Thrombotic Tendencies in Excess Catecholamine States

Catecholamines are neurotransmitters distributed throughout the body including adrenal glands, chromaffin tissues and other tissues innervated by post ganglionic adrenergic neurons. The rate of release of medullary hormones is responsible for the control of serum catecholamines. Thrombogenicity of catecholamines are due various mechanisms including hypercoagulable states, endothelial damage, blood stasis and platelet aggregation. Oxidative stress generated by catecholamine excess causes coronary spasm, ultrastructural cell damage and arrhythmias. Elevated plasminogen activator inhibitor-1 during catecholamine excess causes hypercoagulability by hypofibrinosis. During stress, Catecholamines released in procoagulant environment causes vasoconstriction in adrenal veins resulting in venous thrombosis. Catecholamines generate moderately elevated levels of platelet count which enhances the risk of thrombosis. Hypercoagulability results in formation of coronary thrombus, rupture of atherosclerotic plaque and plaque progression due to gradual fibrinogen accumulation in the vessel walls. High levels of circulating catecholamines produce elevated levels thrombomodulin, the biomarkers of endothelial cell damage. In patients with hypertension in catecholamine excess, resistance to blood flow and damage to the integrity of blood vessels lead to atherosclerosis. A case report has been discussed which suggests an association of thrombotic tendency and catecholamine excess

Gamifying Math Education using Object Detection

Manipulatives used in the right way help improve mathematical concepts leading to better learning outcomes. In this paper, we present a phygital (physical + digital) curriculum inspired teaching system for kids aged 5-8 to learn geometry using shape tile manipulatives. Combining smaller shapes to form larger ones is an important skill kids learn early on which requires shape tiles to be placed close to each other in the play area. This introduces a challenge of oriented object detection for densely packed objects with arbitrary orientations. Leveraging simulated data for neural network training and light-weight mobile architectures, we enable our system to understand user interactions and provide real-time audiovisual feedback. Experimental results show that our network runs real-time with high precision/recall on consumer devices, thereby providing a consistent and enjoyable learning experience

The IDENTIFY study: the investigation and detection of urological neoplasia in patients referred with suspected urinary tract cancer - a multicentre observational study

Objective To evaluate the contemporary prevalence of urinary tract cancer (bladder cancer, upper tract urothelial cancer [UTUC] and renal cancer) in patients referred to secondary care with haematuria, adjusted for established patient risk markers and geographical variation. Patients and Methods This was an international multicentre prospective observational study. We included patients aged ≥16 years, referred to secondary care with suspected urinary tract cancer. Patients with a known or previous urological malignancy were excluded. We estimated the prevalence of bladder cancer, UTUC, renal cancer and prostate cancer; stratified by age, type of haematuria, sex, and smoking. We used a multivariable mixed-effects logistic regression to adjust cancer prevalence for age, type of haematuria, sex, smoking, hospitals, and countries. Results Of the 11 059 patients assessed for eligibility, 10 896 were included from 110 hospitals across 26 countries. The overall adjusted cancer prevalence (n = 2257) was 28.2% (95% confidence interval [CI] 22.3–34.1), bladder cancer (n = 1951) 24.7% (95% CI 19.1–30.2), UTUC (n = 128) 1.14% (95% CI 0.77–1.52), renal cancer (n = 107) 1.05% (95% CI 0.80–1.29), and prostate cancer (n = 124) 1.75% (95% CI 1.32–2.18). The odds ratios for patient risk markers in the model for all cancers were: age 1.04 (95% CI 1.03–1.05; P < 0.001), visible haematuria 3.47 (95% CI 2.90–4.15; P < 0.001), male sex 1.30 (95% CI 1.14–1.50; P < 0.001), and smoking 2.70 (95% CI 2.30–3.18; P < 0.001). Conclusions A better understanding of cancer prevalence across an international population is required to inform clinical guidelines. We are the first to report urinary tract cancer prevalence across an international population in patients referred to secondary care, adjusted for patient risk markers and geographical variation. Bladder cancer was the most prevalent disease. Visible haematuria was the strongest predictor for urinary tract cancer

Waveform optimisation for internal cardioversion of atrial fibrillation

Direct current transthoracic cardioversion is a well-established treatment for atrial fibrillation (AF). Significant changes in the device technology have taken place since the procedure was first described. Since then there has been a constant quest to improve the efficacy of the device by optimising various parameters that affect the success of cardioversion. Particular waveforms used in different models of defibrillators determine the energy used and efficacy of defibrillators. The technique of internal cardioversion was developed to treat patients in whom transthoracic cardioversion was unsuccessful. The aims of this thesis was to address issues surrounding optimisation of internal cardioversion. Data from this thesis will help. in developing a novel atrial defibrillator. Commercially available internal and external cardioversion devices use a capacitor based exponential energy. A unique radiofrequency energy powered defibrillator was developed at the Royal Victoria Hospital in collaboration with the Centre for Advanced Cardiovascular Research (University of Ulster). This device was extensively studied both in animal models and clinical studies at the Royal Victoria Hospital, Belfast. In this study, I compared the safety and efficacy of a novel radiofrequency low tilt monophasic waveform with a low tilt biphasic waveform for internal cardioversion of persistent AF. All the persistent AF patients had a previous history of failed external cardioversion. I also compared the waveforms in patients who inadvertently go into AF during electrophysiological studies. In both the studies, significant proportion of patients were successfully cardioverted to sinus rhythm with low energy. The radiofrequency powered defibrillator was safely used for transvenous cardioversion of atrial fibrillation. In this thesis, I have discussed about cardioversion, internal cardioversion, atrial defibrillators, various waveforms used for cardioversion, development of radiofrequency defibrillator and the concept of novel atrial defibrillator. Data from my work will add to the development of a novel radiofrequency atrial defibrillator. This device will eventually contain a passive implantable atrial defibrillator that is powered by an externally transmitted pulse of RF energy.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Completeness of low anterior resection pathology report: A hospital-based audit with recommendations on improving reporting

