Abdominal pain with oral pigmentations as a clue for Peutz-Jeghers syndrome

A 33-year-old woman presented to the emergency department with colicky abdominal pain, nausea and vomiting, constipation, obstipation, and rectorragia. She had a history of similar abdominal pain from a few months ago. She had no history of any specific disease and taking any medication. She had no history of surgery and specific family diseases. Her vital signs on admission were heart rate 90/minute, respiratory rate 18/minute, blood pressure 110/70 mmHg, and temperature of 37.1°C. There were several brown spots on her lips and inside her mouth. On abdominal examination, she had a generalized tenderness, especially in the LLQ. In the digital rectal examination, the rectum was empty. Lab tests showed the following results: leukocyte count 4000/mm3 with 80.9% neutrophils, hemoglobin 12.1 g/dl, platelet 320000/µl, and creatinine 0.6 mg/dl, BUN 14 mg/dl, glucose 152 mg/dl, sodium 137 mEq/L, potassium 4.5 mEq/L. Chest and abdominal radiographs were performed on the patient (Figure 1). No subdiaphragmatic free air was seen in the chest x-ray. The abdominal x-ray showed no air-fluid levels as well as any gas in the rectum. On abdominal and pelvic ultrasound, a moderate amount of free fluid was seen in the abdomen along with jejunoileal intussusception in the LLQ with an intestinal loops thickness increase

The impact of cataract surgery on depression in elderly Iranian patients: a case–control study

Background: Cataract-related vision impairment is clearly associated with depressive symptoms in old age. This study aimed to evaluate the effect of cataract surgery on depression among elderly Iranian patients.Methods: In this case–control study, a total of 113 elderly patients with and without cataract who were admitted to Buali-Sina Hospital in Sari, Mazandaran, Iran were evaluated. Ophthalmological examinations were first performed at the beginning of the study and then four months later; demographic and clinical characteristics were obtained for all patients. Additionally, depression was assessed using the Hospital Anxiety and Depression Scale (HADS) for all patients during the study period.Results: A statistically significant difference was found between the mean depression score in patients without cataract (3.28), patients with cataract surgery (3.74), and patients without cataract surgery (5.60) (P = 0.024). On the other hand, there was no statistically significant differences between the mean depression score in patients with cataract surgery and patients without cataract (P = 0.582). However, a statistically significant difference was observed between the mean depression score after cataract surgery in men (1.70) and women (4.94) (P < 0.001). Visual function improved in all bilateral cataract patients who had surgery in one eye. Also, the results of this study showed that in all unilateral cataract patients who had eye surgery, visual function in the left and right eyes improved.Conclusion: We conclude that depression is more prevalent in patients with cataract compared to those without cataract. In addition, cataract surgery seems to be associated with reduced depression and better visual acuity in elderly patients with cataract

The Impact of Cataract Surgery on Depression in Elderly Iranian Patients: A Case–Control Study

Background: Cataract-related vision impairment is clearly associated with depressive symptoms in old age. This study aimed to evaluate the effect of cataract surgery on depression among elderly Iranian patients. Methods: In this case–control study, a total of 113 elderly patients with and without cataract who were admitted to Buali-Sina Hospital in Sari, Mazandaran, Iran were evaluated. Ophthalmological examinations were first performed at the beginning of the study and then four months later; demographic and clinical characteristics were obtained for all patients. Additionally, depression was assessed using the Hospital Anxiety and Depression Scale (HADS) for all patients during the study period. Results: A statistically significant difference was found between the mean depression score in patients without cataract (3.28), patients with cataract surgery (3.74), and patients without cataract surgery (5.60) (P = 0.024). On the other hand, there was no statistically significant differences between the mean depression score in patients with cataract surgery and patients without cataract (P = 0.582). However, a statistically significant difference was observed between the mean depression score after cataract surgery in men (1.70) and women (4.94) (P < 0.001). Visual function improved in all bilateral cataract patients who had surgery in one eye. Also, the results of this study showed that in all unilateral cataract patients who had eye surgery, visual function in the left and right eyes improved. Conclusion: We conclude that depression is more prevalent in patients with cataract compared to those without cataract. In addition, cataract surgery seems to be associated with reduced depression and better visual acuity in elderly patients with cataract

