Fruits of Citrus genus play an important role as a dietary supplement and therapeutic assent as well since ages. The present review summarizes some such attributes of Citrus genus. Literature review was done through published works to gather information on nutritional and ethnic values, phytochemical and pharmacological properties of Citrus. Information about the plant and phytochemical constituents, pharmacological activities were collected from the published reports. The plant was found to possess significant analgesic, anti-inflammatory, antioxidant, anthelmintic, antibacterial, antifungal, and hypolipidemic properties. They are found to be significant antihyperglycemic, antidiabetic, and hypoglycemic activity. The phytoconstituents which are present in the plant are mainly coumarins and flavonoids which are responsible for the actions. The phytochemical constituents and isolated bioactive compounds of Citrus can be investigated further to develop novel herbal drugs by using reverse pharmacological approaches especially in the treatment of liver diseases, arthritis, malignancies, and other inflammatory diseases.

Transport of sick newborns is undergoing massive changes in India. Over past few years, specialized transport has been activated in most of the states although out of pocket expenditure and absence of health personnel in the ambulance are still posing hurdles. With gradual expansion of all-weather roads to the furthest corner of the country and introduction of free transport for all neonates, it brings opportunities for us to reach all the sick newborns to the nearest equipped hospital at the earliest. Telecommunication and presence of health personnel during transport and training on life support are other initiatives boosting health care of the neonates during transport. Thus, improved transport could be a solution for reduction of stagnant neonatal mortality in India.

Context: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Recent studies report increased the prevalence of COPD among adult females and nutrition is an important prognostic marker in COPD. Nutrition in Indian females is already a concern, further compromised by increasing the prevalence of COPD. Aims: A study correlation of six selected nutritional parameters: Body mass index, waist-hip ratio, waist-height ratio, serum albumin, hemoglobin, and Mini Nutritional Assessment (MNA) score with the severity of COPD (Global Initiative for Obstructive Lung Diseases [GOLD] categorization) in adult female patients. Settings and Design: A cross-sectional analytical study including all adult female patients diagnosed with COPD based on spirometry, attending pulmonary medicine outpatient department of a medical college between January and June 2014. Patients with pulmonary tuberculosis, acute exacerbations of COPD, and those unwilling to participate were excluded from the study. Subjects and Methods: A total of 100 patients were studied with a detailed history, physical examination, spirometry, anthropometric measurements, laboratory parameters of nutrition, and MNA questionnaire. Statistical Analysis Used: SPSS 14.01 version (IBM analytics) with Pearson's correlation coefficient and one-way analysis of variance (ANOVA) as tests of significance. Results: The study revealed that proportion of adult female COPD patients with GOLD categorization is 7% GOLD1, 40% GOLD 2, 42% GOLD 3, and 11% GOLD 4. Pearson's correlation coefficients calculated for the severity of COPD with six selected nutritional parameters showed statistically significant correlation with MNA score (correlation coefficient = −0.253, P< 0.01) and waist-height ratio. Mean MNA score in GOLD four patients (18.72) was significantly lower than that in GOLD 1 patients (22.14). MNA score decreases toward malnutrition as severity of COPD increases which is statistically significant (F = 2.353, df = 3, P< 0.05) using ANOVA. Similarly, waist-height ratio also decreased significantly with increasing severity of COPD (F = 2.582, df = 3, P< 0.05). Conclusions: The study concludes that malnutrition increases the severity of COPD. Further, it also concluded that MNA score and waist-height ratio correlate better with the severity of COPD than other nutritional parameters.

Background: Communication is a process that allows us to interact with other people. Medical professionals need to possess good communication skills for history taking, diagnosis, and treatment. Communicative skills are hardly taught in medical schools of India. The students are expected to learn them on their own. To address this issue, we introduced communicative skills training (CST) for medical interns. Objective: Primary – To determine the effectiveness of CST in improving history taking on sensitive issues by medical interns. Secondary – To improve patients' satisfaction through improved communicative skills. Materials and Methods: This was a randomized control study carried out on medical interns at Jamnagar. The interns were randomized to either Group A or Group B. Intervention in the form of CST was given to Group A while Group B was control. The topic of CST was “eliciting sexual history.” Assessment of participants was done by pre- and post-intervention objective structured clinical examination. For ethical reasons, Group B was also given CST by experts after completion of our study but their results were not included for analysis. Results: Although mean scores increased in both the groups, (from 6.4 to 13.4 in the intervention group and from 6.5 to 7.5 in controls), the percent increase was much larger in the intervention group than controls (109% vs. 15%). Students gave a positive feedback to CST. Opinion of teachers was favoring CST. Among the patients allotted to intervention group, 83% were satisfied. Conclusion: CST imparted to medical interns helps in improving doctor–patient relationship.

