ADVANCED MEDICAL IMAGE VIEWER FOR X-RAY IMAGES

Since the introduction of CT and other imaging modalities there has been an emerging need for a standard for transferring images and associated images. As a result of which American college of Radiology (ACR) developed a standard called digital imaging and communication in medicine (DICOM). All the modalities present in the system export the images in form of DICOM files. As a result of this there was need for image viewer which can effectively understand the DICOM standard, interpret the DICOM file and display the images present in it. This paper effectively talks what all features should be supported by a DICOM viewer also. It also discusses about digital Image Subtraction (DSA) which is advantageous over most standard arteriographic examinations

Primary fallopian tube cancer in the setting of endometriosis

We report the first case of PFTC arising in the setting of pelvic endometriosis. A 45 year old nulliparous lady, menopausal lady presented with pelvic mass. She had history of pelvic endometriosis. MRI findings were suggestive of ovarian malignancy. Histological analysis of specimen obtained following staging laparotomy proved it to be a case of bilateral PFTC. She received 6 cycles of adjuvant chemotherapy. This case opens a new door to think or investigate if fallopian tube endometrioma behaves as a more aggressive premalignant lesion. This case also poses questions whether it is important to differentiate an endometrioma arising from the ovary to one which is arising from a fallopian tube. Once identified can fallopian tube endometrioma also be managed medically or should it be always removed surgically

Modified Goff Symptom Index : Simple triage tool for ovarian malignancy

Objectives: Ovarian cancer often goes undiagnosed or misdiagnosed in the early stages. The present study aimed to validate a modified version of the Goff Symptom Index (GSI) in an Indian population. Methods: This prospective case-control study was conducted between July 2010 and June 2012 in a university hospital in Manipal, Karnataka, India. A total of 305 inpatients admitted for ovarian pathology investigations and outpatients undergoing routine gynaecological check-ups were included in the study. The modified GSI (MGSI) was used to investigate the presence, severity, frequency and duration of 10 ovarian cancer symptoms on a scale of 1–5. Four additional symptoms were included with those of the original GSI (two symptoms from a previous MGSI and two new symptoms). Patients were regarded as positive for ovarian cancer if symptoms occurred >12 times per month and time since onset was <1 year. Histopathology confirmed the diagnosis of ovarian tumours. Results: A total of 13 patients were excluded. The final sample (n = 292) was divided into a test group (n = 74) and a control group (n = 218) based on histopathology. Within the controls, 144 women were found to have benign tumours. The MGSI was positive in 71.6% of the test group as opposed to only 11.5% of the control group. The addition of two symptoms (loss of appetite and weight) to the GSI increased the test’s sensitivity from 71.6% to 77% without compromising specificity (88.5%). Conclusion: Based on these findings, the addition of two new symptoms (loss of appetite and weight) to the GSI is proposed in order to increase the test’s sensitivity. However, the addition of urinary symptoms to the GSI requires further validation

