An Unusual Case of Gallbladder Carcinoma with Pseudopancreatic Cyst

Generally, carcinoma of the gallbladder is an extremely unusual neoplasm, however, high incidence rates have been reported in certain parts of the world. The role of certain factors such as genetic susceptibility, lifestyle and infections of gallbladder in causing carcinogenesis is still not clearly understood. Due to its early vague symptoms and lack of serosa in the gallbladder to slow its spread, gallbladder carcinoma typically presents at an advanced stage with a five-year survival rate of less than 5%. Pseudopancreatic cyst is an uncommon but not a rare complication of acute pancreatitis and injury to the pancreas. However, it rarely presents with carcinoma of gallbladder. We present here an unusual case of gallbladder carcinoma with pseudopancreatic cyst in a 58-year old male

A robust framework for ensuring data confidentiality and security in modern healthcare networks

The potential implementation of extensive data sharing in dispersed network systems is likely to give rise to concerns surrounding privacy, secrecy, and authentication inside the realm of cyberspace. The main objective of this work is to safeguard the privacy and confidentiality of data inside an unsecured environment during the exchange of audiovisual content between two Internet of Things (IoT) nodes. To effectively counteract an adversary and guarantee the confidentiality of data, we suggest the implementation of a resilient multi-level security strategy that relies on the principles of information hiding and chaos theory. While certain block-based resilient data concealing strategies based on the transform domain have demonstrated favorable outcomes, their suboptimal block and coefficient selection processes lead to inadequate performance against prevalent cyber-attacks. Therefore, we propose a Robust Framework for Ensuring Data Confidentiality and Security in EHR-based networks using federated-learning with homomorphic-encryption. A differential-privacy technique is used here to increase privacy, which entails adding noise to the aggregated model update. The suggested model outperforms the most recent techniques for data security and secrecy in networks based on electronic health records

Substitution of Recycled Plastic Aggregates (RPA) in concrete and its influence on pullout capacity of mechanical and chemical anchors

There is a lot of plastic going to land fill or entering environmentally sensitive systems, that could ideally be converted into a form or material that would be considered as a resource. Much of this plastic waste is not suitable for re-cycling or use, where exposed to sun light or weathering elements. Some of these materials have been converted to granular materials and used in sub-soil drainage systems as free draining materials and as substitute for aggregates in concrete pavements. There is significant enthusiasm for utilising ‘environmentally friendly’ construction systems and materials. Unfortunately, that enthusiasm can result in them being utilised in in-appropriate situations that can have a negative result to the reputation of the material or system. The aim of this project was to determine if anchors and fixings inserted into Recycled Plastic Aggregates (RPA) concrete elements will perform as expected and required. Proprietary RPAs were procured from a commercial supplier to substitute for natural concrete aggregates in various proportions. Normal and RPA concrete cylindrical samples were manufactured in a controlled environment at USQ lab and subsequently cured for 28 days. The purpose of manufacturing and testing normal concrete samples, involving standard concrete blends, was to provide a reference point when comparing the performance of the RPA concrete systems. Compression tests were performed on both normal and RPA concrete samples using the universal load test machine. On the other larger samples, holes were drilled in the normal and RPA concrete samples to install proprietary mechanical and chemical anchors so pull-out tests could be performed to simulate real life scenario. These pull-out tests were also performed on universal load test machine. The 50% RPA concrete demonstrated significant capacity reduction and to the extent that these rates cannot be sustainable. The 20% RPA concrete has demonstrated reduction in capacities that could conceivably be tolerated in the construction industries. The mechanical anchors were noticeably more affected by the RPA substitution than the chemical anchors. The substitution of recycled plastic provides a sustainable option for offsetting waste plastic going to landfill, thereby reducing environmental pollution. This study develops confidence in the performance of post fixed anchors inserted into low percentage RPA concrete, creates awareness in the industry and supports recycling through buying products which include recycled content in line with Australian Government National Plastic Plan 2021

RADIOLOGICAL AND PATHOLOGICAL CORRELATION OF LUNG NODULES IN A BACKGROUND OF METASTATIC DISEASE

Background: Computed tomography (CT) imaging has improved the chances of detecting small indeterminate (<1 cm) lung nodules. The determination of the underlying malignant or benign nature of a lung nodule poses a great diagnostic challenge and depends on a number of factors, including the radiographic appearance of nodule, the presence of non-pulmonary metastases, characteristics of growth and histological criteria. Methods: The medical records of 89 patients admitted to our specialist cancer centre between 2008 and 2013 were reviewed. Patients of all age groups and tumour category were included in the study. Clinical data of these patients were collected and the following parameters were analysed: Radiographic diagnosis, location, size, laterality and number of nodules and histological impression. The radiological findings were then correlated with histopathological findings. The nodules were sub-classified into groups on the basis of size (A = 0–0.5 cm; B = 0.5–0.9 cm; C = 1.0–1.5 cm and D = >1.5 cm). Results: CT scan reports of 89 patients with lung nodules were reviewed. On radiology, 73/89 (82%) were reported to be malignant nodule. Histopathological review of the biopsies of these 89 nodules confirmed malignancy in 50/89 (56.2%) patients. CT scan was found to be highly sensitive (94%, 95% confidence interval [CI]: 83.43–98.68%) but with a very low specificity (33.3%, 95% CI: 19.10–50.22%). CT scan was found to have a higher negative predictive value (81.2%, 95% CI: 54.34–95.73%) and a lower positive predictive value 64.4% (95% CI: 52.31–75.25%) when correlated with histopathological findings. Pathology of these nodules included metastatic sarcoma (27/89; 30.3%) and carcinoma (18/89; 20.2%). The frequency of the biopsy-proven malignant nodules on the right side was 26/45 (57.8%) and on the left side was 24/44 (54.5%) (P = 0.832). Malignant nodules were more frequent in lower lobes (28/43, 65.1%) than in upper lobes (14/32, 43.8%). These two sites combined accounted for 84% of all malignant nodules. There was a significant correlation between nodule size and likelihood of underlying malignancy. The overall prevalence of malignancy in the larger nodules (C and D) was much higher (23/30 and 76.7%) compared to the smaller sized (A and B) nodules (27/58 and 46.8%), P < 0.05.Conclusion: CT scan is a useful tool in the initial clinical assessment of indeterminate lung nodules with high sensitivity (94%) and a high negative predictive value (81.2%).Key words: Computed tomography, fibrosis, indeterminate lung nodule, infection, lung nodule, malignancy, metastase

