Introduction: Pseudomonas aeruginosa is one of the major etiological agents of nosocomial infection. They are difficult to treat as the majority of them exhibit varying degrees of innate resistance. Acquired resistance is mediated by the production of chromosomal and plasmid-mediated AmpC beta-lactamases, extended-spectrum beta-lactamases (ESBLs), and metallo-beta-lactamases (MBLs). Objectives: This study was conducted for the detection of ESBLs and the comparison of various phenotypic methods of AmpC beta-lactamases (both inducible and plasmid-mediated) from various clinical isolates of Pseudomonas aeruginosa. Materials and Methods: A prospective study was conducted for a period of 6 months from January 2014 to June 2014. Isolates of Pseudomonas aeruginosa were tested for ESBLs by combined disk diffusion method using ceftazidime/ceftazidime+clavulanic acid (CAZ+CAC). Inducible AmpC beta-lactamases were detected by both ceftazidime-imipenem antagonism test (CIAT) and cefotaxime/cefoxitin (CTX/CX) inducible disk diffusion test. Plasmid-mediated AmpC were detected using AmpC disk test and ethylenediaminetetraacetic acid (EDTA) disk test. All the isolates were tested for cefepime resistance. Results: Out of 116 Pseudomonas aeruginosa isolates, 70 were ceftazidime-resistant. While ESBLs were observed in 67 out of 70 isolates, 36 were positive for inducible AmpC by both the methods. Plasmid-mediated AmpC were detected in only 8 isolates. All the 70 strains showed resistance to cefepime. Conclusions: High prevalence of ESBL and chromosomal-mediated AmpC was observed in Pseudomonas aeruginosa. Both the inducible disk diffusion tests (CIAT, CTX/CX) were equally effective in the detection of inducible AmpC. As Pseudomonas is one of the major nosocomial pathogens, such high resistance poses a grave threat.

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Ceelen-Gellerstedt syndrome, also known as idiopathic pulmonary hemosiderosis (IPH), is a rare disease characterized by recurrent pulmonary alveolar hemorrhages associated with a classical clinical triad of hemoptysis, unexplained iron deficiency anemia, and diffuse pulmonary infiltrates on imaging. We present a case report of Ceelen-Gellerstedt syndrome in an elderly 69-year-old Indian male patient, which is an unusual case as the condition is more common in children and young adults. Diagnosis was suspected on high-resolution computed tomography (HRCT) scan, which revealed diffuse areas of consolidation, ground glass opacities, and septal thickening with perihilar and basal predominance and further workup with bronchoscopy and bronchoalveolar lavage helped to confirm the diagnosis.

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Background: University students in foreign countries are likely to engage in risky sexual behaviors due to a sense of freedom from restrictions and parental influence. Objective: The objective of this study was to assess attitudes toward condom use and sexual behaviors of Nigerian undergraduate students studying in Karnataka, India. Materials and Methods: This was a descriptive study conducted in five (5) colleges mainly populated by Nigerian students. The colleges were purposively selected because of their involvement in the recruitment of Nigerian students. A total population sampling technique was used to include all Nigerian students currently enrolled in each of the selected colleges. A total of 212 participants (124 males and 88 females) were included in the study. A pretested self-developed questionnaire was the tool used for data collection. Data collected were coded and analyzed using SPSS 17.0 to present results in tables of frequency count and percentage. Results: The majority of both males (55.6%) and females (50%) agreed that they can't really give themselves up to their partners when using condoms. The majority (38.7%) of males did not agree that proper use of condoms could enhance sexual pleasure, while the majority of females (47.7) were undecided. In general, the majority of both male and female students were in favor of condom use. While 47.6% of the males reported their intention to engage in unprotected sex if their partners wanted it, the majority of the females (40.9%) were not sure about this. In addition, although 68.5% of the males reported that they may have had sex with someone who was at risk of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), the majority of the females denied this. Knowledge of present HIV status was higher among females. Conclusion: While attention is paid to the need to prevent and control HIV/AIDS among youths in Nigeria, this effort should be extended to the citizens who are studying abroad through international collaboration and linkage between the home and foreign host countries.

