Cancer Pain is a multi-dimensional pain experience which involves diverse neurophysiological changes and is associated with significant cognitive, emotional and sociocultural problems. Globally, the incidence is very high and usually it is undertreated. Lack of knowledge about managing malignant pain is an important cause of undertreatment. All types of pain are possible with malignancies. Assessment of pain characteristics is vital for proper management. The WHO step ladder pattern is the cornerstone of management. There are different pharmacological and nonpharmacological methods. Morphine is the choice opioid being administered by various routes. All drugs should be used as round the clock regimen. Opioid switch is opted to tackle tolerance. Nerve blockade especially with alcohol are still being used. Newer treatment modalities like implantable intrathecal pumps, dorsal column stimulation are in the pipeline for future. A passionate counselling may frequently release knotted conundrum of difficult analgesic strategies.

Background and Objective: Autism is a neuro-developmental disorder leading to multiple problems including academic difficulties and impaired skills. Information processing is abnormal in children with Autism Spectrum Disorder (ASD) and their central nervous system (CNS) is either over or under aroused. Reaction time (RT) is a useful marker to study the ability of CNS. This study planned to investigate the changes in RT before and after 12 weeks of yoga training Material and Methods: 72 ASD children were divided equally into control group (Group I) who did not undergo yoga training and yoga group (Group II) who received 60 minutes' yoga training, five days a week, for 12 weeks. Components of yoga protocol included jathis, kriyas, asanas, pranayamas and yogic relaxation. Auditory RT (ART) and Visual RT (VRT) were recorded before and after 12 weeks' yoga training using RT apparatus. Data was assessed for normality using GraphPad InStat version 3.06 for Windows 95. Wilcoxon matched?pairs signed?ranks test was used for intragroup comparison and Mann-Whitney test for intergroup comparison. P <0.05 was accepted as indicating significance. Results: Intra-group comparisons showed a highly significant increase in ART in group I (p < 0.001) whereas both ART and VRT decreased significantly in group II (p < 0.001) with yoga training. Intergroup comparisons showed highly significant differences in ART and VRT values (P < 0.0001). Delta % changes were also highly significant for both ART and VRT (P < 0.0001). Conclusion: Yoga training may be utilized to reduce dependency on others and enhance learning capabilities and social skills in ASD children.

Background and Objective: There are very few literature evidence studying the remission rates among mental illness and substance use disorders (MISUD) in India. Knowledge of the remission and its characteristics can help to draw better policies for mental health care delivery in India. Material and Methods: Using the Global Burden of Diseases, 2016 approach and employing the DisMod-MR - 2.1.6 mathematical modelling, prevalence, incidence and remission rates of 4 substance use disorders (alcohol, opioid, cocaine and cannabis), schizophrenia, major depressive disorder, bipolar disorder and anxiety disorders were studied. Results: Within the mathematical model confines the prevalence, incidence characteristics of MISUDs based on age and gender are presented. The remission rate per person year ranged from 0.015 to 1.46 for different MISUD. Gender shows difference in the model for anxiety disorders, opioid and alcohol use disorder. The effect of age on the model are described in detail Conclusion: The outcome of the study indicates the remission rates of MISUDs are highly variable. Remission rates significantly varies between age and gender. Based on these inputs, customized and targeted MISUDs therapies may be designed for better remission. The study also underlines the need for further large scale research efforts required for studying and reporting natural history of MISUDs from India.

