Background: Considerable number of people in the prediabetic stage will go on to develop type 2 diabetes. Early diagnosis and intervention of prediabetic and their cluster of risk factors can prevent the cardiovascular events and other complications of diabetes. Objectives: To estimate the prevalence of prediabetes and associated factors among adults attending fixed mobile clinic in a rural block in Tamil Nadu. Materials and Methods: A cross-sectional study was carried out among 544 individuals over the age of 20 years through our fixed mobile clinic among 30 villages of a block in Tamil Nadu with a structured interview schedule. Results: A total of 544 participants above the age of 20 years were studied of which 72.6% were women and 27.4% were men. The prevalence of prediabetes was 8.5% and diabetes was 10.1%. Higher risk of being prediabetic and diabetic was noted above the age of 40 years (odds ratio [OR] = 7.79, 2.17), male gender (OR = 1.46, 2.34), body mass index of more than 23 kg/m ² (OR = 1.52, 2.13), waist hip ratio of men >1 and women >0.8 (OR = 1.49, 2.28), alcohol intake (OR = 1.59, 2.45), and systolic blood pressure of more than 140 mm of Hg (OR = 2.23 and 2.15). Conclusion: Identifying people with prediabetes and creating awareness on the prevention of diabetes by lifestyle modification and development of cost-effective strategy to prevent or delay the progression of the prediabetic stage to diabetic stage is the need of the hour for the prevention of diabetes in country like India.

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Background: Thyroid hormone is a key substance in normal homeostasis, having variable influence on cell metabolism on different organs. Hypothyroidism is common, potentially serious, often clinically overlooked, readily diagnosed by laboratory testing, and eminently treatable. Aim: This study was conducted with the aim of finding the effect of regular physical exercise of medium-intensity on thyroid function in patients already undergoing treatment for hypothyroidism. Materials and Methods: A total of 20 ambulatory treated hypothyroid patients were included in the study. Serum samples were collected and evaluated for triiodothyronine (T3), thyroxine (T4), thyroid stimulating hormone (TSH) both before and after 3 months of daily 1 h physical exercise, from those patients doing exercise and from those who did not do any physical exercise. T-test was used to find a significant difference between the two groups. Results: Serum TSH was found to be significantly decreased in patients of regular exercise group postinterventionally (P < 0.001) when compared with nonexercise group (P = 0.43). Serum T3 and T4 were also found to be significantly raised in regular exercise group postinterventionally (P = 0.007 and P < 0.001 respectively) but not in nonexercise group (P = 0.92 and P = 0.73 respectively). On inter group comparison significant decrease in TSH was found in regular exercise group (P = 0.002) and significant increase was found in levels of T3 (P = 0.002) and T4 (P = 0.001) in regular exercise group. Mean weight was also found to be decreased in regular exercise group postinterventionally. Conclusion: Every hypothyroid patient should do regular physical exercise along with thyroxine replacement to improve thyroid function.

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Background: Diabetic nephropathy (DN) is one of the major causes of morbidity and mortality among patients with diabetes worldwide. Data on DN patients in Bangladesh are scarce. Objectives: The aim of this study was to determine the clinical status of patients with DN and its associated factors in Bangladesh. Materials and Methods: A cross-sectional study was conducted among 130 DN patients admitted in Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) hospital in Dhaka from May to July 2010. We collected data using structured questionnaires, anthropometric, biochemical, and clinical measurements. Multiple regression analyses were performed to examine the relationships between independent variables and factors associated with DN. Results: The mean age of the patients was 56.50 ± 14.2 years. The mean duration of hypertension, diabetes, and DN was 7.32 ± 5.42, 10.08 ± 6.8, and 3.24 ± 3.67 years, respectively. The mean HbA1c was 10.07 ± 3.27%, and mean serum creatinine 2.91 ± 1.98 mg/dl. The correlation coefficient matrix suggests relationships between many of the patients' characteristics and clinical outcomes. Multiple logistic regression analysis shows that the duration of DN (>3 years) is associated with female sex (odds ratio [OR] 1.01, 95% confidence interval [CI] 0.97-2.12), systolic blood pressure (OR 1.04, 95% CI 0.78-1.53), serum creatinine (OR 1.04, 95% CI 0.96-1.87), HbA1c (OR 1.12, 95% CI 0.89-2.01), and duration of hypertension (OR 1.06, 95% CI 0.83-2.37). Conclusion: The results show that among the study participants DN develops earlier with a shorter duration of hypertension and diabetes, providing a strong case for promoting effective strategies for optimum management of diabetes and hypertension in the clinics.

