Frail elderly are those who have less than normal physiological reserve which predisposes them to more severe adverse outcomes following a stressor compared to normal. As the number of elderly is increasing worldwide, there is increase in the problem of frailty. Frailty is a dynamic state in the sense that if interventions are directed to correct the state of frailty, then an elderly starts to shift toward normal side and if not then deteriorated even more. When it comes to managing a frail elderly, then the place of care can be patientfs home as well as health care facility. Comprehensive geriatric assessment and program for all.-inclusive care for the elderly are the concepts that advocate multidisciplinary approach for the management of frail elderly. There is increasing evidence in favor of the management of these patients at their home and delaying the transfer to health care facility till these patients cannot be managed at home. Apart from the specific treatment of the acute illness and the underlying chronic illness, there are other interventions cum life style modification which can help in improving a frail state. These includes increasing content of whey protein, essential amino acids in the diet, combination of resistance and endurance exercises, Vitamin D supplementation, and pharmacotherapy such as testosterone, ghrelin, and growth hormone.

Introduction: AmpC βlactamases are clinically significant since these confer resistance to cephamycins as well as other extended-spectrum cephalosporins and are not affected by βlactamase inhibitors. Objectives: This prospective study was planned to detect AmpC producers among Gram-negative clinical isolates and to compare drug resistance in AmpC and non-AmpC producers. Materials and Methods: In this 1-year prospective study, all Gram.negative isolates were identified by colony characteristics, Gram.staining, biochemical reactions as per standard procedures. Antimicrobial susceptibility was done by as per Clinical and Laboratory standards Institute guidelines. The AmpC was detected by AmpC disc test. Results: Of 2100 samples received, 581 samples showed growth of Gram-negative isolates. Monomicrobial growth was seen in 79.8% and polymicrobial in 20.1%. There were 711 Gram-negative isolates. Of which Acinetobacter baumannii (32.5%), Klebsiella pneumoniae (29.2%), and Pseudomonas aeruginosa (22.3%) were common. Antimicrobial susceptibility pattern showed increased sensitivity toward carbapenems, polymixin B, and tigecycline. AmpC- β-lactamase production was seen in 13.3% isolates and AmpC producers showed high resistance to various antimicrobial agents as compared to non-AmpC producers. Conclusion: Majority of Gram-negative isolates were multidrug resistant and AmpC production was seen in 13.3% isolates. A. baumannii and K.pneumoniae showed maximal AmpC production. AmpC testing is therefore recommended as a mandatory test in a hospital set up.

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.

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.

Introduction: Tectona grandis Linn. (T.G) is one of the well-known Indian herbs. In Ayurveda, T.G stem extract has tocolytic effect. Our previous study conformed the tocolytic activity of the T.G stem extract on rat uterine contraction. Conventional tocolytic drugs are known to have cardiovascular, skeletal muscle toxicity. This study is undertaken to observe possible adverse effects of T.G stem extract especially on cardiovascular and musculoskeletal system. Materials and Methods: Wistar rats (Rattus norvegicus) and frogs (Rana tigrina) were used for this study. Animals were divided into six groups. Each group contains six animals. To study the effect on the blood vessels and skeletal muscles, frogs were used and for direct cardiac effects, Wistar rats were used. The results were compared with standard drugs such as sodium nitrate (2%), nifedipine, and magnesium sulfate. Results: After analysis by t-test, it was observed that T.G causes vasodilatation same as that of the sodium nitrate, without causing any cardiac toxicity seen with nifedipine and no neuromuscular blockade as seen with magnesium sulfate. Conclusion: T.G causes uterine tocolytic effect without causing any cardiac toxicity or neuromuscular blockage; however, further human studies are desirable.

Parasitic twin is a rare malformation, which involves two fetuses attached to each other, whereby one of the pair is viable and develops into a mature embryo (the host twin) called the autosite, while the second twin (parasite) is usually nonviable, but survives on the host twin; the site and extend of their attachment are varied and may be associated with other congenital malformations. Its exact cause is not completely understood. Though, it has been reported in many countries, there is dearth of information on its occurrence in Nigeria. Therefore, we report two cases of parasitic twins seen in our institution. The first case had an extra-limb, scrotal mass projecting from the anterior abdominal wall, which also had an anterior abdominal wall defect below the extra-limb, while the second case had a sacroccoygeal mass which was a duplicate gluteal mass with malformed lower limb, digit with a toe nail projecting from it and an atrophic scrotal skin attached. Both cases had chest, spinal X-rays and abdominal ultrasounds, which excluded any other malformation. They had successful surgical excision of parasites and are being followed-up in the surgical clinic both having appropriate developmental milestones.

