Context: Stress in medical education is common and process-oriented. It often exerts a negative effect on their academic performance, physical health, and psychological well being. Aims: This study aims at identification of such susceptible students in the early stage i.e. first year of medical education, and to provide them essential support in the form of an intervention program to lessen the negative consequences of stress. Materials and Methods: A cross-sectional survey was carried out among the First MBBS students of NKP Salve Institute of Medical Sciences and Research Center, Nagpur, India. A 41-item questionnaire was designed to assess the sources of stress and their severity. Likert's 5-point scale was used to quantify the extent of severity on each item. Coping strategies adopted by students were assessed by using a 22-item stress inventory, and a questionnaire based on 19 institutional stress-reducing factors was used to identify its role. Results: The survey resulted into an overall response rate of 87% (131 out of 150 students). Median stress level based on 41 items was evaluated for each student. About 29% (40 students) had median stress level greater than 3. Female students were more stressed (17.19%) than male students (14.93%). The study revealed that students generally adopt active coping strategies rather than avoidant strategies like alcohol and drug abuse. The study indicated that emotional support system is a major stress-relieving factor for students. Conclusion: Prevalence of perceived stress is high among medical students. It seems that academic-related problems are greater perceived stressors. Review of academics, exam schedules and patterns, better interaction with the faculty and proper guidance, intervention programs and counseling could certainly help a lot to reduce stress in medical students.

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Background: High blood pressure is on the rise globally, affecting more women than men in many developing countries. It is the leading cause of mortality worldwide, and hospitalization in sub-Saharan Africa. Many known risk factors to hypertension, though prevalent in Nigeria, are controllable. Prevention, however, is difficult where there is poor awareness, attitude, and practices. Objectives: The study aims at determining the level of knowledge of hypertension and its associated factors, attitudes, practices, and prevalence among rural Nigerian women. Materials and Methods: Cross-sectional design was used to study 252 subjects in Sanga Local Government Area. Subject selection was by purposive and stratified sampling techniques. Data were collected using self-administered, semi-structured questionnaire after informed consents were obtained both verbally and in writing. Data were analyzed using SPSS statistical package. Level of significant was taken at 0.05. Results: Prevalence of hypertension was 24.2%. Average level of risk factor awareness was 65.4% with excessive salt intake (77.4%) being the most recognized. Asymptomatic nature of hypertension was recognized by 61.5% of the respondents, while 44.4% only knew the standard method for hypertension detection. While 17.5% strongly believed that hypertension can be managed effectively with drugs, it was only 9.1% that strongly disagreed that it could be caused by evil spirits. The average number of those with good preventive life style practices was 61.3%. Knowledge was associated with several factors and seems to affect practices (P < 0.05). Conclusion: Fair but inadequate level of knowledge and attitudes affected by several factors, as well as moderately high prevalence was recorded.

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Objectives: The paranasal sinuses are complex anatomical structures with a significant inter-individual variation. The dimensions of maxillary sinuses are particularly significant when considering endoscopic sinus surgery . The aims of this study were to estimate different dimensions of the maxillary sinuses measured on head CT, and their relations to sex of the individuals. Materials and Methods: Cranial computerized tomographic images (CT) of 200 normal subjects between the age groups of 18 and 80 years were observed in this study. The height, width, and depth of the maxillary sinuses were measured with a Philips Brilliance 64 CT. The statistical analysis for sex and age comparison for all the parameters was done. Results: The mean width, height, and depth of maxillary sinus in male on both right and left side were 27.8, 28.2, 39.9, 39.6, and 40.0, 39.7 mm but in females were 26.6, 26.7, 36.8, 37.1, and 36.6, 37.4 mm. The discriminative analysis showed that the accuracy of maxillary sinus measurements i.e. the ability of the maxillary sinus size to identify gender was 55% in females and 69.5% in males. Conclusion: This study on CT dimensions of maxillary sinuses may be beneficial for the ENT surgeons when planning for endoscopic sinus surgery and to support gender determination.

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The nasoalveolar molding (NAM) technique is a new approach to presurgical infant orthopedics that reduces the severity of the initial cleft alveolar and nasal deformity. This technique facilitates the primary surgical repair of the nose and lip to heal under minimal tension, thereby reducing scar formation and improving the esthetic result. NAM technique is the nonsurgical, passive method of bringing the gum and lip together by redirecting the forces of natural growth. NAM has proved to be an effective adjunctive therapy for reducing hard and soft tissue cleft deformity before surgery. This paper reviews the basic principles of NAM therapy, various types of appliances used in this therapy, protocol followed, and a critical evaluation of the advantages and disadvantages of this technique. Universally authors have agreed the positive outcome of NAM for better esthetics after cleft lip and palate (CLP) repair, but the long-term effects of this therapy are yet to be substantiated. Despite a relative paucity of high-level evidence, NAM appears to be a promising technique that deserves further research.

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Background: Anxiety disorder is one of the most common mental ailments exhibited by humans. It can cause considerable distress and debility. Anxiety is portrayed as a frame of mind concerned about future in association with preparation for possible, upcoming undesirable happenings. The present treatment for the disorder is having a lot of side-effects. An agent with good therapeutic effect and less side-effects is needed for the treatment of anxiety. Objectives: To investigate the anxiolytic activity of ethanolic extract of Moringa oleifera leaves in Swiss albino mice. Materials and Methods: The ethanolic extract of leaves of Moringa oleifera (200 mg/kg, i.p) was studied for its anxiolytic effect on Swiss albino mice by using Elevated Plus Maze (EPM) and Light Dark Arena (LDA) test. Results: The ethanolic extract of the leaves of Moringa oleifera (200 mg/kg, i.p) demonstrated significant (P < 0.001) anxiolytic activity in EPM and LDA models of anxiety. Conclusion: The data suggests that the ethanolic extract of Moringa oleifera leaves may have produced its anxiolytic effects via multiple mechanisms.

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Onychomycosis (fungal nail infection) is caused by three groups of fungal pathogens namely dermatophyte molds (DM), non-DM (NDM) and yeasts. It is primarily a cosmetic problem but may induce impact on quality of life. Clinically it is characterized by five morphologically distinctive types; distal lateral subungual onychomycosis (DLSO), superficial white onychomycosis (SWO), proximal subungual onychomycosis (PSO), and endothrix onychomycosis. It is difficult to detect the fungal agent responsible for a particular type of onychomycosis by clinical features alone. Mycological methods like direct demonstration of fungal agents by potassium hydroxide mount or nail plate histopathology with Periodic acid Schiff (PAS) staining are sensitive methods for the detection of pathogens. Fungal culture alone is commonly used as a standard for the detection of etiological agent. Molecular biological techniques are currently used only in research laboratories or epidemiological purposes. Therapy is generally not satisfactory. Both topical and systemic agents are used in the therapy. Topical Ciclopirix and Amorolfine are found to be effective but only in early and limited disease. Terbinafine and Itraconazole seems to be the best drugs for the systemic therapy. Clinical cure rates are generally lower than the mycological cure rates.

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Intraosseous vascular lesions are rare conditions, comprising only 0.5% to 1% of all intraosseous tumors. They present with variable and atypical radiographic appearances. Because of this variation, no pathognomonic sign exists that can be used to make a definite clinical diagnosis of these tumors. But, early diagnosis of central hemangioma is essential for preventing uncontrollable hemorrhage and even death during biopsy or surgery. The purpose of this article is to stress on the importance of radiology in the timely diagnosis of such lesions, which can prevent the disaster not only to the patient but also to oral surgeon in legal and professional aspects.

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Background: Papillary carcinoma (PTC) is the most common thyroid malignancy comprising 80-85%. In addition to papillary architecture, nuclear features like clear, ground glass or Orphan Annie-eyed appearance, oval shape, increased nuclear size, hypodense chromatin, intranuclear cytoplasmic inclusions, nuclear grooving, nuclear overlapping, and mitotic figures play a vital role in the diagnosis although some of the features may be seen in other diseases of thyroid. Objectives: To evaluate and establish the diagnostic significance of each nuclear feature in PTC. Settings and Design: Among the thyroidectomy specimens received in the department of pathology, only the PTC cases were chosen. Multiple sections were studied from the tumor by two different pathologists with a special emphasis on morphological and nuclear features. Statistical analysis: Fischer's exact test was done to find the correlation between the grading of nuclear features and cell population. Materials and Methods: Forty-one PTC cases were studied. Many H and E-stained slides of the tumor were studied by two different pathologists, and average of both observers was analyzed with special reference to nuclear features in classical and other variants of PTC. Results: The study evaluated that the ground glass nuclei, nuclear grooving, and nuclear overcrowding were the most common features seen in all (100%) cases though percentage of cells exhibiting these features varied from tumor to tumor. Other features mentioned above were less frequently encountered (42%-95%). Conclusion: In PTC, especially in variants, nuclear features are of utmost importance as they have to be differentiated from other thyroid diseases presenting with similar architectural morphology. Hence, more tissue sections have to be screened.

