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We conducted a prospective clinical trial of 154 patients with duodenal ulcer disease, which was divided in two different steps: healing phase and post-healing phase. In the first phase, the patients were randomly assigned to treatment with H2 blockers (Ranitidine 300 mg or Famotidine 40 mg), in a single bedtime dose. Endoscopy was performed after 4 and 12 weeks of treatment and the healing rate was 70% and 90%. There were no significant differences between the two drugs. After 12 weeks of treatment there were sixteen patients with non-healed duodenal ulcer, considered as refractory duodenal ulcer disease, in which we started therapy with a double dose of H2 receptor antagonists or sucralfate (4 gr/day). Endoscopic follow-up after 12 weeks of this regimen revealed ulcer healing in about half of them; the cummulative healing rate in 6 months was 96.4%. Persistent lesions after 6 months of follow-up were found in 5 patients. Omeprazole 40 mg, single dose, was given and all of them were healed during the first 4 weeks of treatment. In the second phase, 137 patients healed during the first 3 months of treatment, were followed for 12 months and randomized in two groups: 61, with maintenance therapy--ranitidine 150 mg or famotidine 20 mg; 76, without treatment. In the patients without maintenance therapy, the recurrence rate was significantly higher (p less than 0.55), than in the group with maintenance therapy. In this group several parameters were evaluated--clinical, biochemical and psychosocial--to try to identify some prognostic markers of healing, relapse.(ABSTRACT TRUNCATED AT 250 WORDS)

Objectives: The objective of the study was to propose and test a new grading system to quantify the clinical eruption of teeth into the oral cavity. In addition, the study also aimed to apply the grading system to a sample population to determine the chronology and sequence of permanent tooth eruptions, comparing the results with an existing standard table. Methods: A cross-sectional study was designed, and 1220 children aged 5–18 years were selected from five schools in Chennai. The clinical status of permanent tooth eruption was graded using the newly proposed system. The sequence and chronology of permanent tooth eruptions were determined using Probit analysis and compared with those established by Logan and Kronfeld. The difference in stages of eruption between the sexes was analyzed using the ANOVA test. Results: The study sample included 515 boys and 705 girls. A total of 23,218 permanent maxillary and mandibular teeth were examined and graded. Of the 11,085 maxillary teeth, 367 were classified as grade 1, 660 as grade 2, and 10,058 as grade 3. Similarly, of the 12,133 mandibular teeth, 497 were grade 1, 793 were grade 2, and 10,843 were grade 3. The eruption of the maxillary canines, second molars, and mandibular second premolars was observed to have occurred earlier than in the traditional table of tooth eruption. The most significant differences in the stages of eruption between the sexes were observed in the 9–12 age group. Conclusions: The newly proposed grading system was found to be simple, objective, less confusing, and more robust, compared with the existing systems in determining the clinical status of tooth eruptions. The ages of eruption of maxillary canines, second molars, and mandibular second premolars were earlier.

Abstract Background While osteoarthritis is a significant issue within the hemodialysis population and contributes to reduced quality of life, pain related to osteoarthritis is poorly managed by healthcare professionals (HCPs) in hemodialysis settings due to the absence of clinical guidance applicable to this population. The purpose of this study was to explore the perceptions of HCPs on the barriers and facilitators to using a clinical decision support tool for osteoarthritis pain management in the hemodialysis setting. Methods A qualitative descriptive study was conducted. Purposeful and snowball sampling techniques were used to recruit hemodialysis clinicians from academic and community settings across multiple Canadian provinces. One-to-one interviews were conducted with clinicians using a semi-structured, open ended interview guide informed by the Theoretical Domains Framework, a behavior change framework. A general inductive approach was applied to identify the main themes of barriers and facilitators. Results A total of 11 interviews were completed with 3 nephrologists, 2 nurse practitioners and 6 pharmacists. Findings revealed 6 main barriers and facilitators related to the use of the clinical decision support tool. Alignment of the tool with practice roles emerged as a key barrier and facilitator. Other barriers included challenges related to the dialysis environment, varying levels of clinician comfort with pain medications, and limited applicability of the tool due to patient factors. An important facilitator was the intrinsic motivation among clinicians to use the tool. Conclusions Most participants across the included hemodialysis settings expressed satisfaction with the clinical decision support tool and acknowledged its overall potential for improving osteoarthritis pain management among patients on hemodialysis. Future implementation of the tool may be limited by existing roles and practices at different institutions. Increased collaboration among hemodialysis and primary care teams may promote uptake of the tool.

Highly active, long-lasting, and economically feasible nonprecious metal-based electrocatalysts are urgently required for the slow hydrogen evolution reaction (HER) in alkaline conditions. Direct current (DC) electrodeposition was used to develop the highly active Ni–MoS2 composite coatings for efficient hydrogen generation. Scanning electron microscopy (SEM), Energy Dispersive X Ray Spectroscopy (EDS), X-ray diffraction (XRD), and linear sweep voltammetry (LSV) were used to evaluate the coatings. Ni–MoS2 composite coatings behaved almost identically to pure platinum metal. The Ni–MoS2 coating produced 1.0 g/l demonstrated a low overpotential for HER. The HER process's analyzed from Volmer-Tafel mechanistic route has an extremely low slope of 56.5 mV/dec. All the coated samples were subjected to chronopotentiometry (CP). This catalyst's high HER performance shows that it has significant potential for practical applications.

