Drugs and their formulations are mainly used in the prevention and treatment of disease or disorders; out of such drugs, only some are considered to be essential and life-saving, whereas others remain substitutes for each other. When some serious adverse effect is faced by a general population on the consumption of the particular drug, the adverse side effects are monitored through pharmacovigilance; when the hazard overshadows the benefit, then the drug is proposed for a ban in the country. Some drugs potentiate the adverse effect only when it is in combination with another drug, which is considered to be irrational; in such situations, the Fixed Dose Combinations FDC is banned but not the single drug. Banned drugs are still available in India, and this might be due to the lack of awareness and knowledge among clinicians and the persistence of loopholes in Indian laws governing the approval and manufacture of drugs. The government needs to enforce laws and increase drug information centers and ensure their proper functioning, from where the update on each drug will be provided to doctors and the general population.

Axillary web syndrome (AWS) or cording is a clinical entity characterized by a palpable cord tissue or band generally extending from axilla to antecubital fossa with restricted shoulder mobility commonly occurring in both axillary surgical cases and nonaxillary surgeries. Exercises in the form of active and passive exercises, joint mobilizations, manual therapies in the form of massage therapy, myofascial release, manual lymphatic drainage, thermal therapy, and low level LASER therapy are found to be effective in patients with AWS. There is dearth in literature for manual therapy techniques used for AWS in breast cancer patients. Future research is recommended to conduct clinical trials using advanced manual therapy techniques like cupping, jade stone mobilization and matrix in addition to the exercise protocols in larger population for breast cancer survivors with axillary web syndrome.

Context (Background): Long-term negligence of dental diseases results in development of chronic dental problems involving multiple teeth which has an impact on general health and nutrition. Aims: Our study aimed to evaluate the correlation between chronic dental conditions requiring multiple extraction and the anemic status of the patients. Settings and Design: This was a prospective study on hematological data obtained from outpatients over 1 year. Materials and Methods: The study was conducted on 200 patients over a period of 1 year who were divided into Group I (anemic) and Group II (normal) based on Hb values. Statistical Analysis: We used the t test and Chi-square test to find the significance. Results: Eighty-six of the 200 patients (43%) fell into Group I and 114 patients 57% of patients fell into Group II. In Group I the average Hb was 9.9 ± 0.86 g\% for females and 10.5 ± 0.91 g% for males and the mean number of teeth extracted was 4.18± (2.64). 88.3% of patients in Group I underwent extraction of posterior teeth. In Group II the number of teeth extracted was 3.5± (2.14). Approximately 77.1% of patients underwent extraction of posterior teeth. The difference in the number of teeth extracted and the difference in the percentage of patients who had their posterior teeth extracted between Group I and Group II was found to be statistically significant (P = 0.024 and P = 0.0436). Conclusions: Chronic dental diseases involving multiple teeth and impacting the masticatory efficiency of the patient may cause systemic disorders like anemia.

Background: Staphylococcus haemolyticus (S. haemolyticus) is one of the important organisms in hospital-acquired infections. This strain comprises many enzymes, cytolysins, and surface substances which contribute to its virulence. We in the present study tried to evaluate the prevalence of methicillin-resistant S. haemolyticus causing nosocomial infections in a Tertiary Care Hospital. Methods: A total of n = 95 non-repeated S. hemolyticus were isolated in the Department of microbiology out of n = 2116 various clinical specimen present. The strains collected were initially identified by colony morphology on Nutrient agar, Sheep blood agar, Chocolate agar, Uri Chrom agar, gram staining, catalase, coagulase (both slide coagulase and tube coagulase), mannitol fermentation, Amino acid decarboxylation. Results: n = 95 (4.5%) samples of n = 2116 samples were positive for S. haemolyticus. Most positive cultures of S. haemolyticus were from pus samples n = 40 out of n = 95. The susceptibility pattern revealed none were susceptible to penicillin and 94% susceptibility was found with Linezolid and 100% susceptibility to Nitrofurantoin. The vancomycin Minimum Inhibitory Concentration (MIC) results showed 71.57% (68/95) strains were susceptible; out of these 12 (12.63%) were showing MIC < 1 μg/mL, n = 56 isolates (58.94%) were showing MIC value less than n = 2 μg/mL, and none of them were less than MIC 0.5 μg/mL. Conclusion: In this study, variable antimicrobial resistance susceptibilities were shown by S. haemolyticus isolates. Some clinical situations may require a single strain of S. haemolyticus to be identified up to the species level with their antibiogram. Critical and timely detection of drug-resistant S. haemolyticus in hospital settings will be a helpful guide in the management and prevent further proliferation of drug resistance.

