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Sebaceoma is a benign tumour of epidermal appendages with sebaceous differentiation also known as sebaceous epithelioma .We report a case of a 31 year old male presented with an exophytic mass on the posterior side of right ear lobule. Histopathology revealed rippled pattern sebeceoma comprising of cells arranged in sheets, cohesive nests and islands mostly comprising of basaloid cells (>50%)with mature sebocytes interspersed in between. The sebocytes appeared as clear cells , some cells multivacuolated with central indented nuclei. The rippled pattern sebeceoma is a histological variant and is seen predominantly in males in the head, neck and face region.The immunohistochemistry markers Epithelial Membrane Antigen (EMA) was focally positive along with Pan-Cytokeratin being strongly positive and diffuse which were con?rmatory for the disgnosis.
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Introduction Mullerian anomalies arise because of aberrant embryogenesis and a longitudinal vaginal septum (LVS) is a failure of resorption of the distal Mullerian canal. A 26-year-old Material and methods pregnant lady with full-term gestation presented to our rural hospital in labour. Her physical examination was normal except for a partial longitudinal vaginal septum that she had in the proximal vagina distinct from the cervix extending from the 12 O clock position of the anterior vaginal wall to 6 O clock of the posterior vaginal wall along with a bulge felt in the posterior fornix. An emergency lower segment caesarean section was performed for possible fetal distress and a right ovarian mass was encountered which was removed along with the resection of the partial longitudinal vaginal septum. Her postoperative period was uneventful and the histopathology report of the ovarian mass turned out as a mature cystic teratoma. A partial Conclusion longitudinal vaginal septum can be easily resected during labour if it hasn't been diagnosed before. This is one of the ?rst cases reported where a partial LVS along with an ovarian mass was reported and managed successfully by resection
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Autoimmune hemolytic anemia (AIHA) has been rarely reported worldwide or from India as the underlying cause of anemia in malaria. We hereby present a case of complicated Plasmodium falciparum malaria with concomitant warm AIHA in a 31-year-old male. Direct Antiglobulin Test (DAT) was positive and elution studies showed pan-agglutination reaction. Clinico-hematological and serological follow-up of the patient was done post artesunate treatment until day 9. We suggest that it is important to establish the immune basis of anemia in malaria patients for guiding the treatment plan for the clinicians and providing packed red blood cell transfusion if required.
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Introduction: Since 1990, internet usage is increasing day by day and availability of smart mobile phones and electronic gazettes like tablet, laptop etc. has given it an exponential rise. During COVID-19 lockdown period, internet usage pattern has changed a lot as per behaviour of students studying in schools, colleges, educational and coaching institutes etc. To study the prevalence of internet addictionObjective: and the effect of internet usage on lifestyle of college students of Haryana. Total 1035 students, ofMethod: various educational streams in various colleges of Haryana state were included in the study and data was collected by pretested self-designed questionnaire and young's internet addiction test questionnaire was used to assess its effect on life style. Out of 1035 students, 436(42%) participants were belowResults: average users of internet, followed by 369(36%) average users and 230(22%) excessive users of internet. Average of total score of young internet addiction questionnaire was 27.72. Various life style factors like feeling stressed while working, neglects other activities, miss a diet, checks internet many times, obsessed with phone and internet usage per day were found significantly associated with internet addiction(p<0.05). Conclusion : Excessive internet usage during COVID-19 pandemic may lead to various abnormal behavior changes which cause negative effect on various aspects of students like emotional, hyperactivity, depression, sleeping disorder etc.
