Benign intermittent gastric outlet obstruction in an elderly: Endoscopic management and brief review

We describe the clinical scenario in an 80 year old female who presented with history of epigastric discomfort and postprandial fullness of three weeksduration without any alarming symptoms. On upper GI endoscopy she was found to have gastric polyp with a long stalk which was partially obstructing her pyloric ring giving rise to features of intermittent gastric outlet obstruction Polypectomy was done with complete relief of symptoms .She is following our clinic for last 6 months now. Although possibility of malignant etiology in gastric out let obstruction ranks high in the elderly some patients are lucky to have a benign cause as the index case. Report of the case and brief review ispresented.Key words:Inflammatory polyp, Gastric outlet obstruction

Conservation of Natural Resources and their Efficient Use for Sustainable Development in Asia

Ao longo dos séculos, o Rio Tocantins tem desempenhado importante papel como caminho fluvial no processo de conquista e ocupação do interior do Brasil. Atualmente, sua importância se destaca também como potencial energético, com a construção de hidrelétricas e como meio de transporte, pela efetivação do projeto da Hidrovia Tocantins-Araguaia. Este artigo visa analisar os vestígios deixados em um diário de viagem de 1914 em contraste com as transformações que estão ocorrendo atualmente no Rio Tocantins. Por meio desta fonte é possível perceber o cotidiano das viagens, as dificuldades e perigos de uma navegação incipiente, a natureza do rio e suas margens e a cultura das populações ribeirinhas.Palavras-Chaves: Região; Rios; História Ambiental; MemóriaOver the centuries, the Tocantins River has played an important role as a waterway in the process of conquest and occupation of Brazil’s countryside. Nowadays, it is also important as energy potential, with the construction of the hydroelectrics, and as a means of transportation, by the conclusion of the Tocantins-Araguaia Waterway project. This article aims to analyze the traces left in a travel log from 1914 in contrast with the changes that have been happening in the River Tocantins lately. Based on his historical source, it is possible to notice the daily life during the trips, the difficulties and dangers faced in an incipient navigation, the river’s nature and its margins, and the riverine populations’ culture.Keywords: Region; Rivers; Environmental history; Memoi

Venous thromboembolism (VTE) in post-prostatectomy patients

Radical prostatectomy (RP) is one of the recommended treatments to achieve oncological outcomes in localized prostate cancer. However, a radical prostatectomy is a major abdominopelvic surgery. Venous thromboembolism (VTE) is a well-known complication associated with surgical procedures, including RP. There is a lack of consensus regarding VTE prophylaxis in urological procedures. The aim of this systematic review and meta-analysis was to investigate different aspects of VTE in post-radical prostatectomy patients. A comprehensive literature search was performed, and relevant data were extracted. The primary aim was to perform a systematic review and meta-analysis (wherever possible) of VTE occurrence in post-RP patients in relation to surgical approach, pelvic lymph node dissection, and type of prophylaxis (mechanical or combined prophylaxis). The secondary aim was to investigate the incidence and other risk factors of VTE in post-RP patients. A total of 16 studies were included for quantitative analysis. Statistical methods for analysis included the DerSimonian–Laird random effects. We were able to conclude that the overall incidence of VTE in post-radical prostatectomy is 1% (95% CI) and minimally invasive procedures (MIS), including laparoscopic, as well as robotic procedures for radical prostatectomy and RP without pelvic lymph node dissection (PLND), are associated with less risk of developing VTE. Additional pharmacological prophylaxis to mechanical methods may not be necessary in all cases and should be considered in high-risk patients only

Association of vitamin B12 with pro-inflammatory cytokines and biochemical markers related to cardiometabolic risk in Saudi subjects