Introduction: It is very difficult to deliver periodontal treatment to extremely anxious patients. Therefore, there is a need to find measures to reduce the anxiety levels without causing any side-effects. This study was conducted to evaluate the effect of music on the anxiety level of the patients who were undergoing periodontal flap surgery. Objective: The objective of this research was to investigate the effectiveness of music therapy on adult patients undergoing periodontal flap surgery. Methods: Ten patients admitted to the department of periodontics for periodontal surgery were recruited for this study. These patients were provided with a questionnaire including Corah Dental Anxiety Scale, prior to the periodontal surgical procedure. Vital signs (diastolic and systolic blood pressure and pulse) were also recorded before and after the procedure. Patients were asked to fill out a short questionnaire about their experience after the procedure. Results were collected and statistically analyzed. Results: Overall, the evidence points to good results for music and patient satisfaction. Indeed, the overall heart rate and blood pressure decreased over the duration of treatment. When patients were asked whether they felt relaxed as compared to the time they entered the clinic, 90% of the patients said “yes.” When patients were asked about the reduction of pain 70% of them said “yes.” When patients were asked about their experience on music therapy, most of them graded it as “Good.” Conclusion: Music can help people in being more at ease during dental care. It was found to be a non-pharmacological sedative and anxiolytic that was cost-effective, painless, and had no side-effects.

Background and Aims: Videolaryngoscopy has been introduced for the management of difficult airway; however, it remains unclear whether it is helpful in routine prediction of a difficult airway. The aim of our study was to compare the ease of intubation using a McCoy laryngoscope and CMAC® videolayngoscope using the Adnets Intubation Difficulty Scale (IDS) score in an anticipated difficult airway (modified Mallampati grade III and grade IV). Methods: Sixty patients belonging to the American Society of Anaesthesiologists physical status I, II, or III with modified Mallampati grade III and IV undergoing elective surgeries requiring tracheal intubation were randomly allocated into the McCoy group (n = 30) and CMAC® videolaryngoscope group (n = 30). The primary outcome of the study was to compare the ease of intubation between the McCoy laryngoscope and CMAC® videolaryngoscope using Adnet's Intubation Difficulty Scale (IDS) score. Secondary outcomes included time for glottic visualization, time to intubation, total intubation time, hemodynamic and any adverse events. Results: Comparison of both groups showed that CMAC® videolaryngoscope had a significantly (P = 0.028) lower IDS score (1.667) compared to the McCOY laryngoscope (2.467). Time to view glottis (P = 0.002), time to intubate (P = 0.009), and total intubation time (P = 0.002) were significantly prolonged with CMAC® videolaryngoscope compared to the McCoy laryngoscope. There was no difference in the hemodynamic response and adverse events between the groups. Conclusion: Our study concludes that although the time to intubate was prolonged in CMAC® videolaryngoscopy, the ease of intubation was better with CMAC videolaryngoscope compared to the McCoy laryngoscope. Hence, we suggest CMAC® videolaryngoscope for anticipated difficult tracheal intubation.

Background: Carbapenems have been considered as a robust antibiotic to treat extended-spectrum β-lactamases (ESBLs) in the past ten years. Carbapenems, among the β- lactams, are the most effective against gram-positive and gram-negative bacteria presenting a broad spectrum of antibacterial activity. Detection of carbapenemase-producing isolates by clinical microbiology laboratories is essential to provide targeted therapy, antimicrobial stewardship, and to update local antibiotic guidelines for clinicians. Objectives: To identify and characterize carbapenem-resistant Enterobacterales (CRE) by phenotypic and genotypic methods, and the antibiotic sensitivity patterns of CRE isolated from the different clinical samples. Methods: The samples were collected for a period of one year. Enterobacterales strains were identified through standard biochemical reactions and subjected to phenotypic screening for detection of carbapenemase, and confirmed with multiplex PCR. Antibiotic sensitivity patterns were also studied. Results: A total of 447 strains of Enterobacterales species were isolated from various clinical samples over a period of one year. Out of these, 38 (8.5%) of them showed decreased susceptibility to carbapenems including 12 Escherichia coli, 11 Klebsiella pneumonia, 1 Klebsiella oxytoca, 6 Proteus mirabilis, 2 Proteus vulgaris, and 6 Citrobacter freundii. 20 isolates of them showed the presence of carbapenemase genes in Multiplex PCR, isolates included NDM, IMP, OXA-48. Two strains showed simultaneous co-existence of two genes including NDM with OXA-48 in Klebsiella pneumonia, and NDM with IMP in Proteus mirabilis. No KPC genes were detected in our study. 97% of isolates showed sensitivity to fosfomycin (for urine samples only), 73.68% of them to tigecycline, 36.84% of them to polymyxin B, 50% to colistin, 26.31% to amikacin, 18.42% to aztreonam, 21.05% to piperacillin-tazobactam, and 10.52% to cefoperazone + sulbactam combinations. There were seven isolates of urine sample, and the sensitivity of nitrofurantoin to these isolates was 42.85%. Conclusion: The frequency of CRE was found to be low. E. coli and K. pneumoniae were the most common isolates. NDM was the commonest gene detected. Highest sensitivity was found with fosfomycin and tigecycline.

