Acute myocardial infarction and pulmonary embolism in a young man with pernicious anemia-induced severe hyperhomocysteinemia

A 27 year-old man who presented to the hospital with progressive lower extremity weakness, developed an acute ST elevation myocardial infarction on his second hospital day. Primary angioplasty to the left anterior descending coronary artery was performed. Due to persistent dyspnea, the patient underwent a diagnostic chest computed tomography which confirmed multiple small pulmonary emboli. Laboratory analysis revealed a megaloblastic anemia with a reduced vitamin B12 level and positive titers for antibodies against intrinsic factor, establishing a diagnosis of pernicious anemia. Screening for hypercoaguable markers documented an isolated severely elevated homocysteine levels (105 μmol/l). No other significant risk factors for coronary artery disease including a family history of premature atherosclerosis were identified. This case illustrates the importance of testing for hyperhomocysteinemia as part of a workup for atherothrombotic disease, especially in patients without other significant risk factors. The severity of hyperhomocysteinemia found in our patient is unusual for patients with vitamin B12 malabsorption and raises the question of whether the widely practiced folic acid fortification in the United States may mask or even worsen vitamin B12 deficiency over time, leading to more severe cases of vitamin B12 deficiency and hyperhomocysteinemia than seen in the past

Idiopathic Gingival Fibromatosis: Case Report and Its Management

Idiopathic gingival fibromatosis is a rare condition. We present a case of idiopathic gingival fibromatosis with its multidisciplinary approach of management. The clinical, radiographic, and histopathological features have been described in detail

Explainable AI Using Knowledge Graphs

During the last decade, traditional data-driven deep learning (DL) has shown remarkable success in essential natural language processing tasks, such as relation extraction. Yet, challenges remain in developing artificial intelligence (AI) methods in real-world cases that require explainability through human interpretable and traceable outcomes. The scarcity of labeled data for downstream supervised tasks and entangled embeddings produced as an outcome of self-supervised pre-training objectives also hinders interpretability and explainability. Additionally, data labeling in multiple unstructured domains, particularly healthcare and education, is computationally expensive as it requires a pool of human expertise. Consider Education Technology, where AI systems fall along a “capability spectrum” depending on how extensively they exploit various resources, such as academic content, granularity in student engagement, academic domain experts, and knowledge bases to identify concepts that would help achieve knowledge mastery for student goals. Likewise, the task of assessing human health using online conversations raises challenges for current statistical DL methods through evolving cultural and context-specific discussions. Hence, developing strategies that merge AI with stratified knowledge to identify concepts that would delineate healthcare conversation patterns and help healthcare professionals decide. Such technological innovations are imperative as they provide consistency and explainability in outcomes. This tutorial discusses the notion of explainability and interpretability through the use of knowledge graphs in (1) Healthcare on the Web, (2) Education Technology. This tutorial will provide details of knowledge-infused learning algorithms and its contribution to explainability for the above two applications that can be applied to any other domain using knowledge graphs

Clinical impact of a new cardiac magnetic resonance imaging program: a single center US experience

While establishing a Cardiac Magnetic Resonance (CMR) program at an academic institution in the United States, we sought to evaluate indications and direct clinical impact of CMR on patient management and decision- making

