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Chylothorax is an infrequent cause of pleural effusion that is most commonly caused by the obstruction or disruption of the thoracic duct. Chylothorax is rare in nephrotic syndrome. Unilateral chylothorax of the right side is due to the transdiaphragmatic shunting of chylous ascites. It is usually transient and self-limiting but a massive chylothorax requiring therapeutic thoracentesis can also be encountered. Here, we present a rare cause of chylous ascites-nephrotic syndrome resulting in chylothorax, where initially therapeutic thoracentesis is done followed by the management of nephrotic syndrome with modified Ponticelli regimen. This case highlights the need to consider chylous ascites as a cause of chylothorax via transdiaphragmatic shunting in patients with nephrotic syndrome to institute the appropriate treatment.

Background and Aims: Modern psychiatry brings tremendous value to the treatment of mental illness, however, at times is inadequate in providing holistic care within a patient's broader cultural framework. Traditional healing and modern psychiatry together offer a comprehensive, patient-centred approach to treatment, which encompass a patient's spiritual and religious beliefs. In this context, “Dava-Dua” intervention—combination of psychiatric medicine and faith healing—is implemented by the Government of Gujarat at Mira Data Dargah in Mehsana District. The study assesses intervention outcomes, understand implementation challenges and patients' perspectives on the treatment. Methods: Using a multi-method research approach, case records from July 2008 to March 2018 were retrieved for secondary analysis of patients' profile and outcomes; 26 patients from three groups: Dava, Dua and Dava-Dua; and 6 mental health service providers were interviewed to assess perspectives of patients and service providers on mental health, implementation barriers and facilitators. Results: Despite some implementation challenges, the findings indicate that collaboration of modern psychiatry medicine and faith-based treatment practices certainly benefit patients with otherwise limited access to mental health care thereby protects human rights of patients. Conclusion: Dava-Dua model compliments existing primary healthcare services. It provides an access to modern medicine without compromising patients' religious and spiritual practices. It has the potential to scale-up and replicate where faith-healing is the prime treatment modality to cure mental illness provided implementation challenges are proactively addressed.

Introduction: Psychosocial rehabilitation is the process that facilitates opportunities for persons with chronic mental illness to reach their optimal level of independent functioning in society and for improving their quality of life. However, such psychosocial rehabilitation centers are limited in India. Aims: The present study assesses psychosocial rehabilitation centers (of urban day-care and rural residential rehabilitation center) operated by Ashadeep Charitable Foundation, a civil service organization and its effect on health outcomes of patients living with chronic mental illness. Materials and Methods: Records of 170 cases were retrieved for secondary analysis of demographic information, diagnosis, duration of stay, and health outcomes. Results: Rehabilitation activities included yoga, light physical exercises, group discussion, training for daily living skills, social skills, life skills, vocational training, individual, and family counseling. In addition, extensive outreach activities, mental health camps were also integral part of the rehabilitation activities. Patients who have accessed rehabilitation services were diagnosed with schizophrenia, psychosis, bipolar disorder, depression, and intellectual disability. The average duration of rehabilitation of patients (other than persons with intellectual disability) was ranged from three to four months. Out of those rehabilitated, 69% of them were successfully re-integrated with the family. Conclusion: Combination of pharmacological and psychosocial interventions are effective for re-integrate patients with mental illness to the family. This model of community-based rehabilitation has potential for scale-up.

Background: Prediabetes is increasingly being studied in the context of its association with cardiovascular disease (CVD). Besides raised HbA1c and sugar levels, the major underlying defect seems to be insulin resistance (IR). Subclinical atherosclerosis, measured by high sensitivity C reactive protein (hsCRP) and carotid artery intima media thickness (CIMT) underlies the pathogenesis of CVD in prediabetes. Heart-type fatty acid binding protein (H-FABP), a novel cardiac biomarker also might have a role in predictin prediabetic heart disease. Aims: The aim of the study is to compare serum levels of H-FABP in prediabetics and controls and correlate them with the atherosclerotic markers, hsCRP and CIMT. Setting and Design: 50 prediabetic patients and 50 age, sex and BMI matched controls were employed in the case control study. Serum F & PPBS, (HbA1c), fasting insulin levels were measured in cases and controls. Serum H-FABP was measured in both cases and controls. All cases and controls were subjected to bilateral CIMT measurements and Serum hsCRP levels. The values were compared between both the groups and subjected to appropriate statistical analysis. Statistical Analysis Used: Categorical variables were presented in number and percentage (%) and continuous variables were presented as mean ± SD and median. Normality of data was tested by Kolmogorov-Smirnov test. If the normality was rejected then non parametric test was used. Quantitative variables were compared using Independent t test/Mann-Whitney Test (when the data sets were not normally distributed) between the two groups. Qualitative variables were correlated using Chi-Square test/Fisher's Exact test. Spearman rank correlation coefficient was used to find out the correlation of various parameters with each other. Univariate linear regression was used to find out the cause and effect relationship between various parameters. A p

