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To describe a previously unreported anatomical variant of the hepatic arterial supply: a conjoined right hepatic artery, formed by branches of the common hepatic artery and gastroduodenal artery. A 54-year-old female with oligometastatic colorectal cancer with metastases to the liver presented for planning stage arteriography in preparation for Y90 radioembolization. Arteriography of the common hepatic artery demonstrated bifurcation into a right hepatic artery and gastroduodenal artery. The gastroduodenal artery gave rise to a proximal branch, from which the left hepatic artery originated and then continued to anastomose in the hilum of the liver to the right hepatic artery originating from the common hepatic artery. It was initially identified on visceral artery arteriography and then retrospectively recognized on pre-procedural CT scan. Anatomical variants of the hepatic arterial supply are important to recognize during planning stage arteriography in preparation for Y90 radioembolization. Knowledge of these variants is also important for pre-operative planning.

Carpal Tunnel Syndrome (CTS) is the most common entrapment neuropathy in the upper extremity.The median nerve is compressed within its course through the carpal Tunnel just distal to the wrist crease. Usually Occur in middle aged patients Ratio of female to male = 4: 1. It is bilateral in over 50 % of cases, but is usually worse in the dominant hand. Early diagnosis and treatment are important and result in complete cure, delay can result in irreversible median nerve damage Every patient with carpal tunnel syndrome should be care¬fully and individually evaluated clinically for proper diagnosis before surgery and thorough search for any associated condition that mimic carpal tunnel syndrome and may be responsible for postoperative complaints.Frequently use postoperative nerve conduction studies for prognostic purposes and to serve as a baseline in determine the postoperative state of median nerve. A patient with any numbness or tingling in the fingers or with any weakness or atrophy of the thenar muscles must be considered as having carpal tunnel syndrome, unless proves otherwise.

In this era of eHealth, healthcare data has gained a significant importance due to having human survival information. Detection of the atrial fibrillation (AF) from electrocardiogram (ECG) rhythm is a promising area of research because of its critical impact on mortality ratio in all over the world. Although, most of the studies have shown more than 90% results accuracy in terms of specificity (Sp) and sensitivity (Se), yet this accuracy is not sufficient and cannot be considered reliable for AF continuous monitoring due to high ratio of false alarms. Existing works scarcely compare the accuracy of the results generated by a classifier with those of other robust classifiers. Further, the results are needed to be verified with more statistical measures. In this paper, a multiple classifiers-based model is proposed in which the transition between normal sinus rhythm (NSR) and AF are performed on the basis of ventricle activities of the heart. The proposed scheme first extracts several features that are pertinent to AF diagnosis from the ECG data. Later, the classification model categorizes rhythms into classes using statistical techniques. The experimental evaluation is performed on five datasets which include AF Challenge 2017 database, NSR database (NSRDB), NSR RR interval database (NSRDB-2), AF database (AFDB) and long-term AF database (LTAFDB). Based on verification of results using different measures, the proposed scheme outperforms in comparison to the existing systems in terms of area under the curve (AUC), Se, Sp, positive predictive value (PPV), accuracy (ACC), and negative predictive value (NPV) for all datasets. Specifically, the decision tree (DT) obtains 99% AUC, 92% Se and 98% Sp for the AF Challenge 2017 database, which are improved than parallel systems.

Neonatal alloimmune neutropenia (NAIN) is caused by maternal alloimmunisation to fetal human neutrophil antigens (HNAs). This study investigated maternal HNA/HLA alloantibodies involved with NAIN and identified the frequency of NAIN in Brazilian neonates. Neonatal neutropenia (neutrophil count < 1.5 × 109 /L) was investigated in samples from 10,000 unselected neonates, resulting in 88 neutropenic newborns (NBs) and their 83 mothers. Genotyping was performed by PCR-SSP (HNA-1/-4) and PCR-RFLP (HNA-3/-5). Serologic studies were performed by GAT (granulocyte agglutination test), Flow-WIFT (white blood cells immunofluorescence test) and LABScreen-Multi-HNA-Kit (OneLambda®) (LSM). Neonatal neutropenia was identified in 88/10,000 (0·9%) NBs. Genotyping revealed 60·2% maternal-fetal HNA incompatibilities (31·8% for HNA-1; 14·8% for HNA-3; 15·9% for HNA-4; 21·6% for HNA-5). Serologic studies revealed 37·3% of mothers with positive results with at least one technique. The detected anti-HNA specificities were confirmed in eight positive cases related to HNA-1/-3 systems. In cases with maternal-fetal HNA-4/-5 incompatibility, no specific neutrophil alloantibodies were found but anti-HLA I/II were present. Anti-HNA-2 was not identified. This is a large Brazilian study which involved the investigation of antibodies against all five HNA systems in neutropenia cases and showed a frequency of NAIN in 8/10,000 neonates. Among the HNA antibodies identified, we highlight the anti-HNA-1d and anti-HNA-3b, antibodies unusual in alloimmunised women, and rarely related to NAIN cases.

Globally, Cancer is believed to be second biggest reason of mortality and one of the significant social as well as economic liabilities. Despite our advance at molecular level in comprehension of cancer, more therapeutic tools and tactics are needed to exploit this advance. The CRISPER/Cas9 genome modifying approach has lately appeared as an effective cancer therapy method due to its high accuracy and efficiency. CRISPER/Cas9 has enormous clinical potential in discovering new targets for cancer treatment and also to dismember genetic-chemical interaction thus helping us to understand the response of tumor to the treatment by drugs. Additionally, Cas9/CRISPER can also be used in cancer immunotherapeutic applications by engineering immune cells and oncolytic viruses. Perhaps the most important therapeutic application of Cas9/CRISPER is its ability to edit genes with great precision both in animal models and humans. In this review, we will debate and explore some important concerns of using CRISPER/Cas9 in remedial settings and some vital hurdles that are needed to overcome before it is used for a clinical trial for a polygenic and complex ailment like cancer.

