Assessment of hospital rooming-in practice in Abu Dhabi, United Arab Emirates: A cross-sectional multi-center study

© 2020 by the authors. Licensee MDPI, Basel, Switzerland. The World Health Organization (WHO) recommends rooming-in to reduce infant mortality rates. Little research has been done to assess practices such as rooming-in and its relation to breastfeeding in the United Arab Emirates (UAE). The aim of this study was to examine the prevalence of rooming-in during hospital stay among mothers with infants six months old and below, in addition to other associated factors in Abu Dhabi, UAE. This study utilized a sub-sample extracted from a dataset based on a convenience sample of mothers who were recruited from governmental maternal and child health centers as well as from the community. The purpose of the original research was to evaluate infant and young children’s feeding practices. A pre-tested questionnaire was used during interviews with mothers once ethical clearance was in place. Multivariable logistic regression was conducted to describe the results. The original sample included 1822 participants, of which 804 infants met the inclusion criteria. The mean age for mothers and infants was 30.3 years and 3.5 months, respectively. The rate of rooming-in during hospital stay was 97.5%. Multivariable logistic regression analysis indicated factors associated with not rooming-in were low maternal age (Adjusted Odds Ratios (AOR) = 1.15, 95% confidence interval (CI): 1.03, 1.30), low gestational age (GA) (AOR = 1.90, 95% CI: 1.52, 2.36), abnormal pre-pregnancy body mass index (BMI) (AOR = 3.77, 95 % CI: 1.22, 11.76), and delayed initiation of breastfeeding (AOR = 4.47, 95 % CI: 1.08, 18.48). In the context of the high rate of rooming-in revealed in this study, there should be a focus on those groups who do not room-in (i.e., younger women and those with babies of a younger gestational age). Rooming-in practice provides self-confidence in taking care of a baby, knowledge about breastfeeding, and stimulates early-phase lactation

Acquired pure megakaryocytic aplasia successfully treated with cyclosporine

Acquired pure megakaryocytic aplasia is a rare hematological disorder characterized by thrombocytopenia with absent or markedly reduced megakaryocytes in the bone marrow. We report a case of a 25-year-old male diagnosed as acquired pure megakaryocytic aplasia. Treatment with prednisone and intravenous immunoglobulin failed, but he was successfully treated with cyclosporine, with complete remission after 90 days and normal platelet count maintained thereafter

Sanguinarine Induces Apoptosis Pathway in Multiple Myeloma Cell Lines via Inhibition of the JaK2/STAT3 Signaling.

Sanguinarine (SNG), a benzophenanthridine alkaloid, has displayed various anticancer abilities in several vivo and studies. However, the anticancer potential of SNG is yet to be established in multiple myeloma (MM), a mostly incurable malignancy of plasma cells. In this study, we aimed to investigate the potential anti-proliferative and pro-apoptotic activities of SNG in a panel of MM cell lines (U266, IM9, MM1S, and RPMI-8226). SNG treatment of MM cells resulted in a dose-dependent decrease in cell viability through mitochondrial membrane potential loss and activation of caspase 3, 9, and cleavage of PARP. Pre-treatment of MM cells with a universal caspase inhibitor, Z-VAD-FMK, prevented SNG mediated loss of cell viability, apoptosis, and caspase activation, confirming that SNG-mediated apoptosis is caspase-dependent. The SNG-mediated apoptosis appears to be resulted from suppression of the constitutively active STAT3 with a concomitant increase in expression of protein tyrosine phosphatase (SHP-1). SNG treatment of MM cells leads to down-regulation of the anti-apoptotic proteins including cyclin D, Bcl-2, Bclxl, and XIAP. In addition, it also upregulates pro-apoptotic protein, Bax. SNG mediated cellular DNA damage in MM cell lines by induction of oxidative stress through the generation of reactive oxygen species and depletion of glutathione. Finally, the subtoxic concentration of SNG enhanced the cytotoxic effects of anticancer drugs bortezomib (BTZ) by suppressing the viability of MM cells via induction of caspase-mediated apoptosis. Altogether our findings demonstrate that SNG induces mitochondrial and caspase-dependent apoptosis, generates oxidative stress, and suppresses MM cell lines proliferation. In addition, co-treatment of MM cell lines with sub-toxic doses of SNG and BTZ potentiated the cytotoxic activity. These results would suggest that SNG could be developed into therapeutic agent either alone or in combination with other anticancer drugs in MM

