Abstract: Splenic sarcoidosis is a rare clinical entity which can have heterogeneous clinical presentation. We highlight two different clinical encounters of splenic sarcoidosis with coexistent pulmonary sarcoidosis, which needs high degree of clinical suspicion to diagnose in complexed burnt out state and importance of timely diagnosis and early initiation of corticosteroids to minimize disease progression. Case 1; 58 year old previously healthy female presented with marked constitutional symptoms and left side upper abdominal discomfort over 6 months period with unremarkable clinical examination on admission. Her chest X ray on admission simulated the appearance of lymphangitic carcinomatosis, however ultrasound guided splenic tru-cut biopsy confirmed the diagnosis of splenic sarcoidosis and patient responded to corticosteroid therapy. Case 2; 21 year old young male was evaluated for pyrexia of unknown origin for three months. His clinical examination was only significant for bilateral cervical discrete lymph node enlargement and chest X ray on admission showed bilateral hilar enlargement and initial ultrasound abdomen revealed multiple hypoechoiec splenic lesions. Finally brochoscopy guided lung biopsy confirmed the diagnosis and patient was remarkably improved with corticosteroid treatment. Splenic sarcoidosis has heterogeneous clinical presentation. Judicial use of imaging, appropriate tissue biopsy together with correct clinical judgment will enable early diagnosis and early treatment with corticosteroid will have favorable patient outcome.

Sunflower is an important oil seed crop in India. The crop is susceptible to various diseases among which leaf blight caused by Alternaria helianthi is more destructive. The present study aimed at determining antifungal potential of Moringa stenopetala (Baker f.) Cufod (Moringaceae) an indigenous plant to Ethiopia against A. helianthi isolated from sunflower leaves. Antifungal activity was determined by Poisoned food technique. The extract was effective and a dose dependent inhibition of mycelial growth of fungus was observed. At extract concentration 1.5mg/ml and higher, an inhibition of >70% was observed. The plant appears promising and the presence of bioactive principles in the extract might have accounted for the antifungal activity. The plant can be used in the management of leaf blight of sunflower.

We present an ambispective analysis of the Management of Deep Sternal Wound Infections: Open Dressing versus Vacuum Assisted Closure Device Therapy at our Institute. Aim: The aim of our study is to compare and analyse our experience of Management of Deep Sternal Wound Infections with Open Dressing and Vacuum Assisted Closure Device Therapy and outcome. Methods: We analysed and compared our data (Group I) from 01 May 2009 to 31 May 2012 when the modality of management of DSWI was open dressings and irrigation (ie; Pre-VAC era at our institute) with data (Group II) from 01 May 2013 to 31 Apr 2016 when the modality of management of DSWI was changed to Vacuum Assisted Closure Device Therapy. 2228 patients underwent sternotomies from 01 May 2009 to 31 May 2012 and 2168 patients underwent sternotomies from 01 May 2013 to 31 Apr 2016. In Group I postoperative DSWI was diagnosed in 22 patients there were 14 (63.63 %) Males aged 45 to 81 years and 08 (36.37 %) Females aged 43 to 71 years, and in Group II postoperative DSWI was diagnosed in 20 patients. There were 11 (55 %) Males, aged 39 to 74 years and 09 (45 %) Females aged 44 to 66 years. The outcomes were investigated with Kaplan-Meier method, log-rank test, Student’s test and Fisher’s exact test. Results: In Group I - 17 (77.27 %) patients underwent secondary suturing with tension bands and 01 (4.5 %) patient required flap cover to cover the defect. The mortality was 04 (18.18 %) (03 Male and 01 Female), whereas in Group II- 16 (80%) patients underwent Secondary suturing with tension bands and 02 (10 %) patient required flap cover to cover the defect. The mortality was 02 (10%) (01 Male and 01 Female). Conclusion: As compared to open dressings and irrigation, VAC therapy is safe and reliable option in Deep sternal wound infection after cardiac surgery, with excellent survival and low failure rate. VAC reduces mortality, increases sternal stability, patient comfort and can be used in any Hospital. Pre-operative Diabetes Mellitus, Renal Failure and Obesity are risk factors for mortality in patients treated with both modalities

