The safe and effective management of health care biomedical waste has received much attention for improper and inadequate management is associated with an increase in the incidence of health risks to the healthcare workers, the patients, and their environment and to the community at large. Hence the development of safe and effective management of biomedical waste along with handling protocols, institutional plans and policies, appropriate training and feedback programs on proper waste management and handling for all the healthcare workers are highly recommended. In India, with the implementation of Biomedical Wastes (Management & Handling) Rules 1998, emphasis is being placed mainly on the proper handling, segregation and disposal of the healthcare waste by which the risks and hazards to an individual and to the community can be considerably reduced. Though a technology and treatment protocol already exists, liquid biomedical waste management still remains a major problem for all healthcare facilities. So proper training in handling of waste will enable the healthcare facility to diffuse this critical problem safely and cost effectively while managing their liquid biomedical waste. So a literature search using the terms liquid biomedical waste was done and this review describes the problems associated with its management.

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Background: Use of tobacco in cigarettes indeed represents a health concern of growing magnitude among cigarette smokers. As a consequence of its addictive qualities, the consumption of cigarettes often becomes a lifelong habit, with cumulative and deleterious effects on health. Smokeless tobacco has been advocated as a substitute for cigarette smoking. On the contrary, the use of smokeless tobacco is fraught with health risks and needs to be discouraged. Modernisation of life style has affected the population even in rural areas, leading to addiction. Smokeless tobacco is presumed to be less of an evil by the rural folk. Khaini addicts are likely to suffer from mental and physical exhaustion, leading to stress. Khaini is tobacco with slaked lime. This is important in view of the prevailing socio-economic as well as the healthcare system available in any developing country. Therefore, the present study is designed to measure the heart rate variability (HRV) among this special group of the population. Materials and Methods: Fifteen male subjects were enrolled from the rural farm labors' population who regularly chew khaini. They were free from any type of physical and mental health issues and were non-smokers. A similar group of 15 male subjects anthropometrically matched, who did not chew khaini and did not use tobacco in any form, participated as controls. Each individual volunteer was subjected to an HRV analysis on three occasions: the first record was performed on the first day of their arrival in the hospital as subjects during the lean season. The second observation was recorded after 3 months. The final HRV analysis was performed after 6 months of the first recording. Two types of parameters were analyzed: time domain and frequency domain. Statistical analysis was performed using a paired t-test within the study group and the unpaired t-test between non-khaini chewing controls and subjects on Day 1 of the recording. Results: There was no statistically significant difference between the controls and the study group on Day 1 of recording. Both the HRV parameters - time and frequency domain, showed decreased values during the third month and sixth month recording as compared with the first week recording. The decrease is much more during the sixth month recording as compared with the third month recording. A statistically significant decrease is observed in the mean RR interval, heart rate, very large frequency and large frequency only when the first week recording is compared with the third month recording, but when the first week recording is compared with the sixth month recording, a significant decrease in the mean RR interval and heart rate is found. Conclusion: Subjects involved in taking khaini are likely to undergo a lot of physical and mental stress thus affecting their autonomic status. This adds up to the stress induced by their occupation. HRV analysis using short-term electrocardiogram recordings was used to detect changes consequent with this stress.

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Purpose: The physiotherapist facilitates optimum functional independence, health and well being of the community. An idea of the range of conditions that a physiotherapist can treat will help the community to benefit from their skill. Anganwadi workers (AWW) play a key role in health education and care at the primary care settings especially in rural India. Objectives: The objective of this study was to assess the awareness of physiotherapy among AWW in Dakshina Kannada. Materials and Methods: A cross-sectional survey using a validated questionnaire was conducted among 112 AWW. The data obtained were analyzed and described. Results: Fifty percent of the 112 respondents were not aware of the role of physiotherapy in many of the impairments and only 3% of the AWW were informed during their training period regarding physiotherapy. Conclusion and Implications: Awareness about physiotherapy among the AWWs who participated in the study was poor. Adequate awareness programs among the AWW with regard to physiotherapy, through the various means of information transfer, can be beneficial in helping them to direct the people who are in need of such services.

