This article reviews and describes the theoretical concept of organ donation (OD) and transplantation, historical milestones, need, shortage, status of global activities, health system capacity, survival outcome, and update on legislative environment in India, Central/State contribution and Nongovernment Organizations actively involved in OD.

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Over the last 17 years, liver transplant in India has evolved from a rarity to a common procedure available along the length and breadth of the country with survival data comparable to the best centres in the world. India is now in the forefront of Living donor liver transplant (LDLT) in the world, led by the team of the principal author. LDLT is possible for all types of recipients and indications with 95% success, with low incidence of vascular complications and biliary complications. While Deceased donor liver transplants (DDLTs) have picked up steam in Southern India, there is still a large gap between demand and supply of organs. LDLT is essential to bridge this gap and continues to be the main curative option for the majority of patients in India suffering from end-stage liver disease and Hepato cellular carcinoma (HCC) confined to the liver.

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Food safety refers to all those hazards which make the food unsafe to health. The unsafe food creates a vicious cycle of disease and malnutrition which affect all age groups but in particular children, the elderly, and the sick. Foodborne diseases are important hidden causes of morbidity. This article has been written with an objective to assess the current status of food safety and related issues in India and the measures to improve the same. Though most of the foodborne diseases are sporadic and often not reported in India, a nationwide study reported an alarming 13.2% prevalence at the household level. Currently, the mainstay for food safety in India is a legislative approach. The Indian food industry is regulated by the number of legislations covering sanitation, licensing, and permits. Food Safety and Standards Authority of India established by the Government of India develop the standards for food and regulate and monitor the manufacture, processing, storage, distribution, sale, and import of food so as to ensure the availability of safe and wholesome food for human consumption. The literature review shows that the consumer awareness is not very good in India in relation to food safety. There is a need to initiate the public health surveillance for food safety and foodborne diseases. Legislations related to food safety should be enforced strictly. The consumer awareness should be an important part of all initiatives.

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Successful kidney transplantation offers the best possible quality of life for patients with end stage renal disease (ESRD). Despite this, renal transplantation rates in the developing world are considerably lower than in the developed world. Identified reasons for this include lack of awareness, low education levels, lack of a clear national policy, absence of functional dialysis and transplant units with adequately trained staff, and absence of an organized system of organ retrieval from deceased donors and lack of opportunities to fund long-term immunosuppression. Measures to improve the quality of care should center on improvement of the socioeconomic status of the country. Key action points include the implementation of: (1) Chronic kidney disease (CKD) screening and prevention programs; (2) ESRD and transplantation registries; (3) transplantation legislation, covering both living and deceased organ donation; (4) international and regional collaborations for transfer of knowledge and technology. The government should make transplantation more affordable by strengthening the public sector hospitals and by making the transplant medication more affordable. With the National Organ Transplant Programme (NOTP) in the process of being established in India, the transplant community should strive to increase the organ donation awareness, improve the infrastructure for organ retrieval, storage and allocation in an equitable way.

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Anticoagulants are routinely used in stroke, embolism, infarct, etc. Blood clotting profile in such patients needs to be monitored frequently. Anticoagulants which can be administered orally such as warfarin and dicoumarol are preferred in such patients. Injectable anticoagulants such as heparin are prescribed when anticoagulation therapy is required for short duration. Absence of oral form of heparin makes it impractical for long-term use. Currently, warfarin and coumarone derivatives are the best available oral anticoagulants in market. They act by inhibiting decarboxylation of blood clotting factors II, VII, IX, and X. Pharmacological response of warfarin and dicoumarol needs to be monitored by frequent assessments of prothrombin time (PT) and international normalized ratio (INR). There is a need for a drug which can overcome these limitations. Apixaban is an oral anticoagulant which acts by inhibiting factor Xa. It does not require laboratory monitoring of PT and INR. Hence, it overcomes the limitations of heparin and warfarin. It acts by selectively inhibiting the activated factor Xa in a reversible manner. Apixaban has an oral bioavailability of ~50%. It is administered as twice daily dose. It is excreted in urine and feces. Apixaban is useful in atrial fibrillation, venous thromboembolism, and pulmonary embolism. Bleeding is the major side effect of apixaban. It has been found that apixaban has superiority over warfarin and aspirin in terms of efficacy and safety. Further studies are required to monitor and assess the pharmacokinetics, efficacy, adverse effects, and drug interaction data in many populations and sub-populations throughout the world.

