Recurrent acute pancreatitis due to a santorinicele in a young patient

A cystic dilatation of the terminal portion of the minor pancreatic duct (duct of Santorini) is referred to as a santorinicele. It is usually associated with pancreas divisum and has been suggested to be a cause of relative stenosis of the minor papilla, often leading to recurrent pancreatitis. While this anomaly has been reported in the paediatric population, it is more commonly found in the elderly. We present a 27-year-old woman with recurrent acute pancreatitis attributed to a santorinicele with a dorsal duct-exclusive pancreatic drainage

Hydatidosis: experience with hepatic and pulmonary hydatid disease

From 1989-1992, 35 cases comprising of 20 hepatic and 15 pulmonary hydatid cysts were seen. Four patients with pulmonary hydatid disease had previous or concomitant hepatic hydatidosis compared to no concomitant pulmonary hydatid disease in the hepatic group. Hepatic hydatid disease had a greater tendency to be right sides, infected and calcified. Anaphylactic reactions occurred in 3 of 20 patients with hepatic hydatid disease against none in 15 patients with pulmonary disease. Management consisted of evacuation, drainage and obliteration of the residual cavity by capittonage in the lung and omentoplasty in the liver. Two patients, one hepatic and one with pulmonary hydatid disease developed infection of the residual cavity. Bronchocystic fistula occurred in 4 pulmonary and cystobiliary fistula in 2 hepatic hydatid disease patients. One patient with severe pleuropulmonary hydatidosis required a thoracoplasty. No recurrences have been noted in either group over a mean follow-up of 11 months (range 3 weeks- 3 years)

Retained stones in the common bile duct: results of management

Seventeen patients underwent treatment for retained common bile duct stones. In 7 patients the stones were removed via a T-tube tract using steerable catheters while 5 patients underwent ERCP and sphincterotomy and 5 underwent surgical re-exploration. Considering morbidity, mortality, success rate and patients\u27 stay in the hospital, non-operative modalities should be the treatment of choice for retained common bile duct stones

Conversion from laparoscopic to open cholecystectomy: multivariate analysis of preoperative risk factors

Background: Laparoscopic cholecystectomy has become the gold standard in the treatment of symptomatic cholelithiasis. Some patients require conversion to open surgery and several preoperative variables have been identified as risk factors that are helpful in predicting the probability of conversion. However, there is a need to devise a risk-scoring system based on the identified risk factors to (a) predict the risk of conversion preoperatively for selected patients, (b) prepare the patient psychologically, (c) arrange operating schedules accordingly, and (d) minimize the procedure-related cost and help overcome financial constraints, which is a significant problem in developing countries.AIM: This study was aimed to evaluate preoperative risk factors for conversion from laparoscopic to open cholecystectomy in our setting.SETTINGS AND DESIGNS: A case control study of patients who underwent laparoscopic surgery from January 1997 to December 2001 was conducted at the Aga Khan University Hospital, Karachi, Pakistan.MATERIALS AND Methods: All those patients who were converted to open surgery (n = 73) were enrolled as cases. Two controls who had successful laparoscopic surgery (n = 146) were matched with each case for operating surgeon and closest date of surgery.STATISTICAL ANALYSIS USED: Descriptive statistics were computed and, univariate and multivariate analysis was done through multiple logistic regression.Results: The final multivariate model identified two risk factors for conversion: ultrasonographic signs of inflammation (adjusted odds ratio [aOR] = 8.5; 95% confidence interval [CI]: 3.3, 21.9) and age \u3e 60 years (aOR = 8.1; 95% CI: 2.9, 22.2) after adjusting for physical signs, alkaline phosphatase and BMI levels.CONCLUSION: Preoperative risk factors evaluated by the present study confirm the likelihood of conversion. Recognition of these factors is important for understanding the characteristics of patients at a higher risk of conversion

The Association Between Borna Disease Virus and Chronic Fatigue Syndrome: A Systematic Review and Meta-Analysis

