Background: Naval maritime physician is a trained doctor who is responsible for providing promotive, preventive and curative health care to the ship's crew. Injuries and sickness of seafarer's has existed since the time man learned sea travel In earlier day the duties of maritime physician were performed by the captain or barber surgeons who used archaic remedies such as treating sores from the ropes on sailors' hands with sufferer's urine, turpentine for rheumatic pains, limb injuries were frequently treated with amputation and most popular cure for all ailments was always gin, rum or whiskey. Then came the diplomed physicians and trained medical officers on war ships who were wardroom warrant officers and it was only in 1808 that the medical officers were given commissioned ranks. Over the centuries the role of naval maritime physicians has evolved to provide high standards of care even in adverse conditions and with minimal support. Roles and challenges: Good maritime medicalpractice involves meeting numerous challenges of clinical, occupational, emergency, trauma and psychiatric medicine, in addition on board physicians must also have, in depth knowledge of pschycosomatic conditions due to stress andfatigue of crew and special conditions such as diving accidents and accidents involving aquatic animals. The situation on board requires extraordinary skills as interventions are difficult, both physically and technically, because the conditions at sea are often acrobatic and at certain times evacuation is also not possible due to weather and operational constraints. Thus the role naval doctor on board ships is truly of an all round physicians, a team mate and a good leader. Conclusion: In conclusion, responsibilities of Naval Maritime Physician is not limited to clinical activities but is multifaceted and objective training about the specifics of warships' environment and related health problems is the key to achieve professional excellence in every sphere.

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Introduction: A more than one third of stroke survivors are left with permanent disability in the form of significant residualphysical, cognitive andpsychological impairments. The increasing emergences of new therapies for acute stroke suggest that there will be an increase in number of survivor living with disabilities. Accurate outcome prediction following stroke is important for the proper delivery ofpost stroke care and establishment of an effective continuing care program. Numerous trials have been undertaken to study the prognosis of stroke. Recent literature suggests the early clinical courses of the neurological deficit after acute stroke is dependent on the initial stroke severity. Methodology: Study was conducted at a tertiary care centre in over a period of 2 years. The diagnosis of stroke due to vascular event was confirmed in each case by neuroimaging (plain CT Scan Head/ MRIBrain) apart from the clinical evaluation. Patients screened were evaluated at enrolment (within 7 days from stroke onset) and during follow up at 04 weeks and 12 weeks after stroke by the same observer employing the same criteria used at the time of presentation using following scales: Barthel's index (BI) and modified Rankin Scale (mRS) score. All the patients were given standard care as per the guidelines of American Stroke Association. Primary outcome was to study the co-relation between BI and mRS in assessing functional outcome in acute ischemic stroke at the end of 4 weeks and 12 weeks and secondary outcome was to study the correlation between the functional outcome scales andfindings on neuroimaging of brain. Results: Sixty nine patients were screened for the study and 58 patients met the eligibility criteria. Out of 58 patients, 8 patients hadpresented within window period (3h - 41/2 h). The overall mortality during 12 weeks amounted to 10.3% and was higher in men (6.9%) than women (3.4%). Thefunctional outcome scores were calculated by using the BI and mRS at admission and follow up. The mean BI score at admission and at 12 weeks was 36.72 ± 23.72 and 63.88 ± 29.85 respectively. The mean mRS score at admission and at 12 weeks was 4.09 ± 0.77 and 3.00 ± 1.40 respectively. Correlation between the BI score and mRS score at admission, and during follow up showed a significant negative correlation (p<0.001). Infarct size and BI score at admission, 4 weeks and at 12 weeks were found to be negatively correlated (p<0.001) which means that as the infarct size increased, BI score decreased Infarct size and mRS score at admission, 4 weeks and at 12 weeks werefound to be positively correlated (p<0.001) which means that as the infarct size increased, mRS increased. Conclusion: Our study has demonstrated that stroke functional outcome can be predicted from the baseline BI and mRS scales. It is concluded thatBI and mRS Stroke scale can be used to prognosticate functional outcome at admission and at follow up.

