The World Health Organization has estimated that in the year 2012, out of the 6.5 million deaths reported worldwide in the under-five year age group, around 2.4 million were from India alone. All these nutrition-related indices clearly reflect that the nutritional status of under-five children is still bad and needs concerted efforts from the policy makers and the health care professionals in the country. In response to the poor nutrition indicators in the children, the Ministry of Human Resource Development, India, launched the Mid Day Meal scheme in the year 1995. Currently, it is the world's largest school feeding program that caters to about 120 million children in over 1.2 million schools and other centers. Although progress is being observed in the country's commitment to successfully achieve the Millennium Development Goals -1 and 4, the overall achievement is far from the expected. To conclude, the Mid Day Meal Scheme is one of the country's national flagships feeding scheme initiated to improve the nutritional and educational status of the vulnerable children. However, the sustainability of the scheme depends on the political will, community participation, and continuous monitoring of the program.

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Patients with diabetes mellitus undergo surgery more frequently than non-diabetics. Diabetics tend to have increased morbidity and longer hospital stay following surgery, which may be due to higher risk of infection and co-morbidities such as cardiovascular complications and nephropathy. Studies have shown that pre-operative glycemic control have a significant impact on the risk of infections. Glycosylated hemoglobin below 7% is the usual pre-operative target, but values between 8% and 9% may be acceptable depending on individual circumstances. Recent guidelines from Australia and UK no longer recommend withdrawal of oral hypoglycemic agents including metformin before surgery. Cardiac-related and overall mortality are greater with increased post-operative blood glucose levels. American Association of Clinical Endocrinologists and the American Diabetes Association recommends target glucose levels <180 mg/dL in critically ill patients and <140 mg/dL in non-critically ill patients. Insulin-glucose infusion is the preferred mode of insulin therapy until patient is able to take adequate calorie orally. Sliding scale insulin is no longer recommended and supplemental insulin protocol is more appropriate. Hypoglycemia is also a major contributor to an adverse outcome and severe hypoglycemia should be avoided.

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Background and Objective: Due to increased risk of uterine rupture with prostaglandins in previous cesarean patients, its use has been discouraged as ripening agent in previous cesarean patients. This study was conducted to compare the efficacy and safety of Foley catheter with low dose oxytocin as cervical ripening agent in women with previous cesarean section (CS). Materials and Methods: This was prospective randomized study, including 60 women (30 in each group) with previous CS with unfavorable cervix who needs induction of labor after 28 weeks. Outcomes were analyzed in terms of change in Bishop score (BS), route of delivery and complications. Results: The BS before and after ripening between the two groups was similar (P > 0.05). However, the change in BS within each group was 3.07 and 3.30 in Foley and oxytocin group respectively and this was statistically significant (P < 0.001). Twenty (66.7%) patients in Foley group had a vaginal delivery and 18 (60%) in oxytocin group did so. There were two cases of scar dehiscence in oxytocin group and non in Foley group. Conclusion: Both Foley and low dose oxytocin are good cervical ripening agents in previous cesarean patients. However, the two cases of scar dehiscence in low dose oxytocin group is a concern of safety.

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Background: Failure to provide postoperative pain relief is morally and ethically unacceptable. Combination of nonopioid analgesics is being increasingly used to reduce opioid-related side effects. Pregabalin, having an inhibitory modulation of neuronal excitability, is being evaluated in this randomized controlled trial. Materials and Methods: Following institutional ethical clearance, 90 adult females (aged 18-60 years, ASA I and II) undergoing elective abdominal hysterectomy were randomized into two groups (n = 45). Group A patients received pregabalin 150 mg and Group B patients received placebo (vitamin C), 1 h prior to induction of anesthesia. Intraoperative analgesia was provided with paracetamol infusion 1,000 mg over 15 min. Postoperative pain (visual analog scale/VAS), postoperative nausea and vomiting ( four point ordinal scale ) and sedation scale ( Ramsay ) were monitored at 0, 0-4, 4-12, and 12-24 h time intervals. Results: Both static (at rest) and dynamic (during coughing) pain score (VAS) and the consumption of rescue analgesia (ketorolac) were significantly (<0.001) less in the pregabalin group. There were no significant differences in the postoperative nausea and vomiting, and Ramsay sedation scale. Conclusion: Preoperative pregabalin had significant effect in relieving postoperative pain when given as an adjuvant.

