Current status and future directions in the management of chronic hepatitis C

Hepatitis C virus (HCV) is endemic worldwide, and it causes cirrhosis and other complications that often lead to death; nevertheless, our knowledge of the disease and its mechanisms is limited. HCV is most common in underdeveloped nations, including many in Africa and Asia. The virus is usually transmitted by parenteral routes, but sexual, perinatal, and other types of transfer have been known to occur. Approximately 80% of individuals who contract hepatitis C develop a chronic infection, and very few are able to spontaneously clear the virus. Because hepatitis C is asymptomatic in the majority of patients, the presence of HCV RNA in the serum is the best diagnostic tool. Although serious complications from hepatitis C may not occur for 20 years, 1/5 of chronic patients eventually develop life - threatening cirrhosis. More research is needed on the different therapy options for the disease, and many factors, most importantly the genotype of the virus, must be taken into account before beginning any treatment. As there is no vaccine against HCV at present, the most effective and recommended therapy is pegylated-interferon-α-2a plus ribavirin. While interferon is marginally effective as a monotherapy, both adding the moiety and combining it with ribavirin have been shown to dramatically increase its potency. While there are numerous alternative and complementary medicines available for patients with hepatitis C, their efficacy is questionable. Currently, research is being done to investigate other possible treatments for hepatitis C, and progress is being made to develop a vaccine against HCV, despite the many challenges the virus presents. Until such a vaccination is available, prevention and control methods are important in containing and impeding the spread of the virus and mitigating its deleterious effects on the health of people and communities worldwide

Biometric face recognition using multilinear projection and artificial intelligence

PhD ThesisNumerous problems of automatic facial recognition in the linear and multilinear subspace learning have been addressed; nevertheless, many difficulties remain. This work focuses on two key problems for automatic facial recognition and feature extraction: object representation and high dimensionality. To address these problems, a bidirectional two-dimensional neighborhood preserving projection (B2DNPP) approach for human facial recognition has been developed. Compared with 2DNPP, the proposed method operates on 2-D facial images and performs reductions on the directions of both rows and columns of images. Furthermore, it has the ability to reveal variations between these directions. To further improve the performance of the B2DNPP method, a new B2DNPP based on the curvelet decomposition of human facial images is introduced. The curvelet multi- resolution tool enhances the edges representation and other singularities along curves, and thus improves directional features. In this method, an extreme learning machine (ELM) classifier is used which significantly improves classification rate. The proposed C-B2DNPP method decreases error rate from 5.9% to 3.5%, from 3.7% to 2.0% and from 19.7% to 14.2% using ORL, AR, and FERET databases compared with 2DNPP. Therefore, it achieves decreases in error rate more than 40%, 45%, and 27% respectively with the ORL, AR, and FERET databases. Facial images have particular natural structures in the form of two-, three-, or even higher-order tensors. Therefore, a novel method of supervised and unsupervised multilinear neighborhood preserving projection (MNPP) is proposed for face recognition. This allows the natural representation of multidimensional images 2-D, 3-D or higher-order tensors and extracts useful information directly from tensotial data rather than from matrices or vectors. As opposed to a B2DNPP which derives only two subspaces, in the MNPP method multiple interrelated subspaces are obtained over different tensor directions, so that the subspaces are learned iteratively by unfolding the tensor along the different directions. The performance of the MNPP has performed in terms of the two modes of facial recognition biometrics systems of identification and verification. The proposed supervised MNPP method achieved decrease over 50.8%, 75.6%, and 44.6% in error rate using ORL, AR, and FERET databases respectively, compared with 2DNPP. Therefore, the results demonstrate that the MNPP approach obtains the best overall performance in various learning scenarios

Consideration of Disagreement in Modern Sales and Its Relationship to the Purpose of Financial Preservation

This study concerns an important rule in jurisprudence, which is the consideration of friction and its relationship with preserving the purpose of money. The main objective is to maintain personal benefits and avoid corruption while considering the consequences of the rules. The study explores the relationship between the rule and its application in certain types of sales, especially in contemporary sales. The researchers analyze the opinions of jurists and their evidence to choose the best options based on the rule of consideration in friction. The study concludes that it is important to choose between jurists’ opinions in research topics as one of the ways of making decisions. The study recommends researchers to focus on the rules to converge the views of jurisprudence, especially in contemporary matters

Successful treatment of obscure gastrointestinal bleeding with intraoperative enteroscopy

A 51-year-old man was referred to our institution with persistent iron deficiency anemia. Initial gastroduodenoscopy and colonoscopy at his local hospital were unremarkable. A subsequent small bowel capsule endoscopy revealed a distal small bowel polyp with evidence of fresh bleeding ([Fig. 1]). A triple-phase abdominal computed tomography scan confirmed a 13-mm vascular polypoid lesion within the distal small bowel, with hyperenhancement on the arterial phase ([Fig. 2]). After a discussion in a multidisciplinary team meeting, it was decided that surgical resection guided by intraoperative enteroscopy to localize the lesion would be the most appropriate course of action

