Angiogenic biomarkers are polypeptide molecules produced in the trophoblast and endothelial cells of the placenta which regulate important pregnancy-related processes such as implantation, remodeling of spiral arteries, development of tertiary villi, and optimum exchange of nutrients and oxygen between the fetus and the mother. When measured in the early trimester, it helps in predicting adverse pregnancy outcomes and in the third trimester it helps in tailoring antenatal monitoring in women with a myriad of pregnancy-related problems. With more than one women having pregnancies at an older age and with the use of artificial reproductive technology, most pregnancies will have high-risk factors. Angiogenic markers open up a lot of opportunities for obstetricians to be more alert and identify red flag signs and reduce iatrogenic prematurity and perinatal morbidity and mortality.

Aim and objective: To ascertain the determinants of health, nutrition profile differentials, and leisure activities of students of Panjab University (PU). Materials and methods: This cross-sectional study was conducted in PU, Chandigarh, from January 2018 to April 2018 among undergraduate and postgraduate students. Respondents consisted of 300 students (150 hostellers, 150 day-scholars) from medical, non-medical, and arts and commerce streams. The health-promoting lifestyle profile (HPLP) tool was used for collecting the data. Results: The mean value of the HPLP score was 133.95 (SD ± 14.05). Those pupils who had better HPLP scores had good nutrition profiles. A higher HPLP score of the participants was associated with more indulgence in leisure activities. Almost two-thirds of the pupils who had a good nutrition profile had normal body mass index (BMI). The majority of the students, who indulged more in leisure activities, also had better nutritional status. Conclusion: Almost two-thirds of the day-scholars had a good nutrition profile and they were able to keep their health at good levels. Half of the hostellers had poor nutrition profiles; they were not taking care of their health. Students with higher HPLP scores had a better nutritional profile. They were found more energetic and more active in leisure activities. Thus, promotion of the status of health, nutrition profile, and leisure time activities of university students will enhance their quality of life.

Background: The emergency department plays an important role in improving elderly care. As an ever-increasing access point for medical care, the emergency department sits at a crossroads between inpatients and outpatient care. Aim and objective: To evaluate the management strategies to make the emergency OPD elderly friendly through quality assurance of geriatric syndrome. Materials and methods: Four hundred elderly patients admitted to the emergency department of a tertiary care hospital were enrolled consecutively. Information regarding baseline characteristics was recorded. A 34-point observation checklist was used to assess the management strategies being practiced for the elderly population. The checklist comprised of observation pertaining to the geriatric-friendly environment; the practice of using geriatric assessment scales; and training of nursing personnel regarding care of elderly patients. Results: Though the engineering aspects of the study setting had adequate-elderly friendly features, there was a scope of ensuring the provision of assistive and enabling devices like walkers, canes, etc., availability of low-heightened beds and trolleys, bedside commode, raised toilet, etc. There was also a definite scope of initiating a system of formal SOPs/protocols/policies/for various syndromes like cognitive decline, urinary incontinence, falls, polypharmacy, pain management, etc. A need was also observed to organize on-the-job training for the nursing personnel because well-informed professionals will be better able to provide quality and customized care to the elderly. Conclusion: Though elderly patients were being managed adequately in the emergency, there was a definite scope of initiating a system of formal SOPs/protocols/policies/for various domains pertaining to geriatric syndromes and training of nurses regarding the care of the elderly.

