Introduction: The increased risk of morbidity and mortality associated with left ventricular hypertrophy (LVH) diagnosed by electrocardiogram (ECG) or echocardiography is well known. The aim of the study was to evaluate ECG and echocardiography evidence of LVH in patients provisionally diagnosed to have LVH on clinical assessment and to determine the sensitivity and specificity of different criteria of LVH on ECG in comparison with echocardiography. Materials and methods: Hundred patients provisionally diagnosed to have LVH based on clinical assessment were enrolled in this study. A standard 12-lead ECG was recorded. Left ventricular hypertrophy was measured on ECG by applying following criteria: Sokolow–Lyon, Cornell, Romhilt–Estes score. Using two-dimensional echocardiography as the gold standard, LVH was calculated. Sensitivity and specificity of different criteria of ECG were calculated in comparison with echocardiography. Results: Out of 100 patients suspected to have LVH, 91 patients were found to have LVH on echocardiography. Indicating that echocardiography has sensitivity of 91% and diagnostic accuracy of 91%. On comparing different criteria, Sokolow criterion was found to have maximum sensitivity of 38.46%, while Cornell criterion was least sensitive, i.e., 14.29%, and sensitivity of Romhilt–Estes criterion was 19.78%. However, overall sensitivity of ECG can be increased by combining all the criteria, i.e., to 45.05%. Specificity of different criteria of ECG was high, i.e., as much as 100% in case of Romhilt–Estes criterion, while overall specificity of ECG was 77.778%. Conclusion: Sensitivity and diagnostic accuracy of ECG were very low in comparison with echocardiography in detecting LVH; therefore, ECG cannot replace echocardiography in detecting LVH. Overall sensitivity of different criteria of ECG was low. However, sensitivity of ECG can be increased by combining Sokolow-Lyons voltage criteria and Cornell voltage criteria with Romhilt–Estes point score.

Introduction: Urinary retention is defined as the inability to urinate voluntarily. Acute urinary retention (AUR) is the sudden and painful inability to void, despite having a full bladder. Chronic urinary retention (CUR) is painless retention associated with an increased volume of residual urine. Despite the worldwide interest in the subject, there exist only a limited amount of data with respect to the causes of AUR and CUR. The main aim of study was to study the main aspects of causes and frequency of different causes of urinary retention with their age and incidence in this part of India. Materials and methods: In this study, 100 patients presenting to the outpatient department (OPD) and emergency of a tertiary care hospital in Amritsar with urinary retention were evaluated and categorized into two groups: AUR and CUR. Further, these patients were subdivided into etiological classification according to the study. Results: In men, benign prostatic enlargement is the leading cause of urinary retention, with second being stricture urethra. In women, urinary retention was mainly caused by meatal stenosis and blood clots due to urinary bladder growth. We also found some correlation of urinary retention with health negligence and less personal hygiene, which was more common in below-poverty-line patients.

Aim: To determine whether height, body mass index (BMI), hand length, and hand breadth were predictive of hand grip strength in healthy Punjabi adult males and females. Materials and methods: This cross-sectional study recruited 100 healthy adult males (50) and females (50) in the age group of 50 to 60 years randomly. Their anthropometric characteristics including height, weight, BMI, hand length, and hand breadth were measured using standard techniques. Hand grip strength was measured using Jamar dynamometer. Data were analyzed using Student's t-test and analysis of variance (ANOVA). Results: The present study generated the normative data for hand grip strength and its association with gender, height, weight, BMI, hand length, and hand breadth in study subjects. The gender difference in grip strength was statistically significant with higher grip strength found in males than females. Also, it was found that grip strength was more in the dominant hand as compared with the nondominant hand. Subjects with longer and broader hands had stronger grip. Conclusion: The knowledge of determinants of hand grip strength in a normal population is essential as in clinical settings it is used as an indicator of overall physical strength and health. Hand length and hand breadth should be well thought out for hand grip strength measurements in the older age group since these anthropometric measures could affect the results of treatment and control of hand function.

