Immunophenotypic characterization of normal and abnormal plasma cells in bone marrow of newly diagnosed multiple myeloma patients

Background: Identification of plasma cells into abnormal (APC) and normal (NPC) compartments is of utmost importance in flow cytometric (FC) analysis of multiple myeloma (MM) and related plasma cell dyscrasias for diagnosis, prognosis, and follow-up. No single phenotypic marker is sufficient to distinguish NPC from APC. Materials and Methods: 43 newly diagnosed cases of MM and 13 controls were included in the study. Bone marrow (BM) samples from the 2nd pass were processed on the same day with antibodies against CD38, CD138, CD19, CD81, CD45, CD117, CD200, CD56, cytoKappa, and cytoLambda in a 4-color experiment with CD38 and CD138 as gating antibodies. Results: Mean APC% in cases was 96.5%. The expected Immunophenotype (IP) of APC which is CD19-/56+/45-/81-/117+/200+ was found in only 13/43 MM cases. In 30/43 cases, APC revealed deviation from expected IP either for single or a combination of markers. Sensitivity for APC detection was highest for CD19 (95.2%) followed by CD56 (90.4%) and CD81 (83.7%). Specificity was highest for CD19 (100%), CD56 (100%), and CD81 (100%) followed by CD117 (92.3%). Combination of markers with maximum sensitivity to detect APC (97.6%) was CD81- or CD19- and CD200+ or CD56+ (two markers); and for NPC (92.3%) was CD81+ and CD19+ and CD56- (three markers). Conclusion: Plasma cell IP can be highly variable with multiple minor subpopulations in both cases and normal controls. CD 19 and CD56 are highly informative markers for a 4-color experiment. Assessment of multiple markers in an 8–10 color experiment is more informative but the lack of advanced flow cytometers should not limit the use of FC in a 4-color approach. Our results emphasize that even basic equipment with limited fluorochrome can provide meaningful information if used appropriately.

Sjogren’s syndrome presenting as hypokalemic periodic paralysis, a rare manifestation: A case series

Sjogren’s syndrome is a chronic and slowly progressing autoimmune disease characterized by lyphocytic infiltration of exocrine glands resulting in Sicca syndrome (xerostomia and keratocunjuntivitis sicca). The disease can present alone or along with other autoimmune diseases leading to significant organ specific and systemic disease. Middle aged women (Female: Male: 9:1) are primarily affected. Extraglandular (systemic) manifestations are seen in one third of patients with Sjogren’s syndrome. Among the extraglandular manifestations, renal involvement is commonly seen. Renal involvement in the form of tubulointerstitial nephritis (TIN) is more common compared to glomerular involvement. Distal renal tubular acidosis (RTA) is more common manifestation of TIN presenting as mild hypokalemia, metabolic acidosis, and rarely with hypokalemic periodic paralysis. We report three cases of hypokalemic periodic paralysis with metabolic acidosis, two in respiratory paralysis, diagnosed as distal RTA. On further evaluation of distal RTA, the patient diagnosed to have Sjogren’s syndrome and managed accordingly. Our report shows that Sjogren’s syndrome is a rare but important cause of hypokaemic periodic paralysis due to RTA.

Angiotensin Receptor-Neprilysin Inhibitor Therapy and Cardiac Remodeling in Heart Failure: Consensus Statement from India

Adverse cardiac remodeling refers to progressive structural and functional modifications in the heart because of increased wall stress in the myocardium, loss of viable myocardium, and neurohormonal stimulation. The guideline-directed medical therapy for Heart failure (HF) includes Angiotensin receptor-neprilysin inhibitor (ARNI) (sacubitril/valsartan), ?-blockers, sodium-glucose co-transporter 2 (SGLT2) inhibitors, and mineralocorticoid receptor antagonists (MRA). ARNI is under-prescribed in India despite its attractive safety and efficacy profile. Therefore, the consensus discusses objectives and topics related to ARNI in the management of cardiac remodeling, and experts shared their views on the early timely intervention of effective dosage of ARNI to improve the diagnosis and enhance mortality and morbidity benefits in cardiac reverse remodeling (CRR).

Factors Affecting Under-Five Mortality Rate (U5MR) in India- National Family Health Survey (NFHS) 5 Factsheet What It Speaks?

