The impact of COVID-19 on emergency general surgery admissions and operative volumes: A single centre experience

Introduction

The COVID-19 pandemic has placed a significant strain on healthcare resources and utilisation globally. The appearance of the disease in the Republic of Ireland resulted in a broad postponement of scheduled and routine surgical care. The influence of the novel coronavirus, and the associated imposition of public health measures such as school closures and social distancing, on the burden of emergency surgical disease is less clear.

Aim

The aim of this study was to examine the impact of COVID-19 on the number of patients presenting to our institution with emergent surgical illnesses or requiring emergency general surgical procedures.

Methods

All patients attending our service between March 1st 2020 and April 30th 2020 were identified retrospectively by examining electronic handover and electronic discharge summaries, and data were collected relating to demographics, presenting illness, critical care utilisation, length of stay, operative or endoscopic procedure performed, and in-hospital mortality. Similar data were collected March 1st to April 30th 2019, 2018, and 2017 respectively to allow direct comparison.

Results

151 patients were admitted during the study period, compared to a total of 788 during the proceeding three years (mean 2.49 admissions per night versus 4.35 per night, 42.8% reduction, p < 0.001). Median age of admitted patients was 51.8 years, compared to 50.3 years formerly (p = 0.35). 53 emergency procedures were performed, compared to a median of 70 over the same period in the previous years (mean 0.87 per day versus 1.16 per day, 25.4% reduction, p = 0.05).

Conclusion

A significant overall reduction in the number of patients being admitted to our unit and requiring emergency surgical procedures during March and April 2020 was seen, in line with patterns reported internationally.

[To the question of the possibility of using selective chromotherapy for allergic diseases in children]

Allergic diseases are a common pathology in childhood. In the comprehensive medical rehabilitation of children with allergic pathology, non-drug methods of treatment are widely used, which help to reduce the number of drugs used, achieve and prolong the remission of the disease, favorably affect the clinical and functional indicators.

THE PURPOSE OF THE STUDY

Is the scientific justification for the use of selective chromotherapy in children with bronchial asthma (BA) and atopic dermatitis (AD).

MATERIAL AND METHODS

The study included 120 children with allergic diseases (BA and AD). Among 100 patients with BA, the main group included 50 children, who received exposure to monochromatic polarized green light on biologically active zones for 10 days, 50 - a comparison group that did not receive physiotherapy. The main group of children with AD included 10 patients who received selective blue chromotherapy for foci of skin lesions; the comparison group included 10 children who used only moisturizers without physiotherapy methods. In order to assess the effectiveness of the impact of physical factors in all patients, clinical and functional studies were conducted in the dynamics before and after treatment.

RESULTS AND DISCUSSION

The results of clinical and functional examinations showed high therapeutic efficacy of the use of monochromatic polarized green light in children with BA (92.0%). The effectiveness of treating children with blood pressure AD using monochromatic polarized light (blue) was 80%. Indications for the use of selective chromotherapy in children with allergic diseases have been developed. For children with BA, selective chromotherapy of the green spectrum is indicated in the presence of a mild to moderate course of the disease, a period of incomplete remission, and an increased level of anxiety. It is advisable to prescribe selective chromotherapy of the blue spectrum to children with a moderate and mild course of AD.

CONCLUSION

The positive effect of selective chromotherapy of the green spectrum on the clinical course of BA in children, bronchial patency, the functional state of the central nervous system and its autonomic part, and the psychoemotional status of children have been identified. The use of selective blue spectrum chromotherapy in children with AD helps to decrease the severity of objective symptoms, reduce the intensity of itching and sleep disturbance, as well as a marked decrease in the area of skin lesion.

[Modern possibilities of cryotherapy for chronic functional constipation in children]

INTRODUCTION

Among the urgent problems of pediatrics, chronic constipation occupies one of the leading positions due to its high prevalence (20-40%) and the possibility of complications. Conductive cryotherapy, used separately and in combination with percutaneous electroneurostimulation, is a promising technology for the treatment of chronic constipation in children.

AIM OF STUDY

Scientific evidence of the use of conductive cryotherapy and its combined effect with percutaneous electroneurostimulation in children with chronic constipation.

