Recognition of diabetic retinopathy and macular edema using deep learning

Diabetic retinopathy (DR) and diabetic macular edema (DME) are both serious eye conditions associated with diabetes and if left untreated, and they can lead to permanent blindness. Traditional methods for screening these conditions rely on manual image analysis by experts, which can be time-consuming and costly due to the scarcity of such experts. To overcome the aforementioned challenges, we present the Modified CornerNet approach with DenseNet-100. This system aims to localize and classify lesions associated with DR and DME. To train our model, we first generate annotations for input samples. These annotations likely include information about the location and type of lesions within the retinal images. DenseNet-100 is a deep CNN used for feature extraction, and CornerNet is a one-stage object detection model. CornerNet is known for its ability to accurately localize small objects, which makes it suitable for detecting lesions in retinal images. We assessed our technique on two challenging datasets, EyePACS and IDRiD. These datasets contain a diverse range of retinal images, which is important to estimate the performance of our model. Further, the proposed model is also tested in the cross-corpus scenario on two challenging datasets named APTOS-2019 and Diaretdb1 to assess the generalizability of our system. According to the accomplished analysis, our method outperformed the latest approaches in terms of both qualitative and quantitative results. The ability to effectively localize small abnormalities and handle over-fitted challenges is highlighted as a key strength of the suggested framework which can assist the practitioners in the timely recognition of such eye ailments.

Aicardi syndrome in a Nigerian female child: A case report and literature review of a rare neuro-developmental disorder from North-Western Nigeria

Aicardi syndrome is a very rare neurodevelopmental disorder, inherited as an X-linked dominant condition with a triad of infantile spasm, partial or complete agenesis of the corpus callosum, and chorio-retinal "lacunae." We report a case of a female infant with the classical triad of Aicardi syndrome. A female infant presented to the Paediatric Neurology Clinic of the Federal Medical Centre Birnin-Kebbi, North-western Nigeria, at the age of two months with complaints of recurrent afebrile convulsions typical for infantile spasms. The patient was delivered at term with normal Apgar scores and anthropometry. Examination revealed an infant with no dysmorphic features and normal systemic examination. Magnetic Resonance Imaging (MRI) of the brain however, showed complete agenesis of the corpus callosum and dilatation of the posterior horn of the lateral and third ventricles. Fundoscopy showed multiple yellowish spots along the vascular arcades in the right eye. The left eye had a one-disc diameter lacuna in the superior nasal quadrant adjacent to the optic disc with multiple yellowish spots. A diagnosis of Aicardi syndrome was made. The child was placed on oral phenobarbital and followed up. At the age of 18 months, the child can only sit without support, hold an object in each hand, smile socially, and babble. The frequency of the seizures had also reduced from >100 episodes per day to 2-3 episodes per day, but the child had developed right-sided spastic hemiparesis. The patient was commenced on physiotherapy and the anti-epileptic drugs were maintained. We recommend clinicians consider Aicardi syndrome in the differential diagnosis of any child presenting with infantile spasms.

TumorDetNet: A unified deep learning model for brain tumor detection and classification

Accurate diagnosis of the brain tumor type at an earlier stage is crucial for the treatment process and helps to save the lives of a large number of people worldwide. Because they are non-invasive and spare patients from having an unpleasant biopsy, magnetic resonance imaging (MRI) scans are frequently employed to identify tumors. The manual identification of tumors is difficult and requires considerable time due to the large number of three-dimensional images that an MRI scan of one patient's brain produces from various angles. Moreover, the variations in location, size, and shape of the brain tumor also make it challenging to detect and classify different types of tumors. Thus, computer-aided diagnostics (CAD) systems have been proposed for the detection of brain tumors. In this paper, we proposed a novel unified end-to-end deep learning model named TumorDetNet for brain tumor detection and classification. Our TumorDetNet framework employs 48 convolution layers with leaky ReLU (LReLU) and ReLU activation functions to compute the most distinctive deep feature maps. Moreover, average pooling and a dropout layer are also used to learn distinctive patterns and reduce overfitting. Finally, one fully connected and a softmax layer are employed to detect and classify the brain tumor into multiple types. We assessed the performance of our method on six standard Kaggle brain tumor MRI datasets for brain tumor detection and classification into (malignant and benign), and (glioma, pituitary, and meningioma). Our model successfully identified brain tumors with remarkable accuracy of 99.83%, classified benign and malignant brain tumors with an ideal accuracy of 100%, and meningiomas, pituitary, and gliomas tumors with an accuracy of 99.27%. These outcomes demonstrate the potency of the suggested methodology for the reliable identification and categorization of brain tumors.

Influence of Sapindus mukorossi extract in comparison to 17% EDTA as final root canal irrigant on the sealer penetration and microleakage of dentinal tubules

OBJECTIVE

The study evaluated the effect of Sapindus mukorossi (SM) extract as a final root canal irrigant on sealer penetration (SP) in dentinal tubules and microleakage.

