Caesarean scar pregnancy: diagnostic dilemma

Caesarean scar pregnancy is a rare but life-threatening type of ectopic pregnancy if not accurately diagnosed on time. With increasing caesarean section rates, caesarean scar pregnancy is bound to increase. In this report, we describe a case of a woman with pregnancy developed within previous caesarean scar (Type-I, cervico-isthmic type) and successfully treated with medical management. The diagnosis of pregnancy on caesarean scar is easily made by transvaginal ultrasound and color Doppler flux. Unfortunately in some cases, as well as in our case, the diagnosis was not simple. Infact, in our case twin gestation was the initial diagnosis, by serial Beta HCG values and transvaginal ultrasound by an expert sonologist the diagnosis was made. We were successful in treating this rare form of ectopic pregnancy without any maternal morbidity with medical management alone. We report this case to highlight the importance of knowing the ultrasound criteria to diagnose Caesarean scar pregnancy, so that catastrophies can be prevented

The Effects of Dietary Advanced Glycation End-Products on Neurocognitive and Mental Disorders

Advanced glycation end products (AGEs) are glycated proteins or lipids formed endogenously in the human body or consumed through diet. Ultra-processed foods and some culinary techniques, such as dry cooking methods, represent the main sources and drivers of dietary AGEs. Tissue accumulation of AGEs has been associated with cellular aging and implicated in various age-related diseases, including type-2 diabetes and cardiovascular disease. The current review summarizes the literature examining the associations between AGEs and neurocognitive and mental health disorders. Studies indicate that elevated circulating AGEs are cross-sectionally associated with poorer cognitive function and longitudinally increase the risk of developing dementia. Additionally, preliminary studies show that higher skin AGE accumulation may be associated with mental disorders, particularly depression and schizophrenia. Potential mechanisms underpinning the effects of AGEs include elevated oxidative stress and neuroinflammation, which are both key pathogenetic mechanisms underlying neurodegeneration and mental disorders. Decreasing dietary intake of AGEs may improve neurological and mental disorder outcomes. However, more sophisticated prospective studies and analytical approaches are required to verify directionality and the extent to which AGEs represent a mediator linking unhealthy dietary patterns with cognitive and mental disorders

Enabling real-time multi-messenger astrophysics discoveries with deep learning

Multi-messenger astrophysics is a fast-growing, interdisciplinary field that combines data, which vary in volume and speed of data processing, from many different instruments that probe the Universe using different cosmic messengers: electromagnetic waves, cosmic rays, gravitational waves and neutrinos. In this Expert Recommendation, we review the key challenges of real-time observations of gravitational wave sources and their electromagnetic and astroparticle counterparts, and make a number of recommendations to maximize their potential for scientific discovery. These recommendations refer to the design of scalable and computationally efficient machine learning algorithms; the cyber-infrastructure to numerically simulate astrophysical sources, and to process and interpret multi-messenger astrophysics data; the management of gravitational wave detections to trigger real-time alerts for electromagnetic and astroparticle follow-ups; a vision to harness future developments of machine learning and cyber-infrastructure resources to cope with the big-data requirements; and the need to build a community of experts to realize the goals of multi-messenger astrophysics

Relationship between psychological well-being and perceptions of stress among undergraduate dental students in Bengaluru city: A cross-sectional study

Introduction: The dental profession has been considered a stressful occupation. The origins of this stress may also lie in the process of dental education. The perception of stress is frequently influenced by one′s personal system of beliefs and attitudes. Aim: The aim was to assess the relationship between psychological well-being and perception of stress among undergraduate dental students in Bangalore city. Materials and Methods: A cross-sectional questionnaire survey was conducted among 800 1-4 th year dental students. Information on demographics, social background, and health behaviors were collected. The psychological general well-being (PGWB) index and the dental environment stress (DES) questionnaire were used to measure PGWB and perceptions of stress, respectively. Multiple intergroup comparisons were carried out using ANOVA. Correlation analysis was done to find out relationship between PGWB and DES. Regression analysis to find out the strongest predictor of PGWB. P <0.05 was considered as statistically significant. Results: There was no significant difference in PGWB among different year of study. Female students had significantly lower PGWB scores and higher DES scores than male students. The stress differed among different year of study with highest stress in final year students in all domains except for clinical/preclinical training, which was highest among 1 st year students. Correlational analysis showed a negative relationship between PGWB and DES score. Stepwise multiple regression analysis revealed that "workload," "patient treatment," "performance pressure" and "others" domains of stress were significant predictors of PGWB. Conclusion: This study revealed that the perception of stress is influenced by gender and health behaviors which in turn affect PGWB

