Half and half nail or Lindsay’s nail

A 62-year-old diabetic patient came to the outpatient department due to increasing tiredness in the past few months. On examination, his distal half of fingernails revealed pinkish red transverse band which is sharply demarcated by a dull white band proximally, consistent with half and half nail. Further evaluation showed evidence of chronic kidney disease due to long standing poorly controlled diabetes. Although half and half nail is seen in many conditions, it is relatively a specific clinical marker of end stage kidney disease and hence serves as an important diagnostic clue

4(2) 50 Case Study Dapsone Hypersensitivity Syndrome in a Leprosy Patient

ABSTRACT Introduction: Dapsone Hypersensitivity Syndrome (DHS) is a rare potentially fatal systemic idiosyncratic adverse reaction, with multiorgan involvement also known as sulphone syndrome which is particularly seen in leprosy patients who are on world health organization recommended multidrug therapy (WHO-MDT regimen). DHS is a variant of drug rash with eosinophilia and systemic symptoms (DRESS syndrome) caused by dapsone. Even though reaction common in the leprosy patients there is need such reporting to identify the most venerable patient pool. Case: Here we present a case of DHS developed after 25 days in a female patient with a history of PB-MDT regimen treatment, high grade intermittent fever associated with nausea, myalgia, headache since 20 days; swelling of face, bilateral lower limbs and erythematous rashes were observed all over the body since 4 days. She was presented with fever (102.2 0 F), posterior cervical and axillary lymphadenopathy and moderate bilateral lower limb pitting pedal edema was present. Multiple erythematous papules coalesced all over body predominantly involved on the face, trunk and extremities. The main laboratory data on admission were showed, hemoglobin: 9.6 g/dL; WBC: 14.6 x 10³/ µL; neutrophils: 48% mild left shift, lymphocyte: 20% reactive forms; eosinophils: 16%; increased serum levels of aspartate amino transferase, alanine transaminase and alkaline phosphatase. Patient was improved and discharged on treating with antipyretics, antibiotics, oral and topical corticosteroids and antihistamines

Analytics-based decision-making for service systems: A qualitative study and agenda for future research

While the use of big data tends to add value for business throughout the entire value chain, the integration of big data analytics (BDA) to the decision-making process remains a challenge. This study, based on a systematic literature review, thematic analysis and qualitative interview findings, proposes a set of six-steps to establish both rigor and relevance in the process of analytics-driven decision-making. Our findings illuminate the key steps in this decision process including problem definition, review of past findings, model development, data collection, data analysis as well as actions on insights in the context of service systems. Although findings have been discussed in a sequence of steps, the study identifies them as interdependent and iterative. The proposed six-step analytics-driven decision-making process, practical evidence from service systems, and future research agenda, provide altogether the foundation for future scholarly research and can serve as a step-wise guide for industry practitioners

Study of inside-out technique of trans-obturator tape for treatment of stress urinary incontinence in women with utero-vaginal prolapse

Background: Assessment of the success rates and complications of inside-out technique of Trans-Vaginal Tape (Obturator) (TVT-O) for treatment of stress urinary incontinence (SUI) in women with utero-vaginal prolapse. Materials and Methods: A total of 30 consenting subjects with SUI and utero-vaginal prolapse were subjected to TVT-O surgery. These subjects were closely monitored for complications and success rate of surgery up to 1 year of surgery. Results: Urinary tract infection (16.67%) was the most common early post-operative complication. Groin pain (23%) was the most common late post-operative complication while denovo urgency developed in 3 (11.54%) subjects. Majority (88.46%) of subjects had total improvement at 3month follow-up while 100% subjects had total improvement at 12 month follow-up with a "definitely improved quality-of-life." Conclusion: The TVT-O (inside-out) appears to have performed favorably as a safe and effective surgery for SUI associated with utero-vaginal prolapse