A 3D computed tomography based tool for orthopedic surgery planning

Series : Lecture notes in computational vision and biomechanics, vol. 19The preparation of a plan is essential for a surgery to take place in the best way possible and also for shortening patient’s recovery times. In the orthopedic case, planning has an accentuated significance due to the close relation between the degree of success of the surgery and the patient recovering time. It is important that surgeons are provided with tools that help them in the planning task, in order to make it more reliable and less time consuming. In this paper, we present a 3D Computed Tomography based solution and its implementation as an OsiriX plugin for orthopedic surgery planning. With the developed plugin, the surgeon is able to manipulate a three-dimensional isosurface rendered from the selected imaging study (a CT scan). It is possible to add digital representations of physical implants (surgical templates), in order to evaluate the feasibility of a plan. These templates are STL files generated from CAD models. There is also the feature to extract new isosurfaces of different voxel values and slice the final 3D model according to a predefined plane, enabling a 2D analysis of the planned solution. Finally, we discuss how the proposed application assists the surgeon in the planning process in an alternative way, where it is possible to three-dimensionally analyze the impact of a surgical intervention on the patient.(undefined

Increased psychological distress and somatization in patients with irritable bowel syndrome compared with functional diarrhea or functional constipation, based on Rome IV criteria

Background The Rome IV criteria for disorders of gut‐brain interaction define irritable bowel syndrome (IBS) as a functional bowel disorder associated with frequent abdominal pain of at least 1 day per week. In contrast, functional diarrhea (FD) and functional constipation (FC) are relatively painless. We compared differences in mood and somatization between Rome IV IBS and FC/FD. Methods A total of 567 patients with Rome IV defined IBS or FD/FC completed a baseline questionnaire on demographics, abdominal pain frequency, mood (hospital anxiety and depression scale, HADS), and somatization (patient health questionnaire, PHQ‐12). The primary analysis compared differences in mood and somatization between IBS and FC/FD, and the relative influence of abdominal pain frequency on these extra‐intestinal symptoms. The secondary analysis evaluated differences across individual IBS subtypes, and also between FC and FD. Key Results Patients with IBS—in comparison to those with FC/FD—had significantly higher mean PHQ‐12 somatization scores (9.1 vs. 5.4), more somatic symptoms (6.0 vs. 4.3), abnormally high somatization levels (16% vs. 3%), higher HADS score (15.0 vs. 11.7), and clinically abnormal levels of anxiety (38% vs. 20%) and depression (17% vs. 10%). Increasing abdominal pain frequency correlated positively with PHQ‐12, number of somatic symptoms, and HADS; p < 0.001. No differences in mood and somatization scores were seen between individual IBS subtypes, and nor between FC and FD. Conclusion & Inferences Based on the Rome IV criteria, IBS is associated with increased levels of psychological distress and somatization compared with FD or FC. Patients reporting frequent abdominal pain should be comprehensively screened for psychosomatic disorders, with psychological therapies considered early in the disease course

Does a gluten-free diet improve quality of life and sleep in patients with non-coeliac gluten/wheat sensitivity?

Introduction: The role of a gluten-free diet (GFD) in Non-Coeliac Gluten/Wheat Sensitivity (NCGWS) is unclear. We present the largest study comparing adherence to a GFD in patients with Coeliac Disease (CD) and NCGWS and assess its impact on quality of life (QoL) and sleep in patients with NCGWS. Methods: Patients with NCGWS at a tertiary centre completed the Coeliac Disease Adherence Test (CDAT), Coeliac Symptom Index (CSI) and Sleep Condition Indicator (SCI). Higher CDAT scores indicate worse adherence, higher CSI scores indicate poorer QoL, and higher SCI scores indicate better sleep. CDAT scores were correlated with CSI and SCI scores. A second group of patients with CD completed the CDAT questionnaire only. Results were compared with the CDAT responses from the NCGWS group. Results: For the NCGWS cohort (n = 125), the median CDAT score was 17/35, indicating poor adherence. The median CSI score was 44/80, with 40% of scores associated with a poor QoL. The median SCI score was 14/32, and DSM-V criteria for insomnia was met by 42% of patients. There was a positive correlation between CSI and CDAT scores (r = 0.59, p < 0.0001) and a negative correlation between SCI and CDAT scores (r = −0.37, p = 0.0002). In the CD cohort (n = 170), the median CDAT score was 13/35. Patients with NCGWS had poorer adherence compared to CD (CDAT: 17.0 vs. 13.0, respectively, p = 0.0001). Conclusion: Patients with NCGWS adhere to a GFD less than those with CD. Poorer adherence to a GFD in patients with NCGWS correlates with a worse QoL and sleep performance