Background: The coronavirus disease-2019 (COVID-19) pandemic has introduced new ethical challenges in the care of patients and people who may have been exposed to severe acute respiratory syndrome coronavirus-2 or have mild to moderate COVID-19. Refusal to get tested for COVID-19 and having poor adherence to infection prevention protocols are the areas of concern for the ongoing pandemic. Such situations increase the risk of infection to other patients and staff. The factors affecting testing refusal were studied with the help of the Google questionnaire. Methodology: The cross-sectional survey tool was developed and distributed after pilot testing. The study population was selected using mix sampling method, snowball, and random sampling using the mobile number of the participants. All the participants were informed about the purpose of the study and included after taking consent. Results: Of the 176 study participants, the majority were male (112, 63.6%), with a mean age of 37.2 years (standard deviation 10.4). Forty-one (23.3%) were health-care workers and 74 (42.1%) were private company employees. Seventy-one (40.3%) refused to get tested for COVID-19 when asked whether they will get tested in the presence of any COVID-19 symptoms and 81 (46.8%) refused to get tested in the absence of any symptoms. Conclusion: Health policy-makers should utilize the study results to formulate the policy regarding any future pandemic to reduce the level of stigma associated with an unknown disease. These clarifications and excuses asked to the study participants are meant to provide a deeper understanding to address the pandemic better.

Background: The recent coronavirus disease 2019 lockdowns forced people to stay indoors, resulting in lower physical activity, and change in dietary patterns, impacting glycemic control in the diabetic population. We aimed to assess the impact of the 3-month lockdown on glycemic control among outpatients with type 2 diabetes (T2DM) being treated at our hospital. Study Design: This retrospective study included data of outpatients aged ≥30 years with preexisting T2DM, regularly attending the clinic during the prelockdown period and who came for follow-up postlockdown. The primary outcome measures were change in glycated hemoglobin (HbA1c), fasting blood glucose sugar (FBG), and postprandial blood sugar (PPBG) compared to the last value before the lockdown. Results: A total of 200 (male: female – 83:117) patients with a mean (standard deviation [SD]) age of 58.0 (10.8) years were included. The mean (SD) interval between the pre- and post-lockdown visit was 3.9 (0.9) months, and 58.5% of the patients were compliant with the medication. The mean HbA1c levels increased significantly by 1.1 (P = 0.000), FBG by 21.9 mg/dL (P = 0.000), PPBG by 28.0 mg/dL (P = 0.000), and weight by 1.6 kg (P = 0.000), from pre- to post-lockdown visit. The patients noncompliant to therapy had a significantly higher increase in glycemic parameters. The results showed a significant correlation between the interval of follow-up and treatment compliance with increase in glycemic parameters and weight. Conclusion: The results of this study revealed that there was a negative impact of lockdown on glycemic control in T2DM patients, highlighting the need for telehealth strategies to ensure the well-being of diabetic patients during such calamities.

Introduction: Novel coronavirus disease-2019 pandemic continues to rage the world with enormous economic loss, sickness, and deaths. In management of infectious diseases, nurses play crucial roles in rendering care to patients by risking their own lives, going beyond their training and capacities. Frontline nurses are vulnerable for the development of diagnosable and subclinical psychological problems most often triggered with deaths of colleagues, exposure to the mass scale of deaths, perceived inability to save lives despite best efforts, lack of social supports, shift duties, and working in high-risk environment. Aim: The aim of the study is to assess the depression, anxiety, and stress among nurses working in COVID wards versus non-COVID wards. Materials and Methods: A multicenter observational study was done among 176 frontline nurses from seven different referral government hospitals. Psychological ailments were measured on validated instruments of Depression, Anxiety, and Stress Scale-42 items (DASS-42) and Perceived Stress Scale-10 (PSS-10). Results: Using SPSS version 23.0, data were analyzed using Pearson's Chi-square test, with P < 0.055 being considered statistically significant. On PSS, perceived stress was high in 75% of COVID ward nurses and 67% of non-COVID ward ones. On DASS-42 scale, depression, anxiety, and stress levels among nurses in the COVID-19 wards were 21.64% (n = 21), 32.98% (n = 32), and 20.61% (n = 20) compared to 17.72% (n = 14), 24.05% (n = 19), and 15.18%, (n = 12) in the non-COVID wards, respectively. Conclusions: The amount of reported stress, anxiety, and depression was higher in both groups of nurses, i.e., those working in COVID-19 wards and general wards as compared to general population.

