Cannabis has been used by humanity since a long time ago and the common belief by general population is that it is an innocuous drug. The prevalence of its use has been increased in many countries. It has been observed that the use of cannabis has been associated with various psychopathologies since its origin. The study of cannabis use and its consequences remains an interesting area both from the academic and clinical point of view. The various psychopathological syndromes associated with cannabis use that have been researched extensively include cannabis and psychotic disorders, especially, schizophrenia and mood disorders and not uncommon anxiety disorders and cognitive impairment. The association between cannabis and schizophrenia has received much attention. Various epidemiological, clinical, and experimental evidence show an association between the effects of cannabis on the brain and psychopathological disorders including schizophrenia. However, the association is often not clear. Cannabis use might be casually related to the later development of schizophrenia in an indirect way in a few heavy users, but commonly, its use may increase the risk in a person with a preexisting vulnerable to developing psychosis and may worsen the course of the disorder.

Background: India has the highest burden of tuberculosis (TB) despite it being one of the oldest diseases. Defaulting from antitubercular therapy is one of the challenges in the control of TB. Objectives: To study the sociodemographic profile and outcome of TB patients registered under Directly Observed Treatment Short course (DOTS) in East Sikkim from 2009 to 2011, with reference to defaulters. Methods: In this cross-sectional study, primary data were obtained by interviewing defaulters (only 32 out of total 46 defaulters). Secondary data for all defaulters were obtained from district TB registers. Data were entered into excel sheet and analyzed (Limitation of the study: All 46 defaulters could not be interviewed). Results: The defaulters were more commonly from category II of DOTS with an equal male:female ratio with most common age group of defaulters being 20–39 years. The most common timing of default was the early intensive phase and the early continuation phase. The reasons for default were usually multiple in most with consumption of alcohol, relief of symptoms, and migration being the most common. Out of the 46 defaulters, 10 patients were retrieved back, 5 patients were started on non-DOTs therapy, 7 patients expired, 8 patients migrated out, 10 patients were lost to follow-up, and rest 6 patients could not be traced. Conclusions: Causes of default are usually multiple, and most cases are preventable/rectifiable. Some flexibility with respect to drug administration and strengthening in DOTS program by reviewing it at regular intervals will go a long way in further.

Context: The prevalence of autonomic neuropathy in alcoholic liver disease and its correlation with severity of liver disease is not known in Manipur population. Aims: The aim of this study was to study the prevalence of autonomic dysfunction in patients with chronic alcoholic liver disease and to determine the degree of severity of alcoholic liver disease by Child–Turcotte-Pugh scoring and its correlation with autonomic profile. Settings and Design: A cross-sectional study involving eighty adult patients with chronic alcoholic liver attending Medicine out patient's Department in a tertiary care teaching hospital in Imphal, from October 2011 to September 2013. Subjects and Methods: Autonomic profile included a preformed questionnaire and five autonomic function tests (3 parasympathetic and 2 sympathetic). Parasympathetic tests (heart rate variation to [1] deep and slow breathing, [2] Valsalva maneuver, and [3] standing) and sympathetic tests (blood pressure response to [1] postural change and [2] sustained isometric hand grip) were performed. Autonomic neuropathy detected was graded as normal, early, definite, severe, and atypical. Results: Autonomic dysfunction was observed in 58 (72.5%) patients (early 30 [37.5%], definite 10 [12.5%], severe 18 [22.5%], normal 22 [27.5%]). Heart rate response to standing (30:15 ratio) was the most altered parasympathetic test in 39 (67.2%). The parameters that correlated with the severity of autonomic dysfunction were Child–Pugh scoring (P = 0.000), platelet count (P = 0.000, cirrhosis (P = 0.001), varices (P = 0.02), and portal hypertension (P = 0.000). Conclusions: Screening of alcoholic liver disease patients with autonomic function tests directly correlated with the severity of alcoholic liver disease. Autonomic tests should be a part of patient work in alcoholic liver disease so that early intervention can be performed.