Comparative Analysis of the Performance of Popular Sorting Algorithms on Datasets of Different Sizes and Characteristics

Abstract: The efficiency and performance of sorting algorithms play a crucial role in various applications and industries. In this research paper, we present a comprehensive comparative analysis of popular sorting algorithms on datasets of different sizes and characteristics. The aim is to evaluate the algorithms' performance and identify their strengths and weaknesses under varying scenarios. We consider six commonly used sorting algorithms: QuickSort, TimSort, MergeSort, HeapSort, RadixSort, and ShellSort. These algorithms represent a range of approaches and techniques, including divide-and-conquer, hybrid sorting, and simple comparison-based methods. To assess their performance, we employ a diverse set of datasets, including the Iris dataset (1K), student dataset (5.8K), Wine dataset (6.5K), Uniform (10K), Normal (10K), Exponential (10K), Bimodal (10K), Yelp dataset (10K), MNIST dataset (42K), Uniform (100K), Normal (100K), Exponential (100K), Bimodal (100K), Uniform (500K), Normal (500K), Exponential (500K), Bimodal (500K), Uniform (1M), Normal (1M), Exponential (1M), and Bimodal (1M). These datasets cover a wide range of sizes and characteristics, allowing us to analyze the algorithms' performance across different dimensions. We measure and compare several key metrics, including execution time, memory usage, algorithmic complexity and stability. By analyzing these metrics, we gain insights into the efficiency and suitability of each algorithm for different dataset sizes and characteristics. We also discuss the implications of the findings in practical applications. Our results reveal important trade-offs among the sorting algorithms. While some algorithms excel in certain scenarios, others demonstrate better scalability or memory efficiency. We identify the best-performing algorithms for specific dataset characteristics and highlight their strengths and limitations. This research can assist developers and practitioners in selecting appropriate sorting algorithms based on their specific requirements and dataset characteristics. In conclusion, this comparative analysis provides a valuable contribution to the understanding of sorting algorithm performance. The findings contribute insights into the efficiency and suitability of popular sorting algorithms across datasets of different sizes and characteristics. By evaluating key metrics and discussing the implications, we offer guidance for selecting the most appropriate sorting algorithm in various practical scenarios

Sanguinarine Induces Apoptosis Pathway in Multiple Myeloma Cell Lines via Inhibition of the JaK2/STAT3 Signaling

Sanguinarine (SNG), a benzophenanthridine alkaloid, has displayed various anticancer abilities in several vivo and in vitro studies. However, the anticancer potential of SNG is yet to be established in multiple myeloma (MM), a mostly incurable malignancy of plasma cells. In this study, we aimed to investigate the potential anti-proliferative and pro-apoptotic activities of SNG in a panel of MM cell lines (U266, IM9, MM1S, and RPMI-8226). SNG treatment of MM cells resulted in a dose-dependent decrease in cell viability through mitochondrial membrane potential loss and activation of caspase 3, 9, and cleavage of PARP. Pre-treatment of MM cells with a universal caspase inhibitor, Z-VAD-FMK, prevented SNG mediated loss of cell viability, apoptosis, and caspase activation, confirming that SNG-mediated apoptosis is caspase-dependent. The SNG-mediated apoptosis appears to be resulted from suppression of the constitutively active STAT3 with a concomitant increase in expression of protein tyrosine phosphatase (SHP-1). SNG treatment of MM cells leads to down-regulation of the anti-apoptotic proteins including cyclin D, Bcl-2, Bclxl, and XIAP. In addition, it also upregulates pro-apoptotic protein, Bax. SNG mediated cellular DNA damage in MM cell lines by induction of oxidative stress through the generation of reactive oxygen species and depletion of glutathione. Finally, the subtoxic concentration of SNG enhanced the cytotoxic effects of anticancer drugs bortezomib (BTZ) by suppressing the viability of MM cells via induction of caspase-mediated apoptosis. Altogether our findings demonstrate that SNG induces mitochondrial and caspase-dependent apoptosis, generates oxidative stress, and suppresses MM cell lines proliferation. In addition, co-treatment of MM cell lines with sub-toxic doses of SNG and BTZ potentiated the cytotoxic activity. These results would suggest that SNG could be developed into therapeutic agent either alone or in combination with other anticancer drugs in MM