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In the ongoing Corona Virus Disease-2019 (COVID-19) pandemic, the role of health care professionals and outreach workers is indispensable towards the prevention and control of the disease. Anticipating the risk that the disease might land up into stage 3, a wide range of interventions have been implemented. However, the most important strategy will be to spread awareness about the disease and intensify actively search for the suspect cases in the community and here comes the role of outreach community workers. As the doctors and other paramedical staff are overwhelmed with the COVID-19 related work and are also involved in the delivery of emergency services, the importance of the role discharged by these community workers is extremely vital. In conclusion, the role of outreach community workers in creating awareness about COVID-19 and the identification of the suspect cases in the community through active search is extremely crucial in containing the disease and interrupting the chain of the transmission.

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We report a 70 years old female, who presented with huge swellings over the left forehead, left clavicular region, anterior neck, occipital region and the right side of the scalp. The first swelling appeared 8 years back. She had deranged thyroid function tests and highly raised serum thyroglobulin levels. Her T3 level was 300.75 ng/dl (normal range: 40–181 ng/dl); T4 level was 6.7 µg/dl (normal range: 5–10.7 µg/dl) and thyroid stimulating hormone (TSH) level was 0.09 µIU/ml (normal range: 0.5–8.9 µIU/ml). Her serum thyroglobulin level was 30,000 ng/ml (normal range: 0.73–84 ng/ml). We have reported this case due to the unusual presentation of the patient with massive metastatic lesions from a primary thyroid cancer with highly raised serum thyroglobulin levels. Metastatic tumors to the skull are most often from breast, lung and prostate malignancies. In thyroid cancer, Nagamine et al. reported skull metastasis in only 2.5% of the cases. Along with radioactive iodine therapy, curative resection of solitary bone metastasis, wherever possible, is associated with improved survival, especially in younger patients of metastatic thyroid cancer. Only the light of knowledge and health education can dispel the darkness of ignorance. This rare case report highlights the importance of educating the masses, especially the people living in villages, so that it does not take 8 years, as in our case, to present oneself to a tertiary health care facility.

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Dural fistulas associated with dementia are rarely reported and, among these, intracranial dural fistulas constitute an infrequent etiology. Moreover, dementia associated with dural fistulas occurs due to venous hypertension leading to ischemic neuronal dysfunction. This case report describes a male patient exhibiting unusual features of dementia with a concomitant dural fistula compromising the superior sagittal sinus. The fistula was completely occluded via endovascular embolization. Two months after the interventional therapy, clinical assessment revealed complete improvement of executive functions. Afterward, the patient returned to his daily activities without impairment.

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Background: Mosquito-borne diseases constitute an important cause of morbidity and mortality, especially in India. Assessment of knowledge and practices of community about prevention of mosquito borne diseases is important for designing community-based interventions. Therefore, the study was carried out to assess such information. Materials and Methods: A community-based cross-sectional study was conducted among 350 adults selected by systematic sampling method in a rural and urban area in Delhi. Data was collected using pretested semi-structured questionnaire after taking written informed consent. Data was analyzed using SPSS version 17. Chi-square and Fisher's Exact test was used for qualitative variables to find association and P <</i> 0.05 was considered significant. Results: One hundred and forty-two (67.6%) subjects in rural and 89 (63.6%) in the urban area were able to name at least one mosquito borne disease. Only small number of participants (from rural 28.1% and urban 18.6% areas) was aware of "fever with chills and rigor" as a symptom of malaria. Television was most common source of information in both rural and urban areas. Desert coolers were reported to be cleaned regularly in a week in 86.4% houses in a rural area, and 88.4% houses in the urban area. Potential breeding sites were significantly more in urban (n = 34, 24.3%) than rural (n = 13, 6.2%) houses (P = 0.01). Similarly actual breeding of mosquitoes was found significantly more in urban houses (n = 29, 20.7%) than rural houses (n = 14, 6.7%), which was statistically significant (P = 0.01). Knowledge about mosquito borne diseases was significantly associated with education status of the participants. Conclusion and Recommendation: Level of awareness was good; however mosquito breeding was occurring more in urban areas, which demands innovative mass media techniques to convey health messages to the public for prevention and control of mosquito borne diseases.

