Use of satellite remote sensing as a monitoring tool for land and water resources development activities in an Indian tropical site

With the availability of satellite data from free data domain, remote sensing has increasingly become a fast-hand tool for monitoring of land and water resources development activities with minimal cost and time. Here, we verified construction of check dams and implementation of plantation activities in two districts of Tripura state using Landsat and Sentinel-2 images for the years 2008 and 2016-2017, respectively. We applied spectral reflectance curves and index-based proxies to quantify these activities for two time periods. A subset of the total check dams and plantation sites was chosen on the basis of site condition, nature of check dams, and planted species for identification on satellite images, and another subset was randomly chosen to validate identification procedure. The normalized difference water index (NDWI) derived from Landsat and Senitnel-2 were used to quantify water area evolved, qualify the water quality, and influence of associated tree shadows. Three types of check dams were observed, i.e., full, partial, and fully soil exposed on the basis of the presence of grass or scrub on the check dams. Based on the nature of check dam and site characteristics, we classified the water bodies under 11-categories using six interpretation keys (size, shape, water depth, quality, shadow of associated trees, catchment area). The check dams constructed on existing narrow gullies totally covered by branches or associated plants were not identified without field verification. Further, use of EVI enabled us to approve the plantation activities and adjudge the corresponding increase in vegetation vigor. The plantation activities were established based on the presence and absence of existing vegetation. Clearing on the plantation sites for plantation shows differential increase in EVI values during the initial years. The 403 plantation sites were categorized into 12 major groups on the basis of presence of dominant species and site conditions. The dominant species were Areca catechu, Musa paradisiaca, Ananas comosus, Bambusa sp., and mix plantation of A. catechu and M. paradisiaca. However, the highest maximum increase in average EVI was observed for the pine apple plantation sites (0.11), followed by Bambussa sp. (0.10). These sites were fully covered with plantation without any exposed soil. The present study successfully demonstrates a satellite-based survey supplemented with ground information evaluating the changes in vegetation profile due to plantation activities, locations of check dams, extent of water bodies, downstream irrigation, and catchment area of water bodies.

Application of thin layer activation technique for monitoring corrosion of carbon steel in hydrocarbon processing environment

Acidic crude oil transportation and processing in petroleum refining and petrochemical operations cause corrosion in the pipelines and associated components. Corrosion monitoring is invariably required to test and prove operational reliability. Thin Layer Activation (TLA) technique is a nuclear technique used for measurement of corrosion and erosion of materials. The technique involves irradiation of material with high energy ion beam from an accelerator and measurement of loss of radioactivity after the material is subjected to corrosive environment. In the present study, TLA technique has been used to monitor corrosion of carbon steel (CS) in crude oil environment at high temperature. Different CS coupons were irradiated with a 13 MeV proton beam to produce Cobalt-56 radioisotope on the surface of the coupons. The corrosion studies were carried out by subjecting the irradiated coupons to a corrosive environment, i.e, uninhibited straight run gas oil (SRGO) containing known amount of naphthenic acid (NA) at high temperature. The effects of different parameters, such as, concentration of NA, temperature and fluid velocity (rpm) on corrosion behaviour of CS were studied.

Far-from-equilibrium bidirectional transport system with constrained entrances competing for pool of limited resources

Motivated by the wide occurrence of limited resources in many real-life systems, we investigate two-lane totally asymmetric simple exclusion process with constrained entrances under finite supply of particles. We analyze the system within the framework of mean-field theory and examine various complex phenomena, including phase separation, phase transition, and symmetry breaking. Based on the theoretical analysis, we analytically derive the phase boundaries for various symmetric as well as asymmetric phases. It has been observed that the symmetry-breaking phenomenon initiates even for very small number of particles in the system. The phases with broken symmetry originates as shock-low density phase under limited resources, which is in contrast to the scenario with infinite number of particles. As expected, the symmetry breaking continues to persist even for higher values of system particles. Seven stationary phases are observed, with three of them exhibiting symmetry-breaking phenomena. The critical values of a total number of system particles, beyond which various symmetrical and asymmetrical phases appear and disappear are identified. Theoretical outcomes are supported by extensive Monte Carlo simulations. Finally, the size-scaling effect and symmetry-breaking phenomenon on the simulation results have also been examined based on particle density histograms.

Conventional vs virtual autopsy with postmortem MRI in phenotypic characterization of stillbirths and fetal malformations

OBJECTIVE

To compare virtual autopsy using postmortem magnetic resonance imaging (MRI) with conventional autopsy with respect to phenotypic characterization of stillbirths and malformed fetuses, and acceptability to parents.

METHODS

This was a prospective diagnostic evaluation study, conducted from June 2013 to June 2015, including stillbirths and pregnancies terminated owing to fetal malformation at ≥ 20 weeks' gestation, for which parental consent to both conventional autopsy and postmortem MRI was obtained. Cases of maternal and obstetric cause of fetal demise were excluded. Whole-body postmortem MRI (at 1.5 T) was performed prior to conventional autopsy. Taking conventional autopsy as the diagnostic gold standard, postmortem MRI findings alone, or in conjunction with other minimally invasive prenatal and postmortem investigations, were assessed and compared for diagnostic accuracy.

RESULTS

Parental consent for both conventional autopsy and postmortem MRI was obtained in 52 cases of which 43 were included in the analysis. In 35 (81.4%) cases, the final diagnosis based on virtual autopsy with postmortem MRI was in agreement with that of conventional autopsy. With conventional autopsy as the reference standard, sensitivity, specificity, positive and negative predictive values of postmortem MRI were, respectively: 77.7%, 99.8%, 97.4% and 98.0% for whole-body assessment; 93.1%, 99.0%, 87.1% and 99.5% for the nervous system; 61.0%, 100.0%, 100.0% and 96.7% for the cardiovascular system; 91.1%, 100.0%, 100.0% and 98.0% for the pulmonary system; 80.6%, 99.8%, 96.7% and 98.7% for the abdomen; 96.2%, 99.7%, 96.2% and 99.7% for the renal system; and 66.7%, 100.0%, 100.0% and 97.2% for the musculoskeletal system. Virtual autopsy was acceptable to 96.8% of families as compared with conventional autopsy to 82.5%.

