Background: Uveitis is increasingly being reported from south India following epidemics of leptospirosis. The incidence of eye involvement in treated patients has not been investigated properly in prospective studies. Aims :To determine the incidence, clinical spectrum and risk factors for Leptospiral uveitis in antibiotic-treated patients. Settings and Design: A prospective cohort study conducted among the patients treated for leptospirosis at Calicut Medical College between July and November 2002 and a seroprevalence study among sewage workers. Materials And Methods: As many as 360 patients admitted with suspected leptospirosis were studied by clinical examination, baseline ophthalmic survey, laboratory investigations and Leptospira serology (Microagglutination test - MAT; and IgM and IgG using ELISA) during the epidemic. Of the 282 seropositive and antibiotic-treated cases, 174 patients who completed 30 months of regular follow-up were analyzed. A cross-sectional serosurveillance also was performed among 50 sewage workers to determine the baseline MAT titer. Statistical Analysis: Univariate analysis and logistic regression. Results: Thirty-two patients (18.4%) developed the eye disease during follow-up. The mean age was 43.9 years and the sex ratio was equal. Twenty-one patients (65.6%) had anterior uveitis. Only six patients (18.8%) had visual symptoms. Median duration for developing anterior uveitis was 4 weeks. Recurrent uveitis was not seen following treatment. None had vision-threatening eye disease. Clinical and laboratory abnormalities during the acute phase did not pose risk for development of the eye disease later. Forty-six sewage workers (92%) showed a MAT titer of 1/25. Conclusions: Uveitis is common following acute leptospirosis. Antibiotic-treated patients during the acute phase of illness developed only mild uveitis.

Background: Total thyroidectomy has become a routine surgical procedure. However, postoperative complications are not rare and can lead to voice disorders. Aim: To study voice quality after total thyroidectomy. Settings and Design: Prospective study over a period of 5 years in 395 surgical patients undergoing total thyroidectomy. Materials and Methods: The voice quality of patients was based on systematic preoperative and postoperative laryngeal and voice examination. Voice assessment was performed by means of a voice quality questionnaire and recovery time within 12 months postoperatively. Patients who had inferior laryngeal nerve palsy were excluded from the study. Results: Preoperative subjective voice disorders were found in 21% of patients, and 49% had voice impairment after surgery. The recovery time was less than 1 month for one-half of the patients with impaired voices, and 85% of the patients had recovered their voice after 5 months. At the 1-year postoperative examination, the permanent impaired voice rate was 1.26%. Conclusion: Voice impairment is common after thyroidectomy but usually transient, and less than 20% persist at 6 months. Patients must be informed about the risk of voice impairment after thyroid surgery. An objective voice assessment is desirable to monitor the presence and progress of voice disorders.

Objective: Fibromyalgia syndrome (FMS) is a chronic rheumatological condition which could be characterized by generalized pain and fatigue. Cognitive and behavioral therapy has been found to be a suitable technique in the management of FMS. This study intends to evaluate the efficacy of electromyography (EMG) biofeedback to reduce pain in patients with FMS. Materials and Methods: A randomized controlled trial involving two groups of FMS patients, one receiving EMG biofeedback and the other a sham biofeedback, was carried out. The assessment tools included in the study were fibromyalgia impact questionnaire (FIQ), visual analogue scale (VAS), six-minute walk test (SMWT) and number of tender points; and tenderness of each tender point was done for both the groups. Statistics: A Student's 't' test was used to study the test for significance. Results: After using biofeedback, the mean VAS scores and the mean number of tender points were found to be 3 out of 10 and 6 out of 18 respectively. Subjective analysis from both groups showed improvement in physical and psychological realms. Statistical significance (P < 0.001) was observed for decrease in pain and number of tender points. ANOVA analysis revealed a significant decrease in VAS, FIQ and tender points within the groups. Conclusion: Biofeedback as a treatment modality reduces pain in patients with FMS, along with improvements in FIQ, SMWT and the number of tender points.

Context : Stuttering has a life span incidence and it significantly impacts academic, social, emotional and vocational achievements of patients who stutter. Aims : The purpose of the present study was to examine phonological encoding in young children who stutter (CWS) during a nonword repetition task and to test the covert repair hypothesis (CRH) and phonological skills in Persian native children. Setting and Design : The study was conducted among 12 CWS and 12 children who do not stutter (CWNS) between the ages of 5.1 and 7.10 at the rehabilitation clinics in Tehran. Materials and Methods: A list of 40 bisyllabic and trisyllabic nonwords was used in a nonword repetition task to collect information about the following dependent variables: (a) reaction times (RTs), (b) the number of phonological errors (PEs) and (c) nonword length. Data Analysis: An independent sample T-test was performed to compare means of PEs and RTs between the two groups and a paired t-test for analysis of nonword length impacts. Results : Results indicated that the CWS had a slightly poor performance than CWNS but there was no significant difference between the groups. Also, the differences between bisyllabic and trisyllabic nonwords were significant for phonological errors but not for reaction times. Conclusion : In general, it is concluded that CWS might not have a gross problem in phonological retrieval of the novel phonological context even with increase in syllable length. Also, some predictions of CRH were not supported by this research. However, further research into this possibility may shed light on the emergence and characteristics of childhood stuttering.

Purpura fulminans is a rapidly progressive thrombotic disease that has been described during both severe bacterial and viral infections. Disseminated intravascular coagulation (DIC), antiphospholipid antibodies and acquired or congenital C and S protein deficiency are thought to play a role in its pathogenesis. Here we report the case of a 4-year-old girl who developed gangrene of all her fingers and toes following dengue shock syndrome complicated by DIC and also discuss its management.

India has the highest number of medical colleges in the world and consequently the highest number of medical teachers. The unprecedented growth of medical institutions in India in the past two decades has led to a shortage of teachers and created a quality challenge for medical education. In recent years, though medical advances have been understood and adopted by many institutions, the same is not true for educational planning and implementation. There is a need for well-trained faculty who will help improve programs to produce quality graduates. The existing teachers' training programs are insufficient, both in number and the aspects that they cover, to meet this demand. The globalization of education and India's potential as a destination for higher education have brought the issue into sharper focus. Medical educators must stand up to meet this challenge. This paper briefly describes the current status of training programs for medical teachers in India, outlines an approach for developing future programs and defines key content areas to focus on in order to enhance faculty development efforts.