Hand sanitization is the most useful way to prevent the spread of disease-causing microorganisms. Traditionally, to sanitize and clean our hands, we are using soaps and manual hand soap dispenser. Nowadays, due to advancement in the technology, we have optimized the health-care equipment. Currently used modern equipments are very complex and expensive. This research paper proposes the idea of fully automated sensor-based controlled sanitizer dispenser. This research paper advocates radically different approaches: we aim to fully automate the current technique using alternate components for system, thereby reducing the cost of the product. Our designed automated dispenser can be commercially used to develop a good sanitization approach toward a community. The main advantage of this design is that we could design a number of automated dispensers within a small period of time using basic components in a very fewer budget.

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Background: Swachh Bharat Mission (SBM) is a cleanliness mission by the Government of India with an aim to provide adequate facilities for safe water supply, sanitation hygiene, and waste disposal at community level. The present study aimed to assess knowledge and practices regarding water, sanitation hygiene, and waste disposal and the key components of SBM in an urban community of Agartala city and find out their associated factors. Methods: A community-based cross-sectional study was conducted on 100 people from randomly selected families living in the south zone of Agartala Municipal Corporation, Tripura, on June and July 2018. A predesigned, pretested interview schedule was used as the study tool, and data were analyzed by using Statistical Package for the Social Sciences (SPSS) version 16.0. A quantitative research was followed by three focused group discussions to have an in-depth idea. Results: Majority of the study participants showed good knowledge (59%) but poor practice (39%) regarding water, sanitation hygiene, and solid waste disposal. In this study, occupation (P = 0.012) and socioeconomic status (P = 0.003) were shown to have statistically significant association with knowledge of the participants. Conclusion: Poor practice by majority of the participants and inconsistent involvement by municipality department in solid waste disposal were found as the major concerns even though good knowledge regarding SBM was found in this study among the respondents.

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Objective: To study knowledge, attitudes, and practices (KAP) of evidence-based practice (EBP) among health-care professionals (HCPs). Materials and Methods: In this cross-sectional study, a pre-tested questionnaire regarding KAP related to EBP was administered to HCPs. The responses were compared based on level of education, work profile and years of experience. Results: Out of 93 HCPs (47.31% male), 64 (68.82%) were Doctor of Medicine or Master of Surgery and 63 (69.23%) were in clinical practice. Thirteen (14%) had experience of <5 years. Eighty seven (93.55%) HCPs were aware about the term “EBP.” Fifty-three (56.99%) were aware about core elements of EBP with significant difference in responses based on level of education (P < 0.0001). Sixty-two (66.67%) had understanding regarding usage of research findings in clinical practice with significant difference based on the level of education (P = 0.003586). Forty-five (48.39%) reported having discussions at workplace about EBP with significant difference based on level of education (P = 0.03991). Seventy-one (76.34%) HCPs responded that they ask patients about their preferences and consider them in decision-making. Eighty-two (88.17%) HCPs showed interest in improving knowledge of EBP with significant difference based on the highest level of education (P = 0.04043). Conclusion: In the studied population, awareness about the term “EBP” was good. There is further scope for improvement in literature search, understanding core elements of EBP, critical analysis of research findings, statistics, and knowledge to implement EBP. Most of the study population showed interest in improving knowledge about EBP.

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In this article, we introduce a very low-price smartphone fundus camera device with basic amenities. It has become very fruitful toward undergraduate teaching at the bedside or in the outpatient department, especially where there are no facilities for the fundus camera unit. A fundus camera unit is an essential part of retina clinic, and it is very costly. Fundus photographs are very essential for disease diagnosis, its follow-up, and for disease monitoring. It cannot be carried to the camp side. Commercially, available fundus cameras are the alternative to this, but again very costly. Almost zero price this innovation helps the students to see the fundus pathologies with their own eyes and make them more clinically oriented.

