Aims and objectives: Nonfermentative gram-negative bacilli (NFGNB) cause wide spectrum of infections, including nosocomial pneumonia, secondary meningitis, surgical wound infections, skin and soft tissue infection, urinary tract infection, septicemia, and transmission via the hand of hospital personnel. Most of the nonfermenters cause nosocomial bloodstream infections, particularly in debilitated and immunocompromised hosts. The study aimed to prevalence and identification of NFGNB isolates in the clinical samples among patients at Mahatma Gandhi Medical College and Hospital. Introduction: In recent decades, infections most commonly caused by Pseudomonas aeruginosa and Acinetobacter baumannii have also occurred outside the intensive care unit (ICU) or in trauma patients after natural disasters and they have even affected patients after comorbidities in the community. Materials and methods: All NFGNB isolates from different clinical samples received in clinical microbiology laboratory from outpatients & inpatients Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, were included in the study. Routine microscopy of samples was done. Gram staining was done for all samples except urine. All clinical samples were inoculated on blood agar and MacConkey agar was incubated at 37° for 18–24 hours. Colony characteristics were observed. All the organisms that produced pale or colorless colonies on MacConkey agar and also showed GNB on Gram staining of the colonies were considered to be NFGNB and further identified by VITEK 2 compact system. Results: Among 10,707 samples, 879 NFGNB isolates were obtained, so the prevalence of NFGNB in the study was 8.20%. The result was analyzed as follows: out of 879 NFGNB isolates were obtained, of which 415 (47.21%) were Pseudomonas aeruginosa, followed by Acinetobacter baumannii 378 (43.00%), Burkholderia cepacia 29 (3.30%), Burkholderia pseudomallei 17 (1.93%), Stenotrophomonas maltophilia 16 (1.82%), Acinetobacter lwoffii 7 (0.80%), Pseudomonas putida 6 (0.68%), Acinetobacter coffee 2 (0.23%), Acinetobacter fwinii 2 (0.23%), Pseudomonas fluorescens 2 (0.23%), Pseudomonas stutzeri 2 (0.23%), Acinetobacter junii 1 (0.11%), Acinetobacter haemolyticus 1 (0.11%), and Pseudomonas luteola 1 (0.11%). Conclusion: Based on this study, it could be concluded hardships will be experienced in all NFGNB treatments unless the necessary precautions are taken. In order to prevent the spreading of infection control measures should be taken, and clinicians and hospital hygienic rules should be observed.

Background: Assessing the nutritional status of students is very crucial for designing targeted interventions aimed at promoting better health outcomes. By understanding the specific dietary and lifestyle patterns prevalent among college students, tailored strategies can be developed to address the root causes of nutritional imbalances. Educational programs focusing on nutrition, exercise, and sleep hygiene can empower young adults to make informed choices about their health. Additionally, creating environments that facilitate access to nutritious foods and opportunities for physical activity can support students in adopting a healthier lifestyle. With this in mind, the present study was planned to assess the nutritional status of college-going girl students. Methodology: In this regard, a health checkup camp was organized at a government girls, college, and their general lifestyle details, relevant anthropometry, hemoglobin levels, clinical signs and symptoms, and diet intake were noted. Results: The findings of the health checkup camp were quite alarming, as 50% of the student population was found to be malnourished (either overweight or underweight). The alarming rate of anemia, affecting 65% of the students, underscores the significance of addressing nutritional deficiencies. Anemia can have serious implications for overall health and academic performance. Conclusion: Therefore, assessment of nutritional status is of utmost importance to make timely and effective policies and plans of action in order to treat and prevent problems in an effective manner with the best possible utilization of resources.

