The current coronavirus disease-19 (COVID-19) pandemic has triggered intense suffering by causing physical illness, social distancing, stress, anxiety, financial concerns, social variability, and death. The imbalance between the increasing number of cases and the availability of infrastructure, trained personnel, oxygen, and drugs, are further adding to the crisis. The response to the pandemic requires mitigation of suffering in forms. One of the needs of the hour is providing effective and safe palliative care and end-of-life care to mitigate suffering. A vast majority of COVID patients are dying with an unmet need of palliation therapy. Palliative care is an approach that improves the quality of life of patients through the relief of suffering, so this is one of the fundamentals of COVID-19 treatment beyond the use of ventilators. The purpose of this article is to review the recent guidelines of palliative care in COVID-19 patients, to help healthcare workers know how to apply the principles of palliative care in the pandemic scenario, to foster good end-of-life care. India is currently fighting to ebb the second wave of the pandemic, and this article will provide inputs for the government to make triage decisions and policies in view of the paucity of resources. Various aspects of palliation in COVID-19, including recent guidelines, planning, triage, management, communication skills, and necessary decision-making for the health care worker and end-of-life care in the Indian scenario are highlighted in this review.

Background: Cesarean sections are usually done under spinal anesthesia (SA) using local anesthetics. This study is aimed to compare the efficacy of intrathecal isobaric 1% 2-chloroprocaine (CP) and hyperbaric 0.5% bupivacaine in parturients undergoing lower segment cesarean section (LSCS). Materials and Methods: One hundred parturients aged 18–35 years with the American Society of Anesthesiologists physical status I or II undergoing LSCS were randomly allocated into two groups. Group A (n = 50) received intrathecal isobaric 1% 2-CP 5 ml (50 mg), while Group B (n = 50) received intrathecal hyperbaric 0.5% bupivacaine 2 ml (10 mg) in SA. Onset and duration of both sensory and motor block, highest dermatomal level achieved, time to achieve highest dermatomal level, two-segment regression, duration of analgesia, hemodynamic changes, and side effects were noted. Results: The onset of sensory blockade was significantly faster in Group A (1.66 ± 0.49 min) compared to Group B (3.00 ± 0.58 min) (P < 0.05). Duration of sensory block was significantly shorter in Group A (P < 0.05). The time of two-segment regression was also significantly faster in Group A (41.44 ± 5.41 min) compared to Group B (70.24 ± 10.38 min) (P < 0.05). The onset time of the motor block was significantly faster in Group A (P < 0.05). Duration of motor blockade was significantly shorter in Group A (95.7 ± 9.8 min) as compared to Group B (186.26 ± 13.5 min) (P < 0.05). Duration of analgesia was significantly shorter in Group A (97.22 ± 11.82 min) when compared to Group B (191.58 ± 37.06 min) (P < 0.05). No significant hemodynamic changes and side effects were noted (P > 0.05). Conclusion: Intrathecal 1% 2-CP (50 mg) appears to be a safe and effective alternative, preferably in elective and uncomplicated LSCS, as it has faster onset and predictable sensory block height with shorter but adequate duration of motor block and analgesia.

Background: Scrub typhus is becoming an increasing cause of meningitis/meningoencephalitis in endemic areas. Materials and Methods: We conducted a retrospective chart review to describe epidemiological features, clinical characteristics, laboratory profile, and therapeutic outcomes in scrub typhus, considering meningitis/meningoencephalitis as cases and patients without meningoencephalitis as controls. Results: A total of 97 scrub typhus positive cases confirmed by immunoglobulin M enzyme-linked immunosorbent assay and/or polymerase chain reaction were included in the study. By univariant analysis, risk factors such as exposure to a forest, adolescent age and associated oliguria were significantly higher among cases as compared to the control group. Signs and symptoms that were significantly higher among meningitis/meningoencephalitis cases were conjuctival suffusion, pharyngitis, maculopapular rash, pain in the abdomen, splenomegaly, and altered sensorium. Cerebrospinal fluid (CSF) pictures closely resembled aseptic meningitis. All patients had received doxycycline or azithromycin, and the outcome was favorable in the case group. Conclusion: Scrub typhus meningitis/meningoencephalitis was significantly higher in adolescents. Close observation and great care is essential for adolescent patients with associated risk factors. Prompt treatment ensures survival.

