Awareness regarding foot self-care practices among diabetic patients in Northeast part of India. Can primary care physician make a difference? A hospital based cross-sectional study.

Background: About 10% of patients with type 2 diabetes mellitus at the time of diagnosis have more than one risk factor for developing foot ulceration, and it increases to 15% in a lifetime. The risk of development of Diabetic foot ulcers/gangrene can be prevented by the patient's self-foot care practice at home. The present study aimed to determine the prevalence of awareness of self-foot care practice among diabetic patients in a rural setting. The study also aimed to identify the factors preventing dry or wet diabetic gangrene development and subsequent amputation. Methods: A hospital-based cross-sectional study was carried out among 1687 people with diabetes mellitus (DM) who attended orthopedic and diabetic OPD in a tertiary care hospital in Kamrup, Assam, India. An appropriate self-explanatory questionnaire about knowledge of self-foot care practice was given to all study participants. Foot examination was performed by authors participated in the study on all patients. The observations and results were categorized according to the International Diabetes Federation foot risk categories. Results: Of 1687 patients included in this study, 298 (17.7%) had foot ulcers of various grades, 164 (9.76%) had peripheral vascular disease, and 484 (28.7%), had peripheral neuropathy of different grades. After multivariate analysis, patients on insulin and combination therapy and peripheral neuropathy were significantly associated with the presence of foot ulcers. The mean knowledge score was as low as 9.7 ± 4.8 out of a total score of 23. Low awareness and knowledge were associated with low mean scores due to a lack of formal education (8.3 ± 6.1). Among the 1687 patients, only 381 (22.5%) are aware and have some knowledge about self-foot care, and 686 (40.6%) had their feet examined by a doctor only once since their initial diagnosis. The incidence of development of diabetic-related complications was significantly low in those who know about foot self-care as well as those whose feet had been inspected by a physician at least once. Conclusion: The incidence of development of diabetic-related complications was significantly low in those who know about foot self-care as well as those whose feet had been examined by a physician of family doctors at least once. There is a need to educate all patients of diabetes about self-foot care. It is prudent to establish an integrated foot care services within primary care centers and in the diabetic clinic to identify feet at risk, institute early preventive measures, and provide continuous foot care education through images videos on WhatsApp to patients and primary health care givers.

Analysis of relationship of hormonal, hematological and biochemical parameters in Indian alcoholics with severity of alcohol dependence.

Background: Alcohol dependence syndrome (ADS) is a major problem in India. ADS is known to be a systemic disorder involving almost all organ-systems. The evaluation of ADS patients' needs successive assessment of severity of clinical condition. In this study, we attempted to explore Severity of Alcohol Dependence Questionnaire (SADQ-C) as a severity measure by studying its association with laboratory parameters. Methods: During the two months study period 155 diagnosed ADS male patients who had been admitted to the Psychiatric Ward of two zonal level hospitals were enrolled for the study. The participants were examined by the Psychiatrist and the severity of alcoholism ascertained by the SADQ-C scoring. Based on SADQ-C scoring they were divided into three groups: severe alcohol dependence, moderate dependence and mild physical dependence. The patients' blood samples were collected and tested. Results: In our study, morning and evening level of serum cortisol showed positive correlation with increasing SADQ-C scoring. The differences in morning and evening cortisol level also augmented with increasing severity score (r=0.257; p=0.001). Hemoglobin, mean corpuscular volume (MCV) and serum level of LH, FSH and testosterone levels were not shown any statistically significant alterations amongst the studied groups. Serum LH, total bilirubin, direct bilirubin, AST, ALT and GGT level showed positive correlation with SADQ-C scoring but AST/ALT ratio showed negative correlation. Conclusion: This study elaborated relationship between SADQ-C scoring and laboratory parameters in Indian male ADS patients. It highlighted the requirement of incorporation of serum cortisol along with presently evaluated laboratory parameters for ADS severity evaluation.

A review on electrocoagulation process for the removal of emerging contaminants: theory, fundamentals, and applications.

