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Children represent the future of our society and ensuring their healthy growth and development ought to be a prime concern of all. The dental condition of children with special health care needs (SHCN) may be directly or indirectly related to their disabilities. Children with SHCN relatively have poor oral hygiene and increased prevalence of gingival diseases and dental caries. Unfortunately, the importance of dental care for these children has often been overlooked by the health planners. Parents of disabled children usually do not seek dental treatment as they also have the burden of medical treatment. In the past, the emphasis was based on providing basic dental care, but in recent years, the dental profession has shown increased concern in providing complete oral health care to the mentally- or physically-challenged children. The specialty of pediatric dentistry provides both primary and comprehensive, preventive and therapeutic oral health care to children with SHCN. These special children are entitled to the opportunity to achieve appropriate rehabilitation, to enable them to realize their maximal level of functioning, and to assist them in not only “normalizing” their lives but also lengthening their life span.

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Background and Objectives: Headache in the absence of infection or inflammation and other causes may be related with some anatomical abnormalities of nose called contact point headache. Our objective was to study endoscopic and radiological nasal findings of contact point headache and their outcomes after surgery in patients attending department of otorhinolaryngology, tertiary care teaching hospital/center in Northeast India. Study Design: A prospective study. Materials and Methods: A total of fifty patients attending ear, nose, and throat outpatient department and diagnosed as contact point headache were selected after a detailed history of symptoms through questionnaires, diagnostic nasal endoscopy, computed tomography scan, and a positive xylocaine-adrenaline test. All the patients underwent surgery. Pre- and post-operative pain score (visual analog score [VAS]), mean frequency of pain, and mean duration of each attack were noted for comparison. Data collected were analyzed using appropriate tools. Results: A total of thirty males and twenty females were included in the study. At the end of 12-month follow-up, pain score (VAS) reduced from 7.47 with standard deviation (SD) of ± 1.6–0.2 with SD of ± 0.59 postsurgery and the mean frequency of pain reduced from 9.10 with SD of ± 2.86–0.22 with SD of ± 0.67. Both were statistically significant. Conclusion: Contact point headache is a common cause of headache in Northeast India and surgery is effective in a carefully selected cases.

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Background: The fungus Penicillium can cause various infectious diseases in humans and animals. Being present in the environment, its importance in human health has been neglected and is often interpreted as room contaminant. Treatment of regional penicilliosis caused by dimorphic Penicillium marneffei has been according to the protocol available in literature. Objective: The study was conducted to determine the antifungal susceptibility pattern of endemic P. marneffei and other nonmarneffei (NM) Penicillium species in Manipur. Materials and Methods: Clinical and environmental Penicillium species were isolated using standard operating procedure. Antifungal susceptibility of five antifungal agents, namely amphotericin B, voriconazole, itraconazole, fluconazole, and natamycin, was carried out according to the Clinical and Laboratory Standards Institute (CLSI, M38–A2) guidelines. Results: All P. marneffei isolates (100%) showed sensitivity to amphotericin B at ≤1 μg/ml, whereas 96.5% and 76.3% of clinical and environmental NM Penicillium isolates, respectively, were sensitive at ≤1 μg/ml. Clinical isolates were completely inhibited at a concentration of ≤0.25 μg/ml of voriconazole. 30.7% P. marneffei were susceptible at lower minimum inhibitory concentration (MIC) of 0.06 μg/ml of itraconazole, but 31.4% of environmental isolates noted a high MICs of ≥0.5 μg/ml. There was no significant difference in fluconazole MIC among tested strains; however, 10.5% of environmental strains noted higher MIC at 150 μg/ml. 16 μg/ml of natamycin inhibited 100%, 86.2%, and 84.2% of P. marneffei and clinical and environmental NM Penicillium species, respectively. Conclusion: Itraconazole and voriconazole are the drugs of choice for the management of infection caused by P. marneffei and NM Penicillium species. Environmental NM Penicillium isolates with higher MICs may be because of exposure to agricultural fungicides.

