Burn injury continues to be a significant cause of morbidity and mortality. Nutritional support has become an essential element of burn care. Failure to meet the increased substrate requirements may result in impaired wound healing, multi organ dysfunction, increased susceptibility to infection, and death. Therefore, aggressive nutrition support is essential to ensure adequate burn care, attenuate the hypermetabolic response, optimize wound healing, minimize devastating catabolism, and reduce morbidity and mortality. Failure to adequately address the increased levels of inflammatory mediators, catecholamines, and corticosteroids central to the hypermetabolic response postburn injury can lead to catastrophic results. One of the most important perturbations is provision of adequate and early nutrition. The provision of the right balance of macro and micronutrients, along with additional antioxidants is essential to mitigate the hypermetabolic and hypercatabolic state that results following a burn injury.

Benign hypermobility joint syndrome or benign joint hypermobility syndrome (BJHS) is a common yet poorly recognized disorder of joint in children and adults. It is a connective tissue disorder which affects musculoskeletal system in the absence of general rheumatologic features. Benign hypermobility is stated as laxity of joints that may be associated with pain, discomfort after exercise, and even recurrent subluxations. People with this condition generally report prolonged pain and poor exercise tolerability. The term "benign" has been used to separate BJHS from other hereditary connective tissue disorders that besides having a common denominator of joint hypermobility also involve other organs such as the eyes, bones, heart, and blood vessels. Management includes early recognition keeping a high degree of suspicion using Brighton's criteria. Treatment includes patient education, modification of activity and physiotherapy along with anti-inflammatory agents in case of severe joint infliction.

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.

Objective: To assess the correlation of serum C-peptide level to carotid intima media thickness (a surrogate marker of atherosclerosis) and risk of developing cardiovascular disease (CVD) in type 2 diabetes patients as determined by United Kingdom Prospective Diabetes Study (UKPDS) risk engine. Materials and Methods: About 101 cases of diabetes mellitus (DM) type 2 (diagnosed according to American Diabetes Association 2007 criteria) were subjected to detail clinical examination and laboratory investigations. The intima media thickness of both carotid arteries (CIMT) was measured for each patient with color Doppler. The risk of CVD was calculated using UKPDS risk engine. Observations: Age of subjects, glycated hemoglobin (HbA1c), body mass index (BMI), levels of systolic blood pressure (SBP), total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), low-DL (LDL), homocysteine, CIMT, and the 10 years CVD risk according to the UKPDS were significantly different across the C-peptide quartiles (P for trend <0.05). Significant positive correlations of C-peptide levels were found with age of subjects, duration of DM, BMI, fasting plasma glucose, HbA1c, SBP, TC, TG, LDL, and homocysteine. Significant negative correlation of C-peptide levels was observed with HDL. C-peptide levels had significant positive correlation with CIMT (atherosclerosis) and 10 years CVD risk (future CVD) by UKPDS risk engine. Conclusions: Serum C-peptide level seems to be significantly related to the development of atherosclerosis and future CVD in type 2 DM. It may be used as a predictor of subclinical atherosclerosis and CVD in these patients.

Introduction: Adolescence marks the onset of female puberty. The first menstruation is often horrifying and traumatic to an adolescent girl because it usually occurs without her knowing about it. Implications of a girl's response to menarche have a socio-cultural and religious significance. Aim and Objective: To study the sociocultural and physiological implications of menstruation in college going girls. Materials and Methods: This was a community-based cross-sectional observational study undertaken among college girls. All the girls (n = 252) of the college were enrolled in the study. A structured questionnaire was used as the study tool. The questionnaire included topics related to sociodemographic information, sociocultural implications and first informant about the physiological process of menstruation along with its timing. Results: Majority of the study subjects (77.40%) observed restrictions for religious/holy things. Sleep disturbances were the most common (59%) disturbance faced by the study subjects. Of a total of 252 respondents, majority [104 (41.30%)] had leg cramps. The first informant of menstruation was the mother in 196 (77.78%) girls. Of 252 girls, 86 (34.12%) had pre-menarcheal knowledge of menstruation. Mothers from the urban area and with better education tend to give knowledge of menstruation prior to menarche of her daughter. An increasing trend was observed with increasing educational status of the mother and proportion of them giving pre-menarcheal knowledge of menstruation to their daughter. Conclusions: Menstruation is associated with a high burden of sociocultural implications. Pre-menarcheal knowledge of menstruation is poor. Mothers from the urban area and with better educational level tend to give knowledge of menstruation prior to menarche of their daughter.