Objective To evaluate the protective role of L-Arginine in cisplatin induced acute renal injury through assessment of renal, oxidative stress and inflammatory markers in albino wistar rats. Methods: Quasi-experimental study was conducted at the department of physiology and postgraduate research laboratory at Isra University, Hyderabad, Sindh from April 2019 to September 2019. Thirty male Albino wistar rats were selected through non-random purposive sampling and divided equally into three different groups: Group-A (Control group), Group-B (experimental group) received Cisplatin alone and Group-C (experimental group) received Cisplatin along with arginine. After sacrificing the animals, blood samples were collected through cardiac puncture while renal histopathological analysis was under the light microscope. The changes in severity were observed using a graded scale. Data was analysed using SPSS v23.0. Results: There was a statistically significant (p-value

Video Video 1 Case demonstrating endoscopic successful endoscopic repair of type IV paraesophageal hernia.

Pneumonia is a disease which has been prevalent for a long period of time, despite active attempts to limit the harm caused due to it. The effect it can have on an individual can vary diversely from person to person, with age being a critical factor. Infants and people of an older age tend to be at maximum risk due to this disease, which affects the lungs. Two categories of pneumonia exist, viral pneumonia and bacterial pneumonia. Over the past few years, the deep learning community has made significant contributions, especially in order to assist medical staff in the diagnosis of pneumonia in suspected patients. Several pretrained models, whose weights have been trained on different datasets, have also been applied for this application by making use of transfer learning. In this paper, various such methods have been analyzed. Pretrained models, customized to suit the current purpose of detecting pneumonia, have been implemented to observe the performance. Along with this, we have proposed our own convolutional neural network architecture in order to detect pneumonia. We compare the results of these models with our proposed system, by performing experiments on a dataset containing three categories: normal, bacterial pneumonia and viral pneumonia.

Congenital contractural arachnodactyly (CCA) is a rare connective tissue disorder that has several phenotypic similarities to Marfan syndrome. Among the phenotypic characteristics of patients with CCA, severe kyphoscoliosis and thoracic cage abnormalities are commonly reported. In this case report, we describe a patient with coexisting CCA and severe pectus excavatum requiring multiple surgical repairs. The impact severe scoliosis and pectus excavatum in isolation have on cardiopulmonary anatomy and physiology can be significant, and their effects can be profound concomitantly. These defects have the propensity of causing restrictive lung disease and external cardiac compression.

Background and Aims Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has emerged as an option for managing malignant gastric outlet obstruction (GOO). However, there is currently no standardized technique and outcomes are variable with inconsistencies both within and across centers. The present study aims to develop and assess outcomes of a Standardized Clinical and Assessment Management Plan (SCAMP) for EUS-GE. Methods A SCAMP was created by a multidisciplinary team to develop and optimize a systematic approach for EUS-GE. This is a single-center prospective cohort study on patients undergoing EUS-GE for GOO, using the developed SCAMP. Baseline demographics, cancer diagnosis and stage, Eastern Cooperative Oncology Group (ECOG) performance score, clinical and technical success, adverse events and obstruction recurrence were collected. Primary outcomes included technical and clinical success. Obstruction-free and overall survival were calculated and compared with Kaplan–Meier analysis. Results 50 patients underwent EUS-GE in accordance with the SCAMP. Mean age was 67 years, 54% were females, and pancreatic cancer represented the largest cancer type (51%). Technical success was 100% and clinical success was 92%. Adverse events occurred in 2 patients (4%). Recurrent obstruction occurred in 16%, related to distal small-bowel obstruction from carcinomatosis. Estimated mean obstruction-free survival was 217 days. Median overall survival was 230 days among patients with ECOG scores 0 to 2 and 82 days for ECOG=>3, p=0.008. Conclusions The standardized technique used was associated with high technical and clinical success, and low rates of adverse events, morbidity and procedure-related mortality. Adopting a similar uniform systematic approach may improve procedural outcomes and dissemination.

Objectives Despite the growing number of individuals with dementia, clinicians skilled in caring for people with dementia, especially in rural areas, are lacking. The Program for Advancing Cognitive Disorders Education for Rural Staff (PACERS) was designed to improve clinician competency and comfort when caring for individuals with dementia. Based on an interprofessional needs assessment, six 1-hour training modules were created: (1) Dementia and Delirium, (2) Identifying and Assessing for Dementia, (3) Treating Dementia: Case Studies, (4) Normal Cognitive Aging and Dementia Caregiving, (5) Addressing Decision Making and Safety in Dementia, and (6) Dementia and Driving. Each module is available for free on the Department of Veterans Affairs Talent Management System (TMS) for employees and the free TrainingFinder Real-time Affiliate Integrated Network (TRAIN) platform for clinicians in the community. One continuing education unit is earned upon completion of each module. Design Posttest. Setting Online training at VA TMS and TRAIN. Participants To date, more than 3000 modules have been completed by interprofessional healthcare learners (eg, nurses, physicians, psychologists, and social workers). Measurements Satisfaction, perceived utility of training, knowledge, skills, and attitudes were assessed. Results The learners reported high satisfaction (mean [M] > 4) and ability to apply the knowledge and skills learned from the module to their job (M > 4) on a Likert scale (1 = Strongly disagree to 5 = Strongly agree). Conclusion Learners also reported perceived impact on both direct patient care (eg, ability to provide education and support to individuals with dementia and their caregivers) and system-level care (eg, more appropriate referrals). Given the number of users and their evaluation data, PACERS can serve as a model curriculum for online interprofessional dementia training. J Am Geriatr Soc 68:192-197, 2019.