Machine Learning in Transportation

Document type: Articl

Isolated trochlear shear fracture of the distal humerus: a case report

Laugier was the first to describe an isolated humeral trochlea fracture in 1853. We report the case of a patient with an isolated fracture of the trochlea and discuss the underlying mechanisms and the clinical, radiological features of this pathology and surgical management of this rare fracture. The elbow arthrotomy was done via an anteromedial approach, with the interval through the flexor-pronator muscles medially and the brachialis muscle laterally. The trochlea was temporally fixed by two Kirschner wires, and the definitive fixation was obtained by two cannulated. Herbert screws from anterior to posterior. The elbow was immobilized and splinted in a flexed position (70 degrees) for two weeks to allow soft tissue healing and minimize pain. After cast removal, rehabilitation of elbow was established and actively assisted mobilization for three months. The isolated trochlea fracture is a rare injury and usually, it is associated with other injuries such as elbow dislocation. Few studies in the literature described such fracture and the anteromedial approach; most of these studies described the use of a direct medial approach to the elbow. Several fixation methods were described in the literature, including k-wires, AO compression screws, and headless compression screws. Isolated fracture of the trochlea is rare. The mechanisms causing this fracture are complex; the usual mechanism of isolated trochlear fractures is falling on the palm with the elbow extended and supinated. In our report, the patient disclosed that he felt directly on his flexed elbow. Trochlear fractures require open reduction and internal fixation to achieve anatomical reduction, with excision of the small osteochondral fragments that may be complicated by arthritic changes

Integration of Supply Chains and Operational Performance: The Moderating Effects of Knowledge Management

Supply chain integration (SCI) is a strategic process management technique that may be used to boost an organizations performance and thereby gain a competitive edge. The purpose of this paper is to demonstrate both the direct effect of (SCI) on manufacturing firms operational performance and the moderating effect of knowledge management (KM) on the relationship between supplier integration (SI), customer integration (CI), internal integration (II), and operational performance (OP). The study analyzed survey data from 277 Jordanian manufacturing and industrial businesses using the PLS–Structural Equation method. According to the data, (CI), (II), and (SI) are all positively and significantly associated with operational success. (CI), (II), and (SI) all have a strong and beneficial moderate relationship with (OP). There is, however, no connection between (KM) and (OP). Furthermore, further research may be conducted to assess the applicability of the findings from this study to other populations of varied sizes in other countries. A long-term study that tracks the growth of different measures might provide further insight on the relationship between SCI and OP

Factors affecting middle eastern countries' intention to use financial technology

Financial technology, also known as Fintech, continues to transform the financial services sector globally. Fintech adoption has been delayed in some places, particularly in the Middle East, despite the potential positive benefits. This study investigates the mediating effect of perceived ease of use on the relationship between seamless transactions, financial risk, legal risk, security risk, perceived risk, and the intention to use financial technology in Middle Eastern countries. Data was collected from 500 respondents from five Middle Eastern countries (Jordan, Kuwait, Saudi Arabia, Qatar, and the United Arab Emirates) using a structured questionnaire, and partial least squares structural equation modelling (PLS-SEM) was used to test the research model. The findings demonstrate that perceived ease of use strongly mediates the links between seamless transactions, financial risk, legal risk, security risk, perceived risk, and the intention to use financial technology. The study shed light on the significance of perceived ease of use in influencing people's intention to utilize financial technology as well as the function it serves in minimizing the effects of perceived risks. The findings of this study could be useful for financial technology companies operating in Middle Eastern countries, policymakers, and researchers interested in the adoption of financial technology

modeling potential habitats for pergularia tomentosa using maximum entropy model and effect of environmental variables on its quantitative characteristics in arid rangelands southeastern iran

Predicting the potential habitat of plants in arid regions, especially for medicinal ones, is very important. Although Pergularia tomentosa is a key species for medicinal purposes, it appears in very low density in the arid rangelands of Iran, needing an urgent ecological attention. In this study, we modeled and predicted the potential habitat of P. tomentosa using maximum entropy, and the effects of environmental factors (geology, geomorphology, altitude, and soil properties) on some characteristics of the species were determined. The results showed that P. tomentosa was absent in igneous formation while it appeared in conglomerate formation. In addition, among geomorphological units, the best quantitative characteristics of P. tomentosa was belonged to the conglomerate formation-small hill area (plant aerial parts = 57.63 and root length = 30.68 cm) with the highest electrical conductivity, silt, and CaCO3 content. Conversely, the species was not found in the mountainous area with igneous formation. Moreover, plant density, length of roots, and aerial parts of the species were negatively correlated with soil sand, while positive correlation was observed with CaCO3, EC, potassium, and silt content. The maximum entropy was found to be a reliable method (ROC = 0.91) for predicting suitable habitats for P. tomentosa. These results suggest that in evaluating the plant's habitat suitability in arid regions, contrary to the importance of the topography, some environmental variables such as geomorphology and geology can play the main role in rangeland plants' habitat suitability