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Pooja R Shah,1 Elizabeth Cusick,1 Yasmine Nousari,2 Andrea Sandoz,1 Francisco Tausk1 1Department of Dermatology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA; 2Psychology Department, Boston College, Chestnut Hill, MA 02467, USACorrespondence: Francisco TauskDepartment of Dermatology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USATel +1 410 245 1735Email Francisco_Tausk@URMC.Rochester.eduAbstract: Patients that suffer from factitial dermatosis mutilate their skin, often lacking any consciousness of self-injury, attributing the resulting lesions to spontaneous development. The case hereby described shows how the health providers’ interventions led a patient from a baseline undiagnosed factitious disorder to frank delusions of infestation with Mycobacterium Kansasii, and a relentless search for antibiotic treatments. We highlight the need for educating health practitioners on the characteristics of psycho-cutaneous disorders.Keywords: delusions of parasitosis, delusions of infestation, factitious dermatosis, psychodermatology, dermatology

Aneurysms rarely present with features of ischemic stroke. The data on treatment of such strokes is limited. We present a case of multiple aneurysms and an ischemic stroke caused by distal anterior cerebral artery (DACA) aneurysm treated with flow diverter placement, the first case of endovascular treatment of DACA aneurysmal ischemic stroke reported to our knowledge.

At present, augmentation of carbon gases in atmosphere has become a major concern. Regulatory bodies in many countries have focused on reduction of carbon emissions. Several countries follow carbon tax and carbon cap trade policy to control emission of carbon gases. This study has been carried out to obtain joint inventory policies for a supply chain involving a manufacturer and a whole-seller. Moreover, the manufacturer invests in green technology to reduce units of carbon gases. Products are considered deteriorating in nature. Manufacturer delivers product by adopting a lot-forlot policy to meet the whole-seller’s demand. The manufacturer offers the whole-seller flexible payment options including advance payment with discounted product price and delayed payment with increment in product price. Optimal policies for both individuals and the supply chain are discussed with aim to maximize total profit. The model is worked out and results are compared for four cases: (i) advance payment with green technology investments (ii) advance payment without green technology investments (iii) delayed payment with green technology investments (iv) delayed payment without green technology investments. A solution procedure has been proposed and explained through a numerical example. Study is concluded with managerial insights.

The increasing demand for utilities infrastructure and development projects has become a key factor in providing feasible and economical solutions in recent decades. There is a need of the day, to utilize locally available resources while designing such projects. The Reinforced Soil Wall (RSW) with Gabion Facing provides a flexible modular environment-friendly structure that is proven to be suitable for waterfront structures, and feasible with available boulders in the vicinity. This paper showcases a case study of RS wall with Gabion Facing for the diversion of Ulwe River - a part of Navi Mumbai International Airport (NMIA) Project. A roughly 3.2km long river diversion has been widened, moreover, an approximately 90 mt high hill was flattened to pave the way for NMIA, adjacent to Panvel Creek. The proposed channel dimensions of the diversion river were increased after studying the data for the last 100 years of rainfall, so that the heavy rainwater can be discharged without flooding. The composite solution of the RS wall with metal gabions as a facia has facilitated the diversion of the Ulwe River to divert water flow up to Panvel Creek. The geogrids were installed with the stone–filled metal gabions, along with connector rods to form a positive connection. To prevent the scouring of the non-rocky river bed at RS wall base, the Gabion mattresses were provided.

Post-Partum Depression (PPD) influences an enormous number of new mothers in India and impacts both the well-being and improvement of their posterity as well as the new mothers' prosperity. To upgrade PPD location, treatment, and the executives in different medical care settings in India, this exploration researches the conceivable outcomes of using computerized reasoning (simulated intelligence). The study examines how AI technologies could be incorporated into existing healthcare systems to control PPD. This incorporates handling issues like the shortage of psychological wellness subject matter experts, the shame related to emotional well-being, and the shortfall of fitting and delicate screening procedures. Through simulated intelligence calculations, normal language handling, and manmade intelligence-driven chatbots for treatment, it underscores leap forwards in artificial intelligence that permit early discovery and individualized treatment regimens. The paper also discusses the ethical implications of AI technology, such as concerns regarding privacy and the requirement for long-term research to evaluate the continued effectiveness of AI tools. Future drives center around carrying artificial intelligence applications to oppressed populaces and fortifying the joining of these innovations with traditional medical care administrations to give an exhaustive and solid strategy for PPD executives in India.

