Background: The role of ultrasound in acute viral hepatitis (AVH) is limited to exclude the surgical causes of jaundice. However, there are certain ultrasound features which can help us to suspect AVH in the initial few days before the onset of clinical jaundice. Therefore, the aim of the present study was to detect the changes in the hepatobiliary system on ultrasound in the cases of AVH and to find the significance of these ultrasound findings by comparing them with controls. Materials and Methods: All serologically proven cases of enterically transmitted cases of AVH formed the study group and all healthy patients with clinical diagnosis of lower urinary tract symptoms who had no hepatobiliary disease were taken as controls. Results: Out of 120 cases, 102 cases were male and 18 cases were female. Maximum number of cases 54 (45%) were seen in 21–30 followed by 24 cases (20%) in the age group of 31–40 years. Hepatomegaly was seen in 104 (86.6%) of cases and 38 (25.3%) of controls (P < 0.01). Gall bladder (GB) wall thickening was seen in 91 (75.8%) of cases and 22 (14.6%) controls Contracted GB was seen in 75 (62.5%) cases of AVH and 16 (10.6%) of controls (P < 0.01). Porta nodes were seen in 72 (60%) cases and 15 (10%) controls (P < 0.01). Splenomegaly was seen in 33 (27.5%) of cases and 24 (16%) of controls. Periportal cuffing was seen in 28 (23.3%) of cases and 24 (16%) of controls. Conclusion: The ultrasound findings of hepatomegaly, enlarged porta hepatis nodes, contracted gallbladder and GB wall thickening are significant suggesting a role of ultrasound in the early diagnosis of acute viral hepatitis.

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Klippel–Trenaunay–Weber syndrome (KTWS) is a rare congenital malformation, characterized by constellation of arteriovenous malformation, cutaneous capillary malformation, and skeletal or soft-tissue hypertrophy. The exact cause of KTWS is unknown. We present a case of a 1 ½-year-old boy with multiple swellings over the right lower extremity since birth which increased in size in proportion to his general growth. He was diagnosed clinically as Klippel–Trenaunay syndrome (KTS) which on Doppler imaging and on histopathology showed the presence of a multichanneled slow-flowing arteriovenous malformation. KTWS should be distinguished from KTS since clinical features, management, and prognosis of these two entities are distinctly different. Although the diagnosis is primarily clinical, confirmation requires laboratory and imaging studies. The present case is being reported as an interesting case which highlights the fact that distinction between KTWS and KTS may sometimes be difficult.

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Giant inguinal hernia is a very rare event nowadays and occurs after years of neglect. We reported an unusual case of an elderly man with a giant left-sided inguinoscrotal mass containing not only the urinary bladder but also the small bowel loops and the omentum. We managed the hernia just by inguinal incision with extension to the internal ring, using the combined Bassini and Lichtenstein hernioplasty technique. As the hernia was giant and contained the major part of the bowels and the urinary bladder, we considered the risks of various hernia repairs and conducted combined Bassini and Lichtenstein technique to repair the posterior wall of the inguinal canal due to higher stability. After performing this method, the patient had a satisfactory postoperative status and we did not observe any specific problems or complications. Lichtenstein method has been approved to be a safe and efficient method to repair the hernia and is extensively used by surgeons. We suggest combined Bassini and Lichtenstein method in giant inguinoscrotal hernias, especially in those with great adhesions. However, we recommend further studies to compare this method with other techniques.

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A 5-year-old girl presented with abdominal pain, dysphagia, respiratory distress, and fever for the past 3 weeks. The pain was dull in character; present in the epigastrium and right hypochondrium. The patient was unable to swallow solid food and there was difficulty in swallowing even semi-solids and liquids. On examination, there was decreased air entry on the right side with epigastric tenderness. The radiological evaluation suggested caudate lobe liver abscess in close relation with abdominal esophagus resulting in mild compression at gastro-esophageal junction. Pleural effusion on the right side was drained. Broad-spectrum antibiotics including amoebicidal therapy resulted in the dissolution of symptoms and rapid recovery. Caudate lobe liver abscess may result in dysphagia (as its unusual complication) due to inflammation and extraluminal compression at gastro-esophageal junction.

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Introduction: TA scope is an indirect optical video laryngoscope (VL) which provides a better glottic view without manipulating all three airway axis. Cuff inflation in nasal tube (NT) makes tube midline and good alignment with glottic opening. Aim: This study aims to evaluate the success rate of nasal intubation with cuff inflation technique through VL. Methods: A total of 50 patients posted for oral cancer surgery were included. After general anesthesia induction, NT passed up to oropharynx; with VL NT cuff inflation with 15 ml of air done in Group I and no cuff inflation in Group D. NT was advanced to vocal cords, cuff was deflated; the NT was then advanced into the trachea, and then cuff was reinflated (M0). If this failed, cuff inflation was further inflated 5 cc more (M1) or counterclockwise 180° rotation (M3) or help of Magill's forceps (M3) was used. Results: NT tip locations were midline in 88% after cuff inflation. The duration of intubation was earlier in inflated group (32 ± 18 s vs. 44 ± 20 s). Additional maneuvers such as more 5 cc air or Magill forceps were more in Group D (52% vs. 22% P = 0.25). First trail intubation success without any maneuvers was 48% in Group I and 12% Group D (P = 0.006). Counterclockwise 180° endotracheal tube rotation (M2) was useful to pass NT to VC in 32%, 48% Group I and D, respectively (P = 0.25). Air required for cuff inflation was 16.57 ± 2.65 ml in Group I. Conclusion: Cuff inflation technique has a good success rate with minimum additional assistance in video laryngoscopic nasal intubation.

