Objective: Data on acute lymphoblastic leukemia (ALL) in Indian children being limited, we analyzed the clinical, immunophenotype and cytogenetic profile of ALL in our pediatric patients. Materials and Methods: This was a prospective and retrospective observational study in which data of 103 children with ALL, aged three months to 18 years were analyzed. Results: Definite male preponderance (70.87%) was observed, 58.25% patients were aged between two to five years. Common clinical features included fever (92.33%), pallor (87.38%), hepatomegaly (85.44%) and splenomegaly (83.50). central nervous system involvement was seen in 6.80% and tumor lysis syndrome in 32.04% patients. Hemoglobin was <5 gm/dl in 43.69%, between 5-10 gm/dl in 45.63% patients; white blood cell count between 5,000-50,000/hpf seen in 69.90%, >50,000 in 20.39% patients. Platelet count was <50,000 cells/hpf in 48.54%. Blast cells in peripheral smear present in 67.96% patients of 97 in whom immunophenotyping was done, 82.44% were Pre B cell ALL. Pre T and T cell ALL was seen in 15/97 (15.46%) patients. Karyotyping revealed hyperdiploidy in 9/89, hypodiploidy in 2/89, miscellaneous changes in 35 patients. FISH analysis in 63 patients revealed Philadelphia chromosome positivity in seven (11.11%). MLL gene was positive in 12.70%. TELAML was positive in 13.64% (3/22) patients. 97.06% patients went in to remission post induction. Conclusion: Most of our patients come under standard risk by their age, WBC count, immunophenotyping and cytogentic analysis. We suggest larger multi-centric studies even in developing countries to understand the clinical profile and RT-PCR technique in cytogenic analysis for better risk stratification to help in risk adopted therapy.

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Context: Ovarian tumours represent about 30% of all cancers of the female genital system. They manifest in a wide spectrum of clinical, morphological and histological features. Aim: To study the frequency of incidence of different histopathological types of ovarian tumours in our institute. Materials and Methods: This retrospective study included 257 cases of histopathologically proven ovarian tumours, reported in the Department of Pathology of a rural tertiary care referral hospital, over a 12 year period (January 2000 to December 2011). These were classified according to the WHO classification of ovarian tumours (2003). Clinical presentation of the patients was analysed from archived case records. Results: Of the 257 tumours studied, 162 (63.04%) were benign, 15 (5.84%) were borderline and 80 (31.12%) were malignant. Surface epithelial tumours were the most common (68.48%) followed by germ cell tumours (15.95%). Mucinous cystadenomas (32.69%) were the most common benign tumours, while serous cystadenocarcinomas (31.13%) were the most common malignant tumours. Most ovarian neoplasms (43.19%) occurred in the 21-40 years age-group. Dull abdominal pain was the most common clinical presentation. Conclusions: Benign ovarian tumours were more common than malignant ones across all age groups. Surface epithelial tumours were the most common histopathological type of ovarian tumour. Due to vague symptoms, patients present late. Development of methods for early diagnosis of ovarian neoplasia is therefore, a pressing need today. The relative frequency of incidence of different ovarian tumours shows regional variations, highlighting the need to identify region-specific risk factors.

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Context: Autoimmunity against the thyroid gland is one of the most important causes for thyroid dysfunction. Anti-thyroid antibody test is an important tool in the evaluation of autoimmune thyroid disorders. Aims: To study the prevalence of thyroid hormone dysfunction and positive anti-TPO antibody titers in patients being evaluated for thyroid-related disorders. Settings and Design:This retrospective cross-sectional study was done in Father Muller Medical College. Materials and Methods: The TSH (Thyroid stimulating hormone), FT ₄ (Free thyroxine), and anti-TPO titer reports of 74 subjects undergoing evaluation for thyroid-related disorders were analyzed. Statistical Analysis Used: Statistical significance was estimated by P value. Results: About two-third (60%) of hypothyroid patients showed raised TPO antibody titer. The titer was significantly higher in hypothyroid subjects when compared to the euthyroid subjects, and a majority of the hypothyroid subjects had a titer at least twice the upper limit of normal. Two of the three subjects with hyperthyroidism also had elevated anti-TPO titers. Conclusions: The commonest cause of hypothyroidism in our study subjects was autoimmune-related thyroid disease. Anti-TPO antibody estimation is a very useful test for establishing the etiological diagnosis of autoimmune thyroid diseases in our population. In situations where there is a diffuse non-progressive goiter, anti-TPO antibody estimation can substitute for an invasive FNAC.

