Brain imaging with computed tomography (CT) is commonly performed in those with suspected intracranial abnormalities. The indications are many, among which trauma is the commonest followed by meningoencephalitis. We present a retrospective review of 663 pediatric CT scans performed in our secondary care center in the United Kingdom for over three years. The aim of the study was to review (a) Indications for CT scan other than trauma, (b) Evaluate the distribution of scan requests during and outside office hours, (c) Correlation of scan findings with ancillary investigations such as lumbar puncture and clinical recordings such as Glasgow coma scale (CGS), and (d) Positive predictive value (PPV) of CT scan with respect to clinical outcomes in diagnosis of meningoencephalitis In this study, they found no direct correlation of CT findings with signs of raised intracranial pressure and there was a poor positive predictive value of CT findings in the diagnosis of meningoencephalitis and raised intracranial pressure. We conclude that in our center, there is a low clinical referral threshold for CT brain imaging in children with suspected meningoencephalitis. The study shows that CT brain scan is valuable in the diagnosis of complications of meningitis but has a poor predictive value for the diagnosis of meningitis/encephalitis and raised intracranial pressure. We recommend that brain imaging with CT should be performed in the appropriate clinical setting and the risk of radiation in children should not be ignored. Magnetic resonance imaging (MRI) may be a more sensitive modality in clinically stable patients when imaging is required.

Background: Antifungal drug susceptibility testing (ADST) is still not done routinely for detection of drug resistance pattern of Aspergillus species. Physicians prescribe treatment to patients empirically which has led to the emergence of drug resistance in Aspergillus species. Aim: The study aims to standardize the facility for antifungal drug susceptibility testing of Aspergillus species. Materials and methods: In vitro drug sensitivity testing was done using the method as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: Drug sensitivity by phenotypic method revealed resistance to fluconazole for all Aspergillus species whereas miconazole, nystatin, and clotrimazole showed 100% sensitivity to all Aspergillus species. However, itraconazole and amphotericin - B showed 33.33–66.67% sensitivity, and ketoconazole showed 44.44–100% sensitivity. Conclusion: Drug resistance testing by phenotypic method revealed that Aspergillus isolates from patient samples were resistant to fluconazole for all Aspergillus species whereas miconazole, nystatin, and clotrimazole show 100% sensitivity to all Aspergillus species. Itraconazole shows 66.67–33.33% sensitivity. Amphotericin B shows 66.67–33.33% sensitivity. Ketoconazole shows 100–44.44% sensitivity to various Aspergillus species.

Aim and objectives: To study cyclophilin-A, high sensitivity C-reactive protein (hsCRP) and malondialdehyde in obese and nonobese type 2 diabetes mellitus (DM) patients. Material and methods: A total of 120 subjects aged 35–65 years were enrolled and grouped as: • Obese subjects with diabetes, • Nonobese subjects with diabetes, • Obese subjects without diabetes, • Nonobese subjects without diabetes. Their serum was tested for estimation of 4 biochemical parameters, namely cyclophilin-A, hsCRP, malondialdehyde, and lipid profile. Observation and results: The mean cholesterol, triglycerides (TG), VLDL, LDL levels were significantly higher in obese diabetics as compared to obese nondiabetics, normal body mass index (BMI) diabetics, and control group. The mean HDL was higher in nondiabetic obese as compared to obese diabetic patients, normal BMI diabetics and control group and this difference was statistically insignificant. Cyclophilin-A and hsCRP were significantly higher in obese diabetics as compared to non-diabetic obese patients, Normal BMI diabetics and control group. The mean lipid peroxide (malondialdehyde) was significantly higher in nondiabetic obese patients, as compared to obese diabetics, normal BMI diabetics, and control group. Conclusion: Cyclophillin-A (CypA) and hsCRP were significantly elevated in obese type 2 diabetics while malondialdehyde was significantly higher in nondiabetic Obese patients. Lipid profile parameters were also signi.cantly elevated in obese type 2 diabetics. These inflammatory cardiometabolic risk biomarkers can be used for diagnostic, therapeutic and prognostic decisionmaking, especially in the context of inadequate quantitative risk assessments available to clinicians.

