Background: Infant feeding practices, especially exclusive breastfeeding (EBF), are critical for a child’s health and survival. Despite global recommendations, gaps in knowledge and practice persist, influenced by socio-demographic factors. Objective: To compare the knowledge and attitudes regarding infant feeding practices among rural and urban mothers in Puducherry and Tamil Nadu. Methods: A cross-sectional study was conducted among 200 mothers (100 rural and 100 urban) with full-term infants. Data were collected using a validated, pre-tested questionnaire assessing knowledge and attitudes toward EBF and complementary feeding. Statistical analysis was performed using descriptive and inferential methods. Results: Most mothers were aged 20–29 years and belonged to middle socioeconomic status. Urban mothers had better education and employment levels, while rural mothers were more likely to live in joint families. Knowledge about EBF was slightly higher in urban mothers, especially regarding demand feeding (59.54% vs. 40.46%, p=0.004). However, rural mothers had better knowledge about appropriate complementary foods. Both groups were aware of the importance of breastfeeding, with similar understanding of timing for complementary feeding. Conclusion: Knowledge and attitudes regarding infant feeding were comparable between rural and urban mothers, though shaped by different socio-demographic factors. Strengthening health education and counselling, particularly among disadvantaged groups, is essential to bridge these gaps.
Background: The widespread availability of smartphones and social media platforms has led to a rapid increase in selfie-taking behavior worldwide. While selfies serve as a means of self-expression and social interaction, attempts to capture images in hazardous environments have resulted in a growing number of accidental deaths. India reports the highest number of selfie-related fatalities globally, highlighting the need for systematic evaluation of these incidents. Objectives: (1) To analyze the sociodemographic characteristics and causes of death associated with selfie-related fatalities in India. (2) To assess the geographical distribution and environmental circumstances of these incidents. Materials and Methods: A retrospective descriptive study was conducted using publicly available English-language media reports of selfie-related fatalities in India from January 2014 to December 2021. Data on demographics, geographic distribution, environmental settings, and mechanisms of death were extracted and analyzed using descriptive statistics. Results: A total of 151 deaths across 81 incidents were identified. Most victims were aged 21–30 years (51.7%), followed by those below 20 years (37.7%). A strong male predominance (84.1%) was observed. Water bodies were the most common setting (57%), with drowning as the leading cause. Railway-related incidents accounted for 18% of fatalities, followed by falls from height and electrocution. In addition, 29 incidents involved bystanders, resulting in 70 deaths. Conclusion: Selfie-related fatalities are a preventable public health concern, predominantly affecting young males in high-risk environments. Public awareness and implementation of “no-selfie zones” may help reduce such deaths.
Alopecia areata (AA) is an immune-mediated, nonscarring alopecia affecting approximately 1%–2% of the population. Linear AA is an uncommon morphologic variant that can closely mimic the other causes of linear alopecia, often leading to diagnostic uncertainty. We report the case of a 24-year-old woman who developed a progressive linear patch of alopecia over 6 months. Trichoscopic evaluation revealed the classic features of AA, facilitating a noninvasive diagnosis in the absence of histopathology. This case underscores the clinical rarity of linear AA and highlights the pivotal role of trichoscopy in accurately distinguishing it from other linear alopecias such as lupus profundus, trichotillomania, and traction alopecia.
The term angiokeratoma is derived from the Greek words angio meaning “vessel,” kerat meaning “horn,” and oma meaning “tumor,” reflecting its histologic composition of dilated vascular channels with overlying epidermal hyperkeratosis. Angiokeratomas represent benign vascular proliferations involving the superficial dermis and are often characterized by their variable morphology and clinical resemblance to other dermatoses. Because of this heterogeneity, establishing an accurate diagnosis can be challenging for clinicians. We report the case of a 49-year-old female who presented with multiple, chronic, fluid-filled papules over the vulva persisting for the past 10 years. Clinically, the lesions closely resembled lymphangioma circumscriptum (LC), leading to initial diagnostic uncertainty. The significant clinical and dermoscopic overlap between angiokeratoma and LC highlights the potential for misdiagnosis. This case emphasizes the critical role of a comprehensive diagnostic approach – integrating clinical assessment, dermoscopic evaluation, and confirmatory histopathological examination – in the evaluation of atypical vulvar lesions. Correlation of these modalities is essential not only for establishing a precise diagnosis but also for guiding appropriate management and avoiding unnecessary or invasive therapeutic interventions.
