An overview of role of retinoids in management of warts: Review article

Background: Human papillomavirus (HPV)-inducing HPV-types can cause a wide range of cutaneous wart morphology and histological patterns that are distinct from one another. Certain forms of warts are more commonly related with various HPVs that cause cutaneous warts. It is essential that treatments for different forms of warts are both safe and painless. As warts can resolve up to two-thirds of the time without treatment, and treatments should not increase morbidity, this is particularly significant. In contrast, a large number of warts do not self-resolve fast and are associated with diminished quality of life, embarrassment, and pain in the skin. In terms of structure and function, retinoids resemble vitamin A in many ways. Both the differentiation and proliferation of keratinocytes and the immune system are hampered by their immunomodulatory effects. Objective: Assessment of role of retinoids in management of warts.Conclusion: Oral retinoids such as isotretinoin and acitretin are safe and reported to be effective therapy for different types of wart

Fuzzy-Based Histogram Partitioning for Bi-Histogram Equalisation of Low Contrast Images

The conventional histogram equalisation (CHE), though being simple and widely used technique for contrast enhancement, but fails to preserve the mean brightness and natural appearance of images. Most of the improved histogram equalisation (HE) methods give better performance in terms of one or two metrics and sacri ce their performance in terms of other metrics. In this paper, a novel fuzzy based bi-HE method is proposed which equalises low contrast images optimally in terms of all considered metrics. The novelty of the proposed method lies in selection of fuzzy threshold value using level-snip technique which is then used to partition the histogram into segments. The segmented sub-histograms, like other bi-HE methods, are equalised independently and are combined together. Simulation results show that for widerange of test images, the proposed method improves the contrast while preserving other characteristics and provides good trade-off among all the considered performance metrics.This work was supported by the Deanship of Scientific Research (DSR), King Abdulaziz University, Jeddah, under Grant DF-374-135-1441

Aplikasi Sistem Informasi Geografis (SIG) Untuk Menganalisis Kemampuan Lahan di Kabupaten Musi Rawas Provinsi Sumatera Selatan

Dalam menganalisis kemampuan lahan selalu menggunakan data keruangan. Data tersebut merupakan data faktor yang akan menentukan satuan kemampuan lahan diantaranya jenis morfologi, kestabilan lereng, kedalaman efektif dan ketersediaan air. Data lingkungan tersebut ditumpang-susunkan dan diberi nilai untuk mendapatkan kelas kemampuan lahan sesuai potensinya. Tujuan penelitian ini menentukan kemampuan lahan, membandingkan penggunaan lahan dan merekomendasikan pengembangan sesuai kemampuan lahan di wilayah Kabupaten Musi Rawas Provinsi Sumatera Selatan. Pengolahan data pada satuan kemampuan lahan dilakukan dengan pemodelan spasial menggunakan sistem informasi geospasial yaitu dengan metode tumpang susun (overlay). Hasil analisis kelas kemampuan lahan terdiri dari 3 kelas kemampuan lahan yaitu kelas kemampuan lahan b dengan klasifikasi pengembangan rendah dan diarahkan untuk tetap dilestarikan dan tidak merusak tutupan lahannya.  Kelas kemampuan lahan c dengan klasifikasi pengembangan sedang, arahan pengembangan harus mendapat persetujuaan telaah tata ruang. Pada kelas kemampuan lahan d dengan klasifikasi pengembangan agak tinggi yang mempunyai sedikit penghambat perlu perhatian terutama pada lahan sawah, sungai, danau dan rawa agar tidak dialih fungsikan, sedangkan kawasan rawan banjir tidak ada pembangunan. Pada rentang waktu antara tahun 2008 ke tahun 2017, ternyata ada perubahan luasan kemampuan lahan. Pada tahun 2008 luasan kemampuan pengembangan agak tinggi seluas 53,17%, dan pada tahun 2017 menjadi seluas 53,39%. Untuk kemampuan pengembangan sedang, pada tahun 2008 seluas 44,92%, menjadi seluas45,72% pada tahun 2017. Dengan kurun waktu yang sama pada tahun 2008 kemampuan lahan rendah seluas 1,91% dan pada tahun 2017 menjadi seluas 0,89%

Semi-Disparate Impact of Kinases GCN2 and PERK in Modulating the Dynamic Control Properties of eIF2 Pathway

The tumor microenvironment associated with deficiencies in nutrients and oxygen is important in observing the regulation of tumor progression. The aggressiveness of the tumor cells can be stimulated by exposing it to nutrient starvation and hypoxia. During nutrient starvation, activation of an integrated stress response pathway takes place, which helps tumor cells to cope with nutrient stress. In this paper, an evolutionarily conserved central translational control pathway, i.e., the integrated stress response pathway is analyzed with the help of a mathematical model. This paper is of significant novelty in terms of testable predictions about specific pathway properties with the help of analysis tools from control theory. The investigation has suggested that both kinases GCN2 and PERK have semi-disparate impact on the dynamic control properties of the system. The examples include both kinases show analogous behavior toward the robustness and stability of the system, but disparate behavior in compensating the loss of another kinase

Reinforcing synthetic data for meticulous survival prediction of patients suffering from left ventricular systolic dysfunction

Congestive heart failure is among leading genesis of concern that requires an immediate medical attention. Among various cardiac disorders, left ventricular systolic dysfunction is one of the well known cardiovascular disease which causes sudden congestive heart failure. The irregular functioning of a heart can be diagnosed through some of the clinical attributes, such as ejection fraction, serum creatinine etcetera. However, due to availability of a limited data related to the death events of patients suffering from left ventricular systolic dysfunction, a critical level of thresholds of clinical attributes can not be estimated with higher precision. Hence, this paper proposes a novel pseudo reinforcement learning algorithm which overcomes a problem of majority class skewness in a limited dataset by appending a synthetic dataset across minority data space. The proposed pseudo agent in the algorithm continuously senses the state of the dataset (pseudo environment) and takes an appropriate action to populate the dataset resulting into higher reward. In addition, the paper also investigates the role of statistically significant clinical attributes such as age, ejection fraction, serum creatinine etc., which tends to efficiently predict the association of death events of the patients suffering from left ventricular systolic dysfunctio

Deletion variants of middle east respiratory syndrome coronavirus from humans, Jordan, 2015

We characterized Middle East respiratory syndrome coronaviruses from a hospital outbreak in Jordan in 2015. The viruses from Jordan were highly similar to isolates from Riyadh, Saudi Arabia, except for deletions in open reading frames 4a and 3. Transmissibility and pathogenicity of this strain remains to be determined

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially