death and disease. Serious adverse events following immunization (AEFI) are rare. However, coincidental sudden-infant-death-syndrome (SIDS) deaths do occur temporally associated with vaccination. In 2010, the Government of India (GoI) introduced a new standard operating procedure (SOP) to report AEFI. There have been stray newspaper reports of deaths soon after the administration of the pentavalent vaccine (PV) which was introduced by the GoI in December 2011. This study was conducted to examine if there is an epidemiological signal from the data collected passively under the new SOP. Materials and Methods: We used data provided by the GoI on the number children who received three doses of diphtheria-tetanus-pertussis vaccine (DTP), the number receiving PV and the number of deaths in the vaccinated within 72 h. Results: After PV was introduced in the states, 45 million infants received DTP vaccination and 25 million received PV. There were 217 deaths within 72 h after DTP was administered and 237 following PV. There were 4.8 deaths per million vaccinated with DTP (95% confidence interval [CI]: 4.2–5.5) and 9.6 deaths (95% CI: 8.4–10.8) per million vaccinated with PV (odds ratio 1.98 (95% CI 1.65-2.38) There were 4.7 additional deaths (95% CI: 3.5–5.9), per million, vaccinated with PV instead of DTP (P < 0.0001). Discussion: Deaths following DTP vaccination would include the natural rate of deaths within that window period, plus deaths if any, caused by DTP. For purposes of this study, we assumed that all the deaths associated with DTP are coincidental SIDS deaths. Taking that as the base rate of SIDS, we look for any increase in the death rate after PV. This study demonstrated an increase in reports of sudden unexplained deaths within 72 h of administering PV compared to DTP vaccine. Whether improvements in AEFI surveillance system or other factors contributed to this increase cannot be ascertained from this study. Conclusion: These findings do not warrant deviation from current vaccination schedule, but the differential death rates between DTP and PV do call for further rigorous prospective population-based investigations.

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The umbilical polyp is a rare congenital lesion characterized by bright reddish round mass resulting from the persistence of omphalomesenteric duct enteric mucosa at the umbilicus. Umbilical tissue specimens are uncommonly received in the Histopathology Department of Nnamdi Azikiwe University Teaching Hospital. Approximately, one is seen out of every 300 samples received in this center. The aim of this article is to report a rare case of umbilical polyp which was present at birth in a 3-year-old male child who presented with umbilical ulcer with a bloody discharge on contact. This article is the first of its kind in Nigeria and therefore aims to create awareness of this rare condition among Nigerian histopathologists and to differentiate it from more common umbilical anomalies.

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Background: Increased abdominal obesity is related to adverse metabolic markers. Waist circumference (WC) alone has been shown to correlate more strongly to direct measures of abdominal fat accumulation. Waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) are other parameters to estimate abdominal obesity. Increase in total cholesterol (TC), and triglyceride (TG) increases health risks; whereas, decrease in high density lipoprotein cholesterol (HDL-C) increases future health risk. Aim: The aim of the present study was to find if any correlation exist between central obesity and serum lipid profile in otherwise healthy young adults. Materials and Methods: A cross-sectional study was conducted with 76 (male = 41, female = 35) apparently healthy young adults. Weight, height, WC, and hip circumference were measured. WHR and WHtR were calculated from measured parameters. Serum lipid profile parameters were obtained from venous blood collected after overnight fasting (i.e., 12 h fasting). Pearson's correlation (with α = 0.05) was used to obtain a correlation between central obesity parameters and lipid profile parameters. Statistical analyses were performed in GraphPad Prism 6.01 windows based software. Results: Mean age of the subjects was 18.83 ± 0.85 years. Correlation of WC with TC (r = 0.08, P = 0.45), TG (r = 0.21, P = 0.05) and HDL-C (r = −0.06, P = 0.56) was insignificant. Correlation of WHR with TC (r = 0.07, P = 0.49), TG (r = 0.26, P = 0.02) and HDL-C (r = 0.07, P = 0.50) and WHtR with TC (r = 0.09, P = 0.41), TG (r = 0.17, P = 0.12) and HDL-C (r = 0.03, P = 0.74) also showed insignificant correlation. Conclusion: Indirectly measured central obesity has an insignificant correlation with serum lipid profile in healthy young adults.