Background: Infective endocarditis (IE) is an infection of the endocardium, most commonly caused by Streptococcus. The study aims to evaluate the clinical features, blood culture yields, species distribution, and antibiotic susceptibility patterns of streptococcal isolates, with a focus on IE. Materials and Methods: Fifty streptococcal blood culture isolates from clinically suspected cases of bloodstream infection (BSI) were analyzed from January 2022 to December 2024. Species identification was performed using the VITEK 2 compact system, and matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry. Clinical data, association with IE, number of blood culture sets, and antimicrobial susceptibility patterns were analyzed descriptively. Results: Out of 8757 blood samples processed, 900 were culture positive. Streptococcal species accounted for 50 (5%) of these isolates. Streptococcus agalactiae was the most frequently identified species (n = 20, 40%). Most of the patients were >40 years, with male predominance (n = 34, 68%). Of the 50 culture-proven streptococcal BSIs, 18 (36%) were clinically suspected to have IE. Of these, 8 (44%) had positive blood cultures, with viridans streptococci being the most common isolate. Diagnostic yield correlated with the number of blood culture sets. Echocardiography revealed vegetations in 75% of IE patients, the most common being mitral valve involvement (63%). Streptococcal isolates showed high susceptibility to b-lactams (ampicillin, ceftriaxone) and vancomycin. Conclusion: Viridans streptococci remain the most common cause of streptococcal IE, while S. agalactiae is increasingly implicated in adult bacteremia. Obtaining multiple blood culture sets significantly improves IE diagnostic yield. Species-level identification and adherence to Duke International Society for Cardiovascular Infectious Disease criteria are essential for accurate diagnosis and effective management of streptococcal IE.
Blocked D phenomenon is characterized by a negative reaction of fetal Rh(D) antigens with anti-D immunoglobulin antisera. This occurs because all the Rh(D) antigenic sites are blocked by maternally transferred anti-D antibodies in an Rh (D)-positive fetus. This may lead to incorrect grouping of the newborn as Rh(D) negative. We report a case of blocked D phenomenon in a Rh(D)-positive fetus born to a 29-year-old G2P1 L1 woman at 30 weeks + 2 days of gestation. The mother’s blood group was AB negative, and the indirect antiglobulin test was positive, with anti-D antibody identified with a titer of 1:256. Ultrasound examination of the fetus showed hemolytic features (middle cerebral artery peak systolic velocity 1.59 multiples of the median). An intrauterine transfusion was planned. A fetal blood sample was collected and initially grouped as AB negative. Further evaluation of the fetal blood group was performed using the elution technique, which confirmed the fetal blood group as AB positive.
Tachycardia is a frequent physiological abnormality in trauma patients and is often reflexly attributed to hemorrhagic shock. Advances in trauma care have improved survival but have increased the incidence of complications related to resuscitation, surgery, and prolonged critical care. We report a case of blunt abdominal trauma in which tachycardia recurred at multiple time points, each reflecting a distinct underlying pathology. Phase-wise contextual elimination of causes enabled recognition of abdominal compartment syndrome, iatrogenic pulmonary complications, enteral feed intolerance, multiple foci of sepsis, and opioid withdrawal. This case highlights tachycardia as a dynamic clinical signal rather than a static marker of physiological derangement and offers a brief perspective on how emerging artificial intelligence-based predictive models may, in the future, assist clinicians in anticipating such complications earlier.
Alopecia areata (AA) is an autoimmune condition and is the most common cause of nonscarring alopecia in children. There are various treatment options for AA depending upon the severity and age of presentation, but they have limited efficacy and undesirable side effect profiles. Janus kinase inhibitors are a newer group of drugs with proven efficacy and safety. But there are only a very few studies published on the usage of Janus kinase inhibitors in the pediatric population. We had four children with AA treated with oral tofacitinib from September 2023 to November 2023. Clinical characteristics, clinical response, SALT scores, and side effects were evaluated. All four patients demonstrated significant improvement in SALT scores from 55% to <10% in all patients at a treatment duration of 6 months. Children did not have any significant side effects in our study except for minor GI side effects in one child. So we concludeTofacitinib can be considered as a treatment option in treatment-resistant cases.
