Background: Evaluating the optimal dose of intrathecal clonidine adjuvant has a great impact on day-to-day practice of anesthesia, as spinal anesthesia is one of the most commonly performed anesthetic procedure. Objectives: Evaluate for the minimal dose of intrathecal clonidine as an adjunct to bupivacaine heavy for spinal anesthesia that can produce optimal sensory and motor blockade with minimal hemodynamic effects. Methods: Randomized control trials carried out on adult patients, of both genders undergoing elective infraumbilical surgeries under spinal anesthesia with bupivacaine heavy and different doses of clonidine having ethical committee approval were included and articles published in non-English languages were excluded. Databases (PubMed and Google Scholar) and websites of the Indian Journal of Anaesthesia and anesthesia essays and researches journals were systematically searched and interpreted in accordance with the PRISMA guidelines. Quality assessment was done using the Risk of Bias assessment 2.O tool. The mean time taken for the onset of sensory and motor blockade, mean duration of sensory and motor blockade and significant adverse effects were the key outcome variables. Nonstatistical synthesis of quantitative data of the selected articles was done. Results: The efficacy in terms of sensory and motor blockade was comparatively more with 1 μg/kg of intrathecal clonidine than with lower doses, however, cardiovascular adverse effects were dose-dependent, with 15 μg intrathecal clonidine causing least cardiovascular disturbance. Conclusion: 15–30 μg intrathecal clonidine as an adjunct to bupivacaine heavy would produce optimal sensory and motor block with minimal hemodynamic disturbances.

A descriptive literature review of articles where mind–body interventions were used for various conditions including pediatric, obstetric, chronic illnesses, chronic pain, neurology, and oncology conditions was conducted. The aim of this study was to evaluate the evidence for the efficacy of mind–body interventions used in pediatric, obstetric, chronic illnesses, chronic pain, neurology, and oncology conditions. A literature search was done using electronic databases such as MEDLINE, PubMed, Google, and Google Scholar. The search terms included relevant MeSH terms, and Entry Literature sources published internationally up to June 2021 were included in the study. Terms in PubMed and keywords were identified by brainstorming. The keywords “Mind Body therapies in Antenatal and postnatal care, Paediatrics, Neurology, Autism, and Mental illnesses” were searched. There was no restriction on the period of publication of the studies. All the studies fulfilling the search criteria were included in the study. The mind–body therapies that were considered for inclusion were yoga, meditation, relaxation, breathing exercises, biofeedback acupressure, acupuncture, and hypnosis. These therapies show efficacy in providing symptomatic relief in conditions such as anxiety, depression, autism, menopause, dysmenorrhea, and chronic pain. While used as an adjunct in the treatment of cancers, mind–body therapies were found to have great evidence of efficacy. However, many studies lack large sample sizes and matched control groups. Mind–body therapies are efficacious in many ailments of public health significance. They are easy to administer, cost-effective, and not known to have many side effects. Mind–body therapies could be integrated as an adjunct to mainstream medicine. Their effective use could reduce the cost and burden on the health-care system.

Background: Preterm birth potentially plays an important role in visual development. Studies have shown that frequency of myopia, astigmatism, anisometropia, strabismus, and amblyopia in children born preterm is higher than term children. Objective: The aim is to study different types of refractive errors in children under-five years of age born preterm and term. Methods: Comparative cross-sectional study was carried out among 64 children aged 5 years or less. Age, gender, and social status were noted. Children were subjected to refraction according to their age. Detailed anterior segment and posterior segment examination as per the cooperation of the child was conducted with torch light or slit-lamp examination with Ziess, Appasamy AARU 2000. Visual acuity was examined with appropriate methods suitable for age. Results: Fifty percent were preterm and 50% were term. About 50% were male and 50% were female. The most common refractive error was hypermetropia (42%). Among those with compound types of refractive errors, the most common was compound myopic astigmatism ≥2 diopters (17%). Compound types of refractive error were significantly more (62.5%) among the preterm compared to 31.2% among term; significantly more (91.7%) among those born <32 weeks of gestation compared to 45% and 45.5% among those born between 33 and 36 weeks and born >36 weeks of gestational, respectively; significantly more (88.9%) among low birth weight babies compared to 40% among normal birth weight babies. Age and gender were not significantly associated with compound types of refractive errors (P > 0.05). Conclusion: Most common refractive error was hypermetropia. Among those with compound types of refractive errors, the most common was compound myopic astigmatism ≥2 diopters. Being preterm, born at the gestational age of <32 weeks and low birth weight were significant risk factors for compound types of refractive errors.

