In spite of advances in diagnostic techniques, surgery, chemotherapy and radiotherapy, colorectal cancers remain undefeated. In the absence of screening, colorectal cancers are diagnosed in an advanced stage when regional and distant metastasis is present. Hence, the hope for control is primary prevention or early diagnosis. Western lifestyle and diet have been implicated in the causation of colon cancers. However, it is still a controversy whether this is due to excess calories, high fat content, genotoxic agents, or lack of protective agents present in vegetables and fruits. Therefore, recommending a specific cancer prevention diet can have fallacies. In this context reduction in cancer mortality can be achieved by screening population at high risk. The colorectal cancers require investigative modalities like colonoscopy, sigmoidoscopy or fecal occult blood testing (FOBT) for screening. Colonoscopy is the most sensitive and specific of all the available colorectal screening tests, whereas the sensitivity and specificity for FOBT and sigmoidoscopy are much lower. Although performance of FOBT is relatively inexpensive, sigmoidoscopy and colonoscopy must be performed by trained endoscopists and are more expensive. Moreover, lack of awareness that colorectal cancer is a prevalent and serious disease, concerns about the potential discomforts of colorectal cancer procedures or of the preparations for screening appear to be potential barriers for colorectal cancer screening. MicroRNAs (miRNAs) have roles in colon carcinogenesis; therefore, may be useful biomarkers for colorectal carcinoma (CRC). They are short ribonucleic acid (RNA) molecules having very few nucleotides compared with other RNAs. miRNAs have been studied intensively in the field of oncological research, and emerging evidence suggests that altered miRNA regulation is involved in the pathogenesis of cancers. This review summarizes the use of miRNA in the early diagnosis of colorectal cancers.

In the recent years, many modern technologies have been established in the pharmaceutical research and development area. The field of nanotechnology has been revolutionary as substantial and technical, and scientific growth, in basic sciences plus manipulation by physical or chemical process of individual atoms and molecules have widened its horizon. Polymeric nanoparticles with a size in the nanometer range protect drugs against in vitro and in vivo degradation; it releases the drug in a controlled manner and also offers the possibility of drug targeting. The use of polymeric drug nanoparticles is a universal approach to increase the therapeutic performance of poorly soluble drugs in any route of administration. The present review discusses the physico-chemical properties of polymeric nanoparticles, production methods, routes of administration and potential therapeutic applications.

Drug delivery to eye has become a demanding task because of various constraints of eye i.e., physiological and anatomical, which results in improper therapeutic concentration at the site of action. Due to this problem, frequent dosing was recommended causing patient incompliance and adding to the cost of therapy. To overcome these barriers, researchers have discovered novel ocular delivery systems like hydrogels, ocuserts, colloidal carriers, etc. However, every delivery system has its own advantages and disadvantages. Hydrogels are presently utilized as delivery system for actives because of their comparable physical properties to that of living tissue. A plethora of biodegradable polymers are used for hydrogel formulations like polyanhydrides, poly (orthoesters), polyesters and poly (2-hydroxyethyl methacrylate) (pHEMA), chitosan and sodium alginate out of which pHEMA hydrogels are becoming popular from a therapeutic point of view for the ocular drug delivery. The present paper broadly describes the recent advances on drug delivery using pHEMA hydrogels with exhaustive details of researches explored till date.