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Background: With increasing incidence of resistance to antibiotics carbapenems are used as the last resort because they are stable even in response to extended spectrum and AmpC beta-lactamases. However, Gram-negative bacilli producing the acquired metallo-beta-lactamases (MBL) are on the rise. Aim: The aim of the following study is to detect phenotypically the presence of extended spectrum beta-lactamase (ESBL), AmpC and MBL in Gram-negative bacteria isolated from clinical specimen. Materials and Methods: Gram-negative isolates from clinical samples were screened and confirmed for the presence of ESBLs by double disk synergy test (DDST), for AmpC by disk approximation assay and for MBL by Modified Hodge Test and imipenem-ethylenediaminetetraacetic acid DDST. Results: Among 251 isolates studied, 138 (54.98%) were ESBL producers, 49 (19.52%) were AmpC producers and 45 (17.93%) were MBL producers. Highest rates of ESBL detection was by Cefoperazone sulbactam (109/138) 78.98%. Out of 92 of the AmpC producing strains 20 (21.73%) were inducible and 72 were stably derepressed (78.26%). Out of 251 strains studied 45 (17.93%) were phenotypically identified as MBL producers, the highest no. being of Pseudomonas aeruginosa. Among the methods employed for detection of MBL production, Hodge test (62.22%) proved better than DDST (40%). Conclusions: High level of antibiotic resistance pattern exists in various clinical isolates. ESBL production should be looked for routinely in Gram-negative bacteria other than Escherichia coli and Klebsiella. A high percentage of derepressed AmpC mutants are noteworthy and alarming. We recommend phenotypic identification methods as routine practice in laboratories as genotypic methods are not cost-effective.

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Context: Diarrheal disease is the second largest cause of death of children under 5 years. Viral diarrhea is most common which is usually caused by Rotavirus followed by enteric Adenovirus. Rotaviruses are responsible for approximately 527,000 deaths mainly in low-income countries of Africa and Asia. There is limited number of studies done on viral diarrhea in this coastal belt. Aim: To determine the prevalence of Rotavirus and Adenovirus diarrhea among children below 5 years of age and its epidemiological importance in this coastal region of Karnataka State, India. The impact of factors like socio-economic status, drinking water, and Rotavirus immunization status that can contribute to the disease were also evaluated and recommendations are formulated for disease prevention. Materials and Methods: Children below 5 years of age with history of diarrhea, vomiting and fever of less than 3 days were included in this study. The sample size was 35. General physical examination, clinical findings and other details like socio-economic status, personal hygiene, growth milestones and family income were also recorded. A commercial Rotavirus and Adenovirus antigen detection kit was used to detect the presence of Rotavirus and Adenovirus antigen from the stool sample. Results: Out of 35 patients screened, 25 (71.43%) patients were negative for both Adenovirus and Rotavirus, 10 children (28.57%) were positive for Rotavirus and no patients were positive for Adenovirus. Severe dehydration, fever, loose stools and vomiting were the commonest symptoms seen in Rotavirus positive children. The highest incidence of infection with Rotavirus was seen among 7-12 months age group. Children whose stool was positive for Rotavirus used public water supply. Conclusions: Rotavirus is an important cause of diarrhea in children below 5 years in this coastal region. A simple, rapid immunochromatography test is useful and economical tool to simultaneously detect and screen Adenovirus and Rotavirus. Low socioeconomic state and unsafe water supply contributes to diarrheal disease.