CONCLUSIONS

Virtual autopsy using postmortem MRI and other minimally invasive investigations can be an acceptable alternative to conventional autopsy when the latter is refused by the parents. Postmortem MRI is more acceptable to parents and can provide additional diagnostic information on brain and spinal cord malformations. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Reactivity studies of an imine-functionalised phosphaalkene; unusual electrostatic and supramolecular stabilisation of a σ2λ3-phosphorus motif via hydrogen bonding

Protonation with strong acids at an imine over addition to a phosphaalkene; resulting adducts display hydrogen bonding.

TUBERCULOSIS IN BCG VACCINATED AND UNVACCINATED CHILDREN

One hundred, non-consecutive, non-randomized, cases of tuberculosis divided in 2 groups i.e. Group A including 50 BCG vaccinated children and Group B including 50 unvaccinated children were studied to determine the pattern of tuberculosis and the role of protein energy malnutrition in the pathogenesis of tuberculosis. Thirty four per cent of Group A and 52 per cent of Group B had severe protein energy malnutrition. Sixty eight per cent in Group A and 76 per cent in Group B had intrathoracic forms of tuberculosis. Twelve (24%) patients in Group A and 11 (22%) in Group B suffered from serious forms of tuberculosis including tubercular meningitis, miliary tuberculosis and disseminated tuberculosis. The difference was not statistically different (p>0.05). However, in severe form of tuberculosis, the morbidity in vaccinated group was less. Sixty six per cent of vaccinated children with disseminated forms of tuberculosis had features of severe protein energy malnutrition. BCG is not effective in preventing tubercular infection in children of preschool age. It is effective to a certain extent in localizing the infection to a particular organ. Severe protein energy malnutrition is a contributing factor in the genesis of tuberculosis in preschool children vaccinated with BCG at or immediately after birth.

Assessing finasteride-associated sexual dysfunction using the FAERS database

BACKGROUND

Postmarketing reports suggest that finasteride causes sexual dysfunction despite a low incidence reported in clinical trials. Therefore, the extent of risk remains unknown.

OBJECTIVE

To determine whether the risk of sexual dysfunction is higher among individuals treated with finasteride compared to a baseline risk for all other drugs using the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) database.

METHODS

A case by non-case disproportionality approach was used whereby a reporting odds ratio (ROR) with 95% confidence interval (CI) was calculated. The National Ambulatory Medical Care Survey (NAMCS) was used to confirm results.

RESULTS

A significant disproportionality in reporting of sexual dysfunction with the use of finasteride was observed whether finasteride was indicated for hair loss (ROR = 138.17, 95% CI: 133.13, 143.4), prostatic hyperplasia (ROR = 93.88, 95% CI: 84.62, 104.16) or any indication (ROR = 173.18, 95% CI: 171.08, 175.31). When these results were stratified by age, disproportionality was strongest at 31-45 years.

CONCLUSION

Use of finasteride has led to an increase in reports of sexual dysfunction where it is believed to be the primary suspect.

Tofacitinib in the Treatment of Rheumatoid Arthritis and Chronic Plaque Psoriasis

Tofacitinib is an oral immunosuppressant approved for the treatment of rheumatoid arthritis (RA) and is currently undergoing investigation (Phase III trials) for treating chronic plaque psoriasis. Tofacitinib inhibits Janus kinases (JAKs), which are essential for the signaling of multiple inflammatory pathways and have been implicated in the pathogenesis of RA and psoriasis. The efficacy and safety of tofacitinib in the treatment of RA and psoriasis have been demonstrated in Phase III trials. Across all studies, the efficacy of tofacitinib in alleviating symptoms of RA and psoriasis were superior to placebo. Moreover, treatment was generally well-tolerated, with the most frequently reported adverse events, for both RA and psoriasis, being nasopharyngitis and upper respiratory tract infection. As such, tofacitinib proves to be an effective therapeutic option for RA and a promising new therapy for psoriasis.

Concurrent infection of Bluetongue and Peste-des-petits-ruminants virus in small ruminants in Haryana State of India

Bluetongue (BT) and peste-des-petits-ruminants (PPR) are major transboundary diseases of small ruminant, which are endemic in India. Testing of bluetongue virus (BTV) and peste-des-petits-ruminants virus (PPRV) from recent outbreaks (2015-2016) in different regions of Haryana State of India revealed that 27.5% of the samples showed the presence of dual infection of BTV and PPRV. Analysis of Seg-2 of BTV (the serotype-determining protein) showed the presence of BTV-12w in several isolates. However, analysis of N gene fragment amplicons showed that viruses belong to lineage IV were most closely related to a pathogenic strain of PPRV from Delhi. This is the first report of co-circulation of PPRV lineage IV and bluetongue virus serotype 12 in the state.

Haematological profile of 21 patients with hairy cell leukaemia in a tertiary care centre of north India

Background & objectives:

Hairy cell leukaemia (HCL) is a B cell neoplasm which constitutes around 2 per cent of all the lymphoid leukaemias. It has a characteristic morphology and immunophenotypic profile. It is important to distinguish HCL from other B cell lymphoproliferative disorders due to availability of different chemotherapeutic agents. This study presents clinical, haematological and immunophenotypic profile of patients with HCL seen over a period of four years in a tertiary care hospital in north India.

Methods:

Twenty one cases of hairy cell leukaemia were analyzed for their clinical details, haemogram, bone marrow examination and immunophenotypic findings.

Results:

Age of the patients ranged from 28-76 yr with male predominance. Weakness and fever were commonest presentations. Splenomegaly, hepatomegaly, lymphadenopathy were seen in decreasing order of frequency. Anaemia was noted in all 21 patients, leukopenia in 15 and thrombocytopenia in 19 cases. Fourteen patients were pancytopenic. Bone marrow examination showed typical hairy cells in all cases. Immunophenotyping showed expression of CD19, CD20, CD103, CD25 and CD11c in all cases, while positivity was seen for CD79b in 93.7 per cent, kappa light chain restriction in 60 per cent and lambda in 40 per cent cases. Notably, 20 per cent showed CD10 and 12 per cent showed CD23 expression.

Interpretation & conclusions:

This study reveals some unusual findings in otherwise classical disease entity, like absence of palpable spleen, presence of lymphadenopathy, normal or elevated leukocyte counts, expression of CD10, which at times could be diagnostically challenging.

