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Context: The coexistence of tuberculosis (TB) and mental disorder presents a daunting public health challenge. Studies suggest that TB patients often experience co-morbid mental health problems, highlighting a dual burden of illness. However, due to limited research in Gujarat, we cannot draw definitive conclusions or develop targeted mental health interventions for this population. Aim: To investigate the prevalence of depression, anxiety, and associated factors among TB patients from Gandhinagar and Surat cities in Gujarat, India. Settings and Design: The cross-sectional research was conducted in two cities in Gujarat, Gandhinagar and Surat, between October 2021 and July 2023. Methods and Material: Demographic information, anxiety and depressive symptoms, and perceived TB stigma were assessed at baseline (within 1 month of treatment initiation) and at the endpoint (6 months posttreatment) using a self-constructed tool for assessing risk factors and standardized instruments, namely, the Patient Health Questionnaire-4, and the Perceived TB Stigma Scale (12 items). Results: The study population had a mean age of 31.57 ± 12.34 years. The prevalence of anxiety and depression symptoms was found to be 10.5% (749) and 5% (359), respectively, at the baseline. TB patients with high perceived TB stigma and who had been sick for over six months were 3.1 times more likely to experience anxiety symptoms (Adjusted Odds Ratio (AOR) = 3.10, 95% CI: 2.22, 4.23) and 1.6 times more likely to experience symptoms of depression (Adjusted Odds Ratio (AOR) = 1.60, 95% CI: 1.12, 2.53). Gender, occupation, and socioeconomic level were significantly associated with both anxiety and depression (P < 0.05). Being single (AOR: 3.29; 95% CI: 2.45–7.53), low socioeconomic status (AOR: 5.41; 95% CI: 2.44–7.97), and being on TB treatment (AOR: 4.35; 95% CI: 1.83–15.65) were strongly associated anxiety and depressive symptoms. Conclusion: The findings of the current study indicate that TB patients experience a considerable burden of symptoms of both anxiety and depression. It highlights the need for incorporating mental healthcare support within TB care programmes.

BackgroundHealth care students often experience high levels of stress, anxiety, and mental health issues, making it crucial to address these challenges. Variations in stress levels may be associated with changes in dehydroepiandrosterone sulfate (DHEA-S) and interleukin-6 (IL-6) levels and gene expression. Meditative practices have demonstrated effectiveness in reducing stress and improving mental well-being. ObjectiveThis study aims to assess the effects of Heartfulness meditation on mental well-being, DHEA-S, IL-6, and gene expression profile. MethodsThe 78 enrolled participants were randomly assigned to the Heartfulness meditation (n=42, 54%) and control (n=36, 46%) groups. The participants completed the Perceived Stress Scale (PSS) and Depression Anxiety Stress Scale (DASS-21) at baseline and after week 12. Gene expression with messenger RNA sequencing and DHEA-S and IL-6 levels were also measured at baseline and the completion of the 12 weeks. Statistical analysis included descriptive statistics, paired t test, and 1-way ANOVA with Bonferroni correction. ResultsThe Heartfulness group exhibited a significant 17.35% reduction in PSS score (from mean 19.71, SD 5.09 to mean 16.29, SD 4.83; P

Background: Diabetes is a major burden globally, more commonly so in developing countries, as its complications are detected relatively late due to underdeveloped healthcare systems. These complications, when detected, are more or less irreversible, thereby leading to increased morbidity and mortality. Among these, complications related to bones (mainly osteoporosis) start fairly early (even in the prediabetes stage) but are less emphasized, nonetheless are major contributors to morbidity in diabetics due to increased fracture risk. One of the novel bone markers recently discovered is sclerostin, which helps in the assessment of the effect of hyperglycemia on bone homeostasis. Bone mineral density (BMD) by DXA scan is a good tool to assess the status of bone health but requires modern expensive radiological equipment. In this study, we wanted to see the correlation of serum levels of sclerostin to BMD so that by a simple serum investigation, early detection of poor bone quality in treatment-naive prediabetics can be done. Objective: The aim of the study was to measure serum levels of sclerostin in prediabetics, compare them with normoglycemic controls, and find the correlation of serum levels of sclerostin with BMD. Methods: 50 prediabetic patients and 50 age, sex, blood pressure, and BMI-matched controls were recruited in the study. In both the groups, serum levels of fasting blood glucose and postprandial glucose, glycated hemoglobin (HbA1c), Vitamin D, fasting insulin, and serum sclerostin levels were measured in both groups using ELISA. The obtained values were compared between the two groups. Bone mineral density is measured by DXA scan in cases and a correlation between BMD and serum levels of sclerostin was observed. Results: Serum sclerostin was significantly higher in the cases [18.22 (19.42) ng/ml] compared to the control group [11.08 (4.73) ng/ml] with a P value of 0.013. The mean of BMD in prediabetes is 1.06 g/cm2, T score is − 1.02, and Z score is − 0.59. There was a significant negative correlation between serum sclerostin levels and BMD in prediabetes (r = −0.404, P < 0.001). Conclusion: Serum levels of sclerostin are increased in prediabetes and correlate well with low BMD in prediabetes, and can therefore be used for early recognition of osteoporosis and fractures in diabetes.

