Paucity of reports on non-scarring diffuse alopecia in women from this part of the world led us to take up this study. We examined 200 consecutive cases of non-scarring diffuse alopecia in women who attended the skin OPD of a tertiary level urban hospital to find out the different types of diffuse hair loss, their clinical profile, key diagnostic features and etiological factors associated with them. Chronic telogen effluvium (CTE), female pattern hair loss (FPHL) and telogen effluvium (TE) were found to be the most common types of diffuse hair loss, seen in 71 (35.5%), 70 (35%) and 46 (23%) patients, out of a total of 200. These three (CTE, FPHL and TE) together accounted for 93.5% (187/200) of total cases of non-scarring diffuse alopecia in women. Excessive, alarming, diffuse shedding coming from a normal-looking head with plenty of hair and without an obvious cause was the hallmark of CTE. FPHL was presented as gradual diffuse hair loss with thinning of central scalp and intact hair line (Ludwig type), widening of central parting line with or without a Christmas tree pattern (Olsen type), or as fronto-temporal/bi-temporal recession with or without loss at vertex (Hamilton type/Male type). An abrupt onset and rapid, diffuse, excessive shedding of normal club hair, usually seen 2–3 months after a triggering event was the typical presentation of TE cases. High fever, postpartum hemorrhage and emotional stress were the common triggers associated with TE. Abnormal thyroid functions (23/200, 11.50%) and anemia (78/200, 39%) were noted in a significant number of cases of diffuse hair loss, making it mandatory to investigate them in all cases of diffuse hair loss.

Background: Elevation of diastolic BP has been shown in few studies among patients with hypothyroidism. However, the evidence is still obsolete when it comes to Indian settings. This study intends to evaluate association between hypertension and primary hypothyroidism in North Indian population. Methodology: One hundred primary hypothyroid patients (TSH level >5.5) were subjected to a cross-sectional comparative study in a tertiary care hospital in North India from August 2015 to June 2017. Patients had no thyroid complications and were unknown of their blood pressure status. Sociodemographic profile and clinical and laboratory status was evaluated which included blood pressure measurements; lipid profile, kidney function tests, and other vitals were recorded. Results: Individuals with diastolic and overall hypertension had significantly less serum T3 values and high TSH and serum creatinine values as compared to non-hypertensive individuals. Pearson test showed a significant correlation between serum TSH levels with both systolic and diastolic BP. Conclusion: This study showed that both systolic and diastolic blood pressure increased linearly with increasing TSH. Despite the differing estimated prevalence of hypertension in hypothyroidism, there seems to be a positive association of thyroid with BP.

Introduction: The presence of microorganisms with acquired resistance to multiple antibiotics complicates the management and outcome of critically ill patients. In the intensive care units (ICUs), this can lead to increased mortality. A remarkable increase in microbial resistance aiming selected pathogens has been reported over time. Exposure to antimicrobial agents has been thought to be an important contributor to its development. The environment that can contribute to this spread of infection can be of any kind, e.g., equipment, water, mobile phones, sink, taps, etc. Planning for containment and control of hospitalacquired infection (HAI) has to be based on the knowledge of possible sources. Thus we planned this study in the hospital. Methods: A prospective study was conducted, in which surveillance of the ICU environment and personnel, was carried out. Swabs were collected from 13 different sites from the environment (sinks, respirators, medicine trolleys, bed sheets, etc.) and healthcare workers twice a week throughout the duration of the study. The swabs were inoculated into a transport media and processed in the department of microbiology. Data was collected as per reporting received from the microbiology department. Compiled data was presented as actual number and percentage. Result: Two hundred thirteen (63%) of 338 samples collected no growth. All the site samples were infected except the disinfectant solutions and the doctors. Escherichia Coli was the commonest organism grown (74.4%), 12% grew Klebsiella, 4.8% showed Pseudomonas, 4.8% coagulase negative staph, 4% showed Staph aureus. All 52 water samples were positive for E. coli. The prevalence of microorganisms was maximum in the water (100%) and quite high in the sinks. Conclusion: The ICU environment seems to be a potential reservoir for pathogens. Therefore, strict adherence to environmental infection control measures is essential to prevent healthcare-associated infections.