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Background: Birth weight is an important indicator of a child's vulnerability to the risk of childhood illness and chances of survival. The identification of factors contributing to low birth weight (LBW) is therefore of paramount importance. Objective: The objective was to investigate effects of maternal factors on birth weight of the baby. Materials and Methods: In a cross-sectional hospital-based study, data collection was done on 100 women for their age at the time of delivery, gestational age (GA), parity, height, weight, hemoglobin, blood sugar, blood pressure, sex of the delivered child, and weight of the child during the period from June to August 2014. Descriptive statistics, bivariate analysis, receiver operative characteristic (ROC) curve, and logistic regression analysis were used. Results: The proportion of LBW (<2500 g) was found to be 36.8% in the infants. Anemia was seen in 67% of the women. Bivariate analysis showed that GA (r = 0.68) was significantly associated with LBW (P < 0.05). ROC analysis revealed sensitivity (86% and 81%) and specificity (60% and 64%) for GA and parity, respectively. Furthermore, GA <37 and parity <2 found to increase risk of LBW by 8.9 and 4.5 times, respectively (P < 0.05). Maternal age, height, weight, and sex of the child had no statistical significant effect on determining the risk of LBW. Conclusion: GA and parity were found to be the important maternal parameters influencing the birth weight of the child.

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Odontogenic cysts may occur in association with odontogenic tumors. Because neoplastic and hamartomatous aberrations can occur at any stage of odontogenesis, combined features of odontogenic tumors with epithelial and mesenchymal components may arise within odontogenic cysts. One of the most common of these is dentigerous cyst (DC) which has neoplastic potential and shows associated pathologies such as ameloblastoma, squamous cell carcinoma, mucoepidermoid carcinoma (MEC), adenomatoid odontogenic tumor (AOT), and odontoma. The authors report four cases of DC and associated lesions exhibiting AOT in two cases while one case each of complex odontome and MEC. Emphasis is placed on pathogenesis and clinicopathologic features of these lesions.

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Situs inversus totalis is a rare congenital anomaly characterized by transposition of organs to the opposite site of the body. Diagnosis and treatment of cholelithiasis in such cases pose a challenge to operating surgeon because of atypical clinical picture and due to the contra lateral disposition of the visceral organs. No doubt, laparoscopic cholecystectomy in these patients is technically more demanding still it is feasible and should be done by trained and experienced laparoscopic surgeon. Difficulty is encountered in skeletonizing the cystic duct and cystic artery in Calot's triangle, which requires extra time than normally located gall bladder.

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Background: Epistaxis is a symptom which is often benign and nonspecific, but it may be a life threatening in elderly patients. Aim and Objective: The aim was to diagnose the underlying etiology of epistaxis in the elderly patients and identify definite management protocol to reduce the morbidity. Materials and Methods: A retrospective study of admitted elderly patients with epistaxis was carried out for the period of January 2005 to January 2014 in the Department of ENT at a tertiary care referral center in North East India. All the patients with epistaxis were retrospectively analyzed for gender distribution, etiology, and their initial and consequent management. Results: M:F = 2.6:1, hypertension was seen as the most common etiology (59.2%), followed by local cause like trauma (16.4%). Initial management with merocele application (50%) and anterior nasal packing (36.2%) were done in most of the cases and anemia was an important associated sign in 73% of patients. Conclusion: Hypertension on irregular treatment is an important underlying etiology of epistaxis in the elderly patients and comprehensive systemic management with medications should be done, including initial local control measures by nasal packing. Coexisting anemia in epistaxis should be treated to reduce any future complications.

