In the realm of infectious diseases, a global outbreak is a worst-case scenario. In the past, outbreaks such as plague, Spanish flu, severe acute respiratory syndrome, and H1N1 (swine flu) have caused great human suffering. The novel coronavirus, christened as Covid-19, is a zoonotic disease which originated from the Wuhan province in China and spread like wildfire killing people and devastating the global economy. Mammoth efforts are still on to control this viral strain from further spread. Cities have been blocked, air travel banned, ships have been quarantined, and panic-stricken people have been evacuated from China. As Covid-19 continues to ravage countries across the globe, this article is an effort to provide an overview of the impact of Covid-19 and tickle wits of intellectuals to think how easily a nanometer organism can virtually bring down superpowers of the world.

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Background: Artemisinin resistance is being reported from certain regions of the world. Globally, the scientific community is engaged in tracing the epidemiology of this resistance while also working on possible interventions to curb the spread. Aim: We reviewed the epidemiology of antimalarial drug resistance, especially artemisinin resistance both globally and in India, and report the possible ways forward. Literature Search: Resistance to all antimalarial drugs developed initially in South East Asia and thereafter spread globally. Artemisinin-based combination treatment (ACT) was formally recommended by the World Health Organisation (WHO) in 2005 to achieve an enhanced barrier to drug resistance. However in 2008, resistance to artemisinin was first reported from Western Cambodia/Thailand. Subsequently, P falciparum chromosome 13 ('kelch' motif or K13) (Pfk 13) was implicated with slow in vivo parasite clearance. As of 2019, artemisinin resistance has been confirmed in six countries of the Greater Mekong Sub-region. The North east states of India have been the portal for entry of anti-malarial drug resistance over the past decades. Though in vitro testing have not shown evidence of decreased artemisinin sensitivity, however, Pfk13 mutations have been reported from India, thus sounding a note of caution and indicating the need for continued genetic, clinical and public health surveillance. Conclusion: Though clinical cure in falciparum malaria infection continues to be elicited through use of ACT even in the countries reporting artemisinin resistance, however a comprehensive framework for combating the resistance has already been put into action by the WHO.

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Context: Human cytomegalovirus (CMV), otherwise called human herpesvirus 5, is a member of the Herpesviridae family. Maternofetal transmission of CMV can occur during pregnancy following primary or recurrent infections in the mother. Infections in utero are associated with fetal abnormalities, intrauterine growth retardation, and intrauterine death. In India, 80%–90% of the adult population show presence of CMV antibodies; however, there are few articles showing the prevalence of CMV infection in pregnant women. Aims: The aim of this study is to assess seroprevalence of CMV infection in antenatal women. Settings and Design: This is a cross-sectional, observational study, study population: women reporting for antenatal care to the OPD at a tertiary care hospital. Subjects and Methods: Three hundred and seventy serum samples drawn from antenatal women attending OPD in a tertiary care center were tested for IgG and IgM antibodies by enzyme-linked immunosorbent assay. Statistical Analysis Used: Statistical significance was estimated by calculating “P value.” Results: Of the 370 samples tested, 83% showed the presence of CMV IgG and 9.46% were positive for CMV IgM. All those cases which were IgM positive were seropositive for CMV IgG as well. Sixteen percent of the antenatal women were both IgG and IgM negative. Conclusion: The prevalence of CMV IgG in antenatal women in this region is high. Around 16% of the women showed lack of IgG. It would be beneficial to screen pregnant women for CMV IgM antibodies is beneficial and will help guide the testing of newborns suspected to be infected with CMV in order that appropriate therapy of the infected infants can be instituted promptly and appropriate advice can be rendered on prevention of transmission.

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Background: Warts are mucocutaneous infections caused by human papillomavirus (HPV). Of the various modalities of treatment currently available, no single modality is uniformly efficacious and recurrences are common. Homologous autoimplantation is a minimally invasive procedure, which treats warts by stimulating a specific immune response against HPV. Aim: The aim of the study was to evaluate the clinical outcomes and recurrences after a single sitting of homologous autoimplantation therapy for multiple nonvenereal warts. Materials and Methods: Single homologous autoimplantation of wart tissue was done in 75 patients of multiple facial, palmoplantar, or common warts, reporting to a tertiary care dermatology center. They were assessed at 3 months for the outcome of the procedure, and those with complete clearance were followed up for 1 year for any recurrences. Results: Complete clearance was observed in 30 (40%) of the cases and 10 (13.3%) cases showed moderate clearance. In 13 (17.3%) cases, there was mild clearance, whereas 22 (29.3%) patients did not show any response to treatment. Patients with facial warts showed good therapeutic response with complete clearance seen in 62.5%, compared to plantar warts, where complete clearance was achieved only in 16%. At the end of the study period, recurrence was seen in only 1 (3.33%) patient in the complete clearance group. Conclusion: Autoimplantation therapy as a one time minimally invasive procedure has moderate efficacy in treating multiple warts with the best outcome being for facial warts. The virus-specific immunity generated in the process reduces the chances of recurrences.

