India is uniquely placed in the world of generics, as we produce one of the cheapest drugs of world and yet there is further scope of cost reduction. There have been ongoing arguments for use of generic drugs in India but the fact of the matter is that we are almost always using only the generic types of drugs in India. Among generics, branded types of generics are most widely used but they cost more than the unbranded variety of generics.

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Extra pulmonary manifestations of tuberculosis are reported in less than one in five cases with the knee affected in 8% after the spine and hip. We report a case of tuberculous synovitis of the knee joint with a discharging sinus in a 40 year old female. The diagnosis was made by Ziehl - Neelson stain of the caseating discharge from the sinus, positive Mantoux test and radiological findings. The X-ray chest was normal. The patient responded well to anti-tuberculous treatment.

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Background: National Programme for Controlling Blindness in India is encouraging Vision Screening for refractive errors among school children by teachers. Objectives: 1. To find out whether the vision screening conducted by school teachers will be of acceptable quality or not? 2. To find out whether the school environment will influence the eye-health of the school children or not? Methods: Settings and Design: School setting, Cross -sectional descriptive study. Eighty Teachers were trained by the ophthalmologists to test for refractive errors and to detect other eye diseases. These teachers screened 5193 schoolchildren. Screening was repeated by an ophthalmologist assisted by two ophthalmic assistants, to assess the quality of teachers’ screening. Statistical techniques: Cluster sampling, Proportions, X² test, Confidence intervals; Cohen’s Kappa statistic. Results: The vision screening done by the school teachers was found to be of acceptable quality. (Excellent inter -rater agreement with specialists’ screening. Kappa statistic 0.993 for defective Vision and 0.867 for other eye diseases). Refractive errors and other eye diseases were significantly more seen in the schools with poor Sanitation 62 (1.19%), 214 (4.13%) respectively. Overall prevalence of Refractive errors was 85 (1.63%): Myopic 59(1.14) Hypermetropic 12 (0.23%) Astigmatic 11 (0.21 %) and Amblyopic 3 (0.05%) Overall Prevalence of other Eye diseases was 375 (7.23%). Xerophthalmia 156(3%), Conjunctivitis 148(2.8%), Proptosis 19(0.36%) Squint 13(0.14%), Phlycten 10 (0.25%). Conclusion: Vision screening by teachers was of acceptable quality. Poor School environment was resulting in poor eye- health of school children.

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Background: Tobacco in both smoked and smokeless forms is a major killer world wide. It is responsible for100 million premature deaths in the 20^th century, and if the current trends of tobacco use continue, this number is expected to rise to 1 billion in the 21^st century. Objectives: To study the prevalence of tobacco smoking among adolescent students in rural and urban schools in Vizianagaram, and to study the impact of peer groups on their smoking habit, To give suitable recommendations based on findings of this study. Methods: A community based observational cross sectional study was conducted for a period of 2 months among adolescent boys aged 13 to 16 years attending high school from rural and one from urban area were selected by simple random technique and direct one to one interview was done among all the students who are willing to participate in the study. A total of 194 students were interviewed. Results: In the current study it was observed that 10.3% of the participants were current smokers. The mean age of initiation of smoking was found to be 14.1±0.912 years. Peer group influence on smokers in rural area was found to be 58.33% and in urban area it was about 62.5%. Conclusion: It is concluded that adolescent youth smoking is prevalent at high level in both urban and rural areas. It is showing an increase in attitude towards smoking among adolescent youth which has to be reduced with necessary interventions like health education and surveillance by the elderly at home and teachers at school. Peer group impact is found to be at alarming proportion in the study which has to be controlled by educating the peer as a first step.

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Background: Various shapes of coronoid process have been described, they are triangular, rounded and hook shape. The shape and size of the coronoid process is influenced by dietary habit, genetic constitution, hormones and mainly by temporalis muscle activity. The coronoid process is a good auto bone graft. It has advantage of biocompatibility, availability and less operative time for harvesting. Objective: To study variations in shapes of coronoid process in human mandibles Methods: About 100 dried human mandibles were taken for study and categorized according to age group and both sexes. Results: The most prevalent shape was triangular in all age groups and both the sexes. The least prevalent shape was hook in all age groups and both sexes. It was observed that the mandible was triangular in 52.5%, rounded in 38% and hook in 9.5% of coronoid process. Conclusion: The coronoid process can be used for reconstruction of maxillofacial regions, orbital floors. It is also important to anatomist, anthropologist and forensic researches.