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Introduction: Breast disease is the most common and ranks first among malignant tumors affecting females in many parts of the world. Timely and accurate diagnosis of a breast lump is lifesaving. Fine-needle aspiration cytology (FNAC) is a simple, safe, inexpensive method with wide acceptance and used as a first-line diagnostic procedure for diagnosis of breast lesions. Aim: The aim of the study was to diagnose any palpable lump of the breast in females by cytology and correlate with histopathology wherever possible. Setting and Design: This was a retrospective and prospective descriptive study carried out in the pathology department at our institute. Materials and Methods: This study was done for 2 years. FNAC of breast lesions was done, processed routinely, and stained with Papanicolaou stain. Histopathological correlation was done wherever possible on Tru-cut biopsies, excisional biopsies, and surgical specimens received. Statistical Analysis: The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. Results: Among 304 cases, 229 were benign and 75 were malignant on cytology. Out of this, 79 cases underwent histopathological examination, in which 32 were benign and 47 were malignant cases. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the present study were 79.16%, 96.77%, 97.73%, 75%, and 86.08% respectively. Conclusion: The FNAC is an important preliminary diagnostic test in palpable breast lumps and the results show a high degree of correlation with a final histopathological report.

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Introduction: Risk communication is a vital component of the management of health-care crisis including the present pandemic. The health-care professionals play an important role in risk communication; however, health-care professionals have been found wanting when it comes to risk communication during any health-care crisis. The doctors/health-care professionals, being the technical personnel, are required to provide the technical information in a nontechnical or laymen language to the relevant authorities, which in turn are expected to share this knowledge to the people at risk. This study attempts to unravel the perceptions of health-care professionals on this important topic concerning public health. Methodology: A cross-sectional descriptive study was designed for the study question. An online survey was conducted based on Google Forms using snowball sampling technique. The data, collected using a pilot-tested questionnaire, were compiled in MS Excel and analyzed using SPSS software version 23. Requisite permission was taken from the institutional ethic committee. All participants were informed of the voluntary nature of the study, and the data collection was done in an anonymous manner. Results: A majority of participants (61.5%) answered in affirmative when asked if they know what risk communication is and 13 (7.7%) were not aware of it. A majority of the participants (60.9%) perceived risk communication as an exchange of information between health experts and general public, whereas 23 (13.6%) participants felt that risk communication is exchange of information between health experts and other health-care workers. Rumor management was not considered an essential part of risk communication by about half (48.5%) of the participants. Conclusion: We found significant gaps in the knowledge and perception of risk communication in the health-care professionals, which can be attributed to lack of training. Risk communication needs to be incorporated as a part of formal medical education to plug this gap.

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Background: With the COVID-19 pandemic, the lockdown situation, work from home and teaching through the online platform is completely a “new normal” in the present time. It is probably a state of mental turmoil of fear, novelty and anxiety among the faculty. This state is likely to affect teaching performance, learning and also have implications for the health of the faculty. Objectives: To assess the fear of COVID-19 and its impact on the quality of life during the Lockdown situation among the teaching faculty of a Health University and also study the gender differences if any. Materials and Methods: A cross-sectional survey was conducted among the teaching faculty of a Health University during April 28 through to May 8, 2020. Randomly selected 270 faculty were sent Google link of the assessment tool using the University e-mail network. They had to fill the questionnaire based on their experience of the past 1 month. Assessment tools used were fear scale of COVID-19 and adapted with permission World Health Organization quality of life (QOL)-BREF QoL. Results: Out of the 270 participants, only 198 teaching faculty participated in the survey (response rate = 73.33%). The overall mean fear score was 18.69 ± 5.57 and the overall QoL mean score was 46.29 ± 4.02. There was a gender-wise statistically significant difference observed in the fear score (t = 2.34, P = 0.02), reporting more fear in the females (19.45 ± 5.81) as compared to the males (17.57 ± 5.01). There was a negative correlation between QoL scores and Fear score r = −0.24 (P = 0.000). Conclusions: There is certainly a fear about COVID-19, but it has not impacted the quality of life

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Stasis ulcers of the gaiter zone are difficult to heal due to deoxygenated blood congestion in peripheral areas and lack of oxygenated blood supply. Venous ulcers occur due to insufficiency of distal peripheral veins in legs. This manuscript refers to three cases of nonhealing venous leg ulcers treated with local application of Apamarga Kshara Taila along with some oral drugs. Three patients of nonhealing venous ulcer of the gaiter zone were treated with ayurvedic treatment protocol. In all patients after Panchavalkala Kwatha wound wash, Apamarga Kshara Taila was applied locally on wound once daily up to complete wound healing. In this series, wound healing was achieved in 96 days, 27 days, and 38 days, with a unit healing time of 4.311, 7.287, and 3.677 days/cm³, respectively. For the past 8 months, all three patients are living symptom-free life without any reoccurrence. On the basis of these cases, it can be said that Ayurveda principles of ulcer management have shown a promising role in wound healing and resuming improved quality of life without any untoward effects.

