Introduction: Urinary tract infection (UTI) continues to be the most common infection diagnosed in outpatients as well as in hospitalized patients. Citrobacter spp. is an emerging urinary pathogen. The present study assessed the prevalence and antibiotic sensitivity pattern of Citrobacter spp. in patients admitted to or attending outpatient departments with Complain of UTI in a tertiary care hospital. Materials and Methods: A total of 36,250 urine samples were included in the study. UTI was confirmed in 7099 samples. Of these 246 (3.46%) had UTI due to Citrobacter spp. Identification was by conventional biochemical methods. Antimicrobial susceptibility testing was performed using Kirby-Bauer disc diffusion method as recommended by Clinical and Laboratory Standards Institute M2-A9. Multidrug-resistant (MDR) was defined as resistance to more than two groups of drugs. Extended spectrum beta-lactamase (ESBL), AmpC, and metallo beta-lactamase (MBL) were detected by phenotypic methods. Results: Females predominated in the study 193 (78.4%) with 53 (21.5%) males. Most of the isolates were in the age group 21-30 and 31-40. 49 (19.9%) patients were inpatients, and 197 (80.08%) were outpatients. Aminoglycosides had a better spectrum of antimicrobial sensitivity (70.2%) with 85.2% isolates sensitive to amikacin. Fluoroquinolones had a poor activity against Citrobacter (46% sensitive). Ureidopenicillins had poor efficacy (15.4%). Out of the 246 strains, 129 (52.4%) were MDR, 61 (24.7%) of which were ESBL producers and 65 (26.4%) were AmpC producers. Most of the ESBL producing strains were isolated from inpatients. No MBL were identified in this study. Conclusion: Citrobacter though not uncommon isolate is posing a problem due to its MDR character. Infection control practices should be observed strictly, and any type of unnecessary instrumentation should be avoided.

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A middle-aged psychiatric woman was brought to the casualty by national health ambulance. The patient was a destitute and had psychiatric illness. Local examination revealed irreducible third-degree uterovaginal prolapse with necrotic ulcerated areas infested with maggots. The patient was managed conservatively with the removal of maggots with 100% turpentine oil, culture-sensitive antibiotics, and local antiseptics. With treatment, the prolapsed mass got free of maggots, the ulcerated areas healed, and prolapsed mass became reducible.

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Background: Hypertension is a potent modifiable risk factor to develop various cardiovascular diseases. Cardiovascular diseases are the leading cause of death in the world. Cigarette smoking is one of the risk factors of hypertension. Materials and Methods: This was a case-control study, in which young smokers were selected as case and young nonsmokers were as control. A total 111 male MBBS students were selected, divided into two groups - smoker and nonsmoker. Smoker group included 63 current cigarette smokers and 48 nonsmokers. All participants were within 20-25 years of age. Blood pressure (BP) was recorded in the morning between 7 and 8 am by auscultatory method. Results: Minimum and maximum duration of cigarette smoking were 1 year and 13 years. Minimum and maximum number of cigarettes smoke per day were 2 and 12. Minimum and maximum pack year of smoking were 0.1 and 3.3. Mean systolic BP of smoker was 134 ± 10.6 mmHg and nonsmoker was 117 ± 7.5 mmHg. Mean diastolic BP of smoker was 84 ± 7.6 mmHg and nonsmoker was 80 ± 7.5 mmHg. Mean pulse pressure of smoker was 49.9 ± 7.3 mmHg and nonsmoker was 36.7 ± 6.5 mmHg. Among the smokers, only 6.35% were normotensive, 61.9% were prehypertensive, and 31.75% were hypertensive. Conclusion: This study suggested that even short duration of smoking with low pack year can increase BP if not prevented may lead to various cardiovascular diseases. Thus, young adults, the future of country should be motivated to avoid smoking for healthy life.

