Chikungunya is an important mosquito borne arboviral disease causing periodic epidemics world over. India also faces the brunt of this disease every few years which is associated with acute as well as long term consequences. The burden of this disease has been ever increasing since the 2006 outbreak, the latest outbreak occurring in 2016. Chikungunya has been typically associated with fever, joint pains and rash but during the last few epidemics, lot of atypical presentations of this common disease occurred. It was thought to be a benign self- limiting disease but in recent time, severe disease with multi-organ involvement requiring intensive care and causing mortality have been reported from India and other countries, especially in patients with co-morbid illnesses. Many patients suffer from chronic consequences of this chronic inflammatory rheumatism lasting for years, affecting the quality of life and productivity of the affected population. This review highlights the epidemiology, the changing clinical spectrum, the available diagnostic modalities and the management of acute and chronic manifestations of this challenging infection.

COVID 19 has emerged as a global pandemic with high morbidity and mortality. Continuous research and understanding of the disease has led to formulation of various guidelines for the patient management. Fibrinogen plays an essential role in pathology, both as an acute phase reactant and a procoagulant. Baseline and the monitoring of the levels may help in prediction of the prothrombotic or the pro hemorrhagic states. And hence, the interpretation of fibrinogen along with clinical picture, d dimers and coagulation parameters may help in better judgement of the patient situation.

Snake bite is one of the common public health problems especially in developing countries leading to increased morbidity and mortality. Delay in access to appropriate medical services and increased local practices of envenomation further complicate the scenario. Indigenous treatment systems, quacks and many first handlers in snake bites attribute to significant morbidity, end organ damage, septic complications further causing death, increased hospital stay and eventually increased economical burden on our existing health care system. Alleviation of such practices through stringent law and policy making with increased education and mobilization for appropriate medical management, supportive first aid and regular timely supply of anti snake venom is quintessential and need of an hour to curb the devastating complications due to snake bite and leading to improved clinical outcome.

To keep up with the current COVID-19 pandemic, the healthcare infrastructure is continually changing and growing at a rapid pace. Protection of our frontline workers is of utmost priority. Here, we describe the measures taken at our tertiary care center for this purpose. A dedicated COVID-19 screening centre was setup for healthcare workers (HCW), run by frontline HCWs themselves. Over the 6 months that this OPD has run, it has catered to hundreds of HCWs, with a small number of staff themselves contracting COVID-19. The individual cases have been enumerated, and the changes implemented from lessons we learnt have been discussed.

Cerebellar disorders associated with HIV infection are typically the result of discrete cerebellar lesions resulting from opportunistic infections such as toxoplasmosis and progressive multifocal leukoencephalopathy or primary CNS lymphoma. Clinical symptoms and pathologic abnormalities related to the cerebellum may also be observed with HIV dementia. A primary cerebellar degeneration with HIV is rare. In our case the patient presented with progressively unsteady gait, slurred speech, and limb clumsiness. Examination revealed gait ataxia, impaired limb coordination, dysarthria, and abnormal eye movements. CD4 lymphocyte counts was very low 26 cells/mm3. Neuroimaging studies showed prominent cerebellar atrophy. We report a syndrome of unexplained, isolated degeneration of the cerebellum occurring in association with HIV infection.

Histoplasmosis is an opportunistic fungal infection commonly affecting immuno compromised hosts. In HIV patients it usually present as a disseminated form. We hereby report a case of Progressive Disseminated Histoplasmosis in a patient with advanced HIV infection, who presented with prolonged fever and pancytopenia. Bone marrow examination showed yeast forms of Histoplasma capsulatum. Prompt initiation of antifungal therapy and anti-retroviral therapy lead to improvement in her clinical condition. Progressive Disseminated Histoplasmosis is thus an important differential diagnosis to be considered in any HIV patient presenting with prolonged fever and pancytopenia.

