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Objective: Mirror therapy (MT) and neuromuscular electrical stimulation (NMES) are both effective treatments for impaired upper limbs following stroke. The purpose of this study was to compare the effects of the MT and NMES on upper-limb motor recovery, motor function, and quality of life in subacute stroke patients. Materials and Method: Forty poststroke patients within 1 month of duration were assigned to the MT group (n = 20) or the NMES group (n = 20). Both the MT group and NMES group received the same conventional rehabilitation programs and additionally had each of their own therapies for 30 min, 5 days a week for 3 weeks. The action research arm test (ARAT), Fugl-Meyer assessment (FMA), Modified Ashworth scale (MAS), and Modified Barthel index (MBI) were used as an outcome measure to assess changes in upper-limb motor recovery and motor function at pre- and postintervention. Health-related quality of life was assessed by stroke-specific quality of life (SS-QOL) questionnaire at pre- and postintervention. Results: At the baseline, patients of both the groups showed no significant differences regarding ARAT, FMA, MAS, MBI, and SS-QOL scores, but after 3 weeks of intervention, patients of both the group showed statistically significant improvements in all the variables measured (P < 0.05). Conclusion: The present study confirms that MT and NMES are both effective treatment techniques to improve upper-extremity motor recovery, motor functioning, and quality of life in subacute stroke patients except for improvement in spasticity. However, MT is cost-effective, easy, and safe method for rehabilitation and most important can be easily administered at home by the patients.

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Background: In Malaysia, there is a large gap between the number of organ donors and recipients. Aim and Objectives: This study was done to determine the knowledge and attitude toward organ donation among medical students in a private medical institution in Malaysia. Materials and Methods: A cross-sectional study was conducted from April to June, 2019, among 122 randomly selected participants from MBBS students of a private medical university, Malaysia. Data were collected using a pretested semi-structured questionnaire. Results:The mean age of the study participants was 23.23 years (standard deviation ± 0.58 years). The male-to-female ratio was almost equal (49.2: 50.8%). All the participants (100%) had correct knowledge regarding brain death and the place of registration for organ donation. However, only 54 (44.3% students [95% confidence interval (CI): 35.49–53.11]) had adequate knowledge about organ donation and 59 (48.4%) students (95% CI: 39.53–57.27) had a positive attitude toward it. Younger respondents (odds ratio [OR] = 0.3685, P = 0.02) were more likely to have higher knowledge about organ donation. Positive attitude was more among male respondents (OR = 0.8788, P = 0.72) and those aged <24 years (OR = 0.5535, P = 0.19) but were not statistically significant. The study showed that there was no statistically significant relationship between knowledge of organ donation and attitude. Conclusion: Almost half of the study population had adequate knowledge of organ donation, but most of them had a negative attitude toward it. It is crucial to address the misconceptions and sociocultural beliefs regarding organ donation through various awareness campaigns. Further study is required to explore the factors hindering willingness to organ transplantation.

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Background and Objective: Coronavirus is spreading across the globe since December 2019. As India's first case was reported on January 30, 2020, the spread of this virus is experiencing by our population. As a result, there are extensive emotional distress and anxiety among populations due to this pandemic. Screening mental health is important for psychological well-being of any individual during this pandemic. The objective of this study was to validate the Coronavirus Anxiety Scale (CAS) in an Indian population. Materials and Methods: The research proposal was laid out before an ethical clearance committee, which approved the conduct of the research and consequent publication of the paper. Data were collected from 246 respondents through online. CAS, developed by Lee (2020), was adopted for the study. Informed consent was given by all the respondents, and their participation was voluntary. AMOS and SPSS were used to calculate confirmatory factor analysis and other statistical analyses. Bartlett's test of sphericity and Kaiser–Meyer–Olkin (KMO) test, and Cronbach's alpha, were also calculated. Convergent validity was calculated through average variance extracted (AVE) and composite reliability (CR) in Microsoft Excel. Results, and Conclusions: Bartlett's test of sphericity was highly significant measuring Chi-square = 494.004, df = 10, and P < 0.001. The KMO was acceptable at 0.805. Fit indices (P < 0.001, Chi-square/df = 3.24, goodness of fit index = 0.976, Tucker–Lewis index = 0.954, and comparative fit index = 0.977) are statistically significant. Cronbach's alpha coefficient (0.822), AVE (0.526), and CR (0.745) were adequate. The overall findings of the analyses demonstrate that the CAS is a reliable and valid scale that evaluates the severity levels of dysfunctional anxiety linked to COVID-19 in an Indian sample. CAS is applicable to measure the level of dysfunctional coronavirus anxiety in the Indian population.