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The diagnosis of yo-yo reflux in patients with partial collecting system duplications is difficult. We report a case of recurrent urinary tract infections due to partial duplication of the collecting system in which yo-yo reflux is demonstrated with color and pulse wave Doppler. Our aim is to highlight the fact that radiologists and clinicians should be aware of this noninvasive, inexpensive, and easily accessible modality so as to diagnose this phenomenon more frequently in future.

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A genius in more than one basic field, with many important discoveries/inventions such as folate, methotrexate, aureomycin, and diethylcarbamazine etc., The wonder drugs he created helped conquer many diseases considered incurable till then, and even today, these drugs continue to be used routinely. Also, his discoveries led to better understanding of various basic physiological processes in man. Though he received all the support for his research on foreign soil, it is said he always remained an Indian at heart. The accolades he received for his work were few, and moreover, delayed. This article briefly describes the journey of this great man, his discoveries and achievements, which even today remain largely unknown.

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Context: Autoimmunity against the thyroid gland is one of the most important causes for thyroid dysfunction. Anti-thyroid antibody test is an important tool in the evaluation of autoimmune thyroid disorders. Aims: To study the prevalence of thyroid hormone dysfunction and positive anti-TPO antibody titers in patients being evaluated for thyroid-related disorders. Settings and Design:This retrospective cross-sectional study was done in Father Muller Medical College. Materials and Methods: The TSH (Thyroid stimulating hormone), FT ₄ (Free thyroxine), and anti-TPO titer reports of 74 subjects undergoing evaluation for thyroid-related disorders were analyzed. Statistical Analysis Used: Statistical significance was estimated by P value. Results: About two-third (60%) of hypothyroid patients showed raised TPO antibody titer. The titer was significantly higher in hypothyroid subjects when compared to the euthyroid subjects, and a majority of the hypothyroid subjects had a titer at least twice the upper limit of normal. Two of the three subjects with hyperthyroidism also had elevated anti-TPO titers. Conclusions: The commonest cause of hypothyroidism in our study subjects was autoimmune-related thyroid disease. Anti-TPO antibody estimation is a very useful test for establishing the etiological diagnosis of autoimmune thyroid diseases in our population. In situations where there is a diffuse non-progressive goiter, anti-TPO antibody estimation can substitute for an invasive FNAC.

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Context and Aim: The tribal populations are recognized as socially and economically vulnerable; thereby patterns and trends in tribal areas are required to monitor local epidemics and to assess the effectiveness of public health programs in prevention and control of diseases. This prompted us to assess the health status and morbidity pattern among the tribal and non-tribal population of Mysore. Settings and Design: A cross sectional study was carried in the forest areas of Mysore in the 33 tribal hamlets present. Materials and Methods:Among 33 tribal hamlets, a random selection of 18 hamlets was performed by lottery method. A pre-tested structured interview was used for data collection through house to house visits by individual and family scheduling. Data were statistically analyzed using measures of central tendency, standard normal test (Z), and Chi-square test (χ² ). P-value of <0.05 was considered statistically significant. All the tests were performed using Smith's Statistical Software version 2.80. Results: The study revealed more of tribal (45.03%) children compared to non-tribal (22.47%) were suffering from protein energy malnutrition with P < 0.001 and 7.35% of tribal children were severely malnourished. Among tribal under five children, morbidity pattern observed was more with skin infections (31.33%), followed by (21.20%) dental caries; (19.20%) intestinal infections; (21.85%) while in non-tribal counterparts, skin infections were (12.98%), (7.78%) dental caries; (17.98%) intestinal infections; (25.84%) respiratory infections; and (20.22%) vitamin deficiencies. Conclusion: Tribals have low socio-economic status, poor nutritional status, increased prevalence of morbid conditions compared to non-tribal population. Further detailed research surveys among tribal population would be invaluable.