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Background: Cigarette smoking causes small airway obstruction (SAO) and is the harbinger of developing chronic obstructive pulmonary disease (COPD). However, the prevalence of SAO is reported to vary in different ethnic population and with amount of smoking. Respiratory symptoms are reported to be not reliable for determining early airway obstruction Objective: To find out the relationship of respiratory symptoms and amount of smoking with SAO detected by using spirometer among the smokers of an ethnic community. Materials and Methods: In all, 100 male adult current smokers of the Meitei community of Manipur in north east India performed the spirometry test. Results of forced expiratory flow rate at 25-75% (FEF _25-75%) , forced expiratory volume in 1st second (FEV ₁ ) and percentage ratio of FEV ₁ to forced vital capacity (FVC), i.e., (FEV ₁ /FVC)% were used for determining SAO. A modified validated questionnaire was used for labeling respiratory symptoms of obstructive nature. Statistical analysis was done to test independence of symptom with SAO and also of amount of smoking (in pack year) with presence of SAO. Result: In all, 37% of the total study group (n = 100) were detected as having SAO and 49% of the total as having one or more respiratory symptoms. In all, 29.2% of the smokers who smoked less than 3 pack years (n = 65) were detected having SAO, whereas 51.4 % were observed among those smoking more than 10 pack years (n = 35). SAO varies directly with pack year significantly (P < 0.05). Association of respiratory symptoms with SAO was not significant (P > 0.05). Conclusion: The findings of this study revealed that SAO is common among smokers of the Meitei community. It also supports others' studies, done obviously in different ethnic community, in which development of SAO directly varies with amount of tobacco smoking. Respiratory symptoms would not be reliable in the detection of SAO in this ethnic group also.

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Ventricular tachycardia (VT) is rarely observed during pregnancy. Its presence may indicate an underlying cardiac structural abnormality, or undiagnosed congenital arrhythmic disease. However, some pregnant women with VT have structurally normal hearts. There are few reports of new onset VT during pregnancy in absence of structural heart disease. We describe a case of ventricular tachycardia in pregnant woman with no previous heart disease. A 27-year-old, G2P0 + 0 + 1 + 0, at 39 weeks of gestation, presented with episodes of light headedness, vomiting, shortness of breath, and chest discomfort. There was cyanosis with respiratory rate of 56/min and heart rate of 136/min, regular. ECG showed multiple episodes of non-sustained VT with left bundle branch morphology, consistent with VT originating from the right ventricular outflow tract. Considering the diagnosis as VT, the patient was administered bolus doses of amiodarone, followed by maintenance dose. The condition worsened, and the patient expired within 1 hour of admission.

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Background: Workplace violence is any physical assault, threatening behavior or verbal abuse in circumstances relating to work, involving an explicit or implicit challenge to the safety, well-being or health of the employee. Doctors are facing violence in increasing numbers and there are less data available. Hence the study was carried out in an attempt to identify the magnitude of these problems and to assess the attitudes of the doctors regarding this problem. Objectives: To determine the prevalence and attitude of workplace violence among the postgraduate students. Materials and Methods: A cross-sectional study was conducted from January to June, 2011, at the Regional Institute of Medical Sciences, Imphal, Manipur. A self-administered questionnaire was used among the postgraduate students and findings expressed in the form of percentages. Chi-square test was used. Data were analyzed using database software. Ethical approval was obtained from RIMS Institutional ethics committee. Results: Of the total 286 PG students, 230 responded. 78.26% had experienced at least one form of violence, with the escorts of the patients committing 68.33% of the violence. Verbal threats were the commonest form. Maximum violence was committed at the emergency services (48.88%). Male doctors faced more workplace violence than females (P < 0.001). 78.26% of the respondents wanted work place violence to be a non-bailable offence. Conclusion: Our study found a high prevalence of workplace violence. Doctors face the possibility of being victims of aggressive and violent incidents while caring for the patients. Hence doctor's view regarding the punishment for workplace violence as a non-bailable offence should be taken into consideration.

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Objective: Isolation of Helicobacter pylori from biopsy samples taken from cases of gastroduodenal disorder, correlate isolation of H. pylori with urease test, direct modified Grams-stain and H. pylori antibody test, to assess antimicrobial susceptibility pattern of H. pylori isolates. Materials and Methods: Sixty patients with gastroduodenal disorders were included in the study. Urease test, direct modified Grams-stain, H. pylori antibody test, culture and antimicrobial susceptibility were performed as per standard guidelines. Statistical analysis was performed using Fisher's exact test. Results: Antral gastritis was the most common endoscopic findings accounting 43.3%. The study revealed direct Gram-stain positivity of 20%, urease test positivity 46.7%, H. pylori antibody test positivity of 65% and culture positivity rate of 3.3%. Correlation of isolation of H. pylori with Gram-stain found to be significant statistically (P < 0.037). The correlation of isolation with urease test and H. pylori antibody and H. pylori antibody test was statistically not significant. Antimicrobial susceptibility pattern of H. pylori isolates, showed high sensitivity to gentamycin, amoxiclav, tetracycline, clarithromycin, and ciprofloxacin. Higher resistance to metronidazole was observed. Conclusion: Urease test, direct smear, H. pylori antibody test in combination proved to be helpful in the diagnosis of H. pylori infection. Culture from gastric mucosa in infected subjects is low; this could be due to patchy distribution of organisms, prior administration of proton pump inhibitors and antibiotics. Antimicrobial susceptibility testing can be carried out in cases of refractory to treatment.