Background: The students, especially medical and dental undergraduates are more involved in the self-medication practice as they are empowered with good knowledge of drugs and diseases and have greater access to medicine. Recent studies have shown a greater prevalence of self-medication among medical and dental students. Objective: The objective of this study is to study the prevalence and risk factors of self-medication practices among medical and dental undergraduate students. Methods: A cross-sectional study was carried out among 502, medical (252) and dental (250) students. A predesigned, pretested, and semistructured study questionnaire was used for the data collection of the present study. The students were contacted and they were given the self-administered questionnaire. The questionnaire was collected back once they finished it. The questionnaire did not include any identifying information of the students. All batch students were contacted. Results: Majority (35.9%) were aged 20 years. About 58.2% were females. There were 50.2% of medical and 49.8% of dental students. Almost no one agreed to have any kind of addiction; 53.8% were doing physical activity of <1 h. The prevalence of self-medication among students was 73.7%. It was 74.8% among dental students compared to 72.6% among medical students. The most common drug used for self-medication was paracetamol (30.3%). Most commonly, the drugs were used only for 1 day (33.5%). The most common condition for which the self-medication drug was used was cold (19.9%). No variable studied in the present study was found to be associated with self-medication. Conclusion: The prevalence of self-medication among medical and dental students was very high. However, the drugs used were not harmful and the frequency of use was limited. The practice of self-medication was similar in the two groups and it was not associated with any factors.

Background: Cataract surgery is considered refractive surgery. Apart from implanting the right dioptric power of Intra ocular lens (IOL), minimizing postoperative astigmatism plays an important role in good visual rehabilitation. Hence, surgical incision is of major importance in minimizing postoperative astigmatism and reducing or abolishing preexisting astigmatism. Objectives: The objective of this study is to compare surgically induced astigmatism (SIA) following straight and frown scleral incisions in manual small-incision cataract surgery (MSICS). Materials and Methods: This is a prospective randomized comparative study conducted among two groups of patients undergoing MSICS, where the straight scleral incision was performed in one group with 29 cases and the frown incision was performed in the other group with 29 cases. Postoperatively, patients were followed up on postoperative day 1, week 1, and week 6. Uncorrected visual acuity, Kv and Kh readings, and SIA were noted at each postoperative visit. Results: SIA on the postoperative day 1 in the straight incision group (SIG) was 1.4914D ± 1.251 and in the frown incision group (FIG) was 0.629D ± 0.288. On the postoperative week 1 in SIG, it was 0.9655D ± 0.699, and in FIG, it was 0.474D ± 0.397. On the postoperative week 6 in SIG, it was 0.8793D ± 0.599, and in FIG, it was 0.414D ± 0.286. SIA was significantly less in FIG compared to SIG (P = 0.011). Postoperative uncorrected visual acuity was better in FIG compared with SIG. More amount the rule astigmatism was noted in FIG on the postoperative 6^th-week follow-up, which is favorable to the patient, while SIG witnessed more amount against the rule astigmatism. Conclusion: Frown incision is a better incision than the straight incision in MSICS to create a sclerocorneal tunnel.

Background: There is a need to study the performance, validity, and accuracy of cartridge-based nucleic acid amplification test (CB-NAAT) for accessing drug resistance among pulmonary tuberculosis (TB) compared with the solid culture drug susceptibility test (DST). Methods: Patients with symptoms of cough for more than 2 weeks with anyone symptoms such as night sweats, fever, and unintentional weight loss were studied. Cases with previously diagnosed drug-resistant pulmonary TB by sputum CB-NAAT having constitutional symptoms but not on any ATT for a minimum of 2 months were also included in the study. The patient's information, including age, immune surveillance status, clinical features, and chest X-rays, were recorded. Each sputum sample was divided into three aliquots and tested for smear microscopy, liquid culture (LC), and genotypic DST. Results of all three diagnostic modalities were compared with CB-NAAT reports. Results: Of 236 patients with sputum-positive CB-NAAT (n = 236), 49.4% (n = 117) were rifampicin resistant, while 50. 4% (n = 119) were rifampicin sensitive. The genotypic DST assays carried out of all enrolled patients showed that 76.3% (n = 181) patients were resistant to one or more first-line antitubercular drugs (FL ATTs) or second-line (SL) ATTs, while 23.7% (n = 55) patients were sensitive to all ATTs. Among all the study participants, 56.4% (n = 133) of patients had sputum smear-positive by ZN stain, while 88.6% (n = 209) showed growth on LC (BACTEC) media. On concordant analysis of CB-NAAT with DST assays, we found that among 119 CB-NAAT rifampicin-sensitive patients, 66 patients were drug-resistant (DR) TB to any of the FL or SL ATTs. The sensitivity, specificity, positive predictive value, and negative predictive value of CB-NAAT for detecting rifampicin resistance on sputum for pulmonary TB when compared with the gold-standard DST assays were 97.67%, 76.67%, 70.59%, and 98.29%, respectively. Conclusions: This study found that the use of rapid molecular technique (CB-NAAT) in screening DRTB at the community level is suboptimal compared to the gold-standard solid culture method. Although CB-NAAT's sensitivity in detecting DR pulmonary TB is significantly higher, the specificity is lower in that population who have received ATT earlier.