Update on Efinaconazole 10% Topical Solution for the Treatment of Onychomycosis

Efinaconazole 10% nail solution is a novel topical antifungal drug for the treatment of onychomycosis. Two Phase III trials were completed using efinaconazole 10% nail solution, where 17.8% and 15.2% of patients achieved complete cure, and 55.2% and 53.4% achieved mycological cure. Several post hoc analyses were carried out using data from Phase III trials to determine the efficacy of efinaconazole with respect to disease duration, disease progression, and comorbidities of diabetes or tinea pedis with onychomycosis. Efinaconazole produced higher efficacy rates with patients presenting onychomycosis in a small portion of the toenail (≤25%) for a shorter duration of time (<1 year and 1-5 years). When patients presenting with both onychomycosis and tinea pedis underwent concurrent treatment, efficacy of efinaconazole increased from 16.1% to 29.4%, suggesting combination therapy improved results. Most interestingly, there was no difference in efinaconazole efficacy between diabetic and non-diabetic groups, indicating efinaconazole could be a safe and effective form of treatment for diabetics. Overall, efinaconazole 10% nail solution shows potential as an antifungal therapy for the treatment of onychomycosis.

A method of REM-NREM sleep distinction using ECG signal for unobtrusive personal monitoring

Computers are used extensively in sleep labs for polysomnography and for assistance in sleep staging. However, the test is highly inconvenient to the patient and requires availability of specially equipped sleep labs. Alternative approaches that enable unobtrusive in-home sleep staging with ECG or other signals are highly desirable. In this paper we describe a method that can be used for distinction of REM and NREM sleep stages using spectral and non-linear features of ECG derived RR interval series. To test the accuracy of the system, we extracted the RR interval series from sleep studies of 20 young healthy individuals. Time domain, spectral and non-linear features were computed and tested for discriminability. Features showing high degree of discrimination were selected. A polynomial support vector machine was trained with selected features - percent power in HF band, LF/HF, Poincare plot parameters, exponents from Detrended fluctuation analysis, and sampEn of the half of the signals. The hyperplane was used to classify the other half of the data. The results show an accuracy of 76.25% with Cohen's kappa as 0.52 for a two-class model of five minute signal. The results dropped to 72.8% accuracy and k=0.48 for the two class model of one minute signal. The minimal set offers a reasonable trade-off for possible in-home monitoring, at least for some conditions that require only REM-NREM distinction. The method after extensive trials and standardisation, can alleviate the load of special purpose PSG labs and enable the tests to be done on general purpose computers.

Minimally invasive image-guided interventional management of Haemobilia

Hemobilia is a well known cause for upper gastrointestinal (UGI) bleed seen commonly in setting of iatrogenic or accidental trauma and various inflammatory and neoplastic conditions. Patients present with UGI bleed and symptoms of associated biliary obstruction. Management options in intractable cases are surgery and endovascular embolisation. We report a series of eighteen patients presented with severe hemobilia from January 2010 to October 2014, who were managed by endovascular approach in our department. Etiology in these patients were trauma (n = 3), liver biopsy (n = 3), surgery (n = 3), percutaneous procedures (n = 2), inflammatory (n-3), neoplasm (n = 1) and the rest were idiopathic. Angiography revealed pseudoaneurysms of hepatic artery (n = 5), splenic artery (n = 1) and gastroduodenal artery (n = 1) and arterio-biliary fistula (n = 1). Embolising agents used were detachable coils (n = 10) and glue (n = 8). All patients had technical and clinical success with minor non-consequential complications. Our findings show that endovascular embolisation is a simple, safe, accurate and effective treatment in patients with severe hemobilia. It is a viable alternative to major and potentially morbid surgeries.

Detecting mutation pattern of drug-resistant Mycobacterium tuberculosis isolates in Himachal Pradesh using GenoType(®) MTBDRplus assay

CONTEXT

Tuberculosis (TB) is a major public health problem in India and a principal cause of death in adults, especially among the economically productive age group. India accounts for one-fifth of the global burden of TB. It is estimated that about 40% of Indian population is infected with TB bacillus. The GenoType® MTBDRplus molecular method allows rapid diagnosis of the clinical samples and detection of the most common mutations in the genes associated with rifampicin (R) and isoniazid (H) resistance.

AIMS

To study the drug resistance and mutational patterns in multidrug-resistant (MDR) suspects clinical strains using GenoType® MTBDRplus assay.

SUBJECTS AND METHODS

A total of 770 sputum samples of the MDR-TB suspects were included in this study, which were received at Intermediate Reference Laboratory, Government TB Sanatorium, Dharampur, Solan, Himachal Pradesh from the Designated Microscopy Centres of Himachal Pradesh for the culture and susceptibility testing. All the 521 Mycobacterium tuberculosis complex (MTBC) strains were subjected to GenoType® MTBDRplus (HAIN Lifescience) assay to detect molecular resistance pattern to first line anti-tubercular drugs (isoniazid and rifampicin).

RESULTS

Of 770 samples, 556 (72.20%) were from male and 214 (27.80%) were from female. Among the 521 MTBC strains, 19.76% were found to be MDR and mono-resistance to isoniazid and rifampicin was detected in 8.63% and 6.14% strains respectively. About 74.81%, 76.35% and 5.40% strains harboured known mutation in rpoB, katG and inhA genes respectively.

CONCLUSIONS

In rpoB gene, the most common mutation is associated with S531 L region. The GenoType® MTBDRplus assay is a rapid test for the detection of the most common mutations in MDR-TB strains. In our study, unknown rpoB gene mutations were found in 25.18% strains that may further be detected by gene sequencing.

Adalimumab (Humira) for the Treatment of Hidradenitis Suppurativa

Adalimumab (Humira®) is a novel therapy approved by the US Food and Drug Administration, Health Canada, and the European Commission for the treatment of hidradenitis suppurativa (HS). Results of two Phase III trials of adalimumab demonstrate significantly higher efficacies compared to placebo. Primary efficacy outcome of 50% reduction in abscess and inflammatory nodule count was seen in 41.8% and 58.9% of participants receiving adalimumab in PIONEER I and PIONEER II studies, respectively, showing substantial improvement compared with placebo groups in both trials (26.0% and 27.6%, respectively). Although the significance of secondary efficacy measures of adalimumab every week treatment (EW) was not consistent between PIONEER I and PIONEER II studies, participants achieving abscess and inflammatory nodule counts of 0, 1, or 2 were significant (EW 51.8%) compared to placebo (32.2%) in the PIONEER II trial. Participants also demonstrated a marked decrease in skin pain measurements from baseline between EW patients (45.7%) and placebo (20.7%) in the PIONEER II trial. Modified Sartorius scores were decreased from baseline in both PIONEER I (-24.4) and PIONEER II (-28.9) trials versus placebo (-15.7 and -9.5, respectively). Adverse events were mild to moderate and comparable between all treatment groups including placebo. Taken together, these data conclude that treatment of HS with adalimumab is a safe and effective therapy resulting in a significant decrease in abscess and inflammatory nodule counts within the first 12 weeks of treatment.