Introduction: The world is enveloped with the coronavirus disease 2019 (COVID-19) Pandemic with modern medicine and public health facing their most significant challenges ever posed. As the number of COVID-19 cases increased worldwide, an important issue of concern was the continuation of routine immunization services for children. This study has been conceptualized to assess the effect of the COVID-19 pandemic on infant Immunization. Materials and Methods: This study was a descriptive study conducted in an urban community amongst healthy children <1-year-old from January 2018 to September 2021. Immunization records of infants were obtained from data generated during each immunization session and strength, weakness, opportunity, and threat analysis was done using a questionnaire. Results: During the study, a total of 3518 vaccinations were done, a total of 3010 vaccinations (85.5%) were done on time, and the total delayed vaccinations were 508 (14.5%). The difference among the years was statistically significant, with the highest delay in the year 2020 (P < 0.001). However, in the year 2021, the number of vaccinations carried out from April to September was 568, with delayed vaccination of only 10.9%. Conclusion: The Armed Forces childhood immunization program could be sustained during the COVID-19 pandemic due to a multitude of contributing factors such as adherence to national guidelines that prioritized vaccination, infrastructure, and availability of trained workforce and most importantly commitment to strict COVID appropriate behavior.

Background: Caregivers not being allowed into the COVID wards prevented them from being involved in caring for their relatives in respect of day-to-day activities such as eating, drinking, and walking to the washroom. The aim of this study was to observe the challenges faced by patients admitted to intensive care unit (ICU) with COVID-19 pneumonia. We also observed the impact of two simple nursing interventions related to feeding and defecation and noted their impact in terms of patient's satisfaction. Materials and Methods: A semi-structured feedback questionnaire was prepared to cover common challenges faced by patients after interview with 10 patients admitted at a COVID ICU. Two simple nursing interventions were performed related to feeding and defecation. Results: Breathlessness was the most common issue as all the patients admitted were hypoxic. Inability to perform routine day-to-day functions such as feeding, drinking, sitting, and walking were other common issues. Emotional issues like anxiety, fear homesickness, and loneliness were also very high. Most (69.44%) patients were satisfied with a blended diet which was easy to take for patients with breathlessness. Most (77.28%) of patients were satisfied with intervention of helping them sit on a commode chair while on oxygen. Conclusion: During this pandemic, where all our efforts seemed insufficient in face of this unprecedented crisis yet these small seemingly insignificant steps helped both the patients as well as nurses in making the atmosphere more positive.

Introduction: Early intervention programs for developmental disabilities are often not available in India due to non-availability of resources. The objective of this prospective observational study was to measure the efficacy of an early intervention program for neurodevelopmental disabilities in a mid-sized hospital. Methods: The study enrolled infants and toddlers aged 1-30 months who were at risk for, suspected to have or diagnosed with developmental delay. Infants and toddlers with medical instability and profound developmental delay at first assessment were excluded. The patients were tested using Developmental Assessment Scale for Indian Infants (DASII) at first visit after which individualized intervention plans based on modules devised by National Institute for Empowerment of Persons with Intellectual Disabilities (NIEPID) were instituted. Reassessment using DASII was performed during subsequent visits. Results: Twenty infants and toddlers were enrolled from 2017-2019. Improvement or stable status was noted in 18/28 patients in both mental and motor domains. Of the remaining 10, no improvement or regression was noted in (a) both mental and motor domains in three patients (b) mental domain only in five patients and (c) motor domain alone in two patients. Discussion: Early remedial intervention using indigenous instruments/tools is feasible, pragmatic, and effective in a resource-constrained setting.

Background: Carbapenem-resistant Enterobacteriaceae (CRE) is of utmost clinical importance because they challenge the armamentarium of the treating clinicians, hampering current treatment strategies. Aim: The aim of the study is to detect carbapenemase-producing Enterobacteriaceae by phenotypic and molecular methods. Materials and Methods: Nonrepetitive isolates of Enterobacteriaceae were identified by conventional phenotypic methods from various clinical samples. All these isolates were screened for carbapenem resistance by meropenem (10μg) or ertapenem (10μg) disc. All the isolates which were found to be carbapenem-resistant by screening test were subjected to phenotypic confirmatory test in the form of modified Hodge test (MHT). These isolates were then subjected to polymerase chain reaction for the detection of various carbapenemase-producing genes, namely New Delhi metallo-β-lactamase 1 (NDM), verona integron-encoded metallo-β-lactamase (VIM), imipenem-resistant Pseudomonas (IMP), KPC, and OXA-48. Results: Out of 1254 isolates of Enterobacteriaceae, 230 isolates (18.3%) were found to be positive for carbapenemase production by screening test. A total of 150 out of 230 isolates (65.2%) tested positive for carbapenemase production by MHT. Out of these 150 phenotypically confirmed carbapenemase-producing isolates, bla_NDM gene was found in 85, bla_VIM in 32, and bla_IMP in 22 isolates. bla_OXA-48 and bla_KPC genes were not found in any isolate. Moreover, there were 19 isolates, in which no gene was detected. Conclusion: The prevalence of phenotypically confirmed carbapenemase resistance among Enterobacteriaceae is 11.96% (150/1254). Genes responsible for carbapenemase production are widely prevalent in Enterobacteriaceae Routine detection will help in the management of these broadly-resistant pathogens and implementation of appropriate infection control measures, thus limiting their spread.