Introduction: Non-Communicable Diseases (NCDs) are the leading cause of morbidity and mortality globally. In India, the Ministry of Health and Family Welfare reported a rise in mortality rates from 37% in 1990 to 61% in 2016. Additionally, the prevalence of diabetes mellitus and hypertension among young adults was higher than estimated. As the behavioural risk factors are mainly established in adolescence, screening at an earlier age becomes essential. Aim: To estimate the risk for diabetes mellitus and hypertension among individuals aged 18-29 years and to assess the association between the risk factors and at-risk individuals. Materials and Methods: A community-based cross-sectional study was conducted in the field practice area of Madurai Medical College, Madurai, Tamil Nadu, India, to estimate the risk for diabetes mellitus and hypertension among individuals aged 18-29 years. The National Health Mission (NHM) protocol was used for risk assessment, based on American Diabetic Association (ADA) and Joint National Committee (JNC) 8 guidelines. Statistical analysis was carried out using Statistical Package for Social Sciences (SPSS) 20.0 software. Results: A total of 154 residents were included in the study. The mean age of the study participants was 24.64±4.70 years. Approximately 60% of the study participants were males and 40% were females. A total of 54% of the participants were married. Most subjects had completed high school (33.8%), followed by 28.6% who completed postgraduation. Disease categorisation revealed that 54 (35%) were non-diabetics, 89 (58%) were pre-diabetics, and 11 (7%) had diabetes mellitus. Similarly, 24 (16%) were non-hypertensive, 115 (75%) had high normal values, and 15 (9%) had probable stage I hypertension. A statistically significant association was observed between hypertension and educational level, alcoholism, Systolic Blood Pressure (SBP), and Diastolic Blood Pressure (DBP), whereas diabetes mellitus was not significantly associated with any variables. The probabilistic prediction for hypertension using the logistic regression model included alcoholism and SBP, which contributed to 25.6% of the variations in prediction hypertension. Conclusion: The study results highlight a significant burden of undiagnosed cases of diabetes and hypertension in the community. This indicates the need for systematic screening, early lifestyle modifications, appropriate treatment, and regular follow-up for such individuals.

The present study was carried out during 2019 to 2022 at the Floriculture Research Station (Tamil Nadu Agricultural University, Coimbatore, Tamil Nadu), Thovalai, Kanyakumari, Tamil Nadu to access the genetic variability in lotus accessions (Nelumbo nucifera) collected from 6 diverse locations. The research presents significant insights into the growth and flowering characteristics of these extraordinary aquatic plants and their adaptability to various environmental conditions. The analysis of mean performance showcases noteworthy variations in plant height, leaf dimensions, flowering time and the number of leaves, and flowers/plant across different collection sites, highlighting the profound influence of local environmental conditions on lotus growth. Lotus traits with significant genetic diversity and heritability, presenting opportunities for targeted selective breeding were identified. Principal component analysis uncovers key trait influencers, while cluster analysis categorizes accessions based on similarities, streamlining research and cultivation. Correlation and path analysis unveil relationships among lotus traits, enhancing our understanding of growth factors. D2 cluster composition reveals distinct groupings; Cluster I includes KNn1 and KNn5, Cluster II features KNn2, Cluster III comprises KNn6, Cluster IV contains KNn3, and Cluster V houses KNn4. Genetic divergence analysis identifies the number of flowers/plant as the primary driver of genetic diversity, emphasizing its importance for breeding. It underscores the need to consider both genetic and environmental factors in lotus cultivation and highlights the importance of targeted breeding efforts to unlock the full potential of lotus.

The periodic assessment of pavement condition is one of the important requirements in ensuring not only the service life of the pavement but also for the safety of motorists as pavement distresses like potholes led to many fatal accidents in recent years in India. The traditional approach of manual evaluation is a cumbersome and time-consuming process which can be replaced by latest technologies like LiDAR. Literature on use of Terrestrial LiDAR for distress detection are very limited and even the reported studies have used mostly the raw point cloud data from LiDAR for detecting only selected distresses. However, there are many outputs which can be derived from Terrestrial LiDAR data like Digital Elevation Model (DEM), Hillshade, etc. which are not explored much. Hence in the present study, an attempt has been made to utilize all the possible outputs of Terrestrial LiDAR data, i.e., raw 3D model from point cloud data and LiDAR derived DEM and Hillshade to detect 15 pavement distresses in both bituminous and concrete pavement for a case study area of Vellore in Tamilnadu, India. Their suitability also was compared in order to find which output would be more suitable in identifying a particular distress on the road. The results revealed that Hillshade maps can detect all the pavement distresses except cracks when compared to 3D model and DEM. For the detection of pavement cracks, an image processing based solution using LiDAR data was tried out and was found to perform well in detecting the alligator cracks. The distress parameters such as length, width, depth, etc. were also calculated using LiDAR data and compared with the field observations. The error was found to be only few cms and thus indicate that the Terrestrial LiDAR can be employed to detect the pavement distresses accurately than the conventional manual methods.

Objective: To identify the top five Choosing Wisely recommendations for the Trinidad and Tobago Emergency Medicine Association (TTEMA) Methods: A modified Delphi process was used. An initial list of 27 recommendations was compiled from all Choosing Wisely Emergency Medicine recommendations from existing international campaigns. This was distributed to an expert panel from the TTEMA. To generate the final list of five, each panel member voted on each recommendation based on: action-ability, effectiveness, safety, economic burden, and frequency of use. Results: The top five recommendations were: 1) Avoid instituting intravenous (IV) fluids before doing a trial of oral rehydration therapy in uncomplicated emergency department cases of mild to moderate dehydration in children; 2) Don’t order CT head scans in adult patients with simple syncope in the absence of high-risk predictors; 3) Don’t request imaging of the cervical spine in trauma patients, unless indicated by a validated clinical decision rule; 4) Don’t order CT pulmonary angiograms or VQ scans in patients with suspected pulmonary embolism until risk stratification with decision rule has been applied and when indicated, D-dimer biomarker results are obtained; and 5) Avoid coagulation studies in emergency department patients unless there is a clearly defined specific clinical indication, such as for monitoring of anticoagulants, in patients with suspected severe liver disease, coagulopathy, or in the assessment of snakebite envenomation. Conclusion: This is the first Choosing Wisely initiative in the Caribbean. Next steps include creating awareness, developing working groups for each recommendation and strategies for implementation.