Background and Objective: Acinetobacter, has been identified as an important pathogen in nosocomial outbreaks with high levels of emerging drug resistance. The present study was conducted in Acinetobacter spp to find out the utility of the multiplex PCR assay, which may be used as a useful technique in the early detection & prevention of bla_OXA-23 and bla_OXA-58 gene harbouring in clinical isolates taken from the patients coming to a tertiary care hospital. Material and Methods: Strains of Acinetobacter collected from different clinical samples were subjected to antimicrobial susceptibility testing. Strains which were found showing resistance to imipenem by both disk diffusion and minimum inhibitory concentration (MIC), were analysed for the presence bla_OXA-23 and bla_OXA-58 (CLASS D) by using multiplex PCR. Results: Among 175 strains of Acinetobacter collected from the clinical samples, 45 strains showed imipenem resistance, both by disk diffusion and MIC out of which 19(42.2%) were positive for bla_OXA-58 gene and all strains 45(100%) were positive for bla_OXA-23 gene. Conclusion: The present study shows that there is dissemination of genes produced carbapenem resistant in the Acinetobacter isolates. This scientific evidence can be used to limit the spread of such strains in hospital settings as well as in the community, and also may help in initiating specific hospital infection control measures.

Background and Objectives: Student disrespect in higher education is a topic of increasing focus in recent times. This internal audit on faculty perception of student disrespect was conducted among the staff from the Faculty of Medicine in northern Malaysia. Material and Methods: A cross-sectional audit was done among the 95 staff of a private university using the online Google-form as voluntary and anonymous in nature. The descriptive statistics and inferential statistics were done by SPSS software. Results: The total number of respondents were 72 (76%). Of the eight responders (11%) who perceived student disrespect, seven of them perceived it among the students in clinical years. There was no significant association between the gender of the respondent and the perception on student disrespect. The themes of student disrespect were ‘not following rules; not being punctual, lack of social grace or etiquette and absenteeism without prior notice’. Conclusion: Several studies have documented that incivility and disrespectful behaviour are often displayed in the clinical environment, which might adversely affect patient safety and promote medical students' disrespect. For the medical students to learn proper behaviour by role-modelling, the medical educators and professionals must eschew rudeness and incivility in the workplace.

Scholarship or scholarly activity is implied as part of the “job requirement” of faculty in health sciences. However, the concept of scholarship other than an emphasis on publications is hitherto lacking in India with no weightage being given to all four components of scholarship as described by Boyer, viz. the scholarship of discovery, application, integration or teaching leave alone a weightage for innovative activities. This paper describes the components of scholarly activities, the current requirement or lack of it of “mandatory” training right from the undergraduate student days in scholarly activities, poor scholarly requirements for postgraduates and a faculty appraisal which values only publications. Metrics have been suggested for all individual five components of scholarship and an emphasis has been laid on training right from the beginning of medical education for the activity to be internalized.

Mid-facial infection carries potential dangers of developing severe life-threatening intracranial complications. Early intervention and the awareness of possible complications essentially can help bring about a better outcome. Presented here, two paediatric cases of nasal abscesses, who developed such serious intracranial complications as meningitis, cavernous sinus thrombosis and brain infarction, but ultimately survived the crisis with appropriate intervening measures comprising immediate surgical intervention, efficient intensive care and long-term antibiotics. The cases were studied to ascertain a clinical course and outcome in the light of experience at a district hospital for further clinical application. No reconstructive surgery was performed on these patients but in short-term follow-up, no obvious facial developmental problem has been detected yet.

A 62 year old male patient presented with complaints of left sided facial pain for 1 year. Patient was diagnosed to be a case of trigeminal neuralgia predominantly affecting the maxillary region after a thorough clinical examination by different specialties and investigations. Analgesics, antidepressants decreased pain but were unsatisfactory. Increased doses caused more sedation and decreased quality of life. An extra oral single shot maxillary nerve block was given and single drug therapy was continued. Satisfactory analgesia was noticed after a month. This case reports traditional extra oral maxillary nerve block as an adjuvant option for long term pain relief for trigeminal neuralgia.

Branchial cleft cysts commonly present in the upper neck along the anterior border of the sternocleidomastoid muscle and are derived from the second branchial cleft. Their diagnosis is usually straight forward but sometimes due to unusual presentations they may be misdiagnosed and even mismanaged. A thorough knowledge of embryology and anatomy is essential in the diagnosis and surgical management of branchial cleft cysts.