Background: Prolonged use of visual display terminal images on electronic devices such as computers frequently leads to symptoms of dry eye. Tear substitutes form the mainstay of treatment for mild-to-moderate dry eye. Aim: The study aimed to evaluate the efficacy and safety of carboxymethyl cellulose (CMC) versus hydroxypropyl methylcellulose (HPMC) tear substitutes for dry eye due to computer vision syndrome (CVS). Materials and Methods: This was a prospective, randomized, comparative, and open-labeled study. The efficacy of CMC 0.5% and HPMC 0.3% tear substitutes was compared in 180 participants (90 in each group) with dry eye. Change in Ocular Surface Disease Index (OSDI) score, Schirmer I test score, and tear film break up time (TF-BUT) were used as efficacy parameters. Safety was monitored on all visits. Results: The baseline OSDI score? 23.48 and 23.32 in Group A and B, respectively, decreased with treatment in both groups on all follow-up visits as compared to the baseline (day 90: 13.9 ± 3 vs. 14.81 ± 3.17, P: 0.01). The scores of Schirmer I test increased in both groups, with a greater improvement in Group A (at day 90: 22.75 ± 3.04 mm vs. 21.78 ± 3.36 mm, P: 0.04). The values of TF-BUT improved in both groups, the difference being statistically insignificant. An initial stinging was reported by one participant, each in both groups. Conclusion: CMC and HPMC tear substitutes were equally efficacious and safe in reducing symptoms of dry eye due to CVS.

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Context: Feedback is integral in medical education as it improves learner's knowledge, skills, and professional competence, however it is not routinely practiced in medical colleges. Therefore, the present educational research project was designed in a need-based attempt to introduce and implement a program of structured feedback in the department of biochemistry in the first professional MBBS. Aim: The aim was to introduce and implement a program of structured feedback in biochemistry for 1^st year medical undergraduates and to collect students' and faculty perceptions about its effectiveness. Settings and Design: it was a prospective, nonrandomized, interventional study. Methods: The study was conducted over 135 first professional undergraduates with six faculties. The feedback questionnaires to assess the perceptions of students and faculty on the feedback program were designed and peer-expert validated. An educational program for giving structured feedback was designed, peer-expert validated, and introduced and perceptions of students and faculty were collected using the feedback questionnaires. The collected data were analyzed in terms of percentages, medians, modes, and satisfaction index and represented in graphs. Transcripts were prepared for qualitative data, themes were identified, and a thematic map was prepared. Results: Students (n = 135) perceived the feedback sessions to be helpful in making them aware about their learning gaps (70%) and facilitated the process of bridging the learning gaps (62%). Students strongly agreed that feedback has helped in better understanding of the topic (82%), better retention (69%), and acted as effective learning tool (68%). The faculty did not find the feedback sessions as extra burden in their routine schedule (83%). The main themes identified were “More interaction with teacher,” “Increased motivation,” “Student centric,” “Less stressful,” “Improved confidence,” “Identification and bridging of learning gaps,” “Improved efficacy to attempt questions,” and “Improved learning.” Conclusions: The feedback program was perceived satisfactory by both students and faculty agreeing upon more of such sessions and implementation in the curriculum in the near future.

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Context: People living with HIV (PLHIV)/AIDS are faced with the task of maintaining optimal health status despite an increasing insult to their immune status. Antiretroviral therapy (ART) centers provide comprehensive services to all PLHIV enrolled under the program. Patients with higher satisfaction levels may also have improved health outcomes. Aim: The aim of this study was to assess the client's satisfaction on ART service delivery and to identify the factors associated with client's satisfaction. Settings and Design: This was a facility-based, cross-sectional study. Materials and Methods: The study was conducted from August to October 2018 at the ART center of Rajamahendravaram. A total of 485 HIV-positive clients above the age of 15 years on ART for >6 months were selected by systematic random sampling after taking informed verbal consent. Data were collected by interviewing with the help of a validated structured English-version Likert-scale questionnaire, that is, University of Gondar College of Medicine and Health Sciences Institute of Public Health Pro forma. Statistical Analysis Used: Binary logistic regression and Chi-square test were conducted to identify the association between the explanatory variables and outcome variables (patient satisfaction). Results: The mean age of the clients was 39.6 ± 9.9 years. The overall satisfaction rate among the clients was 92.6%. Age, marital status, education, family income, socioeconomic status, and the waiting period to see the doctor were statistically significantly associated with the level of satisfaction of the clients (P < 0.05). Conclusion: The present study shows high levels (92.6%) of client satisfaction with services provided at the ART center, Rajamahendravaram. This motivates the health-care workers, program planners, and policymakers for a better continuum of care.