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We present a case of Teratoid Wilms tumour (a rare histologic variant) in a 4 year old male who presented with an abdominal lump. Wilms Tumour with paracaval lymphadenopathy and tumour thrombi in right renal vein and inferior vena cava was made radiologically. FNAC report was suggestive of Wilms tumour and patient was subjected to 6 cycles of chemotherapy with not much reduction in size. Post nephrectomy histological diagnosis of Teratoid Wilms tumour was established. Resistance to chemotherapy and radiotherapy is thought to be due to presence of well differentiated histologic appearance. Teratoid Wilms tumour is usually not an aggressive neoplasm and prognosis is comparatively neoplasm and prognosis is comparatively good if the tumour is excised completely thus surgery being the best treatment.

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Rupture of the pelvicalyceal urinary collecting system causing perirenal and retroperitoneal extravasation of the urine and subsequent mass with secondary infection is a rare complication of ureteral-obstructing calculi. We report a rare case of calyceal rupture with urinoma formation in a child presenting with acute abdomen and nonremitting fever due to secondary pyonephrosis. The retroperitoneal mass on abdomen sonography was confirmed as urinoma communicating with the upper ureter on computed tomography (CT). Gross anatomical observation during surgical intervention revealed extensive pyonephrosis with adhesions involving the adjacent intestinal loop. In addition to complete resection and removal of urinoma, nephrectomy of nonfunctioning right kidney was performed. Patient was discharged after an uneventful postoperative period of 7 days.

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Background: Oral candidiasis is increasingly seen among hospitalized patients and is usually treated empirically. It can be the marker of systemic infection. Antifingal resistance is one of the emerging problems in candidiasis. Aim and Objectives: To study the distribution pattern of various Candida species among hospitalised patients with oral candidiasis, to detect the antifungal resistance among Candida and to assess the possible risk factors associated with those patients. Methods: Out of 300 patients screened, oral thrush material was collected from 36 patients having oral candidiasis. Candida spp. were isolated and identified. Antifungal susceptibility test was performed by disk diffusion method. Results: Candida albicans was the most frequently isolated species (64%). Highest resistance was seen with ketoconazole (18%). Except one C. tropicalis, all the isolates were sensitive to amphotericin B. All the patients were on broad spectrum antibiotic treatment. Diabetes mellitus was seen in 50 % of the patients. Other predisposing factors include tuberculosis, COPD, cancer and steroid treatment. Conclusion: Eventhough there is progressive shift from a predominance of C. albicans to non-albicans Candida species in candidiasis, C. albicans remains as the most important pathogen in oral candidiasis. Since azole resistance is increasing, accurate identification of Candida spp. and antifungal susceptibility testing is crucial for patient management and for facilitating hospital control measures.

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Numb chin syndrome (NCS), also known as mental neuropathy, is a sensory neuropathy characterized by numbness involving the distribution of the mental nerve and is an uncommon, but underappreciated neuropathy. The clinical importance lies in its frequent association with malignancies, particularly lymphoma and breast cancer. We report a 30-year-old patient who presented with bilateral numb chin for few days for which no cause was found. Over 3 weeks, he developed systemic symptoms and neck swelling. Investigations revealed low platelet count, raised erythrocyte sedimentation rate, alkaline phosphatase, and lactate dehydrogenase. Biopsy of the swelling and Bone marrow confirmed Burkitt's lymphoma. Imaging studies confirmed intracranial and hepatic metastasis. Within few days of initiation of therapy, patient succumbed to the disease. Here, we would like to emphasize that all clinicians should be aware of this entity and investigate thoroughly to rule out underlying malignancies as delay in diagnosis leads to the adverse outcome.

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Background: Systemic sclerosis (SSc) patients are encountered in all parts of the world. Few Indian studies are found in the literature on this connective tissue disorder of unknown etiology. The spectrum of sclerodermatous diseases comprises a wide variety of clinical entities. Renal involvement is not common in Indian patients when compared to western patient's in spite of the kidney being commonly affected in scleroderma due to vascular changes. Aim and Objective: To primarily study the prevalence of renal involvement in SSc and to correlate it with high-sensitivity C-reactive protein (hsCRP) over a period of 1 year in a tertiary care hospital in North-East India. Materials and Methods: A total of 38 consecutive scleroderma patients of both sexes, diagnosed by established criteria, were examined, and hsCRP was estimated in all. Evaluation for nephropathy by biochemical tests and sonography were carried out. Relevant clinical/biochemical examinations were carried out. Results: SSc was 3 times more common in mostly in middle aged females. About 50% presented within 1 year of disease onset. Renal involvement was uncommon (18%) and hsCRP was detected in 26%. Conclusion: SSc with nephropathy, not renal crisis, presents early and hsCRP is a good marker for the same.