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Background and Objectives: There are conflicting opinions in previous studies whether the quality of life (QoL) of patients with psoriasis is affected by its severity. The aim of the study was to assess the QoL of patients with psoriasis attending a tertiary care teaching hospital in central Kerala, India; and to find out if severity of psoriasis as measured by psoriasis area severity index (PASI) affects the QoL. Materials and Methods: We did a cross-sectional study of 49 patients with psoriasis. QoL was assessed using the Malayalam version of the Dermatology Life Quality Index (DLQI). PASI was used to calculate the clinical severity of the disease. We calculated Spearman's rank correlation coefficient between these two scores. Results: Thirty-three (67.3%) patients had marked (moderate or above) impact on overall QoL. Among the various domains of the QoL, symptoms and feeling were found to be affected most, followed by work and school and daily activities. There was no significant correlation between PASI and the overall DLQI (Spearman r = 0.131, P = 0.37), though the domain of leisure activities showed moderately significant positive correlation (Spearman r = 0.037; P = 0.03) with PASI. Conclusion: Psoriasis markedly affects the QoL of the sufferers, especially in the domains of symptoms and feeling, work, and school as well as daily activities. This study does not provide evidence that impairment of QoL is related to severity of psoriasis.

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Background: In India, adolescent age group (10-19 years) constitutes 21.4% of the total population. The health and nutritional status of the adolescents is an index of its future manpower. It is well recognized worldwide that anthropometric measurements are indispensable in diagnosing undernutrition. Objective: To assess the nutritional status and morbidity pattern among school-going adolescents. Materials and Methods: A descriptive cross-sectional study was carried out in three randomly selected co-educational schools of Burdwan District of West Bengal in May 2013 among 424 adolescents in the age group of 10-19 years from class V to class XI (except class X), using a predesigned pretested proforma. Results: The prevalence of underweight and stunting were 53.31% and 47.41%, respectively, which was significantly higher in early adolescence than in late adolescence and more in boys than in girls. About 55.18% had pallor, 40.33% had dental caries, 33.49% were suffering from refractive errors, 23.11% had history of worm infestation, 38.90% had skin problems, and 68.61% adolescents had ENT problems. Conclusion: The health and nutritional status among the school-going adolescents was found to be poor.

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Background: Blood transfusion having some risks of transfusion transmissible infections (TTIs) in the recipients especially when blood is collected during window period. In Africa, about 10-15% of human immunodeficiency virus (HIV) transmission had been related to blood transfusions. Aims: The aim of this study is to present the prevalence of TTIs among the apparently healthy donors, both voluntary as well as replacement donors. Settings and Design: This was a prospective study, carried out in a blood bank attached to a tertiary care hospital, Central India. Materials and Methods: All blood bags collected from these blood donors during the study period were screened for TTIs like hepatitis B surface antigen (HBsAg; Hepalisa, J. Mitra), anti-HIV antibodies (HIV Ab; HIV 3rd generation kit for detection of antibodies to HIV1 and HIV2, J. Mitra), anti-hepatitis C virus antibodies (HCV Ab; MicroELISA 3rd generation, J. Mitra), and Venereal Diseases Research Laboratory (VDRL) reactivity (Carbogen kit, Tulip Diagnostics). Serum were separated from all blood bags and serological test was performed according to the instructions provided by the manufacturers of respective kit. All seroreactive blood bags were considered as positive for TTIs and the blood bags were discarded. Statistical Analysis: A total of 10,582 blood donors were selected for blood donation after clinical history and brief medical examination by medical officer. Blood bags collected from them were screened for TTIs. Among the total blood bags screened, 273 (2.57%) were found positive for transfusion transmissible infectious diseases. Results: Among TTIs, the most common infection was hepatitis B followed by HIV infection in our study. Prevalence of coinfection in our study was very low (0.01%). Voluntary donations have low seroreactivity (2.40%) for TTIs as compared to replacement donations (3.20%). Conclusions: Multiple infections have a very small but definite risk to the recipients, recieving blood and blood products. Hepatitis B was the most common infection in our study. The incidence of coinfection was very low in our study. Prevalence of TTIs was more among replacement donors as compared to the voluntary donors. So, it is possible to improve the safety of blood and blood product by the promotion of voluntary donation, selection of low-risk donors, and use of highly sensitive laboratory screening test.

