Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors arising from the muscularis propria of the gastrointestinal tract. Presenting features include abdominal mass (5%–50%), obstruction (5%), hemorrhage and rarely perforation (0.8%). This is a case report of an elderly male with a perforated jejunal GIST presenting as acute abdomen. GISTs exhibit an unpredictable behavior. Complete surgical excision with clear margins is the treatment of choice with adjuvant chemotherapy.

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Failure of eruption of multiple permanent teeth is uncommon. This may be attributed to some local and systemic factors. In general, systemic factors are responsible for eruption failure of multiple teeth whereas the local causes tend to affect one or few teeth. In this article, we describe a rare case of multiple impacted permanent teeth of normal series and supernumeraries in a 14-year-old girl not associated with any syndrome.

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Gingival recession (GR) is not only a major esthetic concern but also is often associated with dentinal hypersensitivity. Correction of mucogingival recession deformities with a variety of periodontal plastic surgical procedures has been described, each demonstrating a variable degree of success. However, among the various treatment modalities, coronally advanced flaps are the most commonly employed for multiple teeth recession coverage. This case report describes the management of Class I GR due to faulty brushing technique associated with dentinal hypersensitivity with coronally advanced flap combined with guided tissue regeneration membrane.

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Tubercular esophagocutaneous fistula is a very rare complication arising either due to erosion by caseating cervical lymph nodes or due to tuberculosis (TB) of the esophagus. Both of these conditions are themselves rather sporadic. A young male presented with a passage of “orally taken liquids” from an opening in the neck. He had no primary foci of TB detected whatsoever, which was unusual. He was started on antitubercular treatment (ATT) for 8 weeks, but due to nonclosure of tract, the fistula had to be excised. Histopathology confirmed the tubercular nature of tract. ATT was continued postoperatively. There has been no recurrence even after 1½ years of follow-up.

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AIM: This study aims to study the factors which predict the risk of intra-abdominal sepsis (IAS) and burst abdomen in patients with abdominal trauma undergoing laparotomy. MATERIALS AND METHODS: Seventy-five patients with abdominal trauma undergoing laparotomy were evaluated in pre-, intra-, post-operative period for factors such as injury severity score (ISS), abdominal trauma index (ATI), operative severity score (OSS), and intra-abdominal pressure (IAP). The correlation was found among these factors and risk of IAS and burst abdomen following laparotomy. RESULTS: Mean ATI, ISS, and OSS in IAS present and absent group were (35 ± 10 and 21 ± 7), (47 ± 16 and 22 ± 9), and (30 ± 6 and 18 ± 6), respectively. Mean ATI, ISS, and OSS in burst abdomen present and absent group were (35 ± 10 and 22 ± 8), (43 ± 14 and 23 ± 12), and (30 ± 6 and 19 ± 6) respectively. Mean IAP on D0, D1, and D2 in IAS present and absent group were (23 ± 7 mmHg and 16 ± 3 mmHg), (14 ± 4 mmHg and 7 ± 3 mmHg), and (11 ± 5 mmHg and 5 ± 2 mmHg), respectively. Mean IAP on D0, D1, and D2 in burst abdomen present and absent group were (23 ± 7 mmHg and 16 ± 3 mmHg), (13 ± 4 mmHg and 7 ± 4 mmHg), and (11 ± 5 mmHg and 5 ± 2 mmHg), respectively. Out of the 15 patients who had IAS, 13 also had burst abdomen. Significant correlation was found between ATI, ISS, and OSS with IAS and burst abdomen, and between IAS and burst abdomen. CONCLUSIONS: Higher scores of ATI, ISS, OSS, and IAP are associated with higher chance of developing IAS and burst abdomen in the postoperative period. The presence of one complication in the postoperative period increases the risk for the other. Therefore, we can have risk-based approach in managing the patients having above-mentioned risk factors.