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Introduction: Carbon monoxide is known as the silent killer, being colorless, odourless, and tasteless. Initially non-irritating, it is very difficult for people to detect Carbon monoxide is a product of incomplete combustion of organic matter due to insufficient oxygen supply that prevents complete oxidation of carbon to C02. During World War II, Nazis used gas vans to kill an estimated over 700,000 prisoners by carbon monoxide poisoning. This method was also used in the gas chambers ofseveral death camps. The true number of incidents of carbon monoxide poisoning is unknown, since many non-lethal exposures go undetected From the available data, carbon monoxide poisoning is the most common cause of injury and death due to poisoning worldwide. Clinical features and management: The signs of carbon monoxide poisoning vary with concentration and length of exposure. Subtle cardiovascular or neurobehavioural effects occur at low concentration. The onset of chronic poisoning is usually insidious and easily mistaken for viral prodrome, depression, or gastroenteritis in children. The classic sign of carbon monoxide poisoning which is actually more often seen in the dead than the living is appearing red-cheeked and healthy. Cherry pink colour develops in nails, skin and mucosa. In acute poisoning, common abnormalities of posture and tone are cogwheel rigidity, opisthotonus, spasticity or flaccidity and seizures. Retinal haemorrhages and the classic cherry red skin colour are seldom seen. Different people andpopulations may have different carbon monoxide tolerance levels. On average, exposures at 100ppm or greater is dangerous to human health. Treatment and prevention: The mainstay of treatment is 100% oxygen administration until the COHb level is normal When the patient is stable enough to be transported, hyperbaric oxygen (HBOT) should be considered This treatment is safe and well tolerated Public education about the danger of carbon monoxide, with emphasis on safety in the home and workplace, is the key to effective prevention. This could be achieved through a media campaign when risk is greatest, Le. during the winter. Close liaison between public health physicians and leaders of building, gas and home heating industries is a prerequisite for an effective prevention strategy.

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Background: Rigorous exercise is a hallmark of military training and more than often gives rise to dehydration and stress related injuries. Proper hydration and carbohydrate loading can overcome dehydration and protein supplement can prevent its imminent complications. Severe dehydration gives rise to loss of fluid, electrolyte imbalance and acid base disorders and needs to be managed with correct fluids, quantitatively and qualitatively. Objectives. To develop and implement a new hydration protocolfor military endurance training in hot and humid climatic conditions. Methodology: A longitudinal pilot study was conducted amongst the under trainees in a military academy in Southern India which has a hot and humid climate throughout the year. Data was collected for all heat exhaustion and heat stroke cases admitted to the hospital A new hydration and diet protocol based on extensive review of existing and current literature was developed The protocol was divided into three parts Le. pre exercise, during exercise and post exercise. Results: Out of a total of 1200 under trainees being trained in each term of six months (both in 2014 and 2015), there were a total of 95 cases of heat exhaustion and 05 cases of heat stroke in 2014 and 48 cases of heat exhaustion and 05 cases of heat stroke in 2015. Conclusion: The results of implementation of the new protocol for endurance training is encouraging with a sharp decline in number of cases of heat exhaustion in 2015 post introduction of the new hydration and dietprotocol An appropriate selection of food andfluid, timing of intake, and supplement choices as per the new hydration protocol we developedfor the study are highly recommended for optimal health and exercise performance in military training and to prevent heat related illnesses.

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Low back pain (LBP) is a condition which affects most of the individuals at some point of time in their lives. The reportedprevalence of LBP in Indian population is highly variable, and ranges from 6.2% to 92%. The etiology of LBPcovers a vast number of factors including mechanical, psychogenic, degenerative, post traumatic and inflammatory causes. Meticulous history taking andphysical examination are of utmost importance while dealing with a case of LBR Various classes of medicines are available with promising results for control of LBR Non Steroidal Anti Inflammatory Drugs, selective COX2 inhibitors, muscle relaxants, opioid analgesics, tricyclic antidepressants, gabapentin, pregabalin etc. Non pharmacological intervention like spinal manipulation and acupuncture are of controversial effectiveness. Yoga and physiotherapy have evidence supporting their role in improving the pain. Strong need is there to improvise the conventional method of managing LBR Approximately 95% cases of LBP are of non speciJic mechanical wherein diagnostic imaging tests (including X-rays, CT and MRT) are not routinely indicated for acute non-specifi LBR Investigations should be limited for the small minority (<2-5%) where the cause of back pain is suspected to be either inflammatory (ie. systemic autoimmune diseases viz. ankylosing spondylitis or spondyloarthritis) or sinister. Active rehabilitation should be encouraged and the patients should not be prescribed bed rest as a treatntenf Management of LBPrequires an umbrella approach which, apart from pharmacological intervention, screening for psychosocial prognostic indicators in LBP may ultimately guide treatment protocols in physical therapy for more comprehensive patient care along with patient empowerment in terms of health education, participation in decision muking and responsibility of taking good self-care.