Lactococcus garvieae is a Gram-positive coccus [GPC] that has morphological and biochemical similarities to enterococci. L.garvieae strains are rare human pathogens, with only a few cases reported in the literature, mainly as a cause of infective endocarditis but a well-known pathogen in aquaculture. It is well known as a fish pathogen, and in some of the reported cases, the patients had history of contact with raw fish. We report a case of L. garvieae urosepsis in a patient with no history of contact with raw fish.

Abstract: This study is aimed to determine the variations in perihilar branching pattern and extra renal arteries in 25 cadavers at SRM medical college hospital and research center, Chennai, India. Among the 50 kidneys studied, perihilar branching pattern (32%), accessory renal artery (26%), polar renal artery (16%), accessory renal artery & perihilar branching pattern (12%), accessory renal artery & polar artery (10%) and polar renal artery & perihilar branching pattern (4%) were observed in 16, 13, 8, 6, 5 and 2 cases, respectively. The knowledge of these probable variations of renal arteries will be useful for surgical management during renal transplantation, angiographic interventions, urological procedures and repair of abdominal aorta aneurysm.

Cow dung obtained from Bos indicus have been long recognized as multifacted biomass that serve not only as conventional combustion material but also a modern day fuel. Apart from being an essential part of ayurvedic formulations it finds application in healthcare management by virtue of it‘s antibacterial activity. This article addresses the even more recent application of gomeya or the cow dung in various aspects including bioremediation. This implies that conservation of indigenous cattle is very crucial in order to make use this ‗gold mine‘ and further explore it‘s hidden qualities.

Abstract: Tolosa-Hunt syndrome (THS) is essentially a clinical diagnosis of exclusion; painful ophthalmoplegia caused by nonspecific inflammation of the cavernous sinus or superior orbital fissure. We reported a 70 year old male with THS who responded to corticosteroids dramatically and made an uneventful complete clinical recovery.

To assess changes of blood parameters in people living with HIV on antiretroviral therapy, a follow-up study was carried out subjects. A group of 45 subjects in ICBRA (Integrated Centre for Bioclinical Research of Abidjan) with HIV infection were recruited with a mean age was 26.1 ± 0.7 years. These Patients were followed by control of some blood parameters before initiating (J0) antiretroviral therapy. These same biological parameters were assessed after 6 (M6) and 12 (12M) months. The results of study was indicated a decrease of anaemia prevalence during follow-up ((51.1%, 42.2% and 40% respectively at J0, M6 and M12. In the same way, during treatment, microcytic hypochromic anaemia and macrocytic hypochromic anaemia were more observed. Moreover, these two types of anaemia were more revealed according to CD4 classes. In addition, the prevalence of neutropenia was observed in 55.6% at the beginning of treatment, it was decreased to 37.8% at M6. Lymphopenia was reported only in 2.2% of patients at treatment initiation. As for thrombocytopenia, it was revealed in 11.1% of subjects at treatment initiation. In the sixth and twelfth months of treatment, it was recorded respectively in 11.1% and 8.9% of subjects. According to the CD4 count, high prevalence of leukopenia to class B and class C for initiation of neutropenia and lymphocytosis to classes A and B and monocytosis all classes were observed. This study revealed a non-significant increase in CD4 count. The majority of patients had normal glucose levels during follow-up (93.4%, 95.6% and 97.8% respectively at J0, M6 and M12). Normal rate of creatinine was also indicated (73.3%, 71.1% and 84.4% respectively at J0, M6 and M12) and alanine aminotransferase levels (ALT) (88.9%, 84.4% and 82.2% respectively at J0, M6 and M12).

