Introduction: Distractions such as the use of mobile phones or listening to music while driving can prove to be fatal. Reaction time (RT) is the time interval between the application of a stimulus and the appearance of appropriate voluntary response by an individual; it can be used to assess the individual's efficacy to respond to any stimulus in daily life. Choice of music and its influence on the central nervous system (CNS) and hence RT is linked to many neurophysiological reactions. Objectives: The present study was aimed to determine the effect of soft and hard rock music; played at low and high volumes on auditory reaction time in 52 young adult males. The auditory stimulation used was a buzzer simulating honking. Thus this study may help to understand if some types of music should be avoided or preferred while driving. Materials and methods: A total of 52 students from medical college-aged between 18 to 25 years; body mass index (BMI) between 18.5 to 25 kg/m2 participated in the study. Instrumental soft and hard rock music was delivered through two speakers. The low volume of 60 dB and a high volume of 80 dB were gauged by the sound level meter. Auditory reaction time (ART) was recorded with an auditory stimulus delivered from digital reaction time apparatus. After a practice session for an acquaintance, a baseline recording of auditory reaction time without music was recorded. This was followed by ART recording with soft music with low and high volumes and hard rock music with low and high volumes. The difference in mean ART of each music setting was then compared with mean baseline ART using a paired t-test. Result: The mean ART for sound stimulus for soft music at low volume showed improvement while it showed the slower response for high volume; though the difference in mean was not statistically significant (p > 0.05). Faster ART was observed for hard rock music for both low and high volume which was not statistically significant. Conclusion: The varied outcomes suggest a differing preference of type of music and volume that might have affected the arousal and alertness of the participants and hence the reaction time. This is a significant deduction which brings out the importance to conduct similar studies incorporating the taste, preferences of music.

Aim: The aim of this study is to explore the relationship between vitamin D levels and antithyroid peroxidase antibodies (ATPO Ab) in recently diagnosed patients of autoimmune thyroid disease (AITD). Material and methods: A total of 138 and 30 recently diagnosed female patients of Hashimoto's thyroiditis (HT) and graves' disease (GD) along with 46 healthy females as controls were enrolled in groups I, II and III respectively. In this study 25OHD, PTH, calcium, and thyroid autoantibody [anti-thyroid peroxidase (anti-TPO)] levels were evaluated for all subjects (n = 214). Results: Lower serum 25OHD levels were present in groups I and II patients (12.6 ± 9.04 ng/mL, 10.6 ± 5.4 ng/mL respectively) than in group III subjects (22.8 ± 6.4 ng/m}L), (p < 0.00001). Although serum 25OHD levels inversely correlated with anti-TPO (r = –0.32, p = 0.0001) and parathormone (PTH) (r = –0.27, p = 0.0049) but no significant correlation of serum 25OHD levels was found with TSH (r = 0.04, p = 0.07) and FT4 levels (r = 0.02, p = 0.6). Hypothyroid patients (Group I) had higher anti-TPO levels than patient with GD and controls (groups II and III) (p < 0.0001). Conclusion: Our study demonstrated that lower vitamin D levels are found in AITD patients in at present. Severity and prevalence of vitamin D deficiency are higher in GD patients than hypothyroid patients. An inverse correlation was found in this study between antithyroid peroxidase antibodies (ATPO Ab) and vitamin D levels. We may propose that vitamin D deficiency is one of the potential factors in the pathogenesis of autoimmune thyroid disorders. Clinical significance: More larger studies, to evaluate the role of Vitamin D in pathogenesis of AITD and beneficial effect of its supplementation in treatment, are needed.

Introduction: Urinary tract infections (UTIs) is one of the most common bacterial infections. Irrelevant use of antibiotics has resulted in the emergence of resistant strains. Aims and objective: To identify and look for the antimicrobial resistance pattern of various isolates in a tertiary care teaching hospital. Methods: A retrospective study was conducted in a tertiary level hospital for 4 years (March 2014 to March 2018). A total of 41020 urine samples received in the laboratory and 6114 of them diagnosed to be culture positive UTI were processed for Antibiotic sensitivity by the standard microbiological procedure. Results: Out of 6114 culture, positive samples 2829 (46.27%) had significant bacteriuria. Females more affected (52.27%) than males (48.43%). Amongst fermenters (GNF), E.coli (52.7%) was most common followed by Klebsiella spp. (23.65%). Amongst the Gram-positive organisms Enterococcus spp. (3.67%) was more common followed by Staphylococcus saprophyticus (1.44%). While Pseudomonas spp. followed by Burkholderia sp were the common non-fermenters (GNNF). In GNF, imipenem, meropenem and amikacin were most effective drugs whereas, in GNNF, imipenem, meropenem and piperacillin- tazobactam were more effective. Linezolid and vancomycin were the most sensitive antibiotics in Gram-positive isolates. Conclusion: There is increasing resistance to, and nitrofurantoin noted in our study that is frequently considered drugs of choice for empiric therapy. It is important to determine trends in antimicrobials susceptibilities, to formulate local antibiotics policy that will guide the clinicians regarding the empirical choice for UTI to prevent misuse or overuse of antibiotics. Clinical significance: Because of the emerging resistance to the available group of antimicrobials, regular monitoring of the resistance pattern is essential for the clinicians to choose for the best empiric therapy.

