Vulval carcinomas are rare and account for 3%–5% of female genital tract malignancies. Primary vulval adenocarcinoma of intestinal type is an extremely rare tumor which is considered metastatic until otherwise proven with very few case reports available in the literature. A 58-year-old woman presented with recurrent swelling in the genital region associated with pain. She had a past history of surgery done for Bartholin's cyst which was reported as adenocarcinoma. She underwent radical vulvectomy for the recurrent tumor which showed features of adenocarcinoma with glandular and papillary pattern with abundant extracellular mucin production and immunohistochemical (IHC) features favoring a diagnosis of primary vulval mucinous adenocarcinoma of intestinal type after excluding metastasis from other sites. As morphology cannot differentiate it from metastasis, a thorough investigation to rule out any primary in the gastrointestinal tract with a minimum IHC panel of markers including cytokeratin (CK) 20, CK7, carcinoembryonic antigen, and caudal-related homeobox 2 can help in confirming the diagnosis.

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Polymorphous low-grade adenocarcinoma is a neoplasm of the minor salivary glands and is malignant in origin but is indolent in nature. Currently, this neoplasm is documented and known as polymorphous adenocarcinoma (PAC) by WHO Classification of Salivary Gland Tumors (2017). Of all the salivary neoplasms, minor salivary gland neoplasm accounts for 9%–23%. Very rarely, it involves major salivary glands such as parotid, submandibular, and sublingual in <5% cases. It may develop either de novo or from pleomorphic adenoma. PAC mimics some benign as well as malignant neoplasms. Histopathological features alone cannot diagnose PAC due to the overlapping features with other neoplasms, and so immunohistochemistry is essential to confirm the diagnosis and hence aids in the proper management of PAC. We report a case of PAC arising from parotid gland in a 52-year-old male treated with facial nerve preservation.

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Context: Bupivacaine is the most common local anesthetic agent used for brachial plexus blocks (BB). Due to the adverse effects noted with bupivacaine, safer alternative agents such as levobupivacaine and ropivacaine are being used now. Aims: Although several studies exist comparing pairs of anesthetic agents, few studies have compared all three agents using dexmedetomidine (DMT) as an adjuvant. To bridge this knowledge gap, we undertook the present study. Settings and Design: This was a prospective, randomized, placebo-controlled, triple-blind comparative study. Materials and Methods: Eighty patients were randomly allocated to four study groups: group B, given bupivacaine alone, and groups BD, LD, and RD, given twenty-five ml of 0.5% bupivacaine, 0.5% levobupivacaine, and 0.75% ropivacaine, respectively, along with DMT 0.5 μg/kg body weight. Onset of the sensory and motor blocks; duration of the sensory block,motor block and analgesia of the block were compared between the groups. Statistical Analysis Used: Differences between the groups were analyzed using one-way analysis of variance and Tukey's honestly significant difference -β post hoc test for parametric data, and for nonparametric data, Chi-square test and Fisher's exact test were used. Results: The durations of analgesia observed were 7 ± 0.7, 13.4 ± 0.6, 12.7 ± 1.0, and 12.5 ± 0.6 h in groups B, BD, LD, and RD, respectively; these differences were statistically significant (F = 294.825, P < 0.001). Post hoc tests revealed a statistically significant difference between Group B and all the other groups, between the BD and LD groups, and between BD and RD groups. The times to onset of sensory blocks observed were 11.3 ± 11.3, 7.6 ± 0.8, 8.1 ± 0.8, and 8.4 ± 0.8 min in groups B, BD, LD, and RD, respectively, while the times to onset of motor blocks observed were 17.1 ± 1.5, 11.0 ± 0.9, 10.3 ± 1.0, and 10.2 ± 0.7 min in groups B, BD, LD, and RD, respectively. Conclusions: DMT added as an adjuvant to bupivacaine, levobupivacaine, and ropivacaine resulted in a statistically significant enhancement of the duration of analgesia.

