COVID-19, caused by novel coronavirus SARCoV2, is a contagious disease, emerged in the end of December 2019, at Wuhan seafood market, China. This disease is spiraling like a wildfire and rapidly spreading worldwide, overburdening the health system with newly infected cases. As of April 25, 2020, a total of 2,846,536 COVID-19-positive cases and 197,859 total deaths were reported across the globe. This epidemic has exponential growth characteristics in the absence of specific vaccine and treatment for COVID-19. Many countries across the world including India, the USA, China, Italy, and German are implementing the lockdown measures to control the COVID-19 pandemic and to maintain the infection at manageable levels. Keeping the prospectus of future such pandemics, we reviewed; what is lockdown and containment? Does it works? What are the advantages of lockdown and containment in cotrolling the spread of the virus?. The present review answers these questions and tries to spread light on the impact of lockdown. Our review concludes that the implementation of lockdown has forced many countries in flattening the epidemic curve and strengthening the health-care system and improves the environmental quality during the COVID-19 pandemic.

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Background/Objectives: Ice application is one of the treatment procedures used in hydrotherapy. Though its various physiological/therapeutic effects were reported, ice bag application (IBA) to head and spine on cardiovascular changes were not reported. Hence, this study aims at evaluating the immediate effect of IBA to head and spine on cardiovascular changes in healthy volunteers. Materials and Methods: Twenty-eight subjects were randomized into three sessions ([i] IBA [ii] tap water bag application [TWBA] and [iii] control) and intervention was given in one of the 3-different orders. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse rate (PR) was assessed before and after 20-min of each intervention. Pulse pressure, mean pressure (MP), rate pressure product (RPP), and double product (Do-P) were derived by standard formula. Statistical analysis was performed by repeated measures of analysis of variance and post-hoc analysis with Bonferroni adjustment for multiple comparisons with the use of Statistical Package for Social Sciences version-16. Results: The results showed no significant difference between sessions in all variables. Within-group analysis showed significant reductions in SBP, PR, RPP, Do-P in IBA and TWBA sessions; Significant reduction in DBP, MP in IBA unlike TWBA; and no significant changes in all the variables of control session. Conclusions: Result of our study suggest that though both IBA and TWBA to head and spine might be considered as having effect on improving cardiovascular function in healthy volunteers, IBA to head and spine could be considered as a better choice than TWBA.

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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.

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Background: The term disc prolapse is defined as extrusion of nucleus pulposus through a rent in annulus fibrosus. This prolapse disc causes impairment of function by nerve root compression compelling the patient to seek medical advice for low backache. A lumbar herniated disc is a common cause of low back pain radiating to the leg. The problem of prolapsed intervertebral disc is of great importance in this part of the world, because of the fact that people are subjected to various physical stress due to their living habits, low socioeconomic status. Ninety percent of lumbar disc extrusions occur at L₄- L₅or L₅-S₁. Central lesion may cause no symptoms with the exiting nerve roots unaffected whereas paracentral lesions cause symptoms due to compression of the exiting nerve root. Radio imaging technique has a pivotal role in the diagnosis of vertebral disc herniation. Various radiological procedures are used for the diagnosis, but MRI which is a relatively newer technique is treated as the gold standard in the field. Aim of the Study: In the present study, an attempt is made to establish the anatomy of herniated lumbar disc by the help of MRI technique in the patients of Eastern India & to correlate the occurance of disc herniation with age, sex & vertebral level. Methods and Material: The present study included 120 patients who have lumbar disc herniation syndrome & their MRI findingd are compared with MRI findings of 80 normal persons who are used as control. Results and Conclusions: The different parameters are compared & observed that the maximum number of disc prolapse occurs between 31- 40 age group. Taking the vertebral level into consideration, it is seen maximum number of herniation occurs at the level of L₄- L₅.

