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The classification of brain tumors from medical imaging is pivotal for accurate medical diagnosis but remains challenging due to the intricate morphologies of tumors and the precision required. Existing methodologies, including manual MRI evaluations and computer-assisted systems, primarily utilize conventional machine learning and pre-trained deep learning models. These systems often suffer from overfitting due to modest medical imaging datasets and exhibit limited generalizability on unseen data, alongside substantial computational demands that hinder real-time application. To enhance diagnostic accuracy and reliability, this research introduces an advanced model utilizing the Xception architecture, enriched with additional batch normalization and dropout layers to mitigate overfitting. This model is further refined by leveraging large-scale data through transfer learning and employing a customized dense layer setup tailored to effectively distinguish between meningioma, glioma, and pituitary tumor categories. This hybrid method not only capitalizes on the strengths of pre-trained network features but also adapts specific training to a targeted dataset, thereby improving the generalization capacity of the model across different imaging conditions. Demonstrating an important improvement in diagnostic performance, the proposed model achieves a classification accuracy of 98.039% on the test dataset, with precision and recall rates above 96% for all categories. These results underscore the possibility of the model as a reliable diagnostic tool in clinical settings, significantly surpassing existing diagnostic protocols for brain tumors.

IgA nephropathy is a common glomerulonephritis with variable clinical outcomes. The optimal treatment for this condition remains uncertain, and corticosteroid therapy is reserved for patients unresponsive to supportive treatment. The histopathologic examination has a significant role in the diagnosis and prognosis of IgA nephropathy, but its role in the initiation of corticosteroid therapy is still under debate. Recently, targeted release formulation (TRF)-budesonide has emerged as a promising treatment due to its localized delivery to the gut and low systemic adverse effects. This brief review aims to assess recent advancements in IgA nephropathy management, focusing on applying Oxford classification in guiding corticosteroid therapy.

هدف البحث الى معرفة تأثير تمرينات البدنية الخاصة مشابهه للأداء المهاري في تحسين اداء مهارتي الاشتالدر الامامي والخلفي على جهاز العقلة. وفرض البحث ان للتمرينات البدنية الخاصة المشابه للأداء المهاري تأثير معنوي في تحسين أداء مهارتي الشتالدر والاندو على جهاز العقلة. واستعمل الباحثون المنهج التجريبي بتصميم المجموعة الواحدة ذو الاختبارين القبلي والبعدي لملائمته طبيعة المشكلة. وتمثل مجتمع البحث بـ (6) من لاعبي للمنتخب الوطني العراقي للجمناستك فئة الناشئين بعمر (9-13) سنة. واستنتج الباحثون ان للتمرينات البدنية الخاصة المشابه للأداء المهاري تأثير معنوي في تطوير أداء مهارتي الشتالدر والاندو على جهاز العقلة، وضرورة استخدام الأجهزة والادوات المساعدة في تحسين أداء مهارتي الشتالدر والاندو على جهاز العقلة.

