Lokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College

One of the primary treatment objectives in children with Down syndrome is the enhancement of the fine motor skills since the motor disability has a significant impact on the normal living and self-independence. The purpose of the research was to examine the feasibility of Bharatanatyam hasta mudras as a group intervention in improving the quality of fine motor and performance of functional tasks. The protocol was given to forty 6-12 years of age children, where two mudrases were presented during the first five sessions and graded speed practice and functional integration practiced during other sessions. Pre-intervention and post-intervention tests that were set up in visual motor worksheets, coordination, pre-intervention and post-intervention tests included pre- and post-intervention tasks of pre- and post-intervention tests: pre- and post-intervention prehension and precision tasks and time-based fine motor tasks. The results showed statistically significant and stable improvement in all of the areas, which are reflected in increased repetitions, increased hand coordination, increased ability to control movement and reduced the performance of daily functional activities as measured by the number of seconds to press a button, tie shoelaces and open locks. These results imply that the multisensory, rhythmic and proprioceptive elements of Bharatanatyam mudras can be used effectively to facilitate motor learning, dexterity and perceptual-motor integration among children with down syndrome. Being a culturally-based, cost-efficient intervention, mudra-based training can be used as an addition to the existing rehabilitation strategies. Long-term follow-up of a bigger sample size should be conducted in further research.

Background: Measles is a highly infectious disease, and Mumbai experienced an outbreak in 2022, resulting in 600 cases and 17 deaths. Inadequate immunization coverage has been suggested as a key factor, yet the underlying reasons remain unclear. Method: This cross-sectional descriptive study aimed to explore caregivers’ knowledge, attitudes, and practices regarding measles-containing vaccines (MCV) during the outbreak in an urban slum. Caregivers of children aged 9 months to 5 years presenting with febrile rash at Baiganwadi Health Post were surveyed using a 30-item peer-validated questionnaire administered via telephone after verbal consent. Results: Among 100 participants, 99% recognized measles, but only 10% identified all key symptoms, and 53% were unaware of potential complications. Vaccination coverage was low: 50% unvaccinated, 18% unsure, 25% partially vaccinated, and 7% fully vaccinated. Common barriers included lack of awareness, concurrent illness, and fear of side effects. Conclusion: The findings highlight significant immunization gaps and underscore the need for targeted community-based interventions to improve MCV coverage in vulnerable populations.

Hansen’s disease is a chronic granulomatous disease caused by Mycobacterium leprae that still poses challenges for clinicians because of its wide range of presentations, including atypical forms. Atypical manifestations of the disease—such as lazarine leprosy, psoriasiform leprosy, verrucous plaques, histoid leprosy, erythema annulare centrifugum, erythema gyratum repens, subcorneal pustular dermatosis, livedoid plaques, Sweet’s syndrome-like lesions and reactions resembling erythema multiforme or urticarial vasculitis and Lucio phenomenon—can mimic a variety of dermatological and systemic disorders, posing considerable diagnostic challenges, as reported in the literature. Misdiagnosis or delayed diagnosis is common, leading to preventable morbidity, disability, and ongoing transmission. This issue is further amplified in non-endemic areas where clinical suspicion is low. Variability in presentation is influenced by factors such as disease endemicity and host immune status. Unusual forms can obscure recognition. Some cases present with asymptomatic nodules, erythromelalgia, or spontaneous ulceration, further complicating diagnosis. A detailed clinical history, high diagnostic suspicion, and confirmatory investigations—including slit-skin smears and histopathology—are crucial for accurate diagnosis. Early identification of atypical leprosy presentations allows timely treatment, reduces complications, and limits disease spread. We present six cases of leprosy with unusual clinical manifestations, namely, secondary syphilis, hand ulcers, mycetoma, sporotrichosis, purpura fulminans and Sweet’s syndrome. This case series emphasises the diverse clinical spectrum of leprosy and the need for heightened clinical awareness to avoid misdiagnosis, especially in atypical or rare presentations.

