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Introduction: Magnetic resonance imaging (MRI) segmentation algorithms make it possible to study detailed medial temporal lobe (MTL) substructures as hippocampal subfields and amygdala subnuclei, offering opportunities to develop biomarkers for preclinical Alzheimer's disease (AD)., Methods: We identified the MTL substructures significantly associated with tau-positron emission tomography (PET) signal in 581 non-demented individuals from the Alzheimer's Disease Neuroimaging Initiative (ADNI-3). We confirmed our results in our UCLouvain cohort including 110 non-demented individuals by comparing volumes between individuals with different visual Braak's stages and clinical diagnosis., Results: Four amygdala subnuclei (cortical, central, medial, and accessory basal) were associated with tau in amyloid beta-positive (Aβ+) clinically normal (CN) individuals, while the global amygdala and hippocampal volumes were not. Using UCLouvain data, we observed that both Braak I-II and Aβ+ CN individuals had smaller volumes in these subnuclei, while no significant difference was observed in the global structure volumes or other subfields., Conclusion: Measuring specific amygdala subnuclei, early atrophy may serve as a marker of temporal tauopathy in preclinical AD, identifying individuals at risk of progression., Highlights: Amygdala atrophy is not homogeneous in preclinical Alzheimer's disease (AD). Tau pathology is associated with atrophy of specific amygdala subnuclei, specifically, the central, medial, cortical, and accessory basal subnuclei. Hippocampal and amygdala volume is not associated with tau in preclinical AD. Hippocampus and CA1-3 volume is reduced in preclinical AD, regardless of tau., (© 2024 The Author(s). Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.)

Background and Aims: Since 1990, global child and infant mortality rates have typically stabilized or decreased due to improved healthcare, vaccination rollouts, and international funding. However, Afghanistan continues to face the highest child and infant mortality rates globally, with 43 deaths per 1000 live births. This study aims to examine the factors contributing to this high mortality rate and propose interventions to address the issue., Methods: A comprehensive literature search was conducted using databases such as Google Scholar and PubMed, focusing on articles published in English within the last 10 years (2013-2023). The search terms included "Child mortality," "Infant mortality," "SIDS," "COVID-19," and "Afghanistan." Original studies, systematic reviews, case studies, and reports meeting the inclusion criteria were selected for analysis. Additional sources from organizations such as UNICEF, the World Bank Group, WHO, and EMRO were also reviewed., Results: The study findings reveal significant challenges contributing to Afghanistan's high infant and child mortality rates. These challenges include birth defects, preterm birth, malnutrition, sudden infant death syndrome (SIDS), traumatic injuries, fatal infections, infanticide, and abuse. The ongoing conflict, insecurity, and humanitarian crises further exacerbate the situation, leading to increased child casualties. Despite efforts by international agencies like UNICEF to provide vaccines and maternal education, the infant mortality rate remains high., Conclusion: In conclusion, Afghanistan's child and infant mortality rates are of significant concern, and it is imperative that action be taken to reduce the incidence of child and infant mortality rates., (© 2024 The Author(s). Health Science Reports published by Wiley Periodicals LLC.)

Introduction: Uterine fibroids are the commonest benign tumors of the reproductive tract in women of childbearing age. They are usually asymptomatic but can cause menorrhagia. Treatments include myomectomy and uterine artery embolization (UAE). The latter is a relatively new procedure, therefore of special interest., Objectives: We conducted a systematic review and meta-analysis of all published studies to provide a comprehensive outlook on the effectiveness of UAE by comparing its outcomes to those of myomectomy. Electronic databases (PubMed and Cochrane Central) were systematically searched from January 2000 to March 2022 for published randomized control trials, observational studies, and meta-analyses that compared UAE to myomectomy for at least one of the pre-specified outcomes, namely re-intervention rates, length of hospital stay, and complications., Methods: We shortlisted nine studies for the final analysis. For continuous outcomes, results from random-effects meta-analysis were presented as mean differences (MDs) and corresponding 95% confidence intervals (CIs). Risk ratios (RRs) for dichotomous outcomes were pooled using a random-effects model., Results: The final analysis consisted of nine studies. Factors like re-intervention, hospitalization, and complications, each with its unique follow-up duration were assessed. Pooled analysis demonstrated significant results for greater re-intervention rates with UAE as compared to myomectomy (RR: 2.16, 95% CI: (1.27-3.66), p- value 0.004, heterogeneity I 2  = 85%). UAE holds a greater but statistically insignificant risk for major complications (RR: 0.62, 95% CI: (0.29-1.33), p- value 0.22, heterogeneity I 2  = 0%) and myomectomy shows a statistically insignificant greater risk for minor complications (RR: 1.72, 95% CI: (0.92-3.22), p- value 0.09, heterogeneity I 2  = 0%). UAE had a shorter but statistically insignificant duration of hospital stay (MD: -1.12, 95% CI: (-2.50 to 0.27), p- value 0.11, heterogeneity I 2  = 96%) ( p- value for subgroup differences = 0.005)., Conclusion: Our meta-analysis of approximately 196,595 patients demonstrates that myomectomy results in a significant reduction in re-intervention rate compared to UAE., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Purpose: [ 18 F]MK-6240, a second-generation tau PET tracer, is increasingly used for the detection and the quantification of in vivo cerebral tauopathy in Alzheimer's disease (AD). Given that neurological symptoms are better explained by the topography rather than by the nature of brain lesions, our study aimed to evaluate whether cognitive impairment would be more closely associated with the spatial extent than with the intensity of tau-PET signal, as measured by the standard uptake value ratio (SUVr)., Methods: [ 18 F]MK6240 tau-PET data from 82 participants in the AD spectrum were quantified in three different brain regions (Braak ≤ 2, Braak ≤ 4, and Braak ≤ 6) using SUVr and the extent of tauopathy (EOT, percentage of voxels with SUVr ≥ 1.3). PET data were first compared between diagnostic categories, and ROC curves were computed to evaluate sensitivity and specificity. PET data were then correlated to cognitive performances and cerebrospinal fluid (CSF) tau values., Results: The EOT in the Braak ≤ 2 region provided the highest diagnostic accuracies, distinguishing between amyloid-negative and positive clinically unimpaired individuals (threshold = 9%, sensitivity = 79%, specificity = 82%) as well as between prodromal AD and preclinical AD (threshold = 38%, sensitivity = 81%, specificity = 93%). The EOT better correlated with cognition than SUVr (∆R 2  + 0.08-0.09) with the best correlation observed for EOT in the Braak ≤ 4 region (R 2  = 0.64). Cognitive performances were more closely associated with PET metrics than with CSF values., Conclusions: Quantifying [ 18 F]MK-6240 tau PET in terms of EOT rather than SUVr significantly increases the correlation with cognitive performances. Quantification in the mesiotemporal lobe is the most useful to diagnose preclinical AD or prodromal AD., (© 2024. The Author(s).)

