New Indian Journal of Surgery

 Non communicable diseases are the major, emerging and growing public health threats which have been silently creeping down our public health care system. If the current trend continues, NCD’S are expected to account for 73% of the deaths and 63% of the global disease burden, thus becoming the leading cause for mortality and morbidity. So a systematic approach towards these modifiable risk factors and their assessment is required.

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Key words: Latah; Indonesia; Perception; Perspective; Student.
 

  Early intervention, quality of CPR and time to defibrillation improves survival rate after cardiopulmonary arrest. BLS is an important component of the chain of survival. The proper practice of BLS is an important part of a medical student’s training, but there is still no standard protocol and routine training incorporated in the medical undergraduate training in developing countries like India. Medical graduates, never having had any formal training in CPR or BLS, often face difficulty in emergency situations.
 

  The chain of survival includes Basic Life Support (BLS) as an important element. Advanced Cardiac Life Support (ACLS) too plays an important role in its multiple key links. ACLS interventions depend upon the BLS groundwork of immediate recognition and activation of the emergency response system, early CPR, and rapid defibrillation to increase the chances of survival. The likelihood to achieve return of spontaneous circulation increases with drug therapy, advanced airway management and physiological monitoring. Knowledge of CPR is an important part of a medical student’s training, but there is still no routine training included inthe medical undergraduate teaching in developing countries like India. Therefore medical graduates often face difficulty in emergency situations.
 

  Nowadays, antibiotics are widely available and they can decrease the incidence of petrositis to approximately 2 per 100,000 children with acute otitis media. However, if left untreated, the condition may lead to morbidity and mortality from meningitis, brain abscess and lateral sinus thrombophlebitis. Petrositis may be associated with acute or chronic otitis media, as a result of spread of infection from the middle ear cleft to the petrous apex through perilabyrinthine and peritubal air cells. This study was done to discuss the management and outcomeof abducent nerve palsy in petrositis associated with otitis media.
 

  Tuberculosis (TB) is an infectious disease caused by the bacillus Mycobacterium tuberculosis which typically
affects the lungs (pulmonary TB) but can affect other sites as well (extrapulmonary TB). CNS tuberculosis is one of the most dangerous forms of tuberculosis and is noted in 5 to 10% of extrapulmonary TB cases, and accounts for approximately 1% of all TB cases. Any part of the CNS can be involved, from intracranial lesions to spinal lesions. Intracranial lesions can present as an abscess or a tuberculoma. Tuberculomas in the cerebellum are more common in children and usually present with raised intra cranial pressure and ipsilateral cerebellar signs. Our patient, a healthy adult male with no comorbidities, presented with chief complaints of hemiplegia and waslater on diagnosed to be having an ipsilateral cerebellar tuberculoma which is a rare presentation which strengthens the diverse presentations of CNS tuberculosis and the need to work up the patient in detail.

Keywords: CNS tuberculosis; Mycobacterium tuberculosis; Cerebellar tuberculoma; Hemiparesis.

  Breast cancer is the most prevalent malignancy amongst women in India. Increasing use of multimodality approach has led to an increase in the number of long term breast cancer survivors. To determine the long term effects of breast cancer and to evaluate the complete outcome of cancer treatment, it is essential to assess quality of life (QOL) of the survivors.
 

  Depression significantly contributes to the global disease burden. It is important to identify maternal depression in India since death rates due to suicide, a large proportion of which occur in women, are among the highest in the world here. Post partum depression has also been shown to have negative effects on the overall development of the infant. Several studies have been done on the prevalence of and risk factors leading to post partum depression, but there is still scarcity of data in our local context. There is also no standardised objective method, included in our routine post natal checks, to assess depressive symptoms. It is therefore important to study these symptoms in our hospital, it being one of the largest in India. Based on the DSM IV (Diagnostic and Statistical Manual of Mental disorders) criteria, post partum depression falls under the diagnostic criteria for Major Depressive Episode with postpartum onset. It states that symptoms must begin within four weeks of delivery, last a minimum of two weeks and cause clinically significant impairment in daily functioning.

  Breast cancer is the most common cancer among Indian women. Approximately 6% to 7% of women diagnosed with breast cancer are younger than 40 years at the time of their diagnosis. For many young women with early breast cancer, fertility is a priority. Increasing survival rates in patients affected by oncological disease and advances in reproductive medicine have led to the development and increasing use of various fertility preservation techniques.
 

  Housemaid is a female servant employed in domestic work like cleaning house, mopping floors, laundry and cooking. In India there are no laws to regulate the placement agencies for housemaids or even to define the rights of India’s unofficially estimated 90 million domestic workers. These women belonging to low socioeconomic class are subjected to heavy workloads and are thusprone to high health risks.
 

  Stroke is a major cause of long- term disability and has potentially enormous emotional and socioeconomic consequences for patients, their families, and health services. Early neurological deterioration (END) occurs in about 20% to 40% of patients with ischemic stroke and results in increased mortality and functional disability. In recent studies relative dehydration has been found to be associated with END in patients with acute ischemic stroke.
 

  India has earned the dubious distinction of being the “diabetes capital of the world”. As cited by the International Diabetes Federation Atlas 2012, there are 63million diabetics in India. The slum population seems to be at greater risk of developing diabetes.
 

  Diabetes mellitus is a chronic heterogeneous disorder characterized by chronic hyperglycaemia that develops as a result of interplay between the genetics and environmental factors. A high prevalence of Type 2 Diabetes Mellitus in relatives, especially offsprings, confirms that some individuals have an inherited susceptibility to development of disease. Diabetes is an important risk factor for development of cardiovascular & cerebrovascular diseases and an increased risk of mortality is strongly associated with the presence of cardiovascular autonomic neuropathy.Alteration of circadian rhythm of autonomic activity in offspring of type 2 diabetic parents has been reported, more so if they are insulin resistant. Heart Rate Variability(HRV),the computer assisted quantification of beat to beat fluctuation in heart rate, is a powerful tool for diagnostic & prognostic purposes in pathologies such as diabetes mellitus. Exercise, isotonic or isometric, has been reported to have a beneficial effect on the HRV response.
 

  Approaches to teaching correlate with quality of learning. Knowledge of anatomy, a foundation for practice of medicine, can improve by visualization. Dissection on dwindling ‘available cadaver’ population fails to achieve this in totality. Easily available laparoscopic surgery videos can be useful as visual teaching aids. Aim of teaching anatomy is to produce competent physicians. Today’s generation is multimediasavvy. Practice of medicine is also evolving with integration of multimedia technologies. Hence multimedia tools can be incorporated in teaching and learning as well.
 

 Despite the enormous role of Low Birthweight in neonatal mortality and morbidity as well as adolescent and adult morbidity, no clinical attempt is made to predict the possibility of a LBW neonate. A study conducted in Cleveland, Ohio proposed a Four-factor scale (low family functioning, stressful events, Quetelet’s Index, cigarette smoking) which predicted LBW with 65% sensitivity, 84% specificity and 42% positive predictive value. The need for such a scale in the Indian context was strongly felt and the present study undertaken.

  Adolescents constitute a large percentage of population, 21.3% of the total population of India is of adolescent age group. A wide range of issues and concerns faced by adolescents in India include nutritional deficiency, reproductive health problems, sexually transmitted diseases and mental and physical stress related problems. Many adolescent girls and boys are sexually active but lack information and skill for self protection. Communication gap exists with parents and other adults (lack of family connectedness). Habit and behavior picked up during adolescence have a lifelong impact. Adolescence is the last chance to correct these mal-habits.
 

  Nosocomial infections, or Hospital Acquired Infections (HAI), are a major global safety concern for both patients and healthcare professionals. Despite progress in public health and hospital care, infections continue to develop in hospitalized patients, and may also affect hospital staff.
 