Raumladungseffekt in der starken Feld-Ionisierung von dichten Medien

Acknowledgments……………………………………………………… I Abbreviations…………………………………………………………… III List of Figures………………………………………………………….. VI List of Publications…………………………………............................ VII Chapter 1: Introduction……………………………………………….. 1 Chapter 2: Interaction of Atoms and Molecules with Laser Fields….. 5 2.1 Ionization in a Laser Field of Moderate Intensity……………………………. 6 2.2 Strong-Field Ionization……………………………………………….............. 10 2.3 Strong-Field Approximation……………………………………….................... 19 2.4 Strong-Field Ionization in a Circularly Polarized Field…………….................. 22 2.5 Electron Dynamics in a Laser Field…………………………………………….. 24 2.6 High-Order Harmonics Generation……………………………………………. 28 2.7 Principles of Photoelectron Spectroscopy……………………………………. 32 2.7.1 The Methods of Photoelectron Spectroscopy…………….................... 33 2.7.2 Time-Resolved Photoelectron Spectroscopy…………………………… 35 2.8 Space-Charge Effect Induced by a Single Laser Pulse of High Intensity…….. 38 2.9 Space-Charge Effect in Time-Resolved Photoelectron Spectroscopy................. 40 2.10 Electronic Structure of Water………………………………………………….. 43 2.11 The Molecular Structure of Potassium Ferrocyanide………………………….. 46 Chapter 3: Experimental Setup………………………………………… 49 3.1 Laser Setup………………………………………………………………… 49 3.1.1 High Harmonic Generation…………………………………………. 50 3.1.2 Generation of the Third Harmonic Beam…………………………… 53 3.1.3 Beam Diagnostics of the Pump and Probe Pulses…………………… 54 3.2 Interaction Region…………………………………………………............. 56 3.2.1 Liquid Microjet…………………………………………………..... 58 3.2.2 Time-of-Flight Electron Spectrometer……………………………… 59 3.3 Spatial and Temporal Overlap of Pump and Probe Pulses………………… 61 3.4 Sample Preparation………………………………………………………… 65 3.5 Experiment with Strong Laser Field: Laser and Spectrometer Setup…….. 65 3.5.1 Laser Setup………………………………………………………………… 66 3.5.1.1 Optical Parametric Amplifier………..…….................................... 66 3.5.1.2 Control of Linear and Circular Polarization Light………………… 69 3.5.2 Time-of-Flight Electron Spectrometer……………………………………. 71 Chapter 4: Ultrafast Photoelectron Spectroscopy of Solution: Space-Charge Effect…………………………………………………………. 73 4.1 XUV- Photoelectron Spectra of Liquid Water and Iron Hexacyanide ......... 74 4.2 Space-Charge Effect Induced by XUV-Probe Beam………………………. 75 4.3 Space-Charge Effect in Pump-Probe Spectra………………………………. 78 4.4 The Intensity Dependence Study: Spectral Shift vs Water Ionization Yield… 83 4.5 Modeling of the Space- Charge Effect………………………………………… 88 4.5.1 Mean-Field Model and Superposition Principle……………………….. 89 4.5.2 Positive and Negative Space-Charge Effects………………………… 91 4.5.3 Comparison of the Model and the Experimental Results………………. 96 4.6 Conclusion……………………………………………………………………. 98 Chapter 5: Space-Charge Effect Induced by a Single Laser Pulse of High Intensity…………………………………………………………. 99 5.1 Near-Infrared Photoelectron Spectra of Water Vapor for Linearly Polarized Light…………………………………………………………………………… 100 5.1.1 Space-Charge Effect Induced at Different Vapor Pressures in the Vicinity of a Microjet………………………………………………………… 102 5.1.2 The Intensity Dependence Study for Linearly Polarized Field……….. 105 5.2 Near-Infrared Spectra of Water Vapor for a Strong Circularly Polarized Light. 108 5.2.1 Simulated Spectrum and its Comparison to the Experiment Results… 109 5.2.2 The Vapor-Pressure Study in the Vicinity of the Liquid the Microjet for Circularly Polarized Field…………………………………………………….. 110 5.2.3 The Intensity Dependence Study for Circularly Polarized Field………. 112 5.3 Conclusion……………………………………………………………………… 114 Summary…………………………………………………………………. 