Context: Smoking is an abhorrent habit mostly performed by some people in developing countries like Indonesia. Cigarette smoke is believed to cause respiratory disorders and diseases as well as problems of reproduction and infertility, especially for men. Previous research has studied about proprotein convertase subtilisin/kexin type 4 (PCSK4) that plays a role in the reproduction system. Aims: The present study is aimed at investigating the correlation between cigarette and disorder in PCSK4 molecule in the human sperm during fertilization process. Settings and Design: The study was conducted in Indonesia, one of developing countries where the number of smokers keeps increasing. The prospective study employs cross-sectional approach to compare the PCSK4 level in the spermatozoa of male smokers and nonsmokers. Materials and Methods: Spermatozoa ejaculation from ten individuals from both groups at productive age is collected. The enzyme-linked immunosorbent assay (ELISA) is carried out to compare the PCSK4 activity in both sample data. Statistical Analysis Used: The Shapiro–Wilk Method is employed to analyze the data distribution. Moreover, t-test is also used to investigate equality of means. Results: The finding indicates that based on ELISA, the PCSK4 level of male smokers is lower than that of nonsmokers. Conclusions: It is concluded that smoking can decrease the PCSK4 activities in sperm which eventually influence the fertilization process.

Background: Accurate diagnosis of the cause is crucial in the management of obstructive jaundice. Multidetector computed tomography (MDCT) and magnetic resonance cholangiopancreatography (MRCP) play the pivotal roles in the diagnosis. Objective: The objective of this study is to evaluate the diagnostic accuracy of MDCT in determining the level and cause of biliary obstruction in patients with obstructive jaundice and correlates MDCT findings with that of MRCP. Materials and Methods: This cross-sectional study was conducted in the Department of Radiodiagnosis of a tertiary hospital in Manipur after obtaining the Institutional Ethical Committee approval. Fifty-seven patients with obstructive jaundice, age ranging 20–80 years, were subjected to MDCT and MRCP. Final definite diagnosis was made from operative or histopathological findings. Data and findings of MDCT and MRCP were correlated and statistically analyzed. Results: Maximum numbers of cases were seen to occur in the fourth to sixth decades. The female-to-male ratio was 1.4:1. Both MDCT and MRCP could correctly determine the level of obstruction in all the cases. The most common level of obstruction was at the suprapancreatic level. The most common cause of obstruction was choledocholithiasis (45.61%). Benign causes constituted 68% and malignant causes constituted 32%. MDCT could correctly determine the cause in 85.96% of cases, compared to 75.44% by MRCP. Kappa statistics showed fair agreement between MDCT and MRCP in diagnosing the cause of biliary obstruction. MDCT showed comparable sensitivity, specificity, and positive and negative predictive value, in diagnosing the causes of obstruction. Conclusion: Overall performance of the MDCT was comparable or better than that of MRCP.

Background: Overweight and obesity are the resultant of excess consumption and less utilization of calorie resulting in storage of fat in the body. Obesity may have an adverse effect on health, leading to increased health problems and/or reduced life expectancy. It is the precursor of large number of fatal noncommunicable diseases such as diabetes, coronary heart disease, cancers, and osteoarthritis in later stages of life. Materials and Methods: The objectives were to estimate the prevalence and determinants of overweight and obesity among schoolchildren aged 10–12 years. The study was conducted in the year 2012–2013. It was a cross-sectional study among 300 school-going children of 10–12 years. A stratified multistage random sampling method was used to select students for the study, and a pretested predesigned questionnaire was used to collect data from the students. Results: The prevalence of overweight and obesity was 6.3% and 3.3%, respectively. The prevalence of overweight and obesity among boys was 5.6% and 3.4%, respectively, and among girls, the prevalence was 7.4% and 3.3%, respectively. The outdoor activities, cycling, activities after school hours and mode of transportation to school, hours of television viewing, or computer use, all are significantly associated with body mass index status of schoolchildren. Conclusion and Recommendations: The present study shows that overweight and obesity among schoolchildren aged 10–12 years are an emerging health problems in this part of Odisha. The overnutrition problem (overweight/obesity) was reported higher among female students than male students. Health education to students regarding the ill effects of overweight and obesity is the most important step in the prevention of overnutrition. A well-designed, well-implemented school program can effectively promote physical activity and healthy eating behavior among children.