ALTERED ARTERIAL DOPPLER FLOW PATTERN AND PERINATAL OUTCOME IN INTRAUTERINE GROWTH RESTRICTION

ABSTRACTObjectives: Intrauterine growth restriction (IUGR) is one of the common conditions that interfere with the growth of the fetus accounting for 10-15%of pregnant woman. Literature explores a wide range of incidence of perinatal complication including mortality among IUGR pregnancies. Limiteddata available on these complications confined to coastal Karnataka and its association with abnormal arterial Doppler flow pattern. To study theperinatal complications associated with IUGR pregnancies and its prevalence in comparison to healthy controls of comparable gestational age.Methods: This cohort study screened 53 IUGR fetuses by an antenatal scan at gestational age of 27 weeks or more. The diagnosis of IUGR was madeaccording to established criteria from SOGC clinical practice guidelines August 2013. The data also included 48 appropriate for gestational age fetuseswith healthy mothers with the comparable gestational week. Experienced cardiac sonographer and gynecologist performed fetal echocardiography(ECHO) using Vivid 7, GE health-care system ECHO machine with the convex transducer of frequency 1.7-2.4 MHz. The study was conducted at southIndian tertiary care center.Results: This study included 53 IUGR cases and 48 non-IUGR controls. The mean age was 27±4.37 and 26.88±3.14 years in IUGR and non-IUGRgroups, respectively. Fetal Doppler study variables showed a significant decrease in peak aortic velocity and velocity time integral which was notevident on other valves, though mitral antegrade flow during atrial contraction was found to be lower among IUGR group. In two-dimensional chamberquantification of IUGR group revealed significant increase in pulmonary artery dimension, right ventricular (RV) dimension and RV thickness than thecontrol group (p<0.05). The anthropometric parameters such as weight and length; abdomen circumference was significantly lower in IUGR group,whereas head circumference found to be more in IUGR group (p<0.001). The gestational weeks at delivery was significantly different among twogroups with IUGR group depicting the early delivery group. p<0.001(35.58±2.92 and 38.5±0.96 in IUGR and non-IUGR groups, respectively). IUGRgroup also had prolonged neonatal intensive care unit stay when compared to controls (p<0.001).Conclusions: IUGR carries profound course in altered Doppler indices and cardiac function which explore its prediction on mortality and adverseperinatal outcome. This study showed significant perinatal mortality accounting for 5.6% among IUGR cases when compared to normal. Althoughtissue Doppler indices show normal variants, IUGR possesses significant adverse perinatal outcome, however with lesser incidence compared tosevere form of IUGR subsets who show altered tissue annular velocities.Keywords: Intrauterine growth restriction, Echocardiography, Doppler, Perinatal

Integrating artificial intelligence for knowledge management systems – synergy among people and technology: a systematic review of the evidence

This paper analyses Artificial Intelligence (AI) and Knowledge Management (KM) and focuses primarily on examining to what degree AI can help companies in their efforts to handle information and manage knowledge effectively. A search was carried out for relevant electronic bibliographic databases and reference lists of relevant review articles. Articles were screened and the eligibility was based on participants, procedures, comparisons, outcomes (PICO) model, and criteria for PRISMA (Preferred Reporting Items for Systematic Reviews). The results reveal that knowledge management and AI are interrelated fields as both are intensely connected to knowledge; the difference reflects in how – while AI offers machines the ability to learn, KM offers a platform to better understand knowledge. The research findings further point out that communication, trust, information systems, incentives or rewards, and the structure of an organization; are related to knowledge sharing in organizations. This systematic literature review is the first to throw light on KM practices & the knowledge cycle and how the integration of AI aids knowledge management systems, enterprise performance & distribution of knowledge within the organization. The outcomes offer a better understanding of efficient and effective knowledge resource management for organizational advantage. Future research is necessary on smart assistant systems thus providing social benefits that strengthen competitive advantage. This study indicates that organizations must take note of definite KM leadership traits and organizational arrangements to achieve stable performance through KM

Is it worth preserving the uterus? unanticipated pathology in hysterectomy for pelvic organ prolapse (POP)

Background: In recent years concept of uterine conservation has been increasing at the time of surgical management of pelvic organ prolapse (POP). This study was intended to assess the risk of premalignant and malignant uterine/endometrial, and cervical pathology at the time of hysterectomy-based POP procedures, to better understand the risks of uterine conservation in the surgical treatment of POP in Indian setup.Methods: Patients who had undergone vaginal hysterectomy for POP in last five years were identified by medical record tracking using ICD-9 codes. Case records then were reviewed to collect patient characteristics and the final histopathological diagnosis of the hysterectomy specimen. Cases with premalignant or malignant uterine/endometrial or cervical pathology recognized prior to surgery were excluded.Results: A total of 573 women who underwent vaginal hysterectomy and pelvic floor repair for the sole indication of POP were included. On analyzing the histopathological diagnosis of the specimen obtained during surgery in 57.1% of cases the findings were consistent with the changes seen in cases of POP. Only 5.9 % of cases had cervical or endometrial pathologies who would have required treatment/follow up in future if the uterus was left in situ.Conclusions: The risk of missing a malignant and premalignant cervical or uterine pathology in women presenting with uterine prolapse is low if appropriate preoperative workup has been done. Uterine preservation in surgical management of POP could be considered an option