Aim: Carcinoma oral cavity ranks third in the incidence of freshly detected cancers among both the genders. The most impactful prognostic factor in carcinoma oral cavity is the presence of cervical lymph node metastasis. Clinically node negative neck harbors occult metastasis in 06 to 46% of cases. The gold standard currently of managing cN0 neck is Supra Omohyoid neck dissection (SOHND). However, various imaging modalities are challenging the gold standard. The present NCCN guidelines incorporate clinical palpation, USG Neck and contrast-enhanced computed tomography (CECT) in evaluating the nodal status of such patients. This study has critically evaluated, whether USG/CECT is sufficient in the clinically node-negative neck (cN0), in patients with an early stage carcinoma oral cavity or do we need to add other investigations in evaluating the nodal status. Materials and methods: A single-center prospective study of 51 patients of early stage carcinoma oral cavity with cNo neck underwent evaluation of the neck by ultrasonography (USG) and CECT in a tertiary care center. All patients subsequently underwent SOHND and the results were compared. Results: Fifty-eight neck sides were dissected (44 unilateral, 7 bilateral), involving a total of 885 lymph nodes (mean, 15.26 lymph nodes per neck side). Histopathologic analysis revealed occult lymph node metastases in 10 of 51 patients (19.6%) which equated to 10 of 58 neck sides (17.24%). The sensitivity and specificity of USG was 40% and 97.8% respectively with a diagnostic accuracy of 87.9%. CECT neck was found to be a better diagnostic modality with a sensitivity of 90% and specificity of 87.5%. Conclusions: Contrast-enhanced computed tomography (CECT) is a better modality than USG and clinical palpation. However, we recommend further studies with other modalities like PET–CT, and lymphangoscinitigraphy.

Background: Noncontrast computed tomography (NCCT) head provides clinically and surgically important information in brain trauma. It can depict the severity, level, and prognosis of head injuries. Aim: To depict the spectrum of NCCT-radiological findings in cases of head injuries at this center. Material and methods: Noncontrast CT head examination of 518 patients were retrospectively included in the study for the duration of the year 2015 to 2016 and 2016 to 2017 by retrospective screening of the electronic report's data of last two years of about 7000 patients, who had history of head injury as well as NCCT evidence of head injuries and in whom surgical/clinical follow-up for final diagnosis was available. CT scan was done in all the patients with Somatom Emotion CT (16 slices) Siemens medical systems. Patients included have presented with a history of head injuries and those who were brought for suspected head injuries. Postoperative patients and patients associated with other body parts injuries were excluded as the clinical outcomes of these patients could not be judged because of multiple system involvement. Result: A total of 518 patients were taken among whom 355 were male, and 163 were female with age varies from 1 month to 92 years with a total number of deaths noticed in the study were 13. The road traffic accident was the commonest mode of injury. The radiological findings (contusion 15.2% and 3.1%, diffuse axonal injury 2.3% and not reported any case, subarachnoid hemorrhage 13.6% and 4.9%, extradural hemorrhage 8.7% and 3.1%, subdural hemorrhage 15.5% and 11.7%, skull fractures 29% and 18.4%, midline shift 4.5% and 6.1%, scalp hematoma 8.7% and 24.5%) were seen in males and females respectively. The cases associated with > 4 radiological findings have more associated fatal outcomes than the cases with < 4 radiological findings (p-value = 0.0001). Conclusion: The study enlightens the significant positive findings on the NCCT which is the fast easily available procedure and can be used for early diagnoses and management. Thus NCCT head helped in decreasing the mortality. The more radiological findings showed a significant relation with mortality in the study.