Background: Unsafe blood transfusion proves very costly from both human as well as economic point of view. With every unit of blood transfused, there is 1% chance of transfusion transmitted infections (TTIs). In India, blood is screened for all those infections mandated by the World Health Organization, i.e., human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), syphilis, and also malaria. The aim of the present study is to determine the seroprevalence of TTIs and associated factors among healthy blood donors in North Indian population. Materials and Methods: A retrospective observational study was conducted by reviewing the records of all blood donors for a period of 4 years from January 2016 to December 2019 at Blood Bank of our institution. Results: Out of total 10,797 healthy voluntary donors, 2338 (21.65%) were the motivated donors and 8459 (78.35%) were voluntary unpaid family donors. Majority of the donors were males, i.e., 10,332 (95.69%); female donors were 465 (4.31% only. Overall prevalence of TTI was 1.07% (116/10,797). The seroprevalence of the HIV, HBV, HCV, malaria, and syphilis was found to be 0.03%, 0.49%, 0.50%, 0.009% and 0.05%, respectively, which was found to be statistically significant (P < 0.001). Coinfection was not seen in any of the donors. Conclusion: The present study shows a seroprevalence of 1.07% for TTI with positivity of 0.50% for HCV and 0.49% for HBV. Individuals donating in blood camps made only 21.65%. Female donor participation was lean 4.31%. Efforts to motivate and ensure active participation of voluntary blood donors including females are needed.

Introduction: Renal Transplant remains one of the pioneer branches of solid organ transplant and surgical complications can affect the outcome. Material and Methods: Present study was done to find out the incidence of surgical complications in Renal Transplant Recipients, their outcome, to compare it with contemporary studies and suggest remedial measures. It was Prospective non-randomized observational study conducted at tertiary centre. All patients who underwent live related or deceased donor transplant over two yrs were recruited. All relevant data was collected. Data were collected and put in a master chart in Microsoft Excel^© format and statistical analysis was done using SPSS 17 software^®. Student t test was used to compare data with published contemporary series and p value was calculated. Results: one hundred and forty-five cases including 31 (21%) deceased donor recipients were studied. Eleven (7.58%) had surgical complications. Two with arterial complications required graft nephrectomies and one with renal artery stenosis stented successfully. Higher incidence of arterial complications (2.06%) was noted as compared to contemporary studies (0.69%-1.3%) (p>.05) with higher incidence (3.2%) in deceased Donor recipients. No venous complications recorded (contemporary studies 0.15% - 0.55% incidence). One (0.68%) Ureteric stricture was reported, comparable to contemporary studies (0.27%-0.54%) (p>.05) and managed endoscopically. No uretric-vesical anastamosis leak recorded (contemporary studies 0% - 0.97% incidence). Four (2.75%) had Lymphorea, (Three deceased, one live donor) requiring Betadine instillation, significantly lower than contemporary studies (7.14%- 23%) (p<.05). Two (1.4%) had surgical site infection requiring secondary suturing, significantly lower than contemporary studies (3.2%- 15%) (<.05). One (0.68%) had stricture urethra managed conservatively, comparable to contemporary studies (0.83%-1.18%). Conclusion: Overall incidence of surgical complications is reducing. Complication rates are higher in Deceased Donor recipients.

Background: More Indians have access to mobile phones than toilets. Concerns have been raised for addictive potential of Internet. There are few Indian studies on the prevalence of Internet addiction (IA) among adolescents. The present study aimed to assess the prevalence of IA among adolescents and its association with sociodemographic variables in a cantonment school. Methodology: It was a cross-sectional study among students of the age group of 10–19 years in Western Maharashtra. Sociodemographic data were collected using a self-administered questionnaire. Young's IA test was used to diagnose IA. Statistical analysis was done using Chi-square test and odds ratio. Results: A total of 1325 students participated in the study. Among these, 2.5% had scores above 69 (addicted). Among those with scores > 69, 85% were boys, average daily Internet use was 5.3 h in last 1 year. Use for academics, online gaming, and social media were the most common reasons for current use among the study sample. Risk factors included watching pornography, online gaming, use of Internet due to loneliness or boredom, use in Internet café, permanent login status, accessing Internet > 4 h daily, and consumption of tobacco or alcohol by any of the parents. The possible protective factors included using Internet only for academics, restricting Internet use to < 2 h, and having a playground nearby and playing there. Conclusion: In our study, prevalence of IA is around 2.5%. The possible risk and protective factors can be targets of intervention and further study.