  India was the first country in the world to formulate the national family planning program in the year 1952 with the objective of “ reducing the birth rate of the extent necessary to stabilize the population at a level consistent with requirement of National economy”. One of the main objective of the programme is to spread the knowledge of family planning methods and develop among the people an attitude favourable for adoption of contraceptive methods. The progress achieved in this sphere is normally assessed from the result of Knowledge, Attitude and Practice (KAP) Survey. Despite the fact that contraceptive usage has increased over a period of time, there exists a KAP- gap i.e. a gap between the knowledge, attitude and practices regarding contraception. In a developing country like India, over population is a major concern. Despite progress resulting from making contraception widely available, there is poor acceptance of contraceptive methods either due to ignorance or fear of complications using them. Inadequate knowledge about contraceptive methods and incomplete or erroneous information about their use or where to procure them are the main reasons for not accepting family planning. Keeping all the se facts in view this study was carried out to assess the knowledge, attitude and practice of contraceptive methods among females visiting a tertiary care public hospital in Mumbai.

  Spindle Cell Hemangioma (SCH) is a vascular tumour first described in 1986 by Dr. Sharon Weiss. It was initially considered to be a low grade malignant tumour due to its propensity for lymph node metastasis and recurrance after excision. But due to its excellent prognosis, it is now considered to be a benign tumour. It shows a male preponderance with the most common site affected being distal extremities. SCH is a pathological diagnosis with combined features of Cavernous Hemangioma and Kaposi’s sarcoma on histology.
 

Deafness in children is alarming and a cause of worry to near and dear ones. EBM documents that serious hearing impairment is found in one in 800 newborns. Amongst the 50 percent of permanent childhood deafness, 30 percent is syndromic and is thought to be because of abnormal genetic makeup. Syndromic cases of deafness are more accurately diagnosed by the associated additional features of the syndrome. Waardenburg syndrome is a rare, autosomally inherited disorder with distinct clinical manifestations of dystopia canthorum, white forelock, congenital hearing loss and heterochromia iridis.
 

Neonatal mortality in developing countries accounts for 30 – 50 % of infant deaths. Almost 20% of neonates develop sepsis and 1% die of sepsis related causes. Frequently isolated causative pathogens (Klebsiella pneumonia, Staphylococcus aureus, Pseudomonas, etc) known to be ESBL (Extended Spectrum Beta-Lactmase) producers are resistant to third generation cephalosporins, penicillins as well as to monobactams. The rampant irrational use of ordinary and high end antibiotics is responsible for this bacterial resistance.
 

  Diabetes Mellitus is a chronic hyperglycemia condition caused by absolute or relative insulin deficiency. In the course of the disease, metabolic changes occur affecting building blocks of fats, proteins and electrolytes especially calcium. Dexa machines allow early diagnosis and monitoring of minimal changes of 1%. Prolonged bad glycoregulation induces metabolic acidosis in patient with diabetes mellitus, which may cause disturbance in calcium metabolism.
 

 To study the clinical profile of children with Type I Diabetes.

 Hemophagocytic Lymphohistiocytosis (HLH) is a rare disorderofthe immune system,affecting macrophages that grow abnormally and accumulate in body organs which include liver, spleen, bone marrow, CNS and skin. There are 2 types of HLH: 

Primary: An inherited condition where there is a genetic mutation in:
• Perforin (PRF-1)
• Gene encoding Munc 13-4 protein which alters the NK & Tcell function.
Secondary: Triggered by infections (viral, bacterial, fungal), autoimmune disorders, primary immune deficiencies or cancer.

  Outcomes of very low birth weight (VLBW) infants have improved after improvement of medical care.
 

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  The standard care for patent ductus arteriosus (PDA) closure in preterms is by cyclo-oxygenase inhibitors i.e. non-steroidal anti-inflammatory drugs (NSAID) indomethacin or brufen. Administration of NSAIDs may precipitate acute kidney injury (AKI).
 

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  Hepatitis B virus (HBV) infection is a global public health problem. More than 2 billion people worldwide have evidence of past or current HBV infection and 350 million are chronic carriers of the virus, which is harboured in the liver and causes an estimated 600,000 deaths from cirrhosis of liver and Hepatocellular carcinoma.
 

  Misdiagnosis of acute appendicitis is a problem encountered in general surgery. There are different scoring systems for its diagnosis. Alvarado Score was suggested for diagnosis of Acute Appendicitis but this criterion ignores some factors such as age, gender and race.
 

Meningitis is an acute inflammation of leptomeninges and CSF caused by mainly bacteria, virus and less commonly fungus which has 50% case fatality rate if untreated. The most common symptoms are a stiff neck, high fever, sensitivity to light, confusion, headaches and vomiting. Meningitis is potentially fatal and should always be viewed as a medical emergency. Thus early diagnosis and effective management of suspected cases of meningitis will lead to significantly reduction in mortality.
 

  The eating behaviour of adolescents had become increasingly under spotlight in recent years I India, amid claims that many adolescents have a poor diet. Irregular meal pattern and skipping meals are common among adolescents in school going age group. Their food preference and the food fads are mainly formed by the environmental stimuli such as siblings, television advertisements, classmates, social gatherings, etc.
 

  Rheumatoid Arthritis (RA) is a chronic systemic inflammatory disease that primarily affects peripheral synovial joints and is characterized by joint swelling, joint tenderness and leads to destruction of the affected joints. However, persistent uncontrolled inflammation among poorly managed patients may cause several complications in RA known as extra-articular manifestations. RA is a common disease which affects all populations of the world though the prevalence varies in different populations. In a recent study the incidence of RA was found to be 1 %. Recent studies have shown that the cardiovascular disease plays an important role in increased mortality associated with RA. The excess cardiovascular disease encountered is believed to be due to the contribution of traditional risk factors (e.g. dyslipidemia, smoking, obesity, hypertension) as well as due to novel risk factors (e.g. systemic inflammation).In various studies it has been documented that lipid profile in RA is adversely affected. In general most studies have demonstrated a decrease in HDL – Cholesterol (HDL-C), while the effect on LDL-Cholesterol (LDL-C) has been found to be variable. The present study is being conducted as there is paucity of data on prevalence of lipid abnormalities in patients of rheumatoid arthritis in Indian literature. Lack of extensive research in this field necessitates further studies to establish a definitive conclusion in the Indian population.

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  Children need to develop good eating habits early in life. Overweight is a common nutrition problem among urban children in India today, because of reduced physical activity and faulty food habits. Healthy eating does not become habit overnight. Eating foods of little nutritional value such as candy, cookies, chips, savories, and soft drinks contributes empty calories to the diet. This usually prevents children from being open to eating the wide variety of foods needed for growth and good health.
 

  The teenage is a period of acceptance for many negative health behaviour including choice of sfood, vegetable and fruit consumption, etc. Several dietary behaviour have been linked with childhood obesity, including increased number of meals eaten outside the home, larger portion sizes of meals at restaurants and fast-food takeaways, and increased consumption of snacks and soft drinks. The ideations formed during the mid-adolescence lead to adoption of either favorable or unfavorable dietary pattern.
 

The rapid increase over the past three decades in the prevalence of childhood obesity in urban areas across India has led to increased concern about the diets of adolescents and children. Snacking is likely to play an important role in the development of overweight and obesity, yet little is known about the contexts of snacking in adolescents.
 

For many people now, mobile phone is essential to their life. Young adults who are enrolled in professional or other graduation studies in India, apart from using cell phones for call functions and sending and receiving SMS, often use them to play games, surf the internet, and send/receive emails. They also prefer playing with features on the cell phone (including reading online news and downloading songs, wallpaper, and ring tones) appears to have become the adolescent leisure phenomenon in recent years. As the phones have become cheaper and more sophisticated, sales of cell phones to teenagers have become more common. However, as the cell phones become more compact, concerns about problem use are growing. To date, there has been almost no study of whether cell phone use is addictive or dependence-forming among medical undergraduates, a major professional stream in India.

  Undergraduates enrolled in various institutes are highly exposed to usage of internet and most of them are having Facebook accounts. With the advent of availability of internet as data packages in smartphone, which are predominantly preferred by undergraduates worldwide, Most of them are engaged in some form of media use, particularly texting, music, the Internet and social networking like Facebook. So far most of the Indian studies have limited themselves to certain media such as cellphone and internet.
 

