Introduction: Organophosphates (OP) are irreversible cholinesterase inhibitors, producing nicotinic and muscarinic effects. Cardiac complications with these compounds are often fatal. Early recognition of abnormal rhythm protects the patients against acquiring life-threatening arrhythmias. Hence, this study was done to determine the ECG findings in patients with OP poisoning. Aims & Objectives: To determine the various electrocardiographic changes & its importance in acute Organophosphate poisoning. Materials and methods: This prospective observational study of 50 cases was conducted for 2 years in a tertiary care institute. All adults with history of OP poisoning, admitted within 12 hours were enrolled. Patients with cardiac disease or treated from outside were excluded. Diagnosis was made by history, clinical features and confirmed by serum cholinesterase level. ECG analysis of each case was done for rate, rhythm, ST-T changes, PR and QTc intervals, and conduction defects etc. Results: Mean age in the study group was 30.66 ± 11.70(SD). Male:Female ratio was 1.94:1. 78% were suicidal, 22% were accidental and 6(12%) cases expired. Most common mode of poisoning was ingestion 45 cases (90%). Most common ECG abnormality was Sinus Tachycardia in 12(24%) followed by ST-T changes 8(16%), QTc prolongation in 6(12%), Sinus Bradycardia 4(8%), Extrasystole 2(4%), PR Prolongation 1(2%), AF 1(2%) and VT 1(2%). Conclusion: Poisoning with OP compounds can produce significant ECG abnormalities especially sinus tachycardia, non specific ST-T changes and QTc interval prolongation. Since these abnormalities can cause lethal arrhythmia and cardiac damage, careful observation of the electrocardiogram of the patients exposed to OP compound is necessary, parallel to the appropriate medical management.

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Introduction : PAD is an atherosclerotic occlusive condition in which plaque builds up in the distal arteries. Until 10 years ago, conventional angiography and digital subtraction angiography were the only angiographic techniques used in peripheral vascular disease and are considered gold standard. However, the complications and patient discomfort associated with these techniques have prompted the need of less invasive means of assessing the peripheral arterial system. Aim of the study was to compare efficacy of USG and MDCT angiography for investigating the lower limb arterial disease. Method: 40 patients suspected of lower limb PAD were included. Patients with previous amputation surgery were excluded. In all patients color Doppler sonography and multi-detector CT angiography was done. A comparative study of multi-detector CT angiography and color Doppler sonography was undertaken. Result: 50% patients had complaints in left lower limb and 25% in right lower limb. 22% had bilateral lower limb pain which was more on the left side (12%). Three patients examined by angiography showed irregularity of arterial wall on both sides, which appeared as calcifications on CT angiography (sensitivity 100%) while only 2 of them appeared on color coded Doppler examination (sensitivity 75%). Conclusions: Color Doppler USG is the initial modality of choice in PAD. CT Angiography is a better for segmental length assessment, collateral circulation along with a road map reproduction of the arterial system. USG is better than CT angiography in diagnosis of Grade 1 &2 cases, with better assessment of soft plaques, segmental flow and recanalization in PAD.

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Background: Dermatophytosis is a type of superficial fungal infection which is a cause of significant morbidity especially in the Indian subcontinent. One of the major causes of the rising trend in the incidence of dermatophytosis is the unwarranted use of steroids in the management of fungal infection. Methods: A cross sectional study of dermatophytic fungal infections was carried out with research question of ‘Is steroid formulation abused in dermatophytic infections? What are their effects and side effects?’ All patients of dermatophytic infection were primarily selected over period of six months of which patients who had history or findings of some form of steroid use were further analyzed. Quantitative and qualitative data were collected in regards to steroid formulations about type, duration of use, route of administration and their availability by prescription or “over the counter”. Dermatological signs of steroid use were noted. Results: Of total 180 patients of dermatophytosis, 72 patients (40%) had used steroid formulations either topical (52), intralesional (9) or injectable (11) and 108 did not. Most patients (50 of 72) (69%) were from rural background and had long mean duration of illness (24 ± 3 weeks). Multiple site infection of dermatophytosis was present in 60 of 72 (83%) and in 51of 108 (47.22%) in steroid misuse and in non-steroid use patient group respectively. Cutaneous adverse effects were common in steroid modified dermatophysis patients. Unauthorized use of steroid was in form of self application, over the counter availability, use of steroid preparation of relatives and others. Conclusions: Misuse of steroid formulations in dermatophytic infections may lead to adverse effect as well as chronicity. Awareness of this problem is needed for prevention of steroid modified dermatophytosis, which is a rising menace.

