The desire to periodically alter consciousness by using psychoactive substances is an innate drive similar to hunger, thirst or sex. WHO has defined various substances, psychoactive or otherwise which may potentially be abused. An innovative method of intake was observed while evaluating a patient under our care. An 18-year-old boy was brought for consultation with a history of multiple substance use and anti-social personality traits. On interviewing, patient reported of the use of a white powder in the form of a snake bite. Patient described the technique of the snake bite and his experience following the bite. There have been two previous reports of patients resorting to snake bites for recreational purposes and this unique and extreme mode of undergoing a psychoactive experience needs to be studied further.

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Objective: To study the prevalence of concurrent medical comorbidity in patients admitted with psychiatric disorders. Materials and Methods: One hundred patients with psychiatric disorders admitted to the general wards of the Department of Psychiatry, Father Muller Medical College, Mangalore were assessed for evidence of concurrent medical comorbidity. The assessment included clinical examination and investigations. Results: 49% of in-patients with psychiatric disorders had medical comorbidity. 26% of patients with bipolar disorder, 13% of patients with schizophrenia and 8% of patients with depressive disorders had medical comorbidity. Diabetes mellitus, hypothyroidism, and hypertension were the most common medical comorbidity. The medical comorbidity was not related to any of the socio-demographic variables. The medical comorbidity was not related to the clinical variables such as duration, age of onset of the psychiatric disorders. The medical comorbidity was significantly more in patients with bipolar mood disorder. Conclusions: 49% of in-patients with psychiatric disorders have concurrent medical comorbidity. Diabetes mellitus is the most common medical comorbidity. The present investigation is an observational, descriptive, cross-sectional clinical study. It has certain merits and limitations. Future studies with more refined methodology are required to draw definite conclusions.

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Complications of paranasal sinus infection most often involve the orbit and peri-orbita. Because of widespread use of antibiotics, intracranial extension of paranasal sinusitis is rarely seen today. Nevertheless, the clinician must be aware of the potential of these complications as late recognition of this condition and delay in treatment can increase morbidity and mortality rates. An interesting case of sinusitis with orbital and intracranial complication is presented, which was radiologically evaluated and was comprehensively managed. Unparallel role of radiological investigations cannot be over emphasized as it played a very important role in both assessment and timing of the surgical intervention. The key to successful treatment is aggressive management and timely surgical intervention. We have extensively reviewed literature and comprehensively discussed pathophysiology and radiological assessment of such cases.

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Background: Worldwide diabetes affects more than 194 million people and the figure is expected to reach 333 million by 2025. India is considered as the diabetic capital of the world. Diabetic foot is the most common complication of diabetes. Amputation which is the end result of diabetic foot disease is associated with significant morbidity and mortality. Since it is crucial to identity those at an increased risk of diabetic foot complications, a detailed study of the natural history of diabetic foot, various clinical characteristics, the role of micro-organisms and their contribution toward worsening of ulcerations was undertaken in our hospital. Materials and Methods: A prospective study was carried out on 100 diabetic patients with foot ulcers for a period of one and half years at Father Muller Medical college Hospital, Mangalore. Results: The data analysis of 100 patients yielded the following results. Diabetic foot was very common in the elderly age group (>55 years) 54% and male dominant (87%). Majority of them had diabetes for more than 5 years (41%) and complications of diabetes were present on admission in 15% of them. Presentation of diabetic foot in the form of single/multiple toe disarticulation/above knee/below knee amputation accounted for a quarter (23%) of surgical interventions in our hospital. The glycemic control in most of the patients was very poor with random blood sugar >200 mg/dl (70%) and glycosylated hemoglobin >7 g% (74%) of them. One-fourth of the patients stayed for at least a month in the hospital (25%). In culture, Gram-negative organisms were predominant (11%). The most common bacteria isolated were Staphylococcus aureus (20.6%), Pseudomonas (16.2%), Escherichia coli (14.7%), and Klebsiella (11.8%). Conclusion: Based on the results of our study, it can be concluded that diabetic foot in various forms accounts for significant morbidity in the surgical wards. The factors contributing mainly are poor glycemic control at the time of admission, presence of gangrene, complications of diabetes (nephropathy, neuropathy), and associated comorbidities (peripheral vascular disease, hypertension, ischemic disease). There is a lot of scope for improvement in the approach to treatment of diabetic foot in our set-up which needs urgent attention. This article is presented to highlight the colossal neglect in the management of diabetic foot in most of the tertiary care centers in and around this part of the world.

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Objectives: To assess the stress level of childless couples as measured by the stress scale and to determine the coping behavior of childless couples as measured by the coping behavior scale and also to find and study the relationship between the stress levels and the coping behavior of childless couples. Materials and Methods: A descriptive correlational design was used for this study and the study was carried out in a selected community of Mangalore, i.e. at Mullerkad at the home setting of the samples. The sample comprised of 50 couples (50 husbands and 50 wives) selected by snowball sampling technique. Results: Though both husbands and wives had moderate stress toward childlessness, wives had higher stress (mean: 105.26) than husbands (mean: 103.9). There was no significant difference between the stress of husbands and wives (t ₉₈ = 0.435, P > 0.05). Their coping behavior was average. However, wives had better coping behavior (mean: 238.46) than husbands (mean: 221.5). There was significant difference between the coping behavior of husbands and wives toward childlessness (t ₉₈ = 2.938, P < 0.05). There was no correlation between the stress and coping behavior of husbands toward childlessness (r = 0.113, P > 0.05). However, there was significant correlation between the stress and coping behavior of wives toward childlessness (r = 0.515, P < 0.05). There was no association between stress of the couples and selected demographic variables. Similarly there was no association between the coping behavior of the couples and selected demographic variables except education of wives (χ_1² = 5.715, P < 0.05). Conclusion: Both husbands and wives had moderate stress and average coping behavior toward childlessness. However, wives exhibited better coping behavior than husbands.