Hydatid disease is a parasitic infestation that is caused by Echinococcus granulosis. The liver is the most frequently involved organ (75%), followed by the lung (15%). The solitary retro-peritoneal localization is extremely rare, and its incidence is unknown. In our patient, the hydatid cyst was located intra-abdomen, retro-peritoneal, retro vesicular wall which makes this an interesting case.
 

  Trisomy 18 is second most common multiple malformation syndrome due to chromosomal abberation with an incedence of 1:3500 to 1:7000 newborns. This report shows a case presentation of a 7 year old male child with edward syndrome associated with hydrocele.
 

  A Parasitic twin is also known as an asymmetrical or unequal conjoined twin. Parasitic twins occur when a twin embryo begins developing in utero, but the pair does not fully separate, and one embryo maintains dominant development at the expense of the other. The undeveloped twin is defined as parasitic and the independent twin is called the autosite. The estimated incidence of heteropagus parasitic twins is approximately 1 per 1 million live births. Isolated case reports comprise most of published work on this rare congenital anomaly.
 

  Malignant Mesothelioma is an uncommon and aggressive form of cancer that develops in the membrane lining of visceral organs especially lungs. This tumor occurs in men who are exposed to asbestos for over 30 years and is associated with a poor prognosis.
 

  Diabetes has emerged as a major healthcare problem in India. According to Diabetes Atlas published by the international diabetes federation (IDF) there were an estimated 40 million persons with diabetes in India in 2007 and this number is predicted to rise to almost 70million people by 2025. Diabetes Mellitus is multifactorial disease main risk factors include modifiable variables like Body Mass Index (BMI), physical inactivity, diet, infections and non–modifiable variables like age, family history of Diabetes Mellitus.
 

  In the recent past, antibiotic resistance observed from the isolates of the intensive care units was one of the biggest problems faced by the clinicians. E.coli, Staph.aureus, Klebsiella, Acinetobacter, Pseudomonas and Enterococci (ESKAPE organisms) are the most commonly implicated organisms when multi drug resistant pathogens are discussed.
 

  India is one of the countries with a very high prevalence of anemia in the world, affecting almost 75% of the Indian population. Iron supplements are the mainstay of therapy. They are also used for prophylaxis of iron deficiency anemia. There is an increasing concern over the large-scale availability of various iron supplements as fixed dose combinations with other vitamins/minerals/antioxidants as ‘over the counter’ agents, thereby escalating cost of treatment.
 

  Melioidosis is an emerging infection in India caused by gram negative non -fermentative Burkholderia pseudomallei. This bacteria is also known as Vietanami timebomb or remarkable imitator. Infection may be acute or chronic, localised or disseminated. Several reviews have summarized the clinical manifestation of meliodiosis as mild and sub clinical infection, latent infection, clinical disease either septicaemic or localised. Up to 80% of cases have underlying disease, most frequently diabetes mellitus. It may involve any system of the body namely lung, liver, spleen, kidney, prostate, bone and joints. Visceral abscess is one of the most common presentation in melidiosis specially splenic involvement.
 

Deep Vein Thrombosis (DVT), a kind of Venous Thromboembolism (VTE), is a potentially fatal disease causing significant morbidity, mortality and expenditure. Treatment aims at preventing the thrombus extension and pulmonary embolism (PE) and decrease the incidence of recurrent VTE and post-phlebitic syndrome (PPS). Many lines of treatment were tried, however now its dealt with heparin for a week overlapping with Oral Anticoagulants (OACs) and once effects of these are established OACs are continued for 3-6 months with International Normalised Ratio (INR) monitoring. INR is roughly the ratio of the patient prothrombin time to the mean normal prothrombin time. The recommended INR for prophylaxis and treatment of thrombotic disease is 2-3. Resistance to warfarin has been described as the inability to prolong the prothrombin time or raise the INR into the therapeutic range (TTR) when the drug is given at normally prescribed doses. Warfarin resistance is very difficult to determine because it varies within population depending on individual dietary habits, metabolic status let alone the genetic makeup. Warfarin failure is also reported, defined as a new thrombotic event despite a therapeutic prothrombin time and INR. Moreover, warfarin differs from most other drugs in that the dosage required to achieve a desired therapeutic effect varies greatly among individuals, hence many patients are also unable to achieve or maintain the target desired INR.

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Unwanted pregnancy followed by unsafe abortion is one of the major worldwide health problems,which has many negative consequences on the health and well being of women. Information about women’s knowledge, attitude and practice of emergency contraceptives plays a major role in the reduction of unwanted pregnancy. Many misconceptions and misunderstandings abound regarding emergency contraception.
 

  Dieting is emerging as the preferred mode for weight loss among adolescent females. Despite being medical students, the adverse effects of improper dieting may be ignored by many. Healthy diet restriction and restriction of majority of food components for weight loss is perceived assimilar. Thus, often in the process of unguided dieting, intake of even those nutrients which are essential for health is neglected. This may lead to various deficiencies and disorders, e.g. deficiencies of fat soluble vitamins (A,D,E,K), osteoporosis, menstrual abnormalities, etc.
 

  Acute pesticide poisoning is one of the most common causes of intentional death worldwide.
 

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  A non-communicable disease, or NCD, is a medical condition or disease which by definition is non-infectious and non-transmissible among people. They include heart disease, stroke, diabetes and more. Medical students, owing to the pressure associated with this field often ignore their health,unhealthy eating habits,sleeping less and not exercising enough, the reason being the stress associated with this field.
 

  Collodion baby is a rare congenital autosomal recessive skin disorder characterised by parchment like taught membrane covering the whole body.Incidence of collodion baby is very low, 1 in 3, 00,000 cases of newborns worldwide.Neonatal complications can occur in 45% of all collodion babies.
 

  The incidence of Gall Bladder cancer (GBC)is on a rise in India, particularly in the northern parts of the country.The incidence of GBC among women in northern India is one of the highest in the world.The etiopathogenesis of GBC is not well understood. However, the wide geographical and ethnic variations in the incidence of GBC suggest a role of genetic and environmental influences on its carcinogenesis. While gall stones are considered as an important risk factor for GBC only 1 to 3 percent of patients with symptomatic cholelithiasis develop GBC. Other proposed risk factors include female sex, Salmonella typhi carrier status, dietary factors, heavy metals in drinking water and other environmental exposure to specific chemicals. However, the current knowledge about the risk factors for GBC is limited.
 

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  NSAID’s though useful in the treatment of inflammatory conditions, caused increased mucosal damage to upper git. During the past two decades the deleterious effects of NSAID’s on small intestine and colon have been recognized like strictures, ulcerations, perforation and villous atrophy. However the proportion of patients who develop clinically important NSAID induced enteropathy remains relatively small.
 

  Ocular ultrasonography imaging is a diagnostic technique to analyse the intra-ocular structures especially in opaque media like cataract and vitreous haemorrhage. It is useful in cases of injury to the eyeball,posterior segment diseases of vitreous, retina, choroid, opticnerve, retro-bulbar spaces and orbits in addition to calculation of intra-ocular lens power.
 

  The human character of curiosity to explore new things is as old as history of mankind and when he starts exploring different streams of science, it creates wonders. So, let’s engineer dentistry. For a long time, Prosthodontics therapy focused mainly on the technical and clinical expertise required to fabricate complete dentures. This approach helped nurture the development of new ideas. The masticatory functions depend upon muscular forces and facility with which the patient is able to coordinate with these movements.But in complete denture wearers, computed tomographic study of masseter and medial pterygoid muscles have demonstrated greater atrophy and so is the reduced biting force. The sequele of this is impaired nutrition and this leads to poor and debilitated health in old age. The condition becomes worse in which motor control of muscle is affected as in Parkinsonism and Myasthenia Gravis (disorder which interfere with impulses and hence results in weak, easily fatigued muscle). Further more to attenuate problems of elderly debilitated patients in which denture wearing, its retention and mastication is almost impossible.
 