MATERIALS AND METHODS

We examined 80 children aged 3-15 years (average age 8±2 years) suffering from chronic constipation: 35 (43.8%) boys, 45 (56.2%) girls. In 47 (58.8%) children, chronic constipation of the hypotonic type (HT) was detected, in 33 (41.2%) - chronic constipation of the spastic type (ST). Children were divided into 4 groups, comparable in number, age, gender and clinical manifestations. Patients of all groups received basic treatment: laxative diet, probiotics, choleretic drugs, enzymes. Patients of the main group used the combined effect of conduction cryotherapy and percutaneous electroneurostimulation - cryoelectroneurostimulation. Conduction cryotherapy was prescribed for children of the 1st comparison group, percutaneous electroneurostimulation was assigned to the 2nd comparison group. Patients in the control group received only basic therapy. In order to assess the effectiveness of impact of physical factors, clinical and functional examinations of children were carried out before treatment, immediately after the course of treatment, and also 3, 6 and 12 months later after treatment.

RESULTS AND DISCUSSION

The highest treatment efficacy was found in children of the main group with HT and ST (91.6 and 87.5%, respectively) after cryoelectronic neurostimulation. Conduction cryotherapy was most effective for the treatment of ST (77.7%). The results of the study made it possible to develop an algorithm for the prescription of percutaneous electroneurostimulation and conduction cryotherapy, depending on the type of dyskinetic disorders of the colon in children. All children, regardless of the type of chronic constipation, are prescribed to use the combined effects of physical factors (cryoelectroneurostimulation), percutaneous electroneurostimulation is recommended for HT, conductive cryotherapy - for ST.

CONCLUSION

The higher therapeutic effectiveness of the combined use of conduction cryotherapy and percutaneous electroneurostimulation in various types of dyskinetic disorders in children has been proved according to immediate and long-term results of treatment. An algorithm is proposed for differential use of conduction cryotherapy and percutaneous electroneurostimulation taking into account the type of dyskinetic disorders of the colon.

Effects of physical forms of starter and milk allowance on growth performance, ruminal fermentation, and blood metabolites of Holstein dairy calves

A 2 × 2 factorial study was conducted to evaluate the effects of milk allowance and physical forms of starter on growth performance, ruminal fermentation, and blood metabolites of Holstein dairy calves. A total of 48 calves [40.4 ± 1.55 kg of body weight (BW), n = 12 per treatment: 6 males and 6 females] were randomly assigned to 1 of the 4 treatments: (1) calves fed low milk allowance and finely ground (FG) starter feed [low-FG; 1.47 ± 2.12-mm geometric mean particle size (GMLP)], (2) calves fed low milk allowance and textured (TS) starter feed [low-TS, includes steam-flaked grains (corn and barley) with a pelleted supplement, GMLP 4.15 ± 1.77 mm], (3) calves fed high milk allowance and FG starter feed (high-FG); and (4) calves fed high milk allowance and TS starter feed (high-TS). The starter diets were blended with 7% of chopped alfalfa hay as a proportion of diet dry matter (DM). No milk refusal was observed in any treatments, and calves on both treatments were weaned from milk by wk 8 of the study using a gradual weaning procedure. We observed no interaction between milk allowance and physical forms of starter on feed intake, average daily gain, feed efficiency, BW, and structural growth. Calves fed high milk allowance had lower starter feed intake but greater feed efficiency and overall BW compared with those fed low allowance. Total DM intake and average daily gain were not different among treatments. Regardless of the physical form of starter feed, hip height, heart girth, the molar proportion of ruminal acetate, acetate to propionate ratio, plasma cholesterol, and high-density lipoprotein were greater, but ruminal total volatile fatty acids, the molar proportion of propionate, and plasma β-hydroxybutyrate were lower in calves fed high milk allowance compared with those fed low allowance. Regardless of the milk allowance, calves fed the FG starter feeds had greater blood urea nitrogen concentrations compared with calves fed the TS starter diets. In conclusion, both forms of the starter feeds can be used when calves are fed high milk allowance with no negative effect on their performance.

Bone Age Assessment Empowered with Deep Learning: A Survey, Open Research Challenges and Future Directions

Deep learning is a quite useful and proliferating technique of machine learning. Various applications, such as medical images analysis, medical images processing, text understanding, and speech recognition, have been using deep learning, and it has been providing rather promising results. Both supervised and unsupervised approaches are being used to extract and learn features as well as for the multi-level representation of pattern recognition and classification. Hence, the way of prediction, recognition, and diagnosis in various domains of healthcare including the abdomen, lung cancer, brain tumor, skeletal bone age assessment, and so on, have been transformed and improved significantly by deep learning. By considering a wide range of deep-learning applications, the main aim of this paper is to present a detailed survey on emerging research of deep-learning models for bone age assessment (e.g., segmentation, prediction, and classification). An enormous number of scientific research publications related to bone age assessment using deep learning are explored, studied, and presented in this survey. Furthermore, the emerging trends of this research domain have been analyzed and discussed. Finally, a critical discussion section on the limitations of deep-learning models has been presented. Open research challenges and future directions in this promising area have been included as well.