Non-alcoholic Fatty Liver Disease (NAFLD) is currently reliably and increasingly being diagnosed and classified by non-invasive methods in comparison with standard invasive methods. Various permutations and combinations has been studied and explored with different clinical sign and symptoms with or without lab profiles to closely approach the precise diagnosis. It is indeed the need of the hour to understand the most suitable non-invasive clinical modality in a given set of patient profile to reach to the finest and closest diagnosis without compromising the outcome as far as the patient management is concerned. This could well be learnt progressively to more and more effectively use of these non-invasive tools and avoiding cumbersome liver biopsy in parallel

Anal fistula in infants is a common disease. Although many are recovered by conventional treatment, there are some patients who are not repaired easily. We performed the Ksharsutra method to an anal fistula and report the good result that we obtained.

Out of all the haematological aberrations associated with Primary hypothyroidism, anemia is found in 25% of hypothyroid patients. There are few reports of multiple autoimmune diseases co-existing with Hashimoto’s thyroiditis and Grave’s disease, however associations with primary hypothyroidism have not been reported yet. We report patient with primary hypothyroidism who presented with Immune thrombocytopenic purpura.

Children in the age group of 5-15 years are often considered as school age. It is recorded that in India, one-fifth population consists of children between 5-14 years, which includes the primary and secondary school-age (1). Adequate micronutrient status is critical for good health and development during childhood. Access to high-quality data on nutrition and health indicators in this age group would aid in prioritizing and setting up deliberate, evidence-based nutrition intervention programs, targeting the nutritional problems that are of real concern (7). Objectives: 1. to examine the prevalence of clinical signs of nutritional deficiency disorders among school-age children. 2. to find out the difference in prevalence of deficiency disorders among boys and girls.

In this article were analyzed clinical, X-ray and sonographic results of the treatment taken by patients suffering for metatarsalgia. The said study involved 189 patients suffering from metatarsalgia (269 feet) who were divided into a core group that included patients suffering from metatarsalgia and patients having the same disease that was combined with hallux valgus and who underwent a surgery by using of the method developed by us (87 patients, 136 feet) and a control group which included patients suffering from metatarsalgia combined with hallux valgus and who underwent a surgery earlier by using of different techniques which goal was to correct hallux valgus (102 patients, 133 feet).

Toxoplasma gondii (T. gondii) is intracellular protozoa. Infection with T. gondii can result in a serious sequel to the fetus if infection occurs in the first trimester of pregnancy. Laboratory diagnosis is the main method of diagnosis.

The health and efficiency of workers working in any organization get influenced in large measures by conditions prevailing in their work environment. The prevailing conditions are related to physical, biological, chemical and social agents. A worker is usually exposed to these agents for about six to eight hours daily. It is therefore, essential that this environment should be wholesome and free from any kind of harmful agents as far as possible.The study was undertaken to estimate the prevalence and to assess the knowledge regarding prevention on health problems among incense stick workers in selected industries at, Bangalore.

The association of arthritis with Psoriasis is well established; with variable prevalence in different population groups. The timing of onset of arthritis with respect to skin lesion is variable; with the most common pattern being arthritis manifesting concurrently or after the appearance of cutaneous lesion. We document a case of a young male in whom the skin lesions were preceded by arthritis by almost a year. The pattern of arthritis was a combination of symmetrical polyarthritis involving small and large joints of body as well as axial spondyloarthritis. The final diagnosis could only be made after the appearance of skin lesion as the patient had no past history or family history of Psoriasis. Finally there was a striking response to Methotrexate both in terms of skin lesion as well as joint symptoms.

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Purpose. We studied the occurrence of dermatophytes and non-dermatophytes fungi from diabetic patients. In addition, we compared the newly developed dermatophyte identification medium (DIM) that has little cost with the established dermatophyte test medium (DTM).

