Clinical and endoscopic features of pill-induced esophagitis

Background: Medication can cause an injury in the esophagus by local and systemic effect, leading to esophagitis. Many such medications have been identified as a cause of pill-induced esophagitis. This study was performed to evaluate the clinical and endoscopic findings of pill-induced esophagitis.Methods: This was retrospective observational study, conducted among patients diagnosed endoscopically with pill-induced esophagitis at Ansh gastroenterology clinic, Ahmedabad, India, from April 2017 to March 2021. The data of these patients were recorded in pre-designed case record form by evaluating their past medical records.Results: Total 90 patients were diagnosed with pill-induced esophagitis. Retrosternal chest pain (68.9%), odynophagia (41.1%), dysphagia (25.6%), and epigastric pain (14.4%) were common clinical findings. The major culprit medications were antibiotics, and NSAIDs (non-steroidal anti-inflammatory drugs). Common esophageal endoscopic findings were ulcer (84.4%), erosion (17.8%), and active ulcer bleeding (12.2%). Kissing ulcers were observed in the majority (46.7%) of cases. The majority of ulcer and erosion were located in middle third of the esophagus. All the patients were recovered within 6 to 10 days after treatment with PPIs (proton pump inhibitors) and/or antacids, and withdrawal of the causative medication.Conclusions: Pill-induced esophagitis commonly manifests as retrosternal chest pain, odynophagia and dysphagia, and endoscopy reveals kissing ulcer and erosion in the majority of cases. The condition can be treated with PPIs and/or antacids, and withdrawal of the offending medication.

A prospective study of 50 cases of patella fractures treated with different modalities

Background: Fractures of patella account for 1% of all skeletal injuries. There is no universal accepted treatment for patellar fractures. After a fracture of the patella, the best results are obtained by accurate reduction and stable internal fixation. Partial or total patellectomy is generally indicated when the patella is so severely comminuted that an accurate reduction and reconstruction of the retropatellar joint surface cannot be achieved.Methods: The prospective study of 50 cases of patellar fractures was carried out at the department of orthopaedics for the period from May 2015 to December 2017. The maximum period of follow up was 18 months with a minimum period of follow up of 5 months (average 11.68 months). Operative treatment was done in patella fractures for more than 2 mm of articular displacement or 3 mm of fragment separation. Surgical options includes internal fixation with tension band wiring with k wire and partial patellectomy with extensor mechanism repair.Results: We have studied 50 patients where 7 cases were treated conservatively. In the present series 22 patients were treated with internal fixation out of which 13 patients had excellent results. 6 patients had good results. 21 patients were treated with partial patellectomy where 6 patients had excellent results, 11 patients had good and 4 patients had fair results.Conclusions: Patella should be preserved and Osteosynthesis whenever possible has better chance for excellent results. A good surgical technique, optimal operation room environment and judicious use of antibiotics will reduce the possibility of infection

A study of clinicoradiological and functional outcomes of intramedullary nailing in diaphyseal radius ulna fractures

Background: The aim of this study was to evaluate the results of intramedullary nailing in diaphyseal fractures of radius and ulna in age group of 10 to 49 years and to understand its clinicoradiological and functional results.Methods: This is a retrospective case series study of forearm bone fractures and the selected management for the same over a period of 3 years. We chose the cases in which intramedullary nailing was the treatment modality which were followed up over a period of minimum 6 months. Patients with galeazzi variety, monteggia variety, pathological fracture or non-union after previous surgery were excluded. The outcomes were then evaluated with disabilities of the arm, shoulder and hand (DASH) score, Green and O’Brien score, and Grace and Eversmann functional outcome score.Results: Of the 22 patients, 10 patients had excellent functional outcome according to Grace and Eversmann score, 7 patients had good outcome, 4 patients had acceptable while 1 was unacceptable. Green and O’Brien also had similar results, except that patients among fair category were 3 and poor category were 3. The mean DASH score was 16.2.Conclusions: This study shows that closed method for fixation by intramedullary nailing of both bone forearm fractures leads to excellent to good functional outcomes (according to DASH score, Green and O Brien, and Grace and Eversmann score) with less complications. In 6 months follow up x ray there is radiological union in all cases with no angulation, malunion or non-union.

