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SUMMARY Recent research by D. Sharma, V. Sharma, Tanyi, and Cheng (2020) provides new insight into directors serving on multiple public company audit committees. Specifically, they investigate how an individual audit committee director serving on multiple audit committees is related to companies' cost of equity capital. Their evidence suggests that serving on multiple audit committees is viewed positively by investors up to a certain point, but beyond that point investors become concerned. This turning point, on average, is 3.5 audit committees for retired directors and 1.5 audit committees for directors in full-time employment. These results have implications for numerous stakeholders including investors, proxy advisors, boards, nominating committees, stock exchanges, and policymakers. They also have implications for future research.

SUMMARY We find a significant negative association between cost of equity and audit committee directors' simultaneous service on multiple audit committees (ACNUM). However, this association is not linear, as we find that cost of equity begins to increase when ACNUM is 1.50 for non-retired directors compared to 3.50 for retired directors. Further analyses reveal the negative association is more pronounced when a firm's information environment is strong and widely used firm-level measures of multiple directorships are not related to cost of equity. The evidence we present is consistent with the notion that investors positively perceive audit committee directors' service on multiple audit committees, but only to the extent such service does not undermine directors' ability to effectively discharge their governance responsibilities. Our study informs policymakers, boards, and nominating committees and advances the literature on multiple directorships, audit committees, and cost of equity. JEL Classifications: G12; G14; M40; M41. Data Availability: All data are publicly available from sources identified in the text.

Purple urine bag syndrome is a benign condition presenting with purple urine in a urinary bag in chronically catheterised elderly individuals. It is associated with constipation, chronic kidney disease and urinary infection with bacteria like Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa, Morganella morganii, Providencia, Enterococcus species and other bacteria that alkalinise the urine. Since co-occurrence of all factors is unusual, the condition is rarely encountered and rather unknown. In the aetiopathogenesis, tryptophan, an amino acid in the food, is metabolised by tryptophanase enzyme of infecting bacteria to indole. Indoxysulphate is produced from indole by hepatic conjugation and is excreted in urine. The microbes causing urinary infection that produce the enzyme indoxylsulphatase catabolise indoxysulphate to indoxyl. This in turn forms indigo, a blue substance, and indirubin, red in colour. The two mix to produce the colour purple thus accounting for purple urine. The condition is easily treatable but lack of awareness is a cause for alarm amongst the patient and the treating doctor. Thus, the present case will help create understanding of purple urine bag syndrome.

SUMMARY We provide new evidence in examining whether external auditors price environmental responsibility initiatives when performing the audit of financial statements. We also examine how investors value the firm when environmental initiatives occur in conjunction with higher audit fees. Results show environmental initiatives are positively associated with audit fees, but the extent of this association varies across the five different types of environmental initiatives we consider. We further find that auditors appear to price environmental initiatives due to their risk rather than additional audit effort. While environmental initiatives may be costly from an audit standpoint, investors value (Tobin's Q) firms more highly when environmental initiatives occur in conjunction with higher audit fees. Collectively, our findings imply that auditors price environmental initiatives into the audit and investors value firms more highly when auditors consider this social responsibility.

Blue rubber bleb nevus syndrome (BRBNS) is a rare disorder, characterized by multifocal venous malformations predominantly affecting skin, soft tissues, and gastrointestinal (GI) tract. Its presentation is usually sporadic although cases of autosomal dominant inheritance have been reported. Usually seen in children, BRBNS presentation in adults is rare. Most common symptoms of GI tract involvement are iron deficiency anemia and bleeding. We present a case of 16-year-old boy, who presented with recurrent anemia requiring multiple blood transfusions.

Context: Radiotherapy is a very effective treatment modality for pelvic malignancies such as carcinoma of the cervix. However, it is quite common for chronic radiation proctitis (CRP) to manifest after radical radiotherapy. CRP is a source of significant morbidity, and there is a lack of effective treatment modalities. There also exists a general lack of guidelines on management of CRP. Aims: To assess the benefit from 4% formalin application for the treatment of Grade >2 CRP among patients previously treated with radical radiotherapy for cervical carcinoma. Settings and Design: This retrospective descriptive study involved 29 eligible patients who were treated from November 2010 - November 2015 for CRP with 4% formalin application. Materials and Methods: Of the 1864 patients of carcinoma cervix treated during the said patients, 29 patients fulfilled the eligibility criteria. Eligible patients were invited telephonically for follow-up and were assessed for response and complications of the procedure. Results: The treatment of hemorrhagic radiation proctitis with local formalin instillation is effective, well tolerated and safe procedure. The procedure is inexpensive, technically simple and can be done on an outpatient basis. 62% patients had complete freedom from rectal bleed, while 34.5% patients had partial benefit. Only one patient required diversion colostomy for persistent bleeding.