115 Bibliography……………………………………………………………... 121In this study, the method of photoelectron spectroscopy was applied to investigate the photo-process induced by a strong laser field at a liquid interface. The photoelectrons generated by the intense optical field of short pulses in the medium of high density give rise to space-charge effect (SCE) that modifies the emission spectra. Thus, the SCE accompanies other processes induced in a strong laser field. Namely, it causes distortion of the spectral distribution of photoelectrons and, as a result, it decreases the energy resolution in the photoelectron spectroscopy measurements. The present work was focused on revealing the main features of the SCE in pump-probe experiments as well as in experiments with the use of a single laser pulse of high peak intensity. First, a manifestation of the SCE in photoelectrons spectra obtained by the method of time-resolved photoelectron spectroscopy was investigated in the case of a liquid sample. A combination of two techniques, pump-probe photoelectrons spectroscopy, and the liquid microjet techniques, was applied in this study. Such a combination, in general, provides the unique possibility to study the electronic and structural dynamics in solutions and interfaces. Here, an aqueous solution of potassium ferrocyanide [Fe(CN)6]4- was used in the experiment as a model sample. The effect of the laser intensity of probe pulse only on the SCE was investigated. It was observed that at a large number of photon per pulse of the XUV pulse SCE causes a peak broadening and positive energy shift. For the pump-probe experiment, UV light of 4.65 eV photon energy was used to initiate the electronic dynamics of [Fe(CN)6]4-. The XUV beam from high-order harmonic generation (HHG) of 32.55 eV photon energy source was used to probe the entire electronic structure of the valence shell of the ferrocyanide in a one-photon transition to the continuum. The sequence of the pump-probe pulses (which pulse interacts with the sample first) was shown to play a significant role in the manifestation of the SCE. In particular, a positive energy shift in the photoelectron spectra was observed at negative time delays (the probe pulse arriving before the pump pulse). When the pulse sequence is reversed, a large negative energy shift was observed in the photoelectron spectra. The positive energy shift is caused by the negative space charge effect originating from the electron-electron interaction, resulting acceleration the XUV photoelectrons in the far field. The negative energy shift is caused by positive space charge effect originating from the interaction of photoelectrons with positive ions originating in the liquid sample. The latter results in the deceleration of the XUV photoelectrons. The dissipation of the positive charge generated during the ionization process of the sample was found to occur on a nanosecond time scale. Such a long scale reflects the restricted carrier mobility in liquids, as compared to solid conductors. A model based on the mean-field consideration and the field superposition principle was developed to described the SCE. The model reproduces well the spectral shift of XUV photoelectrons observed in the experiment. One should note that the spectral shift represents the main result of the SCE, and no spectral broadening was observed under the applied experimental conditions. In the second part, the SCE induced in the photoemission spectra by a single laser pulse of high intensity was studied in a dense gas. At the given experimental conditions, including the laser peak intensity and the gas density, the