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Background: The objectives of this study were to analyze the results of the right anterolateral thoracotomy approach for primary mitral valve replacement with reference to length of incision, surgical exposure, mean cross-clamp time, mean bypass time, intensive care unit (ICU) stay, hospital stay, overall comorbidity sepsis, dehiscence, healing cosmesis and cost-effectiveness. Materials and Methods: Thirty-three patients were operated for mitral valve disease in the Department of Cardiovascular and Thoracic Surgery at the Sher-i-Kashmir Institute of Medical Sciences from September 2009 to August 2011 and all patients underwent mitral valve replacement. Results: Of the 33 patients, 13 were male (40.6%) and 19 were female (59.4%). The length of incision was 14.8 ± 2.3 cm and, in thoracotomy, there was a significantly lesser duration of ICU stay the entire hospital stay. Scar visibility was around 25% in case of thoracotomy. Conclusion: Approach through a right anterolateral thoracotomy proved to be easy to perform while maintaining maximum security for the patients. Besides its better cosmetic result, especially in female patients, this approach proved to have several advantages. It offered a better exposure to the mitral apparatus even in patients with small left atrium, allowing mitral valve replacement to be performed easily. The shorter hospital stay and cost-effectiveness of thoracotomy approach is an additional relief to the family.

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Objectives: Delirium tremens is the most severe on the spectrum of alcohol withdrawal syndromes. The mortality rate in this condition has been reported as high as 20%; however, with appropriate diagnosis and prompt treatment, mortality has been reduced to 1%. We studied the sociodemographic, clinical and laboratory data in alcohol dependant patients who developed delirium during the period of abstinence and compared them with patients who had uncomplicated withdrawal states. Materials and Methods: This investigation was done in the deaddiction centre, department of psychiatry, Father Muller Medical College Mangalore. A retrospective chart review spanning a period of 8 months (Jan-Aug 2011) was done to select 60 consecutive patients with alcohol dependence syndrome without medical or other psychiatric co-morbidity (excluding nicotine dependence). Socio demographic, clinical and laboratory data comprising haematological and biochemical parameters at the time of admission were compared between 30 alcohol dependents who developed delirium and 30 alcohol dependents who had uncomplicated withdrawal state. Results: No statistical significance is observed on sociodemographic data between the groups. Early onset dependence were noted to be developing delirium in withdrawal period. Elevated bilirubin levels and SGOT levels are significantly more in delirious patients. Statistically significant higher blood glucose levels were seen in patients with uncomplicated withdrawal. Conclusion: Patients with elevated bilirubin and transaminases, and early onset alcohol dependence are prone to develop delirium during alcohol withdrawal states.

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Objectives: The aim of this study is to assess the selected biopsychosocial problems of menopausal women; to explore the relationship between the biological, psychological, and social problems associated with menopause; and to find an association between the biopsychosocial problem and the selected baseline variables. Materials and Methods: A descriptive study conducted among 50 postmenopausal women in Father Muller Medical College Hospital, from November 2011 to January 2012. The purposive sampling technique was used to select 50 postmenopausal women. Data was collected using a rating scale on biopsychosocial problems. Results: The biopsychosocial problems experienced by the women at moderate levels: Most of the postmenopausal women experienced biological problems. The problems were ranked based on the percentage. Conclusion: The finding of the study implicates that biological problems are felt the most in comparison with the psychological and social problems.

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Objective: Diverse medical conditions are associated with alcohol use disorders. Early diagnosis, prompt intervention, and treatment will reduce the morbidity and mortality and improve the quality of life. The aims of this study are to evaluate the frequency and nature of medical comorbidity in inpatients with alcohol dependence syndrome and to study the relationship between medical comorbidity and clinical and sociodemographic factors. Materials and Methods: This is an observational, descriptive, cross-sectional clinical study conducted on 100 consecutive patients with ICD10 diagnosis of alcohol dependence syndrome admitted to the deaddiction center, department of psychiatry, Father Muller Medical College Mangalore. All patients were assessed for evidence of concurrent medical comorbidity. Appropriate scales were used for assessment. Medical diagnosis was based on clinical findings, laboratory, and radiological investigations. The data of 100 patients were analyzed with appropriate statistical methods. Results: 65% of inpatients with alcohol dependence syndrome have medical comorbidity, of which 23% of alcohol-dependent individuals have diabetes mellitus, 20% have hypertension, and 51% of subjects have other medical comorbidities. Conclusion: The prevalence of medical comorbidity particularly diabetes mellitus and hypertension is significantly higher in inpatients with alcohol dependence syndrome. Our findings points to the importance for the need for early diagnosis of comorbid medical diseases.

