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.

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Right iliac fossa pain does not always mean acute appendicitis even though it is the most common etiology. We report a rare case where on clinical grounds patient was diagnosed to have acute appendicitis which on diagnostic laparoscopy turned out to be gangrenous small bowel secondary to a band causing constriction and compression.

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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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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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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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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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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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Hair dye poisoning has emerged as one of the major causes of deliberate self-harm in the rural areas of developing world. This systematic toxicological literature reviews the pathophysiology and clinical features of hair dye poisoning.

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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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Gradient recalled echo (GRE) T2 weighted imaging is more widely used as a standard magnetic resonance (MR) pulse sequence because of its exquisite sensitivity for detection of cerebral hemorrhages. Signal loss on GRE sequence is due to increased sensitivity of this sequence to magnetic susceptibility induced by static field inhomogeneities arising from paramagnetic blood breakdown products. T2 ^* signal intensity loss seen in GRE sequence is greater with longer TE, smaller flip angle, and larger magnetic field strength. The purpose of this review is to discuss the role of GRE imaging in cerebral disorders with bleed. Because of the sensitivity of this sequence to microbleeds, we describe its edge over baseline imaging sequences to provide insight in the etiology of certain diseases.

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Monoarthritis can be inflammatory or non-inflammatory, and can be acute or chronic. A thorough history and physical examination can differentiate inflammatory from non-inflammatory monoarthritis. The most common causes of acute inflammatory monoarthritis are infectious arthritis, crystal induced arthritis (gout and pseudogout). Examination of synovial fluid often is essential in making a definitive diagnosis. Immunoinflammatory diseases like rheumatoid arthritis, systemic lupus erythematosus, spondyloarthritis, Behηet's disease, and reactive arthritis can all begin as acute inflammatory monarthritis. Synovial biopsy is useful to diagnose chronic infections like tuberculosis and brucellosis. In order to arrive at a final diagnosis other organ systems should be thoroughly reviewed, because other systemic illness like sickle cell disease, thalassemia, sarcoidosis can all cause monoarthritis.

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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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Background: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age. Of late, the disease is on its rise due to environmental changes as well as lifestyle disorders, affecting 4%–26% of adolescent and young women all over the globe. Initially, this condition is asymptomatic in young girls, progressing toward menstrual irregularities, obesity, hyperandrogenism in late puberty and eventually developing insulin resistance, hypertension, type 2 diabetes, cardiovascular diseases, and infertility around middle age. Aims: Early diagnosis is necessary for early intervention, including lifestyle modifications to prevent the immediate and chronic consequences of PCOS. Materials and Methods: Our study design was of a cross-sectional questionnaire-based survey, conducted from September 2017 to March 2018 to investigate the prevalence of PCOS and its association with body composition variables. The study population comprised randomly chosen students (age group 18–20 years) of all discipline. The data were collected from the students using structured questionnaire with Rotterdam's criteria, and anthropometric measurements were taken using standard techniques. Results: Approximately 28% of the college students were found to be at high risk of developing PCOS. More than 85% of the PCOS cases had oligomenorrhea, 19% were hirsute, 41% had acne, 63% had emotional disturbance, and 22% with a positive family history. Furthermore, the body mass index of the PCOS students demonstrated a trend of Grade 1 obesity than the normal females of the same age group. Conclusion: The present study is an attempt to create increased awareness among the students for early and accurate diagnosis, which is the primary step in managing PCOS.

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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.

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Bronchogenic carcinoma is one of the most common cancers both in males and females worldwide. Lung malignancies can present with manifestations involving any organ system and also mimic like benign nodules or infective consolidation. Present review highlights spectrum of typical presentations and imaging features of lung malignancies.

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India continues to have the persisting environmental problem of disposal of expired, unused, unwanted medicines. Since this has not been studied well, the exact repercussions, therefore, are not hitherto known fully. There are no laws in country worthy of handling this problem. The municipal corporations handling the waste have not been sensitized to it. The media are insensitive to it, and populations are disorganized to take up the issue. Hence, the environment continues to suffer and will end with higher complication of human life and environment.

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We report a case of a 3-year-old male child presenting with a polymorphous generalized eruption consisting of crusted maculopapular lesions all over body except for face and mucus membrane. Histopathology showed interface dermatitis along with perivascular infiltrates chiefly comprising of lymphocytes and extravasated red blood cells, indicating the diagnosis of pityriasis lichenoides et varioliformis acuta. He was treated with dapsone and eryhthromycin with success.

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Fixed flexion deformity of the neck due to postburn contracture results in the nonalignment of oral, pharyngeal, and laryngeal planes for intubations. Airway management is a challenge to anesthesiologist in these cases. Awake fiberoptic intubation if available is the gold standard in such cases. The design of ProSeal laryngeal mask airway (LMA) is such that it provides a good alternative to the endotracheal tube and its insertion does not require the visualization of the vocal cords. We present the successful airway management of a patient with severe fixed flexion deformity of the neck by an awake ProSeal LMA insertion.

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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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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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