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Introduction: Street vended food is not only appreciated for their unique flavours, convenience and the role which they play in the cultural and social heritage of societies, it also becomes important and essential for maintaining nutritional status of populations. Method: Vendors were chosen randomly for obtaining various samples. Samples were taken after informed consent. Sterile swabs were used to collect sample from the palms, fingers and area between fingers from both the hands of the individuals preparing or contacting the food. Water samples were collected in sterile containers using aseptic precautions. Samples were inoculated on suitable culture media and subjected for identification after obtaining growth. Result: Total of 14 water samples and 28 swabs were collected from 14 different street vendors. Average of 1100 cfu/ml of water sample was isolated. Organisms isolated from water samples were Pseudomonas spp. E coli and Klebsiella. From the swabs taken from both the hands, major organism isolated was Coagulase negative staphylococci followed by Staphylococcus aureus and E coli. Conclusion: Quality of food offered by street vendors directly affects the health of a person and population in general. Our study shows poor quality of hand hygiene maintained by street vendors as well as poor quality of water used for preparation of food, which may affect quality of food provided.

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Introduction: Diabetes is one of the leading non communicable disease throughout the world. Due to its chronic nature it causes a number of complications. Diabetic peripheral neuropathy is one of the most dreaded complications of diabetes as it is associated with significant morbidity. Diagnosis of neuropathy is commonly done by NCV which is a gold standard test for it. Other simpler method to detect early loss of protective vibration sensation, to find out feet at risk of future complications is the need of the hour. Hence this study was done to study the symptoms of peripheral neuropathy in type 2 diabetic patients and to correlate these with patient's age, duration of diabetes, glycemic parameters and other microvascular complications. Methodology: This was a cross sectional study carried out in 40 patients with symptoms of peripheral neuropathy in the Department of General Medicine at Dhiraj General Hospital, Sumandeep Vidyapeeth, Piparia, Vadodara district, Gujarat. All patients were subjected to detailed clinical history, examination of their feet and neuropathy testing by NCV using the RMS NCV/EMG machine using a hand held biothesiometer. Results: Out of the total of 40 patients, 30 were males and 10 were females. Increasing age of the patients, increasing duration of diabetes, smoking and poor glycemic control were significant risk factors for the development of neuropathy. It was also consistently associated with other microvascular complications like retinopathy and nephropathy. The most frequently encountered symptom of neuropathy in our study was burning feet. Conclusion: The study concludes that increasing diabetes duration is an independent and strong risk factor and considering the dreaded complications of end stage diabetic foot disease, routine screening of all type 2 diabetic patients should be done in daily practice.

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Introduction: Understanding the reasons why people do or do not donate the eyes is crucial to address the problem of undersupply of cornea and designing any intervention. Aim of this study was to assess the level of awareness towards eye donation and factors influencing among general population residing in the rural area of Haryana state. Methods: We conducted a cross-sectional study during September-December 2014. Patients attending OPD for the purpose of seeking care for their common ailments or diseases formed the study population. Total 360 adults were interviewed using pre-designed and pre-tested questionnaire in local language. Results: Total 76.9% of participants were aware about eye donation. Education, religion and occupation were found to be important predictors for awareness. Sex and age were not significantly associated with awareness. Awareness about eye donation was significantly lower among illiterates (odds ratio 0.14) compared to those who had higher education. Perceived reasons for willingness to donate eyes were pleased to help the blind, doing good to humanity and noble cause. Reasons for unwillingness to donate eyes were, they don’t want his/her body to be buried with disfigurement, religion and family permission. Conclusion: Willingness to corneal donation of the studied community is relatively good. This rural population is a good target for mobilization for pledges. Motivators for willingness to donate were the feeling of pleasure in helping the blind and the belief that the act of donation is doing good to humanity, while the dislike to separate the eye from the body after death was the main reason for not being willing to donate.

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Abstract We report a curious case of pseudo pancreatic cyst with retro peritonial pancreatico pleural fistula, with masquerading giant hydratid cyst. A 24 year old man, known alcoholic with history of recurrent pleural effusion was referred to our hospital with complaints of cough, breathless, right sided chest pain , fever and weight loss. Abdomino thoracic computed tomography showed thick walled fluid cyst in right hemithorax with multiple pseudo cysts of pancreas and calcified hydratid cyst in right lobe of liver. Patient had history of resection of hydratid cyst (20 x20cm) from liver 15 years ago. For present symptoms, patient had undergone multiple pleural fluid aspirations, which were inconclusive. The computer tomography scan could not confirm any pancreatico pleural fistula. The diagnosis was masked in view of no history of pancreatitis, history of hydratid cyst, and the computer tomography finding of thick walled fluid collection in right hemithorax.

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Introduction: Assisted body mechanics is used to describe the movement we make each day during normal activities, including lying in bed, sitting, standing, lifting, pulling, pushing and walking. Body mechanics can be both good and bad and can have direct effects on back. Good body mechanics will help remedy and prevent future back problem, while bad body mechanics contribute to back problem and other muscle and bone problems. Nursing is a job that needs a lot of bending our back, arms and legs and pushing, pulling patients, because of which many nurses are at risk for developing physical strains and back injuries or even fractures. Aim: The main aim of the study was to assess the knowledge and practice of internship students regarding assisted body mechanics to reduce the musculoskeletal disorders with a view to develop safety guideline on manual handling technique. Methodology: A descriptive approach was used to collect data from 100 internship nursing students using self administered knowledge questionnaire and practice checklist at Sumandeep Nursing College. Result: The study result shows that 85% of internship students had average knowledge regarding assisted body mechanics, 84 % were practicing good body mechanics technique, 14% had fair practice, and 2% had poor practice of body mechanics.

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Introduction: The hemoglobinopathies are a group of genetic disorders in which there is alteration of hemoglobin structure. These hematologic disorders of the skeleton produce radiologic appearances related to marrow infiltration and/or replacement. Common findings are in place of such as osteopenia with trabecular prominence, growth disturbances, and extramedullary hematopoiesis. Conventional Radiography is required for knowing the imaging appearances of sickle cell disease, thalassemia, and other rare causes of anemia. Objectives: To study the role of conventional imaging in detecting various radiological manifestations of hemaglobinopathies. Materials & Methods: An observational descriptive study of 21 cases with hemaglobinopathies was done by conventional radiography & its varied musculoskeletal manifestations were studied. Result: Most common site of involvement was head of femur which was seen in 16 cases out of which isolated involvement was seen in 10 cases. Rest of the cases was associated with spine, skull and upper limb manifestations. Conclusion: Knowledge of the distribution and site of involvement and its musculoskeletal features is of considerable diagnostic importance in the evaluation and treatment of hemoglobinopathies. Conventional Radiography is required and its primary investigation modality It is important to know the extent of the range of radiologic appearances in order to accurately diagnose complications and to provide appropriate treatment.

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Context: Filariasis, an infectious tropical disease is a major public health problem in India but remains neglected. This study was conducted with an objective to evaluate and compare the coverage and compliance of Mass Drug Administration (MDA) and associated factors in Urban and Rural areas of Valsad district, Gujarat, India. Methods and materials: This cross sectional study involved survey of Valsad district covering 128 household. A pretested questionnare was used to collect data regarding administration of Diethyl Carbamazine (DEC) & Albendazole (ALB) to eligible population as a part of routine MDA activity. The data was analysed using Epi info software. Results: The coverage of anti-filarial drug was 94.81% in urban & 100% in rural. The compliance rate, the effective coverage rates were 100% and Coverage Compliance Gap was zero in rural areas of district which were better than those in urban area of district. Conclusion: The effective coverage rate after taking into account the coverage and compliance was more than the target of 85 percent which is needed for eradication and elimination of Filariasis. The rural areas of district had 100% effective coverage rate than urban areas of district. More emphasis must be given on spot consumption of the drug.