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Vitiligo affects all ages but it is most common in the second and third decades of life. Although its exact cause is not completely understood, autoimmunity and viral skin infection have been implicated in the etiology of vitiligo, but its association with urticaria and childhood asthma at an early age in a child without an established autoimmunity disorder is a rare event.

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Cyanotic congenital heart disease is a high iron-requiring illness; therefore affected children may be prone to iron deficiency if not actively sorted and treated. Among problems associated with iron deficiency is pica; the consumption of non-food substances for non-nutritive purposes. Children with pica are at risk of other health hazards like lead toxicity, Intestinal obstruction and parasitic infections from the contaminated substances consumed; however, this is often a forgotten problem in children with cyanotic heart disease; therefore two cases of pica in children with tetralogy of Fallot are reported.

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Context:Roughly three million children die each year of vaccine preventable diseases (VPDs) with a significant number of these children residing in developing countries. Aims: The present study was conducted to assess the immunization status of 12-23 months old children and its determinants in Lucknow. Settings and Design: List of all villages in rural area and mohallas in urban area of Lucknow district was procured. Eight villages and eight mohallas were selected by simple random sampling. A community based cross sectional study was done among 450 children aged 12-23 months. Materials and Methods: A pre-designed and pre-tested questionnaire was used to elicit information on family characteristics, bio social characteristics, and housing characteristics. The immunization status of the child was assessed by vaccination card and by mother's recall, where vaccination card was not available. Statistical Analysis: Data were analyzed using statistical package for social services (SPSS) version 11.5. Chi-square test will be used to find out the significant association. Results: Overall, 62.7% children were fully immunized, 24.4% children were partially immunized, and 12.9% children were not immunized. The various determinants of immunization status of the child the place of residence, religion, socio economic status, father's education and father's occupation, source of information regarding immunization, registration of pregnancy, number of ante natal visits, iron and folic acid tablets consumed by the mother, tetanus toxoid received by the mother, place of delivery and the attendant who conducted the delivery. Conclusion: More awareness should be generated among the people living in rural and urban area, to immunize their children and to prevent the morbidity and mortality from six lethal vaccine preventable diseases.

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Background: Modern day life in cities is associated with an enormous increase in vehicular traffic emitting exhausts and polluting the atmosphere. Airborne dust plays a major part in the overall atmospheric pollution and motor vehicle emissions constitute the most significant source of ultra particle in an urban environment. Traffic related air pollution is an occupational health hazard to individuals with a work environment close to traffic. Hawkers who work near areas located in the vicinity of traffic junctions through which maximum number of vehicles passes are more prone to develop health issues pertaining to the respiratory system. The effect of this occupational hazard in this unorganised workforce is not adequately studied. The present study intends to study the effect of air pollution on the pulmonary system in hawkers exposed to automobile exhaust. Materials and Methods: This study was conducted by performing pulmonary function tests (PFT) on 20 hawkers who are exposed to automobile exhaust by virtue of their work venue nearer to traffic junctions and comparing them with 20 other age , gender matched and similar anthropometric profile hawkers who work in a rural setting free from vehicular air pollution. PFT by computerized spirometer measuring FVC, FEV1, FEV1/FVC, PEFR, and FEF25-75% were measured. Statistical analysis was done by Student's t-test (two-tailed, independent) for inter group analysis. Results: On comparison of pulmonary function test in the study and control group was seen that there is decline in dynamic pulmonary function parameters in the study group when compared to controls which is statistically significant. Conclusion: This was a comparative study to demonstrate the effect of air pollution due to automobile exhaust on pulmonary functions of hawkers exposed to a polluted urban environment with a similar group in the rural relatively pollution free environment. PFT by computerized spirometer measuring FVC, FEV1, FEV1/FVC, PEFR, and FEF25-75% were measured. The results were tabulated and statistically analyzed. It was found that there is a significant decline in various PFT parameters recorded in the study group as compared to the control group.

