Cesarean delivery on maternal request has been producing a mirror of conflicts, which every obstetrician has to face in day-to-day practice. A mother requesting for cesarean reflects the common belief in society that elective cesarean is safer than vaginal delivery in terms of both fetus and mother. When a woman comes with the request of cesarean delivery, it should no doubt be individualized and considered keeping in view the mother's perspective, society, and also the evidence-based guidelines.

Background: Little is known about knowledge and attitudes of pharmacy students regarding human immunodeficiency virus (HIV) or how knowledge and attitudes compare internationally. Aims: The primary objective of this study was to compare pharmacy students' knowledge and attitudes of HIV between students in Doha, Qatar, and Saskatchewan, Canada. Materials and Methods: A cross-sectional survey was administered to pharmacy students enrolled at Qatar University and at the University of Saskatchewan. Results: Overall response rate was 36.1%, with 51% and 32% completing the survey in Qatar and Canada, respectively. While most students at both institutions were knowledgeable about HIV, students from Qatar had a significantly greater number of misconceptions. Attitudes and beliefs differed significantly between students in Canada and Qatar. Conclusions: Findings suggest that students are generally knowledgeable and have positive attitudes; however, several misconceptions and negative beliefs remain. Current educational strategies should further emphasize modes of HIV transmission and prevention.

Background: Infraorbital foramen is an important site for various surgical and anesthetic procedures. Accurate localization of the foramen holds the key to success, although racial variations exist in various population groups. Aims: To study the morphometry of infraorbital foramen and its location with respect to nearby anatomical landmarks. Materials and Methods: A total of 100 dry skulls (60 male and 40 female) were collected and observed for the study. Various parameters in the sagittal and transverse planes were noted from infraorbital foramen on both sides, together with its vertical and horizontal dimensions. In addition, the location of infraorbital foramen with respect to upper tooth and presence of any accessory foramina were noted. Results: We measured 198 sides in 100 Indian skulls. The most common position of infraorbital foramen was observed to be in line with second premolar tooth (64%). The mean distance from infraorbital foramen to infraorbital margin was 7.65 ± 1.35 mm on the right side and 7.11 ± 1.73 mm on the left side and from infraorbital foramen to lower border of alveolus of maxilla on the right and left sides (25.98 ± 1.89 and 25.27 ± 2.17 mm; P = 0.01). Conclusions: This study makes possible the identification of exact position of infraorbital foramen and its application in various surgical procedures.

Background and Aim: Adiponectin is an adipocytokine secreted from adipose tissue, and plays an important role in type 2 diabetes, obesity, and cardiovascular disease. This study aimed to estimate the concentration of serum adiponectin in type 1 diabetic children and to establish its association with vascular complications of the disease. Materials and Methods: A total of 25 children with type 1 diabetes were enrolled in the study. Another group of 20 healthy children with matched gender and age served as control. The diabetic patients were classified into pre-pubertal and pubertal groups, and according to gender, into male and female groups. Results: The results obtained showed a significant elevation in the serum adiponectin value in diabetic children compared to control. Serum adiponectin level showed a highly significant increase in patients with diabetic nephropathy and neuropathy than those without the complications. On the other hand, no significant increase in serum adiponectin was observed in patients with retinopathy compared to those without retinopathy. Serum nitric acid metabolites showed a significant reduction in type 1 diabetes children compared to the control group. A negative significant correlation was found between serum adiponectin and serum nitric acid metabolites levels, and a positive significant correlation was detected between serum adiponectin and random blood glucose, HbA1C, urinary microalbuminuria, blood urea nitrogen, creatinine, total cholesterol, and LDL in the same patients. Conclusion: In type 1 diabetes, regular estimation of adiponectin with nitric oxide metabolite may be a useful biomarker for early prediction and follow-up of diabetic vascular complications.

Context: Palliative care practice, education, research and administration depend upon an evidence-base that comprises of measurement tools, scales and outcome measures which require validation prior to their indicated use. Aims: This study aimed to perform a quantitative analysis of research publications in palliative care journals for reporting of articles on validation studies. Settings and Design: Systematic review of palliative care journals. Materials and Methods: Twelve palliative care journals were searched for articles with 'validation' in PubMed search filter for the articles published from 2006-2011. The reporting rates of all journals were compared. The selected articles were categorized into qualitative and quantitative methods. Each sub-group of original articles category was further classified according to target outcome measures and then grouped according to palliative care dimensions and along the domains of international classification of functioning, disability and health. Statistical Analysis: Descriptive analysis using frequencies and percentiles was done using SPSS for Windows version 16.0. Results: The overall reporting rate among all journals was 1.43% (41/2854) and Journal of Palliative Care (JPC) had the highest reporting rate of 3.09% (3/97) followed by J Palliat Med (JPM) at 2.13% (14/657), and Am J Hosp Palliat Care (AJHPC) at 1.94% (8/412). Conclusions: The overall reporting rate for 'attitudes' articles in palliative care journals were 1.43% and there were very few studies on patient-centered validation methods. More outcome measurement tools were on psychological dimension of palliative care and on participation restrictions.

