Introduction: Scrub typhus is a mite-borne bacterial infection of humans caused by Orientia tsutsugamushi that presents with prolonged fever unless suspected early. The aim of this study was to characterize the epidemiological factors and clinical clues in this region for early diagnosis. Materials and Methods: This study was a retrospective, observational study conducted in all diagnosed scrub typhus cases admitted to the pediatric ward of a tertiary care hospital in-between January 1, 2015 and December 31, 2016. One hundred and one patients admitted with IgM positive for scrub typhus over 2-year period were analyzed for the epidemiological factors and clinical features. Results: Male:female ratio is 1.4:1. The mean age of the patients in our cohort was 4.83 years, ranging from 0.25 to 14 years. Majority (79.2%) was from the rural area. Fever was present in all cases and about 81.19% of children presented with fever for >7 days. Other findings were hepatosplenomegaly (55.45%), respiratory problems (47.54%), abdominal symptoms (40.59%), eschar (26.74%), rashes (15.84%), altered behavior (9.9%) and lymphadenopathy (2.97%) of cases studied. Thrombocytopenia, elevated liver enzymes, and raised C-reactive protein (CRP) were found characteristically. Defervescence after starting doxycycline was within 3.26 ± 2.26 days. Conclusions: Scrub typhus can present in various ways but mostly with prolonged fever. Hepatosplenomegaly, eschar, third spacing, raised CRP, and thrombocytopenia are important clues for early clinical diagnosis. Increased awareness and heightened suspicion, especially in the light of increasing number of patients are required for timely treatment and prevention of complications.

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Aims and Objectives: The aim was to study the demographic pattern, clinical features, management, and prognosis of the patients with firecracker-related ocular injuries during Diwali. Materials and Methods: This institution-based prospective study was done in 30 patients who attended eye emergency and outpatient department (OPD) of Calcutta National Medical College and Hospital, West Bengal, during the period of 1 week of Diwali in 2016 and 2017. The parameters studied were the age and sex of the patients, type of firework (crackers and sparklers), eye involved, severity of injury with respect to active and passive participants, management, severity of injury, and visual outcome with respect to type of firecrackers. Results: A total of 30 patients attended eye OPD and emergency during our study period, of which 23 (76.7%) were male and 7 (23.3%) were female. All of them were in the pediatric age group (1–15). All patients were examined on the day of injury. Patients between 6 and 10 years of age were most commonly affected. Four cases (13.3%) were open-globe injuries and 26 (86.7%) cases were closed-globe injuries. Visual acuity varied from 6/9 to no perception of light. The most common firework involved was the crackers. Conclusions: Careless and indiscriminate use of firecrackers may sometimes lead to serious ocular damage. In India, use of fireworks is quite common during various festivals, particularly during Diwali, thus fireworks-related ocular injuries are important causes of blindness. This prospective study revealed the presentation and outcome of ocular injuries due to firecrackers in this area of mixed culture during this festive week.

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Background: The global burden of hepatitis (inflammation of the liver) infection is still a major public health challenge and burden in the 21^st century, especially in endemic regions due to unavailability of early diagnostic techniques and treatments. The presence of chronic or fulminant hepatitis B virus (HBV) and/or hepatitis C virus (HCV) infection(s) had caused extensive and irreversible liver damage in different population groups from different parts of the world today, including Nigeria. Aim: The aim of this study was to determine the seropositivity prevalence rates of HBV and HCV infections among pregnant women attending antenatal clinic at the State Specialist Hospital Akure, Ondo State, Nigeria. Materials and Methods: A review of hematological data was done for a period of 1 year which spanned from May 2015 to April 2016. During this period, pregnant women were recruited prospectively from the antenatal clinic and screened for HBV and HCV infections. The evaluation includes risk factor assessment based on age group and determination of rapid serology for hepatitis B surface antigen (HBsAg) and hepatitis C antibodies. Results: The results from our study revealed that out of the 1758 pregnant women recruited and screened, 1.47% and 0.00% within the age range of 25–29 years were positive to HBsAg and HCV, respectively. Conclusion: In conclusion, the 4.2% overall prevalence rate obtained for HBsAg-positive women fell within the reference range for the general population in Nigeria (2.4%–18.4%). The observed overall prevalence value for HBsAg positive women also fell within the 2%–7% reference range for South-Western region geographical prevalence category for Nigeria which showed an intermediate endemic rate within the age range of 25–39 years. The prevalence outcome of this study is an alert threshold attributed to endemic sexual activity of this age range (25–39 years) and prevailing epidemic factors for HBV transmission among reproductive age group.

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Glioblastoma multiforme (GBM) is the second-most common central nervous system cancer after meningiomas. GBM is sporadic and is slightly more common in men than women over 50 years of age whereas, females were predominant in the present case series. All patients presented with symptoms of headache, drowsiness, nausea, and personality changes. On ophthalmic examination, all of them had papilledema. On subsequent brain imagining, there were space-occupying lesions and all were confirmed GBM after histopathological examination of the tumor. Neuroimaging is the gold standard of investigations for GBM and diagnosis is confirmed by tissue biopsy.

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Background: On March 27, 2014, the Regional Certification Commission of the World Health Organization certified South-East Asian Region, which includes India, as polio free. Since then, as part of Polio Endgame Strategy, high-quality national and sub-national polio rounds are being conducted to maintain herd immunity through each year. With years of no fresh cases of polio, several sections in the community have raised doubts over the continuation of the Intensified Pulse Polio Immunization (IPPI) program in postcertification era. Thus, this study with mixed method approach was aimed at assessing the community perceptions toward IPPI using quantitative approach and stakeholder's perception using qualitative approach in a high-risk area of Kolkata. Methods: This cross-sectional study was conducted over a period of 2 months from March to April 2018 in Southern part of Kolkata which involved surveying 104 randomly selected households followed by key informant interviews with community influencers. Pearson's Chi-square test was performed to determine the association between categorical variables. SPSS v. 16.0 software was used for analysis. Results: Inadequate knowledge (32%) and unfavorable attitude (45%) regarding IPPI were observed among the interviewed respondents. Safety concern (5.7%), spouse/elderly pressure (4.8%), and sterility issues (1.9%) were identified as prominent barriers resulting in hesitancy (16.2%) during IPPI. Statistically significant association of respondent's attitude was observed between gender, religion, and education. Conclusion: Social behavior change communication involving community and community influencers would help to overcome the barriers to IPPI coverage and thus to mitigate the risk of re-emergence of polio in future.

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Background: An adverse drug reaction (ADR) is a special form of adverse drug event (ADE) in which a causative relationship can be shown or established and is attributable to the offending/precipitating medication. ADR causality assessment is used to determine the likelihood that a particular drug caused a suspected ADR. Causality assessment rating evaluates the relationship between drug treatment and the occurrence of an ADE. It is also used to evaluate, check, confirm, and ascertain that the particular treatment is the cause of an observed adverse event or not. Aim: This study was designed to evaluate the causality assessment rating, mortality rate, and case fatality rate for ADRs among adult medical inpatients in clinical practice setting with the goal of preventing them and improving their treatment outcome. Methods: The patients admitted to the adult medical wards of a Nigerian University Teaching Hospital over 9 months from December 2013 to August 2014 were prospectively recruited for the study and followed up till discharge. Results: Five hundred and seven patients were evaluated during the study, of which 269 (53.1%) of them were male and 238 (46.9%) were female. The mean age of the study population was 48.9 ± 17.8 years (median of 46 years). In this study, the causality assessment rating for the observed ADRs was evaluated using both the World Health Organization (WHO) causality rating criteria and the Naranjo algorithm. Using the WHO causality rating criteria, certain cases were 10 (19.6%), probable cases were 17 (33.3%), and possible cases were 24 (47.1%). Using the Naranjo algorithm, definite cases were 9 (17.6%), probable cases were 19 (37.3%), and possible cases were 23 (45.1%). The number of patients admitted solely because of ADRs (ADR-out) was 18 (3.6%) patients, whereas those that experienced ADRs during admission (ADR-in) stood at 33 (6.5%) patients. Furthermore, the case fatality rate for ADRs was 7.8% (4/51), while the ADR-associated overall mortality rate was 0.8% (4/507). Conclusion: In this study, the two methods used to ascertain causality rate for ADRs caused by a suspected drug; both the WHO causality rating criteria and Naranjo algorithm, showed similar causality ratings, which strengthening the ascribed ADR causality rating. In addition, the mortality rate and case fatality rate for ADRs were significantly high among these adult medical inpatients.

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Hemoptysis is a common respiratory symptom. One of the most common cause for hemoptysis in India is pulmonary tuberculosis. Pulmonary tuberculosis is more common in young and usually present with fever, cough and hemoptysis. Chest x ray usually shows upper lobe lesions. When sputum examination for AFB smear is negative and chest radiology is not typical of tuberculosis further investigations are indicated for definitive diagnosis. We report a rare case of pleomorphic carcinoma of lung in a young female mimicking pulmonary tuberculosis. Definitive diagnosis was established by biopsy from the lung lesion.

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Temporomandibular joint (TMJ) ankylosis is commonly seen in childhood and its etiology is multifactorial. Common causes include congenital malformations, use of forceps during delivery, local or systemic infections or systemic autoimmune diseases (rheumatoid arthritis, psoriasis, and sickle cell anemia), burns, and trauma. TMJ ankylosis leads to dentofacial deformity, restricted mouth opening, malocclusion, difficulty in mastication, malnutrition, dental caries, poor oral hygiene, impaired speech, and cosmetic disability. Neglected childhood bilateral TMJ patients present in adulthood with micrognathia, retrognathia, and severe symptoms of obstructive sleep apnea (OSA). They have narrow airway passages due to pseudoglossia, subatmospheric intrapharyngeal pressure, and hypotonicity of the oropharyngeal muscles which make the mask ventilation difficult. Highlights of the management of the case include the use of the awake fiber-optic-assisted intubation, a gold standard for difficult airway management, and incorporation of Brainlab Kick navigation station 18070 (USA) aiding in the precise surgical dissection and preventing injuries to great vessels and nerves. Extubation strategy with preextubation dose of hydrocortisone and dexmedetomidine helped in the smooth recovery. Early recovery and rehabilitation were further facilitated with the use of nasal continuous positive airway pressure postextubation which helped in reducing symptoms of OSA and airway obstruction.

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Tuberculosis (TB) has been known since ancient times to affect human race and is one of the 10 most common causes of death worldwide. It primarily involves lungs but can affect almost all the parts of the body. In the head-and-neck region, it can affect meninges, orbitomaxillary complex, zygoma, mandible, oral soft tissues, and regional lymph nodes either primarily or secondarily. In jaws, it manifests as tuberculous osteomyelitis. Tuberculous osteomyelitis of mandible accounts for about <2% of all skeletal TB. We present a case report of 39-year-old female patient who had a nontender mild swelling on the left mandible for 3 years following the extraction of her lower left first molar tooth for which we performed an incisional biopsy from the corresponding alveolar bone. The histopathological examination revealed it to be tuberculous osteomyelitis. On further examination with chest X-ray and tuberculin test, it was diagnosed that the patient had chronic pulmonary TB.

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Methotrexate is the most common disease-modifying antirheumatic drug used in the treatment of rheumatoid arthritis. The side effects which are known to occur include pancytopenia, hepatic dysfunction, pulmonary toxicity, and acute renal failure. This is a case report of a patient who presented with florid manifestations of methotrexate toxicity which happened due to mistaken overdosing of methotrexate which had been prescribed to her for rheumatoid arthritis.