Background: The department of biochemistry at a tertiary care teaching hospital had the first offline early clinical exposure (ECE) on gout in October 2021 in the aftermath of COVID 19. This paper is based on our experiences of conducting ECE according to Competency Based Medical Education in the classroom. Aim: To share our experiences of conducting ECE in a faculty constrained setting. Methods: This was a mixed methods study. A total of 187 students out of 200 were present on the day of ECE. A pre- and post-test of ten questions on nucleotide metabolism was administered to the students. The subject for the module was a 48-year-old farmer suffering from gout who kindly consented to be a part of the program which was coordinated with the orthopedics department. After the module, the students wrote their reflections in the logbook and also gave their written feedback. Results: The reflections revealed that they felt motivated to study the biochemical aspects of the disease as this helped them understand the clinical picture. The feedback revealed that they preferred having more such ECE sessions. The mean post-test and pre-test scores were 7.7 and 5.6, respectively. Conclusion: ECE improved the students' learning and motivated them to study the subject. The reflection and feedback by students demonstrate that the students were enthusiastic and motivated to participate in the ECE. The objective in disseminating our findings is to share the ECE experiences so that we can standardize the competencies and objectives of common clinical conditions in biochemistry.

Introduction: The number and type of health related disorders are increasing day by day across the globe and India is not an exception. The emergence of COVID 19 in India is also fuelling health related disorders among Indians. The present study is focused on understanding general health related disorders, medical treatment preferences, and health management practices in South Indians using an exploratory approach. Methods: A survey method was followed to conduct the study using a structured questionnaire. The questionnaire was developed based on a focus group discussion with the experts and researchers in the general medicine field. A convenience sampling method and online survey method were used to collect the data from the respondents. Results: The top six health related disorders reported in the study were skin related problems, eye problems, menstrual problems, mental stress, dental problems, and vitamin and nutritional deficiencies. The most preferred treatment option is allopathy medicine, followed by ayurveda and homeopathy. The preferred place for the treatment were private hospitals, followed by clinics and then government hospitals. A list of 22 positive and negative health related practices currently followed by the respondents was also identified in the study. Discussion: The results of the study will be helpful to understand a comprehensive overview of the study topic by the health professionals, hospital authorities, health researchers, and policymakers to develop strategies to manage the health related disorders, provide effective medical treatment, and enhance the current health management practices. Conclusion: Effective treatment for the top six health-related disorders identified in the study and more awareness programs and training will help achieve better health management.

Background and Objective: Stroke is the most common cause of death and the leading cause of disability worldwide. We aimed to study predictive factors of stroke severity which determine stroke mortality and morbidity. Methods: It is a prospective observational study to analyze predictors of stroke severity in 653 acute stroke patients performed over a period of 18 months. Results: The mean age of stroke was 61.66 years, with males being 317 (48.55%). Stroke severity was significantly associated with parameters such as age, gender, education and economic state, awareness of vascular risk factors, risk factors including family history of coronary artery disease/stroke, alcohol intake, symptom timeline including the first evaluated area and time duration between the last known normal and hospital arrival, with respect to symptoms at presentation, including headache, speech difficulty, and dysphagia, examination findings including respiratory rate, Glasgow Coma Scale (GCS) grade, and higher mental function, with respect to laboratory parameters, including total leukocyte count, neutrophil to lymphocyte ratio, and creatinine, and radiological parameters including Doppler findings. Conclusion: The study has shown that old age, male gender, an increased time duration between the last known normal and hospital arrival, lack of awareness of risk factors, and alcohol consumption for a duration of more than 1 year were independent predictors of increased stroke severity at admission. Headache, dysphagia, low GCS, sub-normal higher mental functions, an abnormal respiratory rate, abnormal Doppler findings, an increased total leukocyte count, and creatinine were independent predictors of stroke severity at admission.