Aims: To audit the information content of the pathology report on Low Anterior Resection (LAR) specimens and to provide recommendations in order to improve the existing standard of reporting. Materials and Methods : All the reports of LAR specimens during 2004 - 2005 were collected from the Hospital Information System (HIS). Individual items of information were compared with the minimum data sets provided by the Royal College of Pathologists (RCP). Results : Fifty-nine reports were audited. Nineteen percent of the reports were classified as satisfactory. Although many items were well reported, only 30.5% (18/59) of the reports contained a statement on the completeness of excision at the circumferential resected margin and only 25.4% of all reports mentioned the relation of tumors to the peritoneal reflection. Conclusion : The information content of the reports on colorectal cancer resection specimens is inadequate. The use of the standard proforma (template) for reporting rectal cancer is therefore recommended, along with improved education, review of laboratory practices in the light of current knowledge, and further motivation of pathologists through their involvement in multidisciplinary cancer management

Completeness of low anterior resection pathology report: A hospital-based audit with recommendations on improving reporting

Aims: To audit the information content of the pathology report on Low Anterior Resection (LAR) specimens and to provide recommendations in order to improve the existing standard of reporting. Materials and Methods : All the reports of LAR specimens during 2004 - 2005 were collected from the Hospital Information System (HIS). Individual items of information were compared with the minimum data sets provided by the Royal College of Pathologists (RCP). Results : Fifty-nine reports were audited. Nineteen percent of the reports were classified as satisfactory. Although many items were well reported, only 30.5% (18/59) of the reports contained a statement on the completeness of excision at the circumferential resected margin and only 25.4% of all reports mentioned the relation of tumors to the peritoneal reflection. Conclusion : The information content of the reports on colorectal cancer resection specimens is inadequate. The use of the standard proforma (template) for reporting rectal cancer is therefore recommended, along with improved education, review of laboratory practices in the light of current knowledge, and further motivation of pathologists through their involvement in multidisciplinary cancer management

Near-infrared measurements of brain oxygenation in stroke

We investigated the feasibility of using frequency-domain near-infrared spectroscopy (fdNIRS) to study brain oxygenation in the first few hours of stroke onset. The OxiplexTS® fdNIRS system was used in this study. Using a standard probing protocol based on surface landmarks, we measured brain tHb and StO2 in healthy volunteers, cadavers, and acute stroke patients within 9 h of stroke onset and 3 days later. We obtained measurements from 11 controls, 5 cadavers, and 5 acute stroke patients. StO2 values were significantly lower in cadavers compared to the controls and stroke patients. Each stroke patient had at least one area with reduced StO2 on the stroke side compared to the contralateral side. The evolution of tHb and StO2 at 3 days differed depending on whether a large infarct occurred. This study shows the proof of principle that quantified measurements of brain oxygenation using NIRS could be used in the hectic environment of acute stroke management. It also highlights the current technical limitations and future challenges in the development of this unique bedside monitoring tool for stroke.National Sciences and Engineering Research Council; Alberta Innovates Health SolutionsYe

Neurological manifestations of glutamic acid decarboxylase autoimmunity in Indian patients

Objective: To study the neurological manifestations of glutamic acid decarboxylase (GAD 65) autoimmunity in Indian patients. Methods: Retrospective study conducted in a tertiary care referral hospital in South India. Patients who tested positive for GAD 65 antibodies from February 2013 to July 2019 were included. Results: We identified 922 patients who underwent GAD 65 testing, of which 81 tested positive (8.78%) [mean age 55.42 years (SD 17.39, range 9–86 years, median age 57 years)]. Males (n = 47) outnumbered the females (n = 34). All the GAD values measured were <5000 IU/ml. There were 34 cases (42%) of atypical parkinsonism (16/34, 47% fulfilled the diagnostic criteria for autoimmune atypical parkinsonism) in our series forming the most common group with GAD 65 positivity, followed by autoimmune encephalitis (8 cases, 9.88%). Men were more affected with atypical parkinsonism (22/34; 64.70%), stiff person syndrome (2/3; 66.66%), and neuropathy (4/7; 57.1%) while women were more with autoimmune encephalitis (6/8; 75%). Eighteen (22.6%) had underlying autoimmunity (three had type 1 diabetes mellitus). Six (7.4%) had underlying neoplasm. Thirty-three out of 43 patients responded to immunotherapy (76.74%). Five had spontaneous improvement. Conclusion: Glutamic acid decarboxylase65 antibody values were much lower in our study population. Male-dominant autoimmunity was seen unlike that in Western literature. The most striking was the high preponderance of atypical parkinsonism in GAD 65-positive patients. We also found that GAD 65 positivity is a useful marker for a positive response to immunotherapy in suspected autoimmune neurological syndromes irrespective of their titers