  Soft contact lenses are finding more users by the day, who often opt for using contact lenses without being
aware of the proper usage and handling instructions leading to their contamination and thus, the incidence of contact lens induced infections is also increasing.
 

  Insertion of drains after surgery has been a matter of constant discussion over the past many decades, yet there is neither conclusive evidence nor guidelines over their benefits and use of drains after surgery. The decision rests on the surgeon’s choice, who takes into consideration patient’s co morbidities and disease conditions.
 

  Osteoporosis and osteopenia are emerging as a major public health problem in India, associated with substantial morbidity and socio-economic burden. An early detection can help in reducing the fracture rates and overall socio-economic burden in adult population.
 

  Ozone therapy has shown promising results due to its analgesic, anti-inflammatory & immunomodulatory effects in treating lumbar disc herniation (LDH). As such, little data is available regarding the efficacy of ozone in Indian literature, evincing it’s low prevalence despite its numerous advantages.Thus, we aim to study the effectiveness of intra-discal ozone therapy in reducing pain & disability in patients of LDH.
 

  The current medical scenario in India has faced a drastic change. A place where doctors were considered next to gods and worshiped now sees them being dragged to the roads and beaten. Moral degeneration has engulfed the noblest profession of them all, in the most ferocious way. Hence, it is important to inculcate moral values in a doctor right from the beginning of the course. And the study is based on such budding doctors of the nation.
 

  By maintaining immunological self-tolerance, a subset of lymphocytes known as regulatory T cells (Tregs) play a key role in preventing the development of autoimmunity. These Tregs express a host of receptors,
including pathogen recognition receptors (PRRs) of the innate immune system known as Toll-like receptors (TLRs). Ligation of these TLRs with pathogenic antigens known as pathogen associated molecular patterns (PAMPs) has been reported to modulate Treg function. Ligation of TLR2 in particular, has been reported to reduce the suppressive capacity of murine and human Tregs by unknown mechanisms. However this was recently elucidated upon when ligation of the TLR1/2 heterodimer was observed to enhance interleukin (IL)-6 and transforming growth factor (TGF)-â expression by Tregs. These cytokines have a vital role in regulating the reciprocal and mutually inhibitory relationship between Tregs and T-helper (Th) 17 cells- a subset of lymphocytes which are key in the pathogenesis of autoimmune diseases and protection against bacterial infections. The presence of IL-6 can alter the balance between Tregs and Th17 cells in favour of the latter by inducing differentiation of naïve T cells towards the Th17 lineage, whilst also inducing concomitant inhibition of Treg differentiation.

  Leprosy continues to be a significant problem in certain pockets of developing countries. India is the leading responsible country for the world-prevalence of leprosy. Globally, 60% of the estimated cases are contributed by India. MDT (Multi-drug therapy), which is the treatment recommended by WHO, cures patients and interrupts transmission of leprosy and prevents disabilities. However, MDT has been associated with problems like undesirable side- effects, poor compliance, drug resistance and high relapse rates. Considering the number of cases contributed by India, it has serious implications. Thus, present study was undertaken to analyse the prescribing pattern and drug-related problems in patients with Hansen’s disease.
 

  People consume drugs to alter the way, they feel, think, or behave. These kinds of substances are named psychoactive and cover alcohol and tobacco as well as natural and manufactured drugs. Drug abuse affects most countries in the world, both rich and poor. This drug menace crosses national, racial, religious and gender lines. Drug addicts vary from the homeless, to white-collar professionals, college students to rural farmers, street children to urban teenagers. Alcohol being a habit forming drug can be harmful in a number of ways, through both immediate effects and damage to health over time. Chronic use of alcohol affects cognitive development and short-term memory.
 

  Type 2 diabetes mellitus(T2DM) has attained a state of epidemic of late. It is known to predispose many a number of systemic complications, starting from myocardial infarction till candidial infections and still the count goes on. A lot of drugs are in use and also in the process of making to control diabetes. Incretin and its analogues are a recent advancement. Artificial sweeteners are also used to control blood sugars. Could they have an impact on the level of incretins as well?
 

  Alcohol is one of the important agents belonging to the group of drug abuse and drug addiction. The consumption of alcohol has been dramatically increased for the quite few years. Human society has been engulfed by the deleterious effect of alcohol. It is proven to cause behavioral abnormalities on long term use.
 

  The non-medical usage of habit-forming drugs is not a new phenomenon. Its pattern and trends may have
differed, but it has been with us for generations. The problem in recent times has reached precarious magnitudes. Chronic alcohol consumption plays a pivotal role in habit formation. Its usage has proven to cause behavioral abnormalities.
 

  The burden of diabetes in Asian countries is disproportionately high in young to middle-aged adults.Evidence of glucometer in self monitoring of blood glucose in diabetes mellitushas been found satisfactory. Capillary blood glucose also being used for screening purpose in epidemiological studies.In view of increased use due to its quick result and easy to use property it is imperative to conduct a study to know its efficacy and correlation venous blood glucose.
 

  The tuberculin test is a time tested immunological tool used for the diagnosis of Mycobacterium tuberculosis infection. Only very few studies are available reporting the prevalence of tuberculin positivity in adolescents, a high risk population for tuberculosis. Tuberculin reaction is read after 48 to 72 hours, which results in delay in the diagnosis of infection. Recent studies in healthy younger children have shown that 24 - hour tuberculin skin test evaluation is possible.
 

  Cardiovascular disease is the leading cause of nonHIV-related death in people with HIV infection. Risk in HIV-infected persons appears to reflect contributions of non-HIV-related cardiovascular risk factors, the chronic inflammatory response in HIV infection, as well as metabolic adverse effects of antiretroviral therapy like insulin resistance, dyslipidemia, abnormal fat distribution, and hypertension.
 

Stroke is cerebrovascular disease caused by cessation of arterial blood flow to the brain. Approximately 80- 85% of strokes are ischemic strokes caused by arterial obstruction in the circulation of cerebellum. Cerebral hypoxia caused by ischemia of the brain gives result in alteration of cells morphology and cell death in which neuron cells become picnotics. This will later manifests in the form of neurological disability shown in the affected individuals resulting in the need to take long term medication. Citicoline is an effective drug for stroke based on research but has drawbacks in term of usage and high price which cause it to be less efficient in the community. The herbs cat root and Indian pennywort are alternative drugs for stroke therapy because of its neuroprotective effects. Combination dose of these two herbs are expected to provide a change in number of picnotic cells in rat’s brain.

  The present study looked at 9 mutations (mentioned in the findings) in young Indian thrombophiliacs for the first time to extensively study their role in the pathogenesis of thrombosis.
 

  Meckel’s diverticulum, an anomaly of the gastrointestinal tract, is usually asymptomatic, but can cause intestinal obstruction.
 

  Diabetes represents a major public health burden, both locally and globally. Future projections have estimated the prevalence of diabetes to exceed 300 million cases by 2030, with the majority of growth occurring in developing countries. It is well known that diabetes is associated with significant morbidity and mortality.
 

WHO progress report- 2011 on HIV/AIDS in South East Asia Region reveals that 34 million people were living globally with HIV , and 2.4 million were in India. National prevalence rate was found to be 0.31% and 0.48% in women attending Antenatal clinics. The Indian subcontinent is classified as an intermediate Hepatitis B Virus (HBV) endemic (HBsAg carriage 2-7%) zone. India has 43 million HBV positive and 15 million HCV positive persons. The risk of transfusion transmission of these viruses may be alarming due to high seroprevalence of HIV, anti-HCV, and HBsAg (0.5%, 0.4%, and 1.4%, respectively) among blood donors. Blood is one of the major sources of transmission of hepatitis B, hepatitis C, HIV, syphilis, and many other diseases. In July 1989, mandatory screening of blood and blood products for HIV antibodies was initiated by Indian National AIDS Control Origination (NACO). Testing for human immunodeficiency virus (HIV), syphilis, and hepatitis B surface antigen (HBsAg) in pregnancy and labor is medically indicated to prevent vertical transmission. Prevalence of these infections among the antenatal population may be a reliable indicator of general population prevalence and determinant of vaccination policy . Successful interventions to prevent vertical transmission linked to intrapartum rapid testing have been demonstrated in a variety of limited resource settings Keeping in mind the grave consequences of these infections and to restrain the transmission to minimum, it is very important to remain vigilant about the possible spread. Routine surveillance, screening of blood donors, strengthening the services for treatment of sexually transmitted diseases, preventing mother to child transmission of blood borne pathogens has been put forward by NACO for strict implementation.