Background: Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) is usually associated with adverse health outcomes in terms of poor nutritional status and impaired quality of life (QOL) often leading to marked morbidity and mortality. Early initiation of antiretroviral therapy (ART) can have a major impact on the overall well-being of HIV-inflicted patients helping them to live a functionally independent life. Aim: The purpose of our study was to determine the short-term impact of ART on the QOL and nutritional status of retropositive patients. Methods: A prospective study was conducted in the Department of General Medicine, Functionally Integrated Anti-retroviral Therapy (FIART) area on 60 ART-naive retropositive patients who were assessed for improvement in nutritional status and QOL domains after 3 months of ART. Results: The patients were assessed before and after the initiation of therapy and showed improvement in the anthropometric parameters along with improvement in the QOL which was assessed using the six domains using the World Health Organization (WHO) questionnaire. Both the parameters were compared on the basis of gender, education, and socioeconomic class. Male patients with higher education and those belonging to higher socioeconomic strata showed better improvement as compared to others. Conclusion: Improvements in the nutrition and QOL are visible even in the initial short-term follow-up and these are important parameters in global assessment for health and well-being in HIV/AIDS.

Background: Platelet count has been widely used to evaluate the severity, guide management and predict outcome in patients with dengue fever. This sole use, however, has prevented the utility of other platelet indices like Mean Platelet Volume (MPV) and Platelet Distribution Width (PDW) from being explored. Objectives: To study the association of MPV and PDW with the disease severity in patients with dengue fever. Materials and Methods: This prospective observational study was conducted in a tertiary care centre of Northern India for a period of one year. A total of 100 patients with confirmed dengue infection who fulfilled the inclusion criteria were followed from the day of admission to recovery. Clinical and laboratory findings, including platelet parameters were noted. They were classified on the basis of World Health Organization (WHO) 2009 criteria, and MPV and PDW values were correlated in each category. Pearson correlation analysis was performed for correlation identification between platelet indices and disease severity. Results: 64% patients with dengue fever had a low MPV (<9.0 fl). An increased PDW (>13 fl) was observed in 77% cases. A significant correlation was observed between low MPV and platelet count in severe dengue (P value <0.01). Strongest correlation was observed between low MPV and severe dengue (r value 0.745). No significant correlation was witnessed between PDW and severity of infection. Conclusion: Mean platelet volume may serve as an additional laboratory marker to predict severe dengue infection, but PDW is inferior in delineating the disease severity.

Background: Osteoporosis is a skeletal illness in which bone strength is weakened, resulting in an increased risk of bone fragility. The homeostatic process is disrupted. The rate of bone resorption is faster than the rate of bone turnover. Osteoporosis causes bone to become porous, brittle, and weak, allowing it to fracture easily under loads that would break normal bone. Materials and Methods: This is a descriptive cross-sectional study conducted for a period of three months from June 2021 to August 2021 at a tertiary care hospital in Chennai, among the population consisting of staff nurses between one and twenty years of experience. A total of 30 staff nurses were selected for this study by a convenient sampling technique after receiving the ethical committee permissions from the institution. Results: The findings of the current study revealed that 16.7% of the respondents belong to the age group of 25–30 years and 30% of the staff nurses were in the age group of 36–40 years and 26.6% of the respondents belong to 31–35 and 41–45 respectively. With respect to the designation, majority, 25 (83%) of samples were staff nurses and 5 (17%) of samples were head nurses. Conclusion: Overall, nurses have little to moderate awareness of osteoporosis, according to the findings. As a result, nurses must make more efforts to improve their understanding of osteoporosis prevention and treatment in order to provide better patient care.