Background and Objectives: Geriatric population is at increased risk of malnutrition which in turn leads to decreased immunity, sarcopenia, frailty and poor clinical outcomes. This study was planned to study the prevalence of malnutrition in the elderly people (>60 yrs) attending Kumbh Mahotsava. The objectives of the study were to see the association of malnutrition with socioeconomic status, gender, age and geriatric syndromes. Methods: Cross sectional observational study in elderly more than 60 years attending Kumbh Festival. Nutritional assessment was done using Mini Nutritional Assessment (MNA) questionnaire. Socioeconomic status was assessed using the modified Kuppuswamy score. Anthropometric data like body mass index (BMI), calf circumference, and upper mid-arm circumference were measured. All the above data points were integrated into a web application and the socioeconomic and nutritional score were calculated automatically. Based on nutritional assessment nutritional advice was given by a short message service and verbal counseling. Prevalence of malnutrition and its association with socioeconomic status, gender, age and geriatric syndromes were analysed. Results: Total 219 elderly were included in the study. Mean age was 68.5 years. Around 70% (152/219) were either malnourished or at risk of malnutrition. Nutritional status was significantly associated with modified Kuppuswamy socioeconomic status (P = < 0.001). There was a significant association between nutritional status and presence of geriatric syndromes in form of having a falls (P= 0.010), leaking of urine (P= <0.001) and forgetfulness (P < 0.01). Conclusion: Around 70% (152/219) of the elderly were either malnourished or at risk of malnutrition with significant ssociation with socioeconomic status and geriatric syndromes. This study shows the importance of screening our geriatric population for malnutrition.

Introduction: Primary gastric lymphoma (PGL) accounts for <15% of all the gastric malignances and <2% of all the lymphomas. Although they can involve any part of gastric tract, however, stomach is predominantly involved. Clinically, it is difficult to diagnose gastric lymphoma as it does not present with specific symptoms. Materials and Methods: It was a retrospective study carried out from July 16 to July 20. Patient's data were obtained from clinical record sheets. Histopathological examination was performed followed by panel of immunohistochemistry with leukocyte common antigen, CD 3, CD138, CD10, CD5, CD79a, CD20, Bcl-2, Bcl-6, Cyclin D1, and Ki-67. Further subtyping of gastric NHL was done using immunohistochemistry. Results: A total of 30 patients of PGL were included in the study. There were 23 males and 7 females, with M:F of 3.1:1. The mean age of presentation was 53 years. Abdominal pain and dyspepsia were common symptoms at presentation. Gastric antrum was the common site of involvement. Diffuse large B-cell lymphoma germinal center type was the most common histological variant seen in the present study. Helicobacter pylori was seen in 9 cases (30%) cases. Majority of patients were diagnosed in Stage II and III. Conclusion: PGL clinically is difficult to diagnose because of its nonspecific symptoms. Endoscopic examination should be done in such patients. All these suspicious patients should undergo biopsy examination of the lesion.

Background: The concept of labor analgesia is widely unknown to the antenatal women and parturients in the Indian medical setup. Aims: The aim of this study was to assess the knowledge, attitude, and practice of labor analgesia in antenatal women visiting the antenatal clinic in a tertiary care hospital. Methodology: One hundred twenty women in the antenatal period between the age group of 18 and 40 years attending the antenatal clinic were included in the study. A Google form-based questionnaire was used to collect data. Statistical Analysis: Ordinal and nominal data were presented as numbers and percentages. Bar diagrams and pie charts were used for graphical representation. Results: Twenty-one (17.5%) respondents, out of 120, were aware of labor analgesia. Among the rest 99, 13 participants did not have knowledge nor they wanted to gather information further. Out of 86 unaware respondents, 62 (72.1%) were interested in acquiring the knowledge of labor analgesia and rather would be comfortable if the treating obstetrician imparts the information; 46 (53.5%) of them wanted the information to be imparted during the obstetric consultation sessions and 10 (11.6%) respondents considered the best time for gathering awareness for labor analgesia at, or after the onset of labor pain. The major concerns of the respondents for labor analgesia were the safety of their health and the effect on the baby. Conclusions: Awareness of labor analgesia in Indian antenatal women is low. The treating obstetrician should impart knowledge regarding labor analgesia in the pre- and antenatal period which should be supplemented with more emphasis during the prelabor period.

Objective: The objective of the study was to study the pattern of sexual behavior and sexually transmitted infections (STIs) among the patients attending the STIs clinic in a tertiary care hospital in Western Uttar Pradesh. Materials and Methods: A cross-sectional study was carried out among all confirmed STI cases attending the STI clinic during the period of 1 year. Data were collected by means of personal interview using pretested pro forma with questions related to their sexual behavior and STIs. Relevant investigations were carried out for all cases. Data were entered in Excel sheet and analyzed by means of Epi Info version 7. Results: A total of 373 patients were reported with anogenital lesions. Out of these, 310 were confirmed cases of STI. Surprisingly, in the clinic, the attendance of elderly was 41 (13% of total cases). The attendance of older adults (>40 years of age) was more (178, 57.41%) in comparison to the younger population (132, 42.58%). Among the older population, males outnumbered female patients. Out of the total lesions, the most common genital lesion was herpes genitalis followed by balanoposthitis. Conclusion: We generally assume that, with increasing age, the chances of acquiring STIs are less, but in our study, most of them admitted to having regular sexual activity and this clearly indicated the vulnerability of the elderly population to STIs. We definitely need to focus on their sexual needs and sex education to prevent the increased rate of infections among them.