Context: Post-operative analgesia forms an essential ingredient of perioperative care. Various adjuvants which include opioids and non-opioids have been used to prolong the post-operative analgesia of intrathecal bupivacaine. Aim: The study was conducted to study the effect of intrathecal midazolam in prolonging post-operative analgesia when used as an adjunct with bupivacaine. Settings and Design: The present study was a randomized control design conducted at Karnataka Institute of Medical Sciences, Hubli, Karnataka, India. Materials and Methods: A prospective randomized double blind placebo controlled study was undertaken to evaluate the efficacy of intrathecal midazolam as an adjunct intrathecal bupivacaine for post-operative analgesia on 150 adult patients of ASA grade I/II scheduled to undergo elective lower abdomen, lower limb, and urological surgeries. Patients in group A (n = 75) received 3 ml of intrathecal heavy bupivacaine with 0.2 ml of saline. In group B, patients received 3 ml of intrathecal heavy bupivacaine with 0.2 ml of preservative free 1 mg of midazolam. Statistical Analysis: Mean, Standard Deviation (SD), Z test, Chi-square test were done. Data was analyzed using Pc (XT) with minitab software version 13. Results: There was no significant difference observed in both the groups with respect to onset of sensory block, time taken to achieve maximum sensory block, or level of sensory block. The duration of sensory block was significantly longer in group B than group A (266.36 ± 22.56 min vs 187.8 ± 22.92 min). The duration of effective analgesia was prolonged in midazolam group than in the control group (232.75 ± 21.44 min vs 133.83 ± 16.23 min) with a P value <.0001. Conclusion: The duration of effective analgesia when midazolam is added to intrathecal bupivacaine is significantly prolonged thereby proving that midazolam is a useful adjunct to intrathecal bupivacaine for post-operative analgesia.

Introduction: β-thalassemia major is one of the most common hereditary hematologic disorders characterized by severely impaired β-globulin synthesis. Renal proximal tubular dysfunction may occur in children with β-thalassemia major without clinical manifestations of renal dysfunction or decrease in GFR. However, there is paucity of information about renal involvement in this disease and its early detection in patients with β-thalassemia major is rare. Aims and Objectives: The aim of the present study was to determine the levels of urinary microalbumin along with serum levels of urea, creatinine, uric acid, calcium and inorganic phosphate and to correlate the levels of urinary microalbumin with the above parameters in β-thalassemia major patients. Results: Serum urea, uric acid and phosphate increased ( P < 0.001, <0.05, <0.001 respectively) while serum calcium was decreased ( P < 0.001) in patients with β-thalassemia major patients when compared to healthy controls. Microalbuminuria ( P < 0.001) was seen in patients with β-thalassemia major patients indicating renal damage. Conclusion: Our study emphasizes the need to include microalbuminuria levels into the routine follow up of these patients. Thereby, impedance of disease progress will improve the patients' quality of life.

Context: Tuberculosis (TB) is a public health emergency, which challenges the health indicators of India. Revised National Tuberculosis Control Programme (RNTCP) of the country has modified the definition of a pulmonary TB suspect so as to include an additional proportion of people with cough of 2 to 3 weeks duration, which will help in reducing the delay in starting treatment. Aims: To estimate the proportion of people with cough of 2-3 weeks duration among the newly diagnosed sputum-positive TB patients. Settings and Design: It is a community-based, cross-sectional study in the geographical setting of Thiruvanathapuram city corporation area, Kerala, India. Materials and Methods: The defined population in this study was tuberculosis cases registered under RNTCP for 1 year after April 2009 at the Thiruvanathapuram Tuberculosis Unit (TU). Simple random sampling procedure was done from the sampling frame, the registry of sputum-positive pulmonary cases. TB patients were interviewed when they came to the DOTS center to start the treatment. Total duration of treatment was the major outcome variable. The study protocol was approved by institutional ethical committee of government medical college, Thiruvananthapuram. Results: Proportion of people having cough of less than 3 weeks duration among newly detected TB patients and eligible for screening as per the new guideline was 32%. The analysis included data of 194 subjects with a mean (standard deviation) age of 47.5 (14.3) years. Male gender (149, 76.8%), an educational level up to secondary school (172, 88.6%), and people who were either unemployed or manual laborers (96, 49.4%) predominated in the study sample. Conclusions: In short, the study revealed that almost one third of recently diagnosed TB patients would not have been considered as 'TB suspect' before the implementation of the new strategic change. The findings support the new definition of pulmonary TB suspect in RNTCP.

