For years, generations of medical students were taught that in stroke, “;In a upper motor neuron (UMN) lesion, the upper part of the face is spared because this part of the face has bilateral representation while in a lower motor neuron (LMN) lesion, both parts of the face are involved.” Is this explanation apt ? Most of the fibers of the corticospinal tract decussate to the opposite side. But only 50% of the corticobulbar fibers decussate, meaning the muscles they supply receive fibers from both motor cortex (bilateral representation). Bilateral representation in the cortex is a perfect example of symmetry in the human body. An exception to this rule would be the lower part of the face which receives fibers from the contralateral cortex alone (unilateral representation). This goes against the general rule and so this represents the first paradox of the cranial nerves. The second paradox is entirely man made and is reversible. Should it not be, “;In a UMN lesion of the facial nerve, only the contralateral lower half of the face is affected, because this part of the face has unilateral representation only” and not “;In a UMN lesion of the facial nerve, the contralateral upper part of the face is spared because this part of the face has bilateral representation.” After all, is not bilateral representation the rule and unilateral representation the exception ?.

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Emotional intelligence (EI) is a social intelligence distinct from academic intelligence and assists us in successfully comprehending complex personal, social, and professional situations. The four components of EI are perceiving, understanding, managing, and using emotions to enable better adaptability and creativity. In this perspective, the authors have examined means to measure EI and its implications across various life situations with special emphasis on the lockdown due to the COVID-19 pandemic. The necessity for research into multiple intelligences (cultural, practical, and spiritual) is further discussed in the way forward.

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Background: Diagnosis of seronegative rheumatoid arthritis (SNRA) remains difficult because chronic synovitis is nonspecific and is seen in a large number of diseases. Although the 2010 American college of Rheumatology (ACR)/European League Against Rheumatism criteria enable early detection of seropositive rheumatoid arthritis (RA), it is not much helpful in identifying seronegative patients. Objective: The objective of the study was to suggest classification criteria for SNRA. Methods: This was a questionnaire-based study. A validated questionnaire was sent to rheumatologists all over the country to collect data regarding the points which they consider for detecting SNRA. The data so collected were analyzed to identify priority given to each point. Weightage given to these points was used to suggest systematic criteria for classifying SNRA. Results: Total 50 rheumatologists participated in the survey. They reported using the presence of inflammatory polyarthritis (62%), elevated acute phase reactants (high erythrocyte sedimentation rate [ESR] - 86% and high C-reactive protein [CRP] - 78%), absence of spondyloarthropathy features (68%), absence of antibodies (rheumatoid factor [RF] – 82% and anticitrullinated protein antibodies [ACPA] – 74%), and chronic infections for detecting SNRA. Based on these results, chronic inflammatory polyarthritis or synovitis confirmed by ultrasonography or magnetic resonance imaging, raised ESR and/or raised CRP, and negative RF and negative RF and ACPA were identified as mandatory criteria, while the absence of SPA features including psoriasis, absence of clinical features of connective tissue diseases, negative Antinuclear antibodies (ANA) by Immunofluorescence assay (IFA), and absence of HCV, HBSAg, HIV, TB as well as leprosy (in endemic regions) were identified as supportive criteria. Conclusion: We propose classification criteria for SNRA. This needs further validation and could be used for studies and clinical practice in future.

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Background: Monitoring and evaluation of tuberculosis (TB) treatment outcome is an essential component of the evaluation of a country's TB control program. Nigeria's current TB treatment success rate of 86% is below the World Health Organization target of 90% by 2025. This study aims to evaluate TB treatment outcomes in a tertiary health center in southwestern Nigeria over a 5-year period and to document the factors associated with poor TB treatment outcomes. Materials and Methods: This was a retrospective study of all TB patients seen at the TB clinic of the hospital from January 1, 2015, to December 31, 2019. Data were extracted from the TB clinic register. Data extracted included sociodemographic factors, HIV status, treatment category, rifampicin resistance, extrapulmonary TB, and treatment outcome. Treatment outcome was categorized as successfully treated or poor treatment outcome (death, treatment failure, and lost to follow-up). Results: Five hundred and nine TB cases were analyzed with a mean (standard deviation) age of 40.2 (17.7) years. Treatment outcome was as follows: successfully treated – 426 (83.7%), died – 62 (12.2%), treatment failure – 14 (2.8%), and lost to follow-up – 7 (1.4%). Poor treatment outcome was associated with older age (P = 0.003), HIV-positive status (P = 0.044), and smear-negative TB (P = 0.047). Conclusion: The treatment success rate in our center is high but can be improved. More efforts should be put in place to ensure improved outcomes, particularly among the elderly and HIV-positive patients.