Introduction Pregnancies resulting from in vitro fertilisation are associated with an increased risk of developing hypertensive disorders of pregnancy, such as preeclampsia, when compared with naturally conceived pregnancies.Objective The efficacy of aspirin prophylaxis to reduce the incidence of preeclampsia is well established in naturally conceived pregnancies identified as high risk for developing preeclampsia. However, the efficacy of aspirin to reduce the rate of preeclampsia for all pregnancies resulting from in vitro fertilisation remains uncertain, although in vitro fertilisation conception is a well-known risk factor for preeclampsia. Therefore, the purpose of this scoping review is to provide a comprehensive overview of the current literature regarding the use of low-dose aspirin to prevent hypertensive disorders of pregnancy after in vitro fertilisation.Inclusion criteria This review will identify all peer-reviewed published articles including pregnant women who underwent embryo transfer after in vitro fertilisation and were prescribed low-dose aspirin to reduce the risk of hypertensive disorders of pregnancy.Methods We have devised a comprehensive search strategy to systematically identify pertinent studies published from January 2000 until May 2024, within the Medline (PubMed interface), Embase and Scopus databases. The search strategy is based on the keywords ‘aspirin,’ ‘pregnancy-induced hypertension,’ and (‘in vitro fertilization’ OR ‘oocyte donation’ OR ‘embryo transfer’ OR ‘donor conception’). Two reviewers will independently screen the titles, abstracts and full-text articles to select the relevant articles, using the Covidence software.Ethics and dissemination No patients are involved in this study. This study aims to be published in a peer-reviewed journal and could be presented at a conference.

Background. Diabetic foot syndrome is defined as the presence of a diabetic foot ulcer (DFU) associated with neuropathy, peripheral artery disease and infection. While the use of antimicrobials in the treatment of DFU infection remains a mainstay, the choice of antimicrobial remains problematic owing to the presence of multidrug-resistant polymicrobial infections. In the South African public healthcare sector, the treatment of DFUs is based on the Standard Treatment Guidelines (STGs) and the Essential Drug List. These guidelines are developed using evidence-based medicine and are based on global susceptibility patterns rather than local susceptibility data, and may not provide the most appropriate treatment options. Objectives. To determine the antimicrobial susceptibility patterns of DFUs isolated from patients visiting selected Gauteng provincial public hospitals in order to determine a clinically effective treatment protocol for the management of these infections. Methods. Sample swabs were taken from 51 DFUs using the Levine method. Each sample swab was spread onto blood agar plates, and thereafter individual pathogens were isolated. The antimicrobial susceptibility patterns of all isolated pathogens were determined using zone of inhibition measurements. Pathogens were grouped according to macromorphological characteristics as well as susceptibility patterns, and a representative isolate from each group was then identified. Results. A total of 51 DFU ulcer swabs from 45 patients were included in the study. From the sample swabs, a total of 445 pathogens were isolated. The most effective antimicrobial was found to be gentamicin, followed by ciprofloxacin. Amoxicillin/clavulanic acid, the first-line treatment according to the STGs, was found to be ineffective for many of the isolated pathogens. The most commonly isolated pathogens were Proteus mirabilis, Enterococcus faecalis and Pseudomonas aeruginosa. Conclusion. These findings demonstrate the urgent need to reassess the STGs and base treatment plans on local epidemiological data. This study provides valuable data on common causative pathogens in DFU infections, as well as the resistance patterns of these pathogens, forming a baseline on which to base future DFU treatment plans.

Introduction: Forensic dental age estimation plays a vital role in determining the identity of a deceased individual. There are numerous dental age estimation methods available to estimate dental age using radiographs based on tooth maturation. Aim: To compare Nolla’s method, Cameriere’s Indian-specific method, and Acharya’s Indian-specific regression formula in estimating dental age in the Puducherry and Cuddalore populations of South India. Materials and Methods: This retrospective study was conducted in the Department of Oral Medicine and Radiology at the Indira Gandhi Institute of Dental Sciences, Puducherry, India, between January 2021 and October 2022. The study included 448 panoramic radiographs (202 males and 246 females) of individuals aged between six and 17 years. Chronological age was recorded based on the subject’s date of birth. Dental age was estimated using Nolla’s method, Acharya’s Indian-specific regression formula, and Cameriere’s Indian-specific method. Two qualified and experienced oral radiologists evaluated all the samples to assess their reliability. Data were analysed using descriptive statistics, the Pearson’s correlation coefficient, and Student’s t-test. Results: Nolla’s method (excluding the third molar) revealed a mean age of 13.52±3.15 years, while Nolla’s method (including the third molar) revealed a mean age of 12.81±2.84 years. Acharya’s Indian-specific method revealed a mean age of 15.08±2.92 years, and Cameriere’s Indian-specific regression formula revealed a mean age of 11.51±2.19 years. The results showed that the age estimated by Nolla’s method (including the third molar) had a p-value of 0.93 (>0.05), indicating no significant differences between the estimated dental age and chronological age. The r-values for Acharya’s Indian-specific regression formula, Nolla’s method (excluding the third molar), Nolla’s method (including the third molar), and Cameriere’s Indian-specific method were found to be 0.682, 0.885, 0.847, and 0.849, respectively, indicating a strong positive correlation among the age estimation methods. Conclusion: Nolla’s method (including the third molar) was found to be the most accurate method for dental age estimation when compared with the other three methods in the Puducherry and Cuddalore populations.

Background: Nicotine replacement therapy (NRT) and habit cessation counseling are considered the mainstay treatment for high nicotine dependence smokers. However, adherence to NRT is very poor. Among the NRTs, nicotine gums and nicotine patches are the most widely available. This study mainly evaluates the efficacy of nicotine gum and nicotine patches as NRT using salivary cotinine levels as a biochemical validation measure. Materials and Methods: A cross-sectional study was conducted on 72 known smokers who were willing to receive nicotine replacement therapy for cessation of smoking habits. The sample was divided into two groups: Group 1 tobacco smokers were offered nicotine chewing gum, and group 2 tobacco smokers were offered nicotine patches. Both groups received treatment for 12 weeks. At baseline and at the end of the trial period, the saliva samples were analyzed for cotinine levels using an enzyme-linked immunosorbent assay (ELISA). The severity of smoking was assessed using the Fagerstrom Test for Nicotine Dependence (FTND). Results: The quit rate was higher in the nicotine patch group compared with the nicotine gum group. On comparison of week one vs week twelve in the nicotine group nicotine gum group showed (CI: 18.10 to 13.83) and in the patch group (CI: 7.754 to 6.56) with P < 0.001. The pre- and post-cotinine estimation was significantly reduced for nicotine patches compared with nicotine gums, and patient compliance also yielded better results for nicotine patches. Conclusion: This study depicts that nicotine patches were better adhered to in comparison with nicotine gums, and salivary cotinine level is an effective biochemical validation measure.