Assessment of Mental Health and Various Coping Strategies among general population living Under Imposed COVID-Lockdown Across world: A Cross-Sectional Study

The 2019 corona virus disease (COVID-19) which outbreak in December 2019, in the Chinese city of Wuhan has became a global threat and is currently the largest known outbreak of atypical pneumonia affecting every continent of the world with about 6,416,828 cases and 382,867 deaths. Disease enforced lockdowns are known to cause heightened levels of depression, anxiety, and stress. Our study aimed to investigate the immediate impact of the COVID-19 pandemic enforced lockdown on mental health and quality of life among general population aged 18 years and to identify various coping strategies used under lockdown. An online survey was conducted between 1st of April-10th of May, 2020; using a validated questionnaire based on DASS-42, employing a snowball sampling technique. A total of 418 responses from 16 different countries were received. The respondents had a high level of depression and anxiety scores, which were significantly different among genders. Also, participants from developing countries-India and Pakistan had severe depression while as participants from India, Pakistan and Kingdom of Saudi Arabia had severe anxiety. We also found that among the various coping strategies, (a) watching television for entertainment, (b) social networking, (c) listening to music, (d) sleeping, (e) doing mundane house chores like cleaning, washing, etc. (f) eating well, and (g) clearing/finishing thepiled-up work were ranked among the most utilized coping strategies by all participants. This study identifies the need to provide the free professional and psychological services to help cope with stress during the disease-enforced lockdown.

Effects of step-down weaning implementation time on growth performance and blood metabolites of dairy calves

The current study evaluated the effects of step-down weaning implementation time on starter feed intake, growth performance, blood metabolites, and ruminal pH in dairy calves. A total of 48 Holstein dairy calves (24 male and 24 female; 3 ± 1 d old; 41.2 ± 1.8 kg of body weight) were assigned (n = 12 per treatment; 6 male and 6 female) to 4 experimental treatments in a completely randomized block design. All calves were fed 6 L/d of milk from d 3 to 10 of age, and the treatments consisted of the following: calves were offered 8 L/d of milk from d 11 to 28 of age and then 4 L/d from d 29 to 63 (Step-28; total milk offered = 326 L); calves were offered 8 L/d of milk from d 11 to 42 of age and then 4 L/d from d 43 to 63 (Step-42; total milk offered = 382 L); calves were offered 8 L/d of milk from d 11 to 56 of age and 4 L/d from d 57 to 63 (Step-56; total milk intake = 438 L); and calves were fed 8 L/d of milk from d 11 to 63 of age and abruptly weaned (control; total milk offered = 466 L). All calves were housed individually in pens and had ad libitum access to water and solid feed throughout the experiment. All calves were completely milk weaned on d 64, and their performance was measured until d 80 of age. During the experiment, the starter intake (kg/d and % of body weight) was greater in calves in the Step-28 group compared with those in the other groups. However, the total metabolizable energy intake was greater in the Step-56 calves compared with the other calves. Overall, the average daily gain (ADG), feed efficiency (ADG/dry matter intake), and ADG/total metabolizable energy intake were similar across the treatments. Circulating glucose, β-hydroxybutyrate, blood urea nitrogen, albumin, total protein, alanine aminotransferase, and aspartate aminotransferase, as well as ruminal pH, were not affected by the treatments. The implementation of step-down weaning in early life (4-6 wk of age) could stimulate solid feed intake compared with weaning at a later age with no negative effect on performance.

Plant growth-promoting endophytic bacteria augment growth and salinity tolerance in rice plants