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Background: Injuries among children lead to disability in early years of life affecting their opportunities to lead a healthy life. It also has multiple impacts on family and society. Objectives: The study was planned to find the prevalence of injuries among children and to study the pattern and determinants of injuries. Materials and Methods: A community-based cross-sectional study was conducted for 3 months among children aged <18 years. Occurrence of injuries during the previous 6 months was included in the study. Data were analyzed using SPSS version 20.0 and presented in the form of mean and percentage. Results: A total of 410 children have participated in this study. Injuries were more common among children aged 6–9 years compared to children of other age groups. Male children (52.8%) had more number of injuries than female children (47.2%). Lower limb (33.9%) was the most common body part injured. Cut injuries and laceration accounted for 56.2% of the injuries. Majority (43%) of the injuries occurred due to falls. Eighty-seven percent of the injuries were mild. Conclusion: Severity of injury was mild in most of the injuries. Still pediatric injuries had contributed to economic loss to the family and affected schooling of the children.

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Context: Intracavitary brachytherapy (ICBT) involves insertion of a tandem applicator through the cervical os into the uterine cavity. Proper placement is critical to the success of ICBT: inadequate applicator geometry is associated with significantly impaired local control and operative complications (uterine perforation). One technique for real-time verification of tandem position is intraoperative ultrasonography (USG). Aims: The aim of this study is to evaluate the role of intraoperative transabdominal ultrasound-guided tandem placement in brachytherapy for cervical cancer. Settings and Design: This was a retrospective interventional study. Subjects and Methods: This was a single institutional study conducted from October 2013 to September 2014. Seventy-seven patients (219 intracavitary applications) of locally advanced cervical cancer were treated with routine ultrasound-guided brachytherapy after pelvic external beam radiotherapy (EBRT). Results: In 62 of the study patients, the cervical os could be identified visually. In 13 patients, ultrasound guidance was necessary for accurate os identification and proper tandem placement due to cervical canal stenosis. In another 2, intraoperative ultrasound helped in identifying the patients suitable for interstitial brachytherapy rather than ICBT (as a result of cervical anatomy distortion). At 24 months, disease-free status was achieved by 68.85% of patients. Seven patients developed Grade 1 bladder Radiation Therapy Oncology Group toxicity, and one had Grade 2 toxicity. Ten patients had Grade 1, and three had Grade 2 Rectal toxicities. Conclusions: We encountered no case of tandem malplacement or uterine perforation in our study. The disease control and treatment toxicity were within acceptable limits. USG image-based tandem application provides an accurate, fast, easily available, and cost-effective method for proper brachytherapy applicator placement.

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Context: Yellow fever (YF) is an infection which could lead to hemorrhage, and malaria is a highly prevalent infectious disease in Africa. These diseases have accounted for colossal loss of lives over time. Aim: To investigate the likelihood of concurrent malaria and YF infection as well as yellow fever virus (YFV) IgG serostatus with respect to predisposing risk factors. Settings and Design: A cross-sectional study of febrile patients attending hospitals in Ilorin metropolis in the first quarter of 2016. Materials and Methods: Blood samples were collected from 176 participants, and the malaria status was determined using rapid diagnostic tests. Positive malaria samples were subjected to reverse transcriptase-quantitative polymerase chain reaction to assay for YFV to ascertain coinfection with YF. All the samples were also tested for anti-YFV IgG antibodies using ELISA. Statistical Analysis Used: Data were analyzed using Statistical Package for the Social Sciences software and Excel. Results: Only 13 (7.4%) participants were positive for malaria and no case of malaria and YF coinfection. There was no statistical association (P > 0.05) between the acquisition of malaria and the predisposing risk factors examined. An overall seroprevalence of anti-YFV IgG antibodies of 21.6% was found. Among the risk factors assessed, age group and marital status had a statistical association with anti-YFV IgG antibodies serostatus of the participants (P < 0.05). Thirty (17%) participants reported that they had been vaccinated against YFV, and 21 (70%) of the vaccinees were seronegative for anti-YFV IgG antibodies. Conclusions: This study revealed a low prevalence of malaria and anti-YFV IgG antibodies, as well as low YF vaccination coverage in Ilorin metropolis.

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Background: Modern day transfusion therapy, even though safe, is associated with noninfectious complication such as transfusion-related reactions. The study was undertaken to determine the incidence of the reactions as to correct their cause and prevent recurrences. Materials and Methods: It was a retrospective review of all transfusion-related adverse events reported within 2014–2015. They were analyzed as per the protocol laid down by the department. Results: A total of 31,074 units of blood components were issued during the study period and 28 patients developed transfusion reactions. Maximum cases were due to allergic reaction (n = 15, 53.57%) and were mostly females. Packed red blood cells were also the most common component associated with the transfusion reactions. Conclusion: Allergic reaction was the most common acute transfusion reaction followed by febrile nonhemolytic transfusion reaction. Sensitization of all the health personnel involved in the transfusion chain and strict hemovigilance program enforcement will help in improving the safety of blood transfusion.