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Background: Malnutrition is one of the most important health problems throughout the world, particularly in developing countries, and has undesirable effects on the mental and physical health of children. Objectives:The objectives of this study were to find out the prevalence of malnutrition in children under 5 years of age (under-five children) and epidemiological determinants associated with it. Materials and Methods:This community-based cross-sectional study was conducted on under-five children in Bareilly, Uttar Pradesh, India belonging to the field practice area of the Rural Health and Training Centre of the Department of Community Medicine of Rohilkhand Medical College and Hospital, Bareilly, applying multistage simple random sampling methodology. Data were collected through measuring weight and height, structural schedules, anthropometric nutritional indicators, and face-to-face interviews with mothers. Malnutrition was measured on the basis of the indices underweight, wasting, and stunting. The obtained data were entered and analyzed using SPSS. Multiple logistic regression analysis was applied as the test of significance. Results:The prevalence of underweight, wasting, and stunting was 33.11%, 46.88%, and 10.44%, respectively. The total prevalence of malnutrition was 57.11%. Malnutrition was found to be significantly associated with age (0-12 months and 25-36 months), sex, socioeconomic status, and maternal education. Conclusion:Malnutrition was found to be more in children aged less than 1 year and in those aged 2-3 years. It was more common in female children, in children of low socioeconomic status, in children from nuclear families, and among those whose mothers were illiterate.

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Occurence of psoriasis and leprosy in a single patient is extremely rare with very few cases reported. Better knowledge of the pathogenesis of these two diseases has led to some understanding of this rare association. We report such an association in one of our patients. We also report the therapeutic dilemma faced in treating lepra reaction with steroids while preventing the acute flare-up of psoriasis.

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Background: The paternal postpartum period is a tremendous transitional time for first-time fathers and so, their unique experiences should be considered. Aim: To explore new fathers' experiences during the child's first year and the factors associated with their experiences. Setting and Design: A descriptive exploratory research conducted among n = 149 new fathers working in private companies in Bengaluru, Karnataka, India recruited by purposive sampling during their first year of paternal postpartum period. Materials and Methods: An individual interview using a four-point structured rating scale consisting of 50 items measuring their experiences during the first year of paternal postpartum period was used to collect data. Statistical Analysis: All statistical analyses were performed by the Statistical Package for the Social Sciences (SPSS) 17 version. An alpha less than 0.05 was considered to be significant in all analyses. Results: The results revealed that the vast majority of the first-time fathers (61.34%) had positive postpartum experiences as compared to 38.66% who reported negative fatherhood experiences. The key concepts related to their experiences were emotional upheaval, changes in lifestyle, pleasant and rejuvenating fatherhood experiences, relationship difficulties with partners, parents, friends, lack of intimacy with spouse, feelings of social isolation, lack of leisure activities and hobbies, difficulties in balancing career and family, ongoing physical problems, and financial constraints. There was no association of their postpartum paternal experiences with sociodemographic factors. Conclusion: Findings from this study suggest the need for realigning health services that have traditionally focused on mothers and children to father friendly services that respect fathers' strengths, experiences, knowledge, relationship, empowerment, and well-being to promote lasting benefits for fathers and their families.

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Context: Molluscum contagiosum (MC) is a highly contagious, nonsevere pediatric viral infection, with the current treatment modalities having negative aesthetic and psychological effects. Aims: To study the efficacy of 10% potassium hydroxide (KOH) solution in the treatment of MC. Materials and Methods: This prospective, open-labeled study was conducted in 40 patients who were clinically diagnosed with MC to know the efficacy of 10% KOH over a period of 18 months attending the outpatient department of Father Muller Medical College Hospital, Mangalore, Karnataka, India. Results: All the 40 patients (100%) showed complete clearance of lesions at the end of 4 weeks. The maximum number of patients belonged to the age group of less than 5 years, with the face being the most common site. Conclusion: Therapy with 10% KOH solution was found to be safe and effective in the treatment of MC.

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Context: Anaerobes are significant pathogens as well as normal flora in a variety of body sites. As the conventional anaerobic culture techniques are laborious, time-consuming and relatively expensive, the interest in anaerobes started narrowing down in the recent past. Objective: This study is aimed at the isolation of bacteria encountered in the surgical infections with an emphasis on anaerobes and to create an awareness among the clinicians regarding the potential role of these silent pathogens Materials and Methods: The present prospective study that was conducted for a period of 1 year, employed 393 specimens collected from various surgical infections. All the samples were subjected for the isolation of both aerobes and anaerobes. Results: Out of 393 specimens, 193 anaerobes and 311 aerobes were obtained. Majority of the cases (226) exhibited polymicrobial etiology. Among the anaerobes, more frequently isolated organisms were nonsporing gram-negative bacilli, such as Bacteroides fragilis group, Prevotella-Porphyromonas group and Fusobacterium, which constitute 68.91% of the cases. Conclusions: This study emphasizes the need to employ anaerobic culture techniques routinely in microbiology laboratories and to create an awareness among the clinicians regarding the potential role of anaerobes.