MATERIALS AND METHODS

Samples were selected based on inclusion and exclusion criteria. An access opening in all samples was performed and the working length was decided using pro taper for canal finishing along with constant irrigation. Specimens were randomly divided into 3 groups. Group 1 was irrigated with 3 ml of 17% EDTA; group 2 was irrigated with SM irrigant and group 3 samples were irrigated with 0.9% saline. After obturation, samples were vertically placed in 1% methylene blue dye cut in half longitudinally, and viewed under a stereomicroscope. Analysis of SP in the dentinal tubule was assessed using scanning electron microscopy (SEM). For microleakage assessment, mean and standard deviation were reported and One-Way ANOVA was applied. SP was compared using Kruskal-Wallis' test. For inspecting the interaction between SM/EDTA and NaOCl, Fisher's exact test was applied. No statistically significant difference between microleakage in any of the tested groups was observed. The control group showed minimum leakage as compared to EDTA and SM.

RESULTS

The results displayed that there was no significant difference, (p=0.67), between dentinal tubule SP at 2 mm. A significant difference between dentinal tubule SP among groups at 5 mm was observed (p<0.05).

CONCLUSIONS

SM ethanolic extract showed comparable outcomes of smear layer removal and sealer penetration to 17% EDTA, as a final irrigant in root canal cleaning. Therefore, SM has the potential to be used as an adjuvant final irrigant in conjunction with NaOCl.

Rapidly Progressive Glomerulonephritis: A COVID-19 Case Report

Anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis is a systemic autoimmune disease that typically presents as a multi-organ manifesting disease of unclear etiology that can predispose to rapidly progressive glomerulonephritis (RPGN). If left untreated, ANCA-associated vasculitis can be fatal, and RPGN can progress to irreversible renal failure. Environmental and genetic factors have been implicated in the pathogenesis of this vasculitis. Coronavirus disease (COVID-19) has been noted to have various physiologic impacts on the body, with literature indicating possible autoimmune effects. We present a rare case of ANCA-associated vasculitis in an elderly male with no known autoimmune history after a recent illness with COVID-19. The patient had been seen as an outpatient with progressively declining renal function until he presented to the hospital with acute renal failure and pericarditis. Workup revealed elevated anti-myeloperoxidase antibody (MPO-AB) and perinuclear ANCA (p-ANCA) antibodies with a biopsy confirming focal cresenteric glomerulonephritis, and the patient was initiated on steroid therapy with notable improvement and a return to baseline kidney function.

Outcomes of gout in patients with cirrhosis: A national inpatient sample-based study

BACKGROUND

Hyperuricemia is a prerequisite for the development of gout. Elevated serum uric acid (UA) levels result from either overproduction or decreased excretion. A positive correlation between serum UA levels, cirrhosis-related complications and the incidence of nonalcoholic fatty liver disease has been established, but it is unknown whether hyperuricemia results in worsening cirrhosis outcomes. We hypothesize that patients with cirrhosis will have poorer gout outcomes.

AIM

To explore the link between cirrhosis and the incidence of gout-related complications.

METHODS

This was a cross-sectional study. The national inpatient sample was used to identify patients hospitalized with gout, stratified based on a history of cirrhosis, from 2001 to 2013 via the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Primary outcomes were mortality, gout complications and joint interventions. The χ² test and independent t-test were performed to assess categorical and continuous data, respectively. Multiple logistic regression was used to control for confounding variables.

RESULTS

Patients without cirrhosis were older (70.37 ± 13.53 years vs 66.21 ± 12.325 years; P < 0.05). Most patients were male (74.63% in the cirrhosis group vs 66.83%; adjusted P < 0.05). Patients with cirrhosis had greater rates of mortality (5.49% vs 2.03%; adjusted P < 0.05), gout flare (2.89% vs 2.77%; adjusted P < 0.05) and tophi (0.97% vs 0.75%; adjusted P = 0.677). Patients without cirrhosis had higher rates of arthrocentesis (2.45% vs 2.21%; adjusted P < 0.05) and joint injections (0.72% vs 0.52%; adjusted P < 0.05).

CONCLUSION

Gout complications were more common in cirrhosis. Those without cirrhosis had higher rates of interventions, possibly due to hesitancy with performing these interventions given the higher complication risk in cirrhosis.

Dose-dependent efficacy of bevacizumab in recurrent glioblastoma

BACKGROUND

Bevacizumab (BEV), at a standard dose of 10 mg/kg every 2 weeks is associated with prolonged progression-free survival (PFS) but no improvement in overall survival (OS) in recurrent glioblastoma (rGBM). Few studies have examined the potential dose-dependent efficacy of BEV. In Ontario, reimbursement for the costs of BEV varies, and as a result, our practice began to routinely use lower dose regimens. The main aim of this study was to ensure that there was no harm to patients who received the low dose protocol.

METHODS

A single-center retrospective study of patients given BEV for rGBM between 2015 and 2020 was performed. Clinical and treatment data including BEV dose regimen [SD (10 mg/kg every 2 weeks) vs. LD (5 mg/kg every 2-3 weeks or 10 mg/kg every 3 weeks)] received at the time of rGBM diagnosis were captured. Overall survival (OS) and progression-free survival (PFS) on BEV were compared using the Kaplan-Meier product-limit method. Log-rank test was used to compare potential predictive factors. Cox regression model was performed for multivariable analysis of OS and PFS.

RESULTS

A total of 96 patients were included with a median follow-up duration of 6.84 months (range 1.12-50.63 months) from the date of the first infusion. The LD group consisted of 55 of the 96 patients. By virtue of funding mechanisms for BEV, the median age in the LD group was significantly higher (62 vs. 54 years p = 0.009). There was no difference in MGMT status between the two groups (p = 0.60). The LD group had prolonged median PFS (5.89 months versus 3.22 months; p = 0.0112) and OS (10.23 months versus 6.28 months; p = 0.0010). Multivariable analysis including the dose of BEV, the extent of resection, gender, and age revealed that standard dose of BEV, subtotal resection, and female sex were associated with worse overall survival. Nine patients in the SD group vs. 18 patients in the LD group reported an adverse event related to BEV.