Mental health burden is a major health concern worldwide. In the last few decades, we are witnessing innovations that are successfully addressing gaps in the mental health service delivery in Indian context. This is an opportune time to explore existing innovative mental health initiatives in the country and integrate viable interventions to primary healthcare facilities to strengthen public mental healthcare delivery. The descriptive review of literature on innovative mental health programs in India was carried out. The initial search from google scholar and PubMed database yielded 1152 articles, of which 1114 were excluded that did not meet inclusion criteria. Full texts of 38 articles were reviewed and finally 22 studies were included for the study. Based on the review, most innovations are broadly summarized into five categories: (1) quality improvement mental health programs; (2) community-based mental health programs; 3) non-specialist mental health programs, 4) mobile-technology based mental health programs, 5) tele-mental health programs. These promising innovations in treatment and care can be customized as per the context for scale up and integrated into the primary healthcare system through District Mental Health Programme. The innovative approach not only makes mental health services more accessible and affordable but also empowering in nature by encouraging community members in early detection, prevention of mental illness and appropriate treatment referral to existing primary health care services.

Sarcoidosis is an autoimmune multisystem granulomatous disorder of unknown aetiology, which mainly affects the adults in the age group of 20–39 years. The disease can affect any organ in the body but mainly presents as bilateral hilar lymphadenopathy, pulmonary infiltrates, cutaneous lesions, ocular manifestations and arthropathy. Lofgren’s syndrome is an uncommon initial presentation of sarcoidosis which is recognised by the classical triad of acute arthritis, erythema nodosum and bilateral hilar lymphadenopathy. We describe a newly diagnosed case of sarcoidosis who presented as Lofgren’s syndrome. Acute sarcoid arthritis should be kept as one of the differential diagnoses for patients presenting with acute arthritis and skin lesions; and chest X-ray should be considered to rule out bilateral hilar lymphadenopathy in these patients. Early suspicion and identification of classical clinical features are essential to establish early diagnosis.

Scrub typhus is a zoonosis, which usually manifests as an acute febrile illness. It is caused by a rickettsia, Orientia tsutsugamushi, which is endemic in the Asian region. It can present with varied clinical manifestations, ranging from acute febrile illness to life-threatening multiorgan dysfunction syndrome. Central nervous system involvement in the form of altered sensorium and/or meningitis is frequently observed in scrub typhus. However, isolated cranial nerve involvement is uncommon and so far only a few such cases have been reported in the literature. We present a rare case of scrub typhus with fever and diplopia at presentation, which completely improved with doxycycline-based treatment.

Internet of Things (IoT) is a robust tool for the renewal of industrial systems and its applications. Industrial Internet of Things (IIoT) is the blend of industrial automation and IoT. It provides automatic sensing, smart processing with correlated transmission and autoimmune systems. With IIoT data shielding is of big concern as cyber-attacks are increasing day by day. IIOT demands a lot because of operational, safety, security, and regulatory issues of industries. This paper presents the current status of IOT in industries and also gives the area where more work is to be done.

The novel Coronavirus Disease-2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection can present with a multitude of clinical symptoms. The virus, disease symptomatology, pathogenesis and complications are being studied and new concepts are evolving rapidly. The current worldwide situation caused by the disease makes it exceedingly important to recognise varied presentations of the disease. Three cases are being discussed hereby, wherein the patients presented with altered sensorium secondary to hyponatremia as the initial and only presentation of SARS-CoV-2 infection, in the absence of fever or any respiratory involvement. Acute symptomatic hyponatremia is an under-recognised presentation with only a few cases reported till date and needs further awareness and understanding.