Background and Objectives: Early diagnosis of pulmonary tuberculosis (PTB) is one of the primary challenges in curtailing its spread. Nucleic acid amplification methods targeting Mycobacterium tuberculosis (MTB) sequences in clinical specimens are increasingly in use as a tool for early tuberculosis (TB) diagnosis. Insertion sequence 6110, specific for MTB complex was targeted in sputum of new pulmonary TB patients in the present study, to determine its suitability for rapid diagnosis. Materials and Methods: A total of 100 new symptomatic for PTB attending a teaching hospital between January 2008 and December 2010 were enrolled in this study. Satisfactory sputum sample from all symptomatic was processed for microscopy by Ziehl-Neelsen (ZN) method, culture on Lowenstein-Jensen medium and polymerase chain reaction (PCR) for the IS6110 element. Results: Concordance among three methods was 87% and discordance in 13%. Positivity by ZN, culture, and PCR was 29%, 35%, and 35%, respectively. PCR picked up additional five cases, which were negative by both smear and culture. Excluding samples which grew MTB isolates lacking IS6110 the sensitivity of target IS6110 was found to be 100% with respect to ZN microscopy and culture. Interpretation and Conclusions: PCR targeting IS6110 in sputum was found to be very sensitive and specific in the rapid diagnosis of new PTB cases.

Background: Despite the fact that digital rectal examination (DRE) is an integral part of medical teaching curriculum, there is lack of standardized grading system for benign prostatic hyperplasia (BPH) that can be followed uniformly. Aims: To evaluate the validity of digital rectal grading for the assessment of prostate volume, in view to improve its reproducibility. Materials and Methods: This study was carried out in 150 eligible patients of BPH. Based on DRE the prostate enlargement was stratified into four grades. The degree of agreement between the expected prostate volume and measured prostate volume against each digital rectal grade were analyzed using Scatter plots. Data were analyzed using the Statistical Package for the Social Sciences. Results: The digital rectal Grades I-IV correlates well with transrectal ultrasound measurement and roughly corresponds to a volume of 27.78 ± 2.55 ml, 40.54 ± 7.69 ml, 61.08 ± 11.90 ml and 98.42 ± 23.44 ml, respectively. The expected prostate volume in digital rectal Grade II (30-50 ml) showed an underestimation and overestimation by 4.76% and 7.94%, respectively. Similarly, Grade III (expected 50-85 ml) and IV (expected >85 ml) showed overestimation by 22.50% and 23.08% respectively. The Cronbach's coefficient showed good internal consistency (α = 0. 851). Conclusions: Our attempt for standardization of the digital rectal grading satisfactorily validated in the clinical setting. It is feasibly sufficient to provide a rough estimation of the prostate volume and to classify patients with BPH.

Advanced abdominal pregnancy (AAP) is a rare event associated with high maternal and perinatal morbidity and mortality. It is commonly seen among patients in the low socioeconomic class, those with previous history of infertility, and women with pelvic infection that seems to be more in the developing countries like Nigeria. It could, however, pose a diagnostic challenge, especially in resource-limited settings where there is lack or restriction of healthcare professionals and medical diagnostic facilities; hence diagnosis is often clinical that is fraught with errors. This may result in misdiagnosis as was observed in our case. Abdominal pregnancy is often associated with congenital deformation anomalies such as talipes and spinal dysraphism. However, the case of a live newborn delivered at term with combination of talipes and hydrocephalus, which are deformation and malformation anomalies respectively is reported.