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Background: The study attempts to evaluate the reasons of attrition in the organization from the perspective of the existing as well as the leaving employees; compare and identify the gaps, if any between the perspectives of these two employees groups. The study also aims to critically analyze the utility of 'exit interviews' for analyzing the reasons of attrition. Methods: This cross-sectional study was conducted in a 150-bedded hospital in Ahmedabad, India, during May-July 2015. Exit interview data of forty leaving employees were collected and reviewed. One hundred existing employees were interviewed through quantitative and qualitative methods to understand their perceptions about attrition in the organization. Results: Attrition rate of 26% was observed in the study and 57% leaving employees were nurses. 70% leaving employees cite "blanket reasons" such as better opportunity and personal reasons during exit interviews. 72.5% leaving employees believed that exit interview is largely for record purpose and 11% were unsure of its utility. However, when existing employees were probed qualitatively, a variety of responses were received. 65% existing employees quoted salary issues, partiality/poor recognition, improper assignment of tasks, and monotonous work as reasons for attrition in the organization. Conclusion: Exit interviews somewhere fail to probe into the real reasons of attrition. To improve retention, organizations must monitor their existing employee's intention to continue working in the organization and any sign indicating a poor intention to continue must be addressed immediately to avoid ripple effects. Moreover, to use exit interview as a tool to improve employee retention, leaving employees must be interviewed in-depth to uncover the actual reasons for quitting the job.

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Rheumatoid arthritis (RA) is the most common systemic, autoimmune, and chronic inflammatory disease causing symmetrical arthritis in joints. To prevent its progression, disease-modifying drugs are used. Among these, methotrexate (MTX) is the first choice drug. MTX is an agent which blocks deoxyribonucleic acid synthesis by competitively inhibiting folic acid metabolism. During treatment, rare but severe side effects such as pancytopenia, hepatotoxicity, mucositis, and pulmonary toxicity can be seen. In this case, a 76-year-old woman diagnosed with RA developed stomatitis and severe pancytopenia after treatment with low-dose MTX is reported.

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Background and Objectives: A large number of children are afflicted by thalassemia in India which may significantly impact their quality of life (QOL); hence, we hypothesized that there exists a strong relationship between socioeconomic status and QOL. We thus designed this study to assess QOL in adolescents diagnosed with β thalassemia major and its association with socioeconomic status. Further, we also compared the QOL and socioeconomic status between thalassemic and nonthalassemic adolescents. Materials and Methods: We recruited 35 adolescents diagnosed with β thalassemia major and 35 nonthalassemics in the age group of 10-18 years who matched in age, sex, and socioeconomic status. Selected cases and their parents were administered using PedsQL 4.0 India/Hindi questionnaire to assess QOL and modified Kuppuswamy scale to assess socioeconomic status. Results: Almost half of the thalassemic adolescents, i.e., 51.4% had poor QOL, whereas 48.6% of adolescents in control group had high QOL. There was no statistically significant association between QOL and socioeconomic status in both groups. It was observed that the difference between QOL and socioeconomic class though not significant but was more pronounced in study group (P = 0.114) than control group (P = 0.594). The receiver operating characteristic curve for QOL parameters indicated that social domain was the major contributor to poor QOL in thalassemics. Conclusion: Our study showed that thalassemic adolescents had significantly poor QOL, social domain being the major contributor as compared to nonthalassemics. We propose that provision of subsidized organized care can negate the impact of poor socioeconomic status on QOL of thalassemics.

