Portal hypertension occurs commonly in patients with cirrhosis and rarely in those without cirrhosis of liver. The two most important causes of non-cirrhotic portal hypertension are non-cirrhotic portal fibrosis (NCPF) and extrahepatic portal venous obstruction (EHPVO). Unlike EHPVO, there is no thrombosis of the extrahepatic portal vein in NCPF. In NCPF, there occurs sclerosis of medium and small branches of the portal vein. The hepatic venous pressure gradient (HVPG) is normal in NCPF, when compared with cirrhosis where it is elevated. NCPF is also known as non-cirrhotic intrahepatic portal hypertension (NCIPH), idiopathic portal hypertension, hepatoportal sclerosis, and benign intrahepatic portal hypertension. It is a disease of obscure etiology, predominantly affecting the middle-aged males and females who present with hematemesis and massive splenomegaly.

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Rabies is a fatal disease caused by rabies virus, a neurotropic virus and a prototype of Lyssavirus of Rhabdoviridae family. It is transmitted to human beings through infected saliva of dogs and cats during bite. Dog is the cause of more than 90% of human rabies in India. The incubation period is 4-8 weeks (but it may vary from 5 days to 7 years). There are two clinical types of rabies - encephalitic (furious) and paralytic (dumb) types. In the encephalitic (furious) form, the principal malfunction is in the brain stem and limbic system. Patient has hydrophobia in the full-blown form, but the mind remains clear till the end. Death occurs within a week after the onset of symptoms. Paralytic rabies resembles Guillain-Barre syndrome. Diagnosis is mostly clinical. However, direct fluorescent antibody test is used to identify the antigen in skin biopsy from the nape of neck. In the postmortem specimen, demonstration of Negri bodies in the brain confirms the diagnosis. Anti-rabies vaccine is used for pre- and post-exposure prophylaxis. The commonly used intramuscular (IM) regimen is being superseded by intradermal (ID) vaccine because it makes the treatment economical. Whereas touching of animal or lick on intact skin does not require vaccination, any transdermal bite with bleeding requires immediate administration of rabies immunoglobulin (RIG) and simultaneous vaccination with a tissue culture vaccine (TCV). Minor abrasion without bleeding may require only vaccination and no RIG. Rabies human monoclonal antibody (RMAb) is the newest entry in the prophylaxis of rabies which may ultimately replace RIG. Prognosis is grave since there are just six reports of survivors. Treatment is mainly palliative with heavy sedation and/or therapeutic coma (Milwaukee protocol).

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Different movement disorders including chorea and hemichorea-hemiballismus are known to be some interesting presentations of uncontrolled hyperglycemic states (both in type 1 and 2 diabetes mellitus). Hemifacial spasm is rarely reported as a manifestation of hyperglycemic state. Here, the author reports an extremely rare case of hemifacial spasm which developed as the presenting manifestation of non-ketotic hyperglycemia in type 1 diabetes mellitus.

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Background: Currently, in India, many healthcare organizations and their managements appreciate the advantages of electronic medical records, but they often use them. The current push for universal health coverage in India with National Rural Health Mission (NRHM) and National Urban Health Mission (NUHM) helping toward healthcare reforms highlights the importance of implementing information technology as a means of cutting costs and improving efficiency in healthcare field. The quality of documentation of patient care rendered at healthcare destinations is very important to showcase the growing stature of healthcare in India. Aims: As maintaining the medical records is very important, storage and retrieval of the information is also important for future patient care. In this regard, implementation of electronic medical records in hospitals is essential. Through this study, we wanted to highlight the perceptions of healthcare personnel, who are in the core team of delivering healthcare, toward implementation of electronic medical records. Methods: A cross-sectional study was carried out among doctors (post-graduates) and staff nurses. The sample size for post-graduate students and nurses was 164 and 296, respectively, in this study. The study was carried out during the period from January to June 2013, and a survey was conducted with the help of a validated, pre-tested questionnaire in a tertiary care medical college hospital in India. Results: The results showed that 75% of the study population are comfortable working with electronic medical records. They mentioned that display of diagnosis, medications, and allergies of patients on the records was most important. Their perception was that electronic medical records improve timely decision-making and patient care due to immediate access to the patient's disease history. Conclusion: The major problems faced by nurses, as per our study, are delay in services due to dispersion of records, multiplicity of form types consuming major time, and inability to understand doctors' notes.

