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Objectives ANCA-associated vasculitis (AAV) can affect all age groups. We aimed to show that differences in disease presentation and 6 month outcome between younger- and older-onset patients are still incompletely understood. Methods We included patients enrolled in the Diagnostic and Classification Criteria for Primary Systemic Vasculitis (DCVAS) study between October 2010 and January 2017 with a diagnosis of AAV. We divided the population according to age at diagnosis: Results A total of 1338 patients with AAV were included: 66% had disease onset at Conclusion Within 6 months of diagnosis of AAV, patients >65 years of age display a different pattern of organ involvement and an increased risk of significant damage and mortality compared with younger patients.

Highlights • Gallstone size correlates with gallbladder malignancy, fistulization, perforation. • A rare case of an asymptomatic patient with a 7.5 cm gallstone is presented. • Surgery is usually offered to surgical candidates with symptomatic cholelithiasis. • Cholecystectomy can be offered to transplant and hemolytic disorder patients. • No indications for cholecystectomy in diabetics and bariatric surgery patients., Introduction Gallstones are present in 10–15% of North Americans, but only 20% become symptomatic. This case report describes a patient with a 7.5 cm gallstone detected incidentally while being investigated for cardiac pathology. This is the first report in the English literature of a stone this size that has remained clinically asymptomatic. This work is reported in line with the SCARE criteria. Case report The patient was a 71-year-old Indigenous Canadian male, with atrial fibrillation. His cardiologist ordered a CT scan of his chest, which incidentally identified a large gallstone. He was referred to surgery for asymptomatic cholelithiasis. An uncomplicated laparoscopic cholecystectomy was performed. Final pathology showed a 7.5 cm gallstone with features of chronic cholecystitis. Discussion The patient’s ethnicity and gallstone size placed him at increased risk for gallbladder cancer, gallstone fistulization and perforation. We reviewed the literature for asymptomatic patients who may benefit from cholecystectomy: transplant recipients and those with hemolytic disorders. Laparoscopic cholecystectomy is not currently indicated in diabetics and bariatric surgery patients. Conclusion This case report shows that there are asymptomatic patients with massive gallstones. A review of their history, risk factors for malignancy and future gallstone related complications must be carefully weighed and discussed prior to deciding on surgical versus expectant management.

Online learning has entirely transformed the way of learning by the students. Online tests and quizzes play an important role in online learning, which provides accurate results to the instructor. But, the learners use different methods to cheat during online exams such as opening a browser to search for the answer or a document in the local drive, etc. They are not authenticated once they login and progress to attend the online exams. Different techniques are used in authenticating the students taking up the online exams such as audio or video surveillance systems, fingerprint, or iris recognition, etc. Keystroke dynamics-based authentication (KDA) method, a behavioral biometric-based authentication model has gained focus in authenticating the users. This chapter proposes the usage of KDA as a solution to user authentication in online exams and presents a detailed review on the processes of KDA, the factors that affect the performance of KDA, their applications in different domains, and a few keystroke dynamics-based datasets to authenticate the users during online exams.

Adolescent gastric cancers are extremely rare with a reported incidence of 0.05–0.10% in North America. We present a de novo case of gastric carcinoma in a 17-year-old teenager with no concomitant family history or risk factors. His main clinical presentation included anaemia and melaena stools. Despite an extensive clinical workup that included a diagnostic laparoscopy, the tumour was deemed surgically irresectable, and he was started on a palliative chemotherapy protocol at the local paediatric oncology centre. He demised 7 months later. This is the first recorded case of an adolescent gastric cancer in Saskatchewan, Canada. This case highlights the need for an international tumour registry to document and investigate rare adolescent gastric malignancies and thereby potentiate a possible cure through the pooling of limited resources.

The population, accidents and pollution level of the agriculture field in India are decreasing. So we have planned to make agriculture easy and it is designed to minimize the labour of farmer in addition to increase the speed and accuracy of the work. To implement this we are using arduino uno as controller and a few sensors that is related to it. It provides employment for 52% of countries workforce. This bot is designed to maintain the water’s pH level properly between 6 -7.5 which is the preferred pH level for cultivation. This proposed system provides a fertilizer, pesticides, it maintains the humidity of the soil and temperature etc. The proposed technique is implemented through this Agribot. For a good yield a farmer needs to monitor the field from time to time and these information of the field are given. The data received are analyzed and discussed. This work invoked to take a preventive measure for loss of crop and also increase the productivity of crop.

Objective End points currently used in lupus nephritis (LN) clinical trials lack uniformity and questionably reflect long-term kidney survival. This study was undertaken to identify short-term end points that predict long-term kidney outcomes for use in clinical trials. Methods A database of 944 patients with LN was assembled from 3 clinical trials and 12 longitudinal cohorts. Variables from the first 12 months of treatment after diagnosis of active LN (prediction period) were assessed as potential predictors of long-term outcomes in a 36-month follow-up period. The long-term outcomes examined were new or progressive chronic kidney disease (CKD), severe kidney injury (SKI), and the need for permanent renal replacement therapy (RRT). To predict the risk for each outcome, hazard index tools (HITs) were derived using multivariable analysis with Cox proportional hazards regression. Results Among 550 eligible subjects, 54 CKD, 55 SKI, and 22 RRT events occurred. Variables in the final CKD HIT were prediction-period CKD status, 12-month proteinuria, and 12-month serum creatinine level. The SKI HIT variables included prediction-period CKD status, International Society of Nephrology (ISN)/Renal Pathology Society (RPS) class, 12-month proteinuria, 12-month serum creatinine level, race, and an interaction between ISN/RPS class and 12-month proteinuria. The RRT HIT included age at diagnosis, 12-month proteinuria, and 12-month serum creatinine level. Each HIT validated well internally (c-indices 0.84-0.92) and in an independent LN cohort (c-indices 0.89-0.92). Conclusion HITs, derived from short-term kidney responses to treatment, correlate with long-term kidney outcomes, and now must be validated as surrogate end points for LN clinical trials.