Optimization of dry period in Karan Fries cow

Aim:

The objective of this study was to optimize dry period (DP) length that can maximize the production across adjacent lactations and overall lifetime yield.

Materials and Methods:

Performance records with respect to DP spread over a period of 15-year in Karan Fries (KF) cattle maintained at Livestock Research Centre (National Dairy Research Institute), were collected for the study. Data of 681 KF cows were analyzed by least square technique to examine the effect of non-genetic factors on DP. Season of calving was classified into four seasons: Winter season (December-March), summer season (April-June), rainy season (July-September), and autumn season (October-November); period of calving into five periods: 1998-2000 (1-period), 2001-2003 (II-period), 2004-2006 (III-period), 2007-2009 (IV-period), and 2010-2012 (V-period), and parity into six parities, i.e., 1^st, 2^nd, 3^rd, 4^th, 5^th, and >6^th parities to see the effect of non-genetic factors on DP.

Results:

Period of calving, season of calving, and parity did not affect the DP significantly (p<0.05). The overall least square mean of DP was 67.93±2.12 days. For the optimization of DP with regard to milk productivity, analysis was carried out by class interval method. DP was classified into eight classes (<22, 23-45, 46-67, 68-89, 90-111, 112-133, 134-155, and >156 days), and optimum level was obtained at 46-67 days (3^rd class) with the following respective milk yield (MY) of 305 daily MY (4016.44±43.68 kg), total MY (4704.21±61.51 kg), MY per day of lactation length (13.03±0.13 kg), and MY per day of calving interval (11.68±0.41 kg).

Conclusion:

From the study, it was concluded that this optimal DP length (46-67 days) is suitable for maximizing the production. Hence, one should aim to dry off pregnant cows to achieve a DP of appropriate length to enhance productivity in the next lactation, as very short and very long DP reduces the economic profitability in dairy animals.

Efficacy of tofacitinib in treatment of alopecia universalis in two patients

BACKGROUND

Autoimmune-triggered non-scarring hair loss is a feature of alopecia areata (AA). Initially patchy and often self-limited, severe hair loss forms include the complete loss of scalp hair or alopecia totalis (AT) and complete loss of all hair or alopecia universalis (AU). For AT and AU a reliable treatment has remained elusive. The targeted kinase inhibitor tofacitinib, in current use for treatment of other immune diseases, has been hypothesized as a viable option for AA, AT and AU therapy and a few case reports support this.

OBJECTIVE

Our study aims to provide evidence for the effectiveness of tofacitinib in the treatment of AU.

METHODS

Two patients diagnosed with long-term AU were prescribed tofacitinib citrate at a dosage of 5 mg twice daily and observed for eight months.

RESULTS

In the first patient, beard growth was significant by 3 months of treatment. By 6 months of treatment, hair growth was apparent throughout the entire body. By 8 months of treatment, scalp hair continued to grow longer and thicker. In addition, eyelashes and eyebrows were established. In the second patient, a noticeable increase in scalp hair was present just 1 month into treatment. By 4 months into treatment, significant scalp regrowth was observed as well as eyelash, eyebrow and beard regrowth. Axillary hair regrowth and isolated leg hair was noted by 8 months.

CONCLUSION

In our patients, tofacitinib successfully alleviated AU in the absence of significant adverse side-effects. We recommend that further study be required to establish safety and confirm efficacy.

Incidence of Retinopathy of Prematurity and Its Association with Oxygen Therapy in Preterm Low Birth Weight Babies

Introduction: The objectives of this study were to study the incidence and risk factors of retinopathy of prematurity (ROP) among preterm low birth weight babies and its association with oxygen therapy.Material and Methods: During one year study period, 50 neonates, who had fulfilled the inclusion criteria (born at gestational age ≤ 35 wks), were included in the present study. They were examined by indirect ophthalmoscopy by an ophthalmologist in NICU or ophthalmology outdoor. Staging of ROP was done according to the International classification. Data obtained from this study were entered in Microsoft Excel and subsequently analysed in SPSS version 20.0.Results: Among study population, 12 neonates (24%) showed evidence of retinopathy of prematurity, and Stage 2 ROP was most common (41.7%) within this group. Those neonates who had born ≤28 wks gestational age, showed more incidence (75%) of ROP. There was significant association between ROP and prematurity, low birth weight, mechanical ventilation, duration and concentration of oxygen therapy.Conclusion: Apart from prematurity and low birth weight, oxygen therapy also carries significant risk for ROP. Thus, judicious use of oxygen in premature babies can reduce incidence of ROP significantly.J Nepal Paediatr Soc 2015;35(3):247-252

Role of diffusion weighted imaging in diagnosis of post transplant lymphoproliferative disorders: Case reports and review of literature

Post transplant lymphoproliferative disorder include a spectrum of conditions occurring in immunosuppressed post transplant recipients, lymphoma being the most ominous. ¹⁸F-fludeoxyglucose positron emission tomography with computed tomography CT) is the current imaging gold standard for lymphoma imaging as it allows both morphological and functional assessment. CT and/or conventional magnetic resonance imaging (MRI) are used for morphological evaluation in transplant recipients. Integrating diffusion weighted imaging with apparent diffusion coefficient analysis in MRI protocol enhances its sensitivity and may prove invaluable in response assessment in transplant recipients.

The prevalence of unsuspected onychomycosis and its causative organisms in a multicentre Canadian sample of 30 000 patients visiting physicians' offices

BACKGROUND

Onychomycosis is difficult to treat and a concern for many patients. Prevalence estimates of onychomycosis in North American clinic samples have been higher than what has been reported for general populations.

OBJECTIVE

A large, multicentre study was conducted to estimate the prevalence of toenail onychomycosis in the Canadian population.

METHODS

Patients were recruited from the offices of three dermatologists and one family physician in Ontario, Canada. Nail samples for mycological testing were obtained from normal and abnormal-looking nails. This sample of 32 193 patients includes our previous published study of 15 000 patients.

