Envenoming by venomous snake evokes a life-threatening response. Rapid diagnosis of acute hemorrhagic disorders, neurorespiratory, renal, and hemodynamic failure subsequent to snake bite and their rapid interventions saves life. Early administration of the appropriate dose of potent snake antivenom along with adjuvant treatment, proper care of the wound, correcting electrolyte imbalance, tissue oxygenation, and maintenance of adequate nutrition may help rapid recovery.

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Over the last three decades, aluminum phosphide has emerged as an important pesticide agent being sued for self-harm in India is well as other countries. High mortality is due to severe mitochondrial dysfunction leading to disruption of cellular respiration leading to tissue hypoxia and organ dysfunction. In spite of a lot of research, no definitive anbtidote is available, and the treatment remains largely supportive.

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Background: Pseudomonas aeruginosa is emerging as a nosocomial pathogen by producing metallo-β-lactamases (MBLs) and acquiring resistance to many antimicrobial agents. The infections caused by metallo-beta-lactamases producing P. aeruginosa (MBL-PA) are associated with higher rates of mortality, morbidity, and overall healthcare costs. Aim: The aim of the study was to find the incidence of MBL in P. aeruginosa isolates and their antimicrobial resistance pattern. Material and Methods: A total of 180 non-duplicate P. aeruginosa isolates from various clinical specimens between April 2016 and March 2017 were subjected to susceptibility testing by disc diffusion test as per the Clinical and Laboratory Standards Institute guidelines 2015. Imipenem and meropenem resistant isolates were selected for the detection of MBL production by disc potentiation test and modified Hodge test. Results: Out of 180 isolates of P. aeruginosa, MBL was detected in 36 (20.00%) isolates. Resistance was significantly higher in the MBL-PA with 94.44% resistance to aztreonam followed by cefoxitin (91.66%), piperacilline/tazobactam and cefepime (80.55%). The prevalence of multidrug-resistant and possible extensively drug-resistant isolates was significantly higher among the MBL group as compared to that in the non-MBL group [50.00% vs. 11.11% and 5.55% vs. 0.69% (P = <0.05)]. None of the isolates were pan drug resistant. Conclusions: Increasing prevalence of MBL-PA producing isolates in hospital settings makes it important to perform routine detection of MBL strains for the purpose of infection control and for minimizing the adverse outcome of infection.

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Background: The present study was aimed to see the effect of practice on visual information processing speed. Reaction time is one of the important physiological parameters, which gives information how fast and quickly person responses. Reaction is purposeful voluntary response to different stimuli as visual stimuli. Visual reaction time (VRT) is the time required to response to visual stimuli. Materials and Methods: The VRT was measured by the multiple choice apparatus in subjects. Simple reaction time and choice reaction time measured. Reaction time was measured in two sessions. In the first session, VRT was measured without practice of task and in the second session VRT was measured after practice of task. The results were statistically analyzed and were recorded as mean ± standard deviation and Student's paired t-test was applied to check the level of significance. Result and Conclusion: In the present study, we found that VRT was less after practice for both simple and choice VRT tasks. Reaction time decreases by practice. Skills can be improved by practice. In daily life majority of work is done by the use of visual information. By the practice of an important task time required for stimulus identification and response can be decreased. Practice is useful for driving vehicles. It is helpful to students, as they have identification of bones, instruments, graphs and viva questions in examination of various medical subjects. Hence by practice students can identify, understand and answer quickly.

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Poisoning with organophosphorus (OP) compounds is a global public health problem. According to World Health Organization (WHO), 3 million cases of pesticide (mainly OP compounds) poisoning occur every year, resulting in an excess of 250,000 deaths. Of these, about 1 million are accidental, and 2 million are suicidal poisonings. The incidence has steadily increased in the recent past and has reached a level in the developing countries, where it can be called a "social calamity." Diagnosis is mainly on clinical grounds. The wellknown antidotes of OP poisonings are atropine and oximes. However, investigations over the recent years have introduced new adjunct therapy and cheap medications such as sodium bicarbonate and magnesium sulfate as well as antioxidants that should be considered for the management of OP poisoning. While efficacy of atropine is clinically proven, clinical experience with pralidoxime has been controversial. A lot of new modalities of management like K-oximes, hemoperfusion, and Fresh frozen plasma are under evaluation. Prevention still appears to be the best modality of management. Appropriate legislations and pesticides control are recommended for the developing countries to prevent occupational, accidental, and intentional poisonings.