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CONTEXT: Gonorrhoea is the second most common sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae. Though asymptomatic infections are common in females, adverse outcome is a long list and they serve as hidden sources for the transmission of infection. AIMS: To study the prevalence of N. gonorrhoeae infection among female outpatients and to compare Clinical Laboratory Standards Institute (CLSI) and calibrated dichotomous sensitivity (CDS) methods for antibiotic sensitivity testing. SETTINGS AND DESIGN: Cross-sectional study. SUBJECTS AND METHODS: Total number of subjects included in the study was 130. Two endocervical swabs were collected from each subject during speculum examination. Gram's stain, culture and antibiotic sensitivity test were performed as per CLSI and CDS methods. STATISTICAL ANALYSIS USED: Results were analysed by Chi-square test using IBM-SPSS Statistics-22 statistical package. RESULTS: Among the 130 females studied, three were positive for N. gonorrhoeae. Gram's stain and culture were equally sensitive. According to CLSI method, all the isolates were sensitive to spectinomycin, while other drugs showed 33% resistance. CDS method detected 33% resistance to ciprofloxacin and the rest of the antibiotics were 100% sensitive. CONCLUSIONS: Prevalence of N. gonorrhoeae was 2.3%. Gram's stain has got similar sensitivity as that of culture. CLSI method showed only spectinomycin was exclusively sensitive. CDS method showed all the tested drugs were sensitive except ciprofloxacin.

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INTRODUCTION: Urinary tract infection poses a serious health threat with respect to antibiotic susceptibility and high recurrence rate. Uropathogenic bacteria may produce biofilm, rendering the bacteria very difficult to eradicate with antibiotics. This study was carried out to compare biofilm formation by Gram-negative organisms in catheterized and noncatheterized patients and also to evaluate their antibiotic susceptibility pattern. MATERIALS AND METHODS: The study comprised fifty consecutive specimens of urine yielding significant colony count of Gram-negative bacteria. Twenty-five specimens were collected from catheterized patients while the rest of the 25 specimens were collected from noncatheterized patients. All the specimens were processed following the standard microbiological guidelines. The isolated organisms were screened for biofilm production by tube method, and antibiotic susceptibility of both biofilm- and nonbiofilm-producing isolates was done by Kirby–Bauer disc diffusion method. RESULTS: Eighteen (72%) of the 25 organisms isolated from the catheterized patients were found to be biofilm producers, while only 4 (16%) of the rest of the 25 organisms, isolated from the noncatheterized patients were found to produce biofilm. The percentage sensitivity of all the biofilm-producing organisms was found to be lower than the nonbiofilm-producing organisms. CONCLUSION: The present study shows that urinary catheterization is a major environmental factor that facilitates biofilm formation by uropathogenic Gram-negative bacilli. As biofilm-producing organisms are difficult to treat, proper measures should be taken to prevent its formation.

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BACKGROUND: Lifestyle has long been associated with the development of many chronic diseases and noncommunicable diseases (NCDs). NCDs are largely preventable through effective interventions by tackling the shared modifiable risk factors, and onset and progress can also be delayed. Therefore, the objectives of this study were to determine the practice of lifestyle and assess the burden of associated risk factors of NCDs among the students of selected colleges of Delhi University. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted among 450 students from two coeducational colleges of Delhi University. Data were collected in accordance with the World Health Organization STEPwise approach to Surveillance (WHO STEPS) questionnaires. Standardized questionnaires of WHO STEPS methodology for surveillance of chronic diseases for Step 1 and clinical measurement on height, weight and blood pressure (BP) for Step 2 were used. Data were collected in September 2013 to November 2013. RESULTS: Of the 450 students, 56.88% were male, all in the age group of 18–26 years. Only 28.66% of the subjects perform the moderate physical activity during a usual week. During the past 7 days, 59.33% consumed carbonated soft drinks at least 1–2 times/day and 49.11% eaten >2 servings of fast foods per day. Tobacco use (smoking only) was prevalent in around 15.77% of the subjects and alcohol in 20.88%. Majorities use tobacco and alcohol in relation to socialization, peer pressure and for enjoyment. 31.55% of the subjects were overweight and obese and 8.22% underweight, while 1.55% high normal BP. CONCLUSIONS: The present study showed a poor practice of healthy lifestyle with a high burden of lifestyle-related risk factors of NCDs among students of Delhi University. Therefore, the University should emphasize on curriculum for a healthy lifestyle in all faculties as a required subject. Frequent campaigns and educational seminars are to be encouraged for the adoption of healthy lifestyle and health promotions.