Gastric cancer is one of the most common malignancies affecting gastrointestinal tract. It a multifactorial illness, both genetic and environmental factors involving in etiology. A wide variation in the incidence of gastric cancer in different geographical regions. Endoscopy is the most sensitive and specific method for the diagnosis. The aims of this study is to describe the distribution rate of gastric cancer in AL-Diwaniyah province in Iraq in correlation with the patients age, sex and the histopathological types of gastric cancer. From about (4078) patients who underwent gastroscopy for different indications at AL-Diwaniyah gastroenterology and hepatology center in Iraq during the period between November 2015 and April 2019, (76) patients were founded to have gastric cancer by documented histopathological study of tissue biopsy. Gastric cancer distribution was about (1.8%). Males are affected more than females in a ratio of (1.37:1). Out of (76) total number of patients with gastric cancer ;(69) patients (90.79%) having gastric adenocarcinoma ( most common type) with male to female ratio of (1.46:1). (5) Patients (6.58%) having gastrointestinal stromal tumors (GIST) and (2) patients ( 2.63%) having lymphoma. In patients with adenocarcinoma,(12) patients (17.39%) were less than (40 years) of age, (31) patients (44.93%) were between (40-60 years) and (26) patients (37.68%) were older than (60 years). The intestinal-type adenocarcinoma was the most common histopathological type (63.77%), followed by diffuse type (30.43%), mixed (4.35%) and mucinous(1.45%). Gastric cancer incidence is increasing with advance age; it still a public health and challenging problem. Mass screening or surveillance programs is the best method for the detection and diagnosis of gastric cancer at an early stage.

To contribute to the outstanding discussion of suggested reasons of obesity, including the hormonal disorders, and how to deal and avoid them, this research attempts to investigate and control the energy balance disturbances resulting from hormonal disorders that may cause obesity by dysregulating appetite. A total of 88 participants are recruited, among whom 50 and 38 were allocated to the control and patients groups, respectively. Venous blood samples are collected from the participants at different time points for the quantification of the pre-prandial and 2, 6 and 12 h postprandial levels of lipid markers, including total cholesterol, high density lipoproteins, low density lipoproteins, very low density lipoproteins, and triacylglycerol, and the appetite-related hormones leptin and intestinal hormones glucagon-like peptide (GLP-1). In healthy controls, leptin levels increased prior to eating, decreased after eating, and then increased to induce hunger at several hours after eating. By contrast, the pre-prandial and postprandial leptin levels of the patients group did not show statistically significant differences. Healthy controls had moderate GLP-1 levels, whereas patients with obesity and leptin resistance had high GLP-1 levels. The GLP-1 was found to be secreted in response to high postprandial energy levels as an adaptation to leptin resistance. This study elucidates the relationship between the adipose tissue hormone leptin and GLP-1 in patients with morbid obesity. Findings of using GLP-1 as an appetite regulator for the morbidly obese patients and have leptin resistance (resistance to its action in appetite regulation), presented here, should provide a valuable information for further experimental investigations.

Twenty years ago, the US Congress articulated a need to decrease the time it takes clinical best practices to move from the literature to daily clinical practice. The Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center was one of several centers of excellence established to address this need. It is also unique in that it focuses on rural and underserved veterans. This article summarizes the education accomplishments of the South Central Mental Illness Research, Education, and Clinical Center thus far in providing educational resources and trainings to frontline Veterans Affairs mental health staff with the goal of bringing best practices to routine clinical care, thus improving mental health services. We describe the use of implementation science to support dissemination of information, such as the monthly mental health grand rounds, especially for rural staff to receive continuing education, and the adoption of evidence-based psychotherapy trainings. The Clinical Educator Grants program allows clinicians to share their clinical expertise through development of practical tools for practice gaps they identify. We describe some future directions to meet the evolving needs of Veterans Affairs and community clinicians to provide the best possible care to Veterans. Take-away messages are that, for trainings to be successful, an implementation plan is critical and that an effective educational program requires funding and leadership commitment.

Study Objectives: To assess pre and post intervention preventive knowledge &practices about Dengue infection. 1). To compare knowledge about Dengue infection between2nd and 5th year medical students. 2). To compare preventive practices about dengue infection,between 2nd year and 5th year medical students. Data Source: 2nd year and 5th year medicalstudents. Study Design: Cross-sectional with descriptive analysis. Setting: Study wasconducted in one medical school in the city of Lahore. Period: Data collection was completed inone month. Material and Method: Out of total number of undergraduate medical schools in thecity of Lahore where each one is considered as a cluster one was selected by simple randomsampling. Within the selected cluster (medical school) the students were (study units) wereselected by simple random sampling. Data collection technique & tool: Data was collectedthrough self-administered questionnaires. Sample size: 200 medical students from the selectedmedical school. Hundred students each from 2nd and 5th year ongoing classes were selectedthrough simple random sampling. Results: 35.5% (71/200) of medical students interviewed inboth the classes had an idea about the causative agent of Dengue infection of which 59.2%(42/71) were 5th year and 40.8% (29/71) were 2nd year medical students. Sufficient knowledgeabout symptoms of Dengue infection was found in 50.0% (100/200) of all participants out of which59.0% (59/100) were in final and 41% (41/100) were in 2ndyear of medical school. 51% (102/200)students were aware about different serotypes of Dengue infection out of which 63.7% (65/102)were 5th year and 36.3% (37/102) were 2nd year medical students (p< 0.0001: 95% CL: 1.7-5.6).About 42.5% (85/200) students interviewed were knowledgeable of different preventivemeasures to combat Dengue infection in community of which 49.4% (42/85) were 5th year and50.6% (43/85) were 2nd year medical students (p= 0.88, 95% CL: .54-1.6). Similarly out of 5thyear students who were aware of preventive measures against Dengue infection 50 %( 21/42)were undertaking preventive practices as compared to 51% (22/43) of 2nd year medical students(p= 0.91, CL: .40-2.2). Conclusions: There was no statistically significant difference inpreventive knowledge and practices against Dengue infection between 5th and 2nd year medicalstudents. Thus Community Medicine curriculum related to vector-borne diseases delivered inyear 4 of medical school was not successful in producing post intervention knowledge andbehavior change in 5th year medical students.

This study involves the important comparison in doing V-P shunt operation before surgical correction and repair to the neonates born with spinal dysraphism meningocele at the lumber region versus doing V-P shunt after repair of neural tube defect meningocele to avoid post operative (correction of neural tube defect) leaking cerebrospinal fluid and surgical wound infection.The study 50 newborn babies with hydrocephalus and spinal dysraphism meningocele.

