Introduction: Scrub typhus is a mite-borne bacterial infection of humans caused by Orientia tsutsugamushi that presents with prolonged fever unless suspected early. The aim of this study was to characterize the epidemiological factors and clinical clues in this region for early diagnosis. Materials and Methods: This study was a retrospective, observational study conducted in all diagnosed scrub typhus cases admitted to the pediatric ward of a tertiary care hospital in-between January 1, 2015 and December 31, 2016. One hundred and one patients admitted with IgM positive for scrub typhus over 2-year period were analyzed for the epidemiological factors and clinical features. Results: Male:female ratio is 1.4:1. The mean age of the patients in our cohort was 4.83 years, ranging from 0.25 to 14 years. Majority (79.2%) was from the rural area. Fever was present in all cases and about 81.19% of children presented with fever for >7 days. Other findings were hepatosplenomegaly (55.45%), respiratory problems (47.54%), abdominal symptoms (40.59%), eschar (26.74%), rashes (15.84%), altered behavior (9.9%) and lymphadenopathy (2.97%) of cases studied. Thrombocytopenia, elevated liver enzymes, and raised C-reactive protein (CRP) were found characteristically. Defervescence after starting doxycycline was within 3.26 ± 2.26 days. Conclusions: Scrub typhus can present in various ways but mostly with prolonged fever. Hepatosplenomegaly, eschar, third spacing, raised CRP, and thrombocytopenia are important clues for early clinical diagnosis. Increased awareness and heightened suspicion, especially in the light of increasing number of patients are required for timely treatment and prevention of complications.

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A 48-year-old man presented to our surgical oncology division with incidentally detected abdominal mass. On examination, a ballotable swelling was present in the right lumbar region. His imaging studies showed a large multicystic mass in the lower pole of the right kidney. With radiological diagnosis of cystic renal cell carcinoma (RCC), the patient was taken up for surgery. Histopathology showed tubulocystic RCC (TC-RCC) with a focus of papillary RCC. Though closely related to papillary RCC, TC-RCCs of kidney are a distinct group of RCC. Analysis of more cases is required to understand the exact tumor biology and to ascertain prognosis.

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Congenital pouch colon (CPC) is a rare variant of anorectal malformation. It has been classified anatomically into five types as per the length of colon involved. Type 5 is the rarest form of CPC with only six cases reported in the literature till date. It has been originally described as pouch-like (segmental) dilatation of the colon with intervening normal colon of varying length, the distal pouch opening into the genitourinary system with a fistula. We present here a 3-day-old male neonate with CPC Type 5, managed with excision of both pouches and end ileostomy; abdominoperineal posterior sagittal anorectoplasty is planned.

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Background: Thyroid dysfunction may be associated with increased perceived stress. Aims: We aimed to study the correlation of perceived stress and thyroid function among females in a rural population of reproductive age group. Materials and Methods: This pilot study was conducted in Burdwan Medical College on 200 newly diagnosed female hypothyroid patients in a period of 12 months after taking institutional ethical clearance and informed consent of the participants. Parameters studied were body mass index (BMI), Presumptive Stressful Life Event Stress Scale (PSLES) scores, Perceived Stress Scale scores (PSS scores), thyroid-stimulating hormone (TSH), and free thyroxine (fT4) levels. To avoid stress effects of the premenstrual phase, we examined our participants during the postmenstrual phase. All the participants were on nonvegetarian diet and their dietary habits were nearly similar. Participants were divided into two groups: G1 – hypothyroid patients and G2 – patients with subclinical hypothyroidism. The computer software “Statistical Package for the Social Sciences (SPSS) version 16 (SPSS Inc., Released 2007. SPSS for Windows, version 16.0. SPSS Inc., Chicago, Illinois, USA)” was used to analyze the data. Results: Two hundred newly diagnosed hypothyroid females were included in the present study. Among them, 130 were clinical hypothyroid (G1) and 70 were subclinical hypothyroid patients (G2). A significant difference was found between clinical and subclinical hypothyroid females for mean PSS scores (P = 0.002). There was no significant difference in PSLES scores between the two groups. A significant difference was found between clinical and subclinical hypothyroid females for BMI (P = 0.002), TSH (P < 0.0001), and fT4 (P < 0.0001). There was no significant difference in age between the two groups. There was a significant positive correlation between PSS scores and TSH levels with r value of 0.97 in G1 and r value of 0.26 in G2, respectively. Conclusion: Females of reproductive age group with clinical and subclinical hypothyroidism faced the same amount of stressful life events. However, their perception of stress was significantly different. High TSH was positively correlated with high score on PSS. Clinical hypothyroidism is associated with hypercortisolemia and also depression. However, a cause–effect relation is yet to be established. Moreover, depression and serum cortisol were not assessed, so no further conclusions can be drawn from the present study.