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Context: Phototherapy is the mainstay of treatment for about 3% of neonates in India who develop significant jaundice in phototherapy range. New devices have been introduced in the market over the past few years. Aims: To compare the efficacy of three types of phototherapy machines, namely Blue and White, Compact Fluorescent Lamp, and Light Emitting Diode type. Settings and Design: A non-randomized prospective interventional study conducted in a tertiary care hospital of Western India. Material and Methods: Ninety neonates with phototherapy range hyperbilirubinemia were assigned into three groups of 30 neonates each to receive phototherapy using one of the three types of phototherapy machines. Need for exchange transfusion, total serum bilirubin (TSB) at 24 hours post-phototherapy and side effect profile were recorded. Decision to stop phototherapy was based on acceptable reduction of serum bilirubin to below phototherapy range. Statistical analysis used: Medcalc^® Version 11.4.2.0 Software was utilised. Comparison of mean TSB was done using one way ANOVA. P-value of <0.05 was considered significant. Results: Baseline parameters, TSB at 24 hour post-phototherapy and at the point of stopping phototherapy in the three groups was not significantly different. None of the babies required exchange transfusion or stopping of therapy. Transient rash was the most commonly observed side effect. Conclusions: The three types of phototherapy equipment studied were comparable in efficacy as measured by need for exchange transfusion and mean TSB values at 24 hrs post-phototherapy. The side effect profile was similar and was not significant enough to stop phototherapy.

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Introduction: Induction of labor is a deliberate attempt to terminate the pregnancy with the aim of vaginal delivery in cases of valid indication. Different methods are being used ranging from nonpharmacological to pharmacological for the same. Induction on demand by patients is also rising in our country. Objectives: The aim of this study is to ascertain the common indications for induction of labor at a tertiary care teaching hospital. Materials and Methods: A prospective observational study, with the study group being all the patients who underwent induction of labor and the total population including all the women delivering at our center, in 1 year. The induction was done using “Dinoprostone” gel or tablet “Misoprostol”. Results: Postdated pregnancy was the reason for induction of labor in 36% of the patients. Hypertensive disorders and gestational diabetes mellitus are other common conditions requiring induction of labor. Pregnancy following assisted reproductive techniques form an important group requiring induction of labor in present day practice. Conclusion: Hypertensive disorders and postdated pregnancy are the most common indication for induction of labor.

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Introduction: Levamisole, a synthetic imidazothiazole derivative has been used as a steroid sparing agent in children with Frequently Relapsing Nephrotic Syndrome (FRNS) and Steroid Dependent Idiopathic Nephrotic Syndrome (SDNS). Levamisole has been essentially considered a safe drug with minimal toxicity. We conducted this study to re-examine the safety of Levamisole in children with nephrotic syndrome and to describe the clinical profile of these children. Materials and Methods: Records of children with idiopathic nephrotic syndrome between June 2014 and December 2016 were reviewed. We identified frequently relapsing or steroid dependent children between 1-18 years of age who had received Levamisole for at least six months or in whom Levamisole was started but had to be withdrawn due to some adverse events in the first 6 months. Results: 21 children were started on Levamisole in the study period. 13 (61.90%) were FRNS and remaining had a steroid dependent course. Levamisole had to be withdrawn in one child at 1 month 13 days after initiation when the child developed severe headache. Levamisole also had to be discontinued in a 9 years old girl at 13 months after initiation of therapy due to polyarticular arthralgia involving both the small and large joints. Conclusions: The use of Levamisole warrants caution in children with Nephrotic Syndrome and its efficacy needs to be balanced against its potential side effects.