Denture-induced stomatitis is the most common pathogenic reaction of denture-bearing mucosa, caused by Candida albicans . Miswak is naturally available oral hygiene tool and have been showed to have antifungal activity against Candida albicans in oral cavity. Aim: The aim of the study was to compare the antifungal efficacy between commercial cleaner (Corega) and Miswak extract ( Salvadora persica ) against Candida albicans on heat cured Polymethyl methacrylate (PMMA) acrylic denture base resin. Materials and methods: Forty-eight samples of heat cured PMMA acrylic denture base resin were fabircated in the study. The sterile acrylic resin specimens were immersed in standardized cell suspension of Candida albicans and incubated for 60 min at 370°C for cell adhesion and 2 h at 370°C for biofilm formation. After 24 h biofilm was evaluated by cell viability (CFUs) on SDA and cell counting of Candida albicans under light microscope at 400× magnification. The fungicidal effect of commercial cleaner and Miswak extract on Candida albicans biofilm was then evaluated by colony-forming units on SDA and cell counting under light microscope at 400× magnification. Results: Screening test agar disk-diffusion assay showed mean inhibitory zone of 3 mm for commercial cleaner as compared to Miswak extract, which showed mean inhibitory zone of 2 and 1 mm for different concentrations. Broth microdilution method showed 31 mg/ml MIC and 62.5 mg/ml Minimal Fungicidal Concentration (MFC) values for commercial cleaner as compared to Miswak extract that showed 125 mg/ml MIC and 250 mg/ml MFC values against Candida albicans . A significant difference ( p < 0.05) was observed between pre and post treatment of both commercial cleaner and Miswak extract, for CFUs and cell count for Candida albicans . Conclusion: Commercial denture cleaner (Corega) showed better antifungal ( C albicans ) activity than Miswak extract ( Salvadora persica ) on heat cured PMMA acrylic denture base resin.

Objectives: This study aims to measure health-care students' willingness to volunteer in disaster situations during the Hajj season. In addition, it provides an assessment of the barriers that may prevent them from volunteering, as well as their perceptions of the required skills to be able to volunteer and be a part of response teams. Materials and Methods: This multicenter study, using a convenience sample including 774 students from health colleges in the Kingdom of Saudi Arabia, was conducted between September 2019 and April 2020. Data were analyzed using the SPSS 21. The variables were expressed in percentages as appropriate. A Chi-squared test was used to determine the association between qualitative variables. Results: This study indicates that 95% of health-care students were willing to volunteer during disasters, especially in wound care, patient follow-up, and triage. Their lack of knowledge and skills was one of the obstacles that affected their willingness to volunteer (55.9%). Of the participants, 79.6% would volunteer during the Hajj season, but family agreement, long distance, and fear of cross-infections were the most significant barriers preventing them from volunteering. Students agreed that cardiopulmonary resuscitation and first aid skills should be acquired to render assistance. Conclusions: The willingness to volunteer during disasters is high among health-care students in the Kingdom of Saudi Arabia, even though enormous barriers are preventing them from doing so.

Background: Simulation-based basic airway management training may enhance the learner's competence and offer practitioners the opportunity to practice infrequently applied skills in cases with difficult airway management. Here, we aimed to examine the effectiveness of implementing the American College of Surgeons/ Association for Surgical Education (ACS/ASE) simulation-based Basic Airway Management module in the current medical school curriculum in PNU. Methods: This is a quasi-experimental study in which 44 students were enrolled in the training course; the instructors comprised six practicing physicians and technicians from the anesthesia and emergency departments. The students were divided among six groups for a 20-minutes hands-on training. Cognitive assessment and performance rating scale were conducted after the introduction of the module. An independent t-test was applied to analyze the pre- and post-test training scores for the cognitive assessment and performance rating scale. Statistical significance was set at p < 0.05. Results: There was a significant improvement in the post-training cognitive assessment scores, especially for basic maneuvers to establish the airway in a restrained and unrestrained driver, and in a patient with neck hematoma. A significant difference was also observed in pre- and post-training procedural steps, product characteristics, and global rating score. Conclusions: The ACS/ASE surgical skills curriculum for basic airway skills training is a feasible and effective approach for teaching basic airway management skills to medical students in PNU and other local universities. [SJEMed 2021; 2(2.000): 106-111]

