Background: Healthcare workers are under substantial level of negative health outcomes due to risk of exposure, workload and moral dilemmas when India is on upsurge of coronavirus disease 19 (COVID-19) cases. Since there is a scare of research on this issue from India, we decided to conduct online survey to evaluate psychological impact and quality of life. Methods: From 25 May to 10 June 2020, a web-based Frontline-COVID survey was conducted. Feeling-related questions, Impact of Event Scale-Revised, Connor-Davidson Resilience Scale (CD-RISC) and Professional Quality of life were administered among healthcare workers from different departments. Results: Among the respondents, 218 (52.1%) belong from low-risk unit and 200 (47.9%) from the 'high-risk unit' including higher proportion of nurses 191 (45.7%), female 282 (67.5%), aged 31–40 years (48.3%) and married 220 (52.6%). Overall female nurses, doctors and working in emergency unit had a greater proportion of psychological distress. Middle aged (31–40 years) had a higher level of resilience contrast to this; working in COVID-19 unit was associated with a lower scale of resilience. Resilience and QoL were an important predictor for psychological distress. Conclusion: Results implicate interventions for stress management and social support among medical staff working in the pandemic. Need for systematic and longitudinal assessment for holistic strategies by policy makers targeting resilience and training for public health emergency.

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There is no immune against work conflict; it is happening in all health-care services. Risk factors for patient conflict in health-care services are many such as low staff communication skills, poor patient perception, history of emotional problems and little personal tolerance. Health-care leaders should revise general underlying causes, nature and the source of the conflict in their organisation. Health-care leaders should study the patient's conflict behaviour appropriately, then provide some creative changes to make a big difference. Moreover, leaders should provide both preventive and managerial resolution. Frequent patient's conflicts have severe consequences for both the patients and employee well-being and ultimately will affect the health-care service outcomes.

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Wound management is an art and as old as the existence of humanity. It can only be assumed that the selection of various materials having wound-healing properties occurred by trial and error over a period. The result was that many effective topical treatments had become available by the time civilisations began to appear about 6000 years ago. The oldest known wound care product is supposed to be beer. The Egyptians may have been the first to use bandages and were most probably the first people to apply honey to the wounds. Chinese practitioners used the extract and tincture of tea leaves for wound dressings. The Greeks were very well aware of the importance of wound closure and were the first to differentiate between acute and chronic wounds, calling them 'fresh' and 'non-healing', respectively. This review shines a light on the background and evolution of different practices engaged in wound management in the ancient times. The well-established principles of wound management in today's practice are the advancement of the principles adopted in the ancient times.

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Endometriosis is a common chronic and debilitating disease with possible life-long implications such as chronic pelvic pain and infertility. This review covers epidemiology, clinical presentation, diagnostic tools as well as current management and therapeutic options for endometriosis patients.

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Muscle transfers and flaps to cover defects have been used in orthopaedics for over a century. We present a case of a 49-year-old female who had surgery many years ago and was referred as a presumed tumour.

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Background: Thyroid diseases are a common health problem affecting 5% of the general world population. Thyroid nodules represent one of the main clinical presentations of many of the thyroid diseases, including benign and malignant lesions. Fine-needle aspiration cytology (FNAC) is considered one of the main techniques used for the evaluation of thyroid nodules. Objectives: The aim of this study is to investigate the accuracy of fineneedle aspiration (FNA) biopsy in the diagnosis and evaluation of thyroid nodules. Patients and Methods: The study is a retrospective study that involves 131 patients presented with a thyroid nodule and attended the surgical departments in Tawam Hospital. Results: Our results showed that the majority of patients (68.6%) were younger than 45 years. Females were pre-dominant, with 88.4% compared to males (11.6%). According to the Bethesda system, 4.87% of the cases were classified as Category I, 32.92% as Category II, 21.95% as Category III, 10.97% as Category IV, 14.63% as Category V and 14.63% as Category VI. Final pathological reports revealed that all the 4 cases of Category II (benign) (100%) were confirmed to be non-cancerous. In addition, 8/18 of cases (44.4%) classified as Category III (atypia of undetermined significance) were confirmed to be malignant and one (5.6%) diagnosed with the atypical follicular lesion, whereas the other cases were diagnosed with non-cancerous lesions. In contrast, all cases 9/9 suspicious for follicular neoplasm (Category IV) were confirmed to be malignant. Similarly, all cases 12/12 with Category V (suspicious for malignancy), and all cases categorised as malignant (VI) in FNA were also confirmed to be malignant. Conclusion: The results highlighted the importance of using a combined approach that consists of clinical, radiological as well as pathological approaches for a more accurate evaluation of the thyroid lesions. In addition, the results also showed that FNAC is a sensitive tool that can detect malignant thyroid nodules.