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Herpes zoster ophthalmicus (HZO) is caused by the varicella-zoster virus, the human herpes virus-3 (HHV-3). HZO is an ocular disease which manifests as unilateral painful skin rash in a dermatomal distribution of the ophthalmic branch of the trigeminal nerve shared by the eye and ocular adnexa. There are many risk factors for HZO like advancing age, immunosupression, and psychological stress. HZO during pregnancy is rare. Although HZ during pregnancy is less likely to cause harm to the unborn child, it is necessary to treat the mother to prevent complications. We report this case as rare because two divisions of trigeminal nerve are involved simultaneously in the form of HZO (ophthalmic nerve) and orocutaneous lesions (maxillary nerve, i.e., maxillary zoster) in an immunocompetent multigravida nullipara pregnant female.

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Epidermal nevi are hamartomas that are characterized by hyperplasia of the epidermis and adnexal structures. Most cases arise sporadically during development of the embryo, but familial patterns of inheritance have been observed. Only 5-10% of patients with verrucous epidermal nevus show histological features of epidermolytic hyperkeratosis. This has a significant clinical importance as this patient carry the risk of parenting a child of congenital bullous ichthyosiform erythroderma. A 7-year-old boy born of non-consanguineous marriage presented with non-pruritic multiple verrucous papules that coalesce to form well-demarcated, skin colored to brown, papillomatous plaques over the right side of abdomen, right loin, right legs including a cauliflower like verrucous plaque over the umbilicus distributed along the line of Blaschko noticed since 1-year of age. Oral cavity, palms and soles were spared. Developmental milestones were normal. A diagnosis of verrucous epidermal nevus was made. Histology showed hyperkeratosis, papillomatosis and vacuolization of the cells in the stratum spinosum and granulosum with keratohyalin granules. Routine examination of blood and chest X-ray were normal. This case is being reported to highlight the rare histological features and to re-emphasize the importance of routine histological examination and genetic counseling in all cases of verrucous epidermal nevus.

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The word 'gossypiboma' or 'textiloma' is used to describe a retained surgical sponge in the body after an operation. If it is left in the abdomen, it may cause serious morbidity and mortality of the patient as well as medico-legal problems. It varies between 1 out of 1,000-1,500 intra-abdominal operations and 1 out of 300-1,000 of all operations. Herein, we report two cases, the first presenting 1.5 years after cesarean section with fever and purulent vaginal discharge and the second, two years after with abdominal swelling and pain. The contrast-enhanced computed tomography (CECT) proved to be diagnostic and guided towards proper management. Imaging detected trans-visceral migration of the sponge in the first case and improved the prognosis. High degree of suspicion raised by imaging and correlation with clinical picture are the cornerstone for a good outcome.

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Pyocolpos is a rare clinical finding in vaginal atresia. Pyocolpos is cystic dilatation of the vagina due to accumulation of pus due to genital tract obstruction. The causes of obstruction can be imperforate hymen, transverse vaginal membrane, and rarely vaginal atresia. We present a case of 18-year-old married women Go Po+o, admitted with severe pain and swelling of the lower abdomen for 3 months. She had undergone laparotomy with vaginoplasty for vaginal atresia with hematocolpos and pyoperitoneum in 2009 and had refused mould insertion. On laparotomy, she was found to have pyocolpos and infected right ovarian cyst, which was probably due to re-obstruction of vagina. Right ovarian cystectomy followed by subtotal hysterectomy was performed. Post-operative period was uneventful. Following vaginoplasty, follow up and regular vaginal dilatation are essential to avoid complications involving re-obstruction and ascending genital infection.

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A rare case of unilateral aplasia of the mandibular condyle along with contralateral ankylosis of the temporomandibular joint in a 15 year old boy is presented here. It was not associated with any soft tissue aberrations suggestive of any syndromic etiology. Aplasia is a rare anomaly and refers to the insufficient development of the mandibular condyle. True agenesis of the mandibular condyle is extremely rare. The simultaneous existence of condylar aplasia on one side and temporomandibular joint ankylosis on the other side makes this case an even rarer one.