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The use of complementary and alternative medical therapies is increasing worldwide. Many of these products have biological activity that can lead to severe toxicity or interact with prescribed medications. We present here a case of 68-year-old female, a known diabetic and hypertensive on treatment, who presented with symptoms of liver failure. This was associated with the consumption of mahogany seeds (sky fruit). She was investigated for other causes of liver failure, which turned out negative. It is important to recognize such possible complications during these therapies and promptly withdraw the offending agent.

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Shared psychotic disorder (folie à deux) is a unique disorder with varied clinical presentation, posing difficulties in management. Parent–child dyads have been described to be commonly affected by this disorder but very few cases from India are available. Three cases who had parents suffering from untreated schizophrenia and shared their psychotic symptoms presented to the department. Two of these were twins with comorbid attention deficit hyperactivity disorder (ADHD), who required management for the ADHD. Social isolation was a common and the most important risk factor. All three cases showed improvement in psychosis with separation from the primary and none required the use of antipsychotics. Implications and treatment strategies for shared psychotic disorder in children are also discussed.

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Pulmonary hypertension (PH) is a progressive disorder of the pulmonary vasculature caused due to vasoconstriction, vasodestruction, or vaso-obliteration. PH results from heterogeneous pathophysiologic mechanisms culminating in elevation of mean pulmonary arterial pressure. Patients may either present with symptoms or with chest radiographic, electrocardiographic, or echocardiographic findings done as a part of diagnostic evaluation for the primary disease or as a part of preoperative assessment. And hence, the clinician resorted to could be a family physician, pulmonologist, cardiologist, surgeon, or anesthesiologist. Hence, there is a necessity of a basic awareness about its clinical presentations, diagnostic modalities, and the available treatment options. The diagnosis can be perplexing and warrants a stepwise evaluation. Echocardiography (ECHO) is the preliminary diagnostic modality and provides a fairly accurate judgment of the pulmonary artery pressure; however, some patients may require an invasive evaluation by right heart catheterization. The definitive management of PH depends on the underlying etiology. Pulmonary arterial hypertension has a specific set of targeted pharmacotherapy, while for other categories of PH, treatment majorly focuses on counseling, management of the underlying disorder, and cardiopulmonary rehabilitation. The 6^th World Symposium on PH has catered to all these issues and has incorporated manifold pertinent modifications in all these areas. Hence, we conducted an online survey to gauge the awareness about the entity and its facets among pulmonologists and penned down this review based the current concepts about PH to bridge the gaps in the existing knowledge.

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Background: COVID-19 has affected millions of people and more than thirty thousand deaths. Social distancing and lockdown are important measures for prevention. Police personnel are losing their lives due to COVID-19 while doing their duty in this lockdown time. Aim: The study aims to assess knowledge, attitude, and practices (KAP) of police force toward COVID-19. To assess correlation of knowledge with their practices and attitude. Materials and Methods: A cross-sectional, self-administered, anonymous survey questionnaire was administered to 8706 police personnel and data collected over a time period from April 11 to 16, 2020. We used t-test and multivariable binary logistic regression analysis to identify the association between KAP and demographic variables. Results: In all 8706 police personnel participated in the study. The median age of participants was 35 years (interquartile range: 19–59), 6787 (77.9%) were male, 6675 (76.6%) were of constable grade. Seven thousand three hundred thirty-two (83.7%) of participants recorded accurate (high) knowledge, and 6790 (78%) reported following preventive practices. Female participants were more likely to follow preventive measures despite low knowledge as compared to their male counterparts (P < 0.0001). Female gender, age more than 35 years, and lower rank were associated with low knowledge and fear of contracting the disease. Multivariable binary logistic regression analysis showed that low knowledge is significantly associated with fear of getting disease odds ratio 1.29; 95% confidence interval (1.15–1.46). Conclusion: In a cohort of police personnel, overall knowledge about COVID-19 is high. Female participants are found to be practicing appropriate preventive measures and they have faced stigmatizing behavior from society. The study provides important information on the need for developing health awareness programs to improve COVID-19 KAP.