Background: Palliative care practice, education, research, and administration depend upon an evidence-based, shared, interpersonal decision-making process that in turn is based on an individual's attitude and existing research evidence. Aims: This study aimed to perform a quantitative analysis of research publications in palliative care journals for reporting of articles on attitudes. Settings and Design: Systematic review of palliative care journals. Materials and Methods: Twelve palliative care journals were searched for articles with "attitudes" in title of the articles, published between 2006 and 2011. The reporting rates of all journals were compared. The selected articles were categorized into assessment and treatment, which were subsequently grouped into original and review articles. The original articles were sub-grouped into qualitative and quantitative studies, and the review articles were grouped into narrative and systematic reviews. Each subgroup of original articles category was further classified according to the study designs and target sample populations. Statistical Analysis: Descriptive analysis using frequencies and percentiles was performed using SPSS for Windows version 11.5. Results: The overall reporting rate among all journals was 2.06% (59/2854), and Indian Journal of Palliative Care (IJPC) had the highest reporting rate of 3.70% (4/108), followed by BMC Palliative Care (BMCPC) at 3.37% (3/89), and Palliative Medicine (PM) at 2.91% (14/481). Conclusions: The overall reporting rate for "attitudes" articles in palliative care journals were 2.06%, and there were no randomized clinical trials and systematic reviews found. The study findings indicate a lack of adequate evidence base for attitudes in palliative care literature.

Background: Neuropathy is the most common complication of diabetes mellitus and diabetes is the highly prevalent non-communicable life-style disorder until the date. Diabetic neuropathy (DN) presents a clinical challenge, with chronic disabling pain, neurological dysfunction, and impaired quality of life. Objective: The objective of this study was to explore the evidence base for DN descriptively and report the current state of published articles indexed in PubMed. Materials and Methods: Descriptive exploratory study through a literature search was carried out to identify 9 time-points in the timeline from 1970-2010, with 5-year intervals in order to identify the scientific trend for the evidence-base in DN. The number of obtained citations were classified and analyzed under the names of search filters of PubMed namely - text availability, publication date, species, article type, language, gender, journal categories, age, and subject areas. The numbers for categories and subcategories of search filters were considered for comparison and analysis. Descriptive analysis using the frequencies on Microsoft Excel 2010 worksheet was carried out. Results: Although overall number of articles was less, there was an exponential increase in number of articles in DN over the 40 years. After comparison for various categories and sub-categories, there was a greater prevalence of "abstract available" articles, human studies, reviews, English language, MEDLINE journals, Middle-age population and cancer, with nearly equal gender representation. Conclusion: This study explored the existing research articles indexed in PubMed utilizing a quantitative approach reflected the status of current practice-based evidence. Future analyzes on DN should address diabetes-specific and age-specific influences on evidence.

Objective: Common symptom requiring palliation in oncologic care is cancer pain. Cancer pain is recognized as global health burden. This paper sought to systematically examine the extent to which there is an adequate scientific research base on cancer pain and henceforth its reporting characteristics in the cancer journal literature. Materials and Methods: Search was conducted in PubMed sought to locate all studies published in 19 cancer journals from 2009 to 2010. The journals included were: Anti-cancer drugs; breast cancer research and treatment; British Journal of Cancer; Bulletin in Cancer; cancer; Cancer and Chemotherapy; Cancer Chemotherapy and Pharmacology; Clinical Cancer Research; Cancer Epidemiology Biomarkers and Prevention; Cancer Genetics and Cytogenetics; Cancer Immunology and Immunotherapy; Cancer Letters; cancer research; European Journal of Cancer; Indian Journal of Cancer; International Journal of Gynecological Cancer; Journal of Cancer Research and Clinical Oncology; Journal of National Cancer Institute; Lung Cancer. Journal contents were searched to identify studies that included pain in title/abstract. Results: During the years 2009 and 2010, of the selected 14,537 articles published in the journals reviewed, only 1.19% (173 articles) was on cancer pain. Conclusion: While researchers in the field of cancer care have studied pain, the total percentage for studies is still a low 1.19%. It is critical that more research be reported upon which to base cancer pain therapy in an evidence-based oncologic care model.

Background: F-waves are late responses often incorporated during performance of nerve conduction studies and have become an integral part of the electrodiagnostic examination. Objective: To study uncommonly measured F-wave parameters and to establish normative data in our country. Materials and Methods: The study included 126 healthy individuals aged between 18 to 55 years. F-waves minimum, mean and maximum latencies, persistence, F-amplitude, F-conduction velocity, chronodispersion, Tacheodispersion, and F-ratio were studied by surface electrodes from the abductor pollicis brevis, abductor digiti minimi, abductor hallucis, and extensor digitorum brevis by stimulating the median, ulnar, tibial, and common peroneal nerves, respectively. Results: Different F-wave parameters were presented in the manuscript. F-wave latencies were correlated with limb length and height. Conclusion: F-wave latencies correlate better to the limb length than the height. The use of F-wave latencies without such correlation may lead to an erroneous conclusion. F-wave parameters should be performed in routine nerve conduction studies.