Background: Neuregulin-4 is a recently recognized adipokine acting as ligands to tyrosine kinases receptor of the Erb B family. This adipose tissue augmented endocrine factor participates in the modulation of lipid and glucose metabolism and energy homeostasis. This novel adipokine is associated with insulin resistance, dyslipidemia, obesity, oxidative stress, and inflammation. Objective: The study aimed to compare plasma levels of neuregulin-4 in newly diagnosed type 2 diabetes mellitus as compared to matched controls and to correlate with glycemic and lipid parameters. Materials and Methods: 100 newly diagnosed T2DM patients and 100 age, sex, and BMI-matched controls after fulfilling all exclusion and inclusion criteria were included in the study. Fasting and postprandial blood glucose levels, glycated hemoglobin (HbA1c), and fasting plasma insulin levels were measured in both cases and controls. HOMA-IR values in both groups were calculated using fasting glucose and insulin levels. Results: Mean levels of plasma neuregulin-4(pg/mL) in newly diagnosed T2DM were 7949.76 ± 949.76) pg/ml, which was significantly lower as compared to 9143 ±949.76) pg/ml in the control group (P-value

Introduction: Patients with gallstone disease have already been investigated for the prevalence of previously undetected thyroid dysfunction, and the findings point to a possible link between hypothyroidism and gallstone disease. This research was carried out to support the need for assessment of the thyroid status in patients presenting with gallstones. Aim: To determine the prevalence of thyroid disorders and to study the relationship between thyroid dysfunction and sociodemographic variables in patients with gallstone disease. Materials and Methods: A cross-sectional, observational, hospitalbased study was carried out at Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India, in 117 patients with gallstones from January 2021 to June 2022. The sampling method was consecutive sampling. Standard baseline investigations and thyroid profiles were conducted. Operative and perioperative factors such as age (ranging from 18-80 years), sex, co-morbidities, radiological findings (number and size of stones, presence of Common Bile Duct (CBD) stones), thyroid profile, surgeries performed, and significance (p-value) of these factors were assessed based on the Chi-square test. Results: The mean age of participants was 44 years. There were 37 (68%) males and 80 (32%) females. Of the 117 patients, 49 patients (41.9%) were found to have hypothyroidism, and the remaining 68 patients (58.1%) were euthyroid. Among these 49 patients, only 15 were known to have hypothyroidism, while the remaining 34 patients were newly diagnosed. Of the 49 patients, 30 were females and 19 were males. There was no significant association between hypothyroid state and gallstone formation in either males (p-value: 0.154) or females (p-value: 0.194). Conclusion: A low prevalence of hypothyroidism was observed in both sexes. Further large population studies are needed to compare these findings.

Workforce shortages represent a major bottleneck to delivering depression care, particularly in lower resource settings. This pilot study aimed to assess the acceptability and feasibility of a digital training program on developing knowledge and skills in the delivery of a brief behavioral activation intervention for depression among non-specialist providers (NSPs) in Gujarat, India. Participating NSPs, such as community health workers and other frontline providers without specialized training in mental health care, were provided access to a digital program covering the core skills and content necessary to deliver the Healthy Activity Program, an evidence-based behavioral activation intervention for depression. NSPs completed knowledge assessments before and after the digital training, followed by focus group discussions to gather their feedback about the program content and delivery format. Of 43 NSPs enrolled in this study, 67% (n = 29) were community health workers called Accredited Social Health Activists and 33% (n = 14) were frontline mid-level health providers called Community Health Officers. Most participants (n = 39; 91%) completed the full course. Knowledge assessment scores showed improvement from pre-training (mean = 29.96; 95% CI: 27.12-32.81) to post-training (mean = 34.62; 95% CI: 31.05-38.19; p = 0.0448). Focus group discussions revealed that participants appreciated the digital mode of training despite facing technical challenges while completing the course. This study further supports the feasibility and acceptability of digital approaches for training frontline providers to deliver brief psychological interventions for depression. With adequate resources and proper execution, digital training holds potential to serve as a key tool to build capacity of NSPs and expand the mental health workforce in India.