Background: Limitations in the operative microscope (OM)'s mobility and suboptimal ergonomics created the opportunity for the development of the exoscope. This systematic review aims to evaluate the advantages and disadvantages of exoscopes and OMs in spine surgery., Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a systematic search was conducted in the major research databases. All studies evaluating the exoscopes and/or OMs in spinal procedures were included., Results: There were 602 patients included in the 16 studies, with 539 spine surgery patients, 19 vascular cases, 1 neural pathology case, 19 cranial cases, and 24 tumor pathologies. When examining surgical outcomes with the exoscope, results were mixed. Compared to the OM, exoscope usage resulted in longer operative times in 7 studies, comparable times in 3 studies, and shorter operative times in 3 studies. Two studies found similar lengths of stay (LOS) for both tools, two reported longer LOS with exoscopes, and one indicated shorter hospital LOS with exoscopes. One study reported higher exoscope-related blood loss (EBL), but four other studies consistently showed reduced EBL. In terms of image quality, illumination, dynamic range, depth perception, ergonomics and cost-effectiveness, the exoscope was consistently rated superior, while findings across studies were mixed regarding the optical zoom ratio and mean scope adjustment (MSA). The learning curve for exoscope use was consistently reported as shorter in all studies., Conclusion: Exoscopes present a viable alternative to OMs in spine surgery, offering multiple advantages, which supports their promising role in modern neurosurgical practice., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Most studies assume midday gas exchange measurements capture the leaf's daytime performance. However, stomatal conductance (g s ) and photosynthesis (A n ) fluctuate diurnally due to endogenous and environmental rhythms, which can affect intrinsic water use efficiency (iWUE). Six Sorghum lines with contrasting stomatal anatomical traits were grown in environmentally controlled conditions, and leaf gas exchange was measured three times a day. Stomatal anatomy and kinetic responses to light transients were also measured. The highest A n and g s and the lowest iWUE were observed at midday for most lines. Diurnally averaged iWUE correlated positively with morning and midday iWUE and negatively with the time taken for stomata to close after transition to low light intensity (k close ). There was significant variation among sorghum lines for k close , and smaller k close correlated with lower g s and higher stomatal density (SD) across the lines. In turn, g s was negatively correlated with SD and regulated by the operational stomatal aperture regardless of stomatal size. Altogether, our data suggest a common physiology to improve iWUE in sorghum related to the control of water loss without impacting photosynthesis relying on higher SD, lower stomatal aperture and faster stomatal closing in response to low light intensity., (© 2023 The Authors. The Plant Journal published by Society for Experimental Biology and John Wiley & Sons Ltd.)

Decades of political turmoil and stifling war, among other issues, has turned Afghanistan into the world's largest humanitarian crisis. Just 4 months after the Taliban seized control, the majority of the Afghan population face starvation, with >3.3 million children unable to afford basic food resources, leading to dozens of deaths every week. Restrictions on humanitarian assistance, withholding of vital food supplies and inadequate medical care play a major role in exacerbating the rates of malnutrition in the vulnerable paediatric population. Global interference is warranted to avoid unfathomable consequences in mitigating this public health catastrophe., (© The Author(s) 2022. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Sustaining crop productivity and resilience in water-limited environments and under rising temperatures are matters of concern worldwide. We investigated the leaf anatomical traits that underpin our recently identified link between leaf width (LW) and intrinsic water use efficiency (iWUE), as traits of interest in plant breeding. Ten sorghum lines with varying LW were grown under three temperatures to expand the range of variation of both LW and gas exchange rates. Leaf gas exchange, surface morphology and cross-sectional anatomy were measured and analysed using structural equations modelling. Narrower leaves had lower stomatal conductance (g s ) and higher iWUE across growth temperatures. They also had smaller intercellular airspaces, stomatal size, percentage of open stomatal aperture relative to maximum, hydraulic pathway, mesophyll thickness, and leaf mass per area. Structural modelling revealed a developmental association among leaf anatomical traits that underpinned g s variation in sorghum. Growing temperature and LW both impacted leaf gas exchange rates, but only LW directly impacted leaf anatomy. Wider leaves may be more productive under well-watered conditions, but consume more water for growth and development, which is detrimental under water stress., (© 2023 John Wiley & Sons Ltd.)

