This article reviews and describes the theoretical concept of organ donation (OD) and transplantation, historical milestones, need, shortage, status of global activities, health system capacity, survival outcome, and update on legislative environment in India, Central/State contribution and Nongovernment Organizations actively involved in OD.

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Successful kidney transplantation offers the best possible quality of life for patients with end stage renal disease (ESRD). Despite this, renal transplantation rates in the developing world are considerably lower than in the developed world. Identified reasons for this include lack of awareness, low education levels, lack of a clear national policy, absence of functional dialysis and transplant units with adequately trained staff, and absence of an organized system of organ retrieval from deceased donors and lack of opportunities to fund long-term immunosuppression. Measures to improve the quality of care should center on improvement of the socioeconomic status of the country. Key action points include the implementation of: (1) Chronic kidney disease (CKD) screening and prevention programs; (2) ESRD and transplantation registries; (3) transplantation legislation, covering both living and deceased organ donation; (4) international and regional collaborations for transfer of knowledge and technology. The government should make transplantation more affordable by strengthening the public sector hospitals and by making the transplant medication more affordable. With the National Organ Transplant Programme (NOTP) in the process of being established in India, the transplant community should strive to increase the organ donation awareness, improve the infrastructure for organ retrieval, storage and allocation in an equitable way.

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Food safety refers to all those hazards which make the food unsafe to health. The unsafe food creates a vicious cycle of disease and malnutrition which affect all age groups but in particular children, the elderly, and the sick. Foodborne diseases are important hidden causes of morbidity. This article has been written with an objective to assess the current status of food safety and related issues in India and the measures to improve the same. Though most of the foodborne diseases are sporadic and often not reported in India, a nationwide study reported an alarming 13.2% prevalence at the household level. Currently, the mainstay for food safety in India is a legislative approach. The Indian food industry is regulated by the number of legislations covering sanitation, licensing, and permits. Food Safety and Standards Authority of India established by the Government of India develop the standards for food and regulate and monitor the manufacture, processing, storage, distribution, sale, and import of food so as to ensure the availability of safe and wholesome food for human consumption. The literature review shows that the consumer awareness is not very good in India in relation to food safety. There is a need to initiate the public health surveillance for food safety and foodborne diseases. Legislations related to food safety should be enforced strictly. The consumer awareness should be an important part of all initiatives.

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Anticoagulants are routinely used in stroke, embolism, infarct, etc. Blood clotting profile in such patients needs to be monitored frequently. Anticoagulants which can be administered orally such as warfarin and dicoumarol are preferred in such patients. Injectable anticoagulants such as heparin are prescribed when anticoagulation therapy is required for short duration. Absence of oral form of heparin makes it impractical for long-term use. Currently, warfarin and coumarone derivatives are the best available oral anticoagulants in market. They act by inhibiting decarboxylation of blood clotting factors II, VII, IX, and X. Pharmacological response of warfarin and dicoumarol needs to be monitored by frequent assessments of prothrombin time (PT) and international normalized ratio (INR). There is a need for a drug which can overcome these limitations. Apixaban is an oral anticoagulant which acts by inhibiting factor Xa. It does not require laboratory monitoring of PT and INR. Hence, it overcomes the limitations of heparin and warfarin. It acts by selectively inhibiting the activated factor Xa in a reversible manner. Apixaban has an oral bioavailability of ~50%. It is administered as twice daily dose. It is excreted in urine and feces. Apixaban is useful in atrial fibrillation, venous thromboembolism, and pulmonary embolism. Bleeding is the major side effect of apixaban. It has been found that apixaban has superiority over warfarin and aspirin in terms of efficacy and safety. Further studies are required to monitor and assess the pharmacokinetics, efficacy, adverse effects, and drug interaction data in many populations and sub-populations throughout the world.

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Over the last 17 years, liver transplant in India has evolved from a rarity to a common procedure available along the length and breadth of the country with survival data comparable to the best centres in the world. India is now in the forefront of Living donor liver transplant (LDLT) in the world, led by the team of the principal author. LDLT is possible for all types of recipients and indications with 95% success, with low incidence of vascular complications and biliary complications. While Deceased donor liver transplants (DDLTs) have picked up steam in Southern India, there is still a large gap between demand and supply of organs. LDLT is essential to bridge this gap and continues to be the main curative option for the majority of patients in India suffering from end-stage liver disease and Hepato cellular carcinoma (HCC) confined to the liver.