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Introduction: The study was aimed to study the outcome of Malaria cases admitted in the medicine department of the tertiary care hospital at Late Brk Memorial Medical College Jagdalpur (C.G), India. and also to see the response of treatment. The cases were attended from Jagdalpur city and nearby districts and villages. Methodology: This was an observational study, which was conducted at LATE B R K MEMORIAL MEDICAL COLLEGE, Jagdalpur, which is a tribal state. The study was carried out from January 2017 to 30^th september 2017 for a period of 9 months. Total cases were 362 confirmed cases of malaria admitted in medicine department. Confirmation was done by peripheral smear, RDT and parasite quality buffy coat (MP-QBC). Result: In our study, subjects enrolled were 362 cases of confirmed Malaria. Age group included were from 15 to 80 years. The mean age of the patients was 49.05 (±14.35) years. The percentage of male were 66.02% (n=239) and female were 33.97% (n=123).Complicated malaria was demonstrated in 260 (71.8%) and uncomplicated malaria in 108 (29.8%). Out of these tribal population comprised of 195 (53.8%) rural 97 (26.7%) and urban population was 70 (19.33%).The mortality reported after treatment in complicated malaria was 74 (20.4%) and no mortality was reported in uncomplicated malaria. Conclusion: In this tribal region of Chhattisgarh, current study depicted that, in spite of patients receiving adequate treatment the mortality was high in complicated malaria and population living in tribal area as compared to uncomplicated malaria. Complicated malaria is a poor prognostic factor.

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Introduction: Acute Renal Failure (ARF) refers to a damage that has already occurred and does not leave any capacity for early detection of “injury” or intervention, to prevent failure. The term ARF was replaced by AKI to provide uniform definition, classification and standardize patient care. Objectives: The aim was to study etiology and outcome of patients with AKI, to study association of AKI with other diseases with and utility of pRIFLE and AKIN as prognostic indicators. Material & Methods: Patients aged one month to 17 years admitted to pediatric intensive care unit were included in the study; patients with known chronic kidney disease & congenital anomaly were excluded. Result: The commonest etiology for patients with AKI was sepsis 15 (30%) of which 5(33.3%) patients had pneumonia. Overall Outcome of patients was 26 (52%) discharged, 12 (24%) tookDAMA, 8(16%) referred,4(8%) expired. Conclusion: Commonest cause for AKI was sepsis, next to it was acute tropical illness. Perhaps good control on vector borne disease may significantly reduce burden of AKI.

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Introduction: Knowledge of MDR- TB in Multi- Purpose Workers (MPWs) is cornerstone for implementation of RNTCP, so its evaluation is necessary. Methods: A Cross sectional study in 174 MPWs was conducted. Seven questions about MDR- TB were asked. Answers graded as no answer, incorrect answer and correct answer were allocated zero point, zero and two points respectively. Total score by the MPWs (out of 14), converted to percentage, was used to categorize the knowledge as no knowledge (0%), poor knowledge (> 0 and ≤ 25 %), fair (> 25 and ≤ 50 %), good (>50 and ≤ 75%) and > 75% as excellent knowledge. Comparison was done with the years of job, the training and DOTS provision status. The data was analyzed in SPSS Statistics version 21 and Microsoft Excel 2010 software. Results: Only 9.2% MPWs had received Modular training. 85.6% had provided DOTS and 86.8% had more than five years of job experience. 9.1% workers had no knowledge about MDR-TB. 16.6%, 53.4% and 20.6% workers had poor, fair and good knowledge respectively. Significant difference of knowledge by gender was found (p-value = 0.02). 15.8% and 52.5% of untrained workers had poor and fair knowledge, respectively. 88.8% of workers having good knowledge were the DOT Providers (p- value of 0.04). 66.7% workers having good knowledge had job experience of more than 20 years (p- value = 0.001). Conclusion: Knowledge about MDR- TB in MPWs has a significant relation with DOTS provision status and the years of service rendered. Absence of Modular trainings leads to poor knowledge of the worker.

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