Context: The objective of this study is to synthesize some novel 2-(naphthalen-1-yl)-N-[2-substituted (4-oxothiazolidin-3-yl)] acetamide derivatives and to study their anti-Parkinson's activity. Materials and Methods: Ethyl (naphthalen-1-yl) acetate (1) was prepared from naphthalene-1-yl acetic acid in ethanol. Condensation of ethyl (naphthalen-1-yl) acetate (1) with an equimolar quantity of hydrazine hydrate in methanol afforded 2-(naphthalen-1-yl) acetohydrazide (2). Compound 2 which on condensation with different aromatic aldehydes yielded respective Schiff bases (3a-e). The Schiff bases are then cyclised with mercaptoacetic acid in dioxane to yield the corresponding naphthalene bearing 4-thiazolidinone derivatives (4a-e). The structures of the synthesized compounds have been established based on their analytical and spectral data such as FT-IR, Mass and NMR spectroscopy. Results: The synthesized compounds were evaluated for their anti-Parkinson's screening using in vitro free radical scavenging assay. Compounds 4c, 4d, and 4e showed potent free radical scavenging activity giving 82%, 74% and 76% respectively. Three compounds 4c, 4d and 4e were taken for in vivo anti-Parkinson's screening by 6-Hydroxydopamine lesioned rat's model (6-OHDA). Among these, one of the 4-thiazolidinone derivatives having a 3-nitro phenyl group at 2 ^nd position 4c exhibited maximum anti-Parkinson's activity. Conclusion: Thiazolidinone derivatives showed significant anti-Parkinson's activity in the 6-OHDA lesioned rat model. The estimated parameters were closely relevant to clinical parkinsonism, and the drug treatment protected the diseased brain of a rat. We appreciate further detailed studies with these drugs in anti-Parkinson's pharmacology and toxicology.

Context: Non-communicable diseases are ever increasing and will soon outnumber the prevalence of communicable diseases. This study aims to detect prevalence of risk factors of non-communicable diseases in high school students and its comparison among students of private and government schools, Mangalore. Materials and Methods: A cross-sectional questionnaire based study was conducted amongst consenting high-school students. The data collected included socio-demographic factors, dietary habits, smoking, alcohol consumption, physical activity, height and weight. Data was tabulated and analyzed using Microsoft excel and SPSS version 11.5 software. Chi square test was used to determine the association of various factors with risk factors, P < 0.05 was considered significant. The results were presented as tables. Result: 413 students were surveyed from private and government schools. Age range was 13-15 years. One-tenth of the students had adequate dietary habits. Though most students were physically active, the type and duration of activity was inadequate. Two students were obese, both females. There were statistically significant differences among various socioeconomic classes, type of school and the presence of certain risk factors. Alcohol intake among students of upper class was significant ( P = 0.006). Conclusion: The prevalence of risk factors for NCD is low among high-school students of Mangalore. Students should be educated about having adequate amount of fruits and vegetables and advised to reduce the consumption of fast food. Vigorous activity should be encouraged amongst the students to prevent them from getting obese.

Context: Alveolar mucosa over the jaw bones in edentulous patients has varying thickness and mobility at different areas and is often imprecise at the time of impression making. Such impressions in the finished dentures cause inflammation and instability of the complete dentures. Aim: To present three methods for selective pressure impressions for complete denture treatment in patients who had different kinds of localization and abnormalities of the thickness of alveolar ridges mucosa. Materials and Methods: Three different impression techniques were used for selective pressure impressions in 15 completely edentulous patients based on the location of flabby tissue and special tray modifications. The patients expressed comfort and satisfaction during the usage of the new dentures, compared with the previous one fabricated with the new impression technique. Conclusion: The suggested methods eliminate the excessive displacement of the soft tissues at the secondary impression; thus, a physiologic and anatomic registration of the attached and the unattached tissue of the denture-bearing areas is attained.

