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Introduction: Hospital-acquired infections complicate 7%–10% of hospital admissions. Patients in the Intensive Care Units (ICUs) are more likely to be colonized or infected. Most of these infections are spread by carriage of microorganisms on the health-care workers' (HCW) hands. Hand hygiene (HH) is the single most important measure to prevent this. Despite relative simplicity of HH procedures and recommendations, compliance with HH is still poor. Aim and Objectives: To assess HH compliance among health-care personnel in the ICU of Ram Manohar Lohia Institute of Medical Sciences, Lucknow. Materials and Methods: A prospective cross-sectional observational study using direct observation technique was done. A single observer collected all HH data. A survey was done, before the study, pertaining to perception and knowledge, opportunities, steps, actions, and attitude toward HH. The nursing staff, doctors, and allied health-care personnel were taken as a sample size. The observations were noted for all five moments of HH before and after patient contact. Results: A total of 10 HCW were observed over 50 h of observation period, spread over 1 month, which created 535 HH opportunities. HH actions actually performed by the HCW were 498, and overall compliance of the study group was 93.1%. Conclusion: The average level of compliance with recommended HH techniques among health-care personnel was 93.1% which is appropriate for critical care areas.

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Cutis verticis gyrata (CVG) is a rare disease manifesting as convoluted folds and furrows, resembling sulci and gyri formed from thickened skin of the scalp. It can be congenital or acquired and primary or secondary. We report a rare case of 28-year-old male with a localized variant of primary essential CVG.

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Ectopic or accessory breast tissue may occur anywhere along the milk line or mammary ridge extending from axilla to groin. The most common location of the ectopic breast is axilla. This article reviews a case of 35-year-old female patient who presented to our hospital with left axillary lump. Mammography and ultrasonography were performed. Imaging findings were further confirmed with fine-needle aspiration cytology revealing left axillary galactocele.

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The purpose of this article is to review the anatomy and magnetic resonance imaging appearances of all the structures which are noted in the posterolateral corner of the knee. These structures may not be commonly heard of but play a crucial role in providing the required stability and force to the knee joint. We hope that by putting light on this less explored part of the knee this article will be useful to many practicing clinicians and operating orthopedicians.

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In spite of significant control of Malaria, vector control measures have been facing setbacks. The dependence on chemical insecticides and development of vector resistance against them is an important factor. Problems have been compounded by re-emergence of other mosquito borne diseases. With the development of resistance to chemical insecticides and possible health impacts of its widespread use, some innovative means of mosquito control has become the need of the hour. The present paper presents an innovative concept for mosquito control based on mosquito bionomics.

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Introduction: Handwashing reduces the risk of transmission of infection; greater emphases are often placed on the practices of doctors and nurses; however, activities of other staffs such as laboratory and ward attendants influence treatment outcome; therefore, this study seeks to determine the hand hygiene practices among laboratory and ward attendants in a federal health institution. Materials and Methods: This was a cross-sectional descriptive study involving laboratory and ward attendants and clinical assistants. Participants were selected by convenience sampling and data were collected using pretested questionnaire. Result: Forty-five respondents were involved in this study. All the respondents (100%) who are aware of handwashing can reduce the risk of acquiring or transmitting infection. Most (84.4%) respondents could not correctly mention the steps in handwashing, “my five-moments in handwashing,” and the date of the Global Handwashing Day. Almost all the respondents (97.8%) washed their hands with water and soap at most times and only one (2.2%) used water only for handwashing. Only 9 (20.0%) of the respondents wash their hands before touching patients, while all respondents wash their hands after touching patients. Similarly, 44 (97.8%) of the respondents wash their hands after handling patient materials. All of the respondents (100%) reported washing their hands after using the restroom. Conclusion: The study showed that although most of the respondents wash their hands with soap and water, they do not know the steps in handwashing, suggesting the need for health education on the steps and procedures for handwashing.

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The primary as well as metastatic tumours of the skin can be diagnosed by fine-needle aspiration cytology (FNAC) because of its easy accessibility; however, the cytomorphological features of skin adnexal tumours are rarely described in literature. A young male presented with solitary subcutaneous nodule over gluteal region measuring 3 cm in diameter for 2 years. FNAC was done and showed an overcrowded cluster of basaloid to polyhedral cells intermingled with hyaline material and foamy macrophages. Few squamous cells were also seen along with foci of calcification. A cytological diagnosis of adnexal tumor, possibly of eccrine origin was given. The excised nodule was received for histopathological examination, and a final diagnosis of nodular cystic hidradenoma was made. Hence, awareness of cytological features by FNAC of skin adnexal tumors is important to prevent misdiagnosis.

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Genital self-mutilation is reported in the context of various psychiatric illnesses ranging from neurotic spectrum disorders to psychotic spectrum disorders, including personality disorders. The term Klingsor syndrome is used to describe penile self-mutilation, mostly in the context of religious delusions. We highlight here a case of penile self-mutilation in the context of religious overvalued idea and dysthymia. The psychodynamics of penile self-mutilation is discussed along with review of literature.