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Context: A retrospective observational study conducted to assess transversus abdominis plane (TAP) block as a tool for providing multimodal analgesia postoperatively for abdominal surgeries. Aims: The aim is to compare the visual analog scale (VAS) of pain and the requirement of rescue analgesia postoperatively in patients undergoing various abdominal surgeries (open and laparoscopic) where TAP block was given for postoperative analgesia and was compared with patients who received pain relief according to the institutional protocol. Settings and Design: Retrospective observational study conducted in a tertiary care hospital. Subjects and Methods: Retrospective data from anesthesia records of patients, who underwent abdominal surgeries from January 2016 to December 2016, were analyzed and were divided into two groups. Group A (n = 250) consisted of patients who received the conventional standard postoperative analgesia protocol of the department of anesthesia. Group B (n = 136) consisted of patients who were administered TAP block postsurgery for the postoperative analgesia by the trained anesthesiologist. Primary outcome considered was (i) average VAS at 02, 06, 12, and 24 h and (ii) average opioid/nonsteroidal anti-inflammatory drug consumption at 24 h postoperatively. Secondary outcome considered was time to first rescue analgesia. Statistical Analysis: All parametric data were analyzed using unpaired t-test. Data are expressed as the mean ± standard deviation. A SPSS version 17 (SPSS Inc., Chicago, IL, USA) was used for statistical analysis. Results: Average pain scores (VAS) were lower in Group B as compared to Group A in all subcategories of surgery postoperatively. Patients given TAP block (Group B) required less rescue analgesia in the postoperative period with time to first rescue analgesia being prolonged. Conclusions: On the basis of our retrospective study, we suggest that TAP block can be utilized as a part of multimodal analgesia regimen for abdominal surgeries, laparoscopic as well as open. Tap block has demonstrated a good safety profile in experienced hands; it is easy to perform and has displayed consistent analgesia over a prolonged period. It reduces postoperative morbidity and supports early ambulation.

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Background: Health information is one of the most accessed topics online. Worldwide, about 4.5% of all Internet searches are for health-related informationand more than 70, 000 websites disseminate health information. However, critics question the quality and credibility of online health information as contents are mostly a result of limited research or are commercialised. There is a need to train people to locate relevant websites where they can efficiently retrieve evidence based information and evaluate the same. The study was conducted with the objectives of determining the prevalence of use of internet for accessing healthcare information amongst literate adult population in an urban area and to assess the association between the demography and the reasons of internet use. Methodology: We used an anonymous, cross sectional survey completed by a sample of out patients of 408 individuals who came to a tertiary care centre at Pune during the year 2015. The survey consisted of 17 questions related to behavioural, attitudinal and demographic items. Results: Out of the total of 408 individuals, 256 (63.2%) individuals used internet for health information though 332 (82.4%) of them were aware of authorised websites for health information and 69 (16.9%) thought information available in the internet can be harmful. Also, 63 out of 256 (24.6%) agreed to the fact that they ask questions to their doctors based on the information that they acquired from internet while surfing about that particular disease/ ailment. More individuals (p<0.05) who were working and who were educated, graduates and above, were using internet for health information. Conclusion: Our results suggest the great potential for using the internet to disseminate the information and awareness to the public about health and healthcare facilities. However, it is important to disseminate credible information from reliable and authorised websites assigned for health since online healthcare information can reach target masses within a very short span of time.

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Background: During COVID-19 pandemic, Indian health authorities implemented massive measures to control the rapid spread of infection. Nonetheless, even during pandemic, pregnant women need constant obstetrics consultations during the antepartum period and adequate care during intrapartum and postpartum period for uneventful outcome. Undeniably, adherence to these control measures is largely affected by knowledge, attitude, and practices (KAP) towards COVID-19. Aims and Objectives: To assess knowledge, attitude, and practice towards COVID-19 amongst pregnant women and to find the association of demographic variables (age, place of residence, and education) with KAP. Materials and Methods: The cross-sectional, descriptive study was conducted for pregnant women attending the outpatient department of Obstetrics in a tertiary care Defense hospital. We investigated 506 pregnant women serially from Obstetrics OPD of the hospital for KAP towards COVID-19 with a questionnaire of 14 questions. The study population was assessed for the KAP score and association of demographic variables with KAP. Descriptive statistics were used to describe the findings. Median and standard deviation (SD) were calculated for KAP and Pearson's Chi-square test was used to analyze the association of demographic variables with KAP. Results: In our study scores for adequate knowledge, positive attitude, and good practices were 75.3 %, 73.9%, and 92.7 % respectively. The analysis of the association of various demographic variables with KAP about COVID-19 revealed significant association. Conclusion: The majority of pregnant women was knowledgeable about COVID-19 and had positive attitude and good practices. However, health authorities may need to take proactive steps for this vulnerable subpopulation.