Background: Several scoring systems have recently emerged to predict stone-free rates (SFRs) after percutaneous nephrolithotomy (PCNL). We aimed to compare the most commonly used scoring systems (Guy's stone score, STONE nephrolithometry and Clinical Research Office of the Endourological Society (CROES) nomogram) and assess their predictive accuracy for stone-free rates (SFRs). We also evaluated these scoring systems in their ability to predict perioperative complications, operative time (OT), length of hospital stay (LOH) and postoperative fall in haemoglobin. Methods: We prospectively evaluated 50 consecutive patients with renal calculi who underwent PCNL at our institute for two years. Preoperative CT was done in all the patients. We applied GSS, STONE nephrolithometry and CROES nomogram in all patients. The association of these scoring systems with SFR, perioperative complications, OT, LOH and fall in haemoglobin was evaluated. Results: The overall SFR in our study was 94%. The mean score of GSS, STONE and CROES was 1.66 ± 0.71, 7.08 ± 1.77 and 86.9 ± 4.35. GSS (AUC – 0.86) and S.T.O.N.E nephrolithometry (AUC – 0.837) score effectively predicted SFR, unlike CROES nomogram (AUC – 0.223). The overall complication rate was 54%. GSS (AUC – 0.643) and S.T.O.N.E nephrolithometry (AUC – 0.628) score effectively predicted post-operative complications, unlike CROES nomogram (AUC – 0.308). All three scoring systems (GSS, STONE and CROES) significantly correlated with OT (P < 0.01). None of the scoring systems correlated with LOH. GSS and CROES nomogram showed a weak correlation with fall in Hb. Conclusion: GSS and STONE nephrolithometry effectively predicted SFR and perioperative complication, unlike the CROES nomogram. All scoring systems correlated with OT. Scoring systems did not correlate with LOH. GSS and CROES nomogram weakly correlated with fall in haemoglobin.

Background: Mental health is a state of harmony between oneself and one's surrounding. According to the Indian Ministry of Health and Family Welfare, it is estimated that by 2020, depression will be the major cause of morbidity next to cardio-vascular disease in India. More than 90% of these cases remain untreated because of various factors such as social stigma, economical factors, and lack of awareness among the general public. Hence, this study was planned owing to the emerging mental health problems especially among women with an aim to estimate the prevalence of depression among women in rural areas and to identify the various determinants of depression. Materials and Methods: A community-based cross-sectional analytical study was conducted among women of the reproductive (15–45 years) age group residing in Sembakkam village for a period of 2 years using a semi-structured validated schedule after obtaining informed consent. Becks depression inventory scale was used for estimating the prevalence of depression. Data were analyzed using the Statistical package for social sciences (SPSS) version 23.0. Results: The prevalence of depression was found to be 17.9%. Socio-economic statuses of the respondents and religion were found to be statistically significant with depression. Among women with depression, 96.1% of them did not have any disputes with their family members, but 19.4% of their family members were alcoholics. Conclusion: Psycho-social and socio-demographic determinants were found to be important determinants of depression. Interventions focused on tackling these determinants and maintaining a positive outlook will help in averting depression.

Context: Acne vulgaris is a chronic inflammatory disease of the pilosebaceous follicles, characterized by comedones, papules, pustules, nodules, and often scars. Patients with acne feel self-conscious about the recurrence of skin lesions, especially their redness and scarring and often describe feelings of embarrassment, low confidence, depression, stress, and anxiety. Aim:

• To assess the levels of anxiety and depression in patients with acne vulgaris.
• To assess the relationship between the severity of acne and anxiety and depression.

Setting and Design: Designed as a cross-sectional study conducted at a tertiary care hospital. Methods and Material: This is a cross-sectional study involving 100 patients diagnosed with acne vulgaris in the dermatology venereology leprosy (DVL) outpatient department between 18 and 40 years of age. The Global Acne Grading System (GAGS) was applied to assess the severity of acne. The hospital Anxiety and Depression Scale (HADS) was used to assess the levels of anxiety and depression in patients with acne vulgaris. Statistical Analysis Used: Statistical analysis was done using the statistical package for social science (SPSS) version 25. Results: GAGS revealed 14 subjects to be having mild acne, 34 moderate, 40 severe, and 12 very severe acne. Symptoms of anxiety were observed in 74 subjects and depression in 48 subjects. A statistically significant association (P<.001) was found between the severity of acne and anxiety and depression. Conclusion: High proportion of patients with acne had anxiety and depression, which were found to be significantly associated with the severity of acne.

