Depression is a common neuropsychiatric condition associated with systemic sclerosis. The association of depression and systemic sclerosis is the result of multiple mechanisms such as autoimmune, significant morbidity due to multi-system involvement, distorted self-image due to disfigurement, chronic disability, and iatrogenic. The prevalence of depression in systemic sclerosis is as high as 65% as found in several clinical studies. Early diagnosis and appropriate intervention of depression in systemic sclerosis through integrated multidisciplinary team approach is more likely to improve the global outcome of illness. Hence, multidisciplinary management approach is highly recommended for the management of depression in systemic sclerosis.

Ultrasonography (USG) is well-known as a fast, safe, and noninvasive technique. Its application for imaging of the airway is now gaining momentum. The upper airway has a complex anatomy, and its assessment forms a vital part of every preanesthetic evaluation. Ultrasound (US) imaging can help in upper airway assessment in the preoperative period. There are various approaches to upper airway USG. The technique has its own advantages, disadvantages, and limitations. This simple yet challenging imaging technique is all set to become an important part of routine preoperative airway evaluation. This article reviews the various approaches to upper airway US imaging, interpretation of the images, limitations, and disadvantages of the technique and its varied clinical applications in the preoperative period. The scientific material presented here was hand searched from textbooks and journals, electronically from PubMed, and Google scholar using text words.

Aims and Objectives: To know the various parameters and diagnostic approach of megaloblastic anemia. To know the age incidence and sex ratio. Materials and Methods: A hospital-based retrospective and prospective study was done for a period of 1-year. Totally, 21 cases were analyzed, and we correlated signs, symptoms, and hematological investigations. Results: Totally, 21 children with megaloblastic anemia in the above said period were studied. The patients age group was ranged from 2 months to 15 years. Megaloblastic anemia was observed in all the cases. Conclusion: Megaloblastic anemia is one of the common causes of undiagnosed anemia, and the treatment is simple and easily affordable. If left untreated, it can lead to morbidity both because of anemia and attendant neurological involvement.

Background: Anemia is a common complication of human immunodeficiency virus (HIV) infection. The role of iron, Vitamin B12, and folate deficiencies, which are otherwise most common causes of anemia, is not well-established in HIV patients. Several studies in India have shown that severe immunodeficiency is associated with higher grade of anemia, but correlation of CD4 cell counts with severity of anemia is not well-documented. Aims: The aims of the present study were: To estimate the point prevalence of anemia in HIV patients, to analyze the causative role of iron, Vitamin B12, and folate deficiencies in anemic HIV patients, and correlating the degree of severity of anemia with CD4 cell counts. Materials and Methods: This study was a cross-sectional study. The study group enrolled 103 consecutive HIV patients attending medical emergency, medical outpatient department, medical wards, and anti-retroviral therapy (ART) center at a tertiary care medical center in North India. Study participation consisted of a single visit during which relevant data, including medical history, current medications, CD4 T-lymphocyte count, complete hemogram with red blood cell indices, peripheral smear picture, iron studies, serum Vitamin B12, serum folate and bone marrow studies, were recorded on a case report form. Anemia was classified according to the World Health Organization criteria. Data analysis was carried out using Microsoft Excel and Statistical Package for the Social Sciences software. Results: 86.4% (89/103) patients were found to be anemic. There was no significant difference in prevalence of anemia in ART-naive patients from those who were on ART (P > 0.05). Pearson's correlation had shown a highly significant positive correlation of hemoglobin and CD4 cell counts in male patients (r = 0.418) as well as female patients (r = 0.565). Normocytic normochromic was the most common type of anemia in males (46%) as well as females (42%). Significant iron deficiency (P = 0.022) was observed in 42.85% of the patients having microcytic hypochromic anemia. Significant Vitamin B12 and folate deficiencies were observed in patients having macrocytic anemia (47.05%, P = 0.003 and 35.29%, P = 0.012, respectively). Conclusions: This study shows that anemia is highly prevalent in HIV patients and severity of anemia increases with decrease in CD4 cell counts. Nutritional deficiencies play a significant role in causing anemia in these patients.