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Proximal focal femoral deficiency (PFFD) is a rare congenital anomaly resulting in limb shortening and disability in young. The exact cause of the disease is not known and it may present as varying grades of affection involving the proximal femur and the acetabulum. Recognition of this rare abnormality on radiographs can help manage these cases better since early institution of therapy may help in achieving adequate growth of the femur.

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Foreign body in nose is one of the most common Ear Nose& Throat emergencies. Button batteries are one ofthe most dangerous foreign bodies as it can cause extensive tissue damage by chemical or thermal burns. We present a 5 years old boy with nasal mucosal necrosis against a button battery foreign body managed at a peripheral centre in the light of literature available.

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Chryseobacterium indologenes thrives well in the environment and does not contribute to the human flora. It is recently being reported to cause a plethora of diseases in humans and has been shown to destroy antimicrobial agents and tissues. We report a case of catheter-associated urinary tract infection (CAUTI) in an immunocompromised male who was treated successfully with appropriate oral antibiotics. Also presented is a review, though not an exhaustive one, of the various case reports from India, proving the organism to be an important, emerging, and potentially dangerous nosocomial pathogen.

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Disease transmission occurs with a perfect balance of the epidemiological triad consisting of an external agent, a susceptible host, and an environment that brings the agent and host together. Conflict situation is an ideal platform that creates this confluence of agent and host in perfect environmental conditions, for pathogens to tear through soldiers and refugees alike. Classically during armed conflicts, soldiers and displaced population get exposed to unsanitary and overcrowded barracks, trenches, refugee shelters, and concentration camps with disruptive health-care services. Many get susceptible to diseases prevalent in the relocated region and some may introduce pathogens in the native population. The earlier wartime epidemics were considered as divine interventions and wrath of God. As medicinal knowledge advanced, prevention strategies evolved from isolation and quarantine to sanitary measures against miasma and further to chemoprophylaxis and immunization against the pathogen. The advent of antivector chemicals and antibiotics revolutionized the control of epidemics during the World War II. Although not infectious in origin, modern-day outbreaks are mostly health events such as posttraumatic stress disorders in postwar or war-like scenario. This article chronicles the epidemiology of the better-known wartime epidemics.

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Background: The debate about the best arthroscopic technique for the anterior cruciate ligament (ACL) reconstruction surgery using semitendinosus (ST) quadruple graft is still unresolved. The aim of the present study was to compare the results of arthroscopic ACL reconstruction surgery techniques (transtibial [TT] and anteromedial portal [AMP]) using ST quadruple graft in terms of functional outcome. Materials and Methods: A total of 50 male patients with ACL tear were operated using the arthroscopic technique. The patients were divided into two groups (TT group and AMP group) and studied prospectively. The TT group (n = 24) included the patients in which femoral tunnel was prepared using the tibial tunnel. While the AMP group B (n = 26) included the patients in which femoral tunnel was prepared through the anteromedial arthroscopic portal. All these patients were assessed regularly and at follow-up of 1 year functionally using Lysholm Knee Score. Two groups were matched in terms of age, mode of injury, and side involved. Results: The average age of the patients in Group TT and AMP was 31.2 years (range: 22–43 years) and 30.6 years (range: 21–45 years), respectively. The mean Lysholm score improved significantly (P < 0.001) from 55.19 (range: 38–66) preoperatively to 82.65 (range 69–100) at the final follow-up in Group TT and 53.54 (range: 38–66) preoperatively to 82.04 (range: 59–100) at the final follow-up in group AMP. However, there was no significant difference in the mean Lysholm score while comparing the two groups at the final follow-up. Conclusion: ACL reconstruction surgery using ST quadruple graft with TT and transportal techniques provide similar functional outcome at 1-year follow-up.

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Background: Nasolacrimal duct (NLD) obstruction is a common clinical entity encountered both by ophthalmologists as well as otorhinolaryngologists. Endoscopic dacryocystorhinostomy (DCR) has emerged as a gold standard surgery for treatment of this disorder. Silicone stents are often promoted as agents to maintain patency of surgically created fistula during postoperative period in this surgery. Aim: The aim of this study is to evaluate and compare the outcomes of endoscopic DCR with and without silicone stenting. Materials and Methods: A prospective observational study was conducted. Totally 50 patients with acquired NLD obstruction were enrolled in the study and were randomly assigned to two groups: Group I underwent the surgery with silicone stent placement while the Group II underwent the surgery without stent placement. The patients were evaluated in terms of relief of symptoms and postoperative complications. Results: The overall success rate for endoscopic DCR in this study was 90% which is comparable with the reports in the literature. Success rate for patients with placement of stent was 92% and without stenting was 88%. However, there was no significant statistical difference between the two groups. Conclusion: Use of silicone stents does not influence results of Endoscopic DCR.

