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Venous thromboembolism (VTE), including deep venous thrombosis and pulmonary embolism, is the most common cause of 30-day morbidity in oncology patients following surgery due to their hypercoagulable state. To combat this, VTE prophylaxis with anticoagulation extending beyond hospital discharge, termed extended duration chemoprophylaxis (EDCP), has been proposed, with the most recent guidelines recommending 28 post-operative days of EDCP. However, the literature has demonstrated poor compliance to these recommendations. We extended the duration of EDCP to 28 days post hospital discharge, effectively creating a standard discharge prescription for all surgical oncology patients. Our aim is to assess our EDCP protocol on patient compliance and VTE rate following major oncologic resection. We performed a retrospective, single institution, cohort study that involved chart review and telephone survey on patients who underwent major open abdominopelvic oncologic resection. A total of 130 patients were included; 60 received EDCP and 68 did not. VTE rate for the EDCP cohort was 0% and 7.4% for the non-EDCP cohort (p = 0.04). 85% of patients were fully compliant with EDCP. No bleeding related complications with EDCP were identified. Our data is consistent with prior literature in demonstrating a lower VTE rate with EDCP without an increase in bleeding related complications and we have demonstrated that it is possible to achieve a high rate of patient compliance with EDCP.

The present study aimed to investigate the renoprotective effect of therapeutic hypothermia (TH) on renal ischemia-reperfusion injury (RI/RI) induced by asphyxial cardiac arrest (CA) in rats. A total of 48 male rats were randomly divided into five groups: i) Sham (n=6); ii) Normothermia + CA (Normo.) (n=14); iii) Normo. and 2 h of TH after return of spontaneous circulation (ROSC) (n=12); iv) Normo. and 4 h of TH after ROSC (n=9); and v) Normo. and 6 h of TH after ROSC (n=7). All rats except the Sham group underwent asphyxia CA and were sacrificed 1 day after ROSC. The survival rate increased from 42.8% in the Normo. group to 50, 66.6 and 85.7% in the groups with 2, 4 and 6 h of TH after CA, respectively. TH attenuated the histopathological changes of the renal tissues following ROSC and the levels of blood urea nitrogen, serum creatinine and malondialdehyde in renal tissues. On immunohistochemistry, the relative optical density of nuclear erythroid-related factor-2 (Nrf2) and heme oxygenase (HO-1) expression in renal tissues increased in the Normo. group compared with that in the Sham group and exhibited further significant increases at 6 h of TH after ROSC. In conclusion, TH attenuated renal injury and increased the expression of Nrf2 and HO-1 in a TH treatment time-dependent manner.

Purpose To investigate the role of Nrf2/HO-1 in renal histopathological ailments time-dependently in asphyxial cardiac arrest (CA) rat model. Methods Eighty-eight Sprague Dawley male rats were divided into five groups of eight rats each. Asphyxial CA was induced in all the experimental rats except for the sham group. The rats were sacrificed at 6 hours, 12 hours, one day and two days post-CA. Serum blood urea nitrogen (BUN), creatinine (Crtn) and malondialdehyde from the renal tissues were evaluated. Hematoxylin and eosin and periodic acid-Schiff staining were done to evaluate the renal histopathological changes in the renal cortex. Furthermore, Nrf2/HO-1 immunohistochemistry (ihc) and western blot analysis were performed after CA. Results The survival rate of rats decreased in a time-dependent manner: 66.6% at 6 hours, 50% at 12 hours, 38.1% in one day, and 25.8% in two days. BUN and serum Crtn markedly increased in CA-operated groups. Histopathological ailments of the renal cortical tissues increased significantly from 6 hours until two days post-CA. Furthermore, Nrf2/HO-1 expression level significantly increased at 6 hours, 12 hours, and one day. Conclusions The survival rate decreased time-dependently, and Nrf/HO-1 expression increased from 6 hours with the peak times at 12 hours, and one day post-CA.