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OBJECTIVE: The objective of this study is to identify some nutritional deficiencies in thalassemic patients on regular transfusion therapy and to assess the improvement after dietetic modification. MATERIALS AND METHODS: This cross-sectional hospital-based study was conducted in thalassemia patients admitted to the Pediatric Ward of JSS Hospital, Mysore for 6 months. Those with any concurrent illnesses that could interfere with dietary intake were excluded. Dietary data were collected by 24 h recall method. The total amount of energy, protein, fat, calcium, iron, phosphorus, fiber, and carbohydrates consumed was estimated. Dietary counseling was then done to meet the recommended daily allowance of deficient nutrients for that specific age group during the next follow-up to the hospital. Using the similar 24-h recall method, the total amount of energy, protein, fat, calcium, iron, phosphorus, fiber, and carbohydrates consumed was again estimated and assessed after 6 months. ETHICAL CLEARANCE: Institutional Ethical Clearance was taken from the ethics committee before commencing the study. An informed written consent was taken from the parents before starting data collection. RESULTS: Before diet counseling, the study showed that all children consuming iron deficient diet suffered from deficiencies of calories, fiber, calcium, and phosphorus. All children seemed to consume adequate levels of protein, fat, and carbohydrates. On the 6-month review, these deficiencies continued to persist, but the nutritional value of the diet seemed to show an improvement when compared to their pre-counseled values. CONCLUSION: The emphasis on iron deficient diets in thalassemic children causes associated deficiencies. Emphasis on diet rich in these elements with follow-up dietary counseling during each visit is required to maintain a balanced nutrition.

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BACKGROUND: Prelacteal feeds are dangerous for newborn health and thus should not be given. Studying the enabling factors of this harmful practice can help determine ways of how to get rid of it. AIMS AND OBJECTIVES: This study aims to assess the pattern of prelacteal feeding in a district of Himachal Pradesh and to study its predictive factors. SETTINGS AND DESIGN: A cross-sectional study was conducted among 200 mothers attending Anganwadi centers in Shimla district of Himachal Pradesh. MATERIALS AND METHODS: Data were obtained by trained field investigator using a pretested interview schedule. In-depth interviews were held to find out the reasons for providing prelacteal feeds. STATISTICAL ANALYSIS: Data were analyzed using Epi Info software for windows (Centre for Disease Control and Prevention, Atlanta). Logistic regressions were used to find out the adjusted odds ratios (AORs) for factors associated with the practice of giving prelacteal feed. RESULTS: The prevalence of prelacteal feeding was 49.5% (confidence interval [CI] = 42.5%–56.4%). In logistic regression analysis, living in joint family (AOR = 2.5, CI = 1.3–4.9) and higher socioeconomic status (AOR = 3.8, CI = 1.1–13.1) were positively associated with prelacteal feeding practice. Mothers who delivered by cesarean section were more likely to give prelacteal feeds to their baby (AOR = 3.4, CI = 1.3–8.8) as compared to those who delivered by normal vaginal delivery. CONCLUSIONS: It is concluded that prelacteal feeding is commonly practiced in both urban and rural areas of Shimla hills of Himachal Pradesh. Child health programs in the study area should use behavior change communication to decrease the harmful practice of giving prelacteal feeds to newborns.