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Aim: The aim of the study was to explore the impact of the coronavirus disease 19 (COVID-19) lockdown on the clinical outcome of patients with Type 2 diabetes mellitus (DM) attending a primary care Diabetes Clinic in Lagos State, Nigeria, in terms of their compliance with medication intake, blood pressure (BP), and glycemic control and ability to modify medication through telephone consultation. Methodology: A retrospective review of the clinical characteristics of patients was carried out. Telephone calls were made to patients with Type 2 DM who attended the chronic medical disorder clinic of the Family Medicine Department, Lagos State University Teaching Hospital, Lagos, Nigeria. The information obtained included questions on demographic data, type of medications used, and medication compliance, use of self-monitoring devices for BP, and blood glucose levels. Data analysis was performed using SPSS program version 26. Results: A total of 178 patients were eligible. Most (87%) reported using their medication as prescribed, 74% of patients had self-monitoring of blood glucose (SMBG) during lockdown, though only 29% checked glucose level regularly and 54% practiced home monitoring of BP (HMBP). Medication was modified in 34% of patients by the doctor who called in. Biguanides and Sulfonylureas were the most prescribed oral antidiabetic medications, while Renin Angiotensin Aldosterone System (RAAS) blockers were the most prescribed antihypertensive class. The HMBP was associated with lower systolic BP (t-test 3.49, P = 0.0008). Conclusions: Type 2 diabetic patients managed through telephone during the COVID-19 lockdown reported good level of drug compliance, while improved practice of SMBG, and HMBP resulted in better level of control. The findings of this review suggest that the use of e-consultation can play a role in patient management of Type 2 diabetes even beyond the COVID-19 era including reaching patients in distant locations who are unable to come to the hospital. There is a need for further studies on e-medicine role on various aspects of medical care.

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Status epilepticus (SE) is a serious complication of epilepsy that warrants both rapid and appropriate emergency management for better outcomes in terms of mortality and morbidity. The initial management of SE in emergency department (ED) involves a rapid neurological assessment and initiation of supportive therapy. Benzodiazepines are the recommended first-line treatment based on high-quality evidence, among them intramuscular (IM) midazolam IM was found to be as effective as intravenous lorazepam. However, it is important to understand that speedy drug delivery and adequate initial dose are of prime importance than selection of drug. Recent evidence shows all three second-line drugs, namely, valproate, fosphenytoin, and levetiracetam are alike in cessation of SE with similar incidence of adverse events. In refractory SE, the therapeutic options include the use of bolus dose followed by infusion of propofol, midazolam, ketamine, lacosamide, and phenobarbital. Magnesium sulfate is safe and superior in the management of eclamptic SE prompt and appropriate management in ED is the key to early cessation of SE, leading to better outcomes.

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Triage is practiced in hospitals around the world and has proved its worth in identifying and prioritizing sick patients for emergency resuscitation, especially in resource-limited settings. Both formal and informal systems are utilized in different health centers to differentiate between patients with varying severity of illness. The Christian Medical College, Vellore Triage System (CMCTS) developed at our emergency department (ED) in 1997 is a four-category system that makes this differentiation based on presenting symptoms, signs, and predefined physiological parameters. In our ED, triaging is performed by a triage team composed of both nursing personnel and emergency physicians. During the COVID-19 pandemic, our triaging system was modified to segregate potential COVID and non-COVID patients into different zones for containment and for safety of healthcare workers.