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Background: Healthcare seeking by pediatric tuberculosis (TB) patients is complicated because of some factors such as lack of knowledge among family members, diagnostic difficulties, limited resources, and treatment challenges. Aims: The aim of this article is to identify the barriers and challenges related to seeking healthcare by pediatric TB patients. Settings and Design: It was a prospective observational study conducted from January 2015 to December 2015 at two chest clinics. Materials and Methods: A predesigned, pretested, and semi-structured questionnaire was used to interview caregivers of pediatric TB patients and followed up at two more occasions, that is, at the end of intensive and of continuation phase, to identify the challenges they were facing during treatment. Statistical Analysis: Data were analyzed using SPSS software version 17 (SPSS Inc., New Delhi, Delhi, India) and P value less than 0.05 was considered significant. Result: The lack of knowledge was a barrier to understand the disease, seeking care, and being compliant with treatment as nearly 40% (41.8%) did not know that TB is infectious and more than half (55.3%) did not know that TB can occur in any age group. Only 14.2% knew about vaccine for TB, but no one had knowledge about isoniazid prophylaxis. Reported challenges in treatment seeking were high transport cost, long distance for higher government facility (83.7%), and interference with daily routine (39.0%), and in-treatment compliance were heavy pill burden (80%), refusal of child to take medicines (41.8%), fear of side effects (71.6%), and difficulty in powdering the medicines (35.5%). Conclusion: Major barrier was lack of knowledge about childhood TB and major challenge was heavy pill burden, which affected the compliance.

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Objective: To assess students’ opinion and perception regarding education environment in a government medical college of Delhi, India. Materials and Methods: Dundee Ready Educational Environment Measure (DREEM), a universal, culturally nonspecific, generic 50-item inventory tool was used. Each item is rated on a five-point Likert scale with score ranging from 0 to 4 where 0 = strongly disagree, 1 = disagree, 2 = unsure, 3 = agree, and 4 = strongly agree. MBBS students of three batches (2^nd, 3^rd, and 4^th year) were considered in the present cross-sectional study. Results: A total of 117 (84.1%) available students could be contacted in person, out of whom 71 (60.7%) were males; 94 (80.3%) passed their 12^th class from private/convent school; nearly 88 (75.2%) students opined that administration is student-supportive; and 111 (94.8%) were in self-assessment state of “happiness.” The overall mean DREEM inventory score (range, 0–200) among all the respondents was 130.34 (±15.76), which is suggestive of “more positive than negative.” Statistically (P < 0.05) higher DREEM score was found among senior medical students [score, 136.5 (4^th year) vs. 131.9 (3^rd year) vs. 123.6 (2^nd year)]; those medical students who were globally satisfied (score, 131.2 vs. 119.3); satisfied getting admitted in current medical college (score, 133.0 vs. 115.7); and who opined that administration is student-supportive (score, 133.4 vs. 120.9). Gender, type of school, marks in 12^th class, native place, current residence, supplementary (extra attempt) in university exam, current mental state (sad/happy), and professional satisfaction had no statistical bearing on overall DREEM score. Overall, none of the inventory item (score range, 0–4) had an avg. score more than 3.5, but the score of the majority (42/50, 84.0%) of question items in the present study was in the range of 2–3 points indicating the aspects of the environment that could be improved or enhanced. Conclusion: Within limitations, the study gauges the experiential learning environment from the students’ perspective indicating overall positive results and moving in right direction. Some challenges inherent with medical education and critical areas requiring strengthening were listed including social and leisure time student involvement.

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Ectopic thyroid is the presence of gland at any location except for its normal position in the anterior neck in front of the trachea. It may result from an early arrest of migration or migration along an abnormal path. Ectopic thyroid in the submandibular region is relatively unusual and may or may not be accompanied with the orthotopically located thyroid gland. Pathological changes reported in the literature in the ectopic gland include goitrous change, hyperplasia, malignancy, and, rarely, inflammation. Patients usually present as a palpable, mobile, and painless mass below the lateral jaw. The important differentials include salivary gland tumor, lymphoma, inflammatory lymphadenopathy, lipoma, and cysts. Ultrasonography, radionuclide scan, computed tomography, and magnetic resonance imaging are the diagnostic modalities for documenting the presence of ectopia. Evaluation of functional status with thyroid profile and histopathological examination after fine-needle aspiration cytology directs further management. Surgical removal is the preferred treatment for ectopic thyroid. Thyroidectomy predisposes the patient to iatrogenic hypothyroidism if eutopic thyroid is absent or hypofunctioning. Such patients require lifelong thyroid replacement. However, asymptomatic cases may be managed conservatively. Ectopic thyroid in the submandibular region has important clinical implications and hence, even though rare, should be considered as one of the differentials in the patient presenting with swelling below the lateral jaw.