Abstract: Cataract is a highly treatable condition due to advances in cataract surgery, procedures and intraocular lens design. Currently 90% of the cataract surgeries are performed with intraocular lens (IOL). The aim of cataract surgery to improve visual function which also improves overall quality of life. The objectives were to find out the current visual outcome among subjects of post cataract surgery (IOL) over a period of 3 to 10 years and correlate visual outcome with selected variables. A community based descriptive cross-sectional study was conducted in selected urban field practice area of Rajah Muthaiah Medical College and Hospital from December 2015 to August 2016. Totally 120 subjects underwent cataract surgery were included in the study. The socio-demographic data and details regarding the surgery were collected using a pretested proforma and visual acuity was measured by Snellen’s chart. The visual acuity has been classified namely good, borderline and poor. The majority of the subjects were in the age group of 46-60 years (65%). 87 were females (72.5%) and 49 were illiterate (40.8%). Among these subjects 83 were homemakers (69.2%), 96 (80%) underwent surgery in institution (picked up through camp). 10.8% had complications immediately after surgery, 50% study subjects had a history of chronic diseases, such as DM, HT or both. Visual acuity measured as good vision (6/6-6/18) 54.2%, borderline vision (<6/18-6/60) 33.3% and poor vision (<6/60-unable to appreciate hand movements) 12.5%. 12.5% of the post cataract surgery (IOL) subjects had poor vision. 30% of the subjects those who had cataract surgery (IOL) surgery more than 5 years ago has poor vision.

Population parameters such as asymptotic length (L∞), growth coefficient (K), mortality rates (Z, F and M), exploitation level (E) and recruitment pattern of the common cuttlefish Sepia officinalis were estimated using length– frequency data from the Ivorian coastal water. Asymptotic length (L∞) was 31.50 cm and growth coefficient (K) was estimated at 0.500 year−1. Total mortality (Z) for S. officinalis was 1.32 year−1, while natural mortality (M) and fishing mortality (F) were 0.94 and 0.38 year−1, respectively. The growth performance index (φ‟) was 2.69 and the exponent “b” of the length–weight relationship was 2.77 during the study period. The asymptotic wet weight estimated from length– weight relationship was 2869.57 g. Exploitation level (E) of Sepia officinalis was 0.29. The recruitment pattern was continuous with one major peak in the months of July–August. The exploitation level (0.29) and lower fishing mortality (0.38 year−1) indicate that the common cuttlefish is under-exploited from Ivorian coastal waters.

Abstract: This study sought to determine the average time spent on social media by medical undergraduates in University of Uyo, Akwa Ibom State, Nigeria and to determine the relationship between social media use and disturbances of sleep quality and quantity amongst medical undergraduates in University of Uyo. It was a cross sectional population based study among 208 medical students in University of Uyo, Southern Nigeria. They were randomly selected with a proportionate stratified random sampling method and data collection was done using a self-reporting anonymous questionnaire. Social media use was assessed using multiple items reflecting the frequency, volume, location and platform of social media use. The average time spent on social media by respondents was 1-3 hours. Proportionately, the most time was spent on Facebook. In models that adjusted for all covariates, participants who spent more time on social media per day had significantly greater odds of having disturbance of sleep quality. Compared with those who spent more than 3 hours per day on social media, those who spent 1-3 hours per day had an adjusted odds ratio of 4.59 (95%CI: 4.14-5.48, p value < 0.001) for sleep disturbance. A significant association was reported between volume of social media use and sleep disturbance. This has important clinical implications for the health of young adults. Future work would focus on the interactions on the various social media platforms that make their use significant to young adults.

