Esophageal cancer is the fourth common cause of cancer-related deaths in India. It is prevalent among both men and women. Squamous cell carcinoma (SCC) accounts for up to 80% of these cancers, although adenocarcinoma is on the increase due to changing lifestyles. The etiological factors for SCCs show a regional variation in different parts of India, but tobacco consumption in various forms, alcohol, hot beverages, and poor nutrition remain the predominant predisposing factors. Generally, these cancers present late and therefore have a poor prognosis. The current status of esophageal cancer in India in relation to the demographics, diagnosis, staging, multimodality treatment, surgical therapy, and the future perspectives are discussed in this review article.

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The use of mobile Internet devices (MIDs), smartphones, and proprietary software applications (also known as "apps" in short) can improve communication among medical caregivers. The utilization of these mobile technologies has further transformed health care, communications, commerce, education, and entertainment, among other fields. Newer technologies have the potential to be adapted for improvement in health care and medical education in general. Mobile technology is one of the latest strings of technological innovations that can be integrated into medical education. M-learning (the use of mobile technologies in teaching/training) has been used as a complimentary resource for interaction between students and instructors for motivation and learning. The main uses described for mobile devices in medical education can be divided into (a) information management (IM), (b) communication, and (c) time management. The field of mobile technology in health-care services and medical education is quite new and throws open ample opportunities for researchers to conduct further studies. Educators in medicine, dermatology, and public health as well as practicing physicians and surgeons need to embrace this new technology, study its further adoption, and assist in the responsible integration of these devices into the art and practice of medicine.

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Background: The National Rural Health Mission has introduced village-level female community health worker, accredited social health activist (ASHA) who acts as an interface between the community and the public health system. The is study was conducted to assess the awareness and perceptions of ASHA regarding their roles and responsibilities in health-care system and factors affecting their performance in delivering health-care services. Methodology: A qualitative study was conducted in seven selected villages under Talegaon Primary Health Centers, Wardha district, Maharashtra, which is also field practice area of a medical college. Nonprobability sampling (purposive sampling) was done. In-depth interviews were conducted on ASHAs (n = 7) of those selected villages till saturation of data. Data were analyzed using the thematic framework approach. Results: ASHAs perception regarding their job responsibilities appeared to be incomplete. They had good awareness regarding their roles and responsibilities as a link worker. They were found to be mostly interested in higher incentive performances. ASHAs clarity regarding their roles and responsibilities as facilitator, social activist, and service provider was found to be somewhat compromised. They were ignorant about their roles and responsibilities under various newly launched national programs. The positive factors influencing ASHAs performances were regular supervision of their performances and appraisal by higher authority and support from community, family, and good relations with coworkers and staff. Challenges faced by most of the ASHAs were more workload, poor orientation to program, lack of quality training, and inadequate and delayed monetary incentives. Conclusion: Good quality training with regular refresher training sessions and regularization of incentives are required to motivate them ASHAs.

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Background: Nutritional status especially that of preschool children is a sensitive indicator of health and nutritional status of a community. Aim: To estimate the prevalence of undernutrition among tribal preschool children and to assess the factors associated with variation in nutritional status. Methods: A cross-sectional survey was conducted among 438 tribal preschool children in 10 clusters of Wayanad district of Kerala. Height, weight, mid-arm circumference and hemoglobin level were measured. Children more than two standard deviations (SDs) below the standard median of World Health Organization Multi Centric Growth Reference Study were considered underweight (weight-for-age), stunted (height-for-age) and wasted (weight-for-height) respectively. Qualitative variables such as prevalence of underweight, stunting and wasting were summarized using percentages. Mean (SD) was used, to summarize, quantitative variables such as height and weight. Generalized estimating equation models were constructed to assess associations. Adjusted models included social factors and child morbidities. Results: More than half of the children say 58.7% (257/438) had deficits in at least one of the three anthropometric indicators. The prevalence of underweight, stunting and wasting was 39% (171/438), 38% (167/438) and 20.5% (90/438) respectively. The prevalence of anemia was 95.7% (419/438). Bivariate analysis showed significant associations between undernutrition and educational status of parents, tribe to which the child belonged, diarrheal episode and low birth weight. In adjusted analysis, lower educational status of mother (adjusted odds ratio 1.9, 95% confidence intervals 1.2-3) and an episode of diarrhea (1.8, 1.03-3.2) independently predicted undernutrition in a tribal preschool child. Conclusion: Undernutrition in the form of stunting, wasting and underweight is very high among the tribal preschool children. There is an urgent need to improve health care services to the tribal population and tribal children.