Introduction: In developing countries various factors lead to Under-5 Mortality and irreversible losses which can be prevented by proper measures take on factors affecting to it. Objective: This study was conducted to analyse the changing trends of Under-5 Mortality in India. The new National Family Health Survey (5th round) which was published recently came up with several new findings, which were both encouraging and disheartening and also one of the major Sustainable Development Goals.Method: A secondary data analysis was conducted of NFHS factsheets to study the U5MR in India. The indica-tors which had a correlation either positive or negative with the Under-five mortality rate were included.Result- When we look at the result, few states' performance is encouraging because they have shown some of the best declines. Correlation was found between dependant variable that is U5MR which is a dependent vari-able and several independent variables which concluded that factors like Women literacy, Men literacy, Breastfeeding, Nutritional insufficiencies, Caesarean delivery, ANC visits and IFA consumptions are negatively associated withU5MR. Conclusion: Various steps have been taken in order to improve our healthcare sector since independence, every government had their fair share of contribution, that’s the reason why we are this stage. Now it’s time to increase efforts with targeted interventions to solve this problem and complete our commitment towards the SDGs.

The Power and Promise of Angiotensin Receptor Neprilysin Inhibitor (ARNI) in Heart Failure Management: National Consensus Statement

Heart failure (HF) is a huge global public health task due to morbidity, mortality, disturbed quality of life, and major economic burden. It is an area of active research and newer treatment strategies are evolving. Recently angiotensin receptor-neprilysin inhibitor (ARNI), a class of drugs (the first agent in this class, Sacubitril–Valsartan), reduces cardiovascular mortality and morbidity in chronic HF patients with reduced left ventricular ejection fraction (LVEF). Positive therapeutic effects have led to a decrease in cardiovascular mortality and HF hospitalizations (HFH), with a favorable safety profile, and have been documented in several clinical studies with an unquestionable survival benefit with ARNI, Sacubitril–Valsartan. This consensus statement of the Indian group of experts in cardiology, nephrology, and diabetes provides a comprehensive review of the power and promise of ARNI in HF management and an evidence-based appraisal of the use of ARNI as an essential treatment strategy for HF patients in clinical practice. Consensus in this review favors an early utility of Sacubitril–Valsartan in patients with HF with reduced EF (HFrEF), regardless of the previous therapy being given. A lower rate of hospitalizations for HF with Sacubitril–Valsartan in HF patients with preserved EF who are phenotypically heterogeneous suggests possible benefits of ARNI in patients having 40–50% of LVEF, frequent subtle systolic dysfunction, and higher hospitalization risk.

A Study On Utility of Web-Based Drug Warehouse Management System (E-Aushadhi) In A Peripheral Hospital of Metropolitan City of Maharashtra

Introduction: An E-Aushadhi management system based on database was introduced in urban health centre for managing stock outs. This study was conducted to assess utility of web-based drug warehouse management system in a peripheral hospital. Objectives: The objectives of this study were to assess the perceived benefits and difficulties by health care providers expected in introducing a web-based Supply Chain Management System (E-aushadhi) and to identify the factors which will govern successful transition from current system of drug logistics man-agement to web-based system. Methods and materials: In this study Focus Group Discussion was conducted with the staff members of an urban health centre who were working on a similar web-based platforms. There are four teams each comprising 3-5 members. Results: Themes and subthemes were made based on the transcripts analysed. It is perceived that with introduction of web-based drug warehouse system, accuracy of the data can be well assured as manual errors can be reduced a lot. Quality of stock maintenance will increase and will prevent stock outs Conclusion: The accuracy and transparency of drug stock maintenance will be increased while technical challenges such as internet availability, technician availability and training of personnel are perceived barriers.

COVID-19: Knowledge, attitude, and practice of health-care workers in tertiary care hospitals of Odisha – A cross-sectional survey

Background: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a contagious viral pathogen, creating a public health emergency, and affecting lives and livelihood of millions of populations globally. Good knowledge, attitude, and practice are essential to prevent and stop the widespread transmission. Aims and Objectives: The aim of the study was to assess the knowledge, attitude, and practices regarding COVID-19 among health-care workers (HCWs) in tertiary care hospitals of Odisha. Materials and Methods: The present study is an observational, cross-sectional, and question-based online research. Questions were created on Google forms. Link was generated and given through social media apps. The questionnaire consists of four sections. First section comprised demographic characteristics. Second, third, and fourth sections contain questions on knowledge, attitude, and practice related to COVID-19, respectively. Descriptive and inferential statistical procedures were done through IBM SPSS statistics version 24.0. The research was granted approval by Institute Ethics Committee of IMS and SUM Hospital. Results: Data were analyzed in 430 subjects, 205 females and 225 males. The majority of HCWs have good knowledge score 86.5%, attitude score 80.9%, and practice score 91.2%. The mean knowledge score was 6.6 ± 0.84 and mean attitude score was 28.5 ± 1.89. Knowledge and attitude score was found to be significantly different among age groups and gender, p<0.001. Mean attitude score had a significant difference with working status, P = 0.025. Mean knowledge and attitude score was significantly higher across professions and work experience, P < 0.001. Good practice score varies significantly across professions, P < 0.001. Conclusions: The most of HCWs had good knowledge, positive attitude, and adopted appropriate practices regarding COVID-19. Periodic educational interventions are strongly recommended for HCWs to upgrade their knowledge, attitude, and practices regarding coronavirus diseases.

