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In the few previous years, high prevalence of energy drinks intake among sportsmen and students is observed. This study was organized to find out this prevalence. The study was self-supervised and questionnaire based. Total medical students enrolled for this study were 233. Out of these, 121(52 %) students were involved in intake of energy drinks. The mostly consumed drink was Red bull and 101(43 %) students were timings to prepare for examination and to obtain energy were main causes of using this drink found in 34(14.6%) and 36(15.4 %) respectively. Medical students were using energy drinks on a large scale. Both friends and television were contributing in provision of information in ratio of 48% (113) and 66% (153) respectively. This is a need of the hour to make the young students and adults aware of disadvantage of intake of energy drinks. Key words: Students, Knowledge, Caffeine, Energy drinks.

Hereditary angioedema (HAE) is a relatively rare clinical entity that can potentially cause life-threatening airway or intestinal oedema, patients with the latter usually presents with symptoms of gastroenteritis like vomiting, diarrhoea and abdominal pain. Here, we present a unique case of a less recognised type of HAE that is type III in a patient who presented with signs and symptoms consistent with infectious colitis. She previously had similar episodes and was managed multiple times with antibiotics, with no satisfactory response. There, she underwent extensive diagnostic evaluation. On the basis of findings of further investigations on the current visit, she was eventually diagnosed with intestinal angioedema. To the best of our knowledge, the present paper represents the third reported case of type III HAE-induced intestinal angioedema. Additionally, we undertake a literature review of HAE.

Objective: Objective of the article to review the advancement in control of Diabetes Mellitus. Methods and material: The patient is a 62-year-old male with a past medical history of Diabetes Mellitus Type 1, Transient Ischemic Attack (TIA), Coronary Artery Disease (CAD), Hyperlipidemia, Hypothyroidism & Hypovitaminosis. Initially, he was started on Accu Check Insulin Pump. His mean blood glucose was 165mg/dL with standard deviation (SD) of + 59mg/dL. His fasting blood Glucose measurement was in the range from 62mg/dL to 280mg/dL. His HbA1c was noted to be 6.5% on 03/20/2013 just prior to putting him on insulin pump therapy. Upon replacement of his insulin pump to MiniMed, his Continuous Glucose Monitoring (CGM), as follows: Mean Blood Glucose 135mg/dL with SD of +52mg/dL and HbA1c of 6.2% with 14 episodes of Hypoglycemia (140mg/dL). In 2017 he received Artificial Pancreas MiniMed 670G (AP) while being on AP, his CGM readings were: Mean Blood Glucose 133mg/dL with SD + 33mg/dL and HbA1c of 6.5%; readings within range (70-180mg/dL) 89 % of the time, with readings in hypoglycemic range (50-70mg/dL) were only 4% of the time and mildly above the range (180-250mg/dL) were only 7% of the time. HbA1C increased from 6.2 to 6.5% because there were less hypoglycemic episodes while being on AP as compare to previous regimens. Results: The result of our study showed that Artificial Pancreas (AP) is an advanced modality of treatment for Type 1 and Type 2 Diabetes Mellitus. This has the advantage of better glycemic control, less frequent monitoring and its ability to monitor and deliver the accurate dose of Insulin according to the body needs during the different activities. Key words: Artificial Pancreas, Type 1 Diabetes Mellitus, Type 2 Diabetes Mellitus, Basal Bolus Insulin, Insulin Pump, Continuous Glucose Monitor. Conclusions: AP is a technically feasible modality and safe by a conservative standard for treatment of patients with Type 1 and Type 2 Diabetes Mellitus. This has the advantage of better glycemic control, less frequent monitoring and its ability to monitor and deliver the accurate dose of Insulin according to the body needs during the different activities. Special care must be taken by clinicians to ensure that the patient education is adequate about the functioning mechanism of AP.

The case report of Community-acquired pneumonia in a male patient with co-morbidities of diabetes mellitus, hypertension, and gout. Empiric antibiotic treatment did not resolve the clinical picture of a productive cough, and a chest computerized tomography and sputum culture with antibiogram were performed, identifying S. maltophilia infection with sensitivity to levofloxacin, ceftazidime and sulfamethoxazole/ trimethoprim. Case Presentation: Our patient is an 80-year-old Punjabi male with the history of controlled diabetes mellitus, hypertension, and gout, who presented to his primary care physician with a chief complaint of persistent productive cough with blood-tinged sputum and unintentional weight loss for four months. He had three episodes of fever, chills and night sweats. Conclusions: S. maltophilia associated pneumonia can occur in the community setting.It is multi-drug resistant and the infection must be treated as soon as possible to avoid the adverse outcomes Key words: pneumonia, stenotrophomonas maltophilia, sputum culture, antibiogram, antibiotic therapy