An abnormal systolic motion is frequently observed in patients with left bundle branch block (LBBB), and it has been proposed as a predictor of response to cardiac resynchronization therapy (CRT). Our goal was to investigate if this motion can be monitored with miniaturized sensors feasible for clinical use to identify response to CRT in real time. Motion sensors were attached to the septum and the left ventricular (LV) lateral wall of eighteen anesthetized dogs. Recordings were performed during baseline, after induction of LBBB, and during biventricular pacing. The abnormal contraction pattern in LBBB was quantified by the septal flash index (SFI) equal to the early systolic shortening of the LV septal-to-lateral wall diameter divided by the maximum shortening achieved during ejection. In baseline, with normal electrical activation, there was limited early-systolic shortening and SFI was low (9 ± 8%). After induction of LBBB, this shortening and the SFI significantly increased (88 ± 34%, p < 0.001). Subsequently, CRT reduced it approximately back to baseline values (13 ± 13%, p < 0.001 vs. LBBB). The study showed the feasibility of using miniaturized sensors for continuous monitoring of the abnormal systolic motion of the LV in LBBB and how such sensors can be used to assess response to pacing in real time to guide CRT implantation.

Abstract This paper was written to explain the process and steps and to describe the experience with building a women-only operated collegiate emergency medical service (EMS) system in the largest women-only university in the world. To the best of the authors’ knowledge, the EMS system described in this report is the first collegiate EMS system in the Gulf region. The concept of the collegiate EMS system at the university, the factors that mandated the creation of this system, the process steps, the challenges faced, and, finally, the reported outcome have been evaluated. The women-only campus conferred unique challenges and additional pressure during the planning and implementation stages of this project; our system had helped in decreasing response time to medical emergency, provided back up support during mass gathering events in the university, and helped in decreasing the load on other national EMS services.

Background: Wilms tumor gene 1 (WT1) expression is a hallmark of ovarian serous carcinoma and considered to be diagnostic marker of these tumors, differentiating them from uterine serous carcinoma (USC), historically thought to rarely express WT1. However, more recent data indicates a significant percentage of USC may express WT1. The clinical implications of WT1 positivity in USC remain unclear. Methods: A multicenter retrospective analysis of patients with USC was conducted from 2000 to 2019. Inclusion criteria were patients who had undergone comprehensive surgical staging/tumor debulking with archival tissue available for WT1 assessment via immunohistochemistry (IHC). Chemosensitive patients were defined as those recurring >6 months from last platinum-based chemotherapy. Progression free survival (PFS) and overall survival (OS) analysis was performed using Kaplan-Meier estimates. Multivariate analysis (MVA) was performed using Cox proportional hazards model. Results: WT1 status was evaluated in 61 patients with USC. 13 (21.3%) were positive for WT1 by IHC. Stage distribution included 32% stage I, 5% stage II, 25% stage III and 38% stage IV. There was no difference in the stage (p = 0.158), race (p = 0.227) or distribution of recurrence sites (p = 0.581) between WT1 positive and WT1 negative tumors. The majority of patients were chemosensitive (63%). Chemosensitivity was significantly improved in WT1 positive (92.3%) vs. WT1 negative tumors (55.8%) (p = 0.016). We observed a trend towards improved PFS among WT1 positive tumors (21 vs. 16-months, respectively) (p = 0.544). On MVA, stage (p

As Ebola has spread beyond West Africa, the challenges confronting health care systems with no experience in managing such patients are enormous. Not only is Ebola a significant threat to a population's health, it can infect the medical personnel trying to treat it. As such, it represents a major challenge to those in public health, emergency medical services (EMS), and acute care hospitals. Our academic medical center volunteered to become an Ebola Treatment Center as part of the US effort to manage the threat. We developed detailed policies and procedures for Ebola patient management at our university hospital. Both the EMS system and county public health made significant contributions during the development process. This article shares information about this process and the outcomes to inform other institutions facing similar challenges of preparing for an emerging threat with limited resources. The discussion includes information about management of (1) patients who arrive by ambulance with prior notification, (2) spontaneous walk-in patients, and (3) patients with confirmed Ebola who are interfacility transfers. Hospital management includes information about Ebola screening procedures, personal protective equipment selection and personnel training, erection of a tent outside the main facility, establishing an Ebola treatment unit inside the facility, and infectious waste and equipment management. Finally, several health policy considerations are presented.