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Background: Pancytopenia is characterized by decreased hemoglobin (adult males <13 g/dl, pregnant females <10 g/dl, nonpregnant females and children <11 g/dl), total leukocyte count (<4 × 10⁹/L), and platelet count (<100 × 10⁹/L). Depending on the severity, patients can present with varied symptoms. Vast majority of conditions causing pancytopenia are known. Hence, a systematic approach is a mandatory requirement to identify the cause of pancytopenia for appropriate management. Aim: Clinicopathological study of new onset pancytopenia and to determine the frequency of different etiologies causing pancytopenia. Materials and Methods: A prospective study of 451 consecutive cases who had pancytopenia and presented in outpatient or emergency room of a tertiary care center of Western India, from July 2017 to September 2019. The clinical data of the patients were obtained and hematological investigations were analyzed in the hematopathology section of the pathology department. Bone marrow (BM) aspirates and biopsies were performed in 355 cases. Data were analyzed using SPSS software. Results: Patients age ranged from 6 months to 84 years with mean standard deviation of 45.89 ± 19.21 years. Overall male to female ratio was 1.87:1. Hematolymphoid malignancy was the most common cause (n = 137, 30.37%) followed by nutritional anemia (n = 97, 21.5%), infections (n = 68, 15.07%), BM failure (n = 66, 14.63%), hypersplenism (n = 55, 12.19%), and autoimmune disorder (n = 11, 2.44%). Conclusion: Pancytopenia is a common hematological entity with the multifactorial etiologies. It can present as a life-threatening condition or can be merely transient. Hematolymphoid malignancy was found to be the most common underlying cause in our study. An accurate etiological break will further assist in appropriate management of these patients.

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Background: The symptoms of autism manifest at an early age in children and are likely to results in lifelong disability. Early identification and institution of early intervention remain the mainstay in the management of autism. However, related community surveillance studies are limited in the literature. Methods: The present study was designed to assess the prevalence of “at risk for autism” among children aged 18–36 months in a semi-urban community of Rohtak, Haryana, India. This cross-sectional study was conducted among 548 children. The eligible children were screened using the Hindi version of the Modified Checklist for Autism in Toddlers-Revised (M-CHAT-R). Results: The prevalence of at-risk symptoms of autism was 0.55% and 6.57% as per M-CHAT-R score of >7 and >3–7, respectively. Most of the cases in the moderate-risk category were having M-CHAT-R score of 3–5 (n = 32, 82%). Conclusion: The study provides preliminary data on the prevalence of caregiver-reported autism using the Hindi version of M-CHAT-R in a semi-urban community of North India. The Hindi version of M-CHAT-R could be a viable community surveillance tool for identifying toddlers at risk for autism in this setting.

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Background: Auxiliary nurse midwife (ANM) provides immunization service at subcenter. This study aimed to assess the quality of care and client satisfaction toward immunization. Materials and Methods: A cross-sectional survey was conducted during January 2018 in three randomly selected subcenters of Gangajalghati block of Bankura district. Immunization services and client satisfaction were assessed by nonparticipant observation of immunization process in 86 “vaccination encounters” and exit interview of mothers of the same vaccinees selected randomly in equal number from each subcenter. Data were collected using checklist and questionnaire containing some questions with options on Likert scale. Clients' satisfaction was also explored through “focus group discussions” (FGDs) among randomly selected samples of eight mothers at each subcenter. Providers' perspective was grasped from an “FGD” conducted among a sample of accredited social health activists and in-depth interview of ANMs of selected subcenters. Verification of cold chain, logistics, and registers was done using checklist. Results: Coverage with appropriate vaccination was universal in each of the subcenters. The waiting time was 21.82 ± 15.37 (mean ± standard deviation) min. Postvaccination message was provided to 97.70% of mothers. Improper biomedical waste management was the rule. Cold chain was maintained properly. Only 45.30% of respondents knew the vaccine that was given in the session; however, 91.90% could utter the next date of vaccination. Sitting arrangement, cleanliness in clinic, attendance, timeliness of service, skill, and attitude of ANMs were labeled as “good” by 59.30%, 82.60%, 100%, 100%, 100%, and 98.80% of respondents, respectively, and overall, 94.00% was satisfied toward service. Conclusion: An overall good quality immunization service was found existing in the study area.