Understanding the nature of linkage disequilibrium (LD) between molecular markers reflects the degree of non-random association between their alleles, which is essential for genome-wide association studies. The main objective of this study was to assess the chromosome-wise linkage disequilibrium and haplotype block structure in indigenous cattle breeds of Tamil Nadu, India. A total of 79 animals belonging to five indigenous cattle breeds were considered as single indigenous cattle population and three samples per breed were sequenced using Illumina NovaSeqTM 6000 and Illumina HiSeq 2500. The LD parameter (r2) was estimated for a total of 62,095,778 pair- wise SNPs for all autosomes. The chromosome-wise number of SNP pairs, mean r2±standard deviation and median r2 values were 2,141,234, 0.484±0.246 and 0.493, respectively. Chromosome-wise mean r2 of different distance bins were calculated and it showed the maximum r2 value of 0.839 at 31-70 kb distance for Chromosome 11 and minimum r2 value of zero for Chromosome 7, 11, 15, 20 and 29, respectively at a distance 71-100 kb. This study also revealed a total of 413, 277 haplotype blocks which covered 2.34% of the autosomal genome. There was a total of 1,589,118 SNPs distributed within the haplotype blocks, covering a total length of 53.62 mb. The results of the study suggest the need for breed-specific reference populations for indigenous cattle breeds, which have a greater density of molecular markers of economic significance and thereby to identify breed-specific haplotypes in future.

In this paper we define Nano soft(NS) s(I) semi open(SO) sets and NS s(I) semi closed(SC) sets in nano soft ideal topological space. Further in nano soft ideal topological space, we define NS s(I) semiinterior and NS s(I) semi-closure. Additionally, we go through the characteristics and features of NS s(I) SO sets.

This research paper presents the framework for a research study that aims to define and evaluate the design requirements and the related feasibility of a controlled environment agriculture (CEA) system concept within a maximum-security prison in Australia. A co-design methodology will guide the study so that the views of a broad range of stakeholders can contribute to the conceptualization of a CEA farm system that is appropriately suited to correctional settings. The unique aspect of this research lies in the application of a bottom-up consultative process involving both prison administrators and inmates. Stakeholders will initially be asked to consider what CEA typology would be most suitable for a prison environment and then use this as a basis for developing a more extensive system design. As open-field agriculture represents a lower-cost alternative to CEA, this will also be considered to complement CEA. The co-design sessions will run in tandem with current growth trials of lettuce within the prison environment using different growing environments. The research is aimed at assisting to reduce the impacts of climate change, by growing produce locally. Growing produce within the prison walls reduces food miles and improves the nutritional quality of produce, which benefits longer-term inmate health. Growth trials that complement the co-design study are aimed at evaluating the ease of use for each of type growing environment. This research contributes significant new knowledge for the application of co-design in prisons, aimed at developing implementation guidelines for a CEA ecosystem that would supply fresh vegetables to pre-cooked inmate meals. The researcher has a unique perspective as an inmate. Outside community groups wishing to try CEA may also benefit from this study.

The soundscape of critical habitat for southern resident killer whale (SRKW) Orcinus orca in the Salish Sea, the waters around southern British Columbia, Canada, and northern Washington State, USA, is shaped by wind and wave noise as well as heavy commercial and recreational vessel traffic loads. First, we used recordings from 6 passive acoustic moorings to characterize the acoustic landscape experienced by SRKW in this region, focusing on the frequencies used for communication and echolocation. Mid-frequency wind noise was prevalent in winter sound fields, whereas higher-frequency noise levels associated with increased numbers of recreational vessels increased during summer. Commercial vessel presence was consistent, with acoustic inputs prevalent in the western part of the study area. The potential implications of these additions on SRKW acoustics use were then explored for the frequency band 1-40 kHz to represent communication calls and at 50 kHz to consider echolocation. The inputs of wind were extrapolated from modelled hourly wind speed measures and commercial shipping noise. The noise impact was expressed as a proportional reduction of communication and echolocation extent compared to maximum acoustic ranges at ‘minimum ambient’ levels, void of vessel and abiotic noise. The reductions calculated were substantial, with the presence and impact of vessel noise greater than wind-derived additions and the greatest impacts around shipping lanes. Impacts were found for SRKW foraging areas, with implications for group cohesion and feeding success. This interpretation of the influence of natural and vessel noise more clearly demonstrates the potential implications of altered soundscapes for SRKW.

Objective: To determine how biochanin-A (BCA) affects high-fat diet and streptozotocin-induced pathological changes in lipid metabolism and antioxidant status in diabetic rats. Methods: Diabetic rats were orally administered BCA (10 mg/kg body weight) for 30 days to investigate its effects on lipid profiles and oxidative stress markers in the liver and kidney. In addition, the mRNA expression of antioxidant and lipid metabolism enzymes in the liver was examined. Results: BCA attenuated hyperlipidemia by regulating mRNA expressions of HMG-CoA reductase, fatty acid synthase, carnitine palmitoyl transferase, and acetyl-CoA carboxylase. Additionally, BCA reduced high-fat diet and streptozotocin-induced oxidative stress by suppressing lipid peroxidation, improving superoxide dismutase, catalase, and glutathione peroxidase levels, and upregulating mRNA expressions of these enzymes. Conclusions: BCA may be a promising nutraceutical for the treatment of dyslipidemia and oxidative stress associated with diabetes.

