Helicobacter pylori eradication therapy has a role in minimizing the complications of peptic ulcer disease, namely, bleeding, perforation, and obstruction. However, the precise role of H. pylori eradication therapy in the complicated ulcers remains inconclusive, especially in perforation and gastric outlet obstruction. The prevalence of H. pylori in peptic ulcer bleeding patients has been widely underestimated owing to the differences in diagnostic tests and patient characteristics, and hence, it is recommended that an initial negative test should be followed up by a delayed repeat testing to rule out false negativity. It is well established now that eradication of H. pylori in patients with bleeding ulcers reduces rebleeding and ulcer recurrence. Multiple studies have attributed high recurrence rates of duodenal ulcer following simple closure to a high prevalence of H. pylori infection. Eradication therapy decreases the recurrence rate of perforated ulcers, thus justifying the role of H. pylori eradication therapy following the primary surgical management of perforated ulcers. The role of H. pylori in duodenal ulcer with gastric outlet obstruction is yet to be evaluated clearly. There are some reports of resolution of gastric outlet obstruction following therapy for H. pylori, obviating the need for surgery. Clarithromycin-containing regimens are recommended as first-line in areas of low resistance, whereas bismuth-containing quadruple therapy is the first-line empirical treatment in areas of high clarithromycin resistance. Treatment of H. pylori is beneficial in most of the patients with complicated peptic ulcer disease, especially in reducing recurrence of ulcer with or without complications.

Background: Amniotic fluid volume may reflect a problem with fluid production or circulation due to fetal, placental, and maternal pathology. Some authors have shown that amniotic fluid index (AFI) is a poor predictor of adverse pregnancy outcome, but others have not confirmed the association of adverse perinatal outcome with oligohydramnios. Objectives: To compare the mode of delivery and neonatal outcome in patients with oligohydramnios (AFI <5 cm) with no-oligohydramnios group (AFI 5–25 cm). Methods: A prospective hospital-based observational study was carried out in the Department of Gynecology and Obstetrics, Nobel Medical College, Biratnagar; a referral center in eastern Nepal. In 1 year duration, 100 patients who completed 28 weeks of gestation with AFI <5 cm were included in the oligohydramnios group and 100 patients having AFI 5–25 cm were enrolled to the no-oligohydramnios group. Results: A total of 8096 women were admitted during the study from March 1, 2015 to February 28, 2016. Among them, 100 patients meeting the inclusion criteria were taken into oligohydramnios group. AFI <5 cm was more in primipara 58 (58%) and 43 (43%) were postdated pregnancy. Increased operative delivery [85 (85%)] was found in oligohydramnios group, whereas it was 30 (30%) in the no-oligohydramnios group. The neonatal outcome which was assessed by Apgar score (P < 0.003) and Neonatal Intensive Care Unit admission (P < 0.026) were significantly different between the two groups. Conclusion: Isolated oligohydramnios in the absence of any other maternal or fetal complicating factor is associated with need for operative intervention and adversely affects the fetal outcome, when compared to no-oligohydramnios group with normal AFI.

Background: Utilization of maternal health services among Janani Suraksha Yojana (JSY) beneficiaries is an important aspect to improve maternal health. Aims: This study aims to assess the antenatal, intranatal, and postnatal maternal health services received by JSY beneficiaries. Materials and Methods: A community-based cross-sectional study was conducted among 152 JSY beneficiaries in the rural and urban field practice area attached to a tertiary care institution in Puducherry, India. Antenatal, intranatal, and postnatal services received by the mothers were assessed by a pretested structured questionnaire. Results: About 144 subjects participated in the study (response rate - 94.7%). About half (79, 54.9%) of subjects belonged to 19–25 years age group. About 82.6% (119) of subjects were registered in the first trimester. The majority (142, 98.6%) had institutional delivery. All had received tetanus toxoid immunization. About 3.5% (5) of beneficiaries were sent for high-risk referral. About 77.8% (112/144) of beneficiaries had consumed at least 100 iron and folic acid (IFA) tablets. About 98.6% (142) had more than three visits. The majority of them (138, 95.7%) reached hospital within 1 h. Around 62% of women breastfed their child within 1 h after birth. The postnatal visit by health worker was 54.2% (78), and minimum one postnatal visit by postnatal mother was 48.6% (70). Conclusions: Overall maternal health services are good for JSY beneficiaries in this area. Efforts should be made to improve the quality of services for early registration of pregnancies, IFA tablet intake, early breastfeeding after birth and postnatal care services.

Background: Undernutrition has a direct correlation with the prevailing feeding practices. Early years are crucial in determining the rate and extent of growth and mainly depend on the level of nutrition and care provided. The first episode of growth faltering occurs mostly in children <2 years of age that often goes unnoticed. Objective: The objective of this study was to explore the faulty feeding practices, their determinants, and association with nutritional status in children <2 years of age. Materials and Methods: This cross-sectional study using mixed (qualitative and quantitative) methods was conducted in a sample of 187 mothers and their children at the mother and child health (MCH) clinic of a rural medical college. Results: Only 144 (77%) of the study children had received colostrum. 47 (25.1%) of the mothers had used prelacteal feeds. Although breastfeeding (BF) was universal, only 133 (71.1%) of the mothers were exclusively breastfeeding (EBF) their children. The duration of each feed was an issue; in 49 (32.4%) of the children, the duration of each feed was <10 min with almost all the mothers swapping the baby to other breast during one episode of feeding. Not giving colostrum, not giving EBF, duration of feeds <10 min, swapping the breasts during each feed, and decreased frequency of feeding during illness were found to be significantly associated with poor nutritional status. Conclusion: In our study, we found out that although practice of BF was universal, there is definite scope for further improving the practices. A definite gap between knowledge and practice was observed, which was associated with adverse nutritional outcomes.