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Background: Over the past few decades there has been a dramatic rise in the prevalence of obesity throughout the world Waist circumference has been found to be positively correlated with intra-abdominalfat content and can be used to predict risk of developing obesity related disorders. Asians' have a higher intra-abdominal fat and CVS risk factors at lower waist circumference, hence lower cutoff valves have been recommended for Asians'. This study was conducted to asses appropriateness of recommended lower Asian waist circumference cutoff's for Indian population. Methods: Anthropometric measurements were recorded for 800 healthy Indian subjects in the age range of 30 to 50 years selected by stratified random sampling. The measurements were used to describe the distribution of waist circumference and its correlation with selected biochemical factors. Results: Waist Circumference for the study subjects ranged from 63 cms to 107 cms with a mean of 83.9 (±8.9) cms. 210 (26.25%) individuals were categorized to be at an increased risk of obesity related disorders, using the current recommended cutoff of waist circumference of >90cms and were found to have higher levels of biochemical parameters. Fasting Blood Sugar, Total cholesterol, Triglyceride, LDL, VLDL and Blood pressure showed significant correlation with Waist Circumference. Conclusion: Findings of this study show that waist circumference cutoffs recommendedfor Asian population are appropriate for Indians and it is recommended that a national level multi-centric study must be carried out, to define a more evidence based criteria of overweight for Indian population.

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Background: Facilities to measure SP02 are not available at all centers especially in the resource poor developing countries. This study is therefore important to identify a minimum set ofclinical signs that can reliably predict presence of hypoxemia in children with hyperreactive airway disease that can be used by health care provider to institute oxygen therapy. Methods: study was carried out as a single centre, prospective, observational study fromyear 2005 to 2007. A total of 51 children were studied equally divided in three groups depending upon oxygen saturation. A clinical scoring system was used which was generated after reviewing many studies and taking more practical aspect in relation to its use in peripheral set up. Result: The average age of the infants with oxygen saturation > 95% (Group A), 90–95% (Group B) and <90% ( Group C) was 7.82, 8.02 and 8.17 months respectively. It was observed that clinical score for group A (Sp02 >95%) was ranging between 1 to 6, for group . (90–95%) was between 6 to 11 andfor group C ( <90%) was between 8 to 13. Median score for patients with Sp02 > 95% was 3, with Sp02 90–95% was 8 and with Sp02 <90% was 11 ( Table 2). Correlation coefficient was −0.906, as oxygen saturation was inversely related to clinical scoring of respiratory distress. Confidence interval at 95% for group A was 3.235±0.815,for group . was 8±0.672 andfor group C was 10.882 ± ft 917. The difference of clinical score between group A, group . and group C were statistically significant (p<0.001). Conclusion: Oxygen can be started for all babies with hyperreactive airway disease who are having clinical score of 7 or more and amount of oxygen to be increased as score increases from 7 to 14.

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Although Jellyfish stings are common medical problem in summer for Indian divers but most of cases are trivial in nature and are treated by first-aid and specific management We report a rare case of jellyfish sting related eye injury probably caused by “hair” jellyfish (cyanea capillata) in channel connected to Arabian sea atKochl The patient a 39 years old diver was stung while swimming without goggles in the channel in the morning hours. He experienced severe pain left eye, requiring narcotic analgesia and had decreased visual acuity with erythema of left side of face. Although brief and self-limiting, eye injuries afterjellyfish stings should be assessed and treated as early as possible to reduce risk of longer term sequelae. Prevention should incorporate information about jellyfish and early treatment of such stings.

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Use of lasers in Operation Theatre (OT) is a challenge for both the surgeons and anesthesiologists due to its potential hazard of thermal injury to both patients and OT personnel Adequate preparations need to be undertaken prior to surgery to reduce the risks associated with laser beams. Pre-considered contingency plans for airway fires should be in place. Strict implementation of safety precautions is key for safety of patients and staff in naval hospitals.

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This is a case of Eating Disorder, which is described in a teenage girl who presented with intractable vomiting, hydropneumothorax and pulmonary Koch's. The patient's initial presentation was markedpreoccupation with body shape and image, restrictive eating, which progressed to episodes of vomiting after every meal, and led to academic decline followed by amenorrhoea and deterioration of general medical condition. She was managed with nutritional restoration, ATT and Olanzapine with Fluoxetine, to which she responded poorly.