The thermal efficiency of the nanofluid flow along the 180-elbow pipe is investigated under effects of double source of non-uniform magnetic field. To model the nanofluid stream with double magnetic sources, computational fluid dynamic is used. Effects of magnetic intensities and velocity of nanofluid on the hydrodynamic of the chosen model is also investigated in this research. The results of simulation indicate that the vortices are generated near the magnetic field and these vortices extend the thermal layer into the main stream and consequently, thermal efficiency of nanofluid stream is enhanced in 180-degree elbow. The results of various magnetic intensities also show that the increasing the magnetic intensities changes the location of maximum heat transfer from 1st magnetic source to 2nd one.

Introduction: Thyroidectomy is a commonly performed surgical procedure, especially in areas with a high prevalence of thyroid disorders. Accurate estimation of thyroid volume is crucial for evaluating and managing these conditions, as thyroidectomy in patients with enlarged thyroids can lead to specific concerns regarding optimal preoperative, intraoperative, and postoperative care. Aim: To assess the relationship between thyroid volume and thyroidectomy complications, specifically Vocal Cord Paralysis (VCP) and hypocalcaemia, using preoperative ultrasound and ellipsoid volumetric analysis. Materials and Methods: A prospective cohort study in the General Surgery ward at a Government Medical College, Kottayam, Kerala, India. A total of 70 patients (64 females and six males) with benign thyroid swelling underwent total Thyroidectomy between June 2020 and December 2020. Follow-up was conducted for one year until December 2021. Thyroid gland volume was assessed using ultrasound and calculated using the ellipsoid formula. Based on volume, patients were classified into two groups: 1) 50 mL (moderate to severe enlargement). Preoperative examination of vocal cords was performed by the Department of Otorhinolaryngology. Serum calcium levels were measured 48 hours postoperatively, or earlier if symptomatic. Hypocalcaemia was defined as corrected calcium 50 mL was 26.9 mL and 103.2 mL, respectively. Temporary hypocalcaemia (resolving within six months) was significantly higher in patients with volumes

Background. Longitudinal integrated clerkships (LICs) are increasingly being implemented across the globe for their educational benefits and the recruitment of rural medical practitioners. As new LICs are established, it is important to explore the extent to which these benefits manifest, and the influence of LICs on the career journeys of graduates. Stellenbosch University’s LIC has been running for 11 years, and to date the career outcomes of graduates have not been described. Objectives. To explore factors that influence the career journeys of graduates from Stellenbosch University’s LIC. Methods. An interpretivist, qualitative study was performed. Semi-structured interviews that were recorded and transcribed were conducted (8 graduates, ≥5 years after graduation). Inductive thematic analysis was done. Participants were asked to depict their career journeys. These pictures and an interview guide were used as prompts during the interviews. Results. Three themes were generated from the data: (i) feeling prepared for the career journey; (ii) acquiring a new motivation and career goals; and (iii) unexpected influences on career journeys. The availability of posts and transformative influences are important factors in the career journeys of LIC graduates. These graduates were enabled by their undergraduate training to explore non-traditional career options and preferred working in rural environments. Although individual priorities caused many participants to work in urban settings, they indicated a desire to return to rural environments. Conclusions. The LIC training at Stellenbosch University acts as a significant influence on the early career journeys of such graduates, which are possibly achieved in two ways. Firstly, LIC supports the development of professional identities among its graduates. Secondly, LIC supports transformative learning within a safe learning environment that leads to changes in perspectives regarding the graduates’ responsibility towards patients and communities.

Introduction: The brachial artery runs at lower border of the teres major muscle as a continuation of the third part of the axillary artery. It divided into radial and ulnar arteries at the neck of the radius. For surgeons performing operations on the upper extremity, clinical knowledge of the morphology of brachial arteries in the upper limb is important. This study aims to study the course, branching pattern, and termination of the brachial artery in human cadavers. Methods: In this study, 30 upper limb specimens were collected from adult human embalmed cadavers used for undergraduate dissection at the Institute of Anatomy, Madras Medical College in Chennai, India. Results: Of 30 dissected specimens, 29(96.7%) had normal brachial artery course and one had superficial brachial artery (3.3%). The brachial artery division was seen in 28 specimens (93.3%) below the intercondylar line (at the neck of the radius). In 2 cases (6.7%), the brachial artery division into radial and ulnar arteries occurred above the intercondylar line. Conclusion: The variations in origin, course, branching pattern, and termination of the upper limb’s brachial artery are important both structurally and therapeutically. Surgeons, physicians, radiologists, and cardiologists should pay attention to these variations. Due to the use of modern surgical techniques in vascular surgery, plastic and reconstructive surgeries, diagnostic & therapeutic tests, these variances have attracted the attention of surgeons, physicians, radiologists, and interventionists.

Rare blood group detection is important as the incidence of these blood groups is very low. These rare blood groups need a transfusion of blood from the same group of people; sometimes, it is not available in blood banks. It is important to detect them in the field of transfusion medicine so that the right transfusion at the right time and for the right patient is ensured. We had one patient who was identified as blood group O in a private laboratory and the patient came to our hospital for anemia during the second trimester of pregnancy whose forward grouping showed no agglutination in the anti-a and anti-b and also no agglutination in the anti-H so we thought it to be Bombay blood group. We performed the reverse grouping and we found agglutination with pooled A cells and pooled B cells but no agglutination in the pooled O cells. We found forward and reverse grouping were discordant so we concluded that the patient had Bombay variant blood group, the secretor status of the patient was done in saliva using hemagglutination inhibition test and we found that the patient had secretion of H substance in the saliva. Rh typing: it was found that the patient had positive in Rh typing. Family members were screened and they all were O positive. Forward and reverse grouping along with the secretor status detection helped to detect the case. This case report highlights the importance of blood grouping forward and reverse and also using Anti-H reagent for blood grouping and also the use of secretor status in the detection of proper blood grouping of the patient.