Impact of microteaching workshop on the teaching skills of postgraduate students, Odisha, India

Background: Young teachers can skill for better teaching-learning ways can be acquired through structured and cheaper faculty training techniques. Microteaching can be adopted as one such measure to improvise teaching-learning skills among young teachers. Aims and Objectives: This study was conducted also to knew the impact of knowledge and perception regarding microteaching among postgraduate medical students and improvise on them. Also to knew the improvement in teaching skills after training and established the usefulness of this modality of microteaching by looking into its effectiveness. Materials and Methods: The participants were 29 1st year postgraduate students of Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha. One day microteaching workshop was arranged for them in the Medical Education Unit of KIMS. The participants were surveyed through questionnaires (A, B, C, D, and E). McNemar’s Chi-square test did this by comparing between pretesting and post-testing scores of Questionnaire A and D (Kirkpatrick level 1, 2, and 3) as well as B and C (Kirkpatrick level 4) by use of the STATA software. A three-point Likert scale (0 = Not useful, 1 = Doubtful, 2 = Useful) was used to assess the participants’ responses based on the qualitative analysis method from questionnaire E. Results: Pre-post testing revealed improvement in knowledge and perception about microteaching among the majority (P < 0.05). They improved skills-wise too (P < 0.05). All the participants believed that microteaching is useful with a score of 2 on a three-point Likert scale. Conclusion: The microteaching among postgraduate medical students before proper lecture is very much useful. This type of workshop and training should be done in regular interval.

Demographic Risk Factors for Mortality of Covid 19 Patients Admitted in A Tertiary Care Hospital: A Cross-Sectional Study

Context/Background: During the COVID-19 pandemic, government worldwide imposed severe re-strictions on public life to limit its spread. For informed decision making it is important to quantitatively assess how the age, gender, and length of stay affects mortality of COVID 19 patients. It is important to find out more useful prognostic factor for mortality. This study revealed prevalence of mortality across age, gender, and length of stay and assessed determinants of mortality using independent variable age, gender, and length of stay. Methodology: A Cross-sectional observational study was conducted on 3084 Covid 19 positive patients admitted during April 2020 to June 2021 at Bundelkhand Medical College Sagar. Results: In this study mortality occurred in 510 patients. Age group analysis presented that majority of patients died in 60–74-year age group whereas maximum patients who died are having length of stay for 0-7 days, whereas gender has no significant role. There was significant influence of age group and length of stay on the mortality of Covid-19 positive patients (χ2(9) =495.30, P<.001). Conclusions: Mortality of covid positive patients being impacted by demographic risk factors like age group, length of stay.

An assessment and correlation of emotional Intelligence and mental health of medical students

Introduction: Emotions like joy, anger, grief, jealousy, love, fear make our life worthwhile. Whatever we do, incites some emotion in us. If we are able to enjoy our emotions, without them having excessive control over us, then we can make ours as well as others’ lives better. Aim of the study was to assess and correlate emotional Intelligence with mental health. Methods: Type of study: Descriptive type of cross sectional study. Sampling: Simple random sampling. Study population: Under graduate students in a private medical college in western Uttar Pradesh. Sample size: 246. Results: The average emotional intelligence score was 26.82 with standard deviation of ±5.80. Average emotional intelligence among males was 27.04(±6.72) and was 26.63(±5.07) among females. Spearman Rank correlation coefficient “r” =0.789, showed highly positive correlation between ranks from both the score. (p=0.0000). Conclusions: The medical students showing higher scores of emotional intelligence are less likely to be mentally stressed.