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A hamartoma is a tumor-like lesion made up of tissues indigenous to the part but lacks the true growth potential of a true neoplasm. Hamartomas are rare in head and neck region. Since they are often asymptomatic, they are easily missed during routine examination. To the best of our knowledge, lymphangiomatous hamartoma of parapharyngeal space has not been reported in medical literature so far. We report a rare case of lymphangiomatous hamartoma of parapharyngeal space in an 8-year-old child managed by surgery.

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Dengue fever over the recent years has gained attention of not only the health care professionals and researchers, but also public at large and it is a major seasonal health care problem in the tropics and the developing countries. Mortality due to complications such as hemorrhage and shock is well-known and is a major concern for the physician. Neurological manifesations include myelitis and encephalitis have started to gain attention as they present with high mortality and morbidity. We report a case of dengue fever with predominant neurological manifestations of acute disseminated encephalomyelitis (ADEM). The patient presented with fever, vomiting, and altered sensorium of recent onset. On evaluation, the patient was positive for dengue serology and magnetic resonance imaging picture suggested ADEM.

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Aim: Carbapenems are one of the last resort drugs against drug-resistant organisms and carbapenem resistance (CR) is increasingly being reported. The present study evaluated the CR pattern in general Intensive Care Unit (ICU) of a tertiary care hospital in India. Materials and Methods: This was a retrospective analysis of data collected from May 2011 to January 2012 of 40 patients admitted in the general ICU with a stay of more than a week. The clinical and demographic data, Sequential Organ Failure Assessment (SOFA) score, need for mechanical ventilation, antibiotic sensitivity reports, and outcome were assessed. The results were statistically analyzed using Student's t-test, Mann-Whitney U-test, Chi-square test, and Fisher's exact test, where appropriate. P < 0.05 was considered statistically significant. Results: Acinetobacter baumanii was the most common organism in tracheal samples, Pseudomonas aeruginosa in blood samples and Escherichia coli in urine samples. CR in fresh episodes was seen maximally with Acinetobacter baumanii (79%) and Pseudomonas aeruginosa (70%). Meropenem resistance (MR) was more common than imipenem resistance in CR organisms. High sensitivity among CR organisms was observed to tigecycline and colistin, and among carbapenem sensitive organisms to tigecycline, piperacillin-tazobactam combination, and levofloxacin. CR was prevalent with age >50 years (P = 0.002), ICU stay of >15 days (P = 0.002), mechanical ventilation (P = 0.003), and ventilation >10 days (P = 0.008). Mortality was more common among mechanically ventilated patients (P = 0.002) and those with higher SOFA scores on admission (P = 0.012). Conclusion: Carbapenem resistance is high in microbiological cultures of ICU patients with a stay for over a week. Acinetobacter baumanii and Pseudomonas aeruginosa were the most common CR organisms. MR was more common than imipenem resistance.

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Objectives: Skin acts as the diagnostic window to many internal organs including the renal system. Subtle changes in the skin may act as clues to the underlying renal pathology. The present study was undertaken to evaluate and compare the cutaneous manifestations among the spectrum of renal failure including post-transplant patients. Materials and Methods: Hundred patients with chronic kidney disease including post-transplant patients were recruited in the bring highlighted line here. In the study conducted at Department Detailed cutaneous examination was performed and findings were recorded and compared among the study groups. Results: Total 61% patients had cutaneous manifestations and 40% had more than one finding. The most common cutaneous finding was xerosis noted in 53%, followed by pruritus in 42%, pallor 37%, pigmentation 34%, and cutaneous infections in 33%. Nail involvement was noted in 43%. The most common nail finding was half and half nail seen in 30%, followed by brittle nails in 20%, beau's line 18%, and leukonychia 16%. The prevalence of skin findings was significantly more among the patients with end stage renal disease and those undergoing dialysis. The post-transplant group showed increased prevalence of infections. Conclusions: Dermatological manifestations increase with duration and severity of renal disease. Though renal transplantation and hemodialysis reverse the metabolic derangement in these patients, they predispose to a number of cutaneous complications.

