Background and Objective: Carcinoma cervix (CC) is a preventable disease, but still remains as the most common cancer among women in India. This study examines the knowledge, attitude, and practice (KAP) concerning CC and screening among female health care providers (HCPs) of Chennai Corporation in 2013. Materials and Methods: In a descriptive cross-sectional study, 107 female HCPs working in Chennai Corporation were interviewed using a standardized questionnaire. Results: About 100% of HCPs were aware of CC. 85% of the HCPs were aware of the major risk factors and symptoms of cancer cervix. About 95.3% of HCPs were aware of the cervical cancer screening either Pap smear or visual inspection using acetic acid or Lugol's iodine. Only 57.9% felt that they were at risk of cervical cancer. About 80.4% felt that they should undergo cervical cancer screening for themselves. Only 18.4% of the female HCPs have ever undergone cervical cancer screening. Conclusion: There was a KAP - gap among HCPs. Misconceptions regarding screening need to be urgently addressed among HCPs.

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Background: In recent years, non-albicans Candida (NAC) are being increasingly reported in many laboratories. There is a need to diagnose them early as some of the species are resistant to antifungals. We evaluated the utility of HiCrome agar for speciation of Candida in comparison to conventional methods. Materials and Methods: Ninety-six isolates of Candida were speciated by morphology on corn meal agar (CMA), sugar assimilation tests (SAT), and HiCrome agar. Sensitivity, specificity, and positive predictive and negative predictive values were obtained. Results: Sensitivity of HiCrome agar in identification of Candida albicans was 97.05%, C. tropicalis was 83.33%, C. glabrata 100%, and C. krusei 87.5%; and specificity was 98.07, 91.93, 92, and 92.30%, respectively. Conclusion: The present Candida differential agar is useful in identifying a few of the species. With further modifications this media may replace the need for conventional methods. The rapid availability of results and identification of species in mixed cultures is significant.

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Compression of cranial nerves (CNs) by an intracranial plasmacytoma is considered to be an unusual presentation of multiple myeloma (MM). Here, we report a case of right 3 ^rd , 6 ^th , 9 ^th , 10 ^th and 12 ^th CN involvement, which emphasizes the fact that multiple CN palsy can be the first presenting feature of MM.

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Pediatric obesity is one of the most important health issues facing the world today. Changing lifestyles, affluence on the rise, introduction to new diets, changing social order and an increasingly sedentary lifestyle of the youth have contributed to the alarming rise of child and adolescent obesity. Recent definitions of obesity by WHO and IOTF have afforded distinct cutoffs to determine prevalence of obesity at the community level in children. Newer insights into leptin and its signaling pathways have helped our understanding of the genesis of obesity, which has been further bolstered by the numerous studies into the genetics of obesity. Endocrine disorders like hypothyroidism, Cushing's syndrome, and syndromic disorders need to be ruled out. In addition to the routine investigations, evaluation of markers of insulin resistance and fat percentage is of great research utility In Indian children, who differ metabolically from children in the west. The cornerstones of treatment are therapeutic lifestyle changes, behavior modification and pharmacological therapy when needed. However, primordial prevention by inculcation of a healthy lifestyle seems to be the best bet in combating pediatric obesity.

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Pregnancy is associated with many physiological changes in the renal system. Pregnancy can alter the course of some renal diseases as also pre-existing renal diseases may affect pregnancy outcomes. Pregnancy may be complicated by hypertension which warrants proper management. Acute kidney injury may complicate pregnancy. With chronic kidney diseases on the rise, it is important for the physician to be aware of management of pregnancy in these patients. Kidney transplant recipients have their unique set of problems and management of these patients poses a challenge for the physician. Hence, this review highlights the management of pregnant patients with renal diseases including issues related to dialysis and transplantation.

