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General duty doctors in all major hospitals -Govt and Private-are often unclear regarding when to label a case as medicolegal. This paper attempts to give general guidelines to doctors regarding this problem.

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A research paper or thesis writing is considered hard and very difficult process of intense concentration and brain work. Readers generally are first interested in new results of the paper. Writing results section contains new results from research investigation but is difficult in comparison to writing methods section as the latter section is already written at the proposal writing stage and requires only language change. Results section is heart of the paper and its completion with methods section already written; implies more than 50% of paper or thesis writing work and it become 70% paper writing work with writing of discussion section. Results writing section should be organized into different segments of text and visuals such as tables, figures, algorithms, etc. In order to start writing results section, we make a beginning with data analysis and its presentation of key findings as summarized results to yield an answer to the research question that study attempted. Answers to the questions and interpretations are presented in the discussion section. Data analysis is primarily linked with writing text part of the results and discussion of results. This is a desired sequence to work with in paper writing. The attempt of working in such a sequence provides a convenient approach to young researchers or post graduate/under graduate medical students to gain confidence in writing a research paper or thesis or a research report. While basic knowledge of study design and analysis is needed, the involvement of a qualified bio-statistician is recommended in various stages up to publication. In this communication, we describe the basic approach of data analysis required for initiating writing results and discussion while quoting the required rules for the purpose.

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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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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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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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The results of mitral valve surgery have improved steadily. The current operative mortality rates for mitral valve surgery are reported to be in the region of 1.5% for mitral valve repair and 5.5% for mitral valve replacement. To ensure good perioperative patient outcome, it is imperative to follow management techniques based on sound scientific principles. In this review article, the authors describe anesthetic management, complexities of cardiopulmonary bypass and weaning from cardiopulmonary bypass in patients of varying severity of mitral stenosis.

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Most of the intracranial pathologies appear hypointense on T1-weighted images. However, there are some intracranial substances and pathological lesions that appear hyperintense on T1-weighted images. This article aims to highlight the various cranial lesions showing hyperintense signal on T1-weighted images. Various substances which are responsible for the intrinsically high signal intensity observed in intracranial lesions at T1-weighted magnetic resonance imaging such as methemoglobin, melanin, lipid, various minerals, and other will be enumerated, and how these signal changes can lead to more specific diagnoses will be discussed.

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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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Background: Leprosy is an oldest chronic infectious disease known to mankind that predominantly affects the skin and peripheral nerves. Objective: To evaluate the bacteriological and morphological indices in smear positive cases. Materials and Method: Retrospective observational study was undertaken for one year duration on suspected cases of leprosy. Smears were prepared from one from each of the ear lobes by slit and scrap method and one from the site of lesion. Smears were stained with modified Ziehl-Neelsen stain and bacteriological/morphological indices were calculated. Results: Among 345 clinically suspected cases, 160 (46.38%) were multibacillary with male to female ratio 1.9:1 and most of cases from rural area of lower/middle class of third and fourth decade. All the three sites smears were positive in 112 (70%) cases. 66 (41.25%) cases had bacteriological index of 1+ while more than 1000 bacilli, on average, in 1each oil-immersion field (BI 6+) was observed in 1 (0.62%) cases. In 70 (43.75%) cases morphological index was less than 25 while in 14(8.75%) cases it was more than 50. Conclusion: Bacteriological and morphological index is one of the most important tools for diagnosis, classification, monitoring of treatment and disease severity.

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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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Background: Plastination is the process to preserve the perishable biological tissues for long time using curable polymers. This technique was invented by Gunther Von Hagens, a German anatomist, in 1977. Since then, there have been many modifi cations according to the need and availability of infrastructure in various institutions. Many deviations from the standard plastination procedure have been suggested and used successfully. Methods: Modified short plastination protocol using epoxy resin has been adopted and standardized by the Department of Anatomy, Maulana Azad Medical College. Results and Conclusion: This technique provides dry, odorless, durable, nontoxic specimens that are easy to handle and can be stored at room temperature indefi nitely. This can be performed in a short period of time with limited and less expensive infrastructure. Our department organizes regular national workshops on “body preservation techniques” to train young anatomists.

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Gynecomastia is a benign enlargement of the male breast tissue, either due to the proliferation of glandular tissue or deposition of fat in breast tissue, usually caused by imbalance of estrogen and androgen hormones in body. Gynecomastia has a trimodal age distribution and begins as a small lump beneath the nipple which may be tender. Gynecomastia is usually benign but may be a cause of embarrassment for some. Evaluation of gynecomastia is performed with an aim at diagnosing the cause for the same. Individual treatment requirements can range from simple reassurance to medical treatment or even surgery depending on the etiology.