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Background: Mosquito-borne diseases constitute an important cause of morbidity and mortality, especially in India. Assessment of knowledge and practices of community about prevention of mosquito borne diseases is important for designing community-based interventions. Therefore, the study was carried out to assess such information. Materials and Methods: A community-based cross-sectional study was conducted among 350 adults selected by systematic sampling method in a rural and urban area in Delhi. Data was collected using pretested semi-structured questionnaire after taking written informed consent. Data was analyzed using SPSS version 17. Chi-square and Fisher's Exact test was used for qualitative variables to find association and P <</i> 0.05 was considered significant. Results: One hundred and forty-two (67.6%) subjects in rural and 89 (63.6%) in the urban area were able to name at least one mosquito borne disease. Only small number of participants (from rural 28.1% and urban 18.6% areas) was aware of "fever with chills and rigor" as a symptom of malaria. Television was most common source of information in both rural and urban areas. Desert coolers were reported to be cleaned regularly in a week in 86.4% houses in a rural area, and 88.4% houses in the urban area. Potential breeding sites were significantly more in urban (n = 34, 24.3%) than rural (n = 13, 6.2%) houses (P = 0.01). Similarly actual breeding of mosquitoes was found significantly more in urban houses (n = 29, 20.7%) than rural houses (n = 14, 6.7%), which was statistically significant (P = 0.01). Knowledge about mosquito borne diseases was significantly associated with education status of the participants. Conclusion and Recommendation: Level of awareness was good; however mosquito breeding was occurring more in urban areas, which demands innovative mass media techniques to convey health messages to the public for prevention and control of mosquito borne diseases.

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In the ongoing Corona Virus Disease-2019 (COVID-19) pandemic, the role of health care professionals and outreach workers is indispensable towards the prevention and control of the disease. Anticipating the risk that the disease might land up into stage 3, a wide range of interventions have been implemented. However, the most important strategy will be to spread awareness about the disease and intensify actively search for the suspect cases in the community and here comes the role of outreach community workers. As the doctors and other paramedical staff are overwhelmed with the COVID-19 related work and are also involved in the delivery of emergency services, the importance of the role discharged by these community workers is extremely vital. In conclusion, the role of outreach community workers in creating awareness about COVID-19 and the identification of the suspect cases in the community through active search is extremely crucial in containing the disease and interrupting the chain of the transmission.

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Arrow neck injuries are rare in the developed countries due to development of modern firearms and ballistic missiles. However, they are still occuring in developing nations, due to incessant community clashes. Neck region houses the airway, the great vessels and other vital structures, any penetrating injury may result in devastating outcomes. The management can be challenging to even a well-trained surgeon especially in a resource limited center. Therefore, we present our experience in the management of penetrating arrow injury to the neck.

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Objectives: Noncommunicable diseases (NCDs) are the leading causes of death globally, killing more people each year than all other causes combined. NCDs are caused to a large extent by four behavioral risk factors that are pervasive aspects of economic transition, rapid urbanization, and 21 ^st century lifestyles: Tobacco use, unhealthy diet, insufficient physical activity, and the harmful use of alcohol. The aim was to find out the prevalence of risk factors for NCDs in working population. Materials and Methods: A cross sectional study was conducted in working population aged 18 years and above in 10 public institutions. World Health Organization STEPS approach was used to find the prevalence of risk factors. The study sample was randomly selected by using random number generator. Results: A total of 350 participants were included in the study. The overall prevalence of tobacco use was 23.4%. The prevalence of alcohol consumption was 36%. Thirty three percent of the participants was consuming more than five servings of fruits and vegetables per day. Physical inactivity was seen in 51%. 33.1% of the participants were overweight, 6% were obese and 32.6%, 5.8% were hypertensive and diabetic, respectively. Conclusions: This study shows the high burden of risk factors for NCDs in the working population. Action should be oriented toward curbing the NCD risk factors and promoting healthier lifestyles to reduce NCD incidence rates and delay the age of NCD onset.

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Background: Healthcare seeking by pediatric tuberculosis (TB) patients is complicated because of some factors such as lack of knowledge among family members, diagnostic difficulties, limited resources, and treatment challenges. Aims: The aim of this article is to identify the barriers and challenges related to seeking healthcare by pediatric TB patients. Settings and Design: It was a prospective observational study conducted from January 2015 to December 2015 at two chest clinics. Materials and Methods: A predesigned, pretested, and semi-structured questionnaire was used to interview caregivers of pediatric TB patients and followed up at two more occasions, that is, at the end of intensive and of continuation phase, to identify the challenges they were facing during treatment. Statistical Analysis: Data were analyzed using SPSS software version 17 (SPSS Inc., New Delhi, Delhi, India) and P value less than 0.05 was considered significant. Result: The lack of knowledge was a barrier to understand the disease, seeking care, and being compliant with treatment as nearly 40% (41.8%) did not know that TB is infectious and more than half (55.3%) did not know that TB can occur in any age group. Only 14.2% knew about vaccine for TB, but no one had knowledge about isoniazid prophylaxis. Reported challenges in treatment seeking were high transport cost, long distance for higher government facility (83.7%), and interference with daily routine (39.0%), and in-treatment compliance were heavy pill burden (80%), refusal of child to take medicines (41.8%), fear of side effects (71.6%), and difficulty in powdering the medicines (35.5%). Conclusion: Major barrier was lack of knowledge about childhood TB and major challenge was heavy pill burden, which affected the compliance.

