Extragonadal germ cell tumors are relatively rare tumor, which usually occurs in the mediastinum or retroperitoneum. In this report, we present a case of primary mixed germ cell tumor (GCT) arising in the pelvic cavity. A 38-year-old male with acute abdominal pain was admitted to our hospital. Computed tomography scan imaging demonstrated a large mass in the pelvic cavity. Histological examination of the specimen revealed germ cell tumor with dual morphology. Immunohistochemical studies detected placental alkaline phosphatase (ALP), OCT3/4, ALP, and pancytokeratin. Taking these results together with the patient's other clinical manifestations, this case was diagnosed with mixed GCT, i.e., seminoma plus yolk sac tumor. Chemotherapy was successful. Mixed germ cell tumor in the pelvic cavity is extremely rare but should be considered as a cause of pelvic mass formation.

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Background: Antimicrobial resistance (AMR) is a real threat having the potential of impacting public health immensely. Biocides may contribute to AMR as they are routinely used in household formulations, often in suboptimal concentrations. Gram-negative bacteria like Pseudomonas aeruginosa (P. aeruginosa) can adapt to biocides such as chlorhexidine and cetrimide (CHX + CET) on repeated exposure and develop cross-resistance to antibiotics. Aim and Objective: The aim was to test CHX + CET laboratory-adapted clinical isolates of P. aeruginosa for the development of cross-resistance to antipseudomonal antibiotics. Materials and Methods: Ten clinical isolates of P. aeruginosa were included in the study. The initial antibiotic susceptibility pattern was noted before they were exposed to increasing concentrations of CHX + CET over several days. Briefly, 10 μl of bacterial suspension was inoculated into 10 ml of nutrient broth with the biocide and incubated at 37°C for 48 h. New series of tubes with increasing concentration of biocide were inoculated with growth from the previous tube every 48 h. Till, no further growth was obtained. Antibiotic susceptibility testing for antipseudomonal antibiotics by the disc diffusion as well as the minimum inhibitory concentration (MIC) by VITEK 2 bacterial identification system was performed and repeated before and after exposure to the biocide. The difference in the zone diameter and MIC was noted. Results: Significant difference (P < 0.05) in the mean of the zone size before and after exposure to CHX + CET was noted. Furthermore, there was an increase in MIC postexposure to the biocide. Conclusions: P. aeruginosa on exposure to biocides developed antibiotic resistance.

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Vitamin D has potential antimicrobial activity, the deficiency of which has deleterious effects on the general well-being and longevity, predisposing major public health problem worldwide. About 1 billion people have Vitamin D deficiency, which is prevalent among all ethnicities and age groups throughout the world. In addition, the incidence of antimicrobial resistance has emerged as a major threat to public health, and it is estimated to cause 10 million deaths annually by 2050 throughout the world. Vitamin D, as a mighty antimicrobial agent, may decrease the occurrence of infection through numerous pathways. Vitamin D strengthens innate immunity by modulating the production of various anti-microbial peptide (AMPs), cytokine, chemokines and interleukin responses. Vitamin D is responsible for the regulation of >200 genes, including cell proliferation, differentiation, and apoptotic genes. It acts as the key holder for modulating systemic inflammation, oxidative stress, and mitochondrial respiratory functions. Thus, a Vitamin D replete state appears to benefit most infections. As an antiviral agent, Vitamin D may constitute an inexpensive prophylactic option either by itself or as a synergistic agent during the treatment of different viral infections. The present review stipulates the importance of Vitamin D and its possible mechanisms against treating any kind of viruses. Relevant published articles were summarized by performing computerized literature searches (searches were made in PubMed/Medline, EMBASE, ScienceDirect, and Scirus) of different authentic databases using the following keywords: Vitamin D, VDR, infections, antimicrobial peptides, viruses, and COVID-19. The future for the sunshine vitamin as an antiviral agent looks brighter. More scientific proposition entailing in vitro, in vivo, or genomic studies are required to understand how important Vitamin D is against viral infections.

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The ongoing Covid-19 pandemic has not only crippled the already overburdened public health system of India, but also adversely affected its economy. Due to gross difference in pandemic stage, geographical variation and socio-demographic diversity in different parts of India, a 'fit-for-all' strategy will not be suitable for managing ongoing pandemic. It necessitates the rationale to develop a decentralized district or city specific action plan. This article brings forth how strategies could be modified based on disease load in different parts of the country.