Pauci-immune crescentic glomerulonephritis is the most common variant of rapidly progressive glomerulonephritis, accounting for approximately 80% of total cases. Most of the cases are associated with the presence of anti-neutrophil cytoplasmic antibody (ANCA) and are usually referred to as ANCA-associated vasculitis. A 68-year-old male with no previous renal history presented with complaints of shortness of breath, cough, and bilateral leg swelling for 2 weeks. Initial workup was significant for creatinine elevated at 2.9 mg/dL, blood urea nitrogen at 65 mg/dL, and glomerular filtration rate of 27 mL/min. Further workup was unremarkable for any significant abnormality. Subsequently patient’s kidney function worsened, and temporary hemodialysis was started. Kidney biopsy was performed, which later came back significant for necrotizing arteritis, multifocal, with focal necrotizing and crescentic glomerulonephritis, pauci-immune type. High-dose corticosteroids were administered, and good clinical response was noticed. This is a very rare case of renal limited pauci-immune crescentic glomerulonephritis with annual incidence of 7 to 10 cases per million every year in the United States. The absence of involvement of other organs makes our case even rarer. Mortality is as high as 90% in untreated patients and aggressive therapy with glucocorticoids and cyclophosphamide or rituximab are the mainstay of treatment. The presence of significant renal impairment in the absence of other organs involvement in our patient makes it a very unique presentation of ANCA-positive vasculitis.

Soft tissue sarcomas (STSs) are rare malignant tumors originating from mesenchymal cells. Extremities are the most commonly affected anatomical sites, and majority of them present as a painless mass. We present a very interesting case of high-grade spindle cell sarcoma of the pelvis manifested as urinary retention and bloody diarrhea. A 68-year-old male presented to the emergency department with abdominal pain, inability to void urine, and bloody diarrhea. Straight urinary catheterization retrieved 900 mL of urine, and a Foley catheter was placed. All laboratory workup including complete blood count, complete metabolic panel, and urinalysis were within normal limits, but computed tomography (CT) of the abdomen and pelvis with contrast was remarkable for bilateral moderate hydronephrosis and a large 14 x 9.1 cm pelvic mass fistulizing into the rectum. To better identify the extent of disease, magnetic resonance imaging (MRI) with contrast was performed, which also revealed a similar large pelvic mass fistulizing into the rectum. Core needle biopsy of the mass was performed, which showed malignant spindle and epithelioid neoplasm with necrosis consistent with high-grade sarcoma. This is a very rare presentation of STS, and, to the best of our knowledge, only few similar cases have been reported thus far.

Background Time of diagnosis (TOD) of benign esophageal perforation is regarded as an important risk factor for clinical outcome, although convincing evidence is lacking. The aim of this study is to assess whether time between onset of perforation and diagnosis is associated with clinical outcome in patients with iatrogenic esophageal perforation (IEP) and Boerhaave’s syndrome (BS). Methods We searched MEDLINE, Embase and Cochrane library through June 2018 to identify studies. Authors were invited to share individual patient data and a meta-analysis was performed (PROSPERO: CRD42018093473). Patients were subdivided in early (≤ 24 h) and late (> 24 h) TOD and compared with mixed effects multivariable analysis while adjusting age, gender, location of perforation, initial treatment and center. Primary outcome was overall mortality. Secondary outcomes were length of hospital stay, re-interventions and ICU admission. Results Our meta-analysis included IPD of 25 studies including 576 patients with IEP and 384 with BS. In IEP, early TOD was not associated with overall mortality (8% vs. 13%, OR 2.1, 95% CI 0.8–5.1), but was associated with a 23% decrease in ICU admissions (46% vs. 69%, OR 3.0, 95% CI 1.2–7.2), a 22% decrease in re-interventions (23% vs. 45%, OR 2.8, 95% CI 1.2–6.7) and a 36% decrease in length of hospital stay (14 vs. 22 days, p p = 0.001), compared with late TOD. Conclusions This individual patient data meta-analysis confirms the general opinion that an early (≤ 24 h) compared to a late diagnosis (> 24 h) in benign esophageal perforations, particularly in IEP, is associated with improved clinical outcome.

