The occurrence of stony material in the anal fistulous tract is a very rare clinical presentation; till today there are only three evident citation in pubmed indexed journals. Anal fistula (bhagandhara) is a chronic inflammatory tubular structure connecting the anorectal canal with peri-anal skin. A 66-year-old male patient presented with complaints of persistent pain in the perianal region and soiling of the undergarments with stool and constipation since 2 years. The case was diagnosed as posterior low anal fistula by per rectal digital, proctoscopic, and by fistulogram. It can be correlated to agantuja/unmargi bhagandhara. In the present case, "stasis" and "infection" might the reasons for the formation of stony hard material. Patient was successfully treated by the excision of whole tract with the unusual stone under local anesthesia. The presence of stony hard material in the fistulous tract is a very rare presentation and was successfully managed.

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Aim and Objective: The main objective of this research was to formulate medicated polyherbal toothpaste with better antimicrobial activity from natural sources for dental infections. Materials and Method: The hydroalcoholic extracts of apple peel, lemon peel, orange peel, banana peel was carried out and the formulated toothpaste from the above extracts were subjected for antimicrobial activity study against Gram-positive bacteria (Staphylococcus aureus, Enterococcus faecalis, Streptococcus mutans) and Gram-negative bacteria (Porphyromonas gingivalis). Results: Antibacterial activity of the toothpaste was determined by the 2-fold serial dilution method. All the extract has showed good antimicrobial against P. gingivalis, with apple extract showing the best result (7.8 mg/ml). Conclusion: Thus, our study shows the potent antibacterial activity of the formulated polyherbal toothpaste compared with the marketed formulation against dental caries.

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Introduction: The prevalence of diabetes is increasing worldwide resulting in foot complications, which leads to poor quality of life and increased cost of living. Aim: The main aim of this study was to find out the foot complications in diabetic patients and to analyze the underlying etiology. Methodology: A retrospective study was carried out in the podiatry Department of Amrita Institute of Medical Sciences, Kerala among 277 diabetic patients with recent and recurrent foot complications. Results: Systemic hypertension (76.89%) has been found to be one of the major risk factor coexisting in the study population. 49.45% patients had preexisting peripheral neuropathy and non-healing ulcers were seen in 41.51%. Other complications include charcot arthropathy (10.46%), gangrene (9.38%), cellulitis (7.94%), fungal infections (6.89%), callus (3.61%), osteomyelitis (3.97%), and necrotizing fasciitis (2.52%). Culture report on foot ulcer patients revealed that Gram-positive Staphylococcus species (18.8%) and the Gram-negative Pseudomonas species (18.2%) were the predominant organisms. Other organisms isolated were Klebsiella species, Escherichia coli, Acenetobacter, Proteus, Enterococcus species, and streptococci. Fluoroquinolones were the most commonly prescribed antibiotics (33.5%), followed by penicillin (8.3%), clindamycin (6.1%), carbapenems (5.05%), cephalosporins (2.8%), cotrimoxazole (2.5%), and chloramphenicol (0.7%). Conclusion: The study highlights the importance of foot care, relevance of early detection of diabetes and subsequent monitoring of diabetic complications.

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Background: Proper knowledge about risk factors and prevention of congenital malformations in pregnant women can lead to primary prevention of disease. The aim of this study was to explore pregnant women's knowledge about congenital anomalies, risk factors, and prevention in relation to their sociodemographic profile. Materials and Methods: A cross-sectional study of the expecting mother's population was conducted over 3 months. Data collection was done through a questionnaire completed in face to face interviews using simple nonrandom sampling method in 150 pregnant women who visited the prenatal clinics in Rasht. The questionnaire contained 6 questions about specific knowledge and 12 questions for risk factors and prevention of congenital anomalies. Statistical analysis was performed using descriptive statistics, Pearson correlation, as well as multivariate regression analysis was performed using SPSS 21 software. Results: The overall knowledge of pregnant women about congenital anomalies showed a significant relationship with age (P = 0.001) and the level of education (P = 0.000). However, there was not a significant relationship between overall knowledge and parity (P = 0.183) and the number of antenatal visits (P = 0.097). The participant who had High School and University education had the highest score in overall knowledge about the disorder. The age group 41-50 years had the lowest overall knowledge about the disorder. Conclusions: There is a need for public programs to increase awareness about congenital anomalies in pregnant women and people. Use of genetic counseling for families at risk for congenital anomalies is proposed.

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The rarest of its kind, the electrical injuries of the commissure areas of the mouth pose a potential threat in terms of management to the practitioner. The most commonly affected young toddlers, in their teething period, chew onto the female end of the live extension wire cord. Saliva which acts a medium transports the electrical current to the fragile mucosa of the oral cavity thereby leading to the treacherous burn injuries. Since children have an overall lower fat component and different surface area to volume ratio, which impacts on the risk of deep tissue damage compared to adults with equivalent injury. The review outlines: (1) A detailed review of literature reflecting the various treatment modalities proposed by different practitioners worldwide and (2) the prosthetic therapy for the conservative management of the electrical injuries of the oral cavity.