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1st in the series of articles on “Unknown Facets of well-known Scientists” was about Sir Frederick Grant Banting, co-discoverer of Insulin, who also researched in Aviation and Diving Medicines, results of which brought extraordinary benefits for Flight crew during the World War II. The article was published in the previous issue of the Journal Unknown facets could be celebrated attributes, talents or otherwise, but it is necessary that we get to know fully about the “great mind". THIS ARTICLE IS ABOUT DR WERNER THEODOR OTTO FORSSMANN, A CARDIOLOGIST, WHO BECAME A UROLOGIST! Does the name Dr Forssmann ring a bell? He shared the 1956 Nobel Prize in Physiology or Medicine with “Andre Cournand and Dickinson Richards". The trio was awarded for their “discoveries concerning heart catheterization and pathological changes in the circulatory system". Dr Forssmann was nominated for performing an experiment in which he introduced a catheter into a vein of his arm, further passing it onward into his heart It was risky. This was in the year 1929. Subject of this article is the self-experimentation he carried out and what happened later.

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Dengue is a vector borne disease exhibiting rapid rise in Southeast Asia especially India. All personnel serving at harbors are at higher risk view exposure in large shipyards with extensive breeding sites amidst massive infrastructure projects where ships undergoing repairs. The year on year morbidity pattern is alarming necessitating detailed study for instituting sustainable preventive measures in tune with the geographicalpattern of breeding. This study was conducted to assess the distribution pattern, the nature of disease and identify resistant breeding sites and institute corrective measures to reduce the incidence in future. From the study of200patients admitted from Sep to Dec 2014,it was observed that the disease peaked in Oct affecting largely personnel working on ships(82.5%). Sensitisation and awareness campaigns prior to monsoons along with strict implementation of preventive measures would drastically reduce recurrence of such outbreaks, n.

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Background: The Global Burden of Diseases (GBD) study reported the estimated mortality from CAD in India at 1.6 million in the year 2000. It has been predicted that by the year 2020 there will be an increase by almost 75% in the global CVD burden. Acute MI in young adults is characterized by the presence of multiple risk factors which tend to be additive in influencing morbidity and mortality. A contributory factor, which may explain the abnormalities in lipid profile of Indians, is the high risk atherosclerotic diet, which promotes over nutrition, obesity and diabetes. Methods: It is an observational study done at tertiary care center. In our study we studied 55 consecutive patients suffered with acute myocardial Infarction (AMI) between age group 15-45 years, fulfilling inclusion criteria. We assessed clinical profile and their risk factors. Results:

1. Mean age of acute myocardial infarction was 40.6 years.
2. Ajority of the patients were male (94.5%) and between the age group of 41-45 years (50.9%), chest pain was commonest presentation.
3. Smoking was the most common risk factor (61.8%), followed raised homocysteine level (45.5%). Family history of Premature CAD was presents in significant number of individuals (36.4%). Obesity with raised BMI was found in 10.9% patients. Incidence of DM was 18.2%, hypertension was seen in 10.9%cases. Abnormalities in lipidprofile were seen 21.8% patients. Hyperuricemia was found in 31 %, AB positive blood group was most common and was presents in 34.5%.
4. In most individuals single blood vessel was involved (76.4%) with good left ventricular (LV) function (49%) and over all prognoses was good in patients with door to stent time less than 60 min. The coronary arteries involved in these cases were LAD in 36.4%, LCX in 20% and RCA in 20%.

Conclusion: In young MI cases conventional risk factors like diabetes mellitus, hypertension play less important role as compared to old individuals. Smoking and novel emerging risk factors like hyperhomocysteinemia, protein C & S deficiency play much prominent role in young patients with MI.

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Introduction: The risk of developing pulmonary tuberculosis (PTB) increases with concurrent nutritional deficiency, of the specific nutrients, social and environmental conditions. PTB, on the other hand, gives rise to both muscle andfat wasting due to loss of appetite and increased catabolic activity. It is also associated with an increased risk of relapse and secondary Multidrug Resistant (MDR) TR Indoor air pollution, smoking and alcohol are well known strong predictors and surprisingly still quite prevalent in rural and urban areas. Methodology: A cross sectional study was carried out over a period of 06 months in PTB cases, above 15 years of age, attending the DOTS centres in an urban area. Extra PTB cases were excludedfrom the study. The sample size was worked out to be 118. Results: Overcrowding was present in 76 (64.4%) of the respondents, 91 (77.1%) had kitchen within the living rooms and 52 (44.1%) of them used cylinders (LPG) and kerosene oil as the cooking fuel Current smoking was reported by 70 (59.3%) patients, and 44 (37.2%) reported alcohol consumption. Of the 118 respondents, 10 (8.2%) had HIV/AIDS and 31 (26.2%) had Diabetes as co morbidities. Around, 69 (58.5%) of them had low BMI (Thinness), PBFwas low in 83 (70.3%) cases andSMM was low in 80 (72%) cases. Conclusion: Proper dietetic advice, taking into consideration local dietary preferences, may be required to be included in the TB management protocol at the DOTS centre. Indoor air pollution needs to be curbed in our society both in the rural as well in the urban area by empowering the community with better fuel.