The development of modern technology in recent years, makes the data security very big issue. To secure our data from unauthorized person, encryption is used before transmission. Various sensitive information is using encryption such as: e-mail messages, banking transactions, credit information and military operations. The encrypted data can be in form of text, image, voice, and video. In this paper, a proposed Hill algorithm with chaos system is used to encrypt colour RGB (Red, Green and Blue) image. The key of Hill algorithm is a square matrix. The selection of matrix key numbers is very important. Therefore, chaos system is used to generate sequences of numbers for Hill key matrix. These sequences have a property of randomness that make it very difficult for guessing. Finally, the proposed system is simulated using MATLAB, and a test image is encrypted and decrypted using proposed system successfully.

Background Burn scar treatment persists as an unsolved problem, involving thousands of affected patients disfigured for life. Objectives We sought to present our experience with the use of combined treatments for patients with burn scars. Methods This was a case series report of the senior author’s experience during 8 years utilizing the combined treatments of Fraxel Restore (fractional laser) and microfat graft injection for 288 patients with burn scars. Results Laser treatment reduced scar intensity and attenuated skin irregularities and hyperpigmentation. All patients demonstrated marked improvement of skin texture and an increase in scar softness after 3 sessions of microfat grafting. However, the degree of improvement varied between patients and was related to the severity of the scar and the type of tissue. Overall, a 40% to 80% improvement was noted in our patients. All patients and their families expressed satisfaction with the results. Conclusions The combined treatment of Fraxel and microfat grafting is an effective technique for improving the appearance of a hypertrophic scar or keloid on burn patients. Fat tissue stem cells may have helped to repair the damaged skin. Level of Evidence: 4

review highlights the importance of photodynamic therapy in periodontolog y. It can be confirmed that the photodynamic therapy as adjunct to classical scaling and root planing can be recommended as treatment option, which can by no means replace the classical therapy concepts. But even over an observation period of six months a slightly higher improvement of the clinical parameters was achieved than with SRP alone. (J Bagh Coll Dentistry 2016

An antenna array with 4 ports is designed and implemented. The proposed antenna consists of four ports and a four-antenna array Microstrip patch antenna with ground plane extruded on the substrate. The overall size of the proposed substrate is 220×220 mm 2. The antenna is fabricated on an inexpensive FR4 a dielectric constant of εr=4.5, loss tangent of tan δ=0.019, with thickness of substrate of 1.6-mm and the thickness of patch is 0.035 mm. The measured results represent that the proposed antenna obtained a reasonable bandwidth from 2.4 GHz that could cover point-to-point application defined by 10-dB return loss. Furthermore, The S-Parameters of antenna are simulated and measured. A four-port antenna operating in point-to-point applications is designed; the antenna shows good pattern diversity low correlation coefficient.

After qualifying, Jacob Plange-Rhule came to the UK to study renal physiology in Manchester. Soon after he obtained his PhD, he returned to Ghana to train in internal medicine. He became consultant physician in the Department of Medicine, Komfo Anokye Teaching Hospital (KATH), where he started hypertension and renal clinics. Later on, he became head of nephrology services at KATH …

Background and Aim: Mental health and quality of life are commonly affected in patients with thalassemia and their caregivers. This review aims to synthesize the available evidence and to assess the prevalence of depression and anxiety in patients with thalassemia and their caregivers. This review also examines the bidirectional relationship between thalassemia and depression and anxiety and its impact on the quality of life of patients and their caregivers. Methods: Five electronic databases were searched [PsychInfo, PubMed, Medline, Google Scholar, and EMBASE] and also other sources. This search combined different terms of mental health and quality of life of patients with thalassemia and caregivers. The search went up until January 2019 Results: Forty articles are included in this review. The studies showed a high prevalence of mental illnesses, particularly depression and anxiety, among patients with thalassemia and their caregivers. Many factors have been found that impacts the quality of life of patients with thalassemia and their caregivers, including thalassemia, its related-complications, medical treatment and, psychological distress, and comorbid mental illness. Although all the studies that looked at comorbid mental illness and thalassemia recommended adding a psychological treatment, only three studies did investigate this and had shown some benefits. Conclusion: Thalassemia should be addressed as an illness with biopsychosocial components and should be treated as such. More studies are needed to assess the effectiveness of different psychological interventions for patients with thalassemia and their caregivers. Also, two new psychotherapies are mentioned and discussed as they address the psychological needs of patients and their caregivers.