Background: This study aimed to examine the relationship between changes in systemic vitamin B12 concentrations with pro-inflammatory cytokines, anthropometric factors and biochemical markers of cardiometabolic risk in a Saudi population. Methods: A total of 364 subjects (224 children, age: 12.99 ± 2.73 (mean ± SD) years; BMI: 20.07 ± 4.92 kg/m2 and 140 adults, age: 41.87 ± 8.82 years; BMI: 31.65 ± 5.77 kg/m2) were studied. Fasting blood, anthropometric and biochemical data were collected. Serum cytokines were quantified using multiplex assay kits and B12 concentrations were measured using immunoassay analyzer. Results: Vitamin B12 was negatively associated with TNF-α (r = −0.14, p < 0.05), insulin (r = −0.230, p < 0.01) and HOMA-IR (r = −0.252, p < 0.01) in all subjects. In children, vitamin B12 was negatively associated with serum resistin (r = −0.160, p < 0.01), insulin (r = −0.248, p < 0.01), HOMA-IR (r = −0.261, p < 0.01). In adults, vitamin B12 was negatively associated with TNF-α (r = −0.242, p < 0.01) while positively associated with resistin (r = 0.248, p < 0.01). Serum resistin was the most significant predictor for circulating vitamin B12 in all subjects (r2 = −0.17, p < 0.05) and in children (r2 = −0.167, p < 0.01) while HDL-cholesterol was the predictor of B12 in adults (r2 = −0.78, p < 0.05). Conclusions: Serum vitamin B12 concentrations were associated with pro-inflammatory cytokines and biochemical markers of cardiometabolic risks in adults. Maintaining adequate vitamin B12 concentrations may lower inflammation-induced cardiometabolic risk in the Saudi adult population

A spectroscopic, thermodynamic and molecular docking study of the binding mechanism of dapoxetine with calf thymus DNA

Dapoxetine is a selective serotonin reuptake inhibitor, used to treat premature ejaculation in men. Dapoxetine may interact with theDNAand hence this study investigated dapoxetine and calf thymusDNA(ctDNA) binding interaction. The interaction study of ligands to DNA is of importance in the development of molecular probes and therapeutic agents. Spectroscopic techniques including spectrofluorometry and spectrophotometry were employed to study this interaction. Fluorescence studies indicated a static quenching mechanism between dapoxetine and ctDNA. Groove binding was suggested as the mode of interaction between dapoxetine and ctDNA based onUVabsorption, circular dichroism (CD) spectroscopy, iodide quenching and molecular docking studies. The studies conducted at three different temperatures 298, 303 and 310 K indicated a strong binding interaction at higher temperatures. Thermodynamic studies conducted indicated involvement of hydrophobic interaction between ctDNA and dapoxetine and were entropy-driven. Ethidium bromide probe study suggested that dapoxetine does not bind to ctDNA in an intercalative fashion. Iodide quenching studies further proved the non-intercalative binding of ctDNA with dapoxetine. Ionic strength studies conducted ruled out the electrostatic binding mechanism between ctDNA and dapoxetine. Molecular docking analysis performed for the dapoxetine with calf thymus DNA (ctDNA) interaction and confirmed minor groove binding of dapoxetine to ctDNA. The study helped to reveal the binding interaction mechanism between dapoxetine and ctDNA

Favorable Changes in Fasting Glucose in a 6-month Self-Monitored Lifestyle Modification Programme Inversely Affects Spexin Levels in Females with Prediabetes

Spexin (SPX) is a novel peptide thought to have a role in various metabolic regulations. Given its presumed body-weight regulatory functions, we aimed to determine whether lifestyle intervention programs on weight loss and fasting glucose (FG) improvement among people with impaired glucose regulation also alter levels of circulating SPX. A total of 160 Saudi adult males and females with prediabetes were randomly selected from a larger cohort (N = 294) who underwent a 6-month lifestyle modification program to improve their glycemic status. Participants were split into two groups based on differences in glucose levels post-intervention, with the first 50% (improved group) having the most significant reduction in FG. SPX was measured at baseline and after 6 months. Changes in SPX was significant only in the improved group [baseline: median (Q1\u2013Q3) of 164 pg/ml (136\u2013227) vs follow-up: 176 pg/ml (146\u2013285); p &lt; 0.01]. When stratified by sex, the significant increase was observed only in females [159 pg/ml (127\u2013252) vs 182.5 (152,369.1); p &lt; 0.01]. Furthermore, SPX levels showed a significant inverse association with FG (\u3b2 = 120.22, p = 0.003) even after adjustment with age and BMI, again only in females. Circulating SPX levels increase over time in people with prediabetes, particularly women who responded favorably in a 6-month lifestyle intervention program. Whether an unknown mechanism regulating the sexual disparity seen in SPX levels post-intervention exists should be further investigated using a larger sample size