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Aims and Objectives: Proton pump inhibitors (PPIs) are the most commonly used drugs in healthcare systems. Their inappropriate use has been reported in several studies. This study was undertaken to assess the prescribing practices, appropriateness of use, and cost incurred on PPI in a tertiary care, public, teaching hospital in India. Methods: A total of 500 inpatients’ records and 600 outpatients’ prescriptions were analyzed. Extent of prescribing, dosing information given, and cost incurred on the use of PPI in both inpatients and outpatients was assessed. The appropriateness of PPI prescribed was analyzed only among inpatients. Results: PPIs were prescribed to 62.2% inpatients and 27% outpatients. Extent of use of PPI was maximum in medicine department in both inpatients (78.5%) and outpatients (44.5%). Complete dosing information was seen in 9.9% (inpatients) and 30.2% (outpatients) prescriptions. In all the prescriptions of outpatients, tablets/capsules were prescribed whereas in inpatients, 79.74% PPI were prescribed as injections. All PPIs were prescribed by branded generic names except three prescriptions in inpatients of the medicine department. Most common PPI prescribed was pantoprazole by the name of PANTOP in both inpatients and outpatients. The use of PPI was appropriate in 7.4% cases, inappropriate in 91% of the cases, and probable in 1.6% cases. Total cost incurred on the prescriptions of inpatients and outpatients was Rs. 10,04,102. Of this cost, Rs. 1,20,085 (11.95%) was spent on PPI. Cost incurred on PPIs in inpatients was Rs. 1,12,621 (11.65%) and in outpatients was Rs. 7463.67 (19.93%). Maximum cost was incurred on pantoprazole in both inpatients and outpatients. Conclusions: PPIs are being prescribed inappropriately to many patients resulting in a waste of economic resources. Lack of regular audits and feedback to prescribers could be the contributing factors. Educational interventions in rational prescription of PPIs are required to encourage their proper utilization for patients.

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Objective: To assess students’ opinion and perception regarding education environment in a government medical college of Delhi, India. Materials and Methods: Dundee Ready Educational Environment Measure (DREEM), a universal, culturally nonspecific, generic 50-item inventory tool was used. Each item is rated on a five-point Likert scale with score ranging from 0 to 4 where 0 = strongly disagree, 1 = disagree, 2 = unsure, 3 = agree, and 4 = strongly agree. MBBS students of three batches (2^nd, 3^rd, and 4^th year) were considered in the present cross-sectional study. Results: A total of 117 (84.1%) available students could be contacted in person, out of whom 71 (60.7%) were males; 94 (80.3%) passed their 12^th class from private/convent school; nearly 88 (75.2%) students opined that administration is student-supportive; and 111 (94.8%) were in self-assessment state of “happiness.” The overall mean DREEM inventory score (range, 0–200) among all the respondents was 130.34 (±15.76), which is suggestive of “more positive than negative.” Statistically (P < 0.05) higher DREEM score was found among senior medical students [score, 136.5 (4^th year) vs. 131.9 (3^rd year) vs. 123.6 (2^nd year)]; those medical students who were globally satisfied (score, 131.2 vs. 119.3); satisfied getting admitted in current medical college (score, 133.0 vs. 115.7); and who opined that administration is student-supportive (score, 133.4 vs. 120.9). Gender, type of school, marks in 12^th class, native place, current residence, supplementary (extra attempt) in university exam, current mental state (sad/happy), and professional satisfaction had no statistical bearing on overall DREEM score. Overall, none of the inventory item (score range, 0–4) had an avg. score more than 3.5, but the score of the majority (42/50, 84.0%) of question items in the present study was in the range of 2–3 points indicating the aspects of the environment that could be improved or enhanced. Conclusion: Within limitations, the study gauges the experiential learning environment from the students’ perspective indicating overall positive results and moving in right direction. Some challenges inherent with medical education and critical areas requiring strengthening were listed including social and leisure time student involvement.