Abstract: Although many students are opting for the convenience of online study, there is a paucity of literature documenting the rationale for students’ choice of face-to-face or online learning format. As such, this study examined learner preferences for discussions in reading instruction. The study also compared the discussions generated by different sub-groups of students and explored the variances within students’ discussions generated from online and face-to-face learning formats. The following research questions guided the study: (a) What are learners’ preferences for discussions in reading instruction? (b) Does one discussion format facilitate meaning-making more than the other for various sub-groups and (c) Do patterns of discourse and learners preferences stay consistent across time and learners sub-groups or do differences occur due to diversity? Results indicated that majority of the participants preferred face-to-face discussion format to online discussion format in reading instruction. Participants also professed a belief that face-to-face discussions facilitate meaning-making more than online discussion. While such perception does not apply to all learner groups in the study, the results further showed that patterns of discourse and learners preferences stay consistent across time and learners, but differences occur due to learner diversity. Recommendations are made on how to facilitate learner inclusion and collaborative learning in both learning formats.

In examining the need for Nigerian economy to encourage the domestic manufacturing sector, this study looks at the effect of imported manufactured goods on the performance of manufacturing sector in Nigeria. The study employed econometric analysis with Ordinary Least Square (OLS) method of data estimation and analysis and Augmented Dickey fuller test to conduct unit root test to ensure the stationarity states of the variables used. The estimated result of model one shows a positive statistically significant relationship between domestic manufacturing sector output and the Nigeria manufactured imports. Model two estimates also indicate that domestic manufacturing sector contributes positively to economic growth of Nigeria. Therefore, the study recommended among other things the use of fiscal policy measures to checkmate or control high importations of goods that can be manufactured domestically to enable domestic manufacturers expand and thus, create employment opportunities for Nigerians.

This paper presents the results of an experimental investigation carried out to evaluate the compressive strength of concrete. An exploratory study on the suitability of the tannery shredded waste as partial replacement for normal fine aggregate in concrete works has been carried out. Physical and mechanical properties of tannery shredded waste and locally available normal aggregates have been determined and compared. A large number of concrete cubes of size 150X150X150 mm were cast with different percentage replacements of fine aggregates by tannery shredded waste in the order 100:0, 5:5, 10:10, and 15:15, were cast and compressive strength test values were determined.

Introduction: Local anaesthetic like bupivacaine is commonly used in spinal anaesthesia, but the duration of spinal anaesthesia may be short and limited, and higher doses of rescue analgesics may be required in the postoperative period. This can be avoided by using higher doses of bupivacaine which again can produce cardiac toxicity. Studies have shown that duration of analgesia due to bupivacaine in spinal anaesthesia can be prolonged by using adjuvants such as midazolam, opioids, neostigmine, dexmedetomidine, and clonidine. Almost all opioids have been used as adjuvants intrathecally. Material and methods: This randomized controlled study was carried out over a period of 6 months, after obtaining approval from the Hospital Ethics Committee and written informed consent from the patients. Ninety-nine patients of Anaesthesiologists Classes I or II of either sex and of age 25-60 years, posted for lower abdominal surgery were randomly divided into 3 groups (n = 33) using computer-generated program. Assigned random group was enclosed in a sealed envelope to ensure concealment of allocation sequence. The anaesthesiologist, who was not involved in the study, opened the envelope in operation theatre and prepared the drug accordingly. The observation was done by the anaesthesiologist who was blinded to the drug. Patients having severe systemic disorders such as diabetes mellitus, hypertension, heart disease, allergy to bupivacaine, spine deformity, increased intracranial pressure, neurological disorders, haemorrhagic diathesis, and infection at the puncture site were excluded from the study. Result: A total of 106 patients initially enrolled in this study, 7 patients had to be excluded because of logistical reasons or other violations of the study protocol. Ninety patients were included and randomly assigned to their treatment groups. Conclusion: Intrathecal clonidine (75 μg) when added to bupivacaine in spinal anaesthesia provides prolonged duration of postoperative analgesia than 25 μg of fentanyl but with higher degree of sedation. Fentanyl (25 μg) may be recommended as a better option when sedation is not desirable. We concluded that intrathecal clonidine 75 𝜇g with bupivacaine prolonged intraoperative anaesthesia and the time to first analgesic request compared to fentanyl, however, the total analgesic consumption in the first 24 h postoperative was similar in fentanyl and clonidine groups following elective lower abdominal surgeries.