Portal Vein Aneurysm: Incidental Detection of Uncommon Entity as Cause of Chronic Abdominal Pain

Portal vein aneurysm is an uncommon anomaly. Both congenital and acquired cases are reported. We report a case of idiopathic probably congenital portal vein aneurysm incidentally detected on contrast CT. There was no evidence of any chronic liver disease or portal hypertension in this patient

Predictors of acute myocardial infarct size in STEMI patients receiving thrombolytic therapy: A delayed contrast enhanced cardiac MRI study

AbstractIntroductionDelayed contrast enhanced Cardiac MRI has been accepted as a standard tool worldwide for determination of infarcted myocardium and viability. Infarct size as determined by cardiac MRI has important therapeutic and prognostic information.MethodsTwenty six STEMI patients who had received thrombolytic therapy were subjected to cardiac MRI assessment at 5–7 day of admission. Base line variables of the study population were compared with the acute infarct size as determined by the Cardiac MRI.ResultsThe mean acute infarct size in our study population was 27.2 ± 17.4% of LV. We found through univariate analysis that final infarct size was dependent on time to thrombolysis (p = 0.04), Status of Thrombolysis (p = 0.01), smoking status (p = 0.02), location of infarct (p < 0.00001), presence of microvascular obstruction (p = 0.01) and viability status (p = 0.0004). Thus, larger acute infarct size was seen in delayed time to thrombolysis, failed status of thrombolysis, smokers, anterior location of the infarct, presence of microvascular obstruction and non viable myocardial status.ConclusionInfarct size as determined by Cardiac MRI has been shown to carry important therapeutic and prognostic information. We have tried to evaluate predictors of acute infarct on cardiac MRI in STEMI patients during their initial hospital stay. Knowing the predictors of acute infarct size can help in early intervention and provide prognostic information for future cardiac events

Association of body mass index, hand grip strength and quality of life with response to anti-tubercular therapy in adult patients of pulmonary and extra-pulmonary tuberculosis

Background: Monitoring of anti-tubercular therapy (ATT) response necessary for successful completion of ATT regimen. Presently available monitoring tools are invasive and have limitations. This study undertaken to see whether non-invasive tools like body mass index (BMI), hand grip strength (HGS) and quality of life (QOL) can serve as a reliable tool for monitoring ATT response.Methods: The 50 patients of tuberculosis were monitored for BMI, HGS and QOL via WHOQOL-BREF questionnaire and analyzed at baseline, 2 months and 6 months of starting ATT.Results: BMI HGS increased significantly at 2 months and 6 months compared to baseline with ATT. Physical and social domain of WHOQOL-BREF increased at 2 and 6 months with ATT, other domains shown no significant changes.Conclusions: Monitoring of BMI, handgrip strength and QOL can be a cost-effective tool for monitoring ATT response, both in pulmonary and extra pulmonary tuberculosis

THE COVID-19 Pandemic's Impact on Academic Practices and Learning Quality in Higher Education

The inclusion of several new models and methods had been taken into consideration by the educational institutes and organisations to battle the negative impact of the COVID-19 pandemic across the educational paradigm. The study looked into the research questions and the research objectives which were based on the core topic of the study. With the help of the section of the literature review, the examination of the past research was looked into. The provision of the themes and concepts was done through the integration of data from secondary sources and the qualitative research method was implemented. The future scope of the study and the limitations of the respective assignment was also jotted down

Preservation of Sensitive Data Using Multi-Level Blockchain-based Secured Framework for Edge Network Devices