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We present a case of multifocal plasmacytoma, one of the rarest hematological malignancies, with an unusual presentation of cervical myelopathy. A 60-year-old male presented with features of cervicalgia and radiculomyelopathy. There was a history of significant weight loss over 2 months with no sphincter involvement. Neurological examination showed spastic quadriparesis with extensor plantars. Radiological workup showed multiple lytic lesions from C3 to C6 with cord compression and myelomalacic changes. The patient underwent three-level corpectomy (C5–C7) with cord decompression. Reconstruction was done with an expandable titanium cage, and anterior cervical plating from C4 to T1 was done. The histopathology and immunohistochemistry markers enabled in clinching this rare diagnosis of multifocal plasmacytoma. It is essential to distinguish early between various entities among plasmacytoma as each one has a different clinical course and prognosis. Multiple solitary plasmacytoma presenting de novo with cord compression and myelopathy is an extremely rare presentation.

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Context: Noncommunicable diseases (NCDs) are emerging as the major scope of death and disability worldwide, which is the result of demographic and epidemiological transition along with increase in risk factors resulting from social and economic changes. Aims: The present work was undertaken to study the prevalence of key risk factors for major NCDs in local population. Materials and Methods: This is a descriptive cross-sectional study conducted from November 2016 to April 2017 by utilizing the World Health Organization formulated STEPwise approach to Surveillance of NCD risk factors. Data were collected from 303 participants aged 25–64 years using structured data collection format which includes demographic details, physical measures, and behavioral measures. Results: The results of the present study shows that illiteracy, overweight, alcohol consumption, smoking/tobacco use, hypertension, physical inactivity, and unhealthy dietary habits are existing in the study population which acts as potential risk factors for the development of various NCDs. Conclusions: The study concludes that both behavioral and physiological risk factors for NCDs exist in the study population. The high prevalence of these risk factors predicts high chances of occurrence of NCDs such as cardiovascular diseases, cancer, and chronic respiratory diseases.

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Background: Successful outcome of concurrent chemotherapy and radiotherapy as organ-preserving protocol in the management of locally advanced laryngeal and hypopharyngeal carcinomas may be a better-accepted modality of management of patients for preservation of the unique functions of the vital organs of communication and deglutition. Aims: The aim of the study is to observe the role of concurrent chemotherapy and radiotherapy as organ-preserving protocol in the management of locally advanced laryngeal and hypopharyngeal carcinomas taking into account the status of human papillomavirus (HPV) in such cases with outcome in a population of Eastern India. Materials and Methods: This cross-sectional observational study was conducted on 73 individuals in Eastern India after taking institutional ethical clearance and informed consent of the individuals in a period of 1 year. Concurrent chemoradiation therapy (CCRT) was the primary mode of treatment. Results: About 49.3% of the patients were smokers and 53.4% were alcoholic. All the patients had squamous cell carcinoma. About 46.6% of the patients had positive HPV in tissue. About 47.9%, 34.2%, and 17.8% of the patients had complete, partial, and no response to the primary treatment after CCRT, respectively. For larynx proportion of complete response was significantly higher for HPV-positive cases (46.2%) as compared to HPV-negative case (19.2%) (P < 0.01). About 22.2% and 11.8% recurrence were found in the hypopharynx and larynx, respectively. Salvage surgery for primary site was performed for 78.4% in the hypopharynx and 56.3% for larynx. The organ was preserved for 29.8% for hypopharynx and 57.7% for larynx during the total follow-up period. Conclusions: HPV was found in tissue of laryngeal and hypopharyngeal squamous cell carcinoma. The response of advanced hypopharyngeal carcinoma to CCRT was the best mode of treatment, as far as the organ preservation was concerned, while the organ preservation rate for advanced laryngeal carcinoma treated with CCRT was found to be a better option of treatment.