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Inverted teeth have been reported in both maxilla and mandible and mostly they are inverted and impacted third molars and premolars. However, a few cases of inverted supernumerary teeth attached to an impacted third molar have been reported. This case report would add to the academic literature and case series on inverted and impacted teeth. The present case reports an inverted and impacted supernumerary tooth attached to a third molar in a middle-aged male patient.

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Castleman's disease (CD) is an uncommon cause of solitary or multiple lymphadenopathy, which may be a target for fine-needle aspiration (FNA). Because of its rarity and lack of adequate literature available on its cytomorphological findings, the condition is misdiagnosed or missed out during routine FNA reporting. The presence of small lymphocytes and plasma cells with large atypical binucleate follicular dendritic cells resembling Reed-Sternberg cells may raise a suspicion of Hodgkin lymphoma (HL). Here, we report the cytodiagnosis and pitfalls in the diagnosis of CD in three cases. FNA smears were reviewed and pitfalls in the diagnosis analyzed and correlated with histopathological findings.

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An elderly male came with h/o loss of appetite and weight loss since 3 months. On evaluation, prothrombin time (PT), activated partial thromboplastin time (aPTT), and international normalized ratio (INR) values were high. Hepatitis B surface antigen (HbSAg) screening was reactive and serum alfa-fetoprotein (AFP) was raised. Ultrasound examination revealed a hepatic mass with inferior vena caval extension and direct invasion of the right atrium. Computed tomography (CT) scan of the lower thorax and abdomen was performed, which confirmed the ultrasound diagnosis. The patient had a brief stay in the hospital and got discharged against medical advice; he was not available for follow-up. Hepatocellular carcinomas (HCCs) commonly metastasizes to the lung, bone, brain, and adrenal glands. About 70% of the patients with HCCs have hepatic and portal vein invasions but encroachment into the right atrium is very rare. The most common symptoms of cardiac metastasis include asymptomatic cases, bilateral lower leg edema, and exertional dyspnea in that order. Typical complications of intravascular tumor extension lead to secondary Budd-Chiari syndrome, right heart insufficiency, or massive pulmonary embolism. The prognosis of HCC with atrial invasion is poor, with median survival ranging from 1 month to 4 months. HCC in these cases may be more aggressive, with a shorter doubling time. The risk for cardiopulmonary collapse is higher, with heart failure or sudden death. Surgical interventions as well as nonsurgical approaches have been used in the treatment of patients with symptomatic inferior vena cava (IVC)/right atrial tumor thrombi. There are few reports of en bloc hepatectomy and resection of the right atrial thrombus under cardiopulmonary bypass. Routine screening in patients with HCC, such as including chest imaging as part of surveillance computed tomographic scans, may facilitate earlier detection and treatment.

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To acquire more knowledge on the communication skills after traumatic brain injury (TBI) caused due to gunshot with the bullet sustained in the brain. Formal speech, language, voice, hearing, and swallowing functions were evaluated using several tests and an informal assessment of reading, writing, and arithmetic skills were performed. Results of the evaluation gave a diagnosis as global aphasia with spastic dysarthria. Moderate to severe impairment was observed in the swallowing function. Right hemisphere functions were severely affected except for the music perception. On hearing screening, otoacoustic emissions were present in both the ears suggesting a normal outer hair cell function. The present study hence outlined the speech and language characteristics secondary to TBI with a persisting metallic bullet in the brain. Therefore, it is important that a speech language pathologist plays a role in the comprehensive assessment and management of individuals with TBI to provide a better quality of life.

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A 21-year-old normotensive male presented with acute onset flaccid paralysis with the history of a similar episode a few months back. Clinical and laboratory evaluation revealed lower motor neuron type of flaccid quadriparesis with hypokalaemia, normal anion gap metabolic acidosis, bicarbonaturia, and transtubular potassium concentration gradient (TTKG) more than 7. Subsequently urine acidification test (by NH4CI challenge test) was done and diagnosis of distal renal tubular acidosis was established. The patient responded to conservative management (Sohl's solution).

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Malaria is one the important endemic diseases in India. The clinical manifestations of malaria are diverse. We report a case of splenic infarction in malaria.

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Gastrointestinal stromal tumor (GIST) is the commonest mesenchymal tumor of the gastrointestinal tract, most commonly arising from the stomach but also arising from the omentum, mesentery, and retroperitoneum, which is called extragastrointestinal stromal tumor (EGIST). Rarely may these tumors undergo cystic changes due to central necrosis. In this report, we present a rare case of cystic EGIST, which was misdiagnosed as pelvic abscess by clinical, radiological, and even cytological evaluations. Excision biopsy and immunohistochemical study were required for a correct diagnosis.