Salt stress negatively affects growth and development of plants. However, it is hypothesized that plant growth-promoting endophytic bacteria can greatly alleviate the adverse effects of salinity and can promote growth and development of plants. In the present research, we aimed to isolate endophytic bacteria from halotolerant plants and evaluate their capacity for promoting crop plant growth. The bacterial endophytes were isolated from selected plants inhabiting sand dunes at Pohang beach, screened for plant growth-promoting traits and applied to rice seedlings under salt stress (NaCl; 150 mm). Out of 59 endophytic bacterial isolates, only six isolates, i.e. Curtobacterium oceanosedimentum SAK1, Curtobacterium luteum SAK2, Enterobacter ludwigii SAK5, Bacillus cereus SA1, Micrococcus yunnanensis SA2, Enterobacter tabaci SA3, resulted in a significant increase in the growth of Waito-C rice. The cultural filtrates of bacterial endophytes were tested for phytohormones, including indole-3-acetic acid, gibberellins and organic acids. Inoculation of the selected strains considerably reduced the amount of endogenous ABA in rice plants under NaCl stress, however, they increased GSH and sugar content. Similarly, these strains augmented the expression of flavin monooxygenase (OsYUCCA1) and auxin efflux carrier (OsPIN1) genes under salt stress. In conclusion, the pragmatic application of the above selected bacterial strains alleviated the adverse effects of NaCl stress and enhanced rice growth attributes by producing various phytohormones.

Effects of conditioner retention time during pelleting of starter feed on nutrient digestibility, ruminal fermentation, blood metabolites, and performance of Holstein female dairy calves

This study evaluated the effects of conditioner retention time during the pelleting process of starter feed on intake, nutrient digestibility, ruminal fermentation, blood metabolites, and growth performance of dairy calves. A total of 30 Holstein female dairy calves [40 ± 1.93 kg of body weight (BW)] were randomly assigned to 1 of 3 treatments: (1) pelleted starter conditioned for 0 min (CON), (2) pelleted starter conditioned for 2 min, and (3) pelleted starter conditioned for 4 min. Three pelleted starter feeds had similar nutritional composition, and the starters were blended with 3% chopped wheat straw and fed to individually housed calves from d 3 to 70 of age. All calves were fed 4 L/d of pasteurized whole milk twice daily at 0800 and 1600 h from d 3 to 50 of calf age, followed by 2 L/d of morning feeding from 51 to 56 d of age. All calves were weaned on d 56 of age and remained in the study until d 70 of age. With the increase of conditioner retention time during pellet processing for 0, 2, and 4 min, the gelatinized starch content of pelleted starter feed linearly increased from 14, 30, and 45%, respectively. Additionally, the pellet durability and hardness also linearly increased with increasing conditioner retention time during pelleting. Feeding pelleted feed prepared using different conditioner retention time did not affect feed dry matter intake, metabolizable energy intake, weaning BW, final BW, or feed efficiency during the study. We observed no differences in the total-tract apparent digestibility of organic matter, neutral detergent fiber, and crude protein around weaning (d 49 to 56 of age) and after weaning (d 63 to 70 of calf cage); however, the digestibility of dry matter and starch after weaning was increased with increasing conditioner retention time during pelleting of starter feed. No difference was found in overall average daily gain (ADG) or growth rates of hip height, withers height, and heart girth. Ruminal volatile fatty acid profile was not affected by pelleting under different conditioner retention times. The ruminal ammonia concentration tended to be lower for calves fed the 4-min diet compared with those fed the CON diet during the postweaning period. The postweaning (d 57-70 of age) ADG was greater for calves fed the 4-min diet compared with those fed the CON diet. In conclusion, the conditioning time during the pelleting process of starter feed increased the gelatinization of starch, durability, and hardness of the pellets but did not influence feed intake, feed efficiency, and skeletal growth during the first 70 d of age. Increasing conditioning time during the pelleting process improved postweaning ADG; however, the final BW of calves was similar among treatments.

Comparison of statistical methods for recurrent event analysis using pediatrics asthma data

When the same type of event is experienced by a subject more than once it is called recurrent event, which possess two important characteristics, namely "within-subject correlation" and "time-varying covariate." As a result, the traditional statistical methods do not work well on recurrent event data. Over the past few decades, many alternatives methods have been proposed for the analysis of recurrent event data. In this article, the six most prominent methods for recurrent event analysis have been compared on pediatric asthma data. Three variance corrected models (viz "Anderson and Gill [AG] model," "Prentice, William, and Peterson-Counting Process [PWP-CP] model," and "Prentice, William, and Peterson-Gap Time [PWP-GT] model") and three corresponding frailty variants (AG-frailty, PWP-CP-frailty, and PWP-GT-frailty) were compared using three mathematical criterion (AIC, BIC, and log-likelihood) and one graphical criteria (Cox-Snell goodness of fit, visual test). All model comparison indices showed the PWP-GT model as the most appropriate model on asthma data over other models. By using PWP-GT model, seven predictors of asthma exacerbation (viz "abdominal pain at previous visit," "Z5 (%) at previous visit," "diagnosis of asthma at previous visit," "calendar month of exacerbation," "history of maternal asthma," "monthly per capita income," and "emotional stress") were identified. The PWP-GT model was identified as the most appropriate model over other models on pediatrics asthma data.