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In patients undergoing ambulatory laparoscopic surgeries, Ryles tubes are required only for the purpose of intraoperative gastric decompression. Insertion of nasogastric tubes can lead to nasal trauma, and hence, oral tubes provide a feasible alternative. In contrast to the nasopharyngeal cavity, whose anatomical orientation allows ease of insertion into the esophagus, oral insertion of Ryles tube is difficult on account of a larger cavity and potential for coiling. Various aids are often used to ease the insertion of these orogastric tubes. One such aid is the use of an oral endotracheal tube (ETT). This case report aims to bring to light, and the inadvertent complications may occur with the improper use of these aids, which in our case, was the misplacement of the said oral ETT.

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Nevoid hyperkeratosis of nipple and areola was first described by Tauber in 1923. It is a rare idiopathic disorder characterized by papular warty excrescences on the nipple and areola or both. Histopathology shows hyperkeratosis, acanthosis, papillomatosis, elongation of rete ridges, filiform interconnecting pattern, increased pigmentation in the basal layer, and sparse perivascular lymphocytic infiltrate. We report two cases of nevoid hyperkeratosis of nipple because of rarity of this condition.

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Ectopic scrotum is defined as abnormal position rather than normal position of the scrotum. Congenital scrotal anomalies are penoscrotal transposition, bifid scrotum, accessory scrotum, and ectopic scrotum. Associated anomalies with ectopic scrotum are inguinal hernia, ectopic ureter, vesical exstrophy, renal dysplasia, and agenesis. Ectopic scrotum is a rare congenital anomaly. We report a case of ectopic scrotum with undescended testis.

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Opportunistic infections acquired during the chemotherapy forms the main limiting factor in the management of acute myeloid leukemia. Bacterial infections are most common, followed by fungal and rarely viral. Alcohol in high doses and long-term consumption also decreases the immunological response. Here, we present a unique case of herpes simplex encephalitis in a 50-year-old male patient who has presented with altered behavior, slurring of speech, disorientation, fever on and off, and confusion for 2 days. He was a known case of acute myeloid leukemia and treated with chemotherapy 5 years back. Moreover, he was also a chronic alcoholic for many years and stopped 1 week before the symptoms. The possible mechanism of immunodeficiency by chemotherapy and alcohol are discussed.

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Hoarseness of voice with hemoptysis in an elderly smoker can occur due to malignancy in the upper respiratory tract or intrathoracic lesion. When ear, nose, and throat examination is normal in such a patient, the lesion is most likely to be intrathoracic. In this case-based discussion, we discuss regarding how to evaluate a patient with hoarseness of voice with hemoptysis. We report an unusual case for hoarseness of voice with hemoptysis in an elderly smoker.

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Disorders of the stomach are frequently seen as clinical diseases. Of all the lesions of the stomach, inflammatory conditions and neoplastic lesions are most common. Primary malignant lymphoma of the stomach accounts for only a small percentage (about 10%) of all malignant tumors of the stomach, and majority of them arise from B-cells. Most common among these are indolent extranodal marginal zone lymphomas, and in the stomach, they are called MALTomas. Occasionally, gastric lymphomas of one type or another are seen adjacent to adenocarcinoma. Sometimes, lymphoma precedes carcinoma by several years. The aim was to study the microscopic patterns of gastric biopsies and mastectomy specimens received for the case in our department. Multiple gastric biopsy specimens as well as gastrectomy specimens were received in our department. Multiple sections were taken and stained with hematoxylin and eosin. Immunohistochemical (IHC) stains were used as applicable. Studies posed a diagnostic difficulty by showing picture of gastritis from biopsy of the cardia; signet ring cell adenocarcinoma was seen in small gastrointestinal biopsies from lesser curvature and gastric lymphoma with gross picture of linitis plastica on gastrectomy specimen. For confirmation and to know the type of gastric lymphoma, multiple B- and T-cell IHC markers were used. CD20, CD10, BCL2, and c-Myc were positive in tumor cells, CD3 positivity was seen in reactive T-cells, and MIB1 positivity was seen in 70%–75% of tumor cells. Hence, it was confirmed to be high-grade large cell lymphoma (double-expresser type). Hence, it can be concluded that IHC markers are necessary to solve the diagnostic difficulties.