Household Perceptions and Patterns of Crop Loss by Wild Pigs in North India

Loss to cultivated crops by wild pigs (Sus scrofa) is widespread and can jeopardize low-income farmers. In India, although there is lot of political interest in the problem, efforts to understand the patterns, correlates, and underlying reasons for wild pig conflict continue to be minimal. We quantified loss of wheat (Triticum aestivum) to wild pigs and assessed the spatial patterns of damage in a forest settlement of Van Gujjar (Haridwar, India), which is a dairy-based pastoralist community. We chose a 4-km2 cultivated area comprising 400 farmlands (each measuring 0.8 ha and belonging to a family) and assessed crop damage by wild pigs through field surveys during the harvest season. We interviewed 159 respondents who manage 219 of the total 400 farmlands in the study area to compare actual crop loss with perceived losses. Wild pigs damaged 2.29 tonnes (2,290 kg) of wheat, which was about 2.6% of the potential yield in the study area. A total of 39 farmlands (9.5%), managed by 28 respondents, suffered losses during the survey period at an average loss of about 58.8 kg (SD ± 89.5, range = 0.7–388 kg). During interviews, 81 respondents managing 155 farmlands (70.7%) reported having suffered wild pig-related crop loss during the survey period. They also perceived losing about 23.4% of the potential yield of wheat due to wild pigs. The perceived losses were much higher than actual losses. Actual losses measured through field surveys underscore the dichotomy between actual and perceived crop loss due to wild pigs. About 81% of recorded wild pig-related damage to wheat occurred within 200 m from the forest edge. The crop protection measures aimed at stopping wild pigs from entering the fields were mostly reactive. Although overall crop losses due to wild pigs seem low at the settlement level, for affected individual families, the losses were financially significant. Such recurrent crop losses can cause families to go into debt, trigger animosity toward conservation, and lead to retaliation measures, which may be indiscriminate and have the potential to affect other endangered mammals in conservation priority landscapes. Because crop losses by wild pigs are severe along the narrow band of fields along the edge of the forest, channeling monetary benefits through insurance-based compensation schemes can help assuage losses to farmers. Further, because crop damage by wild pigs is seasonal, experimenting with mobile fences that can be dismantled and packed away after use would be beneficial

Immediate 3-dimensional ridge augmentation after extraction of periodontally hopeless tooth using chinblock graft

Background: The aim of the present study was to evaluate clinically and radiographically, the efficacy of immediate ridge augmentation to reconstruct the vertical and horizontal dimensions at extraction sites of periodontally hopeless tooth using an autogenous chin block graft. Material and Methods: A total of 11 patients (7 male & 4 female) with localized advanced bone loss around single rooted teeth having hopeless prognosis and indicated for extraction were selected for the study. The teeth were atraumatically extracted and deficient sites were augmented using autogenous chin block graft. Parameters like clinically soft tissue height - width and also radiographic ridge height -width were measured before and 6 months after augmentation. Obtained results were tabulated and analysed statistically. Results: After 6 months of immediate ridge augmentation, the mean gain in radiographic vertical height and horizontal width was 7.64 + 1.47 mm ( P = 0.005) and 5.28 + 0.46 mm ( P = 0.007) respectively which was found to be statistically significant ( P < 0.05). Mean change of width gain of 0.40mm and height loss of 0.40mm of soft tissue parameters, from the baseline till completion of the study at 6 months was observed. Conclusions: The present study showed predictable immediate ridge augmentation with autogenous chin block graft at periodontally compromised extraction site. It can provide adequate hard and soft tissue foundation for perfect 3-Dimensional prosthetic positioning of implant in severely deficient ridges

Complex I dysfunction underlies the glycolytic switch in pulmonary hypertensive smooth muscle cells.

ATP is essential for cellular function and is usually produced through oxidative phosphorylation. However, mitochondrial dysfunction is now being recognized as an important contributing factor in the development cardiovascular diseases, such as pulmonary hypertension (PH). In PH there is a metabolic change from oxidative phosphorylation to mainly glycolysis for energy production. However, the mechanisms underlying this glycolytic switch are only poorly understood. In particular the role of the respiratory Complexes in the mitochondrial dysfunction associated with PH is unresolved and was the focus of our investigations. We report that smooth muscle cells isolated from the pulmonary vessels of rats with PH (PH-PASMC), induced by a single injection of monocrotaline, have attenuated mitochondrial function and enhanced glycolysis. Further, utilizing a novel live cell assay, we were able to demonstrate that the mitochondrial dysfunction in PH-PASMC correlates with deficiencies in the activities of Complexes I-III. Further, we observed that there was an increase in mitochondrial reactive oxygen species generation and mitochondrial membrane potential in the PASMC isolated from rats with PH. We further found that the defect in Complex I activity was due to a loss of Complex I assembly, although the assembly of Complexes II and III were both maintained. Thus, we conclude that loss of Complex I assembly may be involved in the switch of energy metabolism in smooth muscle cells to glycolysis and that maintaining Complex I activity may be a potential therapeutic target for the treatment of PH