Telemedicine in the Era of COVID-19 and Beyond: A new horizon

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Prevalence of Type 2 Diabetes in pediatrics and adolescents newly diagnosed with diabetes in Babylon Governorate, Iraq

Type 2 diabetes in children and adolescents is a rising and ongoing problem around the world. It has adverse medical and economic consequences, and it is underestimated in many countries. Highlight characteristics of children presented with type 2 diabetes, and estimate the prevalence of such type of diabetes among newly diagnosed pediatrics. A total of 253 children and adolescents were diagnosed with diabetes. A thorough history and complete physical examination were done on all patients. Patient’s samples were sent for assessment of serum C peptide levels and glycated haemoglobin (HbA1c). 16 out of 253 newly diagnosed patients with diabetes have been found to have type 2 diabetes (proportion was 6.32%) with a mean age of 14.78 ± 2.87. All 16 patients had a positive family history and high body mass index, which significantly differ from type 1 diabetes patients. Also, all showed acanthosis nigricans and higher C-peptide levels than type1 patients (P=0.0001). Most children and adolescents with type 2 diabetes are obese or overweight, and many show features of insulin resistance. Every effort should be done to differentiate type 2 diabetes from the most common type 1 diabetes in young peopl

Hypothyroidism in paediatric patients with Prader-Willi syndrome; regular monitoring is recommended

Prader-Willi syndrome (PWS) is a genetic disorder described by multifaceted clinical features with implications on the endocrine system, metabolism, and behavior. Some symptoms of PWS syndrome can be confused with the relative clinical aspects of hypothyroidism, such as lethargy, muscular hypotonia, and poor sucking ability. In this review, we would like to enlighten the importance of checking thyroid function in PWS patients at birth, at least annually, in those on growth hormone (GH) treatment, in any child of PWS with growth failure, and in those in whom there is an insufficient response to GH therapy, to ensure that any aberrant thyroid function is not overlooked and adequately treated

Isolated oropharyngeal abscess with hypopharyngeal extension recurring 12 years after initial surgical management: A case report and review of the literature

Pharyngeal abscesses require urgent management as they have the propensity to cause severe and life-threatening complications. The introduction of antibiotics has led to a dramatic decline in the incidence of these infections. Regardless, abscess formation continues to be observed in the peritonsillar, parapharyngeal, and retropharyngeal spaces. Oropharyngeal and hypopharyngeal abscesses that cause airway obstruction are scarcely reported and tend to be secondary to other processes. Herein, we describe the case of an 83-year-old man presenting with an idiopathic, obstructive, oropharyngeal wall abscess, extending from the infratonsillar region to the hypopharynx, which recurred after initial surgical management 12 years prior for the same process. He required reintervention during both episodes for rapid reaccumulation. A detailed electronic literature search of PubMed and MedLine was performed for studies reporting on recurrent pharyngeal abscesses and their management. Results were limited to articles published in English from inception to August 2021. The timely management of pharyngeal infections acutely obstructing the airway is crucial. Physicians should adopt close and frequent monitoring and have a low threshold for reimaging should symptoms worsen or fail to improve after the initial surgical intervention

Peri-operative factors predisposing to pharyngocutaneous fistula after total laryngectomy: analysis of a large multi-institutional patient cohort

BACKGROUND: Pharyngocutaneous fistula (PCF) is a problematic complication following total laryngectomy. Disagreement remains regarding predisposing factors. This study examines perioperative factors predicting PCF following total laryngectomy using a large multicenter data registry. METHODS: Retrospective cohort analysis was performed using patients undergoing total laryngectomy in the ACS-NSQIP database for 2006-2014. Sub-analysis was performed based on reconstruction type. Outcome of interest was PCF development within 30 days. RESULTS: Multivariate analysis of 971 patients was performed. Three variables showed statistical significance in predicting PCF: wound classification of 3 and 4 vs. 1-2 (OR 6.42 P \u3c 0.0004 and OR 8.87, P \u3c 0.0042), pre-operative transfusion of \u3e 4 units of packed red blood cells (OR 6.28, P = 0.043), and free flap versus no flap reconstruction (OR 2.81, P = 0.008). CONCLUSIONS: This study identifies important risk factors for development of PCF following total laryngectomy in a large, multi-institutional cohort of patients, thereby identifying a subset of patients at increased risk

Informed consent: do information pamphlets improve post-operative risk-recall in patients undergoing total thyroidectomy: prospective randomized control study