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Background: Recently, hydroxychloroquine (HCQ) has been advocated by the Indian Council of Medical Research for prophylaxis of COVID-19, and the Food and Drug Administration has given emergency use authorization for its use in the treatment of severe COVID-19 disease in hospitalized patients. HCQ is generally well tolerated; however, concerns about adverse effects in adults prescribed with HCQ for prophylaxis remain. Our study was designed to investigate the adverse drug reaction (ADR) profile of HCQ in prophylactic doses for COVID-19 prophylaxis among doctors. Materials and Methods: This was a cross-sectional study carried out among doctors taking HCQ prophylaxis for COVID-19. The study was carried out over 1 month from April 1, to April 30, 2020. Data regarding age, sex, comorbidities, number of doses taken, concomitant drug therapy, adherence to drug schedule, need for treatment of ADRs, and possible adverse effects were obtained from the patients. The participants were administered an online pretested, validated questionnaire to ascertain the adverse effects they noticed while taking HCQ. Results: One-hundred and forty doctors were included in the study group. Sixty-nine adverse events were documented in 44 participants (31%). The most frequently reported symptoms were headache followed by nausea, dizziness, abdominal cramps, and loose stools. Hypoglycemia was seen in three participants, all with diabetes. Sixteen participants required medication to treat the adverse effects (most commonly ibuprofen for headache), while four participants discontinued the drug due to adverse effects (two each because of hypoglycemia and one each because of nausea and loose stools). There was no statistically significant difference of age, gender, number of doses taken, or comorbidities on adverse effects. Conclusion: Almost a third of the participants reported adverse effects. Utmost care is necessary before using HCQ prophylactically for chemoprophylaxis of COVID-19.

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We rarely come across deficiency of niacin in the current clinical practice. Deficiency of niacin (Vitamin B3) leads to pellagra with constellation of symptoms affecting gut, skin, and nervous system. We present a case of nutritional deficiency of niacin presenting as pellagra in a 45-year-old female. The patient was treated successfully with Vitamin B3 supplementation. Pellagra shall be considered in differential diagnosis of chronic diarrhea when associated with skin lesions affecting sun-exposed areas.

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Pulmonary embolism (PE) is common, but often under-diagnosed or misdiagnosed entity. Pulmonary infarct is often caused by embolus in the peripheral branches, and timely diagnosis is often more challenging. Although peripheral pulmonary infarct is not fatal, it can be misdiagnosed as pneumonia or pleural effusion. Accurate diagnosis is also essential not only to rule out risk factors and prothrombotic states but also to prevent future thrombotic events. We report a case of 35-year-old male who presented with a history of isolated right-sided pleuritic chest pain of 1-week duration, diagnosed as a case of PE with a peripheral infarct. After 3 months of anticoagulation, he underwent screening for thrombophilia and detected to have factor V Leiden mutation. This case report highlights the fact that PE should be considered in the differential diagnosis of pleuritic chest pain.

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A 4-year-old boy presented in a state of septicemic shock, disoriented with peritonitis, and marked hemodynamic instability. The child was resuscitated; radiographs confirmed pneumoperitoneum. Intraoperatively, there were multiple perforations with necrotic changes in the entire colon up to the rectum, suggestive of acute fulminant necrotizing pancolitis. He was managed by total colectomy, ileostomy, with Hartman's pouch. Histopathology confirmed necrotizing amoebic pancolitis. Postoperatively, administration of metronidazole with broad-spectrum antibiotic coverage, hyperalimentation, and multiple platelet concentrates was given. The child had profound immunosuppression and expired due to multiple organ dysfunction syndrome. Acute fulminant necrotizing amoebic pancolitis is an extremely lethal entity in children.