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Background: Tobacco use is the most important modifiable determinant for prevention of noncommunicable diseases. Tobacco use is often initiated during adolescence, and understanding the factors associated with it is vital to prevent initiation. Our objective was to assess the prevalence of tobacco use and its association with adverse childhood experiences (ACE). Materials and Methods: An analytical cross-sectional study was conducted on 200 randomly selected students from a rural school. The World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test tool and WHO ACE international questionnaire were used to assess ever users of tobacco and ACE, respectively. Results: The prevalence of “ever” and “current” use of tobacco was 20.5% (95% confidence interval [CI] = 14.8–26.2) and 14.5% (95%CI = 9.5–19.5), respectively. Majority (65.9%) of the tobacco users had moderate level of tobacco addiction, whereas around 15% had severe addiction. All (100%) the participants had replied in affirmative to at least one of the questions related to the ACEs. On bivariate analysis, male students (prevalence odds ratio [POR] = 10.62, 95% CI = 3.62–31.21]), mothers with <10^th grade education (POR = 2.19, 95% CI = 1.08–4.42), parental awareness regarding free time (POR = 0.21, 95% CI = 0.10–0.42), parents not giving enough food even when possible (POR = 5.28, 95% CI = 1.53–18.29), problem drinker in family (POR = 2.12, 95% CI = 1.05–4.29), having divorced or separated parents (POR = 3.26, 95% CI = 1.22–8.74), and being in a physical fight (POR = 2.41, 95% CI = 1.19–4.87) had significantly higher odds of tobacco use. Adolescent boys (adjusted odds ratios [AOR] = 8.42, 95% CI = 2.60-26.60) and parental awareness regarding free time (AOR = 0.40, 95% CI = 0.17–0.94) were the significant predictors for tobacco consumption (P < 0.05) on binary logistic regression. Conclusions: Tobacco use is prevalent among adolescents and is significantly associated with experiencing ACEs.

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Background: Indwelling urinary catheters (IUCs) are commonly used in hospitalized patients, but often for inappropriate indications. Aims: We aimed to study the appropriateness of IUC insertion among patients admitted under the department of medicine in a tertiary care hospital in southern India. We also studied the proportion of patients in whom the continued use of IUC was unjustified. Methods: During June–August 2019, we prospectively studied adult patients admitted to the emergency and medicine wards in whom an IUC was inserted in the past 48 hours. Appropriateness of catheter use was determined based on predefined criteria. Results: We studied 132 patients; 96 (72%) were male. IUC insertion was found to be inappropriate in 16 (12%) patients. The most common reason for inappropriate use was placing an IUC to monitor urine output in noncritically-ill patients (50%, 8/16). Of the 74 patients with appropriate indications for IUC insertion who were followed up, continued use of IUC was found inappropriate in 23 (31%) patients. In patients without appropriate indications for continued IUC use, the catheter remained in situ longer for a mean duration of 2.9 (95% confidence interval 1.0–4.7) days. Conclusion: More than one in ten IUC insertions were found to be inappropriate. Even when the insertion was appropriate, IUCs were not removed in time in about a third of patients. Institutional policies and physician engagement are urgently needed to promote the appropriate use of IUCs.

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Introduction: Administrative supervision of infection prevention and control (IPC) is the most important aspect of IPC/hazard controls. The practice, uptake, and compliance to IPC is a documented, cost-effective method of interrupting the infection transmission pathways. Poor or nonadherence to this has led to disabilities and loss of lives among health-care workers, especially in the face of emerging and re-emerging infections. The present study evaluated the practice of IPC as well as its uptake and administrative control among the primary health-care workers in Enugu metropolis, Southeast Nigeria. Methodology: This was an analytical cross-sectional study using semi-structured self-administered questionnaires and an observation checklist. Eligible health-care workers (HCWs) were selected using simple random sampling from ten primary health-care (PHC) facilities. Chi-square test was used to examine associations of interest. Binary logistic regression was employed to identify predictors of good IPC practices. Results: Three hundred eligible health-care workers participated in this study. More than a fifth (n = 65, 21.7%) of HCWs exhibited good practice of IPC measures. Correct practice of handwashing was noted among 275 (95.7%) respondents. Majority (n = 224, 74.7%) reported recapping of needles and engaged in unsanitary disposal of health-care wastes (n = 257, 85.7%). The prevalence of needlestick injuries 3 months prior to the study period was 53.3% (n = 160). Majority of those sampled reported a lack of IPC committee (n = 220, 73.3%), conspicuous signage to aid movement (n = 230, 76.7%), and an IPC policy (n = 217, 72.3%) in their respective centers. Identified predictors of good practice of IPC were age <40 years (adjusted odds ratios [AORs] 0.57; 95% confidence interval [CI] 0.38–0.57), being a community health extension worker or community health officer (AOR 3.76; 95% CI 1.56–9.03), and working for <20 years (AOR 5.10;95% CI 5.00-5.73). Conclusion: Poor practice of IPC and poor compliance to administrative control among PHC workers, in addition to lack of administrative facilities, remains a great challenge. There is an urgent need for capacity building on IPC and administrative support to reverse this trend.