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Tubular carcinoma [TC] is a special type of breast carcinoma with favorable prognosis, composed of distinct, well differentiated angular tubular structures (90% or more according to WHO) with open lumina, lined by a single layer of epithelial cells. This pattern is better described as a necklace formed by a string of beads. 2 - 6% of all malignant breast tumors. TC is often multifocal or multicentric [20 - 55%]. Here we present a case report of TC of breast in a 76 years old male.

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Aim: We aimed to study intra-abdominal pressure (IAP) measurement using a new innovative technique with Foley's catheter. Introduction: Intra-abdominal hypertension (IAH) is defined as an IAP equal to or above 12 mmHg (16.31 cm of water) (1 mmHg = 1.3 cm of water) and abdominal compartment syndrome (ACS) is defined as an IAP above 20 mmHg along with organ malfunction. Effect of increased intra-abdominal tension is acute renal failure, pulmonary dysfunction, and decreased blood flow to the gastrointestinal organs. It may cause diaphragm elevation along with an increase in intrathoracic pressure causing pulmonary dysfunction and a decrease in the venous return to the brain leading to intracranial congestion and brain dysfunction. Increased IAP is commonly measured by recording intravesical pressure. In this study, we are using 50 ml of saline for urinary bladder pressure measurement through Foley's catheter. Methods: In this prospective study, we measured IAP by Foley's catheter in the urinary bladder in 250 patients which were admitted to our hospital. In this study, 196 patients were male and 54 patients were female. After establishing normal values in routine patients, the IAP was derived above which the values were considered as IAH. Results: Patients with laparoscopic abdominal surgeries, for example, laparoscopic appendectomy and/or laparoscopic cholecystectomy, obstructed hernia (enterocele) and intestinal obstruction, pancreatic ascites, pneumothorax, alcoholic liver disease with ascites, and chronic obstructive pulmonary disease, had raised IAP as compared to others. The average IAP of our patients who were routine patients was 7–9 cm of water. IAH was considered when values were above 9 cm of water. Conclusion: Our study showed that intravesical pressure measurement is a simple, minimally invasive method that may reliably estimate IAP in patients placed in supine position. When applied clinically, this should alert the clinician to take safety measures to avoid ACS.

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Background: Diagnosis of atypical glandular cells (AGCs) is challenging to the cytopathologist due to the overlapping features of various neoplastic and nonneoplastic lesions. The aim of this study was to assess the utility of conventional Papanicolaou (Pap) smears in detecting uterine glandular lesions. Materials and Methods: Archived records of all histopathologically diagnosed endometrial adenocarcinoma and endocervical adenocarcinoma during the study period were identified. Corresponding Pap smears, if available, were retrieved. In addition, all cytologically reported AGCs and adenocarcinoma during the same period were retrieved. Pap smears of histopathology discordance cases were reviewed. The prevalence of AGC and sensitivity and specificity of Pap smears in detecting glandular lesions were calculated. Results: The prevalence of AGC was 0.65%. There were 11 false negatives and 10 false positives initially, which were reduced to 6 and 5, respectively, after the review. The sensitivity and specificity of Pap smear in detecting AGC was 72.9% and 99.81% initially, which improved marginally to 81.8% and 99.9%, respectively. Conclusions: The prevalence of AGC in Pap smears is low with a moderate sensitivity and good specificity. As the association of clinically significant lesion is high, all cases with AGC diagnosis must be followed up with colposcopic and histopathologic examination of uterus and cervix.

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Oral squamous cell carcinoma metastasizes commonly to the lung, brain, skin, and occasionally to the bones such as vertebra and ribs. However, spread to the dorsal vertebra with cord compression is an extremely rare presentation. This case highlights this rare entity which was managed surgically. It enabled in ameliorating patient's distressing pain and restoring quality of life.