The proliferation of IoT devices has influenced end users in several aspects. Yottabytes (YB) of information are being produced in the IoT environs because of the ever-increasing utilization capacity of the Internet. Since sensitive information, as well as privacy problems, always seem to be an unsolved problem, even with best-in-class in-formation governance standards, it is difficult to bolster defensive security capabilities. Secure data sharing across disparate systems is made possible by blockchain technology, which operates on a decentralized computing paradigm. In the ever-changing IoT environments, blockchain technology provides irreversibility (immutability) usage across a wide range of services and use cases. Therefore, blockchain technology can be leveraged to securely hold private information, even in the dynamicity context of the IoT. However, as the rate of change in IoT networks accelerates, every potential weak point in the system is exposed, making it more challenging to keep sensitive data se-cure. In this study, we adopted a Multi-level Blockchain-based Secured Framework (M-BSF) to provide multi-level protection for sensitive data in the face of threats to IoT-based networking systems. The envisioned M-BSF framework incorporates edge-level, fog-level, and cloud-level security. At edge- and fog-level security, baby kyber and scaling kyber cryptosystems are applied to ensure data preservation. Kyber is a cryptosystem scheme that adopts public-key encryption and private-key decryption processes. Each block of the blockchain uses the cloud-based Argon-2di hashing method for cloud-level data storage, providing the highest level of confidentiality. Argon-2di is a stable hashing algorithm that uses a hybrid approach to access the memory that relied on dependent and independent memory features. Based on the attack-resistant rate (> 96%), computational cost (in time), and other main metrics, the proposed M-BSF security architecture appears to be an acceptable alternative to the current methodologies

Pediatric Cushing disease: disparities in disease severity and outcomes in the Hispanic and African-American populations.

BackgroundLittle is known about the contribution of racial and socioeconomic disparities to severity and outcomes in children with Cushing disease (CD).MethodsA total of 129 children with CD, 45 Hispanic/Latino or African-American (HI/AA) and 84 non-Hispanic White (non-HW), were included in this study. A 10-point index for rating severity (CD severity) incorporated the degree of hypercortisolemia, glucose tolerance, hypertension, anthropomorphic measurements, disease duration, and tumor characteristics. Race, ethnicity, age, gender, local obesity prevalence, estimated median income, and access to care were assessed in regression analyses of CD severity.ResultsThe mean CD severity in the HI/AA group was worse than that in the non-HW group (4.9±2.0 vs. 4.1±1.9, P=0.023); driving factors included higher cortisol levels and larger tumor size. Multiple regression models confirmed that race (P=0.027) and older age (P=0.014) were the most important predictors of worse CD severity. When followed up a median of 2.3 years after surgery, the relative risk for persistent CD combined with recurrence was 2.8 times higher in the HI/AA group compared with that in the non-HW group (95% confidence interval: 1.2-6.5).ConclusionOur data show that the driving forces for the discrepancy in severity of CD are older age and race/ethnicity. Importantly, the risk for persistent and recurrent CD was higher in minority children

Bedaquiline, Delamanid, Linezolid and Clofazimine for Treatment of Pre-extensively Drug-Resistant Tuberculosis.

BACKGROUND Treatment success rates for multidrug-resistant tuberculosis (MDR-TB) remain low globally. Availability of newer drugs has given scope to develop regimens that can be patient-friendly, less toxic, with improved outcomes. We proposed to determine the effectiveness of an entirely oral, short-course regimen with Bedaquiline and Delamanid in treating MDR-TB with additional resistance to fluoroquinolones (MDR-TBFQ+) or second-line injectable (MDR-TBSLI+). METHODS We prospectively determined the effectiveness and safety of combining two new drugs with two repurposed drugs - Bedaquiline, Delamanid, Linezolid, and Clofazimine for 24-36 weeks in adults with pulmonary MDR-TBFQ+ or/and MDR-TBSLI+. The primary outcome was a favorable response at end of treatment, defined as two consecutive negative cultures taken four weeks apart. The unfavorable outcomes included bacteriologic or clinical failure during treatment period. RESULTS Of the 165 participants enrolled, 158 had MDR-TBFQ+. At the end of treatment, after excluding 12 patients due to baseline drug susceptibility and culture negatives, 139 of 153 patients (91%) had a favorable outcome. Fourteen patients (9%) had unfavorable outcomes: four deaths, seven treatment changes, two bacteriological failures, and one withdrawal. During treatment, 85 patients (52%) developed myelosuppression, 69 (42%) reported peripheral neuropathy, and none had QTc(F) prolongation >500msec. At 48 weeks of follow-up, 131 patients showed sustained treatment success with the resolution of adverse events in the majority. CONCLUSION After 24-36 weeks of treatment, this regimen resulted in a satisfactory favorable outcome in pulmonary MDR-TB patients with additional drug resistance. Cardiotoxicity was minimal, and myelosuppression, while common, was detected early and treated successfully

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection