Unusual intraparenchymal pontomedullary epidermoid cyst in a 2 year-old: case report and literature review.

BACKGROUND: Intrinsic brainstem epidermoid cysts are rare, benign, slow growing lesions. Their eloquence preclude complete excision, however subtotal resection will often result in prolonged or sometimes permanent relief of presenting symptoms and signs. We describe an unusual case and review the literature of this pathology in the paediatric population. CASE DESCRIPTION: We report an intra-axial pontine epidermoid cyst in a 2-year-old girl who presented with developmental delay, multiple cranial nerve palsies and pneumonia. Magnetic resonance imaging (MRI) demonstrated an intrinsic pontine lesion with partial restricted diffusion and an enhancing plaque, the latter not typically seen in congenital lesions like epidermoid. However, gross surgical inspection and histopathology confirmed an epidermoid. CONCLUSION: Our case, supported by the literature, shows that brain stem epidermoid cysts may have atypical radiological characteristics, and that near total resection remains safe and can improve outcome

CBin-NN: An Inference Engine for Binarized Neural Networks

Binarization is an extreme quantization technique that is attracting research in the Internet of Things (IoT) field, as it radically reduces the memory footprint of deep neural networks without a correspondingly significant accuracy drop. To support the effective deployment of Binarized Neural Networks (BNNs), we propose CBin-NN, a library of layer operators that allows the building of simple yet flexible convolutional neural networks (CNNs) with binary weights and activations. CBin-NN is platform-independent and is thus portable to virtually any software-programmable device. Experimental analysis on the CIFAR-10 dataset shows that our library, compared to a set of state-of-the-art inference engines, speeds up inference by 3.6 times and reduces the memory required to store model weights and activations by 7.5 times and 28 times, respectively, at the cost of slightly lower accuracy (2.5%). An ablation study stresses the importance of a Quantized Input Quantized Kernel Convolution layer to improve accuracy and reduce latency at the cost of a slight increase in model size

Socio economic crisis and mortality. Epidemiological testimony of the financial collapse of Argentina

BACKGROUND: Natural disasters, war, and terrorist attacks, have been linked to cardiac mortality. We sought to investigate whether a major financial crisis may impact on the medical management and outcomes of acute coronary syndromes. METHODS: We analyzed the Argentine cohort of the international multicenter Global Registry of Acute Coronary Events (GRACE). The primary objective was to estimate if there was an association between the financial crisis period (April 1999 to December 2002) and in- hospital cardiovascular mortality, with the post-crisis period (January 2003 to September 2004) as the referent. Each period was defined according to the evolution of the Gross Domestic Product. We investigated the demographic characteristics, diagnostic and therapeutic procedures, morbidity and mortality. RESULTS: We analyzed data from 3220 patients, 2246 (69.8%) patients in the crisis period and 974 (30.2%) in the post-crisis frame. The distribution of demographic and clinical baseline characteristics were not significantly different between both periods. During the crisis period the incidence of in-hospital myocardial infarction was higher (6.9% Vs 2.9%; p value \u3c 0.0001), as well as congestive heart failure (16% Vs 11%; p value \u3c 0.0001). Time to intervention with angioplasty was longer during the crisis, especially among public sites (median 190 min Vs 27 min). The incidence proportion of mortality during hospitalization was 6.2% Vs 5.1% after crisis. The crude OR for mortality was 1.2 (95% C.I. 0.87, 1.7). The odds for mortality were higher among private institutions {1.9 (95% C.I. 0.9, 3.8)} than for public centers {1.2 (95% C.I. 0.83, 1.79)}. We did not observe a significant interaction between type of hospital and crisis. CONCLUSION: Our findings suggest that the financial crisis may have had a negative impact on cardiovascular mortality during hospitalization, and higher incidence of medical complications

Chronic kidney disease in gout in a managed care setting

<p>Abstract</p> <p>Background</p> <p>To study the prevalence of chronic kidney disease (CKD) and its impact on allopurinol dosing and uric acid control among patients with gout.</p> <p>Methods</p> <p>This was a retrospective study using data from a large US health plan. Claims and laboratory data were analyzed for enrollees from the health plan database from January 2002 through December 2005. Patients with gout were identified from pharmacy and medical claims data based on the presence of codes for gout medication or gout diagnosis. Severity of CKD was determined using the estimated glomerular filtration rate (eGFR). Allopurinol titration was defined as a change in average daily dose from first prescription to last prescription of ≥ 50 mg.</p> <p>Results</p> <p>A total of 3,929 patients were identified for inclusion in this study, 39% of whom had CKD (based on having an eGFR < 90 mL/min/1.73 m²). Subjects with CKD were older (p < 0.01) and more likely to be women (p < 0.01), had a greater number of comorbid conditions (p < 0.01), and were more likely to be prescribed allopurinol (p < 0.01) compared to those with no CKD. The average starting dose of allopurinol was lower among those with CKD, and it decreased with worsening kidney function. Among the 3,122 gout patients who used allopurinol, only 25.6% without CKD and 22.2% with CKD achieved a serum uric acid concentration of < 6.0 mg/dL (p = 0.0409). Also, only 15% of allopurinol users had an upward dose titration (by ≥50 mg), but the average increase in dose did not differ significantly between those with and without CKD.</p> <p>Conclusions</p> <p>About two out of every five patients with gout in this population had CKD. Allopurinol doses were not adjusted in the majority of CKD patients. Serum uric acid control in gout was poor among patients without CKD and even worse among those with CKD.</p