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Background and Aims: Mupirocin is a topical antibiotic that has been used extensively for treating methicillin-resistant Staphylococcus aureus (MRSA) associated infections. However, the prevalence of mupirocin-resistant MRSA has increased with the extensive and widespread use of this agent. The aim was to determine the rates of high-level and low-level mupirocin resistance in MRSA to study the antimicrobial resistance pattern and clindamycin resistance in mupirocin-resistant MRSA. Methods: A total of 267 non-duplicate clinical isolates of MRSA from various clinical specimens were tested for mupirocin resistance by the disk diffusion method using 5 and 200 μg mupirocin disks. MRSA isolates were tested for antibiotics by Kirby-Bauer disk diffusion method as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Erythromycin-resistant isolates of MRSA were further studied for inducible clindamycin resistance by "D test" as per CLSI guidelines. Results: Of 267 MRSA isolates, high-level mupirocin resistance was observed in 5.99% and low-level resistance in 15.35%. Mupirocin-resistant MRSA isolates showed higher antibiotic resistance to fusidic acid (14.03% vs 7.14%), rifampicin (5.26% vs 2.38%), erythromycin (68.42% vs 58.57%), and clindamycin (52.63% vs 45.71%). No MRSA strains were found to be resistant to vancomycin and linezolid. Mupirocin-resistant MRSA isolates showed higher constitutive macrolide-lincosamide-streptogamin B (cMLS _B ; 51.28% vs 42.98%) and inducible macrolide-lincosamide-streptogamin B (iMLS _B ; 17.94% vs 13.15%) resistance, as compared to mupirocin-sensitive MRSA isolates. Conclusion: The emergence of mupirocin resistance could be limited by regular surveillance and effective infection control initiatives so to inform health care facilities to guide therapeutic and prophylactic use of mupirocin.

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Background: Currently stress is an important health issue in view of increasing trend of non-communicable diseases at a global level. There is paucity of data on stress among vulnerable groups like police personnel. Aim: To assess the stress level and its associated factors among police personnel. Methods: A cross-sectional study was conducted among 296 police personnel in urban Puducherry, India. Perceived stress level was assessed by Cohen's Perceived Stress scale and classified into low (0-11), average (12-15), high (16-20), and very high (21-40) levels based on the stress scores obtained. Data were analyzed by proportion, chi-square test, and binomial logistic regression analysis. Results: About two-thirds of the police personnel belonged to the age group of 25-39 years (68.2%). About 56.1% of the police personnel were designated as police constables. Majority of the police personnel had high and very high levels of stress (83.8%). Hypertension and body mass index (BMI) were found to be significantly associated with stress level categories in univariate analysis. With respect to question item analysis, majority of the police personnel were sometimes and fairly often had one or the other symptoms of stress. Multiple regression analysis showed that those with hypertension had 2.23 times more [95% confidence interval (CI): 1.295-3.847] severe and very severe stress levels compared to those with mild and moderate levels of stress. Conclusion: Stress level is high among police personnel, which needs to be addressed by appropriate intervention measures.

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Background: There is a need for biological prognostic indicators in breast cancer that would, alone or in combination with others, be sufficient to predict disease recurrence and, hence, be the basis for supplemental treatment after local therapy. Aims: To investigate the association between tumor marker serum carcinoembryonic antigen (CEA) and clinicopathological parameters in patients with breast cancer. Methods: A total of 134 patients with breast cancer treated in a single general surgery unit between January 2012 and November 2013 were included in the study, with age ranging between 28 and 73 years. Serum CEA values were compared before and after the treatment of breast cancer, between different histological types of breast cancer patients, between axillary lymphnode-positive and axillary lymphnode-negative patients, and between premenopausal and postmenopausal breast cancer patients. Data were analyzed using the statistical software SPSS version 19. Results: There was significant change in the values of serum CEA before (10.71 ± 2.79 ng/ml) and after the surgery for breast cancer (9.73 ± 3.00 ng/ml) (P < 0.006). There was further decline in the serum CEA level after a course of chemo-radiotherapy (7.30 ± 2.79 ng/ml) (P < 0.001). There was no significant difference between the different histological types of breast cancer (P value 0.55). The difference was significant in patients who were axillary lymphnode positive and negative (P < 0.001). There was no significant difference in premenopausal and postmenopausal breast cancer patients (P value 0.86). Conclusions: Serum CEA is a tumor marker of breast carcinoma. Its level decreased after treatment. This decrease is found more after chemo/radiotherapy following surgery. Serum CEA values are found to be elevated in patients with axillary lymphnode metastasis. There is no significant relation with the histologic type of breast cancer and menopausal status of the patient.