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In this serious world everybody are running towards their profession development despite the fact that they attempt to satisfy their family responsibilities. The person who is adjusting their work and life are more useful and more dedicated towards their association. Everybody confronting dif?cult circumstance for adjusting work life. The balance between serious and fun activities is basically centered around depicting about the person needs between time distribution and work. The balance between serious and fun activities is considered as ordinary issues that had been raised at present and this occurs because of the improvement of the opposition and innovation. Here the Clinical agents are the person who are confronting signi?cant issues in regards to their equilibrium between work and life since they are the person who is working in the ?eld. The workplace for them is unstable and they don't have insurance towards their security while driving over the course of the day. The clinical delegates are the person who move towards their objective full ?llment and even they works in an adaptable working hour they are the person who is working in the ?eld for extended periods, because of the work pressure they blow their top so they are feeling the loss of their quality time with their loved ones. Here in this paper the clinical agent balance between fun and serious activities in view of their day to day exercises, dif?culties and purposes behind irregularity are examined and the systems are loped to achieve a fair work life
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Adolescents are the potential human resources of every nation. Various determinants may influence the mental and physical well-being of the youth. Examination anxiety is one such. It is a prevalent problem for many adolescent students; affecting approximately 10-40 percent of all students. Yoga can act as one of the best alternative methods of treatment. It aims at creating and preserving a proper balance between the body and the mind. 61 adolescent students, of age group 14-16 years, suffering from examination anxiety participated in this study. Examination Anxiety Scale for adolescents, developed and standardized by the investigators, was used for assessing examination anxiety. The subjects were divided into two groups randomly- the experimental group and the control group. The experimental group participated in the yoga intervention program for six weeks, whereas, the control group did not participate in the same. After six weeks, both the groups were assessed again. The result showed that the mean examination anxiety score reduced from 71.70 to 68.80 for the experimental group and it was statistically significant at (P<0.05). For the male and the female experimental groups, the mean examination anxiety score reduced from 71.84 to 68.92, and 72.12 to 68.71, respectively. For the male group, reduction in examination anxiety score was not statistically significant (P =0.106) whereas, for the female group changes were statistically significant (P <0.05). From the result, it can be concluded that yoga has a significant effect on attenuating the examination anxiety. Further, the result showed that yoga reduced examination anxiety in both males and females. However, the positive effect of yoga intervention was more significant in females than in males
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Background: Globally 憃ral cancer� is the sixth most common cause of cancer-related death. Oral cancer accounts for approximately 30-40% of all cancers in India. The present study was conducted to assess biochemical parameters in newly diagnosed oral cancer. Methods: The present study was conducted to assess biochemical parameters in newly diagnosed oral squamous cell carcinoma. The study was conducted at GSVM Medical College, Kanpur among 196 newly diagnosed patients with oral squamous cell carcinoma and 196 healthy individuals. Serum samples from the participants were collected. The data were expressed as mean盨D. Values of p<0.001 were considered significant. Results: The present study was conducted to assess biochemical parameters in newly diagnosed oral cancer. The study was conducted at GSVM Medical College, Kanpur among 196 newly diagnosed patients with oral cancer and 196 healthy individuals. The levels of Random Blood Sugar, Serum Total Bilirubin, Direct Bilirubin, Indirect Bilirubin, Glutamic-oxalacetic transaminase (SGOT), glutamic-pyruvic transaminase (SGPT), Serum Protein, Serum Albumin, Serum Creatinine, Serum Sodium, Serum Potassium were increased in cases as compared to controls. The p-value was non-significant for all the biochemical parameters. Conclusion: The present study concluded that the levels of Random Blood Sugar, Serum Total Bilirubin, Direct Bilirubin, Indirect Bilirubin, SGOT, SGPT, Serum Protein, Serum Albumin, Serum Creatinine, Serum Sodium, Serum Potassium were increased in cases as compared to healthy controls.
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Pain is a common and highly distressing symptom in children with advanced malignancies and it is often multifactorial at the end?of?life. The prognosis of cancer pain is reported to be worse in those with mixed pain type, high pain severity, daily opioid use, and poor emotional well?being. We describe a case of 13?year?old boy, known case of metastatic Ewing sarcoma right iliac bone, who presented to our palliative care ward with intractable pain and was finally discharged home for terminal care with high doses of morphine, ketamine, and midazolam infusion through elastomeric pump attached to a peripherally inserted central catheter (PICC line). The suffering of imminently dying children should be reduced, and judicious dose escalation of opioids along with adjuvants is appropriate and often necessary.
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Purpose: To study the relevance of preoperative OCT predictors in large macular holes (MH) treated using the inverted ILM peel technique. Methods: Prospective study of 95 patients undergoing vitrectomy for large MH between January 2019 and December 2020 was performed by dividing the patients into groups depending on various quantitative parameters and indices of MH such as base diameter (BD), hole form factor (HFF), macular hole index (MHI), diameter hole index (DHI), and tractional hole index (THI) by using parameters such as minimal hole diameter, hole height, nasal and temporal arm lengths. Depending upon the duration of symptoms, patients were divided into three groups: <3 months, 3–6 months, and >6 months. Anatomical success rate, type of closure, and postoperative vision gain were analyzed in relation to the abovementioned diameters, indices, and duration to see if any significance existed. Results: The mean age of patients included in the study was 60.48 ± 13.88 years, with female preponderance (males: females = 37:58). Change in logMAR was statistically significant individually with all studied parameters (P < 0.0001) without influence of size of hole and other indices. BD and DHI levels showed significant association with type of closure as indicated by P values of 0.017 and 0.048, respectively. Duration of symptoms showed no significance in terms of anatomical and functional success. Conclusion: OCT predictors of MH success seem to have lost relevance with inverted flap surgeries as 100% anatomical success is achieved with this technique, with 95.78% (91/95) achieving type 1 closure with statistically significant equivalent functional gain across the indices with no effect of duration of symptoms.
