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India initiated National Tuberculosis Control Program (NTCP) in 1962. After reviewing NTCP and realizing its shortcomings, the Government of India evolved and adopted a revised strategy - the directly observed treatment short course (DOTS) - under Revised National Tuberculosis Control Program (RNTCP) with the goal of reducing TB burden and the twin objective of 70% case detection and 85% cure rates. RNTCP was launched in 1993, in a phased manner to be evolved through pilot phase (1993-1996), DOTS intensification phase (1997-2006), Stop TB strategy (2007-2011), and currently the Universal Access or National Strategic Plan (2012-2017). RNTCP has been progressing successfully toward its goal and achieving its objectives since 2007. This addresses the Millennium Development Goal (MDG) and target to be achieved by 2015 and the Stop TB Partnership targets to be achieved by 2015 and by 2050. By 2011, the RNTCP has treated more than 14.2 million TB patients and saved 2.6 million additional lives using the DOTS strategy. The spread of human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS), emergence of multidrug resistant TB (MDR-TB) and the unregulated and underutilized vast private sector using anti-TB regimes different from those under RNTCP pose additional challenges in the control of tuberculosis. For this review, information has been collected from official websites of World Health Organisation (WHO) Geneva, WHO South East Asia Regional Office (SEARO) New Delhi, Ministry of Health and Family Welfare; Government of India and published literature, through search engines like Google, Google Scholar and Pub Med using MeSH Terms "DOTS" and "Tuberculosis Control."

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Background: A review of both Western and Indian literature shows that there are few comprehensive studies on pancytopenia. In India, the causes of pancytopenia are not well defined. This data, if available, would help in planning the diagnostic and therapeutic approach in patients with pancytopenia. Aim: To evaluate the cases of pancytopenia by peripheral smear and/or bone marrow aspiration and/or bone marrow biopsy to find out the etiology, clinical, hematological, and histomorphologic features of pancytopenia. Materials and Methods: Detailed hematological investigations a complete hemogram, peripheral smear examination, bone marrow aspiration, and biopsy examination were done. Results: The most common cause of pancytopenia in our study was megaloblastic anemia (56%), followed by hypoplastic/aplastic anemia (14%), hypersplenism (8%) and post viral illness (6%). Conclusion: Megaloblastic anemia due to vitamin B12/folate deficiency seems to reflect the higher prevalence of pancytopenia in Indian subjects, putting hypoplastic/aplastic anemia in the second position, which is the leading cause for pancytopenia in the Western countries.

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Primary nasal tuberculosis is a rare disease with nearly 40 cases reported. Our patient was a young male presented with left sided nasal obstruction, anosmia and occasional epistaxis for last 7 weeks after 6 months of blunt trauma nose. Contrast enhanced computed tomography of the para nasal sinuses showed increased soft-tissue density with contrast enhancement in the left maxillary antrum with extension through left osteomeatal foramen to the left nasal cavity along with further extension through choana to nasopharynx resulting in partial obliteration of the nasopharyngeal airway. Nasal endoscopy revealed a sessile polypoidal pinkish mass arising from the left osteomeatal foramen. Histopathological examination of excisional biopsy of that area showed caseating granuloma. Our patient diagnosed as primary nasal tuberculosis following trauma and treated with anti-tubercular chemotherapy.

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Aim : The aim of this study was to find out the prevalence of dry eye and evaluate personal and environmental risk factors attributable to dry eye in a hospital-based population. Materials and Methods : In this cross-sectional study, 1890 patients above 15 years of age were screened randomly for dry eye. McMonnies Dry Eye Questionnaire, Schirmer's test, tear film breakup time (TBUT), presence of conjunctival injection, punctate epithelial erosions (PEE), and meibomian gland dysfunction (MGD) were used to diagnose dry eye. Patient demographics including age, sex, smoking, and occupation and working environment were also recorded. Correlation of dry eye signs with symptoms and TFBUT and Schirmer's tests was also assessed. Results : The prevalence of dry eye was 10.58%. The prevalence was higher in outdoor workers (17.77%). The male: female ratio was 2.33:1. The number of males was highest in the 56-60 (13%) and 60-65 (14%) years age groups while that of females was highest in the 46-50 (16.67%) years age group. A total of 10% of the patients were smokers, while 8% were tobacco chewers. A 2.15-fold increase was found in the odds for dry eye in those exposed to excessive wind, 1.91-fold to sunlight exposure, and 2.04 for air pollution. Abnormally low TBUT and Schirmer's tests were significantly associated with dry eye signs (P=0.009 and 0.014, respectively). Conclusion : Dry eye is a leading cause of ocular discomfort in OPD patients. Excessive exposure to wind, sunlight, high temperature, and air pollution was significantly related to dry eyes. There was a significant correlation between patient's history, symptoms, dry eye signs and objective tests for tear film. The rural people and those with outdoor occupation are more exposed to extraneous influences of environmental factors in tropical climate. These factors affect the tear film and ocular surface causing the dry eye syndrome.

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Background: Suprascapular nerve block using anatomical landmark has been shown to be a safe and effective treatment for chronic shoulder pain from rheumatoid and degenerative arthritis. This can be performed as an outpatient procedure that reduces pain and disability. Aims and Objectives: To access efficacy of suprascapular nerve block in chronic shoulder pain. To compare results between placebo and use of methyl prednisolone with bupivacaine for nerve block . Materials and Methods: 60 patients with chronic shoulder pain were taken up for the trial. In the study group, all patients received the block through the anatomical landmark approach, with a single sitting suprascapular nerve block. On randomized basis, 30 patients were given 10 ml of 0.5% bupivacaine and 40 mg of methyl prednisolone acetate (depo medrol) to block the suprascapular nerve. Another 30 patients were injected with 11 ml of 0.9% saline. Patients were followed up on 2 ^nd day, 7 ^th day, and 21 ^st day and 3 months for the status of relief of pain and improvement of movement of joint. Results: Evaluation of the efficacy of the block was achieved by comparing verbal pain scores and improvement in range of movements at 2, 7, 21 days and 3 months after the injection. Significant pain relief is defined as improvement of more than 70% on verbal and visual analog pain scale scores. Results were consistent with VAS score of pain. Maximum improvement was noted in the bupivacaine+methyl prednisolone mixed group. Conclusion: The result of this study shows a clear benefit of methyl prednisolone + bupivacaine for suprascapular nerve block in cases of chronic shoulder pain. There was statistically and clinically significant reduction in pain and improvement in range of movements.

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Poland syndrome is a rare congenital disorder characterized by ipsilateral absence of pectoralis major muscle. This syndrome is associated with various anomalies such as ipsilateral syndactyly, brachidactyly, dextrocardia, herniation of lung, underdevelopment of upper ribs, aplasia or hypoplasia of breast, etc. Only few cases had been reported with absent ribs in Poland syndrome. We report a rare case of Poland syndrome presented to us with mal-development of his right hemithorax and weakness of right hand.

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Olanzapine is considered to have significantly less risk of tardive dyskinesia (TD) compared to first generation antipsychotics. We describe two patients who developed TD after prolonged use of olanzapine. Both the patients received no medications prior to the treatment with olanzapine. They neither received any other medication along with olanzapine nor any injectible antipsychotics. In one patient, TD improved completely after withdrawal of olanzapine and treatment with clozapine, but recurred after a retrial of olanzapine. In the other patient, reduction of dose of olanzapine was tried without any success. Despite a substantially lower risk than first generation antipsychotics, TD is not entirely absent with olanzapine.

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Cutaneous tuberculosis because of its variability in presentation, wider differential diagnosis, and difficulty in obtaining microbiological confirmation continues to be the most challenging to diagnose for dermatologists in developing countries. Despite the evolution of sophisticated techniques such as polymerase chain reaction (PCR) and enzyme-linked-immunosorbent serologic assay (ELISA), the sensitivity of new methods are not better than the isolation of Mycobacterium tuberculosum in culture. Even in the 21 ^st century, we rely on methods as old as the intradermal reaction purified protein derivative standard test and therapeutic trials, as diagnostic tools. We describe a case which has been diagnosed and treated as eczema by renowned physicians for 2 years. Incisional biopsy showed the presence of well-defined granulomas and ZN staining of the biopsy specimen showed the presence of acid fast bacilli; a trial of ATT (antitubercular therapy) for 6 months lead to permanent cure of the lesion.