Elevated [CO2] (eCO2) and water stress reduce leaf stomatal conductance (gs), which may affect leaf thermoregulation during heat waves (heat stress). Two sorghum lines, with different leaf width were grown in a glasshouse at a mean day temperature of 30 °C, under different [CO2] and watering levels, and subjected to heat stress (43 °C) for 6 d at the start of the reproductive stage. We measured leaf photosynthetic and stomatal responses to light transients before harvesting the plants. Photosynthesis at growth conditions (Agrowth) and biomass accumulation were enhanced by eCO2 under control conditions. Heat stress increased gs, especially in wider leaves, and reduced the time constant of stomatal opening (kopen) at ambient [CO2] but not eCO2. However, heat stress reduced photosynthesis under water stress and eCO2 due to increased leaf temperature and reduced evaporative cooling. eCO2 prevented the reduction of biomass under both water and heat stress, possibly due to improved plant and soil water status as a result of reduced gs. Our results suggest that the response of the C4 crop sorghum to future climate conditions depends on the trade-off between low gs needed for high water use efficiency and drought tolerance, and the high gs needed for improved thermoregulation and heat tolerance under an eCO2 future., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Society for Experimental Biology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

The Daily Living Questionnaire (DLQ) constitutes one of a number of functional cognitive measures, commonly employed in a range of medical and rehabilitation settings. One of the drawbacks of the DLQ is its length which poses an obstacle to conducting efficient and widespread screening of the public and which incurs inaccuracies due to the length and fatigue of the subjects., Objective: This study aims to use Machine Learning (ML) to modify and abridge the DLQ without compromising its fidelity and accuracy., Method: Participants were interviewed in two separate research studies conducted in the United States of America and Israel, and one unified file was created for ML analysis. An ML-based Computerized Adaptive Testing (ML-CAT) algorithm was applied to the DLQ database to create an adaptive testing instrument-with a shortened test form adapted to individual test scores., Results: The ML-CAT approach was shown to reduce the number of tests required on average by 25% per individual when predicting each of the seven DLQ output scores independently and reduce by over 50% when predicting all seven scores concurrently using a single model. These results maintained an accuracy of 95% (5% error) across subject scores. The study pinpoints which DLQ items are more informative in predicting DLQ scores., Conclusions: Applying the ML-CAT model can thus serve to modify, refine and even abridge the current DLQ, thereby enabling wider community screening while also enhancing clinical and research utility., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Competing Interests: None declared.

Introduction: The growing demand for Hematology and Oncology services has greatly piqued the interest of potential residents towards this specialty. Since the programs' official websites are now becoming the primary source of information that potential residents turn to, we aimed to analyze program websites' content and availability across parameters that have been used by evaluators of websites., Methods: & Materials: A list of 181 fellowship programs were identified using The Fellowship and Residency Electronic and Interactive Database (FRIEDA). 160/181 were accessed via a hyperlink or Google search. Content of these websites was evaluated on a 40-point criteria system in 10 distinct domains. Websites without accessible links were excluded from the search., Results: The 160 programs were divided based on the region with the North-East having the most programs (32.5%) and the West having the least programs (12.4%). Exactly 3/4th of the websites had been updated with the latest available information. "Program overview" (89%) was the most common domain present on the websites while "Alumni" was the least common, present on only (25%) of the websites., Conclusion: When compared with previous similar research, there have been a few significant improvements across the programs' websites, however many still lack important information regarding certain domains. The content and availability of the program's website can encourage or deter an applicant, in their decision to apply to the program, hence making it necessary for programs to augment their websites., Competing Interests: None to Report., (© 2022 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.)

Child malnourishment is a long-lasting concern that Afghanistan has been facing for many years now. This major factor amongst countless others like growing socioeconomic disparity, ineffective healthcare due to lack of funding and political instability has caused increase in nutritional instability through Afghanistan. This has increased the likelihood of numerous malnourished children contracting deadly infectious diseases like measles. Despite receiving nutritional aid, vaccines (reduce measles spread) and funding from international organizations much of these efforts have fell short due to the political instability and lack of sustained support. Emergence of COVID-19 has further intensified the already existing challenges faced by vulnerable Afghan children. The pandemic has impeded with the eradication of measles and vaccine coverage as much of the funding and attention has shifted to containing COVID-19 spread posing a greater threat for malnourished children. The combined effect of both infections has exacerbated and increased mortality in malnourished children as rate of measle spread increases. Afghan healthcare systems are now struggling more as much of their efforts are ineffectual due to lack of facilities and resources., Competing Interests: None declared., (© 2022 The Author(s).)