Chest wall and cheek swelling are rare sites of involvement by lymphoma. We hereby present two such cases with atypical presentations. Case 1: A 48-year-old male patient presented with a painful swelling over right cheek, which was clinically and radiologically suspected to be cellulitis and thus, incised and drained. Later patient presented to our hospital and fine-needle aspiration (FNA) was performed, which revealed cytological features consistent with non-Hodgkin's lymphoma. Case 2: A 30-year-old female patient presented with right anterior chest wall swelling, which was clinically diagnosed as cold abscess. However, FNA revealed cytological features consistent with Hodgkin's lymphoma. Both cases being reported were thought to be of infective etiology, which were however, diagnosed as lymphoma on FNA and thus led to a different management plan.

Dermatomyositis is an idiopathic inflammatory myopathy involving proximal muscle weakness and non-suppurative skeletal muscle inflammation. Classification of dermatomyositis for a definitive diagnosis requires characteristic rash and other criteria, such as proximal muscle weakness and muscle enzyme level elevation. Muscle biopsy is central in establishing the diagnosis. In this article, we report a case of dermatomyositis without coexisting cancer, which is rare.

Differentiating Stickler syndrome from Marshall syndrome poses a diagnostic challenge. The case of an African child who had physical characteristics of both syndromes and a ventricular septal defect is reported. There is a need therefore to harmonize the clinical features of both syndromes in view to establishing a common diagnostic criteria; more so both syndromes could be variants of same congenital malformation.

Intraosseous lipoma of calcaneus is a rare occurrence. It is a benign tumor and frequently associated with pain in heel. Diagnosis can be done by a biopsy of the lesion. This tumor can be treated with curettage and filling cavity with hydroxyapatite granules. We present a case of intraosseous lipoma treated with curettage and hydroxyapatite granules.

Gestational or pregnancy-associated breast cancer is defined as breast cancer that is diagnosed during pregnancy, in the first postpartum year, or any time during lactation. We report rare imaging findings of a breast cancer seen on fluorodeoxyglucose-positron emission tomography/computed tomography (FDG PET/CT) study in a 32-year-old lactating woman. The FDG PET/CT study demonstrated uptake in the soft tissue lesion noted in the right breast corresponding to primary lesion and multiple nodes in bilateral axilla, right supraclavicular and mediastinum. In addition, there was FDG tracer uptake in both the breast parenchyma-related to breast feeding. This case illustrates the first case of breast cancer in a lactating woman detected by FDG PET/CT.

Calcific tendonitis of gluteus maximus tendon is unusual and only few cases have been reported. A case of calcific tendonitis of gluteus maximus is presented here. A 46 year old female patient with a history of local pain over trochanteric area and radiating along the sciatic nerve. The x-ray showed amorphous calcification around the posterolateral aspect of the proximal femoral shaft, in the vicinity of the linea aspara. Magnetic resonance imaging confirmed the location of calcification over posterolateral aspect of the proximal femoral shaft, in the vicinity of the linea aspera with minimal fluid collection deep to tensor fascia lata and in intermuscular plane between gluteus maximus and medius, which is highly suggestive of calcific tendonitis at this unusual location. Ossifying enthesis with well defined cortical defect are frequent at the femoral insertion of the gluteus maximus muscle in asymptomatic subjects which must be differentiated from real cortical lesion sometimes associated with these calcific tendonitis.

Carotico-cavernous fistula is a dural arteriovenous fistula arising from abnormal arteriovenous shunting between the internal carotid artery and the cavernous sinus. Imaging features in a rare case presenting with intractable glaucoma due to bilateral carotico-cavernous fistula following head injury are reported in this article.

Split-hand/split-foot malformation (SHFM), a congenital limb malformation, occurs due to the absence of the central rays of autopod that results in a deep median cleft of the hand and/or foot. It is also known as ectrodactyly or lobster claw hand. Although SHFM is mostly autosomal dominant, there are isolated case reports which indicate that it can be autosomal recessive. We are reporting a case of ectrodactyly with autosomal recessive mode of inheritance.