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A middle aged male presented with recurrent acute pancreatitis without any feature of extrahepatic biliary obstruction. Evaluation revealed mass in groove area with duodenal lumen compromise without any features of chronic pancreatitis. He underwent classical Whipple's operation with the suspicion of periampullary tumor but histopathology was suggestive of groove pancreatitis ruling out malignancy. This case is first case to report recurrent acute pancreatitis as presentation of groove pancreatitis.

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Metopic suture is a dense fibrous joint extending from the nasion to the bregma. Normally, closure of this suture takes place between 1-8 years of age. Failure of this closure beyond 8 years leads to persistent metopic suture. A rare case of persistent metopic suture in a 60-year-old male is documented, who committed suicide by alleged consumption of organophosphorous compound at District Govt. Wenlock Hospital, Mangalore, Karnataka, India. Metopic suture may mimic skull fracture and may mislead an inexperienced forensic expert. Neurosurgeon should also be aware of this anatomical variation while performing frontal craniotomy, as the persistent metopic suture may mimic vertical fracture of the skull. Hence, in this case report, the clinical and medico-legal implications of the persistent metopic sutures have been discussed.

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Objectives: Bauhinia variegata Linn (leguminosae) is one of the important medicinal herbs used traditionally to treat fever, as tonic, astringent, diarrhea, dysentery, hemorrhoids, piles, edema. Recent findings on Bauhinia variegata Linn have demonstrated its antioxidant, anti-hyperlipidemic, and hepatoprotective potential. The present work is focused to evaluate nootropic potential of Bauhinia variegata Linn in rats. Materials and Methods: The leaves of Bauhinia variegata were collected in the month of January from Jawaharlal Nehru Krishi Vishwavidyalaya Jabalpur (Madhya Pradesh). Leaves were subjected for isolation of crude flavonoids and characterized by total flavonoid content assay. Flavonoid-rich extract of Bauhinia variegata was studied for acute oral toxicity as per revised Organization for Economic Cooperation & Development guidelines No. 423. Nootropic activity was determined by elevated plus maze, rotating rod apparatus, baclofen-induced catatonia, diazepam-induced amnesia. Results: Flavonoid-rich fraction of Bauhinia variegata caused no alteration in locomotion in animals. In the current study, animals treated with flavonoid-rich fraction of Bauhinia variegata (400 mg/kg) showed a significant decrease in transfer latency as compared to the control group, which indicates cognitive enhancement effect flavonoid-rich fraction of Bauhinia variegata. In rota rod studies, flavonoid-rich fraction of Bauhinia variegata increased fall of time as compared to diazepam. In baclofen-induced catatonia, administration of flavonoid-rich fraction of Bauhinia variegata demonstrated protective effect on rats. Over all, flavonoid-rich fraction of Bauhinia variegata was found to enhance the performance of murine models. Conclusion: Thus, it could be concluded that flavonoids from Bauhinia variegata possess nootropic potential. However, more systematic studies are required to determine its exact mechanism of action.

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Mucoepidermoid carcinoma is the second most common salivary gland tumor primarily involving major salivary glands and intraoral minor salivary glands. Although rare, it can occur in the jaw bones, but it is very rare in the maxillary anterior region. Here, we present a case of mucoepidermoid carcinoma occurring in maxillary anterior region in a 33-year-old male patient presented as painless swelling clinically appearing similar to a periapical or nasopalatine cyst. The final diagnosis of this lesion was made after microscopic examination of biopsy specimen.

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Yolk sac tumor (endodermal sinus tumor) is a subtype of germ cell tumor and a highly malignant neoplasm. In addition to presenting in ovaries and testes, the tumor has been detected at several extragonadal sites, including the presacral area, the anterior mediastinum, face, uvula, and the pineal gland. Primary yolk sac tumor of the anterior mediastinum is rare and carries a grave prognosis, affecting mainly young men. Patients often present with advanced, bulky tumors that are unresectable. We present a 16-years-old young male patient with primary yolk sac tumor of mediastinum.

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Stroke is a well-known complication of penetrating neck trauma. Rarely, it can result due to carotid artery thrombosis secondary to non-penetrating blunt pressure over neck. We here discuss the first case report of stroke in a young patient after attempted strangulation.