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Background: Smoking has deleterious effects on breath-holding time (BHT), which has been used in respiratory physiology as a measure of ventilatory response. Evidences regarding assessment of the reversibility of the impact of smoking on BHT and recovery in ex-smokers are ambiguous. Hence, this study was conducted to quantify the reduction in BHT and to assess the reversibility of the same. Materials and Methods: A cross-sectional study was conducted on 84 bus-depot workers consisting of equal number of smokers, ex-smokers, and non-smokers. Breath-holding time was recorded using the mouth piece attached to the mercury manometer where the subjects were advised to blow through the mouth piece after full inspiration as long as possible till the breaking point following standard methods and precautions. Comparisons among 3 groups were performed employing one-way ANOVA and post-hoc tests. The significance of difference in BHT between the 2 categories of frequency and duration of smoking was tested using Student's t-test for independent samples. Results: BHT was found to be significantly reduced among smokers compared to non-smokers. Almost complete recovery of BHT was observed in ex-smokers. There was deterioration in BHT with increase in BMI, and a statistically significant negative correlation was observed when BHT was correlated with age, especially in smokers. Conclusion: Present study has demonstrated considerable reduction of BHT in smokers and indications of recovery in ex-smokers. Further detailed study with larger sample size, stricter definition of ex-smokers, and considering physical activity is recommended.

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The advancement in the technology of the cochlear implants has resulted in increasing trend of cochlear implantation in both the children and elderly population. The anesthesiologist is faced with the task of smoothly conducting the surgery without any interference in the stimulation techniques used. The preoperative evaluation is mainly focused on the presence of any congenital anomalies in these patients which may affect anesthetic technique. The reduction of anxiety of the patient as well as the parents of small children is an important aspect of the preoperative visit. Intraoperatively the anesthetic technique chosen should not interfere with the stimulation of the cochlear implant electrode assembly. The postoperative management is mainly focused at prevention of agitation and good analgesia. A close cooperation between the surgeon and the anesthesiologist is essential for a positive outcome in this surgery. The current review focuses on the important anesthesia aspects related to cochlear implant surgery.

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Vocal nodules are the consequence of functional voice disorders, which are also caused by vocal abuse or misuse. An increased vocal load, for example, due to the patient's profession, demands high-volume speech for the formation of nodules. In the present case report, a 26-year-old female patient acquired this disease followed by common cold cough. Her problems were aggravating by high-volume speech and getting fatigability also. This patient was given Anutaila Nasya with Sitopaladi Churna, Naradiya Laxmi vilasa Rasa, Yashtimadhu Ghanvati (for chewing), and Dashmoola Kwatha(Kavala). The patient was advised for strict voice rest and steam inhalation for better result. After 1 month of treatment, the patient got relief from all her complaints and gained normal voice. On examination, it was found that vocal nodules disappeared in direct laryngoscopy. Hence, this single case report shows that ayurvedic management of vocal cord nodules gives excellent result and improves patients' quality of voice.

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Radiculopathy, commonly referred as pinched nerve, refers to a set of conditions in which one or more nerves are affected and their functioning is hampered. This phenomenon is termed as neuropathy. This can result in pain or more precisely in radicular pain. In a radiculopathy, the problem occurs at or near the root of the nerve, shortly after its exit from the spinal cord. However, the pain or other symptoms often radiate to the part of the body served by that nerve. The management available in the current era of medicine is not satisfactory. Here, we are presenting a case of cervical spondylosis (CS) radiculopathy which was treated with a combination of Panchkarma procedures and Ayurvedic oral drugs. Greeva stambh was considered as the Ayurvedic diagnosis for the case. The treatment protocol designed for the particular case was Panchatikta ksheera Basti (enema with medicated milk) for 16 days along with Shalishastic pind sweda. The oral medication prescribed was Ashwagandha churna (Withania somnifera Dunal), Shatavari churna (Asparagus recemosus Wild), Gokshur churna (Tribulus terrestris L.) each in a dose of 2 g, Sarpgandha churna (Rauvolfia serpentina (L) Benth. Ex Kurz) 1 grms, Shankha bhasma 500 mg with Luke warm water, Yograj guggulu-3 tablet with Dashmool kwath in a dose of 40 ml, Ashwagandha avaleha 10 g with lukewarm water. All these drugs were prescribed for twice a day. Visual analog scale and range of motion were the parameter used to assess patient and considerable improvement was noticed in the case after a month of treatment which sustained in follow-up duration of 2 months. The case study demonstrate that CS radiculopathy may be successfully managed with Ayurvedic treatment.