Oculomycosis is a major cause of visual impairment. Eye pain, redness, discharge, diminution and photophobia are presenting features. We collected corneal scraping, vitreous, aqueous fluids and conjunctival swabs after the slit-lamp examination. Ophthalmological findings were hypopyon, stromal congestion, conjunctival congestion and epithelial defect. Direct microscopy of 10% potassium hydroxide (KOH) wet mounts, gram staining, fungal and bacterial cultures were performed. Fungal isolates were obtained in 24% patients with equal number of both sexes and average age 49 years. KOH revealed fungi in 73% samples and 43.33% were positive on Gram staining. Fusarium spp. (36.66%), Aspergillus spp. (23.33%) and melanised fungi (20%) were common etiological agents. Fusarium spp. was more often associated with complications. Trauma was a predisposing factor in 65% cases and occurred mainly with vegetable matter. The majority responded to the conservative management with 5% natamycin and four patients required surgery.

Enteric fever due to Salmonella Paratyphi A (SPA) is a global problem occurring as outbreaks at times. An unusual SPA (2,12:a:-) variety durazzo has been reported rarely. We report an outbreak of enteric fever due to this variety affecting 43 individuals. The blood samples grew unusual mucoid, lactose non-fermenting colonies with atypical biochemical reactions in sugar fermentation and amino acid decarboxylation. Isolates had sensitivity to ceftriaxone, chloramphenical, cotrimoxazole, intermediate susceptibility to ciprofloxacin and resistance to ampicillin and nalidixic acid. Identification was confirmed as SPA (2,12:a:-) at the National Salmonella Centre.

Purpose – The purpose of this paper is to provide initial evidence on the association between environmental initiatives and earnings management. Prior literature documents firms participating in environmental initiatives to report relatively stronger financial performance. Moreover, firms with superior performance have been shown to engage in greater levels of earnings management. A natural question that arises is to what extent do firms with environmental initiatives engage in earnings management to report better financial performance? Design/methodology/approach – The study draws on two theoretical frameworks, external monitoring and internal corporate culture, to predict an inverse association between environmental initiatives and earnings management. The authors test this prediction using an earnings management regression model, estimating discretionary accruals using the modified-Jones approach. Findings – The study finds that firms with environmental initiatives exhibit lower earnings management proxied by absolute and income-increasing total discretionary accruals. The authors further find pollution prevention and climate related initiatives to help explain this inverse association. The results imply that firms practising environmental responsibility report better financial performance, with the most likely reason being due to real economic performance rather than through earnings management techniques. Originality/value – This study provides initial evidence on the association between environmental initiatives and earnings management, an area of importance to all stakeholders in a market with increasing interest in corporate environmental performance and its implications.

This study provides initial evidence on the association between voluntary audit committee characteristics, incentives and aggressive earnings management in New Zealand. Our results suggest audit committees comprising independent (non-executive) directors reduce (increase) the likelihood of aggressive earnings management. Financial expertise is associated with a lower likelihood of aggressive earnings management but only when the expertise is held by independent directors. Greater stock ownership by non-executive and executive directors serving on the audit committee increases the risk of aggressive earnings management. However, stock ownership by independent directors reduces this risk. Our results show that independent directors serving on other boards are associated with a lower likelihood of aggressive earnings management. Results relating to the New Zealand audit committee regulatory guidelines show that only majority independent directors on the audit committee are associated with the likelihood of aggressive earnings management. We raise potential implications for policy makers in New Zealand.