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is commonly observed in middle aged and elderly individuals. Dyspnoea, with or without expectoration, or isolated dyspnoea, is the primary respiratory symptom. Clinical signs, symptoms, and Pulmonary Function Tests (PFTs) are non specific. Chest radiography poorly correlates with disease severity and extent compared to clinical and functional impairment. High-Resolution Computed Tomography (HRCT) has been widely adopted to detect, characterise, and quantify emphysema. HRCT scoring is a useful radiological method for assessing emphysema severity in COPD patients and can provide prognostic information. Aim: To assess the severity of emphysema based on the HRCT scoring system and its association with clinical profile and PFTs. Materials and Methods: The present cross-sectional observational study was conducted in the Department of Radiodiagnosis at Atal Bihari Vajpayee Institute of Medical Sciences and Ram Manohar Lohia Hospital, New Delhi, India. It included 30 clinically diagnosed COPD patients referred for HRCT lung scans from November 1,2018, to March 31, 2020. HRCT assessment was performed at three levels: carina, 5 cm above carina, and 5 cm below carina. The severity of lung parenchyma was evaluated using the “Sakai Scoring Method.” The emphysema score was correlated with clinical profile (duration of illness, COPD severity, smoking, and pack-years smoked) and PFT parameters (FEV1, FEV1/FVC). Results: The mean age of the cases was 60±9.44 years. There was a strong positive linear correlation between the duration of illness (r=0.67, p=0.001) and COPD severity (r=0.452, p=0.02) with HRCT emphysema score. Significant correlation was found between HRCT emphysema score and pack-years smoked (r=0.558, p=0.004). The emphysema score showed an inverse correlation with FEV1 (r=-0.56, p=0.002) but no correlation with Forced Expiratory Volume 1/Forced Vital Capacity (FEV1/FVC) (r=-0.16, p=0.430). Conclusion: The HRCT semi-quantitative scoring system is valuable for the initial assessment of disease severity and is significantly correlated with the PFT parameter FEV1.

Background: A substantial proportion of health burden in diabetic individuals can be attributed to cardiovascular complications. The increasing risk of cardiovascular complications along the spectrum of dysglycemia warrants the need to devise novel markers for early assessment and management. Activin A is a multifunctional cytokine with an important role in glucose homeostasis and vascular diseases. It can thus serve as a guide for early identification of cardiovascular disease (CVD) risk in prediabetes. Objective: The aim of the study was to measure serum levels of activin A in prediabetics, compare them with normoglycemic controls and find the correlation of activin A with markers of insulin resistance such as the homeostatic model assessment of insulin resistance (HOMA-IR). Methods: Sixty prediabetic patients and similar age-, sex-, blood pressure–, and BMI-matched controls were recruited in the study. In both groups, serum levels of fasting blood glucose and post prandial glucose, glycated hemoglobin (HbA1c) and fasting insulin were measured. HOMA-IR values were calculated. Serum activin A levels were measured in both groups using ELISA. The obtained values were compared between the two groups. Results: The median (IQR) of s. fasting insulin (mIU/L) in the case group was 15.3 (12.2–18.62) which was significantly higher than that in the control group, which was 6 (4.2–7.3). The median (IQR) of s. activin A (ng/mL) in the case group was 263.55 (227.18–279.56) which was significantly higher than that in the control group, which was 159.9 (150.73–178.75) (P < 0.001). There was a very strong positive correlation of s. activin A (ng/mL) with s. fasting insulin (mIU/L) and HOMA-IR (rho = 0.67 and 0.75, respectively, P < 0.001). Conclusion: Activin A, if combined with other atherosclerotic markers, might improve the assessment of insulin resistance and cardiovascular risk in prediabetics and lead to focus on lifestyle modifications and preventive medical therapy, thereby contributing to the prevention of CVD-related mortality and morbidity in these patients.

