Validity of point-of-care device for diagnosing anemia in workers exposed to lead

Detecting anemia in occupational health settings is critical in a high-risk population for anemia like the lead-exposed. Whether the point-of-care devices are sensitive to detect anemia in individuals with high levels of lead exposure is unknown. We compared hemoglobin (Hb) levels from HemoCue® Hb 301 System and standard analyzer, Mindrey-BC 5300, in individuals (n=58) exposed to lead (mean levels = 44.9 ?g/dL) for a chronic period (mean duration of exposure = 105 months). We observed high sensitivity (0.95), specificity(0.95) in detecting anemia by hemocue, and high agreement between the methods. The significant difference in Hb values between the methods (0.171g/dL, p=0.018) was clinically minimal. We conclude that hemocue is a good method for rapidly detecting anemia and estimating Hb levels among the lead-exposed in resource-limited settings

Assessment of Educational Environment of Newly Established Medical College by UG Medical Students: A Mixed Method Study

Introduction: Educational environment always play a crucial role in the development of students as well as faculty of any institution. In India, there is a continuous increase in the number of medical colleges and the number of MBBS seats, but the quality of education with quantity is questionable. To answer this question, the present study was planned to know the educational environment in a new Medical Institution that ejected its alumni in 2018. Aim: To analyze the educational environment of a newly established Medical College in eastern Uttar Pradesh. Materials and Methods: The present study was a descriptive cross-sectional which took six months to complete. This study used the Dundee Ready Education Environment Measure (DREEM) questionnaire, open-ended questions and focus group discussions (FGDs). The study was conducted on MBBS students in Government Medical College, Azamgarh, UP. Results: The batch-wise Global DREEM scores were 169.08 (alumni), 156.23 (interns), 168.76 (2015), 164.16 (2016), 176.23 (2017), 176.94 (2018). This demonstrates that the educational environment is satisfactory in all domains and comes under the 3rd category of the educational environment index. The FGDs showed a positive response in all batches but with high variability in scores, which indicates lack of standardization in Medical Education. The open-ended questions’ responses revealed many merits and demerits about five domains. Conclusion: The variability of DREEM score, FGDs and open ended questions denotes the lack of standardization in the Medical Education system and the scores of the Education Environment Index (all domains) must move from category III (satisfactory) to category IV (excellence)

A Review on Most Opthalmic Viral Disease Conjunctivitivs (Eye Flu)

Ophthalmology clinics around the world see a lot of patients with conjunctivitis. Severe pain, impaired vision, and a painful pupillary reaction are all red flags for more serious intraocular disorders that should be taken into account while treating suspected cases of conjunctivitis. In patients with unusual findings and a chronic course, it is also important to have a complete medical and ocular history and do a comprehensive physical examination. The existence of a systemic ailment affecting the conjunctiva may be shown by concurrent findings on physical exam and pertinent history. The vast majority of cases of conjunctivitis still originate from viruses. Bacterial conjunctivitis is the second most prevalent cause of infectious conjunctivitis; however it is much less common than viral conjunctivitis. Nearly half of the population experiences allergic conjunctivitis, characterised by symptoms like itching, mucoid discharge, chemosis, and edoema of the eyelids. A patient with conjunctival irritation and discharge who has used preservative-containing eye drops regularly likely has toxic conjunctivitis. Timely diagnosis, proper classification of the various aetiologies, and suitable treatment are essential components of effective management of conjunctivitis

Coexistence of carcinoma cheek with tuberculosis: a rarity

Coexistence of tuberculosis and cheek malignancy is a rare phenomenon and it has never been reported to the best of our knowledge. Here, we present a case of carcinoma cheek with tuberculosis in a 50 year old male patient who was successfully managed by multimodality approach by combining anti-tubercular therapy with chemotherapy and radiotherapy

Reversible Inferolateral ST-Segment Elevation Associated with Small Bowel Obstruction

ST-segment elevation is an important and alarming electrocardiographic sign that necessitates immediate attention but does not always indicate that the primary pathology is cardiac in origin. It needs to be interpreted in the clinical context as several pathological conditions involving especially gastrointestinal tract may lead to delayed diagnosis and treatment as well as complications from invasive unnecessary interventions. We present two patients, a 64-year-old male and a 71-year-old female, who were admitted to the emergency room of a community-based hospital with similar complaints of worsening epigastric abdominal pain and were diagnosed later with small bowel obstruction. Both patients reported a history of abdominal surgeries in the past. Also in both patients the ECG showed signs of ST-segment elevation in inferior and lateral leads. These ECG changes were related to the intra-abdominal pathology as no evidence of contributing coronary artery disease could be found. In addition, prompt resolution of ST-segment elevation was seen after surgical treatment. The pathophysiological etiology of electrocardiographic changes accompanying small bowel obstruction is yet to be explored

Corynebacterium propinquum

Nondiphtheria Corynebacterium species are often dismissed as culture contaminants, but they have recently become increasingly recognized as pathologic organisms. We present the case of a 48-year-old male patient on chronic prednisone therapy for rheumatoid arthritis with a history of mitral valve replacement with prosthetic valve. He presented with fever, dizziness, dyspnea on exertion, intermittent chest pain, and palpitations. Transesophageal echocardiography revealed two medium-sized densities along the inner aspect of the sewing ring and one larger density along the atrial surface of the sewing ring consistent with vegetation. Two separate blood cultures grew Corynebacterium propinquum, which were sensitive to ceftriaxone but highly resistant to vancomycin and daptomycin. The patient completed a course of ceftriaxone and repeat TEE study and after 6 weeks demonstrated near complete resolution of the vegetation. To our knowledge, this case represents the first in the literature of Corynebacterium propinquum causing prosthetic valve endocarditis. The ability of these organisms to cause deep-seated systemic infections should be recognized, especially in immune-compromised patients

Association of Immune Checkpoint Inhibitors With Neurologic Adverse Events: A Systematic Review and Meta-analysis.

Importance: Neurologic adverse events (NAEs) due to immune checkpoint inhibitors (ICIs) can be fatal but are underexplored. Objective: To compare NAEs reported in randomized clinical trials (RCTs) of US Food and Drug Administration-approved ICIs with other forms of chemotherapy and placebo. Data Sources: Bibliographic databases (Embase, Ovid, MEDLINE, and Scopus data) and trial registries (ClinicalTrials.gov) were searched from inception through March 1, 2020. Study Selection: Phase II/III RCTs evaluating the use of ICIs were eligible for inclusion. Unpublished trials were excluded from the analysis. Data Extraction and Synthesis: Two investigators independently performed screening of trials using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline. NAEs were recorded for each arm. Data were pooled using a random-effects model. Main Outcomes and Measures: The risk of NAEs with ICI use compared with any drug regimen, cytotoxic chemotherapy, and placebo. Results: A total 39 trials including 23 705 patients were analyzed (16 135 [68.0%] men, 7866 [33.1%] White). The overall risk of a NAE was lower in the ICI group (risk ratio [RR], 0.59; 95% CI, 0.45-0.77) and in the subgroup of RCTs comparing ICI use with chemotherapy (RR, 0.22; 95% CI, 0.13-0.39). In the subgroup of RCTs comparing ICI with placebo, the overall risk of NAE was significantly higher in the ICI group (RR, 1.57; 95% CI, 1.30-1.89). Peripheral neuropathy (RR, 0.30; 95% CI, 0.17-0.51) and dysgeusia (RR, 0.41; 95% CI, 0.27-0.63) were significantly lower in the ICI group. Headache was more common with the use of ICIs (RR, 1.32; 95% CI, 1.10-1.59). In the subgroup analysis of RCTs comparing ICI use with chemotherapy, peripheral neuropathy (RR, 0.09; 95% CI, 0.05-0.17), dysgeusia (RR, 0.42; 95% CI, 0.21-0.85), and paresthesia (RR, 0.29; 95% CI, 0.13-0.67) were significantly lower in the ICI group. RCTs comparing ICIs with placebo showed a higher risk of headache with ICI use (RR, 1.63; 95%, CI, 1.32-2.02). Conclusions and Relevance: Results of this meta-analysis suggest that the overall risk of NAEs, peripheral neuropathy, and dysgeusia is lower with the use of ICI. When compared with chemotherapy, the overall risk of NAE, peripheral neuropathy, paresthesia, and dysgeusia was lower with ICI use; however, when compared with placebo, the risk of NAEs is higher with the use of ICI

AutoMix: Automatically Mixing Language Models

Large language models (LLMs) are now available in various sizes and configurations from cloud API providers. While this diversity offers a broad spectrum of choices, effectively leveraging the options to optimize computational cost and performance remains challenging. In this work, we present AutoMix, an approach that strategically routes queries to larger LMs, based on the approximate correctness of outputs from a smaller LM. Central to AutoMix is a few-shot self-verification mechanism, which estimates the reliability of its own outputs without requiring training. Given that verifications can be noisy, we employ a meta verifier in AutoMix to refine the accuracy of these assessments. Our experiments using LLAMA2-13/70B, on five context-grounded reasoning datasets demonstrate that AutoMix surpasses established baselines, improving the incremental benefit per cost by up to 89%. Our code and data are available at https://github.com/automix-llm/automix.Comment: The first two authors contributed equally. Work started and partly done during Aman's internship at Google. This version adds results on mixing 3 models, and will be presented at the workshop on robustness of zero/few-shot learning in foundation models, Neurips 202

Medical Science The International Weekly Journal for Medicine The International Weekly Journal for Medicine

The initial clinical definition of DAI was posttraumatic loss of consciousness lasting longer than six hours. It was presumed in cases in which no mass lesion was present to explain the coma (Singleton et al. 2008). Classical cerebral concussion results in loss of consciousness which is transient and reversible –in a somewhat, arbitrary definition, the patient returns to full consciousness by six hours, although it is usually much sooner (Raj K Narayan, 1994)

The Root Causes of Lumbar Canal Stenosis: An Insight with a Narrative Review

In the older population, lumbar spinal stenosis is a frequent degenerative condition that can cause clinical symptoms such as neurogenic claudication or sciatica, either with or without low back pain. Anatomically, there are three different forms of lumbar spinal stenosis: central, foraminal, and lateral recess. The relationship between Ligamentum Flavum (LF) hypertrophy and mechanical stress, as seen in segmental instability or disc space expansion, and their correlation with lumbar facet joint arthropathy is still not clear. This review places particular emphasis on the causes like LF hypertrophy, lumbar segmental instability, lumbar segmental motion, disc degeneration, lumbar spine facet joint orientation, facet joint tropism and facet joint Osteoarthritis (OA) in Lumbar Canal Stenosis (LCS) studied in various different studies discovered in various other search databases. The present research will also help surgeons and radiologists to interpret neuroradiological data appropriately for surgery as well as non surgical treatment and get a better knowledge of the architecture of these structures and how they appear on neuroimaging investigations for further proper and apt management of LCS. Additionally, it would assist in creating a diagnostic algorithm for better functional results