Introduction: Lifestyle diseases have multifactorial causation risk factors. Armed forces personnel although constitute healthier sections of society but are not spared from prevalent pandemic of lifestyle diseases in country. This research aims to study the prevalence of lifestyle disease to highlight the importance of keeping suitable preventive measures in place to control the epidemic of lifestyle diseases among the middle-aged army personnel. Materials and Methods: The study is a cross-sectional community-based epidemiological design of 2956 armed forces personnel, aged 35 years and above, selected by multistage random sampling. Data were collected on pretested open-ended questionnaire. Statistical analysis was done using Chi-square test, unpaired t-test, and multiple logistic regression techniques. Results: The study revealed that consistent statistically significant association between major sociodemographic, potential behavioral, and clinical risk factors of lifestyle diseases, especially dietary risk factors, namely snacking in between meals, consumption of energy-dense foods, physical inactivity among tradesman, cooks, clerks contributing to higher prevalence of lifestyle diseases among them. The study indicates that the prevalence of overweight and prehypertensive among study sample is suggestive of alarming proportions. Conclusion: Multi-cross-sectoral-integrated strategies for provisioning of comprehensive health-care and strengthening surveillance mechanism pertaining to prevention and control of lifestyle diseases are the need of the hour. Genuine dietary modifications; improving cooking practices; sustained efforts to be physical active, stringent mechanisms to ensure definite working hours, minimize work-related stress; institutional checks on tobacco, alcohol, substance abuse; screening for lifestyle disease risk factors; addressing common risk factors are desirable lifestyle interventions.

Opioid analgesics play a crucial role in the management of acute pain, but its use is often limited by various adverse effects, especially nausea, vomiting, and respiratory depression. There has always been an attempt to develop analgesics that are equi-efficacious to opioids but carry less risk of respiratory depression. Oliceridine has been the first among such biased/selective molecules approved by the United States Food and Drug Administration. Oliceridine is proposed to act selectively on mu-opioid receptors producing analgesia but does not propagate β-arrestin mediated mechanism postulated to be responsible for respiratory depression of other opioids, especially morphine. Oliceridine has favorable pharmacokinetics for intravenous administration and no significant drug interactions have been proposed.

Lymphoplasmacytic lymphoma (LPL) is a low-grade B-cell neoplasm, composed of small B-lymphocytes, plasmacytoid lymphocytes, and plasma cells involving bone marrow and sometimes lymph nodes or spleen and forms 1% of all non-Hodgkin lymphomas. LPL with bone marrow involvement and an Immunoglobulin M (IgM) monoclonal gammopathy of any concentration is designated as Waldenström macroglobulinemia (WM). Due to their frequent co-occurrence, the terms LPL and WM are often used interchangeably in clinical practice. However, although the clinical diagnosis of WM is restricted to cases with an IgM monoclonal protein, the World Health Organization recognizes that LPL can rarely present with paraproteins of immunoglobulin G (IgG) or immunoglobulin A (IgA). LPL associated with non IgM gammopathies are extremely rare and form >5% of all LPLs. We hereby present the case of a 65-year-old female with no previous co morbidities who presented with nonspecific complaints of weight loss, easy fatigability, and night sweats. Examination was within the normal limits except for the presence of subcentimetric axillary lymphadenopathy. She was found to have anemia with an altered A/G ratio M spike of 2.10 g/which was IgG kappa on immunofixation electrophoresis. The bone marrow revealed a mixture of lymphocytes, lymphoplasmacytoid cells, and plasma cells along with the presence of amyloid deposits. MYD88 L265P mutation done on peripheral blood was positive, and based on these, she was diagnosed with a case of IgG Kappa LPL with associated amyloidosis.

Central nervous system infections are an uncommon cause of acute febrile encephalopathy (AFE) in the elderly. Scrub typhus meningoencephalitis is uncommon and often missed in the elderly. A 70-year-old male presented with complaints of intermittent fever, maculopapular rash, and altered sensorium. Physical examination revealed fever, tachycardia, tachypnea, maculopapular rash on the trunk, and all four limbs, and an eschar on the right thigh. Initial laboratory evaluation revealed anemia, thrombocytopenia, and azotemia. The cerebrospinal fluid revealed lymphocytic pleocytosis, elevated proteins with normal glucose, and adenosine deaminase. Weil–Felix test was positive. The diagnosis of scrub typhus meningoencephalitis with acute kidney injury and atypical pneumonia was established. A prompt treatment with injection doxycycline and tablet rifampicin led to an uneventful recovery. We report the first case of scrub typhus meningoencephalitis as the cause of AFE in the elderly. This case highlights the importance of clinical examination in any febrile encephalopathy presenting in endemic areas or travelers returning from such places.