Child Vaccination Coverage in India and Its Impact: Evidence From NFHS-5 Factsheet

Background: In developing countries various childhood diseases lead the morbidity, mortality and irre-versible losses which can be prevented by proper vaccination. This study was conducted to analyse the changing trends of childhood vaccination in India and its impact on childhood diseases and mortality, the trends in coverage of each vaccine along with identification of geographical areas of concern.Materials and methods: NFHS data published by Government of India was analyzed to see the trends in vaccination coverage, female literacy, childhood diseases and under-five mortality, along with online da-tabase search for relevant literature. Results: Total vaccination coverage in India has reached to 76.4% as per NFHS- 5 data. Orissa stands at the top with 90.5% coverage while Nagaland at the bottom with 57.9% coverage. Prevalence of child-hood diseases and under-five mortality has reduced overtime accountable to increase in vaccination coverage as one of the major factors for same. Conclusion: Despite improvement in total vaccination coverage, the goal of Intensified Mission Indra Dhanush of 90% coverage still remains unachieved. There is reduction in childhood disease and mortali-ty rate, but the pandemic has adversely affected these advances. Therefore, immediate steps should be taken to gain the lost ground.

Epidermal growth factor receptor mutations in adenocarcinoma lung: Comparison of techniques for mutation detection

Background: Targeted therapy using tyrosine kinase inhibitors in cases of non-small-cell lung carcinoma (NSCLC) that harbor epidermal growth factor receptor (EGFR) mutations has drastically improved the overall survival rate. The current study estimated the frequency of EGFR mutations in the Indian population by analyzing the diagnostic parameters of various techniques available for the detection of these mutations. Materials and Methods: A case series of 100 histologically diagnosed and immunohistochemically confirmed NSCLC with the adenocarcinoma phenotype comprises the study sample. EGFR mutations were detected using clone-specific immunohistochemistry (IHC), real-time polymerase chain reaction (PCR), and Sanger sequencing. Results: EGFR mutations were identified in 48% cases with 72.78% mutations involving exon 19. Clone-specific IHC had a low sensitivity of 46.43%, and the specificity was 79.17%. Sanger sequencing yielded interpretable results in 16% cases only, which were in concordance with the results of real-time PCR. Conclusion: EGFR mutations are increasingly being explored for targeted therapy and personalized medicine. Real-time PCR was found to be the best and the most accurate method for the detection of somatic EGFR mutations in adenocarcinoma primarily in the lungs.

Liquid biopsy in CNS tumors: Current status & future perspectives

Precise classification of central nervous system (CNS) malignancies is vital for the treatment and prognostication. Identification of noninvasive markers can be of importance to guide treatment decisions and in monitoring treatment response. CNS tumors are classified based on morphology with an essential complement of molecular changes, including mutations, amplifications, and methylation. Neuroimaging is the mainstay for initial diagnosis and monitoring tumor response with obvious limitations of imprecise tumor typing and no information on diagnostic, predictive and prognostic markers. Liquid biopsy has evolved as a diagnostic tool in body fluids and is being investigated as a surrogate for tissue biopsy in managing primary and metastatic brain tumors. Liquid biopsy refers to analyzing biological fluids such as peripheral blood, urine, pleural effusion, ascites, and cerebrospinal fluid (CSF); however, peripheral blood remains the primary source of fluid biopsy. The analytes include cell-free DNA (cfDNA) circulating tumor cells (CTCs), circulating micro RNAs (miRNAs), circulating proteins and extracellular vesicles (EVs). Analysis of these components is actively used for early cancer detection, auxiliary staging, prognosis assessment, detection of minimal residual disease (MRD), and monitoring drug resistance in various solid tumors. In recent years, liquid biopsy has been studied in CNS tumors, and analysis of CTCs and cfDNA have become relevant research topics. In the current review, we have explained the clinical potential of liquid biopsy in CNS tumors to assist in diagnosing and predicting prognosis and response to treatment.

Evaluation of Proximate Composition, Minerals and Micronutrient Contents of Finger Millet Herbi Dumpling

Finger millet is an important crop in Maharashtra, Orissa, and Tamil Nadu. Millet production and consumption have been on the decline for some years. Finger millet samples were gathered from regional locations in Nashik and Kolhapur, Maharashtra. These were also taken as samples for chemical composition and proximate analysis. Standard analytical procedures were used to determine the results. The result of the chemical composition, Nashik (sample one) was found to be Ca mg (6.19), Mg (0.52), Fe (1.09), Zn (1.74± 0.96), Cu (0.10), P (8.90) These findings suggest that finger millet is a good source of calcium and phosphorus. These can be utilised as calcium supplement foods, and their composite flours can be used to preserve a variety of nutrient-dense recipes that can be employed as part of a supplement feeding regimen.