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Background: Hydrochlorothiazide is a diuretic commonly used in the treatment of hypertension. Recently, there have been published reports of hydrochlorothiazide-induced cutaneous neoplasms among Caucasians. We therefore investigated the risk for cutaneous neoplasms with hydrochlorothiazide use among the Indian population. Methods: We conducted a case–control study comparing hydrochlorothiazide use among patients diagnosed with cutaneous neoplasms between 2008 and 2017. Patients who underwent skin biopsy and had a pathological diagnosis of either nonmelanoma skin cancers or mycosis fungoides were matched with control patients without a skin cancer diagnosis in a 1:1 ratio. Hydrochlorothiazide use, its dose, and duration of use were compared between the groups. Odds ratio (OR) and 95% confidence intervals (CIs) for cutaneous neoplasms were calculated. Results: Among 90 patients in each group, 7 cases (7.78%) and 7 controls (7.78%) had hydrochlorothiazide exposure for at least 30 days, up to 1 year before cancer diagnosis (OR 1.0, 95% CI 0.34–2.98). Cumulative dose (P = 0.242) and duration of hydrochlorothiazide use (P = 0.08) did not differ between cases (n = 6) and controls (n = 5). There was a trend toward increasing risk of cutaneous neoplasms with high cumulative dose (≥25,000 mg) of hydrochlorothiazide (57.14% vs. 14.29%). The groups were similar with respect to comorbidities and concomitant drug intake; however, cases included more homemakers than controls (P = 0.008). Among hydrochlorothiazide-exposed cases, the body site of basal cell carcinoma involvement was predominantly the head/neck (n = 2; 66.67%), followed by the trunk (n = 1; 33.33%). Conclusion: The current findings did not find an association between long-term hydrochlorothiazide use and occurrence of cutaneous neoplasms.

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Background and Objectives: The COVID-19 pandemic has highlighted the risk of airborne transmission of infections in health-care facilities such as dental clinics. In this experimental study, methods to control airborne particles in a simulated dental clinic setting were measured and compared using a low cost and convenient technique. Materials and Methods: Particles representing inhalable airborne particles were generated using smoke from incense sticks and their concentration measured by handheld particle sensors whereas using different engineering controls for the particle removal in dental clinic equivalent settings. Measurements were made at short (<3 ft) and intermediate (between 3 and 6 ft) distance from the source. The particle filtration through surgical masks and N95 masks was also studied. Results: Natural ventilation, by keeping windows open, can reduce intermediate range particles (removal of 4.7% of ambient particles/min). However, in closed facilities without natural ventilation, particle removal by air purifier combined with overhead fan or with high volume evacuators was found most suitable for intermediate range particles (25.9%/min) and for short range particles (27.6%/min), respectively. N95 masks were found to filter out 99.5% of the generated PM 2.5 particles. Conclusions: Potentially inhalable airborne particles can persist in the air of a dental clinic. The use of N95 masks and environmental controls is essential for the dental team's safety. The choice of an engineering control is governed by multiple factors explained in the study. Smoke particles generated by incense sticks and measurement by handheld particle sensors are low-cost methods to estimate the effectiveness of airborne particle controls.

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Background: International electives provide students an opportunity to experience diversity in educational content and the impact of social settings on health-care delivery. Primary eye care provided by optometrists is a crucial aspect of the ocular health chain. Optometrists play a large role in the early diagnosis and prevention of ocular diseases. Knowledge and skill acquisition in ocular diagnostics involving a spectrum of diseases that students have fairly limited exposure to in Urban Australian settings would go a long way in ensuring the wholeness of the optometry curriculum. Methods: The International Elective in Tropical Eye Disease and Community Eye care (TEDCE), based in a tertiary teaching eye hospital in South India, intended to impart this body of knowledge. This study is an educational-program evaluation study that assessed the change in knowledge, skills, and attitude of 10 International Optometry Students before and after TEDCE. Knowledge and skill were measured using multiple choice questions (MCQS) and objectively structured clinical examination (OSCE). Attitude OSCEs was quantified using the the readiness for inter-professional learning scale questionnaire. Results: The pretest MCQ showed a mean score of 44.40 ± 6.22 and posttest MCQ improved to 51.80 ± 3.85. Similarly, the pretest OSCE showed a mean score of 7.10 ± 1.52 and posttest OSCE improved to 12.05 ± 2.58. Qualitative questionnaire analysis indicated that students had better chance to understand interprofessional benefits and limitations. Conclusion: The analysis of the results indicates a positive impact of intervention with respect to knowledge, skills, and attitude gained.