Context: Several studies have controversial results regarding the association between Borna disease virus (BDV) and chronic fatigue syndrome (CFS). The present systematic review and meta-analysis investigated the association between CFS and BDV. Evidence Acquisition: The present study was conducted based on the PRISMA guidelines for systematic review and meta-analysis studies. To avoid bias, all procedures of the study were performed by two researchers independently. A comprehensive search was performed using online databases, including PubMed, Scopus, Embase, PsycINFO, science Direct, Cochrane Library, web of science, and Google scholar using the MeSH keywords until December 12th, 2016. Heterogeneity among studies was evaluated using Cochran's Q test I-2 Index. Finally, the random effect model was used for combined Odds Ratio (OR) using Review Manger software version 5.3.5. Results: Among 9 eligible studies comprising 610 cases and 2176 controls, the total OR for association between BDV and CFS was estimated to be 10.41 (95 confidence interval CI: 4.24 - 25.55, P < 0.0001). For subgroup analysis by the diagnostic methods (ELISA, RT-PCR, and Western blot), OR was 2.47 (95% CI: 0.77 - 7.96, P=0.13), 12.20 (95% CI: 1.66 - 89.57, P=0.01), and 28.36 (95% CI: 3.76- 213.85, P=0.001), respectively (test for subgroup differences: P=0.08; I-2=59.5). Subgroup analysis for BDV and CFS association by antigens and antibodies had an OR of 12.20 (1.66, 89.57) and 8.20 (3.32, 20.22), respectively (test for subgroup differences: P=0.72; I-2=0). Conclusions: This study supports the association between BDV and CFS and shows the role of viral agents in etiology of CFS. Therefore, viral agents may play a role in the etiology of neuropsychiatric disorders

Multiscale Fluctuation Dispersion Entropy of EEG as a Physiological Biomarker of Schizotypy

Altered electroencephalography (EEG) activity in schizotypal individuals is a powerful indicator of proneness towards psychosis. This alteration is beyond decreased alpha power often measured in resting state EEG. Multiscale fluctuation dispersion entropy (MFDE) measures the non-linear complexity of the fluctuations of EEGs and is a more effective approach compared to the traditional linear power spectral density (PSD) measures of EEG activity in patients with neurodegenerative disorders. In this study, we applied MFDE to EEG signals to distinguish high schizotypy (HS) and low schizotypy (LS) individuals. The study includes several trials from 29 participants psychometrically classified as HS (n=19) and LS (n=10). After preprocessing, MFDE was computed in frontal, parietal, central, temporal and occipital regions for each participant at multiple time scales. Statistical analysis and machine learning algorithms were used to calculate the differences in MFDE measures between the HS and LS groups. Our findings revealed significant differences in MFDE measures between LS and HS individuals in the delta frequency band (at time scale 100 ms). HS individuals exhibited increased complexity and irregularity compared to LS individuals in the delta frequency band particularly in the occipital region. Furthermore, the MFDE measures resulted in high accuracy (96.55%) in discriminating between HS and LS individuals and outperformed the models based on power spectrum, demonstrating the potential of MFDE as a neurophysiological marker for schizotypy traits. The increased non-linear fluctuation in delta frequency band in the occipital region of HS individuals implies the changes in cognitive functions, such as memory and attention, and has significant potential as a biomarker for schizotypy and proneness towards psychosis

Perspectives of faculty members toward Iranian National Olympiad for medical students: A qualitative study