Background: The pain of childbirth is one of the most severe pains. The fear of pain during childbirth is universally present in all women, more so in nulliparous women. Epidural analgesia is the mainstay technique for labor analgesia. It is a safe and effective method for pain relief during labor without neonatal complications. Local anesthetics are injected into the epidural space, causing numbness of nerves and pain sensation without compromising the ability to move. Materials and methods: A prospective study was done at Mahatma Gandhi Medical College and Hospital, Jaipur, from December 2022 to December 2023 to assess the fetomaternal outcome of women in labor with epidural analgesia. Aim: To study the fetomaternal outcome of laboring women with epidural analgesia. Primary objective: To study the maternal outcomes of epidural analgesia in terms of pain relief, duration of labor stages, mode of delivery, and other complications. Secondary objective: To study the neonatal outcomes of epidural analgesia in terms of low birth weight, APGAR score, neonatal intensive care unit (NICU) admissions, and other complications. Results and discussion: During the study period, 71 patients were included as per the inclusion and exclusion criteria. According to this study, epidural analgesia did not increase the incidence rate of instrumental or cesarean delivery. It did not affect the first, second, or third stage of labor. Epidural analgesia did not cause neonatal complications. In the absence of contraindications, epidural analgesia is a safe and effective method for labor pain relief.

Vaginal bleeding during early pregnancy is a common condition. It is associated with an underlying abnormality, which often is a serious cause requiring emergency management. Clinical diagnosis in such cases is mostly nonconclusive, and ultrasound (both abdominal and transvaginal), a valuable and easily available tool, is required to identify the cause and guide the clinician in choosing the appropriate line of management. With the objective of evaluating patients presenting with vaginal bleeding in early pregnancy, this study was conducted in the Department of Obstetrics and Gynecology, Mahatma Gandhi Medical College and Hospital, Jaipur, for a period of 1.5 years. All cases with first-trimester vaginal bleeding were selected, and clinical diagnosis was confirmed by ultrasonography (USG). A total of 728 patients with first-trimester bleeding were evaluated. The most common clinical diagnosis was threatened abortion. Out of 505 cases of threatened abortion diagnosed clinically, ultrasound confirmed threatened abortion in 340 cases only. In the rest of these cases, the diagnosis was complete abortion in 24, missed abortion in 85, tubal ectopic in 7, and in one case, a vesicular mole was diagnosed. Eleven cases of arteriovenous malformation and eight cases of scar pregnancy, both requiring specific management, were observed only by ultrasound. The study highlights the importance of USG, which plays an important role in evaluation of the causes of first-trimester bleeding, prognosticate and predict the status of abnormal pregnancies.

Introduction: The satisfaction levels of nurses directly impact patient outcomes, highlighting the importance of assessing nurses’ job satisfaction to identify areas for improvement and enhance patient care. Therefore, this study aimed to evaluate the job satisfaction levels among nurses working in a tertiary care setting. Methods: Job satisfaction was assessed using the Minnesota Satisfaction Questionnaire (MSQ-20), a tool commonly used in healthcare settings for nurses, comprising 20 items related to intrinsic and extrinsic factors. A total of 60 samples were collected using convenience sampling techniques. Results: The findings indicated a significant difference in job satisfaction between single and married nurses (p = 0.012), with married nurses showing higher satisfaction levels. Moreover, nurses aged 50–60 exhibited higher job satisfaction compared to those aged 20–30 (p = 0.049). Additionally, nurses with 15–20 years of experience at the same hospital reported higher satisfaction levels compared to those with 2–3 years of tenure (p = 0.037). Designation was strongly associated with extrinsic factors of job satisfaction (p = 0.008). Conclusion: The study found that married nurses, those aged 50–60, and nurses with 15–20 years of experience at the same hospital reported significantly higher job satisfaction. Designation was also strongly linked to extrinsic factors influencing job satisfaction. The study's findings offer valuable insights for hospital administrators, nurse leaders, and policymakers to enhance nurse job satisfaction and improve overall healthcare outcomes.