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Lip pits are rare congenital anomalies that are recorded on the upper lip, lower lip or the oral commissures. Recognition of this entity is important because of their association with other multiple anomalies. Proper evaluation and treatment of these associated abnormalities and genetic counseling is of utmost importance. Herewith, a rare case of isolated congenital lower lip pits is reported with a brief review of the literature.

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Arteriovenous malformations (AVM's) are serious abnormalities that very rarely affect the eye. They are due to anomalous communications between the arterial and venous systems without any interposing capillaries. Therapeutic management of orbital AVM is not standardized, and it's most essential to strike a balance between spontaneous and iatrogenic risk of any visual loss. Management has to be very patient-specific and includes observation, embolization, surgical excision or a combined preoperative embolization followed by excision. Surgical intervention can also sometimes lead to life-threatening complications like excessive haemorrhage or cardiovascular instability and /or vision threatening complications like retinal vein occlusions. Here we describe an eyelid AVM in a young lady, with a relatively good vision in the affected eye .She was accurately diagnosed and finally after much deliberation involving multiple specialities was offered a combined embolization followed by complete surgical resection, however she declined any active intervention and is now on a regular follow-up

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Background and Objective: High-risk behaviors can have adverse effects on health of adolescents. It is essential to identify risks so that modification can be initiated before any damage. The present study was conducted among adolescents to study their risk behaviors. Materials and Methods: This cross-sectional descriptive study based on the concept of Global School-based Student Health Survey was conducted by interviewing adolescents of one urban and one rural randomly selected school. For quick overall assessment of their risk behaviors, a predesigned three-point scoring system was followed. Data were analyzed using Epi Info version 3.5.1. Results: The study of six domains of important risk behaviors among 788 school-going adolescents (rural: 436 [55.3%], urban: 352 [44.7%]), (male: 406 [51.5%], female: 382 [48.5%]) revealed that occurrence of dietary high-risk behavior was more in urban students (11.4%) than rural students (1.8%). Regarding violence, occurrence of high-risk behavior was also higher among urban students (18.8% vs. 6%). The number of mentally disturbed girls is more than boys. Conclusion: The mean risk scores in all domains, except personal hygiene, are either in 'Moderate' or 'high' risk grade. It is of great concern that rural and urban, male and female adolescents are at risk though their vulnerability varies.

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Millennium Development Goals (MDGs) have to be achieved by 2015. This review article discussed India's progress toward health-related MDGs of reducing child mortality (Goal 4), improving maternal health (Goal 5), and combating HIV/AIDS, malaria, and other diseases (Goal 6). This review article assesses India's progress toward these goals as well as focuses on major but neglected road blocks in progress such as deficiencies in public health infrastructure and public health man power of India.

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A 13-year-old male was operated for a space occupying lesion in the brain. A noncontrast computed tomography scan done in the late postoperative period showed massive subdural air collection causing compression of bilateral frontal lobes with widening of interhemispheric fissure and the frontal lobes acquiring a peak like configuration - causing tension pneumocephalus-"Mount Fuji sign." Tension pneumocephalus occurs when air enters the extradural or intradural spaces in sufficient volume to exert a mass or pressure effect on the brain, leading to brain herniation. Tension pneumocephalus is a surgical emergency, which needs immediate intervention in the form of decompression of the cranial cavity by a burr hole or needle aspiration. The Mount Fuji sign differentiates tension pneumocephalus from pneumocephalus.

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A dentigerous cyst is a developmental odontogenic cyst, which apparently develops by accumulation of fluid between the reduced enamel epithelium and the crown of an unerupted tooth. Through various cases that have been reported, it is observed that 95% of this cyst is associated with permanent dentition while only 5-6% is in association with supernumerary teeth. Mesiodens, a supernumerary tooth situated between the maxillary central incisors, has a prevalence of 0.15-1.9%. Here, a dentigerous cyst in association with a pair of impacted mesiodens is reported in a 56-year-old female patient.