magnitude of the SCE was found to be much larger in the case of linearly polarized field than for circular polarization. This finding was confirmed in two studies, where the laser peak intensity and the gas density were varied, respectively. The interpretation lies in the fact that the ionization rate in the circularly strong field is much lower than in the linearly polarized field. In the case of linearly polarized light, the photoemission spectra show the contributions of the direct photoelectrons forming a peak at lower kinetic energies, and the contributions of HATI electrons forming a plateau beyond the 2UP energy. The magnitude of the SCE was found to be dependent on the kinetic energy value. In particular, the fast HATI electrons are not influenced by the SCE. However, the slower direct electrons experience strong SCE. The SCE leads to redistribution of photoelectrons forming the energy peak of the direct emission. Here, the slower electrons become decelerated, and the faster electrons are accelerated. In the case of a circularly polarized field, the SCE is absent for both the slow and fast photoelectrons and can be attributed to the fact that under the experimental conditions ionization yields are too small to produce the high electron densities necessary for SCE to occur. The photoemission spectra of circularly polarized light were used to test the strong-field-approximation (SFA) theory. By taking the spatiotemporal distribution of the laser intensity in the focus into account, the simulated spectra reproduce well the measured photoemission spectra. The SCE cannot be disregard in the experiments requiring the application of strong laser fields. The present work provides the approach how to treat the SCE in the analysis of photoelectrons spectra.In dieser Studie wurden mittels Photoelektronenspektroskopie die lichtinduzierten Prozesse, die durch ein intensives Laserfeld an Flüssigkeitsgrenzflächen hervorgerufen werden, untersucht. Photoelektronen, die von dem intensiven optischen Feld eines ultrakurzen Laserpulses in einer dichten Probe erzeugt werden, führen zu einem Raumladungseffekt RLE, der die Emissionsspektren verändert. Der RLE ist daher Begleiterscheinung anderer Prozesse, die von intensiven Lasern erzeugt werden. Insbesondere führen sie zu Änderungen in der Spektralverteilung der Photoelektronen und reduzieren damit die Energieauflösung des Photoelektronenspektroskopie-experiments. Die vorliegende Arbeit beschäftigt sich mit der Untersuchung der Haupteigenschaften des RLE in Anregungs-Abfrage-Experimenten und Experimenten mit einem einzelnen Laserpuls hoher Spitzenintensität. Zuerst wurde das Auftreten des RLE für den Fall von Photoelektronenspektren von Flüssigkeiten, die mittels Anregungs-Abfrage-Experimenten durchgeführt wurden, untersucht. Die beiden Techniken Anregungs-Abfrage-Spektroskopie und die Flüssigkeitsmikrojettechnik wurden in dieser Arbeit zusammen angewandt. Im Allgemeinen ermöglicht die Verbindung dieser beiden Techniken die Untersuchung der Elektronendynamik und Struktur in Lösungen und an Grenzflächen. In diesem Fall wurde eine Kaliumhexacyanidoferrat(II)-Lösung [Fe(CN)6]4- als Modellsystem verwendet. Der Einfluss der Intensität des Anregungslasers auf den RLE wurde untersucht. Es wurde beobachtet, dass eine große Zahl von Photonen pro XUV Puls eine Verbreiterung von Peaks und eine positive Verschiebung der Energien aufgrund des RLE erzeugt. Für das Anregungs-Abfrage- Experiment wurde UV-Licht mit einer Photonenenergie von 4.65 eV verwendet, um die Elektronendynamik von [Fe(CN)6]4- auszulösen. Mit dem XUV-Strahl aus einer HHG-Quelle mit einer Photonenenergie von 32.55 eV