Weather extremes can drive substantial crop losses. Farm-level management strategies play a critical role in mitigating the impacts of and consequences for farmer livelihoods and food security. While the impacts of extreme weather on crop yields are well documented in recent studies, these predominantly focused on expansive geographical scales and commonly overlooked the critical role of management practices in modulating the dynamics of weather-crop sensitivities. We fill this gap in the literature by using a unique dataset that explores the timely relationship between extreme weather and crop yields at farm level in the Netherlands. We cover 10 types of crops and elucidate the role of soil types, irrigation and nutrient application in modulating the relationship between extreme weather and crops, by estimating fixed-effects regression models. We show substantial impacts from drought during the growing- and harvesting period and excessive precipitation during the planting- and growing period. Severe droughts show significant ( $p\unicode{x2A7D}0.05$ ) reductions in yield for all crops, and lead to yield reductions up to 24 percent relative to average yields during the growing period. Meanwhile, eight crops show significant reductions in yield due to severe water excess during the planting period, with yield reductions up to 18 percent. Soils such as sand or loess amplify the negative impact of drought on crop yield, while softening the impact of excessive precipitation. Irrigation and to a lesser extent nutrient application are shown to moderately decrease the impact of extreme weather on crop yield. Our findings contribute valuable insights to guide local adaptation priorities which are critical given the projected increase in the intensity and frequency of extreme weather under climate change.

A surge in oxidative stress and weakened antioxidant defense contributes to the initiation and progression of Coronary Artery Diseases (CAD). The resultant burst in free radicals causes oxidation of lipoproteins mainly oxidized low-density lipoprotein (oxLDL). Further studies need to be conducted to find whether the management of CAD can be evaluated within the context of oxidant/antioxidant balance with the contribution of newer markers. This study was performed to evaluate, compare, and correlate oxidative stress parameters and antioxidant status in CAD patients with controls and evaluate and compare pro-oxidant, a pro-inflammatory enzyme, myeloperoxidase (MPO) and anti-oxidant, anti-inflammatory enzyme, and paraoxonase (PON) between CAD patients and controls. OxLDL, an oxidation product of low-density lipoprotein, malondialdehyde (MDA), an oxidative marker, and reduced glutathione (GSH), an anti-oxidant marker, and lipid profile were assessed and compared in CAD patients and controls. The activity of MPO was correlated with that of PON, and MDA level was correlated with GSH level. A total of 100 clinically proven CAD patients, in the age range of 35-70 years, were selected from the Out Patient Department (OPD) of our Institute. A total of 60 controls in the same age range and without CAD were selected after undergoing health checkups in the hospital. Based on the obtained results, oxLDL, MDA, and MPO were significantly increased in patients than in controls (P

Image Processing Techniques (IPTs) are widely used in healthcare. IPTs work on images to extract useful information from them. IPTs are effective in the early diagnosis of cancers which helps in their proper treatment. The number of human beings affected by cancer has drastically increased recently and more in women in the form of Breast Cancers (BCs). This work is on detecting BCs from image datasets using IPTs. This work proposes the use of Weiner Filters (WFs) in Preprocessing BC image data. WFs are applied to images as they can improve the quality of images. Image segmentations are executed using the Watershed Algorithm which detects Regions of Interest (ROIs) in images. Feature Extractions are done using the statistical method Gray Level Co-occurrence Matrix (GLCM). These extracted features are then selected using Black Widow Optimization (BWO) Algorithm. The selected features are then trained by Fuzzy Neural Networks (FNNs) which classify BC cases. The results of the classifier when evaluated were found to have a better performance on medical images in terms of Accuracy.

Abstract Background and Aim: This study aimed to assess the bone thickness at the interradicular spaces in the anterior mandible on cone-beam computed tomography (CBCT) scans of patients to find appropriate sites for mini-implant and miniscrew placement. Materials and Methods: This analytical cross-sectional study was conducted on 161 CBCT scans of patients (98 females and 63 males) between 18 to 50 years old presenting to the School of Dentistry of Islamic Azad University in 2020. Cross-sectional images with 1 mm slice thickness were evaluated to measure the bone thickness at the interradicular areas at 3, 6, 9, 12, 15, and 18 mm distance from the mandibular alveolar crest. The measurements made from the distal surface of right canine to the distal surface of left canine teeth were recorded. The CBCT scans had been taken by Rotograph Evo 3D CBCT scanner, and were analyzed by OnDemand3D software. Data were statistically analyzed by t-test. Results: Bone thickness at 11 sites in the anterior mandible was significantly higher in males (P

Objective Patients with cancer are at increased bleeding risk, and anticoagulants increase this risk even more. Yet, validated bleeding risk models for prediction of bleeding risk in patients with cancer are lacking. The aim of this study is to predict bleeding risk in anticoagulated patients with cancer.Methods We performed a study using the routine healthcare database of the Julius General Practitioners’ Network. Five bleeding risk models were selected for external validation. Patients with a new cancer episode during anticoagulant treatment or those initiating anticoagulation during active cancer were included. The outcome was the composite of major bleeding and clinically relevant non-major (CRNM) bleeding. Next, we internally validated an updated bleeding risk model accounting for the competing risk of death.Results The validation cohort consisted of 1304 patients with cancer, mean age 74.0±10.9 years, 52.2% males. In total 215 (16.5%) patients developed a first major or CRNM bleeding during a mean follow-up of 1.5 years (incidence rate; 11.0 per 100 person-years (95% CI 9.6 to 12.5)). The c-statistics of all selected bleeding risk models were low, around 0.56. Internal validation of an updated model accounting for death as competing risk showed a slightly improved c-statistic of 0.61 (95% CI 0.54 to 0.70). On updating, only age and a history of bleeding appeared to contribute to the prediction of bleeding risk.Conclusions Existing bleeding risk models cannot accurately differentiate bleeding risk between patients. Future studies may use our updated model as a starting point for further development of bleeding risk models in patients with cancer.