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Dirofilaria are tissue nematodes which can cause zoonotic diseases and have been reported from all over the world. They are transmitted by zooanthropophilic arthropods. The genus causes subcutaneous ocular, pulmonary, and lesions in other subcutaneous tissues. The most commonly implicated species are Dirofilaria immitis and Dirofilaria repens. Confirmation of the diagnosis of dirofilariasis is mainly dependent upon microbiological identification of the parasite by macroscopical and microscopical analysis and histology. Documented reports from India are mainly from South India and of ocular presentations by D. immitis. Hence, this case of subcutaneous dirofilariasis is being presented. The present case was a 65-year-old female who presented with a swelling over the left lower side of the neck for 1 month. The patient underwent surgery for the mass and the lesion was excised. The mass was sent for microbiological identification. The parasite showed a cuticle, which had longitudinal as well as transverse striations. The parasite also had a body cavity, which had internal organs and structures. The worm was identified as Dirofilaria spp. based on morphological features, both microscopic and macroscopic. It is likely to be D. repens due to the presentation as a subcutaneous nodule with which it is more associated.

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Filariasis is one of the common health problems in India. Extranodal filariasis occurs rarely, and the breast is one of the uncommon sites. Here, we report two cases of breast filariasis in the middle-aged females presented with a painless lump in the left breast. These cases were clinically mistaken as a malignancy. Cytology smears showed numerous microfilariae in both coiled and uncoiled forms along with benign ductal cells. Thus, the diagnoses of filariasis breast probably arising from intramammary lymph nodes were made in both cases. The patients were treated conservatively, and the recovery was uneventful. Thus, fine-needle aspiration cytology played an important role to avoid unnecessary surgical intervention in these patients.

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Vein of Galen malformation (VOGM) is a rare type of arteriovenous malformation with majority presenting in neonatal period. The most common presentation is high output cardiac failure and association with persistent pulmonary hypertension (PPHN) is rarely reported. If left untreated mortality rate is very high. Endovascular embolization is the preferred treatment modality at present. We describe a full-term male baby presented at 1 h of life with respiratory distress, eventually diagnosed to have PPHN on echocardiography. Ultrasonography cranium done in view of cranial bruit revealed VOGM which later confirmed with magnetic resonance (MR) imaging brain and MR angio and venography. All supportive measures were provided. But because of hemodynamic instability endovascular embolization could not be attempted and baby succumbed due to severe refractory PPHN. We should consider the possibility of VOGM in all refractory cases of PPHN even though the association is very rare.

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Difficult airway still is one of the dreaded crises in anesthesia. A well-formulated plan with all the necessary equipment should be ready when such situations are anticipated, but unanticipated difficulties can arise, and managing such cases is a nightmare for the anesthesiologist. Most hospitals in the developing countries are not equipped technically with all the modern equipment and gadgets as far as anesthesia is concerned. In a resource-constrained area, the skill and innovative ideas of the anesthesiologist often emerge as an alternative option in dealing with such cases. Here, we describe two cases of difficult intubation by conventional approach, which were managed successfully using a pediatric gastroscope and a flexible cystoscope as an alternative to fiberoptic bronchoscope.

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Som rog is a very rare disease in female; it affects <1 in 2000. Water is present all over the body and this water being the sustainer of the body is called as som and the disease caused by the loss of this water is called Som rog. Som rog is correlated with diabetes insipidus (DI). DI is part of a group of hereditary or acquired polyuria and polydipsia disease. To assess the efficacy of Stambhan chikitsa in the management of Som rog with the use of drug Somnath ras, Praval bhasma, Guduchi satva, Chandraprabha vati, Lodhrasava, Ahara, and Vihara was advised and assessed before treatment and after treatment advised for follow-up. The treatment adopted is effective in the management of Som rog and to improve the quality of life.