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Introduction: Neonatal septicemia is a major cause of mortality and morbidity. Surviving neonates can have significant neurologic sequelae, septic shock or hypoxemia. The spectrum of bacteria that cause neonatal septicemia varies in different parts of the world. The management of these infections is being complicated by the emergence of antibiotic resistance. The aim of this study was to determine the etiology, clinical characteristics and outcome of neonatal septicemia cases. Materials and Methods: During a 1-year study, 257 clinically suspected cases of neonatal sepsis were enrolled and classified as early onset septicemia (EOS) and late onset septicemia (LOS) based on appearance of signs and symptoms, i.e. within or after 72 h, respectively. Blood culture was performed using BACTEC 9240, isolates were identified by standard techniques and antibiotic susceptibility was performed as per the CLSI guidelines. Risk factors associated with neonatal sepsis were recorded and analyzed with respect to culture-proven sepsis. Results: In both suspected and culture-proven sepsis cases, majority of the neonates were male, pre-term and low birth weight babies. The prevalence of EOS and LOS was 82.4% and 17.5%, respectively. Culture positivity was seen in 7.8% of the cases. In culture-proven septicemia, 55% neonates presented with EOS and 45% presented with LOS. Gram positive isolates were more as compared with Gram negative isolates. The most common isolates were S. aureus, S. epidermidis and E. coli. All Gram positive isolates were sensitive to vancomycin and linezolid, while carbapenems and polymyxin B were the most effective drugs in the Gram negative isolates. Mortality was higher in LOS as compared with EOS cases, and the difference was statistically significant. Conclusion: Gram positive pathogens were predominant in septicemia. Vancomycin and linezolid were the most effective antibiotics for Gram positive isolates and carbapenems for most effective Gram negative organisms.

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Aim: To identify prevalence of skin diseases and to determine the risk factors of skin diseases among the adult population of rural Central India. Materials and Methods: It was a community-based, observational study in which we prospectively recruited general population in and around Wardha beginning October 1, 2011, through March 2012. The main focus was to study population of 10 years and above. Results: Eczema was the most common dermatosis accounting for 22% participants and among them almost 60% sufferers were female. Fungal infection presented in 13.0% of all the affected participants and was found more in male participants (58%) than in female (42%) among those affected with fungal infection. Eczema, benign skin tumors, and pigmentary disorders were more common in participants aged 51 years and above accounting to 52.7%, 9.4%, and 6.3%, respectively. Fungal infection and acne were more in adolescent age group accounting to 17.4% and 30.4%, respectively. Conclusion: Hence, we concluded that of the entire study population prevalence of skin diseases was 60%. Our study brought a higher prevalence of eczema in female and fungal infection in male. Eczema, benign skin tumors, and pigmentary disorders were more common in participants aged 51 years and above, and fungal infection and acne were more in adolescent age group. Adolescents suffered predominantly from fungal infections and acne due to pubertal changes. Various causes such as environment, overcrowding, and poor living conditions are major factors and not only adolescents or old age group but also entire population between 21 and 50 years of age were found to be suffering more commonly from eczema and infective dermatoses.