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Septic pulmonary embolism (SPE) is a rare clinical presentation mostly seen in patients who are immunocompromised, in which septic thrombi from an infectious nidus are transported in the vascular system of the lungs. We report a patient presenting with features of sepsis and respiratory distress; chest X-ray and computed tomography (CT) thorax of whom showed multiple bilateral small thick-walled cavities associated with right pleural effusion. He was found to have a septic source of Enterococcus sp. cultured from a perianal abscess with the same bacteremia. Pulmonary septic embolism from the abscess was diagnosed by radiology and correlation of bacteremia from septic foci and blood culture. The clinical condition improved with surgical management of the perianal abscess and appropriate antibiotic treatment.

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Adenomyosis is a common problem in women resulting in menorrhagia and dysmenorrhea. Though tuberculosis of endometrium is common in the developing countries, tuberculosis in the adenomyosis is rare. We present a case of 45-year-old lady who came with vague abdominal pain. With the clinical diagnosis of adenomyosis, hysterectomy was done which showed extensive adenomyosis and tuberculosis in the uterus.

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Total leukonychia is a rare nail disorder that may be inherited or associated with systemic disease or idiopathic where the aetiology cannot be established. Herein, we report idiopathic total leukonychia in two young healthy men, presenting with leukonychia of fingernails since childhood. The cause for leukonychia could not be established in both of them as there was negative family and drug history and there was no evidence of systemic disease.

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Pigmented neurofibroma is a rare variant of neurofibroma commonly associated with neurofibromatosis 1 of diffuse type. Histopathologic examination is essential to differentiate it from other pigmented lesions. We report here a case of pigmented neurofibroma of skin, which was diagnosed after histopathology, histochemistry and immunohistochemistry. We also review the pertinent literature to highlight the differential diagnoses.

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Pleomorphic adenoma is a benign salivary gland tumor commonly affecting in the major salivary glands. Incidence of pleomorphic adenoma affecting minor salivary gland tumors has also been reported. Presenting a case report of a 48-year-old male diagnosed with pleomorphic adenoma arising from minor salivary gland.

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We report a case of an 18-year-old male who presented to us with complaints of decreased hearing, ear discharge, and fullness in the right ear for last 2 months. Examination revealed a swelling of 0.5 cm × 0.5 cm in the inferior part of the external acoustic canal, tympanic membrane was found to be normal. Patient was advised antibiotic and steroids ear drops after making a provisional diagnosis of aural polyp. Surgical excision of the swelling was done when conservative treatment was unsuccessful. The excised polyp was sent for histopathological examination which revealed presence of foreign body giant cells and mixed inflammatory infiltrate around the fragments of hair shafts which confirmed the diagnosis of trichogranuloma in the external auditory canal. Owing to the rarity of such location of trichogranuloma, this case is being reported here.

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Scedosporium apiospermum and its asexual state Pseudallecheria boydiiare increasingly recognized as an opportunistic pathogen. Here, we describe a white grain eumycetoma of left foot of a 48-year-old female caused by S. apiospermum. Treatment with oral voriconazole was successful.

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A 51-year-old gentleman, a known hypertensive on medications presented with transient visual disturbance in his left eye. Examination revealed the presence of unilateral optic disc edema. A lumbar puncture revealed elevated opening pressure with normal cerebrospinal fluid biochemical parameters. Neuroimaging showed no evidence for an alternative cause for intracranial hypertension thus confirming the diagnosis of idiopathic intracranial hypertension (IIH). IIH can rarely present with a unilateral papilledema. This emphasizes the need to meticulously examine both optic fundi in all patients with suspected intracranial hypertension. Early diagnosis of this condition can help in the prevention of permanent visual loss. We hereby report the second case of IIH presenting with a unilateral papilledema in Indian literature.