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Introduction: The aim of this study is to describe the epidemiology of urinary tract infection (UTI) in newborn infants admitted to neonatal intensive care unit (NICU) of Zagazig University. Patients and Methods: This study included 206 neonates admitted to the NICU in the period from 1/1/2010 to 1/6/2010. All neonates were subjected to detailed history taking, including prenatal history, natal history, and postnatal history, with stress on symptoms suggestive of UTI. We examined all neonates generally and locally, every case was subjected to urine analysis; suprapubic aspiration was done for all cases. "The diagnosis of UTI was established by the presence of at least 5 leukocytes per high power field." Urine culture, CBC (complete blood count), blood culture, and ultrasound scanning were also done for certain cases. Results: We found 75 newborns with clinical findings suggesting UTI. We classified our neonates according to the presence of at least 5 leukocytes in urine per high power field into two groups: Group I (−ve cases) without UTI included 44 neonates (31 males and 13 females) and Group II (+ve cases) with UTI included 31 neonates (24 males and 7 females). There was no significant difference between Group I and Group II with regard to gender, age, weight, and consanguinity. The incidence of UTI in NICU was 15.05% (33/206), prevalence among suspected cases of UTI in NICU was 41.3% (33/75), and of the 39 neonates with sepsis 33 had UTI (79.5%). Of the positive cases, 77.4% were full-term neonates and 22.6% were preterm neonates. Of the 31 cases with positive urinary culture there were 18 cases (58.1%) showing Escherichia coli, and 13 cases (41.9%) were positive for Klebsiella. Conclusion: This study has highlighted the need for routine urine analysis and culture, especially in high-risk newborns and to monitor the prevalence of UTI early in life. Also routine ultrasonographic screening should be done in all newborns with UTI to save the newborns and prevent the risk of complications, which may end in renal scarring and renal failure.

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This case reviews the history and findings of a young patient with vitamin D deficiency, successfully treated with vitamin D, who became addicted to injectable calcitriol. To the best of our knowledge, this is the first report of such an occurrence in the world literature.

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Background: Leptospirosis is an emerging spirochetal zoonosis world wide. Leptospirosis is common zoonosis that is under reported and under diagnosed in India. The aim of this study was to study the clinical profile outcome and prognostic factors in human leptospirosis at tertiary care centre. Settings and Design: This was a retrospective study of leptospira positive patients who were admitted in tertiary care centre. The study was conducted in 2010, over a period of 6 month from July to December. Materials and Methods: All patients who presented with clinical features and tested IgM positive for leptospirosis were taken into the study and analyzed based on modified Faine's criteria. Results: Out of total 23 patients there were 21 males and 2 females, with mean age was 32 years. Maximum incidence of cases was found in month of July and August. Out of total 23 patients, 18 (78.26%) were farmers and 5 (21.73%) were laborers. Predominant complaints were fever, jaundice, myalgia, and headache. All 23 had positive results for IgM against leptospira. Liver function tests were deranged in 16 (69.56%) and renal functions were deranged in 12 (52.17%). Total 7 (30.43%) patients had Weil's syndrome and 7 (30.43%) had acute respiratory distress syndrome (ARDS). Total 7 (30.43%) patients had neuroleptospirosis, out of which 5 (21.73%) had aseptic meningitis, one had paraparesis secondary to lumbar radiculopathy and one had meningoencephalitis. Hyperkalemia was present in 6 (26.08%) patients, 7 (30.43%) patients had hypokalemia. Total 11 (47.82%) patients had metabolic acidosis (pH<7.3) on arterial blood gas analysis. Two (8.69%) patients had disseminated intravascular coagulation and 3 (13.04%) patients had thrombocytopenia. There was one death due to meningoencephalitis with multiorgan failure with overall case fatality rate of 4.34%. Total nine patients with oliguric renal failure were treated with daily dialysis and seven patients with ARDS were on artificial ventilator. Applying modified Faine's criteria, all 23 were positive for leptospirosis. All patients responded ceftriaxone. Conclusions: Leptospirosis was unexpectedly found to be positive in many of our patients who were having pyrexia with multiorgan dysfunction during the monsoons. Hepatic dysfunction, acute renal failure, ARDS, and neuroleptospirosis in decreasing frequency were the commonest complication. Daily dialysis, ventilatory support and intensive care management has definitely reduced morbidity and mortality associated with leptospirosis with multi-organ failure.