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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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Medical professionals are often unsure of the course of action in medico-legal cases. Thus they are rather reluctant to attend to cases of accident for fear of being involved in unnecessary litigation later on. Even in cases of serious accidents, medical professionals hesitate to offer help, sometimes resulting in patient's death. This paper highlights some important legal precautions to be taken care of in cases of road side vehicular accidents. These simple steps, if observed by medical practitioners, will prevent unnecessary litigation.

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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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Objective: To assess patients preference for preselected doctor attire in outpatient department (OPD) setting of a government hospital. Materials and Methods: An anonymous, predesigned, pretested, semistructured interview schedule was administered to adult (>18 years) ambulatory coherent patients. The brief questionnaire captured selected sociodemographic details of patients, department visited, and use of aprons (white coat) by attending doctor observed and desired practice. To the item—“Was your attending doctor in OPD wearing apron (white coat)?”, the possible response was yes/no. For the item—“Would you like to see your attending doctor wearing apron (white coat)?”, again the possible answer was yes/no. When a patient responded to this item as “no,” we further explored their reason for the same. The patients were shown four colored pictures each for male and female doctor in different dress. They were probed regarding their preference that they would like to see their attending doctor to be wearing. These attires were labeled as 1 = cool casual, 2 = casual, 3 = professional informal, and 4 = professional formal. Result: The mean age of 547 patients was 35.34 (±12.81) years; 322 (58.9%) were males. Out of 547 patients, nearly 395 (72.2%) wanted (desired) to see their attending doctor to be wearing apron; however, only 256 (46.8%) reported that attending doctors were actually wearing the apron in the outpatient department. Only 152 (27.7%) patients responded that it does not matter to them whether attending doctor was wearing white coat (apron) or not. Majority of patients preferred male doctor to be wearing professional formal (42.3%) and professional informal (40.9%) attire, whereas for female doctor, also majority preferred professional formal (38.7%) and professional informal (37.5%), respectively. Casuals were the least preferred attire. Conclusion: It is reiterated that majority of patients in our OPD setting preferred formal attire of attending doctor with apron, a clear and loud message for future physician in training.

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The mitral valve (MV) is a sophisticated natural engineering marvel. The MV requires coordinated action of all its interrelated anatomical components: The MV leaflets, the annulus, the left atrium, the tendinous chords and the papillary muscles with its surrounding left ventricular wall for an effective closure of its orifice. Mitral valve regurgitation (MR) is frequently found in patients undergoing cardiac surgery with cardiopulmonary bypass. MR can be secondary to a structural or a functional defect of one or several components of the MV. The mechanism(s) of functional MR is the most complex. A precise understanding of the pathophysiology of MR helps resolving the cardiac status of a patient and choice of therapy for a particular patient. Transesophageal echocardiography can define the underlying mechanism(s) of MR; a thorough understanding of the mechanism(s) helps deciding the surgical procedure needed to repair the MR. In this article, the author reviews the mechanisms and pathophysiology of MR.

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Forensic facial reconstruction (FFR) is the technique that combines art and science to recreate the antemortem appearance of an individual in order to recognize and identify the decedent. Over the years, many techniques of FFR and imaging modalities that provide the basic data for FFR have evolved. There is always a considerable debate and confusion regarding the advantages and limitations of these techniques. The aim of this review is to summarize the different techniques of FFR and emphasize the role of radiological techniques including cone beam computed tomography in it.

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Background and Objectives: Serratiopeptidase is available as an oral preparation. The effectiveness of this enzymatic preparation is questionable. Despite this fact, serratiopeptidase is prescribed for a variety of inflammatory conditions. The study was conducted to determine the availability, cost and rationality of serratiopeptidase preparations available in Indian market. Materials and Methods: Serratiopeptidase preparations were assessed for total number, composition, strength and cost. Data were collected from ‘The Drug Today’ of the years 2009 (October–December) and 2015 (April–June). The rationality of preparations was assessed on validated 6-point scoring criteria. An extensive literature search was made using evidence-based print and electronic databases for the studies on efficacy and safety of serratiopeptidase. Results: A total of 642 serratiopeptidase preparations were available in the year 2009, which increased to 647 in 2015. Eighty percent preparations were fixed-dose combinations (FDCs) with either non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics, muscle relaxants or miscellaneous drugs. Of all FDCs, 96% preparations were combinations with one or more NSAIDs. Single drug preparations showed a decline from 19.9 to 12.3%. Serratiopeptidase was available in strengths from 2.5 to 50 mg. The cost of 10 mg dose of serratiopeptidase preparations ranged between Rs. 1.35 and Rs. 8.16. The cost of FDCs was more than that of single non-serratiopeptidase agent. FDCs scored poorly on rationality assessment scale in both years, and an increase in irrational preparations was observed. Conclusion: Too many serratiopeptidase preparations are available. Evidence on their efficacy and safety is lacking. The rationality of available FDCs of serratiopeptidase is poor. The availability of expensive FDCs of unknown efficacy and safety is an important contributory factor for the irrational use of drugs.