Background: Trachoma is a leading preventable infectious eye disease caused by repeated infection with eye strains of the bacteria Chlamydia trachomatis. Developing countries that have poor environmental sanitation, inadequate water supply, and poor socioeconomic status are highly exposed with the disease. Aims of the study: The aim of the research was to assess the risk factors of active trachoma among children 1-9 years old in Maksegnit town. Settings and Design: Cross-sectional community based study was conducted in April 2012; in Maksegnit town located at Gondar Zuria District, North Gondar, northwest Ethiopia. Materials and Methods: A total of 420 children (age 1-9-years-old) from 420 households were included in the study. All children were examined for trachoma by optometrists and ophthalmic officers using the World Health Organization (WHO) simplified clinical grading system. Interviews and observations were used to assess risk factors. Descriptive statistics was carried out for variables in the study and odds ratio (OR) with 95% confidence interval (CI) were used to assess the association between the potential risk factors and active trachoma. Result: The prevalence of active trachoma was found to be 100 (23.8 %). Unclean face (adjusted odds ratio (AOR) = 4.12; 95% CI = 1.92-8.81), flies on face (AOR = 2.310; 95% CI = 1.32-4.05), and using wood and animal dung as a source of energy for cooking (AOR = 2.190; 95% CI = 1.152-4.163) were independent predictors of active trachoma. Conclusion: Trachoma is still a major public health problem in the study area. Trachoma prevention programs that include smoke-free household energy, fly control, sanitation, and hygiene are recommended to lower the burden of trachoma in Maksegnit town.

Objective: To study and compare clinical and epidemiological characteristics of pediatric patients hospitalized with 2009 pandemic Influenza A (H1N1) infection during two waves. Materials and Methods: From September 2009 to February 2011, 62 children were admitted in pediatric ward of the hospitals during 1 ^st wave and 55 during 2 ^nd wave, infected with 2009 Influenza A (H1N1) virus in Rajkot city. Real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) testing was used to confirm infection. The clinico-epidemiological features of the disease were closely compared and monitored. Results: First wave reported median age of 2.5 years, which was 2 years during second wave in positive cases. The median duration of diagnosis of infection was reported 5 days after onset of illness, and 7-day median time for hospital stay in both the waves. Majority of patients reported with cough and fever. Total 16.1% patients during 1 ^st wave and 27.3% in 2 ^nd wave reported some underlying condition. All admitted patients received oseltamivir drug, but only 9.7% (1 ^st season) and 12.7% (2 ^nd season) cases received it within 2 days of onset of illness. In both seasons, more than one-fourth (29.0%) of admitted patients expired. Pneumonia was reported in 97.1% patients (1 ^st wave) and in 60.0% (2 ^nd wave) with chest radiography. Conclusion: Influenza A (H1N1)-related illness affects children, including infants with survival of about 71% patients during both waves. The median time from the onset of illness to diagnosis was 5 days. Delayed referral, presence of any coexisting condition, pneumonia and receiving corticosteroid treatment were associated with severe Influenza A (H1N1).

Congenital melanocytic nevi may be common, quite extensive and even benign, but a giant congenital nevus is rare and has potential for malignant transformation. Giant nevus could occur in any part of the body; though, it is most common on the trunk and may be associated with other congenital malformations such as spina bifida, meningocele. However, there is a dearth of information on its combination with ambiguous genitalia. We therefore report a case of an 8-year-old child with a giant melanocytic nevus on the face and neck with widespread satellite nevi and ambiguous genitalia.

Growing skull fracture (GSF) is a rare non-neurological sequel to head injuries in infants and young children and remains almost undetected in the first few years of life. GSF with large calvarial defect in children is difficult to treat because of the absence of sufficient autograft and requires alternative materials for cranioplasty. Autologous split calvarial bone graft is the gold standard for repair, which is difficult to harvest, in very small children. We performed a cranioplasty in a 3-year-old boy with GSF with large temporo-parietal defect using polyethylene sheet along with free galeal graft duraplasty; presented here with review of the literature. It provides a stable, esthetic, permanent calvarial replacement without any additional procedures is easy to perform and does not require extensive instrumentation. Clinicians, especially in the developing world, where specialized services are at a premium, should keep this procedure in their armamentarium while dealing with this rare subset of cases.

Peripheral edema is one of the commonest troublesome adverse effects associated with the use of calcium channel blockers (CCBs). Here, we report a case of amlodipine-induced peripheral edema which could be adequately managed by subtherapeutic doses of angiotensin receptor blocker (ARBs); telmisartan. An elderly hypertensive patient prescribed amlodipine developed edema on both lower limbs to the extent of limiting her normal function and was thus changed to telmisartan monotherapy. Eventually, failure of antihypertensive response to maximal doses of telmisartan (80 mg) despite disappearance of edema made low-dose combination therapy inevitable for achievement of dual goals-Target blood pressure with limitation of adverse effect (edema). To conclude, we come up with two suggestions-First, ARBs can be added to CCBs even in patients who respond to monotherapy with CCBs in order to reduce the incidence of edema and thus improve compliance. Second, when used for attenuation of edema with amlodipine, we suggest use of titrated doses of ARBs.