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Lateral deviation or buckling of the tracheal air column just above the thoracic inlet is infrequently observed on frontal chest X-rays of infants and young children. Tracheal buckling can cause unnecessary concern and alarm to neonatal and pediatric intensivists when dealing with critically ill infants. We report a case of preterm female infant, who was born at 25 weeks of gestation and required intubation at birth and surfactant administration. She was extubated to continuous positive airway pressure support at 5 h of life. On day 24 of life, she had increasing respiratory distress and X-ray of the chest was done. The X-ray showed a significant right lateral deviation of the trachea, raising the concern of mediastinal mass effect or right upper lobe collapse to the attending neonatologist. However, the radiologist diagnosed the lateral deviation of the trachea as benign tracheal buckling. The infant was intubated and ventilated. Two weeks later, a postextubation chest X-ray showed normal trachea.

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Klippel–Trenaunay–Weber syndrome (KTWS) is a rare congenital malformation, characterized by constellation of arteriovenous malformation, cutaneous capillary malformation, and skeletal or soft-tissue hypertrophy. The exact cause of KTWS is unknown. We present a case of a 1 ½-year-old boy with multiple swellings over the right lower extremity since birth which increased in size in proportion to his general growth. He was diagnosed clinically as Klippel–Trenaunay syndrome (KTS) which on Doppler imaging and on histopathology showed the presence of a multichanneled slow-flowing arteriovenous malformation. KTWS should be distinguished from KTS since clinical features, management, and prognosis of these two entities are distinctly different. Although the diagnosis is primarily clinical, confirmation requires laboratory and imaging studies. The present case is being reported as an interesting case which highlights the fact that distinction between KTWS and KTS may sometimes be difficult.

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A 5-year-old girl presented with abdominal pain, dysphagia, respiratory distress, and fever for the past 3 weeks. The pain was dull in character; present in the epigastrium and right hypochondrium. The patient was unable to swallow solid food and there was difficulty in swallowing even semi-solids and liquids. On examination, there was decreased air entry on the right side with epigastric tenderness. The radiological evaluation suggested caudate lobe liver abscess in close relation with abdominal esophagus resulting in mild compression at gastro-esophageal junction. Pleural effusion on the right side was drained. Broad-spectrum antibiotics including amoebicidal therapy resulted in the dissolution of symptoms and rapid recovery. Caudate lobe liver abscess may result in dysphagia (as its unusual complication) due to inflammation and extraluminal compression at gastro-esophageal junction.

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Introduction: Intimate partner violence (IPV) is a significant public health problem with harmful consequences for affected individuals. We report the prevalence of physical and sexual violence and justification of this violence by ever-married women. Methodology: We conducted this cross-sectional study on 500 women in an urban area of a metropolitan city of North India. We used a validated questionnaire to estimate the prevalence and forms of IPV and proportion of women who justify the violence they face. We used logistic regression to determine the association of violence with certain sociodemographic factors. We also studied the association of justification of violence with these sociodemographic factors. Results: Ninety-one (18.2%) women had “ever” experienced physical violence. Alcohol consumption by the husband, initial place of residence, and controlling behavior by the husband were significantly associated with physical violence. Fifty two (10.4%) had “ever” experienced sexual violence. Higher education status of the women, justification of violence by the women, controlling behaviour and alcohol consumption by the husbands was significantly associated with sexual violence. Women who had faced any one form of violence (physical or sexual) were at higher risk of facing the other form as well. One hundred and eight two women (36.2%) justified violence by husbands. Women who faced controlling behavior, experienced sexual violence, were poorly educated, or were married for more than 10 years were more likely to justify any form of IPV they faced. Conclusion: Alcohol consumption, controlling behavior, and justification of violence are important behavioral predictors for physical or sexual violence. We recommend behavioral change communication strategies targeted at male partners and also the families to curb the menace of IPV.