Background Suicide is a major public health challenge globally and specifically in India where 36.6% and 24.3% of all suicides worldwide occur in women and men, respectively. The United Nations Sustainable Development Goals uses suicide rate as one of two indicators for Target 3.4, aimed at reducing these deaths by one third by 2030. India has no examples of large-scale implementation of evidence-based interventions to prevent suicide; however, there is a sizeable evidence base to draw on for suicide prevention strategies that have been piloted in India or proven to be effective regionally or internationally. Method The SPIRIT study is designed as a cluster-randomized superiority trial and uses mixed methods to evaluate the implementation, effectiveness and costs of an integrated suicide prevention programme consisting of three integrated interventions including (1) a secondary-school-based intervention to reduce suicidal ideation among adolescents, (2) a community storage facility intervention to reduce access to pesticides and (3) training for community health workers in recognition, management, and appropriate referral of people identified with high suicidal risk. Discussion Combining three evidence-based interventions that tackle suicide among high-risk groups may generate a synergistic impact in reducing suicides at the community level in rural areas in India. Examination of implementation processes throughout the trial will also help to prepare a roadmap for policymakers and researchers looking to implement suicide prevention interventions in other countries and at scale. Trial registration Clinical Trial Registry of Indian Council of Medical Research, India: CTRI/2017/04/008313. Registered on 7 April 2017. http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=18256&EncHid=&userName=SPIRIT Trial registry was last modified on 28 June 2019.

Background: Family life is a near-universal condition and a fundamental human right. It can also have a significant impact on mental health, including recovery from mental health conditions. In India, families play a considerable role, representing a source of social, cultural, religious and, often, financial support. However, families can also play a stigmatising role. Aim: To examine the experiences of mental health service users (MHSUs) relating to stigma and support provided by family members and to consider ways in which family support can be improved. Method: This is a qualitative study. A total of 17 residential MHSUs at the Ahmedabad Hospital for Mental Health were interviewed. The results were evaluated using thematic content analysis. Results: The results revealed that all 17 MHSUs considered their families to be important sources of support, while 14 of the 17 MHSUs also experienced stigma emanating from their families. A total of 11 experienced lack of knowledge, 4 spoke of prejudicial attitudes and 5 mentioned discriminatory behaviours. There were important gender differences in experiences. MHSUs mentioned needs ranging from education and peer support for family members to financial support. Conclusions: Families act both as sources of support and stigmatisation. Education needs are considerable, while the need for peer support for families and resources to aid families in supporting people with mental health conditions are also important considerations.

Introduction: Perineal urethrostomy is a valuable technique in the management of complex anterior urethral strictures, as well as following penectomy or urethrectomy. Traditional techniques that employ perineal or scrotal skin flaps have documented failure rates of up to 30%. Current techniques for salvage have only modest success, leaving patients few options other than permanent suprapubic catheter or cystectomy and ileal conduit formation.Results: We present a new method of perineal urethrostomy using perforator-based lotus petal flaps in cases which were high risk or unsuitable for traditional perineal urethrostomy techniques, or where traditional strategies had failed. All patients demonstrated continent voiding at a minimum of 22 months follow-up, with patency confirmed by flexible cystoscopy. No complications were encountered.Conclusion: Utilisation of lotus petal flaps in high-risk cases of perineal urethrostomy will lead to significant improvements in patient outcomes. The availability of larger amounts of soft tissue coverage will obviate the need for compromise on either resection of involved urethra, or calibre and inset of urethrostomy. This will subsequently minimise the rates of failure, reduce the requirement for urinary diversion procedures and lead to improved quality of life.

Background Dropout from an outpatient clinic is the loss of patient to the scheduled follow-up. Noncompliance in the form of treatment dropouts is a major problem across outpatient mental health settings and can range from 15% to 60%. Follow-up studies provide valuable insights into improving the quality of existing mental health facilities. Quality Rights Gujarat (QRG) is a step toward improving mental health facilities across various centers. Methods This retrospective observational study aims to explore follow-up pattern, predictors and any change after QRG implementation. Pre intervention Group (A) attended psychiatry OPD for 6 months before implementation of QRG project and Post intervention Group (B) attended psychiatry OPD for 3 months after implementation of QRG project. Results Total 1632 Patients consulted in group A and 926 patients consulted Psychiatry OPD in group B. The most common Psychiatric disorder were Depression (A-19.55%, B-28.62%), Schizophrenia and related disorders (A-14.15%, B-15.01%), Neuropsychiatric disorders like headache and epilepsy (A-14.52%, B-18.68%), substance use disorder (A-15.26%, B-13.71%) and Bipolar disorder (A-11.76%, B-13.17%). 59.56% patients dropped out after the first visit in pre intervention group as compared to 51.94% patients in post intervention group. Significant reduction of about 8% in loss to follow up and 16% increase in follow-ups of initial visits after implementation of Quality Rights Gujarat project. Conclusions Much can be done to improve attendance in most services. The initiative like QRG significantly has positive results on patient's follow-up.

