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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Carcinoma of gall bladder has early lymphatic and haematogenous spread. Most common extra abdominal site of metastasis is the lung. Metastasis to breast from carcinoma of breast is very rare. Our case describes an interesting case of carcinoma of gall bladder metastising to breast. A 50-year-old female presented to our outpatient department with a small nodule on upper outer quadrant of left breast. Patient had a history of cholecystectomy done for symptomatic gall stones 2 years back. Histopathological examination of the gall bladder specimen showed adenocarcinoma of the gall bladder with invasion to lamina propria. No additional treatment was offered to the patient. The breast nodule was excised and sent for histopathological examination. Histopathological examination revealed metastising adenocarcinoma. Patient was subjected to palliative chemotherapy (Gamcitabine and carboplatin). However, patient died of hepatic encephalopathy after 5 months. Our case reports an unusual site of metastasis from carcinoma of gall bladder which is very rare.

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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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Research Question: What determines the trend in coverage of iron folic acid (IFA) supplementation among pregnant women? Objectives: To assess the role of various socio-demographic factors in determining IFA supplementation among pregnant women in RS Pura block of district Jammu. Materials and Methods: A stratified two-stage design with villages as the primary sampling unit and mothers with children less than 1 year of age as secondary sampling unit. Villages were divided into different clusters on the basis of population and sampling units were selected by a simple random technique. Results and Conclusion: Coverage for IFA supplements is still not complete in RS Pura block and the programme needs to focus on informing pregnant women about the advantage of IFA.

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Snakebite is one of the serious medical problems in India; however reliable data on epidemiological and treatment seeking behavior related to snakebite are very few. Hence a cross-sectional study was carried out at a tertiary care hospital among patients admitted with history of snakebite with a pretested structured questionnaire. Analysis of 106 reported cases of snakebite showed that 87.7% of the victims were in the age group of 15-59 years. Snakebite was twice common among males compared to females. Among the snakebite victims 46.2% were agricultural workers. Out of 84.9% snakebite victims who had seen the snake, only 24.5% killed the snake and brought for identification. Nearly two fifth of the cases were reported during the months of July to September. More than three fourth of the bites occurred in the lower limbs and nearly 69% of them occurred at night.

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We report here a case of asymptomatic type IV hyperlipoproteinemia (HLP) in a 28-year-old pregnant woman with gestational diabetes mellitus (GDM) in the third trimester of pregnancy that was diagnosed incidentally due to the presence of milky white serum. Her total cholesterol and triglyceride values were highly elevated, which led to the provisional diagnosis of hyperlipidemia, and, on further evaluating the patient with lipoprotein electrophoresis, a diagnosis of type IV HLP was made. Her treatment consisted of fetal monitoring and control of GDM with dietary management. She was taken up for elective caesarean section at 35 weeks to prevent any emergent conditions arising due to complications such as acute pancreatitis. On investigation, the newborn also showed increased levels of total cholesterol and triglycerides. This case report highlights the fact that type IV HLP can be asymptomatic and diagnosed incidentally. However, increased levels of triglycerides pose a definite risk factor for premature cardiovascular morbidity. Hence, once diagnosed, the patient should be managed with a prescribed diet and appropriate lipid lowering drugs.

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Hutchinson-Gilford progeria syndrome (HGPS) is an extremely rare hereditary disease characterized by multisystem involvement. Although the patients may sport normal intelligence, the disease takes a considerable toll both physically and psychologically resulting in a debilitating state. It may also be compounded by catastrophic/fatal events of accelerated atherosclerosis such as stroke and myocardial infarction. We discuss our experience with HGPS and review the literature.

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Ewing's sarcoma is an uncommon malignant tumor of bone that usually occurs during the first two decades of life. It is most common between the ages of 10 and 15 years. Although it may develop in any bone, the most frequent sites are the femur, ilium, and tibia. It is uncommon in the upper extremity, except in the humerus and it is rare in the hand. We are reporting the case of a 19-year-old girl who had Ewing's sarcoma in the second metacarpal of the left hand 12 years ago and now presented with Ewing's sarcoma in distal left radius with metastasis to brain, liver, and lungs.

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Success of endodontic treatment depends on the proper identification of all the canals, thorough chemo-mechanical preparation followed by three dimensional obturation with hermetic seal. Failure of any of these steps may occur due to unusual tooth morphology. Usually mandibular molars have two roots with three canals (mesiobucccal, mesiolingual and distal) but in few teeth, the number of roots and canals vary. The variation in the number of roots is called radix entomolaris. This article presents a case report of mandibular first molar with extra distal root and five root canals. This report highlights the importance of radiographic examination and points out the need to look for additional canals and unusual canal morphology associated with a mandibular first molar.