RESULTS

Abnormal nails were observed in 4350 patients. Of these, the prevalence of culture-confirmed toenail onychomycosis was estimated to be 6.7% (95% CI, 6.41-6.96%). Following sex and age adjustments for the general population, the estimated prevalence of toenail onychomycosis in Canada was 6.4% (95% CI, 6.12%-6.65%). The distribution of fungal organisms in culture-confirmed onychomycosis was 71.9% dermatophytes, 20.4% non-dermatophyte moulds and 7.6% yeasts. Toenail onychomycosis was four times more prevalent in those over the age of 60 years than below the age of 60 years.

CONCLUSION

The present data highlights that onychomycosis may be a growing medical concern among ageing patients.

A prospective study of wound infection among post-discharge patients at a level 1 trauma centre of India

BACKGROUND AND AIM

To study the rate of wound infections in the post-discharged patient population and to assess the usefulness of post-discharge surveillance.

METHODS

A prospective surveillance of all the post-discharged trauma patients was done during a period of 6 months. Discharge instructions were given to all the patients regarding identification of the signs and symptoms of wound infections. They were telephonically followed up after a week to enquire about the wound condition and followed up in the outpatient department (OPD). Microbiology culture samples of those showing any signs and symptoms of infections were sent and their antimicrobial therapy, any change in the treatment schedule and the length of their hospital stay were noted. Factors such as wound class, type of surgeries and readmissions were noted.

RESULTS

A total of 281 postdischarge patients were enrolled, of which 101 were completely followed up for wound infections. Males were predominant (89%). Of the 101 patients, 42 (41.6%) patients wound showed infection during the intense follow-up in the OPD. However, 59 patients (59/101, 58.4%) showed wound swab culture positivity before discharge. These 42 patients developed signs and symptoms of infection post-discharge; 23 (22.7%) of them had change of antibiotic therapy during the follow-up period due to culture positivity. Acinetobacter sp., Staphylococcus aureus and Klebsiella pneumoniae were the predominant organisms isolated in the study. A total of 45 patients (44.5%) had to be readmitted due to wound site infections.

CONCLUSIONS

Wound infections are common after discharge among trauma patients highlighting the importance of active surveillance and participation of patients.

Conventional and fluorescent based semen quality assessment in Karan Fries bulls

Aim:

The present study was carried out on semen ejaculates of 15 Karan Fries (KF) bulls maintained at Artificial Breeding Research Centre, National Dairy Research Institute, Karnal, India with an objective to evaluate the relationship between the conventional and fluorescent based semen quality analysis of the bulls.

Materials and Methods:

A total of 96 ejaculates were collected from 15 KF (Holstein Friesian [HF] crossbred) bulls. Semen were evaluated for color, volume, mass activity (MA) and percentage of individual motility (IM), sperm concentration, percent live spermatozoa, hypo-osmotic swelling test and acrosome integrity, chromatin integrity, sperm viability, and membrane integrity. Data were analyzed using SPSS software package for descriptive analysis. The correlation between rankings of sires based on conventional and fluorescent semen parameters were calculated by Spearman’s rank correlation coefficient.

Results:

The average ejaculates volume (ml), sperm concentration (10⁶/ml), MA, IM (%), live (%), morphological abnormalities (%), host (%), acrosome integrity (%), chromomycin A3 (CMA3) (%), SYBR-PI (%), and fluorescent isothiocyanate-peanut agglutinin (FITC-PNA) (%) were 4.57±0.36, 1162.98±97.93, 2.95±0.09, 60.8±1.22, 71.41±2.10, 9.31±1.15, 65.5±1.81, 86.6±1.59, 3.53±0.43, 65.39±2.23 and 74.47±2.53, respectively. Rank correlations were found to be significant for SYBR-PI and FITC-PNA with most of the parameters evaluated by conventional methods. Overall, among conventional criteria, IM revealed ranking of bulls almost similar to that of fluorescent criteria.

Conclusion:

Overview of our results indicated that, among conventional criteria, MA and IM revealed ranking of bulls almost similar to that of fluorescent criteria.

Genetic and environmental causes of variation in gestation length of Jersey crossbred cattle

AIM

The objective of this study was to investigate the effect of genetic and non-genetic factors and estimate the genetic parameter for gestation length (GL) of Jersey crossbred cattle.

MATERIALS AND METHODS

The data included the 986 parturition records on Jersey crossbred cattle maintained at the Eastern Regional Station of ICAR-National Dairy Research Institute, Kalyani, West Bengal, India during 36 years (1978-2013). The data were analyzed applying mixed model least square technique considering the fixed effects of genetic group, season of calving, period of calving, parity of animal, birth weight, and sex of calf born from animal. The effect of sire was included as a random effect in the model.

RESULTS

The genetic group of animal, season of calving, parity of animal, and birth weight of calf born were found to be a significant source of variation in the GL, whereas the period of calving and sex of calf did not affect this trait. Cows with <50% and >62.5% Jersey inheritance had the shortest and longest GLs, respectively. Cows calved in summer and rainy season had shorter GL than those calved in the winter season. Older cows in 4(th) parity carried calves for longer days than the cows in 1(st) parity. The increase in calf birth weight significantly (p<0.01) contributed to a linear increase in GL value in this study. The heritability estimate of GL was 0.24±0.08.

CONCLUSION

It can be concluded that selection for lower GL without distressing future growth of calf can be used to reduce calving difficulty, but a very small standard deviation of GL limits the benefit. Moreover, more accurate prediction of calving date will help in better management and health care of pregnant animals.

Anticipating regime shifts in gene expression: The case of an autoactivating positive feedback loop

Considerable evidence suggests that anticipating sudden shifts from one state to another in bistable dynamical systems is a challenging task; examples include ecosystems, financial markets, and complex diseases. In this paper, we investigate the effects of additive, multiplicative, and cross-correlated stochastic perturbations on determining the regime shifts in a bistable gene regulatory system, which gives rise to two distinct states of low and high concentrations of protein. We obtain the stationary probability density and mean first-passage time of the system. We show that increasing the additive (multiplicative) noise intensity induces a regime shift from a low (high) to a high (low) protein concentration state. However, an increase in the cross-correlation intensity always induces regime shifts from a high to a low protein concentration state. For both bifurcation-induced (often called the tipping point) and noise-induced (called stochastic switching) regime shifts, we further explore the robustness of recently developed critical-down-based early warning signal (EWS) indicators (e.g., rising variance and lag-1 autocorrelation) on our simulated time-series data. We identify that using EWS indicators, prediction of an impending bifurcation-induced regime shift is relatively easier than that of a noise-induced regime shift in the considered system. Moreover, the success of EWS indicators also strongly depends upon the nature of the noise.