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Background: Estrogen receptor (ER)-α and ERβ, members of family of ERs are expressed in many breast tumors. However, their role in carcinogenesis and their association with regard to the prognosis are still under the investigation and unclear because of limited data. Aims: The present cross-sectional, observational pilot study was aimed to study the immunohistochemical expression and prognostic significance of ERα and ERβ in invasive luminal Type A breast carcinoma patients. Materials and Methods: Twenty-five old diagnosed cases of luminal Type A breast carcinoma diagnosed between 2012 and 2015 were included in the study. The expression of markers ERα and ERβ was correlated with the clinical characteristics and disease outcome in 2–7 years' follow-up period. Statistical analysis was performed by SPSS version 17.0 and graph pad PRISM 5.0 version. Results: Eleven cases out of 25 were both (ERα and ERβ) positive, whereas 1 case was both (ERα and ERβ) negative. Positivity with single marker was 12 for ERα and 20 for ERβ. Adverse outcomes, i.e., recurrence, distant metastasis, and death were reported in 10 cases (40%), 8 out of which were ERα negative cases. While ERα-positive expression alone or along with ERβ expression was shown to be associated with less adverse outcomes (2 out of 10, P = 0.005). Conclusions: When both ERα and ERβ expression is present, they appear to act as allies and together presents with the better prognosis in disease outcomes of breast cancer in our study cases.

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Introduction: Health-care workers (HCWs) need to have adequate knowledge, the right attitude, and should practice disinfection procedures diligently. The study aimed to assess the knowledge, attitude, and practice (KAP) of HCWs and the role of training in KAP of HCWs. Materials and Methods: The study population consists of all HCWs undergoing training for disinfection. A structured training module for paramedicals, i.e., module for paramedics in disinfection (MoPDis), was designed. The knowledge, attitude, and practice were assessed before and after the training. Results: A total of 183 male HCWs participated in the study. The mean age of the participants was 31.33 ± 6.8 years and ranges from 21 to 49 years. The mean years of experience were 11.5 ± 7.1 years. The mean pretraining and posttraining scores were 8.1 ± 2.4 and 10 ± 1.9, respectively. The score increases from 53% pretraining score to 66.6% posttraining score. Age, experience, and specialty did not have any association with the gain in knowledge. Conclusions: The training program had significantly increased the KAP levels of the HCWs and hence may improve disinfection practices in hospitals, thus preventing the spread of infection.

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Pulmonary artery aneurysm is an infrequent entity and is generally congenital in origin or secondary to pulmonary arterial hypertension. Infections causing pulmonary artery aneurysm are limited, in which tuberculosis and bacterial infections being the shared causative etiologies. There have been only scarce cases reported in the past, in which mucor caused pulmonary artery aneurysm. Pulmonary mucormycosis causing pulmonary artery aneurysm is an infrequent and almost fatal complication, as most of the diagnoses are made postmortem. Our case is the first case report in Indian literature that brings out a case of disseminated mucormycosis, causing bilateral segmental pulmonary artery aneurysm in a patient with uncontrolled diabetes. This patient was cured by timely treatment with antifungals.

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Extraskeletal Ewing's sarcoma (ES) is an aggressive, malignant small round-cell tumor usually occurring in children and adolescents. It needs to be differentiated from other malignant small round-cell tumors. Immunohistochemistry plays a pivotal role in establishing the diagnosis. ES/peripheral primitive neuroectodermal tumor is presumed to be neuroectodermal in children and young adults.

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Kimura's disease is a rare idiopathic chronic inflammatory disease which usually presents as deep-seated subcutaneous swelling in the head and neck region. Accompanied by lymphadenopathy, peripheral eosinophilia, and elevated immunoglobulin E levels, it is more prevalent among young Asian males. Here, I report the case of a 20-year-old male presenting with left posterior cervical lymph node swelling. Based on proper clinical setting and characteristic cytological features, a cytological diagnosis of Kimura's disease was rendered which was later confirmed by histopathological examination.

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The coronavirus disease-2019 (COVID-19) outbreak has taken the world by storm and has made each and every government to introspect about their preparedness and the response action plan. Amidst all the unknown epidemiological attributes of the novel virus, the health care professionals have been at the forefront dealing with infectious cases to save their lives by compromising their own safety. In order to ensure that health professionals actively participate in the process of health care, it is their right to have access to all standard preventive & protective measures. To conclude, in the ongoing outbreak of Coronavirus disease, the efforts of the health care professionals will be the real factor in improving the survival chances of thousands of the affected patients. However, considering the fact that they are working in high-risk settings, it is the responsibility of the health administrators to safeguard the health and wellbeing of health professionals.