Aim: We aimed to analyze the early predictors to differentiate primary from secondary dengue infection and the severity of liver involvement with reference to mortality. Materials and Methods: This prospective study was conducted on 200 children having acute febrile illness between 3 months to 15 years age group. One hundred and five serologically confirmed dengue patients were included in the study and classified into primary and secondary dengue infection. Liver function tests (LFTs) and electrolytes were analyzed, and the hepatic dysfunction was correlated to the severity of the disease. Results: Of the 105 serologically confirmed dengue, 62 (59%) were primary and 43 (41%) were secondary dengue infection. Primary dengue infection was more common in <1 year age group (35.5%), whereas secondary dengue infection was more common in 6-10 years age group children (41.9%). There was no difference in means of LFTs, but hyponatremia (<134 meq/L) and thrombocytopenia (<50,000/mm³) were more frequent in secondary dengue infection. The mortality rate of dengue infection was 3.8%. Conclusion: Abnormal LFTs can be a marker to predict disease severity, but may not differentiate primary from secondary dengue infection. Occurrence of hyponatremia and thrombocytopenia may identify children likely to have secondary dengue.

Introduction: Invasive fungal infections are an important nosocomial health problem, candidal infections being the most common. Candidal bloodstream infections (BSIs) account for one-fourth of the nosocomial BSIs. Candida albicans once the most common has now been replaced by nonalbicans Candida, accounting for majority of cases of candidal infections. The knowledge and understanding of specific risk factors, epidemiology, prophylactic measures, and outcomes with relation to speciation are changing rapidly. Emergence of antifungal resistance is a cause of concern. With this background, a prospective study was undertaken. Aims and Objectives: To isolate Candida spp. from blood cultures of patients with clinically diagnosed or suspected septicemia; to identify and speciate Candida isolates and carry out the antifungal susceptibility test; to determine incidence of candidemia; to find out the crude mortality rate in candidemia patients. Materials and Methods: Blood cultures received in the Department of Microbiology from various critical care units over a 1-year period were included in this study. Samples were cultured on Sabouraud dextrose agar and routine bacteriological cultures. Speciation of suspected Candida growth was done by conventional and automated system. Results: A total of 225 out of 839 blood cultures were culture positive. A total of 196 were bacterial pathogens. Candida spp. were isolated in 29 samples. These included 10 cases of Candida tropicalis, 8 Candida parapsilosis, and three cases each of C. albicans and Candida krusei. Fluconazole resistance was seen (minimum inhibitory concentration ≥64 μg/ml) in 4 isolates, 2 of C. krusei and 2 of Candida haemulonii. Incidence of candidemia was 3.46%. Crude mortality rate in the present study was 24%.

Background: The majority of parotid masses are benign pleomorphic adenomas that rarely recur, leaving a large group of patients healthy after their parotid surgery. Nearly, 80–90% of salivary gland tumors occur in the superficial lobe of the parotid gland, and the vast majority of them are benign. The optimal treatment for benign parotid tumors, of which pleomorphic adenomas is the most common is superficial parotidectomy with dissection and preservation of the facial nerve. Aims and Objectives: The aim of this study was to evaluate the postoperative complications and tumor recurrence following superficial parotidectomy for benign parotid tumors. Settings and Design: This was a retrospective study conducted of all patients who underwent superficial parotidectomy in a General Surgical Unit of the Goa Medical College, Bambolim, Goa, between December 2013 and December 2014. Materials and Methods: The records of 17 patients were analyzed in detail with regard to the complications and tumor recurrence that followed the operation of superficial parotidectomy. Data regarding age, gender and histology were also included in the study. Patients had all been chosen from the out-patient department on the basis of clinical presentation of swelling over the parotid region. The location of the tumor and diagnosis was confirmed in every case by advising ultrasound of the parotid region and/or computed tomography scan along with fine needle aspiration cytology of the swelling. All data were meticulously entered in a previously prepared proforma for this purpose. Patients were followed up for 1 year. Results: Twelve (70.5%) patients were male and 5 (29.5%) female, with ages ranging from 21 to 65 with a mean age of 38.2. There were 16 pleomorphic adenomas 94.1% and 1 adenolymphoma. Partial or temporary facial nerve damage was seen in six patients at 35.3%. At 6 months follow-up, however, recovery was complete, and we had no permanent facial nerve damage. Of 17 patients, 10 (58.9%) complained of numbness of the ear lobule which gradually improved with time. None of our patients had an infection, permanent facial weakness, or tumor recurrence. However, it should be stressed that Goa is a small state and due to the small number of cases in the study, it could be labeled more as a personal one. Conclusions: Superficial parotidectomy is a safe operation if performed with attention to detail, meticulous gentle dissection and avoidance of direct trauma or stretches to the nerve to prevent facial weakness.