Background: Some of the common problems observed during cesarean section under regional anesthesia are nausea, retching, and vomiting. In this study, the effects of subhypnotic dose of propofol (1.0 mg/kg/h) alone and a combination of propofol with dexamethasone (8 mg) were compared for prevention of nausea and vomiting during cesarean delivery under spinal anesthesia. Materials and Methods: A randomized, double-blind study was carried out on 100 parturients by allocating them into two groups using computer-generated randomization method. Group I (n = 50) received intravenous (IV) saline and Group II (n = 50) received (IV) dexamethasone 8 mg respectively, followed by continuous infusion of propofol (1.0 mg/kg/h). Intraoperative emetic episodes were observed, and safety assessments were performed by an investigator, and propofol infusion was stopped at the end of surgery. Chi-square test and independent Student's t-test were used for statistical analysis wherever appropriate and P < 0.05 was considered significant. Results: The maternal demographics and operative management were comparable in the two groups. The incidence of nausea, retching, and vomiting in the intraoperative, postdelivery period were: Group I: Versus Group II: Nausea 26% (13/50) versus 8% (4/50) P = 0.014; retching 24% (12/50) versus 4% (2/50) P = 0.004; vomiting 20% (10/50) versus 4% (2/50) P = 0.014, respectively. No clinically significant adverse events were observed in both groups. Conclusion: The sub hypnotic-dose propofol 1 mg/kg/h combined with dexamethasone 8 mg was more effective than propofol alone for reducing the incidence of intraoperative emetic symptoms in parturient undergoing cesarean delivery under spinal anesthesia.

Background of Study: Besides reproductive and sexual function, testosterone is reported to regulate metabolism, cardiovascular health, body composition, and enhancement cognitive function. Objective: The aim is to determine the impact of type 2 diabetes mellitus (T2DM) on serum testosterone, in a relationship with insulin resistance in men. Materials and Methods: This was a case-control study comprised 63 male type 2 diabetics (T2Ds) and sixty anthropometrically matched nondiabetic controls that fulfilled the inclusion criteria. Type 2 diabetes was diagnosed based on history and the WHO criteria. Results: There was a significantly lowered testosterone (P = 1 × 10-13) in the diabetics compared to the matched controls. A significantly elevated (P < 0.0005) fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), and (P = 0.015) homeostatic model assessment of insulin resistance (HOMA IR) was observed in the diabetics compared with the matched controls. A significantly elevated (P = 0.001) testosterone and lowered (P = 0.009) HOMA-IR was observed in diabetics with good glycemic control compared to poor glycemic control. There was a significant (P < 0.05) inverse correlation (r = –0.421) between testosterone and connecting peptide (C peptide), testosterone and HOMA IR (r = –0.396), testosterone and HbA1c (r = –0.402), testosterone and FPG (r = –0.270) in male T2Ds. Conclusions: In this study, the low testosterone observed is a consequence of T2DM. Testosterone production seems to be impaired by elevated insulin that accompanies insulin resistance. Normalization of testosterone in controlled diabetes points at diabetic control instead of testosterone replacement therapy in the management of hypogonadism in male T2Ds.

