A Unique Case of Lemierre Syndrome Associated with Thrombophilia in an Adult and the Role of Anticoagulation

Acute septic thrombophlebitis of the internal jugular vein (IJV), better known as Lemierre syndrome, is a rare entity which poses several challenges in management. Treatment involves prompt use of intravenous antibiotics over a prolonged period of time, typically 6–8 weeks. The use of anticoagulation is controversial, but indicated for some. We describe the first reported case of Lemierre syndrome associated with a hypercoagulable state in an adult. We propose that all patients with Lemierre syndrome should be evaluated for hypercoagulable states and that the indications for anticoagulation in Lemierre syndrome are (1) propagation or nonresolution of IJV thrombus despite antibiotics and (2) identification of a hypercoagulable state, as in our case

An Improved Integrity-Based Hybrid Multi-User Data Access Control for Cloud Heterogeneous Supply Chain Databases

Cloud-based supply chain applications play a vital role in the multi-user data security framework for heterogeneous data types. The majority of the existing security models work effectively on small to medium-sized datasets with a homogenous data structure. In contrast, Supply Chain Management (SCM) systems in the real world utilize heterogeneous databases. The heterogeneous databases include a massive quantity of raw SCM data and a scanned image of a purchase quotation. In addition, as the size of the database grows, it becomes more challenging to provide data security on multi-user SCM databases. Multi-user datatypes are heterogeneous in structure, and it is complex to apply integrity and confidentiality models due to high computational time and resources. Traditional multi-user integrity algorithms are difficult to process heterogeneous datatypes due to computational time and variation in hash bit size. Conventional attribute-based encryption models such as "Key-policy attribute-based encryption" (KP-ABE), "Ciphertext-Policy Attribute-Based Encryption" (CP-ABE) etc., are used to provide strong data confidentiality on large textual data. Providing security for heterogeneous databases in a multi-user SCM system requires a significant computational runtime for these conventional models. An enhanced integrity-based multi-user access control security model is created for heterogeneous databases in the cloud infrastructure to address the problems with heterogeneous SCM databases. A non-linear integrity model is developed to provide strong integrity verification in the multi-user communication process. A multi-user based access control model is implemented by integrating the multi-user hash values in the encoding and decoding process. Practical results proved that the multi-user non-linear integrity-based multi-access control framework has better runtime and hash bit variation compared to the conventional models on large cloud-based SCM databases

Atrial and placental melanoma metastasis: a case report and literature review

Malignant melanoma can metastasize to virtually any organ of the body. The aggressiveness is determined by the primary site, depth of dermal invasion, presence or absence of ulceration, lymphovascular infiltration and regional lymph node involvement. We report a case of a pregnant woman with a previous history of stage 3 melanoma who presented with cardiac metastasis and placental melanoma infiltration. A review of literature on cardiac and placental involvement of melanoma is also provided

Can Transcutaneous CO2 Tension Be Used to Calculate Ventilatory Dead Space? A Pilot Study

Dead space fraction (Vd/Vt) measurement performed using volumetric capnography requires arterial blood gas (ABG) sampling to estimate the partial pressure of carbon dioxide (PaCO2). In recent years, transcutaneous capnography (PtcCO2) has emerged as a noninvasive method of estimating PaCO2. We hypothesized that PtcCO2 can be used as a substitute for PaCO2 in the calculation of Vd/Vt. In this prospective pilot comparison study, 30 consecutive postcardiac surgery mechanically ventilated patients had Vd/Vt calculated separately using volumetric capnography by substituting PtcCO2 for PaCO2. The mean Vd/Vt calculated using PaCO2 and PtcCO2 was 0.48 ± 0.09 and 0.53 ± 0.08, respectively, with a strong positive correlation between the two methods of calculation (Pearson’s correlation = 0.87, p<0.05). Bland-Altman analysis showed a mean difference of −0.05 (95% CI: −0.01 to −0.09) between the two methods. PtcCO2 measurements can provide a noninvasive means to measure Vd/Vt, thus accessing important physiologic information and prognostic assessment in patients receiving mechanical ventilation

Abstracts of National Conference on Research and Developments in Material Processing, Modelling and Characterization 2020

This book presents the abstracts of the papers presented to the Online National Conference on Research and Developments in Material Processing, Modelling and Characterization 2020 (RDMPMC-2020) held on 26th and 27th August 2020 organized by the Department of Metallurgical and Materials Science in Association with the Department of Production and Industrial Engineering, National Institute of Technology Jamshedpur, Jharkhand, India. Conference Title: National Conference on Research and Developments in Material Processing, Modelling and Characterization 2020Conference Acronym: RDMPMC-2020Conference Date: 26–27 August 2020Conference Location: Online (Virtual Mode)Conference Organizer: Department of Metallurgical and Materials Engineering, National Institute of Technology JamshedpurCo-organizer: Department of Production and Industrial Engineering, National Institute of Technology Jamshedpur, Jharkhand, IndiaConference Sponsor: TEQIP-

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)