Pregnancy allows the maternal blood to alter both the hormonal and biochemical material. This research was therefore aimed at investigating the shift in the profile of Thyroid stimulating hormone (TSH), triiodothyronine (T3), tetraiodothyronine (Thyroxin T4), prolactin and lipid during the three stages of pregnancy. The study included 30 pregnant women and 20 non-pregnant women as a control group (the age of women was 20-41 years). The study was performed from October to May 2017 at AL-Batool Teaching Hospital in Baqubah District, Diyala Governorate, Iraq. Hormones were assessed using an automated hormone analyzer (Cobase411, Roche, Germany) and the lipid profile was measured using an automated biochemistry analyzer (Cobase400Integra Plus, Roche, Germany). The findings revealed a substantial elevation of prolactin in the three phases of pregnancy (p 0.05) in the first trimester relative to the control group, TC and TG increased significantly (p

A diagnosis of carpal tunnel syndrome (CTS) in a human often contains more than one test. Calcification of the carpal transverse ligaments (TCL) is one of the common reasons why patients seek CTS surgery. However, determination of calcium (Ca) concentration in TCL has not been studied, and results of environmental toxicity studies assessing the relationship between Ca, and elemental deposition in TCL are inconsistent. The purpose of this paper was to verify this hypothesis by conducting a chemical analysis of a portion of the released TCL to assess whether there is a relationship between CTS and Ca, measured as the total concentration of Ca, and to measure the precipitation of elements, the most closely related elements associated with Ca and toxic are cadmium and lead. Surgical release of TCL was performed on forty patients, and total concentrations of Ca, Cd and Pb in the extracted portion of TCL were digested and determined using inductively coupled plasma mass spectrometry (ICP-MS) and the possibility of using X-ray spectroscopy (XRF) for direct elemental analysis. Ca mineralization revealed in some TCLs. In assessing patients’ environmental pollution, it was observed that the Cd and Pb concentrations were significant with the higher Ca concentration, and XRF was useful for direct detection of the elements in samples of human body. In conclusion, these results indicate that TCL mineralization by Ca does not characterize CTS, which has important concerns in improving patients’ therapeutic strategies, and Cd and Pb concentrations varied due to different factors.

Background: Acute Appendicitis first characterized as a surgical entity in 1886 by pathologist Reginald Fitz,appendicitis is now the most common abdominal emergency and appendectomy is the non-elective surgerymost frequently performed by general surgeons. More than 250,000 cases are diagnosed and intervenedannually in the United States. It occurs less frequently in men than in women, with a lifetime risk of 8.6%and 6.7% respectively. Acute appendicitis occurs infrequently in very young children as well as in olderadults. Having its peak incidence in patients between the end of the second decade and the third decade oflife. Showing an inverse relationship between incidence and mortality, its prevalence was less than 1% in thegeneral population and increases to 4-8% in older adults.Aim of the Study: To assess Alvarado scoring system as a diagnostic tool for acute appendicitisMethod: A prospective cross-sectional study carried at Al-Yarmouk Teaching hospital and BaghdadTeaching hospital in the period from the first of Jan 2020 to end of July 2020, in which 190 patients fromboth genders were enrolled, and their ages ranged from 12-68 years.Conclusion: Alvarado score was better than Ohmann score in diagnosis of the patients with acute.

Background: Street traffic accidents were a main community healthiness problematic particularly in lowand middle-income countries, head injuries were found to be the most common injuries. Objectives: toidentify the relationship of road traffic injuries with different associated factors.Methodology: This was a cross sectional study conducted on 500 Road Traffic Accidents victims admitted tothe emergency unit at Al-Sader Teaching General Hospital in Al Najaf Holy province- Iraq. Data collectionwas done using a pretested questionnaire. A medical team including neurosurgeon, medical, and orthopedicsto identify the types (pattern) of cranio-cerebral injuries evaluated outcomes of the injury cases.Results: Most of the victims are males in their productive age, motorcycle is the most common cause ofaccidents, head injuries constituted the highest proportion (39.6%), the mortality rate was (13.6%), andunhealthy behaviors during driving were dominated.Conclusion: Cerebral contusions and skull fractures were the most common lesions among head injuriesand trauma brain injuries victims.

The aim of this work is to find the best medications to get the maximal health rate recovery for coronavirus (COVID-19) patients. Sometimes the patients may take more than one medication. But they do not heal within the same time. So in this paper, we will study new technical depends on the lower approximation, upper approximation, and boundary region for nano topological space (NTS). This technical will help us to choose and determine some of these medications that are suitable activities and necessary to health rate recovery for coronavirus patients.

A 73-year-old female patient presented for mitral valve replacement and coronary artery bypass grafting secondary to multivessel coronary disease and severe mitral valve regurgitation with moderate stenosis. After bypass, the patient developed refractory hypotension with decreased biventricular volume and elevated central venous pressure (CVP). Transesophageal echocardiography (TEE) was utilized to make the diagnosis of acute intraoperative superior vena cava (SVC) syndrome. The SVC cannulation site was revised, resulting in resolution of the hypotension and a decrease in the CVP. Intraoperative TEE was vital in recognizing, managing, and ultimately repairing the acute intraoperative SVC stenosis.