BOL: POVIJEST, KULTURA I FILOZOFIJA

Pain, one of the universals of existence, has a long and venerable history, its origin initially attributed to godly punishment for disbelievers; and, with improved understanding, to physical and psycho-social factors. “Pain is emotion or sensation?” has been a debatable issue. Razes developed pleasure-pain theory, founded on the theories of Socrates, Plato, Aristotle and Epicurus. Descartes’ Dualism shifted the centre of pain from the heart to the brain but negated the psychological contribution to its pathogenesis. Gate Control Theory, fascinated with the idea of “neurological gates”, highlighted the important role of the brain in dealing with the messages received. The International Association of the Study of Pain, in 1979, coined a definition of pain which is currently in use and was last updated on 6th October 2014. Its validity has been challenged and a new definition has been suggested. Whereas the experience is personalized, immeasurable and unsharable, different cultural groups react differently to pain from relative tolerance to over-reaction. Gender and ethnic differences in the perception of pain are well proven and the effects of various religious beliefs adequately scored. Despite extensive research over centuries, understanding of pain mechanisms is still far from optimal. Untiring efforts to identify a paincentre in the brain have been futile. Had it been possible, millions of pain sufferers would have been relieved of their physical agony and mental anguish by the prick of needle.Bol, jedna od univerzalija egzistencije, ima dugu i štovanja vrijednu prošlost, čiji se izvori mogu primarno pripisati božjoj kazni za nevjerne; i s unaprijeđenim shvaćanjem fizičkog i psihosocijalnog. “Da li je bol osjećaj ili utisak?” pitanje je za raspravu. Razes je razvio teoriju zadovoljstva-boli, na temeljima Sokratove, Platonove, Aristotelove i Epikurove teorije. Descarteov dualizam premjestio je centar boli sa srca na mozak, ali je negirao psihološki doprinos u patogenezi. Teorija ulaznih vrata (Gate Control Theory) fascinirana idejom “neuroloških ulaznih vrata” pokazala je važnu ulogu mozga u prenošenju poruka. Nepobitnost njenih pojedinih elemenata bila je dovedena u pitanje, te je predložena alternativa, nova definicija. Međutim iskustvo je osobno, nemjerljivo i nedjeljivo, različite kulturološke skupine različito reagiraju na bol: od relativne tolerancije do pretjeranih reakcija. Spolne i etničke razlike u percepciji boli jasno su dokazane, kao što su adekvatno zabilježeni učinci različitih vjerskih uvjerenja na nju. Unatoč višestoljetnim opsežnim istraživanjima, razumijevanje mehanizma boli, vrlo je udaljeno od optimalne razine

IBN SINA (AVICENA) I KORIJENI SEDAM DOKTRINA ODRŽAVANJA ZDRAVLJA

Ibn Sina, the most eminent Muslim physician, illuminative philosopher, great thinker and a versatile genius is regarded as the “Father of Early Modern Medicine” and as the “Father of Clinical Pharmacology”. The “Kitab al-Qanun fi-al-Tibb”, commonly known as the “Canon Medicinae” is the most important of his medical works and, at the same time, the most carefully preserved treasury both in original Arabic and in the initial Latin version. It is the final codification of all Greco-Arabic medical thoughts up to his time, enriched and modified with his own scientific experimentations and independent observations. It is considered “The First Textbook of Medicine on the Earth”. The “Canon” surpassed the books of Hippocrates and Galen and remained supreme for more than six centuries, in the West. Ibn Sina described “Seven Doctrines” for Preservation of Health, based on the Mudawa Salookia, in his magnum opus. The roots of these principles can be traced, to a significant extent, to Egyptian Medicine, Hebrew Medicine, Greek Medicine, Roman Medicine, Traditional Chinese Medicine, Ancient Persian Medicine, Ayurvedic Medicine (Hindu Medicine) and Islamic Medicine.Avicena (Ibn Sina), najugledniji muslimanski liječnik, prosvijećeni filozof, veliki mislilac i svestrani genij, smatra se na polju medicine “ocem rane moderne medicine” i “ocem kliničke farmakologije”. Kitabal-Qanunfi-al-Tibb, općepoznat kao Canon Medicinae, najvažnije je od njegovih medicinskih djela te istovremeno najpomnije očuvana riznica i u izvornoj i u prvoj latinskoj verziji. To je konačna kodifikacija grčkoarapske medicinske misli do njegova vremena, obogaćena i dopunjena njegovim vlastitim znanstvenim ispitivanjima i neovisnim promatranjima; smatrana “prvim udžbenikom medicine na Zemlji”. Canon je nadmašio Hipokratove i Galenove knjige i ostao vrhovni autoritet na Zapadu više od šest stoljeća. Avicena je opisao “Sedam doktrina” za održavanje zdravlja u svom remek-djelu Mudawa Salookia. Korijeni tih principa mogu se naći u egipatskoj, hebrejskoj, grčkoj, rimskoj, kineskoj, staroperzijskoj, indijskoj i islamskoj medicini

To identify the features differentiating peritoneal tuberculosis from carcinomatosis on CT scan abdomen taking omental biopsy as a gold standard