Sindh Health Authorities have declared a new outbreak of cholera in Karachi, Pakistan after 129 lab-confirmed cases were reported from the Central, East, and South districts. With COVID-19 already having wreaked havoc on the country's health condition in the past years, any neglect in early preventative measures against this cholera outbreak implies progression to a perilous situation with millions of individuals at stake of acquiring the disease. Factors contributing to the occurrence of cholera outbreak include poor hygiene practices, overpopulation, increasing poverty and climate change. Appropriate responsive approaches by health authorities in cooperation with the World Health Organization (WHO) must be implemented to address the situation accordingly., Competing Interests: None., (© 2022 The Authors.)

Despite its importance for crop water use and productivity, especially in drought-affected environments, the underlying mechanisms of variation in intrinsic water-use efficiency (iWUE = net photosynthesis/stomatal conductance for water vapour, g sw ) are not well understood, especially in C 4 plants. Recently, we discovered that leaf width (LW) correlated negatively with iWUE and positively with g sw across several C 4 grasses. Here, we confirmed these relationships within 48 field-grown genotypes differing in LW in Sorghum bicolor, a C 4 crop adapted to dry and hot conditions. We measured leaf gas exchange and modelled leaf energy balance three times a day, alongside anatomical traits as potential predictors of iWUE. LW correlated negatively with iWUE and stomatal density, but positively with g sw , interveinal distance of longitudinal veins, and the percentage of stomatal aperture relative to maximum. Energy balance modelling showed that wider leaves needed to open their stomata more to generate a more negative leaf-to-air temperature difference, especially at midday when air temperatures exceeded 40°C. These results highlight the important role that LW plays in shaping iWUE through coordination of vein and stomatal traits and by affecting stomatal aperture. Therefore, LW could be used as a predictor of higher iWUE among sorghum genotypes., (© 2021 John Wiley & Sons Ltd.)

Background: Self-sucking is an abnormal behavior lead to important economic losses for dairy farms. The objective of this study was to evaluate tongue piercing as a novel technique to prevent self-sucking in cattle and buffaloes. The study was carried out on 26 cows and 4 buffaloes suffered from self-sucking. Tongue piercing was achieved by the application of an implant in the midline of the tongue and anterior to the frenulum linguae. With a follow up period of 6 months., Results: This implant produced mechanical disruption of the affected animals ability to curl their tongues, in a U- shape manner, subsequently it was impossible for these animals to cup their tongues and suck its own teats. Slight swelling around the piercing site of the tongue was observed among all animals on the first 3 days after surgery. No other complications have been reported., Conclusion: Tongue piercing is an effective, rapid, easy, minimally invasive technique to prevent self-sucking among cattle and buffaloes, moreover, the technique was more widely acceptable by the owners than other traditional and surgical methods., (© 2022. The Author(s).)

Isolation of DNA is one of the important processes for biotechnological applications such as investigation of DNA structures and functions, recombinant DNA preparations, identification of genetic factors and diagnosis and treatment of genetic disorders. The aim of this study was to synthesis and characterizes the galactoacrylate based nanopolymers with high surface area and to investigate the usability of these synthesized nanopolymers for DNA isolation studies. Nanopolymers were synthesized by the surfactant free emulsion polymerization technique by using the monomers of 2-hydroxyl ethylmethacrylate and 6-O-(2 ' -hydroxy-3 ' -acryloyloxypropyl)-1,2:3,4-di-O-isopropylidene-α-D-galactopyranose. Galactoacrylate origin of these newly synthesized nanopolymers increased the interaction between DNA and nanopolymers. Prepared nanopolymers were characterized by SEM, FT-IR and ZETA sizer analysis. Synthesized nanopolymers were spherical, and their average particle size was about 246.8 nm. Adsorption of DNA onto galactoacrylate based nanopolymers was investigated by using different pHs, temperatures, ionic strength, DNA concentrations and desorption studies and maximum DNA adsorption was found to be as 567.12 mg/g polymer at 25 °C, in pH 5.0 acetate buffer. Reusability was investigated for 5 successive reuse and DNA adsorption capacity decreased only about 10% at the end of the 5th reuse.

A series of chiral Schiff base ligands has been prepared using aminochloralose derivatives of glucose and galactose. These ligands were used as catalysts in the asymmetric Henry reaction in the presence of Cu(II) ions giving yields of up to 95%. An interesting solvent dependency on enantiomeric control was observed with the best enantiomeric excesses (up to 91%) being obtained in the presence of water., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

The objective of this study was to assess the frequency of blood culture (BC) collection among neonates who received vancomycin. Demographic, clinical, microbiologic, and pharmacy data were collected for 1275 neonates (postnatal age 0-27 days) who received vancomycin at an Intermountain Healthcare facility between 1/2006 and 9/2011. Neonates treated with vancomycin had a BC collected 94 % (n = 1198) of the time, of which 37 % (n = 448) grew one or more bacterial organisms (BC positive). Of these, 1 % (n = 5) grew methicillin-resistant Staphylococcus aureus (MRSA), 71 % (n = 320) grew coagulase-negative Staphylococci (CoNS), 9 % (n = 40) grew methicillin-sensitive Staphylococcus aureus (MSSA), and 22 % (n = 97) grew other bacterial species (total exceeds 100 % due to co-detection). In patients with negative BC or no BC, vancomycin therapy was extended beyond 72 h 52 % of the time. The median duration of vancomycin therapy for patients with a negative BC was 4 (IQR: 2-10) days. BCs were frequently obtained among neonates who received vancomycin. Vancomycin therapy beyond the conventional 'empiric' treatment window of 48-72 h was common without isolation of resistant gram-positive bacteria.