To address potential threats to auditor independence, the Sarbanes-Oxley Act of 2002 (SOX) requires the audit committee to pre-approve nonaudit services (NAS) procured from the auditor. However, the presence of a former audit firm partner (FAP) affiliated with the current auditor on the audit committee could undermine the audit committee's due diligence over the NAS pre-approval process. To alleviate such concerns, the Securities and Exchange Commission approved a three-year “cooling-off” period for appointing audit firm alumni as independent directors. Our analyses show that the presence of both affiliated and unaffiliated FAPs on audit committees does not lead to greater NAS procured from the auditor; rather, FAPs reduce NAS procured from the auditor. Moreover, NAS decline significantly following the appointment of FAPs to the audit committee. Further tests suggest the three-year cooling-off period may not be warranted and deserves further investigation. Our study raises important implications for regulators, policy makers, corporate boards, and future research. Data Availability: Data are publicly available from sources identified in the text.

SUMMARY This study examines the association between multiple-directorships and tenure of independent audit committee members and financial misstatements in the pre- and post-Sarbanes-Oxley (SOX) reform environment. Regulatory reforms following the accounting scandals at Enron and WorldCom substantially expanded the responsibilities and scrutiny of the audit committee and, consequently, amplify the reputational and litigation risks facing the directors serving on the committee. Our results show a significant positive association between financial misstatements and multiple-directorships in the post-SOX environment. This finding suggests that independent audit committee members serving on multiple boards may be stretched too thinly to effectively perform their monitoring responsibilities. We also find a significant positive association between the tenure of independent audit committee members and financial misstatements in the post-SOX environment, suggesting that directors with longer tenure may not exercise independent judgment. These observations support calls for limits on multiple-directorships and director tenure, and add to our understanding of how independent directors' characteristics affect the effectiveness of the audit committee.

New Zealand provides a natural laboratory to test whether knowledge spillovers arise from auditor-provided non-audit services. Unlike prior research, we do not assume constant audit quality but first test whether audit quality varies with auditor-provided non-audit services and audit efficiency. Results show that higher non-audit fees paid to the auditor in conjunction with shorter audit lag does not reduce the quality of the audit. Results reveal a negative association between non-audit fees and audit lag, thus suggesting the presence of knowledge spillovers. However, the knowledge spillover effect is limited to the city office providing both the audit and non-audit services.

Using data from 944 public companies in 2006, I examine how a firm's propensity to pay dividends is related to (i) board independence and (ii) independent directors' tenure, number of board seats (busy) and equity incentive compensation. After controlling for the effects of traditional economic, CEO entrenchment and ownership determinants of the propensity to pay dividends, I find evidence of a positive association between the propensity to pay and (i) board independence and (ii) director tenure, and a negative association between the propensity to pay and (i) busy directors and (ii) greater equity incentive compensation in the director pay structure. I find consistent results when the decision is to pay cash dividends or repurchase shares. In further tests, I find that equity incentive compensation in the independent director pay structure is the most pervasive determinant across other dividend measures such as dividend payout, total payout and repurchases. Overall, the findings suggest that the characteristics of independent directors are important determinants of the payout policy. The results also suggest that future corporate governance research could benefit from incorporating characteristics of independent directors rather than limiting governance measures to board independence especially when recent empirical evidence (Linck et al., 2008, 2009) shows convergence, and therefore, narrowing variation in the proportion of outsiders and insiders on a board.

SUMMARY This study provides empirical evidence on how the association between the economic importance of a client to the auditor and earnings management is moderated by the audit committee. We employ city office-level client importance fee-based measures, both performance-adjusted discretionary total and current accruals as proxies for earnings management, and a measure of audit committee best practices. We document a positive association between client importance and our two proxies for earnings management. This association is stronger for income-increasing earnings management. However, the association between client importance and earnings management is more pronounced when the audit committee does not meet best practices. We infer that the economic importance of a client appears to threaten auditor independence and thus the quality of financial reporting, but only when the audit committee exhibits characteristics associated with the provision of weak oversight. We also find that the association between client importance and earnings management is conditional on inside ownership, growth, leverage, and firm size, which are moderated by the audit committee. This study is the first to demonstrate that audit committees can moderate threats to auditor independence thus protecting the quality of financial reporting. The study discusses potential implications for policy making and empirical research.