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Objective: Very low birth weight (VLBW) preterm neonates are fed every 2 hourly (2H) or 3 hourly (3H), but there is not sufficient evidence to determine the best feeding schedule. The study objectives were to compare the effects of 2H or 3H feeding schedule in neonates weighing <1500 g at birth, on the incidence of feed intolerance, apnea, necrotizing enterocolitis (NEC), hypoglycemia, and time to attain full feeds. Design and Setting: This longitudinal observational study was conducted in a level III neonatal unit of a teaching hospital in North India between October 2012 and March 2014. Materials and Methods: All stable intramural neonates born <1500 g were eligible for the study. Neonates with major malformations, congenital heart diseases, gastrointestinal anomalies, and those contraindicated for enteral feeding as decided by the treating clinicians were excluded. Sixty VLBW preterm neonates were assigned to 2H or 3H feeding groups. The incidence of feed intolerance, apnea, NEC, hypoglycemia, and time to attain full feeds was assessed. Results: There was no difference in incidence of feed intolerance between the two groups (30% vs. 23.3%, P = 0.56). The incidence of apnea, NEC, hypoglycemia, and time to attain full feeds was also similar between the two groups. Conclusion: 3H feeding is possibly as good as 2H feedings for VLBW neonates.

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Introduction: There is dearth of data on Spinal Cord Injury (SCI) from developing countries where ironically, special focus is required. Aims and Objectives: To study SCI in an organisational set up. Material and Methods: An observational, cross sectional study at a tertiary care rehabilitation centre was conducted. Patients who had injury during service were included. Questionnaire and case records were used to collect socio-demographic variables, cause, level, severity and duration of injury and clinical, functional and psychological status. Organisational support was estimated for pre-hospitalisation services, inpatient welfare measures and post-hospitalisation rehabilitative services. Results: A total of 157 patients participated. Median age at time of injury was 27 years with 89.2% injuries within 18 - 37 years of age. Trauma was underlying cause in 94.3%. Most common level of injury was thoracic (37.6%) and majority (66.9%) were paraplegic. RTA was most common (42.6%) traumatic cause and Tuberculosis among non-traumatic causes(66.6%). Scores suggestive of stress disorder were present in 13%. Pre-hospitalization health facilities were available to 79.6%. Majority (59.2%) had access to health facilities within two hours. Personal assistance was available to 88.5% and 66.9% undertook rehabilitation course. Conclusion: Health education with emphasis to trauma prevention in young is required. Social security measures need to be replicated by all organisations, both public and private in the country.

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Background: To analyze the nerve fiber layer thickness in a heterogeneous Indian population according to age and sex and to compare this parameter to published normative data on the Caucasian population to better understand the racial differences. Materials and Methods: A total of 400 patients of both gender belonging to various age groups were evaluated using Cirrus HD optical coherence tomography (OCT), Carl Zeiss, Meditec, Dublin. The results were evaluated and compared to determine the normal retinal nerve fiber layer thickness (RNFLT) and its variations with age and sex. Results: Average nerve fiber thickness along the 3.4 mm diameter circle around the optic nerve head was approximately 90.57 ± 11.59 μm. There was no significant difference seen between males and females for mean, quadrant, and clockwise RNFLT. This was the same in all the subgroups of our study. Conclusions: Our results provide the variations of RNFL in Indian population. To the best of our knowledge, this is the first study in our country done with a high sample size in the Cirrus HD-OCT machine.

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Introduction: High blood pressure (BP) is one of the most common chronic medical problems prompting visits to primary health-care providers. The incidence of lifestyle diseases over the years has shown an upward trend in developing countries too, which is a cause of grave concern for the health care professionals. Research suggests that undesirable body composition has a major bearing on health, fitness and lifestyle diseases such as hypertension, ischemic heart disease, and diabetes. Study: The aim of the study was to compare the body composition of hypertensive patients with normal subjects using state of the art impedance based noninvasive body composition analyzer. The study evaluated the body composition of hypertensive patients and compared the same with subjects with normal BP. The study was carried out at a tertiary care hospital in Pune. Body composition variables considered for the study were anthropometry, percent body fat, lean body mass, fat distribution, and visceral fat composition. Results: The analysis of body fat included obesity degree, visceral fat area (VFA), body fat mass, and percent body fat. The mean body fat mass was found to be 21.7Kg. The mean percent Body Fat was 28.9%, which was much higher than the normal. Various parameters depicting body fat were compared. All of them, namely body fat mass, percent body fat, obesity degree, and VFA were found to be significantly higher in hypertensives as compared to the other group. Conclusion: Besides other anthropometric parameters, assessment of VFA may be included as an essential measure to assess and even predict hypertension. Those with high VFA must be monitored closely for developing hypertension and other lifestyle diseases.