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Background: Anemia is a global problem with higher prevalence in India. Anemia is known to affect endurance and will have a direct impact on the productivity of combatants. Hence, it is important to recognize and treat anemia in combatants. A cost-effective point-of-care test in the hands of the primary health-care provider will be a useful tool for diagnosis of anemia. This study endeavors to validate a point-of-care hemoglobin test-World Health Organization (WHO) hemoglobin colur scale (HbCS) against the gold standard test (GST) of cyan methhemoglobin method. Materials and Methods: The test validation study was conducted at a mid-zonal peripheral hospital. The participants were assessed for hemoglobin status by the WHO HbCS at the Outpatient department by means of capillary blood sample using a lancet. Subsequently, venous blood sample was drawn and processed by GST at the hospital laboratory. The hemoglobin values obtained were statistically analyzed. Results: A total of 200 participants were included in the study with a predominant age group of 19–40 years with most belonging to the male sex. The HbCS showed a mean difference of 1.21 g/dl in comparison with GST. The study showed HbCS to have a high sensitivity and negative predictive value. The ideal cutoff value was found to be 12 g/dl having the maximum area under the receiver operating characteristic curve. Conclusion: HbCS is an effective diagnostic tool to assess mild to moderate anemia in a resource-poor setting.

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Aneurysmal bone cyst (ABC) is a locally aggressive nonneoplastic tumor-like lesion commonly involving metaphysis of long tubular bones. Primary ABC in the talus is extremely rare and of unknown etiology. Until now, only about thirty cases have been reported in the literature. We report a case of primary ABC of the talus in a 20-year-old male patient who was treated by intralesional curettage and cancellous iliac crest bone grafting. The patient showed excellent functional outcome.

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Introduction: Thinness among adolescent girls has not received due to attention in many developing countries including Ethiopia. However, adolescence period is the last window of opportunity to implement strategies to correct potential growth deficits thereby breaking the vicious cycle of intergenerational malnutrition. Objectives: The aim of this study is to assess the prevalence of thinness and associated factors among adolescent girls. Methods: School-based cross-sectional study design was employed from April to May 2014. Multi-stage sampling technique was used to select a total of 823 adolescent girl students. Data were collected using interviewer-administered technique using a pretested semi-structured questionnaire and anthropometric measurements. Five nurses as data collectors and three BSc nurse supervisors were included in the study. Data were entered into EPI INFO version 7 and then exported to SPSS version 20 software and WHO AnthroPlus software for analysis. Descriptive statistics was performed. Binary logistic regression was fitted, odds ratio (OR) with 95% confidence interval (CI) and P value was calculated to identify associated factors. Results: The overall prevalence of thinness in this study area was 12.6%. Age of the respondent (adjusted OR [AOR] =2.7, 95% CI: 1.4, 5.3), education status of mother (AOR = 5.4, 95% CI: 3.3, 6.5), menstruation status (AOR = 0.5, 95% CI: 0.3, 0.9), individual dietary diversity (AOR = 3.9, 95% CI: 2.3, 7.0), and wealth index (AOR = 3.8, 95% CI: 1.5, 5.6) were significantly associated with thinness of adolescent girls. Conclusion and Recommendation: Thinness was found to be a serious problem in the study area. Strategies are needed to improve the nutritional status of adolescent girls before they reach conception to break the vicious cycle of intergenerational malnutrition.

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Context: Dengue is an acute febrile disease transmitted by bite of Aedes aegypti mosquito. It leads to “classical” dengue fever, dengue hemorrhagic fever with/without shock. The disease is prevalent throughout India and Maharashtra recorded 5610 dengue cases in 2013 with 48 deaths and 3551 cases with 7 deaths until 29^th October 2014. Aims: To study demographic and clinical spectrum of dengue patients admitted in a tertiary care hospital in Pune. Settings and Design: This was a cross-sectional record-based study. Population of Inpatients of tertiary hospital, Pune, admitted during June 1, 2016–November 31, 2016. Materials and Methods: Records of indoor patients admitted used to fill prestructured pro forma. Data were entered into Microsoft Excel to calculate percentages. Results: A total of 299 patients' records were assessed. Patients belonging to age group of 0–30 years were 70.16% (210). Out of 299 patients, 63.21%were males. The common symptoms were fever with chills in 87% patients and headache/body ache in 89% of patients. Stay in hospital for 95.29% (285) was a week. Approximately 31% (92) patients had a platelet count of 10,000–40,000 and 99.6% (269) patients did not require platelet transfusion. Ns1Ag positive were 81% patients. The most common complication was thrombocytopenia (79%). Conclusion: Age group 21–40 years was affected. Ns1Ag positive were 81% patients, blood transfusion not required by majority.

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Tuberculous infection of neuroparenchyma is commonly manifested on magnetic resonance imaging as meningitis with basal exudates and associated complications. Involvement of supratentorial neuroparenchyma is far more common than infratentorial compartment. Variation in imaging finding of infratentorial tuberculous involvement is challenging for a radiologist.

