Fibrolipomatous hamartoma of the median nerve with macrodystrophia lipomatosa

Fibrolipomatous hamartoma (FLH) is a rare congenital condition that presents with a benign overgrowth of the bone and fibroadipose tissue termed as macrodystrophia lipomatosa (MDL). Although commonly seen in the median nerve, other peripheral nerves can be involved. Diagnosis can be made on magnetic resonance imaging (MRI) due to the characteristic coaxial cable appearance on axial images and the spaghetti appearance on sagittal images. Histology shows mature adipose and fibrous tissue infiltrating the epineural and perineural compartments. Multiple or debulking surgeries are often needed, with an emphasis on cosmetic aspects. We present one such case in which wide margin excision and sural nerve graft were carried out

Pharmacists’ Perception of the Sale of Non-Clinically Proven Health Supplements in Penang, Malaysia

Purpose: To explore community pharmacists’ perception of the sale of non-clinically proven health supplements and over-the-counter (OTC) products available in Penang, Malaysia.Methods: A cross-sectional survey using a self-completed postal questionnaire was conducted in July 2010 among 200 community pharmacists practicing in Penang Island.Results: Fifty six pharmacists participated in the study (response rate, 28.0 %). A total of 10.7 % respondents indicated that the sale of non-clinically proven products result in high profit. Only 25.0 % of the pharmacists believed that non-clinically proven OTC products are effective, while 35.7 % thought that it is not ethical to sell these products. A majority of the respondents (94.7 %) agreed that manufacturers’ advertisement have a huge effect on positive consumers’ behaviour towards such products. Most respondents agreed that manufacturers of these products claim that their products are effective (57.1 %) and have fewor no side effects (60.7 %).Conclusions: Pharmacists who participated in the study have mixed  opinions on the efficacy and effectiveness of non-clinically proven products. There is a need for pharmacists to be well educated on the  evidence-based use of these products in order to be able to offerappropriate advice to those who come to them to purchase the items.Keywords: Perception, Health promotion, Urban poor, Health supplements

Hydrolysis, Microstructural Profiling and Utilization of Cyamopsis tetragonoloba in Yoghurt

The present study investigates the hydrolysis, microstructural profiling and utilization of guar gum (Cyamopsis tetragonoloba) as a prebiotic in a yoghurt. Guar galactomannans (GG) was purified and partially depolymerized using an acid, alkali and enzyme to improve its characteristics and increase its utilization. The prebiotic potential of hydrolyzed guar gum was determined using Basel and supplemented media. Crude guar galactomannans (CGG), purified guar galactomannans (PGG), base hydrolyzed guar galactomannans (BHGG), acid hydrolyzed guar galactomannans (AHGG) and enzymatic hydrolyzed guar galactomannans (EHGG) were analyzed using scanning electron microscope (SEM), X-ray diffraction (XRD) and Fourier transform infrared spectroscopy (FTIR). Yoghurt was prepared with a starter culture and incorporating guar gum, its hydrolyzed forms (0.1, 0.5 and 1%) and Bifidobacterium bifidum. The results showed that PHGG significantly improved the viability of B. bifidum. SEM revealed a significant change in the surface morphology of guar gum after acidic and enzymatic hydrolysis. Enzymatic hydrolysis developed a well-defined framework within guar gum molecules. The XRD pattern of CGG, PGG and AHGG presented an amorphous structure and showed low overall crystallinity while EHGG and BHGG resulted in slightly increased crystallinity regions. FTIR spectral analysis suggested that, after hydrolysis, there was no major transformation of functional groups. The addition of the probiotic and prebiotic significantly improved the physiochemical properties of the developed yoghurt. The firmness, cohesiveness, adhesiveness and syneresis were increased while consistency and viscosity were decreased during storage. In sum, a partial hydrolysis of guar gum could be achieved using inexpensive methods with commercial significance

Accuracy of procalcitonin levels for diagnosis of culture-positive sepsis in critically ill trauma patients: A retrospective analysis