A novel nonsense variant in SLC24A4 causing a rare form of amelogenesis imperfecta in a Pakistani family

Background

Amelogenesis imperfecta (AI) is a highly heterogeneous group of hereditary developmental abnormalities which mainly affects the dental enamel during tooth development in terms of its thickness, structure, and composition. It appears both in syndromic as well as non-syndromic forms. In the affected individuals, the enamel is usually thin, soft, rough, brittle, pitted, chipped, and abraded, having reduced functional ability and aesthetics. It leads to severe complications in the patient, like early tooth loss, severe discomfort, pain, dental caries, chewing difficulties, and discoloration of teeth from yellow to yellowish-brown or creamy type. The study aimed to identify the disease-causing variant in a consanguineous family.

Methods

We recruited a consanguineous Pashtun family of Pakistani origin. Exome sequencing analysis was followed by Sanger sequencing to identify the pathogenic variant in this family.

Results

Clinical analysis revealed hypomaturation AI having generalized yellow-brown or creamy type of discoloration in affected members. We identified a novel nonsense sequence variant c.1192C > T (p.Gln398*) in exon-12 of SLC24A4 by using exome sequencing. Later, its co-segregation within the family was confirmed by Sanger sequencing. The human gene mutation database (HGMD, 2019) has a record of five pathogenic variants in SLC24A4, causing AI phenotype.

Conclusion

This nonsense sequence variant c.1192C > T (p.Gln398*) is the sixth disease-causing variant in SLC24A4, which extends its mutation spectrum and confirms the role of this gene in the morphogenesis of human tooth enamel. The identified variant highlights the critical role of SLC24A4 in causing a rare AI type in humans.

Modelling, Simulation and Optimization of Diagnosis Cardiovascular Disease Using Computational Intelligence Approaches

Background: To provide ease to diagnose that serious sickness multi-technique model is proposed. Data Analytics and Machine intelligence are involved in the detection of various diseases for human health care. The computer is used as a tool by experts in the medical field, and the computer-based mechanism is used to diagnose different diseases in patients with high Precision. Due to revolutionary measures employed in Artificial Neural Networks (ANNs) within the research domain in the medical area, which appear to be in the data-driven applications usually described in the domain of health care. Cardio sickness according to name is a type of an ailment that is directly connected to the human heart and blood circulation setup, so it should be diagnosed on time because the delay of diagnosing of that disease may lead the sufferer to death. The research is mainly aimed to design a system that will be able to detect cardiovascular sickness in the sufferer using machine learning approaches. Objective: The main objective of the research is to gather information of the six parameters that is age, chest pain, electrocardiogram, systolic blood pressure, fasting blood sugar and serum cholesterol are used by Mamdani fuzzy expert to detect cardiovascular sickness. To propose a type of device which will be successfully used in overcoming the cardiovascular diseases. This proposed model Diagnosis Cardiovascular Disease using Mamdani Fuzzy Inference System (DCD-MFIS) shows 87.05 percent Precision. To delineate an effective Neural Network Model to predict with greater precision, whether a person is suffering from cardiovascular disease or not. As the ANN is composed of various algorithms, some will be handed down for the training of the network. The main target of the research is to make the use of three techniques, which include fuzzy logic, neural network, and deep machine learning. The research will employ the three techniques along with the previous comparisons, and given that, the results will be compared respectively. Methods: Artificial neural network and deep machine learning techniques are applied to detect cardiovascular sickness. Both techniques are applied using 13 parameters age, gender, chest pain, systolic blood pressure, serum cholesterol, fasting blood sugar, electrocardiogram, exercise including angina, heart rate, old peak, number of vessels, affected person and slope. In this research, the ANN-based research is one of the algorithms collections, which is the detection of cardiovascular diseases, is proposed. ANN constitutes of many algorithms, some of the algorithms are employed in the paper for the training of the network used, to achieve the prediction ratio and in contrast of the comparison of the mutual results shown. Results: To make better analysis and consideration of the three frameworks, which include fuzzy logic, ANN, Deep Extreme Machine Learning. The proposed automated model Diagnosis Cardiovascular Disease includes Fuzzy logic using Mamdani Fuzzy Inference System (DCD-MFIS), Artificial Neural Network (DCD–ANN) and Deep Extreme Machine Learning (DCD–DEML) approach using back propagation system. These frameworks help in attaining greater precision and accuracy. Proposed DCD Deep Extreme Machine Learning attains more accuracy with previously proposed solutions that are 92.45%. Conclusion: From the previous comparisons, the propose automated Diagnosis of Cardiovascular Disease using Fuzzy logic, Artificial Neural Network, and deep extreme machine learning approaches. The automated systems DCDMFIS, DCD–ANN and DCD–DEML, the framework proposed as effective and efficient with 87.05%, 89.4% and 92.45 % success ratios respectively. To verify the performance which lies in the ANNs and computational analysis, many indicators determining the precise performance were calculated. The training of the neural networks is made true using the 10 to 20 neurons layers which denote the hidden layer. DEML reveals and indicates a hidden layer containing 10 neurons, which shows the best result. In the last, we can conclude that after making a consideration among the three techniques fuzzy logic, Artificial Neural Network and Proposed DCD Deep Extreme Machine, the Proposed DCD Deep Extreme Machine Learning based solution give more accuracy with previously proposed solutions that are 92.45%.