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Super refractory status epilepticus (SRSE) is a rare but serious neurological emergency. This case report aims to highlight the challenges faced during the diagnosis and management of SRSE in a 36-year-old preeclamptic patient taken for cesarean delivery under spinal anesthesia. The patient developed a seizure episode minutes after administration of intrathecal bupivacaine, necessitating administration of general anesthesia. Postoperatively, SRSE developed which did not respond to multiple anti-epileptics and thiopentone sodium infusion. Although the clinical picture and magnetic resonance imaging findings supported the diagnosis of posterior reversible encephalopathy syndrome, the role of intrathecal bupivacaine in causing SRSE could not be ruled out due to the temporal association of events. The patient had a prolonged and complicated hospital stay and despite a multimodal approach to the treatment, suffered neurological sequelae.
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Mental health is an integral and essential component of “Health”. It is more than the mere absence of mental disorders or disabilities. It determines the quality of life of the individuals. The progress and prosperity of a nation depend on the overall quality of health of its citizens. However, until early twentieth century the issues of mental health and well-being were inadequately addressed. Often people with psychological ailments were considered to be non-productive people, confined in asylums, received inhumane treatment and were completely secluded from the mainstream society. Since independence initiatives have been taken by individuals and by the central government and the state governments, to develop the mental health services in India. This paper reviewed published articles, book-chapters and books to explore the development of mental health services in India since Independence. It was observed that measures were taken to improve the conditions of the mental hospitals. A trend towards deinstitutionalization was set by the Government of India and that initiated the creation of general hospital psychiatric units and community mental health services. Humanistic approach in treatment, development of psychotropic drugs and psychotherapies facilitated the management and care of the patients with psychiatric diseases, thereby improving their quality of life.
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Background: Diabetic membranes are always a challenge for a surgeon because of sticky nature and chances of iatrogenic break while removing. Purpose: To demonstrate a safe reverse swiss roll technique to dissect diabetic vitreous membranes. Synposis: Approaches and techniques for membrane dissection are segmentation, delamination and en-bloc dissection using various types of instruments and illumination. With vitreous cutte, picks and scissors, surgical steps are traditionallu performed by using classic lift and shave technique. After identifying the plane, tissue is lifted and then cut, which puts the retina at risk of break because of traction and active suction. Such a threat can be reduced by placing the cutter above the membrane thereby having the membrane itseld acting as a protective cushion to the retina. Port here, unlike lift and shave technique, doesn抰 face the edge of membrane but is exactly 180 degree opposite and membrane curls into port because of suction. Also, hemostasis is maintained by continuous aspiration and cutting as the instrument is moved side to side, retracting from the edge. Highlights: Reverse swiss roll technique is safer compared to lift and shave because of the safety cushion of the membrane between the port and the retina. There is inherently less chances of retinal break because the active suction from the port is directed away from the retina. The technique also minimises traction and localised pull on the atrophic macula
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Background: Direct pulp treatment is carried out when a healthy pulp gets mechanically/accidentally exposed during the operative procedures or trauma. Aim: To determine the effects of various direct pulp capping materials as measured by the clinical and radiographic analysis. Design: Two reviewers performed a database search of the studies published between January 2005 and November 2020. The inclusion criteria were papers published in the English language; children aged 3–12 years having deep carious lesions in primary teeth. All potential studies were acknowledged by their title and abstract. The full-text analysis of potentially relevant studies, the selected studies were included in the systematic review. A meta-analysis calculation was performed for the overall data and the subgroup data. Results: The database searching led to 57 articles, which were of direct pulp treatment in primary teeth, after the removal of duplicates, 55 records remained but did not meet all inclusion criteria. A high variability was observed among the papers. Further filtering with criteria led to nine articles, which met all inclusion criteria. Meta-analysis demonstrated the success rates of DPT in primary teeth (95% confidence interval −0.799–0.898); P < 0.001. Clinical assessments of various direct pulp capping materials suggested 84.9% of success irrespective of the material used. The nine studies were heterogeneous according to the random effect model (P < 0.001, I2 = 84.08%). Conclusions: Direct pulp treatment has the advantage of being a conservative vital pulp therapy reducing the need for a more invasive treatment.