Background: Telomerase is an enzymes which can be expressed in approximately 90% of carcinomas and in over 90% of breast cancer whereas in normal tissues it is not detectable. Recent studies have been proved that high telomerase expression is associated with poor prognosis of breast carcinoma.Objective: We investigated the telomerase activity by immune-histochemistry and its expression in tumor and non-tumor breast tissue and its clinco-pathological correlation with other established prognostic markers.Methods: Immuno-histochemistry (IHC) was used to detect the expression of human telomerase reverse transcriptase (hTERT) in the tissues of 20 cases of breast carcinoma and 20 cases of benign breast lesions and its correlation with other prognostic factors like ER, PR and her2-neu status.Results: Nuclear expression of telomerase by IHC was found in 7 out of 20 breast cancer patients (35%). None of the 20 benign breast tissue samples stained for telomerase. The variation of hTERT expression as per T stage, N stage, ER, PR and her2-neu status were not statistically significant in breast cancer. hTERT expression was comparable in patients with triple negative and non triple negative breast cancer.Conclusion: hTERT expression needs to be correlated with response to chemotherapy by further studies and may emerge as a useful tool in selecting most appropriate chemotherapy protocol for a given patients.

Contents Volume 6 Issue 1 June

Purpose. We studied the occurrence of dermatophytes and non-dermatophytes fungi from diabetic patients. In addition, we compared the newly developed dermatophyte identification medium (DIM) that has little cost with the established dermatophyte test medium (DTM).

With high number of young people taking up IT jobs and facing stressful life affecting their quality of life; there is a high degree of necessity to find the tools which can reduce stress levels among them. Yoga may be regarded as one such tool. Suryanamaskar a form of yogic exercise is well-known, but there are very few evidence-based studies in the past on the effects of suryanamaskar on stress. Hence present study was undertaken to assess the effects of suryanamaskar on professional stress by measuring it using Professional Life Stress Scale (PLSS) before and after the intervention of 30 days of suryanamaskar. It was noticed that, the stress score was reduced significantly from problematic to moderate level after the intervention. Suryanamaskar may be a useful tool, to be practiced on a daily basis, especially in the IT industry, which can help to alleviate stress, raise the quality of life of employees and thus productivity. However, detailed studies employing larger sample size and advanced methods are recommended to understand the scope of suryanamaskar further.

Background: Tuberculosis of the breast is a rare and its diagnosis is difficult to establish clinically as the signs and symptoms may mimic that of carcinoma of the breast and sometimes a chromic breast abscess.Aim: In this series of 102 patients we review our experience and high-light that breast TB should be considered as a differential diagnosis of breast lesions like breast carcinoma.

In this article were analyzed clinical, X-ray and sonographic results of the treatment taken by patients suffering for metatarsalgia. The said study involved 189 patients suffering from metatarsalgia (269 feet) who were divided into a core group that included patients suffering from metatarsalgia and patients having the same disease that was combined with hallux valgus and who underwent a surgery by using of the method developed by us (87 patients, 136 feet) and a control group which included patients suffering from metatarsalgia combined with hallux valgus and who underwent a surgery earlier by using of different techniques which goal was to correct hallux valgus (102 patients, 133 feet).

Toxoplasma gondii (T. gondii) is intracellular protozoa. Infection with T. gondii can result in a serious sequel to the fetus if infection occurs in the first trimester of pregnancy. Laboratory diagnosis is the main method of diagnosis.

Children in the age group of 5-15 years are often considered as school age. It is recorded that in India, one fifth population consists of children between 5-14 years, which includes the primary and secondary school-age (1). Adequate micronutrient status is critical for good health and development during childhood. Access to high quality data on nutrition and health indicators in this age group would aid in prioritizing and setting up deliberate, evidence based nutrition intervention programs, targeting the nutritional problems that are of real concern (7). Objectives: 1. to examine the prevalence of clinical signs of nutritional deficiency disorders among school-age children. 2. to find out the difference in prevalence of deficiency disorders among boys and girls.