Diarrhea disease is caused by multipathogens and multifactors. It is widespread all over the world, and not only threatens human health but also greatly affects society and economy. Formulations that restrain two or more than two herbs are called polyherbal formulations. Drug formulation in Ayurveda is based on two principles: use as a single drug and use of more than one drug. The last is known as polyherbal formulation. The idea of polyherbalism is peculiar to Ayurveda even though it is tricky to explain in terms of modern parameters. The Ayurvedic literature Sarangdhar Samhita tinted the idea of polyherbalism to attain greater therapeutic efficacy. Polyherbal formulations have been used all around the earth due to their medicinal and therapeutic application. It has also been recognized as polyherbal therapy or herb–herb combination. The active phytochemical constituents of individual plants are inadequate to attain the desirable therapeutic effects. When polyherbal and herbo-mineral formulations combined with the multiple herbs in a meticulous ratio, it will give an enhanced therapeutic effect and decrease the toxicity. The active constituents used from individual plants are inadequate to provide attractive pharmacological action. There are evidences that crude plant extracts often have greater potency rather than isolated constituents. In traditional medicine, whole plants or mixtures of plants are used rather than isolated compounds. Due to synergism, polyherbalism confers some benefits which are not accessible in single herbal formulations. Polyherbal formulations express high effectiveness in numerous diseases with safe high doses. Plants and their products have been used by humans for treatments of numerous diseases for thousands of years. Traditional medicine (also known as indigenous or folk medicine) comprises knowledge that developed over generations within various societies before the era of modern medicine. Natural products derived from medicinal plants have proven to be an abundant source of biologically active compounds. The main focus of this review paper is to develop alternate natural ecofriendly herbal formulations to treat diarrheal diseases.

Background: Bifid uvula is an anomaly usually seen in infancy and found rarely in adults. It is an abnormal division in the uvula, which is the tissue hanging down at the end of the soft palate in the roof of the mouth. It contains less muscular tissues than the normal uvula. The presence of a bifid uvula can also indicate a submucous cleft palate. Certain problems are associated with submucous cleft palate, such as swallowing difficulties, speech, and ear problems. The majority of the cases with bifid uvula have a genetic association. Aim: This case report will provide insight into this rare condition, and we aim to share our experience about this case so that anesthesiologists can foresee the complications in future. Case description: A 29-year-old female presented with seizures, headache, and projectile vomiting. She was diagnosed with a case of corpus callosal glioma and was posted for an excision of the same. During a preanesthetic checkup, she was found to have a bifid uvula. Her surgery was conducted under general anesthesia uneventfully. Conclusion: Bifid uvula can be a warning sign for an underlying syndrome and a detailed preanesthetic evaluation should be conducted along with vigilance throughout the course in hospital. Clinical significance: Bifid uvula with corpus callosum glioma is a rare entity in adults. Such cases need a thorough history and physical examination as well as a detailed family history. Any associated and underlying syndromes should be ruled out and evaluated. One should remain vigilant for any complications in the perioperative period. Always perform a gentle laryngoscopy to avoid injury to the hard and soft palate. Therefore, a case of bifid uvula should not be taken lightly, and an anesthesiologist should be vigilant and well-prepared to anticipate any underlying associated anomaly and related complications.

Nonaka myopathy, also known as hereditary inclusion body myopathy (HIBM), glucosamine (UDP-N-acetyl)-2-epimerase/N-acetyl mannosamine kinase (GNE) myopathy is a very rare form of autosomal recessive myopathy characterized by adult-onset distal skeletal muscle weakness. Its prevalence is estimated at around 1–9/10,00,000. Patients with HIMB present in early adulthood with the age of onset between 20 and 40 years with distal muscle weakness, predominantly bilateral foot drop, or tripping (tibialis anterior weakness). Sparing of the quadriceps muscle is the specific topographic feature of this myopathy. Despite these specific features and specific genetic mutations, HIMB is rarely diagnosed. We hereby report a case of a 33-year-old male presenting with distal-onset muscle weakness with quadriceps muscle-sparing myopathy with proven genetic analysis and diagnosed as Nonaka myopathy. Diagnosis of GNE myopathy is based on clinical features and muscle pathology findings and is confirmed by the identification of mutations in the GNE gene. Though no specific treatment is available for this myopathy, early diagnosis helps in avoiding unnecessary interventions and prognostication for further progression.