OBJECTIVE: To differentiate peritoneal tuberculosis from carcinomatosis on computed tomography scan of abdomen, taking omental biopsy as the gold standard.. METHODS: This retrospective diagnostic accuracy review of cases was conducted at Aga Khan University Hospital, Karachi, and comprised patient\u27s medical record files from February 2007 to February 2016. Computed tomography scan findings were compared with diagnosis made on the basis of histopathology. Multiple logistics regression analysis was done and sensitivity and specificity were tested through Pearson chi square test. RESULTS: Of the 98 patients identified, 62(63.2%)were found to be cases of disseminated tuberculosis and 36(36.7%) were diagnosed as malignant on histopathology. Computed tomography features were significantly specific to differentiate abdominal tuberculosis from carcinomatosis (p=0.004). On computed tomography,4 findings showed statistical significance: Smooth thickening of the peritoneum (p\u3c0.001), abdominal mass (p=0.03), lymph node necrosis (p=0.024) and high-density ascitic fluid (p\u3c0.001). Out of these, smooth thickening of the peritoneum (sensitivity=77%; specificity=86.1%) and high-density ascitic fluid (sensitivity=68.9%; specificity=72.2%) were more specific findings. Overall, the sensitivity and specificity of computed tomography was found to be 88.5% and 83.3%, respectively. CONCLUSIONS: Although no single finding on a computed tomography scan was diagnostic proof of peritoneal tuberculosis, a combination of findings could reliably distinguish between peritoneal tuberculosis and carcinomatosis

Groundwater-food security nexus under changing climate-historical prospective of Indus basin irrigation system in Pakistan

Irrigated agriculture plays a vital role in the economy of Pakistan by contributing about 90% of food production, 22% of GDP, employing about 45% of the overall labor force, and generating over 60% of foreign exchange. The role of water resources has become significant which underpins the food security in the country. Indus Basin Irrigation System (IBIS) is the lifeline for the economy of Pakistan and is the major pillar of food security. IBIS is one of the largest irrigation networks in the world and is confronted with multidimensional challenges out of which climate changes have attained paramount importance. The irrigation system was designed on a 67% irrigation system during the 19th century while the current cropping intensity has crossed the limits of 150-160% or even more. Continuous increase in population and consequently more food demands have shifted the pressure on the aquifer underlying the Indus Basin. India, USA & China, and Pakistan has become the 4th largest user of groundwater where about 40% of irrigated food production is dependent on groundwater. In Punjab province, about 1.2 million tubewells are extracting about 40-45 MAF of groundwater annually. Consequently, groundwater management has confronted a multitude of tiny users in Pakistan. Climatic changes have made the availability and reliability of surface water a question mark. Resultantly pressure on groundwater is increasing and water levels are dropping abruptly taking this resource beyond the bounds of rural poor farmers. The intrusion of saline water into the fresh aquifer, secondary salinity, and seawater intrusion are the major threats to groundwater quality.  About 3000 piezometers have been installed to monitor groundwater behavior (levels and quality) in the Punjab province. A research study carried out in Lower Bari Doab Canal (LBDC) has indicated that by falling of water table from 40 to 70 ft. the cost of pumping per acre-feet of groundwater has increased by 125%.  Similarly, it has been observed that in many urban areas groundwater is depleting at an annual alarming rate of 2.54 ft., (Lahore city) and the water table in sweet water zones in rural areas (Vehari District) has gone beyond 70-90 ft. Human activities like increasing cropping intensities, unplanned over pumpage, lack of awareness/capacity, use of chemicals in agriculture/food production, industrialization, urbanization, solid waste landfills, domestic effluents, lack of legal and regulatory framework, etc. are the major threats to sustainable use of groundwater for food security. Climatic changes are posing severe adverse impacts on the sustainable use of groundwater which is putting food security under threat. Global warming, rising sea levels, glacier melting, unprecedented rainfall, prolonged droughts, and floods are the consequences of changing climate which are affecting directly or indirectly the groundwater resources in the aquifer underlying the Indus Basin