CONCLUSION

For patients with recurrent GBM, we found that a low dose regimen of BEV was associated with prolonged OS and PFS compared to the standard dose regimen. Lower dose schedules may be a better and more cost-effective option for patients with rGBM. Lower costs might provide more equitable access to this very important palliative drug.

Community based assessment on Knowledge, Attitude and Practices (KAP), Risk Factors and One Health Perspective of Brucellosis in rural and urban settings of Pakistan: A Cross-Sectional Study

Bovine brucellosis is an endemic zoonotic infection of ruminants in Pakistan with detrimental impacts on livestock economy. The major losses caused by brucellosis in animals include abortions, week calves, infertility, and reduced milk production. Regardless of the prevalence of the disease, limited data is available about brucellosis in Pakistan. The present study aimed to access the one health concept in prospective of Brucellosis among small-scale dairy farmers by examining knowledge, attitude and practices at the farms and household level that might pose a risk for humans contracting brucellosis. A community-based cross-sectional survey was conducted among small household dairy farms (n=333) in rural and urban areas of district Rawalpindi and Islamabad. The results revealed almost 74.17% of the participants knew about animal brucellosis and about 69.97% of the participants were able to identify the symptoms of animal brucellosis. 58.26% of participants showed knowledge about the transmission of disease from animals to humans. A majority (70.87%) of participants used the raw milk for making other dairy products. Most household farmers are unaware of routes of transmission and major risk factors of brucellosis. Almost all the participants, except veterinarians, including butchers, dairy farm owners and workers, slaughterhouse owners and workers and farmers were involved in at least one risky practice. The moderate knowledge and poor understanding of the disease emphasize the need to initiate awareness programs to educate the farmers who are at high risk along with the improvement of vaccination programs for animals and strict implementation of brucellosis eradication policy which should be devised by government.

The first Australian experience with ward-based CPAP for COVID19 respiratory failure: A retrospective cohort study

We present the first Australian cohort of patients with COVID‐19 respiratory failure managed with escalating respiratory support including Continuous Positive Airway Pressure (CPAP) on a standard medical ward at a tertiary Sydney hospital during the 2021 COVID‐19 Delta variant outbreak. We demonstrate an equivalent mortality to CPAP delivered in ICU and outline our ward structure and management during the pandemic.

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Does the Combined Use of Aspirin and Immunotherapy Result in Better Outcomes in Non-Small Cell Lung Cancer Than Immunotherapy Alone?

Introduction: Immunotherapy works by stimulating the immune system against cancer cells. Resistance to immunotherapy represents a significant challenge in the field of medical oncology. The mechanisms by which cancer cells evade immunotherapy are not well understood. Prior research suggested overexpression of prostaglandin E-2 (PGE-2) by cancer cells, which bind to EP-2 and EP-4 receptors on the tumor-specific cytotoxic T-lymphocytes (CTLs) and suppress their anticancer role. This immunosuppressive effect is involved in evading the programmed cell death-1 (PD-1)/programmed death-ligand 1 (PD-L1) blockade of immunotherapy, which fuels cancer cell growth and recurrence. Studies found that combining PGE-2 blockade and a PD-1 signaling inhibitor helped promote the anticancer immunity cells. If confirmed in a clinical setting, the above in vitro findings could be of great clinical significance.

Methods: Given that aspirin (ASA) blocks PGE-2 production, this work aimed to evaluate whether ASA use with immunotherapy results in better outcomes than immunotherapy alone. We performed a retrospective chart review of 500 non-small cell lung cancer (NSCLC) patients aged 21 years or older treated with PD-1 and/or PD-L1 directed immunotherapy at St. Luke’s University Health Network between July 2015 and July 2021. Relevant patient, disease, and treatment-related variables were collected, including ASA use (≥ 81 mg daily) and the type of immunotherapy. Bivariate analyses were conducted to determine which variables to include in a multivariable model. 

The four primary outcomes included survival at 18-months, both after diagnosis and starting immunotherapy, achieving complete remission (CR), and having a progressive disease (PD), as defined by RECIST (Response Evaluation Criteria in Solid Tumors) criteria. Secondary outcomes included therapy-related toxicities and complications in the different treatment groups.  

Results: After bivariate analysis, no statistical significance was found for a difference in 18-month survival between ASA and non-ASA groups (50.3% vs 49.7%, p-value = 0.79). ASA with PD-L1 inhibitor showed a trend towards a higher likelihood of achieving CR [adjusted odds ratio (AOR) 1.85] with a p-value close to statistical significance (0.06). However, ASA with PD-L1 showed high statistical significance as an independent variable associated with a decreased likelihood of having PD (AOR 0.44, p < 0.001). These findings suggest that NSCLC patients receiving PD-L1 inhibitors could benefit more from daily ASA than patients treated with PD-1 inhibitors. Our study emphasizes using the Eastern Cooperative Oncology Group (ECOG) scoring of the performance status (PS) in NSCLC patients. Poorer PS was associated with lower survival, decreased likelihood of CR, and more PD. Other variables associated with worse outcomes were advanced cancer stage at diagnosis and male gender. Low-PD-L1 expression in NSCLC was associated with an increased likelihood of survival; this could be of clinical significance, especially with previous studies suggesting better outcomes of using ASA in PD-L1 low tumors. 