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Neurodegeneration with brain iron accumulation (Hallervorden-Spatz Disease) is a rare, slowly progressing disorder characterized by progressive extrapyramidal dysfunction resulting in dementia, dystonia, torticollis, ataxia, kyphoscoliosis, and seizures. In chronic cases, muscle contractures, bony changes, temporomandibular joint, and cervical spine immobility may occur. Due to chronic malnutrition, there is increased the tendency for pathological fractures. Any noxious stimulus (anxiety, pain, light plane of anesthesia) intensifies dystonia. Significant speech disturbances, confusion, disorientation, mental retardation, dementia, and visual loss make communication with these patients a problem. Managing anesthesia in such patients is quite challenging as there is difficulty in positioning, intravenous cannulation, and airway management. We present a case report of a 14-year-old male patient with neurodegeneration with brain iron accumulation who was administered anesthesia for the stem-cell therapy.

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Synovial chondromatosis is a rare benign condition arising from the synovial membrane of the joints, synovial sheaths, or bursae around the joints. Primary synovial chondromatosis typically affects the large joints in the third to fifth decade of life. The purpose of this case report is to document this rare giant synovial pathology, which was mimicking malignancy clinically but diagnosed as intra-articular synovial chondromatosis histopathologically. In our case, the gross size was measuring 11 cm × 8 cm × 6 cm.

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Gonadoblastomas are rare gonadal tumors, arising from a dysgenetic gonad with a Y chromosome. These tumors may manifest as dysgerminomas and if not appropriately managed can lead to disastrous consequences. 24 year female reported with lump in abdomen and abdominal pain on and off since 6 months and primary amenorrhoea. She underwent laparotomy with removal of an abdominal mass at a hospital 2 years back for similar complaints. Histopathology report of the mass read 'Dysgerminoma/Seminoma with both male and female elements'. Thereafter, patient was referred to a higher oncology centre for further management. 2 years hence she reported to us without any follow up in oncology centre as advised. On clinical and CT examination a diagnosis of recurrent tumor mass was made. Laparotomy revealed a non-resectable mass, whose biopsy report was Dysgerminoma. Patient was put on BEP regime. Second look laparotomy showed a significantly regressed necrotic mass with no evidence of residual malignancy. Till date she has shown no sign of recurrence of disease. Patients with dysgenetic gonads should be investigated judiciously and appropriately managed.

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Background: Alcoholic liver disease (ALD) is the most common liver disease in India, caused by excessive intake of alcohol even though being a preventable disease. The three principal types of ALD are fatty liver, alcoholic hepatitis, and cirrhosis. Objectives: Study of clinical presentation, laboratory parameters, abdominal sonographic and upper gastrointestinal endoscopic findings, and complications in patients of ALD in Sikkim. Methods: Descriptive observational hospital-based study was carried on 100 ALD patients admitted in Department of General Medicine in a teaching hospital of Sikkim, who fulfilled the inclusion criteria. Data were tabulated and analyzed using IBM-SPSS statistics version 22 software. Results: The mean age was 48 years with majority being males (84%), occupied in unskilled work (67%), with lower education level (52%), and belonging to middle socioeconomic status (56%). The average intake of alcohol by males was 63 g/day, and in females, it was 40 g/day with average duration of alcohol intake being 16 years. Most common presenting features were nausea (90%), jaundice (67%), and anorexia (64%). The mean total bilirubin (mg/dL), aspartate aminotransferase (IU/L), alanine aminotransferase (IU/L), serum albumin (g/dL), and prothrombin time difference (seconds) were 4.74, 110.2, 59.1, 3.4, and 4.1. Abdominal sonography revealed ascites (53%) and cirrhosis (43%), and upper gastrointestinal endoscopy revealed varices (52%) as common finding. The most common complications were gastrointestinal bleeding (54%) and portal hypertension (51%). Conclusions: Due to high mortality and morbidity associated with this preventable liver disease along with a multidisciplinary approach to tackle this alcohol menace, a sound regional knowledge of clinical presentation and workup findings can help in effective treatment strategies of the same.

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Pregnancy in the rudimentary horn of a unicornuate uterus is extremely rare and usual fate is rupture in the second trimester. We have reported this case due to rarity of rupture of rudimentary horn in the third trimester initially misdiagnosed as cesarean scar rupture. A 27-year-old G2P1 L1 with previous lower segment cesarean section presented at 33-week gestation with pain abdomen and syncopal attack with hemodynamic instability. The abdomen was distended and tender, uterine contour could not be made out, fetal parts were felt superficially, and fetal heart sound was absent. On vaginal examination, os was closed, bleeding was absent, and presenting part of the fetus was high up. A provisional diagnosis of cesarean scar rupture was made, and the patient was taken up for emergency laparotomy with simultaneous resuscitation. Intraoperatively, a left-sided ruptured rudimentary horn pregnancy and a unicornuate uterus with an intact lower segment transverse scar were found, a 1.5-kg macerated stillborn fetus was lying in the peritoneal cavity, and approximately two litres of hemoperitoneum was present. Excision of the rudimentary horn with ipsilateral salpingectomy was performed. High index of suspicion for uterine malformation is required for cases with a previous history of cesarean section for malpresentation. Moreover, catastrophic hemorrhage consequent to ruptured horn pregnancy can be avoided by excision of the rudimentary horn encountered incidentally.

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Tubular adenoma of breast is a rare benign pure epithelial tumor, which presents as a palpable mass. Clinical examination and imaging modalities are similar to that seen in a case of fibroadenoma. In such a situation, fine-needle aspiration can be a useful diagnostic tool. However, the cytopathologist has to be aware of the subtle cytology traits of tubular adenoma to make an informed assessment. We discuss a case diagnosed preoperatively as a case of tubular adenoma with histopathological confirmation.

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Inguinal hernia repair is one of the most common operations performed in worldwide. The success of the hernia repair is judged mainly by the recurrence rate after following the operation. Different techniques have different recurrence rates. Open hernia repairs have recurrence rate between 10% and 30%. Lichtenstein's tension-free open hernia repair heralded a new era the reported recurrence after this repair in around 0%–1.7%.

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Rhabdomyosarcoma (RMS) is the most common soft-tissue sarcoma in children and frequently involves the head and neck region with 10% of the cases primarily involving the orbit. It is a highly malignant tumor which can be life-threatening. It usually produces a precipitously progressing unilateral proptosis of sudden onset. Computed tomography and magnetic resonance imaging are important in the evaluation of this tumor. Histologically, embryonal subtype is most common in children. Complete resection followed by chemotherapy and radiotherapy is the preferred treatment of choice. We are reporting here a case of the embryonal RMS of orbit presenting with rapid proptosis of the right eye in a 14-month-old male child.

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Mucinous carcinoma (MC) of the breast is a rare, malignant tumor accounting for 2% of all breast cancers with better prognosis, usually seen in postmenopausal women with only 0%–4% lymph node metastasis. Cytologic findings of MC overlap with other benign and malignant breast lesions making the cytodiagnosis challenging. Here, we report two cases of MC of the breast in reproductive age females and one case showed axillary lymph node metastasis. A 30-year-old female presented with firm, nontender lump in the right breast of 8 months' duration, measured 3 cm × 2 cm with palpable right axillary lymph nodes. A 28-year-old female presented with firm, nontender lump in the left breast of 7 months' duration, measured 6 cm × 5 cm. Cytologically, one case diagnosed as MC with lymph node metastasis and other case reported as MC; subsequently, both cases confirmed by histopathology, thus highlighting the role of fine-needle aspiration cytology in diagnosis of MC.

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Pulmonary arteriovenous malformation (PAVM) is a rare vascular anomaly, in which there is direct connection between branches of the pulmonary artery and pulmonary vein, therefore, bypassing the capillaries; this may remain asymptomatic. However, in severe cases, patients may manifest with cyanosis and high-output heart failure. Furthermore, they stand the risk of stroke and cerebral abscess. This remains a diagnostic challenge in childhood because most patients present in adulthood; therefore, it is easily overlooked. Furthermore, limited diagnostic facilities in resource-limited setting make proper evaluation a constraint. Therefore, the case of a 2-month-old boy, who presented with PAVM early in life and was wrongly treated for chest infection, is reported. The diagnosis in the index case was established using contrast-enhanced computerized tomography of the chest.

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Background: Echocardiographic abnormalities in patients with human immunodeficiency virus (HIV) infection have been well documented. However, their relation with CD4 count and reversibility with treatment has not been studied prospectively. We studied prevalence and nature of echocardiographic abnormalities in HIV-infected patients and prospectively correlated with their CD4 count. Materials and Methods: We studied 108 consecutive patients with HIV infection. Baseline CD4 cell count and two-dimensional echocardiography were done. The study participants were categorized into two; one with CD4 count <100/mm³ and the other with CD4 >100/mm³. They were followed up quarterly with CD4 count and repeat echocardiography for 1 year. Results: Abnormalities on echocardiography were noted in 36 of 108 patients (33.3%). Thirty-two patients (29.6%) were detected to have diastolic dysfunction of the left ventricle, ten patients (9.25%) left ventricular (LV) systolic dysfunction and eight patients (7.4%) pericardial effusion. Abnormalities were more frequent when CD4 was <100/c.mm. LV systolic dysfunction (and dilated cardiomyopathy) occurred exclusively in patients with CD4 <100/c.mm. As the CD4 count improved with treatment, many of the echocardiographic changes reversed. Conclusions: HIV-infected individuals frequently have asymptomatic and subclinical cardiac involvement. LV diastolic dysfunction, systolic dysfunction, and pericardial effusion are more common with lower CD4 cell count. With treatment, as the CD4 count improved, there was reversibility of systolic dysfunction, diastolic dysfunction, and pericardial effusion.

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