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Background: Adenomyosis is myometrium uterine pathology commonly seen in peri-menopausal women who usually present with menorrhagia and dysmenorrhea. Adenomyosis uterus is diagnosed by the histopathological examination of the hysterectomy specimens. Aims: To know the clinical symptoms seen with adenomyosis and to diagnose endometrial, ovarian, and other associated pathologies in adenomyosis uteri patients. Setting and Design: Tertiary care hospital and retrospective study. Materials and Methods: Present study was performed on hysterectomy specimens between January 2008 and December 2014 in the Pathology Department of Rural Institute of Medical science and Research, Saifai, Etawah (Uttar Pradesh). Specimens were grossly examined, sectioned, and hematoxylin and eosin stain was applied. Statistical Analysis: Percentage. Result: A total of 353 patients were included. The common age group of patients with adenomyosis was 41–50 years (44.75%). Menorrhagia (70.25%) was a prime clinical symptom. Among endometrial pathologies and changes, proliferative phase was maximum (44.47%), followed by secretory phase (25.21%) and endometrial hyperplasia (12.46%). Common pathologies seen in ovary were simple serous cyst (39.58%), corpus luteal cyst (27.08%), and endometrial polyp (40.74%). Conclusion: Adenomyosis is a myometrial lesion present in 41–50 years of age group with clinical symptoms of dysfunctional uterine bleeding. Proliferative phase, secretory phase, and endometrial hyperplasia were commonly seen with adenomyosis. Simple serous cyst was a common pathology seen in ovary. Endometriosis change in the ovary was also seen, confirming a strong association between adenomyosis and endometriosis. Endometrial polyp was also common.

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Background: Rate of coverage and consumption is the most crucial factor in the success of MDA program against lymphatic filariasis. The roles of the drug distributors and other health workers cannot be ignored in order to achieve success in MDA coverage and compliance. Materials and Methods: This was a cross-sectional study conducted in Solapur district in January 2015. A sample of 672 participants from four clusters was selected through multistage cluster sampling and interviewed using pretested and prestructured questionnaire. Additionally, MDA drug distributors were also interviewed to understand some of the operational issues encountered in MDA program. Results: The average coverage of MDA in Solapur district was 63.7%, the compliance rate was 75.5%, and effective coverage rate was 48.1%. The important reason for higher rate of noncompliance was unsupervised treatment by the drug distributor, beneficiaries were on empty stomach at the time of distribution of drugs, not received the drugs and not available at the time of drug distributor's visit and in urban area was lack of knowledge about the disease. The important reasons for noncompliance quoted by drug distributors were inadequate training of drug distributor, fear of side effects in beneficiaries, and the empty stomach at the time of drug distributor's visit. The majority of health personnel (69.7%) suggested Booth activity as an ideal method for MDA that is planned on a holiday, and more extensive training well before the planned MDA activity.

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Context: Hypothyroidism has been associated with neurocognitive deficit, but status of cognitive function in subclinical hypothyroidism is unclear. Also, cognitive impairment found in these patients has been associated with aging. Aims: The purpose of this study was to evaluate cognitive function in hypothyroid and subclinical hypothyroid patients using objective methods and to correlate it with age, thyroid stimulating hormone (TSH) level, and education status of patients. Settings and Design: It was a cross-sectional study conducted on 90 female participants aged 30-50 years. Thirty patients diagnose with subclinical hypothyroidism (group 1) were compared with 30 age- and sex-matched hypothyroid patients (group 2) and euthyroid controls (group 3). Subjects and Methods: Cognitive function was evaluated using three parameters such as mini mental scale examination (MMSE), event-related potentials - P₃₀₀latency and amplitude, auditory and visual reaction time. Statistical Analysis Used: SPSS version 17 was used for statistical analysis. The data were also analyzed for variables related to age, TSH, and education level. Results: Significant delay in P₃₀₀latency and prolonged reaction time was found in both subclinical hypothyroid and hypothyroid group compared to controls (P < 0.001). P₃₀₀amplitude and MMSE score showed no significant difference in all groups. In hypothyroid patients, P₃₀₀latency at Fz, Pz was positively correlated with age while nonsignificant correlation was observed in subclinical hypothyroid patients. TSH and education level of patients showed no significant correlation with cognitive function tests. Conclusions: Delayed P₃₀₀latency and prolonged reaction time in both subclinical hypothyroid and hypothyroid patients shows that cognitive function is affected adversely. Event-related potentials may be more sensitive than clinical evaluation by MMSE, for early diagnosis of mild cognitive impairment in subclinical hypothyroidism.

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