Background: Lateral skull base has a complex anatomy and has numerous foramina that transmit neurovascular structure between intracranial and extracranial compartments. The pediatric skull has significant variation in anatomical dimensions with the adult counterpart and poses challenges to the otolaryngorhinologists and neurosurgeons. It is therefore important to know these anatomical surgical landmarks to perform safe surgery and give a safer outcome and also to prevent complications. Although many studies on the lateral skull base anatomy have been published, a comparative study of the anthropometric difference between adult and pediatric lateral skull base is still lacking. Aims and objective: To compare the anthropometry of the carotid canal, jugular foramen, styloid foramen, foramen ovale, foramen spinosum, foramen lacerum between adult and pediatric dry skulls. Materials and methods: A systematic measure of the anthropometric parameters of the lateral cranial base in the adult and pediatric dry skulls were performed using standardized digital callipers. The data were recorded and analyzed using SPSS. Results: The result showed that mean distances were higher in the adult patients as compared to pediatrics and the differences were statistically significant for the variables—mastoid base to stylomastoid foramen, stylomastoid foramen to foramen spinosum, foramen spinosum diameter, foramen spinosum to foramen ovale, foramen ovale width, mastoid base to base of lateral pterygoid, lateral end of bony EAC to stylomastoid foramen, stylomastoid foramen to jugular foramen, jugular foramen longitudinal diameter, jugular foramen anterior, posterior diameter, carotid canal diameter, infratemporal crest to base of lateral pterygoid, root of zygoma to foramen ovale and root of zygoma to foramen spinosum except, foramen ovale to the base of lateral pterygoid and, jugular foramen to the hypoglossal canal. Conclusion: Measures of the anthropometric parameters of the skull base have provided a profound and precise understanding of the topography of the various landmarks in the lateral skull base. Because of the presence of the landmarks in close vicinity to one another, millimeter level error in identifying them can be detrimental in the outcome of surgical procedure.

Background and objective: Technology is an important part of today's scenario. In the healthcare department, many technological advancements took place that make it easy for patients as well as healthcare providers. This study was designed to assess the effectiveness of the mobile app-based non-surgical nursing management on reducing the problems of knee osteoarthritis (KOA) patients attending physiotherapy OPD, PGIMER, Chandigarh. Materials and methods: This randomized control trial was conducted at physiotherapy OPD, PGIMER, Chandigarh. A total of 80 participants attending physiotherapy OPD from July 15, 2019, to August 30, 2019, were involved in the study and randomized into two groups (experimental and control groups) using a random number table. Problems of KOA patients were assessed by interviewing them. The protocol was in the form of a mobile app (Jiyyo app)-based non-surgical nursing management of KOA patients. This app contained the patient's information, audio call and messages option, medical record-keeping, bills, appointments. Follow-up can also be done through this app. Through this app exercise pdf file was sent to the patient's app that contained exercises related to the KOA. After baseline assessment, a mobile app was installed in the mobile of the experimental group. Weekly motivational telephonically call was done to participants of the experimental group. Monthly two follow-ups were done to motivate the participants. The control group was asked to carry out the instructions given to them. Post-assessment was done after 3 months in both groups by using the same interview schedule. Results and analysis: There was a significant improvement in physical function and movement of the knee. Knee movement, physical functions improved and there was decreased joint stiffness (p ≤ 0.01) and level of pain (p ≤ 0.01). The experimental group had significantly better adherence to treatment and exercises. The control group had no significant improvement after 3 months. Conclusion: Mobile-based non-surgical nursing management for KOA patients was effective in improving the adherence to the prescribed exercises, treatment and helped in reducing pain and improving activities of daily living among patients with KOA.

Aim: To describe a 4-year-old male child who presented bilateral gluteal lipodystrophy following intramuscular amikacin injections. Background: Intramuscular injection of various drugs can lead to localized lipodystrophy. These include insulin, corticosteroids, benzathine penicillin, methotrexate, aminoglycosides, human growth hormone, iron dextran, vasopressin, and DPT vaccine. The localized lipodystrophy following multiple intramuscular amikacin injections was not well described in pediatric population. Case description: We report a 4-year-old male who received multiple amikacin injections over bilateral gluteal region for 6 months and now presented with localized lipodystrophy over bilateral gluteal regions. Details of history avoided further unnecessary investigation, and parents were counseled about the nature of the lesion and no further active treatment. Conclusion: Intramuscular injection of amikacin can lead to localized lipodystrophy in children.

Aim: We aim to describe an unusual pathology presenting as a parapharyngeal mass and its successful surgical management. Background: Chondromas of hyoid bone are rare in occurrence; only a few cases have been reported in the literature. We are reporting the first case of hyoid chondroma presenting as parapharyngeal mass. Case description: We report a 45-year-old male presented with a neck mass on the right submandibular gland region with a change in voice. The computed tomographic scan of the patient showed a heterogeneous mass in the parapharyngeal region, seemed to be originating from the greater cornu of the right hyoid bone. The tumor was removed completely using trans-cervical approach with part of the hyoid bone. Conclusion: Chondroma is a rare tumor of the hyoid, and it should be kept in mind for the differential diagnosis of parapharyngeal tumors.