Acetylcholinesterase, Tyrosinase, α-Glucosidase inhibition by Ammodaucus leucotrichus Coss. & Dur. Fruits Essential oil and Ethanolic Extract and Molecular Docking Analysis

Medicinal and aromatic plants serve as valuable reservoirs of bioactive molecules and mineral compounds that are harnessed for therapeutic and agro-food applications. The objective of this study was to assess the inhibitory enzyme properties of Ammodaucus leucotrichus Coss &amp; Dur fruit essential oil, as well as its aqueous and ethanol extracts, against acetylcholinesterase, tyrosinase, and α-glucosidase. Additionally, the antioxidant activity of these natural mixtures was evaluated using three different methods: DPPH, FRAP, and β-carotene bleaching tests. Furthermore, this research endeavors to examine the mineral constituents of various components of the plant under investigation. The various natural combinations that were examined exhibited a notable inhibitory impact on the enzymes acetylcholinesterase (67.56-92.30%), tyrosinase (57.52-63.44%), and α-glucosidase (61.22-72.49%). The analyzed extracts also demonstrate a significant antioxidant activity. Furthermore, the results obtained from the analysis indicate a notable presence of both macro and microelements, such as calcium (2.028 mg/g for leaves and 1.787 mg/g for fruits), within the Ammodaucus leucotrichus Coss &amp; Dur plant. The current study supports the significance of utilizing Ammodaucus leucotrichus Coss &amp; Dur fruits in the medicinal and agro-alimentary sectors. The utilization of molecular docking techniques was employed in order to make predictions regarding the therapeutic effects of Ammodaucus leucotrichus Coss &amp; Dur fruits

Intervention in acute coronary syndromes:do patients undergo intervention on the basis of their risk characteristics? The Global Registry of Acute Coronary Events (GRACE)

OBJECTIVE: To determine whether revascularisation is more likely to be performed in higher-risk patients and whether the findings are influenced by hospitals adopting more or less aggressive revascularisation strategies. METHODS: GRACE (Global Registry of Acute Coronary Events) is a multinational, observational cohort study. This study involved 24,189 patients enrolled at 73 hospitals with on-site angiographic facilities. RESULTS: Overall, 32.5% of patients with a non-ST elevation acute coronary syndrome (ACS) underwent percutaneous coronary intervention (PCI; 53.7% in ST segment elevation myocardial infarction (STEMI)) and 7.2% underwent coronary artery bypass grafting (CABG; 4.0% in STEMI). The cumulative rate of in-hospital death rose correspondingly with the GRACE risk score (variables: age, Killip class, systolic blood pressure, ST segment deviation, cardiac arrest at admission, serum creatinine, raised cardiac markers, heart rate), from 1.2% in low-risk to 3.3% in medium-risk and 13.0% in high-risk patients (c statistic = 0.83). PCI procedures were more likely to be performed in low- (40% non-STEMI, 60% STEMI) than medium- (35%, 54%) or high-risk patients (25%, 41%). No such gradient was apparent for patients undergoing CABG. These findings were seen in STEMI and non-ST elevation ACS, in all geographical regions and irrespective of whether hospitals adopted low (4.2-33.7%, n = 7210 observations), medium (35.7-51.4%, n = 7913 observations) or high rates (52.6-77.0%, n = 8942 observations) of intervention. CONCLUSIONS: A risk-averse strategy to angiography appears to be widely adopted. Proceeding to PCI relates to referral practice and angiographic findings rather than the patient\u27s risk status. Systematic and accurate risk stratification may allow higher-risk patients to be selected for revascularisation procedures, in contrast to current international practice

Six-month mortality rates are lower in patients with an acute coronary syndrome treated with the combination of clopidogrel and a statin than in patients treated with either therapy alone: An analysis from the global registry of acute coronary events

La remunta la podem data de l'any 1928, aproximadament.Primer pla d'un edifici d'habitages, inicialment de planta baixa i pis, en què es remunten tres plantes en la part de la parcel·la que forma xamfrà a tres carrers. La remunta forma un volum molt potent que revalora estèticament l'edifici

Circulating Secretory Phospholipase A2 Activity Predicts Recurrent Events in Patients With Severe Acute Coronary Syndromes

ObjectivesThe purpose of this study was to determine the prognostic value of circulating secretory phospholipase A2 (sPLA2) activity in patients with acute coronary syndromes (ACS).BackgroundThe plasma level of type IIA sPLA2 is a risk factor for coronary artery disease (CAD) and is associated with adverse outcomes in patients with stable CAD. The prognostic impact of sPLA2 in patients with ACS is unknown.MethodsSecretory phospholipase A2 antigen levels and activity were measured in plasma samples of 446 patients with ACS, obtained at the time of enrollment.ResultsBaseline sPLA2 activity was associated with the risk of death and myocardial infarction (MI). The unadjusted rate of death and MI increased in a stepwise fashion with increasing tertiles of sPLA2 activity (p < 0.0001). The association remained significant in the subgroup of patients who had MI with ST-segment elevation (p = 0.014) and the subgroup of patients who had unstable angina or non–ST-segment elevation MI (p < 0.002). After adjustment for clinical and biological variables, the hazard ratios for the combined end point of death or MI in the third tertile of sPLA2 compared with the first and second tertiles was 3.08 (95% confidence interval, 1.37 to 6.91, p = 0.006).ConclusionsA single measurement of plasma sPLA2 activity at the time of enrollment provides strong independent information to predict recurrent events in patients with ACS