Annular pancreas is a well-known developmental anomaly. It usually presents in neonatal period with duodenal obstruction due to pancreatic tissue enveloping the second part of duodenum. It is associated with other anomalies such as Down's syndrome, duodenal atresia, and Hirschsprung disease. Presentation in adults can be due to pancreatitis or obstruction. While complete annular pancreas is well described in literature, imaging appearance of incomplete annular pancreas is only described recently. We present imaging findings in two cases of partial annular pancreas.

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Background: Plants have the major advantage of being the most treasured and cheaper alternative supplies of drugs. Phytochemicals in fruits and vegetables have gained increasing interest among consumers, and the scientific community as epidemiological studies has indicated that regular consumption of phytochemicals is related to a lower risk of noncommunicable diseases. Aim: The aim of the present study was to prepare extracts from the peel of indigenous fruit Carica papaya using five different solvents and to carry out qualitative and quantitative phytochemical analysis to establish the different classes of compounds present in the fruit peel and evaluate its antioxidant property by radical scavenging methods. Materials and Methods: Evaluate the antioxidant property of C. papaya peel by radical scavenging methods. Results: The various extracts revealed the presence of phytoconstituents such as phenols, flavonoids, and tannins in appreciable amounts and the antioxidant potential of papaya peel which can be used as a functional food to prevent and treat diseases.

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Objective: The aim of this study is to develop an assessment tool for in-hand manipulation skills (IHMS) and establish its psychometric properties. Design: Items are pooled based on literature and expert opinion. Content validation was performed by ten rehabilitation professionals. The test was administered to 123 typically developing, and 15 children with hand dysfunction-cerebral palsy (3), developmental coordination disorder (5), and Down syndrome (7). The latter group was given intervention, specific to upper extremity for 15 days, and test was readministered. Rasch analysis for rating scale structure, fit statistics, and dimension analysis was done. Results: Content validation was analyzed qualitatively. Suggestions were incorporated which consisted of instructions for scoring and test administration. The four-level ordinal rating scale was appropriate according to Rasch analysis. Of fifty items, three misfit items from translation subscale were removed based on fit statistics and clinical decision. The final test has 47 items. The tool had excellent inter-tester reliability and test stability and was responsive to change. Conclusion: Assessment of in-hand manipulation is a robust tool for clinical use in assessment IHMS.

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Context: Walking, both forward and backward, is found to be effective for reducing pain in subjects with osteoarthritis (OA) of the knee and improving physical function and quality of life (QOL). Aims: This study aims to determine and compare the effects of forward walking (FW) and backward walking (BW) on pain, physical function, and QOL in subjects with OA knee. Settings and Design: Quasi-experimental study set up at general hospital, Ahmedabad, India. Subjects and Methods: Thirty subjects >40 years diagnosed as having bilateral OA knee according to American College of Rheumatology criteria having indoor and outdoor walking ability without aids were included in this study. Group A and B subjects received FW and BW respectively for 10 min in addition to conventional treatment thrice daily for 2 weeks. Group C received conventional treatment in the form of hot water fomentation and exercises. Exercises comprised of static quadriceps, short arc terminal extension of the knee, ankle toe movements, straight leg raises, knee flexion and extension, proprioceptive exercises in the form of lunges, weight shifts, partial squats and balance training on the balance board and stretching of hamstrings, tendo-Achilles and rectus femoris muscles. Statistical Analysis Used: SPSS 16.0 (IBM Corporation). Parametric tests were used. The level of significance was 5%. Results: The results showed improvement in all the outcome measures within all the three groups. However, there was no statistically significant difference between the groups except Western Ontario and McMaster Universities Arthritis Index (WOMAC). Visual analog scale (VAS) at rest on the right side in all three groups and on the left side in Group A as well as in scores of VAS at activity on both the sides (P < 0.05) and no improvement in VAS at rest on the left side in Groups B and C (P > 0.05). Improvement in WOMAC scores within all the 3 groups (P < 0.05) and SF-36 (P < 0.05). No statistically significant difference between the groups for VAS at rest (left P = 0.919, right P = 0.823) or activity (left P = 0.706, right P = 0.052) on both the sides and SF-36 scores (P > 0.05). Statistically significant difference between the groups for WOMAC (P = 0.043), Group A was better than Group C (P = 0.043). Conclusions: FW and BW along with conventional therapy are equally effective and not better than conventional treatment alone in reducing pain and improving physical function and QOL.

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Various restorative materials used in dentistry may cause contact allergy reactions in mouth. The pathogenic relationship between oral lichenoid reaction (OLR) and dental materials has been confirmed many times. This case reports occurrence and management of OLR to acrylic material.