Objective: To describe the clinical profile of hemophiliac patients and their quality of life (QoL) in Western Uttar Pradesh. Materials and Methods: This was an observational cross-sectional study. Patients of all age groups with hemophilia admitted in the medicine and pediatrics ward for factor/fresh frozen plasma transfusion or having history of such type of transfusion were consecutively enrolled. A detailed clinical history was elicited from the accompanying parent/guardian. The HAEMO-QoL questionnaire was used for the assessment of QoL of the patients. Results: Out of the total 71 hemophilia patients, 66.2% (51/77) were >18 years of age. Type A hemophilia was observed in 88.3% (68/71) patients. Majority of the patients had severe hemophilia (80.5%). The family history and joint involvement were present in 58.4% and 77.9% of the patients, respectively. Knee joint was observed to be as the target joint among 57.1% of the patients. 76.6% of the patients had joint swelling, resulting in compromised joint movement. Bleeding occurred in soft tissues and joints in 62.3% and 15.6% of the patients, respectively. The patients had poor QoL scores. Overall, hepatitis B and C infection were observed in 6.5% and 9.1% of the patients, respectively. Orthophysiotherapy was needed in 22/26 (84.6%) patients. Conclusion: The severe type of haemophilia Type A was more common than mild and moderate types. The study suggests that important determinants for QoL in haemophilia patients are availability of factor concentrate from the clinical perspective and social and psychological support to ensure a holistic care approach.

Background: Patient satisfaction can be explored which may draw attention of the health care providers, administrators, and health policy makers, in order to monitor the performance, determine patients' needs, plan the development of services, and provide evidence to support the applications for financial support and expenditure. Aims and Objectives: To assess the level of satisfaction of patients regarding the different aspects of health care in an Urban Health Care Centre of Siliguri Municipal Corporation, Darjeeling, West Bengal and to identify the reasons of dissatisfaction among patients in that urban health care center. Materials and Methods: A cross-sectional survey on 102 patients with a Patient Satisfaction Questionnaire-18 was done. Systematic random sampling was adopted to draw samples. Results: Overall satisfaction was 73.1% with a mean value of 3.655. Highest satisfaction was in general satisfaction, and the lowest was in time spent with doctors Conclusion: Mean score and percentage of the patient satisfaction was high in that Urban Health Centre. Only matter of concern was time spent with the doctor. Doctor's time, lack of facility and poor quality of services were the major reasons for dissatisfaction among a few dissatisfied patients.

Background: Work-related musculoskeletal disorders, especially low back pain (LBP), cause substantial economic loss to individuals as well as to the community. Salespersons in department stores are at an increased risk of developing musculoskeletal symptoms. Among these, LBP is most extensively reported. Their jobs involve prolonged standing and manual handling tasks such as lifting, carrying, pushing, and pulling which have been identified as risk factors for musculoskeletal symptoms. Objectives: To find out the prevalence of LBP in salespersons and its association with ergonomic risk factors. Materials and Methods: A cross-sectional survey consisting of 150 salespersons from different malls between 20 and 40 years with body mass index between 18 and 24 kg/m ² , having at least 1-year working experience and standing for 5 h/day, was conducted in Ahmedabad. Those with a history of trauma, preexisting medical conditions, or musculoskeletal deformities were excluded. One-year prevalence of self-reported LBP was assessed using Standardized Nordic Pain Questionnaire. Individual factors and ergonomic risk factors were also assessed. The level of significance was set at 5%. Statistical software GraphPad Prism version 5 was used for analysis. Results: One-year prevalence of self-reported LBP was 58%. Frequency of prolonged forward bending and twisting the body was significantly associated with LBP (P < 0.001). Working in static posture for longer periods during work was also associated with LBP (P < 0.01). Conclusion: Prevalence of self-reported LBP in salespersons of Ahmedabad was 58%, and it has a significant association with ergonomic risk factors.