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Introduction: Lifestyle modification is one of the methods to promote healthy lifestyle among adolescents. In this study, the researcher planned to develop, implement and evaluate a need based Participatory Adolescent Strategic Health Action (PASHA) for lifestyle modification among selected adolescents. Materials and Methods: An evaluative approach with Quasi experimental one group pretest post test design (time series) was adopted. Sample constituted 103 adolescents, aged 12-17 years studying in high schools and pre university colleges of Udupi district selected based on convenient sampling. Data was gathered using reliable and valid tools. Results: The mean combined preventive health lifestyle score among all adolescents increased from 75.65-81.56. Similarly the number of adolescents with healthy lifestyle score also increased from 28.2-53.4% after practicing for 180 days. Analysis of all the components of lifestyle showed that the adolescents had adopted healthy lifestyle practices in all the components of lifestyle. The number of adolescents with combined health status score also showed an increase from 31.1-54.4% after implementing PASHA practice. Analysis of reported outcome among subjects indicated that PASHA was motivating to improve their lifestyle practices. Conclusion: PASHA was found to be effective in lifestyle modification of adolescents. It is reiterated that when lifestyle modification is to be done, a strategy to improve self directedness and self efficacy should be adopted.

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Introduction: Testicular cancer (TC) is the most common neoplasm affecting males between 15 and 35 years of age and testicular self-examination (TSE) has been recommended for its early detection and treatment. Aim: This study evaluated the effect of video-based teaching module (VBTM) on knowledge about TC and TSE among male undergraduate students of a selected college in Bangalore. Materials and Methods: A preexperimental (one group pretest-posttest) study design was adopted, and a purposive sampling technique was used to select 87 participants. Tool for data collection was a self-developed structured questionnaire which was used to assess participants' knowledge of TC and TSE before and after the educational intervention (VBTM). Data collected were analyzed with SPSS 17.0 presenting them in descriptive and inferential statistics. Results: Findings showed that the pretest knowledge score of participants was very poor, and the rate of TSE practice was also very low. Participants' pretest awareness was associated with their attempt/practice of TSE (P = 0.001). After the intervention, there was a significant increase in participants' knowledge. Majority (54%) and 32 (36.8%) had very good and good knowledge, respectively, after the intervention. There was a highly significant difference between the overall pretest knowledge level (mean = 12.66, standard deviation [SD] = 4.62) and posttest knowledge level (mean = 25.7, SD = 3.62) at P ≤ 0.001. Conclusion: VBTM used in this study was effective in improving the knowledge of TC and TSE among male undergraduate students.

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Background: The efficacy of different types of bisphosphonates has already been established in the treatment of osteoporosis and some studies have also shown some correlation to its side effects on oral health. Aim and Objective: To determine the role of different bisphosphonate drugs (inhibitor osteoclast-mediated bone resorption) in the treatment osteoporosis and their adverse effects jaw under one study over a period of 24 months. Materials and Methods: This is a longitudinal study of selected patients and the changes were studied during follow-ups that were designed at 6, 9, 12, 24 months. Four groups (16 patients in each) were formed with patients undergoing treatment for osteoporosis and were administered different bisphosphonates group medicine (Alandronate- short acting; Ibandronate- medium acting; Zoledronic acid- long acting) and effects and side-effects on jaw were studied during follow-up. Results: After 2 years, the patients receiving bisphosphonates (groups A, B, C) had significant increase in their mean (±SE) spinal bone density (4.2 ± 0.8% and 5.2 ± 0.7%, respectively; P < 0.017). The rate of new vertebral fractures was reduced by half in the bisphosphonate-treated patients as compared with the patients who only received calcium and vitamin Db (group D) (29.5 vs. 62.9 fractures per 1,000 patient-years; P = 0.043); also there were seen osteonecrosis-like symptoms in jaw more in zoledronic-acid-using patients and as compared to oral bisphosphonates. Conclusion: Bisphosphonate therapy for 2 years significantly increases spinal bone mass and reduces the incidence of new vertebral fractures in osteoporotic patients, but also has risk factor for jaw bone necrosis associated with it.