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Drugs used locally or systemically induce several micro- and macroscopic tissue alterations. However, nearly 20 drugs have been reported so far in the literature, having association with the gingival enlargement. Many systemic diseases have their limited therapeutic options and such drugs or their metabolites have adverse influence on different systems/organs, and one of such is, they initiate or accelerate the overgrowth of gingival tissue. The over increase in the size of gingiva may be to the extent that, teeth may be partially or completely covered. And the resultant "gummy smile" may result in esthetic insult of the sufferer. In the presence of bacterial inflammation in gingiva, many of these drugs enhance collagen production by fibroblast cells, and simultaneously retard collagen destruction and hence increase the bulk of gingival tissue. It is apparent that there is subpopulation of fibroblasts those are sensitive to these drugs. The exuberant growth of gingival tissue has great esthetic concern, which may require mechanical removal of bacterial plaque, calculus, and surgical intervention and/or substitution of drug therapy by analogs. Relatively healthy oral environment provided by the dentist will reduce local micro-flora that will help eliminating the major focus of infection. Patient's physicians, general practitioners and dentist need to make coordinated and concise treatment plane to prevent or minimize the overgrowth and will be beneficial for the patients. This article will facilitate full information to physicians and general practitioners to involve dentists in the multidisciplinary treatment plane for these patients.

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Laparoscopic procedures are commonly performed and preferred over open laparotomies due to their unique advantages. Many laparotomies are now amenable to laparoscopic repair. One such surgery is laparoscopic fundoplication for hiatus hernia repair. The advent of this surgery has given rise to unique consequences which may turn out to be complications if not attended appropriately.

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Acute Necrotizing Pancreatitis is not uncommon but pancreatic encephalopathy, which is a complication and a very rare as sparse are the published reports, linking the risk of continuous ambulatory peritoneal dialysis (CAPD) to acute necrotizing pancreatitis, especially in India. We report a rare case of pancreatic encephalopathy in a patient who was on long-term CAPD for end stage renal disease (ESRD) and developed acute necrotizing pancreatitis. This case suggests that the risk of acute necrotizing pancreatitis increases in patients on long-term peritoneal dialysis. It is also been seen in other studies, that the risk of acute necrotizing pancreatitis is significantly high in patients undergoing CAPD, when compared with the general population.

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Purpose: This study was conducted to assess the knowledge of Revised National Tuberculosis Control Programme ( RNTCP) and attitude to tuberculosis (TB) among medical students and interns. Materials and Methods: This cross-sectional survey was carried out in a private medical college among 200 medical students. The students were asked to complete a written questionnaire. The answers were statistically analyzed using Statistical Package for the Social Sciences (SPSS) software program, IBM. In addition, item analysis was carried out for each question, wherever applicable. Results: Our analysis revealed that all students were aware of TB. They were also aware of RNTCP. In addition to the didactic lectures, students had gained information from different sources such as textbooks (168), case discussion (155), seminar (95), journals (75), and WHO publications (22). The average number of students with correct response was 122 (59.63%). Among the various categories of TB, the correct responses were highest for questions relating to diagnosis (146.25; 73.12%), followed by epidemiology (114; 62.16%), management (130.33; 61.75%), and risk perception (75.33; 28.5%). About 90% students feared the risk of transmission by inhalation from a TB patient with cough. Majority of the students were aware that all smear-positive patients should be isolated and treated. Item analysis of the multiple choice questions (MCQs) showed the areas that required more emphasis. Conclusions: Overall performance of III/I students was better than the rest of the study group. Students performed better in the epidemiology domain compared with the management and preventive aspects of TB. To ensure the successful control of TB and implementation of RNTCP, medical students need to be sensitized by conducting continuous medical education and orientation courses on RNTCP at regular intervals.

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Background: The World Health Organization (WHO) describes Diabetes Mellitus (DM) as the most common endocrine disease in the world. The most common complication of DM is diabetic retinopathy. Diabetic retinopathy is increasingly becoming a major cause of blindness throughout the world in the age group of 20-60 years. Objectives: This study was conducted to assess the prevalence of diabetic retinopathy and its associated risk factors among diabetic patients attending Pravara Rural Hospital, Loni, Maharashtra. Materials and Methods: A cross-sectional study was carried out in the Department of Ophthalmology of Pravara Rural Hospital, Loni, Maharashtra from 1 ^st October 2011 to 31 ^st December 2011. A total of 88 diabetic patients who attended the Department of Ophthalmology of Pravara Rural Hospital, Loni during the study period were included and underwent pupil dilatation for fundus examination to screen retinopathy; after screening, it was classified according to the stages of diabetic retinopathy and associated history of hypertension, addictions and presence of family history was also noted. Data was analyzed by using Statistical Package of Social Sciences (SPSS) 16.0. Results: In the present study, the prevalence of diabetic retinopathy was 39 (44.4%). Of the 39 patients who had signs of diabetic retinopathy, 25 (64.10%) were males and 14 (35.89%) were females. Non-proliferative diabetic retinopathy was documented in 71.79%, while 5.12% had proliferative diabetic retinopathy. Conclusion: This study demonstrated that prevalence was 44.4% and poor control of diabetic retinopathy. This suggests the need for adequate prevention and treatment in patients with diabetes.

