Rickettsial infections are both one of the oldest and recently recognized reemerging zoonotic infections. Misdiagnosis and underreporting of rickettsial infections are significant public health problems leading to extensive investigations in patients with fever of unknown origin, thus contributing to economic burden on families. We review the situation of rickettsial outbreaks in India with the advent of the 20^th century. We did a PubMed and Google search for literature available for rickettsial outbreaks in India. Literature was searched for outbreaks that were reported before the year 2000 and after the year 2000. The data were compiled and tabulated for comparative and descriptive analysis of the clinicoepidemiological profile, diagnosis, and existence of rickettsial infections in India. Rickettsial infections are reemerging and are reported from almost all parts of India such as Himachal Pradesh, Rajasthan, Jammu and Kashmir, Uttaranchal, Maharashtra, Tamil Nadu, Karnataka, Kerala, Assam, Mizoram, and West Bengal. Nonspecific clinical presentation and nonavailability of sensitive and specific diagnostic test make it difficult to document the diagnosis of these infections in India. Recently, molecular biological methods such as polymerase chain reaction and loop-mediated isothermal amplification have been developed but available only at reference laboratories.

Diabetes is one among the various lifestyle disorders and was reported to be 7^th leading cause of death by the WHO in 2016. To manage blood glucose levels and combat associated medical conditions, polypharmacy is becoming the choice of treatment by diabetics. Due to the unawareness of diabetics regarding the polypharmacy, it was thought to gather the scientific published literature at a place which will guide both the physicians as well as patients to choose a right herb along with conventional medicine. The scientific online portals were reviewed, and data reporting synergistic or antagonistic effects were searched for their clinical as well as preclinical evidence. There are several herbs mentioned in classical texts, which have antidiabetic potential and other beneficial effects on one's body. These drugs do exhibit synergistic as well as antagonistic effects when used along with conventional medicines. One should opt for polypharmacy cautiously and judiciously under medical supervision only.

INTRODUCTION: In view of the difficulty being faced by the pregnant women and parents of sick newborn along with high expenditure on delivery and treatment of sick newborn, the Ministry of Health and Family Welfare has taken a major initiative to ensure better facilities for women and child health services through the Janani Shishu Suraksha Karyakram (JSSK) on June 1 2011. It is an initiative to provide completely free and cashless services to pregnant women. OBJECTIVES: The objective of this study was (1) to find out the awareness level about JSSK among pregnant women and lactating mothers and to determine the sources of awareness and knowledge about the components of JSSK and (2) to find out the association between demographic factors and benefits and satisfaction level about JSSK among the rural women of Kangra district. MATERIALS AND METHODS: A descriptive cross-sectional study was carried out among 106 pregnant women and lactating mothers selected by convenient sampling technique with the help of structured questionnaire from December 2016 to February 2017. The data were analyzed using SPSS version 22. RESULTS: It was observed that among 106 women, good awareness was found only in 84.9% of them, maximum awareness (56.6%) was created through anganwadi workers, 49.1% of the women heard about it before pregnancy, 44.3% heard about it during pregnancy, and 15.1% of the women had no knowledge about the program. The study showed that educational status (P = 0.001) was significant with receiving the benefits of JSSK. However, it revealed that both educational status (P = 0.001) and occupation (P = 0.03) of the women were significantly associated with the satisfaction with JSSK. CONCLUSION: The level of awareness regarding JSSK in pregnant women and lactating mothers was found to be good, but it was found that despite having good knowledge of the program, the women are not taking much concern about the ongoing program. The women need to be encouraged for more utilization of the services which are comprehensively built for them.