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Aim: To evaluate the therapeutic effectiveness of muscle energy technique (MET) and mobilization with the movement of elbow in subjects with lateral epicondylalgia (LE). Settings and Design: This study was conducted in Global Hospitals and Health City, Chennai 100. Subjects were allocated into group A and B through simple randomization method and double-blinded randomized controlled trial was performed. Materials and Methods: An interventional comparative study was conducted on 30 patients having LE. They were randomly assigned to one of the two groups. Group A (n = 15) was treated using movement with mobilization, group B (n = 15) was treated with MET. Both groups received conventional treatment of therapeutic ultrasound, after corresponding interventions. Visual analog scale (VAS) and elbow functional assessment (EFA) scales were the outcome measures, respectively. Measurements were performed before the beginning of treatment, after 10 days and 3 weeks afterward. Statistical Analysis Used: ANOVA and post-hoc analysis Bonferroni method were used to analyze measurements taken at baseline and follow-up at 10 ^th day and 3 ^rd week. Results: Subjects who received mobilization with movement showed a significant improvement in both VAS and EFA than the other group which received MET. Conclusion: We conclude that mobilization with the movement of elbow appears to be more effective manual technique in treating LE in comparison with MET.

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Cardiogenic shock is a pathophysiologic state where an abnormality of cardiac function is responsible for the failure of the cardiovascular system to meet the metabolic needs of the body tissues.Though it is less common than hypovolemia as the primary etiology in paediatric shock, eventually myocardial function is affected because of reduced perfusion in all forms of shock. Myocardial malfunction, in other forms of shock, is secondary to ischemia, acidosis, drugs, toxins or inflammation. Cardiogenic shock is a low output state characterized by elevated filling pressures, neurohormonal activation with the evidence of end-organ hypoperfusion. The management is challenging and consists of a combination of conventional cardio-respiratory support, vasoactive medications with correction of the anatomic cardiac defects. Treatment options like Extracorporeal membrane oxygenation and Ventricular assist devices provide a bridge to recovery, surgery or transplant. As cardiogenic shock in children carries a high risk of morbidity and mortality, emphasis should be placed on expedient management to arrest the pathophysiological cascade and avoid hypotension.This article aims to review the aetio-pathophysiological basis of pediatric cardiogenic shock, diagnostic options, recent advances in management modalities and outcome.

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Psoriasis is a multisystem, chronic, and incapacitating inflammatory disease, which can be associated with comorbidities of varying severity. These comorbidities can have a notable influence on the quality of life and result in mortality in rare instances. Although the disorders represent separate entities, the underlying chronic inflammatory nature of psoriasis and overlapping pathogenic pathways explain most of these associations. These disorders often present years after the initiation of psoriasis and are usually associated with extensive disease. In this review article, we discuss the various comorbidities associated with psoriasis as their early recognition will enable timely intervention, influence management options, and go a long way in improving the quality of life and life expectancy of these patients.

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This paper explores the evolution of the conceptualization of schizophrenia. Specifically, the paper focuses upon negative symptomology and the emphasis that such symptoms have garnered over time. Negative symptoms are associated with higher levels of impairment and poorer outcomes in schizophrenia. Historically, negative symptoms were the core feature of schizophrenia in the early conceptualizations of Kraepelin and Bleuler, holding precedence until the emergence of Schneiderian theory in the 1970's. The focus on negative symptoms then changed to positive symptoms; which is still the key focus today. This shift in emphasis has resulted in a dearth of knowledge and treatment for such symptoms and as such an area requiring further research. The paper also addresses the conceptual changes in the nosology of Schizophrenia and other psychosis with respect to the Diagnostic and Statistical Manual of Mental Disorders-5. Further the potential for the clinical assessment interview for negative symptoms to facilitate understanding and treatments for negative symptomology in schizophrenia is also discussed.

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Supernumerary teeth or Hyperdontia is reported to be more common in the permanent dentition than deciduous dentition. The incidence of hyperdontia is found to be in the range of 0.1-3.8%. The timely diagnosis and therapeutic interventions may avoid the unwanted complications.

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Calcinosis cutis is a condition of accumulation of calcium salts within the dermis. The clinco-radiologic features of a 60 year old lady with idiopathic calcinosis cutis is reported. Emphasis on appropriate laboratory workup is crucial once the diagnosis of calcinosis cutis is established.

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