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Background:Menstrual cycle length is an indicator of reproductive health of a woman. Duration of menstrual cycle in a womanis affected by a number of factors including BMI. The effect of BMI on menstrual cycle length has been studied less extensively. Not many studies have been conducted on Indian populations. This study was conducted to study the relation of body mass index and menstrual cycle length in reproductive age women. Methods:The study included 225 women of age 15-45 years. Women with average menstrual cycle length of 24-38 were regarded as regularly menstruating women. Menstrual cycle length wasdefined as short (<24 days), normal (24-38 days), long (>38 days). During the menstrual phase of the cycle BMI of each participant was recorded.Results:A significant (p=0.0008) increase in mean BMI was found with increased in length of menstrual cycle. The majority of thewomen with long menstrual cycle were obese compared to women having normal and short length of menstrual cycle.Conclusions: The results of present study indicates that women with long menstrual cycle have increased body mass index compared to women having normal or short menstrual cycle length.
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A patent urachus is one of the spectrums of congenital urachal anomalies. It has been termed as "urachal fistula" when the lumen of intra-embryonic portion of allantois persist abnormally. Persisting urachal fistula is a rare condition mostly diagnosed during childhood or in autopsies. Here we report a very rare case of urachal fistula of a young male. We present a case of 22 years male with intermittent periumbilical pain and sero-purulent discharge from umbilicus since birth. On examination sero-purulent discharging umbilical sinus with granuloma was present. Surgical excision of whole of the urachal fistulous tract was done with repair of bladder. Patient did well during post-operative period. Persisting urachal fistula in adult is rare entity and difficult to diagnose because of low incidence and non-specific symptoms. So a high index of suspicion is required in order to make the early diagnosis of urachal anomalies.
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As an otorhinolaryngologist it is not an everyday occurrence to find a swelling in the nasolabialfold area. The challenge however lies in the diagnosis, proper and timed treatment of the existing pathology, especially in a non –infective case. There are various pathologies that can lead to a swelling in the nasolabial area. We here report a rare case of a female patient who presented to our outpatient department with a slowly progressive nasolabial swelling which radiologically pointed towards a Nasolabial cyst. However, the final diagnosis was an entity on the other end of spectrum, an Ameloblastoma, an odontogenic tumor
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Background: Antenatal corticosteroid administration in preterm pregnancies is recommended to promote fetal lung maturation. Studies have reported temporary reduction in fetal heart rate, breathing and movements following maternal corticosteroid administration. Authors studied effect of maternal corticosteroid administration on fetoplacental circulation in preterm pregnancies with IUGR and its correlation with perinatal outcome.Methods: Observational study included 77 preterm singleton pregnant women with IUGR. Color doppler day 0 (before betamethasone) of umbilical artery of 77 cases done. All received two doses of 12 mg of betamethasone intramuscularly 24 hours apart. Umbilical artery doppler on day 2 (24 to 48 hours of 1st dose of betamethasone) and day 4 (72 to 96 hours of 1st dose of betamethasone) done. Pulsatility index (PI) of umbilical artery on doppler and Neonatal details of all women noted.Results: On day 2 doppler, 56 (73%) women (Group A) showed decrease in umbilical artery PI while 21 (27%) women (Group B) did not show decrease in umbilical artery PI. Mean umbilical artery PI of 77 cases on day 0 and day 2 were 1.73±0.73 and 1.54±0.76 respectively (p<0.001). Mean Umbilical artery PI values of undelivered 60 cases on day 0, day 2 and day 4 were 1.55±0.61, 1.33±0.55 and 1.47±0.63 respectively (p<0.001). Group B neonates had poorer Apgar scores, higher neonatal complication, longer hospital stay, lesser umbilical pH at birth and higher perinatal mortality rate than Group A neonates.Conclusions: Significant reduction in mean umbilical artery PI observed on day 2 following betamethasone administration (p<0.001), which was maintained till 4th day after 1st dose of betamethasone (p<0.05). Women who showed improvement in umbilical artery pulsatility index following betamethasone administration had a better perinatal outcome as compared to women who did not.