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Choking is the obstruction of the flow of air into the lungs and is almost always accidental. In this paper, a case of choking mistaken as death due to police torture is reported. A man was brought by the police to a hospital in Imphal, and the person expired on reaching there. Family members alleged that the police had a hand in the victim's death and that he died due to their torture. A meticulous autopsy helped in establishing the exact cause of death in this case thereby disproving the false charge of assault.

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Background: In a global perspective, there is a requirement of a universal classification system to monitor the worldwide childhood obesity. Confusion concerning which classification system to use on national levels complicates monitoring of the development of the obesity and comparisons between various studies. Objectives: This study highlights the specific problems associated with body mass index (BMI) classifications, compares the body weight status according to Indian, Centers for Disease Control and Prevention (CDC), and international classifications, and determines their applicability for the caries free 3-6 years old children of Mathura city. Materials and Methods: A total of 150 children aged caries free 3–6 years without contributing medical history from Mathura city were selected for this study. Weight (kg) and height (m) measurements were done; BMI (kg/m²) and the body weight statuses were evaluated using Indian-, CDC-, and international-based classifications. Chi-square test was used to compare the body weight status derived from these classification systems. Results: The majority of the caries free children (96%) were classified as underweight according to BMI-based Indian and international classifications. About 59.3% and 36% of children were classified as underweight and normal body weight status according to CDC classification. There was significant difference observed in the body weight status derived from the BMI-based Indian with the CDC classification. Conclusions: Majority of the disease-free (systemic and dental caries free) 3–6-year-old children were observed to be underweight. The BMI-based Indian and international classifications are applicable for the evaluation of body weight statuses for these children of Mathura city.

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Introduction: There is a paucity of published literature for patients who leave against medical advice (LAMA). There is no such published study conducted in pediatric surgery in India. Materials and Methods: We retrospectively analyzed our records of those patients who left against medical service. We evaluated the records on various parameters such as age at presentation, sex, duration of stay, and any procedure performed. Duration of stay was subdivided into early LAMA (<3 days) or delayed (>3 days). Results: The study period ranged from July 2012 to July 2015. During this period, the total number of admissions was 5604. Of these, 520 (9%) patients left the hospital. Most of the patients were <1 year of age (380, 73%). Male-to-female ratio was 2.9:1. The ratio of emergency to elective admission was 4.4:1. The ratio of patients who left in <3 days to patients who stayed more than 3 days was 3.3:1. Most of the patients had gastrointestinal problems. Four hundred and thirty-nine patients left without any surgical intervention, whereas remaining 81 patients underwent some sort of surgical intervention. The exact cause of LAMA was difficult to ascertain; however, probable causes included cost factor, poor general condition, and dissatisfaction with available resources. Conclusion: LAMA is higher in neonatal period, emergency admission, and within 72 h. Attention toward education, avoiding gender bias, and raising the standards of living may help in accomplishing our goals. A large database of the causes and demographics is important to formulate the measures to minimize it.

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Desmoplastic infantile gangliogliomas (DIGs) are rare supratentorial, neuroepithelial low-grade brain tumors that arise in the cerebral hemispheres and represent 1.25% of all intracranial tumors in children. They present commonly in the infantile age group within the first 2 years of life and are exceedingly rare in the noninfantile population. Less than sixty cases of this tumor type have been reported in literature. We present here a 9-year-old female child with a huge right frontoparietal DIG with midline shift and mass effect on ventricles. This rare case highlights the remarkable heterogeneous nature of this pediatric tumor and the importance of appropriate immunohistochemical examination for accurate pathologic diagnosis.