Lafora disease is fatal intractable progressive myoclonic epilepsy. It is frequently characterized by epileptic seizures, difficulty walking, muscle spasms, and dementia in late childhood or adolescence. We chronicle here an unusual case of an asymptomatic young male soccer player who presented with elevated liver enzymes. Neurological examination was unremarkable. The diagnostic workup for hepatitis, infectious etiologies, autoimmune disorders, hemochromatosis, Wilson's disease, alpha-1 antitrypsin deficiency, and other related diseases was inconclusive. He subsequently underwent an uneventful percutaneous liver biopsy. Based on the pathognomonic histopathological findings, Lafora disease was considered the likely etiology. The present study is a unique illustration of this rare disorder initially manifesting with abnormal liver enzymes. It underscores the importance of clinical suspicion of Lafora disease in cases with unexplained hepatic dysfunction. Prompt liver biopsy and genetic testing should be performed to antedate the onset of symptoms in these patients.

The purpose of this study is to guide the readers to the impact of the articles published on hepatic magnetic resonance imaging (MRI). We searched Scopus using 10 different search terms for hepatic MRI. The selected studies were thoroughly reviewed by two independent authors and any disagreement was sorted out by mutual consensus. The list of articles and journals was downloaded into an excel spreadsheet. Only the top 100 cited articles were selected by mutual consensus among all the authors. These articles were further read in the full-text form and were further categorized into subgroups. Three authors independently reviewed the top 100 selected articles, and subsequently data was extracted from them and analyzed. Our study showed that the highest number of top 100 cited articles on hepatic MRI were from Radiology (30 articles) followed by European Radiology (14 articles). The American Journal of Roentgenology, Radiographics, and Journal of Magnetic Resonance had seven articles each. The United States had the highest number of articles by region. Nineteen other journals contributed only one article each to the list of top 100 cited articles. The contribution of authors to the top 100 cited articles was reviewed; all the authors contributing with more than two articles to the highly cited articles are given in Table 3 in the supplementary material. The maximum number of articles were published during 2009 (14 articles), and for a five-year period, the maximum contribution was made during 2008-2013 (44 articles). Our analysis gives an insight on the frequency of citations of top articles on hepatic MRI, categorizes the subtopics, the timeline of the publications, and contributions from different geographic distributions.

Formaldehyde is a highly reactive impurity that can be found in many pharmaceutical excipients. Trace levels of this impurity may affect drug product stability, safety, efficacy, and performance. A static headspace gas chromatographic method was developed and validated to determine formaldehyde in pharmaceutical excipients after an effective derivatization procedure using acidified ethanol. Diethoxymethane, the derivative of formaldehyde, was then directly analyzed by GC-FID. Despite the simplicity of the developed method, however, it is characterized by its specificity, accuracy, and precision. The limits of detection and quantification of formaldehyde in the samples were of 2.44 and 8.12 µg/g, respectively. This method is characterized by using simple and economic GC-FID technique instead of MS detection, and it is successfully used to analyze formaldehyde in commonly used pharmaceutical excipients.

Injury is defined medically as being harm as a result of trauma; it is one of the most common problems that may face people in their daily life especially at home. Domestic injuries may sometimes be life-threating issue and in another situations they may also lead in the decrease of life expectancy in some cases due to the bad prognosis they represent. First aid is the urgent medical care that is provided to the victim till further medical treatment and care arrives. Simply first aid knowledge provides skills and practice to give a required life support and develop safety habits in the population?s life, therefore it is really important to have good knowledge about it and enough experience in it. This study is a cross sectional study conducted in July and August 2013, study collection of data is done at shopping malls (Alkout, Sharq, Alfanar and Almobarkyya).), and study sample is 600 Kuwaitis aged from 18 years and above. Questionnaire is used as the data instrument (appendix 1 and 2). SPSS is used for analysis of the data and interpretation of the results. This study is conducted to determine the prevalence of domestic injuries among Kuwaitis, know the most common injury in each particular age group, Asses awareness of first aid and know the best way to raise first aid knowledge. The aim of this research is to raise the awareness of first aid in the Kuwaiti population, improve the Kuwaiti population abilities to deal with the most common domestic injuries. The results of this research showed that the prevalence of domestic injuries is more than two third of the sample, Cut wounds represented the highest injury and electric shock was the lowest. There was variation on whether the response is right (12) or wrong depending on the injury. There was also variation in the opinions of the participants on how to improve first aid knowledge, preferring it to be part of the school curriculum, taking it as practical courses or making television shows about it and not forgetting about the other opinions they shared. In conclusion this study shows that the prevalence of domestic injuries in the Kuwaiti population is high. More than half of the injuries dealt with by the responders in a correct way according to first aid instructions, which reflect somehow good level of awareness within the Kuwaiti population ,furthermore in Support to this statement, the majority believes in the importance of first aid kit and also it was found that they have first aid kit in their possession. The sources of their knowledge were obtained mainly from media, first aid courses and others. However, the majority of the sample believe that the best way of dissemination first aid knowledge is by making it part of the school curriculum. Finally, it can be concluded that there is a big chance for Kuwaitis to fill the missing gap in learning the most fundamental basic aspects of first aid.