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Background: The Lassa viral hemorrhagic fever disease (LVHFD) outbreak usually occurs in the Northern senatorial district of Ondo State, Nigeria. Precisely local government areas (LGAs) such as Ose and Owo LGAs; these are the adjacent LGAs to Edo State in Nigeria where LVHFD outbreak has been recorded highest in the country at recent times. Aim: This research was designed to disseminate a general public awareness message about the recent trend regarding the observed seasonal variation pattern in the epidemiological transmission, outbreak, and status of Lassa viral hemorrhagic fever disease in Ondo State, Nigeria. Materials and Methods: This was a retrospective observational longitudinal study carried out to report the recent trend regarding the observed seasonal variation pattern and changing epidemiology of Lassa viral hemorrhagic fever disease in Ondo State, Nigeria. The data in this study were sourced and collected from the state epidemiological records on Lassa fever (LF) at the Department of Public Health Services, Epidemiology Unit, State Ministry of Health, Akure, Ondo State, Nigeria. Results and Findings: The outbreak of the disease has been recurring since 2014 up till date (2018). LF outbreak in the period under consideration showed an increasing trend, except in 2015, where the rate of seropositively infected and confirmed cases reduced by 62.5% (dropped from 8 to 3 cases). The rate of confirmed seropositive cases increased by 533.3% in 2016 compared to 2015, 300% in 2017 compared to 2016, and 19.7% increase in 2018 compared to 2017 events. The mortality rate recorded which was also directly dependent on the rate of confirmed seropositively infected cases; it was 50% in 2014, 0% in 2015, 63.1% in 2016, 23.6% in 2017, and 25.3% in 2018. Furthermore, the peak seropositive outbreak cases for Lassa viral hemorrhagic fever disease in the year 2017 analyses occurred during February (12 cases) and August (12 cases), and then followed by June (11 cases) and December (9 cases). Conclusion: The observed seasonal variation pattern and changing epidemiology of Lassa viral hemorrhagic fever disease in Ondo State, Nigeria, can be attributed the challenging poor socioeconomic factors and persistent situations peculiar to the outbreak. The year 2017 analyses revealed that there was an all year round disease outbreak for LF in the state. This was contrary to the widely circulating report that LF outbreak is being influenced by dry seasons. The peak of the disease outbreak in the year 2017 occurred during February and August, as this is the peak months of dry seasons and wet seasons, respectively, in Ondo State, Nigeria.

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Context: Prevalence of musculoskeletal disorders (MSDs) is common among farmers as agriculture work is highly physically demanding. India's 54.6% of the population is engaged in agriculture and allied activities. There is a need for accurate measurement and assessment of the impact of musculoskeletal conditions for public health action. Hence, in order to obtain prevalence and health impact of these problems as well as to evoke interest of researchers in this area, this study was conducted. Aim: To study the prevalence and health impact of MSD among farmers. Subjects and Methods: Study settings: Village from Sangli district. Study design: This was a cross-sectional study. Study subjects: Farmers of both sexes. Exclusion criteria: Farmers having history of arthritis or having MSD due to accidents. Sample size and sampling technique: Calculated sample 1150 from randomly selected village. Study tools: (a) Pro forma developed by investigator, (b) Modified Nordic Questionnaire, and (c) Ovako Working Posture Analyzing System. Statistical Analysis Used: Frequencies, percentages, Chi-square test, and binary logistic regression analysis was done with the help of SPSS software. Results: A total of 964 (83.8%) farmers experienced MSD in the last 1 year. Knee was the most commonly affected body part. Weeding with squatting position was most common posture. MSDs were significantly associated with age, addiction, and associated diseases. Binary logistic regression analysis concluded age, weight, height, and body mass index as strong predictors of MSD. Duration of disability as a result of MSD ranged from 1 to 190 days. Mean expenditure on medication was Rs. 3040.82. Conclusions: Prevalence of MSDs in farmers was high. MSDs had affected farmers adversely in terms of long disability days resulting into economic loss in terms of failure to work to earn and expenditure on treatment.

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Background: The role of ultrasound in acute viral hepatitis (AVH) is limited to exclude the surgical causes of jaundice. However, there are certain ultrasound features which can help us to suspect AVH in the initial few days before the onset of clinical jaundice. Therefore, the aim of the present study was to detect the changes in the hepatobiliary system on ultrasound in the cases of AVH and to find the significance of these ultrasound findings by comparing them with controls. Materials and Methods: All serologically proven cases of enterically transmitted cases of AVH formed the study group and all healthy patients with clinical diagnosis of lower urinary tract symptoms who had no hepatobiliary disease were taken as controls. Results: Out of 120 cases, 102 cases were male and 18 cases were female. Maximum number of cases 54 (45%) were seen in 21–30 followed by 24 cases (20%) in the age group of 31–40 years. Hepatomegaly was seen in 104 (86.6%) of cases and 38 (25.3%) of controls (P < 0.01). Gall bladder (GB) wall thickening was seen in 91 (75.8%) of cases and 22 (14.6%) controls Contracted GB was seen in 75 (62.5%) cases of AVH and 16 (10.6%) of controls (P < 0.01). Porta nodes were seen in 72 (60%) cases and 15 (10%) controls (P < 0.01). Splenomegaly was seen in 33 (27.5%) of cases and 24 (16%) of controls. Periportal cuffing was seen in 28 (23.3%) of cases and 24 (16%) of controls. Conclusion: The ultrasound findings of hepatomegaly, enlarged porta hepatis nodes, contracted gallbladder and GB wall thickening are significant suggesting a role of ultrasound in the early diagnosis of acute viral hepatitis.

