Tuberculosis of the oral mucosa: Case report

There is an increase in the incidence of extra-pulmonary tuberculosis (TB) despite decline in cases of  pulmonary TB. Oral TB lesions are non-specific in their presentation and are often a forgotten differential  diagnosis in oral lesions. This report presents a previously undiagnosed case of TB whose oral lesions led to  diagnosis and treatment

Factors affecting interdisciplinary approach to patient care at Vihiga County Referral Hospital

Background: Interdisciplinary collaboration is a vital phenomenon to healthcare providers and patients. The level of collaboration that takes place among providers can directly impact patient outcomes. Increase in teamwork among the healthcare workers across all cadres can lead to a better patient care as compared to only one cadre depending on itself.Objective: To identify factors affecting interdisciplinary approach in patient care at Vihiga County Referral Hospital.Study Design: A descriptive cross-sectional studyStudy Setting: The study was carried out at Vihiga County Referral Hospital (VCRH).Study Subjects: All healthcare givers from 13 disciplines that is, nursing, medicine and surgery, clinical medicine, dentistry, pharmacy, laboratory, nutrition, physiotherapy, occupational therapy, psychiatry, public health social work and imaging department.Results: Majority (96.43%) of the respondents were aware that interdisciplinary approach in patient care is important and necessary for better patient care. The remaining 3.57% were not aware of the interdisciplinary approach in patient care since they do not practice it. About 14.26% agreed to cooperate with each other while working as a team, 21.43% reported to cooperate occasionally, 32.14% reported to cooperating most of the time and 35 % reported cooperating always while working as a team. 42.86% reported to be comfortable working with each other while 7.14 reported to be rarely comfortable. 42.86% agreed to have excellent communication always with their team members, patients and their families while 3.6% reported to rarely have excellent communication with their team members, patients and families. 53.6% reported to negotiate differences of opinions most of the time 46.4% agreed to negotiate differences of opinions among the team members when they arise while 7.14% reported to rarely negotiate differences of opinions. 46.4% reported to encourage each other, patients and their families to use the knowledge and skills that each of them can bring in developing plans of care. Half (50%) of the respondents reported to always encourage and support open communication, including the patients during team meetings while 28.6% reported to occasionally do so. 53.6% of the respondents reported to always understand that they shared knowledge and skills between health professions as 25% reported that most of the time they do so.Conclusion: Majority of the VCRH healthcare givers are aware of the interdisciplinary approach in patient care and its importance. The challenge is how to in-cooperate it into the system. From the study, it was evident that the facility has the potential of achieving IDA in patient care if the barriers are addressed. These can be achieved if all the stake holders are brought on board regardless of the cadre. This will improve the standard of patient care in line with the WHO guidelines

A hot ultraviolet flare on the M dwarf star GJ 674

As part of the Mega-Measurements of the Ultraviolet Spectral Characteristics of Low-Mass Exoplanetary Systems Hubble Space Telescope (HST) Treasury program, we obtained time-series ultraviolet spectroscopy of the M2.5V star, GJ 674. During the far-ultraviolet (FUV) monitoring observations, the target exhibited several small flares and one large flare (E FUV = 1030.75 erg) that persisted over the entirety of an HST orbit and had an equivalent duration >30,000 s, comparable to the highest relative amplitude event previously recorded in the FUV. The flare spectrum exhibited enhanced line emission from chromospheric, transition region, and coronal transitions and a blue FUV continuum with an unprecedented color temperature of TC sime 40,000 ± 10,000 K. In this Letter, we compare the flare FUV continuum emission with parameterizations of radiative hydrodynamic model atmospheres of M star flares. We find that the observed flare continuum can be reproduced using flare models but only with the ad hoc addition of a hot, dense emitting component. This observation demonstrates that flares with hot FUV continuum temperatures and significant extreme-ultraviolet/FUV energy deposition will continue to be of importance to exoplanet atmospheric chemistry and heating, even as the host M dwarfs age beyond their most active evolutionary phases

Machine Learning Algorithm to Estimate Distant Breast Cancer Recurrence at the Population Level with Administrative Data