Nivolumab for Metastatic Melanoma

Melanoma is an aggressive skin cancer with a generally poor prognosis at Stage III-IV disease. Traditionally, metastatic melanoma was treated by surgical resection, when possible, and with systemic chemotherapy. New developments in molecular biology have led to the identification of immune checkpoints which are exploited by malignant cells, allowing them to go undetected by the immune system. Nivolumab (Opdivo®) is a human monoclonal antibody which prevents immune inhibition by interacting with PD-1 on tumor cells; thus, increasing tumor-specific T cell proliferation. Nivolumab has demonstrated efficacy superior to that of standard chemotherapy and relative safety in clinical trials. Indeed, the outcomes for patients with advanced melanoma are being improved by novel biologic agents such as nivolumab.

Comparative study of immediate functional loading and immediate non-functional loading of monocortical implants

BACKGROUND

Attempts to shorten the overall length of treatment have focused on immediate loading, subsequent to implant placement. Prosthetic rehabilitation immediately after implant placement can be either functional or non-functional in nature. There is paucity of literature on the comparative evaluation of immediate functional and immediate non-functional loading of implants. This in-vivo study was undertaken to comparatively evaluate Immediate Functional Loading and Immediate Non-Functional Loading of monocortical implants with a follow-up period of 18 months.

METHODS

50 partially edentulous cases were selected for the study. The cases were divided into two groups. In first group (Group-1), 25 implants were subjected to immediate functional loading. In second group (Group-2), 25 implants were subjected to immediate non-functional loading. The crestal bone loss, clinical stability and degree of osseointegration of these two groups were comparatively evaluated.

RESULTS

The crestal bone loss in both groups was within acceptable limits. The implant stability, which is a reflection of the status of bone-to-implant interface, was comparable in both the groups at different time intervals. Although, the ISQ values in Group-2 were slightly higher than those in Group-1, the results were not statistically significant. Radiodensity indicating degree of osseointegration at different time intervals in both groups was also comparable.

CONCLUSION

Both the IFL and INFL protocols can be undertaken satisfactorily in rehabilitation using endosseous implants; however, the main factors for success in IFL and INFL are case selection, meticulous treatment planning and the precision of technique.

Tavaborole topical solution, 5% for the treatment of toenail onychomycosis

Tavaborole topical solution, 5% (tavaborole) is a novel, boron-based, antifungal pharmaceutical agent indicated for treatment of toenail onychomycosis due to the dermatophytes Trichophyton rubrum or Trichophyton mentagrophytes. In preclinical studies, tavaborole effectively penetrated through full-thickness, non-diseased cadaver fingernails, including those with up to four layers of nail polish. Limited systemic absorption was observed following topical application of tavaborole. In phase III clinical trials involving patients with distal subungual onychomycosis affecting 20-60% of a target great toenail, significantly more patients treated with tavaborole versus vehicle achieved completely clear nail with negative mycology following daily application for 48 weeks. Treatment-emergent adverse events reported by at least 1% of patients treated with tavaborole and at a greater frequency versus vehicle included ingrown toenail, exfoliation, erythema and dermatitis. Treatment discontinuations were uncommon. Results from preclinical studies and phase III clinical trials establish tavaborole as a safe and efficacious treatment for toenail onychomycosis.

The Relevance of Interictal Bold Changes to Lateralize Seizure Focus Using Simultaneous EEG-fMRI

Background and Purpose:

The main challenge in assessing patients with epilepsy is the localization of neuronal networks involved in seizure generation and the lateralization of seizure onset. Electro encephalogram-functional magnetic resonance imaging (EEG-fMRI) is a noninvasive multimodal imaging technique for epilepsies where the data is acquired based on the interictal epileptiform discharges (IED). Since this is a new technique, the specificity for lateralizing epileptic focus is yet to be established. The peak blood oxygen level dependent (BOLD) signal in an interictal recording is known to correlate with seizure onset focus. In this study we are proposing a simple and practical method without the need for high end post processing techniques of fmri data. The peak BOLD signal derived from EEG-fMRI aids to lateralise seizure focus in a given cerebral lobe (region of interest, ROI). This is a very useful tool in a clinical setting on a given individual clinical case, when other modalities may be conflicting or inconclusive.

Methods:

We analyzed simultaneous EEG-fMRI of 10 different types of refractory epilepsy. The lateralization index was calculated from the statistical significant clusters obtained between the different ROI and results were validated with other modalities.

Results:

Lateralization of seizure focus corroborated well in temporal and extratemporal lobe epilepsy, reflex epilepsy and lesional epilepsy. The only drawback of EEG-fMRI in our study was if insignificant BOLD changes were associated with the given IED.

Conclusions:

EEG-fMRI can be helpful additional tool in the pre-surgical work-up of refractory epilepsy particularly when lateralization with other modalities is conflicting or inconclusive.

An analysis of time utilization and cancellations of scheduled cases in the main operation theater complex of a tertiary care teaching institute of North India

Context:

Operation theater (OT) utilization.

Aims:

To analyze the time utilization and to assess the stated causes of cancellations of scheduled cases in the OT complex of a tertiary care teaching institute.

Settings and Design:

This prospective study was carried out from December 2010 to April 2011.

Materials and Methods:

each of the 16 OT tables was observed for 6 days (total 96 days). The available resource hours were taken as 0800-1600 hrs. (480 min/day; 46,080 min in 96 days). The following parameters were recorded — time spent on supportive services, time spent on actual surgery, room turn over time, time spent for total procedure and time between entry and exit of patient.

Statistical Analysis:

Data were analyzed using the SPSS software version 15.

Results:

Of the total 325 scheduled cases, 252 were operated and 73 (22.5%) were cancelled. There were delays on 15 days (15.63%) in starting the OT table at the scheduled time. Of the total resource hours (46,080 min), the mean “Raw utilization” was 37,573 min (81.54%) and the “Adjusted utilization” was 39,668 min (86.09%). The mean time spent on “supportive services” was 5539 min (12.02%) and on “actual surgery”’ was 28,277 min (61.37%), and the “room turn over time” was 2095 min (5.39%). Among the stated reasons for cancellations, lack of operating time — 57 cases (78.1%) — was the most common.

Conclusion:

Study of time utilization and cancellation are important tools in assessing the optimal utilization of available resource hours in an OT.