Abstract Background Informed consent consists of basic five elements: voluntarism, capacity, disclosure, understanding, and ultimate decision-making. Physician disclosure, patient understanding, and information retention are all essential in the doctor-patient relationship. This is inclusive of helping patients make and manage their decisions and expectations better and also to deal with any consequences and/or complications that arise. This study investigates whether giving patients procedure-specific handouts pre-operatively as part of the established informed consent process significantly improves overall risk-recall following surgery. These handouts outline the anticipated peri-operative risks and complications associated with total thyroidectomy, as well as the corrective measures to address complications. In addition, the influence of potential confounders affecting risk-recall, such as anxiety and pre-existing memory disturbance, are also examined. Methods Consecutive adult (≥18 years old) patients undergoing total thyroidectomy at a single academic tertiary care referral centre are included. Participants are randomly assigned into either the experimental group (with pamphlets) or the control group by a computerized randomization system (Clinstat). All participants filled out a Hospital Anxiety and Depression Scale (HADS) and they are tested by the physician for short-term memory loss using the Memory Impairment Screen (MIS) exam. All patients are evaluated at one week post-operatively. The written recall questionnaire test is also administered during this clinical encounter. Results Forty-nine patients are included - 25 of them receive verbal consent only, while another 24 patients received both verbal consent and patient education information pamphlets. The overall average of correct answers for each group was 83 % and 80 % in the control and intervention groups, respectively, with no statistically significant differences. There are also no statistically significant differences between the two groups, in both interview duration, in time between interviews, and in recall tests. No correlation is also apparent between the pre-op HADS score and the recall questionnaire overall score. Conclusions A pre-operative thyroid surgical information pamphlet alone might not be sufficient to enhance patient test scores and optimally educate the patient on their expected care pathway in thyroid surgery. Supplementation with alternative means of patient education perhaps using emerging technologies needs to be further investigated

PhishCatcher:Client-Side Defense Against Web Spoofing Attacks Using Machine Learning

Cyber security confronts a tremendous challenge of maintaining the confidentiality and integrity of user’s private information such as password and PIN code. Billions of users are exposed daily to fake login pages requesting secret information. There are many ways to trick a user to visit a web page such as, phishing mails, tempting advertisements, click-jacking, malware, SQL injection, session hijacking, man-in-the-middle, denial of service and cross-site scripting attacks. Web spoofing or phishing is an electronic trick in which the attacker constructs a malicious copy of a legitimate web page and request users’ private information such as password. To counter such exploits, researchers have proposed several security strategies but they face latency and accuracy issues. To overcome such issues, we propose and develop client-side defence mechanism based on machine learning techniques to detect spoofed web pages and protect users from phishing attacks. As a proof of concept, a Google Chrome extension dubbed as PhishCatcher , is developed that implements our machine learning algorithm that classifies a URL as suspicious or trustful. The algorithm takes four different types of web features as input and then random forest classifier decides whether a login web page is spoofed or not. To assess the accuracy and precision of the extension, multiple experiments were carried on real web applications. The experimental results show remarkable accuracy of 98.5% and precision as 98.5% from the trials performed on 400 classified phished and 400 legitimate URLs. Furthermore, to measure the latency of our tool, we performed experiments over forty phished URLs. The average recorded response time of PhishCatcher was just 62.5 milliseconds

Lymphadenopathy: what defines a palpable lymph node?

BACKGROUND: The threshold size required to detect lymphadenopathy via palpation has never been formally determined. The purpose of this study was to determine the threshold, sensitivity, and error of node palpation and how this changes with experience. METHODS: Lymphadenopathy models were created using polyvinyl alcohol cryogel (PVA-C) to mimic tissue tactility. Node diameter ranged from 0.5 to 4 cm. Study subjects were medical students, otolaryngology residents, and otolaryngology consultants. Each subject provided 22 estimates of size. Primary outcomes were the sensitivity, error (true vs estimated size), and threshold of palpation. RESULTS: Thirty subjects completed the study. Sensitivity was 60%, 74%, and 86% for students, residents, and consultants, respectively (p < .01). Error was 0.88 cm, 0.61 cm, and 0.57 cm, respectively (p < .05). Palpation threshold was 1.32 cm, 0.83 cm, and 0.75 cm, respectively (p < .05). All participants detected nodes 652 cm, whereas consultants detected nodes 651 cm.Peer reviewed: YesNRC publication: Ye