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Antidepressants can be classified into 13 different classes based on their pharmacological mechanisms of action. As of this present moment, 11 out of these 13 classes of antidepressants accomplish their pharmacoactivities by blocking one or more of the reuptake transporter pumps and/or receptors for the three monoaminergic neurotransmitters, namely serotonin, norepinephrine, and dopamine. The 12^th class inhibits the enzyme monoamine oxidase, while the 13^th class works by blocking the N-methyl-D-aspartate (NMDA)-glutamatergic ionoceptor. Previous experimental results suggest that depression is associated with hyperfunction of NMDA-glutamatergic receptors (NMDARs) in the subcortical regions (i.e., hippocampus, locus coeruleus, and amygdala); whereas at the same time, there is hypofunction of NMDARs in the cortical regions (i.e., prefrontal, perirhinal, and temporal cortices). Moreover, this finding has led to a conclusion that postulates the new “Glutamatergic hypothesis of depression” which is now moving our understanding of the pathophysiology of major depression disorder (MDD), a step further from the several decades' old “Monoaminergic theory of depression.” Collectively, clinical data suggest the involvement of the glutamatergic neurotransmission system in the pathophysiology of MDD or bipolar depression or schizoaffective depression, which includes disruptions in glutamatergic substrate concentrations and NMDAR alterations. Although the role of glutamatergic systems is yet to be fully elucidated, a “proof of concept” clinical study reported that the noncompetitive NMDAR antagonist ketamine produced rapid-onset and prolonged antidepressant effects in patients suffering from MDD or bipolar depression or schizoaffective depression. Still, this has generated tremendous interest in developing new drugs that will target the glutamatergic neurotransmission mechanisms for the treatment of MDD or bipolar depression or schizoaffective depression. These potential drug targets are the NMDAR as antagonist or inverse agonist or partial agonist, metabotropic glutamatergic receptors as positive or negative modulator, excitatory amino acid transporter-2 (EAAT-2) as a reuptake enhancer, and as a terminal presynaptic glutamate release inhibitor.

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Oromandibular dystonia (OMD) is a chronic, disabling focal dystonia involving masticatory, facial, pharyngeal, lingual, and lip muscles. OMD interferes with normal orofacial functions, such as deglutition and speech leading to impaired quality of life. Cosmetic disfiguration and social embarrassment faced by these patients owing to the perturbing nature of movements leads to anxiety, depression and social isolation. There are very few reported cases of OMD in Indian literature as the disorders are often misdiagnosed. We present two cases of OMD who were initially misdiagnosed but later responded well to appropriate therapy. A comprehensive evaluation and a holistic approach are crucial for the prompt management of OMD.

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Transversus abdominis plane (TAP) block is relatively newer method for the management of postoperative pain after abdominal surgery in pediatric patients. Although there is emerging evidence proving the safety and efficacy of TAP blocks, there is limited literature on use of TAP catheters in pediatric patients. This technique involves the injection of local anesthetics into the plane between the internal oblique and transversus abdominis muscle and thus giving pain relief. The technique when performed under ultrasound guidance or under vision after dissection of the plane between two muscles is most effective and safe. This helps in significant reduction in the analgesic requirement postoperatively and hence the side effects with their use. We report successful pain management postoperatively in three pediatric patients, in whom neuraxial block was contraindicated.

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Congenital cystic adenomatous malformation (CCAM) is a rare developmental abnormality of the lung occurring in 1–35,000 live births. In most cases, the outcome of a fetus with CCAM is very good whereas in some cases, it can be life-threatening. It is usually discovered in neonates because of respiratory distress. Spontaneous resolution of CCAM has been reported as rare. We report a case of spontaneous resolution of CCAM in a 21-day-old-female baby with respiratory distress and chest X-ray suggestive of multicystic lesion of the left lung.

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Introduction: Neck pain is a frequent complaint of the era. The muscles around the neck tend to get shorter, leading to restricted neck mobility. There are not much data about the effectiveness of deep friction massage in comparison with static stretching for reducing nonspecific neck pain. Purpose: The purpose was to find out whether these two interventions gave similar results and if one method is better to the other which could be the substitute of remedy. Study Design: This study was based a randomized control trial. Place of Study: This study was conducted at the Department of Physical Therapy, Mayo Hospital Lahore. Materials and Methods: Fifty-six patients with nonspecific neck pain were randomly located to have static stretching (Group A, n = 28) and deep friction massage (Group B, n = 28). Group A received six sessions of static stretching during 3 weeks (two sessions per week), whereas Group B received six sessions of deep friction massage during 3 weeks (two sessions per week). Results: Paired sample t-test was used. Statistically significant improvement was observed in both the groups in improving pain, Neck Disability Index (NDI), and range of motion (P > 0.05). No difference was found between the deep friction massage and static stretching in improving pain and range of motion. However, deep friction massage shows superior effects in NDI (P > 0.05). Conclusion: Deep friction massage and static stretching are equally effective in reducing the nonspecific neck pain in terms of alleviating pain and improving ranges of neck movement. However, deep friction massage shows superior effects in NDI.