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Suicide is a complex human behavior with multiple interacting determinants. Clinicians and practitioners often face difficulties in assimilating the evidence base for suicide prevention interventions, evaluating their effectiveness and decoding the best practice elements of each approach. In this article, we do not aim to provide an exhaustive coverage of every approach. Instead, we provide an overview of the following eight major suicide prevention interventions: awareness programs, screening, gatekeeper training, access to means restriction, follow-up care, hotlines, media strategies, pharmacotherapeutic and psychotherapeutic approaches. The evidence base and components of each approach are described to facilitate replication. The best practice elements are synthesized from each approach and presented to aid program development and practice. Although a number of approaches hold promise, there are difficulties in ascertaining the effective elements under each of them. Innovative research designs are needed to address this knowledge gap as it will facilitate optimal allocation of resources for suicide prevention.

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Background: Seeking assistance from multiple physicians for an illness is a major obstacle in providing efficient care by the health care systems. It not only alters the disease condition but also adds to excess health care costs. This study aimed at exploring healthcare-seeking behavior in adult patients with diabetes and also to identify the factors associated with doctor-shopping behavior. Methods: This questionnaire-based cross-sectional study was conducted in an urban ward of Puducherry. A total of 100 patients aged more than 18 years with diabetes were included in the study. Results: Around 80% of the study subjects were availing treatment from government facilities. Prevalence of doctor-shopping behavior was found to be 14%. Reasons for change in their treatment facility were mainly due to patient-related factors like unaffordability of medicines and consultant fees, or illness-related factors like no improvement in symptoms. Physician/facility-related factors were due to prolonged waiting hours and poor interpersonal communication by the doctor. Various factors associated with doctor-shopping behavior in diabetics such as chronicity of illness (P< 0.005), past treatment facility being private (P< 0.001), and upper socioeconomic status (P = 0.045) were statistically found to be significant. Conclusion: The present study shows the prevalence of doctor shopping among diabetic patients to be 14% in urban Puducherry and this change in consultation was mainly due to the patient, illness, physician, or facility-related factors. Patient education, good interpersonal communication skills, and health system strengthening measures can increase responsiveness of the community toward the health systems and thereby reduce doctor shopping behavior among diabetic patients.

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Background: Stroke is one of the leading causes of death and disability worldwide. Poststroke, most survivors experience trunk control impairment and instability. Previous works on exercise on an unstable surface to improve trunk stability in nonstroke population had proven effective. Thus, physioball exercises (PBEs) in poststroke subjects may be useful in the recovery of trunk stability and thereby reduce disability. We hypothesize that PBE is feasible and effective in enhancing trunk stability. Aims: To test the feasibility and successful implementation of conducting a randomized controlled study to assess the clinical effectiveness of PBE and proprioceptive neuromuscular facilitation (PNF) technique to enhance trunk control in poststroke subjects. Methods: This study was conducted in a stroke unit of Global Hospitals and Health City, Chennai, India. Thirty patients with the first onset of stroke within 40 days of stroke duration, lesion to one side, and ability to sit independently with or without arm support for 15 days were recruited. All thirty poststroke subjects were randomized either into PBE group or PNF group, and outcome assessors involved in the trail were blinded to allocation. PBE group performed task-oriented activities on an unstable surface and PNF group were treated with PNF-specific trunk stability exercise program for 4 weeks (30 min/day, 5 times/week). Trunk impairment scale (TIS) was used as a main outcome measure. Results: Data were analyzed using Wilcoxon signed rank sum test and Mann–Whitney U-test for intra- and inter-group comparison. The baseline characteristics between both groups were statistically nonsignificant. Within groups, there were significant improvements between baseline and at 4 weeks in the measure of TIS. In addition, PBE group showed a significant increase in trunk control (mean 2.33, 95% confidence interval 1.14-3.52, P = 0.002) than the PNF subject. Conclusion: This pilot randomized controlled trial (RCT) showed the potential efficacy of PBE in developing more trunk stability than PNF in poststroke subjects. The current study had proved the feasibility of undertaking a large-scale RCT. Since this is a pilot study to establish any sort of conclusive evidence on the efficacy of PBEs in the poststroke population, a larger sample-sized trial is needed.