  Self medication is the use of medication without prescription, orientation or supervision of a physician or dentist. Self medication may create a serious health problem in a young generation of medical fraternity.
 

  Nephrotic syndrome and cholelithiasis is very rare association though not unexpected. Nephrotic syndrome itself or prolonged steroid therapy can lead to persistent hyperlipidemia which may cause atherosclerosis and glomerular injuiry. But association of nephrotic syndrome and cholelithiasis has not been described in literature and very few cases have been reported previously.
 

  Diabetes mellitus is a metabolic disease characterized by hyperglycemia resulting from defect in insulin secretion, insulin action or both. The chronic hyperglycemia of diabetes mellitus is associated with long-term damage, dysfunction and failure of various organs, especially retina, kidney, nerves, and in addition an increased risk of cardiovascular disease. 347 million people worldwide have diabetes and it is a major health problem for developing and developed countries. Diabetes retinopathy is a one of the major diseases causing blindness. It is important to assess the knowledge, attitude and practices regarding eye complications and eye care in order to prevent the occurrence of diabetes retinopathy and to implement effective health promotion among diabetes patients.
 

  The Consumer Protection Act(CPA) was enacted by Parliament of India in 1986. CPA was passed to provide better protection of the interests of consumers which turned out an important milestone in Indian Legislation giving rise to consumer jurisprudence.The medical profession was brought under the ambit of CPA in 1995 by Supreme Court. Before this act the medical negligence disputes were dealt by relevant sections of Indian Penal Code. These claims expensive and time consuming. The changes in the trends of practice of medical profession, increasing awareness of consumers, changing concepts, updated laws makes it imperative on part of medical practitioners to have adequate knowledge and awareness about CPA with updates to provide better services and prevent consumer disputes.
 

Trichuriasis is a worldwide problem for public health and estimated 25% of world population infected with T. Trichiura or Trichuriasis. Trichuriasis is an infection of the gastrointestinal tract caused by T. trichiura. Especially in Indonesia, trichuriasis has high prevalence because Indonesia located in tropical and subtropical regions that have a warm and humid climate. The prevalence of intestinal worms (including Trichuriasis) in Indonesia is still relatively high at 40% -60%, but in children the prevalence of infection can reach 90% it is caused by frequent contact with soil, poor sanitation, the type of soil and the lack of awareness to maintain hygiene. Trichuriasis can cause a variety symptomps, but in children can lead to failure growth and development. In East Jakarta, there is an orphanage that housed many orphans with varying characteristics demography and relatively poor hygiene, hence susceptible to get Trichuriasis and need to educate. Appropriate education depend by prior knowledge and demographic characteristics. Therefore need to understand the relationship between characteristics demographic and level of knowledge about Trichuriasis.
 

Leukemia showing relapse in the eye, may have the ocular manifestations ranging from leukemic retinopathy to involvement of the iris and anterior chamber. Ocular manifestations presenting as hypopyon may occur in relapse Acute lymphoblastic leukemia (ALL), Acute Myeloid Leukemia (AML), and Chronic Myeloid Leukemia (CML). We report a case of unilateral hypopyon as a rare presenting feature of relapsed Acute Lymphoblastic Leukemia (ALL) in a paediatric patient. Relapse in ALL usually occurs in bone marrow, CSF and testis. Ocular manifestations are extremely rare. We report a 5- yearold male child presented with unilateral hypopyon after completion of chemotherapy. Anterior chamber aspirate showed malignant cells (leukemic infiltrates). Subsequently, he was found to have relapse in bone marrow and CSF too. After initiation of chemotherapy, his hypopyon resolved and he is doing well in follow up.

Dermatoglyphics have been correlated with different diseases by many of the studies. Several studies have explored the relationship of dermatoglyphics to schizophrenia, alopecia, mental retardation, congenital heart defects and diabetes melli-tus. Special space is occupied by the ones with the severe congenital and hereditary ocular diseases. There were reports on isolated clinical cases only, or in a small number of patients which demonstrated the presence of important abnormalities or distortions, with clinical implications, in the dermatoglyphic picture of the affected people. However, there is no documented work concerning dermatoglyphics in blind patients of South India.
 

Alcohol abuse and alcoholism are one of the major public health problems in both developed and developing countries. It is major cause of mortality and morbidity. Consumption of alcohol has increased in Indian society in recent years. Alcohol consumption accounts for nearly 4% disability -adjusted life years (DALYs) lost. It not only causes chronic disease like liver cirrhosis, pancreatitis but also has social consequences such as road traffic accidents, family and domestic problems, interpersonal violence and received more public and research attention. Pondicherry is place where there was French rule before independence and influenced by mix culture .Tourism and easy availability of alcohol in shops in comparatively low rate increases alcohol consumption in this Union Territory.
 

Immune checkpoint pathways are the signaling pathways which regulate the immune response to minimize the peripheral tissue damage during an immune response. These immune checkpoint signaling pathways are activated by receptor-ligand mediated interactions. As seen in the formation of many kinds of tumors, the improper regulation of the immune checkpoint receptors and/or ligands in the tumor microenvironment lead to a suppressed immune response against the tumor. Cytotoxic T lymphocyte associated antigen 4 (CTLA4) or CD 152 is an immune checkpoint receptor expressed on T lymphocytes. When engaged with its ligands, which also happen to be the ligands for the T cell Co stimulatory Receptor, CTLA4 inhibits T cell activation. Experimental data suggests that CTLA4 is overexpressed in the tumor microenvironment leading to a suppressed immune response against the tumor. Ipilimumab, a fully humanized monoclonal antibody for CTLA4 was developed and rigorously tested in the clinic. In 2010, Ipilimumab was US FDA approved for the treatment of patients suffering from advanced and unresectable metastatic melanoma as it was the first ever drug to show a survival benefit in advanced metastatic melanoma. Even though treatment with Ipilimumab showed a survival benefit, the response rates were not satisfactorily high. The response was also delayed and in few patients the response was seen after an initial increase in the tumor burden. In this poster we suggest the administration of different therapeutic agents in synergy with Ipilimumab, also known as combination therapies, for a faster and more efficient response. The delayed response might be explained due to an insufficient immune response which might happen due to the following three possibilities: (i) Insufficient amounts of antigen available. (ii) The increase in T cell activation due to the blockade of CTLA4 might not be sufficient. (iii) The effector T cell functioning might be reduced. We put forward a few combination therapies with Ipilimumab that can overcome the above three possibilities and hopefully increase the response rates as well as time for response in the treatment of advanced metastatic melanoma.

 The short discontinuance of cerebral blood flow causes permanent brain injury and behavioral dysfunction. The hippocampus, specifically the CA1 pyramidal cell layer, is highly vulnerable to ischemic injuries. There is no effective pharmacological strategy for improving brain tissue damage induced by cerebral ischemia. Previous studies reported that pentoxifylline has a neuroprotective effect on brain trauma and it is well known that endogenous estrogen improves stroke outcome during vascular occlusion by exerting both neuroprotective and flow-preserving effects. The possible positive effects of pentoxifylline and endogenous estrogen on behavioral deficit were studied in female Wistar rats in estrous phase subjected to an experimental model of transient global brain ischemia.

Keywords: Pentoxifylline; Spatial memory; Brain ischemia; Estrous phase.