Birth injuries, including long bone fractures, are most often observed following breech delivery or difficult deliveries. Although a long bone fracture is a relatively rare complication, femoral fractures constitute one of the most common forms of injury of the lower extremity presenting in newborns. A low birth weight, female neonate was delivered by C-section with breech presentation in utero and presented with swelling and abnormal mobility of the right thigh immediately after birth. The femoral shaft fracture was successfully treated by conservative management using a Pavlik harness for 6 weeks. Even though cesarean deliveries reduce traumatic complications, especially in breech presentations, compared with vaginal delivery, they do not completely eliminate the possibility of accidental injuries to the newborn.

Pediatric subtrochanteric fractures have been treated historically with intramedullary nailing, sliding hip screw, or pediatric proximal femoral locking plates, which are often based on the fracture pattern or availability of suitable implants. It is desirable to use a technique of fixation that will not only restore the hip biomechanics but also be a stable construct. We present a conventional technique of reduction and fixation of a subtrochanteric femoral fracture in an 8-year-old child using an unconventional implant, namely an adult proximal humerus locking plate, with a successful outcome and no postoperative complications.

A team of 10 personnel from a mountaineering team has undertaken an expedition to Mt Menthosa at an altitude of 21138 ft. in October 2018. After scaling the peak and in the following days during descent, the three members of the team had developed cold injuries. They were given first aid during descent. Later, they were diagnosed as cases of frostbite. All three personnel were evacuated to a Military Hospital, Delhi, India and were treated with oral vasodilators, antiplatelet drugs, analgesics, and hyperbaric oxygen therapy (HBO₂T) was administered at a Recompression chamber at Delhi for 1 week. These personnel were thereafter referred to INHS Asvini for further management and continuation of HBO₂T. After 30 sessions of HBO₂T administration at this hospital, there was a significant improvement in the wounds of all three personnel with minimal surgical intervention and no major amputation. The treatment of frostbite includes treating hypothermia before thawing of cold injury, nonsteroidal anti-inflammatory drugs, antibiotics, tissue plasminogen activators and iloprost, a potent vasodilator which is used in severe cases. Planning of surgery is vital with the goal of obtaining the best functional outcome. Premature amputation increases morbidity and is likely to lead to poor subsequent function. This article aims to discuss the advantages of HBO₂T administration as an adjuvant therapy in the management of frostbite cases along with wound care management.

Cutaneous pseudolymphoma (CPL) is an umbrella term encompassing reactive lymphoproliferation that imitates cutaneous lymphomas clinically and/or histopathologically. We present the case of an elderly male presenting with solitary, painless, raised, and progressive swelling on the right side of the face of 9-month duration. Examination revealed a solitary, raised, slightly erythematous nodule without any surface changes. Clinically, the neoplastic differentials were given precedence owing to rapid onset and age at presentation. The nodule was excised in toto and, following histopathological examination and immunohistochemistry (IHC), diagnosed as CPL. We elaborate how pseudolymphomas can mimic lymphoma and can be distinguished only with an integrated clinical, histomorphological approach and the use of ancillary techniques including IHC.

Cystoid macular edema (CME) is the most common cause of reduced vision in branch retinal vein occlusion (BRVO). The treatment protocols for macular edema in BRVO have changed considerably in the previous decade because of the increased popularity of the wide use of optical coherence tomography (OCT) and intravitreal drugs. Intravitreal injection of anti-vascular endothelial growth factors (anti-VEGF) and steroids result in the reduction of CME. However, the effect is transient, and multiple injections may be required. On repeated use, few patients become non-responders to these drugs. Nonetheless, anti-VEGF drugs may have potentially life-threatening complications because of systemic absorption. Intravitreal steroids may lead to severe ocular side effects such as cataract and glaucoma. Chances of endophthalmitis, retinal tear, and inflammation can occur with any of the intravitreal injections. We present a case of BRVO with recalcitrant CME following focal laser, multiple intravitreal anti-VEGF, and steroid injections. However, he had cardiovascular risk factors, so repeated anti-VEGF injections were not given. He was planned for hyperbaric oxygen therapy and showed favorable response. His visual acuity improved and macular edema reduced to more than half from baseline values on OCT.

Although tracheal injury during esophagectomy is a rare complication, it is a dreaded one when encountered in the intraoperative period. It can be managed conservatively or by primary repair. We report an incident and successful management of tracheal injury during transhiatal esophagectomy performed in a case of carcinoma esophagus (upper one-third). The tracheal rent of the posterior wall of the trachea was repaired with bovine pericardial patch through a right thoracotomy we added one endotracheal tube (ETT), cut at 19 cm mark from its patient end, reversed to another ETT with a refashioned ETT connector. This innovation gave us enough length to place the tube comfortably inside the left main bronchus without making the ETT cuff herniate inside the tracheal tear. The tracheal rent was repaired with bovine pericardial patch hitched with pledgeted sutures through a right thoracotomy. Postrepair, the patient was electively ventilated; gastric pull-up was postponed pending the healing of the trachea. At the time of second surgery, we had to take all the precautions not to disrupt the repaired wall. The tracheal wall was found intact with some permanent deformity but functionally competent.

Brucellosis is a zoonotic infectious disease, which mainly involves lymphoreticular system. Our case report describes an isolated splenic lesion diagnosed in a 48-year-old individual who is a farmer by occupation, had a history of animal contact, and has the habit of consuming raw milk. He was admitted as a case of pyrexia of unknown origin (PUO) and detected to have splenic Space occupying lesion (SOL) on imaging. His serum Brucella IgM was positive and ultrasonography-guided fine-needle aspiration cytology of splenic SOL showed features of necrotizing granulomatosis inflammation or an organizing abscess. The patient was successfully treated for brucellosis with oral doxycycline and rifampin for 6 weeks. Hereby, we report a case of PUO with splenic SOLs, Diagnosed on the basis of clinical, radiological, histopathological, and serological basis as a case of spleenic brucellosis. This case required a very high index of clinical suspicion and further highlighted the fact that even in present times of advanced diagnostic modalities, clinical inputs cannot be overlooked. Thereby, we were able to demystify a case of PUO successfully.

Pericardial effusion is commonly present in patients with moderate-to-severe hypothyroidism. However, large pericardial effusion causing cardiac tamponade (CT) is extremely rare. We report an atypical presentation of primary hypothyroidism (PH) where a young male presented with CT as the first manifestation of PH. The patient was treated with an immediate pericardiocentesis followed by levothyroxine replacement and showed complete resolution of pericardial effusion on follow-up. Hypothyroidism should be suspected as a possible etiology of massive pericardial effusion/CT in patients who have associated signs and symptoms of hypothyroidism and have bradycardia in the setting of CT.

Lichen sclerosus (LS) et atrophicus is a known premalignant condition affecting both sexes. Squamous cell carcinoma is the most common malignancy seen in LS et atrophicus. We report a case of 42-year-old female suffering from vulval LS et atrophicus for 12 years who developed squamous cell carcinoma. It is imperative to counsel the patients with LS regarding the malignant potential and actively monitor them for better outcome in terms of survival as well as quality of life.

Inhalant abuse is common in adolescents and young people. However, awareness about its harmful effects is low, and the potential to cause dependence remains a cause of concern. Inhalant abuse is often associated with underlying novelty-seeking traits, which can also predict propensity for other substances of abuse. Inhalants are cheap, freely available, and legal to possess and escape detection in vulnerable groups. There is a need to spread awareness about the harmful effects of inhalants and devise effective primary and relapse prevention strategies.

Overlap syndromes are distinct entities with manifestations of rheumatic diseases in a patient that are not restricted to a particular disease. Rheumatoid arthritis, systemic lupus erythematosus (SLE), scleroderma, Sjogren's syndrome, and idiopathic inflammatory myositis (IIM) are definite connective tissue diseases that can have symptoms with significant overlap. If the clinical, biochemical, and serological parameters do not fulfill the criteria of any of the four diseases, it is termed as undifferentiated connective tissue disease. On the contrary, mixed connective tissue disease is a distinct clinical entity with specific parameters and positive U1RNP titers. Although scleroderma and SLE have their overlap profiles with other inflammatory rheumatic conditions, overlap with IIMs has been the commonest co-association in both the conditions. SLE-scleroderma overlap has been infrequently reported in the literature and can be considered as the rarest overlap as far as prevalence is concerned. We report a case of SLE-scleroderma overlap in a 21-year-old female along with discussing various aspects of the manifestations and complications of the overlap along with the challenges faced by the clinician in managing this relatively rare entity.

Prostate cancer (PC) is the most prevalent malignancy in men (after lung cancer). It commonly presents with lower urinary tract symptoms such as urgency, hesitancy, and poor stream besides some patients may present with bone pain. Anemia is the most common presentation of solid tumors with bone marrow involvement, however, pancytopenia as the presenting feature is rare. Here, we describe a 60-year-old man with significant comorbidities in the past who now presented with symptomatic anemia without any urinary symptoms. On evaluation, he was found to have pancytopenia with elevated alkaline phosphatase levels. Work up for pancytopenia revealed metastatic deposits from the adenocarcinoma in the bone marrow. Further, he was diagnosed as a case of PC on transrectal prostate biopsy and managed with denosumab and maximal androgen blockade.