wurde die gesamte elektronische Struktur der Valenzschalen von Cyanoferrat in einem Ein- Photonenschritt zum Kontinuum untersucht. Es wurde gezeigt, dass die Reihenfolge der Anregungs-Abfrage-Pulse (welcher Puls interagiert zuerst mit der Probe) eine wichtige Rolle in der Erscheinung des RLE spielt. Insbesondere wurde eine positive Energieverschiebung in den Photoelektronenspektren bei negativer Zeitverzögerung (der Abfrage Puls kommt vor dem Anregungspuls an) beobachtet. Bei umgekehrter Reihenfolge wurde eine große negative Verschiebung beobachtet. Die positive Verschiebung wird durch einen negativen RLE erzeugt, der mittels Elektron-Elektron-Wechselwirkung zu einer Beschleunigung der XUV- Photoelek-tronen im Fernfeld führt. Die negative Energieverschiebung wird durch einen positiven RLE hervorgerufen, der durch positive Ionen in der flüssigen Probe erzeugt wird. Die Abfuhr der während der Ionisation in der Probe erzeugten positiven Ladungen findet auf einer Zeitskala von Nanosekunden statt. Solch lange Zeiten verdeutlichen die eingeschränkte Ladungsträgermobilität in Flüssigkeiten verglichen zu der in leitfähigen Festkörpern. Ein Modell basierend auf der mean-field Betrachtung und dem Superpositionsprinzip von Feldern wurde zur Beschreibung des RLE entwickelt. Das Modell beschreibt die spektrale Verschiebung der Photoelektronen, die im Experiment beobachtet wurde, gut. Es sei darauf hingewiesen, dass die spektrale Verschiebung das Hauptresultat des RLE ist und dass unter den gewählten Bedingungen keine spektrale Verbreiterung beobachtet wurde. Im zweiten Teil wurde der RLE, der von einem einzelnen Laserpuls hoher Intensität in einem Gas hoher Dichter erzeugt wird, untersucht. Unter den gegebenen experimentellen Bedingungen wie Spitzenintensität des Lasers und Gasdichte, war der RLE deutlich stärker im Fall von linear polarisiertem Licht verglichen zum Fall von zirkular polarisiertem Licht. Diese Beobachtung wurde in zwei Studien bestätigt, in denen die Spitzenintensität des Lasers beziehungsweise die Gasdichte variiert wurden. Dies lässt sich mit der Tatsache interpretieren, dass die Ionisationsrate in zirkularen, intensiven Feldern viel kleiner als in linear polarisierten Feldern ist. Im Fall von linear polarisiertem Licht enthalten die Photoemissionsspektren Beiträge von direkten Photoelektronen, die einen Peak bei niedrigen kinetischen Energien erzeugen und Beiträge von HATI-Elektronen, die ein Plateau über eine Energie von 2UP hinaus erzeugen. Die Stärke des RLE war abhängig von der kinetischen Energie. Insbesondere sind die schnellen HATI-Elektronen nicht vom RLE beeinflusst. Die langsamen Elektronen erfahren hingegen einen starken RLE. Der RLE führt zur Umverteilung von Photoelektronen, die den Peak der direkten Emission erzeugen. Langsame Elektronen werden abgebremst und schnelle Elektronen werden beschleunigt. Im Fall eines zirkular polarisierten Feldes kann das Fehlen des der RLE sowohl für langsame als auch für schnelle Elektronen mit der geringen Ionisationsausbeute erklärt werden, die dazu führt, dass die Elektronendichte nicht hoch genug ist um den RLE hervorzurufen. Die Photoemissionsspektren von zirkular polarisiertem Licht wurden dazu verwandt, die Strong-Field- Approximation (SFA) zu untersuchen. Unter Berücksichtigung der räumlichen und zeitlichen Verteilung der Laserintensität im Fokus lassen sich die gemessenen Photoemissionsspektren gut reproduzieren. Der RLE in Experimenten, die die Verwendung von intensiven Laserfeldern erfordern, nicht vernachlässigt werden. Die vorgelegte Arbeit beschreibt den Ansatz, wie der RLE in der Auswertung von Photoelektronenspektren berücksichtigt werden kann