Retinopathy predicts progression of fasting plasma glucose: An Early Diabetes Intervention Program (EDIP) analysis

Background Retinopathy is increasingly recognized in prediabetic populations, and may herald increased risk of metabolic worsening. The Early Diabetes Intervention Program (EDIP) evaluated worsening of glycemia in screen-detected Type 2 diabetes, following participants for up to 5 years. Here we have evaluated whether the presence of retinopathy at the time of detection of diabetes was associated with accelerated progression of glycemia. Methods We prospectively studied 194 participants from EDIP with available baseline retinal photographs. Retinopathy was determined at baseline using 7-field fundus photography and defined as an Early Treatment of Diabetic Retinopathy Study Scale grading score of ≥ 20. Results At baseline, 12% of participants had classical retinal lesions indicating retinopathy. In univariate Cox proportional hazard analysis, the presence of retinopathy at baseline was associated with a doubled risk of progression of fasting plasma glucose (HR 2.02; 95% CI 1.05–3.89). The retinopathy effect was robust to individual adjustment for age and glucose, the most potent determinants of progression in EDIP. Conclusion Retinopathy was associated with increased risk of progression of fasting plasma glucose among adults with screen-detected, early diabetes. Early detection of retinopathy may help individualize more aggressive therapy to prevent progressive metabolic worsening in early diabetes

Enhancing variational quantum state diagonalization using reinforcement learning techniques

The development of variational quantum algorithms is crucial for the application of NISQ computers. Such algorithms require short quantum circuits, which are more amenable to implementation on near-term hardware, and many such methods have been developed. One of particular interest is the so-called the variational diagonalization method, which constitutes an important algorithmic subroutine, and it can be used directly for working with data encoded in quantum states. In particular, it can be applied to discern the features of quantum states, such as entanglement properties of a system, or in quantum machine learning algorithms. In this work, we tackle the problem of designing a very shallow quantum circuit, required in the quantum state diagonalization task, by utilizing reinforcement learning. To achieve this, we utilize a novel encoding method that can be used to tackle the problem of circuit depth optimization using a reinforcement learning approach. We demonstrate that our approach provides a solid approximation to the diagonalization task while using a small number of gates. The circuits proposed by the reinforcement learning methods are shallower than the standard variational quantum state diagonalization algorithm, and thus can be used in situations where the depth of quantum circuits is limited by the hardware capabilities.Comment: 17 pages with 13 figures, some minor, important improvements, code available at https://github.com/iitis/RL_for_VQSD_ansatz_optimizatio

Assessment of a Wearable Device for Minute Ventilation in Detecting Different States of Ventilation

Introduction: Minute ventilation (MV) and breathing status are valuable vital signs to measure in patients clinically such as in detecting opioid induced respiratory depression. However, there are few devices capable of continuously monitoring MV in an accurate fashion. RTM Vital Signs, LLC and TJU are developing a non-invasive wearable Tracheal Sound Sensor to determine if a device can accurately and continuously measure respiratory rate (RR), tidal volume (TV), MV, and changes in ventilation patterns based on sound recordings of breathing. Methods: Tracheal breathing sounds were recorded in six researchers using a prototype sensor placed on the skin above the sternal notch. Simultaneously, researcher’s RR and MV were recorded in minute long intervals using a pneumotach. Researchers were asked to mimic various breathing patterns by adjusting breathing rate and breathing depth. A variety of signal processing methods and algorithms were used to analyze the data to produce RR, TV, and breathing pattern estimates. Results: Researchers tolerated use of the sensor and breathing apparatus system without difficulty and data was successfully obtained. Initial signal processing and analysis methods applied to this data were able to accurately measure the respiratory rate (~ 98% sensitivity/specificity), and accurately characterize normal breathing from hyperventilation and hypoventilation (~ 98% sensitivity/specificity). The sensor’s algorithm estimated tidal volume with ± 100 ml accuracy compared with the commercial pneumotach. Discussion: Based on the results, a non-invasive wearable device could obtain accurate measures of RR and classify breathing patterns based solely on measurements of breathing sounds. Although the TV results were not as accurate as we expected, this may be due in part to systematic error from the pneumotach device used for the reference TV. With the satisfactory sensor and data acquisition system, future trials are planned in volunteers and hospitalized patients using this system with more accurate pneumotach devices