Introduction: Breast engorgement occurs in 72 to 85% of postnatal mothers. One home remedy, i.e., cabbage leaves application, is very effective for engorgement. The objective of the study was to assess the effectiveness of cabbage leaves application on breast engorgement among postnatal mothers. Materials and methods: The study was conducted in tertiary care medical institute and one private hospital in Amritsar. Totally, 63 (33 in study and 30 in control group) postnatal mothers with engorgement of breast were selected by purposive sampling technique and quasi-experimental design was adopted. Storr breast engorgement scale was used to assess the breast engorgement. The chilled cabbage leaves were applied on engorged breast twice a day for 3 subsequent days. The obtained data were analyzed by using descriptive and inferential statistics like frequency, percentage mean, standard deviation, unpaired t-test, and Chi-squared test. Results: The study result showed that there was reduction in breast engorgement level after the intervention and also showed statistically highly significant difference in between the groups. Conclusion: There was a significant reduction in severity of breast engorgement among postnatal mothers after application of chilled cabbage leaves. Thus, it was proved to be an effective intervention for severity of breast engorgement. Therefore, this intervention should be promoted as an institutional policy and implemented as a routine care for all postnatal mothers having breast engorgement for reducing severity of breast engorgement.

Introduction: Chemotherapy is the use of cytotoxic drugs in the treatment of cancer that provides cure, control, and palliation. The study was conducted with the aim of assessing knowledge about safety measures regarding handling of chemotherapeutic agents among staff nurses. Materials and methods: A descriptive research approach was used with one point of data collection. Through convenience sampling with random assignment, 40 study subjects were selected. Structured knowledge questionnaires were prepared and validated. Results: This revealed that 60% of the staff nurses had adequate knowledge and 40% had inadequate knowledge regarding handling of chemotherapeutic agents. The chisquared test value was found to be statistically significant at p-value <0.05 regarding knowledge of chemotherapeutic agents with educational status and work experience. Conclusion: Health talks, in-service education, and seminar and workshop programs should be conducted and staff nurses should be certified to handle the chemotherapeutic agents.

Acute coronary syndrome (ACS) is one of the leading causes of admission to the emergency departments (EDs) worldwide. The diagnosis of ACS involves the evaluation of clinical signs and symptoms, electrocardiographic assessment, and measurement of cardiac circulating biomarkers. In the last 60 years, the use of laboratory markers has changed considerably. Early biomarker assessment has entailed testing for total enzyme activity of aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and creatine kinase (CK) but was highly nonspecific. Soon thereafter, the development of immunoassays, as well as technical advances in automation, allowed the measurements of the CK MB isoenzyme (CK-MB) in mass rather than in activity and myoglobin. Currently, cardiac troponins (CTn) have the highest sensitivity and specificity for myocardial necrosis and represent the biochemical gold standard for diagnosing acute myocardial infarction (AMI). This review provides a chronology of the major events that marked the evolution of cardiac biomarker testing and the development of the relative assays from the first introduction of AST in the 1950s to the last high-sensitivity troponin immunoassays in the 2010s.

Introduction: Congenital radioulnar synostosis is a rare anomaly of the upper limb with functional limitations of the limb. However, it occurs more commonly than perceived and is often a part of syndromes, such as Crouzon, Apert's, and Poland's. The exact etiology is not clear, but there is genetic basis for the failure of differentiation between the radius and ulna. Case report: A 6-year-old child with pain and limited mobility of the elbow joint came to the outpatient department, Department of Orthopedics, Government Medical College Amritsar, Punjab, India. Plain X-ray anteroposterior and lateral views were taken that showed bilateral superior radioulnar synostosis. Conclusion: Diagnostic imaging like radiological studies can help the surgeons to plan for surgery of radioulnar synostosis.

We present a rare case of meningitis caused by Aeromonas hydrophila that complicated an otherwise successful endoscopic removal of pituitary microadenoma. Review of literature revealed very few cases of meningitis in both immunocompetent and immunocompromised patients. In this case, the patient died within 48 hours of admission despite prompt treatment and extensive resuscitation. This highlights the morbidity and mortality potential of a seemingly harmless organism.

Angioma serpiginosum is a rare benign vascular condition which is characterized by the presence of multiple, minute, erythematous angiomatous macules or patches present in linear blaschkoid, gyrate, or serpiginous patterns. It usually affects lower extremities and buttocks. Involvement of upper trunk and extremities is rare. Histologically, there is dilatation of blood vessels in papillary dermis. Dermoscopic findings reveal presence of oval-to-round red lagoons. It shows female preponderance. Hence, we report a rare case of angioma serpiginosum in a male child with bilateral distribution.