Tubercular lymphadenitis (TBLN) is the most common manifestations of extra-pulmonary tuberculosis (EPTB) accounting for 30-40% of cases with multiple discrepancy in diagnosis. Rapid diagnosis and timely initiation of anti-tubercular therapy (ATT) is the key for successful clinical effects. This study was carried out to evaluate multiplex polymerase chain reaction (MPCR) using MTP40, IS6110, 32 kD-alpha antigen encoding gene, and mycobacterial specific genes (rpoB, katG & inhA promoter region), and compare with the conventional methods for rapid diagnosis of TBLN

Macroglobulinemia refers to the excess production of IgM monoclonal protein that occurs in certain lymphoproliferative disorders and plasma cell dyscrasias. This broad definition includes patients with monoclonal gammopathy of undetermined significance of the IgM type (IgM MGUS), smoldering Waldenström macroglobulinemia (SWM), Waldenström macroglobulinemia (WM), and a number of related disorders in which an IgM monoclonal protein is detected, such as chronic lymphocytic leukemia (CLL), a number of lymphoma variants, and primary (AL) amyloidosis.WM is a diagnosed by demonstrating lymphoplasmacytic lymphoma (LPL) in the bone marrow with an IgM monoclonal gammopathy in the blood. Infiltration of the hematopoietic tissues or the effects of monoclonal IgM in the blood causes the symptoms associated with disorder.

Systemic lupus erythematosus (SLE) is an autoimmune connective tissue disease characterised by multisystem involvement. Pulmonary manifestation of SLE varies from pleuritis to severe parenchymal involvement as pneumonitis mimiking as acute respiratory distress syndrome (ARDS). Other pulmonary manifestations of SLE include pulmonary artery hypertension, diffuse alveolar haemorrhage, pulmonary embolism, acutely reversible hypoxaemia, and shrinking lung syndrome. We present the case report of a young woman who presented with severe lupus pneumonitis with central nervous system and renal involvement.

The health and efficiency of workers working in any organization get influenced in large measures by conditions prevailing in their work environment. The prevailing conditions are related to physical, biological, chemical and social agents. A worker is usually exposed to these agents for about six to eight hours daily. It is therefore, essential that this environment should be wholesome and free from any kind of harmful agents as far as possible.The study was undertaken to estimate the prevalence and to assess the knowledge regarding prevention on health problems among incense stick workers in selected industries at, Bangalore.

Abdominal lymphadenopathy is regularly encountered clinical entity and planning a management on likely diagnosis may prove disastrous. In the present case, clinical features with CT findings of massive diffuse paraaortic, mesenteric and splenic group of lymph nodes, mass at the head of the pancreas, encasement of the portal vein, gross splenomegaly and ascites added with suggestion from bone marrow biopsy almost clinched the diagnosis in favour of Hodgkin’s disease. Biopsy, however, turned the table topsy-turvy by confirming these lymph nodes to be of tuberculous origin. Histopathology, thus remains a must tool of information to find a correct diagnosis as observed in this case.

Contents Volume 5 Issue 2

Garment industry employs most of unskilled labour, it demands physical performance of the employees. There is a need to find tools which can enhance the muscle performance and overall health of the employees. Hence, the present study was undertaken to study the effect of regular practice of pranayama on muscle performance. Muscle performance was measured as hand grip strength in terms of Maximum Voluntary Contraction (MVC) and Time to Fatigue at 30% of MVC on day 0 and day 30 of pranayama intervention. After analysing the data statistically, it was found that MVC was significantly (p<0.02) better in Post-Pranayama recording (159.42±18.25) compared to Pre-Pranayama recording (153.7±20.26). Time to fatigue at 30% MVC too was significantly higher during Post-Pranayama session (210.22±18.651) than Pre-Pranayama session (189.58±25.05). Effectiveness of pranayama on muscle performance was evidenced in this study.

Tuberculosis is one of the major public health challenges globally. Extra pulmonary tuberculosis (EPTB) is defined as an isolated occurrence of TB at the body sites other than lungs. The aim of this study was to see the frequency of isolation of Mycobacterium from different EPTB samples.