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Background: Blood groups of different people have different antigenic and immune properties, so that, antibodies in the plasma of one blood react with antigens on the surface of the red cells of another blood type. If proper precautions are taken then transfusion reactions can be prevented. ABO and Rh are important. They are likely to cause blood transfusion reactions. Objectives: Study was carried out to determine the frequency and distribution of ABO and Rh Blood groups in patients visiting Malla Reddy Health City, Suraram, Telangana. Methods: Study was carried out from Dec., 2015 to May 2016. Comprised of 5000 subjects visiting Pathology Lab. Blood groups were determined by direct agglutination method by using antisera. Results: Percentage of distribution of ABO blood groups was in order of O (37.90%), B (31.88%), A (21.80%) & AB (8.42%). Percentage distribution of Rh Positive (95.34%) & Rh negative (4.66%). Conclusion: Commonest blood group in this study was O Rh positive & least common was AB Rh negative.

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Acute viral hepatitis is a major public health problem and is important cause of morbidity and mortality.HAV and HEV are the enterically transmitted viruses, resulting in acute viral hepatitis in the developing countries .The aim of the presentation of this case report is to emphasize on the screening of HAV and HEV in the patients with acute viral hepatitis as seroprevalence of the coexistence of this infection is higher in our country.

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Background: Nowadays, the simulation practice is becoming more popular in nursing education and that can improve the nursing students’ clinical skills and soft skills. Moreover, it allows the students from conductive simulated environment to the real-like situation that they may experience later in their clinical attachment period. Due to little current information of issues pertaining to the relevant type of simulation that is able to create the students’ competency and satisfaction, therefore, a thorough comparison between the effectiveness of high fidelity and medium fidelity simulation is needed. Objective: The aim of this study was to compare the effectiveness of medium and high fidelity simulation towards developing student’s competency skill in drug administration via oral, subcutaneous, intramuscular and intravenous route and also to identify the student’s satisfaction level towards high and medium fidelity simulation. Methods: A comparative cross-sectional study was conducted in Kulliyyah of Nursing, International Islamic University Malaysia (IIUM) at Jalan Hospital Campus, Kuantan. First year nursing students who match including criteria were recruited as a compulsory class (N= 54) and the students were divided into two groups using simple random assignment sampling. The students were assessed during the simulation using rubric checklist and completed Likert scale after finished each simulation sessions. Data analysis involved Wilcoxon signed rank test using PASW Statistic 18. Results: The findings on the competency level (technical skills and non-technical skills) showed statistical significant improvement of mean score (p< 0.05) in high fidelity simulation compared to medium fidelity simulation in both groups. The students’ satisfaction levels towards simulation were significant increased statistically for both groups (p< 0.05) in second session of simulation regardless of the type fidelity simulation. Conclusion: The high fidelity simulation was able to prepare better technical and non-technical skills as compared to medium fidelity simulation. However, the students’ satisfaction did not associate with the type of fidelity simulation but showed improvement after repeated or sequential simulation. More research is required to compare and to explore more about the simulation fidelity.

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Placenta percreta is a potentially life threatening condition that requires a multidisciplinary approach. Placenta percreta describes invasion of placenta through myometrium and serosa and occasionally into adjacent organs. Here we describe a 23 year old G2P1L1 with 29 weeks of gestation with post-ceaserean pregnancy with placenta percreta with bladder invasion on USG and MRI. She was posted for elective LSCS and emergency hysterectomy was done with bladder suturing. She was managed postoperatively well and was discharged.

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Clubbing of the fingers and toes has been recognized as a clinical manifestation of intra thoracic disease from the earliest times. Hippocrates particularly described the condition as occurring with advanced phthisis and empyema and emphasized the importance of the changes as diagnostic of purulent pleural effusion. Many subsequent authors have described clubbing of the fingers associated with chronic disease of the heart or lungs, but it is still rare in medical literature to find the condition mentioned as being of primary origin. We here present the case of 24 years old female having developed clubbing of all fingers that had no found secondary cause after an extensive search and so thought to be of primary origin.

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