Introduction: The morphological mensurative data of the portal venous system is important, as regards portal hypertension and surgical aspects related to portocaval anatomosis. Aims and Objectives: The study under consideration was under taken to determine the actual percentage incidence of major variations occurring in the disposition of the portal vein (PV) and its tributaries. The basis of major variations has different reasons such as genetic, metabolic, hemodynamic factors depending on the type of variations. Materials and Methods: This study was conducted on 30 adult human cadavers by dissection method. The abdomen was opened by standard cruciform incision, and the region of PV was cleaned and observations were made and recorded. Result: The PV had normal standard pattern in 30% cases and the rest 70% showed variations in one or the other form. The splenic vein was variant in 76.6% cases. The superior mesenteric vein showed variation in 73.3% cases. The mode of termination of the inferior mesenteric vein was variable in 60% of cases. Conclusion: The incidence of variations in the portal venous system can be of prime surgical and radiological importance for portocaval anastomosis and to study hemodynamic flow radiologically.

Background: Many disorders of pregnancy, which are associated with a high perinatal morbidity and mortality, are accompanied by gross pathological changes in placenta. Hypertensive disorders of pregnancy are common, and form one of the deadly triads along with hemorrhage and infection that greatly contribute to maternal mortality and morbidity. In addition, they are strongly associated with fetal growth restriction, prematurity, and contributing largely to perinatal mortality and morbidity. A study of placentae was done to find out the morbid and histological changes in placentae of hypertensive mothers and to correlate the findings with the birth weight of new born babies. Materials and Methods: Ninety placentae were studied. The weight of the placenta, placental fetal ratio, retroplacental hematoma, infarction, and histopathological findings were noted. Placental findings were correlated with fetal outcome. Results: The placental weight and fetoplacental weight ratio (5.38:1) was decreased in the hypertensive group. There was an increase in the incidence of infarction (28.8%) and retroplacental hematoma (15.5%) in the hypertensive group. Percentage of cytotrophoblastic proliferation of villi, >30% syncytial knots formation (64.5%), basement membrane thickening of villi (37.8%), and fibrinoid necrosis of villi (46.7%) increased in the placentae from pregnancy-induced hypertension group as compared to the normal group. Conclusions: Hypertensive disorders of pregnancy adversely influence the morphology of placenta. Fetal outcome is poor in the presence of infarction, retroplacental hematoma, basement membrane thickening of villi, and fibrinoid necrosis of villi. The pathological changes observed in the placentae of patients with hypertensive disorders of pregnancy adversely influence the perinatal outcome.

Background: Nephrotic syndrome (NS) is the manifestation of a wide variety of underlying disease processes. The spectrum of diseases causing NS is changing globally in the last few decades. In this context, renal biopsy findings in adult nephrotics studied during 1996-1998 are revisited Materials and Methods: The cross-sectional analytical study was conducted during the period May 1996-July 1998 at a medical college in Western India. Renal biopsies were performed on 72 adult nephrotic patients. Histopathology reports along with clinical data reviewed and analysed. Results: Primary glomerular diseases accounted for 70% of cases, while amyloidosis was the most common secondary glomerular disease. Mesangiocapillary glomerulonephritis was the most common cause of primary NS followed by minimal change disease (MCD) and membranous glomerulonephritis (MGN). Previous studies showed that MGN was the most common cause of adult NS. More recent studies have shown that the focal segmental glomerulosclerosis (FSGS) is increasing significantly with reduction in diffuse proliferative glomerulonephritis while there was no major change in incidence of other diseases. FSGS which is the most common cause of NS in adult in other studies accounted for only 8.5% in our study. Immunofluorescence and electron microscopy was not done in these cases resulting in more cases of MCD and less number of IgA nephropathy and FSGS. Conclusion: In view of changing spectrum of renal diseases, evaluation of adult NS should be done on a regular basis for the correct diagnosis.

Background: The maternal health status of Indian women was noted to be lower as compared to other developed countries. Promotion of maternal and child health has been one of the most important components of the Family Welfare Programme of the Government of India. For sustainable growth and development of country, there is a need to improve MCH Care in the country. Safe motherhood by providing good antenatal care (ANC) is very important to reduce maternal mortality ratio and infant mortality rate and to achieve millennium development goals. Objectives: This study aimed to determine the level of knowledge, attitude, and practice on ANC among pregnant women attending the antenatal clinic at a Tertiary Care Hospital in Pune and their association with various sociodemographic factors. Materials and Methods: A cross-sectional study was carried out among 384 pregnant women in their 3 ^rd trimester attending the antenatal clinic in a Tertiary Care Hospital of Pune, Maharashtra during October 2011 to September 2012. Pretested questionnaire was used for collecting data by interview after obtaining informed consent. Statistical analysis was performed using SPSS version 20 and Epi Info Software. Results: Study reveals that about 58% women had adequate knowledge regarding ANC. It was found that almost all the variables such as age, education, occupation, parity, type of family, and socioeconomic status (SES) had a significant association with awareness about ANC. 100% women were having a positive attitude toward ANC. Around 70%, women were practicing adequately, and variables such as education and SES had a significant association with practices about ANC. Conclusion: These findings can be used to plan a Health Intervention Program aiming to improve the maternal health practices and eventually improve the health status of the women.

A young patient reported to neurosurgery outdoor department with symptoms of increased intracranial pressure. Noncontrast computed tomography examination showed a single calcified mass within right lateral ventricle with mild hydrocephalus. Contrast-enhanced magnetic resonance imaging revealed nonenhancing single mass within right lateral ventricle with mild hydrocephalus. Intraventricular calcified choroid papilloma/calcified epidermoid were radiological differentials. The mass was excised, removed from the lateral ventricles and found to be calcified epidermoid on gross and microscopic examination, which is rare.

A 57-year-old asymptomatic lady had come for a master health check-up with a report of fibroid uterus diagnosed on ultrasound at a private hospital. Intraoperatively, a large retroperitoneal tumor was found with the uterus and adnexae being normal. The mass was removed in toto, and its pathological examination revealed a malignant mixed Mullerian tumor (MMMT). Immunohistochemistry also supported the diagnosis of MMMT. The postoperative period was uneventful, and the patient was discharged with the advice of oncology referral.

Pilomatrixoma, a benign skin appendageal tumor, is seen commonly in head and neck. Pilomatrixoma also known as pilomatricoma or calcifying epithelioma of Malherbe. These lesions are typically found in the head and neck region, but also occur in the upper extremities and are rarely reported in other sites. Most cases of pilomatrixoma occur in children under the age of 7 and the condition is twice as common in females as in males. Pilomatrixomas are frequently misdiagnosed when the evaluation is based on clinical or radiographic examination alone. Therefore, the final diagnosis requires histopathological examination.

A submucosal lymphangioma is a rare pathology in the alimentary tract. It is a benign entity of the lymphatic system. A duodenal lymphangioma is extremely rare and has an unknown etiology. Clinical and laboratory findings are nonspecific, and they are incidentally found by endoscopy and their treatment is surgical excision. Small lesions are often asymptomatic. Recently, the authors experienced a 62-year-old man, who had a duodenal lymphangioma, showing gastric outlet obstruction symptoms. A multidetector computed tomography abdomen study revealed a single submucosal cystic lesion in second part of duodenum. The lesion was successfully excised after Whipple's procedure. Histopathology confirmed the diagnosis of lymphangioma.

Nondiphtherial Corynebacterium (diphtheroids) has been related to blood and wound infections but are an uncommon cause for soft tissue infection. We report a case of periorbital soft tissue infection with ulceration caused by multidrug-resistant Corynebacterium spp. in a 9-year-old girl who is apparently immunocompetant. Computed tomography scan showed soft tissue involvement of right periorbital region with no bony destructions or focal calcifications. Vision remained unaffected. Patient was treated by debridement and skin grafting, but condition did not improve. Pus collected from the periorbital ulcerated area was cultured in blood agar and Corynebacterium spp. was isolated from the pure culture, which was identified as a new species Corynebacterium sp. strain UCL557 using 16S rDNA- based molecular technique based on nucleotide homology and phylogenetic analysis. Antibiogram showed multiresistance pattern with sensitivity to ceftriaxone-sulbactum vancomycin and linezolid. After initiation of treatment with vancomycin infusion and oral linezolid, the patient responded well and lesion started to heal. To the best of our knowledge, this is the first ever case report of periorbital ulceration by new species of Corynebacterium sp. strain UCL557.