Objective: To compare the change in preoperative and postoperative dyspeptic symptoms. Introduction: In the era of increasing prevalence of gall stones due to more frequent incidental detection radiologically, it is the need of the hour that we assess the benefit of these increasing cholecystectomies with regard to dyspeptic symptoms. Till now there is not enough evidence on the basis of which we can determine whether laparoscopic cholecystectomy can resolve the dyspeptic symptoms in patients of gall stones. There is a need to establish a guideline to operate in view of alleviating dyspeptic symptoms. Methodology: A total of 308 (M:F=2:3) patients were evaluated for dyspeptic symptoms using the Glasgow dyspepsia severity score (GDSS). They were followed up after 1 month, 6 months. Disease distribution and change in GDSS scores were analysed. Results: The mean age was 47.2 ± 15.42 years. Preoperatively mean GDSS was 11.49 ± 2.11. One month post surgery 82% had a GDSS around 2.95. 12% had a significant drop in GDSS at the end of 6 months (p

A 22-year-old man with a history of tinea barbae was administered 200 mg dose of itraconazole. After 10 hours, he presented to the skin out patient department with a history of bright red rash on his right thigh. The rash was associated with burning and mild itching. On examination, there was single oval, mildly swollen, bright red to dusky red patch measuring 4.5×3 cm with erythematous halo over his right thigh (figure 1). He gives a history of a similar episode about 11 months ago, when he had taken itraconazole for treatment of tinea cruris. He was not taking any other medications. Oral cavity and genitalia were not involved. Haematological and biochemical investigations were normal. Systemic examination was unremarkable. Naranjo …

Background: The term necrotizing soft tissue infection encompassing simple pyoderma to life threatening infection, varying with regards to anatomical location, tissue involvement and offending organism. Early diagnosis of necrotizing-STI is important for timely surgical intervention, but physical findings can vary, so misdiagnosis is common. By using WBC, CRP, haemoglobin, Na, creatinine, glucose and clinical examination we can distinguish NF from other STI.Methods: This was a retrospective and randomized study in the Geetanjali Medical College and Hospital affiliated to Geetanjali University from January 2017 to January 2019 during this period total 66 patients with soft tissue Infection were admitted and included. Clinical details and investigations were recorded from the case sheet and were analyzed with WBC, CRP, Hb, Na, creatinine and glucose.Results: The most commonly affected age group was 46-60 years with male preponderance. Most common cause of STI was Trauma 66.66% of the patients having Primary Site Lower Limb in 12.12% and as per LRINEC score 50% of the patients have low risk, 37.87% of the patients have high risk and strongly in favour of NF and 12.12% of the patients have intermediate risk.Conclusions: The LRINEC score is a good tool for NF risk stratification and patients are advised to be careful for presence of NF if LRINEC score is≥6.

Background: Thoracic injuries account for a substantial proportion of all injury-related admissions, morbidity and mortality in all tertiary health care centres. The study was conducted to do comprehensive study of chest trauma at a tertiary health care centre.Methods: In this retrospective study we included all polytrauma patients with chest trauma admitted to Geetanjali medical college and hospital, Udaipur for a period of 2 years, from January 2017 until January 2019. Clinical details of the patients were recorded from their case sheets and were analyzed with reference to their age, sex, mode of injury, type of injury, severity of injury, treatment modalities, complications and final outcome.Results: Prevalence of chest trauma was 16.61% out of total cases of polytrauma. Males were predominantly involved (79.61%). Majority were in the age group of 21-30 years. Road traffic accidents (RTA) was the most common mode of injury (68.93%). A total of 53.40% patients required inter costal tube drainage (ICTD). About 17.47% of patients developed complications during treatment in the hospital.Conclusions: Chest trauma occurs in a significant number of polytrauma patients and majority of victims are males of 21-30 years of age. Majority of these patients were treatable with simple procedures like tube thoracostomy or ICU based treatment.