Background: The gingival and overall oral health status is affected by the changes in lifestyle, dietary habits, and aberrant oral hygiene practices. Objectives: To determine the prevalence of gingival diseases among school children of Himachal Pradesh. Materials and Methods: A cross-sectional study was conducted among a sample of 1188 school children in the age group of 9 and 12 years from randomly selected schools of rural and urban areas of Himachal Pradesh and they were included as study subjects. The survey was carried out according to the WHO Oral Health Assessment Form (modified). Community periodontal index was used to assess gingival health, using three indicators: Healthy, gingival bleeding, and calculus. Plaque index was used to assess oral hygiene as poor, fair, and good. Statistical Analysis: SPSS version 15. Results: A total of 1188 children were examined, of these 650 (54.8%) were males and 538 (45.2%) were females. A total of 564 belonged to the 9 and 624 to 12 years age group. The overall prevalence of gingival disease was 22.9%. The majority (14.2%) were presented with calculus and 8.7% showed gingival bleeding ( P < 0.0000001). The most affected 24.3% with gingivitis were females in comparison to 21.7% males that is not statistically significant, P < 0.5. Age wise prevalence showed a linear increase; 12-year-old children were affected more 34.8% as compared to 9.8% in 9-year-old children. Conclusion: There is a need for reinforcement of dental services to difficult and hard areas.

Background: With the recent advances in clinical tests and treatments for those suffering from HIV/AIDS, the survival of these patients has been increased and their quality of life has become an important focus for researchers and healthcare providers. HIV affects the CD4 cells and CD4 count is the basis on which the ART treatment is started. Objective: To study the relationship of CD4 count with Quality of life of HIV/AIDS patients. Materials and Methods: This cross-sectional study was done in 255 HIV/AIDS patients at ART center in tertiary care hospital, Mysore. WHO-QOL-BREF a summarized quality of life questionnaire was used to assess the Quality of life. CD4 count of each patient was done. Statistical analysis was done using Epi-info software. To test the significance between QoL score and CD4 count, a t test was applied and to see the correlation between QoL score and various domains, Pearson's correlation co-efficient was calculated. Results: Out of 255 patients, 149 patients had their CD4 count below 350 with a mean QOL score 50.6 and 106 patients had their CD4 count above 350 with a mean QOL score 55.2. A positive correlation was seen with a r value of 0.31. Patients with higher CD4 count had better QOL than those with lower CD4 counts; the t test showed statistically significant association ( P < 0.05) between CD4 count and QOL. Conclusion: Present study has revealed a strong relationship between QOL and CD4 count of HIV/AIDS patients which necessitates pragmatic interventions to improve the CD4 count.

Background: Occupational asthma (OA) is a major cause of respiratory morbidity and the most common cause of non-acute lung disease in the industrialized world. The incidence of OA in developed country is increasing, while in developing countries is still unknown. Automobile industry is a place where workers are exposed to harmful chemicals and toxic substances. In automobile industry work floor assembly lines chassis move continuously and pass by "Robot Painter" that spray them and workers assemble the chassis. The paint that is used contains isocyanate (low-molecular-weight compound) which is most common agent responsible for OA. Objective: The present study is undertaken to assess respiratory morbidity of paint workers in terms of obstructive and restrictive lung pattern and to study relationship between duration of exposure and respiratory morbidity. Materials and Methods: This cross-sectional study included 70 car spray paint workers, who are working for 1-6 years in an automobile industry. A pre-structured questionnaire was used to record the clinical, sociodemographic profile, and clinical examination. Pulmonary function parameters were recorded by a computerized spirometer-Medspiror during their working hours. An independent t test and a correlation test were applied. Results: Sixty-one workers had normal lung functions. The nine isocyanate-exposed workers showed a significant reduction in FEV ₁ /FVC (P < 0.05) suggestive of obstructive lung pattern. There is a strong correlation between duration of exposure and pulmonary functions (P value = 0.002). Conclusion: Decreased pulmonary function tests (PFT) in spray painters were related to duration of exposure to isocyanate.

Skin disease may provide the first suspicion of diagnosis of HIV infection. Infection with HIV has great impact on skin diseases. In the context of HIV, the clinical presentation of dermatoses assumes either a classic or an uncommon form. Herein, we report six dermatological cases in the setting of HIV, with varied presentation and outcome after treatment. Knowledge of changing disease pattern with HIV may help the clinician to identify dermatoses and act in appropriate manner in the case management to support the patient.