Regulators and others recently highlighted the increasingly important role of internal auditing in supporting and interacting with the audit committee to ensure the integrity and quality of financial reporting. Likewise, one of the roles of the audit committee is to oversee the quality of monitoring mechanisms implemented by the firm, which includes the internal audit function. However, our understanding of the relationship between the audit committee and internal auditing is limited. We fill this void by providing the first empirical evidence of the association between audit committee characteristics and the investment in internal auditing. Our analyses, from a sample of 181 SEC registrants, suggest that the investment in internal auditing (internal audit budget) is negatively related to the presence of auditing experts on the committee and the average tenure of audit committee members, but positively related to the number of audit committee meetings (a proxy for audit committee diligence). These observations suggest potential complementary and substitution effects between the audit committee and internal auditing, and thus raise important implications for future research.

SYNOPSIS: Because authoritative statements on corporate governance (e.g., the Sarbanes-Oxley Act of 2002) are silent about how frequently audit committees should meet, corporate audit committees have considerable discretion in scheduling meetings. Although prior research shows the frequency of audit committee meetings is an important indicator of the effectiveness of the audit committee, we know very little about the underlying determinants of meeting frequency. In this study, we examine the determinants of the frequency of audit committee meetings in a voluntary governance system, New Zealand. We find that multiple directorships, audit committee independence, and an independent chair of the audit committee are negatively associated with meeting frequency. Other variables negatively associated with meeting frequency include a Big 4 auditor, growth opportunities, and regulated industry. Audit committee meeting frequency is positively associated with the size of the audit committee and the level of institutional and managerial ownership. We also find that financial expertise and board independence are positively associated with meeting frequency when the risk of financial misreporting is higher.

Due to the high incidence of fraud in Australia, regulatory reports suggest strengthening the monitoring role of the board of directors (BOD). These reports recommend greater independence and no duality (chairperson of the BOD should not be the CEO) on the BOD. While there is no Australian evidence, research evidence in the U.S. supports these suggested reforms. It is not clear whether the research evidence observed in the U.S. will generalize to the Australian setting because of contextual differences. This study extends the U.S. findings to the Australian context and investigates the relationship between two attributes of the BOD, independence and duality, and fraud. In addition, I examine whether institutional ownership plays a role in the context of fraud. The more highly concentrated institutional ownership in Australia suggests the presence of some relationship. Using a matched sample of fraud and no-fraud firms from 1988–2000, I find that as the percentage of independent directors and the percentage of independent institutional ownership increases, the likelihood of fraud decreases. As expected, the results show a positive relationship between duality and the likelihood of fraud. These results support the call for strengthening the composition and structure of the BOD in Australia.

Background: Increased expression of linkage-specific 9-O-acetylated sialoglycans (9-O-AcSGs) has been demonstrated on erythrocytes from patients with visceral leishmaniasis (VL) by use of Achatinin-H. We assessed the capacity of this glycotope to influence hemolysis via activation of the alternative complement pathway in patients with VL, compared with that in healthy control subjects. Methods: The differential expression of 9-O-AcSGs on surfaces of erythrocytes was measured, 9-O-AcSGs were affinity purified, and the molecular determinants were identified byWestern blotting. The degree of alternative complement pathway-mediated hemolysis was compared with expression of 9-O-AcSGs on erythrocytes. Results: Enhanced expression of linkage-specific 9-O-AcSGs was demonstrated on erythrocytes from patients with active VL. Six distinct molecular determinants present only on diseased erythrocytes were affinity purified and were absent after elimination of parasite burden. A correlation (r 2 =0.9) was observed between the presence of 9-O-AcSGs and the degree of alternative complement pathway-mediated hemolysis. Conclusion: The 9-O-AcSGs expressed on erythrocytes from patients with VL are potent complement activators, causing enhanced hemolysis via activation of the alternative complement pathway, and may account for the anemia that is a common manifestation of VL.

Fungus is a rare cause of rhinosinusitis in children. Its incidence has been reported as ranging between 13.5 and 28%. Fungus balls are extramucosal tangled masses of fungal hyphae. It commonly involves just one paranasal sinus. Most commonly maxillary sinus is involved and occasionally sphenoid sinus. Concha bullosa is one of the most common anatomical variations in the nasal cavity, with a frequency of reporting ranging from 14-53.6%. There are very few case reports in which Concha bullosa was affected with fungus ball. In this case report 13 years female child presented with complaints of swelling right cheek. The patient underwent endoscopic sinus surgery and there was involvement of concha bullosa and sphenoid sinus with fungus ball. Fungus was confirmed on microscopic examination and culture. Fungus ball is a rare presentation of fungal rhinosinusitis. It should be considered in enlarged middle turbinate with heterogenous opacity on CT. The diagnosis should be confirmed by microscopy or culture.