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Iron deficiency anemia in pregnancy can lead to significant adverse effects on the mother and fetus. Patients with iron deficiency anemia are treated with parenteral iron therapy when oral iron therapy is ineffective or in case of non-compliance due to side effects. Parenteral iron preparations such as iron dextran and sodium ferric gluconate complex can cause side effects including life-threatening anaphylactic reactions. However, parenteral iron sucrose has a favorable safety profile and anaphylactic reactions are extremely rare. We report a rare case of near-fatal anaphylaxis following intravenous iron sucrose therapy in a postnatal mother with iron deficiency anemia.

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Introduction: Febrile neutropenia is one of the most common presentations to the emergency department. Identification and empirical antibiotic therapy improve the outcome of these patients. The objectives of the study are to collect prospective data on febrile neutropenic patients and describe their clinical profile. Materials and Methods: The study was conducted at the Emergency Department, Christian Medical College and Hospital, Vellore, from July 2017 to February 2018. After obtaining informed consent, all adult patients who presented with fever and neutropenia were included in the study. Results: Of 3778 patients with fever, 101 patients had febrile neutropenia and were included in the study. Males comprised 55.5%. Moderate neutropenia was seen in 30 patients and severe neutropenia was seen in 71 patients. Among the various comorbidities, diabetic patients were more at risk of developing febrile neutropenia (17. 82%). The common organisms isolated were Gram-negative organisms (62. 5%). Coagulase-negative staphylococci and Escherichia coli were the most common organisms. Aplastic anemia was the main diagnosis among those patients with febrile neutropenia (43.76%). The mortality of the febrile neutropenic patients was 1.98%. Overall survival was 96.04%. Conclusion: Empirical antibiotic therapy covering the most common organisms should be started early in febrile neutropenia patients.

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Pandemics bear unique challenges which require a fast response from health system on many aspects ranging from prevention to management through rapid diagnostic modalities, drug/vaccine discovery, and health resource allocation and planning management. However, in low resource settings, the mismatch between demand & supply of health services and inadequate knowledge about the course of pandemic results in failure in management of pandemic & resulted in loss of human lives. However, due to discovery of the latest technologies like artificial intelligence (AI), the pandemic is often managed from prevention to management level in a predictive manner. AI is increasingly being studied as a useful gizmo to assist in preventing pandemic and managing existing crisis in a timely manner. However, while AI has been proved to be useful in its ability to assist halting the rapid spread or contamination of disease during a pandemic, there exist few ethical and legal issues that have gotten to be taken care of before it is to be utilized in a mass scale.

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Background: Men with lower urinary tract symptoms (LUTS) often present late. This work aims at studying the reasons for delayed presentation to the urologist by men with LUTS. Materials and Methods: This is a cross-sectional study. Delay was taken as 5 months of symptoms before consulting the urologist. The predictors assessed were age, occupation, education, number of children, number of brothers, number of wives, participants' location, and reason for delay. The outcome was the proportion of men with symptoms of more than 5 months and the correlation between predictors and outcome variables. Data were analyzed using International Business Machines–Statistical Programming for Social Sciences version 21. P value of 0.05 was taken as significant. Results: Three hundred and fifty-four men correctly filled the questionnaires. Finance (12.4%), belief symptoms were due to aging (18.4%), not knowing where to seek help (18.6%), and not knowing the diseases are treatable in the hospital (8.8%) were the reasons for delay. On linear regression analysis, only location (urban or rural) (P = 0.001) of the participants significantly predicted the reasons for delay, while on binary regression analysis, only the number of living brothers (P = 0.53) was close to predicting delay. Conclusion: Ignorance, poverty, culture, and beliefs are the factors that determine how long men delay before consulting the urologist.

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Intracystic papillary carcinoma breast is an uncommon breast cancer consisting of 0.5%–1.0% of all breast cancers. Papillary carcinoma is a rare type of breast carcinoma which is divided into two types, which are intraductal and intracystic papillary carcinoma. Intracystic papillary carcinoma may present as pure intracystic carcinoma or may be associated with in situ carcinoma. Here, we report a case of intracystic papillary carcinoma of both breasts which created diagnostic dilemma.

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Recurrent pneumothorax is an entity that needs evaluation to determine the etiology. We report a case where the diagnostic delay occurred in a child with recurrent pneumothorax.

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