  Cerebral ischemia is known as a major problem in the world. Transient global cerebral ischemia causes loss of pyramidal cells of brain cortex following global ischemic/reperfusion. Recently, using immunophilin ligands has been considered as a potential and appropriate strategy for neuroprotection. Since it was observed that tacrolimus (FK506), a useful immunosuppressant used in organ transplantation, provides neuroprotection and prevents neuronal damage,the importance of immunophilins in the development of neuroprotectors has emerged.
 

  Sedentary lifestlye affects health of the population.

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  Multiple gastric polyps are a very rare occurrence and are most often seen as part of polyposis syndromes of the gut. The polyps have considerable malignant potential.
 

  Pharmaceutical Promotion refers to all the information and persuasive activities by manufacturers and distributors in order to induce the prescription, supply, purchase and/or use of medicinal drugs. There is evidence that drug utilization problems are increasingly encountered in many developing countries due to irrational drug advertisement, lack of knoweledge and practice regarding WHO Ethical Criteria for medicinal drug promotion among prescribers and medical representatives.
 

  Indonesia as a tropical country is a good place for the growth of A. lumbricoides. Infection of A. lumbricoides is usually asymptomatic, but it can manifest symptomps such as abdominal pain, nausea, diarrhea an respiratory disorder.

Keywords: Knowledge; A. lumbricoides; Clinical manifestation; Orphanage.

  Primary malignant brain tumours are rare with high mortality rate. Management and prognostication of these tumours remain as the greatest challenge in oncology. Correct identification of the lineage of origin and also differentiating primary from secondary neoplasms constitute the basis for definitive management of these tumours. In many cases the clinical profile, neuroimaging studies, and histological appearances of the tumour may not be diagnostic of a particular neoplasm.
 

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 The cytochrome P-450c17alpha enzyme encoded by the P-450c17alpha (CYP17) gene functions in the key steps of the estrogen synthesis pathway. The genetic variation in the maternal CYP17 gene leads to differences in estrogen level which affects fetal growth and causes fetal growth restriction (FGR). Organochlorine pesticides (OCPs) are endocrine disruptors which alter the normal estrogen-progesterone balance and are reported to be associated with adverse reproductive outcomes.

  Since 1992, the World Health Organization(WHO) has recommended initiation of breastfeeding in the first hour of life. Early initiation reduces neonatal mortality and long term morbidity in children. According to WHO , an estimated 4 million newborn deaths occur every year of which most are caused by infections which can be prevented by early initiation of breastfeeding. Also, early successful establishment of breastfeeding sustains breastfeeding throughout infancy. Even after 21 years of the recommendation, early breastfeeding is followed by only a mere 23% of Indian women. Lack of knowledge is a major barrier, and hence this study was conducted to determine if counseling improved the statistics of early breastfeeding.
 

Ameloblastoma is a benign odontogenic tumor, usually affecting the posterior region of mandible. It is seen in the third to fifth decades of life. It is believed to arise from dental lamina remains, the enamel organ in development, epithelial cover of odontogenic cysts or from the cells of the basal layer of the oral mucosa. Its clinical presentation is that of an asymptomatic slowgrowing tumor. Despite being a benign tumor, it has an invasive behaviour with a high rate of recurrence if not treated properly.
 

 Alström syndrome is a rare autosomal recessive genetic disorder characterised by multi organ dysfunction
with an estimated prevalence of less than 1 in 1 million has about 700 cases reported worldwide and only about 20 cases from India.It is a rare autosomal recessive genetic disorder, first described in 1959, by Carl Henry Alstrom. It is caused by mutation in the ALMS1 gene, located on the chromosome 2p13. The clinical features usually start from childhood with congenital progressive cone-rod retinal dystrophy leading to blindness, sensorineural deafness, truncal obesity. They also have features of insulin resistance with hyperinsulinemia, type 2 diabetes and acanthosis nigricans. The other biochemical alteration is hypertriglyceridemia which may lead to pancreatitis. The endocrinal abnormalities are hypothyroidism and hypogonadism with gynecomastia and reduced fertility. Increased incidences of serous otitis media and fluid retention have also been reported.

  Menopause marks the end of the reproductive phase of a woman’s life. A range of symptoms are experienced by women at this stage of life. These symptoms are mainly vasomotor, somatic and psychological in nature and disrupt the quality of life of women in that age group. Sufficient data from Indian studies to formulate strategies to alleviate these problems faced by a large proportion of women is still lacking from both rural and urban populations.

 In India, around 46% of all children below the age of three are too small for their age, 47% are underweight and at least 16% are wasted. Many of these children are severely malnourished. Malnutrition in early childhood has serious, long-term consequences because it impedes motor, sensory, cognitive, social and emotional development. Malnourished children are less likely to perform well in school and more likely to grow into malnourished adults, at greater risk of disease and early death. Around one-third of all adult women are underweight. Inadequate care of women and girls, especially during pregnancy, results in low birth weight babies. Nearly 30% of all newborns have a low birth weight, making them vulnerable to further malnutrition and disease.

 Hospitals have hundreds of patients, visitors and health care professionals who are at risk in case of a fire. Health care setups are particularly high risk zones for fires because of the chemicals, materials and other consumables used. Hospitals may be well equipped with all gears required to combat a fire emergency, but lack of knowledge among staff regarding its usage will prove it futile. All healthcare facilities must have a plan for the protection of all persons on their premises and for their evacuation from the building in case of fire. Recent fire accidents in two of the reputed tertiary care teaching hospitals in Mangalore and the ill-fated fire accident in AMRI Hospital, Kolkata have provoked the need for this study.

  Unintended pregnancies are pregnancies that were unwanted at the time of conception. Unwanted pregnancies are the primary cause of induced abortion. Unwanted pregnancy is linked to numerous maternal and child health problems. Most of the deaths occurred in less developed parts of the world, where family planning and reproductive health services were less available. In recent years, unwanted pregnancy has emerged as an important public health concern in both developed as well as developing countries because it is not only distressing for the affected women and children, but can also have far-reaching health, social and economic consequences.
 

  The main purpose of Frozen Section (FS) reporting is to provide rapid diagnosis to guide intra or peri-operative patient management. The indications of FS are rapid diagnosis of benign versus malignant in an undiagnosed tumour, identification of tissue and unknown pathological processes, evaluation of margins, identification of lymph node metastasis, confirmation of presence of representative samples for paraffin section diagnosis. Clinically detected ovarian masses have a heterogenous nature, including neoplasms and benign non-neoplastic lesions or cysts. The 3 main categories of ovarian neoplasms are benign, borderline and malignant, which differ with respect to their biological characteristics, management and prognosis. Perioperative imaging have only limited value in differentiating between these tumor categories. Intraoperative pathology consultation or frozen sections can help clinicians in making an appropriate decision on the surgical management of ovarian neoplasms.The extent of surgical management is based on the histologic diagnosis and the category of tumors.

  Physical activity and Sports are generally promoted for their positive effect on children’s health. In addition to the positive physical & mental health impact of physical activity there is a strong belief that regular participation in physical activity is linked to enhancement of brain function & cognition Regular participation in sport activities may improve children’s classroom behavior & increase the odds of better concentration on classroom teachings. Participation can help students to set goals, manage time & build self-esteem. Thus, these students are determined to do better in life than those students who do not undergo any Physical activity. The time a student devotes to his physical activity is inversely proportional to his Body Mass Index (BMI), a reliable indicator to classify an individual as healthy or otherwise .In our country, due to the increased syllabus & academic pressure, supplemented by pressure from parents, many students now prefer to study in their play time hours. This has resulted in increased obesity with increased BMI.
 