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Objective: To study the clinical profile, laboratory data, histopathology, and outcome of infantile nephrotic syndrome (INS). Materials and Methods: Over a 5 year period, 30 infants with nephrotic syndrome were seen at Osmania General Hospital. They were studied with regard to family history, antenatal details, birth history, clinical features including anthropometry and developmental milestones, laboratory investigations and histopathology of renal tissue (light microscopy and immunofluorescence), and treatment outcome. Results: There were 17 males and 13 females (1:0.8). The mean age at presentation was 8.6 months (2.5-12 months). History of consanguinity was obtained in 12 infants (40%) and birth asphyxia was present in 8 infants (26%). Eighteen (60%) were growth retarded and 10 (33.3%) had developmental delay. Hypertension was recorded in 8 (26%) and edema in 24 (80%). At presentation, renal failure was evident in 18 (60%) infants. Nephrotic range proteinuria and hypoalbuminemia were found in all and microscopic hematuria in 4 (13%) infants. Histology of renal tissue revealed congenital Finnish type (CNF) in 8 (26%), diffuse mesangial sclerosis (DMS) in 6 (20%), minimal change disease (MCD) in 6 (20%), mesangial proliferation with IgM deposits in 4 (13%), and focal segmental glomerulosclerosis (FSGS) in 4 (13%). Mesangial hypercellularity with cytomegalovirus infection was found in 2 (6.6%) infants. CNF and DMS on histopathology carried a very poor prognosis with none recovering, while the others showed variable response to treatment with steroids and cytotoxic therapy. Conclusion: INS is a rare disorder. The predominant histopathological lesions are CNF and DMS which carry a very poor prognosis.

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Cutaneous cysticercosis in human is an uncommon parasitic infection, mostly presents as asymptomatic subcutaneous nodules with prevalence of 12.9-38% in India. It may occur as an isolated feature or as part of the disseminated cysticercosis. Here with we report a 23 years female presenting with 6 months duration of seizures and subcutaneous nodules poorly responding to anti epileptics. Diagnosis of cutaneous cysticercosis was made by biopsy of subcutaneous nodules and patient responded to treatment.

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Pyomyositis is a suppurative infection of the skeletal muscles. The predisposing conditions include immunosuppression accompanying malignancy, diabetes mellitus, renal failure, and acquired immunodeficiency syndrome, etc. We report a 49-year-old female with diabetes mellitus and chronic renal failure undergoing maintenance hemodialysis who presented with the suppurative stage of gram-negative bacterial pyomyositis due to Escherichia coli. She fully recovered following incision and drainage and appropriate antibiotic therapy. We highlight the importance of timely diagnosis of this uncommon and potentially life-threatening entity and the role of chronic renal failure and hemodialysis in causing this condition.

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Hoffman's syndrome is characterized by hypothyroidism with muscle stiffness and pseudo hypertrophy We herewith present a case report of 28 years male with cramps of both lower limbs associated swelling of both calf muscles. Investigations revealed hypothyroidism with elevated TSH and TPO antibodies with focal hypertrophy and hyperplasia of calf muscles on biopsy with normal nerve conduction studies.