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Background: Inguinal hernias are one most common problem dealt by general surgeons and have significant morbidity and mortality. In the developed countries, almost all of the inguinal hernias are recognized early and present early in the course of disease to the surgeon. However, in developing countries, quite a considerable percentage of it is not repaired leading to a higher incidence of morbidity and mortality. Hence, we planned this study to understand the clinicoepidemiologic profile of inguinal hernia in rural medical college in central India. Methodology: This is a descriptive epidemiological, prospective study carried out in rural medical college. All patients who presented to the surgical wards and outpatient with a clinical diagnosis of inguinal hernia were included in the study. Results: Among the 61 patients included in the study, most of them were men (91.8%) with a mean age of 45.02 ± 22.87 years, married (77.05%) and farmer (37.7%) by occupation. All the patients of inguinal hernia presented with the complaints of lump above the inguinal crease and three-fourth of these patients had complaints of pain (73.77%) and had predominantly right-sided hernia. More than half of the patients had one of the signs of obstruction at the time of presentation of which crease in pain was the most common (52.46%). Most of the patients presented late to the hospital due to the lack of awareness of the disease. The most common operative procedure done was open hernioplasty (Lichtenstein's procedure) in 61.67% patients followed by herniotomy (18.33%) and herniorrhaphy (modified Bassini's procedure) in 13.33% patients. Conclusion: Late presentation of disease is the hallmark of this disease in rural areas due to the lack of awareness. Increasing awareness of the disease among general population will lead to inguinal hernias being detected at earlier stage and will decrease the morbidity due to this disease.

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Introduction: The resistance to antimicrobial agents among staphylococci is an increasing problem. This has led to renewed interest in the usage of macrolide-lincosamide-streptogramin B (MLSB) antibiotics to treat Staphylococcus aureus infections. Clinical failure has been reported due to multiple mechanisms that confer resistance to MLSB antibiotics. The present study was aimed to detect inducible clindamycin resistance among S. aureus isolates and to study the relationship between clindamycin and methicillin resistance. Materials and Methods: During a period of 1 year, a total of 593 S. aureus isolates from various clinical specimens were included in the study. Antimicrobial susceptibility test was done by Kirby-Bauer's disc diffusion method as per Clinical and Laboratory Standards Institute (CLSI) guidelines. For detection of inducible clindamycin resistance, D test using erythromycin and clindamycin as per CLSI guidelines was performed, and three different phenotypes were interpreted as methicillin-sensitive (MS) phenotype (D test negative), inducible MLSB (iMLSB) phenotype (D test positive), and constitutive MLSB phenotype. Results: Of the total 593 S. aureus isolates, majority were obtained from pus (31.1%) followed by blood and body fluids (27.3%). All the isolates were sensitive to vancomycin, teicoplanin, and linezolid. Out of 306 (51.7%) erythromycin resistant isolates, 280 (91.5%) were methicillin-resistant S. aureus (MRSA) and 26 (8.5%) were methicillin-sensitive S. aureus (MSSA). iMLSB phenotype in 33.3%, MS phenotype in 44.8%, and constitutive MLSB phenotype was observed in 21.9% of isolates. Inducible clindamycin resistance was almost equal among MRSA and MSSA isolates. Conclusion: D test should be included as a mandatory method in routine disc diffusion testing to detect inducible clindamycin resistance in staphylococci for the optimum treatment of patients.

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Background: Nonalcoholic fatty liver disease (NAFLD) is commonly associated with type 2 diabetes mellitus (DM) though its prevalence is not well studied. We conducted a prospective study of prevalence of NAFLD in patients with type 2 DM and its relation with Insulin Resistance. Materials and Methods: 100 patients of Type 2DM attending Tertiary care center in South Gujarat were evaluated. Abdominal ultrasonography was performed to determine the presence of fatty liver. For assessment of Insulin Resistance, Homeostasis Model Assistant - Insulin Resistance (HOMA-IR) and Quantitative Insulin Sensitivity Check Index (QUICKI) were calculated. A probability value of P < 0.05 was considered statistically significant. Results: The study group (n = 100) was divided into a NAFLD group (n = 45) and a non-NAFLD group (n = 55). The prevalence of NAFLD was 45%. The NAFLD subgroup had higher prevalence of obesity (measured by BMI), central obesity (measured by waist circumference and waist hip ratio), higher HbA1c, higher triglyceride levels. HOMA-IR and QUICKI indexes for Insulin Resistance were significantly higher in NAFLD group than Non NAFLD group (P value 0.03, 0.04). Conclusion: The prevalence of NAFLD is high in patients of Type 2 DM. Insulin resistance seems to be correlated with the presence of NAFLD among T2DM patients.