OBJECTIVES: Capacity for safe and independent living (SAIL) refers to an individual’s ability to solve problems associated with everyday life and perform activities necessary for living independently. Little guidance exists on the assessment of capacity for SAIL among nursing home residents. As a result, capacity for SAIL is not fully considered in the development of discharge plans to ensure safety and independence in the community. We reasoned that this problem could be addressed with the Making and Executing Decisions for Safe and Independent Living (MEDSAIL) tool, developed to screen for capacity for SAIL among community-dwelling older adults. In this report, we describe findings on the validity of the MEDSAIL when used with nursing home residents. DESIGN: Prospective cross-sectional pilot study. SETTING AND PARTICIPANTS: Twenty-four residents of a Veterans Health Affairs Community Living Center (CLC; nursing home); exclusion criteria were cognitive impairment too severe to complete the protocol, diagnosis of serious mental illness or developmental disability, inability to hear, or inability to communicate verbally. METHODS: Participants completed 2 assessments: the MEDSAIL interview administered by a research assistant and the criterion standard capacity interview administered by a geriatric psychiatrist. We examined internal consistency, divergent validity, and criterion-based validity. RESULTS: Five of 7 MEDSAIL scenarios approximated acceptable levels of internal consistency (α >0.70). MEDSAIL scores were highly positively correlated with criterion standard capacity determination (0.88, P=.001), and the Wilcoxon rank-sum test statistic for the 2 assessments was also statistically significant (P =.001). CONCLUSIONS AND IMPLICATIONS: MEDSAIL has promise as a user-friendly brief screening tool for use by nursing home staff to understand resident capacity for SAIL. This information can be used in the development of discharge plans to keep the resident safe and independent in the community. In addition, tailoring the MEDSAIL scenarios specifically to the nursing home setting may further enhance the tool’s validity and utility in this new application. Published by Elsevier Inc. on behalf of AMDA – The Society for Post-Acute and Long-Term Care Medicine.

IntroductionMalignant tumors of the lung are the most important cause of morbidity and mortality due to cancer all over the world. A rising trend in the incidence of lung cancer has been observed. Histopathological diagnosis of lung cancer is a vital component of patient care. The use of artificial intelligence in the histopathological diagnosis of lung cancer may be a very useful technology in the near future.AimThe aim of the present research project is to determine the effectiveness of convolutional neural networks for the diagnosis of squamous cell carcinoma and adenocarcinoma of the lung by evaluating the digital pathology images of these cancers.Materials & MethodsA total of 15000 digital images of histopathological slides were acquired from the LC2500 dataset. The digital pathology images from lungs are comprised of three classes; class I contains 5000 images of benign lung tissue, class II contains 5,000 images of squamous cell carcinoma of lungs while Class III contains 5,000 images of adenocarcinoma of lungs. Six state of the art off the shelf convolutional neural network architectures, VGG-19, Alex Net, ResNet: ResNet-18, ResNet-34, ResNet-50, and ResNet-101, are used to assess the data, in this comparison study. The dataset was divided into a train set, 55% of the entire data, validation set 20%, and 25% into the test data set.ResultsA number of off the shelf pre-trained (on ImageNet data set) convolutional neural networks are used to classify the histopathological slides into three classes, benign lung tissue, squamous cell carcinoma-lung and adenocarcinoma - lung. The F-1 scores of AlexNet, VGG-19, ResNet-18, ResNet-34, ResNet-50 and ResNet-101, on the test dataset show the result of 0.973, 0.997, 0.986, 0.992, 0.999 and 0.999 respectively.DiscussionThe diagnostic accuracy of more 97% has been achieved for the diagnosis of squamous cell carcinoma and adenocarcinoma of the lungs in the present study. A similar finding has been reported in other studies for the diagnosis of metastasis of breast carcinoma in lymph nodes, basal cell carcinoma, and prostatic cancer.ConclusionThe development of algorithms for the recognition of a specific pattern of the particular malignant tumor by analyzing the digital images will reduce the chance of human errors and improve the efficiency of the laboratory for the rapid and accurate diagnosis of cancer.

Anaplasma sp. is an obligatory intracellular Gram-negative tick-transmitted bacterial pathogen of humans and animals. Oxytetracycline and chlortetracycline are the drugs of choice for treating domestic animals with acute anaplasmosis. Lack of documented information about oxytetracycline resistance in Anaplasma species in the world was the scope of this study to screen by PCR for the detection of the oxytetracycline-resistance genes in Anaplasma species from infected cattle and sheep in the Northwest and Southwest of Iran. Total of 100 cattle and sheep blood samples collected from 2 provinces in the Northwest and 1 province in the Southwest of Iran were tested microscopically by the Giemsa staining examination and confirmed by PCR. Then the presence of two different oxytetracycline-resistance genes (otrA, and otrB) was detected by PCR in positive samples. The results showed that 60% of Anaplasma-infected samples were identified to have an otrA-resistance gene, and 26.67% had an otrB-resistance gene. The coexistence of two oxytetracycline-resistance determinants was encountered in 13.33% of the isolates. The significant difference in the frequency of otr genes was found among three Anaplasma species (A. marginale, A. centrale and A. ovis), and among three studied regions in Iran (p

Brain involvement occurs in 2–3% of patients with systemic echinococcosis. Children are most often affected and, in countries where echinococcosis is common, up to 50% of all childhood CNS “tumors” prove to be echinococcal cysts, life saving rapid burr hole aspiration of cyst with total removal of cyst membrane with the use of hypertonic solution as cidal agent with pre and post operative antiprotozoal is very successful procedure in emergency deteriorating patient with brain hydatid.

Lung epithelial-mesenchymal transition (EMT) plays an important role in silicosis fibrosis. The reverse process of EMT is mesenchymal-epithelial transition (MET), which is viewed as an anti-EMT therapy and is a good target toward fibrosis. MicroRNAs (miRNAs) have emerged as potent regulators of EMT and MET programs, and, hence, we tested the miRNA expression using microarray assay and investigated their roles in silica-induced EMT in lung epithelial cells. We found that miRNA-29b (miR-29b) was dynamically downregulated by silica and influenced the promotion of MET in RLE-6TN cells. Furthermore, delivery of miR-29b to mice significantly inhibited silica-induced EMT, prevented lung fibrosis, and improved lung function. Together, our results clearly demonstrated that miR-29b acted as a novel negative regulator of silicosis fibrosis-inhibited lung fibrosis, probably by promoting MET and by suppressing EMT in the lung. These findings may represent a new potential therapeutic target for treating silicosis fibrosis., Graphical Abstract

The current study is the identification and isolation dermatophyte species in clinical isolates by both Sabouraud’s Dextrose Agar (SDA) and on Dermatophyte Test Medium (DTM). Clinical specimens of hair, nails and skin scales were collected from patients with dermatophytosis and submitted to direct microscopic examination after immersion in 20% of potassium hydroxide solution. The clinical specimens were cultured on SDA containing chloramphenicol and cycloheximide, and on DTM. Tinea corporis showed the highest prevalent dermatophyte infection among patients (26.7%), followed by Tinea pedis (23.3%), whereas Tinea manuum exhibited the lowest fungal infection (6.7 %). Rural areas revealed the highest prevalence of dermatophyte infection (70.0 %) in comparison to 30.0% in urban areas. Based on the conventional laboratory methods, 30 clinical isolates of dermatophytes showed positive cultures which belong to three genera (Trichophyton, Microsporum and Epidermophyton). Trichophyton mentagrophytes was the most common species (21.7%) isolated among 30 positive dermatophytes, followed by Epidermophyton flocosum (17.4%), then Trichophyton bullosum and Trichophyton tonsurans (13.0%).

