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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Context: Shilajatvadi Lauha (SL) is used in Ayurveda as Indian traditional medicine for treating diabetes mellitus. Aims: To explore the anti-diabetic potential of SL in nicotinamide-streptozotocin induced diabetic rats. Materials and Methods: SL (10, 30, and 100 mg/kg) and glibenclamide (10 mg/kg) were orally administered once daily to diabetic rats for 14 days. Blood glucose, plasma insulin, total cholesterol (TC), triglycerides (TGs), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), and very LDL-C (VLDL-C) were examined. Results: SL significantly lowered the blood glucose without any hypoglycemic effect on their control counterparts, which was comparable to that of the standard anti-diabetic drug, glibenclamide. SL also showed reduction in the levels of TC, TGs, LDL-C, VLDL-C, but it increases the levels of plasma insulin and HDL-C in diabetic rats. Conclusions: SL possesses anti-diabetic and anti-hyperlipidemic activities in Type 2DM rats, which seems to scientifically validate its traditional uses and might be a promising drug in the therapy of diabetes mellitus and its hyperlipidemic complications.

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Background: Skin tags (STs) are common benign lesions composed of loose fibrous tissue and occur mainly on the neck and flexures as small, soft protrusions. They are common and are merely considered as a cosmetic problem. However, they have been associated with various clinical conditions and that with metabolic syndrome (MetS) has been a matter of special concern. Objective: To investigate the prevalence of MetS in patients with STs and healthy controls. Materials and Methods: We performed a hospital-based case-control study on 30 adult patients with STs and 30 controls. MetS was diagnosed by the presence of 3 or more of the South Asian Modified National Cholesterol Education Program's Adult Panel III criteria. Results: MetS was significantly more common in STs patients than in controls (70% vs. 30%, P = 0.0019). Psoriatic patients also had a higher frequency of triglyceridemia and abdominal obesity (P < 0.05) There was no significant difference in the fasting blood sugar, high density lipoprotein levels, and presence of hypertension among patients with psoriasis and controls. Conclusion: STs could be considered as a warning sign for MetS and their presence may help in the early detection of at-risk patients for cardiovascular morbidities.

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Organophosphate poisoning is an important medical emergency exist in agriculture-oriented countries such as India. This case report describes the treatment strategies followed for a management of suicidal intoxication of a pregnant woman by chlorpyrifos compound at a secondary care public hospital, Udhagamandalam, India. The patient was unable to perceive fetal movements and had classic clinical symptoms of organophosphate poisoning such as excess salivation and pinpoint pupil. The patient was administered with 2 g of pralidoxime and 10 ampoules of atropine sulfate (1.2 mg each). The fetotoxic evaluation showed fetal death. The antidote given to the patient was according to the criteria given by the World Health Organization. The late admission of the patient may be considered as a reason for fetal death. Psychosocial, educational programs are highly recommended for the population in this region to reduce the number of intentional poisoning attempts.

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Infrarenal inferior vena cava (IVC) duplication is a rare anomaly. Most of the cases are asymptomatic and are detected incidentally. Prior knowledge of the anomaly is essential for safe procedure by intervention radiologist, retroperitoneal operation, and multi-visceral recovery operation from deceased donor by surgeon. We report a case of infrarenal IVC duplication detected incidentally during contrast-enhanced computed tomography examination of abdomen of a patient presenting with viral hepatitis and mild obstructive jaundice.

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Aim: Cirrhosis is an important cause of morbidity and mortality in India. Global burden of diseases study estimated 1 million deaths due to liver cirrhosis in the year 2010 and out of which one-fifth occurred in India alone. The purpose of this study was to assess the clinical profile of cirrhosis in adults in a Tertiary Care Hospital in the Northern hilly state of Western Himalayas. Materials and Methods: A hospital-based prospective study was conducted in a Tertiary Care Center of Himachal Pradesh, located in the North of India from June 1, 2012 to May 31, 2013. In all 178 patients who were proved of cirrhosis on the basis of history, physical examination, biochemistry, and radiology and of age >18 years were included in the study. All the patients were closely followed for a maximum of 1 year after recruitment. Results: In this study, most of the patients were from age group 40 to 59 years (64.6%), and mean age was 51.2 ± 8.9 years. Most common cause for cirrhosis was alcohol which constituted 62.9% of total cases. Majority of patients (61.8%) presented to our hospital in Child-Turcotte-Pugh (CTP) Class C. Most common complication of cirrhosis at presentation was ascites which was present in 89.8% of the patients. One year mortality in CTP Class B was 23.2% and in CTP Class C was 55.5%. Conclusion: The study identified alcohol as the leading cause of cirrhosis affecting people in the state and most of the patients presented to the hospital in an advanced stage of cirrhosis.