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Background and Objective: A common side effect with phenytoin is gingival hyperplasia. This apparent stimulatory effect of phenytoin on connective tissue suggested the possibility for its use in wound healing. This study aims to evaluate the effect of 1% and 2% phenytoin ointment on the excisional wound healing process in experimental albino rats, in comparison to 5% betadine ointment. Materials and Methods: Albino rats of Wistar strain (150200 g) were divided randomly into four groups (n = 6). The animals were anesthetized with ether, shaved on the back, and the skin was disinfected using cotton and alcohol wipes. Excisional round, full-thickness skin wounds of diameter 15 mm were created in the paravertebral area, at 5 mm from the midline on the back of all the animals, using sterile disposable acuderm biopsy needle. The following medications were applied topically to the wound twice daily for a maximum of 20 days. Group A rats served as negative control (untreated). Group B rats were applied 5% betadine ointment (positive control). Group C and group D rats had 1% and 2% phenytoin powder applied on them, respectively. Wound healing was measured on days 0, 4, 8, 12, 16, and 20 of the experiment. Number of days taken for complete epithelization of wound was also noted. Statistical analysis was done using analysis of variance (ANOVA) followed by TukeyKramer test and P < 0.05 was considered significant. Results: Both 1% and 2% phenytoin powder hastened healing and reduced the time taken for complete epithelization of excisional wound in albino rats, when compared to negative control (P < 0.05). While 2% phenytoin powder was superior (P < 0.05) to both 1% phenytoin powder and 5% betadine, the latter two were comparable (P > 0.05). Conclusion: 2% phenytoin may be considered as an important agent for wound healing, but its role in the healing of infected wound needs to be explored further.

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Background: The importance of a clean environment and linen for optimal patient care has been stressed upon since the very inception of hospitals. Individuals who work in a laundry are required to be adequately informed about the physical and health hazards present in the laundry, the known risks, and what to do if an accident occurs. Every laundry worker must be trained to know the location and proper use of the available personal protective clothing and equipment. Therefore, safe environment in the laundry is essential to maintain their health, and awareness programs should be conducted. Objective of the Study: To assess the awareness regarding occupational health hazards among the employees in the Laundry Department. Materials and Methods: The research method adopted in this study is of a descriptive type. The study was conducted in the Laundry Department of the selected hospital. The sample consisted of 15 respondents. All the employees in the department were included. The tools used to collect the data were an informal interview and the check-list and observation methods. The collected data was analyzed by percentage. Result: The study reveals that a majority of the respondents were knowledgeable about the occupational health hazards and safety measures. However, very few of them were aware of the types of occupational hazards. Conclusion: Awareness of occupational health and safety among the employees is important in the laundry area; therefore, planned orientation, training programs, and proper guidance to the employees will help reduce any kind of danger involved in the job and adoption of the necessary safety measures.

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Background: Prevalence of TV and computers in today's times has also driven the regular outdoor activities of children out from their lives. An increased calorie intake along with a decreased physical activity level has a great bearing on the level of obesity found in children. The present study was done with the objective to study the obesity among children of aged 5-18 years in Jaipur, Rajasthan. Methods: A Cross sectional study was undertaken on children of 5-18 years of urban field practice area, Mahatma Gandhi Medical College and Hospital, Jaipur. Simple random sampling was done. A semi-structured questionnaire was developed, pilot study was carried out to draw the necessary questionnaire which was tested and retested for necessary modifications. Body Mass Index (BMI) ¹⁰ was derived by dividing the subject's mass by the square of his or her height, Statistical test was applied in our study accordingly. Results: 12.5% children were overweight having percentage between 85 to 95, while only 5.6% children were obese having percentage equal or greater than 95. Out of 564 boys 101 (17.9%) were obese or over-weight and out of 436 boys 69 (15.9%) were obese or over-weight. Among 783 vegetarian children, 14.8% were obese and overweight. Conclusions: Children eating more frequent junk foods were more obese and overweight as comparative eating them in low frequency. Children with lesser physical activity were more obese.

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Introduction: This study is conducted to evaluate the seroprevalance of HIV, HBsAG, HBV and syphilis among blood donors at blood bank of medical college hospital along the five years. Material and methods: Study includes both voluntary and replacement donors. HIV, HBsAG and HCV were tested by ELISA methods approved by NACO and RPR was carried out for screening of Syphilis. Results: The seroprevalance of HIV, HBsAG, HCV and Syphilis was 0.08%, 0.3%, 0.07% and 0.17% respectively in voluntary blood donors while seroprevalance of HIV, HBsAG , HCV and Syphilis was 0.31%, 1.18%, 0.16% and 1.12% respectively in replacement blood donors. Conclusion: We observe that seroprevalance is higher in replacement donors than voluntary donors. These facts strongly indicate that we need more motivational and educational programmes to shift complete voluntary donation.