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Context: Chronic inflammatory arthritis (IA) refers to a joint disease with pain, morning stiffness more than 30 min, redness, and swelling, lasting for more than 6 weeks. Aims: This study was conducted to evaluate the pattern of joint involvement of these patients, evaluate etiologies, and delineate acute-phase reactants and immunological markers. An attempt was made to correlate the severity of joint involvement with acute-phase reactants and immunological markers. Settings and Design: This was a descriptive, cross-sectional study conducted for 24 months. Subjects and Methods: One hundred patients with clinically diagnosed chronic IA fulfilling criteria for inflammation and lasting more than 6 weeks were studied clinically and by laboratory parameters. Patients with vague, noninflammatory, periarticular or acute disease were excluded from the study. Statistical Analysis Used: Data was collected and analyzed using Epi Info version 7. Chi-square and Fisher's exact tests were applied. Results: The mean age of affection was 40 ± 15 years. A total of 77 patients were female and 23 were male. Seventy-six patients had rheumatoid arthritis (RA), seven had ankylosing spondylitis, six had systemic lupus erythematosus, four had mixed connective tissue disease (MCTD), four had gout, one had juvenile idiopathic arthritis, one had systemic sclerosis, and one had overlap syndrome. Erythrocyte sedimentation rate was raised in 66% of patients, and C-reactive protein (CRP) was raised in 57%. Of the RA patients, 42.1% were rheumatoid factor (RF) positive and 91.5% were anti-cyclic citrullinated polypeptide (CCP) positive. Out of 44 patients who were RF negative, positivity for anti-CCP was 86.1%, which was found significant. Nearly 6.52% of the patients were seronegative. Overall, the correlation of severity of joint involvement with CRP was significant. In RA, severity correlated with CRP, RF, and anti-CCP. Conclusions: RA was the most common etiology (76%) and in it, the positivity of RF was 42.1% and anti-CCP was 91.5%. Overall, the severity of joint involvement was significantly correlated with CRP.

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The thymus is a primary lymphoid organ which establishes and maintains the pool of effector T-cells throughout life; however, it is one of the sites for antigen-independent B-cell maturation. Primary thymic B-cell lymphoma is a rare entity, unremarkable clinically but amenable to chemotherapy. We report a 34-year-old male who presented with nonspecific right-sided chest pain, backache, and shortness of breath for 4 months. Computed tomography scan of the thorax revealed a mass in the superior mediastinum, extending to anterior mediastinum with the right pleural effusion. The suggested diagnosis was thymoma. A median sternotomy was done to resect the thymus. The definitive histologic study revealed a primary thymic B-cell lymphoma positive for CD45/leukocyte common antigen and CD20 and negative for CK and CD30. Thymic lymphoma may be considered among the diagnostic options of a mediastinal mass.

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Fecopneumothorax is an unusual and uncommon cause of hydropneumothorax. It is an extremely rare pleural disease, with only 16 cases being reported from worldwide. Here we report, a 35-year-old, previously healthy man with an incidental Bochdalek hernia whose chest radiograph was misinterpreted as hydropneumothorax and managed by an intercostal chest drain. This leads to a left colopleural fistula and fecopneumothorax. The patient was managed surgically and recovered well. To the best of our knowledge, this is the first case of fecopneumothorax which is iatrogenic in nature.

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Background: Accurate prediction of motor recovery and functional outcome is difficult, but it is important for proper rehabilitative planning and poststroke care. Infarct location may be more important for some patients in determining eventual clinical outcome. Objectives: To study the functional outcome of ischemic stroke in relation to the site of lesion. Materials and Methods: A prospective cohort study was conducted in the Department of Physical Medicine and Rehabilitation, Regional Institute of Medical Sciences, Imphal, Manipur. All computed tomography confirmed ischemic stroke patients attending the outpatient department within 7 days of stroke onset were included in the study. Functional Independence Measure (FIM) scoring was done on 7, 30, and 90 days poststroke. Site was categorized as cortical (C), subcortical (S), combined cortical and subcortical (CS), basal ganglia (BG), or combined cortical, subcortical, and BG. Results: Ninety patients with mean age of 58.26 ± 7.021 years in the range of 45–70 years were studied. Males constituted 55.6% of the total participants. The site of lesion was in BG in majority of cases 37 (41.1%), subcortical in 31 (34.4%) cases, and cortical in 20 (22.2%) cases. Mean FIM score was highest 53.70 (±13.2) when the site of lesion was in BG. The mean FIM scores differed significantly between the different sites of lesion (P = 0.000) at subsequent follow-up examinations. Post hoc test further revealed that there was statistically significant differences in the FIM scores between BG and all the other sites of lesion at baseline and at subsequent follow-up. Conclusion: Site of lesion influenced the functional outcome significantly early on and at 30 days and 90 days after stroke, and the most favorable outcome was observed when the site of lesion was in BG.

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