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Septicemia is an inflammatory host response to infection, which rapidly progresses to multiorgan failure and may develop skin lesions. The skin lesions of septicemia often present as purpura, purpura fulminans, and bleeding from erosion. However, there is a paucity of literature describing the features of septicemia both on the intact and eroded skin. The diagnosis of septicemia by identifying its features on the skin is very important for a dermatologist. This case report describes the dermatological changes of septicemia on the eroded skin of pemphigus vulgaris under treatment.

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Background: Ischemic injury in stroke leads to intracellular calcium accumulation, which activates the enzyme cascade causing cell death. Aims: To determine the correlation between serum calcium (Ca) and albumin-corrected calcium (CCa) levels with acute ischemic stroke (AIS) for short-term outcome and infarct size (IS). Methods: An observational study was carried out in 50 patients in a tertiary care hospital in India over 2 years (from December 2008 to December 2010). Patients presenting within 72 h of stroke onset and aged ≥40 years were included. Ca was measured, CCa calculated, and head computed tomography (CT) scan was done. National Institute of Health Stroke Scale (NIHSS) was calculated on admission and after 1 week, and Barthel Index (BI) was calculated at 1 week. Pearson's correlation coefficient was calculated between NIHSS, BI, and IS with both, Ca and CCa. Also, subgroup analysis was done in lacunar, lobar, anterior circulation, posterior circulation, unilateral, and bilateral stroke subgroups. Results: Ca had a significant correlation with NIHSS, BI, and IS (all patients), with BI in lacunar and unilateral strokes and both NIHSS (admission) and BI in lobar, anterior circulation, and bilateral strokes. CCa had a significant correlation with IS and with BI in all patients and in anterior circulation strokes. NIHSS (admission) and BI had a significant correlation with IS. Conclusions: Higher Ca (CCa in some subgroups) is associated with better prognosis and recovery after AIS (except in posterior circulation strokes), and higher Ca and CCa are both associated with smaller IS.

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Disseminated cysticercosis (DCC) is the widespread dissemination of cysticercus cellulosae (larva of pork tapeworm). CNS complications of DCC include encephalitis, obstructive hydrocephalus, raised intracranial pressure, ischemic infarctions, hemorrhage, and rarely subarachnoid hemorrhage. Here, we report a case of young male who developed corpus callosal infarction following cysticercal angitis.

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Background: Neonatal jaundice is a common condition that can be treated with phototherapy. Phototherapy may cause oxidative stress in addition to the usual side effects. Aim: In this study, the oxidative stress in babies with neonatal jaundice was assessed before and after phototherapy by estimating plasma malondialdehyde (MDA) level. Methods: Eighty babies with neonatal jaundice were chosen for the study. Among them, 40 babies whose total serum bilirubin level was >15 mg/dl formed the case group and the other 40 babies with total serum bilirubin level <15 mg/dl who did not require phototherapy formed the control group. Total serum bilirubin was measured using Automated Clinical Chemical Analyser with standard reagent kit. Plasma MDA was estimated by Satoh's method using spectrophotometry. Results: The plasma MDA level, which is one of the oxidant markers, was significantly elevated in post-phototherapy cases compared to pre-phototherapy and controls. Conclusion: Phototherapy results in significant oxidative stress among babies with neonatal hyperbilirubinemia. So, usage of phototherapy should be restricted to those with significant hyperbilirubinemia.

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Tracheoesophageal fistula and bronchoesophageal fistula (BEF) usually result from malignancy. BEF caused due to benign conditions is rare. Here, we report a case of BEF due to tuberculosis. A 65-year-old lady presented with 15 days history of dysphagia, cough, and fever. Esophagoscopy revealed an ulcerated lesion at 22 cm. Further evaluation with contrast-enhanced computed tomography revealed mid-esophageal wall thickening, mediastinal and supraclavicular lymphadenopathy, along with BEF. Endoscopic tissue biopsy from ulcer revealed tuberculosis. The patient was put on antituberculous drugs and showed good response to therapy.

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Eosinophilic cholecystitis is a rare form of cholecystitis. It is believed that eosinophilic cholecystitis is associated with eosinophilic cystitis, parasitic infections, eosinophilic gastroenteritis, and drugs. We report the case of a 23-year-old female who presented with the clinical complaints of pain in epigastrium and burning sensation for 1 month. Ultrasound showed the presence of cholelithiasis. Open cholecystectomy was done. Histopathological report showed the presence of eosinophilic cholecystitis and xanthogranulomatous cholecystitis. Both these entities are rare and their association has not been reported in the literature so far. We report this case because of the rarity of its association.

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