Actinic cheilitis is an oral potentially malignant disorder caused by UV radiation leading to damage to epithelial keratinocytes of the lips. It predominantly affects the vermillion border of the lower lip. Due to its association with chronic UV exposure, associated risk factors include geographic areas, outdoor occupations, and skin subtypes. A high proportion of lip squamous cell carcinomas arise from actinic cheilitis lesions, with histological examination usually showing a degree of dysplasia. This paper aims to review the existing literature regarding the clinical picture of actinic cheilitis, its prevalence, differential diagnoses, and consensus on management, for the education of the general dental practitioner in identifying and surveillance of this lesion.

Vehicle accidents on mountain roads have been a major concern for many years. The narrow roads, acute turns, and steep slopes of these areas can make it difficult for drivers to see approaching vehicles, leading to a high incidence of collisions. This research paper aims to propose a solution to this problem using emerging modern technology to prevent and reduce the number of accidents on mountain roads. The proposed model consists of techniques such as image processing to detect the type of vehicle present at the other end of a blind spot, alerting the driver and thus allowing them to make safe decisions while taking turns also there is a system to detect vehicle using sensors and also to manipulate the signal so proper instruction can be conveyed. Through this research, we aim to demonstrate the effectiveness of this system and show how it can be used to reduce the loss of life and property on mountain roads.

Because of the rising worry about global warming and the depletion of fossil fuel supplies, many individuals are looking into sustainable energy alternatives to protect the environment for future generations. Because of the situation of our deteriorating globe, eco-friendly items are more in demand than ever. The outcomes of using PI and PID controllers in solar and wind integration are compared in this research. This investigation contains a boost converter, an inverter, a converter, and three induction motors. Wind and solar energy are transformed to DC voltage, then to AC voltage via an inverter, and ultimately to a three-phase induction motor. The boost converter receives output from the wind energy conversion system (WECS). The solar output is routed to the three-phase complete converter. Sinusoidal pulse width modulation used in generating trigger pulses to the inverter. The output of the boost converter is fed into the common dc link by the three phase Sinusoidal pulse width modulation (SPWM) inverter, which converts its dc input to three phase AC output. This system's behaviour is examined using MATLAB Simulink.

Introduction: Controversy around sub-specialisation in a district general hospital (DGH) has been ongoing for years.Aim: To study the effect of colorectal sub-specialisation on general surgical cases.Methods: A retrospective audit between October 2002 and September 2003, including all referrals to the outpatient clinics of a single consultant surgeon in a DGH.Results: 1,055 patients were seen in outpatient clinics, of which 53% (563) were seen in rapid access colorectal clinics. Overall, 87% (914) of patients were diagnosed to have colorectal pathology. The majority of the colorectal cases were referred using the designated referral forms. There were 427 urgent, 162 soon and 325 routine referrals with colorectal pathology, and 35 urgent, 22 soon and 84 routine referrals with non-colorectal pathology. Median waiting times for urgent, soon and routine referrals were 12, 61 and 91 days, respectively, for patients with colorectal pathology, in comparison with 44, 75 and 397 days for non-colorectal pathology.Conclusion: This audit confirms that colorectal sub-specialisation has resulted in a significant delay in the management of patients with non-colorectal diseases. This has major implications within a DGH setting. [ABSTRACT FROM AUTHOR]