Background: Measurement of testicular volume is one of the ways of assessing testicular function. Ultrasonography is an important and accurate radiological method for measurement of testicular volume. Objective: This study was aimed at evaluating the relationship of ultrasound measured testicular volume using the three formulae with the subjects' height, body weight, body surface area (BSA), and body mass index (BMI) in adults. Methodology: One hundred twenty-five adult male subjects comprising staff and students of a University Teaching Hospital were recruited into the study. Height and body weight were measured while the BMI and BSA were calculated. Ultrasound measurement of the height, length, and width of both testes were done and used to calculate the volumes using the three formulae. Results: The subjects' age ranged from 19 to 29 years with a mean of 23.48 ± 2.26 yrs. The mean ultrasound measured volumes for the right and left testes were 15.38 ± 3.29 ml and 15.29 ± 3.89 ml using the prolate ellipsoid formula; 22.86 ± 5.43 ml and 23.54 ± 6.88 ml by the prolate spheroid formula; 21.20 ± 5.28 ml and 20.87 ± 5.35 ml by the Lambert formula, respectively. The calculated mean for height, body weight, BMI, and BSA were 174.64 ± 6.36 cm, 68.68 ± 8.25 kg, 22.48 ± 2.17 kg/m², and 1.82 ± 0.13 m², respectively. The right testes showed a negative correlation, while the left and combined testicular volumes showed a positive correlation with the subjects' height, body weight, BMI, and BSA for all the three formulae. Conclusion: The right testicular volume showed negative correlation, while the left and combined testicular volumes showed a positive correlation with the height, body weight, BSA, and BMI in Nigerian adults.

Palatal myoclonus is one of the rare causes of tinnitus characterized by rhythmic involuntary contraction of muscles of soft palate as well as pharynx. Among the two types, the essential palatal myoclonus, which is idiopathic as no cause can be identified in children, is rarely reported in literature. In this case report, we present a 12-year-old girl who complained of hearing abnormal sound in her ears, which could be perceived by the examiner also. She had myoclonus of soft palate and uvula for which no obvious cause could be identified. Hence, it was diagnosed as essential palatal myoclonus and was successfully treated with clonazepam.

Two rare complications of twin gestation, namely, conjoined twins and interlocking of twins, manifested as arrest of descent in the second stage of labor. This article reports in detail about how the diagnosis of conjoined twins was missed by ultrasonogram and interlocking of twins unusually occurred in diamniotic twins. The management of these rare conditions is also mentioned to aid readers to act accordingly in rare undiagnosed cases.

Lymphangiomatosis is an extremely rare multisystem disorder resulting from congenital malformations of lymphatic development mainly affecting the pulmonary and skeletal systems without a preset therapeutic approach. We hereby present a unique case of diffuse lymphangiomatosis in a 2-year-old male child who presented with massive right pleural effusion, ascites, right hydrocele, and lytic lesions in right hemipelvis, vertebrae, and femur. Biopsy from right thigh revealed lymphangiomatosis. The child was treated with upfront conformal radiotherapy (RT) to the affected sites with fractionated doses of 18–20 Gy which he tolerated well. Post-therapy evaluation by imaging showed a significant response to radiation with excellent symptomatic relief. Presently, he is on follow-up for over 1 year with a Karnofsky performance status of 90% without any evidence of progression of the disease. The aim of reporting this case is to sensitize the medical fraternity about RT as an effective, noninvasive, definitive therapeutic modality for treating this uncommon disease.

Pancreatic duct disruption may follow acute pancreatitis, chronic pancreatitis, pancreatic surgery, and trauma. Diagnosis in these patients is usually made by endoscopic retrograde cholangiopancreaticogram or secretin-stimulated magnetic resonance cholangiopancreaticogram. We report five cases where pancreatic duct disruption was diagnosed by contrast-enhanced computed tomography (CECT). Five patients with acute pancreatitis were studied; three were secondary to alcohol and two were posttraumatic. Three patients developed pancreatic ascites, one developed pancreatico-pleural effusion, and the other had pancreatic pseudocyst. CECT of the abdomen revealed pancreatic ductal injury in all the patients. In one patient with pancreatic ascites, multiple peripancreatic collections and dilated and disrupted pancreatic duct communicating with the peritoneal cavity were noted. The patient of traumatic pancreatitis had a fracture of the head of the pancreas, with peripancreatic collection communicating with the main pancreatic duct (MPD). In the other traumatic pancreatitis, there was a pseudocyst near the head of pancreas communicating with the MPD. CECT can provide a comprehensive assessment in acute pancreatitis including duct integrity, type and location of pancreatic ductal injury and can be an effective noninvasive alternative imaging modality in diagnosing pancreatic duct disruption.

Magnesium sulfate has an established role as an anticonvulsant. Hypocalcemia with magnesium sulfate therapy is a well-known complication but rarely encountered in clinical practice. Concurrent use of nifedipine may unmask hypocalcemia in these patients. The resulting hypocalcemia can lead to acute cardiac events endangering patient's life.