Plastics has been playing a very significant role in our life. Being light weight, inexpensive and heving good insulating properties it is being used in all aspects of life, from clothes to contact lenses and from mobile phones to automobiles as well as in medical equipments, However it is not biodegradable, and while degrading to fragments it gets converted in to microplastics and nanoplastics The plastic waste is being recognized as an environmental hazard, since these micr- and nanoplastics find way from landfills to water and foods, It is said that we are not only using, but we are eating, drinking and even braething the plastics. These microplastics in body release certain hazardous chemicals and found to be disrupting functions of certain endocrine organs. Whether the rising prevalence of Diabetes, thyroid disorders or infirtility etc., are realated to the plastics?

Population health management is the aggregation of patient data from health information technology resources, analytical output of which is used for improving clinical and financial outcomes. The PHM programs use business intelligence tool to monitor and aggregate data and provide a comprehensive clinical picture of each patient. Using such data, providers can track, and improve, clinical outcomes while lowering the costs. Effective PHM benefits all stakeholders – the patients, physicians, health-care organizations, health-care system, and the nation.

Introduction: Acute Upper Gastrointestinal bleeding (UGIB) is one of the common causes with which the patients present to emergency. The upper gastrointestinal (UGI) endoscopy remains a crucial tool in identification of UGIB. The aim of the present study was to determine the endoscopic profile of UGIB in adult population of rural central India admitted with history of UGIB (hemetemesis and/or malena). Methods: This prospective, cross sectional study was conducted in rural hospital in central India and we enrolled all consecutive patients aged 18 years and above who were admitted in the hospital ward with the history of UGIB. After obtaining the demographic data, all patients underwent clinical examination, laboratory investigations and video-endoscopy. We used Student's t test to compare means, Chi-square test to compare proportions and Mann-Whitney test to compare medians. P value <0.05 will be considered significant. Results: The mean age of our study population (N = 118) was 46.2 years. Among 118 patients who underwent endoscopy, 47.4% had esophageal varices, 27.1% had portal hypertensive gastropathy, 14.4% had gastric erosions, 5.9% each had duodenal ulcers and esophagitis, 5% had gastric ulcer disease, 4.2% each had Mallory-Weiss tear and had gastric malignancy, 1.7% had esophageal malignancy and 16.1% had normal endoscopic findings. Conclusion: Esophageal varices were the most common cause of UGIB in the adult population of rural central India presenting with UGIB, when diagnosed by video-endoscopy.

Introduction: As it is not always possible to do Modified Mallampati Test (MMT) in sitting position, this study was designed to test the effect of supine position and phonation on classical MMT and use of such effect in predicting difficult laryngoscopical view or difficult intubation. Aim: To know the effect of phonation and supine position on classical MMT grade and to establish usefulness of modification in predicting difficult laryngoscopy or intubation. Objectives: 1. To compare classical MMT grades with those obtained in supine position with or without phonation. 2. To correlate MMT gradings obtained in all the three variations with Modified Cormack Lehane (MCML) grading and actual difficult intubations to obtain their powers in predicting difficult laryngoscopic view and difficult intubations. Material and Methods: A prospective observational study, conducted at a tertiary care hospital.Consenting, 130 adults, undergoing elective surgical procedures were included. MMT score in sitting position, in supine position with or without phonation was recorded in the preoperative area and MCML grading and actual difficulty for intubation were noted at the time of intubation. Emergency cases and patients with altered airway were excluded.Statistics: 'Kappa' agreement analysis was done to compare the agreement between various scores. Sensitivity, specificity, positive predictive value and negative predictive values were calculated. Results: Supine posture without phonation worsens the classical Mallampati grading whereas supine posture with phonation improves it. MMT in sitting and in supine position without phonation have very good agreement with each other in predicting difficult laryngoscopy and intubation. Conclusions: When the patient cannot sit for examination, MMT scoring can be done in supine position without phonation. Mallampati score in supine position with phonation is not recommended due to high false negatives.