Objective - Regarding to the status of medical science Olympiads in medical science pedagogy, the views of beneficiaries are needed to be examined on them, in particular, faculty members who are the most interested group in the given issue. As such, the purpose of this study is the evaluation of views of the faculty members on the mission and performance of medical science Olympiads in Iran. Material and Methods - The data for this qualitative study were collected through semi-structured interviews and then were analyzed using the content-analysis method. Finally, 95 members of faculty board were selected from universities of medical sciences in Iran and data collection continued till data saturation. Results - Four themes including: points of strength in Olympiads, points of weakness in Olympiads, attitudes of faculty members to Olympiads, and suggestions for better performance of the Olympiads were extracted. The points of strength consisted of: mission, the performing procedures, and the scientific level of the competitions. The points of weakness included: mission, the performing procedures, and the scientific level of the competitions. Most of the participants (79) had positive attitude toward the Olympiads. Participants presented 8 strategies in order to manage the competitions better. Conclusion - It necessary to do more researches to identify the related problems and to use the required. Applying instructor's points and views on the strengths, weakness, and suggestions can be efficient in policy making, designing and performing medical Olympiads. © 2016, Azami-Aghdash S., Ghojazadeh M., Nazavar R., Yaghoubi S., Vahedi L

Development and evaluation of massive open online course (MOOC) as a supplementary learning tool: an initial study

The popularity of Massive Open Online Courses (MOOCs) is prevalent among researchers and practitioners as a new paradigm of open education resource. Since the development of this technology may entail enormous investment, it is critical for institutions to clearly plan the process in designing, developing and evaluating MOOCs that fulfill the needs of target users while keeping the investment to a minimum. Evaluation plays a vital role in assuring that the developed product meets user's satisfaction. This study presents the process of developing a MOOC as a supplementary learning tool for students in a higher education and its usability evaluation which are rarely discussed in detail in prior literatures. Evaluation was done through a questionnaire and the items were adapted from Computer System Usability Questionnaire (CSUQ). The MOOC development process in this research which was based on the ADDIE (Analysis, Design, Development, Implementation and Evaluation) model and the MOOC usability evaluation results enrich existing literatures on MOOC. Overall, findings showed that users were satisfied with the developed MOOC with most of the items gained high mean score above 4.00. When respondents were asked to comment on the strength of the MOOC, the most prominent one turned out to be the MOOC's ability to make students' learning easier

Enhancement of Edge-based Image Quality Measures Using Entropy for Histogram Equalization-based Contrast Enhancement Techniques

An Edge-based image quality measure (IQM) technique for the assessment of histogram equalization (HE)-based contrast enhancement techniques has been proposed that outperforms the Absolute Mean Brightness Error (AMBE) and Entropy which are the most commonly used IQMs to evaluate Histogram Equalization based techniques, and also the two prominent fidelity-based IQMs which are Multi-Scale Structural Similarity (MSSIM) and Information Fidelity Criterion-based (IFC) measures. The statistical evaluation results show that the Edge-based IQM, which was designed for detecting noise artifacts distortion, has a Person Correlation Coefficient (PCC) > 0.86 while the others have poor or fair correlation to human opinion, considering the Human Visual Perception (HVP). Based on HVP, this paper propose an enhancement to classic Edge-based IQM by taking into account the brightness saturation distortion which is the most prominent distortion in HE-based contrast enhancement techniques. It is tested and found to have significantly well correlation (PCC > 0.87, Spearman rank order correlation coefficient (SROCC) > 0.92, Root Mean Squared Error (RMSE) < 0.1054, and Outlier Ratio (OR) = 0%)

The application of taḥawwul (transformation) process for determination of vinegar status in the Malaysia market

Taḥawwul is a changing process of a form to another form thus could affect the status of a particular ḥukm especially in vinegar products. Vinegar which produced before the taḥawwul ṣaḥīḥ can be considered as low-quality vinegar and is classified as fasīd vinegar (ḥarām) due to the presences of alcohol which is prohibited in Islam. Therefore, in this study, twenty-five different types of vinegar in Malaysian market were tested using Gas Chromatography attached with Flame Ionization Detector (HS-GC-FID) with Head Space Analyzer (HS-10) and Gas Chromatography (GC) with time of flight mass spectrometry (TOF-MS) to find out the contents of alcohol and acetic acids present in the said vinegar products. The results showed that majority of the sample were ḥalāl. However, there were two types of vinegar that were not considered ḥalāl because these products did not go through a complete process of (taḥawwul ṣaḥīḥ)