Background: Recurrent aphthous stomatitis (RAS) is a chronic inflammatory disease of the oral cavity. Although many factors have been suggested as possible causes of RAS, its precise etiology is controversial. Vitamin B12 (vit B12) and iron deficiencies may cause RAS. Aims: We investigated the level of serum hemoglobin (Hb) and vit B12 in patients with RAS and to compare them with healthy controls. Materials and Methods: This was a prospective, cross-sectional study. Patients who had had at least one episode of oral ulcerations per month since childhood were diagnosed as having RAS. Blood samples were drawn from the RAS group and control group for measuring blood Hb and vit B12 concentrations. Results: Exactly 195 patients (62 men and 133 women) with RAS and 217 healthy controls (62 men and 155 women) were enrolled in the study. The RAS group had significantly lower mean Hb levels than the control group (P < 0.001). No significant difference in the mean vit B12 level was demonstrated between the study group and controls. Around 58 (29.7%) patients were diagnosed as Hb deficient in the RAS group and 21 (9.7%) patients in controls. Vit B12 deficiency was diagnosed in 63 (32.3%) individuals in the RAS group and 32 (14.7%) individuals among controls. Conclusions: In our study, vit B12 and Hb deficiency were found higher in patients with RAS compared to the control group. Therefore, we suggested the investigation of the level of vit B12 and Hb in patients with RAS.

Background: Mitral regurgitation (MR) after acute myocardial infarction is common and often silent. Therefore, it should be specifically sought with careful physical examination and Doppler echocardiography. It also denotes an adverse prognosis. Materials and Methods: In this prospective study, we studied 52 patients of ST elevation acute myocardial infarction. The patients of ST elevation acute myocardial infarction whose admission electrocardiogram showed ST elevation of more than 0.1 mv (1 mm) in two or more limb leads or more than 0.2 mv (2 mm) in two or more chest leads were included in the study. Detailed echocardiographic analysis was done in all patients within 48 h of admission. MR jet was systematically evaluated using color Doppler as a primary tool. MR was classified as mild or moderate to severe depending on the recorded values. Results: Ischemic MR was detected in 22 patients. There were 12 patients with mild MR and 10 with moderate-to-severe MR. Thus, we had two groups of patients. One who had echocardiographically detected MR and other group without echocardiographically detected MR. Percentage of smokers was higher in the group of patients with MR than those without MR (72% and 60%, respectively). In addition, patients in the group with MR were with higher body mass index and were likely to present with higher Killip class on admission. Percentage of patients presenting with left ventricular (LV) enlargement was higher in the group of patients presenting with MR than those without MR (60% and 20%, respectively). In addition, LV dysfunction (both systolic as well as diastolic) was more prevalent in the group of patients presenting with MR than those without MR. Mortality percentage was higher in the group of patients presenting with MR than those without MR (22% and 10%, respectively). However, this difference was not statistically significant (P = 0.2597). Conclusion: Clinical or echocardiographic detection of MR derives its prognostic significance from an integration of multiple clinical, radiographic, electrocardiographic, and other echocardiographic characteristics.

Introduction: Varicose veins cause a great deal of morbidity in our population today. They are part of the penalty we pay for the adoption of the erect posture. They affect 10–20% of population in the Western world but in India, it is 5%. Varicose veins do not threaten life and are seldom disabling, but they cause a considerable demand on medical care. They are the cause of morbidity and loss of precious work hours and a significant financial burden on the health-care system. Aims and Objective: To study the epidemiological factors with respect to age, sex, and occupation and clinical profile as per Clinical, Etiologic, Anatomical, Pathophysiological classification of varicose veins. Materials and Methods: A total of sixty cases of were examined at a teaching Medical College, Hospital and Research Centre during the period from July 2013 to September 2015. Examination of patients was carried out according to the pro forma. All patients underwent detailed clinical examination followed by color Doppler ultrasound. Results: In our study, 70% patients were males and 30% patients were females. Maximum patients were in age group of 45–54 years. Twenty were in CEAP C2, 15 cases in CEAP C3 and 15 cases in CEAP C4 and 10 cases in C5. Sixty percent patients had involvement of great saphenous vein (GSV), 17% patients had short saphenous vein (SSV) while 23% patients had involvement of both GSV and SSV. Conclusion: Not only prolonged standing but also sitting posture can cause varicose veins. Obesity and increasing age are other risk factors. Classifying the varicose veins has an impact on the course of the disease and preventing its complications. Color Doppler is superior to clinical examination in the evaluation of superficial and perforator veins incompetence.