Aim: To describe an unusual presentation of juvenile nasopharyngeal angiofibromas (JNAs) in the form of a midline palatal ulceration. Background: Juvenile nasopharyngeal angiofibromas are benign fibrovascular tumors that usually present with nasal obstruction and epistaxis. They preferably take the paths of least resistance and thereby frank bony erosions are rare. Case description: A teenaged boy presented with classical features of JNA and midline palatal ulceration with a mass protruding through it, with no previous history of surgical manipulation. After adequate workup, he underwent endoscopic excision of the mass which was postoperatively confirmed to be an angiofibroma. Conclusion: Rare presentations of a vascular tumor should always be kept in mind while dealing with classical history. Clinical significance: With nasal obstruction and epistaxis, midline palatal ulcerations should be dealt with caution keeping JNA as a differential; surgical history is of utmost importance.

Acute fatty liver of pregnancy (AFLP) is a dreaded complication seen mostly in the third trimester of pregnancy. It carries significant perinatal and maternal mortality and requires early diagnosis and intervention to prevent maternal and fetal death. If untreated, AFLP can lead to complications, such as, disseminated intravascular coagulation (DIC), renal failure, clotting disorders and coagulopathy, hypoglycemia, fulminant hepatic failure, and eventually multiorgan dysfunction. Even though induction of labor with delivery remains the only real cure for this disease, some other therapies for complicated cases include plasmapheresis with renal replacement, and the use of molecular absorbent recirculating system (MARS). Orthotopic liver transplantation has proved to be effective in cases that progress to multiorgan failure despite aggressive therapy. Here, we present two cases who presented to the hospital with near term pregnancies and features of AFLP. Both the patients rapidly worsened postpartum due to persistent bouts of hypoglycemia and rapidly developing fulminant hepatic failure. Despite all our efforts, both the patients expired a few days after admission.

Aim and objective: To emphasize the infrequent scenarios associated with orbital complications of rhinosinusitis. Background: Orbital sterile collections leading to functional limitation including diplopia can occur in patients with inadequately treated rhinosinusitis and require timely detection followed by definitive management. Case description: We present a case of a previously healthy male with sudden onset left eye proptosis and diplopia of 2 weeks duration referred after endoscopic sinus surgery. Contrast-enhanced magnetic resonance imaging confirmed an organized collection with rim enhancement in the inferior orbit. Endoscopic drainage of the collection along with a microbiological and histopathological examination of the specimen was done. The patient had immediate postoperative alleviation of symptoms. Specimen culture revealed no microbiome growth which was suggestive of a sterile collection or an antibioma. A regular follow-up for a duration of 5 months showed no evidence of residual disease postprocedure and complete recovery. Conclusion: Adequate drainage of the sinuses and orbital abscess with antibiotic coverage during initial surgery with prompt imaging and also ruling out fungal etiology would best treat the orbital complications of acute rhinosinusitis. Clinical significance: Orbital complications of acute rhinosinusitis can be persistent despite treatment and should arise suspicion of residual or recurrent disease. Fungal disease should be ruled out and prompt imaging is helpful in diagnosis. Endonasal endoscopic surgery whenever feasible gives the best results.

REALITY CHECK Health researchers routinely collect a subset of data (sample) to study disease characteristics. However, the purpose almost always is to generalize findings to the population. Inferential statistics plays a significant role in the generalization of conclusions from sample to population. The inferential statistics uses probability theory to quantify uncertainty for generating evidence in favor or against the intervention. There are several statistical software for data analysis. However, the lack of fundamental statistical concepts may lead to flawed assumptions and incorrect data analysis. The erroneous statistical analysis precedes both inaccurate reporting and interpretation. Thus, it is essential to understand the fundamentals of statistical jargon before delving into the statistical analysis. In this context, the researcher wants to understand few concepts such as: • What is the difference between random selection and random allocation? • What are the differences between standard deviation (SD) and standard error (SE)? • Are α and p value the same or different? • What are type-I and type-II errors?