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The 2030 Agenda for Sustainable Development and its Global Strategy for Women's, Children's and Adolescents' Health provides a unique opportunity for accelerated action for the health of adolescents. Investment in adolescent health is also essential to achieve the 17 SDGs and their 169 targets, each of which relates to adolescent development, health or well-being directly or indirectly. India has the largest adolescent population in the World. The health status of an adolescent determines the health status in his/her adulthood. Many serious diseases in adulthood have their roots in adolescence. The main health issues faced by the adolescents include: Mental health problems, early pregnancy and childbirth, (HIV/STI) and other infectious diseases, violence, injuries, malnutrition and substance abuse. To achieve wholesome adolescent health, we need to have a multidimensional approach covering all the adolescent health problems with special emphasis on mental health, behaviour change communication towards healthy lifestyle and positive social environment to acquire life skills.

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While providing health services, (preventive, curative, rehabilitative), health care personnel (HCP) face hazards. Developments in medical science provide some safety, still modern technology has made health care very complex with many hazards. Biological (viruses, bacteria, and parasites) and chemical (disinfectants, drugs, and diagnostics) therapeutic modalities in health delivery are leading to many disorders in HCP. Needle prick injuries, radiation exposure, violence, psychiatric disorders, stalking by patients, and suicides are common. HCP are at high risk for musculoskeletal disorders, due to patient handling, compounded by increasing number of obese patients. With increase in workload because of human immunodeficiency virus, hardships have increased. Despite potential for exposure to hazards, many HCP lack awareness about prevention. Also the system is not conducive, policies of prevention not clear, inaccessibile, or there is attitude problem. Hence, HCP continue to suffer, more in developing countries. Health managers need to ensure that health care is geared toward assessment of hazards suffered by HCP, there reasons, and do everything possible for prevention.

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Appropriate and rational use of blood/components is essential for ensuring availability for the needy as well as preventing risks of transfusion-transmitted diseases and saving resources. Rational use means providing the right blood or products, in the right quantity, to the right patient and at the right time, bridging demand, and supply gap. The safety, adequacy, and effectiveness can only be achieved if unnecessary transfusions can be prevented. Further, risk can be reduced, but cannot be eliminated completely. Alternative to banked blood, autologous blood donation, normovolemic hemodilution, and intraoperative cell salvage should be considered as possible options. Recombinant factor VIIa is a new adjunct for treatment of massive hemorrhage and should be considered, if available.

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In this age of noncommunicable diseases, communicable diseases still contribute 30% of disease burden in India. Hundreds of epidemics occur each year and we fail to respond and contain most of them. Apart from various biological and behavioral public health interventions, we need to closely look at the structural intervention, that is, the legal framework to review health system preparedness. Although India has a number of legal mechanisms to support public health measures in an epidemic situation, they are not being addressed under a single legislation. The Epidemic Act 1897 is a century old blunt act which needs a substantial overhaul to counter the rising burden of infectious diseases both new and old. Issues like definition of epidemic disease, territorial boundaries, ethics and human rights principles, empowerment of officials, punishment, etc., need more deliberations and warrant a relook.

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Lemierre's syndrome is a form of septic thrombophlebitis characterized by internal jugular vein thrombosis and septic emboli caused by Fusobacterium species which follows a spell of pharyngotonsillits. We highlight a case of 16 year old female, a known case of lupus nephritis presenting with Lemierre's syndrome. A brief review of imaging findings on various imaging modalities with an emphasis on classical computed tomographic features of the disease is presented.

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Dyschromatosis universalis hereditaria is an autosomal dominant disorder but may be recessive or sporadically inherited disorder, infrequently occurring genodermatosis with peculiar pigmentary changes, consisting of varying sized, intermingled hyperpigmented and hypopigmented macules that give an overall impression of mottling. Herein, we report this extremely rare case of dyschromatosis universalis hereditaria in a young male with a family history of the same disorder in his younger brother.

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Single isolated jejunal perforation (IJP) due to blunt abdominal trauma is uncommon and most often occurs with road traffic accidents. The diagnosis of traumatic single IJP is challenging as there are minimal clinical features initially. For most favorable results, strict monitoring, a high index of clinical suspicion, and the help of available appropriate diagnostic tools like diagnostic peritoneal lav age (DPL)/focused abdominal sonography for trauma (FAST) are preferable. Here we report a case of IJP following blunt trauma abdomen.

