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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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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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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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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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: 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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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 and Aims: General anesthesia is known to elicit stress response during endotracheal intubation, but the equally important period of extubation is usually not addressed. The aim was to compare dexmedetomidine and esmolol for attenuation of extubation response. Materials and Methods: In this prospective randomized double-blind trial, 100 American Society of Anesthesiologists I/II patients between 18 and 60 years of age undergoing abdominal and lower-limb surgeries were randomly allocated into two groups (n = 50 each). Patients in Group D received dexmedetomidine (0.5 μg/kg intravenous [IV] bolus) over 10 min and in Group E received esmolol (1 mg/kg bolus IV) before extubation. Hemodynamic parameters, namely, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP), were compared at baseline, 10 min before extubation, at extubation, and at 1, 3, 5, 10, and 15 min thereafter. Data were expressed as mean ± standard deviation and analyzed using Student's unpaired t-test and Chi-square test. P <0.05 was considered statistically significant. Results: Patients in Group D exhibited lower HR, SBP, DBP, and MAP at the time of extubation till 15 min postextubation (P < 0.001) although the difference was clinically insignificant. Incidence of hypotension was similar in both groups (6% vs. 4%). Two patients in Group D developed bradycardia which was successfully treated with injection glycopyrrolate, while none exhibited any complication in Group E. Conclusion: Dexmedetomidine is a better, effective, and safe alternative to esmolol in attenuating stress response during extubation.

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Chorangioma of the placenta is a rare tumor with a frequency of about 1%, which usually presents as a solitary nodule or, less frequently, as multiple nodules. It is benign vascular tumors of the placenta arising from chorionic tissue. Large chorangioma has adverse effects on both mother and fetus. Chorangiosis is characterized by an increase in number of small-sized vascular channel within chorionic villi. Chorangiosis is considered as a hypoxia-related angiogenesis mainly associated with numerous maternal, fetal, and placental disorders. The case presented to highlight incidental detection of this rare tumor of large size without causing any pregnancy disorders or developmental anomalies of the fetus in a young female.

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Natal teeth and neonatal teeth are rare occurrences. In some parts of the world, they are considered as good omen while in some parts as devil's sign. The history of natal teeth dates way back to 23 BC. It causes difficulty in feeding the infant as well as the feeding mother and also possesses the danger of accidental aspiration. This article presents two case reports where the natal teeth were extracted due to the risk of aspiration.

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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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The clinical spectrum of dengue fever is ever increasing as we encounter more cases of this disease regularly for the past few years. Dengue fever continues to surprise us with its myriad presentations and combinations with other disease entities. Catastrophic antiphospholipid antibody syndrome (APS) is uncommon and often a fatal form of primary APS. Here, we present a 37-year-old lady who presented with catastrophic APS with dengue fever. The coexistence of these two conditions has not been reported earlier, to the best of our knowledge.

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Glassy cell carcinoma is a rare clinical entity involving uterine cervix with aggressive course and relatively poor prognosis. It is a poorly differentiated variant of adenosquamous carcinoma. This neoplasm has poor response to radiotherapy and carries worse prognosis than the usual types of adenocarcinoma and squamous cell carcinoma. A case of a 40-year-old female patient is reported and the published literature is reviewed.

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Background: Acanthosis Nigricans (AN) is an easily identifiable dermatoses characterized by thickened, hyperpigmented plaques. Metabolic syndrome refers to a clustering of metabolic risk factors including central obesity, glucose intolerance, hyperinsulinemia, low HDL cholesterol, high triglycerides and hypertension. AN is a skin marker associated with this syndrome. Aims and Objectives: This study aimed to determine the relationship between AN and metabolic syndrome by studying its clinico-epidemiological features and also the relation of severity of AN over neck with metabolic syndrome. Methodology: This is a case-control study. One hundred consecutive patients of AN attending dermatology OPD of a tertiary care hospital were included in this study. They were evaluated for AN and severity of AN over neck was assessed. Age and sex matched 100 controls were included in the study. Epidemiological, clinical and anthropometric characteristics (height, weight, waist circumference) were measured of all the cases and controls. Body Mass Index (BMI) was calculated. Fasting Blood Sugar, High Density Lipoprotein and Serum Triglyceride levels were estimated. Result: The average age of the patients was 32.4 years and females (62%) were more than the males (38%). Neck was involved in all the patients. There was statistically significant correlation of increasing severity of AN with each component of Metabolic syndrome. On comparing between cases and controls, each component of metabolic syndrome was raised in cases as compared to the controls. 70% cases had Metabolic syndrome which was statistically significant. Conclusion: There was a high prevalence of AN in subjects with metabolic syndrome. Also there was a positive correlation between severity of AN and Metabolic syndrome.