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The most common cause of hypercapnic respiratory failure is acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Many other factors can contribute to hypercapnia and may lead to refractory hypercapnia in AECOPD. One of the important causes is electrolyte imbalance. We report a case of refractory hypercapnic respiratory failure in an elderly female due to postthyroidectomy hypocalcemia. The patient responded well after the correction of hypocalcemia.

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Background: Diabetic retinopathy (DR) is a microvascular complication as a consequence of prolonged hyperglycemia and other risk factors. It is seen in both types of diabetes mellitus (DM) and can lead to progressive vision loss. Many prevalence studies were undertaken in the past, but the eastern part of India was less explored. Aim: (1) The aim of this study is to determine the prevalence of DR among both types of DM patients in an institution-based population of Kolkata. (2) To compare the clinic-biochemical profiles of patients with and without DR. Materials and Methods: From January 2019 to December 2019, 313 patients with a history of DM were screened for DR using slit-lamp bio microscopy with +90D lens after dilating the pupils. Classification of DR was done on the basis of International Clinical classification of DR. Metabolic profile of all participants was noted. Results: The overall prevalence of DR was 16.60% (14.37% nonproliferative and 2.23% proliferative). The prevalence was 80% and 15.58% among Type 1 and 2 DM patients, respectively. Diabetic macular edema was observed in 2.54% of cases. Highest prevalence (38.46%) was observed in patients suffering for more than 20 years of DM. The duration of DM was significantly higher among DR patients (9.46 ± 5.23 years vs. 7.34 ± 5.57; P = 0.012). Patients with DR also displayed significantly higher levels of glycated hemoglobin, creatinine, and albumin-creatinine ratio in comparison to the patients without DR. Conclusion: The prevalence of DR from an institution of Eastern India is comparable to other institutional studies conducted in the various parts of the country. The prevalence is higher among Type 1 DM patients. Nonproliferative DR is the most common type. Comparatively, DR patients had a longer duration of DM. Glycemic control and renal statuses are poor in DR than non-DR patients.

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5 month old female baby presented with cough followed by respiratory distress and not gaining weight. There was no history of fever, diarrhea or recurrent infections. Her elder brother died due to respiratory illness at the age of 8 months. There was accelerated reaction at BCG site. Repeated peripheral blood examination showed absolute lymphopenia. Thymus shadow was absent in X-ray. Patient was evaluated and diagnosed as Severe combined immune deficiency (T-, B+, NK-).

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Introduction: Posterior Reversible Encephalopathy syndrome (PRES) is an emergency medical condition with varied etiology, presentation and outcome reported in literature. The objective of this study was to determine the clinical and radiological presentations, and clinical outcomes in cases of PRES admitted over the last one year at a tertiary care hospital. Materials and Methods: We retrospectively analysed all cases diagnosed with PRES from May 2019 to May 2020. We reviewed clinical presentations, etiological history, imaging characteristics, management and clinical outcomes. Results: Five patients diagnosed with PRES were identified. All patients were females, with age range between 16 to 32 years. Etiological factors were eclampsia (2/5), drug (tacrolimus), massive blood transfusion and chronic kidney disease with hypertension. Headache was the most common clinical presentation. Other clinical presentations were visual symptoms, seizures, altered sensorium, vertigo and vomiting. The most common imaging characteristic was supratentorial T2/FLAIR white matter hyperintensity on MRI, predominantly in parieto-occipital region. Other areas of white matter involvement were cerebellum and brainstem. One patient had hemorrhage complicating PRES. All patients were primarily managed by elimination and treatment of the precipitating factors, along with standard anti-oedema measures and anti-epileptic drugs. There was complete recovery in all patients within one week. Conclusion: PRES has variable clinical and radiological presentation. Early diagnosis and elimination of precipitating factors are vital for complete recovery.

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Melkersson–Rosenthal syndrome (MRS) is a rare clinical syndrome. The onset of illness usually occurs in the second decade of life. It is characterized by idiopathic facial paralysis and/or fissured tongue with oro-facial swelling, mainly lip edema. The diagnosis is mainly clinical as the biochemical marker is not ascertained. The isolated facial palsy can mimic various other clinical entities including Bell palsy. The treatment guidelines for MRS are not mentioned in the literature, due to the paucity of randomized clinical trials, which could not happen because of its rarity. However, steroids are effective in this condition. This case report highlights the case of MRS with the typical triad of features, which is quite rare.