Conclusion: These findings suggest that daily ASA use with PD-L1 inhibitors is associated with more favorable outcomes in NSCLC. More studies are needed to investigate further the potential benefits vs. risks of using ASA with different immunotherapies and the other possible variables affecting treatment outcomes. 

Comparison of Pneumonitis Rates and Severity in Patients With Lung Cancer Treated by Immunotherapy, Radiotherapy, and Immunoradiotherapy

Introduction

Radiation pneumonitis (RP) is a common dose-limiting toxicity of radiotherapy to the chest in lung cancer patients. Similarly, the revolutionary use of immune checkpoint inhibitors (ICIs) to treat lung cancer can be complicated by immune-related adverse events (irAEs), particularly checkpoint inhibitor pneumonitis (CIP). Our study aimed to assess the effect of immunotherapy, with and without radiotherapy, on pneumonitis and other outcomes.

Methods

We performed a retrospective chart review of 680 lung cancer patients treated with either radiotherapy, immunotherapy, or both at St. Luke's University Health Network to determine the incidence rates of pneumonitis. Then, a more extensive review of 346 patients was completed, 181 of whom had pneumonitis, to investigate risk factors and outcomes.

Results

All-grade pneumonitis incidence was 26.6% while more severe pneumonitis (grade 3 or higher) was 13%. Receiving programmed cell death-1 (PD-1) or ligand-1 (PD-L1) inhibitors, having squamous cell carcinoma (SCC), and having poorer performance status were independently and significantly associated with increased risk of pneumonitis, with AOR (adjusted odds ratios) of 8.32, 4.10, 2.91, and 1.71, respectively. Among those who had pneumonitis, more severe cases (grade 3 or higher) were related to immunotherapy, either alone (58.32%) or with radiation (55.7%), compared to radiation therapy alone (36.2%).

Poorer performance status (defined as a higher Eastern Cooperative Oncology Group (ECOG) score) was the only covariate we found to be significantly and independently associated with reduced odds of 18-months survival. More of the patients treated with both lung radiation and immunotherapy had progressive disease (53.8%) compared to those treated with only radiation (30.4%) or immunotherapy (36.7). Progressive disease occurred more in patients with pneumonitis grade 3 or higher (48.3%) than those with no or low-grade pneumonitis (27.2%).

Conclusion

Receiving PD-L1 and PD-1 inhibitors, either with or without radiotherapy, was associated with a higher risk of more severe pneumonitis (PD-L1 > PD-1) than radiotherapy alone. Given its high incidence and complications, more about therapy-induced pneumonitis is yet to be studied. Learning more about pneumonitis' risk factors and complications is of great clinical importance, as it may result in better treatment planning and improved outcomes. Future studies are needed to investigate the suggested association between symptomatic pneumonitis and poorer response to treatment and whether SCC increases the risk of higher-grade pneumonitis.

Dose-dependent efficacy of bevacizumab in recurrent glioblastoma

e14042

Background: Bevacizumab (bev), at a standard dose of 10 mg/kg every 2 weeks is associated with prolonged progression free survival (PFS) but no improvement in overall survival (OS) in recurrent glioblastoma (rGBM). While there are reports of lower dose regimens of bev being better tolerated and effective in rGBM, this has not been studied in comparison to a standard dose of bev. The main aim of this study is to report on the dose-dependent efficacy of bev by comparing PFS and OS in rGBM patients receiving standard dose (SD) vs lower dose (LD) of bev. Methods: A single-center retrospective study of patients with rGBM started on bev between 2015 – 2020 was performed. Clinical and treatment data including bev dose regimen (SD [10 mg/kg every 2 weeks] vs LD [5 mg/kg every 2-3 weeks or 10 mg/kg every 3 weeks]) received at the time of rGBM diagnosis were captured. Overall survival (OS) and progression-free survival (PFS) on bev were compared between the two groups using the Kaplan-Meier product-limit method. Log-rank test was used to compare potential predictive factors. Cox regression model was performed for multivariable analysis of OS and PFS. Results: A total of 96 patients were included with a median follow-up duration of 6.84 months (range 1.12-50.63 months) from date of the first infusion. The LD group consisted of 55/96 patients (57 %) and the age in the LD group was significantly older than the SD group (62 vs 54 years p = 0.009). There was no significant difference in MGMT status between the 2 groups (p = 0.73). Eight patients received lomustine with bev (3 from the standard and 5 from the low dose group). The LD group had prolonged OS (10.23 months versus 6.28 months; p-value = 0.0010) and PFS (5.89 months versus 3.22 months; p-value = 0.0112). Multivariable analysis including dose of bev, extent of resection, gender and age revealed that standard dose of bev, subtotal resection and female sex were associated with worse OS. Eleven patients in the SD group vs 15 patients in the LD group reported an adverse event related to bev. Conclusions: In this study we demonstrate that a reduced dose of bev (5 mg every 2-3 weeks) prolonged both the OS and PFS compared to a standard dose of 10 mg/kg every 2 weeks. This may represent a better and more cost-effective option for patients with rGBM in need of salvage therapy.