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Background: E-mail addresses of the corresponding author can be accessed from open-access online articles. These addresses are commonly collected by journal promoters and used to send invitations to authors with attractive publication offer to allure young authors. Aim: The aim of this study was to ascertain the quantity and type of unsolicited academic invitations and to find the effect of an intervention on the reduction of quantity of invitations. Materials and Methods: A total of seven young authors had participated in the study. In preintervention phase, each Sunday, the authors counted their unsolicited e-mails and reported it for consecutive 6 months. A list of commonly used words/phrases in those e-mails was made. That list was used to make e-mail filters to divert unsolicited e-mails to a different label (SPAM STUDY). In postintervention phase, the participants reported the number of unsolicited e-mails received in different labels for consecutive 3 months. Results: The authors received average 5.27 ± 0.93 (2.04 ± 0.28 in inbox and 3.23 ± 0.89 in spam label) academic invitations per day in the preintervention phase. Majority of the e-mails (98.97%) requested for submission of the manuscript. Postintervention total unsolicited academic e-mails (5.43 ± 1.25) remain unchanged (P = 0.67); however, e-mails to inbox (0.08 ± 0.02/day) were significantly (P < 0.0001) decreased. Conclusion: Young authors receive lots of unsolicited academic invitations; most of them request to submit manuscript. These unsolicited e-mails can be diverted to a different e-mail label by creating e-mail filters. This would help authors to reduce the burden of unsolicited mails in inbox.

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Background: The teething process is part of normal development of the skeletal system; however, different tribes and ethnic groups seem to have a list of symptoms they believe are linked to teething. Could it be that health professionals also hold to these false believes concerning teething? This is important to find out because when systemic problem is misdiagnosed as teething and nothing is done, it may result in death. This study aims to assess the level of knowledge of infants' teething and associated myths among health professionals, to ascertain the attitude of health professionals toward teething in infants, and to identify practices by health professional toward “teething problems.” Materials and Methods: This study was cross-sectional study, conducted from August to September 2016, and multistage sampling method was adopted. Results: Four hundred and fifty health workers participated in the study; however, 427 of them correctly completed the questionnaire giving a response rate of 94.9%. There were 213 (49.9%) males and 214 (50.1%) females with m:f ratio of 1:1. Most respondents (322; 77.8%) believed teething was associated with significant systemic symptoms, 92 (21.5%) did not associate teething with any significant systemic complaint, while only 3 (0.7%) of them were not sure if teething causes systemic illness. Fever and loss of appetite were the most common symptoms associated with teething followed by stooling while skin rash was the least common complaint associated with teething. Conclusion: Teething myths are still prevalent among health-care workers; common illnesses attributed to teething included fever, loss of appetite, excessive salivation, and diarrhea.

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Background: Identification plays a major role in any crime investigation. Study of finger prints (Dactyloscopy) and palatal rugae patterns (Palatoscopy) have been recognized and accepted as gold standard for personal identification worldwide. Yet another biological record that remains timeless throughout the lifespan of a person is the blood group. Research works have been carried out on Dactyloscopy/Palatoscopy and blood groups independently. However, studies focusing on correlation and comparison of both these parameters have not been undertaken to a great extent. Aim: The aim of the present study is to correlate and compare Dactyloscopy and Palatoscopy with blood group among dental students from western Maharashtra population. Materials and Methods: A total of 200 dental students with age group ranging between 18-25 years with known blood group were included in the study. Finger print, Palatal rugae patterns were obtained and compared and the data was subjected to Excel sheet 2016 and Chi square test. Results: There was significant association between finger print patterns and ABO - Rh factors (χ² statistic= 30.6, P value = < 0.05) and No correlation exists between palatal rugae patterns with blood groups and Rh factor (χ² statistic= 17.71, P value = P > 0.05). Conclusion: Hence, the study concluded that finger prints rather than palatal rugae when correlated with suspect's specific blood group - Rh factor can be used to narrow down the suspect list and can also prove significant in identifying individuals in case of any disaster. Though the comparison of palatal rugae and finger print with blood group - Rh factor yielded no result.

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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: Vascular access is the lifeline for a patient on hemodialysis. An arteriovenous fistula is the gold standard for hemodialysis access. The order of preference as given by the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative guidelines suggests radiocephalic, brachiocephalic, and brachiobasilic transposition fistulae and then prosthetic grafts as vascular access options. Brachiobasilic transposition fistulae are associated with multiple challenges and complications. By our modified technique of brachiobasilic fistula, we have overcome the challenges posed by the conventional technique. In this study, we have evaluated the results of our modified technique and compared them with conventional technique. Materials and Methods: A retrospective analysis was done, in which all cases of proximal fistula for hemodialysis performed in our institute by the modified technique from January 2010 to December 2014 were included in the study. Result: Of the 171 patients, 136 (79.5%) were successful. The primary failure rate was 20.5%. Maturation time required for the fistula to develop was 46.7 (±4.17) days. Flow rates of more than 250 ml/min could be maintained in 58.8% of patients. Patency rates were 79% at the end of 1^st year, 74.2% at the end of 2^nd year, 45.7% at the end of 3^rd year, and 40.2% at the end of 5^th year. Ease of access was determined by a number of pricks required to gain access and development of forearm veins. Of the 136 successful cases, 110 (80%) could be cannulated with ease in the first prick itself. Access over forearm was possible in 117 (86.1%) cases. Conclusion: The modified technique of brachiobasilic fistula overcomes the risk of complications and morbidity of conventional brachiobasilic transposition fistula and is equally effective as vascular access.

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