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Introduction: Girl child continues to be insecure and vulnerable in South-East Asia particularly in India despite various legal measures. Only law cannot be a solution, identifying the social factors and working on their improvements are also essential. Aims and Objectives: (1) To assess the present child sex ratio (0-6 child sex ratio [CSR]) in defined study population. (2) To assess the attitude of the women of the reproductive age group toward the girl child and relate it to the status of sex ratio. Methodology: A cross-sectional descriptive study was conducted in a sub locality of 283 households out of which 147 households having children in age group of 0-6 years were selected and mothers of children were interviewed with a prestructured pretested questionnaire containing a rating scale of 40 items in vernacular language to determine the attitude of the mother toward girl child. Results: Total no. of children in the age group of 0-6 years were found to be 241, with CSR of 709 but had a sharp contrast in children <2 years with CSR nearing 1000 as compared to elder children with much lower Figures 50.4%, 10.9%, and 38.7% of the respondent mothers had a positive, mixed, and negative attitude toward girl child respectively. Discussion: The negative attitude especially among mothers should be well addressed. Awareness among them needs to be raised along with appropriate changes in society to bring the reputation of females at par with male counterparts.

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Objective: The present study was designed to investigate the protective and potential effect of gallic acid against doxorubicin (DOX) induced cardiotoxicity. Materials and Methods: Adult Wistar albino rats of either sex weighing 150-200 g were used in this study. DOX administered intraperitoneally in six equal injections (each containing 2.5 mg/kg at 48 h intervals) to total cumulative doses of 15 mg/kg over a period of 2 weeks to induce cardiotoxicity. The estimation of cardiac and lipid biomarkers of both control and treated animals were observed. In vivo antioxidant parameters such as glutathione, superoxide dismutase, catalase, and malondialdehyde were also monitored. The remaining portion of the heart tissue used for histopathological studies. Results: The treatment with doxorubicin increased the levels (P > 0.01) of serum cardiac and lipid biomarker which were brought down by gallic acid treatment. It also exhibited electrocardiographic changes such as reduced R wave and ST segment elevation. Histopathological study revealed that gallic acid restored the myocardial cells towards normal. The restoration of the endogenous antioxidant system clearly depicts that gallic acid have produced its protective effect by scavenging the reactive oxygen species. Conclusion: The results of this study indicated that the cardioprotective effect of gallic acid might be attributed to its antioxidant property.

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Introduction: Prevalence of uterovaginal prolapse is increasing with increase in life expectancy of women. The reported prevalence of uterovaginal prolapse is different in different countries. Various studies have been reported on the prevalence, determinants, clinical manifestations and treatment modalities of uterovaginal prolapse. Objectives: Determine the prevalence of uterovaginal prolapse, identify determinants of uterovaginal prolapse, its clinical manifestations and describe different treatment options. Study Design: Retrospective study done on uterovaginal prolapse at Indira Gandhi Medical College and Research Institute in Puducherry in India from January 1, 2014 to December 31, 2014. Results: The mean age of the patients in our study was 57.5. 87.3%belonged to the Hindu religion. 77% of women with prolapse were post-menopausal. 86.2% of women were multiparous. The predominant presenting complaint was history of mass protruding out of vagina. Non-surgical treatment was offered for 33.7%. Vaginal hysterectomy with pelvic floor repair was the predominant surgical treatment offered. Conclusion: Prolonged labor and vaginal delivery involving sphincter and vaginal tear are the main determinants of uterovaginal prolapse. Modifiable risk factors warrant health programs to develop interventions targeting the prevention of uterovaginal prolapse.

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Background: Hypertension is an overwhelming disorder worldwide with high morbidity and mortality rates; this may be due to poor adherence. Poor adherence leads to a bad outcome of the disease and increases the more loss of expenditure on resources. Adherence is a methodology of coincidence between the medication advices and patient's medication management behavior; it includes dosing frequency and time of intake. This study mainly focuses on the prevalence of adherence and its factors affecting on hypertensive patients follow-up at Jimma University Specialized Hospital (JUSH). Methods: It is a hospital-based cross-sectional survey designed with a sample size of 150 subjects. This study is conducted at chronic ambulatory care unit in JUSH from January 24 to February 7, 2014. The collected data were executed for 95% confidence interval between the various demographic levels to identify the significance of the results. Results: The sociodemographic survey of this study showed from the total of 150 respondents, majority of the characteristics were in the categories of sex, female subjects have higher percentage of 56.7% non-adherence significantly, when compared with male subjects, the same significance was observed in age group of 50 years and illiterates of educational level in 63.3% and 50%, respectively. The significant differences were not observed in the characteristics of occupation, area of residence, income, and marital status of the participants. Various factors was analyzed to determine the different reasons behind the non-adherence of hypertensive medication, most of them (120 subjects) reported side effects of hypertensive medications and forgetfulness is one of the major factors, that misses their medication, followed by financial and religious believes. Conclusion and Recommendations: The non-adherence to hypertensive medication was high at JUSH. Hence, the pharmacists and other health care professionals should work in collaboration for escalating the patient's quality of life. They need to stress the importance of antihypertensive adherence to the patient's life and the benefits of their medication.