Electrocoagulation (EC) is an excellent and promising technology in wastewater treatment, as it combines the benefits of coagulation, flotation, and electrochemistry. During the last decade, extensive researches have focused on removal of emerging contaminants by using electrocoagualtion, due to its several advantages like compactness, cost-effectiveness, efficiency, low sludge production, and eco-friendness. Emerging contaminants (ECs) are micropollutants found in trace amounts that discharging into conventional wastewater treatment (WWT) plants entering surface waters and imposing a high threat to human and aquatic life. Various studies reveal that about 90% of emerging contaminants are disposed unscientifically into water bodies, creating problems to public health and environment. The studies on removal of emerging contaminants from wastewater are by global researchers are critically reviewed. The core findings proved that still more research required into optimization of parameters, system design, and economic feasibility to explore the potential of EC combined systems. This review has introduced an innovative collection of current knowledge on electro-coagulation for the removal of emerging contaminants.

Intracranial Inflammatory Myofibroblastic Tumor: A Review of 49 cases.

Inflammatory Myofibroblastic Tumor (IMT) is a rare pathologic entity that was first described in 1973. This lesion is most commonly found in the lungs, but other organs' involvement has also been reported. Intracranial location of Inflammatory Myofibroblastic Tumor is rare, and the first case was reported in 1980. An intriguing fact about the intracranial IMT is its resemblance with meningioma on clinical presentation and neuroimaging. We came across a case of intracranial Inflammatory Myofibroblastic Tumor (IIMT) in a 27-year-old male who presented with recurrent episodes of seizures and was diagnosed as meningioma on neuroimaging. The lesion did not subside with medical management and kept on progressing in size. The patient had to undergo surgery, and diagnosis of Inflammatory Myofibroblastic Tumor was ascertained on histopathology. This 'surprise' diagnosis prompted us to review the literature on all cases of IIMTs reported to date to better understand the entity and its implications. In this review article, we present our observations regarding various studied parameters, including patient profile, clinical presentation, site of involvement, focality of the lesion, special associations, and lines of management of the 49 published cases of IIMTs.

Intracranial Inflammatory Myofibroblastic Tumor: A Review of 49 cases

Inflammatory Myofibroblastic Tumor (IMT) is a rare pathologic entity that was first described in 1973. This lesion is most commonly found in the lungs, but other organs' involvement has also been reported. Intracranial location of Inflammatory Myofibroblastic Tumor is rare, and the first case was reported in 1980. An intriguing fact about the intracranial IMT is its resemblance with meningioma on clinical presentation and neuroimaging. We came across a case of intracranial Inflammatory Myofibroblastic Tumor (IIMT) in a 27-year-old male who presented with recurrent episodes of seizures and was diagnosed as meningioma on neuroimaging. The lesion did not subside with medical management and kept on progressing in size. The patient had to undergo surgery, and diagnosis of Inflammatory Myofibroblastic Tumor was ascertained on histopathology. This 'surprise' diagnosis prompted us to review the literature on all cases of IIMTs reported to date to better understand the entity and its implications. In this review article, we present our observations regarding various studied parameters, including patient profile, clinical presentation, site of involvement, focality of the lesion, special associations, and lines of management of the 49 published cases of IIMTs.

Post-mortem findings in Staphylococcus aureus acute infective endocarditis.

Infective endocarditis (IE) is a microbial infection of the heart valves or the mural endocardium that leads to the formation of vegetations composed of thrombotic debris and microorganisms often associated with the destruction of the cardiac tissues. Most of the infections are bacterial (bacterial endocarditis), although fungi and other microorganisms can be etiological agents. Causative organisms differ among the major high-risk groups. Virulent microorganisms like Staphylococcus aureus, commonly found on the skin, can infect normal or deformed valves and are responsible for 20-30% of all IE cases. Staphylococcus aureus is the major offender in IE among intravenous drug abusers. Acute infective endocarditis is typically caused by infection of a previously normal heart valve by a highly virulent organism (e.g., Staphylococcus aureus) that rapidly produces necrotizing and destructive lesions. These infections may be difficult to cure with antibiotics, and despite appropriate treatment, death can ensue within days to weeks. Here we present autopsy findings of a 31-year-old male patient who died of acute infective endocarditis caused by Staphylococcus aureus as the causative organism.

Techno-economical optimization using Box-Behnken (BB) design for chemical oxygen demand and chloride reduction from hospital wastewater by electro-coagulation.