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Poncet's disease is a rare form of tuberculosis (TB). It is described as a hypersensitivity reaction of extra-articular TB, which manifests as acute-onset non-destructive polyarthritis of large joints. It resolves completely on anti-tubercular therapy. We describe a case of a young female patient who presented with symmetrical polyarthritis on a background of tubercular lymphadenitis. The workup for rheumatological diseases was negative. A diagnosis of Poncet's disease or tubercular rheumatism was made by exclusion. There was complete resolution of symptoms of joint disease following anti-tubercular therapy. Poncet's disease should be kept under suspicion in TB endemic areas while investigating patients of arthritis. In a resource-limited setting, in patients with TB, the response of coincident inflammatory arthritis to anti-tubercular therapy may be first observed, before subjecting them to further investigations and/or empirical therapy.

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Mental Health Issues are an important public health problem. It has also social and economic costs. The Government of India is implementing the National Mental Health Program which includes upgrading of Psychiatry services of the medical colleges so as to provide community psychiatry services. This concept paper discusses the modalities of setting up a data base of psychiatric illnesses in the field practice areas of a medical college located in the twin township of Pimpri-Chinchwad, Pune District, Maharashtra. This database will enable practice of community psychiatry in collaboration with the Department of Community Medicine and can be a model for adoption in other medical institutions and nonteaching public hospitals as well as private hospitals. Most psychiatric illnesses require follow up and a good digital tracking system would minimise attritions. It would also facilitate community based research in mental disorders.

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Context: Malaria is one of the major public health problems worldwide with increased morbidity and mortality. India has the fourth highest malaria burden in the world. Malaria parasite affects multiple organs of the body including liver, spleen, brain, kidney, blood vessels etc. Organ dysfunction predominantly seen in Plasmodium falciparum malaria, is not in Plasmodium vivax infections. Aims: The present study investigated the abnormalities of liver function test in acute cases of Plasmodium Falciparum infection. Settings and Design: A hospital-based case–control study conducted in a tertiary care center in West Bengal, India, for a duration of 7 months and included 53 acute falciparum malaria cases attending the outpatient department (OPD) and 47 age and sex matched patients, with complaints unrelated to the present study, as controls. Materials and Methods: Serum levels of bilirubin, serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvate transaminase (SGPT), alkaline phosphatase, total protein and albumin were assayed using autoanalyzer (Konelab 60i autoanalyser). Statistical analysis used: SPSS software version 20 (IBM, New York, USA). Results: In this study serum bilirubin (total, conjugated and unconjugated ) SGOT, SGPT, alkaline phosphatase levels were highly significantly raised in cases with respect to controls. Levels of total protein, albumin and globulin in cases was not significantly different from the corresponding levels in controls. Conclusions: Hepatic function impairment in malaria is an important and potentially dangerous complication. Data from the present study can be useful for future research and also help in determining the prognosis and treatment.

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Aim: Oral submucous fibrosis (OSF) is a potentially malignant disorder with 7.6% of malignant transformation rate into oral squamous cell carcinoma (OSCC). The aim of the study is to assess the genetic markers p16 and ki-67 in OSF, OSCC, and OSCC with the background of OSF and control group. Materials and Methods: Ten cases of each group were stained with p16 and Ki-67 by immunohistochemistry technique. Results: Statistically significant results were found among the four groups with moderate-to-severe expression (P < 0.05) for Ki-67 and results were negative for p16 in all groups. Conclusion: According to our result, p16 is found not significant marker and Ki-67 can be useful as a proliferative index marker for malignancy development in oral precancerous conditions.

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Background: Pregnancy-induced hypertension (PIH) is one of the most common causes of both maternal and neonatal morbidity, affecting about 5%–8% of pregnant women. The risk factors postulated to influence the risk of PIH among the mothers include sociodemographic factors, genetic factors, pregnancy-related complications, or personal factors. Objectives: The objective of this study is to study the sociodemographic profile, prevalence, and epidemiological risk factors of PIH in antenatal patients. Materials and Methods: A cross-sectional study was conducted at GMC Latur, Maharashtra, India, as a part of postgraduation thesis work and was approved by MUHS Nashik. A total of 1600 antenatal care cases were selected. The study variables included mother's age, parity, height, body mass index, socioeconomic profile, and diet. Interviewer administered questionnaires were used to capture the demographic data and obstetric history. PIH prevalence in this study was found to be 6.06%. Primi-parity, age above 30 years, poor socioeconomic status, less education, joint family, >36 weeks of gestation, >5 g of salt intake, and moderate-to-severe anemia are some of the important epidemiological risk factors found to be associated with PIH. Conclusion: Pregnancy in later stages and primigravida's should be monitored carefully for PIH, and it should be prevented. Health education should be given about the consumption of iron tablets and iron rich food items to prevent anemia.