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Lifestyles of human beings have changed drastically due to the industrial age, increasing work, living speed, longer work schedules, and various psychological pressures, which have led to an increased incidence of diabetes, obesity, various cancers and vascular diseases. With recent advances in medical and nutrition sciences, natural products and health-promoting foods have received extensive attention in the public. To achieve better quality of life, people started eating more vegetables, fruits, dietary supplements, nutraceuticals, phytotherapeutical substances and other plant foods. The demand for nutraceuticals and phytonutrients has increased over the past few years and they are being used by people for various therapeutic outcomes. This article brings out the importance of nutraceuticals and their usage in various diseases and ailments.

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Background: Distal radius fracture is one of the common injuries seen in casualty often managed by closed reduction and percutaneous pinning. Aim: The purpose of this prospective study is to determine the incidence of infection following percutaneous wire fixation of distal radius fractures and it's bearing on the outcome in the management of distal radius fractures. Materials and Methods: We studied eighty-eight cases of closed distal end radius fractures managed with closed reduction and percutaneous Kirschner wires (K-wires) fixation with splinting for pintract infection. Results: Out of the 88 cases included in the study, 14 cases had pintract infections that were mild to moderate in nature. In 6 cases of early K-wire removal due to pintract infection, shortening of radius, malunion, reduced finger grip and poor functional outcome was noticed. Pintract infections resulted in extended hospital stay, early pin removal, decreased functional outcome, malunion of distal radius and requirement of second surgery to correct the deformity and to improve functional outcome. However, percutaneous K-wire fixation with keeping the wire outside has been advocated and routinely performed, though incidence of pintract infection and complications arising from early removal of K-wires cannot be ignored. Conclusion: Therefore, our study proposes to bury the pin ends under the skin to reduce complications and to achieve better functional outcomes.

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Acrochordons are flesh-colored pedunculated lesions which occur in areas of skin folds. Although they are common in other sites of the body, herein we describe a case of acrochordon at an unusual site over the tip of glans penis which is a rarity. We report this case for its rarity, as there have been no similar reports and paucity of literature after extensive research according to our knowledge. Clinical presentation and pathological findings are presented and discussed.

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Subcutaneous emphysema is not an uncommon condition and occurs following a chest injury or surgical procedures. Spontaneous subcutaneous emphysema (SSE) is a rare entity, it usually present when broncho-alveolar walls are weakened by chronic lung pathology and precipitated by chronic cough. Most widely accepted mechanism is rupture of broncho-alveolar walls with escape of air into the subcutaneous plane. Usually, it will be associated with pneumothorax or pneumomediastinum. However, its occurrence without pneumothorax or pneumomediastinum has been reported in the literature. We report a case of 46 years male presented with a history of cough of 1-month duration with swelling over the face, neck and upper part of the chest. The diagnosis of SSE without pneumothorax secondary to pulmonary tuberculosis was made by examination, confirmed by chest X-ray and computed tomography imaging. The probable mechanism in our patient could be due to the existence of pleural adhesions surrounded the point of rupture.