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Context: Blood is a living tissue that is transfused into another human body and hence blood safety is a major issue in transfusion medicine. It is well-known that a large number of apparently healthy donors are deferred from successful blood donation because of varied reasons. They are the potential motivated donors the society is losing. Hence, it is very important to analyze the reasons for deferral and retain the motivated donors. Aims: The objective of this study was to determine the various causes and its proportion for blood predonation deferrals. Settings and Design: Department of transfusion medicine, Tertiary Care Hospital, Mysore, Karnataka, India. Materials and Methods: A retrospective study was carried out by retrieving the data of deferred blood donors over a period of 1-year from January 2014 to December 2014. Results: Among 8894 donors screened, 8.62% (n = 767) were deferred from blood donation. The main reason for deferral was low hemoglobin (Hb) (25.3%), followed by alcohol consumption (21%), high blood pressure (14%), under age and underweight (12.4%), medication (6%), tattooing (4.3%), dental extraction (3.1%), sleep deficit (3%), and miscellaneous causes (5.7%). Interesting observation in our study was that 47 males were deferred due to high Hb levels (6%) ranging from 18.8 to 23 g%. Conclusion: Increased public education on common causes of donor deferral may lower deferral rates by allowing prospective donors to “prescreen” themselves. Thus, the temporary deferrals can be prevented by proper health care education, creating awareness, and guiding to improve their health status for future donation.

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Rhinocerebral mucormycosis is a rare, aggressive, and rapidly progressive life-threatening opportunistic infection affecting the immunocompromised patients. It manifests as facial swelling, cellulitis, nasal obstruction and discharge, large areas of tissue destruction and necrosis, orbital cellulitis, ptosis, proptosis, and vision loss in advanced cases. The pathognomonic feature of the disease is the presence of invasive mycelium in the tissues. A case series on four patients diagnosed with rhinocerebral mucormycosis is presented. Diabetic ketoacidosis was the common risk factor observed in all the three patients. It was concluded that early diagnosis and aggressive medical and surgical treatment are necessary for decreasing the high mortality rate of the infection.

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Background and Aim: Pheochromocytoma and paraganglioma (PPGL) are rare chromaffin cell tumors with variable clinical presentation which are derived from neural crest cells. Pheochromocytomas arising from the adrenal glands are sympathetic, and the paragangliomas arising from extra-adrenal sites are either sympathetic or parasympathetic in origin. These tumors usually come to clinical attention due to the catecholamine secretion or maybe detected as incidentalomas while imaging for unrelated symptoms. Our objective is to study the histopathological and histochemical features of PPGL with clinical correlation. Materials and Methods: PPGLs arising from both sympathetic and parasympathetic nervous systems were retrospectively selected from the records for 5 years, and clinical details were obtained. Routine hematoxylin and eosin (H and E) stain and argentaffin and argyrophilic reactions were employed. Immunohistochemistry for chromogranin was done for cases with doubtful histomorphology in H and E sections. Results: Our study material consisted of 10 cases out of which five cases were adrenal pheochromocytomas; 4, carotid body tumors; and 1, paraganglioma of the organ of Zuckerkandl. Three pheochromocytomas out of five and the paraganglioma of organ of Zuckerkandl were functional and clinically presented with palpitation and hypertension. All the carotid body tumors and two of the pheochromocytomas were nonfunctional. The 24 h urinary levels of vanillylmandelic acid was increased in two cases, and urinary fractionated metanephrine levels was increased in one case of pheochromocytoma. Urinary normetanephrine alone increased in paraganglioma of organ of Zuckerkandl. All pheochromocytomas except one were positive for argentaffin reaction, and all paragangliomas at other sites were positive for argyrophilic reaction. Chromogranin immunohistochemistry stain was done for organ of Zuckerkandl lesion which came out to be positive. Conclusion: Proper clinical evaluation, preoperative preparation, and appropriate early surgical treatment can cure the lesion. Preoperative diagnosis, if not done and if there is a delay in the treatment, will lead to complications such as intraoperative hypertensive attack, persistent hypertension even after removal of the tumor, and progression to malignancy.