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Background: As per the WHO global status report on Non Communicable Diseases, the South East Asian region has been found to have 36% adults who are hypertensive. Epidemic of hypertension is touching epic proportions today, with even children and adolescents being affected Studies highlight that excess salt consumption is a significant risk factor for development of hypertension. It has been found that consumer knowledge to a large extent influences salt consumption thus; there is a need to clarify the role of salt and beliefs in relation to its usage within the population. With this background it was decided to carry out an assessment of knowledge, attitude and practice of salt consumption in a representative sample of individuals in an urban community. Methods: The survey was a descriptive study based on a validated salt knowledge assessment questionnaire administered to 405 individuals. Results: 88.9% individuals felt that high quantities of salt can damage health. 53.3% individuals were aware of the quantity of salt that is considered optimum 57.8% had a habit of sprinkling salt over food and 86.7% got their blood pressure checked regularly. Conclusion: Despite being educated large gaps in knowledge and practice still exist in the society. Until the time when there is widespread availability of food products with lower amounts of salt, active participation from consumers will be required to reduce the salt in their diet Awareness generation is the need of the hour with a holistic approach targeting the children also.

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Background: There are only very few studies which compared 25 and 50 microgram of misoprostol in relation to neonatal outcome and Indian data in this context are lacking. Methods: This study was carried out as a single centre, prospective, observational study which consisted of 100 term pregnant women divided in two groups. Neonatal outcome was compared in relation to frequency of abnormalfetal heart rate tracings, meconium passage, 1- or 5-minute Apgar scores < 7, neonatal resuscitations, or admissions to the neonatal intensive care unit Result: Meconium stained liquor was observed in 6% of cases in both groups. Apgar score at 1 min was <7 in 10% of cases in 25 meg group against 6% in 50 meg group. Requirement of neonatal resuscitation was observed in 10% of cases in each group. Fetal heart rate abnormality was observed in 22% of cases in 50 meg group against 12% in 25 meg group. Neonatal problems were detected in 14% and 12% of cases in 25 meg and 50 meg group respectively. Statistically these difference were not significant Conclusion: There is no significant difference in neonatal outcome with 25 and 50 microgram of misoprostol used for induction of delivery in term pregnancy.

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Personality studies of Indian adventurers are rare. This case report is an explorative descriptive study of a solo circumnavigator who completed a non-stop, unassisted voyage around the world in 151 days. His personality factors, resilience and coping styles were studied and have been discussed below.

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Lofgren’s syndrome is characterized by triad of Erythema Nodosum, hilar lymphadenopathy and polyarthralgia. [1] It is mostly seen as an acute form of sarcoidosis, in 35 % of such cases. In India sarcoidosis is rare condition and only 5-6% of such rare cases may present as Lofgren 's syndrome. Other possible causes ofLofgren 's may be infections and environmental factors as the disease tends to have increased incidence during spring season. [3] In this article we are reporting a rare case of Lofgren's with rarer presentation of Erythema Nodosum, polyarthritis, hilar lymphadenopathy and episcleritis, from India which was triggered by infection.

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Carcinoma breast is the commonest malignancy among the females in developed countries. These patients require Radiation Therapy as an integral part of multimodality treatment Surgery commonly involves breast conservation, with or without breast reconstruction. One of our patients underwent modified radical mastectomy with immediate breast reconstruction using a temporary tissue expander. Postoperative irradiation was delivered to the breast mound encompassing the tissue expander. The effect of post-operative radiotherapy (port) in a patient who was treated with radiotherapy with the tissue expander in situ was assessed and reported here. The purpose of this study was to quantify the radiation dose distribution due to the presence of tissue expander and determine its potential contribution towards complication rate.

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SCUBA diving is an increasingly popular recreational sport across the globe and normally conducted by trained diving instructors. Increased commercialization, inadequate professional knowledge/training and poor compliance to the existing safety guidelines may be the contributing factors responsible for accidents related to SCUBA diving. We present a rare case of vaso-occlusive sickle cell crisis mimicking Decompression S

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