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OBJECTIVES: Canalith repositioning therapy (CRP) is usually effective treatment in benign paroxysmal positional vertigo (BPPV). However, still, some patients present residual dizziness after successful and effective repositioning maneuver. The objective of this study was to evaluate the therapeutic effect of Ginkgo biloba extract on residual dizziness after canalith repositioning maneuver in patients of BPPV. G. biloba is a phytomedicine which enhances the blood supply to inner ear and brain. MATERIALS AND METHODS: Ninety-two patients with BPPV were divided into two treatment groups, Ginkgo biloba group and Non-Ginkgo biloba group. In this prospective study, the Ginkgo biloba group received the similar CRP as the non-Ginkgo biloba group, with addition of G. biloba treatment after CRP. The duration of residual dizziness of Ginkgo biloba group and non-Ginkgo biloba group were compared. The scores of dizziness handicap inventory of these two groups were also compared. RESULTS: The duration of residual dizziness of Ginkgo biloba group was shorter than non-Ginkgo biloba group. There were no significant differences in the dizziness handicap inventory scores in the 1^st week, whereas many significant differences in 2^nd, 3^rd, 4^th, 5^th, 6^th, 7^th, and 8^th weeks. CONCLUSION: This study demonstrates that G. biloba can significantly minimize the residual dizziness after successful therapy with repositioning maneuver in patients of BPPV.

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Objective: The aim of this study was to develop taste masked oral soluble films (OSFs) for levocetirizine dihydrochloride (LCT) and ambroxol hydrochloride (AMB) using different combination of polymers such as polyvinyl pyrrolidone (PVP) K30, propylene glycol (PG), gelatin, sodium alginate (SA), pectin, gaur gum (GG), and hydroxypropyl methylcellulose (HPMC) K15M and super disintegrants like carboxymethyl cellulose (CMC) and sodium starch glycolate (SSG). Materials and Methods: The different basic formulations were developed using solvent casting method for with and without drugs loading and prepared films were evaluated different morphological and mechanical parameters facilitated the screening of a formulation with best characteristics. Results: The films made from HPMC K15M (42.2% w/w) and pectin (35.2% w/w) and considered as an optimized batch among the other formulations. The addition of (titanium dioxide) (TiO ₂ ) films was shown opaque nature. The optimized films were subjected to further of drugs content, drugs release profile, stability, and organoleptic properties by human volunteers. The percentage release at end of 90 ^th s found 73.11 ± 5.2% in pH 6.0 and 81.07 ± 5.6% in water for LCT and 89.2 ± 4.5% in pH 6.0 and 86.22 ± 4.2% in water for AMB, respectively and there were insignificant changes showed at stability study. The organoleptic properties revealed that by complexing drugs with hydroxypropyl β-cyclodextrin (HPβ-CD) in 1:1.5 ratios masked the bitter taste of drugs. Conclusion: Developed OSFs can be considered as one of the promising formulation to administer bitter drugs such as LCT and AMB especially for pediatric, geriatric, and non-cooperative patients.

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Context : Breastfeeding practices play an important role in reducing child mortality and morbidity. This study was aimed to describe the breastfeeding practices prevalent in Mysore city. Objectives: The primary objective of this study was to describe and explain the factors influencing breastfeeding practices in Mysore city, and the secondary objective was to compare the breastfeeding practices of lactating mothers attending well baby clinic (A clinic run by pediatric specialist in good hospitals) with their selected personal variables. Settings and Design: The study was conducted at selected hospitals of Mysore city from January 2009 to June 2009 for the period of six months. Materials and Methods: Lactating mothers having at least a single infant attending well baby clinic at selected hospitals were included in the study and data was collected using the pre-tested questionnaire on breastfeeding practices. Results: Our study shows 74.29% of the mothers initiated breastfeeding, more than 50% used pre-lacteal feeds, 36% had discarded the colostrum and the majority of mothers had followed hygienic practices while feeding their child. Conclusions: This study emphasizes the need for breastfeeding intervention programs especially for the mother during antenatal and postnatal check-ups and practices like discarding the colostrum and early/late weaning are still widely prevalent and need to be addressed.