BACKGROUND: Diabetes is a major disease burden in India, and we are home to the second largest number of diabetes cases in the world with currently over 72 million cases of diabetes. The reported prevalence of obesity in type 2 diabetes mellitus (T2DM) was 60%–90%. Obesity and overweight pose a major risk for chronic diseases and are considered to be a strong risk factor for the development of T2DM. AIMS: The aim of the study was to determine the prevalence of obesity among T2DM patients. MATERIALS AND METHODS: This community-based cross-sectional study was conducted among T2DM patients residing in areas under Ashok Nagar and Rukmini Nagar Urban Health Centres, Belagavi. Three hundred and eighty T2DM patients were included in the study over a period of 1 year (January 1–December 31, 2017). Predesigned and pretested questionnaire was used to collect sociodemographic profile, and patient's height and weight were measured, and body mass index (BMI) was calculated and categorized based on Asian population. STATISTICAL ANALYSIS USED: Statistical analysis was done using the Chi-square test for categorical variables. P < 0.05 was considered statistically significant. RESULTS: The prevalence of generalized obesity (GO), abdominal obesity (AO), and combined obesity (CO) among T2DM patients were 58.68%, 81.84%, and 53.42%, respectively. Multiple logistic regression analysis showed that female gender and hypertension were significantly associated with GO, AO, and CO. Physical inactivity and hyperglycemic state were significantly associated with AO and CO but not with GO. The duration of T2DM was significantly associated with AO but not with GO and CO. CONCLUSIONS: Our study concluded that obesity is a highly prevalent comorbidity in diabetic patients. AO appears to be a better indicator of diabetic risk than BMI. The combination of a low-calorie diet, increased physical activity, and behavioral therapy as the first-line intervention for weight loss should be stressed for the effective management of T2DM.

BACKGROUND: Ovarian malignancy is the second most common cancer of the female reproductive system and the leading cause of death from gynecologic malignancy. Study on the distribution of the different ovarian neoplasms is limited from Eastern India, especially in rural areas. AIMS AND OBJECTIVES: The aim was to study the distribution of morphological pattern of benign, malignant, and nonneoplastic lesions of the ovary in different age groups and to determine the likelihood of bilateral involvement in different morphologic subtypes. MATERIALS AND METHODS: A retrospective study from January 2009 to December 2018 was undertaken. A total of 2100 surgical specimens were obtained. Detailed clinical information and radiological findings were recorded from the case sheets. Grossing of the surgical specimens was done in the pathology department, followed by histological examination. RESULTS: Of 2100 cases, benign cases were 1491 (71%), malignant cases were 252 (12%), and nonneoplastic were 357 (17%). The distribution of malignant cases was 10–19 years (18 cases, 7.14%), 20–29 years (50 cases, 19.84%), 30–39 years (23 cases, 9.13%), 40–49 years (61 cases, 24.20%), 50–59 years (70 cases, 27.78%), and 60–69 years (30 cases, 11.91%). Among the benign cases, serous cystadenoma was 684 cases (32.57%), followed by mucinous cystadenoma cases (330, 15.71%) and mature cystic teratoma cases (270, 12.86%). Among the malignant cases, bilateral serous cystadenocarcinomas were found in 42.85% of the cases, and among benign cases, bilateral endometrioid tumors were found in 27.58% of the cases, and among nonneoplastic diseases, bilateral follicular cysts were found in 35.21% of the cases. CONCLUSION: In this study, an earlier presentation of malignant tumors was observed. Furthermore, a lower percentage of serous cystadenocarcinoma was noted compared to other studies.

AIM OF THE STUDY: The present study was undertaken to compare the effectiveness for two mouthrinses Stevia and chlorhexidine (CHX) on plaque and gingival scores among 12–15-year-old government school children in Belagavi city. MATERIALS AND METHODS: This was a triple-blind randomized controlled field trial which was crossover in design. The study included 70 children aged 12–15 years from two randomly selected government schools in Belagavi city. The study was divided into two phases: each phase lasted for 7 days separated by a washout period of 21 days in between them. Each group was subjected to both the interventions in a phased manner. The study participants were instructed to use 10 ml of the assigned mouthwash twice daily for 30 s for 7 days. At the baseline, examination parameters such as plaque and gingival scores were recorded. Reevaluation of both the parameters was done after 7 days at both the phases of the study. Data obtained was compiled, tabulated, and subjected to statistical analysis using the Wilcoxon signed-rank test. RESULTS: Statistically significant reductions (P<0.001) in plaque and gingival scores were found for both the mouthrinse group at both the phases of the study from the baseline to the 8^th day (immediately after discontinuing the mouthwash). CONCLUSION: Among the two mouthwashes, CHX had superior effectiveness in reducing plaque scores and gingival scores. Stevia mouthwash exhibited almost similar anti-plaque and antigingivitis effect and can be used as an adjunct to the regular oral hygiene practices and can also be potentially included in various oral hygiene products.