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Antiphospholipid syndrome is being increasingly recognized as a disease with a myriad of clinical manifestations ranging from recurrent thrombosis and pregnancy morbidity to valvular lesions, transverse myelitis, thrombocytopenia and hemolytic anemia. It may be primary or secondary, i.e., associated with other autoimmune diseases. The latest classification criteria (Sydney 2006) recognize just three tests to define this syndrome-lupus anticoagulant, anticardiolipin antobodies and anti β2 glycoprotein 1 antibodies. Treatment of thrombotic events involves lifelong anticoagulation with vitamin K antagonists like warfarin. Antiphospholipid antibody syndrome (APS) with only pregnancy morbidity is treated with thromboprophylaxis using heparin during pregnancy and postpartum for 6 weeks. Catastrophic APS occurs in approximately 1% of APS, and is characterized by microvascular thrombosis (thrombotic storm) and organ dysfunction. In this review we discuss the pathogenesis, diagnosis, treatment and prognosis of the APS.

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Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease characterized by multisystemic involvement. Neuropsychiatric manifestations are found in 50-70% of SLE patients. These manifestations include mild cognitive dysfunction, mood disorders, headache, depression, anxiety, seizures, psychosis, acute confusional states, and delirium, to life-threatening coma. Psychiatric symptoms as an initial presentation of SLE are rare and difficult to diagnose. We present the case of a 23-year-old woman, who developed the catatonic syndrome for the first time during hospitalization for lower respiratory tract infection, and she was eventually diagnosed with SLE. Her catatonia responded well to oral corticosteroids, lorazepam, risperidone, and modafinil. This case illustrates the importance of considering medical causes (SLE) in the diagnosis and treatment of the catatonic syndrome. The recognition of SLE as a cause of catatonia is essential for its optimal management.

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Substance use has been present in India since many millennia, and the type and pattern of substances being abused have seen changes over time. In the review, we look at the traditional recreational substance and then describe the newer and emerging recreational drugs in India.

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Background and Objective: The objective was to evaluate clinical trial data on the use of ketamine in treating treatment-resistant depression (TRD). Materials and Methods: PubMed search (November 2012) was initiated using the keywords: Ketamine, resistant depression. Inclusion criterion included: English language publications describing clinical trial reports on humans with TRD. Results: A total of 360 patients across 15 clinical trials with TRD were treated with infusional ketamine. On average 15-90% of patients reported a >50% decrease in their baseline Montgomery-Åsberg Depression Rating Scale/Hamilton Rating Scale for Depression scores at 4 h. Response rates decreased significantly as time progressed. Conclusion: Infusional ketamine has a significant rapid, short-term antidepressant effect in the treatment of TRD.

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Background: Even after more than 3 decades of implementation, the success of integrated child development services (ICDS) program in tackling maternal and childhood problems still remain a matter of concern. The present study was conducted to assess issues related to Anganwadi worker (AWW) and Anganwadi center (AWC) including infrastructure facilities. Materials and Methods: A total of 60 AWCs were selected including 46 AWCs from a rural area and 14 AWCs from an urban area during April 2012 to March 2013 from 12 districts of Gujarat. Five AWCs were selected from one district. Information on AWWs background characteristics, along with infrastructure and other services delivered at AWCs were observed and recorded. Results: Majority (66.7%) AWCs building were owned by state and 73.3% AWCs having pucca type of building. Almost two-third (65%) AWWs had >10 years of experience. Induction training was given to only 1 AWW (7.1%) in an urban area. Poor findings were reported for regular health checkups (30%), immunization (10.0%), referral slips availability (18.3%), and referral of sick children (8.3%). Significant number of 6 months to 3 years age group and 3 to 6 years in rural areas received services from Anganwadi. Similarly, significant number of pregnant mothers (P < 0.00), lactating mothers (P < 0.00) and adolescent girls (P < 0.00) in rural areas compared to urban areas received Anganwadi services. Nutrition and health education day was observed in 81.7% AWCs. Conclusion: The performance of AWCs and maternal and child health services delivered by AWCs still needs improvement. Coordinated steps catering to different services provided at the centers are needed to optimize the functioning of the ICDS scheme.

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