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Background: Idiopathic pulmonary fibrosis (IPF) is a progressive idiopathic interstitial pneumonia. Gender-Age-Physiology (GAP) is the first prognostic staging system for IPF which predicts mortality. Disadvantage is the cumbersome diffusion lung capacity for carbon monoxide (DLCO) testing, one of the parameters in calculating GAP. Hence, we proposed The New Modified Classification of GAP (TNMC-GAP) index by replacing the DLCO parameter with the easy to perform and established prognostic test; 6 min-walk distance (6MWD). Aim: The aim of the study was to apply the TNMC-GAP index and compare with GAP index in IPF. Settings and Design: A retrospective observational study conducted at a tertiary care center after Ethics Committee permission. It was an independent subanalysis of IPF patient's data collected for National ILD India Registry. Statistical Analysis: The statistical analysis used mean, percentages, Chi-square test, and paired-t-test. Results: Seventy IPF (34 men and 36 women) patients were included in the study. Mean age was 62 years. Cough and dyspnea were the predominant symptoms. Most patients had comorbidities. Average partial pressure of oxygen on arterial blood gas (PaO2), forced vital capacity, and 6MWD were 68 mmHg, 1.42 L, 229 m, respectively. Patients, when classified as per GAP index, were distributed as 11, 26, and 33 against 16, 25, and 29 on applying the TNMC-GAP index in stages I, II, and III, respectively. At 3-year follow-up, 21 (30%) patients lived and 49 (70%) patients died. Of the deaths, 30 (43%), 42 (60%), and 49 (70%) had occurred at 1-, 2-, 3-year follow-up, respectively. Mortality prediction with TNMC-GAP and GAP yielded concordant results. We observed overall higher mortality. Cardiac comorbidity (P = 0.03), 6MWD <200 m (P = 0.0002), severe restriction (P = 0.0142), and moderate-to-severe pulmonary hypertension (P = 0.0068) were significant contributing factors for the same. Conclusion: The replacement of the DLCO parameter in the GAP with 6MWD yielded concordant results. Thus, TNMC-GAP serves a reliable replacement for GAP in resource-limited settings.

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Context: Japanese encephalitis (JE) stands foremost among the etiologies of encephalitis in Southeast Asia, causing mortality and residual disability. A profile of the disease is invaluable in aiding effective management. Aims: The aim of the study was to observe differing clinical features of JE from non-JE encephalitis and identify morbidity and mortality patterns. Settings and Design: This was a prospective observational study conducted in patients aged ≥13 years admitted in medical wards with clinically suspected encephalitis from January 2011 to December 2016. Subjects and Methods: Persons with clinically suspected acute encephalitis were evaluated with medical history taking, clinical examination, neuroimaging, serology, and cerebrospinal fluid (CSF) analysis. Statistical Analysis Used: The results were statistically analyzed with Fisher's exact test with two-tailed P value. Results: Out of 795 patients with clinically suspected acute encephalitis, 87 were positive for IgM JE. JE positivity was significantly higher in persons aged above 50 and during the months from February to July. The male:female ratio was 1.49:1. JE patients presented with fever and neurological symptoms (100%), which included altered sensorium (56.32%), meningismus (55.17%), headache (33.33%), neurological deficits (11.49%), and seizures (3.45%). CSF was pleocytic >5 cells/mm³ in 74.71%, with lymphocyte predominance in 68.97% and mixed cellularity in 5.75%. About 59.77% had elevated protein, and 96.55% had normal sugar levels. Gastrointestinal complaints predominated significantly in patients aged below 50. Five patients died, all of whom were aged above 50 years. Conclusions: Persons aged above 50 years were especially susceptible to JE. Fever and neurological manifestations occurred in 100%, and the mortality was 5.75%.

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Introduction: Oral hygiene is an important aspect of personal hygiene. Doctors are expected to be in the forefront in promoting the general well-being of the populace. However, oral and dental health are areas that are often neglected by nondental doctors during patient consultation; therefore, for a doctor to give an effective advice, his/her knowledge and practice of good oral hygiene should be optimal according to the laid down guidelines. Materials and Methods: This was a cross-sectional study. Medical doctors in the hospital were consecutively recruited, and a pretested self-administered questionnaire was employed. The questionnaire contained information on their oral hygiene and their care for patient oral hygiene. Results: There were 36 (66.7%) males and 18 (33.3%) females, with a male-to-female ratio of 2:1. Toothpaste and toothbrush were the most common materials used for oral cleansing; majority of the respondents change their toothbrush within 2–3 months. Most respondents brushed their mouth/teeth twice (66.7%) in a day; however, other oral cleansing materials were documented in 66.7% of the respondents; their use were mostly after meals and majority (44.4%) used wooden toothpicks. Use of dental floss was reported in only 41.7% of the respondents; lack of information on the need for dental flossing was the main reason among respondents who did not floss. Conclusion: Toothpaste and toothbrush are the most common oral cleansing materials; the respondents in this study frequently changed their toothbrush and most respondents cleaned their mouth twice in a day and use of dental floss was less reported among the respondents.