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The current study was done to determine various behavioral disorders among 5-15 years of children attendingPaediatric OPD and to determine underlying risk factors associated with behavioral disorders among children.This observational cross-sectional study was carried out among 200 children between 5-15 years of age usingDSM IV Diagnostic Criteria. Some risk factors that lead to the manifestation of the disorder were also studiedby history taking. The increasing sequence of disorders positivity was 0.5%, 1%, 1.5%, 1.5%, 2.5%, 12.5%for CD, LD, GAD, ADHD, AD and ODD, while observing 51.28% ODD cases among males, 12.5% ODDamong overall subjects, 19.5% ADHD cases, 27.02% GAD, 1% LD and 0.5% CD cases. The overall observanceof any one disorder was 39 (19.5%). Herein observed high prevalence of behavioral disorders requiresbehavioral, technical and managerial interventions and therefore is the priority intervention area in the field ofpublic health globally, nationally and locally.
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Suprascapular notch is a depression located in the superior border of the scapula near its lateral part, close to the root of the coracoid process. It is bridged by the superior transverse scapular ligament & serves as a path for the suprascapular nerve. The notch is commonly seen in all the scapulae with variable morphology. Sometimes, it is associated with ossified transverse scapular ligament which plays an important role for the suprascapular neuropathies which has been suggested in many previous literatures. But, its absence can also be a reason for nerve entrapment which has been mentioned less frequently. The purpose of this study was to find out the incidence of completely absent suprascapular notch among dry scapulae of north India, especially Gurugram region along with a morphometric evaluation of superior border of scapular where the notch is situated.METHODSOne hundred & ten adult dry scapulae of unknown sex from the osteology museum of SGT Medical College, Gurugram, were obtained for evaluation of absence of suprascapular notch in the superior border of the scapulae near the root of the coracoid process by subjective evaluation (visual inspection). We have also done a morphometric evaluation (length) of the superior border of all the scapulae irrespective of the suprascapular notch. Our observations were compared with other osteological studies performed on other population groups.RESULTSOf the 110 scapulae studied, 43 belonged to right side & 67 scapulae of left side. By visual inspection, 13 scapulae (11.8%) were devoid of suprascapular notch on the upper border & rest 88 scapulae (88.81%) had different variety of suprascapular notch. Among the 13 scapulae without suprascapular notch, 8 scapulae (61.5%) were of right side and 5 scapulae (38.46%) were of left sided bone. Apart from this, the average length of the superior border of the scapulae was 42.73 mm.CONCLUSIONSIncidence of completely absent suprascapular notch in our study is 11.8% which will act as a reference point among Gurugram population in north India. Clinicians should keep in mind about complete absence of suprascapular notch which can be a probable reason for the suprascapular nerve entrapment.
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Background: Preeclampsia is defined as systolic blood pressure level of 140 mmHg or higher or a diastolic blood pressure level of 90 mmHg or higher that occurs after 20 weeks of gestation with proteinuria. Objective of this study was to study the role of spot urine protein: creatinine ratio as an alternative to 24 hours proteinuria for the diagnosis of pre-eclampsiaMethods: This is a prospective observational study conducted in the department of obstetrics and gynaecology, BRD Medical College Gorakhpur, since October 2016 to September 2017 included 120 pregnant women with hypertension of gestational age more than 20 weeks. Ramdom urine sample of all the patient was taken before 12 noon after first voiding. For 24 hours urine sample patient was asked to collect all her urine she voids during 24 hours. The creatinine was estimated by the alkaline picrate method (Jaffe's Reaction) modified by the Bonsnes and Taussky, 1945. Creatinine in a protein free solution reacts with the alkaline picrate and produces red colour complex which is measured colorimeterically. Urinary protein was estimated in all the subjects by the Turbidimetric method. Urinary protein was precipitated by 3% sulphosalicylic acid and turbidity so produced was measured colorimetrically.Results: Protein: creatinine ratio in a random urine sample is better than random urine protein detection by dipstick method in cases of emergency when there is no time for detection of 24 hours urine protein.Conclusions: If cut-off level for urine protein: creatinine ratio in random urine sample is taken as 0.25 or more then sensitivity and specificity become same as 24 hours urine protein.