Background: Abdominal trauma and intra-abdominal sepsis are associated with significant morbidity and mortality. Microcirculation in the gut is disrupted in hemorrhagic and septic shock leading to tissue hypoxia, and the damaged gut acts as a reservoir rich in inflammatory mediators and provides a continual source of inflammation to the systemic circulation leading to sepsis. Sepsis is defined as the presence (probable or documented) of infection together with a systemic inflammatory response to infection. Blood culture is commonly considered to be the preferred approach for diagnosing sepsis, although it is time-consuming, that is, reports are normally available only after 12-48 hours. Procalcitonin levels (PCT) have recently emerged as a promising biomarker in the diagnosis of sepsis. The aim of the present study is to determine the diagnostic accuracy of PCT levels in predicting sepsis in critically ill trauma patients.Methodology: This was designed as a validation study conducted in the Indoor Department of General Surgery, Liaquat National Hospital, Karachi. The sample size was calculated by taking the estimated frequency of sepsis in suspected patients at 62.13%, expected sensitivity of PCT at 70.83%, and specificity at 84.21% and the desired precision level of 12% for sensitivity; the calculated sample size was 96. The non-probability consecutive sampling method was used to recruit participants who were diagnosed with sepsis on clinical assessment. Blood culture samples were sent for the enrolled patients and a final diagnosis was made on the blood culture report. PCT levels were measured in these suspected patients on the same day of sending blood culture. Diagnostic accuracy of PCT size was measured using the receiver operating characteristic (ROC) curve. ROC curve was formulated for PCT levels against culture-proven sepsis to determine the ideal cut-off value of PCT levels. Two different cut-offs were determined to obtain the highest sensitivity and highest specificity accordingly.Results: A total of 97 individuals met the inclusion criteria with a mean age of 34.89 ± 10.52 years. Mean PCT levels were 0.96 ± 0.59, with a gender predilection towards females (p \u3c 0.001). No age difference was documented among gender (p = 0.655). The mean duration of intensive care unit stay was 11.73 ± 3.56 days. Culture-proven sepsis was identified in 67.0% of the study participants with a higher PCT level (p \u3c 0.001). Among the 52.6% males included in the study, half were reported to have culture-positive sepsis, but among the 47.4% females culture was positive in 87% (p \u3c 0.001). ROC revealed PCT was predictive for culture-positive sepsis at a cut-off value 0.47 ng/mL (p \u3c 0.001), with a sensitivity of 92.3%, specificity of 68.7%, positive predictive value (PPV) of 85.7%, and negative predictive value (NPV) of 81.5%. By increasing the cut-off value to 0.90 ng/mL at area under the curve of 0.816, the specificity increased to 81.3% and sensitivity became 66.2%, with a PPV of 87.8% and NPV of 54.2%.Conclusion: Our study determined two cut-values for PCT to predict sepsis, one with the highest sensitivity and the other with better specificity. Other than that, higher PCT levels were significant in female trauma patients. We conclude that PCT is a reliable marker for culture-proven diagnosis of sepsis and may aid physicians/surgeons to promptly manage patients accordingly

A Comparison of Re-Sampling Techniques for Detection of Multi-Step Attacks on Deep Learning Models

The increasing dependence on data analytics and artificial intelligence (AI) methodologies across various domains has prompted the emergence of apprehensions over data security and integrity. There exists a consensus among scholars and experts that the identification and mitigation of Multi-step attacks pose significant challenges due to the intricate nature of the diverse approaches utilized. This study aims to address the issue of imbalanced datasets within the domain of Multi-step attack detection. To achieve this objective, the research explores three distinct re-sampling strategies, namely over-sampling, under-sampling, and hybrid re-sampling techniques. The study offers a comprehensive assessment of several re-sampling techniques utilized in the detection of Multi-step attacks on deep learning (DL) models. The efficacy of the solution is evaluated using a Multi-step cyber attack dataset that emulates attacks across six attack classes. Furthermore, the performance of several re-sampling approaches with numerous traditional machine learning (ML) and deep learning (DL) models are compared, based on performance metrics such as accuracy, precision, recall, F-1 score, and G-mean. In contrast to preliminary studies, the research focuses on Multi-step attack detection. The results indicate that the combination of Convolutional Neural Networks (CNN) with Deep Belief Networks (DBN), Long Short-Term Memory (LSTM), and Recurrent Neural Networks (RNN) provides optimal results as compared to standalone ML/DL models. Moreover, the results also depict that SMOTEENN, a hybrid re-sampling technique, demonstrates superior effectiveness in enhancing detection performance across various models and evaluation metrics. The findings indicate the significance of appropriate re-sampling techniques to improve the efficacy of Multi-step attack detection on DL models

Neuroprotective effects of trigonelline in kainic acid-induced epilepsy: Behavioral, biochemical, and functional insights

Trigonelline, an alkaloid found in the seeds of Trigonella foenum-graecum L. (fenugreek), has been recognized for its potential in treating various diseases. Notably, trigonelline has demonstrated a neuroprotective impact by reducing intrasynaptosomal calcium levels, inhibiting the production of reactive oxygen species (ROS), and regulating cytokines. Kainic acid, an agonist of kainic acid receptors, is utilized for inducing temporal lobe epilepsy and is a common choice for establishing kainic acid-induced status epilepticus, a widely used epileptic model. The neuroprotective effect of trigonelline in the context of kainic acid-induced epilepsy remains unexplored. This study aimed to induce epilepsy by administering kainic acid (10 mg/kg, single subcutaneous dose) and subsequently evaluate the potential anti-epileptic effect of trigonelline (100 mg/kg, intraperitoneal administration for 14 days). Ethosuccimide (ETX) (187.5 mg/kg) served as the standard drug for comparison. The anti-epileptic effect of trigonelline over a 14-day administration period was examined. Behavioral assessments, such as the Novel Object Recognition (NOR) test, Open Field Test (OFT), and Plus Maze tests, were conducted 2 h after kainic acid administration to investigate spatial and non-spatial acquisition abilities in rats. Additionally, biochemical analysis encompassing intrasynaptosomal calcium levels, LDH activity, serotonin levels, oxidative indicators, and inflammatory cytokines associated with inflammation were evaluated. Trigonelline exhibited significant behavioral improvements by reducing anxiety in open field and plus maze tests, along with an amelioration of memory impairment. Notably, trigonelline substantially lowered intrasynaptosomal calcium levels and LDH activity, indicating its neuroprotective effect by mitigating cytotoxicity and neuronal injury within the hippocampus tissue. Moreover, trigonelline demonstrated a remarkable reduction in inflammatory cytokines and oxidative stress indicators. In summary, this study underscores the potential of trigonelline as an anti-epileptic agent in the context of kainic acid-induced epilepsy. The compound exhibited beneficial effects on behavior, neuroprotection, and inflammation, shedding light on its therapeutic promise for epilepsy management