BACKGROUND: Perimenopause symptoms need attention of health.care providers and public health personnel to enable the appropriate healthcare, including improving psychological makeup and for planning for further studies. Hence, the study was undertaken with an objective to study the menopause along with factors affecting the quality of life. MATERIALS AND METHODS: A cross.sectional study has been carried out to investigate the factors affecting/related with perimenopausal symptoms, during February to July 2016, using proportional to population size inverse cluster sampling. The present study was conducted covering 712 women of age 40-55 years, comprised of 550 menopause, 40 surgical induced menopause and 122 yet to achieve menopause. RESULTS: The odds ratio (OR) of menopaused women in other than �gHindus�h and �gMuslims�h were found higher than the reference group (Hindus). OR of menopause groups was statistically significant with �gMild�h heart discomfort, �gMild�h sexual desire, dryness of vagina, hot flushes, physical and mental exhaustion, depressive mood, anxiety, sleep problem, and irritability as compared with their respective reference groups (absence of symptoms). Similar results were exhibited by �gMild�h physical and mental exhaustion (OR = 2.22; P < 0.05), �gModerate�h depressive mood women (OR = 2.30; P < 0.05), �gSevere�h anxiety (OR = 1.84; P < 0.05), �gMild�h sleep problem (OR = 2.31; P < 0.05), and �gMild�h irritability (OR = 1.86; P < 0.05). CONCLUSION: Psycho.physiological changes were seen by heart discomfort, sexual desire problem, irritability, depressive mood, anxiety, hot flushes, sleep problems, physical and mental exhaustion, and dryness of vagina exhibited significantly higher in perimenopause women. Hence, well.planned and calibrated health education and necessary symptomatic treatment must always be arranged for the welfare in the perimenopause period.

Introduction: Ayurveda recommends standardization of different useful parts of herbal drug, either organized or unorganized, starting from its collection. The latex of snuhi is said to be collected at the end of Shishira ritu. This article highlights the result of scientific study on effect of season on collection of latex of Euphorbia caducifolia Haines. (EC), one of the botanicl source of Snuhi. Materials and Methods: The fresh crude latex of EC was collected in clean glass vials in all the six ritu, i.e. Hemanta-S1 (November–December), Shishira-S2 (January–February), Vasanta-S3 (March–April), Grishma-S4 (May–June), Varsha-S5 (July–August), and Sharada-S6 (September–October). The collection was done for 4 days in each ritu and 3 times in a day, i.e. before sunrise, 3 h after sunrise, and 6 h after sunrise (6AS), by incision of branch, incision of main stem, and Plucking of branch. The observations regarding volume, girth of plant parts, pH, viscosity, and specific gravity along with preliminary phytochemical analysis of latex were carried out in samples of crude latex collected in six seasons. The seasonal similarity and diversity was assessed by applying principal component analysis using Unscrambler software 9.7 version. Results and Conclusion: Rakta Snuhi latex collected during Hemanta ritu (November–December) was well differentiated from other ritu, with regard to volume and girth. Highest volume of latex was collected by plucking of branch. Data shows that the latex is having highest pH (5.29) in Varsha ritu (July–August), specific gravity (1.034) in Vasanta ritu (March–April), and the relative viscosity (2.444) in Shishira ritu (January–February)

Plastic bronchitis (PB) is an extremely rare clinical entity where inspissated cast is found in endobronchial airway leading to respiratory distress. It is a large gelatinous or rigid branching airway cast. Removal of this endobronchial cast rapidly improves this condition. The underlying causes for this PB are pulmonary diseases, congenital heart disease, and few other conditions. The treatment of this condition includes rigid bronchoscopy and removal of this cast. Here, we present a case of PB in a previously healthy 6-year-old boy presenting with respiratory distress. This child was managed by rigid bronchoscopy and this cast was removed from the right bronchus.

The anatomical and physiological differences in children make the administration of anesthesia difficult compared to the adults which is made more challenging when the child presents with a congenital anomaly. In this case, we report the anesthetic challenges presented by an 8-month-old baby born of full gestation with a lumbar swelling and hydrocephalus posted for ventriculoperitoneal shunt insertion. Magnetic resonance imaging scan revealed the presence of a large meningomyelocele with tethered sac and Arnold–Chiari malformation (Type 2). Anesthetic management included a thorough preoperative assessment of associated comorbidity, proper positioning, management of a difficult airway, prevention of any rise in intracranial pressure, and prevention of hypothermia. The perioperative period was uneventful, and the child recovered well.

Symmetrical drug-related intertriginous and flexural exanthema or drug-related Baboon syndrome is an adverse drug reaction reported to be caused by various drugs. In this report, we describe a case induced by hydroxyzine in a 65-year-old man. Review of literature identified only one case of hydroxyzine-induced Baboon syndrome.