Simultaneous malignant hyperthermia reactions in two siblings during living donor liver transplantation

We report a case of simultaneous malignant hyperthermia reactions occurring in two siblings during living donor liver transplantation. This report highlights the conflicting goals in the clinical management of liver transplantation and malignant hyperthermia, including the use of total intravenous anaesthesia and dantrolene in the face of the potential for drug-induced hepatotoxicity in the remnant liver or transplanted liver graft, as well as cautious fluid management needed for liver transplantation balanced against the liberal fluid therapy required to prevent acute kidney injury associated with malignant hyperthermia. The logistical challenges of managing this emergency in two closely related patients are discussed, including rapid preparation of two vapour-free anaesthesia machines, the need for availability of additional dantrolene and the requirement for additional personnel. Prompt recognition, immediate removal of the triggering agents and conversion to total intravenous anaesthesia helped to curtail the malignant hyperthermic reactions in our patients, both of whom made a full recovery.

Antibiotic Resistance Pattern Of Acinetobacter Baumannii Isolated From Bacteremia Patients In Pakistan

BACKGROUND

Acinetobacter baumannii causes a number of life-threatening infections in Hospitalized patients attributed to its ability to develop resistance against multiple antibiotics. The current scrutinisation is aimed to observe the prevalence and antibiotic resistance profile of A. baumannii strains isolated from blood of tertiary care Hospitalized patients in Lahore, Pakistan.

METHODS

This research is a retrospective study conducted over a period of one year where 1864 blood samples were collected from both male and female patients with septicaemia. Total 156 A. baumannii species were identified by conventional method and their antimicrobial resistance pattern against 22 antimicrobials (representing all known classes of antibiotics) was evaluated by Kirby Bauer disc diffusion method. MICs of colistin, polymyxin B and vancomycin against A. baumannii were calculated by E test and broth dilution method.

RESULTS

More males (n=97, 62%) were found infected than females (n=59, 38%). The spreading rate of A. baumannii was highest (n=101, 65%) in patients of age ≤20 years, and lowest (n=12, 7%) in the patients with the age of 41-60 years. Most of the strains of A. baumannii (n=118, 75.6%) were found to be MDR (multi drug resistant), 37 (23.7%) strains were XDR (Extensively drug-resistant) and only 1 (0.05%) strain was PDR (pandrug resistant). All the strains were sensitive to minocycline and tigecycline whereas highest non-susceptibility (n=144, 92%) was seen against Ampicillin-Sulbactam. Most of the strains demonstrated resistance against carbapenem and cephalosporin beckoning that A. baumannii can no longer be considered for salvage therapy by carbapenem. MICs of colistin, polymyxin B and vancomycin against A. baumannii divulged polymixin B as the most effective drug.

CONCLUSIONS

Use of wide range of drugs has made A. baumannii multidrug resistant. Colistin, polymyxin B and vancomycin are the preferable drugs for the treatment of A. baumannii infections.

Identification of locally isolated entomopathogenic Fusarium species from the soil of Changa Manga Forest, Pakistan and evaluation of their larvicidal efficacy against Aedes aegypti

Dengue fever vectored by the mosquito Aedes aegypti is one of the most rapidly spreading insect-borne diseases. Current reliance of dengue vector control is mostly on chemical insecticides. Growing insecticide resistance in the primary mosquito vector, Aedes aegypti, limits the effectiveness of vector control through chemical insecticides. These chemical insecticides also have negative environmental impacts on animals, plants and human health. Myco-biocontrol agents are naturally occurring organisms and are found to be less damaging to the environment as compared to chemical insecticides. In the present study, entomopathogenic potential of local strains of fungi isolated from soil was assessed for the control of dengue vector. Local fungal isolates presents better alternative to introducing a foreign biocontrol strain, as they may be better adapted to environmental conditions of the area to survive and may have more entomopathogenic efficacy against target organism. Larvicidal efficacy of Fusarium equiseti and Fusarium proliferatum was evaluated against Aedes aegypti. Local strains of F. equiseti (MK371718) and F. proliferatum (MK371715) were isolated from the soil of Changa Manga Forest, Pakistan by using insect bait method. Larvicidal activity of two Fusarium spp. was tested against forth instar larvae of A. aegypti in the laboratory, using concentrations 105, 106, 107 and 108 conidia /ml. LC50 values for F. equiseti after 24h, 48h, 72h and 96h of exposure were recorded as 3.8x 108, 2.9x107, 2.0x107, and 7.1x106 conidia /ml respectively while LC50 values for F. proliferatum were recorded as 1.21x108, 9.6x107, 4.2x107, 2.6x107 conidia /ml respectively after 24h, 48h, 72h and 96h of exposure. The results indicate that among two fungal strains F. equiseti was found to be more effective in terms of its larvicidal activity than F. proliferatum against larvae of A. aegypti.

Pharmacological Applications of Phlorotannins: A Comprehensive Review

BACKGROUND

Seaweeds, including marine brown algae, are traditional food sources in Asia. Phlorotannins, as the product of the polyketide pathway, are mainly found in brown algae. Different properties have been attributed to this group of marine products ranging from antiallergic to anticancer activity. Mechanism of action is not obvious for all these properties, but there are some explanations for such effects.

OBJECTIVE

The current study aimed to review the phlorotannins and to assess the beneficial uses in medicine.