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The incidence of tuberculosis is high in developing country; primary tuberculosis of breast is extremely rare, 3-4% of all breast lesions. Tuberculosis of breast often mimics breast cancers clinically. We are reporting here three cases of primary tuberculosis of breast presented with painless breast lump. Diagnosis was difficult and made by several parameters in different cases. Made by excision biopsy or the presence of acid-fast bacilli or Tuberculin test or Fine needle aspiration cytology of breast lump depending upon the cases. All the patients responded well to anti-tubercular regimen.

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Background: Management of high velocity trauma is a challenging problem because of morbidity of trauma and sometime residual problems of failure of proper healing of fractures with the restriction of movements of knee, shortening, and added risk of compartment syndrome in the proximal tibia fracture. There is always risk of post-operative infection and infected non-union in extensive open surgical procedure and internal fixation. Hence, there is always look out for the middle path procedure for a solution to the above said problems with the added advantage of less hospital stay and early return to work by minimal invasive procedure and stabilization of fracture reduction by multiple K-wire fixation with a frame applied externally. Stabilization of fracture with reduced pain allows early movements of neighbouring joint knee and ankle; hence, reduces the chances of fracture diseases. With this we have been stimulated to take-up the study of managing the proximal tibia fracture by mini external fixator. Aim: The aim of this study was to manage proximal tibia fractures by mini external fixator and evaluate the results and efficacy of this method. Material and Method: A total of 30 patients having proximal tibial fractures admitted at our center between 2008 and 2010 were taken and the procedure carried out was closed manipulative reduction and stabilization with mini external fixator. All acute proximal tibia fractures including tibial plateau fractures above 17 years of age of either sex were included in the study. Fracture more than 3 weeks old were excluded from the study. Result: Out of 30 cases 13 were excellent, 14 cases good, and 3 showed fair. It was found that type 5 and 6 of Schatzker's classification have lesser outcome type of fractures Conclusion: We have found that management of the proximal tibia fractures by mini external fixation method has a better outcome. Early mobilization of knee in the proximal tibia fractures after stabilization with mini external fixator results in good functional outcome of the knee and reduces hospital stay. Complications associated with this method of treatment are minimal.

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Salivary gland is one of the rare sites of tuberculosis, even though extrapulmonary tuberculosis accounts for 15-20% of all cases of tuberculosis. When it involves parotid gland, the presentation is usually with a slow growing swelling, which makes one to think of a neoplasm. The treatment of tuberculosis is medical, with antituberculosis treatment. However occasionally, the diagnosis of tuberculosis is done following a surgery performed for a suspected parotid tumor. Here we report a case of tuberculosis of parotid gland in a lady who underwent superficial parotidectomy for a parotid mass.

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Hydatid cyst disease is rare and it is a parasitic infection where humans accidentally get infected by ingesting larval forms of parasite whereas, the definitive hosts are dog. The common sites of hydatid cyst are liver, lungs, spleen. Unusual sites of the hydatid cyst is reported in subcutaneous tissue of anterior abdominal wall, peritoneum. We report an unusual form of the primary hydatid cyst disease involving peritoneum in a 65-year-old female, presenting as swelling in the abdomen since 3 months. Sonography revealed a cystic mass and diagnosis of ovarian tumor was considered. The Cancer Antigen 125 (CA-­125), an ovarian malignant marker was normal. Exploratory laprotomy was carried out. Cytological examination, gross, and the histopathological findings suggested the diagnosis of hydatid cyst disease involving only peritoneum. Primary isolated hydatidosis involving peritoneum is very rare and only few cases have been reported. Moreover, it mimics other tumors of the abdomen like in our case we considered it as an ovarian tumor.

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Castleman's disease is a rare disease of lymph node with two identified forms, the hyaline vascular type and plasma cell type. It presents as localized or systemic lymphadenopathy or even as extranodal mass and may give rise to several differential diagnoses. Castleman's disease represents a morphologically distinct form of lymph node hyperplasia rather than a neoplasm or a hamartoma. It occurs most commonly in adults but it can also affect children. Here we present a case of Castleman's disease in a 22 year male patient involving right cervical lymphnode.