  The Government of India estimates that about 2.40 million Indians are living with HIV (1.93 3.04 million). Children (<15 years) account for 3.5% of all infections, while 83% are the in age group 15-49 years. A study prescribing patterns is an important tool to determine rational drug therapy and maximum utilization of resources. The incidence of HIV is currently on the rise. The rapeutics in HIV positive patients is complicated and involves poly-pharmacy. Presence of co-morbidities further complicates the situation. In such a scenario it is necessary to be aware of the prescribing patterns in current existence and to evaluate them for their appropriateness. There is currently a dearth of data on the subjec
 

Over 33 million people world-wide and 2.40 million Indians are suffering from HIV/AIDS. The first-Line ART proposed by WHO includes two Nucleoside Reverse Transcriptase Inhibitors (NRTIs) and a Non Nucleoside Reverse Transcriptase Inhibitor (NNRTI). The ART treatment was initiated in India in the year 2004.

 

Stress is a reaction of the body to any change that requires physical, mental or emotional adjustments. Individual differences in stress reactivity have been proposed as a potentially important risk factor for genderspecific health problems in men and women. The Autonomic regulation of the cardiovascular system is most commonly affected and is assessed by means of spectral analysis of short term heart rate variability (HRV). HRV was measured in time and frequency domain parameters.
 

  Dyslipidemia which has been closely linked to the pathophysiology of cardiovascular disease is a key independent risk factor for cardiovascular disease. Highly active antiretroviral (HAART) has dramatically reduced AIDS morbidity and mortality; however the studies have shown that HAART is associated with increase in incidence of dyslipidemia. So it is very necessary to screen every individual seropositive with HIV who is going to start HAART to minimize the comorbid risk of cardiovascular disease in AIDS and ensure proper planning of health actions for both primary and secondary prevention of cardiovascular disease.
 

Teratomas are neoplasms that arise from the primordial germ cells. They can undergo malignant transformation, with squamous cell carcinoma being the most common type. Other malignancies that can arise in a teratoma include adenocarcinoma, thyroid malignancies, carcinoid tumors and mucinous adenocarcinoma etc.
 

The advent of Ponseti’s technique has made the management of idiopathic clubfoot simple and effective. Though a number of scoring systems have been used in the past Pirani and Dimeglio scoring systems have stood the test of time for classification of clubfoot deformity in daily practice. Still superiority of any one scoring system over another has not been validated yet.
 

  High dose Stosstherapy (600000 IU intramuscular vitamin-D) is being used since 1930 to treat nutritional rickets. However, lack of treatment guidelines and inadequacy of studies evaluating it’s safety, efficacy and follow-up schedule has led to wrong practices. Physicians give multiple vitamin-D injections using alkaline phosphatase as a surrogate marker, leading to the possibility of vitamin-D toxicity. This along with frequent follow-up biochemical and radiological tests increases the cost of therapy and negates Stosstherapy’s main advantage of better compliance.
 

 Erythrocytosis (increased RBC mass or polycythemia) maybe primary due to an intrinsic defect in the bone marrow stem cells/erythroid progenitor cells or secondary where the red cell production is driven by factors external to the erythroid compartment, such as increased erythropoietin production for any reason. Primary and secondary causes can be further classified into congenital and acquired causes. The classical acquired primary erythrocytosis is Polycythemia Vera where patients have an abnormal clone and frequently an increased white blood cell and platelet count. Majority of patients have a clone of cells with gain of function mutations in JAK2. Congenital causes include mutations of the erythropoietin receptor and defects in oxygen sensing pathways including VHL, PHD2 AND HIF2A mutations.

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Diabetes is an emerging epidemic of the current scenario.It is evident now that the role of vitamin D extends beyond calcium homeostasis and includes modulationincludes modulation of skeletal and cardiac muscle function and immune cell function. One of the major site of involvement of Diabetes Mellitus is musculoskeletal system.
 

Among Diabetic patients, peripheral neuropathy is an important factor that predisposes to plantar ulcers and amputation. It is imperative to diagnose the onset of neuropathy early. The Semmes- Weinstein Monofilament examination is appropriate for the same, as a simple diabetic neuropathy screening instrument generalizable to the clinical setting. The 5.07/10g Monofilament, as recommended by the American Diabetes Association has been used in this study.
 

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  Non-operative pathology diagnoses should constitute an essential part of comprehensive work-up of mass lesions. A quick and reliable preliminary diagnosis is essential in the management of such cases as information is valuable for the same day patient counselling and management planning. The possibility of severe complications such as respiratory distress or circulatory compression mandates rapid diagnosis and treatment of lung/mediastinal masses. With an on-site approach, imprint cytology(IC) on core biopsy (CB) can assess the adequacy of biopsy specimens, optimise the biopsy procedure and provide a rapid diagnosis regarding the malignancy or benignity of a lesion. It is an attempt to get the best of both worlds i.e., cytology and histology without significant extra cost. Imprint cytology(IC) on core biopsy (CB) offers an
attempt to get the best of both worlds i.e., cytology and histology without significant extra cost.

Keywords: Imprint cytology; Core biopsy; Mass lesions.
 

School health is a medium for primary prevention wherein promotion of positive health and early diagnosis of preventable problems form the core components.
 

Cervical cancer claimed over 250,000 deaths in 2005, of which 80% occurred in developing countries. In India it is projected to rise by 25% over the next 10 years. Lack of awareness is considered to be a barrier in the control of cervical cancer. A study from Kolkata reported limited knowledge about cervical cancer. Another study revealed a correlation of literacy with higher awareness levels. Studies related to assessing effectiveness of awareness campaigns related to cervical cancer are scanty in India.
 

  Adolescence is a period of transience and turmoil. Adolescents are under pressure to find their place in society, get recognised by their peers and be accepted as individuals. This often leads to restlessness, anxiety and feelings of insecurity, which may lead to pathological disorders.
 

Diarrhoea is defined as the passage of loose, liquid or watery stools, more than three times a day. It is a major public health problem and is one of the leading causes of illness and death, in children, living in insanitary conditions. World Health Organization (WHO) estimates that about 3.5 million deaths occur each year because of diarrhoea and its related complications of dehydration and malnutrition.
 

Nearsightedness, or myopia, as it is medically termed, is a vision condition in which close objects are seen clearly, but objects farther away appear blurred. Nearsightedness occurs if the eyeballs are too large or the cornea, the clear front cover of the eye, has increased curvature. As a result, the light entering the eyes isn’t focused correctly and distant objects look blurred. Nearsightedness is a very common vision condition. Some research supports the theory that nearsightedness is hereditary. There is also growing evidence that it is influenced by the visual stress of too much close work. Generally, nearsightedness first occurs in school-age children. Because the eye continues to grow during childhood, it typically progresses until about age 20. According to literature, some parental factors like parental myopia, duration of breastfeeding, smoking, alcoholism may influence occurrence of prevalence of myopia among school children.

Cardiovascular disease is the leading cause of nonHIV-related death in people with HIV infection. Risk in HIV-infected persons appears to reflect contributions of non-HIV-related cardiovascular risk factors, the chronic inflammatory response in HIV infection, as well as metabolic adverse effects of antiretroviral therapy like insulin resistance, dyslipidemia, abnormal fat distribution, and hypertension.
 

  The deleterious effects of peri-operative malnutrition on recovery after general surgery are established. Since the effects of peri-operative malnutrition on recovery after cardiac surgery are not known.
 

  Internet has become the world’s biggest library, where retrieval of scientific resources can be done within minutes. Web-based search tools and techniques in order to find high-quality information resources (Romanov & Aarnio, 2006). The development and evolution of internet has brought profound changes in the health care delivery systems across the globe ranging from education and training to diagnosis and patient management. Internet has fundamentally transformed the patient management practices of health care professionals. According to an estimate, 30% of a physician time will be spent in the use of various information and communication technology tools in 2010.
 

Anesthetists in India have long and erratic working hours. They lack regular intervals of rest and sleep. The strenuous nature of their work also causes disturbed sleep among anesthetists and also the quality of sleep is poor. Prolonged periods of sleep deprivation may affect their judgment, performance, and poses risk to the patients’ lives.
 

 Incidence of Breast Cancer is rising alarmingly all over the world, and India is no exception. Reproductive risk factors such as age at menarche and menopause, age at first pregnancy and the parity of the woman are considered contributory.