Introduction: Serratia marcescens is a Gram‐negative, aerobic, motile bacillus belonging to the family Enterobacteriaceae. S. marcescens has been implicated in different types of infections including urinary tract infection, septicaemia, meningitis and wound infections. Very few cases of skin infections caused by this organism have been reported in the medical literature. S. marcescens is an important nosocomial pathogen but has rarely been implicated as a cause of community‐acquired soft‐tissue infections. Case presentation: We present a rare case of a community‐acquired spontaneous cutaneous ulcer in an immunocompetent child from a sub‐Himalayan region. Infections caused by S. marcescens may be difficult to treat because of its ability to produce a β‐lactamase, which confers resistance to broad‐spectrum, β‐lactam antibiotics. Conclusion: In our patient, the treatment was modified to ceftazidime and amikacin after sensitivity testing and the patient’s condition improved. This necessitated isolation by culture and antimicrobial susceptibility testing to ensure appropriate therapy.

Substitution of the -OH group at C-9 of sialic acid by an O-acetyl ester has been suggested to modify various biological phenomena that are regulated by sialic acids. Amongst them, enhancement of erythrocyte lysis by 9-O-acetylated sialic acid determinants through modulation of the alternate pathway of complement has been extensively studied on murine erythrocytes [1]. A variable expression of linkage specific 9-O-acetylated sialoglycoconjugates as defined by the lectinogenic epitope of Achatinin-H namely 9-O-acetylated sialic acid α2→6Gal NAc was identified on rabbit, guinea pig, hamster, rat, mouse and human erythrocytes. This differential expression of linkage specific 9-O-acetylated sialoglycoconjugates strongly correlated with the susceptibility of mammalian erythrocytes to lysis by the alternate pathway of complement. Additionally, low levels of antibodies directed against O-acetylated sialic acids in these mammalian species suggested that these constitutively present determinants have low immunogenicity. Taken together, our results indicate that complement mediated hemolysis depends not simply upon the extent of surface 9-O-acetylated sialic acids present but more importantly upon the specific linkage.

A case of extensive chromoblastomycosis of the right leg and thigh with verruciform to nodular lesions evolving rapidly over five years duration is reported. The diagnosis was confirmed by visualizing pathognomonic pigmented muriform bodies with unique septate hyphae and mycological culture yielding Fonsecaea pedrosoi.

In a randomized, double blind, placebo controlled study; the acceptability, efficacy and safety of injectable midazolam as oral premedicant in children was evaluated. One hundred children (ASA 1,2) aged 6 months to 6 years, undergoing elective neurosurgical operations, like meningomyelocele, meningo-encephalocele, ventriculo peritoneal and other shunts and craniotomies for tumour decompression etc., were included in the study. The patients were randomly assigned to one of four groups (A, B, C, D) receiving respectively saline or 0.50, 0.75 and 1.0 mg/kg midazolam in honey, 45 min before separation from parents. All received identical general anesthesia (GA). Age, sex, weight, heart rate, blood pressure, respiratory rate, saturation (SaO2), reaction to parent's separation, sedation score and duration of anesthesia, recovery conditions and side effects were noted. We found no difference in age, sex, weight, patient acceptability vomiting after ingestion and duration of anesthesia between groups. Even though many children resisted the placement of premedicant in the mouth, only three children spat it out and none vomited after swallowing. The reaction to separation from parents was better after midazolam premedication. However, on reaching the operating room, 24% children (placebo-60%) were found anxious after 0.50 mg/kg, but 12% were deeply sedated after a dose of 1.0 mg/kg. Recovery was similar in groups A, B and C except that more (48%) patients were anxious in group A. Recovery, however was delayed in 16% patients of group D. Though, fewer complications were reported during recovery after midazolam than placebo premedication, they were minimal in the 0.75 mg/kg group. We concluded that giving injectable midazolam orally as premedication in pediatric age group scheduled for neurosurgical operations is acceptable, effective and safe in 0.75 mg/kg dose. While 0.50 mg/kg is less effective, 1.0 mg/kg does not offer any additional benefit over 0.75 mg/kg but does delay recovery and may compromise safety.