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Background: Low birth weight (LBW) is highly prevalent in India and has a multifactorial causation. There is a need to study and identify the modifiable and non-modifiable risk factors determining birth weight. This will help in planning ante natal care more effectively. Materials and Methods : Study-type-cross-sectional study-setting: Hospital based. Study-subject: Mothers and their new borns. Sample size: All the births taken place during the study period. Study period: July 2010-June 2011. Study tools : (0 i) Questionnaire. (ii) pediatric weighing machine. Inclusion criteria : m0 others attending ante natal care (ANC) clinic from 1 ^st trimester with minimum three antenatal visits, non-anemic at the end of 2 ^nd trimester, had full-term and singleton delivery. Exclusion criteria : H/O pregnancy induced hypertension (PIH), diabetes mellieutus (DM), tuberculosis (TB), urinary tract infection (UTI), delivered preterm and tobacco chewers or mishri users. Statistical Analysis : Percentages, mean and SD of birth weight, χ² test, ANOVA, Z-test, and Binary logistic. Results: By using birth weight as a continuous data it was observed that birth-weight was significantly associated with maternal age (F = 3.360, df = 2, P = 0.035), education (F = 4.401, df = 4, P = 0.002) and breakfast (z = 3.970, P = 0.00). Proportion of LBW was 42.4%. For analysis, groups of newborns on the basis of birth weight showed significant association between LBW and maternal education (χ² = 12.734, df = 4, P = 0.013), breakfast (χ² = 13.241, df = 1, P = 0.00) and evening snacks (χ² = 4.275, df = 1, P = 0.013). According to the binary logistic regression, breakfast and education were significant and best predictors for birth weight. Conclusion: Education and breakfast are strong determinants of birth-weight. Less educated women need more intense health education.

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A 75-year-old female patient was operated for cataract in her left eye. Cyclopentolate eye drops were started due to intraoperative handling of the iris. After the second dose of the eye drops, irrational behavior was observed. Psychiatrist's opinion was taken and drug-induced psychosis was suspected. Thereafter, eye drops were withdrawn and the patient's behaviour reverted to normal within 48 h.

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Papillary carcinoma of the thyroid with clinically significant cervical lymphadenopathy is a common presentation (particularly in young patients), and it may be the first manifestation of disease. Occasionally, besides metastatic deposits, the cervical lymph nodes may harbor other diseases, and determining the etiology in such a case becomes critical for the institution of proper treatment and complete cure of the patient. Detection of tuberculous lymphadenitis and metastatic deposits by radiological and/or fine needle aspiration cytology methods may not be always easy and may be missed due to inherent defects of the techniques hence, histopathological examination still remains the final resort. We report a case of papillary carcinoma of the thyroid and its rare association with both metastatic deposits and tuberculosis of the contiguous cervical lymph node groups. We suggest that tuberculosis must always be borne in mind besides metastases while evaluating the enlarged neck nodes in papillary carcinoma of the thyroid.

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Apert syndrome is a rare genetic disorder, characterized by premature fusion of skull sutures, mid-face hypoplasia and syndactyly of the hands and feet. It is inherited as autosomal dominant or sporadic and is associated with increased paternal age. It arises from mutations in the fibroblast growth factor receptor 2 gene on chromosome 10q26. A case of Apert syndrome who had undergone craniofacial surgery elsewhere 4 years back presented to us with purulent discharge near the lateral orbital margin of right orbit, watering and redness of the right eye. He had telltale signs of this syndrome in the form of skull deformities such as brachycephaly, frontal bony prominence, mid-face hypoplasia, proptosis and syndactyly of both hands and feet. There was a surgical scar of previous craniofacial surgery over the bi-coronal region. He had a discharging granuloma over the lateral orbital margin and the adjacent lower eyelid had developed cicatricial ectropion. X-ray and computed tomography scan orbit confirmed the clinical suspicion of osteomyelitis of the underlying zygomatic bone at the site of miniplate and screw fixation of the earlier surgery. He was treated with excision of granuloma and extraction of loose screw and infected miniplate while ectropion was corrected by rotation advancement of temporal skin flap.