  Premenstrual Syndrome (PMS) is a collection of emotional symptoms related to a woman’s menstrual cycle, with or without the presence of any physical symptoms. While most women of child-bearing age report having experienced physical symptoms related to normal ovulatory function, medical definitions of PMS are limited to a consistent pattern of emotional and physical symptoms occurring only during the luteal phase of the menstrual cycle. PMS is particularly common in the younger age groups, thus representing a significant public health problem in young girls. There is a need for health and educational authorities need to recognize the problem and provide appropriate support for female students with premenstrual disorders.
 

 The prediction of duration of mechanical ventilation (MV) is difficult. Vital capacity, forced expiratory volume in one second (FEV1) and arterial oxygen pressure, before surgery can predict the duration of MV. For emergency intubation, respiratory parameters cannot be measured before the tracheal intubation. Prognostic factors such as nutritional depletion as assessed by body mass index (BMI) and serum albumin and overall systemic inflammation as estimated by C-reactive protein (CRP) appear to be major determinants of hospitalization. 

  Diabetes mellitus is a chronic condition which has reached epidemic proportions throughout the world. According to World Health Organization, in India in the year 2000 there were 31,705,000 diabetics and it is estimated to double by the year 2030. The two basic approaches to keep Diabetes under control are Lifestyle modification and pharmacological approach. Diabetes requires a lifelong management plan, and people with diabetes have a central role in this plan. Lifestyle modifications provide an opportunity for diabetics to take charge of their health.
 

  Family planning methods are used by many women in developing countries to prevent unwanted pregnancies. Lack of knowledge about contraceptives acts as a barrier to use contraceptives among many women leading to unplanned pregnancies. The current study is proposed to explore knowledge, perception about contraceptive among the postnatal women attending government hospital.
 

 Worldwide, cervical cancer is the second most common and the fifth deadliest cancer in women. Approximately 80% of cervical cancers occur in developing countries. In Bangladesh, every year 17676 women are diagnosed with cervical cancer and 10364 die from the disease. It has been proved that cervical cancer is a preventable disease. Most common types of cervical cancer can be prevented by regular cytological screening program. To achieve this there must be a high rate of acceptance by the women.

 Maternal health refers to the health of women during pregnancy, childbirth and the postpartum period. While motherhood is often a positive and fulfilling experience, for too many women it is associated with suffering, illhealth and even death. In many developing countries, complications of pregnancy and childbirth are the leading causes of death among women of reproductive age. A woman dies from complications from childbirth approximately every minute.
 

  The delivery which occurs at home without adequate hygiene and treatment facilities under the birth attendant (trained or untrained) is called home delivery. On the other hand, delivery which occurs in hospitals or health institutions with adequate hygiene and treatment facilities under trained birth attendants is called hospital or institutional delivery.
 

The prevalence of HBsAg among general population in Bangladesh is 3%. Bangladesh is moderately endemic for HBV infection. Vaccination is an effective way to prevent HBV infection as its protective efficacy is 90- 95%. Doctors and medical students are at a high risk of acquiring HBV infection.

 Formative assessment is defined as “Information communicated to the learner that is intended to modify his or her thinking or behavior for the purpose of improving learning”. It is part of a feedback process in which a learner is able to evaluate their response in light of the information received, and learn. Feedback is most effective if it focuses students’ attention on their progress in mastering educational tasks. Feedback to any pupil should be about the particular qualities of his or her work, with advice on what he or she can do to improve, and should avoid comparisons with other pupils.

 Cytomegalovirus (CMV) is one of the most frequently encountered opportunistic viral pathogens in kidney transplantation.

  Clostridium difficile associated colitis is mediated by its toxins A and B and results in recruitment of immune cells to the intestinal mucosa. Subsets of immune cells have previously been shown to be differentially susceptible to toxin A. However, there is little research on their interactions with toxin B.

 Respiratory Tract Infections (RTIs) are a major health problem in developing countries. An estimated 2.2 million people, worldwide, die yearly because of acute respiratory infections. . It is estimated that Bangladesh, India, Indonesia, & Nepal together account for 40% of global acute respiratory infection mortality. RTIs are the most common reason for physician visits and prescription of antibiotics. Cefixime is quickly establishing as a potent broad-spectrum antibiotic with a wide variety of indications. This observational study was designed to describe the treatment pattern of third generation oral Cefixime in managing RTIs in general practice.

Cryptosporidium parvum is a protozoan causing cryptosporidiosis. Primary symptoms are acute, watery, and non-bloody diarrhoea. The study analyzes the prevalence of cryptosporidium infestation in the immune-compromised patient and compares the same among immune-competent subjects within the same age group having complaints of diarrhoea. The study also helps in forming a scoring system relating the numbers of oocysts of cryptosporidium observed per oil immersion field with the CD4 counts of the immune compromised  patients to quantify the severity of the decreased immunity.
 

 Natural disasters are common in Sri Lanka which affect a lot of people and displace from their own residence and make them residein temporary shelters with other people. Therefore they are prone to certain health problems including physical, mental and social health aspects. A lot of health camps are conducted to medically manage these health issues faced by the displaced people. Involving medical students in such programmes may be helpful to carry out these programmes effectively.

 Wilms’ tumor is an embryonal tumor of childhood occurring in 1 out of 1,00,000 children less than 15 years of age. An incidental case was found in the Paediatric surgery ward of Dhaka Medical College Hospital on 20th June 2012. A 3 years old girl complained of right sided painless abdominal mass for one month with occasional hematuria for 15 days. Detailed history and investigation confirmed the diagnosis as Wilms’ tumor. In developing countries most of such cases present at advanced stages. Having no scope for specific treatment, multimodal approach i.e., neoadjuvant chemotherapy followed by surgical excision has been the best choice to reduce the morbidity and mortality of these cases. Wilms’ tumor or Nephroblastoma is a cancer of kidneys that typically occurs in children. Its common name is an eponym, referring to Dr. Max Wilms, the German surgeon (1867–1918) who first described this kind of a tumor. It is the most common renal malignancy of childhood containing metanephric blastema, stromal and epithelial derivatives. It tends to be encapsulated and vascularized tumor that does not cross the midline of the abdomen. It usually metastesize to the lungs and liver. It is usually unilateral and presents with microscopic haematuria , malaise, weight loss, anaemia and sometimes with varicocele or thromboembolic disorder in the heart. A rupture of Wilms’ tumor puts the patient at risk of hemorrhage and peritoneal dissemination of the tumor. In such cases, surgical intervention by a surgeon who is experienced in the removal of such a fragile tumor is imperative.

 Parents are important members of cochlear implant team that analysis of their views is effective to improve services and outcomes. The present study was down among parents of children with cochlear implant who passed aural rehabilitation sessions to assess “parental attitude towards various aspects of cochlear implantation”.

Once regarded as a single disease entity, Diabetes is now seen as a heterogeneous group of diseases characterized by a state of chronic hyperglycaemia, resulting from a diversity of etiologies, environmental & genetic factors acting jointly. Diabetes mellitus is causing an enormous burden on the people and economics worldwide. Now a days, it is a major concern in the developed as well as in the developing countries.The magnitude of awareness in Bangladesh remains unknown due to lack of country wide survey.
 

In today’s fast paced life and its associated stress & strain, depression has become common in not only elderly but in young working adults as well. According to WHO, depression affects around 121 million people worldwide. Numerous studies carried out in India as well as abroad have found that the relative risk of developing Coronary Artery Disease (CAD) increases 2 fold in cases of depression.Various workers in the past have tried to assess autonomic dysfunction in cases of depression using Heart rate Variability(HRV)analysis.A few studies show low HRV in cases of depression. While, some studies have shown that there is no distinct relationship between HRV and depression. A few studies have also questioned the reliability of HRV as a measure of autonomic activity. Also, most of the studies have been done on study population > 45 years of age and similar evidence in younger population is grossly lacking. Most of the investigators have studied only the cases of major depression leaving out other types of depression episodes. Therefore, the exact relationship between depression and cardiac autonomic functions in young patients of depression is still obscure.