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The aim of this communication is to give an overview of basic biostatistics procedures that are helpful in understanding medical research findings. There are several books on this topic now and several articles are written on this subject in various reputed journals on individual topics of interest or as a series of chapter articles. On the contrary, this article attempts to cover summary of basic biostatistics in a descriptive manner with the attempt to provide the reader the essential basis of research methodology. This may also be useful for medical undergraduate/postgraduate (UG/PG) students and biomedical junior faculty in understanding advancement of knowledge in their area of specialization. This article as such is not complete on the basics of the subject attempted to present. The reader is, however, advised further reading of reference books for more details.

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Background: According to World Health Organization (1999), mental health is defined as “subjective well-being, perceived self-efficacy, autonomy, competence, intergenerational dependence, and self-actualization that deals with the individual’s awareness, attitude, and belief about the mental disorders.” Hence, the present study was conducted among Indian college students to assess belief, attitude, and perception about causes and treatment of mental disorder (illness) with respect to depression and schizophrenia. Material and Methods: The present descriptive study was undertaken at Amity university, Rajasthan, with a sample of 150 college undergraduate and postgraduate students in the age group of 18 to 27 years by using cases “Vignettes of Depression and Schizophrenia” and “Short Version of Orientation Toward Mental Illness Scale (OMI).” Results: The present study indicated that depression was easily recognizable as compared to schizophrenia among college students. Stressful factors were considered as the primary cause for both depression and schizophrenia. Majority of the participants were convinced of the favorable outcome of both depression and schizophrenia. Conclusion: It was concluded that majority of the participants had negative attitude toward folk therapy, psychosocial manipulation, and physical method of treatment with the perception of family as a main source for seeking help regarding mental illness. Moreover, majority of participants had a belief that mental disorder is a cause for depression and stress is the main cause for schizophrenia among the mental illness. Therefore, the prognosis of both depression and schizophrenia was considered good.

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Objectives: Skin acts as the diagnostic window to many internal organs including the renal system. Subtle changes in the skin may act as clues to the underlying renal pathology. The present study was undertaken to evaluate and compare the cutaneous manifestations among the spectrum of renal failure including post-transplant patients. Materials and Methods: Hundred patients with chronic kidney disease including post-transplant patients were recruited in the bring highlighted line here. In the study conducted at Department Detailed cutaneous examination was performed and findings were recorded and compared among the study groups. Results: Total 61% patients had cutaneous manifestations and 40% had more than one finding. The most common cutaneous finding was xerosis noted in 53%, followed by pruritus in 42%, pallor 37%, pigmentation 34%, and cutaneous infections in 33%. Nail involvement was noted in 43%. The most common nail finding was half and half nail seen in 30%, followed by brittle nails in 20%, beau's line 18%, and leukonychia 16%. The prevalence of skin findings was significantly more among the patients with end stage renal disease and those undergoing dialysis. The post-transplant group showed increased prevalence of infections. Conclusions: Dermatological manifestations increase with duration and severity of renal disease. Though renal transplantation and hemodialysis reverse the metabolic derangement in these patients, they predispose to a number of cutaneous complications.

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Acute Pancreatitis is one of the commonest gastro-intestinal diseases, in which patients need emergency hospitalization. It carries 10-30% mortality in severe cases. Early identification of severe cases helps in prognostication of the disease and institution of aggressive treatment. Aim To evaluate the severity of acute gall stone pancreatitis using Modified Atlanta Classification at admission and 48 hours. To compare severity of acute pancreatitis as assessed by Modified Atlanta Classification with Modified CT Severity Index (CTSI) in the second week. Materials and Methods We use Modified Marshal Score, as recommended by Revised Atlanta Classification, in our study group of 26 patients. Patients were classified into Mild, Moderate, and Severe categories at 48hrs. Contrast Enhance Computer Tomography of chest and abdomen (Gold standard) was performed at 2 weeks of presentation. Using Modified CTSI Score, patients were again categorised into Mild, Moderate, Severe cases. Results Modified Atlanta Classification correctly picked up the severe pancreatitis cases, as early as at 48hrs, with 100% sensitivity and specificity, which corresponded with CTSI at 2wks.

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