Managing unusual root canal anatomies, like the C-shaped configuration common in mandibular second molars, is challenging. A deep understanding of anatomical variations, accurate diagnosis, strategic treatment planning, and clinical expertise are crucial for success. These canals often remain unnoticed due to their complex structure, making negotiation, debridement, and obturation difficult, leading to treatment failure. This article discusses how C-shaped root canal configurations were managed to utilize cold lateral condensation and thermoplasticized obturation procedures. Cone-beam computed tomography (CBCT) was utilized to verify the extent of the unusual anatomy. Clinicians should anticipate encountering unusual features during endodontic treatment. The use of diagnostic aids like CBCT, enhanced magnification with a dental operating microscope, and innovative file systems like SAF can ensure successful outcomes.

Aim: This case report delves into the intricate relationship between bipolar affective disorder (BD) and hyperthyroidism, presenting the case of a 28-year-old male experiencing a manic episode with psychotic features secondary to an unmanaged thyroid condition. Case description: A 28-year-old male presented with a 1-month history of hyperphagia, weight loss, diaphoresis, tremors, insomnia, hyperactivity, grandiosity. Past history revealed a similar episode resolving spontaneously. Mental status examination displayed elevated mood, labile affect, and delusions. Further investigations revealed hyperthyroidism. Initial management included antipsychotics, mood stabilizers, and a beta blocker. Conclusion: In conclusion, this case highlights the complex intertwining of hyperthyroidism and mania. While hyperthyroidism can mimic or exacerbate underlying bipolar disorder, the exact mechanisms remain under investigation. Studies suggest involvement of catecholamines, neurotransmitters, and inflammation. This case underscores the potential for hyperthyroidism to act as a trigger, particularly in individuals with a predisposition to mood disorders. Clinical significance: Psychosis is uncommon in Graves’ disease, despite its frequent symptoms like agitation and mood swings. A thyroid function test becomes crucial for individuals experiencing these or other psychiatric symptoms, such as delirium, to rule out underlying medical causes during initial screening. Likewise, when encountering new or recurring mental health conditions, inquiring about potential hypothyroidism or hyperthyroidism symptoms from both patients and caregivers is valuable.

Aim and background: For a successful root canal therapy one must be aware of the internal and external anatomy of the tooth. Dental treatments frequently face challenges due to anomalies present in the tooth. Similar to any other tooth, mandibular first molars are susceptible to anatomical malformations. One such variation involves the presence of an additional root distolingually which is known as radix entomolaris (RE). Case description: This case report describes the treatment and endodontic management of mandibular first molar with RE and internal root resorption. Conclusion: The effectiveness of root canal treatment relies on the thorough removal of pulp tissue from the root canals. Therefore, thorough knowledge of the morphology is of utmost importance as the presence of variations creates further challenges to the treatment. Clinical significance: For successful endodontic treatment in such variations, appropriate diagnosis of the case plays a vital role.

Mixed neuroendocrine nonneuroendocrine neoplasms (MiNEN) are a heterogeneous subgroup of rare neoplasms. The present study describes two cases: the first case of an 82-year-old male with complaints of chronic constipation, loss of appetite, and weight loss in the last 6 months, with a history of bleeding per rectum; and the second case of a 45-year-old female with complaints of loss of appetite, chronic constipation, and weight loss for the past 4 months. A contrast-enhanced computed tomography (CECT) of the whole abdomen for the first case revealed irregular mural thickening involving the lower aspect of the descending colon and its junction with the sigmoid colon, while the second case showed circumferential mural thickening involving the mid-third of the transverse colon with mild submucosal edema involving the cecum and ascending colon. Right hemicolectomy and transverse hemicolectomy were performed, respectively, and histopathological findings of the resected specimens revealed them to be mixed neuroendocrine carcinoma with a nonneuroendocrine component (adenocarcinoma) (MiNEN). For the first case, immunohistochemically, the neuroendocrine tumor (NET) showed synaptophysin positivity and a 70% Ki-67 index, which indicates small cell carcinoma. For the second case, immunohistochemistry (IHC) of the tumor revealed positivity for cytokeratin, synaptophysin, chromogranin A, and SATB2, while the monoclonal antibody to Ki-67 (MIB) labeling index was 30%. The prognosis of colorectal MiNEN is the poorest compared with adenocarcinoma and neuroendocrine carcinoma.

