Background: Sexuality is an important part of personality of adolescents. The age of sexual debut is falling globally. The subject of adolescent sexuality is taboo in most societies. Since 2007 sexual health education program has been banned in six states including Maharashtra and Karnataka. This may lead to misconceptions about sexual heath knowledge and practices among young people. Objective: The aim was to assess the knowledge about sexual health among male students of junior colleges of an urban area and to evaluate the change in their knowledge after imparting sexual health education. Settings and Design: Pre-post-intervention study. Materials and Methods: All 245 male students of 11 ^th standard of all three educational streams of two junior colleges were included in the study. The data analysis was performed using Statistical Package for Social Sciences 18. Results: Science students had "adequate" knowledge about sexual health when compared to arts and commerce students (P = 0.004). Students whose parents were unskilled and semiskilled by occupation had "inadequate" knowledge about sexual health when compared with students whose parents were skilled by occupation (P < 0.05). Education of parents had positive effect on the knowledge about sexual health of students (P = 0.062). In posttest, the knowledge about sexual health of students was found to have increased significantly when compared to pretest. The mean posttest score was 12.61 (standard deviation [SD] 3.12), which was significantly higher than the mean pretest score of 6.34 (SD 3.23) (P < 0.001). Students from nuclear families had "adequate" knowledge about sexual health when compared to students from joint families (P = 0.158) Conclusion: Imparting knowledge about sexual health in adolescent age will be beneficial to the students in avoiding risky sexual behavior. Such educational programs must be given due importance to achieve desirable behavior change among them.

Context: Traffic policemen are at an increased risk of suffering from hazards of noise pollution because they are engaged in controlling traffic noise, particularly at heavy traffic junctions. The effect is more in this subgroup because they are continuously exposed to it. Aim: The present study was aimed at assessing the knowledge, attitude and practices of traffic policemen regarding auditory effects of traffic noise pollution in Ambala city. Settings and Design: Cross-sectional workplace survey. Materials and Methods: The present descriptive study was carried out in different traffic zones of Ambala city during April-June 2013. The study population consisted of 100 traffic policemen working in different traffic intersections of Ambala city. Statistical Analysis Used: Structured interview schedule was used to collect the data. SPSS version 17.0 was used for analysis. Interpretation of data was performed using percentages and proportions. Results: Majority (75%) of the study subjects were exposed to traffic noise pollution for more than 5 years. Of the total subjects, 5% of respondents reported below-average hearing on self-assessment of hearing ability. Seventeen percent of the study population accepted that while hearing over phone they do miss some conversation. Most (98%) of the traffic police did not use any personal protective equipment (PPEs) like earplugs/earmuffs, and the non-availability of these PPEs (90%) is the common reason for the hearing loss. Conclusions: The study concludes that traffic policemen are not much aware regarding impending auditory effects of traffic noise pollution. Duty rotation, duty scheduling and other forms of preventive modalities for exposure limitation are suggested.

Background: Self-medication is one of the major health concerns worldwide and World Health Organization has laid emphasis on correctly investigating and controlling it. There is much public and professional concern regarding self-medication practices, which has dramatically increased in the last few decades, especially in the developing countries. Hence, this study was designed to study the prevalence and practice of self-medication practices in an urban area of Delhi, India. Materials and Methods: A cross-sectional study was conducted in March 2013 and data were collected by personal interviews using pretested questionnaires. An urban colony in the south district of Delhi was chosen and the eldest member of the family, present at the time of the visit was interviewed. Data were collected from 236 persons and analyzed using SPSS version 21. Results: The prevalence of self-medication was 92.8% (95 confidence interval: 66.5-79.4). 74.9% preferred allopathic medicines. Self-medication was found to be practiced more among younger persons than older age group persons (P = 0.000). Graduates and postgraduates practiced self-medication more than others (P = 0.002). Common cold (61.6%) and fever (51.8%) were the most common ailments for which self-medication were practiced. Paracetamol and cough syrups were the most commonly used class of drugs. Conclusion: The prevalence of self-medication in this study was high. Drugs especially antimicrobials were not taken for the proper length of time. Awareness regarding self-medication practices to help patients decide on the appropriateness of self-medication is required.