Introduction: Lower abdominal surgeries are one of the most frequently performed surgeries in the pediatric age group. A large number of these operations are done as day-care procedures. Caudal block is one of the most common regional anesthetic techniques in children being used to supplement general anesthesia for a wide variety of sacral-segment surgery. The local anesthetics currently in use are safe and their pharmacological effects have been well evaluated. There is no fear of neurological sequelae as in the past. Several studies have demonstrated that Clonidine added to the local anesthetic in caudal block both enhances and prolongs the analgesia produced by the block without the unpleasant or hazardous sideeffects associated with the use of other adjuvant drugs like opioids, epinephrine and some newer adjuvants like neostigmine and dexmedetomidine. Our study aimed to evaluate the efficacy of single-dose caudal epidural Clonidine in prolonging the post-operative analgesia when mixed with Bupivacaine in children. Materials and Methods Sixty children of ASA I and ASA II physical status, between 1 and 12 years of age, who underwent elective lower abdominal surgeries, were randomly divided into two groups B (N=30) and C (N=30). All the children were administered general anesthesia. After induction, a single-shot caudal block was administered using 0.25% Bupivacaine (group B) and 1.5 mg/kg of Clonidine hydrochloride (group C). Vital monitoring was done intraoperatively as per institutional protocol. Post-operative monitoring was done in the post-anesthesia care unit (PACU) for 2–3 hours and in the ward for next 24 hours. Data with respect to duration of surgery, duration of pain-free period, time to void and any other complications was compiled. The final results of the study were tabulated and analyzed for significance using standard statistical techniques (unpaired t-test). Results This study was undertaken to evaluate the efficacy of Clonidine in prolonging post-operative analgesia of Bupivacaine when given caudally in 60 children undergoing lower abdominal surgeries. The duration of pain-free period with caudal Bupivacaine with Clonidine (group C) is significantly longer than caudal Bupivacaine (group B). The duration of pain relief was 20.4 hours in group C as compared to 14.2 hours in group B. This is statistically significant (p<0.05). Conclusion We conclude that adding Clonidine 1.5 mg/kg to Bupivacaine 0.25% for caudal anesthesia in children undergoing lower abdominal surgeries enhances and prolongs postoperative analgesia compared to caudal Bupivacaine 0.25% alone. Clonidine may be the drug of choice to prolong the duration of caudal anesthesia provided by a single injection in children.

Background: Hemorrhoid is one of the most common diseases encountered by a surgeon on daily basis. The choice of method of treatment for hemorrhoids depends on the severity and the type of symptoms, on the degree of prolapse and on the expertise of the surgeon and available equipment. Aim of this study is to compare stapled hemorrhoidectomy with conventional Milligan-Morgan hemorrhoidectomy in terms of surgical outcomes. Materials and Methods: Out of total of 50 patients selected, 25 underwent open and 25 stapled hemorrhoidectomy. Inclusion criteria for selection of the patients were large grade II, III and IV hemorrhoids and externo-internal hemorrhoids with well-developed external hemorrhoids. Results: Out of 50 patients included in our study, 15 were female and 35 male. The youngest was of 25 years of age and eldest 59 years. In group A, mean operative time was 29.8 min as against 51.32 min in group B with p value <0.001. All patients of group A were virtually pain free 7 days postoperatively, while mean pain of 1.04 was still recorded at 7 days in group B patients. Conclusion: Early functional and symptomatic outcomes have been found satisfactory and comparatively better with stapled hemorrhoidectomy. However, long-term follow-up in respect of so many factors is yet to be seen and further studies are required for this

Background: Congestive heart failure (CHF) is a serious clinical condition, with not many established treatment options. Eplerenone (Inspra) is the second aldosterone antagonist commonly used (in preference to Spironolactone) for treatment of hypertension and CHF in the US. Literature for its effectiveness in India is lacking, hence the need for the present study. Methodology: The present cross-sectional, observational study was done among 100 adult patients (>20 years) (50 patients in each study group: Eplerenone and Spironolactone), diagnosed with chronic CHF and poor left ventricle function (ejection fraction <40%) unknown of their blood pressure status. Sociodemographic profile, clinical and laboratory status was evaluated which included blood pressure measurements, lipid profile, kidney function tests, and other vitals. Assessment of parameters was done after 8 weeks of treatment. Results: Systolic blood pressure, diastolic blood pressure and CK levels showed a significant change over the study duration, with Eplerenone producing a better result than Spironolactone (p<0.05). Remaining parameters showed a non-significant difference. Conclusion: Eplerenone group proved to be associated with a better outcome in hypertension and cardiovascular parameters; however, due to limitations in sample selection, more research is warranted