Background: From the early days of the HIV epidemic to the current COVID-19 crisis, a major challenge around infectious diseases has been dealing with the deep-seated stigma around affected populations. There is a paucity of literature on the prevalence of social stigma among patients who survived after COVID-19 infection in India. Objective: The objective is to estimate the prevalence of social stigma and its associated factors among COVID-19 survivors. Methodology: It was a cross-sectional study conducted among 150 COVID-19 survivors with predesigned questionnaire using a simple random sampling technique in a tertiary care center from October to November 2020. Social stigma was measured for different socio-demographic parameters and compared. Results: Of 150 study subjects, 29.3% of them faced social discrimination. Majority of them were discriminated by neighbors (75%) and even by their family members and 11.4% not allowed them into community/village. 50% had fear of infecting others and 55.3% of them blamed themselves for getting COVID-19 infection. 18% had faced social devaluation by others. 23.3% lost their job due to COVID-19 and 40.7% had economic loss. Conclusion: COVID-19-related stigma was widespread among participants. Social discrimination was more with increased age, female gender, among educated people, in joint families, among married individuals, in upper social class and those who had a long hospital stay; however, it was not significantly associated statistically.

Background: A tool to detect overweight and obesity among children should be simple, reliable, valid, and cost-effective. There is a need to monitor obesity among children in different populations. For this, there should be only one tool that is accepted worldwide or nationally which can be used to detect and compare the trends in different population settings. Objective: To assess obesity among children aged 4–17 years using waist-to-height ratio and to study its correlation with blood pressure. Materials and Methods: A hospital-based cross-sectional study was carried out among 261 children aged 4–17 years. Different variables such as age, sex, residence, parent's education and occupation, total family income per year, total family members, height, weight, waist circumference, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were considered. Results: The mean age was 8.05 ± 2.75 years. The mean height was 122.71 ± 16.06 cm. The mean waist-to-height ratio was 0.45 ± 0.05. Males were more than females. Children from rural areas were more. The prevalence of obesity based on waist-to-height ratio was 19.2%. Waist-to-height ratio was significantly correlated with age, height, weight, body mass index (BMI), DBP, father education, mother education, and mother occupation. SBP was not correlated with waist-to-height ratio, but DBP was significantly correlated. As waist-to-height ratio increased by one unit, DBP increased by 0.157 mmHg. Age and weight were significantly associated with waist-to-height ratio. Conclusion: The overall prevalence of obesity using waist-to-height ratio was 19.2%. Waist-to-height ratio was significantly correlated with age, height, weight, BMI, DBP, waist circumference, father education, mother education, and mother occupation. Age and body weight were significantly associated with waist-to-height ratio.

Background: Medical education requires an undergraduate medical student to study a wide range of medical specialties. The number of postgraduation specialties as well as carrier options after graduation has increased in recent years. Hence, we sought to identify the postgraduation specialty choices, factors influencing these choices, and future carrier aspirations. Methodology: This was a cross-sectional study. Pretested self-administered questionnaire was used for data collection. Data were analyzed using SPSS IBM software version 20. Results: Majority were in the age group of above 20. Nearly 16.6% of the students' fathers and 5.9% of the students' mothers were having professional education. About 47.6% prefer medicine or its allied specialty subjects. About 43.4% wanted a job in the public sector and 30.8% wanted to adopt the private sector. Conclusion: Postgraduate specialty choices are still traditional with the majority preferring clinical subjects and wanted to settle in an urban area with a public sector job.

We report a rare case of cutaneous zygomycosis by Saksenaea vasiformis in post-COVID-19 individuals. A 55-year-old patient was COVID-19 positive and treated as per the protocols. Following recovery after 5 weeks, presents to the surgery outpatient department with complaints of slowly progressive cutaneous lesion developed into ulcerative lesion over the left lateral part of the abdomen, hip, and thigh. Based on histopathological and microbiological findings, he was diagnosed with as a case of cutaneous zygomycosis by S. vasiformis. Initially, conservative management with intravenous amphotericin B was given and followed by surgical debridement; later, the patient succumbed. In general, mucormycosis is associated with immunosuppression or debilitating diseases. The mode of entry for molds and spores of zygomycetes is through the respiratory tract through the nose and then reaches the sinuses, orbit, and intracranial structures. Hence, early clinical diagnosis, direct smears, and proper interventions lead to a good prognosis and reduced morbidity caused by zygomycosis. The therapeutic management of fungal infection is quite challenging; hence diagnosing zygomycosis at the earliest will be appropriate, especially in an immunocompromised state. The misusing of prophylactic drugs, steroids, and immunosuppressants for COVID-19 should be avoided and must be used as per protocol and guidelines.