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Background: Transporting sick neonates from the periphery to a tertiary care unit is a challenge and transport-related factors can have a bearing on their survival. These factors influence ultimate survival in resource poor settings. Objectives: The objective is to evaluate the transport characteristics for sick newborns from peripheral centers to tertiary care referral hospital. Methods: A prospective study was done with sick newborns transported to our tertiary care teaching hospital over a period of 1 year. The transport logistics were recorded in detail and analyzed. The analyses were repeated for preterm and term babies separately. Results: There were 36.32% preterm babies in the study cohort of 961 newborns. The descriptive profile of the newborns enrolled in the study has been presented along with descriptive summary of the newborn transport logistics. Approximately 23% of babies were born to teen age mothers. Some prereferral counseling was done for only about 20% babies and <1% had vitals monitored during transport. Prereferral stabilization was scarce and around 41% babies had labored breathing or gasping at admission. As many as, 47% babies had no prereferral intervention and 31% had no referral notes; in only 3.3% instances, there was clear prior intimation to the referral unit. Conclusion: Sick newborn transport logistics are to be improved for reducing neonatal mortality in resource poor settings.

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Background: Aphakia is the most dreaded and inadvertent complication of cataract surgery. Visual rehabilitation with wide variety of surgical options is a challenge for the ophthalmologist. Our study evaluates the safety and efficacy of the retropupillary implantation of the iris-fixated intraocular lens (IOL) in a 2-month follow-up period. Aims: This study aims to assess the visual outcome, identify complications, and assess the long-term stability of eyes undergoing retropupillary iris-claw lens implantation for aphakia. Settings and Design: This was a prospective interventional study (single-group, before–after study). Materials and Methods: Sixty eyes with surgical aphakia fulfilling the inclusion criteria were considered. Preoperatively, evaluation of visual acuity, slit-lamp examination, fundus examination, intraocular pressure, corneal endothelial cell count, macular thickness, and edema was done. Anterior vitrectomy was done, and retropupillary iris-claw lens was implanted. Postoperative best-corrected visual acuity (BCVA), IOP, corneal endothelial cell density, macular edema, and IOL stability were evaluated. Statistical Analysis: The computer software statistical package for the social sciences, version 20.0 (SPSS) was used, and a 0.05 level of significance was considered. Results: The major cause of aphakia was posterior capsular rupture (55%). Postoperative BCVA on day 60 was 6/6–6/18 in 83.33% of cases. Three patients had disenclavation of the haptic which required retucking of IOL. No patient had corneal decompensation, cystoid macular edema, or IOP rise. Conclusion: Our results demonstrate that retropupillary technique of iris-claw implantation is a safe and effective method for visual rehabilitation in aphakic patients. This surgical procedure has an advantage of posterior chamber implantation with a low intraoperative and postoperative complication profile.

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Context: Pancytopenia is defined by reduction of all the three formed elements of blood below the normal reference. Hematological investigation forms the bedrock in the management of patients with pancytopenia and therefore needs detailed study. The aim of this study was to identify the underlying etiologies of pancytopenia cases presenting at our institute with clinico-hematological evaluation. Materials and Methods: In this 2-year prospective study, 105 patients aged ≥15 years admitted in hospital with a hematological diagnosis of pancytopenia followed by bone marrow aspiration and/or biopsy after receiving an informed consent were studied. The criteria applied for pancytopenia were hemoglobin level: <13.5 g/dL for males and <11.5 g/dL for females; total leukocyte count: <4 × 10⁹/L; and platelet count: <150 × 10⁹/L. Pregnant women and patients aged <15 years along with those who did not give consent for bone marrow aspiration or biopsy were excluded. A detailed clinical examination was carried out in all cases. Results: In the present study, megaloblastic anemia (67.62%) was the most common cause of pancytopenia, followed by aplastic anemia (15.25%), leukemia (3.81%), malaria (3.81%), hypersplenism (3.81%), liver cirrhosis (1.90%), myelofibrosis (1.90%), multiple myeloma (1%), and enteric fever (1%). Conclusions: The severity of pancytopenia and the underlying pathology determine the management and prognosis. Thus, comprehensive clinical and hematological evaluation of pancytopenia cases will help in identification of the correct cause and in implementing the appropriate therapy.

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