METHODS

Different databases were explored with the exact terms "Phlorotannin", "Seaweed" and "Brown Algae". Data assembly was finalized by June 2019. The papers showing the effects of phlorotannins in medicine were gathered and evaluated for further assessment.

RESULTS

General physiological aspects of phlorotannins were firstly evaluated. Different arrays of pharmacological properties ranging from anti-diabetic activity to cancer treatment were found. The mechanism of action for some of these beneficiary properties has been confirmed through rigorous examinations, but there are some features with unknown mechanisms.

CONCLUSION

Phlorotannins are characterized as a multifunctional group of natural products. Potential antioxidant characteristics could be attributed to preventive and/or their curative role in various diseases.

Future Location Prediction for Emergency Vehicles Using Big Data: A Case Study of Healthcare Engineering

The number of devices equipped with GPS sensors has increased enormously, which generates a massive amount of data. To analyse this huge data for various applications is still challenging. One such application is to predict the future location of an ambulance in the healthcare system based on its previous locations. For example, many smart city applications rely on user movement and location prediction like SnapTrends and Geofeedia. There are many models and algorithms which help predict the future location with high probabilities. However, in terms of efficiency and accuracy, the existing algorithms are still improving. In this study, a novel algorithm, NextSTMove, is proposed according to the available dataset which results in lower latency and higher probability. Apache Spark, a big data platform, was used for reducing the processing time and efficiently managing computing resources. The algorithm achieved 75% to 85% accuracy and in some cases 100% accuracy, where the users do not change their daily routine frequently. After comparing the prediction results of our algorithm, it was experimentally found that it predicts processes up to 300% faster than traditional algorithms. NextSTMove is therefore compared with and without Apache Spark and can help in finding useful knowledge for healthcare medical information systems and other data analytics related solutions especially healthcare engineering.

A Survey for the Ranking of Trajectory Prediction Algorithms on Ubiquitous Wireless Sensors

The number of wireless sensors in use-for example, the global positioning system (GPS) intelligent sensor-has increased in recent years. These intelligent sensors generate a vast amount of spatiotemporal data, which can assist in finding patterns of movements. These movement patterns can be used to predict the future location of moving objects; for example, the movement of an emergency vehicle can be predicted for health care decision-making. Although there is a body of research work regarding motion trajectory prediction, there are no guidelines for choosing algorithms best suited for individual needs in uncertain and complex situations and as per the application domains. In this paper, we surveyed existing trajectory prediction algorithms. These algorithms are further ranked scientifically in terms of accuracy (performance), ease of use, and best fit as per the available datasets. Our results show three top algorithms, namely NextPlace, the Markov model, and the hidden Markov model. This study can be beneficial for multicriteria decision-making for various disciplines, including health care.

UCDiff: Difference Detection in Use Case Models of Healthcare System

Development of large-scale healthcare software projects essentially need the efficient management of the created software artifacts during software development process. In such projects different versions of an artifact are created at different times. Traditional software configuration management systems, such as Git, Subversion (SVN), etc., are designed for later phases of software development, which mainly handle the source code document. These systems are unable to perform difference detection and version management tasks on models such as unified modeling language diagrams. UML use case model is used for capturing functional requirements at analyses phase. Different versions of the use case model are created during analyses phase. This paper addresses the detection of differences between two versions of a use case model. In order to perform difference detection, we need to perform three main tasks, i. e., extract the contents of the model, comparison of models and difference representation. Most of the existing approaches in literature of model comparison deal with UML class diagrams. To the best of our knowledge, so far no appropriate approach addresses difference computation of use case model. Existing approaches are not applicable on use case model due to different semantics of use case model. In this research, the concept of model-based software configuration management (SCM) for use case difference detection is proposed. The use case models are created in an open source tool, starUML. The proposed difference algorithm is applied on intermediate tree structure representation of models. As a case study, different versions of a patient appointment healthcare system is used to evaluate different evaluation parameters, such as accuracy, domain independence, high conceptual level and tool independence.

UCDiff: Difference Detection in Use Case Models of Healthcare System

Development of large-scale healthcare software projects essentially need the efficient management of the created software artifacts during software development process. In such projects different versions of an artifact are created at different times. Traditional software configuration management systems, such as Git, Subversion (SVN), etc., are designed for later phases of software development, which mainly handle the source code document. These systems are unable to perform difference detection and version management tasks on models such as unified modeling language diagrams. UML use case model is used for capturing functional requirements at analyses phase. Different versions of the use case model are created during analyses phase. This paper addresses the detection of differences between two versions of a use case model. In order to perform difference detection, we need to perform three main tasks, i. e., extract the contents of the model, comparison of models and difference representation. Most of the existing approaches in literature of model comparison deal with UML class diagrams. To the best of our knowledge, so far no appropriate approach addresses difference computation of use case model. Existing approaches are not applicable on use case model due to different semantics of use case model. In this research, the concept of model-based software configuration management (SCM) for use case difference detection is proposed. The use case models are created in an open source tool, starUML. The proposed difference algorithm is applied on intermediate tree structure representation of models. As a case study, different versions of a patient appointment healthcare system is used to evaluate different evaluation parameters, such as accuracy, domain independence, high conceptual level and tool independence.