Aims and Objectives: The aim of the present study was to compare the laryngeal mask airway (LMA) insertion conditions using either nalbuphine - propofol or dexmedetomidine - propofol. Materials and Methods: Sixty female patients aged 25–35 years posted for interval tubal ligation were randomly allocated in two groups of 30 each. Group N received intravenous injection nalbuphine 0.2 mg/kg over 5 min, and Group D received injection dexmedetomidine 1 μg/kg over 5 min. Later, all the patients were induced with injection propofol 2 mg/kg and 90 s after induction, classic LMA of number 3 was inserted in all the patients. LMA insertion conditions were assessed using various parameters. Heart rate, mean arterial pressure, respiratory rate, and SpO₂were recorded before induction and at 1, 3, 5, and 10 min after LMA insertion. Incidence and duration of apnea were also recorded. Observations and Results: Demographic data were comparable in both the groups. LMA insertion conditions were comparable in both the groups (P = 0.15), and both the groups had excellent LMA insertion conditions. The apnea duration was slightly more in dexmedetomidine group (140 s) as against nalbuphine group (120 s). The reduction in heart rate was more in Group D and the difference was statistically significant at 1 and 3 min after induction (P < 0.001). Conclusion: Nalbuphine combined with propofol provides similar conditions of LMA insertion as that of dexmedetomidine - propofol combination with advantage of better maintenance of hemodynamic stability.

Background: Magnetic resonance imaging (MRI) is an excellent noninvasive technique to evaluate the female pelvis due to its high spatial resolution, excellent tissue contrast, and multiplanar imaging capability. Radiologists often evaluate a wide range of pelvic masses during routine clinical practice. Objective: Aim and objective of the study is to evaluate the importance of MRI in the pelvic masses and to characterize the MRI findings in female pelvic masses. Materials and Methods: We prospectively performed MRI in our institute in 58 patients which detected pelvic pathologies or pelvic masses on clinical examination and/or ultrasonography. These lesions were examined for size, shape, signal intensity, character, and postcontrast enhancement. Secondary signs such as ascites, lymphadenopathy, and invasion of the adjacent organs were observed. Results: MRI was significantly superior to ultrasound in the evaluation of the tumor extension, myometrium invasion, detection of lymph nodes, and parametrical involvement anorectal carcinoma. Overall accuracy for detection of lesion by MRI was 97%, and sensitivity for the diagnosis of malignancy was 94%. Conclusion: MRI is an excellent investigation to evaluate the female pelvic masses due to its high spatial resolution, excellent tissue contrast, and multiplanar imaging capability. It is a very good modality for the tumor staging and follow-up of the cases. Certain key imaging features of uterine or adnexal pathologies on MRI are helpful in the specific diagnosis or narrow down the differential diagnosis. Characterization of uterine and ovarian tumors helps in the surgical planning.

Since the emergence of Middle East respiratory syndrome in Saudi Arabia in 2012, it has been acknowledged as a major global public health threat. The Kingdom of Saudi Arabia (KSA) serves as one of the biggest hosts for millions of pilgrims. However, owing to the potential of the virus to spread internationally, overcrowding, and tough physical conditions for the pilgrims, it is quite a tricky situation for the travelers planning to visit Saudi Arabia. Experts have recommended that the current situation in KSA does not meet the criteria to be acknowledged as a public health emergency of international concern. Indirectly, it means that currently there is no public health justification to suggest that travel or trade should be restricted to Saudi Arabia. To conclude, travel to Saudi Arabia by the pilgrims for Hajj has been declared safe and no restrictions have been imposed. Nevertheless, it is the responsibility of policy makers, health professionals, and pilgrims themselves to prevent any major outbreak by adhering to the recommendations proposed by the International Health Regulations.

A 40-day-old baby presented with prolonged fever, petechial spots, hepatosplenomegaly, generalized lymphadenopathy, and pancytopenia. Investigations revealed positive anti-dengue virus IgM antibody, and bone marrow examination demonstrated the presence of hemophagocytes. The diagnosis of hemophagocytic lymphohistiocytosis (HLH) was made according to HLH-2004 guidelines. HLH associated with primary dengue in an infant who was symptomatic from neonatal age has hitherto not been reported in the literature.