The history of banking is as old as Islam but the histoy of Islamic banking is only half a century old. It is agreed that Islamic banking started with a saving bank based on profit sharing in Mit Ghamr, Egypt in 1963. But, the first proper Islamic bank is deemed to be the Nasser Social Bank in 1971, again in Egypt. In 2013, after 50 years, there are about 400 Islamic banks and institutions in 53 countries with a fund based of USD 992 billion and asset based of USD 1.3 trillion. When Islamic banking started, Malaysia was busy with independence. Therefore, the start of Islamic banking in Malaysia was delayed by two decades. Malaysia passed Islamic banking Act in 1983 to start Bank Islam Malaysia Berhad with a capital based RM 80 million. The next three decades saw a tremendous growth. By 2013, there were 16 domestic and 5 international Islamic banks in Malaysia with an asset based of RM 442 billion, which does not include 15 Takaful operators. In spite of this tremendous growth, Islamic banking does not compare with conventional banking in terms of volume and acceptability. There have been studies which show that while 80% of the banking customers in Malaysia are aware of Islamic banking, but were not aware of Islamic banking products like Ijarah, Murabahah, etc. This conceptual paper brings out the challenges of marketing Islamic banking products in Malaysia and traces the roots of the problem to the lack of customer centricity.

Background: The spectrum of Diabetes Mellitus and various complications associated with it have been regarded as major global health challenges. Raised TG/HDL has been regarded as one of the valid markers for Insulin resistance. It leads to increased risk of CVD by causing Insulin resistance and also by its own effect on the vessel wall. Detection of raised TG/HDL ratio and early intervention before the patients develop clinical disease can help in mitigation of future consequences of CVD. Aims: The aim of our study was to compare TG/HDL ratio between prediabetics and controls and further to look for any correlation between the TG/HDL ratio value with HOMA-IR and Carotid Intima Media Thickness (CIMT) in prediabetics. Settings and Designs: A cross sectional study Methods and Material: Study was done at ABVIMS and Dr RML Hospital, New Delhi. 60 prediabetics and 60 age, sex, BMI matched controls were employed. In both cases and controls fasting and postprandial blood glucose, glycated Hemoglobin (HbA1C) and fasting Insulin levels were measured. HOMA-IR values in both the groups were calculated using fasting glucose and Insulin levels. Serum lipid profile was obtained and TG/HDL ratio was analysed in two groups. Values obtained were compared between the two groups. CIMT was only measured in cases using B mode ultrasonography. Statistical Analysis and Results: Median (IQR) of fasting plasma Insulin (μIU/ml) in cases was 11.3 (10.175-13.505) versus that in controls being 5.73 (4.3-7.1). HOMA-IR (IQR) values in cases and controls were 3.12 (2.73 - 3.595) and 1.21 (0.918 – 1.505) respectively. Median (IQR) for TG/HDL ratio was 3.26 (2.712 – 4) for cases and 2.05 (1.755- 2.502) for controls. However no correlation was observed between either the mean CIMT (mm) or HOMA-IR with TG/HDL ratio. Conclusions: Diabetes Mellitus and its various complications are of a great burden to society. Diagnosing the risk factors early before the onset of these manifestations can help us in combating these major issues. One of the risk factors among them is raised TG/HDL ratio. Early detection of elevated TG/HDL in prediabetics may serve in early detection of atherosclerotic complications and help physicians in framing primary preventive strategies for tackling ASCVD in patients with prediabetes and full-blown Diabetes.

Background Complex bulbar urethral strictures are a heterogeneous group, including those secondary to radiotherapy, failed previous open urethroplasty, and total bulbar necrosis following pelvic trauma. Traditional urethroplasty techniques in this group are unpredictable. We describe a novel technique of a buccal mucosa-prelaminated radial forearm free flap urethroplasty, which seeks to improve the quality of life for this group of patients. Methods Known, reliable techniques from two surgical specialties were combined to create a novel surgical solution, consisting of a radial forearm free flap prelaminated with buccal mucosa. Prospective data were collected on patient and stricture characteristics, complications, and results, including voiding flow rates, urethrography, and cystourethroscopy. Success was defined as the ability to void per urethra. The procedure was performed in four patients, previously considered unreconstructable and who were suprapubic catheter dependent. Results Microsurgical transfer was successful in all four cases. All patients were voiding per urethra and remained catheter free at a minimum of 12-month follow-up. There was no significant donor morbidity and all patients were able to return to their usual occupation. Mean voiding flow rates were 17.3 mL/s. Flexible cystoscopy revealed well-vascularized, patent neomucosa. Conclusions We demonstrate proof of concept for a novel technique of microsurgical urethroplasty. We believe this technique may have widespread application in the treatment of radiation-induced and other complex urethral strictures where traditional urethroplasty has limited success.