Measles (rubeola) is a highly contagious airborne disease that was declared eliminated in the U.S.in the year 2000. Only sporadic U.S. cases and minor outbreaks occurred until the larger outbreakbeginning in 2014 that has become a public health emergency. The “Identify-Isolate-Inform” toolwill assist emergency physicians to be better prepared to detect and manage measles patientspresenting to the emergency department. Measles typically presents with a prodrome of high fever,and cough/coryza/conjunctivitis, sometimes accompanied by the pathognomonic Koplik spots.Two to four days later, an erythematous maculopapular rash begins on the face and spreads downthe body. Suspect patients must be immediately isolated with airborne precautions while awaitinglaboratory confirmation of disease. Emergency physicians must rapidly inform the local public healthdepartment and hospital infection control personnel of suspected measles cases. [West J EmergMed. 2015;16(2):212–219.]

Background: Since December 2019, the COVID-19 pandemic has challenged the international community on health and legislative fronts. The widespread disease needs an effective response from the health-care system as well as the legislative framework. Pakistan is facing a challenge from the under-developed health-care system as well as a lack of awareness about the available laws to deal with the issue. Awareness about the relevant laws is a precursor to the establishment of rule of law. This study will doctrinally analyse the national laws of Pakistan to make the response more effective. The awareness about the relevant laws will supplement the healthcare response against the pandemic of COVID-19. Since Pakistan is a federation and healthcare is a provincial subject, therefore the study limits itself to the laws of Punjab, the largest populated province of Pakistan. Objectives: This study will analyse the available healthcare laws to deal with the recent outbreak of COVID-19. The focus will remain on the doctrinal measurement of the effectiveness of The Punjab Infectious Diseases (Prevention and Control) Act 2020 (PIDA) vis-à-vis already existing laws. It will also highlight the salient features of the PIDA 2020 along with its effectiveness to deal with the current pandemic. Method: The study benefits from documentary analysis of legal documents. The method is nearer to the doctrinal research method in law. The study will shape itself into two parts. First will be lax lata that will ascertain what is the relevant healthcare law to deal with infectious diseases like COVID-19. The next step will be lax ferenda where the study will propose how it can become more effective to deal with the issue. The research will opt black letter approach. Conclusion: This study finds that the adoption of PIDA 2020 is in spirit with dealing with the pandemic of the COID-19. The law has shown positive trends in protecting the population from the widespread impact of the diseases. The World Health Organization has appreciated Pakistan’s methods and strategies against the first wave of the COVID-19 with reference to response in Punjab, the largest province of Pakistan.

Additionally, the tumour cells can have different morphologies that can overlap with dedifferentiated chordoma including spindled, ovoid, plasmacytoid, epithelioid, or rhabdoid cells with eosinophilic to clear cytoplasm and variable nuclear pleomorphism, macronucleoli or necrosis. Cytomorphology along with positive AE1/AE3 staining and Brachyury staining support the dignosis of metastatic dedifferentiated chordoma. Additionally, the tumour cell morphology was similar to the patient's previously diagnosed metastatic dedifferentiated chordoma of the IVC tumour thrombus. [Extracted from the article]

this research is looking at notion of urban regeneration and housing role on it. the research is structured into two parts; the first part is concerned with defining urban regeneration, its importance, and the and the different factors in academic literature. then it continues by dividing and thoroughly analyzing/discussing the different housing contributions to urban regeneration both directly and indirectly. it will provide critical review of these contributions against future needs and changes. the second part will further evaluate all discussed in the first part in practice through a casestudy of the welsh housing quality standards (whqs) and "the can do toolkit 1 & 2" introduced by the welsh housing committee in the united kingdom in 2003, 2006 and 2008 respectively. the research will consider the links between the different contributions and possible effects it may have on the region. finally, some key points will be presented in the conclusion to highlight the different housing contributions to urban regeneration and their potential benefits and limitations.