Introduction: Urinary tract infections (UTIs) are one of the widespread human microbial disorders affecting all the age groups, which may involve the whole part of the urinary tract from the urethra to kidneys and are associated with a significant burden of mortality and morbidity. Although various microorganisms, including viruses, fungi, and parasites, are responsible for UTIs, bacteria are the leading cause. The prevalence of uropathogens in cases of UTI varies according to demographic features, community or hospital-based and also due to the use of different antibiotics in the community and hospital settings. Aim of the Study: To determine the prevalence of uropathogens and their antibiotic susceptibility pattern in rural populations. Study Design: This is a cross-sectional observational study conducted at the Department of Microbiology, Dr.PSIMS & RF, Chinaoutapalli, Andhra Pradesh. Materials and Methods: A total of 1378 clean-catch midstream urine samples from clinically suspected cases of UTI which were received from outpatient and inpatient set-up of various clinical departments were processed according to standard protocol and guidelines and the isolated pathogens were subjected to antibiotic susceptibility testing by Kirby-Bauer disc diffusion method and interpreted according to CLSI guidelines. Results: In the present study, the prevalence of UTI is 29.53%, where Escherichia coli is the predominant isolate (56.06), followed by Klebsiella spp (16.95%) and among Gram-positives, Enterococcus faecalis is the predominant isolate (10.81%) followed by Staphylococcus aureus (2.70%). Conclusion: As the prevalence of bacterial uropathogens as well as their antibiotic sensitivity pattern varies in different geographical locations and time to time it is important that the diagnosis of UTI is not only dependent on the clinical signs and symptoms, it should be correlated with the positive urine culture and the antibiotic susceptibility pattern of the uropathogen isolated. Without having knowledge about the prevalence of uropathogens in that particular area and their susceptibility pattern, starting empirical antibiotic therapy will not only prolong the disease and lead to complications in the patients, and a negative consequence will also be added in the form of the development of multidrug resistance (MDR).

Context: Although the traditional methods of medical education have proven to be of utmost value, exploring the new aspects of today's millennial generation is essential to move forward and gain knowledge. Aims: To provide insight into students' perspectives about the availability, accessibility, and utility of social media in medical education. To understand the impact of social media on medical education postpandemic. Methods and Material: After obtaining clearance from the institutional ethical committee, a semi-structured questionnaire with open and closed-ended questions related to social media and medical education was created and circulated randomly to medical students, interns, and medical graduates through various online groups. The study was conducted for a month in December 2020, and the responses obtained were analyzed. Statistical analysis used: Statistical Package for Social Sciences (SPSS) Software 25.0 (IBM). Results: A total of 415 responses were recorded. A total of 99.3% of the students owned a smartphone, and 15.9% mainly utilized it for educational purposes. A total of 89.4% of the students didn't solely rely on the information from the internet. A total of 80% of the students only plan to use social media as supplementary aids. A total of 57.6% of the students found video content most informative, and 49.2% found social media interactive. A total of 80.5% of the students have agreed that social media has enabled studying during the recent COVID-19 pandemic. Conclusions: The study suggests that students perceive judicious use of social media as an advantageous addition to the present learning patterns of medical education. The deleterious effects of it can be reduced by productive usage. The recent pandemic encouraged students to use social media for learning.

Background: The pharmaceutical companies are flooded with newer and numerous antimicrobial agents. At the same time, bacterial resistance is more challenging and problematic and the biggest threat to Global health of India. Therapeutic failure complicates presentation and sensitivity patterns create a dilemma for the prescriber, and sometimes, the patients respond erratically to antimicrobial agents. This problem will cause 10 million deaths per year by 2050. Culture and sensitivity reports will benefit both the doctors and patients simultaneously. It can affect anyone at any age, and in any country. Therefore, a study was conducted in the new medical college to establish own sensitivity and resistance pattern of this instituition. At the same time, it prevents inappropriate or irrational use of antibiotics, rapid emergency of resistance, adverse drug reaction, higher cost to the patient, longer hospital stays and increases mortality. Aim and Objective: To know the sensitivity and resistance and sensitivity patterns of antimicrobial agents; regulate and promote the appropriate use of antimicrobial agents in PRMMCH, Baripada, Mayurbhanj. Materials and Methods: This prospective study was conducted from May to October 2019 in PRMMCH, Baripada, Department of Pharmacology, in collaboration with the Department of Microbiology. The data were collected from culture sensitivity reports of all positive samples of urine, throat swab, and blood culture from the microbiology department on the prescribed format and finally be analyzed by percentage. Result: The total number of samples with positive culture was 100. Staph aureus was positive in 60%, E. coli 10%, Enterococcus sp and Klebsiella sp 7%, Pseudomonas 6%, Acinetobacter 5%, Citrobacter sp 3%, and Corynebacterium sp 2%. Conclusion: More studies are needed to evaluate the sensitivity and resistant pattern of the microorganisms to different antibiotics from different clinical specimens in this geographical area.