Introduction: Core stability relies on the effectiveness of abdominal muscle function in their stabilizing role. A wide variety of tests are available to quantify the strength of trunk muscles. Aim: The objective of this study was to determine the relationship between double-leg-lowering (DLL) test and core strength test in normal healthy individuals. Materials and Methods: This study was conducted on 843 volunteers between the ages of 18 and 60 years. Assessment of core strength was done using a pressure biofeedback unit. The actual task, i.e., abdominal draw-in the test was performed with the subject lying in a prone position. Then, pressure reduction which was held up to at least 10 s was noted. The DLL test was performed with the subject lying in supine position with hands folded across the body on a plinth. The therapist passively raised both the lower limbs simultaneously to 90° hip flexion with the knees kept straight. Subjects then performed a posterior pelvic tilt and maintained this position while slowly lowering the legs to horizontal. The angle at which the back arched was noted. Grading was done in a similar manner for three times with a rest-period of 1 min in between the repeats. The best of the three repetitions was used for the analysis. Results: Spearman's correlation coefficient (ρ) between core strength test and DLL test was found to be 0.24. The median for DLL test was 4 and pressure reduction on the pressure biofeedback unit was 9 mmHg. Conclusions: We found that there is weak positive correlation between the core strength test and DLL test.

Introduction: Arsenic contamination in soil and its environmental effects have been studied for its global impact around the globe. Materials and Methods: This study evaluated the role of five plant species collected from arsenic-contaminated sites in in vitro phytoremediation of arsenic and its correlation with rhizobacteria under hydroponic conditions using high-performance liquid chromatography -ICP. Results: Mimosa pudica showed the ability to uptake arsenic with/ without Rhizobium. Conclusion: It is concluded that rhizosphere microbiota helps plants to increase arsenic uptake and may be utilized as an efficient biological alternative in phytoremediation.

Background: Sickle cell disease is a heritable disorder having an autosomal recessive inheritance. The disease arises as a consequence of a single base mutation in the sixth codon of the β-globin gene, which leads to an interchange of valine for glutamic acid. Aim: The aim of this study is to provide an insight to physicians about sickle cell disease being a cause of sudden demise, so that future unexpected deaths due to complications can be avoided. Materials and Methods: This study is a retrospective study conducted over a period of ten years from January 2010 to December 2019. The data was collected from the hospital information system of our institute. A total of 18 cases were collected over a period of ten years. The respective case related findings along with past history were reviewed. Results: Out of 18 cases, 11 cases were males and 7 were females. The youngest person was a nine-year old male and oldest was a 65-year-old male. Four cases were known patients of sickle cell disease, while in the remaining cases no history of sickle cell disease was available. Conclusions: Sickle cell crisis is an important reason of sudden unexplained deaths and this study highlights the role of autopsy in such cases.

Background: Periodontal disease is one among the most common oral health problems which are prevalent among the adult population throughout the world. There is a notable lack of awareness related to oral hygiene-related practice among transgenders, a vulnerable group of population who face social stigma. Materials and Methods: 156 participants comprising 52 each of transgenders (Group T), males (Group M,) and females (Group F) were recruited. The oral health-related knowledge, attitude, and practices were estimated by means of a prevalidated questionnaire. The periodontal status, in terms of modified gingival index (MGI) and modified Community Periodontal Index (M-CPI), probing pocket depth (PPD), and clinical attachment loss (CAL), was estimated pre- and post-video counseling. Wilcoxon signed-rank test and Kruskal–Wallis test were used to compare scores. Results: The MGI scores were comparatively higher among Group T when compared to groups M and F before (1.72 ± 0.8) and after (0.93 ± 0.9) the video intervention (P < 0.005). The bleeding component of M-CPI, was highest in group F (23.35), followed by group T (21.8) and group M (19.71). The CAL comparisons were in the order of M > T > F while PPD followed F > T > M. Conclusion: The periodontal disease was marginally high among females, while the oral hygiene-related knowledge, attitude, and practices were observed to be poor among them. Video-based education improved the periodontal status, oral hygiene related knowledge, attitude, and practices of all male, female, and transgender populations.