Effect of arginine or glutamine supplementation and milk feeding allowance on small intestine development in calves

The development of the small intestine (SI) is important for the health and growth of neonatal calves. This study evaluated the effect of arginine (Arg) and glutamine (Gln) supplementation and 2 levels of milk allowance on the histomorphological development of the SI in preweaning calves. Sixty mixed-sex Friesian × Jersey calves (3-5 d of age) were offered reconstituted whole milk (125 g/L, 26% fat, 26% protein) at either high (20% of arrival body weight/d; HM) or low (10% of arrival body weight/d; LM) milk allowance without (Ctrl) or with supplementary Arg or Gln (at 1% of milk dry matter) in a 2 × 3 factorial design (n = 10/treatment). After 35 d on the diets, all calves were slaughtered to collect tissues for examination of SI development. Calves in the HM group had higher milk intake, total weight gain, and average daily gain compared with LM calves, but no effect of AA supplementation nor an interaction between milk allowance and AA supplementation was observed. For the duodenum, we observed an AA by milk allowance interaction for villus height and width, and goblet cell number per villus (HM-Arg > HM-Gln > HM-Ctrl), and villus height to crypt depth ratio (HM-Arg > HM-Gln = HM-Ctrl), but no effect of AA supplementation in the LM group. Goblet cell numbers per 100 µm of SI were greater in Arg-supplemented calves than in unsupplemented controls, with Gln-supplemented calves intermediate to but not different from the other groups. Epithelium thickness was greater in LM than in HM calves. Villus density, crypt depth, and muscle thickness did not differ between groups. For the jejunum, there was an AA by milk allowance interaction for villus height, villus surface area, and villus height to crypt depth ratio (HM-Arg = HM-Gln > HM-Ctrl), with no effect of AA supplementation in the LM groups. Amino acid supplementation affected goblet cell number per villus (HM-Gln > HM-Ctrl calves, HM-Arg intermediate), and both LM-Arg and LM-Gln calves had greater numbers than LM-Ctrl calves. Villus width, crypt depth, and muscle thickness were greater in HM than LM calves but there was no effect of AA supplementation. Villus density, goblet cell number per 100 µm of SI, and epithelium thickness were unaffected by AA supplementation and milk allowance. Milk allowance and AA supplementation had no effect on SI morphology in the ileum. Increasing milk allowance improved villus height, width, and surface area but only in Arg- or Gln-supplemented calves, not in control calves. The observed changes in development may be important for intestinal functionality, integrity, and barrier function in preweaning calves, potentially through increased cell growth and proliferation or reduced levels of cellular atrophy.

Brain Tumor Analysis Empowered with Deep Learning: A Review, Taxonomy, and Future Challenges

Deep Learning (DL) algorithms enabled computational models consist of multiple processing layers that represent data with multiple levels of abstraction. In recent years, usage of deep learning is rapidly proliferating in almost every domain, especially in medical image processing, medical image analysis, and bioinformatics. Consequently, deep learning has dramatically changed and improved the means of recognition, prediction, and diagnosis effectively in numerous areas of healthcare such as pathology, brain tumor, lung cancer, abdomen, cardiac, and retina. Considering the wide range of applications of deep learning, the objective of this article is to review major deep learning concepts pertinent to brain tumor analysis (e.g., segmentation, classification, prediction, evaluation.). A review conducted by summarizing a large number of scientific contributions to the field (i.e., deep learning in brain tumor analysis) is presented in this study. A coherent taxonomy of research landscape from the literature has also been mapped, and the major aspects of this emerging field have been discussed and analyzed. A critical discussion section to show the limitations of deep learning techniques has been included at the end to elaborate open research challenges and directions for future work in this emergent area.