Splenic injury following colonoscopy is rare, with only 28 cases reported so far in the English language literature. Direct trauma during colonoscopy or traction on the spleno-colic ligament is the proposed mechanism of injury. Computed tomography (CT) of the abdomen is usually considered to be the most sensitive and specific modality for diagnosis. We report a case of a 56-year-old female, who was diagnosed having a splenic rupture following a routine colonoscopy for investigation of anaemia. She underwent an emergency laparotomy with splenectomy and made a satisfactory recovery post-operatively. We wish to highlight that there should be a high index of suspicion of splenic rupture in patients presenting with abdominal pain and demonstrating a positive Kehr's sign following colonoscopy. Only two case reports from the United Kingdom have been published, raising the possibility of under-reporting of such cases. [ABSTRACT FROM AUTHOR]

Abstract Background Alzheimer's disease (AD) is common among older adults and leads to significant disability. Volatile anesthetic gases administered during general anesthesia (GA) have been hypothesized to be a risk factor for the development of AD. The objective of this study is to systematically review the association between exposure to GA and risk of AD. Methods We searched electronic databases including MEDLINE, Embase, and Google scholar for observational studies examining the association between exposure to GA and risk of AD. We examined study quality using a modified version of the Newcastle-Ottawa risk of bias assessment for observational studies. We used standard meta-analytic techniques to estimate pooled odds ratios (OR) and 95% confidence intervals (CI). Subgroup and sensitivity analyses were undertaken to evaluate the robustness of the findings. Results A total of 15 case-control studies were included in the review. No cohort studies were identified that met inclusion criteria. There was variation in the methodological quality of included studies. There was no significant association between any exposure to GA and risk of AD (pooled OR: 1.05; 95% CI: 0.93 - 1.19, Z = 0.80, p = 0.43). There was also no significant association between GA and risk of AD in several subgroup and sensitivity analyses. Conclusions A history of exposure to GA is not associated with an increased risk of AD although there are few high-quality studies in this area. Prospective cohort studies with long-term follow-up or randomized controlled trials are required to further understand the association between GA and AD.

Abstract Background The rising epidemic of obesity is associated with cognitive decline and is considered as one of the major risk factors for neurodegenerative diseases. Neuroinflammation is a critical component in the progression of several neurological and neurodegenerative diseases. Increased metabolic flux to the brain during overnutrition and obesity can orchestrate stress response, blood-brain barrier (BBB) disruption, recruitment of inflammatory immune cells from peripheral blood and microglial cells activation leading to neuroinflammation. The lack of an effective treatment for obesity-associated brain dysfunction may have far-reaching public health ramifications, urgently necessitating the identification of appropriate preventive and therapeutic strategies. The objective of our study was to investigate the neuroprotective effects of Momordica charantia (bitter melon) on high-fat diet (HFD)-associated BBB disruption, stress and neuroinflammatory cytokines. Methods C57BL/6 female mice were fed HFD with and without bitter melon (BM) for 16 weeks. BBB disruption was analyzed using Evans blue dye. Phosphate-buffered saline (PBS) perfused brains were analyzed for neuroinflammatory markers such as interleukin-22 (IL-22), IL-17R, IL-16, NF-κB1, and glial cells activation markers such as Iba1, CD11b, GFAP and S100β. Additionally, antioxidant enzymes, ER-stress proteins, and stress-resistant transcription factors, sirtuin 1 (Sirt1) and forkhead box class O transcription factor (FoxO) were analyzed using microarray, quantitative real-time RT-PCR, western immunoblotting and enzymatic assays. Systemic inflammation was analyzed using cytokine antibody array. Results BM ameliorated HFD-associated changes in BBB permeability as evident by reduced leakage of Evans blue dye. HFD-induced glial cells activation and expression of neuroinflammatory markers such as NF-κB1, IL-16, IL-22 as well as IL-17R were normalized in the brains of mice supplemented with BM. Similarly, HFD-induced brain oxidative stress was significantly reduced by BM supplementation with a concomitant reduction in FoxO, normalization of Sirt1 protein expression and up-regulation of Sirt3 mRNA expression. Furthermore, plasma antioxidant enzymes and pro-inflammatory cytokines were also normalized in mice fed HFD with BM as compared to HFD-fed mice. Conclusions Functional foods such as BM offer a unique therapeutic strategy to improve obesity-associated peripheral inflammation and neuroinflammation.