Being a Medical student is known to be a stressful period. And failure to cope with stress may lead to different psychiatric illness. Among which is adjustment disorder. A cross-sectional, descriptive study was conducted at an undergraduate medical school with a seven-year curriculum, in Bahrain. Approximately twenty Medical students were included from each year of all seven years. Total number of students who completed the questioner (135). Aiming to measure the prevalence and severity of adjustment disorder (AD) among medical students. The study was conducted using Kessler Psychological Distress Scale (K10), which is used to assess the extent of stress. The results showed that 65.9% (89) of the students included are free from adjustment disorders and 34.1% (46) are having potential adjustment disorder. Of those who have potential adjustment disorder was found to be almost equal between male and female.

Infrastructure vulnerability has drawn significant attention in recent years, partly because of the occurrence of low-probability and high-consequence disruptive events such as 2017 hurricanes Harvey, Irma, and Maria, 2011 Tuscaloosa and Joplin tornadoes, and 2015 Gorkha, Nepal, and 2017 Central Mexico earthquakes. Civil infrastructure systems support social welfare, thus viability and sustained operation is critical. A variety of frameworks, models, and tools exist for advancing infrastructure vulnerability research. Nevertheless, providing accurate vulnerability measurement remains challenging. This paper presents a state-of-the-art data collection and information extraction methodology to document infrastructure at high granularity to assess preevent vulnerability and postevent damage in the face of disasters. The methods establish a baseline of preevent infrastructure functionality that can be used to measure impacts and temporal recovery following a disaster. The Extreme Events Web Viewer (EEWV) presented as part of the methodology is a GIS-based web repository storing spatial and temporal data describing communities before and after disasters and facilitating data analysis techniques. This web platform can store multiple geolocated data formats including photographs and 360° videos. A tool for automated extraction of photography from 360° video data at locations of interest specified in the EEWV was created to streamline data utility. The extracted imagery provides a manageable data set to efficiently document characteristics of the built and natural environment. The methodology was tested to locate buildings vulnerable to flood and storm surge on Dauphin Island, Alabama. Approximately 1,950 buildings were passively documented with vehicle-mounted 360° video. Extracted building images were used to train a deep learning neural network to predict whether a building was elevated or nonelevated. The model was validated, and methods for iterative neural network training are described. The methodology, from rapidly collecting large passive datasets, storing the data in an open repository, extracting manageable datasets, and obtaining information from data through deep learning, will facilitate vulnerability and postdisaster analyses as well as longitudinal recovery measurement.

The time–cost trade-off problem (TCTP) is fundamental to project scheduling. Risks in estimation of project cost and duration are significant due to uncertainty. This uncertainty cannot be eliminated by any scheduling or estimation techniques. Therefore, a model that can represent uncertainty in the real world to solve time–cost trade-off problems is needed. In this chapter, fuzzy logic is utilized to consider affecting uncertainties in project duration and cost. An optimization algorithm based on time-driven activity-based costing (TDABC) is applied to provide a trade-off between project time and cost. The presented model could solve the time–cost trade-off problem while accounting for uncertainty in project cost and duration. This could help generate a more reliable schedule and mitigate the risk of projects running overbudget or behind schedule.

Stereology had been widely used around the globe for estimating the value of the biological structure. It interlinks the connection between the dimensions using a sample that is 2D for a quantification in 3D structure. Volume estimation using stereology method is the most common and basic quantification that shows an example of how stereology works. Stereology method has a drawback when it comes to a lot of samples, so it is common for a researcher to use the computer to help to quantify and to do repetitive work, which is known as computer-assisted stereology quantification. The purpose of this research is to develop software that can assist researchers using stereology method for estimating the volume of a sample object from its 2D digital images with point counting method. The software was built based on the manual procedure of volume estimation using stereology method performed by experienced researchers. The volume estimation using the software were then compared with the results of the manual procedure by the experts on the same samples, i.e., the kidney and trigeminal ganglion of a rat. The experimental results showed that the relative difference of the volume estimations between manual and computer assisted calculations were 0.93% for rat kidney sample and 10.81%. TA1 trigeminal ganglion sample. Based on the results, the software estimation can be used for further analysis.