Cephalic tetanus presenting with bilateral facial palsy

We discuss the case and differential diagnoses of an elderly man who presented with bilateral facial palsy. He had injured his forehead in the garden during a fall on his face and the open wound was contaminated by soil. He then presented to the emergency department with facial weakness causing difficulty speaking. The penny dropped when he started developing muscle spasms affecting his lower jaw a day after admission. It also became clear that he could not open his mouth wide (lock jaw). The combination of muscle spasms and lock jaw (trismus) made tetanus the most likely possibility, and this was proven when he had samples taken from his wound and analysed under the microscope, which showed Clostridium tetani bacilli. C. tetani spores are widespread in the environment, including in the soil, and can survive hostile conditions for long periods of time. Transmission occurs when spores are introduced into the body, often through contaminated wounds. Tetanus in the United Kingdom is rare, but can prove fatal if there is a delay in recognition and treatment.

Turnip (Brassica Rapus L.): a natural health tonic

Abstract In addition to basic nutrition, plant-based foods provide substantial amounts of bioactive compounds which deliver desirable health benefits. During the last decade, secondary metabolites, also known as phytochemicals, obtained from plants, have aroused special attention by researchers. Amongst such plants, the turnip contains a few valuable components which not only endorse health benefits but also provide healing properties. Various bioactive components, for example peroxidase, kaempferol, phenolic compounds, sulforaphane, organic acids, vitamin K, glucosinolates etc are highlighted in this manuscript. Likewise, numerous minerals, such as copper, manganese and calcium, and organic acids, such as sinapic and ferulic acids and their derivatives, found in different amounts in fresh greens and turnip roots, are also discussed briefly. The current paper is focused on the phenolic compounds, which act as beneficial compounds for human health and can be isolated from plant foods, especially turnip. Due to the presence of bioactive constituents, turnip imparts a positive role with respect to the hepatic injury caused by diabetes, high antioxidant activity and a good hepatoprotective role. The impact of environmental conditions and processing mechanisms on the phenolic compound composition of Brassica vegetables, with special reference to turnip, was also briefly discussed.

Morbidity patterns and healthcare utilisation among older people in Malaysia: 1996-2015

OBJECTIVE

This article examines the trends in morbidities and healthcare utilisation in Malaysian older people aged 60 years and above.

STUDY DESIGN

This is a repeated cross-sectional study.

METHODS

Data from three nation-wide community-based surveys, which were conducted in 1996, 2006, and 2015 were analysed. Multivariate analysis was performed for 2015 data to identify factors associated with healthcare utilisation.

RESULTS

Analysis noted increasing trends in the prevalence of diabetes, hypertension, hypercholesterolaemia and obesity from 1996 to 2015. Decreasing trends were noted in the prevalence of current smokers and drinkers over this 20-year period, whereas health service utilisation increased with age in all surveys. In 2015, both inpatient and outpatient care are significantly associated with increasing age and diabetes.

CONCLUSIONS

Increasing trends of health problems and healthcare utilisation were observed among older people in Malaysia. Policymakers should plan for appropriate resources to meet the challenges of an ageing population in Malaysia.

Long-term functional outcomes after primary surgical repair of acute and chronic patellar tendon rupture: Series of 25 patients

OBJECTIVE

We aimed to evaluate the clinical outcomes after surgical repair of patellar tendon rupture (PTR) and compare the evolution of 2 types of rupture (acute and chronic) after the same rehabilitation protocol.

METHODS

This was a prospective cohort study of patients with PTR treated between January 2006 and January 2014 in the department of trauma surgery, Ibn Rochd university hospital, Casablanca.

RESULTS

We evaluated 25 patients (21 men) after a median follow-up of 75 months (range 29-120). The mean age was 34.7±8.59 years. Overall, 17 patients had acute rupture and 8 chronic rupture. Fifteen healthy volunteers (13 men) were recruited as a control group. Mean Knee Society Score (KSS) knee score was significantly higher after than before surgery (82.28±12.297 vs 20.64±7.6; P<0.0001) as was KSS function score (88.40±17.483 vs 23.40±8.98; P<0.0001). Pain measured on a visual analog scale was significantly lower after than before surgery (1.96±1.24 vs 6.60±1.26; P<0.0001). ROM and KSS knee and function scores were significantly lower on the operated than non-operated side after surgery. For both types of PTR, only knee extensor muscle strength was significantly lower on the operated than non-operated side and as compared with healthy volunteer knees.

CONCLUSIONS

Surgical repair of PTR with reinforcement and an early rehabilitation program demonstrate good results after a long follow-up. However, chronic PTR may need longer or a different rehabilitation protocol of the knee-extensor apparatus.

Severe hyperkalemia following adrenalectomy for aldosteronoma: prediction, pathogenesis and approach to clinical management- a case series

BACKGROUND

As the field of Primary Aldosteronism (PA) becomes ever expanded, diagnosis of PA is increasingly diagnosed by endocrinologists. With increased PA screening, many of the cases are now found in patients with complex co-morbidities in addition to their hypertension. Post adrenalectomy renal impairment with hyperkalemia is now increasingly seen in these complex patients, as evidenced by the numerous reports on this issue that have appeared within the past 3 years. We present a small case series to illustrate the breadth of the problem, along with a discussion about how such CKD/hyperkalemic events may be predicted.