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Context: One-third of breast cancer survivors report difficulties with concentration, multi-tasking, and memory. Cognitive dysfunction can have an impact on quality of life by affecting activities of daily living, treatment compliance, interpersonal relationships, work/profession, and future. Aims: The objective of this study was to evaluate the cognitive functions in breast cancer patients. Settings and Design: This study was conducted in the outpatient department of Oncology from where the cases were recruited. The controls were patients attending other departments and not suffering from cancer. Materials and Methods: A total of 60 patients, 30 breast cancer patients and 30 non-cancer individuals patients matched for age, education were evaluated. Tools used were SMMSE, TMT-B, and DSST for evaluation of cognitive functions. Statistical Analysis: The various findings were analyzed using Chi-square test, Mann-Whitney Test, T test and ANOVA. Results: Breast cancer patients had highly statistically significant cognitive deficits in language and recall domains and significant deficit on orientation domain of SMMSE. They performed poorly in TMT-B, taking more time to complete the test which was statistically highly significant. No significant deficits were noted on the DSST test. Conclusion: Breast cancer patients show statistically significant cognitive deficits as compared to non cancer individuals.

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Context: Most of the females suffer from breast diseases during their life at some time or the other. Confirmation of breast diseases by clinical examination and pathological confirmation by fine needle aspiration cytology (FNAC) and histopathologic examination has been found to be an important part of diagnostic workup in breast diseases. Aims: To establish a clinicopathologic correlation in patients suffering from breast diseases. Settings and Design: We conducted a prospective study from December 2008 to August 2010. One hundred and twenty-one cases were enrolled using simple random sampling methods. Materials and Methods: Data including age, complaints, and clinical examination was collected from patients presenting for FNAC with breast complaints. Results: A total of 128 cases were studied which included 101 benign cases, 21 malignant cases, and 6 inadequate cases. The final 122 cases included 3 (2.5%) cases of acute mastitis, 2 cases (1.6%) of tubercular mastitis, 44 cases (36.1%) of fibroadenoma, 42 cases (34.4%) of benign breast disease with non-specific descriptive diagnosis, 2 cases (1.6%) of fibrocystic disease, 3 cases (2.5%) of galactocele, 1 (0.9%) case of lactational adenoma, 2 cases (1.6%) of cellular fibroadenoma, and 2 cases (1.6%) of phyllodes tumor. Apart from this, there were 21 cases (17.21%) of ductal carcinoma. Majority of benign cases were between 30 and 39 years of age (43.6%). Majority of malignant cases fell between 50 and 59 years of age (47.6%). Majority (61.5%) of lumps (>3 cm) were malignant, whereas 94.8% of lumps (<3 cm) were benign. Left breast was commonly involved (49.18%) than the right breast (44.26%). Superolateral quadrant (63.1%) was the most commonly involved quadrant. Histology was available for 35 benign cases (34.65%) and out of total malignant cases (21), histology was available for 14 cases (66.66%). No discrepancy was noted.

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Introduction: Nutritional anaemia is a worldwide problem with the highest prevalence in developing countries. It is found especially among women of child-bearing age, young children and during pregnancy and lactation. It is estimated to affect nearly two-thirds of pregnant and one-half of non pregnant women in developing countries. Objectives: To study the trend and severity of anaemia among people attending at Ratua RHTC and various socio demographic factors for the same. Materials and Methods: Hospital based cross sectional study. Observation: The trend of anaemia from 2008 to 2011 was in increasing trend, 9%, 15%, 22%, and 27% respectively and in 2012 constant around 26%. Anaemia was more common in females than males, 18% males and 82% females were reported anaemia of various degrees in the study period. Anaemia was highest among 11-25 years of age 42% followed by 26-40 years 23% and lowest among 0-10 years of age 8.69%. Anaemia among elderly was quite higher 15.5%. Most of the males had mild anaemia 16% followed by moderate 6.61% and severe 0.77% in contrast most of the females had moderate anaemia 42% followed by mild 31.35% and severe 3%. Trend of anaemia in female patients were in increasing trend from 2008-2009, than little decreases in 2010 and further decreases in 2011 after that again increases in 2012. Conclusion: Anaemia was significantly higher in females in comparison to males in moderate and severe category. Anaemia was highest among 11-25 years of age group.