Aim: Although crucial in prevention and transmission of bloodborne infections (BBI), the concept of universal safety precautions (USP) is disregarded by the medical professionals in their early career years, mainly due to the lack of knowledge and awareness regarding the same. This study, through a questionnaire survey, aimed to assess the awareness of the 1st year medical and dental students about USP and its application in daily practice. Materials and methods: A questionnaire-based survey consisting of 12 questions on USP was given to the students to fill. An interventional lecture with interactive sessions was conducted for the students to educate them about USP. The same set of questions was again provided to the students one week after the lecture. Results: Out of the 210 participants that were included, 63% were unaware of USP. Eighty-three percent of the students did not adhere to proper barrier protections like gloves, gowns, and goggles and 56% did not handle sharps such as needles and blades correctly. These results showed a significant improvement when assessed after the interventional lecture. Conclusion: The knowledge of students regarding USP is inadequate. The interventional lecture and interactive sessions helped increase their awareness of USP. Clinical significance: The importance of teaching USP to medical and dental students in their early years of professional career for preventing transmission of BBI is highlighted in this study.

Microalbuminuria has been shown to be an intermediate end point and a powerful predictor of morbidity and mortality in patients with diabetes. This study aims to analyze the correlation between microalbuminuria and estimated glomerular filtration rate (eGFR) in hypertensive nondiabetic patients, to understand the role of microalbuminuria as a disease marker in hypertensive renal disease. Data of 100 patients meeting the inclusion and exclusion criteria were collected. Early screening of patients with hypertension, for microalbuminuria, by carrying out simple, inexpensive tests like urinary dipstick and spot urinary albumin/creatinine ratio, can help prompt the physician to initiate antihypertensive therapy in positive cases. Prevalence of microalbuminuria, which is an indicator of early chronic kidney disease (CKD), is about 49% among patients with hypertension.

Background: Rapid identification of fungi and molds reduce turnaround time and cost for diagnosis of infections with these organisms in a clinical microbiology laboratory. We report here the clinical evaluation of the VITEK mass spectrometry system for rapid fungal identification in comparison to the internal transcribed spacer (ITS) DNA polymorphism method. Methods: Total 136 archived isolates comprising 126 yeast and 10 molds were analyzed by mass spectrometry (VITEK system) and ITS sequencing for identification of fungi. Results: Majority of the yeast isolates belonged to genus Candida (N = 123), followed by one isolate each of Trichosporon, Cryptococcus, and Rhodotorula. Amongst molds, Aspergillus (N = 4), Trichophyton (N = 3), Fusarium (N = 2) and Rhizopus (N = 1) were identified. Overall, correct species-level identification was obtained in 135/136 (99.26%) isolates with a single isolate of Candida auris misidentified as Candida haemulonii by VITEK MS. Conclusion: The VITEK MS system, a matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDITOF MS) system, is a reliable and rapid method for the identification of most of the fungi. Further expansion of the database of the VITEK MS for emerging pathogens is needed to enhance its performance.

Background: Pritchard regime is considered the benchmark for control of convulsions in patients with eclampsia. Indian patients with smaller body mass may require smaller doses of Magnesium sulfate. Aims: To compare the efficacy of low dose magnesium sulfate (MgSO₄) regimen in eclampsia with standard Pritchard’s regimen. Materials and methods: A total of 60 patients presenting with eclampsia were recruited and randomly divided into two groups: Group A: 30 patients who received standard Pritchard’s regime and Group B: 30 patients who were given low dose MgSO₄. The outcome was measured in terms of effectiveness in control of convulsions and magnesium related toxicity. Results: Overall success rate was 100% with a low dose regimen as compared to 93.3% with Pritchard’s regimen. Failure to control convulsions was noted in two patients on Pritchard’s regimen group as compared to none on a low dose regimen (p <0.01). No difference was observed among study groups with respect to the type of delivery (p <0.59). Maternal complications were higher in cases receiving Pritchard’s regimen: loss of knee jerk (30% vs. 16.7%), oliguria (16.7% vs. 10%) and postpartum hemorrhage (PPH) (23.3% vs. 16.7%). However, the difference was not statistically significant. Conclusion: A lower dose of magnesium sulfate is equally efficient with fewer complications as compared to the standard dose regimen in the management of eclampsia.