Electrical conductivity and total dissolved solid of raw milk for the detection of bovine subclinical mastitis

Background and Aim: Bovine subclinical mastitis (SCM) is highly prevalent among dairy cattle. A cross-sectional study was conducted in Bangladesh to evaluate the performance of electric conductivity (EC) and total dissolved solids (TDS) tests for the detection of SCM. Materials and Methods: We randomly selected 108 milk samples from cows of different breeds in the primary milk-producing region of Pabna and Sirajgonj districts of Bangladesh. Samples were subjected to the California mastitis test (CMT), white side test (WST), electric conductivity (EC), TDS, and culture. A cow was considered positive for SCM if it tested positive in CMT, WST, and culture, whereas a cow was considered negative for SCM if it tested negative in all three methods. These gold standards have been used to evaluate the performance of the EC and TDS tests. The optimal EC and TDS cutoff values for the detection of SCM were determined using the “optimal cutoff” function in R version 4.3.1. Results: The optimal EC cutoff value for SCM detection was found to be 6159 μS/cm or 6.16 mS/cm. A positive likelihood ratio (LR+) of 31.2 and an area under the curve (AUC) of 0.905 were obtained for this cutoff value. The optimal cutoff value for TDS was 3100 mg/L of milk, which resulted in a positive LR+ of 45.5 and an AUC of 0.924. Conclusion: To the best of our knowledge, this is the first study to evaluate the performance of EC and TDS tests in detecting SCM in Bangladesh. These results suggest that EC and TDS tests, which are inexpensive, rapid, and easy to conduct, can effectively detect SCM at the farm level

Extracorporeal membrane oxygenator as a bridge to successful surgical repair of bronchopleural fistula following bilateral sequential lung transplantation: a case report and review of literature

<p>Abstract</p> <p>Background</p> <p>Lung transplantation (LTx) is widely accepted as a therapeutic option for end-stage respiratory failure in cystic fibrosis. However, airway complications remain a major cause of morbidity and mortality in these patients, serious airway complications like bronchopleural fistula (BPF) are rare, and their management is very difficult.</p> <p>Case presentation</p> <p>A 47-year-old man with end-stage respiratory failure due to cystic fibrosis underwent bilateral sequential lung transplantation. Severe post-operative bleeding occurred due to dense intrapleural adhesions of the native lungs. He was re-explored and packed leading to satisfactory haemostasis. He developed a bronchopleural fistula on the 14^thpost-operative day. The fistula was successfully repaired using pericardial and intercostal vascular flaps with veno-venous extracorporeal membrane oxygenator (VV-ECMO) support. Subsequently his recovery was uneventful.</p> <p>Conclusion</p> <p>The combination of pedicled intercostal and pericardial flaps provide adequate vascular tissue for sealing a large BPF following LTx. Veno-venous ECMO allows a feasible bridge to recovery.</p

Study protocol of DIVERGE, the first genetic epidemiological study of major depressive disorder in Pakistan

INTRODUCTION: Globally, 80% of the burdenof major depressive disorder (MDD) pertains to low- and middle-income countries. Research into genetic and environmental risk factors has the potential to uncover disease mechanisms that may contribute to better diagnosis and treatment of mental illness, yet has so far been largely limited to participants with European ancestry from high-income countries. The DIVERGE study was established to help overcome this gap and investigate genetic and environmental risk factors for MDD in Pakistan. METHODS: DIVERGE aims to enrol 9000 cases and 4000 controls in hospitals across the country. Here, we provide the rationale for DIVERGE, describe the study protocol and characterise the sample using data from the first 500cases. Exploratory data analysis is performed to describe demographics, socioeconomic status, environmental risk factors, family history of mental illness and psychopathology. RESULTS AND DISCUSSION: Many participants had severe depression with 74% of patients who experienced multiple depressive episodes. It was a common practice to seek help for mental health struggles from faith healers and religious leaders. Socioeconomic variables reflected the local context with a large proportion of women not having access to any education and the majority of participants reporting no savings. CONCLUSION: DIVERGE is a carefully designed case-control study of MDD in Pakistan that captures diverse risk factors. As the largest genetic study in Pakistan, DIVERGE helps address the severe underrepresentation of people from South Asian countries in genetic as well as psychiatric research

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London