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Context: This study highlights the correlation between functional and radiological outcome in a pediatric cohort who were surgically managed for displaced supracondylar humerus fractures at a level V trauma center. Settings: Surgically managed pediatric Gartland type III supracondylar humerus fracture patients were retrospectively assessed. All patients were managed at the level V trauma center from 2011 to 2015. Patients with regular follow-up were included in the study. Methodology: Baumann's angle and pediatric outcomes data collection instrument (PODCI) upper extremity and physical function core scale administered at 6 months follow-up were used to assess the radiological and functional outcomes. Results: Thirty-seven children with supracondylar humerus fracture were treated at our center. Fifteen patients underwent surgical management for Gartland type III fracture. One patient presented with open fracture. Three patients with delayed presentation underwent open reduction and K-wire fixation. Ten patients underwent closed reduction under fluoroscopy guidance and K-wire fixation. Fourteen patients were followed up for 6 months and underwent radiological evaluation and functional assessment. One patient was lost to follow-up. Two patients had median nerve palsy, one patient had complete recovery at 6 months follow-up, and the other patient had partial recovery. Average Baumann's angle was 72.97΀ (standard deviation [SD] =8.5), ranging from 57.8΀ to 84.86΀. The average PODCI outcome was 50.5 (SD = 6.16), ranging from 36 to 57. A weak Pearson's correlation coefficient (r = 0.476) was observed between radiological and functional outcomes. Conclusions: Satisfactory outcomes were observed in most patients who underwent surgical management of severe Gartland type III supracondylar fracture. Low PODCI score was observed with partial median nerve recovery. A weak linear correlation between Baumann's angle and PODCI score suggests multifactorial determinants of functional outcomes in pediatric supracondylar fracture.

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Introduction: Thyroid disorders are among the most common endocrine disorders, with an overall prevalence of hypothyroidism about 10.95% in the general population. Prevalence of the metabolic syndrome (MetS) in the Indian population is about 31.6%, with the prevalence of 22.9% in men and 39.9% in women. Aim: The aim of this study is to determine the prevalence of MetS and its components in people with hypothyroidism. Materials and Methods: A total of 154 hypothyroid patients attending our outpatient department were consecutively enrolled for the study. MetS identified by National Cholesterol Education Program's Adult Treatment Panel III report (ATP III). Clinical data were obtained by interviewing the patients and referring to their case folders and prescriptions. The anthropometric indices were recorded. The laboratory parameters that were analyzed included fasting lipid profile, thyroid function tests, and fasting blood sugars. Results: The patients were aged between 18 and 75 years, with a mean age of 43.6 years, and the female-to-male ratio was 123:31. The overall prevalence of the MetS was 53.24% by ATP III criteria, which is significantly higher than that in the general population, as reported earlier in various studies. The most common occurring MetS-defining criterion was increased waist circumference, and hypertension was the least documented criterion. Conclusion: MetS occurs in approximately every second patient of hypothyroidism, and so, routine screening for components of MetS may be of benefit in this group.

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Dermatoglyphics deals with the study of the epidermal ridges and their configurations on the fingers, palms, and soles. The word dermatoglyphics is derived from the Greek word derma meaning skin and glyphics meaning carvings. Dermatoglyphics, once matured, remain unchanged throughout the life of an individual and are not influenced by either the environmental or age-related factors. Because of these unique characteristics, these dermal ridges play a very crucial role in the personal identification of an individual, for forensic purposes. Dermatoglyphics has also been accepted as a simple and inexpensive means for deciding whether a patient would have a particular genetic or chromosomal disorder or not. The question, now, is to test the predictive possibilities of dermatoglyphics in search of the various oral precancers and cancers as the studies conducted so far have been convincing. The present review focuses on this aspect of dermatoglyphics.

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Background: Traumatic dental injuries (TDIs) are one such condition that can occur at any age, but the trauma to children's teeth occurs quite frequently. TDIs involving the anterior teeth may not only lead to restriction in biting, phonetics, and esthetics but also have an impact on a child's personality and quality of life. The objective of this study was to assess the prevalence of the TDIs of the permanent anterior teeth among 12-year- and 15-year-old schoolchildren of urban and rural areas of Bhopal district, Central India. Materials and Methods: The descriptive cross-sectional survey was carried on 1100 schoolchildren. For the selection of schools, a three-stage sampling procedure was adopted. A specially prepared and pretested pro forma designed for collecting all the required and relevant general information and clinical findings. The pro forma including the demographic data and questions regarding history of injury to detect the cause, place, duration of trauma to anterior teeth as well as those seeking the treatment for concerned problem was recorded. For clinical examination of TDI to anterior permanent teeth, the World Health Organization (International Classification of Diseases to Dentistry and Stomatology) classification of tooth fracture was used. SPSS version 20 was used for the statistical analysis. The Chi-square test used for categorical data. P < 0.05 was considered statistically significant. Results: The overall prevalence rate of TDIs to permanent incisor teeth was 12.8%. The prevalence of TDI was higher in rural areas compared to urban areas. The major cause of TDI was sports activities. Conclusion: This indicates the need for community health activities and awareness program.