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Intestinal diaphragm disease is a very rare entity and is generally recurrent subacute intestinal obstruction. A 38-year-old male admitted to hospital with subacute intestinal obstruction. The patient had a history of long-term nonsteroidal anti-inflammatory drugs (NSAIDs) intake. On computed tomography scan, no pathology found except for dilated bowel loops. He underwent diagnostic laparoscopy which showed stricture along distal jejunum with proximal dilated gut loops with collapsed distal gut loops, found unusual thin intraluminal diaphragm with pinpoint 3 mm opening along with it there was one more diaphragm 2 cm distal to it with 2 mm pinpoint opening, resection of both the stricturous part was done, and end-to-end jejunojejunostomy was done. Here on, histopath grossly received a segment of the intestine in two pieces along with fibrofatty tissue. Cut-open specimen showed narrowing of the lumen and at one place is marked band-like constriction. Microscopic appearance shows ulcerations of lining epithelium. The submucosa shows fibrosis along with the proliferation of the muscle fiber, neural, and vascular elements giving impression consistent with the jejunal diaphragm. Here, we report an unusual case of intestinal diaphragm disease in relation to the use of NSAIDs. The aim is to sensitize the medical officers regarding the rational use of NSAIDs.

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Objective: The objective was to determine the sensitivity and specificity of tuberculin skin test (TST) in Bacillus Calmette–Guerin (BCG)-vaccinated children for diagnosis of tuberculosis (TB). Materials and Methods: This observational study was conducted at a single tertiary care center over a period of 32 months from March 2012 to November 2014. All children up to 15 years of age who had received BCG at birth, suspected of TB, and referred to pediatric TB clinic were enrolled in the study. All patients were given TST by 5 Tuberculin Unit Purified Protein Derivative-Standard. The diagnosis of TB was based on either clinical, histopathological, or bacteriological grounds. Results: Out of 371 patients, 341 (91.91%) had TB. TST was positive in 227 (61.2%) and negative in 144 (38.8%) patients. The sensitivity of TST to detect active TB was 62.8% and specificity was 56.7%. TST cutoff as ≥15 mm increased specificity of TST to 73.3%, but sensitivity decreased to 25.8%. Age, gender, and contact with TB patients did not affect TST results. Conclusion: The accuracy of TST for the diagnosis of TB is low with low sensitivity and specificity. By increasing the cutoff for positive TST to >15 mm, the number of false-positive TST can be reduced.

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The clinical impact of the new SARS-CoV-2 lineage B.1.1.7 on children and young people (aged 18 years or younger) regarding acute respiratory COVID-19 is yet to be fully defined. Media reports of increases in admissions to hospital and more serious illnesses in children and young people have resulted in chaos and panic in public and implicated the B.1.1.7 variant as a cause of more pathogenic infection within this group.

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The coronavirus disease 2019 (COVID-19) pandemic continues to increase in number and geographic distribution with each day. The Democratic Republic of Congo (DRC) has reported 161 cases, which amounts to 2.4% of the caseload in the African region, but it is the second leading nation in terms of reported deaths. From the public health perspective, the cause of concern is that local transmission has been reported and the fact that the nation has not yet completely recovered from the outbreak of the Ebola virus disease. The nation has already started its preparedness activities, and they are utilizing the setup, the facilities, and the experience gained by the health personnel for the effective containment of the outbreak of Ebola. In conclusion, the DRC has initiated its outbreak readiness and even implemented the response action plan in the nation against the COVID-19. Although the availability of resources in the nation is a challenging ask, the health personnel have utilized their experiencing of managing the Ebola outbreak and given a positive head start toward the containment of the infection within their settings.

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Non-fermenters are a group of organisms commonly isolated in different specimens from patients admitted in ICU. Besides, injudicious use of WHO Reserve group antimicrobials poses a patient at risk of acquiring infections by uncommon organisms especially non-fermenters. One such organism, Chryseobacterium indologenes has been mentioned in few case reports as causative agent of meningitis, infections of respiratory tract, urinary tract, surgical site infections, prosthetic valve infections and blood stream infections. Its identification and instituting antimicrobial as per the sensitivity pattern is a must for appropriate patient care. We report a case of pneumonitis by C. indologenes in an immunocompromised patient in ICU of a tertiary care hospital.

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