Effectiveness of three different oral hygiene techniques on Viridans streptococci: A randomized controlled trial

Introduction: Tongue cleaning is an important aspect of oral hygiene maintenance along with other mechanical and chemical aids. These methods have an influence on microorganism count in saliva. Aim: To assess the effectiveness of three different oral hygiene techniques on Viridans streptococci. Materials and Methods: This was a randomized controlled trial with 45 study subjects aged between 14 and 16 years and were randomly allocated into three groups: Group A - plastic tongue scraper, Group B - chlorhexidine mouthwash along with plastic tongue scraper, and Group C - chlorhexidine mouthwash. Unstimulated salivary samples were collected on the 1st, 7th, and 15th day before routine oral hygiene practices. Saliva samples were collected and incubated for 48 h on itis Salivarius(MS) agar. Streptococcus mitis, Streptococcus mutans, and Streptococcus salivarius were counted. Data were analyzed using descriptive and inferential statistics. Results: The mean count of S. mitis, S. mutans, and S. salivarius for Group A, B, and C was found to be significant (P < 0.001) when compared between 1st, 7th, and 15th day. Between-groups comparisons revealed a significant difference between Groups A and C, B and C (P < 0.001). Conclusion: There was a significant reduction in bacterial count in all the participants indicating that all the three methods are useful in improving oral hygiene. Combination technique was found to be most effective

To assess the knowledge, level of awareness, and attitude on biomedical waste management among practicing dentists in Bengaluru city: A cross-sectional study

Background: Dental waste is a subset of hazardous biomedical (BM) waste. It has been observed that most of the dental health facilities, the guidelines for proper management of dental waste are not adopted and not up to the prescribed standard. Aim: The aim of this study is to assess the knowledge, awareness, and attitude/behavior of BM waste generation, hazards, and legislation among the study subjects using self-structured questionnaire. Methodology: A cross-sectional study was conducted in 337 practicing dentists in Bengaluru city for the past 2 months. A self-structured questionnaire was used to obtain required data. The questionnaire was divided into three sections. The first section of the questionnaire contained questions regarding knowledge of BM waste generation, hazards, and legislation, whereas the second section contained questions regarding the level of awareness on BM waste management practice, and the third section contained questions regarding attitude/behavior toward BM waste. Results: Of 337 (100%) study participants, 176 (52.2%) were males and 161 (47.8%) were females. Among 337 (100%) study participants, more than three-fourth, i.e., 291 (88.4%) knew about BM waste generation and legislation, whereas 23 (6.8%) each did not know and were not aware of it. Conclusion: There is a good level of knowledge and awareness about BM waste generation hazards, legislation, and management among health care personnel in Bengaluru city. Regular monitoring and training are still required at all levels, and there is a need for continuing dental education on dental waste management practices to these dental practitioners

Health-Care and Societal Costs Associated with Non-Persistence with Subcutaneous TNF-α Inhibitors in the Treatment of Inflammatory Arthritis (IA) : A Retrospective Observational Study