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Introduction: Leprosy or Hansen's disease is a chronic infectious disease; the social stigma attached to this or faced by the patients is wildly prevalent due to misconception related to disease, which needs a multidimensional effort to eliminate it. Aims and Objectives: To identify the factors which are obstructing the eradication of diseases like people's belief, social stigma, gender bias, and information regarding disease processes. Materials and Methods: This is a cross-sectional observational study carried out in the Department of Dermatology, Government Medical College, Jagdalpur, Chhattisgarh. Data were collected from August, 2007 to September, 2010. During this period, 178 leprosy diagnosed patients were registered and treated in the Department of Dermatology. Results: A total of 178 patients were enrolled in the project, out of which 41.5% were females. Tribal population dominance was evident as it constituted 81.5% of population and 72% of population was illiterate, with majority 87% representing the poor socioeconomic strata. Conclusion: The key to success is bringing health seeker/sufferer to the health setup and development of tools for early diagnosis and detection of infection and nerve damage as early as possible to attack the disease at nascent stage.

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Background: Glibenclamide is the second generation anti-diabetic drug used for the treatment of type 2 diabetes. Glibenclamide is practically insoluble in water, and possesses poor solubility, gastrointestinal absorption, and bioavailability. Aim: To prepare fast disintegrating tablets of glibenclamide in order to improve the dissolution rate and absorption. Materials and Methods: In this study, fast disintegrating tablets of glibenclamide were formulated with a view to enhance patient compliance by a direct compression method. In this method, mucilages of Leucaena leucocephala and Trigonella foenum-graceum were used as natural disintegrants and crospovidone as synthetic super disintegrant and directly compressible mannitol (Pearlitol SD 200) to enhance mouth feel. Results: The prepared batches of tablets were evaluated for hardness, friability, drug content uniformity, in vitro dispersion time, wetting time, water absorption ratio, in vitro drug release (in pH 6.8 phosphate buffer), stability studies (at 40°C/75% relative humidity for 3 months), and drug-excipients interaction (infra-red spectroscopy). Among all formulations, formulation (FG ₃ ) containing 12% w/w of T. foenum-graceum was the overall best formulation (t_50% = 8 min) based on the in vitro drug release characteristics as compared with the conventional commercial tablet formulation (t_50% = 10 min). Stability studies on the formulation indicated that there are no significant changes in drug content and in vitro dispersion time (P < 0.05). Fourier transform-infra red studies revealed the integrity of the drug in the formulation. Conclusion: From the above work, it can be concluded that the fast disintegrating tablets of glibenclamide prepared using mucilage of L. leucocephala and T. foenum-graceum can be used as natural disintegrants for faster disintegration of tablets in mouth.

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Background: Timed "up and go" (TUG) test is a quick test, used in clinical practice as an outcome measure to assess functional ambulatory mobility or dynamic balance in adults. However, little information is available of TUG test used in cerebral palsy (CP). Hence, the purpose of our study was to find score of TUG with respect to gross motor function classification system (GMFCS) in CP children. Aims: To find the mean score of TUG test with respect to GMFCS level in children diagnosed as CP. Materials and Methods: It was a cross-sectional observational study conducted in neuro rehabilitation unit and included 30 CP children of 4-12 years, those within GMFCS level I, II, III, and IQ ≥50. The sampling technique used was purposive sampling excluding children with cognitive deficit. Subjects performed on TUG on three occasions: Initial assessment (time 1); 30 min after initial assessment (time 2); 1 week after initial assessment (time 3). Three trials were conducted for each of the three occasions. A mean score of three trials was documented as final score. The mean of scores of TUG test of all the subjects within the particular GMFCS levels was calculated. Results: Significant variation was seen in the TUG score for three levels of GMFCS. Conclusions: Significant variation was seen as GMFCS levels get increases time duration of TUG also increases.

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Monotherapy as well as effective and safe combination therapy for diabetes is practiced widely by both private and government hospital prescribers. This study attempted to compare the prescriptions of government and private practitioners to obtain a fair idea of the trends of diabetes management in either group. Prescriptions for diabetic patients from both private practitioners and government medical college prescribers were collected. These were analyzed for parameters such as number and type of drugs, cost, and generic prescription. Private prescribers were not significantly different from hospital prescribers in terms of number of drugs per prescription, cost of therapy, and treatment regimens. However, there was a dearth of generic prescriptions from private consultants (33% vs. 9%). Metformin and Glimepiride were the most prescribed drugs in both groups. However, private practitioners preferred Gliclazide, Glipizide, and Glibenclamide more than hospital prescribers.

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