Background While effective lay-health worker models for mental health care have been demonstrated through efficacy trials, there is limited evidence of the effectiveness of these models implemented in rural LMIC settings. Aim To evaluate the impact of a volunteer community-led intervention on reduction in depression and anxiety symptoms and improvement in functioning, and social participation among people living in rural Gujarat, India. Methods Stepped-wedge cluster randomized controlled trial was used to assess the effectiveness of delivery of psychosocial intervention across 645 villages in Mehsana district of Gujarat, India between April 2017 and August 2019. The primary outcome was an improvement in depression and/or anxiety symptoms assessed using GHQ-12 at 3-month follow-up. Secondary outcomes were improvement in (a) depression and anxiety (Patient Health Questionnaire, (PHQ-9), Generalized Anxiety Disorder (GAD-7) & Self-Reporting Questionnaire-20 (SRQ-20); b) quality of life (EQ- 5D); c) functioning (WHO-DAS-12), and social participation (Social Participation Scale SPS). Generalized linear mixed-effects models were used to assess the independent effect of the intervention. Results Out of a total of 1191 trial participants (608- intervention & 583-control), 1014 (85%) completed 3-month follow-up. In an adjusted analysis, participants in the intervention condition showed significant recovery from symptoms of depression or anxiety (OR 2.2; 95% CI 1.2 to 4.6; pConclusion Findings suggest that Atmiyata had a significant effect on recovery from symptoms of depression and anxiety with sustained effects at 8-month follow-up. Trial registration Trial registration details. The trial was registered prospectively with the “Clinical Trial Registry in India” (registry number: CTRI/2017/03/008139).

Introduction: A Lichtenstein tension-free mesh hernioplasty is the most commonly performed surgery for an inguinal hernia. Chronic inguinodynia is the most prevalent surgical complication, with a 25% overall incidence. The second most common complication is hypoesthesia. Ilioinguinal neurectomy has been proven in several studies to alleviate chronic inguinodynia. Aim: To compare the postoperative inguinal pain and aesthesia in Ilioinguinal Nerve (IIN) preservation patients with neurectomy patients in Lichtenstein tension-free mesh hernioplasty. Materials and Methods: This randomised clinical trial was conducted at GMCH, Udaipur, Rajasthan, India during January 2020 to June 2021 on 70 individuals (35 in each group). The IIN was excised in group A, while it was preserved in group B. Pain and aesthesia was assessed at day seven, one month and three month follow-up. Chi-square test was used for data analysis. A p-value

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: 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.

Abstract 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.

Spinal tuberculomas form a meagre fraction of cases of Tuberculosis (TB). Most common presentation of spinal tuberculoma is weakness. A 45-year-old female presented with dysthesias, gait instability and numbness involving both lower limbs for a period of 7-10 days. Patient was vitally stable (blood pressure of 128/78 mm of Hg, pulse rate of 86 beats per minute and respiratory rate of 18 breaths per minute with a normal pattern), alert and co-operative. Neurological examination suggested non length dependant sensory involvement of lower limbs, sensory ataxia and areflexia, level of lesion being at the Dorsal Root Ganglia (DRG) (sensory neuronopathy). Contrast Enhanced Magnetic Resonance Imaging (CEMRI) spine revealed tuberculoma at D9 spinal level. Patient responded to Antitubercular Therapy (ATT) and recovered. The intention of sharing the clinical experience is with the sole purpose of remembering the fact that common pathologies may at times be great mimickers. In the present case, while a lot of rare causes (autoimmune, neoplastic) were searched for, tuberculoma happened to be the culprit.

Hemophagocytic lymphohistiocytosis (HLH) is a rare, poorly recognized and underdiagnosed syndrome of excessive immune activation, which is rapidly fatal. HLH can occur as a familial or secondary disorder. Secondary HLH is most commonly associated with infections, malignancies, or autoimmune diseases. It primarily affects patients with a compromised immune system and rarely presents in immunocompetent individuals. Acute cytomegalovirus (CMV) associated HLH in the immunocompetent individual is extremely rare and only documented in five case reports till date. We, hereby, report a case of 18 years old young immunocompetent man who was diagnosed to have HLH secondary to CMV infection.

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.