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Background: Postpartum intrauterine copper device (PPIUCD) is a reliable and efficient method of contraception for women. In spite of its ease of administration, its acceptance is very low owing to a number of factors. The current study was undertaken to analyze the continuation rates and problems among women accepting PPIUCD as contraceptive method. Methods: The present study was undertaken in the family planning department of a teaching hospital in New Delhi. It was an ambispective, observational study in which 880 beneficiaries of PPIUCD were telephonically contacted and interviewed. A pro forma containing demographic profile, obstetric history of the women, date and timing of insertion of PPIUCD, source of information about PPIUCD, side effects encountered, willingness to continue, and reasons of discontinuation, if applicable, was filled and the data, collected thus, were analyzed. Results: Most of the women enrolled in the study had a mean age of 26.5 (±4.1) years; the average parity was two. The timing of insertion of PPIUCD was postplacental in majority of women (91.7%). Most of the women received information about PPIUCD from health-care workers (90.1%). It was found that 86.7% of women were using PPIUCD at the time of interview and 73.3% were satisfied with it and willing to continue further. The predominant side effect observed was pain abdomen (15%), followed by menstrual irregularity. Conclusion: The present study revealed a high continuation rate of PPIUCD. Health-care professionals were the foremost source of information for PPIUCD. It is a highly effective method which needs to be popularized among the masses by the active participation of media and other agencies as it has the potential to bridge the gaps in existing family planning services.

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In the last two decades, India has seen a massive rise in the number of medical schools. As a result, numerous issues, including the availability of qualified teachers, have made medical education in India challenging. Faculty development (FD) has gained significant attention because of its importance in educational capacity building. FD programs help faculty become more aware of their professional responsibilities. Medical education units can play a vital role in FD and thus improve the quality of medical training by training the teachers. The National Teacher Training Centre (NTTC), Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, was the first center established by the Ministry of Health and Family Welfare, Government of India in 1975, with the assistance of the World Health Organization, to promote the training of health professionals in educational science and technology, including educational planning and research. This article describes the profile of activities of NTTC, which is functioning under the aegis of the Department of Medical Education (DME), JIPMER, and lists the outcomes that contributed to the success of DME with particular reference to the last decade. The establishment of DME is seen to affect the medical school positively.

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Case reports are considered the smallest units of descriptive studies. They serve an important function in bringing out information regarding presentation, management, and/or outcomes of rare diseases. They can also be a starting point in understanding unique associations in clinical medicine and can introduce very effective treatment paradigms. Preparing the manuscript for a case report may be the first exposure to scientific writing for a budding clinician/researcher. This manuscript describes the steps of writing a case report and essential considerations when publishing these articles. Individual components of a case report and the “dos and don'ts” while preparing these components are detailed.

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Medicine is an ever-changing science, and the pace of this change has been rapid in recent years. A researcher in an academic institution is now obliged to publish their research work for career advancement with recognition, access to grants, fellowships, etc., as secondary objectives. Besides, it is paramount for anyone engaging in active clinical practice to remain up to date with recent advances in the field. Hence, it is the author's responsibility to publish authentic data with integrity as it helps modulate opinions on a wide platform globally in today's digital age. While the pressure to publish is immense, it is vital to have a system of checks and balances before publishing and adhere to good research practices because a wrong step may bring lasting discredit to the authors. This article attempts to provide an overview for novice researchers regarding how to select an appropriate journal for publication, evaluate it in view of its reach and relevance, and how to avoid predatory journals. The article also briefly outlines the various databases available, peer-review process, important journal metrics such as impact factor and indexing, and the concept of open access in a simple language to enable young authors to select the best journal for publishing their work.

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Mental health issues are common among health professionals due to the enormously stressful nature of their work. The paucity of workforce, resources, and high patient load, are liable to make mental health professionals, including psychiatrists, overburdened. The work pressure, demand-output mismatch, and burden of expectations from psychiatrists may make them distressed despite their training in stress management. This review discusses key mental health issues faced by psychiatrists, their possible attributes, and remedial measures.

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