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Background: L-arginine is the precursor for nitric oxide (NO) synthesis in vascular cells. The sources of L-arginine are endogenous and exogenous. Although macrophages and endothelial cells can generate L-arginine, most synthesis takes place in the liver and kidney. Level of L-arginine as of other amino acids is affected in malnourished patients; NO regulates platelet activation by inhibiting adhesion and aggregation. Objectives: The aim of the study is to evaluate the level of L-arginine in patients of end-stage kidney disease (ESKD) under regular hemodialysis and to determine its relation to platelet aggregation as a risk factor for vascular thrombosis which is a very important complication that affects the life span of those patients. In addition, we also tried to establish the relationship between L-arginine, platelet aggregation, and nutritional state of patients with ESKD. Subjects and Methods: Our study was "a case-control study", comparing data between 30 patients with ESKD under treatment with regular hemodialysis-group (A); group A1 (16)-patients with ESKD on regular hemodialysis with malnutrition, group A2 (14)-patients with ESKD on regular hemodialysis with normal nutrition state, and group B 10 subjects as healthy control group, each patient was evaluated for serum arginine level by high-performance liquid chromatography, and platelet aggregation, as well as other routine investigations. A thorough clinical history and examination were performed for all the patients. Results: Our study shows significant higher level of platelet aggregation to ADP in group A than group B (119±11.9% and 81.1±6.5% respectively, P < 0.05), a lower level of serum arginine in group A (71±45.3 μg/L) than in group B (120.5±14.6 μg/L) with P< 0.05. Also our study shows a lower level of serum arginine in group A1 (60.5±12.3 μg/L) than group A2 (83±27 μg/L) and a lower level in group A2 than group B (120.5±14.6 μg//l), and we found a negative correlation between serum arginine level and platelet aggregation expressing a more risk for thrombosis in patients with ESKD specially those with malnutrition. Conclusions: We concluded that patients with ESKD has a low level of L-arginine specially in those with malnutrition and this leads to increase in platelet aggregation and may increase the possibility of thrombus formation in malnourished patients with ESKD. We suggest the use of nutritional supplementation of L-arginine to suppress this process of atherothrombosis.

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Background and Objective : Many neonates with sepsis die worldwide due to lack of early diagnosis and prompt treatment. This study was carried out to analyze various immunological and hematological parameters singly and in combination to formulate a guideline for the rapid diagnosis of neonatal sepsis. Materials and Methods : In a prospective study, 62 patients having clinical suspicion of neonatal sepsis were evaluated with a battery of investigations. Neonates admitted for other causes and without clinical suspicion of sepsis were selected as controls (n = 40). The tests included blood culture, hemoglobin (Hb) level, total and differential blood count, absolute neutrophil count (ANC), immature to total neutrophil count (I/T ratio), micro-erythrocyte sedimentation rate (m-ESR), C-reactive protein (CRP), platelet count, serum immunoglobulin M (IgM), and plasma fibrinogen level. Patients were divided into proven cases (positive blood culture) and probable cases (blood culture negative). Results : Positive blood culture was seen in 38 cases (61.3%). Raised m-ESR (>8 mm in 1 ^st h) was seen in 63.2% of proven and 66.7% of probable cases. An I/T ratio of ≥0.2 was seen in 63.2% and 58.3% of proven and probable cases. Morphological changes were detected in 68.4% of proved and 91.7% of probable cases. Positive CRP test (≥6 mg/L) was found in 84.2% of proven and 100% of probable cases. Raised serum IgM, leukopenia, and neutropenia were seen in minority of patients (11-37%). Raised fibrinogen (>400 mg/L) was seen in the patients as well as in controls. Conclusions : Four useful tests were m-ESR, I/T ratio, morphological changes in neutrophils, and CRP; and were statistically significant (P < 0.05). Most sensitive test was CRP (84%) and m-ESR was most specific test (94%). Combination of three or more of these four tests were highly specific (95-100%).

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Toxoplasmosis is a parasitic disease caused by the protozoan Toxoplasma gondii and infects most genera of warm-blooded animals, including humans, but the primary host is the felid (cat) family. This infection may clinically resemble influenza, hence causing diagnostic dilemma. Here we report a rare case of toxoplasmosis in a male patient aged 21 years with healthy immune system presented with flu like symptoms and eosinophilic leukocytosis. There was no clinical suspicion of toxoplasmosis. Serological detection of antibody titers is useful and rapid technique in the diagnosis of toxoplasmosis. Toxoplasmosis should be included in the differential diagnosis of parasitic infestation with persistant eosinophilia and detection of antibody titers is the best guide to a clinician in the absence of clinical suspicion.

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Hemichorea-hemiballismus (HC-HB) is a rare, but dramatic complication of nonketotic hyperglycemia specially in elderly Asian females. We report a case of HC-HB syndrome with emotional lability in a poorly-controlled diabetic female. MRI brain showed T1 and FLAIR hyperintensities in the right caudate and hippocampus.

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