Gall stones: a fundamental clinical review

Formation of stones in the gall bladder is known as cholelithiasis. About 10% to 20% of Western population are suffering from gall stones and this percentage is increasing day by day. Biochemically gall stones are classified into black pigment stones, brown pigment stones and cholesterol stones. Gall stones can be anatomically located at two possible sites; in the gall bladder known as cholelithiasis and in the common bile duct known as choledocholithiasis. Gall stones may present with symptoms known as symptomatic gallstones or without symptoms known as asymptomatic gallstones. The major causes of gallstones are high cholesterol diet, low bile salt levels, decreased gall bladder motility etc. Obesity, female gender, family history, rapid weight loss and vitamin B12 or folic acid deficiency are considered as important risk factors in the development of gall stones. The clinical presentations include acute cholecystitis and febrile illness with pain and tenderness in the right upper quadrant (Murphy sign). Generalized body weakness and weight loss are considered as generalized symptoms of gallstones. The complications include cholangitis, empyema of gall bladder, pancreatitis, abscess formation, porcelain gall bladder and gall bladder perforation. The differential diagnosis of gall stones is carried out based on endoscopy, ALT and AST serum levels. Non-surgical treatment for gall stones is oral dissolution therapy. The standard surgical treatment for gall stones is cholecystectomy

Diabetes insipidus: the basic and clinical review

Diabetes insipidus (DI) is a complex disease. DI is inability of the body to conserve water. Polydipsia and polyuria are the major manifestations of DI. DI has various variants including central diabetes insipidus (due to defect in ADH secretion), nephrogenic diabetes insipidus (due to defect in ADH receptors or urea receptors), gestational diabetes insipidus (due to catabolism of ADH by placental vasopressinase) and primary polydipsia (due to massive fluid intake). The cause of various variants of DI is either acquired or congenital. High plasma osmolality due to hypotonic urine excretion can be fatal because it can cause psychosis, lethargy, seizures, coma or even death. Polyuria and polydipsia help in the diagnosis of DI. Differential diagnosis of various variants of DI can be carried out on the basis of water deprivation test, MRI and other radiological techniques. The proper management of DI is the replenishment of water loss and correction of clinical presentations produced as a result of DI, major is hypernatremia. The best management for primary polydipsia is fluid restriction while fluid intake is used for adipsic diabetes insipidus. ADH replacement therapy is widely used to treat DI. DDAVP or desmopressin is mostly preferred ADH analogue because it has less side effects and resistant to placental vasoprssinase

Double Truncated Transmuted Fréchet Distribution: Properties and Applications

In this paper, we modify the Mahmoud and Mandouh (2013) model by adopting double truncation technique. It is referred to as Double Truncated Transmuted Fréchet (DTTF) distribution. Diverse probabilistic and reliability measures are developed and discussed. The MLEs of parameters are derived and a simulation study is also made. The DTTF distribution is modeled by two real-time datasets and supportive rationalized results provide the evidence that DTTF distribution is a reasonably better fit model than its competing models. Keywords: Fréchet Distribution, Double Truncation, Hazard Function, Moments, MLE, Quadratic Rank Transmutation Map (QRTM), Rényi entropy, Order Statistics. DOI: 10.7176/MTM/9-3-02 Publication date: March 31st 201

Effect of Beclomethasone Dipropionate Versus Mast Cell Stabilizer on Mucociliary Clearance in Patients of Allergic Rhinitis

Objective: The study was conducted to compare the effect of Beclomethasone dipropionate with mast cell stabilizer on mucociliary clearance in patients of allergic rhinitis.Patients and Methods: A randomized trial was carried out in ENT department of Nishtar Hospital Multan from December 2016 to February 2017. Patients of allergic rhinitis from both genders were included in the study after written consent. Mucociliary transport velocity was measured by saccharine dye test. The collected data was processed and analyzed by SPSS software 23 version and presented in tabulation form. Qualitative variables were analyzed in percentage and frequency form. The main outcome variable, mucociliary transport velocity, age and weight of patients were presented as mean and stranded deviation. Students’ test was applied to calculate p value. P value <0.05 was taken as significant.Results: A total number of 140 patients were included in the study and were divided in two main groups. There were 70 volunteers in each group.  One group was provided Beclomethasone and other group was given mast cell stabilizer for one week.  After careful analysis and calculation, it was observed that the mean of mucociliary transport velocity after one week of Beclomethasone dipropionate treatment was 7.33±1.27 mm/minute with p value 0.558 and mean of velocity after mast cell stabilizer (Nedocromil sodium) was 7.82±1.2 mm/minute with p-values 0.304.Conclusion: No statistical significance was found with both treatment regimens

Lateral Pre-crash Sensing and Avoidance in Emotion Enabled Cognitive Agent based Vehicle-2-Vehicle Communication System