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Background: Awareness about danger signs during pregnancy is essential for a woman to seek prompt care. This can avert long-term morbidity and mortality. This study was aimed to find the level of knowledge and its related factors about danger signs of pregnancy and childbirth among pregnant women attending a tertiary care hospital in southern India. Patients and Methods: We conducted a cross-sectional survey of pregnant women attending a tertiary care hospital in South India. Systematic random sampling of every 10^th woman exiting the antenatal clinic was done. Results: We studied 382 pregnant women. Of them, 188 (49.2% [95% confidence interval (CI): 44%–54%]), 104 (27.2% [95% CI: 23%–32%]), and 81 (21.2% [95% CI: 17%–26%]) women had sufficient knowledge about danger signs during pregnancy, labor, and childbirth, respectively. On multivariable analysis, lack of exposure to formal awareness raising health counseling classes was the only factor found to be significantly associated with a lack of knowledge about danger signs of pregnancy (adjusted prevalence ratio, 95% CI: 1.8 [1.2–2.7]) and after childbirth (1.4 [1.1–1.7]). Lower education level was significantly associated with a lack of knowledge about danger signs of labor (1.2 [1.1–1.4]). Conclusion: We found that lack of exposure to formal awareness raising health counseling classes is a modifiable risk factor to improve knowledge about danger signs. We recommend structured mandatory health awareness sessions addressing the danger signs of pregnancy and child health to all pregnant women.

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Different movement disorders including chorea and hemichorea-hemiballismus are known to be some interesting presentations of uncontrolled hyperglycemic states (both in type 1 and 2 diabetes mellitus). Hemifacial spasm is rarely reported as a manifestation of hyperglycemic state. Here, the author reports an extremely rare case of hemifacial spasm which developed as the presenting manifestation of non-ketotic hyperglycemia in type 1 diabetes mellitus.

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Background: Currently, in India, many healthcare organizations and their managements appreciate the advantages of electronic medical records, but they often use them. The current push for universal health coverage in India with National Rural Health Mission (NRHM) and National Urban Health Mission (NUHM) helping toward healthcare reforms highlights the importance of implementing information technology as a means of cutting costs and improving efficiency in healthcare field. The quality of documentation of patient care rendered at healthcare destinations is very important to showcase the growing stature of healthcare in India. Aims: As maintaining the medical records is very important, storage and retrieval of the information is also important for future patient care. In this regard, implementation of electronic medical records in hospitals is essential. Through this study, we wanted to highlight the perceptions of healthcare personnel, who are in the core team of delivering healthcare, toward implementation of electronic medical records. Methods: A cross-sectional study was carried out among doctors (post-graduates) and staff nurses. The sample size for post-graduate students and nurses was 164 and 296, respectively, in this study. The study was carried out during the period from January to June 2013, and a survey was conducted with the help of a validated, pre-tested questionnaire in a tertiary care medical college hospital in India. Results: The results showed that 75% of the study population are comfortable working with electronic medical records. They mentioned that display of diagnosis, medications, and allergies of patients on the records was most important. Their perception was that electronic medical records improve timely decision-making and patient care due to immediate access to the patient's disease history. Conclusion: The major problems faced by nurses, as per our study, are delay in services due to dispersion of records, multiplicity of form types consuming major time, and inability to understand doctors' notes.

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Background: In India, overall prevalence of blindness is 1.1%, the principal cause being cataract (62.6%) affecting over 9 million people. Aim: The present study was carried out to find the prevalence, barriers and facilitating factors related to cataract health services in a rural community of Tamil Nadu. Methods: The study was carried out in four villages in sub-center Kondur, under Primary Health Centre (PHC) Kondur, Villupuram district, Tamil Nadu, during November-December 2010. All adults of more than 50 years (n = 331) residing in the sub-center Kondur, were examined for lenticular opacity and visual acuity. A structured proforma was used to assess the awareness, barriers and facilitating factors related to available cataract health services. Results: The prevalence of cataract among the population studied was 62.8% (95% confidence interval [CI]: 57.5-67.9%). There was a significant increase in cataract with increase in age (P < 0.001). Only 13% (95% CI: 9.6-16.3%) of the persons with cataract were operated at the time of interview. The major barriers were no one to accompany (25.5%) and absence of felt need (22.6%). Less than one-fifth (17.8%) reported the awareness of cataract as a condition affecting eye. The facilitating factors were free surgery in camps (83.7%), self-decision due to defective vision (69.7%) and quality of service provided (65.1%). More than one-half (56.7%) of subjects diagnosed for cataract during the survey were willing to be operated. Conclusion: Prevalence of cataract was high in Kondur PHC area. It is vital to increase the level of awareness regarding the need and availability of cataract health services.