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Introduction: The etiology of urinary tract infections (UTIs) and the antibiotic resistance of uropathogens have been changing over the past years. This retrospective study was conducted to survey the resistance pattern of Gram-negative uropathogens to first-line agents for UTIs; this would be helpful for the clinicians to facilitate the empiric treatment and management of patients with UTI and maybe useful for the formulation of guidelines of antibiotic policies. Materials and Methods: Isolated uropathogens were tested against ampicillin-sulbactam, amikacin, ceftriaxone, cefotaxime, cefoperazone, gentamicin, norfloxacin, ofloxacin, piperacillin-tazobactam, and imipenem. Result: A total of 2,146 urine samples were cultured, of which 448 samples were positive for Gram-negative bacilli. The most common Gram-negative isolate was Esherichia coli (52%) followed by Klebsiella pneumoniae (17.6%) and Pseudomonas aeruginosa (12.9%). E. coli was found to be most resistant to ampicillin-sulbactam (90.1%), followed by norfloxacin (76.3%), and most sensitive to imipenem. P. aeruginosa was least resistant to amikacin (27.5%). Overall resistance to imipenem is less than 20% among the Gram-negative uropathogens except Acinetobacter spp. and P. aeruginosa. Conclusion: Ofloxacin and amikacin are recommended as the drugs of choice for the empirical treatment of UTI, whereas specific treatment should be based on the etiological agent isolated in the urine culture. There is a strict need for developing specific guidelines for antibiotic prescriptions for UTI in India.

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Background: Poor infant feeding practices and their consequences are one of the world's major problems and a serious obstacle to social and economic development. Various studies have shown that infant feeding could be influenced by socioeconomic status, maternal education, place of living and many other factors. Hence a prevalence study on exclusive breastfeeding was conducted in rural Tamil Nadu. Aim and Objective: To assess the prevalence of exclusive breastfeeding practices and the factors influencing them among women in a rural area in Tamil Nadu. Materials and Methods: It is a cross-sectional study conducted in Attyampatti Panchyat Union, Salem district, Tamil Nadu, from March 2011-June 2011. All the 291 children in the age group of six months to two years in Attyampatti Panchayat Union were included in the study, irrespective of any sample. The data was analyzed using SPSS package. Results: Among the study population 52.6% were male children and 47.4% were females. Only 99 (34%) children were exclusively breastfed for six months. The majority of women (60.5%) initiated breastfeeding within half an hour after delivery. Various demographic factors like the education of the mother, type of delivery, type of family, occupation, number of children, monthly income, family size, age at marriage and religion had a direct influence on exclusive breastfeeding, which in turn influenced the weight of the baby and immune status of the child. Most of the mothers (44.7%) inferred that the main reason for giving bottle feed is because of inadequate breast milk secretion. Conclusion: The prevalence of exclusive breastfeeding is low in this particular area. Hence promotion of exclusive breastfeeding and focus on the factors affecting them is highly warranted in this area.

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Background: Myofascial trigger point (MTrP) is a hyperirritable point or spot, usually within a taut band of skeletal muscle or in the muscle fascia which is painful on compression and can give rise to characteristic-referred pain and motor dysfunction. Studies suggest that various types of massage forms are available for treating MTrPs. Aims: To find the difference in effect of two forms of massage techniques: Ischemic compression and muscle energy technique (MET) on upper trepezius MTrPs. Settings and Design: Quasi experimental design was conducted with convenient sampling method. Materials and Methods: Patients ( n = 30) who fulfil the screening criteria were randomly assigned to Group A ( n = 15) treated with ischemic compression and ultrasound and Group B ( n = 15) treated with MET and ultrasound for 4 weeks and they were assessed at baseline and after 4 weeks. Outcome measures included pain intensity by visual analog scale (VAS) and range of motion by universal goniometer. Statistical Analysis Used: Intergroup analysis was done with Mann-Whitney test and intragroup analysis was done with Wilcoxon signed-rank test. Results: Statistically, no significant ( P > 0.05) changes in the scores were found in the Groups A and B for VAS, and statistically significant ( P < 0.05) changes in the scores were found in the Groups A and B for Range of Motion (ROM) with greater change scores in the Group B compared with Group A. Conclusion: Treatment program consisting of MET with ultrasound may be more effective in reducing pain and improve ROM in patients in upper trepezius MTrPs.