Tavaborole 5% Solution: A Novel Topical Treatment for Toenail Onychomycosis

Onychomycosis is a stubborn fungal infection of the nails that can be difficult to effectively manage. One of the challenges with topical therapies is penetrating the nail plate to reach the site of infection. As the first antifungal in a boron-containing class of drugs with a novel mechanism of action, tavaborole is able to penetrate the nail plate more effectively than ciclopirox and amorolfine lacquers. In Phase II/III clinical trials, tavaborole was shown to be safe and clinically effective. Tavaborole 5% solution was approved by the US FDA for the treatment of toenail onychomycosis in July 2014 and is an important addition to the topical treatment arsenal against this stubborn infection.

Clinical audit of patients using DPP4 inhibitors in longstanding type 2 diabetes

AIMS

Dipeptidyl peptidase-4 inhibitors (DPP 4i) are oral hypoglycemic agents and are supposed to be beneficial in the early stages of diabetes. In this study, we evaluated the role of DPP4i in long standing type 2 diabetes mellitus (T2DM).

MATERIALS AND METHODS

This retrospective data analysis was conducted from the patient records. All the patients (T2DM>5 years; Age>50 years; Gliptin use >12 months) were divided into 2 groups based on the duration of T2DM: Group A (<10 years) and Group B (>10 years). We excluded patients with type 1 diabetes and drug default of more than one month. Our primary objective was to study the change in HbA1c and secondary objectives were change in body weight and insulin requirement. Data are presented as mean ± S.D and comparison between the groups was done using Mann-Whitney and Fisher's exact tests.

RESULTS

The study participants (n=501) had a mean age (64.2 ± 8.2 yr), diabetes duration (10.1 ± 4.9 yr), body weight (65.3 ± 9.5 kg), BMI (23.4 ± 3.9 kg/m(2)) and HbA1c of 9.7 ± 1.3%. The use of gliptins resulted in similar HbA1c reduction between the groups (p=0.8405) and greater reduction of insulin requirement in group B (p=0.0433) at the end of one year. Body weight and hypoglycemia episodes did not differ between the groups.

CONCLUSION

DPP4 inhibitors give similar benefit irrespective of the duration of diabetes and our data gives reassurance about their role in long standing diabetes.

Inhaled insulin: A "puff" than a "shot" before meals

Diabetes is a metabolic disorder characterized by relative or absolute deficiency of insulin, resulting in hyperglycemia. The main treatment of diabetes relies on subcutaneous insulin administration by injection or continuous infusion to control glucose levels, besides oral hypoglycemic agents for type 2 diabetes. Novel routes of insulin administration are an area of research in the diabetes field as insulin injection therapy is burdensome and painful for many patients. Inhalational insulin is a potential alternative to subcutaneous insulin in the management of diabetes. The large surface area, good vascularization, immense capacity for solute exchange and ultra-thinness of the alveolar epithelium facilitates systemic delivery of insulin via pulmonary administration. Inhaled insulin has been recently approved by Food and Drug Administration (FDA). It is a novel, rapid-acting inhaled insulin with a pharmacokinetic profile that is different from all other insulin products and comparatively safer than the previous failed inhaled insulin (Exubera).

Crystallographic studies of the extracytoplasmic function σ factor σ(J) from Mycobacterium tuberculosis

Mycobacterium tuberculosis has multiple σ factors which enable the bacterium to reprogram its transcriptional machinery under diverse environmental conditions. σ(J), an extracytoplasmic function σ factor, is upregulated in late stationary phase cultures and during human macrophage infection. σ(J) governs the cellular response to hydrogen peroxide-mediated oxidative stress. σ(J) differs from other canonical σ factors owing to the presence of a SnoaL_2 domain at the C-terminus. σ(J) crystals belonged to the tetragonal space group I422, with unit-cell parameters a = b = 133.85, c = 75.08 Å. Diffraction data were collected to 2.16 Å resolution on the BM14 beamline at the European Synchrotron Radiation Facility (ESRF).

Endovascular embolization of pseudoaneurysm of left colic artery developing after renal biopsy

Vascular complications after percutaneous renal biopsy are uncommon and may require interventional management. In most of these cases, the pathology is a renal arterial pseudoaneurysm (PsA) or an arterio-venous fistula. Injury to other vessels like aorta, lumbar arteries or mesenteric arteries is rare with only one case of left colic artery PsA reported in literature. We report a case of a 60-year-old female, who developed left colic artery PsA after renal biopsy, which was successfully embolized through endovascular route using microcoils.

Implementation of prevention of mother-to-child transmission of HIV programme through private hospitals of Delhi--policy implications

In India, programme for prevention of mother-to-child transmission (PMTCT) of HIV is primarily implemented through public health system. State AIDS Control Societies (SACSs) encourage private hospitals to set up integrated counselling and testing centres (ICTCs). However, private hospitals of Delhi did not set up ICTCs. Consequently, there is no information on PMTCT interventions in private hospitals of Delhi. This study was undertaken by Delhi SACS during March 2013 through September 2013 to assess status of implementation of PMTCT programme in various private hospitals of Delhi to assist programme managers in framing national policy to facilitate uniform implementation of National PMTCT guidelines. Out of total 575 private hospitals registered with Government of Delhi, 336 (58.4%) catering to pregnant women were identified. About 100 private hospitals with facility of antenatal care, vaginal/caesarean delivery and postnatal care and minimum 10 indoor beds were selected for study. Study sample comprised of large corporate hospitals (≥100 beds; n = 29), medium-sized hospitals (25 to <100 beds; n = 42) and small nursing homes (10 to <25 beds; n = 29). A pre-tested questionnaire was designed to obtain basic information about hospital in context to PMTCT programme. Interviews of heads of obstetrics and gynaecology and paediatric departments were conducted by trained interviewers. It was observed that in private hospitals in year 2012, out of 38,186 antenatal women tested, 52 (0.14%) were detected HIV-positive. However, against National Policy, HIV testing was done without pre/post-test counselling/or consent of women, no PMTCT protocol existed, delivery of HIV-positive women was not undertaken and no efforts were made to link HIV-positive women to antiretroviral treatment. Major intervention observed was medical termination of pregnancy, which indicates lack of awareness in private hospitals about available interventions under national programme. The role of private hospitals in management of HIV in pregnant women must be recognized and mainstreamed in HIV control efforts. There is an urgent need for capacity building of private health care providers to improve standards of practice. National AIDS Control Organization may consider establishing linkages or adopting model developed by some countries with generalized epidemic for delivering PMTCT services in private health sector.