Subject area The case discusses Islamic Banking Principles and Products (Banking), Business Strategy for Niche Markets (Strategic Management) and Segmentation and Marketing Strategy (Marketing Management). Study level/applicability Undergraduate Graduate Training – Executives at junior level. Case overview This case is about the dilemma faced by Azhar Mehmud, a newly recruited Marketing Manager, Islamic Products (MMIP) in Bank Islam on six-month probation. Prior to Bank Islam, Azhar had an MBA degree from the UK and about 15 years of experience of business development in a multi-national bank in Indonesia. Looking at his experience, he was awarded to promote Islamic banking (IB) products in Malaysia where the competition was very intense. After his interactions with customers for about six to seven months, he prepared a report for his boss, General Manager, Consumer Banking (GMCB). In this report, he had summarized the challenges of marketing IB products in a market meant for conventional banking. When he presented the report to GMCB, he met with unfavorable reactions. GMCB was not convinced that IB products had any competition from conventional banking. He gave Azhar one additional month to either revise his thinking or quit the organization. Expected learning outcomes The expected learning outcomes are as follows: to enhance the awareness of IB products, principles and differences from the conventional banking products; to introduce the concept of business strategies for niche markets; to make students realize the importance of segmentation in view of niche market like IB. Supplementary materials Teaching notes are available for educators only. Please contact your library to gain login details or email support@emeraldinsight.com to request teaching notes.

Despite the knowledge that people with mental illness often seek care from multiple healing systems, there is limited collaboration between these systems. Greater collaboration with existing community resources could narrow the treatment gap and reduce fragmentation by encouraging more integrated care. This paper explores the origins, use, and outcomes of a collaborative programme between faith-based and allopathic mental health practitioners in India. We conducted 16 interviews with key stakeholders and examined demographic and clinical characteristics of the user population. Consistent with previous research, we found that collaboration is challenging and requires trust, rapport-building, and open dialogue. The collaboration reached a sizeable population, was reviewed favourably by key stakeholders—particularly on health improvement and livelihood restoration—and perhaps most importantly, views the client holistically, allowing for both belief systems to play a shared role in care and recovery. Results support the idea that, despite differing practices, collaboration between faith-based and allopathic mental health practitioners can be achieved and can benefit clients with otherwise limited access to mental health care.

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe mucocutaneous disease with high mortality rate. It is characterised by severe necrosis and detachment of the epidermis. Drugs are the most common triggering agent for SJS/TEN. These are commonly reported with the use of aromatic antiepileptics, antiretrovirals, allopurinol, NSAID’S and sulfonamide antibiotics. Non antibiotic sulfonamides rarely cause SJS/TEN. Metolazone is a well known diuretic and is extensively used by clinicians. Although this drug is in market for last several decades, no case of SJS/TEN has been reported till date. We report a rare case of metolazone induced SJS/TEN overlap in a 55-year-old lady.

Background The aim of the study was to evaluate the clinical presentation, and to investigate the effectiveness of continuous catheter drainage in comparison to needle aspiration in the treatment of liver abscesses. Method This is a comparative study of 50 patients, presented in outpatient and emergency department at the hospital,equally into two groups, percutaneous needle aspiration and pigtail catheter drainage. The effectiveness of either treatment was measured in terms of duration of hospital stay, days to achieve clinical improvement, 50% reduction in abscess cavity size and total/near total resolution of abscess cavity. Results The success rate was significantly better in catheter drainage group. The patients in pigtail catheter drainage group showed earlier clinical improvement and decrease in abscess cavity volume as compared to those who underwent percutaneous needle aspiration. Conclusions Percutaneous catheter drainage is a better modality as compared to percutaneous needle aspiration especially in larger abscesses which are partially liquefied or with thick pus.