Background: Animal studies have shown that nicotine affects the peristalsis of the ureter. The aim of the study is to analyze the effect of smoking on spontaneous passage of distal ureteral stones., Methods: 88 patients in whom distal ureteral stone below 10 mm diameter diagnosed with helical computerized tomography enhanced images were reviewed. Patients were grouped as either smokers (n:33) or non smokers (n:50). Follow-up for spontaneous passage of stones was limited with 4 weeks. Patients did not receive any additional medical treatment other than non-steroid anti inflammatory drugs only during painful renal colic episodes.Two groups were compared with the chi-square test in terms of passing the stone or not. Stone passage was confirmed with either the patient collecting the stone during urination or by helical CT., Results: Smoking habits was present in 30(34%) patients and the frequency in both groups were similar (smokers: 23(76%) vs non-smokers: 46(79%)). Spontaneous passage of the stone was observed in 69(78%) patients. The two groups were comparable in terms of patient age, male to female ratio and stone size. Stone passage decreased as stone diameter increased. Total stone passage rates were similar in both groups (smokers: 76% vs. non-smokers: 79%) (p > 0.05). Passage of stones > 4 mm was observed in 46% and 67% of smokers and non-smokers respectively. However passage of stones with a diameter ≤ 4 mm were similar in both groups (smokers: 100% vs non-smokers: 92%) (p > 0.05)., Conclusion: Smoking has neither a favorable nor un-favorable effect on spontaneous passage of distal ureteral stones. However, spontaneous passage rates in patients with a stone diameter > 4 mm was lower in smokers. These results should be further confirmed with studies including larger numbers of patients.

Evolution of the synthetic strategy that culminated in the first total syntheses of the structurally unique plectosphaeroic acids B (2) and C (3) is described. The successful enantioselective route to (+)-2 and (+)-3 proceeds in 6 and 11 steps from the known hexahydro-2H-pyrazinopyrrolo[2,3-b]indole-1,4-dione 39, which in turn is available in enantiomerically pure form by chemical synthesis. The central challenge in this synthesis endeavor was uniting the hexahydro-2H-pyrazinopyrrolo[2,3-b]indole-1,4-dione and cinnabarinic acid fragments of these marine alkaloids. Critical for achieving this successful C-N bond formation was the use of an iodocinnabarinic acid diester in which the amino group was masked with two Boc substituents, a Cu(I) carboxylate complex and the weak base KOAc. The highly congested C-N bond generated in this coupling, in conjunction with the delicate nature of the densely functionalized coupling partners, provided a striking testament to the power of modern copper-mediated amination methods. Two approaches, one stereoselective, for introducing the methylthio substituents of (+)-plectosphaeroic acid B were developed. The epitrisulfide ring of (+)-plectosphaeroic acid C was formed by ring expansion of an epidisulfide precursor.

Objective: To evaluate the effectiveness of small group teaching (SGT) in improving the undergraduate medical students` knowledge and skills., Methods: This study took place at the College of Medicine, Taibah University, Madina, Kingdom of Saudi Arabia between September 2011 and September 2012. Small group teaching was applied by the surgery department. In this prospective study, fifth year students were divided into groups of 8 students, and teaching strategies of SGT were applied. The marks in the clinical examinations of long case and objective structured clinical examination (OSCE) of the students with a traditional teaching cohort of 2010-2011 were compared to a SGT cohort of 2011-2012. Data were analyzed by comparing the means, standard error, and standard deviation., Results: One hundred and sixty-four students were incorporated, 82 students for each year (41 males and 41 females) in each group. The analysis showed a statistical significant difference in marks obtained by male and female students of both cohorts (p=0.000). In the 2011-2012 group, male students` mean score was 43.1+/-2.99 which was higher than the 2010-2011 male students` (mean+/-SD: 38.7+/-2.81; p=0.000). Similarly, the 2011-2012 female students attained a higher mean score than those in the 2010-2011 (39.8+/-4.0 and 35.6+/-3.88) (p=0.000)., Conclusion: Small group teaching is a valuable strategy in enhancing students` performance in the clinical settings. Small group teaching can be applied to other clinical disciplines of the medical curriculum for production of safe and clinically competent graduates.

