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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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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Over the last three decades, aluminum phosphide has emerged as an important pesticide agent being sued for self-harm in India is well as other countries. High mortality is due to severe mitochondrial dysfunction leading to disruption of cellular respiration leading to tissue hypoxia and organ dysfunction. In spite of a lot of research, no definitive anbtidote is available, and the treatment remains largely supportive.

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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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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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The pineal gland is located near the center of the brain, between two hemispheres in between the two thalamic bodies. It is activated by light and controls the various bio-rhythms of the body. It also secretes melatonin - a potent regulator of gonadotrophic and other endocrine hormonal activity. It is made of cells, called pineocytes and tumors arise from these cells as also from other cells in the pineal region. Pineal tumors account for 1% of all brain tumors. Tumors of pineal parenchymal lineage include germ cell tumors, embryonal pineoblastoma, the mature pineocytoma, and lesions exhibiting mixed histology or intermediate degree of differentiation. During the period January 2008 to December 2011, we encountered three cases of pineal tumors. A brief summary of these cases is given in this case report.

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Background and Objective: The objective was to evaluate clinical trial data on the use of ketamine in treating treatment-resistant depression (TRD). Materials and Methods: PubMed search (November 2012) was initiated using the keywords: Ketamine, resistant depression. Inclusion criterion included: English language publications describing clinical trial reports on humans with TRD. Results: A total of 360 patients across 15 clinical trials with TRD were treated with infusional ketamine. On average 15-90% of patients reported a >50% decrease in their baseline Montgomery-Åsberg Depression Rating Scale/Hamilton Rating Scale for Depression scores at 4 h. Response rates decreased significantly as time progressed. Conclusion: Infusional ketamine has a significant rapid, short-term antidepressant effect in the treatment of TRD.

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Literature on the incidence of empyema thoracis complicating chest infection in developing countries is scanty; though it may occur in pneumococcal, Staphylococcal pneumonia in children. However its association with acute chest syndrome is a rare event. Hence we report, a case of a 10-year-old child with sickle cell anemia with empyema thoracis complicating acute chest syndrome.

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Tubercular abscess of the brain are rare lesions and usually occur in the supratentorial compartment in immune-compromised hosts. We report an uncommon case 12-year-child with otogenic tubercular cerebellar abscess that was managed successfully with surgical excision and anti-tubercular treatment and review the literature.

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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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Synovial cysts are uncommon in spine. In spine, they can occur in cervical, thoracic or lumbar region whereas they are the most common in the lumbar spine. These cysts are associated with pain in back with radicular pain. Magnetic resonance imaging (MRI) scan of the spine is best diagnostic modality for these cysts. Furthermore computed tomography scan can be used. Surgical treatment is necessary for excision of the cyst. Complete excision of cyst gives good results. We present a case of L4-L5 synovial cyst diagnosed with MRI scan and treated with posterior surgical excision.

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Primary lung cancer frequently metastasizes to distant organs, however pancreas is a relatively infrequent site of metastasis and accounts for approximately 2% of pancreatic malignancies. We report a case of 62-year-old male patient who presented with left shoulder pain and was evaluated to have primary small cell cancer of the right lung lower lobe with humeral metastasis. He was referred for fluorodeoxyglucose-positron emission tomography/computed tomography (FDG PET/CT) to find out extent of primary disease. PET/CT showed intense FDG uptake in the right lung lower lobe nodule and large lesion in the tail of pancreas along with multiple nodes, liver, muscle and skeletal metastasis. He was started on palliative chemotherapy.

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Actinomycosis is a chronic suppurative disease caused by anaerobic bacteria, Actinomycetes israelii. The disease is conventionally included in mycology though the causative organism is filamentous bacteria and not true fungus. The disease is world-wide in distribution. The organism is a commensal in the oral cavity, alimentary tract and vagina. The infection is always endogenous in origin and not person-to-person. Here we present a case of subcutaneous actinomycosis involving the spine which is a very rare finding.

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Thrombotic thrombocytopenic purpura (TTP) is a rare disorder of the blood-coagulation system, causing extensive microscopic thrombi to form in the small blood vessels throughout the body. Plasma exchange is the mainstay of treatment of TTP. Here, we report this case of TTP which was successfully treated with glucocorticoids alone.

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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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Macrophage activation syndrome or hemophagocytic lymphohistiocytosis is a heterogeneous group of disorders characterized by activated macrophage activity leading to a sepsis-like clinical presentation with hemophagocytosis, hyperferritinemia, hypercytokinemia, and variable cytopenias often resulting in multiple organ failure, occurs much more frequently in individuals with systemic onset juvenile idiopathic arthritis.

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Background: Cirrhosis of liver is an important cause of morbidity and mortality. Autonomic neuropathy need to be focused as it is independent predictor of mortality with 5-fold increased risk in patients with chronic liver disease (CLD). The aim of the present study was to study the magnitude and pattern of autonomic neuropathy (AN) among subjects with cirrhosis of liver presenting to teaching hospital in central rural India. Methodology: A cross-sectional study was performed in a tertiary care teaching hospital. In all patients of cirrhosis of liver irrespective of etiology, aged 15 and above, underwent clinical assessment and cardiovascular autonomic function tests to confirm autonomic nervous systems damage. We used chi square test to study associations. P value ≤0.05 was considered as significant. Crude odds ratios were computed to assess the strength of association between independent variables and dependent variables along with their 95% confidence intervals. Results: We included 199 cirrhosis of liver patients admitted in medicine department from November 2010 through November 2013. Nearly 83% patients were male and 63.3% patients were under the age of 45 years. Common features present in these patients were ascites (67.8%), splenomegaly (63.5%), pedal edema (60.3%), icterus (45.2%) and gastrointestinal bleeding (39.7%). Among the manifestation of autonomic nerves involvement dizziness on standing was the most common feature in 47.2%, followed by gustatory sweating in 21.6%, and nocturnal diarrhoea in 21.1%. Autonomic neuropathy was found in 70.9% [95% CI: 64.02-77.17] of study subjects on cardiovascular autonomic function tests. Conclusions: Analysis of cardiovascular autonomic function tests shows that the AN is very common in subjects with cirrhosis of liver.

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Recreational drugs are those drugs, which are taken for the sole purpose to create positive feeling and emotions by altering the conscious state of the user. In recent years, the "rave club drug" scene has changed significantly as many new synthetic drugs have become available. Here is a brief commentary based on the evolving menace of recreational drug.

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Ethanol ingestion with alcoholic intoxication is one of the commonest emergencies followed by "alcohol withdrawal syndrome" in chronic alcoholics presenting to the emergency department with medical conditions. Isolated toxic alcohol (other than ethanol) ingestion cases may report to the emergency department when inadvertently methanol or ethylene glycol is ingested. In areas with prohibition occasionally outbreaks of toxic alcohol ingestion are observed. As an emergency physician, it is important to identify toxic alcohol ingestion as timely treatment will prevent morbidity and mortality.

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The use of hair dyes can be traced back at least 4000 years. Today, millions of consumers use hair dyes. The main content of hair dye is para-phenylenediamine (PPD) is a derivative of paranitroaniline. Hair dyes are commonly available at any general store. However, toxicity with this compound, although previously reported, is not very frequent. Under-recognition of this form of poisoning in the medical community may be a cause for this. We report a case of PPD poisoning with the characteristic features of angioneurotic edema, rhabdomyolysis, intravascular hemolysis, acute tubular necrosis. Management is only supportive, and helpful only if instituted early; a little delay spells imminent death for the unfortunate victim. Diagnosis requires a high degree of suspicion, as the clinical features are quite distinctive.

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