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Background: Lifestyle diseases which include hypertension, type 2 diabetes mellitus, obesity, and stroke are caused by influences on the human body by the way people live their lives. This study is an effort to describe the prevalence of various lifestyle diseases; factors associated with their causation and suggest measures for improvement of the health status among the industrial workers. Materials and Methods: A total of 351 workers were included in this study. The prevalence and pattern of lifestyle diseases among industrial workers were studied. The survey had two principal components, namely, the pretested standardized questionnaire and clinical examination. Blood sugar levels were assessed by a glucometer. Results: Hypertension was the most common lifestyle disease, seen among 43.0% of workers. It was significantly related to age, socioeconomic status type 2, body mass index (BMI), and habit of tobacco chewing. Only one-fourth were aware of their blood pressure status. Other diseases brought out were diabetes type 2 mellitus (7.7%) and obesity (4%). In this study, among those with type 2 diabetes mellitus, 29.63% were not aware of their blood sugar status. Diabetes was significantly related to BMI and increased significantly with increase in age. Also, one-third of the study population was overweight. Conclusion: Lifestyle diseases were found to be the major causes of morbidity among the study participants. Hypertension, type 2 diabetes mellitus, and overweight/obesity were the common morbidities. These conditions were associated with factors such as age, socioeconomic status, BMI, and history of tobacco chewing.

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Objective: The objective of the study was to compare the outcomes of the incidence of nausea/vomiting and other complications along with the time taken for discharged in patients undergoing Thoracic Epidural Analgesia (TEA) and General Anaesthesia (GA) for breast oncological surgeries. Background: GA with or without TEA or other postoperative pain-relieving strategies remains the traditional anesthetic technique used for breast oncological procedures. We initiated the use of high segmental TEA for patients undergoing these procedures in our hospital. Methods: Eighty patients undergoing breast oncological procedures performed by one surgical team were randomly allocated into two groups receiving TEA and GA. The Chi-square test and Fisher's exact test were used for categorical parameters, paired t-test and Student's t-test was used for continuous measurements. Results: In comparison with GA, TEA was associated with lesser incidence of complications of nausea/vomiting. In lumpectomy with axillary node dissection, 1 out of 18 patients (5.55%) in the TEA group had nausea/vomiting, while 11 out of 19 (57.8%) of the GA group had similar symptoms (P < 0.001). The discharge rate for the thoracic epidural group was 12 out of 18 by day 3 (66.6%) while all patients in the GA group required more than 3 days of hospitalization (P < 0.001). Conclusion: Thoracic epidural anesthesia is a safe technique and its use in breast oncological procedures could improve patients' recovery and facilitate their early discharge to home.

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Background: Breast lesions are always a diagnostic challenge and range from benign to malignant. Fine-Needle Aspiration Cytology (FNAC) is done in patients with breast lesions. However, to get an accurate and diagnostic yield is difficult at times. Aims: The aim of this study is to highlight the role of triple approach in diagnosing breast lesions. Design and Setting: This is an observational prospective study carried out in the Department of Pathology at a tertiary care hospital over 2 years. Materials and Methods: One hundred and fifty cases of breast lump were studied. Clinical findings, imaging findings, and cytology along with histopathological findings were correlated. Results: Cytological findings were benign in 102 out of 107 patients, who were otherwise clinically and radiologically benign. In rest five patients, Breast Imaging Reporting and Data Systems (BIRADS) BIRADS II category was given on mammography. In four of these five patients, there was cytological atypia. Biopsy in these four patients showed features of fibroadenoma with mild cytological atypia and one patient showed infiltrating duct carcinoma. Mammography was suggestive of malignant breast lump in 43 patients. In three patients, breast lump was diagnosed as benign on cytological examination. However, histopathological examination confirmed the mammography findings of malignancy. Conclusion: FNAC is a well-established procedure for diagnosing breast lesion but has got many pitfalls. Hence for diagnosis a breast lesion, the triple approach consisting of histopathological examination in addition to mammography and FNAC, should be considered.

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