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Introduction: Type-2 Diabetes Mellitus is a pandemic now and most of the patients are treated on OHAs. There are very specific indications to initiate insulin therapy. However, very often, physician's attempt to introduce insulin is met with stiff resistance from the patient. Methods: This was a single-centre, cross-sectional, interviewer-administered survey study, conducted in order to assess the perception of Insulin therapy among patients with type 2 Diabetes Mellitus as well to see the effects of a structured 'Diabetes Education Program' on this perception. Pre-Education & Post-Education data was compiled and analyzed. Result: Out of 88 subjects, 60 were males and 28 females. 14 subjects were on non-pharmaceutical management, 67 were on OHAs only and 7 were taking OHAs+Insulins. Worst Pre-Education perceptions were about: feeling fault of self (in the sense of inability to control diabetes), feeling that insulin therapy means that disease has become much worse. Younger patients and better educated patients had better perceptions about insulin therapy. There was significant Post-Education improvement was found in perception, across all four groups. Conclusion: This Study could identify the worst perception problems for initiation of insulin therapy in patients of type-2 diabetes. A structured 'Diabetes Education Program was highly effective in improving patients' perception about insulin therapy. Patient's education level and availability of 'Diabetes Education Program' were the two most important factors in determining the level of perception of insulin therapy in serving soldiers & their families.

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Context: The study was carried out to ascertain the effectiveness of peer-assisted learning (PAL) as compared to teacher-assisted learning. Aims: The aim of this study is to determine the efficacy of PAL for the first MBBS students. Settings and Design: A retrospective analytical study on medical education was conducted at a medical college in North India. Materials and Methods: The study had two activities. In the first, six students of the same batch were randomly selected to conduct a peer-guided symposium. A total of 83 students participated in this activity as experimental group. For the second activity, 54 students participated as a control group for a tutorial class conducted by two faculty members. In both activities, a questionnaire pertaining to the topic was given before and after the activity, and scores obtained were taken as pre- and post-activity scores, respectively. Change in performance, understanding, and knowledge was assessed. Statistical Analysis Used: Pre- and post-activity scores were compared using t-test. Mann–Whitney U-test was used to determine which activity was better. Results: Both activities showed a significant improvement in postactivity scores (P < 0.001) indicating that both activities are comparable and effective; however, improvement was better in teacher-assisted tutorial as compared to peer-assisted symposium (P < 0.001). Conclusions: Improvement in postactivity score of peer-assisted symposium showed that PAL may be implemented under the guidance of a teacher.

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Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disease with renal and extrarenal involvement. It is characterized by progressive cyst formation in both kidneys, often leading to a progressive decline in renal function due to compression of normal functioning parenchyma by enlarging cysts, with renal failure or end stage renal disease occurring in up to 70% of affected patients. Indications for surgical removal of an ADPKD kidney include intractable pain, hematuria, infection, or exceptional enlargement and small abdominal cavity hampering implantation of a donor kidney. The incidence is 1 in 500–1000, with 50% of cases progressing to end-stage renal disease by the age of 60. Renal manifestations include multiple cysts, pain, hypertension, hemorrhage, infection, and renal failure. Extrarenal involvement includes liver cysts, intracranial aneurysms, mitral valve prolapse, and colonic diverticulosis. We report a case of a huge polycystic kidney having the weight of 6.24 kg requiring nephrectomy.

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Gout is a disorder of uric acid metabolism, characterised by deposition of monosodium urate crystals in joints and periarticular soft tissues as well as renal calculi and chronic nephropathy. The accumulation of crystals in the joints and periarticular soft tissue may cause recurrent episodes inflammatory arthritis. Over the years chronic form may occur with presence of tophi and chronic arthropathy frequently in peripheral and rarely in axial joints. Surgical intervention is usually reserved for cases of recurrent attacks with deformities, severe pain and joint destructions.

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Wilson's disease (WD) or hepatolenticular degeneration is a rare genetic disorder involving excessive copper accumulation in the liver and brain. It can present with a myriad of presentations, ranging from neurological, motor, hepatic, and psychiatric. A high level of suspicion needs to exist among the mental health professional if the initial presentation is only psychiatric. We present a case of a 12-year-old male patient presenting with mood disturbances and sexual disinhibition, later diagnosed as WD.

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Electrical injuries to the eye can have diverse manifestations. However, uveal tract injuries following exposure to electric current are infrequently reported. The present case report describes pigmentary changes in both irides in a 22 year old man following electrical injury. The changes persisted during the period of follow up for six months. Vision was not affected. This case report highlights a rarely reported feature of ocular electrical injury.

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