A usable medical information system should allow for reliable and accurate interaction between users and the system in emergencies. A participatory design approach was used to develop a medical information system in two Turkish hospitals. The process consisted of task and user analysis, an icon design survey, initial icon design, final icon design and evaluation, and installation of the iconic medical information system with the icons. We observed work sites to note working processes and tasks related to the information system and interviewed medical personnel. Emergency personnel then participated in the design process to develop a usable graphical user interface, by drawing icon sketches for 23 selected tasks. Similar sketches were requested for specific tasks such as family medical history, contact information, translation, addiction, required inspections, requests and applications, and nurse observations. The sketches were analyzed and redesigned into computer icons by professional designers and the research team. A second group of physicians and nurses then tested the understandability of the icons. The user interface layout was examined and evaluated by system users, followed by the system's installation. Medical personnel reported the participatory design process was interesting and believed the resulting designs would be more familiar and friendlier., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Introduction: The aim of the present study is to determine the preoperative and operative factors associated with bleeding in percutaneous nephrolithotomy (PNL) operations where tract dilatation was formed by balloon dilators., Material and Methods: A total of 378 patients underwent PNL in our department between 2003 and 2008. After excluding missing data 310 patients were included in the study in whom nephrostomy tract dilatation was performed using balloon dilators. The amount of blood loss was estimated by calculating the change in hemoglobin (Hgb). Preoperative and operative factors were assessed for association with the change in Hgb levels. The preoperative factors were age, sex, hypertension, diabetes mellitus (DM), smoking, ipsilateral pyelonephritis, body mass index, serum creatinine level, stone localization and burden, previous ipsilateral renal stone surgery and extracorporeal shock wave lithotripsy and degree of hydronephrosis. Operative factors were operation time, calyx of puncture and tract number. The possible effect of surgical experience was also taken into consideration. Univariate and stepwise multiple linear regression analysis were performed., Results: The average Hgb drop was 1.9 g/dL (range: 0.1 g/dL-8.8 g/dL). Ancillary procedures were performed due to the residual calculi in 23% of patients. The stone free rates increased from 77% to 94% after the secondary interventions. Prolonged operation time and presence of diabetes mellitus (DM) had a significant association with the decrease in Hgb levels (p < 0.05). However the remaining factors analyzed did not have any association with the change in Hgb values (p > 0.05). Previous ipsilateral open renal stone surgery was not associated with a change in Hgb levels (p > 0.05). Staghorn stones and operation expertise were the factors related with operation time (p < 0.05)., Conclusions: In patients where tract dilatation is gained by balloon dilators prolonged operation time and DM are the major risk factors related with a higher incidence of blood loss. Surgical expertise is highly related with operation time. It would be wise to operate staghorn stones when a high surgical experience is gained.

Objective: To report our experience of varied presentations and diverse histopathological spectrum of parotid gland malignancies., Methods: This retrospective analysis incorporated patients with histological evidence of malignant parotid tumors at King Khalid University Hospital, Riyadh, Saudi Arabia over a 20-year period from 1984 through 2004. The medical records of these patients were analyzed for their demographic characteristics, clinical features, operations performed, and pathological diversity., Results: Thirty-two patients comprised this study group. There is a male preponderance over females with a ratio of 2.2:1 (22 men and 10 women) and mean age of 51.8 (range 28-81 years). A painless lump was the most frequent clinical manifestation observed in 23 (71.8%) patients followed by facial nerve dysfunction in 14 (43.7%) patients. Parotidectomy was performed in 22 (68.7%) patients: 16 superficial and 6 total. A partial facial nerve sacrifice was undertaken in 14 (43.7%), and total nerve sacrifice in 9 (28.1%) patients. Four (12.5%) patients presented with cervical lymph node metastases necessitating radical neck dissection. Nine (28.1%) patients had mucoepidermoid carcinoma, 8 (25%) adenoid cystic carcinoma, 6 (18.7%) adenocarcinoma, not otherwise specified, and 2 (6.2%) were reported to have carcinoma in pleomorphic adenoma. Twenty (62.5%) specimens revealed high-grade aggressive lesions, and out of these, 19 (59.3%) patients presented with stage III/IV disease., Conclusion: Malignant parotid tumors are exceedingly rare, occurring at a relatively earlier age group with male preponderance, and invariably declare at a late clinical stage in our community. Histopathological features hallmark a locally advanced disease with an aggressive behavior.

Objective: To report the pattern, subsite distribution and histological features of colorectal cancer in a University Hospital in Riyadh., Methods: The study was carried out in King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia, where the medical records of patients diagnosed to have colorectal carcinoma were retrieved spanning a 5-year period from 1999 through 2004. The demographic data, primary location and extent of the lesion, and various pathologic characteristics were analyzed., Results: Fifty-seven patients with colorectal carcinoma were included; 45 men and 12 women, age range 21-76 years (mean 44 years). Thirty-six (63%) subjects were found to be younger than 40 years, whereas 33 (57.8%) cases had right sided and 24 (42.2%) left sided colon cancers. Eighteen (31.5%) patients presented with early (I, II) and 39 (68.5%) with late (III, IV) stage. Dukes B and C were reported in 53 (92.9%) patients and out of those, 30 cases presented with right sided colonic carcinoma., Conclusion: There is a profound rightward shift of colorectal carcinoma compounded with a rising incidence of advanced lesions in younger age group.

Objective: To ascertain whether white blood cell (WBC) count with differential analysis may predict severity of disease in acute appendicitis., Methods: We conducted this retrospective study on appendectomy patients from 1996 to 2001, at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. We reviewed patient's age, gender, duration of symptoms, temperature on admission, WBC count including differential and the histological diagnosis of the appendicular specimen. We further analyzed the data of those patients found to have acute, gangrenous and perforated appendicitis to determine the correlation between a high WBC count and a more advanced form of appendicitis., Results: Out of an aggregate of 232 patients, 162 were males and 70 females with a mean age of 23.7 years (range, 12-70 years). Mean duration of symptoms was 1.9 +/- 1.1 days, mean temperature 37.8 +/- 1.4 degrees C, with reported elevated WBC count in 167 (71.9%) and normal in 65 (28.1%) cases. Mean WBC counts in acute were 14.5 +/- 7.3 x 10(9)/L, gangrenous 17.1 +/- 3.9 x 10(9)/L and perforated appendicitis 17.9 +/- 2.1 x 10(9)/L. This reflected a persistently higher WBC count in the complex (gangrenous, perforated) appendicitis compared with acute appendicitis (p < 0.05). The differential analysis showed neutrophilia in 123 (53%) and lymphopenia in 112 (48%) cases and out of these, 116 (94%) with neutrophilia and 107 (95%) with lymphopenia were reported to have appendicitis., Conclusion: A high WBC with differential count is a reliable indicator of the severity of appendicitis and signifies a more advanced stage.