Hyperosmolar Hyperglycaemic State and Diabetic Ketoacidosis in Nivolumab-Induced Insulin-Dependent Diabetes Mellitus

Nivolumab is a monoclonal antibody directed against programmed cell death-1 receptor. It has an increasing application in the treatment of various advanced metastatic cancers. The incidence of autoimmune side effects associated with such agents is expected to increase. New-onset autoimmune diabetes mellitus associated with immune checkpoint inhibitor treatment is rare, occurring in less than 1% of patients. Nivolumab-induced diabetes often presents as diabetic ketoacidosis, which could be life-threatening if not recognized and treated promptly. We present the case of a patient who developed severe diabetic ketoacidosis concomitant with hyperosmolar hyperglycaemic state (HHS) after receiving nivolumab for metastatic testicular lymphoma. Pre-nivolumab blood glucose levels were normal, apart from transient hyperglycaemia related to steroids as part of the chemotherapy protocol. The diagnosis was confirmed with extremely low C-peptide in the clinic

Prediction of Multiple Clinical Complications in Cancer Patients to Ensure Hospital Preparedness and Improved Cancer Care

Reliable and rapid medical diagnosis is the cornerstone for improving the survival rate and quality of life of cancer patients. The problem of clinical decision-making pertaining to the management of patients with hematologic cancer is multifaceted and intricate due to the risk of therapy-induced myelosuppression, multiple infections, and febrile neutropenia (FN). Myelosuppression due to treatment increases the risk of sepsis and mortality in hematological cancer patients with febrile neutropenia. A high prevalence of multidrug-resistant organisms is also noted in such patients, which implies that these patients are left with limited or no-treatment options amidst severe health complications. Hence, early screening of patients for such organisms in their bodies is vital to enable hospital preparedness, curtail the spread to other weak patients in hospitals, and limit community outbreaks. Even though predictive models for sepsis and mortality exist, no model has been suggested for the prediction of multidrug-resistant organisms in hematological cancer patients with febrile neutropenia. Hence, for predicting three critical clinical complications, such as sepsis, the presence of multidrug-resistant organisms, and mortality, from the data available from medical records, we used 1166 febrile neutropenia episodes reported in 513 patients. The XGboost algorithm is suggested from 10-fold cross-validation on 6 candidate models. Other highlights are (1) a novel set of easily available features for the prediction of the aforementioned clinical complications and (2) the use of data augmentation methods and model-scoring-based hyperparameter tuning to address the problem of class disproportionality, a common challenge in medical datasets and often the reason behind poor event prediction rate of various predictive models reported so far. The proposed model depicts improved recall and AUC (area under the curve) for sepsis (recall = 98%, AUC = 0.85), multidrug-resistant organism (recall = 96%, AUC = 0.91), and mortality (recall = 86%, AUC = 0.88) prediction. Our results encourage the need to popularize artificial intelligence-based devices to support clinical decision-making

Tubercular Meningitis and Lymphadenitis Mimicking a Relapse of Burkitt's Lymphoma on 18F-FDG-PET/CT: A Case Report

Tuberculosis (TB) can present with various forms and can occasionally be mistaken for malignancy. Hereby, we report a 53-year-old man diagnosed and treated for Burkitt's lymphoma in 2009 who achieved a complete remission confirmed by a computed tomography (CT) scan. During the follow-up 2 years later, he complained of left hip pain that warranted investigation with magnetic resonance imaging and whole-body 18F-fludeoxyglucose-positron emission tomography (FDG-PET)/CT which showed a benign lesion in the left hip associated with multiple lymph nodes in the chest and abdomen not amenable for biopsy. A follow-up PET/CT scan a few months later showed intense tracer uptake in the lymph nodes with size progression and appearance of new lymph nodes suspicious of lymphoma relapse. The patient was asymptomatic, and all investigations including viral and connective tissue disease studies were negative. Also the tuberculin skin test and QuantiFERON were negative. Lymph node biopsy was planned; however, the patient presented a few days earlier with fever, headache and photophobia. Cerebrospinal fluid (CSF) examination confirmed meningitis with lymphocytic pleocytosis and elevated protein. The CSF Gram stain, culture, viral and acid-fast bacilli were negative. CSF flow cytometry and cytopathology confirmed polyclonal lymphocytosis and suggested reactive causes. CSF TB culture grew Mycobacterium tuberculosis. Mediastinal lymph node biopsy also confirmed TB lymphadenitis. Four antituberculosis drugs were started. One year later, a PET/CT scan showed regression of all the involved lymph nodes. This case highlights the importance of excluding TB in patients with suspected malignancy, especially if they belong to endemic regions, and the increasing role of 18F-FDG-PET/CT in the early detection of extrapulmonary TB