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Background: Domestic injuries contribute a major proportion in the prevalence of injuries. Although domestic injuries lead to significant morbidity and mortality, most of these injuries are under recognized. Methodology: Community-based cross-sectional study was conducted among 200 households. A structured questionnaire was used to collect information on the injuries that occurred in previous 6 months, and the results were analyzed using SPSS version 20. Results: The prevalence of domestic injury was 4.8% among 839 individuals interviewed. The majority of the injuries occurred among males, and all injuries were unintentional in nature. Forty-two percent of the injuries occurred in hand which was the most common site. More than 50% of the injuries occurred due to handling of sharps, and 62.5% of injuries were mild in nature. No domestic injury-related deaths had occurred. Conclusions: Majority of the domestic injuries occurred due to handling of sharps. Careful handling of sharps, preventing handling of sharps by children would help reducing the occurrence of domestic injuries in this community.

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Osteoporosis is a bone resorptive disorder which results in diminished bone strength predisposing the patient to a risk of fracture. Extensive research in the medical fraternity has shown that India bears a large population which is exposed to this skeletal disorder. Lately, the relationship between osteoporosis and periodontal disease has been brought into the limelight. The overlap of etiological factors of both the disease entities cannot be overlooked. In lieu of this, pain-staking research and modern concepts derived to ease the evaluation of the two pathologies have taken a boost since the last decade. Further, it is necessary to identify if either of the two diseases could be coined as a risk factor for the other. Adequate knowledge about the interrelationship could aid in apt diagnosis and subsequently an appropriate treatment planning. The following narrative review of literature is an encapsulation of facts that have been procured to affiliate the two diseases with each other.

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Background: Urinary tract infections (UTI's) are a major public health concern globally. Recurrent UTI's that are predominantly caused by uropathogenic Escherichia coli's forms biofilm that is an intracellular, structured bacterial community, enclosed in a self-produced matrix, adherent to an inert, or living surface. Biofilm physiology is characterized by increased tolerance to stress, antibiotics, and immunological defenses, which is at the origin of their resilience in most medical and industrial settings. Materials and Methods: The present prospective study was carried out from December 2013 to May 2014 in the Department of Microbiology of a Teaching Tertiary Care hospital located in central India. A total of 100 consecutive, nonrepetitive E. coli isolates were subjected to biofilm formation study by Christensen's tube adherence method. All the isolates were also subjected to antimicrobial susceptibility testing by Kirby-Bauer disc diffusion method in accordance with the Clinical Laboratory Standard Institute 2013) guidelines. Results and Discussion: Out of the 100 E. coli isolates studied, 62 (62%) were positive for biofilm formation. High percentage of resistance was detected in isolates among the male inpatient group. Overall drug resistance was found to be very high among both biofilm as well as nonbiofilm forming isolates indicating excessive drug resistance among both community and hospital organisms. Conclusion: A greater understanding of the nature of biofilm organisms in chronic UTI's would help in the development of novel and more effective treatments for these problematic diseases.

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Introduction: Bloodstream infections (BSIs) are associated with a high mortality rate of 20%-50%. Blood culture is paramount to identify causative agents of BSIs to choose an appropriate antimicrobial therapy. Objectives: The present study was undertaken to analyze the various microorganisms causing BSIs and study their antimicrobial resistance patterns in a tertiary care hospital, Eastern India. Materials and Methods: A total of 239 blood specimens from clinically suspected cases of BSIs were studied for 6 months from July 2015 to December 2015. Blood specimens were incubated in BacT/ALERT ^® 3D system (bioMerieux, Durham, NC, USA) a fully automated blood culture system for detection of aerobic growth. Identification and antimicrobial susceptibility testing were conducted on VITEK ^® 2 (bioMerieux, Durham, NC, USA) as per Clinical Laboratory Standards Institute guidelines. Results: Out of 239 specimens, 41 (17.2%) yielded growth of different microorganisms. From these isolates, 20 (48.8%) were Gram-negative bacilli, 18 (43.9%) were Gram-positive cocci and rest 3 (7.3%) were yeasts. Among Gram-negative bacilli, Klebsiella pneumoniae sub spp. pneumoniae (70%) was most commonly isolated. Coagulase-negative staphylococci (88.9%) were the most common isolate among Gram-positive cocci. All three Candida spp. isolated were nonalbicans Candida (two Candida tropicalis and one Candida krusei). Gram-negative isolates were least resistant to tigecycline and colistin. All Gram-positive cocci were sensitive to linezolid. Conclusion: Monitoring of data regarding the prevalence of microorganisms and its resistance patterns would help in currently prescribing antimicrobial regimens and improving the infection control practices by formulating policies for empirical antimicrobial therapy.