Introduction: Case-based learning (CBL) promotes integration of knowledge and practice. During CBL, students are exposed to the real medical problems. The present study was conducted to introduce CBL as a teaching/learning (T/L) tool in the Department of Biochemistry and to determine its effectiveness in enhancing students’ knowledge and also to make the students aware of relevance of biochemistry in clinical settings. Materials and methods: After permission from Ethical Committee, both faculty and students were sensitized to CBL; questionnaires and feedback pro forma for students and faculty were finalized. Total of 126 students of first-year Bachelor of Medicine and Bachelor of Surgery (MBBS) were included in the study, and they were divided into two groups. Both groups I and II comprised 63 students each. The study group I (n = 63) was given a clinical problem with specific learning objectives 2 days before CBL session. Pretest questionnaire was administered to both the groups. Group I underwent a CBL session and group II had the same teacher teaching the topic in a didactic lecture form. Both the groups were given a posttest. Crossover of groups was done for the second clinical case. Structured feedback questionnaire on acceptability and usefulness of this method was taken from both the students and the faculty. Using Student's paired and unpaired t-test, the results of pretest and posttest were analyzed. Results: The majority of students (89%) agreed that CBL form of teaching was better than didactic lectures in understanding the topic. For clinical application of knowledge of biochemistry, 85% of the faculty agreed that CBL was a better T/L tool. Conclusion: Among medical students, CBL is effective for better understanding of biochemistry. It motivates students to become self-directed learners. Along with didactic lectures it should be a part of teaching curriculum.

Three-parent baby technique is the latest tool in preventive methods for mitochondrial diseases. It uses the mitochondrial deoxyribonucleic acid (DNA) replacement therapy (MRT) to get rid of defective mitochondrial DNA (mtDNA). The MRT has been made possible by pronuclear transfer and maternal spindle transfer (MST). This shall take away the need of surrogacy and adoption, if practiced with certainty. The MRT replaces defective mtDNA, but its close functioning with the individual's nuclear DNA (nDNA) makes the whole process complicated. This article provides a summarized understanding of the biological mechanisms involved in MRT and the need to consider three-parent in vitro fertilization (IVF). It also discusses the bioethical issues of the technique considering its future implications and whether it is a boon or a bane for our society and subsequent generations.

The notion of population was discussed scientifically in 1994 at Cario during the international conference of Population and development where it was highlighted that not just poverty but lack of development is population explosion. During subsequent years the focus shifted to women's reproductive rights. Apart from physiological phenomenon, it was recognized that reproduction is also a social issue especially in developing world where around 40% pregnancies are unwanted. Hence we need to look at women empowerment from a broader perspective, from their right to education to have the freedom to choose work for being economically independent. Reproductive right it its true sense is to have the control on their bodies which eventually translated into reproductive health. To conclude action at various levels is required to address this issue.

Health care organizations are the most intricate and exacting to manage because of the diverse field and dynamic innovative changes and spiraling costs. In this article, we discuss different approaches to leadership in health care and that whatever approaches chosen should endeavor for a strong team identity, inspiring vision, and strong commitment to collaborating teamwork. Framework of process management established in three domains—align, enable, and innovate—is also discussed. Many bodies of research have focused on the competencies related to effective managerial/leadership skills. Guidance for effective leadership should focus on the communication, relationship management, motivational leadership, collaboration, business skills, and knowledge. Effective leaders provide highquality empathetic patient care. They prioritize patient satisfaction by ensuring their voice is heard. We must strive toward collective and consistent leadership by clinicians and other staff at the forefront, rather their designated managers alone.

Clinical examination, ultrasonography, and fine-needle aspiration cytology (FNAC) are the diagnostic modalities to diagnose breast lesions in adolescents. But histopathological examination of lumpectomy or biopsy is required to confirm the diagnosis and also the way to management. Inflammatory conditions can be easily managed on medical treatment but awareness and more emphasis should be on the potentially malignant diseases, malignancy, and metastatic breast diseases.