Introduction: Association between caesarean section and intra operative and post operative bleeding is known. Post-partum hemorrhage is still a leading cause for maternal morbidity and mortality. This study will evaluate the efficacy and safety of tranexamic acid in reducing the blood loss after placental delivery following lower segment caesarean section (LSCS) and note any adverse effects. Materials and Methods: A total of 100 women, who underwent elective or emergency primary caesarean section at term between 37 and 41 weeks have been studied prospectively. They were divided into two groups. In the study group of 50, tranexamic acid 1 gm IV was given 20 minutes before making incision for caesarean section and the control group of 50 did not receive tranexamic acid. Statistical Analysis: For quantitative outcomes, the t-test was used to test for difference in the two groups. For categorical outcomes, chi square and odds ratio with 95% confidence interval were used as applicable. Results: The patient characteristics, namely age, height, weight, gestational age and gravidity in two groups were similar which was statistically insignificant. Hemoglobin decreased slightly after birth in both groups but no statistical difference between two groups was noticed. There was no episode of thrombosis in the study. Tranexamic acid significantly reduced the quantity of the blood loss from time of placental delivery to 2 hours postpartum (P < 0.001) and from end of LSCS to 2 hours postpartum (P < 0.001). However, there was no statistical difference in quantity of blood loss from time of placental delivery to end of LSCS in both groups (P < 0.001). Conclusion: A safe dose of tranexamic acid has an effective role in reducing blood loss during LSCS without causing adverse reaction. Thus, drug can be used effectively in reducing maternal morbidity and mortality during LSCS.

Introduction: Assessment of gestational age (GA) in pregnancy can be carried out by measuring several fetal parameters in ultrasound scans and serial ultrasounds can monitor fetal growth. This study was carried out to assess GA in second and third trimesters with the help of ultrasonography measurements of one of the important fetal parameter that is, the bi-parietal diameter (BPD) in the local population (southern zone) of Rajasthan. Aim: The aim was to provide data for GA estimation by ultrasonic measurement of fetal BPD. Materials and Methods: A total of 200 normal pregnant females were studied with the known last menstrual period in the southern part of Rajasthan. GA determined by measurement of fetal BPD with real time ultrasonography machine. Statistics was applied to correlate GA and BPD. Observation and Results: In this study, fetal mean BPD showed a linear increase from 13 to 36 weeks. Statistically significant correlation was found between GA and BPD (r = 0.38). Mean BPD showed an increase of 2.38 cm in 13-20 weeks, 2.18 cm between 20 and 27 weeks and only 1.72 cm from 27 to 34 weeks. Average growth rate of BPD was found to be 0.31 cm/week from 13 to 28 week, which then later reduced to 0.23 cm/week from 28 to 36 weeks of gestation. Conclusion: Bi-parietal diameter is one of the useful criteria to measure GA and to predict expected date of delivery. Mean measurements of BPD in this study was found to be lower than that of western studies except Hadlock series, which compares well with this study. The mean BPD values of this study compares well with some Indian studies and other found higher results. Variation in predicted values is attributed to anthropometric differences between the two populations due to racial, genetic, nutritional, and socioeconomic factor. Therefore, large scale studies should be done and population-specific tables should be derived to correlate BPD and GA.

Context: Laparoscopic cholecystectomy is one of the most common laparoscopic procedures done. Laparoscopy involves pneumoperitoneum and its subsequent effects. It involves changes in cardiorespiratory system. Earlier studies have documented usefulness of Clonidine in this context. Aims: (1) Evaluation of hemodynamic changes in patients undergoing laparoscopic cholecystectomy receiving pre-operative clonidine infusion. (2) Effect of intravenous clonidine on post-operative analgesia measured in time duration for first rescue analgesic. Settings and Design: This was a prospective, randomized, double blind study. It was conducted at a single specialty high volume tertiary care center. Subjects and Methods: The study took place at a tertiary specialty institute from July 2012 to September 2012. It involved 60 cases randomized into 2 groups by simple randomization. Statistical Analysis Used: The statistical analysis for the inter group hemodynamic parameters and numerical data was done using paired t-test, while categorical data was analyzed by Chi-square test. P ≤ 0.005 was considered to be significant. Results: Clonidine group of patients had significantly lower systolic, diastolic and mean arterial blood pressures with significantly lower heart rate and also statistically significant prolongation of post-operative analgesia and sedation. Conclusions: Clonidine pre-operatively given as infusion in dose of 4 mcg/kg in laparoscopic surgeries, provides a stable hemodynamic state with minimal additional drug requirement and good post-operative analgesia.