Comparison of circulating DNA in malignant neoplasia from diverse locations: Investigating a diagnostic role

Context: Circulating free DNA (cfDNA) analysis has emerged as novel noninvasive diagnostic biomarker in several solid tumors. Raised levels have been reported in several malignancies and may correlate with clinicopathological and treatment response. The current study was designed to assess the diagnostics of cfDNA in different tumor types of malignancies correlating with tumor (T), nodes (N), and metastases (M) stage. Design: Serum samples were collected from treatment naïve cases with histologically diagnosed tumors including 23 brain tumors, 48 breasts, 50 gallbladder carcinoma (GBC), 13 lungs, 68 oral squamous cell carcinoma (OSCC), and 25 normal controls. CfDNA was quantified with real-time polymerase chain reaction (PCR), Invasive ductal carcinoma (IDC) using beta-globin gene amplification. Cut off values for diagnostics were calculated using receiver operating curve analysis. Results: Contrary to other cfDNA studies where it was postulated that cfDNA would not cross the blood–brain barrier and reach the systemic circulation, we found detectable cfDNA in glioma with median (Q1–Q3) of 349.22 ng/ml (19.87–1276.58). Median cfDNA concentration in breast, gallbladder, lung, oral and normal controls was 328.72 (128.38–624.44), 778.50 (589.88–1864.35), 348.73 (194.67–483.61), 386.27 (47.88–959.67), and 74.12 (49.66–120.00), respectively. Grades I and II glioma had significantly lower levels compared to Grades III and IV (P = 0.0001). Significant difference in median cfDNA values in IDC and GBC was observed with increasing tumor grades, stage, T stage, nodal stage and metastasis and with stage of OSCC cases. Conclusion: CfDNA levels showed good diagnostic discrimination in glioma, GBC, breast, lung carcinoma, and OSCC. Significant increase in titers was evident with increase in cancer stage from I to IV in breast, GBC and OSCC.

Morphometric Analysis of Anatomy of Anterior Cruciate Ligament of Knee and its Attachments - a Cadaveric Study in Indian Population

@#Introduction: The Anterior Cruciate Ligament tends to stabilise the knee in various range of extension and flexion. Precise study of anatomy, attachments and position of bundles is important for successful ACL reconstruction. In our study, we attempt to assess general anatomy of ACL, determine and compare its morphometric data pertaining to length and width and its tibio-femoral foot prints in different gender and secondarily determine changes in the same during ACL dynamics witnessed during knee flexion changes. Materials and methods: A total of 19 knees from 10 cadavers were used in the research with mean age of 61±7 years. After dissecting the skin, muscles, patellar and articular capsule were removed and bundle attachments were studied. Thereafter the relative length, width and stiffness of ACL bundles at 0, 90, 140 (maximum) angles of knee flexion were measured along with maximum horizontal and vertical bundle footprints at tibio-femoral attachments were recorded. Results: Mean length and width of insertion of anteromedial (AM) bundle on the tibial surface was 8.8mm and 9.0mm in males and 8.1mm and 8.8mm in females. Furthermore, that of PL bundle was 9.1mm and 7.8mm in males and 8.9mm and 7.1mm in females. Conclusion: The anteromedial (AM) bundle and posterolateral (PL) bundle of ACL were found to be most relaxed at full extension and were most taut at maximum flexion of 140°. AM bundle underwent greater stretching and change of length in comparison to the PL bundle, indicating that it is comparatively a more dominant bundle.

Graphene Conjugated Usnic Acid Nano-Formulation For The Treatment Of Topical Fungal Infection

Objective: The study aims to investigate the antifungal response of the dug usnic acid with the carrier graphene. Methods: Nano-precipitation method by sonication was adopted to formulate the conjugate. SEM test was performed to check the shape and average size of the conjugate. FTIR test was performed for the chemical interaction between the drug and the carrier. Ointment was prepared by the fusion method and the viscosity test was performed by Brookfield viscometer. Spreadability test was performed by slide method. Animal activity was performed to confirm the antifungal effect of the formulated nano-conjugate. Statistical analysis was done by Anova. Results: SEM study shows that the conjugate is in the nano range and possess a spherical shape. FTIR study shows no interaction between the drug and the carrier. The result of in vitro drug release study shows that the conjugate posses a higher drug release rate as compared to the drug alone. Topical drug administration is more suitable for the treatment of the fungal infection, so the nano-conjugate was incorporated into the ointment by geometric mixing. The viscosity and the spreadability test were performed on the different formulations of the ointment and the suitable one was selected for the topical administration. Anti-fungal study had been performed on the Wistar albino rats for 6 d. Skin culture of rats was performed for the formation of the fungal colonies. Statistical analysis by Anova gives p<0.001. It was found that the normal form of usnic acid, graphene and the nano form both possess anti-fungal activity as 3/6 and 2/6 experimental animals are cured by normal formulation and nano-formulation. Conclusion: The present anti-fungal study revealed that the nano-form of the conjugate possess higher anti-fungal activity than the normal formulation of usnic acid with graphene.