Benign intracranial hypertension (BIH) due to hypothyroidism in children is rare. We report a case of BIH due to hypothyroidism with bilateral sixth nerve palsy in a hemophilic child. The child presented with headache, vomiting, and inward deviation of both eyes for 10 days. On examination, her vision was 20/40 both eyes with restricted abduction in both the eyes. Anterior segments were within normal limits. Fundus showed bilateral disc edema. No marked abnormality was detected by neuroimaging. Baseline investigations were normal except a raised thyroid stimulating hormone. We started the patient on tablet acetazolamide, domperidone, and systemic steroids. Disc edema and ocular movements started improving. We have not come across any such case in literature after thorough PubMed search. The presentation, management, and future problems of this rare case are discussed.

Heterotopic gastric tissue has been described in various parts of the gastrointestinal tract as an incidental finding. However, its presentation as a mass in the jejunum with obstructive manifestations is a rare event. We report here a rare case of giant polypoid gastric heterotopia in the jejunum that presented with intestinal obstruction in a 22-year-old female, along with a brief review of the literature.

Verrucous carcinoma is an uncommon locally invasive slow growing squamous cell carcinoma of the skin and mucous membrane. It usually appears as a raised, fungating, white cauliflower-like mass. It usually occurs in oral cavity followed by genital region. Human papillomavirus, betel nut chewing, alcohol consumption, and schistosomiasis are the accepted causes for verrucous carcinoma. The recommended treatment is wide local excision with a negative margin. Even after wide local excision, local recurrence is very high compared to squamous cell carcinoma. Until now, only one case was reported with presternal verrucous carcinoma which is a rare occurrence.

Myeloid sarcoma is rare. It is a tumor of immature myeloid cells. We present one such case where the patient presented with a soft tissue swelling in the thigh. The fine needle aspiration cytology (FNAC) was reported as myeloid sarcoma. Simultaneously, the patient was subjected to routine hematological examination which revealed chronic myeloid leukemia in chronic phase. The diagnosis was further confirmed by bone marrow aspiration and cytogenetic study. This case emphasizes FNAC as the easy, rapid, and cost-effective method of diagnosis. The patient was subsequently treated and is currently under follow-up. Hereby, we are presenting an uncommon case of myeloid sarcoma with brief literature review and discussion about the differential diagnoses.

Acute muscarinic and nicotinic side effects of organophosphate (OP) poisoning are well known and easily recognized, but neuropsychiatric changes are rarely reported. We are reporting a case of a 22-year-old male who developed psychotic features and motor neuropathy following acute OP poisoning.

Tropical pyomyositis, a disease often seen in tropical countries, is characterized by suppuration within skeletal muscles, manifesting as single or multiple abscesses. The most common organism implicated is Staphylococcus aureus. In 20-50% of cases there is a history of trauma to the affected muscles. Commonly involved muscles are quadriceps, glutei, pectoralis major, serratus anterior, biceps, iliopsoas, gastrocnemius, abdominal, and spinal muscles. Early diagnosis is often missed because of lack of specific signs, unfamiliarity with the disease, atypical manifestations, and a wide range of differential diagnosis. Diagnostic techniques such as ultrasound and computed tomography/magnetic resonance imaging are very useful in diagnosis. The diagnosis is confirmed either by biopsy or aspiration of pus from the affected muscles. The initial antibiotic of choice is cloxacillin. Incision and drainage are important components of management. Treatment for Gram-negative or anaerobic organisms should be instituted, whenever indicated. Physicians should become more familiar with this potentially life-threatening but curable infective disease entity.

In humans, hydatid cyst is caused by Echinococcus granulosus. E. granulosus mainly affects the liver and lungs. It is very rare to get a primary ovarian hydatid cyst. Hence, we are reporting a very rare case of primary ovarian hydatid cyst.

Cystic lymphangiomas are rare benign tumor of the breast in adults. They are usually located in head and neck, axilla, and mediastinum. They are most commonly diagnosed in young children. Nearly 90% are apparent by the age of 2 years. Here, we reporting a case of 20-year-old female presented with gradually increasing painless swelling in the upper outer quadrant of her left breast for 1½ years. Mammography of the breast showed multiple irregular hypoechoic lesions associated with irregular duct dilatation. Lumpectomy was performed and diagnosed as cystic lymphangioma. Complete excision is the treatment of choice.