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The safe and effective management of health care biomedical waste has received much attention for improper and inadequate management is associated with an increase in the incidence of health risks to the healthcare workers, the patients, and their environment and to the community at large. Hence the development of safe and effective management of biomedical waste along with handling protocols, institutional plans and policies, appropriate training and feedback programs on proper waste management and handling for all the healthcare workers are highly recommended. In India, with the implementation of Biomedical Wastes (Management & Handling) Rules 1998, emphasis is being placed mainly on the proper handling, segregation and disposal of the healthcare waste by which the risks and hazards to an individual and to the community can be considerably reduced. Though a technology and treatment protocol already exists, liquid biomedical waste management still remains a major problem for all healthcare facilities. So proper training in handling of waste will enable the healthcare facility to diffuse this critical problem safely and cost effectively while managing their liquid biomedical waste. So a literature search using the terms liquid biomedical waste was done and this review describes the problems associated with its management.

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Complications of paranasal sinus infection most often involve the orbit and peri-orbita. Because of widespread use of antibiotics, intracranial extension of paranasal sinusitis is rarely seen today. Nevertheless, the clinician must be aware of the potential of these complications as late recognition of this condition and delay in treatment can increase morbidity and mortality rates. An interesting case of sinusitis with orbital and intracranial complication is presented, which was radiologically evaluated and was comprehensively managed. Unparallel role of radiological investigations cannot be over emphasized as it played a very important role in both assessment and timing of the surgical intervention. The key to successful treatment is aggressive management and timely surgical intervention. We have extensively reviewed literature and comprehensively discussed pathophysiology and radiological assessment of such cases.

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Background: Worldwide diabetes affects more than 194 million people and the figure is expected to reach 333 million by 2025. India is considered as the diabetic capital of the world. Diabetic foot is the most common complication of diabetes. Amputation which is the end result of diabetic foot disease is associated with significant morbidity and mortality. Since it is crucial to identity those at an increased risk of diabetic foot complications, a detailed study of the natural history of diabetic foot, various clinical characteristics, the role of micro-organisms and their contribution toward worsening of ulcerations was undertaken in our hospital. Materials and Methods: A prospective study was carried out on 100 diabetic patients with foot ulcers for a period of one and half years at Father Muller Medical college Hospital, Mangalore. Results: The data analysis of 100 patients yielded the following results. Diabetic foot was very common in the elderly age group (>55 years) 54% and male dominant (87%). Majority of them had diabetes for more than 5 years (41%) and complications of diabetes were present on admission in 15% of them. Presentation of diabetic foot in the form of single/multiple toe disarticulation/above knee/below knee amputation accounted for a quarter (23%) of surgical interventions in our hospital. The glycemic control in most of the patients was very poor with random blood sugar >200 mg/dl (70%) and glycosylated hemoglobin >7 g% (74%) of them. One-fourth of the patients stayed for at least a month in the hospital (25%). In culture, Gram-negative organisms were predominant (11%). The most common bacteria isolated were Staphylococcus aureus (20.6%), Pseudomonas (16.2%), Escherichia coli (14.7%), and Klebsiella (11.8%). Conclusion: Based on the results of our study, it can be concluded that diabetic foot in various forms accounts for significant morbidity in the surgical wards. The factors contributing mainly are poor glycemic control at the time of admission, presence of gangrene, complications of diabetes (nephropathy, neuropathy), and associated comorbidities (peripheral vascular disease, hypertension, ischemic disease). There is a lot of scope for improvement in the approach to treatment of diabetic foot in our set-up which needs urgent attention. This article is presented to highlight the colossal neglect in the management of diabetic foot in most of the tertiary care centers in and around this part of the world.