Prenatal diagnosis of anencephaly and acrania in pregnant females – Report series of eight cases

Acrania and anencephaly are characterized by the partial or complete absence of skull and brain tissue. Due to this, the neural tissue is exposed and it leads to non-function of few parts of the hemispheres. A total of eight cases of acrania and anencephaly were included in the report. Five cases were acrania and three cases were anencephaly. Both cases were diagnosed between 15 and 24 weeks of gestation period. In the present report, all the pregnant women carry fetuses with neural tube defects. Out of five acrania cases, there is a partial or complete absence of cranium in all the cases, and in one case, there is a twin intrauterine gestational sac that was noted. However, out of twin sac, the first one is having a good heart rate (155 bpm) and the second fetus is having no cardiac activity, i.e., early fetal demise. On the other hand, out of three anencephaly cases, two anencephaly cases were diagnosed with partial absence of the fetal brain and the complete absence of the cranium, and in one case, there is a partial absence of cerebral parenchymal tissue above the orbit with the absence of cranial vault. By the use of ultrasonography, we can diagnose the anencephaly and acrania at a very early stage without any side effects. The cause of anencephaly and acrania is dependent on the number of factors one of which is a folic acid deficiency. Sentence is reviewed and corrected): It is always better to consume the folic acid supplements that are advised by the physician during the planning of pregnancy to avoid the congenital anomalies of the fetus like anencephaly and acrania. The ultimate focus of the study is to evaluate the morphology of the fetus in case of anencephaly and acrania which could lead to the early detection of abnormalities and also to create awareness among people to take folic acid supplements to eschew such abnormalities.

Morbidity pattern and health-seeking behavior among elderly population in rural area of district Barabanki: A cross-sectional study

Background: Aging is a universal and inevitable process of life. Elderly people are the most vulnerable group in terms of their health. In India geriatric-aged population is increasing day by day. Understanding the morbidities and health-seeking behavior of the elderly is essential for strengthening geriatric health-care services delivery. Objectives: The objectives of the study were (1) to assess the morbidity pattern in elderly people and (2) to know the health-seeking behavior of the aged population. Materials and Methods: This community-based, cross-sectional, and descriptive study was conducted among 160 elderly individuals over a period of 3 months from February 2019 to April 2019. Participants were interviewed and clinically examined for the assessment of sociodemographic detail, morbidity profile, and health-seeking behavior. Results: Of 160 study subjects, 71 were males and 89 were females. The majority (61.3%) of the elderly were in the age group of 60–69 years. Overall the prevalence of morbidity was high, i.e., 76.9%. The most common illness was a nonspecific generalized weakness (48.1%) and gastrointestinal problems (44.4%). Majority of them (65.4%) have faith in allopathic medicines and used government facilities. Of the total morbid elderly, 15.5% of them could not get medical advice. Conclusions: High prevalence of morbidity among elderly population stresses the need to provide suitable health facilities and affordable health care to the elderly. Non-specific generalized weakness was one of the most important problems in this age group. Further research is to be done to know the cause of this weakness. Policymakers must focus on rural elderly and their beliefs which prevent them from seeking healthcare.

Post cataract Pseudomonas stutzeri endophthalmitis: Report of a case and review of literature

We report a rare case of Pseudomonas stutzeri endophthalmitis in an immunocompetent individual along with the review of the literature. A 39-year-old healthy lady presented with sudden painful loss of vision in her right eye. She was diagnosed with postcataract surgery acute endophthalmitis and underwent vitrectomy, intraocular lens explantation and intravitreal antibiotics. P. stutzeri was isolated from vitreous. Though the infection was controlled, the anatomy of the eye could not be salvaged and the right eye became phthisical. P. stutzeri is a rare cause of endophthalmitis with usually poor outcomes.