Systemic Lupus Erythematosus Presenting as Thrombotic Thrombocytopenia Purpura: How Close Is Close Enough?

Thrombotic thrombocytopenic purpura (TTP) is an uncommon life-threatening disease characterized by microangiopathic hemolytic anemia and thrombocytopenia, commonly associated with infections, malignancy, drugs, and autoimmune diseases. We report a case of 19-year-old previously healthy female that presents with anemia and thrombocytopenia diagnosed with thrombotic thrombocytopenic purpura that was treated successfully with plasmapheresis and corticosteroids. Laboratory findings also revealed antinuclear antibodies and antibodies to double-stranded DNA. Two weeks after presentation developed inflammatory arthritis, fulfilling diagnostic criteria for systemic lupus erythematosus (SLE). Prompt diagnosis and treatment with plasma exchange and corticosteroids should be instituted as soon as the diagnosis of TTP is suspected, even if other diagnoses, including lupus, are possible. When present, the coexistence of these two etiologies can have a higher mortality than either disease alone. An underlying diagnosis of SLE should be considered in all patients presenting TTP and the study of this association may provide a better understanding of their immune-mediated pathophysiology

Pre-operative Prediction of Difficult Laparoscopic Cholecystectomy

Introduction: Laparoscopic cholecystectomy is one of the most common operation performed. Though LC have become safer and easier at times it can be difficult. Difficult cases can result in prolonged operative time, bleeding, bile spillage, conversion to open technique and bile duct injury resulting in unplanned prolonged hospital stay, increase in estimated cost to the patients and for the surgeon it leads to increased stress during operation and time pressure to complete the operative list. . Identification of difficult cases has potential advantages for surgeons, patients and their relatives. We aim to develop and validate a scoring system to predict difficult LC preoperatively. Methods: Prospective study. History, physical examination, abdominal ultrasound and biochemical parameters were included to develop a scoring system. Hundred patients undergoing LC were included and preoperative scores were calculated preoperatively to predict difficult LC which was compared with operative assessment. Results: Sensitivity and specificity of the preoperative scoring for difficult case was 53.8 % and 89.2 % respectively with PPV of 63.64 % and NPV of 84.62%. Only three parameters (history of acute cholecystitis, gall bladder wall thickness and contracted gall bladder) were statistically significant to predict difficult LC individually. Area under ROC curve was 0.779 (95 % CI, 0.657-0.883). Conclusions: Preoperative scoring system can be used to predict difficult LC. Surgeons can plan operation based on predicted difficulty. Patients and relatives can be counselled preoperatively for the possibility of difficult operation, prolonged hospital stay and increased cost in predicted difficult case. Keywords: difficult cholecystectomy; laparoscopic cholecystectomy; symptomatic cholelithiasis

Association Rule Mining of Biological Field Data Sets

Association rule mining is an important data mining technique, yet, its use in association analysis of biological data sets has been limited. This mining technique was applied on two biological data sets, a genome and a damselfly data set. The raw data sets were pre-processed, and then association analysis was performed with various configurations. The pre-processing task involves minimizing the number of association attributes in genome data and creating the association attributes in damselfly data. The configurations include generation of single/maximal rules and handling single/multiple tier attributes. Both data sets have a binary class label and using association analysis, attributes of importance to each of these class labels are found. The results (rules) from association analysis are then visualized using graph networks by incorporating the association attributes like support and confidence, differential color schemes and features from the pre-processed data.Bioinformatics Seed Grant Program NIH/UNDNational Science Foundation (NSF) Grant IIA-135546

Feed my people food bank projecta case study of space planning and costing of warehouse

Includes bibliographical references

Bilateral indirect ovarian inguinal hernia in a young female with type 1 Mayer–Rokitansky–Küster–Hauser syndrome: An extremely rare clinical context

Key Clinical Message Incidence of bilateral inguinal hernia encompassing bilateral ovaries in adult female is very thin and concomitant association with Mayer–Rokitansky–Küster–Hauser syndrome is out of ordinary. Along with surgical management of hernia, these females need multidisciplinary slant to manage gynecological, social, and emotional issues. Abstract In mature females, bilateral ovarian inguinal hernias are a rarity. In this situation, ultrasonography is the basic adjunct to confirm the diagnosis. Mayer–Rokitansky–Küster–Hauser syndrome is typically linked to ovarian hernias in grown‐up females. The most important ways to avoid problems are early diagnosis and surgical repair. A 25‐year‐old lady presented to our outpatient clinic with a history of swelling in bilateral inguinal region for 1 month. On the ultrasound examination, the right ovary was visualized in the right high inguinal canal, and the left ovary was seen at the level of deep inguinal ring with no visualization of the uterus in its normal anatomical position. The patient underwent bilateral inguinal exploration under spinal anesthesia, and herniated contents were successfully reduced back to anatomical locations. Clinical care for such a clinical condition must be multifaceted, involving intensive counseling, relocating the uterus, fallopian tube, and ovary to preserve fertility, and preventing consequences like incarceration and strangulation

Dental Implants and General Dental Practitioners of Nepal: A study of existing knowledge and need for further education

Background &amp; Objectives: The use of dental implants in partially or completely edentulous patients has proved effective and an accepted treatment modality with predictable long-term success. Dental implants are becoming a popular choice for replacing the missing teeth because of increased awareness about implants both in dentists and patients. The objective of the study was to assess the basic knowledge and education about dental implants among general dental practitioners (GDPs) of Nepal.Materials &amp; Methods:  A cross sectional questionnaire was carried out among 110 GDPs which consist of twenty questions that were divided into three categories; first with some basic knowledge in implant dentistry, second with clinical knowledge of dental implants and third with dental implant education and training.Results: Out of 110 GDPs, 72.7% had basic knowledge about implant dentistry and 65.5% were not aware about advance surgical procedures like sinus lift and guided bone regeneration. All the GDPs were positive regarding more training and education in dental implants and 95.5% of them would like to incorporate dental implant treatment in their practice in future. Conclusion: GDPs should have adequate knowledge and training of dental implants which can be incorporated at undergraduate or post doctoral level so that they are skilled to provide quality dental implant therapy to their patients confidently.</p

A 14-year-old girl presenting with tuberculous intestinal perforation while in a temporary shelter after the 2015 earthquake in Nepal.

A 14-year-old Nepalese girl presented with fever, abdominal pain and vomiting. She was living with her family in a temporary settlement camp following the earthquake in Nepal in 2015. She had had abdominal pain for 2 months and fever for 1 month. Abdominal examination suggested acute peritonitis. At laparotomy, three ileal perforations were detected and histopathology demonstrated caseous granulomas. Her father had sputum-positive pulmonary tuberculosis. She was diagnosed with abdominal tuberculosis and responded well to anti-tuberculosis chemotherapy. Intestinal perforation is a rare complication of tuberculosis in children