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Joubert syndrome (OMIM 213300) is an uncommon autosomal recessive disorder that is characterised by distinct mid-hindbrain abnormalities, hypotonia and developmental delay. The molar tooth sign is a distinctive radiological feature of Joubert Syndrome that is best seen on a magnetic resonance imaging (MRI) or axial computed tomography (CT) scan. Here, we present a case of Joubert syndrome with mutation of the TMEM67 gene associated with Blake's pouch cyst. Blake's pouch cyst is a rare finding that is considered a part of the Dandy–Walker spectrum. In more than 90% of the surviving neonates with Blake's pouch cyst diagnosed by ultrasound prenatally, there were no associated abnormalities and a normal developmental progress was assessed at 1–5 years. Rarely, however, trisomy 21, cardiac anomalies and Beckwith–Wiedemann syndrome have been found to be associated with Blake's pouch cyst.

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Primary intestinal lymphangiectasia (PIL), also known as Waldmann's disease, is a rare disorder, characterised by dilated lymphatics supplying the small intestinal wall resulting in lymph leakage into the small-bowel lumen. This protein-losing enteropathy leads to lymphopenia, hypoalbuminaemia and hypogammaglobinaemia. PIL is generally first diagnosed before 3 years of age, rarely in adulthood. Here, we present the case of a 13-year-old Emirati boy with protein-losing enteropathy secondary to intestinal lymphangiectasia refractory to the standard treatment. He was diagnosed initially at 18 months of age and presents with recurrent episodes of lower limb and scrotal swellings and diarrhoea. He requires 4–5 albumin and immunoglobulin infusions per year to control his symptoms. Most of the standard therapies tried so far failed to keep him from remissions. Moreover, he has a persistently positive helicobacter gastritis not controlled by aggressive eradication therapy. He is currently on low-fat diet and sirolimus drug therapy.

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Background: Lactate dehydrogenase (LDH) is an important enzyme and is recently being investigated in various orodental pathologies. The present study was carried out to investigate whether there is any correlation between LDH with the various histopathological gradings. Materials and Methods: Saliva was collected between 9 and 10 AM from patients of head and neck cancers (HNCs). Concomitantly, saliva was also collected from age matched healthy volunteers for comparing the results of the study population. Saliva collected from both the cohorts were processed and evaluated for LDH levels using standard kit. The data were analyzed using analysis of variance and with Bonferroni multiple comparison. A value of P < 0.05 was considered statistically significant. Results: The results indicate that when compared to the healthy individuals, a significant increase was observed in the salivary LDH of cancer patients (280.55 ± 17.48 vs. 353.58 ± 30.19; P < 0.001). A significant difference was also observed with differentiation, size, nodal status and metastasis (P < 0.0001). Conclusions: The results indicate that salivary LDH is helpful as an adjunct to the standard histopathological grading in the diagnosis and prognosis of HNCs.

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Context: Although the benefits of visual triggers as a learning tool have been proven, no study has explored the conditions, in which they can be used in clinical training. Aims: This study aims to explore the conditions in which visual triggers can enhance remote learning. Settings and Design: The study design involves a pedagogical intervention transmitting visual triggers of 5 cases on WhatsApp. Subjects and Methods: Analysis was performed on 21 participants, comprised of ophthalmology residents and teaching faculty, posted at a multi-centered teaching hospital. Statistical Analysis Used: Qualitative data of all participants' perception and quantitative weighted average of residents' perception (Likert scale 1–5) are analysed by triangulation. Results: The intervention generated a high level of engagement. Qualitative feedback was positive with suggestions for appropriate timing to ensure work-life balance and prudent case selection. Visual triggers were unforgettable and thought-provoking. Weighted average scores of questions show high desirability (range 4.0–4.55). Trigger-based sequence, discussions, motivation to read and coverage of cases were rated highly. Conclusions: Transmitting visual triggers electronically can be an effective remote learning modality when combined with collaborative discussions and feedback. Visual triggers should consist of still images or very short videos of striking characteristics presented sequentially to stimulate thinking. Other criteria for success are maintaining positivity in discussions, pre-defined appropriate timing, setting clear ethical guidelines and prudent selection of cases. It is most beneficial as an adjunct to regular teaching and enhances diagnostic skills by increasing case coverage, thereby, leaving more time for surgical skill development.