Objective: The aim of this study is to assess the association of insulin resistance with sensory neuropathy in prediabetes. Materials and Methods: Fasting serum insulin levels were measured and the homeostatic model assessment of insulin resistance (HOMA-IR) was calculated in all patients. These were compared in prediabetic patients having sensory neuropathy to those who did not have sensory neuropathy as determined by vibration perception thresholds (VPTs) measured using Digital Biothesiometer. Furthermore, direct correlation between insulin resistance and VPTs was checked. Results: A total of 60 prediabetic cases were included in this study. Among the study population, the age distribution ranged from 35 years to 60 years with the mean age of 48.68 years. Male and female formed 65% and 35% of the study population, respectively. The maximum fasting serum insulin levels were 21.8 mIU/L, and the minimum fasting serum insulin levels were 3.5 mIU/L, with the mean value being 10.61 ± 4.99 mIU/L. The maximum HOMA-IR was 6.4, and the minimum was 0.986, with the mean value being 2.81 ± 1.37. Among all the prediabetic patients, 43.3% of patients had neuropathy according to VPTs measured using Biothesiometer. T-test analysis suggests that mean fasting serum insulin levels (P = 0.026) and HOMA-IR (P = 0.032) were significantly higher in patients with neuropathy than patients without neuropathy. VPTs were found to have statistically significant positive correlation with fasting serum insulin levels (Pearson correlation coefficient = 0.317 [R], 0.296 [L];P = 0.013 [R], 0.022 [L]) and HOMA-IR (Pearson correlation coefficient = 0.299 [R], 0.281 [L];P = 0.02 [R], 0.03 [L]). Conclusion: Insulin resistance, quantified with the help of the index, HOMA-IR, has an important role in the development of this sensory neuropathy.

Background Diabetic foot is one of the most significant and devastating complications of diabetes. Not all foot complications can be prevented, but it is possible to dramatically reduce their incidence through appropriate management and prevention. Various dressings are available that fulfils a number of functions like cosmesis, haemostasis, protection, support and absorption. Objectives To study and compare the efficacy of different topical agents like phenytoin sodium powder, eusol solution, nanocrystalline silver gel in patient with diabetic foot ulcer by recording the mean ulcer size pre-treatment, during the course of treatment (1 week, 2 week, 3 week and 4 week follow up) and post- treatment and mean percentage of the wound size healing after treatment. Material & Method This prospective study was conducted in the Department of General Surgery, Geetanjali Medical College & Hospital, affiliated to Geetanjali University from January 2017 to June 2018. 90 patients with diabetic foot ulcers without any other co-morbid conditions and ulcers belonging to Grade I & II as per Wagner diabetic foot ulcers classification were compared with the efficacy of different topical agents. Results Out of 90 patients, there was a highly significant reduction in the mean ulcer size after 2 week, 3 week and 4 week follow up in nanocrystalline silver gel group (p

Hydatid disease or echinococcosis is one of the oldest known zoonotic diseases. Although known to be found in liver and lungs, these cysts are rarely found in the pancreas. We report a patient who not only had hydatid cyst in the pancreas but also pancreatitis and subsequently diabetes because of it.

Insulinoma is a rare pancreatic endocrine tumour with an incidence of four cases per million per year. A recurrent episode of fasting hypoglycaemia is the most common manifestation of these tumours. Diagnosis is often delayed due to varied presentation but once diagnosed, prognosis is often good after surgical resection of the lesion. Severe hypoglycaemia in insulinoma causing coma and death is rare. We report a case of hypoglycaemic coma secondary to an insulinoma in an elderly man which proved fatal.

Background: Retrosternal goitre was defined as any thyroid enlargement identified below the thoracic inlet at operation, with the patient’s neck held in extension. The aim of this study was to determine the characteristics of the patients, the goitres, the surgery and its morbidity (including tracheomalacia, recurrent laryngeal nerve palsy and hypocalcaemia) and the incidence of malignancy in order to establish guidelines for managing patients with a retrosternal goitre. Methods: Data were collected prospectively on all thyroidectomies carried out by a single surgeon over 14 years. Patients underwent appropriate preoperative assessment and thyroidectomy was carried out using a standardized capsular dissection technique. There were 199 cases of retrosternal extension. Results: Retrosternal extension was significantly more common on the left side than on the right side (ratio 3:2, P