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Introduction: Urinary tract infection (UTI) is a common bacterial infection in children and associated with significant morbidity. Recently, UTI has become more difficult to treat because of the appearance of multidrug resistance pathogens. Objectives: The main aim of this study was to evaluate the changing trends of etiology, and antibiotic susceptibility pattern of urinary isolates in children of 0-12 year age group attending our hospital. Materials and Methods: A total of 930 urine samples were analyzed from children aged 0-12 years complaining of fever with or without urinary symptoms attending pediatric out- or in-patient of a tertiary care hospital from March 2011 to September 2012. In children under 2 years, urine sample was collected in a sterile bag and in above 2 years freshly passed clean-catch mid-stream urine was collected. All specimens were subjected to urine culture and sensitivity tests. Results: Significant bacteriuria was detected in 24.95% of patients. The most common pathogens isolated were Escherichia coli (60.34%), Klebsiella pneumoniae (20.63%), and Enterococcus spp. (5.17%). Extended spectrum beta-lactamase (ESBL) detection rate was low (3.77%). Most of the pathogens were susceptible to amikacin, piperacillin-tazobactam, nitrofurantoin, and imipenem. E. coli which was the main isolate was found to be most susceptible to imipenem (94.28%), amikacin (88.57%), nitrofurantoin (81.43%) and piperacillin-tazobactam (74.29%). Conclusion: This study reveals that most of the urinary isolates in pediatric age group are multidrug resistant, although ESBL detection rate is low. This suggests regular monitoring and modification of empirical therapy, and it should be validated by culture report to prevent morbidity associated with this disease.

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The spine is an infrequent location for giant cell tumor (GCT). The incidence of GCT in the spine, above sacrum, is only 1%-1.5%. We report a case of recurrent GCT of the lumbar spine which was clinically diagnosed as spinal tuberculosis. A 24-year-old female presented with complaints of pain in the right leg during the last trimester of her pregnancy. One month later, she complained of retention of urine along with weakness in both the lower limbs. X-ray showed destruction and sclerosis of L3 vertebra with involvement of the adjacent discs. The magnetic resonance imaging showed severe compression and collapse of L3 vertebra with diffusely altered marrow signals and an associated expansible lobulated soft tissue component. With a provisional clinical diagnosis of spinal tuberculosis, the mass was decompressed and sent for histopathological examination, where it was diagnosed as GCT of the spine. Follow-up details were not available. However, the patient presented with similar complaints 6 months later. A near total resection of the tumor was done with fixation of the spine. Histopathology confirmed it as GCT. Although rare, still GCT needs to be considered in the differential diagnosis of spinal lesions so that specific treatment modality may be provided to the patient.

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Context: People tend to use social networking sites (SNSs) often as a means of communication. Aim: This study was designed to find out the view, trend, and influence of SNSs among students and faculties of a Pharmacy School in India. Subjects and Methods: One hundred and eighty pharmacy students and 45 faculties received the questionnaire, out of which 132 students and 20 faculties provided their response. The questionnaire was framed using SurveyMonkey, an online paid survey tool to gather information from the responders. The questionnaire was sent as a link via E-mail to all the students and faculties with formal periodical reminders. Results: The response rate was 95.56% and 44.44% from the students and faculties, respectively. About 80.9% had regular access to SNS. Facebook was the most widely used SNS. All the student responders claimed that their study time as well as academic performance was not influenced by their involvement in social networking; in fact 72.73% of the students reported to have improved their academic performances even while using SNSs. Neither the students nor the faculties had any health-related concerns because of the use of social networking. Conclusions: The use of SNSs did not bring any changes in one's personal behavior or led to any health-related issues to worry. Instead it was helpful for learning purposes, professional activities, and to improve educational acquaintance.

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Extraosseous fat-fluid level is a rare but specific sign of hematogenous osteomyelitis. It results due to marrow necrosis due to infection with the release of fat globules and pus which extends into periosseous tissues through bony erosions. To form a fat-fluid level, the marrow necrosis has to be extensive which is not always present. However, when present and in appropriate clinical settings, it is fairly specific for hematogenous osteomyelitis. We describe radiographic, computed tomography, and magnetic resonance imaging findings in a case of osteomyelitis with extraosseous fat globules and fat-fluid level.