Background: Management of nonunion with bony defect and infection in long bones is a challenging problem for orthopedic surgeons. Objectives: Evaluation of Ilizarov circular fixation method of treatment for the management of nonunited and infected fractures of tibia. Materials and Methods: This prospective study was conducted in a tertiary care hospital of eastern region of India on 30 subjects in a time span of 3 years after taking clearance of the Institutional Ethical Committee and informed consent of the patients. Results: All the patients had infected nonunion before undergoing Ilizarov procedure. Following initial injury, 22 patients were treated with external fixation and 8 cases were treated with internal fixation. At the time of presentation, 18 patients had infected gap nonunion, 5 patients had infected hypertrophic and 2 patients had atrophic nonunion. The Ilizarov fixator was kept for an average period of 303.7 days. Based on Association for the Study and Application of Methods of Ilizarov scoring system, bony and functional results were assessed. The bony result was excellent in 16 patients, good in eight, fair in four and poor in two. The functional result was excellent in 10 patients, good in 16, fair in two, poor in two. Conclusion: Ilizarov ring fixator still remains an excellent treatment modality for tibial nonunion with a defect, regarding bone union, deformity correction, infection eradication, limb-length achievement, and limb function.

Background: Clinical and histomorphological features of psoriasis and its close mimickers have many overlapping features. The diagnostic differentiation of psoriasis from other psoriasiform eruptions enables treatment as per the extent of eruptions and modified according to the tissues involved and associated co morbidities. Morphometric analysis of histopathological features may help to alleviate this dilemma. Aim: This study attempts to evaluate the morphometric measurements using eye-piece micrometer in differentiating psoriasis from psoriaform dermatitis. Materials and Methods: The 50 cases, 25 each of clinically and histologically confirmed cases of psoriasis and psoriasiform dermatitis were compared by using measurable morphometric parameters. The results were statistically analyzed for significance. Results: Length of rete pegs, length of dermal papillae and the ratio of length/average width of rete pegs showed statistically significant increase in psoriasis when compared to psoriaform dermatitis. Suprapapillary thickness had less significance. Some other important histomorphological parameters were also compared. Conclusion: The length of rete pegs, the length of dermal papillae and the ratio of length/average width of rete pegs are statistically more significant in the diagnosis of psoriasis when compared to psoriasiform dermatitis.

Protein C and S are essential in limiting the activation of coagulation in vivo. Their deficiencies predispose the patient to thrombophilia and leads to thrombosis, often at unusual sites. Arterial thrombosis is rarely observed. We report a case of a patient with abdominal arteriovenous thrombosis leading to multiorgan infarction secondary to deficiency of protein C and protein S and presenting as acute abdomen.

Hypothyroidism is a systemic disorder characterized by low circulating thyroxine levels. Of late there was some western and sporadic literature from India on the association of hypothyroidism and reversible renal impairment. We here report this association from two of our patients, who presented to us with simultaneously elevated serum thyroid-stimulating hormone and creatinine levels.

Molluscum contagiosum (MC) is a common childhood viral infection caused by a large, double-stranded deoxyribonucleic acid poxvirus. A 22-year-old male patient presents with an infected lesion on his right pinna since the last 1 month, which oozed out a cheesy material on pressing and clinically a sebaceous cyst was suspected, However, on careful histopathological examination a diagnosis of MC was made.

In the past few years, many polio survivors have experienced late-onset neuromuscular symptoms such as fatigue, pain, new, and unusual muscular deficits and decreased functional abilities. Post polio syndrome (PPS) refers to a clinical disorder affecting polio survivors with sequel years after the initial polio attack. The purpose of the present study was to present the results of electrodiagnostic findings in muscle weakness encountered in PPS. Study was suggestive of ongoing axonal degeneration in Rt. Deltoid, biceps, and both soleus muscles with regeneration. Presence of new symptoms of weakness and fatigue in some muscles previously not affected by poliomyelitis and electrodiagnostic findings were suggestive of a diagnosis of PPS.

Vogt-Koyanagi-Harada syndrome (VKH syndrome) is named after ophthalmologists Alfred Vogt from Switzerland and Yoshizo Koyanagi and Einosuke Harada from Japan. It is an uncommon multisystem disorder characterized by chronic, bilateral, diffuse granulomatous uveitis with associated dermatological, neurological and auditory manifestations. It is an autoimmune disease directed against melanocytes. We report a case presenting with vitiligo, auditory defect with additional dextrocardia.

Human hydatid disease occurs due to infection with larval form of Echinococcus granulosus. The disseminated hydatid disease is a very rare finding. Disseminated hydatid disease presenting as a cause of fever of unknown origin is a rare phenomenon. We present to you such a rare case.