Purpose The Renal cell cancer: Lifestyle, prognosis and quality of life (ReLife) study is set up to obtain insight into the association of patient and tumour characteristics, lifestyle habits and circulating biomarkers with body composition features in patients with localised renal cell cancer (RCC). Further, it aims to assess the association of body composition features, lifestyle habits and circulating biomarkers with clinical outcomes, including health-related quality of life.Participants The ReLife study is a multicentre prospective cohort study involving 368 patients with newly diagnosed stages I–III RCC recruited from January 2018 to June 2021 from 18 hospitals in the Netherlands. At 3 months, 1 year and 2 years after treatment, participants fill out a general questionnaire and questionnaires about their lifestyle habits (eg, diet, physical activity, smoking and alcohol consumption), medical history and health-related quality of life. At all three time points, patients wear an accelerometer and have blood samples taken. CT scans for body composition analysis are being collected. Permission is asked for collection of tumour samples. Information about disease characteristics, treatment of the primary tumour and clinical outcomes is being collected from medical records by the Netherlands Cancer Registry.Findings to date A total of 836 invited patients were eligible and 368 patients were willing to participate and were included (response rate 44%). The mean age of patients was 62.5±9.0 years and 70% was male. The majority had stage I (65%) disease and were treated with radical nephrectomy (57%). Data collection at 3 months and 1 years after treatment have been finalised.Future plans Data collection at 2 years after treatment is expected to be finalised in June 2023 and longitudinal clinical data will continue to be collected. Results of studies based on this cohort are important to develop personalised evidence-based lifestyle advice for patients with localised RCC to enable them to get more control over their disease course.

Introduction: Determination of age and gender using bones of skull is central aspect of forensic odontology. Maxillary sinuses in this regard have shown high accuracy in predicting gender. Aim: To identify gender using the volumetric and linear measurements of maxillary sinuses obtained from a Cone Beam Computed Tomography (CBCT) by using Artificial Neural Network (ANN) based tool. Materials and Methods: A retrospective study was conducted on 80 volumes of CBCT (derived from n=80 patients) with equal gender distribution. The CBCT images were analysed for eight linear and two volumetric measurements namely the maxillary sinus height, maxillary sinus length, maxillary sinus width, distance between infraorbital foramen and distance between maxillary sinus. The data from these parameters were reported by two experts and subjected to discriminant analysis and McNemars test for gender determination. The same data was also fed to the ANN software and the accuracy of its gender prediction was analysed by Receiver Operating Characteristics Curve (ROC) and Area Under the Curve (AUC). Results: The ROC test and AUC (ANN –test) had shown high accuracy for prediction of gender form the data of the CBCT parameters for maxillary sinuses. McNemars test showed that the difference in proportion between the actual gender and ANN predicted gender was not significant (p-value=0.687) and the agreement between the actual gender and ANN in measuring the gender was 84.6%. The male sex was predicted correctly upto 89.7% and female sex upto 94.9%. Conclusion: This study has found ANN to have an encouraging predictive power in gender determination based on linear and volumetric measurements of maxillary sinus obtained from CBCT.

Introduction: Papillary Muscles (PaM) are the muscular components of the mitral apparatus and include a small portion of the wall of the Left Ventricle (LV). There are Anterolateral Papillary Muscles (ALPM) and Posteromedial Papillary Muscles (PMPM) that are usually single, though may be seen in groups or as accessory PaM. The mitral papillary muscle is usually conical in shape with a single base and single apex, though they may also be pyramidal, fan-shaped or broad-apexed which may influence the passage of blood flow. Various patterns like bifid-apexed, perforated or long PaM may also be present with variable length. Alterations in the left ventricular shape and size may lead to disturbances in the Mitral Valve (MV) function. A papillary muscle, like the MV complex is unique and differs in morphology from one individual with high variability. Due to above mentioned reasons, knowledge of variations of mitral papillary muscle is crucial. Aim: To study variations in the morphology of mitral PaM in terms of length, number, shape and pattern in adult human cadaveric hearts. Materials and Methods: A total of fifty adult heart specimens, without gross deformity, were taken from the Institute of Anatomy, Madras Medical College and studied by conventional dissection method. The presence of mitral PaM, their number, length, shape and pattern were studied. A data sheet was made using Microsoft excel software and the mean, percentages and mode of variables were calculated. Results: In the present study, it was found that the two mitral PaM, namely anterolateral and PMPM were present in all the specimens. PMPM had a mean length of 21.6±4 mm and were longer than ALPM that had a mean of 18.9±3.97 mm. PMPM (68%) were mostly present in groups and ranged between one and four whereas the ALPM was predominantly single (76%). Most AMPM (56%) and PMPM (60%) were cone shaped. A 40% of ALPM and 60% PMPM had single, undivided base with an undivided apex. Conclusion: Considerable variations in number, shape, pattern and length of the PaM observed in the present study correlated with the findings of most other studies done previously. The data obtained may be useful for radiologists and cardio-thoracic surgeons.

Background. Early identification of patients at high risk of severe disease requiring referral and treatment at a high‐care facility is imperative in the management of COVID‐19 pneumonia in a limited‐resource setting, as transfer of unstable patients can be detrimental. Objectives. To examine the value of the neutrophil‐to‐lymphocyte ratio (NLR) calculated on admission to a healthcare facility as a predictor of the need for early referral to a high‐care facility for further treatment. Methods. We designed a cohort analytical study of 198 patients with COVID‐19 pneumonia admitted to the COVID‐19 unit at Universitas Academic Hospital in Bloemfontein, South Africa, between 20 May and 30 September 2021. Results. Of the 198 patients enrolled in the study, 134 (67.7%) were admitted to high care and 93 (46.9%) died. The median (interquartile range (IQR)) NLR measured on admission to the hospital was 8.09 (4.90 ‐ 14.86), and the NLR ranged from 0.26 to 136.7. The admission NLR was statistically significantly higher in the high‐care group v. the general ward group (p