CASE PRESENTATION

We present three cases of primary aldosteronism with long standing hypertension (more than 10 years) hypokalemia (2.0-3.0 mmol/l). Serum aldosterone was high with low renin activity leading to high aldosterone to renin ratio (ARR). They underwent abdominal CT scan revealing adrenal mass and adrenal vein sample confirmed lateralization. None of the patients had evidence of renal disease before surgery (as evident by normal eGFR and serum creatinine). Post adrenalectomy they had reduction in the blood pressure and became eukalemic. Serum aldosterone and renin activity were low leading to a low ARR. Case 1 developed hyperkalemia and increased serum creatinine 6 weeks post operatively which resolved with initiation of fludrocortisone and every attempt to discontinue fludrocortisone resulted in hyperkalemia and rising creatinine. Her hyperkalemia is under control with oral sodium bicarbonate. Case 2 developed hyperkalemia and increasing creatinine 2 months post operatively transiently requiring fludrocortisone and later on managed with furosemide for hyperkalemia. Case 3 developed renal impairment and hyperkalemia 2 weeks post operatively requiring fludrocortisone.

CONCLUSION

Post APA resection severe hyperkalemia may be a common entity and screening should be actively considered in high risk patients. Older age, longer duration of hypertension, impaired pre-op and post-op GFR and higher levels of pre-op aldosterone and are all risk factors which predict the likelihood of developing post-operative hyperkalemia. Fludrocortisone, sodium bicarbonate, loop diuretics and potassium binders can be used for treatment. Treatment choice should be tailored to patient characteristics including fluid status, blood pressure and serum creatinine. Potassium binders should be avoided in patients with history of recent abdominal surgery, opioid use and constipation. Serum electrolytes and creatinine should be monitored every 1-2 weeks after starting treatment to ensure an adequate response. Prolonged management may be necessary in some cases and at-risk patients should be counselled as to the meaning and importance of post-operative changes in measured renal function and potassium.

Design of enzyme-immobilized polymer brush-grafted magnetic nanoparticles for efficient nematicidal activity

Parasitic nematodes adversely affect agricultural industry and global health. An efficient and reusable nematicidal platform is developed by immobilization enzyme on the surface of magnetic NPs.

A kick in the shins: the financial impact of uncontrolled warfarin use in pre-tibial haematomas

Warfarin is increasingly prescribed in the elderly population for a number of medical conditions. Pre-tibial haematomas are a common cause of morbidity in this group. The aim of the study was to identify the proficiency of INR monitoring at a primary care level in correlation with their recommended INR range and to study the treatment outcome in this group. A retrospective single-centre study of patients diagnosed with pre-tibial haematomas was conducted over a two-year period. Length of hospital stay, time delay until operative intervention, blood transfusion and warfarin reversal requirements, social care input and cost to the NHS were considered. A total of 62 patients were admitted with pre-tibial haematomas of which 20 were on Warfarin. Females were predominantly more affected (5.6:1). The mechanism of injury was as a result of minor trauma. The mean INR level was 3.8 with a standard deviation of 3.1. Mean length of hospital stay was 11 days with a standard deviation of 13.6. Nine patients required skin grafting. Average cost for the acute episode was £3500 per patient. INR levels were significantly outwith the target range causing substantial patient morbidity and imposing a significant financial burden on the NHS. Tighter regulation at a primary care level should help reduce this risk.

Hepatic transaminase and alkaline phosphatase enzyme levels in HIV/HBV co-infected and HIV mono-infected patients in Maiduguri, Nigeria

BACKGROUND

Studies have shown that HIV-HBV co-infected patients have an increased risk of liver-related morbidity and mortality compared to their HIV-mono-infected counterparts. Furthermore, it has been reported that HIV-HBV co-infected patients have a significantly high incidence of drug-induced hepatotoxicity following commencement of HAART than HIV-mono-infected patients.

OBJECTIVES

To compare the levels of aspartate amino transferase (AST), alanine amino transferase (ALT) and alkaline phosphatase (ALKPO 4 ) enzyme levels between HAART naïve HIV-HBV co-infected patients and their HIV-mono-infected counterparts.

MATERIALS AND METHODS

A cross-sectional descriptive study in which 142 newly diagnosed HIV/HBV co-infected and HIV mono-infected adults were investigated for alkaline aminotransferase, aspartate aminotransferase and alkaline phosphatase enzyme levels.

RESULTS

The study subjects comprised of 80 (56.3%) females and 62 (46.7%) males. The age range of the study population was 15-65 years. The mean ages of male and female subjects were 45.5 ± 10.5 years and 39.1 ± 7.5 years respectively ( P < 0.05). Sixty-three (44.4%) study subjects were HIV/HBV co-infected while 79 (55.6%) were HIV mono-infected. The mean ALT enzyme level of HIV/HBV co-infected subjects was significantly higher than that of HIV mono-infected ones i.e., 42.12 IU/l vs. 27.86 IU/l, ( P = 0.038). However, there was no statistically significant difference in the mean AST (30.14 IU/l vs. 29.09 IU/l, P = 0.893) and ALKPO 4 (55.86 IU/l vs. 60.97 IU/l, P = 0.205) enzyme levels between HIV-HBV co-infected and HIV mono-infected subjects albeit the two enzymes were moderately elevated in both categories of subjects.

CONCLUSION

The significantly elevated ALT enzyme levels amongst HIV-HBV co-infected subjects suggest that HIV-HBV co-infected patients may have an increased risk of liver-related morbidity and mortality than their HIV mono-infected counterparts. Screening for serological markers of chronic HBV infection, as well as hepatic transaminase enzyme levels in all newly diagnosed HIV-positive patients is therefore recommended before commencement of HAART.