Headache is a common reason for presentation to the emergency department (ED), ranging from benign primary headache disorders to life-threatening secondary causes. This narrative, nonsystematic review provides a practical ED-oriented synthesis of the assessment and management of nontraumatic headache using the International Classification of Headache Disorders, 3rd edition (ICHD-3), together with contemporary guideline-based recommendations. We intentionally included both adult and pediatric literature when it informed ED triage, diagnostic workup, or early management. A search was conducted in PubMed/Medline, Scopus, LILACS, and SCIELO for English-language articles from July 2008 to July 2023, with supplementary targeted hand-searching during manuscript revision to identify key guideline documents and major ED-relevant publications published through January 2025. Grey literature sources were reviewed selectively, and priority was given to clinical practice guidelines, systematic reviews, major narrative reviews, and pivotal original studies relevant to emergency care. Literature was reviewed to summarize the epidemiology, clinical classification, diagnostic strategies, and treatment of both primary and secondary headache disorders. Particular attention was given to triage principles, red flags, neuroimaging indications, and syndrome-specific treatment. The review also addresses acute ED management, disposition decisions, and clearly distinguishes ED interventions from specialist-directed therapies and outpatient preventive strategies. By aligning clinical assessment with the ICHD-3 and current therapeutic evidence, this review provides a structured, ED-oriented framework to improve diagnostic accuracy, early management, and safe patient disposition. This review is intended to support ED decision-making and is not a substitute for individualized clinical judgment.
Pyogenic granuloma (PG) is a common vascular lesion of the oral cavity that is reactive rather than neoplastic in nature. It commonly develops in response to trauma, chronic irritation, or hormonal influences and shows a higher prevalence in females. The lesion is more frequently observed in the mandibular region than in the maxilla. Standard management includes the elimination of local irritants and complete surgical excision. This case report describes the case of a 45-year-old male who presented with a firm, painless gingival swelling in the maxillary region, associated with localized alveolar bone loss. The patient had a medical history of hypoxic ischemic encephalopathy with associated intellectual disability, a nonprogressive neurological condition that may contribute to compromised oral hygiene and increased susceptibility to chronic irritation. In addition, the patient’s long-term tobacco use may have further exacerbated local inflammation, contributing to lesion development. Histopathological examination confirmed the diagnosis of sclerosed PG, characterized by extensive collagen deposition and a reduced vascular component. Complete surgical excision of the lesion, along with thorough debridement and elimination of local irritants, was performed. The patient exhibited uneventful healing and showed no evidence of recurrence during a 1-year follow-up period. This case highlights the importance of accurate diagnosis and comprehensive management in ensuring favorable long-term outcomes.
Background: Obesity remains a critical public health issue worldwide. Respiratory complications such as obstructive sleep apnea (OSA) and obesity hypoventilation syndrome (OHS) significantly impact the quality of life and often go undiagnosed. This study aimed to determine the prevalence of OSA and OHS among obese patients presenting to the emergency department (ED). Methodology: A prospective observational study was conducted in the ED of a quaternary care hospital. All patients with a body mass index (BMI) >30 kg/m2 were enrolled after obtaining informed written consent. Demographic and clinical data, including the STOP-Bang score, Epworth Sleepiness Scale (ESS) score, neck circumference and arterial blood gas, were collected. Results: The mean age of the study population was 54 (standard deviation 14.15) years with a female predominance (60%). The prevalence of a significant risk of OSA and OHS was 86.5% and 17.3%, respectively. The most common comorbidities were Type 2 diabetes mellitus (58%) and hypertension (59%). The average BMI was 37 (±6.41), with a mean neck circumference of 41.73 cm (±5.08), mean PaO2 of 76 mmHg, and mean PaCO2 of 38 mmHg. Logistic regression analysis showed a significant association of OSA with male sex, diabetes, hypertension, BMI >35 and neck circumference >40 cm. About 27 (17.3%) had daytime PaCO2 of >45 mmHg, consistent with the OHS definition. Conclusion: This study underscores the high burden of undiagnosed OSA and OHS in obese individuals. Early recognition using validated screening tools in the ED can facilitate timely diagnosis and intervention, potentially mitigating the long-term complications associated with these conditions.
Background: Autism spectrum disorder (ASD) is a neurodevelopmental disorder affecting communication, behavior, and social interaction. Early intervention can improve outcomes, and teachers play a key role in identifying early signs. Enhancing their knowledge is essential for timely recognition and referral. Objective: The objective is to determine the knowledge about ASDs among preschool and primary school teachers and to assess the impact of an awareness program about ASDs among preschool and primary school teachers. Methods: A quasi-experimental study with 40 preschool and primary teachers from a Puducherry CBSE school was conducted using convenience sampling. Knowledge was assessed before and immediately after the awareness session using a validated questionnaire. A follow-up test was done after 4 weeks via Google Forms. Data were analyzed using descriptive and inferential statistics. Results: Before the intervention, the mean knowledge score was 12.05 (standard deviation [SD] =3.52), with 50% of teachers having inadequate and 42.5% having moderate knowledge. After the awareness program, the mean score significantly increased to 17.15 (SD = 1.93; t = 12.8, P < 0.001), with 75% showing moderate and 25% adequate knowledge. At 1-month follow-up, the mean score further improved to 18.95, indicating sustained knowledge retention. Conclusion: The study demonstrated that the awareness program was highly effective in improving the knowledge of preschool and primary school teachers regarding ASD. This study underscores the importance of teacher training programs to enhance the ability of teachers to recognize and support students with ASD.