This study was designed to evaluate serum and electrocardiographic (ECG) changes in cattle with foot-and-mouth disease (FMD). Thirty-two cows with clinical signs of FMD and 13 healthy cows were randomly enrolled. After blood sampling, ECG was performed on 23 of the 32 ill cows. Serum circulatory troponin I (cTnI), CPK, LDH, and CK-MB activities were determined in the patient and control groups. Arrhythmias including ventricular tachycardia (VT), sinus tachycardia (ST), atrial fibrillation (AF), and premature ventricular complex (PVC) were seen in 4, 4, 2, and 1 of the patients, respectively. The patients had higher cTnI levels than the control group (P = 0.05). A significant rise in cTnI was observed in patient cows with VT (0.86 ± 0.33; P < 0.01) and AF (0.22 ± 0.01 ng/mL; P < 0.05) in comparison with the control group (0.14 ± 0.04 ng/mL). The most significant finding of this study was the death of all of the cows with VT. It appears that the cause of death in the cows with VT was cardiac impairment, which was marked by serum cTnI elevation. It can be concluded that cows with VT have a grave prognosis. In some FMD cases with an increase in cTnI, AF was also observed, but with a fairly good prognosis.

BACKGROUND Neonatal alloimmune neutropenia results from maternal alloimmunization to human neutrophil antigens. The alloantibodies involved in neonatal alloimmune neutropenia are against human neutrophil antigens HNA-1a, HNA-1b, HNA-1c, HNA-1d, HNA-2, HNA-3a, HNA-4a, HNA-4b, and HNA-5a; however, to date, antibodies specific to HNA-3b have not been reported. STUDY DESIGN AND METHODS Blood samples from 10,000 unselected neonates were analyzed, resulting in the selection of 88 neutropenic newborns (neutrophil count

Cholinesterase inhibitors (ChEIs) are the primary pharmacological treatment for symptom management of Alzheimer disease (AD), but they carry known risks during long-term use, and do not guarantee clinical effects over time. The balance of risks and benefits may warrant discontinuation at different points during the disease course. Indeed, although there is limited scientific study of deprescribing ChEIs, clinicians routinely face practical decisions about whether to continue or stop medications. This review examined published practice recommendations for discontinuation of ChEIs in AD. To characterize the scientific basis for recommendations, we first summarized randomized controlled trials of ChEI discontinuation. We then identified practice guidelines by professional societies and in textbooks and classified them according to 1) whether they made a recommendation about discontinuation, 2) what the recommendation was, and 3) the proposed grounds for discontinuation. There was no consensus in guidelines and textbooks about discontinuation. Most recommended individualized discontinuation decisions, but there was essentially no agreement about what findings or situations would warrant discontinuation, or even about what domains to consider in this process. The only relevant domain identified by most guidelines and textbooks was a lack of response or a loss of effectiveness, both of which can be difficult to ascertain in the course of a progressive condition. Well-designed, long-term studies of discontinuation have not been conducted; such evidence is needed to provide a scientific basis for practice guidelines. It seems reasonable to apply an individualized approach to discontinuation while engaging patients and families in treatment decisions. .

Pica is often considered a nutritional disorder of cattle and other farm animals, but the etiology is controversial. Roles for the shortage or imbalance of some nutritional elements have been debated. This study was conducted to evaluate serum variations of some electrolyte, mineral, and protein factors in cattle with pica. After history taking and clinical examination, of the 285 referred native cows, 15 with an ongoing history of pica were included as the pica group. Fifteen healthy-looking cows without pica were randomly chosen as the control. Serum levels of Ca, P, Mg, Na, Cl, K, Cu, Zn, Fe, total protein, albumin, urea, and ferritin were quantified. Body condition score and any deformity of the legs of the cows in the study were visually determined. The prevalence rate of pica was 5.96%. Six out of 15 of the cows with pica (40%) had deformation of the legs associated with hypophosphatemia (1.82 ± 0.7 mg/dL). Profound hypophosphatemia and hypochloremia were seen in all diseased cattle. There was no significant difference between serum values of copper, zinc, total protein, albumin, and urea between the 2 groups. The serum ferritin and iron concentration of pica group was also lower than those of control group ( P

The growing number of older adults with cognitive impairment is increasing the need for healthcare services. However, there is a great shortage of geriatric trained primary care providers and psychiatrists. A positive attitude towards people with cognitive impairment is associated with better quality of life among residents of long-term care settings. This led us to develop a simulation exercise to raise learners’ awareness of, and attentiveness to, physical and cognitive changes experienced by the aging population. Fifty-one learners rotating through Psychiatry at the Michael E. DeBakey VA Medical Center received the 10-min training over 1 year. The Approaches to Dementia Questionnaire was used to measure attitudes towards older persons with cognitive impairment. Pre- and postsimulation data subscores for the Hope, Person-centered, and total score were calculated, and a paired sample t test was conducted. Results of the questionnaire showed statistically significant improvement in the Approaches to Dementia Questionnaire scores among participants after they completed the simulation exercise, indicating an increase in positive attitudes. The mean difference in the total score of the Approaches to Dementia Questionnaire was 3.22, with a 95% CI of 1.67 to 4.74, t = 4.20, df (47), p