Hava Izci,1 Gilles Macq,2 Tim Tambuyzer,2 Harlinde De Schutter,2 Hans Wildiers,1,3 Francois P Duhoux,4 Evandro de Azambuja,5 Donatienne Taylor,6 Gracienne Staelens,7 Guy Orye,8 Zuzana Hlavata,9 Helga Hellemans,10 Carine De Rop,11 Patrick Neven,1,3 Freija Verdoodt2 1KU Leuven - University of Leuven, Department of Oncology, Leuven, B-3000, Belgium; 2Belgian Cancer Registry, Research Department, Brussels, Belgium; 3University Hospitals Leuven, Multidisciplinary Breast Center, Leuven, B-3000, Belgium; 4Department of Medical Oncology, King Albert II Cancer Institute, Cliniques Universitaires Saint-Luc, Brussels, Belgium; 5Institut Jules Bordet and l’Université Libre de Bruxelles (U.L.B), Brussels, Belgium; 6CHU UCL Namur, Site Sainte-Elisabeth, Namur, Belgium; 7Multidisciplinary Breast Center, General Hospital Groeninge, Kortrijk, Belgium; 8Department of Obstetrics and Gynecology, Jessa Hospital, Hasselt, Belgium; 9Department of Medical Oncology, CHR Mons-Hainaut, Mons, Hainaut, Belgium; 10Department of Obstetrics and Gynaecology, AZ Delta, Roeselaere, Belgium; 11Department of Obstetrics and Gynaecology, Imelda Hospital, Bonheiden, BelgiumCorrespondence: Hava Izci, KU Leuven, Department of oncology, Herestraat 49 Box 7003-06, Leuven, 3000, Belgium, Email [email protected]: High-quality population-based cancer recurrence data are scarcely available, mainly due to complexity and cost of registration. For the first time in Belgium, we developed a tool to estimate distant recurrence after a breast cancer diagnosis at the population level, based on real-world cancer registration and administrative data.Methods: Data on distant cancer recurrence (including progression) from patients diagnosed with breast cancer between 2009– 2014 were collected from medical files at 9 Belgian centers to train, test and externally validate an algorithm (i.e., gold standard). Distant recurrence was defined as the occurrence of distant metastases between 120 days and within 10 years after the primary diagnosis, with follow-up until December 31, 2018. Data from the gold standard were linked to population-based data from the Belgian Cancer Registry (BCR) and administrative data sources. Potential features to detect recurrences in administrative data were defined based on expert opinion from breast oncologists, and subsequently selected using bootstrap aggregation. Based on the selected features, classification and regression tree (CART) analysis was performed to construct an algorithm for classifying patients as having a distant recurrence or not.Results: A total of 2507 patients were included of whom 216 had a distant recurrence in the clinical data set. The performance of the algorithm showed sensitivity of 79.5% (95% CI 68.8– 87.8%), positive predictive value (PPV) of 79.5% (95% CI 68.8– 87.8%), and accuracy of 96.7% (95% CI 95.4– 97.7%). The external validation resulted in a sensitivity of 84.1% (95% CI 74.4– 91.3%), PPV of 84.1% (95% CI 74.4– 91.3%), and an accuracy of 96.8% (95% CI 95.4– 97.9%).Conclusion: Our algorithm detected distant breast cancer recurrences with an overall good accuracy of 96.8% for patients with breast cancer, as observed in the first multi-centric external validation exercise.Keywords: machine learning, breast cancer, distant metastases, recurrences, algorithm, administrative dat

Estimating the ultraviolet emission of M dwarfs with exoplanets from Ca II and H

M dwarf stars are excellent candidates around which to search for exoplanets, including temperate, Earth-sized planets. To evaluate the photochemistry of the planetary atmosphere, it is essential to characterize the UV spectral energy distribution of the planet's host star. This wavelength regime is important because molecules in the planetary atmosphere such as oxygen and ozone have highly wavelength-dependent absorption cross sections that peak in the UV (900–3200 Å). We seek to provide a broadly applicable method of estimating the UV emission of an M dwarf, without direct UV data, by identifying a relationship between noncontemporaneous optical and UV observations. Our work uses the largest sample of M dwarf star far- and near-UV observations yet assembled. We evaluate three commonly observed optical chromospheric activity indices—Hα equivalent widths and log10 LHα/Lbol, and the Mount Wilson Ca II H&K S and R'HK indices—using optical spectra from the HARPS, UVES, and HIRES archives and new HIRES spectra. Archival and new Hubble Space Telescope COS and STIS spectra are used to measure line fluxes for the brightest chromospheric and transition region emission lines between 1200 and 2800 Å. Our results show a correlation between UV emission-line luminosity normalized to the stellar bolometric luminosity and Ca II R'HK with standard deviations of 0.31–0.61 dex (factors of ~2–4) about the best-fit lines. We also find correlations between normalized UV line luminosity and Hα log10 LHα/Lbol and the S index. These relationships allow one to estimate the average UV emission from M0 to M9 dwarfs when UV data are not available