Background: Diabetes mellitus (DM) is an endocrinal disorder characterized by chronic hyperglycemia. Managing DM without side effects is a challenge till date that attracts researchers toward plant-based new products. In some studies, seeds of Syzygium cumini were found to have anti-diabetic and anti-hyperlipidemic properties, attributed to saponins, glycosides, and flavonoids. Hence, it should be further explored for its benefits. Aims and Objectives: To study the effect of jamun seed powder on glycemic control in type 2 DM. Materials and Methods: Patients with type 2 DM and uncontrolled blood sugar (n = 99) were randomly divided into two groups - Group A (n = 50) was supplemented with 10 g/day jamun seed powder and Group B (n = 49) was given placebo powder. Oral hypoglycemic agents (OHAs) were continued as before. Patients and investigators were blinded about the treatment allocated. Fasting plasma glucose (F.P.G.) and post-prandial plasma (P.P.) glucose were noted at baseline and 30^th, 60^th, and 90^th day and HbA1c on 0 and 90^th day. Observations and Results: In Group A, F.P.G. decreased by 9%, 18%, and 30% and P.P. glucose by 8%, 15%, and 22% after 30, 60, and 90 days, respectively. In Group B, F.P.G. increased by 3% and P.P. glucose by 2% after 90 days. HbA1c in Group A reduced from 8.99 ± 1.39% to 8.31 ± 1.40% on 90^th day (P < 0.05), while a nonsignificant rise from 8.70 ± 1.17% to 9.03 ± 1.31% was noted in Group B. Conclusion: Supplementation with jamun seed powder improves glycemic control significantly in type 2 DM with poorly controlled glycemic levels on diet and OHA. However, before recommendation, multicentric trial with larger sample size, dose, and duration should be planned.

Background: Pterygium is a fleshy, triangular, or wing-shaped growth of the conjunctiva that encroaches onto the cornea. It is an active, invasive, inflammatory process associated with cellular proliferation, connective tissue remodeling, and angiogenesis. Materials and Methods: It is a prospective 2-year study. One hundred eyes with pterygium presenting in ophthalmology department in a tertiary care hospital in Western Maharashtra, India, were selected. Clinical and histopathological characteristics of pterygia were noted. Statistical analysis of the obtained results was carried out by a statistical program package (SPSS, version 15 and Epi Info, version 7). Results: Out of 100 pterygia, 93% were nasally located, 17% were seen in bilateral eyes, 91% of the pterygia were ≤4 mm in size, and 75% were progressive in nature. Stocker's line was seen in 25% of cases whereas Fuchs spots were seen in only 4% of cases. Thirty-four percent of pterygia were having Grade 1 inflammation whereas 18% were having Grade 0 and Grade IV inflammation each. Similarly 36% pterygia were showing grade II vascularization and 35% were showing grade III fibrinoid necrosis. A total number of pterygia that recurred in our study (n = 3) were showing high grades of inflammation, vascularization, and fibrinoid change (Grade IV each). Conclusion: All the pterygia were surgically removed with conjunctival autograft technique, and the pterygia which recurred in our study (n = 3) were all nasally located, progressive in nature, and > 4 mm in size with positive Fuchs spots and negative Stocker's line. All were showing high-grade (Grade IV) inflammation, vascularization, and fibrinoid change.

Background: Development of parathyroid gland starts at 5 week of intra-uterine life but it is visible histologically only after 14 weeks. Objectives: To study the histological changes of the developing parathyroid gland in human fetus at different periods of gestations. Methods: Parathyroid from 50 fresh human fetuses belonging to both sex and gestational age ranging from 14-40 weeks were studied using Hematoxylin- Eosin, and Masson Trichrome stains. Results: Early developing parathyroid gland is visible between trachea and oesophagus as small collection of cells invaded by blood vessels and surrounded by loosely arranged connective tissue at 14th week. It is found between trachea and thyroid gland at 16th week with uniformly arranged round cells having vesicular nuclei and pale cytoplasm. A solid nodule with groups and cords of chief cells is visible at 18th week. Blood filled sinusoidal capillaries appear at 24th week. A definite capsule is well visualized at 26th week. A supernumerary parathyroid is also present. Parathyroid can be differentiated from the surrounding adipose tissue, thymus and thyroid follicles at 32nd, 36th and 40th weeks respectively. Conclusion: Due to diffuse and variable growth, parathyroid gland is not visible on naked eye examination. Histologically it is first observed at 14th week of gestation as small collection of fibroblastic cells which finally form well-defined encapsulated and vascular parathyroid gland. It maybe present near thyroid as its organisation occurs side by side with folliculogenesis of thyroid gland. It maybe present within thymus as both develop from same source. Early division of the primordium may lead to the supernumerary parathyroid.