Introduction Benign liver tumours and cysts (BLTCs) comprise a heterogeneous group of cystic and solid lesions, including hepatic haemangioma, focal nodular hyperplasia and hepatocellular adenoma. Some BLTCs, for example, (large) hepatocellular adenoma, are at risk of complications. Incidence of malignant degeneration or haemorrhage is low in most other BLTCs. Nevertheless, the diagnosis BLTC may carry a substantial burden and patients may be symptomatic, necessitating treatment. The indications for interventions remain matter of debate. The primary study aim is to investigate patient-reported outcomes (PROs) of patients with BLTCs, with special regards to the influence of invasive treatment as compared with the natural course of the disease.Methods and analysis A nationwide observational cohort study of patients with BLTC will be performed between October 2021 and October 2026, the minimal follow-up will be 2 years. During surveillance, a questionnaire regarding symptoms and their impact will be sent to participants on a biannual basis and more often in case of invasive intervention. The questionnaire was previously developed based on PROs considered relevant to patients with BLTCs and their caregivers. Most questionnaires will be administered by computerised adaptive testing through the Patient-Reported Outcomes Measurement Information System. Data, such as treatment outcomes, will be extracted from electronic patient files. Multivariable analysis will be performed to identify patient and tumour characteristics associated with significant improvement in PROs or a complicated postoperative course.Ethics and dissemination The study was assessed by the Medical Ethics Committee of the University Medical Center Groningen and the Amsterdam UMC. Local consultants will provide information and informed consent will be asked of all patients. Results will be published in a peer-reviewed journal.Study registration NL8231—10 December 2019; Netherlands Trial Register.

The present study was carried out to validate the single nucleotide polymorphism (SNP) in mitochondrial gene- cytochrome b oxidase at 14,716 bp (C to T transition) position obtained from whole genome sequence data of indigenous cattle breeds at Department of Animal Genetics and Breeding, Madras Veterinary College, Tamil Nadu. A total of 288 animals, viz. Alambadi (16), Bargur (99), Kangayam (54), Pulikulam (58) and Umblachery (61) were genotyped. The wild type allele C was observed to be fixed in all the breeds except Kangayam cattle. The gene frequency of C and T alleles and genotype frequencies of CC, CT and TT were estimated in Kangayam breed of cattle and chi-square test revealed the population in Hardy- Weinberg disequilibrium at CYTB locus. Phylogenetic analysis showed that the indigenous cattle breeds were present under the same genetic ancestry of Bos indicus reference genome, while the Bos taurus reference genome diverged separately. From this study, the possibilities of selective sweep or population expansion after a recent bottleneck among the indigenous cattle breeds of Tamil Nadu could be concluded.

Malignancy is a bunch of infection which spreads all through the human body. Since it is an exceptionally deceptive illness its determination is of vital importance. Information mining innovation helps in arranging and bunching the malignancy information and this procedure assists with distinguishing potential disease patients by investigating the data alone. In this examination we analyze three information mining calculations, namely PCA, Genetic calculation and Hierarchical Fuzzy C Means (HFCM). The hereditary calculation is done using the Quantum-enhanced Support Vector Machine (QSVM). The outcome demonstrates that the proposed calculation accomplishes a better outcome when contrasted to the other two calculations.

Nevus flammeus is the most common benign congenital capillary malformation, often known as a port-wine stain. Sturge–Weber syndrome (SWS) is a congenital, sporadic, nonfamilial disease characterized by intracranial and ophthalmic vascular anomalies and nevus flammeus. It usually manifests as developmental delay, learning problems, paralysis, seizures, glaucoma and attention deficit, and hyperactivity disorder. A 29-year-old male patient presented with a reddish patch over the face since birth. He was found to have hemihypertrophy of face, hemiparesis of right limbs, and low intelligence quotient. On ophthalmic examination, the patient was found to have glaucoma and only perception of light in the left eye. Computed tomography brain showed atrophy of the left cerebral hemisphere and calcifications in the left frontal, parietal and occipital regions. With these findings, he was diagnosed as SWS type I. A multidisciplinary approach was followed for patient evaluation and management. This case also highlights the irreversible sequelae of this rare phacomatosis.

Objectives: The immunologic profile and opportunistic viral DNA increase were monitored in Italian patients with COVID-19 in order to identify markers of disease severity. Methods: A total of 104 patients infected with SARS-CoV-2 were evaluated in the study. Of them, 42/104 (40.4%) were hospitalized in an intensive care unit (ICU) and 62/104(59.6%) in a sub-intensive care unit (SICU). Human cytomegalovirus (HCMV) and Epstein-Barr virus (EBV), Parvovirus B19 and Human Herpesvirus 6 virus reactivations were determined by real-time PCR, and lymphocyte subpopulation counts were determined by flow cytometry. Results: Among opportunistic viruses, only EBV was consistently detected. EBV DNA was observed in 40/42 (95.2%) of the ICU patients and in 51/61 (83.6%) of the SICU patients. Comparing the two groups of patients, the EBV DNA median level among ICU patients was significantly higher than that observed in SICU patients. In parallel, a significant reduction of CD8 T cell and NK count in ICU patients as compared with SICU patients was observed (p

Background. In South Africa (SA), road traffic injuries, homicides and burns are the leading causes of injury-related deaths among children. Injury-related deaths are well documented for SA, but this is not the case for non-fatal injuries. Objectives. To describe the non-fatal injuries sustained among children aged 0 - 13 years, to identify any significant sex differences by age group, cause of injury, admission status and injury severity. Methods. The trauma unit database from 1997 to 2016 at Red Cross War Memorial Children’s Hospital, Cape Town, was utilised for this analysis. The prevalence of injuries and the boy/girl ratios with 95% confidence intervals (CIs) were reported. Results. Analysis indicated significant differences by sex for individual injury causes (transport, assault, burns, falls and other injuries), age group, injury severity and admission status. Moderately severe injuries were largely caused by burns, while severe injuries were mostly transport related. Boys had significantly higher proportions of all injury causes. The boy/girl ratio was lowest for assault (1:18), where significantly more girls aged 1 - 3 and 4 - 6 years were injured. Rape/sexual assault was 5.5 times higher for girls, with a significantly higher proportion of moderate-severity injuries (87%; 95% CI 84.7 - 89.4). Conclusion. The study findings call for a more targeted prevention response for boy and girl children. Interventions should be targeted at the prevention of burns, traffic collisions and interpersonal violence, in particular sexual assaults against girls.