In this paper, sewage sludge, a solid waste from wastewater treatment plant, which eagerly requires proper treatment was reused as solid support in the form of sewage sludge biochar, then modified with carboxymethyl chitosan to form a bio-adsorbent. Further, carboxymethyl chitosan coating on sewage sludge biochar improved carboxymethyl chitosan's stability in water. The prepared bio-adsorbent revealed a shorter equilibrium time (60 min) for Pb(II) adsorption and a superior capacity of 594.17 mg g

Introduction: South Asian population has a particularly high prevalence of thyroid disorders mainly due to iodine deficiency and goitrogen use. There is no data available for prevalence of thyroid disorders in the general population living in nonmountainous regions of Pakistan. Materials and Methods: A total of 2335 residents of Pak Pattan, Punjab, Pakistan were interviewed about demographic, dietary, medical and environmental history as well as screened for goiter. Individuals of all ages and either gender were included. Results: Median age was 34 (10-88) years and 1164 (49.9%) were males. Median monthly income was 49 (3.9-137) USD. Six hundred and sixty-nine (28.7%) subjects had palpable goiter. 77.5% (n = 462) and 22.5% (n = 133) had World Health Organization Grade I and Grade II goiters respectively, further screened by measuring thyroid-stimulating hormone (TSH). In subjects with TSH

Breast cancer is the most common cancer among the population as a whole and among females, yet it is highly curable if diagnosed at an early stage. Different methods are used to diagnose breast cancer. One of these methods features immunological tests using flow cytometry to determine T-lymphocyte (CD4/CD8) ratios in peripheral blood. One hundred patients with breast cancer (50 from Basra, Iraq, and 50 from Baku, Azerbaijan) confirmed to have breast cancer by histopathology were studied. Blood samples were collected from all patients before initiation of treatment and were used for analysis. The mean age of women from Basra was 51.2 ± 10.7 years and that of women from Baku was slightly higher at 54.8 ± 12.2 . The mean CD4/CD8 ratio in Basra was 1.4 and in Baku was 1.8 with P value < 0.05. The percentage of Basra patients who have CD4/CD8 value less than 1 was 50%, while the percentage for Baku patients was 24 % (p < 0.05). While the CD4/CD8 T-lymphocyte ratio might be useful for early diagnosis in patients with breast cancer parallel with other confirmed tests factors involved in explaining variation between countries such as that observed here need to be taken into account.

We have successfully synthesized chromium doped gamma ferrite (γ-Fe2O3) nanopowders (16.9 nm to 25.6 nm) of the composition (Fe2−xCrxO3 for x = 0.00, 0.05, 0.06, 0.07, 0.08, 0.09, 0.10) by a slightly modified solution combustion method using citric acid as fuel at considerably low temperature. The so prepared powders were extensively studied for complex permeability and optical behaviour. It was found that Cr3+ doped γ-Fe2O3 has significant permeability values and it can therefore be used as a high permeability core material and in Multi-layer Chip Inductor (MLCI) applications in electronic products, such as cellular phones, computers and video cameras. The results obtained in terms of permeability spectra suggest that γ-Fe2O3 and its doped variants when made in nano-form behave as a high permeability material at ultra high frequencies (5–25 MHz) with permeability showing unusual inverse dependence on the grain dimension. Optical studies of the material confirm the presence of two band gaps BGd1 and BGd2 falling within the solar energy spectrum, thereby making this material a promising candidate for single junction photovoltaics with enhanced power conversion efficiency. We have also shown that the nano-sized γ-Fe2O3 synthesized by cost effective and modified sol–gel auto-combustion technique can be a good alternative to highly mismatched alloys (HMAs).