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Dural fistulas associated with dementia are rarely reported and, among these, intracranial dural fistulas constitute an infrequent etiology. Moreover, dementia associated with dural fistulas occurs due to venous hypertension leading to ischemic neuronal dysfunction. This case report describes a male patient exhibiting unusual features of dementia with a concomitant dural fistula compromising the superior sagittal sinus. The fistula was completely occluded via endovascular embolization. Two months after the interventional therapy, clinical assessment revealed complete improvement of executive functions. Afterward, the patient returned to his daily activities without impairment.

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Post-kala-azar dermal leishmaniasis (PKDL) is a dermatosis that usually occurs after visceral leishmaniasis (VL) caused by Leishmania donovani and characterized by macular, maculopapular, and nodular skin lesions on the whole body surface. It is a late cutaneous manifestation of VL in untreated or inadequately treated patients, first described by Brahmachari in 1922. In India, PKDL occurs in 6–20% of the cases of VL, 6 months to 5 years after the apparently successful treatment of VL. The diagnosis of PKDL presents a challenge due to low parasite burden in the lesions. We report a case of PKDL that presented with polymorphic skin lesions along with the involvement of the oral cavity including an insight into the recent advances in diagnosis, pathogenesis, and case management.

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Dengue fever over the recent years has gained attention of not only the health care professionals and researchers, but also public at large and it is a major seasonal health care problem in the tropics and the developing countries. Mortality due to complications such as hemorrhage and shock is well-known and is a major concern for the physician. Neurological manifesations include myelitis and encephalitis have started to gain attention as they present with high mortality and morbidity. We report a case of dengue fever with predominant neurological manifestations of acute disseminated encephalomyelitis (ADEM). The patient presented with fever, vomiting, and altered sensorium of recent onset. On evaluation, the patient was positive for dengue serology and magnetic resonance imaging picture suggested ADEM.

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We report a 70 years old female, who presented with huge swellings over the left forehead, left clavicular region, anterior neck, occipital region and the right side of the scalp. The first swelling appeared 8 years back. She had deranged thyroid function tests and highly raised serum thyroglobulin levels. Her T3 level was 300.75 ng/dl (normal range: 40–181 ng/dl); T4 level was 6.7 µg/dl (normal range: 5–10.7 µg/dl) and thyroid stimulating hormone (TSH) level was 0.09 µIU/ml (normal range: 0.5–8.9 µIU/ml). Her serum thyroglobulin level was 30,000 ng/ml (normal range: 0.73–84 ng/ml). We have reported this case due to the unusual presentation of the patient with massive metastatic lesions from a primary thyroid cancer with highly raised serum thyroglobulin levels. Metastatic tumors to the skull are most often from breast, lung and prostate malignancies. In thyroid cancer, Nagamine et al. reported skull metastasis in only 2.5% of the cases. Along with radioactive iodine therapy, curative resection of solitary bone metastasis, wherever possible, is associated with improved survival, especially in younger patients of metastatic thyroid cancer. Only the light of knowledge and health education can dispel the darkness of ignorance. This rare case report highlights the importance of educating the masses, especially the people living in villages, so that it does not take 8 years, as in our case, to present oneself to a tertiary health care facility.

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Aim: Carbapenems are one of the last resort drugs against drug-resistant organisms and carbapenem resistance (CR) is increasingly being reported. The present study evaluated the CR pattern in general Intensive Care Unit (ICU) of a tertiary care hospital in India. Materials and Methods: This was a retrospective analysis of data collected from May 2011 to January 2012 of 40 patients admitted in the general ICU with a stay of more than a week. The clinical and demographic data, Sequential Organ Failure Assessment (SOFA) score, need for mechanical ventilation, antibiotic sensitivity reports, and outcome were assessed. The results were statistically analyzed using Student's t-test, Mann-Whitney U-test, Chi-square test, and Fisher's exact test, where appropriate. P < 0.05 was considered statistically significant. Results: Acinetobacter baumanii was the most common organism in tracheal samples, Pseudomonas aeruginosa in blood samples and Escherichia coli in urine samples. CR in fresh episodes was seen maximally with Acinetobacter baumanii (79%) and Pseudomonas aeruginosa (70%). Meropenem resistance (MR) was more common than imipenem resistance in CR organisms. High sensitivity among CR organisms was observed to tigecycline and colistin, and among carbapenem sensitive organisms to tigecycline, piperacillin-tazobactam combination, and levofloxacin. CR was prevalent with age >50 years (P = 0.002), ICU stay of >15 days (P = 0.002), mechanical ventilation (P = 0.003), and ventilation >10 days (P = 0.008). Mortality was more common among mechanically ventilated patients (P = 0.002) and those with higher SOFA scores on admission (P = 0.012). Conclusion: Carbapenem resistance is high in microbiological cultures of ICU patients with a stay for over a week. Acinetobacter baumanii and Pseudomonas aeruginosa were the most common CR organisms. MR was more common than imipenem resistance.