Health profession education course teaching to undergraduate medical and dental students for making consensus: A mix research method among medical educationist of Peshawar by using Delphi technique

This article was migrated. The article was not marked as recommended. Introduction:The future medical education demands newer strategies to enforce positive teaching change. The Pakistan Medical & Dental Council (PM&DC) has added outcomes such as leadership and management, professionalism, communication skills, and personal professional development. However, the level of difficulty and the importance of the contents need to be identified for the undergraduate medical and dental students. Methodology:This study was conducted at four institutions of Peshawar, Khyber College of Dentistry, Khyber Medical College, Khyber Girls Medical College and Khyber Teaching Hospital, the study was completed from April to December 2018, mix method study design of modified Delphi survey was used through a self-administered questionnaire. The study comprised of two iterative rounds of opinion seeking. The questionnaire included baseline data about the participants including instructions, consent form and name, teaching experience, professional degree, and institute. The first and second round of the questionnaire had 09 statements and 01 Likert scales ranging from strongly agree to strongly disagree. The data were analyzed by using SPSS version 21. Results:The analysis showed that out of 11 items, 07 items in the key contents of teaching medical education could not achieve consensus, while 04 items achieved consensus. The 40(67%) of respondents agreed to include medical education at the undergraduate level. Majority 32(53%)of the respondents agreed that medical education contents should be taught in the third year of MBBS and second-year BDS 43(72%). Conclusion: Key content areas of medical education to the undergraduate medical and dental students should be taught in the form of small group discussions. However, the consensus could not be developed on the assessment procedures for assessing medical education topics to the undergraduate medical and dental students.

[Medical Rehabilitation after Hydronephrosis Surgical Treatment in Children]

The article presents modern technologies of medical rehabilitation of children operated for hydronephrosis. The importance of medical rehabilitation of children with hydronephrosis is associated with high incidence, possibility of developing chronic kidney disease, and early disability of these patients. After surgery on the ureter it is important to use medical rehabilitation technologies aimed at preventing urodynamics disorders of upper and lower urinary tract, and at stimulation of regenerative processes. In recent years, particular attention has been paid to high-intensity pulsed electromagnetic field therapy, which has a more significant and long-term stimulating effect compared to various types of electrical stimulation. Clinical studies were conducted in 80 children operated for hydronephrosis, aged 3 to 15. The main group consisted of 40 children who received high-intensity pulsed magnetic therapy, and 40 children were included in the control group (without physiotherapy). Basic treatment included uroseptics and exercise therapy. Effectiveness of the method was assessed using clinical, laboratory and ultrasound data, and Doppler ultrasound of the renal blood flow. The results of the study demonstrated the rationale of including high-intensity pulsed electromagnetic field therapy in medical rehabilitation of children operated for hydronephrosis. The positive effect of high-intensity pulsed electromagnetic therapy on the urodynamics of the urinary tract (reduction in the size of renal pelvis and calyx) and renal blood flow (restoration of blood flow to the renal cortex) were revealed. This method helped to reduce inflammation in the renal parenchyma (reduction of proteinuria, leukocyturia) in children operated on for hydronephrosis. A significantly higher effectiveness of medical rehabilitation with the use of high-intensity pulsed magnetic therapy was proved (87.5%).

"Mobile Health" for the Management of Spondyloarthritis and Its Application in China

PURPOSE OF THE REVIEW

Spondyloarthritis (SpA) is a group of inflammatory diseases characterized by inflammation in the spine, peripheral joints, and entheses that usually start at the prime of one's life and lead to impaired physical function and reduced quality of life. Ankylosing spondylitis (AS) is prototype of SpA. This article reviews the opportunities and challenges of using mobile health (mHealth) in managing SpA, and report some of our experiences using a mHealth solution for management of SpA patients and performing related research in China.

RECENT FINDINGS

The recent rapid development of mobile communications and the common use of intelligent electronic devices have led to the increasing application of mHealth for chronic disease management by healthcare providers and patients alike. This is a promising new technology that can help mitigate limitations in time and space for patient management, promote easier communication between patients and their healthcare providers, reduce medical expenses, and optimize medical services. We have developed a smartphone-based mHealth SpA management system (SpAMS) that also helps the patients to monitor, manage, and share information on their disease with their physician at regular intervals. There is a shift from a paternalistic model of healthcare to more personalized healthcare in which disease management is conducted by the patient together with their healthcare providers. The increasing utility of mHealth is expected to benefit disease management, promote patient-doctor communication, reduce medical expenses, and optimize medical services.