Vitamin D deficiency prevalence and predictors in early pregnancy among Arab women

Data regarding the prevalence and predictors of vitamin D deficiency during early pregnancy are limited. This study aims to fill this gap. A total of 578 Saudi women in their 1st trimester of pregnancy were recruited between January 2014 and December 2015 from three tertiary care antenatal clinics in Riyadh, Saudi Arabia. Information collected includes socio-economic, anthropometric, and biochemical data, including serum vitamin D (25(OH)D) levels, intake of calcium and vitamin D, physical activity, and sun exposure indices. Pregnant women with 25(OH)D levels 3.5), low HDL-cholesterol, and living in West Riyadh were significant independent predictors for vitamin D deficiency, with odds ratios (ORs) (95% confidence interval) of 25.4 (5.5–117.3), 17.8 (2.3–138.5), 4.0 (1.7–9.5), 3.3 (1.4–7.9), 2.8 (1.2–6.4), and 2.0 (1.1–3.5), respectively. Factors like increased physical activity, sun exposure at noon, sunrise or sunset, high educational status, and residence in North Riyadh were protective against vitamin D deficiency with ORs 0.2 (0.1–0.5); 0.2 (0.1–0.6); 0.3 (0.1–0.9); and 0.4 (0.2–0.8), respectively. All ORs were adjusted for age, BMI, sun exposure, parity, summer season, vitamin D intake, multivitamin intake, physical activity, education, employment, living in the north, and coverage with clothing. In conclusion, the prevalence of vitamin D deficiency among Saudi women during early pregnancy was high (81%). Timely detection and appropriate supplementation with adequate amounts of vitamin D should reduce the risks of vitamin D deficiency and its complications during pregnancy

Survival Prediction of Children Undergoing Hematopoietic Stem Cell Transplantation Using Different Machine Learning Classifiers by Performing Chi-squared Test and Hyper-parameter Optimization: A Retrospective Analysis

Bone Marrow Transplant, a gradational rescue for a wide range of disorders emanating from the bone marrow, is an efficacious surgical treatment. Several risk factors, such as post-transplant illnesses, new malignancies, and even organ damage, can impair long-term survival. Therefore, technologies like Machine Learning are deployed for investigating the survival prediction of BMT receivers along with the influences that limit their resilience. In this study, an efficient survival classification model is presented in a comprehensive manner, incorporating the Chi-squared feature selection method to address the dimensionality problem and Hyper Parameter Optimization (HPO) to increase accuracy. A synthetic dataset is generated by imputing the missing values, transforming the data using dummy variable encoding, and compressing the dataset from 59 features to the 11 most correlated features using Chi-squared feature selection. The dataset was split into train and test sets at a ratio of 80:20, and the hyperparameters were optimized using Grid Search Cross-Validation. Several supervised ML methods were trained in this regard, like Decision Tree, Random Forest, Logistic Regression, K-Nearest Neighbors, Gradient Boosting Classifier, Ada Boost, and XG Boost. The simulations have been performed for both the default and optimized hyperparameters by using the original and reduced synthetic dataset. After ranking the features using the Chi-squared test, it was observed that the top 11 features with HPO, resulted in the same accuracy of prediction (94.73%) as the entire dataset with default parameters. Moreover, this approach requires less time and resources for predicting the survivability of children undergoing BMT. Hence, the proposed approach may aid in the development of a computer-aided diagnostic system with satisfactory accuracy and minimal computation time by utilizing medical data records.Comment: 25 pages, 14 figures, 38 table

Date Palm Thorn Injury: A Literature Review and a Case Study of Extensive Hand Haematoma.

Date palm thorn injuries require a high level of clinical suspicion and careful management as they can lead to severe complications, such as tissue inflammation, synovitis, and extensive haematoma. Although it is associated with serious injuries, this type of injury is often underdiagnosed and is not sufficiently reported in the literature. We describe a case report of an 18-year-old male patient who presented with significant progressive swelling of the right hand that extended to the distal third of the forearm, having received a date thorn injury the day before. The patient underwent multiple incisions and hand fasciotomy to reduce the haematoma and relieve compartment pressure in his hand