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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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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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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Insulin analogues have revolutionized the treatment of diabetes mellitus, and the advent of newer insulin analogues have provided better glycemic control with lesser incidence of hypoglycemia. Insulin degludec is a second-generation, ultra-long-acting acylated basal insulin analogue that possesses a flat, stable glucose-lowering effect in patients with type 1 or type 2 diabetes mellitus. Findings from clinical trials have demonstrated that new-generation, once-daily basal insulin degludec provides similar A1C control as compared to insulin glargine, both administered as basal-oral therapy or in combination with insulin aspart, with the added benefits of lower rates of hypoglycemia, particularly nocturnal hypoglycemia.

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The availability of multidetector computed tomography (MDCT) scanners, coupled with imaging workstations that allow multiplanar and three-dimensional (3D) evaluation of isotropic data sets, have allowed improved depiction and characterization of small bowel obstruction (SBO). In this article, we present a series of five cases and emphasize that addition of coronal images to axial images enhance the identification of site and etiology of SBO especially in unusual cases of SBO.

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Acute abdomen accounts for 5-10% of emergency department visits. It designates symptoms, signs of intraperitoneal disease with sudden onset, can persist for hours to days, and is associated with wide variety of clinical features which may not be, specific to underlying disease. Pregnant state complicates the issue because of anatomic, physiologic changes during pregnancy. Its causes are many, obstetric, gynecological, many others which encompass a wide spectrum of surgical and medical conditions from aortic dissection to psychogenic pain, almost anything in between, a trivial to life-threatening condition, which requires immediate therapy. Diagnosis is challenging, requires careful history, thorough evaluation of symptoms, examination, and judicious use of investigations to specify disease and management which many times could be surgery only. Individualized approach is the best with basics known.

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Pituitary macroadenoma is a rare tumor with varied presentation. It can present acutely due to apoplexy. Here, we present a rare presentation of total ophthalmoplegia with normal vision in a case of pituitary macroadenoma with apoplexy.

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Background: Contrast-induced nephropathy (CIN) is a form of acute kidney injury (AKI) that is caused by exposure to contrast media in diagnostic imaging and interventional procedures such as angiography. At present serum creatinine is the only standard test for it. A few studies have been published analyzing the potential use of neutrophil-gelatinase-associated lipocalin (NGAL) in AKI. Aim: The aim of this study is to search for new markers to identify AKI acute renal failure earlier than serum creatinine. Materials and Methods: We studied 100 consecutive patients with normal serum creatinine undergoing angiographic procedure against Urine NGAL, serum NGAL, serum Cystatin C and urinary interleukin-18 (IL-18) at basal, and 2 h, 4 h, 8 h, 24 h, and 48 h after the angiography. Results: There was a significant rise in serum NGAL levels at 2 h, 4 h, and 8 h after angiography and in urinary NGAL levels at 4 h, 8 h, and 24 h after the procedure. Cystatin C rose significantly at 8 h and 24 h after the procedure, On the other hand, there was mild rise in urinary Il-18 levels at 24 h, but not significant. The presence of CIN associated with AKI was 13%. Conclusion: The present study highlighted the importance of serum NGAL, urine NGAL and Cystatin C in detecting AKI associated with contrast administration earlier than serum creatinine.

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Intracerebral hemorrhage is a dangerous occurrence in systemic lupus erythematosus (SLE). This may occur due to hypertension, anticoagulation, aneurysmal rupture, and catastrophic anti-phospholipid antibody syndrome. Factor XIII is required for stabilizing the fibrin clot. Decreased activity of factor XIII is a relatively rare coagulation abnormality, which may be due to congenital and acquired causes. Acquired causes of this condition are drugs such as isoniazid and phenytoin, liver disease, lymphoproliferative disorders, disseminated intravascular coagulation, sepsis and autoimmune disease, including SLE. The association of intra-cerebral hematoma in SLE due to decreased activity of factor XIII as its only detectable cause is a rarity in the medical literature. We report a case of SLE with intra-cerebral hemorrhage presenting as headache, found to be due to decreased activity of factor XIII. The activity of factor XIII increased after treatment with intravenous cyclophosphamide and there were no further bleeds reported.

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The chances of congenital cardiac defects are often increased in multiple birth orders. However, there is a paucity of data on its incidence amongst triplets in Nigeria. Here is a report of a set of triplet with concordant atrial septal defects and the third triplet found to have a concomitant ventricular septal defect.

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Heterotopic ossification (HO) is a less known but an agonizing complication after primary total knee arthroplasty (TKR). Early detection can help in avoiding it so that the patient returns back to normal ambulatory life at the earliest. This article depicts the sequence of radiological and biochemical events that occurred in a patient who developed this complication following total knee arthroplasty for severe osteoarthritis.

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