We report a case of renal leiomyoma in a 64-year-old diabetic lady who presented with mild derangement of renal function. Radiological evaluation found a space-occupying lesion in the lower pole of the right kidney. A nephron-sparing operation was done, and the final histopathology revealed renal leiomyoma. Renal leiomyoma is a rare benign disease, found incidentally in autopsy report and nowadays more commonly by radiological evaluation for other diseases. It is most commonly found in female in their 40s. They are most often asymptomatic with larger ones presenting with abdominal pain, abdominal lump, and rarely with hematuria. They are very difficult to differentiate radiologically from leiomyosarcoma to renal cell carcinoma. Diagnosis is confirmed by histopathology. Prognosis is excellent after operation.

This case report presents the case of a 17-year-old female who developed a generalized rash after 5 days of aceclofenac therapy prescribed for acute tonsillitis. This case highlights the importance of early recognition of adverse drug reactions (ADRs) in adolescents. After causality assessment, aceclofenac was considered to be the suspect. As per the Naranjo scale, it was found to be ”probable.”

Background: Primary adenocarcinoma of the renal pelvis is an extremely rare type of cancer, accounting for only 1% of all tumors in the urinary tract. Unfortunately, there are no distinct symptoms, imaging characteristics, or established treatments for this condition. These rare tumors can be categorized into three subtypes: (1) Tubulovillous (71.5%)—gland-like structures with villous projections, (2) mucinous (21.5%)—producing excessive mucus, and (3) papillary (7%)—forming finger-like projections. Although their pathogenesis is not well defined, adenocarcinomas are likely to appear from the neoplastic metamorphosis of the glandular cells of the urothelial intestinal metaplasia generally arising in response to habitual prickly stimulants, chronic inflammation, urolithiasis, and hydronephrosis. Case description: A 43-year-old female presented with complaints of left flank pain for 6 months and was diagnosed with left pyelonephrosis with nonfunctioning kidney. She underwent left open simple nephrectomy 4 months ago. The specimen was sent for histopathological examination. Gross examination of the kidney showed a congested external surface, and the cut surface was necrotic and friable with no hemorrhage. The corticomedullary junction could not be identified with a dilated pelvicalyceal system. Microscopic examination showed the presence of tumor cells in an irregular glandular pattern with features of dysplasia. The adjacent renal parenchyma showed the presence of glomerulosclerosis, tubular thyroidization, and marked chronic inflammatory infiltrate within the interstitium. Histopathological findings suggested adenocarcinoma likely of pelvic origin with chronic pyelonephritis. Immunohistochemistry (IHC) markers such as CD20, special AT-rich sequence-binding protein 2 (SATB2), and CDX2 showed positivity, while CK7 and GATA3 were negative, confirming the diagnosis of renal pelvis adenocarcinoma, enteric type. Conclusion: Our case was presumably one of many cases showing contemporaneously every step of carcinogenesis in this rare excrescence, supporting the thesis of cancer progression from the urothelium through metaplasia in an accretive process analogous to colonic carcinogenesis. Clinical significance: Accurate diagnosis of this uncommon neoplasm necessitates postoperative histopathological and immunohistochemical evaluation. Urologists, pathologists, and radiologists must remain vigilant for neoplastic changes in patients with chronic inflammatory conditions or prolonged nephrolithiasis.