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Objective: The purpose of the study was to evaluate the effect of internal drainage on the perinephric drain after open renal surgeries. Materials and Methods: 68 patients who had undergone open renal surgeries were prospectively studied. Patients were divided in two groups randomly: Group A (n = 33) without double J stent and group B (n = 35) with Double J stent. In both groups, perinephric drain was placed. Results: The average drain output and duration of perinephric drain kept in group A and B were 36 ml and 29 ml and 4.63 days and 3.35 days, respectively. The commonest surgical complication was wound infection (9.72%). Complaints like frequency, dysuria, and hematuria during follow-up were less in group A than in group B. Conclusion: With the use of double J stent, there is considerable decrease in drain volume and early removal of perinephric drain. Late irritative urinary complaints were seen more in the group with double J stent.

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The handle bar injury is quite common in pediatric age group. The nature of injury may vary from minor abrasions to life-threatening acute abdomen. We present a case who came to us after five days of sustaining such injury with anterior abdominal wall hematoma and surprisingly, we found free gas under the right dome of diaphragm. We successfully treated the patient conservatively and the patient is being followed up at regular interval.

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Open globe injuries are a very common cause of unilateral visual loss, with children accounting for up to 20% of all these injuries. The principles of management of ocular injuries are the same for children and adults. However, the management in the case of a child is made much more difficult due to variable cooperation with assessment and continuing therapy as well as the subsequent possibility of amblyopia further complicating the treatment. Here we report the successful management of a 3-year-old child who was brought to this center with a full thickness penetrating injury to her cornea, with a pencil, and the presence of hypopyon, 3 days after the occurrence of the injury.

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Dermatofibrosarcoma protuberans (DFSP) is a rare skin tumor of the dermal layer. Incidence is only about one case per million per year. It is a cutaneous soft tissue sarcoma that rarely metastasizes but it has got a malignant potential in 2% of cases. The challenge with DFSP is that the malignant potential of this tumor depends on the components histologically and on immunohistochemistry. The second challenge is that these tumors cannot be diagnosed on fine needle aspiration and require a core or incisional biopsy. Only in nodular stage we have to diagnose DFSP. This case presented in a male patient simulating malignancy of breast and fine needle aspiration cytology was inconclusive. The treatment also poses a challenge as not all surgeons are well versed with Moh's surgery and hence here local wide resection was done. All margins were free. Although chemotherapy forms a part of treatment, it is reserved for large and recurrent tumors.

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Background: Laparoscopic cholecystectomy has become the gold standard in symptomatic gallstone disease. Today more than 80% of cholecystectomies worldwide are carried out laparoscopically. The present study describes our experience with laparoscopic cholecystectomy in a rural setup. Aim: To study the results of laparoscopic cholecystectomy in a rural setup. Settings and Design: Prospective study done at R. L. Jallapa Hospital Tamaka Kolar from January 2003 to November 2012. Materials and Methods: A total of 120 patients undergoing laparoscopic cholecystectomy by the same surgeon were included. Results: Out of the 120 patients, 108 (90%) were females and 12 (10%) were males. Their age ranged from 16 to 75 years. Majority were in fourth decade of life. Majority of the patients [70 (58.3%)] had gallstones. The procedure was converted to open cholecystectomy in six patients. Twenty-four patients had minor complications. Majority of the patients stayed in the hospital postoperatively for less than 5 days. Conclusion: Laparoscopic cholecystectomy in our setup proved to be a safe procedure and an effective treatment for gallstone disease.

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Non-tuberculosis mycobacteria (NTM) include those mycobacterium species that are not members of the Mycobacterium tuberculosis complex. They assumed significance with the growing pandemic of the acquired immune deficiency syndrome (AIDS) since the 1980s, when Mycobacterium avium infections were found to be associated with AIDS. However, the epidemiology of NTM disease among patients without Human immunodeficiency virus infections is not well documented. We report a case of NTM soft tissue swelling in an immunocompetent 18-year-old male who responded well to local excision and antitubercular treatment.

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