Giant hydronephrotic kidney is a rare form of obstructive uropathy in children and adolescents. The congenital ureteropelvic junction obstruction is the most frequent cause. The CT scan is very important for the diagnosis. We report a 6-year-old boy with progressively increasing abdominal distension since birth. There were no associated urinary or gastrointestinal symptoms. He had bilateral hydronephosis with giant hydronephrosis over right side. The cystic mass occupied the right retroperitoneal space and crossed the midline.

Slipped capital femoral epiphysis (SCFE) is a common hip condition occurring in adolescents, with a prevalence of 10 cases per 100,000 children. It usually affects younger age group from 10 to 17 years. The condition is usually found to be coexistent with various other conditions such as obesity, growth surges, and endocrine disorders such as hypothyroidism, growth hormone supplementation, hypogonadism, and pan-hypopituitarism. Patients present with limping and a poorly localized pain in the hip, groin, thigh, or knee. Diagnosis of the condition is often delayed due to its nonassociation with trauma and hence increases the chances of developing various complications such as avascular necrosis, chondrolysis and deformity. Majority of researches of SCFE are from Europe and North America, while studies in Asian populations are rare. Delay in diagnosis of SCFE is usually due to patients presenting with knee pain. Imaging can thus aid in early diagnosis and appropriate treatment of the disease, which in turn reduces incidence of deformity and disability in the affected children. Bilateral hip radiography - anteroposterior and frog's-leg lateral views and magnetic resonance imaging (MRI) are the radiological techniques that help in early diagnosis. MRI detects early physeal changes of both preslip and SCFE even when radiographs and computed tomography are normal. MRI should be routinely used to diagnose early SCFE in preslip stage to avoid further complications.

Giant cell tumor (GCT) also called osteoclastoma of bone is the most common bone tumor encountered by an orthopedic surgeon. GCT generally occurs in skeletally mature individuals with peak incidence in the third decade of life. Less than 5% are found in patients with open physis and only about 10% of cases occur in patients older than 65 years. We present a case of distal femoral GCT managed with custom mega prosthetic arthroplasty.

Systemic lupus erythematosus is an autoimmune systemic disease, particularly affecting women of reproductive age group. Male lupus and associated nephropathy is very uncommon. Elderly male presenting with lupus nephropathy is still a rare finding in literature. We report a case of lupus nephropathy in a 67-year-old male presenting with heavy proteinuria. We also conclude that age and sex of a patient is no bar for lupus, and every physician must consider autoimmune disease even in elderly male patients.

Alkaptonuria is a rare, autosomal-recessive disorder of phenylalanine/tyrosine metabolism due to congenital deficiency of the enzyme homogentisic acid oxidase. Herein, we are reporting a classical case of alkaptonuria with extensive skin pigmentation and skeletal involvement. Histopathological examination also revealed classical ochre-colored deposits in dermis.

Giant cell tumors of the tendon sheath (GCTTS) are the second most common tumor affecting the hand. Lesions are often solitary, painless, slow growing, and sub-cutaneous masses. We present here a case of GCTTS involving the dorsal aspect of little finger with sonographic and magnetic resonance findings favoring the disease, which was further confirmed by biopsy. Most of the cases mentioned previously in literature however show these tumors to occur more commonly on the volar aspect whenever there is involvement of the hand.

Noma is a rapidly progressive, polymicrobial, opportunistic infection that occurs during periods of compromised immune function. It occurs in children with poor nutrition and compromised immune system. Early presentation is unclear as noma is often well progressed at initial presentation. Noma, unlike most infections, is able to spread through anatomic barriers such as muscle, which might also extend to other facial structures leading to extensive soft tissue and bony defects with or without temporomandibular joint ankylosis. Reconstruction of such type of defects poses a challenge for the surgeon as it requires staged surgical approach. A residual noma with a full-thickness defect of upper lip in a 6-year-old child was reconstructed using Estlander flap.

Anemia and jaundice are two important clinical signs in medicine. Occurrence of these two signs together in a patient suggests hemolytic disorders. Hemochromatosis is a disease characterized by hyperpigmentation, arthralgia and diabetes. The disease usually presents in elderly individuals and is rare in menstruating females. We present a case of a young lady with anemia and unexplained jaundice with extensive work-up leading to the diagnosis of hereditary hemochromatosis with megaloblastic anemia. We present the case to highlight the unusual presentation of anemia and jaundice in a case of hemochromatosis.