Background: Chromoblastomycosis, a chronic subcutaneous mycosis, is caused by several dematiaceous Fungi, the most common being Fonsecaea pedrosoi. A majority of cases from India have been reported from the sub-Himalayan belt and South India. Aim: The aim was to study chromoblastomycosis in the eastern coastal parts of Odisha including demographic and clinicomycological profile. Materials and Methods: This report is a retrospective hospital record-based analysis of all cases of chromoblastomycosis who presented to the dermatology outpatient department of our tertiary care hospital during the past 5 years. Results: A total of 11 cases of chromoblastomycosis were diagnosed during the above period. The disease was seen predominantly in middle-aged male farmers from a rural background. The lower extremity (72.7%) was more commonly affected. Verrucous and nodular lesions are the common clinical presentation. Sclerotic bodies are demonstrated in potassium hydroxide mount and histopathological section in 81.8 and 90.9% cases, respectively. The causative fungus was isolated in 90.9% of cases with F. pedrosoi, as the most common species. Conclusion: Chromoblastomycosis mostly affects male agriculturalists, especially from a rural background. Early etiological diagnosis helps in effective management of the condition.

Multilocular cystic renal cell carcinoma (MCRCC) is a rare adult cystic tumor of the kidney and is considered as a distinct type of clear cell renal cell carcinoma. Most patients are asymptomatic and they are detected incidentally. MCRCC is consistently low nuclear grade and has an excellent prognosis. Concern still persists regarding its true malignant potential. Although surgical resection is curative, lymph node metastasis has been reported recently. There are very few reports on large series of cases and limited available follow-up. We report a case of MCRCC in a 60-year-old male patient who presented with abdominal distention. Careful follow-up is essential in these patients for better prognosis.

Xanthogranulomatous inflammation is a chronic inflammatory process most commonly described in the kidney and gallbladder. There are few reports in literature of this process occurring in the vermiform appendix. In this case, a 36-year-old male patient presented with typical signs and symptoms of acute appendicitis necessitating an emergency appendectomy. Histopathological examination revealed typical features of xanthogranulomatous inflammation in the appendix. We report this case in view of the rarity of its occurrence.

Keratitis due to Nocardia species is a rare clinical presentation. We present a case report of Keratitis caused by Nocardia asteroides in an immunocompetent 23-year-old male without any history of trauma or previous ocular intervention. Clinical picture of the patient indicated fungal pathology but good collaboration between the clinical and diagnostic departments helped in timely diagnosis and appropriate management of the patient.

Endometriosis is a condition where endometrial glands and stroma are ectopically located in sites other than the uterine cavity. Cesarean scar endometriosis is rare with an incidence varying from 0.03% to 0.5%. Fine-needle aspiration cytology (FNAC) can be a valuable diagnostic aid in the evaluation of these subcutaneous abdominal masses which are often misdiagnosed. We report a case of cesarean scar endometriosis presenting as a tender abdominal nodule which was diagnosed by FNAC and confirmed by cell block preparation with progesterone receptor and CD10 positivity on immunohistochemistry. The use of cell blocks has been widely advocated in the diagnostic workup of patients with masses amenable to fine-needle aspiration (FNA) since they provide diagnostic architectural information which complement FNA smears.

Worldwide, childbirth has been acknowledged as a significant and a delightful event for the families and the society. However, the birth of a congenitally malformed child poses a major challenge for the parents, their families, society, and the health system. The current global estimates suggest that almost 0.27 million newborns die within the neonatal period due to congenital anomalies each year. If not all, some of the anomalies can be prevented through appropriate primary prevention interventions. Moreover, the early detection of the condition through screening will offer multiple benefits and can be done before the conception, during conception, and through neonatal screening. To conclude, congenital anomalies tend to cast a significant burden on the families, communities, and the health sector. The need of the hour is to strengthen the primary prevention interventions and expand the reach of care and supportive services to ensure the welfare of the affected people.