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Objective: To study the prevalence of concurrent medical comorbidity in patients admitted with psychiatric disorders. Materials and Methods: One hundred patients with psychiatric disorders admitted to the general wards of the Department of Psychiatry, Father Muller Medical College, Mangalore were assessed for evidence of concurrent medical comorbidity. The assessment included clinical examination and investigations. Results: 49% of in-patients with psychiatric disorders had medical comorbidity. 26% of patients with bipolar disorder, 13% of patients with schizophrenia and 8% of patients with depressive disorders had medical comorbidity. Diabetes mellitus, hypothyroidism, and hypertension were the most common medical comorbidity. The medical comorbidity was not related to any of the socio-demographic variables. The medical comorbidity was not related to the clinical variables such as duration, age of onset of the psychiatric disorders. The medical comorbidity was significantly more in patients with bipolar mood disorder. Conclusions: 49% of in-patients with psychiatric disorders have concurrent medical comorbidity. Diabetes mellitus is the most common medical comorbidity. The present investigation is an observational, descriptive, cross-sectional clinical study. It has certain merits and limitations. Future studies with more refined methodology are required to draw definite conclusions.

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Objectives: Delirium tremens is the most severe on the spectrum of alcohol withdrawal syndromes. The mortality rate in this condition has been reported as high as 20%; however, with appropriate diagnosis and prompt treatment, mortality has been reduced to 1%. We studied the sociodemographic, clinical and laboratory data in alcohol dependant patients who developed delirium during the period of abstinence and compared them with patients who had uncomplicated withdrawal states. Materials and Methods: This investigation was done in the deaddiction centre, department of psychiatry, Father Muller Medical College Mangalore. A retrospective chart review spanning a period of 8 months (Jan-Aug 2011) was done to select 60 consecutive patients with alcohol dependence syndrome without medical or other psychiatric co-morbidity (excluding nicotine dependence). Socio demographic, clinical and laboratory data comprising haematological and biochemical parameters at the time of admission were compared between 30 alcohol dependents who developed delirium and 30 alcohol dependents who had uncomplicated withdrawal state. Results: No statistical significance is observed on sociodemographic data between the groups. Early onset dependence were noted to be developing delirium in withdrawal period. Elevated bilirubin levels and SGOT levels are significantly more in delirious patients. Statistically significant higher blood glucose levels were seen in patients with uncomplicated withdrawal. Conclusion: Patients with elevated bilirubin and transaminases, and early onset alcohol dependence are prone to develop delirium during alcohol withdrawal states.

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Background: Even though several factors like respiratory muscle strength, lung compliance, resistance to airflow, and elastic recoil of lungs determine lung functions, physical factors such as height, weight and central pattern of fat distribution also affect the pulmonary functions. Objective: The present study was done to assess the impact of both general as well as central adiposity markers on PEFR in young adult females. Materials and Methods: The study was conducted on 186 healthy young female medical students in the age group of 18-22 years. The study group was divided into three groups based on BMI (as per WHO Asian guidelines). Those with BMI between 18.5 to 22.9 kg/m ² were considered as normal weight individuals, those having a BMI of 23-24.9 kg/m ² were taken as overweight individuals and those with a BMI more than 25 were considered as obese. Waist circumference (WC), Waist to hip ratio (WHR) and waist to height ratio were also calculated; these serve as measures for central pattern of fat distribution. PEFR was recorded with Wright's peak flow meter and the best of three readings was considered. The data obtained was statistically analyzed using one way ANOVA and Pearson's correlation tests. A P-value less than 0.05 was considered as significant. Results: Mean value of PEFR did not show significant differences when compared between three groups. On correlation a negative association of various adiposity markers with PEFR was observed and was more related with central adiposity markers than BMI. Conclusion: Our findings suggest that obesity itself and especially the pattern of body fat distribution have independent effects on PEFR in young adult females. Abdominal adiposity may influence pulmonary functions by restricting the descent of the diaphragm and limiting lung expansion as compared to overall adiposity which may compress the chest wall.

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The desire to periodically alter consciousness by using psychoactive substances is an innate drive similar to hunger, thirst or sex. WHO has defined various substances, psychoactive or otherwise which may potentially be abused. An innovative method of intake was observed while evaluating a patient under our care. An 18-year-old boy was brought for consultation with a history of multiple substance use and anti-social personality traits. On interviewing, patient reported of the use of a white powder in the form of a snake bite. Patient described the technique of the snake bite and his experience following the bite. There have been two previous reports of patients resorting to snake bites for recreational purposes and this unique and extreme mode of undergoing a psychoactive experience needs to be studied further.

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