Background: Gestational diabetes mellitus is a metabolic disorder defined as glucose intolerance with onset or first recognition during pregnancy. Similar to other members of the Asian race, Pakistani women are also considered to be at a high risk for developing gestational diabetes. Materials and Methods: In order to better understand whether this heightened risk attributed to race really exists, we conducted a prospective study to assess the glycemic status of primigravida women presenting to our hospital. Results: The mean age of 135 subjects enrolled was 22 (16-31), with 21 (16%), 60 (44%), and 54 (40%) subjects in the first, second, and third trimesters of pregnancy, respectively. The mean fasting, 1-hour, and 2-hour plasma glucose levels were 69.9 mg/dL (3.9 mmol/L), 129 mg/dL (7.2 mmol/L), and 103.6 mg/dL (5.76 mmol/L), respectively. Of 135 women, 6 had a blood pressure reading ≥140/90 mm Hg and only one met the criteria for gestational diabetes mellitus. In our study, despite using the newly proposed International Association of Diabetes and Pregnancy Study (IADPS) cut-offs for diagnosis of gestational diabetes, the incidence rate of gestational diabetes mellitus in primigravida was still

Introduction Gitelman syndrome is an inherited autosomal recessive renal salt-wasting disorder. It presents with variable clinical symptoms including muscle weakness and fatigue, and the diagnosis is based on metabolic alkalosis, hypokalemia, hypomagnesemia and hypocalciuria. It is usually diagnosed incidentally in early adulthood. There are rare cases of Gitelman syndrome presenting in early childhood; however, to the best of our knowledge it has not previously been associated with delayed puberty. Case presentation A 17-year-old South Asian man with recurrent episodes of generalized muscle weakness, fatigue and cramps from the age of two years was admitted for further workup. Before the age of 12 years, the episodes had been mild, but they then got progressively worse. Other symptoms include polyuria, polydipsia, nocturia, paresthesia and occasional watery diarrhea. He also had a history of short stature, poor weight gain and delayed developmental landmarks. His family history was unremarkable except for the consanguineous marriage of his parents. An examination revealed a thin and lean man with blood pressure of 95/60mmHg. His height and weight were below the third percentile and his sexual development was at Tanner Stage II. Laboratory work revealed serum sodium of 124mmol/L, potassium 2.4mmol/L, calcium 6.5mmol/L and magnesium of 1.2mg/dL. His testosterone level was low (0.85ng/mL, normal for his age 2.67 to 10.12ng/mL) with normal levels of luteinizing hormone and follicle-stimulating hormone. The sex hormone findings were attributed to delayed puberty. A 24-hour urinary analysis revealed decreased excretion of calcium (25.9mg/24 hours). Based on the findings of hypokalemic metabolic alkalosis without hypertension, severe hypomagnesemia and hypocalciuria, a diagnosis of Gitelman syndrome was made. Treatment was started with oral supplementation of potassium, magnesium and calcium along with spironolactone and liberal salt intake. Conclusion Diagnosis of Gitelman syndrome is usually made incidentally during adolescence or early adulthood based on clinical and biochemical findings. We report that Gitelman syndrome can present during the early childhood years. If undiagnosed and untreated, it can lead to growth retardation and delayed puberty.

Sir, Diabetic Cardiac Autonomic Neuropathy (DCAN) is associated with high risk of cardiovascular morbidity and mortality.[1] Several methods have been devised to assess cardiac autonomic neuropathy such as measurement of resting heart rate (HR), HR variability, etc. Reduced HR variability has been associated with increased cardiac events in diabetic subjects.[2] Portable ANSiscope is a device that noninvasively measures the parasympathetic/sympathetic nervous system imbalance in an office setting. The ANSiscope computes a percentage of dysautonomia from a recording of 571 RR intervals termed ANS index. Based on scoring described by Bellavere et al.,[3] five risk categories have been identified using the computed ANS Index. Subjects with ANS index