Contractures of hand produce considerable morbidity. Despite improvements in the overall management of acute thermal injuries, contractures still occur and are the most common cause of skin contracture in hand. These are largely preventable by good initial care. We studied 24 consecutive patients of postburn contractures of hand treated at MGM Medical College, Aurangabad, Maharashtra, India, with the aim to evaluate the functional outcome. Age of patients ranged from 2 to 60 years. The right hand was affected in 10, left in 7 and both hands in 7. Average total body surface area burned was 10.15%. The flame burn was a major cause of deformity in 16 patients. Mean QuickDASH Score was 19.6 and it improved to 5.1 at 1 year. All patients underwent contracture release, full thickness skin grafting, and K wire fixation. Post-treatment, the majority of the patients had good to excellent Total Active Motion (TAM) rating. To conclude, appropriate and timely reconstructive procedures can greatly improve the function of hands afflicted with post-burn contractures. Time of presentation, age and gender do not significantly affect the degree of improvement in the functional outcome.

Easy accessibility and affordability of the mobile phone network have made a mobile network-based tele-electrocardiography (ECG) a reality during the last 15 years. The instrument required for this purpose is very small compared to conventional ECG machines. It is lightweight, easy to carry and several folds lower in cost. Thus, it can be used in rural areas where there are no facilities available for managing cardiac emergencies. Many products are commercially available from domestic as well as international manufacturers. The technology has moved on from sequential 12 lead configurations to simultaneous 12 lead configurations; yet maintaining the overall size limited to credit card dimensions. Some of these have built-in interpretation algorithms (like Glasgow interpretation algorithm ECG), some offer cloud computing, whereas othersare developing their algorithms for incorporating diagnostic features. All these technologies are reviewed in this paper for comparison.

India is currently facing an epidemic of noncommunicable diseases. This epidemic can possibly be halted by creating awareness about these diseases and inculcating a healthy lifestyle among adolescent children. Keeping this in mind, National Heart Institute has started a ‘Novel School Health Initiative’ in which senior faculty gives illustrative lectures on a healthy lifestyle like ‘you and your heart’, ‘menstrual hygiene’ (exclusively for girls) and ‘personal hygiene’ giving power point presentations to class VIII/IX students. There were no financial implications for the schools. Twenty Delhi schools including public, private and central schools were included in this program to make it more objective. Lectures were preceded and followed by an objective questionnaire. Though a large number of students knew about healthy lifestyle and heart disease in general, the awareness level increased considerably following the lecture. The fact that the students received these lectures with enthusiasm and their level of awareness increased in the post-test evaluation, indicates that these students will be an awakened lot and will try to follow a healthy lifestyle. The long-term effect of such lectures needs periodical evaluation. This model can be replicated in other schools by neighborhood medical college/ hospitals in the entire country.

A 56-year-old male patient with end-stage kidney disease (ESKD) on hemodialysis, presented with features of severe secondary hyperparathyroidism (SHPT). He failed to respond to conservative management. So he was evaluated for surgical treatment (parathyroidectomy). Radionuclide scintigraphy revealed hypertrophied and adenomatous parathyroid glands. He underwent parathyroidectomy, in which all parathyroid glands were excised. Postoperatively patient felt significant relief in bone pain. Parathyroidectomy can be offered to a patient of secondary hyperparathyroidism due to chronic renal failure if conservative measures fail.

Depression in children and adolescents with chronic medical conditions is an important area of clinical interest and research. There is sparse literature from developing countries such as India on the interface areas of pediatric mood disorders and chronic medical conditions. Clinical manifestations of depression in children and adolescents with chronic medical conditions can be different as compared to adult depression. Behavioral overlays can be present in child and adolescent depression which can add on to the complexities of diagnosis and treatment. We present three sick children with behavioral problems, who were suffering from á-thalassemia, systemic lupus erythematosus (SLE), and xeroderma pigmentosum. Relevant literature on clinical manifestations, atypical behavioral presentations, challenges faced in clinical assessments, diagnosis, and management of depression in chronic medically sick children and adolescents are discussed.