A clinical study to describe the corneal topographic pattern and estimation of the prevalence of keratoconus among diagnosed cases of vernal keratoconjunctivitis

Background

Association of keratoconus with vernal keratoconjunctivitis is well known, but there are few topographic studies describing actual prevalence especially in India where it is a common condition. There is also scarce literature on the topographic patterns and subclinical topographic anomalies in cases of vernal catarrh and their relationship with various subtypes. This study was conducted to estimate the prevalence of subclinical keratoconus among Indian subjects with vernal keratoconjunctivitis and describe the various topographic abnormalities which can help in screening for these cases.

Methods

In the cross-sectional study conducted at a tertiary care center, 76 established cases of vernal keratoconjunctivitis were evaluated with placido disc-based videokeratography for topographic abnormalities and early keratoconus based on modified Rabinowitz-McDonnell criteria.

Results

Seventeen (11.2%) eyes satisfied both the modified Rabinowitz-McDonnell criteria of keratoconus. Corneal topographic pattern analysis showed asymmetric bowtie with inferior steepening in 17.11% of the patients. None of these patients had clinical evidence of keratoconus.

Conclusions

The study showed 11.2% prevalence of keratoconus in patients suffering from vernal keratoconjunctivitis. The findings highlight the importance of using a simple placido disc-based corneal topography system for screening the patients with vernal keratoconjunctivitis for keratoconus. This can help in early detection and preventive intervention.

Maintenance of photosynthesis and the antioxidant defence systems have key roles for survival of Halopeplis perfoliata (Amaranthaceae) in a saline environment

Coastal salt marsh plants employ various combinations of morphological and physiological adaptations to survive under saline conditions. Little information is available on salinity tolerance mechanisms of Halopeplis perfoliata, a C3 stem succulent halophyte. We investigated the growth, photosynthesis and antioxidant defence mechanisms of H. perfoliata under saline conditions (0, 150, 300 and 600 mM NaCl) in an open greenhouse. Optimal shoot succulence, projected shoot area and relative growth rate were obtained in the low (150 mm NaCl) salinity treatment, while growth was inhibited at the highest salinity (600 mm NaCl). The CO₂ compensation point and carbon isotope composition of biomass confirmed C₃ photosynthesis. Increases in salinity did not affect the photosynthetic pigment content or maximum quantum efficiency of PSII of H. perfoliata. Assimilation of CO₂ (A) also remained unaffected by salinity. A modest effect on some gas exchange and photochemistry parameters was observed at 600 mm NaCl. With increasing salinity, there was a continual increase in respiration, suggesting utilisation of energy to cope with saline conditions. Under 300 and 600 mm NaCl, there was an increase in H₂ O₂ and MDA with a concomitant rise in AsA, GR content and CAT activity. Hence, H. perfoliata appears to be an obligate halophyte that can grow up to seawater salinities by modulating photosynthetic gas exchange, photochemistry and the antioxidant defence systems.

A Novel Recombinant Eel Pout (Macrozoarces americans) Type III Antifreeze Protein Improves Cryosurvival of Buffalo Sperm

BACKGROUND

The quality of cryopreserved buffalo semen is low due to high susceptibility of sperm membranes to cold shock.

OBJECTIVE

The present study was designed to investigate the effect of recombinant type-III antifreeze protein from the eel pout Macrozoarces americanus (rAFPIII) on freezability of buffalo semen.

MATERIALS AND METHODS

Semen was collected from three buffalo bulls for three weeks (replicates). Qualified ejaculates (N=18) were split into four aliquots and diluted in Tris-citric acid extender containing 0.0, 0.1, 1 and 10 µg mL^-1 of rAFPIII. Semen was cooled to 4 C, evaluated for sperm motility and PMI, cryopreserved and assessed for post-thaw quality.

RESULTS

Supplementation of the extender with rAFPIII didn't affect motility and PMI of chilled semen. Post-thaw sperm motility and PMI were higher in extender supplemented with rAFPIII (10µg mL^-1) compared to control. Sperm viability and acrosome integrity remained the same.

CONCLUSION

Addition of rAFPIII in extender improved motility and PMI of cryopreserved buffalo semen.