Recently, dramatic advances in research have elucidated the prognosis of gallstone disease and have permitted a more selective choice of persons for treatment based on symptom status and projected prognosis. Ultrasound- detected-incidental gallstones are infrequently clinically significant, but this finding has prompted the surgeons to have a liberal attitude towards the operative indications for cholelithiasis particularly after the advent of laparoscopy. At the same time, the management of gallstones in the diabetics still remains controversial. Early retrospective studies reported an alarmingly high incidence of gallstones in diabetics as compared with the general population and in view of profound morbidity and mortality rates observed in the diabetics, prophylactic cholecystectomy was generally recommended. However, recent evidence-based studies challenged this approach and concluded that prophylactic cholecystectomy is not justified in diabetic patients with asymptomatic gallstones. It is inferred that, as in the general population, asymptomatic cholelithiasis in diabetics should be managed expectantly and preemptive surgery should not be routinely performed. However, early laparoscopic cholecystectomy is preferred in cases of symptomatic cholelithiasis.

Objective: Bilateral breast cancer is uncommon (1-2.6% of all patients with breast carcinoma). There are conflicting reports and inadequate data regarding the incidence and survival of such patients. This study examined the frequency, mode of detection, therapeutic modalities and histological features among the 2 breasts., Methods: Medical records of patients who were treated for breast cancer were reviewed at Khartoum Teaching Hospital, Sudan during a 5-year period of 1994 to 1999. Data of patients found to have bilateral breast cancer was analyzed focusing on the demographic information, family history, menstrual status, surgical therapy, chemoradiation, staging and histopathological characteristics., Results: Of 521 patients treated for breast cancer, 90 (17.2%) were reported to have advanced breast carcinoma (stage III, IV) and 7 (1.3%) revealed bilateral cancer: 5 (0.9%) synchronous and 2 (0.4%) metachronous breast cancer. The median age was 47.3 years (range, 24-81 years). Four (57.1%) patients had positive family history for breast cancer. First breast cancer was detected by mammogram in 2 cases while second cancer was diagnosed by the same study in 5 patients. Five (71.5%) underwent mastectomy and 2(28.5%) were treated by lumpectomy and axillary dissection. Six patients presented with stage III and one with stage IV breast cancer. Invasive ductal carcinoma was reported to be the most common type found in 10 (71.5%) breasts. Grade III breast carcinoma was revealed in 9 and Grade I cancer in 3 specimens., Conclusion: Bilateral breast cancer is invariably advanced when diagnosed. Mammogram is a valuable tool in early detection. Whether synchronous or metachronous, both breasts often share the same histological type.

Objective: To present our experience of carcinoid tumors of the appendix managed at a university teaching hospital. Complex symptomatology, varied biochemical affections and different surgical therapeutic modalities are discussed., Methods: The medical records of all the patients who underwent consecutive appendectomies at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia from 1994 to 1999 were retrospectively analyzed. The data of patients identified to have histological evidence of carcinoid tumors of the appendix were further reviewed for the demographic details, indications for surgery, surgical procedure, tumor localization in the appendix and size; concomitant appendicitis and further surgical procedures were considered., Results: During the study period, 1547 appendectomies were performed and, out of these, 9 (0.6%) cases were reported to have carcinoid tumors of the appendix. There were 4 male and 5 female patients, age range 17-51 years (median 29.8 years). Seven subjects had a clinical evidence of appendicitis while 2 presented with chronic abdominal pain. There were 6 open and 3 laparoscopic appendectomies. Six carcinoid tumors were encountered at the appendiceal apex, 2 at the midportion, and one at the base with a mean diameter of 9.5 mm (range, 4-19 mm). One patient had histologically confirmed residual tumor, which necessitated a right hemicolectomy 3 weeks later. All patients remained disease-free during a mean follow up of 7 years (range, 4-10 years)., Conclusion: Carcinoid tumors of the appendix are extremely rare and invariably remain asymptomatic. Simple appendectomy offers adequate relief while the need for further extensive surgery depends on tumor characteristics and dissemination. Despite an excellent prognosis, all reported patients should be followed up with urinary 5-hydroxyindoleacetic acid and abdominal ultrasonography.

Quantitative measurements of tumor volume becomes more realistic with the use of imaging- particularly specially when the tumor have non-ellipsoidal morphology, which remains subtle, irregular and difficult to assess by visual metric and clinical examination. The quantitative measurements depend strongly on the accuracy of the segmentation technique. The validity of brain tumor segmentation methods is an important issue in medical imaging because it has a direct impact on many applications such as surgical planning and quantitative measurements of tumor volume. Our goal was to examine two popular segmentation techniques seeded region growing and active contour "snakes" to be compared against experts' manual segmentations as the gold standard. We illustrated these methods on brain tumor volume cases using MR imaging modality.