A novel inter-vehicle communication system based on emotion enabled cognitive (EEC) agent has been anticipated as an intelligent solution to evade the road catastrophe due to hasty decisions by drivers. An input stimulus is processed in human brain using a short route and a long route during any emergency situation. The proposed EEC agent, mounted inside a vehicle, acts like a human brain and is stirred by short route information processing mechanism of human brain in fear condition. The results are acquired for the decisions made by the proposed approach through the EEC agent using short route and human drivers using long route during urgent situations. A pre crash sensing and avoidance algorithm has been proposed as well to mitigate the lateral or side by side collision using EEC agent.  Experimental findings reveal that by commencing emotions with cognition, and using formulated L-PCSA algorithm, lateral collisions chances can be sensed and avoided to secure the valued lives of passengers. It has been pragmatic that the new approach is very effectual and useful in shunning the lateral road collisions

Bioaugmentation-Enhanced Remediation of Crude Oil Polluted Water in Pilot-Scale Floating Treatment Wetlands

Floating treatment wetlands (FTWs) are cost-effective systems for the remediation of polluted water. In FTWs, the metabolic activity of microorganisms associated with plants is fundamental to treatment efficiency. Bioaugmentation, the addition of microorganisms with pollutant-degrading capabilities, appears to be a promising means to enhance the treatment efficiency of FTWs. Here, we quantified the effect of bioaugmentation with a four-membered bacterial consortium on the remediation of water contaminated with crude oil in pilot-scale FTWs planted with Phragmites australis or Typha domingensis. The bacteria had been isolated from the endosphere and rhizosphere of various plants and carry the alkane hydroxylase gene, alkB, involved in aerobic hydrocarbon degradation. During a treatment period of 36 days, FTWs planted with P. australis achieved a reduction in hydrocarbon concentration from 300 mg/L to 16 mg/L with and 56 mg/L without bioaugmentation. In the FTWs planted with T. domingensis, respective hydrocarbon concentrations were 46 mg/L and 84 mg/L. The inoculated bacteria proliferated in the rhizoplane and in the plant interior. Copy numbers of the alkB gene and its mRNA increased over time in plant-associated samples, suggesting increased bacterial hydrocarbon degradation. The results show that bioaugmentation improved the treatment of oil-contaminated water in FTWs by at least a factor of two, indicating that the performance of full-scale systems can be improved at only small costs

The cross-sectional study of anxiety levels and ratio of severity of thirteen symptoms of anxiety among medical students

Background: Anxiety is defined as physical, behavioral, social and psychological response to treat self-concept characterized by subjective, consciously perceived feelings of tension. Nowadays anxiety is most commonly found among medical students. This study was conducted to find out the anxiety levels and ratio of severity of thirteen symptoms of anxiety.Methods: A questionnaire based study was conducted among 178 medical students which tests the level of anxiety and severity of symptoms of anxiety. The questionnaire used was hamilton anxiety rating scale (HAM-A).Results: Out of 178 students, 80 (44.94%) students scored mild anxiety levels, 63 (35.39%) students scored moderate anxiety levels and 35 (19.66%) students scored severe anxiety levels.Conclusions: Mild form of anxiety is much more common among medical students and majority of these medical students are females. Moreover, the symptoms of anxiety including tension, anxious mood, depressed mood, insomnia, fear and CVS symptoms appear with moderate severity in majority of medical students while on the other hand some symptoms including general somatic muscular and sensory symptoms, difficulties in concentration and memory, genitor-urinary symptoms, respiratory symptoms, GIT symptoms and other autonomic symptoms appear with least severity among majority of medical students

Operational parameters optimization for remediation of crude oil-polluted water in floating treatment wetlands using response surface methodology

The application of floating treatment wetlands (FTWs) is an innovative nature-based solution for the remediation of polluted water. The rational improvement of water treatment via FTWs is typically based on multifactorial experiments which are labor-intensive and time-consuming. Here, we used the response surface methodology (RSM) for the optimization of FTW’s operational parameters for the remediation of water polluted by crude oil. The central composite design (CCD) of RSM was used to generate the experimental layout for testing the effect of the variables hydrocarbon, nutrient, and surfactant concentrations, aeration, and retention time on the hydrocarbon removal in 50 different FTW test systems planted with the common reed, Phragmites australis. The results from these FTW were used to formulate a mathematical model in which the computational data strongly correlated with the experimental results. The operational parameters were further optimized via modeling prediction plus experimental validation in test FTW systems. In the FTW with optimized parameters, there was a 95% attenuation of the hydrocarbon concentration, which was very close to the 98% attenuation predicted by the model. The cost-effectiveness ratio showed a reduction of the treatment cost up to $0.048/liter of wastewater. The approach showed that RSM is a useful strategy for designing FTW experiments and optimizing operational parameters

Eradication of Stage IV Gastric Cancer: Case Report

Background. Gastric cancer has a low overall survival rate worldwide, and surgery still remains the intent to cure option on early stages of disease. HER-2 positive cancers may have a survival advantage. We present a patient with stage IV gastric cancer HER-2 positive responsive to Herceptin, free of detectable disease two years after surgery. Patient Presentation. 70 years old Caucasian male complained of left-sided chest pain. Upon evaluation, he was diagnosed with HER-2 positive adenocarcinoma of the stomach at the pylorus with two liver metastases. Near complete response was observed with Herceptin and Cis-platinum based chemotherapy followed by 80% distal gastrectomy and liver resection with uneventful recovery. Two years follow up reported a patient living normal life with undetectable disease. Conclusion. Multimodality targeted therapy may accomplish 24months cure of advanced malignant gastric disease