Schwannoma of the neck is a relatively uncommon tumor. Schwannoma present as insidious, slow-growing, painless masses, characteristics that often lead to an incorrect diagnosis. Cystic schanommas among schanommas are a rare entity. This is a case report of a cystic schwannoma presenting as the cystic lesion in the neck. We report the computed tomography (CT) findings in a 40-year-old female patient presented with a lateral neck mass histologically shown to be a schwannoma, but having certain radiographic features (like tail sign) commonly considered pathognomonic for a type III second branchial cleft cyst (BCC). It is very necessary to differentiate cystic schwannoma from other cystic lesions preoperatively. CT may misguide us for a benign cystic lesion like second BCC. Contrast magnetic resonance imaging and ultrasound findings are very much helpful in differentiation of cystic schwannoma from other cystic lesions of the neck.

We present a case of uretero-appendicular fistula. A 30-year-old woman with fever and lower abdominal pain since 3 months was being investigated. Ultrasound abdomen showed appendicitis with connection between appendix and ureter. Appendicectomy with segmental ureterectomy and end to end ureteral anastomosis was carried out.

Wallenberg syndrome or lateral medullary syndrome occurs due to infarction of the lateral medulla usually supplied by the posterior inferior cerebellar artery (PICA). It most commonly results from occlusion of the vertebral artery followed by the PICA. The clinical manifestations result from impaired functioning of vestibular nuclei, inferior cerebellar peduncle, central tegmental tract, descending sympathetic fibers, nucleus ambiguus, spinothalamic tracts and spinal trigeminal nucleus. The clinical manifestations include dysphagia, nausea, vomiting, ataxia, Horner's syndrome, ipsilateral loss of pain and temperature over the face and contralateral loss over the trunk and body etc. Manifestations depend on the site of lesion. The most common etiology of Wallenberg syndrome being atherosclerotic occlusion of the arteries followed by secondary thrombosis. However, prothrombotic states rarely present as lateral medullary syndrome. Therefore, we report two cases of Wallenberg syndrome where patients were found to have hyperhomocysteinemia as a risk factor for the prothrombotic state.

Teratomas are neoplasms, which are foreign to the anatomic site of occurrence. They occur in children, most commonly in sacrococcygeal region and gonads and less frequently at other sites. Teratomas of gastrointestinal tract are very rare. We report pathological aspects of an unusual case of teratoma having communication with the duodenum with exomphalos minor and malrotation of the intestine.

The hematological malignancy is a well-known complication following breast carcinoma (BC), but the type of malignancy that occurs and treatment regimens followed are still under evaluation. The literature mostly describes therapy-related acute myeloid leukemia and myelodysplastic syndrome associated with BC. Chronic lymphocytic leukemia (CLL) is extremely rare following BC and is mostly described in patients treated with radiotherapy. Herein, we present a rare case of CLL detected at the time of recurrence in a 61-year-old female patient with a previous history of BC solely treated with surgery. She presented simultaneously with metastatic recurrent carcinoma and CLL.

Placental site nodule (PSN) is an uncommon, benign, generally asymptomatic lesion of trophoblastic origin, which may often be detected several months to years after the pregnancy from which it is resulted. This entity may have bizarre histologic findings and should be distinguished from other aggressive lesions like placental site trophoblastic tumor, epithelioid trophoblastic tumor and squamous cell carcinoma.

Congenitally corrected transposition of great arteries (CCTGAs) is a rare congenital heart disease. The literature review reveals that asymptomatic CCTGA is even rarer in elderly male. We report a case of a 54-year-old male, with no past significant medical history, who presented with angina type of chest pain. On examination, he had bradycardia, lower limb hypertension and grade 3 pansystolic murmur in the mitral area. Investigations revealed complete heart block in electrocardiograph, chest radiograph showed cardiomegaly, transthoracic echocardiography showed an apically located systemic atrio-ventricular (AV) valve, parallel arrangement of the great arteries, AV and ventriculoarterial discordance, hypertrophied right ventricle and significant systemic AV valve insufficiency with ejection fraction of 40%. These findings were consistent with congenitally corrected transposition of the great arteries with systemic AV valve insufficiency. Holter monitoring showed complete heart block, no significant pauses and one event of ill-sustained ventricular tachycardia (ventricular triplet) with the patient being asymptomatic during the study period. Need of internal cardioverter-defibrillator or pacemaker was deferred. The remaining hospital stay was uneventful. At the time of discharge, the patient was stable.