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Background: Healthcare-seeking behavior is associated with the severity of infectious diseases, particularly in low-income countries. We need better understanding about the current healthcare-seeking behavior of rural people in low-resource settings. This study aimed to describe the healthcare-seeking behavior of rural people for infectious diseases and identify the associated factors. Methods: We conducted a cross-sectional survey in a rural community in Bangladesh. We interviewed a total of 450 persons to collect data on demographics, household income, household expenditure, and healthcare-seeking behavior. We performed a descriptive analysis to summarize the demographic characteristics and multivariate logistic regression analysis to identify the association between healthcare-seeking behavior and variables of interest. Results: Among the study participants, 42% went to the health facilities, 30% went to the pharmacy, 14% went to the nonregistered doctors, 1% went to the traditional healers, 1% went to the spiritual healer, and 2% took self-treatment. Proximity of the health-care facilities (prevalence ratio [PR] 1.97, 95% confidence interval [CI]: 1.55–2.49) and number of clinical symptoms (PR 1.23, 95% CI: 1–1.52) were significantly associated with the care-seeking behavior. Conclusions: Healthcare-seeking behavior for infectious diseases among rural people in Bangladesh was poor. Information obtained from this study could be useful to develop, design, and improve health-care systems in low-resource settings.

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Pseudoaneurysm of the visceral arteries is a rare condition. The common causes for pseudoaneurysm are pancreatitis, infection, autoimmune disorders, vascular intervention, surgery, and blunt trauma. Pseudoaneurysm is usually noticed during investigation in an emergency situation. Such rare cases involving superior mesenteric artery, gastroduodenal artery, and splenic artery were managed recently using endovascular techniques.

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Background: Over the years, coronary angiogram (CAG) has evolved to become indispensable diagnostic and therapeutic procedure for coronary artery disease (CAD). The procedure even though minimally invasive with shorter length of hospital stay and low cost has some risk for morbidity and even mortality. Large extents of the risks are dependent on the clinical status of the patient at the time of the study and comorbid illness. Aims: The present study was planned to assess the complications and to identify the risk factors associated with complications among patients undergoing CAG for CAD. Methods: A cross-sectional observational design was used in 250 patients who underwent diagnostic or interventional procedure of CAG through either transradial or femoral route. The convenience sampling technique was used to select the study sample. Results: Majority (32.8%) of the patients were in the age group of 50-59 years, followed by 28.0% of the patients in the age group of 60-69 years. Male preponderance was noted (87.6%). About 6.8% of the participants had developed complications, among them 4.4% had hematoma, 1.2% had vasovagal reactions, and 1.2% had periprocedural myocardial infarction. History of current smoking was identified as risk factor for complications (P< 0.05). The risk of complications was higher in percutaneous coronary intervention (PCI) patients, (odds ratio 6.21 [1.96-19.68] at 95% confidence interval) and who had femoral access site (P< 0.05). Conclusion: Even as the improved patient outcome is seen with cardiac catheterization, it is not totally free from risk. Newer strategies such as radial approach have managed to reduce the risks considerably. History of smoking, femoral access, and PCI were identified as risk factor for complications following CAG.

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Background: Cerebrovascular accident is the most common and devastating disorders in old age group. The diagnosis of stroke remains a clinical one, with confirmatory evidence obtained through neuroimaging. Neurobiochemical markers have gained special importance in the determination of brain damage resulting from acute stroke. Aim: In this study, we aimed to evaluate serum S-100 protein in blood samples from patients with acute ischemic stroke and investigate the relationship of serum S-100 protein level with the involved territory and size of the lesion. Methods: This was a prospective observational study conducted among 94 patients of acute ischemic stroke admitted to the Medicine Department within 48 h. Serum sample was collected within 48 h and was sent for measurement of serum S-100 protein level. Patients were classified according to involved territory as anterior cerebral artery (ACA), middle cerebral artery (MCA), posterior cerebral artery (PCA), and more than one territory and correlate it with S-100 protein level. All patients had cranial computerized tomography scan and magnetic resonance imaging in the first 48 h. Neurological examination was done with National Institute of Health Stroke Scale in acute stage and Rankin scale at the time of discharge. Results: Serum S-100 protein levels were significantly higher and maximum in multiple territory involvements followed by MCA, PCA, and ACA infarct. Conclusions: As serum S-100 protein level correlates with the involved territory or infarct size, we can predict the involved territory with the level of S-100 protein.