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Mucormycosis is an acute, opportunistic infection caused by a saprophytic fungi typically inhabiting the soil or decaying organic matter. It is an invasive and potentially fatal infection caused by fungi of the order Mucorales, which commonly affects structures in the head and neck including air sinuses, orbits, and the brain. We describe our clinical experience of a case of mandibular mucormycosis, developing in a 45-year-old male who had a family history of diabetes. He presented with complaints of pain and foul-smelling discharge from a nonhealing, ulcerative wound at the mandibular alveolus, encompassing the area around the left canine and 1st premolar. The x-ray revealed osteolytic bony lesion with massive destruction of the mandibular ramus. A clinical impression of osteosarcoma was deduced. Surgical curettage was performed; however, the histopathological examination and subsequent treatment with periodic acid-Schiff stain aided in achieving a conclusive diagnosis of mandibular mucormycosis.

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Context:Childbirth is a natural and universal phenomenon. Although labor is often thought of as one of the most painful events in human experience, supportive care is intended to ease a woman's anxiety and discomfort. A wide variety of pain relief measures, pharmacological and nonpharmacological, are available for women in labor. Aim: To assess the practices adopted during labor among the primigravid women in the experimental and control group, to compare the practices adopted during labor among the primigravid women in control and experimental group, and to find the association between selected baseline variables and childbirth practices. Settings and Design: Father Muller Medical College Hospital, Mangalore, Quasi-experimental design. Materials and Methods: Observational checklist to assess the childbirth practices. Statistical Analysis: Frequency, mean, standard deviation (SD), mean percentage, Spearman's rank correlation coefficient, chi-square for association. Result:The mean practice scores are higher among the experimental group compared to the control group, which indicates that the Planned teaching Programme has helped to adopt the practices during labor among primigravid women specially in the experimental group. No association was found between demographic variables and childbirth practices. Conclusion: Planned Teaching Programme is a simple and cost-effective method that can be initiated by nurses who are to be used by mothers during labor.

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Context: Dental caries is considered to be a major public health problem globally due to its high prevalence and significant social impact. The World Health Organization reports 60-90% of schoolchildren worldwide have experienced caries, with the disease being most prevalent in Asian and Latin American countries. Aim: To determine the level of knowledge regarding prevention of dental carries among schoolchildren and to find an association between the knowledge on prevention of dental caries and the selected baseline variables. Materials and Methods:A descriptive design was used for the present study. The subjects consisted of 100 higher primary schoolchildren from a government school who were selected using purposive sampling method. Data were collected by administering a structured knowledge questionnaire. Data were analyzed using descriptive statistics such as mean, median, and standard deviation, and inferential statistics such as chi-square test was used. Result: Majority of the schoolchildren (50%) had average knowledge, 33% had good knowledge, 16% had poor knowledge, and 1% had very good knowledge regarding the prevention of dental caries. There was a significant association between the level of knowledge and the selected baseline variables such as age. Conclusion: The findings of this study revealed that a majority of the subjects had average knowledge on the prevention of dental caries, which indicates that children are at risk of developing dental caries. Hence, this study may help to develop healthy interventions about the prevention of dental caries among schoolchildren.

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Background and Objectives: Snakebite is a common medical emergency requiring immediate medical attention. This study was conducted to understand snakebite cases, with particular attention given to where the lacunae lie in current management so that remedial steps may be undertaken. Materials and Methods: This was a cross-sectional, descriptive study and was carried out in Davangere, Karnataka, India. Snakebite cases (729) were included in the study and all the victims were interviewed using a prestructured questionnaire. Victims were evaluated for the nature of bites, first aid measures, treatment modalities, and treatment outcome. Results: The majority of the snakebite victims were from villages, were farmers, and belonged to the 20-40 years age group. Viper bites were the most frequently reported, and an overwhelming number of victims resorted to first aid measures with tourniquet application at the site. Most victims reached a peripheral health institution (PHI) first following the bite, and a small fraction received only one vial of anti-snake venom (ASV). The longest referral pathway to a tertiary hospital was as follows: Bite-traditional healer- primary health center (PHC)-tertiary hospital; fatality was 2%. Most victims had signs of envenomation and received ASV, of whom 32% administered with ASV had developed hypersensitivity reaction. Conclusion: This study showed that PHCs were inadequate in terms of providing optimal treatment and that measures are needed to upgrade these facilities.

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