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Introduction: Ocimum sanctum has been in use for thousands of years because of its diverse healing property in various conditions. Hence, to evaluate its effect on intestinal motility, the present study aimed to find the effects of O. sanctum on intestinal motility of Wistar albino rats by in vitro study. Materials and Methods: Aqueous extract of O. sanctum was prepared from mature leaves, and from this stock solution, various dilutions of 1:10,000, 1:1000, 1:100, and 1:10 were prepared and used. Thirty healthy adult Wistar-stained male albino rats were selected and divided into five groups (each group comprises six animals): control, 1:10,000, 1:1000, 1:100, and 1:10 dilution groups. Intestinal segments 2-3 cm below the duodenum was removed from the intestinal segment and mounted in the Dales Organ Bath with Tyrode's solution and respective contraction responses for the various dilutions were recorded separately in the physiograph. Results: O. sanctum aqueous extract showed that the amplitude and force of contractions in various dilutions have increased when compared to the control group in the intestinal motility. Among the various dilutions, 1:100 dilution group showed significant (P < 0.01) difference in the contraction than the other dilutions. Conclusion: The increase of amplitude with an increase in duration indicates that O. sanctum could slow down the intestinal motility. This reveals that the aqueous extract of O. sanctum contains pharmacologically active substances with antidiarrheal properties.

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Background: Integrative system of health-care widens the horizon of health-care services where both allopathic and complementary and alternative medicine (CAM) practitioners play complementary role and make services more accessible, affordable, and safety monitoring is ensured. Objective: The objective of this study is to assess perception of herbalists on allopathic medicine and doctors. Settings and Design: The survey was carried out within Sokoto metropolis. Health services of the community were provided by a teaching hospital, 5 secondary levels hospitals and a host of primary health-care centers coupled with CAM. Herbalists were located mainly within the city located in 'Yarmarna, behind Maryam Abacha Children and Women Hospital and Kara herbs markets in the metropolis where they hawked herbs. This was a cross-sectional descriptive. Methods: Validated semi-structured interviewer-administered questionnaires were used to obtain information from the respondents. A sample of 92 herbalists was selected by multistage sampling technique. Selection of actual respondents who participated in the study was by proportionate allocation along the three major herbal centers. Results and Conclusion: The mean age of respondents was 53.1 ± 1.8 years. The mean age of years of experience in practice was 29.04 ± 1.7. On relationship with orthodox doctors, 50% admitted that it was poor while the remaining 19.6% and 30.4% described it as good and very good, respectively. More than 85% support integration of herbalism into orthodox medicine (95% confidence interval 3.67-12.12). The respondents expressed their enthusiasm to be integrated.

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Paragangliomas are rare neuroendocrine tumors that arise from the extra-adrenal autonomic paraganglia. Most paragangliomas are either asymptomatic or present as a painless mass. While all contain neurosecretory granules, only in 1%-3% of cases is secretion of hormones such as catecholamines abundant enough to be clinically significant with manifestations often resembling those of pheochromocytoma. Paragangliomas should be considered in the differential diagnosis in a patient presenting with an episodic headache and hypertension. New-onset hyperglycemia or worsening of preexisting diabetes may be the presenting feature in some patients with paragangliomas.

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Context: Herbal antimalarials are promising to be a sure way to offset malaria. Aim: The aim of this study was to assess the patronage and the perceived efficacies of artemisinin-based combination therapies (ACTs) and herbal antimalarials in Ghana. Methods: A cross-sectional survey on this subject was conducted in Kumasi, Ghana, between January and April 2014. Statistical Analysis: Statistical analysis was performed by Pearson's Chi-square analysis; P ≤ 0.05 was considered statistically significant. Results: Of 500 respondents (46.8% males; 53.2% females) interviewed, 75% were aged between 20 and 40 years. Majority (82.9%) had secondary education although 2.5% had no formal education. Respondents had a good knowledge of the symptoms of malaria; headache (93.8%), fever (99.1%), nausea and vomiting (93.8%), and general body weakness (88.4%) were most frequently mentioned. For malaria therapy, 73.6% use ACTs, while 47.6% use prepackaged or extemporaneous herbal antimalarials; 52.1% of the herbal users had used ACTs before. Commonly used herbs were Phyllanthus fraternus, Vernonia amygdalina, Khaya senegalensis, Azadirachta indica, and Cryptolepis sanguinolenta. Although 69.8% of ACT users recovered from malaria after a complete course, 27.2% recovered after course repetition(s) within 4 weeks. Nearly 82.8% of herbal users recovered fully after taking required quantities as stated by the manufacture, with 17.2% having recurrence. Side effects such as general malaise and dizziness reported by ACT and herbal antimalarial users were 15.3% and 10.1%, respectively. Although there was no significant relationship between preferred antimalarial type and age as well as working status, there was high significant (P ≤ 0.001) relationship with tertiary education. Conclusion: Although both ACTs and herbal antimalarials are highly patronized, a greater percentage of consumers find herbal antimalarials to be more efficacious.

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