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Background: Young people are most vulnerable to sexually transmitted diseases (STDs) and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in Bangladesh. Lack of knowledge about reproductive health issues is also common in this group. Aims: This study aimed to assess the knowledge and perceptions of STDs, HIV/AIDS, and reproductive health of young female university students (19-27 years) in Dhaka, Bangladesh. Methods: A cross-sectional study was carried out among 402 female students from seven universities in Dhaka, Bangladesh. Data were collected through face-to-face interviews using a structured questionnaire on sociodemographic information, knowledge, and perceptions of STDs, HIV/AIDS, and reproductive health. Descriptive analysis was used, and data were presented as frequencies and percentages. Results: The majority of the participants were young, unmarried, undergraduate students. Most of the participants reported that they knew about STDs (79%) and HIV/AIDS (66%). However, knowledge about the modes of transmission and prevention of the diseases was poor. HIV/AIDS was considered by 90% participants as a public health threat to Bangladesh, mostly due to illiteracy (76%), increased mortality (20%), existence of risky sexual behavior (18%), and aggression of Western culture (31%). About 65% of the participants mentioned that AIDS can be prevented by safe sexual practice, 55% mentioned prevention through upholding religious values and moral education, and 59% mentioned that education about AIDS would help prevent transmission. Conclusions: Although a majority of young Bangladeshi female students reported knowing about HIV/AIDS, their knowledge regarding transmission and prevention of the diseases was poor. Strategies for creating reproductive health education targeted at young female students are essential for the prevention of STDs and HIV/AIDS.

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Background: Since there is a high mortality due to malaria, there is a need of a parameter to identify patients at risk of developing complications, whereby intensive care is given to those patients who are at higher risk for complications and mortality. Aims: This study was undertaken to estimate serum lactate levels in patients with Plasmodium vivax, Plasmodium falciparum, and mixed malaria, and also to correlate it with various clinical and biochemical parameters and with the severity and prognosis of malaria. Methods: This was a cross-sectional, analytical, and observational study, which was conducted on 100 patients diagnosed with malaria and older than 14 years of age. Diagnosis of malaria was made by the gold standard method of peripheral blood smear examination and rapid tests. The blood sample for plasma lactate levels on admission was collected from a stasis free vein. The Student's t-test for continuous normally distributed variables was used. For categorical data, the chi-square test was used and for the small numbers, Fisher's exact test was used for small numbers. P < 0.05 was considered as a statistical significance at 95% confidence intervals. Results: In this study, there were 90% survivors and 10% of patients succumbed. Out of 90 survivors, 43 patients (47.7%) had some form of complicated malaria, whereas all patients who succumbed (10) had complicated malaria. All the patients who had jaundice, severe thrombocytopenia, renal failure, severe anemia, or hypotension (hypotension was confirmed clinically, but the remainder were confirmed by biochemical parameters such as liver functions, renal functions, platelet count, and hemogram) had hyperlactatemia in this study. All patients who died had a serum lactate level of >2 mmol/l. Conclusions: Hyperlactatemia had significant associations with complications of malaria. Raised serum lactate levels were significantly associated with mortality (P < 0.05).

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Background: Neonatal jaundice is a common condition that can be treated with phototherapy. Phototherapy may cause oxidative stress in addition to the usual side effects. Aim: In this study, the oxidative stress in babies with neonatal jaundice was assessed before and after phototherapy by estimating plasma malondialdehyde (MDA) level. Methods: Eighty babies with neonatal jaundice were chosen for the study. Among them, 40 babies whose total serum bilirubin level was >15 mg/dl formed the case group and the other 40 babies with total serum bilirubin level <15 mg/dl who did not require phototherapy formed the control group. Total serum bilirubin was measured using Automated Clinical Chemical Analyser with standard reagent kit. Plasma MDA was estimated by Satoh's method using spectrophotometry. Results: The plasma MDA level, which is one of the oxidant markers, was significantly elevated in post-phototherapy cases compared to pre-phototherapy and controls. Conclusion: Phototherapy results in significant oxidative stress among babies with neonatal hyperbilirubinemia. So, usage of phototherapy should be restricted to those with significant hyperbilirubinemia.

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Background: Ischemic injury in stroke leads to intracellular calcium accumulation, which activates the enzyme cascade causing cell death. Aims: To determine the correlation between serum calcium (Ca) and albumin-corrected calcium (CCa) levels with acute ischemic stroke (AIS) for short-term outcome and infarct size (IS). Methods: An observational study was carried out in 50 patients in a tertiary care hospital in India over 2 years (from December 2008 to December 2010). Patients presenting within 72 h of stroke onset and aged ≥40 years were included. Ca was measured, CCa calculated, and head computed tomography (CT) scan was done. National Institute of Health Stroke Scale (NIHSS) was calculated on admission and after 1 week, and Barthel Index (BI) was calculated at 1 week. Pearson's correlation coefficient was calculated between NIHSS, BI, and IS with both, Ca and CCa. Also, subgroup analysis was done in lacunar, lobar, anterior circulation, posterior circulation, unilateral, and bilateral stroke subgroups. Results: Ca had a significant correlation with NIHSS, BI, and IS (all patients), with BI in lacunar and unilateral strokes and both NIHSS (admission) and BI in lobar, anterior circulation, and bilateral strokes. CCa had a significant correlation with IS and with BI in all patients and in anterior circulation strokes. NIHSS (admission) and BI had a significant correlation with IS. Conclusions: Higher Ca (CCa in some subgroups) is associated with better prognosis and recovery after AIS (except in posterior circulation strokes), and higher Ca and CCa are both associated with smaller IS.

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Helicobacter pylori eradication therapy has a role in minimizing the complications of peptic ulcer disease, namely, bleeding, perforation, and obstruction. However, the precise role of H. pylori eradication therapy in the complicated ulcers remains inconclusive, especially in perforation and gastric outlet obstruction. The prevalence of H. pylori in peptic ulcer bleeding patients has been widely underestimated owing to the differences in diagnostic tests and patient characteristics, and hence, it is recommended that an initial negative test should be followed up by a delayed repeat testing to rule out false negativity. It is well established now that eradication of H. pylori in patients with bleeding ulcers reduces rebleeding and ulcer recurrence. Multiple studies have attributed high recurrence rates of duodenal ulcer following simple closure to a high prevalence of H. pylori infection. Eradication therapy decreases the recurrence rate of perforated ulcers, thus justifying the role of H. pylori eradication therapy following the primary surgical management of perforated ulcers. The role of H. pylori in duodenal ulcer with gastric outlet obstruction is yet to be evaluated clearly. There are some reports of resolution of gastric outlet obstruction following therapy for H. pylori, obviating the need for surgery. Clarithromycin-containing regimens are recommended as first-line in areas of low resistance, whereas bismuth-containing quadruple therapy is the first-line empirical treatment in areas of high clarithromycin resistance. Treatment of H. pylori is beneficial in most of the patients with complicated peptic ulcer disease, especially in reducing recurrence of ulcer with or without complications.

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Rabies is a fatal disease caused by rabies virus, a neurotropic virus and a prototype of Lyssavirus of Rhabdoviridae family. It is transmitted to human beings through infected saliva of dogs and cats during bite. Dog is the cause of more than 90% of human rabies in India. The incubation period is 4-8 weeks (but it may vary from 5 days to 7 years). There are two clinical types of rabies - encephalitic (furious) and paralytic (dumb) types. In the encephalitic (furious) form, the principal malfunction is in the brain stem and limbic system. Patient has hydrophobia in the full-blown form, but the mind remains clear till the end. Death occurs within a week after the onset of symptoms. Paralytic rabies resembles Guillain-Barre syndrome. Diagnosis is mostly clinical. However, direct fluorescent antibody test is used to identify the antigen in skin biopsy from the nape of neck. In the postmortem specimen, demonstration of Negri bodies in the brain confirms the diagnosis. Anti-rabies vaccine is used for pre- and post-exposure prophylaxis. The commonly used intramuscular (IM) regimen is being superseded by intradermal (ID) vaccine because it makes the treatment economical. Whereas touching of animal or lick on intact skin does not require vaccination, any transdermal bite with bleeding requires immediate administration of rabies immunoglobulin (RIG) and simultaneous vaccination with a tissue culture vaccine (TCV). Minor abrasion without bleeding may require only vaccination and no RIG. Rabies human monoclonal antibody (RMAb) is the newest entry in the prophylaxis of rabies which may ultimately replace RIG. Prognosis is grave since there are just six reports of survivors. Treatment is mainly palliative with heavy sedation and/or therapeutic coma (Milwaukee protocol).

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