Background: Lung cancer and diabetes mellitus (DM) are diseases of high occurrence worldwide. Increased incidence of lung cancer in DM patients is frequently observed. In this context, an insulin-sensitizing drug, metformin (biguanides) may have inhibitory effects on the proliferation of lung cancer cells. Aim: The present study was aimed to evaluate the growth proliferation effect of insulin on nonsmall cell lung carcinoma (NSCLC) cell lines. It also proposed to assess the preventive role of metformin in insulin-mediated proliferation in p53 and liver kinase B1 (LKB1) mutant and wild-type cell lines. Materials and methods: Two non small cell lung carcinoma cell lines, A549 and H1299 (p53 and LKB1 wild-type and mutant) were used to analyze the mitogenic role of insulin by incubating for 24 hours with human recombinant insulin at concentrations of 1nM to 10μM and followed by the addition of metformin (concentrations from 1μM to 50mM) for 24 hours along with insulin (500nM for A549 and 1μM for H1299). The proliferation was assessed by MTT dye reduction test. Results: Both the cell lines exhibited a significant and dosedependent growth proliferation (p < 0.001) with different concentrations of insulin. This was effectively (p < 0.001) inhibited by metformin treatment for 24 hours. The maximum reduction in growth was 73% and 67% for A549 and H1299 respectively. Conclusions: Insulin in high circulating concentrations can augment the growth proliferation of lung cancer cells. Metformin can inhibit this in a multifaceted way, wherein the mechanism of action is independent of p53 and liver kinase B1. Clinical significance: Metformin could inhibit the insulinmediated proliferation of cells, and hence it may be considered for the new therapeutic policies for treatment of human NSCLC.

Aim: The present review is aimed to assess the role of inflammatory mediators in the initiation and progression of the disorders, related to air pollution, with a special focus on cytokines. Background: Air pollution adversely affects human health. The outdoor and indoor pollution accounts for approximately 4 million deaths every year. The major pollutants include gaseous compounds, polycyclic aromatic hydrocarbons (PAH) and particulate matter (PM). Epidemiologic data shows the increase in the incidence of cardiopulmonary and central nervous system disorders on exposure of the pollutants and how do they aggravate the pre-existing disease conditions. Also, it contributes to the higher rate in cancer prevalence also. Review results: Numerous studies were carried out in delineating the underlying pathological changes of these diseases due to pollution. The suggestive mechanisms include the local and systemic inflammatory response and bone marrow stimulation elicited as a result of the entry of the toxic compounds. The oxidative stress developed also is said to be a contributing factor. The multiple interactions of a broad range of compounds like, cytokines, growth factors, adhesion molecules, reactive oxygen species, and acute phase proteins are also involved in the reactions. Conclusion: Multiple interrelated molecular pathways of inflammation are stimulated as a result of air pollution and which in turn leads to the secretion of the mediators and effector molecules. Cytokines are significant intermediaries of both the innate and the adaptive immune responses. These compounds take a m ajor position in the events in pathogenesis. Clinical significance: The concentrations of cytokines are seen altered in circulation and tissues. Hence, these may have the potential in considering as markers for evaluating adverse effects of air pollution.

Introduction: Urinary tract infections (UTIs) are one of the most common infectious diseases worldwide. Approximately >50% of women at least once in their lifetime have suffered from UTI and received antibiotic treatment. Serious UTIs are difficult to treat as it involves a wide array of Gram-positive as well as Gram-negative bacteria. Escherichia coli (E. coli) is the primary causative agent implicated in >80% of UTI cases. Current approach to treatment: A variety of drugs are indicated for the treatment of various clinical forms of UTI. These include nitrofurantoin, cotrimoxazole, fluoroquinolones, some cephalosporins, piperacillin-tazobactam, meropenem, ertapenem etc. Recently various studies have reported ciprofloxacin resistance among E. coli, the most common uropathogen. Review of literature pertaining to ciprofloxacin resistance: The prevalence, factors contributing to resistance and mechanism thereof have been reviewed. Hence, it is necessary to rationalize the use of ciprofloxacin to control the threat of antibiotic resistance. Conclusion: The incidence of resistance to ciprofloxacin has increased steadily during the past few years. Thus, the empirical use of fluoroquinolones for treatment of UTI should be reconsidered and the drug used only whenthere are clear laboratory tests confirming sensitivity to the drug.

Aim: This review intends to recapitulate the knowledge about pulmonary alveolar proteinosis (PAP) and insight into the advances in the pathogenesis and treatment of this condition. Background: A PAP is a seldom occurring disease with numerous possible etiologies. Review results: The disease has an insidious onset and the opinion is mostly delayed due to the fact that patients present late when there is abundant surfactant assimilation in alveoli to diminish gas exchange and cause dyspnea. An appropriate history, typical chest radiographic and high resolution computed tomography (HRCT) findings together with characteristic b ronchoalveolar lavage (BAL) fluid help to elucidate the diagnosis in most cases. However, transbronchial lung biopsy (TBLB) or open lung biopsy may be rarely needed for difficult to diagnose cases. Treatment is needed for patients with symptomatic disease and whole lung lavage is the treatment of choice. Conclusion: A PAP is a rare disease entity with variable natural history. The clinical course varies from respiratory failure to spontaneous resolution. Clinical significance: This review will help to furnish an outline of the various aspects of this disease in light of fresh scientific advancements in the pathogenesis and treatment of this condition. Knowledge about the disease will serve to better define the role of alternative and new therapies for the same.