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Introduction: Micronucleus/micronuclei) have the potential to serve as an important biomarker in exfoliated cell. Exfoliated buccal mucosal cells can be evaluated using MN assay which can be applied to individuals practicing tobacco habits and are at risk of developing oral cancer. Material and Methods: 80 tobacco users and 20 non tobacco users as control were included in the study. Smears were taken and stained with H&E, feulgen, acridine orange. MN was counted using criteria given by Tolbert et al. Data was analyzed using SPSS software. Results: MN higher in tobacco users. The values obtained for the MN count in tobacco chewers using these stains were statistically significant (P<0.05). The values obtained for the MN count in tobacco smokers using these stains were statistically significant (P<0.05). Qualitatively a good score for staining intensity; MN outline and nuclear outline was obtained for acridine orange, followed by H&E and feulgen stain. Discussion: In our study quantitatively, MN was counted in maximum number using H&E stain, followed by acridine orange and feulgen. Qualitatively, MN count was best viewed using acridine orange stain under a fluorescence microscope, followed by H&E and feulgen under a light microscope. Conclusion: Assessment of MN in exfoliated cells is a promising tool to study epithelial carcinogens in the oral cavity.

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Introduction: Adverse drug reactions (ADRs) are among the leading causes of morbidity and mortality globally. The college has recently been recognized as an Adverse Drug reaction Monitoring Center under the National Pharmacovigilance Program. This study was conducted to assess the knowledge, attitude, and practice (KAP) about pharmacovigilance among healthcare providers and medical students of the college and associated hospital. Materials and Methods: A cross-sectional, questionnaire-based survey was conducted. A pretested, validated questionnaire for assessing the KAP of pharmacovigilance among the healthcare providers and medical students was used. Results: The knowledge and attitude of healthcare providers toward reporting of ADRs was satisfactory. Awareness about the pharmacovigilance activities in the institution was less as only 27.8% were aware. More than 90% participants agreed that reporting of ADRs is important, should be made mandatory, and believed that it would help patient safety in the long term. Less than 50% healthcare providers reported regular ADRs. The reasons for not reporting ADRs included difficulty in knowing whether an ADR has occurred or it is a symptom of disease, lack of time, ADR is already well known, managing the patient is more important, or ADR is mild. Training on how to report an ADR during their professional course was received by 60.4% of the healthcare providers. The pharmacists were less aware, whereas the medical students were well aware about the importance of pharmacovigilance. Conclusion: There is a need to improve the culture of reporting ADRs among the healthcare providers in the institute. The first step would be to increase awareness about facilities and processes in place for reporting ADRs. Incorporation of training about pharmacovigilance in the curriculum of all the healthcare providers may help in increasing awareness and practice of reporting ADRs.

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Zika virus is responsible for causing Zika virus disease (ZVD), is another vector borne disease which is being linked to the sudden rise of microcephaly in few states of United States of America and the cases of Guillain-Barré syndrome in French Polynesia. Looking at the cases and the relation between congenital malformations found in children of women who were suffering from ZVD, it has been declared as public health emergency of international concern by World Health Organization in February 2016 and now it has become important local public threat with impending pandemicity. Case fatality though is not very high but number of suffering individuals crossed 5 lakh alone in Brazil and still increasing. The symptoms are similar to Dengue virus disease or Chikungunya virus disease.

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Upper gastrointestinal bleed (UGIB) causes significant morbidity and mortality the world over. The two main causes have been due to increasing nonsteroidal anti-inflammatory drug use along with the high prevalence of Helicobacter pylori infection in patients with peptic ulcer and bleeding from gastroesophageal varices due to portal hypertension. Other causes of esophageal tears, gastrointestinal malignancy, and arteriovenous malformations also contribute to the morbidity and motality. Rapid assessment, resuscitation, and early endoscopy form the basis of early management of patients with severe bleeding. Risk stratification is based on clinical assessment and endoscopic findings. Early Upper gastrointestinal endoscopy (UGIE) (within 24 h of presentation) confirms the diagnosis and allows for targeted endoscopic treatment, which results in reduced morbidity, hospital stay, the risk of recurrent bleeding, and need for surgery. Despite successful endoscopic therapy, re-bleeding remains a risk and a second attempt at endoscopic therapy is recommended in most. Arteriography with embolization can serve as an extremely useful therapeutic option. Thanks to excellent medical and endoscopic control, surgery for UGIB is rarely required nowadays.

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