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Background: Carvedilol is a nonselective beta-blocker with an additional alpha 1 adrenoceptor blocking action, causing a much greater decrease in portal pressure as compared to propranolol. Materials and Methods: One hundred two consecutive patients of cirrhosis of the liver with significant portal hypertension were included, and hepatic venous pressure gradient (HVPG) was measured at the baseline and after 90 min of administration of 12.5 mg carvedilol. Results: A total of 102 patients with mean age of 58.3 ± 6.6 years were included. A total of 42.2%, 31.9%, and 26.6% patients had child Class A, child Class B, and Child Class C cirrhosis, respectively. Mean baseline HVPG was 16.75 ± 2.12 mmHg that dropped to 13.07 ± 2.32 mmHg, after 90 min of administration of 12.5 mg of carvedilol. The mean drop of HVPG was 4.5 ± 2.2 mmHg and 2.4 ± 1.9 mmHg between responders and nonresponders, respectively. Overall, 52 patients (51%) showed acute response while 50 (49%) were nonresponders. Baseline low cardiac output (CO) and high mean arterial pressure (MAP) were significant predictors of acute response on univariate analysis. On multivariate analysis, low baseline CO was found as an independent predictor. Conclusion: Carvedilol is a drug of choice among beta-blockers for primary prophylaxis of variceal bleed. Hemodynamic parameters like baseline low CO high MAP are significantly predicting acute response while as etiology, child class, and variceal size are not significantly associated with acute response to a safe dose of carvedilol.

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Schwannoma originates from the Schwann cells at the Obersteiner-Redlich zone, which marks the junction of central and peripheral myelin of the cranial nerves. Most frequently affected are the vestibular, trigeminal, and facial nerves followed by the lower cranial nerves. Trochlear schwannoma in the absence of neurofibromatosis is a rare entity. The purpose of this report is to serve as a reminder to consider trochlear nerve schwannoma in the list of differential diagnosis of such tumors as the outcome is far better than the intraaxial tumor in that location.

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Background: Pharmaceutical companies indulge in medicine promotion through printed material which is distributed to the prescribers. The aim of this study was to evaluate the rationality of such printed promotional medicine literature and find if it was in accordance with World Health Organization (WHO) recommendation and assess the promotion in regard to medicine interactions, truthfulness and accuracy of the contents, validity of the references quoted, and other qualitative content. Materials and Methods: This was an observational, cross-sectional study on 300 printed brochures of modern and herbal medicines collected by the investigators from private practitioners in Bhopal, which were distributed by the medical representatives. These were assessed for complying with the WHO criteria of 1988, medicine interactions, accuracy, consistency, and validity with the quoted reference in the promotional literature. We also assessed whether the quoted study was sponsored, correlation of pictorial content with given scientific data and actual area utilization for the information. Results: The majority of the brochures were not in accordance with the WHO criteria. The most of the studies quoted in references were of randomized controlled trials, but the data quoted were inconsistent with the original reference. About 18% of the studies focused on the patient-oriented outcome like mortality, whereas 57.7% included disease-oriented outcome. Around 80% of the brochures contained emotionally exaggerated, nonscientific claims. Maximum brochures promoted heir, other branded medicines also. Conclusion: Pharmaceutical companies followed the WHO guidelines to some extent but not completely to promote their products with commercial intention rather than deliver the scientific content.

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Plasmacytoid urothelial carcinoma (PUC) of the urinary bladder is an uncommon and aggressive variant of urothelial carcinoma associated with late presentation and poor prognosis. Immunohistochemical examination showing expression of epithelial markers, CD138, and losing the membranous expression of E-cadherin confirms evidence of PUC. Here, we report a case of bladder PUC in a 78-year-old male who presented with hematuria. A transurethral biopsy revealed urothelial carcinoma with plasmacytoid appearance. The diagnostic dilemmas of this unusual variant of urothelial malignancy and its clinical impact are discussed. The pathological diagnosis was PUC with diffuse muscle and vascular invasion, in which almost of the areas studied on the tissue section showed the plasmacytoid appearance of tumor cells. The tumor cells showed positivity for CK7 and CD138. The diagnostic dilemmas of this unusual variant of urothelial malignancy and its clinical impact are discussed.

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