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Background and Objectives: Urinary tract infections (UTI) are one of the most frequent infections encountered in hospital settings as well as in community, making urine the most cultured specimens in laboratories across the world. Urine samples occupy most of the time and manpower in the form of resources in the microbiology laboratories. The microbiological performance of HiCrome UTI agar was compared with cysteine lactose electrolyte deficient (CLED) agar for isolation and presumptive identification of bacteria from urine culture with ease of reporting with less human resource and reduction in the cost. Materials and Methods: The study was conducted in a total of 208 collected midstream catch urine samples from patients attending the Department of Microbiology, Khartoum Teaching Hospital Central Laboratories. Urine samples received in the bacteriology laboratory were inoculated on CLED agar and for HiCrome UTI agar simultaneously and incubated overnight. Isolates were identified by the colony's color for HiCrome UTI agar and by standard microbiological techniques for CLED agar. Results: Out of 208 urine samples tested, significant growth was obtained in 94 (45.2%) plates of CLED agar and 84 (40.4%) of HiCrome UTI; moreover, 15 (7.2%) and 28 (13.5%) plates showed mixed with no growth observed in 99 (47.6%) and 96 (46.1%) on CLED agar and HiCrome UTI agar, respectively. The rate of presumptive identification was found significantly higher on HiCrome UTI agar (94%) than CLED agar (84%) (P < 0.05) as the primary urine culture medium. out of 43 (100%) polymicrobial growths 28 (65.1%) were demonstrated distinctly on HiCrome UTI agar and only 15 (34.9%) were obtained from CLED agar. Conclusions: HiCrome UTI agar was found to be more useful as a primary urine culture medium in both higher rate of isolation and presumptive identification of uropathogens in comparison to conventional media. Its inherent characteristics in demonstrating polymicrobial growth and ease of rapid identification by distinct colony color are unique.

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Context: Soft neurological signs are present more frequently in schizophrenics than other patients suffering from other psychiatric illnesses and normal individuals. Objectives: The objective of this study is to find out the causal relationship of neurological soft signs (NSSs) to schizophrenia. Materials and Methods: The study was initiated after taking approval of the institute ethics committee. A total of thirty schizophrenic patients and thirty controls were included in the study. Their diagnosis was confirmed by consultant and then were administered Neurological Evaluation Scale developed by Robert Buchanan. The accumulated data were then analyzed statistically. Results: This study shows a higher prevalence of NSSs in schizophrenia as compared to controls. Conclusion: To ascertain their role in aetiogenesis and pathogenesis of schizophrenia, further research is needed.

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Context: Introduction of competency-based medical education in India has necessitated a diversion from traditional methods of teaching and assessment. Aim: The aim of this study was to assess the feasibility and acceptability of mini-clinical evaluation exercise (mini-CEX) as a tool for formative assessment of postgraduates in psychiatry at our institute. Settings and Design: It was a prospective, quasi-experimental study carried out in the Department of Psychiatry, PGIMS, Rohtak (India). Materials and Methods: After obtaining written informed consent, trainees (18) were sensitized and faculty members (5) were trained to use mini-CEX and regarding the feedback process with the help of workshops. Statistical Analysis Used: Data collected were analyzed using descriptive statistics. Mean differences between the sessions were assessed using a paired sample t-test. P < 0.05 was considered as level of significance. Results: Statistically significant difference was found between session 1 and session 6 for counseling skills but not for three sessions of diagnostic skills. Mini-CEX was accepted as a better learning method by 61% of the postgraduates, 36% felt that it improved their clinical skills, 64% reported a boost in their confidence, and 89% looked forward to these encounters. Majority of the postgraduates and faculty members suggested that the mini-CEX should be regularly used in academic settings and should be introduced early in the training. Conclusions: Mini-CEX is a feasible formative assessment tool for postgraduates in psychiatry and an effective method of learning by the postgraduates, inducing a significant improvement in the counseling skills of students. Teaching faculty also accepted mini-CEX as an effective method of formative assessment.

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Churg-Strauss syndrome (CCS) or eosinophilic granulomatosis with polyangiitis is a rare condition, which is a challenge for both diagnosis and treatment in clinical work. Occurrences of cardiac complications represent a negative predictor of treatment outcome for these patients. The aim of this article is to present the diagnostic and therapeutic modality of a 33-year-old male diagnosed with? CCS. Treatment of these patients should be multidisciplinary, with a comprehensive therapeutic modality, while early diagnosis is imperative.

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Background: Incisional hernia remains a frequent complication of abdominal surgery. Results of surgical repair are disappointing with recurrence rates of suture repair being in the range of 5%–63% depending on the type of repair used, with better results using mesh implantation. For the management of such large hernias, interest has been generated in the Component Separation Technique. This technique relaxes abdominal wall by translation of muscular layers without severing the innervation and blood supply, with or without the mesh augmentation. This can accommodate for defects up to 25–30 cm in the waistline. Materials and Methods: The study was conducted on 20 patients with “Large Incisional Hernia” with defect size >5 cm at its maximum width or with a surface area >50 cm² operated upon with Component Separation. Clinical outcome was measured over a follow-up period of 3 months from the surgery in terms of recurrence and other local complications. Results: There were 20 patients (3 men and 17 women; 70% of cases above the age of 50 years). Mean defect size was 9.5 cm (range = 6–20 cm). Average body mass index was 28.97 kg/m² (range = 22–37 kg/m²). Mean duration of hospital stay was 9 days (range = 5–21 days). Early complications occurred in 15% (3/20) cases and postoperative abdominal compartment or recurrence was not reported over a follow-up period of 3 months. Conclusions: Component Separation Technique is a safe, easy, and quick option for patients with large hernias.