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Context: Adolescent Reproductive and Sexual Health Programme has been widely conducted some time now, but it requires improvement for creating a more supportive environment, generating requisite level of awareness among adolescents, organizing better services, improving the capacity of service providers, and monitoring service provision and utilization. Aims: This study aimed to review the current implementation status of the programme in Sonitpur district of Assam and develop a proposal to improve the programme coverage. Settings and Design: Evaluation of various program indicators was carried out in the district by using secondary data available and interview of all stakeholders. Subjects and Methods: A review of the current implementation status was done by a review of programme indicators; interviewing the staff affiliated with the District Health Office and identifying geographic areas or population groups requiring a high focus. Results: There was a lack of awareness on the part of target population, inadequacy of staff especially grassroot workers, and insufficient advertisement and promotion by the authorities. Limitations of program implementation that came to light included sporadic implementation, lack of motivation at the level of staff for outreach activities to areas that do not have proper connectivity, limited information and awareness of population in certain blocks due to geographical remoteness, and lack of political will and commitment. Conclusions: Improvements in health-care facilities aimed specifically at adolescent population have been introduced relatively recently. There are barriers that hamper the implementation of programme on ground. It is important to address the limitations by better political will, intersectoral co-ordination, and interpersonal communication.

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Context: Antibiotic resistance is a major threat to global health emerging rapidly in recent years, especially in countries such as India. Aims: This study aims to study the knowledge, attitude, and practices of physicians toward this issue. Settings and Design: A cross-sectional study, over a period of 9 months, involving 100 medical officers working at primary and secondary tier hospitals in West Bengal. Subjects and Methods: A pretested, structured questionnaire with 15 items was used to collect information on knowledge, attitude, and practices. Statistical Analysis Used: Data were tabulated and analyzed. Results: About 61% had worked in infectious disease ward, 95% did not have any special training on rational antibiotic use. 84% had prescribed antibiotics more than 30 times in the past 3 months. Furthermore, 87%, 80%, and 67% reported confidence in prescribing correct type, correct dose, and correct duration of antibiotic, respectively. Previous knowledge/training and national policy/guidelines were prominent guiding factors for prescribing. 84% think antibiotic resistance is a national problem and 69% think that it exists in their hospitals. Patient push and fear of the treatment failure were the driving forces behind overprescription of antibiotics. More than half of the respondents think too many antibiotics prescribed, too long duration, too low dose, and use in livestock were the reason for the spread of antibiotic resistance. More than 50% think policy, training, monitoring, and regulation would help in combating antibiotic resistance. Conclusions: Identifying and addressing the driving forces behind the irrational use of antibiotics and bridging knowledge and attitude gap of clinicians would help combating antibiotic resistance. Appropriate policies, training, monitoring, and involving physicians as key stakeholders would be necessary for addressing the issue.

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Objective: Childhood disabilities are common and impose a significant handicap on the affected children and their caregivers. There are limited data on the prevalence of childhood disabilities as assessed by specialist evaluation. We aimed to explore the spectrum of childhood disabilities in a cohort of rural children in North Bengal. Materials and Methods: A descriptive observational study was done in a tertiary care center of rural North Bengal over 2 years. Children aged between 2 and 12 years with some form of disability were included in the study. The demographic and socioeconomic profile and potential risk factors were recorded. Assessment was done by a multidisciplinary team involving pediatricians and faculty from other relevant disciplines. Relevant national guidelines were followed in assessing individual disabilities and their severity. Results: Four hundred and ninety-one disabled children were included in the study. The prevalence of childhood disability was approximately 2/10,000. Majority had multiple disabilities (56.62%). Sixty-one percent of the children were male, and the majority hailed from low-income families. Combination of locomotor disability and mental retardation was the most common form of disability, pure locomotor disability being the next most common. Proportions of visual and hearing impairment were 15.28% and 13.65%, respectively; 20.57% of the children had moderate to profound mental retardation, and 2.65% were diagnosed with mental illness. Consanguineous parents were noted in 12.42%, and one or more adverse perinatal events were recorded in the great majority of cases. Conclusions: This study exclusively on children by team of specialist medical personnel can serve as an index study profiling childhood disability in rural India.

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