It has been reported that germline DICER1 mutations correlate with a distinctive human disease syndrome. Many published studies within this field have been conducted based on rare cases. We systematically searched bibliographic databases, including PubMed, Embase, and COSMIC for articles which are related to diseases covered by DICER1 syndrome. The weighted summary of mutation frequencies among patients with pleuropulmonary blastoma (PPB), cystic nephroma (CN), and Sertoli-Leydig cell tumor (SLCT) were calculated. Forty-nine eligible articles were included. In total, 72 cases with multimorbidity of DICER1 syndrome were identified. More females (n=46, 64%) presented with multimorbidity than males (n=18, 25%) and the remaining 8 patients' sex were unknown. Nineteen of 72 patients with multimorbidity suffered from another disease that was not yet included in DICER1 syndrome, which would provide potential phenotypes of DICER1 syndrome. The germline DICER1 mutation frequencies in PPB, CN, and SLCT were 66.9%, 73.2%, and 57.1%, respectively. The somatic DICER1 mutation frequencies of PPB, CN, and SLCT were 92.4%, 87.9%, and 43.3%, respectively. Majority of patients with multimorbidity of DICER1 syndrome were mutation positive individuals so that multimorbidity may suggest the possible germline mutation of these patients and their relatives.

Purpose The SENSIMED Triggerfish® contact lens sensor (CLS) has an embedded micro-sensor that captures spontaneous circumferential changes at the corneoscleral junction and transmits them via an antenna to a device where these measurements are stored. During laparoscopic colorectal surgery, patients are placed in Trendelenburg position which has been shown to increase intraocular pressure (IOP). Laparoscopic colorectal surgery requires both pneumoperitoneum and Trendelenburg positioning; therefore, IOP can vary significantly. We aimed to assess whether circumferential changes in the corneoscleral area can be correlated to IOP changes measured using Tono-pen® XL applanation tonometer during laparoscopic colorectal surgery. Method Patients undergoing laparoscopic colorectal resections were included. On the day of surgery, baseline IOP was taken and the SENSIMED Triggerfish® CLS was then set up in one eye of the patient. During surgery (whilst under general anaesthetic), IOP measurements were taken in the contralateral eye using a Tono-pen® XL applanation tonometer every hour and any time the table was moved to record the fluctuations of IOP during surgery and any association with position change. The timings of these readings were documented. Results Twenty patients were included in this study (six males, 14 females). Average age was 64.6 years (SD = 16.3). The fluctuation in IOP measured in the reference eye ranged between 6.3 and 46.7 mmHg. The mean correlation coefficient between CLS output measurements and these IOP measurements was r = 0.291 (95% CI). Conclusion Our results showed a weak correlation between the SENSIMED Triggerfish® CLS data output and IOP measurements taken using the Tono-pen® XL applanation tonometer.

The spectrum of anxiety disorders occurring in later life is diverse and includes the same disorders that occur with younger adults—such as generalized anxiety disorder, panic disorder, specific phobias, and social anxiety disorder—but also unique presentations, including a fear of falling and the anxiety often seen in various neurocognitive disorders. Therefore, diagnosis and treatment are arguably more challenging in older populations. In addition, many older adults have subthreshold symptoms that can benefit from proper management. This article summarizes the literature on anxiety disorder presentations in later life and offers key recommendations to assist clinicians working with this growing population.

There is a paucity of research, in general, on TRD-LL and on novel approaches and interventional methods for older adults suffering with TRD-LL. Most of the lack of data stems from limited studies on these interventions in older adults since most pharmacotherapy and neuromodulation trials specifically exclude older adults or those with comorbid medical or psychiatric conditions. Broadly, approaches can be divided into those that are FDA approved for depression (but not specifically for TRD-LL) and those that are available and empirically supported but not FDA approved. Among the FDA approved treatments of transcranial magnetic stimulation (all forms of rTMS and dTMS), vagus nerve stimulation (VNS), deep brain stimulation (DBS), and now intranasal ketamine, TMS has been most extensively studied for treatment of late life depression. Newer forms of TMS are also being evaluated in older adults. Though there are extensive data on the use of VNS in TRD, there are no studies in older adults specifically, although a multicenter trial supported by the US Center of Medicare and Medicaid Services, which will recruit adults aged 65 and above, will soon be underway. Published studies in DBS have included older adults but not in appreciable numbers for separate analyses. Studies thus far suggest some benefit in TRD but no specific data for TRD-LL. Most of the published studies of IV ketamine, which is not FDA approved for depression, are limited to case reports which tend to support its use and tolerability in TRD-LL when used as monotherapy or in combination with other interventions. Use of intranasal ketamine, which was recently FDA approved earlier in 2019, in TRD-LL remains anecdotal. Among other approaches with empirical support, but not necessarily FDA approved specific indications, are behavioral interventions (exercise, stress reduction activities), bright light therapy, combination pharmacotherapy (lithium, T3/T4, atypical antipsychotics, psychostimulants, D3 agonists, and opioid analogs), and combination pharmacotherapy and psychotherapy. After briefly reviewing the above interventions, discussion will focus on the clinical assessment of TRD-LL and possible treatment algorithms.

Background Despite significant improvement in imaging quality and advanced scientific knowledge, it may still sometimes be difficult to distinguish different parathyroid lesions. The aims of this prospective study were to evaluate parathyroid lesions with ultrasound elastography and to determine whether strain index can help to differentiate parathyroid lesions. Methods Patients with biochemically confirmed hyperparathyroidism and localised parathyroid lesions in ultrasonography were included. All patients underwent B-mode US and USE examination. Ultrasound elastography scores and strain index of lesions were determined. Strain index was defined as the ratio of strain of the thyroid parenchyma to the strain of the parathyroid lesion. Results Data of 245 lesions of 230 patients were analysed. Histopathologically, there were 202 (82.45%) parathyroid adenomas, 26 (10.61%) atypical parathyroid adenomas, and 17 (6.94%) cases of parathyroid hyperplasia. Median serum Ca was significantly higher in atypical parathyroid adenoma patients than parathyroid hyperplasia patients (P = 0.019) and median PTH was significantly higher in APA compared to PA patients (P P = 0.003). Conclusion Our study revealed that SI of parathyroid lesions as well as serum calcium, parathyroid hormone levels, and B-mode US features may help to predict the atypical parathyroid adenoma. Ultrasound elastography can be used to differentiate among parathyroid lesions and guide a surgical approach.