A case of invasive multiple paranasal sinus aspergillosis with bony involvement is reported. A young immunocompetent lady presented with bilateral nasal obstruction due to polyps. Radiologically and histopathologically a fungal cause was kept a possibility, and the diagnosis of Aspegillus fumigatus was established by demonstration of acute angle branching septate hyphae on direct wet mount and repeated isolation in culture. Patient responded favourably to surgical excision of polyps and oral itraconazole post operatively.

This study explores the impact of corporate governance on auditors' client acceptance, risk and audit planning judgements. Specifically, we investigate the effect of the strength of the board of directors and audit committee on auditors' likelihood of accepting a client, assessment of risk, and the extent and timing of evidence testing. Sixty audit managers from three Big 4 audit firms are randomly assigned to one of three experimental conditions. The three experimental conditions represented weak, moderate and strong corporate governance. We make the following inferences from the analysis of our experimental data. We find that auditors are more likely to accept a client with strong corporate governance. Clients with strong corporate governance are assessed lower control and audit risks. After controlling for control risk, we find that strong corporate governance results in auditors increasing their reliance on the clients' internal controls, reducing the number of planned audit hours and extent of substantive tests. Finally, we find that auditors conduct a greater extent of substantive testing during the interim period compared to year-end, when the corporate governance of the client is stronger. Overall, our results suggest that audit strategies are responsive to the strength of a client's corporate governance.

Employing bovine submaxillary mucin (BSM) as the coating agent, an enzyme-linked immunosorbent assay (BSM-ELISA) was developed to detect antibodies directed against O-acetylated sialic acids (O-AcSA) in canine visceral leishmaniasis (CVL). Serum samples were collected from 50 dogs previously screened by a parasite-ELISA to detect anti-leishmanial antibodies and designated as seropositive (n = 30) and seronegative (n = 20). The BSM-ELISA detected anti-O-AcSA antibodies in 29 out of 30 seropositive dogs and was negative in 15 out of 20 seronegative dogs; the sensitivity and specificity of the assay being 96.6% and 75%, respectively. Seven dogs from an endemic area in central Israel were longitudinally monitored for 15 months clinically, serologically and cultured for parasite. The levels of antibodies directed against O-AcSA increased with the appearance of clinical symptoms and/or seropositivity, disappeared when the disease was self-limiting as also with chemotherapeutic response and reappeared with relapse. The BSM-ELISA, therefore, represents a valuable tool for assessment of disease progression.

We have developed a rapid, accurate, and inexpensive hemagglutination assay (HA) for diagnosis of Indian visceral leishmaniasis (VL) using achatininH, a 9-O-acetylated sialic acid binding lectin. The assay is based on the selective binding of achatininH to 9-O-acetylated derivatives of sialic acid (9-O-AcSA), which appears exclusively on the erythrocytes of patients with VL. Blood samples from 35 patients with demonstrable splenic or bone marrow amastigotes were assayed by HA and compared with an ELISA. All cases were correctly diagnosed by HA, and were in concordance with the ELISA. The increase in 9-O-AcSA was corroborated by direct fluorimetric estimation of sialic acid and its 9-O-acetylated derivative. Therefore, 9-O-acetylated derivatives of sialic acid, absent in normal erythrocytes, serve as an important biomarker, and indirectly reflect the presence of the parasite. Accordingly, this assay can be used for detection of active kala-azar cases and merits clinical consideration.