In modern days, we must use various high-tech machineries and equipments to get our jobs done and make the life easier. These machineries should be controlled by the home-owner from any location as the homeowner might be away from home at workplace or traveling in a different place in the weekend. Thus a system of remote monitoring and controlling are very much necessary. Smart home is one of these types of system equipped with home appliances which we wish to control smartly from anywhere. Some products are commercially available which allow remote home appliance controlling through internet which is undoubtedly emerging. We designed and constructed a cell phone controlled house automation system. The system allows users to send commands from their cell phones to control both a LIGHT and cooler & various other devices. Commands are sent via a cell phone’s numeric code dialing capability. The system is equipped with DTMF decoder and relay driver for controlling any appliance. The design is modular hence we can expand the system for more switches. The main advantage of the circuit is its vast range it can control any device from anywhere in the world. The reliability of the circuit is greatly enhanced due to availability of low cost cell phones and interfacing connectors. Our design met all the intended objectives however; improvements can still be made in the algorithm to make it more users friendly and reliable. Overall, the final price of implementation was kept low due to simplicity of the circuit. All the components are locally available. However, if this product were to be produced and sold, further cuts would be needed to make the end price competitive.

All patients with prolonged cough with a history of atopy, even if not clinically asthmatic, should be evaluated for allergic bronchopulmonary aspergillosis (ABPA); also, we suspect that we may miss the early diagnosis of ABPA if bronchial asthma is considered as a major criteria for the diagnosis of ABPA.

This study investigated the influence of group norms and self-regulatory efficacy on workplace deviant behaviour. A web-based survey was used to collect data from 217 teaching staff from various higher education institutions in Nigeria. The data collected was analysed using Partial Least Squares (PLS) path modeling. As predicted, the path coefficient results supported the direct influence of perceived injunctive norms and self-regulatory efficacy on organisational deviance. Similarly, perceived injunctive norm and self-regulatory efficacy were found to be significant predictors of interpersonal deviance. On the contrary, perceived descriptive norms were not significant predictors of both organisational deviance and interpersonal deviance. In addition, self-regulatory efficacy does not moderate the relationship between perceived descriptive norms and organisational deviance. We also found support for the moderating role of self-regulatory efficacy on the relationship between perceived injunctive norms and dimensions of workplace deviance. The moderating role of self-regulatory efficacy on the relationship between perceived descriptive norms and interpersonal deviance was also supported. Finally, the policy implications of the study are discussed.

We describe a 70-year-old male with a history of diabetes mellitus, hypertension, and asthma who presented with increasing breathlessness for 5 months. He was diagnosed to have allergic bronchopulmonary aspergillosis (ABPA) by serological and radiographic criteria. He was treated with steroids and itraconazole. After initial improvement, he developed fever with cough and mucopurulent sputum. X-ray chest revealed multiple cavities with air fluid level. Patient was treated with antibiotics without any response. Sputum was negative for acid fast bacilli (AFB). Sputum culture for bacteria and fungus did not reveal any significant growth; however a delayed growth of Nocardia was noted on fungal plates. Modified Ziehl Nelsen stain was positive for AFB. Patient was treated with cotrimoxazole. We discuss the serological and radiological criteria of ABPA, presentation and treatment ofnocardiapulmonary infection and other possible causes of necrotizing pneumonia in immunocompromised settings.

Summary The deep inferior epigastric perforator (DIEP) flap has become a popular free flap for use in breast reconstruction, providing a versatile volume of tissue with low donor site morbidity and in particular its ease of direct donor site closure. While its use in free tissue transfer has been widely reported, its use as a local pedicled flap has been more scarcely described. Limited reports include its use for hip and groin defects and in penile reconstruction. A long and robust vascular pedicle is ideal for islanded local advancement or so-called ‘propeller' rotation to adjacent abdominal wall defects, with Seyhan and Borman (2008) describing such a technique for coverage of the lower abdominal wall, and we have described such a technique to aid closure of the lower abdominal wall during contralateral DIEP flap harvest. Having been presented with a large central-lower anterior abdominal wall defect, we describe a further application of the pedicled ‘propeller' DIEP flap.

As the use of percutaneous intervention is increasing for closure of the patent ductus arteriosus, procedure-related complications are also on the rise. An Amplatzer duct occluder used in a 4-year-old child was dislodged into the right pulmonary artery. It was removed through median sternotomy by temporarily occluding the right pulmonary artery.