Noninvasive diagnosis of Ascaris lumbricoides in the common bile duct: A pediatric case report of acute pancreatitis

Key Clinical Message This case report highlights the importance of considering parasitic infections, particularly Ascaris lumbricoides, as a possible cause of acute pancreatitis in children, especially in endemic regions. Noninvasive imaging techniques, such as ultrasonography, can play a crucial role in the early detection and diagnosis of this unusual presentation. Timely administration of anthelmintic therapy led to the resolution of symptoms and prevented the need for invasive procedures. Healthcare providers should be vigilant about the diverse clinical manifestations of ascariasis, and regular deworming programs and health education are essential in minimizing the burden of this neglected tropical disease among children. Abstract Ascariasis is a common public health problem globally but it is more prevalent in school‐age children and it often goes undiagnosed, leading to severe complications. The purpose of this report is to spread awareness of its unusual presentation and how to judiciously use noninvasive approaches for its diagnosis. We present a case of a 10‐year‐old girl that was presented in pediatric emergency with gradually worsening epigastric pain. Initial lab work‐up showed elevated pancreatic enzymes which lead to the diagnosis of acute pancreatitis. The patient was managed in the line of acute pancreatitis and with further evaluation by imaging techniques such as ultrasound and CT‐scan abdomen, Ascaris lumbricoides (A. lumbricoides) was visualized. She was then treated with prophylactic antibiotics and antiparasitic medications, which resolved her symptoms and the child responded to the treatment. In children, parasites should be considered as a cause of acute pancreatitis by clinicians, especially in low‐income countries, and before performing invasive procedures, noninvasive approaches should be considered as an initial option. This can save the patient from multiple invasive procedure and its severe complications

Management of closed tibial plateau fractures with percutaneous cancellous screw fixation

Background: Tibial plateau fractures, intra-articular in nature and caused by high-velocity trauma, constitute approximately 1% of all fractures. Primary goal in the management of proximal tibial articular fracture aims for a stable, congruous, pain-free, mobile joint. Objective: To study the technique, results, and complications of percutaneous cancellous screw fixation for tibial plateau fractures. Materials and Methods: Twenty-three men and seven women aged 18-65 years (mean = 36.8 years) underwent closed reduction and percutaneous screw fixation for closed tibial plateau fractures with <5 mm depression. According to the Schatzker classification, patients were grouped as type I (n = 18), type II (n = 4), type III (n = 0), type IV (n = 8), type V (n = 2), and type VI (n = 1). Closed reduction was achieved by manual ligamentotaxis technique under image intensifier control and fixed percutaneously with two cancellous screws (6.5 mm) with or without washers in a parallel fashion. Results: Functional outcome was evaluated using the Mason Hohl evaluation system. A total score of 19-24 was considered as excellent, 13-18 as good, 7-12 as fair, and <6 as poor. Outcomes were excellent in 10 patients, good in 15, fair in 4, and poor in 1 patient. Patients were allowed partial weight bearing with walker after 1 month and full weight bearing after radiological union in approximately 3-4 months. The mean period of hospital stay was 5 (range 2-15) days. All the fractures united radiologically after a mean of 3 (range 2.5- 5) months. Patients were evaluated at a mean of 3 years after injury. No patient had any complication like infection, wound dehiscence, or hardware problem. Conclusion: Percutaneous cancellous screw fixation for closed tibial plateau fractures is minimally invasive. It reduces hospital stay and cost, enables early mobilization with minimal instrumentation, and achieves satisfactory outcomes

The gem5 Simulator: Version 20.0+

The open-source and community-supported gem5 simulator is one of the most popular tools for computer architecture research. This simulation infrastructure allows researchers to model modern computer hardware at the cycle level, and it has enough fidelity to boot unmodified Linux-based operating systems and run full applications for multiple architectures including x86, Arm®, and RISC-V. The gem5 simulator has been under active development over the last nine years since the original gem5 release. In this time, there have been over 7000 commits to the codebase from over 250 unique contributors which have improved the simulator by adding new features, fixing bugs, and increasing the code quality. In this paper, we give an overview of gem5's usage and features, describe the current state of the gem5 simulator, and enumerate the major changes since the initial release of gem5. We also discuss how the gem5 simulator has transitioned to a formal governance model to enable continued improvement and community support for the next 20 years of computer architecture research