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Background and Aims: As a part of Global Polio Eradication Programme by the World Health Organization, 1988 surveillance of acute flaccid paralysis (AFP) was an important public health activity in many countries. With nearing the eradication of poliomyelitis, other causes of AFP are gaining importance in both children and adults. This study was designed to know the clinical characteristics, and differential diagnosis of causes of AFP, including distribution by age, gender, and time. This was a prospective observational study. Methods: AFP cases were diagnosed on the basis of history and physical examination. The underlying etiology was ascertained by appropriate laboratory investigations such as arterial blood gas analysis, urinary pH, electrolytes, thyroid profile, electrophysiological studies, cerebrospinal fluid analysis, and imaging. Results: Between July 2010 and September 2012, 106 cases of AFP were enrolled. Out of 106 patients, 58 (54.7%) were suffering from Guillain-Barrι syndrome (GBS), 15 (14.2%) from hypokalemic paralysis, 8 (7.5%) from myasthenia gravis, 8 (7.5%) from thiamine deficiency, 5 (4.7%) from transverse myelitis, and 2 (1.9%) from cord compression. Other diagnoses include; acute motor axonal neuropathy 3 (2.8%), acute disseminated encephalomyelitis 2 (1.9%), meningoencephalitis 2 (1.9%), diabetic polyneuropathy 2 (1.9%), and chemotherapy-induced neuropathy 1 (0.9%). Most cases, 42/106 (39.6%) were admitted during the spring season. Conclusion: GBS was the most common cause of AFP in all age groups. Most of the AFP cases occurred during the spring season. No case of poliomyelitis was found.

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Hyperplastic dental follicles are very commonly seen associated with an impacted tooth. Multiple calcifying hyperplastic dental follicles (MCHDF), a term used for multiple unerupted teeth with abundant calcifications and rests of odontogenic epithelium in enlarged dental follicles is a rare entity. Varied pattern of calcifications have been observed in such follicles. We report one such case with four patterns of calcifications and odontogenic epithelium associated with bilaterally impacted canines.

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Postkidney transplant recipients are more susceptible to opportunistic infections including fungal infections. Voriconazole is a broad-spectrum antifungal with a good safety profile even in patients with renal dysfunction. Hallucination is a rare and underreported complication of oral voriconazole therapy, especially in kidney transplant recipients. Two patients of postrenal transplant who developed hallucination following oral therapy with voriconazole have been highlighted here. Symptoms improved in both patients following a reduction in dosage or cessation of therapy. This case report highlights the fact that even though voriconazole-induced hallucinations are a rare complication, it is important to be aware of the same so as to be able to diagnose it and institute appropriate corrective measures.

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Dengue is a vector borne disease, known for its serious life threatening complications. It is endemic in India. Early diagnosis of dengue virus is important and can be established with the easily available laboratory tests. Rapid tests detecting NS1, IgM, and IgG identify the cases at earlier stage, thus reducing the morbidity and the mortality due to dengue haemorrhagic fever(DHF) and dengue shock syndrome (DSS).

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Hyperplastic dental follicles are very commonly seen associated with an impacted tooth. Multiple calcifying hyperplastic dental follicles (MCHDF), a term used for multiple unerupted teeth with abundant calcifications and rests of odontogenic epithelium in enlarged dental follicles is a rare entity. Varied pattern of calcifications have been observed in such follicles. We report one such case with four patterns of calcifications and odontogenic epithelium associated with bilaterally impacted canines.

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