Detecting Different States of Ventilation with a Wearable Device through Minute Ventilation

Introduction: Detecting changes in respiration are essential to monitoring a patient’s vital signs. Few devices accomplish this in a non-invasive manner. We are developing a wearable Trachea Sound Sensor that measures respiratory rate (RR), tidal volume (TV), minute ventilation (MV = RR x TV). A prototypical Trachea Sound Sensor (TSS) was created and compared to a reference pneumotachometer. Both were used to record the sounds of breathing with research team members. Methods:The TSS recording device was tested on six research team members and breath sounds were recorded. Simultaneously, the member’s RR and MV was recorded using a calibrated pneumotachometer. The researchers were instructed to adjust their breathing rate and depth while intervals were recorded. Signal processing techniques were used to analyze and produce measurements of RR, TV, and characterize hyperventilatory or hypoventilatory states. Results: Based on the results, we found that it is possible to obtain accurate measures of RR and identify breathing patterns through the TSS. Signal processing and analysis calculated RR, states of hyperventilation and hypoventilation with 98% sensitivity and specificity. Results obtained for measuring TV were less accurate (±100 mL). Discussion: Our results suggest that it is viable to obtain accurate measures of RR and classify breathing sounds solely on measurements of breathing sounds from the TSS. The inaccuracy in TV measurements may be partly due to the systematic error from the pneumotachometer used. The prototypical TSS are suitable for upcoming NIH-funded clinical trials to test the TSS in volunteers and hospitalized patients

Profound defects in β-cell function in screen-detected type 2 diabetes are not improved with glucose-lowering treatment in the Early Diabetes Intervention Program (EDIP)

BACKGROUND: Few studies have measured the ability of interventions to affect declining β-cell function in screen-detected type 2 diabetes. The Early Diabetes Intervention Programme (ClinicalTrials.gov NCT01470937) was a randomized study based on the hypothesis that improving postprandial glucose excursions with acarbose would slow the progression of fasting hyperglycaemia in screen-detected type 2 diabetes. In the Early Diabetes Intervention Programme, the effect of acarbose plus lifestyle advice on progression of fasting hyperglycaemia over a 5-year period was not greater than that of placebo. However, there was an early glucose-lowering effect of the trial. The objective of the current secondary analysis was to describe β-cell function changes in response to glucose lowering. METHODS: Participants were overweight adult subjects with screen-detected type 2 diabetes. β-cell function was measured using hyperglycaemic clamps and oral glucose tolerance testing. The primary outcome was the change in β-cell function from baseline to year 1, the time point where the maximal glucose-lowering effect was seen. RESULTS: At baseline, participants exhibited markedly impaired first-phase insulin response. Despite significant reductions in weight, fasting plasma glucose (PG) and 2-h PG, there was no clinically significant improvement in the first-phase insulin response. Late-phase insulin responses declined despite beneficial glycaemic effects of interventions. CONCLUSIONS: Insulin secretion is already severely impaired in early, screen-detected type 2 diabetes. Effective glucose-lowering intervention with acarbose was not sufficient to improve insulin secretion or halt the decline of β-cell function

Walking and Calcified Atherosclerotic Plaque in the Coronary ArteriesHighlights: The National Heart, Lung, and Blood Institute Family Heart Study

Studies have reported mixed findings on the association between physical activity and subclinical atherosclerosis. We sought to examine whether walking is associated with prevalent coronary artery calcification (CAC) and aortic calcification (AC)

Practitioner\u27s Guide to Technology, Pedagogy, and Content Knowledge (TPACK): Rich Media Cases of Teacher Knowledge

The goal of the TPACK Practitioners Guide is simple--to offer exemplary cases of technology integration efforts that result in curriculum-based student learning in each of the following nine content areas and grade level contexts: Elementary Science, Elementary Math, Elementary Social Studies, Elementary Reading, Middle School Language Arts, Secondary Science, Secondary Math, Secondary Social Studies, and, Secondary English.https://scholarworks.wm.edu/book/1000/thumbnail.jp