The study examines the optimum condition of an electro-coagulation (EC) unit for treatment of hospital wastewater (HWW) using iron (Fe) electrodes. The impact of factors such as pH, current, and electrolysis time on COD, chloride, and anode dissolution was investigated. For this purpose, Box-Behnken (BB) design based on the response surface methodology (RSM) was used to design and analyze the results. The predicted value of chemical oxygen demand (COD) and chloride removal at optimum conditions (pH: 7.41, current: 2.64 A and electrolysis time: 41.31 min) were 92.81% and 71.23%, respectively. At same optimum conditions, the value of energy and electrode consumption per kg of COD was 0.06376 kWh/kg COD and 1.362 kg/kg COD, respectively. High value of R2 (i.e., R2  > 99%) for all three responses (Y1 , Y2 , and Y3 ) obtained from ANOVA confirms that the proposed model is valid, accurate, and acceptable. The kinetic study shows linear relationship and follows pseudo-first-order kinetics. Pareto graph shows that the percentage impact of current factor on COD and chloride removal was maximum, that is, 54.984% and 66.79%, respectively. Lastly, the total cost of EC treatment was calculated in terms of COD removal and was found to be 55.47 â‚¹/kg COD. PRACTITIONER POINTS: Using Fe electrode results in 92.81% COD and 71.23% Chloride removal, respectively. High value of R2  > 99% for all three responses from ANOVA confirms the proposed model is valid. Pareto analysis shows current factor has maximum percentage impact on pollutant removal. Kinetic study shows linear relationship and follows pseudo-first-order kinetics.

Optimization and economical study of electro-coagulation unit using CCD to treat real graywater and its reuse potential.

The reclamation of graywater for non-potable purposes has attained utmost importance, particularly in developing nations. The present research aimed to evaluate the optimal condition of electro-coagulation system in treatment of graywater and its reuse. Moreover, the study also evaluates the impact of major operating parameters on pollutant removal and anode dissolution. To achieve this, two-factor (voltage potential and time) and 5-level (- 1, - 0.5, 0, + 0.5, and + 1) full factorial design, based on response surface methodology (RSM) has been executed for the actual design. The data were acquired after conducting 20 experiments, as suggested by RSM (response surface methodology). Design Expert 12.0.8.0 software has been used to design mathematical model to obtain optimum condition (14 V and 47 min) at pH of 7.35, which provides experimental removal efficiency (75.6% chemical oxygen demand, 78.7% total dissolved solids, 93.4% turbidity, and 63.2% chloride) with minimal electrode consumption of 1.38 mg L-1. Adequacy of the model developed has been verified by ANOVA. The operating cost of treating graywater at the optimized condition obtained as 0.7 US$/kg COD.

Post-mortem findings in Staphylococcus aureus acute infective endocarditis

Infective endocarditis (IE) is a microbial infection of the heart valves or the mural endocardium that leads to the formation of vegetations composed of thrombotic debris and microorganisms often associated with the destruction of the cardiac tissues. Most of the infections are bacterial (bacterial endocarditis), although fungi and other microorganisms can be etiological agents. Causative organisms differ among the major high-risk groups. Virulent microorganisms like Staphylococcus aureus, commonly found on the skin, can infect normal or deformed valves and are responsible for 20-30% of all IE cases. Staphylococcus aureus is the major offender in IE among intravenous drug abusers. Acute infective endocarditis is typically caused by infection of a previously normal heart valve by a highly virulent organism (e.g., Staphylococcus aureus) that rapidly produces necrotizing and destructive lesions. These infections may be difficult to cure with antibiotics, and despite appropriate treatment, death can ensue within days to weeks. Here we present autopsy findings of a 31-year-old male patient who died of acute infective endocarditis caused by Staphylococcus aureus as the causative organism.

Comparative study on decentralized treatment technologies for sewage and graywater reuse - a review.

Currently, reservoirs, lakes, rivers etc. are being overloaded by the demand for fresh water, due to rapid industrialization and population explosion, and also the effluents from industries and domestic wastewater are continuously polluting these resources. To address this issue, several decentralized wastewater treatment system (DWTS) have been installed all over the globe to reuse and recycle wastewater/graywater for non-potable uses such as fire protection, toilet-flushing, and landscape irrigation. In this review, a comparison between different DWTS was carried out to evaluate their performance, merits and limitations. Hybrid technologies like the electrically enhanced biomass concentrator reactor and integration of physical/ biological methods with bio-electrochemical systems such as microbial fuel cells were found to be the most promising methods for near complete removal of pollutants from wastewater and also the issue of membrane fouling was reduced to a good extent.