Background: We assessed the occurrence of dengue fever in association with travel in a non-endemic hilly region. The clinical presentation and laboratory parameters of febrile patients with a travel history to an endemic region were studied, and the role of the laboratory in the diagnosis was affirmed. Materials and Methods: Febrile patients presenting with clinical features defining dengue with a history of travel to an endemic area constituted the study group.Serum samples were tested for dengue-specific NS1 antigen and IgM, IgG antibodies. The demographic data were retrieved from the hospital information system. A hematological and biochemical workup was done and the results analyzed using percentage, proportion, mean, and median. Results: Out of 189 febrile patients, 58 were reactive to serological tests for dengue, with 47 (81%) males. The presenting features were chills and rigors, myalgia, cough, sweating, and vomiting. Thrombocytopenia (74.35%), lymphopenia (52.94%), and leucopenia (47.05%) were present in early disease, with AST >34 IU/L in 58.97% of the patients. The NS1 antigen was detectable between three and seven days of fever and the IgM antibodies after five days. The positivities to only NS1, both NS1 and IgM, and IgM alone were 60.34, 27.58, and 10.34%, respectively, and the median duration of fever was five, seven, and ten days, respectively. One case of dengue hemorrhagic fever and one of probable secondary dengue infection with detectable IgG were encountered. Conclusion: Dengue fever remains unsuspected in febrile cases in non-endemic regions. History of travel is an essential criterion to suspect dengue. A non-specific clinical presentation eludes diagnosis. Serological tests for antigen and antibodies, and hematological and biochemical markers are vital for distinguishing the diagnosis.

Fifty children in the first decade of life, and suffering from multiple drug resistant kala-azar, confirmed by demonstration of amastigotes in aspirates of bone marrow or spleen were treated with amphotericin B in gradually increasing dosage to a total dose of 20 mg/kg. All patients had classical features of severe kala-azar, and had taken more than one course of antimony and pentamidine, and three patients had taken one additional course of ketoconazole besides many courses of antimony and pentamidine. The clinical response started just after first infusion in 8 patients, and the patients became afebrile. By 5th infusion, all looked better and 18 patients became afebrile. By 15th infusion all patients were afebrile and cheerful. Their spleens became smaller and body weights and total white cell counts increased. Forty eight patients had parasitological cure at the end of treatment, and only 2 patients required an additional 5 infusions for parasitological cure. All patients were ultimately cured. No one relapsed within six months of follow up. All patients had shivering, rigor and rise of temperature on the day of infusion, which could be minimized with prior administration of low dose of hydrocortisone, but could not be eliminated. Eighteen patients had loose motions during treatment, while 14 patients had decrease in appetite which improved quickly when the treatment was over. Fourteen patients had transient rise of blood urea, in six patients serum creatinine also increased and 16 patients had a minor fall in serum potassium.(ABSTRACT TRUNCATED AT 250 WORDS)

Small, chalky-white, threadlike, motile worms were isolated from the conjunctival sac of a 32 year-old woman residing in the Himalaya mountains. They were identified as both male and female worms of Thelazia callipaeda . To the best of our knowledge, this is the second case report of human thelaziasis from India.

We examine the effect of non‐mandatory corporate governance practices on a comprehensive set of audit judgments.1 We provide initial evidence on how auditors respond to corporate governance in an institutional environment where corporate governance is not mandated by law. Based on the agency and resource dependence theories, we hypothesise associations between corporate governance and auditors’ judgments relating to client acceptance, risk assessments, and the extent and timing of substantive testing. Sixty Big 4 audit managers from Singapore are randomly assigned to one of three experimental conditions comprising weak, moderate and strong corporate governance. Our results show auditors make more favourable client acceptance judgments when corporate governance is stronger. Clients with stronger corporate governance are assessed as having lower control environment risk. After controlling for control environment risk, we find that stronger corporate governance increases auditors’ reliance on the cl...

Results A total of 10,134 cases were screened for detection of HBV infection and among these 1650(16.3%) were receiving ART (anti retroviral therapy) while HIV status was not divulged in 8484 (83.7%). HBsAg positive in 324/10134 (3.20%) cases, out of these HBV mono infection was seen in 264 (2.6%) and coinfection with HIV in 60 (0.6%).The concomitant HIV infections were seen in 3.64% (95 %confidence interval 2.8-4.7) while in HBV mono infections were in 3.1% (95 % confidence interval 2.8-3.4). There is no statistical difference among the two groups (p value >0.05). Among the pediatric age group 0.95% had concomitant HIV infections as against 5.2% with HBV infection alone. The mean age of presentation was 40.39 years. Males had higher prevalence rate of co infection (4.5:1). Conclusion Nearly identical prevalence of HBV infection irrespective of HIV infection strongly indicates HIV screening for Hepatitis B infected patients. The presence of undetected co infection shall result in missed cases, incomplete or partial treatment and suboptimal clinical follow up.