Lymphatic filariasis is a major public health problem in tropical countries and India is endemic for it. However, lymphatic filariasis presenting as pleural effusion is an unusual manifestation and finding microfilaria in pleural effusion without any lung pathology is rare. We report a case of pleural effusion without any underlying lung pathology and normal blood picture. Clinical cure occurred after treatment with diethyl-carbamazepine. Filariasis should be kept in view while considering the differential diagnosis of idiopathic pleural effusion, especially in endemic countries.

During dissection in the Department of Anatomy, a female cadaver was encountered with arterial variations bilaterally. From third part of axillary artery, a branch was observed running superficial to median nerve, which was called as superficial brachial artery. The axillary artery after passing through the two roots of median nerve continued as normal (deep) brachial artery. The course of superficial and deep brachial arteries was different on both sides. Common interosseous artery was observed as a branch of radial artery bilaterally. Also, ulnar artery was seen entering the hand passing deep to flexor retinaculum bilaterally, which may get affected in carpal tunnel syndrome. It is important for the clinicians to have knowledge of such variations. An attempt has also been made to explain the variations ontogenically.

Lysinuric protein intolerance (LPI), also known as cationic aminoaciduria, hyperdibasic aminoaciduria type 2, or familial protein intolerance, is an autosomal recessive defect of diamino acid transport. LPI is characterized by the inability of the body to digest and utilize certain amino acids, namely lysine, arginine, and ornithine. As a result, there is an increased excretion of these amino acids, which in turn affects the liver, the gastrointestinal tract, lungs, immune system, spleen, and organs producing blood. We report a 5-month-old girl born of third degree consanguineous marriage who presented with hepatosplenomegaly with sepsis and worsening jaundice due to LPI.

Moyamoya means hazy in Japanese. It is a rare progressive idiopathic condition that affects major intracranial vessels. The disease is characterized by the distinct angiographic appearance of cerebral vessels resembling "puff of cigarette smoke." Although rare, a high index of suspicion in correct clinical setting can be helpful in apt diagnosis. The disease cloaked in common symptoms can lead to a devastating outcome, both in children and adults. Hence, comprehensive knowledge of this peculiar entity is a must.

We report two cases of neonatal hepatitis with herpes simplex virus (HSV) infection. Whether the HSV infection was the cause of hepatitis, or merely associated with it is not clear. While, in the first case, resolution could not be achieved despite high-dose antiviral treatment with acyclovir and liver transplant had to be advised; in the second case, there was complete resolution of the disease without antiviral therapy. Role of acyclovir in these children needs further assessment.

Double extradural hematomas (DEDH) comprise 2-10% of all extradural hematomas (EDH). The ipsilateral occurrence of more than one EDH is quite uncommon. We are reporting a case of ipsilateral DEDH in a 10-year-old child following a head injury. Though DEDH is extremely lethal and a rare diagnosis, ipsilateral DEDH is still uncommon. Furthermore, the occurrence of EDH in the pediatric age group is quite unusual. As compared to single EDHs, DEDH should be considered more urgently for neurosurgical intervention.

Keratocystic odontogenic tumor is considered to be a benign cystic neoplasia of jaw bone with a higher rate of recurrence. It is noted to be third most common odontogenic cyst after radicular and dentigerous cyst. Most common location is posterior mandible and ascending ramus. A case with odontogenic keratocyst of the right posterior mandible is presented with proper clinical and radiographic examinations along with histopathological investigation. Cystic lesion was surgically resected with iliac crest bone graft replacement and reconstruction plate placement. Follow-up of 1 year is completed with repeated radiographic examinations in 4 months interval with no evidence of recurrence.

Endurance exercise after orange ingestion cause anaphylaxis which is food-dependent exercise-induced anaphylaxis (FDEIA) which is a form of exercise-induced anaphylaxis. In this article, an individual develops symptoms such as flushing, itching, urticaria, angioedema, and wheezing after eating a food allergen and proceeds to exercise. Neither the food alone nor exercise alone is sufficient to induce a reaction. This case report describes a 36-year-old asthmatic male athlete who experienced nausea, vomiting, flushing, urticaria, and facial swelling while exercising in a gymnasium after eating oranges. Neither oranges alone nor exercise alone induced the reaction. Total avoidance of suspected food allergens would be ideal. Persons with FDEIA should keep at hand an emergency kit with antihistamines, injectable rapid action corticoids, and adrenaline.