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

Introduction: Hyperglycaemia and insulin resistance are two important risk factors for the development of atherosclerosis and Atherosclerotic Cardiovascular Disease (ASCVD). Whilst the association of diabetes and atherosclerosis has well been studied and is well known, the data on prediabetes is limited. Carotid Artery Intima-media Thickness (CIMT) and high sensitivity C-reactive Protein (hsCRP) are recognised markers of subclinical atherosclerosis. Aim: To measure CIMT and hsCRP levels in prediabetics in cases and controls and correlate them with Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). Materials and Methods: Fifty prediabetic patients and 50 age, sex and Body Mass Index (BMI) matched controls were enrolled in this case control study. Serum fasting and postprandial blood sugars, glycated haemoglobin (HbA1c) and fasting insulin levels were measured in cases and controls. HOMA-IR index was calculated from fasting glucose and insulin values. All cases and controls were subjected to bilateral CIMT measurements and the mean was tabulated. Serum hsCRP values were assessed and compared between both the groups by unpaired t-test. Results: The mean serum fasting insulin level among cases was 12.22 mIU/mL and that of the control group was 5.37 mIU/mL (p-value

Introduction: Prediabetes or intermediate hyperglycaemia is a high risk condition with blood glucose levels higher than the normal glycaemic values but lower than the Diabetes Mellitus (DM) diagnostic value. Individuals in prediabetic state have increased likelihood of development of Cardiovascular Diseases (CVD), endothelial dysfunction and obesity. Increased oxidative stress leads to pathogenesis of DM. Early assessment of DNA damage and vitamin D helps in timely management of the condition. Aim: To assess the association of oxidative stress and serum vitamin D levels in prediabetic individuals. Materials and Methods: This cross-sectional study was conducted in the Departments of Medicine and Biochemistry, PGIMER and Dr. Ram Manohar Lohia Hospital, New Delhi, India. A total of 60 prediabetic cases and 30 age and sex matched healthy controls were included in the study. Serum and urinary levels of 8-hydroxy-2'-deoxyguanosine (8-OHdG) (a marker of oxidative stress) and serum levels of vitamin D were compared between prediabetic subjects and healthy controls. An 8-OHdG was measured by sandwich Enzyme-linked Immunosorbent Assay (ELISA) and serum vitamin D levels were measured by enhanced chemiluminescence. Continuous variable was assessed using t-test and nominal variables were compared using chi-square test. The p-value

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.

**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 per cent. 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.

Prior research has indicated that employee turnover is detrimental to both individuals and organisations. Because a turnover intention in the workplace is detrimental, several factors have been suggested to better understand the reasons why employees may decide to leave their organisations. Some of the organizational-related factors that have been considered by previous research include perceived organizational justice, job satisfaction, perceived psychological contract breach, and perceived organizational support, among others. Despite these empirical studies, literatures indicate that less attention has been paid to the influence of perceived organisational politics, organizational trust, and perceived human resource practices management (HRM) practices on employee turnover. Hence, the present study fills in the gap by examining the relationship between perceived organisational politics, organizational trust, perceived human resource management practices and employee turnover among Registered Nurses in Nigerian public hospitals using multiple regression analysis technique. One hundred and seventy five Registered Nurses participated in the study. Result indicated that perceived organisational politics was significantly and positively related to turnover intentions. The result also showed that both organizational trust and perceived human resource practices were significantly and negatively related to turnover intentions. Theoretical and practical implications of the results are discussed.

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.

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.

Extant empirical research has reported conflicting findings with respect to the effects of punishment certainty and punishment severity on organizational deviance, suggesting the need to introduce a moderator. The present study tested whether self-regulatory efficacy matters on the relationships among punishment certainty, punishment severity, and organizational deviance. Drawing on deterrence and self-efficacy theories, this study examined the effects of punishment certainty, punishment severity, and self-regulatory efficacy on organizational deviance among 197 employed postgraduate students who enrolled in the Master of Business Administration program at two large universities located in the north-west geopolitical zone of Nigeria. We used self-administered questionnaires to collect data. Using Partial Least Squares Structural Equation Modeling (PLS-SEM), we found a significant negative relationship between punishment certainty and organizational deviance. Similarly, the results indicated that punishment severity had a significant negative relationship with organizational deviance. The study also found a significant negative relationship between self-regulatory efficacy and organizational deviance. As expected, self-regulatory efficacy was found to moderate the relationship between punishment certainty and organizational deviance. On the contrary, no significant interaction effect was found between self-regulatory efficacy and punishment severity. Implications of the study in the Nigerian context have been 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 of nocardia pulmonary infection and other possible causes of necrotizing pneumonia in immunocompromised settings.