Propofol, an induction agent for general anesthesia (GA), is associated with a significant risk of hypotension. Perfusion index (PI) is known to predict vascular responses in various situations; however, its utility in the prediction of hypotension postpropofol administration is not fully established. To evaluate the performance of PI in the prediction of hypotension postinduction with propofol. This observational, prospective study involved 120 adult patients who underwent elective surgeries under GA. The PI, heart rate, systolic blood pressure (SBP), diastolic blood pressure, mean arterial pressure (MAP), and oxygen saturation were recorded at baseline, postinduction (every minute for the first 5 min), and postintubation (every minute for the first 10 min and then at 5-min interval till a total of 20-min). Hypotension was defined as a fall in SBP by >20% of baseline or MAP <60 mmHg. As per SBP and MAP criteria, the incidence of hypotension during induction was 28.3% and 35.8%, respectively, with corresponding values during postintubation period being 22.5% and 29.2%, respectively. Based on the SBP and MAP criteria (area under the curve [AUC]: 0.810 and 0.76, respectively; cutoff: 1.08), at 5 min, PI had sensitivity of 73% and 71%, and specificity of 74% and 69%, respectively. At 10 min, based on the SBP (AUC: 0.66, cutoff: 1.15) and MAP (AUC: 0.77, cut-off: 1.17) criteria, PI had a sensitivity and specificity of 65% and 52%, and 71% and 65%, respectively. The baseline PI is a useful noninvasive tool for the prediction of hypotension, with MAP criterion performing slightly better than SBP criterion.

Introduction: Prostaglandin D2 (PGD2) is elevated in the bald scalp of men with androgenetic alopecia (AGA) and inhibits hair growth. Cetirizine, an H1-antihistamine, reduces PGD2 production and has anti-inflammatory effects, making it a potential therapeutic candidate. Methods: Ten men aged 18–60 years with Norwood-Hamilton grade III vertex to V AGA applied 1 mL of 1% cetirizine in propylene glycol/butylene glycol daily for 16 weeks. Exclusion criteria included recent use of minoxidil, finasteride, or other antiandrogenic therapies. Hair counts in a 1 cm2 tattoo-marked vertex area and blinded photographic assessments were evaluated at baseline and week 16. Results: Nine participants completed the study. Mean hair count increased from 139.6 (SE 13.9) to 163.4 (SE 15.5), a statistically significant change (p = 0.009). Blinded global photographs showed a +2 improvement in 1 patient, +1 in two, and no change in six. Trichoscopic counts improved in all patients. No adverse events occurred. Conclusion: Despite limitations, this report provides additional real-world data supporting cetirizine as a potential therapy in AGA. Larger randomized controlled studies with longer follow-up are needed to establish efficacy, durability, and mechanism of action.

Stature estimation is an essential component of forensic anthropology, aiding in personal identification from skeletal remains. While appendicular skeleton measurements are commonly used, in cases of mutilation or trauma, alternative reliable indicators such as the foramen magnum (FM) become crucial. To determine the correlation between stature and the dimensions of the FM and to derive regression equations for stature estimation in the Western Indian population. This prospective observational study was conducted on 106 medicolegal autopsies (76 males and 30 females) in a tertiary care center in Mumbai. Cadaveric stature was measured in the supine position. Anteroposterior (AP) and transverse diameters of the FM were measured post-brain removal using vernier calipers. Data were analyzed using SPSS v17.0 to derive regression equations. Strong positive correlations were observed between FM dimensions and stature in both sexes. In males, AP and transverse lengths showed very strong correlations ( R = 0.89 and R = 0.91, respectively), while in females, correlations were slightly lower ( R = 0.84 and R = 0.75). Regression equations were derived for each sex. The FM offers a valuable parameter for stature estimation, especially in cases involving fragmented or mutilated remains. This study provides population-specific regression equations useful for forensic investigations in the Western Indian population.