Background: The first month of life is the most important and hazardous as neonates are prone to a number of infections and obstacles. This hospital-based prospective study was conducted for two years from June 1, 2017, to May 31, 2019, in the neonatal intensive care unit (NICU) of District Hospital, Kargil-Ladakh. Aims and Objective: The aim of this study is to analyze the causes of morbidity and mortality among neonates in the tribal population of Ladakh region. The final diagnosis of the patients was made mainly on clinical grounds by pediatricians with the help of available necessary laboratory investigations. Results: During the period of 2 years, a total of 686 neonates were admitted to the NICU of district hospital Kargil. Out of the 686 neonates, 57.1% were male and 42.8% female with a ratio of 1.34:1. Of the admitted neonates, 68.8% were inborn and 31.1% were outborn babies. Of them, 628 (91.5%) neonates were discharged, two left against medical advice, four were referred to a specialty hospital in Kashmir valley, and 52 (7.5%) died. Of the 52 expired neonates, 27 (51.9%) were male and 25 (48%) were female. Thirty-seven were inborn and delivered at a district hospital, while 15 were born outside the district hospital. The major causes of morbidity among neonates in NICU were preterm with low birth weight (36.5%), neonatal sepsis (19.2%), meconium aspiration syndrome (19.2%), birth asphyxia (13.4%), and intrauterine growth restriction (5.7%). Conclusion: We found prematurity, neonatal sepsis, meconium aspiration syndrome, and asphyxia to be the common causes of mortality in neonates. Most of these problems can be prevented by improving the quality of the concerned health units, improved maternal care, timely intervention, and timely referral to tertiary care hospitals in high-risk situations.

Introduction: Rise in the introduction of newer drugs in the market has increased the need to monitor the adverse drug reactions (ADRs) to ensure patient safety. To overcome this need, a nation-wide Pharmacovigilance Programme was initiated by the Government of India with an objective to assure drug safety. Even after a decade of its initiation, the program is in the stage of infancy. Aims and Objectives: To document knowledge, attitude, and practice (KAP) regarding pharmacovigilance among Primary Health Center/Community Health Centers (PHC/CHC) and private doctors. To document the opinion of PHC/CHC and private doctors with regard to reporting of ADRs. Materials and Methods: Doctors working in private setup, PHC and CHC in rural district and doctors willing to give written informed consent were included. A cross-sectional study design was used. KAP questionnaire was designed to assess the demographic details of doctors, their knowledge of pharmacovigilance, attitudes toward pharmacovigilance and practice on ADR reporting. Data entry and analysis was done using SPSS software. Results: 109 doctors of PHC/CHC and private set-up responded in the study. Out of 109 doctors, 52 were private practitioners. The mean age of participants was 43.09 ± 14.15 years. 56 (51.4%) of PHC/CHC and private set-up doctors were aware regarding the existence of a National Pharmacovigilance Programme in India. 107 (98.2%) doctors of PHC/CHC and private set up have the opinion that there is the necessity of reporting ADRs. Conclusion: This study will definitely act as a sensitizer toward ADR reporting among rural and private doctors. It is the need of the hour that doctors must spare time out of their busy schedule to report ADRs. Strong policy formation should be done to motivate them for reporting ADRs.