Background and Aim Post‐ERCP pancreatitis (PEP) is the most common complication following endoscopic retrograde cholangiopancreatography (ERCP). It is still controversial whether the presence of a trainee would increase the risk of PEP. Additionally, the effects of demographic factors and comorbidities on the risk and severity of PEP are not fully understood. Our aim was to evaluate these factors using national database. Methods Nationwide Inpatient Sample 2000–2014 was used to identify adult patients admitted with biliary obstruction without acute pancreatitis and had an inpatient ERCP. PEP was defined as having a subsequent diagnosis of acute pancreatitis. The presence of major organs failure marked moderate–severe PEP. Demographic information, hospital characteristics, and ERCP intervention types were collected. Results We included 654 394 patients. Overall PEP rate was 5.4%. The PEP rate was lower in teaching (4.8%) compared with nonteaching (6.2%, P, Post‐ERCP Pancreatitis (PEP) is the most common complication following ERCP. Additionally, the effects of demographic factors and comorbidities on the risk and severity of PEP are not fully understood. Nationwide Inpatient Sample 2000–2014 was used to identify adult patients admitted with biliary obstruction without acute pancreatitis and had an inpatient ERCP. We included 654 394 patients and found no evidence of higher PEP rates in teaching hospitals. Asians and Hispanics had higher PEP rates. We note that ERCP intervention type is the major PEP predictor, and its severity was dependent upon patient characteristics.

Forecasting skills for a wind farm would significantly degrade if the complex wake effects of the upstream wind farms are excluded, especially when they are spatially close to each other. In this study, the Weather Research and Forecasting (WRF) model has been used to predict wind speed and power for a wind farm in Pakistan in the presence of wake interference from neighboring wind farms for two different seasons. Forecasting is done for two different cases i.e. without and with inter-farm wake effects, and different statistical error parameters were evaluated based on the real observations. A significant reduction in errors was observed in the latter case. For instance, the mean absolute errors in wind speed prediction were reduced by 7.7% and 14% in June (summer) and January (winter) respectively, by the inclusion of inter-farm wake effects. Similarly, an improved forecast of power output was obtained by incorporating the interaction of upstream wind farms i.e. a reduction of 15% and 26% in the normalized mean absolute error in power output values was observed for June and January, respectively. However, the prediction accuracy of power output substantially deteriorated in the winter season.

Gastrointestinal bleeding (GIB) is a common adverse event after mechanical circulatory support device implantation. However, the majority of the reported data were obtained from small single-center studies. Our aim was to study the prevalence and predictors of GIB during the index hospitalization of mechanical circulatory support devices implantation using a nationwide database. Nationwide inpatient sample (2009–2011) was used to perform a retrospective cross-sectional study. Adult patients with discharge diagnosis codes of congestive heart failure and procedure codes of left-ventricular assist device (LVAD) or intra-aortic balloon pump (IABP) implantation or orthotopic heart transplant (OHT, reference group) were identified. Our outcome was GIB during the index hospitalization when the device was implanted. Predictors that achieved statistical significance on the univariate analysis were included in a multivariable logistic-regression analysis. A total of 87,462 patients were included, 87 % of the patients received an IABP, 6 % received LVAD, and 5 % underwent OHT. Prevalence of GIB was 8, 5, and 3 % among those who had LVAD, IABP implantation, and OHT recipients, respectively (p

Introduction:Glanzmann’s thrombasthenia (GT) is a rare, genetically inherited, functional disorder of platelets. The pathology is deficient or dysfunctional platelet glycoprotein IIb/IIIa (GP IIb/IIIa) complex resulting in bleeding diathesis.Case Report:Here in, we report the effectivity of angioembolization with factor VII in a patient with Glanzmann’s thrombasthenia (GT), who presented with recurrent bleeding from duodenal ulcer.Conclusion:Angioembolization with added infusion of factor VII, can be considered an equally effective alternate to platelet transfusion in patients of GT, who present with recurrent bleeding. Link: http://aeirc-edu.com/ojs14/index.php/IJEHSR/article/view/123/340

Background The efficacy of clinical examinations, and hematologic, hemostatic, and serum biochemical assessments to determine appropriate early medical or surgical therapy in Arabian horses with colic have not been well-described. Objectives We aimed to evaluate clinical and hematologic findings, coagulation-fibrinolytic parameters, and organ dysfunction markers in association with survival in horses with colic. Methods Seventeen Arabian horses with colic and ten healthy horses were enrolled. After clinical examinations, including heart rates (HRs), capillary refill times (CRTs), abdominal sounds, rectal palpations, and nasogastric (NG) reflux assessments in both healthy and diseased horses, blood samples were collected and hematologic parameters, coagulation indices such as the prothrombin time (PT), activated partial thromboplastin time (APTT), plasma d-dimer (PDD), platelet count, fibrinogen, and hepatorenal biomarkers were measured. Based on the outcomes, horses with colic were divided into survival (10) and nonsurvival (7) groups, and all mentioned parameters were compared with the control group horses. Results Unlike HRs, CRTs, and abdominal sounds, rectal palpations (57.1%) and NG reflux (28.6%) findings were least sensitive in being able to determine survival. At least three of the five coagulation indices were significantly abnormal (prolonged PT, increased PDD, and decreased plasma fibrinogen) in 71.4% of the horses in the nonsurvival group compared with the control and survival groups. Significantly increased urea, creatinine, and bilirubin levels, and AST activities were also observed in the survival group compared with the control and nonsurvival groups. Conclusions The combination of prolonged PT, increased PDD, and hypofibrinogenemia could be a reliable predictor of survival in horses with colic. The significant renal and hepatic dysfunctions in nonsurviving horses with colic appeared to be consistent with disseminated intravascular coagulation (DIC) and a grave prognosis.