Herpes zoster (HZ) duplex symmetricus is an extremely rare variant of multidermatomal HZ where there is the involvement of bilaterally symmetrical dermatomes. This generally occurs in immuno-compromised individuals and is unusual in immunocompetent host. When occurring over the face, it can be associated with Ramsay Hunt syndrome. Bilateral symmetrical lesions present a unique diagnostic dilemma owing to morphological similarities with Eczema Herpeticum and rarely enteroviral infections. In such cases, correct interpretation of serological tests helps in the diagnosis of the condition. Here, we present the case of HZ duplex symmetricus occurring in an immune-competent individual over bilateral V1 3 and C4 dermatome (left) along with facial palsy.

32 yr old individual presented with headaches and detected to have cerebral venomous thrombosis. MRI revealed internal cerebral vein thrombosis with unilateral that edema. He was managed conservatively.

Onychomadesis is an anomaly of nails characterized by shedding of nail plates due to temporary arrest in the activity of the nail matrix. Systemic or local factors ranging from acute febrile illnesses, auto-immune diseases, drugs, chemotherapy, trauma, etc., have been known to cause onychomadesis. We report a unique case of onychomadesis following frostbite in a serving soldier posted at high altitude and extreme cold climate area.

Tubercular meningitis is prevalent in India as various clinical subtypes. Our case illustrates an unusual presentation of tuberculosis (TB) meningitis with cerebral venous sinus thrombosis. Our patient had presented with fever and headache for about 1 week, followed by acute onset left hemiparesis. His evaluation revealed features of cerebral venous sinus thrombosis (CVT) on neuroimaging along with cerebrospinal fluid picture of the central nervous system (CNS) TB. He was managed with antitubercular therapy with steroids and anticoagulation following which the patient recovered. The coexistence of CVT with CNS TB is very rare. It is pertinent to diagnose the same early to prevent life-threatening complications.

Multiple causes can result in nosocomial meningitis. Here, we report a case of recurrent healthcare-associated bacterial meningitis caused by different bacteria in a postoperative case, who has been successfully treated with appropriate antibiotic therapy. A 65-year-old woman underwent an elective bilateral total knee replacement. On the postoperative day 5, she exhibited features of meningitis. Acinetobacter baumannii was isolated from the cerebrospinal fluid (CSF) culture. Magnetic resonance imaging of the brain was suggestive of ventriculitis. Later, she had to be shifted to the intensive care unit. An external ventricular drain (EVD) was placed due to persisting ventriculitis. Subsequent CSF culture sent from EVD repeatedly showed growth of Burkholderia cepacia. After the CSF cultures became sterile, a thecoperitoneal shunt was placed. She showed significant clinical improvement and was discharged. She was readmitted after 11 days with altered sensorium. Computed tomography of the head showed an increase in the noncommunicating hydrocephalus. The CSF cytology was inconclusive. An EVD was immediately placed. Vancomycin-resistant Enterococcus faecium was isolated from a repeat CSF culture. A ventriculoperitoneal shunt was placed after the CSF cultures showed no growth. She showed dramatic improvement in sensorium and cognition and was discharged. This case highlights the diagnosis and successful management of recurrent central nervous system nosocomial infection caused by rare but emerging healthcare-associated infections. To the best of our knowledge, this is the only case of recurrent nosocomial meningitis caused by three different bacteria and is also one of the rare cases of nosocomial meningitis caused by B. cepacia and vancomycin-resistant E. faecium.

Background: Mycobacterium kansasii is being increasingly recognized as an important pathogen mimicking clinically Mycobacterium tuberculosis (MTB). We describe here a series of cases due to M. kansasii lung disease from a tertiary care private hospital from South India. Methods: A retrospective chart review of patients diagnosed with M. kansasii pulmonary infection at a tertiary care referral center between January 2017 and April 2019 was conducted. Positive bronchoalveolar lavage (BAL) cultures were included in the study. Results: Seven patients with majority having underlying predisposing conditions presented with respiratory symptoms and radiological features resembling pulmonary tuberculosis. Smear acid fast bacillus (AFB) positivity was seen in 3 out of 7 cases. M. kansasii was isolated from bronchial culture in all of them with negative GeneXpert MTB reports. Five patients showed clinical improvement after starting treatment, while two were lost to follow up. Conclusion: M. kansasii should be suspected in AFB smear positive but GeneXpert MTB negative patients. Getting AFB cultures done is crucial in such patients to make an appropriate etiological diagnosis.

The recent advances in telemedicine have offered real and practical opportunities to health-care providers in sharing expertise and resources in health care over distances. In India, telemedicine has revolutionized the health-care system by minimizing the cost, avoiding the long-distance travels and in timely providing specialist care in remote areas. The Indian Army is also reaping the benefits of telemedicine, by providing round-the-clock medical care to the troops deployed in high-altitude areas.