Mucor and Rhizopus cause life-threatening infections primarily involving the lungs and sinuses, which disseminate very rapidly by necrosis and infarction of the contiguous tissues. We present a case of a 64-year-old African American posttransplant patient who presented with a productive cough and weight loss. He had a past surgical history of renal transplant for renal cell carcinoma and was on dual immunosuppressive therapy, that is, mycophenolate and tacrolimus. During his hospital stay, he developed a pneumopericardium due to the direct extension of a lung lesion. The diagnosis was made by radiological imaging and PCR result which was consistent with Mucor species. He was treated with antifungal therapy. The purpose of this report is to highlight the unusual association of mucormycosis with pneumopericardium.

High output heart failure is a less frequent cause of heart failure and numerous etiologies should be considered in order to evaluate and treat these patients. A 32-year-old female presented with dyspnea for 1 week. Physical exam revealed bilateral lung crackles, normal S1, S2, and a faint S3, and

Patients with chronic kidney disease (CKD) are prone to heart failure (HF) exacerbations and have difficult to manage volume status. Remote pulmonary artery (PA) hemodynamic monitoring device has shown to decrease HF admissions. To study efficacy of remote PA hemodynamic monitoring with CardioMEMS

Cardiac magnetic resonance (CMR) has been gaining traction recently as a non-invasive modality to diagnose coronary artery disease (CAD). Studies comparing the diagnostic accuracy of CMR versus fractional flow reserve (FFR) were identified and analyzed using RevMan and Stata software. A total of

Warfarin is used widely in end-stage renal disease (ESRD) patients with atrial fibrillation (AF) for stroke prophylaxis but has been associated with higher bleeding rates, labile INR and skin necrosis. Apixaban has recently been approved as an alternative but evidence on its safety and efficacy is

Anastrozole is an aromatase inhibitor that has been used more frequently over the last decade especially for oestrogen receptor-positive breast cancer. It has a relatively safe side effect profile. However, occasionally it has been associated with serious adverse events. Here, we present the case of a 58-year-old woman who presented with significantly elevated liver enzymes 4 years after starting anastrozole. She was not taking any other medications and an extensive workup did not reveal any other cause for her liver injury. The patient’s liver enzymes normalised after discounting the anastrozole. She scored 4 on the updated Roussel Uclaf Causality Assessment Method grading system which was possible for drug-induced liver injury. A review of the literature revealed six prior cases of anastrozole-related liver injury. Anastrozole should be considered as a possible culprit in patients who develop an unexplained acute liver injury.

Amiodarone is an antiarrhythmic agent that is used commonly in clinical practice. It is associated with many side effects, the most common being pulmonary manifestations. Interstitial pneumonitis is one of the most common complications, however rarely amiodarone can cause diffuse alveolar haemorrhage (DAH) too. We describe the case of a 73-year-old woman who presented with shortness of breath and haemoptysis 4 days after starting amiodarone. She was diagnosed with amiodarone-induced DAH based on imaging and bronchoalveolar lavage. She was treated with intravenous and then oral steroids, and amiodarone was discontinued. The patient made a significant clinical and radiological recovery. She was discharged 10 days after her presentation. This case highlights a rare but potentially life-threatening complication of a commonly used medication.

Many cases of appendicitis can be associated with appendicoliths. These may sometimes be lost during appendectomies and may be lodged in the body. Most of these cases lead to recurrent abscess formation, and these appendicoliths invariably need removal. Typically, this used to be done as an open surgery or laparoscopically. Here we describe the case of a transcutaneous removal of an appendicolith that was lodged between the liver and diaphragm that led to recurrent perihepatic abscess formation in a 24-year-old otherwise healthy man. The patient made a successful recovery without any recurrence. A transcutaneous approach to remove a retained appendicolith may be a feasible, a safe and an easy method to extract appendicoliths that are accessible for transcutaneous removal.

Air bersih merupakan salah satu kebutuhan pokok bagi kehidupan manusia. Sejak tahun 2004, Indonesia telah memiliki undang-undang yang mengatur tentang Sumber Daya Air, yaitu Undang-undang Nomor 7 Tahun 2004. Tetapi di berbagai wilayah di Indonesia masih ditemukan daerah yang mengalami kekurangan persediaan air bersih. Pembuatan alat pengolahan air baku sederhana menggunakan sistem filtrasi diharapkan dapat membantu masyarakat untuk mengolah air kotor menjadi air baku dalam skala kebutuhan rumah tangga. Alat tersebut mudah dioperasikan, dengan bahan yang murah dan mudah didapatkan, serta dapat dipindahkan karena memiliki dimensi yang tidak terlalu besar. Kata Kunci : Sistem Filtrasi, Air Baku, Alat Pengolahan Air