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Background: Multi-parametric magnetic resonance imaging (mp-MRI) is a promising tool in the diagnosis of clinically significant prostate cancer. Morphologic assessment using T2-weighted (T2W) images and functional assessment with diffusion-weighted imaging is the cornerstone for the diagnosis of prostate cancer on mp-MRI. Aim/Objectives: The aim of this study is to evaluate the role of mp-MRI based prostate imaging reporting and data system version 2 (PI-RADS v2) for the assessment of prostate cancer and its correlation with serum prostate specific antigen (S.PSA) levels, local (T) staging on MRI and histopathology. Materials and Methods: The study was carried out from June 2019 to February 2020. All patients with raised S.PSA levels and abnormal digital rectal examination who underwent mp-MRI of the prostate were included. MRI findings were characterized on the basis of PI-RADS v2 grading. All the patients underwent biopsy and histopathology. The score was correlated with S.PSA levels and the local stage of disease on MRI. Statistical analysis was performed, and results interpreted. Results: Carcinoma prostate was reported in 32/33 cases on biopsy. A significant correlation was observed between PI-RADS v2 score and S.PSA Levels and between PI-RADS v2 score and T stage of disease in our study. MRI was highly sensitive (93.75%) and specific (100%) in the diagnosis of prostate cancer in our study. Conclusions: Significant correlation between lesion score on PI-RADS v2 with the local stage and S.PSA levels was seen, thus signifying the importance of mp-MRI in detecting clinically significant prostate cancer. Diffusion-weighted and T2W sequences were the primary diagnostic sequence for the prostate cancer with no additional role of dynamic contrast enhanced sequences.

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Myelolipoma of the kidney is a very rare benign disease which is composed of mature adipose tissue admixed with mature hematopoietic elements in varying proportions. The most common location of myelolipoma is in the adrenal glands, but extra-adrenal myelolipomas in other locations such as the retroperitoneum, presacral region, pelvis, and mediastinum has also been reported. In this case report, we present a case of huge extra-adrenal myelolipoma in renal parenchyma which is rare site for its origin. We report a case of extra-adrenal myelolipoma occurring in the left kidney of a 46-year-old Indian man. We describe the radiological and clinicopathologic features of this unusual tumor with a review of the literature. This case is noteworthy because the tumor was very enlarged and its site was unusual. It is generally impossible to distinguish extra-adrenal myelolipoma from other retroperitoneal tumors by radiological imaging given the rarity of tumor more cases need to be reported to elucidate its biological behavior.

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Mycoses fungoides is a common cutaneous T cell lymphoma. Tumor and ulcerative stages are advanced lymphoma. We report a case of mycosis fungoides that presented with ulcerated plaques and nodules over the body and infraorbital region, he was being treated as leprosy without improvement of the lesions. Diagnosis was established with clinical presentation and histopathology of the lesion.

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We present a rare case of simultaneous occurrence of pleomorphic adenoma of the left parotid gland and squamous cell carcinoma (SCC) of left buccal mucosa in a 59-year-old patient. The synchronous occurrence of these two entities has not been reported in the literature. A PubMed database search did not yield any results for search words involving “Oral Cancer,” “Synchronous Oral Cancer and Pleomorphic Adenoma of Parotid gland” and “Oral SCC and Pleomorphic Adenoma of Parotid gland.” Furthermore, synchronous development of these two tumors may give rise to diagnostic and ma?nagement conundrums as the parotid growth may be considered to be a nodal metastasis.

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Encephalotrigeminal angiomatosis, also called Sturge–Weber syndrome (SWS), is a syndrome of etiology which is not yet clear. It is a nonhereditary condition. The clinical features include pigmentation over the facial skin known as port-wine stain, abnormalities of ocular region, and central nervous system involvement as leptomeningeal angioma. In this manuscript, we present a rare case report with an unusual combination of SWS with facial lobular capillary hemangioma.

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The term cholesteatoma refers to “chole”: cholesterol, “steat”: fat and “oma,”: “tumor”. This tumor has been reported to be the most common in the middle ear. The occurrence of such a tumor in the maxillary sinus is deemed to be very rare and hardly 4 cases were reported in India and 26 cases described worldwide. This case report intends to discuss the uniqueness and indolent nature of this lesion in terms of histopathology and radiography.

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