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BACKGROUND: One of the most effective and safest medical abortion (MA) regimens consist of the use of a combination of mifepristone and misoprostol. Misoprostol can be administrated by oral or vaginal route after giving a single dose of mifepristone. The present study was conducted to assess the effectiveness and complications by these two routes. SUBJECTS AND METHODS: The present study was nonrandomized clinical trial conducted at two private hospitals and medical college, Amravati city. The women having a history of amenorrhea ≤49 days and who were willing for medical termination of pregnancy by MA pills method were included in the study during the 1-year after obtaining ethical approval. The women in both groups were given tablet mifepristone (200 mg day) on day 1 orally followed by tablet misoprostol (two tablets of 200 μg) on day 3 orally in one group and vaginally in other group. RESULTS: The success rate of medical termination in group with oral administration of misoprostol was 96.3% as compared to 97.7% success rate in group with vaginal administration of misoprostol. The gastrointestinal side effects were 41.4% in group with oral administration of misoprostol as compared to 21.7% in group with vaginal administration of misoprostol. The Chi-square test of significance was applied using SPSS software version 16.0. CONCLUSIONS: The success of medical termination of pregnancy was comparable in both groups with slightly higher success rate by vaginal route of administration of misoprostol.

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BACKGROUND: Modern radiotherapy treatment machine today comes along side with sophisticated treatment planning systems (TPSs). The accuracy of any TPS depends on the mathematical algorithm it uses and can be well verified using a dedicated phantom. AIMS AND OBJECTIVES: To design a low-cost pelvic phantom and to use the designed phantom to verify whether the accuracy of an Irregular Field Algorithm of a Precise PLAN 2.16 TPS is within ±5% International Commission on Radiation Units and Measurements (ICRU) minimal limit. MATERIALS AND METHODS: Designed pelvic phantom was made of Plexiglas with six tissue equivalent inserts and an ion-chamber port. The mimicked organs for the inserts were: Prostate, bladder, adipose, muscle, rectum, and bone. A Hi-speed computed tomography (CT) simulator was used for acquiring images and CT numbers of the designed pelvic phantom, a Precise PLAN 2.16 TPS was used for image planning, an Elekta-Precise Clinical Linear Accelerator was used for prescription of the planned images and a precalibrated NE 2570/1 farmer-type ion-chamber with an electrometer was used to calculate the mean dose. Data analysis value was done using GraphPad Prism 5.0 statistics software. RESULTS: The maximum percentage deviation with large field sizes of 22 cm × 25 cm for six different inhomogeneous inserts was −3.95%, and bone only homogeneous inserts was 2.38%. The maximum percentage deviation with small field sizes of 5 cm × 5 cm with six different inhomogeneous inserts was −3.57%. The percentage deviation between the solid water phantom and the locally designed pelvic phantom was −3.46%. CONCLUSION: The irregular field algorithm showed an overall accuracy of approximately ±4% with the locally designed pelvic phantom for both large and small field sizes against ±5% ICRU minimal limit. Although there were significant differences in percentage deviation between inhomogeneity and homogeneous insert irrespective of field sizes.

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Surgery is a stressful and anxiety provoking experience for children. Millions of children undergo surgery every year. The majority of children experience significant preoperative anxiety which intern can affect their recovery. Preoperative anxiety may bring about physical and physiological changes in children, which can be particularly evident in terms of increased heart rate and blood pressure. To identify various strategies used to minimize the preoperative anxiety of children and update their clinical effectiveness among children undergoing surgery, the authors searched PubMed, MEDLINE, CINAHL, ScienceDirect, Google Scholar, Scopus, and Cochrane Library for identifying the relevant studies and retrieved available literature. It is concluded that utilization of the strategies available to reduce the preoperative anxiety of children will be a promising intervention to reduce anxiety, to promote relaxation, satisfaction, and speedy recovery. Many of these techniques are simple, cost-effective and can be easily carried out by nurses. It is essential to use the age appropriate and individualized methods in preparing children for surgery. Further research is required to strengthen the evidence.

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