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Background: Stress-related diseases are becoming the number one killer in the modern age. Aims: The aim of the study is to identify the effects of yoga on cardiorespiratory profile and stress levels of young adult Indian males residing in West Bengal. Materials and Methods: This cross-sectional pilot project was conducted after taking institutional ethical clearance and informed consent of the participants. Hundred healthy young adult Indian males in the age group of 18–30 years performing yoga regularly were selected as study population, and hundred age- and sex-matched participants from local population not performing any type of yoga were selected as control. Life event stress and perceived stress scores of the participants were measured using presumptive life event stress scale and perceived stress scale (PSS), respectively. Fasting blood sugar (FBS) and lipid profile were analyzed. Anthropometric measurements, resting pulse rate, blood pressure, electrocardiogram, and pulmonary function test were recorded. Unpaired t-test was used to analyze the data. Results: Weight, waist–hip ratio, and body mass index were significantly raised in participants not practicing yoga. Resting pulse rate, systolic blood pressure, and diastolic blood pressure were significantly lower in participants practicing yoga. PSS scores were significantly less in participants practicing yoga. FBS, total cholesterol, triglyceride, and low-density lipoprotein level in serum were significantly lower in participants practicing yoga, and high-density lipoprotein value was significantly raised. Duration of QRS complex, P-R interval, Q-T interval, and R-R interval were significantly raised in participants practicing yoga. The amplitude of T-wave and amplitude of S-T segment were significantly lowered in participants practicing yoga. Forced expiratory volume in 1 s and forced vital capacity values were found to be significantly raised in participants practicing yoga. Conclusions: Perceived stress adversely affects cardiovascular and respiratory profile of healthy young adult males, and regular practice of yoga may decrease perceived stress levels and help in modulating cardiorespiratory profile.

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Objectives: The objective of this study is to compare the Vitamin D₃ level in obese children in a tertiary care center in Jammu (Jammu and Kashmir), India, and to find the association between Vitamin D₃ levels and the comorbidities of obesity. Materials and Methods: Twenty obese children and 20 controls were included in the study group. Obesity defined by international obesity task force (criteria) Questionnaires Form and anthropomorphic data were collected on patients, and fasting blood glucose, lipids, liver function tests, renal function test and 25-hydroxyvitamin D (25-OHD) were measured. Results: The levels of 25-OHD in the obese group were significantly lower than those of the control group (χ = 0.000). About 80% of obese children and 10% of controls were Vitamin D deficient; similarly, 20% of obese children and 35% of controls had Vitamin D insufficiency. There was no statistical significant difference of mean serum Vitamin D level between male and female children in both cases and controls. Calorie intake (P = 0.11), serum cholesterol, and triglycerides were significantly raised among the obese group with the mean (152.70 ± 18.85) than in the control group (134.65 ± 15.27) (P = 0.002). There was no significant association of 25 (OH) Vitamin D₃ level with the other comorbidities of obesity such as deranged blood sugar, liver function tests, and lipid profile. Conclusion: Vitamin D deficiency is significantly more prevalent in obese children and showed a linear relationship, but we were unable to find any significant statistical association between 25 (OH) Vitamin D₃ levels with the comorbidities of obesity.

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Introduction: Various media are reporting that violence against doctors in country is increasing. Due to this, doctors are stressed out in their profession. The present study was conducted with objectives to find out the prevalence of verbal and physical violence against doctors and to identify the perceived aggravating factors associated with workplace violence. Materials and Methods: It was a cross-sectional study. A total of 117 doctors participated in the study from different cities of Gujarat. The study was conducted in the year 2017. Results: The mean age of the study participants was 44.11 ± 11.77 years. Ninety-eight (83.8%) participants were male and 19 (16.2%) were female. One hundred and ten (94.02%) study participants believed that violence against health-care staff is a serious issue in the current scenario. More than two-third (89.74%) of the participants perceived increases in violence in the past few decades. Sixty-five (55.56%) study participants had experienced verbal violence. Five (4.27%) study participants had experienced physical violence. One hundred and eleven (94.87%) study participants believed that hospital securities are given less importance. Almost all the (93.16%) study participants assumed that violence occurs due to absence of law. Conclusion: The study concludes that violence on doctors' has increased in the last few years in India. Verbal violence was experienced by more than 50% of the participants. The common determinants of violence against doctor were poor hospital security, absence of proper law, unrealistic expectation from patients and relatives, overburdened hospital, low literacy, and poor communication skills among doctors.

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