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Introduction: Neoplasms of the gastrointestinal tract (GIT) are one of the most common malignancies accounting for 11% of all cancers. There is an increasing burden of GI cancer worldwide, wherein gastric cancer ranks fourth and esophageal cancer ranks the eighth most common cancer. Histopathological confirmation is always necessary for planning appropriate treatment regimen. Hence, in this study, we aim to analyze and correlate with clinical parameters the spectrum of all GI neoplasms encountered in our institute. Materials and Methods: The present study is carried out during 5 years' period of all neoplastic GI specimens received in the department of pathology. Results: Of the total 259 biopsy and excised specimens from neoplastic cases, benign were 14 (5.4%) and malignant lesions were 245 (94.6%) with adenocarcinoma being the most common histotype. The frequency of male was marginally higher with M:F ratio of 1.1:1 was observed in all GI diseases with exception of gall bladder which revealed female predominance. The mean age of patients was 55.2 years. Colorectal carcinoma was more commonly observed (40.5%) than esophageal squamous cell carcinoma (27.4%). Conclusion: Neoplasm of the colorectal region was the most common followed by esophagus tumors. The most common age group affected was 51–60 years. With an increasing incidence of neoplastic lesion in GIT, prevalence and mortality of the disease can be minimized with early detection of lesion, histopathological examination being gold standard.

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Background: Internet has become the major source of health-related information, leading to a growing trend toward unsupervised self-medication using internet. This survey was conducted to assess the extent of internet use to obtain health information/self-medication, their perception regarding side effects of drug used, types/quality of information, and which site was commonly surfed for information. Materials and Methods: A web-based tool (Google Forms) was used to develop a questionnaire to obtain information about extent and impact of internet on self-medication by general population. The questionnaire included 9 questions along with demographic details of participants. The questionnaire was sent to participants by WhatsApp and E-mail and their responses were analyzed. Results: Four hundred and forty-eight (56%) persons responded to survey. There were 226 (50.4%) males and 222 (49.6%) females. The average age of responders was 35.10 years. Overall, 59.8% of responders used internet to obtain health information and self-medication. Out of these, 54.47% took allopathic medications without consulting the doctors. The majority of persons self-medicated for minor illnesses, but 11.6% of persons self-diagnosed and self-medicated for serious illnesses such as heart disease, diabetes, cancers, and psychological problems. 23.2% of peoples think that information on internet carries no risk for self-medication and 21% think that internet use can be a substitute for consulting a doctor. Google was the most common site (93.8%) surfed by participants. The health information provided on net was perceived as very good by 43.7%. Conclusions: There are growing trends toward the self-medication using internet. The health information on internet should be made easier, simpler, and safer to achieve positive health outcomes, but patients should be discouraged for self-medication. To support the safe and appropriate use of nonprescription medicines, minimum practice standards should be set by the governing medical bodies in each country.</ABS>

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Aim: The aim of this study is to assess parent's knowledge, attitude, and practice (KAP) regarding their children's oral health maintenance and its correlation with dental caries experience. Methodology: A cross-sectional study was conducted among 504 parents of children aged 5–10 years between September 2013 and November 2014. A self-designed pretested 15-item questionnaire was used to assess the KAP. Dental caries experience was recorded as Decayed, Missing, Filled, Teeth (DMFT) and decayed-extracted-filled teeth among the children. Results: Dental caries prevalence among children was 61.1%. Good KAP was reported among 23% of the parents, 64% had fair, whereas 11.5% had poor KAP. One-way ANOVA showed a significant difference (P = 0.04) in deft scores among parents having good, fair, and poor KAP. The highest deft score was found among children of parents with poor KAP. The DMFT scores did not show a significant difference between the KAP categories (P = 0.76). Conclusion: Better knowledge, positive attitude, and good oral health practices followed for children by the parents will reflect the good dental health status of their children.

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