Objective: A few studies have suggested that patients with inflammatory arthritis (IA) who remain persistent with subcutaneous TNF-α inhibitors (SC-TNFi) incur lower health care costs than patients who discontinue treatment, whereas data on the impact of non-persistence on indirect costs are largely lacking. Furthermore, existing estimates are based on fixed follow-ups, in relation to treatment initiation, and therefore do not measure costs in direct relation to treatment discontinuation. Therefore, by capturing costs in direct relation to treatment discontinuation, this study aimed to estimate direct and indirect costs associated with non-persistence with SC-TNFis in IA. Methods: Adult Swedish biologic-naïve IA patients initiating biologic treatment with a SC-TNFi (adalimumab, etanercept, certolizumab or golimumab) between May 6, 2010, and December 31, 2017, were identified in population-based registers with almost complete coverage. IA was defined as a diagnosis of rheumatic arthritis, ankylosing spondylitis/unspecified spondyloarthritis or psoriatic arthritis. Non-persistent patients were matched on propensity score to patients persistent with treatment by at least an additional 12 months. This enabled comparisons of direct healthcare costs and indirect costs for sick leave and disability pension, respectively, 12 months before and 12 months after treatment discontinuation. Results: A balanced cohort of 486 matched pairs was generated. The total direct and indirect costs were significantly higher among non-persistent patients already during the 12 months before index ($20,802 [18,335–23,429] vs.$16,600 [14,331–18,696]). However, while non-persistent patients increased their total direct and indirect costs, persistent patients significantly decreased the same, further widening the difference in costs during the 12-month period after index date ($22,161 [19,754–24,556] vs.$13,465 [11,415–15,729]). Conclusions: Among biologic-naïve Swedish IA patients treated with SC-TNFis, persistent patients incurred about 40% lower aggregated direct and indirect costs compared to non-persistent patients the year following SC-TNFi discontinuation. This highlights the impact of treatment persistence from an economic viewpoint, adding further aspects to the clinical perspective

Dual-Energy CT Images: Pearls and Pitfalls

Dual-energy CT (DECT) is a tremendous innovation in CT technology that allows creation of numerous imaging datasets by enabling discrete acquisitions at more than one energy level. The wide range of images generated from a single DECT acquisition provides several benefits such as improved lesion detection and characterization, superior determination of material composition, reduction in the dose of iodine, and more robust quantification. Technological advances and the proliferation of various processing methods have led to the availability of diverse vendor-based DECT approaches, each with a different acquisition and image reconstruction process. The images generated from various DECT scanners differ from those from conventional single-energy CT because of differences in their acquisition techniques, material decomposition methods, image reconstruction algorithms, and postprocessing methods. DECT images such as virtual monochromatic images, material density images, and virtual unenhanced images have different imaging appearances, texture features, and quantitative capabilities. This heterogeneity creates challenges in their routine interpretation and has certain associated pitfalls. Some artifacts such as residual iodine on virtual unenhanced images and an appearance of pseudopneumatosis in a gas-distended bowel loop on material-density iodine images are specific to DECT, while others such as pseudoenhancement seen on virtual monochromatic images are also observed at single-energy CT. Recognizing the potential pitfalls associated with DECT is necessary for appropriate and accurate interpretation of the results of this increasingly important imaging tool. (C) RSNA, 202

Multimodality Imaging in the Detection of Ischemic Heart Disease in Women

Women with coronary artery disease tend to have a worse short and long-term prognosis relative to men and the incidence of atherosclerotic cardiovascular disease is increasing. Women are less likely to present with classic anginal symptoms when compared with men and more likely to be misdiagnosed. Several non-invasive imaging modalities are available for diagnosing ischemic heart disease in women and many of these modalities can also assist with prognostication and help to guide management. Selection of the optimal imaging modality to evaluate women with possible ischemic heart disease is a scenario which clinicians often encounter. Earlier modalities such as exercise treadmill testing demonstrate significant performance variation in men and women, while newer modalities such as coronary CT angiography, myocardial perfusion imaging and cardiac magnetic resonance imaging are highly specific and sensitive for the detection of ischemia and coronary artery disease with greater parity between sexes. Individual factors, availability, diagnostic performance, and female-specific considerations such as pregnancy status may influence the decision to select one modality over another. Emerging techniques such as strain rate imaging, CT-myocardial perfusion imaging and cardiac magnetic resonance imaging present additional options for diagnosing ischemia and coronary microvascular dysfunction