Introduction: Humans have been using substances in one form or the other for centuries. Adolescents seem to be the most vulnerable group, and the slum dwellers are particularly at risk because of the prevailing environment. Objectives: The objective of this study is to study the prevalence of substance use among adolescents of slums of Guwahati city and to find out various factors influencing substance use among them. Materials and Methods: A cross-sectional study was conducted among the adolescents living in slums of Guwahati, Assam, from February to May 2014. Using cluster sampling method, 23 slums were selected, and desired clusters were obtained by applying probability proportionate to size method. From each slum, equal number of boys and girls were interviewed to get a total of 414 study subjects. Statistical Analysis: Proportions, Chi-square test, and binary logistic regression were used. Results: The prevalence of ever users was 37.68% and 35.02% were current users. Gutkha was the most common substance used. The mean age of initiation of abusive substances was around 12 years for both boys and girls. Age, sex, religion, caste, schooling status, occupation, living status of parents and respondents, peer usage, and relationship with the family members showed significant association with substance use. Binary logistic regression concluded that age group, sex, and peer usage were the most significant factors influencing substance use behavior. Conclusion: As increasing age and peer usage influenced the substance usage, peer group counseling, recreational activities, and skill development programs in the early years hold promising in curbing the problem.

Adolescent being at risk for substance use has become a cause of concern. Hence, there arises a need to highlight the predictors and to address the range of problems caused by substance use. Here is a brief commentary on adolescent substance use.

Background: Teenage pregnancies are pregnancies between the age group of 13 and 19 years. Such pregnancies are categorized as high-risk pregnancies worldwide. This makes monitoring during the antenatal, intrapartum, and puerperal periods highly important. Objectives: The aim of this study is to determine the incidence, the mode of presentation, and the materno-fetal outcome in teenage parturients and compare with a control group. Materials and Methods: this prospective case–control study, recruited 63 teenage parturients who presented in labor ward in active phase labour between February 2013 and January 2015. These teenage parturients were matched with a control group in terms of parity and cervical dilatation of not less than or more than 1 cm (+1 cm), but are of age, 22–30 years. Thus, a total number of 126 parturients were studied. The mothers and their babies were followed up until the first 7^th day postpartum. Results: In this study, 39 (61.90%) and 24 (38.10%) were married and unmarried, respectively, among the teenage parturients, whereas 60 (95.24%) and 3 (4.7%) were married and unmarried among the control group. Majority of the teenage parturients, 57 (90.47%) had only primary and secondary education, while 59 (93.47%) among the controls had secondary and tertiary levels of education. There were statistically significant differences in the incidences of genital lacerations (9 [14.28%] and 2 [3.18%]: P < 0.05), and the incidences of anemia in pregnancy (9 [14.28%] vs. 2 [3.18%]: P < 0.05) in the teenage and the older parturients. The other outcome measures in the two groups were similar. Conclusion: This study showed that teenage pregnancies with good antenatal, intrapartum, and neonatal care, gives almost the same materno-fetal outcomes as the control group. The determining factors for poor maternal and fetal outcomes are poor socioeconomic status and lack or poor quality of antenatal, intrapartum, and puerperal care.

Retroperitoneal paragangliomas are rare neoplasms usually seen as histological surprises and can be confused with more common retroperitoneal neoplasms. The present case is reported to discuss the clinical presentation, radiological features, and histological features of a nonfunctioning retroperitoneal paraganglioma of unusual histology which presented as a diagnostic dilemma which was confirmed by immunohistochemistry.

Wandering spleen is a rare condition resulting from laxity of the suspensory ligaments of the spleen which predisposes it to torsion. We present a 24-year-old female who presented with acute abdominal pain due to torsion of the wandering spleen.

The azygos anterior cerebral artery (ACA) is a rare variation in the circle of Willis. Azygos ACAs often associated with other vascular or nonvascular anomalies. These aneurysms can be noninvasively imaged either by conventional computed tomography (CT) angiography or magnetic resonance angiography, but digital subtraction angiography is the gold standard for diagnosis. We report a case of saccular aneurysm of azygos ACA, diagnosed by multidetector CT cerebral angiography and treated by craniotomy and clipping of aneurysm. The clinical significance of the rare anomaly is highlighted. We report this rare clinical experience with review of the literature.