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Purpose: The efficacy of assisted reproductive technology has improved significantly over the past decade. Due to lifestyle changes and sociological factors couples are delaying childbirth and resorting to the treatment of assisted reproductive technology. In spite of the success of IVF, traditional management of infertility has still a role to play. Recent findings: Expectant management and treatment with clomiphene should be the first line of management in couples with unexplained infertility where the cause for infertility cannot be detected. IUI with superovulation has been successful in some couples, but the risk of multiple pregnancies should be kept in mind. WHO guidance for semen analysis is still the method of choice to investigate male infertility. Hysterosalpingographyor sonohysterography can replace diagnostic hysteroscopy and diagnostic laparoscopy as a diagnostic tool in majority of patients with infertility. Operative hysteroroscopic procedures like myomectomy, polypectomy, metroplasty, and dissection of intrauterine adhesions can be performed when intrauterine pathology is detected. Tubal surgeries like tubal anastomosis, salpigostomy, and fimbrioplasty have a definite role to play in addition to other surgeries done to enhance the in vitro fertilization outcome. Endometriomas >4 cm need to be operated and a higher pregnancy rate has been found with laparoscopic excision rather than the popular methods of laparoscopic stripping, ablation or fenestration. The surgical mode of treatment for endometriosis has a limited place, like in conditions of chronic pelvic pain and whenever there is difficulty in follicular aspiration due to dense adhesions in IVF treatment. Inadvertent excision of healthy ovarian tissue is the most common complication of surgeries for ovarian endometriomas. Conclusion: In the present era of IVF there is still place for expectant management, ovulation inducing drugs, and limited place for laparoscopy and hysteroscopy surgeries before subjecting the infertile patients for IVF treatment.

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Escherichia coli, as the predominant pathogen in pyogenic liver abscess, resulting from underlying ascending hepatobiliary disease is well recognized. Klebsiella pneumoniae is a common pathogen responsible for diverse nosocomial and community-acquired infections, and is the third most common pathogen (10%) found in cases of nosocomial bacteremia, after Escherichia coli (20%) and Staphylococcus aureus (16.5%). Klebsiella pneumoniae has emerged as a major cause of primary or cryptogenic liver abscess with the recognition of the Cryptogenic Invasive Klebsiella Pneumoniae Liver Abscess Syndrome (CIKPLA). The syndrome appears to target populations of Asian descent with underlying disorders reflecting an impaired immunity, and is associated with the K1 hyper viscous serotype of this organism. We report a case of the CIKPLA syndrome, thus highlighting its continued evolution.

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Elongation of the styloid process is a very rare clinical phenomenon, affecting 4% of the overall population. The etiopathogenesis of this syndrome is still an enigma although several theories are proposed in the literature. Clinical manifestations of this syndrome occur only in 4-10% of the affected population. If it occurs, an appropriate clinical diagnosis can be made. Most commonly, this syndrome is seen in routine radiographic investigations with elongation of the styloid process, which may be unilateral or bilateral. We report a case of a 45-year old female who had dysphagia with vague cervicofacial pain and was diagnosed with Eagle's syndrome.

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Hepatic encephalopathy (HE) is an important and common metabolic disturbance in children. The causes are many. Reye-like syndrome (RLS) can manifest with hypoglycemia, hyperammonemia and altered sensorium with elevated liver enzymes as in Reye syndrome, where the cause remains elusive. This disease is associated with a significant risk of mortality. This report discusses the diagnostic possibilities with a brief review of literature in a one year boy who recovered completely from acute hepatic encephalopathy.

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Metachromatic leukodystrophy or Scholz's disease is a rare disorder transmitted as an autosomal recessive trait, leading to demyelination and neurological impairment. An 18-year-old boy was brought to the psychiatry out-patient department with a history of progressive decline of cognitive functions and self-help skills since 8 years. On examination, the patient was alert, easily distractible, and restless with stereotypic movements of the head. He was unable to speak, able to comprehend simple commands but not complex instructions and had an inappropriate affect. EEG revealed frequent intermittent clusters of biphasic spike-slow wave and sharpish discharges arising from bilateral fronto - centro - temporal regions. MRI brain showed non-enhancing altered signal intensity involving bilateral periventricular deep white matter, with a possibility of metachromatic leukodystrophy. Metachromatic leukodystrophy is a progressive demyelinating disorder which may present with cognitive or behavioral symptoms. It may be misdiagnosed as a psychiatric disorder, delaying intervention, leading to unnecessary exposure to neuroleptics and increasing financial burden for the family.

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