Background: Screen usage by children is a common cause of health concern among parents and pediatricians in the current generation. This study explores the screen habits of growing children and their possible effects on the physical and social-emotional development of children. Materials and Methods: This was a cross-sectional study done among children visiting the outpatient department of pediatrics. Details regarding screen habits were collected by a pretested and validated questionnaire. Anthropometric measurements were recorded by standard methods and interpreted using the WHO growth standards. Social-emotional development was assessed using the Ages and Stages Questionnaire-Social-Emotional 2 Questionnaire Tool (ASQ-SE-2). Categorical variables were presented as numbers and percentages and continuous variables presented as mean and standard deviation. Chi-square test or Fisher’s exact test was used to identify risk factors for high screen time and ASQ-SE-2 scores. Independent risk factors were identified by univariate and multiple regressions. Results: High screen time was observed in 66.9% of children. Access to multiple devices and the absence of siblings were found to be significant risk factors for high screen time. In our study, there was no significant association between high screen time and nutritional status or social-emotional scores of children. Bedtime screen usage has a significant association with high risk for social-emotional delay. Conclusions: Screen time is high among children <5 years. Apart from screen duration, other screen factors can also have an adverse influence on children’s development. Access to multiple devices and the absence of siblings were found to have a significant association with high screen time.
Dental implants placed in the maxillary molar region, can get displaced, and can lead to migration of the implant into the maxillary sinus. This is more likely to happen when placement is done immediately after tooth extraction. A male aged 54 years underwent implant placement after extraction, which got displaced and later migrated into the maxillary sinus. The implant was removed by endoscopic sinus surgery. Many techniques for the retrieval of dental implants displaced into the maxillary sinus are described in literature, but the least traumatic and minimally invasive method is endoscopic removal of the implant via maxillary sinus ostium in the middle meatus of the nose.
Wernicke encephalopathy (WE) is an acute neuropsychiatric syndrome caused by thiamine deficiency, classically associated with chronic alcohol abuse. However, it is increasingly recognized in nonalcoholic settings. We report a 62-year-old male with chronic kidney disease on recent torsemide therapy who presented with acute confusion, ophthalmoplegia, and gait ataxia. Magnetic resonance imaging of the brain revealed symmetric T2/FLAIR hyperintensities in the medial thalami and periaqueductal region with mammillary body involvement, characteristic of WE. Whole-blood thiamine diphosphate levels were markedly reduced. The patient showed dramatic neurological improvement following high-dose intravenous thiamine therapy. This case highlights that chronic loop diuretic therapy may precipitate severe thiamine deficiency and WE even in nonalcoholic patients. Early recognition and prompt parenteral thiamine administration can result in complete neurological recovery. Routine thiamine supplementation should be considered in high-risk patients with cardiac or renal disease receiving prolonged diuretic therapy.
Villous adenomas are extremely uncommon in the urinary tract, particularly within the renal pelvis, and are predominantly associated with the gastrointestinal system. Their clinical presentation often mimics more routine conditions like urinary tract infections or kidney stones, making diagnosis before surgery quite challenging. We describe a rare instance involving a 54-year-old male who was diagnosed with a villous adenoma of the renal pelvis following nephrectomy. The patient had symptoms of left-sided flank pain, painful urination, and reduced urine output. Radiological investigations identified obstructive stones, pronounced hydronephrosis, and cortical thinning. Histological evaluation of the resected specimen revealed multiple villous adenomas with dysplastic epithelium and goblet cell metaplasia, in the background of pyonephrosis and intestinal-type metaplasia. Immunohistochemical staining was positive for CK7, CK20, CEA, and EMA, and no stromal invasion was observed. Given the known risk of malignant transformation, careful pathological examination is crucial. At a follow-up of 6 months, the patient exhibited no symptoms or recurrence. This case illustrates the importance of considering this rare entity in differential diagnoses and emphasizes the need for meticulous histopathological assessment to guide appropriate treatment and prevent progression to malignancy.
Urachal carcinoma is a rare and aggressive type of bladder cancer that originates from the urachus, a fibrous tissue left over from the allantois, connecting the bladder to the umbilicus. We present the case of a 65-year-old man with an unremarkable medical history who presented with obstructive lower urinary tract symptoms. His imaging showed a calcific mass lesion along the anterosuperior wall of the bladder. He underwent partial cystectomy and was histologically diagnosed as urachal adenocarcinoma.