UK, Gupta AK. Do the cervical spinal canal dimensions predict pre-myelopathic changes of cervical spinal cord? - a magnetic resonance image study

Background and aims: The cervical region is the most mobile portion of the spinal column and it is here that the earliest disc degenerations are encountered. Hence it is of great interest to neurologists and neurosurgeons. Degenerative arthritic changes in the cervical spine secondary to ageing may result in bony and soft tissue overgrowth causing encroachment on the cervical spinal canal resulting in cervical canal stenosis. This may predispose to compressive myelopathy. The study aims to determine the predictability of myelopathy based on the dimensions of spinal canal at the cervical region. Materials and methods: The study included 600 patients who underwent MRI scan of cervical spine in the Department of Imaging Sciences and Interventional Radiology, Sree Chithra Thirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, Kerala. It included patients of different age groups of both sexes who were classified into six groups. T1 weighted axial images were obtained using spin echo sequence. The axial slices were made at the mid vertebral levels from C2-C7 vertebrae. The anteroposterior diameters of spinal canal in axial images at mid cervical vertebral levels from C2-C7 were measured. Analysis of data was done by mean, standard deviation, independent sample t test, ANOVA and Chi­ square test. Results: The mean anteroposterior diameter of the canal at different cervical vertebral levels decreases as age advances. Tbe premyelopathic changes were more in males which may be attributed to change in canal shape. Conclusion: Cervical spinal canal dimensions are useful to predict premyelopathic changes of cervical spinal cord.

Ivermectin 1% cream for rosacea

The etiology of papulopustular rosacea (PPR) is not well understood yet appears to involve both the innate and adaptive immune response in addition to possible infestation with Demodex mites. Current treatments for PPR consist mainly of antibiotics. Ivermectin cream 1%, a new topical treatment for PPR, possesses both anti-inflammatory and anti-parasitic properties. After 12 weeks of treatment, subjects treated with ivermectin cream 1% had significantly greater reductions in PPR symptoms and enhanced diseaserelated quality of life improvements compared to subjects who received vehicle. Furthermore, PPR symptoms continued to improve with prolonged treatment (40 weeks). Ivermectin cream 1% offers a multi-pronged approach to combat the complex pathophysiology of rosacea.

Effect of preputial washing on bacterial load and preservability of semen in Murrah buffalo bulls

Aim:

To study the effect of preputial washing on bacterial load, preservability and semen quality in Murrah buffalo bulls

Materials and Methods:

A total of 36 collections of three Murrah buffalo bulls maintained at Artificial Breeding Research Centre, ICAR-National Dairy Research Institute, Karnal, were collected at weekly intervals from each bull without preputial washing and latter ejaculates from same bull with preputial washing by infusing normal saline (0.85%), KMnO₄ (0.02%) and savlon (2.0%) to first, second and third bull, respectively. The microbial load and semen quality were evaluated during different hours of storage at refrigerated temperature (0, 24 and 48 h) and after thrawing of cryopreserved (at −196°C) semen.

Results:

The results of preservation of semen at refrigerated temperature showed that bacterial load was markedly lower in ejaculates of bulls subjected to preputial washing. Semen preserved at refrigerator temperature and cryopreserved, the effect of washing solution was significant for individual motility (IM), non-eosiniphilic count, hypo-osmotic swelling reactivity (HOST), total plate count (TPC) and acrosome integrity. KMnO₄ was found to be the best in lowering bacterial load, sperm abnormalities and in improving semen quality such as motility, non-eosinophilic count, HOST and acrosome integrity even up to 48 h of preservation and cryopreserved semen. Effect of duration of preservation and stage of cryopreservation was also significant for IM, non-eosiniphilic count, HOST, sperm abnormalities and acrosome integrity.

Conclusion:

Overall the results suggested that preputial washing with KMnO₄ solution improved the semen quality and reduced microbial load of Murrah buffalo bull’s semen preserved at refrigerated temperature and cryopreservation.

Sexual behavior and its relationship with semen quality parameters in Sahiwal breeding bulls

AIM

The study was conducted at Artificial Breeding Research Centre, NDRI, Karnal, to determine the sexual behavior and its relationship with semen quality parameters in Sahiwal breeding bulls.

MATERIALS AND METHODS

A total of 63 ejaculates were collected from six adult Sahiwal bulls (age ~47 mo and bwt ~466 kg), to study the relationship of sexual behavior and semen quality. The degree of association between different variables was estimated by Pearson's correlation coefficient method.

RESULTS

The results depicted that, sexual aggressiveness showed significantly high positive correlation with libido score (LS) and sexual behavior score (SBS). Reaction time (RT) and total time taken in mounts (TTTM) had a significant negative correlation with LS and SBS. Penile erection score and penile protrusion score (PPS) both had a significant positive correlation with ejaculatory thrust score, mating ability score, and SBS. Results of correlation among seminal attributes and with sexual behavior depicted that ejaculate volume had positive significant correlation with initial progressive motility (IPM), sperm concentration (SCON), head abnormality, total abnormality, hypo-osmotic swelling test (HOST), acrosomal integrity (AI) whereas, mass activity had positive significant correlation with IPM, SCON, non-eosinophilic spermatozoa count (NESC), HOST, AI, RT and TTTM and IPM had positive significant correlation with SCON, NESC, HOST, AI, and TTTM, whereas and HOST had positive significant correlation with AI. Among seminal attributes, SCON had a positive significant correlation with PPS where as head abnormalities had a positive significant correlation with RT and TTTM.

CONCLUSION

It can be concluded that the relationship of sexual behavior and semen quality parameters are reflecting that the sexual behavior of individual bulls is important to harvest good quality and quantity of semen as desired type of sexual preparation can be provided.

The role of MDCT in the diagnosis of primary pericardial tumours: a case report and review of literature

Primary pericardial tumours are very rare and are hence not usually part of our differential diagnosis, especially since they have non-specific signs and symptoms. While chest radiography remains the most common initial imaging investigation in the assessment of suspected cardiothoracic pathology, the diagnostic yield for assessing pericardial lesions is limited, often necessitating the need for further assessment with echocardiography, CT scan or MRI. We present a case of an adult male patient with an incidental primary pericardial tumour diagnosed during the routine imaging assessment of suspected pulmonary infections. After proper formulation of diagnosis, the patient was managed accordingly for pulmonary pathology and discharged on recovery. Over the years, with advancement and widespread increase in use of multidetector CT and MRI, diagnosing primary pericardial tumours has become easier. MRI has now become the modality of choice for imaging of pericardial tumours because of its better soft-tissue contrast resolution.