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Anaphylactic reactions occurring during anaesthesia remain a major cause of concern for anaesthesiologists. Serious and occasionally fatal anaphylactic reaction may occur when a patient is exposed to a drug for the first time. On time prompt recognition and treatment of the acute event by the attending anaesthesiologist and subsequent determination of the responsible agents with strict avoidance of subsequent administration of all incriminated cross reacting compounds is very important. However, correct identification of the causative compound immediately is not always straightforward. In this case report, we summarized the alarming rare causes of anaphylaxis during anaesthesia and the diagnostic approach of this rare but potentially life-threatening complication and management.

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Background: Anxiety disorders are becoming a common mental health problem in our society. This could be attributed to the law and order situation, and the socioeconomic problems faced in our social setup. However, very few people are aware of the fact that these disorders, if not treated properly in time, can give rise to major cardiovascular health problems such as myocardial infarction, cardiac arrhythmias, and even coronary heart diseases. Reduction of the cardiac vagal tone (decreased parasympathetic function) is reported as a common associated finding. Objectives: To study involvement of autonomic nervous function, particularly parasympathetic, in Manipuri patients with anxiety disorders. Materials and Methods: Parasympathetic function was tested for 38 patients with anxiety disorders and 30 age- and sex-matched normal healthy subjects (control) by using a battery of three tests, that is:

1. Heart rate variability (HRV) to deep and slow breathing (E:I).
2. Heart rate response to postural change (30:15).
3. Heart rate response to Valsalva maneuver (VR)

Results: The E:I value was significantly low (statistically) in anxiety patients compared to normal healthy subjects indicating reduced parasympathetic function. Conclusion: Patients with anxiety disorders are usually associated with lower cardiac vagal tone (reduced parasympathetic function) making them vulnerable to different cardiovascular disorders such as myocardial infarction, cardiac arrhythmias, and coronary heart diseases.

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Spontaneous hemoperitoneum (SHP) also known as abdominal apoplexy is a rare medical condition but often life threatening. The most important treatment strategy for abdominal apoplexy is surgery where identification and ligation of the bleeding points is the main goal. Gastric hemangioendothelioma is an intermediate-grade vascular neoplasm. Vascular tumors of the stomach are rare, 0.9-3.3% of all gastric neoplasms hemangioendothelioma. It may develop in any organ, but more common in lungs and liver. We present an unusual case report of a 42 year-old gentleman admitted as a case of acute cholecystitis, who was intra operatively found to have spontaneous hemoperitoneum due to a ruptured serosal gastric tumor. Histopathological examination of the tumor reported as gastric hemangioendothelioma-epithelioid type. Although the treatment of choice is surgery, radical surgery can be avoided if there is no evidence of any malignant potential.

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Background: As compared with all other countries India suffers the highest lost in potentially productive years of life, due to deaths from cardiovascular disease in people aged 35-64 years (9.2 million years lost in 2000). Low- and middle-income countries and by any measure, noncommunicable diseases (NCDs) account for a large enough share of the disease burden of the poor to merit a serious policy response. Objectives: (1) To identify the prevalent cases reporting NCD's under urban health center area (UHC). (2) To suggest the need of a few anti-hypertensive and anti-diabetic drugs with facilities of an electrocardiogram machine and counseling for life style modifications. Study Design: Cross-sectional study. Materials and Methods: A few residential societies having around 1000 population were arbitrarily selected from Udhna Center functioning under Surat Municipal Corporation. A house to house survey was conducted by a team of two medical students to materials collect information related to the occurrence of NCDs and other relevant information. Data were analyzed using Epi 6 software. Results: A total of 195 families having a population of 1028 were visited. Mean age of the population was 29.3 ± 17.64 years. 547 (53.3%) persons were males while 480 (46.7%) of the studied population were females. A good number of persons (46) reported having one of the chronic illnesses such as diabetes mellitus, hypertension (HT), ischemic heart disease (IHD), and cancer. The proportion of individuals suffering from such kind of illnesses was 8.6% in the adult population over the age of 30 years. Conclusion: In light of rising NCDs, UHCs are required to provide treatment for the cases of HT, diabetes and IHD as part of primary health care.

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Situs inversus is also known as situs transversus or oppositus and is a congenital condition. In this condition, the major visceral organs are observed to be reversed or mirrored from their normal position. Symptomatic cholelithiasis in a patient of situs inversus can give rise to diagnostic dilemma and calls for modification of the surgeon's operative approach. Owing to the rarity of the condition, here, we report a case of laparoscopic cholecystectomy in a patient of situs inversus at Regional Institute of Medical Sciences (RIMS). Though operative time was slightly prolonged and there were minor orientation difficulties, intra-operative and post-operative periods were uneventful and there is no report of complication till date.

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