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Background: Acute psychiatric emergencies such as excitement, violence, stupor, and suicidal attempts, previously the domain of mental hospitals, are now handled by the general hospital psychiatric units. There is a paucity of Indian data concerning psychiatric emergency referrals. Aim: The aim is to study psychiatric emergency referrals in a teaching hospital. Materials and Methods: This hospital-based, descriptive study was undertaken in Emergency Medicine and Psychiatry Departments of a tertiary care hospital during the period of November 2016 to April 2017. All patients were first evaluated by the postgraduate resident on duty of Emergency Medicine Department and triaged using mental health triage scale (MHTS). The total sample size was 60. Sociodemographic particulars of patients and reason of referral were recorded on a special proforma, and the Brief Psychiatric Rating Scale (BPRS) was administered. Psychiatric diagnoses were made according to the International Classification of Disease, 10^th Revision Diagnostic Criteria for Research. Results: Out of total 60 patients, 70% were males and 30% female. Most of the patients (41.7%) belonged to the age group of 31–40 years and 53.3% were married. Majority (61%) were referred by family members while 25% were referred by a nonpsychiatric medical professional. The most common reason for psychiatric referral was the presence of coexisting mental symptoms along with physical illness (38%) while 25% were referred as they had predominant psychiatric symptoms. The most common triage category was yellow (38%) and the least common was red category. Schizophrenia (33.3%) was the most common psychiatric diagnosis, followed by alcohol dependence (25%) and mania (16.7%). There was a significant correlation of BPRS score to severity according to triage. Conclusions: The common psychiatric disorders seen in Emergency Department (ED) are schizophrenia, substance use disorder, and mania. MHTS can be easily used by ED doctors for quick and appropriate triage of patients with psychiatric symptoms.

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One of the promising innovations in the field of surgical dentistry is the use of platelet-rich fibrin (PRF), alone or as an additive with other biomaterials. It accelerates the healing mechanism of the tissue and reduces the inflammation. The following article summarizes the role of PRF in the process of healing, its advantages, disadvantages, and clinical implications including advanced surgical dentistry.

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Antidepressants can be classified into 13 different classes based on their pharmacological mechanisms of action. As of this present moment, 11 out of these 13 classes of antidepressants accomplish their pharmacoactivities by blocking one or more of the reuptake transporter pumps and/or receptors for the three monoaminergic neurotransmitters, namely serotonin, norepinephrine, and dopamine. The 12^th class inhibits the enzyme monoamine oxidase, while the 13^th class works by blocking the N-methyl-D-aspartate (NMDA)-glutamatergic ionoceptor. Previous experimental results suggest that depression is associated with hyperfunction of NMDA-glutamatergic receptors (NMDARs) in the subcortical regions (i.e., hippocampus, locus coeruleus, and amygdala); whereas at the same time, there is hypofunction of NMDARs in the cortical regions (i.e., prefrontal, perirhinal, and temporal cortices). Moreover, this finding has led to a conclusion that postulates the new “Glutamatergic hypothesis of depression” which is now moving our understanding of the pathophysiology of major depression disorder (MDD), a step further from the several decades' old “Monoaminergic theory of depression.” Collectively, clinical data suggest the involvement of the glutamatergic neurotransmission system in the pathophysiology of MDD or bipolar depression or schizoaffective depression, which includes disruptions in glutamatergic substrate concentrations and NMDAR alterations. Although the role of glutamatergic systems is yet to be fully elucidated, a “proof of concept” clinical study reported that the noncompetitive NMDAR antagonist ketamine produced rapid-onset and prolonged antidepressant effects in patients suffering from MDD or bipolar depression or schizoaffective depression. Still, this has generated tremendous interest in developing new drugs that will target the glutamatergic neurotransmission mechanisms for the treatment of MDD or bipolar depression or schizoaffective depression. These potential drug targets are the NMDAR as antagonist or inverse agonist or partial agonist, metabotropic glutamatergic receptors as positive or negative modulator, excitatory amino acid transporter-2 (EAAT-2) as a reuptake enhancer, and as a terminal presynaptic glutamate release inhibitor.

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