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In the fixed partial denture (FPD) prosthesis with rigid connectors, forces of mastication are transmitted to the terminal retainers, which make the middle abutment act as a class I lever fulcrum. This techno-clinical cycle often causes failure of the fixed partial dentures. To overcome this dilemma, a non-rigid connector may be incorporated on the distal aspect of the middle (pier) abutment. The non-rigid connector counterbalances the effects of these forces of leverage. This clinical report presents the use of a non-rigid connector in a long-span, five-unit FPD, replacing two missing teeth with an intermediate pier abutment.

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INTRODUCTION: Creutzfeldt–Jakob disease (CJD) is an uncommon, fatal, genetic, transmissible and degenerative, brain disorder. It affects one person in every one million in the United States. A definite diagnosis can be made by histopathological confirmation which is often not possible for various reasons. Therefore, great caution is needed before the diagnosis is offered. MATERIALS AND METHODS: Patients with radiological diagnosis of CJD in the past 2 years were assessed clinically, reassessed at 1-month, and results are discussed. RESULTS: Four out of the 12 patients seen had nonprion cause. Hyperacute onset with coma, nonprogressive changes in imaging and electroencephalography, were seen in those who improved. The presence or absence of 14-3-3 in cerebrospinal fluid was not useful in either confirming or excluding the diagnosis in a given case. CONCLUSION: All patients with cortical ribboning need correlation with clinical features and follow-up to confirm or exclude prion disease.

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Background: Study of marrow in iron deficiency anemia is very much essential, and it helps to decide whether iron therapy would be of any use or not. Where sophisticated instruments and facilities are not available for measuring iron in the blood by chemical method, this simple technique, is efficient, cost-effective, and result oriented. Aim: The aim was to study the marrow finding in various blood disorders. To establish the fact "old is gold" as "bone marrow iron store by Prussian blue stain" still has its stand in hematology in era of genetic engineering markers study and ferrokinetic study. Materials and Methods: Bone marrow aspiration was performed in 73 patients. Marrow films were stained with hematoxylin and eosin stain, observed and then submitted for Prussian blue stain. Results: In a study of iron deficiency anemia 92.7% of cases received iron store grade in marrow in range of 0-1 (P = 0.001). In megaloblastic anemia, 70% of cases received in the range of 3-4 (P = 0.164), whereas all cases of dimorphic anemia received in the range of 2-3 (P = 0.000) when compared to the normal range of 1-2. Conclusion: Prussian blue stain is simple and helpful technique to see and measure body iron store semi-quantitatively. Furthermore, it helps to decide whether iron therapy would be useful or not.

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Context: Use of Co-60 source in place of Ir-192 in high dose rate brachytherapy unit (HDR unit) has come for discussion in recent publications. Co-60 based system has been advocated for centers which have fewer brachytherapy procedures as it has comparative economically and administrative advantage. This study has direct practical application for such institutions, which are at the cusp of moving from Ir-192 to Co-60 based brachytherapy. Aims: Conversion of Ir-192 HDR room to Co-60 HDR room and to analyze radiation safety around the room. Materials and Methods: Uniform thickness of 15 cm concrete was added to all walls (except one wall adjoining to linear accelerator bunker) to convert existing room forIr-192 HDR unit to suitable room for Co-60 HDR unit. Radiation survey around room was done. Actual and calculated wall thicknesses were compared. Results: Radiation survey data indicates that modified room is suitable for Co-60 HDR unit and all values are in full conformity to annual dose limits mentioned in Safety Code for Radiation Therapy Sources (SCRTS), Atomic Energy Regulatory Body (AERB; the regulatory body in India). Also, modified wall thicknesses are appropriate for annual design dose limits mentioned in Safety Report Series No. 47 of International Atomic Energy Agency (IAEA). However, console wall thickness (0.45 m) is less than the calculated thickness (0.53 m) for instantaneous dose rate (IDR) design dose limit (7.5 ΅Sv/h) as perabove safety report of IAEA. Conclusions: The modified wall thicknesses are appropriate for annual design dose limits. However, console wall thickness is less than the required thickness for IDR design dose limit. It has been suggested to add 2.64 cm steel on console wall. It has been found that design dose limits should be considered while making room layout plan and regulatory body should add these constraints inSCRTS.

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