We present a case of disseminated tuberculosis (DTB) in a young serving soldier with no prior medical history and admitted with respiratory symptoms of short duration. Tuberculosis (TB) was not suspected on examination. Investigations revealed anemia, relative neutrophilia, and a deranged coagulation profile. He died within six hours of admission. An autopsy revealed evidence of TB in the lungs, kidney, lymph nodes, liver, spleen and bone marrow. This case highlights the importance of recognizing this disease, especially in endemic, resource-limited settings.

Background: Sepsis is a significant cause of morbidity and mortality worldwide despite advanced critical life-support. Septic shock and multiorgan dysfunction is the terminal stage in critically ill patients leading to perfusion abnormalities, lactic acidosis, oliguria and altered mental status creating a rapid downhill course and mortality. Sepsis ensues through stages of exaggerated immune response including systemic inflammatory response syndrome, in the backdrop of infectious stimuli. Case report: Polymicrobial septic shock with multiorgan dysfunction leads to demise in an otherwise healthy immunocompetent patient. Microbiological profile revealed Escherichia coli urinary tract infection (UTI), Staphylococcus sciuri bacteremia, Acinetobacter baumanii ventilator-associated pneumonia, and central line catheter tip Pseudomonas aeruginosa, thereby pointing towards polymicrobial sepsis. Neutropenia of 290/dL along with serum procalcitonin 5 ng/mL was detected. An autopsy revealed anasarca, bilateral lung abscesses, Hepatosplenomegaly, intracerebral hemorrhage, consolidated lungs, myocardial hypertrophy, and acute tubular necrosis were observed. Bacterial colonies from lungs, liver and cerebrospinal fluid grew Pseudomonas aeruginosa. Conclusion: Polymicrobial sepsis can rapidly deteriorate a patient and mandate aggressive fluid, inotrope, ventilation, and antimicrobial therapy, notwithstanding challenges in diagnosis, prognosis and optimal management

Aim: Approach to a case with social phobia that presented with recurrent transient delusions of reference and persecution and responded with anti-anxiety medication without the need for antipsychotics. Background: Social phobia presents with symptoms of fear of scrutiny by other people in public, usually leading to avoidance of social situations. It is uncommon to have associated referential or persecutory ideations in it. In the present case study, we bought about a case with a social phobia that presented with recurrent transient delusions of reference and persecution, which responded to anti-anxiety measures alone. Discussion: Paranoid symptoms in the background of severe anxiety in social phobia may be explained by three models (a) Inability to challenge suspected criticism; (b) Presence of stressor leading to transient psychotic breakdown; (c) Understanding the disorder itself as a primary thought abnormality rather than an effective disturbance. In our case, despite paranoia, the patient responded satisfactorily to anti-anxiety measures alone, without the need of antipsychotics. Conclusion: Acute onset paranoia arising in a patient with a history of social phobia should get the benefit of being treated with anti-anxiety measures before starting antipsychotics, as they may respond satisfactorily to anti-anxiety measures alone and exposing patients to long-term side effects of antipsychotics may be unwarranted.

Background: The commonest differentials in a case of inguinal swelling are a hernia, hydrocele, lipoma and lymph nodal mass. However, we may come across some rare causes of inguinal lumps such as leiomyosarcoma. This is a case of an elderly gentleman who presented with a history of a painless, progressively enlarging mass over the right inguinal region which on further investigation was found to be a malignant tumour. Case presentation: A 70-year-old male patient presented with a mass over the right inguinal region 7 × 7 × 8 cm in size. It was nonreducible and non-trans illuminant. There was no cough impulse either. Sonography of the lump revealed a heterogeneous mass originating in the right inguinal canal queried to be an enlarged lymph node. Computed tomography (CT) scan of the abdomen and pelvis had similar findings. Fine needle aspiration cytology (FNAC) of the lump was inconclusive. The patient underwent an excision biopsy, and intraoperatively a huge fleshy tumour originating from the spermatic cord structures was visualized. Histopathological examination was suggestive of a grade II leiomyosarcoma. Conclusion: Spermatic cord leiomyosarcoma, although rare, should be kept in mind when dealing with an unusual lump in the cord. This article reviews the literature regarding paratesticular leiomyosarcoma presentation, diagnosis, and treatment.

Introduction: Rifampicin is a potent antitubercular drug used in the treatment of tuberculosis (TB). It is known to cause nephrotoxicity of which nephrotic syndrome is a less common though well-known manifestation. Case report: We present a case of rifampicin induced minimal change disease in a patient with HIV and TB who responded completely to the withdrawal of drug alone and did not require any specific therapy for nephrotic syndrome.