Enteric fever is a common infectious disease of the tropical world; about 80% of these cases occur in Asian countries. With the advent of newer and effective antibiotics, the disease usually runs a benign course with complications occurring only in a miniscule minority. Enteric fever with its classical symptoms and signs is easily diagnosed and managed by most of the physicians and general practitioners. However, when patients present with rare features, the diagnosis and treatment may not be prompt and may be unduly delayed. Shock and encephalopathy are the most common complications. But meningocerebellitis due to enteric fever is a rare complication which has been reported in only 7 cases till date and ours is the 8 ^th report. Here, we will be discussing a patient of enteric fever who presented with cerebellar signs where our prompt diagnosis helped in starting immediate treatment which led to an uneventful and quick and complete recovery.

Amelogenesis imperfecta (AI) represents a group of developmental disorder of teeth structure, genomic in origin, which affects the structure and clinical appearance of enamel of all or nearly all the teeth, and which may be associated with morphologic or biochemical changes elsewhere in the body. It can be hypoplastic, hypomineralized, or both. Teeth affected may be discoloured, sensitive, or prone to disintegration. A case of yellow brown discoloration in a hindu female aged 26, reported with same chief complaint. On examination of the patient, generalized yellowish brown discoloration of the teeth was seen. Radiographic and histopathologic examination confirms the diagnosis of AI.

Necrotizing fasciitis (NF) is not uncommon but in the era of therapeutic and prophylactic antimicrobial, it is considered to be a rare entity. The diagnosis requires a prerequisite high index of suspicion. Many classifications of such a entity do exist depending mainly on the causative agent. Others have classified it according to the immune-competent status or the anatomical location. The causative agent varies depending on the patients' risk factors. We report a case of a 28-year-old female who developed NF in the postcesarean section period. She was managed by surgical debridement, and made a full recovery. The recovered pathogen was Providencia stuartii. The patient made a full and uneventful recovery. Such a report will increase the awareness of the existence of nontypical sole agents. This would initiate empirical therapy in timely fashion.

A 53-year-old female presented with an intermittent low back pain above the sacroiliac joints to the orthopedic outpatient department. There was no history of trauma. Clinically, the straight-leg-raising test was negative. There was left paraspinal tenderness just above the sacroiliac joint and a nodular swelling in that area was felt. A plain radiograph was taken, which showed bilateral elongation and fusion of the fifth lumbar transverse process with the iliac crests and was diagnosed as a rare and unusual variant of Bertolotti's syndrome. There was also fusion of body of the fifth lumbar with first sacral vertebra. The patient was advised conservative treatment in the form of rest, medication, ergonomic advice, and local steroid injection in tender nodular area besides epidural administration of methylprednisolone with local anesthetic ropivacaine. The patient got therapeutic relief from the pain associated with lumbosacral pathology after epidural injection of local anesthetic and steroid. The patient was advised magnetic resonance imaging scan for further evaluation so as to plan surgical excision of fused transverse processes.

Context: The current linear models of pathways to psychiatric care fail to explain the complexities of pathways to psychiatric care found in Indian setting. Aims: To examine the pathways to psychiatric care taken by patients before attending the psychiatry outpatient department (OPD). Settings and Design: A cross-sectional descriptive study of pathways taken by patients attending the Psychiatry OPD of a tertiary care referral hospital in Delhi. Materials and Methods: All new patients attending the Psychiatry OPD who provided informed consent were asked questions as per a specifically designed semistructured proforma for collecting relevant data on pathways to psychiatric care. Statistical Analysis: Descriptive statistical analysis was employed in this study. Results: A total of 225 patients were analyzed for pathways to psychiatric care. No set sequence of any carer in pathway could be found. Hence, a web model of pathways to psychiatric care was used to explain the pathways. Conclusions: Web model is most suitable model to explain the complexities of pathways to psychiatric care found in Indian setting.