Various normal anatomical variations of azygous and hemiazygous venous system have been described. We report computed tomography features of incidentally detected anatomical variation of the hemiazygous venous system in a patient with interstitial lung disease. The knowledge of normal anatomical variations of the hemiazygous and accessory hemiazygous venous system is important for both to the reporting radiologist as well as the operating surgeon.

Metronidazole is a nitroimidazole derivative antibiotic, commonly used against protozoa and anaerobic bacteria, considered relatively safe at usual doses. Metronidazole induced encephalopathy (MIE) is a rare adverse effect at high doses, the incidence of which is unknown. Magnetic resonance imaging (MRI) is a useful modality in detecting these lesions very well. The lesions in MIE are always symmetrical and are reversible after 4–6 weeks of discontinuation of metronidazole. In this article, we describe MRI in a patient of MIE, which was found to be reversible upon discontinuation of the drug.

Lateral medullary syndrome or Wallenberg syndrome is an interesting clinical entity with varied presentations. Its clinical features include ipsilateral Hornerfs syndrome, ataxia, pain, numbness, decreased sensation over face, palate, pharynx, vocal cord palsy, dysphagia, dysarthria and contralateral decreased sensation of pain and temperature over trunk and extremities. However, variability in the presentation of this syndrome is the rule, as illustrated in this case presentation and literature review. Facial nerve involvement can occur in variant of lateral medullary syndrome with pontomedullary sulcus infarct. Its involvement in pure lateral medullary infarct is very unusual. We hereby report a case of a 55-year-old male with classical features of lateral medullary syndrome with ipsilateral central facial palsy. Magnetic resonance imaging brain showed dorsolateral medullary infarct. The facial nerve involvement can be explained by possible damage to ascending the hypothetical looping pathway of supranuclear cortico.facial fibers, which is dispersed in dorsolateral medulla.

A 5-year-old girl child presented with features of pseudoprecocious puberty in the form of bleeding per vaginum and bilateral breast enlargement since 10 days. The radiological imaging showed a right ovarian cyst and the biochemistry revealed elevated estradiol. With a provisional diagnosis of functioning ovarian lesion, a right-sided ovarian cystectomy and ovariotomy was performed, which showed features of cystic juvenile granulosa cell tumor.

Although ovarian ectopic pregnancy is rare, nevertheless, it is an important source of morbidity for women of childbearing age. Its incidence is on rise following the use of ovulation-inducing agents as well as after the increased usage of assisted reproductive technology. We report a case of a natural non-assisted right ovarian ectopic pregnancy detected primarily on transvaginal ultrasound in a lady who came with pain in the right lower abdomen and was subsequently confirmed at surgery and proven on histopathology. Judicious use of ultrasound in an appropriate clinical setting can thus prevent mishaps and enable better management of such conditions.

Malignant peripheral nerve sheath tumor (MPNST) is a malignant soft tissue tumor arising from peripheral nerve sheath cells. MPNST is uncommon and can be associated with neurofibromatosis Type I (NF-I). MPNST involving bone is very rare, and we report the case of MPNST involving the distal femur in a patient without NF-I. A 17-year-old boy presented with a history of left knee joint pain and X-ray showed lytic lesion in the distal part of left femur. He was referred for fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) to find out the extent of disease. PET/CT showed intense FDG uptake in the lobulated well-defined lesion in the medial part of left distal femur. He underwent biopsy from the lesion which confirmed MPNST.

Solid pseudopapillary neoplasms (SPNs) accounts for only 1–2% of pancreatic neoplasm. It occurs predominantly in young females. These are slow growing tumor having low-grade malignant potential with good long-term survival rate after complete resection. Due to its rarity, there are no large published series in a single institution and multicenter studies being necessary for its deeper understanding. We report one such rare case of SPN. A 19 year old female presenting with vague abdominal pain and no other significant Symptoms and after all investigations was found to have mass in the head of pancreas. Pancreaticoduodenectomy with complete resection of tumor mass was done. Histopathological features were suggestive of SPN with tumor-free margins. There were no signs of local or distant metastasis and is under 2 monthly follow-up for last 8 months