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Practicing medicine in India has revolutionized during the last five decades affecting the health-care delivery in both positive and negative directions. This actually let the establishment of norm that would legally govern the medical treatment and make it answerable everyway; therefore, doctors were covered by various laws. Moreover, the doctor-patient relationship has undergone a transition throughout the ages. This liaison was primarily between a patient in quest of help and a doctor whose decisions were silently compiled with by the patient. Medical negligence arises from an act or omission by a medical/dental practitioner, which no reasonably-competent and careful practitioner would have committed. Here, authors have sought the Consumer Protection Act and related legal-issues that may assist dental professionals to be on a legally safer side.

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When the history of inborn errors of metabolism is written, the name that will be mentioned foremost is that of Sir Archibald Garrod, who through his pioneering work on Alkaptonuria laid a solid foundation for this evolving specialty of medicine in the early years of the 20 ^th century. This article gives a brief overview of his work and his accomplishments of his career.

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To gain a better insight into voice characteristics and various contributing factors causing voice problem of patients who have undergone surgical treatment and radiation therapy for glottic cancer. A detailed voice assessment was carried out. Various acoustic, aerodynamic and perceptual measures were evaluated following the surgery and radiation therapy for glottic cancer. Results of acoustic and perceptual analysis indicated a severe hoarse voice. From the current study, it is inferred that the extent of tumor/site of lesion, modality of treatment and type of surgery also contribute to the deviation in voice characteristic in patient with glottic cancer. The glottic cancer can have several effects on an individual's daily living as it affects voice, which becomes a major hindrance for communication. The affected individuals should be evaluated by a speech language pathologist to identify the exact nature of voice impairment at the earliest in order to plan a comprehensive management strategy that could restore voice to give a good quality of life.

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Histoid leprosy is a variant of Lepromatous leprosy believed to occur due to a mutant strain of leprosy bacillus called as Histoid Bacillus. It was first described by Wade in 1960 in patients from Phillipines. It occurs in patients relapsing after Dapsone monotherapy, in the presence of Dapsone resistance or at times denovo, presenting with lesions mainly over bony prominences. Herein, we present a case of a 37 year old male who presented with skin coloured raised lesions mainly over the trunk, chest, neck and ears in contrast to its usual site of presentation, associated with tingling sensation over the hands and feet. A histopathological examination of the skin lesion was ordered which revealed sheets of histiocytes and lepra bacilli on hematoxylin and eosin and acid fast staining. On correlating the clinical and histopathological findings we came to a diagnosis of Histoid leprosy. The patient was promptly treated with MB-MDT and followed up.

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Cavernous hemangiomas are congenital vascular malformations that are now known as venous malformations. They can occur in any tissue but are especially common in the skin, where they usually are seen at birth or within the first several years of life. Nevus sebaceous is a benign tumor of the sebaceous gland presenting from birth to adolescence. A 34-year-old male patient presented with an asymptomatic raised lesion over the scalp that was present since birth and had been increasing in size over the past 3 years. Provisional diagnosis of nevus sebaceous was carried out due to the site, age of appearance and non-blanchability, but histopathology showed features suggestive of cavernous hemangioma. We report this case for its misleading form of presentation.

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Mixed epithelial and stromal tumor (MEST) of the renal pelvis or the older terminology cystic hamartoma of renal pelvis is a rare benign tumor and recently been recognized as a distinct clinical and pathological entity. These complex neoplasms are composed of a mixture of stromal and epithelial elements and are seen predominantly in women (ratio of women to men 6:1) and are generally seen in perimenopausal women with presenting symptoms of flank pain, hematuria or symptoms of urinary tract infection. We present here a case of MEST in a 48-year-old female who presented with a mass per abdomen associated with a mild dragging pain of 6 months duration. The ultrasonography report was of a multi-cystic lesion in the right kidney. Surgical excision of the lesion showed a mass measuring 18 × 14.5 × 7 cm with attached normal ureter. The outer surface was bosselated and showed multiple-cystic nodules with pale brown to dark brown smooth and glistening surface. The tumor was well circumscribed and there were multiple cysts of varying sizes separated by stroma arising from the dilated pelvicalyceal system. The wall of the cysts are covered by papillary excrescences. On histological examination, a well delineated tumor composed of cysts of varying sizes lined by columnar, cuboidal and transitional epithelium. Surrounding stroma showed a mixture of ovarian type of stroma and spindle shaped cells of smooth muscle type having plump nuclei. Sections from the renal-tissue adjacent to the tumor showed normal glomeruli and tubules.

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