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Background: The term student-centered learning (SCL) is widely used in the teaching and learning literature. Student-centered learning, if implemented properly, offers benefits to all, including the institution, students and staff involved, higher education staff unions, students' unions, and society as a whole. Materials and Methods: Present cross-sectional study was done to find out faculty attitudes and practice towards student-centeredness of curriculum in their own settings. Results: that learning environment (66.18%) is student-centered in most of the institute, followed by teaching and learning methods (57.65%), and the least student-centeredness was observed in learning outcome component (23.53%). All other components i.e. professional academic development (48.53%), student assessment methods (47.06%), mobility, recognition and prior learning (46.08%), social dimensions (44.12%), quality assurance (39.22%), consultation with students (28.43%) were student-centered in less than 50% institutions, indirectly suggesting practice of teacher centered curriculum. Conclusion: It has become clear from the study that, overall, there is practice of teacher centered curriculum. Particularly students need to be consulted in process of curriculum and in preparing learning outcome. Students should be part of quality assurance process.

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Objectives: To find out the reasons for discrepancy in the serum prostate-specific antigen (PSA) values (normal, borderline, and high) in prostatic adenocarcinoma. Materials and Methods: It is a retrospective correlation study of serum PSA levels with the histomorphological variables and age of the patients in adenocarcinoma prostate with normal, borderline, and high serum PSA values. Age of the patients was noted down and hematoxylin and eosin-stained, paraffin-blocked sections were studied. Results: Serum PSA values were found to be directly related to histomorphological variables like Gleason grade and score, tumor cell mass to stroma ratio, necrosis, and cell size; but not with the age of the patients with prostatic adenocarcinoma. Discussion: Publications on relationship between serum PSA levels and Gleason grade and score in adenocarcinoma prostate are rarely found in the literature. Infarction (coagulation necrosis) increases serum value of PSA in benign prostatic tissue which can be true with carcinomas also, as in the present study. Various histomorphologic variables also may affect the serum PSA levels. The age of the patient and serum PSA levels in carcinoma prostate is not found directly proportional, in this study, unlike in normal individuals who show age-specific PSA ranges.

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Dementia or the "silver tsunami" is a public health challenge of epidemic proportions of the 21 ^st century. It imposes enormous burden in terms of economic and social impact on the health care systems and the quality of life of people with dementia, their families and caregivers. For a number of decades, clinicians, researchers, and pharmaceutical companies have laid emphasis on the development of a drug armamentarium for fighting dementia. However, the neurotherapy of dementia targeting the "pathogenesis model" still remains disappointing with no breakthrough in-sight. The cure for dementia is worthy, but an elusive and frustrating goal. On the contrary, epidemiological research does spell optimism and provides a substantial amount of evidence of modifiable risk and protective factors to delay, prevent or shorten dementia. Thus time has come for a "strategic vision for the future" to move away from the current paradigm of curative therapies to a strategy of "preemptive medicine" that identifies disease processes at the earliest stages and prevents rather than attempting to reverse disability. Such a strategy is not only a safer, more dignified option, but also a step forward for a sustainable society in an aging world in order to preserve the mental capital and brain well-being of nations. This would reiterate the concept of "anthroposophical medicine," neurocentric health and preventive neurology strategies to promote healthy brain aging and brain protection. The need to rethink and redefine dementia from a "salutogenesis" perspective as a "lifestyle disorder" and implement multiple preventative life-course approaches through well-designed randomized controlled trials is quintessential to delay, prevent or keep dementia at bay.

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Though the importance of psychological factors in maintenance of health, as well as etiology and prognosis of diseases have been recognized in ancient medicine by discerning and thoughtful clinicians in all ages, for the large majority of the practitioners such a perception has not been there. A cross-sectional, organ-based, and symptom-centered clinical approach was largely prevalent in day-to-day medicine. Medical training also followed more or less the same path. The positive psychological and behavioral qualities needed in the physician are left to the individual student to develop on his own during studies or to the physician afterwards. Some do, many do not. The importance of communication, doctor-patient relationship, empathy and psychological sensitivity in the making of a physician started getting identified in advanced medical universities in western countries by the middle of the last century. Since then behavioral science and medical humanities have been incorporated as important modules in the graduate medical training curriculum not only in advanced western medical universities, but also in good universities elsewhere. The situation in India, till now has been quite unsatisfactory. The undergraduate medical students had only 2 weeks of clinical posting and few hours of lectures, allotted for psychiatry: Even these were not actually carried out in many institutions properly. Responding to repeated representations from mental health experts in the country and abroad, medical universities and educationists, the Medical Council of India in 2012 has made 2 weeks of Residential Internship in Psychiatry (CRRI) mandatory, and also recommended incorporation of medical humanities in the MBBS curriculum. The paper presents a brief outline of how a Clinical Behavioral Sciences Training Program l incorporating medical humanities can be developed and carried out as a mainstream component for the undergraduate medical training in the country. The author points out that, if medical administrators and medical teachers take it up in right earnest, it would be the most significant contribution to humanize medical education in the country-which is precisely the need of the hour in the field.

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