4-Chloro-N-(4-nitro­benzo­yl)benzene­sulfonamide

In the crystal structure of the title compound, C13H9ClN2O5S, the N—H bond is trans to the C=O bond (H—N—C—O torsion angle = 158.4°). The dihedral angle between the two aromatic rings is 87.8 (1)°. In the crystal, mol­ecules are linked into chains along the b axis via N—H⋯O hydrogen bonds

ASSESSMENT OF LEFT ATRIAL FUNCTION IN PATIENTS WITHMITRAL VALVE DISEASES

ABSTRACTObjective:To observe and assess left atrial (LA) function by observing the differences in conventional Doppler echo parameters of left ventricular inflow, Left atrial appendage, among patients with mitral valve disease.Methods: Forty three mitral valve disease subjects appearing consecutively for echocardiogram (ECHO) test at the cardiology department in a tertiary care hospital were recruited into the study as per the pre-set inclusion and exclusion criteria. The data from the ECHO was pooled using Microsoft excel and analyzed using SPSS software by application of appropriate statistical tests.Results:Of the 43 objects, 39 had MS, 3 had MR and 2 of them were found to have both MS and MR. The major presenting symptom as observed in 33 subjects, was dyspnea. LA maximum volume was found to be 91±59 ml and minimum was 66±51 ml. Left atrial expansion index was 128±91. Left atrial active emptying fraction was 29±13 and passive emptying fraction was 31±15. No significant change in LA global strain among groups with MR and without MR was observed. Further, no significant difference was observed in left atrial indices like left atrial emptying fraction, left atrial passive emptying fraction, atrial fraction, Left atrial expansion index among   groups having MR and no MR.Conclusion:LA contractile, reservoir and conduit function was significantly reduced in mitral valve diseases due to increased hemodynamic load. No significant difference was noted in global LA strain irrespective of MS or MR.Key Words: Valvular disease; Left atria; Strain; Contractile functio

Inhaled corticosteroids and adverse outcomes among chronic obstructive pulmonary disease patients with community-acquired pneumonia: a population-based cohort study

IntroductionWhile inhaled corticosteroids (ICS) may increase pneumonia risk in patients with chronic obstructive pulmonary disease (COPD), the impact of ICS on pneumonia outcomes is debated. We examined whether ICS use is associated with adverse outcomes among COPD patients with community-acquired pneumonia (CAP).Materials and methodsPopulation-based cohort study of all COPD patients with an incident hospitalization for CAP between 1997 and 2013 in Northern Denmark. Information on medications, COPD severity, comorbidities, complications, and death was obtained from medical databases. Adjusted risk ratios (aRRs) for pleuropulmonary complications, intensive care unit (ICU) admissions, and 30-day mortality in current and former ICS users were compared with those in non-users, using regression analyzes to handle confounding.ResultsOf 11,368 COPD patients with CAP, 6,073 (53.4%) were current ICS users and 1,733 (15.2%) were former users. Current users had a non-significantly decreased risk of pleuropulmonary complications [2.6%; aRR = 0.82 (0.59–1.12)] compared to non-users (3.2%). This was also observed among former users [2.5%; aRR = 0.77 (0.53–1.12)]. Similarly, decreased risks of ICU admission were observed among current users [aRR = 0.77 (0.57–1.04)] and among former users [aRR = 0.81 (0.58–1.13)]. Current ICS users had significantly decreased 30-day mortality [9.1%; aRR = 0.72 (0.62–0.85)] compared to non-users (12.6%), with a stronger association observed among patients with frequent exacerbations [0.58 (0.39–0.86)]. No significant association was observed among former ICS users [0.89 (0.75–1.05)].ConclusionOur results suggest a decreased risk of death with ICS use among COPD patients admitted for CAP