Various metastatic solid tumors including renal cell carcinoma are treated with multikinase inhibitors like sorafenib and sunitinib which produce various cutaneous side effects. We report a case of sorafenib induced hand foot skin reaction, in a 75 year old female presented with complaints of bullae over palms and soles preceded by pain and burning sensation after first cycle of sorafenib chemotherapy 400mg BD for metastatic renal cell carcinoma. On examination, multiple tense, well defined tender bullae with surrounding erythema and with yellowish tinge on both palms and soles. She was advised for dose reduction of sorafenib to 200mg BD, topical clobetesol propionate and to avoid friction. She completed five cycles of sorafenib with said dose and was doing well. HFSR is a dose limiting cutaneous toxicity occurs within 3-6 weeks of treatment, dose reduction and simple treatment are sufficient to overcome. As the drug is excreted in the sweat glands it results in dose dependant direct skin toxicity .The differential diagnosis were hand foot syndrome, erythema multiforme, chemotherapy induced raynaud's disease, erythromelalgia, other cutaneous drug reactions. Awareness about the adverse cutaneous reaction to sorafenib is important to alert the clinicians which can be tackled successfully.

Various dermatological manifestations have been reported in this pandemic of COVID-19. COVID and autoimmunity is known. We report a case of Bullous pemphigoid associated with COVID-19. Clinical features were suggestive of Bullous pemphigoid which was confirmed by histopathology, direct immunofluorescence and salt split technique. Patient did not respond to conventional therapy for BP. However, she responded dramatically to COVID-19 treatment with antiviral therapy. Though rare, this association between COVID and BP needs to be kept in mind while evaluating BP lesions during this pandemic.

The cardiovascular system is one of the commonly affected systems in various inflammatory and metabolic conditions, and rhythm abnormalities are most vulnerable in this context. Here, we are describing a rare presentation of acute pancreatitis, in which a young male appeared with cardiac rhythm irregularity. The patient presented with localized chest pain of recent onset and had a blood pressure of 88/54 mm Hg initially. On electrocardiogram (ECG), an accelerated idio-ventricular rhythm was identified with the absence of P wave and borderline QRS complex duration. However, his electrolytes were normal, qualitative troponin T was negative, echocardiography ruled out structural cardiac anomalies, and coronary arteries had no occlusion in angiogram. In the absence of any identifiable cause, the recent alcohol intake history made us to measure his serum amylase and lipase levels, and surprisingly, the levels were more than three times the upper value. Additionally, his ultrasound of the abdomen depicted bulky pancreatic head, and thus, the diagnosis of acute pancreatitis was made. Rhythm abnormality subsided with conservative management and the patient was discharged with a normal ECG. The case will shed some light on pancreatitis-associated acute cardiac rhythm abnormality, which is uncommon in emergency department.

Splenic artery pseudoaneurysms are a rare complication of pancreatitis and occurs due to erosion and weakening of the vessel wall by enzyme rich peri-pancreatic fluid by the cells or contained within an adjacent pseudocyst. Although pseudoaneurysm rupture associated with pancreatitis is very rare, it has a high mortality rate of up to 40%. Therefore, it is necessary to have a sufficient knowledge of this catastrophic complication to make prompt diagnosis and treatment, that is critical in the management of pseudoaneurysms.

Endocervical polyps constitute the most common new growths of the uterine cervix. They are most often found during the fourth to sixth decades and in multigravidas. The paucity of smooth muscles in the cervical stroma makes the leiomyomas uncommon in the cervix and accounts for less than 1% of all fibroids. Cervical leiomyomas or fibroids usually arise from the supravaginal portion of the cervix. Studies indicate that the prevalence of atypia, dysplasia, and malignancy in cervical polyps is none to very low. The occurrence of neoplastic change in the overlying mucosa of the leiomyomatous cervical polyp is extremely rare. There has been only a single case of squamous cell carcinoma (SCC) arising on the mucosal surface of a cervical leiomyomatous polyp. We are presenting a case of SCC arising from the mucosal surface of the cervical leiomyomatous polyp.