Objective: To report the incidence of cholesterolosis in the surgically removed gallbladders, its association with serum cholesterol level and to review the role of laparoscopic cholecystectomy in the treatment., Methods: This retrospective study included all patients who had consecutive cholecystectomies for various gallbladder disorders, performed by 2 consultants during a 5-year period from January 1997 through to December 2002, in the College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia. The clinical records of those found to have cholesterolosis on histopathological examination were reviewed, and the data were analyzed for their age, sex, fasting serum cholesterol level and the final outcome of cholecystectomy., Results: The study group was comprised of 549 patients and out of which, 74 (13.4%) had cholesterolosis of the gallbladder. There were 59 (79.9%) female and 15 (20.1%) male patients. Age ranged from 18-64-years with a mean of 35.7-years. Sixty-three (85.1%) cases were reported to have abnormally high fasting serum cholesterol levels (>=5.5 mmol/L), whereas 11 (14.9%) had normal serum cholesterol level. Cholesterolosis with coexistent gallstones was documented in 47 (63.3%) patients while 27 (36.5%) subjects showed acalculous cholesterolosis. Laparoscopic cholecystectomy was performed in 71 (95.9%) individuals, whereas 3 patients ended up with open cholecystectomy (conversion rate of 4.2%). There were no postoperative complications., Conclusion: Cholesterolosis of the gallbladder is a distinct pathologic entity and carries a positive correlation with high serum cholesterol level. Laparoscopic cholecystectomy is effective, safe and a feasible treatment modality for cholesterolosis.

Malignant duodenocolic fistulas are the most rare and evolutive complication of colonic cancer due to their rapid nutritional disturbances and difficult surgical management. This case report details a 23-year-old female who presented with diarrhea, anorexia, weight loss, anemia and abdominal pain. A series of examinations showed a transverse colon carcinoma with a malignant duodenocolic fistula and direct infiltration of the right lobe of the liver. The patient underwent extended right hemicolectomy with wide local excision of the duodenum and segmental hepatic resection. Postoperative recovery was uneventful. The analysis of other similar cases from the literature treated with this procedure or less frequently, with right hemicolectomy and pancreaticoduodenectomy, allows us to discuss the indications and results of radical surgery. Whenever feasible, resection offers the best treatment as lesser techniques such as bypass and exclusion result only in minimal palliation. The benefit of exploration should almost always be offered, even in such secondary fistulas, as a better quality of life and long term survival are realistic goals and prognostically justifiable.

1,2-O-(R)-Trichloroethylidene-beta-D-mannofuranose (1) was obtained from the reaction of D-mannose with chloral. Reaction of 1 with potassium tert-butoxide (3 Mequiv) gave the thermodynamically stable 1,2,5-O-orthodichloroacetyl-beta-D-mannofuranose as the sole product whereas 1.5 Mequiv of reagent gave the kinetically controlled 1,2,3-O-orthodichloroacetyl-beta-D-mannofuranose (10) as the main product. Orthoester 10 gave the 5,6-isopropylidene derivative, which was also obtained from the reaction of 5,6-O-isopropylidene-1,2-O-(R)-trichloroethylidene-beta-D-mannofuranose with potassium tert-butoxide (1.5 Mequiv). These novel orthoesters are expected to prove useful as protecting groups and as building blocks in the formations of new mannofuranisidic units.

Objective: To report demographic data, etiological spectrum, the varied presentation, certain vascular techniques and their outcome in patients with peripheral vascular trauma., Methods: This study included the patients who presented to the emergency room of Jinnah Hospital and Allama Iqbal Medical College Complex, Lahore, Pakistan with acute peripheral vascular injuries from May 1998 to April 2002. The Mangled Extremity Severity Score (MESS) was calculated for each individual to determine the magnitude of injury. A trauma database was devised to analyze each patient's characteristics, time since the injury, etiology of trauma, clinical presentation, associated injuries, surgical procedures performed and the result., Results: Fifty-seven individuals were managed. The male to female ratio was 49:8 with an age range of 6-69 years (mean 29.1). The time since injury ranged 3-19 hours (mean 9.3). Thirty-one (54.3%) cases sustained vascular trauma by firearm, 10 (17.5%) by blunt trauma, 7 (12.2%) stabs, 6 (10.5%) machinery work and 3 (5.2%) by crush injury. Arterial bleeding from the wound was the most frequent presentation found in 18 (31.5%) patients followed by absent distal pulses recorded in 13 (22.8%) subjects. Fifty-one (89.5%) patients presented with arterial, 6 (10.5%) venous and 9 (15.7%) of these had concomitant arterial and venous injuries. Complete vascular transaction was the most common operative finding noted in 26 (45.6%) cases followed by partial tear in 23 (40.3%) subjects. Fifteen (29.4%) common femoral, 10 (19.6%) brachial, 9 (17.6%) superficial femoral, 7 (13.7%) axillary, 5 (9.8%) popliteal and 4 (7.8%) radial arteries were traumatized. The interposition vein graft was used in 21 (41.1%) cases while primary vascular repair was carried out in 19 (37.2%) patients. Forty-five (78.9%) subjects had a functional limb after vascular reconstruction. Wound infection was recorded in 7 (12.2%) individuals. Six (10.5%) amputations were carried out, all with an average MESS of 7.8 +/- 1. 3 (p<0.05). Three patients died within 10 hours of injury due to torrential hemorrhage., Conclusion: Prompt surgical intervention, frequent use of saphenous vein graft and a low threshold for fasciotomy contributes to a successful outcome in patients with extremity vascular trauma.

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