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Context: Antimicrobials are commonly used and reducing antimicrobial resistance (AMR) is an urgent matter to be addressed globally. Aims: The knowledge, attitude and practice (KAP) of participants before and immediately following a 3-day workshop (17^th–19^th April 2019) on various strategies for reducing AMR and promoting rational use of antimicrobials was measured. Settings and Design: The pre-post interventional study was conducted during the workshop at a medical college in Nepal. Materials and Methods: There were 33 participants. A questionnaire containing 12 sections related to various themes of the workshop was developed to measure KAP. Feedback regarding each session was also obtained. Statistical Analysis Used: Mean scores were compared before and after the workshop using paired t-test. The ratings for individual sessions were also calculated. Results: Most participants were between 26–30 years of age and 22 (66.7%) were male. Nineteen (57.6%) participants had <5 years' work experience. Post-intervention scores significantly improved for 6 out of 12 sessions-rational use of antimicrobials, infection prevention and control for limiting AMR, monitoring the use of antimicrobials in Nepal, effectiveness of various programmes to prevent AMR, familiarising with microbes to tackle AMR, and role of government, media and other organisations for preventing AMR. Conclusions: The 3-day workshop was effective in increasing KAP scores of the participants and may lead to more rational use of antimicrobials. The overall score for the post-test was significantly higher by 1.21 points compared to the pre-test (paired t-test, P < 0.001). Post-intervention scores were significantly higher for six sessions.

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A schizophrenic patient suffers from emotional, social, occupational and devastating mental symptoms that have a significant effect on their families. The struggle for families living with a schizophrenic patient includes fear, embarrassment, stigma, uncertainty, and the lack of social support. Hostile, critical environment or overly involved families have a negative impact which, tends to increase patient relapse. Developing therapeutic family intervention skills will decrease negative family emotional outbursts and construct a healthy household environment which enhances more patient recovery.

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Hypertriglyceridaemia is one of the well-known causes of acute pancreatitis. As it is a serious condition, it is important to be recognised and treated promptly with various modalities suggested. We report a 30-year-old male presented to the emergency room with the complaint of generalised abdominal pain and vomiting. On physical examination there were diffuse abdominal tenderness and distension. Laboratory tests suggest acute pancreatitis with mild elevation of amylase level. Fasting triglycerides (TGs) were 26 mmol/L. Computed tomography of the abdomen confirmed the presence of pancreatic necrosis. Plasmapheresis was decided to rapidly lower the excess TGs, after which the patient symptoms improved drastically. The most of the previous cases reported dealt with the excess TGs either by insulin alone or accompanying plasmapheresis. Our case responded well to apheresis alone, with a reduction percentage of the TGs equalling to 78.2% in one session, which negated the need for insulin.

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Background: Autosomal recessive disorders are the most common forms of hereditary diseases in consanguineous populations. Despite their frequencies, the diagnosis of these disorders continues to be a challenging task, given their extreme genetic heterogeneities. However, since the discovery of next-generation sequencing-based techniques, the number of pathogenic mutations linked to autosomal recessive disorders has increased dramatically due to the time and cost-effectiveness of these methods. Succinyl-CoA: 3-ketoacid CoA transferase (SCOT) deficiency is considered as one of these rare autosomal recessive genetic disorders. Aim and Objectives: In the present study, we aimed to identify the responsible mutation in a UAE family with autosomal recessive SCOT deficiency. Materials and Methods: Whole-exome sequencing was performed in the affected individual. Sanger sequencing was used to confirm the existence and the segregation of the novel pathogenic mutation. Real-time polymerase chain reaction (PCR) was used to measure the expression of the OXCT1 gene in the mRNA of affected, carrier and normal individuals. Results: Our analysis revealed a new frameshift mutation. Sanger sequencing confirmed its homozygosity in the patient and its cosegregation with the disease in the studied family. Using real-time PCR, we showed that this new frameshift mutation affects the OXCT1-mRNA by nonsense-mediated mRNA decay (NMD). Conclusion: To the best of our knowledge, this is the first study associating SCOT deficiency with an OXCT1 frameshift mutation in the world. In addition, we report for the first time by studying this new OXCT1 mutation evidence for an NMD effect associated with SCOT mutations.

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