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Wilson's disease is a rare genetic disorder of copper metabolism. The basic genetic defect is a combination of reduced synthesis of ceruloplasmin and defective excretion of copper in the bile. Abnormal and toxic amount of copper are deposited in various tissues. Clinical manifestations in Wilson ^' s diseases are protean and varied. We report a 13-year-old male child with knock-knee deformity, which progressed over 8 years without any other manifestations. High index of suspicion, meticulous examination, and relevant investigations confirmed Wilson's disease.

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The current review integrates findings of published data which provides a comprehensive summary of the neuropsychological assessments conducted and have assessed the patients with type 2 diabetes mellitus (T2DM) for cognitive function. There is a convincing evidence of increased prevalence of T2DM in inactive individuals and cognitive deficits due to poorer control and inappropriate management of the T2DM. Exercise therapy has beneficial effects on improving glycemic control, cardiovascular risk profile, body composition, cardiorespiratory fitness, physical functioning, cognitive functions, and the well-being of patients with T2DM.

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Background: Majority of men over age 50 are sexually active and sex is an important part of overall quality of life. Both benign prostatic hyperplasia (BPH) with lower urinary tract symptoms-BPH (BPH-LUTS) and erectile dysfunction (ED) are often found in this age group simultaneously. Pathophysiological mechanisms for both these diseases are almost common. All males presenting with LUTS should be assessed for sexual dysfunction and viceversa. The aim of this study is to evaluate the effects of once-daily tadalafil on erectile function in men with ED and benign prostatic hypertrophy with LUTS. One drug for treatment of both diseases and better patient's compliance are important issues for proper management. Materials and Methods: We did a study of 60 men. All patients were divided in two groups: 30 in group A who were given tadalafil 5 mg (megalis-5 mg of Macleods Pharmaceutical Company) and 30 patients in group B who were on placebo (plain sugar pills) for 12-week. This was a randomized, placebo-controlled study of once-daily tadalafil, which was carried out in men with BPH-LUTS in a rural Medical College of Northern India during June 2009 to November 2011. Results: International index of erectile function-erectile function (IIEF-EF) domain score improvements from baseline with 5 mg once-daily tadalafil were significantly greater throughout the study for tadalafil groups versus placebo (all P ≤ 0.001). International Prostate Symptom Score (IPSS) improvements from baseline to end point were significantly greater with 5 mg tadalafil dose versus placebo (all P < 0.05). Conclusion: There are encouraging results with tadalafil. It was used in 30 patients who were suffering with both ailments of BPH and LUTS simultaneously and is effective in both diseases.

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Acute promyelocytic leukemia (APL) has defined biology and clinical course that is, distinct from the other forms of acute myelogenous leukemia. It may present with potentially devastating coagulopathy and the sensitivity to retinoid differentiating agents, including all-trans retinoic acid and arsenic trioxide, hence a fast and definite diagnosis is imperative. Reciprocal 15, 17 translocation creates a PML/RARA fusion gene on the derivative chromosome 15, which can be detected by various molecular tests such as cytogenetics, fluroscence in-situ hybridization (FISH), reverse transcriptase-polymerase chain reaction. We present here a diagnostically challenging case, both morphologically and immunophenotypically proven to be APL, which was negative for the PML/RARA by FISH.

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This is a case of an 18-year-old female Nigerian student who presented to the emergency department with symptoms of depression that was subsequently diagnosed with anorexia nervosa (AN). The clinical features, diagnosis, and complications of AN were also discussed. This case report supports the suggestions that anorexia previously unreported in Nigeria and other sub-Saharan countries may be underreported. Therefore, general practitioners and family physicians should be aware of the emergence of this illness in Nigeria in order to identify and treat adolescents with this illness.

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Galactorrhea is one of the rarest complications of selective serotonin reuptake inhibitors (SSRIs). We report a case of 35-year-old married woman who underwent treatment for somatoform disorder in psychiatry outpatient department. After receiving 7 weeks treatment of paroxetine, one of the SSRIs, she had whitish discharge from both of the nipples, which spontaneously disappeared within 1-week after withdrawal of drug. She had no concomitant pregnancy. No evidence of any raised intracranial pressure, extrapyramidal symptoms, visual disturbance were present and she had no history of local surgery or any infection. Thyroid and other hormonal assay like prolactin, follicle-stimulating hormone and dehydroepiandrosterone sulfate were within normal limits. The magnetic resonance imaging scan (T1-, T2-weighted and fluid attenuated inversion recovery sequences) did not show any abnormality. Hence, we conclude that galactorrhea was caused by SSRI-paroxetine and we must be aware about this side-effect.

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