Significant interest in the application of chloroquine (CQ) and hydroxychloroquine (HCQ) for prophylaxis and treatment of COVID-19 has been recently reported throughout the world. In the light of this, it has become important to revisit the mechanisms of action, as well as clinical evidence for the efficacy of CQ and HCQ in similar viral infections. We note that while some evidence exists for therapeutic efficacy of CQ and HCQ in mitigating morbidities associated with virus-induced inflammation and immunohyperactivity, abundant caution is necessary for expecting prophylactic efficacy in the light of therapeutic evidence. In particular, we intend to draw urgent attention to the fact that the same immunosuppresive and immunomodulatory properties of CQ and HCQ which render them useful as therapeutic agents in viral pneumonia and cytokine storm syndrome are also expected to make them dangerous prophylactic agents against viral infections. We also intend to draw attention to some other potential concerns associated with widespread prophylactic usage of CQ and HCQ.

We report a case of Waardenburg Syndrome (WS) who underwent simultaneous bilateral cochlear implantation and the evolution of auditory performance over a 5 year follow-up. Examination revealed a white forelock with iris heterochromia and confluent eyebrows (synophoris). Audiometric evaluation revealed bilateral profound sensorineural hearing loss. High resolution tomography of temporal bone showed normal inner ear anatomy and subsequently child underwent bilateral cochlear implantation which was followed by regular postoperative rehabilitation and speech therapy.

Incidence of total hip arthroplasties being performed is on a rise across the world, consequently we would see more and more revisions hip arthroplasties being done for various indications such as infection, loosening, wear, metallosis, trauma; alone or a combination of the above factors. This case report highlights one of the rare but interesting scenarios that a revision hip surgeon must be prepared to encounter while planning to perform a technically challenging revision hip arthroplasty surgery. This report also thus emphasizes the importance of extensive pre-operative planning in terms of technique and timing of the procedure, the skills set and the armamentarium of tools that may be needed for a demanding revision arthroplasty procedure.

Griscelli syndrome (GS) is a fatal autosomal recessive condition characterized by genetic mutation in the intracellular melanosome transport system leading to congenital partial albinism with neurological and/or immunological involvement. It is classified into three subtypes. We present here a case of a 13-year-old girl along with her two siblings (7-year-old male and 9-year-old female) who presented with complaints of gradual onset of pigmentation of the skin with silvery grey hair, eyebrows, and eyelashes since birth. All three cases were diagnosed as GS Type 3 on the basis of clinical presentation, family history, absence of any systemic abnormality, and characteristic microscopic findings of the hair shaft and skin biopsy. To the best of our knowledge, this is the first-ever report of three non-identical siblings of GS Type 3, which is a rare syndrome. GS type 3 needs no active intervention except for regular follow-up.

Vitamin D usage is becoming more and more common in the world with newer roles ascribed to it. The side effects of inadvertent overdose have been documented. Here, we present a case of Vitamin D toxicity who presented uniquely with quadriparesis.

Dengue fever is caused by dengue virus of Flavivirus family transmitted by Aedes aegypti. It causes acute febrile illness with various constitutional symptoms with bleeding manifestations and shock in some instances. Neurological involvement has been frequently reported reported. However, cerebellar involvement is very rare. Here we report a case of 32-year-old male patient presented with fever of 8 days, giddiness, unsteadiness of gait with swaying to the right, slurring of speech and incoordination. Diagnosis of acute cerebellitis was made, and involvement of the cerebellum in this patient was attributed to dengue fever. Patient treated for dengue fever, cerebellar symptoms were gradually improved in the course of hospital stay. He got discharged and on follow-up there was complete resolution of cerebellitis.

Echinococcosis is an infection caused in humans by larval stage of Echinococcus, especially Echinococcus granulosus and is endemic in the Middle East and Central Asia. Humans who act as intermediate host get infected incidentally by ingestion of eggs from the fecal matter. The eggs hatch inside the intestine, penetrate the walls enter portal circulation and lymphatic system eventually reaching the liver and lungs commonly. They can lodge in almost any part of body including brain, heart, and bones. There are two types of Echinococcus infections, Echinococcus granulosis and Echinococcus multilocularis. In this article, we are going to report atypical locations of hydatid disease with reference to review of literature.